The development and psychometric evaluation of the Perceptions of Empowerment in Midwifery Scale

Objective

to develop and psychometrically evaluate a scale to measure midwives’ perceptions of their levels of empowerment.

Design

a cross-sectional postal survey, carried out in May 2005.

Participants

a random sample of midwives practising in Ireland (n=244).

Measurement and findings

the Perceptions of Empowerment in Midwifery Scale (PEMS) was developed and psychometrically evaluated in this study. Exploratory factor analysis was performed on the scale, using Principal Axis Factoring with an oblique (Direct Oblimin) rotation. This suggested three sub-scales: autonomous practice; effective management and women-centred practice. The scale was found to be a valid and reliable instrument.

Key conclusions

the PEMS is an appropriate tool to measure midwives’ perceptions of their levels of empowerment.

Implications for practice

within the current context of change in Irish midwifery, this research facilitates the articulation and measurement of the conditions that facilitate empowerment in midwifery, which can assist in enhancing the midwifery contribution to maternity care.     

重组早孕因子(EPF)的表达、纯化及鉴定

目的:获取大量具有良好生物活性的早孕因子(EPF)重组蛋白。方法:从HeLa细胞中提取总RNA,采用RT-PCR的方法扩增EPF cDNA,将该cDNA插入载体pGEX-5X-1,获得重组表达质粒pGEX-5X-1/EPF,将重组表达质粒pGEX-5X-1/EPF转化大肠杆菌BL21后通过IPTG进行诱导表达,然后用谷胱甘肽-琼脂糖球珠亲和层析方法,分离纯化得到纯重组GST-EPF融合蛋白(rEPF)。再用Xa酶切GST,得到纯化的EPF重组蛋白。用SDS-PAGE鉴定其纯度,用Western blotting鉴定其特异性,用玫瑰花环抑制试验(RIT)检测其生物学活性。结果:HeLa细胞总RNA中有效扩增出EPF cDNA。EPF cDNA以正确的阅读框架插入表达载体pGEX-5X-1,经IPTG诱导后高效表达EPF重组蛋白。Western blotting表明其与抗EPF抗体有特异性结合,RIT检测结果显示目的蛋白具有良好的EPF生物学特性。结论:成功构建了EPF的原核表达载体,并纯化获得了具有生物学特性的重组蛋白,为进一步开展EPF蛋白的相关研究奠定了基础。     

辅助生殖技术(ART)助孕获得多胎妊娠行减胎术后妊娠结局观察

目的:探讨辅助生殖技术(ART)获得的多胎妊娠孕早期行经阴道减胎术的有效性和安全性。方法:以经ART助孕获得多胎妊娠行经阴道减胎术的患者123例为减胎组,根据减胎后保留的胎儿数分为双胎组(A组,n=90)和单胎组(B组,n=33)。另以同期经ART助孕获得单胎妊娠(C组,n=36)和双胎妊娠(D组,n=57)的患者为对照组。回顾性分析患者的妊娠结局及妊娠期并发症发生情况。结果:减胎组的减胎成功率为100.0%,妊娠成功率为91.9%。A组胎膜早破发生率、早产发生率、新生儿低出生体质量发生率、新生儿重症监护室(NICU)入住率均高于B组(P<0.05)。结论:多胎妊娠孕早期行经阴道减胎术安全、有效、可行。多胎妊娠实施减胎术中减为单胎更为安全。     

腹腔镜在治疗剖宫产后子宫瘢痕妊娠中的应用

目的:探讨腹腔镜在治疗剖宫产后子宫瘢痕妊娠(CSP)中的应用价值.方法:回顾分析2008年3月至2011年5月经腹腔镜诊治7例CSP患者的临床资料.结果:7例患者均腹腔镜下完成手术,治愈并保留子宫,手术成功率100％,平均手术时间85.7±17.2分钟,平均手术出血量202.9±270ml,无中转开腹.6例同时行瘢痕修补,术后血人绒毛膜促性腺激素(β-HCG)降至100 U/L以下时间平均14.6±5.2天,超声显示子宫恢复正常时间平均21.7±30.2天,1例未同时行瘢痕修补的患者,超声显示3个月后子宫恢复正常.结论:腹腔镜在明确CSP诊断的同时还能在阻断双侧子宫动脉后行妊娠物清除和瘢痕修补,是治疗CSP的理想方法.     

