High Birth Rates Research Articles

A POPULATION CENSUS AS A HISTORICAL SOURCE ON DATA ON POPULATION DYNAMICS IN NIZHNY NOVGOROD REGION (2002–2021)

The population census is an important historical source, a statistical tool that enables to obtain objective and comprehensive data on the number and composition of the population in a country or region, which is crucial for forming the national policy, planning economic and social programs. Population censuses are conducted at regular intervals and help government agencies to assess the dynamics of demographic changes, including migration, birth rate, mortality, changes in the educational level and the earning capacity of the population. The information obtained is the basis for the strategic development of educational, health and social infrastructure and affects economic planning and the development of industry and the agricultural sector. The purpose of the undertaken research is to study the data of population censuses in 2002–2021, their statistical processing and elucidation of the dynamics in various aspects of the socio-economic development of Nizhny Novgorod region. The results of the population census make it possible to assess the socio-economic status of different population groups, their age and gender composition, educational level, language and nationality, necessary to formulate an effective state policy aimed at improving the lives of citizens and meeting their needs. Materials and methods. This article is based on studying the complex of All-Russian censuses for the period 2002–2021. When writing this article, data on the state of the population in Nizhny Novgorod region were of particular importance. When preparing the article, first of all, concrete-historical and statistical methods of research were used, mathematical processing of quantitative data was carried out. In the historiographical aspect, the article is notable for its novelty and has practically no predecessors. Research results. The analysis of the data from the population censuses of Nizhny Novgorod region for 2002, 2010 and 2021 revealed a steady decline in the population size, which decreased from 3.524 million to 3.119 million people. The main factors were negative natural increase due to high mortality and low birth rate, as well as intensive migration outflow, especially among young people. At the same time, demographic aging was recorded, expressed in an increase in the proportion of the elderly population. Changes in the educational structure show an increase in the number of people with higher and secondary specialized education, which does not compensate for the loss of the able-bodied population. Conclusions. The study demonstrates that Nizhny Novgorod region is facing serious demographic problems, deepening due to natural decline and migration outflow. Aging of the population and disproportions in its age structure are increasing, despite the increase in the educational level. To stabilize the demographic situation and ensure the economic development of the region, comprehensive measures are needed for labour power intake, for improving the quality of life and supporting socio-economic activity.

Seasonal Distribution of Births in Anatolian Buffaloes and Effects of the Season on Some Milk and Reproductive Traits of Cows and Growth Traits of Calves

The aims of this study were i) to evaluate the seasonal changes in births of Anatolian buffaloes, ii) to examine the changes of some milk [lactation milk yield (LMY) and lactation length (LL)] and fertility [first calving age (FCA) and calving interval (CI)] according to seasons and iii) to investigate the effects of seasons on the growth traits of calves [birth weight (BW0), live weight at 6 mo (LW6) and live weight at 12 mo (LW12)]. A total of 8614 to 15605 yield records were evaluated including milk yield and fertility traits of buffalo cows and growth traits of calves between 2012 and 2023. The mean temperature, relative humidity, the duration of sunshine, and temperature humidity index (THI) values were calculated for these years. While the highest birth rate was observed in the summer season (34.27%), the lowest birth rate was determined in the winter season (11.99%). The BW0, LW6 and LW12, LMY, LL, FCA, and CI values of the calves were determined as 30.8±0.04 kg, 107.6±0.23 kg, 172.6±0.27 kg, 994.7±2.05 kg, 262.6±0.22 d 1175.5±3.46 d and 561.7±1.84 d, respectively. Except for CI, all characteristics were significantly affected by seasonal changes (P<0.001). The growth traits of the calves born in autumn were higher than the other seasons. The LMY values in spring and winter were higher than those determined in the different seasons. Also, the highest FCA was obtained in heifers born in the winter. It was concluded that the season could affect both some fertility and milk yield characteristics of buffalo cows and the growth performance of calves.

Maternal and perinatal mortality: Geospatial analysis of inequality in pregnancy and perinatal mortality in Ethiopia.

