Knowledge, Attitudes, and Stigma Related to Dementia Among Illiterate and Literate Older Adults in Shanghai.

BACKGROUND: China has the largest population of patients with dementia worldwide, no assessment of illiterate old population's dementia knowledge, attitudes, stigma have been conducted so far in China. AIM: This study focused on the impact of education on knowledge, attitudes, and stigma related to dementia. METHODS: The community-based sample used in this study was recruited using multi-stage random sampling from residents aged ≥60 years registered in Shanghai. We used the Geriatric Depression Scale (GDS-30) to identify depression, and the Ascertain Dementia 8 questionnaire (AD8) for evaluating participants' cognitive impairment. Knowledge, Attitude, Belief, and Practice scale, Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) were used for measuring dementia knowledge, attitudes, stigma. We separated the population into illiterate and literate group, propensity score matching based on age, sex, depression, and cognitive impairment. We calculated the difference of knowledge, attitudes, and stigma related to dementia between illiterate and literate groups. RESULTS: Two thousand five hundred and eighteen participants completed the survey. After propensity score matching, 186 pairs of matched participants left. The overall correct rate of dementia knowledge was 70.34%. The illiterate group had a lower percentage of correct answers for each knowledge item. The item "Dementia is not a disease, it is forgetfulness due to aging" had the lowest accuracy rate in both groups (38.71% vs. 50.54%, p=0.022). Illiterate older adults were less accepting of dementia than literate older adults. The majority of participants did not agree that: "There is no need to visit a doctor when older people have memory loss, difficulty communicating, or finding words" (56.99% vs. 68.28%). Illiterate older adults had higher scores for the items assessing stigma toward dementia than literate older adults. CONCLUSION: Dementia-related knowledge and attitudes among community-dwelling older adults in Shanghai may be related to literacy.

An Exploratory Study of the Use of the Electronic Health Records of Hypertensive Patients to Support the Primary Prevention of Stroke in Shanghai.

BACKGROUND: The value of identifying and targeting population demographics at high risk of stroke based on patient-reported outcomes (PROs) with electronic health records (EHRs) in Shanghai is largely undiscovered. AIM: To test the hypothesis that establishing an evidence-based support system composed of PROs integrated with EHRs could be effective at identifying individuals at high risk of suffering from stroke. METHODS: The patients included in this study joined the hypertensive patient management system from 2014 to 2018. We merged the Hypertension Patients Management Database and the Diabetes Mellitus Patients Management Database of Shanghai Jiading district, then kept the hypertension patients with or without diabetes. We subsequently performed a screen analysis utilizing EHRs to target the population with any risk factor for stroke, namely, hypertension, diabetes mellitus, obesity, smoking and physical inactivity. We also calculated the distribution of each risk factor and the combinations of risk factors. RESULTS: In the Jiading District of Shanghai, 46,580 hypertensive patients with complete baseline information joined the hypertensive patient management system from 2014 to 2018. The majority of the patients were aged above 60 years old. Physical inactivity (83.24%), smoking (24.07%), diabetes (16.87%), and obesity (12.23%) were highly prevalent in hypertensive participants. Approximately 4377 patients were diagnosed with hypertension exclusively, accounting for 9.70% of the total number of patients in this study. Meanwhile, approximately 52.47% of the patients were diagnosed with two concurrent risk factors, and 38.13% of the patients had hypertension, meaning that 17,762 patients could be labeled as the high-risk population for stroke according to the criteria established by the National Stroke Screening Survey. CONCLUSION: Our exploratory findings demonstrate the feasibility of pinpointing and targeting populations at high risk of stroke using the EHRs of hypertensive patients.

Effects of midwife-led maternity services on postpartum wellbeing and clinical outcomes in primiparous women under China's one-child policy.

