四川省流动孕产妇接受孕产期保健服务情况及其影响因素分析

目的 了解四川省流动孕产妇接受孕产期保健服务情况及其影响因素,为将来孕产期保健服务项目的实施提供科学依据。 方法 采用多阶段随机抽样,抽取四川省流动孕产妇进行问卷调查,对孕产期保健知识知晓情况、保健服务利用情况进行描述,并采用非条件logistic回归分析流动孕产妇接受孕产期保健服务情况的影响因素。结果 共纳入研究对象620人,年龄范围为18～42岁;孕产期保健知识知晓率为96.6%;孕早期建卡率为92.6%,孕早期产检率为93.9%,产检次数≥5次者占95.2%,在产后3～7 d进行产后访视者占95.6%,产后访视总次数≥3次者占77.3%。多因素分析结果显示在孕早期进行首次产检的影响因素包括年龄（OR = 0.680, 95%CI: 0.471～0.981）、流入地居住时间（OR = 2.470, 95%CI: 1.200～5.086）、民族（OR = 19.495, 95%CI: 5.250～72.396）、文化程度（OR = 2.300, 95%CI: 1.414～3.742）、孕产期保健知识知晓情况（OR = 3.471, 95%CI: 1.086～11.089）;配偶文化程度（OR = 2.288, 95%CI: 1.410～3.713）和民族（OR = 13.302, 95%CI: 3.785～46.752）是产检次数≥5次的影响因素;生育保险（OR = 1.856, 95%CI: 1.174～2.934）是产后访视次数≥3次的影响因素。结论 四川省流动孕产妇接受孕产期保健服务情况较好;但针对流动孕产妇,还应提倡有计划的怀孕,并加强孕产妇相关医学常识的健康教育以及免费发放叶酸的宣传;此外,应重点关注少数民族、且本人或配偶文化程度较低的大龄流动孕产妇。     

上海市0～6月龄婴儿母乳喂养现状及影响因素分析

目的了解上海市0～6月龄婴儿母乳喂养现状及影响因素,为制定提高母乳喂养率干预措施提供依据。方法采用横断面研究的方法,利用产后访视、儿保门诊的时机对0～6月龄婴儿的母亲进行面对面问卷调研,包括母亲的社会经济学因素、生育因素、母乳喂养情况调查、母乳喂养的障碍等进行问卷调查。对收集的问卷进行数据录入和统计学分析。结果共获得有效问卷5 668份。上海市全人口的纯母乳喂养率0月龄为60.4%,1月龄为56.8%,2～4月龄都在60%左右,5～6月龄的婴儿母乳喂养率下降到29.0%和30.3%。外地户籍者的纯母乳喂养率高于本地户籍者。母乳喂养的障碍中,上班和外出是主要原因。影响纯母乳喂养的多因素结果:户籍[外地户籍OR=1.15(95%CI:1.01～1.31)]、母亲年龄[年龄20岁～:OR=2.25(95%CI:1.33～3.81);年龄30岁～:OR=2.08(95%CI:1.22～3.54)]、早吸吮[产后30 min～:OR=0.80(95%CI:0.67～0.96);产后60 min～:OR=0.84(95%CI:0.73～0.96)]、第一口摄入[配方奶OR=0.60(95%CI:0.53～0.69);糖水/白开水OR=0.62(95%CI:0.49～0.79)]差异有统计学意义(均P0.05)。结论上海市0～6岁纯母乳喂养率较低,主要影响因素有户籍、年龄、早吸吮和第一口摄入,建议加强母乳喂养制度保障、相关健康教育和医务人员培训。     

