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1.
Natl Vital Stat Rep ; 70(2): 1-51, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33814033

RESUMO

Objectives-This report presents 2019 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.75 million births that occurred in 2019 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age are also shown. Trend data for 2010 through 2019 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2019. Results-A total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15-44 in 2019. The birth rate for females aged 15-19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20-34 and increased for women aged 35-44 for 2018-2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019; the percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019 (Figure 1). Medicaid was the source of payment for 42.1% of all births in 2019. The preterm birth rate rose for the fifth straight year to 10.23% in 2019; the rate of low birthweight was essentially unchanged from 2018 at 8.31%. Twin and triplet and higher-order multiple birth rates both declined in 2019 compared with 2018.


Assuntos
Coeficiente de Natalidade/tendências , Adolescente , Adulto , Declaração de Nascimento , Ordem de Nascimento , Coeficiente de Natalidade/etnologia , Peso ao Nascer , Grupos de Populações Continentais/estatística & dados numéricos , Parto Obstétrico/economia , Parto Obstétrico/métodos , Feminino , Idade Gestacional , Hispano-Americanos/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Estado Civil/etnologia , Estado Civil/estatística & dados numéricos , Idade Materna , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Uso de Tabaco/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
2.
J Surg Oncol ; 123(4): 1045-1049, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33497472

RESUMO

INTRODUCTION: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly accepted as the best therapeutic option in primary and some secondary peritoneal malignancies. The ramifications of this procedure on fertility are unknown. The aim of this study was to assess the current association of CRS/HIPEC with fertility following surgery. METHODS: A review of patients who underwent CRS/HIPEC between 2009 and 2018 was performed. Female patients were included if they were between ages 18-50 at the time of surgery. Gynecologic and obstetric history before and following CRS/HIPEC was collected by phone interview. RESULTS: Of 48 eligible participants, 21 completed the survey. Sixty-five percent of women underwent a total abdominal hysterectomy before or during CRS. Twenty-nine percent of these women recall fertility counseling before CRS/HIPEC, while 14.3% saw a fertility specialist for consultation, and only one patient proceeded with oocyte cryopreservation before treatment. There were no pregnancies reported following treatment with CRS/HIPEC. CONCLUSION: Few patients after CRS/HIPEC retain child-bearing potential, partly due to the high rate of hysterectomy and oophorectomy at time of surgery. Efforts towards improved preoperative counseling, increased oocyte cryopreservation, and evaluating the safety of preserving reproductive organs at the time of surgery are needed.


Assuntos
Coeficiente de Natalidade/tendências , Quimioterapia do Câncer por Perfusão Regional/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Hipertermia Induzida/efeitos adversos , Neoplasias/terapia , Neoplasias Peritoneais/terapia , Adolescente , Adulto , Terapia Combinada , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Neoplasias/patologia , Neoplasias Peritoneais/patologia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
3.
BMJ Glob Health ; 5(9)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32999054

RESUMO

BACKGROUND: Aetiology of births involving very low birthweight (VLBW) and extremely low birthweight (ELBW) infants is heterogeneous and preventive strategies remain elusive. Socioenvironmental measures implemented as Ireland's response to the SARS-CoV-2 virus (COVID-19) pandemic represented a national lockdown, and have possibly influenced the health and well-being of pregnant women and unborn infants. METHODS: Regional trends of VLBW and ELBW infants in one designated health area of Ireland over two decades were analysed. Poisson regression and rate ratio analyses with 95% CI were conducted. Regional data covering most of the lockdown period of 2020 were compared with historical regional and national data and forecasted national figures for 2020. RESULTS: Poisson regression analysis found that the regional historical VLBW rate per 1000 live births for January to April, 2001-2019 was 8.18 (95% CI 7.21 to 9.29). During January to April 2020, an unusually low VLBW rate of just 2.17 per 1000 live births was observed, reflecting a rate ratio of 3.77 (95% CI 1.21 to 11.75), p=0.022, representing a 73% reduction of VLBW during the first 4 months of 2020 compared with same period for the preceding two decades. There were no ELBW infants admitted to the regional neonatal intensive care unit. National Irish VLBW rate for 2020 is forecasted to be reduced to approximate 400 per 60 000 births compared with the historical 500-600 range. CONCLUSION: An unprecedented reduction in regional births of VLBW and ELBW infants was observed in Ireland coinciding with the COVID-19 lockdown. Potential determinants of this unique temporal trend possibly reside in the summative socioenvironmental impact of the COVID-19 lockdown. Our findings, if mirrored in other regions that have adopted a lockdown, demonstrate the potential to evaluate these implicated behavioural and socioenvironmental modifiers to positively influence VLBW and ELBW rates globally.


