上海市某社区婴儿缺铁性贫血影响因素研究

[目的] 探讨上海市某社区6月龄婴儿缺铁性贫血发生情况及其影响因素。[方法] 对上海市某社区2007年1月至2009年6月出生的190例6月龄婴儿进行血红蛋白检测与相关因素调查。[结果] 该社区6月龄婴儿缺铁性贫血的患病率为21.58%,经单因素分析与多因素Logistic回归分析,婴儿喂养方式和4~6个月是否添加辅食是婴儿缺铁性贫血的重要影响因素,6个月内纯母乳喂养和4~6个月未添加辅食的OR值分别为3.0和19.8。[结论] 在提倡母乳喂养的同时,应注意合理添加辅食和适时补充铁元素,以减少婴儿缺铁性贫血的发生。     

婴幼儿及学龄前儿童热性惊厥与缺铁性贫血关联的Meta分析

目的通过对已发表的文章进行荟萃分析以明确婴幼儿及学龄前儿童发生热性惊厥与缺铁性贫血的关系。 方法利用PubMed、Web of science、MEDLINE、万方数据知识服务平台、中国知网数据库(CNKI)、维普等数据库数据库(VIP)和Cochrane图书馆数据库等中英文电子数据库，收集1990年1月至2017年9月前已发表的关于3个月至6岁婴幼儿及学龄前儿童发生热性惊厥与缺铁性贫血相关性的文章。按纳入与排除标准由2名研究者阅读全文后进行文献筛选和资料提取，采用纽卡斯尔-渥太华量表(the Newcastle-Ottawa Scale，NOS)进行文献质量评估。Stata SE 12.0软件对缺铁性贫血是否为热性惊厥患儿风险因素进行Meta分析，计算比值比(OR)，并依据缺铁性贫血诊断标准的不同进行亚组分析。 结果本研究共检出相关文献89篇，排除重复和不相关的搜索记录11篇、只有摘要的文章18篇，以及对全文进行排查：综述2篇、缺少数据9篇以及数据雷同2篇剔除，最终纳入符合纳入与排除标准的26篇文献进行Meta分析。分析结果表明：热性惊厥与缺铁性贫血具有相关性[OR＝2.24，95%CI(1.758，2.854)，P<0.05]。 结论缺铁性贫血是婴幼儿及学龄前儿童发生热性惊厥的风险因素之一。     

铁用于静脉营养混合液的安全性及临床有效性

铁剂常用来治疗由于铁缺乏引起的低色素小细胞性贫血，肠外铁剂的补充对于无法经口服补铁或者口服补铁无效的患者是必需的。但目前全营养混合液中加入铁剂仍然存有争议。本文就全营养混合液中加入铁后的稳定性、安全性和临床有效性进行论述。     

不同口服铁剂治疗儿童缺铁性贫血安全性的网络Meta分析

目的 应用网络Meta分析评价8种口服铁剂治疗儿童缺铁性贫血安全性。方法 检索收集2015年7月之前国内外发表有关口服铁剂与儿童缺铁性贫血文献。采用Microsoft Excel 2013软件加载NetMetaXL宏命令调用WinBUGS 1.4.3软件选择随机效应模型进行统计分析,系统评价8种口服铁剂之间的OR值及优劣顺序。结果 纳入文献31篇,3 417例缺铁性贫血儿童。与右旋糖酐铁相比,硫酸亚铁、铁叶绿素钠、琥珀酸亚铁、葡萄糖酸亚铁、多维铁复合物、多糖铁复合物、富马酸亚铁的OR值及95% CI分别为0.00（0.00~0.03）、0.03（0.00~0.39）、0.02（0.00~0.23）、0.01（0.00~0.07）、0.01（0.00~0.11）、0.02（0.00~0.19）、0.01（0.00~0.12）。右旋糖酐铁发生不良反应风险最小（SUCRA=0.999 4）,而硫酸亚铁的风险最高（SUCRA=0.034 1）。结论 硫酸亚铁发生不良反应的风险较高,临床医生和患者在选择硫酸亚铁治疗儿童IDA时需慎重。     

