福建省免费婚前医学检查督查情况分析

[目的]了解福建省免费婚前医学检查（婚检）现状与质量。[方法]在问卷式调查的基础上,每个设区市抽取2所婚检机构重点现场督查,通过听汇报、现场查看、查阅资料、个别交谈、电话核查等方法进行。[结果]85所婚检机构均取得婚前保健执业许可证,婚检医师绝大部分取得母婴保健合格证,配有主检医师;各级机构均按规范进行各项常规检查,进行婚前医学检查、婚前卫生咨询与婚前卫生指导和健康教育,85．9％的机构半天内发证。免费婚检大部分始于2007午,85．9％婚检机构全部由政府买单,婚检率由2004年的1．2％上升至2008年81．9％。[结论]福建省均开展了免费婚检,婚检质量有待进一步提高。     

婚检对象心理状态分析及对策

对５５８名婚检对象心理状态进行调查，结果显示：５０．３６％的婚检对象理解婚前医学检查意义，配合婚 检；４９．６４％的婚检对象因多种原因，检查时不够合作。通过开展健康教育、运用人际交流技巧、营造温馨舒适环境及加强 婚检服务质量管理等措施，增强了婚检对象自我保健意识，提高了婚前医学检查率及婚前保健工作质量。     

福建省婚前保健服务满意度及影响因素分析

目的 了解婚前保健服务对象满意度和影响因素,为提高婚前保健服务质量提供依据.方法 采用分层随机抽样方法,抽取福建省福州市、莆田市、三明市、鼓楼区、晋江市、石狮市、芗城区、大田县、沙县9家婚检机构参与婚检的830人进行调查.结果 满意度各指标平均分为(4.51±0.65)分,满意率最低的后5位依次为交通便利78.0％(647/830)、候诊条件86.1％ (715/830)、候诊时间87.5％(726/830)、宣教40 min 87.8％ (729/830)、及时出报告88.1％ (731/830);不同性别、居住地、年龄的婚检服务对象平均分差异均有统计学意义(P＜0.05).结论 婚检服务对象对婚前保健服务的总体评价较高,但婚检工作仍存在一些薄弱环节,婚前保健服务过程中尤其要关注女性、居住在乡村的服务对象.     

102 204例婚检女性疾病检出率及分类

目的 进一步强调女性婚前保健的必要性。方法 婚前医学检查（简称婚检）按照卫生部《婚前保健工作规范》及《青岛市婚前保健服务基本标准》执行，对青岛市2000年至2001年102204例婚检女性检出疾病情况进行回顾性分析。结果 疾病检出率8．1％（8224／102204）；生殖系统疾病占36．2％（2973／8224），内科系统疾病占19．8％（1624／8224），严重遗传病及先天性疾病占3．9％（322／8224），指定传染病占3．7％（301／8224），有关精神病占0．6％（45／8224），其它系统疾病占36．0％（2959／8224）；有人流史者占婚检人群的28．5％（29128／102204）；对患影响婚育疾病的375人提出了医学处理意见，其中暂缓结婚346人（92．3％），不宜生育29人（7．3％）。结论 做好婚前保健，是实现生殖健康的重要环节，是优生优良提出出生人口质量的重要措施。     

360例涉外婚检受检查对婚检认识状况的分析及干预

为进一步贯彻《母婴保健法》，提高婚前医学检查（简称婚检）质量，解决婚检中存在的问题，2001年10月－2002年3月末，调查了360名涉外婚检查对婚检认识的状况。结果显示，50．28％的婚检者理解婚前医学检查的意义，能配合婚检；49．72％的婚检者因多种原因对婚前医学检查有不同的认识，检查时不够合作。通过开展婚前保健健康教育，提高婚检服务人员的自身素质，营造温馨舒适的婚检环境及加强涉外婚检服务质量管理等措施，增强了婚检者的自我保健意识，提高了婚检疾病检出率及婚前保健工作质量。     

嘉兴市婚前保健工作现状

为进一步提高全市婚前保健质量 ,嘉兴市卫生局于2 0 0 1年 7月组织培训了市级调查人员 ,随后组成 5个婚检调查小组 ,对全市 2 9家婚检机构进行婚前保健质量调查。婚前保健现状1　机构和人员情况 :嘉兴市总人口 346 32 89人 ,辖 5县(市 ) 2区 ,全市 2 9家婚检机构中 7家为县市妇保院 (所 ) ,7家为县级人民医院 ,15家为地区中心医院 ,均取得中华人民共和国母婴保健技术服务执业许可证。嘉兴市妇幼保健院同时是涉外婚检机构。婚检医师 16 5人 :高级职称 7人 ,占 4 2 4 % ;中级职称 70人 ,占 4 2 4 2 % ;初级职称 88人 ,占 5 3 34%。本科学历 …     

认真贯彻《母婴保健法》 实行婚前保健规范化管理

我市加大对《母婴保健法》的宣传力度，积极协调各部门的关系，整顿规范了婚前医学检查（婚检）机构，制定了相应的规章制度，加强了婚检医师的法律法规知识和业务素质培训，强化监督检查，使我市的婚前保健工作取得了良好的效果，婚检率由１９９５年的６９％提高到１９９...     