While there is ample evidence of the overall reduction in perinatal and pregnancy-related mortality in Ethiopia, it remains uncertain if geographic disparities have diminished. This study aimed to investigate perinatal and pregnancy-related mortality spatial distributions, trends over time, and factors associated with the distribution in Ethiopia. We used data from Ethiopian Demographic and Health Surveys conducted in Ethiopia in 2000, 2005, 2011, and 2016. In each survey, around 15,500 women aged 15-49 were interviewed from about 550 neighborhoods randomly sampled from across the country. Perinatal and pregnancy-related mortality were used as outcome variables. We carried out Optimized Hotspot Analysis using the Getis-Ord Gi* statistic in ArcGIS Pro to identify the time trend of geographical clusters with high (hot spot) and low (cold spot) perinatal and pregnancy-related mortality. In addition, we conducted a Geographically Weighted Poisson Regression in R to examine the factors associated with the spatial distribution of perinatal and pregnancy-related mortality. Perinatal and pregnancy-related mortality exhibited a clustering pattern indicating the presence of geographic inequality, with a decreasing pattern from 2000 to 2016. We detected hotspot areas in developed administrative regions of Amhara, Oromia, and Southern Nations, indicating inequality within large regions. Inequality in perinatal mortality was associated with rural residence, younger age of women, and high birth rate, whereas pregnancy-related mortality was associated with low autonomy, younger age, and anemia. We found that anemia (p-value = 0.01) has a geographically varying relationship with perinatal mortality, while education (p-value = 0.03) and wealth (p-value = 0.01) with pregnancy-related mortality. While there has been a reduction during the study period, geographical disparities in perinatal and pregnancy-related mortality still persist. Therefore, targeting intervention programs in areas where spatial inequalities still persist is essential for effectively utilizing scarce resources.

The challenge of preventing extinctions: Lessons from managing threatened land snails on Norfolk Island.

Norfolk Island, situated between Australia, New Zealand and New Caledonia, has a rich, narrowly endemic land snail fauna, which has suffered considerably from habitat loss and introduced predators. Eleven species (Stylommatophora, Microcystidae) are currently listed by the IUCN and/or Australia's EPBC Act 1999 as Endangered, Critically Endangered or Extinct. Based on targeted surveys undertaken since 2020, we re-assess the threat status of these taxa. For three species assessed to be at imminent risk of extinction, we report on the implementation of in-situ and ex-situ conservation actions and assess their effectiveness after a three-year period. We document current distributions and abundances of these species and describe experimental conservation methods, such as increased predator control, the erection of predator-proof exclosures, and the establishment of an ex-situ breeding population. We found that the relative abundance of one subspecies, Advena campbellii campbellii, was strongly correlated with monthly rainfalls. Trials of predator-proof exclosures that retain adults but allow juveniles to disperse indicated that snails can be successfully secured from predation. Increased efforts in predator control led to the killing of more rodents and chickens; however, the impact on the snail population is unclear. The ex-situ breeding population had high birth rates initially followed by high adult mortality. Adjustments in husbandry conditions reduced stress levels leading to sustainable birth rates and increased survivorship with the result of rapid population growth. We determined that the ovoviviparous A. campbellii campbellii matures at the age of 3-4 months and has a lifespan of 10-12 months in captivity. We conclude that focused predation studies are needed to determine the impact of introduced predators. The use of exclosures requires further refinement especially regarding feeding schedules. In-situ breeding requires significant time for establishment but can be implemented successfully. We assess three endemic species as Extinct, four as Critically Endangered and two as Vulnerable.

Twin home birth: Outcomes of 100 sets of twins in the care of a single practitioner.

Research on community (home or birth center) twin birth is scarce. This study evaluates outcomes of twin pregnancies entering care with a single community practitioner. This is a retrospective observational cohort study of 100 consecutive twin pregnancies planning community births during a 12-year period. Outcomes measured included mode of birth; birth weights; Apgar scores; ante-, intra-, and post-partum transports; perineal integrity; birth interval; blood loss; chorionicity; weight concordance; and other maternal or neonatal morbidity. 31 women (31%) transferred to a hospital-based clinician prior to labor. Of the 69 pregnancies still under the obstetrician's care when labor began, 79.7% (n = 55) were Dichorionic Diamniotic and 21.3% (n = 14) were Monochorionic Diamniotic. The vaginal birth rate was 91.3% (n = 63): 77.3% for primips and functional primips (no previous vaginal births) and 97.9% for multips. Six mothers (8.7%) had in-labor cesareans (1 multip and 5 primips). Rates of vaginal birth did not vary significantly by chorionicity. There were 8 transports in labor (11.6%): 2 vaginal and 6 cesareans. Average gestational age was 39.0 weeks (range 35-42). Compared to primiparas, multiparas had less perineal trauma and higher rates of vaginal birth and spontaneous vaginal birth. One twin infant and one mother required postpartum hospital transport. Of the babies born in a community setting, there was no serious morbidity requiring hospital treatment. A community birth can lead to high rates of vaginal birth and good outcomes for both mothers and babies in properly selected twin pregnancies. Community twin birth with midwifery style care under specific protocol guidelines and with a skilled practitioner may be a reasonable choice for women wishing to avoid a cesarean section-especially when there is no option of a hospital vaginal birth. Training all practitioners in vaginal twin and breech birth skills remains an imperative.

