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The studies on the association between maternal gestational weight gain (GWG) and spontaneous preterm birth (SPTB) in twin pregnancies are limited and inconsistent. There are no standardized guidelines for GWG in twin pregnancies in China. This retrospective cohort study included 1510 women who delivered living twins from January 1, 2015 to December 31, 2019. The basic demographics and outcomes of mothers and neonates were listed, and logistic regression was used to analyze the relationship between GWG and SPTB in the total population and different subgroups. In the overall population, 464 (30.7%) women had inadequate GWG, and 316 (20.9%) women had excess GWG. Compared to women with adequate GWG, women with inadequate GWG had a significantly higher risk of SPTB (adjusted odds ratio [aOR]: 2.46, 95% CI [1.92, 3.15]), while women with excess GWG also had a significantly higher risk of SPTB (aOR: 1.48, 95% CI [1.12, 1.95]). Both inadequate GWG and excess GWG had a significantly higher risk of SPTB in normal-weight women and women with dichorionic diamniotic twins. Only IGWG was significantly associated with SPTB in women with monochorionic diamniotic twins and underweight women. Our findings indicate that inadequate GWG and excess GWG were significantly associated with a higher risk of SPTB, providing an empirical basis for establishing weight gain guidelines for women with twin pregnancies in China.
Women’s sexual and reproductive rights are crucial for achieving gender equality and promoting women’s rights. Across East Africa, there are limited studies about husbands’ knowledge of their partner’s reproductive rights and their associated factors. Hence, this study aimed to assess husbands’ knowledge of partners’ reproductive health rights and associated factors in Central Ethiopia.
Methods:
A community-based cross-sectional study was conducted from March 15 to April 30, 2023, using multi-stage stratified sampling. A structured, interviewer-administered questionnaire was utilized to gather the data, and then SPSS version 26 was employed for analysis. Statistical significance was declared at a p-value < 0.05.
Results:
The overall good knowledge of partners’ reproductive health rights was found to be 47.8% (95% CI: 43.8, 51.8). Age of the husbands 25–35 years (AOR: 2.7; 95% CI: 1.10, 6.6), below primary educational status (AOR: 2.4; 95% CI: 1.3,4.3), primary educational status (AOR: 5.98; 95% CI: 3.10, 11.4), secondary educational status (AOR: 2.1; 95% CI: 1.01, 4.3), above secondary education status (AOR: 8.0; 95% CI: 4.3, 15.2), discussion with a partner (AOR: 3.2; 95% CI: 2.0, 5.2), and vehicle as a means of transport (AOR: 3.3; 95% CI: 2.2, 4.9) were statistically significant for good husbands’ knowledge of partners reproductive health rights.
Conclusion:
These findings indicate that more than half (52.2%) of the study participants had a poor understanding of their partners’ reproductive rights. Therefore, counselling and education should be offered to husbands to ensure equitable access to health services and to disseminate information on reproductive rights, particularly targeting young men.
How healthy you are is dependent on where you live. Americans suffer more cancers, heart disease, mental illness, and other chronic diseases than those who live in other wealthy nations, despite having the most expensive healthcare system in the world. Why? Embark on a journey to unravel the profound impact of public policies on American health from before birth in Born Sick in the USA: Improving the Health of a Nation. Delve into the intricate web where economic inequality weaves a tapestry of sickness stemming from a highly stressed society. This compelling read illuminates the need for transformative change in social safety nets and public policies to uplift national health and well-being. Through vivid storytelling, the book unveils the symptoms, diagnosis, and 'medicine' required to steer the nation toward a healthier future. Join the movement for a healthier America by embracing the insightful revelations and empowering calls to action presented within the pages of this eye-opening book.
