Using Robson's Ten-Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro-Peristat study.

OBJECTIVE: Robson's Ten Group Classification System (TGCS) creates clinically relevant sub-groups for monitoring caesarean birth rates. This study assesses whether this classification can be derived from routine data in Europe and uses it to analyse national caesarean rates. DESIGN: Observational study using routine data. SETTING: Twenty-seven EU member states plus Iceland, Norway, Switzerland and the UK. POPULATION: All births at ≥22 weeks of gestational age in 2015. METHODS: National statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups. MAIN OUTCOME MEASURES: Overall caesarean rate, prevalence and caesarean rates in each of the TGCS groups. RESULTS: Of 31 countries, 18 were able to provide data on the TGCS groups, with UK data available only from Northern Ireland. Caesarean birth rates ranged from 16.1 to 56.9%. Countries providing TGCS data had lower caesarean rates than countries without data (25.8% versus 32.9%, P = 0.04). Countries with higher caesarean rates tended to have higher rates in all TGCS groups. Substantial heterogeneity was observed, however, especially for groups 5 (previous caesarean section), 6, 7 (nulliparous/multiparous breech) and 10 (singleton cephalic preterm). The differences in percentages of abnormal lies, group 9, illustrate potential misclassification arising from unstandardised definitions. CONCLUSIONS: Although further validation of data quality is needed, using TGCS in Europe provides valuable comparator and baseline data for benchmarking and surveillance. Higher caesarean rates in countries unable to construct the TGCS suggest that effective routine information systems may be an indicator of a country's investment in implementing evidence-based caesarean policies. TWEETABLE ABSTRACT: Many European countries can provide Robson's Ten-Group Classification to improve caesarean rate comparisons.

An ecohydrological approach to the river contamination by PCDDs, PCDFs and dl-PCBs - concentrations, distribution and removal using phytoremediation techniques.

The levels of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (dl-PCBs) in the Pilica River and Sulejów Reservoir were found to be 46% higher during the flood season than during stable flow periods. In addition, PCDD/PCDF and dl-PCB mass loads increased by 5- to 12-fold and by 23- to 60-fold for toxic equivalency (TEQ) during flooding. The Sulejów Reservoir was found to play a positive role in reducing PCDD, PCDF and dl-PCB transport within the study period, with reductions ranging from 17 to 83% for total concentrations, and 33 to 79% for TEQ. Wastewater Treatment Plants (WTPs) were not efficient at mass concentration removal, with small displaying the least efficiency. WTPs discharge pollutants into the aquatic environment, they also produce sludge that requires disposal, similar to reservoir sediments. Sludge- or sediment-born PCDDs, PCDFs and dl-PCBs may be removed using phytoremediation. The cultivation of cucumber and zucchini, two efficient phytoremediators of organic pollutants, on polluted substrate resulted in a mean decrease in PCDD + PCDF + dl-PCB TEQ concentrations: 64% for cucumber and 69% for zucchini in sludge-amended soil, and by 52% for cucumber and 51% for zucchini in sediment-amended soil.

Ethnic variation in maternity care: a comparison of Polish and Scottish women delivering in Scotland 2004-2009.

OBJECTIVES: Birth outcomes in migrants vary, but the relative explanatory influence of obstetric practice in origin and destination countries has been under-investigated. To explore this, birth outcomes of Scots and Polish migrants to Scotland were compared with Polish obstetric data. Poles are the largest group of migrants to Scotland, and Poland has significantly more medicalized maternity care than Scotland. STUDY DESIGN: A population-based epidemiological study of linked maternal country of birth, maternity and birth outcomes. METHODS: Scottish maternity and neonatal records linked to birth registrations were analysed for differences in modes of delivery and pregnancy outcomes between Polish migrants and Scots, and compared with Polish Health Fund and survey data. RESULTS: 119,698 Scottish and 3105 Polish births to primiparous women in Scotland 2004-9 were analysed. Poles were less likely than Scots to have a Caesarean section and more likely to have a spontaneous vaginal or instrumental delivery. The Caesarean section rate in Poland is significantly higher and instrumental delivery rate lower than for either group of women in Scotland. CONCLUSIONS: Methodologically, comparing a large group of migrants from one country with the host population has advantages over grouping migrants from several countries into a single category, and allows more informed analysis of the effect of health services. Polish mothers' being slightly healthier explains some of their lower Caesarean section rate compared to Scots in Scotland. However, dominant models of obstetrics in the two countries seem likely to influence the differences between Poles delivering in Poland and Scotland. Further investigation of both is required.

