妊娠妇女血清亮氨酸氨基肽酶的水平变化及其临床意义

目的 探讨妊娠妇女血清亮氨酸氨基肽酶(LAP)的水平变化及其临床意义.方法 选取120例正常妊娠正常分娩的妇女作为正常妊娠组,根据其怀孕周数将其分为正常早期组、正常中期组与正常晚期组各40例;以28例患有妊娠期高血压的妇女作为妊高征组、26例出现早产的妇女为早产组、30例健康未妊娠妇女作为未妊娠组,检测各组妇女血清中的LAP水平.结果 未妊娠组、早产组、正常妊娠组、妊高征组的血清LAP水平依次升高(P<0.05).正常晚期组、正常中期组、正常早期组妇女的血清LAP水平依次降低(P<0.05),正常妊娠妇女的血清LAP水平与孕周呈正相关性(P<0.05).结论 妊娠妇女体内血清中LAP水平的变化存在着一定的规律,监测LAP水平对于评估妊娠期高血压疾病及早产的发生具有重要价值.     

双球囊导管促宫颈成熟在延期妊娠 引产中的应用效果及对妊娠结局的影响研究

目的 研究双球囊导管促宫颈成熟在延期妊娠引产中的应用效果及对妊娠结局的影响.方法 前瞻性选择2016年1月至2019年12月安徽医科大学附属宿州医院产科收治的80例延期妊娠产妇作为研究对象,采用随机数字表法将其分为2组:对照组40例采用传统的缩宫素引产,研究组40例采用双球囊导管引产.比较2组宫颈成熟度、引产效果、分娩...     

米非司酮联合米索前列醇片应用于瘢痕子宫中期妊娠引产的开放性、阳性药物随机对照临床试验简

目的 探讨米非司酮联合米索前列醇片用于16 ～ 24周瘢痕子宫中期妊娠引产的疗效.方法 根据入选、排除标准,入选140例16～24周的瘢痕子宫的妊娠妇女,孕妇自愿选择终止妊娠,随机分为两组,治疗组70例,给予米非司酮联合米索前列醇终止妊娠,对照组A 70例,则应用非司酮联合羊膜腔内注射利凡诺针终止妊娠.选取同期子宫孕16～24周的非瘢痕子宫病例70例,采用米非司酮联合米索前列醇片终止妊娠,作为对照组B.评价三组引产成功率、引产后出血量、产程时间、术前紧张、不完全流产率等.结果 治疗组引产时间（宫缩时间、胎儿娩出时间、总产程）均显著低于对照组A,完全引产率则明显高于对照组A（51.4％比27.1％,x2=8.655,P=0.003）,差异有高度统计学意义（P＜0.01）.引产过程中治疗组紧张发生率（48.5％比95.7％,x2=38.7,P=0.000）、中重度疼痛率（61.4％比91.4％,x2=17.48,P=0.000）均明显低于对照组A.引产过程,胎盘残留发生率治疗组可能更低（18.5％比41.4％,x2=8.707,P=0.003）.治疗组与对照组B比较显示,在引产时间、完全引产率、并发症发生率差异均无统计学意义（P＞0.05）.结论 相比于米非司酮联合利凡诺,联合米索前列醇片引产产程时间更短,孕妇紧张发生率、引产并发症更少,对医务人员技术要求更低.     

先兆早产孕妇联合应用抗生素的延续时间观察

目的：分析和探讨先兆早产孕妇联合应用抗生素的延续时间观察。方法将具有先兆早产症状的患者采用随机数字表法分为观察组（n=200）和对照组（n=60）。对观察组实行单一抗生素和联合抗生素进行治疗,对照组实行普通保胎,不进行抗生素治疗。观察2组出生体质量、Apger评分、早产儿听力评分、视力评分、早产儿行为评定等各项指标。结果使用单一抗生素组和联合抗生素组以及48 h以内相比较,差异有统计学意义（P<0.05）。观察组出生体质量评分为（6.58±1.35）分,对照组（5.12±0.56）分;观察组Apger评分（8.95±2.33）,对照组（6.45±1.45）;观察组早产儿听力评分（40.76±1.96）,对照组（33.45±1.29）;观察组视力评分（5.12±0.23）,对照组（4.79±0.92）;观察组早产儿行为评定（96.45±2.45）,而对照组（87.94±3.26）。2组比较差异有统计学意义（均P<0.05）。观察组中>48 h和<48 h的患者相比,早产延长时间明显增加,差异有统计学意义（P<0.05）。结论使用联合抗生素治疗并且延长治疗时间,对于延长先兆早产孕妇具有极大意义,值得临床推广。     

Prevalence and Characterization of Thrombocytopenia in Pregnancy in Indian Women

To find the prevalence and causes of thrombocytopenia during pregnancy. An analytical prospective observational study was conducted in Department of Obstetrics & Gynecology, CSMMU, Lucknow. 1079 antenatal women screened for thrombocytopenia and investigated for cause and management strategies and fetomaternal outcome were recorded. Prevalence of thrombocytopenia was 8.8%. Gestational thrombocytopenia was seen in 64.2%, obstetric in 22.1% and medical in 13.68% cases. Mean platelet count in controls was lower with a significant fall (P < 0.001) in the platelet count as pregnancy advanced. Hypertensive and hepatic disorders were the most common obstetric causes of thrombocytopenia. Mode of delivery was not affected by thrombocytopenia. Maternal morbidity and mortality was seen only in medical and obstetric thrombocytopenia. The low platelet counts and declining trend with increasing gestational age predispose Indian women to risk of thrombocytopenia and a routine platelet count is suggested.     