The USA has among the highest levels of mental illness of all countries, together with the most treatment. We seek happiness through mechanisms that produce pleasure, most of which are not effective. Those lower down in the hierarchy use more destructive means to gain gratification, thereby becoming worse off. Americans may suffer more pain than people in other rich nations, especially social pain in response to chronic stressors present here. We consume 80% of the world’s opioids Smartphone use, especially among youth, may be harmful for mental health. Evolutionary pressures make us live to reproduce and nurture the progeny until they can have children. Various mental illnesses that don’t impact propagation can manifest, especially in later life, such as anxiety to cope with danger. Mental health is political, like other aspects of health
Humans are born helpless and require others to nurture and care for them for a lengthy period. This requires paid parental leave policies, which the US, almost uniquely, doesn’t have, thereby compromising our health. During our forager-hunter era, vigilant sharing took place. The advent of agriculture 10,000 years ago led to a decline in health as exploitation began. This reversed only in the last few hundred years due to advances in sanitation, standard of living, and basic medical care. Population health is much more than adding up factors affecting individual health, with political context and governance being the most significant factors. Income inequality impacts health in three realms. Health promotion requires action by policy makers and national leaders. Women live longer than men. Geography matters, with a wide range of health outcomes across US counties. Culture and racism have strong impacts. Diets are less important. Physical and chemical environmental hazards impact health outcomes, mostly to a lesser degree
To be adopted, health-producing policies need to be supported by the elites. Although everyone’s health suffers from economic inequality, the poor suffer more social murder. Creating awareness is the challenge. Countries have goals and becoming healthier is one that is possible for the US. Charities and philanthropies, which command great power, mostly serve the rich, and are unaccountable to the public, won’t create the awareness needed to produce health-generating policies. Public resources should benefit the public. The government has subsidized much technology that, once profitable, is given to private industry at no cost. To change American policies requires creating awareness of the problem, reaching an agreement on a potential solution, and some transforming event such as a market shock, invasion, or other stimulus. Various ways of creating understanding are presented. Telling stories is the most effective
The United States spends close to half of the world’s healthcare bill, yet this huge industry does not produce good health. Citizens believe the US is the best at almost everything. In the 1950s we were one of the healthiest nations. Now, comparisons show more diseases present in Americans than in the citizens of the other rich nations, even when considering the healthiest subpopulations here. Life expectancy is now declining here, a unique situation for advanced countries. This plight results in almost 800 excess deaths per day that wouldn’t happen in other nations. Well-being mirrors mortality here and has been declining, despite our pursuing happiness with all the advanced technology in our palms. Reasons include our high income inequality and poor social safety net
Transcatheter completion of the extracardiac Fontan provides a minimally invasive option for selected children with single-ventricle physiology who have undergone staged preparation at the time of the bidirectional cavopulmonary connection.
Methods:
We performed a retrospective single-centre review of consecutive patients treated between 2022 and 2025. Candidate selection, cross-sectional imaging, diagnostic catheterisation, procedural steps, early recovery, and follow-up outcomes were collected.
Results:
Five patients underwent transcatheter completion at a median age of 7 years (range 4–17). The interval between the preparatory operation and catheter procedure was 7 months (range 6–9). Median procedure time was 140 minutes (range 120–180). The ICU stay was 2 days (range 1–3), and the total hospital stay was 5 days (range 4–6). Minimal pleural effusions occurred in four patients, none requiring drainage. At a median follow-up of 28 months (range 4–36), all patients were clinically stable; resting oxygen saturation was 96% (range 94% to 97%). One late-presenting patient had biochemical evidence consistent with protein-losing enteropathy but remained asymptomatic without targeted therapy. No thromboembolic events occurred.
Conclusions:
In a programme that couples surgical preparation with later catheter-based completion, the extracardiac Fontan can be performed safely and effectively in carefully selected candidates, with rapid recovery and stable mid-term clinical status. Larger studies are needed to define long-term outcomes and comparative effectiveness versus surgical completion.
Status comparisons are constantly made in many societies today, leading to an inferiority complex. Income inequality is linked to diverse health and social outcomes in the world, including violence, lack of trust, prevalence of heart failure, environmental degradation, and poor oral health. Chronic stress, induced by inequality, leads to many of the chronic diseases we face. Economic inequality influences power distribution, which is now captured by big corporations in the US. Middle-aged White American men, especially those without college degrees, have seen their mortality increase though drugs, alcohol, and suicides, termed deaths of despair, as their livelihoods have declined because their jobs have migrated to poor countries. Ranking countries by life expectancy situates the US tied with Cuba for longevity
To review the historical, conceptual, and ethical foundations of intelligence testing in neuropsychology and to consider whether alternative cognitive performance labels offer greater conceptual precision while reducing stigma.
