Objectives Assistive reproductive therapies can help those who have difficulty conceiving but different forms of assistive reproductive therapies are associated with different treatment characteristics. We undertook a large, multinational discrete choice experiment to understand patient preferences for assistive reproductive therapies. Methods We administered an online discrete choice experiment with persons who had experience with subfertility or assistive reproductive therapies in the USA, UK, the Nordic region (Denmark, Norway, Sweden, Finland), Spain, and China. Attributes encouraged trade-offs between effectiveness, risk of adverse effects, treatment (dis)comfort, (in)convenience, cost per cycle and shared decision making. We used multinomial logit and mixed-logit models to estimate preferences and attribute importance by country/region, and estimated willingness to pay for changes in attribute levels. Results A total of 7565 respondents participated. Mixed logit had a better fit than multinomial logit across all samples. Preferences moved in expected directions across all samples, but the relative importance of attributes differed between countries. Willingness to pay was greatest for improvements in effectiveness and a greater degree of shared decision making, and we observe a substantial 'option value' independent of treatment characteristics. Unexpectedly, preferences over cost were insignificant in the Chinese sample, limiting the use of willingness to pay in this sample. Conclusions Respondents balanced concerns for effectiveness with other considerations, including the cost and (dis)comfort of treatment, and the degree of shared decision making, but there is also substantial option value independent of treatment characteristics, demonstrating value of assistive reproductive therapies to individuals with experience of subfertility. We hypothesise that price insensitivity in the Chinese sample may reflect a degree of social desirability bias.

Background Globally, it is becoming more common for pregnant women to deliver by caesarean section (CS). In 2020, 31% of births in England were CS, surpassing the recommended prevalence of CS. Concerns have been raised regarding potential unknown consequences of this mode of delivery. Childhood adiposity is also an increasing concern. Previous research provides inconsistent conclusions on the association between CS and childhood adiposity. More studies are needed to investigate the consequences of CS in different populations and ethnicities. Therefore, this study investigates the association between mode of delivery and BMI, in children of 4–5 years and if this differs between White British (WB) and Pakistani ethnicities, in Bradford UK. Methods Data were obtained from the Born in Bradford (BiB) cohort, which recruited pregnant women at the Bradford Royal Infirmary, between 2007 and 2010. For these analyses, a sub-sample (n = 6410) of the BiB cohort (n = 13,858) was used. Linear regression models determined the association between mode of delivery (vaginal or CS) and BMI z-scores at 4–5 years. Children were categorised as underweight/healthy weight, overweight and obese, and logistic regression models determined the odds of adiposity. Effect modification by ethnicity was also explored. Results Multivariable analysis found no evidence for a difference in BMI z-score between children of CS and vaginal delivery (0.005 kg/m2, 95% CI = − 0.062–0.072, p = 0.88). Neither was there evidence of CS affecting the odds of being overweight (OR = 1.05, 95% CI = 0.86–1.28, p = 0.65), or obese (OR = 0.98, 95% CI = 0.74–1.29, p = 0.87). There was no evidence that ethnicity was an effect modifier of these associations (p = 0.97). Conclusion Having CS, compared to a vaginal delivery, was not associated with greater adiposity in children of 4–5 years in this population. Concerns over CS increasing adiposity in children are not supported by the findings reported here using the BiB study population, of both WB and Pakistani families.

ObjectivesTo understand attitudes towards infertility and willingness to pay (WTP) towards a publicly funded national assistive reproductive therapies (ART) programme.DesignAttitudes survey with dichotomous and open-ended WTP questions.SettingOnline survey administered in the USA, UK, Norway, Sweden, Finland, Denmark and China.Participants7945 respondents, analysed by country. Nordic respondents were pooled into a regionally representative sample.Primary and secondary outcome measuresPrimary outcome measures were proportion of sample agreeing with different infertility-related and ART-related value statements and supporting a monthly contribution to fund a national ART programme, expressed in local currency. Secondary outcome measure was maximum WTP.ResultsAcross the nationally representative samples, 75.5% of all respondents agreed with infertility as a medical condition and 82.3% and 83.7% with ART eligibility for anyone who has difficulty having a baby or a medical problem preventing them from having a baby, respectively. 56.4% of respondents supported a defined monthly contribution and 73.9% supported at least some additional contribution to fund a national ART programme. Overall, converting to euros, median maximum WTP was €3.00 and mean was €15.47 (95% CI 14.23 to 16.72) per month. Maximum WTP was highest in China and the USA and lowest in the European samples.ConclusionsThis large, multicountry survey extends our understanding of public attitudes towards infertility and fertility treatment beyond Europe. It finds evidence that a majority of the public in all sampled countries/regions views infertility as a treatable medical condition and supports the idea that all infertile individuals should have access to treatments that improve the chance of conception. There was also strong agreement with the idea that the desire for children is a basic human need. WTP questions showed that a majority of respondents supported a monthly contribution to fund a national ART programme, although there is some evidence of an acquiescence bias that may overstate support among specific samples.

