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1.
How do women and frontline health workers engage in preventing mother-to-child HIV transmission (PMTCT) in urban areas of Vietnam and Indonesia, where HIV is highly stigmatized and is associated with injecting drug use and sex work? This qualitative study explores local dynamics of care, using a mix of observations, focus group discussions, and interviews. In Indonesia the study was conducted in a community-based PMTCT program run by an NGO, while in Vietnam the study explored the care dynamics in routine PMTCT services, implemented by district and provincial public health facilities. In both of these PMTCT arrangements (the routine provider initiated approach in Vietnam and a more client-oriented system in Indonesia), pregnant women value the provision of HIV tests in antenatal care (ANC). Concerns are raised, however, by the unhappy few who test positive. These women are unsatisfied with the quality of counselling, and the failure to provide antiretroviral treatments. Acceptability of HIV testing in ANC is high, but the key policy issue from the perspective of pregnant women is whether the PMTCT services can provide good quality counselling and the necessary follow-up care.We find local level providers of PMTCT are pleased with the PMTCT program. In Vietnam, the PMTCT program offers health workers protection against HIV, since they can refer women away from the district health service for delivery. In Indonesia, community cadres are pleased with the financial incentives gained by mobilizing clients for the program.We conclude that achieving the global aims of reducing HIV infections in children by 50% requires a tailoring of globally designed public health programs to context-specific gendered transmission pathways of HIV, as well as local opportunities for follow-up care and social support.  相似文献
2.
The case described is that of a man raised in the Vietnamese peasant countryside who clearly fits the transsexual syndrome. On physical examination he appears to be a normal male, yet he insists that he is a female. He dresses as a woman and is able to successfully pass in society. He relates that he felt he was a female from earliest childhood. He prefers nonhomosexual men, denies any heterosexual experience, and has an all-consuming desire for the sexual transformation operation. This paper focuses on the social aspect of transsexualism and the manner a society, particularly the Vietnamese, may handle transsexual behavior. These ways can be seen to fall into a continuum. On one end, sexual role reversal is institutionalized and transsexual-like behavior is carried on according to a prescribed cultural pattern. The Vietnamese hermaphroditic witch could be included in this category. In the middle of the continuum, the idiosyncratic transsexual is provided an acceptable cultural role, and he therefore should be visible when he occurs. The Vietnamese young person who cross-dresses could perhaps be in this category. On the other extreme, the transsexual role is not conceivable or, at best, is very marginal. Here, the transsexual remains hidden in the general culture and can only be detected, as the person described in this paper, by accident.  相似文献
3.
The postservice mortality of a cohort of 10,716 US Marine veterans who served in Vietnam was compared with that of 9,346 Marine veterans who did not serve in Vietnam. There was a significant excess of death for Vietnam Marines from all causes and all external causes. After adjustments for age and rank in military, overall mortality continued to be statistically significant, with a relative risk of 1.15 (95% confidence interval (CI) = 1.02 to 1.29) for Vietnam Marines compared to non-Vietnam Marines. All external causes was also significant, with a relative risk of 1.21 (95% CI = 1.00 to 1.47). The excess overall mortality was mainly due to excess deaths from external causes. The risks for several site-specific cancers were elevated but not statistically significant. Periodic follow-up of this Marine cohort should continue to determine whether there are statistically significant differences in the mortality patterns of Marine Vietnam and non-Vietnam veterans, especially for cancers.  相似文献
4.
After independence, the Vietnamese government made an enormous effort to construct a comprehensive health care network from the central down to the grass roots levels, however, the health situation of the population has not improved as much as was expected. The most fundamental cause is poverty, as it is in other developing countries. Because of poverty, the means to achieve a safer environment such as sanitation, safe drinking, water and adequate nutrition, is often absent. Inefficient administration due to the sectionalism among different organizations makes the situation worse. With the introduction of a market policy in 1986, privatization has been introduced into the health sector in order to address some of the inadequacies inherent in the current system. Although privatization might reduce public health expenditures by reducing utilization pressure on public facilities, it deprives the most vulnerable inhabitants of health services. An erratum to this article is available at .  相似文献
5.
Opinions regarding gender roles and family were investigated among 389 urban dwellers in Vietnam using a questionnaire composed of eitht items. As far as gender role is concerned, about 60% of men and 70-80% of women considered that a woman should be responsible for most of the household affairs, even if she is working outside. About 30% of respondents showed a positive response to the idea of child labor. Almost all of the respondents considered it quite natural that children must take care of their elderly parents. For the education of chldren, about 90% thought that children must be offered an opportunity to receive as much education possible, regardless of the gender of the child. For the education of girls, people with higher educational levels showed a more positive response. The present analysis has clarified that traditional beliefs regarding gender roles and family still remain strong even among people with high education level in urban areas of Vietnam.  相似文献
6.
