云南和安徽两省县、乡计划生育机构宫内节育器放置人员工作满意度差异分析

目的:了解云南和安徽两省县、乡计划生育机构宫内节育器(IUD)放置人员工作满意度及其差异。方法:采用JSS工作满意度量表对县、乡计划生育服务机构496名IUD放置人员进行问卷调查并作统计分析。结果:县、乡计划生育机构IUD放置人员工作满意度得分为142.4±24.1,不同维度中得分较高项包括领导、沟通和同事满意度;较低项包括薪酬、晋升和福利。县级IUD放置人员工作满意度要高于乡级,主要表现在晋升、领导、回报、同事、工作性质、工作流程等方面。多因素回归分析显示县级IUD放置人员工作满意度主要受年龄、教育程度、执业类型和近5年培训次数影响;而乡级IUD放置人员主要受教育程度、职称和从事IUD放置工作年限影响。结论:县级计划生育服务机构IUD放置人员工作满意度高于乡级计划生育服务机构,人才结构及其工作环境是差异的主要原因。     

宫内节育器综合评价指标体系研究

目的:建立宫内节育器(IUD)综合评价指标体系,为临床应用及政府采购、推广和新产品研发提供理论依据。方法:借鉴卫生服务三环节评价理论和产品评价理论构建指标体系框架,经多次专家讨论确定初始指标体系,结合临床随访资料,利用相关系数法、变异系数法和因子分析法筛选指标,运用主成分分析结合专家意见法计算指标的权重,用TOPSIS法、综合指数法、秩和比法和模糊数学法对元宫Cu300 IUD、TCu380A IUD和活性165 IUD进行综合评价。结果:①构建出由服务提供、产品性能、经济性3个一级指标,服务过程、随访、产品有效性、副反应、并发症、可接受性6个二级指标,放置不顺利率、带器妊娠率、并发症率和避孕效果满意率等16个三级指标组成的IUD综合评价指标体系。②TOPSIS法、综合指数法和模糊数学法对3种IUD的综合评价结果为:元宫Cu300 IUD排名第一,TCu380A IUD第二,活性165 IUD第三。秩和比法的排序为:元宫Cu300 IUD第一,活性165 IUD第二,TCu380A IUD第三。结论:指标体系的构建由理论基础、专家的丰富经验以及大样本临床随访资料做支撑,采用主客观相结合的方法筛选指标,构建过程科学、严谨。利用指标体系评价3种IUD的结果具有一致性,与临床经验相符,说明具有现实可行性和可操作性。     

1450例人工流产女性实施流产后服务的随访研究

目的:对流产后服务(post-abortion care,PAC)进行临床实践和评价。方法:1 450例因非意愿妊娠在计划生育门诊自愿进行人工流产者,在流产后接受相关的流产后服务,比较患者流产前的一般情况、接受流产后服务用的避孕方案及其相应副作用、坚持避孕方案的时间、重复人工流产的发生率及间隔时间等。结果:所有接受PAC的患者术后均立即采用了避孕措施,术后首月主要采用的避孕方式为口服避孕药(n=573)、屏障避孕(n=551)、曼月乐(n=287)及普通IUD(元宫药铜IUD、活性γ型IUD、TCu220IUD、吉妮致美IUD等)(n=39)。随访12个月后曼月乐组100%坚持使用,普通IUD组使用人数则由最初的39例增至83例,比流产术后增加了1倍以上,主要由原口服避孕药组转入。口服避孕药组的坚持使用率为46.4%。所有坚持随访的女性均未发生随访期间意外妊娠。坚持避孕的各组中,起始有痛经、点滴阴道出血、漏服、环位置下移等不适,均遵医嘱来院处理;随访3个月后各组的不适症状均明显缓解;随访6个月后各组均无不适主诉。结论:科学系统的优质PAC能有效防范重复流产发生,保证避孕效率,从而保护女性的生殖健康。     

云南和安徽两省农村育龄妇女使用宫内节育器SF-36量表的信度和效度分析

目的:评估SF-36量表使用宫内节育器(IUD)的农村育龄妇女生存质量的信度和效度。方法:使用自行改编设计的调查问卷,采用分层随机抽样方法,抽取安徽和云南2省的4个县计划生育服务站及下属12个乡服务所放置IUD的育龄妇女,进行面对面调查。结果:量表的分半信度Spearman Brown系数为0.89(P0.01)。内部一致性信度α系数除总体健康(general health,GH)(α=0.63)、活力(vitality,VT)(α=0.55)、社会功能(social functioning,SF)(α=0.27)、精神健康(mental health,MH)(α=0.64)外,其余各维度α系数均0.7。各条目与该条目所在的维度的相关系数均≥0.4,与其他维度的相关系数均该条目与该条目所在的维度的相关系数。35个条目中提取的6个因子分布与量表理论假设基本一致。主成分分析法提取2个因子,累计贡献率达57.19%。与常规模型比,农村育龄妇女使用IUD生存质量5个维度得分低于常规模型。结论:从总体上看,中文版SF-36量表用于评价使用IUD的农村育龄妇女生存质量有较好的信度和效度。     

