河南省卫生Ⅷ项目对妇女产前保健的影响

目的:评价卫生Ⅷ项目对河南贫困地区妇女产前保健的影响。方法:采用分层随机抽样的方法确定要调查的村,入户问卷调查综合项目县、基本项目县和对照县共1238名5岁以下儿童母亲。结果:项目县的产前检查率、检查次数和在乡镇卫生院检查人次都比较高;3县的平均产前检查次数都小于5次,孕早期检查率也都比较低(综合项目县25.80%、基本项目县26.26%、对照县9.40%)。结论:项目在很大程度上改善了产前保健情况,但河南省贫困地区妇女产前保健服务水平相对还比较低,有待项目进一步支持。     

卫生Ⅷ项目对孕产期保健服务利用的影响

目的分析卫生Ⅷ项目实施对于孕产期保健服务利用的影响。方法利用"卫生Ⅷ项目/卫生Ⅷ支持性项目对母婴保健与健康的影响"专项评估中的孕产妇入户调查数据库,分析2001—2006年期间4018例生过小孩的妇女,按年份比较项目县和对照县对象的孕产保健服务利用关键指标。结果项目县被调查对象的平均产前检查次数、住院分娩率、产后访视率等孕产期保健服务利用的关键指标都显著高于对照县。结论卫生Ⅷ项目的实施有效地促进了孕产期保健服务的利用。     

卫生Ⅷ项目对孕产期保健服务利用公平性的影响

目的探讨卫生Ⅷ项目在实现孕产期保健服务利用公平性目标中的作用。方法利用"卫生Ⅷ项目/卫生Ⅷ支持性项目对母婴保健与健康影响"专项评估中的孕产妇入户调查数据库,分析项目县和非项目县不同家庭收入妇女利用孕产期保健服务的差异。结果综合试点县和一般项目县的各项产前、产时和产后保健服务利用率的"最高收入组-最低收入组"的极差都不同程度地低于对照县,且随收入变化的等级趋势也明显弱化。结论乡镇卫生院建设和住院分娩费用减免等项目措施的综合实施,有效地提高了贫困孕产妇利用基本孕产期保健服务的可及性和可负担性,从而改善了孕产妇医疗保健服务利用的公平性。     

产前保健服务利用的公平性调查分析

目的:探讨不同收入状况孕妇产前保健服务利用情况及公平性。方法:以1 685例不同收入水平孕妇为研究对象,利用五分组法测算孕早期检查率、产前检查总次数达标率和健卡率,不同收入状况孕妇各率的比较采用列联表χ2检验,用极差法(率差RD、率比RR)和集中指数(CI)进行产前保健服务利用的公平性比较。结果:在产前保健服务利用情况项目中,孕早期检查率、产前检查总次数达标率及建卡率在不同经济水平孕妇间差异有统计学意义(P<0.05),三项指标均随着经济水平的增高而呈现明显增加的趋势。三项指标中的RD均为负值,集中指数为正值。结论:年均经济收入高、经济状况好的孕妇首次接受孕早期检查率、产前检查总次数达标率及建卡率高于年均收入较低的孕妇,该地区不同经济状况孕妇产前保健服务利用方面存在不公平性。     

经济欠发达地区农村产前保健项目中间结果评价

目的:对经济欠发达地区农村开展的产前保健项目的中间结果进行评价.方法:由县卫生局组织有关产前保健专家对乡镇卫生院产科医务人员进行业务培训;由县卫生局和乡镇领导协调卫生与计划生育部门开展农村社区产前保健的健康教育;由乡镇卫生院产科助产士负责开展产前检查.应用整群随机分组的设计及做干预前后测量的方法进行评价.评价的指标包括初次产前检查孕周、产前检查次数和产前检查率.结果:干预使孕妇初次产前检查的时间提前.干预提高了产前检查率.干预提高了高危妊娠妇女的产前检查次数.结论:卫生与计划生育部门合作开展产前保健是促进经济欠发过地区农村母婴保健工作可行与有效的途径.     

