Birth preparedness and place of birth in rural Mysore,India: A prospective cohort study

BackgroundIndia accounts for almost a third of the global deaths among newborns on their first day of birth. In spite of making significant progress in increasing institutional births, large numbers of rural Indian women are still electing to give birth at home. The aim of this study was to identify factors associated with place of birth among women who had recently given birth in rural Mysore, India.MethodsBetween January 2009 and 2011, 1675 rural pregnant women enrolled in a prospective cohort study in Mysore District completed interviewer-administered questionnaires on maternity care services. Ethical approval of the original study was obtained from the Institutional Review Boards of Vikram Hospital and Florida International University. Logistic regression analyses were conducted to identify factors associated with place of birth among the 1654 (99%) women that were successfully followed up after childbirth.FindingsThe median age of the women was 20 years; the majority were educated (87%), low-income (52%), and multiparous (56%). The prevalence of home births was low (4%). Half of the women giving birth at home did not adequately plan for transportation (55%), finances (48%), or birthing with a skilled provider (55%). Multiparous women had greater odds of giving birth at home compared to public (adjusted odds ratio [AOR]=7.83, p<0.001) and private institutions (AOR=7.05, p<0.001). Women attending ≥4 antenatal consultations had greater odds of giving birth at public (AOR=2.53, p=0.036) and private institutions (AOR=3.58, p=0.010). Those with higher scores of birth preparedness also had greater odds of giving birth at public (AOR=2.53, p<0.001) and private institutions (AOR=3.00, p<0.001).Conclusions and implicationsAs a means to reduce newborn mortality, maternal health interventions in India and similar populations should focus on increasing birth preparedness and institutional births among rural women, particularly among those from lower socio-economic status.     

农村大学生领悟社会支持、大五人格与主观幸福感的关系

目的:探讨农村大学生领悟社会支持、大五人格和主观幸福感之间的关系。方法:随机选取某两所高校大学生578人,采用领悟社会支持量表、大五人格量表和主观幸福感量表分别测量农村大学生的领悟社会支持水平、大五人格特质和主观幸福感水平。结果:领悟社会支持、大五人格、生活满意度、正性情感及主观幸福感总分均呈正相关(r=0.11~0.73,P0.05),领悟社会支持与负性情感呈负相关(r=-0.36,P0.01)。多元回归分析表明,外向性、领悟社会支持、开放性、宜人性对主观幸福感依次具有预测力(β=0.18,0.15,0.12,0.10;P0.001)。路径分析表明,领悟社会支持对主观幸福感和大五人格的直接效应均显著(路径系数分别为0.69,0.53,P均0.001),大五人格对主观幸福感的直接效应显著(路径系数为0.21,P0.05)。结论:大五人格在领悟社会支持与主观幸福感之间起部分中介作用,大五人格是领悟社会支持影响农村大学生主观幸福感的重要内在因素。     

Comparative analysis of non-adherence to medication treatment for systemic arterial hypertension in urban and rural populations

OBJECTIVE:

to evaluate the indexes and the main factors associated with non-adherence to medication treatment for systemic arterial hypertension between urban and rural areas.

METHOD:

analytical study based on an epidemiological survey with a sample of 247 hypertensive residents of rural and urban areas, with application of a socio-demographic and economic questionnaire, and treatment adherence assessment. The Pearson''s Chi-square test was used and the odds ratio (OD) was calculated to analyze the factors related to non-adherence.

RESULTS:

the prevalence of non-adherence was 61.9% and it was higher in urban areas (63.4%). Factors significantly associated with non-adherence were: male gender (OR=1.95; 95% CI 1.08-3.50), age 20-59 years old (OR=2.51; 95% CI 1.44-4.39), low economic status (OR=1.95; 95% CI 1.09-3.47), alcohol consumption (OR=5.92, 95% CI 1.73-20.21), short time of hypertension diagnosis (OR=3.07; 95% CI 1.35-6.96) and not attending the health service for routine consultations (OR=2.45; 1.35-4.42).

CONCLUSION:

the socio-demographic/economic characteristics, lifestyle habits and how to relate to health services were the factors that presented association with non-adherence regardless of the place of residence.     

陕北农村地区居民土源性线虫感染调查分析

目的 了解陕北农村居民土源性线虫感染现状、土源性线虫病防治知识知晓及健康行为形成情况.方法 按照随机抽样法,选择8个村作为调查点,以调查点≥3岁的常住人口为调查对象.采用改良加藤厚涂片法检测调查对象粪便中蛔虫、钩虫、鞭虫虫卵,12周岁以下儿童以透明胶纸法检测蛲虫卵.在每个调查点随机抽取8户以上的家庭,对家庭成员进行土源性线虫病防治知识知晓情况及卫生行为调查.结果 共粪检1 352人,阳性4人,土源性线虫总感染率为0.29％;蛲虫感染检测108人,阳性11人,蛲虫感染率为10.18％;入户调查329人,土源性线虫病防治知识知晓率为38.29％,62％以上的调查者有良好卫生行为.结论 陕北农村居民土源性线虫感染率较低,但儿童蛲虫感染率较高;人群卫生行为较好,但防治知识知晓率偏低.应继续加强防治工作,促进健康教育,以有效降低该病的危害.     

