Lifeng Zhou

Background: New Zealand’s Bowel Screening Pilot (BSP) used a mailed invitation to return a faecal immunochemical test. As a pilot it offered opportunities to test interventions for reducing ethnic inequities in colorectal cancer screening prior to nationwide programme introduction. Small media interventions (e.g. educational material and DVDs) have been used at both community and participant level to improve uptake. We tested whether a DVD originally produced to raise community awareness among the Māori population would have a positive impact on participation and reduce the proportion of incorrectly performed tests (spoiled kits) if mailed out with the usual reminder letter. Methods: The study was a parallel groups pseudo-randomised controlled trial. Over 12 months, all Māori and Pacific ethnicity non-responders four weeks after being mailed the test kit were allocated on alternate weeks to be sent, or not, the DVD intervention with the usual reminder letter. The objective was to determine changes in participation and spoiled kit rates in each ethnic group, determined three months from the date the reminder letter was sent. Participants and those recording the outcomes (receipt of a spoiled or non-spoiled test kit) were blinded to group assignment. Results: 2333 Māori and 2938 Pacific people participated (11 withdrew). Those who were sent the DVD (1029 Māori and 1359 Pacific) were less likely to participate in screening than those who were not (1304 Māori and 1579 Pacific). Screening participation was reduced by 12.3% (95% CI 9.1–15.5%) in Māori (13.6% versus 25.9%) and 8.3% (95% CI 5.8–10.8%) in Pacific (10.1% versus 18.4%). However, spoiled kit rates (first return) were significantly higher among those not sent the DVD (33.1% versus 12.4% in Māori and 42.1% versus 21.9% in Pacific). Conclusion: The DVD sent with the reminder letter to BSP non-responders reduced screening participation to an extent that more than offset the lower rate of spoiled kits. Trial registration: Australia and New Zealand Clinical Trials Registry ACTRN12612001259831. Registered 30 November 2013.

Transition interventions aim to improve care and reduce hospital readmissions but evaluations of these interventions have reported inconsistent results. We report on the evaluation of an intervention implemented in Auckland, New Zealand. Participants were people over the age of 65 who had an acute medical admission and were at high risk of readmission. The intervention included an improved discharge process and nurse telephone follow‐up soon after discharge. Outcomes were 28 day readmission rates and emergency attendances. The study is observational, using both interrupted times series and regression discontinuity designs. 5239 patients were treated over a one year period. There was no change in readmission rates or ED attendances or secondary outcomes. Not all patients received all components of the intervention. This transition intervention was not successful. Possible reasons for this and implications are discussed. Although non‐experimental methods were used, we believe the results are robust.

Rates of caesarean section are progressively increasing in many parts of the world. As a result of psychosocial factors there has been an increasing tendency for pregnant women without justifiable medical indications for caesarean section to ask for this procedure in China. A critical examination of this issue in relation to maternal outcomes is important. At present there are no clinical trials to help assess the risks and benefits of caesarean section in low risk women. To fill the gap left by trials, this indication-matched cohort study was carried out to examine prospectively the outcomes of caesarean section on women with no absolute obstetric indication compared with similar women who had vaginal delivery.

Study on the effect of a community-based early education and service program regarding intelligence To assess the effect on a community-based early education and service programs regarding the development of infants' intelligence. A community-based intervention study was carried out among 359 infants and their families. Base-line survey were carried out when infants reached their one month, where after infants and their families in the intervention group received instructions and services focused on baby fostering and intelligence development. When the infants reached their six-months and twelve-months of age, their families were informed to complete the follow-up surveys, using both questionnaire investigation and testing the infants' intelligence quotients. The infants' intelligence quotients were measured by Development Screening Test for children under six. By comparing intelligence quotients of infants in two study groups in the follow-up surveys, this paper evaluated the impacts of community intervention on the infants' intelligence development. During two follow-ups, no statistical difference had been detected between the two groups of infants in term of gender or delivery process. Baseline data showed that infants' mental index (MI) scored 98.26 in the intervention group and 101.79 in the control one, and development quotient (DQ) scored 94.50 and 99.36 in respective groups. Infants' MI score increased 6.07 and 8.86 at the six-month and twelve-month follow-up periods respectively in the intervention group compared during the baseline, higher than the MI increments of the control group at the two follow-up periods (-2.46 and 1.05 respectively). DQ score of infants in the intervention group increased 12.94 and 11.24 respectively in the two follow-up surveys, which were also higher than increments in the control group (-0.18 and 0.34). The group x time effect(interaction effect) of MI and DQ in six-month and twelve-month follow-ups were both significantly higher than that of the baseline level. The community-based early education and service programs could effectively improve the infants' intelligence.

