Migrant parents of children and young people (CYP) living with sickle cell disease (SCD) must manage complex care needs within unfamiliar healthcare systems. Drawing on qualitative interviews with migrant parents in England, this study examines how migration reshapes healthcare navigation. Using navigation as an analytical lens, the findings show that parents act as de facto navigators, coordinating services across healthcare, education and welfare domains without structured support. Beyond practical coordination, navigation involved sustained relational, emotional and identity work. Parents described learning to interpret new institutional rules, (re)negotiating expectations of 'good' parenting in a different national context and managing stigma linked to illness, ethnicity and immigration status. Migration intensified caregiving responsibilities through disrupted support networks, legal and economic constraints and uneven access to resources. Although UK services were valued for specialist expertise, parents reported the need for continual self-advocacy within fragmented systems. The study extends navigation scholarship by foregrounding migrant parents' unpaid and often unrecognised labour and demonstrates how healthcare navigation is shaped by intersecting migration, policy and racialised contexts. The findings highlight the importance of embedding condition-specific navigation support within existing specialist services.
Objectives A population approach focuses on improving the health status of the entire population, depending on the fact that the majority of diseases occur among low-risk individuals rather than high-risk individuals. However, the onset of permanent tooth caries in children with high or low caries risk remains unclear, especially among children of different socioeconomic statuses. This study investigated the distribution of caries occurrence in children across different caries experience and income groups. Methods This cohort study was based on the Adachi Child Health Impact of Living Difficulty (A-CHILD) study, which surveyed all elementary school children in Adachi City, Japan. The explanatory variables were the number of permanent carious teeth and three tertiles of income when children were 7 or 8 years old in 2016. The outcome was an increase in permanent carious teeth when children were 11 or 12 years old, between 2016 and 2020. Negative binomial regression analyses were applied with adjustment for sex. Results Among the participants (n=3,321), the low-income group had 1.44 (95% CI: 1.14; 1.81) times higher risk than the high-income group. Children with two or more carious teeth showed 2.52 (95% CI: 1.57; 4.06) times higher caries risk than caries-free children. However, over 80% of carious teeth occurred among caries-free children in all income groups. Conclusions The majority of new caries cases occurred not merely in high-risk children but in a large number of initially low-risk children, regardless of income level. These findings suggest the importance of a population approach in preventing caries. Clinical significance The majority of new caries lesions occurred in caries-free children across all income statuses. The population approach appears appropriate for preventing the incidence of dental caries among elementary school children.
Rationale Intravenous oxytocin is widely used to induce labour or to augment labour (i.e. enhance contractions to promote progression), with approximately one-quarter of pregnant women at term receiving the medication. While continuous administration of intravenous oxytocin stimulation from induction until birth is recommended by most clinical guidelines, this may increase the risk of uterine hyperstimulation, foetal distress, and adverse maternal and neonatal outcomes. Discontinuation of oxytocin in the active phase of labour could reduce these risks without compromising labour progression. However, evidence from randomised trials is conflicting, and optimal management is unclear. Objectives To assess the effects of the discontinuation of intravenous oxytocin stimulation in pregnant women during the active phase of induced or augmented labour. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science Core Collection, as well as ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. We also screened reference lists of included studies and relevant reviews, and contacted trial authors for additional data. No language or date restrictions were applied. The last search was conducted on 17 November 2025. Eligibility criteria We included randomised controlled trials comparing continuation versus discontinuation (or placebo) of intravenous oxytocin in the active phase of labour (≥ 4 cm cervical dilation) in term singleton pregnant women undergoing labour induction or augmentation. No restrictions to inclusion were applied regarding parity, maternal age, comorbidities, labour setting, or presence