Explain that if they plan birth at home there is a small increase in
the risk of an adverse outcome for the baby.
It is essential to note that these significantly increased
risks of adverse outcomes from the setting of home and from the setting of free - standing birth centers reported here may be serious underestimations of clinical complications.
«When one considers the modest decrease in
risk of adverse outcomes associated with the use of a number of widely used medications such as anti-cholesterol drugs, the effect sizes seen in this study are really impressive,» said Dr. Memtsoudis.
«After careful examination of the burden of disease among women aged 40 to 54 years, the guideline development group (GDG) concluded that the lesser, but not insignificant, burden of disease for women aged 40 to 44 years and the higher cumulative
risk of adverse outcomes no longer warranted a direct recommendation to begin screening at age 40 years.»
In the article, Stamatina Iliodromiti from the University of Glasgow, UK, and colleagues found birth weight less than 25th or greater than 85th centile to be associated with greater
risk of adverse outcomes compared with birth weight within these cutoffs, suggesting an expansion of the definition of «fetus at risk» beyond the less than 10th or greater than 90th centile range that is commonly used to trigger surveillance of fetal well - being and / or delivery.
In a new study, a hospital surveillance program focusing on reducing the risks of sepsis, known as the two - stage Clinical Decision Support (CDS) system, was found to reduce
the risk of adverse outcomes, such as death and hospice discharge for sepsis patients, by 30 % over the course of one year.
The hospital's early recognition and treatment of sepsis resulted in a 30 % reduced
risk of adverse outcomes for sepsis and severe sepsis patients, such as death or discharge to hospice.
According to new research published in the Journal of Clinical Endocrinology and Metabolism, the current policy of limiting thyroid tests to women at high risk of thyroid disease overlooks most cases of thyroid disease during pregnancy, and undiagnosed, untreated thyroid disease in pregnancy carries a significant
risk of an adverse outcome for both mother and baby.
Approximately 37 % of all children live in poverty for some period during their childhood.16 Children who are born into poverty and live persistently in poor conditions are at greatest
risk of adverse outcomes.
Examples of risk factors that have been found to be associated with depression included partner conflict, single - parenthood, low education and stressful life events [44, 45, 46], which have all, in turn, been related to greater
risk of adverse outcomes in children [47, 48, 49].
It is vital to consider the role of treatment of ADHD in decreasing the individual's
risk of adverse outcomes.
Not exact matches
Important factors that could cause actual results to differ materially from those reflected in such forward - looking statements and that should be considered in evaluating our outlook include, but are not limited to, the following: 1) our ability to continue to grow our business and execute our growth strategy, including the timing, execution, and profitability
of new and maturing programs; 2) our ability to perform our obligations under our new and maturing commercial, business aircraft, and military development programs, and the related recurring production; 3) our ability to accurately estimate and manage performance, cost, and revenue under our contracts, including our ability to achieve certain cost reductions with respect to the B787 program; 4) margin pressures and the potential for additional forward losses on new and maturing programs; 5) our ability to accommodate, and the cost
of accommodating, announced increases in the build rates
of certain aircraft; 6) the effect on aircraft demand and build rates
of changing customer preferences for business aircraft, including the effect
of global economic conditions on the business aircraft market and expanding conflicts or political unrest in the Middle East or Asia; 7) customer cancellations or deferrals as a result
of global economic uncertainty or otherwise; 8) the effect
of economic conditions in the industries and markets in which we operate in the U.S. and globally and any changes therein, including fluctuations in foreign currency exchange rates; 9) the success and timely execution
of key milestones such as the receipt
of necessary regulatory approvals, including our ability to obtain in a timely fashion any required regulatory or other third party approvals for the consummation
of our announced acquisition
of Asco, and customer adherence to their announced schedules; 10) our ability to successfully negotiate, or re-negotiate, future pricing under our supply agreements with Boeing and our other customers; 11) our ability to enter into profitable supply arrangements with additional customers; 12) the ability
of all parties to satisfy their performance requirements under existing supply contracts with our two major customers, Boeing and Airbus, and other customers, and the
risk of nonpayment by such customers; 13) any