南京地区流动孕产妇产前保健利用状况及其影响因素

目的:了解影响流动人口孕产妇产前保健服务利用现状及其影响因素,为今后制定相关卫生工作政策提供参考依据。方法:分层随机抽取409例流动产妇进行问卷调查,调查内容包括社会人口学特征、孕产史、孕早期检查及产前检查次数等情况。结果:调查结果显示,流动人口中孕产妇初次产前检查平均孕周为(21.1±9.1)周,早期检查率仅为24.9%,平均产前检查次数为(6.2±3.6)次,≥5次的产前检查率为56.2%。影响产前保健利用及时性的主要有月人均收入及是否经产;影响产前保健利用足够程度的因素主要有婚姻、文化程度、配偶有无工作、月人均收入及是否经产。结论:流动孕产妇产前保健利用率低,产前保健利用的主要影响因素为婚姻、文化程度、丈夫有无工作、是否经产及经济因素。     

广东省农村育龄妇女产前保健服务研究

目的了解广东省农村育龄妇女产前保健服务利用现状,探讨妇女产前保健的影响因素。方法利用广东省第三次卫生服务调查数据,研究分析调查时15～49岁农村育龄妇女回顾在1998年1月1日-2003年10月20日最后一次活产时的产前保健服务利用情况。结果全省农村育龄妇女产前检查率85.65%,高于全国农村水平;平均产前检查次数5.14次;产前检查次数≥5次的占48.88%;平均初检孕周13.67周;早孕检查率49.50%,低于全国农村水平。多因素Logistic回归分析发现,影响产前保健利用及时性的主要因素有:文化程度、居住地区、职业和活产次;影响产前保健利用足够性的主要因素有:文化程度、居住地区、经济状况、职业、活产次和家庭离最近医疗点的距离。结论广东省农村育龄妇女产前保健覆盖率扩大,产前检查次数及产前检查次数符合率提高,但早孕检查率下降,早孕检查不受重视;全省不同地区间农村妇女的产前保健服务利用不均衡,非珠三角农村妇女产前保健利用明显不足。建议采取相应措施,提高农村育龄妇女文化程度,加强计划生育管理,提高广东省农村育龄妇女孕产期保健服务利用水平。     

我国部分农村地区产前保健状况分析

目的:了解我国农村地区产前保健状况,探讨存在的问题。方法:利用联合国儿童基金会与中国卫生部目前在中国13个省50个县进行的"母子系统保健项目"的基线调查资料进行描述性分析和分层描述。结果:5岁以下儿童母亲和孕中晚期孕妇产前检查率分别为82.9%和88.9%;孕早期检查率分别为45.9%和50.0%;首次产前检查地点均以乡卫生院为主;产前检查次数分布为产前检查率较高,而至少4次检查率低、按时检查率低;5个基础项目全部检查率分别为17.6%和16.5%。四类农村地区之间,产前保健各项指标均随经济水平下降而下降。结论:被调查农村地区产前保健服务存在一定的质量问题,且四类地区间发展不平衡,应大力提高产前保健服务质量。     

项目县农村地区产前保健现状及影响因素分析

目的:了解项目县农村孕产妇产前保健服务利用状况,分析其影响因素,为制定干预策略提供依据。方法:采用分层整群抽样的方法抽取样本1223名,运用SAS8.2对资料进行统计分析。结果:产前检查覆盖率为95.58%,5次及以上产检率为62.30%,孕早期检查率为47.44%。是否参加母婴保健保偿制是产前检查覆盖率和5次及以上产检率的主要影响因素,产前检查覆盖率的影响因素还有到最近乡镇卫生院的时间,5次及以上产检率的影响因素还包括已有小孩数和家庭硬件设施。孕早期检查率的影响因素包括已有小孩数、父亲和母亲的年龄以及怀孩子前1年家庭收入。结论:该地区产前保健服务利用率有待提高,是否参加母婴保健保偿制是产前保健服务利用的主要影响因素之一。     

卫生Ⅷ项目对妇女孕产期保健知识、就医态度和行为的影响

目的探讨卫生Ⅷ项目对于提高贫困地区妇女的孕产期保健知识、改善就医态度和行为的作用。方法利用"卫生Ⅷ项目/卫生Ⅷ支持性项目对母婴保健与健康的影响"专项评估中的孕产妇入户调查数据库,分析比较项目县和非项目县妇女的孕产期保健知识来源和掌握程度,产前检查和住院分娩的就医/不就医原因。以及所选择的医疗机构级别。结果"乡镇卫生院医生"和"村医或村妇幼专干"为项目地区孕产妇传播了较多的孕产期保健信息。费用不再是影响项目地区孕产妇去医院进行产前检查和分娩的主要原因。在曾进行过产前检查和住院分娩的被调查对象中,项目县的大多选择的是乡镇卫生院,而对照县的大多选择的是县级及以上医疗机构。结论卫生Ⅷ项目的实施使贫困地区孕产妇在乡镇卫生院获得了更多的孕产期保健知识和服务,就医态度和行为趋向合理,有利于各级卫生资源效率的最大发挥。     

Implementation of the Brazilian Breastfeeding Network and prevalence of exclusive breastfeeding

OBJECTIVE

To evaluate the association between the level of implementation of the Brazilian Breastfeeding Network and the prevalence of exclusive breastfeeding.

