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1.
Background
Excessive gestational weight gain appears to be a risk factor for low and high birthweight, preterm delivery, gestational diabetes, pre-eclampsia, caesarean section, and post-partum haemorrhage). The objective of this study was to determine the association between gestational weight gain and pregnancy outcomes.Methods
This retrospective cohort study was done at a primary health-care centre supported by the Palestinian Ministry of Health in Tulkarem (one of the main cities in northern occupied Palestinian territory) and in two United Nations Relief and Works Agency (UNRWA) primary health-care centres (in the Tulkarem and Nourshams Camps) in 2016. Patient files of women who had given birth were reviewed, and sociodemographic data, medical history, body-mass index (BMI), and gestational weight gain were recorded. We used SPSS version 20 for statistical analysis. Significance was set at a p value of less than 0·05. This study was approved by the Institutional Review Board committee at An-Najah National University, and permission was obtained from the Ministry of Health and the UNRWA.Findings
771 patient files were reviewed (326 from Tulkarem City, 274 from Tulkarem Camp, and 171 from Nourshams Camp). The mean age of mothers at first visit was 26·5 years (SD 5·81), and 328 (43%) women had attended tertiary education. 341 (44%) women had a normal BMI at first visit, 254 (33%) women were overweight, and 147 (19%) women were obese. 283 (37%) women gained weight within recommended levels, and 213 (28%) women gained more than the recommended weight. 210 (27%) women had a caesarean section. The incidences of preterm delivery, gestational diabetes, pre-eclampsia, and post-partum haemorrhage were 9%, 6%, 2%, and 10%, respectively. 405 (53%) newborn babies were boys and 366 (48%) were girls, with an overall mean birthweight of 3313 g (SD 511·83). 37 (5%) neonates had low birthweight, and 60 (8%) neonates had high birthweight. Bivariate analysis showed a significant association between gestational weight gain and BMI at first visit, high birthweight, and post-partum haemorrhage (p<0·001). Multivariate logistic regression showed that women who gained weight above recommendations had a higher risk of giving birth to a baby with high birthweight (odds ratio 3·4, 95% CI 1·65–7·00), whereas women who gained less than recommended had a lower risk of developing post-partum haemorrhage (odds ratio 0·44, 95% CI 0·199–0.996).Interpretation
Gaining more than the recommended weight during pregnancy is consistently associated with negative maternal and infant outcomes. These effects could be avoided if improved individualised care were systematically implemented in both ministry of health and UNRWA clinics to support women preconceptionally, prenatally, and post partum.Funding
None. 相似文献2.
Background
Inadequacy of breastfeeding was considered the only factor leading to excessive weight loss, which might lead to unnecessary initiation of formula. However, other factors might contribute and should be considered. The aim of this study was to observe the effect of fluids given antenatally to mothers on the weight of their newborn children.Methods
This prospective observational study was done in the newborn nursery and labour room of the Al-Makassed Hospital. We included all women who had an uncomplicated pregnancy, were admitted between May 1 and Aug 31, 2015, and gave birth to a single healthy full-term baby weighing 2500–3999 g. We documented amount of intravenous fluids, weight of the newborn baby, and weight of diapers every 8 h until the mother and child were discharged from hospital. This study was approved by the ethical committee at Al-Makassed Hospital. Parental consent was taken verbally for participation.Findings
375 pregnant women participated in this study, of whom 266 (71%) were multiparous and 247 (66%) had a normal spontaneous vaginal delivery. 255 (68%) mothers received intravenous fluids. The administration of intravenous fluids 24 h before delivery was associated with a statistically significant but not clinically significant increase in weight loss in the newborn child at 48 h compared with those who did not receive any fluids (190 g vs 156 g; p<0·05). Other predictors of weight loss were feeding and delivery method. The use of formula in addition to breastfeeding was associated with more weight loss compared with exclusively breastfed infants (215 g [6·5%] vs 168 g [5·2%]; p=0·03). Both delivery by caesarean section and induced labour were associated with a marginally significant increase in weight loss (p<0·05) compared with spontaneous normal vaginal delivery.Interpretation
Weight loss in the newborn child is a multifactorial process. Intravenous fluid infused before delivery is a contributory factor. We recommend an intravenous fluid-restrictive policy to avoid false positive weight loss.Funding
None. 相似文献3.
