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目的 探讨孕妇孕期活动量水平及与跌倒恐惧的关系,为孕妇孕期活动干预提供参考。方法 对产科门诊常规产前检查的439例孕妇采用一般资料调查表、孕期身体活动调查问卷、国际版跌倒效能量表进行问卷调查。结果 孕妇孕期总活动能量消耗为72.16(39.62,103.28)MET/(h·周),跌倒恐惧总分为39.50±12.52;孕妇孕期活动量与跌倒恐惧呈负相关(r=-0.528,P<0.01);多元线性回归结果显示:家庭月收入、孕期工作、受孕方式、跌倒恐惧可以解释孕期活动量60.3%的变异。结论 孕妇孕期活动量偏低,跌倒恐惧较高,跌倒恐惧可影响孕妇孕期活动量。医务人员应积极进行跌倒恐惧干预,提升孕妇活动信心,增加孕期活动量以促进母婴健康。  相似文献   
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目的 通过实施院内外联动母乳喂养与产褥期照护支持,了解母婴产褥期健康问题,总结入户访视经验,为完善产褥期健康管理提供依据。方法由医院指导团队对社区入户指导团队4名成员进行培训和一对一对接指导,协助制订入户照护方案,由入户指导团队对102名存在母乳喂养问题的产妇行入户访视服务,包括母乳喂养与产褥期照护支持。结果共完成118人次入户访视服务。最常见的产妇问题为哺乳姿势问题,占73.7%;最常见的婴儿问题为喂养遇到的难题,占65.2%。产妇对访视服务的满意度为100%,未发生事故和投诉。结论院内外团队协作入户对产妇行母乳喂养与产褥期照护支持,能帮助产妇解决母乳喂养遇到的问题,提高产妇满意度。在实施前应构建访视团队以及相应的指导团队,加强入户指导质量把控,提高院内外联动性、对指导者进行一对一指导以提高服务质量。  相似文献   
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ImportanceChicago is one of the most racially segregated cities in the US, with the largest mortality gap between neighborhoods. Computed tomographic coronary artery calcium scoring (CACS) is an excellent risk stratification tool, but costs about $200 out-of-pocket, making it inaccessible to some.ObjectiveTo determine whether this ACC/AHA guideline-recommended screening tool is accessible to all populations and neighborhoods, we evaluated the price and availability of CACS in Chicago area hospitals.DesignWe used the Illinois Department of Public Health list of area hospitals to inquire about CACS availability and price. We compared these results to US Census Bureau data for each hospital's service area's demographic, ethnic and socioeconomic population characteristics.ResultsOut of the 40 hospitals in Chicagoland, 30 offered CACS. The 10 hospitals without CACS were smaller hospitals in zip codes with a higher population density (p ?< ?0.01), higher poverty rates (22% vs. 13%, p ?< ?0.01), lower percentage of white population (p ?< ?0.02), lower frequency of higher education (35% vs. 51%, p ?< ?0.05), and a trend toward more black residents (p ?< ?0.10). Life expectancy was greater in areas with CACS available (78 vs. 75 years, p ?< ?0.05).Even in areas with CACS, there was wide price variation, with higher prices in poorer areas (r ?= ?0.57, p ?< ?0.01). The highest vs. lowest quintile of income had higher education, larger white population (80% vs. 14%, p ?< ?0.0001), and longer life expectancy (81 vs. 72 years, p ?< ?0.0002), but tended to have a lower price of CACS ($86 vs. $487, p ?< ?0.08).Conclusions and relevanceCACS is a powerful, evidenced-based clinical tool, but the availability and price vary widely in Chicagoland, and directly correlate with the socioeconomic and health care disparities that are known to exist. Removing these barriers to coronary artery disease screening may be one method to improve the poor cardiovascular outcomes in these areas.  相似文献   
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目的 运用标准化患者法评估四川农村地区基层医生不稳定型心绞痛和2型糖尿病两种慢性病诊断准确性现状,探讨基层医生两种慢性病诊断准确性的主要影响因素,为提升基层医生两种慢性病诊断准确性提供科学依据。方法 采用多阶段随机整群抽样方法,抽取四川省自贡市5个区/县50个乡镇100个村为研究现场,以调查当日在岗的全科及内科医生作为研究对象。共进行两轮数据采集,第1轮采集样本乡镇卫生院和村卫生室医生的基本信息;第1轮调查完成1个月后,运用标准化患者法开展第2轮调查,收集农村基层医生对不稳定型心绞痛和2型糖尿病诊断结果信息。运用Logistic回归分析农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性的影响因素。结果 共纳入172名农村基层医生,完成186次标准化患者访问,正确诊断率为48.39%。其中不稳定型心绞痛的正确诊断率为18.68%(17/91),2型糖尿病的正确诊断率为76.84%(73/95)。Logistic回归分析显示,具有执业医师资质的农村基层医生更有可能做出正确诊断(OR=4.857,95%CI=1.076~21.933,P=0.040)。农村基层医生在诊断过程中涉及的必要问诊和检查条目越多,做出正确诊断的概率越高(OR=1.627,95%CI=1.065~2.485,P=0.024)。与不稳定型心绞痛相比,农村基层医生对2型糖尿病做出正确诊断的可能性更高(OR=6.306,95%CI=3.611~11.013,P<0.001)。结论 四川农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性整体较差,建议以基层医生慢性病诊断过程质量改善为突破口,提升基层医生执业水平,进而提高慢性病诊断准确性。  相似文献   
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《Vaccine》2022,40(6):904-911
