Cost Analysis of the Dutch Obstetric System: low-risk nulliparous women preferring home or short-stay hospital birth - a prospective non-randomised controlled study

Background  

In the Netherlands, pregnant women without medical complications can decide where they want to give birth, at home or in a short-stay hospital setting with a midwife. However, a decrease in the home birth rate during the last decennium may have raised the societal costs of giving birth. The objective of this study is to compare the societal costs of home births with those of births in a short-stay hospital setting.     

Gender and physical activity one year after myocardial revascularization for stable angina

Improvement in physical activity (PA) is an important benefit for patients undergoing CABG. It is suggested that women make less improvement than men. Of 568 patients (466 men and 102 women) undergoing an isolated primary CABG for stable angina (NYHA<4) pre- and 1-year postoperative PA was registered. The Corpus Christi Heart Project criteria are used for assessing PA. The different PA-levels are coded from 1, the worst, to 5, the best. Preoperatively, female patients were older, in a higher NYHA class, and PA level was significantly different and lower 2.30+/-1.01 vs. 2.89+/-1.03 (P=0.000). At follow-up, the mean PA increased significantly for women (2.7+/-1.02) and men (3.2+/-1.06) (P=0.000). Despite this broad increase, 20% of men and 10% of women had a decreased PA. Multiple logistic regression analysis identified a preoperative high PA-level, diabetes, vascular- and pulmonary disease (odds ratio 7.11, 2.6, 2.3, 2.69) as variables that contribute independently to a worse PA for men and only high preoperative PA level (odds ratio 11.0) for women. This study confirms that patients with a preoperative high level PA are unlikely to improve PA, but in men, diabetes, vascular- and pulmonary disease are also independent risk factors.     

The incidence and prevalence of cluster headache: a meta-analysis of population-based studies

Cluster headache is a trigemino-autonomic cephalgia with a low prevalence. Several population-based studies on its prevalence and incidence have been performed, but with different methodology resulting in different figures. We analysed all available population-based epidemiological studies on cluster headache and compared the data in a meta-analysis. The pooled data showed a lifetime prevalence of 124 per 100 000 [confidence interval (CI) 101, 151] and a 1-year prevalence of 53 per 100 000 (CI 26, 95). The overall sex ratio was 4.3 (male to female), it was higher in chronic cluster headache (15.0) compared with episodic cluster headache (3.8). The ratio of episodic vs. chronic cluster headache was 6.0. Our analysis revealed a relatively stable lifetime prevalence, which suggests that about one in 1000 people suffers from cluster headache, the prevalence being independent of the region of the population study. The sex ratio (male to female) is higher than published in several patient-based epidemiological studies.     

Hepatoblastoma in two siblings and familial adenomatous polyposis: causal nexus or coincidence?

Infantile and childhood hepatoblastoma (HB) occurs more frequently in children with hereditary predisposition to familial adenomatous polyposis (FAP) than in the general population. The occurrence of HB in two infant siblings is reported. The sister died of the disease. The brother survived the HB and was later diagnosed with familial adenomatous polyposis and advanced rectal cancer. He was found to carry a germline mutation of the APC gene. Presuming that the HB in the two siblings was the first manifestation of FAP we performed APC mutation analysis in DNA from archived tumour tissue of his sister and in blood samples of both parents. Surprisingly, the mutation was neither found in both parents, nor in the tissue samples of the sister. We outline the impact of this finding for genetic counselling and review the literature on FAP and HB.     

The schistosome intermediate host, Bulinus nyassanus, is a 'preferred' food for the cichlid fish, Trematocranus placodon, at Cape Maclear, Lake Malawi

Over the last decade, transmission of the schistosome parasites of humans has increased in parts of Lake Malawi, possibly because over-fishing has led to a decline in the numbers of molluscivorous fish. The stomach contents of 51 wild-caught Trematocranus placodon from the Cape Maclear area of Lake Malawi have now been investigated and compared with the field abundance of snail species at two sites, close to where the fish were caught. The snails found in the fish stomachs were identified to genus or species on the basis of their shell fragments and/or opercula. The sizes of the prosobranchs consumed by the T. placodon were determined from their operculum sizes whereas the Bulinus nyassanus ingested by the fish were categorized as small (<4 mm) or large (> or =4 mm) on the basis of their shell fragments. The proportion of the Bu. nyassanus ingested that were categorized as large increased with fish size. Furthermore, the relative abundance of Bu. nyassanus in the guts of the fish was considerably higher than in the field, indicating that the T. placodon had a 'preference' for Bu. nyassanus over the Melanoides species that dominated the snail fauna. Small specimens of Bellamya species were also consumed in a greater proportion than found in field.