BACKGROUND: The Midwife-led maternity services have been implemented in China in response to the high rates of primiparous women and Caesarean Sections (CS) which may be related to China's one-child policy. However, few studies in China have been reported on the effectiveness of Midwife-led Care at Delivery (MCD) and the Continuity of Midwife-led Care (CMC) on postpartum wellbeing and other clinical outcomes. Therefore, evidence-based clinical validation is needed to develop an optimal maternity service for childbearing women in China. METHODS: A concurrent cohort study design was conducted with 1730 pregnant women recruited from 9 hospitals in Shanghai. Among the 1730 participants at baseline, 1568 participants completed the follow-up questionnaire, with a follow-up rate of 90.6%. RESULTS: Compared with the routine Obstetrician-led Maternity Care (OMC), Midwife-led Care at Delivery (MCD) was associated with CS rate (OR were 0.16; 95%CI: 0.11 to 0.25) and a higher total score of postpartum wellbeing (ßwere 2.70; 95%CI: 0.70 to 4.70) when adjusting for the baseline differences and other confounders during delivery or postpartum period. Moreover, continuity of Midwife-led Care (CMC) was associated with CS rate (OR were 0.30; 95%CI: 0.23 to 0.41), as well as increased rate of breastfeeding within the first 24 h (OR were 2.49; 95% CI: 1.47 to 4.23), higher postpartum satisfaction (ß = 4.52; 95% CI: 1.60 to 12.68), lower anxiety (ßwere 0.66; 95% CI: 0.16 to 1.17), increased self-control (ßwere 0.39; 95% CI: 0.02 to 0.76) and a higher total score of postpartum wellbeing (ßwere 3.14; 95% CI: 1.54 to 4.75). CONCLUSION: CMC is the optimal service for low-risk primiparous women under China's one-child policy, and is worthwhile for a general implementation across China.

Infant BMI peak as a predictor of overweight and obesity at age 2 years in a Chinese community-based cohort.

OBJECTIVES: Infant body mass index (BMI) peak has proven to be a useful indicator for predicting childhood obesity risk in American and European populations. However, it has not been assessed in China. We characterised infant BMI trajectories in a Chinese longitudinal cohort and evaluated whether BMI peak can predict overweight and obesity at age 2 years. METHODS: Serial measurements (n=6-12) of weight and length were taken from healthy term infants (n=2073) in a birth cohort established in urban Shanghai. Measurements were used to estimate BMI growth curves from birth to 13.5 months using a polynomial regression model. BMI peak characteristics, including age (in months) and magnitude (BMI, in kg/m2) at peak and prepeak velocities (in kg/m2/month), were estimated. The relationship between infant BMI peak and childhood BMI at age 2 years was examined using binary logistic analysis. RESULTS: Mean age at peak BMI was 7.61 months, with a magnitude of 18.33 kg/m2. Boys (n=1022) had a higher average peak BMI (18.60 vs 18.07 kg/m2, p<0.001) and earlier average achievement of peak value (7.54 vs 7.67 months, p<0.05) than girls (n=1051). With 1 kg/m2 increase in peak BMI and 1 month increase in peak time, the risk of overweight at age 2 years increased by 2.11 times (OR 3.11; 95% CI 2.64 to 3.66) and 35% (OR 1.35; 95% CI 1.21 to 1.50), respectively. Similarly, higher BMI magnitude (OR 2.69; 95% CI 2.00 to 3.61) and later timing of infant BMI peak (OR 1.35; 95% CI 1.08 to 1.68) were associated with an increased risk of childhood obesity at age 2 years. CONCLUSIONS: We have shown that infant BMI peak is valuable for predicting early childhood overweight and obesity in urban Shanghai. Because this is the first Chinese community-based cohort study of this nature, future research is required to examine infant populations in other areas of China.

Infant's sex, birth control policy and postpartum well-being: a prospective cohort study in Shanghai, China.

