Birth rates and reproductive risk in adolescents in Chile, 1990-1999]

OBJECTIVE: For Chilean teenage mothers under 15 years old and from 15 to 19 years old, to evaluate the trends in birth rates and reproductive risk for the period of 1990-1999. METHODS: A database was constructed using data from the Demography Yearbook (Anuario de demografía) volumes published by Chile's National Institute of Statistics (Instituto Nacional de Estadísticas) for 1990-1999. From that database we calculated the trends in the number of live births and in the rates of maternal mortality, late fetal mortality, neonatal mortality, and infant mortality among the teenage mothers under 15 and from 15 to 19 years old. We calculated the risk odds ratio (OR) for both of those age groups in comparison with women from 20 to 34 years old. The groups were compared using Fisher's exact test or the chi-square test, and the analysis of trends in the period studied was carried out with Pearson's correlation, with an alpha level of 0.05. RESULTS: In the period studied, for the teenage mothers under age 15, the respective rates for maternal mortality, late fetal mortality, neonatal mortality, and infant mortality were 41.9 per 100 000 live births, 5.1 per 1 000 live births, 15.2 per 1 000 live births, and 27.4 per 1 000 live births. For the adolescents from 15 to 19 years, the corresponding rates were 19.3, 4.1, 8.1, and 16.6; for the women 20-34 years old, they were 26.8, 5.0, 6.7, and 12.1. The adolescents under 15 had higher risks of maternal mortality (OR = 1.56; 95% confidence interval (CI): 0.50 to 4.31; P = 0.372) and of fetal mortality (OR = 1.02; 95% CI: 0.76 to 1.36; P = 0.890), but those differences were not statistically significant. However, the younger adolescents did have significantly higher risks of neonatal mortality (OR = 2.27; 95% CI: 1.92-2.68; P < 0.0001) and of infant mortality (OR = 2.39; 95% CI: 2.04 to 2.62; P < 0.0001). In comparison to the women 20-34 years old, the teenage mothers from 15 to 19 years old had significantly lower risks of maternal mortality (OR = 0.72; 95% CI: 0.56 to 0.92; P < 0.008) and of fetal mortality (OR = 0.81; 95% CI: 0.77 to 0.86; P < 0.0001) but significantly higher risks of neonatal mortality (OR = 1.20; 95% CI: 1.16 to 1.25; P < 0.0001) and of infant mortality (OR = 1.38; 95% CI: 1.35 to 1.42; P < 0.0001). Among both the older teenage mothers and the mothers 20-34 years old there was a significant downward trend in maternal, fetal, neonatal, and infant mortality rates in the period studied; in the younger adolescents only neonatal mortality and infant mortality declined significantly. There was a rising trend in the number of live births among the two groups of teenage mothers, but that trend was statistically significant only for the mothers under 15; among mothers 20-34 years old there was a statistically significant downward trend. CONCLUSIONS: In the period studied, the Chilean teenage mothers faced greater reproductive risk than did the women 20-34 years old. The number of live births among teenage mothers tended to rise during the 1990-1999 period, but the change was significant only for the mothers under age 15. These results point to the need to develop programs that improve both sex education and birth control practices starting in early adolescence.     

Fertility profile of a rural community of Kashmir in longitudinal association with maternal age

The study was conducted among 264 rural women past menopause who had never used contraception and who attended Hajin Health Block attached to the Community Medicine Department of the SKIMS Srinigar, Kashmir Valley, India. Retrospective reports of pregnancy histories and outcomes were collected. 1405 live births occurred: 654 (46.55%) were male and 751 (53.45%) were female. The sex ratio at birth was 1148 females per 1000 males. 39.29% of births occurred to women 20-25 years old. By the age of 35 years and higher, only 5.90% of births occurred. 1217 children survived: 578 male and 639 female. The survival ratio was 1105 females to 1000 males. Child survival was 92.20% among women under 20 years old and only 57.83% among women 35 years and older. Child survival decreased with increasing age; maternal age and child survival were found to be highly significantly correlated for male children and for both sexes. Average number of children during the entire reproductive period was 5.32 children: 2.48 male and 2.84 females. 84.77% of children were born by the maternal age of 30 years. An average of 4.62 children survived per woman: 2.19 male and 2.43 female. 87.23% of infants born to mothers under 30 years old survived. 1.41 children were born to women by the age of 20 years; 1.30 children survived, which represented 26.50% of the average family size. The gross reproduction rate in this study was 2.84, and the net reproduction rate was 2.43. An increase in marriage age to 20 years would reduce fertility by 26.50%. The most cost effective approach to family planning would concentrate on women 20-25 years old, the most fertile years of the reproductive period. Permanent methods could be introduced among women 25-30 years old, because 85% of family size would have already been achieved.     

