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( MENAFN - The Conversation) The Canadian Institute for health Information (CIHI) has updated its interactive tool,“Your Health System,” which reviews health-care data across all provinces and makes recommendations for the delivery of services, such as childbirth. This includes“low-risk” caesarean rates, meaning the number of low-risk women who have surgery after labouring with a single baby in their first pregnancy. Provincial “low risk” caesarean rates are compared to the 17.9 per cent national average, including Alberta's 20.8 per cent rate and British Columbia's 24.5 per cent rate , which are graded“below average.” In fact, CIHI's message to all hospitals, physicians and patients on caesarean births in general is clear: A lower rate is“desirable.” But is it? Challenging this inherently flawed measure of patient care is long overdue. As a standalone statistic, a“low risk” caesarean rate lacks the nuance needed to inform and improve individual clinical care. It simply tells us how many first-time mothers who went into spontaneous labour had a caesarean birth. It does not tell us the clinical considerations behind the decision to intervene, or the relief many mothers feel when a caesarean is performed due to unforeseen complications during labour. We are not reminded that the average age of a mother giving birth in Canada has risen to 31.7 years , representing an upward trend that carries higher risks . Nor does it consider changes in baseline rates of pre-existing medical conditions and pregnancy related medical conditions , high infant birth weights that are associated with obstructed labour and fetal distress , and modern developments in fetal monitoring that more frequently diagnose potential fetal distress. CIHI's indicator targets those for whom vaginal birth“is expected,” implying that many caesareans are unnecessary. However, childbirth is intrinsically unpredictable, and tolerance for poor outcomes is low. Parents expect a living and healthy baby, and caesareans are an important part of how obstetricians achieve this for Canada's families. Outcomes for mothers matter, too. Last year, new evidence highlighted Canada's“unacceptably high” rate of severe injuries to the pelvic floor from forceps and vacuum use, and the highest anal sphincter injury rate of 24 high-income countries. Researchers criticized a lack of concerted effort to reduce these injuries. A province's increasing caesarean rate could mean obstetricians are offering caesarean birth as an alternative, and that more mothers are choosing to avoid an instrumental delivery. Especially as pelvic floor injuries increase a woman's lifetime risk for urinary and fecal incontinence, pelvic organ prolapse, and complex surgeries that cannot always solve these issues . Any policy or practice denying choice in childbirth, or refusing and delaying caesareans on the mere presumption that rates should be lower, defies the principles of patient-centred care. Read more: Requests for caesarean birth brushed aside, despite guidelines to respect maternal choices And given the United Kingdom's landmark Montgomery Supreme Court judgment on autonomy, maternal satisfaction is a more appropriate measure of success than any caesarean rate. CIHI could learn another valuable lesson from the U.K., too, since its stated intention“to help reduce C-section rates” in Canada is linked to concerns about“higher costs .” For decades, U.K. hospital staff and even safety inspectors blindly supported extraneous efforts to reduce caesarean births , until outstanding multi-billion (yes, billion) dollar litigation costs for maternity services caught the attention of government. Demands for change by families whose babies and mothers died or were seriously injured as a result of delayed and absent caesareans, often for“low-risk” pregnancies, led to police investigations , a national safety inquiry and criticism of birth mode targets . Litigation may be notoriously difficult for patients similarly harmed in Canada's health-care system, but it is rising , as are the long-term costs associated with pelvic floor damage. Furthermore, Canada has long faced challenges with regional health-care variations driven by diverse patient needs, physician practices and resource availability (staff and blood, for example). Recognizing this, CIHI recommends better access to caesareans in remote areas. However, we argue it now needs to rethink its blanket position elsewhere that a“lower rate is desirable.” Especially as its recent statement inexplicably links to an obsolete national “normal childbirth” policy that warns it is for historical research only, not clinical use. To genuinely guide health-care evolution, CIHI's childbirth metrics must adopt a broader, patient-centred perspective. It should recognize that women's reproductive health extends far beyond the delivery room, and incorporate data on common but often overlooked conditions, such as pelvic floor disorders , endometriosis, infertility and uterine bleeding. Women are not merely vessels for childbirth - they are whole individuals with diverse health needs. Canadian women deserve comprehensive, thoughtful reporting of data that acknowledges and addresses these unique aspects of their health. MENAFN23122024000199003603ID1109025348 Legal Disclaimer: MENAFN provides the information “as is” without warranty of any kind. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the provider above.Honda, Nissan announce plans to merge, forming the world’s third-largest automaker by sales TOKYO: Japanese automakers Honda and Nissan have announced plans to join forces, forming world’s third-largest automaker by sales as the industry undergoes dramatic changes in its transition away from fossil fuels. The two companies said they had signed a memorandum of understanding on Monday and that smaller Nissan alliance member Mitsubishi Motors also had agreed to join the talks on integrating their businesses. “We anticipate that if this integration comes to fruition, we will be able to deliver even greater value to a wider customer base,” Nissan’s CEO Makoto Uchida said in a statement. Automakers in Japan have lagged behind their big rivals in electric vehicles and are trying to cut costs and make up for lost time. News of a possible merger surfaced earlier this month, with unconfirmed reports saying that the talks on closer collaboration partly were driven by aspirations of Taiwan iPhone maker Foxconn to tie up with Nissan, which has an alliance with Renault SA of France and Mitsubishi. A merger could result in a behemoth worth more than $50 billion based on the market capitalisation of all