Outcome of patients with acute coronary syndrome in hospitals of different sizes. A report from the AMIS Plus Registry.

To assess the impact of admission to different hospital types on early and 1-year outcomes in patients with acute coronary syndrome (ACS). Between 1997 and 2009, 31 010 ACS patients from 76 Swiss hospitals were enrolled in the AMIS Plus registry. Large tertiary institutions with continuous (24 hour/7 day) cardiac catheterisation facilities were classified as type A hospitals, and all others as type B. For 1-year outcomes, a subgroup of patients admitted after 2005 were studied. Eleven type A hospitals admitted 15987 (52%) patients and 65 type B hospitals 15023 (48%) patients. Patients admitted into B hospitals were older, more frequently female, diabetic, hypertensive, had more severe comorbidities and more frequent non-ST segment elevation (NSTE)-ACS/unstable angina (UA). STE-ACS patients admitted into B hospitals received more thrombolysis, but less percutaneous coronary intervention (PCI). Crude in-hospital mortality and major adverse cardiac events (MACE) were higher in patients from B hospitals. Crude 1-year mortality of 3747 ACS patients followed up was higher in patients admitted into B hospitals, but no differences were found for MACE. After adjustment for age, risk factors, type of ACS and comorbidities, hospital type was not an independent predictor of in-hospital mortality, in-hospital MACE, 1-year MACE or mortality. Admission indicated a crude outcome in favour of hospitalisation during duty-hours while 1-year outcome could not document a significant effect. ACS patients admitted to smaller regional Swiss hospitals were older, had more severe comorbidities, more NSTE-ACS and received less intensive treatment compared with the patients initially admitted to large tertiary institutions. However, hospital type was not an independent predictor of early and mid-term outcomes in these patients. Furthermore, our data suggest that Swiss hospitals have been functioning as an efficient network for the past 12 years.

Pregnancy outcome following maternal exposure to Mirtazapine: Preliminary results of a collaborative ENTIS study.

Introduction: Mirtazapine is a noradrenergic and serotonergic antidepressant mainly acting through blockade of presynaptic alpha-2 receptors. Published data on pregnancy outcome after exposure to mirtazapine are scarce. This study addresses the risk associated with exposure to mirtazapine during pregnancy. Patients (or Materials) and Methods: Multicenter (n = 11), observational prospective cohort study comparing pregnancy outcomes after exposure to mirtazapine with 2 matched control groups: exposure to any selective serotonin reuptake inhibitor (SSRI) as a diseasematched control group, and general controls with no exposure to medication known to be teratogenic or to any antidepressant. Data were collected by members of the European Network of Teratology Information Services (ENTIS) during individual risk counseling between 1995 and 2011. Standardized procedures for data collection were used in each center. Results: A total of 357 pregnant women exposed to mirtazapine at any time during pregnancy were included in the study and compared with 357 pregnancies from each control group. The rate of major birth defects between the mirtazapine and the SSRI group did not differ significantly (4.5% vs 4.2%; unadjusted odds ratio, 1.1; 95% confidence interval, 0.5-2.3, P = 0.9). A trend toward a higher rate of birth defects in the mirtazapine group compared with general controls did not reach statistical significance (4.2% vs 1.9%; OR, 2.4; 95% CI, 0.9-6.3; P = 0.08). The crude rate of spontaneous abortions did not differ significantly between the mirtazapine, the SSRI, and the general control groups (9.5% vs 10.4% vs 8.4%; P = 0.67), neither did the rate of deliveries resulting in live births (79.6% vs 84.3% in both control groups; P = 0.15). However, a higher rate of elective pregnancy-termination was observed in the mirtazapine group compared with SSRI and general controls (7.8% vs 3.4% vs 5.6%; P = 0.03). Premature birth (< 37 weeks) (10.6% vs 10.1% vs 7.5%; P = 0.38), gestational age at birth (median, 39 weeks; interquartile range (IQR), 38-40 in all groups; P = 0.29), and birth weight (median, 3320 g; IQR, 2979-3636 vs 3230 g; IQR, 2910-3629 vs 3338 g; IQR, 2967-3650; P = 0.34) did not differ significantly between the groups. Conclusion: This study did not observe a statistically significant difference in the rate of major birth defects between mirtazapine, SSRI-exposed, and nonexposed pregnancies. A slightly higher rate of birth defects was, however, observed in the mirtazapine and SSRI groups compared with the low rate of birth defects in our general controls. Overall, the pregnancy outcome after mirtazapine exposure in this study is very similar to that of the SSRI-exposed control group.

Ten years of lung transplantation in Switzerland: results of the Swiss Lung Transplant Registry.

