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Rekha S, Nalini SJ, Bhuvana S, Kanmani S, Hirst JE, Venugopal V. Heat stress and adverse pregnancy outcome: Prospective cohort study. BJOG 2024; 131:612-622. [PMID: 37814395 DOI: 10.1111/1471-0528.17680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To explore the relationship between occupational heat exposure, physiological heat strain indicators and adverse outcomes in pregnant women. DESIGN Prospective cohort. SETTING Workplaces in Tamil Nadu, India. SAMPLE A cohort of 800 pregnant women engaged in moderate to heavy physical work in 2017-2019 and 2021-2022. METHODS Participants were recruited at between 8 and 14 weeks of gestation. Occupational heat exposure and heat strain indicators were captured each trimester. 'Heat exposed' was defined as heat stress exceeding the threshold limit value (TLV) for safe manual work (with maximum wet-bulb globe temperatures of 27.5°C for a heavy workload and 28.0°C for a moderate workload). Physiological heat strain indicators (HSIs) such as core body temperature (CBT) and urine specific gravity (USG) were measured before and after each shift. Heat-related health symptoms were captured using the modified HOTHAPS questionnaire. MAIN OUTCOME MEASURES The main outcome measures included (1) a composite measure of any adverse pregnancy outcome (APO) during pregnancy (including miscarriage, preterm birth, low birthweight, stillbirth, intrauterine growth restriction and birth defects), (2) a composite measure of adverse outcomes at birth (3) and miscarriage. RESULTS Of the 800 participants, 47.3% had high occupational heat exposure. A rise in CBT was recorded in 17.4% of exposed workers, and 29.6% of workers experienced moderate dehydration (USG ≥ 1.020). Heat-exposed women had a doubled risk of miscarriage (adjusted odds ratio, aOR 2.4; 95% confidence interval, 95% CI 1.0-5.7). High occupational heat exposure was associated with an increased risk of any adverse pregnancy and foetal outcome (aOR 2.3; 95% CI 1.4-3.8) and adverse outcome at birth (aOR 2.0; 95% CI 1.2-3.3). CONCLUSIONS High occupational heat exposure is associated with HSIs and adverse pregnancy outcomes in India.
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Affiliation(s)
- Shanmugam Rekha
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, Chennai, India
| | - Sirala Jagadeesh Nalini
- Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, Chennai, India
| | - Srinivasan Bhuvana
- Department of Obstetrics and Gynaecology, Sri Ramachandra Medical Centre, Tamil Nadu, Chennai, India
| | - Sellappa Kanmani
- Centre for Environmental Studies, Anna University, Tamil Nadu, Chennai, India
| | - Jane Elizabeth Hirst
- Nuffield Department of Women's Reproductive Health and George Institute for Global Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Imperial College London, London, UK
| | - Vidhya Venugopal
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Tamil Nadu, Chennai, India
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Ismail AM, Ismail A, Hirst JE. Prevalence and risk factors of obstetric violence in the Gaza strip: A retrospective study from a conflict setting. Int J Gynaecol Obstet 2023; 163:383-391. [PMID: 37350406 DOI: 10.1002/ijgo.14911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/09/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To assess the prevalence and risk factors of obstetric violence (OV) among laboring women in the past 5 years in the Gaza Strip (GS). METHODS Women who delivered between January 2017 and December 2021 were invited to complete an anonymous online survey between November 2021 and February 2022 to explore their experiences of labor. RESULTS Seven hundred twenty-two women completed the online questionnaire. Two-thirds (484; 67.2%) were in their 20s, and half (362; 50.1%) were from low socioeconomic households. A vast majority (508; 70.4%) delivered in a government hospital. Four out of ten (300; 41.6%) reported experiencing at least one form of OV. Among these women, the types of OV reported were physical (143; 47.8%), psychological (122; 40.8%), verbal (109; 36.4%), and sexual (13; 4.4%). Delivery in private facilities (adjusted odds ratio [AOR] 0.45, 95% confidence interval [CI] 0.32-0.74) and prior knowledge of the care provider (AOR 0.37, 95% CI 0.23-0.59) were both independently protective for OV. In contrast, women's awareness of OV increased their likelihood of reporting it (AOR 3.45, 95% CI 2.37-5.01). CONCLUSION GS has an alarming prevalence of reported OV. Increasing awareness of OV, identifying its causes, and developing locally led initiatives to eliminate it are urgently needed.
