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Background: Exploration of the relationship between individual work immersion and perceived stress is critical for clinical nurses' effective psychological interventions and human resource management, as well as to alleviate nursing staff shortages. In order to further dissect the influencing factors of perceived stress among nursing staff, our study introduces the concepts of perfectionism and social connectedness to analyze the specific pathways that influence perceived stress in terms of an individual's intrinsic and external personality traits. This study provides relevant recommendations for the development of stress management measures for nursing staff. Methods: This was a cross-sectional survey. 993 registered clinical nurses were included from four hospitals in Guangzhou through a convenience sampling method. Clinical nurses' work immersion, perceived stress, perfectionism, and social connectedness were investigated using questionnaires based on latent profile analysis. The relationships between variables were analyzed using t-tests, analysis of variance, Pearson's correlation analysis, latent profile analysis, and moderated mediation analysis. Results: The results showed that (1) general influences on nurses' perceived stress included only child, labor relationship, labor allowance, and family support; (2) nurses' work immersion contained four subgroups: lowest (12.6%), medium-low (39.8%), medium-high (39.9%), and highest (7.7%); (3) positive and negative perfectionism played a mediating role between the association of work immersion and perceived stress; (4) social connectedness played a moderating role in the mediation model of perceived stress. Conclusions: Work immersion, perfectionism, and social connectedness have an important impact on clinical nurses' perceived stress. Nursing managers or leaders should pay attention to the differences of individual work immersion status, adopt reasonable stress management strategies, accurately identify positive perfectionist groups and strengthen the relationship between groups, so as to ensure the quality of nursing care, and reduce nursing turnover and alleviate the problem of staff shortage. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the distribution of bacteria and their drug resistance changes in Intensive Care Units (ICUs) across Southwest China from 2018 to 2022 and establish the antibiogram in this region to provide a basis for early empirical antimicrobial use.Methods: Non-repetitive pathogens isolated from 109 member units with qualified data were obtained from the Antimicrobial Resistance Surveillance System in Sichuan Province, southwest China. The results obtained were interpreted with reference to CLSI M100-31th, and analyzed with WHONET 5.6 software.Results: A total of 46,728 clinical isolates in ICUs were collected from 2018 to 2022, of which gram-negative organisms accounted for 76.1%, and gram-positive were 23.9%. The top 5 were Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus, respectively. From 2018 to 2022, the resistance rates of Klebsiella pneumoniae to imipenem and meropenem changed from 14.5% and 17.8% to 14.0% and 14.4%, showing a steady downward trend. Escherichia coli was always highly sensitive to carbapenems, with a total resistance rate of 3.8%. Among non-fermented gram-negative bacteria, the resistance rates of Pseudomonas aeruginosa to imipenem and meropenem decreased significantly, changed from 25.3% and 22.9% in 2018 to 20.0% and 15.1% in 2022. However, Acinetobacter baumannii showed high resistance rates of 76.2% and 76.9% to imipenem and meropenem, respectively. MRSA and MRCNS accounted for 31.7% and 82.7%, respectively. No vancomycin and linezolid-resistant Staphylococcus aureus was isolated. Enterococcus faecalis maintained high activity to vancomycin, teicoplanin, and linezolid; no vancomycin or teicoplanin-resistant Enterococcus faecium strains were detected.Conclusion: From 2018 to 2022, the isolated bacteria in ICU were mainly gram-negative bacteria, and the growth of some multidrug-resistant bacteria was effectively controlled. All levels of medical institutions should continue to strengthen bacterial resistance surveillance, promote the establishment of antimicrobial stewardship program, and enhance restrictions on outpatient antimicrobial use. [ABSTRACT FROM AUTHOR]

