Maternal employment and pregnancy outcomes in a large European maternity hospital.

OBJECTIVE: Epidemiological studies have previously reported that maternal socioeconomic disadvantage is associated with adverse feto-maternal outcomes. However, little attention has been paid to the question of the woman's employment status. The aim of this observational study was to examine the relationship between maternal employment status at the first antenatal visit and pregnancy outcomes. STUDY DESIGN: The study was confined to women with a singleton pregnancy who attended for maternity care between the years 2010 and 2017 and delivered a baby weighing ≥500 g. Self-reported sociodemographic and clinical details were recorded at the first antenatal visit by a trained midwife and updated before hospital discharge. The hospital is one of the largest in Europe and accepts women from all socioeconomic groups, including women in the public system and those with private health insurance, across the rural-urban spectrum. RESULTS: Of the 62,395 women, the mean age was 31.5 years (SD 5.4), 39.3% were nulliparas and 70.7% were Irish born. Compared with the 45,028 (72.2%) women who reported as being in paid employment, the 4984 (8.0%) women who were unemployed had a higher rate of stillbirth (8/4984 vs. 27/45,028, p = 0.005) and homemakers had a higher incidence of neonatal death (31/12,383 vs. 73/45,028, p = 0.02). On multivariable analysis, women who were unemployed or homemakers had increased adjusted odds ratios for neonatal unit (NNU) admissions, preterm birth, low birth weight, and small-for-gestational-age. Compared to women in paid employment, women who were unemployed or homemakers were associated with younger age (<30 years) in pregnancy, multiparity, unplanned pregnancy, no or postconceptional only folic acid supplementation, anxiolytic/antidepressant use, as well as persistent smoking and illicit drug use during pregnancy. CONCLUSIONS: In a high-income European country, women who reported as unemployed or homemakers were associated with higher rates of adverse pregnancy outcomes. Furthermore, these women were associated with suboptimal lifestyle behaviours such as smoking and illicit drug use in early pregnancy. This highlights the need for long term public policies on female unemployment and retaining women with children in employment.

Health effects of the London bicycle sharing system: health impact modelling study.

OBJECTIVE: To model the impacts of the bicycle sharing system in London on the health of its users. DESIGN: Health impact modelling and evaluation, using a stochastic simulation model. SETTING: Central and inner London, England. DATA SOURCES: Total population operational registration and usage data for the London cycle hire scheme (collected April 2011-March 2012), surveys of cycle hire users (collected 2011), and London data on travel, physical activity, road traffic collisions, and particulate air pollution (PM2.5, (collected 2005-12). PARTICIPANTS: 578,607 users of the London cycle hire scheme, aged 14 years and over, with an estimated 78% of travel time accounted for by users younger than 45 years. MAIN OUTCOME MEASURES: Change in lifelong disability adjusted life years (DALYs) based on one year impacts on incidence of disease and injury, modelled through medium term changes in physical activity, road traffic injuries, and exposure to air pollution. RESULTS: Over the year examined the users made 7.4 million cycle hire trips (estimated 71% of cycling time by men). These trips would mostly otherwise have been made on foot (31%) or by public transport (47%). To date there has been a trend towards fewer fatalities and injuries than expected on cycle hire bicycles. Using these observed injury rates, the population benefits from the cycle hire scheme substantially outweighed harms (net change -72 DALYs (95% credible interval -110 to -43) among men using cycle hire per accounting year; -15 (-42 to -6) among women; note that negative DALYs represent a health benefit). When we modelled cycle hire injury rates as being equal to background rates for all cycling in central London, these benefits were smaller and there was no evidence of a benefit among women (change -49 DALYs (-88 to -17) among men; -1 DALY (-27 to 12) among women). This sex difference largely reflected higher road collision fatality rates for female cyclists. At older ages the modelled benefits of cycling were much larger than the harms. Using background injury rates in the youngest age group (15 to 29 years), the medium term benefits and harms were both comparatively small and potentially negative. CONCLUSION: London's bicycle sharing system has positive health impacts overall, but these benefits are clearer for men than for women and for older users than for younger users. The potential benefits of cycling may not currently apply to all groups in all settings.

The structure of spatial networks and communities in bicycle sharing systems.

Bicycle sharing systems exist in hundreds of cities around the world, with the aim of providing a form of public transport with the associated health and environmental benefits of cycling without the burden of private ownership and maintenance. Five cities have provided research data on the journeys (start and end time and location) taking place in their bicycle sharing system. In this paper, we employ visualization, descriptive statistics and spatial and network analysis tools to explore system usage in these cities, using techniques to investigate features specific to the unique geographies of each, and uncovering similarities between different systems. Journey displacement analysis demonstrates similar journey distances across the cities sampled, and the (out)strength rank curve for the top 50 stands in each city displays a similar scaling law for each. Community detection in the derived network can identify local pockets of use, and spatial network corrections provide the opportunity for insight above and beyond proximity/popularity correlations predicted by simple spatial interaction models.