OBJECTIVES: The majority of Chinese families were under either one-child or two-child birth control policy status from 2001 to 2015. We explore the association between an infant's sex and the mother's postpartum well-being, which may be moderated by birth control policy status in China. SETTING AND PARTICIPANTS: We conducted a prospective cohort study in Shanghai City, one of the largest cities in China. A total number of 1730 childbearing women from eight obstetric hospitals across Shanghai were included in the study at baseline, with 1503 women completing the survey 7 days postpartum in 2013. MEASURES: The General Well-Being Schedule (GWBS) was used to assess maternal well-being at baseline and follow-up investigation in the study. The women's demographic, clinical characteristics, and well-being were measured at baseline. Maternal satisfaction and postpartum well-being were assessed in the follow-up survey. RESULTS: Multivariable linear regression analyses showed that women who gave birth to male infants were positively associated with the total score of maternal well-being, when the participating hospitals, maternal well-being at baseline, sociodemographic characteristics, and maternal and infant health outcomes were added to the adjustments (ß=1.462, p<0.05). The association disappeared when the two-child policy status was added to the adjustments (p>0.05). The results of a multiple logistic regression model showed that having a male infant was a risk factor of 'severe distress' (OR=1.607, p<0.05), which was moderated by the two-child policy status (p>0.05). CONCLUSIONS: Our results emphasise the importance of conducting interventions to increase maternal general well-being, especially for those with a female infant in a society such as China where preference is for a son, and enhance the necessity of sustainability of a newly relaxed two-child policy which allows more couples to have a second child in China.

Changes in work behavior during pregnancy in rural Anhui, China from 2001-03 to 2009: a population based cross-sectional study.

BACKGROUND: In low- and middle-income countries, many women continue working later into pregnancy. In our recent study on some areas in rural China, most women stopped working already during the first trimester (≤3 months) of pregnancy. In this paper we aimed to explore whether stopping work during early pregnancy has changed over an 8 year period (between 2001-03 and 2009); we also studied whether the reasons for stopping work early were the same in the two time periods. METHODS: A population-based cross-sectional survey with a representative sample of new mothers was carried out in one rural county in Anhui Province in 2001-03 (N = 1479 respondents) and in two other rural counties in 2009 (N = 1574 respondents). Both surveys were used to evaluate prenatal care interventions not related to work behavior. The surveys targeted all women who had recently given birth. Multilevel logistic regression analysis was used to examine the determinants of work behavior in the two time periods. RESULTS: There was a big change in the working behavior between the two survey years: in the period 2001-03 6 % and in 2009, 53 % of pregnant women stopped working at ≤3 months (percentage change 839, 95 % CI -15.90 to 1694.49). In 2001-03, 30 % and in 2009, 23 % of pregnant women worked the same as before pregnancy (percentage change -22.30, 95 % CI -90.28 to 45.68). In both time periods women with two children were less likely to stop work at ≤3 months of pregnancy. Non-farmers were more likely in 2001-03 but less likely in 2009 to stop work at ≤3 months of pregnancy. Women with medium township-level income were more likely to maintain the same level of work as before pregnancy in 2001-03, while in 2009 women with high township-level income were less likely to work the same. CONCLUSION: Stopping work very early during pregnancy appeared to have become very common from 2001-3 to 2009 in rural Anhui, China and was not explained by women's background characteristics.

The availability and affordability of long-term care for disabled older people in China: The issues related to inequalities in social security benefits.

BACKGROUND: China is experiencing increasing pressure from issues relating to an ageing population. The rationality of different eligibility criteria of the benefits within the social security system has been widely challenged; however, to date, no previous study has explored its association with the availability and affordability of long-term care (LTC). AIM: This study evaluates the availability and affordability of Long-Term Care (LTC) services for disabled older people (aged 65 and above) in China, with special attention to the differences among groups in receipt of specific social security benefits. METHODS: The data of availability and affordability of LTC services for disabled older people is from a nationally representative sample Chinese Longitudinal Healthy Longevity Survey (CLHLS). Three different social security benefits were identified and their effects on the long-term care services for disabled older people were explored. RESULTS: The overall proportions of disabled older people who have only limited or no available or affordable LTC services were remarkably high, especially for those who have moderate or no social security benefits. Compared to those who are entitled to generous social security benefits, older people who have no social security benefits are 18.45 times more likely to be unable to afford health care expenses. CONCLUSION: The findings imply that policy makers in China could focus on the LTC needs for the social security and socioeconomically disadvantaged (who have limited or no social security benefits and in low household income) disabled older people which could reduce the gap between them and those who are entitled to generous social security benefits.

