Objective To explore the effects of the multiple shared decision-making mode using a decision aid manual in conjunction with online labor and delivery decision support on the delivery mode for pregnant women with a scarred uterus.Methods A total of 94 women with scarred uterus who received prenatal care at a tertiary hospital from September 2019 to October 2022 were enrolled and assigned to experimental and control groups using the random number table method.The control group received standard prenatal education,and the experimental group received multiple shared decision-making interventions in addition to standard prenatal education.The degree of conflict in decision-making for delivery,preference for delivery mode,postpartum decision regret,and the final delivery mode between the two groups were compared,respectively.Results Following the multiple shared deci-sion intervention,decision conflict scores in the experimental group were significantly reduced(P<0.001).In the survey on delivery mode preferences,there was a reduction in the number of individuals in the experimental group expressing"uncertainty",and an increase in those choosing vaginal delivery.Ultimately,in the experimental group,30 women(68.2%)underwent cesarean sections,and 14(31.8%)had vaginal deliveries.The level of post-decision regret in the experimental group was lower than that in the control group(P<0.001).Conclusions Multiple shared decision-making for women pregnant with a scarred uterus could reduce the level of decision-making conflict,increase the willingness for vaginal delivery,and assist them in making rational and scientifically informed decisions regarding childbirth.

Schizophrenia is a chronic psychiatric disorder with complex etiology and diverse clinical manifestations, whose pathogenesis and triggering factors remain incompletely understood. Numerous studies have demonstrated significant gender differences in the age of onset, clinical presentation, disease progression, treatment efficacy, and prognosis among patients with schizophrenia. These differences are largely attributed to variations in sex hormone levels, with estrogen emerging as a key focus of research. Some studies suggest that adjunctive estrogen therapy during schizophrenia treatment not only alleviates symptoms but also reduces the required dosage of antipsychotic medications. A systematic review of research on estrogen as an adjunctive treatment for schizophrenia may provide new perspectives and references for future therapeutic strategies.
Humans ; Schizophrenia/drug therapy* ; Estrogens/therapeutic use* ; Antipsychotic Agents/administration & dosage* ; Male ; Female ; Sex Characteristics ; Clinical Trials as Topic ; Estrogen Replacement Therapy

Objective:To construct a scientific, comprehensive, and reliable core competency evaluation index system for doulas based on the perspective of midwives.Methods:From September 2021 to March 2022, a preliminary core competency evaluation index system for doulas was developed by consulting domestic and foreign literature. Using the Delphi expert consultation method, two rounds of correspondence were conducted with 32 senior midwives and obstetric managers to form the final version of the core competency evaluation index system for doulas. The expert positive coefficient was expressed by the effective recovery rate of the questionnaire. The degree of expert authority was expressed by the authority coefficient, and calculated by the coefficient of expert judgment basis and the arithmetic average of experts ' familiarity with the index. The degree of expert opinion coordination was expressed by coefficient of variation and Kendall 's harmony coefficient (Kendall 's W) . Results:The response rate of the first round of questionnaire was 93.75% (30/32), and the second response rate of the first round of questionnaire was 100.00% (30/30). The expert judgment coefficient for two rounds was 0.96, the familiarity coefficient with the problem was 0.93, and the degree of authority of expert opinions was 0.95. After two rounds of correspondence, the expert opinions tended to be consistent, and the coefficient of variation of indicators at all levels was lower than 0.25. The Kendall 's harmony coefficients of the first round indexes were 0.486, 0.374 and 0.268 ( P<0.01), and the Kendall 's harmony coefficients of the second round indexes were 0.487, 0.410 and 0.287 ( P < 0.01). The core competency evaluation index system for doulas based on the perspective of midwives constructed in the study included 3 first-level indicators, such as theoretical knowledge, operational skills and comprehensive ability, 12 second-level indicators and 45 third-level indicators. Conclusions:The core competency evaluation index system for doulas based on the perspective of midwives constructed in the study is comprehensive, reliable and practical, which has guiding significance for training and assessment, the qualification certification and management of doulas.