This paper describes the first year of an ongoing village health care and economic development project in the Krong Buk district of Dak Lak province in Vietnam's Central Highlands. The project serves 21 villages with a total population of just over 15,000. Most belong to ethnic minority groups. Physicians from the province capital of Boun Me Thuot were trained by a multi-disciplinary team of American health care workers to be trainers and supervisors of 21 village health care workers (VHWs). Two months later, a VHW from each village was trained in primary and preventive health care by the physician-supervisors. Since this initial training, each VHW has been provided with materials, medicines and monthly supervision by the physician-supervisors. The health care component has been complemented by an economic development project based on a system of small loans. Data from the first year of monthly reports and from a baseline survey are presented in this paper.  相似文献
7.
Reportedly 40-60% of people in Vietnam depend on self-medication. To assess the current situation of self-medication practices as compared with medication given by health professionals in rural areas in Vietnam, we conducted a cross sectional survey at household level. A total of 505 women with at least one child younger than 5 years of age were interviewed in their homes about their drug utilisation practices and attitudes toward medication, by using structured questionnaires. Of the 505 households, 138 stocked drugs for anticipated illness in the future. A total of 96 different antibiotics (in terms of generic type) were kept at 76 households. These antibiotics were kept mainly for coughs and diarrhoea. The self-medication group was twice as likely to use antibiotics than the other group. In addition, self-medication practice was increased when a mother kept medicines in the house. This study revealed that mistaken beliefs about medicines and undesirable attitudes toward medication were prevalent. Mothers used antibiotics as if such drugs were panaceas. In this context, there was insufficient public health education, no control over pharmaceutical promotion, and no efficient drug policy and regulation. More attention should be given to consumers and patients as the ultimate users of drugs so that they can access accurate information, assess the reliability of information and ask necessary questions.  相似文献
8.
Objective To ascertain the extent of under-utilization and insufficiency or inappropriateness in provision of health services as one of the possible causes of high mortality from pediatric pneumonia in pilot areas in Vietnam. Method The household survey on morbidity and treatment of acute respiratory infections, simple cough, and cold and pneumonia, was conducted in two communities with 10% sampling of the child population. Results Both under-treatment of “fast breathing”, a proxy for pneumonia, and over-treatment of simple cough and cold with antimicrobials by health workers, mothers, and private practitioners were common. Conclusions A household survey on morbidity and treatment was found to be useful to clarify actual practices in the treatment of acute respiratory infections in the community, which cannot be obtained by mere interview with health workers or mothers. Since a change of knowledge did not automatically lead to change of practice, the training of health workers, health education of mothers and provision of antimicrobials at village health stations would not guarantee improved practice of health workers and mothers. Therefore, constant supervision for health workers, continued health education of mothers and involvement of private practitioners are needed to improve the situation.  相似文献
9.
In 2000, the government of Vietnam conducted the first assessment of its national peer education program for HIV prevention. Twenty (32%) of Vietnam's 61 provinces and urban areas had functioning peer education programs, and program coordinators of all 20 were interviewed regarding their programs. In addition, on-site reviews were done for 10 of the 20 programs, including interviews of peer educators and high-risk persons in each program.The assessment found that a total of 500 peer educators were functioning either independently or as part of one of 79 teams. In the 20 provinces, the peer educators made an estimated 7,000 total contacts per month with high risk persons, but many persons were likely contacted repeatedly. Despite this, coverage was limited: some provinces with high numbers of persons reported with HIV/AIDS had few peer educators. Although most provinces targeted IDU and many targeted CSW, few provinces targeted sex partners of IDU or CSW. The definition of peer education and composition of teams varied substantially by province; only one province included persons living with HIV/AIDS as peer educators. The services provided by peer educators were primarily distributional: delivering information either through word of mouth, pamphlets, or brochures, providing condoms, and sometimes providing clean syringes and needles. Skills building or goal setting interventions aimed at HIV risk reduction were rarely provided. Most provinces had concerns about ongoing funding and sustainability of the programs. Based on the assessment, specific recommendations were provided for strengthening and expanding Vietnam's peer education programs.  相似文献
10.
The HIV infection rate has shown a rapid increase among the young people in Vietnam. In order to inform an HIV education prevention program, we have conducted a knowledge, attitudes, beliefs and practices (KABP) survey among 902 young vietnamese people in Ho Chi Minh City (HCMC) in 1999. Results show that overall knowledge about HIV, sexually transmitted diseases and safe sex is good. A minority of them (11%) declare having sexual activity. Eighty percent of those sexually active use condoms. This rather optimistic picture needs to be confirmed by qualitative measures of sexual behavior among the youth of HCMC. Gender specific interventions should be developed since there appear to be significant differences of knowledge, beliefs and practices between males and females. Other groups of young people should be investigated in order to have a better picture of the Vietnamese context at a time of expansion of the Aids epidemic.  相似文献
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