ORCID Profile
0000-0001-7527-694X
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University of Oxford
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Publisher: Elsevier BV
Date: 12-2018
Publisher: CMA Joule Inc.
Date: 11-04-2006
DOI: 10.1503/CMAJ.060171
Publisher: Wiley
Date: 27-05-2008
Publisher: BMJ
Date: 11-2004
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.JAD.2019.03.002
Abstract: Early identification of postnatal depression is important in order to minimize adverse outcomes. The Edinburgh Postnatal Depression Scale (EPDS) is commonly used as a screening tool but a single, direct question on depression may offer an alternative means of identifying women in need of support. This study examines the agreement between these methods and characteristics of women who self-identify as depressed and those with EPDS ≥ 13. Secondary analysis of two national maternity surveys conducted in England and Northern Ireland. Agreement between the direct question and EPDS scores was assessed using Cohen's kappa. Logistic regression was used to identify characteristics of women in each group. 6752 women were included. At three months postpartum, 6.1% of women self-identified as having depression, 9.1% scored EPDS ≥ 13, 2.8% were positive on both. Agreement between the two methods was minimal (Cohen's kappa 40 years (OR 1.8 95% CI 1.2-2.8). EPDS ≥ 13 was associated with < 16 years of education (OR 1.4 95% CI 1.1-1.8), minority ethnicity (OR 1.4 95% CI 1.1-1.9), living without a partner (OR 1.7 95% CI 1.3-2.2), and a less than happy reaction to the pregnancy (OR 1.7 95% CI 1.4-2.1). Low survey response limits the representativeness of findings. The absence of a diagnostic interview limits conclusions on accuracy or internal validity of the measures. A direct question about postnatal depression may offer a valuable addition to screening tools to identify women in need of support.
Publisher: Elsevier BV
Date: 02-2006
DOI: 10.1016/J.EARLHUMDEV.2006.01.002
Abstract: Previous assessments of the economic impact of preterm birth focussed on short term health service costs across the broad spectrum of prematurity. To estimate the societal costs of extreme preterm birth during the sixth year after birth. Unit costs were applied to estimates of health, social and broader resource use made by 241 children born at 20 through 25 completed weeks of gestation in the United Kingdom and Republic of Ireland and a comparison group of 160 children born at full term. Societal costs per child during the sixth year after birth were estimated and subjected to a rigorous sensitivity analysis. The effects of gestational age at birth on annual societal costs were analysed, first in a simple linear regression and then in a multiple linear regression. Mean societal costs over the 12 month period were 9541 pounds sterling (standard deviation 11,678 pounds sterling) for the extreme preterm group and 3883 pounds sterling (1098 pounds sterling) for the term group, generating a mean cost difference of 5658 pounds sterling (bootstrap 95% confidence interval: 4203 pounds sterling, 7256 pounds sterling) that was statistically significant (P<0.001). After adjustment for clinical and sociodemographic covariates, sex-specific extreme preterm birth was a strong predictor of high societal costs. The results of this study should facilitate the effective planning of services and may be used to inform the development of future economic evaluations of interventions aimed at preventing extreme preterm birth or alleviating its effects.
Publisher: BMJ
Date: 12-2007
Publisher: Wiley
Date: 12-2003
DOI: 10.1046/J.1523-536X.2003.0251A.X
Abstract: Studies that measure benefits of health care interventions in natural or physical units cannot incorporate the several health changes that might occur within a single measure, and they overlook in iduals' preferences for those health changes. This paper discusses and critically appraises the application of preference-based approaches to the measurement of the benefits of perinatal care that have developed out of economic theory. These include quality adjusted life year (QALY)-based approaches, monetary-based approaches, and discrete choice experiments. QALY-based approaches use scaling techniques, such as the rating scale, standard gamble approach, and time trade-off approach, or multi-attribute utility measures, to measure the health-related quality of life weights of health states. Monetary-based approaches include the revealed preference approach, which involves observing decisions that in iduals actually make concerning health risks, and the willingness-to-pay approach, which provides a framework for investigating in iduals' willingness to pay for benefits of health care interventions. Discrete choice experiments describe health care interventions in terms of their attributes, and elicit preferences for scenarios that combine different levels of those attributes. Empirical ex les are used to illustrate each preference-based approach to benefit measurement, and several methodological issues raised by the application of these approaches to the perinatal context are discussed. Particular attention is given to identifying the relevant attributes to incorporate into the measurement instrument, appropriate respondents for the measurement exercise, potential sources of bias in description and valuation processes, and the practicality, reliability, and validity of alternative measurement approaches. The paper's conclusion is that researchers should be explicit and rigorous in their application of preference-based approaches to benefit measurement in the context of perinatal care.
