基于集中指数的妇幼健康服务和妇幼健康公平性分析

目的 对妇幼健康公平性进行分析,为促进妇幼保健服务和提高妇幼健康公平程度提供借鉴和参考.方法 利用《中国卫生统计年鉴》《中国卫生和计划生育统计年鉴》《中国统计年鉴》中的相关资料,计算反映妇幼保健服务和妇幼健康水平的各项指标的集中指数.结果 孕产妇系统管理、产前检查、产后访视、儿童保健管理的集中指数均为正值,反映出其主要集中在社会经济发展水平相对富裕的省份,围产儿死亡、孕产妇死亡的集中指数均为负值,反映出其主要集中于社会经济发展水平相对落后的省份.2008-2013年我国妇幼保健服务及妇幼健康的不公平性在各省(市、区)间的差距有所改善.结论 不同省(市、区)的妇幼保健服务和妇幼健康状况的不公平程度有所改善,应发展贫困地区经济,缩小贫富差距,注重对中部地区的支持,提高妇幼保健服务的效率和质量,从而改善妇幼健康.     

Assessing Capacity and Measuring Performance in Maternal and Child Health

Objectives: To understand the similarities, differences, and relationships between three tools for performance and capacity assessment currently available for Maternal and Child Health (MCH) programs and for state and local health agencies. Methods: Three tools for performance and capacity assessment currently available for Maternal and Child Health (MCH) programs and for state and local health agencies, the Title V MCH Block Grant Performance and Outcome Measures (Title V 24), CAST-5, and the National Public Health Performance Standards Program (NPHPSP) were compared using two metrics, a conceptual model of the public health system, and a set of attributes related to the use of the instruments. Results: Both CAST-5 and the NPHPSP are focused on the capacity and key processes (10 Essential Public Health Services) of the public health system, although CAST-5 is intended for capacity assessment and the NPHPSP is intended for performance measurement. The Title V 24 tool is also intended for performance measurement; however, its focus is on the outputs and outcomes of the health system. The Title V 24 tool is the only one of the three that is mandatory, and the only one whose results at the current time can be used to compare across entities. In addition, both the Title V 24 and the NPHPSP include explicit standards, while CAST-5 does not specify explicit standards against which to compare findings. Conclusions: While there are various tools available to MCH practitioners for capacity assessment and performance measurement, knowing how the tools relate to each other, and their defining characteristics, should lead to more effective and productive use.     

新疆部分县级妇幼保健机构人力资源配置现状分析

目的：了解新疆11个样本县级妇幼保健机构人力资源配置现状及其存在的问题,为今后新疆县级妇幼保健机构的规范化建设提供科学依据。方法对所收集数据采用 Excel 电子表格建立数据库,运用 SPSS 17.0描述性的分析方法对有关指标的变化情况进行不同类型的比较分析。结果卫生技术人员中,35岁及以下人员所占比例最高,为45.40%,学历以大专及以下学历人员所占比例最高,占50%以上,职称以初级为主,占47.77%,高级人员占13.54%。专业以临床医学及护理为主,妇幼专业人员所占比例为13.79%,药学专业和管理专业人员所占的比例最小,均为3.60%。结论新疆县级妇幼保健机构卫生人员编制不足,且整体素质偏低、结构不合理,应增加人员编制、加强人才队伍的建设。     

母婴健康素养量表编制及考评

目的 编制母婴健康素养量表用以测量孕妇母婴健康素养,并对该量表的信度、效度和可行性进行评价.方法 参考《母婴健康素养——母婴健康素养55条》和相关文献构建量表框架并建立条目库,经条目筛选形成测试版量表,对207名孕妇进行实测后,检验量表信度、效度和可行性.结果 初步建立了包含74个条目的条目库,经条目筛选,最终形成了包含55个条目的母婴健康素养量表,分属基本知识和理念、健康生活方式与行为和基本技能3个维度.总量表和3个维度的Cronbach'sα系数分别为0.890,0.824,0.689和0.536;量表重测相关系数为0.897,分半相关系数为0.802;各条目与其所在的维度/方面相关性均较高;因子分析提取了7个公因子,解释65.99%的方差变异;孕妇大多能在8-15分钟内完成问卷.结论 母婴健康素养量表具有良好的信度、效度和可行性,但对各文化层次人群的适用情况有待于进一步研究.     

