Therapeutic Communication Methods Targeting Families and Family Members: A Literature Review

Background and Purpose: Therapeutic communication is a new term in family health care nursing, defined by Hohashi (2019) as a method of family intervention, and characterized by inclusion of not only verbal conversation but also nonverbal interaction. However, specific therapeutic communication methods have not been systematized. The purpose of this study was to clarify therapeutic communication methods for families/family members from the perspectives of verbal communication and non-verbal communication through a review of existing literature. Methods: We conducted a search using the medical literature databases PubMed and Ichushi-Web using the keywords “therapeutic communication”. Analysis was performed on seven articles from PubMed and 14 articles from Ichushi-Web that described therapeutic communication methods performed by healthcare professionals for families/family members. Through directed content analysis, therapeutic communication methods were subcategorized, and classified into three categories: verbal communication, non-verbal communication, and verbal/non-verbal communication. Results: A total of 23 subcategories were extracted. Verbal communication included 11 subcategories, such as “asking questions using the communicatee’s words as they are”. Non-verbal communication included five subcategories, such as “noticing changes in the content of the communicatee’s story”. And verbal/non-verbal communication featured seven subcategories, such as “making the communicatee aware of one’s own beliefs”. Conclusion: Therapeutic communication methods included basic care/caring in family interviews/meetings, as well as verbal communication and non-verbal communication that act on family/family members’ beliefs. It is believed that changes in family/family members’ beliefs can be used to eliminate, reduce, or improve problematic conditions in the family. .

Support from Healthcare Professionals for Couples/Partners Undergoing Assisted Reproductive Technology in Japan: A Literature Review

Background and Purpose: A growing number of couples/partners have been undergoing assisted reproductive technology (ART) in Japan. The purpose of this study was to clarify the support from healthcare professionals based on the support vectors in the Family Care/Caring Theory proposed by Hohashi (2015) through a literature review. Methods: Using Ichushi-Web, we searched for original articles using the keywords “assisted reproductive technology”, “infertility”, “family”, “couple”, “nursing”, “care”, and “support”. Thirteen articles suitable for the purpose of this study were subjected to content analysis. Family support was encoded and grouped into subcategories and categories, and classified according to support vectors. Results: A total of 21 categories of support from healthcare professionals was extracted. Intervention for family internal environment included seven categories, such as “Nursing professionals stay close to females”. Intervention for family system unit included five categories, such as “Nursing professionals adjust couple/partner relationships”. Intervention for micro system only included “Nursing professionals provide opportunities for peer support to the couples/partners” and intervention for macro system only included “Nursing professionals encourage medical doctors to relate to females”. Intervention for family chrono environment included seven categories, such as “Healthcare professionals resolve female’s anxieties”. Conclusion: The support from healthcare professionals could be organized by the support vectors of Family Care/Caring Theory, but intervention for supra system (culture, religion, etc.) was lacking. Moreover, because most support was directed toward females or couples/partners, male-focused direct and/or indirect support are also needed. .

Effect of Aspergillus niger prolyl endopeptidase in patients with celiac disease on a long-term gluten-free diet

