Prevalence of Antibiotic Resistance and Virulence Genes in Escherichia coli Carried by Migratory Birds on the Inner Mongolia Plateau of Northern China from 2018 to 2023.

(1) Background: Antibiotic resistance in bacteria is an urgent global threat to public health. Migratory birds can acquire antibiotic-resistant and pathogenic bacteria from the environment or through contact with each other and spread them over long distances. The objectives of this study were to explore the relationship between migratory birds and the transmission of drug-resistant pathogenic Escherichia coli. (2) Methods: Faeces and swab samples from migratory birds were collected for isolating E. coli on the Inner Mongolia Plateau of northern China from 2018 to 2023. The resistant phenotypes and spectra of isolates were determined using a BD Phoenix 100 System. Conjugation assays were performed on extended-spectrum ß-lactamase (ESBL)-producing strains, and the genomes of multidrug-resistant (MDR) and ESBL-producing isolates were sequenced and analysed. (3) Results: Overall, 179 isolates were antibiotic-resistant, with 49.7% MDR and 14.0% ESBL. Plasmids were successfully transferred from 32% of ESBL-producing strains. Genome sequencing analysis of 91 MDR E. coli strains identified 57 acquired resistance genes of 13 classes, and extraintestinal pathogenic E. coli and avian pathogenic E. coli accounted for 26.4% and 9.9%, respectively. There were 52 serotypes and 54 sequence types (STs), including ST48 (4.4%), ST69 (4.4%), ST131 (2.2%) and ST10 (2.2%). The international high-risk clonal strains ST131 and ST10 primarily carried blaCTX-M-27 and blaTEM-176. (4) Conclusions: There is a high prevalence of multidrug-resistant virulent E. coli in migratory birds on the Inner Mongolian Plateau. This indicates a risk of intercontinental transmission from migratory birds to livestock and humans.

A p21-ATD mouse model for monitoring and eliminating senescent cells and its application in liver regeneration post injury.

Cellular senescence associates with pathological aging and tissue dysfunctions. Studies utilizing mouse models for cell lineage tracings have emphasized the importance of senescence heterogeneity in different organs and cell types. Here, we constructed a p21- (Akaluc - tdTomato - Diphtheria Toxin Receptor [DTR]) (ATD) mouse model to specifically study the undefined mechanism for p21-expressing senescent cells in the aged and liver injury animals. The successful expressions of these genes enabled in vitro flow cytometric sorting, in vivo tracing, and elimination of p21-expressing senescent cells. During the natural aging process, p21-expressing cells were found in various tissues of p21-ATD mice. Eliminating p21-expressing cells in the aged p21-ATD mice recovered their multiple biological functions. p21-ATD/Fah-/- mice, bred from p21-ATD mice and fumarylacetoacetate hydrolase (Fah)-/- mice of liver injury, showed that the majority of their senescent hepatocytes were the phenotype of p21+ rather than p16+. Furthermore, eliminating the p21-expressing hepatocytes significantly promoted the engraftment of grafted hepatocytes and facilitated liver repopulation, resulting in significant recovery from liver injury. Our p21-ATD mouse model serves as an optimal model for studying the pattern and function of p21-expressing senescent cells under the physical and pathological conditions during aging.

Production and prediction of hydroxyl radicals in distinct redox-fluctuation zones of the Yellow River Estuary.

Hydroxyl radicals (·OH) produced in subsurface sediments play an important role in biogeochemical cycles. One of the major sources of·OH in sediments is associated with reduced compounds (e.g., iron and organic matter) oxygenation. Moreover, the properties of iron forms and dissolved organic matter (DOM) components varied significantly across redox-fluctuation zones of estuaries. However, the influence of these variations on mechanisms of·OH production in estuaries remains unexplored. Herein, sediments from riparian zones, wetlands, and rice fields in the Yellow River Estuary were collected to systematically explore the diverse mechanisms of·OH generation. Rhythmic continuous·OH production (82-730 µmol/kg) occurred throughout the estuary, demonstrating notable spatial heterogeneity. The amorphous iron form and humic-like DOM components were the key contributors to·OH accumulation in estuary wetlands and freshwater restoration wetlands, respectively. The crystalline iron form and protein-like DOM components influenced the capabilities of iron reduction and continuous·OH production. Moreover, the orthogonal partial least squares models outperformed various multivariate models in screening crucial factors and predicting the spatiotemporal production of·OH. This study provides novel insights into varied mechanisms of·OH generation within distinct redox-fluctuation zones in estuaries and further elucidates elemental behavior and contaminant fate in estuarine environments. ENVIRONMENTAL IMPLICATION: Given that estuaries serve as sinks for anthropogenic pollutants, various organic pollutants (e.g., emerging contaminants such as antibiotics) have been widely detected in estuarine environments. The production of·OH in sediments has been proven to affect the fate of contaminants. Therefore, the varied mechanisms of·OH in estuarine environments, dominated by diverse iron forms and DOM components, were explored in this study. MLR and OPLS models exhibited good performance in screening crucial factors and predicting·OH production. Our work highlights that in estuarine subsurface environments, the presence of·OH potentially leads to a natural degradation of pollutants.

