广州市青少年生殖健康现状及服务需求分析

目的 了解目前广州市青少年对生殖健康服务利用情况、这一人群的基本需求、青少年对于生殖健康知识以及对生殖健康服务的认知程度。方法 以社区为单位进行研究，采取整群抽样的方法，年龄范围包括10-24岁的青少年共1292人。结果 利用目前生殖健康服务的行为、心理和社会文化等相关因素，为下阶段开展符合我市青少年特点的生殖健康保健服务模式提供具体可行的措施。结论 发展和改善医疗保健机构，提供青春期健康服务十分必要。     

农村青少年及家长对青少年保健门诊服务的需求调查

根据联合国人口基金与中国政府第六周期合作方案中“计划生育和生殖健康项目”的实施方案，将在全国30个省项目县大力推行青少年生殖健康服务。为此卫生部和中国疾病预防控制中心妇幼保健中心组织专家编写了项目地区青少年保健门诊服务指南。为使青少年保健门诊服务指南进一步完善，妇幼保健中心深入部分项目县（河北承德县、吉林东辽县、重庆铜梁县）了解农村地区青少年及其父母对青春期保健服务的具体需求，以及服务提供者对青少年保健门诊服务内容、服务形式的建议。     

青少年生殖健康服务需求及影响因素分析

目的:探讨符合我国国情的、并为青少年所接受的青春期生殖健康服务方式,为今后改善青少年的生殖保健服务提供依据。方法:采用整群分层抽样方法,样本总数为4 000人。采用自行设计的自陈式不记名问卷,内容涉及调查对象的一般情况、青春期保健服务现况、青少年生殖健康服务需求及影响因素。结果:(1)青少年对青春期发育和生殖健康问题,男女性的关注有所差异。(2)青少年获取青春期生殖健康知识和信息的途径各年龄段存在明显差异。(3)青少年出现青春期发育、生殖健康问题就诊者,随着年龄的增加,就诊的比例逐渐增加。(4)青少年对青春期发育和生殖健康服务形式的需求,随着年龄增加,需求逐渐增多。(5)青少年对青春期保健门诊服务内容的要求是多种多样的。(6)青少年对青春期门诊服务质量的需求居前3位的是医护人员对病人的态度是否友善、医护人员能够为病人保密、具有精湛的技术。结论:影响青少年对青春期保健服务利用因素是多方面的,既包括青少年自身因素(个体特征、个人经历、知识水平、对保健服务的态度等)、家庭和社会的因素,也包括医疗保健机构提供的服务及提供服务人员因素等。     

北京市怀柔区青少年青春期健康教育需求调查

目的了解怀柔区青少年青春期健康知识的来源和生殖健康服务需求,为开展青春期健康教育提供依据。方法随机整群分层抽取怀柔区某中小学校学生600名,采用自行设计的封闭式问卷进行调查,对所得资料进行分析。结果青少年生殖健康知识知晓率仅为48.3%,另有51.7%的青少年缺乏青春期生殖健康知识。目前获取生殖健康知识的途径主要是通过网络、学校健康教育课、书籍、报纸杂志等,分别占28.43%、19.6%、18.5%、16.24%,来自家长的只占7.11%,97.3%的青少年对青春期生殖健康教育有强烈的需求。结论青少年生殖健康教育有待加强。开展青春期生殖健康教育应实行保健机构、学校、家长相结合的教育方式[1]。     

北京市某区高中生性与生殖健康知识、态度与行为调查研究

目的了解高中生关于性与生殖健康的知识、态度和行为状况,及知识来源和服务需求．为卫生服务机构制定相应的青少年性与生殖健康服务内容及健康教育形式提供依据。方法对636名高中生进行不记名自填式问卷调查。结果被调查高中生时青春期性发育及艾滋病相关知识知晓度较高;男生对边缘性行为及性行为袁示赞同者的比例高于女生．且性行为发生率明显高于女生;有关性与生殖健康知识来源依次为纸质媒体、学校和网络。被调查高中生对心理咨询、青春期疾病的检查与治疗以及青春期生殖健康保健咨询服务需求程度较高。结论应重视学生生殖健康知识教育,对目前部分高中生存在性行为给予正确的引导,卫生服务机构应提供专业服务及咨询工作,使青少年能够得到更专业、更适合的服务。     

