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Late transition to parenthood is no longer a phenomenon only observed in Europe; rather, it is even more prominent in high-income and low-fertility East Asian societies. Yet, there is a significant gap in the literature about the trends, causes and consequences of late child bearing in Asian societies. Underpinning the ultra-low fertility rates in high-income East Asian societies including Hong Kong, South Korea, Taiwan, Singapore, and Japan is the significant delay in transitioning to parenthood. The median age at first birth in these societies is now the oldest among all high-income societies globally, and more than 20 per cent of all first births occurred to women aged 35 and above. Taking a life course perspective to investigate the shifting age norm for parenthood and the causes of late parenthood would provide a more insightful understanding of the phenomenon. In addition, the consequences of late parenthood observed in Western countries are also likely to manifest in these societies, with intergenerational consequences deserving special attention within the Asian context. [ABSTRACT FROM AUTHOR]

Intergenerational emotional closeness (IEC) in multi-child families manifests not only in the overall parent-child relationship but also by the extent of its within-family differentiation. This study aimed to identify distinct trajectories of collective IEC in multi-child families and to examine its potential associated factors. The study used four waves of the China Family Panel Studies (2010–2018). Based on a sample of 3474 older adults (age >60), growth mixture modelling and logistic regression were conducted. Two latent trajectory patterns of IEC were identified: increasingly tight-knit (93%) and persistently collectively ambivalent (7%). Compared to the latter trajectory, older adults who had a married/cohabiting partner, had better health and received support from all children, were more likely to have increasingly tight-knit trajectories of IEC. The study tells a story more about emotional cohesion between Chinese older adults and multiple offspring over time. Aging families experiencing persistently collectively ambivalent IEC deserve more attention. [ABSTRACT FROM AUTHOR]

Highlights: This work proposes a tactic for improving the efficiency of thermal energy conversion and expanding the application scenarios of phase change materials by constructing non-binder and oriented MXene-K+ aerogel. The prepared phase change composites (PCCs) can rapidly transform solar, electric, magnetic energy into latent heat for keeping warm, power generation, and thermal physiotherapy. Owing to the suggested tactic, the prepared PCCs achieves ultrahigh energy storage density and realize 99.9998% electromagnetic wave energy attenuation. The severe dependence of traditional phase change materials (PCMs) on the temperature-response and lattice deficiencies in versatility cannot satisfy demand for using such materials in complex application scenarios. Here, we introduced metal ions to induce the self-assembly of MXene nanosheets and achieve their ordered arrangement by combining suction filtration and rapid freezing. Subsequently, a series of MXene/ K+/paraffin wax (PW) phase change composites (PCCs) were obtained via vacuum impregnation in molten PW. The prepared MXene-based PCCs showed versatile applications from macroscale technologies, successfully transforming solar, electric, and magnetic energy into thermal energy stored as latent heat in the PCCs. Moreover, due to the absence of binder in the MXene-based aerogel, MK3@PW exhibits a prime solar–thermal conversion efficiency (98.4%). Notably, MK3@PW can further convert the collected heat energy into electric energy through thermoelectric equipment and realize favorable solar–thermal–electric conversion (producing 206 mV of voltage with light radiation intensity of 200 mw cm−2). An excellent Joule heat performance (reaching 105 °C with an input voltage of 2.5 V) and responsive magnetic–thermal conversion behavior (a charging time of 11.8 s can achieve a thermal insulation effect of 285 s) for contactless thermotherapy were also demonstrated by the MK3@PW. Specifically, as a result of the ordered arrangement of MXene nanosheet self-assembly induced by potassium ions, MK3@PW PCC exhibits a higher electromagnetic shielding efficiency value (57.7 dB) than pure MXene aerogel/PW PCC (29.8 dB) with the same MXene mass. This work presents an opportunity for the multi-scene response and practical application of PCMs that satisfy demand of next-generation multifunctional PCCs. [ABSTRACT FROM AUTHOR]