婴儿神经心理发育的影响因素分析

目的探讨婴儿神经心理发育的影响因素,为临床提供参考依据。方法选取2015年3月-2017年3月在珠海市第二人民医院健康中心进行体检的528例婴儿作为研究对象,通过比较婴儿的一般人口学因素(性别、月龄、是否首胎)、孕母的一般人口学资料(年龄、性格、文化程度、月收入)、孕期情况(父母吸烟情况、孕母饮酒情况、饮食规律、情绪状况、保胎情况、接触电脑手机时间)以及抚养情况(喂养方式、有无基本功能锻炼、亲子触摸、户外活动)对婴儿DQ评分的影响,来通过采用多因素的Logistic回归分析影响婴儿心理发育的主要因素。结果性别、婴儿月龄、是否首胎对婴儿DQ评分的影响显著(P0.05);月收入水平、母亲年龄、母亲文化程度、母亲性格对婴儿DQ评分影响显著(P0.05);父母吸烟、孕母饮酒、孕母情绪、孕期保胎、日常接触电脑手机时间对婴儿DQ评分影响显著(P0.05);喂养方式、基本功能锻炼、亲子触摸对婴儿DQ评分影响显著(P0.05);各因素对DQ评分影响拟合的多因素回归方程有统计学意义,各因素影响能力大小依次为:基本功能锻炼(OR=3.78)、喂养方式(OR=3.49)、父母吸烟情况(OR=3.32)、是否首胎(OR=3.06)、母亲文化程度(OR=2.59)、孕母情绪状况(OR=2.51)、性别(OR=2.32)。结论婴儿基本情况、孕母情况和培养方式对婴儿神经心理发育均有一定程度的影响,其中婴儿功能锻炼、喂养方式、父母吸烟情况、是否首胎、母亲文化程度、孕母情绪状况、婴儿性别对神经心理发育结果的影响较为明显。     

天津市6～8月龄婴儿缺铁性贫血的影响因素分析

目的了解天津市6～8月龄婴儿缺铁性贫血发生情况并分析其影响因素,为预防婴儿贫血的发生提供参考依据。方法选取2016年1—6月天津市16个行政辖区到社区卫生服务中心进行健康检查的6～8月龄婴儿作为调查对象,分析婴儿缺铁性贫血的影响因素。结果共调查婴儿22 659例,缺铁性贫血发病率为6.69%。低出生体重儿(OR=2.34,95%CI:1.74～3.15,P 0.01)、分娩前贫血(OR=1.20,95%CI:1.02～1.41,P0.05)、分娩孕周37周(OR=1.69,95%CI:1.29～2.21,P0.01)、剖宫产或阴道手术产(OR=1.32,95%CI:1.16～1.51,P0.01)及分娩产次≥3次(OR=1.24,95%CI:1.06～1.46,P0.01)是婴儿缺铁性贫血的危险因素;女婴(OR=0.72,95%CI:0.63～0.82,P 0.01)、非纯母乳喂养(混合喂养OR=0.58,95%CI:0.49～0.67,P0.01;人工喂养OR=0.39,95%CI:0.28～0.54,P0.01)、孕早期血红蛋白(Hb)高(OR=0.99,95%CI:0.98～0.99,P0.01)是婴儿缺铁性贫血的保护性因素。结论天津市6～8月龄婴儿缺铁性贫血为多种影响因素联合作用所致,应加强对孕妇的健康教育及孕期保健管理,提倡母乳喂养的同时添加适量辅食,以有效降低婴儿缺铁性贫血的发生。     

乙肝病毒携带母亲喂养方式对阻断免疫后婴儿母婴传播影响Meta分析

目的探讨对婴儿采取免疫措施后,乙肝病毒(HBV)携带母亲采用不同的喂养方式对母婴HBV传播的影响。方法检索PubMed、Medline、Embase、Cochrane图书馆、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库等,对免疫干预后比较母乳喂养和人工喂养婴儿HBV感染率的前瞻性研究进行Meta分析。结果 10篇随机对照试验满足纳入条件进入Meta分析,其中母乳喂养组婴儿873例,人工喂养组751例。在对婴儿进行免疫干预后,母乳喂养组与人工喂养组的6～12月龄婴儿乙肝表面抗原或HBV DNA阳性率差异无统计学意义(7个研究:OR=0.86,95%CI=0.51～1.45,P=0.56;I2=0,P=0.99);母乳喂养组与人工喂养组6～12月龄婴儿的乙肝表面抗体阳性率差异无统计学意义(8个研究:OR=0.98,95%CI=0.69～1.40,P=0.93;I2=0,P=0.99)。结论 HBV携带者母亲采用不同的喂养方式对免疫干预措施阻断母婴HBV传播没有影响,HBV携带产妇母乳喂养并不增加HBV母婴传播的风险。     