Aim: The incidence and risk factors of low anterior resection syndrome (LARS) largely variate in different studies. In addition, there is lack of study on how patients evaluate the therapeutic effect of LARS. This single-center retrospective study aims to investigate the status of LARS in Chinese patients undergoing laparoscopic low anterior resection (LAR). Methods: Consequent patients undergoing laparoscopic LAR and free from disease recurrence from January 2015 to May 2021 were issued with both LARS questionnaire and satisfaction survey. Related data were collected and analyzed. Results: Both LARS questionnaires and self-made satisfaction survey were received from 261 eligible patients. The overall incidence of LARS was 47.1% (minor in 19.5%, major in 27.6%), decreased with the passage of postoperative time (64.7% within 12 months, and 41.7% within 12–36 months), and became stable 36 months later (39.7%). The most common symptoms were defecation clustering (n = 107/261, 41.0%) and defecation urgency (n = 101/261, 38.7%). According to the multivariable regression analysis, risk factors of major LARS were: 1 year increase in age (OR 1.035, 95% CI 1.004–1.068), protective stoma (OR 2.656, 95% CI 1.233–5.724) and T3 − 4 stage (OR 2.449, 95% CI 1.137–5.273). Most patients complained defecation disorder (87.3%) to doctors and 84.5% got suggestions or treatments for it. However, only 36.8% patients thought the treatments worked for them. Conclusions: LARS frequently occurs after laparoscopic LAR, while the therapeutic effect is not satisfying. Elder, advanced T-stage and protective stoma were risk factors for postoperative major LARS. [ABSTRACT FROM AUTHOR]

To explore the association between inter-pregnancy intervals and placenta previa and placenta accreta spectrum among women who had prior cesarean deliveries with respect to maternal age at first cesarean delivery. This retrospective study included clinical data from 9981 singleton pregnant women with a history of cesarean delivery at 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. The study population was divided into four groups (<2, 2–5, 5–10, ≥10 years of the interval) according to the inter-pregnancy interval. The rate of placenta previa and placenta accreta spectrum among the four groups was compared, and multivariate logistic regression was used to analyze the relationship between inter-pregnancy interval and placenta previa and placenta accreta spectrum with respect to maternal age at first cesarean delivery. Compared to women aged 30–34 years old at first cesarean delivery, the risk of placenta previa (aRR, 1.48; 95% CI, 1.16–1.88) and placenta accreta spectrum (aRR, 1.74; 95% CI, 1.28–2.35) were higher among women aged 18–24. Multivariate regression results showed that women at 18–24 with <2 years intervals exhibited a 5.05-fold increased risk for placenta previa compared with those with 2–5-year intervals (aRR, 5.05; 95% CI, 1.13–22.51). In addition, women aged 18–24 with less than 2 years intervals had an 8.44 times greater risk of developing PAS than women aged 30-34 with 2 to 5 years intervals (aRR, 8.44; 95% CI, 1.82–39.26). The findings of this study suggested that short inter-pregnancy intervals were associated with increased risks for placenta previa, and placenta accreta spectrum for women under 25 years at first cesarean delivery, which may be partly attributed to obstetrical outcomes. [ABSTRACT FROM AUTHOR]

