Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence-based lens.

Based on prediction models and expert opinion, most obstetric venous thromboembolism guidelines recommend low-molecular-weight heparin for many postpartum women, including most delivering by caesarean. Scrutiny reveals major oversights: prediction models are based on studies that report asymptomatic deep vein thrombosis; risk estimates are not adjusted for time exposure; and harm caused by heparin has been overlooked. The benefits of heparin are exaggerated and its harms are under-appreciated. Estimates of the numbers-needed-to-treat and harm are universally lacking. This paper critically reviews the evidence and quantifies the benefit and harm from low-molecular-weight heparin in postpartum women with common risk factors. FUNDING: This work was unsponsored and unfunded. TWEETABLE ABSTRACT: Randomised trials should demonstrate more benefit than harm before widespread postpartum low-molecular-weight heparin is recommended.

Type-specific prevalence of Human Papillomavirus infection among women in the Northwest Territories, Canada.

BACKGROUND: Certain types of Human Papillomavirus (HPV) are highly associated with cervical cancer and precursor lesions (dysplasia), but the distribution of HPVs in Northern Canada is largely unknown. This study determined the prevalences of HPV infection due to different virus types and the association of different virus types with cervical dysplasia in the Northwest Territories (NWT). METHODS: Between April 2008 and March 2009, women who underwent routine Pap testing in the NWT were included in the study. An in-house Luminex assay detected type-specific HPV infections. The HPV prevalence rates and population attributable risk fractions were calculated. RESULTS: In 5725 bio-samples, the overall HPV prevalence was 24.2%, and of the HPV-positive samples, 76.6% harbored high-risk types, 35.2% harbored multi-type infections, and 21.6% harbored HPV16 or 18 infections. The HPV prevalence was approximately 50% higher among Aboriginal than non-Aboriginal women. The age-specific HPV prevalence exhibited a U-shape distribution in the Aboriginal group. The prevalence of HPV16 or 18 infections found in high-grade lesions was 34.1%. Among this study population, 89.5% of the cases with cervical dysplasia were attributable to HPV infection, with 27.1% attributable to HPV16/18. CONCLUSION: The high prevalence of high-risk HPV in this population, particularly in the Aboriginal group, will require further studies to identify specific predictors of infection.

Infant nutrition program effectively prevents iron-deficiency anemia in a First Nations community.

Iron-deficiency anemia (IDA) has received relatively little attention in Canada, with no national public health initiatives even among high-risk infants. IDA has a high prevalence in First Nations children and has been shown to cause developmental delay. This study is a before/after prevalence survey studying the effect of a public health intervention, conducted on a First Nations reserve off the central coast of British Columbia (BC). We screened for IDA one cohort of infants born January 1993 to August 1994 and between the ages of 6 and 24 months. Twenty-five of a possible 37 infants were screened. We found 13 (52%) of the 25 had anemia, with a hemoglobin less than 100 g/L. The average hemoglobin was 98.9 +/- 19.2 g/L. The subsequent implementation of an infant nutrition program focused on educating parents and encouraging the use of iron-fortified formula for nonbreast-fed infants. In the year following program implementation, the cohort of infants born between September 1994 and September 1995 were screened for IDA when they were between the ages of 6 and 15 months. Twenty-four of 27 infants participated. Only one infant was anemic with a hemoglobin less than 100 g/L. The average hemoglobin was 116.6 +/- 11.6 g/L. The increase in the average hemoglobin and the decrease in the prevalence of anemia were both highly significant (p < .01). We judged our intervention to be very effective and would recommend similar programs for other First Nations communities.