Impact of the Changes in Women’s Characteristics over Time on Antenatal Health Care Utilization in Egypt (2000-2008)

Objectives: This study empirically assesses the impact of the changes in women’s characteristics, empowerment, availability and quality of health services on woman’s decision to use antenatal care (ANC) and the frequency of that use during the period 2000-2008. Study Design: The study is a cross-sectional analytical study using 2000 and 2008 Egypt Demographic and Health Surveys. Methods: The assessment of the studied impact is conducted using the Zero-inflated Negative Binomial Regression. In addition, Factor Analysis technique is used to construct some of the explanatory variables such as women’s empowerment, the availability and quality of health services indicators. Results: Utilization of antenatal health care services is greatly improved from 2000 to 2008. Availability of health services is one of the main determinants that affect the number of antenatal care visits in 2008. Wealth index and quality of health services play an important role in raising the level of antenatal care utilization in 2000 and 2008. However, the impact of the terminated pregnancy on receiving ANC increased over time. Conclusions: Further research of the determinants of antenatal health care utilization is needed, using more updated measures of women’s empowerment, availability and quality of health services. In order to improve the provision of antenatal health care services, it is important to understand barriers to antenatal health care utilization. Therefore, it is advisable to collect information from women about the reasons for not receiving antenatal care.

Women’s Perception Concerning Health Care in the Post-Partum Period: A Meta-Synthesis

This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or) “postpartum period”, (and) “care”, “women”, “perception”, “qualitative research”, “women’s health services”, “community health services”, “allied health personnel”, “primary health care”, resulting in 9 articles for analysis. Six themes were identified: interpersonal relationship, information, communication, attending the necessities, service organization and other supports. Results report mainly on the unsatisfactory professional care for women, appreciating the form of dealing with promptness and the timing to be attended;trust;content, coherence and the way to inform;clarification of doubts;friendly conversation and clinical assistance. The professional workload was restricted on postpartum period care quality. There were gaps found in clinical practice and in dialogical communication and information on women’s health necessities.

Can Labor Make Women Happier?The Relationship Between Labor Time,Cross-generational Care and Women’s Subjective Well-being——A Research Based on CFPS (2016)

Marxism women-theory advocates women to achieve gender equality and liberation through employment.But due to the influence of culture,if the promotion of female employment,women may face the dual pressure of housework and work,that is,the promotion of female employment may deviate from the ruling effect of people’s happiness.This study aims to explore the relationship between labor time,cross-generational care and women’s subjective well-being by using the data of CFPS(2016).Findings are as follow.Firstly,the time spent on housework differs between men and women,and the burden of housework still falls on women.Secondly,women’s employment reduces women’s subjective well-being to a certain extent,but this effect turns into a positive one under the moderating effect of cross-generational care.China’s family culture weakens the negative impact of the increase in working hours of women to a certain extent.

Women with overweight, mixed hyperlipidemia, intolerance to glucose and diastolic hypertension

Primarily healthy women who attended a practice of General Medicine were examined and coded data were evaluated using two statistical methods (n = 248, aged 36 ± 14 years). It was found that participants with LDL-related (mixed) hyperlipidemia showed higher blood pressure, a higher proportion of alcohol problems and/or smoking compared to normolipidemic women (p ≤ 0.05). These hyperlipidemic women who reported alcohol problems and/or smoking more often showed proteinuria and/or hematuria, rise of LDL/HDL, critical fasting blood glucose and lower HDL-cholesterol compared to hyperlipidemic women reporting healthy lifestyle (p ≤ 0.05). Likewise, high triglycerides were associated with rise of blood pressure and intolerance to glucose (p ≤ 0.05) and also with elevated total cholesterol. Alcohol-related hypertriglyceridemia overlapped with diastolic hypertension, rise of body weight and urine pathology, lowering of HDL-cholesterol and critical fasting blood glucose. The motivating message was that women with mixed hyperlipidemia and healthy lifestyle had functionally renal endothelium and healthy HDL-related baseline measures. Altogether, LDL-related hyperlipidemia and/or high triglycerides were correlated with diastolic hypertension whereby critical alcohol consumption declined renal endothelium and lowered HDL-cholesterol implicating baseline strategies to neutralize early risk factors.