BACKGROUND The gluten-free diet(GFD)has limitations,and there is intense research in the development of adjuvant therapies.AIM To examine the effects of orally administered Aspergillus niger prolyl endopeptidase protease(AN-PEP)on inadvertent gluten exposure and symptom prevention in adult celiac disease(CeD)patients following their usual GFD.METHODS This was an exploratory,double-blind,randomized,placebo-controlled trial that enrolled CeD patients on a long-term GFD.After a 4-wk run-in period,patients were randomized to 4 wk of two AN-PEP capsules(GliadinX;AVI Research,LLC,United States)at each of three meals per day or placebo.Outcome endpoints were:(1)Average weekly stool gluten immunogenic peptides(GIP)between the run-in and end of treatments and between AN-PEP and placebo;(2)celiac symptom index(CSI);(3)CeD-specific serology;and(4)quality of life.Stool samples were collected for GIP testing by ELISA every Tuesday and Friday during run-ins and treatments.RESULTS Forty patients were randomized for the intention-to-treat analysis,and three were excluded from the per-protocol assessment.Overall,628/640(98.1%)stool samples were collected.GIP was undetectable(<0.08μg/g)in 65.6%of samples,and no differences between treatment arms were detected.Only 0.5%of samples had GIP concentrations sufficiently high(>0.32μg/g)to potentially cause mucosal damage.Median GIP concentration in the AN-PEP arm was 44.7%lower than in the run-in period.One-third of patients exhibiting GIP>0.08μg/g during run-in had lower or undetectable GIP after AN-PEP treatment.Compared with the run-in period,the proportion of symptomatic patients(CSI>38)in the AN-PEP arm was significantly lower(P<0.03).AN-PEP did not result in changes in specific serologies.CONCLUSION This exploratory study conducted in a real-life setting revealed high adherence to the GFD.The AN-PEP treatment did not significantly reduce the overall GIP stool concentration.However,given the observation of a significantly lower prevalence of patients with severe symptoms in the AN-PEP arm,further clinical research is warranted.

Discussing menstrual health in family medicine

MENSTRUAL HEALTH Menstrual health is a general biological marker for many cisgender women,transgender men and non-binary people.Despite more than half of the population being people who menstruate,stigma,lack of conversation and pressing social needs around menstrual health persists throughout medicine.1 Discussions around menstruation and menstrual management can be difficult for individuals,whether it is with friends or family,or in the healthcare setting.1 Patients who have never discussed menstruation with a clinician may not know what is healthy,assume that an abnormal experience is normal and may endure periods that negatively affect their life,career or well-being.2–5 Menstruation plays a vital role in overall well-being and contributes significantly to an individual’s quality of life.Given their scope of care,family medicine clinicians are poised to identify red-flag menstrual symptoms in their routine visits with patients,reducing time to diagnosis of menstrual disorders.We urge family medicine clinicians to have renewed conversations surrounding menstrual health with their patients.The purpose of this report is to supply a brief overview of the importance of menstrual communication in primary care and serve as a resource to enhance menstrual communication between patient and clinician,with the ultimate goal of decreasing menstrual stigma and promoting improved menstrual health and experiences for patients.

Impact of the Coronavirus Pandemic on Family Well-Being: A Rapid and Scoping Review

The coronavirus disease of 2019 (COVID-19) has had a serious impact not only on the society, economy, and medical system, but also on the families and family members affected by it. This scoping review aimed to describe the effects of the COVID-19 pandemic on family well-being. Original articles in English published between January 2020 and August 2021 that examined the association between COVID-19 and family well-being, were searched on MEDLINE and CINAHL. The literature search was conducted using Mesh or CINAHL Subject Headings on COVID-19 and families. Of the 923 references extracted from MEDLINE and CINAHL, this review included 25 references based on exclusion criteria. The largest number of articles examined the impact of COVID-19 on family caregivers’ mental health, followed by its impact on family relationships. The pandemic reportedly worsened family relationships and functioning, increasing domestic violence. The increased burden of caregiving for children and older adults due to COVID-19 was a risk factor for poor physical, psychological, and social health among family caregivers. The workplace environments and health conditions of workers involved with COVID-19 patients affected their family members’ physical, psychological, and social health. The social and economic impact of the pandemic could change the internal family system and the permeability of its boundaries, necessitating strategies to maintain an open family system. Additionally, family caregivers are at high risk for poor mental health and need a provision of psychosocial support. Moreover, devising strategies to improve workplace environments and alleviate health issues of workers involved with COVID-19 patients would be crucial for better mental health among their family members.

