Saturday, April 22, 2006

22 April, 2006


An alarming rise in the number of women giving birth prematurely risks overloading the NHS and may be linked to increases in obese and older mothers, according to doctors. A study of more than 600,000 births over the past decade found that the number of deliveries occurring before nine months of pregnancy had increased by almost a quarter. Researchers also found that among women without factors that normally increase the chances of a pre-term birth - such as fertility treatment, an earlier premature birth or cervical surgery - the rate had increased more than 50 per cent.

Leading obstetricians yesterday gave warning that the rise was likely to be replicated in "similar societies" such as Britain, although comprehensive data has yet to be collated. They said that the trend carried serious implications for the NHS with chronic illnesses such as diabetes, high blood pressure and heart disease linked to early deliveries. Pre-term babies are also at greater risk of developing severe mental and physical disabilities. A quarter of babies born after 25 weeks or less have such problems, and a high number of children born at 32 weeks have educational and behavioural problems by the age of 7. Although premature deliveries account for fewer than 1 in 10 births, they result in 75 per cent of neonatal deaths and most neonatal intensive care admissions.

Writing in an editorial accompanying the Danish study, published this week in the British Medical Journal, doctors said that it was essential that the exact causes of the growth were investigated. Andrew Shennan, Professor of Obstetrics at King's College London School of Medicine, at St Thomas's Hospital, said that the growing number of women deciding to postpone having children and increasing female obesity were "good candidates" to explain the trends. More accurate ultrasound dating of conceptions might also play a role, he added. "We know about the problems encountered with severely premature births, but I worry about the more subtle things that are clearly happening to a much larger number of babies, such as educational problems and chronic conditions like diabetes and hypertension," Professor Shennan said. "If you want really to address the big health problems affecting society, this is where to start."

Professor Shennan and his co-author, Susan Bewley, concluded that if the findings from Denmark were accurate the implications for neonatologists, health economists, teachers, parents, and children were worrying. "Premature babies are at great risk of death and disability, and the total health burden to the population will not change unless the number can be reduced," he said.

The Danish study included four national birth registries of 646,000 deliveries - almost all live births - in Denmark between 1995 and 2004. The authors said that the prevalence of several premature birth risk factors - IVF, high maternal age, first-time mothers and elective early deliveries - have changed in recent years and may explain the increases in pre-term deliveries.

Concerns have been raised by many gynaecologists and obstetricians about the health impacts of the rapid rise of career women becoming pregnant later in life. Fertility problems increase after 35, and greatly so for women over 40. According to the Office for National Statistics, the over-35s have the fastest-growing birthrates. Women having babies in their forties have nearly doubled in ten years. The number in their thirties is up by two thirds and outstrips those in their twenties. Charlotte Davies, of the baby charity Tommy's, said that research was urgently needed. "If this increase continues, and is extrapolated to the UK, then it's very concerning and means that we need, more than ever, to work out exactly why it's happening and bring in preventive measures."


A truly insane public medicine system

It has spent $2 million to sort out a $300 matter. It shows how nasty and irresponsible bureaucrats can be

A $300 overtime claim by ambulance staff has led to a five-year, $2 million legal and wages bill -- paid for by Queensland taxpayers. And the wrangling between Queensland Ambulance Service management and the officers could go on for at least another year.

The saga started in 2001 and has seen four separate investigations, numerous court cases and staff suspended on full pay pending decisions. The wages bill alone for three staff suspended on full pay for three years and eight months was between $600,000 and $800,000. A source said the QAS legal bill had topped $1 million "a long time ago" and that the State Government spent hundreds of thousands of dollars flying relieving staff into Mount Isa and Doomadgee to cover the suspended officers.

The Industrial Relations Commission will soon hand down a finding in relation to a paramedic claiming unfair dismissal for his part in the overtime claim. Ken Gramm, 52, a decorated ambulance officer, was fired last year for allegedly falsifying records. Mr Gramm strenuously denied all allegations. He was suspended on full pay of $85,000 a year in February 2002. A Mount Isa magistrate ruled there was no evidence of dishonesty, and the Crime and Misconduct Commission also found no case to answer. But Ambulance Commissioner Jim Higgins ordered another internal investigation, and Mr Gramm was found guilty on five of 14 counts relating to overtime claims involving just over $300. Sources said the QAS rejected an early offer by Mr Gramm to repay the disputed amount.

Another court case begins on April 24, when a former communications operator takes on WorkCover after it refused a medical payout following his sacking from the QAS. Greg Haddow, 43, was also suspended on full pay in 2002 amid claims he helped Mr Gramm falsify the overtime. Mr Haddow -- who denied any wrongdoing -- was also cleared by the courts, the CMC and an internal investigation. But sources said QAS bosses "medically terminated" Mr Haddow last year after he had been on stress leave and Workcover refused a payout. Mr Haddow appealed against that decision, and his case is due to be heard in Townsville Magistrates Court.

The only officer who admitted a role in falsifying overtime claims was not sacked -- he has been promoted. He also had been suspended on full pay. QAS declined to comment, as Mr Gramm and Mr Haddow's cases are before the courts.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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