贵州省“全面两孩”政策下产科床位供给与需求分析

目的:根据国家生育政策调整,了解贵州省产科床位配置、产科服务供给与利用现状,为合理调配产科床位资源提供政策建议。方法:通过问卷调查获取全省产科床位现状资料,采用灰色系统预测模型预测近5年出生人口数,利用卫生服务需求法对产科床位资源配置进行测算。结果:2017—2021年全省及各市(州)现有产科床位总量不能满足服务需求,供需比均小于1。结论:全省产科床位资源总量不足,利用与分布不平衡,应加强基层医疗保健机构产科床位资源的合理配置及高效利用。     

浦东新区产科床位和人力资源服务现状分析

目的了解浦东新区的产科床位、产科人力资源的现状以及存在的问题,并做出客观的评价,为浦东新区卫生行政部门制定缓解产科医疗服务供需矛盾的决策提供依据。方法使用统一调查表对区内的14家助产医疗机构产科床位使用情况和产科医护人员进行调查。结果①浦东新区14家助产医疗机构有8家连续3年床位使用率超过93％;②浦东新区产科床位和产科医护人员配置比例平均为1：0．92,产科医生平均助产服务效率为112．36％,助产士平均助产服务效率为116．19％;③产科医护人员对目前工作感到一般和不满意者占64．17％,不满意前5位原因分别是职业风险高、工作强度大、收入低、医患关系紧张、职称晋升困难。结论①浦东新区的产科床位配置不足;②浦东新区的产科医护人员配置不足;③产科医护人员的工作满意度状况令人担忧。     

2016—2020年青岛市床位资源配置标准与测算方法研究

目的:测算青岛市2020年床位资源配置标准,为青岛市2016-2020年区域卫生规划提供决策依据。方法：卫生服务需求法。结果：2020年青岛市总床位配置标准为68 290张,康复床位2 500张,老年护理床位12 708张,治疗床位53 100张,产科床位1 988张,儿科床位3 493张, 精神卫生床位4 781张,传染病床位1 404张。结论：床位资源配置在满足卫生服务需求的同时,须留有一定的弹性发展空间,以满足城市发展的需要,同时建议采用床位分类的管理方法。     

“全面二孩”政策下双流区基层妇幼卫生现状及建议

目的了解"全面二孩"政策实施后双流区基层妇幼卫生的现状,并提出可行性建议。方法通过资料汇总和定性访谈等方法对双流区现有妇幼卫生资源配置情况及存在的问题进行总结,并采用线性回归分析法和相关出生人口预测方法,对2016-2020年的出生人口总量进行预测。结果全区总计拥有产科床位115张,儿科床位106张,床位使用率分别达到102.6%和103.9%,2018年双流区出生人口最高将达到11 086人,远远超出双流区现有妇幼卫生服务能力。结论 "全面二孩"实施后,出生人口总量超出了现有妇幼卫生服务能力,给基层妇幼卫生提出了新挑战。基层助产机构要做好准备措施,正确应对,并抓住机遇,提高服务能力。     

武汉市产科床位与人力资源的配置和利用

目的了解2013-2016年武汉市产科床位与人力资源配置和利用以及变化情况,为迎接生育高峰制定相关政策提供参考。方法收集2013-2016年武汉市全部助产机构产科服务总量和基本情况数据,计算相关指标分析武汉市产科床位和人力资源配置及利用的变化。结果 2013-2016年全市活产数逐年增长,其中公立三级明显增长,公立一级及未评逐年递减。全市每千活产床位数逐年递减,公立二级、一级及未评和民营每千活产床位数均高于公立三级。全市产科床位使用率维持在70.0%~73.0%之间,其中公立三级最高维持在90.0%左右。相比2014年,2016年全市每千活产医生数减少,产科医生年人均门诊量和助产服务效率增加,年人均担负床位数减少,其中公立三级3项指标均高于公立二级、一级及未评和民营。结论调整生育政策对武汉市公立三级和一级及未评的助产机构影响大,其中公立三级床位利用相对紧张,产科医生相对不足,而公立一级及未评存在产科床位和人力闲置,并逐步停止助产服务的现象。     

基于地理信息系统的区县老年护理床位配置方法研究

老年护理床位是养老护理资源中的核心部分,养老护理床位的设置规划对合理利用卫生资源,缓解老年护理床位一床难求的现状需求具有重大意义。老年护理床位配置问题可以分解为在哪里配置、配置多少和配置什么性质床位的问题。运用基于地理信息系统(GIS)的"引力法"模型,结合对老年人开展抽样调查,能够计算区县范围内的每个居委会的老年护理床位地理可及性,体现居民需求,并以地图的形式直观表达,从而较合理地解决上述问题。     

