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This article investigates the history of midwifery from the 1920s to 1940s in China through looking at the linkage between modern midwifery and maternal mortality in urban areas. It first shows that people's perceptions of maternal mortality and its causes changed from the nineteenth to the twentieth century, and that a modern form of midwifery service took shape in the Republican era (1912–49) in order for reducing maternal mortality rate and building a strong nation. Evidence from urban areas of Beijing and Sichuan between the 1920s and the 1940s demonstrates that the practice of modern midwifery varied with medical infrastructure and personnel in different places, and that modern midwives in small towns may practise against the rules, taking the initiative to use forceps and perform surgery to save mothers' lives. The relationship between modern midwifery and maternal mortality in the researched period was more complex than medical experts' anticipation. [ABSTRACT FROM AUTHOR]

This article offers a comparative analysis of the transformation of midwifery practices in Beijing city and its rural neighborhood in China between 1926 and 1937. From the 1920s onwards, impelled by supports of governments, academic groups and foreign foundations, a reform of midwifery practices was triggered across China. Beijing was one of the forerunners in this reform. Through examining the midwifery regulations, the new style midwifery service, the midwife education/training programs, as well as the consequential influences on birth attendants and birth outcomes (neonatal, infant and maternal mortality rates) in Beijing's first health district and the nearby Qinghe district, this article shows that in the urban district the trained birth attendants performed better than the untrained personnel in preventing neonatal deaths. Also, the growing use of trained midwifery contributed to the reduction of infant and maternal mortality rates in the urban community. However, because of the paucity of sources of rural areas, such positive outcomes cannot be ascertained in the rural district. Yet an obvious urban-rural divergence in midwifery services and maternal care is still observed. [ABSTRACT FROM AUTHOR]

Background: The relationship between frailty and dementia is unclear and there are very few population-based studies regarding this issue in China. The purpose of this study is to estimate the association between frailty and incident dementia in China, and to explore different effects of frailty established by three definitions of frailty on dementia incidence.Methods: A five-year prospective cohort study was carried out in 2022 participants aged 65 years and over in urban and rural sites in Beijing, China. The participants were interviewed by trained community primary health care workers from 2004 to 2009. Frailty was defined using modified Fried frailty phenotype, physical frailty definition, and multidimensional frailty definition. Dementia was diagnosed using the 10/66 dementia criterion for calculating cumulative incidence. Both competing risk regression models and Cox proportional hazards models were applied to examine the associations between frailty at baseline and five-year cumulative incidence of dementia.Results: At the end of follow-up the five-year cumulative incidence rates of dementia with frailty and without frailty defined by the modified Fried frailty were 21.0% and 9.6%, those defined by the physical frailty were 19.9% and 9.0%, and those defined by the multidimensional frailty were 22.8% and 8.9%, respectively. Compared with non-frail participants, frail people had a higher risk of incident dementia using multidimensional frailty definition after adjusting covariates based on competing risk regression model (HR = 1.47, 95% CI 1.01~2.17) and Cox proportional hazards model (HR = 1.56, 95% CI 1.07~2.26). The association between frailty and incident dementia was statistically significant in participants in the upper three quartiles of age (aged 68 years and over) using the multidimensional frailty definition based on the competing risk regression model (HR = 1.61, 95% CI 1.06~2.43) and Cox proportional hazard model (HR = 1.76, 95% CI 1.19~2.61).Conclusions: Multidimensional frailty may play an inherent role in incident dementia, especially in the people aged over 68, which is significant for distinguishing high risk people and determining secondary prevention strategies for dementia patients. [ABSTRACT FROM AUTHOR]