青少年生殖健康现状及服务利用状况调查

目的掌握我省青少年生殖健康现状及服务利用情况,以便为广大青少年提供青春期生殖健康适宜的服务方式和途径。方法采用不等比分层整群抽样的方法,以社区为基础,对我省大、中城市3156名青少年生殖健康现状及服务利用情况进行了入户问卷调查。结果我省青少年生殖健康知识缺乏,生殖健康服务及利用不足,生殖健康服务需求存在多种形式和多种内容。结论湖北省青少年生殖健康知识认知水平低,应通过多种途径积极开展青少年生殖健康服务,建立和配备促进青春期生殖健康的医疗服务体系和人力资源。     

妇幼保健机构实施青少年友好服务的可行性研究

目的:分析全国妇幼保健机构现有的青春期门诊现状,探索实施青少年友好服务的可行性.方法:采用信函调查的方式,从财政资源、硬件条件、服务提供情况、物资与健康教育材料、信息系统、青年参与、相关制度与政策支持、人力资源八个方面来综合评价.结果:青春期门诊的开设情况不理想,区域间发展不均衡;多数三级和二级妇幼保健机构尚不具备青少年友好服务实施的可行性.结论:环境布置对青少年友好服务、多种信息宣传方式、面向青少年的多种服务模式以及青年参与青春期门诊的设计和运营可以有效提高友好服务实施的可行性.     

我国青少年性与生殖健康研究进展

青少年性与生殖健康问题已成为一个不容忽视的严峻问题,通过对青少年性与生殖健康知识、态度及行为等现状,性与生殖健康相关问题,性与生殖健康服务的研究,探讨适合中国传统文化和国情的青春期健康教育模式,利用现有资源向青少年提供性与生殖健康教育和服务.     

对新加坡和马来西亚青春期生殖健康的考察与思考

受世界卫生组织西太区的资助 ,“青春期生殖卫生需求及健康促进”项目于 1999年初派出由卫生部、北京医科大学儿童青少年卫生研究所及天津市防病中心组成的 5人考察团 ,对新加坡和马来西亚进行了为期2 w的有关“青春期生殖卫生”项目考察。考察的目的是了解两国在青春期卫生服务及生殖健康促进方面的经验 ,为我国开展这类工作提供借鉴。考察团在新加坡和马来西亚的考察活动主要从政府部门、非政府机构及青少年健康服务及与教育相关的医疗和教育单位、学校等几个层面进行。在这两个国家 ,考察团分别访问了卫生部、教育部、社会福利部以及计划…     

男性青少年对生殖健康服务的利用及影响因素分析

【目的】探讨男性青少年对生殖健康服务利用情况及其影响因素。【方法】选取北京、济南、广州、武汉4城市作为研究现场。采用整群分层抽样和入户调查方法,对2405名10～24岁男性青少年进行调查研究。【结果】研究发现52.9%的男性青少年显示愿意"因青春期健康问题去医院就诊"意愿,有46.4%的男性青少年认为有必要开设青春期生殖健康专科门诊,然而仅有5.5%的男性青少年曾经就青春期生殖健康问题到医院就诊。运用医疗保健服务利用模型进行分析,发现男性青少年的利用倾向和服务需求是影响其生殖健康服务利用的重要因素。【结论】促进男性青少年对生殖健康服务的利用要从提高男性青少年的服务利用倾向、引导服务需求两方面进行努力。     

湖南省妇幼保健机构孕期营养门诊现状分析

目的了解湖南省妇幼保健机构孕期营养门诊设置和服务现状,为规范化孕期营养门诊的建设提供依据。方法湖南省市、县2级妇幼保健机构共16家项目单位(市级4家、县级12家),采用普查方法对机构相关工作人员进行问卷调查。采用SPSS19.0进行统计分析处理。结果湖南省16家妇幼保健机构中开设孕期营养门诊的比例为62.5%,其中县级妇幼保健机构开设比例只有50.0%;开设的孕期营养门诊隶属部门不统一,人员配备、设施设备无统一规范,提供的服务情况无统一标准。结论湖南省妇幼保健机构孕期营养门诊设置比例较低,且无统一规范。应加强孕期营养门诊规范化建设、提高基层妇幼保健院医务人员对孕期营养相关性疾病专病管理水平。     

Does making clinic-based reproductive health services more youth-friendly increase service use by adolescents? Evidence from Lusaka, Zambia.

