孕前保健对妊娠结局的影响

目的:探讨系统孕前保健对孕妇妊娠过程及妊娠结局的影响。方法:将2009年6～11月曾在南京妇幼保健院孕前门诊进行系统孕前保健的孕妇与意外怀孕的孕妇各500例分别设为研究组与对照组,进行对照研究,跟踪其妊娠过程及妊娠结局。结果:研究组孕妇较对照组文化程度高,多有固定职业,以往不良孕产史发生率高,本次妊娠研究组妊娠期高血压疾病、妊娠期糖尿病、胎儿宫内窘迫等妊娠合并症及并发症的发生率均明显低于对照组,且妊娠结局也明显好于对照组,产后出血量、非足月妊娠、新生儿窒息发生率均明显低于对照组。结论:孕前保健可有效降低妊娠合并症、并发症的发生率,并改善妊娠结局,有利于提高围产保健水平。     

孕前优生指导及孕期保健指导对妊娠结局的影响

目的:探讨孕前优生指导及孕期保健指导对妊娠结局的影响.方法:选择30例由我中心承担孕前优生指导的孕妇作为观察组,并与同期未予孕前优生指导的30例孕妇进行对比研究,对照组进行常规产检,观察组给予孕前的优生指导及孕期的健康教育、运动、饮食等孕期保健指导,对两组孕妇的妊娠结局进行跟踪分析.结果:观察组的妊娠结局明显优于对照组.结论:通过有效的孕前优生指导和孕期保健指导,对妊娠结局有着显著的改善作用.     

孕前体重指数及孕前体重增长对妊娠结局的影响

随着孕期保健的加强,孕妇的体重变化已逐渐受到重视.孕前体重指数及孕期体重的增长已成为影响孕产妇妊娠结局的重要因素.本研究对1000例孕妇进行回顾性分析,探讨孕前体重指数及孕期体重增长对妊娠结局的影响.     

孕前保健对孕妇健康与妊娠结局的影响

目的 研究规范的孕前保健对孕妇健康状况及妊娠结局的影响.方法 按照随机化的原则,选择2012年10月-2014年4月期间在我院孕前门诊采取规范孕前保健的妇女和意外受孕的妇女各120例分别作为观察组和对照组.随访观察两组孕妇的妊娠结局.结果 与对照组相比,观察组孕妇职业稳定性较好,文化程度较高,妊娠并发症如妊娠高血压、妊娠糖尿病及先兆子痫发生率低,两组比较差异有统计学意义（P＜0.05）.此外,早产或过期妊娠及新生儿窒息发生率在两组之间存在显著性差异,观察组显著低于对照组（P＜0.05）,剖腹产率及产后出血量在两组之间差异不明显（P＞0.05）.结论 有效规范的孕前保健对降低妊娠并发症、促进孕妇健康具有重要的意义,并且能有效改善妊娠结局.     

糖尿病妇女的孕前保健

糖尿病是常见的内分泌疾病,可分为胰岛素依赖型(1型,β细胞破坏,胰岛素绝对缺乏),非胰岛素依赖型(2型,胰岛素抵抗为主,伴胰岛素相对缺乏至以胰岛素分泌缺陷为主,伴或不伴胰岛素抵抗),妊娠期糖尿病(gestational diabetes mellitus,GDM)[妊娠期间发生或发现的任何程度的糖耐量异常(impair...     

妇女孕前生活方式和体重控制行为研究

目的 探讨妇女孕前3个月的生活方式和体重控制行为.方法 选取2018年7月至2019年5月在十堰市妇幼保健院首次进行产前检查的816名妇女进行问卷调查.根据体质量指数(body mass index,BMI)将其分为正常体重组(403人,49.39％)、肥胖前期组(238人,29.17％)、肥胖组(175人,21.45...     

