84例流动人口孕产妇死亡资料分析

目的:探讨流动人口孕产妇的死亡原因及影响因素,制定针对性的干预措施。方法:调查2001～2004年各市(县、区)妇幼所上报的孕产妇死亡报告卡及个案,经省级孕产妇死亡评审小组审核后整理分析。结果:流动人口孕产妇死亡中非住院分娩占67.9%,直接产科原因占73.8%,产科出血和妊高征占63.1%。可避免死亡及创造条件可避免死亡占91.7%,其中个人家庭知识技能问题占66.7%。结论:非住院分娩、文化程度低、经济困难、孕期未接受保健及个人家庭保健意识缺乏是流动人口孕产妇死亡的重要因素;政府应将流动人口孕产妇管理纳入议事日程,加强孕产期保健管理及健康教育;加大对非法行医的打击力度,取缔非法接生;采取多种融资方式,设立贫困孕产妇救助基金,提高流动人口孕产妇的住院分娩率,切实保障流动人口的母婴安全。     

流动人口孕产妇保健服务利用现状调查

目的了解流动人口孕产妇女保健服务利用现状,提出促进流动人口孕产妇女保健服务利用的建议。方法在北京和杭州两市流动人口聚集区,对1 446例流动孕产妇女进行问卷调查。结果43.3%的流动孕产妇女建立了孕产妇保健档案,5次及以上产前检查率为59.5%,住院分娩率为86.9%,产后访视率为11.6%。结论流动人口对孕产期保健服务利用率低,需要通过加强流动人口孕产妇管理、健康教育、打击非法接生,来促进流动人口接受孕产期保健服务。     

流动人口孕产妇保健服务利用现状调查

目的 了解流动人口孕产妇女保健服务利用现状,提出促进流动人口孕产妇女保健服务利用的建议.方法 在北京和杭州两市流动人口聚集区,对1 446例流动孕产妇女进行问卷调查.结果 43.3%的流动孕产妇女建立了孕产妇保健档案,5次及以上产前检查率为59.5%,住院分娩率为86.9%,产后访视率为11.6%.结论 流动人口对孕产期保健服务利用率低,需要通过加强流动人口孕产妇管理、健康教育、打击非法接生,来促进流动人口接受孕产期保健服务.     

流动人口产妇在京分娩状况分析

目的:了解海淀区流动人口孕产妇在北京分娩状况及分娩费用,为提高流动人口孕妇住院分娩率提供依据。方法:选取海淀区两个乡卫生院保健科,对630名产妇进行问卷。结果:630名流动人口产妇的住院分娩率为79.2%,Logistic回归分析后产妇文化程度和产次对住院分娩有影响,随着产妇文化程度提高住院分娩率提高,随着产次增加住院分娩率降低。住院产妇阴道分娩的平均费用为2 274元,剖宫产的平均费用为4 915元,非住院分娩的产妇分娩费用平均为456元。131名产妇在家(或私人诊所)分娩的原因中70.2%(92名)是因为“经济困难,”15.3%(20名)是“认为没必要到医院分娩”。结论:经济因素是影响流动人口住院分娩的主要因素;要提高流动人口孕妇的住院分娩率必须要对医院的收费进行限定;要做好流动人口孕产妇管理,必须要政府参与,多部门协作。     

流动人口特约分娩点孕产妇保健状况调查

目的:了解流动人口特约分娩点孕产妇保健状况,为进一步完善流动人口孕产妇保健管理提供依据。方法:以2005年1~12月在上海市南汇区新场社区卫生服务中心分娩的所有流动人口孕产妇为研究对象,收集病史资料和流动人口分娩登记表信息,对1152例流动孕产妇构成、产前检查次数、分娩方式及分娩费用等进行分析。结果:没有做过产前检查或只有1次产前检查的流动孕产妇占60%,产前检查次数与产次有关(P<0.0001),流动孕产妇剖宫产组平均住院费用为3 387元,阴道分娩组平均住院费用为1105元,结论:流动人口妇女孕产期保健服务利用率低,住院分娩费用相对其收入仍偏高,需要加强对流动人口孕产期保健知识的宣传,降低经济负担,为更多的孕产妇提供限价服务。     