adverse impact on Boeing's and Airbus» production
of aircraft resulting from cancellations, deferrals, or reduced orders by their customers or from labor disputes, domestic or international hostilities, or acts
of terrorism; 14) any
adverse impact on the demand for air travel or our operations from the outbreak
of diseases or epidemic or pandemic outbreaks; 15) our ability to avoid or recover from cyber-based or other security attacks, information technology failures, or other disruptions; 16) returns on pension plan assets and the impact
of future discount rate changes on pension obligations; 17) our ability to borrow additional funds or refinance debt, including our ability to obtain the debt to finance the purchase price for our announced acquisition
of Asco on favorable terms or at all; 18) competition from commercial aerospace original equipment manufacturers and other aerostructures suppliers; 19) the effect
of governmental laws, such as U.S. export control laws and U.S. and foreign anti-bribery laws such as the Foreign Corrupt Practices Act and the United Kingdom Bribery Act, and environmental laws and agency regulations, both in the U.S. and abroad; 20) the effect
of changes in tax law, such as the effect
of The Tax Cuts and Jobs Act (the «TCJA») that was enacted on December 22, 2017, and changes to the interpretations
of or guidance related thereto, and the Company's ability to accurately calculate and estimate the effect
of such changes; 21) any reduction in our credit ratings; 22) our dependence on our suppliers, as well as the cost and availability
of raw materials and purchased components; 23) our ability to recruit and retain a critical mass
of highly - skilled employees and our relationships with the unions representing many
of our employees; 24) spending by the U.S. and other governments on defense; 25) the possibility that our cash flows and our credit facility may not be adequate for our additional capital needs or for payment
of interest on, and principal
of, our indebtedness; 26) our exposure under our revolving credit facility to higher interest payments should interest rates increase substantially; 27) the effectiveness
of any interest rate hedging programs; 28) the effectiveness
of our internal control over financial reporting; 29) the
outcome or impact
of ongoing or future litigation, claims, and regulatory actions; 30) exposure to potential product liability and warranty claims; 31) our ability to effectively assess, manage and integrate acquisitions that we pursue, including our ability to successfully integrate the Asco business and generate synergies and other cost savings; 32) our ability to consummate our announced acquisition
of Asco in a timely matter while avoiding any unexpected costs, charges, expenses,
adverse changes to business relationships and other business disruptions for ourselves and Asco as a result
of the acquisition; 33) our ability to continue selling certain receivables through our supplier financing program; 34) the
risks of doing business internationally, including fluctuations in foreign current exchange rates, impositions
of tariffs or embargoes, compliance with foreign laws, and domestic and foreign government policies; and 35) our ability to complete the proposed accelerated stock repurchase plan, among other things.
These
risks and uncertainties include, among others: the unfavorable
outcome of litigation, including so - called «Paragraph IV» litigation and other patent litigation, related to any
of our products or products using our proprietary technologies, which may lead to competition from generic drug manufacturers; data from clinical trials may be interpreted by the FDA in different ways than we interpret it; the FDA may not agree with our regulatory approval strategies or components
of our filings for our products, including our clinical trial designs, conduct and methodologies and, for ALKS 5461, evidence
of efficacy and adequacy
of bridging to buprenorphine; clinical development activities may not be completed on time or at all; the results
of our clinical development activities may not be positive, or predictive
of real - world results or
of results in subsequent clinical trials; regulatory submissions may not occur or be submitted in a timely manner; the company and its licensees may not be able to continue to successfully commercialize their products; there may be a reduction in payment rate or reimbursement for the company's products or an increase in the company's financial obligations to governmental payers; the FDA or regulatory authorities outside the U.S. may make
adverse decisions regarding the company's products; the company's products may prove difficult to manufacture, be precluded from commercialization by the proprietary rights
of third parties, or have unintended side effects,
adverse reactions or incidents
of misuse; and those
risks and uncertainties described under the heading «
Risk Factors» in the company's most recent Annual Report on Form 10 - K and in subsequent filings made by the company with the U.S. Securities and Exchange Commission («SEC»), which are available on the SEC's website at www.sec.gov.