Publisher: Wiley
Date: 08-2002
DOI: 10.1046/J.1469-0705.2002.00724.X
Abstract: To estimate resource use and costs associated with routine obstetric ultrasound and follow-up tests from both the British National Health Service and women's perspectives. Women attending Liverpool Women's Hospital (UK) in 1998 and 1999 were involved in the study. Bottom-up and top-down costings of National Health Service resources using questionnaires and diaries to record staff time associated with procedures were performed. Questionnaires were used to assess women's costs of attending for antenatal ultrasound scans. Routine antenatal ultrasound scans at Liverpool Women's Hospital cost the National Health Service between 14 pounds sterling and 16 pounds sterling per scan. More detailed secondary scans and other follow-up procedures cost substantially more. Costs to women, their families and their employers were estimated at between 9 pounds sterling and 15 pounds sterling per scan, depending on assumptions about the opportunity costs of time when not in paid employment and costs to employers of women who were in paid employment. Accurate estimates of costs to the National Health Service associated with routine antenatal ultrasound scanning are substantially lower than that cited in much of the literature. Costs to women are very similar to National Health Service costs. Economic evaluations should attempt to include costs to users of the service, particularly when the burden of cost is likely to shift.
Publisher: Springer Science and Business Media LLC
Date: 14-01-2014
Abstract: For women at low risk of childbirth complications, water immersion during labour is a care option in many high income countries. Our aims were (a) to describe maternal characteristics, intrapartum events, interventions, maternal and neonatal outcomes for all women who used a birthing pool during labour who either had a waterbirth or left the pool and had a landbirth, and for the subgroup of women who had a waterbirth in 19 obstetric units, and (b) to compare maternal characteristics, intrapartum events, interventions, and maternal and neonatal outcomes for women who used a birthing pool with a control group of women who did not use a birthing pool for whom we prospectively collected data in a single centre. Prospective observational study in 19 Italian obstetric units 2002-2005. Participants were: (a) 2,505 women in labour using a birthing pool in 19 obstetric units and (b) 114 women in labour using a birthing pool and 459 women who did not use a birthing pool in one obstetric unit. Descriptive statistics were calculated for the s le as a whole and, separately, for those women who gave birth in water. Categorical data were compared using Chi square statistics and continuous data by T-tests. Overall, 95.6% of women using a birthing pool had a spontaneous vertex delivery, 63.9% of which occurred in water. Half of nulliparas and three quarters of multiparas delivered in water. Adverse maternal and neonatal outcomes were rare. There were two cases of umbilical cord snap with waterbirth. Compared with controls, significantly more women who used a birthing pool adopted an upright birth position, had hands off delivery technique, and a physiological third stage. Significantly fewer nulliparas had an episiotomy, and more had a second degree perineal tear, with no evidence of a difference for extensive perineal tears. Birthing pool use was associated with spontaneous vaginal birth. The increase in second degree tears was balanced by fewer episiotomies. Undue umbilical cord traction should be avoided during waterbirth.
Publisher: Wiley
Date: 18-01-2007
DOI: 10.1111/J.1471-0528.2006.01163.X
Abstract: The aim of this study was to review systematically the available evidence on studies in humans on the effects of low-moderate levels of prenatal alcohol consumption (up to 10.4 UK units or 83 g/week) compared with consumption of no alcohol on pregnancy outcome. Systematic review. Pregnant women or women who are trying to become pregnant. The search strategy included Medline, Embase, Cinahl and PsychInfo for the years 1970-2005. Titles and abstracts were read by two researchers and inclusion/exclusion being decided according to prespecified criteria. All the included articles were then obtained and read in full by the two researchers to decide on inclusion. The articles were assessed for quality using the Newcastle-Ottawa Quality Assessment Scales. Outcomes considered were miscarriage, stillbirth, intrauterine growth restriction, prematurity, birthweight, small for gestational age at birth and birth defects including fetal alcohol syndrome. The search resulted in 3630 titles and abstracts, which were narrowed down to 46 relevant articles. At low-moderate levels of consumption, there were no consistently significant effects of alcohol on any of the outcomes considered. Many of the reported studies had methodological weaknesses. This systematic review found no convincing evidence of adverse effects of prenatal alcohol exposure at low-moderate levels of exposure. However, weaknesses in the evidence preclude the conclusion that drinking at these levels during pregnancy is safe.
