我国西部四省县乡级助产机构新生儿早期基本保健技术能力现状调查

目的 了解我国西部四省县乡助产机构新生儿早期基本保健技术能力现状,为制定有针对性的干预措施提供依据。方法 采用信函调查方式,于2017年6月-2018年9月收集贵州、青海、四川、宁夏4省(区)21个县的助产机构数据,采用描述性统计方法分析各省新生儿早期基本保健干预措施的开展情况,采用χ²检验比较不同级别机构的干预措施实施率。结果 233所县、乡级助产机构参与调查。1)孕产妇相关干预措施:高危孕妇管理率(98.9%)、梅毒孕妇治疗率(97.9%)、孕妇叶酸服用率(88.8%)等均处于较高水平,早产儿胎膜早破母亲使用抗生素治疗的比例较低(60.1%)。2)新生儿分娩后相关干预措施:出生后进行90 min母婴皮肤接触的比例为41.8%,生后1 h内完成首次母乳喂养的比率为77.7%,开展早产儿袋鼠式护理的机构比例为24.7%。3)新生儿疾病相关干预措施:可开展新生儿败血症和新生儿肺炎疾病诊疗的机构分别为33.5%和47.8%,接受肌肉注射维生素K₁的新生儿比例为69.8%。结论 我国西部4省县乡级助产机构的新生儿早期基本保健技术实施现状与世界卫生组织的建议存在差距,应针对这些不足和差距开展干预。     

湖南省医疗保健机构新生儿早期基本保健技术服务现状调查

目的了解湖南省医疗保健机构新生儿早期基本保健服务现状,为开展有针对性的新生儿保健干预提供依据。方法采用随机抽样方法,于2017年11-12月抽取湖南省长沙市和株洲市各4所助产机构的住院产妇进行问卷调查,收集分娩期间新生儿早期基本保健服务措施的开展情况。采用SPSS 23.0统计软件进行数据分析,比较不同级别医院服务措施开展率的差异。结果720例产妇中41.8%的产妇表示在新生儿出生后立即进行了母婴皮肤接触,但仅有28.1%的皮肤接触持续时间在90 min及以上。新生儿出生24 h后洗澡的占42.3%。86.1%的新生儿在停止皮肤接触前完成首次母乳喂养,71.5%的新生儿出院前喂养方式为纯母乳喂养。接受延迟断脐(断脐时间不早于生后1 min)的新生儿占94.8%。市级机构大多数干预措施的实施率均高于县级机构。结论湖南省助产机构的新生儿早期基本保健技术实施现状与世界卫生组织的建议存在差距,应加强宣传和培训,促进医务人员对新生儿早期基本保健措施相关知识和技能的了解与应用。     

Reducing childhood mortality in poor countries: Implementing a community-based participatory intervention to improve essential newborn care in rural Nepal

The persistence of high perinatal and neonatal mortality rates in many developing countries make efforts to improve perinatal care in the home and at local health facilities important public health concerns. We describe a study which aims to evaluate a community-level participatory intervention in rural Nepal. The effectiveness of community-based action research interventions with mothers and other key members of the community in improving perinatal health outcomes is being examined using a cluster randomized, controlled trial covering a population of 28 000 married women of reproductive age. The unit of randomization was the village development committee (VDC): 12 VDCs receive the intervention while 12 serve as controls. The key elements of the intervention are the activities of female facilitators, each of whom works in one VDC facilitating the activities of women's groups in addressing problems in pregnancy, childbirth and the newborn period. Each group moves through a participatory planning cycle of assessment, sharing experiences, planning, action and reassessment, with the aim of improving essential maternal and newborn care. Outcomes assessed are neonatal and perinatal mortality rates, changes in patterns of home care, health care seeking and referral. The study also aims to generate programmatic information on the process of implementation in communities.     