Effects of home and education environments on children's motor performance in China.

AIM: The aim of this study was to examine the effects of home and educational environments on children's motor performance in China. METHOD: We conducted a cross-sectional study of 4001 preschool children selected from 160 classes. The children's motor performance was assessed using the Movement Assessment Battery for Children, 2nd edition (MABC-2). Home and educational environments were evaluated using validated checklists. The effects of home and educational environments on motor performance were analysed using mixed and multilevel logistic regression models. RESULTS: The results showed that one score increase in the outside space of the family home was positively associated with the increase in total test score (0.104) subtest score of aiming and catching (0.037), and balance (0.034) of the MABC-2, after adjusting for potential confounders (each p<0.05). Possession of motor toys at home and parental rearing behaviours were also related to total test score, manual dexterity, and balance (ß=0.022-0.104, each p<0.05). Space and furnishings, activity, and interaction in the classroom had a significant positive association with total test score (ß=0.069-0.201), and with subtest scores of manual dexterity, aiming and catching, and balance respectively (ß=0.115-0.206). Space and furnishings of classrooms and possession of toys in the household were protective factors for 'at risk' or significant poor performance (odds ratio 0.942-0.973, each p<0.05). INTERPRETATION: A permissive and accepting family and educational environment made a positive contribution to children's motor performance. Access to sufficient space and furnishings within the classroom, as well as toys in the family, were protective factors for poor motor performance. Future assistance is needed to support an advantageous environment in early childhood programmes in China.

[Environmental factors associated with developmental coordination disorder in preschool children in urban area of Suzhou city].

OBJECTIVE: A population-based study on developmental coordination disorder (DCD) was conducted in Suzhou to explore the impacts of family and kindergarten environment on pre school children with DCD so as to provide a basis for etiological research and early intervention. METHOD: Stratified clustered sampling was used to select 160 classes from randomly selected 15 public nursery schools distributed throughout the five main districts in Suzhou city. A total of 4 001 children were included in the study. The family environment scale on motor development for urban preschool children (FESMDPU) which was established by our study group and early childhood environment rating scale-revised (ECERS-R) which has been applied well in China were used to assess the family and kindergarten's environment. The multilevel logistic regression was used to analyze the risk factors of DCD when kindergarten environment were considered as "context variables" and the family environment as "individual variables". RESULT: According to DSM-IV criteria, a total of 330 children were diagnosed as DCD. The prevalence of DCD was 8.3%. However, there were differences between the two groups in age, gender and Kaup index (all P < 0.05). The results of ECERS-R and FESMDPU showed that the scores of "class space and faculty" "class activity" "class interaction" "family material environment" "family rearing environment" in DCD group were 48.00, 51.00, 49.00, 39.00, and 30.00, respectively, which were higher than those of control group (45.00, 50.00, 47.00, 41.00, 31.00) with statistical significance (U = 455 446.000, 550 787.000, 508 109.000, 543 159.000, and 490 119.000, P < 0.05 for all comparisons) . The score of ECERS-R and FESMDPU were grouped into different levels using the method of K-MEANS. The school and family environment were compared after the clustering. The results showed that the distribution of the rates in different levels between the DCD and control group were different with statistical significance (χ(2) = 51.091, 9.295, 35.464, 15.174, 13.500, P < 0.05 for all comparisons) . There was no significant difference between DCD and non-DCD children in parents' schooling years and family per-capita income of every month (all P > 0.05). The results of the multilevel logistic regression model showed that when children's gender, age and Kaup index were controlled, "class space and faculty" "class activity" "class interaction" "family material environment" "family rearing environment" were included in the model (OR was 3.486, 1.840, 1.623, 1.531, and 1.379, respectively, P < 0.05 for all) . CONCLUSION: The prevalence of DCD in study area was higher than that reported by European and American countries. The family and kindergarten environment may affect the incidence of DCD in preschool children. Parents and preschool educational and child health care practitioners should conduct the early prevention and intervention on DCD based on the risk factors of environment in preschool children.

