Preconception Care Health Education for Female Workers of Reproductive Age in Japan Evaluation up to 6 Months after the Program

Objectives: The aim of this study was to implement a health education program for education of preconception care (PCC) for female workers of reproductive age through a seminar and to evaluate the program based on PCC knowledge and awareness and behaviors before the seminar and at 3 and 6 months after the seminar. Methods: A small group health education seminar was implemented using leaflets for 84 female workers of reproductive age, age 20 to 35 years old, and an intervention by group discussion and feedback was provided. Of these participants, 60 (71%) who provided valid survey responses were included in the analysis. The primary outcome indicators were PCC knowledge, PCC awareness and behaviors, and a food frequency questionnaire, and the secondary outcome indicators were self-efficacy and the health awareness and stress management subscales of the Health-Promotion Lifestyle Profile scale. The survey was conducted three times, before the seminar and at 3 and 6 months after the seminar, and the results were compared. Results: The percentage of individuals with PCC knowledge was significantly increased at 3 months after the seminar as compared with before the seminar, and it remained at this level even at 6 months after the seminar. The percentage of individuals with PCC awareness and behaviors was significantly increased for the items actively eat foods containing folic acid, prevent sexually transmitted diseases, and conduct self-examinations for breast cancer at 3 months after the seminar and for the items eat well-balanced meals, make the mind active, prevent sexually transmitted diseases, and conduct self-examinations for breast cancer at 6 months after the seminar. Furthermore, the score for the health awareness subscale of the Health-Promotion Lifestyle Profile scale was significantly increased at 6 months after the seminar. Conclusion: The health education program established PCC knowledge at 6 months after the seminar and improved some PCC awareness and behaviors. Therefore, it was suggested that the program would be effective for education of PCC for female workers of reproductive age.

Predictors of antenatal health service utilization among left-behind wives of male outmigrants:Evidence from Patna District,India

Objective:To analyze the sociological support system available for left-behind wives of male outmigrants and develop a model that predicts the antenatal care(ANC)services utilization.Methods:A cross-sectional survey was conducted in rural regions of the Patna district,India.The sample size(n=328)was estimated using Cochran’s formula.Five parameters of the social support system were identified(autonomy,spousal support,family support,social circle support,and government support).The score for each was calculated as a composite score using multiple variables;these served as independent variables.The respondents were categorized as efficient and non-efficient users of ANC service based on established criteria.Results:The regression results showed that four out of five social parameters had a significant effect on ANC behavior.Spousal support was the strongest predictor(standardized regression coefficient β=0.57,OR 1.16,95%CI 1.08-1.79,P=0.007).Government support was found to be the second strongest predictor(β=0.40,OR 1.49,95%CI 1.04-2.14,P=0.027),followed by family support(β=0.31,OR 1.36,95%CI 1.23-2.57,P=0.034)and autonomy(β=0.11,OR 1.32,95%CI 1.11-2.26,P=0.030).The social circle support was found to be non-significant in predicting ANC behavior(P>0.05).Conclusions:The policymakers could focus on the identified predictors to strengthen and modify the existing policies for leftbehind wives of male outmigrants.The need of the hour is a strategic intervention for behavioral modification of not only the left-behind wives but also their family members along with reinforcement of the existing social-security net.One strategy we suggest is to launch an awareness campaign focusing on husbands(male outmigrants)and family members.

Cross-sectional Study on Their Reproductive Health Status of 604 Fem ale Floating Residents in Beijing

This study on the reproductive health statusw asbased on the data from a survey and an exam ination of severalhundredsof fem ale floating residentsin Beijing. The results w ere compared w ith those from fem ale perm anent residents in Beijing. The study revealed thatm ostof theinvestigated fem alefloating residentshad lived in Bei- jing w ith their fam ily for threeyearson an average. They had a harderlifethan that of Beijing perm anentresidents. Also they did notreceiveadequateprenatalcaresdur- ing their pregnanciesin Beijing and a quarter of thesem othersdid notreceiveany pre- natal exam ination during their pregnancies at all. Again the fem ales had a great prevalence of reproductive tractinfections, reaching 29.3of thoseexam ined, high- er than the w om en perm anently residing in Beijing.