教练式培训在新生儿早期基本保健技术推广中的应用及效果评价研究

目的 研究教练式培训在新生儿早期基本保健技术推广中的应用及效果,为今后临床开展各项培训提供新的方法和思路。方法 在北京、陕西省和四川省各选择1所省级医疗保健机构和1所地市级医疗保健机构作为试点单位,医务人员接受2 d教练式培训,比较研究对象培训前后新生儿保健理论知识的得分、洗手情况以及对于出生时有自主呼吸和无自主呼吸新生儿临床操作技能的得分情况。培训3个月后,每个试点医院随机抽样10名产妇进行出院前访谈,分析干预后各项新生儿保健措施的实施情况。结果 培训后医务人员的理论知识得分(16.82±1.00)较培训前显著提高(11.90±2.68)(P<0.001)。三省及总体培训后洗手操作技能均提高,手部清洁程度显著改善(P<0.001)。培训后有呼吸和无呼吸新生儿操作技能得分中位数分别为41分和58分。培训3个月后,87%(52/60)的产妇分娩后进行了母婴皮肤接触,分娩后1 min内开始母婴皮肤接触率为55%(33/60),皮肤接触持续90 min的占47%(28/60);出院前母乳喂养率达到77%(46/60),纯母乳喂养率为48%(29/60)。结论 新生儿早期基本保健技术的教练式培训方法效果较好,培训后医务人员能迅速掌握正确的操作技能,有利于促进新技术在临床上的推广和使用。     

广州市社区低出生体重儿相关因素分析

目的为探讨低出生体重儿围产期相关因素及防治措施,针对病因进行防治,提高出生人口素质,降低新生儿死亡率。方法回顾性分析广州市天河区天园街和员村街2001~2006年低出生体重儿的相关危险因素及低出生体重儿的发生率。结果低出生体重儿的发生率3.81%,低出生体重儿发生原因与分娩孕周、双胎妊娠有很大关系,同时与胎膜早破、妊娠期高血压疾病、孕期贫血、胎儿生长受限、胎盘因素、参加孕检的次数也有一定关系。结论做好婚前生育知识的宣传教育,强调婚检的重要性,不断提高孕妇的自我保健意识,完善妇幼保健网络,预防早产,及时发现和治疗高危因素,规范高危门诊,是降低低出生体重儿发生率的有效的防治措施。     

Traditional birth attendants in rural Nepal: Knowledge,attitudes and practices about maternal and newborn health

Abstract

Efforts to formalise the role of traditional birth attendants (TBAs) in maternal and neonatal health programmes have had limited success. TBAs’ continued attendance at home deliveries suggests the potential to influence maternal and neonatal outcomes. The objective of this qualitative study was to identify and understand the knowledge, attitudes and practices of TBAs in rural Nepal. Twenty-one trained and untrained TBAs participated in focus groups and in-depth interviews about antenatal care, delivery practices, maternal complications and newborn care. Antenatal care included advice about nutrition and tetanus toxoid (TT) immunisation, but did not include planning ahead for transport in cases of complications. Clean delivery practices were observed by most TBAs, though hand-washing practices differed by training status. There was no standard practice to identify maternal complications, such as excessive bleeding, prolonged labour, or retained placenta, and most referred outside in the event of such complications. Newborn care practices included breastfeeding with supplemental feeds, thermal care after bathing, and mustard seed oil massage. TBAs reported high job satisfaction and desire to improve their skills. Despite uncertainty regarding the role of TBAs to manage maternal complications, TBAs may be strategically placed to make potential contributions to newborn survival.     

Newborn health: Everybody's business

Despite advances in issue-attention and in evidence of what works to save newborn lives (e.g., kangaroo mother care, antenatal corticosteroids, immediate and exclusive breastfeeding), we are still falling short on impact. To advance the unfinished newborn survival agenda, newborns must become an integral priority in developing countries where the burden of neonatal mortality is highest. Interventions must be adapted to local contexts and cultures and integrated into packages along the continuum of care delivered through the primary health-care systems that countries have at their disposal.     