健康教育联合添加辅食营养素补充品预防婴幼儿缺铁性贫血效果观察

目的 探讨小儿缺铁性贫血的预防措施,降低婴幼儿贫血发病率.方法 选取在河北省昌黎县妇幼保健院产科出生的新生儿150名,随机分为健康教育联合辅食营养素补充品添加观察组、健康教育对照组和普通对照组,每组50人.3组小儿出生后满9个月进行血红蛋白和末梢血铁和锌元素检测,对检测结果进行统计分析.结果 健康教育联合辅食营养素补充品添加组小儿贫血患病率为12％,末梢血铁元素含量为(8.05±0.58) mmol/L,锌元素含量为(78.90 ±9.18)μmol/L;健康教育组小儿贫血患病率为16％,末梢血铁元素含量为(7.65 ±0.50) mmol/L,锌元素含量为(71.70 ±11.4)μnol/L,2组小儿贫血患病率差异无统计学意义(P＞0.05),末梢血铁、锌元素含量比较,差异有统计学意义(P＜0.01).普通对照组小儿贫血患病率为28％,末梢血铁元素含量为(7.06±0.65) mmol/L,锌元素含量为(63.02±7.53) μmol/L,健康教育联合辅食营养素补充品添加组和普通对照组小儿比较,贫血患病率差异有统计学意义(P＜0.05);2组小儿末梢血铁、锌元素含量比较,差异有统计学意义(P＜0.01).健康教育组和普通对照组小儿贫血患病率差异无统计学意义(P＞0.05);2组小儿末梢血铁、锌元素含量比较,差异有统计学意义(P＜0.01).结论 健康教育联合添加辅食营养素补充品是预防婴幼儿缺铁性贫血的可靠方法.     

北京地区6~8月龄婴儿缺铁性贫血发病率及危险因素分析

目的 了解北京地区6~8月龄婴儿缺铁性贫血发生率以及危险因素,为下一步制定婴儿贫血干预措施提供数据支撑。方法 研究采用队列研究的方法,分层整群抽取项目社区新生儿进行随访,直至其6~8月龄进行血常规检测为止。数据归纳整理后,运用单因素及Logistic回归探讨缺铁性贫血的危险因素。结果 西城区、海淀区和密云区16家项目社区卫生服务中心共2 243名儿童在6~8月龄时进行血色素测定,缺铁性贫血发病率为19.6%(446/2 243)。Logistic回归显示,父母一方或双方是农业户籍(OR=1.568,95%CI:1.164~2.112),家庭孩子数较多(OR=1.490,95%CI:1.150~1.929),出生时父亲年龄≤25岁(OR=1.660, 95%CI:1.119~2.464),母亲孕前未服用铁剂(OR=1.440,95%CI:1.071~1.936),二级机构出生(OR=1.465,95%CI:1.112~1.931),低出生体重(OR=3.340,95%CI:1.398~7.980),性别为男性(OR=1.285,95%CI:1.025~1.611)以及母乳喂养(OR=2.217,95%CI:1.584~3.102)的6~8月龄婴儿发生缺铁性贫血的风险较高。结论 1)北京地区6~8月龄婴儿缺铁性贫血发生率较高。2)影响婴儿铁水平的因素以及社会经济因素均可导致婴儿缺铁性贫血的发生。     

华泾镇6月龄～2岁婴幼儿缺铁性贫血调查

目的 了解华泾镇6月龄～2岁婴幼儿缺铁性贫血的患病情况，为更好地做好婴幼儿缺铁性贫血的预防和早期矫治工作提供依据。方法 从2005年1月至12月在本中心儿保门诊接受系统管理的3600名6月龄～2岁婴幼儿中，系统抽样360名，采左手无名指末梢血，采用铁氰化法测定。结果 ①6月龄～2岁婴幼儿缺铁性贫血患病率为11．94％；②6～12月龄，〉1且≤1．5岁和≥1．5且〈2岁，3个年龄组婴幼儿的贫血患病率的差异有统计学意义（Х^2=12．98，P〈0．01），以6月龄～1岁组的婴幼儿患病率最高，达20．87%；③添加辅食的时间、乳母的文化程度、常患上呼吸道感染、肺炎或腹泻等疾病均是影响婴幼儿缺铁性贫血患病比例的因素。结论降低婴幼儿缺铁性贫血患病率的有效方法在于儿保医师采取早期有效的健康干预，家长及时、正确、科学地添加辅食的依从性增加。     

