从服务人群视角评价云南省国家免费孕前优生健康检查项目效果

目的:从服务人群视角评价其利用孕前优生健康检查服务的现状和需求。提出改善服务质量的建议。方法:以定性和定量研究方式对参加云南省国家免费孕前优生健康检查的群众完成6个小组访谈和15例个人访谈,对45个县(区)随机抽取的229个家庭进行电话回访。结果:44.5%的参检人群从计划生育宣传员处获取参检信息,76.9%在县级服务机构获得国家免费孕前优生健康检查服务;92.6%的人能收到检查结果和告知书,其中37.7%为电话告知;74.7%的参检人群对项目工作表示满意或非常满意,收到或未收到告知书、电话告知或纸质告知的参检对象对服务满意度的评价有统计学差异(均P0.001)。结论:云南省参检人群对国家免费孕前优生健康检查项目的满意度较好,孕前优生健康评估结果反馈是育龄群众对服务质量的直接感受,改善评估告知书的送达途径、加强咨询指导是提高群众获得感和满意度的关键。     

重庆市孕前优生咨询指导医生岗位情况调查分析

正国家免费孕前优生健康检查项目属公共卫生服务范畴,为符合政策的计划妊娠夫妇提供免费的健康教育、健康检查、咨询指导和跟踪随访服务~([1]),目的是减少出生缺陷的发生,提高出生人口素质~([2])。咨询指导是孕前优生健康检查项目中的一个关键的环节,其目的是了解计划妊娠夫妇风险因素与优生的关系,开展针对性的孕前优生咨询和健康指导,帮助其降低出生缺陷的发生风险~([3])。从事孕前优生咨询指导的人员需要掌握遗传学、妇产科学及内科学     

育龄妇女对免费孕前优生健康检查的知识、态度和行为调查

目的对接受健康检查的育龄妇女进行调查,了解其对免费孕前优生健康检查的知识掌握、态度和行为方式,以加强对育龄妇女优生措施的制定提供重要的生物学材料。方法选取自2014年3月15日—2016年5月2日来安阳市文峰区妇幼保健所接受健康检查的待孕妇女共1 365名作为研究对象,采用事先设计好的问卷进行免费孕前优生健康检查的知识、态度和行为状况的调查。结果其中知道出生缺陷定义者占35.31%,知道性病与出生缺陷有一定相关性者占15.24%,知道孕前须进行优生检查者占65.35%,知道优生检查免费者46.38%,知道通过孕前优生检查能够有效避免出生缺陷者占60.95%。工人对妊娠前开始就可导致出生缺陷的知识知晓率最高,文职人员对性病与出生缺陷之间存在一定关系中知晓率最高,技术人员和文职人员对需要进行孕前优生检查知晓率较高,技术人员和文职人员对需要孕前优生性病筛查知晓率较高,对孕前可以进行风险评估及免费咨询指导文职人员知晓率最高,需要进行健康检查技术人员知晓率最高,而文职人员对实验室检查知晓率最高,技术人员对遗传病筛查、地中海贫血和G6PD缺乏知晓率最高。正准备妊娠、已妊娠,有意向、希望检查结果准确可信,有亲戚、朋友参加、可评估生育风险和保密性好几个因素能够影响育龄妇女接受健康检查。结论不同职业人群对免费孕前优生健康检查的知识、态度和行为不同,应该加强对不同职业人群的健康教育宣传。     

新婚育龄妇女对免费孕前优生健康检查的知识、态度、行为调查

目的：了解新婚育龄妇女的免费孕前优生健康检查相关知识、态度、行为（KAP）,为探索制定适宜高效的一级预防干预模式提供依据.方法：对2011年9月～2012年8月在吴川县和惠城区民政部门新婚登记的育龄女性进行出生缺陷一级预防和免费孕前优生健康检查的KAP调查.结果：1 178名新婚育龄妇女年龄25.19±3.34岁,71.39％妇女准备妊娠.83.4％的对象知道预防出生缺陷须从妊娠前开始准备;76.4％知道出生缺陷是由遗传与环境因素共同作用导致的;86.76％对象愿意参加免费孕前检查.关于孕前优生健康检查项目相关信息,调查对象对临床实验室检查了解最多,其次是健康检查,而关于地中海贫血、G6PD缺乏、其他遗传病筛查、优生四项筛查和免费咨询指导、健康教育和风险评估等内容了解较少.准备妊娠或已经妊娠妇女更希望享受免费优生检查;亲戚朋友参加过免费孕前优生健康检查的对象参与检查的意愿较强;化验结果的可靠性和保密性以及生育风险的评估等能增强对象参加免费孕前优生健康检查的意愿.结论：加强出生缺陷知识科普宣传和孕前保健,按需提供出生缺陷干预服务,改善计划生育技术服务水平,可提高目标人群孕前优生健康检查参与率.     

