Maternal mortality ratio in Jiangsu Province, China: recent trends and associated factors.

BACKGROUND: In recent years, births to older mothers and multiparous mothers have increased rapidly with the change of birth policy in China. And mothers of advanced age are more likely to have maternal complications and poor birth outcomes. We aimed to estimate the recent trends and underlying risk factors of maternal mortality. METHODS: In this systematic assessment, we used data from the National Maternal and Child Health Routine Reporting System (2013-2018), Jiangsu Provincial Maternal Mortality Surveillance System (2017-2018), the Integrated National Mortality Surveillance System (2018), City Statistical Yearbooks (2018), City Health Statistical Yearbooks (2018). The factors associated with maternal mortality ratio (MMR) were explored using the stepwise regression analysis and cluster analysis. RESULTS: The MMR maintained at low levels between 2013 and 2016 and there was a slight increase in maternal mortality after 2016 in Jiangsu province. With the implementation of the China's universal two child policies, the percentage of multiparous mothers ascended from 34.2% (95% confidence interval (CI) = 34.1-34.3%) in 2013 to 51.4% (95% CI = 51.3-51.6%) in 2018 (beta = 3.88, P < 0.001). Consistently, the percentage of advanced maternal age (≥ 35) increased from 8.4% (95% CI = 8.4-8.5%) in 2013 to 10.4% (95% CI = 10.3-10.4%) in 2018 (beta = 0.50, P = 0.012). And we found that the percentage of multiparous mothers and advanced maternal age among maternal deaths were higher than all pregnant women (P < 0.001). In the stepwise regression analysis, four risk factors were significantly associated with maternal mortality ratio (primary industry of gross domestic product (GDP), rate of delivery in maternal and child health hospital, rate of cesarean section and rate of low birth weight). As the results derived from cluster analysis, the relatively developed regions had lower preventable maternal mortality ratio (43.5% (95% CI = 31.2-56.7%) vs. 62.6% (95% CI = 52.3-72.0%), P = 0.027). CONCLUSIONS: Since the universal two child policy has been associated with changes in health related birth characteristics: women giving birth have been more likely to be multiparous, and more likely to be aged 35 and over. This somewhat magnifies the impact of differences in economic development and obstetric services on MMR. The findings based on prefecture level data suggest that interventions must target economic development, the health system and maternal risk factors in synergy. These approaches will be of great benefit to control or diminish environmental factors associated with preventable deaths and will effectively reduce MMR and narrow the gap among the different regions.

Internal migration and maternal health service utilisation in Jiangsu, China.

OBJECTIVES: To investigate the use of maternal health care services by internal migrants in view of their migration status. METHODS: Cross-sectional household survey in two cities of Jiangsu Province. Questions elicited data on socioeconomic information and MHC service use (pre-natal examination, post-natal visit, pre-natal health education). Chi-square tests and multivariate logistic regression analyses were used to identify factors associated with MHC service use. RESULTS: A total of 946 married women were recruited, of whom 22.3% were internal migrants. Compared to local residents, migrants were five times less likely to attend pre-natal examinations (84.4% vs. 91.7%; OR = 0.49, P = 0.002), three times less likely to have post-natal visits (15.6% vs. 50.2%; OR = 0.18, P < 0.001) and less likely to attend health education during pregnancy (87.0% vs. 95.7%; OR = 0.30, P < 0.001). Multivariate logistic regression also revealed a lower proportion of MHC use among migrants (ORm 0.52, 0.16, and 0.3, respectively). CONCLUSIONS: Internal migrants in Jiangsu Province underuse MHC services to a significant degree. More attention needs to be paid to pregnant migrant women, as they are vulnerable group in society.

Matrix-degrading soft-nanoplatform with enhanced tissue penetration for amplifying photodynamic therapeutic efficacy of breast cancer.

The dense extracellular matrix (ECM) in the tumor microenvironment forms an abnormal physical barrier, which impedes the delivery and penetration of nanomedicines and hinders their therapeutic efficacy. Herein, we synthesize matrix-degrading soft-nanocapsules composed of human serum albumin (HSA) and hyaluronidase (HAase) for overcoming the obstruction of ECM in the tumor microenvironment. The matrix-degrading human serum albumin/hyaluronidase soft-nanocapsules, referred to as HSA/HAase SNCs, possess a uniform diameter, inward hollow structure, and wrinkled morphology. In vitro biocompatibility results indicate that the HSA/HAase SNCs display no adverse effects on the viability of human umbilical vein endothelial cells (HUVECs), smooth muscle cells (SMCs), and mouse breast cancer (4T1) cells and do not induce hemolysis towards red blood cells (RBCs). The HSA/HAase SNCs exhibit a 1.4-fold increase in tumor cellular uptake compared to the stiff-counterparts and enhanced penetration in 4T1-, mouse colon carcinoma 26- (CT26-), and mouse pancreatic cancer- (PanO2-) multicellular spheroids. Thanks to the advanced biological properties, a photodynamic platform prepared by loading Ce6 in the HSA/HAase SNCs (HSA/HAase@Ce6) shows improved reactive oxygen species production, a stronger killing effect for cancer cells, and deeper penetration in tumor tissues. In vivo experiments show that HSA/HAase@Ce6 effectively inhibits tumor growth in breast cancer mouse models. RNA-seq analysis of the mice that received the treatment of HSA/HAase@Ce6 shows enrichment of signaling pathways associated with ECM-degradation, which demonstrates that the matrix-degrading nanocapsules overcome the ECM-induced physical barriers in tumors. Overall, the matrix-degrading soft-nanoplatform represents a highly promising strategy to overcome ECM-induced physical barriers and enhance the therapeutic efficacy of nanomedicines.