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。     

The importance of children's ADHD for parents' relationship stability and labor supply

Children with attention-deficit/hyperactivity disorder (ADHD) have much worse long-term outcomes than other children. This paper uses Danish register-based data on children born from 1990 to 1997 to investigate the significance of children's ADHD for parents' outcomes. We observe 172,299 pairs of parents from 1990 to 2007 of which 2457 have a firstborn child diagnosed with ADHD and 169,842 have a firstborn child without ADHD. Ten years after the birth of the child, parents of children diagnosed with ADHD have a 75% higher probability of having dissolved their relationship and a 7–13% lower labor supply. Parents of children with ADHD are, however, particularly disadvantaged in terms of socioeconomic background and mental health. We explain about half of the gaps in partnership stability and labor supply when these factors are taken into consideration, but a statistically and economically significant gap remains to be explained. Additionally, we find that the receipt of a diagnosis to some extent moderates the influence of underlying ADHD on partnership stability. Still, our study concludes that poor child health in terms of ADHD reduces parental socioeconomic status (SES) by lowering their labor supply (and earnings) and reducing relationship stability.     

Energy efficiency and nutrition in societies based on human labor

Improving the conditions of poor traditional societies is a standard goal of development policies. The definition of ‘improvement’ requires a previous definition of values, that is to say, ‘better’ or ‘worse’ can change according to the parameters used to optimize the system. Different scientific disciplines generally focus on different levels of analysis: the individual, the socio‐economic, or the environmental level. Consequently, optimization parameters derived from single disciplines are not holistic in assessing development. System energy analysis can provide a way to describe the interaction among individuals, human societies and natural processes, that bridges the different levels of analysis.

This paper investigates the relationship between nutrition and energy efficiency in farming systems based on human labor. By describing the energetic budget of a society, trade‐offs can be assessed between a better diet at individual level, and the consequent decrease in the conversion ratio of energy input into applied power at societal level (more elderly, larger body size, dramatic increase of energetic cost for nutritional calories). The relationship between energy efficiency and nutrition in the process of societal development is also addressed.     

The influence of demographics and working conditions on self-reported injuries among Latino day laborers

Abstract

Background: The majority of day laborers in the USA are Latinos. They are engaged in high-risk occupations and suffer high occupational injury rates.

Objectives: To describe on-the-job injuries reported by Latino day laborers, explore the extent that demographic and occupational factors predict injuries, and whether summative measures for total job types, job conditions, and personal protective equipment (PPE) predict injuries.

Methods: A community survey was conducted with 327 participants at 15 corners in Houston, Texas. Hierarchical and multiple logistic regressions explored predictors of occupational injury odds in the last year.

Results: Thirty-four percent of respondents reported an occupational injury in the previous year. Education, exposure to loud noises, cold temperatures, vibrating machinery, use of hard hats, total number of job conditions, and total PPE significantly predicted injury odds.

Conclusion: Risk for injury among day laborers is not only the product of a specific hazard, but also the result of their exposure to multiple occupational hazards.     

Lifetime Cost-Effectiveness of Trial of Labor After Cesarean in the United States

ObjectiveTo estimate the cost-effectiveness of a trial of labor after one previous cesarean (TOLAC) when incorporating long-term events and outcomes.MethodsA Markov model comparing TOLAC with elective repeat cesarean delivery (ERCD) was developed for a hypothetical cohort with no contraindication to a TOLAC. Women were selected from a prospective study to derive probability estimates for potential events through three subsequent pregnancies. Probabilities for cerebral palsy and stress urinary incontinence, cost data, and quality-adjusted life-years (QALYs) were obtained from the literature. The primary outcome was cost-effectiveness measured as the marginal cost per QALY gained, with a $50,000 threshold per QALY used to define cost-effectiveness.ResultsThe TOLAC strategy dominated the ERCD strategy at baseline, with $164.2 million saved and 500 QALYs gained per 100,000 women. The model was sensitive to six variables: the probability of uterine rupture and successful TOLAC among women with no prior vaginal delivery, the frequency of stress urinary incontinence, and the costs of failed TOLAC, successful TOLAC, and ERCD. When the probability of TOLAC success was at the base value, 67.2%, TOLAC was preferred if the probability of uterine rupture was 3.1% or less. When the probability of uterine rupture was at the base value, 0.8%, the TOLAC strategy was preferred as long as the probability of success was 47.2% or more. Probabilistic sensitivity analysis confirmed the base-case analysis.ConclusionsUnder baseline circumstances, TOLAC is less expensive and more effective than an ERCD when considering long-term consequences when the likelihood of success is 47.2% or more.