The influence of Chinese one-child family status on developmental coordination disorder status.

We conducted a population-based study on Developmental Coordination Disorder (DCD) in mainland China to explore the influence of one-child status in Chinese families on DCD. A total of 4001 children selected from 160 classes in 15 public nursery schools. The Movement Assessment Battery for Children assessed motor function. The prevalence of DCD in Chinese one-child families (8.7%) was higher than that in multi-child families (5.9%). Chinese one-child family status (compared with younger children in multi-child families) were negatively related with total score (-1.793), Manual dexterity (-0.228), Aiming and catching (-1.145), Balance (-0.433) of MABC-2 and DCD (OR=2.294) when adjusted for the children's and family's characteristics, and perinatal factors (each p<0.05). As one of the studies in this Chinese context, it provides a platform for future intervention programs in one-child families in preventing children's developmental disorders.

Cesarean section in Shanghai: women's or healthcare provider's preferences?

BACKGROUND: Cesarean section (CS) rate has increased rapidly over the past two decades in China mainly driven by non-medical factors. This study was to compare recalled preferences for CS among first-time mothers in early and late pregnancy with actual delivery mode; to explore factors related to CS preference and CS performed without medical indications; and to consider the role of healthcare providers in delivery mode preferences. METHODS: An anonymous questionnaire survey, combined with data on CS indications taken from the patient record, was conducted among 272 first-time mothers having their first postnatal check-up in one university affiliated obstetrics and gynecology hospital in Shanghai, China, between September 2006 and January 2007. Logistic regression was used to study factors related to the recalled preference for CS and CS performed without medical indication, adjusting for maternal age, education and income. RESULTS: The CS rate was 57% (151/263) among all women, 17% with medical indications and 40% without medical indications. For women without medical indications for CS (n = 215), there was no significant difference between women's preference for CS in early (25%) and late pregnancy (28%); 48% of women actually had CS. Women recalled preferring a vaginal delivery but who had CS were more likely to have had a CS suggested by a prenatal care doctor [OR (95% CI): 20 (3.88-107.1)] or by a delivery obstetrician [OR (95% CI): 26 (6.26-105.8)]. Among women recalled preferring and having CS, a suggestion from the prenatal care doctor to have CS was very common. CONCLUSIONS: In the primiparous women without a medical indication for CS, women recall of a provider suggestion for CS was a strong predictor of CS both among women who recalled a preference for CS and among women who recalled a preference for vaginal delivery. Public health education needs strengthening, including discussion of the risks associated with CS and psychological and social support given to women to help them prepare for and cope with childbirth.

[Prenatal and perinatal risk factors for developmental coordination disorder in children].

OBJECTIVE: To explore the prenatal and perinatal risk factors for developmental coordination disorder (DCD) in children so as to provide a basis for etiological studies and early diagnosis on DCD. METHODS: Stratified clustered sampling was used to select 160 classes from randomly selected 15 public nursery schools which were distributed throughout the five main districts in Suzhou city. A total of 4 001 children were included in the study. Multilevel logistic regression and structural equation model (SEM) were used to analyze the risk factors of DCD. RESULTS: Results from the multilevel logistic regression model showed that when factors as:class internal clustering, children's gender, age and Kaup value etc., were under control, factors as acute fetal distress, premature and newborn pathological jaundice would be included in the model (OR values were 7.030, 3.374, 1.993, with all their Ps<0.001), and showing these variables were related to DCD. RESULTS: of SEM showed that the related coefficient between 'Minimal Brain Dysfunction' and 'Motor coordination skill' was -0.18 with statistical significance (P < 0.05). It also indicated that the minimal brain dysfunction would negatively impact on the children's motor skill. CONCLUSION: There were risk factors of DCD noticed during the prenatal and peri-natal periods. Practitioners working at the maternity and child health care areas should improve the skills in assessing and monitoring the prenatal and peri-natal risk factors related to DCD, and to better carry out early screening, diagnosis, treatment and prevention of DCD.