GnRH拮抗剂方案对新鲜移植周期子宫内膜容受性影响的回顾性分析

目的：通过回顾性分析应用促性腺激素释放激素激动剂（GnRHa）长方案或GnRH拮抗剂（GnRHA）方案进行体外受精-胚胎移植（IVF-ET）助孕的患者，比较2种方案的人绒毛膜促性腺激素（hCG）日子宫内膜厚度、临床妊娠率和胚胎着床率等相关指标，以期寻找GnRHA是否会对子宫内膜容受性产生影响的临床证据。方法：选择2015年1月-2017年6月于大连市妇女儿童医疗中心第一周期行IVF-ET助孕，应用GnRHa长方案（长方案组，1 459例）或者GnRHA方案（拮抗剂方案组，395例）的患者。比较2组患者的基本特征，根据年龄分为＜30岁组（352例），30～35岁组（781例），35～40岁组（601例）及≥40岁组（120例）；根据获卵数分为低反应组（获卵≤3枚，218例），正常反应组（获卵4～14枚，1 535例）、高反应组（获卵≥15枚，101例）；比较各组患者hCG日子宫内膜厚度、临床妊娠率、胚胎着床率、早期流产率。结果：长方案组与拮抗剂方案组患者的体质量指数（BMI）差异无统计学意义（P＞0.05），但年龄、不孕年限、基础卵泡刺激素（bFSH）、窦卵泡数（AFC）和平均移植胚胎数比较，差异有统计学意义（均P＜0.05）。＜30岁及≥40岁的人群，2种方案的hCG日子宫内膜厚度、胚胎着床率比较，差异无统计学意义（均P＞0.05），＜30岁人群长方案组临床妊娠率高于拮抗剂方案组（P＜0.05）。30～35岁及35～40岁人群，长方案组hCG日子宫内膜厚度、胚胎着床率和临床妊娠率高于拮抗剂方案组，差异有统计学意义（均P＜0.05）。在低反应组中长方案移植胚胎数少，胚胎着床率高，差异有统计学意义（均P＜0.05）。在正常卵巢反应组中，长方案hCG日子宫内膜厚度、胚胎着床率和临床妊娠率大于拮抗剂方案组，差异有统计学意义（均P＜0.05）。在卵巢高反应组2种方案各项指标比较差异无统计学意义（均P＞0.05）。结论：在30～40岁及正常卵巢反应人群拮抗剂方案可能降低子宫内膜容受性，减少胚胎着床率及临床妊娠率。 【关键词】     

