上海市24小时生殖健康咨询热线的报告

目的 :为了解上海市民的生殖保健需求 ,对上海市首条 2 4h生殖健康咨询热线开通 9个月结果进行分析 ,以发现新的需求 ,提出改善措施。方法 :对热线开通 9个月的所有咨询记录输入计算机进行统计分析 ,并按春、夏、秋三季 ,随机抽取 40 0 0多个性问题进行深入分析。对不同性别、不同性质的问题 (性问题或其他问题 )进行对比分析。结果 :9个月共接听 44 2 1 6人次。咨询者包括各个年龄层次 ( 1 2～ 78岁 )、不同婚姻状况、来自上海及外地。咨询总体中男女比例相当。咨询内容囊括生殖健康各个方面 ,其中男女性问题和孕期优生保健及婴幼儿保健分别占 2 6.5%和 3 4% ;咨询性问题男性远多于女性 ,咨询孕期及婴幼儿保健女性多于男性。性问题及其他咨询内容在 2 4h各时刻均存在 ,但前者在夜间至凌晨明显增高。男性性问题在各时段均居前三位。结论 :上海市民对性保健、孕期和婴幼儿期保健知识的需求非常高 ,日常生活中出现问题或存在困惑时需要医务人员和专业人员的及时指导 ;上海应该建立相应的保健机构或门诊以满足育龄人群的生殖保健需求。     

上海市核心家庭避孕情况、满意程度及生殖健康服务利用情况调查

目的了解上海市核心家庭中育龄对象的避孕情况、对避孕方法的满意程度以及生殖健康服务的利用情况,发现存在的问题,为进一步实施干预措施,提高家庭的生殖健康水平提供依据。方法通过面对面方式对1,060个符合标准的核心家庭中的成员进行问卷调查,分析核心家庭成员的避孕情况、避孕方法的满意程度以及生殖健康服务的利用情况。结果调查对象避孕方法的总体使用率为90.66%;其中使用率最高的避孕方法为宫内节育器,其次是避孕套;调查对象对女性目前所使用的避孕方法是比较满意的;2,120名调查对象中,过去一年曾去生殖健康相关门诊寻求生殖健康服务的有375人(17.74%);其中接受过避孕节育方面咨询的有264人(70.40%)。结论调查对象避孕方法构成上存在避孕率高、宫内节育器使用率(54.25%)高、绝育率极低、避孕套使用率(25.66%)较高的特点。绝大多数对象对目前使用的避孕方法感到满意或基本满意。但是在过去一年中接受过生殖健康相关服务的对象所占比例较低。因此,今后相关部门应该开展广泛的针对性的宣传教育,打破这种生殖健康需求“沉默”的局面,提高核心家庭育龄成员的生殖健康水平。     

医科大学新生生殖健康问题的KAP研究———艾滋病知识、态度的调查及启示

为了解低年级医科大学生的艾滋病知识和态度，以及他们对在大学生中开展预防艾滋病教育的看法，１９９７年６月对２６６名上海某医科大学一年级学生（年龄１６～２３岁，男１３０名、女１３６名）进行了问卷调查。调查显示，由于近年来大众媒体对艾滋病的广泛报道，大学新生对艾滋病有一般性了解，但不能正确判断接种疫苗、被蚊虫叮咬、共用坐厕、共用饮食器皿等途径能否传播艾滋病的比例，约为６９％、４８％、３８％和３０％；知道正确使用避孕套能降低感染艾滋病危险性的占６７％。提示，在一年级大学生中应加强艾滋病预防教育，澄清误解，对保护他们自己免受艾滋病威胁，以及在全社会开展控制艾滋病疫情的活动具重要意义。     

中国西部青海省农村妇女生殖健康需求的研究

目的　调查中国西部农村生殖健康现状 ,了解农村育龄妇女对生殖健康服务的需求 ,为制定有效的干预方案做准备。　方法　使用封闭式调查问卷 ,对青海省互助县农村 1 790名已婚育龄妇女进行调查。　结果　调查对象主要通过医生和计划生育服务人员的服务来获得生殖健康的知识 ( 3 8.8% ) ,通过婚前培训 ( 3 .8% )和学校教育( 1 .7% )获得的比例较低。 93 .65%的调查对象认同“生育一个孩子后放环 ,生育两个孩子后结扎”的避孕节育方法。但如果允许知情选择 ,44.7%选择放环 ,45.5%实行结扎。不知道避孕套有何作用者占 65.8% ,98.5%没有使用过避孕套。 58.5%的调查对象在怀孕期间没有产前检查 ,3 4.3 % 1 4次、0 .9%≥ 1 0次。 91 %的调查对象在家分娩。出现生殖道感染症状时 61 .9%的被调查者没有就诊 ,在就诊者中 79.5%的妇女认为症状未缓解。Logistic分析显示 :年纪越轻、受教育程度越高越重视孕产期保健。　 结论　该西部地区农村生殖健康现状较差 ,主要表现在 :生殖健康知识贫乏 ,通过婚前培训、学校教育来获得生殖健康知识的比例很小 ;男性避孕节育方法的宣传和使用以及孕产期保健、生殖道感染的诊断治疗严重不足。该地区农村育龄妇女对生殖健康服务的需求主要是 :加强婚前和学校生殖健康方面的教育 ,?     