In urban China, the social welfare system and the family structure have changed dramatically, while gender norms are still deep-rooted, particularly among older adults. Under this social, demographic and cultural context, this study aims to take a gender-specific perspective to investigate whether and how gender moderates the roles of pensions, social support and self-care ability on older adults' life satisfaction. Based on the survey data collected from 2,047 older adults aged 65 years and over in urban China in 2018, multiple linear regressions were applied to explore the moderation effects. The results show that the pension is important to older adults' life satisfaction regardless of gender. For social support, the association between family support and life satisfaction is stronger for older men than for older women; interdependent social support, especially being a confidant, matters more to women than to men. The interaction between self-care ability and gender reveals some interesting patterns: self-care ability is found to have a positive association with women's life satisfaction but a negative association with men's. This study contributes to the existing literature by demonstrating how gender intertwines with the most important factors of older adult's life satisfaction in China – a society with strong gender norms and a patriarchal culture. These findings could be relevant to other Asian societies. [ABSTRACT FROM AUTHOR]

Currently, very few studies have comprehensively investigated how intergenerational relationship quality (IRQ) between older parents and adult children is related to older adults' activity engagement. To fill this gap, this study endeavoured to examine the associations between IRQ and older adults' activity profiles, not only considering the overall IRQ but also different dimensions of IRQ. We also aimed to reveal the different roles of IRQ with son(s) and with daughter(s). This study made use of survey data collected in Yibin City, Sichuan Province of China in 2018 (N = 4,211). We adopted hierarchical cluster analysis to identify activity profiles, and performed multinomial logistic regressions to assess the association between IRQ and the profiles. We identified five activity profiles among older adults: "caregiving‐oriented", "employment‐oriented", "social withdrawal", "diverse engagement" and "physically active". Those with greater IRQ were more likely to be "caregiving‐oriented" and have "diverse engagement" relative to "social withdrawal". It also showed that structural‐associational solidarity and affectual closeness were more predictive of the activity profiles, compared to consensual‐normative solidarity and intergenerational conflict. Children's gender plays an important role in the relationship between IRQ and activity engagement profiles. Good intergenerational relationships might not narrow down older adults' activity domains, and instead might actually promote their participation in diverse domains. Promoting structural‐associational solidarity and affectual closeness was likely to reduce social withdrawal among older adults in China. [ABSTRACT FROM AUTHOR]

In Hong Kong, extended households are declining while households with helpers are increasing. More and more couples resort to hiring helpers instead of living with elderly parents to outsource domestic work. Currently, it is not clear whether elderly parents and helpers would have the same impact on couples' time use. To fill this gap, the study examines couples' paid work time and domestic work time, as well as the gender gap in time use in different household types (i.e. couple-only households, households with elderly parents, and households with helpers). It uses the couple data from the first wave of Hong Kong Panel Study of Social Dynamics in 2011 and conducts the inverse propensity weighting with regression adjustment (IPWRA) analysis. The results show that couples' total domestic work is reduced to a greater extent in the helper household than that in the elderly-parent household. But this difference disappears if couples live with relatively younger, healthy, and retired parents. Although the impact of younger, healthy, and retired parents and hired helpers would reduce couples' total domestic work time similarly, they are different in the sense of "help for whom": hired helpers reduce the gender gap in paid work time and domestic work time, mainly by influencing wives' time use; elderly parents reduce couples' domestic work time in a less gendered way, favoring both husbands and wives. Elderly parents and helpers could reduce couples' domestic workload more or less, but whether gender equality is promoted through outsourcing is worth more attention. [ABSTRACT FROM AUTHOR]

Climate change is likely to worsen the food security situation through its impact on food production, which may indirectly affect fertility behaviour. This study examines the direct and indirect effects of climate change (e.g., temperature and precipitation) via the production of major crops, as well as their short- and long-term effects on the total fertility rate (TFR) in Bangladesh. We used structural equation modelling (SEM) to perform path analysis and distinguish the direct influence of climate change on fertility and its indirect influence on fertility through food security. We also applied the error correction model (ECM) to analyze the time-series data on temperature and precipitation, crop production and fertility rate of Bangladesh from 1966 to 2015. The results show that maximum temperature has a direct effect and indirect negative effect–via crop production–on TFR, while crop production has a direct positive effect and indirect negative effect–via infant mortality–on TFR. In the short term, TFR responds negatively to the maximum temperature but positively in the long term. The effect of rainfall on TFR is found to be direct, positive, but mainly short-term. Although indicators of economic development play an important part in the fertility decline in Bangladesh, some climate change parameters and crop production are non-negligible factors. [ABSTRACT FROM AUTHOR]

