Practical Experience of Establishing German Standard Level 1 Perinatal Center in Chongqing Health Care for Women and Children

Germany,as a western developed country,has an advanced medical level,especially in the health care of very immature premature infants.We trace the medical history of perinatology to understand the development of perinatal centers in Germany.After analyzing the classification and function,hierarchical management and quality control systems of German perinatal centers,we established a German standard level 1 perinatal center in the Chongqing Health Center for Women and Children(CHCWC).During more than two years of practice,we changed concepts,continuously updated clinical knowledge and skills,developed a series o f high-quality work processes and supervision systems and introduced advanced medical equipment.We believe that the experience of establishing a German standard level 1 perinatal center and perinatal center network in Chongqing is worthy of being promoted to the Chinese maternal and child health care system.

Experiences of Children’s Care Received at Windhoek Residential Child Care Facilities, Namibia

The caring is a very important aspect for every child’s well-being and development. A child should be cared for by biological parents or extended family members when possible. In the absence of these two possibilities, other options are in place such as Residential Child Care Facilities (RCCFs). However, RCCFs are generally regarded as last resorts, as it is noted that they have a negative impact on the well-being of the children. Caregivers in RCCFs should ensure that these children are being adequately cared for as they substitute their biological or extended families. It is also a child’s rights to be provided love, care and support coupled with a sense of belonging, recognition and independence. However, children without or inadequate parental care are likely to be vulnerable from all forms of violence. The aim of this qualitative, exploratory, descriptive, contextual and phenomenological study was to explore and describe the children’s experiences regarding the care received at the Residential Child Care Facilities and to provide recommendations regarding research findings. Data were collected through one on one in-depth interviews and Tech method was used to analyze data. The results of the study show that children in RCCFs have experienced both positive and negative care. The care is experienced through relationships with staff in the facilities, provision of their basic needs, knowledge of their cultural identity and their adult future preparation once they leave the facilities. Thus, it is recommended that a conducive environment that contributes to the quality of care for children in RCCFs be established, taking into consideration human resources capacity, policy guidelines and standards in place while providing care to those children.

Care and Support Programmes for Orphans and Vulnerable Children: Achievements and Implications of HIV/AIDS Funded Project in Osun State, Nigeria

Orphans and Vulnerable Children (OVC) and their families face many challenges but there are opportunities to provide care and support programmes for them in their communities. This paper presents the achievements and implications of HIV Programme Development Project (HPDP) funded by World Bank on care and support services for OVC in Osun State, Nigeria. Eight Civil Society Organisations (CSOs) were engaged by Osun State Agency for the Control of AIDS (OSACA) as part of HPDP to provide care and support services for OVC between year 2013 and 2015. Using reporting tools, data collected by the CSOs were entered into District Health Information System 2 (DHIS2) platform and analysed using Microsoft Excel. In addition, Key Informant Interviews (KII) were conducted among the selected CSOs, OVC and the caregivers who were beneficiaries of HPDP in Osun State, Nigeria. A total of 12,353 OVC were reached and about half of them were female. There was an increase in the trends of number of OVC seen and the support services provided from the year 2013 to 2015. Of the 12,353 OVC that benefitted from this programme, 1905 (15.4%) received health care services, 5383 (43.6%) received nutritional services, 5317 (43.0%) received educational services and 9861 (79.8%) were provided with psychosocial support services. About 503 (4.1%) of the OVC received economic strengthening services while 270 (2.2%) of household heads were provided with economic support. However, 3 OVC were lost to follow-up, 14 OVC voluntarily withdrew from the project and 6 OVC died. The FGD and KII revealed that the project was very impactful in transforming the lives of the OVC. Programmes for children orphaned and made vulnerable by HIV/AIDS will contribute to the achievement of HIV/ AIDS prevention and control efforts. The HIV/AIDS free generation can be built by responding to the physical, social and mental needs of these children and their families in their communities. There is a need to scale-up this programme.

