Pregnancy is likely to end in a live birth in a majority of organ transplant recipients. In patients with greater prepregnancy SCr and/or drug-treated hypertension during pregnancy, however, subsequent renal function may be adversely affected.

Background Indigenous women in the high‐income countries of Canada, Australia, New Zealand and USA, have a higher incidence and mortality from cervical cancer than non‐Indigenous women. Increasing cervical screening coverage could ultimately decrease cervical cancer disparities. Aims To increase cervical screening for under‐screened/never‐screened Māori women. Materials and Methods This study was a cluster randomised controlled trial. Inclusion criteria were women aged 25–69, last screened ≥4 years ago, in Northland, New Zealand. The intervention arm was the offer of a human papilloma virus (HPV) self‐test and the control arm was the usual offer of standard care – a cervical smear. The primary outcome was rate of cervical screening in the intervention group compared to control in Māori, the Indigenous peoples of New Zealand. Six primary care clinics were randomly allocated to intervention or control. Results Of 500 eligible Māori women in the intervention arm, 295 (59.0%) were screened. Of 431 eligible Māori women in the control arm, 94 (21.8%) were screened. Adjusting for age, time since last screen, deprivation index, Māori women in the intervention arm were 2.8 times more likely to be screened than women in the control arm (95% CI: 2.4–3.1, P‐value <0.0001). Conclusions Offer of HPV self‐testing could potentially halve the number of under‐screened/never‐screened Māori women and decrease cervical morbidity and mortality. These results may be generalisable to benefit Indigenous peoples facing similar barriers in other high‐income countries.

Mortality in men admitted to hospital with acute urinary retention: database analysis James N Armitage, urology research fellow, 1 Nokuthaba Sibanda, research fellow, 2 Paul J Cathcart, urology registrar, 1 Mark Emberton, reader in interventional oncology, 3 Jan H P van der Meulen, reader in public health medicine and clinical epidemiology 2 ABSTRACT Objectives To investigate mortality in men admitted to hospital with acute urinary retention and to report on the effects of comorbidity on mortality. Design Analysis of the hospital episode statistics database linked to the mortality database of the Office for National Statistics. Setting NHS hospital trusts in England, 1998England, -2005. Participants All men aged over 45 who were admitted to NHS hospitals in England with a first episode of acute urinary retention. Main outcome measures Mortality in the first year after acute urinary retention and standardised mortality ratio against the general population. Results During the study period, 176 046 men aged over 45 were admitted to hospital with a first episode of acute urinary retention. In 100 067 men with spontaneous acute urinary retention, the one year mortality was 4.1% in men aged 45-54 and 32.8% in those aged 85 and over. In 75 979 men with precipitated acute urinary retention, mortality was 9.5% and 45.4%, respectively. In men with spontaneous acute urinary retention aged 75-84, the most prevalent age group, the one year mortality was 12.5% in men without comorbidity and 28.8% in men with comorbidity. The corresponding figures for men with precipitated acute urinary retention were 18.1% and 40.5%. Compared with the general population, the highest relative increase in mortality was in men aged 45-54 (standardised mortality ratio 10.0 for spontaneous and 23.6 for precipitated acute urinary retention) and the lowest for men 85 and over (1.7 and 2.4, respectively). Conclusions Mortality in men admitted to hospital with acute urinary retention is high and increases strongly with age and comorbidity. Patients might benefit from multi-disciplinary care to identify and treat comorbid conditions.

Background: The lack of robust systems for monitoring quality in healthcare has been highlighted. Statistical process control (SPC) methods, utilizing the increasingly available routinely collected electronic patient records, could be used in creating surveillance systems that could lead to rapid detection of periods of deteriorating standards. We aimed to develop and test a CUmulative SUM (CUSUM) based surveillance system that could be used in continuous monitoring of clinical outcomes, using routinely collected data. The low Apgar score (5 minute Apgar score < 7) was used as an example outcome.

