分娩前宣教助于降低剖宫产率的临床分析

目的:分析分娩前宣教对降低剖宫产率的临床意义。方法:对漯河市源汇区妇幼保健院妇产科1999～2008年剖宫产率及剖宫产指征比率的变化进行回顾性统计和分析。结果:1999～2005年剖宫产率逐年上升,以"社会因素"为指征的比率逐年增加,2006年开展分娩前宣教以来,社会因素指征比率明显下降,剖宫产率逐年下降。结论:分娩前的宣教有助于降低剖宫产率。     

727例社会因素剖宫产的原因分析及对策

目的:分析剖宫产指征中社会因素的相关因素,降低社会因素所致的剖宫产率。方法:对2001年1月～2006年12月因社会因素行剖宫产终止妊娠的727例病例进行回顾性分析。结果:以社会因素为指征的剖宫产率呈逐年上升趋势,其中,产妇害怕产痛52.27%、对阴道分娩认识不足30.26%、医生因素9.49%、担心胎儿安危5.23%、选择"吉日"2.76%。结论:应采取积极的应对措施,促进和支持自然分娩,降低社会因素为指征的剖宫产率。     

社会因素对剖宫产率的影响及对策

目的:探讨本院以社会因素为指征剖宫产率上升的影响,寻求降低以社会因素引起的剖宫产率增高的对策。方法:对本院产科2004年1月～2007年10月866例孕妇或家属要求填写剖宫产申请书和1251例医师以胎儿、孕妇、头盆方面因素为指征实施剖宫产病案进行回顾性调查分析。结果:孕妇及家属自愿申请剖宫产率逐年上升,剖宫产主要原因是担心胎儿危险占首位,其次是担心无法正常分娩,剖宫产指征被扩大放宽。结论:正确认识不必要剖宫产对孕妇、胎儿的危害及医疗资源浪费,加强健康宣传教育及孕期锻炼,为自然分娩创造有利条件。同时加强对医护人员职业风险及社会保护,以降低因社会因素引起的剖宫产率上升。     

徐州地区2005～2009年分娩方式的变化

目的:分析徐州地区孕产妇分娩方式的变化趋势,探讨剖宫产术的影响因素。方法:回顾性分析2005～2009年在徐州市妇幼保健院接受阴道分娩和剖宫产的孕产妇9 712例。结果:2005～2009年34.75%的产妇为阴道分娩,其中1.15%为阴道助产,阴道助产率明显下降,从2005年的1.93%下降至2009年的0.63%(P<0.01);65.15%为剖宫产,剖宫产率从2005年的60.17%上升至2009年的67.53%(P<0.01);各年剖宫产率呈逐渐上升趋势。剖宫产因素为:胎儿窘迫、胎位异常、及社会因素等,但每年顺位有变化;其中社会因素剖宫产的比率逐渐上升。结论:徐州地区剖宫产率处于较高水平,高剖宫产率受多种因素影响。社会因素中对剖宫产弊端了解不足、住院时未临产、医生的分娩建议不明确,因不孕症通过辅助生殖技术的应用而妊娠等是无指征剖宫产的影响因素。社会因素一定程度上影响着科学合理分娩方式的选择。     

社会因素对剖宫产的影响及其对策

目的:分析社会因素剖宫产原因,探讨社会因素剖宫产的对策。方法:对2002年1月～2007年12月住院分娩产妇的剖宫产资料进行回顾性分析。结果:剖宫产率呈逐年上升趋势,社会因素剖宫产占剖宫产总数24.53%。主要原因有孕妇对分娩的恐惧,对剖宫产的误解,择日择时分娩等。结论:社会因素是剖宫产上升的主要因素,因此加强宣传教育,更新产科医务人员的服务理念,提高医院整体产科质量,积极开展无痛分娩,加强医患沟通等策略是控制社会因素剖宫产的关键。     