Psychological pathway to emotional exhaustion among nurses and midwives who provide perinatal bereavement care in China: a path analysis.

BACKGROUND: A lack of confidence in perinatal bereavement care (PBC) and the psychological trauma experienced by nurses and midwives during bereavement care leads to their strong need for sufficient organisational support. The current study intended to test a hypothesised model of the specific impact paths among organisational support, confidence in PBC, secondary traumatic stress, and emotional exhaustion among nurses and midwives. METHODS: A descriptive, cross-sectional survey was conducted in sixteen maternity hospitals in Zhejiang Province, China, from August to October 2021. The sample (n = 779) consisted of obstetric nurses and midwives. A path analysis was used to test the relationships among study variables and assess model fit. RESULTS: Organisational support directly and positively predicted confidence in PBC and demonstrated a direct, negative, and significant association with secondary traumatic stress and emotional exhaustion. Confidence in PBC had a positive direct effect on secondary traumatic stress and a positive indirect effect on emotional exhaustion via secondary traumatic stress. Secondary traumatic stress exhibited a significant, direct effect on emotional exhaustion. CONCLUSIONS: This study shows that nurses' and midwives' confidence in PBC and mental health were leadingly influenced by organisational support in perinatal bereavement practice. It is worth noting that higher confidence in PBC may lead to more serious psychological trauma symptoms in nurses and midwives. Secondary traumatic stress plays an essential role in contributing to emotional exhaustion. The findings suggest that support from organisations and self-care interventions were required to improve confidence in PBC and reduce negative psychological outcomes among those providing PBC. The development of objective measures for assessing competence in PBC and organizational support are essential.

Parents' experiences and need for social support after pregnancy termination for fetal anomaly: a qualitative study in China.

OBJECTIVE: The aim of this study was to explore the experiences and need for social support of Chinese parents after termination of pregnancy for fetal anomalies. DESIGN: A qualitative study using semistructured, in-depth interviews combined with observations. Data were analysed by Claizzi's phenomenological procedure. SETTING: A large, tertiary obstetrics and gynaecology hospital in China. PARTICIPANTS: Using purposive sampling approach, we interviewed 12 couples and three additional women (whose spouses were not present). RESULTS: Four themes were identified from the experiences of parents: the shock of facing reality, concerns surrounding termination of pregnancy, the embarrassment of the two-child policy and the urgent need for social support. CONCLUSION: Parents experienced complicated and intense emotional reactions, had concerns surrounding the termination of pregnancy and an urgent need for social support. Paternal psychological reactions were often neglected by healthcare providers and the fathers, themselves. These findings suggest that both mothers and fathers should receive appropriate support from family, medical staff and peers to promote their physical and psychological rehabilitation.

Predictors of pregnancy stress and psychological birth trauma in women undergoing vaginal delivery: a cross-sectional study in China.