Publisher: BMJ
Date: 08-1993
Abstract: To determine whether the distribution of ABO blood groups in women with ovarian cancer differs from that in the general population in a large, defined English region. Analysis of record abstracts of hospital care held in the Oxford record linkage study supplemented with data from the Oxford cancer registry. Oxford Regional Health Authority area. A total of 1261 women who had ovarian cancer between 1968 and 1986 with ABO blood groups recorded on the Oxford Record Linkage Study and cross checked against the cancer registry comprised the study group. The relative incidence of A:O and B:O blood groups in women with ovarian cancer were compared with the general population in the same region. Ovarian cancer was more common in women of blood group A than in others, with a relative incidence of 1.17. In particular, adenocarcinomas were the most common type of tumour and were associated with blood group A. The association was more striking in married women than in single women probably reflecting differences associated with parity. The association between ABO blood groups and ovarian cancer found in this English population is similar in size to that reported from several other populations. Childbearing is known to reduce the risk of ovarian cancer and our findings suggest that the blood group association may be most apparent in married, parous (that is, relatively low risk) women.
Publisher: Wiley
Date: 02-2001
DOI: 10.1111/J.1471-0528.2001.00044.X
Abstract: To carry out a systematic review of the literature relating to economic aspects of alternative modes of delivery. A comprehensive literature search of the years 1990-1999 was conducted of electronic and non-electronic sources using a tested search strategy. Papers considered to contain useful cost or resource use data were read in full and classified according to their relevance to the review and their methodological quality. Relevant cost and resource use data were converted to pound sterling and inflated to 1998-1999 price levels. The literature search resulted in 975 papers, 49 of which met criteria for the review. Thirty-two papers were from the USA where the organisation, structure and costs of health care are significantly different from that of other industrialised countries. The aggregate costs of different modes of delivery reported in these American studies were between four and five times higher than costs reported in other studies. The majority of included studies were of poor quality. Data from the better quality studies demonstrated that caesarean section costs a health service substantially more than other modes of delivery. The range of costs of an uncomplicated vaginal delivery were 629 pound sterling - 1,298 pound sterling compared with1,238 pound sterling - 3,551 pound sterling for a caesarean section. However, papers have so far only considered short term health service costs. Research is required to estimate the cost and resource use attributable to alternative modes of delivery. Future research should investigate the long term health service costs and the costs that arise outside the health service which are likely to vary according to mode of delivery.
Publisher: Wiley
Date: 03-2013
DOI: 10.1111/BIRT.12022
Abstract: Poor outcomes after childbirth are associated with physical ill health and with an absence of a positive sense of well-being. Postnatally poor physical health is thought to be influenced by the care received, the nature of the birth, and associated complications. The aim of this study was to estimate the effects of a range of clinical and other factors on positive outcome and well-being 3 months after childbirth. This study used data on more than 5,000 women from a 2010 National Maternity Survey about their experiences of maternity care, and health and well-being 3 months after childbirth. Positive outcome was defined as women reporting no problems and feeling "very well" at the time of the survey. In the univariate analysis, several variables were significantly associated with positive outcome, including sociodemographic, antenatal, intrapartum, and postnatal factors. In the final logistic regression model, young mothers, those without physical disability and those with no or few antenatal or early postnatal problems, were most likely to have positive outcomes. Other significant factors included a positive initial reaction to the pregnancy, not reporting antenatal depression, fewer worries about the labor and birth, and access to information about choices for care. This study shows how positive outcomes for women after childbirth may be influenced by health, social, and care factors. It is important for caregivers to bear these factors in mind so that extra support may be made available to those women who are likely to be susceptible to poor outcome.
Publisher: Elsevier BV
Date: 02-2001
Publisher: BMJ
Date: 1992
DOI: 10.1136/ADC.67.1.83
Abstract: To identify the clinical conditions associated with substantial time spent in hospital by children aged 1-14 years, records of children admitted to hospital in 1975, 1979, and 1984 were studied. Analysis was by linkage of abstracts of routine records of hospital inpatient care in six districts in southern England covered by the Oxford record linkage study. The total time spend in hospital in the acute specialties each year was calculated by summing the lengths of stay of all episodes of care for each child in each year. First, admissions with long median times in hospital per child admitted were identified. These included, notably, fracture of femur and, in the later years, leukaemia, other malignant neoplasms, and congenital disorders of metabolism. Second conditions were identified which accounted for large numbers of children with lengths of stay of five days or more. These included, in particular, congenital anomalies, asthma, and appendicitis. Third, conditions were identified which accounted for the largest numbers of bed days used. These included congenital anomalies, hypertrophy of tonsils and adenoids, asthma, otitis media, appendicitis, and head injury. Median time spent in hospital per child admitted declined for most conditions but increased for leukaemia, other malignant neoplasms, and congenital disorders of metabolism. Admission rates for children who spent five days or more in hospital each year declined for all common conditions except asthma which increased. Total numbers of beds used increased for asthma and otitis media but declined for all other common conditions.