[Basic principles of evaluation of neural tube defects primary prevention programme]. / Zasady ewaluacji programu pierwotnej profilaktyki wad cewy nerwowej.

Neural Tube Defects (NTD) Primary Prevention Programme has been developed in Poland since 1997. The Programme directed by Professor Z. J. Brzezinski is based on an information and education campaign directed at health professionals, women in childbearing age and high school students. The Central Programme Office has been directing the development and implementation of the Programme through a network of provincial programmes. In the present paper the main principles of NTD primary prevention were presented as well as some principles of Programme building and evaluation. Due to the relatively short period of Programme implementation, it is too early to perform the full evaluation. However, some examples were presented including process evaluation and testing the main tools (questionnaires, school programme project). It was assumed that the effectiveness of NTD Primary Prevention Programme in Poland will be assessed by: 1) changes in women's knowledge, attitude and behaviour concerning folic acid supplementation, 2) changes in NTD mortality and morbidity rates, 3) changes in the amount of sold tablets containing 0.4 mg of folic acid. For each of these indicators some international results and Polish baseline results were discussed.

[Methylene tetrahydrofolate reductase mutations as genetic risk factors for neural tube defects (NTF)]. / Mutacje reduktazy metylenotetrahydrofolianowej jako genetyczny czynnik ryzyka wystapienia WCN.

Folic acid supplementation before conception and during the first trimester of pregnancy prevents about 70% of all neural tube defects (NTD). Folic acid is a cofactor in the homocysteine metabolism. Its product--S-adenosylmethionine is a major methyl donor for reactions taking place in a cell. The 677 C-->T mutation in the methylene tetrahydrofolate reductase gene leads to thermolability and decreased activity of the enzyme. In the individuals homozygous for that mutation hyperhomocystynemia and lowered plasma folate level are observed. Presence of the MTHFR 677 C-->T mutation increases the requirements for folic acid, especially at the time of rapid foetal growth. Studies showed higher rate of TT homozygotes in people with NTD and their parents compared with the control group. Hyperhomocystynemia has been associated with higher risk of recurrent miscarriages in women. It was also proved that stillbirths are a risk factor associated with NTDs. TT homozygosity varies among different country populations, from 6% to 16%. An additional risk factor for NTD is MTHFR 1298 A-->C mutation. Combined heterozygosity for the 1298 A-->C and 677 C-->T mutations is associated with increased homocysteine and lowered plasma folate levels. This genotype is more frequent in NTD patients compared with controls. Further investigations in the field of genetic aspects of NTD in Poland will be very important for the primary prevention of NTD.

[Lung manifestation of visceral larva migration syndrome due to Toxocara canis infection]. / Plucna postac zespolu wedrujacej larwy trzewnej wywolana przez Toxocara canis.

32 year-old patient was hospitalized because of disseminated lung lesions. 2 years earlier he manifested chorioditis. Exact disease history suggested suspicion of toxocare infection. The diagnosis was confirmed by serological tests with anti-Toxocara canis antibodies, bronchial lavage and chest CT scan. Administration of 450 mg of dietylokarbamasin (Hetrazan) resulted in complete resolution of pulmonary lesions.

[Brain perfusion changes after head trauma assessed by cerebral SPECT with aminophylline test]. / Przeplyw mózgowy i reaktywnosc naczyniowa w odleglym okresie po urazie mózgowym badane przy pomocy tomografii emisyjnej SPECT z testem acetazolamidowym i aminofilinowym.

Tomographic cerebral blood flow SPECT scanning using Tc-99m-HMPAO was performed before and after i.v. administration of aminophylline in 36 patients between 6 months to 11 years after closed head trauma. Asymmetries of brain perfusion were found in 34 patients, normal rCBF distribution in 2 patients. Bi-focused asymmetries on the presumed line: trauma-contra coup were seen in 64% of the patients. In 70.4% of the patients with brain perfusion asymmetries the CT scan was normal. The aminophylline test improved the perfusion in 42% of the patients, indicating preserved perfusion reserve. Persistence of brain perfusion alterations after head trauma exists. Aminophylline test may be useful in the assessment of brain perfusion reserve in post-traumatic focus. Brain perfusion SPECT scans may be useful for medico-legal purposes.

[Primary brain lymphoma: diagnostic problems]. / Pierwotny chloniak mózgu--problemy diagnostyczne.

Diagnostic difficulties in a patient with primary malignant lymphoma of the brain are presented. Computerized tomography scans disclosed, at the beginning, a large mass located in the frontocallosal region, and 15 months later another focus in the cerebellum. Differential diagnostic considerations based on CT and NMR pictures, included infectious diseases, demyelinating diseases also metastatic tumours. The patient was successfully treated surgically, and had than radiotherapy.