Despite much attention paid to the surging divorce rate in China, knowledge on divorce patterns and trends at the subnational level is still very limited. This study aims to systematically explore social and economic factors affecting divorce trends between 1990 and 2015 at the provincial level from a tempo–spatial perspective. Traditional fixed effects panel regression and fixed effects spatial autoregression are adopted. Divorce maps demonstrated great variations in the levels and trends of divorce across provinces, highlighting the spatial diversities obscured in the national divorce trend. It is further revealed that factors such as economic development, urbanisation, and employment have augmented their influence over time. Factors that reflect gender equality issues such as the gender gap in education, employment, and sex ratio at birth have different effects across the East, Central and West regions in China. These findings provide insights into the future prospects of divorce in China. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) occurs more frequently in cancer patients than in the general population. A retrospective cross-sectional study was carried out in patients with solid tumor complicated with VTE admitted to the Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 1st, 2008 and December 31th, 2017. The incidence of VTE in hospitalized cancer patients was 1.8%, twice the incidence of VTE in hospitalized non-cancer patients. The annual incidence of cancer-associated VTE in our center varied between 1.6% in 2015 and 0.4% in 2009 with an overall average incidence of 1.3% over the research decade. BMI values of 549(67.7%) cancer patients were within the normal range, but none of patients had BMI greater than 35 kg/m2. 747(92.1%) cancer patients had ECOG PS score ≤ 2 and 481(59.3%) had distant metastasis. Patients with pancreatic, bladder, ovarian and endometrial cancer had the highest incidence of VTE. Upper extremity DVT (47.2%) was more common in cancer patients and might be closely associated with CVC (74.9%), while lower extremities DVT (36.1%) intended to PE development (15.0%). The annual incidence rates showed a fluctuating and upward trend over the research decade. VTE occurrence was closely related to tumor stage, tumor site, catheterization and anti-neoplasm therapy in cancer patients. [ABSTRACT FROM AUTHOR]

Marriage, divorce, and remarriage have undergone significant changes in the past two decades in Hong Kong. Types of marriages have become more diverse, with increasing number of cross-border marriages between Hongkongers and Mainland Chinese as well as cross-national marriages with non-local-and-non-Chinese ethnic groups. Meanwhile, divorces and remarriages are surging, with disproportionate increase of remarriages among those in transnational marriages. Particularly, the proportion of remarriages among marriages between Hong Kong men and Mainland women, and Hong Kong women and Mainland men increased to 40% and 27%, respectively in 2012. This study investigates assortative mating in marriages by separating remarriages from first marriages, to uncover the real patterns and uniqueness in Hong Kong. The results show that assortative mating in first marriages and remarriages appear across local marriages and six types of transnational marriages. And it also shows that remarriages between Hong Kong men and Mainland women have become more hypergamous, and more welfare support is needed to assist socially deprived cross-border couples to reside in Hong Kong. [ABSTRACT FROM AUTHOR]

In China in 2017, the elderly dependency ratio (EDR) – which is the number of elderly per 100 working-age population – was 14.8. This represents a huge increase from 6.7 in 1970. The speed and magnitude of the ageing trend remains a serious threat to the sustainable development of China. However, the EDRs exhibit wide and unusual spatial variations within the nation. In this study, based on a decomposition analysis, the spatial pattern of the EDRs across 31 provinces in China in 2000 and 2010 are investigated. The analyses attributed the change in the EDRs to four factors: working-age migration, mortality of the population aged 5–54, population momentum, and growth of the elderly population. It is found that the impacts of internal migration offset or even reverse the regional differentials in fertility and mortality, leading to an unusual ageing pattern in China. More developed provinces attracted young workers, which reduced the EDRs despite persistent low fertility; whereas the less developed provinces saw young workers outflow, increasing the EDRs despite the relatively high fertility rate. To some extent, it could be said that some provinces are 'growing old before growing rich', while other provinces are growing rich without growing old. [ABSTRACT FROM AUTHOR]