孕晚期抑郁与婴儿气质发育关联的随访研究

目的探讨孕32～36周高水平抑郁情绪对婴儿气质发育的影响。方法以741名孕32～36周进行产前检查的孕妇为研究对象,采用自制问卷获得人口统计学信息,并使用流调中心用抑郁自评量表(CES-D)进行抑郁情绪筛查。产妇分娩后收集分娩结局资料。在产后6个月时进行家庭访视,应用婴儿气质量表评估婴儿气质发育。结果抑郁组母亲中,低年龄、低教育水平、分娩女婴和产后人工喂养比例均高于无抑郁组。控制潜在混杂因素后,抑郁组婴儿6月龄时,适应性(差值=0.33, 95%CI:0.16～0.51, P=0.001)、情绪(差值=0.31, 95%CI:0.006～0.614, P=0.047)、注意分散(差值=0.29, 95%CI:0.13～0.45, P=0.002)和反应阈(差值=0.28, 95%CI:0.02～0.54, P=0.028)4个维度的得分均高于无抑郁组母亲的婴儿。结论孕晚期抑郁情绪可能与婴儿气质发育间存在独立关联。     

婴儿早期喂养行为及与生长发育的关系研究

目的了解3月龄内婴儿喂养行为,分析其与婴儿生长发育的关系。方法采用方便抽样的方法,在北京等7地依托当地妇幼保健院抽取3月龄内的婴儿及其母亲各500例进行调查,自拟调查问卷获得调查对象人口学特征及婴儿喂养行为,当地儿保医生测量获得婴儿体格发育资料。结果婴儿早期喂养行为评分中位数为5分,低得分组占25.4%,中得分组占35.0%,高得分组占39.6%。婴儿出生1 h内早吸吮率为53.4%,哺喂初乳率为95.7%,奶瓶喂养率为57.5%。母亲文化程度高、非早产、自然分娩的婴儿喂养行为得分较高(P0.05)。分析发现喂非母乳奶的婴儿发生体重不足的风险更高(OR=2.733,95%CI:1.346~5.551),采用奶瓶喂养的婴儿超重肥胖的可能性更低(OR=0.331,95%CI:0.143~0.768),有除母乳外的其他液体食物喂养(OR=0.538,95%CI:0.302~0.959)、奶瓶喂养(OR=0.492,95%CI:0.275~0.882)的婴儿发生超重的可能性更低。结论婴儿早期喂养行为得分较低者较多,母亲文化程度低、剖宫产、早产可能是婴儿喂养行为的危险因素,喂养非母乳奶更易发生体重不足,而采用奶瓶喂养及有除母乳外其他液体摄入的婴儿更不易发生超重肥胖。     

不良妊娠结局的影响因素分析

目的分析不良妊娠结局的影响因素,为改善妊娠结局和提高母婴健康水平提供依据。方法选取2017年1月—2018年11月在杭州市妇产科医院产检并成功分娩的初产妇为研究对象,收集产妇的年龄、文化程度、身高、孕前体重、分娩前体重、分娩方式、妊娠合并症和新生儿体重等资料,采用多因素Logistic回归模型分析早产和分娩方式的影响因素。结果纳入3 559名产妇,年龄中位数为28岁。多因素Logistic回归分析结果显示,妊娠糖尿病(OR=2.211,95%CI:1.283～3.824)和低体重新生儿(OR=74.612,95%CI:47.581～116.986)是早产的危险因素;孕前超重(OR=1.552, 95%CI:1.228～1.965)或肥胖(OR=3.273, 95%CI:1.715～6.247)、妊娠糖尿病(OR=1.528,95%CI:1.159～2.015)、子痫前期(OR=77.225,95%CI:18.651～319.759)和早产(OR=1.890,95%CI:1.318～2.712)是剖宫产的危险因素,孕前偏瘦(OR=0.732,95%CI:0.608～0.814)是剖宫产的保护因素;孕前超重(OR=2.236,95%CI:1.224～4.083)是产钳助产的危险因素。结论孕前体质指数和妊娠糖尿病可增加早产和剖宫产等不良妊娠结局发生的风险,应加强孕前体重管理和预防妊娠期代谢性疾病。     