To find out the occurrence of cesarean section (CS) and to probe the factors associated with CS. Women with CS as "case group" and women without CS as "control group" were chosen in a case-control study. Among 14 071 childbirth women, 6 421 had CS (case group) with the occurrence rate of 45.6% and 7 650 (54.4%) had normal delivery (control group). In comparison with the control group, the CS group had following several higher rates [with significant differences between case group and control group (P < 0.01)]: well-educated (78.9% vs 69.5%), white collar jobs (38.0% vs 32.3%), urban residents (79.1% vs 70.6%), high monthly income (>/= 500 Yuan) (81.0% vs 70.6%), of older age (>/= 25 years) (73.3% vs 63.0%), heavier baby weight (> 4 000 gram) (8.3% vs 2.9%), male babies (53.9% vs 51.4%), BMI of mother (> 24) (8.8% vs 4.8%), cephalopelvic disproportion (21.1% vs 0.9%), intrauterine asphysia (20.3% vs 6.7%), abnormality of force of labor (4.2% vs 2.7%), prolonged labor (2.9% vs 1.0%) and placenta previa (1.4% vs 0.4%). Our study also indicated that the higher the educational level was, the higher the rate of CS appeared; and the older the pregnant women was, the higher the rate of CS was. In CS group, over 70% primipara were over 24 years, and over 20% primipara had cephalopelvic disproportion and over 20% had intrauterine asphysia in CS group. At present, the occurrence rate of cesarean section was rather high (45.6%) in China. The high rate of CS was more likely to associate not only with abnormal physiological/medical factors (eg. cephalopelvic disproportion, intrauterine asphysia, abnormality of force of labor, and prolonged labour, etc.), but also with some demographic factors as education, occupation, income and age, etc. It is necessary to take measures to reduce the unnecessary CS in China.

To compare the incidence of reported insertion problems with the levonorgestrel-releasing intrauterine device (Mirena) with that of the copper device Multiload Cu 375. Prescription Event Monitoring (PEM) methodology, as used in the Intensive Medicines Monitoring Programme, was used to identify cohorts of women and record events associated with insertion. Data were analysed from 16 159 women receiving Multiload Cu 375 between 1991 and 2001, and 3452 women receiving Mirena between 1998 and 2001. Difficult insertion was reported more often with Mirena (RR= 2.7, 95% CI = 2.2--3.3, p <0.0001). Stratified analyses suggested this was not explained by the presence of more nulliparous women in the Mirena cohort or the non-contraceptive indications for use of Mirena. Mechanical problems with the device were reported in about 1% of Mirena insertions compared with 0.01% of Multiload Cu 375 insertions and this difference was significant (p <0.001). About 2% of Mirena insertions were performed under general anaesthetic compared with 0.1% of Multiload Cu 375 insertions. Adverse reactions to insertion, including pain and vaso-vagal reaction, were more frequent with Mirena than with Multiload Cu 375 (p <0.001). During the period of study, insertion of Mirena was more difficult and was associated with more device problems and adverse reactions than insertion of Multiload Cu 375.

To investigate the association between low-dose combined oral contraceptive (COC) widely distributed in China and the risk of hemorrhagic stroke so as to decrease the adverse reaction of COC. A prospective cohort study was made among 44 408 women who took hormonal contraceptives (HCs) and 75 230 women who used in trauterine device (IUD) in 25 townships and toens in Rudong County and Taicang City, Jiangsu Province, to compare the incidence of stroke among them from 1 July 1997 to 30 June 2000. (1) The incidence of hemorrhagic stroke (age-and-county standardized rates) was 34.74 per 100 000 py in the HC cohort, 2.72 times higher than that in the IUD cohort (P < 0.01). The incidence of hemorrhagic stroke among women less than 45 years of age was remarkably higher in HC cohort than in the IUD cohort. The relative risk of incidence of hemorrhagic stroke was 2.17 (1.16, 4.06) among the HC users who had stopped HC use for more than 10 years, still significantly higher than among the IUD users. (2) The relative risk of incidence of hemorrhagic stroke among the women who used low-dose COCs during the survey was 3.60 (1.73, 7.53) times higher than that among the IUD users. The relative risk of incidence of hemorrhagic stroke was 3.09 (1.26, 7.57) among the women who had stopped low-dose COC use for less than five years, however, the risk of hemorrhagic stroke remarkably decreased after they stopped taking COC for more than 5 years. (3) No obvious increase in incidence of infarctional stroke was found among the women who took low-dose COC during the survey. (4) Hypertension might be the most important risk factor of hemorrhagic stroke among the low-dose COC users. There is an obvious increase in risk of hemorrhagic stroke among the Chines women who take low-dose of China-made COCs for a long time. The efffect of China-made COCs on pathogenesis of hemorrhagic stroke lasts sometime after the discontinuation of COC use.