剖宫产率增高的因素及降低措施探讨

目的:分析剖宫产率上升的因素,探讨降低剖宫产率的措施。方法:统计1995~2005年在该科住院分娩的孕妇总数、剖宫产数及剖宫产指征,对10年来剖宫产率及手术指征进行回顾性分析。结果:10年间剖宫产率逐年上升,多年来剖宫产指征一直以难产为第1位,近几年,以胎儿窘迫、社会因素为剖宫产指征上升较为明显,差异均有显著性意义(P<0.05)。结论:胎儿窘迫、社会因素是剖宫产年增加的主要因素,正确诊断胎儿窘迫,严格掌握剖宫产指征,普及卫生知识,进行心理调控等是降低剖宫产率的关键。     

天津市宁河县近5年剖宫产率上升的原因分析

目的:分析天津市宁河县医院近5年来剖宫产率上升的原因,以便采取可行的干预措施。方法:对该院2003年1月～2007年12月住院分娩的5211例剖宫产病例进行回顾性分析。结果:剖宫产指征的首位因素2003～2005年为胎儿宫内窘迫及头盆不称,2006～2007年为社会因素及瘢痕子宫。结论:剖宫产率升高的主要原因是由社会因素剖宫产及瘢痕子宫剖宫产增多所致。     

河北省秦皇岛市7年剖宫产现状调查分析

目的:分析剖宫产指征的变迁,探讨剖宫产率增高的原因及降低剖宫产率的措施与对策。方法:统计2002～2008年在妇产科住院分娩的孕妇总数、剖宫产数及剖宫产指征构成比,对7年来剖宫产率及剖宫产指征进行回顾性分析。结果:7年来剖宫产率逐年持续上升,2004年前头位性难产占居剖宫产指征第1位,2005年以后社会因素上升为第1位;2次剖宫产率上升较为明显,差异均有统计学意义(P<0.01)。结论:社会因素是剖宫产率增加的主要因素,由此引发的高2次剖宫产率成为剖宫产率持续增高的又一因素。     

618例剖宫产原因分析

目的:探讨剖宫产率上升的原因和可能降低剖宫产率的有效途径。方法:对沈阳市妇女儿童保健中心围产期门诊2005年1月1日~2008年12月31日间分娩产妇的分娩资料进行回顾性分析,探讨剖宫产指征及其原因。分析剖宫产率的变化趋势及剖宫产指征的变化。结果:4年间该院分娩产妇1 496例,其中剖宫产618例,剖宫产率为41.31%,剖宫产率逐年上升,其中初产妇占89.20%,年龄25~30岁产妇占87.54%。剖宫产指征依次为胎儿因素、母儿因素、社会因素、母亲因素。在选择剖宫产产妇中,城市产妇占85.60%,农村产妇占14.40%。剖宫产指征的变化中,相对性头盆不称、社会因素造成的剖宫产率逐年升高,居第1、2位;胎儿窘迫居第3位。结论:剖宫产率的上升是诊疗技术与社会因素综合作用的结果,正确掌握剖宫产指征是降低剖宫产率的有效途径。     

社会因素剖宫产临床评价及控制策略

目的对社会因素剖宫产进行临床评价,探讨降低社会因素剖宫产率的策略。方法总结分析1994～2003年剖宫产的病历资料;在2003年病历中随机筛选出116例社会因素剖宫产病例,并选取同期自然分娩病例进行1:1配对,比较分析两组产妇及新生儿的临床指标。结果2003年剖宫产率为57.9%,约为10年前的2.6倍,社会因素剖宫产率为16.5%,上升为10年前的33倍;社会因素剖宫产的产后体温、产后出血量、住院天数、住院费用及新生儿体重高于自然分娩组,差异有显著性(P<0.05)。结论控制社会因素剖宫产率可采取以下策略:加强宣传教育,更新产科医务人员的服务观念,提高医院产科整体质量,积极开展无痛分娩术及社会保险机构进行质控考核等。     

