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To explore how primary care organizations assess and subsequently act upon the social determinants of noncommunicable diseases in their local populations. For this systematic review we searched the online databases of PubMed®, MEDLINE®, Embase® and the Health Management Information Consortium from inception to 28 June 2019, along with hand-searching of references. Studies of any design that examined a primary care organization assessing social determinants of noncommunicable diseases were included. For quality assessment we used Cochrane's tool for assessing risk of bias in non-randomized studies of interventions. We used narrative data synthesis to appraise the extent to which the assessments gathered data on the domains of the World Health Organization social determinants of health framework. We identified 666 studies of which 17 were included in the review. All studies used descriptive study designs. Clinic-based and household surveys and interviews were more commonly used to assess local social determinants than population-level data. We found no examples of organizations that assessed sociopolitical drivers of noncommunicable diseases; all focused on sociodemographic factors or circumstances of daily living. Nevertheless, the resulting actions to address social determinants ranged from individual-level interventions to population-wide measures and introducing representation of primary care organizations on system-level policy and planning committees. Our findings may help policy-makers to consider suitable approaches for assessing and addressing social determinants of health in their domestic context. More rigorous observational and experimental evidence is needed to ascertain whether measuring social determinants leads to interventions which mitigate unmet social needs and reduce health disparities.

Background Cardiovascular disease (CVD) is the leading cause of death in women, responsible for approximately a third of all female deaths. Pregnancy complications are known to be associated with a greater risk of incident CVD in mothers. However, the relationships between pregnancy loss due to miscarriage, stillbirth, or therapeutic abortion, and future maternal cardiovascular health are under-researched. This study seeks to provide an up-to-date systematic review and meta-analysis of the relationship between these three forms of pregnancy loss and the subsequent development of CVD. Methods This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist (PRISMA) and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) Checklist. A systematic search will be undertaken using publications identified in MEDLINE (PubMed), Scopus, Web of Knowledge, the CINAHL Nursing Database, and the Cochrane Library. The eligibility of each publication will be determined by predefined selection criteria. The quality of the included studies will be rated using the Newcastle-Ottawa Scale. Pooled measures of association will be computed using random-effects model meta-analyses. Between-study heterogeneity will be assessed using the I 2 statistic and the Cochrane χ 2 statistic. Small study effects will be evaluated for meta-analyses with sufficient studies through the use of funnel plots and Egger’s test. Discussion The results of this systematic review will discuss the long-term risks of multiple types of cardiovascular disease in women who have experienced miscarriage, stillbirth, and/or therapeutic abortion. It will contribute to the growing field of cardio-obstetrics as the first to consider the full breadth of literature regarding the association between all forms of pregnancy loss and future maternal cardiovascular disease. Systematic review registration PROSPERO registration number [CRD42020167587]

A wealth of evidence shows the importance of partner attendance in maternity care, not just during birth but more generally across maternity services, to improve patient outcomes and promote gender equality.234567 Results of our recent freedom of information request to all maternity services in England show severe restrictions on partner attendance during the covid-19 pandemic.8 Most notably, almost half of trusts have not lifted restrictions, despite NHS England guidance encouraging them to do so.9 Moreover, one in four trusts explicitly stated an intention to reinstate restrictions in the event of a major second spike. Companion of choice during labour and childbirth for improved quality of care: evidence-to-action brief, 2020. https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/companion-during-labour-childbirth/en/ 4 Tokhi M Comrie-Thomson L Davis J Portela A Chersich M Luchters S. Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions. CD012449. 10.1002/14651858.CD012449.pub2 30883666 7 Morrell CJ Sutcliffe P Booth A. A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression.

[phrase omitted] [phrase omitted] Metodos Para esta revision sistematica se realizaron busquedas en las bases de datos en linea de PubMed[R], MEDLINE[R], Embase[R] y el Health Management Information Consortium desde su inicio hasta el 28 de junio de 2019, junto con una busqueda manual de referencias. Se incluyeron estudios de todos los disenos que analizaron a una organizacion de atencion primaria en la que se evaluaban los determinantes sociales de las enfermedades no transmisibles. Para la evaluacion de la calidad se utilizo la herramienta de Cochrane para evaluar el riesgo de sesgo en los estudios no aleatorizados de las intervenciones. Se utilizo la sintesis narrativa de datos para evaluar el alcance de las evaluaciones para recopilar datos sobre los dominios del marco de los determinantes sociales de la salud de la Organizacion Mundial de la Salud. Resultados Se identificaron 666 estudios, de los cuales 17 se incluyeron en la revision. Todos los estudios utilizaron disenos de estudio descriptivos. Se utilizaron las encuestas y las entrevistas en los consultorios y en los hogares con mayor frecuencia que los datos a nivel de la poblacion para evaluar los determinantes sociales locales. No se encontraron ejemplos de organizaciones que evaluaran los factores sociopoliticos determinantes de las enfermedades no transmisibles, ya que todas se centraban en los factores sociodemograficos o en las circunstancias de la vida cotidiana. No obstante, las medidas que se adoptaron para abordar los determinantes sociales fueron desde intervenciones a nivel individual hasta medidas a nivel de la poblacion y la integracion de la representacion de las organizaciones de atencion primaria en los comites de planificacion y de politicas a nivel del sistema. Conclusion Los resultados obtenidos pueden ayudar a los responsables de formular las politicas a considerar los enfoques adecuados para evaluar y abordar los determinantes sociales de la salud en su contexto nacional. Se necesitan evidencias observacionales y experimentales mas rigurosas para determinar si la medicion de los determinantes sociales conduce a las intervenciones que mitigan las necesidades sociales que no se atienden y que reducen las desigualdades en la salud.

Abstract Aims Miscarriage and stillbirth have been included in cardiovascular disease (CVD) risk guidelines, however heterogeneity in exposures and outcomes and the absence of reviews assessing induced abortion, prevented comprehensive assessment. We aimed to perform a systematic review and meta-analysis of the risk of cardiovascular diseases for women with prior pregnancy loss (miscarriage, stillbirth, and induced abortion). Methods and results Observational studies reporting risk of CVD, coronary heart disease (CHD), and stroke in women with pregnancy loss were selected after searching MEDLINE, Scopus, CINAHL, Web of Knowledge, and Cochrane Library (to January 2020). Data were extracted, and study quality were assessed using the Newcastle-Ottawa Scale. Pooled relative risk (RR) and 95% confidence intervals (CIs) were calculated using inverse variance weighted random-effects meta-analysis. Twenty-two studies involving 4 337 683 women were identified. Seven studies were good quality, seven were fair and eight were poor. Recurrent miscarriage was associated with a higher CHD risk (RR = 1.37, 95% CI: 1.12–1.66). One or more stillbirths was associated with a higher CVD (RR = 1.41, 95% CI: 1.09–1.82), CHD (RR = 1.51, 95% CI: 1.04–1.29), and stroke risk (RR = 1.33, 95% CI: 1.03–1.71). Recurrent stillbirth was associated with a higher CHD risk (RR = 1.28, 95% CI: 1.18–1.39). One or more abortions was associated with a higher CVD (RR = 1.04, 95% CI: 1.02–1.07), as was recurrent abortion (RR = 1.09, 95% CI: 1.05–1.13). Conclusion Women with previous pregnancy loss are at a higher CVD, CHD, and stroke risk. Early identification and risk factor management is recommended. Further research is needed to understand CVD risk after abortion. Graphical Abstract Graphical Abstract