Family-centred care in early intervention: A systematic review of the processes and outcomes of family-centred care and impacting factors

Family-centred care (FCC) has been established as a best practice model for child disability services internationally. However, further empirical support is required to explore the operationalization and efficacy of FCC, in the absence of a universal practice model. This review aimed to identify the key processes and outcomes of FCC in early intervention (EI) settings and the factors that impact FCC. A systemic review was conducted exploring the processes and outcomes of FCC delivered to children predominantly aged 0–6 years with disabilities/suspected disabilities and families as part of EI or early services. The search procedure was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009). Narrative analysis of data was guided by Braun and Clarke (2006, 2014). Data were presented as per the standards for reporting qualitative research (SRQR; O'Brien et al., 2014). Forty-two studies were included. The majority (90.5%) outlined the processes of FCC, with 59.5% of studies detailing outcomes. Processes were largely reported as qualitative data and/or subscales of the Measure of Processes of Care (MPOC; King et al., 1995), which were subsequently collated. Findings indicated eight key operational processes and corresponding outcomes. Variables that hinder or facilitate FCC included family/professional characteristics, family/service resources, and parent attitudes, engagement and agency. FCC was largely conceptualized as the application of services to children and their families. Critical perspectives on FCC are discussed. It is hoped this research will contribute to the development of a framework of FCC in EI to inform services provided to young children with complex needs and their families and future research.     

Re-thinking family-centred care across the continuum of children's healthcare

BACKGROUND: The terms family-centred care (FCC) and family-centred services (FCS) are used interchangeably across the continuum of children's healthcare to encompass concepts of: parental participation in children's healthcare; partnership and collaboration between the healthcare team and parents in decision-making; family-friendly environments that normalize as much as possible family functioning within the healthcare setting; and care of family members as well as of children. However, authors from different professional and policy perspectives have used different definitions and literatures when arguing the evidence for FCC and FCS. METHOD: A critical literature review and theoretical discussion exploring common concepts and issues forming the basis for a research agenda further strengthening of the evidence base for FCC. A systematic identification of constructs, concepts and empirical indicators is developed and applied to exemplars in pain and asthma that span the continuum of children's healthcare across acute and community settings. CONCLUSIONS: The extent to which the concepts are supported by research and applied in practice remains unclear. We propose that re-thinking of FCC is required in order to develop a more coherent programme of research into the application of FCC theory in children's healthcare.     

新生儿个体化发育支持和评估项目在早期早产儿全身运动中的应用

目的探讨新生儿个体化发育支持和评估项目(newborn individualized development care and assessment program,NIDCAP)在早期早产儿全身运动(general movements,GMs)中的应用价值,旨在临床上对早产儿进行早期干预,改善神经发育预后。方法 2014年1-5月在本院新生儿科住院的早期早产儿为研究对象,分为干预组(n=41)和对照组(n=41)。对于干预组,入院即开始给予NIDCAP干预,对照组给予早产儿常规护理,评估两组早产儿在足月前的GMs。结果正常GMs NIDCAP干预组34例(82.9%),多于对照组[22例(53.6%)],而单调性扭动运动[5例(12.1%)]、痉挛-同步性扭动[2例(4.8%)]例数均少于对照组[分别为12例(29.2%)和7例(17.0%)],差异均有统计学意义(P0.05)。结论通过NIDCAP干预可提高早期早产儿足月前正常GMs发生率,减少异常GMs发生率,可能会对神经发育结局有影响。     

The development and implementation of a newborn medicine program in a resource-limited setting

The reduction in global neonatal mortality rates remains a challenge. Internationally recognized protocols for hospital care of sick and small newborns are limited, although this specialized area lends itself to standardization. An interdisciplinary team including international and local clinical experts worked with the Rwandan Ministry of Health and Rwandan professional associations to develop and implement a neonatal care program in a rural Rwandan district hospital that was ultimately accepted as the national standard for newborn medicine. Successful features and challenges are discussed. It is realistic to develop, implement and disseminate neonatal protocols for sick newborns.     