Samah W Al-Jabi Rayah Yahya Ru&#x;a Salameh Haya Jabi Warde Msaime Mohammad Daraghmeh Ala&#x; Barakat Sa&#x;ed H Zyoud Waleed M Sweileh 《Lancet》2018
Background
The negative effect of breast cancer on survivors highlights the importance of increased knowledge about patients' health-related quality of life (HRQOL). The aim of this study was to assess HRQOL in women with breast cancer and to examine the effect of patient characteristics on HRQOL.Methods
This cross-sectional study took place in four oncology centres in the West Bank, occupied Palestinian territory, during a 6 month period in 2014. We used a convenient sampling method to recruit participants and the EuroQol-5 Dimension (EuroQoL EQ-5D) scale to assess their HRQOL. All analyses were done in SPSS version 16.0. The study was approved by the Institutional Review Board at An-Najah National University. Informed verbal consent was obtained from the participants before the start of the study.Findings
244 women with breast cancer were interviewed. Their mean age was 52·7 years (SD 12·2), and the mean number of years of breast cancer was 3·38 years (SD 3.6). 136 (56%) women had stage 2 breast cancer, and 54 (22%) women had stage 3 breast cancer. 233 (96%) participants received chemotherapy, and 206 (84%) participants had surgery. The median EQ-5D index was 0·72 (IQR 0·51–0·84), and the median of EQ-visual analogue scale (EQ-VAS) was 70 (IQR 55–80). We found a positive correlation between the EQ-5D index and EQ-VAS scores (R=0·51; p<0·001). The highest EQ-5D index scores were found in elderly patients (p=0·006), employed women (p=0·002), women with high income (p=0·012), women with higher education (p=0·001), and women who exercised regularly (p=0·006). Additionally, patients with advanced disease stage had the lowest median EQ-5D index (p=0.002).Interpretation
Palestinian women who had survived breast cancer reported favourable overall HRQOL. Increased educational attainments, monthly income, and physical activity was associated with improved overall HRQOL. Thus, improved overall HRQOL should be considered a very important goal in treatment of breast cancer.Funding
None. 相似文献4.
Background
Antimicrobial resistance (AMR) is one of the greatest threats to public health in China. The primary cause of AMR is antibiotic misuse, especially used for self-limiting illnesses. Little is known about regional differences of antibiotic-misuse behaviors in China. We aimed to explore such behaviors among university students in western and eastern China.Methods
The participants were recruited from universities in Guizhou, a less developed province in western China, and from Zhejiang, a more developed province in eastern China, using a cluster random sampling method. A validated, self-administered questionnaire was designed to collect data, and the χ2 test and logistic regression were adopted to assess the associations between region and antibiotic misuse.Findings
A total of 2073 university students from Guizhou and 1922 from Zhejiang completed questionnaires. Students in Guizhou had lower household income, parents' education, and urban residence proportion than those in Zhejiang. Compared with those in Zhejiang, students in Guizhou had higher antibiotic use prescribed by doctors (79·8% vs 56·2%) and self-medication (33·0% vs 16·1%). The students in Guizhou were more likely to buy over-counter antibiotics (73·9% vs 63·4%), ask for antibiotics from doctors (21·4% vs 15·6%), and use antibiotics prophylactically (29·9% vs 15·7%). Adjusted models also showed that less developed region was associated with higher antibiotic misuse behaviours, including antibiotic use prescribed by doctors (odds ratio 2·95; 95% CI 1·68–5·18; p<0·0001), self-medication (3·00; 1·84–4·90; p<0·0001), buying over-counter antibiotics (1·71; 1·36–2·15; p<0·0001), and taking antibiotics prophylactically (2·28; 1·89–2·76; p<0·0001).Interpretation
Misuse of antibiotics for self-limiting illnesses by well-educated young adults was very high in these two regions but most serious in less-developed western China. A campaign is urgently needed for rational prescribing of antibiotics by doctors, enforcing restrictions on over-the-counter antibiotics, and to educate the general public about the management of self-limiting illness.Funding
Zhejiang University Zijin Talent Programme. 相似文献5.