Publisher: Springer Science and Business Media LLC
Date: 05-1991
DOI: 10.1038/EYE.1991.61
Abstract: to report on trends in ophthalmology workload using linked statistical data analysis of linked abstracts of hospital inpatient and day case records for ophthalmology six districts in Southern England covered by the Oxford record linkage study records for hospital admissions to ophthalmology from 1975 to 1985 Over the period of study, the number of episodes of inpatient and day case care increased by 16.3%. Notable increases in age-specific admission rates were seen among the elderly. An increase in the number of in iduals treated contributed about 67% and an increase in multiple admissions per in idual contributed about 33% to the increase in admission rates. Both average length of stay per episode and total time in hospital per in idual decreased consistently during the 11 years and there was no increase in emergency readmissions over time. No significant changes over time were found in admission rates for retinal detachments and defects or for glaucoma. There was a statistically significant increase averaging 4.8% per annum in admission rates for cataract, and a significant decrease averaging 5.2% per annum in admission rates for strabismus and other disorders of binocular eye movement between 1975 and 1985. Age-specific admission rates in ophthalmology are much higher in the very young and old than in other age groups. Patterns of work in the specialty are therefore particularly affected by variation in the age distribution of the population. The increase in cataract surgery reflected both the increase in numbers of old people in the population and an increase in age-specific operation rates for cataract. Attempts to alter attitudes and behaviour of the elderly regarding eye diseases, disability, and facilities for treatment may have had a positive impact on the use of services. The decrease in admissions for children probably reflects the impact made by child health surveillance programmes. As the child screening programme has expanded, the admission rates for strabismus have decreased.
Publisher: SAGE Publications
Date: 06-2000
DOI: 10.1136/JMS.7.2.59
Abstract: A systematic review of recent economic evaluations of antenatal screening was conducted. Relevant studies were identified from a number of sources including computerised databases, bibliographies of economic evaluations, and searches of unpublished manuscripts. Each study identified by the literature searches was categorised on the basis of its title and abstract. Studies considered relevant to the systematic review were obtained from libraries. The methodology, results, and policy implications of studies categorised as economic evaluations upon full review were documented.A total of 566 studies were identified by the literature searches, 41 of which were categorised as economic evaluations upon full review. The economic evaluations covered a range of antenatal screening practices, aimed mainly at the prevention of infectious diseases and fetal anomalies. The review highlighted the poor methodological quality of the bulk of economic evaluations of antenatal screening. The study design, data collection methods, and analysis and interpretation of results frequently violated methodological guidelines adopted by health economists. The review also highlighted the narrow definition of benefits adopted by this body of literature, with most studies reporting outcomes in terms of cases detected, cases of particular disorders prevented or, most often, costs averted.The conclusions arrived at differed by area of antenatal screening. There appeared to be clear economic arguments in favour of some forms of antenatal screening, for ex le, triple test screening for Down's syndrome. Other economic evaluations pertained to specific locations, which suggests that the results may not necessarily be generalisable to different settings. For all areas of antenatal screening, an updating of published economic evaluations may be required to account for evolving economic, epidemiological, and clinical effectiveness evidence.
Publisher: BMJ
Date: 15-07-2015
Abstract: Implications for practice and research: The importance of physical and mental health in the postnatal period has been recognised in this study and in other research. Postnatal visiting has declined in the UK and satisfaction with postnatal care is low compared to other aspects of maternity care. Further research should focus on cost-effective strategies to improve this.
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1111/J.1524-4733.2010.00731.X
Abstract: To estimate the cost-effectiveness (CE) of total body hypothermia plus intensive care versus intensive care alone to treat neonatal encephalopathy. Decision analytic modeling was used to synthesize mortality and morbidity data from three randomized controlled trials, the Total Body Hypothermia for Neonatal Encephalopathy Trial (TOBY), National Institute of Child Health and Human Development (NICHD), and CoolCap trials. Cost data inputs were informed by TOBY, the sole source of prospectively collected resource utilization data for encephalopathic infants. CE was expressed in terms of incremental cost per disability-free life year (DFLY) gained. Probabilistic sensitivity analysis was performed to generate CE acceptability curves (CEACs). Cooling led to a cost increase of £3787 (95% confidence interval [CI]: -2516, 12,360) (€5115 95% CI: -3398-16,694 US$5344 95% CI: -3598, 26,356 using 2006 Organisation for Economic Co-operation and Development (OECD) purchasing power parities) and a DFLY gain of 0.19 (95%CI: 0.07-0.31) over the first 18 months after birth. The incremental cost per DFLY gained was £19,931 (€26,920 US$28,124). The baseline CEAC showed that if decision-makers are willing to pay £30,000 for an additional DFLY, there is a 69% probability that cooling is cost-effective. The probability of CE exceeded 99% at this threshold when the throughput of infants was increased to reflect the national incidence of neonatal encephalopathy or when the time horizon of the economic evaluation was extended to 18 years after birth. The probability that cooling is a cost-effective treatment for neonatal encephalopathy is finely balanced over the first 18 months after birth but increases substantially when national incidence data or an extended time horizon are considered.