孕前体重指数及孕期增长与母婴结局的关系探讨

目的探讨孕妇孕前体重指数（BMI）及孕期增长与母婴结局的关系。方法随机选取河南科技大学第一附属医院2012年1月-2013年12月间建册、正规产检、住院分娩的孕妇260例,按孕前BMI分为3组（消瘦组、适宜组、超重组）,比较各组出现剖宫产、巨大儿、产后出血、胎儿窘迫、新生儿窒息的发生率。此外,根据孕期BMI增幅（△BMI）的不同,将所有孕妇重新分为3组（不足组、适宜组、过多组）,再比较各组不同的母婴结局。结果超重组孕妇的妊娠期高血压、妊娠糖尿病、剖宫产率、巨大儿出生率均明显高于消瘦组、适宜组（P〈0.05）,3组孕妇产后出血、胎儿窘迫、新生儿窒息比较,差异无统计学意义（P〉0.05）,但超重组的发生率均高于消瘦组及适宜组。孕前BMI适宜组的孕妇,其孕期BMI控制效果最差,增幅超标的比例最高。孕期△BMI过多组产妇的妊娠期高血压、妊娠糖尿病、剖宫产率、巨大儿发生率均明显高于不足组及适宜组（P〈0.05）,3组孕妇产后出血、胎儿窘迫、新生儿窒息的发生率比较差异无统计学意义（P〉0.05）,但是孕期△BMI过高组均高于其他两组。结论孕前BMI过高及孕期BMI增长超幅的孕妇,其母婴结局往往不如人意。孕前BMI及孕期BMI增长的快慢及程度可以作为母婴并发症的危险因素之一。     

孕前营养指导

介绍夫妻双方孕前每日饮食的要求及饮食结构。     

孕前门诊健康教育对不良嗜好戒除的效果评价

目的评价对孕前有不良嗜好的妇女实施健康教育的效果。方法选择自2008年6月至2009年5月,在第一妇婴保健院进行孕前检查的妇女中,有饲养宠物或有吸烟饮酒嗜好的妇女共169名,进行健康教育,并进行为期2年的随访。结果有46．2％的受查妇女对医生宣教很满意。各类不良嗜好的完全戒除率分别为：家中饲养宠物60：0％,明显被动吸烟62．9％,每日吸烟75．0％,每日重度饮酒50．0％。医生宣教的质量与孕前饲养宠物（Rs=0．326,P=0．014）,明显被动吸烟（Rs=0．377,P=0．ooo）的戒除呈正相关。孕前无或已戒除明显被动吸烟者妊娠不良结局发生率低于未戒除者（Fisher’s exact=0．014）。结论孕前健康宣教对改变不良嗜好起到了一定的作用。应针对工作的薄弱点加强健康教育。     

孕前保健与婚前保健的区别

孕前保健是目前世界上大多数国家采用的卫生服务理念,目标是为育龄妇女及其家庭提供健康教育和预防保健服务,以减少可能造成不良妊娠结局(如流产、早产、死产、胎儿发育障碍或迟缓、先天畸形、孕产妇严重妊娠合并症等)的危险因素。从生育生命周期分析,一名女性进入青春期直至更     

Health-related lifestyle advice: critical insights

This article situates itself within contemporary public health workforce development issues and provides critical insights into the newly developed roles of health trainers and the wider practice of health-related lifestyle advice. It highlights a number of contradictions and paradoxes in relation to health-related lifestyle advice, in terms of the organisation of the public body in intervention targets, in terms of choice and risk, of the power relation it involves and in terms of the dichotomy between professionalisation and personalisation of public health messages. The analysis highlights the competing discourses of expertise on the one side, and empowerment, autonomy and independence on the other. It is likely that, rather than enforcing only one kind of narrative, health trainer roles would realise a greater liberating potential by facilitating the navigation between different sets of realities at different times and different geographical, cultural and conceptual places.     

