Analysis of the Effect of Midwives’ Psychological Care Intervention on the Progress of Labor and Cesarean Rate of Elderly Women in Labor

Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control group and the observation group.In addition to the routine perinatal nursing interventions,the observation group strengthened the implementation of midwives’psychological nursing interventions.The duration of labor,mode of delivery,psychological state,and stress response indexes of the two groups were analyzed and compared.Results:The observation group had a shorter duration of all labor stages and total duration of labor than the control group,a lower cesarean section rate than the control group,and a higher degree of improvement in anxiety,depression,and stress response indexes in the 3-day postpartum period as compared to the control group(P<0.05).Conclusion:The implementation of midwife psychological care intervention in perinatal care of elderly women can further shorten the duration of labor,reduce the cesarean section rate,and improve the psychological state and stress indicators,which is worth promoting.

Parity and carotid atherosclerosis in elderly Chinese women

Background The relationship between parity and atherosclerosis has been reported in some ethnic populations.However,results regarding Chinese women are still lacking.This study aimed to investigate the association of parity and carotid atherosclerosis,which has a predictive value of subsequent atherosclerotic events in elderly Chinese women.Methods A total of 2,052 participants from the medical examination center of the Third Xiangya Hospital were enrolled in the study.A standardized,structured questionnaire was administered to collect information on subjects’demographic characteristics,socioeconomic status,and cardiovascular risk factors.High-resolution ultrasound was used to examine carotid plaques and carotid intima-media thickness(IMT).Results The mean age of participants was 66.1±5.5 years.Women with more birth appeared to have a higher risk of carotid artery plaques.A multivariate-adjusted model yielded an odds ratio of 1.38(95%CI:12%-70%,P=0.003)per birth.A positive association was observed between parity and common carotid IMT(β±SE:0.029±0.006,P<0.001),and internal carotid IMT(β±SE:0.011±0.005,P=0.03)in a univariate model;however,these associations became non-significant in multivariate-adjusted models.When common carotid IMT was classified into an IMT≥1 mm group and an IMT<1 mm group,higher parity was associated with more obvious thickening both in the unadjusted model(OR=1.61,95%CI:1.29-2.00,P<0.001)and in the fully adjusted model(OR=1.43,95%CI:1.09-1.88,P=0.01).Conclusions There is a positive association between parity and risk of carotid plaques,as well as between parity and risk of obvious thickening for common carotid IMT in elderly Chinese women,indicating multiparous women might experience more atherosclerotic challenges.

Modified Gant procedure for treatment of internal rectal prolapse in elderly women

BACKGROUND Although rectal prolapse is not a life-threatening condition,it can cause defecation disorders,anal incontinence,sensory abnormalities,and other problems that can seriously affect quality of life.AIM To study the efficacy of the modified Gant procedure for elderly women with internal rectal prolapse.METHODS Sixty-three elderly female patients with internal rectal prolapse underwent the modified Gant procedure.The preoperative and postoperative anal symptoms,Patient Assessment of Constipation Quality of Life(PAC-QOL),Wexner incontinence score,incontinence quality of life score,and complications(massive hemorrhage,infection,anorectal stenosis,and anorectal fistula)were compared.RESULTS The improvement rates of postoperative symptoms were defecation disorders(84.5%),anal distention(69.6%),defecation sensation(81.4%),frequent defecation(88.7%),and anal incontinence(42.9%)(P<0.05).All dimensions and total scores of the PAC-QOL after the procedure were lower than those before the operation(P<0.05).The postoperative anal incontinence score and Wexner score were significantly lower than those before the procedure(P<0.05).The quality of life and total scores of postoperative anal incontinence were significantly higher than those before the procedure(P<0.05).There were no serious complications and no deaths.CONCLUSION The modified Gant procedure has significant advantages in the treatment of elderly women with internal rectal prolapse.

