预防与控制梅毒母婴传播项目信息管理系统的设计与效果分析

目的开发适合于深圳市预防与控制梅毒母婴传播项目的信息管理系统,分析系统使用前后信息管理的效果变化。方法以项目标准病历为基础,经专家讨论确定系统的数据集;运用以FLEX开发框架为代表的富客户端技术进行界面的搭建与系统设计。通过比较系统使用前后信息管理效果指标的变化,初步分析系统使用效果。结果建立了预防与控制梅毒母婴传播项目的信息管理系统。通过比较,信息管理系统能有效提高项目信息报告的及时性、准确性及完整性。结论深圳市预防与控制梅毒母婴传播信息系统的开发及应用,规范了项目信息报告、管理与利用,为其他地区建立预防与控制梅毒母婴传播的信息管理系统提供参考。     

Factors associated with lack of prenatal care in a large municipality

OBJECTIVE

To analyze the factors associated with a lack of prenatal care in a large municipality in southern Brazil.

METHODS

In this case-control age-matched study, 716 women were evaluated; of these, 179 did not receive prenatal care and 537 received prenatal care (controls). These women were identified using the Sistema Nacional de Informação sobre Nascidos Vivos (Live Birth Information System) of Pelotas, RS, Southern Brazil, between 2009 and 2010. Multivariate analysis was performed using conditional logistic regression to estimate the odds ratios (OR).

RESULTS

In the final model, the variables associated with a lack of prenatal care were the level of education, particularly when it was lesser than four years [OR 4.46; 95% confidence interval (CI) 1.92;10.36], being single (OR 3.61; 95%CI 1.85;7.04), and multiparity (OR 2.89; 95%CI 1.72;4.85). The prevalence of a lack of prenatal care among administrative regions varied between 0.7% and 3.9%.

CONCLUSIONS

The risk factors identified must be considered when planning actions for the inclusion of women in prenatal care by both the central management and healthcare teams. These indicated the municipal areas with greater deficits in prenatal care. The reorganization of the actions to identify women with risk factors in the community can be considered to be a starting point of this process. In addition, the integration of the activities of local programs that target the mother and child is essential to constantly identify pregnant women without prenatal care.     

Experience of taking care of children exposed to HIV: a trajectory of expectations

OBJECTIVE:

to learn about the experience of caregivers/mothers providing care to infants exposed to HIV through vertical transmission.

METHODS:

this qualitative study used Symbolic Interactionism as the theoretical framework. A total of 39 caregivers of children exposed to HIV in follow-up at a specialized service were interviewed. Data were analyzed through inductive content analysis.

RESULTS:

four categories were identified that report on the lonely experience of handling the child''s antiretroviral therapy, mainly due to a lack of information or incomplete information; being attentive to required care, such as the use of prophylaxis for pneumonia, vaccines, and other practices restricted to the mother-child interaction; the desire to omit the HIV out of fear of prejudice and fear of the disease, considering future prospects.

CONCLUSION:

the HIV and the threat this infection may affect the child cause apprehension and feelings such as fear, guilt and anxiety in the caregivers. Healthcare workers need to work together with mothers so they are able to cope with demands and distress. Only then will the treatment to avoid vertical transmission be efficient and will mother and child be supported during the process, despite apprehension with the outcome.     

浙江省有HIV传播风险的HIV感染者梅毒感染情况及影响因素

目的 了解浙江省有HIV传播风险的HIV感染者梅毒感染情况及相关因素。方法 资料来源于中国疾病预防控制信息系统截至2018年12月31日浙江省现存活、HIV确证时间>1年、未接受抗病毒治疗或HIV病毒载量≥50拷贝数/ml、年龄≥15岁的HIV感染者,收集其人口学特征、性行为特征、抗病毒治疗和梅毒血清学检测结果等信息,采用logistic回归模型分析梅毒感染及影响因素。采用SPSS 19.0软件进行统计学分析。结果 浙江省HIV感染者中,2 275例有HIV传播风险,75.5%（1 717/2 275）进行了梅毒血清学检测,梅毒感染率为8.7%（150/1 717）。在梅毒感染的HIV感染者中,未接受抗病毒治疗占11.3%（17/150）,病毒载量为50~999拷贝数/ml占38.7%（58/150）和≥1 000拷贝数/ml占50.0%（75/150）。多因素分析结果显示,男性（aOR=2.04,95%CI：1.06~3.96）、同性性传播（aOR=1.53,95%CI：1.04~2.27）、HIV确证前性病史（aOR=1.98,95%CI：1.35~2.92）和病毒载量≥1 000拷贝数/ml（aOR=1.90,95%CI：1.09~3.30）为梅毒感染危险因素,已婚（aOR=0.47,95%CI：0.29~0.76）是梅毒感染的保护因素。结论 浙江省有HIV传播风险的HIV感染者的梅毒感染率较高,亟须开展HIV感染者分类管理和针对性强化干预,探索开展多病共防共治,加强HIV感染者梅毒筛查和治疗,降低HIV和梅毒传播风险。     