BACKGROUND: Psychological birth trauma exhibits a high incidence worldwide, resulting in a wide range of negative impacts on mothers, infants, couples, families and society at large through the maternal-centered ripple effect. However, there is currently limited research on psychological birth trauma in China. Social support and pregnancy stress are important influencing factors of psychological birth trauma. Consequently, this study aimed to explore predictors of pregnancy stress and psychological birth trauma in women undergoing vaginal delivery in China. METHODS: This cross-sectional study was performed at a single medical center between December 2021 and May 2022 in Hangzhou, China. Participants were selected using a convenience sampling technique. A total of 351 postpartum women within one week after vaginal delivery were included. Questionnaires were used to collect sociodemographic and obstetric characteristics and scores on the Pregnancy Stress Rating Scale (PSRS), City Birth Trauma Scale (City BiTS), Social Support Rating Scale (SSRS) and Family Adaptation Partnership Growth Affection and Resolve index (Family APGAR). Both univariate analysis and multiple linear regression analysis were conducted to assess predictors of pregnancy stress and psychological birth trauma. RESULTS: The median (IQR) of PSRS and City BiTS scores were 10.00 (14.00) and 3.00 (9.00), respectively. The incidence of postpartum posttraumatic stress disorder was 4.0% (14/351). Parity, social support, family support and level of education were predictors of pregnancy stress. Delivery complications, psychological traumatic event, pregnancy stress and family support were predictors of psychological birth trauma (P < 0.05). CONCLUSION: Pregnancy stress is related to social support, family support and some sociodemographic and obstetric characteristics. Psychological birth trauma is correlated with delivery complications, psychological traumatic event, pregnancy stress and family support. Consequently, enhancing social support, especially family support, for pregnant women as a means of reducing pregnancy stress can effectively prevent psychological birth trauma.

Vibrio parahaemolyticus from Migratory Birds in China Carries an Extra Copy of tRNA-Gly and Plasmid-Mediated Quinolone Resistance Gene qnrD.

Vibrio parahaemolyticus is a marine bacterium coming from estuarine environments, where the migratory birds can easily be colonized by V. parahaemolyticus. Migratory birds may be important reservoirs of V. parahaemolyticus by growth and re-entry into the environment. To further explore the spreading mechanism of V. parahaemolyticus among marine life, human beings, and migratory birds, we aimed to investigate the characteristics of the genetic diversity, antimicrobial resistance, virulence genes, and a potentially informative gene marker of V. parahaemolyticus isolated from migratory birds in China. This study recovered 124 (14.55%) V. parahaemolyticus isolates from 852 fecal and environmental (water) samples. All of the 124 strains were classified into 85 known sequence types (STs), of which ST-2738 was most frequently identified. Analysis of the population structure using whole-genome variation of the 124 isolates illustrated that they grouped into 27 different clonal groups (CGs) belonging to the previously defined geographical populations VppX and VppAsia. Even though these genomes have high diversity, an extra copy of tRNA-Gly was presented in all migratory bird-carried V. parahaemolyticus isolates, which could be used as a potentially informative marker of the V. parahaemolyticus strains derived from birds. Antibiotic sensitivity experiments revealed that 47 (37.10%) isolates were resistant to ampicillin. Five isolates harbored the plasmid-mediated quinolone resistance (PMQR) gene qnrD, which has not previously been identified in this species. The investigation of antibiotic resistance provides the basic knowledge to further evaluate the risk of enrichment and reintroduction of pathogenic V. parahaemolyticus strains in migratory birds. IMPORTANCE The presence of V. parahaemolyticus in migratory birds' fecal samples implies that the human pathogenic V. parahaemolyticus strains may also potentially infect birds and thus pose a risk for zoonotic infection and food safety associated with re-entry into the environment. Our study firstly highlights the extra copy of tRNA as a potentially informative marker for identifying the bird-carried V. parahaemolyticus strains. Also, we firstly identify the plasmid-mediated quinolone resistance (PMQR) gene qnrD in V. parahaemolyticus. To further evaluate the risk of enrichment and reintroduction of pathogenic strains carried by migratory birds, we suggest conducting estuarine environmental surveillance to monitor the antibiotic resistance and virulence factors of bird-carried V. parahaemolyticus isolates.

The effect of exercise intervention on improving sleep in menopausal women: a systematic review and meta-analysis.