大理州国家免费宫内节育器使用和管理情况调查

目的：通过对国家免费宫内节育器（IUD）的使用和管理情况的调查和分析，为免费IUD充分发挥作用提供依据。方法：在12个县市144家计生服务和卫生医疗机构中进行了使用和管理情况调查。结果：免费IUD占总放置例数的比例中，计划生育系统比例高。国家免费提供宫内节育器的质量良好，但有浪费现象存在。结论．提出要加强宣传、加强目标责任考核、加强培训等七条对策措施。     

996名已婚育龄妇女使用IUD的心理因素分析

<正> 放置宫内节育器(下称IUD)是我国已婚育龄妇女采用的一种主要避孕方式,占节育总数的50%左右。本研究试图了解已婚育龄妇女放置IUD的心理行为状况,为提高计划生育技术服务质量、开展计划生育心理咨询及加强计划生育宣教工作提供参考。研究对象和方法     

宫内节育器反复脱落92例临床分析

宫内节育器 (IUD)是一种安全、长效、简便、可逆的避孕方法。影响 IUD续用率的主要原因是脱落、妊娠和出血等副反应。本文就 IUD反复脱落 92例进行临床分析。1　临床资料1.1　一般资料 :92例为 1997年 5月至 1998年 12月间在本站就诊 ,有 2次以上宫内节育器脱落史 ,年龄 2 2～ 35岁。1.2　放置 IUD后脱落情况 :92例均在外单位置器 ,81例在乡医院和基层计划生育服务站手术 ,11例曾在县级以上服务机构检查及手术。放置 IU D后脱落时间最短发生在术后 4h,最长 3年 ,共脱落 2 77次 ,其中脱落 2次 2 0例 ,3次者 5 2例 ,4次者 19例 ,5次者 1…     

更新换代后的活性IUD安全性和有效性随访研究

目的 :了解更新换代后的 IUD使用情况及效果 ,为采取相应的干预措施提供依据。方法 :由 1 998年采用历史前瞻性流行病学的调查方法 ,对上海 2 1个区 1 0 387例放置活性 IUD的对象进行临床效果调查。结果 :放置 2 4个月末 ,活性 IUD总的带器妊娠率为1 .0 3% ,意外妊娠率 0 .1 1 % ,脱落率为 2 .52 % ,续用率 94.95%。其中年龄 ,孕产次 ,放置技术 ,放置时期及 IUD的种类等因素影响 IUD的临床效果。结论 :活性 IUD全面使用后 ,其临床效果与科研时的效果相似。但放置技术还需提高 ,各种活性 IUD使用比例的现状还需改变     

应用B超对5000例宫内节育器的定位观察分析

宫内节育器（简称IUD）的应用是一种常见避孕节育方法，目前我国城乡育龄妇女普遍采用IUD避孕措施，约占所有措施的40％左右。由于放置节育器的数量增多，因失败而受孕者也增多，为了提高其有效率及继续存放率，及时发现IUD移位、脱落等异常情况，切实做好计划生育的孕前管理，应用B超对IUD进行监护是目前较为理想的监测手段。     

宫内节育器异位11例分析

目的探讨IUD异位的原因及延误治疗而导致严重的并发症.方法对1982～1999年收治IUD异位11例进行回顾性分析.结果11例中3例于置环术中发现IUD异位并及时处理;另8例因延误诊治,其中7例造成临床上少见、罕见的严重并发症.结论11例中7例由于放置IUD术中粗暴操作造成子宫穿孔致IUD异位;4例由于误将IUD经尿道口置入膀胱造成IUD异位.结论应加强基层计划生育工作者的培训,提高医疗质量,避免粗暴操作,发现异常,及时处理.     

Availability and quality of emergency obstetric care in Shanxi Province, China

Objective

To investigate the availability and quality of emergency obstetric care (EmOC) received by women in a rural Chinese province.

Methods

The study was conducted in 7 rural counties and townships in Shanxi Province, China. Data sources included interviews with 7 hospital leaders, 5 maternal and child health workers, and 7 obstetricians; 118 records of complicated delivery were audited, 21 Maternal and Child Health Annual Reports analyzed, and observations conducted of facilities and advanced labor care.