Child neglect in one-child families from Suzhou City of mainland China.

BACKGROUND: The one-child policy introduced in China in 1979 has led to far-reaching changes in socio-demographic characteristics. Under this policy regime, each household has few children. This study aims to describe the prevalence of child neglect in one-child families in China and to examine the correlates of child neglect. METHODS: A cross-sectional study of 2044 children aged 6 to 9 years and recruited from four primary schools in Suzhou City, China was conducted. Neglect subtypes were determined using a validated indigenous measurement scale reported by parents. Child, parental and family characteristics were obtained by questionnaires and review of social security records. Linear regression analyses were performed to estimate the associations between these factors and the subtypes of child neglect. RESULTS: The prevalence of child any neglect was 32.0% in one child families in Suzhou City, China. Supervisory (20.3%) neglect was the most prevalent type of child neglect, followed by emotional (15.2%), physical (11.1%), and educational (6.0%) neglect After simultaneous adjustment to child and family characteristics and the school factor, boys, children with physical health issues and cognitive impairment, younger and unemployed mother, were positively associated with neglect subtypes. We also found that parents with higher education and three-generation families were negatively associated with neglect. CONCLUSION: The rates of child neglect subtypes vary across different regions in China probably due to the different policy implementation and socio-economic levels, with a lower level of physical and educational neglect and a higher level of emotional neglect in this study. The three-generation family structure was correlates of neglect which may be unique in one child families. This indicates that future intervention programs in one-child families should target these factors.

Work behaviour during pregnancy in rural China in 2009.

OBJECTIVES: To describe the pattern and determinants of working during pregnancy in rural China. METHODS: A cross-sectional survey was carried out in 2009 in three provinces (Anhui, Chongqing and Shaanxi) in rural China among 3966 mothers who had recently given birth. Multilevel logistic regression was used to examine the determinants of work behaviour during pregnancy. RESULTS: Overall, 39% of the women stopped working during early pregnancy, 32% worked the same throughout pregnancy and the rest decreased their work or stopped later in pregnancy. Women from Anhui (53%) and Chongqing (54%) provinces were more likely to stop work in early pregnancy than women from Shaanxi province (20%). Older women [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.56-0.99], those having two or more children (OR 0.55, 95% CI 0.43-0.69) and non-farmers (OR 0.50, 95% CI 0.65-0.99) were less likely to stop working on the first trimester, but those with higher education (high school OR 1.43, 95% CI 1.05-1.94) were more likely to stop working. Stopping work early was not related to household income and adequacy of prenatal care. Women with two or more children, non-farmers and those from Shaanxi province were more likely to continue to work to the same extent during pregnancy. But those with higher household income and middle and high school were less likely to work the same. CONCLUSIONS: Women's working patterns during pregnancy in rural China were polarized: many women stopped working already in early pregnancy, but others continued to work as before. The key determinant of the working patterns was the province of residence.

Age band 1 of the Movement Assessment Battery for Children-Second Edition: exploring its usefulness in mainland China.

The aim of this paper was to examine the validity and reliability of age band 1 of the Movement Assessment Battery for Children-Second Edition (MABC-2) in preparation for its standardization in mainland China. Interrater and test-retest reliability of the MABC-2 was estimated using Intraclass Correlation Coefficient (ICC). Cronbach's alpha for each item and Item-total correlation were used to determine internal consistency. The content validity was determined by the Item-level content validity index (I-CVI). Confirmatory factor analysis was used to examine the factorial validity of the MABC-2 test. The correlation coefficients between the MABC-2 and the Peabody Developmental Motor Scales-2 (PDMS-2) were used to assess the criteria-related validity. The Cronbach's alpha values of all eight items together were moderate but acceptable. The correlation coefficients between each test item and the total score were moderate except for two items. The ICC of interrater and test-retest reliability for each test items was good. The I-CVI of each item was excellent (each above 0.78). The result of confirmatory factor analysis showed that the goodness-of-fit indices of the adjusted model were good (each above 0.9), indicating a satisfactory fit of the data to the model. The total score on MABC-2 and PDMS-2 was correlated well (r=0.631). It is concluded that the reliability and validity of age band 1 of MABC-2 were fair in this study based on a large sample. However, there was a need to adjust part of items to improve the test's psychometric properties when it is used in Chinese children.

