社区医护干预预防产后抑郁症的研究

[目的]调查产后抑郁症患者的现状及需求,探讨预防措施。[方法]定性与定量研究相结合,定性采用专题小组讨论和半结构性访谈,12人参加专题讨论、9人半结构性访谈;定量研究随机抽取本市各社区产后42d的产妇776例行问卷调查。[结果]产妇月子期间常发生头疼、恶心、焦虑、恐惧、失眠以及照顾新生儿困难;半结构性访谈中有1产妇处于产后抑郁症的临界,EPDS量表测定为12分;776例产妇月子里有身心健康问题者692例,求助者91.0%,其中需要社区护理人员帮助的71.7%,实际寻求帮助仅12.7%。[结论]预防产后抑郁症应实行社区医护人员培训与产后访视人员的准入制度,采取社区医护干预的三级预防,同时拓展社区产后保健服务的内涵。     

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。     

福建省社区产后访视质量调查研究

目的: 研究社区产后访视服务现状, 提高社区护理质量, 促进母婴健康。方法: 定量与定性研究相结合, 定量研究随机抽取福州市 5区内产后 42d左右的产妇 776例问卷调查, 定性研究采用专题小组讨论和半结构性访谈。产妇 12人参加专题讨论, 半结构性访谈 9人。结果: 产后访视率为 62. 9%, 按 3 ~4次标准进行的仅 4.3%~48 .2% 。社区产后访视内容中,询问母子一般情况达 98 .4%; 对产妇及新生儿体检的内容欠缺多; 进行母乳喂养指导为 94. 7%; 认为对产妇心理情绪状况“关心与非常关心”的占 28 7%, 对预防产后抑郁症的保健建议率占 9 9%; 对社区产后访视满意率不高为 33 .6% 。结论: 与产后访视的次数和内容的标准对照, 实际操作中的偏差是由于缺乏规范化的管理, 因此今后既要加快产后访视人员对产褥期护理与保健知识的更新, 拓展提供保健知识的内容, 又要在现有社区产后访视过程中, 加强规范化管理, 区级妇幼保健机构应对辖区内的社区产妇的产后访视工作实行面对面的质量评估问卷, 达到规范化管理的目的, 并采取针对性措施提高产后访视中的护理与保健质量。     

产后抑郁症的社区护理干预研究

目的:探讨产后抑郁症的社区护理干预.方法:定性与定量研究相结合,定性研究采用专题小组讨论和半结构性访谈,产妇9人参加专题讨论,半结构性访谈12人;定量研究随机抽取本市各社区产后42d左右的产妇200例问卷调查.结果:产妇"月子"期间常发生头疼、恶心、焦虑、恐惧、失眠以及照顾新生儿困难;半结构性访谈中有1产妇处于产后抑郁症的临界,EPDS量表测定为12分;173例"月子"里有身心健康问题的产妇中,求助者91.3%,其中需要社区护理人员帮助的64.2%,但实际寻求帮助的只有13.9%.结论:实施产后抑郁症的社区护理干预,应针对产妇"月子"期间的身心健康问题提供护理支持与指导,做到预防为主.与此同时,应加强社区护理人员培训、强化社区服务的规范化管理.     

产后抑郁症的社区护理干预研究

目的：探讨产后抑郁症的社区护理干预。方法：定性与定量研究相结合，定性研究采用专题小组讨论和半结构性访谈，产妇9人参加专题讨论，半结构性访谈12人；定量研究随机抽取本市各社区产后42d左右的产妇200例问卷调查。结果：产妇“月子”期间常发生头疼、恶心、焦虑、恐惧、失眠以及照顾新生儿困难；半结构性访谈中有1产妇处于产后抑郁症的临界，EPDS量表测定为12分；173例“月子”里有身心健康问题的产妇中，求助者91．3％，其中需要社区护理人员帮助的64．2％，但实际寻求帮助的只有13．9％。结论：实施产后抑郁症的社区护理干预，应针对产妇“月子”期间的身心健康问题提供护理支持与指导，做到预防为主。与此同时，应加强社区护理人员培训、强化社区服务的规范化管理。     

