Objective:To explore the relationships among workplace bullying,resilience and work perform-ance in nurses,employing a moderation and matching analysis perspective.Methods:A total of 3 026 nurses from 4 tertiary hospitals in Shandong Province were recruited.The Negative Acts Questionnaire Revised,Connor-Davidson Resilience Scale-10item,and Work Performance Scale were used to evaluate workplace bullying,psychological re-silience and work performance.Moderation analysis and response surface analysis were used to investigate the rela-tionships among workplace bullying,psychological resilience and work performance in nurses.Results:The results of the moderation effect analysis indicated that psychological resilience could moderate the negative relationship be-tween workplace bullying and work performance(β=0.07,95％CI:0.03-0.10).Response surface analysis re-vealed that compared to nurses with low bullying-low resilience,nurses with high bullying-high resilience showed higher work performance(Z-hat difference=2.06;95％CI=0.48-3.58).Nurses with high bullying-low resili-ence exhibited lower work performance compared to those with low bullying-high resilience(Z-hat difference=-8.31;95％CI=-12.06--5.68).Conclusion:Psychological resilience plays a moderating role in the negative effects of workplace bullying on job performance of nurses,and there are relative differences in work performance between individuals with different levels of workplace bullying and psychological resilience.

Advanced paternal age has been overlooked, and its effect on fertility remains controversial. Previous studies have focused mainly on intracytoplasmic sperm injection (ICSI) cycles in men with oligozoospermia. However, few studies have reported on men with semen parameters within reference ranges. Therefore, we conducted a retrospective cohort study analyzing the reproductive outcomes of couples with non-male-factor infertility undergoing in vitro fertilization (IVF) cycles. In total, 381 cycles included were subgrouped according to paternal age (<35-year-old, 35-39-year-old, or ≥40-year-old), and maternal age was limited to under 35 years. Data on embryo quality and clinical outcomes were analyzed. The results showed that fertilization and high-quality embryo rates were not significantly different (all P > 0.05). The pregnancy rate was not significantly different in the 35-39-year-old group (42.0%; P > 0.05), but was significantly lower in the ≥40-year-old group (26.1%; P < 0.05) than that in the <35-year-old group (40.3%). Similarly, the implantation rate significantly decreased in the ≥40-year-old group (18.8%) compared with that in the <35-year-old group (31.1%) and 35-39-year-old group (30.0%) (both P < 0.05). The live birth rate (30.6%, 21.7%, and 19.6%) was not significantly different across the paternal age subgroups (<35-year-old, 35-39-year-old, and ≥40-year-old, respectively; all P > 0.05), but showed a declining trend. The miscarriage rate significantly increased in the 35-39-year-old group (44.8%) compared with that in the <35-year-old group (21.0%; P < 0.05). No abnormality in newborn birth weight was found. The results indicated that paternal age over 40 years is a key risk factor that influences the assisted reproductive technology success rate even with good semen parameters, although it has no impact on embryo development.
Pregnancy ; Infant, Newborn ; Female ; Humans ; Male ; Adult ; Paternal Age ; Retrospective Studies ; Semen ; Fertilization in Vitro ; Reproductive Techniques, Assisted ; Oligospermia

Objective:To explore the application value of online and offline interactive teaching combined with three-dimensional quality theory mutual evaluation in the standardized residency training of general practitioners.Methods:Twenty-four general practitioners who were trained in The Second Hospital of Tianjin Medical University from January 2019 to December 2019 were selected as the control group, receiving traditional teaching; another 22 residents who were trained from March 2020 to February 2021 were selected as the observation group, taking online and offline interactive teaching combined with mutual evaluation of three-dimensional quality theory. After the training, the theoretical knowledge, skill operation and case analysis assessment scores, clinical ability and teaching satisfaction were compared between the two groups. SPSS 25.0 software was used for t test and rank sum test. Results:There was no significant difference in the scores of theoretical knowledge assessment, operation skills assessment, and case analysis assessment between the two groups before the training. After the training, the scores of the two groups were all increased, and the observation group had higher scores than the control group ( P<0.05). There was no significant difference in the scores of each dimension in the Direct Observation of Procedural Skills (DOPS) scale between the two groups before training, while after training, the scores of each dimension in the DOPS scale of the two groups were increased ( P<0.05), and the scores in the observation group were higher than those in the control group. The difference of mutual evaluation results after the training between the two groups was statistically significant, and the results of the observation group were higher than those of the control group ( P<0.05). Conclusion:The application of online and offline interactive teaching combined with mutual evaluation of three-dimensional quality theory in the standardized residency training of general practitioners can help improve the theory, skill practice, case analysis assessment performance and clinical ability of residents, and also obtain higher teaching satisfaction.