Results

The number of comprehensive EmOC facilities was adequate in all counties. Three counties had fewer basic EmOC facilities than recommended and only 4 counties reached the recommended level. Most of the existing township hospitals did not provide birthing services. All the county hospitals could perform cesarean deliveries with rates from 6.8%-40.8%. The management of complications was not evidence-based. For example, women with pre-eclampsia and eclampsia were given too little magnesium sulfate; women were not closely monitored for hemorrhage after birth and the partograph was used incorrectly with consequences for obstructed labor.

Conclusion

Basic EmOC facilities are not adequate and township hospitals should be upgraded to provide birthing services. The quality of EmOC is poor and needs improvement.     

放置IUD服务质量与IUD下移取器关系的巢式病例对照研究

目的:探讨云南省农村地区育龄妇女IUD下移取器与手术人员服务质量间的关联。方法:采用巢式病例对照研究方法,从队列中获得246例IUD下移取器病例,按1:1的比例分别匹配以末次妊娠结局、所置IUD种类相同、地区、年龄相当的对照,调查分析为此组患者施术人员的相关服务质量。结果:单因素条件logistic回归分析显示施术人员本调查置器时间点前一年(2004年)所置IUD数量、是否有计划生育手术上岗合格证、5年内IUD相关培训次数、置环、取环术熟练程度、对放置IUD绝对禁忌证的了解程度、所施行过的手术种类与IUD下移取器有统计学关联(P<0.05),进一步用多因素条件logistic回归分析,施术人员5年内IUD相关培训次数、2004年置环数量、置环、取环术熟练程度与IUD下移取器有统计学关联(P<0.05),OR值分别为0.35(95%CI:0.18～0.66)、0.50(95%CI:0.33～0.77)和2.46(95%CI:1.89～3.20),其他各因素对致育龄妇女IUD下移取器未显示有统计学意义。结论:影响IUD下移取器有关服务质量的因素包括施术人员的服务水平和培训情况,今后需进一步探讨IUD技术服务质量管理模式,提高人民的生殖健康水平。     

避孕方法知情选择对人工流产发生的影响

目的:从个体角度解析知情选择避孕方法对人工流产发生的影响,并进一步探究两者间的相互关系。方法:采取病例对照研究方法(case-control),根据已婚育龄妇女管理信息系统登记名单,从浙江省德清县、山东省即墨市、安徽省居巢区、宁夏回族自治区中卫市四县(市、区)中,每县(市、区)随机抽取在2002￣2004年间有过人工流产经历的已婚妇女200名,以及截止2004年底从未有过人工流产经历的已婚妇女200名进行1∶1配对。结果:IUD使用者对IUD禁忌证、副作用知情,以及避孕套使用者对正确使用知识知情,可降低人工流产的发生;此外,促进群众能够主动地选择避孕节育方法,而不是由计划生育干部代替选择,则人工流产的发生会降低。从提供个性化咨询服务、规范化筛查服务以及常规化随访服务等方面提高服务能力和质量,促进知情和自主选择避孕方法,可以降低人工流产的发生。结论:对使用IUD和避孕套者,知情可降低人工流产的发生;自主选择对减少避孕失败的发生有重要的影响;技术服务贯穿整个知情选择的全过程,服务到位是降低人工流产的重要手段。     

Low postnatal care rates in two rural counties in Anhui Province, China: Perceptions of key stakeholders

Objective

to explore the perceptions of stakeholders on postnatal care and to describe the rate of postnatal home visits in two rural counties in Anhui Province, China.

Design

this was a mixed methods study which uses mainly qualitative methods including focus group discussions, in- depth interviews and key informant interviews. A household survey of postpartum women was used to calculate the rates of postnatal home visits.

Setting

two rural counties in Anhui Province, China.

Participants

qualitative study participants: officials responsible for maternal health care at county level, health providers at township and village level and maternal health-care users. Household survey participants: 2326 women who gave birth in the two counties from January 2005 to December 2006.

Findings

the survey of postpartum women revealed that only 4.2% and 4.5% of women received one or more postnatal visits at home in County A and County B. Qualitative interviews revealed a range of perceived reasons for this low rate of provision and utilisation of postnatal care, including: inadequate funding for maternal health care; limited human resources; lack of transport in township hospitals; and limited value placed on postnatal care by women and providers. In addition, where services were provided, a number of factors were likely to restrict health providers from delivering high-quality postnatal health service, such as: weak skills and knowledge of staff; inadequate in-service training; lack of equipment in township hospitals; and poor supervision and monitoring.

Key conclusions

the rate of postnatal visits was extremely low in two counties in rural China. Understaffing and inadequate funding are the main factors that affect provision of postnatal health care.

Implications for practice

more emphasis should be attached to political support and funding for postnatal care. Research into feasible ways to provide quality postnatal care needs to be conducted.     