METHODS

Cross-sectional study of a representative sample of 916 infants < 6 months, in Ribeirao Preto, SP, Southeastern Brazil, in 2011. Data on breastfeeding, place of outpatient care and other characteristics were collected during the National Vaccination Campaign. The factor studied is where outpatient care took place: Private; Non-Network Public; Public with Network Workshop; and Public certified by Network. The individualized effect of the factor studied on the outcome was analyzed using Poisson regression with robust variance.

RESULTS

The comparison between private (reference category) and other outpatient care showed significant dose-response relationship with a progressive increase in the prevalence of exclusive breastfeeding in public non-Network, public with Network Workshop and public accredited by Network outpatient care (p = 0.047). As regards the Basic Health Units accredited by Network category, the Prevalence Ratio of exclusive breastfeeding was equal to 1.47 (95%CI 1.00;2.17), after adjustment for confounding variables.

CONCLUSIONS

The prevalence of exclusive breastfeeding for infants < 6 months was higher in places accredited by the Brazilian Breastfeeding Network, which evinces the importance of investing in accreditation of Basic Units of Health by this strategy.     

Assessment of patient management skills and clinical skills of practising doctors using computer-based case simulations and standardised patients

CONTEXT: Standardised assessments of practising doctors are receiving growing support, but theoretical and logistical issues pose serious obstacles. OBJECTIVES: To obtain reference performance levels from experienced doctors on computer-based case simulation (CCS) and standardised patient-based (SP) methods, and to evaluate the utility of these methods in diagnostic assessment. SETTING AND PARTICIPANTS: The study was carried out at a military tertiary care facility and involved 54 residents and credentialed staff from the emergency medicine, general surgery and internal medicine departments. MAIN OUTCOME MEASURES: Doctors completed 8 CCS and 8 SP cases targeted at doctors entering the profession. Standardised patient performances were compared to archived Year 4 medical student data. RESULTS: While staff doctors and residents performed well on both CCS and SP cases, a wide range of scores was exhibited on all cases. There were no significant differences between the scores of participants from differing specialties or of varying experience. Among participants who completed both CCS and SP testing (n = 44), a moderate positive correlation between CCS and SP checklist scores was observed. There was a negative correlation between doctor experience and SP checklist scores. Whereas the time students spent with SPs varied little with clinical task, doctors appeared to spend more time on communication/counselling cases than on cases involving acute/chronic medical problems. CONCLUSION: Computer-based case simulations and standardised patient-based assessments may be useful as part of a multimodal programme to evaluate practising doctors. Additional study is needed on SP standard setting and scoring methods. Establishing empirical likelihoods for a range of performances on assessments of this character should receive priority.     

2008年度母子系统保健健康促进与健康传播项目效果评估

目的:评估2008年度卫生部/联合国儿童基金会母子系统保健康促进与健康传播项目的实施效果。方法:通过听取汇报、查看档案资料、现场考察和访谈等方式,评估项目执行情况;采取批质量抽样方法评估目标人群健康知识知晓和健康行为形成程度。结果:各项目省组织管理规范;采取大众传播和人际传播相结合的形式传播母婴保健核心信息,重点开展了参与式传播活动;经费拨付及时、使用得当;目标人群核心信息知晓率和行为形成率基本达到了预期的年度目标。结论:通过项目实施,各级项目工作者的项目执行能力均得到提升;在项目地区建立了一支健康传播骨干队伍;目标人群的知识知晓率和行为形成率基本达到项目要求。     

Health literacy weakly but consistently predicts primary care patient dissatisfaction.