Socioeconomic inequalities in the access to and quality of health care services

OBJECTIVE

To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status.

METHODS

This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days) for assistance, and waiting time (in hours) in lines. We used Poisson regression for the crude and adjusted analyses.

RESULTS

The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status.

CONCLUSIONS

Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.     

Healthcare-associated infections: challenges to public health in Brazil

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.     

边远山区妇女孕早期艾滋病、梅毒、乙型肝炎检测影响因素病例对照研究

目的:了解边远山区妇女孕早期艾滋病、梅毒、乙型肝炎检测的现况,探讨检测的影响因素.方法:采用成组病例对照的研究方法,以云南省艾滋病高发地区4个边缘乡为研究地点,问卷调查怀孕32周～产后6月的妇女孕早期艾滋病、梅毒、乙型肝炎检测情况及相关因素.结果:共调查孕早期未接受艾滋病、梅毒、乙型肝炎检测的妇女83例,孕早期接受艾滋病、梅毒、乙型肝炎检测的妇女83例,42.0％的孕产妇未接受检测的原因是不知道有艾滋病、梅毒、乙型肝炎检测.病例组孕产妇艾滋病、梅毒、乙型肝炎相关知识知晓率分别为55.8％、38.6％和44.1％;对照组孕产妇艾滋病、梅毒、乙型肝炎相关知识知晓率分别为67.6％、73.3％和55.3％.无住院分娩经历、缺乏孕期动员检测、不知道艾滋病性传播途径、不知道梅毒的危害、艾森克人格问卷N量表分高是未接受检测的危险因素.结论:孕期保健与动员检测难以有效结合,缺乏艾滋病、梅毒、乙型肝炎的相关知识限制了边远山区妇女孕早期对其检测的开展,神经质人格特质也影响孕产妇接受检测.     

Antenatal Care Services and Incidence of Low Birth Weight: A Comparison of Demographic and Health Surveys in 4 ASEAN Countries

Objectives:This study aimed to assess the effect of complete coverage and content of available antenatal care (ANC) on the incidence of low birth weight (LBW) in 4 countries belonging to the Association of Southeast Asian Nations (ASEAN).Methods:Measures of complete coverage and content of ANC services included the frequency of ANC visits and the seven service components (blood pressure measurement, iron supplementation, tetanus toxoid immunization, explanations of pregnancy complications, urine sample test, blood sample test, and weight measurement). The complete coverage and content of ANC services were assessed as high if more than 4 ANC visits and all seven components were delivered. Multivariable logistic regression with complex survey designs was conducted using Demographic Health Survey data from the 4 ASEAN countries in question from 2014 to 2017.Results:The proportion of LBW infants was higher in the Philippines (13.8%) than in Indonesia (6.7%), Cambodia (6.7%), or Myanmar (7.5%). Poor ANC services were associated with a 1.30 times higher incidence of LBW than a high level of complete coverage and content of ANC services (adjusted odds ratio [aOR], 1.30; 95% confidence interval [CI], 1.11 to 1.52). In addition, the risk of LBW was higher in the Philippines than in other countries (aOR, 2.25; 95% CI, 2.01 to 2.51) after adjusting for mothers’ demographic/socioeconomic factors, health behaviors, and other factors.Conclusions:In sum, complete coverage and content of ANC services were significantly associated with the incidence of LBW in Indonesia, Cambodia, and Myanmar. The Philippines did not show statistically significant results for this relationship, but had a higher risk of LBW with poor ANC.     

