Texas has highest maternal mortality rate in developed world, study finds

The rate of Texas women who died from complications related to their pregnancy doubled from 2010 to 2014, a new study has found, for an estimated maternal mortality rate that is unmatched in any other state and the rest of the developed world.

The finding comes from a report, appearing in the September issue of the journal Obstetrics and Gynecology, that the maternal mortality rate in the United States increased between 2000 and 2014, even while the rest of the world succeeded in reducing its rate. Excluding California, where maternal mortality declined, and Texas, where it surged, the estimated number of maternal deaths per 100,000 births rose to 23.8 in 2014 from 18.8 in 2000 – or about 27%.

But the report singled out Texas for special concern, saying the doubling of mortality rates in a two-year period was hard to explain “in the absence of war, natural disaster, or severe economic upheaval”.

From 2000 to the end of 2010, Texas’s estimated maternal mortality rate hovered between 17.7 and 18.6 per 100,000 births. But after 2010, that rate had leaped to 33 deaths per 100,000, and in 2014 it was 35.8. Between 2010-2014, more than 600 women died for reasons related to their pregnancies.

No other state saw a comparable increase.

In the wake of the report, reproductive health advocates are blaming the increase on Republican-led budget cuts that decimated the ranks of Texas’s reproductive healthcare clinics. In 2011, just as the spike began, the Texas state legislature cut $ 73.6m from the state’s family planning budget of $ 111.5m. The two-thirds cut forced more than 80 family planning clinics to shut down across the state. The remaining clinics managed to provide services – such as low-cost or free birth control, cancer screenings and well-woman exams – to only half as many women as before.

Related: The biggest US city without an abortion clinic: El Paso’s sole facility faces closure

At the same time, Texas eliminated all Planned Parenthood clinics – whether or not they provided abortion services – from the state program that provides poor women with preventative healthcare. Previously, Planned Parenthood clinics in Texas offered cancer screenings and contraception to more than 130,000 women.

In 2013, Texas restored funding to the family planning budget to original levels. But the healthcare providers who survived the initial cuts reported struggles to restore services to their original levels.

Indeed, the report said it was “puzzling” that Texas’s maternal mortality rate rose only modestly from 2000 to 2010 before doubling between 2011 and 2012. The researchers, hailing from the University of Maryland, Boston University’s school of public health and Stanford University’s medical school, called for further study. But they noted that starting in 2011, Texas drastically reduced the number of women’s health clinics within its borders.

The report comes just as public health advocates are raising questions about Texas’s ability to prepare for the Zika virus, which is transmitted by a common species of mosquito and has been linked to severe birth defects. The World Health Organization has advised women in areas of local transmission to delay pregnancy.

Texas is one of several southern states where health officials say there is a risk of a local outbreak. But about half the state lacks ready access to OB-GYN care, making it difficult for women to obtain contraception or for pregnant women to confirm the health of their babies. Just this month, Texas’s health department drew fire for allocating $ 1.6m of the $ 18m the state budgets for low-income women’s family planning to an anti-abortion group that does not provide basic health services.

“There is a need to redouble efforts to prevent maternal deaths and improve maternity care for the 4 million US women giving birth each year,” the authors said.

Texas has highest maternal mortality rate in developed world, study finds

The intense wheelchair that is developed like a tank

In 2005, Brad Soden invented a modified wheelchair for his wife Liz, who is paralyzed from the waist down, so she could actively participate in much more routines with their family.

These fearsome looking machines can traverse rugged hillsides, sandy beaches and snowy embankments.

Mr Soden has said he is not a rich guy from his invention but he ”has a great deal of fun”.

The intense wheelchair that is developed like a tank

The environment and well being atlas of England and Wales: how it was developed and what it demonstrates

The Tiny Area Well being and Statistics Unit (SAHSU) has been studying risks to the well being of the population from environmental elements for much more than 25 years, with much of the research making use of routinely collected well being and population information at a tiny location scale.

Launched nowadays, the atmosphere and health atlas of England and Wales is meant as a resource to help much better understand the geographic distributions of environmental factors and disease, offers some of this accumulated details as interactive maps of wellness circumstances and of selected environmental agents at a tiny-location level in England and Wales.

The overall health maps offer a baseline image of long-term geographical variability of 14 circumstances (nine cancers, 3 frequent causes of mortality and two reproductive outcomes) over a 25 yr time period at a small-spot scale. They display relative hazards for each wellness problem (dangers relative to those of England and Wales as a complete) for locations, not risks for an individual. Dangers are offered at ward degree, there are 8,800 wards in England and Wales with an average population of 6,000 folks.

A map of male skin cancer (melanoma) incidence – relative danger. Photograph: The setting and overall health atlas/Small Spot Health Statistics Unit

Health information (mortality, births and population) were provided by the Workplace of National Statistics (ONS) and the cancer incidence information had been derived from statistics compiled by national cancer registries by the ONS for England and by the Welsh Cancer Intelligence and Surveillance Unit (WCISU) for Wales.

We produced the environmental maps at the finest resolution obtainable, but to receive detailed environmental data, we had to use a wide variety of sources which incorporated some specific projects carried out by SAHSU.