My conclusion is that the easing
of financial conditions resulting from non-traditional policy actions has had a material effect on both nominal and real growth and has demonstrably reduced the
risk of particularly
adverse outcomes.
Quote from the midwife site:» There was no evidence that planned home birth among low
risk women leads to an increased
risk of severe
adverse maternal
outcomes in a maternity care system with well trained midwives and a good referral and transportation system.»
I counter: To insist the general
risk pool (etc) pay for your first birth without medical resources present, in spite
of the fact that same
risk pool will still be responsible for caring for any
adverse outcomes due to lack
of medical resources is hypocritical beyond belief.
Helping adolescent males to delay fatherhood may also be important from a child health perspective: research that controlled for maternal age and other key factors found teenage fatherhood associated with an increased
risk of adverse pregnancy
outcomes, including preterm birth, low birth weight and neonatal death (Chen et al, 2007).
Women who planned a home birth were at reduced
risk of all obstetric interventions assessed and were at similar or reduced
risk of adverse maternal
outcomes compared with women who planned to give birth in hospital accompanied by a midwife or physician.
For healthy nulliparous women with a low
risk pregnancy, the
risk of an
adverse perinatal
outcome seems to be higher for planned births at home, and the intrapartum transfer rate is high in all settings other than an obstetric unit
Impact
of interpregnancy interval on the subsequent
risk of adverse perinatal
outcomes.
For healthy women with low
risk pregnancies, the incidence
of adverse perinatal
outcomes is low in all birth settings
Regulating it, using better trained practitioners and proper guidelines for
risking - out and transfer definitely would reduce the rate
of adverse outcomes.
For nulliparous women, there is some evidence that planning birth at home is associated with a higher
risk of an
adverse perinatal
outcome.
There is a lack
of good quality evidence comparing the
risk of rare but serious
adverse perinatal
outcomes in these settings
There was no evidence that planned home birth among low
risk women leads to an increased
risk of severe
adverse maternal
outcomes in a maternity care system with well trained midwives and a good referral and transportation system.
The strengths
of the study include the ability to compare
outcomes by the woman's planned place
of birth at the start
of care in labour, the high participation
of midwifery units and trusts in England, the large sample size and statistical power to detect clinically important differences in
adverse perinatal
outcomes, the minimisation
of selection bias through achievement
of a high response rate and absence
of self selection bias due to non-consent, the ability to compare groups that were similar in terms
of identified clinical
risk (according to current clinical guidelines) and to further increase the comparability
of the groups by conducting an additional analysis restricted to women with no complicating conditions identified at the start
of care in labour, and the ability to control for several important potential confounders.
A 2014 study that examines nearly 17,000 courses
of midwife - led care confirms that among low -
risk women, home births result in low rates
of interventions without an increase in
adverse outcomes for babies and mothers alike.
Secondly, some conditions mentioned in this brochure may increase the
risk of adverse pregnancy
outcomes including premature labor and delivery, birth injury, and stillbirth.
The study reviewed the births
of nearly 17,000 women and found that, among low -
risk women, planned home births result in low rates
of birth interventions without an increase in
adverse outcomes for mothers and newborns.
We categorized out -
of - hospital and in - hospital births in Oregon according to the intended place
of delivery and in comparing
outcomes found that the
risks for some
adverse neonatal
outcomes were increased among planned out -
of - hospital births.
