球囊仿生助产术在产科的临床价值

目的观察分析球囊仿生助产术在产科中的临床价值。方法选取本院(在2018年1月—2019年2月)收治的260例产妇,按照不同助产处理方法分为实验组(130例,实施球囊仿生助产术)和对照组(130例,实施常规助产术)。采用统计学分析两组产妇的顺产率、总产程时间(第一产程时间、第二产程时间)、平均产后出血量、并发症(会阴血肿、尿潴留)发生率以及新生儿窒息率。结果实验组产妇顺产率高于对照组(P<0.05),实验组新生儿窒息率低于对照组(P<0.05),实验组产妇的总产程时间短于对照组(P<0.05),实验组产妇平均产后出血量少于对照组(P<0.05),实验组产妇并发症(会阴血肿、尿潴留)发生率低于对照组(P<0.05)。结论球囊仿生助产术在产科中的临床价值显著。     

痛风患者的健康素养：一项关于东北地区中青年患者的质性研究

背景　痛风是一种代谢性疾病，可以并发肾、心脑血管等多器官疾病，目前痛风发病和预后的影响因素已经得到揭示，但鲜有通过质性研究方法全面评估痛风患者的疾病认知和健康素养状态。目的　探讨东北地区中青年痛风患者的健康素养，并了解痛风患者的一般感知能力及知识需求状况，为增强我国痛风患者的健康素养水平，改善其自身管理能力、提高痛风患者的生活质量提供理论依据。方法　招募2017年3月-2018年3月于大庆油田总医院、大庆市人民医院、大庆市第五医院3家医院确诊为痛风的中青年患者，信息饱和后停止招募，共招募13例患者。采用非结构式与半结构式访谈相结合的方式对患者资料进行收集，采用Colaizzi的现象学资料分析方法进行分析。结果　对访谈资料进行分析，提炼如下主题：痛风患者的疾病感知能力〔包括对痛风的认知及知晓情况较差；严重的疼痛可影响痛风患者的生活质量；自我感知导致疾病发作或加重的原因为饮食习惯及生活方式等〕、就诊状况及行为（包括首次发病对疾病认识缺乏；就医体验不良）、痛风药物管理计划（包括药物选择依从性低、治疗方案的知晓及应对差）、痛风非药物管理计划（包括生活方式的调整、社会资源互动、疾病信息挖掘）。结论　东北地区中青年痛风患者健康素养水平较低，对疾病相关信息获取途径单一，对疾病和治疗判断片面，因此不能有效进行疾病管理，阻碍医疗决策制定。提示根据需求状况、针对具体薄弱环节提升痛风患者的健康素养、提高知识水平对改善患者健康结局很有必要。     

Digital Social and Emotional Literacy Intervention for Vulnerable Children in Brazil: Participants’ Experiences

Social emotional literacy (SEL) interventions are widely implemented through schools, with growing evidence for a range of positive child outcomes. Increasingly, such interventions are delivered on online platforms. To date, there is limited evidence about digital SEL interventions in low- and middle-income countries (LMIC). The aim of this study was to explore the perceptions and experiences of children, parents and facilitator of the potential value of addressing SEL via tailored digital intervention. The intervention was designed to help children, in Brazil, to cope during the first COVID-19 pandemic lockdown. The intervention was delivered via a digital platform to groups of three children for 45 min per week for nine. Thirteen children, nine parents and nine facilitators were interviewed following the completion of the intervention. The data was analysed through a codebook thematic approach, which led to three themes: empowerment, participatory aspects of the intervention and digital adaptation. Overall, children’s SEL development was reported to be supported during the COVID-19 pandemic, by the application of new skills outside the sessions. Children reported a number of empowering factors such as being heard and belonging. A range of useful participatory tools were identified including storytelling, games, drawings and videos. Blended SEL interventions involving both face-to-face and web-based facilitation could be developed within a tiered model of universal mental health promotion and targeted prevention. Access to online platforms would increase reach to large numbers of children in LMIC, especially in contexts of disadvantage.     

新产程模式下剖宫产和产钳术对持续性枕后位难产孕妇分娩结局的评估

目的：探索新产程模式下剖宫产和产钳术对持续性枕后位难产孕妇分娩结局的评估。方法:收集2017年至2020年间于浙江省湖州市妇幼保健院收住入院的103例持续性枕后位难产孕妇, 其中以产钳分娩的60例孕妇为研究组，53例以剖宫产术分娩的孕妇为对照组，评估其分娩结局，分析两种分娩方式对孕产妇的影响。采用χ2 检验比较剖宫产及产钳分娩两组的新生儿窒息、产后出血、产时、产后感染、软产道裂伤（包括会阴III度裂伤、阴道裂伤、宫颈裂伤）、切口预后不良的差异。结果：研究组产后出血、产时发热、产后发热发生率[分别为1.66%（1/60）、1.66%（1/60）、3.33%(2/60），χ2 值分别为（4.514 和5.698、4.826，P值分别为 0.040 和 0.020、0.030）]，明显低于对照组[分别为11.32%（6/53）、13.20%（7/53）、15.09%(8/53）]，但是研究组会阴III度裂伤、宫颈裂伤、阴道裂伤、发生率为分别为[15.00%（9/60）、13.33%（8/60））、（11.66%（7/60）），明显高于对照组（1.88%（1/53）、1.88%（1/53）、3.77%（2/53））]，差异有统计学意义（P值均＜0.05）。但研究组的新生儿窒息发生率及切口预后不良的比例分别为[5（8.33%）、4（6.66%）]，略低于对照组[（6（11.32%）、4（7.54%）]，差异无统计学意义（χ2值分别为0.286、0.233，P 值均＞0.05）。结论：新产程标准下持续性枕后位难产孕妇选择产钳分娩可明显降低产时、产后感染及产后出血的发生率，但软产道裂伤发生率较高，差异有统计学意义。所以持续性枕后位难产孕妇选择产钳分娩是相对比较安全的分娩方式，但同时需要注意软产道裂伤的发生。     

Readability of Patient Educational Materials in Hip and Knee Arthroplasty: Has a Decade Made a Difference?