Women’s Experience with Socio-Economic Factors Associated with Perinatal Morbidity and Mortality in Lusaka and Mumbwa Districts of Zambia

Background: More than half a million women and four million infants are reported to die every year due to complications related to pregnancy and child bearing. The efforts to improve quality maternity care have been on the World Health Organization member countries’ agenda. Zambia has been striving to reduce maternal mortality by ensuring universal access to maternal and child health care services. Our study aimed to explore women’s experience with socio-economic factors associated with perinatal morbidity and mortality in Lusaka and Mumbwa districts, Zambia. Methodology: This hermeneutic phenomenological study was conducted at four health facilities in Mumbwa and Lusaka Districts of Zambia. A purposeful sample of 45 consenting women organized in four groups was selected. Each group comprised of 11 to 12 women. The focus group discussion guide was used to direct the discussion and the Olympus Digital Voice Recorder WS-852 (Olympus Corporation, Shinjuku, Tokyo, Japan) was used to record the discussions. The audio data was manually transcribed and verbatim transcript analyzed using ATLAS.ti 8.0 qualitative data software (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany) to ascertain patterns of relationships between themes and quotations. Results: Money, husbands and family support, adequate health care resources, and good nurses attitude simplify the burden of pregnancy, delivery and child rearing for the health care providers, mothers and society. Conclusion: Having money and all the necessary resources during pregnancy simplifies the burden of pregnancy, delivery and child rearing for the health care providers, mothers and society. Women are still ignorant and believe in myths and need information on the dangers of depending on herbs and God in preparation for labor and care of the new born, but also seek help from qualified medical personnel when labor starts. Nurse’s attitude needs to change to ensure a reduction in women and newborn mortalities. Nurses were mentioned as the cause of mortality among women and newborn. Recommendations: There’s a need for training of nurses and other health care workers on self-awareness of attitudes. Women should be empowered with resources that facilitate labor and delivery. Midwives and health care providers should take responsibility for evaluating and correcting the beliefs and traditional practices of the community. Training should be planned for raising awareness in order to support beneficial practices and prevent harmful ones.

Limitations and possibilities on health assessment to women in violence situation

The aim was to know how health assessment to women in violence situation is developed. Literature review on LILACS and MEDLINE databases was conducted in April 2013 with the descriptors: “domestic violence” and “women’s health”, on a 1994-2012 timeframe. Statistics characterization and content theme analysis of the scientific production were developed. Results showed that the assessment is permeated by institutional limitation and an approach strictly clinical that makes identification and diagnosis of violence difficult, reinforcing invisibility in health care. Professional assessment is influenced by socio-cultural and the naturalization of the phenomena, which is not considered a public health issue. Technical knowledge is insufficient, making the possibility of promoting violence cycle rupture difficult. However, we envisage reception as a possibility to assess female demands. We conclude the need to include the theme in health undergraduate courses and also the urgency of this learning experience to support a multidisciplinary and intersectoral work web. Thus, rethinking assessment as a way of (re)organizing how health care is structured in order to compose an assessment web to women and guarantee reception of their demands is needed. Else, constructing competence allied to coping public policy to the problem and guaranteeing a human and full assistance will stay only on the academic field, constituting itself as a limit on protecting life of these women and their families.

Therapeutic termination of pregnancy and women’s mental health:Determinants and consequences

The therapeutic termination of pregnancy(TToP)is an induced abortion following a diagnosis of medical necessity.TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability.This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother.Sociocultural and economic determinants could influence the desire for children and family planning in couples,as well as the use of effective contraception and the choice to perform an induced abortion.Also,pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP.Furthermore,the TToP is a reproductive event with an important traumatic burden,but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples.The aim of this review is to evaluate what demographic,reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women.Also,we will examine both positive and negative consequences of this procedure on women’s mental health,underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.

基于B/S模式的孕妇儿童体检系统的设计与实现

为了改善孕妇、儿童体检流程的繁重手工管理,提高保健质量和体检效率,同时实现系统在妇幼保健等医疗单位更好地共享。参照《国家基本公共卫生服务规范(2011年)》提出基于B/S模式的孕妇儿童体检系统。介绍系统的总体结构,开发环境、数据库及功能模块设计,并以医生平台为例详细说明儿童体检模块的具体实现过程。系统基本上实现了妇幼保健机构孕妇儿童体检信息及工作考核等的无纸化、规范化和高效化管理,具有较好的实用价值。

Change in Preoperative Nervousness: A Randomized Controlled Trial in Gynecological Cancer Patients