Objective: To examine the relative importance of four emotion regulation strategies (i.e. cognitive reappraisal, expressive suppression, rumination and mindfulness) in explaining job burnout and depression of nurses. Methods: We conducted a cross-sectional study with questionnaires for 1 037 nurses from two general hospitals. Maslach Burnout Inventory-Human Service Survey (MBI-HSS), the Patient Health Questionnaire-9 (PHQ-9), Emotion Regulation Questionnaire (ERQ), Ruminative Responses Scale (RRS) and Short Inventory of Mindfulness Capability (SIM-C) were assessed. Results: Dominance analysis revealed that in terms of job burnout, rumination, cognitive reappraisal and mindfulness could explain 41.38% (0.132/0.319), 30.09% (0.096/0.319) and 28.53% (0.091/0.319). In terms of depression, rumination and mindfulness could explain 68.6% (0.362/0.528)and 24.43% (0.129/0.528). Conclusions Rumination and mindfulness were important predictors of job burnout and depression of nurses. This study indicates that reducing ruminative responses and enhancement of mindfulness are the important approach to reduce nurses′ job burnout and depression.

Objective:To investigate the characteristics of posttraumatic stress disorder (PTSD) symptom and posttraumatic growth (PTG) in the patients with burns during rehabilitation, and the relationships among PTSD symptom, PTG, neuroticism and resilience.Methods:A cross-sectional study was carried out among 110 patients with burns during rehabilitation.The PTSD Check-list-Civilian Version (PCL-C), Posttraumatic Growth Inventory (PTGI), Five Factors Inventory-Neuroticism Subscale (FFI-N) and the 10-item Connor-Davidson Resilience Scale (CD-RISC) were used.Result:A significant effect of different groups of marital status (F=5.66, P=0.019), annual household income (F=7.97, P=0.006), and neuroticism (F=34.24, P＜0.001, Partial η2=0.259) on PCL-C scores.A significant effect of different groups of gender (F=6.44, P=0.013) and resilience (F=14.87, P＜0.001, Partial η2=0.132) were significant for PTG scores.There existed a significant interaction between neuroticism and resilience on PTG (F=4.47, P=0.037, Partial η2=0.044).Conclusion:Being married, low annual household income, and high levels of neuroticism were associated with high PTSD symptom levels.Being female and high levels of resilience were associated with high PTG levels.Resilience moderated the effect of neuroticism on PTSD symptoms.

Objective To explorepredictive factors of psychological stress reaction of medical staff members with blood-occupational exposure and to provides scientific basis for the hospital administrators toprovide psychological support and interventionfor medical staff members with blood-occupational exposure. Methods Seventy-eight medical staff members with blood-occupational exposure were recruited as participants. The Socio-demographic Questionnaire, Posttraumatic Stress Disorder Checklist-5, the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, the Ruminative Responses Scale and the Emotion Regulation Questionnaire were used to evaluate the participants' psychological stress reactionat different stages and the styles of their emotion regulation. Correlation analysis and Hierarchical Regression analysis were used to analyze the predictive factors of psychological stress reaction of medical staff members with blood-occupational exposure. Results Ruminative thinking and emotion regulation can predict the psychological stress reaction of medical staff members with blood-occupational exposure at different stages. Conclusions According to the psychological stress reaction and ruminative thinking of medical staff members with blood- occupational exposure, psychological intervention should be implemented within one month to decrease the psychological trauma of medical staff members with blood-occupational exposure.

Objective The aim of the longitudinal was to explore the level of posttraumatic growth (PTG) and the effect on rehabilitation outcome in patients who received renal transplant. Methods A questionnaire survey was carried out in patients after renal transplant in one month (T1) and six months (T2) in China during hospitalization. PTG was measured by the Posttraumatic Growth Inventory (PTGI), depression by the Patient Health Questionaire (PHQ-9), anxiety by the Generalised Anxiety Disorder Questionaire (GAD-7). Totally 180 patients were recruited, and 160 completed the follow-up measure. Data were analyzed using IBM SPSS 20.0. Results There were 88.3% (158/180) patients reported positive PTG in T1, and 94.3% (151/160) in T2. The mean score of posttraumatic growth at T1 and T2 had no significant difference (T1:77.96 ± 16.36,T2:79.54 ± 17.58;t=-1.302,P=0.195). PTG was not significant to the recovery of physical symptoms (χ2Creatinine=0.504,P=0.841,χ2recover=0.609,P=0.777, χ2complication=6.131,P=0.150), while it affected the incidence of anxiety (χ2=7.541, P=0.021), but not related with the incidence of depression (χ2=3.926,P=0.130). Conclusions There is no difference in the level of PTG in time. PTG has no obvious effect on body health recovery for patients with renal transplantation after six months, while for the mental health, PTG has no effect on depression symptoms, but can reduce the occurrence of anxiety symptoms.

