青年学生性健康知信行的自我分类偏差对相关问题求助意愿的影响

目的 探讨青年学生性健康知信行自我分类偏差对相关问题求助意愿的影响，为精准实施青年学生性健康促进提供科学依据。方法 2019年3-4月性健康和HIV感染风险评估干预微信小程序（"熊探"）测试期间的青年学生使用者纳入为研究对象。根据研究对象性健康知信行的自我分类和系统分类结果差异划分为3组，包括分类一致组、自我分类偏低组（自评比实际性资讯获取更少、性态度更传统、性经历更少）和自我分类偏高组（自评比实际性资讯获取更多、性态度更开放、性经历更多）。采用logistic回归分析3组研究对象的性健康相关问题求助意愿差异。结果 2 009名研究对象的年龄（19.2±1.1）岁，女性占54.7%（1 099/2 009），大专及以上者占98.4%（1 976/2 009）。性健康知信行自我分类一致、偏低和偏高者分别占49.0%（984/2 009）、10.9%（219/2 009）和40.1%（806/2 009）。与分类一致者相比，自我分类偏低青年学生的HIV自愿咨询检测服务接受意愿更低（aOR=0.65，95%CI：0.43~0.99），自我分类偏高青年学生的性相关疾病求助意愿更低（aOR=0.76，95%CI：0.59~0.98）。结论 性健康知信行自我分类偏差会降低青年学生对相关问题的求助意愿，尤其自我分类偏低会使青年学生低估HIV感染风险，接受咨询检测意愿下降，引起青年学生艾滋病疫情加速扩散。在性健康教育中需加强引导，提高青年学生群体自我评估能力、客观感知和应对风险。     

Disease stigma and intentions to seek care for stress urinary incontinence among community-dwelling women

Objectives

Urinary incontinence (UI) threatens women's physical and mental health, but few women seek healthcare for their incontinence. Evidence is substantial that stigma may be associated with health service utilization for such diseases as mental illness, but sparse for UI. We examine the relationship between disease stigma and intentions to seek care for UI.

Design and setting

A cross-sectional community-based study was used. A purposive sample of 305 women aged 40–65 years in a Chinese city who had stress urinary incontinence (SUI) was enrolled from May to October in 2011.

Measurements

Data were collected on socio-demographic characteristics, UI symptoms, disease stigma and intentions to seek care.

Results

Social rejection was positively linearly related to intentions to seek care for UI (β = 0.207; 95% CI = 0.152, 0.784), indicating that more social rejection predicted stronger intentions to seek care. Significant curvilinear association between internalized shame and intentions to seek care was observed (β = −0.169; 95% CI = −0.433, −0.047). Compared to women with the low and high levels of internalized shame, those with the moderate level of internalized shame reported stronger intentions to seek care.

Conclusion

The impact of stigma on intentions to seek care varies by aspects and levels of stigma. Social rejection enhances intentions to seek care while internalized shame influences intentions to seek care in a quadratic way. The crucial step of targeted interventions will be to disentangle subgroups of SUI women with different aspects and levels of stigma.     

江西省3~5岁儿童对口腔卫生服务需求与就诊利用的现状及对策

目的 了解江西省3~5岁儿童口腔卫生服务需求与就诊利用现状,为制定相关的口腔保健政策,提高口腔卫生服务利用及就诊率,优化口腔人力及服务资源提供数据支持。方法 采用分层整群抽样法随机抽取2 880名儿童进行口腔检查,并对家长进行问卷调查。检查方法和诊断标准参照第四次全国口腔健康流行病学调查方案的规定。用Excel 2007和SPSS 19.0软件对数据进行处理,主要方法为统计描述,卡方检验与Logistic回归分析。结果 2 880例3~5岁儿童乳牙患龋率为49.13%（1 415/2 880）,53.37%（1 537/2 880）的儿童有口腔卫生服务需求,低年龄儿童家长对孩子的口腔状况评价好于高年龄儿童（P<0.05）,城市儿童的评价好于农村儿童（P<0.05）。全部调查对象的口腔就诊率为12.33%（355/2 880）;有口腔疾病儿童就诊率为17.31%（266/1 537）,未就诊原因的前3位依次为：“认为孩子的牙没问题”、“以为牙坏得不严重”、“认为乳牙会替换不需要看”。影响就诊的因素：女性较男性就诊率低（OR=0.499,95%CI：0.411~0.606）,农村较城市就诊率低（OR=0.428,95%CI：0.353~0.519）,口腔健康状况差、口腔知识得分高的对象其口腔就诊率高。结论 江西省3~5岁儿童患龋率低于全国水平,有口腔卫生服务需要而主动寻求就诊服务的比例较低,就诊目的以治疗为主,预防咨询较少。相关部门应加强口腔健康教育宣传并建议纳入幼师培训计划,以提高居民就诊意识和儿童口腔健康水平。     

发挥中心医院优势,合理配置卫生资源

方法：抽样调查1997年4月至9月沙市精神病医院门诊病人788例。结果：自费病人比例大（74．7％）；与96年调查结果比较病人来源、分布发生变化；50．1％的患者愿意舍近求远到该医院就诊，首次发病的患者及家属希望得到咨询服务，部分病人希望开设家庭病床，6．3％患者对医疗质量不够满意；联合用药占一定比例，并存在不合理用药现象。     