Characteristics of Body Composition and Relationship between Muscle Mass and Muscle Strength among Elderly Women in Different Age Groups

Age-related changes in the body composition of older adults differ among age groups. The purpose of the present study was to clarify the characteristics of body compositions in young (age, 65 - 74 years;yE group) and old (age, ≥75 years;oE group) elderly women, and compare the relationship between muscle mass and strength in elderly women with that in young women for preventing motor function loss in older adults. A total of 30 elderly and 45 young women aged ≥ 65 and 19 - 22 years, respectively, participated in this study. The participants underwent body composition measurement via bioelectrical impedance analysis and examinations of handgrip and leg muscle strength. The age-related body composition changes varied among age groups. Compared with young women, fat-free mass (FFM) in the yE group did not decrease significantly;however, fat mass (FM) and waist-hip ratio (WHR) were significantly greater. Compared with the yE group, decreases in FFM, FM, and WHR in the oE group were significant;furthermore, the decrease in FM measurements was attributed to the loss of FM in the trunk and limbs (upper and lower). The measurement results suggested that the greater FM decrease in the oE group was characterized by decreases in both visceral and subcutaneous fat. In the yE group, the muscle mass was comparable to that in young women;however, there was a remarkable reduction in the lower-limb muscle mass (9% - 10%). In the oE group, muscle mass was reduced in all body parts, including upper and lower limbs and trunk. In young women, significant positive correlations between muscle mass and muscle strength in the upper and lower limbs were observed. No such correlations in the lower limbs were found in elderly women, indicating that muscle mass is not proportionally reflected in muscle strength. In conclusion, for improving and maintaining the health of elderly women, especially those above the age of 75 years, it is important to maintain muscle mass, including muscle strength, and prevent the loss of muscle quality.

Exclusive Hormonal Therapy in Breast Cancer in Elderly Women:Clinical Response and Survival over 10 Years

Breast cancer is the first cancer of women in the world and in France.In very elderly patients,the treatment options are often very limited.Neoadjuvant hormone therapy has shown similar or even better results than chemotherapy.This is why we decided to evaluate the clinical response following exclusive hormonal therapy and the 5,then 10 years survival in these very elderly women.This was a retrospective,longitudinal cohort-type study with descriptive and analytical purposes.The study population consisted of 59 patients,with an average age of 85 years.Fifteen(15,25%)of our patients had a complete clinical response after two years of treatment,16(27%)a partial clinical response,23(39%)lesion stabilization and 5(9%)cancer progression.The presence of metastasis at diagnosis increased the risk of cancer progression by 2.84.Overall 5-year survival was 72.5%,and breast cancer mortality 5.88%.The 10-year survival was 27.5%and breast cancer mortality 15%.In the age group 85 and over increased the risk of death by 3.25 in the first 10 years of treatment.The clinical response after 2 years was marked by a low rate of cancer progression.Mortality over 5 and 10 years was mostly related to patient comorbidities.

Practices and Knowledge on the Prevention of Cervical Cancer in Elderly Women

Cancer is a public health problem, primarily in developing countries. Elderly women are more prone to contracting different diseases, including sexual related neoplasms. The aim of this study was to determine the strategies used and knowledge regarding the prevention of cervical cancer in elderly women. This is a cross-sectional observational study. The sample was comprised of elderly women residents from the Brazilian Northeastern city who attended a coexistence group for elder people. After sample, calculation was obtained N of 209 participants. Associations between the independent and dependent variables were analyzed using the chi-squared test, considering p ≤ 0.05 as significant. The following programs were used for statistical analyses: Excel (Microsoft Office?), to tabulate the data and prepare the tables and Bioestat? 5.3 to test the associations. The prevalent age range was 60 to 70 years;most of the subjects were retired and had secondary schooling. Although a large number of those interviewed knew about cervical cancer, their knowledge was insufficient to take preventive measures. It is important that the elderly undergo a Pap smear, since the number of increasing cervical cancer cases is known to increase in this age range. In the coming decades, Brazil will have a significant elderly population, reaffirming the growing need for educational campaigns related to the health of elderly women, encouraging self-care and prevention in old age.

