湖北农村婴幼儿急性呼吸道感染管理与应用研究

1990年9月～1993年3月对孝感、老河口两市农村儿童生存状况;ARI对儿童生存的影响;ARI病例管理的科学性、适用性,乡村医生的可接受性和推广应用的可行性;ARI管理与评估方法进行研究。结果:两市IMR分别为45.08‰和34.59‰,U5MR分别为55.34‰和41.35‰,肺炎分别为25.9％和26.8％,婴儿肺炎死亡专率分别为842.6/10万和975.1/10万;228例ARI症状与X线诊断相关分析,呼吸增快与听诊罗音敏感性相同(t=0.77,P>0.05),可为轻度肺炎诊断依据,胸凹陷特异性高(90.19％),可为重度肺炎诊断依据。两市两年监测,1990～1992年IMR由39.04‰降至26.06‰,U5MR由50.35‰降至35.95‰;婴儿肺炎死亡专率电1081/10万降至659/10万,肺炎在婴儿死亡中的构成比由24.80‰降至18.35％。     

无咳嗽症状小儿早期肺炎的临床诊断及误诊分析

目的无咳嗽症状的小儿早期肺炎的临床诊断及误诊研究。方法预先将我科医生分成三组:提醒组和两对照组(提醒组被告知要重视持续或反复高热及呼吸和心率,注意无咳嗽症状的支气管肺炎)。16个月共收集无咳嗽症状的支气管肺炎41例,然后对病例进行诊断及误诊分析。结果提醒组和两对照组在发现无咳嗽症状的支气管肺炎的例数有显著性差异,在首次诊断率、首次误诊率和复诊误诊率中提醒组和两对照组亦有显著性差异。结论要减少无咳嗽症状的支气管肺炎的误诊,儿科医生要重视发热病人,持续或反复高热、呼吸和心率增快的患儿应注意肺炎诊断,早期诊断有赖于及时行胸部影像学检查。     

急性呼吸道感染的健康教育研究

为制定急性呼吸道感染（ＡＲＩ）的健康教育方法、内容和教材提供科学依据,应用定性的专题人类学研究的方法在汉、回、藏、壮、侗等不同的民族地区收集母亲对儿童急性呼吸道感染的临床症状及体症的识别及当地术语,卫生资源的利用、就诊的行为和当地的文化习俗等进行急性呼吸道感染的健康教育研究。结果,非提示时,随着小儿年龄的增大,母亲对呼吸增快和呼吸困难的识别能力显著增强,宁夏回族母亲识别能力较好,汉族相对较差;患儿在就诊时,母亲主诉呼吸增快和／或呼吸困难占２７％;汉族母亲对肺炎症状和体症的认识程度以湖北最好,少数民族以宁夏回族最好;当小儿出现呼吸道症状后,母亲首先采取的措施是去村医生处就诊,其次是去医院;有过ＡＲＩ病史的患儿的母亲叙述在发现孩子生病的当天就去看病,而在卫生机构访谈的母亲中,只有广西、湖南的汉族母亲和广西的壮族母亲是这样做的。提示给母亲进行健康教育,提高她们对肺炎症状的识别能力很重要。     

小儿重症肺炎的诊治方法及体会

<正>小儿尤其是婴幼儿由于全身器官和免疫系统发育不成熟、呼吸道粘膜分泌型IgA分泌不足、咳嗽、咳痰能力弱、吞咽反射较差易致反流等原因,呼吸系统感染尤其是肺炎仍是儿科领域的常见病和导致死亡的主要因素。由于小儿急症尤其是重症肺炎起病快、来势猛、并发症多、常累及全身、典型表现常被掩盖或被忽略等,因抢救时间仓促易致诊治不当,导致病情进展恶化,甚至死亡。1诊断思路(一)首先确立肺炎①在急诊室首先注意呼吸频率在基层条件较差且情况较急时,可根据WHO儿童急性呼吸道感染防治规划强调呼吸加快是肺炎的主要表现,呼吸急促即可诊断肺炎(2个月呼吸≥60     