转乳期早产儿喂养困难现状及其影响因素

目的 了解转乳期早产儿喂养困难发生现状及其影响因素，为早产儿喂养管理提供科学依据。方法 运用《中文版婴幼儿喂养困难评分量表》(MCH-FS)及自行设计《早产儿喂养困难影响因素调查表》调查2021年4—5月成都市5所妇幼保健机构儿童保健门诊的矫正6～24月龄早产儿喂养现状及影响因素。结果 231例早产儿中喂养困难发生率32%,其中轻、中、重度喂养困难发生率分别为15.2%、7.8%、9.1%;二元Logistic逐步回归分析结果显示食物过敏(OR=4.253,95%CI:1.430～12.649)、带养人焦虑情绪(OR=6.064,95%CI:2.998～12.268)、进食时逗引或追喂(OR=2.873,95%CI:1.382～5.970)、进食时伴有娱乐活动(OR=2.328,95%CI:1.115～4.860)、强迫喂食(OR=2.772,95%CI:1.239～6.198)是转乳期早产儿发生喂养困难的主要危险因素(P<0.05)。结论 转乳期早产儿喂养困难发生率较高，喂养指导应重点关注食物过敏、家长焦虑情绪、不当喂养行为的早产儿，采取恰当干预措施促进科学喂养。     

北京市学龄前儿童单纯性肥胖影响因素研究

目的分析影响学龄前儿童肥胖的主要因素,为采取干预措施提供理论依据。方法采用方便样本整群抽样方法,对北京市五所幼儿园中2~7岁儿童的家长共计400名进行问卷调查和访谈。定性访谈结果采用关键词提取,进行归纳分析。根据中国学龄前儿童生长发育标准[体质指数(body mass index,BMI)≥85%为超重或肥胖]判断是否超重或肥胖;将人口学特征,家庭因素及饮食和运动行为作为自变量进行多因素Logistic回归分析。结果儿童超重或肥胖的独立危险因素包括:儿童高出生体重(≥4 000g)(OR=31.55;95%CI:1.78~4.17,P0.001);母亲选择剖宫产(OR=4.89;95%CI:1.42~16.89,P=0.01);混合喂养(OR=25.90;95%CI:3.07~218.39,P0.001),人工喂养(OR=11.15;95%CI:1.686~73.7121,P=0.01)。保护因素包括:父亲的受教育程度高(OR=0.32;95%CI:0.12~0.89,P=0.03)、每天吃粗粮的次数多(OR=0.43;95%CI:0.21~0,87,P=0.02)、家人一起吃饭的次数多(OR=0.86;95%CI:0.75~0.98,P=0.02)。结论学龄前儿童肥胖的危险因素与父母受教育程度、对肥胖的认知及儿童的饮食运动行为有关。     

Maternal symptoms of stress, depression, and anxiety are related to nonresponsive feeding styles in a statewide sample of WIC participants

