宁波市宫颈癌防治资源及社区女性人群对宫颈癌筛查认知度调查

目的了解宁波地区医疗机构宫颈癌防治资源的情况以及当地女性对宫颈癌筛查的认知情况。方法采用整群抽样的方法,在宁波地区随机抽取医疗机构19家,其中市级医疗机构2家、县级医疗机构11家、乡级医疗机构6家。女性常住人口3 900人进行问卷调查。采用SPSS 17.0软件进行统计分析,采用计数资料行列表的χ2检验,P<0.05为差异有统计学意义。结果各级医疗机构均开展了宫颈癌筛查项目,市级医疗机构全部开展了6种宫颈癌筛查项目,但仅有6家医疗机构开展HPV-DNA检测,9家开展宫颈病理诊断。宫颈癌筛查方式包括组织性筛查、门诊机会性筛查、体检等方式。对常住人口共发放问卷3 900份,回收有效问卷3 609份。宁波地区妇女对宫颈癌可以早期发现的认知度为71.71%,年龄、职业、文化程度、城乡分布、经济状况等影响妇女的认知度(χ2=19.719、69.963、257.236、88.373、91.290,P<0.05)。对"持续高危型HPV感染"是宫颈癌的病因的认知度仅为28.10%。85.48%的被调查者愿意参加宫颈癌筛查。48.96%的人愿意承受100元以下的费用。2年内参加过宫颈癌筛查的女性仅占50.9%。结论宁波地区医疗机构具备开展宫颈癌筛查和治疗的条件。宁波地区妇女对宫颈癌筛查及其病因的认知度较低,其认知度与年龄、职业、文化程度、城乡分布、经济状况等有联系。     

苏州市40岁以上女性乳腺癌筛查现状及影响因素分析

目的 了解苏州市40岁以上女性乳腺癌筛查现状,分析乳腺筛查行为的影响因素。方法 调查苏州市40岁以上未患过乳腺相关疾病女性的基本情况和乳腺癌筛查情况,结合健康信念模式（感知易感性、感知严重性、感知利益、感知障碍、自我效能）分析乳腺筛查的影响因素。结果 共644名女性完成调查,乳腺自我检查率为63.8%、临床检查率为44.7%、B超检查率为36.6%、X线筛检率为22.4%。健康信念模式中,感知利益得分最高,为（3.83±0.51）分,感知易感性得分最低,为（2.73±0.88）分。多因素Logistic回归分析显示,年龄50～59岁（与40～49岁相比）、家庭收入≥10 000元（与＜5 000元相比）、教育程度较高、感知易感性、自我效能得分较高、亲友曾患乳腺癌的女性更易接受乳腺筛查（P＜0.05）。结论 苏州市40岁以上女性乳腺癌筛查率较低,应加强对乳腺癌早期筛查知识的宣传和教育,提高感知易感性和自我效能。     

健康教育对妇女乳腺癌筛查行为的影响

目的通过医学院校本科护生和体检中心参与社区健康教育，提高妇女对乳腺癌疾病、筛查措施的认知及乳腺癌筛查行为。方法采用便利抽样的方法，抽取某社区35岁以上妇女72名，随机分为实验组和对照组各36名。对照组给予常规健康教育，实验组在充分评估学习对象的基础上，由临床教师给予健康教育，并安排本科护生给予一对一的健康指导，填写登记表后交于体检中心提醒预约筛查的程序及就医方式。结果干预后两组妇女乳腺癌疾病、筛查措施的认知平均得分均高于干预前，干预后实验组得分高于对照组，差异有统计学意义（P〈0．01）；实验组的乳腺癌筛查行为优于对照组，差异有统计学意义（P〈0．01）。结论通过本科护生、临床教师和体检中心实施社区健康教育更有助于提高妇女对乳腺癌疾病、筛查措施的认知及改善乳腺癌筛查行为。     