Translation and cross-cultural adaptation of the Pregnancy Physical Activity Questionnaire (PPAQ) into Spanish

Abstract

Aim: The objective of this study was to translate and transculturally adapt into Spanish the Pregnancy Physical Activity Questionnaire.

Methods: The translation procedure included a forward step (translation and synthesis) and a quantitative and qualitative control of the usefulness of the Pregnancy Physical Activity Questionnaire. Afterwards, a prefinal version of the Spanish adapted questionnaire was pretested on 58 pregnant women from Granada (south of Spain). The content, semantic, technical, conceptual, and experiential equivalents of cultural adaptation were discussed by the research members at each step.

Results: After the pre-test, two items of the original Pregnancy Physical Activity Questionnaire were replaced by new items that the team considered more culturally appropriate for Spanish pregnant women. Also, some rewording into the European metric system. The response time ranged from 5 to 15?minutes. These changes were well understood and worked properly in the final version. A final version of the Pregnancy Physical Activity Questionnaire was agreed on after a discussion among the research members about the results obtained in the prefinal version.

Conclusion: The final Spanish version of the Pregnancy Physical Activity Questionnaire has showed cross-cultural equivalence with the original English version.     

The Well-being of Women in the Post-menopausal Years

Objective: to evaluate the well-being of post-menopausal women and to determine whether certain factors may have a positive, negative or neutral influence on well-being in this sector of the population.Design: a survey of public attitude.Setting: the general post-menopausal population of Canada.Participants: twenty-eight physicians and two nurse directors of health clinics in various parts of Canada agreed to give the questionnaire to interested post-menopausal patients. A total of 2,000 stamped, self-addressed surveys were sent to these physicians and nurses with the request to distribute the questionnaires, between July 1994 and March 1995. Four hundred and thirty-four individuals subsequently returned a completed questionnaire.Main outcome measures: the subjective well-being (SWB) of post-menopausal women was assessed. Family history, medical history, therapeutic interventions economic status, social factors and philosophical perspectives were explored and analysed and related to well-being. Comments and demographic data were also solicited.Results: most post-menopausal women reported a high level of subjective well-being with 61.7 percent stating that they are happy and satisfied. Forty-six percent stated that their lives were close to their ideal and just over half (52%) reported feeling as happy as they were at a younger age. Various social economic, philosophical and medical factors appeared to influence SWB in this population, with logistic regression analysis indicating that the three most important factors were the degree of loneliness, the amount of stress and any difficult financial circumstances. Of the 47.7 Percent of respondents who had used or were using hormone replacement therapy (HRT), 84.3 Percent reported some or marked improvement in SWB following therapy. While the preferred source of information on menopausal issues was health care workers 49.7 Percent of respondents were not satisfied with the teaching on this topic received from their personal physicians.Conclusions: although most Canadian women report being content in the post-menopausal stage of life well-being appears to be associated with both medical and social events, with demographic factors and philosophical outlook. Social and familial factors are of at least as much importance to overall well-being as is actual physical health. Given the lack of satisfaction with the scope of teaching on menopausal issues, it is important that health care delivery to this population moves beyond symptomatology to addressing questions related to physical and social well-being.     