Background
Coronary artery bypass graft (CABG) surgery is one of the major surgeries requiring long-term stay in hospital. This generally leads to the detrimental effects of bed-rest, including dependency in self-care, transfer, and locomotion. Our aim was to compare the effect of high-frequency and low-frequency exercise therapy in patients who had undergone CABG.Methods
Patients who had undergone CABG were recruited from PSG Medical College and Hospital, Coimbatore, India, between Jan 1 and March 31, 2006. Functional Independence Measure (FIM) and modified Borg Rating of Perceived Exertion (RPE) were used to assess functional outcome. In a quasi-experimental design, patients received either high-frequency exercise therapy (exercise three times a day for 10 days, group 1), or low-frequency exercise therapy (once a day for 10 days, group 2). Data were analysed with paired t tests.Findings
30 patients were recruited (15 in each group). Mean FIM was 75 (SD 1·77) in group 1 and 64 (1·65) in group 2. There was a significant difference between the pretest and post-test FIM values in group 1 patients (49·07 [2·43] vs 124·07 [1·75], p<0·0001) but not in group 2 patients. The RPE in group 1 and group 2 was 6·3 (0·62) and 4·2 (0·7), respectively.Interpretation
Patients given high-frequency exercise thearpy had a significant improvement in their physical activity, but low-frequency exercise did not lead to significantly improved changes. In conclusion, the high-frequency exercise therapy improves the functional ability of patients with CABG.Funding
None. 相似文献6.
Background
Accelerated cellular ageing, shown as lower telomerase activity, might be responsible for the well documented adverse health outcomes of intimate partner violence such as increased risk of cardiovascular diseases and depression. Mind-body interventions such as qigong are thought to be effective in alleviating accelerated cellular ageing but evidence of effectiveness is scarce. This study aimed to test the effect of a qigong intervention on telomerase activity of Chinese women who have experienced intimate partner violence.Methods
We did this assessor-blind, waitlist, randomised controlled trial in the HKSKH Lady MacLehose Centre, a community centre located in one of the 18 districts in Hong Kong. Chinese women meeting the inclusion criteria (aged 18–55 years and abused by an intimate partner) were randomly assigned (1:1) by computer-generated blocked randomisation to either the intervention group or the control group. The intervention group received a 5·5-month qigong intervention provided by a qigong master assisted by trained project workers. The waitlist control group received the same training but after the intervention group had completed the intervention. The primary outcome was change in telomerase activity measured by telomerase level in peripheral blood mononuclear cells obtained at baseline and on completion of the intervention, and it was analysed with a TeloTAGGG telomerase PCR ELISA kit. Adopting the principle of intention to treat, we used a mixed-effects model to analyse adjusted telomerase activity. Ethical approval was obtained from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (Reference number UW12–555, Jan 9, 2013). All participants provided written informed consent. This trial is registered with ClinicalTrials.gov, number NCT02060123.Findings
Between March 12, 2014, and May 26, 2016, we enrolled 271 participants of whom 136 were assigned to the intervention group and 135 to the control group. 247 (91%) participants completed the intervention (attrition 9%). Telomerase activity increased significantly in intervention group (from 186·93 to 265·86, relative unit to internal standard, p=0·015) but not in the control group (from 251·57 to 241·16, p=0·742), and the group?×?time interaction effect was significant (p=0·049).Interpretation
Evidence from the study may inform the use of mind-body interventions for alleviating accelerated cellular ageing in abused Chinese women. Strengths of the study include robust study design, objective biomarkers, and low attrition while the short follow-up is among the limitations.Funding
Health and Medical Research Fund awarded by the Food and Health Bureau of the Hong Kong SAR Government. 相似文献7.
8.
Background
Maternal obesity during pregnancy increases the risk of large-for-gestational age (LGA) infant and childhood obesity. We aimed to investigate the association between maternal weight change between consecutive pregnancies and risk of having a LGA baby.Methods
A population-based cohort of routinely collected antenatal health-care data between Jan 1, 2003, and Dec 31, 2017, at University Hospital Southampton, UK, was used. No age restriction was applied, and records of all women with their first two singleton livebirth pregnancies were analysed. Regression analysis was used to examine the association between interpregnancy change in maternal body-mass index (BMI) measured at first antenatal appointment of each pregnancy and LGA (adjusted for age, ethnicity, educational qualification, infertility treatment, smoking, employment status, infant sex, gestational diabetes in current pregnancy, and interpregnancy interval). We also stratified by maternal BMI category and LGA outcome in first pregnancy.Findings
15?940 records were analysed. 2548 women (16%) lost weight and 7607 (48%) gained weight (≥1 BMI unit) between pregnancies. LGA incidence was 7% (n=1109) in first and 13% (2106) in second pregnancies; and was 12% (315) in women who lost weight and 12% (690) in women whose weight remained stable between pregnancies compared with 14% (1101) in women who gained weight. Normal-weight and overweight women who gained weight had an increased risk of LGA after having a non-LGA baby in the first pregnancy (adjusted odds ratio 1·37 [95% CI 1·16–1·61], p<0·0001 in normal weight and 1·30 [1·02–1·65], p=0·03 in overweight). Overweight women who had a previous LGA birth were at lower risk of LGA in the second pregnancy if they lost 1 or more BMI unit (0·44 [0·23–0·85], p=0·02).Interpretation
Losing weight after LGA birth in overweight women reduces the risk of subsequent LGA, whereas gaining weight increases its risk in women with no previous history of LGA. Avoiding weight gain between pregnancies is an important preventive measure to achieve better maternal and offspring outcomes.Funding
Supported by a University of Southampton Primary Care and Population Sciences PhD studentship (to NZ), the Academy of Medical Sciences, and the Wellcome Trust (grant no: AMS_HOP001\1060 to NAA). 相似文献9.