Method:
We conducted a narrative review of early twentieth century cognitive assessments, tracing the evolution of intelligence testing and its intersections with eugenic ideology. Key examples include the Army Alpha and Beta tests administered during World War I and Ellis Island immigration assessments, which were frequently interpreted without consideration of cultural or educational influences. We examine how these practices informed early interpretations of neuropsychological performance, particularly in individuals with epilepsy, and shaped initial characterizations of neurologically based cognitive abilities.
Results:
Early intelligence testing was grounded in the belief that intelligence was a fixed and directly genetically determined trait. Test performance was interpreted as an index of biological superiority, lending scientific legitimacy to eugenic ideologies and reinforcing stigma toward individuals with epilepsy. Although modern frameworks emphasize multidimensional cognitive abilities, intelligence-based characterization persists and continues to be frequently reported as a primary outcome of neuropsychological testing.
Conclusions:
In contexts that require a single summary indicator of cognitive performance, labels such as Total Cognitive Composite are recommended since they avoid implying a fixed or unitary capacity. Continued reliance on the construct of “intelligence” is inconsistent with contemporary models of cognition, reflects outdated theoretical assumptions, and carries enduring psychosocial stigma. Moreover, its circular and internally inconsistent definitions substantially limit its validity and appropriateness within contemporary adult clinical neuropsychological practice.
To audit data on clinical outcomes and suicidal ideation, as part of a service evaluation, in individuals presenting with low mood at an Irish frontline, community-based, rural psychology service, to determine whether the intervention provided was effective in reducing suicidal ideation and low mood.
Method:
Clinical outcome data from 428 service users who scored in the clinical range for depression and who completed an intervention with the service were audited to determine if scores on suicidal and self-harm ideation – as measured by PHQ9 Q9 – changed between assessment and discharge.
Results:
91% of service users who scored in the clinical range for depression and expressed suicidal or self-harm ideation at assessment reported an improvement post-intervention. At discharge, 85% of these individuals no longer reported any suicidal or self-harm ideation. A majority (68.5%) of those who reported ideation at assessment, and a majority of those who did not report ideation (78%), achieved reliable change (i.e. an improvement of ≥5pts) in their final PHQ-9 scores. Clinical recovery was achieved by discharge in 69% of those without and 47% of those with ideation at assessment. Not reporting suicidal or self-harm ideation at assessment was statistically more likely to result in reliable change at discharge than reporting such ideation.
Conclusions:
Results from this clinical service evaluation suggest swift access to psychological intervention, by this rural, frontline primary care psychology service, was associated with reductions in levels of suicidal and self-harm ideation in those suffering from depressive symptoms in the clinical range.
This commentary responds to the study by Kelly Garton et al., “Monitoring the impacts of international trade and investment agreements on food environments: a Canadian case study,” published in Public Health Nutrition, which applies the INFORMAS trade and investment monitoring framework to the Canadian food system.
Medical care treatments can cause harm or even death. Healthcare workers assess vital signs of individuals to gauge their health. Medical care treats cells and organs while ignoring the plight of that person. Improvements in sanitation and standard of living over the last century are responsible for having longer lives. Economic growth leads to longer lives, but after a plateau of around $10,000 per person, more growth does not lead to better health. The US is an outlier with a high GDP but considerably lower health measures than many other countries. Recently, when comparing Americans with their counterparts in other rich nations, Americans demonstrate worse disease outcomes, no matter their skin color or wealth. US life expectancy declines result in almost 800 excess deaths per day here that aren’t present in comparable countries. US well-being and happiness similarly rank behind those of many other nations, despite the happiness industry telling Americans that they can make themselves happy
When necessary, the turning on of your stress physiologic response can save your life. Maternal stress can affect the fetus so it engages survival strategies. Socioeconomic inequality in early life impacts adults in various ways. Stress in infancy can be positive, such as when taking the first step, tolerable, such as when a family member is seriously ill but supportive adults are present, or toxic, when there is strong, frequent, or prolonged activation in the absence of buffers, which can have lifelong effects. Stress impacts various cellular organelles and produces inflammation. Cumulative chronic stresses produce wear and tear, limiting effective activation when needed to save your life. Those lower down the socioeconomic gradient have poorer functioning organs and suffer more harmful effects of stress. Ever more common obesity can be related to increasing chronic stresses of modern life. Metabolic syndrome, the way energy is stored, is related to many chronic diseases today. Prenatal stress and low birthweight predispose children to this condition