江苏农村医务人员结核病知识、态度和行为的定性研究

目的研究苏北农村地区医务人员有关结核病的知识、态度和行为(KAP),为农村结核病防治提供依据.方法采用定性研究方法,以专题小组讨论(FGD)和个人深入访谈的形式对从事结防工作的医务人员进行调查.结果⑴医务人员具有结核病发生、诊断和治疗的基本知识,认为结核病发生的危险因素包括外出打工、贫穷和营养差;病人经济条件和年龄是影响病人能否坚持治疗的主要原因之一;延误就医和不规范治疗可能导致治疗失败;⑵结防专业医务人员能与病人保持良好的医患关系;⑶对结核病人能及时准确地按照规程开展诊治,积极宣传结核病预防知识.结论医务人员对结核病具有一定的认识;能诊治当地的结核病,但过程不甚规范,进一步业务培训应着重强调病人教育、早期识别病人和鉴别诊断.     

江苏农村医务人员结核病知识、态度和行为的定性研究

目的 研究苏北农村地区医务人员有关结核病的知识、态度和行为（KAP）,为农村结核病防治提供依据。方法 采用定性研究方法,在专题小组讨论（FGD）和个人深入访谈的形式对从事结防工作的医务人员进行调查。结果 （1）医务人员具有结核病发生、诊断和治疗的基本知识,认为结核病发生的危险因素包括外出打工、贫穷和营养差;病人经济条件和年龄是影响病人能否坚持治疗的主要原因之一;延误就医和不规范治疗可能导致治疗失败;（2）结防专业医务人员能与病人保持良好的医患关系;（3）对结核病人能及时准确地按照规程开展诊治,积极宣传结核病预防知识。结论 医务人员对结核病具有一定的认识;能诊治当地的结核病,但过程不甚规范,进一步业务培训应郑重强调病人教育、早期识别病人和鉴别诊断。     

再生育妇女孕产期抑郁的调查 及影响因素分析

目的 旨在纵向探讨再生育妇女孕产期的抑郁水平及影响因素。方法 选取2019年7月至2021年6月在温州市人民医院行产前检查并分娩的2587例孕妇为研究对象，将其中1285例再生育妇女设为观察组，1302例初产妇设为对照组，分别在孕晚期、产后1周、产后6～8周3个时间点采用抑郁自评量表进行评价，另采用多元线性回归法分析观察组抑郁的影响因素。结果 孕晚期、产后1周、产后6～8周观察组抑郁发生率分别为16.54%、20.64%、21.21%，对照组抑郁发生率分别为15.91%、18.85%、19.65%；观察组产后1周、产后6～8周轻度抑郁发生率高于孕晚期（2=4.199、9.187，P=0.040、0.002），产后6～8周中度抑郁发生率低于产后1周（2=4.389，P=0.038）；对照组产后6～8周轻度抑郁发生率高于孕晚期（2=5.529，P=0.019）。观察组产后1周和产后6～8周抑郁发生率均高于孕晚期（P<0.05），对照组产后6～8周抑郁发生率高于孕晚期（P<0.05）。单因素分析和多元线性回归分析显示，年龄、文化程度、家庭年收入、不良孕产史、妊娠并发症、睡眠质量为观察组孕晚期抑郁的影响因素（P<0.05）；年龄、家庭年收入、睡眠质量、分娩方式、新生儿健康状况为产后1周抑郁的影响因素（P<0.05）；年龄、家庭年收入、睡眠质量、喂养方式、是否家庭支持、婆媳关系均为产后6～8周抑郁的影响因素（P<0.05）。 结论 再生育妇女在孕晚期、产后1周、产后6～8周抑郁发生率呈逐渐上升趋势，不同时间点存在抑郁的孕产妇受不同因素的影响，应积极采取相应的心理干预措施，改善其抑郁状况。     

Domestic abuse on women in China before, during, and after pregnancy

Background Some researchers found that partner-perpetrated physical violence increased in frequency and severity during the postpartum period compared with the antenatal period, however, limited data exists describing abuse of women in China. The purpose of this study was to examine patterns of abuse in China before, during, and after pregnancy, and explore possible factors related to abuse. Methods A community-based face-to-face survey of a representative group of women who had a child aged 6 to 18 months in 32 communities of Tianjin, Liaoning, Henan, and Shaanxi provinces was carried out between November 1,2001 and February 28, 2002. Results The prevalence of domestic abuse (emotional, sexual, or physical) occurring in any period (before, during, or after pregnancy) was 12.6%. The prevalence of abuse during the approximate 9 months of pregnancy (4.3%) was relatively lower compared with the prevalence of abuse during the 12 months before pregnancy (9. 1%) and after delivery (8.3%) during the mean 11-month postpartum period studied. Abuse before pregnancy was a strong risk factor for abuse during pregnancy and abuse after pregnancy, and abuse during any previous period was a strong risk factor for subsequent abuse. Many women who suffered abuse of any kind generally experienced multiple acts over time and most acts were not severe. The results of logistic regression analysis showed that the factors associated with abuse during pregnancy included women previously witnessing domestic violence, a poor relationship with the panner, socioeconomic level, alcohol consumption, and smoking. Conclusions It is necessary to do in-depth training and to raise awareness of panner abuse among all health professionals. Routine screening of abuse in maternity clinics is advocated to decrease the adverse impact of abuse on women and fetuses.     

