北京市无痛人工流产育龄妇女接受流产服务的现状调查

目的:了解选择行无痛人工流产术的育龄妇女接受流产服务的现状。方法:采用分层随机抽样的方法在北京市18个区县中抽取6个区县的18家开展计划生育技术服务的医疗机构,在门诊对早孕后选择终止妊娠的育龄妇女进行问卷调查。结果:在至少有1次流产史的1 005例行无痛人工流产调查对象中,前次流产有49.2%的人选择了无痛人工流产,在前次流产时有77.9%接受了避孕宣传教育,只有50.1%获得了避孕药具,前次流产告知流产后需避孕者其流产后首次性生活避孕的比例明显高于未告知者,而且提供避孕宣传教育服务与流产的地点有关。本次流产83.6%为意外妊娠,外地户籍、大学或大专学历、收入>3 000元、丈夫或性伴年龄<25岁的育龄妇女选择无痛人工流产的比例较高,选择无痛人工流产的育龄妇女中有29.0%存在高危因素,仅有61.9%被告知无痛人工流产可能发生并发症。结论:无痛人工流产育龄妇女高危流产的比例较高,其流产前、后获得的知识和信息不足,应开展多种形式的生殖健康知识宣传教育,落实避孕措施,减少非意愿妊娠。     

Maternal age ≥45 years and maternal and perinatal outcomes: A review of the evidence

Objective

to examine the evidence in relation to very advanced maternal age (≥45 years) and maternal and perinatal outcomes in high-income countries.

Background

this review was conducted against a background of increasing fertility options for women aged ≥=45 years and rising birth rates among this group of women.

Methods

established health databases including SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001–2011, that examined very advanced maternal age (VAMA) and maternal and perinatal outcomes. Further searches were based on references found in located articles. Keywords included a search term for maternal age ≥45 years (very advanced maternal age, pregnancy aged 45 years and older) and a search term for maternal complications (caesarian section, hypertension, pre-eclampsia, gestational diabetes) and/or adverse perinatal outcome (preterm birth, low birth weight, small for gestational age, stillbirth, perinatal death). Of 164 retrieved publications, 10 met inclusion criteria.

Data extraction

data were extracted and organised under the following headings: maternal age ≥45 years; maternal characteristics such as parity and use of artificial reproductive technology (ART); and pre-existing maternal conditions, such as diabetes and hypertension. Additional headings included: gestational conditions, such as pre-eclampsia and gestational diabetes (GDM); and perinatal outcomes, including fetal/infant demise; gestational age and weight. Study quality was assessed by using the Critical Appraisal Skills Programme (CASP) guidelines.

Findings

this review produced three main findings: (1) increased rates of stillbirth, perinatal death, preterm birth and low birth weight among women ≥45 years; (2) increased rates of pre-existing hypertension and pregnancy complications such as GDM, gestational hypertension (GH), pre-eclampsia and interventions such as caesarian section; and (3) a trend of favourable outcomes, even at extremely advanced maternal age (50–65 years), for healthy women who had been screened to exclude pre-existing disease.

Key conclusions

although there is strong evidence of an association between very advanced maternal age and adverse maternal and perinatal outcomes, the absolute rate of stillbirth/perinatal death remains low, at less than 10 per 1000 births in most high-income countries. Therefore, although women in this age group encounter greater pregnancy risk, most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centres may also contribute. This information should be used to counsel women aged ≥45 years who are contemplating pregnancy.     

Functional ovarian lesions in children and adolescents: when to remove them

Study objective.?Functional ovarian lesions represent 45% of all pediatric adnexal abnormalities. Their surgical management, even if frequent, is not clear, especially in pediatric age.

Materials and methods.?We retrospectively reviewed 22 pediatric patients surgically treated for functional ovarian lesions from 2000 to 2006. The following characteristics were analysed: age, size of the lesion, ultrasound (US) aspect and clinical presentation.

Results.?The average age was 16.1 years of age (range: 6 months–18 years). Of the 22 functional lesions, 12 (55%) were follicular cysts and 10 (45%) corpus luteum ones. The average size was 6.7 cm (range: 5.1–33 cm). US scan showed simple lesions in 10 cases (45%) and complex ones in 12 cases (55%). In 16 girls (72.8%) the presenting symptom was abdominal pain while 2 patients (9%) presented abdominal distention. In the other 4 patients (16.2%) the lesion was found accidentally during US examination.

Conclusion.?In pediatric subjects, functional ovarian cysts rarely required surgical intervention, though no complications or disorder recurrence were reported. To preserve ovarian function, conservative surgery has to be performed whenever feasible.     

