产后访视在实际工作中的体会

目的探讨访视医生在产后访视中是为了全面了解产妇及新生儿的健康问题,促进母婴健康。方法对1656名产妇进行了上门访视,给予产妇及家属进行母乳喂养知识、健康教育及育儿知识进行宣教和指导。结论产后访视对产妇及婴儿实施连续性的健康服务,使产妇和家属掌握母乳喂养知识、新生儿护理、产褥期自我保健,预防疾病,保障母婴健康。     

产后访视720例分析

目的通过产后访视情况分析,了解产后母婴的健康情况和主要健康问题,制定相应的干预措施,达到提高产后保健质量、预防疾病,促进健康,减少并发症及再次入院治疗的目的。方法对在我院分娩的市区内产妇产后访视情况进行回顾性调查分析。结果出院后母乳喂养率较住院时低,产妇育儿知识及技能缺乏,婴儿臀红、湿疹发生率高。结论加强健康教育,对孕期、住院期间孕产妇进行母乳喂养宣教、指导和新生儿护理知识的宣教,对出院后产妇及时进行产后访视,为其提供连续性健康教育,护理支持及技能指导等。     

与医院对接的产后访视对母婴健康状况的影响

目的研究对产妇使用与医院对接的产后访视后对母婴健康状况的影响。方法收集产妇共800例,按照完全随机化分组原则将其分为对照组(400例)和观察组(400例),对照组接受常规访视,观察组接受与医院对接的产后访视,将两组产后知识知晓率、母乳喂养率、婴儿黄疸消退率、脐带脱落率以及母婴健康状况进行观察和对比。结果相较于对照组,观察组的产后知识知晓率、母乳喂养率、婴儿黄疸消退率以及脐带脱落率均更高;在母婴健康状况方面,观察组显著优于对照组(P<0.05)。结论在产妇的产后护理过程中,与医院对接的产后访视能够提升产妇对婴儿以及自身的护理能力,从而使母婴健康得到有效保证,值得推广应用。     

北京市海淀区某社区产后访视效果评价研究

目的 通过对社区产后访视效果评价,了解产妇及新生儿的健康需求,有针对性地开展健康教育工作.方法 保健人员在产妇出院后3～7天、生后28～30天各访视1次,比较产妇出院后相关知识和技能掌握情况.结果 产后家庭访视后产妇掌握自我护理及新生儿护理知识和技能明显提高,访视前后各项观察内容分别经χ2检验,均P<0.05,有显著性差异.访视后产妇母乳喂养率明显提高(χ2=12.840,P<0.05).结论 通过产后访视,对产妇及时进行健康教育,可提高母乳喂养率,提高产妇保健意识,促进产妇和新生儿身体健康改善.     

健康教育在产后访视中的应用体会

产后访视是妇幼保健工作的重要部分,通过访视可了解产妇及新生儿健康和哺乳情况,开展健康教育以指导产妇进行产后自我保健,传授科学育儿知识,促进母乳喂养成功,进行婴儿卫生保健护理,同时对影响母婴健康的异常情况及时指导处理,完成对母婴保健的整体服务。现就开展社区母婴保健服务中应用健康教育取得的良好效果介绍如下:1 访视内容1.1 产妇一般情况 体温、呼吸、脉搏、血压、自我感受。子宫收缩情况:如大小、硬度、活动度及有无压痛,恶露的颜色、量、性状、气味。腹部和会阴伤口愈合情况:如有无渗血、血     

社区产后访视对母婴健康的影响

目的:研究社区产后访视对母婴健康的影响。方法:选择2007～2008年该辖区住院分娩,出院后产后访视产妇780例作为研究对象,分成两组,分别为观察组(社区入户产后访视组)和对照组(电话访视组)各390例。结果:观察组产妇贫血、乳头皲裂、乳腺炎、母乳汁不足、伤口愈合不良、晚期产后出血、产褥感染发生率均明显低于对照组,有统计学差异(P0.01);观察组纯母乳喂养、混合喂养、人工喂养与对照组相比有统计学差异(P0.01);观察组新生儿口腔黏膜感染、脐部感染、黄疸、红臀、湿疹发病率均明显低于对照组,有统计学差异(P0.01)。结论:产后访视可及时发现产妇及新生儿的疾患,降低产褥期及围生儿的发病率,对提高母婴保健水平具有重要意义。     

福州城市社区产后访视质量调查研究

[目的]研究社区产后保健服务现状,提高保健质量以促进母婴健康。[方法]定量与定性研究相结合,抽取福州市776名产妇问卷调查,并采用了专题小组讨论(产妇12人)和半结构性访谈(9人)。[结果]产后访视率为62.9%。内容询问母子一般情况达98.4%;进行母乳喂养指导为94.7%;对产妇心理情绪状况"关心"的只28.7%,对预防产后抑郁症的保健建议率仅9.9%;产妇对访视满意率不高(33.6%)。[结论]今后既要加快产后访视人员对产褥期保健知识的更新,又要加强规范化管理,实行面对面的质量评估,以提高产后访视保健质量。     