Operationalizing Adolescent Health Services at Primary Health Care Level in India: Processes, Challenges and Outputs

Background: Ministry of Health, Government of India developed the Adolescent Reproductive and Sexual Health (ARSH) strategy and operationalized adolescent health services up to district and sub-district hospital level. Objectives: To operationalize adolescent health services at primary health care level in a block of Maharashtra;assess impact of need based interventions on quality of services;and understand potential for scalability in the state. Methods: Adolescent and Youth friendly centers were established at primary health care settings and interventions such as health system strengthening, sensitizing gatekeepers, involving Accredited Social Health Activist (ASHAs), developing inter and intra-sectoral linkages, improving monitoring and evaluation were tested. Results: Over a period of 2009-2014, there was a steady increase in the number of clients attending the Adolescent and Youth Friendly Health Centers (A&YFHCs). Attitude of providers to address adolescents’ needs improved significantly. Successful interventions were networking with schools, colleges and Non Government Organization (NGOs), linkages with HIV program and Integrated Child Development Services (ICDS), and involvement of ASHAs. Conclusions: The study demonstrates that although health system has the primary responsibility of addressing health issues among adolescents;it has limitations in terms of its reach to adolescents and generating demand for services. There is a need to network with education sector, ICDS, NGOs working for adolescent health and development to work as a team and address the multifaceted needs of the adolescents. Such a strategy will be crucial while implementing the recently launched Rashtriya Kishor Swasthya Karyakram— the new national adolescent health programme in India.

Healthcare access and the patterns of maternal health care utilization among poor and non-poor women living in urban areas in Portugal

Introduction: Studies on attitudes and practices are increasingly used but not specifically related to the motivations for the use of reproductive health care among women of fertile age, living in urban areas and in different social contexts. Objectives: The aim of this study was to estimate the associations between the variables of social status (degree of poverty in the studied groups) and the variables of fecundity (representations, tensions, practices and control of fertility) and, in addition, to compare access to health care in the different studied groups, assessing the association between use of maternal health care and poverty in urban areas. Design: A case-control study was conducted in the Municipality of Lisbon, Portugal, with a total sample of 1513 women of fertile age: 499 cases of women considered very poor were selected from the database of beneficiaries of RSI (Social Welfare Payment for Inclusion);1014 controls (two controls for each selected case), divided as 507 poor women selected from the other beneficiaries of Santa Casa da Misericórdia in Lisbon and 507 non-poor women selected from four Health Centers from the Municipality of Lisbon, Portugal. A total of 1054 women answered the questionnaire: 304 cases (response rate of 61%) and 750 (response rate of 74%) controls. The statistical analysis involved descriptive analysis and multinomial logistic regression. Results: The analysis confirms the association between poverty and patterns and representations of fecun dity regarding pregnancy planning. The results of this study thus show the existence of different distributions on several variables and the gradients of poverty. Regarding access to health care, the major impact of poverty on women is limiting access to pharmaceuticals. The incapacity to afford the cost of health care appears as a central aspect of access to health care. Conclusion: A number of factors seem to be associated with poverty in women, such as ethnicity, single motherhood, low household income, low household size, low educational level of women and marital status. The association of poverty with not planning the pregnancy of the last child on one hand and large household size on the other hand points to a vicious circle that sustains poverty and leads to extreme poverty. Limited financial access to health care seems to mediate the association between women’s poverty and low coverage with family planning as well as the lack of access to safe termination of pregnancy.

低危孕妇孕产保健服务方案的临床实施效果评价

目的评价以助产士为主导的低危孕妇孕产保健服务方案的应用效果。方法将在上海市某三甲妇产科医院预约初诊建卡的低危孕妇随机分为干预组485例和对照组499例。对照组接受以产科医生为主导的常规孕产保健服务;干预组在对照组的基础上接受以助产士为主导的低危孕妇孕产保健服务方案,包括孕期8次助产士门诊访视、微信群组干预及电话访视、产时陪伴分娩及产后访视。结果干预组助产士门诊访视中位数为7次,分娩计划制定率和执行率分别为76.70%和84.68%。干预组剖宫产率为27.68%,显著低于对照组的35.25%(P<0.05)。干预组硬膜外镇痛率、人工破膜率、会阴切开率、新生儿转入NICU率、第三产程出血量、产后2 h出血量及总出血量显著低于对照组(均P<0.05)。干预组孕期保健服务体验、分娩体验、产后保健服务体验、孕晚期生殖健康素养、产前母乳喂养自我效能、分娩自我效能评分及出院前纯母乳喂养率显著高于对照组(均P<0.05)。结论以助产士为主导的低危孕妇孕产保健服务方案的临床实施有利于促进正常妊娠分娩,提升孕产保健服务体验,实现孕产妇和助产士之间的双重赋能。

China’s Experience of Quality Care in Family Planning

Objective To evaluate and overview the experience of quality care of family planning of China.Methods The framework of quality care of China was summarized and analyzed, that was clients, technology and management triangle program system.Results The 8fundamental elements of quality care in China were presented： 1） policy environment of QoC, 2） comprehensive services, 3） choice of method, 4） IEC to policy-makers and providers, 5） technical competence, 6） interpersonal communications, 7） institutional guideline and regulation, 8） appropriate constella- tion of service.Conclusion FP sectors should prepare different constellations of service to meet their individual reproductive health need for different clients and develop institutional guide- line and regulation for FP service to follow up in practice. QoC should be a kind of standardized service process.

