An evaluation of fertility- and migration-based policy responses to Japan's ageing population.

Japan's ongoing struggle with rapid ageing is well known. Fertility and migration policies have both been proposed as solutions to Japan's ageing population. We used stock flow population models to estimate the impact of hypothetical fertility and migration policy interventions on measures of aging in Japan from 2015 to 2050. We evaluated policy models based on the Old Age Dependency Ratio (OADR) they produced at the specified end date. Start dates ranged from 2020 to 2030 to assess the time horizons of individual policies. Fertility policies were found to be highly time dependent and only slowed the rate of increase of OADR. It would require a Total Fertility Rate far above replacement levels to compensate for Japan's already aged demography. Migration policy was less time dependent. However, such measures would require unprecedented, and ultimately unrealistic, volumes of migration over coming decades in order to reduce Japan's OADR. Our results suggest that fertility and migration based policy responses will be unable to significantly reduce Japan's OADR or reverse Japan's ageing population within the next few decades. Japan should focus on activating its human capital through the prolongation of working lives, increasing participation, and improving productivity within the Japanese labour force to mitigate and adapt to the inevitable effects of ageing populations.

Prophylactic antibiotics for manual removal of retained placenta during vaginal birth: a systematic review of observational studies and meta-analysis.

BACKGROUND: Manual removal of the placenta is an invasive obstetric procedure commonly used for the management of retained placenta. However, it is unclear whether antibiotic prophylaxis is beneficial in preventing infectious morbidity. We conducted a systematic review to determine the efficacy and safety of routine use of antibiotics for preventing adverse maternal outcomes related to manual placenta removal following vaginal birth. METHODS: A detailed search of MEDLINE, EMBASE, Cochrane library and the CINAHL databases was conducted for non-randomized studies involving women undergoing manual placenta delivery after vaginal births and where antibiotic prophylaxis use was compared with no treatment or placebo to prevent maternal infection. Search terms including 'delivery, obstetric', 'placenta, retained', 'anti-infective agents', and 'chemoprevention' were used. RESULTS: Of the 407 citations that resulted after elimination of duplicates, 81 full texts were potentially eligible after independent assessment of the title and abstracts. Independent review of the full texts identified three eligible cohort studies which were retrospective in design. These studies contained data on two of the pre-specified outcomes, endometritis and puerperal fever. Other secondary outcomes such as perineal infection and/or any infection, hospital stay duration, sepsis, hemorrhage >1000 ml or hospital readmissions were not reported on excluding puerperal fever. A meta-analysis showed no significant reduction in the incidence of endometritis (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.38 to 1.85, three studies, 567 women) and puerperal fever (OR 0.99, 95% CI 0.38 to 2.27, one study, 302 women). CONCLUSIONS: There is currently no evidence to suggest beneficial effects for routine antibiotic use in women undergoing manual placental removal following vaginal birth. In appropriate settings, further research is required to determine whether a policy of routine antibiotic prophylaxis for the procedure should be maintained or discouraged.

Blunt chest trauma in the elderly patient: how cardiopulmonary disease affects outcome.

Blunt trauma patients with rib fractures have significant risk of morbidity and mortality. The risk of complications increases with age and cardiopulmonary disease. We reviewed our experience at a community hospital Level II trauma center over a 5-year period. A review of the trauma registry revealed 62 patients over the age of 65 with multiple rib fractures and no associated injuries. Thirty-one patients with cardiopulmonary disease (CPD+) were compared with 31 patients without cardiopulmonary disease (CPD-). Charts were reviewed for morbidity, mortality, the need to upgrade level of care (readmission to the hospital or intensive care unit), and length of hospitalization. Complications occurred in 17 of 31 CPD+ patients and in four of 31 CPD- patients (P < 0.001). The only three deaths were in CPD+ patients. Ten CPD+ patients and four CPD- patients required an upgrade in the level of care (P < 0.05). The CPD+ patients had longer hospitalization than the CPD- patients: 8.5 versus 4.3 days (P < 0.05). We conclude that elderly patients with multiple rib fractures and cardiopulmonary disease are at significant risk for complications that result in readmission to the hospital and intensive care unit and prolonged length of hospitalization. Admission to the intensive care unit with attention to cardiac and pulmonary status upon transfer to the ward is warranted.