relationship, and patients with higher body mass index (BMI), obese or overweight, have improved survival. BMI is the ratio between the weight in kilograms and the height in meters squared and is commonly used as surrogate for body composition. Using the BMI, obesity is defined as a BMI 30 Kg/m 2 , of overweight as a BMI between 25 and 29,9 Kg/m 2 , normal weight as a BMI from 18,5 to 24,9 Kg/m 2 and underweight below 18,5 Kg/m 2 . The objective of this study was to analyze the BMI of the patients with Non-Small Cell Lung Cancer (NSCLC) and to investigate its impact on overall survival. Methods: We conducted a retrospective analysis of patients diagnosed with metastatic non-small cell lung cancer diagnosed between 2000 and 2019, at AC Camargo Cancer Center, Brazil. Demographics, clinical-pathological characteristics, treatment patterns and outcomes data were obtained from electronic medical records. We collected weight and height information to calculate the BMI. Other variables such as ECOG, Charlson's comorbidity score, histological subtype, smoking load and number of metastasis were also analyzed. Overall survival was defined as the time between diagnosis and death by any cause. We used descriptive statistics to characterize the study population. Association between BMI and other variables was tested with Pearson's Chi-Squared or Fisher's exact tests. The Kaplan-Meyer method was used to estimate survival. Impact of BMI on survival was calculated with Cox regression method. P-values <0.05 were considered statistically significant. Results: We analyzed data from 456 patients with metastatic NSCLC. About 52,9% were men, 73,9% were white, 21,9% were smokers, 42,1% were former smokers and 32,2% non-smokers. Most of the patients had adenocarcinoma (78,5%). 63,2% of patients had 2 sites of metastasis. Median Charlson's score was 8 and 46,7% had ECOG 1. Median BMI was 24,3 kg/m2 (13,0-50,8). Patients were dichotomized into two groups based on the median BMI: <24,3 (89,7%) and 24,3 (10,3%). At a median follow up of 41,5 months, the median overall survival of the group who had lower BMI was 15,8 months versus 24,3 months in the group with higher BMI (HR¼1,56; 95% IC 1,0-2,3; P-value¼0,034). Conclusion: According to our data, there is an inverse relation between BMI and risk of death in patients with metastatic NSCLC. Patients who had lower BMI had a worse overall survival. BMI is associated with survival and should be considered as a prognostic factor in patients with lung cancer.

Background Globally, it is becoming more common for pregnant women to deliver by caesarean section (CS). In 2012, 21% of births in the UK were CS, surpassing the recommended prevalence of 15%. Concerns have been raised regarding potential unknown consequences of this mode of delivery.Childhood adiposity is also an increasing concern. Previous research provides inconsistent conclusions on the association between CS and childhood adiposity. More studies are needed to investigate the consequences of CS in different populations and ethnicities. Therefore, this study investigates the association between mode of delivery and BMI, in children of 4-5 years and if this differs between White British (WB) and Pakistani ethnicities, in Bradford UK.Methods Data were obtained from the Born in Bradford (BiB) cohort, which recruited pregnant women at the Bradford Royal Infirmary, between 2007-2010. For these analyses, a sub-sample (n=6410) of the BiB cohort (n=13858) was used. Linear regression models determined the association between mode of delivery (vaginal or CS) and BMI z-scores at 4-5 years. Children were categorised as underweight/healthy weight, overweight and obese, and logistic regression models determined the odds of adiposity. Effect modification by ethnicity was also explored.Results Multivariable analysis found no evidence for a difference in BMI z-score between children of CS and vaginal delivery (0.005 kg/m2, 95% CI= -0.062–0.072, p=0.88). Neither was there evidence of CS affecting the odds of being overweight (OR=1.05, 95% CI=0.86–1.28, p=0.65), or obese (OR=0.98, 95% CI=0.74–1.29, p=0.87). There was no evidence that ethnicity was an effect modifier of these associations (p=0.97). Conclusion Having CS, compared to a vaginal delivery, was not associated with greater adiposity in children of 4-5 years in this population. Concerns over CS increasing adiposity in children are not supported by the findings reported here using the BiB study population, of both WB and Pakistani families.