Concept Development and Implementation of Family Care/Caring Theory in Concentric Sphere Family Environment Theory

Caring is directed toward a variety of things. One of them is thought to be the concept of “family caring” aimed at families. This study attempts to clarify family caring and develop Family Care/ Caring Theory (FCCT), with the aim of implementing it in conjunction with an existing family nursing theory, the Concentric Sphere Family Environment Theory (CSFET). In Japan and in Hong Kong, family ethnography (including formal interviews) was conducted. As a result, the item “family health care nurses and their colleagues” was added to the family external environment of the CSFET. In the family environment, evidence was obtained to the effect that the family system unit is cared for by the nursing professional, and conversely the family system unit cares for the nursing professional, in a circular transaction. Observing the two-dimensional plane formed by the structural distance and functional distance, family caring assumes a structure of concentric circles, and according to transactions, the structural distance and functional distance between the nursing professional and family system unit are gradually approached, and through deepening of mutual trust maintain an appropriate distance. Moreover observing the three-dimensional space-time continuum which is created through addition of the temporal distance, family caring forms a helical structure. As transactions are repeated along the temporal axis, the family system unit’s self-actualization of other individuals and the self-actualization of the nursing professional are realized. Through these processes, a family care/caring relationship is reinforced and established. This is the concept of FCCT. Through future utilization in clinical settings this will be empirically substantiated, and it will be necessary to continue making creative corrections and revisions.

Spatial patterns of health clinic in Malaysia

Background: This manuscript aimed to map the spatial distributions of health clinics for public and private sectors in Malaysia. It would assist the stakeholders and responsible authorities in the planning for health service delivery. Methods: Data related to health clinic were gathered from stakeholders. The location of health facilities was geo-coded using a Global Positioning System (GPS) handheld. The average nearest neighbour was used to identify whether health clinics were spatially clustered or dispersed. Hot spot analysis was used to assess high density of health clinics to population ratio and average distance of health clinics distribution. A Geographically Weighted Regression (GWR) was used to analyse the requirement of health clinic in a sub-district based on population density and number of health clinics with significant level

Quantitative risk of positive family history in developing colorectal cancer: A meta-analysis

BACKGROUND Positive family history is a risk factor for development of colorectal cancer.Despite numerous studies on the topic,the absolute risk in patients with a positive family history remains unclear and therefore studies are lacking to validate non-invasive screening methods in individuals with positive family history.AIM To quantify the risk of colorectal cancer in individuals with a positive family history.METHODS A comprehensive electronic literature search was performed using PubMed from January 1955 until November 2017,EMBASE from 1947 until 2018,and Cochrane Library without date restrictions.Two independent reviewers conducted study selection,data extraction and quality assessment.A meta-analysis of Mantel-Haenzel relative risks was performed using the random effects model.Newcastle-Ottawa scale was used to score the quality of selected papers.Funnel plot and Egger’s regression test was performed to detect publication bias.Subgroup analysis was performed comparing Asian and non-Asian studies.Sensitivity analyses were performed to rule out the effect of the timing of the study,overall quality,the main outcome and the effect of each individual study in overall result.RESULTS Forty-six out of 3390 studies,including 906981 patients were included in the final analysis.41 of the included studies were case-control and 5 were cohort.A positive family history of colorectal cancer in first-degree relatives was associated with significantly increased risk of colorectal cancer with a relative risk of 1.87(95%CI:1.68-2.09;P<0.00001).Cochrane Q test was significant(P<0.00001,I2=90%).Egger’s regression test showed asymmetry in the funnel plot and therefore the Trim and Fill method was used which confirmed the validity of the results.There was no difference between Asian versus non-Asian studies.Results remained robust in sensitivity analyses.CONCLUSION Individuals with a positive family history of colorectal cancer are 1.87 times more likely to develop colorectal cancer.Screening guidelines should pay specific attention to individuals with positive family history and further studies need to be done on validating current screening methods or developing new modalities in this high-risk population.

Comparative efficacy of social media delivered health education on glycemic control: A meta-analysis

