A randomised controlled trial of the effectiveness of a breastfeeding training DVD on improving breastfeeding knowledge and confidence among healthcare professionals in China.

BACKGROUND: Despite almost all babies being breastfed initially, the exclusive breastfeeding rate at six months is less than 30% in China. Improving professionals' knowledge and practical skill is a key government strategy to increase breastfeeding rates. This study aimed to test the effectiveness of a breastfeeding DVD training method for clinicians on improving their knowledge and confidence in the breastfeeding support skills of teaching mothers Positioning and Attachment (P & A) and Hand Expression (HE). METHODS: A randomised controlled trial was conducted in three hospitals in Zhejiang province, China in 2014. Participants were recruited before their routine breastfeeding training course and randomly allocated to intervention group (IG) and control group (CG). The 15 min "Breastfeeding: Essential Support Skills DVD" was the intervention for IG and a vaginal delivery DVD was used for CG. All participants completed questionnaires of job information, knowledge and confidence in the two skills before (baseline) and immediately after viewing the DVD (post DVD). RESULTS: Out of 210 participants, 191 completed knowledge assessments before and after watching the DVD (IG n = 96, CG n = 95), with the response rate of 91.0%. At baseline, there are no significant differences in job variables, total knowledge scores and confident scores. The total knowledge score significantly increased post-DVD for IG (pre-DVD: M = 5.39, SD = 2.03; post-DVD: M = 7.74, SD = 1.71; t (95) = - 10.95, p < 0.01), but no significant change in total knowledge score for CG between pre- and post-DVD (pre-DVD: M = 5.67, SD = 1.70; post-DVD: M = 5.56, SD = 1.63; t (94) = 0.85). The total confidence scores were significantly higher post-DVD than pre-DVD in IG (pre-DVD: M = 66.49, SD = 11.27; post- DVD: M = 71.81, SD = 9.33; t (68) = - 4.92, p < 0.01), but no significant difference was seen in CG between pre- and post-DVD total confidence scores (pre-DVD: M = 68.33, SD = 11.08; post-DVD: M = 68.35, SD = 11.40; t (65) = - 0.25). Personal and job variables did not mediate these effects. CONCLUSIONS: The breastfeeding training DVD improved professionals' knowledge and confidence of the two breastfeeding support skills. However, the effect on professionals' practice and on breastfeeding outcomes needs to be examined in the future.

[A case-control mortality study of migrant pregnant women in Zhejiang province].

OBJECTIVE: To explore the mortality factors of migrant pregnant women and learn the healthcare utilization status to provide efficient interventions. METHODS: A case-control study was conducted in Zhejiang province with a case-control ratio of 1: 4. Cases included migrant pregnant women who died. And controls were migrant pregnant women who survived and matched with single birth, age, hospital and gestational weeks. A questionnaire was used to survey social and demographic factors, healthcare status during antenatal or postpartum period and delivery conditions, etc. RESULTS: Seventy-two cases and 288 controls were recruited. There were significant differences in socio-demographic, antenatal care and obstetric complications between two groups (P < 0.05). No prenatal examination was an important factor affecting maternal mortality by multivariate conditional Logistic regression. CONCLUSION: Prenatal examination is an important influencing factor of maternal mortality. And improving the ability of utilizing health care system is an efficient method of lowering the migrant maternal mortality.

Value of P16 expression in the triage of liquid-based cervical cytology with atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions.

BACKGROUND: The management of atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesions (ASCUS/LSIL) is still controversial and it is advisable to make a triage for these two cytological abnormalities. P16(INK4) (P16) has been shown to be a potential biomarker for predicting high-grade cervical intraepithelial neoplasia (CIN) and cervical cancer. The aim of the study was to determine the value of P16 expression by immunostaining method compared with high-risk human papillomavirus (HR-HPV) DNA test in the triage of ASCUS/LSIL women. METHODS: Totally 86 eligible residual liquid-based cytological specimens with ASCUS and 45 with LSIL were obtained. All specimens were submitted to HR-HPV DNA test (HC2) and P16 immunocytochemical staining simultaneously. And all women underwent colposcopy and biopsy after cytology. RESULTS: The positive rate of P16 staining was 32.6% in ASCUS and 42.2% in LSIL, which was significantly lower than that of HR-HPV test in both ASCUS (P < 0.05) and LSIL (P < 0.05). Moreover, the positive rate of P16 staining was 12.7% in normal histology, 61.5% in CIN 1, 87.0% in CIN 2-3, and 100.0% in cancer, in which P16 positive rate was significantly lower than HR-HPV positive rate in normal group. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of P16 staining for predicting CIN 2 or more were 87.5%, 68.6%, 38.9%, 96.0%, and 72.1%, respectively in the ASCUS; while 90.0%, 71.4%, 47.4%, 96.2% and 54.7%, respectively in the LSIL, in which the specificity and accuracy of P16 staining were significantly higher than those of HR-HPV test in both ASCUS and LSIL (P < 0.05). CONCLUSION: P16 immunostaining had significantly higher specificity and accuracy than HR-HPV DNA test for predicting for high-grade CIN and cervical cancer in ASCUS and LSIL and can be used for the triage of women with ASCUS/LSIL cytological abnormality.