Yu-Lan Zhao Han-Huan Luo Xin-Tian Zhang Zashi Bianba Lin Li Qian Wang Lei Guo Dian Wang Yong-Ge Ze Shan Zheng 《Lancet》2017
Background
The rural and urban integration health-care system is a new and improved health-care system in Tibet, China. The aim of this study was to investigate whether these improvements might alter the clinical–pathologic characteristics of Tibetan female with breast cancer in Tibet.Methods
This was a single-centre cross-sectional study at Tibet Autonomous Region People's Hospital. We included Tibetan adult women who had been treated for breast cancer in this hospital between Jan 1, 1973, and Dec 31, 2015. The inclusion criteria were: (1) Tibetan adult woman living in Tibet; (2) histopathology or cytopathology, or both, confirming primary breast cancer; and (3) all the treatments were finished in this hospital. The Ethics Committee of TAR People's Hospital passed this project (ID Num: ME-TBHP-15-1). Patient consent was not required according to the routine. χ2 test and logistic regression were applied, using age group and census register as the two covariates.Findings
We included 273 patients with breast cancer in the final analysis. 14 patients were in the free health-care system, 183 patients had medical insurance combined with a rural cooperative health-care system, and 76 were in a rural and urban integration health-care system. We found a decrease in tumour size (>2 cm vs 2cm; odds ratio 0·117; 95% CI 0·036–0·383) and a decrease in the proportion patients who had invasion (0·460; 0·265–0·797) among women in the rural and urban integration health–care system. The proportion of patients in early stage cancer (5·737; 1·117–29·468) and advanced stage cancer (3·917; 1·406–10·914) increased in the rural and urban integration health–care system.Interpretation
This was the first report about Tibetan women with breast cancer in Tibet. Except for advanced stage breast cancer, the clinical–pathological characteristics of Tibetan women with breast cancer improved during different health-care systems. The overall management in patients with breast cancer in advanced stage might be one of the emphases in the rural and urban integration health-care system. Information and selection bias might be the limitations of this study.Funding
Natural Science Foundation of Tibet Autonomous Region (2015ZR-13-61). 相似文献10.
Junjie Huang Jason LW Huang Mellissa Withers Kuo-Liong Chien Indang Trihandini Edmar Elcarte Vincent Chung Martin CS Wong 《Lancet》2018
Background
The prevalence of metabolic syndrome is growing because of increasing rates of obesity and sedentary lifestyle. Metabolic syndrome is one of the most important risk factors associated with diabetes, cardiovascular disease, and all-cause mortality. Few studies have examined its sex-specific prevalence in China across time. We compared the prevalences and temporal trends of metabolic syndrome in Chinese women and men.Methods
We conducted a PRISMA-compliant search in MEDLINE and Embase from their inception to Feb 15, 2018, for epidemiological studies that reported metabolic syndrome prevalence in Chinese individuals. We included data from population-based studies for individuals aged 15 years and older and a random effect model was used to estimate prevalence and 95% CI. We modelled within-study variability by binomial distribution and Freeman-Tukey double arcsine transformation to stabilise the variances. We did subgroup analyses by sex, age, region, and screening period.Findings
We identified 80 eligible studies that included 734?511 individuals. The overall prevalence of metabolic syndrome in China was 22·0% (95% CI 19·9–24·1). Its prevalence was higher in women (23·6%, 21·0–26·3) than in men (21·0%, 18·8–23·3), in urban (23·5%, 20·7–26·) than in rural regions (20·3%, 16·4–24·6), and in people older than 40 years (27·6%, 23·9–31·6) than in those aged 15–40 years (8·3%, 6·5–10·3). From 1991–1995 to 2011–2015, prevalence of metabolic syndrome rose rapidly from 8·8% (2·8–17·7) to 29.3% (21·8–37·3), with a greater rise in women (from 7·9% to 30·7%) than in men (9·4% to 27·2%).Interpretation
We found a rapidly increasing prevalence of metabolic syndrome in Chinese women. These findings suggest that more targeted lifestyle intervention and early screening programmes should be implemented for women in China.Funding
None. 相似文献11.