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Affiliation(s)
- Alaa M Ismail
- Department of Obstetrics and Gynecology, Islamic University, Gaza, Palestine
| | - Anas Ismail
- King's Centre for Global Health and Health Partnerships, London, UK
| | - Jane Elizabeth Hirst
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Imperial College, London, UK
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Hirst JE, Votruba N, Billot L, Arora V, Rajan E, Thout SR, Peiris D, Patel A, Norton R, Mullins E, Sharma A, Kennedy S, Jha V, Praveen D. A community-based intervention to improve screening, referral and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trial. Trials 2023; 24:510. [PMID: 37559158 PMCID: PMC10410790 DOI: 10.1186/s13063-023-07510-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Medical complications during pregnancy, including anaemia, gestational diabetes mellitus and hypertensive disorders of pregnancy place women are at higher risk of long-term complications. Scalable and low-cost strategies to integrate non-communicable disease screening into pregnancy care are needed. We aim to determine the effectiveness and implementation components of a community-based, digitally enabled approach, "SMARThealth Pregnancy," to improve health during pregnancy and the first year after birth. METHODS A pragmatic, parallel-group, cluster randomised, type 2 hybrid effectiveness-implementation trial of a community-based, complex intervention in rural India to decrease anaemia (primary outcome, defined as haemoglobin < 12g/dL) and increase testing for haemoglobin, glucose and blood pressure (secondary outcomes) in the first year after birth. Primary Health Centres (PHCs) are the unit of randomisation. PHCs are eligible with (1) > 1 medical officer and > 2 community health workers; and (2) capability to administer intravenous iron sucrose. Thirty PHCs in Telangana and Haryana will be randomised 1:1 using a matched-pair design accounting for cluster size and distance from the regional centre. The intervention comprises (i) an education programme for community health workers and PHC doctors; (ii) the SMARThealth Pregnancy app for health workers to support community-based screening, referral and follow-up of high-risk cases; (iii) a dashboard for PHC doctors to monitor high-risk women in the community; (iv) supply chain monitoring for consumables and medications and (v) stakeholder engagement to co-develop implementation and sustainability pathways. The comparator is usual care with additional health worker education. Secondary outcomes include implementation outcomes assessed by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), clinical endpoints (anaemia, diabetes, hypertension), clinical service delivery indicators (quality of care score), mental health and lactation practice (PHQ9, GAD7, EuroQoL-5D, WHO IYCF questionnaire). DISCUSSION Engaging women with screening after a high-risk pregnancy is a challenge and has been highlighted as a missed opportunity for the prevention of non-communicable diseases. The SMARThealth Pregnancy trial is powered for the primary outcome and will address gaps in the evidence around how pregnancy can be used as an opportunity to improve women's lifelong health. If successful, this approach could improve the health of women living in resource-limited settings around the world. TRIAL REGISTRATION ClinicalTrials.gov NCT05752955. Date of registration 3 March 2023.
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Affiliation(s)
- Jane Elizabeth Hirst
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
- The George Institute for Global Health, Imperial College London, London, UK.
