Impact of Antimicrobial Stewardship Programs on Antibiotic Use and Drug Resistance:Analysis of Data from Maternal and Child Health Care Hospitals in Hubei Province,China

ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).

Maternal complications and the utilisation of maternal health care services with special reference to West Bengal, India

The study aims to examine maternal complications in the eastern states of India. Further, an attempt is also made to understand the socioeconomic factors that determine the utilization of health care services during maternity in the state of West Bengal. The data used for the study are District Level Household Survey (DLHS) 2007-08, which reveals wide regional variations in maternal complications in India. But the state of West Bengal depicts a unique picture. It has the dubious distinction of achieving low fertility and mortality with high maternal complications. The utilisation of health care services in West Bengal was never near completion. Full utilisation of ANC which is essential for safe motherhood is just above national average. A large number of deliveries still take place out of the institution and are unsafe. Analysis reveals that higher age at motherhood increases the probability of utilising maternal health care services. Social groups, years of schooling, wealth index and place of residence also show significant relationship. The findings of the study provide an insight that efforts should be made to create awareness among socially and economically disadvantaged groups of the society about the benefits of utilisation of health care services. Further it also addresses the issue of creating awareness about MDG’s.

The Management of Mental Health, and Service Networks in Italy

Madness has attracted and frightened for centuries,and talking about this means discussing how this diversity was built and managed in different social contexts and historical periods.Not all societies have had,and still have,the same relationship with madness.It is only with the affirmation of the Modern State,and of Capitalism,that the idea of“normality”indispensable to be able to conceive diversity as something dangerously distant and different from the norm takes over.In our post-modern society,people with mental illness in Italy can resort to specialists and social-health services.But the heterogeneous answers given after the approval of law 180 appear to be increasingly diversified.In this research,much attention will be paid to how the social and health services,located in different areas of Italy(Messina,Rome,Trento)face the current growing risk of social,housing and economic isolation of these fragile subjects.The aim of the research is to explore the possibility of a new relationship between the social-health service and the local community.On the one hand,research investigates what the contribution of the services could be.On the other what the spaces of protagonism and participation of the community could be in inclusion process account.In order to better understand the differences between these two dimensions,a qualitative research approach was chosen through the conduct of in-depth interviews.In this way it was possible to investigate:(1)the partial representations characteristic of the single individual,family members,operators and stackholders in general;(2)the services around the topic dealt with is articulated.From the first results of the research it emerges that the territory can no longer be considered as an abstract entity,but becomes the social space within which the construction of a new community welfare can and must take place.

Classification,prevalence and integrated care for neurodevelopmental and child mental health disorders:A brief overview for paediatricians

‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including autism spectrum disorder,attention deficit/hyperactivity disorder,tic disorder/Tourette’s syndrome,developmental language disorders and intellectual disability.Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability.Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm.Together these are referred to as neurodevelopmental,emotional,behavioural,and intellectual disorders(NDEBIDs)in this paper.Varying prevalence rates for NDEBID have been reported in developed countries,up to 15%,based on varying methodologies and definitions.NDEBIDs are commonly managed by either child health paediatricians or child/adolescent mental health(CAMH)professionals,working within multidisciplinary teams alongside social care,education,allied healthcare practitioners and voluntary sector.Fragmented services are common problems for children and young people with multi-morbidity,and often complicated by subthreshold diagnoses.Despite repeated reviews,limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research.The recently developed“Mental,Behavioural and Neurodevelopmental disorder”chapter of the International Classification of Diseases-11 offers a way forward.In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID,enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.