上海市产科服务现状调查

目的:了解全市产科服务现状,为政府出台应对生育高峰的决策提供依据。方法:2012年6月通过统一问卷对全市所有助产机构进行现况调查,结合专题现场调研。结果:全市2012年1～5月分娩90 239人,同比增加14.33%;其中3家三级专科医院分娩20 333人,7家二级专科医院分娩20 429人。全市2012年1～5月产科初诊建卡孕妇94 227人,同比增加26.81%;其中3家三级专科医院建卡18 141人,7家二级专科医院建卡25 908人。全市产科医师1 164人,产科护士2 032人,助产士963人,产科B超医生221人;其中三级专科医院的产科医生186人,产科护士415人,助产士116人,产科B超医生44人。全市产科开放床位3 889张,其中3家三级专科医院的开放产科床位755张,7家二级妇幼保健院的产科床位850张;3家三级专科医院的床位使用率106.09%,四家危重孕产妇救治中心使用率都超过100%。床位与人员比为1∶1.07。结论:产科人员不足,产科服务的供需矛盾集中凸显"结构性"问题,服务对象集中于专科医院和三级医院呈现"重心上移",而使服务资源出现"超负荷"与闲置并存现象,急需以"缓解短期矛盾和解决深层次问题"双管齐下为原则,从供需两方考虑解决对策。     

嘉兴市医疗保健机构产科服务能力调查

目的了解嘉兴市医疗保健机构的产科服务能力,为提高医疗保健服务质量提供依据。方法自制调查表,对嘉兴市开展助产技术服务的各县(市、区)医疗保健机构的产科业务量、产科床位、产科医生和助产士配置情况进行调查分析。结果嘉兴市各县(市、区)医疗保健机构产科床位使用率为47.90%~99.58%,平均73.57%;每千分娩量产科床位数为27张。产科医师高级、中级和初级专业技术职称分别占31.92%、33.17%和34.91%;助产士高级、中级和初级专业技术职称分别占8.67%、33.24%和58.10%;产妇分娩人数与产科医师人数比为138.72∶1,产妇分娩人数与助产士人数比为160.77∶1。结论嘉兴市医疗保健机构的产科服务能力基本满足要求,但存在产科医务人员紧缺、资源分配不均等问题。     

老年护理床位规划配置的地区实证研究

目的提出并实证研究老年护理床位的规划方法。方法运用地理信息系统技术对现有老年护理床位可及性进行分析,规划老年护理床位配置位置、配置方式和配置数量;按地理位置、年龄构成对老年人进行抽样调查,明确老年人照护需求地理分布,规划配置床位类型。结果研制了老年护理床位规划方法,并结合样本地区实际提出了床位配置方案。方案被样本地区"十三五"卫生发展规划采纳。结论地理信息系统技术和人群抽样调查方法的结合应用,将极大地增进老年护理床位规划的科学性。     

长沙市助产机构产科服务能力调查

目的 为了解长沙市助产机构产科服务能力,为政府合理配置医疗资源、提高产科医疗保健服务质量提供依据。 方法 2020年11—12月采用长沙市妇幼保健院设计《长沙市助产机构产科服务能力情况调查表》,收集2019年长沙市助产机构产科服务能力数据,2016—2019年机构活产数从湖南省妇幼卫生信息直报管理系统中获取。 结果 2019年长沙市开展助产技术服务的医疗保健机构共74家,以公立医院为主(33.78%),其次是基层医疗卫生机构(31.08%)和民营医院(22.97%)。全市共有产科床位2 790张,其中床位利用率最高的是妇幼保健机构(58.94),较低的是基层医疗卫生机构(8.65)和其他医疗机构(包括部队医院和职工医院)(4.24)。全市共有产科医师966人,其中服务效率最高的是妇幼保健机构(192.06),较低的是基层医疗卫生机构(27.27)和其他医疗机构(包括部队医院和职工医院)(8.31)。全市共有助产士739人,其中服务效率最高的是妇幼保健机构(233.74),较低的是基层医疗卫生机构(94.69)和其他医疗机构(包括部队医院和职工医院)(8.31)。 结论 各类助产机构、各区域间产科床位利用情况不均衡,助产人员配置待进一步优化;建议通过医疗资源合理配置、加强基层医疗卫生机构产科服务能力建设、加强区域性信息化建设、保证危重孕产妇救治床位等措施,在缓解医疗资源供求矛盾的同时,保障母婴安全。     