6~24月龄婴幼儿不同铁和贫血状况与神经行为发育的关系

目的 探讨6~24月龄婴幼儿不同铁和贫血状况与神经行为发育的关系,为神经行为发育偏移儿童的早期干预提供参考。方法 采用横断面研究的方法,选取2020年1月1日—12月31日在广州市白云区妇幼保健院儿童保健科健康体检、家长自愿参与本研究的322例6~24月龄婴幼儿为研究对象,经知情同意后,采集静脉血进行血常规、血清铁蛋白、C-反应蛋白和α-1-酸性糖蛋白检查以判定婴幼儿铁营养和贫血状况,采用《0~6岁儿童发育行为评估量表》进行神经行为发育评估。结果 本研究中6~24月龄婴幼儿贫血发生率为8.07%,铁缺乏发生率为11.49%。缺铁性贫血与6~24月龄婴幼儿的大运动、精细动作和适应能力发育存在负相关关系(P<0.05),偏回归系数β分别为-6.70(95%CI:-12.84~-0.56)、-6.27(95%CI:-11.87~-0.68)和-6.19(95%CI:-11.91~-0.47);缺铁无贫血与6~24月龄婴幼儿的精细动作和适应能力发育存在负相关关系(P<0.05),偏回归系数β分别为-1.65(95%CI:-3.19~-0.10)和-2.24(95%CI:-3.86~-0.63);非缺铁性贫血与6~24月龄婴幼儿的大运动、精细动作和适应能力发育存在负相关关系(P<0.05),偏回归系数β分别为-1.52(95%CI:-2.92~-0.16)、-1.46(95%CI:-2.70~-0.23)和-1.39(95%CI:-2.68~-0.11)。结论 铁缺乏、贫血均与6~24月龄婴幼儿的神经行为发育水平负相关,可能存在不良影响,需进一步探明其机制。     

合肥市农村地区6个月~7岁儿童贫血及铁缺乏现况调查

目的 了解合肥市农村地区6月~7岁儿童的贫血及铁缺乏情况, 为有效防治婴幼儿贫血及铁缺乏提供科学依据。方法 采取随机抽样的方法抽取2 095名6月~7岁以下儿童进行血红蛋白和铁蛋白测定。结果 研究对象2 095人中, 检出贫血患儿331例, 检出率为15.80%;铁缺乏的有392人, 检出率为18.71%, 贫血患儿中铁缺乏人数为114, 检出率为34.44%;贫血及铁缺乏检出率均随年龄的增加而有所下降, 小年龄组检出率最高。结论 合肥市农村地区贫血及铁缺乏仍有一定程度的发生, 且年龄越小, 贫血及铁缺乏发生率越高, 建议进一步加强营养知识宣教, 指导家长及时添加婴幼儿辅食, 引导家长形成科学合理的喂养知识和喂养行为。     

Impact of a quality improvement program on primary healthcare in Canada: A mixed-method evaluation

PurposeRigorous comprehensive evaluations of primary healthcare (PHC) quality improvement (QI) initiatives are lacking. This article describes the evaluation of the Quality Improvement and Innovation Partnership Learning Collaborative (QIIP-LC), an Ontario-wide PHC QI program targeting type 2 diabetes management, colorectal cancer (CRC) screening, access to care, and team functioning.MethodsThis article highlights the primary outcome results of an external retrospective, multi-measure, mixed-method evaluation of the QIIP-LC, including: (1) matched-control pre-post chart audit of diabetes management (A1c/foot exams) and rate of CRC screening; (2) post-only advanced access survey (third-next available appointment); and (3) post-only semi-structured interviews (team functioning).ResultsChart audit data was collected from 34 consenting physicians per group (of which 88% provided access data). Between-group differences were not statistically significant (A1c [p = 0.10]; foot exams [p = 0.45]; CRC screening [p = 0.77]; advanced access [p = 0.22]). Qualitative interview (n = 42) themes highlighted the success of the program in helping build interdisciplinary team functioning and capacity.ConclusionThe rigorous design and methodology of the QIIP-LC evaluation utilizing a control group is one of the most significant efforts thus far to demonstrate the impact of a QI program in PHC, with improvements over time in both QIIP and control groups offering a likely explanation for the lack of statistically significant primary outcomes. Team functioning was a key success, with team-based chronic care highlighted as pivotal for improved health outcomes. Policy makers should strive to endorse QI programs with proven success through rigorous evaluation to ensure evidence-based healthcare policy and funding.     