Background: Sleep disturbance is common in menopausal women and negatively affects their quality of life and could cause increased risks of other menopause-related diseases. Objective: This systematic review aims to synthesize evidence regarding the effects of exercise interventions on improving sleep in menopausal women. Methods: A comprehensive search in seven electronic databases for randomized controlled trials (RCTs) was performed on June 3, 2022. The systematic review included seventeen trials, ten of which provided data for the meta-analysis. The effects on outcomes were presented as mean differences (MDs) or standard mean differences (SMDs) and their 95% confidence intervals (CI). Cochrane risk-of-bias tool was used in quality assessment. Results: The results suggest that exercise intervention significantly reduces insomnia severity (SMD = -0.91, 95% CI = -1.45 to -0.36, Z = 3.27, P = 0.001) and alleviates sleep problems (MD = -0.09, 95% CI = -0.17 to -0.01, Z = 2.20, P = 0.03). For sleep quality, the results showed that insignificant differences were found between the exercise intervention and the control groups (MD = -0.93, 95% CI = -2.73 to 0.87, Z = 1.01, P = 0.31). The results of the subgroup analysis indicated that more apparent effects of exercise intervention were found among women with sleep disorders than among women without sleep disorders. Which exercise intervention duration was more beneficial to sleep outcomes could not be judged. Overall, there was a moderate risk of bias in the primary studies. Conclusion: According to this meta-analysis, exercise interventions can be recommended for menopausal women to improve their sleep. High-quality RCTs applying different types of exercise (e.g., walking, yoga, meditative exercise and so on) with different intervention durations as well as subjective and objective sleep assessment are warranted. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022342277, identifier: CRD42022342277.

Characteristics of Carbapenem-resistant Klebsiella pneumoniae in sewage from a tertiary hospital in Jilin Province, China.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a serious problem in hospitals worldwide. We monitored a tertiary hospital in Changchun, Jilin Province, China, and found that CRKP was the major species among the carbapenem-resistant isolates in sewage. Subsequently, we evaluated the drug susceptibility, resistance genes, virulence genes, outer pore membrane protein-related genes (OmpK35 & OmpK 36), multi-locus sequence typing and replicons, biofilm formation capabilities, and resistance to chlorine-containing disinfectants among KP isolates. Identification of drug sensitivity, multiple resistance profiles were observed including 77 (82.80%) multidrug resistant (MDR), 16 (17.20%) extensive drug resistant (XDR). Some antibiotic resistance genes were detected, the most prevalent carbapenemase gene was blaKPC, and 16 resistance genes were associated with other antibiotics. In addition, 3 (3.23%) CRKP isolates demonstrated loss of OmpK-35 and 2 (2.15%) demonstrated loss of OmpK-36. In the detection of multi-locus sequence typing (MLST), 11 ST11 isolates carried virulence genes. The most common replicon type was IncFII. Biofilm-forming capabilities were demonstrated by 68.8% of the isolates, all of which were resistant to chlorine-containing disinfectants. The results of the study showed that antibiotic-resistant isolates, especially CRKP, could resist disinfectants in hospital wastewater, and improper treatment of hospital wastewater may lead to the spread of drug-resistant bacteria and their genes. Thus, these bacteria must be eliminated before being discharged into the municipal sewage system.

Experiences of obstetric nurses and midwives receiving a perinatal bereavement care training programme: A qualitative study.

Aim: To explore obstetric nurses and midwifery professionals' experiences with the Perinatal Bereavement Care Training Programme (PBCTP) after implementation. Design: A qualitative descriptive design was used. Method: This qualitative study was conducted at a tertiary level maternity hospital in China. The PBCTP was implemented at Women's Hospital School of Medicine, Zhejiang University from March to May 2022. A total of 127 nurses and 44 midwives were invited to participate in the training. Obstetric nurses and midwives studied a 5-module training programme comprised of eight online theoretical courses and submitted a reflective journal after each session. Semi-structured interviews were conducted with 12 obstetric nurses and four midwives from May to July 2022 as a post-intervention evaluation. Thematic analysis was used in data analysis. Findings: A total of 16 participants in this study ranged in age from 23 to 40 years [mean age (SD), 30 (4) years]. Six main themes within participants' experiences of PBCTP intervention were identified: participants' aims of undertaking the training; personal growth and practice changes after training; the most valuable training content; suggestions for training improvement; directions for practice improvement; influencing factors of practice optimization. Conclusion: Nursing and midwifery professionals described the PBCTP as satisfying their learning and skills enhancement needs and supporting positive changes in their care providing for bereaved families. The optimized training programme should be widely applied in the future. More efforts from the hospitals, managers, obstetric nurses, and midwives are needed to jointly contribute to forming a uniform care pathway and promoting a supportive perinatal bereavement care practice.

Art-based interventions for women's mental health in pregnancy and postpartum: A meta-analysis of randomised controlled trials.