Rates
of obstetrical intervention are high in U.S. hospitals, and we found large absolute differences in the
risks of these interventions between planned out -
of - hospital births and in - hospital births.38 In contrast, serious
adverse fetal and neonatal
outcomes are infrequent in all the birth settings we assessed, and the absolute differences in
risk that we observed between planned birth locations were correspondingly small; for example, planned out -
of - hospital births were associated with an excess
of less than 1 fetal death per 1000 deliveries in multivariate and propensity - score - adjusted analyses.
For example, the Dutch home - birth system (in which home birth is common and
adverse outcomes are rare) includes formal collaborative agreements between out -
of - hospital and in - hospital providers, clear and mutually agreed - upon stratification
of risk, and protocols for the transfer
of care.35, 36 The process
of devising evidence - based guidelines for U.S. home births is under way.37
In analyses adjusted for maternal race and ethnic group, age, parity, and medical conditions associated with greater
risk, the associations between planned location
of delivery and most
adverse outcomes and obstetrical procedures remained significant (Table 4).
Planned birth at home in low
risk women without complicating conditions at the start
of care in labour was associated with significant cost savings and a significant decrease in
adverse perinatal
outcomes avoided.
There was, however, an increased incidence
of adverse perinatal
outcome associated with planned birth at home in nulliparous low
risk women, resulting in the probability
of it being the most cost effective option at a cost effectiveness threshold
of # 20000 declining to 0.63.
Nevertheless, «travel times greater than 20 minutes [to a healthcare facility] have been associated with increased
risk of adverse neonatal
outcomes, including mortality.»
There was, however, an increased incidence
of adverse perinatal
outcomes associated with planned birth at home in nulliparous low
risk women, resulting in the probability
of it being the most cost effective option at a threshold
of # 20000 declining to 0.63.
The definition
of low
risk used in the cohort study was based on criteria contained in the NICE Intrapartum Care Guidelines.11 The primary clinical
outcome was a composite measure
of adverse perinatal
outcomes encompassing perinatal mortality and specified neonatal morbidities (box).
This cost effectiveness information, however, should be considered in the light
of an increased
risk of adverse perinatal
outcome associated with planned home birth in low
risk nulliparous women.
There does not appear to be an associated increased
risk of adverse maternal, fetal, or neonatal
outcomes.
The available evidence does not suggest an increased
risk of adverse maternal
outcomes with water immersion during labor and delivery.
The author examined the safety
of CNM attended home deliveries compared with certified nurse midwife in - hospital deliveries in the United States as measured by the
risk of adverse infant
outcomes among women with term, singleton, vaginal deliveries.
Enabling women to breastfeed is also a public health priority because, on a population level, interruption
of lactation is associated with
adverse health
outcomes for the woman and her child, including higher maternal
risks of breast cancer, ovarian cancer, diabetes, hypertension, and heart disease, and greater infant
risks of infectious disease, sudden infant death syndrome, and metabolic disease (2, 4).
Low -
risk women in this cohort experienced high rates
of physiologic birth and low rates
of intervention without an increase in
adverse outcomes.»
In today's peer - reviewed Journal
of Midwifery & Women's Health (JMWH), a landmark study confirms that among low -
risk women, planned home births result in low rates
of interventions without an increase in
adverse outcomes for mothers and babies.
I would say the death
of one's child is an
adverse outcome, and even a small
risk of that should be taken very seriously.
The last study is a British one, which accounted for socioeconomic factors, age, parity, smoking and BMI and still found an elevated
risk of adverse maternal
outcome for African and Carribean women.
They go on to say «Low -
risk women in this cohort experienced high rates
of physiologic birth and low rates
of intervention without an increase in
adverse outcomes» which is a lie.
«among low -
risk women, planned home births result in low rates
of interventions without an increase in
adverse outcomes for mothers and babies.»
A comparison
of adverse neonatal
outcomes did not identify increased
risk for babies born at home as part
of the HBDP.