Use of Pap test among Hispanics and non-Hispanic whites in a rural setting

BACKGROUND: Hispanic women in the United States have a higher incidence of invasive cervical cancer than non-Hispanic whites. A key factor related to the relatively high incidence is the underutilization of cancer-screening services. Several previous investigations have reported that Hispanic women are less likely to comply with screening recommendations for Pap testing; some have identified factors that are associated with non-compliance with screening recommendations. METHODS: Using baseline personal interview data from a randomized community trial on cancer prevention in a rural area, we assessed the association between health barriers and non-compliance with cervical screening recommendations. RESULTS: Among Hispanic women (n = 382), those with a lower level of acculturation were more likely than highly acculturated Hispanic and non-Hispanic white women (n = 385) to report personal barriers as reasons for not getting an initial or subsequent screening exam. Such barriers include fear of finding cancer, fear of finding diseases other than cancer, and embarrassment about receiving a physical exam. Certain structural barriers, such as cost of care, no time off work, and lack of transportation, were reported to be associated with non-compliance with routine cervical cancer screening, especially among non-Hispanic white women. CONCLUSIONS: Future research should examine barriers related to initial and subsequent screening among Hispanics with varying levels of acculturation.     

Satisfaction with health care and cancer screening practices among women in a largely rural region of West Texas

BACKGROUND: Satisfaction with medical care has been shown to influence patient behavior, but its effect on the use of preventive services is largely unstudied. This study examined whether women's satisfaction with the accessibility and quality of care was associated with the odds of receiving an annual clinical breast examination, conducting a monthly self-breast examination, or receiving an annual Pap smear. METHODS: A telephone survey was conducted among 675 women in West Texas, an area with a relatively high proportion of rural residents and Hispanics. Multiple logistic regression analyses were performed to model the odds of each screening practice. RESULTS: Women who rated the overall quality of their health care as excellent had a higher odds of receiving an annual clinical breast examination, conducting a monthly self-breast examination, and receiving an annual Pap smear. No rural/urban differences were revealed, but Hispanic women had a lower odds of conducting a self-breast examination than non-Hispanic Whites. CONCLUSIONS: Rural residence and Hispanic ethnicity were largely unassociated with cancer screening practices. Rather than directing outreach programs toward these subgroups, efforts to increase cancer screening among women may need to focus more on improving the quality of primary health care.     

Barriers and facilitators related to mammography use among lower educated Mexican women in the USA

This study explores barriers to and facilitators of breast cancer screening and how people in a woman's social network influence these screening behaviors. A total of 40 semi-structured qualitative interviews were conducted in rural Washington State (USA) among Mexican women aged 50 and over. Eligible women reported either having had a mammogram within the last two years, over two years ago, or never. We found that lack of health insurance, the perception that the mammogram is painful, and fear of finding cancer were cited as barriers to participation in mammography screening. Women who had lived in the US for a shorter period were more likely to report never having had a mammogram than women who had lived in the US for a longer period. Women often cited daughters and female friends as those from whom they received advice or encouragement to receive a mammogram. Few differences were found related to network size and mammography use among the groups. These findings may be useful in designing interventions to promote mammography use. Including daughters in intervention activities may help facilitate mammography use among Mexican women.     

Prevention practices and cancer screening among general practitioners in Picardy, France

BACKGROUND: Due to their frequent contact with a large proportion of the population, general practitioners (GPs) appear to play a particularly important role in primary and secondary (screening) cancer prevention. The objective of this survey was to describe the attitudes of GPs in relation to the major risk factors of cancer, and the most frequent forms of cancer screening. METHODS: A questionnaire concerning primary prevention and cancer screening by GPs was sent to all doctors in the Picardy region. In total, 480 GPs agreed to participate in this survey (31%). The questions concerned primary prevention (alcohol, smoking, diet, sun exposure, etc.) and cancer screening (breast, cervix, colorectal, prostate and other cancers). GPs were also questioned about their perception of these preventive actions and the difficulties that they encounter in application of these measures. RESULTS: The most structured preventive action appears to concern smoking in terms of primary prevention. GPs report greater difficulties in the prevention of alcoholism or dietary advice. A marked diversity of clinical practice was also observed in terms of cancer screening, even for cancers for which clear guidelines have been defined, such as breast, cervical and colorectal cancer. CONCLUSION: GPs appear to be receptive to cancer prevention, but encounter many difficulties in daily application due to lack of time or poor patient compliance.     