探讨服中求阳与阳中求阴对谷氨酸单钠大鼠下丘脑—垂体— …

目的：研究弓状核（ＡＲＣ）毁坏后下丘脑－垂体－肾上腺－胸腺（ＨＰＡＴ）轴的变化以及与肾阴肾阳的内在联系。方法：给 出生后（第２、４、６、８、１０天）大鼠每天皮下注射左旋谷氨酸单钠（ＭＳＧ）４ＭＧ／Ｇ损毁下丘脑ＡＲＣ,成年后分别以左 右归饮灌胃（每天５ｇ／ｋｇ）结果：ＭＳＧ大鼠下丘脑室旁核促肾上腺皮质激素释放激素（ＣＲＨ）阳笥细胞及垂体前叶肿肾上腺皮质激素（ＡＣＴＨ）分泌细胞数量明显多于生理盐水组,     

成年女性尿失禁就医意向及生活质量研究进展

尿失禁作为重要的医疗卫生问题,其导致的经济损失已受到广泛关注。在我国,多达3.49亿成年女性受到尿失禁的困扰,但很少有女性主动求医。对疾病的认知、症状的严重程度及人口社会学因素与女性就医意向密切相关,评价尿失禁生活质量以促进女性就医、改善其生活质量是迫切需要解决的问题。综述近年来成年女性尿失禁就医意向及生活质量的相关研究,为医疗工作提供参考。     

Incidences and risk factors of first-line HAART discontinuation: a limitation to the success of the “seek,test, treat,and retain” strategy?

To evaluate the incidence and risk factors of first-highly active antiretroviral therapy (HAART) modifications/interruptions and their causes in a cohort of newly-treated patients by using a competing risk model. In nine centers of the French cohort Dat'AIDS, in 1 year and 2 years of censorship, a competing risk analysis was implemented in HIV1 patients aged 18 years or older first-treated between September 2002 and March 2012. In 4669 patients, 3628 modifications (77.7%) were observed (median: 13.5 months). Cumulative incidence in 1 year: 46.8% [45.4–48.3]; in 2 years: 65.3% [63.8–66.8]. Intolerance (n = 1167; 32.3%): in 1 year, except first-treated from 2002 to 2005, modifications were not different: 2002–2003 (24.6%) 2004–2005 (26.1%), 2006–2007 (19.4%), 2008–2009 (18.8%) and 2010-2011 (15.7%). Women, AIDS patients, and those aged 50 years and older had an excess risk. Therapeutic simplification (n = 1037; 28.6%): in 1 year, except first-treated from 2002 to 2003, modifications were not different: 2002–2003 (9.0%), 2004–2005 (16.0%), 2006–2007 (11.0%), 2008–2009 (15.7%) and 2010–2011 (10.0%). Conversely to injecting-drug-users and AIDS patients, women and first-treated with non-nucleosides had an excess risk. Therapeutic failure (n = 189; 5.2%): contrary to first-treated between 2002 and 2003 or 2008 and 2009, in 1 year as in 2 years, modifications were not different. In 1 year, 1.9% for 2004–2005, 1.6% for 2006–2007 and 1.2% for 2010–2011. Maximum viral load ≥5.0 log₁₀ copies/ml and CD4 <200 cells/mm³ had a high probability. The study of first-HAART modifications suggests that in 1-year follow-up, intolerance incidence in the recent calendar year is still as frequent as the previous period which may constitute a limitation to the success of the seek, test, treat, and retain.     

产前二维超声筛选胎儿异常或畸形的探讨(附204例分析)

目的：利用二维超声前筛查胎儿异常或畸形，提高人口出生质量，方法：收集了1999年1月至2001年12月在我院作B超筛选胎儿畸形的孕妇共17803人，发现异常或畸形胎儿204例，占1．15％，一般情况下，孕妇排尿后取仰卧位，在腹部扫查，特殊情况可改变体位；特殊脏器可以分时段或隔日重复检查，或结合其他辅助检查的特征辨别比较。结果：在204例中，单发畸形156例，占76．47％，多发畸形48例，占23．53％，头面部畸形发生率最高占46．57％，其次为泌尿生殖系统异常或畸形占30．88％；伴发羊水过多者占17．16％；羊水过少者占4．90％，其中绝大多数在本院或外院引产证实，极少数经过尸解，结论：二维超声可发现大多数的胎儿形态结构异常，使一些致死性的畸形及早终止妊娠，非致死性的异常或畸形有了选择的空间，在此基础上发现某些异常，可采用彩色超声及三维超声等进一步检查。     

从现代医学技术伦理视域析"看病贵"

现在,大多数的医生诊断不再是望闻问切,而是让患者先进行本不需要的各项化验检查。医生完全依赖于现代医学技术。这是形成"看病贵"的重要原因之一。笔者分析了几种原因的形成,并提出了一些解决的办法。     

神经症病人就医行为分析

（１）目的 探讨城乡症病人就医模式。（２）方法 对１３２例城乡神经症病人临床资料进行比较。（３）结果 城乡神经症就诊率差异显著,城市明显高于农村（Ｘ＾２＝１０．２４,Ｐ〈０．０１）,求巫医者农村显著多于城市（Ｘ＾２＝２１．６９,Ｐ〈０．００１）。（４）结论 神经症病人就医行为与经济、文化密切相关,加强精神疾病知识宣传十分必要。