Over the past few decades, the level of divorce, measured by the crude divorce rate (CDR), has increased dramatically in both the East and the West, but has recently appeared to fall or level off in some countries. To investigate whether the recent decline or stabilisation of the CDRs reflects the real trends in divorce risk, a decomposition analysis was conducted on the changes in the CDRs over the past 20 years on two western and three East Asian countries, namely, the UK, Australia, Taiwan, South Korea, and Singapore. The following is observed: the decline in the CDRs of the UK and Australia in the 1990s, and of Taiwan and Korea in the 2000s, was mainly due to shrinkage in the proportion of the married population rather than any reduction in divorce risk; only Australia experienced a genuine reduction in divorce risk between 2001 and 2011; and the continuous increase of Singapore’s divorce level between 1990 and 2010 may be is an unintentional effect of the government’s marriage promotion policies. The shift in the population age structure, and more importantly, the drastic decline in marriage, has seriously distorted the CDRs, making them unreliable indicators for monitoring divorce trends. [ABSTRACT FROM AUTHOR]

A country’s total fertility rate (TFR) depends on many factors. Attributing changes in TFR to changes of policy is difficult, as they could easily be correlated with changes in the unmeasured drivers of TFR. A case in point is Australia where both pronatalist effort and TFR increased in lock step from 2001 to 2008 and then decreased. The global financial crisis or other unobserved confounders might explain both the reducing TFR and pronatalist incentives after 2008. Therefore, it is difficult to estimate causal effects of policy using econometric techniques. The aim of this study is to instead look at the structure of the population to identify which subgroups most influence TFR. Specifically, we build a stochastic model relating TFR to the fertility rates of various subgroups and calculate elasticity of TFR with respect to each rate. For each subgroup, the ratio of its elasticity to its group size is used to evaluate the subgroup’s potential cost effectiveness as a pronatalist target. In addition, we measure the historical stability of group fertility rates, which measures propensity to change. Groups with a high effectiveness ratio and also high propensity to change are natural policy targets. We applied this new method to Australian data on fertility rates broken down by parity, age and marital status. The results show that targeting parity 3+ is more cost-effective than lower parities. This study contributes to the literature on pronatalist policies by investigating the targeting of policies, and generates important implications for formulating cost-effective policies. [ABSTRACT FROM AUTHOR]

In recent years, various pro-natalist policies have been adopted in Singapore and other high-income Asian countries with low fertility, aiming at raising fertility rates. Previous studies were mainly focused on the impact or outcome of the policies. This paper, however, aims to identify the most influential groups in determining Singapore's total fertility rate (TFR) and evaluate the targeting of pro-natalist measures adopted by the government. We first reveal the changing age-parity-and-marital-status composition of women at childbearing age, and further conduct an elasticity analysis to assess the roles of different subgroups of women in changing the TFR. Our results show that compared to other groups, the 20–29-year-old single women and the married childless women aged 30–34 (‘married’ throughout this paper includes women who are or have been married) are more influential in determining the TFR and should be the potential pro-natalist target groups. However, Singapore's pro-natalist policies are more in favour of third and higher-order births. Such mismatch indicates that, if more efforts are devoted to facilitating marriage and first births in these potential groups, the TFR may be increased effectively. In order to achieve a long-term and significant fertility reversal, it calls for a long-term and integrated policy package. [ABSTRACT FROM PUBLISHER]

The total fertility rate (TFR) of Taiwan has remained below the replacement level 2.1 for past thirty years. Currently, 16 of its 22 counties and cities have TFRs below 1.3, with TFRs in middle and southern Taiwan even below 1. In the recent decade, various pronatalist policies have been adopted in Taiwan to cope with the low fertility issue. However, little is known about the effectiveness of these policies. In order to identify the group(s) of women that should be targeted to increase the TFR effectively, we have constructed a stochastic model to perform an elasticity analysis. The results show that changes in marriage rates among women aged 25–29 years would have the largest impact on the TFR, with an elasticity value of 0.32. This means that every 1 per cent increase in the marriage rate of women aged 25–29 may increase the TFR by about 0.32 per cent (i.e. an increase of about 2.6 children per 1000 women). The TFR is also very sensitive in responding to changes in the marriage rate and parity-1 fertility rate of 30–34-year-old women, with elasticities of 0.19 and 0.16 respectively. The divorce rate has a small but negative impact on the TFR. Also, the possible contribution of third- and higher-order births is insignificant. These findings suggest that policies aimed at increasing the marriage rate among women in their late twenties and early thirties, and supporting first births of women in their early thirties, are likely to raise Taiwan’s fertility rate effectively. [ABSTRACT FROM AUTHOR]