认真贯彻《母婴保健法》 依法管理婚前保健工作

我们对我市７区１２县的婚前保健工作进行检查评审，针对存在的问题制定出相应的措施和对策。通过两年多的实践，取得了良好的效果，婚前医学检查（简称婚检）覆盖率由１９９５年的７４１１％提高到１９９８年的９２７８％，疾病检出率由１９９５年的５１３％提高到１９９８年的１０４４％。具体做法是：１　宣传《母婴保健法》，争取各级领导的重视我市于１９８６年开始实行婚前保健工作，长期以来婚检覆盖率一直停留在５６００％～７４００％左右。部分郊县存在着婚检机构过多过滥，婚检标准不统一，责任不清，质量低下的问题…     

婚前保健需求的调查

目的 :了解婚检对象的现况及对现有婚前医学服务的需求 ,探讨改善婚前保健服务及改进婚检服务质量提供依据。方法 :对 2 0 0 2年 5～ 6月在本院接受婚前医学检查的 2 80名对象进行统一式问卷调查 ,并结合病史进行个案分析。结果 :(1 )调查对象中涉外婚配者占 63.2 %。 (2 )男女平均结婚年龄分别为 36.2 9岁和 32 .36岁 ,男女初婚年龄均为涉外婚大于涉内婚。在 35岁以上结婚者中女性涉外婚占 83.6% ,涉内婚为 1 6.4% ;涉外婚中女性再婚占 42 .9% ,无业占 42 .1 % ,均明显高于涉内婚。 (3)女性疾病检出率 (1 6.4% )高于男性疾病检出率 (1 2 .1 % ) ,男性疾病以高血压和包皮过长为多 ,女性疾病以贫血和乳房小叶增生为多。(4)对生殖保健知识与节育知识的知晓率均为涉内婚对象高于涉外婚对象 ,67.5%的婚检者认为婚前保健服务很有必要 ,71 .1 %表示婚检医师很认真 ,婚前检查项目符合需求。结论 :婚前保健应对涉外婚配女性人群给予重点关注 ,加强婚检对象孕前的健康教育 ,充分发挥咨询、宣教的作用 ,提高婚检服务质量 ,以满足婚检对象的生殖健康需求     

接受婚前保健服务的对象对婚前医学检查或咨询的评价

目的:了解上海地区结婚登记时接受婚前保健(包括婚前医学检查及围婚保健咨询)服务对象对于婚前保健服务的评价,为改进服务、更好地适应对象的需求提供科学依据。方法:采用问卷调查的方式对上海6个区结婚登记并参加婚前体检或围婚保健咨询的1279例进行调查,在结婚登记后6个月采取电话随访了解其对婚前保健服务的评价。结果:婚检组评分平均为88.04分,咨询组评分平均为84.17分,婚检组的评分较高。评分较低的婚检组对象认为医生的态度、服务时间及技术等方面需更多地改进;评分较低的咨询组对象认为医生的态度及咨询时提供的信息及技巧需更多地改进。参加婚检的对象绝大部分认为有必要参加婚检。结论:改善婚前保健服务的关键在于服务提供者增强服务意识及提高服务水平,同时应加强宣传教育。     

合肥市包河区2007-2012年婚前医学检查情况分析

目的：探讨近年来婚前医学检查工作的新变化,提出相应对策。方法：收集2007-2012年上报的合肥市包河区《婚前保健情况年报表》,采用流行病学回顾性研究方法,对上述婚检资料从婚检人数、婚检率、疾病检出率、婚检质量等方面进行汇总统计,分析婚检变化情况。结果：实施免费婚前保健服务后,婚检率由0．72％逐步上升到92．17％;疾病检出率为6．58％-18．32％;其中生殖系统疾病检出率占第一位（48．68％）。结论：开展免费婚前保健服务可有效提高婚检率。要根本做好婚前保健服务,需要多部门配合协作、加强宣传、改进服务模式、提高婚检质量。     

对婚前检查中不宜婚育者的随访调查

为了解婚前医学检查分类指导落实情况,对1988年4月～1993年12月经婚前医学检查为不宜婚配或婚后需采取避孕措施者进行随访调查。共调查不宜婚育者556对,其中结婚527对,婚后未采取避孕措施338对,占60.8％,分娩婴儿268例,其中有先天缺陷16例,出生缺陷率为59.7‰。结果表明本组婚前医学检查对象对医师提出的分类指导意见接受甚差,致使新生儿出生缺陷率比文献报道的6.72‰高8倍;影响了婚前医学检查的优生筛查作用。因此,要大力宣传婚前医学检查的意义,采取各种有效措施保障婚前医学检查分类指导意见的落实。     