There is limited information describing the course and severity of illness in subjects infected by the severe acute respiratory syndrome coronavirus 2 Omicron variant, especially in children. In this population-based cohort study, subjects with Omicron variant infection during the outbreak between January 8 and February 12, 2022 in Tianjin, China were included (n = 429). The main outcomes were the distribution of asymptomatic, mild, moderate, and severe patients, and clinical courses including the interval from positive polymerase chain reaction (PCR) test to the onset, aggravation or relief of symptoms, and the interval of reversing positive PCR-test into negative, and length of hospital stay. Of the 429 subjects (113 [26.3%] children; 239 [55.7%] female; median age, 36 years [interquartile range 15.0 to 55.0 years]), the proportion (95% CI) of symptomatic subjects on admission was 95.6% (93.2%, 97.2%), including 60.4% (55.7%, 64.9%) mild, 35.0% (30.6%, 39.6%) moderate, and 0.2% (0.0%, 1.3%) severe. Compared with adults, children had lower proportion of moderate Covid-19 (8.8% vs 44.3%). On discharge, 45.9% (41.3%, 50.7%) and 42.2% (37.6%, 46.9%) of the subjects were diagnosed as having experienced mild and moderate Covid-19. The median (interquartile range) length of hospital stay was 14.0 (12.0, 15.0) days. The median interval of reversing positive PCR-test into negative was 12.0 (10.0, 13.0) days. Symptomatic and moderate Covid-19 in Omicron infections was common in adults and children, recovery from Omicron infections took around 2 weeks of time. The severe acute respiratory syndrome coronavirus 2 Omicron infection in this study was not as mild as previously suggested., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background : The psychological problems of Shidu Parents (SDP) under the China's One-Child Policy have been documented. The purpose of this study was to investigate the relationships among personality types, social support, and post-traumatic stress disorder (PTSD) in SDP. Methods : The PTSD Checklist-Civilian Version (PCL-C), The Big Five Personality Traits (NEO), and Social Support Revalued Scale (SSRS) were administered to the sample of 149 SDP who were over 50 years old and had lost their only child more than one year ago. Results : Among SDP, mothers were more likely to develop PTSD than fathers (χ 2 = 11.16, p < 0.01). Parents who were extraverted had a lower risk of developing PTSD-related symptoms (χ 2 = 8.58, p < 0.01), and the effect of neuroticism was significant (χ 2 = 23.73, p < 0.01). The more social support parents utilized, the lower the incidence of PTSD ( t = 4.56, p < 0.01). The result of multilevel linear regression showed that sex, neuroticism, and objective social support remained significantly different after combining all personality types and social support systems in the same model. Social support partially mediated the relationship between neuroticism and PTSD. Meanwhile, it was a complete mediator between extraversion and PTSD. Conclusions : Female sex/gender, neuroticism, and introversion were risk factors of developing PTSD, while receiving social support protected SDP from developing PTSD symptoms. Losing an only child is undoubtedly an enormous disaster for the family, which has become a huge, unavoidable social problem that must be addressed in China., (Copyright ©2022, Yale Journal of Biology and Medicine.)

Service satisfaction with public policies is an important component of public service quality management, which is of great significance to the improvement of public service quality. Based on an online questionnaire survey and in combination with the characteristics of public policies and services, in this study the influencing factors of residents' satisfaction with COVID-19 pandemic prevention services were analyzed with structural equation modeling. The results reveal that the data fit the model well, and all the hypotheses formulated in this study were supported. Among the factors that were found to directly affect residents' satisfaction with pandemic prevention services, perceived quality (PQ) has the greatest impact on satisfaction, followed by the disaster situation (DS) and policy expectation (PE). The observed variables that have significant impacts on the latent variables were also explored. Regarding the main findings, the residents who were seriously affected by the pandemic tended to have lower satisfaction with the policies and services provided by the government. Moreover, the improvement of PQ was found to significantly increase pandemic prevention service satisfaction (SS). Finally, the residents with a good psychological status during the pandemic were found to have higher satisfaction. According to the results, implications for the prevention and control practices of similar public health emergencies are proposed.

To determine the factors predicting the probability of severe postpartum hemorrhage (SPPH) in women undergoing repeat cesarean delivery (RCD). This multicenter, retrospective cohort study involved women who underwent RCD from January 2017 to December 2017, in 11 public tertiary hospitals within 7 provinces of China. The all-variables model and the multivariable logistic regression model (pre-operative, operative and simple model) were developed to estimate the probability of SPPH in development data and external validated in validation data. Discrimination and calibration were evaluated and clinical impact was determined by decision curve analysis. The study consisted of 11,074 women undergoing RCD. 278 (2.5%) women experienced SPPH. The pre-operative simple model including 9 pre-operative features, the operative simple model including 4 pre-operative and 2 intraoperative features and simple model including only 4 closely related pre-operative features showed AUC 0.888, 0.864 and 0.858 in development data and 0.921, 0.928 and 0.925 in validation data, respectively. Nomograms were developed based on predictive models for SPPH. Predictive tools based on clinical characteristics can be used to estimate the probability of SPPH in patients undergoing RCD and help to allow better preparation and management of these patients by using a multidisciplinary approach of cesarean delivery for obstetrician.