PURPOSE: To report the findings of a study that evaluated the impact of three youth-friendly service (YFS) projects in Lusaka, Zambia. In 1994, the Lusaka District Health Management Team (LDHMT) identified adolescents as a priority underserved population with regard to reproductive health information and services. As part of its long-term goal to improve the health and well-being of Lusaka youth, the LDHMT, in collaboration with CARE, UNICEF/Zambia Family Life Movement, and John Snow International, implemented three separate YFS projects to increase service use among adolescents. METHODS: Service statistics from 10 clinics (8 "treatment clinics" and 2 "non-YFS clinics") were used to measure adolescent service use. Qualitative and quantitative data were collected to measure the degree of "youth-friendliness" at the clinics and the level of community acceptance of providing reproductive health services to youth. Specific indicators of youth-friendliness were developed that measured the attitudes of the clinic staff toward giving services to youth, whether clinic staff honored privacy and confidentiality, whether boys and young men were welcomed, whether the clinic policies supported providing services for youth, whether clinic staff promoted its services to youth in surrounding community, and whether youth, themselves, perceived that they would be welcomed and have their needs met at the clinics. Similarly, indicators of community acceptance were developed that measured whether parents and other adults supported the provision of reproductive health services to youth. RESULTS AND CONCLUSIONS: Although the projects appear to have improved the clinic experience for adolescent clients and to have increased service use levels at some clinics, the findings suggest that community acceptance of reproductive health services for youth may have a larger impact on the health-seeking behaviors of adolescents.     

农村地区县妇幼保健院助产服务现状及优势分析

目的:调查农村地区不同类别助产机构产科服务提供情况及服务能力,对县妇幼保健院助产服务现状和优势进行分析。方法:在全国随机抽取44个地市全部助产服务机构2010年产科服务情况进行问卷调查,重点对农村地区(县和县级市)中不同类型助产机构进行分析。结果:农村助产服务机构中县妇幼保健院占6.5%,县妇幼保健院产科床位数占辖区产科总床位数的18.1%,分娩数量占辖区分娩量的42.9%,平均每个县妇幼保健院年分娩为1 259人,高于县级综合性医院和其他医疗机构。县妇幼保健院中能提供综合产科和综合新生儿科服务的比例最高分别为85.3%、61.9%,高于县级综合性医院83.1%、59.4%,并明显高于其他医疗机构32.4%、19.3%。结论:县妇幼保健院是农村地区助产服务的主要力量之一,与其他助产机构相比,县妇幼保健院在助产服务提供数量和能力方面都具有一定优势。应进一步加强对妇幼保健机构的规范化建设,以保证其职能的履行。     

关注男性生殖健康发展生殖保健服务

分析和探讨生殖健康研究领域中对男性关注不足的问题和加强中国男性生殖保健服务的策略和对策。通过比较女性生殖保健服务,发现男性生殖保健服务的提供明显不足。目前的生殖保健多是建立在妇幼保健服务的背景上,服务对象多为女性和青少年,少有为男性提供生殖保健服务或方便男性就医的机构。男性对生殖保健服务的利用也明显不足。因此,应该关注男性生殖健康,把开展男性生殖保健服务作为生殖健康领域未来的一项重要任务,积极营造促进男性生殖健康的社会氛围,探索为男性及其家庭提供生殖保健服务的适宜途径。     

高校附属医院城市社区妇幼保健服务模式探讨

目的:探索高校附属医院城市社区妇幼保健服务模式,为公立医院改革提供新思路、新方法。方法:采用便利抽样方法,对辽宁省锦州市区由三级医院管理的某社区395名孕产妇进行问卷调查,分析孕产妇对保健知识和医院社区医疗服务模式的需求。结果:不同社会人口学特征的孕产妇对健康教育知识及健康教育方式的需求均不同。结论:高校附属医院城市社区妇幼保健作为一种新的妇幼保健管理工作服务模式,能增强医院对妇幼保健服务的支持,加快妇幼保健专业人才的培养,强化护理人员对妇幼保健护理的主动服务意识,为促进更加有效的妇幼保健管理模式和公立医院改革提供了新的工作思路和方法。     