Assuntos
Infecções por Coronavirus/epidemiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido de muito Baixo Peso , Pneumonia Viral/epidemiologia , Adulto , Betacoronavirus , Coeficiente de Natalidade/tendências , Feminino , Humanos , Recém-Nascido , Irlanda/epidemiologia , Pandemias , Gravidez
5.
PLoS One ; 15(10): e0240065, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017439

RESUMO

Ever since the grey system theory was proposed about 40 years ago, its characteristics such as small samples, few data, and uncertainty have been used for study in the literature with increasingly wider scope. Recent studies on grey relation analysis have included static data analyses, and most of them have adopted initial values with only a relational order. Under the same study conditions, if different data preprocessing methods are used, then the relational order will be ranked differently. This study took Taiwan as the object to explore seven economic indices (birth rate (%), Taiwan's total population (thousand people), unemployment rate (%), income per capita (USD), weighted average interest rate on deposits (%), Consumer Price Index (CPI), and national income (NI)) and how they affect the economic growth rate. The traditional static grey relational analysis treated the collected data with taking consideration of time effect which is irrational under some circumstance. An innovative dynamic grey relational analysis was carried out by shifting the raw data due to the time leading or lagging effect which is a mean to improve the capability of traditional grey relational analysis. The differences in analyses between static grey relational analysis and dynamic grey relational analysis via different data preprocessing methods were further discussed, finding that different data preprocessing methods generated a new set of relational orders through the latter. Finally, the prosperity index was used to identify the effects of all factors on economic growth (leading, synchronization, and lagging indices).


Assuntos
Desenvolvimento Econômico/estatística & dados numéricos , Coeficiente de Natalidade/tendências , Modelos Econômicos , Projetos de Pesquisa , Taiwan , Desemprego/estatística & dados numéricos
6.
Am J Public Health ; 110(10): 1466-1471, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816548

RESUMO

Objectives. To review the trends in pregnancy outcomes after Hurricane Katrina and assess effects of the disaster on research and public health related to pregnant women.Methods. We reexamined the 2004-2006 vital statistics data from Alabama, Louisiana, and Mississippi, assessing what the risk of adverse pregnancy outcomes in the population would have been under varying risk scenarios.Results. We saw a reduction in number of births as well as in low birth weight and preterm birth. If the number of births had stayed constant and the relative higher risk in the "missing" births had been between 17% and 100%, the storm would have been associated with an increased risk instead of a decrease. Because the relative decline in births was larger in Black women, the higher risk in the "missing" births required to create a significant increase associated with the storm was generally not as great as for White women.Conclusions. Higher exposure to Katrina may have produced a reduction in births among high-risk women in the region rather than increasing adverse outcomes among those who did give birth.


Assuntos
Coeficiente de Natalidade , Resultado da Gravidez , Medição de Risco , Alabama/epidemiologia , Coeficiente de Natalidade/etnologia , Coeficiente de Natalidade/tendências , Tempestades Ciclônicas/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Louisiana/epidemiologia , Mississippi/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Resultado da Gravidez/etnologia , Saúde Pública
7.
Natl Vital Stat Rep ; 69(6): 1-12, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32730736

RESUMO

Objectives-This report presents changes in state-specific birth rates for teenagers between 2017 and 2018 by race and Hispanic origin of mother. Methods-Data are from birth certificates of the 50 states and the District of Columbia (D.C.). Teen birth rates, the number of births to females aged 15-19 per 1,000 females aged 15-19, are shown by state for all births and for non-Hispanic single-race white, non-Hispanic single-race black, and Hispanic females for 2017 and 2018. Results-Birth rates for females aged 15-19 declined in 38 states between 2017 and 2018; nonsignificant declines were reported in eight additional states and D.C. Among non-Hispanic white teenagers, rates declined in 29 states between 2017 and 2018; nonsignificant declines were reported in 16 additional states. Teen birth rates for non-Hispanic black females declined in 10 states between 2017 and 2018; nonsignificant declines were seen in 21 additional states and D.C. For Hispanic teenagers, birth rates declined in 10 states between 2017 and 2018; nonsignificant declines were reported in 30 additional states and D.C. The magnitude of change between 2017 and 2018 varied by state for each race and Hispanic-origin group.