输卵管间质部妊娠临床特点变化分析

目的:分析近5年输卵管间质部妊娠的临床特点变化情况。方法:采用回顾性分析方法对90例输卵管间质部妊娠(间质部妊娠组)的临床特点进行分析,并选择同期收治的壶腹部妊娠组(120例)及峡部妊娠组(100例)患者的临床资料进行对照分析。结果:间质部妊娠组临床表现以阴道流血、伴或不伴腹痛为主要症状(60例,66.7%),无症状表现者14例(15.6%),出现单纯腹痛者(16例,17.8%),平均停经天数48.9±10.4天,为间质部妊娠组出现症状时,停经时间最短者。间质部妊娠组患者在停经8周内确诊59例(65.6%),8～12周内确诊27例(30.0%),与壶腹部妊娠组相比差异无统计学意义(P>0.05)。间质部妊娠组术前通过B超检查结合血β-HCG检测提示为间质部妊娠者37例(41.1%),血β-HCG在就诊时平均12579±9548U/L,明显高于壶腹部妊娠组(2132±567U/L)及峡部妊娠组(2079±607U/L),3组比较,差异有统计学意义(P<0.05)。结论:随着检测水平及检测手段的提高,输卵管间质部妊娠发现及诊断时间并不比其他类型的异位妊娠时间晚,输卵管间质部妊娠可以早期发现、早期诊断、早期治疗。     

神经激肽B及胎盘生长因子与妊娠期高血压疾病

妊娠期高血压疾病是常见的妊娠并发症,是孕产妇及嗣生儿死亡的主要原因之一。探讨其发病机制一直是产科领域研究的主要课题。胎盘滋养细胞可分泌胎盘生长因子（PLGF）和神经激肽B（NKB）,两者可能在滋养细胞浸润、胎盘血管重铸和血管舒缩调控等方面起一定作用。妊娠期高血压疾病患者胎盘PLGF水平显著降低而NKB水平明显升高,二者的异常变化可能是导致该疾病血管损伤、滋养细胞功能异常的原因之一。     

缺氧诱导因子与妊娠期肝内胆汁淤积症

缺氧诱导因子（HIF）是广泛存在于人类细胞并调节细胞内氧代谢的关键因子,受缺氧信号调控,参与缺氧诱导多种基因的转录,目前研究较多的是HIF-1和-2。HIF类与正常妊娠胎盘胚胎的发育相关,其缺失或表达异常导致异常妊娠。妊娠期肝内胆汁淤积症（ICP）胎儿多有急慢性缺氧,近年对HIF类在ICP患者胎盘中作用开始有研究。其在胎盘中表达调节对维持胎盘功能起一定代偿作用,与该疾病发生发展有关。     

Pregnancy outcome after treatment with etoposide (VP-16) for low-risk gestational trophoblastic tumor

The aim of this study was to evaluate subsequent fertility and pregnancy in patients treated for persistent trophoblastic tumors with single-agent VP-16. Records of all patients treated for persistent trophoblastic tumors at the Chiba University Hospital between January 1, 1986 and December 31, 1997 were reviewed. Of these, 85 patients were initially treated with single-agent VP-16. Subsequent pregnancy outcome of these patients was investigated. After remission with VP-16, 36 patients (92.3%) of those who wished for a pregnancy (45.9% of all patients studied) conceived, and 91.7% had at least one live birth. A total of 56 conceptions resulted in 42 (75.0%) term live births, seven (12.5%) first-trimester spontaneous abortions, one (1.8%) second-trimester spontaneous abortion, four (7.1%) therapeutic abortions, and two (3.6%) repeated moles. There were no congenital anomalies, no stillbirths, and the neonates' physical growth was comparable to that of the standard population in Japan. Single VP-16 regimen for patients with low-risk gestational trophoblastic tumor appears to have no adverse effects on fertility potential and pregnancy outcome.     

Issues in Pregnancy Dating: Revisiting the Evidence

As the end point date in pregnancy, the estimated date of delivery provides guidance for the timing of specific prenatal tests, gauges fetal growth, and informs critical decision making for specific obstetric complications. It is prudent to use the most evidenced‐based methods available to accurately determine gestational age. This article explores the accuracy of both menstrual and ultrasound dating techniques and discusses some of the issues and limitations for each method. In addition, a simple formula called the rule of eights can be used to determine a final estimated date of delivery when a discrepancy between menstrual and ultrasound dating occurs.     