产后抑郁症的社区护理干预研究

目的:探讨产后抑郁症的社区护理干预。方法:定性与定量研究相结合,定性研究采用专题小组讨论和半结构性访谈,产妇9人参加专题讨论,半结构性访谈12人;定量研究随机抽取本市各社区产后42 d左右的产妇200例问卷调查。结果:产妇"月子"期间常发生头疼、恶心、焦虑、恐惧、失眠以及照顾新生儿困难;半结构性访谈中有1产妇处于产后抑郁症的临界,EPDS量表测定为12分;173例"月子"里有身心健康问题的产妇中,求助者91.3％,其中需要社区护理人员帮助的64.2％,但实际寻求帮助的只有13.9％。结论:实施产后抑郁症的社区护理干预,应针对产妇"月子"期间的身心健康问题提供护理支持与指导,做到预防为主。与此同时,应加强社区护理人员培训、强化社区服务的规范化管理。     

社区健康服务中心开展产后访视工作的研究

目的:了解产妇及新生儿主要健康问题,分析产妇参加产前系统管理、接受产后访视和产褥期状况的影响因素,总结社区健康服务中心开展产后访视工作模式的优势和可行性。方法:2001年1月1日~12月31日,深圳市罗湖区共22家社区健康服务中心对休养地在罗湖区的产妇6 110人和新生儿6 135人进行了产后访视,对其健康状况进行统计、汇总,并在4家社区健康中心随机抽取213名产妇进行问卷调查,在Foxpro中建立数据库,采用SAS统计软件进行统计分析。结果:产褥期妇女的主要健康问题是乳汁分泌不足(17.89%),伤口愈合欠佳(6.07%);新生儿的主要异常情况是黄疸症状重或持续时间延长(8.43%),湿疹(4.37%)。抽样调查显示:①产妇的丈夫为教师、对访视工作的满意度高者,产妇接受产后访视的次数较多;②产妇为科技人员、丈夫为商业人员和个体者是产妇产褥期健康的危险因素;产妇和丈夫的文化程度高则是产妇参加产前系统管理的保护因素;产妇为阴道产、在产褥期适当运动、每天清洗会阴、定时开窗和产后访视次数多为产褥期健康的保护因素。结论:①产后母乳分泌不足、新生儿黄疸是母婴的主要健康问题,应采取综合措施,提高母乳喂养率;②严格掌握剖宫产指征,遏制不合理剖宫产的增加;③社区健康服务中心开展产后访视具有一定的优势和可行性;④运用社区妇幼保健服务新的管理模式,不断完善产后访视工作。     

某社区产妇对“产后访视和健康教育”的需求分析

目的了解江苏街道产妇对"产后访视及健康教育"的需求意向,产妇对产后访视的内容和产后保健知识需求的形式和方向。方法采用随机抽样的方法,在本街道2006年分娩的产妇中,随机抽取80人次填写意向表。结果本街道产妇对产后访视的满意率达98.8%,能接受产后家访服务形式的产妇达100%,产妇的母乳喂养率达90.0%,需要接受更多保健知识的产妇达100%。结论对产妇进行产后保健、科学育儿、产褥期保健等一系列指导,使产妇能更顺利恢复到孕前的身体状况,使新生儿能够健康成长。     

奥马哈系统理论在产后社区访视中的应用

目的 探讨奥马哈系统理论在产后社区访视中的应用,并观察护理干预的效果评价. 方法 对200例在本院分娩的产妇进行2～3次的家庭访视,通过对产妇和新生儿保健知识掌握情况的调查,找出存在问题进行护理干预,访视过程中最常用的干预方法是健康教育,指导和咨询. 结果 访视后产妇对进食高蛋白、水果蔬菜等饮食习惯方面的认识有了显著提高,对开窗、通风等接受率及产褥感染、痔疮、乳房疾病的认识程度均有了显著改善,访视后产妇对新生儿保健知识掌握有了显著提高,与访视前相比,差异具有统计学意义(P＜0.05). 结论 奥马哈系统理论,是适用产后社区延续护理的护理记录系统,能够全面的、有效的确保母婴产褥期的健康,在临床工作中值得推广.     