Problem of mortality in women of reproductive age in rural area of Haryana

To learn the extent of mortality among women of reproductive age, data was analyzed on causes of death, as reported by anganwadi workers and heads of households, for all maternal deaths in 1992 in Haryana, India. The community was comprised of 300,907 persons and 58,961 women (19.6%) of reproductive age. 9894 live births were recorded, which is higher than the national average. 219 women died in 1992 from maternal and nonmaternal causes (3.7 per 1000 women). In the study blocks (Rohtak, Chiri, and Kathure) the range of mortality was from 3.4 to 4.1 per 1000. 78.5% (172 deaths) were considered nonmaternal deaths. Mortality was 20.9% among mothers 15-20 years old, 25.6% among mothers 20-25 years old, and 18.6% among mothers 25-30 years old. 65.1% of women died at home. 58.1% sought medical care prior to death. 1.2% of deaths were certified. 36.7% of deaths were to literate women, and the remaining 63.3% were illiterate. Causes of nonmaternal death included accidents, respiratory disorders, poisoning, and digestive disorders. Slightly over 20% of accidental deaths were due to burns and suicide. 21.46% (47 deaths) were maternal deaths (475 per 100,000 live births). Maternal mortality ranged from 46 to 488 in the 3 blocks. Rohtak had the highest maternal mortality. Maternal mortality was highest among women 30-44 years old (996 per 100,000), followed by women 15-20 years old (575 per 100,000). 21.3% died during labor and delivery, and 68% died during the postpartum period. 57.4% died at home, and 25.5% died at the Medical College Hospital. 61.7% used prenatal services. 36.2% did not seek medical care prior to their death. 55.3% of deliveries were by trained birth attendants. 25.5% died with their first births. 51.0% of women with a birth interval under 3 years died. Maternal mortality was distributed by cause as follows: postpartum hemorrhage (17.0%), puerperal sepsis (17.0%), anemia (12.8%), preeclampsia and eclampsia (14.9%), obstructed labor (6.4%), hemorrhage antepartum (4.25%), abortions and MTP (10.6%), and indirect causes (12.8%). Improvement is needed in literacy, contraception, women's empowerment, and prenatal care in order to reach the goal of reduced maternal mortality by the year 2000.     

High mortality despite good care-seeking behaviour: a community study of childhood deaths in Guinea-Bissau.

The care-seeking behaviour of mothers of 125 children deceased aged 1-30 months was investigated by verbal autopsy in an urban area of Guinea-Bissau. A total of 93% of the children were seen at a health centre or hospital during the 2 weeks before death. In a previous survey covering the period 1987-90 we found that 78% of the children who died had presented for consultation (8); despite this increase in care seeking, infant mortality had not decreased. Comparison of elapsed time from disease onset to first consultation between children who died and matched surviving controls indicated that the interval was shorter for children who died than for those who survived (odds ratio (OR) = 0.7; 95% confidence interval (CI): 0.5-0.99). Of the 125 terminally ill children, 56 were hospitalized. A total of 20 children died on the way to hospital or while waiting in the outpatient clinic. Lack of hospital beds resulted in 15 mothers being refused hospitalization for their child. Of hospitalized children, 42% were discharged as improved or recovered during the 30 days preceding death. These results reveal a need for improved hospital admission criteria, improved recognition of the symptoms of serious illness, better discharge criteria, and the implementation of quality assurance systems for health services.     

Parental age and outcome of pregnancy

Researchers compared data on 150 women who underwent induced abortion with data on 50 women who experienced a spontaneous abortion to examine the role of parental age on pregnancy outcome. The women all lived in the city of Patiala in the Punjab, India. The 25-30 year old age group had the greatest proportion of women experiencing an induced abortion (49.33%), while the 20-25 year old age group had the greatest proportion of women suffering from a spontaneous abortion (52%). Older women who had already completed their families were more likely to undergo an induced abortion than younger women (X2 = 11.6; p 0.05). The 25-30 year old age group for males had the greatest proportion for both spontaneous abortion (48%) and induced abortion (38.67%). These findings show that, among both the abortion categories, the age of both mothers and fathers lies within the optimum age for reproduction (i.e., 20-30 years), suggesting that parental age might not contribute to unsuccessful pregnancy outcome.     

Breast-feeding and fertility. Part I: Lactational amenorrhoea.

A cross-sectional survey describing the current fertility performance and breast-feeding of 1134 urban mothers, who gave birth within the last 2 years was carried out. Mothers were recruited from MCH centers in Alexandria governorate. The results indicated that the mean time elapsed since birth before return of menstruation was (5.1 +/- 4.3) months for breast-feeding mothers and (2.5 +/- 2.3) months for non-breast feeding mothers. At four-month of postpartum period, 50% of the mothers were still amenorrhoeic and at six-month, 31% of the mothers were still amenorrhoeic. A total confirmed pregnancies was 8.5% and 3% of new pregnancies occurred during amenorrhoea and while women were breast-feeding. Use of contraceptives was practiced by 57% of mothers, with 65% of all users starting as early as the second month.     