Parenting, including nonresponsive feeding styles, has been related to under- or overweight among young children. The relationship between maternal mental health and feeding styles has not been examined. We hypothesized that mothers who report more symptoms of stress, depression, or anxiety report less responsive (e.g. more controlling, indulgent, and uninvolved) feeding styles than mothers who report fewer symptoms of stress, depression, or anxiety. Our analyses included 702 mother-infant pairs from a statewide sample of Special Supplemental Nutrition Program for Women, Infants, and Children mothers. We assessed maternal mental health and feeding styles by a telephone survey. After adjusting for potential confounding variables, maternal stress symptomatology was significantly associated with forceful (beta = 0.03; 95% CI = 0.02, 0.05) and uninvolved (OR = 1.4; 95% CI = 1.1, 1.7) feeding style scores, maternal depression symptomatology was significantly associated with forceful (beta = 0.03; 95% CI = 0.004, 0.05), indulgent (beta = 0.03; 95% CI = 0.004, 0.06), and uninvolved (OR = 1.5; 95% CI = 1.001, 2.2) feeding styles scores, and maternal anxiety symptomatology was significantly related to restrictive (beta = 0.11; 95% CI = 0.01, 0.21), forceful (beta = 0.04; 95% CI = 0.02, 0.06), and uninvolved (OR = 1.4; 95% CI = 1.01, 1.9) feeding style scores. Among mothers who perceived their infant as temperamentally fussy, there was a significant positive relationship between restrictive feeding styles scores and 3 indices of maternal mental health (stress, beta = 0.18; 95% CI = 0.07, 0.28; depression, beta = 0.21; 95% CI = 0.04, 0.38; and cumulative mental health symptomatology, beta = 0.29; 95% CI = 0.10, 0.48). Mothers who report stress, depression, or anxiety symptoms are at risk for nonresponsive feeding styles. These findings provide support for broadening the focus of existing child nutrition programs to include strategies that recognize how issues of maternal mental health can affect feeding styles.     

婴幼儿湿疹影响因素分析:一项五省市的前瞻性队列研究

  目的  了解婴幼儿湿疹的发病现状,从多角度探索其发病因素。  方法  以中国孕产妇队列研究-子代项目中的681名婴幼儿为研究对象,在孕期收集父母亲的一般人口学信息、孕期膳食摄入及婴幼儿出生信息,随访调查其家居环境和婴幼儿湿疹状况,应用多因素非条件logistic回归分析模型分析婴幼儿湿疹发病的影响因素。  结果  研究对象婴幼儿湿疹的发生率为23.79%。logistic回归分析模型分析结果显示,相比初产妇,经产妇(OR=0.601, 95% CI:0.398~0.908)所分娩的孩子患湿疹风险会降低47.6%。母亲有过敏史(OR=2.191, 95% CI:1.393~3.447)和父亲有过敏史(OR=2.008, 95% CI:1.244~3.239)的孩子更容易患湿疹。相比于母乳喂养,人工喂养(OR=4.165, 95% CI:1.450~11.963)和混合喂养(OR=8.151, 95% CI:5.165~12.866)增加婴幼儿患湿疹的风险。孕期禽肉摄入频率越高的孕妇,产后孩子患湿疹的风险增高(OR=1.145, 95% CI:1.011~1.297)。家庭地板、窗台、墙壁有褪色、变黑或霉变(OR=2.051, 95% CI:1.094~3.843)会使婴幼儿湿疹的发病风险增高。  结论  产次、喂养方式、父母过敏史、孕期禽肉摄入频率及居家环境对于婴幼儿湿疹发病有影响,应加强开展针对性宣传指导,有效预防婴幼儿湿疹发生。     

Association of Family and Health Care Provider Opinion on Infant Feeding with Mother's Breastfeeding Decision