or absence of previous caesarean section. Outcomes The critical outcome was caesarean section. Important maternal outcomes included instrumental vaginal birth (vacuum extraction or forceps delivery), postpartum haemorrhage, maternal infection, maternal satisfaction, duration of the active phase of labour, uterine hyperstimulation (tachysystole with abnormal CTG (cardiotocography)), and uterine tachysystole with normal CTG. Important neonatal outcomes included admission to neonatal unit, hypoxic ischaemic encephalopathy or therapeutic hypothermia, neonatal infection, perinatal death, acidotic cord blood gases (arterial pH < 7.10), and Apgar score < 7 at five minutes. Risk of bias Two review authors independently assessed the risk of bias for each trial using Cochrane's risk of bias tool RoB 1, following the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We assessed random sequence generation, allocation concealment, blinding, incomplete outcome data, selective reporting, and other potential sources of bias. We resolved disagreements through discussion or by involving a third review author. We assessed potentially eligible and included trials using the Cochrane Pregnancy and Childbirth Trustworthiness Screening Tool. Synthesis methods For dichotomous outcomes, we calculated risk ratios (RR) with 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) with 95% CIs. For our primary analysis, we used the fixed-effect model, implemented using the Mantel-Haenszel method for dichotomous outcomes and inverse variance for continuous outcomes. We prespecified random-effects meta-analysis as a secondary analysis to explore the robustness of the findings in the presence of between-study heterogeneity. We conducted sensitivity and subgroup analyses for the critical outcome only. We assessed statistical heterogeneity using Tau², I² and Chi² statistics. We evaluated the certainty of evidence using the GRADE approach for the prespecified outcomes included in our summary of findings table. Included studies During the study selection process, we placed 10 studies in the 'awaiting classification' category because we needed additional information to assess eligibility or trial trustworthiness. These studies could potentially change the review's conclusions once verified and incorporated. This review includes a total of nine trials evaluating nine comparisons and involving 4814 women. The overall risk of bias of included trials varied. Several studies were open label, and allocation concealment was unclear in some. The certainty of evidence ranged from high to low, mainly due to risk of bias, inconsistency, and imprecision across studies. Synthesis of results Discontinuation of oxytocin at the onset of the active phase of induced or augmented labour may make little or no difference to the risk of caesarean section compared with continuation (RR 0.98, 95% CI 0.85 to 1.13; I² = 5%; 8 studies, 4710 participants; low-certainty evidence). In a sensitivity analysis for the critical outcome excluding trials with high risk of bias in one or more domains, only one trial remained (RR 1.17, 95% CI 0.90 to 1.53; 1198 women). Discontinuation makes little or no difference to the risk of instrumental vaginal birth (RR 1.05, 95% CI 0.90 to 1.21; I² = 0%; 5 studies, 3776 participants; high-certainty evidence). The duration of the active phase of labour may be longer after discontinuation, with a mean difference of 34.72 minutes compared to continued stimulation, but the certainty of this evidence is very low (MD 34.72, 95% CI 26.34 to 43.11; I² = 82%; 8 studies, 4141 participants; very low-certainty evidence). Discontinuation may reduce uterine hyperstimulation (RR 0.65, 95% CI 0.55 to 0.77; I² = 56%; 3 studies, 1371 participants; low-certainty evidence). Discontinuation makes little or no difference to admission to a neonatal unit (RR 0.98, 95% CI 0.76 to 1.27; I² = 0%; 7 studies, 4606 participants; high-certainty evidence) or acidotic cord gasses at birth (arterial pH < 7.10) (RR 1.01, 95% CI 0.75 to 1.35; I² = 0%; 6 studies, 4086 participants; high-certainty evidence). Discontinuation probably makes little or no difference to the risk of having an Apgar score less than seven at five minutes (RR 0.92, 95% CI 0.40 to 2.11; I² = 0%; 5 studies, 2096 participants; moderate-certainty evidence). Authors' conclusions Discontinuation of oxytocin in the active phase of induced or augmented labour may have little or no effect on caesarean birth and has little or no effect on instrumental birth. It may reduce uterine hyperstimulation at the expense of a longer duration of the active phase of labour, but this evidence is of very low certainty. The discontinuation strategy appears safe for both mother and baby, provided that adequate monitoring of uterine activity and foetal heart rate is maintained. Funding None REGISTRATION: The protocol for this Cochrane review was published in November 2024.