The pregnancy during adolescence as a risk factor for low birth weight, Brazil

OBJECTIVE: To identify the role of pregnancy during adolescence as a risk factor to low birth weight (LBW). METHODS: A stratified sample of live births from the Information System of Live Births in the municipality of Rio de Janeiro, in the period 1996-98, was selected. The risk factors of LBW were analyzed for the two strata composed by the mother age, 15-19 and 20-24 years old. For the statistical analysis, odds ratios and correspondent confidence intervals were estimated. Logistic regression procedures were used. RESULTS: The LBW was significantly greater among the adolescent mothers group than the 20-24 years one. Regarding prenatal care, adolescents had a lower number of appointments and a higher percentage of no attendance. More than 50% of the older mothers completed high school, but only 31.5% among the younger mothers had the same level of instruction. The percentage of premature live births in this group was significantly greater. Differences were observed by type of hospital (public or private) and there was a predominant use of public hospitals by the adolescents. The logistic regression analysis showed a significant effect of the mother age on LBW, even when controlled for other variables. CONCLUSIONS: The results suggest that further investigation on the mechanisms that underlie the association between LBW and pregnancy during adolescence should be carried out, taking into consideration sociocultural factors such as poverty and social deprivation, as well as biological and nutritional factors during pregnancy.     

Health and poverty: health management by the woman.

The goal this follow-up study was to relate the mother's marital satisfaction to family health status in a low SES. The random sample was made up of 30 families with children under 7 years old: 15 considered as sick (Group A) and 15 as healthy (Group B). Both group had similar demographic characteristics (age of father and mother, persons per family group and age of children) and SES. Results showed that mothers were those mainly in charge of their family groups. Mothers of Group A were significantly less understanding and more dissatisfied than those of Group B (p < .05 and p < .01). Mothers of Group A had significantly more arguments with their partners than those of Group B (p < .006). Health care was learned less from the child's own mother in group A than in B (p < .05). Health was considered by mothers of Group A as something that "must be taken care of" more than by those of Group B p < .01). The behaviours of mothers in choosing one of the health systems was similar in both groups. Dissatisfied mothers were associated more with sick family members during the 6 month follow-up. It is suggested that the satisfaction of the mother is a factor that needs further investigation because health is managed by mothers is the large majority of families.     

高龄产妇中期引产的临床效果

目的:探讨高龄(>35岁)是否增加中期引产的相关风险。方法:收集北京协和医院2013-2019年经依沙吖啶羊膜腔内注射引产的93例患者,以35岁为界,分为低龄组、高龄组,两组根据有无辅助应用欣普贝生分为低龄单药组、低龄双药组、高龄单药组、高龄双药组。均除外内科合并症、瘢痕子宫、哺乳期、多次人工流产史、多次宫腔镜治疗史等高危因素,比较各组引产情况。结果:高龄组与低龄组宫缩发动时间、胎儿娩出时间、总产程时间、产后2h出血量、引产出血率、宫腔残留率、软产道损伤、是否加用宫缩干预、产后感染率、引产成功率均无差异(P>0.05)。但宫颈裂伤均发生在单药组,引产出血均发生在低龄组,宫缩发动和胎儿排出时间双药组均呈缩短趋势。结论:高龄产妇不增加依沙吖啶羊膜腔内注射引产术的风险,经腹依沙吖啶羊膜腔内穿刺术对>35岁孕妇仍是一种安全有效的中期引产方式,依沙吖啶联合欣普贝生引产可能会减少宫颈裂伤的发生。     