Objective To compare the differences and clinical value of prognostic evaluation between American Joint Committee on Cancer (AJCC) TNM staging system 7th edition and 8th edition for gastric cancer (GC).Methods The retrospective case-control study was conducted.The clinicopathological data of 1 383 GC patients who were admitted to the First People's Hospital of Changzhou between January 2008 and August 2012 were collected.Distal gastrectomy,proximal gastrectomy + pyloroplasty or total gastrectomy were performed according to preoperative evaluation and intraoperative exploration.Observation indicators:(1) surgical and postoperative situations;(2) follow-up and survival situations;(3) T staging comparison between AJCC TNM staging system 7th edition and 8th edition;(4) N staging comparison of AJCC TNM staging system 8th edition;(5) prognostic analysis in N staging of AJCC TNM staging system 8th edition;(6) TNM staging comparison between AJCC TNM staging system 7th edition and 8th edition;(7) prognostic analysis in different TNM staging between AJCC TNM staging system 7th edition and 8th edition.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to October 2017.Measurement data with normal distribution were represented as x ± s.Measurement data with skewed distribution were described as M (range).The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.Results (1) Surgical and postoperative situations:1 383 GC patients underwent successful radical gastrectomy,including 923 with distal gastrectomy,165 with proximal gastrectomy and 295 with total gastrectomy.Of 1 383 patients,115 with postoperative complications were improved by symptomatic treatment,including 87 with surgical complications and 28 with non-surgical complications.Postoperative pathological examinations:total number of intraoperative lymph node dissection and number of lymph node metastasis were 25± 12 and 7±4;577 didn't have lymph node metastasis and 806 had regional lymph node metastasis;308 were in early GC and 1 075 in advanced GC.(2) Follow-up and survival situations:1 383 patients were followed up for 1-117 months,with a median time of 34 months.The 1-,3-and 5-year survival rates of 1 383 patients were respectively 90.5％,71.9％ and 61.1％.(3) T staging comparison between AJCC TNM staging system 7th edition and 8th edition:T staging definition between AJCC TNM staging system 7th edition and 8th edition was identical.T staging of 1 383 patients:308,192,65,628 and 190 were respectively detected in T1,T2,T3,T4a and T4b stagings.(4) N staging comparison between AJCC TNM staging system 7th edition and 8th edition:N staging definition between AJCC TNM staging system 7th edition and 8th edition was identical.N staging of 1 383 patients:577,255,207,230 and 114 were respectively detected in N0,N1,N2,N3a and N3b stagings.N3a and N3b were classified as N3 staging of AJCC TNM staging system 7thedition,but they were classified as independent staging of AJCC TNM staging system 8th edition.(5) Prognostic analysis in N staging of AJCC TNM staging system 8th edition:5-year survival rate of patients in N0,N1,N2,N3a and N3b stagings was respectively 85.6％,76.5％,59.4％,45.2％ and 32.5％ based on AJCC TNM staging system 8th edition,with a statistically significant difference in survival (x2 =394.400,P＜0.05).There was a statistically significant difference between N0 and N 1 stagings (x2 =45.630,P＜0.05),between N 1 and N2 stagings (x2 =19.470,P＜0.05),between N2 and N3a stagings (x2 =7.602,P＜0.05) and between N3a and N3b stagings (x2=13.020,P＜0.05).(6) TNM staging comparison between AJCC TNM staging system 7th edition and 8th edition:TNM staging of 366 patients had changes,including 2 in T1N3b staging,2 in T2N3b staging,18 in T3N3b staging,120 in T4aN2 staging,149 in T4aN3a staging,34 in T4bN0 staging and 41 in T4bN2 staging;364 were detected in staging Ⅲ in 7th edition and 8th edition,and sub-staging of staging Ⅲ had a change;2 in T1N3b of ⅡB staging were redistricted into Ⅲ B staging based on AJCC TNM staging system 8th edition.(7) Prognostic analysis in different TNM staging between AJCC TNM staging system 7th edition and 8th edition:according to 7th edition,cases and 5-year survival rate were respectively 247,89.5％ in Ⅰ A staging and 147,83.7％ in Ⅰ B staging and 77,75.9％ in ⅡA staging and 207,70.5％ in ⅡB staging and 136,61.0％ in ⅢA staging and 236,37.5％ in Ⅲ B staging and 333,35.4％ in Ⅲ C staging,with a statistically significant difference in survival among sub-stagings (x2 =228.800,P＜0.05).There was a statistically significant difference in survival among Ⅰ,Ⅱ and Ⅲ stagings (x2=189.000,P＜0.05) and between ⅢA and ⅢB or ⅢC stagings (x2=22.710,18.010,P＜0.05).There was no statistically significant difference in survival between Ⅰ A and Ⅰ B stagings (x2=0.179,P＞0.05),between Ⅱ A and Ⅱ B stagings (x2 =0.265,P＞0.05),and between Ⅲ B and Ⅲ C stagings (x2 =1.550,P＞0.05).According to 8th edition,cases and 5-year survival rate were respectively 247,89.5％ in Ⅰ A staging and 147,83.7％ in Ⅰ B staging and 77,75.9％ in Ⅱ A staging and 205,70.7％ in Ⅱ B staging and 288,53.8％ in ⅢA staging and 258,37.3％ in ⅢB staging and 161,28.5％ in ⅢC staging,with a statistically significant difference in survival among sub-stagings (x2=234.900,P ＜ 0.05).There was no statistically significant difference in survival between Ⅰ A and Ⅰ B stagings (x2 =0.179,P＞0.05) and between Ⅱ A and ⅡB stagings (x2 =0.564,P＞0.05).There was statistically significant differences in survival between Ⅲ A and Ⅲ B or ⅢC stagings (x2 =29.790,43.060,P＜0.05) and between Ⅲ B and Ⅲ C stagings (x2 =7.494,P＜0.05).Further analysis showed that changes of TNM staging system between 7th edition and 8th edition were in T3N3b,T4aN2,T4aN3a,T4bN0 and T4bN2 stagings,5-year survival rate in above stagings was respectively 16.7％,35.8％,30.2％,47.1％ and 26.8％,with statistically significant differences in survival between T3N3b and T4aN2,T4aN3a,T4bN0 and T4bN2 stagings (x2 =19.590,8.039,12.070,3.853,P＜0.05),between T4aN2 and T4aN3a,T4bN2 stagings (x2 =6.529,3.859,P ＜ 0.05),between T4aN3a and T4bN0 stagings (x2 =10.400,P＜0.05) and between T4bN0 and T4bN2 stagings (x2=4.636,P＜0.05).There was no statistically significant difference in survival between T4aN2 and T4bN0 stagings (x2 =3.607,P＞0.05) and between T4aN3a and T4bN2 stagings (x2 =0.029,P＞0.05).Conclusions Compared with AJCC TNM staging system 7th edition,N3a and N3b stagings are classified as independent staging in AJCC TNM staging system 8th edition,and 8th edition is more accurate in prognostic evaluation of GC patients in stage Ⅲ.