Impact of financial and educational interventions on maternity care: results of cluster randomized trials in rural China, CHIMACA.

To report on the design and basic outcomes of three interventions aimed at improving the use and quality of maternity care in rural China: financial interventions, training in clinical skills, and training in health education. Community-based cluster randomized trials were carried out in one central and two western provinces between 2007 and 2009: (1) financial interventions covered part of women's costs for prenatal and postnatal care, (2) training of midwives in clinical skills was given by local maternity care experts in two- or three-group training courses, (3) health education training for midwives and village doctors were given by local experts in health education in two- or three-group training courses. A survey was conducted in a stratified random sample of women who had been pregnant in the study period. 73% of women (n = 3,673) were interviewed within 1-10 months of giving birth. Outcomes were compared by the different intervention and control groups. Adjusted odds ratios were calculated by logistic regression to adjust for varying maternal characteristics. Most of the differences found between the groups were small and some varied between provinces. The financial intervention did not influence the number of visits, but was associated with increased caesarean sections and a decrease in many ultrasound tests. The clinical intervention influenced some indicators of care content. There was no consistent finding for the health education intervention. Financial and training interventions have the potential to improve maternity care, but better implementation is required. Unintended consequences, including overuse of technology, are possible.

[Assessment on the validity and reliability of Family Environment Scale on Motor Development for Urban Pre-school Children].

OBJECTIVE: To assess the validity and reliability of Family Environment Scale on Motor Development for Urban Pre-school Children (FESMDUPC) so as to provide valid and reliable tools for measuring the influencing factors from home environment on motor development of the children. METHODS: One thousand eight hundreds and twenty four preschool children from 15 kindergartens in Suzhou city were included in this study which related to reliability and validity of FESMDUPC. Data on test-retest reliability, internal consistent reliability, content validity and construct validity were assessed using the Intra-class Correlation Coefficient (ICC), Cronbach α coefficient, Item-level content validity index (I-CVI) and Confirmatory Factor Analysis (CFA). When the Observation for Measurement of the Environment Revisited was used as criteria, the criteria-related validity of MABC was assessed, using the Spearman correlation analysis. RESULTS: This study showed that the ICC of all items was above or close to 0.9. The total Cronbach α coefficient was 0.875 and the Cronbach α coefficient was 0.868-0.873 when each item was deleted. Formal validity and reliability study showed that I-CVI of the 23 items was 0.79-1.00. The average I-CVI was 0.92. Results from the CFA model showed that χ2=1077.5, df=224 and χ2/df=4.810. Fit of Goodness on the other indices of the model were as follows: GFI (0.949), AGF (0.937), NFI (0.889), CFI (0.896), with each of them above or close to 0.9. The RMSEA was 0.046 which showed that the model's Fit of Goodness could be accepted. The factor loadings were all above 0.3 with statistical significance. However, according to this model, the strengths of relationship between Outside Space, Inside Space and Toy were high, so the high-step CFA of FESMDUPC was further analyzed. The model's Fit of Goodness was good. The factor loadings were all above 0.3 with statistical significance. Results showed that the Spearman Coefficient of the total score of FESMDUPC and HOME scale was 0.476 (each P<0.001). Among them only the learning staff and movement variety were comparatively and highly correlated with Toy, Parental Rearing Patterns. Spearman coefficients were all above 0.3 (each P<0.001). CONCLUSION: The above results showed that the reliability of test-retest, the internal consistent reliability, the content validity and the construct validity of FESMDUPC were fair and had met the basic psychometric demands. FESMDUPC could be used as a quantitative tool to assess the motor development among children.