Assuntos
Coeficiente de Natalidade/etnologia , Grupos de Populações Continentais/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Gravidez na Adolescência/etnologia , Adolescente , Coeficiente de Natalidade/tendências , Feminino , Humanos , Gravidez , Gravidez na Adolescência/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
8.
Lancet ; 396(10258): 1285-1306, 2020 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-32679112

RESUMO

BACKGROUND: Understanding potential patterns in future population levels is crucial for anticipating and planning for changing age structures, resource and health-care needs, and environmental and economic landscapes. Future fertility patterns are a key input to estimation of future population size, but they are surrounded by substantial uncertainty and diverging methodologies of estimation and forecasting, leading to important differences in global population projections. Changing population size and age structure might have profound economic, social, and geopolitical impacts in many countries. In this study, we developed novel methods for forecasting mortality, fertility, migration, and population. We also assessed potential economic and geopolitical effects of future demographic shifts. METHODS: We modelled future population in reference and alternative scenarios as a function of fertility, migration, and mortality rates. We developed statistical models for completed cohort fertility at age 50 years (CCF50). Completed cohort fertility is much more stable over time than the period measure of the total fertility rate (TFR). We modelled CCF50 as a time-series random walk function of educational attainment and contraceptive met need. Age-specific fertility rates were modelled as a function of CCF50 and covariates. We modelled age-specific mortality to 2100 using underlying mortality, a risk factor scalar, and an autoregressive integrated moving average (ARIMA) model. Net migration was modelled as a function of the Socio-demographic Index, crude population growth rate, and deaths from war and natural disasters; and use of an ARIMA model. The model framework was used to develop a reference scenario and alternative scenarios based on the pace of change in educational attainment and contraceptive met need. We estimated the size of gross domestic product for each country and territory in the reference scenario. Forecast uncertainty intervals (UIs) incorporated uncertainty propagated from past data inputs, model estimation, and forecast data distributions. FINDINGS: The global TFR in the reference scenario was forecasted to be 1·66 (95% UI 1·33-2·08) in 2100. In the reference scenario, the global population was projected to peak in 2064 at 9·73 billion (8·84-10·9) people and decline to 8·79 billion (6·83-11·8) in 2100. The reference projections for the five largest countries in 2100 were India (1·09 billion [0·72-1·71], Nigeria (791 million [594-1056]), China (732 million [456-1499]), the USA (336 million [248-456]), and Pakistan (248 million [151-427]). Findings also suggest a shifting age structure in many parts of the world, with 2·37 billion (1·91-2·87) individuals older than 65 years and 1·70 billion (1·11-2·81) individuals younger than 20 years, forecasted globally in 2100. By 2050, 151 countries were forecasted to have a TFR lower than the replacement level (TFR <2·1), and 183 were forecasted to have a TFR lower than replacement by 2100. 23 countries in the reference scenario, including Japan, Thailand, and Spain, were forecasted to have population declines greater than 50% from 2017 to 2100; China's population was forecasted to decline by 48·0% (-6·1 to 68·4). China was forecasted to become the largest economy by 2035 but in the reference scenario, the USA was forecasted to once again become the largest economy in 2098. Our alternative scenarios suggest that meeting the Sustainable Development Goals targets for education and contraceptive met need would result in a global population of 6·29 billion (4·82-8·73) in 2100 and a population of 6·88 billion (5·27-9·51) when assuming 99th percentile rates of change in these drivers. INTERPRETATION: Our findings suggest that continued trends in female educational attainment and access to contraception will hasten declines in fertility and slow population growth. A sustained TFR lower than the replacement level in many countries, including China and India, would have economic, social, environmental, and geopolitical consequences. Policy options to adapt to continued low fertility, while sustaining and enhancing female reproductive health, will be crucial in the years to come. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Coeficiente de Natalidade/tendências , Carga Global da Doença/tendências , Migração Humana/tendências , Mortalidade/tendências , Crescimento Demográfico , Feminino , Previsões , Humanos , Masculino
10.
Gac. sanit. (Barc., Ed. impr.) ; 34(3): 238-244, mayo-jun. 2020. tab, mapas, graf
Artigo em Inglês | IBECS | ID: ibc-196614

RESUMO

OBJECTIVE: To describe trends in fertility in Spain before (pre-recession; 1998-2008) and during (recession period; 2009-2013) the economic crisis of 2008, taking into account women's age and regional unemployment in 2010. METHOD: The study consisted of a panel design including cross-sectional ecological data for the 17 regions of Spain. We describe fertility trends in Spain in two time periods, pre-recession (1998-2008) and recession (2009-2013). We used a cross-sectional, ecological study of Spanish-born women to calculate changes in fertility rates for each period using a linear regression model adjusted for year, period, and interaction between them. RESULTS: We found that compared to the pre-recession period, the fertility rate in Spain generally decreased during the economic recession. However, in some regions, such as the Canary Islands, this decrease began before the onset of the recession, while in other regions, such as the Basque country, the fertility rate continued to grow until 2011. The effects of the recession on the fertility rate are clearly observed in women aged 30-34 years. CONCLUSIONS: The current economic recession has disrupted the positive trend in fertility that began at the start of this century. Since Spain already had very low fertility rates, the further decline caused by the economic recession could jeopardize the sustainability of welfare-state systems