Background: To determine the effects of maternal age at first cesarean on maternal complications and adverse outcomes of pregnancy with the second cesarean., Methods: This was a multicenter, historical, cross-sectional cohort study involving singleton pregnancies ≥28 gestational weeks, with a history of 1 cesarean delivery, and who underwent a second cesarean between January and December 2017 at 11 public tertiary hospitals in 7 provinces of China. We analyzed the effects of maternal age at first cesarean on adverse outcomes of pregnancy in the second cesarean using multivariate logistic regression analysis., Results: The study consisted of 10,206 singleton pregnancies. Women were at first cesarean between 18 and 24, 25-29, 30-34, and ≥ 35 years of age; and numbered 2711, 5524, 1751, and 220 cases, respectively. Maternal age between 18 and 24 years at first cesarean increased the risk of placenta accreta spectrum (aOR, 1.499; 95% CI, 1.12-2.01), placenta previa (aOR, 1.349; 95% CI, 1.07-1.70), intrahepatic cholestasis of pregnancy (aOR, 1.947; 95% CI, 1.24-3.07), postpartum hemorrhage (aOR, 1.505; 95% CI, 1.05-2.16), and blood transfusion (aOR, 1.517; 95% CI, 1.21-1.91) in the second cesarean compared with the reference group (aged 25-29 years). In addition, maternal age ≥ 35 years at first cesarean was a risk factor for premature rupture of membranes (aOR, 1.556; 95% CI, 1.08-2.24), placental abruption (aOR, 6.464, 95% CI, 1.33-31.51), uterine rupture (aOR, 7.952; 95% CI, 1.43-44.10), puerperal infection (aOR, 6.864; 95% CI, 1.95-24.22), neonatal mild asphyxia (aOR, 4.339; 95% CI, 1.53-12.32), severe asphyxia (aOR, 18.439; 95% CI, 1.54-220.95), and admission to a neonatal intensive care unit (aOR, 2.825; 95% CI, 1.54-5.17) compared with the reference group (aged 25-29 years)., Conclusions: Maternal age between 18 and 24 years or advanced maternal age at first cesarean was an independent risk factor for adverse maternal outcomes with the second cesarean. Advanced maternal age at the first cesarean specifically increased adverse neonatal outcomes with the second. Therefore, decisions as to whether to perform a first cesarean at a young or advanced maternal age must be critically evaluated.

BACKGROUND The rate of delivery by cesarean section is rising in China, where vaginal birth after cesarean (VBAC) is in its early stages. There are no validated screening tools to predict VBAC success in China. The objective of this study was to identify the variables predicting the likelihood of successful VBAC to create a predictive model. MATERIAL AND METHODS This multicenter, retrospective study included 1013 women at ≥28 gestational weeks with a vertex singleton gestation and 1 prior low-transverse cesarean from January 2017 to December 2017 in 11 public tertiary hospitals within 7 provinces of China. Two multivariable logistic regression models were developed: (1) at a first-trimester visit and (2) at the pre-labor admission to hospital. The models were evaluated with the area under the receiver operating characteristic curve (AUC) and internally validated using k-fold cross-validation. The pre-labor model was calibrated and a graphic nomogram and clinical impact curve were created. RESULTS A total of 87.3% (884/1013) of women had successful VBAC, and 12.7% (129/1013) underwent unplanned cesarean delivery after a failed trial of labor. The AUC of the first-trimester model was 0.661 (95% confidence interval [CI]: 0.61-0.712), which increased to 0.758 (95% CI: 0.715-0.801) in the pre-labor model. The pre-labor model showed good internal validity, with AUC 0.743 (95% CI: 0.694-0.785), and was well calibrated. CONCLUSIONS VBAC provides women the chance to experience a vaginal delivery. Using a pre-labor model to predict successful VBAC is feasible and may help choose mode of birth and contribute to a reduction in cesarean delivery rate.