In the past 20 years, Hong Kong and Shanghai's total fertility rates (TFR) have undergone drastic changes: first declining and then rebounding. We use a decomposition method to assess changes in the TFRs of these two cities during the period 1990–2010. During the period of decline from 1990 to 2000, the decrease in marital fertility rate (MFR) was the major cause behind Shanghai's TFR decline; the decrease in nuptiality and MFR were equally responsible for the decline in Hong Kong's TFR. During the 2000–2010 period, although the decline in nuptiality exerted downward pressure on TFR, both cities experienced an increase in TFR mainly due to an increase in the MFR. Analysis of the difference in TFR between the two cities in 2010/2011, also reveals that Hong Kong's marriage delay has a negative impact on fertility and it is the higher MFR that leads to a higher TFR than Shanghai's TFR. It also shows that a reduction of first- and second-order births is equally responsible for Shanghai's lower MFR. Despite the one-child policy in Shanghai, some couples continue to postpone their first births, while others have even chosen to be childfree (a preferred term to ‘childless’). The tempo distortion is diminishing more prominently in Hong Kong, while the decline in fertility aspiration adds much uncertainty to future fertility trends in Shanghai. [ABSTRACT FROM PUBLISHER]

The PANI/Au0 nanocomposite films were successfully prepared on glassy carbon electrode (GCE) using a simple alternate adsorption of water soluble polyaniline (PANI) and ${{\rm AuCl}{{- \hfill \atop 4\hfill}}}$. The growth of the films was monitored by UVVis spectroscopy and cyclic voltammetry. ${{\rm AuCl}{{- \hfill \atop 4\hfill}}}$ was in-situ reduced in the film due to the redox interaction between PANI and ${{\rm AuCl}{{- \hfill \atop 4\hfill}}}$, without extra reductant. The ultrafine Au nanoparticles with the size of 2-4 nm were observed by transmission electron spectroscopy. The existence of zero-valence Au nanocrystals (Au0) was confirmed by X-ray photoelectron spectroscopy, X-ray Diffraction and FTIR. PANI in the nano-structured PANI/Au0 composite films displayed a good redox activity in neutral pH solution. The as-obtained PANI/Au0/GCE presents an excellent electrocatalytic activity to hydrazine oxidation, and the mechanism of hydrazine oxidation was studied. The calibration curve on (PANI/Au0)5/GCE was obtained in the concentration range of 0.01-6 mM with the detection limit of 1 µM ( S/ N>3). The modified electrode has a great potential for hydrazine sensor application due to its ease of fabrication, good reproducibility and high stability. [ABSTRACT FROM AUTHOR]

ZnO nanofibers (ZnO NFs) were fabricated by electrospinning a dimethylformamide solution of zinc acetate containing polyvinylpyrrolidone and polymethylmethacrylate binary polymer matrix, followed by calcination. The obtained ZnO NFs are composed of close-packed ZnO nanoparticles of ca.20 nm in diameter. With Nafion acting as adhesive, the ZnO NF coated glassy carbon electrode (ZnO NF/GCE) has been prepared and applied as a new sensing platform for heavy metal determination with square wave stripping voltammetry. The high surface area and the strong affinity to cadmium (Cd) render the ZnO NF/GCE sensitive to Cd ion measurement. The experiment parameters were optimized by the design of orthogonal experiment. Under the optimal conditions, the current response exhibits a good linear relationship with the concentration of Cd(II) ranging from 4.8 × 10 −9 to 1.3 × 10 −6 mol L −1 ,with the detection limit of 1.8 × 10 −9 mol L −1 (S/N > 3). The developed sensor has been successfully applied for the determination of Cd(II) in water sample. The simultaneous analysis of Cd(II), Pb(II), Cu(II) and Hg(II) has been demonstrated to be feasible. [ABSTRACT FROM AUTHOR]

