中期引产镇痛方法的临床比较

目的 评价硬膜外镇痛、腰麻联合硬膜外镇痛、静脉镇痛用于中期引产的临床效果和不良反应。方法 选取本院收治的因有妊娠合并症及计划外妊娠要求镇痛终止妊娠者240例。随机分为3组，I组为硬膜外镇痛组，II组为腰麻联合硬膜外镇痛组，III组为静脉镇痛组，每组80例。同期非镇痛引产者228例作为对照组（D组）。于镇痛开始前及镇痛后0.5h时记录孕妇生命体征、VAS评分、孕妇满意度、引产时间及并发症情况。结果与D组比较，其余3组引产时间缩短（P〈0.05）；I、II和III组镇痛优良率均高达96％以上，优于D组（P〈0.05）；各组间孕妇生命体征平稳，无统计学差异（P〉0.05）；与D组比较，其余3组并发症总数较多（P〈O.05）；III组恶心呕吐发生率低，呼吸抑制和嗜睡发生率高（P〈0.05）。结论对于中期引产，硬膜外镇痛、腰麻联合硬膜外镇痛、静脉镇痛均具有良好的镇痛效果，但静脉镇痛具有创伤小、方便快捷等优势。     

Children at birth,children growing up. Integration between healthcare and family educational care

This research is based on the assumption that in order to improve the quality of life of children with major health problems in the early stage of their life, especially in the case of disability, it is necessary to ensure the continuity and proper two-way integration of early childhood educational planning and health care, both provided by the adults involved, that is parents and professionals. Therefore, we tried to explore and piece together the complex set of family support experiences, both in the process of forming an attachment and affiliation to the newborn and in the construction of a common evolutionary history, aimed at the well-being of the entire family unit. We considered the context and actors of the first few days and months in the lives of children with a difficult life course, in a city of Northern Italy. By means of qualitative investigation, we carried out observations in the neonatal intensive care units of hospitals over a period of 10 months. Our observations continued in the local healthcare, social, and educational services, entrusted with providing care to children and support to parents after hospital discharge. We also carried out observations in nursery schools, in order to highlight early forms of individualised educational planning, drawn up by the educators together with the family.     

Multiple primary (even in situ) melanomas in a patient pose significant risk to family members

BackgroundWe aimed at assessing familial risk of melanoma by considering a detailed family history of multiple primary (invasive/in situ) melanomas (MPM), stratified by histology and location.MethodsAmong 65,429 melanoma patients diagnosed in 1958–2010 in the Swedish Family-Cancer Database, there were 4248 patients with familial melanoma. A detailed family history of MPM was investigated by number of melanomas in one first-degree relative (FDR) and in ⩾2 FDRs. Familial melanoma risk was assessed by standardised incidence ratios (SIRs) comparing those with family history of melanoma to those without. Combining invasive/in situ melanoma was due to essentially identical familial risks.ResultsFor one affected FDR, familial risk increased from SIR = 2.2 (95% confidence interval (CI) = 2.2–2.3) for single melanoma to 16.3 (9.5–26.1) for ⩾5 melanomas, while for ⩾2 affected FDRs, the risk increased from 5.5 (4.8–6.2) for single melanoma to 23.9 (13.6–38.8) for ⩾2 melanomas. Significantly higher familial risks for superficial spreading melanoma (SSM) [2.5 (2.3–2.6)] than lentigo maligna melanoma (LMM) [1.8 (1.6–2.1)], and for multiple parts [5.3 (3.1–8.4)] and trunk [2.6 (2.5–2.8)] than head/neck [2.0 (1.8–2.2)] were observed. Only at head/neck, significantly higher risk for SSM [2.4 (1.9–3.0)] than LMM [1.6 (1.4–1.8)] was noted.ConclusionWe found, for the first time, that familial risks were similar for two/three melanomas in one FDR or for a single melanoma in ⩾2 FDRs and, higher familial risks for SSM than LMM occurred only at head/neck. This study provides new evidence for genetic counselling in melanoma, suggesting the need for considering not only the number of affected family members but also the diagnosis of MPM (even in situ) in relatives.     

家庭支持对母乳喂养的影响分析

目的 分析家庭支持对产妇母乳喂养的影响效果.方法 选择2009年3月～6月住我院产科的180例产妇及其家庭成员按照住院的先后顺序随机分为对照组、观察组各90例.对照组给予常规护理;观察组实行系列强化干预措施,并对两组产妇主动母乳喂养情况（首次主动哺乳时间、每天主动哺乳次数）进行比较分析.结果 观察组经强化干预措施后,其主动母乳喂养情况明显优于对照组,两组间比较,差异有统计学意义（P＜0.05）.结论 母乳喂养是产后护理的一项重要任务,不仅需要产科医护人员的耐心指导,有针对性地对孕产妇及家人采取干预措施,更需要产妇及家人的鼎力配合.     

Abuse and neglect in adolescents of Jammu,India: The role of gender,family structure,and parental education

The present study aimed to assess the factor structure of the childhood trauma questionnaire (CTQ; Bernstein & Fink, 1998), and use it to describe the prevalence of abuse and neglect in Indian adolescents, and its associations with gender, family structure (nuclear vs. joint), and level of parental education. Participants were 702 adolescents from Jammu in the age range of 13–17 years (41.5% female). We found acceptance for a four-factor intercorrelated model for the CTQ with emotional abuse, physical abuse, sexual abuse, and neglect (5 emotional neglect and 2 physical neglect items) factors following a confirmatory factor analysis (CFA). Forty-one to sixty-one percent of adolescents reported maltreatment which is higher in comparison with CTQ based studies from the West. Analysis of CFA with covariates (MIMIC model) indicated that males, and adolescents of less educated mothers’ and from joint families reported higher abuse and neglect, and sexual abuse, respectively, while fathers’ education level was not associated with abuse or neglect. Implications of these findings are highlighted.