高龄二胎孕妇心理一致感的影响因素分析

目的调查分析高龄二胎孕妇的心理一致感评分及其相关影响因素。方法收集2017年10月至2021年5月我院妇产科收治的842例高龄二胎孕妇的临床资料,通过一般资料问卷、心理一致感量表(SCO-13)进行调查,分析高龄二胎孕妇心理一致感的影响因素。结果842例不同孕周高龄二胎孕妇的SCO-13评分为(58.22±6.18)分。单因素分析发现,不同SCO-13评分高龄二胎孕妇的年龄、体质量、妊娠期并发症、对胎儿性别期待、计划妊娠、孕周比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄≥40岁、体质量≥60 kg、妊娠期并发症、对胎儿性别期待、孕早期为影响高龄二胎孕妇SCO-13评分的危险因素,而有妊娠计划为影响高龄二胎孕妇SCO-13评分的保护因素(P<0.05)。结论高龄二胎孕妇心理一致感处于较低水平,年龄、体质量、妊娠期并发症、对胎儿性别期待、孕周、妊娠计划均为其影响因素。为提高心理一致感水平,临床可根据相关影响因素对高龄二胎孕妇进行针对性干预。

高龄产妇妊娠研究进展

对高龄产妇比例、特点、合并症与并发症发生现状、不良妊娠结局等进行综述,以期为高龄产妇围生期的个性化治疗提供指导。

高龄卵巢储备功能不全不孕患者使用非降调节方案行IVF/ICSI-ET助孕治疗的临床分析

目的比较4种非降调节方案应用于高龄卵巢储备功能不全(DOR)患者中的临床效果,为高龄DOR不孕患者选择最佳方案。方法回顾性分析2016年1月至2022年6月于广东医科大学附属医院生殖医学科采用非降调节方案行体外受精(IVF)/卵胞浆内单精子注射(ICSI)助孕的221例DOR不孕患者临床资料,根据促排卵方案不同将患者分为4组:A组为高孕激素状态下促排卵(PPOS)方案组(n=41)、B组为拮抗剂方案组(n=71)、C组为微刺激方案组(n=45)以及D组为黄体期促排卵方案组(n=64),比较4组患者的基本资料、促排卵情况、胚胎质量以及妊娠结局。结果4组患者的不孕类型、不孕年限、女方年龄、体质量指数、基础性激素(FSH、E2及LH)水平以及双侧窦卵泡(AFC)等基本资料差异均无统计学意义(P>0.05);促排卵结果中的卵母细胞成熟率、2PN率、2PN卵裂率、优胚数及优胚率差异均无统计学意义(P>0.05);临床妊娠结局比较中,胚胎种植率、临床妊娠率、活产率及早期流产率在4组患者间的差异也均无统计学意义(P>0.05)。4组患者的Gn启动剂量、Gn总量、Gn天数、HCG日LH值、获卵数、成熟卵母细胞数、2PN数、早发LH峰率、囊胚形成率以及周期取消率的比较,组间差异均有统计学意义(P<0.05)。进一步的两两比较结果显示:B组的Gn启动剂量显著高于其余3组(P<0.05);C组的Gn总量及Gn天数均显著低于其余3组,HCG日LH值显著高于其余3组(P<0.05);获卵数、成熟卵母细胞及2PN数比较中,B组显著高于D组(P<0.05);早发LH峰率比较中,C组显著高于A组和B组(P<0.05);囊胚形成率比较中,C组显著高于A组(P<0.05);其余两两比较均无显著性差异(P>0.05)。结论拮抗剂方案可为高龄DOR不孕患者提高临床获卵数,增加临床妊娠几率,是高龄DOR不孕患者可以优先考虑的方案;PPOS方案在Gn用量少于拮抗剂组的情况下,也可以获得较为理想的促排卵结局。