Effects of health expenditure, death rate, and infant mortality rate on life expectancy: A case study of the United States

Understanding the factors that influence life expectancy (LEXP) is crucial for promoting economic development, as a nation's prosperity depends on the health of its population. Various socioeconomic, nutritional, lifestyle, genetic, and environmental factors can significantly impact a nation’s health and longevity. Our study investigates these drivers of LEXP, focusing on the United States as a case study. Using quarterly data from 2000 to 2022, we examined the relationship between LEXP and multiple determinants, including environmental degradation, income levels, inflation dynamics, educational attainment, birth and death rates, health expenditure patterns, urbanization trends, and infant mortality rates. Employing advanced analytical methodologies, we accounted for the nonlinear nature of the time series data by utilizing approaches such as quantile-on-quantile Kernel Regression Least Squares and quantile-on-quantile Granger causality. The study revealed that factors such as inflation rate, rapid urbanization, high birth rates, CO2 emissions, death rates, and infant mortality negatively affect LEXP. On the other hand, higher income levels, educational attainment, food production, and health expenditure positively influence LEXP. Based on these findings, we have proposed significant policy recommendations.

The evolution and causes of the change in the demographic model of Russia. Message 1. General assessment of historical, medical, social and demographic events

The demographic situation in different periods was determined by the general patterns of childbearing, epidemics and the state of society. In Russia, even against the background of great upheavals, population growth has been observed for several centuries with a high birth rate, which exceeded the total mortality rate. Epidemics, wars and political events of the twentieth century, as well as the change of priorities in the 1990s, left their mark and led to a decrease in the population. This analytical review is devoted to the evolutionary changes in the Russian population model. The main historical, medical, social and demographic events that dynamically affect the demographic situation in our country are considered. Special attention is paid to the factors influencing the decline in the population in the country, which must be taken into account when planning and implementing state and territorial programs to stimulate the birth rate, taking into account the main political and economic changes.

International migration and the advent of a new demographic era

AbstractThe paper explores whether international migration is linked to currently decreasing levels of fertility in high birth rates countries, thereby to the advent of a stage of population degrowth at the world's level. Methodology is in two steps. First, a global dataset is assembled comprising 13 variables for each country. For the country itself: emigrant stock, total fertility rate, girls' enrolment rate, women's labour force participation, global gender gap, and income per capita; for a fictitious average region of destination of migrants originating from this specific country, the last six variables. In the second step, links between origin and destination countries in terms of fertility levels and determinants are analysed using bivariate correlations. A remarkable fact emerges, namely national levels of fertility and their determinants vary quasi perfectly parallel at both ends of international migration corridors. Fertility at origin is not correlated to any phenomenon as much as to fertility, girls' school enrolment and gender equity at destination. Three complementary hypotheses explaining this apparently puzzling fact are discussed: transmission of norms by migrants; cultural similarities at both ends of migrant corridors; and congruency between the global diffusion of norms and the global migration of people. The conclusion highlights the original contribution of the paper, both to the demographic discipline (migration should also be dealt with as a remote determinant of fertility) and political debates on migration (erecting barriers to migration works against the preservation of earth).

Delivery mode and subsequent birth rate: A nationwide register-based analysis in Finland.