广州市外来务工人员婚前医学检查调查

目的分析影响流动人口婚检态度和行为的相关因素，为提高流动人口的婚检行为提供参考。方法采用统一的“贫困地区外出打工群体（流动人口）生殖健康需求与服务（已婚女性）”问卷和“贫困地区外出打工群体（流动人口）生殖健康需求与服务（已婚男性）”问卷对广州市3423名打工的已婚流动人口进行问卷调查，并对婚检的相关问题进行分析。结果本次调查的人群中做过婚前体检的占66．92％，未做过的占33．08％。认为婚检有必要的占80．96％，没必要的占8．86％，说不清楚的占9．96％。在性别、文化程度和职业方面，流动人口的婚检态度和行为存在差异，强制婚检取消的政策和经济原因影响流动人口的婚检态度和行为的作用有限。结论多数流动人口对婚检认可，但实际的婚检行为相对较低。这需要提高流动人口婚检服务的可及性来满足婚检服务的需求，同时要考虑性别、职业以及文化程度的差异。     

A Description of the Southern Rural Access Program's Practice Management Strategies

ABSTRACT: Context: Many state, federal, and foundation resources have been invested in improving the recruitment of primary care providers to rural communities. The Southern Rural Access Program of the Robert Wood Johnson Foundation (RWJF) has provided varying levels of support to several southern states to assist with retention of those providers. Purpose: This study describes the strategies that 6 states used to develop and implement practice management technical assistance services for rural health care providers. Methods: Practice managers in each of the 6 states were surveyed regarding how their service was structured, what types of entities were eligible, and the nature of the technical assistance offered. Information regarding what types of entities used the service, characteristics of the practices, and the number of practices served was also collected. Findings: The survey results showed that almost half (46%) of all practices assisted were private stand-alone physician practices, with overall practice assessments being the practice management service rendered most often. Although the type of organizational home for the technical assistance services varied by state, overall states employed an average of 1.67 full-time equivalent practice managers (0.81 full-time equivalent supported by RVF) and received an average of $136 055 per state from the RWJF for the 2–year period beginning April 2002 for practice management support. Conclusions: Overall, the study found that the type of organizational home did not appear to affect the type of technical assistance services offered. However, the type of organizational home did appear to affect what types of providers used the service, with trade associations assisting their members or constituents at least half the time.     

Comparative quality of private and public health services in rural Vietnam

BACKGROUND: Private health care services were officially recognized in Vietnam in 1989, and for the last 15 years have competed with the public health system in providing primary curative care and pharmaceutical sales to rural populations. However, the quality of these private and public health care services has not been evaluated and compared. METHODS: A community-based survey was conducted in 30 of the 160 communes in Hung Yen, which were selected by probability proportional to population size (PPS) sampling. All commune health centres (CHCs) and private health care providers in the selected communes were surveyed on human resources, services provided, availability of medical equipment and pharmaceuticals, knowledge and clinical performance for acute and chronic problems. Patient satisfaction and cost of care associated with recent illness were measured using a random household survey covering 30 households from each of the selected communes. RESULTS: There were 11.5 private providers per 10,000 population, compared with 6.7 public providers per 10,000. A quarter of private providers were employees of the public health sector. Less than 20% of the private providers had registered their practice with the government system. Eleven per cent (26/234) had no professional qualifications. Fifty-eight per cent (135/234) provided treatment as well as selling medications. Public sector infrastructure was superior to that of the private providers. The quality of services provided by public providers was poor but significantly better than that of private providers. Patient satisfaction and costs of care were similar between the two groups. CONCLUSIONS: Private providers are successfully competing with the public health centre system in rural areas but not because they provide cheaper or better services. The quality of private health care services is not controlled and is significantly poorer than public services. Current practice in both systems falls below the national standard, especially for the management of chronic health problems. The low quality of health care services at a community level may help explain the previously observed phenomena of high levels of self-medicating, low utilization of commune health centres and over-utilization of tertiary health care facilities.     

Shared networks of interpreter services, at relatively low cost, can help providers serve patients with limited english skills

Language barriers in health care-a large and growing problem in the United States-contribute to disparities in health care quality and outcomes in populations with limited English proficiency. Providing access to adequate interpreter services has been shown to reduce health disparities in these populations. However, many health care organizations do not provide such services because of the perceived high cost. In this observational study we calculated the costs incurred by a group of California public hospitals that formed a network to make trained interpreters available via videoconference and telephone. We found that encounters in this network where interpreters helped patients and providers communicate lasted an average of 10.6 minutes and cost an average of $24.86 per encounter. Such costs should be weighed against the likely alternatives, such as the opportunity costs of having other hospital staff act as ad hoc interpreters; medical errors that could result from inadequate interpretation; and the fact that not providing such services may leave providers out of compliance with federal law. We also discuss ways in which providers could be compensated for providing interpreter services.     