Advances in the Health Training Process Quality:Links between Education,Service and Community

This study proposes to discuss the experience lived by Pró-Saúde and PET-Saúde team of FACISA/ UFRN together with the Municipal Health Department of Santa Cruz/RN from a critical-reflexive perspective about the interaction between education, service and community as well as advances in approach and the strengthening between the school and Primary Health Care. This is an exploratory study with an experience report approach of the Pró-Saúde and PET-Saúde team from 2012 to 2014. The integration of these programs in experimental scenarios of the Unified Health System and the strengthening of the proposed training of human resources capable of the current healthcare system were observed. Thus, contributions in health in undergraduate courses and practices of health services are important, since the approach to the reality of the population and their social needs contribute to the vocational training quality.

Assessment of reproductive health service utilization in urban slums: Evidence from Western Rajasthan

Objective:To assess the utilization of reproductive health services in urban slum of Jodhpur city,India.Methods:A community based cross-sectional study was conducted in an urban slums of Jodhpur city amongst 300 married women of reproductive age between March and June 2021.Semi-structured questionnaire was used to gather demographic data and information about utilization of antenatal care(ANC)services,delivery and post-partum services.Results:The majority of females were aged less than 25 years(n=195;65.0%),married after 18 years(n=240;80%),living in extended families(n=265;88.3%)and with monthly family income less than 10000 rupees(n=182;60.7%).Statistically significant associations were found between≥4 ANC visits and educational level of secondary and above(OR 2.47,95%CI 1.03–6.28;P=0.04),older age(OR 15.70,95%CI 14.87–16.54 for women aged 26-35 years,OR 16.14,95%CI 12.12–20.01 for women aged≥36 years;P<0.01),and backward and general castes(OR 15.91,95%CI 13.57–17.85 for backward caste and OR 8.11,95%CI 8.07–8.26 for general category of caste;P<0.01).Seven percent of females had undergone parturition.Older age was associated with higher risks of postpartum complications(OR 1.06,95%CI 1.01–1.57 for women aged 26-35 years,OR 3.56,95%CI 1.29–4.69 for women aged≥36 years;P<0.01).In addition,risks of postpartum complications were associated with backward and general castes(OR 1.69,95%CI 1.34–2.13 for backward classes and OR 5.01,95%CI 4.29–5.31 for general category castes;P<0.01),and more than 4 ANC visits(OR 0.20,95%CI 0.09–0.34;P<0.01).Conclusions:More frequent ANC visits are associated with a lower risk of postpartum complications.Furthermore,a high utilization of reproductive health services represents good implementation of reproductive and child health programme at the peripheral level resulting in a stark rise in maternal health indicators in the state of Rajasthan.

The Role of Health Inequality in the Maternal Health Services Provided by Public Institutions in Mexico

This work aims to determine the role of inequality in the provision of maternal health services among five regions in Mexico (northwest, northeast, central, the Mexico City-State of Mexico region and the south). We consider the most important service providers corresponding to the main health institutions in Mexico (IMSS, ISSSTE, SESAS, IMSS-Oportunidades). Therefore, a cross-sectional prospective study was conducted to analyze eight intervention packages (Prenatal Care, Syphilis, Influenza, Obstetric Urgent Care, HIV in pregnancy, delivery care, neonatal care and accessibility) offered by the Maternal and Perinatal Health (MPH) program. A quantitative analysis demonstrates low to marginal performance of the MPH program in three regions (South, Mexico City-State of Mexico and the Northwest) and marginal in two other regions (Central and Northeast). Furthermore, four of the intervention packages presented the lowest performance in the South (Prenatal Care, Syphilis, Influenza and Obstetric Urgent Care), as did the average of the total of the MPH packages. The performance of HIV in Pregnancy package was marginal in the Southern and Mexico City-State of Mexico regions and Neonatal Care was low in the Northwest. The assessment of the MPH intervention packages allows us to identify their strengths and weaknesses. This information allows us to identify similarities and differences among the geographical regions in order to describe and analyze the strengths, weaknesses, opportunities and threats in the current system and hence to improve the decision making regarding the Maternal and Perinatal Health Programs in Mexico. The results suggest that a homogenization has taken place in terms of the low quality of the services.