The study aimed to calculate the subsequent birth rate for different delivery modes, comparing them with spontaneous vaginal deliveries, using a comprehensive nationwide high-quality registry. Data from the National Medical Birth Register (MBR) were used to evaluate the birth rate after different delivery modes. All first deliveries for a mother during the years 2004 to 2016 were included. For these women, all second pregnancies from the MBR during the years 2004 to 2018 were retrieved and combined with the data of the first deliveries. A Cox regression model was used to evaluate the risk for the second pregnancy after giving birth the first time. The results were interpreted with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). A total of 375 619 women with a first and second pregnancy leading to birth were included in this study. Of these, a total of 50 579 women underwent assisted vaginal delivery, 50 429 had an unplanned cesarean section (CS), 22 021 had elective CS, and 252 593 had spontaneous vaginal delivery as a mode of delivery in their first pregnancy. Women with assisted vaginal delivery (aHR, 1.23 [CI, 1.21-1.24]) and unplanned CS (aHR, 1.03 [CI, 1.02-1.05]) had higher birth rates after the first birth, and women with elective CS as a mode of delivery had lower birth rates (aHR, 0.86 [CI, 0.84-0.88]) when compared with women who had spontaneous vaginal delivery. The findings of this study indicate that the CS operation itself is not the only cause of the observed lower birth rate; rather, there are underlying factors that have a greater impact on birth rates.

Phonocardiogram (PCG) Murmur Detection Based on the Mean Teacher Method.

Cardiovascular diseases (CVDs) are among the primary causes of mortality globally, highlighting the critical need for early detection to mitigate their impact. Phonocardiograms (PCGs), which record heart sounds, are essential for the non-invasive assessment of cardiac function, enabling the early identification of abnormalities such as murmurs. Particularly in underprivileged regions with high birth rates, the absence of early diagnosis poses a significant public health challenge. In pediatric populations, the analysis of PCG signals is invaluable for detecting abnormal sound waves indicative of congenital and acquired heart diseases, such as septal defects and defective cardiac valves. In the PhysioNet 2022 challenge, the murmur score is a weighted accuracy metric that reflects detection accuracy based on clinical significance. In our research, we proposed a mean teacher method tailored for murmur detection, making full use of the Phyionet2022 and Phyionet2016 PCG datasets, achieving the SOTA (State of Art) performance with a murmur score of 0.82 and an AUC score of 0.90, providing an accessible and high accuracy non-invasive early stage CVD assessment tool, especially for low and middle-income countries (LMICs).

Urinary Bacterial Profile and Antibiotic Susceptibility Pattern among Pregnant Women in Eastern Libya

Urinary tract infections, which affect approximately 20% of pregnancies globally, particularly in developing nations with high birth rates like Libya, are a public health concern that complicate pregnancy and are linked to catastrophic maternal, fetal, and neonatal outcomes. Choosing an appropriate therapy depends on current understanding about antibiotics, which is essential for early issue detection and prevention. In this study, antenatal care clinics in several eastern Libyan cities, including "Benghazi, Almarj, Albayda, Shahat, Darna, Alquoba," participated in a cross-sectional investigation to identify the most common causes of UTIs and to ascertain the sensitivity and resistance of antibiotic patterns. From February 9 to April 15, 377 samples were gathered utilizing a standardized questionnaire to obtain data. UTI was diagnosed using mid-stream urine culture on standard culture media. Out of the 377 pregnant women who were included, E. Coli had the greatest infection rate (43.0%), followed by Klebsiella pneumonia (10.3%), Staphylococcus aureus (16.4%), and Staphylococcus saprophyticus (11.4%). The most effective antibiotics were found to be Augmentin (58.9%), Ciprofloxacin (52.6%), and Nitrofurantoin (51.3%), although Azithromycin and Nalidixic acid showed strong resistance to most uropathogens. Our research reveals that urinary tract infections (UTIs) are prevalent among pregnant women in eastern Libya and that bacteria that are extremely resistant to most tested antibiotics are appearing more frequently. These results should cause doctors to reevaluate their treatment strategies in light of antibiotic susceptibility data.

Perinatal and Neonatal Chikungunya Virus Transmission: A Case Series.