Patients are often nervous prior to surgery and females might suffer the most. Increased nervousness needs attention as it can negatively affect postoperative recovery. Support from nurses, i.e. being present, attentive, empowering and helpful to the patient, and talking about what is on the patient’s mind, might help to reduce nervousness. However, there is a lack of evidence as to the ideal level of attention and resources to reduce preoperative nervousness. The objective of the current study was to compare a range of care combinations with standard care to female patients prior to sedation and cancer surgery primarily on difference in change in nervousness from admission until sedation before cancer surgery, measured on a Visual Analouge Scale. Using simple randomization and numbers in sealed envelopes, adult gynaecological patients scheduled for open cancer surgery were allocated to care provided by a nurse anaesthetist and: A) a surgical nurse, B) no additional care, C) a known nurse , and D) a relative. Only the statistician was blinded. The trial stopped when the calculated numbers were included. In the full analysis set, compared to standard care A) (n = 61), we observed the following mean changes and [95% confidence intervals]: B) (n = 65) 1.05 [CI: 0.298 to 1.794] with p = 0.006, C) (n = 61): -0.38 [-1.140 to 0.385] with p = 0.330, D) (n = 71): 0.23 [-0.498 to 0.967] with p = 0.528. Female cancer patients will benefit from supportive care by a surgical nurse from the time of arrival on the operating ward plus supportive care from a nurse anesthetist from 5 - 10 minutes after entering the operating ward. It is not recommended at any time to rely fully on the support of relatives. The effect on adults of preoperative painful procedures and patients’ time alone on the operating ward should be further investigated.

The men’s health center:Disparities in gender specific health services among the top 50“best hospitals”in America

Objective:Gender-specific integrated health services have long existed in the arena of women’s health care,but men’s health centers(MHCs)have only recently emerged as a novel practice model.Here,we seek to evaluate the prevalence and format of MHCs found in the leading academic medical centers in the United States.Methods:The US News&World Report’s Top 50 Ranked Hospitals for Urology was used as our cohort.Data were gathered on the presence of MHCs and types of providers and conditions treated.An equivalent search was performed for women’s health centers(WHCs).Results:Sixteen of 50(32%)promoted some type of MHC,compared to 49 of 50(98%)offering a WHC.Eight of the top 15 ranked institutions(53%)had an MHC compared to eight of 35(23%)remaining programs.Six of 16 MHCs incorporated providers from a variety of medical disciplines,including urologists,internists,endocrinologists,cardiologists,and psychologists,while another six of 16 MHCs were staffed solely by urologists.Eight of 16 provided services for exclusively urologic issues,four of 16 offered additional services in treatment of other medical conditions,and four of 16 did not specify.

Lean Management in Obstetrics and Gynecology: Application in the Ambulatory Clinic Pre- and Post-Kaizen

OBJECTIVE: The ambulatory clinic was an important departmental problem. Providers hated working there and patients complained about the wait times there. It seemed there were equal numbers of patients and provider complaints. In the spirit of solving the problem, data was gathered, a LEAN intervention was planned, and data was collected. METHODS: We defined the service families in the clinic as registration, vital signs, provider or ultrasound visit, nursing visit, and registration for the return visit. We walked the Gemba engaging all the staff in the process. Many observations pointed to long waits between and among the five stations. In order to study the current state, time data was collected by attaching a sheet of paper to a folder that the patient would carry themselves to all the clinical steps. On the sheet of paper each station logged the time that patient appeared and the time the patient left their sight. Data was gathered each day and every day from October 2016 to the summer of 2017. The data was analyzed. Leadership met and identified value and waste in the process. A Kaizen event was scheduled after the first set of measurements engaging all the staff. After the data was thoroughly analyzed and digested, brainstorming occurred. Together we determined our future state. We created a vision and strategic goals to reach our future state. RESULTS: The data pre-Kaizen event showed that the process of arrival to leaving took 124 minutes. We discovered that not every patient passed through each station. We learned the patients were on time or early for their visit most of the time. The providers were late most of the time by 1 - 1.5 hours. We learned how long each station took from the patient’s point of view. There were no statistically significant differences between ultrasound and provider visits;there were no statistically significant differences between midwife and physician visits. Each day of the week was similar. The arrival rate was higher in the morning because of the template. After the event, the total time in clinic did not change however the variability in time between and among each station decreased in variance. We informed the staff of these findings so that they could take responsibility for their part in the process. The atmosphere in clinic changed dramatically and the complaints from both providers and patients stopped. CONCLUSION: LEAN management was used to improve the clinic. It yielded important results, got the staff engaged in the process, and provided a way for the patients to see the efforts made by staff to improve.