Complaints and complications in pregnancy: a study of ethnic Norwegian and ethnic Pakistani women in Oslo

Objectives. To describe the pattern of complaints and complications in pregnancy among ethnic Norwegian and ethnic Pakistani women in Oslo in order to modify antenatal care services. Design. A cross-sectional study of hospital patients conducted in community hospitals in Oslo, Norway. A total of 137 obstetrical patients, 66 ethnic Pakistani and 71 ethnic Norwegian women were included in the study. Medical complications and subjective reported physical complaints during pregnancy were the main outcome measures. Results. Among the ethnic Pakistani women complications were more common and the risks were higher for gestational diabetes (crude odds ratio (OR) = 5.6, 95% confidence interval (CI) = 1.5-20.5), intrauterine growth retardation (crude OR = 5.0, 95% CI = 1.4-18.8), hyperemesis gravidarum (crude OR = 3.7, 95% CI = 1.1-12.2) and anaemia (crude OR = 10.2, 95% CI = 3.3-31.4). The frequency of congenital malformations (p = 0.048, OR not calculated) were also higher. Among the ethnic Norwegian women the frequency of subjective reported physical complaints were more common and the risks were higher for pelvic girdle pain (crude OR = 0.4, 95% CI = 0.2-0.8) and exhaustion (crude OR = 0.2, 95% CI = 0.04-0.1). Infections such as hepatitis and tuberculosis only occurred in the Pakistani study group. Conclusion. This study indicates that health personnel delivering antenatal care to women of Pakistani origin need to be watchful for the following conditions: gestational diabetes, hyperemesis gravidarum, early diagnosis of the type of anaemia, fetal malformations and infections like hepatitis and tuberculosis. In addition, a correct diagnosis of intrauterine growth retardation is important. Among ethnic Norwegian women pelvic girdle pain and exhaustion were common complaints .     

Social and ethnic inequalities in the offer and uptake of prenatal screening and diagnosis in the UK: a systematic review

OBJECTIVE: To review studies addressing the question of whether there are social inequalities in either the offer or the uptake of prenatal testing in the UK. METHOD: Systematic review of studies assessing the offer or uptake of prenatal screening or diagnosis according to social class or ethnic origin. Electronic databases were searched using a strategy developed for a review of inequalities in access to maternity care supplemented with terms specific to prenatal testing. Further papers were identified from reference lists, citation searches and key organizations. RESULTS: From over 600 identified papers, 41 were potentially relevant. Twenty met the inclusion criteria. The studies included covered screening and/or diagnosis for Down's syndrome, neural tube defects, haemoglobin disorders and HIV. Many studies were limited by small numbers or poor reporting of data and analysis. Six studies reported data on prenatal testing according to women's social class or educational level. None found any significant social inequalities in testing. Some studies suggested that women of South Asian origin might be up to 70% less likely to receive prenatal testing for haemoglobin disorders and Down's syndrome than White women. A small number of studies suggested that South Asian women might be less likely to be offered testing. CONCLUSIONS: This review provides some evidence of ethnic inequalities in access to prenatal testing. Further research is required to improve our understanding of why testing may not be offered, the reasons for failure to take up testing when offered, and to identify whether there are other social inequalities in access to prenatal testing.     

Inpatient care of the elderly in Brazil and India: Assessing social inequalities

The rapidly growing older adult populations in Brazil and India present major challenges for health systems in these countries, especially with regard to the equitable provision of inpatient care. The objective of this study was to contrast inequalities in both the receipt of inpatient care and the length of time that care was received among adults aged over 60 in two large countries with different modes of health service delivery. Using the Brazilian National Household Survey from 2003 and the Indian National Sample Survey Organisation survey from 2004 inequalities by wealth (measured by income in Brazil and consumption in India) were assessed using concentration curves and indices. Inequalities were also examined through the use of zero-truncated negative binomial models, studying differences in receipt of care and length of stay by region, health insurance, education and reported health status. Results indicated that there was no evidence of inequality in Brazil for both receipt and length of stay by income per capita. However, in India there was a pro-rich bias in the receipt of care, although once care was received there was no difference by consumption per capita for the length of stay. In both countries the higher educated and those with health insurance were more likely to receive care, while the higher educated had longer stays in hospital in Brazil. The health system reforms that have been undertaken in Brazil could be credited as a driver for reducing healthcare inequalities amongst the elderly, while the significant differences by wealth in India shows that reform is still needed to ensure the poor have access to inpatient care. Health reforms that move towards a more public funding model of service delivery in India may reduce inequality in elderly inpatient care in the country.     