产后访视对36例产妇新生儿保健知识掌握的影响分析

目的:探究分析产后访视对产妇新生儿保健知识掌握的影响。方法:抽取2015年1月-2016年1月期间在我院分娩的36例产妇,并在分娩后对其进行产后访视,对比分析房事前后新生儿保健知识掌握情况。结果:通过有效的产后访视后,36例产妇护理和饮食知识、乳房疾病、生活习惯等自我保健意识有所提高;同时新生儿观察和护理相关保健知识掌握程度也越来越高,对比差异显著(P0.05)。结论:产后访视有利于提高产妇自我保健意识和新生儿保健知识掌握程度,确保产妇和新生儿健康,临床应用价值大。     

Exploring the Roles of Family Members in Women’s Decision to Use Postpartum Healthcare Services from the Perspectives of Women and Health Care Providers

Although the postpartum period is a significant time in a family’s life, few studies have addressed the lack of continuity of care and service use during the postpartum period. The aim of this study was to explore the roles of family members in Jordanian women’s decision to use postpartum health care services. An exploratory qualitative design was employed to elicit the perspectives of 24 women and 30 health care providers through six focus groups discussions conducted in April 2006. Interviews were transcribed verbatim, translated to English, and analyzed using an inductive content analysis approach. In our study, three roles of family members influencing Jordanian women’s decision to use postpartum health care services emerged: supporter role, opponent role, and active participant in care role. Findings supported the need for a family-centered approach when providing postpartum care to enhance positive family roles and limit negative ones to promote continuity of healthcare services use during the postpartum period.     

Barriers to Uptake of Postpartum Long‐Acting Reversible Contraception: Qualitative Study of the Perspectives of Ugandan Health Workers and Potential Clients

Health workers have received training on delivering postpartum long‐acting reversible contraceptives (LARCs) through several projects in Uganda, yet uptake still remains poor. To understand the reasons, and to gather suggestions for improving uptake, we conducted individual semi‐structured interviews with a total of 80 postpartum parents, antenatal parents, health workers, and village health teams in rural south‐west Uganda. Interviews were recorded, transcribed, translated, and analyzed using qualitative thematic analysis. Specific barriers to uptake of immediate postpartum contraception for women included: the need to discuss this option with their husband, the belief that time is needed to recover before insertion of a LARC, and fear that the baby might not survive. Furthermore, social consequences of side‐effects are more serious in low‐income settings. Suggestions for improving uptake of postpartum contraception included health education by “expert users,” couples counseling during antenatal care, and improved management of side‐effects.     

产褥期抑郁症的发生率及其相关因素的分析

目的 探讨产褥期抑郁症的发生率及其相关影响因素.方法 使用自编产褥期1～5天、产后42天调查表和爱丁堡产褥期抑郁表,对535例产妇分别于产后1～5天及产后42天进行调查分析.结果 产褥期抑郁症产褥期1～5天发生率为11.96%,产后42天为14.77%,两者无显著性差异.产妇的年龄、学历、居住条件、家庭关系(与丈夫、与家庭其它成员)等因素与产褥期抑郁症的发生有显著性差异(P＜0.05).产妇的性格倾向、职业、家庭收入、分娩方式、及新生儿性别等因素与产褥期抑郁症的发生无显著性差异(P＞0.05).结论 充分重视围产期及产褥期的心理保健和心理护理,营造良好的家庭氛围,加强孕产妇及其家属的产前、产时宣教,积极预防产褥期抑郁症的发生.     