美国妇女对妇科恶性肿瘤症状的认识、关注和就医情况：多现场定性研究

背景 由于妇科恶性肿瘤有效的筛查手段有限，要实施妇科恶性肿瘤的早期检测有赖于妇女认识到出现症状的重要性并及时就医。     

早发型子痫前期终止妊娠血清学指标的临床研究

目的 通过分析血清胱抑素C(CYS-C)、尿酸(UA)、肌酐(CREA)和尿素氮(BUN)数值的变化及相关性,探讨血清胱抑素C(CYS-C)、尿酸(UA)、肌酐(CREA)和尿素氮(BUN)在早发型重度子痫前期终止妊娠中的应用价值。 方法 选取2015年1月—2016年12月济宁医学院附属章丘区人民医院收治的轻度早发型子痫前期患者64例(轻组),重度55例(重组),随机选择同期孕周(28～34周)正常分娩的孕妇55例作为对照组(正常组),观察血清CYS-C、UA、CREA和BUN水平的变化。 结果 血清指标各组间差异均有统计学意义(均P<0.01)。ROC曲线最佳临界值CYS-C、UA、CREA和BUN分别为:1.29 mg/L、420.00 μmol/L、59.10 μmol/L、5.94 mmol/L;其灵敏度分别为90.1%、73.4%、68.3%、42.3%;特异度分别为:99.8%、99.8%、88.2%、77.8%;Youden指数最大值分别为89.9%、73.2%、56.5%、20.1%;OR值分别为16.50、1.05、1.25、18.67;r值分别为0.413、0.118、0.345、0.112(均P<0.01)。 结论 血清CYS-C、UA、CREA和BUN水平随疾病的严重程度升高而升高,它们是独立的危险因素,与子痫前期重度正相关,血清CYS-C与UA、CREA和BUN正相关。CYS-C≥1.29 mg/L、UA≥420.00 μmol/L、CREA≥59.10 μmol/L,BUN≥5.94 mmol/L,可作为早发型子痫前期终止妊娠的血清学指标。血清CYS-C、UA、CREA诊断效能好,BUN诊断效能差,联合检测效果好,经临床综合评估,适时终止妊娠。      

孕期体重管理对高危妊娠对象妊娠期并发症和妊娠结局的影响

目的探讨孕期体重管理对高危妊娠对象妊娠期并发症和妊娠结局的影响。方法选取2016年6月～2017年12月在我院进行产检的高危孕妇230例为研究对象,根据患者体重管理不同分组,将进行体重管理联合常规管理的孕妇纳入观察组(n=130),采用常规管理的孕妇纳入对照组(n=100),记录两组妊娠期并发症、妊娠结局及新生儿健康状况。结果观察组并发症发生率为13.85%显著低于对照组的43.00%,差异有统计学意义(P0.05);观察组剖宫产率为30.77%明显低于对照组的47.00%,且观察组阴道产率为69.23%高于对照组的53.00%,差异有统计学意义(P0.05);观察组新生儿窒息率为8.46%及早产率为19.23%均低于对照组的21.00%、30.00%,观察组新生儿出生体重及出生1 min后、出生5 min后Apgar评分均高于对照组,差异有统计学意义(P0.05)。结论对高危妊娠对象进行孕期体重控制,能有效降低妊娠期并发症及剖宫差产率,促进良好妊娠结局。     

双胎妊娠孕妇的心理压力及压力源研究

目的分析双胎妊娠孕妇的压力水平,探讨双胎妊娠孕妇主要压力源及压力管理。方法采用妊娠压力量表测量56例双胎妊娠孕妇的压力水平及压力源,56例单胎妊娠孕妇为对照组。结果双胎妊娠孕妇心理压力处于中度水平,高于单胎孕妇,差异有统计学意义（P〈0.05）。其中,＂为确保母子健康和安全而引发的压力感＂因子分值最高;＂担心胎儿能否安全娩出＂压力源发生频率居双胎及单胎孕妇压力源的首位。结论医务工作者应重视双胎妊娠孕妇的压力,有效进行压力管理,确保母婴健康。     

A comparative study on family, social supports and mental health of rural and urban Malay women

The present study aims to compare the family's social environment, social supports and mental health of Malay women from rural and urban areas. Equal number (n-184) of Malay women from similar socio-economic back grounds were chosen from the rural areas of Kedah and urban areas of Pulau Pinang using the stratified random sampling method. The results indicated significantly higher level of mental health problems among the rural respondents when compared with the urban subjects. Among the family related variables included in the present study, cohesiveness, moral religious emphasis and organization and intellectual and cultural orientation were found to be significantly associated with the mental health problems of rural respondents. Whereas, only one variable, namely, active recreational orientation was found to be having an impact on the mental health of urban respondents. Similarly, deficiencies in the social support perceived from family and other members of the community were found to be significantly associated with the mental health problems of rural samples when compared to the social support perceived from the others for the urban subjects. The implications of these observations are discussed.     

