Socioeconomic determinants of rural women's desired fertility: A survey in rural Shaanxi, China

There has been evidence demonstrating that China has had a persistently low and below-replacement level fertility since early 1990s, causing concerns of a rapidly aging population and sustainability of the Chinese economy. To avoid adverse effects of excessively low fertility, the Chinese government has recently changed its family planning policy from "one-child policy" to "two-child policy." Nonetheless, the effectiveness of the newly initiated two-child policy is questionable if women's average desired number of children or desired fertility for their lifetime is below the threshold fertility allowed by the two-child policy. Therefore, this study argues that it would be interesting and pertinent to know women's fertility desires under the circumstances of no policy restrictions and understand major factors that may affect their desired fertility. Based on a multi-stage stratified cluster sampling survey with 2,516 women respondents in rural Shaanxi, this study tries to estimate desired fertility of rural women and evaluate the impact of important socioeconomic factors on their desired fertility. The results of this study reveal that the average lifetime desired fertility for rural women of childbearing age in Shaanxi is about 1.71, below the total fertility rate at the replacement level. The findings of this study suggest that women's marriage age, the pecuniary costs of having children, women's income forgone for having children, and social security benefits available for rural residents at retirement age, are significantly and negatively related to desired fertility. However, rural women's cultural views towards fertility are significantly but positively related to their desired fertility. This study further confirms that China has entered an era of low fertility, and thus, any policy restrictions on fertility may no longer be necessary. Instead, government programs which support childbearing and childrearing are needed to prevent excessive low fertility and rapid aging of the population

A propensity-matched study of the association between prepregnancy maternal underweight and perinatal outcomes among singletons based on an ART cohort

Research question Is prepregnancy maternal underweight associated with perinatal outcomes of singletons who were conceived by assisted reproductive technology (ART)? A 10-year (2006-2015) Chinese sample of 6538 women and their singletons who were conceived by ART was used to examine the association between prepregnancy maternal underweight and perinatal outcomes. Propensity scores(PS) for underweight were calculated for each participant using multivariable logistic regression, which was used to match 740 (91.35% of 810) underweight women with 740 normal weight women and then the effects of underweight on birth weight (BW) and gestational age (GA) were assessed by the generalized estimating equation (GEE) model. Results After PS matching, the BW was lower (difference=-136.83 g, 95% CI=-184.11 to -89.55 g) in the underweight group than in the normal weight group. The risks of low birth weight (LBW) and small for gestational age (SGA) were increased in the underweight group compared with those in the normal weight group (LBW: RR=1.64, 95% CI=1.01 to 2.67; SGA: RR=1.46, 95% CI=1.06 to 2.02). The risks of fetal macrosomia and being large for gestational age (LGA) were decreased in the underweight group compared with those in the normal weight group (macrosomia: RR=0.39, 95% CI=0.26 to 0.61; LGA: RR=0.36, 95% CI=0.24 to 0.53). The associations between underweight and GA and preterm birth (PTB) were not statistically significant. Conclusions Among women undergoing ART, prepregnancy maternal underweight was associated with lower BW, increased LBW and SGA risks and decreased fetal macrosomia and LGA risks in singletons

Changes in inequality in utilization of preventive care services: evidence on China’s 2009 and 2015 health system reform

BACKGROUND: Ensuring equal access to preventive care has always been given a priority in health system throughout world. This study aimed to decompose inequality in utilization of preventive care services into its contributing factors and then explore its changes over the period of China's 2009-2015 health system reform. METHODS: The concentration index (CI) and decomposition of the CI was performed to capture income-related inequalities in preventive services utilization and identify contribution of various determinants to such inequality using data from China Health and Nutrition Survey. Then, changes in inequality from 2009 to 2015 were estimated using Oaxaca-type decomposition technique. RESULTS: The CI for preventive services utilization dropped from 0.2240 in 2009 to 0.1825 in 2015. Residential location and household income made the biggest contributions to income-related inequalities in these two years. Oaxaca decomposition revealed changes in residential location, regions and medical insurance made positive contributions to decline in inequality. However, alternation in household income, age and medical services utilization pushed the equality toward deterioration. CONCLUSION: The pro-rich inequality in preventive healthcare services usage is evident in China despite a certain decline in such inequality during observation period. Policy actions on eliminating urban-rural and income disparity should be given the priority to equalize preventive healthcare

Increase in the prevalence of health anxiety in medical clinics: Possible cyberchondria.