使用GnRH-a超促排卵时卵泡发育数与妊娠相关血浆蛋白-A的关系

目的:探讨超排卵周期卵泡发育数与卵泡颗粒细胞妊娠相关血浆蛋白-A(PAPP-A)的关系。方法:根据取卵时卵泡发育数不同,将卵巢对超排卵药物的反应分为低反应型(卵泡数≤3个,A组,n=5)、中反应型(卵泡数4-13个,B组,n=20)和高反应型(卵泡数≥14个,B组,n=14)。采用RT-PCR法和ELISA法测定卵泡颗粒细胞PAPP-A mRNA的表达量及其蛋白含量。结果:A组PAPP-A mRNA表达量显著低于B、C组(分别为0.368±0.084、0.572±0.187、0.605±0.188,P<0.05和P<0.01)。A组与B、C组相比,PAPP-A蛋白含量减少,差异有显著性(分别为0.371±0.111mIU/ml、0.531±0.181mIU/ml、0.503±0.154mIU/ml,P<0.05)。结论:颗粒细胞中的PAPP-A含量可能影响超排卵周期卵泡发育数。     

Assessment and Management of Bleeding in the First Trimester of Pregnancy

Vaginal bleeding occurs in 15% to 25% of early pregnancies. While 50% of women who have vaginal bleeding in the first trimester of pregnancy will continue to have a viable pregnancy, the event creates significant anxiety for the woman and can be managed in a multitude of ways. The 3 main differential diagnoses associated with vaginal bleeding are spontaneous abortion, ectopic pregnancy, and gestational trophoblastic disease. This article reviews early pregnancy development, etiologies of vaginal bleeding in the first trimester, strategies for evaluation, and recognition and management of the main diagnostic considerations. Case study examples illustrating the complexity of the assessment and management of vaginal bleeding in early pregnancy are presented.     

Pregnancy during the use of levonorgestrel intrauterine system

OBJECTIVES: This study was undertaken to evaluate the pregnancy rate with the levonorgestrel intrauterine system (LNG IUS) and to analyze the outcome of pregnancies with the LNG IUS in situ in regular use. STUDY DESIGN: Questionnaires from 17,360 users of the LNG IUS were analyzed. With the consent of women reporting pregnancy during the use of the LNG IUS, related hospital records were reviewed concerning the pregnancies. RESULTS: Originally 132 pregnancies were reported. Medical records were reviewed from 108 of these women. In 64 pregnancies, conception occurred with the LNG IUS in situ. Thirty-three pregnancies were ectopic. The 5-year cumulative pregnancy rate per 100 users was 0.5 and the 5-year Pearl rate was 0.11. CONCLUSION: Pregnancy with the LNG IUS in situ is rare. Ectopic pregnancies constitute 53% of all pregnancies. Typical pregnancy symptoms occur during pregnancies with the LNG IUS. The importance to counsel about the risk of pregnancy before insertion is emphasized.     

Assessing physical symptoms during the postpartum period: reliability and validity of the primary health questionnaire somatic symptom subscale (PHQ-15)

Introduction: This study aimed at establishing the reliability and validity of the primary health questionnaire (PHQ-15) somatic symptom severity subscale for postpartum women.

Methods: Women (N?=?495) completed the PHQ-15 approximately 6 weeks postpartum during the baseline phase of a randomized controlled trial evaluating a writing intervention for postnatal health in England. Reliability was assessed using internal consistency statistics and convergent validity by comparing differences in self-reported physical health, health-related quality of life (QoL) and primary care usage by PHQ-15 symptom severity category.