Longitudinal Care Evaluation in Child Healthcare

Objective: To evaluate the essential attribute of Primary Health Care, longitudinal care, care directed at children from birth to two years old. Methods: This is a descriptive and exploratory study of evaluative character and quantitative approach, conducted with parents/caregivers of 186 children, younger than two years old, patients of primary health care services in the city of Santa Cruz/RN, Brazil. For data collection, the instrument Primary Care Assessment Tools (PCA Tools) was used, and the results of the questions dealing with longitudinal attribute were evaluated. The data were stored and processed in Statistical Package for Social Sciences (SPSS). The study was approved by the Research Ethics Committee of the Health Sciences School of Trairí, under number 348896. Results: The mean age of children in months was 8.21;84.4% (n = 157) were assisted by the same doctor/nurse every time;in 81.7% (n = 152) of cases the doctor/nurse know the full medical history of the child;73.7% (n = 137) answered that the professional know their child more as a person than just as someone with a health problem;48.9% (n = 91) stated that the doctor/nurse do not know their family very well;86.6% (n = 161) reported finding the doctor/nurse understands what is saying or questioning;96.2 (n = 179) of respondents said the doctor/nurse answers the questions so that they understand;96.2% (n = 179) of the interviewed said they feel comfortable telling the concerns or problems of their child to the doctor/nurse;66.7% (n = 124) claimed that they would not change the service/doctor/nurse to another health service. Conclusion: It is concluded that the attribute was well rated by the mothers of children seen in primary health care services and that they can establish good communication and relationship with the health professionals who treat their children.

Evaluation of the Maternal Health Indicators: An Ecological Study from 2000 to 2014

The aiming of this worksheet is to evaluate and to compare the quantity of prenatal appointment indicators;childbirth by kind of delivery;maternal mortality coefficient and maternal deaths number. It is about an ecological, descriptive and analytical study, made through the appreciation of secondary data related to the maternal mortality in Rio Grande do Norte, from 2000 to 2014. To that, it was used information from SISPACTO to compare real data to the estimated goals. The results show that there was an increase on the number of women who performed seven or more prenatal queries, in turn, there was an increase of alive newborns through cesarean, moreover, it is observed an oscillation on the maternal deaths number by residence during the studied period, achieving superior values to the agreed goals during the last two analyzed years. It is concluded that the maternal health, in Rio Grande do Norte, negative indicators are being presented concerning the maternal mortality, in spite of presenting an improvement on the prenatal access.

Assessing the influence of digital technologies on antenatal care visits in Zimbabwe:insights from 2019 Zimbabwe Multiple Indicator Cluster Survey

Background and objective:To provide good health and well-being as established by the Sustainable Development Goal(SDG)3,access to digital technologies can act as conduits to achieve such progress in a population.As guided by the World Health Organization,antenatal care(ANC)attendance is one of the measures promoted to curtail the global health burden of maternal and infant mortality.ANC services are seldom utilized to their full potential in Zimbabwe.This study explores if any of the women's digital technology characteristics were associated with antenatal care visits.Methods:The study analyzed population-based cross-sectional data with a subsample of 1932 women aged 15-49 years from the 2019 Zimbabwe Multiple Indicator Cluster Survey.Test of associations with chi-square test,bivariate,and multivariate multinomial logistic regression analyses were used to examine the predictors of adequate(4-7)and optimal(≥8)ANC visits relative to undesirable(1-3)antenatal care visits among women who had given births 2 years before the survey.Results:The results indicate that 64.5%(1246/1932)of the women attained adequate ANC while about 9.8%(189/1932)attained optimal ANC.Reading a newspaper/magazine at least once a week(odds ratio[OR] 1.73,β'=0.551,t=2.030,P=0.043)and watching television at least once a week(OR 1.72,β=0.545,t=2.454,P=0.015),listening to the radio less than once a week(OR 1.28,β'=0.247,t=1.750,P=0.080),and owning a mobile phone(OR 1.48,β'=0.394,t=3.020,P=0.003)were positively associated with adequate ANC.Optimal ANC was significantly associated with women being able to read a newspaper at least once a week(OR 2.93,β'=1.074,t=3.120,P=0.002),listen to the radio less than 0nce a week(OR 2.07,p'=0.73,t=2.700,P=0.007)and have ownership of a mobile phone(OR 1.88,β'=0.631,t=2.620,P=0.009).Conclusion:Access to a newspaper,radio,television,and mobile phone were important predictors of a woman's ability to achieve her ANC attendance.Policies to improve the knowledge of ANC packages can be facilitated using digital technology to achieve adequate and preferably optimal ANC in Zimbabwe.It is important to improve digital infrastructure to support digital technologies in providing ANC services.