The postpartum approach to family planning. Experiences in Thailand, from 1966 to 1971

Since 1966, 4 large Bangkok hospitals and since 1969, 11 rural Thailand hospitals have operated a postpartum program with a total of 99,434 women accepting family planning services within 3 months of delivery or abortion, the majority accepting the IUD or female sterilization before hospital discharge. There were more than 48,000 immediate postpartum acceptors of the IUD which may be the largest series of cases yet reported. Acceptors had a mean age of 28 years, median 3.2 living children and most accepted to limit family size. "First method" continuation rates were high: 79% at 12 months, 65% at 24 months, and 47% at 48 months. Success was due to emphasis on motivation during antenatal and postpartum period. It was recommended that family planning become a routine part of postpartum care. This program should be modified to reach women delivering at home in the rural areas.     

Privatisation of health services and the reproductive health of rural Chinese women

China’s rural health care system has undergone major changes since the early 1980s, when the country began privatising rural health services. Following fiscal devolution, the rural primary health service was transformed into a fee-for-service system, dependent on the availability of local resources. This article reports some of the results of a study undertaken in 1994–96 to examine the impact of privatization on financing, provision and use of reproductive health services by women in two rural counties in Yunnan Province, China. The most common self-reported symptoms of reproductive morbidity were abnormal vaginal discharge and vaginal tears during home delivery, which went mostly untreated. Hospital-based delivery and use of antenatal care was very low, adversely affected by costs and perceived low quality. Service quality was affected by low investment in training, maintenance and supervision of workers. Most of the burden for maternal and child health care fell on local health workers, yet resources for these services had declined from 1985 to 1995. Only support for family planning services, which were funded and provided separately, had increased. Rural women’s reproductive health needs were inadequately attended to by rural health services following reforms. Our data has helped to increase attention to those needs within planned reform efforts.     

加强计划生育技术服务机构能力建设的调查

为配合《计划生育技术服务管理条例》的贯彻实施 ,加强计划生育技术服务能力的建设 ,我们利用国家计划生育委员会举办的“第二期地市级计生干部学习《计划生育技术服务管理条例》培训班”,对学员进行了调查。调查发现 ,现有县乡级机构技术服务能力仍有明显不足 ,尤其在乡级单位最为明显。主要表现为有资格的技术服务人员和设备器材的缺乏以及服务项目的不足 ,且东、西部省份间存在明显差异。建议抓好技术服务人员的全面培训 ;规范乡级技术服务机构的服务项目和范围 ;保证各级政府部门对计划生育事业的财政投入和改进现行的不相适应的考核制度。     

云南白族、贵州苗族已婚育龄妇女节育模式的研究

为了探索少数民族计划生育工作现状和节育模式,调查了云南白族、贵州苗族地区2026例已婚妇女,结果显示白族、苗族计划生育工作成绩显著,育龄妇女节育比例均高于80％,云南白族以宫内节育器为主要避孕方法（62．03％）,贵州苗族以男女绝育为主（76．62％）。Logistic多元回归分析显示夫妇的生育意愿、性别偏好、计生干部作用均影响是否采用绝育措施本道避孕方法较少、曾用避孕方法较多者倾向于绝育。两地相比,云南白族地区的计划生育工作较好,妇女避孕知识较多,自觉节育比例更大。鉴于今后计划生育全程服务和“知情选择”的推广,建议少数民族地区在继续推行现行的长效避孕方法（绝育和宫内节育器）的同时,积极宣传避孕知识,加强对群众生育观念的正确引导,增强基层计生技术力量,逐步向知情选择过渡。     

Current status of contraceptive use among rural married women in Anhui Province of China

Objectives  This study aims to explore the current status of married women in regard of their use of contraceptive methods (permanent methods versus non-permanent methods) and to find out factors that affect the use of contraceptive methods in rural areas of Anhui Province of China.
Design  Survey.
Setting  Anhui, China.
Population  A total of 53,652 married women aged 18–49 years.
Methods  A multistage probability sampling method was used to identify a representative sample of 53,652 married women aged 18–49 years. All women were asked to provide detailed information by completing detailed questionnaires.
Main outcome measures  Contraceptive prevalence and influence factors.
Results  The total birth control rate of the sample was 95.2%. Samples choosing the permanent and nonpermanent contraceptive methods have taken up 46.7 and 48.5% respectively. Female sterilisation was the first choice with a usage rate of 43.6%, followed by intrauterine device (IUD), which was used by 41.1% of samples. Single-variable analysis showed that the choice of contraceptive methods was associated with age, education level, parity, frequency of sex intercourses in a month, contraceptive knowledge, RTI symptom and the gender of the last child of rural married women.
Conclusions  A significant increase in contraceptive use of rural married women in Anhui Province of China. Female sterilisation and IUD still play the dominant role. Effective family planning methods should be advocated through adequate counselling on the correct use and proper management, with consideration of the background of custom and belief.