OBJETIVO: Describir las tendencias de la fecundidad en España en la época precrisis (1998-2008) y durante la crisis (2009-2013) económica, teniendo en cuenta la edad de las mujeres y el desempleo regional en 2010. MÉTODO: Se utiliza un diseño panel que incluye datos ecológicos transversales para las 17 comunidades autónomas de España. Se describen las tendencias de fecundidad en los dos periodos. Para calcular los cambios en las tasas de fecundidad se utiliza un modelo de regresión lineal ajustado por año, periodo e interacción de ellas. RESULTADOS: En comparación con el periodo anterior, la tasa de fecundidad global en España disminuyó durante la crisis económica. Sin embargo, en algunas comunidades, como las Islas Canarias, esta disminución comenzó antes del inicio de la crisis, mientras que en otras, como el País Vasco, la tasa de fecundidad continuó creciendo hasta 2011. Los efectos de la crisis en la fecundidad se observan claramente en mujeres de 30 a 34 años. CONCLUSIONES: La crisis económica actual ha interrumpido la tendencia positiva en la fecundidad que comenzó a principios de este siglo. Dado que España ya tenía tasas de fecundidad muy bajas, el descenso causado por la crisis económica podría poner en peligro la sostenibilidad de los sistemas de bienestar social


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Taxa de Fecundidade , Desemprego/tendências , Coeficiente de Natalidade/tendências , Taxa de Gravidez/tendências , Recessão Econômica/estatística & dados numéricos , Estudos Ecológicos , Idade Materna , Espanha/epidemiologia
11.
J Psychosom Obstet Gynaecol ; 41(3): 183-190, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32379999

RESUMO

Purpose: To evaluate the impact of the COVID-19 pandemic lifestyle change on couples of reproductive age and on their desire for parenthood.Materials and methods: A quantitative correlational research study, based on a web survey, was conducted among Italian men and women in heterosexual stable relationships, aged between 18 and 46 years. The self-administered Italian version questionnaire was created using Google Forms and posted on chats and social networks.The mood of participants before and during the quarantine was assessed using a scale from 1 to 10 (1 = no wellbeing; 10 = total wellbeing). Couples' quality of life and their reproductive desire were evaluated.Results: 1482 respondents were included: 944 women (63.7%) and 538 men (36.3%). A significant trend toward reduced mean wellbeing scores during the quarantine, compared to before, was found (p < .01). From 18.1% participants who were planning to have a child before the pandemic, 37.3% abandoned the intention, related to worries of future economic difficulties (58%) and consequences on pregnancy (58%). Of 81.9% who did not intend to conceive, 11.5% revealed a desire for parenthood during quarantine than before (p < .01), related to will for change (50%) and need for positivity (40%). 4.3% of these actually tried to get pregnant. Stratifying by age, a trend toward older ages was found in the desire for parenthood before and during the COVID-19 pandemic (p < .05).Conclusions: COVID-19 pandemic is impacting on the desire for parenthood. It is unknown whether these findings will result in a substantial modification of birth rate in the near future.


Assuntos
Infecções por Coronavirus , Estilo de Vida , Pandemias , Poder Familiar/psicologia , Pneumonia Viral , Qualidade de Vida , Reprodução , Comportamento Reprodutivo/psicologia , Adulto , Betacoronavirus , Coeficiente de Natalidade/tendências , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Tomada de Decisões , Feminino , Previsões , Humanos , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Inquéritos e Questionários
12.
Biodemography Soc Biol ; 65(2): 119-136, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32432938

RESUMO

The two fertility stalls that occurred in Bangladesh emerged as substantial barriers in controlling its burgeoning vast population. The first stall occurred during 1996-2000 in the mid-transition of fertility, while the second stall occurred during the recent period 2011-2014 in the late transition of fertility. This article explores the role of proximate determinants in those stalls by using the data of Bangladesh Demographic and Health Surveys. Data have been analyzed using proximate determinants model and a descriptive analysis technique. Findings show that contraceptive use and induced abortion are the main drivers of fertility transition in Bangladesh. Both stalls in Bangladesh are found to be associated with a stall in induced abortion. In addition, declining postpartum infecundability plays a vital role in setting first stall. At the end of this stall, composition of contraceptive use is also found less efficient. While, declining fertility-inhibiting effect of marriage and a marginal increase in contraceptive use are the additional factors that play key roles in setting second stall. The mixture of contraceptive use shows a shift to a more efficient composition in the recent years. Change in the timing of birth does not show any consistent link with any of the fertility stalls.