Maternal health behaviors and infant health outcomes among homeless mothers: U.S. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) 2000-2007

Objective

To determine whether participation in the Women, Infants, and Children Program is associated with improved maternal and infant health outcomes among homeless women in the Pregnancy Risk Assessment Monitoring System.

Method

Analyses were based on Pregnancy Risk Assessment Monitoring System participants from 31 states/cities in the United States, 2000-2007 (n = 272,859). Overall, 4% of women completing the Pregnancy Risk Assessment Monitoring System survey were homeless, with 76% participating in the Women, Infants, and Children Program, a federally-funded supplemental nutrition program for low-income women and children less than 5 years old.

Results

Among women in the Pregnancy Risk Assessment Monitoring System survey who reported using the Women, Infants, and Children Program, those experiencing homelessness were older, less educated, less likely to have private health insurance, and more likely to receive government assistance. Homeless women in the Women, Infants, and Children Program compared with those not in the program were significantly more likely to have a higher body mass index, to initiate breastfeeding after delivery, have prenatal care visits, have a longer gestational age, and have a greater infant birth weight.

Conclusion

Characteristics of homeless pregnant women choosing to participate in the Women, Infants, and Children Program are consistent with the requirements for program participation for women in general. Homeless women accessing the Women, Infants, and Children Program had better maternal and infant health outcomes.     

Barriers to breast cancer screening for low-income Mexican and Dominican women in New York City

The proportion of Mexican and Dominican women has increased rapidly in New York City and in other urban areas, and breast cancer screening rates continue to be lower for Latina women as a whole, but particularly for some nationality sub-groups. The current analysis explored the reasons why Mexican and Dominican women from medically underserved communities in New York City do not seek breast cancer screening. Data were collected through interviews with 298 Mexican and Dominican women aged 40–88 years; the interviews included an open-ended question on the barriers women face in seeking screening. The three most commonly cited barriers were not taking care of oneself (descuido) (52.3%), lack of information (49.3%), and fear (44.6%). Women who had been screened cited fear, pain, or other personal barriers more often, but women who had never had a mammogram cited cost or other logistical barriers. Responses from Dominican and Mexican women were significantly different, with Mexican women more often citing shame or embrarrassment and Dominican women more often citing fear. The dependent variable, barriers to screening, was grouped into major categories. When sociodemographic factors were controlled for, the effect of ethnicity disappeared. Multivariate logistic regression revealed that women with a source of health care were less likely to cite any logistical barriers, but significantly more likely to report only personal barriers (such as fear ordescuido). The analysis indicated that personal barriers were very prevalent in the communities studied. It may not be sufficient merely to increase access to breast cancer screening services for low-income Latinas: even when women have a source of health care, personal barriers may prevent many women from seeking screening. Outreach programs need to be tailored to the target communities as there are significant differences among groups of Latinas. Targeted outreach programs must work in tandem with programs to increase access to ensure that both personal and logistical barriers to screening are addressed.     

贵州省中小医院住院患者营养风险筛查及营养支持应用现状

目的调查贵州省中小医院住院患者营养风险、营养不足、超重和肥胖发生率及营养支持的应用现状。方法采用定点连续抽样,选择2008年2月至2009年3月贵州省4家中小医院普通外科、胸外科、神经内科、消化内科、呼吸内科、。肾内科住院患者进行营养风险筛查2002（NRS2002）,于患者入院次日早晨实施,并调查患者2周内（或至出院时）的营养支持状况,分析营养风险和营养支持的关系。NRS2002i〉3分为有营养风险,体重指数〈18．5kg／m。并结合患者临床情况判定为营养不足。结果共1668例患者人选并全部完成NRS2002筛查,营养不足和营养风险的发生率分别为12．2％和30．2％,504例有营养风险的患者中54例（11．7％）接受营养支持,所有营养支持均为肠外营养。结论NRS2002适用于住院患者的营养筛查;营养支持在贵州省中小医院应用不足,应用方式单一,需进一步规范基于循证医学证据的营养支持应用。     

Racial disparities in health and health behaviors among gay,lesbian, bisexual and heterosexual men and women in the BRFSS-SOP

ABSTRACT

Objectives: Research on sexual minority health lack examinations of how sexual orientation intersects with other identities, including racial/ethnic identity, to shape health outcomes among U.S. adults. This study examines how health status and health behavior varies for gay, lesbian, and bisexual men and women who identify as non-Hispanic white, non-Hispanic black, Latino, Asian/Pacific Islander, and American Indian/Alaskan Native. By examining health and health behaviors within and across sexual minority subgroups, our study reports on race/ethnic, gender, and sexual orientation specific health risks.