Introduction Cervical oedema during labour is relatively common, but severe circumferential oedema persisting at advanced dilation is rare, particularly in multiparous women. In such cases, the swollen cervix may mimic an obstructive mass and raise concern for labour obstruction, cervical laceration or avulsion if pushing is initiated. Case presentation We report the case of a 41-year-old Gravida 5, Para 4 woman who underwent induction of labour at 39 weeks' gestation for diet-controlled gestational diabetes. Labour progressed to 8 cm dilation, at which point a tense, circumferential, purple-hued cervical swelling developed. The clinical presentation raised concern for obstructed labour and potential cervical trauma, although maternal and fetal parameters remained reassuring. The main diagnostic challenge was to distinguish severe reactive cervical oedema from cervical prolapse, haematoma or other cervical pathology. After interdisciplinary discussion and detailed counselling, the patient chose to proceed with a cautious trial of pushing. This decision was based on multiparity, a deeply engaged fetal head, reassuring fetal status, the absence of clinical obstruction to descent and the immediate availability of senior obstetric support and emergency resources. She achieved spontaneous vaginal delivery of a healthy infant within two pushes, without instrumentation, cervical trauma, postpartum haemorrhage or neonatal complication. The cervix remained oedematous but intact. Partial resolution was observed by postpartum Day 3, and follow-up colposcopy at 2 months showed no suspicious cervical lesion. Written informed consent for publication was obtained from the patient. Discussion This case illustrates that, in carefully selected multiparous women, severe reactive cervical oedema at advanced dilation may not necessarily preclude vaginal birth. However, this observation is hypothesis generating and should not be generalised to nulliparous women, cases with high fetal station, suspected obstruction, fetal compromise or limited access to emergency obstetric care.
Purpose A sudden illness in family, such as cancer, is known to have significant economic effects, but the consequences of a child's genetic disease on parental income and employment have gained much less attention. This study examines the association of having a child with neurofibromatosis 1 (NF1) and parental income and employment. Methods The Finnish cohort of 1,811 individuals with verified NF1 was cross-linked with income and employment data from Statistics Finland. The 772 parents of 390 children with sporadic NF1 and 446 parents of 229 children with familial NF1 born in 1988-2019 were compared with 7,635 and 4,465 parents of 3,862 and 2,252 matched non-NF1 individuals, respectively. Results Parents of children with NF1 experienced slower income growth and lower employment rate increases following the birth of a child compared to the parents in the comparison group. Specifically, the parents of children with NF1 had a 14-23% lower income increase and 1-3 percentage points lower rise in employment rates compared to the comparators' parents after the child's birth. Conclusions The effects of a child's NF1 are gradual rather than immediate, reflecting both pre-existing labour market disparities and age-related income trends.
Objective To assess pregnancy and neonatal outcomes in women with rheumatoid arthritis treated with an etanercept biosimilar, and to provide real-world safety evidence. Methods This retrospective, single-centre study included 11 pregnant women with rheumatoid arthritis who received an etanercept biosimilar at the National Center for Child Health and Development (Tokyo) between October 2018 and March 2022. The clinical characteristics, disease activity, medications, delivery outcomes, and neonatal health were reviewed. Results All 11 pregnancies were live births. The median maternal age was 34 years, the gestational age at delivery was 39.7 weeks, and the birth weight was 2929 g. One preterm birth (9.1%) and two caesarean deliveries (18.2%) occurred. No cases of low birth weight or neonatal intensive care unit admission were reported. One case of patent foramen ovale was noted. All neonates had 5-minute Apgar scores of ≥9. The etanercept biosimilar was discontinued before delivery in four cases to allow for infant vaccination. Conclusion Use of the etanercept biosimilar during pregnancy was associated with favourable outcomes, supporting its safety and utility in managing rheumatoid arthritis during pregnancy.
Purpose The Sustainable Development Goals (SDGs) recognize the complex intersections of health, economic development, and mining activities. This is exemplified among adolescent girls and young women (AGYW) who work in artisanal mining (ASM), in Ghana and Uganda, who experience general and poor sexual and reproductive health (SRH) outcomes, partly due to risky behaviors, poverty and poor access to quality healthcare. Achieving the SDGs necessitates translating global goals into actionable national policies, considering local contexts. To date, the literature assessing the degree to which policies address intersecting health and economic needs of AGYW in ASM communities is limited. This paper examines the extent to which global and national (Ghana and Uganda) policies focus on the economic and health needs of last-mile AGYW in ASM communities in Ghana and Uganda. Methods Using Daglish's (2020) Ready your materials, Extract data, Analyze data and Distil (READ) policy analysis approach, a comparative analysis was conducted on 14 global (2010-2023) and 27 national (2010-2023) Uganda and Ghana policy documents on mining, SRH, socio-economic well-being, gender and adolescents. Results & conclusion The global and national policies showed alignment in their commitment to addressing adolescent SRH, attaining Universal Health coverage, youth employability, and child labor. Although the national policies focused on SRH, equitable healthcare access, education, and vocational skills training, they did not specifically address the unique challenges of last-mile adolescents in ASM communities. It is important that ASM-AGYW are identified as vulnerable last mile populations and ensure their SRH needs and intersecting challenges are addressed and prioritized in policies.