Objective: Pregnant and postpartum women are vulnerable to psychological problems with a high estimated prevalence. To date, there is no meta-analysis that specifically assesses the effectiveness of art-based interventions to improve mental health in pregnant and postpartum women. The objective of this meta-analysis was to assess the efficacy of art-based interventions when delivered to pregnant and postpartum women. Methods: Systematic literature searches were conducted from the inception to 6 March 2022 in seven English databases, including PubMed, Embase, Cochrane Central Register, CINAHL, ProQuest, Scopus, and Web of Science. Randomised controlled trials (RCTs) reporting art-based interventions targeting the improvement of women's mental health in pregnancy and postpartum were included. Cochrane risk of bias tool was applied to assess evidence quality. Results: Twenty-one randomised controlled trials (RCTs) involving 2,815 participants were eligible for data analysis. A pooled analysis demonstrated that art-based interventions significantly reduced anxiety (SMD = -0.75, 95% CI = -1.10 to -0.40) and depression symptoms (MD = -0.79, 95% CI = -1.30 to -0.28). However, art-based interventions did not alleviate stress symptoms as expected in our findings. Subgroup analysis demonstrated that intervention implementation time, intervention duration and music selected by the participants vs. not could have influence on the efficacy of art-based intervention for anxiety. Conclusion: In perinatal mental health, art-based interventions may be effective in alleviating anxiety and depression. In the future, we still need to conduct high-quality RCTs to validate our findings and enrich clinical application of art-based interventions.

Prevalence of antimicrobial resistance and virulence genes in Klebsiella pneumoniae and Congenetic Raoultella Isolates from captive giant pandas.

To study antimicrobial resistance and virulence genes of Klebsiella pneumoniae and Raoultella strains isolated from captive giant pandas. Non-duplicate fecal samples were collected from 128 giant pandas during 2017-2019. All isolated microbial strains were tested for antimicrobial drug susceptibility using BD verification panels. Four extended-spectrum ß-lactamase resistance genes, nine virulence genes and six capsular serotype genes were detected using PCR. 42 K. pneumoniae and nine Raoultella strains were isolated from different giant pandas. Antibiotic resistance rates were 1.9%-23.5%, except for ampicillin, and 7.8% of the isolates were multidrug-resistant to 7-10 antibiotic classes. This is the first time that a multidrug-resistant R. ornithinolytica strain has been isolated from captive giant pandas. The blaTEM, blaCTX-M, blaSHV and blaDHA genes were detected in four MDR ESBL- K. pneumoniae strains. The rmpA, iutA, ybtS, iroN and iroB genes were positively detected in 11.7% of the isolates. Capsular serotype (K2, K5, K54 and K57) genes were all detected in four K. pneumoniae strains, and one was identified as hypervirulent. This study showed that MDR ESBL- K. pneumoniae, hypervirulent K. pneumoniae, MDR R. ornithinolytica and the colistin-resistant strain may pose risks to captive giant pandas and their keepers, and that the diversity of antibiotic resistance and virulence genes in Klebsiella and Raoultella should be monitored regularly.

Impact of contact with the baby following stillbirth on parental mental health and well-being: A systematic review and meta-analysis.

AIM: This study aims to identify and synthesize available research reporting parental mental health outcomes related to contact with a stillborn baby. BACKGROUND: Stillbirth is devastating events for parents. The effects of contact with the stillborn baby on parental mental health are uncertain. METHODS: This was a systematic review and meta-analysis carried out by searching six international electronic databases including PubMed, EMBASE, Cochrane, Web of Science, PsycINFO and CNKI databases from inception to 15 January 2023. Review Manager software was used for data analysis. RESULTS: Ten studies were included (n = 3974). Contact with a stillborn baby increased the risks of anxiety, depression and post-traumatic stress disorder in the short term and increased the risks of anxiety and post-traumatic stress disorder in the long term. Parents who had contact with a stillborn baby were more satisfied with their decision. Subgroup analysis showed that seeing a stillborn baby had no significant effect on anxiety or depression, but holding a stillborn baby increased the risks of anxiety. CONCLUSIONS: Caregivers should respect the parents' decision on whether to have contact with the stillborn baby and provide parents with continuous information, emotional and behavioural support after they have contact with stillborn babies.

Virulence genes and antimicrobial resistance in Enterococcus strains isolated from dogs and cats in Northeast China.