Results: Cronbach’s α for the PHQ-15 was 0.73 and item-total statistics met recommended guidelines. Validity analyzes showed 6% of women reported severe symptoms, 17% medium, 50% low and 27% minimal symptoms. Women with severe symptoms reported poorer overall physical health, poorer physical health-related QoL and greater use of primary care. Women with severe symptoms also rated their baby’s health as worse and used primary care more for their baby.

Discussion: This study suggests the PHQ-15 has the potential to be a useful and valid measure of physical symptoms in postpartum women in high-income countries.     

输卵管妊娠治疗现状与趋势

由于定量测定 HCG水平和阴道超声的应用 ,大约 80 %异位妊娠可以在破裂前得到早期诊断 ,因此 ,治疗倾向于保守性。甲氨蝶呤 (MTX) 1mg/ m2 单次肌内注射总成功率达 88% ,对大约 4 0 %患者可作为首选方案。多次注射方案成功率略高于单次注射 ,但副反应发生率明显升高。腹腔镜下输卵管线形切开造口术 (开窗术 )已成为治疗输卵管妊娠的标准保守性手术。若对侧输卵管异常 ,患侧输卵管行保守性治疗虽稍增加重复异位妊娠的发病率 ,但在一定程度上也能提高宫内孕率     

人工流产妇女非意愿妊娠的原因及可预测妊娠的比例分析

根据对上海市三所妇幼保健院 6 0 6名人工流产妇女的调查资料 ,分析了人工流产妇女非意愿妊娠的原因及可预测妊娠的比例。结果表明 ,人工流产对象中 98.1 8%为非意愿妊娠 ,其中 6 3.70 %为可预测的妊娠。已婚对象非意愿妊娠的主要原因是避孕失败 (73.1 % ) ,其中以安全期失败、体外排精失败和避孕套破裂或脱落为多 ;未婚对象非意愿妊娠的主要原因为未用或未坚持用避孕措施 (5 5 .4% ) ,而未用措施的主要原因是认为自己不会怀孕。意愿妊娠对象做人工流产的主要原因是优生 ,非意愿妊娠中已婚无子女对象的人工流产原因则主要是想晚点生育及工作学习的需要。本文提示 ,提高妇女的避孕措施使用率 ,鼓励对象使用效果可靠的避孕措施及推广紧急避孕法是降低人工流产的三个重要环节     

Pregnancy outcome in the setting of extremely low first trimester PAPP-A levels

Background: Serum pregnancy-associated plasma protein-A (PAPP-A) is part of first trimester Down syndrome screening. Low levels have been associated with adverse outcome as well as chromosomal abnormality.
Aims: To assess the incidence of adverse outcome when PAPP-A levels are at or below 0.2 multiples of the median (MoM).
Methods: Data on consecutive patients attending a first trimester screening program were collected. Those with PAPP-A levels ≤ 0.2 MoM were divided into three groups: ≤ 0.1 MoM; 0.11–0.15 MoM; and 0.16–0.2 MoM.
Results: Screening 44 535 patients resulted in 197 with PAPP-A levels ≤ 0.2 MoM. The incidence of karyotypic abnormality increased with decreasing PAPP-A levels. In the absence of chromosome abnormality, pregnancy outcomes were defined as 'normal' in at least 30% and 'good' in at least 60%, with both percentages increasing as the PAPP-A level rose. The PAPP-A levels were significantly lower in the group with a poor outcome. The incidence of prematurity was similar in the three groups, but higher than the statewide average, while the incidence of extreme prematurity appeared to be related to reducing PAPP-A levels. The incidence of growth restriction in the three groups was similar, but was still double the incidence in the normal population.
Conclusion: If the PAPP-A level is ≤ 0.2 MoM and the karyotype is normal, there is an increased risk of adverse outcome. Even with PAPP-A below 0.1 MoM, a good outcome can be expected in 60% of cases. Careful morphological assessment is suggested and later monitoring of fetal growth and well-being.