Family,Maternal, and Child Health Through Photovoice

OBJECTIVE: (1) To introduce photovoice, a participatory action research methodology, for use by MCH program managers to enhance community health assessments and program planning efforts, (2) to enable community people to use the photovoice methodology as a tool to record, reflect, and communicate their family, maternal, and child health assets and concerns, and (3) to educate community leaders about family, maternal, and child health issues from a grassroots perspective. METHODS: Photovoice is based upon the theoretical literature on education for critical consciousness, feminist theory, and community-based approaches to documentary photography. Picture This Photovoice project took place in Contra Costa, an economically and ethnically diverse county in the San Francisco Bay area. Sixty county residents of ages 13-50 participated in 3 sessions during which they received training from the local health department in the techniques and process of photovoice. Residents were provided with disposable cameras and were encouraged to take photographs reflecting their views on family, maternal, and child health assets and concerns in their community, and then participated in group discussions about their photographs. Community events were held to enable participants to educate MCH staff and community leaders. RESULTS: The photovoice project provided MCH staff with information to supplement existing quantitative perinatal data and contributed to an understanding of key MCH issues that participating community residents would like to see addressed. Participants' concerns centered on the need for safe places for children's recreation and for improvement in the broader community environment within county neighborhoods. Participants' definitions of family, maternal, and child health assets and concerns differed from those that MCH professionals may typically view as MCH issues (low birth weight, maternal mortality, teen pregnancy prevention), which helped MCH program staff to expand priorities and include residents' foremost concerns. CONCLUSIONS: MCH professionals can apply photovoice as an innovative participatory research methodology to engage community members in needs assessment, asset mapping, and program planning, and in reaching policy makers to advocate strategies promoting family, maternal, and child health as informed from a grassroots perspective.     

安徽省县级妇幼保健机构现状分析

目的为了解全省县级妇幼保健机构的发展现状,为妇幼保健机构建设和发展评估提供依据。方法使用调查表,采用信函调查法对全省100所县级妇幼保健机构进行全面调查,并将调查结果录入EXCEL进行分析。结果安徽省县级妇幼保健机构人员编制严重不足;人员技术素质不高,人力资源管理滞后;业务用房面积狭小、拥挤;业务经费紧张,收支基本平衡,仅能维持目前运转,没有后续发展能力;开展工作必须的基本设备装备不全;技术服务内容单一,缺乏深层次、高技术的保健服务。结论县级妇幼保健机构经过多年的发展,有了一定的规模和基础,但发展缓慢,与人民群众日益增长的卫生服务需求还有较大差距。各级政府政府和相关部门应把妇幼卫生纳入公共卫生体系建设规划同步推进妇幼卫生建设,落实人员编制,保证正常运转及合理发展的必要经费,改善房屋建设、装备,提高人员技术素质,以提供全面、优质、适应当前妇女儿童健康需求的保健服务。     

Indicators of children's development: considerations when constructing a set of national Child Health Indicators for the European Union

