Abstract Purpose: To observe the clinical effect of the acupoint injection (Hegu, Sanyinjiao) of ropivacaine for epidural blockade for labour analgesia. Methods: A total of 100 women who received labour analgesia at Shangyu Maternal and Child Health Hospital, Shaoxing City, from January 2024 to June 2024, who met the inclusion and exclusion criteria and who signed informed consent forms were included. The patients were randomly divided into two groups: the epidural analgesia group (Group C) and the acupoint injection combined with epidural analgesia group (Group O). Following application of additional exclusion criteria, 80 patients were ultimately included in this clinical observation, with 40 patients assigned to each group. The following observation indices were used: the pain visual analogue scale (VAS) score [before labour analgesia (T0), 15 min after analgesia (T1), when the uterine opening reached 6 cm (T2), and when the perineal suture was closed in the third stage of labour (T3)], modified Bromage score, use of oxytocin, mode of delivery, amount of postpartum haemorrhage (ml), Apgar score [at 1 min and 5 min], additional amount of self-controlled analgesia administered, epidural ropivacaine dosage, total ropivacaine dosage, maternal adverse reactions [postpartum headache, urinary retention, and epidural-related maternal fever (ERMF)],and conduct a survey on maternal satisfaction and postpartum depression scale one day after delivery. DISCUSSIONS: The acupoint (Hegu, Sanyinjiao) injection of ropivacaine increased the effectiveness of epidural labour analgesia, reduced the required dosage of epidural ropivacaine without significant adverse effects, and significantly improved maternal satisfaction. This method of analgesia is therefore worthy of clinical promotion and use. (Retrospectively Registered No. ChiCTR2400092969,Registration date 2024-11-26)
Background Neonatal and under-five mortality rates are critical indicators of a country's health status and progress toward Sustainable Development Goals. Despite a decline in mortality rates globally, preventable child deaths continue to occur, particularly in Pakistan, which has one of the highest child mortality rates in the world. In this analysis, we present the latest cause-specific neonatal and under-five mortality estimates determined through verbal and social autopsy (VASA) procedures in a population-based household survey across Pakistan. Methods We used a household survey based on the Pakistan National Nutrition Survey sampling frame, which covered 115 600 households in both urban and rural areas. We identified 3880 neonatal and post-neonatal under-five deaths within the three years prior to the survey. The VASA interviews were conducted in households where deaths were reported. We determined the causes of death using the computerised InterVA-5, InSilicoVA, and Expert Algorithm VA methods and the physician-certified VASA method, utilising thorough reviews by verbal autopsy-trained paediatric and obstetric physicians. Results Neonatal mortality was estimated at 39.8 per 1000 live births (95% confidence interval (CI) = 39.3-40.3), with higher rates in rural (40.8; 95% CI = 40.2-41.4) compared to urban areas (37.3; 95% CI = 36.5-38.1). Post-neonatal under-five mortality was 35.9 per 1000 live births (95% CI = 35.4-36.4) and was also higher in rural (36.8; 95% CI = 36.2-37.4) than in urban areas (33.6; 95% CI = 32.6-34.5). The major causes of neonatal death included preterm birth complications, birth asphyxia, and infectious diseases. For post-neonatal under-five mortality, the leading causes were infectious diseases, diarrheal disorders, and pneumonia. Conclusions Our findings highlight the persistent burden and disparities in neonatal and under-five mortality across urban and rural areas in Pakistan. Targeted interventions are essential to address these preventable deaths and reduce mortality rates in high-risk populations.