Methods: We respond to shortcomings in current data by utilizing aggregated data from fourteen states from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2005 and 2010 (n?=?557,773). We investigated the odds of reporting poorer health, current cigarette smoking, and obesity by sexual orientation within race/ethnic and gender subgroups; all statistical analyses were performed in 2016.

Results: Results suggest persistent health and behavior disadvantages for lesbian and bisexual women of all racial and ethnic identities, relative to heterosexuals. Some of the heightened odds are extreme. Asian/Pacific Islander lesbian (OR?=?3.92) and bisexual (OR?=?4.61) women, for example, have 4.0 times higher odds of smoking than heterosexual A/PI women. Results for men are more variable. To illustrate, the odds of obesity for White and A/PI men are indistinguishable between bisexuals and heterosexuals, and Black and American Indian/Alaskan Native bisexuals have lower odds of obesity than their heterosexual counterparts.

Conclusion: These findings highlight the need for policy efforts aimed at improving health and health behaviors among lesbian and bisexual women across groups, and more targeted efforts among sexual minority men.     

Pap screening and knowledge of risk factors for cervical cancer in Chinese women in British Columbia, Canada

Objective. Cervical cancer is a significant cause of mortality and morbidity for Chinese Canadian women, due in part to inadequate Pap screening. A community‐based survey was conducted involving 528 Chinese immigrant women residing in British Columbia, Canada, in order to identify barriers and facilitators to Pap testing. This paper addresses the relationship between knowledge level about cervical cancer risk factors and Pap screening practices.

Design. Female trilingual Chinese interviewers conducted personal at‐home interviews about knowledge of cervical cancer risk factors, history of Pap screening, sociodemographic and acculturation factors.

Results. The average summary score for knowledge about cervical cancer risk factors was 5.2/10, and knowledge level was significantly associated with the woman's educational level and the gender of the doctor providing usual care. Seventy‐four per cent of respondents reported ever having received a Pap test, and 56% reported having received a test within the last two years. Respondents with the highest knowledge were more likely to have ever received a Pap test (OR 6.4, 95% CI: 2.6, 15.9), and to have recently received a test (OR 3.1, 95% CI: 1.4, 6.7).

Conclusion. The average knowledge level about cervical cancer risk factors is low in Chinese Canadian women, especially among those with less education and who receive their usual care from a male doctor. Knowledge of these risk factors influences Pap screening behaviour. Culturally and linguistically appropriate education interventions addressing Pap testing and risk factors for cervical cancer are needed in the Canadian Chinese community. Educational resources are also needed for their primary care givers.     

Time in the United States, social support and health behaviors during pregnancy among women of Mexican descent

Among women of Mexican descent, increased acculturation in the US has been associated with poorer health behaviors during pregnancy. This study examined a population of low-income women of Mexican descent in an agricultural community to determine: whether social support patterns were associated with age at arrival in the US; whether social support was associated with pregnancy behaviors; and whether increased social support could prevent some of the negative pregnancy behaviors that accompany acculturation. Participants were 568 pregnant women enrolled in prenatal care in the Salinas Valley, California. Participants were predominantly Spanish speaking, born in Mexico, and from farmworker families. Information on social networks, social support, age at arrival in the US, and pregnancy health behaviors was gathered during interviews conducted during pregnancy and immediately after delivery. Poorer health behaviors were observed among women who had come to the US at a younger age. Social support during pregnancy was lowest among women who had come to the US at an older age. High parity, low education, and low income were also associated with low social support. Higher social support was associated with better quality of diet, increased likelihood of using prenatal vitamins, and decreased likelihood of smoking during pregnancy. High social support also appeared to prevent the negative impact of life in the US on diet quality. Women with intermediate or low levels of social support who had spent their childhoods in the US had significantly poorer diet quality than women who had spent their childhoods in Mexico. However, among women with high social support, there was no difference in diet quality according to country of childhood. Thus, in the case of diet quality, increased social support appears to prevent some of the negative pregnancy behaviors that accompany time in the US among women of Mexican descent.     