社会因素剖宫产与自然产临床评价的配对比较研究

[目的 ]　对社会因素剖宫产临床的有关利弊问题进行客观评价。　 [方法 ]　对上海市某综合性医院 1994～2 0 0 2年的剖宫产率进行趋势分析。采用随机抽样和严格配对的方法 ,对最近 3年该院 10 7对社会因素剖宫产与自然产者的有关临床指标进行比较和评价。　 [结果 ]　 9年来该院剖宫产率呈显著递增趋势 ,2 0 0 2年达 5 7.5 7% ;社会因素剖宫产组产妇的产后出血量、体温、产后住院天数、住院费用及胎儿窘迫症的发生率 ( 11.2 1% )均显著高于自然产组 ;发生新生儿窒息 ( 1.87% )、产后大出血 ( 0 .94% )、手术及麻醉并发症的风险也大于自然产组。　 [结论 ]　过高的剖宫产率亟须加以控制。社会因素剖宫产与自然产比较 ,对母、婴健康的危害颇多 ,建议临床上仍应从严掌握 ,尽量避免社会因素剖宫产术。     

Socioeconomic factors and utilization of public family practice facilities in Madrid

OBJECTIVES: To describe the possible association between demographic, social and economic characteristics of health areas in the autonomous community of Madrid and utilization of public family practice facilities. METHODS: An ecological study was carried out using health areas as the unit of analysis. The information sources were official data on population statistics and the reports of the National Institute of Health for 1996 and 2001. Indicators were income, mean household size, unemployment rate, the percentage of housewives, and the percentage of individuals with university education. The association between these indicators and utilization of public family practice facilities was analyzed using the Spearman correlation coefficient. A multivariate linear regression model was also fitted. RESULTS: The consultation rate in public family practice facilities in Madrid was directly associated with the percentage of housewives (r = 0.44), income (r = -0,697), and the percentage of individuals with university education (r = -0.72). In the multivariate linear regression model, 77% of the varian-ce in utilization was explained by income (48%), the percentage of housewives (19%), and average household size (9%). CONCLUSIONS: The results show the relationship between social and economic factors and utilization of public family practice facilities and suggest the advisability of including demographic and socioeconomic factors in primary care planning.     

Life-style and self-rated global health in Sweden: A prospective analysis spanning three decades

Objective

To study the relations between lifestyle factors (smoking, drinking, exercise, vegetable consumption, social relations) and global self-rated health in the adult Swedish population.

Method

The data come from the Swedish Level of Living Survey, a face-to-face panel study. The analysis follows the respondents with good health in 1991 (N = 4035) and uses multivariate logistic regression to assess the relations between lifestyle factors in 1991 and health in 2000 and 2010.

Results

Baseline (1991) exercise, social support, smoking and vegetable consumption are associated with health in 2000 and/or 2010. 2000: Weekly exercise in 1991 increases the probability of good health by 6 percentage points [95% CI: 1–10] compared to no exercise, and smoking 10 or more cigarettes a day decreases the probability of good health by 5 percentage points [95% CI 1–8]. Lacking social support decreases the probability of good health by 17 percentage points (95% CI: 9–25). 2010: Smoking 10 or more cigarettes a day decreases the probability of good health by 10 percentage points [95% CI 5–15], and eating vegetables every day increases the probability of good health by 4 percentage points [95% CI 0.2–7].

Conclusions

Exercise, smoking, social support and vegetable consumption are related to self-rated health 2000 and/or 2010.     