A map of air pollution – PM10. Photograph: Little Spot Health Statistics Unit

Air pollution mapping was carried out for a task entitled ‘use of geographic details for evaluation of human exposure to air pollution’.

Water chlorination disinfection by-products (DBPs) information and water supply zone boundaries for the maps had been provided by twelve water organizations as component of a preceding review investigating likely associations with birth outcomes.

The sunshine duration map was primarily based on United kingdom Meteorological Workplace information supplied by the Met Workplace, even though the pesticides maps have been designed for the INTARESE venture to assess the affect of agriculture on well being, making use of data came from the Pesticide Utilization Survey (PUS) which is carried out by the Food and Setting Investigation Company (FERA).

A map of sunshine duration. Photograph: Little Spot Wellness Statistics Unit

It is crucial to note that easy comparison of the maps of environmental agents with the health maps cannot be employed to demonstrate a causal association. Any such hypothesis would want to be investigated with extra information. This may contain estimating the actual dose of the environmental agent received by an person, asking about person factors such as smoking, health care situation, family historical past and occupation and so on. and by conducting more statistical evaluation.

What is various about the environment and wellness atlas?

At first sight, the format of these maps looks acquainted – and this is on goal as men and women entry information a lot more rapidly from acquainted formats. However, several items are different about the information underlying the maps:

• The maps are at a much finer resolution than numerous currently accessible maps of distinct well being conditions or environmental agents – typically these are at local authority or regional degree details, or they look at ‘health’ much more normally rather than separate ailments or circumstances as right here


• The two-tone colour scale picked assists the eye to much more quickly recognize spatial patterns above or under the average for England and Wales


• Yet another variation is that the maps are adjusted for deprivation a lot of diseases are strongly linked to deprivation so with no this adjustment several of the maps would be likely to display patterns of deprivation rather than condition


• The maps have also undergone statistical smoothing to enable for likelihood fluctuations in which there are small numbers of situations. Smoothing helps make sense of geographical patterns when outcomes are uncommon

By taking account of these elements, the maps in this atlas are greater capable to support identify underlying variations in ailment threat that may possibly potentially be due to environmental chance elements.

Also measures of statistical uncertainty are presented alongside all the health maps and – in which attainable and available – the environmental maps. This is important as all the risks presented are estimates.

What insights does the new atlas supply?

Some examples of geographical patterns in the atlas are:

• Skin cancer danger is biggest in southwest England even though sunshine duration is highest in southeast England. This suggests that in spite of the somewhat decrease duration of sunshine in the southwest, men and women might be far more exposed, which could set off even more study into behavioral distinctions between the areas to make clear this variation


• The highest risks for liver cancer are witnessed in the Merseyside spot. Some of this could be due to differences in coding of liver cancer in this area, but it could also in component reflect greater prevalence of chance elements, this kind of as hepatitis C infection – there is a recognized increased prevalence of hepatitis C in current or former injecting drug customers in London and the North West. More work to assist comprehend these geographical patterns in liver cancer is currently being performed by researchers at Imperial College

The atlas does not have separate versions for researchers and for the public, but aims to offer details that is available to any person employing it. To aid do this, SAHSU have been operating with Sense About Science above the last two many years to develop the format and text so that the info is pertinent not just to researchers, but also to policy makers and members of the public and as component of this improvement, the atlas has been examined out in 5 workshops with 28 likely consumers of the atlas.

Maps featured in the atlas have accompanying data to assist with interpretation and understanding. A print edition is published at the identical time by Oxford University Press this has further maps, statistics and review of the literature summarising what is recognized about each situation and agent.

• Dr Anna Hansell is the assistant director of the Little Region Well being Statistics Unit (SAHSU) primarily based at Imperial College London and a clinical senior lecturer at the MRC-PHE Centre for Surroundings and Health.

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The environment and well being atlas of England and Wales: how it was developed and what it demonstrates

Swift Consider: All Strategic Digital Health Investments Not Developed Equal

The digital wellness planet is enthusiastic nowadays by the information that the strategic venturing arm (SR One) of an additional large pharma business appears interested in coming into the area.

As reported by MedCityNews and other people, SR One particular has supplied a comparatively tiny seed-stage investment, in conjunction with Atlas Ventures (who led the round), in a startup known as ZappRx, focused on streamlining the buy and delivery of specialty items, an increasingly critical supply of pharma business revenue.

It’s fascinating more pharma businesses are starting up to acknowledge that digital wellness startups can materially effect their companies, suggesting these drugs giants have innovative past the contemplative stage, and into actual preparation.

At the very same time, we must consider care to distinguish amongst this kind of strategic investment – nicely integrated into the pharma company’s present company model – and the sort of investments that Merck Merck’s GHI fund has pursued with the excess weight loss business Health Management Resources, and Medtronic Medtronic has completed with the ailment management and patient monitoring company Cardiocom.  The Merck and Medtronic investments each seem aimed at exploring new business versions, and possibly  finding other, inventive ways for big health-related item organizations to leverage their present strengths.

The contrast looks like the pharma version of this latest, a lot more common discussion exploring regardless of whether digital well being startups should look for to work inside of the technique, or orthogonal to it.  It’s a promising signal that at the moment, there are pharma businesses hunting to invest in every single technique.

Swift Consider: All Strategic Digital Health Investments Not Developed Equal