BACKGROUND: In a recent project, commissioned by the European Union, a set of Child Health Indicators were identified and recommended for use in all Member States. In that work, by a group of European experts, children's development was one of the key areas that were reviewed to clarify its role in this set of indicators. This paper deals with neurological (in a broad sense), social and moral aspects of development; other aspects, such as nutrition and physical growth, mental health, quality of life were dealt with in other areas. METHODS: A number of methods are used to monitor children's neurodevelopment, to identify early deviations that could be treated or alleviated. Few tests fulfil basic criteria of screening and quality of evidence. For Child Health Programmes, developmental surveillance is instead recommended. As a proxy to social development, as part of children's process of adaptation into society, education indicators are recommended, such as suggested by OECD and UNICEF. Moral development is discarded as an indicator, because norms and values vary too much between countries. CONCLUSION: For now the Child Health Indicators of Life and Development Project found no ground to recommend any particular method or combination of methods for a general monitoring of children's neurological, intellectual, language and moral development, and for including the results as national indicators of children's health and well-being in EU. For social development, indicators in the educational area seem most promising, as they have been proposed and used by OECD and UNESCO. In an ambitious monitoring programme, these indicators could be included as determinants of children's health and development.     

Mixed Signals in Child and Adolescent Mental Health and Well-Being Indicators in the United States: A Call for Improvements to Population Health Monitoring

Policy Points

• Social indicators of young peoples’ conditions and circumstances, such as high school graduation, food insecurity, and smoking, are improving even as subjective indicators of mental health and well-being have been worsening. This divergence suggests policies targeting the social indicators may not have improved overall mental health and well-being.
• There are several plausible reasons for this seeming contradiction. Available data suggest the culpability of one or several common exposures poorly captured by existing social indicators.
• Resolving this disconnect requires significant investments in population-level data systems to support a more holistic, child-centric, and up-to-date understanding of young people's lives.

     

妇幼保健机构在出生缺陷防控工作中的作用探讨

阐述了出生缺陷发生率的严峻形势及重大危害;分析了妇幼保健机构在出生缺陷防控工作中的重大责任;指明了妇幼保健机构如何发挥在出生缺陷防控工作中重要作用的基本思路和具体做法。旨在为有效降低区域出生缺陷的发生率提供决策思路和方法借鉴。     

国家级妇幼卫生监测数据网络直报系统信息安全现状分析

通过调查妇幼卫生监测数据网络直报系统的相关资金投入、设备建设和信息安全措施,探讨中国妇幼卫生监测数据网络直报系统的信息安全现状。 方法选择2009年1月至2011年12月参与全国妇幼卫生监测数据网络直报工作的546家各级妇幼保健监测机构作为研究对象。采用自填式问卷调查参与直报工作的保健机构信息系统的资金投入、设备建设和采用的信息安全措施情况,分析不同行政级别(省、地市和区县)和地区(东部、中部、西部)间的差异。 结果本研究回收有效问卷为503份。2009－2011年间,监测机构信息化资金总额为1.97亿元,直接用于监测的经费仅占16.17%。机构平均投入和单位平均监测专用资金方面,东部地区均高于中部和西部地区,省级机构高于地市级和区县级机构。资金来源为本单位自筹的机构分别占41.16%,来源为上级拨款的机构占7.83%,来源为监测项目的机构分别占29.29%。资金的主要用途为购买计算机硬件和网络设备。无监测专用计算机、服务器、硬件防火墙和不间断电源系统(UPS)设备的监测机构分别占14.51%,26.84%,77.14%和42.94%;无局域网、单机病毒防护措施的机构占9.85%和9.09%。 结论现有妇幼卫生监测机构信息安全发展不平衡,中部和西部地区滞后于东部地区,县级机构滞后于地市级和省级机构。妇幼卫生监测机构应增加计算机硬件投入和加强网络设备建设,以满足卫生行业信息化发展的需求。     

线性插值法用于妇幼保健工作质量的综合评价

目的探讨客观、定量、真实反映不同区域妇幼保健工作质量的综合评价方法,为妇幼保健工作决策提供科学依据。方法应用线性插值法对某年某省10个地区妇幼保健工作质量进行综合评价。结果某年某省妇幼保健工作以H地区为最优,J地区为最差,与实际工作情况相符。结论线性插值法计算简单、易懂、排序明确,与RSR法比较,结果一致。显示在卫生工作质量综合评价中,具有较好的应用价值。     