Objective:To compare outcomes associated with patient education about glycemic control via group chat versus patient education as usual among individuals with diabetes in China.Methods:We searched the following databases both in English and in Chinese languages:PubMed,CNKI,Wanfang database,VIP database,and CBM for articles published up to Jan 1,2018.The studies were screened by two independent reviewers.Using criteria from the risk of bias assessment tool developed by Cochrane Collaboration to assess the risk of bias of eligible studies.A meta-analysis of studies was performed using comprehensive meta-analysis version 3.0.Results:Twenty-five unique randomized clinical trials,including 2,838 patients,were identified.The education delivered via group chat had large overall pooled effect sizes in improving glucose control measured by hemoglobin A1c[Hedges'g=-0.81,95%CI:(-0.98,-0.64)],fasting blood glucose[Hedges'g=-1.11,95%CI:(-1.37,-0.85)],and 2 h postprandial blood glucose[Hedges'g=-0.98,95%CI:(-1.20,-0.76)].Additionally,patient education delivered via group chat has shown consistently superior outcomes in glucose control in short-term(0-3 months),mid-term(3-6 months)and longer-term(6-12 months).Conclusions:Educational interventions via group chat had a superior outcome in blood glucose control compared to education as usual in China.Educational interventions via group chat had superior shortterm,mid-term,and longer-term outcomes in blood glucose control compared to education as usual in China.

Factors Affecting the Perception of Family Functioning among Couples in Child-Rearing Japanese Families

In family healthcare nursing, the family system unit (i.e., a group in which the members, seen as a whole, mutually interact) is the target of care. As nurses tend to obtain family-related information from particular family members in the clinical setting, when assessing families, they often confront the issue of the differences between the theoretical level and methodological level. Although this issue needs resolving for evidence-based family nursing practice, sufficient research is lacking on the methodology related to family assessment. The present study aimed to clarify the factors that affected evaluation of family functioning among couples. Semi-structured interviews were conducted with 10 child-rearing families (couples) using the Survey of Family Environment (SFE) as a family functioning scale. Content analysis identified 12 factors that affected discrepancies in the couples’ evaluations and eight factors that affected agreement in those evaluations. These factors were classified into three categories: factors concerning family or family members;factors concerning questions related to the SFE;and factors concerning the view of the family as a whole. The results of this study should contribute to the development of family assessment tools and effective methods for evaluation of family care.

Chagas Disease: Proposal of Health Education for Community Health Workers in the City of Petrolina, Pernambuco, Brazil

The Education for Health at PET Work Program (PET-Health) is focused on education as a pre-supposition. Actions are directed towards to the integration of service-learning and community. Interdisciplinary principle is directed from fusion of work of graduate students, academics and professionals of health services for the benefit of strengthening primary care and health surveillance. This work aimed to carry out educational activities with Community Health Agents (ACS) of the health facilities of PET-health, with the theme of Chagas disease. This descriptive cross-sectional study was carried out from January to May 2013, and the sample consisted of 25 active ACS in six Basic Health Units in the city of Petrolina, Brazil. In spite of actuation of ACS in primary care for over 10 years, a limited knowledge has been developed about this pathology. The health education workshops developed by the PET group clarified the ACS on Chagas disease allowing them to have an expansion of knowledge about the vector, habitat Barber, transmission, clinical manifestations… After the workshop, it was found that the ACS expanded their knowledge about the disease cycle, expanding the possibilities for action in the prevention of this pathology in their respective coverage areas. This work shows an important form of integration between education, service and community that can govern the new direction of health education.

The COVID-19-Effect on Social Life of Dentist Working in Specialist Dental Centers for Adult: Sample Al-Resafa Health Directorate

Background: While causing a financial and economic loss in many countries in a few months, COVID 19 was of great impact on public health. The Iraqi government took several measures since the first Iraqi case was discovered in February 2020. One of the fundamental measures to control this pandemic is social isolation, which depends greatly on people’s awareness to decrease the incidence of COVID-19. Objectives: To study the COVID-19-effect on dentists’ social life and their future plan, and to find the relation between that effect and some dentists’ demographic variables. Methods: A cross-sectional study was conducted from 2nd January to 7th May 2021, by an electronic version of the questionnaire through Google form. With facilitating orders delivered to all the specialist dental centers for adults of Al-Resafa health directorate;any dentists working in specialist dental centers for adults of Al-Resafa health directorate, and accept to participate in this study. Results: A total of 10 specialist dental centers for adults of the Al-Resafa health directorate represent 566/628 dentists enrolled in this study with a response rate of 88.99%. Most of them aged less than 30 years old (62.2%), female (60.6%), married status (50.4%), had 1 - 3 children (71.91%), Rotator (51.1%), with less than five years of experience (61.3%). Conclusion: COVID-19 affected so many aspects of health workers’ lives including dentists. About two-thirds of dentists had negative feelings, of which almost all had anxiety. Younger ages, females, married and having children are factors that contribute to the affection of dental social lives more than other categories.