Background Closely spaced pregnancies increase the risks of maternal and perinatal morbidity. Initiation of contraception in the immediate postpartum period offers a critical opportunity to address this unmet need during a window when women are in contact with health services. We explored barriers and facilitators of immediate postpartum contraceptive uptake at a tertiary hospital in southwestern Uganda, using the Theory of Planned Behavior. Methods We conducted a qualitative descriptive study between August and December 2025 at Mbarara Regional Referral Hospital. Using purposive sampling, we conducted 7 focus group discussions among postpartum women (24), spouses (19), midwives (20), and doctors (12) involved in maternity care using semi-structured interview guides grounded in the TPB. Audio-recorded interviews were transcribed verbatim, translated where necessary, and analysed using thematic analysis. Themes were deductively mapped onto the TPB domains of attitudes, subjective norms, and perceived behavioural control until no new themes emerged across successive focused group discussions. Results Participants generally viewed postpartum family planning positively and recognized its role in child spacing, maternal recovery, and family wellbeing. However, uptake was hindered by fears of side effects, misconceptions about infertility and contraceptive failure, concerns regarding immediate postpartum initiation, and limited awareness of methods suitable for use. While partner support facilitated uptake, opposition and community myths discouraged use. Perceived behavioural control was constrained by inadequate counselling, limited provider confidence, poor integration of family planning services within maternity care, and inconsistent availability of contraceptive methods. Conclusion Immediate postpartum contraceptive uptake is influenced by interconnected individual, social, and health-system factors. It requires multi-level interventions: integrated contraceptive counselling across the antenatal-postnatal continuum, structured male partner engagement, correction of community misconceptions, training of health care providers, and onsite availability of methods within labour wards and theatres.
Ainomugisha B, Owaraganise A, Tumuhimibise W et al.
Study question How are educational level, labour market attachment, and income associated with achieving a live birth following ART treatment initiation among women in Denmark? Summary answer Higher educational level, labour market attachment, and higher income were strongly associated with achieving a live birth after initiating ART treatment among women in Denmark. What is known already During the study period 1994-2017, three 'fresh' IVF or ICSI treatments with hormonal stimulation were offered free of charge in public healthcare in Denmark, while additional ART treatments were self-financed in the private healthcare sector. Earlier research indicates that higher socioeconomic position (SEP) increases the probability of initiating ART treatment; however, knowledge about SEP and its relation to outcomes after ART treatment is limited. Study design size duration This is a national, register-based cohort study based on the Danish National ART-Couple (DANAC II) Cohort. Women initiating ART treatment during 1994-2017 were identified in the Danish IVF register and individually linked with data from sociodemographic registries and the Medical Birth Registry using the Danish Personal Identification number. The study population comprised 68 738 women who initiated ART. The women were followed until achieving a live birth, death, migration, or end of study (31/12/2017). The median follow-up time was between 1.3 and 1.9 years. Participants/materials settings methods Women included in the analyses were aged 18-45 years. Overall associations between achieving a live birth after initiating ART treatment and educational level, labour market attachment, and income were examined and further stratified by nulliparity at baseline and age group. Hazard ratios (HRs) with confidence intervals (CIs) were estimated by Cox proportional hazards regression, and with adjustment for potential confounders including age and ethnicity. Live births refer to both treatment and non-treatment-related births. Main results and the role of chance Adjusted results showed that educational level, labour market attachment, and income significantly determined the probability of achieving a live birth after initiating ART treatment. HRs of achieving a live birth after initiating ART treatment increased stepwise with higher education and income level, respectively. Compared with primary school education, the highest HR was found among women with a research education (adjusted HR (aHR) = 3.02 [95% CI, 2.71; 3.35]). Unemployed women had the lowest HR of achieving a live birth after initiating ART treatment (aHR = 0.67 [95% CI, 0.64; 0.69]) compared to employed women. Women at the highest income level had two times higher HR (aHR = 2.00 [1.94; 2.06] of achieving a live birth after initiating ART compared to women at the lowest income level. Analyses of different age groups showed that higher SEP was associated with a live birth after ART treatment in all ages. The same consistency was found for both childless women and women who had a child or children prior to ART treatment. Analyses showed that women with higher SEP were more likely to continue ART treatment after unsuccessful attempts, which could explain the observed social inequality in achieving a live birth after ART treatment. Limitations reasons for caution The Danish IVF register did not register non-ART treatments (intrauterine inseminations) before 2007; thus, these treatments were not included. Whether the severity of infertility differs among SEP groups is unclear. Also, geographical distance to fertility clinics could have provided additional perspectives. Wider implications of the findings Free access to fertility treatment in public healthcare should ideally provide equal access. Patients encounter barriers during treatment, and as shown, treatment success differs based on socioeconomic background. Difficulties encountered during treatment that challenge certain patients more than others based on their socioeconomic background need to be considered further. Study funding/competing interests No specific funding was achieved for this project. The authors have no conflicts of interest to declare. Trial registration number N/A.