Objective:To probe into the status characteristics and the dynamic change trend of the psychological stress among medical staff at four time points after exposed to blood-borne pathogen.Methods:A longitudinal study was carried out among 78 medical personnel in this study,with 67 of hepatitis B virus,5 of hepatitis C virus,4 of HIV and 2 of treponema pallidum respectively.Perceived stress scale (PSS-4),Post-traumatic stress disorder Checklist-5 (PCL-5),Hospital anxiety and depression scale (HADS) were used to assess the psychological status,including perceived stress,post-traumatic stress symptom,anxiety and depression at the four times.Data analysis was performed using repeated measures analysis of variance (RMANOVA) and paired sample t test to explore time effect of the psychological stress reaction in the exposed population.Results:The scores of PSS-4,PCL-5,HADS-A,and HADS-D increased from exposure,and gained highest at one month after exposed,then gradually declined with time (Ps ＜ 0.05).Conclusion:It suggests that the levels of perceived stress,post-traumatic stress symptom,anxiety,depression may be the highest at one month after exposed.

Objective To probe into the relationship of the cumulative effect of childhood trauma types and symptoms of depression and anxiety among pregnancy women. Methods A total of 276 cases of pregnancy women were investigated by using Childhood Trauma Questionnaire (CTQ- SF), the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). Results The cumulative number of childhood trauma types were positively correlated with the scores of EPDS, state anxiety and trait anxiety (r=0.245, 0.262 and 0.292, P<0.01);the scores of CTQ-SF, EPDS, state anxiety and trait anxiety of multi-CTQ group were higher than that of non-CTQ group, as well as the positive rate of depression symptom and anxiety symptom (P<0.05 or 0.01);Logistic regression analysis showed that the cumulative number and accumulation group of CTQ may be predictors or risk factors of depression and anxiety of women during pregnancy, and existed cumulative effect. When the cumulative number of childhood trauma types more than two types, it increased 2.37 and 3.12 times likelihood of depression and state anxiety comparing to non-CTQ group. Conclusions It suggested that childhood trauma experience may be a risk factors of depression and anxiety during pregnancy, and exist cumulative effect.