Analysis of Antenatal Care and its Related Factors among Married Chinese Women

Objective To explore the related factors of antenatal careMethods The data derived from National Demography and Reproductive Health Survey in1997 conducted by National Population and Family Planning Commission. 11 892 women whohad given birth to at least one survival child were involved in this study. SAS software was usedin multivariate analysis.Results The average rate of general antenatal care is 57.3% and has increased dramatically inthe recent 30 years. The major reason why most subjects didn’t have antenatal care was lackingthe recognition of the importance of antenatal care. The antenatal care was associated withresidence in rural area or urban area, age, educational level, parity of the last birth, localaverage income, distance between home and township in rural area and so on.Conclusion Women of childbearing age need to improve their health knowledge; thegovernment should increase the availability of antenatal care.

Assessment of quality of postnatal care services offered to mothers in Dedza district, Malawi

This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descriptive cross sectional and utilized quantitative data collection and analysis method to determine structural, process and outcome components of postnatal care in two facilities that offer emergency obstetric and neonatal care and five that offer basic emergency obstetric and neonatal care. All 60 midwives who were providing postnatal care during the time of study in the district were interviewed using a structured questionnaire. In addition, the midwives actual practice was observed and compared to a standard checklist on postnatal care practice which was developed by the Malawi Ministry of Health. Data were analyzed using SPSS version 16.0. Results show that structure for providing postnatal counseling services was inappropriate and inadequate. Furthermore, the contents of postnatal services were below reproductive health standards because the clients were neither monitored nor examined physically on discharge. On average, all the seven facilities scored 48% on postnatal services rendered which is far below the recommended 80% according to the Reproductive Health Standards. There is a need to provide basic infrastructure in all the basic emergency obstetric and neonatal care facilities. In addition, refresher training courses for midwives in maternal and neonatal health with emphasis on postnatal care are recommended. There is also a need to restructure the maternal and neonatal health departments in the facilities so that the postnatal care units become stand-alone priority sites to improve the quality of the postnatal care services rendered.

中医辨证保健在男性生殖健康中的应用

辨证保健是将中医辨证论治和治未病理念与中医养生保健思想协调统一的创新保健模式。中医辨证保健在男性生殖健康中应用广泛,通过微观辨证,将中医辨证思想与现代理化指标有机融合,并在以益肾填精为基础治法的基础上辨证用药,同时内治与多种外治疗法配合应用,并强调未病先防,为男性生殖健康提供全方位、多角度中医药预防保健的方案,充分发挥中医药在生殖领域的优势,以期更好地服务广大有生育需求男性群体。

负有照护职责人员性侵罪保护法益的教义学重塑

《刑法修正案(十一)》在第236条之一规定了负有照护职责性侵罪。在本罪的保护法益问题上,性自主权说和身心健康权说都难以在立法必要性和解释合理性问题上同时做出妥当说明。作为法益的性自主权与被害人同意理论相混淆,导致解释论存在问题。性自主权是在通过去暴力化来实现去道德化的立法修改中逐渐形成的概念,并不是性犯罪应然的保护法益。我国刑法上并未也不必采取这种去暴力化的路径来实现去道德化的目的。相比之下,身心健康权作为一种保护法益更具优越性,不应认为只在不具备性自主权时才对其进行保护。作为本罪保护法益的身心健康权的具体内容是生理上女性一身专属的生殖健康权,社会性别上的女性不是本罪的保护对象。认为本罪是抽象危险性犯不会造成处罚扩大化。认为本罪并未提升性同意年龄、女性的真实同意是本罪的成立要件不会造成本罪被架空。应当认为负有照护职责的人不必利用身份造成隐性强制,在女性知道其身份时即可成立犯罪。其自手实施和利用他人实施狭义性行为均能成立犯罪。

标准化护理联合阶段式健康教育模式在辅助生殖护理中的应用及对睡眠质量的影响

目的:探究标准化护理联合阶段式健康教育模式在辅助生殖护理中的应用及对睡眠质量的影响。方法:选取2022年1月至2023年3月中国科学技术大学附属第一医院/安徽省立医院进行辅助生殖技术的患者100例作为研究对象,按照随机数字表法分为对照组和观察组,每组50例。对照组使用常规的护理干预,观察组使用标准化护理与阶段式健康教育模式结合干预。对2组患者的健康知识水平、睡眠质量及心理状态进行统计分析比较。结果:本研究显示,在4个阶段中观察组知识水平均高于对照组,差异有统计学意义(P<0.05)。2组患者在治疗后睡眠质量都有所改善,差异有统计学意义(P<0.05);其中观察组的睡眠质量评分比对照组低,差异有统计学意义(P<0.05)。2组在治疗后汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分都较治疗前下降,差异有统计学意义(P<0.05),其中观察组的HAMA、HAMD评分比对照组低,差异有统计学意义(P<0.05)。结论:在辅助生殖技术助孕患者的护理过程中,将标准化与阶段式的健康教育模式相结合,可以有效地提升患者对整个治疗过程和疾病的认知水平,从而使患者的睡眠质量及不良心理得到改善。