KAP study on reproductive health among medical freshmen: a survey of AIDS related knowledge and attitudes and their implications

SincethefirstAIDScasewasreportedin1981,HIV/AIDShasspreadwithanalarmingspeedacrossalmostallcountriesandregionsovertheworld,immenselythreateningallindividuals,familiesaswellascommunities.Sofar,ChinaisatlowepidemicstatusintermsofHIVprevalencerate.However,alloftheriskingfactorsandchannelsoftransmissiondoexist.Forexample,alargefloatingpopulationnumberingin100millions,mainlyruralpeopleseekingjobsinurbancenters,lackingofsexrelatedknowledgeingeneralpopulation,mushroominginsexindustryacrossthenat…     

Analysis on the reproductive health situation of unmarried floating young women in cities

Objective: To understand the prevalence of RTIs/STIs, the incidence of sex violence and the KAP of the sex and reproductive health among unmarried floating young women.Methods: During Ocb.2002 to Feb.2003, in the maternal and child health hospital of Beijing, Shenzhen, Nanning and Zhengzhou, 1,219 unmarried floating young women who wanted termination of pregnancy and was under 24 years old before induced abortion received gynecological and laboratory examination. At the same time, they also answered a self-questionnaire. Results: The mean age of all respondents was (22.0±1.6) years old. The respondents' average age of having first sexual activity was (20.3±1.8) years old. The rate of induced abortion history was 38.7%. 17.5% of young women had never used contraception. The incidence of sex violence was 15.6%. The prevalence of RTIs and STIs was 56.1% and 9.7%, respectively. Young women were lack of the knowledge about reproductive health care. Conclusions: The reproductive health situation of unmarried floating young women was serious, especially on sex violence and RTIs/STIs and higher rate of induced abortion.     

Sexual and reproductive health service needs of university/college students: updates from a survey in Shanghai, China

AIM: To promote the provision of reproductive health services to young people by exploring the attitudes and perceptions of university students in Shanghai, China, toward reproductive health. METHODS: From July 2004 to May 2006, 5 243 students from 14 universities in Shanghai took part in our survey. Topics covered the demands of reproductive health-care services, attitudes towards and experience with sex, exposure to pornographic material, and knowledge on sexual health and sexually transmitted infections (STIs)/AIDS. RESULTS: Of the 5 067 students who provided valid answer sheets, 50.05% were female and 49.95% were male, 14.86% were medical students, and 85.14% had non-medical backgrounds. A total of 38.4% of respondents had received reproductive health education previously. The majority of students supported school-based reproductive health education, and also acquired information about sex predominantly from books, schoolmates, and the Internet. Premarital sexual behavior was opposed by 17.7% of survey participants, and 37.5% could identify all the three types of STIs listed in the questionnaire. Although 83.7% knew how HIV is transmitted, only 55.7% knew when to use a condom and 57.8% knew that the use of condoms could reduce the risk of HIV infection. CONCLUSION: The reproductive health service is lagging behind current attitudes and demands of university students. Although students' attitudes towards sexual matters are liberal, their knowledge about reproductive health and STIs/AIDS is still limited. It is therefore necessary to provide effective and confidential reproductive health services to young people.     

Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study

ABSTRACT: The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4?years (range 4-98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.     

Sexual and reproductive health in men with cystic fibrosis: Consistent preferences, inconsistent practices

BackgroundSexual and reproductive health (SRH) is increasingly relevant for men with CF. However, the extent of similarities or differences in SRH clinical practices across different centres or states is unknown as single clinic studies are not informative about variations in male preferences or clinical practices. We wished to determine the variability of male SRH knowledge and preferences, and clinical practices across different CF clinics.MethodsMen attending 5 adult CF clinics in Australasia completed a survey of SRH knowledge, attitudes and behaviours.Results264 (64%) men participated, with a median age of 30 years (17–56). 65% knew of near universal infertility due to a transport problem. 43% heard about infertility from their preferred source, but significantly later than desired. Less than half had undergone semen analysis (SA), which, while varying by site, was consistently later than preferred. 57 men were fathers, of whom 29 had utilised ART.ConclusionMen's preferences around SRH were more consistent than clinical practices. Clinical practice guidelines and training for health professionals would help reduce the gap between men's SRH preferences and clinical practice.     