Large-scale epidemics in countries with high birth rates can create a concerning scenario where pregnant people are more likely to transmit the virus. In addition, increased international mobility has made arboviruses a growing problem for travelers. The increased risk of vertical transmission has been related to maternal viremia near delivery. Such transmission leads to severe infection of newborns and may be associated with subsequent neurological impairment including cerebral palsy. This case series provides an overview of clinical and laboratory findings in pregnant individuals with confirmed chikungunya virus (CHIKV) infection as well as the clinical effects on their newborn emphasizing the severity of neonatal chikungunya. An ambispective case series enrolled newborns with confirmed exposure to CHIKV in utero or in the neonatal period. During the delivery period, the transmission rate among viremic individuals was approximately 62% (18/29). Fever, irritability, rash, and poor feeding in the first week of life were critical signs of neonatal chikungunya, highlighting its severity. Close monitoring of healthy newborns during the first week of life is essential in areas affected by CHIKV epidemics, and in offspring of pregnant travelers who visited the outbreaks zones. This case series is intended to increase neonatologists' awareness of the possibility of mother-to-child transmission of CHIKV among newborns with a sepsis-like presentation. Prioritizing CHIKV vaccination for women of childbearing age should also be considered.

Tennessee Medicaid patient immediate postpartum long-acting reversible contraception utilization

ObjectivesTo understand immediate postpartum long-acting reversible contraception (IPP LARC) desire and utilization trends among publicly insured patients delivering at one academic hospital in a state with health care barriers and high short-interval birth rates. Study designWe conducted a retrospective cohort study of electronic delivery records between March 2018 and June 2023 for publicly insured patients. Patient demographics, IPP LARC desire and utilization trends were compared using χ2 or Fisher exact tests. Binary logistic regression explored the relationship between IPP LARC utilization and demographics. Multivariable logistic regression was performed on all statistically significant variables. ResultsAnalysis included 10,472 delivery encounters; 2459 (23.5%) requested IPP LARC on admission and 464 (4.4%) changed contraception to IPP LARC after admission. Among those obtaining IPP LARC (n = 2523, 24.1%), 1224 (48.5%) selected arm implants and 1299 selected intrauterine devices (IUDs). Patients who self-reported as non-Hispanic Black and non-Hispanic Other or multiple races utilized IPP LARC less (adjusted Odds Ratio (aOR)=0.84, 95% CI: 0.72–0.98, aOR=0.68, CI 95%: 0.48–0.97, respectively). Patients with cesarean delivery (aOR=1.45, 95% CI: 1.31–1.61) or inadequate prenatal care (aOR=1.54, CI 95%: 1.35–1.75) were more likely to utilize IPP LARC. Maternal age and years of education were inversely associated with utilization. Primiparous patients were less likely to utilize IPP LARC. ConclusionsLong-acting reversible contraception (LARC) utilization was 24.1% during the immediate postpartum period; higher than the 11% nationally reported interval LARC use among publicly insured patients. Understanding the demographics of those desiring IPP LARC could highlight accessibility gaps. The impact of IPP LARC utilization on rates of short-interval birth is being evaluated. ImplicationsUnderstanding the demographics of IPP LARC utilizers may contribute to understanding accessibility gaps and facilitate discernment of factors impacting patient initiation. Evidence suggests that comprehensive contraception access during delivery admission is feasible, patient-desired, and essential.

ANALISIS PENGARUH PENDIDIKAN ORANG TUA TERHADAP FERTILITAS DI INDONESIA

Fertility is the result of female reproduction. Fertility is a term that describes the number of children born alive. The large number of children born in Indonesia is one of the causes of rapid population growth. The high birth rate is influenced by many factors, one of which is education. The education received by both parents greatly influences the thoughts of both wives and husbands in having children because parents who have higher education tend to be more open-minded. Their minds are more rational so they will take everything into account before acting. This research aims to find out how parents' education influences their choice in the number of children they want to have. The research method used is a qualitative method with data collection techniques through literature study. Researchers collect data through articles and journals which are then read and studied. The results of this research are that education is a factor that has a very significant influence on fertility or birth, especially the wife's education which determines the amount of fertility. Meanwhile, for husband's education, husband's education does not have much influence on fertility.