OBJECTIVES: To study relationships between health literacy and multiple satisfaction domains. Health literacy is related to some domains of patient satisfaction such as communication and understanding, but little is known about relationships of health literacy with other satisfaction domains. Moreover, the importance of health literacy in predicting satisfaction compared with other patient sociodemographics is underexplored. DESIGN: Cross-sectional survey. SETTING: Primary care waiting areas with a Veterans Administration Medical Center and a university health system. PARTICIPANTS: One thousand five hundred and twenty-eight primary care patients. MAIN OUTCOME MEASURES: A brief demographics questionnaire, the Rapid Estimate of Adult Literacy in Medicine, the Veterans Affairs ambulatory care patient satisfaction survey, and an adaptation of the Charlson Comorbidity Index. RESULTS: In unadjusted regression analyses, lower health literacy level was a significant predictor of worse satisfaction in 7 of 10 domains (P < 0.01). When adjusting for patient sociodemographics, predicted relationships remained significant in six of the seven domains (P < 0.05), with each unit change in the 4-stage literacy classification associated with a 3-6 point decrease in dissatisfaction scores (0-100 scale). Health literacy did not predict overall dissatisfaction (P = 0.55). CONCLUSIONS: These results suggest that health literacy, as assessed through a pronunciation exercise that is closely related to more comprehensive measures of literacy, has a consistent, albeit weak relationship with patient satisfaction. Future work is needed to clarify if patients with lower literacy are really receiving different care than those with higher literacy and to pinpoint the sources of their more negative responses.     

Primary Health Care Evaluation: the view of clients and professionals about the Family Health Strategy

Objective:

to evaluate the attributes of primary health care as for access; longitudinality; comprehensiveness; coordination; family counseling and community counseling in the Family Health Strategy, triangulating and comparing the views of stakeholders involved in the care process.

Method:

evaluative research with a quantitative approach and cross-sectional design. Data collected using the Primary Care Assessment Tool for interviews with 527 adult clients, 34 health professionals, and 330 parents of children up to two years old, related to 33 family health teams, in eleven municipalities. Analysis conducted in the Statistical Package for Social Sciences software, with a confidence interval of 95% and error of 0.1.

Results:

the three groups assessed the first contact access - accessibility with low scores. Professionals evaluated with a high score the other attributes. Clients assigned low score evaluations for the attributes: community counseling; family counseling; comprehensiveness - services rendered; comprehensiveness - available services.

Conclusions:

the quality of performance self-reported by the professionals of the Family Health Strategy is not perceived or valued by clients, and the actions and services may have been developed inappropriately or insufficiently to be apprehended by the experience of clients.     

Prevalence of HCV infection among health care workers in a hospital in central Italy

Health care workers are at risk of acquiring transmissible diseases. Controversial results have been reported about HCV. The aims of the present study are to assess the prevalence of HCV in health care workers in Pistoia General Hospital (central Italy) and to compare prevalence with other groups, particularly with a sample of the general population. Serum samples collected from 511 health care employees engaged in direct clinical task and 222 clerical and nurse school attendees have been tested by ELISA and confirmed by RIBA. Total seroprevalence was 3.8%:4.7% in the first group; 1.8% in the second group. The data showed a slight increase in prevalence by age and not by length of stay in the health care workers' group. Comparison of HCV prevalence with blood donors from the province of Pistoia and the general population from Sersale (Catanzaro, southern Italy), restricted to under-40 subjects, indicates an increasing trend in this order: Blood donors, general population, clerical and nursing school attendees, health care workers' group with the highest value (3.4%). A cohort study is needed to evaluate pattern of HCV seroconversion.     

Implementing Family Health Nursing in Tajikistan: from policy to practice in primary health care reform

The health systems of former Soviet Union countries are undergoing reform away from the highly centralised, resource-intensive, specialised and hierarchical Soviet system, towards a more generalist, efficient health service with greater focus on primary health care. Family Health Nursing is a new model designed by WHO Europe in which skilled generalist community nurses deliver primary health care to local communities. This paper presents a qualitative evaluation of the implementation of Family Health Nursing in Tajikistan. Using Stufflebeam's 'Context, Input, Process, and Product' model, the paper aims to evaluate the progress of this reform, and to understand the factors that help or hinder its implementation. A four-phase research design investigates the development of the Family Health Nurse role over time. In 5 rural areas, 6 focus groups and 18 interviews with Family Health Nurses, 4 observations of their practice, 7 interviews with families and 9 interviews with physicians were carried out. Data were analysed according to the components of Stufflebeam's model. Although the legacy of the Soviet health system did not set a precedent for a nurse who is capable of decision-making and who works in partnership with the physician, Family Health Nurses were successfully implementing new practices. Crucial to their ability to do so were the co-operation of physicians and families. Physicians were impressed by the nurses' development of knowledge, and families were impressed that the nurses could offer real solutions to their problems. However, failure to pay the nurses regular salaries had led to serious attrition of the workforce. We conclude that the success of the Family Health Nurse role in other countries will depend upon its position in relation to the historical health care system.