The purpose of this study is to suggest the physicians using olanzapine to strengthen the recognition and treatment of restless leg syndrome （RLS） in clinical practice. In this paper， one patient with schizophrenia suffered from RLS during olanzapine administration， which was characterized by unpleasant sensory disturbances in bilateral lower extremity at night， intense urges to move legs， and inability to sleep. After taking gabapentin， the above symptoms were significantly improved.

Objective:To screen, obtain domestic and foreign evidence on the prevention and treatment of nausea and vomiting during pregnancy, and evaluate and summarize the quality of the evidence.Methods:We searched the Joanna Briggs Institute (JBI) , UpToDate, the Cochrane Library, PubMed, British Medical Journal (BMJ) , Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI) , WanFang Data, Yimaitong, VIP by computer. The search time limit was from January 1, 2011 to January 1, 2021. Four researchers independently screened the articles, and extracted and summarized the evidence that met the quality standards.Results:A total of 16 articles were included, including 4 guidelines, 1 evidence summary, 8 systematic reviews, 2 Meta-analysis and 1 expert consensus. Through the screening and acquisition of evidence for the prevention and treatment of nausea and vomiting during pregnancy, the 32 best evidences were finally summarized from 7 aspects including assessment and diagnosis, classification and grading, risk factors, basic management principles, prevention, non-drug treatment, and drug treatment.Conclusions:The prevention and treatment of nausea and vomiting during pregnancy should first evaluate the patient, determine the patient's symptoms and severity, analyze the risk factors, and conduct cognitive, psychological, and behavioral interventions for the patient, as well as non-pharmacological or drug treatment.

Objective:To explore the symptom experience of stress urinary incontinence (SUI) in pregnant women, so as to provide a basis for strengthening the prevention and control of SUI and formulating standardized symptom management strategies.Methods:From July 2018 to November 2019, purpose sampling was used to select 11 pregnant women with SUI undergoing routine prenatal examination in the Obstetric Clinic of Nanfang Hospital, Southern Medical University as the research objects. The semi-structured interview was conducted with pregnant women, and the data were analyzed using grounded theory in qualitative research.Results:A total of four themes were extracted, namely, lack of cognition, different coping attitudes, poor symptom experience, and urgent need for symptom management knowledge.Conclusions:SUI pregnant women generally have insufficient knowledge of the disease, poor symptom experience, different response attitudes, and urgent need for symptom management knowledge. Therefore, for SUI pregnant women, all aspects of personal-family-society support should be provided, social publicity of SUI symptom management knowledge should be strengthened, positive guidance and encouragement should be given, family members should be encouraged to participate, and an internet digital information platform should be actively constructed to ultimately reduce the incidence of SUI in pregnant women.

Schizophrenia is a kind of neurodevelopmental brain disease with genetic background.Cognitive impairment has always been concerned as the core symptom of schizophrenia, and genetic factors play an important role in the cognitive impairment process of schizophrenia.This paper intends to explore the relationship between various neurotransmitter systems and neurodevelopmental related genes and cognitive impairment in schizophrenia. With " schizophrenia" " cognitive" and " genetic" " dopamine" " glutamate" " serotonin" " norepinephrine" " acetylcholine" " neurodevelopmental" " genome-wide association studies" as key words, the author searched the English and Chinese literatures published from January 2001 to October 2019 in several databases, such as Pubmed, ScienceDirect, CNKI academic journal database, Wanfang academic journal database, and selected the literature that was in line with the review topic after a large number of readings.Meanwhile, the author applied the literature tracing method to search the references of the literature that had been reviewed. Finally, 29 related literatures were included, and it was found that cognitive impairment in schizophrenia is related to multiple neurotransmitter system genes and neurodevelopmental genes, and these genes have different mechanisms of action in the process of cognitive impairment. The occurrence and development of cognitive impairment in schizophrenia involve multiple gene effects. The genetic study of neurotransmitter system and neurodevelopmental level is helpful to explore the pathological mechanism of cognitive impairment in schizophrenia.Future research should focus on how the pathogenesis/candidate genes of schizophrenia affect the neurotransmitter system and neurodevelopmental circuits, and further elucidate the mechanism of genetic factors in the development of cognitive impairment in schizophrenia.