This study aimed to characterize the antimicrobial resistance and virulence of Enterococcus from dogs and cats in Northeast China and evaluate its zoonotic risk based on a total of 469 enterococci strains from 610 samples, including 238 strains of E. faecium and 128 strains of E. faecalis. The isolation rate from police dog samples was 93.79%, pet dog samples was 69.90% and pet cat samples was 76.67%. The differences in the prevalence of E. faecalis among different hosts were statistically significant (P<0.05). The assays showed that most of the virulence genes detected were existed in E. faecalis and police dogs carried the least number of virulence genes. The correlation between enterococcal surface protein (esp) and aggregation substance (asa1) was determined. Enterococci are most resistant to tetracycline and erythromycin, 68.92% of the isolates were classified as multiple drug resistant. Significant differences (P<0.01) were found between E. faecium and E. faecalis in the resistance rates of nine antimicrobials. Four positive and four negative correlations were found between virulence genes and antimicrobial resistance. The results show that Enterococcus colonization and excretion in dogs and cats were related to animal species and living environments. Some correlation between virulence factors and antimicrobial resistance was obtained. This study confirmed the presence of strains carrying multiple virulence factors and antimicrobial resistance at the same time, suggesting a public health risk for dogs and cats as reservoirs of enterococci.

Enhanced reductive degradation of chloramphenicol by sulfidated microscale zero-valent iron: Sulfur-induced mechanism, competitive kinetics, and new transformation pathway.

Crystalline iron sulfide (FeSx, i.e., FeS or FeS2) minerals as sulfur sources were used to prepare the mechanochemically sulfidated microscale zero-valent iron ((FeSx+ZVI)bm). Metastable FeS and FeS2 precursors were generated via aqueous coprecipitation and applied to fabricate FeSx@ZVI samples. (FeSx+ZVI)bm and FeSx@ZVI exhibited better chloramphenicol (CAP) degradation than ZVI due to the increase in specific surface areas, the decrease of electrochemical impedance, the formation of galvanic cells, and sulfur-induced pitting and local acidity. (FeSx+ZVI)bm had better CAP removal capacity than FeSx@ZVI under different S/Fe molar ratios, initial pH, and oxygen conditions. At the same time, FeSx@ZVI showed better electron utilization under oxic conditions, related to their Fe0 and sulfur spatial distribution. Nitro reduction and dechlorination of CAP by (FeSx+ZVI)bm produced nitroso, azoxy, amine, and monodechlorination products, while dechlorination was not involved in the degradation process of CAP by FeSx@ZVI. A new transformation pathway of nitroso-CAP to amine-CAP mediated by azoxy products is proposed via coupling a chain decay multispecies model and DFT calculations. The larger competitive reaction rates among O2, CAP, and its degradation products was determined by their lower LUMO energy. The contribution of direct electron transfer to nitro reduction was greater than that of atomic hydrogen, but the opposite was true for dechlorination. FeSx@ZVI had a larger DET contribution than (FeSx+ZVI)bm, and FeS2 promoted the DET contribution better than FeS. Toxicity assessment indicated that the rapid transformation of nitroso and azoxy products was crucial for eliminating the biotoxicity of CAP.

Nonpharmacological pain management interventions in medical and surgical abortion: A scoping review.

AIMS: The study aimed to present a broad overview of the research conducted and to synthesize evidence of the utility of nonpharmacological interventions for pain management in medical and surgical abortions. BACKGROUND: High-quality care for medical and surgical abortion requires pain to be managed effectively. However, women reported low satisfaction with pain management in abortion care. DESIGN: A scoping review design was employed. DATA SOURCES: No date limit was set. PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL, PsycINFO, ProQuest and Scopus were searched in April 2021. REVIEW METHODS: Arksey and O'Malley's framework was used. The Preferred Reporting Items for Systematic reviews and Meta-analysis extension-Scoping Reviews was followed. RESULTS: Fifteen studies were included. The results revealed that support interventions, music therapy, acupoint stimulation and hypnotic analgesia were nonpharmacological interventions used to decrease abortion pain. CONCLUSIONS: Clinical nurses, nurse managers and policymakers should attach full importance to the pain management in abortion and may use the study findings to guide the pain management practice.

A clinical Pseudomonas juntendi strain with bla IMP-1 carried by an integrative and conjugative element in China.

