Family Welfare Effort, Total Fertility, and In Vitro Fertilization: Explaining the Israeli Anomaly.

The theory of family welfare effort is a leading macro-sociological explanation of variation in human fertility. It holds that states which provide universally available, inexpensive, high-quality day care, generous parental leave, and flexible work schedules lower the opportunity cost of motherhood. They thus enable women, especially those in lower socioeconomic strata, to have the number of babies they want. A considerable body of research supports this theory. However, it is based almost exclusively on analyses of Western European and North American countries. This paper examines the Israeli case because Israel's total fertility rate is anomalously high given its family welfare effort. Based on a review of the relevant literature and a reanalysis of data from various published sources, it explains the country's unusually high total fertility rate as the product of (1) religious and nationalistic sentiment that is heightened by the Jewish population's perception of a demographic threat in the form of a burgeoning Palestinian population and (2) the state's resulting support for pro-natal policies, including the world's most extensive in vitro fertilization (IVF) system. The paper also suggests that Israel's IVF policy may not be in harmony with the interests of many women insofar as even women with an extremely low likelihood of becoming pregnant are encouraged to undergo the often lengthy, emotionally and physically painful, and risky process of IVF.

La théorie de l'effort pour le bien-être familial est une explication macrosociologique majeure de la variation de la fécondité humaine. Cette théorie soutient l'idée que les États offrant des garderies universellement accessibles, peu coûteuses et de grande qualité, des congés parentaux généreux et des horaires variables réduisent le coût d'opportunité de la maternité. Ces États permettent ainsi aux femmes, en particulier celles appartenant à des strates socioéconomiques inférieures, d'avoir le nombre d'enfants qu'elles souhaitent. Un nombre considérable de recherches appuient cette théorie. Cependant, elle repose presque exclusivement sur des analyses des pays d'Europe occidentale et d'Amérique du Nord. Cet article examine le cas israélien parce que l'indice synthétique de fécondité d'Israël est anormalement élevé compte tenu de ses efforts en matière de bien-être familial. Reposant sur un examen de la littérature appropriée et d'une nouvelle analyse des données provenant de diverses sources publiées, il explique l'indice synthétique de fécondité anormalement élevé du pays comme le résultat: (1) d'un sentiment religieux et nationaliste renforcé par la perception par la population juive d'une menace démographique au vu d'une population palestinienne croissante et (2) du soutien que l'État apporte aux politiques natalistes, notamment grâce au système de fécondation in vitro le plus important au monde. Cet article suggère également que la politique israélienne de fécondation in vitro ne correspond peut-être pas aux intérêts de nombreuses femmes dans la mesure où l'on encourage même les femmes ayant une probabilité extrêmement faible de devenir enceintes à avoir recours au processus de la fécondation in vitro souvent long et douloureux sur les plans émotionnel et physique ainsi que risqué.

Parents' perception of stroller use in young children: a qualitative study.

BACKGROUND: Despite their wide usage, it has recently been suggested that stroller use may reduce physical activity levels of young children. However, there have been no studies on stroller use as it relates to physical activity outcomes. The objectives of this study were to understand the context of stroller use for young children and parents' perceptions of the relationship between stroller use and their children's physical activity. METHODS: Parents of children 1 to 5 years of age were recruited through two sites of TARGet Kids!, a primary-care, practice-based research network in Toronto, Canada. Fourteen semi-structured interviews were conducted. Interviews were audio recorded and transcribed verbatim and two independent reviewers conducted thematic analysis. A number of strategies were employed to ensure the trustworthiness of the data. RESULTS: Parents discussed reasons for stroller use (i.e., transportation; storage; leisure; supervision/confinement; parent physical activity; and sleep), factors that influence the decision to use a stroller (i.e., caregiver choice; convenience, timing, distance; family lifestyle; and child preference), and perceived impact of stroller use on physical activity (i.e., most parents did not recognize a connection between stroller use and physical activity). CONCLUSION: This study provides a context for researchers and policy makers to consider when developing stroller related physical activity guidelines for young children.

Comparison of outcomes after cardioversion or atrial fibrillation ablation in patients with differing periprocedural anticoagulation regimens.

BACKGROUND: There is a paucity of data that compare traditional vitamin K antagonist (VKA) with novel oral anticoagulant regimens in periprocedural management of cardioversion or ablation of atrial fibrillation (AF). We sought to compare outcomes of use of VKA, dabigatran (DABI), and rivaroxaban (RIVA) anticoagulation around the time of intervention. METHODS: We studied consecutive patients undergoing cardioversion or ablation of AF at our centre from October 2010 to October 2013. There were 3 different anticoagulation groups: warfarin (VKA), DABI, and RIVA. Safety was assessed according to number of strokes, transient ischemic attacks (TIAs), and clinically important and not important bleeding events. RESULTS: Baseline characteristics were well balanced between the groups. Average follow-up was 6 months (± 4 months). A total of 901 patients who underwent cardioversion were studied (VKA [n = 471], DABI [n = 288] and RIVA [n = 141]). In these patients there were no strokes seen during follow-up and 2 TIAs in the DABI group. Bleeding rates were low, with no significant difference between the 3 groups. A total of 680 patients who underwent ablation were studied (VKA [n = 319], DABI [n = 220] and RIVA [n = 171]). There were no strokes reported during follow-up and 3 TIAs: 2 in the VKA group and 1 in the DABI group not resulting in a significant difference between the groups. Bleeding rates were low, with no significant difference between the groups. CONCLUSIONS: Overall, there was a low incidence of adverse events for all anticoagulation regimens. Warfarin, DABI, and RIVA use around the time of the procedure are safe and reasonable options for patients who undergo cardioversion or AF ablation.