Asthma in Children at the Pediatric Intensive Care Unit of University Hospital of Brazzaville (Congo)

Objectives: To describe the epidemiological, clinical and therapeutic aspects of asthma in children at the Pediatric Intensive Care Unit of University Hospital of Brazzaville. Patients and methods: We reviewed the records of children hospitalized in the Pediatric Intensive Care Unit of University Hospital of Brazzaville from January 1 to December 31, 2015, and retained those from two months to 17 years hospitalized for asthma. The study variables were: age, sex, influence of seasons, history of atopy;the factors triggering the crisis, the type of follow-up, the degree of severity of asthma exacerbation, the type of treatment instituted and the course of the disease. In total, out of 2012 hospitalized children, 65 children met the inclusion criteria. Results: The hospital prevalence of asthma was 3.5%. Among 65 children of study, 42 (59.2%) were male and 29 (40.8%) female. The mean age was 3.9 ± 2.9 years (range from 2 months to 14 years). Children aged 30 months to 5 years were the most represented (40%). They were known as asthmatics, n = 18 (27.7%). Family atopy was found, n = 11 (16.9%). Acute Otorhinolaryngologic infections were in all cases the factors triggering the crisis. The peak frequency of hospitalizations for asthma occurred during the short rainy season. The crisis was moderate n = 46 (70%) and severe n = 19 (29%). Beta 2 mimetics were administered in all cases, by subcutaneous in 18 cases (27.7%) and inhaled in 47 cases (72.3%). The outcome was favorable in all cases with a mean hospital stay of 1.46 ± 0.92 days. Conclusion: Childhood asthma remains a public health challenge and severe asthma is the paradigm of uncontrolled and costly asthma. This first work suggests that a large-scale study be carried out for a better knowledge of it.

Barriers of Asthma Care among Asthmatic Children in Saudi Arabia: Maternal Perspectives

Background Bronchial asthma is one of the most common chronic conditions among children. Despite the improvement in asthma treatment regimens, its prevalence and related morbidity are increasing, especially among underserved, minority children. There are barriers in the management of asthma, which may impact the quality of outcomes. The goal of this study is to explore these barriers. Methods A cross-sectional study was conducted on interview data collected through 2019 from mothers of children (aged 6 - 12 years) with asthma visiting, for convenience, a public shopping mall. The interviewees were randomly selected, because they met the inclusion criteria. Participants were considered if the mother answered “yes” to the following questions: Has your child had physician-diagnosed asthma? Is your child currently taking asthma medications of asthma? Two community nurses conducted the interviews. Data was obtained using administrative questionnaires. Data were analyzed using SPSS version 21.0 (IBM Inc., Chicago, IL, USA). Descriptive statistics of percentage, mean, frequency and standard deviation were applied for categorical and continuous variables. Results Three hundred mothers participated in this study. Their average age was 36.8 years, 55% were housekeepers by profession, and 34% had obtained less than high school education. The majority of children (61%) were males, 45% had moderate asthma, and 42% had mild asthma. The most frequent types of barriers identified by parents were environmental factors (67.7%), followed by health care providers (63%), the health care system (48%), and patient or family characteristics (43%). Mothers were specifically concerned about the use, safety, and long-term complications of medications, the impact of exercise limitation on their child’s quality of life, and their own quality of life. Conclusion This study showed several barriers against asthma care in Saudi Arabia, which mainly related to environmental or personal characteristics. This highlights the need to enhance current policies within the health care system in Saudi Arabia to overcome these barriers.