Family functioning integrated with diabetes self-management： a concept analysis

Although the concept of family functioning has gained recent popularity, the terms ＂family functioning＂ and ＂family resilience＂ are sometimes confused and used interchangeably. The aim of this concept analysis was to clarify what is meant by family functioning in the context of diabetes self-management by assessing specific attributes, antecedents, and consequences. A concept analysis model by Walker and Avant was applied. The identified attributes of family functioning in a diabetes self-management context included problem-solving, communication, roles, affective responsiveness, affective involvement, and behavioral control. Antecedents included family structure, socioeconomic status, family functioning relationships, family stage, and life events. Consequences included family satisfaction, family cohesion, and family relationships. This analysis provided a deeper understanding of a family functioning concept within a diabetes self-management context. It is recommended that health care providers should be aware of antecedent factors that could inhibit outcome improvement. Further research is needed to explain family functioning attributes in relation to antecedents and potential consequences.

The Correlation between Sexuality and Family Functioning among Patients with Inflammatory Bowel Disease in Japan

Purpose: The objective of this study was to examine the correlation between the sexuality of patients with Inflammatory Bowel Disease and family functioning. Methods: The study took the form of a self-administered questionnaire survey, utilizing the Sexuality Satisfaction Index for IBD (SEXSI-IBD) for measuring sexuality and the Survey of Family Environment Survey of Family Environment (SFE) for measuring family functioning. SEXSI-IBD consists of 28 items and five domains, and SFE consists of 30 items and five domains. The participants were recruited at 15 self-help groups and 14 hospitals. Results: Of 146 participants, 48.6% were male and 52.4% female, with an average age of 41.1 years. A significant correlation was observed between the item average score of SEXSI-IBD and Overall Satisfaction Score (OSS) of SFE. Significant correlations were observed in two domains of the SEXSI-IBD, “Daily interaction” and “Sexual communication,” and in all five domains of the SFE. In particular, for “Daily interaction,” the strongest correlation was observed in the SFE’s “Macro system” and “Family internal environment system.” A correlation was observed between the “Physical contact importance” in SEXSI-IBD and the “Macro system” in the OSS of the SFE. Conclusions: Sexuality correlates with family functioning not only in the family internal environment system but also in the family external environment system. Through an approach aimed at elevating the degree of satisfaction for sexuality, it becomes possible to improve family functioning and realize a sense of family well-being.

What Advice Can We Give to Optimize Our Patients＇ Odds of Aging with Better Health？

The world＇s population is ageing rapidly, which will have substantial consequences. According to WHO： ＂Process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age＂. The aim of this work is to make a literature review on key measures that contribute to healthy ageing. A search was conducted in the following databases： PubMed, Cochrane, National Guideline Clearinghouse, Trip Database, Guideline finders, NICE and WHO database, written in English and published in the last ten years. The following MeSH words were used： ＂healthy ageing＂. The search was conducted from July first till end of December 2015. Based on the articles searched there are many measures with potential to achieve gains in healthy ageing such as prevention of falls; vaccination; regular physical activity, eating fruits and vegetables daily, drinking alcohol moderately; never smoking; prevention of social isolation and social exclusion; prevention of elder maltreatment; public support for informal care giving and create strategies to ensure the quality of care for older people. Getting older can come with a variety of health challenges. In the daily practice of family doctor there are many effective interventions that can improve health and wellbeing in elderly people.

