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Abstract
Aberrant uterine contractions can lead to preterm birth and other labour complications
and are a significant cause of maternal morbidity and mortality. To investigate the
mechanisms underlying dysfunctional uterine contractions, researchers have used experimentally
tractable small animal models. However, biological differences between humans and
rodents change how researchers select their animal model and interpret their results.
Here, we provide a general review of studies of uterine excitation and contractions
in mice, rats, guinea pigs, and humans, in an effort to introduce new researchers
to the field and help in the design and interpretation of experiments in rodent models.
Summary Background Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. In this paper, we updated our annual estimates of child mortality by cause to 2000–15 to reflect on progress toward the MDG 4 and consider implications for the Sustainable Development Goals (SDG) target for child survival. Methods We increased the estimation input data for causes of deaths by 43% among neonates and 23% among 1–59-month-olds, respectively. We used adequate vital registration (VR) data where available, and modelled cause-specific mortality fractions applying multinomial logistic regressions using adequate VR for low U5MR countries and verbal autopsy data for high U5MR countries. We updated the estimation to use Plasmodium falciparum parasite rate in place of malaria index in the modelling of malaria deaths; to use adjusted empirical estimates instead of modelled estimates for China; and to consider the effects of pneumococcal conjugate vaccine and rotavirus vaccine in the estimation. Findings In 2015, among the 5·9 million under-5 deaths, 2·7 million occurred in the neonatal period. The leading under-5 causes were preterm birth complications (1·055 million [95% uncertainty range (UR) 0·935–1·179]), pneumonia (0·921 million [0·812 −1·117]), and intrapartum-related events (0·691 million [0·598 −0·778]). In the two MDG regions with the most under-5 deaths, the leading cause was pneumonia in sub-Saharan Africa and preterm birth complications in southern Asia. Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR in 2000–15. Stratified by U5MR, pneumonia was the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia were both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR. Interpretation In the SDG era, countries are advised to prioritise child survival policy and programmes based on their child cause-of-death composition. Continued and enhanced efforts to scale up proven life-saving interventions are needed to achieve the SDG child survival target. Funding Bill & Melinda Gates Foundation, WHO.
To update national population-level pregnancy-related mortality estimates and examine characteristics and causes of pregnancy-related deaths in the United States during 2011-2013.
[1]Center for Reproductive Health SciencesDepartment of Obstetrics and Gynecology
Washington University School of Medicine
St. Louis
MO
USA
Author notes
[*][*
]Correspondence
Sarah K. England, Center for Reproductive Health Sciences, Department of Obstetrics
and Gynecology, Washington University School of Medicine, 425 South Euclid Avenue,
Campus Box 8064, St. Louis, MI 63110, USA.
This is an open access article under the terms of the
http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original
work is properly cited, the use is non‐commercial and no modifications or adaptations
are made.
History
Date
revision received
: 07
December
2020
Date
received
: 17
August
2020
Date
accepted
: 11
December
2020
Page count
Figures: 3,
Tables: 3,
Pages: 17,
Words: 12245
Funding
Funded by: Eunice Kennedy Shriver National Institute of Child Health and Human Development , open-funder-registry 10.13039/100009633;
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