Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn

The huge majority of the annual 6.3 million perinatal deaths and half a million maternal deaths take place in developing countries and are avoidable. However, most of the interventions aiming at reducing perinatal and maternal deaths need a health care system offering appropriate antenatal care and quality delivery care, including basic and comprehensive emergency obstetric care facilities. To promote the uptake of quality care, there are two possible approaches: influencing the demand and/or the supply of care. Five lessons emerged from experiences. First, it is difficult to obtain robust evidence of the effects of a particular intervention in a context, where they are always associated with other interventions. Second, the interventions tend to have relatively modest short‐term impacts, when they address only part of the health system. Third, the long‐term effects of an intervention on the whole health system are uncertain. Fourth, because newborn health is intimately linked with maternal health, it is of paramount importance to organise the continuum of care between mother and newborn. Finally, the transfer of experiences is delicate, and an intervention package that has proved to have a positive effect in one setting may have very different effects in other settings.     

野战X光片辅助洗片装置环境适应性实验研究

野战条件下,自动洗片机常因缺乏电源而无法正常工作。野战X光片辅助洗片装置的研制可很好解决在野外复杂地理、气候条件下的X光片洗片功能。该装置不仅可以较好的实现平时对于放射科工作人员的训练任务,使他们了解摄影后的X胶片进入洗片过程的每一个步骤要领,达到熟悉和适应野战条件下的对野战影像技师要求;同时该装置还可作为野战医院或卫生队平时的洗片之用。为验证该洗片装置在复杂地理、气候条件下能否正常工作,我们设计了一组模拟野战环境条件的洗片试验。结果洗出的胶片质量合格率为100%。     

The challenge of balancing methodological research rigour and practical needs in low-income settings: What we are doing and what we need to do better

A roundtable discussion was held with 29 experienced Public Health researchers and policy makers from 9 countries at an international conference in Australia. Their experiences were discussed about establishing and maintaining research projects and health programs in developing countries. This paper aims to (1) Highlight methodological issues relevant to the conduct of research and development in low income settings as discussed at the roundtable; (2) List the main barriers in implementing research and project initiatives in low-income settings; and (3) present recommendations for meeting researchers' needs across cultures without jeopardising methodological rigour. Lessons learnt on barriers for the conduct of methodologically sound research were classified in four domains: investigator factors, community factors, strategic factors and methodological factors. Proposed solutions emerged in the areas of strategic guidelines, attitudinal changes and methodological approaches. Practical solutions to individual and systematic barriers were also suggested. It is hoped that these recommendations will influence current practice and assist other researchers in preparing and undertaking appropriate research methods and health program delivery strategies in low-income settings.     

先进文化在医院核心竞争力中的地位和作用

医院文化是一种管理科学，贯穿于医疗行为的始终，对打造医院核心竞争力有着极其重要的地位和作用。创新机制、外在形象是医院文化建设的核心。医院在发展医疗技术的同时，通过树立医院核心价值观，注重培养团队精神，不断提升服务理念，着力培育先进的医院文化，使文化成为核心竞争力的保障力量。     

我国临床工程发展方向的探讨

介绍了我国和美国医院目前临床工程的现状,并分析了我国临床工程与美国的差距。最后从人员配备和临床工程工作范围等方面提出了我国临床工程发展的方向和实施对策。     

Breastfeeding and Socioeconomic Status in Southern Brazil

ABSTRACT. Patterns of breastfeeding were studied in a cohort of 5 914 infants followed from birth in Pelotas, Southern Brazil. Overall, 92% of the babies commenced breastfeeding and 54% were still breastfed by 3 months of age. This proportion dropped to 30% by 6 months, 20% by 9 months, and 16% by 12 months. The prevalence of breastfeeding soon after birth, and at 3, 6, 9 and 12 months of age was studied according to socioeconomic status as measured by family income. Children from the poorest families were less likely to be breastfed from birth than those from the richest families (89% and 97%, respectively), and also showed lower prevalence of breastfeeding at 3 and 6 months. By the age of 12 months poor children showed the highest prevalence of breastfeeding.     

Which health services reduce maternal mortality? Evidence from ratings of maternal health services

We report cross-national regressions for maternal mortality in 49 developing countries, using indices of the adequacy of maternal health services derived from ratings by at least 10 experts per country. As in previous such regressions, a socioeconomic factor - in this case per capita income - has a significant effect, but having a trained attendant at delivery does not. Instead, the ratings index for access to services has a consistent, significant effect regardless of which estimates of maternal mortality ratios are predicted. Further analysis suggests that access to treatment for pregnancy complications and to services that help avoid pregnancy and birth are most closely related to lower mortality. Service ratings are interdependent, however, so that focusing only on individual services may not be productive.     

A development framework for promoting evidence-based policy action: drawing on experiences in Sri Lanka

Most developing countries have embarked on one form or another of 'health sector reform' as a result of the global trend for health and health care reform that has emerged during the past decade. One consequence is that the issue of health sector performance is moving higher on the agenda of many developing countries, and particularly that of the corporate performance of health sector staff. Along with this movement has come increased attention to strengthening evidence-based management decision-making. To date, studies on measuring health sector performance, have had little impact on developing country health systems and have been limited to explorations primarily at an operational level. However, there is a growing recognition that there is a need to strengthen the policy function of ministries and their ability to monitor policy impact. Sri Lanka is one country that has identified the need to strengthen policy at national level. Many developing countries, like Sri Lanka, are familiar with input, process and output dimensions of operational performance. However, most are not ready to engage in routine performance assessment that can strengthen policy processes at national level. This paper explores (1) the implication and the use of indicators to support evidence based policy decision-making, and (2) the complexity of doing so in Ministries of Health that are undergoing some form of health sector reform. The paper emphasizes that new forms of organizational support are required for performance management at policy level. A conceptual framework for managing the collection and use of performance evidence is developed, including proposals for the introduction of outcome indicators into that process. The paper concludes with recommendations on initiatives required to develop appropriate organizational and technical capacity to engage with performance management at policy level and for further research towards creating ministries of health as 'learning organizations' that can change and adapt with informed decisions.