A comprehensive analysis of contraceptive safety: Implications for gynecological health and education levels

The use of contraceptives is essential for lowering the net reproduction rate and stabilizing population growth. Developing countries are characterized by high birth rates and rapid population growth. With lower contraceptive usage rates among eligible couples and resistance towards family planning methods, achieving population stabilization seems challenging. Therefore, this study aims to study the effects of various contraceptive methods on gynecological health and their safety profiles, The present observational study, was conducted in Department Obstetrics and Gynaecology at tertiary health care centre, Panjab, India. A total of 450 women were evaluated with the help of a pre-designed and pre-tested questionnaire to address knowledge, awareness, and perception of contraception among the rural and urban population in Punjab. The data were collected and analysed.All the participants were known to the traditional contraception and only few were aware about the modern contraception. Participants preferred tubal ligation (43.78%) over vasectomy (75.78%) and rarely considered hysterectomy (1.11%). Most knew about male condoms (99.56%) but fewer about female condoms (0.44%). Among the participants, 59.78% were aware of contraception side effects. Regarding condom use, opinions were divided, with 48.67% in favor and 51.33% against. Educated individuals were aware of contraception but not its major side effects. Therefore, we suggest investigating social, cultural, and knowledge aspects to improve understanding.

Uterus Transplant in Women With Absolute Uterine-Factor Infertility

Uterus transplant in women with absolute uterine-factor infertility offers the possibility of carrying their own pregnancy. To determine whether uterus transplant is feasible and safe and results in births of healthy infants. A case series including 20 participants with uterine-factor infertility and at least 1 functioning ovary who underwent uterus transplant in a large US tertiary care center between September 14, 2016, and August 23, 2019. The uterus transplant (from 18 living donors and 2 deceased donors) was surgically placed in an orthotopic position with vascular anastomoses to the external iliac vessels. Participants received immunosuppression until the transplanted uterus was removed following 1 or 2 live births or after graft failure. Uterus graft survival and subsequent live births. Of 20 participants (median age, 30 years [range, 20-36]; 2 Asian, 1 Black, and 16 White), 14 (70%) had a successful uterus allograft; all 14 recipients gave birth to at least 1 live-born infant. Eleven of 20 recipients had at least 1 complication. Maternal and/or obstetrical complications occurred in 50% of the successful pregnancies, with the most common being gestational hypertension (2 [14%]), cervical insufficiency (2 [14%]), and preterm labor (2 [14%]). Among the 16 live-born infants, there were no congenital malformations. Four of 18 living donors had grade 3 complications. Uterus transplant was technically feasible and was associated with a high live birth rate following successful graft survival. Adverse events were common, with medical and surgical risks affecting recipients as well as donors. Congenital abnormalities and developmental delays have not occurred to date in the live-born children. ClinicalTrials.gov Identifier: NCT02656550.

Labor outcomes in caseload midwifery compared with standard midwifery care: A cohort study.

Research has shown caseload midwifery to increase the chance of vaginal birth, but this may not be the case in settings with high vaginal birth rates in standard care. This study investigated the association between caseload midwifery and birth mode, labor interventions, and maternal and neonatal outcomes at a large obstetric unit in Denmark. Cohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log-binomial regression. Among 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54-0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75-0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02-1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96-1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82-0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37-0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17-1.28]) in caseload midwifery. In caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores.

DNA Methylation of Postnatal Liver Development in Pigs.

DNA methylation plays an important role in the development and tissue differentiation of eukaryotes. In this study, bisulfite sequencing (BS-seq) technology was used to analyze the DNA methylation profiles of liver tissues taken from Rongchang pigs at three postnatal feeding stages, including newborn, suckling, and adult. The DNA methylation pattern across the genomes or genic region showed little difference between the three stages. We observed 419 differentially methylated regions (DMRs) in promoters, corresponding to 323 genes between newborn and suckling stages, in addition to 288 DMRs, corresponding to 134 genes, between suckling and adult stages and 351 DMRs, corresponding to 293 genes, between newborn and adult stages. These genes with DMRs were mainly enriched in metabolic, immune-related functional processes. Correlation analysis showed that the methylation level of gene promoters was significantly negatively correlated with gene expression. Further, we found that genes related to nutritional metabolism, e.g., carbohydrate metabolism (FAHD1 and GUSB) or fatty acid metabolism (LPIN1 and ACOX2), lost DNA methylation in their promoter, with mRNA expression increased in newborn pigs compared with those in the suckling stage. A few fatty acid metabolism-related genes (SLC27A5, ACOX2) were hypomethylated and highly expressed in the newborn stage, which might satisfy the nutritional requirements of Rongchang pigs with high neonatal birth rates. In the adult stage, HMGCS2-which is related to fatty acid β-oxidation-was hypomethylated and highly expressed, which explains that the characteristics of high energy utilization in adult Rongchang pigs and their immune-related genes (CD68, STAT2) may be related to the establishment of liver immunity. This study provides a comprehensive analysis of genome-wide DNA methylation patterns in pig liver postnatal development and growth. Our findings will serve as a valuable resource in hepatic metabolic studies and the agricultural food industry.