2016—2021年某妇幼保健院早产儿医院感染影响因素分析

目的 了解早产儿医院感染现状及影响因素,为早产儿医院感染防控提供理论和实践依据。方法 采用回顾性研究方法,对2016年1月—2021年12月某院新生儿病房收治的早产儿进行调查分析,查阅病历,收集早产儿基本信息及住院期间诊疗信息。结果 共纳入早产儿3 559例,其中男1 964例,女1 595例;平均出生体重(2 108.66±631.17)g。发生医院感染109例,发病率3.06%;主要感染类型为下呼吸道感染(44.04%)、血流感染(28.44%)、胃肠道感染(14.68%);检出医院感染相关病原菌38株,其中革兰阴性菌33株(86.84%),革兰阳性菌3株,真菌2株。主要分离病原菌为产气肠杆菌(28.95%)、肺炎克雷伯菌(28.95%)。经单因素、非条件多因素logistic回归分析,羊水污染、出生体重<2 500 g、使用呼吸机、中心静脉插管是早产儿医院感染的独立危险因素(OR值分别为2.424、3.805、3.776、5.412,均P<0.05);剖宫产是早产儿医院感染的保护因素(OR=0.362,P<0.05)。结论 早产儿医院感染风险高,影响因素多,临床应引起重视,积极采取有循证依据的防控措施减少风险因素暴露,保护早产儿健康。

The innovations in China’s primary health care reform: Development and characteristics of the community health services in Hangzhou

Objective:This study focuses on Hangzhou,a Chinese city with a population of nine million urban and rural residents,to examine the successful development and innovation experience of its primary health care service system during the new health reform in China since 2009 and then dis-seminate the findings through international third parties.Methods:Measures such as data analysis,study of documents and regulations,fieldwork,and expert discussions were used to systematically investigate primary health care in Hangzhou.The findings will have a profound practical impact on the health reform for nine million rural and urban residents throughout Hangzhou’s municipal boroughs.Results:Community health services in Hangzhou are characterized as follows:They are gov-ernment led;they are guaranteed with enough financing,personnel,facilities,and regulation;sup-ported by the unified information platform;general practitioners have been assigned the key role of health‘gatekeepers’;they provide primary care combined with basic public health services;there are integrated urban and rural health services and insurance coverage;and there is health care-pen-sion-nursing integration and general practitioner-contracted‘smart’services.Preliminary data collection and analysis indicate that the basic health status of Hangzhou residents is superior to that of residents of China as a whole,and some health indicators in Hangzhou are comparable to those in Western developed countries.Conclusion:It is reasonable to believe that the primary health care level in China,including Hangzhou,will be further developed and promoted with indexed performance evaluations and more effective implementation of additional measures.