Background
The burden of non-communicable diseases burden in China is enormous, with tobacco consumption a leading risk factor for the most prevalent NCDs. Therefore, understanding pattern of socioeconomic equalities of tobacco consumption will help to design targeted public health control measures. We aimed to investigate who tends to consume most tobacco in China.Methods
Nationally representative data from the 2013 China Health and Retirement Longitudinal Study (CHARLS) included smoking information on 17?663 respondents aged 45 years and older. Smoking prevalence and smoking quantities were defined to capture tobacco consumption. Using concentration index (defined as twice the area between the concentration curve and the line of equality), we estimated income-related inequality of tobacco consumption grouped by gender. The inequality of tobacco consumption was further decomposed into each determinant's specific contribution on using probit regression analysis and Ordinary Least Squares (OLS) regression models.Findings
About 16·03% of respondents consumed tobacco. By sex, 8449 men (29·65%) and 9213 women (3·54%) consumed tobacco. Furthermore, we found a significant pro-rich inequality of tobacco consumption. The concentration index of smoking incidence was 0·0438 (0·0412 for men; ?0·0393 for women). The concentration index of smoking quantities among people who smoke was 0·0385 (0·0333 for men; 0·0381 for women), whereas the concentration index of smoking quantities in the whole population was 0·0748 (0·0675 for men; ?0·0044 for women). Most of the inequality can be explained by education attainments, age, geographical areas, and economic status.Interpretation
Sex, education attainments, age, geographical areas, and economic status were strong predictors of tobacco consumption in China. Public health policies need to be targeted towards the less educated people and elderly people. Both the pattern and magnitude of inequality varied greatly between men and women, and public policies for tobacco control in men should be strengthened at southern-central and northern areas of China, whereas public policies for women should be strengthened in the eastern and northeastern areas of China.Funding
Research Program of Shaanxi Soft Science (2015KRM117), Shaanxi Provincial Youth Star of Science and Technology in 2016, Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007), and National Program for Support of Top-notch Young Professionals and China Medical Board (15-227). 相似文献12.
Background
Breastmilk is the recommended form of enteral nutrition for all infants. Infants nourishing on breastmilk contaminated with lead are at high risk of exposure to this neurotoxic heavy metal. The aim of this study was to screen lead concentrations in samples of breastmilk obtained from women living in three main regions of the West Bank and to investigate the sociodemographic characteristics associated with high lead concentrations.Methods
In this cross-sectional study, breastmilk samples were collected from breastfeeding women living in Nablus, Ramallah, and Jerusalem. The participants' sociodemographic characteristics were recorded, and the lead concentration in breastmilk samples were quantified using a graphite furnace atomic absorption spectrophotometer. Ethical approval was obtained from the Institutional Review Board of An-Najah National University, and all participants provided written informed consent.Findings
Breastmilk samples were obtained from 89 women. The median lead concentration was 4 μg/L (range 2–12 μg/L). The lead concentration was higher than WHO's safety limits for occupationally unexposed population in 17 (19%) samples. Lead concentrations were also significantly higher in samples obtained from women living in refugee camps and cities (p=0·003) than in women living in villages, higher in women with low monthly household income than in women with high monthly household (p=0·020), higher in women living in houses with peeling paint than in women living in houses with no peeling paint (p=0·026), higher in women who worked in agriculture for more than 3 years than in women who worked in agriculture for less than 3 years or less (p=0·005), and higher in women who frequently used eye kohl than in women who did not (p=0·004). Multiple linear regression analysis showed that using eye kohl was a significant predictor (p=0·040) of lead concentration in breastmilk above WHO's safety limits.Interpretation
In this study, about one-fifth of women had concentrations of lead in their breastmilk above the WHO's safety limits. Authorities need to implement measures to eliminate or reduce lead exposure, especially in refugee camps and cities. Eye kohl preparations marketed in the occupied Palestinian territory should be screened for lead content.Funding
None. 相似文献13.