金华市国家免费孕前优生健康检查项目实践与思考

<正>国家免费孕前优生健康检查项目(以下简称国家优生项目)是降低出生缺陷的有效举措。金华市在前几年实施免费婚前医学检查和免费孕前优生检测(简称"两免")的基础上,实现了"两免"与国家优生项目有效对接,2012年开始实施国家优生项目试点工作,2013年实现了国家优生项目区域全覆盖。2013年1~9月参加优生健康检查的有6.93万人,目标人群覆盖率达90%以上,对被确定为优生高风险的对象给予了个性化指导和咨询,并提出进一步复查、诊断、治疗和转诊的建议,有效减少了出生缺     

深圳市龙岗区孕前优生健康检查结果分析

目的通过分析深圳市龙岗区免费孕前优生健康检查结果,探讨孕前优生健康检查对预防出生缺陷的重要价值。方法搜集深圳市龙岗区各承检机构2016-2018年37 505例计划妊娠夫妇免费孕前优生健康检查资料,分析可能存在的妊娠危险因素。结果参加孕前优生健康检查的37 505例,其中参加常规体格检查37 315例,常规体格检查异常16 528例(44. 29%),参加生殖系统检查36 187例,生殖系统检查异常15 994例(44. 20%),筛查出具有风险因素人群数为6 385例(17. 02%),其中男、女所占比例分别为31. 60%、68. 40%。结论做好孕前优生健康检查,可有助于正常怀孕、实现优生,有效降低出生缺陷发生率,提高出生人口素质。     

基层免费孕前优生健康检查现状浅析

<正>免费孕前优生健康检查项目以实施出生缺陷一级预防为主要内容,以孕前优生健康检查为重点,把预防关口前移,为广大育龄群众提供优生指导和服务,降低出生缺陷的发生风险。2012年抚宁县作为第三批国家试点县开展了该项目,2012、2013年共为6188对农村待孕夫妇提供了免费孕前优生健康检查,目标人群覆盖率分别为86.6%、93.83%。本文对抚宁县两年来免费孕前优生健康检查项目开展情况进行总结分析,浅谈开展该项目的工作体会。     

浙江省缙云县7792例孕前优生健康检查结果分析

目的了解浙江省缙云县免费孕前优生健康检查人群的高风险因素,探讨风险干预措施及Rh血型、肾功能(肌酐)、甲状腺功能(TSH)检测在孕前优生检查中的应用价值。方法对2017年1月-2018年12月自愿参加免费孕前优生健康检查的7792例计划怀孕夫妇的检查结果和高风险因素进行研究分析。结果参检者7792例,其中男性3788例、女性4004例;筛查出高风险人群1180例(15. 14%),其中男性452例(11. 93%)、女性728例(18. 18%);高风险因素分布前四位依次为:TORCH病毒感染、妇科疾病、乙肝五项检测异常、甲状腺功能异常。其中TSH检测异常321例(8. 02%),Rh血型阴性19例(0. 25%),肾功能(肌酐)异常11例(0. 14%)。结论加强免费孕前优生健康检查和风险干预,大力推广免费孕前Rh血型、肾功能(肌酐)、TSH检测,有效减少出生缺陷发生。     

2013-2015年深圳市福田区免费孕前优生健康检查结果分析

目的通过对深圳市福田区免费孕前优生健康检查结果进行分析,探讨孕前优生健康检查对优生优育的重要价值,旨在有效降低出生缺陷发生率,提高孕育质量。方法 2013年1月-2015年12月福田区共有57 753人进行免费孕前优生检查,其中男28 669人,女29 084人,按实验室检测各个项目的要求进行规范化检测,根据检查结果和评估办法,将其分为正常人群和风险人群。结果筛查出风险人群数6 592人,风险人群比例为11.41%,其中男性风险人群比例为10.72%,女性风险人群比例为12.10%。结论孕前优生健康检查对预防出生缺陷具有重要作用,应当加强免费孕前优生健康检查的宣传,动员计划怀孕夫妇接受孕前优生健康检查,减少出生缺陷的发生。     