产后家庭访视对母婴健康的影响

目的探讨产后家庭访视对母婴健康的影响。方法产后7天对产妇及家属产后相关知识和技能掌握情况进行评估,针对每个家庭存在的健康问题予以健康教育,产后14天再次对上述内容进行评估。结果家庭访视后,产妇及家属对产褥期保健知识有了更多的了解、产妇的自理能力以及对新生儿护理知识、技能有了显著提高（P〈0．05）。结论家庭访视可提高产妇的自我保健水平,增强产妇及家属的新生儿护理能力;同时可提高访视人员的自身综合素质及医院的社会效益。     

两种产后访视方式对母婴健康状况的影响

目的研究产后访视服务的方式、促进母婴健康,提高母婴生存质量。方法将2008年7月～2009年12月在本院产科分娩出院的接受传统访视的400例产妇作为常规组,将2010年l月～2011年6月在本院产科分娩出院的接受访视的410例产妇作为观察组,观察组在常规访视的基础上提高了产后访视人员的综合素质并增加新的访视内容,观察两组母婴健康状况。结果常规组中产妇有异常情况132例,发生率33%;新生儿有异常情况127例,发生率为31.75%。观察组中产妇有异常情况65例,发生率15.85%;新生儿有异常情况63例,发生率为15.36%。结论通过提高访视人员的综合素质和拓展访视内容等方法提高产后访视质量,能更好地促进母婴健康,提高母婴生存质量。     

300例产妇母婴保健认知度及影响因素调查

目的调查产妇母婴保健认知度及相关影响因素。方法回顾性选择2013年4月-2016年4月于胶州市人民医院妇产科分娩的300例产妇为研究对象,在生产后定期对产妇进行回访,比较在回访前、后产妇对母婴保健的认知度,并对相关影响因素进行综合性分析。结果 (1)在回访指导后,300例产妇对产后护理和饮食知识、泌乳情况及生活习惯等认知度比回访前明显提高,差异均有统计学意义(均P0.05);(2)产妇对新生儿的护理知识和操作技能逐渐提高,回访前、后比较差异有统计学意义(均P0.05);(3)Logistic回归分析显示,受教育程度、职业、户籍是影响产后母婴保健认知的主要影响因素。结论产后母婴保健对产妇和新生儿健康有重要的意义,定期回访指导,有利于产妇提高自我保健意识和加强新生儿的护理,确保母婴健康。     

责任制护理模式下的QQ群平台在孕期健康教育中的应用

目的：探讨责任制护理模式下的QQ群平台在孕期健康教育中应用的效果。方法：选择产科门诊初诊建卡孕妇160例,对照组采用定期门诊产检加QQ群平台的健康教育方式,实验组采用在定期门诊产检基础上加责任制护理模式下的QQ群平台健康教育方式。结果：实验组与对照组知识知晓率、产前检查次数、并发症的发生率、自然分娩率、满意率比较,差异有统计学意义。结论：责任制护理模式下的QQ群平台健康教育方式在孕期健康教育中应用能增加知识知晓率、产前检查次数,提高自然分娩率和满意率;同时降低妊娠并发症的发生率,是一种值得推广的孕期健康教育方式。     

健康教育对高血压患者服药依从性及复诊率的影响

目的 探讨健康教育对高血压患者服药依从性及复诊率的影响.方法 选择2009年3月～2010年3月,在某社区卫生服务中心门诊建卡管理正在服药的162例高血压病患者参与该研究.随机分为两组,实验组和对照组各81例.对照组进行常规指导;实验组除常规指导外实施有计划、有目的、有组织的一系列健康教育,比较两组服药依从性、复诊率及高血压控制情况.结果 实验组患者在集体培训,小组讲课,个别指导和电话咨询等健康教育形式下,第6、12个月后实验组服药依从性率为92.6％、93.9％,对照组为74.1％、79.2％,实验组服药依从性显著高于对照组(均P＜0.01).第6、12个月实验组患者复诊率为93.8％、90.1％,对照组为72.8％、59.3％,实验组复诊率显著高于对照组(均P＜ 0.01),实验组高血压控制水平优于对照组(分别P＜0.05、P＜0.01).结论 健康教育可以明显提高高血压患者服药依从性及复诊率,使患者血压保持平稳,控制其疾病的进一步发展,预防并发症的发生发展,提高生存质量.     

Breast screening: a randomised controlled trial in UK general practice of three interventions designed to increase uptake.