产科床位利用情况研究

采用定性研究的方法，对《区域卫生规划项目》地区（浙江省金华市、江西省九江市、陕西省宝鸡市）产科床位使用率低的原因进行了研究。结果表明，产科床位使用率低的原因有：住院分娩率低、产科平均住院日少、个别地区产科床位有些偏多以及分娩的季节差异。同时也了解了孕产妇保健服务中的一些问题，进而提出了提高住院分娩率、提高产科服务质量，确保孕产妇和婴儿安全的措施。     

An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina.

BACKGROUND. Care coordination is an important component of the enhanced prenatal care services provided under the recent expansions of the Medicaid program. The effect of maternity care coordination services on birth outcomes in North Carolina was assessed by comparing women on Medicaid who did and did not receive these services. METHODS. Health program data files, including Medicaid claims paid for maternity care coordination, were linked to 1988 and 1989 live birth certificates. Simple comparisons of percentages and rates were supplemented by a logistic regression analysis. RESULTS. Among women on Medicaid who did not receive maternity care coordination services, the low birth weight rate was 21% higher, the very low birth weight rate was 62% higher, and the infant mortality rate was 23% higher than among women on Medicaid who did receive such services. It was estimated that, for each $1.00 spent on maternity care coordination, Medicaid saved $2.02 in medical costs for newborns up to 60 days of age. Among the women who did receive maternity care coordination, those receiving it for 3 or more months had better outcomes than those receiving it for less than 3 months. CONCLUSIONS: These results suggest that maternity care coordination can be effective in reducing low birth weight, infant mortality, and newborn medical care costs among babies born to women in poverty.     

Shortening gestational age at term and organisation of birth care in the Czech Republic

A trend of the shortening duration of pregnancies carried to term has been observed in several countries and represents a growing public health concern. This paper describes the trend in the Czech Republic and shows its relation to the changing demographic structure of mothers and the organisation of maternity care. Data from the birth register are used and supplemented with information about the capacity of maternity care (number of beds at maternity clinics, number of obstetricians and midwives). Logistic regression is used to estimate the odds of 37 to 39 vs 40+ completed weeks of gestation. The results show that the average gestational age at term decreased by 2.1 days between 2000 and 2013. The odds of 37 to 39 weeks of gestational duration increased, mainly due to the reduction in the number of beds at maternity clinics (adjusted odds ratio of 1.51). The effects of the number of health care staff members were weaker. The number of midwives positively influenced gestational duration, while the number of obstetricians had a negative effect. Maternal demographic structure cannot explain the trend. A likely explanation is the increased use of planned early term caesarean sections.     

Are doctors part of the problem?

Many doctors believe that the maternity services they provide are the key to achieving safe motherhood. With emergency facilities immediately available, they know that a complicated delivery is far less likely to result in maternal death. Most medical experts therefore tend to assume that more maternity beds means less maternal mortality. That assumption, however, may not be valid. Many women in Africa and elsewhere choose not to use available maternity facilities because they dislike the services provided by hospital physicians. Examples of women's aversion to hospital delivery are briefly presented from Guinea Bissau, the Philippines, and Ecuador. Women may not want to be attended by a male physician, have fear of being asked to give birth lying down rather than in a squatting position, and/or wish to avoid the rude and callous treatment received in hospital. Anthropology researchers working in Bolivia recommended regular discussion sessions between mothers-to-be and the hospital and health service staff to help make hospital services more acceptable to pregnant women without adversely affecting the quality of medical care.     

Does Paid Maternity Leave Affect Infant Development and Second‐Birth Intentions?

Given the economic implications of a low‐fertility rate, many countries have implemented paid maternity leave to promote births. However, the efficacy of this policy is mostly unknown. We examined whether paid maternity leave in South Korea, which has a fertility rate among the lowest in the world, is directly related to infant development and employed mothers' second‐birth intentions, and indirectly associated with these outcomes via parenting stress. Participants included 315 married and employed Korean mothers in the months after giving birth to their first child. Paid maternity leave was beneficial for infant development but was not a solution for promoting second‐birth intentions among employed mothers in Korea. Parenting stress adversely affected both infant development and employed mothers' second‐birth intentions, and it may therefore need to be considered as work–family policies, fertility issues, and infant development in families are addressed. Implications considering cultural and familial contexts are discussed.     