Publisher: Springer Science and Business Media LLC
Date: 20-03-2013
Publisher: BMJ
Date: 11-1993
DOI: 10.1136/ADC.69.5.559
Abstract: Epidemiological information about detailed patterns of physical morbidity within the adolescent age group is not generally available. To illustrate the distinctive patterns of morbidity indicated by the use of hospital inpatient care, hospital admission rates in the Oxford region (1979-86) were analysed at each single year of age from 10 to 19 years. At the age of 10 years 22% of general hospital admissions were to paediatrics, 24% to general surgery, 23% to ear, nose, and throat surgery, and 20% to trauma and orthopaedics. By 14 years of age only 6% of general hospital admissions were to paediatrics. By 16 years of age 24% of general hospital admissions of young women were to gynaecology and 40% of admissions of young men were to trauma and orthopaedics. The most common reason for hospital admission in young men was head injury and the second most common was appendicectomy. Termination of pregnancy was the single most common reason for admission for girls aged 15 and 16 years childbirth and terminations were the most common reasons for admission in girls aged 17-19 years and over. Self poisoning was also common in older teenage girls. Younger girls were admitted most commonly for tonsillectomy. Most admissions of adolescents are thus for surgical rather than medical reasons and some of the most common in idual reasons for admission are attributable to behavioural factors rather than disease processes.
Publisher: BMJ
Date: 11-2015
Publisher: BMJ
Date: 23-09-1995
Abstract: To determine how changes in the number of admissions from waiting lists and changes in the number of additions to the lists are related to list size and waiting times, in the context of local waiting list initiatives. Review of national and Körner statistics. England (1987-94) and districts of the former Oxford region (1987-91). Correlation of quarterly changes in the number of admissions from waiting lists in England with changes in total list size, numbers of patients waiting one to two, or over two years, and number of additions to the lists examination of changes in waiting list statistics for in idual district specialties in one region in relation to funding for waiting list initiatives. Nationally, changes in the number of admissions to hospital from lists closely correlated with changes in the number of additions to lists (r = 0.84 P < 0.01). After adjusting for changes in the number of additions to lists, changes in the number of admissions correlated inversely with changes in list size (r = -0.62 P < 0.001). Decreases in the number of patients waiting from one to two years were significantly associated with increases in the number of admissions (r = -0.52 P < 0.01) locally, only six of 44 waiting list initiatives were followed by an increase in admissions and a fall in list size, although a further 11 were followed by a fall in list size without a corresponding increase in admissions. An increase in admissions improved waiting times but did not reduce list size because additions to the list tended to increase at the same time. The appropriateness of waiting list initiatives as a method of funding elective surgery should be reviewed.
Publisher: Wiley
Date: 08-1991
DOI: 10.1111/J.1365-2273.1991.TB00956.X
Abstract: Trends in admission rates, lengths of stay, and clinical case mix (adjusted for multiple admissions per person) for Otolaryngology from 1975 to 1985 are described using the Oxford Record Linkage Study. Person-based admission rates increased generally, most strikingly amongst children and adolescents. Both length of stay per episode and total number of days an in idual stayed in hospital each year decreased. Operations on tonsils and adenoids decreased averaging 2.2% per annum admissions for diagnoses for otitis media with effusion increased averaging 8.2% per annum for the operations of myringotomy and tympanostomy tube insertion increased averaging 9.2% per annum for other diagnoses related to the ear increased averaging 5.7% per annum and admissions for malignant neoplasms decreased averaging 2.0% per annum. Clearly more people are being treated for a changing case mix. The largest increases are occurring with children and adolescents.