| | - Nicole Votruba
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Imperial College London, London, UK
| | - Laurent Billot
- The George Institute for Global Health, University of New South Wales, Kensington, Australia
| | | | - Eldho Rajan
- The George Institute for Global Health, New Delhi, India
| | | | - David Peiris
- The George Institute for Global Health, Newtown, Australia
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Kensington, Australia
| | - Robyn Norton
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Kensington, Australia
| | - Edward Mullins
- The George Institute for Global Health, Imperial College London, London, UK
| | - Ankita Sharma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Stephen Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Kensington, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Devarsetty Praveen
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Kensington, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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4
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Cansdale LG, Kelly G, Khashan A, Malata A, Kachale F, Lissauer D, Yosefe S, Roberts J, Woodworth S, Mmbaga B, Redman C, Hirst JE. Use of mHealth tools to register birth outcomes in low-income and middle-income countries: a scoping review. BMJ Open 2022; 12:e063886. [PMID: 36223965 PMCID: PMC9562304 DOI: 10.1136/bmjopen-2022-063886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Accurate reporting of birth outcomes in low-income and middle-income countries (LMICs) is essential. Mobile health (mHealth) tools have been proposed as a replacement for conventional paper-based registers. mHealth could provide timely data for individual facilities and health departments, as well as capture deliveries outside facilities. This scoping review evaluates which mHealth tools have been reported to birth outcomes in the delivering room in LMICs and documents their reported advantages and drawbacks. DESIGN A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Joanna Briggs Institute guidelines for scoping reviews and the mHealth evidence reporting and assessment checklist for evaluating mHealth interventions. DATA SOURCES PubMed, CINAHL and Global Health were searched for records until 3 February 2022 with no earliest date limit. ELIGIBILITY CRITERIA Studies were included where healthcare workers used mHealth tools in LMICs to record birth outcomes. Exclusion criteria included mHealth not being used at the point of delivery, non-peer reviewed literature and studies not written in English. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened studies and extracted data. Common themes among studies were identified. RESULTS 640 records were screened, 21 of which met the inclusion criteria, describing 15 different mHealth tools. We identified six themes: (1) digital tools for labour monitoring (8 studies); (2) digital data collection of specific birth outcomes (3 studies); (3) digital technologies used in community settings (6 studies); (4) attitudes of healthcare workers (10 studies); (5) paper versus electronic data collection (3 studies) and (6) infrastructure, interoperability and sustainability (8 studies). CONCLUSION Several mHealth technologies are reported to have the capability to record birth outcomes at delivery, but none were identified that were designed solely for that purpose. Use of digital delivery registers appears feasible and acceptable to healthcare workers, but definitive evaluations are lacking. Further assessment of the sustainability of technologies and their ability to integrate with existing health information systems is needed.
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Affiliation(s)
| | | | - Ali Khashan
- University College Cork School of Public Health, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Address Malata
- Malawi University of Science and Technology, Limbe, Malawi
| | | | - David Lissauer
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Simeon Yosefe
- Central Monitoring and Evaluation Division, Malawi Ministry of Health, Lilongwe, Malawi
| | - James Roberts
- Magee-Women's Research Institute, Pittsburgh, Pennsylvania, USA
| | - Simon Woodworth
- INFANT Research Centre, University College Cork, Cork, Ireland
- University College Cork Business School, Cork, Ireland
| | - Blandina Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Christopher Redman
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Jane Elizabeth Hirst
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
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Smith R, Michalopoulou M, Reid H, Riches SP, Wango YN, Kenworthy Y, Roman C, Santos M, Hirst JE, Mackillop L. Applying the behaviour change wheel to develop a smartphone application 'stay-active' to increase physical activity in women with gestational diabetes. BMC Pregnancy Childbirth 2022; 22:253. [PMID: 35346075 PMCID: PMC8962081 DOI: 10.1186/s12884-022-04539-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Physical activity (PA) interventions are an important but underutilised component in the management of gestational diabetes mellitus (GDM). The challenge remains how to deliver cost effective PA interventions that have impact on individual behaviour. Digital technologies can support and promote PA remotely at scale. We describe the development of a behaviourally informed smartphone application (Stay-Active) for women attending an NHS GDM clinic. Stay-Active will support an existing motivational interviewing intervention to increase and maintain PA in this population. METHODS The behaviour change wheel (BCW) eight step theoretical approach was used to design the application. It provided a systematic approach to understanding the target behaviour, identifying relevant intervention functions, and specifying intervention content. The target behaviour was to increase and maintain PA. To obtain a behavioural diagnosis, qualitative evidence was combined with focus groups on the barriers and facilitators to PA in women with GDM. The findings were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework to identify what needs to change for the target behaviour and linked to appropriate intervention functions. Finally, behaviour changes techniques (BCT) and modes of delivery that are most likely to serve the intervention functions were selected. Current evidence, patient focus groups and input from key stakeholders informed Stay-Active's development. RESULTS We found that psychological capability, reflective and automatic motivation, social and physical opportunity needed to change to increase PA in women with GDM. The four key intervention functions identified were Enablement, Education, Persuasion and Training. Stay-Active incorporates these four intervention functions delivering ten BCTs including: goal setting, credible source, self-monitoring, action planning, prompts and cues. The final design of Stay-Active delivers these BCTs via an educational resource centre, with goal setting and action planning features, personalised performance feedback and individualised promotional messages. CONCLUSION The BCW has enabled the systematic and comprehensive development of Stay-Active to promote PA in women with GDM within an NHS Maternity service. The next phase is to conduct a trial to assess the feasibility and acceptability of a multi-component intervention that combines Stay-Active with PA Motivational Interviewing.