重庆市育龄妇女孕前优生健康检查认知程度与知识获取途径研究

目的探讨重庆市育龄妇女对孕前优生健康检查的认知程度和服务获取途径,分析影响其主动获取孕前保健服务的原因,为有针对性的完善和制定有效的孕前保健推广策略提供科学依据。方法采取分层整群随机抽样的方法,对重庆市5大功能区10个区县育龄妇女进行问卷调查,调查其对孕前保健知识、免费孕前优生健康检查项目了解情况及知晓的途径等。采用χ~2检验和Kruskal-Wallis Test秩和检验进行数据分析。结果收回有效问卷2 100份。研究对象对孕前保健和建立健康生活方式知晓率69. 00%;对国家免费孕前优生健康检查知晓率81. 62%;对优生相关的传染病、病毒、遗传病的知晓程度依次降低,结果差异有统计学意义(χ~2=317. 746 5,P0. 000 1);不同职业间获取孕前优生知识的途径差异有统计学意义(χ~2=44. 329 7,P=0. 044 5)。结论找准目标人群对孕前优生健康检查的有效开展起重要作用。不同人群免费孕前优生检查知晓率有差异,应针对不同人群选用特定途径进行宣传。     

Moderate eugenics and human enhancement

Though the reputation of eugenics has been tarnished by history, eugenics per se is not necessarily a bad thing. Many advocate a liberal new eugenics—where individuals are free to choose whether or not to employ genetic technologies for reproductive purposes. Though genetic interventions aimed at the prevention of severe genetic disorders may be morally and socially acceptable, reproductive liberty in the context of enhancement may conflict with equality. Enhancement could also have adverse effects on utility. The enhancement debate requires a shift in focus. What the equality and/or utility costs of enhancement will be is an empirical question. Rather than philosophical speculation, more social science research is needed to address it. Philosophers, meanwhile, should address head-on the question of how to strike a balance between liberty, equality, and utility in cases of conflict (in the context of genetics).     

植入前诊断在优生方面的应用

植入前遗传学诊断技术是随着辅助生殖技术和分子生物学迅速发展起来的一门新技术,主要用于单基因遗传病夫妇、染色体异常夫妇,此外,还可用于肿瘤遗传易感性分析、组织相容性抗原配对、Rh血型的选择、迟发起病疾病的诊断和性别选择。植入前遗传学诊断对于提高人口素质、控制出生缺陷以及不孕症的治疗是一项非常好的措施,而且大量临床经验初步表明这项技术的安全可靠性。     

From preventive eugenics to slippery eugenics: Population control and contemporary sterilisations targeted to indigenous peoples in Mexico

Eugenic ideas in Mexico were popularised after the Mexican Revolution (1910–1920) as a way of ‘modernising’ and ‘civilising’ the nation. As a result, eugenic ideas were able to linger and be maintained through different departments, institutions, and individuals from all disciplines. After eugenics was considered a pseudoscience, its practices and ideas continued through population control measures that targeted indigenous populations for sterilisation, a trend that still prevails. The purpose of this article is to explore the legacies of eugenics in current sterilizations procedures mostly targeted at indigenous communities in Mexico. I offer the term ‘slippery eugenics’ to account for the legacies of eugenics in Mexico which, in this specific case, resurface in the systematic forced and coerced sterilisation procedures targeted at indigenous communities.     

Genetic testing,eugenics and risk

Many critics regard contemporary human genetic practices as a continuation or resurrection of eugenic programmes of the past. By contrast, others hold that there is a fundamental rupture between old eugenics and modern human genetics. In this paper I argue that neither the continuation hypothesis nor the assumption of a discontinuity are ultimately tenable. While the notion of risk and the focus on individual decisions mark key criteria for distinguishing genetic tests today from the deterministic and collectivistic conceptions of the past, this difference may at the same time be the condition for a universalization of eugenic goals. As, in principle, everyone is affected by genetic risk and potentially 'ill', current eugenic practices no longer focus on 'purification of a collective genetic pool, but on 'government' of individual genetic risks. Instead of eugenic programmes enforced by state institutions, relying primarily on repressive means, we find apparatuses of risk, aiming at the productive enhancement of individual human capital in the name of self-determination and choice.     