Assessment of Health Purchasing Functions for Universal Health Coverage in Nigeria: Evidence from Grey Literature and Key Informant Interviews

Objective: Out of pocket expenditure is the primary means of financing healthcare in middle and low-income countries. The 2021 government health expenditure in Nigeria at 4.52% falls short of the 15% recommendation of the 2001 Abuja Declaration. This paper examines healthcare purchasing in Nigeria, in order to explore how resources were allocated and create better insight into healthcare purchasing for universal health coverage. Data Source/Study Setting: The study was conducted in the Federal Capital Territory and three states—Lagos, Enugu and Sokoto. Study Design: A cross sectional method was used to examine health purchasing functions in Nigeria. Key informant interviews and review of grey and published literature on health financing in the selected study areas. Data Collection Methods: Primary data were collected from relevant stakeholders across the selected study areas, using a structured interview guide. A search of grey and published literature gave a total of 57 references. Principal Findings: The NHIS has a clearly articulated benefit package, for its formal sector and pro-poor BHCPF program. NHIS covers only about 5% of the Nigerian population. BHCPF (SOML) program targets the bottom 40% of Nigerians on paper, but there is no specific design for reaching them. The NHIS uses both public and private sector providers. It is not clear which providers are used for the BHCPF (SOML) program. The NHIS uses actuarially calculated capitations for primary care services and market-based fee-for-service rates for reimbursing secondary and tertiary care. BHCPF (SOML) uses a macroscale pay-for-performance mechanism to reward states achieving specific health outcomes. Conclusion: Health purchasing functions have serious implication for UHC. However, health care provision in Nigeria is not pro-poor and government efforts do not promote efficiency. Available option is prioritization of health initiatives that ensure value for money through performance-based financing and partnering with the private sector.

Reliability and Validity of the Chinese Version of the Survey of Family Environment (SFE)

This study, in which 519 child-rearing families in Hong Kong participated, examined the reliability and validity of Chinese-language version of the Survey of Family Environment (SFE-C). The SFE-C is a self-administered questionnaire containing 30 items that examines family functioning and family support needs. It is designed to yield an instrument satisfaction score (SS score: family functioning score). Internal consistency was estimated at 0.92 (Cronbach’s alpha for SS scores). In a test-retest study of 33 families, the correlation coefficient for families’ mean SS score over a two-week period was 0.93, indicating high test-retest reliability. Confirmatory and exploratory factor analysis using the Concentric Sphere Family Environment Theory indicated that the SFE-C’s structure included seven factors, thereby supporting the SFE-C’s construct validity. The SFE-C demonstrates good reliability and validity and may be used to evaluate Chinese families’ functioning.

Anemia and Its Associated Risk Factors at the Time of Antiretroviral Therapy Initiation in Public Health Facilities of Arba Minch Town, Southern Ethiopia

Background: Anemia is the most common hematologic abnormality in HIV patients and is associated with disease progression and decreased survival. This study aims to describe the prevalence and predictors of anemia in HIV positive patients at the time of ART initiation at public health facilities of Arba Minch town, Southern Ethiopia. Methods: A total of 411 adults (?15 years) HIV positive patients with complete information on hemoglobin levels and CD4 count and clinical characteristics registered from 2006 to 2013 were assessed for anemia prevalence and risk factors at the ART clinic of the Arba Minch hospital and health center. The measurements of Hemoglobin and CD4 + T cell count were performed using standard methodology at baseline of ART initiation. Results: A total of 411 HIV positive patients (195 males and 216 females) with a mean ± SD age of 33.9 ± 9.0 years were assessed. Hemoglobin levels were between 6.0 and 16.5 mg/dL. The overall prevalence of anemia at the time of ART initiation was 52.3%;with 28.1%, 22.9% and 1.3% mild, moderate and severe anemia respectively. The overall prevalence of anemia was 62.4% among males and 46.7% among females (P < 0.001). An increased risk of anemia was seen in males (adjusted OR = 2.78, 95% CI = 1.77 - 4.35);low CD4 cell counts (adjusted OR = 3.48, 95% CI = 2.09 - 5.79);and history of TB (adjusted OR = 2.89, 95% CI = 1.28 - 6.54). Conclusions: Anemia in HIV-positive patients was highly prevalent at the time of ART initiation. Male gender, low CD4 count and history of TB were associated with higher risk of baseline anemia.