BACKGROUND Health anxiety may be an increasing problem because of the focus on monitoring health and increasing use of the Internet for self-diagnosis (cyberchondria). There is very little information about changes in the prevalence of health anxiety. AIM We compared the prevalence of health anxiety in four medical clinics in one hospital over a 4-year period using the Health Anxiety Inventory (HAI) as a diagnostic marker. METHOD Patients attending cardiology, endocrine, gastroenterology and respiratory medicine clinics at King's Mill Hospital, North Nottinghamshire, completed the HAI while waiting for their appointments. There were eight research assistants involved in collecting data, two in the 2006-2008 period and six in the 2008-2010 period. As a consequence, more data were collected on the second occasion. RESULTS There was an increase in the prevalence of health anxiety from 14.9% in 2006-2008 (54 positive of 362 assessed) to 19.9% (1,132 positive out of 5,704 assessed) in 2008-2010. This increase was primarily noted in gastroenterology clinics (increase of 10%) and not shown in endocrine ones. CONCLUSION The prevalence of health anxiety is increasing in those who attend medical out-patient clinics. Reasons are given that this may be a possible result of cyberchondria, as the excessive use of the Internet to interpret troubling symptoms is growing. Further studies are needed in other populations, but there is reason to be concerned at this trend as it is likely to increase the number of medical consultations unnecessarily

Use of Cumulative Live Birth Rate per Total Number of Embryos to Calculate the Success of IVF in Consecutive IVF Cycles in Women Aged ≥35 Years

Objective. The use of cumulative live birth rate (CLBR) per ovarian stimulation cycle is proving to be an accurate method to calculate the success of IVF; however, the cycle outcome is closely associated with the number of embryos transferred (ET). Our aim was to report CLBR after IVF according to the number of embryos required to achieve a live birth in women aged ≥35 years, considering age, body mass index (BMI), and ethnicity. Methods. We conducted a retrospective cohort study including 1344 patients who underwent IVF between January 2013 and June 2016 at the First Affiliated Hospital of Xinjiang Medical University. The cumulative probability of live birth for each couple was estimated using the Kaplan–Meier method, and survival curves were compared according to age, BMI, and ethnicity using the log-rank test. Results. CLBR increased rapidly from 1 to 5 ETs, moderately from 6 to 10 ETs, and slowly thereafter. CLBR was significantly different across 4 categories based on BMI as well as across those based on age; low CLBR was significantly associated with the age of ≥42 years and obesity. Conclusion. The association between CLBR and number of ET provides realistic and precise information regarding the success of IVF and can be applied to guide clinicians and patients

The percutaneous coronary intervention prior to transcatheter aortic valve implantation (ACTIVATION) trial: study protocol for a randomized controlled trial

Background Current guidelines recommend treatment of significant coronary artery disease by concomitant coronary artery bypass grafting (CABG) in patients undergoing surgical aortic valve replacement. However there is no consensus as to how best to treat coronary disease in high-risk patients requiring transcatheter aortic valve implantation (TAVI). Methods/Design The percutaneous coronary intervention prior to transcatheter aortic valve implantation (ACTIVATION) trial is a randomized, controlled open-label trial of 310 patients randomized to treatment of significant coronary artery disease by percutaneous coronary intervention (PCI - test arm) or no PCI (control arm). Significant coronary disease is defined as ≥1 lesion of ≥70% severity in a major epicardial vessel or 50% in a vein graft or protected left main stem lesion. The trial tests the hypothesis that the strategy of performing pre-TAVI PCI is non-inferior to not treating such coronary stenoses with PCI prior to TAVI, with a composite primary outcome of 12-month mortality and rehospitalization. Secondary outcomes include efficacy end-points such as 30-day mortality, safety endpoints including bleeding, burden of symptoms, and quality of life (assessed using the Seattle Angina Questionnaire and the Kansas City Cardiomyopathy Questionnaire). In conclusion, we hope that using a definition of coronary artery disease severity closer to that used in everyday practice by interventional cardiologists - rather than the 50% severity used in surgical guidelines - will provide robust evidence to direct guidelines regarding TAVI therapy and improve its safety and efficacy profile of this developing technique. Trial registration ISRCTN75836930, http://www.controlled-trials.com/ISRCTN75836930 (registered 19 November 2011)

Do standardised prognostic algorithms reflect local practice? Application of EORTC risk tables for non-muscle invasive (pTa/pT1) bladder cancer recurrence and progression in a local cohort.