1988～1996年福建省妇幼卫生项目县孕产妇死亡动态分析

为了探讨我省贫困县降低孕产妇死亡率的有效途径，本文对１９８８￣１９９６年诏安，长汀，漳平，福安，周宁五个县孕产妇死亡率动态进行分析。这五个县的妇幼卫生项目启动以来，孕产妇死亡率由项目前的１１２．０４／１０万下降到项目后的４９．６６／１０万，结果表明：加强围产保健工作是降低孕产妇死亡率的基础；消除文盲和贫困是提高保健服务利用的必要条件；减少计划外生育是降低孕产妇死亡率的关键。     

2012年昆山市产科现状分析与对策

目的：了解全市产科服务现状,以便对各接产机构的产科服务能力与潜力做出客观评价,为卫生行政部门制定缓解产科医疗服务供需矛盾的决策提供依据。方法对全市所有助产服务机构产科资源利用和服务数量进行调查。结果2012年全市共有产科医院11家其中一级医院7家,二级医院2家,三级医院2家。分娩产妇17728人,其中在一级医院、二级医院、三级医院分娩占比分别是15.90%、20.16%、63.94%。产妇分娩与床位比44.32：1,其中一级医院、二级医院、三级医院的产妇分娩与床位比为17.29：1、53.36：1、66.68：1。产科人均助产服务率84,其中一级医院、二级医院、三级医院分别为43、80、113。全市产科人员与床位比为0.91：1。结论产科服务的供需矛盾集中凸显＂结构性＂问题,服务对象集中于三级医院,呈现＂重心上移＂,而使服务资源出现＂超负荷＂与闲置并存现象,急需以＂缓解短期矛盾和解决深层次问题＂双管齐下为原则,从供需两方考虑解决对策。     

Low birthweight and maternity care for all

The decline in infant mortality in 1983-84 was less than the average decline the US has been experiencing since the mid-1960s, suggesting that infant mortality may be reaching a plateau. Moreover, indicators of timely provision of prenatal care decreased in 1983-84. 3 observations have been made regarding these new trends:) 1) the fact that infant mortality has been declining, albeit at a slower rate, despite relative stagnation in the rate of low birth weight infants, suggests that hospital-based intensive care is succeeding in preserving low birth weight babies; 2) the plateau in infant mortality may reflect the fact that the ability of neonatal intensive care to salvage low birth weight infants may be nearing its limit; and 3) Reagan's attack on social programs may be creating access problems that have a negative impact on infant mortality. Many feel that further reductions in neonatal mortality will be achieved only by reducing low birth weight, which accounts for 2/3 of infant mortality. Activities with potential for reducing low birth weight include: 1) risk identification, general health education, and family planning; 2) increased accessibility of early and regular prenatal care; 3) expansion of the content of prenatal care; 4) an extensive public information campaign; and 5) a multifaceted program of research on low birth weight. The Council on Maternal and Child Health of the national Association for Public Health Policy has proposed a universal maternity care program for the US aimed at assuring comprehensive prenatal and delivery care to all women and expanding the content of prenatal care to include nutrition, health education, and support services. Inadequacies in coverage for women with and without private insurance will be addressed by requiring insurrers to fully cover maternity care and offer coverage for the indigent. Such a program of universal maternity care would be a step toward a national health program.     

北京市东城区产科医院1999～2009年出生缺陷资料分析

目的:了解北京市东城区产科医院出生缺陷发生情况,为制定干预措施,降低出生缺陷发生率提供依据。方法:对近10年该区产科医院出生缺陷发生情况进行回顾性分析。结果:围产儿共113565例,死亡1134例,死亡率为9.99‰;出生缺陷1693例,发生率为14.91‰;由出生缺陷导致死亡403例,占围产儿死亡的35.54%。10年间平均出生缺陷产前检出率为28.98%。结论:应继续宣传围孕期服用叶酸的重要性,降低神经管畸形发生率;加强产前筛查及产前诊断工作,提高出生缺陷产前检出率,降低出生缺陷发生率。     

Out-of-hospital births and the supply of maternity units in France

Maternity unit closures in France have increased distances that women travel to deliver in hospital. We studied how the supply of maternity units influences the rate of out-of-hospital births using birth certificate data. In 2005–6, 4.3 per 1000 births were out-of-hospital. Rates were more than double for women living 30 km or more from their nearest unit and were even higher for women of high parity. These associations persisted in multilevel analyses adjusting for other maternal characteristics. Long distances to maternity units should be a concern to health planners because of the maternal and infant health risks.