Morbi-Mortality Linked to Unsafe Abortions—Difficulties in Accessing Safe Abortions in Cameroon: Meta-Analysis and Systematic Review

Background: Unsafe abortions are one of the leading causes of maternal mortality, especially in developing countries. In Cameroon, the maternal mortality rate remains high, and the scarcity of data on abortions leads to a lack of solid evidence to advocate on the extent of the abortions related complications. Our objective was to evaluate the unsafe abortions related complications, and to assess the difficulties of accessing safe abortions in our setting. Methods: We carried out a meta-analytic and systematic review in the biomedical databases MEDLINE (Pubmed), Google Scholar and African Journal Online concerning unsafe abortions and/or difficulties in accessing safe abortions in Cameroon. The keywords used for the search are seen in table I. Selection of studies was simultaneously done by two authors. Data were extracted through a form designed on Google Form. We used a random-effect model for proportion estimation, and The I2 and Q statistics to assess the extent of heterogeneity. Results: A total of 430 studies were identified, from which 28 were included and analysed. About 5% (95% CI: 3 - 7) of unsafe abortions leads to death. The contribution of unsafe abortions in maternal deaths was 23% (95% CI: 20 - 27). The rate of severe bleeding and/or anemia were 40% (95% CI: 18 - 63) and the rate of infection was 17% (95% CI: 7 - 28), dominated by pelvic infections, pelviperitonitis, severe sepsis, and septic shock. Case reports described uterine perforations, uterine rupture during the following pregnancy. Abortion was performed in the practitioner’s or patient’s home in 41.4% of cases, in a health center in 35.1% of cases, in a private clinic in 21.2% of cases, drugs selling places and in traditional healer clinics. The restriction of abortion laws, the stigma surrounding abortion and its consequences at any level of the society, lead to the underreporting of unsafe abortions and a deep reluctance to advocate for safe abortion services. Conclusion: The strengthening of awareness campaigns for provider behavior change communication, family planning, the de-stigmatization of abortions, the training of health personnel in post-abortion care, a multidisciplinary and multicentric action would contribute to the reduction in morbidity and mortality due to abortions.

应用中国商环包皮环切手术标准化方案对328例成年男性包皮环切的临床报告

目的:成年男性包皮环切手术标准化和培训可显著降低因手术引起的并发症发生率。由于目前国内外尚无可供参考的成年男性包皮环切手术标准化方案和培训制度,使得临床医生开展成年男性包皮环切手术的质量无法保证。为了建立成年男性包皮环切手术标准化和培训制度,便于临床医生和相关医护人员学习和掌握包皮环切器的临床应用技巧,以中国商环(简称"商环,ShangRing")包皮环切技术为例,根据商环的技术特点和临床实践经验,特别制订了商环包皮环切手术标准化方案,并将其标准化操作运用于临床。方法:采用商环包皮环切手术标准化方案对328例受术者(年龄18～58岁,平均27.8岁;已婚134例,未婚194例;包茎25例,包皮过长303例)进行包皮环切手术。对手术时间、疼痛评分(视觉模拟评分法,VAS)、术后并发症、包皮创口愈合时间、术后外观满意情况进行观察和随访。结果:手术时间为(4.70±1.31)min。手术时受术者疼痛(VAS)评分为(0.24±0.59)分,术后24h疼痛评分为(1.59±0.95)分,去环前24h内疼痛评分(1.72±1.11)分,去环时疼痛评分为(2.72±1.37)分。主要并发症发生率为术后感染0.6%(2/328)、出血0.6%(2/328)、伤口裂开0.6%(2/328)和水肿4.89%(16/328)。在发生出血和伤口裂开的受术者中无1例需要缝合。术后包皮创口完全愈合时间为(20.30±6.69)d。受术者对术后外观满意率99.7%(327/328)。结论:商环包皮环切术具有手术方式易于标准化、手术时间短、术中疼痛轻、术后无须特殊护理、容易完整保留系带,并完全暴露冠状沟、术后外观满意度高、受术者易于接受等优点。初步证明了中国商环包皮环切手术标准化方案的可接受性,严格按照此方案实施手术和随访护理,能最大化地实现商环包皮环切技术的诸多临床优势,将并发症发生率控制在可接受的范围内。