Therapeutic Camps and Their Impact on the Family of Children with Special Health Care Needs: A Mixed Method Study

Respite care through therapeutic summer day camps is a service used to relieve the physical and mental strains placed on caregivers of children with special health care needs while also creating unique opportunities to benefit the child. The purpose of this study is to determine how respite care in the form of a therapeutic summer day camp for children with special needs impacts a family’s ability to manage their child’s special health care needs within their family. This research study used mixed methodology combining quantitative data collection through pre- and post-survey and qualitative data collection through interviews that worked to answer questions relating to the effects of a therapeutic summer day camp on parents’ perspective and management of their child’s condition. The theoretical framework used to guide the study is the Family Management Style Framework. Twenty-two parents completed The Family Management Measure that was administered prior to and at the conclusion of an 8-week therapeutic summer day camp program. Qualitative interviews with 11 parents helped to better understand specific interventions and experiences of the therapeutic camp that benefitted their child and family. Although the quantitative analysis did not yield statistically significant changes in the family’s ability to manage their child’s condition as a result of attendance at the camp, the qualitative interviews demonstrated robust evidence that the camp provided meaningful experiences for the campers and parents while alleviating stress within the family. Themes include: 1) Family-Child themes of loss of normalcy, relationships affected, increased stress, family adaptations, and love for the child;2) Camp-Child themes of meeting individual needs, creating happiness, and behavior changes;and (3) Camp-Parent themes of improved perception of the child, decreased stress, parent involvement with staff, and need for specific environment at camp. Implications of the results are discussed, along with recommendations for future research.

0~6岁儿童眼保健和视力检查服务现状及对策研究

目的了解0~6岁儿童眼保健和视力检查服务现状,为相关部门提供决策依据。方法采用方便抽样方法,于2019年9—12月从北京市、安徽省、青海省抽取15家区县级妇幼保健院及基层卫生机构进行问卷调查,并采用现场观察及小组访谈的方式了解儿童眼保健服务现状及存在的问题等。结果被调查的区县级妇幼保健机构均配备了开展儿童眼保健服务的基本用房及设备;基层卫生机构均配备了开展儿童眼保健服务的基础设备,但有些设备陈旧破损、闲置未用。被调查机构儿童眼保健人员均不足,区县级妇幼保健院、社区卫生服务中心和乡镇卫生院的儿童眼保健人员分别占卫生技术人员的9.5%、5.5%和2.4%,不同类型卫生机构的儿童眼保健人员占比差异有统计学意义(χ^(2)=8.966,P=0.011)。社区卫生服务中心无眼科医生,该岗位由儿保人员兼职。被调查机构儿童眼保健人员接受上级指导及培训的机会普遍较少,年人均1~3次。各地儿童眼保健及视力检查服务覆盖率均在90%以上,但现场观察发现儿童眼保健人员操作技能尚不熟练、不规范。结论各卫生机构均需进一步完善儿童眼保健及视力检查服务设备,提高儿童眼保健人员的知识技能及服务质量。

政社力量帮扶事实无人抚养儿童家庭的联动机制研究——以上海市为例

现代家庭的儿童保护功能趋向弱化甚至缺失,本研究关注地方政府和社会力量在为事实无人抚养儿童家庭提供福利服务方面如何开展联动工作并优化协同路径,通过分析相关政策文件,并在政策实施地开展参与观察、半结构访谈和焦点小组访谈总结地方帮扶经验,借助生态位理论视角对事实无人抚养儿童家庭关爱服务生态系统进行全面梳理。研究发现,不同层级的政府部门、群团组织和社会组织三大福利供给主体分别构成了三条生态链主线,通过“政社合作”和“群社协同”两条上行和下行联动路径吸纳各类社会资源并转化为社会服务。其中,专业社会组织处于关键生态位,是各类联动工作的中枢核心;发现报告是联动工作的关键环节,但仍需进一步优化协作机制。未来应强化专业社会组织的培育与发展,实施家庭增权服务,管控伦理风险,推进社会力量的有序联动和社会资源的广泛吸纳,并完善相关儿童福利政策监督反馈机制,以增进事实无人抚养儿童家庭的福祉。