农村地区重度子痫前期/子痫病例产前检查服务质量现状分析

目的:探讨农村地区重度子痫前期/子痫产前检查服务质量,针对存在的问题提出改进措施。方法:收集孕产妇死亡率较高的河南省某县2005年7月～2007年8月所有开展助产技术服务的医疗保健机构中重度子痫前期/子痫住院病例,对其病历资料进行调查研究,评价其产前检查服务质量,分析产前检查与妊娠结局及并发症的关系。结果:257例研究对象中,有168例(65.37%)做过产前检查。记录产前检查次数的69例中,最少的1次,最多的6次,≥5次的只有8例(11.59%)。做过产前检查的患者其并发症的发生率(12.50%)要低于未做产前检查的患者(27.27%),差异有统计学意义(P<0.05)。结论:该地区产前检查服务质量有待进一步提高,以促进母婴健康。     

The contribution of material,psychosocial, and behavioral factors in explaining educational and occupational mortality inequalities in a nationally representative sample of South Koreans: Relative and absolute perspectives

The contributions of material, psychosocial, and behavioral factors in explaining socioeconomic inequalities in health have been explored in many Western studies. Most prior investigations have looked at relative abilities to explain such inequalities. In addition, little research focuses on Asian countries, despite the fact that the prevalence and socioeconomic distribution of risk factors for mortality are different there. This study examined relative and absolute abilities of material, psychosocial, and behavioral pathways to explain educational and occupational inequalities in mortality in a nationally representative sample from South Korea. The 1998 and 2001 National Health and Nutrition Examination Survey data were pooled and linked to national mortality data. Of 8366 men and women over 30 years of age, 310 died between 1999 and 2005. Nine pathway variables were examined: three material factors (income, health insurance, and car ownership status), three psychosocial factors (depression, stress, and marital status), and three behavioral factors (smoking, alcohol consumption, and physical exercise). The relative risk and relative index of inequality were used as measures of relative inequality, and risk differences and the slope index of inequality were used as measures of absolute inequality. Material factors explained a total of 29.0% of the excess in relative risk for education and 50.0% of the excess in relative risk for occupational class. Material factors explained 78.6% of the excess in absolute mortality difference for education and 41.1% for occupational class. Psychosocial factors for both education and occupational class had a relative and absolute explanatory power of less than 15%. Behavioral factors showed a relative explanatory power of about 15%, but absolute explanatory power reached 84.0% for education and 105.4% for occupational class. However, the number of deaths used to calculate the absolute explanatory power was small. Results of this study suggest that absolute socioeconomic mortality inequalities could be substantially reduced if behavioral risk factors were reduced in the whole population.     

Conjugal violence in the perspective of "Family Health Strategy" professionals: a public health problem and the need to provide care for the women

Objective

to construct a theoretical matrix based on the meanings of the interactions and actions experienced by the professionals regarding the nursing care practices and the health of women in situations of conjugal violence in the ambit of the Family Health Strategy.

Methods

research based in Grounded Theory. Following approval by the Research Ethics Committee, 52 professionals were interviewed in Santa Catarina, Brazil. The analysis was based on open, axial and selective codifications.

Results

the theoretical model was delimited based on the phenomenon "Recognizing conjugal violence as a public health problem, and the need for management of the care for the woman", which reflects the experience of the professionals in relation to care for the woman, as well as the meanings attributed to this care.

Conclusions

the phenomenon allows one to understand the movement of action and interaction regarding the care for the woman in a situation of conjugal violence.     

Racial and ethnic differences in general health status and limiting health conditions among American children: parental reports in the 1999 national survey of America's families

Objectives . This research investigates the association between race/ethnicity and child health, and examines the role of family structure, family socioeconomic status (SES), and healthcare factors in this association. Five major racial/ethnic groups in the US are studied. Two child health outcomes, including parent-rated health and limiting health condition, are examined. The analysis is stratified into three age groups: age 0–5, age 6–11, and age 12–17.

Design . Cross-sectional study using data from a large, nationally representative sample collected in 1999 in the US.