北京市新农合大病保险实施效果分析与评价

目的:测算分析北京市新农合大病保险对患者疾病经济负担的减轻作用,对制度实施效果进行评价。方法:按照经济发展水平和大病保险承办方式选取北京市三个区县,再从中选择大病患者较多的2~3个乡镇。通过与大病保险管理者进行访谈,了解其运行现状;对样本乡镇全部大病患者进行问卷调查了解患者主观感受,收到有效问卷497份。利用新农合管理中心信息平台测算患者疾病经济负担。对定量和定性资料分别采用统计分析与主题框架法进行分析。结果:经大病保险报销,三个区县大病患者平均自付费用明显减轻,实际补偿比均有不同程度的提高,但灾难性卫生支出情况无显著改善。结论:应通过提高大病保险起付线与报销比例,拓宽报销目录等举措提高其补偿水平,重点缓解极重患者疾病经济负担。     

乡村医生签约服务实践分析——以江苏省大丰市和浙江省嵊州市为例

目的:分析江苏省大丰市和浙江省嵊州市乡村医生签约服务实践及其初步成效。方法:采用典型抽样,对江苏省大丰市和浙江省嵊州市卫生局的局长或分管局长、乡镇卫生院的院长、乡村医生进行访谈,对访谈内容和政策文件进行归纳,对签约服务前后的服务量变化进行描述性分析。结果:大丰和嵊州乡村医生签约服务以村卫生室和乡镇卫生院为主体,面向全体居民并侧重重点人群,因地制宜地设计了不同的个性化服务包,并建立了相应的保障措施和激励机制。结论:通过签约服务,满足了群众的个性化需求;乡村医生收入增加,积极性提高,农村卫生服务网底得到巩固;基本公共卫生服务质量有所改善;基层医疗卫生机构基本医疗功能得到进一步强化;乡村医生签约服务助推了农村卫生改革,为地方制定和完善农村卫生改革政策提供了依据,但仍需进一步完善。建议:加强乡村医生队伍建设;完善乡村医生签约服务的激励机制;加强对乡村医生签约服务工作的总结评估,为进一步推广签约服务提供依据。     

Collective efficacy,alcohol outlet density,and young men’s alcohol use in rural South Africa

Alcohol use contributes to morbidity and mortality in developing countries by increasing the risk of trauma and disease, including alcohol dependence. Limited research addresses determinants of alcohol use beyond the individual level in sub-Saharan Africa. We test the association of community collective efficacy and alcohol outlet density with young men's drinking in a cross-sectional, locally representative survey conducted in rural northeast South Africa. Informal social control and cohesion show protective associations with men's heavy drinking, while alcohol outlet density is associated with more potential problem drinking. These findings provide initial support for intervening at the community level to promote alcohol reduction.     

2013年连州市农村饮水安全工程水质卫生状况调查

目的了解连州市2013年农村饮水安全工程水质卫生状况,为有效运行管理提供依据。方法对连州市12个乡镇的185个农村饮水安全工程水质卫生状况进行调查,随机抽取45个监测点,分别于枯水期和丰水期采集出厂水和末梢水进行检测。结果全市185宗农村饮水安全工程中,具备完全水处理工艺工程的占11.35%,大多数工程仅对水质沉淀、过滤处理;日供水量300t的占70.05%,82.17%的工程未对水质进行消毒或有效消毒。共采集180份,合格率60.56%,枯水期、丰水期水质分别为52.22%、68.89%,不同采样时期、水处理方式、供水能力、消毒情况合格率差异均有统计学意义(P值均0.05)。主要超标项目是微生物学指标。结论连州市农村饮水安全工程水质合格率偏低,微生物污染较为严重,存在传播介水传染病的隐患。     

皖西农村地区留守居民饮食习惯及其影响因素调查

目的 调查皖西农村地区留守居民的饮食习惯及其影响因素,为预防和控制一系列慢性病提供线索.方法 采用整群抽样方法从安徽六安三个地区抽取18个行政村,对4 040位留守居民进行饮食习惯问卷调查.结果 共收集有效问卷3 936份.本次调查发现:(1)92.53％的农民饮食规律,98.02％经常吃蔬菜;(2)较少摄入(7.93％～28.38％)酸、甜、油炸、加工食品等食品;(3)农民饮食偏咸(98.98％),爱吃腌制食品(74.87％),米/面等谷物摄入多(80.31％),半数以上农民经常吃肉类、热烫、辛辣等食品;(4)白肉、水果、牛奶等食品摄入很少;(5)性别、年龄、经济收入、文化程度和地区分布是很多饮食习惯的重要影响因素.结论 需重视农村留守居民这一个弱势群体,对农村居民的饮食习惯积极进行健康干预并引导预防和控制相关疾病.     

武汉市农村留守妇女生殖道感染状况分析

目的分析农村留守妇女的性传播感染与生殖道感染状况及其影响因素,为改善其生活质量提供参考依据。方法采用整群抽样的方法,随机抽取武汉市某远城区2个村的留守妇女117人为研究对象,先在流动诊所内和村医务室内开展体检和采样,随后对其进行问卷调查。问卷内容主要包括一般状况、艾滋病知识知晓情况、与配偶和非固定性伴安全套使用情况、既往性病感染及就医情况等。结果农村留守妇女采取的避孕措施以结扎为主,而使用安全套的人很少,47.44%的妇女有过流产史,其艾滋病知识知晓率较低,共检测出2例梅毒螺旋体感染病例、9例沙眼衣原体感染病例、4例滴虫感染病例、14例霉菌感染病例,配偶外出打工组的生殖道感染风险均要高于配偶未外出打工组。结论加强对农村留守妇女的艾滋病防治及安全套使用知识的宣传教育,同时在城市加强对农民工的行为干预,有助于降低农村留守妇女生殖道感染的风险。