儿童运动看护家庭嵌入支持策略探索

学龄前儿童的身体健康与家庭教育一直是国家和社会的关切焦点,通过家庭嵌入的运动看护可以更好的促进学龄前儿童身心健康发展。本文运用文献资料法及系统科学思想,提出了相应的支持策略:重视家庭教育与看护培训,构建儿童运动看护发展动力源;提供心理支持与健康监督,保障儿童运动看护整体科学性;推进家校共育与信息共享,搭建儿童运动看护家校平台;完善社区参与与家庭融合,促进儿童运动看护持续协调发展。

4例儿童肝移植术后糖尿病的诊治与药学监护

目的:探讨儿童肝移植受者移植后糖尿病(PTDM)的诊治和药学监护要点。方法:回顾性分析首都医科大学附属北京友谊医院2014-2022年4例儿童肝移植受者PTDM的临床资料,总结临床特点和治疗过程。结果:4例受者肝移植术后均使用以他克莫司为基础的免疫抑制方案,确诊PTDM中位年龄15.5(14.0~17.0)岁,确诊PTDM中位时间为肝移植术后60.5(7.0~81.0)月,确诊后3例将他克莫司转换为环孢素,1例因不耐受环孢素而又转换为他克莫司。根据患儿情况选用胰岛素、二甲双胍和阿卡波糖治疗。中位随访时间10.5(3.0~30.0)月,仅1例完全停用降糖药;4例血糖控制良好,肝功能平稳。结论:儿童PTDM的治疗需综合考虑患儿个体情况和药物因素等,制定个体化治疗方案。可根据情况将他克莫司转换为环孢素,选用胰岛素、二甲双胍等降糖药物,并加强药学监护。

流动学前儿童教育照顾服务的社会支持现状及对策

完善学前儿童教育照顾服务,实现幼有所育是新时代的重要议题。作为最年幼的流动人口,流动学前儿童属于脆弱群体。由于教育照顾服务等社会支持不足,流动学前儿童的生存发展面临着诸多困境。通过对托育机构、幼儿园、社区、社会组织等为流动学前儿童及其家庭提供教育照顾服务的情况进行调查,厘清教育照顾服务的社会支持状况发现,目前还存在针对托育机构、幼儿园等公益性和普惠性教育照顾机构供应不足与质量参差不齐、社区支持力度单薄、社会组织关注度不够等问题,需要大力发展普惠性托育、学前教育等机构教育照顾服务,充分发挥社区、社会组织和社会工作的联动作用,提高流动学前儿童教育照顾服务水平。

糖尿病患儿的整体护理效果分析

目的探究整体护理对糖尿病患儿的应用价值。方法选取2022年6月—2023年7月滕州市中心人民医院收治的50例糖尿病患儿为研究对象,通过随机数表法将其分为常规组与研究组,各25例。常规组开展常规护理,而研究组开展整体护理,对比两组血糖、护理满意度。结果护理后,研究组空腹血糖、餐后2 h血糖、糖化血红蛋白水平低于常规组,差异有统计学意义(P均<0.05)。与常规组相比,研究组护理满意度更高,差异有统计学意义(P<0.05)。结论针对糖尿病患儿,整体护理模式效果显著,能够明显改善患儿的血糖指标,有效提升患儿家属的满意度。

促进婴幼儿健康发展的公共卫生策略述评

婴幼儿期是生长发育的关键阶段,需要充足的营养和照护,以预防未来健康风险。鉴于中国的生育现状,国家在尽快推出完善的生育支持政策的同时,还需要制定更加全面有效的儿童早期发展干预策略。文章旨在结合生命早期发育的特点,对从资源整合、政策规范、营养刺激和护理保护等方面进行全生命周期的干预措施进行评述,以期为提升儿童全面发展质量和国家的人口可持续发展提供参考和依据。

