Background: To address the worldwide dramatically increased caesarean section (CS) rate in the past decades, the World Health Organization (WHO) has recommended the CS rate should not be higher than 10-15%. Whether it is achievable remains unknown.Methods: We collected data of delivery from 2008 to 2017 in two typical regional hospitals in China: Longhua Hospital (national policies rigorously implemented) and Dongguan Hospital (national policies not rigorously implemented). We compared between two hospitals the 10 years trend in annual rate of CS, standardized by parity and CS history, against the time of issuing relevant national, local, and hospital policies.Findings: 42441 women in Longhua and 36935 women in Dongguan gave birth in the 10 years. China’s first national policy on CS reduction was issued in 2010 and the formal relaxation of one-child policy was in 2015-16. The standardized annual CS rate was around 40% in 2008-09, declined sharply since 2010 down to 10.9% in 2016 (p for trend <0.001) and leveled off then in Longhua. In contrast, the rate stayed around 30% at the beginning, started to decrease slightly since 2012 down to 26% in 2015 (p for trend <0.001), and then bounced back to 31% in 2017 in Dongguan. Proportion of women with history of CS increased significantly in two hospitals (both roughly from 6% before 2010 to 20% after 2015). Analyses stratified by modified Robson classification showed that CS rates reduced in all risk classes of delivery women in Longhua but only in the Robson class 2 group in Dongguan. Major complications did not differ by hospital.Interpretation: With vigorously implementing national policies at micro levels, the WHO recommended CS rate could be achieved without increase in major complications.Funding Information: The study was funded by Guangdong Provincial Science and Technology Plan (2017A020214007) and Dongguan Technology Development Society (201950715032188).Declaration of Interests: The author(s) declare that they have no competing interests.Ethics Approval Statement: The study was approved by the institutional review boards of the two participating hospitals. Informed consent was not obtained as this was a retrospective study and the data came from the hospital's medical records.
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Objective: Excess sodium consumption is a major cause of high blood pressure and subsequent vascular disease. However, factors driving people's salt intake behavior remains largely unknown. Excess sodium consumption is a major cause of high blood pressure and subsequent vascular disease. However, factors driving people's salt intake behavior remains largely unknown. Design and Method: Study aim is to assess the relationship of salt intake behaviors with knowledge and belief on salt and health among older adults in rural China. A cross-sectional survey was conducted among 4,693 older participants (male 50 and female 60 years old) randomly selected from 120 rural villages in 5 Northern provinces in China. Healthy salt intake behavior was defined as either not eating pickled foods or not adding pickles/soy sauce/salt when food was not salty enough in past 3 months. Results: There were 81% participants having healthy salt intake behavior. Healthy salt intake behavior was more common among women (p < 0.01) and was positively associated with age (p < 0.01) and poorer health status (p < 0.01), but negatively associated with years in school (p < 0.05). After adjusting for age, gender, years in school, and health status, participants who believed in the harm of high salt intake were more likely to have healthy salt intake behavior, compared with those who did not believe (Odds Ratio = 1.6, p < 0.001). Knowledge of salt intake was not significantly related to healthy salt intake behavior. Conclusions: Our study demonstrated that belief in harm of high salt intake rather than knowledge on salt and health was associated with healthy salt intake behavior, independent of age, sex, years in school and health status. Future population salt reduction program should place more emphasis on establishing health belief rather than only on delivering salt-related knowledge.
To evaluate the effect of statin therapy on the decrease of common carotid artery intima-media thickness (CCA-IMT) compared to placebo or usual care.A systematic search of electronic databases (MEDLINE, EMBASE, and Cochrane Center Register) up to December 2011 was performed. Two reviewers independently determined the eligibility of randomized controlled trials (RCTs) comparing statin therapy with a placebo or usual care with a minimum follow-up of 6 months.Twenty-one RCTs involving 6317 individuals were included in this review. The pooled weighted mean difference (WMD) between statin therapy and placebo or usual care on CCA-IMT was -0.029 mm (95%CI: -0.045, -0.013). Subgroup analyses showed significant effects of lovastatin (WMD: -0.077; 95%CI: -0.082, -0.073) and simvastatin (WMD: -0.069; 95%CI: -0.094, -0.045), followed by pravastatin and rosuvastatin, but no significant benefits of atorvastatin, fluvastatin, or cerivastatin. A greater decrease in mean CCA-IMT was observed in the setting of secondary prevention versus primary prevention (WMD: -0.045 vs. -0.004), in younger patients versus older patients (WMD: -0.057 vs. -0.041), and in studies where the patient proportion was males ≥ females (-0.044 vs. -0.008). Meta-regression analysis showed a significant association between changes in mean CCA-IMT with decreasing triglyceride levels. A similar, but not statistically significant trend was also found between CCA-IMT decrease and the decrease in LDL-C levels or increase in HDL-C levels.Statin therapy is associated with a favorable decrease in CCA-IMT, an effect that seems to be mainly driven by the CCA-IMT at baseline and the extent of lipid decrease, specifically triglycerides.