Sterilization in Finland: From eugenics to contraception

The purpose of this paper was to describe the transition of sterilization in Finland from an eugenic tool to a contraceptive. Historical data were drawn from earlier reports in Finnish. Numbers of and reasons for sterilizations since 1950 were collected from nationwide sterilization statistics. Prevalence, characteristics of sterilized women, and women's satisfaction with sterilizations were studied from a 1994 nationwide survey (74% response rate). Logistic regression was used for adjustments. In the first half of the 20th century, eugenic ideology had influence in Finland as in other parts of Europe, and the 1935 and 1950 sterilization laws had an eugenic spirit. Regardless of this, the numbers of eugenic sterilizations remained low, and in practice, family planning was the main reason for sterilization. Nonetheless, prior to 1970 not all sterilizations were freely chosen, because sterilizations were sometimes used as a precondition for abortion. Female sterilizations showed remarkable fluctuation over time. Male sterilizations have been rare. The reasons stipulated by the law did not explain the numbers of sterilizations. In a 1994 survey, 9% of Finnish women reported they were using sterilization as their current contraceptive method (n = 189). Compared to women using other contraceptive methods, sterilized women were older, had had more births and pregnancies, and came from lower social classes. Sterilized women were satisfied with their sterilization, but there were women (8.5%) who regretted it. In conclusion, sterilizations have been and are likely to continue to be an important family planning method in Finland. The extreme gender ratio suggests a need for promoting male sterilizations, and women's expressed regrets suggest consideration of a higher age limit.     

地中海贫血基因诊断对指导优生优育的价值分析

目的 统计分析当地孕妇地中海贫血(简称地贫)筛查情况,得出相关基因构成比以指导优生工作.方法 回顾性统计分析2012年我院进行地中海贫血产前筛查的孕妇的筛查结果.结果 在7 996例产检人群中,检出地贫阳性者79例,占0.99％,其中α地贫34例,占0.43％,β地贫45例(包括4例β-地贫合并α-地贫),占0.56％.α地贫以--SEA/αα为主,占61.76％,β地贫以CD41-42最为常见,占40％.结论 本研究获得了永川地区孕妇地中海贫血的常见基因突变类型,有利于指导我区地贫孕妇进行遗传咨询及产前诊断,减少Hb H病和Hb Bart's胎儿水肿综合征患儿的出生,实现优生优育.     

孕前优生健康检查人群中不孕不育发生情况的5年随访研究

目的了解江苏地区孕前检查人群5年生育和不孕不育发生情况。方法采取分层整群抽样方法对江苏苏南、苏中、苏北的3个县7个乡镇在2013年前参加免费孕前优生健康检查的5086对夫妇进行5年跟踪随访。结果①5年内共完成3次随访,随访应答率为100%。孕前检查人群1年累积受孕率为88.68%,1年累积不孕率为11.32%;2年累积受孕率为90.47%,2年累积不孕率为11.97%;5年累积受孕率为96.88%,5年累积不孕率为11.98%。②孕前检查一般风险人群不孕率为11.16%,低风险人群不孕率为11.78%,高风险人群不孕率为14.50%,差异有统计学意义(Z=2.45,P<0.05)。③不孕症患者的5年就诊率为31.42%。孕前检查后第1年就诊的患者5年累积受孕率为53.93%,第2年就诊的患者5年累积受孕率为44.29%,第3~5年就诊的患者5年累积受孕率为18.18%,差异有统计学意义(Z=2.87,P<0.05)。④122对已知不孕原因的对象中,女方原因占58.20%,男方原因占11.48%,双方原因占4.92%,不明原因占25.41%,包括2例性染色体异常对象。结论应加强孕前检查人群中不孕症患者的早期管理,结合孕前检查风险评估结果加以指导,做到早诊断、早治疗。     

Negative and positive eugenics: meanings and contradictions

Eugenics constitutes an important subject of debate, associated with current biogenetics improvements. Considering that the central point in eugenics has always been the preoccupation with future generations' health and constitution, and that the use of scientific means and knowledge for the birth of a physically and mentally healthy child can be considered a eugenic action, this paper tries to analyze the meanings and contradictions of negative and positive eugenics actions, constructed concomitantly with 20th-century technical-scientific improvements. The meanings range, respectively, between limiting or stimulating human reproduction, at the beginning of this century, and preventing diseases or improving physical and mental characteristics, nowadays. In the implantation of actions, contradictions were produced, such as the discrimination and elimination of many people in view of one ideal man, the biologization of eminently social factors, the defense of a supposed scientific neutrality and the indiscriminate use of the reproductive choice right.     

不当出生诉讼与优生认知的探讨

不当出生是指医疗机构或医务人员在产前咨询或产前诊断过程中,因未尽到应有的注意义务向孕妇夫妇提供了关于胎儿的不准确甚至错误的诊断信息,使父母丧失了可以选择终止妊娠的机会,生下了具有先天缺陷的孩子。针对当前社会对不当出生诉讼和优生学的误解,笔者分析了不当出生诉讼的实质和优生学的内涵以及对我国优生的认知,并在此基础上从既要维护个人合法权益,同时也要向社会传达正确的优生观念的角度出发,提出了合理有效解决不当出生诉讼的思考和建议。