Unlabelled This guideline covers assessing for, and managing, blood transfusions in adults, young people and children aged 1 year and over. It covers the general principles of blood transfusion, but does not make recommendations relating to specific conditions. This guideline does not cover blood transfusions, or use of tranexamic acid for surgery, during pregnancy and labour. For more information on what the guideline does and does not cover, see the section on inclusions and exclusions. Some people have religious beliefs that do not allow the transfusion of blood. Specific issues relating to these people have been addressed when reviewing the evidence and writing the recommendations. For guidance on blood transfusions and anticoagulant reversal for people with acute upper gastrointestinal bleeding, see the section on resuscitation and initial management in NICE's guideline on acute upper gastrointestinal bleeding in over 16s. Who is it for? Healthcare professionals who assess for and manage blood transfusions and their alternatives. Commissioners and providers of transfusion services. People aged 1 year and over who may need a blood transfusion, their families and carers.
Background Preterm birth leads to adverse neonatal outcomes. Data on neonatal outcomes in middle-income settings like Vietnam are lacking. Aims Describe preterm neonatal outcomes in Vietnam. Materials and methods Retrospective cohort study including all live singleton births at 28-36 weeks' gestation in Vietnam from June 2019 to June 2020. Outcomes included neonatal morbidity and mortality and were examined by labour onset and gestational age groups. Logistic regression was used to estimate the odds of neonatal morbidity and mortality following planned birth (labour induction and prelabour caesarean) relative to spontaneous birth. Results Among 5374 live singleton preterm births, 663 (12.4%) occurred between 28 and 31 weeks, 824 (15.3%) between 32 and 33 weeks and 3887 (72.3%) between 34 and 36 weeks; 2765 (51.5%) births followed spontaneous labour and 2616 (48.5%) were planned births. Mortality rates decreased with increasing gestational age. More than 90% of neonates born at 28-33 weeks had morbidity, with the rate of morbidity decreasing from 34 weeks. The odds of mortality were no different following labour induction (aOR 1.22, 95% CI, 0.72-2.09) or prelabour caesarean (aOR 1.04, 95% CI, 0.63-1.73) compared with spontaneous labour. The odds of morbidity were higher among pregnancies following labour induction (aOR 1.53, 95% CI, 1.31-1.80) and prelabour caesarean section (aOR 2.14, 95% CI, 1.84-2.50) than spontaneous labour. Among planned preterm births < 35 weeks, antenatal corticosteroids were associated with higher morbidity (90.7% vs. 74.3%, p < 0.001) and lower mortality rates (2.5% vs. 5.1%, p = 0.022). Conclusions Preterm neonates born before 34 weeks are at particularly high likelihood of morbidity and mortality, with planned preterm birth associated with a higher rate of morbidity.
While everyone, parents and non-parents alike, benefit from children, parents alone incur the cost of bearing and raising them. Johan Bester argues that, since society tasks parents with the labourious and financially burdensome task of raising children, and children are a social good, society has an obligation to help ease the burden of parenting by offering direct financial compensation to parents. While I agree that society should do much more to support parents, I am not convinced that the support should include direct financial payment to parents. After setting out Bester's arguments for this position and distinguishing it from a similar argument in political science, I offer a series of concerns: parenting is unlike socially beneficial employment-type work; Bester's argument may extend in problematic directions; financial incentives may harm the parent-child relationship; and there are other ways to promote parenting. Despite being critical, the purpose of this paper is to invite further discussion among bioethicists on how society can support parents in the important task of parenting.
Self-rated health (SRH) is a validated epidemiological measure that captures an individual's overall health perception and predicts morbidity and mortality. Despite extensive research on SRH among older adults in India, evidence on its transition across the life course remains limited. Using data from 70,595 individuals aged 45 years and above from the Longitudinal Aging Study in India (LASI) 2017-2018, this study examined transitions in SRH from childhood to older adulthood. An adverse SRH trajectory was defined as a shift from good childhood health to poor or fair health in later life. Descriptive, bivariate, and multivariable logistic regression analyses were conducted. Overall, 51% of older adults experienced an adverse SRH trajectory. Higher odds were observed among women (AOR: 1.30), individuals with substance consumption (AOR:1.24), chronic multimorbidity (AOR: 3.37), functional limitations (AOR: 2.03), and depression (AOR: 1.51). Early-life disadvantages - child labour, child marriage, and persistent household poverty - were also significant risk factors. In contrast, higher education and participation in social and physical activities were protective. These findings indicate that an adverse subjective health trajectory is shaped by cumulative life-course exposures rather than ageing alone. Strengthening early-life social investments and community-based wellness initiatives is vital to promote healthy and equitable ageing in India.
