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In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
Initiatives to optimise preconception health are emerging following growing recognition that this may improve the health and well-being of women and men of reproductive age and optimise health in their children. To inform and evaluate such initiatives, guidance is required on indicators that describe and monitor population-level preconception health. We searched relevant databases and websites (March 2021) to identify national and international preconception guidelines, recommendations and policy reports. These were reviewed to identify preconception indicators. Indicators were aligned with a measure describing the prevalence of the indicator as recorded in national population-based data sources in England. From 22 documents reviewed, we identified 66 indicators across 12 domains. Domains included wider (social/economic) determinants of health; health care; reproductive health and family planning; health behaviours; environmental exposures; cervical screening; immunisation and infections; mental health, physical health; medication and genetic risk. Sixty-five of the 66 indicators were reported in at least one national routine health data set, survey or cohort study. A measure of preconception health assessment and care was not identified in any current national data source. Perspectives from three (healthcare) professionals described how indicator assessment and monitoring may influence patient care and inform awareness campaign development. This review forms the foundation for developing a national surveillance system for preconception health in England. The identified indicators can be assessed using national data sources to determine the population’s preconception needs, improve patient care, inform and evaluate new campaigns and interventions and enhance accountability from responsible agencies to improve preconception health.
The public sector equality duty (PSED), contained in the Equality Act 2010, requires public bodies to have ‘due regard to the need to eliminate discrimination, advance equality of opportunity and foster good relations between different people’ when carrying out their activities. This applies to all ‘protected characteristics’, such as race, sex, disability, age, sexual orientation, and to policy-making at all levels – central, national and local.
The PSED has had a positive impact on equality practice within public authorities and, to a limited extent, in policy-making. However, its aim was to bring about a transformative approach to equality by going beyond simply outlawing discrimination to tackle inequality at a structural level. The duty has failed to fulfil this aim.
In particular, there has been a failure to consider the gender equality impact of a number of economic policies. This is true not only of the government, but also of the manifesto commitments of opposition parties (with the exception of the Women's Equality Party).
Why does knowing about the gender impact of policies make for better policy-making?
The Equality Act 2010, which included the PSED, was one of the last Acts passed under the Labour government. Practice in implementing it has therefore been set by the coalition and subsequent Conservative governments.
The coalition government made a number of changes to the duty that reduced both its scope and its effectiveness. These included the removal of the socioeconomic duty, which would have required policy-makers to consider the impact of their policies on income-based inequality as well as other forms of inequality.
The government has also weakened the PSED in its implementation. It has significantly cut the budget and remit of the Equality and Human Rights Commission (EHRC), the body responsible for monitoring and enforcement of the PSED. Ministers have questioned the need for public bodies to carry out equality impact assessments (EIAs) and government departments have failed to publish them, making it impossible to judge whether ‘due regard’ has been paid to equality considerations.