部分妇幼保健机构遗传咨询现状调查

目的 了解妇幼保健机构中遗传咨询工作的现状。 方法 采用邮寄调查表的方法对参加“中美预防神经管畸形和残疾合作项目”的33个市县的妇幼保健院(所)进行调查。 结果 33张问卷全部收回且均为有效问卷。在33所妇幼保健机构中76%(25/33)提供遗传咨询服务,其中80%(20/25)有遗传咨询或类似科室,8%(2/25)的机构的遗传咨询单独由专职咨询医生承担,8%(2/25)的遗传咨询由专职咨询医生、婚检医生、妇产科医生、儿科医生等共同承担,84%(21/25)由婚检医生单独或与妇儿临床及保健医生共同承担,32%(8/25)机构中的咨询医生没有接受过遗传咨询专业培训,76%(19/25)的机构没有遗传咨询工作指南和考核标准。67%(22/33)的机构没有遗传学实验手段,30%(10/33)的机构不提供新生儿遗传病筛查服务。 结论 妇幼保健机构中遗传咨询开展的不够广泛,从事遗传咨询工作的专业技术人员不足,机构专业设施缺乏。     

Perceptions of Quality of Care for Serious Illness at Different Levels of Facilities in a Rural Area of Bangladesh

This study was conducted to explore care-seeking for perceived serious morbidities and users'' perceptions about quality of care at different facilities in Matlab, Bangladesh. This is a secondary analysis of baseline community survey data of the Matlab Essential Obstetric Care Project conducted in 2001. Principal component and factor analysis methods were used for computing summary quality and socioeconomic indicators. During perceived serious morbidity of any household member within the last one year, 88.1% (776/881) used health resource outside home. Of them, 25.6% visited informal care providers, 17.8% peripheral public facilities, 7.9% tertiary hospitals, 7.3% facilities of non-governmental organizations, and 41.4% private facilities as the highest healthcare resources. Socioeconomic status and type of morbidity were significant predictors for choice of the highest level of care. Most (86.1%) of those who sought care outside the home were satisfied with the quality of services provided for their last serious morbidities. Users of organized private-sector and tertiary facilities perceived the quality of services better than users of informal care providers and peripheral public facilities. Behaviour and attitude of the service providers and availability of medicines were significant predictors for perceived quality of care. Peripheral public-health facilities were of poor quality and grossly under-used. Further research should explore the technical aspect of quality of care in different facilities, along with perceptions of service providers to design client-focused interventions to impact the use of healthcare services. There is no reason to overlook informal care providers, they should rather be trained and monitored.Key words: Healthcare, Healthcare-seeking behaviour, Health services, Patients'' satisfaction, Quality of care, Bangladesh     

Managing outcomes: the perspective of the players

Outcomes management is most deeply rooted in clinical issues that interrelate concerns about quality with cost effectiveness of care. This is ground-breaking activity from many perspectives. Researchers must work more closely with clinicians and decision makers than ever before. Hospital executives must contend with many new external data demands and determine how to operationalize outcomes management programs within their institutions. There are new roles for clinician executives who act as change agents within health care organizations, while data on outcomes of care can lead to increased bargaining power among purchasers of services. In this article we discuss the major implications this new focus on managing outcomes is having on researchers, hospital executives, clinicians, and the purchasers of health care services.     

出生缺陷知识与文化和经济的关系

目的:了解孕妇对预防出生缺陷的知识、态度、行为情况,为进一步完善婚前保健、孕前保健及围产期保健服务提出合理化建议,提高出生人口素质。方法:采用分层抽样和随机抽样的方法,抽取深圳市龙岗区三个街道的90例孕期妇女作为调查对象,利用自行设计的调查表,进行面对面问卷调查,了解孕期妇女出生缺陷的知信行(KAP)情况。结果:文化层次高的孕妇,夫妇双方婚前医学检查率明显高于文化水平低者,差异有统计学意义(χ2=6.771 7,P<0.05);文化程度越高的孕妇对孕期保健、预防出生缺陷知识掌握得越多。对孕期"保持良好心情"的知晓率以月收入4 000～7 000元组最高(95.00%),月收入7 000元以上组的知晓率最低(61.54%);在孕期"注意少接触农药/油漆"及"注意少接触猫狗等"行为方面也有不同,家庭人均月收入越高的孕妇对上述行为的重视程度越高。结论:文化程度与家庭经济状况是孕期妇女掌握出生缺陷相关知识的影响因素。