疫情防控中乡村医生的角色重塑与功能实践——基于突发公共卫生事件的分析

新冠肺炎疫情暴发背景下,乡村医生在疫情防控中的作用凸显。在村庄社会场域和乡村医疗空间中,乡村医生扮演着农村医疗卫生技术人员、农民健康守门人和村庄社会成员的多重角色,表现出专业性、制度性和乡土性的特征。乡村医生的专业性与制度性角色嵌入到其乡土性身份之中,通过乡村医疗场域重构机制和熟人社会信息交换机制,提升了乡村医生防疫能力,激活了乡村医生在疫情防控过程中的治理功能,并形成了乡村医生与村干部合作治理、联防联控的防疫格局,推动农村疫情防控的进展。对乡村医生多元角色内涵及其功能的理解为促进农村健康治理和推动农村医疗体制建设提供了改革方向。     

酚妥拉明辅助治疗小儿肺炎合并心衰报告

小儿肺炎是婴幼儿时期的常见病、多发病,如诊治不及时,可发生严重的心力衰竭及呼吸衰竭。笔者采用酚妥拉明辅助治疗小儿肺炎合并心力衰竭36例,获得较满意效果,现报告如下。1 诊断标准 除具有小儿肺炎临床表现:如咳嗽气喘,口周发绀,呼吸困难外,而出现下列症状者可诊断为肺炎合并心力衰竭:①突然出现显著的烦躁不安或躁动。②发绀和面色苍白明显加重,心音明显变纯。③呼吸突然加快超过60次/分,二肺布满细湿罗音。④心率突然增快超过 160～180次/分,不能用发热、呼吸困难、烦躁解释者。⑤肝脏在短期内进行性增大,超过肋下     

706代血浆治疗重症婴幼儿肺炎疗效观察

婴幼儿肺炎是一个常见病、多发病 ,重症婴幼儿肺炎病、死亡率较高 ,八年来我们在综合疗法基础上 ,应用 70 6代血浆抢救重症婴幼儿肺炎 ,取得较好疗效 ,现报告如下 :1　对象和方法1.1　对象　 1990年 3月～ 1998年 4月收治患儿 ,男性 41例 ,女性 37例 ,共 78例。起病 1～ 5天 ,生后 1月至 1岁 43例。 1岁至 3岁 35例 ,其中 6 2例在当地医疗单位经过综合性治疗。所有病例经物理检查 ,Ｘ线胸透诊为婴幼儿肺炎 ,且存在以下表现 :①呼吸困难 ,呼吸增快 ,安静时呼吸频率在每分钟5 0次以上或低于每分钟 30次 ,而出现呼吸节律改变或 /及呼吸暂停者 ,…     

吐泡泡,肺炎的信号?

口吐泡泡是肺炎的一种表现 对于溜溜家人的不解,医生解释说,婴幼儿肺炎患者,特别是新生儿、早产儿,很多时候症状并不明显,不一定发烧、咳嗽.除了发烧、咳嗽这样的典型肺炎症状以外,有时候一些不典型症状也是患肺炎的信号之一,比如小婴儿吃奶减少、口吐泡泡、呼吸增快、口唇三角发青等.临床上像溜溜这样的新生儿肺炎患者口吐泡泡,主要是因为他们的气管又短又窄且呈漏斗状,呼气时肺内气体通过狭窄的气管冲出,将其中的痰液通过呼吸道冲出口腔,气体通过污浊的痰液时便产生了泡泡.     