Economic rationality and health and lifestyle choices for people with diabetes

Economic rationality is traditionally represented by goal-oriented, maximising behaviour, or 'instrumental rationality'. Such a consequentialist, instrumental model of choice is often implicit in a biomedical approach to health promotion and education. The research reported here assesses the relevance of a broader conceptual framework of rationality, which includes 'procedural' and 'expressive' rationality as complements to an instrumental model of rationality, in a health context. Q methodology was used to derive 'factors' underlying health and lifestyle choices, based on a factor analysis of the results of a card sorting procedure undertaken by 27 adult respondents with type 2 diabetes in Newcastle upon Tyne, UK. These factors were then compared with the rationality framework and the appropriateness of an extended model of economic rationality as a means of better understanding health and lifestyle choices was assessed. Taking a wider rational choice perspective, choices which are rendered irrational within a narrow-biomedical or strictly instrumental model, can be understood in terms of a coherent rationale, grounded in the accounts of respondents. The implications of these findings are discussed in terms of rational choice theory and diabetes management and research.     

Development of food groupings to guide dietary advice for people with diabetes

Objective: To describe the development and characteristics of a food categorisation system and its application to guide advice for diabetes treatment. Design and methods: Foods commonly consumed by 16 adults with diabetes were grouped by macronutrient content and type of fat to form a set of reference food groups for dietary advice. Means for energy and macronutrients from individual food groups were then used to construct an overall intake pattern targeting 8000 kJ and relative amounts of carbohydrate, protein and fat (saturated fatty acids (SFA) < 10%E and (polyunsaturated fatty acids) PUFA ～ 10%E). Variation in energy and macronutrients contributed by all foods partitioned into each food group was assessed by the coefficient of variation of data on the whole diet. Results: To differentiate between sources of fat, 13 food groups emerged and 10 were deemed acceptable to nutritional guidelines for diabetes treatment. The food group pattern was judged adequate for the achievement of dietary recommendations with low‐potential variation in total energy (5%) and macronutrient proportions (protein 6%, fat 6%, carbohydrate 3%), but higher for fat types (SFA 22%, (monounsaturated fatty acids) MUFA 11%, PUFA 12%). Targeted proportions for fat types were achieved only when daily servings of PUFA‐rich, oils, nuts and oily fish or soy were included in an ideal intake pattern. Conclusions: In theory, a dietary pattern constructed from food group sources of macronutrients and individual fat types results in low‐potential variation from recommended nutrient targets and, therefore, is appropriate to guide advice for the treatment of diabetes.     

Portfolio of health advice for young people with disabilities transferring to adult care

BACKGROUND: The transition from paediatric to adult services for young people with complex disabilities is fraught with anxieties for families. To facilitate the transition process a portfolio comprising reports from parents, paediatrician and therapists was collected and given to the young person and family on leaving school. AIM: To evaluate the young people and their parents' views of the usefulness of portfolios in providing comprehensive picture of their health needs. METHODS: A prospective study was performed. Eight families were interviewed and semi-quantitative feedback obtained using standardized questionnaires. RESULTS: Seven out of eight young people and their families were satisfied with the portfolios they received. All of them found the portfolios worthwhile and useful. A quarter of the families would like to have been consulted more about the content of the individual reports. CONCLUSIONS: Portfolios of health reports facilitate transfer of information when young people with disabilities move from paediatric to adult services. Ideally portfolios should be interagency, and include reports from education and social services.     

The dietitians challenge: the implementation of nutritional advice for people with diabetes*

The evidence base for current nutritional recommendations has been extensively reviewed on behalf of the European Association for the Study of Diabetes (EASD) 1998 and the American Diabetes Association (ADA) 2002. The nutrition Sub‐Committee of Diabetes UK is in general agreement with those recommendations. This paper provides consensus‐based recommendations that emphasize the practical implementation of nutritional advice for people with diabetes, and describe the provision of dietetic services required to provide the information. Important changes from previous Diabetes UK (previously British Diabetic Association Diabet. Med. 9 , 189) recommendations include greater flexibility in the proportions of energy derived from carbohydrate and monounsaturated fat, further liberalization in the consumption of sucrose, more active promotion of foods with a low glycaemic index, and greater emphasis on the provision of nutritional advice in the context of wider lifestyle changes, particularly physical activity. Monounsaturated fats are now promoted as the main source of dietary fat because of their lower susceptibility to lipid peroxidation – and consequent lower atherogenic potential. Consumption of sucrose for patients who are not overweight can be increased up to 10% of daily energy derived from carbohydrate provided that this is eaten in the context of a healthy diet and distributed throughout the day. The role of the dietitian is outlined in facilitating lifestyle changes and evidence is presented for the effectiveness of advice provided by trained dietitians. The increasing evidence for the importance of good metabolic control and the growing requirement for measures to prevent Type 2 diabetes in an increasingly obese population will require major expansion of dietetic services if the standards in National Service Frameworks are to be successfully implemented at local level.     

