Editor’s Choice Articles

(1) Background: There are persistent racial/ethnic disparities in cesarean delivery in the United States (U.S.), yet the causes remain unknown. One factor could be provider bias. We examined medical indications for cesarean delivery that involve a greater degree of physician discretion (more subjective) versus medical indications that involve less physician discretion (more objective) to better understand factors contributing to the higher rate among Micronesian, one of the most recent migrant groups in the state, compared to White women in Hawai‘i. (2) Methods: A retrospective chart review was conducted to collect data on 620 cesarean deliveries (N = 296 White and N = 324 Micronesian) at the state’s largest maternity hospital. Multivariate regression models were used to examine associations between maternal and obstetric characteristics and (1) subjective indication defined as non-reassuring fetal heart tracing (NRFHT) and arrest of labor disorders, and (2) objective indication defined as all other indications (e.g., malpresentation). (3) Results: We found that Micronesian women had significantly higher odds of cesarean delivery due to a subjective indication compared to White women (aOR: 4.17; CI: 2.52-6.88; P < 0.001; N = 619) after adjusting for multiple covariates. (4) Conclusion: These findings suggest unmeasured factors, possibly provider bias, may influence cesarean delivery recommendations for Micronesian women in Hawai‘i. Full article

Persons living with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) vary widely in terms of the severity of their illness. It is estimated that of those living with ME/CFS in the United States, about 385,000 are homebound. There is a need to know more about different degrees of being homebound within this severely affected group. The current study examined an international sample of 2138 study participants with ME/CFS, of whom 549 were severely affected (operationalized as ‘Homebound’). A subsample of 89 very severely affected participants (operationalized as ‘Homebound-bedridden’) was also examined. The findings showed a significant association between severely and very severely affected participants within the post-exertional malaise (PEM) symptom domain. The implications of these findings are discussed. Full article

With the rapid increase in the ageing population (60+) in China since 1999, the problem of supporting the aged is facing increasingly severe challenges. Based on the 2072 valid samples from the Chinese General Social Survey (CGSS) of 2017, a non-sequential multinomial logistic regression model was established to analyse the changing trends and micro-influencing factors of Chinese people’s cognition of old-age care responsibility (COACR). The result shows that offspring responsibility still is a common COACR, but this concept has been gradually weakened and been replaced by the responsibility of the government and the aged. Individual characteristics and relationships with relatives in the models all significantly affect people’s COACR. It is obviously unrealistic for China to completely rely on government and society to provide for the aged. The traditional ethical role of inter-generational responsibility in providing for the aged should be brought into play. Reshaping the inter-generational responsibility ethics of old-age care requires the joint efforts of government, society, families, individuals and other responsible subjects to construct a diversified old-age care service system. Full article