IVF-ET中卵巢低反应临床资料分析及再次治疗策略

目的:探讨在体外受精-胚胎移植(IVF-ET)周期控制性超排卵(COH)中出现临床卵巢低反应患者的临床特征及其再治疗策略。方法:回顾性分析接受IVF-ET治疗,表现为临床卵巢低反应的189例患者临床资料(以获卵≤4枚为诊断标准),并按照患者年龄分为≤30岁、>30～35岁、>35岁3组;未妊娠接受第2次IVF-ET治疗共71个周期的临床资料进行自身对照分析。结果:第1周期治疗中,≤30岁组、>30～35岁组优质胚胎率和妊娠率均高于>35岁组,周期取消率低于>35岁组;第2周期调整COH方案可以获得正常的卵巢反应;对于卵巢低反应的高龄患者,小剂量的生长激素可以增加其优质胚胎率。结论:在COH方案中,部分卵巢低反应患者存在卵巢反应的不一致性,应结合既往超排经历重新评估卵巢储备。     

Study of hematological indices in tannery workers exposed to chromium in Sheikhupura (Pakistan)

Chromium (Cr), being an excellent tanning agent, is widely used in the leather industry and tannery workers (TW) are exposed to it either in the form of inorganic Cr(III) compounds or Cr bound to proteins (leather dust) in the process of leather production. During the present study, the effect of Cr on the hematological indices in TW was evaluated. In this study, hematological indices of 92 male TW aged 20-60 years were compared with 79 control males who hardly had a chance of exposure to chromium. Both groups were subdivided into four age groups with an interval of 10: group A, 20-29 years; group B, 30-39 years; group C, 40-49 years; group D, 50-60 years. Total erythrocyte count (TEC) was significantly lower (p < 0.05) in TW of age group A, B and C than control subjects. Packed cell volume (PCV) was significantly higher (p < 0.05) in TW of age group B while mean corpuscular hemoglobin (MCH) was significantly lower (p < 0.05) in TW of age group D. Within the TW, MCH was significantly lower (p < 0.05) in the age group D as compared to age group A and B. No significant changes were observed in the values of hemoglobin, mean corpuscular volume and mean corpuscular hemoglobin concentration between TW and control individuals. The low values of TEC, PCV and MCH might be a result of chromium exposure in the tannery workers and may act as indicators of chromium toxicity.     

1996至2000年全国先天性腹裂畸形监测资料分析

目的对1996至2000年全国先天性腹裂畸形的变化趋势以及流行病学特征进行分析.方法 1996至2000年全国31个省、自治区、直辖市(不包括香港、澳门特别行政区和台湾省)的450～466所县级以上医院参加全国出生缺陷监测,监测对象为孕满28周以上出生的围产儿,最大诊断期限为生后7 d.结果 1996至2000年全国共监测2 218 616例新生婴儿,其中腹裂畸形患儿569例.全国的腹裂总发生率为2.56/万,城市的发生率为1.98/万,农村的发生率为3.93/万;男性的发生率为2.15/万,女性的发生率为2.64/万,差异均有统计学意义.1996至2000年间腹裂的发生率无上升趋势.腹裂的发生率孕母<20岁年龄组是25～29岁年龄组的5.4倍,但1996至2000年期间孕母年龄<20岁组的围产儿腹裂发生率没有出现上升趋势(P>0.05).腹裂畸形围产期产前诊断比例为41.46%.27.44%腹裂畸形为多发畸形.围产期腹裂畸形的死亡率为74.69%.结论 1996至2000年我国腹裂畸形没有出现上升趋势.孕母年龄<20岁是围产儿腹裂发生的危险因素.我国腹裂畸形围产期死亡高.     