Assuntos
Coeficiente de Natalidade/tendências , Infertilidade/complicações , Bangladesh/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Humanos , Infertilidade/epidemiologia , Modelos Lineares , Dinâmica Populacional , Inquéritos e Questionários
13.
BMC Public Health ; 20(1): 789, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460822

RESUMO

BACKGROUND: The One-Child Policy led to the imbalance of the sex ratio at birth (SRB) in China. After that, Two-Child Policy was introduced and gradually liberalized at three stages. If both the husband and wife of one couple were the only child of their parents, they were allowed to have two children in policy (BTCP). If only one of them was the only child, they were allowed to have two children in policy (OTCP). The Universal Two-Child Policy (UTCP) allowed every couple to have two children. The objective of this study was to explore the changing trend of SRB at the stages of Two-Child Policy, to analyze the effect of population policy on SRB in terms of maternal age, delivery mode, parity, maternal education, delivery hospital, and to figure out what factors have greater impact on the SRB. METHODS: The data of the study came from Hebei Province Maternal Near Miss Surveillance System, covered the parturients delivered at 28 gestation weeks or more in 22 hospitals from January 1, 2013 to December 31, 2017. We compared the SRB at different policy stages, analyzed the relationship between the SRB and population policy by logistic regression analysis. RESULTS: Total 270,878 singleton deliveries were analyzed. The SRB, 1.084 at BTCP, 1.050 at OTCP, 1.047 at UTCP, declined rapidly (χ2 = 15.97, P < 0.01). With the introduction of Two-Child Policy, the percentage of parturients who were 30-34, ≥35 years old rose significantly, and the percentage of multiparous women increased significantly (40.7, 47.2, 56.6%). The neonatal mortality declined significantly (8.4‰, 6.7‰, 5.9‰, χ2 = 44.49, P < 0.01), the mortality rate of female infant gradually declined (48.2, 43.7, 43.9%). The logistic regression analysis showed the SRB was correlated to the three population policy stages in terms of maternal age, delivery mode, parity, maternal education, delivery hospital. CONCLUSIONS: The SRB has declined to normal level with the gradually liberalizing of Two-Child Policy in China. Advanced maternal age, cesarean delivery, multiparous women, middle level education, rural hospital are the main factors of effect on the decline of the SRB.


Assuntos
Coeficiente de Natalidade/tendências , Parto Obstétrico/tendências , Paridade , Política Pública/tendências , Adulto , Cesárea/tendências , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Idade Materna , Gravidez , História Reprodutiva , Razão de Masculinidade
14.
PLoS One ; 15(4): e0231557, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32287303

RESUMO

BACKGROUND: Information on repeat adolescent birth remains scarce in sub-Sahara Africa. We investigated the prevalence and time trends in repeat adolescent birth in Uganda, and associated factors. METHODS: We analyzed Uganda Demographic and Health Survey data of women age 20-24 years collected on 6 surveys (1988/89-2016) to estimate repeat adolescent birth (first live birth <18 years of age followed by another live birth(s) <20 years). Further, we estimated the wantedness of the second order birth and the prevalence of short birth intervals birth (<13 months) between the first and second such birth. On the 2016 survey, we examined factors associated with repeat adolescent birth using bivariate and multivariate modified Poisson regression. RESULTS: At the 1988/89 survey, 58.9% of women with first birth <18 years reported a repeat adolescent birth. This percentage increased to 66.8% in 2006 (+7.9 percentage points [pp], p = 0.010) and thereafter declined to 55.6% by 2016 (-11.2 pp, p<0.001), nevertheless, no change occurred between 1988/89 and 2016 (-3.3pp, p = 0.251). Among women with repeat adolescent births, the mean number of live births by exact age 20 years (2.2 births) and prevalence of short birth intervals (3.5% in 1988/89, 5.4% in 2016) (+1.9pp, p = 0.245) did not change. Increasingly more women with repeat adolescent births preferred to have had the second child later, 22.5% in 1995 and 43.1% in 2016 (+20.6pp, p = <0.001). On the 2016 survey, women from poorer households and those of younger age at first birth were significantly more likely to report repeat adolescent birth. CONCLUSION: Following a first birth <18 years, more than half of the women report a repeat adolescent birth (<20 years), with no decline observed in 30 years. Increasingly more women wanted the second adolescent pregnancy later, highlighting the need to support adolescents with improved family planning services at each contact.