上海市中学生焦虑状况及其相关因素

目的 调查都市中学生焦虑的程度和内容,分析其相关因素,为干预提供更合理的建议。方法 2004年11至12月,采用中学生心理健康诊断测验及生活环境和养育方式调查表调查上海市中学生。结果 调查有效人数3050人,年龄11～18岁。焦虑程度为中等或偏下水平（0．24-0．54）,总体焦虑程度偏高的占16．7％,各项内容程度偏高的占8．8％～21．8％,主要为自责、学习焦虑、对人焦虑和过敏倾向;女生的焦虑程度普遍高于男生,男生的孤独倾向高于女生;总焦虑分随年龄增长而降低,男生除过敏倾向外的其他内容均表现为降低的趋势,女生表现为孤独倾向降低、过敏倾向增高;15岁是多个因子变化幅度最明显的年龄。与中学生焦虑相关的不利因素为：父母文化程度过低、父母个性焦虑忧郁、主要抚养者的养育态度专断或冷漠、父母之间的养育态度经常或完全矛盾、父母经常吵架、较长时间不与父母生活、被打骂的经历较多、遇到困难缺乏其他人的关心。结论 应适当降低中学生的学习压力,重视培养中学生的自信和社会交往能力。良好的家庭环境和家庭以外支持对青少年的心理健康至关重要,能够有效地降低焦虑程度。     

Social and dietary determinants of body mass index of adult Jamaicans of African origin

OBJECTIVES: To determine the relationships between body mass index (BMI) and diet, social and behavioural factors among adult Jamaicans of African origin. DESIGN: Cross-sectional. SETTING: Urban communities in Jamaica, West Indies. SUBJECTS: Three-hundred and sixty-three males and 561 females of African origin, aged 25-74 y. RESULTS: Women had higher mean BMIs (27.5+/-6.4 kg/m(2)) than men (23.4+/-4.3 kg/m(2)); 30.7% of women compared with 6.7% of men were obese. There was a tendency for obese men to have higher percentage of intakes from fat and less from carbohydrate, and women reported diets in which the percentage contribution of protein increased significantly with increasing BMI. In multivariate analyses, BMI was not explained by energy but was associated with protein intakes in females only. Predictors of relative weight were inversely related. Social (marital status) and behavioural (cigarette smoking) factors predicted BMI in both genders; older age in men and increased fibre intakes in women were associated with lower BMI. CONCLUSIONS: Social and behavioural factors are important determinants of body weight. Further investigations are needed which consider factors such as physical activity, genetic and other environmental variables as predictors of relative weight.     

The relation of socioeconomic status to oral and pharyngeal cancer

We assessed the relation between socioeconomic status and risk of oropharyngeal cancer in a population-based interview study of 762 male cases and 837 male controls in four areas of the United States. Three primary indicators of socioeconomic status were evaluated: education, occupational status, and percentage of potential working life spent in employment. With adjustment for the effects of established risk factors, such as use of tobacco products, alcohol consumption, and poor dentition, a relatively low percentage of years worked was also a risk factor. Educational attainment and occupational status were not independently related to risk of oropharyngeal cancer. These results are consistent with the hypothesis that behaviors that lead to social instability, and/or social instability itself, are linked to an increased risk of oral and pharyngeal cancers.     

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.     

Adjusting for case mix and social class in examining variation in home visits between practices

OBJECTIVES: The purpose of this study was to investigate whether adjusting for clinical case mix and social class explains more of the variation in home visits between general practices than adjusting for age and sex alone. METHODS: The setting was 60 general practices in England and Wales taking part in the 1 year Fourth National Morbidity Survey. The participants comprised 349 505 patients who were registered with one of the participating general practices for at least 180 days, and who had at least one consultation during the period. The outcome measure is whether or not a patient received a home visit in that year. A clinical case mix category (morbidity class) based on 1 year's diagnostic information was assigned to each patient using the Johns Hopkins Adjusted Clinical Groups (ACG) Case Mix System. The social class measure was derived from occupation and employment status and is similar to that of the 1991 UK census. Variations in home visits between practices were examined using multilevel logistic regression models. The variability between practices before and after adjusting for clinical case mix and social class was estimated using the intracluster correlation coefficient (ICC). RESULTS: The overall percentage of patients receiving a home visit over the 1 year study period was 17%, and this varied from 7 to 31% across the 60 practices. The percentage of the total variation in home visits attributable to differences between practices was 2.5% [95% confidence interval (CI) 1.4-3.2%] after adjusting for age and sex. This reduced to 1.6% (95% CI 1.1-2.4%) after taking into account morbidity class. The results were similar when social class was included instead of morbidity class. Morbidity and social class together reduced variation in home visits between practices to 1.5% (95% CI 1.1-2.2%). CONCLUSIONS: Age, sex, social class and clinical case mix are strong determinants of home visits in the UK. Adjusting for morbidity and social class results in a small improvement in explaining the variability in home visits between practices compared with adjusting for age and sex alone. There is far more variation between patients within practices; however, it is not straightforward to examine the factors influencing this variation. In addition to morbidity and social class, there could also be other unmeasured factors such as varying patient demand for home visits, disability or differences in GP home visiting practice style that could influence the large within-practice variability observed in this study.     