An assessment of lifestyle video education for people newly diagnosed with type 2 diabetes

Background: Education plays a key role in the development of self‐management skills for people with type 2 diabetes, although there is limited evidence for the use of video education. Aims: To develop a video‐based lifestyle education programme for people newly diagnosed with type 2 diabetes and to evaluate changes in knowledge, biomedical indices and quality of life. Methods: Forty‐two newly diagnosed type 2 diabetic subjects were recruited and randomly allocated to either a video education or control group. Data were collected at baseline and 6 months after the intervention. Subjects (43% male) had a mean (SD) age of 60.8 (9.6) years, weight 89.5 (15.5) kg, BMI 31.3 (5.1) kg m², glycated haemoglobin (A1c) 7.4 (1.7)%, total cholesterol 4.7 (1.2) mmol L^?1, high‐density lipoprotein cholesterol 1.15 (0.34) mmol L^?1, triglycerides 1.8 (1.0) mmol L^?1, low‐density lipoprotein cholesterol 2.8 (1.0) mmol L^?1, pedometer reading 5721 (3446) steps per day. There were 63.7% correct answers given to the ADKnowl questionnaire and the WHO‐5 Well‐Being score was 65.8%. Results: At 6 months, the intervention group showed increased knowledge compared to controls (74.3% versus 56.4% correct answers, P ≤ 0.0001). Although there were no significant differences in changes over 6 months between the two groups, the intervention group showed improvements in A1c (?0.7%, P = 0.024), total cholesterol (?0.5 mmol L^?1, P = 0.017), low‐density lipoprotein cholesterol (?0.5, P = 0.018) and increased physical activity measured by pedometer (1266 steps per day, P = 0.043) from baseline, with no significant changes in the control group. Conclusions: A brief video intervention increased diabetes knowledge amongst those newly diagnosed with type 2 diabetes and may comprise an effective way of directing education to such individuals.     

社区高血压前期生活方式群组干预研究

目的 研究通过社区群组干预改善生活方式对高血压前期人群血压的影响。方法 采用社区随机对照试验设计。干预组188人参与群组干预,对照组234人进行常规指导,用重复测量方差分析比较干预开展前、开展后6、12、18个月各指标变化情况。结果 单因素重复测量方差分析结果显示,干预组中所有指标随时间变化均有统计学意义（均有P<0.05）,其中饮酒量、吸烟量、油摄入量、盐摄入量、千步当量数、收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）7个方面呈线性趋势;其中饮酒量通过干预减少了5.94 g/d,油、盐摄入量分别减少了4.47 g/d和0.56 g/d,千步当量数增加了10.10/d,SBP从（124.54±5.87）mmHg降低到（122.40±8.32）mmHg,DBP从（79.47±4.86）mmHg降低到（77.14±6.05）mmHg;而对照组中只有吸烟量、体质指数（body mass index,BMI）和DBP随时间变化有统计学意义且呈线性趋势（均有P<0.05）。多因素重复测量方差分析结果显示,吸烟量、盐摄入量、千步当量数、BMI和DBP的组间差异均有统计学意义（均有P<0.05）,且后4个方面存在分组与时间的交互作用。结论 社区群组干预对高血压前期人群的生活方式有改善作用,同时也有控制血压的效果。