Assuntos
Paridade , Gravidez na Adolescência/estatística & dados numéricos , Adolescente , Adulto , Ordem de Nascimento/psicologia , Coeficiente de Natalidade/tendências , Serviços de Planejamento Familiar/tendências , Feminino , Inquéritos Epidemiológicos , Humanos , Idade Materna , Parto/psicologia , Gravidez , Uganda/epidemiologia , Adulto Jovem
15.
Dis Colon Rectum ; 63(6): 816-822, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32149783

RESUMO

BACKGROUND: Impact of restorative proctocolectomy failure on fertility has not been studied and is greatly relevant. OBJECTIVE: The purpose of this study was to evaluate the impact of restorative proctocolectomy failure on birth rate in women and men, along with in vitro fertilization incidence and success. DESIGN: This was a retrospective registry-based cohort study over 17 years. SETTINGS: Records for parenting a child were cross-linked with patient records. In women, in vitro fertilization records were cross-linked. All data were prospectively registered. PATIENTS: Patients of fertile age with ulcerative colitis between 1994 and 2010 were identified in Danish national databases. Patients with restorative proctocolectomy and restorative proctocolectomy failure were identified as subgroups. MAIN OUTCOME MEASURES: Birth rate ratios and in vitro fertilization incidence and success were measured. RESULTS: We included 11,939 women and 13,569 men with ulcerative colitis. A total of 711 women and 730 men had restorative proctocolectomy; 114 women and 90 men had failure. Birth rate in women with failure was significantly reduced compared with women without (birth rate ratio = 0.50 (95% CI, 0.29-0.82)). In men with failure, birth rate tended to be lower compared with men without (birth rate ratio = 0.74 (95% CI, 0.51-1.05)). In vitro fertilization incidence was similar with and without failure (HRs adjusted for age at start of follow-up = 0.98 (95% CI, 0.58-1.67]). In vitro fertilization success was significantly lower with failure compared with ulcerative colitis (OR adjusted for age at start of follow-up = 0.36 (95% CI, 0.4-0.92)). LIMITATIONS: Information on patients leading up to restorative proctocolectomy failure is lacking. Failure patients may have had children during a period with pouch function. Therefore, the impact of failure may be underestimated. CONCLUSIONS: Restorative proctocolectomy failure impairs birth rate, primarily in women. Although in vitro fertilization incidence is similar in women with and without failure, the likelihood of giving birth after in vitro fertilization is reduced. See Video Abstract at http://links.lww.com/DCR/B202. IMPACTO SOBRE LA FERTILIDAD DESPUéS DEL FRACASO DE LA PROCTOCOLECTOMíA RESTAURADORA EN HOMBRES Y MUJERES CON COLITIS ULCEROSA: UN ESTUDIO DE COHORTE DE 17 AñOS: No se ha estudiado el impacto de la falla de la proctocolectomía restauradora en la fertilidad y es muy relevante.Evaluar el impacto del fracaso de la proctocolectomía restauradora en la tasa de natalidad en mujeres y hombres, junto con la incidencia y el éxito de la fertilización in vitro.Estudio de cohorte retrospectivo basado en el registro de más de 17 años.Los registros de crianza de un niño se cruzaron con los registros de pacientes. En las mujeres, los registros de fertilización in vitro se cruzarón. Todos los datos se regitraron de forma prospectiva.Los pacientes de edad fértil con colitis ulcerosa entre 1994-2010 fueron identificados en las bases de datos nacionales danesas. Los pacientes con proctocolectomía restauradora y fracaso de la proctocolectomía restauradora se identificaron como subgrupos.Tasas de natalidad e incidencia y éxito de la fertilización in vitro.Se incluyeron 11939 mujeres y 13569 hombres con colitis ulcerosa. 711 mujeres y 730 hombres tuvieron proctocolectomía restauradora; 114 mujeres y 90 hombres tuvieron fracaso. La tasa de natalidad en las mujeres con fracaso se redujo significativamente en comparación con las mujeres sin fracaso (tasa de natalidad: 0,50; IC del 95% [0,29; 0,82]). En los hombres con fracaso, la tasa de natalidad tendió a ser más baja en comparación con los hombres sin fracaso (tasa de natalidad: 0,74; IC del 95% [0,51; 1,05]). La incidencia de fertilización in vitro fue similar con y sin falla (aHR: 0.98, IC 95% [0.58; 1.67]). El éxito de la fertilización in vitro fue significativamente menor con el fracaso en comparación con la colitis ulcerosa (aOR: 0.36 IC 95% [0.4; 0.92]).Falta información sobre los pacientes que conducen al fracaso de la proctocolectomía restauradora. Los pacientes con fracaso pueden haber tenido hijos durante un período con función de bolsa. Por lo tanto, el impacto del fracaso puede ser subestimado.El fracaso de la proctocolectomía restauradora afecta la tasa de natalidad, principalmente en mujeres. Aunque la incidencia de la fertilización in vitro es similar en las mujeres con y sin fracaso, la probabilidad de dar a luz después de la fertilización in vitro se reduce. Consulte Video Resumen en http://links.lww.com/DCR/B202. (Traducción-Dr Gonzalo Hagerman).