基于PCAT的签约服务模式下社区儿童健康服务质量研究

背景基层医疗卫生机构以其综合、连续、协调、便捷和经济的特点,扮演着儿童常见病、多发病诊疗、计划免疫以及儿童健康管理的重要角色,为儿童健康服务奠定坚实基础。开展家庭医生签约管理下的儿童保健服务,对于提升儿童健康服务质量至关重要。然而,我国基层机构在儿童健康服务能力方面存在地区差异,因此,准确评价基层儿童健康服务质量,有助于及时发现问题,推动基层儿童健康服务向更高水平发展。目的了解签约儿童家长对社区儿童健康服务质量的评价情况,分析质量问题,提出优化策略,为进一步提升社区儿童健康服务质量、推进儿童签约服务高质量发展提供决策参考。方法以成都市某区为案例地区,2022年采用方便抽样,抽取该区3家社区卫生服务中心为样本机构,采用初级卫生保健服务质量评价工具(PCAT)中文版,对样本机构签约儿童家长进行社区儿童健康服务质量在线问卷调查。结果共完成3631名签约儿童家长调查。样本机构社区儿童健康服务质量PCAT中文版总得分为(58.72±13.43)分。社区儿童健康服务质量PCAT得分相对较高的维度为“持续性”“社区首诊(服务可及性和服务使用)”以及“服务综合性(服务提供)”,而“以家庭为中心”“综合性(可用服务)”和“协调性(转诊)”等维度得分相对较低。不同户籍、文化程度、平均年收入、有无熟悉的医护人员和过去1年在该中心就诊次数的调查对象PCAT中文版总得分比较,差异有统计学意义(P<0.05);多元线性回归分析结果显示,调查对象的户籍所在地,母亲的文化程度、家庭平均月收入、有无熟悉的医护人员和过去1年在该中心就诊次数均是PCAT总得分的影响因素(P<0.05)。结论案例地区签约服务模式下社区儿童健康服务质量水平有较大提升空间,应重点加强社区儿童健康服务综合性(可用服务)和服务协调性(转诊),推动以儿童及家庭为中心理念落实,关注非本地户籍儿童健康服务工作。

不同病因妊娠合并急性胰腺炎患者的临床特征及母婴预后研究

背景由于经济发展及国内生育政策改变,妊娠合并急性胰腺炎(APIP)发病率逐渐增加,不同病因的APIP临床特点不同,且对母婴预后的影响可能存在较大差异,既往对此研究较少。目的分析不同病因APIP的临床特征及其与母婴预后的关系。方法收集2016—2022年首都医科大学附属北京友谊医院收治的48例住院APIP患者的临床资料,根据病因分为胆源性组(n=27)及高脂血症组(n=21),对比分析两组实验室检查指标以及母婴结局。结果胆源性组起病至就诊时间长于高脂血症组,入院时孕周短于高脂血症组,既往孕次多于高脂血症组,腹泻及停止排便所占比例低于高脂血症组(P<0.05)。两组患者严重程度比较,差异无统计学意义(P=0.912)。胆源性组血红蛋白、血小板计数、C反应蛋白、胆固醇、三酰甘油水平低于高脂血症组,总胆红素、直接胆红素、丙氨酸氨基转移酶、碱性磷酸酶、谷氨酰转肽酶、血肌酐、血钙、血钠、血淀粉酶、N末端脑钠肽前体水平高于高脂血症组(P<0.05)。胆源性组分娩时孕周短于高脂血症组(P<0.05)。胆源性组和高脂血症组早产率、剖宫产率、剖宫产人为干预终止妊娠率比较,差异均无统计学意义(P>0.05)。胆源性组新生儿重量小于高脂血症组,身长短于高脂血症组,病理性黄疸、呼吸窘迫、呼吸机辅助呼吸发生率高于高脂血症组(P<0.05)。结论胆源性疾病目前仍为APIP患者的第一位病因,可显著缩短母体的分娩孕周,并造成胎儿低体质量,增加胎儿病理性黄疸、呼吸窘迫、呼吸机辅助呼吸的发生率,引起胎儿更为严重的预后。