流动人口孕产妇系统保健在社区卫生服务中的效果评价

目的了解北京市大兴区流动人口孕产妇系统保健效果。方法 2012年1—3月选择2006—2010年参加北京市流动人口孕产妇管理模式研究的304名孕产妇作为研究组,把未参加该项目的 698名流动人口孕产妇作为对照组。研究组采用多种形式的健康教育、宣传、早期指导等干预措施,对照组未进行干预。结果研究组孕产妇建册率为63.49%,接受5次以上产前检查的占70.72%,住院分娩率为99.34%;对照组流动人口孕产妇建册率49.14%,接受5次以上产前检查的占54.01%,住院分娩率为85.39%,差异有统计学意义(P<0.05)。结论该项目在大兴区城市流动人口妇幼保健服务模式研究探讨出政府主导、部门合作、属地管理、社区参与的管理模式以及三级网络(区、镇、村)和四级管理(户、村、镇、区)的服务模式。对流动孕产妇获得妇幼保健服务的可及性、可获得性、可持续性和服务利用的公平性起到促进作用。     

上海市两区流动人口孕产妇利用保健服务的障碍因素

目的:分析上海市闵行区和松江区流动孕产妇利用保健服务的障碍因素。方法:定量调查:以上海市闵行区和松江区各1个计划免疫门诊作为研究现场,调查当天3岁以下外来儿童的母亲共195名作为研究对象,通过自编问卷调查其孕产期保健状况。定性访谈:对流动人口特约分娩点4名医护人员、4名流动妇女和2名行政管理人员进行访谈。结果:56.4%的调查对象文化程度在初中及以下,家庭人均月收入在上海市最低工资水平以下的占40.0%,61.0%的调查对象参加了不同形式的国家基本医疗保障计划。产前建卡率为74.9%,产前检查率为97.9%,产前检查9次完成率为42.1%;孕期并发贫血的患病率为36.4%;住院分娩率为98.5%,但剖宫产率高达44.6%,低出生体重儿发生率为2.6%;合格产后访视率仅为18.5%。政府对流动人口孕产妇保健提出一系列优惠政策,但73.3%的调查对象对所有优惠政策都不知晓。结论:流动人口孕产妇接受保健服务的障碍因素:①流动人口孕产妇相对较低的文化水平导致保健意识较弱;②社会保障不足,政策宣传和实施不到位;③基层卫生人员缺乏,无法满足流动人口日益增高的卫生保健需求。     

农村妇女分娩地点及影响因素的调查

多年来 ,为降低孕产妇及新生儿的死亡率 ,我省大力宣传并提倡住院分娩 ,但农村仍有相当一部分妇女非住院分娩。1998年全省住院分娩率为 71.92 % ,城市住院分娩率为 80 .54% ,农村住院分娩率为 6 8.4 6 %。1998年上报孕产妇死亡中 ,有孕产妇死亡报告卡的 81例 ,其中死于家中 14人 ,死于途中 1人 ,共计 15人 ,占18.52 %。 1998年全国“社区与家庭健康促进项目”在我省宁国、金寨、界首、霍山四县 (市 )对 80 0名农村 2岁以下儿童母亲进行了有关健康需求的问卷调查。通过调查 ,探讨这些地区农村妇女分娩地点及影响因素 ,从中找出存在的问题 ,为…     

流动人口孕产妇死亡分析

目的对北京市朝阳区2001~2004年流动人口中孕产妇死亡情况进行分析,制定干预措施,降低孕产妇死亡率。方法执行北京市孕产妇死亡报告及评审制度,统计学方法应用卡方检验。结果流动人口孕产妇分娩数占分娩总数的58.73%,死亡率为58.22/10万,以农民、低文化层次孕产妇为主,家庭接生率高,均无孕期系统保健,第1位死因为产科出血。结论我区流动人口分娩数占分娩总数的比率逐年上升,流动人口孕产妇死亡率居高不下,说明尚无对流动人口孕产妇管理的有效办法,提出以卫生、计生共管的综合管理措施。     

西藏地区住院分娩现状分析

目的了解西藏地区住院分娩状况,分析其影响因素。方法采用横断面设计及分层多阶段随机抽样的方法,对西藏地区15个项目县有3岁以下儿童的家庭户(每乡保证20户),对其母亲进行问卷调查。利用Epidata2·0软件建立数据库和逻辑检错程序,采用二次录入法。使用Stata8·0软件完成统计分析。结果调查获得1512例妇女。被调查妇女的住院分娩率为40·2%。被调查4个地区的住院分娩率从25·2%~52·4%不等。平均住院天数6·8天,平均住院花费515·9元。多因素分析显示,影响西藏地区妇女住院分娩的因素为是否做过产前检查,有无动员住院分娩和怀孕次数。结论西藏地区住院分娩率较低,应加强对孕产妇的孕期保健和宣传教育。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.