新生儿早期基本保健对初产妇泌乳启动的影响

目的 研究新生儿早期基本保健(EENC)技术对初产妇母乳喂养得分、泌乳启动时间及产后前72 h纯母乳喂养率的影响。方法 2018年6-7月随机选取潍坊医学院附属医院自然分娩的89对初产妇及新生儿,分为干预组(n=45)及对照组(n=44)。干预组新生儿实施EENC,对照组进行常规护理。采用母乳喂养测量工具(BAT)进行母乳喂养评分,并在产后24、48、72 h随访记录产妇泌乳启动时间及纯母乳喂养情况。结果 干预组首次母乳喂养评分为(10.84±1.36)分,对照组为(10.23±1.43)分,差异有统计学意义(t=-2.085,P=0.040);干预组产妇泌乳启动时间[(48.51±10.71)h] 早于对照组[(53.66±10.99)h] ,差异有统计学意义(t=2.238,P=0.028);干预组产后24、48、72 h的纯母乳喂养率(33.3%、51.1%、71.1%)均高于对照组(13.6%、29.5%、50.0%),差异有统计学差异(χ²=4.788,4.295,4.155,P<0.05)。但两组首次母乳喂养或成功率和泌乳启动率间差异均无统计学意义(P>0.05)。结论 新生儿早期基本保健对母乳喂养评分及产妇泌乳启动有促进作用,能够提高早期纯母乳喂养率,值得推广。     

Family‐centred care: a qualitative study of Chinese and South Asian immigrant parents' experiences of care in paediatric oncology

Background Over the past two decades, there is increasing emphasis being placed upon providing family‐centred care (FCC) in paediatric oncology settings. However, there is a lack of knowledge of FCC in paediatric oncology from the perspectives of immigrant parents. The purpose of this paper is to describe Chinese and South Asian immigrant parents' experiences of FCC in paediatric oncology settings in Canada. Methods This study adopted a constructivist grounded theory approach. Fifty first generation Chinese and South Asian parents of children with cancer who were at least 6 months post‐diagnosis were recruited from six Canadian paediatric oncology centres. Interviews were conducted in English, Cantonese, Mandarin, Urdu, Punjabi or Hindi, and transcribed into English. Analysis involved line‐by‐line, focused and theoretical coding, and the use of the constant comparison method. Results Findings indicated that overall parents were highly satisfied with the care and services they received, and their experiences were reflective of the key elements of FCC. However, there were some areas of concern identified by participants: parents not perceiving themselves as a member of the medical team; inconsistency in the quality and co‐ordination of services among healthcare providers; disrespectful and mechanical manner of a few healthcare providers; and parents' discomfort with healthcare providers communicating sensitive health‐related information directly with their child. Conclusions In order to successfully provide family‐centred services to immigrant parents of children with cancer, better communication of the elements of FCC between healthcare staff and families is needed to negotiate a clear role for the parents as partners of the healthcare team. Moreover, a better understanding of how family relationships are structured in immigrant families will assist healthcare providers to balance the best interests of the child with that of the family as a unit.     

Evolving Models of Family-Centered Services in Neonatal Intensive Care

The article examines the evolution of midels for providing family-centered servies in neo- natal intensive one settings Child-focused par- ent-infant interactin and ecological models are presented and discussed One specific eco- logical model the family-centered care model is examined in details While most current pro- grams endorsed family-centered care (FCC) as I best practice for develpmental interven- tion with infants few were found that imple mented these prectices Most utilized only lim- ited componets of FCC Instead programs operating in NICU settings had features di- tected toward child care staff training family support an transition to community Either than impacting the philosophy of cart ind/on service delivery system in the NICU Suggestions for working toward FCC in NICU setting the given and barriers are discussed.     

新生儿家长儿童保健知识认知现状及健康教育需求调查

目的 了解新生儿家长对儿童保健知识的知晓情况、健康教育的需求和乐意接受的健康教育形式,有针对性地为父母进行科学育儿技能的培训提供依据.方法 采用自编问卷对99名新生儿家长进行调查.结果 新生儿家长的儿童保健知识知晓率较低(47.2%),对健康教育的需求依次为小儿生长发育是否正常(70.7%),小儿常见疾病的预防(69.7%),儿童营养与喂养(60.6%),早期教育的方法(60.6%),小儿家庭护理知识(50.5%),婴幼儿智能发育规律(48.5%),小儿意外伤害的预防(36.4%).结论 应广泛开展形式多样的健康教育,提高家长的儿童保健知识水平,引导家长认识到婴幼儿早期教育、小儿意外伤害预防的重要性.     