Prenatal and Parenting Stress on Adolescent Maternal Adjustment: Identifying a High-Risk Subgroup

OBJECTIVES: Identifying adolescents who are at increased risk for a particularly difficult pregnancy and adjustment into parenthood is important, as the physical and psychological development of their infants rest in the well-being of these new mothers. This study aims to examine the effects of prenatal stress and parenting stress and the association with: (1) adolescent maternal adjustment; and (2) postpartum emotional distress. METHODS: In a prospective longitudinal cohort study, 154 pregnant adolescents (age 14-19) from 10 public clinics were interviewed four times from the third trimester of pregnancy to 16 months postpartum. Planned comparisons of four stress groups were used to compare mean scores for measures of feelings about motherhood, infant care, parenting competency, and emotional distress. RESULTS: Adolescent mothers who experienced high prenatal stress and high parenting stress had lower maternal adjustment (i.e., fewer positive feelings about motherhood, less infant care, and low parenting competency) and high postpartum emotional distress. Even when compared to adolescent mothers who experienced prenatal or parenting stress only, these adolescents were still at a greater disadvantage. CONCLUSIONS: Results suggest that adolescents who experience high stress during and after pregnancy are at increased risk for difficult maternal adjustment and high postpartum emotional distress. Findings support the need for health services targeting this subgroup of adolescent mothers, including both prenatal and parenting support. Early intervention to increase maternal adjustment and decrease emotional distress should remain a priority in facilitating the most optimal maternal and child health outcomes.     

Family planning clinic patients: their usual health care providers, insurance status, and implications for managed care.

PURPOSE: To understand the extent to which family planning clinic patients have health insurance or access to other health care providers, as well as their preferences for clinic versus private reproductive medical care. METHOD: An anonymous self-report questionnaire was administered at three Planned Parenthood clinics in Los Angeles County to 780 female patients aged 12-49 years. Dependent variables included insurance status, usual source of care, and a battery of questions regarding the importance of confidentiality. RESULTS: A total of 356 adolescents (aged 12-19 years) and 424 adults (aged 20-49 years) completed the survey in 1994. Fifty-nine percent of adolescents and 53% of adults had a usual source of care other than the clinic. The majority of each group reported some degree of continuity of care in their usual provider setting. Nearly half (49%) of all adolescents had health insurance compared with 27% of adults. Adolescents cited not wanting to involve family members as the primary reason for not using their usual providers, whereas adults were more likely to cite being uninsured. The majority of both adult and adolescent patients indicate they would prefer the clinic over private health care if guaranteed health care that was free, confidential, or both. CONCLUSION: Despite many patients' having health insurance and other sources of health care, family planning clinics were primarily chosen because of cost and confidentiality. Their reasons for preferring clinics may continue despite changes in access to insurance or efforts to incorporate similar reproductive services into mainstream health care provider systems. Making public or private health care funds available to family planning clinics through contracts or other mechanisms may facilitate patients' access to essential services and reduce potential service duplication.     

Why include men? Establishing sexual health clinics for men in rural Bangladesh

Subsequent to recommendations from the 1994 United Nations International Conference on Population and Development, and given recent findings outlining the links between control of sexually transmitted infections (STIs) and a reduction in HIV incidence, many countries are now seeking to establish STI control programmes. In many cases this is through a policy of providing comprehensive reproductive health care through the maternal and child health/family planning (MCH-FP) system. This involves management of all reproductive tract infections including STIs. This paper demonstrates how such an approach may miss one of the largest target groups--men. In general, men are at higher risk of initially contracting STIs, but, once infected, their clinical management is usually simpler than treating equivalent infections in women. It is argued that these two factors alone make the inclusion of men in STI control programmes critical. The paper outlines the experiences of one programme in rural Bangladesh in establishing sexual health clinics for men within the existing service structure. In response to client demand, the clinics moved beyond simple STI care towards provision of comprehensive sexual health services. Finally, the paper argues that whilst including men in sexual health programmes should never be at the expense of providing services for women, excluding them from service provision may make the objectives of STI control programmes unattainable.     

