Objectives: We aimed to (1) assess parental hesitancy about category A (Expanded Program on Immunization (EPI)) and B (non-EPI) vaccines, (2) assess parental willingness for COVID-19 and influenza vaccinations, and (3) explore the association of vaccination hesitancy of parents and healthcare workers (HCWs). Methods: The study was performed in Wuxi, eastern China between 21 September 2020 and 17 October 2020. Parents of children aged <18 years and HCWs were recruited from the selected immunization clinics. Vaccine hesitancy was assessed using the Strategic Advisory Group of Experts (SAGE) vaccine hesitancy survey (VHS) by summing the total score for 10 items (maximum 50 points). Results: A total of 3009 parents and 86 HCWs were included in the analysis. The category A VHS scores were significantly higher than the category B VHS scores (p = 0.000). Overall, 59.3% and 52.4% of parents reported willingness to avail COVID-19 and influenza vaccination for their children, respectively; 51.2% of the HCWs wanted to be vaccinated against COVID-19. Parental category B VHS scores were associated with HCW category B VHS scores (r = 0.928, p = 0.008). Conclusions: In China, parents are more hesitant about category B vaccines than category A vaccines. More than 40% of parents showed hesitancy and a refusal to use COVID-19 and influenza vaccines.

Background The optimal technique for performing caesarean section with respect to minimising postoperative adhesions has not been determined.Objectives To evaluate adhesion formation for three common caesarean section techniques in women undergoing repeat caesarean section surgeries.Search strategy A database was constructed from Medline, EMBASE, Cochrane Library, National Science Digital Library, China Biological Medicine Database and through contact with experts in this field from January 1990 to May 2010.Selection criteria Studies were included if they examined adhesion formation in repeat caesarean sections as a primary objective, delineated a clear study design, specified an adhesion scoring system, and had sufficient patient exclusion criteria.Data collection and analysis We abstracted data regarding adhesion formation. The Mantel-Haenszel random-effects model was employed for all analyses using odds ratio or inverse variance, along with 95% CI.Main results Thirty-three qualified studies including 4423 women were analysed. There were 406 adhesions among 571 women and 238 adhesions among 596 women in the Stark's caesarean section (also known as Misgav-Ladach method) group and modified Stark's caesarean section group, respectively, with pooled OR 4.69 (95% CI 3.32-6.62; P < 0.01, 12 studies); 1173 adhesions among 1555 women and 1179 adhesions among 1625 women in Stark's caesarean section group and classic lowersegment caesarean section group, respectively, with pooled odds ratio 1.28 (95% CI 0.97-1.68; P = 0.08, 21 studies); and 29 adhesions from 102 women and 115 adhesions from 193 women in modified Stark's caesarean section group and classic lowersegment caesarean section group, respectively, with pooled odds ratio 0.28 (95% CI 0.10-0.82; P = 0.02, two studies).Authors' conclusions Closure of the peritoneum in modified Stark's caesarean section resulted in less adhesion formation and should be recommended.Keywords Adhesion, caesarean section, postoperative.

Consumer citizenship behavior is widely considered to be vital to business success. However, the role of resource uniqueness and service quality in encouraging citizenship behavior in tourism settings has not been well understood. Grounded on a framework integrating the Stimulus-Organism-Response Model and Social Exchange Theory, this study examines whether tourism resource uniqueness and service quality affect tourists’ citizenship behaviors (i.e., word-of-mouth recommendations and providing feedback) through the mediating effect of tourist emotion (i.e., positive and negative emotions). A total of 321 samples collected from three types of scenic spots in China were analyzed using structural equation modeling and Bootstrapping procedures. Results suggest that both tourism resource uniqueness and service quality positively predict positive emotion and negatively influence negative emotion, which is further positively and negatively associated with word-of-mouth recommendation and providing feedback, respectively. Moreover, both positive emotion and negative emotion mediate the effects of tourism resource uniqueness and service quality on tourists’ citizenship behaviors. Findings provide evidence that both resource uniqueness and service quality are critical to understand tourists’ citizenship behavior, and offer important marketing implications for destinations to manage tourist emotional experiences.

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