Publisher: Springer Science and Business Media LLC
Date: 26-02-2014
Publisher: BMJ
Date: 06-1992
Abstract: The aim was to report on the extent to which death certificates which specify that death occurred in hospital can be matched and linked with routine hospital inpatient information systems. The study involved linkage of hospital records which specified that death occurred in hospital to corresponding death certificates and linkage of death certificates which specified that death occurred in hospital to corresponding hospital records. Six health districts in southern England covered by medical record linkage. Records were examined of patients aged 65 years and over, which specified that death occurred in hospital between 1979 and 1985. 98.2% of hospital record abstracts which specified that death occurred in hospital were linked by our standard computer-based techniques to death certificates. Conversely, however, only 94.4% of death certificates which specified that death occurred in hospital could be linked to the abstracts of corresponding hospital inpatient records. A major factor contributing to the latter failures may be a difference of definition of what constitutes a death "following hospital admission" in patients who die shortly after arrival at hospital. Linkage of hospital records to death certificates is both feasible and desirable. Error rates are generally small but hospital inpatient record abstracts corresponding to death certificates for deaths in hospital may not invariably exist when death occurs shortly after the arrival of the patient at hospital.
Publisher: Wiley
Date: 12-2002
DOI: 10.1046/J.1523-536X.2002.00198.X
Abstract: Ultrasound has become a routine part of care for pregnant women in most countries with developed health services. It is one of a range of techniques used in screening and diagnosis, but it differs from most others because of the direct access that it gives parents to images of the fetus. A review of women's views of ultrasound was commissioned as part of a larger study of the clinical and economic aspects of routine antenatal ultrasound use. Studies of women's views about antenatal screening and diagnosis were searched for on electronic databases. Studies about pregnancy ultrasound were then identified from this material. Further studies were found by contacting researchers, hand searches, and following up references. The searches were not intentionally limited by date or language. Studies that reported direct data from women about pregnancy ultrasound were then included in a structured review. Studies were not excluded on the basis of methodological quality unless they were impossible to understand. They were read by one author and tabulated. The review then addressed a series of questions in a nonquantitative way. The structured review included 74 primary studies represented by 98 reports. Studies from 18 countries were included, and they employed methods ranging from qualitative interviewing to psychometric testing. The review included studies from the very early period of ultrasound use up to reports of research on contemporary practice. Ultrasound is very attractive to women and families. Women's early concerns about the safety of ultrasound were rarely reported in more recent research. Women often lack information about the purposes for which an ultrasound scan is being done and the technical limitations of the procedure. The strong appeal of diagnostic ultrasound use may contribute to the fact that pregnant women are often unprepared for adverse findings. Despite the highly varied study designs and contexts for the research included, this review provided useful information about women's views of pregnancy ultrasound. One key finding for clinicians was the need for all staff, women, and partners to be well informed about the specific purposes of ultrasound scans and what they can and cannot achieve.
Publisher: BMJ
Date: 16-09-1989
Abstract: Readmission rates after inpatient care were studied by using routinely collected data from the Oxford record linkage study for 1968-85. Discharges from hospital and subsequent admissions were identified for people who were both resident and treated in the area covered by the linkage study. Rates were calculated for readmissions within 28 days after discharge from the first, index event. Readmission rates for elective readmissions after elective index admissions rose from 3.5% in 1968 to 7.1% in 1985. Those for elective readmissions after immediate (emergency or accident) index admissions rose from 2.4% to 3.5% during the same period. Emergency readmissions after an immediate index admission rose from 4.0% to 7.0%, and emergency readmissions after an elective index admission rose from 1.3% to 2.5%. All these increases were significant. The rise in elective readmissions may in part reflect a trend towards planned discharge with the expectation of readmission. The rise in emergency readmissions, which has been fairly gradual over many years, may, in some cases, be due to pressure on resources and inappropriately short lengths of stay. Further evidence is required to confirm or refute this. Readmission rates are one of the few potential measures available from routine statistics for assessing outcome, but due consideration must be given to issues of method and interpretation.
Publisher: BMJ
Date: 07-07-1990
Abstract: To determine whether among people aged 65 and over those who died at advanced old age spent more of their last year of life in hospital than those who died younger, and whether the increase in longevity in the elderly between 1976 and 1985 was accompanied by increased time spent in hospital in the last year of life. Linkage of death records to abstracts of records of hospital inpatient care in the preceding year of patients' lives. Six health districts in England covered by the Oxford record linkage study. People who died at advanced ages (85 and over) were less likely than people who died at younger ages (65-84) to have been admitted to hospital in the last year of life. Once admitted the very old tended to spend longer in hospital than others. The mean total time spent in hospital by the elderly in the year before death (based on all deaths including those among people not admitted at all) showed no appreciable change over time. The median time in hospital based on all deaths increased by about three days between 1976 and 1985. During that time there was a gain in life expectancy in the population of about one year from the age of 65. The gain in life expectancy in this population was not at the expense of any substantial increase in time spent in hospital in the final year of life.