中国五省农村地区妇幼卫生状况指标的综合评价

目的 通过综合指标定量反映某一类别地区的整体水平,对不同地区妇幼卫生状况进行综合评价和比较。方法 利用我国五省114个县的农村妇幼卫生服务现况调查资料中10个有代表性的指标进行归一化处理,对处理后的指数值作Q型在分析及平均指数法分析。结果 样本县的妇幼卫生情况波动范围较大。聚类后三个类别的平均指数和五省的平均指数较好地反映了样本地区妇幼卫生状况总体水平。结论 本研究所用的综合评价方法不仅可进行组间的地区比较,还可作组内的指标比较,并针对不同地区的重点内容提出了改善农村妇幼卫生状况的合理建议。     

MCH Functions Framework: A Guide to the Role of Government in Maternal and Child Health in the 21st Century

Objectives: At the close of the 20th century, the government's role in maternal and child health is in a state of transition. What is needed is a framework defining roles and responsibilities and guidance on how to operationalize these functions. This article presents the Maternal and Child Health (MCH) Functions Framework and discusses its value as an advocacy, planning, evaluation, and educational tool. Methods: The Johns Hopkins Child and Adolescent Health Policy Center developed the Framework in collaboration with leading public health organizations. The process entailed formulating a conceptual approach and facilitating consensus among the relevant organizations. Results: The Framework consists of three main components: (a) a list of ten essential public health services to promote maternal and child health, (b) an outline detailing program functions specific to MCH that apply to all levels of government and to all MCH populations, and (c) selected examples of local, state, and federal activities for implementing MCH program functions. Conclusions: The MCH Functions Framework can be used in advocacy, policy development, program planning, organizational assessment, education, and training. To date, it has been used by several state and local MCH agencies and in MCH education and training programs.     

Effective MCH Epidemiology in State Health Agencies: Lessons from an Evaluation of the Maternal and Child Health Epidemiology Program (MCHEP)

Objectives: The Maternal and Child Health Epidemiology Program (MCHEP), jointly sponsored by the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA), was evaluated in 1996–1997. As part of this evaluation, an effort was undertaken to identify components of effective MCH epidemiology, to examine their prevalence across participating states, and to assess differences with respect to these components between MCHEP and non-MCHEP states. Methods: A case-study evaluation was undertaken in which nine states (five MCHEP and four non-MCHEP) rated themselves on a benchmark questionnaire and participated in interviews conducted during site visits. At the completion of the evaluation, 16 components of effective MCH epidemiology in state health agencies were identified. The nine states were rated by the evaluation team on each component. Ratings across all states and between MCHEP and non-MCHEP states were compared. Results: There was a great deal of variability among the nine states with respect to the presence of the components of effective MCH epidemiology. Components on which the states appeared weakest overall were the presence of adequately trained personnel, the presence of adequate management information systems to support MCH programs, and whether the state health agency's epidemiologic unit understands the MCH planning cycle. States with an MCHEP assignee had a higher overall mean score than non-MCHEP states across all components. There were seven components on which the two groups of states differed. These include whether the MCH director is empowered in the state health agency, whether the state health agency has identified internal epidemiologic capacity building as a priority, and whether analytic leadership is available for MCH epidemiologic activities. Conclusions: Building and maintaining MCH epidemiologic capacity in state health agencies requires attention to a variety of factors. While the presence of an MCH epidemiologist is important, this is only one of many components that must be considered as both the federal and state governments seek to promote and institutionalize effective MCH epidemiology in state health agencies.     