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Affiliation(s)
- R Smith
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Oxford, OX3 7LD, UK.
| | - M Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - H Reid
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Oxford, OX3 7LD, UK
| | - S Payne Riches
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Y N Wango
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Y Kenworthy
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - C Roman
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England
| | - M Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England
| | - J E Hirst
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, England
| | - L Mackillop
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, England
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Zhang P, Chen H, Shang J, Ge J, Zhang H, Xu M, Bian C, Zhao Y, Chen M, Hirst JE. Mobile Phone App Use Among Pregnant Women in China and Associations Between App Use and Perinatal Outcomes: Retrospective Study. JMIR Form Res 2022; 6:e29644. [PMID: 35076402 PMCID: PMC8826146 DOI: 10.2196/29644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/26/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Maternal and child health (MCH)-related mobile apps are becoming increasingly popular among pregnant women; however, few apps have demonstrated that they lead to improvements in pregnancy outcomes. OBJECTIVE This study aims to investigate the use of MCH apps among pregnant women in China and explore associations with pregnancy outcomes. METHODS A retrospective study was conducted at 6 MCH hospitals in northern China. Women who delivered a singleton baby at >28 weeks' gestation at the study hospitals were sequentially recruited from postnatal wards from October 2017 to January 2018. Information was collected on the women's self-reported MCH app use during their pregnancy, along with clinical outcomes. Women were categorized as nonusers of MCH apps and users (further divided into intermittent users and continuous users). The primary outcome was a composite adverse pregnancy outcome (CAPO) comprising preterm birth, birth weight <2500 g, birth defects, stillbirth, and neonatal asphyxia. The association between app use and CAPO was explored using multivariable logistic analysis. RESULTS The 1850 participants reported using 127 different MCH apps during pregnancy. App use frequency was reported as never, 24.7% (457/1850); intermittent, 47.4% (876/1850); and continuous, 27.9% (517/1850). Among app users, the most common reasons for app use were health education (1393/1393, 100%), self-monitoring (755/1393, 54.2%), and antenatal appointment reminders (602/1393, 43.2%). Nonusers were older, with fewer years of education, lower incomes, and higher parity (P<.01). No association was found between any app use and CAPO (6.8% in nonusers compared with 6.3% in any app users; odds ratio 0.77, 95% CI 0.48-1.25). CONCLUSIONS Women in China access a large number of different MCH apps, with social disparities in access and frequency of use. Any app use was not found to be associated with improved pregnancy outcomes, highlighting the need for rigorous development and testing of apps before recommendation for use in clinical settings.