中老年男性生殖健康评估体系的初步研究与建立

目的初步建立适用于中国不同地区社区人群的中老年男性生殖健康评估体系,为管理者决策提供信息及合理化建议。方法通过对38名专家采用咨询法并结合54名基层生殖健康服务管理者、提供者以及中老年男性生殖健康接受者的问卷调查,按3级评分结果对备选框架各项指标进行排序、遴选,形成评估体系,供进一步研究。结果综合考察总分和平均分,以总分最高分数段（≥210分）的11个指标作为必备指标,次之分数段（180-209）的15个指标作为补充指标,总分〈180分的14个指标作为参考指标。结论本研究遴选的指标覆盖面广、代表性强,初步建立了一套适用于农村和城市的中老年男性生殖健康评估体系。     

中华医学会生殖医学分会年度报告:2017年辅助生殖技术数据分析

目的汇报中国辅助生殖技术(ART)2017年年度情况,以期为中国的ART技术发展、标准化建设和质量控制提供依据。方法运用“中华医学会生殖医学分会(CSRM)数据上报系统”,汇总中国内地216家生殖中心上报的2017年ART数据,对ART技术的应用情况进行横断面调查。结果2017年CSRM数据上报系统共报告AID/AIH治疗周期数94131、取卵周期数266579、鲜胚移植周期数117253、冻融胚胎移植(FET)周期数198918。患者年龄主要集中在<35岁组,占比70.19%。新鲜取卵周期妊娠率52.63%、活产率43.03%;FET周期妊娠率50.80%、活产率40.19%。ART并发症中,中重度OHSS发生率为1.59%,术后出血发生率为0.02%,术后盆腔感染发生率为0.01%,其他并发症发生率为0.03%。结论从“CSRM数据上报系统”所获得2017年ART年度情况显示,中国大陆地区的ART周期数多,具有良好的妊娠结局和极低的合并症。     

Adverse trends in male reproductive health: we may have reached a crucial 'tipping point'

Healthy men produce an enormous number of sperms, far more than necessary for conception. However, several studies suggest that semen samples where the concentration of sperms is below 40 mill/mL may be associated with longer time to pregnancy or even subfertility, and specimens where the concentration of sperms is below 15 mill/mL may carry a high risk of infertility. Historic data from the 1940s show that the bulk of young men at that time had sperm counts far above 40 mill/mL with averages higher than 100 mill/mL. However, recent surveillance studies of young men from the general populations of young men in Northern Europe show that semen quality is much poorer. In Denmark approximately 40 percent of the men have now sperm counts below 40 mill/mL. A simulation assuming that average sperm count had declined from 100 mill/mL in 'old times' to a current level close to 40 mill/mL indicated that the first decline in average sperm number of 20-40 mill/mL might not have had much effect on pregnancy rates, as the majority of men would still have had counts far above the threshold value. However, due to the assumed decline in semen quality, the sperm counts of the majority of 20 year old European men are now so low that we may be close to the crucial tipping point of 40 mill/mL spermatozoa. Consequently, we must face the possibility of more infertile couples and lower fertility rates in the future.     

Declining trends in conception rates in recent birth cohorts of native Danish women: a possible role of deteriorating male reproductive health

Recent findings of poor semen quality among at least 20% of normal young men in Denmark prompted us to use unique Danish registers on births and induced abortions to evaluate a possible effect of the poor male fecundity on pregnancy rates among their presumed partners--the younger cohorts of women. We have analysed data from the Danish birth and abortion registries as well as the Danish registry for assisted reproduction (ART) and defined a total natural conception rate (TNCR), which is equal to fertility rate plus induced abortion rate minus ART conception rate. A unique personal identification number allowed the linkage of these databases. Our database included 706,270 native Danish women born between 1960 and 1980. We used projections to estimate the fertility of the later cohorts of women who had not yet finished their reproduction. We found that younger cohorts had progressively lower TNCR and that in terms of their total fertility rate, the declining TNCR is compensated by an increasing use of ART. Our hypothesis of an ongoing birth cohort-related decline in fecundity was also supported by our finding of increasing and substantial use of ART in the management of infertility of relatively young couples in the later cohorts. Furthermore, the lower rates of induced abortion among the younger birth cohorts, often viewed as a success of health education programs, may not be fully explained by improved use of contraception. It seems more likely that decreased fecundity because of widespread poor semen quality among younger cohorts of otherwise normal men may explain some of the observed decline in conception rates. This may imply increasing reproductive health problems and lower fertility in the future, which is difficult to reverse in the short term. The current and projected widespread use of ART in Denmark may be a sign of such an emerging public health problem.     

