The objective of this study was to evaluate the effect of institutional and policy interventions on reducing the rate of cesarean delivery on maternal request (CDMR) in Wenzhou, China. Institutional interventions included health education, painless delivery introduction, and doula care. Additionally, a series of health policies were developed by the Chinese central and local governments to control cesarean section rates, mostly through controlling CDMR rates. We conducted a pre-/post-intervention study using 131,312 deliveries between 2006 and 2014 in three tertiary-level public hospitals in Wenzhou, China. Chi-square tests and predictive models were used to examine changes in the CDMR rate before and after institutional and policy interventions. After institutional interventions were introduced, the overall CDMR rate increased from 15.76% to 16.34% (p = 0.053), but the average annual growth rate (AAGR) of the overall CDMR rate quickly declined from 20.11% to -4.30%. After policy interventions were introduced, the overall CDMR rate, the AAGR of the overall CDMR rate, and the probability of performing CDMR declined. Further, the overall probability of a woman undergoing CDMR decreased in all three age groups (group one: <24; group two: 24–34; group three: >34) after institutional and policy interventions. These results show that institutional and policy interventions can reduce the CDMR rate. Additionally, the CDMR rate should be included in hospitals’ performance assessment matrix to reduce the CDMR rate further.
Background The increasing trend of Caesarean section (CS) in childbirth has become a global public health challenge. Previous studies have proposed financial intervention strategies for reducing CS rates by limiting caesarean delivery on maternal request (CDMR). This study synthesizes such strategies while evaluating their effectiveness. Methods The sources of data for this study are Cochrane Library, PubMed, EMBASE, and CINAHL. The publication period included in this study is from January 1991 to November 2018. The financial intervention strategies are divide into two categories: healthcare provider interventions and patient interventions. Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) was employed to assess the risk of bias of included studies. The outcome of each study was evaluated with Grades of Recommendation, Assessment, Development and Evaluation (GRADE) through the GRADEpro Guideline Development Tool software. Results Nine studies were included in this systematic review: five with high certainty evidence (HCE), three with moderate certainty evidence (MCE), and one with low certainty evidence (LCE). Of the nine studies, seven are centered on the effect of provider-side interventions. Three of the HCE studies found that the diagnosis-related group payment system, risk-adjusted capitation, and equalizing fee for both facilities and physicians were effective intervention strategies. One HCE and one MCE study showed that only equalizing facility fees between vaginal and CS deliveries in healthcare service settings had no significant effect on reducing the CS rate. The MCE study showed that case payment had a negative effect on reducing the CS rates. One LCE study revealed that the effect of a global budget system was uncertain, and one HCE and one MCE study focused on combining both provider and patient-side interventions. However, equalizing fees for vaginal and CS deliveries and a co-payment policy for CDMRs failed to reduce the CS rate. Conclusions The effectiveness of risk-adjusted payment methods appears promising and should be the subject of further research. Financial interventions should consider stakeholders’ characteristics, especially the personal interests of doctors. Finally, high-quality randomized control trials and comparative studies on different financial intervention methods are needed to confirm or refute previous studies’ outcomes. Electronic supplementary material The online version of this article (10.1186/s12889-019-7265-4) contains supplementary material, which is available to authorized users.
The fast blue optical transients (FBOTs) are a new population of extragalactic transients of unclear physical origin. A variety of mechanisms have been proposed including failed supernova explosion, shock interaction with a dense medium, young magnetar, accretion onto a compact object, and stellar tidal disruption event, but none is conclusive. Here we report the discovery of a possible X-ray quasi-periodicity signal with a period of ~250 second (at a significance level of 99.76%) in the brightest FBOT AT2018cow through the analysis of XMM data. The signal is independently detected at the same frequency in the average power density spectrum from data taken from the Swift telescope, with observations covering from 6 to 37 days after the optical discovery, though the significance level is lower (94.26%). This suggests that the QPO frequency may be stable over at least 1.1×10^4 cycles. Assuming the ~250 second QPO to be a scaled-down analogue of that typically seen in stellar mass black holes, a black hole mass of ~10^3-10^5 solar masses could be inferred. The overall X-ray luminosity evolution could be modeled with the stellar tidal disruption by a black hole of ~10^4 solar masses, providing a viable mechanism to produce AT2018cow. Our findings suggest that other bright FBOTs may also harbor intermediate-mass black holes.
The ancient road cultural route is an important part of Huizhou cultural heritage, which is closely related to Huizhou tradition. Huizhou ancient villages are important historical and cultural heritage. The important features of their locations and layouts are the high integration with nature, forming a traditional residential environment pattern of “backing mountain, surrounding water and facing screen”. From the perspective of Huizhou Ancient Road, this paper selects Chengkan ancient village, which is an important cultural route of “Shuyuan Lingshan Chengkan ancient road”, as the research object, and takes the construction of human settlements as the main research content. From the natural environment and cultural background, and the formed human environment as the starting point, the paper focuses on the village agglomeration spatial pattern, the village water system, the street space environment, the architectural environment and the Shuikou landscape environment to analyze the characteristics and concepts of traditional residential environment construction in Huizhou ancient villages represented by Chengkan village, so as to make a beneficial discussion on the regional rural revitalization, the protection and development of traditional village human settlement environment.
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