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Affiliation(s)
- Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wale, Sydney, Australia
| | - Huan Chen
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jie Shang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Jun Ge
- Shijiazhuang Obstetrics and Gynaecology Hospital, Shijiazhuang, China
| | - Huichen Zhang
- Shijiazhuang Luquan People's Hospital, Shijiazhuang, China
| | - Mingjun Xu
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Cui Bian
- Gaoyang Maternal and Child Health Hospital, Baoding, China
| | - Yang Zhao
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Minyuan Chen
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Jane Elizabeth Hirst
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Central Working - Fourth Floor Translation and Innovation Hub Imperial College London, London, United Kingdom
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7
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Hirst JE, Frise C, Thanabalasingham G, Owen K. Diabetes in pregnancy: time to focus on women with type 2 diabetes. Lancet Diabetes Endocrinol 2021; 9:332-333. [PMID: 33838743 DOI: 10.1016/s2213-8587(21)00091-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jane Elizabeth Hirst
- Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Charlotte Frise
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gaya Thanabalasingham
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Katharine Owen
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
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Abstract
Healthcare systems prioritise antenatal and intrapartum care over the postpartum period. This is reflected in clinical resource allocation and in research agendas. But from metabolic disease to mental health, many pregnancy-associated conditions significantly affect patients' lifelong health. Women from black and ethnic minority backgrounds and lower socioeconomic groups are at greater risk of physical and psychiatric complications of pregnancy compared to white British women. Without sufficiently tailored and accessible education about risk factors, and robust mechanisms for follow-up beyond the traditional 6-week postpartum period, these inequalities are further entrenched. Identifying approaches to address the needs of these patient populations is not only the responsibility of obstetricians and midwives; improvement requires cooperation from healthcare professionals from a wide range of specialties. Healthcare systems must encourage data collection on the long-term effects of metabolic and psychiatric conditions after the postpartum, and s support research that results in evidence-based care for the neglected field of women's postpartum health.
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Affiliation(s)
- Kate Womersley
- Royal Infirmary of Edinburgh, Edinburgh, UK, and honorary research associate, The George Institute for Global Health, Imperial College London, London, UK
| | - Katherine Ripullone
- obstetrics and gynaecology, Oxford University, Oxford, UK, and honorary research associate, The George Institute for Global Health, Imperial College London, London, UK
| | - Jane Elizabeth Hirst
- Oxford University, Oxford, UK, and honorary senior research fellow, The George Institute for Global Health, Imperial College London, London, UK
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Thompson KJ, Hirst JE. Prophylactic antibiotics after operative vaginal delivery. Lancet 2020; 395:187-188. [PMID: 31954458 DOI: 10.1016/s0140-6736(19)32471-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Kelly Jane Thompson
- Critical Care and Trauma Division, George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia.
| | - Jane Elizabeth Hirst
- George Institute for Global Health, Oxford, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
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Paltiel O, Lemeshow S, Phillips GS, Tikellis G, Linet MS, Ponsonby AL, Magnus P, Håberg SE, Olsen SF, Granström C, Klebanoff M, Golding J, Herceg Z, Ghantous A, Hirst JE, Borkhardt A, Ward MH, Holst Søegaard S, Dwyer T. The association between birth order and childhood leukemia may be modified by paternal age and birth weight. Pooled results from the International Childhood Cancer Cohort Consortium (I4C). Int J Cancer 2019; 144:26-33. [PMID: 30098208 DOI: 10.1002/ijc.31635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 04/12/2018] [Accepted: 04/27/2018] [Indexed: 01/14/2023]
Abstract
The "delayed infection hypothesis" states that a paucity of infections in early childhood may lead to higher risks of childhood leukemia (CL), especially acute lymphoblastic leukemia (ALL). Using prospectively collected data from six population-based birth cohorts we studied the association between birth order (a proxy for pathogen exposure) and CL. We explored whether other birth or parental characteristics modify this association. With 2.2 × 106 person-years of follow-up, 185 CL and 136 ALL cases were ascertained. In Cox proportional hazards models, increasing birth order (continuous) was inversely associated with CL and ALL; hazard ratios (HR) = 0.88, 95% confidence interval (CI): (0.77-0.99) and 0.85: (0.73-0.99), respectively. Being later-born was associated with similarly reduced hazards of CL and ALL compared to being first-born; HRs = 0.78: 95% CI: 0.58-1.05 and 0.73: 0.52-1.03, respectively. Successive birth orders were associated with decreased CL and ALL risks (P for trend 0.047 and 0.055, respectively). Multivariable adjustment somewhat attenuated the associations. We found statistically significant and borderline interactions between birth weight (p = 0.024) and paternal age (p = 0.067), respectively, in associations between being later-born and CL, with the lowest risk observed for children born at <3 kg with fathers aged 35+ (HR = 0.18, 95% CI: 0.06-0.50). Our study strengthens the theory that increasing birth order confers protection against CL and ALL risks, but suggests that this association may be modified among subsets of children with different characteristics, notably advanced paternal age and lower birth weight. It is unclear whether these findings can be explained solely by infectious exposures.