Publisher: Springer Science and Business Media LLC
Date: 22-10-2013
Publisher: Oxford University Press (OUP)
Date: 12-2002
DOI: 10.1093/HUMREP/17.12.3090
Abstract: Approximately one in six couples experiences problems with their fertility at some point in their reproductive lives. The economic implications of the use of assisted reproductive techniques require consideration. Herein, the health economics research in this area are critically appraised. Multiple strategies were used to identify relevant studies. Each title and abstract was independently reviewed by two members of the study team and categorized according to perceived relevance. The selected papers were then assessed for quality and data were extracted, converted to UK pounds sterling at 1999/2000 prices, tabulated and critically appraised. A total of 2547 papers was identified through the searches this resulted in 30 economic evaluations, 22 cost studies and five economic benefit studies that met the selection criteria. The quality of these studies was mixed many failed to disaggregate costs, discount future costs or conduct sensitivity analyses. Consistent findings included the following: initiating treatment with intrauterine insemination appeared to be more cost-effective than IVF vasectomy reversal appeared to be more cost-effective than ICSI factors associated with poor prognosis decreased the cost-effectiveness of interventions. The cost-effectiveness of different interventions should be considered when making decisions about treatment. Future economic appraisals of assisted reproductive techniques would benefit from more robust methodology than is evident in much of the published literature to date.
Publisher: Mary Ann Liebert Inc
Date: 06-2013
Abstract: Postnatal depression has a serious impact on new mothers and their children and families. Risk factors identified include a history of depression, multiparity, and young age. The study aimed to investigate factors associated with experiencing antenatal depression and developing subsequent postnatal depression. The study utilized survey data from 5332 women about their experience and well-being during pregnancy, in labor, and postnatally up to 3 months. Prespecified sociodemographic and clinical variables were tabulated against the incidence of antenatal depression and postnatal depression. Binary logistic regression was used to estimate the effects of the principal underlying variables. Risk factors for antenatal depression were multiparity, black and minority ethnic (BME) status, physical or mental health problems, living in a deprived area, and unplanned pregnancy. Different factors for postnatal depression were evident among women who had experienced antenatal depression: multiparity and BME status were protective, whereas being left alone in labor and experiencing poor postnatal health increased the risk of postnatal depression. This study confirms previous research on risk factors for antenatal depression and stresses the importance of continuous support in labor and vigilance in the postnatal period regarding the potential ill effects of continuing postnatal health problems.
Publisher: BMJ
Date: 09-1989
Abstract: Data from the Oxford Record Linkage Study were analysed to determine the amount of work undertaken in day case surgery for 12 surgical conditions in five districts in the Oxford Region during the years 1976 to 1985. Record linkage was used to study readmission rates, comparing day surgery with inpatient care. The use of day surgery gradually increased in some conditions (eg, termination of pregnancy, female sterilisation) but did not increase from a fairly low base for others (eg, inguinal hernia repair, operations on varicose veins and haemorrhoids). There were striking differences between the districts in the use of day case care. For ex le, the use of day case care as a percentage of all hospital admissions for termination of pregnancy varied from 1% in one district to 24% in another that for dilatation and curettage varied from 1% to 43% and that for female sterilisation varied from less than 1% to 35%. Emergency readmission rates after day surgery were similar to those following inpatient treatment. We conclude that the use of day surgery for some conditions judged suitable for day care is still low and, even within one region, variation in the use of day surgery is considerable. The reasons for continued reluctance in some places to undertake more day surgery merit investigation.
Publisher: Wiley
Date: 25-01-2016
DOI: 10.1111/BIRT.12219
Abstract: Pregnancy at a young age is a continuing public health concern strongly associated with socioeconomic deprivation, social isolation, and stigma. The objectives were to see whether, compared with women aged 21 or more, women aged 20 years or younger worried more about labor and birth, and had poorer maternal outcomes. Another objective was to investigate the extent to which worries about labor and birth mediated the associations between young age and outcomes. A secondary analysis of data was conducted relating to 2,598 primiparous women's experience of maternity care in England in 2010. The survey collected data on care in the antenatal, intrapartum, and postnatal periods, and sociodemographic factors. A validated checklist measured worries about labor and birth. Compared with women aged 21 or more, women aged 20 years or younger worried more about labor and birth. The pain and duration of labor worried all women and those aged 20 years or younger were particularly worried about the uncertainty of labor onset, cesarean section birth, and about embarrassment. In logistic regression, after adjusting for potential confounders, young age was a significant independent risk factor for worries about pain and distress in labor, and self-reported depression at 1 and 3 months. However, young age was also significantly associated with having a normal vaginal delivery. It may be appropriate to focus support on women experiencing multiple disadvantage, rather than young age alone.