Perinatal Outcomes of Singleton, Twin and Triplet Gestations after Oocyte Donation: A Retrospective, Population-Based Cohort Analysis.

Although high live birth rates are associated with oocyte donation (OD), these pregnancies are associated with increased obstetric and perinatal risks. This study evaluated maternal and neonatal risks after OD compared to in vitro fertilization (IVF) with autologous oocytes, and to spontaneous pregnancies (SPs), among singletons, twins and triplets. A retrospective, large, population-based cohort study was conducted based on electronic data from Maccabi Healthcare Services. A total of 469,134 pregnancies were grouped according to the mode of conception. The main outcome measures were preterm birth (PTB), small for gestational age (SGA) and pregnancy-induced hypertension (PIH). The data were analyzed separately for singletons, twins and triplets. The mean maternal age was older in the OD group compared with the IVF and SP groups (singletons: 39.7 ± 4.1 vs. 34.5 ± 4.8 and 31.7 ± 5.3 years; twins: 39 ± 4.6 vs. 32.6 ± 4.4 and 31.2 ± 5.1 years; and triplets: 35.6 ± 2.5 vs. 32 ± 3.9 and 29.7 ± 5 years). The mean gestational age was younger among the OD group compared to the SP group (singletons: 37.5 ± 3 vs. 39 ± 2 p = 0.001, and twins: 35 ± 3 vs. 36 ± 2.5 p = 0.001). Higher rates of PTB < 37, PTB < 34 and PTB < 28 weeks were found among OD singletons. Multivariable logistic regressions for PTB < 37 weeks and SGA in singletons demonstrated that OD and IVF are significant risk factors (OR = 4.1, 95%CI = 3.3-5.2; OR = 4.3, 95%CI = 4.1-4.6; OR = 1.9, 95%CI = 1.3-2.6; OR = 2.2, 95%CI = 2-2.4, respectively). Significantly higher rates of PIH were demonstrated among the OD vs. IVF and SP groups in singleton (4.3% vs. 1.7% and 0.7%) and in twin pregnancies (7.5% vs. 4.3% and 3.4%). OD pregnancies are at increased risk for PTB, SGA and PIH.

Lack of skilled medical personnel as a structural problem

The healthcare system in Germany is characterized by a comprehensive local patient care. Nevertheless, due to the increasing lack of medical personnel bottlenecks are impending, which are not only of a temporary nature. The increasing demography-related needs for care, insufficient healthcare competence of many people and the inadequate prevention will strengthen the demand for medical and nursing personnel. At the same time, physicians and nursing personnel from the high birth rate baby boomer years are leaving the healthcare system. This age cohort must now be replaced by a younger workforce; however, in Germany too few physicians are being trained when measured against the requirements. A marked increase in the number of university study places in medicine will not be able to alleviate the deficit in the short term but prospectively there is no way past an expansion of capacities. The decline in panel physicians, especially in general practitioner care, is accompanied by a clear increase of employees in the outpatient sector. The desire for reduced working hours is clearly recognizable throughout all age cohorts. The part-time quota is increasing. The discrepancy between desired and actual working times is largely underestimated. The increased part-time quota already shows that something must fundamentally change to be able to provide sufficient medical manpower and working hours for the treatment of patients. The association between increased part-time quota and dissatisfaction with the working situation in hospitals is obvious and has repercussions for the medical care. In a multifactorial process the causes and sequelae of bottlenecks in skilled personnel are mutually strengthened in a negative spiral. In the short term, the deficit in medical personnel can only be counteracted by a better cooperation between the outpatient and inpatient fields of care and by a massive reduction in bureaucracy. The digitalization can without doubt contribute to the relief of the healthcare system. Telemedical applications can improve the treatment in rural and structurally weak regions.