Wei-Hong Zhang Jiong Li Yan Che Shangchun Wu Xu Qian Xiaojing Dong Jialin Xu Lina Hu Rachel Tolhurst Marleen Temmerman 《Lancet》2017
Background
Around 10 million induced abortions are conducted annually in China; a third of the women having had those abortions have undergone repeat abortions. Most abortions are performed in hospital settings in which post-abortion family planning (PAFP) services are often lacking. This study aims to evaluate the effects of integrating PAFP services into abortion services on the reduction of unintended pregnancy and repeat abortion in China.Methods
This was a three-arm cluster (hospital) randomised controlled trial. Study participants were women undergoing an abortion within 12 weeks of pregnancy. 90 hospitals were selected from 30 Chinese provinces and allocated randomly (1:1) into two intervention groups or one control group. Intervention group 1 included provision of family planning information, contraceptive counselling, involvement of the male partner, and free provision of contraception; intervention group 2 included incentive mechanisms for health-care providers in addition to group 1; and the control group received normal care, with no intervention. Eligible women were followed up for 6 months. The primary outcomes were the rates of unintended pregnancies and repeat induced abortions. We used a three-level random intercept model to estimate the effects of intervention using a generalised linear mixed model, and we used SAS PROC GLIMMIX with maximum likelihood with Laplace approximation to perform this multilevel modelling approach. This study received ethical approval from the Ethical Committees at Ghent University, Belgium, on May 26, 2014 (B670201421116), and from the National Research Institute for Family Planning, China, on March 6, 2014. All participants provided a Chinese written informed consent. This trial has been registered at International Standard Randomised Controlled Trial, number ISRCTN01846583.Findings
We recruited 17?235 eligible women from July 11, 2014, to Aug 20, 2015. The intervention 1 group included 5856 women, intervention 2 group included 5791 women, and the control group included 5588 women. The proportion of patients who were followed up for up to 6 months were similar in the three groups (74·7% [4372 of 5856] in intervention group 1, 77·1% [4466 of 5791] in intervention group 2, and 75·7% [4231 of 5588] in the control group). The proportion of patients with unintended pregnancy within 6 months after abortion was lower in both intervention groups (1·2% [59 of 5011] in group 1 and 1·2% [58 of 4986] in group 2) than in the control group (3·2% [155 of 4817]). The proportion of patients who had a repeat abortion was 0·9% (45 of 5011) for the intervention group 1, 0·8% (41 of 4986) for the intervention group 2, and 1·6% (77 of 4817) for the control group (ie, 16–38% lower in the interventions group than that in the control group). Statistical analysis is ongoing.Interpretation
Integrating post-abortion family planning services into hospital-based abortion services could decrease unintended pregnancy and repeat abortions. A policy and guidelines on integration of PAFP into routine abortion services is urgently needed to reduce the number of abortions.Funding
European Commission FP7 (282490). 相似文献14.
Background
Women with a history of recurrent miscarriage are accorded dedicated medical care during a subsequent pregnancy (or subsequent pregnancies). Previous studies of subsequent pregnancy and perinatal outcome in women with a history of recurrent miscarriage give conflicting results, with some reporting an increase in adverse obstetric and perinatal outcomes, and others reporting no difference. There is a lack of systematic review based on a large-scale population.Methods
We carried out a systematic review and meta-analysis to incorporate direct and indirect data from relevant studies. We searched PubMed, Scopus, Embase, Web of Science, and Ovid, up to Dec 31, 2017. Studies that were included were full text reports of pregnancy outcomes in women with a history of recurrent miscarriage. We used the random-effect model or the fixed-effect model to estimate the incidence of different obstetric and perinatal outcomes. We also carried out subgroup analysis to determine the effect of the sex of the fetus on the incidence of different obstetric and perinatal outcomes.Findings
Among 1842 full articles retrieved, 7 articles with a total of 224?879 participants, including 10?174 women with a history of recurrent miscarriage and 21?4705 control subjects, were included in this systematic review and meta-analysis. Recurrent miscarriage was associated with a significantly increased incidence of antepartum haemorrhage (odds ratio [OR] 2·38, 95% CI 1·98–5·27), gestational diabetes (1·23, 1·02–1·47), preterm delivery (1·73, 1·28–2·07), small for gestational age (1·52, 1·19–1·98), and perinatal death (2·30, 1·62–4·97). There was no significant difference in the incidence of gestational hypertension, or in Apgar scores at 1 and 5 minutes after birth. There was also no significant difference in risk between male fetus and female fetus.Interpretation
Women with a history of recurrent miscarriage have an increased risk of several obstetric and perinatal complications, and therefore may require more dedicated medical care in their subsequent pregnancies.Funding
This work was supported by the Health and Medical Research Fund in Hong Kong (number 04152786) and the Hong Kong Obstetrical and Gynaecological Trust Fund in 2017. 相似文献15.
