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Background: Continuum of care for maternal health services (CMHS) is a proven approach to improve health and safety for mothers and newborns. This study aims to explore the influence of China’s 2009 healthcare reform on improving the CMHS utilisation. Methods: This population-based cross-sectional quantitative study included 2332 women drawn from the fourth and fifth National Health Service Surveys of Shaanxi Province, conducted in 2008 and 2013 respectively, before and after China’s 2009 healthcare reform. A generalised linear mixed model (GLMM) was applied to analyse the influence of this healthcare reform on utilisation of CMHS. Concentration curves, concentration indexes and its decomposition method were used to analyse the equity of changes in utilisation. Results: This study showed post-reform CMHS utilisation was higher in both rural and urban women than the CMHS utilisation pre-reform (according to China’s policy defining CMHS). The rate of CMHS utilisation increased from 24.66% to 41.55% for urban women and from 18.31% to 50.49% for rural women (urban: χ 2 =20.64, P<0.001; rural: χ 2 =131.38, P<0.001). This finding is consistent when the WHO’s definition of CMHS is applied for rural women after reform (12.13% vs 19.26%; χ 2 =10.99, P=0.001); for urban women, CMHS utilisation increased from 15.70% to 20.56% (χ 2 =2.57, P=0.109). The GLMM showed that the rate of CMHS utilisation for urban women post-reform was five times higher than pre-reform rates (OR=5.02, 95%CL: 1.90, 13.31); it was close to 15 times higher for rural women (OR=14.70, 95%CL: 5.43, 39.76). The concentration index for urban women decreased from 0.130 pre-reform (95%CI: -0.026, 0.411) to -0.041 post-reform (95%CI: -0.096, 0.007); it decreased from 0.104 (95%CI: -0.012, 0.222) to 0.019 (95%CI: -0.014, 0.060) for rural women. The horizontal inequity index for both groups of women also decreased (0.136 to -0.047 urban and 0.111 to 0.019 for rural). Conclusions: China’s 2009 healthcare reform has positively influenced utilisation rates and equity of CMHS’s utilisation among both urban and rural women in Shaanxi Province. Addressing economic and educational attainment gaps between the rich and the poor may be effective ways to improve the persistent health inequities for rural women. Keywords: Healthcare Reform; Continuum of care for Maternal Health Services; Equity; National Health Service Surveys; China

Background: This study aims to assess the level and determinants of the general public's willingness to organ donation.Methods: We conducted a population-based cross-sectional study of 4261 participants in China. The primary outcome was the willingness to donate organs. Logistic regression modelling was used to determine the factors that affect willingness to donate organs.Results: Overall, the proportion of participants who showed a willingness to donate organs was 47.45% (95%CI: 0.46, 0.49) in this study. Logistic regression modelling showed participants from Western (OR=1.35, 95%CI=1.13-1.62) and Eastern China (OR=1.54, 95%CI=1.20-1.66) were more willing to donate organs compared with those from Central China. The odds of being willing to donate organs was higher in females than males (OR=1.34, 95%CI=1.17-1.55); and was higher in those participants with experience of organ donation (OR=1.57, 95%CI=1.12-2.20), experience of caring for organ transplant patients (OR=1.47, 95%CI=1.03-2.10), and those undertaking related voluntary activities (OR=1.68, 95%CI=1.45-1.94), than those without. Conclusion:The general public's level of willingness to organ donation was not high in China. Geographical region, gender, experience of organ donation related activities, taking care of organ transplant patients and volunteering in related activities were independently associated with participants' willingness to donate organs.

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Background: Continuum of care for maternal health services (CMHS) is a proven approach to improve health and safety for mothers and newborns. This study aims to explore the influence of China's 2009 healthcare reform on improving the CMHS utilisation. Methods: This population-based cross-sectional quantitative study included 2332 women drawn from the fourth and fifth National Health Service Surveys of Shaanxi Province, conducted in 2008 and 2013 respectively, before and after China's 2009 healthcare reform. A generalised linear mixed model (GLMM) was applied to analyse the influence of this healthcare reform on utilisation of CMHS. Concentration curves, concentration indexes and its decomposition method were used to analyse the equity of changes in utilisation.

