助产士电话随访对产妇出院后产褥期心身健康的影响

目的探讨助产士电话访视对产褥期产妇生活质量的影响。方法入选2005年7月至2009年7月我院产科1108例经阴道分娩产妇,分为电话访视组（732例）及无电话访视组（376例）。产妇出院后4—14天由责任助产士通过电话访视对产妇进行产褥期健康教育,对如何预防产褥期感染、奶胀、乳头皲裂进行讲解,对产妇提出的疑问进行解答,让产妇学习产褥期护理的知识;产后8周对产妇产褥期感染、奶胀、乳头皲裂及产后心理进行评估。结果电话访视组产妇院后产褥期感染、奶胀、乳头皲裂及产后抑郁症的发生率分别为O％、4．0％、2．5％及2．9％;无电话随访组产妇院后产褥期感染、奶胀、乳头皲裂及产后抑郁症的发生率分别为0．7％、8．5％、5．1％及10．1％。两组比较,电话访视组产妇院后产褥期感染、奶胀、乳头皲裂及产后抑郁症的发生率明显降低,差异有统计学意义,P〈0．05。结论助产士电话随访能改善产妇院后产褥期心身健康,有助于产妇顺度过产褥期,预防疾病。     

助产士门诊对糖耐量降低孕妇管理行为作用

目的探讨成立助产士专科门诊,进行糖尿病健康教育对改善妊娠期糖耐量降低孕妇血糖控制及改善孕妇自我管理行为的促进作用。方法选择105例妊娠糖尿病患者,分为糖尿病干预组39例,糖尿病对照组66例。干预组由助产士专科门诊糖尿病健康教育助产士进行系统的糖尿病教育,对照组只给予一般的健康教育,比较其血糖控制及自我管理行为。结果干预组在接受糖尿病教育后其糖尿病相关知识水平和疾病控制行为有了显著的提高。干预组孕妇餐后2h血糖与对照组相比,有显著改善。结论通过专科门诊助产士加强对糖尿病干预组实施糖尿病教育后,孕妇糖尿病相关知识水平和疾病控制行为有了显著的提高。     

Newborn hearing screening at a community-based obstetric unit: Screening and diagnostic outcomes

ObjectivePostnatal visits at community-based midwife obstetric units (MOUs) have been proposed as an alternative primary healthcare screening platform in South Africa. This study evaluated the outcomes of distortion product otoacoustic emissions (DPOAEs) and automated auditory brainstem response (AABR) screening conducted by a dedicated non-professional screener at a community-based MOU in the Western Cape, South Africa.MethodsUniversal newborn hearing screening (UNHS) at a community-based MOU was evaluated over a 16-month period. A dedicated non-professional screener was trained to follow a two-stage screening protocol targeting bilateral hearing loss. A two group comparative design was used alternating AABR (Maico MB11 BERAphone™⁾ and DPOAE (Bio-logic AuDX I) technology on a daily basis. Infants referring the initial screen received a follow-up appointment in two days’ time and were rescreened with the same technology used at their first screen. Those referring the second stage were booked for diagnostic assessments.Results7452 infants were screened including 47.9% (n = 3573) with DPOAE and 52.1% (n = 3879) with AABR technology. Mean age at first stage screen was 6.1 days. The initial bilateral referral rate was significantly lower for AABR (4.6%) compared to DPOAE (7.0%) and dropped to 0.3% and 0.7% respectively following the second stage screenings. First rescreen and initial diagnostic follow-up rates of 90% and 92.3% were obtained for the DPOAE group and 86.6% and 90% for the AABR group. Follow-up rates showed no significant difference between technology groups. Diagnostic assessment revealed a higher prevalence rate for bilateral SNHL among the AABR group (1/1000) compared to the DPOAE group (0.3/1000). Screening technology had no significant influence on daily screening capacity (23 AABR/day; 24 DPOAE/day).ConclusionsPostnatal visits at community-based MOUs create a useful platform for hearing screening and follow-up. AABR technology with negligible disposable costs provides opportunity for AABR screening to be utilised in community-based programmes. AABR screening offers lower initial referral rates and a higher true positive rate compared to DPOAE.     

Performance appraisal of rapid on-site malaria diagnosis (ICT malaria Pf/Pv test) in relation to human resources at village level in Myanmar.

Logistic, economic and technical factors limit rapid access to microscopic confirmation of symptomatic diagnosis of malaria in many rural areas in endemic countries such as Myanmar. A study was conducted to evaluate a rapid on-site immunochromatographic test (ICT Malaria Pf/Pv) for detection of Plasmodium falciparum and P. vivax in two villages in the Taikkyi region of Myanmar. The ICT Malaria tests were performed by a volunteer health worker (VHW) in Yae-Aye-San village and by a professionally trained midwife (MW) in Kankone village. A total of 1000 symptomatic patients participated in the study by providing blood samples for an ICT test and for microscopy. The ICT performance indices, relative to microscopy, were better for the trained MW compared with the less experienced VHW. For P. falciparum and/or P. vivax infections, the sensitivities were 82.7% for the VHW compared with 93.7% for the MW. For P. falciparum infections, the sensitivities were 82.2% for the VHW and 91.3% for the MW, while the corresponding values for P. vivax infections were 66.7 and 79%, respectively. Although the test kit appeared to perform better in more experienced hands, this study questions whether this difference is related to the use of the ICT Malaria Pf/Pv test kit, or related to other factors such as differences in the quality of blood slides prepared by the VHW and MW for microscopic examination. Overall, the results suggest that a rapid diagnostic assay such as the ICT Malaria Pf/Pv test kit can be used in rural settings by relatively inexperienced persons, such as VHWs, with a reasonable degree of sensitivity, thus providing on-site confirmation of symptomatic diagnosis of malaria.     