In the United States, about 25% of women choose not to initiate breastfeeding, yet little is known about how opinions of individuals in a woman's support network influence her decision to breastfeed. In the 2005-2007 Infant Feeding Practices Study II, women completed questionnaires from the last trimester of pregnancy until 12 months postpartum. Mothers indicated prenatally their family members' and health care providers' opinion on how newborns should be fed: breastfed only, formula fed only, breast and formula fed, or no opinion/don't know. Breastfeeding initiation was determined by asking mothers around 4 weeks postpartum (n=2,041) whether they ever breastfed. Logistic regression was used to examine the association between mothers' perception of family members' and health care providers' opinion on how to feed the infant and the initiation of breastfeeding, adjusting for sociodemographic characteristics. Nearly 14% of mothers surveyed did not initiate breastfeeding. Mothers who believed their family members or health care providers preferred breastfeeding only were least likely not to initiate breastfeeding. Never breastfeeding was significantly associated with the following perceptions: the infant's father (odds ratio [OR]=110.4; 95% CI 52.0 to 234.4) or maternal grandmother (OR=15.9; 95% CI 7.0 to 36.0) preferred only formula feeding; the infant's father (OR=3.2; 95% CI 1.7 to 5.9) or doctor (OR=2.7; 95% CI 1.2 to 6.2) preferred both breast and formula feeding; and the infant's father (OR=7.6; 95% CI 4.5 to 12.7), maternal grandmother (OR=5.4; 95% CI 2.6 to 11.0), or doctor (OR=1.9; 95% CI 1.0 to 3.7) had no opinion/didn't know their feeding preference. The prenatal opinions of family members and health care providers play an important role in a woman's breastfeeding decisions after the infant's birth.     

Risk factors for anemia among 6- to 12-month-old children in Brazil]

OBJECTIVE: To estimate the prevalence of anemia and to determine associated risk factors among infants receiving routine health care in public clinics in Brazil. METHOD: This cross-sectional study included 2,715 infants between 6 and 12 months old in 12 cities, in all five of the geographic regions of Brazil. Information regarding the child and its feeding habits was obtained from the mother or other caregiver, using a questionnaire. Nutritional status was determined based on height and weight measurements. The hemoglobin concentration was measured using the HemoCue portable hemoglobinometer. Anemia was defined as hemoglobin < 11 g/dL. The infants' eating habits were assessed based on what they were eating around the time of the questionnaire interviews. The association between anemia and the different variables was evaluated through bivariate analysis, followed by multiple logistic regression using a hierarchical selection model. RESULTS: The prevalence of anemia for the entire group was 65.4%. Multiple regression analysis identified the following risk factors for anemia: living in the Southeastern Region of Brazil (odds ratio (OR) = 1.57, 95% confidence interval (95% CI) = 1.25- 1.99), maternal age < 20 years (OR = 1.58, 95% CI = 1.21-2.07), birthweight < 2,500 g (OR = 2.09, 95% CI = 1.48-2.95), not being breast-fed (OR = 1.28, 95% CI = 1.02-1.61), receiving both breast milk and other foods (OR = 1.40, 95% CI = 1.10-1.78), and male gender (OR = 1.24, 95% CI = 1.06-1.46). CONCLUSIONS: The high proportion of anemic children indicates the need to emphasize, in prenatal and infant health programs, intervention measures for anemia control. Our results could guide these measures, focusing on the groups at greatest risk, such as low birthweight babies and the children of adolescent mothers.     

Risk factors for early neonatal mortality

OBJECTIVE: To assess risk factors for early neonatal mortality. METHODS: A population-based case-control study was carried out with 146 early neonatal deaths and a sample of 313 controls obtained among survivals of the neonate period in the south region of the city of S?o Paulo, in the period of 8/1/2000 to 1/31/2001. Information was obtained through home interviews and hospital charts. Hierarchical assessment was performed in five groups with the following characteristics 1) socioeconomic conditions of mothers and families, 2) maternal psychosocial conditions, 3) obstetrical history and biological characteristics of mothers, 4) delivery conditions, 5) conditions of newborns RESULTS: Risk factors for early neonate mortality were: Group 1: poor education of household head (OR=1.6; 95% CI: 1.1;2.6), household located in a slum area (OR=2.0; 95% CI: 1.2;3.5) with up to one room (OR=2.2; 95% CI: 1.1;4.2); Group 2: mothers in recent union (OR=2.0; 95% CI: 1.0;4.2), unmarried mothers (OR=1.8; 95% CI: 1.1;3.0), and presence of domestic violence (OR=2.7; 95% CI: 1;6.5); Group 3: presence of complications in pregnancy (OR=8.2; 95% CI: 5.0;13.5), previous low birth weight (OR=2.4; 95% CI: 1.2;4.5), absence of pre-natal care (OR=16.1; 95% CI: 4.7;55.4), and inadequate pre-natal care (block 3) (OR=2.1; 95% CI: 2.0;3.5); Group 4: presence of clinical problems during delivery (OR=2.9; 95% CI: 1.4;5.1), mothers who went to hospital in ambulances (OR=3.8; 95% CI: 1.4;10.7); Group 5: low birth weight (OR=17.3; 95% CI: 8.4;35.6) and preterm live births (OR=8.8; 95% CI: 4.3;17.8). CONCLUSIONS: Additionally to proximal factors (low birth weight, preterm gestations, labor complications and unfavorable clinical conditions in gestation), the variables expressing social exclusion and presence of psychosocial factors were also identified. This context may affect the development of gestation and hinder the access of women to health services. Adequate prenatal care could minimize the effect of these variables.     