STUDY OBJECTIVES: To determine the relative effectiveness of three interventions designed to increase the uptake of breast screening. DESIGN: Randomised controlled trial of a nurse visit with health education (group A), nurse visit without health education (group B), and GP letter (group C). SETTING: The area of south east London served by the Butterfly Walk Breast Screening Unit in Camberwell. PARTICIPANTS: Women aged between 50 and 64 years who were registered with 27 GPs in the Lambeth, Southwark and Lewisham family health services authority and who had not attended for first round screening. MAIN RESULTS: Altogether 799 women were randomly allocated to the three groups. In general, delivering the nurse based interventions proved difficult. In group A, 11.4% (95% CI 7.9, 14.9%) of women subsequently attended for screening compared with 7.8% (95% CI 5.1, 11.4%) in group B and 13.1% (95% CI 7.9, 18.4%) in group C. The differences between the groups (95% CIs) were not statistically significant: A versus C, -1.7% (-8.0, +4.6%); B versus C, -5.3% (-11.3, +0.7%); A versus B, +3.6% (-1.0, +8.2%). CONCLUSIONS: A personal letter from the GP seems to be at least as effective at increasing the uptake of breast screening in non-attenders as a nurse making a home visit to discuss the issue of breast screening, and is not noticeably less effective than a visit at which a health education intervention is delivered. It is possible that the GP letter is considerably more effective than either of the two interview-based interventions. With regard to implementing strategies which will increase breast screening uptake and are cost effective, further trials of similar minimal interventions in primary care are required.     

Update: Health Insurance and Utilization of Care Among Rural Adolescents

CONTEXT: Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences. PURPOSE: To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents. METHODS: Cross-sectional design using data from the 1999-2000 National Health Interview Survey, a nationally representative sample of US households. Analysis was restricted to white, black, and Hispanic children aged 12 through 17 (8,503 observations). Outcome measures included health insurance, ambulatory visit within past year, usual source of care (USOC), and well visit within past year. Independent variables included race, residence, demographics, facilitating/enabling characteristics, and need. RESULTS: Across races, rural adolescents were as likely to have insurance (86.8% vs 87.7%) but less likely to report a preventive visit (60.1% vs 65.5%) than urban children; residence did not affect the likelihood of a visit or a USOC. Minority rural adolescents were less likely than whites to be insured, report a visit, or have a USOC. Most race-based differences were not significant in multivariate analysis holding constant living situation, caretaker education, income, and insurance. Low caretaker English fluency, limited almost exclusively to Hispanics, was an impediment to all outcomes. CONCLUSIONS: Most barriers to care among rural and minority youth are attributable to factors originating outside the health care system, such as language, living situation, caretaker education, and income. A combination of outreach activities and programs to enhance rural schools and economic opportunities will be needed to improve coverage and utilization among adolescents.     

The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial

Observational studies suggest that including men in reproductive health interventions can enhance positive health outcomes. A randomized controlled trial was designed to test the impact of involving male partners in antenatal health education on maternal health care utilization and birth preparedness in urban Nepal. In total, 442 women seeking antenatal services during second trimester of pregnancy were randomized into three groups: women who received education with their husbands, women who received education alone and women who received no education. The education intervention consisted of two 35-min health education sessions. Women were followed until after delivery. Women who received education with husbands were more likely to attend a post-partum visit than women who received education alone [RR = 1.25, 95% CI = (1.01, 1.54)] or no education [RR = 1.29, 95% CI = (1.04, 1.60)]. Women who received education with their husbands were also nearly twice as likely as control group women to report making >3 birth preparations [RR = 1.99, 95% CI = (1.10, 3.59)]. Study groups were similar with respect to attending the recommended number of antenatal care checkups, delivering in a health institution or having a skilled provider at birth. These data provide evidence that educating pregnant women and their male partners yields a greater net impact on maternal health behaviors compared with educating women alone.     

妇女对产后访视服务的体验与需求

为了深入了解产后妇女对社区提供的产后访视服务的看法及对此项服务的需求 ,并由此提出改进现有产后访视服务的可能做法 ,在上海某中心城区的 2个街道深入访谈了 5 3名在 1998年 12月～ 1999年 7月期间接受过产后访视服务的妇女 ,并进行了 2组产后妇女的专题小组讨论。结果 :产后访视覆盖率达 10 0 % ,其中 9%的对象接受过 1次、32 %的对象接受过 2次、5 9%的对象接受过 3次产后访视。大多数产妇接受了产后访视常规中问诊、检查和宣教。在产妇所遇的问题中有关小儿护理的问题占第 1位 ,其次是产后妇女本人的情绪问题。产后妇女对与婴儿健康成长有关的服务内容需求最大 ,希望能从专业医护人员处获取可靠信息 ,有多种媒体的健康教育教材可供家庭选用 ,同时还呼吁在社区内有形式多样的面对面教育活动 ,如咨询、父母学校和母亲俱乐部等。研究结果提示产后访视服务现已有较满意的覆盖率 ,但其内容、形式和服务质量尚有待以服务对象需求为导向 ,在条件具备的情况下不断改善。     