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Affiliation(s)
- Ora Paltiel
- Braun School of Public Health and Community Medicine and Department of Hematology, Hadassah-Hebrew University, Jerusalem, Israel
| | - Stanley Lemeshow
- College of Public Health, The Ohio State University, Columbus, OH
| | - Gary S Phillips
- Statistical consultant, Department of Biomedical Informatics, The Ohio State University, Center for Biostatistics, Retired
| | - Gabriella Tikellis
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Royal Childrens Hospital, University of Melbourne, Melbourne, Australia
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sjurdur F Olsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Charlotta Granström
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Mark Klebanoff
- The Research Institute at Nationwide Children's Hospital, Departments of Pediatrics, Obstetrics and Gynecology, and Epidemiology, The Ohio State University, Columbus, OH
| | - Jean Golding
- Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom
| | - Zdenko Herceg
- Epigenetics Group, International Agency for Research on Cancer, Lyon, France
| | - Akram Ghantous
- Epigenetics Group, International Agency for Research on Cancer, Lyon, France
| | - Jane Elizabeth Hirst
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, Oxford, United Kingdom
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Mary H Ward
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Signe Holst Søegaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Terence Dwyer
- The George Institute for Global Health, Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
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11
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Mackillop L, Hirst JE, Bartlett KJ, Birks JS, Clifton L, Farmer AJ, Gibson O, Kenworthy Y, Levy JC, Loerup L, Rivero-Arias O, Ming WK, Velardo C, Tarassenko L. Comparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e71. [PMID: 29559428 PMCID: PMC5883074 DOI: 10.2196/mhealth.9512] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/31/2018] [Accepted: 02/17/2018] [Indexed: 12/15/2022] Open
Abstract
Background Treatment of hyperglycemia in women with gestational diabetes mellitus (GDM) is associated with improved maternal and neonatal outcomes and requires intensive clinical input. This is currently achieved by hospital clinic attendance every 2 to 4 weeks with limited opportunity for intervention between these visits. Objective We conducted a randomized controlled trial to determine whether the use of a mobile phone-based real-time blood glucose management system to manage women with GDM remotely was as effective in controlling blood glucose as standard care through clinic attendance. Methods Women with an abnormal oral glucose tolerance test before 34 completed weeks of gestation were individually randomized to a mobile phone-based blood glucose management solution (GDm-health, the intervention) or routine clinic care. The primary outcome was change in mean blood glucose in each group from recruitment to delivery, calculated with adjustments made for number of blood glucose measurements, proportion of preprandial and postprandial readings, baseline characteristics, and length of time in the study. Results A total of 203 women were randomized. Blood glucose data were available for 98 intervention and 85 control women. There was no significant difference in rate of change of blood glucose (–0.16 mmol/L in the intervention and –0.14 mmol/L in the control group per 28 days, P=.78). Women using the intervention had higher satisfaction with care (P=.049). Preterm birth was less common in the intervention group (5/101, 5.0% vs 13/102, 12.7%; OR 0.36, 95% CI 0.12-1.01). There were fewer cesarean deliveries compared with vaginal deliveries in the intervention group (27/101, 26.7% vs 47/102, 46.1%, P=.005). Other glycemic, maternal, and neonatal outcomes were similar in both groups. The median time from recruitment to delivery was similar (intervention: 54 days; control: 49 days; P=.23). However, there were significantly more blood glucose readings in the intervention group (mean 3.80 [SD 1.80] and mean 2.63 [SD 1.71] readings per day in the intervention and control groups, respectively; P<.001). There was no significant difference