16.
Background
Prostaglandins are commonly used for labour induction in obstetric practice. Given the harsh effects of occupation and siege on provision of health care and on economic conditions, this study was conducted to compare the efficacy and safety of oral misoprostol and vaginal dinoprostone, to find the more appropriate and economic drug for labour induction in the Gaza Strip, occupied Palestinian territory.Methods
In this case-control study, we screened medical files of 155 women undergoing labour induction at Al-Helal Al-Emirati Hospital, Rafah, in the Gaza Strip. Inclusion criteria were singleton, cephalic presentation, and full-term pregnancies (40 weeks) needing labour induction. Patient files were divided into two groups according to the drug regimen. 76 women received 50 μg oral misoprostol for parity 0–4 or 25 μg for parity 4 or greater, every 6 hours. 79 women received dinoprostone vaginal tablets, with a dose of 3 mg then 1·5 mg for nulliparous women and 1·5 mg for parity 1 or greater, every 8 hours. There were no significant differences between the misoprostol and dinoprostone groups in terms of mean age (25·07 [SD 5·66] vs 27·86 [6·56] years, p=0·34), mean gestational age (279·43 [SD 11·41] vs 285·57 [SD 15·50] days, p=0·81), and mean parity (2·10 [SD 1·97] vs 2·73 [SD 2·64], p=0·05). Outcome measures were induction success, induction–delivery interval, number of used drugs and doses, caesarean section rate, and maternal complications. Data were analysed with SPSS software. We compared outcomes using the Mann–Whitney U-test, student's t-test, or chi squared test. A p value of less than 0·05 was considered significant. The study was approved by the Helsinki Committee, Gaza Strip.Findings
Induction of labour succeeded in 80% (61 of 76) and 78% (62 of 79) cases (p=0·492) in the misoprostol and dinoprostone groups, respectively. There was no significant difference between the misoprostol and dinoprostone groups in the induction–delivery interval (15·2 h vs 16·4 h, p=0·625). The number of doses required was 2·2 and 1·8 in the misoprostol and dinoprostone groups, respectively (p=0·070). The caesarean section rate did not differ significantly between the misoprostol and dinoprostone groups (7·9% [six of 76] vs 10·1% [eight of 79], p=0·369). In addition, complications (mild vaginal bleeding, post-partum haemorrhage, and puerperal fever) also did not differ significantly between the misoprostol and dinoprostone groups (37·7% [23 of 76] vs 33·9% [21 of 79], p=0·430), and all were mild.Interpretation
Oral misoprostol and dinoprostone vaginal tablets have the same safety and efficacy. Misoprostol is a good alternative for induction of labour.Funding
None. 相似文献17.
Background
Ethnic minorities have greatly increased rates of schizophrenia. The risk is most pronounced when individuals are living in areas with few people of the same ethnicity as them. Amygdala hyperactivity has been linked to paranoid symptoms in psychosis, and increased levels of paranoia have been observed in ethnic minority individuals. White individuals show an increased amygdala response when viewing black faces; however, whether a similar effect is seen in black individuals is not clear.Methods
20 individuals of white British ethnicity, and 20 of black ethnicity underwent a 3T MRI scan while viewing faces of black and white ethnicity. Participants were aged 18–45 years, with no history of mental illness. Population density, indices of multiple deprivation, and percentage own-group ethnic density were obtained from the 2011 census. Neighbourhood segregation was quantified with the Index of Dissimilarity method. Ethics approval was granted by the West London National Research Ethics Service Committee.Findings
At the within-group level, both groups individually showed greater right amygdala activation to the out-group faces (white ethnicity t=2·08, p=0·02; black ethnicity t=2·38, p=0·015). Between groups, the black ethnicity group showed a greater increase in right amygdala activation for the white faces compared with baseline than did the white ethnicity group (t=1·84, p=0·038). Within the black ethnicity group, amygdala reactivity to white faces showed significant correlations with measures of neighbourhood population density (r=0·61, p=0·01), segregation (r=0·71, p=0·003), deprivation (r=0·67, p=0·04), and own-group ethnic density (r=–0·51, p=0·04).Interpretation
We have shown for the first time, to our knowledge, increased amygdala response to white faces in individuals of black ethnicity. Significant correlations were observed between amygdala response and neighbourhood variables associated with increased psychosis risk. This finding has relevance for our understanding of the increased rates of paranoia and psychotic disorders in ethnic minority individuals. Further research in patient populations will help clarify aetiological relevance.Funding
National Institute for Health Research, Medical Research Council, Wellcome Trust. 相似文献18.