Impact of Chinese one-child policy on sibling structure: experience from rural areas in three provinces.

OBJECTIVES: To study the influence of population policy and boy preference on the sibling structure, that is, in which order and combinations boys and girls are born into families. DESIGN: A population-based survey with a representative sample of new mothers in 2008-2009 in rural China. SETTING: Two provinces (Anhui and Shaanxi) where authorisation for a second child was usually given if the first birth was a daughter and one province (Chongqing) where only one child was authorised. PARTICIPANTS: The mothers giving birth in 2008-2009 were identified from family planning and hospital birth registers (including births outside hospitals) (n=5049). Of them, 3673 were interviewed by trained medical university staff members and students using structured questionnaire (response rate 73%). MAIN OUTCOME MEASURES: Children's distribution by sex and families' distribution by children's birth order and sex composition were calculated and compared with theoretical values based on the assumption that family planning policy is fully followed. RESULTS: The recommended family policy was varyingly followed in the three provinces. In all provinces, there were more second children than allowed. If the policy allowing a second child only after a first-born girl were fully followed, it would result in a sibling structure in which the one-child family is always with a boy and in the two-child family the first one is always a girl. This sibling structure was partly seen in Anhui but weakly in Shaanxi. The policy allowing only one child would result in an equal number of boys and girls, but in Chongqing, there were more boys. In Anhui, unlike the other provinces, there were many more first-born girls than boys, which the authors could not fully explain. CONCLUSION: Population policy and boy preference influence the actual and relative number of girls and boys and also sibling structure.

Maternal socio-economic indices for prenatal care research in rural China.

BACKGROUND: The conceptualization and measurement of socio-economic status (SES) is difficult in developing settings. In the absence of SES indices for women in rural China, we constructed SES indices for prenatal care research, and examined their relation to perinatal care and outcomes. METHODS: This study utilized data of 4364 rural women having recently given birth, collected by a cross-sectional survey in three rural Chinese provinces in 2007. Principal component analysis (PCA) was used to construct the SES indices and multilevel logistic regression was use to relate the indices to low birthweight, short exclusive breastfeeding (≤4 months), childbirth at the county or higher level health facility, caesarean section, inadequate prenatal care and no postnatal care. RESULTS: Three separate SES indices (wealth, occupational and educational indices) were obtained from the PCA analysis, capturing maternal, paternal and household SES characteristics. After adjusting for individual level factors, village and township wealth, higher levels of the indices were inversely associated with inadequate prenatal care. Higher occupational status was positively associated with short exclusive breastfeeding and childbirth at the county or higher level health facility, but inversely associated with no postnatal care. Higher educational status was positively associated with no postnatal care. CONCLUSION: Three SES indices (wealth, occupational and educational) were obtained from this study for prenatal care research. The indices gave mostly varying results on their associations with perinatal care and outcomes, indicating that SES measures may be outcome-specific.

Determinants of the use of prenatal care in rural China: the role of care content.

Several maternal demographic factors have been identified to influence the timing of starting prenatal care and its adequate use. However, how the content of prenatal care modifies these factors has not been studied previously. Using a representative sample collected for other purposes in rural China, we examined the factors predicting the uptake of prenatal care by taking into account the content of care (advice: on nutrition during pregnancy, diseases and pregnancy-related problems, and on child care after birth; and routine tests: blood pressure, blood tests, and ultrasound). We studied 1,479 women who answered a house-hold KAP (knowledge, attitude, and practice) survey (97% response rate) collected after a prenatal care intervention from 2001 to 2003 in 20 townships located in a county in Anhui Province. A multinomial logistic regression was used for the analysis. The most prominent factors that predicted late start of prenatal care and inadequate care were younger age, low maternal income, and having more than one child. When we adjusted for the content of care, the influence of these factors on the use of prenatal care attenuated to varying degrees: in some cases there was up to 20% reduction in the values of the risk estimates, while in other cases the statistical significance of the estimates were lost. It is important to take into account the content of prenatal care when assessing the factors predicting women's use of prenatal care.