The parent-provider relationship: Does race/ethnicity concordance or discordance influence parent reports of the receipt of high quality basic pediatric preventive services?

Recent research among adults suggests that having a provider of the same race/ethnicity may enhance the quality of health care above and beyond just having any regular source of care. It is not known whether such relationships exist in pediatric care. The purpose of this study is to identify the distribution and methods by which families have a race/ethnicity concordant provider of well-child care and examine whether differences exist in the receipt of basic preventive services (BPS) and familycentered care (FCC) among those with concordant, discordant, and no regular providers. Analyses are stratified by geography to assess whether urban versus nonurban setting moderates these differences. This study uses publicly available data from the 2000 National Survey of Early Childbood Health (NSECH), a nationally representative, cross-sectional telephone survey of parents of children ages 4–35 months (n=1,996). African Americans and Latinos were more likely than whites to lack a regular provider of well-child care (60.9% and 65.7% vs. 50.6%) and less likely to have a concordant provider (9.8% and 5.7% vs. 38.5%) (P<.0011). African Americans with a regular provider were about three times more likely to establish a concordant relationship in urban versus nonurban settings (32.4% vs. 12.5%, P<.011), No statistically significant differences in BPS or FCC were found by concordance versus discordance for any group, a finding that held regardless of geographic setting. White children with no regular provider received better BPS than those with a discordant provider (e.g., excellent BPS of 37.2% vs. 27.1%, P<..05), but children with no regular provider were more likely than those with either concordant or discordant providers to have lower FCC in one (Latinos, whites) or three domains (African Americans). Despite racial/ethnic differences in the likelihood of having a concordant regular provider of well-child care, no disparities were found in BPS or FCC associated with discordance, even after stratification by urban/nonurban setting. Lacking a regular provider was associated with lower FCC versus having either a concordant or discordant provider, suggesting that efforts to improve these aspects of well-child care might focus less on linking children with a race/ethnicity concordant provider and more on social, cultural, and linguistic factors that impact having any regular provider.     

Family-Centered Care in the Critical Care Setting: Myth or Reality?

Family-centered care (FCC) has been upheld as the standard for providing quality health care for children However, some professionals question its applicability in the critical care setting Despite the barriers to FCC ACCHs eight essential elements of FCC can provide the bases for devising strategies for successfully implementing FCC in the critical care setting.     

Family-Centered Care: Current Applications and Future Directions in Pediatric Health Care

Family-centered care (FCC) is a partnership approach to health care decision-making between the family and health care provider. FCC is considered the standard of pediatric health care by many clinical practices, hospitals, and health care groups. Despite widespread endorsement, FCC continues to be insufficiently implemented into clinical practice. In this paper we enumerate the core principles of FCC in pediatric health care, describe recent advances applying FCC principles to clinical practice, and propose an agenda for practitioners, hospitals, and health care groups to translate FCC into improved health outcomes, health care delivery, and health care system transformation.     

Parent and health care professional perspectives on family-centered care for children with special health care needs: are we on the same page?

A family-centered approach to health care for children with special health care needs (CSHCN) is widely acknowledged as the ideal model of service delivery, but less is known about the actual practice of family-centered care (FCC), especially from the viewpoints of parents and health care professionals. This cross-sectional research compared parent and health care professional perspectives on the degree to which FCC is being provided at a large, urban hospital in the United States. The Measure of Process of Care (MPOC) was administered to a representative sample of 92 parents of CSHCN; a convenience sample of 43 health care professionals completed the service provider version of the MPOC. A mixed-model analysis of variance was conducted to test for group differences on matched domain scores of the MPOC. No significant differences emerged between the two stakeholder groups, but significant differences were detected among the four domain scores. The data suggest that health professionals are generally meeting families' needs for specific communication and are respectful of parents' expertise. However, parents and professionals alike indicated the need for continued professional growth in the area of providing holistic, comprehensive services to advance FCC.