Comparing the pelvis of Tibetan and Chinese Han women in rural areas of China: two population-based studies using coarsened exact matchingThis study aims to investigate the difference of pelvic size and shape between Tibetan and Chinese Han women. Data on pelvic dimension measures including interspinous diameter (IS), intercrestal diameter (IC), external conjugate (EC) and transverse outlet (TO) were acquired from two population-based studies among Tibetan women in Lhasa, and Chinese Han women in Shaanxi province in China. After coarsened exact matching, there was no statistical difference between any characteristics among Tibetan and Chinese Han women (p>0.05).The generalized estimating equation models showed Tibetan women had significantly lower IS and IC means than Chinese Han women (IS: 24.39cm vs 24.77cm, p<0.001; IC: 26.35cm vs 26.93cm, p<0.001) but statistically higher in TO mean (9.12cm vs 9.03cm, p<0.001). This study showed Tibetan women have smaller pelvis compared to Chinese Han women. This should offer a useful literature on the comparison of pelvis between Tibetan and Chinese Han women although the difference is small.

Background: Multiple (two or more) chronic conditions (MCCs) is an important influencing factor on healthy ageing, which is associated with an increased risk of mortality, functional decline, mental health problems, especially depression in the elderly. However, evidence on associations between MCCs and depression among the elderly is not clear. The aim of this study was to explore the relationship between MCCs and depression in a large Chinese community study. Methods: Cross-sectional data of 6360 elderly were screened from the China Health and Retirement Longitudinal Study (CHARLS, wave 4) database. Depression symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D-10), and the elderly with MCCs is that who have been diagnosed at least two or more chronic diseases by the doctor. To test the relationship between MCCs and depression among the elderly, chi-square test and generalized linear model (GLM) were carried out.Results: The prevalence of chronic diseases in the elderly was 50.0%, of which 60.5% suffered from depression. Among the elderly with chronic disease, 19.8% suffered from MCCs, and the probability of depression in the elderly with MCCs was 1.332 times higher than that in the elderly without MCCs (OR:1.332, OR95% CI: 1.152 to 1.541). Urban and rural source, elementary school and above, social activities, life satisfaction, health satisfaction and child relationship satisfaction were the influencing factors of depression in the elderly with MCCs, while gender, urban and rural source, age(≥75y), per capita household income, life satisfaction, health satisfaction and child relationship satisfaction were the influencing factors of depression in the elderly without MCCs.Conclusion: The results of this study contributed to the exiting research gap on the relationship between MCCs and depression among the elderly, and can develop depression interventions targeting specific chronic disease for elderly.

Background The purpose of this study is to assess the level of knowledge, attitudes, and willingness to organ donation among the general public in China. Methods The study population consisted of 4274 participants from Eastern, Central and Western China. The participants’ knowledge, attitudes and willingness to organ donation were collected by a self-designed questionnaire consisting of 30 items. Knowledge is measured by 10 items and presented as a 10 point score, attitudes is measured by 20 items using a 5-step Likert scale and total score ranged between 0 and 80; while the willingness to donate is assessed as binary variable (0 = No; 1 = Yes). A logistic regression model was used to assess the association of knowledge and attitudes with willingness to organ donation, controlling for demographic and socioeconomic confounders. Results The questionnaire response rate was 94.98%. The mean score (± SD) of the general public’s knowledge to organ donation was 6.84 ± 1.76, and the mean score (± SD) of attitudes to organ donation was 47.01 ± 9.07. The general public’s knowledge and attitudes were the highest in Eastern China, followed by West and Central China. The logistic regression model indicated a positive association between knowledge and the willingness to organ donation (OR = 1.12, 95%CI: 1.08, 1.17; P < 0.001); attitudes were also positively potential determinant of more willingness to organ donation (OR = 1.08, 95%CI: 1.07, 1.09; P < 0.001). Conclusions Knowledge and attitudes were found to be positively associated with the Chinese general public’s willingness to organ donation. Knowledge about the concept of brain death and the transplant procedure may help raise the rate of willingness to organ donation.