Background Patterns of health and disease in Qatar have shifted substantially over the past three decades, reflecting demographic expansion, economic transition, and significant improvements in health system capacity. A comprehensive, up-to-date evaluation of disease burden is essential to guide priority-setting, resource allocation, and national health planning. However, no prior study has systematically assessed long-term trends in morbidity, mortality, and risk factors in Qatar using the most recent epidemiological data consistent with the Global Burden of Disease (GBD) Study framework. This study addresses this gap by providing a detailed analysis of population health outcomes in Qatar from 1990 to 2023. Methods We conducted a secondary analysis of publicly available Global Burden of Disease (GBD) 2023 modelled estimates of mortality, prevalence, incidence, disability-adjusted life-years (DALYs), years of life lost (YLLs), and risk factor-attributable disease burden in Qatar. Data sources included vital registration records, hospital and registry datasets, survey data, and modelled estimates, as appropriate. Changes were examined across three major cause categories: non-communicable diseases (NCDs), communicable, maternal, neonatal, and nutritional (CMNN) diseases, and injuries-over four analytic periods (1990-2000, 2000-2015, 2015-2023, and 1990-2023). Uncertainty intervals (UIs) were derived from 250 posterior draws. The study followed GBD guidelines for reporting and estimation transparency. Findings Qatar has achieved substantial progress in reducing the burden of CMNN diseases since 1990, driven by expanded immunisation coverage, improved maternal and neonatal care, and strengthened primary health services. However, the burden of NCDs has risen markedly and now accounts for the majority of mortality and DALYs. The leading contributors to NCD burden in 2023 were ischaemic heart disease, diabetes mellitus, cancer, chronic kidney disease, and neurological disorders. High body-mass index, high fasting plasma glucose, hypertension, dietary risks, and tobacco use were the predominant metabolic and behavioural risk factors. Road traffic injuries remained a leading cause of premature mortality, particularly among young men, reflecting Qatar's predominantly male working-age expatriate population and high rates of occupational and vehicular mobility. COVID-19 temporarily reversed declines in infectious disease burden during 2020-2021, although trends returned to levels consistent with the 2018 pre-pandemic trajectory by 2023. Interpretation The epidemiological profile of Qatar is characterised by declining infectious disease burden and rising chronic disease and injury burden, shaped by demographic composition and lifestyle transitions. Addressing the growing impact of NCDs and injuries will require sustained preventive strategies, population-level risk factor reduction, strengthened primary care for chronic disease management, and coordinated multisectoral policy responses targeting diet, physical activity, road safety, and occupational health. These findings provide an evidence base to support national health planning and ongoing progress toward equitable and sustainable population health in Qatar. Funding The publication of this study was funded by the Medical Research Center (MRC)at Hamad Medical Corporation (HMC), Doha, Qatar.
Introduction A dominant narrative, referred to as "the standard tale," prevails in popular representations about female genital cutting (FGC) that often contrast with how cut women traditionally narrate their FGC experience as meaningful in contexts where FGC is customary. However, scholarship has increasingly highlighted how global eradication campaigns and migration to countries where FGC is stigmatized provide women with new frames of understanding which may lead to a reformulation of previous experiences. This article subjects the storytelling itself to analysis and explores how participants narrate and make sense of their FGC experience in a post-migration setting where FGC is stigmatized. Methods Semi-structured focus groups (9) and individual interviews (12) with Swedish-Somali girls and women (53) were conducted. Results The article highlights how the participants navigate their storying in relation to "the standard tale" of FGC in their efforts to make sense of their experiences. Navigation was conducted both at an intrapersonal level through continuous identity work, and in relation to the social context in interpersonal encounters, i.e., with service providers and others, among whom the standard tale has become a truth. Discussion The article places the analysis within broader discussions about anti-FGC work and considers the implications in relation to efforts to end FGC.