Economic contraction and maternal health behaviors during pregnancy in a national sample of U.S. women

PurposeThe purpose of this study was to examine associations between maternal exposure to unexpected economic contraction and health behaviors during pregnancy using methods to account for impacts of economic contraction on selection into pregnancy.MethodsData on health behaviors among 7074 pregnancies in the National Longitudinal Survey of Youth 1979 were linked to monthly unemployment rates in maternal state of residence. The study examined associations between exposure to unexpected economic contraction (higher than expected state-level unemployment) during each trimester of pregnancy and maternal smoking, alcohol use, and gestational weight gain using generalized linear models.ResultsEconomic contraction was not associated with maternal smoking or gestational weight gain. Associations between economic contraction and maternal alcohol use differed by maternal race–ethnicity and education. Among black–non-Hispanic women, exposures to economic contraction during the first and second trimester of pregnancy were associated with a 42% (95% confidence interval, 1.08, 1.85) and 33% (95% confidence interval, 1.01, 1.74) increased risk of alcohol use, respectively.ConclusionsFindings suggest that exposure to extreme economic contraction during pregnancy may be associated with increased use of alcohol with differences by maternal race–ethnicity and educational attainment. Economic contraction was not associated with other maternal pregnancy behaviors.     

Health status, health behaviors, and acculturation factors associated with overweight and obesity in Latinos from a community and agricultural labor camp survey

BACKGROUND: U.S. Latino adults have experienced an 80% increase in obesity in the last decade. METHODS: A cross-sectional survey of 18-64-year-old Latino women (N = 380) and men (N = 335) from a community sample, and men (N = 186) from an agricultural labor camp sample in Monterey County, California, provided data on correlates of obesity. RESULTS: In the community and labor camp samples, prevalences of chronic disease risk factors (high blood pressure and cholesterol, diabetes) were 1.5-7 times higher in the heaviest compared with the leanest weight groups. Higher acculturation (generational status, years lived in the United States) was the strongest correlate of obesity (measured by BMI) in the community sample (P < 0.001), followed by less exercise and poorer diet (P values < 0.05). Women who exercised <2.5 h/week, watched TV regularly, ate chips/fried snacks, and ate no fruit the previous day were 45 lbs heavier than women with healthier habits. Men who did not exercise, rarely trimmed fat from meat, and ate fried foods the previous day were 16 lbs heavier than men with healthier habits. Discussions with health care providers about diet/exercise were associated with more accurate weight perception and more weight loss attempts in obese participants in both samples. CONCLUSIONS: The associations of acculturation, exercise, and diet to BMI implicate societal as well as individual contributors to obesity among U.S. Latinos.     

天津某理工科高校学生健康危险行为影响因素分析

目的了解天津市某理工科高校大学生健康危险行为发生情况及其影响因素,为探讨大学生健康危险行为的形成原因提供参考。方法选取天津市某理工科大学一～四年级的学生268名,采用《青少年健康与发展问卷》的中文版进行调查。结果男女生吸烟、饮酒行为发生率差异有统计学意义;而在每周运动时间、试图自杀、饮食行为和步行危险行为上的发生率差异无统计学意义。影响行为的主要因素包括了个人、环境和行为等方面。成功期望(OR=0.84)是完整吸完一支烟的保护因素,压力情绪(OR=1.18)是其危险因素;同伴控制(OR=0.50)是每周吸烟次数大于1次的保护因素,偏差行为(OR=1.36)是其危险因素;学校控制(OR=0.83)是每次饮酒量大于5杯的保护因素,同伴支持(OR=1.39)是其危险因素;同伴支持(OR=0.84)是每周饮酒次数大于1次的保护因素,学校危险行为榜样(OR=1.21)是其危险因素;自尊(OR=0.77)是每周运动时间<3 h的保护因素,压力(OR=1.19)是其危险因素;学习行为(OR=0.88)等是经常吃早饭的保护因素,抑郁情绪等(OR=1.17)是其危险因素;学习行为等(OR=0.83)是尝试自杀的保护因素,偏差行为(OR=1.27)是其危险因素;同伴健康行为榜样(OR=0.65)是步行危险行为的保护因素,抑郁情绪(OR=1.16)是其危险因素。结论应用问题行为理论可以部分解释大学生健康危险行为问题。     