Marie Jonassen Amira Shaheen Mohammed Duraidi Khaled Qalalwa Bernard Jeune Henrik Brønnum-Hansen 《Lancet》2018
Background
People living in the occupied Palestinian territory have high levels of poverty and unemployment and low educational level. The aim of this study was to investigate the association between socioeconomic status and self-reported chronic disease and to determine whether this association differed between Palestinians living in and outside refugee camps.Methods
The study was based on representative samples of Palestinians living in the occupied Palestinian territory (West Bank and Gaza Strip), aged 25 years and older, collected by the Palestinian Central Bureau of Statistics in 2006 and 2010. Educational level, wealth, and employment status were used as measures of socioeconomic status. Participants reporting a diagnosis and treatment for at least one chronic disease were categorised as having a chronic disease. We used logistic regression models to estimate the association between socioeconomic status and chronic disease and to compare the prevalence of chronic disease between Palestinians living in or outside refugee camps adjusted by socioeconomic status.Findings
The sample included 38?888 participants. Associations between all measures of socioeconomic status and chronic disease were highly significant. In 2010, the odds ratio (OR) of reported chronic disease in illiterate men and women were 1·37 (95% CI 1·21–1·56) and 1·45 (1·29–1·63), respectively, compared with men and women with elementary or preparatory educational levels. Compared with the richest quintile, the OR in the poorest quintile was 1·70 (1·47–1·96) for men and 1·80 (1·56–2·07) for women. Compared with employed people, the OR in unemployed people was 1·50 (1·31–1·71) for men and 1·12 (0·76–1·65) for women. Similar results were found for 2006. The prevalence of chronic disease was substantially higher in Palestinians living in refugee camps (29%) than in those living outside refugee camps (24%). The associations between socioeconomic status and chronic disease did not differ between people living in or outside refugee camps.Interpretation
We found highly significant associations between socioeconomic status and self-reported chronic disease. Although the prevalence of chronic disease was highest in Palestinians living in refugee camps, the pattern of association between socioeconomic status and chronic disease did not differ between Palestinians living in and outside refugee camps.Funding
None. 相似文献19.
Background
Psychological distress remains a significant challenge for patients with poorly controlled type 2 diabetes. This study aimed to evaluate if an empowerment-based self-management programme would optimise psychological wellbeing in this vulnerable population of patients with diabetes.Methods
Adult patients with poorly controlled type 2 diabetes from two tertiary hospitals in Xi'an city, China, were randomly allocated to intervention or control groups using a computer-generated randomisation list with a block size of four. Participants in the intervention group received the DESIRE programme, which is a patient-centred consultation programme to empower and engage patients in self-management and active coping. The trial's primary outcome was effect on HbA1c. In this secondary analysis, we report findings for diabetes distress measured by the Diabetes Distress Scale [DDS]; patients with a mean score of three or higher were deemed to be those with diabetes distress worthy of clinical attention. Analysis was with a generalised estimating equation model according to the intention-to-treat method. Data were collected at baseline and at 8 and 20 weeks after randomisation by trained nurses who were masked to group assignment. Written consent was obtained from participants before study commencement. This trial is registered with the Chinese Clinical Trial Register, number ChiCTR-IPR-14005492.Findings
Between April, 2014, and October, 2015, 242 patients were enrolled and randomised to control (n=121) or intervention (n=121) groups. Participants had similar social, demographic, and disease characteristics at baseline (mean diabetes duration 8·0 years [SD 6·0]; mean HbA1c 10·0% [SD 1·8]). Compared with participants in the control group, those in the intervention group had a significantly greater reduction in emotional-related distress (from mean score 3·24 [SD 1·19] to 2·54 [1·05] in the intervention group vs 3·45 [1·21] to 3·21 [1·23] in the control group; effect size 0·59, 95% CI 0·45–0·73, p=0·027) and regimen-related distress (from 3·45 [1·28] to 2·97 [0·96] vs 3·68 [1·14] to 3·55 [1·13]; effect size 0·56, 95% CI 0·42–0·69, p=0·011) after 20 weeks of follow-up. These reductions were clinically significant.Interpretation
The empowerment-based, patient-centred DESIRE programme could significantly reduce diabetes distress in patients with poorly controlled type 2 diabetes. Our findings provide a basis for integrating the DESIRE programme into routine care.Funding
No funding. 相似文献20.