注意缺陷多动障碍伴学习障碍患儿家庭环境因素对照研究

摘要：目的　探讨注意缺陷多动障碍（ADHD）伴学习障碍（LD）儿童父母教养方式及家庭亲密度和适应性的特点。方法　2005年9月至12月采用两阶段流行病学调查方法对湖南省9495名儿童及其家长进行问卷调查,对符合DSM-Ⅳ诊断标准的ADHD伴LD患儿123例（ADHD伴LD组）和正常儿童142名（对照组）,采用父母教养方式评价量表及家庭亲密度和适应性量表做进一步调查。结果　ADHD伴LD组父母惩罚、拒绝、过度干涉、过度保护及偏爱被试明显高于对照组,差异均有统计学意义（P < 0.05）;而母亲的情感温暖低于对照组,差异均有统计学意义（P < 0.05）。ADHD伴LD组实际亲密度、理想亲密度、实际适应性和理想适应性均明显低于对照组,差异有统计学意义（P < 0.01）。结论　ADHD伴LD患儿父母养育方式存在诸多问题。对该类患儿避免不良的家庭教育方式,采取干预措施尤为重要。     

Mental health and the ageing population

The ageing population of the world presents major challenges for society and for health services. Mental health issues are extremely important, as mental disorders, notably dementia and depression, are common in old age. Mental ill health can profoundly affect the quality of people's old age and has a significant impact upon the use of health and social services. In this paper, we examine these problems from the point of view of older people as consumers, and discuss the role of health promotion, primary care, social services and specialist mental health services for older people. Certain groups within the population, including women, people from minority ethnic backgrounds, very old people, people with learning disabilities, and gay and lesbian older people face some particular issues, which are briefly discussed. Although this paper takes a mainly UK perspective, the mental health of older people is a huge global public health issue. Good epidemiology is central to understanding the needs of ageing populations and responding to them appropriately. Further research is needed in other areas, especially as to which service interventions are effective and efficient.     

Evaluation of a Student‐Nurse Doula Program: An Analysis of Doula Interventions and Their Impact on Labor Analgesia and Cesarean Birth

Introduction: The aim of this study was to describe specific doula interventions, explore differences in doula interventions by attending provider (certified nurse‐midwife vs obstetrician), and examine associations between doula interventions, labor analgesia, and cesarean birth in women receiving doula care from student nurses. Methods: A secondary analysis of data from the Birth Companions Program at the Johns Hopkins University School of Nursing was conducted using t tests, chi‐square statistics, and logistic regression models. Results: In the 648 births in the sample, doulas used approximately 1 more intervention per labor with certified nurse‐midwife clients compared to obstetrician clients. In multivariate analysis, the increase in the total number of interventions provided by doulas was associated with decreased odds of epidural (adjusted odds ratio [AOR] 0.92; 95% confidence interval [CI], 0.86‐0.98) and cesarean birth (AOR 0.90; 95% CI, 0.85‐0.95). When examined separately, a greater number of physical interventions was associated with decreased odds of epidural (AOR 0.85; 95% CI, 0.78‐0.92) and cesarean birth (AOR 0.80; 95% CI, 0.73‐0.88), but number of emotional/informational interventions was not. Discussion: Student nurses trained as doulas have the opportunity to provide a variety of interventions for laboring clients. An increase in the number of interventions, especially physical interventions, provided by doulas may decrease the likelihood of epidural use and cesarean birth.     

The role of alternative medicine in treating postnatal depression

Postnatal depression is a serious and debilitating condition. Due to the perceived stigma of mental illness, the incidence of it is underreported and many mothers refuse psychiatric help either assuming postnatal depression to be normal or because of the potential consequences of having a psychiatric history. Community practitioners who are in contact with new mothers may welcome additional interventions which can enhance the supportive care they give to these women. This article discusses the evidence for a number of these interventions which mothers may find more acceptable than orthodox treatment. The aim of this article is to highlight the possible role of a number of complementary and alternative medicines as adjuncts or alternative treatments for postnatal depression. The interventions discussed in this article include Ayurvedic medicine, herbalism, homeopathy, aromatherapy, massage, hypnosis and traditional Chinese medicine (TCM). With the exception of TCM and Ayurvedic medicine, these interventions have been supported by the House of Lord's Select Committee on Science and Technology (2000) as having an evidence base. Ayurvedic medicine and TCM have been included in this article however, because a number of clients may be using them as their main system of health care--thereby validating the need for information regarding their efficacy. This article is not exhaustive, nor a licence to practice, but is intended as a resource for practitioners with a sound understanding of postnatal depression and conventional treatments whose clients may reject these approaches and be looking for alternative interventions. The final choice of treatment should be the result of discussion between the health visitor and the client and will depend on considerations such as availability, cost and acceptability of the intervention--this article does not, therefore, suggest a 'best option' approach. In addition, it does not address the professional and legal responsibilities of practitioners since these have been well reviewed by Darley (1995), Mantle (1997), Knape (1998) and Rankin-Box (2001).     