[Stomach neoplasm with pulmonary dissemination--diagnostic difficulties]. / Rak zoladka z przerzutami do pluc--trudnosci rozpoznawcze.

The case of nineteen years old patient with a milliary-like lesions in the lung due to gastric carcinoma is presented. Rapid progression and atypical course of the disease were a cause of difficulties in establishing a proper diagnosis.

[Gall bladder tuberculosis and stomach cancer]. / Wspólistnienie gruzlicy pecherzyka z[symbol: see text]ólciowego i raka z[symbol: see text]oladka.

The case of a seventy year old woman with delayed diagnosis of stomach cancer due to misinterpretation of signs and symptoms is presented. A few months earlier a gall bladder tuberculosis was found in this patient. Abdominal symptoms which appeared afterwards were therefore interpreted as manifestation of tuberculosis until the thorough examination allowed diagnosing a gastric cancer.

[Clinical and electroencephalographic signs of side effects in patients after myelography using "amipaque"]. / Kliniczne i elektroencefalograficzne objawy uboczne u chorych po mielografii wykonanej preparatem "amipaque".

The authors present the results of own investigations on the occurrence of side effects following myelography with the contrast medium Amipaque administered usually by the lumbar route. Sixty patients aged 21-65 years with various diseases of the spinal cord and cauda equina were studied. Clinical and myelographic investigations were performed before and after myelography. In 6 out of 60 cases (10%) transient neurological disturbances developed including epileptic seizures, speech disturbances of the type of aphasia and dysartria, visual disturbances and twitching of lower extremities. Other symptoms and signs included: headaches, vomiting, collapse. One patient with cardiorespiratory failure died hours after myelography with evidence of increased symptoms of cardiorespiratory failure. EEG changes appeared after myelography in 2/3 of cases and persisted for up to 12 days. The authors call attention to the high proportion of neurological complications and EEG changes which must be taken into account when indications to myelography are considered. Particular caution is necessary in cases with coexistent cardiorespiratory failure.

[Electroencephalographic and clinical correlates in patients with occlusion or stenosis of the carotid arteries and their intracranial branches]. / Korelacje elektroencefalograficno-kliniczne u chorych z niedroznoscia lub zwezeniem tetnic szyjnych i ich wewnatrzczaszkowych odgalezien.

Electroencephalographic-clinical investigations were carried out in 94 patients with ischaemic syndromes of the cerebral hemispheres divided into two groups: with occlusion or stenosis of arteries in the neck (37 patients) and with lesions of intracranial arteries (57 patients). In all cases EEG was done and the diagnosis was verified on the basis of cerebral arteriography. The types of signs in EEG and the correlations between them and the clinical manifestations and their intensity were analysed. These data were related to the results of angiography. No significant differences were observed between the patterns of EEG changes with regard to the location, extent and morphology between the group with lesions of neck arteries and the group with lesions of intracranial arteries.

[Tolosa-Hunt syndrome (ophthalmoplegia dolorosa recurrens)]. / Zespól Tolosa-Hunta (ophtalmoplegia dolorosa recurrens).

On the basis of clinical manifestations and results of angiographic and phlebographic investigations the author discusses the symptoms of the Tolosa-Hunt syndrome. Angiographic findings, that is narrowing and uneven contour of vascular lumen in the internal carotid artery siphon as a result of infiltration of the arterial wall occur in early stage of the disease and are not observed in the patients in whom angiography is done after several weeks of the disease. The author stresses as a very characteristic feature of the syndrome rapid regression of symptoms, especially pain, after introduction of steroid therapy.

[Clinical pattern of malignant brain tumors in patients over 50 years of age]. / Obraz kliniczny guzów nowotworowych mózgu u ludzi po 50-tym roku zycia

On the basis of a material of 180 cases from a hospital department of neurology the clinical course of malignant brain tumours in patients aged over 50 years was outlined. In 154 cases the clinical diagnosis was confirmed by histological investigations. The study showed that intracranial raised pressure syndrome was rather infrequent in this age group (5% in this material), with the exception of headaches. The most frequent manifestations were psychic changes and neurological deficit signs (hemiparesis). The course of the disease was frequently acute with rapid increase in the intensity of symptoms and signs. The cases unrecognized clinically accounted for 14.4% of this material. From the admission to the hospital a very rapid progression of manifestations was observed which seemed to be connected with association of blood flow disturbances.