Signalling,status and inequities in maternal healthcare use in Punjab,Pakistan

Despite rising uptake of maternal healthcare in Pakistan, inequities persist. To-date, attempts to explain and address these differentials have focused predominantly on increasing awareness, geographic and financial accessibility. However, in a context where 70% of healthcare is private sector provided, it becomes pertinent to consider the value associated with this good. This study examined patterns of maternal healthcare use across socioeconomic groups within a rural community, and the meanings and values attached to this behaviour, to provide new insight into the causes of persistent inequity. A 10-month qualitative study was conducted in rural Punjab, Pakistan in 2010/11. Data were generated using 94 in-depth interviews, 11 focus group discussions and 134 observational sessions. Twenty-one pregnant women were followed longitudinally as case studies. The village was comprised of distinct social groups organised within a caste-based hierarchy. Complex patterns of maternal healthcare use were found, linked not only to material resources but also to the apparent social status associated with particular consumption patterns. The highest social group primarily used free public sector services; their social position ensuring receipt of acceptable care. The richer members of the middle social group used a local private midwife and actively constructed this behaviour as a symbol of wealth and status. Poorer members of this group felt pressure to use the afore-mentioned midwife despite the associated financial burden. The lowest social group lacked financial resources to use private sector services and opted instead to avoid use altogether and, in cases of complications, use public services. Han, Nunes, and Dreze's (2010) model of status consumption offers insight into these unexpected usage patterns. Privatization of healthcare within highly hierarchical societies may be susceptible to status consumption, resulting in unforeseen patterns of use and persistent inequities. To-date these influences have not been widely recognised, but they deserve greater scrutiny by researchers and policy-makers given the persistence of the private sector.     

助产分娩泵的临床应用

目的探讨助产分娩泵在产科临床中的应用。方法选择住院分娩孕妇93例,其中观察组47例实施助产分娩泵,另选同样条件46例作为对照组,不使用助产分娩泵。观察两组产妇的产程进展、分娩方式及对疼痛的感觉。结果观察组第一产程平均时间比对照组缩短4.4 h,第二产程平均时间较对照组缩短0.47 h,总产程平均时间较对照组缩短5.0 h,两组产程比较差异有统计学意义(P<0.05)。观察组阴道分娩36例,分娩率为76.6%,剖宫产11例,剖宫产率为23.4%,对照组阴道分娩22例,分娩率为47.8%,剖宫产24例,剖宫产率为52.2%,两组分娩方式比较差异有统计学意义(P<0.05)。观察组使用助产分娩泵0分18例,6分0例;对照组0分0例,6分12例。观察组孕妇分娩时疼痛感明显低于对照组,两组比较差异有统计学意义(Z=6.7885,P<0.05)。结论在产科分娩中运用助产分娩原可以明显缩短产程,降低剖宫产率,不增加母婴并发症,是一种助产新技术,值得推广应用。     

Midwives’ experiences of providing contraception counselling to immigrant women

ObjectiveTo describe midwives’ experiences of providing contraception counselling to immigrant women.MethodsThe study was conducted with a qualitative design, based on interviews followed by inductive content analysis. Ten midwives were interviewed, working at midwife-led prenatal clinics in immigrant-dense areas in southern Sweden.ResultsMidwives require knowledge and understanding of cultures and religions in order to provide contraception counselling to immigrant women. It is important for the midwives to be aware that women have different values regarding sexual and reproductive health. The challenge for the midwives is to understand and to be curious about every woman’s lifeworld perspective, culture and religion. The midwives knowledge and understanding of cultures and religions is acquired through experience and shared between them. Knowledge makes a midwife confident in her role as the contraception counselling provider to immigrant women.ConclusionCultural and religious factors affect contraception counselling. According to the midwives, knowledge and awareness of these factors is crucial and leads to improved understanding of midwives providing contraception counselling, better compliance, fewer unwanted pregnancies and improved sexual and reproductive health among women.     

家庭分娩室助产103例临床研究

综合阐述了２ 组２１３ 例产妇助产过程中可促进胎儿娩出的半卧位分娩式,倾斜角为４０ ～５０ 度的临床意义。母婴共同完成娩出过程中产道、胎儿、肌肉收缩力（ 产力） 的生理功能和改进分娩环境及监护产程、助产、降低产妇分娩期紧张情绪的护理方法。经临床对比研究,结果：家庭分娩组较一般分娩组第二产程（ 胎儿娩出期） 平均缩短１２ 分钟, Ｐ＜ ０ ．０５ 。头位难产率降低１１ ．６６ ％ , Ｐ＜ ０ ．０１ ,相对减少了新生儿窒息率。