Randolph-Koranteng N, Chidwick H, Kwagala B et al.
Background Declining physician density threatens access to primary care. Although physicians may adjust their labour supply in response to local shortages, little is known about the extent of these adjustments and the role of family circumstances in shaping them. Objective To examine how French self-employed GPs adjust their labour supply to declining physician density and whether family circumstances explain observed gender differences. Methods We analyse a representative 4.4% panel of 2898 self-employed French GPs observed from 2010 to 2017 (INSEE Permanent Demographic Sample matched with tax and territorial data). Labour supply is proxied by private practice income. Physician fixed-effects models relate income to local physician density, controlling for individual, household and territorial characteristics. Heterogeneity analyses consider gender and family composition. Results A 10% decrease in GP density is associated with a 1.7-1.8% increase in private practice income (p < 0.01), indicating partial labour supply adjustment. Male GPs increase income by about 2.2% (p < 0.01), whereas no significant response is observed among female GPs overall. Among physicians without dependent children, however, responses are similar for men (+2.4%) and women (+1.9%) (both p < 0.01), suggesting that gender differences primarily reflect unequal family responsibilities during the child-rearing years rather than gender itself. Conclusions Self-employed GPs partially adjust their labour supply to declining physician density, but these responses vary with family circumstances. Policies improving access to primary care should therefore complement workforce planning with measures that facilitate the reconciliation of professional and family responsibilities.
Abstract Background The partograph is an essential maternal tool for monitoring labour progression in child birth, significantly lowering maternal and newborn complications. However, some clinics in Ghana often fail to apply it appropriately, during childbirth. We assessed partograph utilisation and documentation completeness among midwives in selected health facilities in the Cape Coast Metropolitan Area. Methods A cross-sectional study was employed. Questionnaires were administered to 67 consenting midwives working in six selected facilities, which collectively accounted for 96% of deliveries in the metropolis. A retrospective record review was conducted on 285 partographs. Descriptive statistics were computed and the Chi-square (χ²) test was used to determine associations between selected variables and partograph utilisation, Results Overall partograph documentation completeness was 75%. Labour progression factors had the highest section-level completeness (91%), while maternal pre-risk factors had the lowest section completeness (53%). Among individual variables, the age of the client was the least documented (2%), whereas gravida was fully documented (100%). The average knowledge score on partograph application was 73% across 10 assessed components. The lowest knowledge domain was the interpretation of partograph observations (27%). Conclusions Partograph documentation and midwife knowledge in the Cape Coast Metropolis fell short of the anticipated 90% standard. There is a need for structured mentorship, routine in-service training, and supervisory support, for midwives to enhance skills, completeness and interpretation of the partograph.
Abstract Background Infant mortality characterizes a critical public health concern in developing country like India, with considerable disparities across socio-economically marginalized and deprived communities. Despite widespread research at the national and state levels, inadequate empirical evidence exists regarding infant mortality among the tea garden labour community in Assam, who exhibits distinct socio-cultural and livelihood conditions. Addressing this gap, the current study aims to explore the level and determinants of infant mortality among the tea garden community in Assam. Method The study is empirical in nature, based on primary data collected from 1,308 households across five main tea-growing districts of the state- Dibrugrah, Tinsukia, Sivasagar, Jorhat and Sonitpur, adopting a multistage random sampling method. Information was obtained from women belonging to the reproductive age group (15–49 years). The analysis of the research employs a binary logistic regression model to determine the key factors influencing infant mortality. Result The findings of the study reveal that average infant mortality rate in the study area is 33.14 per 1000 live births during the reference period 2019–2023. The results of the regression analysis reveals that maternal education, pre-maturity at the time of birth and ante-natal care of the mother during pregnancy are the most significant determinants (p < 0.001) of infant mortality in the study. Moreover, sanitation facility (p < 0.05) and sex of the child (p < 0.10) are also found to be significant factors having marginal effects on infant mortality. On the contrary, the influence of other variables such as Monthly Income of Household, Mother’s Age at birth, Birth Order of infant, and Access to Safe Drinking Water are not found to have significant impact on experience of infant mortality. Conclusion The study therefore highlights the need for targeted policy measures and interventions focusing on maternal education, healthcare availability and accessibility, and improved sanitation to reduce infant mortality among the tea garden communities. These findings of the study provide context-specific insights that can help in policy formulation for marginalized population in Assam.