中国出生缺陷高发地区出生缺陷的发生水平和流行病学特征

目的研究中国出生缺陷高发地区出生缺陷的发生水平,分析主要出生缺陷的分布和流行病学特征。方法在出生缺陷高发的山西省选择2个高发县作为调查现场,对调查地区2002年1月1日至2004年12月31日期间孕满20周及以上的所有出生人口开展了以人群为基础的出生缺陷回顾性调查。结果调查地区2002—2004年出生缺陷发生率为844.2/万,发生率位于前五位的出生缺陷包括腹股沟疝(182.2/万)、无脑儿(104.4/万)、先天性智力低下(79.4/万)、先天性心脏病(73.2/万)和脊柱裂(63.9/万),前五位出生缺陷占全部出生缺陷的60%。国内外出生缺陷统计分析一般不包括腹股沟疝、鞘膜积液、隐睾和先天性智力低下,如果不包括这四类出生缺陷,调查地区出生缺陷发生率为537.2/万,位于前五位的出生缺陷分别为无脑儿、先天性心脏病、脊柱裂、脑积水(40.5/万)和脑膨出(31.2/万)。男性出生缺陷发生率为966.2/万,明显高于女性(640.4/万)。孕产妇年龄<20岁组和>30岁组出生缺陷发生率明显高于20～24岁和25～29岁年龄组。低龄孕妇发生神经管畸形和先天性心脏病的风险甚至显著高于高龄孕妇,孕产妇年龄<20岁组神经管畸形和先天性心脏病的发生率分别是408.8/万和188.7/万,而>30岁组两类出生缺陷的发生率分别为204.8/万和91.0/万。出生缺陷发生率随着孕产次的增加而明显提高。结论中国高发地区出生缺陷的发生呈现出与其他地区不同的流行病学特征,尤其是神经管畸形异常高发。不仅是高龄孕妇,20岁以下的低龄孕妇同样是一些出生缺陷发生的高危险因素。     

A comparison of pregnancy and child health outcomes between teenage and adult mothers in the slums of Nairobi, Kenya

The study assessed and compared pregnancy and child health outcomes of teenage (aged less than 20 years) and adult (20-34 years of age) mothers. A total of 226 teenage and 205 adult mothers met the study criteria out of the 3,256 women in the reproductive age group (15-49 years) and 318 adolescent girls (12-14 years of age) covered by the Nairobi Cross-sectional Slums Survey (NCSS). The main comparison involved socio-demographic variables, events during pregnancy, obstetric outcome, child morbidity and mortality and care provided during an illness episode. Results showed that a significantly higher percentage of teenage mothers and their partners had lower educational achievement compared with adult mothers and their partners. They were more likely to be economically disadvantaged than the adult mothers. Teenage mothers and their parents were also less likely to have ever been married. The two groups of mothers were comparable in terms of the rate and timing of antenatal care visits, place of delivery, rate of operative deliveries, reported size of the baby at birth, child vaccination status and reported morbidity and health care practice during an illness episode. The index child was alive during the survey period for 89.4% of the teenage and 96.6% of the adult mothers (OR = 3.36; 95% CI = 1.34, 8.79; P = 0.004). Child survival rates in the two groups of mothers were found to be quite similar after controlled analysis for the influence of socio-economic factors. The study concluded that bad obstetric outcomes were not associated with maternal age. Although teenage and adult mothers were not significantly different on child health practices, children born to the former group died most frequently probably due to their poor socioeconomic achievements.     

Adolescent motherhood. Comparison of outcome with older mothers

The purpose of this study was to determine whether there were differences in maternal role attainment behaviors for three age groups (15-19, 20-29, 30-42 years) of 294 first-time mothers over a 1-year period. Interviews and questionnaires were completed at early postpartum, 1, 4, 8, and 12 months. Findings are in agreement with more recent research that the health status of adolescent mothers and their infants does not differ greatly from that of older mothers during the first year of motherhood. The adolescent's infant's growth and development were not handicapped. There were no group differences in feelings of love for the infant. The adolescent mother consistently scored lower than older mothers on observed and self-rated maternal competency behaviors. The adolescent mother derived greater gratification in the mothering role than older mothers through 8 months; at 12 months, the 20-29-year-old mother scored higher in gratification. The help received from the adolescent's mother declined at 8 and 12 months suggesting an increased need for social support from other sources at this time.     

Epidemiology of varicella in Slovenia over a 20-year period (1979-98)

Varicella is one of the most common childhood diseases. The course of the disease is usually mild and uncomplicated. In Slovenia, varicella is a notifiable communicable disease which must be reported. Data collected from 1979-98 were analysed. Over the 20-year period the number of varicella cases reported ranged from a low of 11,086 (in 1994) to a maximum of 21,141 (in 1987). During the last 10 years, the highest incidence of varicella was reported in children aged from 12 months to 2 years. In adults over 20, incidence has slightly but steadily increased over the 20 year period. Overall, the number of males with varicella exceeded that of females. The proportion of females was higher only in the 20-30-year age group, probably as a consequence of more frequent and closer contact with infected children by mothers. The highest number of reported cases was during winter and early spring.     