in direct health care costs between the two groups, with a mean cost difference of the intervention group compared to control of –£1044 (95% CI –£2186 to £99). There were no unexpected adverse outcomes. Conclusions Remote blood glucocse monitoring in women with GDM is safe. We demonstrated superior data capture using GDm-health. Although glycemic control and maternal and neonatal outcomes were similar, women preferred this model of care. Further studies are required to explore whether digital health solutions can promote desired self-management lifestyle behaviors and dietetic adherence, and influence maternal and neonatal outcomes. Digital blood glucose monitoring may provide a scalable, practical method to address the growing burden of GDM around the world. Trial Registration ClinicalTrials.gov NCT01916694; https://clinicaltrials.gov/ct2/show/NCT01916694 (Archived by WebCite at http://www.webcitation.org/6y3lh2BOQ)
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Affiliation(s)
- Lucy Mackillop
- Oxford University Hospitals NHS Foundation Trust, Headington, United Kingdom.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Jane Elizabeth Hirst
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Katy Jane Bartlett
- Oxford University Hospitals NHS Foundation Trust, Headington, United Kingdom
| | | | - Lei Clifton
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Oliver Gibson
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Yvonne Kenworthy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Jonathan Cummings Levy
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Lise Loerup
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, University Of Oxford, Oxford, United Kingdom
| | - Wai-Kit Ming
- Department of Obstetrics and Gynaecology, Sun Yat-Sen University, Guangzhou, China
| | - Carmelo Velardo
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
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12
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Hirst JE, Villar J, Victora CG, Papageorghiou AT, Finkton D, Barros FC, Gravett MG, Giuliani F, Purwar M, Frederick IO, Pang R, Cheikh Ismail L, Lambert A, Stones W, Jaffer YA, Altman DG, Noble JA, Ohuma EO, Kennedy SH, Bhutta ZA. The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH-21 st Project. BJOG 2016; 125:1145-1153. [PMID: 28029221 PMCID: PMC6055673 DOI: 10.1111/1471-0528.14463] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify risk factors for antepartum stillbirth, including fetal growth restriction, among women with well-dated pregnancies and access to antenatal care. DESIGN Population-based, prospective, observational study. SETTING Eight international urban populations. POPULATION Pregnant women and their babies enrolled in the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. METHODS Cox proportional hazard models were used to compare risks among antepartum stillborn and liveborn babies. MAIN OUTCOME MEASURES Antepartum stillbirth was defined as any fetal death after 16 weeks' gestation before the onset of labour. RESULTS Of 60 121 babies, 553 were stillborn (9.2 per 1000 births), of which 445 were antepartum deaths (7.4 per 1000 births). After adjustment for site, risk factors were low socio-economic status, hazard ratio (HR): 1.6 (95% CI, 1.2-2.1); single marital status, HR 2.0 (95% CI, 1.4-2.8); age ≥40 years, HR 2.2 (95% CI, 1.4-3.7); essential hypertension, HR 4.0 (95% CI, 2.7-5.9); HIV/AIDS, HR 4.3 (95% CI, 2.0-9.1); pre-eclampsia, HR 1.6 (95% CI, 1.1-3.8); multiple pregnancy, HR 3.3 (95% CI, 2.0-5.6); and antepartum haemorrhage, HR 3.3 (95% CI, 2.5-4.5). Birth weight <3rd centile was associated with antepartum stillbirth [HR, 4.6 (95% CI, 3.4-6.2)]. The greatest risk was seen in babies not suspected to have been growth restricted antenatally, with an HR of 5.0 (95% CI, 3.6-7.0). The population-attributable risk of antepartum death associated with small-for-gestational-age neonates diagnosed at birth was 11%. CONCLUSIONS Antepartum stillbirth is a complex syndrome associated with several risk factors. Although small babies are at higher risk, current growth restriction detection strategies only modestly reduced the rate of stillbirth. TWEETABLE ABSTRACT International stillbirth study finds individual risks poor predictors of death but combinations promising.