Results . Older age groups tend to exhibit larger racial/ethnic disparities in child health. Except for some age groups of Asian youths, minority children and adolescents generally show higher risks of fair or poor parent-rated health and limiting health condition relative to Whites. Family SES partly explains the effects of Black, Hispanic, and Native American groups, but significant amount of residual effects remain. Family structure explains some Black effects, but not for other minority groups. Healthcare factors do not contribute much to the racial/ethnic differences. Both family structure and healthcare factors are important factors of child health in their own right. None of the social factors examined can explain the effects of the Asian group. Data also show that economic resources play a more salient role in child health than parental education, especially in young children. In addition, healthcare factors, to some extent, can explain why children from higher SES families fare better in health.

Conclusion . Racial/ethnic disparities in health start early in life. Except for Asians, class explains a substantial amount, but not all, of these disparities. Healthcare factors play some role in explaining health disparities by class. Structural solution seems to be needed to reduce disparities by race/ethnicity among youths.     

Cooccurrence of lifestyle risk factors and the explanation of education inequalities in mortality: results from the GLOBE study

BACKGROUND: To investigate whether the cooccurrence of two lifestyle risk factors (smoking, excessive alcohol consumption, physical inactivity in leisure time) has an additional contribution to the explanation of education inequalities in mortality, over and above the contribution of single risk factors. METHODS: Prospective cohort study, 1991-1998, in the South East of the Netherlands. Participants were 16,980 men and women aged 15-74 years at baseline. RESULTS: Education differences in the cooccurrence of risk factors were of a similar magnitude as education inequalities seen for single risk factors. A significant (P = 0.04) interaction effect on mortality was found between smoking and physical inactivity. Adjustment for both smoking and inactivity reduced the mortality hazard ratio of the lowest level of education by 30% (from 1.66 to 1.46). Further adjustment for the interaction between the two risk factors did not change the hazard ratio significantly. CONCLUSION: The cooccurrence of lifestyle risk factors did not provide any additional contribution to the explanation of education inequalities in mortality, over and above that of single risk factors. However, because risk factors tend to cooccur and have a higher prevalence among lower-educated people, it is still useful to focus interventions on more than one risk factor.     

孕妇母婴健康素养与产前抑郁的关系:家庭功能的中介作用

目的 探讨孕妇母婴健康素养与产前抑郁的关系及家庭功能在母婴健康素养水平与产前抑郁间的中介作用。方法 采用单纯随机抽样的方法抽取贵阳市妇幼保健院孕产保健科产检的1 493名孕妇作为研究对象;采用一般情况调查问卷、患者健康问卷抑郁量表、家庭关怀度指数问卷和母婴健康素养测评问卷进行问卷调查;利用Bootstrap中介效应检验法检验各变量间的效应关系,运用AMOS建立结构方程模型。 结果 本研究孕妇产前抑郁情绪检出率为46.1%,孕妇产前抑郁评分为(5±4.55)分,家庭功能评分为(6.85±2.84)分,母婴健康素养评分为(40.97±15.70)分;产前抑郁与母婴健康素养(r=-0.147)、家庭功能(r=-0.251)呈负相关,母婴健康素养与家庭功能(r=0.222)呈正相关(均P<0.05);孕妇母婴健康素养对产前抑郁的直接效应为-0.084,占总效应的71.19%,家庭功能在母婴健康素养与产前抑郁间起部分中介作用,中介效应值为-0.034,占总效应的28.81%。 结论 孕妇的母婴健康素养可反向预测产前抑郁,家庭功能在母婴健康素养与产前抑郁间起部分中介作用。母婴保健人员可通过提高孕妇的母婴健康素养水平,增强孕妇的家庭功能,降低产前抑郁情绪的发生。     

急危重症孕产妇转诊体系建设:以陕西省某医院为例

转诊过程的高效管理和运行是急危重症孕产妇成功救治的关键。在梳理急危重症孕产妇转诊现状基础上,通过明确急危重症孕产妇转诊指征、规范急危重症孕产妇转诊救治流程、设计急危重症孕产妇转诊系统架构及功能等,构建了以某院为中心的急危重症孕产妇转诊体系,实现了急危重症孕产妇转诊指征识别、会诊、转诊救治等一体化管理,提高了急危重症孕产妇转诊率,改善了转诊急危重症孕产妇救治效果和基层医院转诊满意度。