Adolescents and access to health care.

The developmental characteristics and health behaviors of adolescents make the availability of certain services--including reproductive health services, diagnosis and treatment of sexually transmitted disease, mental health and substance abuse counseling and treatment--critically important. Furthermore, to serve adolescents appropriately, services must be available in a wide range of health care settings, including community-based adolescent health, family planning and public health clinics, school-based and school-linked health clinics, physicians'' offices, HMOs, and hospitals. National, authoritative content standards (for example, the American Medical Association''s Guidelines for Adolescent Preventive Services (GAPS), a multispecialty, interdisciplinary guideline for a package of clinical preventive services for adolescents may increase the possibility that insurers will cover adolescent preventive services, and that these services will become part of health professionals'' curricula and thus part of routine practice. However, additional and specific guidelines mandating specific services that must be available to adolescents in clinical settings (whether in schools or in communities) are also needed. Although local government, parents, providers, and schools must assume responsibility for ensuring that health services are available and accessible to adolescents, federal and state financing mandates are also needed to assist communities and providers in achieving these goals. The limitations in what even comprehensive programs currently are able to provide, and the dismally low rates of preventive service delivery to adolescents, suggests that adolescents require multiple points of access to comprehensive, coordinated services, and that preventive health interventions must be actively and increasingly integrated across health care, school, and community settings. Unless access issues are dealt with in a rational, coordinated fashion, America''s adolescents will not have access to appropriate health services. Current efforts to minimize current health care expenditures through managed care programs inevitably conflict with efforts to deliver comprehensive preventive services to all adolescents. Use of multiple sites may not represent inadequate access to care. However, as managed care reimbursement continues to expand, school-based clinics and free-standing adolescent health programs increasingly report decreases in reimbursement without a change in demand for services. The Office of Technology Assessment study called for explicit funding and expansion of services for America''s youth; since then, a federal Office of Adolescent Health has been authorized, and, by the time this reaches print, should have received appropriations and been staffed. Dryfoos has called for expansion to nearly 5000 comprehensive programs in the coming years.(ABSTRACT TRUNCATED AT 400 WORDS)     

Telepsychiatry Consultation for Primary Care Treatment of Children and Adolescents Receiving Child Protective Services in Chile: Mixed Methods Feasibility Study

BackgroundChildren and adolescents living under the supervision of child protective services have complex mental health care needs. The scarcity and uneven distribution of specialized mental health teams in Chile may limit the provision and quality of care for this vulnerable population. Telepsychiatry can address such health inequities.ObjectiveThe objective of this study was to evaluate the feasibility of a telepsychiatry consultation program for primary health care (PHC) treatment of children and adolescents living under the supervision of child protective services.MethodsWe developed a telepsychiatry consultation program for two rural PHC clinics located in central Chile (Valparaíso Region) and evaluated its implementation using a mixed methods study design. The program consisted of videoconferencing mental health consultation sessions scheduled twice per month (each 90 minutes long), over a 6-month period, delivered by child and adolescent psychiatrists based in Santiago, Chile. We described the number of mental health consultation sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the telepsychiatry consultation program.ResultsDuring the 6-month study period, 15 videoconferencing mental health consultation sessions were held. The telepsychiatry consultation program assisted PHC clinicians in assigning the most adequate diagnoses and making treatment decisions on pharmacotherapy and/or psychotherapy of 11 minors with complex care needs. The intervention was perceived to be useful by PHC clinicians for improving the resolution capacity in the treatments of this patient population. Limitations such as connectivity issues were resolved in most sessions.ConclusionsThe telepsychiatry consultation program was feasible and potentially useful to support PHC clinicians in the management of institutionalized children and adolescents with complex psychosocial care needs living in a poorly resourced setting. A larger scale trial should assess clinical outcomes in the patient population. Regulations and resources for this service model are needed to facilitate sustainability and large-scale implementation.