Near miss experiences of transport and recreational cyclists in New South Wales, Australia. Findings from a prospective cohort study

ObjectiveTo determine whether the association between highest educational attainment and stroke differed by sex and age; and whether potential mediators of observed associations differ by sex.DesignProspective cohort study.SettingPopulation based, New South Wales, Australia.Participants253 657 stroke-free participants from the New South Wales 45 and Up Study.Outcome measuresFirst-ever stroke events, identified through linkage to hospital and mortality records.ResultsDuring mean follow-up of 4.7 years, 2031 and 1528 strokes occurred among men and women, respectively. Age-standardised stroke rate was inversely associated with education level, with the absolute risk difference between the lowest and highest education group greater among women than men. In relative terms, stroke risk was slightly more pronounced in women than men when comparing low versus high education (age-adjusted HRs: 1.41, 95% CI 1.16 to 1.71 and 1.25, 95% CI 1.07 to 1.46, respectively), but there was no clear evidence of statistical interaction. This association persisted into older age, but attenuated. Much of the increased stroke risk was explained by modifiable lifestyle factors, in both men and women.ConclusionLow education is associated with increased stroke risk in men and women, and may be marginally steeper in women than men. This disadvantage attenuates but persists into older age, particularly for women. Modifiable risk factors account for much of the excess risk from low education level. Public health policy and governmental decision-making should reflect the importance of education, for both men and women, for positive health throughout the life course.

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Evaluating Midwifery Units (EMU): a prospective cohort study of freestanding midwifery units in New South Wales, Australia

BMJ Open ◽

10.1136/bmjopen-2014-006252 ◽

2014 ◽

Vol 4 (10) ◽

pp. e006252 ◽

Cited By ~ 25

Author(s):

Amy Monk ◽

Mark Tracy ◽

Maralyn Foureur ◽

Celia Grigg ◽

Sally Tracy

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Neonatal Intensive Care ◽

New South ◽

Tertiary Level ◽

South Wales ◽

Secondary Outcomes ◽

Freestanding Midwifery Unit

ObjectiveTo compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in two freestanding midwifery units and two tertiary-level maternity units in New South Wales, Australia.DesignProspective cohort study.Participants494 women who intended to give birth at freestanding midwifery units and 3157 women who intended to give birth at tertiary-level maternity units. Participants had low risk, singleton pregnancies and were at less than 28+0 weeks gestation at the time of booking.Primary and secondary outcome measuresPrimary outcomes were mode of birth, Apgar score of less than 7 at 5 min and admission to the neonatal intensive care unit or special care nursery. Secondary outcomes were onset of labour, analgesia, blood loss, management of third stage of labour, perineal trauma, transfer, neonatal resuscitation, breastfeeding, gestational age at birth, birth weight, severe morbidity and mortality.ResultsWomen who planned to give birth at a freestanding midwifery unit were significantly more likely to have a spontaneous vaginal birth (AOR 1.57; 95% CI 1.20 to 2.06) and significantly less likely to have a caesarean section (AOR 0.65; 95% CI 0.48 to 0.88). There was no significant difference in the AOR of 5 min Apgar scores, however, babies from the freestanding midwifery unit group were significantly less likely to be admitted to neonatal intensive care or special care nursery (AOR 0.60; 95% CI 0.39 to 0.91). Analysis of secondary outcomes indicated that planning to give birth in a freestanding midwifery unit was associated with similar or reduced odds of intrapartum interventions and similar or improved odds of indicators of neonatal well-being.ConclusionsThe results of this study support the provision of care in freestanding midwifery units as an alternative to tertiary-level maternity units for women with low risk pregnancies at the time of booking.

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