Inadequate prenatal care and elevated blood lead levels among children born in Providence, Rhode Island: a population-based study

OBJECTIVE: This study was conducted to determine whether children born to mothers receiving inadequate prenatal care are at an increased risk for having an elevated blood lead level during early childhood. METHODS: The authors conducted a population-based study of children born in Providence, Rhode Island, from 1997 to 2001 whose mothers had received adequate, intermediate, or inadequate prenatal care. The children's blood lead levels were compared between groups using bivariate and logistic regression. To understand the regulatory implications and public health impact of changing the definition of an elevated blood lead level, "elevated" was defined as 5 microg/dL, 10 microg/dL, and 15 microg/dL. RESULTS: Children born to mothers who received inadequate prenatal care were at an elevated risk for having an elevated blood lead level later in life. This relationship remained statistically significant for each definition of elevated blood lead level and after controlling for other socio-economic status measures and birthweight (at 5 microg/dL, odds ratio [OR] = 1.36, 95% confidence interval [CI] 1.09, 1.68, p = 0.006; at 10 microg/dL, OR = 1.68, 95% CI 1.26, 2.24, p < 0.0004; at 15 microg/dL, OR = 1.83, 95% CI 1.10, 3.04, p = 0.019) represent an opportune moment to identify expectant mothers living in lead-contaminated environments. CONCLUSIONS: Results suggest that conducting lead screening as a regular part of prenatal care provision could help identify women possibly experiencing ongoing lead exposure and help reduce or prevent exposures to their offspring.     

流动人口孕产妇产前保健服务利用现状及影响因素分析

目的 了解流动人口孕产妇产前保健服务利用情况并分析其影响因素,为改善流动人口孕产妇的产前保健质量、保障其身心健康提供参考。方法 对2018年全国流动人口卫生计生动态监测问卷中的6 285名流动人口孕产妇相关数据进行分析,主要分析方法有统计描述、χ2检验、Fisher精确性检验和二元logistic回归分析等。结果 流动人口孕产妇产前建档率为95.1%,产前检查达标率为88.7%。二元logistic回归分析表明,本人文化程度为初中（OR = 0.358,95%CI:0.196～0.654;OR = 0.651,95%CI:0.454～0.933）、家庭月均收入3 000元以下（OR = 0.394,95%CI:0.236～0.660;OR = 0.419,95%CI:0.293～0.597）、未接受过妇幼和生殖健康教育（OR = 0.512,95%CI:0.397～0.659;OR = 0.756,95%CI:0.639～0.893）的流动人口孕产妇产前档案建立情况和产前检查达标情况均较差,配偶文化程度在初中及以下（OR = 0.592,95% CI:0.424～0.827）的孕产妇产前检查达标情况较差;流入东部地区（OR = 1.436,95% CI:1.071～1.925;OR = 1.394,95%CI:1.138～1.708）的孕产妇产前档案建立情况、产前检查达标情况较好,流动范围为跨县流动（OR = 1.481,95%CI:1.106～1.982）的孕产妇产前档案建立情况较好。结论 流动人口孕产妇产前保健服务利用情况相对较好,但仍存在可改善空间,应继续推进基本公共卫生服务均等化,提高产前保健服务质量。     

