Rate of caesarean section is alarming in China

The Lancet (Impact Factor: 45.22). 04/2014; 383(9927):1463-4. DOI: 10.1016/S0140-6736(14)60716-9
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Available from: Fangchao Liu, Jul 18, 2014
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    • "(Note that the Caesarean section rate, although high, is consistent with the general rate across China.) [12]. There were statistically significant differences in the frequency of self-reported past HBV vaccine and previous HBV testing between the women with initial positive vs. negative HBsAg tests. "
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    ABSTRACT: In regions where hepatitis B virus (HBV) is endemic, perinatal transmission is common. Infected newborns have a 90% chance of developing chronic HBV infection, and 1 in 4 will die prematurely from HBV-related liver disease. In 2010, the Hepatitis B Foundation and the Haimen City CDC launched the Gateway to Care campaign in Haimen City, China to improve awareness, prevention, and control of HBV infection citywide. The campaign included efforts to prevent perinatal HBV transmission by screening all pregnant women for hepatitis B surface antigen (HBsAg), following those who tested positive, and administering immunoprophylaxis to their newborns at birth. Of 5407 pregnant women screened, 185 were confirmed HBsAg-positive and followed until delivery. At age one, 175 babies were available for follow up testing. Of those, 137 tested negative for HBsAg and positive for antibodies to HBsAg, indicating protection. An additional 34 HBsAg-negative babies also tested negative for antibodies to HBsAg or had indeterminate test results, were considered to have had inadequate immune responses to the vaccine, and were given a booster dose. A higher prevalence of nonresponse to HBV vaccine was observed among babies born to hepatitis B e antigen (HBeAg)-positive mothers and mothers with high HBV DNA titers. The remaining 4 babies tested positive for HBsAg and negative for antibodies, indicative of active HBV infection. The mothers of all 4 had viral loads ≥8 × 106 copies/ml in the third trimester. Although inadequate response or nonresponse to HBV vaccine was more common among babies born to HBeAg-positive and/or high viral load mothers, these risk factors did not completely predict nonresponsiveness. All babies born to HBV-infected mothers should be tested upon completion of the vaccine series to ascertain adequate protection. Some babies of HBeAg-positive mothers with high viral load may still become HBV infected despite timely immunoprophylaxis with HBV vaccine and HBIG.
    Vaccine 02/2015; 55(26). DOI:10.1016/j.vaccine.2015.01.054 · 3.62 Impact Factor
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    ABSTRACT: Objectives To obtain a general overview of infant and young child feeding practices in one rural county in China and identify current delivery channels and challenges. Design A cross-sectional study. Setting A rural county, Zhao County, in Hebei Province, China. Participants 10 clusters were first selected within each township (16 townships in total) with proportional to population size sampling. In each cluster, a name list was used to select 13 children aged 0–23 months. We interviewed caregivers of all the selected children. Primary and secondary outcomes measures Coverage of infant feeding practices, reasons for low coverage of infant feeding practices and current delivery channels of infant feeding practices. Results Findings from our survey indicated that infant feeding practices were poor. Early initiation of breastfeeding was only 22.4%, exclusive breastfeeding for 6 months was less than 10% and continued breastfeeding up to the age of two was just 38.2%. Only 32.5% of children were given iron-rich or iron-fortified foods. The leading sources of infant feeding information were family members, neighbours, friends and popular media. Only around 20% of the information came from health facilities and nearly none came from communities. Household property data showed that 99.9% of households owned televisions and 99.4% owned mobile phones. In addition, 61.2% of the households owned computers, with 54.8% having access to the internet. Conclusions Few caregivers of children in Zhao County received feeding information during pregnancy and after delivery. Moreover, their feeding knowledge and practices were poor. Multi-channel approaches, delivered through health facilities, community resources, popular media, the internet and mobile phones, hold potential to improve infant feeding practices and should be explored in future studies. Strengths and limitations Although this study took place only within one county, a full range of globally standard feeding indicators was used to assess the feeding practices of caregivers in our study. The name lists of children in some villages may not be complete, and therefore selection bias may have occurred. Some indicators may have recall bias due to long recall time. Trial registration number ChiCTR-PRC-11001446.
    BMJ Open 07/2014; 4(7):e005108. DOI:10.1136/bmjopen-2014-005108 · 2.27 Impact Factor
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    ABSTRACT: Background The outcomes of pregnancy in immunoglobulin A nephropathy (IgAN) are uncertain. This study assessed the effects of pregnancy on kidney disease progression and risk factors for adverse pregnancy outcomes in IgAN. Study Design A matched-cohort study. Setting & Participants Women with IgAN with at least one pregnancy, 1 year of follow-up, and kidney function and proteinuria measurement at baseline (time of biopsy) matched with nonpregnant women with IgAN from Peking University First Hospital. Predictors Pregnancy, treated as a time-dependent variable; proteinuria; hypertension; and estimated glomerular filtration rate (eGFR). Outcomes Kidney disease progression, defined as eGFR halving or end-stage kidney disease; rate of eGFR decline; and adverse pregnancy outcomes, including severe pre-eclampsia, intrauterine death, embryo damage, fetal malformation, and induced and spontaneous abortions. Results Of 239 female patients, 62 women had 69 pregnancies and 62 matched nonpregnant patients were selected as controls. Pregnant patients had median proteinuria at baseline with protein excretion of 1.27 (range, 0.06-7.25) g/d and mean eGFR of 102.3 (range, 40.0-139.0) mL/min/1.73 m2. During a mean follow-up of 45.7 months, 4 patients in the pregnancy group and 6 in the nonpregnancy group had kidney disease progression events. Time-dependent Cox analysis showed that pregnancy was not an independent risk factor for kidney disease progression events (HR, 1.2; 95% CI, 0.3-5.7). There was no significant difference in the median rate of eGFR decline in the 2 groups (−2.5 vs −2.4 mL/min/1.73 m2 per year; P = 0.7). Adverse pregnancy outcomes were observed in 15 patients. Proteinuria during pregnancy (OR, 1.39; 95% CI, 0.96-2.01) was a borderline predictor of adverse pregnancy outcomes. Limitations Retrospective study, most patients had preserved kidney function, study underpowered to detect a difference in kidney failure events. Conclusions The study does not permit a definitive conclusion about the effect of pregnancy on kidney disease progression in IgAN.
    American Journal of Kidney Diseases 11/2014; 64(5). DOI:10.1053/j.ajkd.2014.06.021 · 5.90 Impact Factor
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