Assuntos
Coeficiente de Natalidade/tendências , Colite Ulcerativa/cirurgia , Fertilidade/fisiologia , Proctocolectomia Restauradora/efeitos adversos , Adolescente , Estudos de Casos e Controles , Estudos de Coortes , Colite Ulcerativa/complicações , Gerenciamento de Dados , Dinamarca/epidemiologia , Feminino , Fertilização In Vitro/estatística & dados numéricos , Humanos , Incidência , Masculino , Estudos Retrospectivos , Falha de Tratamento , Adulto Jovem
16.
Fertil Steril ; 113(4): 811-817, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32147171

RESUMO

OBJECTIVE: To determine the optimal endometrial preparation protocols of frozen-thawed embryo transfer (FET) in young women with regular menstrual cycles. DESIGN: Retrospective cohort study. SETTING: Public fertility center. PATIENT(S): Infertile women with regular menstrual cycles undergoing FET. INTERVENTION(S): Natural cycle (NC) treatment for patients with proven ovulation in previous cycles or who refused medication (n = 308), or hormone treatment (HT) for patients who could not be frequently monitored (n = 1,538). MAIN OUTCOME MEASURE(S): Live-birth rates. RESULT(S): The live-birth rates were 61.73% in the NC group and 55.11% in the HT group. The effect size of the endometrial preparation on live-birth rates was evaluated in prespecified and exploratory subgroups in each subgroup, and multivariable logistic regression analysis was used to determine which variables could be independently associated with the live-birth rate. The HT patients had a lower chance of live birth in all subgroups: endometrial thickness on the day of progesterone administration, triple-line endometrial pattern, female age at embryo transfer, fertilization type, and protocol in the fresh cycle. Multivariable analysis showed NC to be associated with an increased likelihood of live birth compared with HT. CONCLUSION(S): Natural cycle treatment has a higher chance of live birth than HT for endometrial preparation in young women with regular menstrual cycles.


Assuntos
Criopreservação/métodos , Transferência Embrionária/métodos , Terapia de Reposição Hormonal/métodos , Infertilidade Feminina/terapia , Nascimento Vivo , Ciclo Menstrual/fisiologia , Adulto , Coeficiente de Natalidade/tendências , Estudos de Coortes , Criopreservação/tendências , Transferência Embrionária/tendências , Estradiol/administração & dosagem , Feminino , Terapia de Reposição Hormonal/tendências , Humanos , Infertilidade Feminina/epidemiologia , Nascimento Vivo/epidemiologia , Gravidez , Taxa de Gravidez/tendências , Estudos Retrospectivos
17.
BMC Public Health ; 20(1): 265, 2020 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-32087705

RESUMO

BACKGROUND: The world population is expected to increase greatly this century, aggravating current problems related to climate, health, food security, biodiversity, energy and other vital resources. Population growth depends strongly on total fertility rate (TFR), but the relative importance of factors that influence fertility needs more study. METHODS: We analyze recent levels of fertility in relation to five factors: education (mean school years for females), economy (Gross Domestic Product, GDP, per capita), religiosity, contraceptive prevalence rate (CPR), and strength of family planning programs. We compare six global regions: E Europe, W Europe and related countries, Latin America and the Caribbean, the Arab States, Sub-Saharan Africa, and Asia. In total, 141 countries are included in the analysis. We estimate the strength of relationships between TFR and the five factors by correlation or regression and present the results graphically. RESULTS: In decreasing order of strength, fertility (TFR) correlates negatively with education, CPR, and GDP per capita, and positively with religiosity. Europe deviates from other regions in several ways, e.g. TFR increases with education and decreases with religiosity in W Europe. TFR decreases with increasing strength of family planning programs in three regions, but only weakly so in a fourth, Sub-Saharan Africa (the two European regions lacked such programs). Most factors correlated with TFR are also correlated with each other. In particular, education correlates positively with GDP per capita but negatively with religiosity, which is also negatively related to contraception and GDP per capita. CONCLUSIONS: These results help identify factors of likely importance for TFR in global regions and countries. More work is needed to establish causality and relative importance of the factors. Our novel quantitative analysis of TFR suggests that religiosity may counteract the ongoing decline of fertility in some regions and countries.