北京海淀地区中老年妇女骨质疏松性骨折情况调查研究

目的通过调查北京海淀地区121例住院骨质疏松性骨折患者,探讨骨质疏松性骨折的危害及流行情况。方法选取121例于2008年1月至2012年12月在解放军第309医院全军骨科中心出院的中老年女性骨质疏松性骨折患者,年龄≥50岁,通过电话随访完成问卷调查,将结果统计分析。结果121例骨折患者,年龄71.41±10.35岁,平均住院天数15.69±10.67天,平均住院费用4.05±2.86万元;骨折原因中,跌倒所致占60.33%,日常活动所致占36.36%,其他原因占3.31%;出院后有14.88%的患者再次发生骨折。所有骨折患者中脊柱骨折98例,髋部骨折23例,两组的平均年龄分别为69.74±10.21和78.48±7.76岁,住院天数分别为13.62±7.95和24.48±15.58天,平均住院费用分别为3.79±2.73和5.15±3.20万元,骨折原因中,脊柱骨折组和髋部骨折组因跌倒所致分别为53.06%和91.3%,骨折后脊柱骨折组和髋部骨折组生活完全不能自理的分别为5.10%和21.74%,以上结果均具有统计学差异(P<0.05)。所有患者骨折前使用抗骨质疏松药物的占14.87%,未进行任何治疗的占85.13%;骨折后使用抗骨质疏松药物治疗的有62.81%,未进行任何治疗的占37.19%。结论50岁以上女性骨质疏松性骨折患者,跌倒是首要致病因素,其中髋部骨折比脊柱骨折平均住院日更长,花费更多,危害更大。所有患者骨折前后的骨质疏松诊断率、治疗率均不足。

雌激素水平与老年妇女股骨颈骨折的相关性分析

目的通过分析雷洛昔芬辅助治疗老年妇女股骨颈骨折的效果分析,探讨雌激素水平与老年妇女股骨颈骨折的相关性。方法老年妇女股骨颈骨折患者110例根据随机数字表法分为治疗组与对照组各55例,两组都采用内固定治疗,对照组术后口服钙尔奇D600片,治疗组术后开始口服盐酸雷洛昔芬,两组患者都服药3个月。结果治疗组术后第1周与术后第3个月的疼痛评分都明显低于对照组,对比差异明显(P<0.05);同时两组组内不同时间点的疼痛评分对比也有统计学意义(P<0.05)。两组术后第1天的患侧髋部骨密度值对比差异无统计学意义,术后第3个月骨密度值都呈现明显上升的趋势(P<0.05),同时治疗组的骨密度值明显高于对照组(P<0.05)。治疗组在术后第1个月与术后第3个月的骨折愈合率分别为58.2%和92.7%,都明显高于对照组,对比差异有统计学意义(P<0.05)。在术后第3个月进行Harris评分,治疗组的优良率为96.4%,对照组优良率为80.0%,治疗组的优良率明显高于对照组(P<0.05)。结论老年妇女股骨颈骨折的发生与体内雌激素水平的下降有一定的相关性,而外源雌激素的加入能缓解疼痛,提高骨密度值,从而促进患者的康复。

有氧运动结合力量训练对中老年女性握力及功能性体适能的影响

目的:探讨有氧运动结合不同力量训练方法对中老年女性握力及功能性体适能的促进效果。方法:招募上海市杨浦区中老年女性120例,随机分为握力圈组、哑铃组和对照组(各40例),均进行有氧运动。前两组分别有各自的力量训练,每周3次,每次45min,共12周,对照组仅做有氧运动。干预前后分别测试握力、功能性体适能等指标。结果:干预前后,握力圈组握力有极显著提高(P<0.001),哑铃组握力也有明显提高(P<0.05),对照组的握力无显著差异;功能性体适能指标中,三个组在30s立坐、30s臂屈伸和2min原地踏步三项指标上均显著改善(P<0.05),双手后勾和座位体前屈仅握力圈组有显著增加(P<0.01),握力圈组和哑铃组8英尺立走时间有显著减少(P<0.01),对照组无显著差异。结论:有氧运动结合力量训练能够增强中老年女性的握力和改善中老年女性的功能性体适能,且较单纯有氧运动干预效果更为显著。