[Evaluation of P16(INK4α) expression in Thinprep cervical specimens for the predication of high-grade cervical intraepithelial neoplasia].

OBJECTIVE: to explore the value of P16 in the predication of high-grade cervical intraepithelial (HGCIN) by P16 expression in cervical specimens. METHODS: one hundred ninety-two residual ThinPrep samples were collected and detected by HPV DNA test and P16 detected by immunocytochemistry. All women underwent colposcopy and histological examination of biopsy specimen if needed. P16 test, cytology and HR-HPV DNA (HC2) test were compared based on histological examination of colposcopic biopsies. RESULTS: (1) the expression of P16 showed 16.3% in normal or inflammatory cases, 46.7% in CIN 1, 93.8% in CIN 2, 91.1% in CIN 3 and 100.0% in carcinoma. A positive relation between P16 and the grade of cervical lesions was observed by Spearman analysis (P < 0.05, r = 0.900). (2) By P16 test, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for ≥ CIN 2 were 94.1%, 78.5%, 77.7%, 94.4% and 85.4% respectively. By HR-HPV DNA test, the sensitivity, specificity, PPV, NPV and accuracy for ≥ CIN 2 were 95.3%, 56.1%, 63.3%, 93.8% and 73.4% respectively. By cytological test, the sensitivity, specificity, PPV, NPV and accuracy for ≥ CIN 2 were 82.4%, 92.5%, 89.7%, 86.8% and 88.0% respectively. There were significant difference of specificity, PPV and accuracy between P16 and HR-HPV DNA (P < 0.05). And no significant difference of accuracy was found between P16 and cytology (P > 0.05). CONCLUSION: the specificity, PPV and accuracy of P16 are significantly higher than those of HR-HPV DNA. Thus P16 test is valuable to diagnose HGCIN in ThinPrep specimens.

[Comparison of midazolam and propofol as conscious sedation in oocyte retrieval of IVE-ET].

OBJECTIVE: To compare the efficacy and safety of midazolam combined with fentanyl and propofol combined with fentanyl as conscious sedation in oocyte retrieval of in vitro fertilization and embryo transplantation (IVF-ET). METHODS: Eighty patients receiving IVE-ET were randomly divided into midazolam combined with fentanyl group (midazolam group) and propofol combined with fentanyl group (propofol group). Antalgic effects, circulation status (blood pressure, heart rate), respiration status (rate, oxygen saturation and respiration depression) during operation, nausea and vomiting, and amnestic effects after operation were compared. RESULT: No differences of antalgic effects and circulation status between two groups were observed. Percentages of respiration depression,vomiting and amnesia of midazolam group were 5.0 %, 10.0 % and 25%, respectively, and those of propofol group were 25%, 27.5% and 7.5%, respectively, which had statistical significance. CONCLUSION: As conscious sedation, midazolam combined with fentanyl is better than propofol combined with fentanyl in oocyte retrieval of IVF-ET.

[Effects of endogenous histamine on memory impairment induced by pentylenetetrazole-kindled epilepsy in rats].

OBJECTIVE: To investigate the mechanisms of memory impairment induced by pentylenetetrazole (PTZ)-kindled epilepsy in rats and the effects of endogenous histamine. METHODS: Rats were injected i. p with a subconvulsive dose of PTZ every 48 h until fully kindled. Memory was tested by shuttle box with passive avoidance. Brain histamine was measured spectrofluorometrically. Neurons of hippocampus were investigated with HE stain. RESULT: PTZ-kindled epilepsy caused memory impairment in rats, i .e. latency of passive avoidance was shortened in shuttle box. Pretreatment of histidine, the precursor of histamine, showed an ameliorating effect on memory impairment induced by epilepsy. Decreased histamine contents in the hippocampus, thalamus and hypothalamus were observed after fully kindled in rat. In addition, intact neurons of the CA1 and CA3 regions in hippocampus decreased to 72.7 % and 78.9 % compared with those in control group. CONCLUSION: PTZ-kindled epilepsy causes memory impairment, and it might be due to a decrease of brain histamine and loss of hippocampal neurons induced by epilepsy.