Lung transplantation has evolved from an experimental procedure to a viable therapeutic option in many countries. In Switzerland, the first lung transplant was performed in November 1992, more than ten years after the first successful procedure world-wide. Thenceforward, a prospective national lung transplant registry was established, principally to enable quality control. The data of all patients transplanted in the two Swiss Lung Transplant centres Zurich University Hospital and Centre de Romandie (Geneva-Lausanne) were analysed. In 10 years 242 lung transplants have been performed. Underlying lung diseases were cystic fibrosis including bronchiectasis (32%), emphysema (32%), parenchymal disorders (19%), pulmonary hypertension (11%) and lymphangioleiomyomatosis (3%). There were only 3% redo procedures. The 1, 5 and 9 year survival rates were 77% (95% CI 72-82), 64% (95% CI 57-71) and 56% (95% CI 45-67), respectively. The 5 year survival rate of patients transplanted since 1998 was 72% (95% CI 64-80). Multivariate Cox regression analysis revealed that survival was significantly better in this group compared to those transplanted before 1998 (HR 0.44, 0.26-0.75). Patients aged 60 years and older (HR 5.67, 95% CI 2.50-12.89) and those with pulmonary hypertension (HR 2.01, 95% CI 1.10-3.65) had a significantly worse prognosis The most frequent causes of death were infections (29%), bronchiolitis obliterans syndrome (25%) and multiple organ failure (14%). The 10-year Swiss experience of lung transplantation compares favourably with the international data. The best results are obtained in cystic fibrosis, pulmonary emphysema and parenchymal disorders.

Health (Miscellaneous Provision) Bill 2009

AN ACT TO PROVIDE FOR THE DISSOLUTION OF THE NATIONAL COUNCIL ON AGEING AND OLDER PEOPLE, THE WOMEN’S HEALTH COUNCIL, THE NATIONAL CANCER SCREENING SERVICE BOARD, THE DRUG TREATMENT CENTRE BOARD AND THE CRISIS PREGNANCY AGENCY, TO PROVIDE FOR THE EXERCISE OF CERTAIN FUNCTIONS RELATING TO SUPERANNUATION BY THE MINISTER FOR HEALTH AND CHILDREN, TO PROVIDE FOR THE AMENDMENT OF THE HEPATITIS C COMPENSATION TRIBUNAL ACT 1997, THE HEALTH ACT 2007 AND THE NATIONAL CANCER REGISTRY BOARD (ESTABLISHMENT) ORDER 1991 AND TO PROVIDE FOR RELATED MATTERS.   Click here to download PDF 410kb Explanatory Document PDF 325kb Regulatory Impact Analysis PDF 31kb

Protection of Life During Pregnancy Bill

An Act to protect human life during pregnancy; to make provision for reviews at the instigation of a pregnant woman of certain medical opinions given in respect of pregnancy; to provide for an offence of intentional destruction of unborn human life; to amend the Health Act 2007; to repeal sections 58 and 59 of the Offences Against the Person Act 1861; and to provide for matters connected therewith. Click here to download PDF 296KB

Preliminary draft of regulations to be made under the Protection of Life During Pregnancy Bill, 2013

Preliminary draft of regulations to be made under the Protection of Life During Pregnancy Bill, 2013 Preliminary draft of Regulations to be made under the Protection of Life During Pregnancy Bill, 2013. It is the intention to bring these Regulations into effect when the Bill is enacted. The Regulations are as follows: Click here to download The Protection of Life During Pregnancy Act 2013 (Certification Regulations) PDF 466KB Click here to download The Protection of Life During Pregnancy Act 2013 (Application for Review of Medical Opinion) PDF 219KB Click here to download The Protection of Life During Pregnancy Act 2013 (Notifications) PDF 180KB

The pregnancy book

This book provides information on many aspects of pregnancy and a list of useful organisations. It is available to first time expectant mothers through primary care services (antenatal clinics, GPs or health visitors).

Malaria during pregnancy in a reference centre from the Brazilian Amazon: unexpected increase in the frequency of Plasmodium falciparum infections

