生殖健康/计划生育服务满意度及其影响因素分析

目的:了解计划生育优质服务项目实施后已婚育龄妇女对生殖健康/计划生育服务的满意度,分析其影响因素。方法:资料来源于“中国/联合国人口基金生殖健康/计划生育合作项目”中期评估调查。本文就其中5 533名已婚有偶育龄妇女对生殖健康/计划生育服务的满意度进行了分析。结果;已婚育龄妇女对服务的总体满意度高（98.9％）。育龄妇女本人及其丈夫对所用避孕方法适应证、副作用的了解程度、近两年内获得生殖健康/计划生育服务的场所、计划生育/生殖健康宣传品的发放、开展生殖健康知识培训以及生殖健康/计划生育管理和服务方面的变化等因素会影响育龄妇女对服务的满意度。结论:避孕方法知情选择是提高育龄妇女对服务满意度的重要途径。生殖健康/计划生育管理和服务模式的转变是全面推进计划生育优质服务的保障。     

Menstrual Health Literacy and Management Strategies in Young Women in Australia: A National Online Survey of Young Women Aged 13-25 Years

Study ObjectiveTo explore key aspects of menstrual health literacy and menstrual management in young women at school or in tertiary education.DesignCross-sectional online survey.SettingAustralia-wide.ParticipantsA total of 4202 adolescent and young women (13-25 years of age; median age 17 years), having reached menarche, living in Australia and currently attending school (n = 2421) or tertiary education (n = 1781).InterventionsOnline survey hosted by Qualtrics between November 2017 and January 2018. Data were collected on contraceptive use, management strategies, sources of information, and knowledge of menstruation.Main Outcome MeasuresInformation on prevalence and effectiveness of different management strategies, health-seeking behavior, knowledge about menstruation, and common menstrual disorders such as endometriosis.ResultsThe majority of young women did not seek medical advice for their menstrual symptoms, but used information from the Internet (50%) and engaged in self-management, most commonly with over-the-counter medications such as paracetamol (51%) or ibuprofen (52%). Oral contraceptive use was relatively common (35%), and mostly for reduction of menstrual pain (58%). Despite having significant dysmenorrhea, approximately one-half of the participants (51%) thought that their period was normal. Women with higher pain scores were more likely to rate their period as “abnormal” (P < .0001) but not more likely to consult a doctor (P = .13). Only 53% of those at school had heard of endometriosis.ConclusionSelf-management of menstrual symptoms is common, but a significant minority of women are underdosing or choosing ineffective methods. Most women do not seek medical advice even when symptoms are severe, and cannot identify symptoms suggestive of secondary dysmenorrhea. Improved education on menstruation is vital.     

Teaching Trainees to Deliver Adolescent Reproductive Health Services

Study ObjectiveDelivery of reproductive services to adolescents varies according to specialty and has been linked to differences in clinical training. Few studies have explored how different specialties' graduate medical education (GME) programs prepare providers to deliver adolescent reproductive services. We explored the perceptions of resident physicians regarding their training in delivering adolescent reproductive health services.DesignBetween November 2008 and February 2009, 9 focus groups were conducted with graduate medical trainees in 3 specialties that routinely care for adolescents. The semistructured discussions were audio-recorded, transcribed, and analyzed using an inductive approach to content analysis.SettingLarge, urban academic medical center in Pittsburgh, Pennsylvania.ParticipantsFifty-four resident trainees in pediatrics, family medicine, and obstetrics/gynecology.InterventionsNone.Main Outcome MeasuresTrainees' perspectives regarding the didactic teaching and clinical training in providing adolescent reproductive services.ResultsFive themes emerged, reflecting trainees' beliefs regarding the best practices in which GME programs can engage to ensure that trainees graduate with the belief that they are competent and will be comfortable delivering adolescent reproductive services. Trainees believed programs need to: (1) provide didactic lectures and diverse inpatient and outpatient clinical experiences; (2) have faculty preceptors skilled in providing and supervising adolescent reproductive services; (3) teach skills for engaging adolescents in clinical assessments and decision-making; (4) train providers to navigate confidentiality issues with adolescents and caregivers; and (5) provide infrastructure and resources for delivering adolescent reproductive services.ConclusionThe 3 specialties differed in how well each of the 5 best practices were reportedly addressed during GME training. Policy recommendations are provided.     

The Use of Family Planning Services by Non-English Speaking Background (NESB) Women

This study was undertaken to determine the proportion of family planning organization clients who are from a non-English speaking background (NESB), to analyse the services they used, and to compare it to the services used by other clients. Analysis of clinic data sheets from the 8 State/Territory family planning organizations (FPO) was conducted. From a total of 185,879 client visits in FPO clinics between July, 1996 and June, 1997, 27,349 (14.7%) were from NESB. The proportion of clients with NESB was quite similar to that in the community. This means that in general, FPOs are reaching their share of clients with NESB. The patterns of reproductive health services used varied between NESB women compared to English speaking women.     