A risk calculator algorithm to allow prediction of probabilities of 1- and 5-year recurrence and progression rates in individuals with pTa/pT1 bladder cancer has been proposed by the European Organisation for Research and Treatment of Cancer (EORTC) and was incorporated into the European Association of Urology guidelines in 2006. We attempted to validate this algorithm in a cohort of patients with known outcome. Prognostic data were collected from a consecutively presenting cohort of 109 patients with non-muscle invasive (pTa/pT1) transitional cell cancer (TCC) at a single institution between 1983 and 1985. Using the same statistical models as in the EORTC original paper, predicted probabilities of 1- and 5-year recurrence and progression were calculated. Patients were divided into four risk groups for recurrence (Ir-IVr) and progression (Ip-IVp), respectively, using six prognostic criteria. These were then compared to the probabilities predicted in the EORTC algorithm. The predicted 1- and 5-year probabilities of recurrence were significantly higher in the study population as compared to the original EORTC algorithm for all four risk groups. The predicted 1-year probabilities for progression in groups Ip/IIIp and at 5-years for groups Ip/IIp were in accordance with the original algorithm, but were higher for the other progression groups. The concordance for the model of prediction using the study group for recurrence at 1 and 5 years was 62 and 63%, respectively, and for progression was 65 and 67%, respectively. We were unable to validate the proposed algorithm in our group of patients. Although our study has limitations that prevent firm conclusions on the validity of the algorithm, it does expose some of the drawbacks of standardised nomograms when applied to local clinical practice

Urgent need to develop evidence-based self-help interventions for mental health of healthcare workers in COVID-19 pandemic

Thepandemicof COVID-19 has rapidly spread to over 200 countries and territoriesin the past 4months. To save lives and minimizetransmission, millions of healthcareworkers are working in frontlines worldwidebut putting themselves at high risk from the disease. All of themare workingunder extreme pressuresandexperiencinggreat psychological distressin such a challenging situation.In addition to the huge psychological pressure, healthcare workers around the world face morale and burnout issues as they have to make impossible decisions(Greenberg, Docherty, Gnanapragasam, & Wessely, 2020).It is encouraging is that the World Health Organization (WHO) and manyinstitutions have proposedguidelinesto providepsychological assistance for healthcare workers duringthispandemi

Clinical characteristics and risk factors of patients with severe COVID-19 in Jiangsu province, China: a retrospective multicentre cohort study

BACKGROUND Coronavirus Disease-2019 (COVID-19) pandemic has become a major health event that endangers people health throughout China and the world. Understanding the factors associated with COVID-19 disease severity could support the early identification of patients with high risk for disease progression, inform prevention and control activities, and potentially reduce mortality. This study aims to describe the characteristics of patients with COVID-19 and factors associated with severe or critically ill presentation in Jiangsu province, China. METHODS Multicentre retrospective cohort study of all individuals with confirmed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infections diagnosed at 24 COVID-19-designated hospitals in Jiangsu province between the 10th January and 15th March 2020. Demographic, clinical, laboratory, and radiological data were collected at hospital admission and data on disease severity were collected during follow-up. Patients were categorised as asymptomatic/mild/moderate, and severe/critically ill according to the worst level of COVID-19 recorded during hospitalisation. RESULTS A total of 625 patients, 64 (10.2%) were severe/critically ill and 561 (89.8%) were asymptomatic/mild/moderate. All patients were discharged and no patients died. Patients with severe/critically ill COVID-19 were more likely to be older, to be single onset (i.e. not belong to a cluster of cases in a family/community, etc.), to have a medical history of hypertension and diabetes; had higher temperature, faster respiratory rates, lower peripheral capillary oxygen saturation (SpO), and higher computer tomography (CT) image quadrant scores and pulmonary opacity percentage; had increased C-reactive protein, fibrinogen, and D-dimer on admission; and had lower white blood cells, lymphocyte, and platelet counts and albumin on admission than asymptomatic/mild/moderate cases. Multivariable regression showed that odds of being a severe/critically ill case were associated with age (year) (OR 1.06, 95%CI 1.03-1.09), lymphocyte count (10/L) (OR 0.25, 95%CI 0.08-0.74), and pulmonary opacity in CT (per 5%) on admission (OR 1.31, 95%CI 1.15-1.51). CONCLUSIONS Severe or critically ill patients with COVID-19 is about one-tenths of patients in Jiangsu. Age, lymphocyte count, and pulmonary opacity in CT on admission were associated with risk of severe or critically ill COVID-19