Impact evaluation of a Dutch community intervention to improve health-related behaviour in deprived neighbourhoods

This study investigates the impact of a 2-year community intervention on health-related behaviour among adults aged 18-65 years living in deprived neighbourhoods in Eindhoven, The Netherlands. The intervention is evaluated in a community intervention trial with a quasi-experimental design in a longitudinal cohort survey (n=1926 and attrition rate: 31%) using postal questionnaires. In the 2-year implementation phase, more than 40 intervention activities were planned and delivered by intersectoral neighbourhood coalitions. Outcome measures were fruit consumption, vegetable consumption, physical activity, smoking, alcohol consumption and intermediate outcomes of behaviour (i.e. attitudes, self-efficacy, awareness, knowledge and stages of change). The intervention demonstrated no evidence for an impact on vegetable consumption, physical activity, smoking and alcohol consumption and weak evidence for a small impact on (intermediate) outcomes of fruit consumption.     

Universal and targeted policy to achieve health equity: a critical analysis of the example of community water fluoridation cessation in Calgary,Canada in 2011

In May of 2011, a decision was made by city council in Calgary, Canada, to cease community water fluoridation and to re-allocate the annual operating costs to targeted dental programming. The purpose of this study was to critically analyze this decision as an example of a shift from a universal approach (fluoridation) to a targeted approach (dental programming delivered to children in low-income communities). We were especially interested in how the concept of equity played out in the deliberations, and we used Hilary Graham’s three conceptualizations of equity as a framework. We examined publicly available municipal council documents pertaining to this policy decision, with a prominent focus on the 26 January 2011 meeting of the Standing Policy Committee on Utilities and Environment at which Calgarians (citizens and professionals) were invited to speak. We extracted and critiqued statements or exchanges pertaining to equity or related concepts (e.g. poverty). We observed different perspectives on the concept of equity, and the notion of community water fluoridation as equitable. In particular, there was a tendency, expressed strongly by some participants in the debate, to conflate equity and poverty (Graham’s ‘disadvantages’ conceptualization of equity), such that a targeted approach was seen as the only viable way of addressing the dental health needs of children living in poverty. This research is timely considering the apparently increasing frequency of cessation of fluoridation in Canada, the consequent search for alternative approaches to preventive dental health, and the apparently strong appeal of a targeted approach.     

Pattern of milk feeding and family size as risk factors for iron deficiency anemia among poor Egyptian infants 6 to 24 months old

Infants between 6 and 24 months of age are at the highest risk of development of iron deficiency anemia (IDA) in developing countries. Consuming unmodified cow's milk, delayed introduction of solid foods after 6 months, and high birth order could be predictors of the presence of IDA. Three hundred infants between the ages of 6 and 24 months (mean, 13.94 ± 6.17 months) from Ain Shams University Children's Hospital were enrolled in the study. Data collected included demographic information and dietary assessment including the type of milk feeding, introduction of solid foods, and daily iron intake. The infants were examined, and anthropometric measurements were recorded. Anemic infants (hemoglobin level <11 g/dL) were further evaluated by complete blood count, hemoglobin electrophoresis, and iron profile. Anemia was diagnosed among 198 infants (66%), of whom 129 (43%) had IDA. Red cell distribution width at a cutoff value of 15.8% was 86% sensitive and 74% specific in predicting IDA. The main risk factors for IDA included being between 6 and 18 months of age, of the male sex, birth order above the second order, consuming cow's milk, predominant breast-feeding beyond 6 months of age, and low daily iron intake. We conclude that IDA is the most common cause of anemia among Egyptian infants 6 to 24 months old of low socioeconomic standard. Independent clinical predictors were consuming cow's milk during the first 6 months, delayed introduction of solid foods after 6 months, and birth order beyond the second order.     

Human papillomavirus (HPV) vaccine uptake among a community-recruited sample of gay,bisexual, and other men who have sex with men in the three largest cities in Canada from 2017 to 2019

IntroductionIn 2015/2016, Canada’s largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization.MethodsEngage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator.ResultsAcross the three cities, 26–35% and 14–21% of men ≤ 26 years and 7–26% and 2–9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06–4.36; ≥27: PR = 2.73, 95%CI 1.14–6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64–5.05; ≥27: PR = 2.03, 95%CI 1.07–3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance.ConclusionsSixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.