妇幼卫生项目对降低贫困地区儿童主要疾病发病和死亡的作用

为了分析妇幼卫生综合项目对降低贫困地区儿童主要疾病发病和死亡的作用 ,2 0 0 1年选取青海、云南省卫生 项目县和对照县各 1个 ,现场收集项目实施以来儿童主要疾病的发病和死亡资料 ,同时调查获得 41份乡村医生问卷和 475份家长问卷。结果显示项目县乡村医生急性呼吸道感染急重症的诊断和口服补液指导技术比较好 ,家长接受健康教育的次数、知识和行为均明显优于对照县 (P<0 .0 1 )。与 1 997年相比 ,2 0 0 0年项目县 5岁以下儿童肺炎发病率和死亡率明显降低 ,儿童腹泻发病率虽然在此期间下降不显著 ,但死亡专率下降速度大于对照县。提示妇幼卫生综合项目的实施对增强家长自我保健能力、提高乡村医生的卫生服务水平、提高家长对服务的利用 ,降低儿童肺炎、腹泻的发病和死亡起到了积极的作用     

肺炎病儿的家庭护理

肺炎是婴幼儿的常见病,好发于冬春两季。婴幼儿之所以易患肺炎,是由于呼吸系统生理解剖上的特点,如气管、支气管腔狭窄、粘液分泌少,纤毛运动差,肺弹力组织发育差,血管丰富易于充血,肺泡数少,肺含气量少,易被粘液所阻塞以及免疫功能较弱等。这些内在的因素不但使幼儿容易发生肺炎,而且发生后也较严重。婴幼儿肺炎表现为:发热、咳嗽、咽部有痰、呼吸增快急促,病情严重的还会发生呼吸困难、鼻翼扇动、喘气憋     

Nutritional correlates of acute respiratory infections

During October 1992 to June 1993 in eight villages covered by the Primary Health Center Machhra in Meerut District, India, interviews with mothers and examinations of 1600 children aged less than 5 years (under-fives) were conducted to examine the relationship between acute respiratory infection (ARI) and malnutrition. 42.25% of all children had an ARI within the last 15 days. Most ARIs (73.4%) were considered mild (cough and cold with no pneumonia). Pneumonia accounted for 19.5% of all ARI cases, which were considered moderate. The remaining ARI cases were severe (severe and very severe pneumonia). 57.5% of all children suffered from protein energy malnutrition (PEM). 78.6% of children aged 12-14 months had PEM. ARI was more common among malnourished children than well-nourished children (52.2% vs. 28.8%; p 0.001). The incidence of ARI increased as the nutritional status deteriorated (p 0.05). It also increased as the midarm circumference decreased (p 0.001). These findings confirm the synergistic action between malnutrition and infection, in this case ARI. Malnourished children suffer considerable impairment in immunity, especially cellular immunity, which makes them more prone to ARI. These findings reinforce the need to strengthen the quality, quantity, and accessibility of nutritional services, particularly promotion of breast feeding and vitamin A supplementation.     

Cooking smoke increases the risk of acute respiratory infection in children

Acute respiratory infections (ARI) are a major cause of illness among children throughout the world, with an estimated 4.1 million children under age 5 in developing countries dying from ARI annually. ARI is the leading cause of childhood death in India. Data collected in India's 1992-93 National Family Health Survey (NFHS) indicate that 1 in every 15 children sampled under age 3 had experienced ARI during the 2 weeks before the survey. At the same time, about 75% of households in the survey reported using wood or animal dung as their main source of energy for cooking. Analysis of the data found that children under age 3 living in households which use wood or animal dung as their primary cooking fuel have an almost one-third higher risk of ARI than do children living in households which use cleaner fuels, even after controlling for a number of other variables. The effects of cooking smoke on ARI rates are most likely greater than what has been estimated. Considerable childhood morbidity and mortality from ARI could be prevented by reducing indoor air pollution from biomass fuels used for cooking.     