宝钢地区妇女生殖健康调查和研究

目的从宝钢地区妇女的普查了解我国工业系统职业妇女的生殖健康.方法1995年、1997年、1999年采用妇科常规检查、宫颈刮片、阴道B型超声检查等方法调查了宝钢地区23～70岁妇女28879例次.结果1995、1997、1999年度总的阴道感染率分别为13.95%、13.21%、13.79%(P＞0.05);慢性宫颈炎总的发病率为16.78%、15.11%、11.87%,1999年比前2年明显下降(P＜0.001).1999年确诊宫颈原位癌1例(10.7/10万),卵巢癌5例(53.8/10万);与1997年相比,卵巢癌的发病率上升(P＜0.001).结论应积极防治下生殖道感染、降低人工流产率;卵巢癌发病率上升中的致病因素与工业化的环境可能有重要的关系;对有高危因素的妇女应加强定期的盆腔B超检查,必要时加用其他生化免疫等方法进行筛查、以达到早期诊断和治疗的目的.     

中国四城市医院未婚人流女青年生殖道感染状况研究

目的:了解未婚人流女青年生殖道感染/性传播疾病(RTIs/STIs)的患病率、性暴力的发生率及其相关的影响因素;了解未婚人流女青年性和生殖健康知识、态度、行为和生殖健康保健需求。方法:2002.10-2003.02期间,广东省深圳市、广西省南宁市、北京市、河南省郑州市的市级医院妇产科对2002名年龄<24岁来院要求人工流产的未婚女青年进行妇科检查和实验室检查及自填式问卷调查。结果:调查对象平均年龄为22.0±1.7岁,流动人口占61.0%。在调查中生殖道感染的患病率为57.1%,性传播疾病的患病率是9.8%。与生殖道感染有关的影响因素包括非流动人口、首次性行为年龄≤19岁、未使用避孕方法、既往有患RTIs病史、清洁外阴间隔时间≥2d。调查对象性暴力的发生率是11.7%。首次性行为的平均年龄为20.3±1.9岁。平均拥有性伴侣数为1.2±0.9个。生殖健康知识总分平均为4.2±2.3分(总分9分)。调查对象对生殖健康保健知识的需求依次为避孕知识、人工流产危害、性生理知识、性传播疾病的危害与预防等。结论:未婚人流女青年有关性和生殖健康知识贫乏;首次性行为平均年龄提前;RTIs/STIs是未婚人流女青年生殖健康的主要问题;未婚人流女青年中的性暴力现状不容忽视。     

Utilization of Health Care Services of Pregnant Women Complicated by Preeclampsia in Ontario

Objective: To assess the utilization of health care services by pregnant women affected by preeclampsia (PE). Design: Population-based study. Setting: Perinatal partnership hospitals in Ontario. Population: Obstetric deliveries in 2005 Canadian province of Ontario (about 95% of births). Methods: For each PE case, four subjects without PE matched by age, parity, plurality, and hospital at childbirth were chosen as the controls. We compared the utilization of intra-partum care services and infant outcomes between the two groups. We also estimated the extra costs to the health care system in Ontario for caesarean delivery and caring of extremely low birth weight infants attributable to PE during the neonatal period and in the first 2 years of life. Main Outcome Measures: Cesarean delivery, hospital stay, extremely low birth weight infants, cost. Results: Of the 120,611 obstetric deliveries included in this analysis, 1240 (1.3%) were diagnosed with PE. Patients with PE and matched controls were similar in maternal age, parity, and other demographic characteristics. Compared with study subjects without PE, those with PE had increased uses of spinal anesthesia, maternal transfer, Cesarean delivery, labour induction, neonatal transfer, newborn resuscitation, longer hospital stay for childbirth, and higher rates of preterm births and low birth weight. The extra costs to the health care system for cesarean delivery and caring of extremely low-birth-weight infants attributable to PE during the neonatal period and in the first 2 years of life in Ontario were $0.5 millions, 3.1 millions, and $5.1 million per year, respectively, if we use the reported PE rate in this database. Conclusion: PE is associated with substantially increased costs to the health care system.     