Background Patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) have a poor prognosis. In Ph+ALL04, allogeneic hematopoietic stem cell transplantation (HSCT) in first complete remission (CR) was indicated for all patients, and was performed in those who remained in CR at the scheduled time of transplantation, with 4-year event-free survival (EFS) and overall survival (OS) rates of 54% (95% confidence interval [CI]: 38%-68%) and 78% (95% CI: 62%-88%), respectively. Procedure The Japan Children's Cancer Group conducted ALL-Ph13, a multicenter single-arm Phase 2 clinical trial, to improve outcomes and reduce HSCTs by using chemotherapy with tyrosine kinase inhibitors (TKIs) guided by minimal residual disease (MRD). The primary endpoint was the 3-year EFS rate. Results Between 2013 and 2017, 41 of 43 enrolled patients with Ph+ ALL aged 1-19 years were eligible. Imatinib was started on Day 15 of induction and switched to dasatinib if MRD-positive after consolidation IB. TKIs were administered until the end of maintenance treatment (Week 104), with temporary discontinuation due to the severity of nonhematological adverse events and resumption at 80% of the original dose. When MRD was positive after the three HR blocks, HSCT was performed. Following four sepsis-related deaths, the protocol was amended in 2016, after which no such deaths occurred. Six patients (15%) underwent HSCT in the first CR, one per protocol indication and five without. The 3-year EFS and OS rates were 65% (95% CI: 48%-78%) and 85% (95% CI: 70%-93%), respectively. As several relapses occurred beyond 3 years, the 5-year EFS and OS rates were also calculated: 48% (95% CI: 30%-64%) and 85% (95% CI: 70%-93%), respectively. Conclusions Compared with Ph+ALL04, HSCT was substantially reduced in ALL-Ph13 while maintaining comparable outcomes. Further optimization of treatment, particularly the duration of TKI administration, is needed to maintain long-term EFS.
Objectives Underweight is a common health concern among individuals of reproductive age. Although sleep and metabolic regulation share neuroendocrine pathways, the relationship between underweight and sleep problems remains unclear. This study aimed to investigate the associations between underweight and questionnaire-based sleep-related outcomes among adolescent girls and adult women. Methods These cross-sectional, web-based surveys were conducted from November to December 2023 among adolescent girls (aged 12-18 years) and adult women aged 18 to 49 years. Valid responses were obtained from 996 adolescent girls and 4689 adult women. Logistic regression analyses were conducted within age-defined subgroups to examine associations between weight categories and sleep-related outcomes, including a sleep debt-related pattern with daytime sleepiness and self-reported insomnia symptoms, adjusting for sociodemographic and lifestyle factors. Results Among respondents, 14.7% of adolescent girls and 23.5% of adult women were underweight. Underweight was not associated with either of the sleep-related outcomes among adolescent girls. In adult women, underweight was associated with self-reported insomnia symptoms in women in their 20s, with no associations observed in other age groups. An interaction between age and underweight was observed, suggesting that this association weakened with increasing age. Conclusions Underweight was associated with self-reported insomnia symptoms, but not with a sleep debt-related pattern with daytime sleepiness, among adult women in their 20s. These findings suggest that sleep assessment may be considered as part of comprehensive strategies addressing underweight, although further studies using validated sleep measures are needed.
Introduction postpartum depression (PPD) is a major global public health concern with profound effects on maternal and child wellbeing. It remains one of the most common but under-recognised complications of childbirth, with higher prevalence in low- and middle-income countries, including Nigeria. Limited data are available on the prevalence of PPD in Nigeria, despite unique sociodemographic and psychosocial contexts. This study assessed the prevalence of PPD and its associated sociodemographic, obstetric, and psychosocial factors among pregnant women attending a 6-week postnatal clinic at the Gwarinpa General Hospital, Abuja, Nigeria. Methods a cross-sectional study of 400 postpartum women was conducted using systematic random sampling. Data was collected using interviewer-administered questionnaires on sociodemographic, obstetric, and psychosocial factors. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess depressive symptoms (cut-off ≥9). Analysis employed descriptive statistics, chi-square, and logistic regression with significance at p < 0.05. Results PPD prevalence was 19.0% (76/400). Most sociodemographic and obstetric factors were not significantly associated with PPD. However, prolonged labour was a strong predictor. Women with labour lasting >12 hours had significantly higher odds of PPD (OR = 3.88, 95% CI: 1.64-9.16). Conclusion postpartum depression had a prevalence of nearly one in five women in this study population, and prolonged duration of labour was significantly associated with PPD. These findings highlight the importance of strengthening intrapartum care and integrating targeted postpartum mental health screening for women who experience prolonged labour.