LDL-Related Intolerance to Glucose, Diastolic Hypertension and Additive Effects of Smoking Were Found with Three Female Study Groups

Initial prodiabetic risk profiles were invented here with three female study groups consisting of primarily healthy women (A1: 1990-1999, n = 160;A2: 2009, n = 88;A: n = 248, 36 ± 14 years;B: 2014: n = 65, aged 37± 11 years). Significantly higher blood pressure was found comparing intolerance versus tolerance to glucose (p p p = 0.02), of fasting blood glucose (p = 0.07) and of urine pathology (p = 0.07). High LDL-C of women who reported smoking at baseline was correlated with diastolic hypertension whereby alcohol problems overlapped (p = 0.036, A). Unhealthy combinations were found consisting of LDL-related intolerance to glucose, LDL-related smoking, of alcohol-related hypertriglyceridemia or of combined drinking and smoking testing urine pathology over the course of time. Obese women were at direct risk for hypertension in the presence of high LDL-C and submaximal ratio of serum albumin to triglycerides (Alb/Trig). Obese women reacted highly sensitive to critical alcohol consumption showing then macroalbuminuria. Current participants who disowned daily alcohol consumption showed healthy morning urines and normal fasting blood glucose. Mild decrease of HDL-C was observed during heavy smoking of relatively young women who had normal biomarkers. Women with intolerance to glucose were at direct risk for hypertension whereby high LDL-C and/or smoking triggered prodiabetic risk profiles. Obese women had elevated LDL-C during hypertension and reacted highly sensitive to alcohol-related proteinuria and/or hematuria.

Acting Front to Nursing Psychological Repercussions in Breast Cancer Patients

Breast cancer is a heterogeneous and complex disease with different situations of threat to their patients, which can cause psychological discomfort, anxiety and a depressed state in women. The aim of this study was to analyze the performance of nursing to psychological repercussions on living with breast cancer. This is a descriptive and cross-sectional study with qualitative characteristics. It was conducted with professional nurses in Basic Health Units (UBS) in the municipality of Juazeiro do Norte-CE, Northeast of Brazil, located in the region of Cariri. The study began to be developed after the approval of the Research Ethics Committee, CAAE: 50809315.8. 0000.5624. Data collection occurred through a semi-structured interview. For the interpretation of the results, the technique of content analysis was used. The results showed that nurses realize that emotional support, care and assistance in coping, improve the construction of a good performance of the professional nurse. However, it is possible to realize the need for information and qualified assistance by multidisciplinary team to these patients and even their family members. It was identified as difficulty in assisting the denial of patient to start the treatment, but the facility is in the intimacy that the professional nurse can engage with the customer. It highlighted the care through dialogue and health education. And, finally, the nurse is aware of such importance of his/her role when supporting the patient. Thus, the improvement of professional assistance was evidenced as regards emotional support, reception, qualified listening, health education measures leading to self-knowledge, self-esteem and acceptance of the disease and the creation of bonds with the patients.

上海妇幼保健系统党员和业务骨干“双培养”工作现状与对策建议

目的调查当前上海市妇幼保健机构党员和业务骨干“双培养”工作现状,对本系统人才队伍建设提出对策建议,为打造一支政治过硬、业务精湛、作风优良的妇幼健康人才队伍打好基础。方法通过召开1场人才工作专题会,发放17张机构调查表和321份调查问卷,到3个区妇幼保健院(所)实地调研,收集17家机构工作总结等方式,了解2020—2022年上海市、区两级17家妇幼保健机构党员和业务骨干“双培养”工作情况。结果上海妇幼保健系统党员和业务骨干“双培养”工作在机制建设、思想引领和培养方式上已经取得一定成效,但在受访者中,仍有39.75%对该项工作不了解;57%的非党员业务骨干不愿意或不确定是否入党;82名非业务骨干党员认为自身与业务骨干在工作格局(27.27%)、管理能力(24.43%)、业务能力(14.2%)和人际沟通能力(11.93%)等方面存在差距。结论本市妇幼保健系统要进一步加强党员和业务骨干“双培养”工作的推进力度:一要立足“党管”、立足“精准”、立足“长远”;二要加强对业务骨干思想引领和文化引领;三要实现党员工作格局、职业素养和综合实力三方面超越,从而不断提升人才素质,夯实妇幼事业的人才基础。

Women and Children's Health Care in the Yimeng Mountain Area

The Yimeng Mountain area in the central and southern part of Shandong Province, is very poor.