Management of acute respiratory infections in children: evaluation in Rio de Janeiro health care facilities

The goal of this article was to assess quality of case management for acute respiratory infection (ARI) in children and to detect barriers to proper management. A cross-sectional approach was used with a representative sample of primary and out-patient health care facilities under the Rio de Janeiro Municipal Health Department. Physicians were observed while attending children under five years of age with ARI, and the children were then evaluated according to standard criteria, and the results compared. Physicians were interviewed and health care facilities evaluated for availability of antibiotics. We studied 29 facilities (two hospitals, 20 health centers, and seven health posts), interviewed 46 physicians, and observed 267 children. Sensitivity of the classification used to detect pneumonia was 21.8 (95% CI: 9.3-40.4), specificity was 77.3 (95% CI: 70.3-82.4), and accuracy was 70.6 (95% CI: 64.7-75.5). Antibiotics were prescribed unnecessarily for 8.9% of ARI cases. Standard antibiotics were available in all the health care facilities. We conclude that quality of ARI case management in children can be improved substantially, especially with more training and supervision and better organization of services.     

The role of health education in promoting acceptance of an ARI control project

In India, acute respiratory infection (ARI) is responsible for 20% of all annual deaths of children under 5 years old (600,000-800,000 deaths). Children have from 3 to 5 ARI episodes a year. Thus, it is important to inform communities about ARI prevention and control. Health education activities of ARI control projects should convey knowledge, improve attitudes, and encourage health-inducing practices in such a way that a community should voluntarily assume responsibility to actively prevent and control ARI in children. These activities should empower communities to identify and report ARI in children, provide home care and supportive therapy, use the UIP cover to protect all infants, promote breast feeding, reduce indoor air pollution, and cooperate with health workers in ARI control as well as use oral rehydration therapy as soon as diarrhea starts. To design an effective health education program, planners need to interview a sample of the local population to learn the people's knowledge, attitudes, and practices toward ARI in children. Any ARI health education program should also include UIP, oral rehydration therapy, maternal and child health, and family welfare. The health educator can use 1 or more educational methods. Discussion is a 2-way process of exchanging ideas and should raise questions about ARI control, provide answers, and yield solutions. If an educator chooses the demonstration method, he or she should take the target audience to a health facility so the staff can demonstrate the clinical signs of a child with ARI, including the fast breathing, chest indrawing, cyanosis, wheezing, and stridor. The display method involves audiovisual aids, such as posters, puppet shows, and films. The health educator can use any of these methods when dealing with individuals, groups, or crowds. He or she must attune the approach and materials to the values of the community and present them so the individual can readily adapt the messages into his or her way of living.     

儿童维生素A缺乏对感染性疾病的影响

目的:了解儿童血清维生素A缺乏(vitamin A deficiency,VAD)与感染性疾病的关系。方法:采取整群分层抽样抽取福建省9个地市3178名5岁以下儿童,检测维生素A,对其疾病史进行询问。结果:近3个月患急性呼吸道感染(ARI)、腹泻的儿童维生素A缺乏患病率为明显高于正常儿童;有腹泻的儿童维生素A缺乏患病率为无腹泻的2.37倍;等级剂量分析显示,发现腹泻次数越多,儿童维生素A缺乏患病率越高;有呼吸道感染的儿童维生素A缺乏患病率明显高于无呼吸道感染儿童,存在明显差异。结论:亚临床VAD是引起儿童发生急性感染性疾病的重要原因之一。婴儿早期预防应从服用鱼肝油开始,多食胡萝卜、肝脏等维生素A含量高的食物才是预防维生素A缺乏的根本方法,也是最有效、最迅速、经济的手段;同时口服维生素A对感染性疾病是一项有效而廉价的预防和辅助治疗的措施。     

Acute respiratory illness in children: PHC responses

Acute respiratory illness (ARI) is one of the major health problemsand killers of young children. Along with diarrhoea, immunizablediseases, malnutrition and antenatal and intranatal insults,ARI contributes to about 75% of child mortality in developingcountries. Evidence is clear that much of the mortality andmorbidity from ARI is preventable. Specific efforts to decreaserisks of ARI have been proposed and the development of new vaccinesis being pushed. The use of antibiotics for lower respiratorytract infections is well accepted and of known efficacy in bacterialinfections. The evidence from developing countries demonstratingthat a high proportion of pneumonias involve bacterial infectionand the documentation of the effectiveness of simple antibioticregimens have convinced many that the time is ripe to introducecontrol efforts for ARI much more actively into primary healthcare programmes. This involves a number of controversial issuesincluding making antibiotics more available at the primary carelevel, special training of health care workers to give injections,potentials for misuse and development of antibiotic resistance.But the deaths of 4 million children a year demand that we moveas rapidly into this programme as possible, all the while strivingto identify more effective approaches.     