Client participation and provider communication in family planning counselling and the sample study from Turkey.

BACKGROUND: The family planning program in Turkey was established in 1965 to curb the rapid increase in population growth. The last Demographic and Health Survey showed that about 64 % of married women in Turkey used contraception. OBJECTIVES: This study examines of behaviour of family planning clients and provider in Eskisehir/Turkey, to see whether they can achieve this ideal parnership. METHODS: Consultation between 83 physicians, 222 nurses and 324 clients requesting family planning methods were audiotaped and analysed for physicians and nurses communication style. Data were collected from 3 hospital and 14 small health units that give services in Eskisehir. The audiotaped consultations were coded using an adaptation of the RIAS which has been used extensively in both developed and developing countries and in statistical analysing chi(2) and t test were utilized. RESULTS AND CONCLUSION: The single strongest factor was providers giving biomedical and technical information. The qualitative analysis of audiotapes found that most of clients' questions concern contraceptive side effects and symptoms. The next category social talk, consisted largely of greetings. Most of the providers (87.6 %) are women. The results show that providers dominate most counselling session and clients rarely take on active role.     

Special issues in contraception: caring for women with disabilities

Women with disabilities make up a diverse population of underserved clients needing skilled, sensitive, and culturally-competent contraceptive care. Barriers to care for these women are structural, attitudinal, and informational, and lack of attention to their needs is also reflected in limited research and clinical guidelines. Special techniques for a modified gynecologic examination can be employed, and disabled women can work in partnership with providers to promote comfort, respect, and safety. There are specific considerations for the use of different contraceptive methods in women with movement limitations, sensory impairments, seizure disorders, developmental disability, and emotional and psychiatric disorders. A climate of welcoming respect as well as clinical expertise in issues specific to this population can enhance the ability to provide contraception to these women.     

The impact of the quality of family planning services on safe and effective contraceptive use: A systematic literature review

The aim of this review is to identify the features of family planning service provision that are influential in ensuring safe and appropriate contraceptive use and optimal effectiveness of user-dependent methods. A systematic search was carried out of the published and unpublished studies available up to December 1997 that examined the relationship between family planning service provision and contraceptive use. Articles that reported primary data on long-term outcomes were scored by at least two of the authors of the present study. Particular attention was paid to evaluating methods of measuring quality of care. A total of 142 articles were identified, but only 16 reported primary data relating to long-term outcomes. The quality of provider-client exchanges was found to have a net incremental effect on contraceptive use. Evidence of effectiveness of methods to improve uptake, continuation of method use, and safe and appropriate use of fertility control is scant. The evidence that is available indicates that training in communication with clients (particularly about side-effects of contraceptive methods) and an emphasis on client choice are key components of effective interventions. The tasks of listening to clients, and tailoring services to local needs, are crucial to the success of family planning service provision.     

The impact of the quality of family planning services on safe and effective contraceptive use: a systematic literature review

The aim of this review is to identify the features of family planning service provision that are influential in ensuring safe and appropriate contraceptive use and optimal effectiveness of user-dependent methods. A systematic search was carried out of the published and unpublished studies available up to December 1997 that examined the relationship between family planning service provision and contraceptive use. Articles that reported primary data on long-term outcomes were scored by at least two of the authors of the present study. Particular attention was paid to evaluating methods of measuring quality of care. A total of 142 articles were identified, but only 16 reported primary data relating to long-term outcomes. The quality of provider--client exchanges was found to have a net incremental effect on contraceptive use. Evidence of effectiveness of methods to improve uptake, continuation of method use, and safe and appropriate use of fertility control is scant. The evidence that is available indicates that training in communication with clients (particularly about side-effects of contraceptive methods) and an emphasis on client choice are key components of effective interventions. The tasks of listening to clients, and tailoring services to local needs, are crucial to the success of family planning service provision.     

Learning disabilities and the menopause

How menopause affects women with learning disabilities is a neglected area of research. Women with learning disabilities experience the same physiological effects of the menopause as others, including hot flushes and night sweats, but difficulties in understanding and communication mean that additional supports are often required. They are less likely to report the psychological difficulties or symptoms associated with menopause than women in the general population. Menopause is usually earlier in women with learning disability and earlier still for those with Down's syndrome. Debate about hormone replacement therapy often ignores the needs of women with learning disabilities who, as a result, are very often excluded from the decision-making process. Physical problems among women with learning disabilities and other aspects of ageing warrant particular focus.     