Development of a model to predict closure of chronic wounds in Germany: Claims data analysis

Patients with chronic leg ulcer, pressure ulcer, or diabetic foot ulcer suffer from significant disease burden. With a view to improving healthcare provision sustainably, a predictive model of time to closure (time-to-event analysis) based on claims data was developed. To identify potential predictors of wound closure, clinical information absent from statutory health insurance (SHI) data was modelled. In patients with leg ulcers, age of the patient (hazard ratios [HR] 0.99), increasing number of comorbidities (HR 0.94), inpatient stays (HR 0.74), and treatment by a specialised wound care professional (HR 1.18) were significant predictors of time to closure (adjusted model). In almost all models, the number of inpatient stays and of comorbidities predicted a lower probability of healing. In addition, the age and the sex of the patient were found to be significant predictors in some models (leg ulcer: HR 0.99; pressure ulcer: HR 0.99). Increasing number of comorbidities and inpatient stays were predictors for closure time in all models. Since these predictors may give an indication of wound severity, further clinical information should be considered in future models, as also indicated by the moderate values of the c-statistics. This requires future data linkage between SHI and primary studies (eg, registers).     

Effects of a new community-based reproductive health intervention on knowledge of and attitudes and behaviors toward stress urinary incontinence among young women in Shanghai: a cluster-randomized controlled trial

Introduction and hypothesis

This study aimed to evaluate the prevalence of stress urinary incontinence (SUI) and to introduce a new community-based reproductive health intervention. We then evaluated the effectiveness of this intervention.

Methods

In this cluster-randomized trial, 2100 participants aged 18–40 years were divided randomly into an intervention group (IG, 1400 women) and a control group (CG, 700 women). The CG received traditional community intervention, cmprising limited reproductive information and education; the IG received the new community-based reproductive health intervention model, comprising self-designed handbooks, health lectures, and free medical consultations, in addition to the traditional community intervention. All participants were surveyed face to face using a self-designed questionnaire before and after the 6-month intervention.

Results

In Shanghai, the prevalence rate of SUI was 14.3 %. No difference was observed between groups regarding mean knowledge, attitudes, and practices (KAPs) about SUI and the total score at baseline (P?>?0.05). The IG scored significantly higher than the CG on the KAP questions at follow-up, and a significant improvement was observed in the IG after the intervention. Total scores increased with age, educational level, income, and time spent working in Shanghai per year but decreased with gravidity and the number of abortions. Native respondents scored higher than did migrants.

Conclusions

The prevalence of SUI is high in Shanghai, and the new community-based reproductive health intervention model is both effective and easily implemented. This intervention should focus on women with a low income, women with low education levels, young women, migrant women, and women who have had multiple abortions or pregnancies.

     

Postoperative extradural infusions in children: preliminary data from a comparison of bupivacaine/diamorphine with plain ropivacaine

To try to decrease the incidence of side-effects associated with postoperative extradural infusions of local anaesthetics in combination with opioids, we have used plain ropivacaine solutions in 200 children. The first 72 children received an infusion of bupivacaine 0.125% + diamorphine 20 microg x ml-1, then 200 children received plain ropivacaine solutions. The children who received ropivacaine were found to have lower incidences of nausea, pruritus, urinary retention, and were less sedated, despite comparable analgesia. The management of plain ropivacaine for extradural analgesia is discussed.     

Assessing emotion recognition in 9-15-years olds: preliminary analysis of abilities in reading emotion from faces, voices and eyes

Primary objective: Little is known about how emotion recognition abilities develop during childhood and adolescence, although adolescence is a time marked by significant changes in socio-emotional behaviour. The first aim of this study was to explore the range of emotion recognition skills that 9-15-year olds would normally display and whether emotion-reading skills are reliably measurable. Secondly, one wanted to determine whether adolescence is a period during which skills in recognizing emotions improve.

Methods and procedures: Novel and adapted measures of emotion processing were used in tasks that required 67 9-15-year olds to read emotion from voices, eyes and faces.

Main outcomes and results: Findings indicate that emotion recognition abilities are reliably measurable skills. A stage of improvement in facial expression recognition and reading emotion from eyes was found to occur at ∼11 years of age.

Conclusions: The findings show that these skills can be measured and that it is possible to devise assessment tests which are sensitive to developmental improvements in emotion recognition skills in early adolescence, when screening for the effects of child brain injury.