Cardiovascular, respiratory, and related disorders (CVRDs) and conditions are responsible for a significant portion of the world’s health burden. In 2012, 52 percent of global adult deaths were caused by CVRDs, and most occurred in low- and middle-income settings. Most CVRDs and related disorders are preventable or can be treated to reduce morbidity. Doing so, however, requiresgreater capacity to detect and treat at an early stage, as they are often “silent” diseases. These conditions also threaten economic development due to reduced productivity among those affected with illness and early death, as well as high household treatment costs that are often paid out of pocket in low-resource settings. Combined with the enduring presence of infectious diseases, suchas tuberculosis and HIV/AIDS, CVRDs in low-income countries create a double burden of disease. The Cardiovascular, Respiratory, and Related Disorders volume of DCP3 contributes to existing research efforts in several ways: By summarizing the best available evidence for effective and scalable interventions; By identifying the most effective and cost-effective priority interventions; By describing the health platforms that can deliver these interventions and thereby curtail the increasing risk for chronic conditions and diseases. The volume also provides an essential package of policy and health interventions that are cost-effective and feasible in lower-middle-income countries and can significantly reduce the health burden of these diseases. The author focus primarily on cardiovascular diseases and the primary risks—including ischemic heart disease,stroke, and congestive heart failure—as well as secondary risk factors, such as tobacco use, physical activity, and obesity. The authors also include three other major chronic conditions: respiratory diseases, diabetes, and kidney disease. These conditions share risk factors and are often precursors for one another, and address treatment and prevention of these conditions together. Cancer and mental health, typically grouped among non-communicable diseases, are covered in DCP3 volumes three and four, respectively. This volume finds that effective prevention strategies are often under used in countries at all income levels. Substantial progress against CVRDs has been achieved in high- and upper-middle-income countries, partly as the result of policies that are applied at the population level—such as tobacco taxation or bans on trans-fats—and partly due to the availability of cost-effective pharmacological treatments. These policies have not been widely implemented in lower-income countries. This volume’s essential package recommends 36 policy and health system interventions using primary health servicedelivery platforms. This set of interventions is focused on population prevention, as well as on targeting high risk populations in LMICs to prevent and reduce early mortality from CVRDs.
Objective: To compare the BP lowering effect of ARBs and thiazide diuretics in high sodium intake patients with mild to moderate hypertension. Design and Method: This research was a multicenter randomized double-blinded parallel controlled trial. Eligible participants were randomly divided into T40 and H25 groups, with 3 follow-ups, scheduled on the 15th, 30th and 60th day to compare the difference of average BP decrease, blood pressure control rates, FBG (fast blood glucose), hypokalemia and other adverse events between two groups after intervention. Results: 1333 participants were enrolled from 14 county hospitals in high-salt-intake area of China in 2014, with average sodium intake of 5893 mg per day. Baseline characteristics were well balanced between groups. In general, SBP/DBP reduction in T40 group was 12.5/8.0, 14.3/9.1 and 12.8/7.2 mmHg at 15 days, 30 days and 60 days of follow-up, respectively, while the counterparts in H25 group was 11.0/5.8, 13.6/7.1 and 11.5/5.3 mmHg, respectively. BP reduction in T40 group was greater than that in H25 group at 3 follow-up visits, but with only statistical significance for DBP. When controlled by gender, age, body mass index and baseline BP, subgroup analysis showed that DBP reduction was still higher in T40 group than that in H25 group (P < 0.001) regardless of the amount of urine sodium excretion and pulse pressure (PP). SBP reduction was positively related to increasing urine sodium and PP level for patients in both groups, but increased faster with increasing PP in H25 group than that in T40 group (P = 0.0238 for group*PP). Compared with T40, patients in H25 group showed more hypokalemia (T:0.4% vs H:4.5%, P < 0.001). Conclusions: Telmisartan 40 mg showed better DBP lowering effect and less hypokalemia than HCTZ 25 mg among high sodium intake patients with mild to moderate hypertension. Effect superiority of HCTZ among patients with large pulse pressure might exist and needs further test.