Background: China has experienced dramatic social changes in the last three decades. This study aimed to investigate socio-economic factors related to suicide rates in China from 1990 to 2015, and examine how the impacts of these factors on suicide rates changed over time., Methods: Suicide rates in 31 provinces in mainland China between 1990 and 2015 were obtained from the Global Burden of Disease (GBD) Study 2019. Temporal-spatial modelling was applied to assess the effects of GDP per capita, urbanization, migration, employment, divorce, proportions of children and older adults on provincial overall, male and female suicide rates., Findings: The overall suicide rate in China declined from 18·1 /100,000 in 1990 to 8·6 /100,000 in 2015, with considerable spatial variation in the magnitude of decline across provinces. The protective effects of increasing in GDP per capita, and urbanization, on provincial suicide rate were strong in 1990 (log GDP: -3·56 [95% CI: -6·15, -0·96], urbanisation: -0·07 [-0·14, -0·01]), however these effects were negligible by 2015. The association between employment and suicide rates has shifted from positive to negative over the study period, while migration remained a constant risk factor for high suicide rates (0·04 [0.00, 0·09])., Interpretation: This study highlighted the dynamic effects of economic and social factors on suicide rates in the context of transforming China. To maintain further reductions in suicide rates cannot rely simply on improving people's materialistic and economic conditions. A more holistic approach to improve overall population well-being is needed., Funding: Humanities and Social Sciences Prestigious Fellowship (37000320) and the General Research Fund (17611619) at the University of Hong Kong., Competing Interests: The authors declare that there are no competing interests., (© 2021 The Author(s).)

Background: During the coronavirus disease 2019 (COVID-19) epidemic, tumor patients and their families might suffer from greater psychological stress as a result of anxiety or other psychological disorders. We conducted an online study during the epidemic to explore the mental state of tumor patients and their families during this extraordinary time., Methods: A cross-sectional survey was carried out. Questionnaires were distributed through the WeChat "Questionnaire Star" network. The snowball sampling technique was adopted and further promoted by subjects who had completed the questionnaire., Results: A total of 1,030 valid questionnaires were collected. There were 609 (59.13%) tumor patients and 421 (40.87%) family members. One hundred and fifty-six (15.15%) subjects had anxiety, among which 65 (6.31%) had moderate to severe anxiety. Single-factor analysis indicated that age (>60 years old), the farmer occupation, and a high sleep disorder assessment score were risk factors for anxiety, while the latter two might also be independent risk factors, as suggested by multi-factor analysis. Infrequent contact with doctors was an independent risk factor for cancer patients, while uninterrupted anti-tumor therapy was an independent protective factor. 40.19% of the subjects expressed a need for psychosocial support during the COVID-19 period., Conclusions: The COVID-19 outbreak resulted in tumor patients and their relatives experiencing greater psychological pressure than usual, and patients were more worried about anti-tumor treatment and disease progression impacted by the epidemic. Both groups had a significant need for psychosocial help.

Background: Life expectancy and life disparity are 2 useful indicators to assess the health condition of a society. Both Hong Kong and Japan have one of the longest life expectancies in the world. Recently, Hong Kong has overtaken Japan and topped the life expectancy rankings. However, whether Hong Kong has also outperformed Japan in life disparity is still unknown., Methods: Decomposition analyses have been conducted to evaluate age-specific contributions to the changes in life expectancy and life disparity for each of the populations. Furthermore, the differences between the 2 populations were examined over the period 1977-2016., Results: Reduction in mortality of the adult and the old age groups contributes most to the increase in life expectancy for the study period. Hong Kong has a higher life disparity than Japan, and due to the great improvement in reducing premature deaths, the Hong Kong-Japan gap has been narrowing. However, in recent years, further reduction in mortality of the oldest elderly in Hong Kong has actually contributed to the increase in its disparity, thus widening its gap with Japan again., Conclusion: Increasing dominant influence of "saving lives at late ages" is very likely to cause the reemergence of increasing life disparity in these 2 long-lived populations., (© 2021 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

The decline in Avoidable Mortality (AM) and increase in life expectancy in Shanghai is impressive. Gusmano and colleagues suggested that Shanghai's improved health system has contributed significantly to this decline in AM. However, when compared to other global cities, Shanghai's life expectancy at birth is improving as London and New York City, but has yet to surpass that of Hong Kong, Tokyo, and Paris. Over the past decade, the reduction in AM of Shanghai is just in line with the international experience in reducing avoidable premature deaths. We suggest that a more elaborate research design is needed to examine the impact of the improvement in Shanghai's health system on its population health status., (© 2015 by Kerman University of Medical Sciences.)