This is an overview of evidence of the effectiveness of antenatal care in relation to maternal mortality and serious morbidity, focused in particular on developing countries. It concentrates on the major causes of maternal mortality, and traces their antecedent morbidities and risk factors in pregnancy. It also includes interventions aimed at preventing, detecting or treating any stage along this pathway during pregnancy. This is an updated and expanded version of a review first published by the World Health Organization (WHO) in 1992. The scientific evidence from randomised controlled trials and other types of intervention or observational study on the effectiveness of these interventions is reviewed critically. The sources and quality of available data, and possible biases in their collection or interpretation are considered. As in other areas of maternal health, good-quality evidence is scarce and, just as in many aspects of health care generally, there are interventions in current practice that have not been subjected to rigorous evaluation. A table of antenatal interventions of proven effectiveness in conditions that can lead to maternal mortality or serious morbidity is presented. Interventions for which there is some promising evidence, short of proof, of effectiveness are explored, and the outstanding questions formulated. These are presented in a series of tables with suggestions about the types of study needed to answer them.

Study objective-To assess the impact on mortality of the heatwave in England and Wales during July and August 1995 and to describe any diVerence in mortality impact between the Greater London urban population and the national population. Design-Analysis of variation in daily mortality in England and Wales and in Greater London during a five day heatwave in July and August 1995, by age, sex, and cause. Setting-England and Wales, and Greater London. Main results-An estimated 619 extra deaths (8.9% increase, approximate 95% confidence interval 6.4, 11.3%) were observed during this heatwave in England and Wales, relative to the expected number of deaths based on the 31-day moving average for that period. Excess deaths were apparent in all age groups, most noticeably in women and for deaths from respiratory and cerebrovascular disease. Using published daily mortality risk coeYcients for air pollutants in London, it was estimated that up to 62% of the excess mortality in England and Wales during the heatwave may be attributable to concurrent increases in air pollution. In Greater London itself, where daytime temperatures were higher (and with lesser falls at night), mortality increased by 16.1% during the heatwave. Using the same risk coeYcients to estimate the excess mortality apparently attributable to air pollution, more than 60% of the total excess in London was apparently attributable to the eVects of heat. Conclusion-Analysis of this episode shows that exceptionally high temperatures in England and Wales, though rare, do cause increases in daily mortality.

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Although the relationship between suicide and unemployment has been extensively studied [1][2][3][4] demonstrating an increased rate of suicide among the unemployed, the relationship between suicide and occupation has been much less frequently studied, probably because of the relatively smaller number of people in each occupational group compared with the population in other socio-demographic groups defined, for example, by age or geography. Mortality data collated by the Office for National Statistics (ONS) in England and Wales have, however, been an invaluable source for examining the relationship between suicide and occupation. [5][6][7][8] In the late 1990s these findings were updated to cover trends in suicide in England and Wales, and suicide data for 1982-1987 and 1991-1996 were used to calculate proportional mortality ratios (PMRs) for both men and women according to their occupation. 9 In addition to the national statistics describing the relationship between occupation and suicide, a number of studies have looked in more detail at some of the specific occupations with high suicide PMRs. These included health-related occupations such as doctors, 10-12 nurses, 13 farmers (including horticulturalists and farm managers), 14 armed forces, 15 students 16,17 and artists. 18,19 We aim to identify the occupations in 2001-2005 with significantly high suicide rates in England and Wales, and to compare these with patterns in suicide rates by occupation over earlier decades. The data from 2001-2005 can be regarded as a further update with the possibility of examining the stability of patterns. MethodUsing data collected by the ONS from death registrations in England and Wales over the calendar years 2001-2005, PMRs were calculated for suicides by occupation. Standardised mortality ratios (SMRs) were also calculated.The ONS usually classifies deaths from suicide as those with an underlying cause of suicide or death from injury or poisoning of undetermined intent. These latter deaths are traditionally assumed to be probable suicides for the purposes of calculating the number of suicides in England and Wales. 20 The ICD-10 was used to code cause of death based on coroners' verdicts. 21 Grouping both deaths from suicide and undetermined intent together to give an estimate of suicides removes biases that may be introduced if there are differences between occupations in the propensity of coroners to record a suicide verdict.The deceased's occupation is collected from the informant at death registration and is based on the last gainful occupation of the deceased if they were retired or unemployed. This is then coded by the ONS using the Standard Occupational Classification 2000 (SOC2000). 22 This contains 352 occupation codes at its lowest (four-digit) level. Data from the 2001 Census were also coded using the SOC2000, and are based on the occupation of respondents in the week before census, or their last occupation in the past 5 years not working. We restricted our analysis to the age range 20-64 years to improve the li...