Objectives This study aimed to compare the effects of traditional childbirth (TC), water birth (WB) and the combination of WB and five-element music therapy (FEMT) on maternal childbirth experiences and clinical outcomes. Material and methods A total of 314 women who delivered at our hospital between November 2022 to June 2023 were enrolled and divided into three groups: the TC group (n = 126), the WB group (n = 95) and the WB-FEMT group (n = 93), which included labour pain relief through FEMT and WB. Data were collected, compared and analysed, including labour duration, first-stage labour pain duration, postpartum blood loss, neonatal Apgar scores, scores on the Labour Agentry Scale (LAS) and scores on the Childbirth Experience Questionnaire (CEQ2.0). Results The first-stage labour duration and overall labour duration were significantly shorter in the WB and WB-FEMT groups than in the TC group (p < 0.001, respectively). Pain scores in the WB-FEMT group were significantly lower than in the WB and TC groups, and postpartum blood loss was significantly less than that in the TC group (p = 0.007). The WB-FEMT group showed the highest neonatal Apgar score (p < 0.001). Moreover, maternal satisfaction with the childbirth experience in the WB-FEMT group was higher, with significantly better LAS and CEQ2.0 scores than in the TC group (p < 0.001, respectively). Conclusions The study demonstrates that WB and WB-FEMT are superior to TC in labour duration, pain management and postpartum recovery. The WB-FEMT combination significantly enhanced maternal psychological comfort. Offering diverse childbirth options can better meet the physiological and psychological needs of mothers, ultimately promoting the health of both mothers and newborns.
Children with language difficulties are at elevated risk of mental health problems, yet tools commonly used to assess mental health rely heavily on language. It is unclear if children's language ability influences their self-report measures. We tested language-related measurement invariance using moderated non-linear factor analyses. We used self-report data from children (10-11 years) with a wide range of language abilities, living in the UK, on the Revised Child Anxiety and Depression Scale-25 (RCADS-25; n = 342; 171 female; 80 with language difficulties) and the Strengths and Difficulties Questionnaire-Youth Report (SDQ-YR; n = 349; 174 female; 84 with language difficulties). Language-related differences were identified in both measures: six RCADS-25 items and three SDQ-YR items functioned differently in relation to language ability. For the RCADS-25, these differences did not affect anxiety and depression factor means. For the SDQ-YR, language-related item differences did affect peer problems and prosocial factor means, but not emotional problems, conduct problems, or hyperactivity. RCADS-25 factor scores appear robust for children with language difficulties, though item responses should be interpreted cautiously. In contrast, language-related differences in the SDQ-YR may limit comparisons of peer problems and prosocial subscales across children with differing language abilities.
Objective This study aims to examine cases of fi'l-i şenî' (sexual abuse) against children during the Tanzimat period using archival documents and scholarly literature, with the goal of revealing the punitive measures imposed on perpetrators. Methods The research employs qualitative methods, specifically document analysis. A keyword search using 'fiil-i şeni' in the database of the Ottoman Archives under the Presidency of the Republic of Turkey yielded 29 relevant cases. The documents were examined with particular attention to maintaining semantic integrity on completion of the translation process. These cases were systematically tabulated in the findings section and analysed in the discussion section. Results The study identified 29 cases of fi'l-i şenî' between 1839 and 1876. Four of these cases occurred before the implementation of the 1858 Penal Code, while 25 were adjudicated based on the 1858 Ottoman Penal Code. In the majority of cases, punishment was imposed in accordance with Articles 197, 198, 199 and 200 of the code. Conclusion In the period preceding the 1858 Penal Code, pranga punishment-entailing the chaining of offenders' feet and forcing them to perform hard labour-was prominent. This served both punitive and deterrent functions. With the enforcement of the 1858 Penal Code, the legal framework became more systematic and sexual crimes were more explicitly defined and categorised. In particular, Articles 197, 198, 199 and 200 determined the type and severity of punishment based on the nature of the crime, the victim's age and the perpetrator's relationship to the victim.
