Objective:To explore the influence of a midwife-led group health care model on primiparas′ self-efficacy and quality of life.Methods:The study included 200 primiparas who registered with the obstetrics department of our hospital between January and December 2019. The puerperas were divided into two groups with 100 cases each according to the random number table method. The control group received routine health care during pregnancy. The T-test and χ 2 test were used, while the observation group received midwifery-led group health care during pregnancy. The scores of maternal role adaptability, self-efficacy, weight control, delivery mode, breastfeeding, mental state, and quality of life was compared between the two groups. Results:After nursing, the mother′s role adaptability (63.14±9.38) and self-efficacy (34.16±2.89) scores in the observation group were higher than those in the control group (52.89±8.41 and 31.28±2.43, respectively) ( t=8.136, 7.627, P<0.05). The weight gain of the observation group in the third trimester [(3.68±1.22) kg] was less than that of the control group [(5.49±1.76) kg] ( t=8.452, P<0.05). The vaginal natural delivery rate of the observation group was 91% higher than the 71% of the control group (χ2=12.966, P<0.05), the cesarean section rate of the observation group was 9% lower than the 29% of the control group (χ2=12.966, P<0.05), and the exclusive breastfeeding rate in the observation group was higher than that in the control group ( χ2 =6.258, P<0.05). After nursing, the SAS (40.74±4.93) and SDS scores (42.16±5.07) of the observation group were lower than those of the control group (47.10±5.27 and 48.59±5.42, respectively) ( t=8.813, 8.664, P<0.05), and the four-dimension quality of life scores of the observation group were higher than those of the control group ( t=7.293, 7.406, 7.357, 8.767, P<0.05). Conclusion:A midwife-led group pregnancy care model can effectively enhance the self-efficacy of primiparas and improve their quality of life.

Objective To evaluate the effect of surgery-radiotherapy interval (SRI) on clinical prognosis of locally advanced stage c Ⅱ-Ⅲ breast cancer patients treated with neoadjuvant chemtherapy and modified radical mastectomy.Methods Clinical data of 1 087 breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy from 11 hospitals in China were retrospectively analyzed.The optimal threshold value of SRI upon clinical prognosis was determined by maxstat method.The effect of SRI on clinical prognosis was evaluated by using multivariate Cox regression analysis and propensity score matching (PSM).Results The median follow-up time was 72.9 months.The 5-year disease-free survival (DFS) and overall survival (OS) rates were 68.1％ and 81.8％.All patients were divided into SRI ≤18 weeks (n=917) and SRI＞ 18 weeks groups (n=170).Multivariate Cox regression analysis demonstrated that hormone receptor status (P＜0.001),pathological T stage (P＜0.001),pathological N stage (P＜0.001) and SRI (P=0.023) were independent influencing factors of DFS.Hormone receptor status (P=0.013),pathological T stage (P=0.006),pathological N stage (P＜0.001),endocrine therapy (P=0.013) and SRI (P=0.001) were significantly associated with OS.After balancing the clinical and pathological factors with PSM,patients with SRI＜ 18 weeks had superior DFS and OS to those with SRI＞ 18 weeks.Conclusions SRI affects the clinical prognosis of locally advanced breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy.Radiotherapy should be performed within 18 weeks after mastectomy.