Human herpes viruses in pregnancy: cytomegalovirus, Epstein-Barr virus, and varicella zoster virus

Viruses of the human herpesvirus family can have profound effects on pregnancy. Primary maternal infection with cytomegalovirus (CMV) and varicella during pregnancy has been associated with fetal abnormalities and neonatal disease. Public awareness of the role of cytomegalovirus in the etiology of developmental disorders and chronic disabilities needs to increase. With time, we may see new interventions for treatment of infected pregnant women and prevention of long-term effects. Attention must be focused on development of a safe and effective vaccine. With the introduction of an efficacious varicella vaccine, the rate of varicella in pregnancy is expected to decrease dramatically. Physicians caring for women have the opportunity to prevent the complications of varicella by identifying and vaccinating susceptible women.     

The Disability-Related Education and Training Experiences of Perinatal Care Providers in Ontario

We describe the disability-related education and training experiences of perinatal care providers in Ontario. Twenty perinatal care providers (e.g., obstetricians, midwives) participated in semi-structured interviews. Using a content analysis approach, we found most acquired disability-related training through their own initiative as opposed to education through professional training programs. Barriers to training included lack of data on disability and pregnancy and limited experiential learning opportunities. Providers recommended that future training focus on experiential learning and social determinants of health, with people with disabilities involved in developing and delivering training. These efforts are vital to optimize pregnancy outcomes for people with disabilities.     

Therapeutic caring: a learning disability experience

This paper is a reflective account of our experiences of giving Therapeutic Touch (TT), for the first time within a learning disability setting, to a client who has profound learning disabilities. Using a case study approach, we share our story of this pathfinder journey of discovery and show how the process of reflection was instrumental in enabling us to gain insight on the unfolding therapeutic and caring relationship which we developed with this client. Issues relating to informed consent were addressed, however these were complex and needed special consideration. As client consent could not be achieved through verbal means we needed to draw on our senses and use intuitive skills together with team involvement. IntroducingTT into a learning disability setting was breaking new ground, and as this case study has shown it does appear to have the potential to enhance therapeutic caring.     

Midwives' attitudes to counselling women about their smoking behaviour during pregnancy and postpartum

OBJECTIVE: to investigate the attitudes of midwives to counselling women about their smoking behaviour during pregnancy and postpartum. DESIGN: survey using postal questionnaires. SETTING: the entire federal state of Mecklenburg-West-Pomerania in Germany. PARTICIPANTS: 189 midwives constituting 77% of all midwives working in that State. FINDINGS: midwives reported that they assessed smoking behaviour regularly (77%), addressed the consequences of smoking (70%) and advised women to quit. Among the midwives, 81% saw low chances of success and parents' expectations as the biggest barriers to counselling. Midwives reported that about 28% of women quit following their advice. KEY CONCLUSIONS: smoking and exposure to environmental tobacco smoke are seen as prominent health threats that midwives reported they addressed routinely, including giving advice to stop smoking. IMPLICATIONS FOR PRACTICE: midwives should be supported in learning effective intervention strategies to further strengthen their work. They are a target population to deliver brief smoking interventions.     

Contraceptive counselling for women with multiple unintended pregnancies: the abortion client’s perspective

Objectives: Some women have multiple unintended pregnancies. Appropriate interventions could prevent some of the abortions that follow. This article presents the opinions of some abortion clients about their contraception and the counselling they received. It also formulates suggestions for counselling strategies of health care providers (HCPs) and other interventions that can support effective contraceptive behaviour.

Methods: A mixed method approach was used. A quantitative survey was carried out in one clinic in the Netherlands (N?=?201), assessing topics related to contraceptive use and counselling. Semi-structured interviews (n?=?11) were conducted with women who had had at least three unintended pregnancies. Interview topics included the type of contraceptive counselling, experience with contraceptive counselling and preferences regarding access to contraceptive information.

Results: Women who had had multiple abortions were more likely to express a need for contraceptive counselling and more often discussed contraception with their HCP compared with women who had had one abortion. Several themes emerged from the semi-structured interviews that had partially contributed to further unplanned pregnancies: experience with counselling, acceptability of the contraceptive method, sources of information and cultural influences. Many women with multiple unintended pregnancies could not find suitable advice and stated preferences for future decision making.

Conclusion: This study offers insight into the motives for contraceptive use of women with multiple unintended pregnancies. Contraceptive efficacy could be improved by implementing counselling that is adapted to individual needs. The respondents stated that they would appreciate other sources of information, such as support through other forms of communication. The formation of a working group would be helpful in developing these services.     