Results of a health systems approach to identify barriers to population-based cervical and colorectal cancer screening programmes in six European countries

The aim of this study was to identify barriers to effective cervical and colorectal cancers screening programmes in Europe. The Barriers to Effective Screening Tool (BEST), based on a health systems approach, was completed by teams of three to six experts on cancer screening in each of the six countries involved in leading the EU-TOPIA project (TOwards imProved screening for breast, cervical and colorectal cancer In All of Europe). While the basic components of screening systems and the challenges they face, such as low participation, are similar, there are also many differences, both in the structures underpinning particular functions, such as maintenance of populationregisters and monitoring outcomes, and the ways that they operate. Many of these lie outside the strict organisational boundaries of screening programmes. BEST offers a means to identify and prioritise issues for further detailed exploration. The holistic health systems approach to assessing barriers differs from previous approaches. Those focus on individual characteristics that determine participation. The approach described here provides additional opportunities to improve outcomes with measures that are largely within the control of those managing the health system.     

武汉市20余万农村妇女宫颈癌和乳腺癌筛查情况分析

目的:了解武汉市农村妇女宫颈癌和乳腺癌患病情况及相关因素。方法:采用液基薄层细胞学技术(TCT)和DNA倍体定量分析技术检测宫颈脱落细胞,初筛阳性者采用阴道镜下取宫颈活体组织进行病理检查;采用触诊及彩色多普勒超声进行乳腺检查,初筛阳性者行钼靶摄片检查或乳腺穿刺行细胞学检查。对所有初筛阳性者进行问卷调查,了解一般人口学情况、环境因素、遗传因素、既往史及现病史、女性个人健康史、生活习惯及饮食习惯以及社会心理因素等因素。结果:全市共对202 067例妇女进行"两癌"筛查,共检出宫颈癌前病变770例、宫颈癌33例(27.13/10万),乳腺癌32例(23.85/10万)。对"两癌"影响因素分析提示:HPV感染、宫颈癌家族史、基础妇科疾病、初次性行为年龄早是宫颈癌前病变发生的危险因素;HPV感染、初次生育年龄早以及经历不良生活事件是宫颈癌发生的危险因素;初婚年龄晚、文化程度低、经常使用电脑或电视机、有癌症家族史、流产及引产史是乳腺癌发生的危险因素。结论:通过开展宫颈癌和乳腺癌筛查,起到早发现、早诊断、早治疗的作用,对降低宫颈癌和乳腺癌的发病率及死亡率具有重要的意义。将来需根据"两癌"高危因素进一步加强针对性的健康教育工作,完善"两癌"筛查与随访制度,保障妇女的生殖健康。     

上海市长宁区退休妇女宫颈病筛查结果及影响因素分析

目的了解上海市长宁区退休妇女宫颈病患病现况,分析其可能的影响因素。方法采用分层整群抽样的方法获取研究样本,采用问卷调查和体检相结合的方法收集相关信息。结果共调查退休妇女6488人,宫颈病检出率居前三位的分别为宫颈涂片≥Ⅱ级(19.88%)、宫颈息肉(5.35%)和宫颈纳氏囊肿(3.87%)。其中,已绝经者宫颈纳氏囊肿、宫颈肥大和宫颈糜烂的检出率均低于未绝经者;30-49和50-54岁组宫颈纳氏囊肿和宫颈肥大检出率较高;而30-49、50-54和55-59岁组宫颈涂片≥Ⅱ级的检出率较低。结论退休妇女的宫颈病检出率较高,应积极开展退休妇女宫颈病普查、普治和针对性的健康教育工作。