Socioeconomic factors and the risk of anencephaly in a Mexican population: a case-control study

OBJECTIVE: The study was designed to evaluate the association between socioeconomic level (as measured by maternal education, maternal occupation, and monthly family income) and anencephaly. METHODS: The authors conducted a case-control study using data from the Epidemiological Surveillance System Register for Neural Tube Defects for three states of the Mexican Republic: Puebla, Guerrero and the State of Mexico. Mothers of 151 cases of infants born with anencephaly and mothers of 151 control infants born during the period March 2000 to February 2001 were interviewed about their socioeconomic characteristics and other factors including reproductive history, use of prenatal care, use of tobacco and alcohol, fever during pregnancy, and folic acid supplementation. RESULTS: After adjustment for potential confounders, a risk gradient was seen with decreasing maternal education. Women with less than a primary school education (adjusted odds ratio [OR]=3.0; 95% confidence interval [CI] 1.2, 7.6) and women who had completed primary school but had not completed junior high school (adjusted OR=2.2; 95% CI 0.9, 5.7) had higher risks of giving birth to an infant with anencephaly, compared to women with a higher educational level. A monthly income < or = 1,000 pesos (approximately dollars 100 U.S.) was also associated with a higher risk of anencephaly (OR=2.5; 95% CI 1.2, 5.1). Women employed in industry or agriculture during the acute risk period (three months prior to conception to one month after conception) had a risk 6.5 times (95% CI 1.4, 29.6) that of professional and business women. CONCLUSIONS: This study helps to identify groups that may be especially vulnerable to this type of congenital malformation so that primary and secondary preventive strategies can be targeted to these groups.     

大城市综合医院冠心病病人抑郁/焦虑影响因素探讨

目的探讨中国大城市冠心病患者发生抑郁和/或焦虑症状的危险因素。方法采用现况研究方法,于2004年6月1日到12月1日在北京、上海、广州和成都的7家综合性医院的心内科连续收集确诊的冠心病患者359例。由经培训的调查员用统一的调查表进行面对面调查,同时使用综合医院焦虑抑郁量表(HAD)进行心理测评。对数据进行多元无序多分类Logistic回归分析。结果359名对象中HAD9分或以上者82名(22·8%)。生活不能完全自理影响罹患单纯抑郁症状,OR=17·996(95%CI:3·872~83·636);非老年人、受教育年限不超过9年、主观感觉病情加重影响罹患单纯焦虑症状,相应OR分别为3·151(95%CI:1·151~8·629)、3·154(95%CI:1·094~9·092)和4·229(95%CI:1·396~12·809);住院和生活不能完全自理影响罹患抑郁合并焦虑症状,OR分别为4·887(95%CI:1·711~13·960)和6·583(95%CI:2·776~15·612)。结论中国大城市综合医院冠心病病人的抑郁症状和/或焦虑可能与生活不能完全自理、非老年人、受教育年限不超过9年、主观感觉病情加重和住院有关,这些病人的抑郁焦虑问题应该在临床诊疗和健康促进过程中得到更多关注。     

Intimate partner physical violence: an obstacle to initiation of childcare in primary healthcare units in Rio de Janeiro, Brazil?

The aim of this study was to evaluate whether intimate partner physical violence is a risk factor for late initiation of childcare in primary healthcare units (PHCU). This cross-sectional study included 927 mothers and their infants less than six months of age seen at 27 PHCU in Rio de Janeiro, Brazil. The target outcome was delay in first visit to the service (at 60 days of age or later). Interactions between intimate partner physical violence, maternal employment, and quality of prenatal care were explored using multivariate logistic regression. Postpartum intimate partner physical violence was an independent risk factor for late initiation of children's healthcare when mothers had no formal occupation (OR = 3.1, 95%CI: 1.5-6.3) or reported inadequate prenatal care (OR = 4.8, 95%CI: 2.4-9.5). The results emphasize the need for better training of health professionals to detect cases of intimate partner violence during prenatal and pediatric care, which themselves are important steps for reducing such occurrence and thus promoting adequate maternal and child care.