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1.  Economic evaluation of strategies for managing crying and sleeping problems 
AIMS—To estimate the financial cost to the NHS of infant crying and sleeping problems in the first 12 weeks of age and to assess the cost effectiveness of behavioural and educational interventions aimed at reducing infant crying and sleeping problems relative to usual services.
METHODS—A cost burden analysis and cost effectiveness analysis were conducted using data from the Crying Or Sleeping Infants (COSI) Study, a three armed prospective randomised controlled trial that randomly allocated 610 mothers to a behavioural intervention (n = 205), an educational intervention (n = 202), or existing services (control, n = 203). Main outcome measures were annual total cost to the NHS of infant crying and sleeping problems in the first 12 weeks, and incremental cost per interruption free night gained for behavioural and educational interventions relative to control.
RESULTS—The annual total cost to the NHS of infant crying and sleeping problems in the first 12 weeks was £65 million (US$104 million). Incremental costs per interruption free night gained for the behavioural intervention relative to control were £0.56 (US$0.92). For the educational intervention relative to control they were £4.13 (US$6.80).
CONCLUSIONS—The annual total cost to the NHS of infant crying and sleeping problems is substantial. In the cost effectiveness analysis, the behavioural intervention incurred a small additional cost and produced a small significant benefit at 11 and 12 weeks of age. The educational intervention incurred a small additional cost without producing a significant benefit.


doi:10.1136/adc.84.1.15
PMCID: PMC1718606  PMID: 11124777
2.  The EMBL nucleotide sequence database. 
Nucleic Acids Research  1998;26(1):8-15.
The EMBL Nucleotide Sequence Database (http://www.ebi.ac.uk/embl. html ) constitutes Europe's primary nucleotide sequence resource. DNA and RNA sequences are directly submitted from researchers and genome sequencing groups and collected from the scientific literature and patent applications (Fig. 1). In collaboration with DDBJ and GenBank the database is produced, maintained and distributed at the European Bioinformatics Institute. Database releases are produced quarterly and are distributed on CD-ROM. EBI's network services allow access to the most up-to-date data collection via Internet and World Wide Web interface, providing database searching and sequence similarity facilities plus access to a large number of additional databases.
PMCID: PMC147241  PMID: 9399791
3.  West Berkshire perineal management trial: three year follow up. 
Women who had participated in a randomised controlled trial of policies of restricted (10%) versus liberal (51%) episiotomy during spontaneous vaginal delivery were recontacted by postal questionnaire three years after delivery. Altogether 674 out of 1000 responded, and there was no evidence of a differential response rate between the two trial groups. Similar numbers of women in the two groups reported further deliveries, almost all of which had been vaginal and spontaneous. Fewer women allocated to restrictive use of episiotomy required perineal suturing after subsequent delivery, but this difference was not significant. Pain during sexual intercourse and incontinence of urine were equally reported in the two groups. The similarity in incontinence rates persisted when severity, type of incontinence, and subsequent deliveries were taken into account. Liberal use of episiotomy does not seem to prevent urinary incontinence or increase long term dyspareunia.
PMCID: PMC1247773  PMID: 3119022
4.  West Berkshire perineal management trial. 
One thousand women were allocated at random to one of two perineal management policies, both intended to minimise trauma during spontaneous vaginal delivery. In one the aim was to restrict episiotomy to fetal indications; in the other the operation was to be used more liberally to prevent perineal tears. The resultant episiotomy rates were 10% and 51% respectively. An intact perineum was more common among those allocated to the restrictive policy. This group experienced more perineal and labial tears, however, and included four of the five cases of severe trauma. There were no significant differences between the two groups either in neonatal state or in maternal pain and urinary symptoms 10 days and three months post partum. Women allocated to the restrictive policy were more likely to have resumed sexual intercourse within a month after delivery. These findings provide little support either for liberal use of episiotomy or for claims that reduced use of the operation decreases postpartum morbidity.
PMCID: PMC1442865  PMID: 6432201

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