Key Points• Fibtem is an early and rapidly available biomarker for predicting progression of moderate to severe postpartum hemorrhage.• Fibtem was predictive of need for blood transfusion and invasive procedures, bleeds .2500 mL, duration of bleed, and time in high dependency.
BackgroundThe summer of 2007 was the wettest in the UK since records began in 1914 and resulted in severe flooding in several regions. We carried out a health impact assessment using population-based surveys to assess the prevalence of and risk factors for the psychosocial consequences of this flooding in the United Kingdom.MethodsSurveys were conducted in two regions using postal, online, telephone questionnaires and face-to-face interviews. Exposure variables included the presence of flood water in the home, evacuation and disruption to essential services (incident management variables), perceived impact of the floods on finances, house values and perceived health concerns. Validated tools were used to assess psychosocial outcome (mental health symptoms): psychological distress (GHQ-12), anxiety (GAD-7), depression (PHQ-9) and probable post-traumatic stress disorder (PTSD checklist-shortform). Multivariable logistic regression was used to describe the association between water level in the home, psychological exposure variables and incident management variables, and each mental health symptom, adjusted for age, sex, presence of an existing medical condition, employment status, area and data collection method.ResultsThe prevalence of all mental health symptoms was two to five-fold higher among individuals affected by flood water in the home. People who perceived negative impact on finances were more likely to report psychological distress (OR 2.5, 1.8-3.4), probable anxiety (OR 1.8, 1.3-2.7) probable depression (OR 2.0, 1.3-2.9) and probable PTSD (OR 3.2, 2.0-5.2). Disruption to essential services increased adverse psychological outcomes by two to three-fold. Evacuation was associated with some increase in psychological distress but not significantly for the other three measures.ConclusionThe psychosocial and mental health impact of flooding is a growing public health concern and improved strategies for minimising disruption to essential services and financial worries need to be built in to emergency preparedness and response systems. Public Health Agencies should address the underlying predictors of adverse psychosocial and mental health when providing information and advice to people who are or are likely to be affected by flooding.
In this review, we examine the epidemiology of teenage pregnancy (girls aged 15-17 years) in the UK and consider the evidence for its impact on the health and well-being of the mother, the baby, the father and society. There has been some decrease in the teenage pregnancy rate over the last decade in the UK but rates are still considerably higher than those in other European countries. Pregnancy and childbirth during the teenage years are associated with increased risk of poorer health and well-being for both the mother and the baby, possibly reflecting the socio-economic factors that precede early pregnancy and childbirth. There is little evidence concerning the impact of teenage fatherhood on health and future studies should investigate this. The effect on society is a perpetuation of the widening gap in health and social inequalities. Public health interventions should aim to identify teenagers who are vulnerable and support those who are pregnant with evidence based interventions such as teenage antenatal clinics and access to initiatives that provide support for early parenthood.
Background Rates of preterm birth have increased in most industrialised countries but data on later lung function of late preterm births are limited. A study was undertaken to compare lung function at 8e9 and 14e17 years in children born late preterm (33e34 and 35e36 weeks gestation) with children of similar age born at term ($37 weeks gestation). Children born at 25e32 weeks gestation were also compared with children born at term. Methods All births from the Avon Longitudinal Study of Parents and Children (n¼14 049) who had lung spirometry at 8e9 years of age (n¼6705) and/or 14e17 years of age (n¼4508) were divided into four gestation groups. Results At 8e9 years of age, all spirometry measures were lower in the 33e34-week gestation group than in controls born at term but were similar to the spirometry decrements observed in the 25e32-week gestation group. The 35e36-week gestation group and term group had similar values. In the late preterm group, at 14e17 years of age forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC) were not significantly different from the term group but FEV 1 /FVC and forced expiratory flow at 25e75% FVC (FEF 25e75% ) remained significantly lower than term controls. Children requiring mechanical ventilation in infancy at 25e32 and 33e34 weeks gestation had in general lower airway function (FEV 1 and FEF 25e75 ) at both ages than those not ventilated in infancy. Conclusions Children born at 33e34 weeks gestation have significantly lower lung function values at 8e9 years of age, similar to decrements observed in the 25e32-week group, although some improvements were noted by 14e17 years of age.
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