To achieve Sustainable Development Goal 5 for gender equality by 2030, it is crucial for health and development professionals and governmental officials to understand how legal systems empower or oppress populations on the basis of gender worldwide, including opportunities and challenges of statutory provisions created by legal pluralism. Using Ethiopia as a case study, this paper examines how local laws applied in Sharia and Customary Dispute Resolution courts impact gender equality and the health of women and girls inspite of the inculcation of human rights statutes into national legislation, including the Constitution. We identify several key issues with the substantive law and its enforcement. First, laws which have been instituted at the national level to improve gender equally have been poorly enforced at the local level. Second, there is a sustained enforcement of laws that oppress women and that protect male perpetrators of gender-based violations. Third, local courts limit female representation and uphold patriarchy. To improve the health of women and girls, stakeholders must take into consideration the ways in which legal systems uphold harmful gender norms and obstruct and/or advance progress towards equal representation, opportunities, and constitutionally-mandated protections for all.
Abstract Background:Female genital mutilation comprises all procedures involving the partial or total removal of female external genitalia or other injury to the female external organs, whether for religious, cultural or other non-therapeutic reasons. The impact of female genital mutilation is diverse, including physical, social and psychological impact. We report a case of a 36-year-old woman with type three female genital mutilation who did not seek medical treatment due to lack of awareness that there was no treatment for it, and use this case as an entry point to comprehensively review literature regarding long-term complications associated with female genital mutilation and its impact on women’s quality of life. Case presentation: We present a case of a 36-year-old woman with type three female genital mutilation who had presented with difficulty with urination since childhood. She had difficulty with menstruation since her menarche, and she had never had sexual intercourse. She never sought treatment, but recently went to hospital after she heard of a young lady who had the same problem in her neighborhood who was treated surgically and got married. On external genitalia examination, there was no clitoris, no labia minora, and labia majora were fused to each other with a healed old scar between them. There was a 0.5 cm by 0.5 cm opening below the fused labia majora near to the anus through which urine was dribbling. De-infibulation was done. Four months after the procedure, she was married and at that moment she was pregnant. Conclusion: The physical, sexual, obstetrics and psychosocial consequences of female genital mutilation are neglected issues. The improvement of women’s socio-cultural status in combination with planning programs to enhance their information and awareness as well as trying to change the cultural and religious leaders’ viewpoints regarding this procedure is essential to reducing female genital mutilation and its burden on women’s health. Cognitive behavioral therapy is also recommended to treat psycho-social disorders in both girls and women.
Purpose of review Female genital mutilation/cutting (FGM/C or FGM) are procedures that involve partial or total removal of external female genitalia and other injuries to the female genital organs for non-medical reasons. Over 4 million girls are at risk of FGM annually. Since urogynecologic and obstetric complications of FGM have been extensively described and characterized, the aim of this review is to shift the focus on other aspects like perception of women, awareness of community, and knowledge of health workers. Our purpose is to highlight those aspects and understand how their grasp might help to eradicate this practice. Recent findings Self-perception of women with FGM changes when they emigrate to western countries; awareness of complications and awareness of their rights are factors that make women reject the practice. Women from rural areas, already circumcised, or without a secondary level education are more likely to have a circumcised daughter. Women with at least a secondary education are more likely to agree with the eradication of the practice. Lack of education and poor wealth index are factors associated with men's support of FGM. Although aware of FGM, healthcare professionals need to be trained on this topic. General practitioners play a central role in addressing patients with FGM to the right path of diagnosis and treatment and psychologists in helping them with psychological sequelae. Conclusion These findings point out the future area of intervention, stressing the need of higher standard of care and global effort to eradicate this practice.
A growing body of evidence has shown the effects of poor preconception health on adverse pregnancy outcomes and, subsequently, maternal and child morbidity and mortality. However, the cost of poor preconception health remains relatively unexplored. Using the case of Nigeria, this study provides the first estimate of the disease and economic burden of poor preconception health at a country level. Using data from international databases and the scientific literature, the study used a cost-of-illness approach to quantify the foregone productivity and direct healthcare costs resulting from six preconception risk factors (adolescent pregnancy, short birth interval, overweight and obesity, intimate partner violence, female genital mutilation, folate deficiency). The results indicate that 6.7% of maternal deaths, 10.9% of perinatal deaths, and 10.5% of late neonatal deaths were attributable to the selected preconception risk factors in 2020. The economic burden of poor preconception health in Nigeria was estimated at US$ 3.3 billion in 2020, of which over 90% was generated by premature mortality. If prevalence rates remain constant, total economic losses could amount to US$ 46.2 billion by 2035. This analysis paves the way for further studies investigating the economic costs and benefits of preconception interventions and policies in low and middle-income countries.