Communication strategies for the intrapartum nurse

Communication is a dynamic process involving the use of verbal and nonverbal techniques. The intrapartum nurse must use effective communication techniques when eliciting information during the initial interview and throughout the labor and delivery process. The use of effective communication techniques positively affects the clients birth outcome and satisfaction with the birthing experience. This article provides an overview of communication techniques and illustrates specific communication interventions useful in the clinical setting.     

Client participation and provider communication in family planning counselling and the sample study from Turkey

Background?The family planning program in Turkey was established in 1965 to curb the rapid increase in population growth. The last Demographic and Health Survey showed that about 64 % of married women in Turkey used contraception.

Objectives?This study examines of behaviour of family planning clients and provider in Eskisehir/Turkey, to see whether they can achieve this ideal parnership.

Methods?Consultation between 83 physicians, 222 nurses and 324 clients requesting family planning methods were audiotaped and analysed for physicians and nurses communication style. Data were collected from 3 hospital and 14 small health units that give services in Eskisehir. The audiotaped consultations were coded using an adaptation of the RIAS which has been used extensively in both developed and developing countries and in statistical analysing χ² and t test were utilized.

Results and conclusion?The single strongest factor was providers giving biomedical and technical information. The qualitative analysis of audiotapes found that most of clients' questions concern contraceptive side effects and symptoms. The next category social talk, consisted largely of greetings. Most of the providers (87.6 %) are women. The results show that providers dominate most counselling session and clients rarely take on active role.     

Social and ethical determinants of sexuality: gender and health

The aim of this paper is to expand concepts of gender and explore how behaviours associated with sexual identity affect health risks, as well as the right to sexual expression for sexual minorities and persons with disabilities, to promote safe sexual behaviour and reduce the incidence of sexually transmitted diseases, through the internationally sanctioned Sexual and Reproductive Health concept. During the XX century the multiple meanings of sexuality have been progressively recognized and its physical and psychological health dimension have become a reality, enshrined in United Nations (UN) documents. Countries have begun to adapt their legislations to this new reality and Conventions today guarantee equal sexual and reproductive rights to persons with disabilities, while the nature of variant sexual behaviours is being debated. Sexual and reproductive health is today an acknowledged goal for every individual and the right to equality for persons with variant behaviours and disabilities, as well as the coexistence of diverse meanings of sexuality an established fact. Healthy and safe sexual behaviour should become an important goal for all societies and cultures.     

Effectiveness of interventions using apps to improve physical activity,sedentary behavior and diet: An umbrella review

Technology has been recently found to be an effective tool to deliver public health interventions [1]. More specifically, the effects of interventions using apps to improve health have been targeted lately [2]. The goal of the present study was to conduct a systematic review of systematic reviews to summarize the scientific evidence. Three research questions were formulated to guide the research: RQ1. Are interventions using apps effective to improve PA? RQ2. Are interventions using apps effective to improve sedentary behavior? RQ3. Are interventions using apps effective to improve diet? This review of reviews was registered with PROSPERO (CRD42022345909). Systematic reviews were included following the PICOTS framework (population, intervention, comparator, outcomes, time and setting). In addition, reviews with several research objectives were included only when they comprised more than two-thirds of the studies analyzing one or more of the objectives of this review. As a result, 12 systematic reviews were selected for data extraction. Findings uncovered that apps could be effective to improve individuals’ PA, sedentary behavior and diet. However, elements like the intervention components, the context/environment/setting, the length of the intervention or the population targeted should be carefully considered in future studies.     

Changing behaviour in pregnant women: A scoping review

ObjectivesBehaviour change programmes (BCPs) for pregnant women are frequently implemented as part of health promotion initiatives. At present, little is known about the types of behaviour change programmes that are being implemented and whether these programmes are designed and delivered in accordance with the principles of high quality maternity care. In this scoping review, we provide an overview of existing interventions related to behaviour change in pregnancy with a particular emphasis on programmes that include empowerment components to promote autonomy and woman-led decision-making.MethodsA systematic search strategy was applied to check for relevant papers in August 2017 and again in October 2018.ResultsThirty studies met the criteria for inclusion. These studies addressed weight management, smoking cessation, general health education, nutrition, physical activity, alcohol consumption and dental health. The main approach was knowledge gain through education. More than half of the studies (n = 17) included three or more aspects of empowerment as part of the intervention. The main aspect used to foster women`s empowerment was skills and competencies. In nine studies midwives were involved, but not as programme leaders.ConclusionsEducation for knowledge gain was found to be the prevailing approach in behaviour change programmes. Empowerment aspects were not a specific focus of the behaviour change programmes. This review draws attention to the need to design interventions that empower women, which may be beneficial through their live. As midwives provide maternal healthcare worldwide, they are well-suited to develop, manage, implement or assist in BCPs.