60岁以上女性乳腺癌150例治疗分析

目的总结60岁以上女性乳腺癌的临床治疗体会。方法回顾分析2002年10月—2010年9月收治的150例60岁以上女性乳腺癌的临床资料,并进行讨论。结果 150例患者中103例患者合并有其他系统的基础疾病,150例患者均接受手术,其中乳癌改良根治术116例,保乳手术5例,单纯乳房切除19例,乳房部分切除10例。术后辅助内分泌治疗127例,辅助放疗33例,辅助化疗115例(包括新辅助化疗55例)。随访125例,其中复发转移9例。结论老年乳腺癌患者应早诊断、早治疗,采用个体化原则,选择不同的手术方式以及不同的辅助治疗措施。

中年女性与老年女性正常行走足底压力分布特征

研究通过使用Rs-scan 2米测力板对10名中年女性(43.5±1.5岁)与10名老年女性(70.6±2.3岁)正常行走时足底压力、压强峰值和压力中心轨迹3个足底压力特征参数进行了比较和分析。结果显示:中年女性在行走时无论是在脚刚接触地面还是在离地时所用的力均大于老年女性;中年女性第一跖骨和足跟部位的肌肉活动和平衡能力控制优于老年女性;中年女性可以在身体其他部位运动的同时使踝关节产生更多的运动,并产生更大的水平力来确保压力中心处于支撑面范围内。

关于老龄女性化与农村老年妇女生存状况的思考——基于吉林省百村老年妇女生存现状调查

随着我国老年人口的增多,老龄女性化的趋势日益突出,老年妇女问题也逐渐凸显。但农村老年女性作为社会的边缘群体很少得到社会的关注。笔者针对"吉林省百村老年妇女生存现状调查"的结果进行研究,发现农村老年女性中存在着身体健康状况差、政治参与度低、文化娱乐资源匮乏、孤寡老年妇女贫困化程度高的生存问题。为此,笔者提出要推进老龄化社会下的性别主流化,改善老年妇女的生存状况,并提出对策建议。

体外受精-胚胎移植技术中高龄妇女的移植策略的选择

目的了解影响体外受精-胚胎移植(IVF-ET)结局的年龄界限值及探讨高龄妇女的移植策略。方法回顾性的分析本中心2008年1月至2010年10月行IVF-ET治疗,常规长方案患者的临床妊娠率及早期流产率,找出高龄患者的年龄分界点;并根据移植时间的不同将高龄患者分为D2、D3、D5新鲜周期移植组和D5复苏周期移植组,比较各组的胚胎耗损率及临床妊娠率、早期流产率。结果 37岁后患者的临床妊娠率急剧下降,早期流产率明显升高。≥37岁的患者,D2、D3、D5新鲜周期移植及D5复苏移植的胚胎耗损率分别为29.9%、55.2%、60.4%和61.6%;临床妊娠率分别为10.7%、26.8%、27.7%和45.9%,早期流产率分别为50.0%、24.4%、20.0%和22.2%。结论 37岁是本中心高龄妇女的年龄分界点;对高龄妇女行D5冻胚复苏移植,可以获得更好的临床结局。

农村社区中老年妇女肥胖及相关因素分析

目的分析安徽省农村社区中老年妇女肥胖患病率及其危险因素,为开展农村社区中老年妇女肥胖防治工作提供依据。方法采用整群抽样方法选择45岁及其以上的中老年妇女进行入户健康状况调查和体检。结果共调查3 319名中老年农村妇女,其中超重959人（标化率28.89%）,肥胖270人（标化率8.06%）,腹型肥胖为2 052人（标化率60.86%）。≥65岁年龄组妇女体质指数（BMI）低于其他年龄组,腰臀比高于其他年龄组。55～64岁中老年妇女超重和肥胖患病率均高于其他年龄组,≥65岁年龄组妇女的腹型肥胖患病率高于其他年龄组。Logistic回归分析结果表明,年龄、职业、睡眠时间、蔬菜摄入、蛋类摄入和水果摄入是肥胖的影响因素,其中,年龄小、蔬菜摄入多和蛋类摄入多为保护因素;职业（务农、务工和家务）、睡眠时间长和水果摄入多为危险因素。结论肥胖与多种危险因素密切相关,农村社区中老年妇女超重、肥胖和腹型肥胖患病率高,应积极开展健康知识教育,提高农村社区中老年妇女的保健意识和健康水平。