Between older adults' needs and the law: The Israeli Long Term Care Insurance Law from the Perspectives of Service Users and Providers

The Israeli Long Term Care Insurance Law (LTCIL) was one of the first long term care insurances in the world to support older adults and their family members and allow them to stay in their homes for as long as possible. The present study aimed to evaluate the perspectives of older adults, their family members and home care workers regarding the LTCIL. Views of workers of the National Insurance Institute (NII), which is directly responsible for the enactment of the law, are also integrated. Interviews were conducted between June 2016 and June 2017. Thematic qualitative analysis is based on interviews with 15 NII workers, 31 older adults, 31 family members, and 6 paid home care workers. The present study stresses the tension between the LTCIL and older adults' perceived rights and needs. It also demonstrates how even though the NII workers are engaged with various stakeholders, they often lack direct contact with older adults, their family members and paid home care workers: those most directly influenced by the LTCIL. Policy considerations are discussed.     

Factors Influencing Women’s Decision to Seek Antenatal Care in the ANDES of Peru

This qualitative study aimed to assess factors influencing pregnant women’s decision to seek or avoid antenatal care (ANC) in the Andes of Peru. Open-ended, semi-structured interviews were conducted with 24 women utilizing ANC (+) and 10 women avoiding ANC (?). Interviews were translated to English from Quechua and Spanish, transcribed, and analyzed using grounded theory. Factors influencing ANC? women included: expecting criticism for having additional children; long ANC wait time and inconvenient hours of operation; and masculine gender of health workers. For ANC+ women, motivating factors included: maximizing positive health outcomes; past negative maternity experiences; pressure from family members; and avoidance of rumored fines or fees associated with ANC non-attendance and in-hospital deliveries, respectively. Both ANC+ and ANC? women were fearful and embarrassed about possible criticism for having additional children and the gender of the health workers, yet they weighed these factors differently. To better understand how rural women make decisions about ANC attendance, it is important to consider the value they place on the factors influencing their decision, and their emotional assessment of such issues.     

Understanding Factors Associated with Postpartum Visit Attendance and Contraception Choices: Listening to Low-Income Postpartum Women and Health Care Providers

Background While there is considerable variability with respect to attendance at the postpartum visit, not much is known about women’s preferences with respect to postpartum care. Likewise, there is also limited information on providers’ practices regarding the postpartum visit and care including the delivery of contraception. To understand and address deficits in the delivery and utilization of postpartum care, we examined the perceptions of low-income postpartum women with respect to barriers to and preferences for the timing and location of the postpartum visit and receipt of contraception. We also examined providers’ current prenatal and postnatal care practices for promoting the use of postpartum care and their attitudes toward alternative approaches for delivering contraceptive services in the postpartum period. Methods Qualitative face-to-face interviews were completed with 20 postpartum women and in-depth qualitative phone interviews were completed with 12 health care providers who had regular contact with postpartum women. Interviews were coded using Atlas.ti software and themes were identified. Results Women believed that receiving care during the postpartum period was an important resource for monitoring physical and mental health and also strongly supported the provision of contraception earlier than the 6-week postpartum visit. Providers reported barriers to women’s use of postpartum care on the patient, provider, and system levels. However, providers were receptive to exploring new clinical practices that may widen the reach of postpartum care and increase access to postpartum contraception. Conclusion Approaches that increase the flexibility and convenience of postpartum care and the delivery of postpartum contraception may increase the likelihood that women will take advantage of essential postpartum services.     