Radiation therapy is the method of choice for subjects with inoperable salivary gland malignancies. I-125 brachytherapy, delivering a high radiation dose to a tumor but sparing surrounding normal tissues, is supposed to be ideal modality for the treatment of salivary gland malignancies. We designed a randomised controlled clinical trial to compare the efficacy of I-125 permanent brachytherapy (PBT) versus intensity-modulated radiation therapy (IMRT) for inoperable salivary gland malignancies. In this study, inclusion criteria are subjects with inoperable salivary gland malignancies, aged 18–80 years, have provided informed consent, with at least one measurable tumor focus, be able to survive ≥3 months, Karnofsky performance status ≥60, have adequate hematopoietic function of bone marrow, have normal liver and kidney function, and are willing to prevent pregnancy. Exclusion criteria include a history of radiation or chemotherapy, a history of other malignant tumors in the past 5 years, receiving other effective treatments, participating in other clinical trials, with circulatory metastasis, cognitive impairment, severe cardiovascular and cerebrovascular diseases, acute infection, uncontrolled systemic disease, history of interstitial lungdisease, and being pregnant or breast feeding. The study will be conducted as a clinical, prospective, randomised controlled trial with balanced randomisation (1:1). The planned sample size is 90 subjects. Subjects with inoperable salivary gland malignancies are randomised to receive either I-125 PBT or IMRT, with stratification by tumor size and neck lymph node metastasis. Participants in both groups will be followed up at 2, 4, 6, 9, 12, 15, 18, 21 and 24 months after randomization. The primary outcome is local control rate of the primary site (based on imaging findings and clinical examination, RECIST criteria) in 1 year. Secondary outcomes are progression-free survival, overall survival, quality of life (QOL) measured with the European Organization for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C30 and QLQ-H&N35) of Chinese version, and safety of treatment. Chi-squared test is used to compare the local control rates in both groups. The survival curves are estimated by the Kaplan-Meier method, and log-rank test is used to test the significant difference. Only few observational studies have investigated the effect of I-125 PBT on inoperable salivary gland malignancies. To our knowledge, this is the first randomised controlled trial to investigate the efficacy of I-125 PBT for subjects with inoperable salivary gland malignancies, and will add to the knowledge base for the treatment of these subjects. The study is registered to Clinical Trials.gov ( NCT02048254 ) on Jan 29, 2014.
Tumor necrosis factor α inhibitors (TNFi) is effective for rheumatoid arthritis (RA) patients who fail to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Because of high cost, the discontinuation is common but often lead to disease relapse. The study aims to investigate, if the combination therapy of csDMARDs is more effective in reducing disease relapse than methotrexate (MTX) monotherapy, and more cost-effective than continuing TNFi and MTX.It will be a two-stage trial. In the first stage, all RA patients who failed to csDMARDs treatment [disease activity score 28 (DAS28)-CRP > 3.2] will receive MTX plus TNFi for no more than 12 weeks. Patients achieving DAS28-CRP < 3.2 during the first stage will be randomized into three groups at 1:1:1 ratio: (A) add hydroxychloroquine (HCQ) and sulfasalazine (SSZ) for the first 12 weeks and then remove TNFi but continue other treatments for the next 48 weeks; (B) maintain TNFi + MTX for 60 weeks; and (C) maintain TNFi + MTX for the first 12 weeks and then remove TNFi but continue MTX monotherapy for the next 48 weeks. The primary outcome will be disease relapse (DAS28-CRP increases by at least 0.6 and > 3.2). Secondary outcomes will include the incremental cost per reducing 1 case of relapse; patient reported intolerance to the treatment; adverse events; change of mean disease activity measured by DAS28, clinical disease activity index (CDAI) and simplified disease activity index (SDAI); the proportion of modified Sharp score increase < 0.3; ultrasound-detected remission in hands; Health Assessment Questionnaire Disability Index (HAQ-DI) and health related quality of life [the five-level EuroQol-5D (EQ-5D-5L) and short form-6D (SF-6D)].The aim of this trail will be to seek effective treatment options of preventing relapse of RA. The results of the current study may provide an instructive recommendation for more economical application of TNFi treatment in RA. Trial registration NCT, NCT02320630. Registered on 16 December 2014. https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=3&cx=-jg9qo2 .
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