Publisher: Wiley
Date: 09-01-2012
Publisher: Wiley
Date: 22-07-2013
DOI: 10.1111/AOGS.12211
Abstract: To investigate women's experience of induction of labor. Mixed methods study. English maternity units. Women who gave birth in a two-week period in late 2009, excluding women aged less than 16 years and women whose baby had died. This study involved secondary analysis of data from questionnaires relating to care in childbirth. Women's experience of induction of labor was compared with that of women who had spontaneous labor by analysis of responses to structured survey questions. Responses to open questions relating to induction were analysed qualitatively. Satisfaction with care, mode of delivery, experience of induction of labor. The response rate to the survey was 55.1% representing 5333 women, 20% of whom were induced. Nulliparous women, those with long-term health problems, or specific pregnancy-related problems were significantly more likely to be induced. Women who were induced were generally less satisfied with aspects of their care and significantly less likely to have a normal delivery. In the qualitative analysis the main themes that emerged concerned delay, staff shortages, neglect, pain and anxiety in relation to getting the induction started and once it was underway and in relation to failed induction, the main themes were plans not being followed, wasted effort and pain, and feeling let down and disappointed. Women having an induction were generally less satisfied with their care, suggesting the need for a focused service for these women to address their additional needs.
Publisher: American Academy of Pediatrics (AAP)
Date: 12-2003
Abstract: Objectives. To compare the cumulative use and cost of hospital inpatient services to 5 years of age by in iduals ided into 4 subgroups by gestational age at birth. Design. Costs applied to the hospital service utilization profile of each infant born in 2 areas covered by the Oxford Record Linkage Study during 1970–1993. Setting. Oxfordshire and West Berkshire, southern United Kingdom. Subjects. 239 694 in iduals ided into 4 subgroups by gestational age at birth: & weeks, 28 to 31 weeks, 32 to 36 weeks, ≥37 weeks. Main Outcome Measures. Number and duration of hospital admissions during the first 5 years of life and costs, expressed in £ sterling and valued at 1998–1999 prices, of hospital inpatient services. Results. The total duration of hospital admissions for infants born at & and at 28 to 31 gestational weeks was 85 and 16 times that for term infants, respectively, once duration of life had been taken into account. Hospital inpatient service costs were significantly higher for preterm infants than for term infants, with the cost differences persisting throughout infancy and early and mid-childhood. Over the first 5 years of life, the adjusted mean cost difference was estimated at £14 614 (US $22 798) when infants born at & weeks gestational age were compared with term infants and £11 958 (US $18 654) when infants born at 28 to 31 weeks gestational age were compared with term infants. Independent contributions to total cost came from being born: small for gestational age, a multiple, during the 1970s and early 1980s, to a woman of extreme maternal age or who was hospitalized antenatally, and from experiencing extended survival or childhood disease. However, preterm birth remained the strongest predictor of high cost. Conclusions. Preterm birth is a major predictor of how much an in idual will cost hospital service providers during the first 5 years of life.
Publisher: Wiley
Date: 09-12-2011
DOI: 10.1111/J.1365-2214.2010.01177.X
Abstract: It is well recognized that breast milk is the best form of nutrition for babies. However, many women do not breastfeed or give up soon after birth. Some report feeling unsupported in the post-natal period and many stop breastfeeding earlier than they would have wished. This study aimed to estimate the separate effects of midwifery factors in the overall context of sociodemographic and clinical influences on breastfeeding. Data from a national survey conducted in England in 2006 were used. Questionnaires were sent to a random s le of 4800 new mothers (63% response rate). Questions relating to infant feeding allowed calculation of rates of initiation of breastfeeding and rates of exclusive and any breastfeeding in the first few days and at 3 months. Univariate analyses were carried out to estimate the associations between sociodemographic, clinical and midwifery factors and breastfeeding. Logistic regression was used to estimate the specific effects of midwifery factors, while adjusting for other significant variables. The most powerful explanatory factor was antenatal feeding intention. Maternal age, absence of clinical problems in the baby and a short post-natal stay were important in the early days. At 3 months, breastfeeding was associated with sociodemographic and intrapartum factors. At all stages, breastfeeding was significantly associated with either receiving consistent advice, practical help and/or active support and encouragement from midwives. The antenatal decision about infant feeding is the most powerful predictor of infant feeding behaviour. Some sociodemographic and clinical factors are also important influences on breastfeeding. However, after adjusting for these, midwifery factors are still influential.
Location: United Kingdom of Great Britain and Northern Ireland
Location: Australia
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Jane Henderson.