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Affiliation(s)
- J E Hirst
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - J Villar
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - C G Victora
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - A T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - D Finkton
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - F C Barros
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.,Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, RS, Brazil
| | - M G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Seattle, WA, USA
| | - F Giuliani
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, Torino, Italy
| | - M Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - I O Frederick
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA
| | - R Pang
- School of Public Health, Peking University, Beijing, China
| | - L Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - A Lambert
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - W Stones
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Y A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Oman
| | - D G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J A Noble
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - E O Ohuma
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - S H Kennedy
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Z A Bhutta
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.,Center for Global Health for Sick Children, Toronto, ON, Canada
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13
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Hirst JE, Loerup L, Mackillop L, Farmer A, Kenworthy Y, Bartlett K, Velardo C, Kevat DA, Tarassenko L, Levy JC. Digital blood glucose monitoring could provide new objective assessments of blood glucose control in women with gestational diabetes. Diabet Med 2016; 33:1598-1599. [PMID: 26606543 DOI: 10.1111/dme.13035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- J E Hirst
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - L Loerup
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - L Mackillop
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
- Oxford University Hospitals, NHS Trust, Oxford, UK
| | - A Farmer
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Y Kenworthy
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - K Bartlett
- Oxford University Hospitals, NHS Trust, Oxford, UK
| | - C Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - D A Kevat
- Oxford University Hospitals, NHS Trust, Oxford, UK
| | - L Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - J C Levy
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals, NHS Trust, Oxford, UK
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15
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Abstract
BACKGROUND The benefits of breastfeeding to both maternal and infant health are vast and widely known. The aim of this study was to elicit the rates of exclusive breastfeeding, early initiation of breastfeeding, and colostrum feeding and to determine the attitudes, knowledge, and influences around breastfeeding in postpartum Vietnamese women. MATERIALS AND METHODS A cross-sectional study was conducted at the Hung Vuong Hospital in Ho Chi Minh City, Viet Nam, between December 2010 and January 2011. Postpartum women were randomly selected and interviewed within 48 hours of delivery. RESULTS Of the 223 women interviewed, 86% had initiated breastfeeding at the time of the interview. Modes of feeding included exclusive breastfeeding (7%), mixed feeding (79%), which included breastmilk and formula or water, and exclusive formula feeding (14%). Of the breastfeeding women, 14% had initiated breastfeeding within 60 minutes of delivery, 92% had initiated within 24 hours, and 8% had initiated after 24 hours of delivery. Of women who had initiated breastfeeding, 37% had discarded their colostrum. Factors that positively influenced breastfeeding were knowledge that breastfeeding is good for the infant, advice obtained from "public information," and the influence of health professionals and family on the decision to breastfeed. Factors that influenced the decision not to initiate breastfeeding included pain or fever after cesarean section and perceived lack of breastmilk after delivery. CONCLUSIONS The rate of exclusive breastfeeding at Hung Vuong Hospital in this study was lower than the national average of 17%. Specific interventions targeting this must be formulated to increase these rates.
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Affiliation(s)
- Shamini Ramoo
- 1 The Village Medical Practice, Royal Prince Alfred Hospital , Liverpool Hospital, Sydney, New South Wales, Australia
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16
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Abstract
Laboratory rabbits kept in barren 'traditional' cages tend to develop stereotypic behaviours and bone deformities. We have used an alternative regime, housing adult does as groups of four or five in floor pens (2.5-3 m2) supplied with hiding places and bedding. High- and low-ranking members of each group were identified, and their immunological status compared in terms of blood leucocyte function (chemiluminescence and mitogen tests), complement activity, and antibody production to soluble and cellular antigens. We found no evidence of immunosuppression, either in groups of a 'docile' breed (New Zealand White) or Dutch crosses. These results, together with the animals' general health and ease of handling, lead us to conclude that group-housed does are suitable for raising antisera and other purposes, provided that they are adequately monitored.
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Affiliation(s)
- R J Turner
- Institute of Biological Sciences, University of Wales, Aberystwyth, UK.
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