新医改下县区级妇幼保健机构人力资源发展问题研究

目的：分析黑龙江省县、区级妇幼保健机构人力资源发展中存在的问题,为新医改进程中基层妇幼保健机构的建设和发展提供参考依据。方法依托国家妇幼保健中心妇幼保健机构监测信息网络直报系统,对2013年度黑龙江省127家县、区级妇幼保健机构进行调查,运用数据包络分析（data envelopment analysis ,DEA ）方法对人力资源相关数据进行分析。结果80％以上机构人力资源配置处于无效状态,65.35％的机构处于规模效率递增阶段,具有很大的发展潜力;县、区级机构人力资源发展具有显著性差异;卫生技术人员数量达标机构仅占51.18％;专业妇幼保健人员数量严重短缺;机构发展自主性相对较差。结论县、区级妇幼保健机构人力资源配置效率较低,基础数量不足,具有很大发展潜力。     

Promotion of Maternal and Child Health: A Path Model of Care for Substance Using Pregnant Women

Maternal use of licit and illicit substances during pregnancy has been shown to have serious effects on the fetus, the pregnancy outcome, and the physical, emotional, and social growth of children after birth. Such children require specialized and intensive care during their growing years. Substance using women themselves face a series of related consequences in physical and mental health, and in social functioning, which in turn limit their parenting abilities, often resulting in neglect and abuse of children. Many substance using pregnant women coming to public attention are economically disadvantaged and Medicaid recipients, requiring costly intensive care during pregnancy and subsequently in the development of children. Four fields of human services, namely, Public Health, Substance Abuse Treatment, Child Welfare, and Criminal Justice, have responded to these problems in recent years. This paper examines the existing treatment models in these fields, and proposes a comprehensive, coordinated, and managed care model for improving the current service delivery.     

母子健康手册手机APP在社区孕产妇健康管理教育中的作用探究*

目的探讨母子健康手册手机APP在社区孕产妇健康管理教育中的作用。方法回顾性分析2015年7月—2016年8月社区医院98例孕产妇基本资料,其中常规建卡孕产妇参加健康教育者为对照组,下载母子健康手册手机APP进行健康教育者为观察组,各49例。采用问卷调查形式了解孕产妇孕期保健知识知晓率和对产检随访的满意度情况。结果观察组孕产妇孕中晚期保健、出生缺陷的预防与诊断、母乳喂养与婴儿智护、新生儿特点及常见问题、和0~3岁早期教育相关孕期保健知识知晓率均明显高于对照组,P0.05。观察组孕产妇对产检随访的满意度为97.96%(48/49),明显高于对照组89.79%(44/49),χ~2=10.41,P=0.00。结论社区孕产妇健康管理教育中应用母子健康手册手机APP可有助于提高孕产妇孕期保健知识知晓率,获得更多孕产妇的欢迎,从而提高孕产妇的满意度,有助于为孕产妇提供更加优质的健康教育。     

山西省妇幼保健机构2008～2011年科研情况分析

目的 分析山西省各级妇幼保健机构科研投入和产出情况,为妇幼保健机构科研政策的制定和完善提供参考依据.方法收集山西省全部（131所）妇幼保健机构科研投入和产出数据,按照不同年份或不同机构级别进行描述性分析.结果 2008～2011年4年间山西省妇幼保健机构年度科研经费投入波动较大,呈现2008年和2010年多、2009年和2011年少的现象,省级妇幼保健机构科研经费的投入大约占全省妇幼保健机构科研经费的1/2.省级妇幼保健机构新技术、新成果引进情况不如市县级机构,而论文发表数和承担的科研项目数明显多于市县级机构.结论 山西省妇幼保健机构的科研投入不稳定,且严重向省级机构倾斜;省级妇幼保健机构对新技术和新成果的引进有待加强.     

西部妇幼卫生对口支援模式探索

目的：通过对长沙市妇幼保健院参与西部地区妇幼卫生能力提升项目的分析,从理论上初步探索适合妇幼保健院之间的对口支援模式,为上级行政部门更好地开展对口支援工作提供依据。方法采用实地调查法、文献法,对对口支援工作的情况进行调研和分析,解析西部地区妇幼卫生能力提升项目的对口支援现状与模式创新之间的关系。结果对口支援的成效与对口支援的模式密切相关。结论对口支援工作必须采取切实可行的具体模式、方法,认真落实各项工作,才能真正起到推动对口支援工作上台阶、上水平的效果。