BackgroundThe Internet has become an increasingly popular resource among orthopedic patients for health education. Numerous organisations recommend that patient educational materials (PEMs) should not exceed the 6^th grade reading level. Despite this, studies have repeatedly shown the reading grade level (RGL) of PEMs to be too advanced across a range of surgical specialties. We aimed to determine the readability of online hip and knee arthroplasty PEMs.MethodsThe readability of 134 articles pertaining to hip and knee arthroplasty from 5leading worldwide healthcare websites were assessed, using 8 readability formulae; the Flesch-Kincaid Reading Grade Level, the Flesch Reading Ease Score, Raygor Estimate, SMOG, Coleman-Liau, Fry, FORCAST and Gunning Fog. The mean RGL was compared to the 6^th and 8^thgrade reading level. The mean RGL of each website was also compared.ResultsThe mean cumulative RGL was 12 (range = 7-16.1). No articles (0%) were written at a 6^th grade reading level and only 4 articles (3%) were written at or below the 8^th grade reading level. The mean RGL was significantly higher than the 6^th (95% CI, 5.62-6.30; P < .0001) and 8^th grade reading level (95% CI, 3.63-4.30; P < .0001). There was a significant difference between the RGLs of the 5websites (P = .001).ConclusionArthroplasty PEMs produced by leading worldwide healthcare organisations have readability scores that are above the recommended levels. Given the imperative role of health literacy in patient outcomes and satisfaction, and the increasing prevalence of Internet use among orthopedic patients, a substantial amount of work needs to be done to improve the readability of these materials.     

Trial of Labor After Cesarean in Adolescents – A Multicenter Study

Study ObjectiveData regarding trial of labor after cesarean delivery (TOLAC) among young women are limited. The aim of this study was to assess the TOLAC success rate and its related factors among adolescent women who had never delivered vaginally.DesignA multicenter retrospective cohort study of all adolescent women aged ≤21 years with a history of 1 previous cesarean delivery, who delivered in 2 tertiary medical centers during 2007-2019. Women were allocated to 2 groups: 1) women who underwent TOLAC, and 2) women who had a repeat cesarean delivery with no trial of labor. Maternal and neonatal outcomes were compared between the two groups. In addition, perinatal outcomes were compared between women with successful and unsuccessful TOLAC.ResultsThe study cohort included 167 women who had a previous caesarean delivery; 117 underwent TOLAC and 50 underwent a repeat cesarean delivery with no trial of labor. Neonatal birthweight (median 2937 vs 3170 g, P = .03) and gestational age at delivery (median 38 weeks vs 39, P = .009) were lower in the repeat cesarean group as compared to those undergoing TOLAC. Overall, 97 of 117 participants (83%) had a successful TOLAC. Failed TOLAC was associated low birthweight as compared to successful TOLAC (5 [25%] vs 7 [7%], odds ratio [OR] 4.3, 95% confidence interval [CI] 1.2-15.3, P = .02), and birthweight difference between current and previous deliveries was higher in the failed TOLAC group (median 315 vs 197 g, P = .04). Rates of neonatal Apgar score at 1 minute < 7 and of neonatal intensive care unit admission were higher in the TOLAC failure group (4 [20%] vs 5 [5%], OR 4.6, 95% CI 1.1-19.0, P = .03, and 4 [20%] vs 4 [4%], OR 5.8, 95% CI 1.3-25.6, P = .02), respectively). In a multivariable logistic regression analysis, only low birthweight was independently associated with TOLAC failure (adjusted OR 9.9, 95% CI 2.1-45.4, P = .003). Two cases of uterine rupture occurred in the no trial of labor group, whereas none were encountered in participants undergoing TOLAC.ConclusionsTOLAC in adolescent women who had never delivered vaginally is associated with a relatively high success rate.     

经皮电刺激联合导乐镇痛对分娩结局的影响及安全性分析

目的 探讨经皮电刺激联合导乐分娩镇痛对分娩结局的影响及安全性。方法 选择160例在我院住院待产的产妇作为研究对象,随机将其分为观察组与对照组,每组各80例;其中对照组予导乐分娩镇痛,观察组给予经皮电刺激联合导乐分娩镇痛。观察比较两组的VAS评分、产程时间、产后出血、剖宫产率、产妇满意度、新生儿情况、不良反应发生情况等。结果 与镇痛前比较,观察组镇痛后各时间段VAS评分降低,P＜0.05;与对照组比较,观察组的产后2 h出血量、剖宫产率降低,产妇满意度提高,P＜0.05。结论 经皮电刺激联合导乐镇痛可减轻产妇痛苦,降低剖宫产率,减少产后出血,提高产妇满意度,且无明显不良反应,值得在临床上推广应用。