Malaria remains globally the most important parasitic disease of man. Data on its deleterious effects during pregnancy have been extensively documented in hyperendemic, holoendemic, and mesoendemic areas from Africa and Asia where Plasmodium falciparum is responsible for almost all infections. However, knowledge about malaria during pregnancy in areas where transmission is unstable and P. vivax is the most prevalent species, such as the Brazilian Amazon, is scarce. Here, we report a preliminary cross sectional descriptive study, carried out at the Fundação de Medicina Tropical do Amazonas, a reference centre for diagnosis and treatment of tropical diseases in the west-Amazon (Manaus, Brazil). A total of 1699 febrile childbearing age women had positive thick blood smears to Plasmodium species, between January and November 1997: 1401 (82.5%) were positive for P. vivax , 286 (16.8%) for P. falciparum and 12 (0.07%) carried mixed infections. From the malarious patients, 195 were pregnant. The ratio of P. falciparum to P. vivax infections in the group of non-pregnant infected women was 1:5.6 while it was 1:2.3 in that of pregnant infected ones. Similar rates or even proportionally more vivax infections during pregnancy were expected to occur, in function of the contraindication of primaquine with the resulting increased P. vivax relapse rates. Such an observation suggests that the mechanism of resistance/susceptibility to infection and/or malaria pathogenesis in pregnant women may differ according to Plasmodium species and that the extensively described increase in the frequencies of malaria infection during pregnancy may be specifically due to P. falciparum infection.

Watching your Weight in Pregnancy

Pregnant women in the Southern Health and Social Care Trust area are learning how to manage their weight as a result of a project being funded by the Public Health Agency.The 'Watching your Weight in Pregnancy' project, being delivered by the Southern Health and Social Care Trust, got underway in December 2011 to address the rising levels of obesity across the southern area. It also aims to reduce the impact that obesity can have on the health of women and their unborn children during pregnancy and birth.Two pilot programmes are currently underway in the Kilkeel area teaching both antenatal and post natal women that feeling good about yourself and your baby is important during pregnancy.The programmes provide information about managing weight during and after pregnancy and include advice on good nutrition along with opportunities to take part in appropriate physical activities. As part of the project, there have also been training sessions for midwives in the Southern HSC Trust on healthier eating and physical activity during pregnancy.Patricia McStay, Southern Trust Head of Midwifery, explained why there was a need for this project: "Every woman wants a healthy baby and we are supporting the women to improve their own health and wellbeing. We have been seeing increasing numbers of women who are overweight or obese at their first contact with the midwife. We want to support these women to manage their weight gain in pregnancy to reduce the risk of experiencing health complications such as high blood pressure, and diabetes in pregnancy."Angela McComb, Health and Social Wellbeing Improvement Manager, for the PHA, said: "The southern office of the PHA recognised the many risks associated with obesity in pregnancy, both to the mother and her baby, and allocated funding for this pilot project to test out ways in which these health risks can be reduced. "We look forward to seeing the results of the evaluation which will inform the further development of effective approaches to support pregnant women to manage their weight both locally and across Northern Ireland."

Listeria and pregnancy

Listeria is a bug that can cause an illness like the flu. It can be dangerous for a number of groups including pregnant women, unborn babies and new babies.

A Seroprevalence Study of HIV among Childbearing Women and Women having Termination of Pregnancy, and a Discussion of HIV Testing Programmes for Pregnant Women including their Merits and Demerits

Ninety-one percent of antenatal clinic attenders and 97% of women having a termination of pregnancy agreed to HIV testing on a named or anonymous basis. HIV period prevalence's for Antenatal clinic attenders, and women having termination of pregnancy tested in Dundee were 0.13% and 0.85% respectively and for antenatal clinic attenders in Edinburgh, 0.26%. For those at "low risk", rates for antenatal clinic attenders and women having termination of pregnancy in Dundee were 0.11% and 0.13%, and for antenatal clinic attenders in Edinburgh, 0.02%. In dundee HIV prevalence among women having a termination of pregnancy (0.85%) was significantly greater (p< 0.001) than that among antenatal clinic attenders (0.13%). The investigation's findings show that HIV undoubtedly is occurring among women at "low risk" and it is clear that a policy of selective voluntary testing of those at "high risk" only, is inadequate for pregnant women living in areas of high prevalence such as Edinburgh and Dundee. Moreover, when studying pregnant populations in such areas there is a need to include those having a termination of pregnancy.This resource was contributed by The National Documentation Centre on Drug Use.

HSE Crisis Pregnancy Programme annual report 2010.

January 2010 saw the former Crisis Pregnancy Agencyâ?Ts integration into the Health Service Executive to become the HSE Crisis Pregnancy Programme. For most of 2010, the Programme was located in Children and Family Social Services Care Group in the Integrated Services Directorate and reported to Assistant National Director for Children and Family Social Services. The Programme commenced the process of forging links and relationships within the wider HSE and with services which support and add value to the work of the Programme. The Programme also made efforts to identify areas where it could share its expertise in the areas of crisis pregnancy and sexual health. In the latter part of 2010, the Programme was moved to Public Health with the aim of improving the alignment of the Programme to achieve better integration and create more opportunity to synchronise approaches with other related parts of the health service and to work more effectively at long term integration and planning 2012 - 2016.This resource was contributed by The National Documentation Centre on Drug Use.