社区干预项目对未婚青少年生殖健康知识的长期影响

目的:评价社区干预项目对未婚青少年生殖健康知识的长期影响。方法:在上海市郊两个镇开展以社区为基础的干预研究,干预持续20个月,干预项目包括性与生殖健康知识教育、咨询及避孕服务。通过干预前、干预结束时及干预结束后28个月3次问卷调查评价干预项目的长期影响。结果:干预前干预组和对照组对象的各分类知识得分及总知识得分均无统计学差别,干预后不同时点干预组对象的各分类知识得分及总知识得分均显著高于对照组,但第3次调查原干预队列对象和对照组对象知识得分增值的差值均明显低于干预结束时的调查。多因素分析结果显示,在调整了可能的影响因素后,第3次调查两组对象知识得分增值的差值为13.00,是干预结束时的50.68%。从新对象的知识得分看,除避孕知识得分两组比较无统计学差别外,其余各分类知识得分及总知识得分干预组均高于对照组。多因素分析显示,在调整了可能的影响因素后,干预效应的OR值为1.64。结论:干预项目对原干预队列对象生殖健康知识增加有较强的持续影响,对新对象生殖健康知识增加有延续影响,应继续通过社区向未婚青少年提供性与生殖健康教育和服务。     

Impact of Dietary Folate Intake on Depressive Symptoms in Young Women of Reproductive Age

Introduction: Folate deficiencies may be linked to depressive disorders among persons suffering from neurological and psychiatric problems. The purpose of the present study was to evaluate the impact of dietary folate intake on depressive symptoms in young Japanese women of reproductive age. Methods: The study was conducted in Japan in 2009 with 141 Japanese women aged 18 to 28 years. A Japanese version of the Center for Epidemiologic Studies Depression (CES‐D) scale was used to screen for depressive symptoms. Dietary intake was investigated by a diet history questionnaire. Nonfasting blood samples were collected from the women to measure folate and homocysteine levels. Results: The proportion of women with lower folate intake (< 240 μg/d) was significantly higher in the women with CES‐D scores greater than or equal to 19 when compared with the folate levels in those with CES‐D scores less than 19 (75.0% vs 43.6%, respectively; P < .001). Logistic regression analysis revealed significant associations between CES‐D scores greater than or equal to 19, low folate intake, and low vitamin B₆ intake when adjusted for age, living status, smoking, and body mass index. Adequate folate intake of more than the recommended dietary allowance (RDA) level of 240 μg per day was independently related to a decreased risk of depression (adjusted odds ratio 0.22; 95% confidence interval, 0.11‐0.56; P < .001). Discussion: Multiple logistic regression analysis revealed a reduced incidence of depression in women whose intake of folate exceeded the RDA of 240 μg per day. This finding suggests that dietary folate intake may be causally related to depressive symptoms in women of reproductive age. If results of studies powered to determine causal relationships are similarly positive, folate supplementation could reduce the incidence of depression.     

上海婚前体检男女青年生殖健康知识状况分析

目的:了解上海地区婚前体检男女青年的生殖健康知识水平,为更有效地在未婚青年中开展性教育提供科学依据。方法:采用结构式问卷对上海三个市区和两个郊县婚前体检的男女青年各2580名进行调查。结果:男女青年具有一定的生殖生理、避孕及性病知识,但明显不足,特别是与妊娠有关的生理知识、避孕知识和性病防治知识。男女青年现有的知识主要来自学校教育、书报传媒以及同学朋友。他们认为最理想的知识来源途径主要有学校教育、书报传媒和医院宣教。结论:应加强学校、家庭与社会的性教育,提高未婚青年的生殖健康知识水平。     

Sense of Mission and Sexual Health Outcomes Among Young Adult Women

Study ObjectiveTo examine the association between self-reported sense of mission and sexual health behaviors in a geographically diverse cohort of U.S. young adult females in the Growing Up Today Study (GUTS).DesignWe conducted a cross-sectional analysis of the 2007 wave of GUTS data from self-reported online or mailed surveys. Outcomes were early sex initiation and history of sexually transmitted infection (STI), which were analyzed as a binary outcome using logit link, and number of sex partners, which was analyzed as a continuous outcome. Models for number of sex partners and history of STIs were adjusted for age.ParticipantsThere were 5,624 young women aged 20 to 25 years who participate in GUTS and who answered the question on “sense of mission.”Main Outcome MeasuresAge at sexual initiation, history of STIs, and number of lifetime partners.ResultsWhen asked whether they had a sense of mission in their life, 28.1% of women strongly agreed, 54.9% agreed, and 17% disagreed. Women with a low sense of mission had higher odds of reporting a history of STI (odds ratio 1.35, 95% confidence interval 1.08 to 1.70), and more lifetime sexual partners (β = .83, P < .001).ConclusionsHaving a high sense of mission is associated with lower sexual risk in young women. Interventions to increase sense of mission among young women may improve sexual health outcomes.