Perinatal variables and health inequalities in a health-care district in Cáceres, Spain

OBJECTIVES: To analyze the relation between perinatal variables (gestational, neonatal, demographic, and social) at time of delivery. To evaluate differences between rural and urban areas --and differences between social status within these areas-- as an approach to studying health inequality. To identify variables associated with the risk of prematurity and low birth weight from onset of pregnancy. METHODS: A retrospective study was made of deliveries in a 4-year period (1993-1996) in a health-care district of the province of Cáceres (Spain) (population: 176,511 inhabitants). Data were obtained from hospital records (N = 5922 deliveries). Gestational (mother's age, multiparity), neonatal (sex, birth weigh, weeks of gestation, twin birth), and sociodemographic variables (mother's place of residence and social rank) were studied. A logistical regression analysis was made to identify the main risk factors. RESULTS: The percentage of infants with birth weight less than 2800 g (16.92%) or less than 2500 g (7.80%), and of preterm births (6.16%) in the health-care district of Cáceres were higher than those reported for other studies made in Spain and elsewhere. The risk of low birth weight (<2800 g) was greater for twin births (OR = 16.50; IC 95%: 9.67-28.15); female infants (OR = 1.36; IC 95%: 1.19-1.56), adolescent mothers (<20 years: OR = 1.54; IC 95%: 1.14-2. 09), older mothers (>35 years: OR = 2.12; IC 95%: 1.41-3.17), and first pregnancies (OR = 1.25, IC 95%: 1.09-1.44). The mother's social status was a risk factor for urban marginal groups compared with non-marginal groups (OR = 1.43, IC 95%: 1.12-1.82). The risk of preterm birth depended mainly on the mother's age and was greater in adolescents (OR = 1.84, IC 95%: 1.17-2.89) and older women (OR = 3. 08, IC 95%: 1.81-5.24), as well as for twin births (OR = 10.47; IC 95%: 6.49-16.89). Women in marginal urban groups had the highest rates of multiple pregnancies and adolescent pregnancies. Women in non-marginal urban areas had the highest rate of first pregnancies in older women. Women in rural areas showed intermediate characteristics. CONCLUSIONS: The percentage of low-birth-weight or preterm newborns and of adolescent mothers was greater in women of lower socioeconomic level. The greatest differences in perinatal variables were observed in urban areas (marginal vs. non-marginal groups) and between regions and countries.     

浙江省乡村医生社会保障现状调查

目的分析影响浙江省乡村医生社保情况的重要因素,探讨解决浙江省乡村医生社会保障问题的对策。方法采取分层随机调查,结合问卷调查与个案访谈、文献分析等方法对浙江省乡村医生参保情况进行调查,收集数据并进行统计学处理。结果 429位被调查乡村医生未参保比例为23%,其中参保情况在乡村医生的学历水平、职称及工资水平上差异有统计学意义（P〉0.05）。结论浙江省乡村医生未参保比例较高,社保费用的缴纳方式、乡村医生的工资水平是重要影响因素。