Community participation and childhood immunization coverage: A comparative study of rural and urban communities of Bayelsa State,south-south Nigeria

Background:

Immunization coverage rates in Nigeria have remained very poor, in spite of numerous programs and strategies, specifically designed to improve coverage. This study was to assess the possible effects of greater community participation on immunization coverage, by comparing the immunization coverage in a rural community with a functional community health committee, with an urban community, with no distinct community structure.

Materials and Methods:

The study was carried out in Ondewari, a rural, riverine community, in Bayelsa State; and Yenagoa, the capital of Bayelsa State, south-south Nigeria; using a cross-sectional, comparative study design. The data were collected using a structured interviewer-administered questionnaire, administered on female head of households in both communities, with under-five children; and used to collect information on the socio-demographic characteristics of the respondents, the immunization status of children in the household below the age of 2 years, and reasons for none and incomplete immunization.

Results:

A total of 288 respondents were studied in the rural community, while 270 respondents were studied in the urban center. The respondents in the urban center were significantly younger (P<0.01), better educated (P<0.001), and had fewer number of children (P<0.01). The immunization status of children in the rural community was significantly better than those in the urban community (P<0.000). Only 11.46% of the children in the rural community were not immunized, compared to 47.04% in the urban community. However, the dropout rate in the rural community was much higher; with a DPT dropout rate of 77.34%, compared to 12.39% in the urban community. Most of the reasons given in the urban community for the incomplete immunization were linked lack of motivation, and include relocation (11.34%) and the adverse rumor about childhood immunization (17.23%), while the reasons in the rural community were mostly health facility related, and included the absence of the vaccinator (20.46%) and nonavailability of vaccines (26.64%).

Conclusion:

The immunization coverage in the rural community was surprisingly better than that of the urban community, which can be attributed to better mobilization and participation in the delivery of immunization services.     

Challenges of kidney care in a resource poor nation: A study of private kidney care centre in Nigeria

Background:

Resource poor nations are froth with various confounding challenges in their social, political, financial, physical and healthcare needs. Care of patients with health problems’, including those with kidney related disorders is associated with many challenges. This study is aimed to highlight the challenges of kidney care in a resource poor nation.

Materials and methods:

The activity of a private kidney care centre in Nigeria was reviewed from establishment to 6 months of operation. The details were documented and analysed.

Result:

The commencement of the kidney care centre was delayed as a result of financial and bureaucratic challenges. A total of 64 patients were seen during the period studied, 59.4% were male and the mean age was 48.2±5.5 years. 40.3% of the patients had chronic kidney disease. Twenty patients had haemodialysis however only 2 patients sustained the dialysis for the period studied. Most patients were unable to adhere to medication. The centre still depend on the parent hospital financially.

Conclusion:

The challenges of kidney care in resource poor nation are numerous and multifactorial.     

妊娠期高血压疾病患者认知功能的随访研究

目的:妊娠期高血压疾病(HDCP)具有远期不利影响.研究HDCP患者认知功能的变化,并探讨其机制.方法:选择HDCP患者53例,分为妊娠期高血压组(20例)、轻度子痫前期组(18例)和重度子痫前期组(15例),选择正常产妇22例为对照组.所有研究对象在分娩后60～80 d内进行认知功能检查.认知功能测定包括听觉词语学习及延迟回忆、数字广度、言语流畅、积木测验、连线测验A、符号数字替换测验. 结果:重度子痫前期组患者的词语学习(P<0.01)、符号数字替换测验(P<0.05)、连线测验A(P<0.05)较对照组显著下降. 结论:重度子痫前期组患者在分娩60d后仍有认知功能损害,对其应积极治疗,并关注疾病的长期转归.     

The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study

Background

Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization''s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake.

Methods

A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites.

Results

Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve.

Conclusions

The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.     

General practice and residential aged care: A qualitative study of barriers to access to care and the role of remuneration

Background

More than 169,000 people live in residential aged care facilities (RACFs). As people age they use health services, particularly general practitioner (GP) services, more frequently but many GPs do not attend patients in RACFs.

Aims

To examine GPs’ perceptions of barriers to providing care to patients in RACFs.

Methods

This study was conducted in June 2014 in the Bayside Medicare Local (BML) region in Victoria, Australia; all participants were drawn from this region. Two focus groups (FGs) were conducted. One was for GPs (n=5) that have a specific interest in practicing in RACFs, the other with RACF staff (n=8) representing public, private, and not-for-profit aged care providers. Results were presented to the Royal Australian College of General Practitioners (RACGP) National Standing Committee for General Practice Advocacy and Support for feedback and validation of the findings against national perspectives of the effect of remuneration on the provision of GP services in RACFs.

Results

Remuneration problems are a barrier to the provision of GP services to patients in RACFs. These problems can be grouped into: direct remuneration, opportunity cost, additional administrative burden, and unremunerated work. GPs’ perceptions of the effects of these problems on willingness to practice in RACFs are described.

Conclusion

Innovative models of remuneration for GPs attending RACFs are needed to ameliorate the problems identified. Such models need to capture and pay for activities that are time consuming but often unremunerated.