BackgroundGSK initiated a Pregnancy Registry in the United States (US) for the reduced-antigen-content tetanus-diphtheria-acellular pertussis (Tdap; Boostrix, GSK) vaccine with the aim to detect and describe pregnancy outcomes in women vaccinated with Boostrix 28 days before estimated conception or during pregnancy.MethodsVoluntary reports of pregnancy exposure to Boostrix received from spontaneous and post-marketing surveillance sources in the US were assessed. Reports were classified as prospective or retrospective based on the knowledge of pregnancy outcomes at the time of reporting. For completeness, reports of exposure to Boostrix or to the Tdap-inactivated poliovirus vaccine (Boostrix-IPV, GSK) reported to the global safety database from countries outside the US were also evaluated.ResultsFrom May 2005 to August 2019, 1517 (1455 prospective and 62 retrospective) pregnancy reports were received in the Boostrix US Pregnancy Registry. Of the prospective reports, 250 had known outcomes: 244 live infants with no apparent birth defects (BDs), three live infants with BDs, and three spontaneous abortions with no apparent BDs. Of the retrospective reports, 55 had known outcomes: 33 live infants with no apparent BDs, 16 live infants with BDs, one spontaneous abortion with no apparent BDs, four stillbirths with no apparent BDs, and one stillbirth with BDs. Cumulatively, 1321 pregnancy reports (1006 for Boostrix; 315 for Boostrix-IPV) were received from countries outside the US. Of these, 163 prospective reports and 551 retrospective reports had known outcomes. Results were in line with those from the Boostrix US Pregnancy Registry.ConclusionsData currently available from the Boostrix US Pregnancy Registry and from countries outside the US suggested that exposure to Boostrix or Boostrix-IPV during pregnancy does not raise safety concerns related to adverse pregnancy outcomes or BDs.  相似文献   
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We designed a systematic literature review to identify available evidence on adherence to and persistence with antidiabetic medication in people with type 2 diabetes (T2D). Electronic screening and congress searches identified real-world noninterventional studies (published between 2010 and October 2020) reporting estimates of adherence to and persistence with antidiabetic medication in adults with T2D, and associations with glycaemic control, microvascular and/or macrovascular complications, hospitalizations and healthcare costs. Ninety-two relevant studies were identified, the majority of which were retrospective and reported US data. The proportions of patients considered adherent (median [range] 51.2% [9.4%-84.3%]) or persistent (median [range] 47.7% [16.9%-94.0%]) varied widely across studies. Multiple studies reported an association between greater adherence/persistence and greater reductions in glycated haemoglobin levels. Better adherence/persistence was associated with fewer microvascular and/or macrovascular outcomes, although there was little consistency across studies in terms of which outcomes were improved. More adherent and more persistent patients were typically less likely to be hospitalized or to have emergency department visits/admissions and spent fewer days in hospital annually than less adherent/persistent patients. Greater adherence and persistence were generally associated with lower hospitalization costs, higher pharmacy costs and lower or budget-neutral total healthcare costs compared with lower adherence/persistence. In conclusion, better adherence and persistence in people with T2D is associated with lower rates of microvascular and/or macrovascular outcomes and inpatient hospitalization, and lower or budget-neutral total healthcare expenditure. Education and treatment strategies to address suboptimal adherence and persistence are needed to improve clinical and economic outcomes.  相似文献   
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通过文献研究和经验总结法,归纳我国互联网医疗的现状特点,并系统分析互联网医疗对构建新型医患关系的有利影响和不利影响。互联网医疗有助于推动转变医患关系模式,促进医患关系多元化发展,降低就医成本,增进医患沟通,但其在医疗质量、数据隐私、行业监管和负面效应方面的风险也亟待重视。在互联网医疗中保持医患关系良性发展的策略需要政府机构和医疗单位在实践过程中不断探索。  相似文献   
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