妇幼保健体系子宫颈癌医防一体化管理与技术服务专家共识

子宫颈癌可防可控却仍严重威胁女性健康。人乳头瘤病毒(HPV)疫苗接种、子宫颈癌筛查和早诊早治的综合干预策略是实现全球消除子宫颈癌战略目标的重要路径。目前我国已建立比较完善的妇幼保健体系,承担人群子宫颈癌防控技术服务与管理的重要职能。在妇幼保健体系内建立子宫颈癌医防一体化服务管理模式与协同机制,整合健康教育、疫苗接种、筛查、诊断与治疗、随访管理,对提高防治服务可及性,加速消除子宫颈癌的目标实现具有重要的公共卫生意义。本共识在对我国妇幼保健体系充分调研和专家研讨基础上,系统梳理妇幼保健体系在子宫颈癌防控工作中的作用、服务模式和瓶颈因素,提出构建妇幼保健机构内医防服务一体化和妇幼保健机构间医防服务全流程闭环的双路径模式,以及实现医防一体化模式的关键要素和建设原则,为推动我国妇幼保健体系子宫颈癌防治服务向连续、整合、系统转型提供指导建议。

4~7岁儿童代谢综合征有关指标之间相关模式研究

目的探究4~7岁儿童代谢综合征有关指标之间的相关模式。方法依托前期开展的孕期增补复合微量营养素预防母婴不良结局项目,在河北满城、元氏2县选取参加项目孕妇所生儿童1454名,于儿童4~7岁时测量身高、体重、腰围、血压并检测血脂和血糖。采用Pearson相关分析检验体质指数(BMI)、腰围、总胆固醇(CHO)、甘油三酯(TG)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、空腹血糖(FPG)、收缩压和舒张压共9个指标之间的线性相关关系。参照美国心脏学会标准判定儿童中心性肥胖、高血压、高TG血症、低HDL-C血症和高血糖发生情况,采用关联分析的φ系数描述5个代谢综合征组分间的相关关系。结果儿童CHO与LDL-C相关关系强(r=0.82,P<0.001),腰围与BMI、收缩压与舒张压、CHO与HDL-C相关关系较强(r依次为0.63、0.60和0.74,P均<0.001),CHO与TG、TG与LDL-C、HDL-C与LDL-C中等强度相关(r依次为0.34、0.30和0.43,P均<0.001),其他指标之间为弱相关或无相关。儿童中心性肥胖与高血压、高TG血症、低HDL-C血症三者均呈弱相关关系(φ系数依次为0.06、0.08和0.07,P均<0.05),高血压和高TG血症呈弱相关关系(φ=0.05,P<0.05),其他代谢综合征组分间的φ系数无统计学意义。结论儿童收缩压与舒张压之间、腰围与BMI之间以及几个血脂指标彼此之间相关关系较强,包括HDL-C与CHO、LDL-C均为中等强度正相关关系,而血压、肥胖与血脂三类指标之间无明显相关,血糖与所有指标均无明显相关;儿童代谢综合征各组分间相关较弱或无相关,提示儿童代谢指标间相关模式与成人不完全相同,代谢综合征这一概念应用于儿童宜审慎。

基于PEST-SWOT分析模型的省级妇幼保健机构科技创新发展策略

目的探讨省级妇幼保健机构科技创新发展的内外部因素并提出有效策略。方法采用PEST-SWOT分析模型从政治、经济、社会和技术四个宏观环境角度对某省级妇幼保健机构科技创新发展的优势、劣势、机会、威胁进行全面分析。结果某省级妇幼保健机构科技创新发展在政策支持、科研管理制度、科研经费投入、学科特色等方面具有优势和机会,但是在人才队伍、信息化水平、行业竞争等方面存在一定的威胁和劣势。结论妇幼保健机构科技创新发展受内部、外部多方面影响,需要牢牢把握机遇,从医教研协同、学科布局、人才队伍、信息化建设等方面全面促进科技创新发展。

