Objective The aim of this study was to assess long-term effects for women following the use of magnesium sulphate for pre-eclampsia.Design Assessment at 2-3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998(recruitment in -2001, which compared magnesium sulphate with placebo for pre-eclampsia.Setting Follow up after discharge from hospital at 125 centres in 19 countries across five continents.Population A total of 7927 women were randomised at the followup centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow-up, of whom 3375 (71%) were traced.Methods Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed.Main outcome measures Death or serious morbidity potentially related to pre-eclampsia at follow up, other morbidity and use of health service resources.Results Median time from delivery to follow up was 26 months (interquartile range 19-36). Fifty-eight of 1650 (3.5%) women allocated magnesium sulphate died or had serious morbidity potentially related to pre-eclampsia compared with 72 of 1725 (4.2%) women allocated placebo (relative risk 0.84, 95% CI 0.60-1.18).
ConclusionsThe reduction in the risk of eclampsia following prophylaxis with magnesium sulphate was not associated with an excess of death or disability for the women after 2 years.
Public health restrictions were not fully relaxed between national lockdown 1 and national lockdown 2. Regional restrictions remained in place during December 2020 and a third national lockdown started on 6 January 2021. (A) Chlamydia diagnoses and tests; (B) gonorrhoea diagnoses and tests; (C) infectious syphilis diagnoses and tests. Infectious syphilis includes primary, secondary and early latent stages. Different scales are used on the y-axes of the graphs above.
Background
Oxygen is vital in the treatment of illnesses in children and adults, yet is lacking in many low and middle-income countries health care settings. Oxygen concentrators (OCs) can increase access to oxygen, compared to conventional oxygen cylinders. We investigated the costs and critical success factors of OCs in three hospitals in Fiji, and extrapolated these to estimate the oxygen delivery cost to all Sub-Divisional hospitals (SDH) nationwide.
Methods
Data sources included key personnel interviews, and data from SDH records, Ministry of Health and Medical Services, and a non-governmental organisation. We used Investment Logic Mapping (ILM) to define key issues. An economic case was developed to identify the investment option that optimised value while incorporating critical success factors identified through ILM. A fit-for-purpose analysis was conducted using cost analysis of four short-listed options. Sensitivity analyses were performed by altering variables to show the best or worst case scenario. All costs are presented in Fijian dollars.
Results
Critical success factors identifed included oxygen availability, safety, ease of use, feasibility, and affordability. Compared to the status quo of having only oxygen cylinders, an option of having a minimum number of concentrators with cylinder backup would cost $434,032 (range: $327,940 to $506,920) over 5 years which would be 55% (range: 41 to 64%) of the status quo cost.
Conclusion
Introducing OCs into all SDHs in Fiji would reduce overall costs, while ensuring identified critical success factors are maintained. This study provides evidence for the benefits of OCs in this and similar settings.
Background Disseminated gonococcal infection (DGI) is caused by the spread of Neisseria gonorrhoeae into the bloodstream and can lead to severe illness. We established a surveillance system for DGI in England to quantify the burden of disease. Methods On June 26, 2020, all sexual health clinicians in England were asked to retrospectively and prospectively report DGI cases to Public Health England. Case finding was conducted for N gonorrhoeae isolates confirmed by the national reference laboratory from sterile sites from June, 2019 onwards. A secure web-based survey was shared with clinicians to collect demographic and clinical data on affected individuals. Individuals with culture-positive or 16S rDNA-positive N gonorrhoeae at a sterile site were classified as confirmed cases. Probable cases were defined as individuals with culture-positive or nucleic acid amplification test-positive N gonorrhoeae from a non-sterile site with clinical manifestations of DGI.
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