时机关怀结合焦点式心理干预对电子支气管镜检查患儿应对方式、心理应激情况的影响

目的探究时机关怀结合焦点式心理干预对电子支气管镜检查患儿应对方式、心理应激情况的影响。方法选择2022年5月—2023年8月于济南市第三人民医院接受电子支气管镜检查的患儿50例为研究对象,按随机数字表法将其分为对照组和观察组,每组25例。对照组在患儿检查时实行焦点式心理干预,观察组在对照组基础上采用时机关怀护理。对比两组患儿的心理应激情况、应对方式、治疗配合度、行为配合度及并发症发生情况。结果干预前,两组的儿童医疗恐惧量表(CMFS)中各项评分比较,组间差异无统计学意义(P>0.05);干预后,观察组的CMFS各项评分均低于对照组,组间差异有统计学意义(P<0.05)。干预前,两组的简易应对方式量表(SCSQ)中各项评分比较,组间差异无统计学意义(P>0.05);干预后,观察组的SCSQ中积极应对评分高于对照组,消极应对评分低于对照组,组间差异有统计学意义(P<0.05)。干预前,两组的Frankl治疗依从性量表、Houpt行为量表评分比较,组间差异无统计学意义(P>0.05);干预后,观察组的Frankl治疗依从性量表评分、Houpt行为量表评分均高于对照组,组间差异有统计学意义(P<0.05)。观察组的并发症发生率为0.00%,低于对照组的24.00%,差异有统计学意义(P<0.05)。结论将时机关怀结合焦点式心理干预应用于行电子支气管镜检查患儿中的效果良好,可缓解其心理应激,改善应对方式,提高患儿治疗配合度和行为配合度,减少并发症的发生,值得推广。

药学干预对某儿童医院国家基本药物使用情况的效果评价

目的:评价药学干预对某儿童医院国家基本药物使用情况的效果。方法:从医院信息系统分别抽取2021年(干预前)和2022年(干预后)某儿童医院国家基本药物使用数据,包括基本药物采购品种比、基本药物配备使用金额占比、门诊患者基本药物处方占比、门诊患者基本药物处方使用占比、住院患者基本药物使用率和住院患者基本药物使用占比,比较2021年与2022年各指标的全院增长率和不同临床科室的增长率。结果:与2021年相比,2022年我院基本药物采购品种比降低了1.32%,基本药物配备使用金额占比增长率为2.26%,门诊患者基本药物处方占比增加了13.82%,门诊患者基本药物处方使用占比增加了11.69%,住院患者基本药物使用率持平,住院患者基本药物使用占比增加了1.30%。基本药物各项考核指标明显改善的科室包括心内科、新生儿科、综合内科、神经外科、感染性疾病科、新生儿重症监护室、耳鼻喉科、血液科1、外科监护室和血液科2。结论:我院基本药物使用情况经临床药师干预后有一定的改进成效,但基本药物配备使用金额占比和住院基本药物使用率仍未达到省考要求,需要药师与医师积极配合对患儿家属进行基本药物宣教,增加其对基本药物的信赖程度,同时呼吁国家能够增加国家基本药物目录中儿童专科用药品种,提高儿童用药的经济性和可及性。

社会投资视角下农村留守儿童社会支持政策的反思与构建

“以儿童为中心”的社会投资战略已成为发达国家社会政策的新趋向。因城镇化巨大的虹吸效应,农村传统差序格局下以血缘、地缘为主的先赋性儿童照料资源日趋消解,农村留守家庭劳动力再生产能力不足,以“农村留守儿童关爱体系”为主要内容的社会政策进入公共政策领域。然而,从社会投资的视角来看,我国农村留守儿童政策尚缺乏“支持家庭”“多元共治”等理念,“事后补缺型”的制度设计难以满足农村留守儿童和家庭的发展性需求,可能会通过降低未来人力资本增加贫困代际传递的风险。要实现“社会救助”向“社会投资”的理念转变,应以提升农村留守儿童及其家庭发展能力为根本,从导致亲子分离的制度根源入手,利用服务供给、时间补偿等“支持家庭”手段,构建政府、家庭、社会等“多中心协同治理”的社会支持体系,为农村留守儿童及其家庭提供普惠性的公共资源,以切断先赋性弱势与“留守事件”的链接机制。

