University of London

About: University of London is a education organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Public health. The organization has 44838 authors who have published 88086 publications receiving 4002499 citations. The organization is also known as: London University & Lond..

Born Too Soon: The global epidemiology of 15 million preterm births

Abstract: This second paper in the Born Too Soon supplement presents a review of the epidemiology of preterm birth, and its burden globally, including priorities for action to improve the data. Worldwide an estimated 11.1% of all livebirths in 2010 were born preterm (14.9 million babies born before 37 weeks of gestation), with preterm birth rates increasing in most countries with reliable trend data. Direct complications of preterm birth account for one million deaths each year, and preterm birth is a risk factor in over 50% of all neonatal deaths. In addition, preterm birth can result in a range of long-term complications in survivors, with the frequency and severity of adverse outcomes rising with decreasing gestational age and decreasing quality of care. The economic costs of preterm birth are large in terms of immediate neonatal intensive care, ongoing long-term complex health needs, as well as lost economic productivity. Preterm birth is a syndrome with a variety of causes and underlying factors usually divided into spontaneous and provider-initiated preterm births. Consistent recording of all pregnancy outcomes, including stillbirths, and standard application of preterm definitions is important in all settings to advance both the understanding and the monitoring of trends. Context specific innovative solutions to prevent preterm birth and hence reduce preterm birth rates all around the world are urgently needed. Strengthened data systems are required to adequately track trends in preterm birth rates and program effectiveness. These efforts must be coupled with action now to implement improved antenatal, obstetric and newborn care to increase survival and reduce disability amongst those born too soon.

Why we need observational studies to evaluate the effectiveness of health care

Abstract: The view is widely held that experimental methods (randomised controlled trials) are the “gold standard” for evaluation and that observational methods (cohort and case control studies) have little or no value. This ignores the limitations of randomised trials, which may prove unnecessary, inappropriate, impossible, or inadequate. Many of the problems of conducting randomised trials could often, in theory, be overcome, but the practical implications for researchers and funding bodies mean that this is often not possible. The false conflict between those who advocate randomised trials in all situations and those who believe observational data provide sufficient evidence needs to be replaced with mutual recognition of the complementary roles of the two approaches. Researchers should be united in their quest for scientific rigour in evaluation, regardless of the method used. Despite the essential role of observational methods in shedding light on the effectiveness of many aspects of health care, some scientists believe such methods have little or even nothing to contribute. In his summing up at a major conference held in 1993, the eminent medical epidemiologist Richard Doll concluded that observational methods “provide no useful means of assessing the value of a therapy.”1 The widely held view that experimental methods (randomised controlled trials) are the “gold standard” for evaluation has led to the denigration of non-experimental methods, to the extent that research funding bodies and journal editors automatically reject them. I suggest that such attitudes limit our potential to evaluate health care and hence to improve the scientific basis of how to treat individuals and how to organise services. My main contention is that those who are opposed to the use of observational methods have assumed that they represent an alternative to experimentation rather than a set of complementary approaches. This in turn stems from a misguided notion that everything …