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Objective To analyze clinical characteristics of severe community-acquired pneumonia during pregnancy and its outcomes, and to explore the relevant risk factors. Methods From September 2012 to September 2017,324 398 pregnancies admitted in 7 tertiary hospitals were included. Clinical data of 33 cases of pregnancies with severe community-acquired pneumonia(severe pneumonia group)and 214 cases of pregnancies with common community-acquired pneumonia (control group) were reviewed retrospectively, including the clinical information, manifestations, laboratory examinations and pregnancy outcomes. Relevant risk factors were analyzed by multivariate logistic regression analysis. Results (1) General data: pregnancies with severe community-acquired pneumonia accounted for 0.010%(33/324 398) of hospitalized pregnancies, the gestational age of two groups were(28±8)and(23±8)weeks, body mass index were(21.7±2.1)and(25.5±3.4)kg/m2, rate of low income were 54.5%(18/33)and 31.8%(68/214), respectively. The differences between two groups were all statistically significant(all P<0.05). No significant differences were found in age, pregnancy and parity times, rate of main pregnant complications such as diabetes and hypertension, educational level, asthma and onset seasons between two groups(all P>0.05). (2)Clinical data: the severe pneumonia group had significantly higher incidence of fever [100.0%(33/33)vs 75.2%(161/214)], shortness of breath(90.9% vs 16.8%)compared with the control group(all P<0.05).The median peripheral leukocytes counts were 12.3×109/L and 10.2×109/L, the hemoglobin level were(84±18) and(107±14)g/L,the albumin level were(26±4)and(37±3)g/L, the median serum urea nitrogen level were 3.7 and 2.4 mmol/L,the serum creatinine level were(72±25)and(45±11)μmol/L, respectively in two groups. The differences were all statistically significant (all P<0.05). No significantly statistical differences were found in coagulation indicator and cardiac function between two groups(all P>0.05).(3) Treatments: in severe pneumonia group, 12 patients(36.4%,12/33)needed invasive mechanical ventilation, 9 patients(27.3%,9/33)needed non-invasive mechanical ventilation, average time of mechanical ventilation was(7±4)days;8 patients(24.2%,8/33)with septic shock needed vasoactive drugs. However, there was no patient in control group needing mechanical ventilation and vasoactive drugs.(4)Pregnant outcomes: one patient(3.0%,1/33)died in the severe pneumonia group, while no death occurred in the control group. The hospital stay between two groups were(15.1±4.1)and(7.0±1.9)days, the rates of abortion and stillbirth between two groups were 42.4%(14/33)and 3.3%(7/214), the rates of premature were 10/19 and 6.3% (13/207), the rates of cesarean were 15/19 and 43.0%(89/207), the rates of low birth weight newborn were 17/19 and 14.0%(29/207), the rates of infected newborn were 15/19 and 10.1%(21/207), the birth weights were(2 165±681)and(3 102±400)g, respectively. The differences between two groups were all statistically significant(all P<0.05).(5)Multivariate logistic regression analysis demonstrated that anemia, low body mass index, hypoproteinemia were risk factors for severe pneumonia in pregnancy(all P<0.05). Conclusions Pregnancy with severe community-acquired pneumonia may be complicated by multiple organ dysfunctions, lead to adverse outcomes. Anemia, malnutrition are risk factors for pregnancy with severe pneumonia. Active and effective treatment may improve its prognosis.
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Objective To understand the correlation between health beliefs and family environment of stroke patients. Methods A questionnaire survey was carried out on 115 stroke patients with the first onset of stroke by using the special health belief simple table (SF-HBMS) and the family environment scale (Chinese version FES-CV), and the correlation was analyzed. The scores of each subscale of the family environment were compared with the domestic norm. Results The total score of health belief (75.15 ± 10.20) was at the middle level. There were significant differences in age (F=8.41), education level (F=4.44), complications (F=4.05), family history (t=2.68) and first visit time (F=3.76) among different characteristics of health belief scores (P < 0.01 or 0.05). The score of intimacy (6.23 ± 1.27) in family environment, emotional expression score (5.30 ± 1.97), success score (5.88 ±1.62), cultural score (4.54 ± 2.20) and organizational score (5.60 ±1.67) were all lower than the domestic norm and spear. The score of shield score (3.16 ± 2.00) was higher than that of domestic norm (P<0.01 or 0.05), and the total score of health belief was positively correlated with family intimacy (r=0.190), emotional expression (r=0.204), culture (r=0.206) and tissue (r=0.227) (P<0.05), and was negatively correlated with the contradiction (r=-0.186, P<0.05); regression analysis, whether there were family history (β=0.338, P<0.01), first onset time (β=0.242, P<0.01), family intimacy (β=1.614, P<0.05), emotional expression (β=1.114, P<0.05) were the factors affecting the health belief level of first stroke patients. Conclusions The level of health belief is closely related to family environment. It is suggested that the clinical medical staff should pay attention to the negative emotion and family psychological intervention, provide psychological support for the patients and their families, promote the promotion of their health beliefs, and reduce the rate of recurrence and disability.
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Objective To investigate the correlation of self perceived burden, family cohesion and adaptability in advanced cancer patients. Methods The Chinese version self perceived burden scale (SPBS), Chinese version of family cohesion and Adaptability Scale (FACES-CV) were used to investigate 139 cases of patients with advanced cancer, and to analyze their correlation with family cohesion and adaptability compared with the norm. Results Patients' self perceived burden score (35.83 ± 5.59) points in the moderate level. The 3 dimensions of the item score from high to low was economic burden (4.12 ± 0.86), body burden (3.63 ± 0.53), emotional burden (3.49 ± 0.63); survey of patients with family cohesion and adaptability, intimacy score (67.96 ± 9.35) points, the ideal intimacy score (83.68 ± 6.05), satisfaction score (15.71 ± 9.39) points, were higher than the national norm, the actual adaptability score (48.00 ± 6.92) and ideal adaptability score (56.47 ± 4.99) points lower than the national norm, the difference was statistically significant (P<0.01 or 0.05). Patients' self perceived burden score and intimacy was negatively correlated (r=-0.186, P<0.05), and positively correlated with intimacy satisfaction (r=0.175, P<0.05). Regression analysis, gender (B=0.236, P<0.01), family medical burden (B=0.183, P<0.05), actual family cohesion (B=-0.111, P<0.05) was the influencing factors of patients' self perceived burden. Conclusions The burden of self perception in advanced cancer patients is closely related to family cohesion and adaptability. It is suggested that the medical staff should pay attention to the family psychological intervention and provide emotional connection for the patients and their families, so as to reduce the negative emotion of the patients with advanced cancer.
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In the background of the crisis of doctor-patient relationship and the effectiveness of medical humanities education doubts we need to think about how to achieve,transform and reflect the value of doctors' understanding on their professional meaning,how to realize the functional significance of doctorpatient cooperation and how to make doctors put themselves in patients' place by the curriculum and its operating mechanism.This paper discussed the external environment and the microcosmic environment from the externality and connotation of the humanities curriculum.And the way to reflect and achieve the value transformation of the medical humanistic curriculum in the mechanism of education was considered.This paper put forward combining the institutional mechanism of policy leading,the subject mechanism that is the basis of the curriculum,the constitutive mechanism of curriculum system and the cultural mechanism to make students study and internalize,and made some suggestions.