脊髓损伤患儿父母照顾体验的质性研究

目的深入了解脊髓损伤患儿父母的照顾体验,为促进其身心健康提供参考。方法采用现象学研究方法,以立意抽样法抽取11名脊髓损伤患儿的父母进行半结构化访谈,运用Colaizzi分析法归纳主题。结果提炼出4个主题,分别为承受照顾负荷、心理体验复杂、适应角色改变并提高照顾技能、渴望家庭和社会支持。结论脊髓损伤患儿父母的照顾负荷较重,存在负性心理,医护人员需重视评估患儿父母照顾感受,并提供积极的心理干预指导,必要时提供适当的社会支持,以减轻其照顾负荷,改善其心理状况。

重庆市基层全科医师儿童支气管哮喘防治服务评价研究

背景支气管哮喘(以下简称哮喘)是儿童期最为常见的慢性气道疾病,其因病程长、反复发作,从而严重影响儿童的生长发育和生活质量。全科医师作为基层医疗健康服务的主要提供者,在儿童哮喘早期筛查和分级管理过程中发挥着重要作用,了解全科医生对该病的防治服务水平,可为基层儿童哮喘防治服务质量提升提供建议。目的调查基层全科医师对儿童哮喘的防治服务水平及其影响因素。方法2022年4—7月,从重庆市38个区(县)中随机抽取22个区(县),并对样本区(县)的基层全科医师进行问卷调查。调查问卷由课题组查阅相关指南及文献自行设计,并经过两轮专家函询和预调查形成,包括知识、态度、行为和自评4个维度。调查基层全科医师对儿童哮喘防治的认知、态度、行为及自评情况并分析其影响因素。结果共有234名基层全科医师参与问卷调查。全科医师对儿童哮喘防治的知识得分为(6.03±2.04)分,合格率为44.9%;态度得分为(49.42±4.94)分,合格率为100.0%;行为得分为(30.55±6.66)分,合格率为87.2%;自评得分为(21.57±5.30)分,合格率为85.0%。在转诊指征的选择上,有98.7%(231/234)的全科医师认为中度以上急性哮喘发作,经过紧急处理后仍无明显缓解的患儿需要转诊,有94.0%(220/234)的全科医师认为规范化治疗哮喘后仍得不到有效控制的患儿需要转诊。在遇到症状控制不佳的患儿就诊时,33.8%(79/234)的全科医师会仔细分析控制不佳的原因,17.5%(41/234)的全科医师会告诫其谨遵医嘱、暂时观察并约好下次复查时间。33.8%(79/234)的全科医师对在基层进行儿童哮喘诊疗活动持有不确定或者反对的态度,影响因素主要为医护人员缺乏疾病相关知识储备和学习机会、家长不愿来基层就诊、儿科医患关系较成人紧张、该病种患儿较少、相关设施设备缺乏。多元线性回归分析显示:职称和儿童哮喘知识培训经历是知识得分的影响因素(P<0.05);学历和基层工作年限是态度得分的影响因素(P<0.05);儿科工作经验和儿童哮喘知识培训经历是行为和自评得分的影响因素(P<0.05)。结论重庆市基层全科医师对哮喘患儿的防治有一定信心,但防治理论知识水平欠佳;态度较积极,行为积极性也尚可,但两者之间存在一定差距。提示在做好基层儿科设施设备优化配置和提高居民信任度的同时,知识与实践培训仍是提升全科医师知识储备、防治自信和自身能力方面的重要因素,应加强全科医师的学历教育和继续教育培训,有效激励全科医师学习和自我提升的能力。

1例急性淋巴细胞白血病患儿合并右手背坏死性筋膜炎的护理

总结1例急性淋巴细胞白血病患儿合并右手背坏死性筋膜炎的护理经验。护理要点包括感染防治、创面管理、疼痛控制、营养支持、康复指导与人文关怀。通过上述综合护理措施,患儿治疗78天后伤口愈合,继续按疗程化疗。