Acute respiratory infections in children: a community based longitudinal study in south India

A community based longitudinal study was conducted in Malpe, a coastal village of Udupi district, Karnataka state, to investigate acute respiratory infections (ARI) in children. A cohort of 91 children under 3 years of age were followed up for 1 year, leading to 2047 fortnightly observation. On an average every child had 11.3 months of follow up. The overall incidence of ARI was 6.42 episodes per child per year. On an average each episode lasted for 5.06 days. Mean duration of ARI during one year was 32.5 days per child. Most of the ARI episodes in children (91.3%) were of simple Cough & Cold (no pneumonia). However, 8.2% developed pneumonia and only 0.51% had severe pneumonia. Incidence of ARI was almost same in male and female children. There was no significant difference in incidence among various age groups. But the incidence of pneumonia was significantly higher among infants (p<0.00002). Children of poor housing with smoke producing conditions suffered more frequently (p,002).     

The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries.

This article reviews the available evidence of mortality from acute respiratory infections (ARI) among children aged under 5 years in contemporary developing countries and compares the findings with European populations before 1965. In European populations before 1965, the level of mortality was found to be a determinant of the proportion of deaths due to ARI. There were marked differences according to regional patterns of mortality. Deaths from ARI played a smaller role after 1950, when the use of antibiotics became generalized. In developing countries, the role of ARI mortality seems to be similar to the European experience. The age pattern is very marked. In absolute values, ARI mortality is highest in the neonatal period and decreases with age. In relative values, ARI mortality is highest in the postneonatal period. ARI, mainly pneumonia, accounts for about 18% of underlying causes of death in developing countries. Pneumonia and other ARI are frequent complications of measles and pertussis; ARI is also commonly found after other infections and in association with severe malnutrition. Virtually no data are available in developing countries to provide final estimates of the role of ARI in mortality of children aged under 5 years. However, the WHO figure of 1 out of 3 deaths due to--or associated with--ARI may be close to the real range of the ARI-proportional mortality in children of developing countries. Results are discussed in light of the definitions of ARI used in various studies, the difficulties in ascertaining and coding multiple causes of death and the quality of data from some sources.     

Burden of acute respiratory infections in a family cohort in Iran

Acute respiratory infections (ARIs) are the most important infectious cause of death, but there is less information of their burden in the community. This study describes the burden of ARI in a cohort of 50 Iranian families visited weekly over 2 months. Eighty-one out of 113 (72%) children and 29/103 (28%) adults had a total of 124 episodes of ARI. Seventy-five per cent of the episodes occurring in children were primary/co-primary compared to 40% of those in adults (P<0.01). Children were more likely to be the first symptomatic cases and infections were frequently transmitted within the family. Frequencies were lowest among adults, low among infants aged <6 months and highest among children aged <5 years (P<0.01). Winter episodes occurred more frequently in January (P<0.01). The high frequency and apparent transmissibility of ARI in this cohort highlights its enormous burden in the community.     

Knowledge, attitude and practice factors in childhood acute respiratory infections in a peninsular Malaysia health district

This study compares the knowledge, attitudes and practice of mothers in two ethnic groups with regard to acute respiratory infections (ARI) in their child. Most had traditional beliefs as to the cause of ARI with only a minority knowing the causes. Most mothers were aware of the effect of frequent attacks of ARI on the health status of their child and of the importance of early treatment. Reasons for their becoming worried during an episode of ARI in their child indicated that problems of distance, transportation and arrangements for care of their other children predominate. A large proportion of the respondents felt that their present knowledge of ARI was inadequate and were thus interested in obtaining more information.