静吸复合麻醉与单纯静脉麻醉对老年子宫肌瘤腹腔镜切除术患者认知功能及应激指标影响

目的:探讨静吸复合麻醉与单纯静脉麻醉对子宫肌瘤腹腔镜切除术对老年患者认知功能及应激指标影响。方法:本院2018年1月30日—2019年5月30日行腹腔镜下子宫肌瘤切除术的100例老年患者,年龄≥65岁,随机数表法分为复合麻醉组(接受静吸复合麻醉)和单纯麻醉组(接受单纯静脉麻醉),每组50例。监测麻醉诱导前即刻(T0)、建立气腹前(T1)、建立气腹后(T2)、术后24h(T3)的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)。观察并比较两组苏醒指标及手术指标、不良反应发生情况。检测两组患者术后24h后外周血SOD、MDA水平。评估患者认知功能。结果:两组患者T0、T1、T2、T3时刻HR、MAP、CVP无差异,苏醒指标(苏醒时间、定向力恢复时间、恢复自主呼吸时间)及手术指标(手术时间、术中出血量)无差异(均P>0.05)。复合麻醉组术后24h SOD水平高于单纯麻醉组,MDA低于单纯麻醉组(P<0.05)。拔管后1h、6h,复合麻醉组认知功能评分高于单纯麻醉组(P<0.05)。两组不良反应发生率(4%、4%)无差异(P>0.05)。结论:静吸复合麻醉可改善腹腔镜老年子宫肌瘤切除术患者认知功能及氧化应激水平,且不影响血流动力学,安全性高。

高龄妇女疤痕子宫再次妊娠与非疤痕子宫再次妊娠结局的比较研究

目的分析高龄妇女疤痕子宫再次妊娠与非疤痕子宫再次妊娠的结局差异。方法随机选取2014年7月至2017年6月在梧州市红十字会医院接受治疗的高龄产妇疤痕子宫再次妊娠与非疤痕子宫再次妊娠产妇各150例,分别设为研究组和对照组。比较两组人员的妊娠并发症、妊娠合并症、围生儿结局、手术中出血量、术后24小时出血量和恶露时间等的差异。结果研究组和对照组产妇的羊水量异常、前置胎盘、胎盘黏连、子宫肌瘤、手术中出血量、术后24小时出血量和恶露时间比较,其差异均具有统计学意义(均P<0.05)。结论高龄妇女疤痕子宫再次妊娠比非疤痕子宫再次妊娠的风险性更高,产妇需要根据适应症,合理选择顺产或剖宫产。

乌拉地尔对合并高血压的老年女性急性射血分数保留性心力衰竭疗效分析

目的探讨乌拉地尔注射液对合并有高血压的老年女性急性射血分数保留性心力衰竭(HFpEF)的疗效。方法选取合并高血压的老年女性急性HFpEF患者68例,随机分为硝酸甘油注射液组34例和乌拉地尔注射液组34例,进行血液及超声心动图检查。分析乌拉地尔注射液对合并高血压的老年女性急性HFpEF的疗效。结果乌拉地尔注射液组收缩压在治疗72 h和7 d后下降较硝酸甘油注射液组明显(P<0.05)。2组舒张压和心率在各个时间点差异无统计学意义(P>0.05)。乌拉地尔注射液组中的NT-proBNP较硝酸甘油注射液组在72 h时有所降低,但差异无统计学意义(P>0.05),在治疗7 d时乌拉地尔注射液组的NT-proBNP较硝酸甘油注射液组的NT-proBNP下降更明显(P<0.05)。LVEF在2组中都随时间略有上升,但2组患者各时间点差异无统计学意义(P>0.05)。结论乌拉地尔注射液能在很好地控制血压同时不会引起反射性心率变化,说明乌拉地尔可以改善合并有高血压的老年女性急性HFpEF患者心脏功能。