家庭老年照料对女性非正规就业的影响效应研究

利用1993-2011年"中国健康与营养调查"数据,在控制内生性的条件下研究中国家庭老年照料对女性非正规就业选择和非正规就业工资收入的影响效应。研究发现,家庭老年照料会降低女性从事正规就业的可能性而提高其从事非正规就业的可能性,并且老年照料的强度越高(每周照料时间超过10小时),女性劳动者非正规就业倾向越大。家庭老年照料对女性非正规就业工资收入的负面影响随着照料强度的增加而减弱,对女性正规就业工资收入的负面影响随着照料强度的增加而增加。据此,文章认为,当女性要承担家庭照料责任时,非正规就业为她们提供了兼顾老年照料与就业的平衡,既解决了自身的就业问题、增加了家庭收入,又节省了老年照料家庭支出。基于实证结果,本文提出了相应的政策建议。

妇产专科医院门诊绝经综合征患者性激素类药物使用情况分析

目的:了解妇产专科医院门诊绝经综合征患者性激素类药物的使用情况,为绝经妇女健康保健提供相关数据资料。方法:回顾性分析2019年复旦大学附属妇产科医院(以下简称“我院”)门诊临床诊断含“绝经”或“更年期”的处方中性激素类药物的使用情况,对患者年龄、药物品种等进行整理与分析。结果:共收集处方12268张,其中使用性激素类药物的处方为5808张(占47.34%),涉及患者5808例。使用性激素类药物患者的平均年龄为(48.85±5.39)岁,其中40~<50岁患者3299例,50~<60岁患者2216例,≥60岁患者189例,35~<40岁患者104例。5808张处方涉及14种性激素类药物(总用药例次数为6102例次),例次数排序居前3位的药品依次为雌二醇片/雌二醇地屈孕酮片复合包装(2521例次)、替勃龙片(1832例次)和地屈孕酮片(499例次)。不同年龄段患者性激素类药物的使用各有特点,40~<50岁患者中,雌二醇片/雌二醇地屈孕酮片复合包装的使用例次数最多,为1954例次(占该药总使用例次数的77.51%);50~<60岁患者中,替勃龙片的使用例次数最多,为1151例次(占该药总使用例次数的62.83%),此外,该年龄段患者中阴道局部用雌激素制剂使用例次数亦最多;≥60岁患者使用的性激素类药物以替勃龙片、阴道局部用雌激素制剂为主;35~<40岁患者使用的性激素类药物以雌二醇片/雌二醇地屈孕酮片复合包装、替勃龙片为主;不同年龄段患者使用性激素类药物品种的差异具有统计学意义(Fisher确切概率检验,P<0.001)。结论:我院不同年龄段绝经综合征患者使用性激素类药物各有特点,可为绝经激素治疗的个体化方案选择提供参考。

关于3岁以下托幼公共服务理念的再思考——跨学界视野与跨学界对话

《国家中长期教育改革和发展规划纲要(2010—2020年)》及《国务院关于当前发展学前教育的若干意见》为重启新时期托幼公共服务事业的发展奠定了政策基础。随着我国生育政策的调整,未来几年将带来一定规模婴幼儿人口的增长,由此导致家庭对托幼服务的需求会呈刚性增长,这将给我国托幼公共服务事业的发展带来全新的机遇和严峻的挑战。但相比现实需要,目前3岁以下托幼公共服务的发展还相对滞后,政府和社会包括学界对3岁以下托幼公共服务理念的理解和宣传普及还存在一些问题,不利于今后托幼公共服务事业的进一步发展。为此,本研究从社会学、学前教育学和人口学的综合视角出发,对3岁以下托幼公共服务理念进行再思考,认为应进一步在全社会树立3岁以下托幼服务是公共服务的理念,并要重新确立解除妇女后顾之忧和教育幼儿的双重目标;政府应继续承担发展托幼公共服务的主体责任,通过统筹规划与合理布局,适度扩大面向3岁以下婴幼儿的托幼公共服务。

农村贫困地区家庭幼儿照料对女性非农就业的影响

自从1978年改革开放以来,非农就业已经成为中国农村家庭收入增长的主要来源。然而,男性和女性对非农经济活动的参与机会存在不平等。考察了农村女性的家庭幼儿照料责任对此所产生的影响。在农村贫困地区,缺乏稳定可靠的幼儿看护机构是母亲非农就业的主要障碍。2001年四个国定贫困县592户调查数据的回归分析结果证实,拥有6岁以下幼儿使女性农业生产的参与率增加1.94个百分点,而非农私营活动和挣工资活动的参与率分别下降1.22和0.7个百分点。

创建以人为本的产科新模式:孕期全程服务

目的探索新的以人为本的产科服务模式,改善医患关系,优化妊娠结局。方法取2000年1月至12月的产前门诊1 200名孕妇为实验组,选择一对一孕期全程服务,取1999年1月至12月产前门诊1000名孕妇为对照组,常规检查,将两组孕妇分娩结局进行统计学比较。结果两组的产检率、高危管理率,围产儿死亡率、患者投诉及患者满意度经卡方检验,均差异有统计学意义(P<0.05)。结论孕期全程服务模式能改善妊娠结局。