Characterization and photocatalytic activity of CoCr2O4/g-C3N4 nanocomposite for water treatment.

One of the materials that has recently been used to remove environmental pollution from industrial effluents with photocatalytic technology is cobalt chromate (CoCr2O4) nanoparticles. An effective way to improve the photocatalytic properties of materials is to composite them with other photocatalysts to prevent recombination of electron-holes and accelerate the transfer of oxidation/reduction agents. Graphitic carbon nitride (g-C3N4) is an excellent choice due to its unique properties. In this research, CoCr2O4 and its composite with g-C3N4 (5, 10, and 15%) were synthesized by polyacrylamide gel method and characterized by X-ray diffraction, scanning electron microscopy, FTIR, UV-Vis spectroscopy techniques. The photocatalytic behavior of synthesized nanoparticles was investigated in the degradation process of methylene blue dye. The results showed that the composite samples have higher efficiency in photocatalytic activity than the pure CoCr2O4 sample. Using CoCr2O4-15 wt%g-C3N4 nanocomposite, after 80 min, methylene blue was completely degraded. The mechanism of degradation by CoCr2O4-g-C3N4 nanocomposite was the superoxide radical produced by the reaction of electrons with oxygen absorbed on the catalyst surface, as well as optically produced holes directly.

The Effects of the Addition of Polyurethane-MgO Nanohybrids on the Mechanical Properties of Ordinary Portland Cement Paste.

One of the most important methods of controlling the properties of concrete and cement-based materials is to control the rate and kinetics of cement hydration. In the present study, novel flexible polyurethane-decorated MgO nanohybrids were synthesized using a simple chemical method, added to cement paste in different amounts, and utilized as an effective mechanical performance-enhancing factor for cement paste. It was observed that by adding 3 wt% synthesized PU-MgO nanohybrids to cement paste, its mechanical properties were improved and its compressive strength and flexural strength were increased by up to 13% and 15%, respectively, compared to the plain cement, after 45 days. The effect mechanism of adding PU-MgO nanoparticles on the properties of the cement paste was investigated. The addition of PU-MgO nanohybrids increased the pozzolanic reactions and formed more C-S-H phases.

Correction: Comparing Maternal Services Utilization and Expense Reimbursement Before and After the Adjustment of the New Rural Cooperative Medical Scheme Policy in Rural China.

[This corrects the article DOI: 10.1371/journal.pone.0158473.].

Comparing Maternal Services Utilization and Expense Reimbursement before and after the Adjustment of the New Rural Cooperative Medical Scheme Policy in Rural China.

BACKGROUND: The New Rural Cooperative Medical Scheme (NCMS) includes a maternal care benefits package that is associated with increasing maternal health services. The local compensation policies have been frequently adjusted in recent years. This study examined the association between the NCMS maternal-services policy adjustment and expense reimbursement in Yuyao, China. METHODS: Two household surveys were conducted in Yuyao in 2008 and 2011 (before and after the NCMS policy adjustment, respectively). Local women (N = 154) who had delivery history in the past three years were recruited. A questionnaire was used to collect information about delivery history, maternal health services utilization (prenatal care, postnatal care, and the grade of delivery institutions), NCMS participation, and reimbursement status. Logistic regression analyses were used to predict the association between policy adjustment and maternal health utilization and the association between policy adjustment and out-of-pocket proportion. Next, t-tests and covariance analyses adjusting for household income were used to compare the out-of-pocket proportion between 2008 and 2011. RESULTS: Results revealed that compensation policy adjustment was associated with an increase in postnatal visits (adjusted OR = 3.32, p = 0.009) and the use of second level or above institutions for delivery (adjusted OR = 2.32, p = 0.03) among participants. In 2008, only 9.1% of pregnant women received reimbursement from the NCMS; however, this rate increased to 36.8% in 2011. After policy adjustment, there were no significant changes in the proportion of out-of-pocket expenses shared in delivery fee (F = 0.24, p = 0.63) and in household income (F = 0.46, p = 0.50). CONCLUSIONS: Financial compensation increase improved maternal health services utilization; however, this effect was limited. Although the reimbursement rate was raised, the out-of-pocket proportion was not significant changed; therefore, the compensation design scheme must be adjusted in practice.