Objective To explore the influence of duration of untreated psychosis (DUP)on cognition and social function in first-episode drug-na?ve schizophrenia. Methods Ninety-three first-episode drug-na?ve schizophrenic were enrolled as the schizophrenia group and 93 normal people served as the control group. The Positive and Negative Symptoms Scale (PANSS) were used to assess the degree of mental symptoms. The Matrics Consensus Cognitive Battery (MCCB) was used to evaluate the cognitive function. Personal and Social Performance Scale (PSP) and the Global Assessment Function Scale (GAF) were used to evaluate the social function. Result There were significant differences in scores of Trail Marking Test, Symbol Coding test, Category Fluency test, Stroop color word test, Continuous Performance Test, Spatial Span test, Brief-Visuospatial Memory Test-Revised (HVLT-R), Brief-Visuospatial Memory Test-Revised (BVMT-R) and Maze test between the schizophrenia group and the control group (all P<0.05). There were significant differences in scores of GAF and PSP between the schizophrenia group and the control group (all P<0.05). DUP was negatively related to the score of HVLT-R2 (r=-0.265, P=0.010) or BVMT-R3 (r=-0.328, P=0.001). DUP was negatively related to the scores of GAF score(r=-0.292,P=0.005)or PSP score(r=-0.397,P<0.001). Conclusion There are social function impairment and a wide range of cognitive function impairment in the first-episode drug-na?ve schizophrenic. The length of the DUP is associated with the severity of the social functional and cognitive functional impairment.

Objective To explore the relationship between DNA methyctransferace1(DNMT1)gene polymorphism and cognitive function in the first episode, drug-na?ve schizophrenia. Methods One hundred eighty-six first episode, drug-na?ve schizophrenia patients and 182 healthy controls were examined by using polymerase chain reaction (PCR), denaturing polyacrylamide gel electrophoresis and silver staining to determine genotype and allele of DNMT1 gene. Cognitive function was assessed by using the standardized measurement tools—the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) Chinese version. Comparisons were made on the cognitive function and the genotype and allele distribution of SNP rs2114724 and rs2228611 between schizophrenia group and the control group.The relationship between DNMT1 gene polymorphism and cognitive function was analyzed. Results There was no significant difference of the genotype T/T, T/C, C/C and allele T, C distribution of SNP rs2114724 between schizophrenia group and healthy controls group (P>0.05). There was no significant difference of the genotype G/G, G/A, A/A and allele G, A distribution of SNP rs2228611 between schizophrenia group and healthy control group (P>0.05). There was significant difference in Spatial Span Test (SST) scores(P<0.05)among three different genotype T/T,T/C and C/C of rs2114724 in schizophrenic group.The SST scores of the patients with C/C genotype were higher than that of the patients with T/T or T/C genotype (P<0.05). Conclusion DNMT1 gene polymorphisms is not associated with the first-episode, drug-na?ve schizophrenia, but may be associated with the work memory in cognitive function of schizophrenia in the Chinese Han population.

Objective To explore the Kano model analysis in the application of midwife outpatient service quality management. Methods Kano questionnaire was consisted of 24 items, including five parts, environment facilities, service evaluation, service technology, the team service, delivery service′quality. Using the Kano model analysis, the impact factors of the midwife outpatient service quality in five different quality attributes were determined. It included property and had the opposite answer to the question, charisma, essential properties and one property. Results By identifing the quality index classification of the pregnant women with satisfactory service quality to midwife outpatient service, attributable to a property were 1,2,3,4,8,9,10,14,20,21;attributable to mandatory attributes were 13, belonging to the charm of the property had 5,6,7,11,12,15,16,17,18,19,22,23,24. Midwives outpatient had most of charisma attribute, 54.2%(13/24) of the total;The second was one attribute, 41.7% (10/24) of the total. The technology level of midwife was essential attribute. Conclusions Kano mode analysis technology will be introduced to the midwife outpatient service quality management to provide decision reference for improving the quality of the hospital management level, improve maternal satisfaction, improve the obstetric operation efficiency.