广州市荔湾区产妇心理卫生服务利用现状调查

目的:调查产妇心理状况及其对心理卫生保健服务的利用现状,为探索在社区开展产妇心理卫生服务的模式提供依据。方法:在广州市荔湾区随机抽取5所社区卫生服务中心,对各中心产妇心理卫生服务状况进行调查,随机抽取产后42天产妇进行产后抑郁、心理卫生服务问卷调查。结果:产妇抑郁阳性率34.5%。27.6%产妇曾有心理卫生服务需要,16.3%曾接受过某种形式心理卫生服务。产妇对心理卫生服务的主观需求与产妇的心理健康状况、职业、家庭经济状况、费用支付方式、生育准备、是否上孕妇学校有关。结论:产妇存在着较大的心理问题,但针对产妇的心理卫生服务缺乏,为了增加产妇对心理卫生服务的主动性,社区卫生保健工作者应考虑服务的价格因素,加大心理卫生知识的宣传力度,将心理医生整合到初级保健机构,实现初级保健和心理关怀的融合。     

Health Status and Health Insurance Coverage of Women with Live-Born Infants: An Opportunity for Preventive Services After Pregnancy

Most women in the US have access to health care and insurance during pregnancy; however women with Medicaid-paid deliveries lose Medicaid eligibility in the early postpartum period. This study examined the association between health insurance coverage at the time of delivery and health conditions that may require preventive or treatment services extending beyond pregnancy into the postpartum period. We used 2008 Pregnancy Risk Assessment Monitoring System data from 27 states (n = 35,980). We calculated the prevalence of maternal health conditions, including emotional and behavioral risks, by health insurance status at the time of delivery. We used multivariable logistic regression to assess the association between health insurance coverage, whether Medicaid or private, and maternal health status. As compared to women with private health insurance, women with Medicaid-paid deliveries had higher odds of reporting smoking during pregnancy (adjusted odds ratio [AOR]: 1.85, 95 % confidence interval [CI]: 1.56–2.18), physical abuse during pregnancy (AOR: 1.73, 95 % CI: 1.24–2.40), having six or more stressors during pregnancy (AOR: 2.48, 95 % CI: 1.93–3.18), and experiencing postpartum depressive symptoms (AOR: 1.24, 95 % CI: 1.04–1.48). There were no significant differences by insurance status at delivery in pre-pregnancy overweight/obesity, pre-pregnancy physical activity, weight gain during pregnancy, alcohol consumption during pregnancy, or postpartum contraceptive use. Compared to women with private insurance, women with Medicaid-paid deliveries were more likely to experience risk factors during pregnancy such as physical abuse, stress, and smoking, and postpartum depressive symptoms for which continued screening, counseling, or treatment in the postpartum period could be beneficial.     

非计划医院外分娩产妇产后出血的临床分析

目的:探讨非计划医院外分娩产妇产后出血的产科特征及防治方法。方法:对1993年1月~2005年12月我院收治的116例院外分娩产后出血病例进行回顾性分析。结果:13年间非计划院外分娩产妇产后出血共116例,占同期产后出血21.93%,平均出血量863.60ml,89.66%发生在产后2h内。院外分娩产妇趋向于年龄大、产次多、教育程度低、社会经济地位低下和缺乏产前检查。子宫收缩乏力(49.14%)、胎盘滞留(40.52%)、软产道损伤(10.34%)是产后出血的主要原因。仅2例行全子宫或次全子宫切除术,无1例死亡。结论:非计划医院外分娩是产后出血的重要危险因素,应切实加强计划生育和围产期保健工作,坚决取缔非法诊所和非法接生,提高住院分娩率以降低产后出血的发生。     

176例产妇心境状况调查与分析

目的:分析产妇的心境状况,为有针对性的开展健康教育提供依据。方法:对176例产妇在产后3～4天进行访视,自行填写基本问卷和SCL90症状自评量表(部分因子)及爱丁堡抑郁量表。结果:家人关心程度与孕妇本人是否善于交往是影响产妇抑郁的重要因素;对孕妇进行系统的孕产期健康教育有助于减少产后抑郁,而是否选择接受系统健康教育受孕妇本人文化程度影响。结论:对孕产妇进行系统的健康教育,以及提高其社会支持系统中的家人关心程度和增加孕妇之间的交往,将有助于减少产后抑郁。