中青年脑力与体力劳动职业女性身体素质的比较

[目的]比较广州市中青年脑力和体力劳动职业女性的身体素质，探讨不同劳动类型对身体素质的影响。[方法]采用整群随机抽样方法，选取广州市各区1332名20．39岁女性人群为研究对象，根据职业特点分为体力劳动组和脑力劳动组。观察肌肉力量、柔韧性、速度和灵敏度、反应能力、平衡能力5方面指标。[结果]体力劳动组握力、坐位体前屈好于脑力劳动组（P〈0．01）；脑力劳动组仰卧起坐、纵跳高度、10×4m往返跑、选择反应时、闭眼单脚站立等均好于体力劳动组（P〈0．01或P〈0．05）。[结论]体力劳动对中青年职业女性的大部分身体素质并不一定有促进作用，体力劳动不可以做为全面提高身体素质的手段。     

Use of primary health services in sparsely populated country districts by patients with musculoskeletal symptoms: consultations with a physician.

STUDY OBJECTIVE--To examine the extent to which people consult health centre doctors about various musculoskeletal symptoms and to identify those groups of patients who are responsible for the main workload in primary health care caused by musculoskeletal complaints. DESIGN--A cross sectional investigation based on case records of people who visited health centre physicians. SETTING--The population of six Finnish health centre districts (93,000 inhabitants, 64 physicians' posts in primary care centres). SUBJECTS--6526 patients (7634 visits) who consulted a physician at any of six health centres during a two week period, of which 1380 consulted for musculoskeletal symptoms. MEASUREMENTS AND MAIN RESULTS--The reasons for the visits were abstracted from the case records and were analysed by cross tabulation. The rate of people visiting for musculoskeletal symptoms during a two week period was on average 15 per 1000 inhabitants. It was highest in men aged 45-54 years (25/1000) and in women aged 55-64 years (26/1000); the rate fell to the average in men over 54 and women over 64 years. Patients with musculoskeletal symptoms accounted for 21% of all patients and 27% of those over 15 years of age. Low back pain was the most common reason for consultation in men aged 25-54 years, while for women aged 35-74 years, the most common reason was neck and shoulder pain. CONCLUSIONS--Over one quarter of adults visiting a health centre doctor do so because of musculoskeletal disorders. This fact must be considered when developing health care services and organising basic education and further in-service training for doctors.     

2004 - 2016年荆州市甲型病毒性肝炎流行特征分析

目的 分析2004 - 2016年荆州市甲型病毒性肝炎（甲肝）流行病学特征并提出防控建议。方法 采用描述性流行病学方法分析2004 - 2016年荆州市甲肝疫情资料,采用集中度值法分析甲肝季节特征,采用系统聚类分析甲肝地区分布特征。结果 荆州市2004 - 2016年共报告甲肝2 232例,年均发病率为2.89/10万,13年间荆州市甲肝发病率呈下降趋势（χ2 （趋势） = 158.445,P＜0.05）,年平均下降速度为5.93％。各年份发病无明显季节性。地区发病顺位为:城乡结合部＞中心城区＞远郊（χ2 = 31.907,P＜0.05;χ2 = 15.178,P＜0.05）。男性发病高于女性（χ2 = 18.268,P＜0.05）,人群分类以农民为主（62.10％）。发病高峰年龄:2004 - 2008年病例以30～54岁为主,2008 - 2012年病例以35～59岁为主,2013 - 2016年病例以40～69岁为主,病例发病年龄有后移现象。2009以来荆州市甲肝疫苗报告接种率均在99％以上。结论 2004 - 2016年荆州市甲肝发病呈下降趋势,甲肝疫苗预防接种为主的预防控制措施成效明显。今后应在进一步做好小年龄组儿童免疫接种工作的同时,加强高发地区高危人群的疫苗接种工作。