Assuntos
Coeficiente de Natalidade/tendências , África ao Sul do Saara , Mundo Árabe , Ásia , Região do Caribe , Anticoncepção/estatística & dados numéricos , Escolaridade , Europa (Continente) , Serviços de Planejamento Familiar/organização & administração , Feminino , Produto Interno Bruto/estatística & dados numéricos , Humanos , América Latina , Religião
18.
Demography ; 57(1): 297-322, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32034723

RESUMO

Because immigrant fertility is situated within two societies, the resultant childbearing patterns reflect a culmination of selectivity into migration alongside blended experiences of origin-destination contexts around fertility norms. We analyze the ways that national origin shapes patterns of childbearing within fertility covariates. We use data from Statistics South Africa and the United States Census Bureau harmonized in the Integrated Public Use Microdata Series, International for a disaggregated analysis of the odds of a birth in the past year among the three most prominent immigrant groups compared with native-born women in each receiving country. Interacted logistic regression analyses and margins results demonstrate significant nativity-based differences in the odds of childbearing across age, previous childbearing, and marital status, but not across educational attainment. We attribute variation in the covariates of fertility across nativities to demographic composition and the contexts of migration unique to each group.


Assuntos
Coeficiente de Natalidade/tendências , Emigrantes e Imigrantes/estatística & dados numéricos , Fatores Socioeconômicos , Aculturação , Adolescente , Adulto , Fatores Etários , Demografia , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , África do Sul/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
19.
BMC Public Health ; 20(1): 26, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914967

RESUMO

BACKGROUND: From 2000 to 2008, in urban areas in Spain, adolescent fertility and abortion rates underwent unprecedented increases, consecutive to intensive immigration from developing countries. To address unmet needs for contraception information and services, a community-based, gender-sensitive and culturally adapted brief counselling intervention (SIRIAN program) was launched in some deprived neighbourhoods with a high proportion of immigrants in Barcelona. Once a randomized controlled trial demonstrated its effectiveness in increasing the use of contraceptives, we aim to examine its population impact on adolescent fertility rates. METHODS: Quasi-experimental study with comparison group, using population data from 2005 to 2016. Five neighbourhoods in the lowest tercile of Disposable Household Income were intervened in 2011-13. The comparison group included the three neighbourhoods which were in the same municipal district and in the lowest Disposable Household Income tercile, and displayed the highest adolescent fertility rates. Generalized linear models were fitted to assess absolute adolescent fertility rates and adjusted by immigrant population between pre-intervention (2005-10) and post-intervention periods (2011-16); Difference in Differences and relative pre-post changes analysis were performed. RESULTS: In 2005-10 the intervention group adolescent fertility rate was 27.90 (per 1000 women 15-19) and 21.84 in the comparison group. In 2011-16 intervention areas experienced great declines (adolescent fertility rate change: - 12.30 (- 12.45 to - 12.21); p < 0.001), while comparison neighbourhoods remained unchanged (adolescent fertility rate change: 1.91 (- 2.25 to 6.07); p = 0.368). A reduction of - 10.97 points (- 13.91 to - 8.03); p < 0.001) is associated to the intervention. CONCLUSION: Adolescent fertility rate significantly declined in the intervention group but remained stable in the comparison group. This quasi-experimental study provide evidence that, in a country with universal health coverage, a community counselling intervention that increases access to contraception, knowledge and sexual health care in hard-to-reach segments of the population can contribute to substantially reduce adolescent fertility rates. Reducing adolescent fertility rates could become a feasible goal in cities with similar conditions.


Assuntos
Coeficiente de Natalidade/tendências , Serviços de Saúde Comunitária , Anticoncepção/psicologia , Aconselhamento , Adolescente , Cidades , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Áreas de Pobreza , Gravidez , Avaliação de Programas e Projetos de Saúde , Características de Residência/estatística & dados numéricos , Espanha , Adulto Jovem
20.
Demography ; 57(1): 267-296, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31970647

RESUMO

This study applies survival analysis to the birth histories from 317 national surveys to model pathways to low fertility in 83 less-developed countries between 1965 and 2014. It presents period measures of parity progression, the length of birth intervals and total fertility that have been standardized fully for age, parity, and interval duration. It also examines parity-specific trends in the proportion of women who want no more children. Outside sub-Saharan Africa, fertility transition was dominated by parity-specific family size limitation. As the transition progressed, women also began to postpone their next birth for lengthy periods in many countries. During the first half of the fertility transition in much of sub-Saharan Africa and in some other countries, however, women stopped childbearing without targeting particular family sizes. Moreover, birth intervals in sub-Saharan Africa have been lengthening since the onset of the transition. Birth control is not restricted to a dichotomy between limitation and spacing. Other reasons for curtailing childbearing and postponing having another birth also shape countries' pathways through fertility transition.


Assuntos
Intervalo entre Nascimentos/estatística & dados numéricos , Coeficiente de Natalidade/tendências , Países em Desenvolvimento/estatística & dados numéricos , Características da Família , África ao Sul do Saara/epidemiologia , Fatores Etários , Feminino , Humanos , Paridade , Fatores Socioeconômicos
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