广西妇幼保健机构资源配置效率评价及提升路径研究

目的:对广西妇幼保健机构卫生资源配置效率进行研究,分析卫生资源利用过程中存在的主要问题,探讨其卫生资源配置的提升路径,为优化妇幼保健机构卫生资源配置提出可行的对策与建议。方法:从《广西卫生健康统计年鉴(2022)》中选取妇幼保健机构的投入产出指标数据,采用数据包络分析法对投入产出效率进行综合评价,并利用模糊集定性比较分析方法,结合妇幼保健机构卫生资源配置现状,从社会、政府、组织3个层面构建卫生资源配置效率的不同提升路径。结果:广西14个地级市中有6个城市卫生资源配置有效,1个城市未能同时达到技术和规模有效,7个城市显示为无效,均存在不同程度的投入冗余及产出不足问题;提高资源配置效率的路径有4条,可归结为社会环境驱动型、政府-组织驱动型。另外,抑制资源配置效率的路径有3条,归结为全面失衡型、政府-社会环境缺失型。结论:广西大部分地区妇幼保健机构卫生资源配置不能同时达到技术和规模有效,卫生资源综合效率相对较低,不同地区间存在分布差异,不同城市间的卫生资源配置优化路径也存在差异。广西妇幼保健机构卫生资源配置效率的影响因素较为复杂,建议在加强机构设施建设的同时,注重政府与社会的投入,避免投入冗余及产出不足的问题。

以助产士为主导的群组式母婴保健模式构建在基层医院的应用

目的探讨以助产士为主导的群组式母婴保健模式构建在基层医院的应用。方法选择2022年8月至2023年5月在杭州市富阳区妇幼保健院常规产检并分娩的200名产妇作为研究对象,根据随机数字表法将其分为对照组和观察组,每组100名。对照组行常规护理,观察组在对照组的基础上以助产士为主导的群组式母婴保健模式进行护理,从孕12周开始进行,直到产后6周结束。比较两组产妇的分娩方式、产妇产程及新生儿情况,产后1、3、6个月母乳喂养率,干预前后对孕期理论知识掌握情况,产后2、24 h的出血量及产后1个月的妊娠合并症。结果干预后,观察组产妇自然分娩率高于对照组,而剖宫产率及会阴侧切率低于对照组,差异有统计学意义(P<0.05);观察组产妇产后1、3、6个月母乳喂养率均高于对照组,差异有统计学意义(P<0.05);干预后,观察组孕期理论知识的掌握情况评分高于对照组,差异有统计学意义(P<0.05);干预后,两组合并症例数比较,差异无统计学意义(P>0.05);观察组产后2、24 h出血量低于对照组,差异有统计学意义(P<0.05)。结论对孕妇使用以助产士为主导的群组式母婴保健模式可以明显改善其妊娠结局,值得在临床中应用。

上海金山区朱泾镇2013-2022年孕产妇保健管理的现状分析

目的:分析上海市金山区朱泾镇2013-2022年应用孕产妇保健管理信息系统(简称孕保系统)开展孕产妇保健的状况,为提高孕产期保健管理水平提供依据。方法:采用回顾性研究方法对2013-2022年朱泾镇孕产妇系统保健相关数据进行回顾性分析。结果:2013-2022年朱泾镇孕产妇管理各项指标逐年全面提升。本市户籍孕产妇的孕早期册卡率、产检≥5次率和系统管理率等指标都明显高于同期非本市户籍孕产妇,差异均有统计学意义(93.65%比64.34%、98.19%比89.45%和90.73%比64.61%,均P<0.05)。2013-2022年朱泾镇孕产妇保健质量指标提示高危孕产妇数量逐年增多,检出率由2013年(36.97%)增加至2022年(87.56%);剖宫产率波动在39.13%~48.74%之间。结论:朱泾镇孕产妇系统管理各项指标逐年全面提升,但不同户籍类别的孕产妇健康管理水平存在差距,孕早期保健是影响朱泾镇孕产妇系统管理的主要环节,应进一步加强孕情监测工作,提高了孕产妇产前、产后保健质量,更好的保障母婴健康。