孕前口腔保健预防妊娠期龈炎的效果分析

目的观察妊娠前进行口腔保健对妊娠期龈炎的预防效果,提出防治妊0娠期龈炎的最佳方法及时机.方法将216名接受孕前咨询的妇女随机分为治疗组和对照组.检查初诊时的牙龈指数和孕后复诊时的牙龈指数. 结果在初诊时治疗组和对照组牙龈指数无明显差异(χ2=1.45,P》0.05),而在孕期3月和孕期6月复诊时,经过洁牙处理后的治疗组与对照组牙龈指数差异显著(分别为χ2=39.77和χ2=29.33,P均《0.05),治疗组牙龈状况明显好于对照组.结论孕前进行口腔专业保健并进行洁牙术对预防妊娠期龈炎有良好的效果.     

妇女孕产期保健服务利用状况及影响因素调查

目的探讨妇女孕产期保健服务的利用状况,对其影响因素进行分析和调查。方法选取2014年3月在我市工作的流动人口育龄妇女为研究对象,其中470人有分娩经历。对这些妇女的产前检查、产后访视服务的利用状况及其影响因素进行分析。结果470例流动人口育龄妇女做过产前检查的共有356例．产前检查率为75．74％;得到产后访视的妇女有342例,产后访视率为72．77％。大专及以上文化程度的妇女产前检查次数为8．72±3．19,产后访视次数为1．12±1．25,明显高于初、高中文化程度妇女的5．86±3．23、0．65±1．12和小学以下文化程度妇女的3．70±2．69、0．29±0．68．差异均具有统计学意义（P＜0．05）。家庭月收入4ooo元以上的妇女产前检查次数为7．78±3．64．产后访视次数为0．98±1．26,明显高于家庭月收入2ooo～3999元妇女的6．22±3．14、0．71±1．23和家庭月收入2000元以下妇女的4．98±3．06、0．49±0．97,差异均具有统计学意义（P＜0．05）。结论文化程度、家庭收入、年龄和是否参加生育保险是影响妇女孕产期保健服务利用状况的重要因素．应加强针对流动人口育龄妇女的孕产期保健管理力度,开展孕产期健康教育,充分发挥计生网络的作用,努力改善流动妇女的孕产期保健状况。     

Achieving Comprehensive Contraceptive Counseling for Young Women and Improved Contraceptive Uptake Through the Implementation of a Reproductive Health Educator Program

Objectives

To evaluate the effect of student-volunteer reproductive health educators (RHEs) on frequency of counseling about long acting reversible contraception (LARC) and uptake of more effective contraception.

Methods

This was a non-randomized intervention study conducted at a resident continuity clinic. Eligible patients were females aged 14–25. Participants met with an RHE during their visit in addition to the standard care team. Patients in the historical group met only with the standard care team. We compared counseling patterns and uptake of more effective contraceptive methods between the baseline historical comparison and intervention groups.

Results

Nearly all eligible patients in the intervention group received counseling about LARC during their visit, whereas less than half of patients seen in the baseline period received the same counseling. Approximately two-thirds of patients who had no contraceptive method at the beginning of the visit chose to initiate a short- or long-acting method in the intervention group, compared to less than half of patients who were using no method in the baseline group.

Conclusions for Practice

Integration of student-volunteer RHEs increased the frequency with which patients were counseled about LARC and also increased the number of patients who switched to more effective contraception during their visit compared to patients seen in the same clinic before RHEs were introduced. Student-volunteer RHEs are a potentially cost-effective way to provide comprehensive health education in busy clinical settings.

     

农村孕产期保健服务可及性的定性研究

目的:了解安徽省农村孕产期保健服务可及性,为制定干预方案及改善我国农村孕产期保健服务提供科学依据。方法:选取服务提供者及地方不同级别的关键知情人采用焦点小组访谈和个人深入访谈进行定性调查。结果:产前检查、住院分娩、产后访视和健康教育在乡镇卫生院都已开展,但是数量和质量达不到要求;计划生育部门协助开展了部分孕产期保健服务。近几年,服务提供者提高重视程度、加大经费投入、加强人员培训、加大宣传力度、改变行政管理,提高了孕产期保健服务的可及性。但是也存在资金投入不足、资金分配不平衡、"重临床轻保健"思想、健康教育不足、妇幼保健网络建设不完善、人力制约因素、私人门诊增加等问题,制约了孕产期保健的发展。结论:农村孕产期保健服务取得了一定的成绩,同时也存在着制约服务可及性的问题,应该采取因地制宜的措施,探索新的政府投入方式、乡镇和农村结合的孕产期保健模式,制定统一的孕产期保健服务规范等。