Objective: To precisely determine the species of a carbapenem-resistant Pseudomonas strain 1809276 isolated from the urine of a Chinese patient and analyze its integrative and conjugative element (ICE) 1276 formation mechanism. Methods: Single-molecule real-time (SMRT) sequencing was carried out on strain 18091276 to obtain the complete chromosome and plasmid (pCN1276) sequences, and average nucleotide identity (ANI) was used for precise species identification. The ICEs in GenBank with the same integrase structure as ICE 1276 were aligned. At the same time, the transfer ability of bla IMP-1 and the antibiotic sensitivity of Pseudomonas juntendi 18091276 were tested. Results: This bacterium was P. juntendi, and its drug resistance mechanism is the capture of the accA4' gene cassette by the Tn402-like type 1 integron (IntI1-bla IMP-1) to form In1886 before its capture by the ΔTn4662a-carrying ICE 1276. The acquisition of bla IMP-1 confers carbapenem resistance to P. juntendi 18091276. Conclusion: The formation of bla IMP-1-carrying ICE 1276, its further integration into the chromosomes, and transposition and recombination of other elements promote bacterial gene accumulation and transmission.

Effectiveness of the implementation of a perinatal bereavement care training programme on nurses and midwives: protocol for a mixed-method study.

INTRODUCTION: The psychological outcomes for many parents who experience perinatal loss depend on nursing staff's ability to provide effective bereavement support. However, most nurses and midwives lack the ability to provide bereavement care and suffer from heavy emotional burden. The study aims to investigate the effectiveness of the perinatal bereavement care training programme on nurses and midwives to increase their perinatal bereavement care confidence (PBCC) and to reduce secondary traumatic stress and emotional exhaustion. METHODS AND ANALYSIS: This study will follow a mixed methodology consisting of two stages. The first stage will adopt a pre/post repeated quasi-experimental design without a control group. The second stage will use a qualitative interview study. This study will be conducted in a tertiary maternity hospital in China in 2022-2023. Ethical approval was obtained from the institutional review board in January of 2020. Outcome measures will be assessed using the Chinese version of the PBCC, STS and the EE subscale of Chinese Burn-out Inventory at baseline, postintervention and at the 3-month follow-up. Participants will be interviewed to understand their perceptions of the training programme. ETHICS AND DISSEMINATION: This research protocol was approved by the Ethics Committee of the Women's Hospital School of Medicine, Zhejiang University (IRB no. 20210091). The results will be disseminated through peer-reviewed journals and academic conferences. TRIAL REGISTRATION NUMBER: ChiCTR2100049730.

Influencing factors of perinatal bereavement care confidence in nurses and midwives: A cross-sectional study.

BACKGROUND: Most nurses and midwives are not prepared to provide bereavement care. The conflict between the need for high-quality care of bereaved parents and the lack of confidence in providing perinatal bereavement care among nursing staff is becoming increasingly prominent in China. OBJECTIVE: To describe the current situation and identify influencing factors of perinatal bereavement care confidence (PBCC) among nurses and midwives in China. METHODS: This descriptive and cross-sectional survey was conducted in 2021. A convenience sample was created by recruiting 571 nurses and midwives in 11 hospitals in Zhejiang Province. Collected the data of PBCC, secondary traumatic stress (STS) and emotional exhaustion (EE) in this study. RESULTS: The average score of the PBCC was 67.83 ± 10.78. Average levels of STS were (23.32 ± 7.39) and EE (17.87 ± 8.62). PBCC was found to be most often associated with self-awareness, organisational support and training in perinatal bereavement care. CONCLUSIONS: Managers should take measures to improve PBCC and optimise perinatal bereavement care practice from the perspective of enhancing self-awareness of nursing staff, strengthening organisational support and providing training in perinatal bereavement care. The mental health of nursing professionals in the context of perinatal bereavement care needs to be emphasised. Nursing managers should make clear policies and establish a communication platform for nursing staff. Professional training should be conducted in the future.

Factors influencing parental posttraumatic stress disorder in cases of fetal abnormality requiring pregnancy termination in China.

PURPOSE: To estimate the prevalence of posttraumatic stress disorder (PTSD) among parents in cases of fetal abnormalities and associated factors. DESIGN AND METHODS: A cross-sectional study. The study sample comprised 169 couples who experienced fetal abnormalities. FINDINGS: We observed a high prevalence of PTSD. Fathers had similar levels of PTSD to those of mothers. Social support was an important protective factor against parental PTSD. In addition, a negative psychological reaction to the loss of a child in either the father or the mother affects the other spouse. PRACTICE IMPLICATIONS: This study emphasizes recognizing the importance of social support and of psychological interactions between mothers and fathers in PTSD intervention for parents.