BackgroundHip and knee replacement are some of the most frequently performed surgical procedures in the world. Resurfacing of the hip and unicondylar knee replacement are increasingly being used. There is relatively little evidence on their performance. To study performance of joint replacement in England, we investigated revision rates in the first 3 y after hip or knee replacement according to prosthesis type.Methods and FindingsWe linked records of the National Joint Registry for England and Wales and the Hospital Episode Statistics for patients with a primary hip or knee replacement in the National Health Service in England between April 2003 and September 2006. Hospital Episode Statistics records of succeeding admissions were used to identify revisions for any reason. 76,576 patients with a primary hip replacement and 80,697 with a primary knee replacement were included (51% of all primary hip and knee replacements done in the English National Health Service). In hip patients, 3-y revision rates were 0.9% (95% confidence interval [CI] 0.8%–1.1%) with cemented, 2.0% (1.7%–2.3%) with cementless, 1.5% (1.1%–2.0% CI) with “hybrid” prostheses, and 2.6% (2.1%–3.1%) with hip resurfacing (p < 0.0001). Revision rates after hip resurfacing were increased especially in women. In knee patients, 3-y revision rates were 1.4% (1.2%–1.5% CI) with cemented, 1.5% (1.1%–2.1% CI) with cementless, and 2.8% (1.8%–4.5% CI) with unicondylar prostheses (p < 0.0001). Revision rates after knee replacement strongly decreased with age.InterpretationOverall, about one in 75 patients needed a revision of their prosthesis within 3 y. On the basis of our data, consideration should be given to using hip resurfacing only in male patients and unicondylar knee replacement only in elderly patients.

Sexual selection via mate choice may have influenced the evolution of women's breast morphology. We conducted an image-based questionnaire quantifying and comparing the preferences of men from Papua New Guinea (PNG), Samoa, and New Zealand (NZ) for images of women's breast size, breast symmetry, areola size, and areolar pigmentation. Results showed that men from PNG preferred larger breasts to a greater extent than men from Samoa and NZ, providing some support for the hypothesis that men from subsistence living cultures have a greater preference for morphological cues indicative of caloric reserves. Symmetrical breasts were most attractive to men in each culture. However, preferences were highest among NZ men, followed by men from Samoa, and were lowest among men from PNG. These results did not support the hypothesis that people living in higher pathogen environments have a greater preference for traits indicative of pathogen resistance and developmental stability. Large areolae were preferred among men from PNG, and to a lesser extent in Samoa, while in NZ men preferred medium-sized areolae. Thus, men's preferences for women's areolar size appear to be highly culturally specific. Darkly pigmented areolae were most attractive to men from Samoa and PNG, whereas men from NZ preferred areolae with medium pigmentation. These findings suggest that areolar pigmentation indicative of sexual maturity is preferred by men rather than lighter pigmentation, which may signal that a woman is in the early years of reproductive maturity. This study highlights the importance of cross-cultural research when testing the role of morphological cues in mate choice.

Aim To examine the degree to which area, isolation, environmental conditions and time since first settlement explain variation in language richness among islands.Location Pacific islands ranging east-west from Rapa Nui to Indonesia and north-south from Hawaii to New Zealand. MethodsWe constructed a dataset of 264 Pacific islands that support 1640 languages (c. 24% of the world's languages). We examined possible predictors of language richness using three different types of models: linear regression models, linear mixed models that included random effects for language phylogeny and simultaneous autoregressive models. We tested whether the following variables, alone or in combination, predict language richness: island area and isolation, climate (rainfall, temperature), mean growing season, soil fertility, habitat heterogeneity (elevation, number of ecoregions), time since first human settlement. ResultsWe identified two optimal models (delta Akaike information criterion < 2). One (R 2 = 0.52) included area, with 86% of remaining variation accounted for by random effects for phylogeny. The other (R 2 = 0.56) included a spatial component, area and a suite of other variables (of which isolation and settlement scale were significant). Of the hypotheses tested (mean growing season, ecological risk, habitat heterogeneity, climate, time since settlement, area-isolation theory), areaisolation performed best, alone explaining 44% of variation in language richness.

Objective To explore preterm birth among Māori indigenous peoples through Kaupapa Māori research of preterm birth in Aotearoa New Zealand. Methods Linked maternity, mortality, and hospital data were analyzed for women and their infants born between January 1, 2010 and December 31, 2014. Relative risks (RR) were calculated for each ethnic group for preterm birth, small for gestational age (SGA), and mortality. Results Adjusted rates showed that compared with Māori women, European women were at significantly less risk of having extremely and very preterm infants (RR 0.86, 95% confidence interval [CI] 0.76–0.95). Preterm infants of European women had a significantly lower adjusted RR of early neonatal death (RR 0.65, 95% CI 0.45–0.93) or post‐neonatal death (RR 0.41, 95% CI 0.26–0.64). In addition to ethnicity, preterm rates were influenced by maternal age, body mass index, smoking status, and SGA status. Conclusion This study demonstrates that the Aotearoa New Zealand maternity system privileges whiteness, suggesting that clinical pathways for evidence‐based medical care are not delivered systemically and equitably for all. Health pathways that focus on equity as a fundamental right will enhance health outcomes for Māori women and their infants.