Ethnic differences in risk factors for adverse birth outcomes between Pakistani, Bangladeshi, and White British mothers.

AIM: Reducing poor maternal and infant outcomes in pregnancy is the aim of maternity care. Adverse health behaviours lead to increased risk and can adversely mediate birth outcomes. This study examines whether risk factors are similar, different, or clustered according to maternal ethnicity. DESIGN: Retrospective analysis of routinely collected data (2008-2013). METHODS: We analysed data routinely collected data from a local University Hospital Ciconia Maternity information System (CMiS), for White British, Pakistani, and Bangladeshi women (N = 15,211) using cross-tabulations, ANCOVA, adjusted standardized residuals (ASR), and Pearson's chi-squared statistics. RESULTS: The results demonstrate distinct clusters of risk factors between White British, Pakistani, and Bangladeshi mothers. Additionally, Pakistani mothers had the highest number of statistically significant risk factors, according to maternal ethnicity, showing that 49% of women in this cohort that were diagnosed with diabetes were Pakistani, 21.5% of White British women smoked and results showed that Bangladeshi mothers delivered the lightest weight infants (adjusted mean: 3,055.4 g). CONCLUSIONS: This study showed differences in the risk factors between White British, Pakistani, and Bangladeshi mothers. The identified risk factors were clustered by maternal ethnicity. IMPACT: Identification of these risk factor clusters can help policymakers and clinicians direct resources and may help reduce ethnic variation found in these populations that might be attributed to adverse health behaviours and increased risk factors.

Muscle atrophy and metal-on-metal hip implants: a serial MRI study of 74 hips.

BACKGROUND AND PURPOSE: Muscle atrophy is seen in patients with metal-on-metal (MOM) hip implants, probably because of inflammatory destruction of the musculo-tendon junction. However, like pseudotumors, it is unclear when atrophy occurs and whether it progresses with time. Our objective was to determine whether muscle atrophy associated with MOM hip implants progresses with time. PATIENTS AND METHODS: We retrospectively reviewed 74 hips in 56 patients (32 of them women) using serial MRI. Median age was 59 (23-83) years. The median time post-implantation was 83 (35-142) months, and the median interval between scans was 11 months. Hip muscles were scored using the Pfirrmann system. The mean scores for muscle atrophy were compared between the first and second MRI scans. Blood cobalt and chromium concentrations were determined. RESULTS: The median blood cobalt was 6.84 (0.24-90) ppb and median chromium level was 4.42 (0.20-45) ppb. The median Oxford hip score was 34 (5-48). The change in the gluteus minimus mean atrophy score between first and second MRI was 0.12 (p = 0.002). Mean change in the gluteus medius posterior portion (unaffected by surgical approach) was 0.08 (p = 0.01) and mean change in the inferior portion was 0.10 (p = 0.05). Mean pseudotumor grade increased by 0.18 (p = 0.02). INTERPRETATION: Worsening muscle atrophy and worsening pseudotumor grade occur over a 1-year period in a substantial proportion of patients with MOM hip implants. Serial MRI helps to identify those patients who are at risk of developing worsening soft-tissue pathology. These patients should be considered for revision surgery before irreversible muscle destruction occurs.

Exploring commitment, professional identity, and support for student nurses.

Problems with the recruitment and retention of nurses globally mean that insight into the factors that might increase retention in qualified staff and students is crucial. Despite clear links between work commitment and retention, there is little research exploring commitment in student nurses and midwives. This paper reports the findings of a qualitative study designed to provide insight into commitment using semi-structured interviews conducted with nine pre-registration students and a qualitative survey completed by 171 pre-registration students. Thematic analysis of the data emphasised the impact of placement experiences on commitment via interpersonal relationships. Students typically emphasised their professional identity as the basis for commitment, although many participants also highlighted a lack of acceptance by qualified practitioners, which reduced it. There was evidence that suggested that practitioner workload may impact the student experience due to challenges in making sufficient time to provide support. Implications for retention strategies are discussed.

Truck driver fatigue risk assessment and management: a multinational survey.

As part of an organizational review of safety, interviews and questionnaire surveys were performed on over 700 commercial goods drivers and their managers within a series of related companies operating across 17 countries. The results examine the reported incidence of fatigue-related problems in drivers and their associations with near miss and accident experience as well as work and organizational factors. Experience of fatigue problems while driving was linked to time of day and rotation of shifts, though most associations were small. There were significant associations found between fatigue experiences and driver and management systems of break taking and route scheduling. The quantitative combined with qualitative information suggested that, where feasible, more flexible approaches to managing the scheduling and sequencing of deliveries assisted drivers in managing their own fatigue problems through appropriate break-taking. The results are interpreted within the overarching principles of risk assessment and risk control.