three automakers. Together, Honda and the Nissan alliance with Renault SA of France and smaller automaker Mitsubishi Motors Corp would gain scale to compete with Toyota Motor Corp and with Germany’s Volkswagen AG. Toyota has technology partnerships with Japan’s Mazda Motor Corp. and Subaru Corp. Even after a merger Toyota, which rolled out 11.5 million vehicles in 2023, would remain the leading Japanese automaker. If they join, the three smaller companies would make about 8 million vehicles. In 2023, Honda made 4 million and Nissan produced 3.4 million. Mitsubishi Motors made just over 1 million. Nissan, Honda and Mitsubishi announced in August that they would share components for electric vehicles like batteries and jointly research software for autonomous driving to adapt better to dramatic changes centred around electrification, following a preliminary agreement between Nissan and Honda set in March. Honda, Japan’s second-largest automaker, is widely viewed as the only likely Japanese partner able to effect a rescue of Nissan, which has struggled following a scandal that began with the arrest of its former chairman Carlos Ghosn in late 2018 on charges of fraud and misuse of company assets, allegations that he denies. He eventually was released on bail and fled to Lebanon. Speaking Monday to reporters in Tokyo via a video link, Ghosn derided the planned merger as a “desperate move”. From Nissan, Honda could get truck-based body-on-frame large SUVs such as the Armada and Infiniti QX80 that Honda doesn’t have, with large towing capacities and good off-road performance, Sam Fiorani, vice president of AutoForecast Solutions, told The Associated Press. Nissan also has years of experience building batteries and electric vehicles, and gas-electric hybird powertrains that could help Honda in developing its own EVs and next generation of hybrids, he said. But the company said in November that it was slashing 9,000 jobs, or about 6% of its global work force, and reducing its global production capacity by 20% after reporting a quarterly loss of 9.3 billion yen ($61 million). It recently reshuffled its management and Makoto Uchida, its chief executive, took a 50% pay cut to take responsibility for the financial woes, saying Nissan needed to become more efficient and respond better to market tastes, rising costs and other global changes. Fitch Ratings recently downgraded Nissan’s credit outlook to “negative”, citing worsening profitability, partly due to price cuts in the North American market. But it noted that it has a strong financial structure and solid cash reserves that amounted to 1.44 trillion yen ($9.4 billion). Nissan’s share price also has fallen to the point where it is considered something of a bargain. On Monday, its Tokyo-traded shares gained 1.6%. They jumped more than 20% after news of the possible merger broke last week. Honda’s shares surged 3.8%. Honda’s net profit slipped nearly 20% in the first half of the April-March fiscal year from a year earlier, as sales suffered in China. The merger reflects an industry-wide trend toward consolidation. At a routine briefing Monday, Cabinet Secretary Yoshimasa Hayashi said he would not comment on details of the automakers’ plans, but said Japanese companies need to stay competitive in the fast changing market. “As the business environment surrounding the automobile industry largely changes, with competitiveness in storage batteries and software is increasingly important, we expect measures needed to survive international competition will be taken,” Hayashi said. Agencies
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TEHRAN- Iran has risen from seventh to fourth place globally in intangible cultural heritage, the Deputy Minister for Cultural Heritage has announced. Over the past four years, Iran has improved its standing from seventh to fourth position and currently leads in the registration of multinational heritage files, Ali Darabi has said. He made these remarks on Sunday during a ceremony in Tehran celebrating the International Day of Intangible Cultural Heritage, which was attended by various cultural heritage officials. In his remarks at the ceremony, he emphasized the importance of intangible cultural heritage as a vital asset of society, one that is transmitted from generation to generation and from era to era, CHTN reported on Monday. He stressed the importance of transforming cultural heritage literacy into a shared cultural value within society, asserting that cultural heritage should be accessible and significant to all. Furthermore, Darabi pointed out the vital role of cultural heritage in public diplomacy, noting that the primary aim of public diplomacy is to influence public opinion, facilitated through cultural exchanges such as exhibitions, festivals, and sister-city relationships. Emphasizing the need for networking and coordination both domestically and internationally, he called for all effective institutions in the country to contribute to this cause. "Cultural heritage does not belong to any single institution but is the responsibility of all components and individuals in the nation. We must have short-term, mid-term, and long-term plans, and we need to have a significant presence on the global stage," he stated. Intangible cultural heritage refers to the practices, expressions, knowledge, and skills that communities, groups, and individuals recognize as part of their cultural inheritance. Unlike tangible heritage, such as monuments and artifacts, intangible cultural heritage includes traditions, oral histories, performing arts, social practices, rituals, and festive events. This form of heritage plays a crucial role in maintaining cultural diversity in the face of globalization, as it fosters a sense of identity and continuity among communities, allowing them to express their values, histories, and social cohesion. The preservation of intangible cultural heritage is essential for promoting cultural sustainability and fostering mutual respect among diverse cultures. Recognized by the United Nations Educational, Scientific and Cultural Organization (UNESCO) through the Convention for the Safeguarding of the Intangible Cultural Heritage, efforts are being made to safeguard these practices through documentation, education, and community involvement. By engaging local communities in preserving their traditions and encouraging intergenerational transmission, intangible cultural heritage not only enriches the cultural landscape but also empowers communities, enhances social cohesion, and promotes a deeper understanding of cultural diversity on a global scale. SAB/
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