深圳市蛇口地区育龄妇女生殖健康情况调查分析

目的 了解深圳市蛇口地区育龄妇女生殖健康状况,为制定相关干预措施提供依据.方法 随机发放暨南大学专家编制的《妇女生殖健康情况调查表》及《常见妇科疾病知晓率调查表》,对蛇口地区2010年1月至2011年4月于社区健康服务中心就诊、咨询、参加义诊及健康讲座的1100名育龄妇女进行相关调查,同时进行妇科检查及白带常规检查.结果 1100名育龄妇女中501人(48.1％)有人工流产史,人均1～4次,平均1.5次;有582人(55.8％)曾经或现患有阴道炎,阴道炎的患病可能与生活环境潮湿、工作环境高温、工作时间较长、经常穿紧身内裤、不清洗阴道、性伴侣个数＞1个等因素有关.结论 深圳蛇口地区育龄妇女对生殖健康相关知识知晓情况不足,女性生殖健康教育工作还有发展空间.     

年龄对颈动脉血流动力学影响的初步研究

目的研究年龄对颈总动脉血流动力学参数的影响。方法 47名不同年龄健康受试者的双侧颈动脉分别被MR扫描,在颈动脉分叉部位下2 cm颈总动脉平面上,把颈总动脉壁平均分为24等份,利用相位对比MRI和三维抛物面模型拟合的方法,计算每个空间位置一个心动周期内的平均剪切力以及空间位置上最小的剪切力。观察年龄对颈动脉血流动力学参数的影响。结果有9名受试者的9条颈动脉,因难以耐受较长时间的扫描或扫描结果有伪影,在分析时排除。余85条血管颈动脉血管壁上平均剪切力及空间位置上最低剪切力分别为(7.45±2.12)dyne/cm2和(5.98±1.93)dyne/cm2,均与年龄负相关(P<0.05)。结论随着年龄的增长,颈总动脉总的平均剪切力和空间分布最低剪切力下降。     

新型氧气湿化装置在老年科患者中的应用及效果观察

目的 探讨一次性氧气湿化装置(聚四氟乙烯过滤膜式)在老年科患者中的应用方法及临床效果.方法 将210例老年科氧疗患者随机分为实验组和对照组各105例,实验组使用YYSLP-C型一次性氧气湿化装置(聚四氟乙烯过滤膜式)氧气输送装置,对照组使用传统塑料瓶氧气湿化装置.观察比较两组24 h、72 h、5 d细菌培养合格率及湿化噪音主观感受.结果 实验组24 h、72 h、5 d细菌培养合格率及湿化噪音主观感受均优于对照组(P＜0.05,P＜0.01).结论 新型一次性氧气湿化装置能减少老年科氧疗患者发生院内呼吸道感染的风险,且无噪音,值得临床推广.     

Skin Protection for (SPF) Kids Program

Skin cancer is increasing faster than any other cancer in the United States. Individuals who have had excessive sun exposure during childhood and adolescence set the stage for the development of skin cancers later in life. In 2009, there were more than 1 million newly diagnosed cases of skin cancer in the United States. This primary prevention program combined the guidelines in the literature resulting in a unique evidence-based program for teachers and informational guidelines for parents. These guidelines were used in classrooms and at home, supporting intervention among school-age children, specifically those in kindergarten through fifth grade.     

我院就诊育龄妇女避孕知识掌握及需求程度调查研究

目的调查研究本院就诊育龄妇女避孕知识掌握情况及需求程度。方法选取2010年7月～2012年6月于本院就诊的210例育龄妇女为研究对象,将其中不同年龄段及婚否者的避孕知识掌握情况及需求程度进行调查及比较。结果年龄较大者及已婚者的避孕知识掌握较佳率高于其他人,而20～30岁及已婚者知识需求程度较强率高于其他人,差异均有统计学意义（P〈0.05）。结论本院就诊不同年龄段及婚否育龄妇女避孕知识掌握及需求程度存在一定的差异。     

低分子肝素钙治疗早发型重度子痫前期临床疗效观察

目的 观察低分子肝素钙治疗早发型重度子病前期临床疗效.方法 选取孕龄26～34周重度子痫前期患者60例,分为观察组28例和对照组32例,观察组在常规治疗基础上加用低分子肝素钙,对比两组治疗后延长孕龄时间、脐动脉S/D比值、羊水指数、胎盘重量、新生儿体质量及Apgar评分间的差异.结果 平均延长孕龄时间观察组与对照组比较差异有统计学意义[(10.19±4.57)d与(6.14±3.56)d,t=3.872,P＜0.01].脐动脉S/D比值、羊水指数、胎盘重量、新生儿体质量,两组比较差异均有统计学意义(t值分别为9.056、5.259、2.157,2.027;P ＜0.01,＜0.05).1分钟及5分钟新生儿Apgar评分提高,两组比较差异均有统计学意义(x2值分别为8.058、7.190,P均＜0.01).结论 应用低分子肝素钙治疗早发型重度子痫前期可延长孕龄,增加新生儿体质量,有效改善新生儿预后.