《妇女保健学》课程思政教学设计思路与实践探索

高校作为人才培养的重要阵地,要全面贯彻党的教育方针,落实立德树人根本任务,要将价值观引导和塑造有机融合于知识传授和能力培养之中,把思政工作贯穿教学全过程,实现全程育人、全方位育人。在《妇女保健学》的教学实践中,从国家人口发展战略角度讲授妇女生殖保健工作,使学生树立正确的马克思主义妇女观,理解相关理论知识,发展职业能力,培养职业素质,立足平凡岗位,树立“全心全意为人民服务”的职业精神,为促进妇女健康事业发展努力学习。文章根据课程思政建设指导纲要精神,从《妇女保健学》教学目标出发,论述了《妇女保健学》课程思政建设的重要意义,讲述了《妇女保健学》课程思政教学设计思路和教学实践探索,为今后全面开展课程思政教学改革提供了新思路。

流产后关爱服务对未婚人工流产后女性的影响

目的:探讨流产后关爱服务对未婚人工流产后女性的影响。方法:选取2021年1月—2022年1月于南方医科大学顺德医院附属陈村医院行人工流产术的未婚女性200例为观察对象,按照就诊时间分为对照组(n=98)和观察组(n=102)。对照组给予常规护理,观察组在对照组基础上给予流产后关爱服务。比较两组患者子宫内膜血流动力学、健康知识掌握程度和再次妊娠率、流产率。结果:干预后,两组阻力指数、波动指数、子宫动脉收缩期血流峰值速度均下降,观察组低于对照组,两组舒张末期血流速度均上升,观察组高于对照组,差异有统计学意义(P<0.05);观察组生殖健康知识掌握状况掌握率高于对照组,差异有统计学意义(P=0.001);干预后,观察组避孕套、口服避孕药应用率高于对照组,差异有统计学意义(P<0.05);观察组再次妊娠率、人工流产率低于对照组,差异有统计学意义(P<0.001)。结论:对人工流产后未婚女性实施流产后关爱服务,可提高其生殖健康知识水平及避孕程度,改善子宫内膜血流动力学,降低再次妊娠率、流产率。

基于医联体智慧医疗的辅助生殖专科护理门诊服务模式的应用成效

目的:探索"三甲医院-下级医院"不孕症联动的辅助生殖专科护理门诊延伸服务的建设内容及模式,实现上下级医院思维同步、知识和信息共享,服务同质、对接和指导无缝隙;同时通过辅助生殖专科护理门诊联动干预来提高患者就诊有效率,减少患者就诊往返次数,帮助患者节约时间成本、经济成本,改善其应对方式,增强治疗信心,提高生活质量,有助于临床妊娠。方法:设立基于医联体智慧医疗平台下的护理门诊实验组和常规护理门诊对照组,分别进行辅助生殖专科护理门诊服务。选取对象为下级医院不孕症患者300例,其中本中心医联体辐射点下级医院患者150例为实验组,非辐射点下级医院患者150例为对照组。周期结束时,对两组患者的门诊就诊次数、健康教育知晓率(就诊流程、按时完成检查、及时进入周期治疗、精准执行医嘱)、医学应对测评和生活质量进行测评。结果:实验组患者门诊就诊次数明显减少,健康教育知晓率明显高于对照组(P<0.05);实验组不孕症患者面对得分高于对照组,屈服得分低于对照组,实验组不孕症患者生活质量明显高于对照组(P<0.05)。结论:基于医联体智慧医疗的辅助生殖专科护理门诊服务模式有利于实现上下级医院护理思维同步、知识和信息共享,对接和指导无缝隙,从而达到同质化护理服务,进而可有效的减少患者往返医院次数,提高患者健康教育知晓率,改善不孕症患者的应对方式,增加患者积极应对方式,减少其消极应对方式,进而全面提高生活质量。

贫困农村育龄妇女生殖健康/计划生育状况调查研究

目的 :了解农村育龄妇女避孕节育的知识、行为和态度 ,以及计划生育优质服务现况 ,为提高妇女生殖健康状况提供依据。方法 :采用多阶段抽样方法 ,对湖北省英山县 6 5 4名农村育龄妇女进行面对面问卷调查。结果 :调查对象避孕知识平均得分 2 8.9分 (百分制 ) ,妇女的文化、职业、所受的计划生育服务为其影响因素 ;避孕方法中多使用常见的宫内节育器 (48.5 8% )及女性结扎 (36 .14 % )、男性结扎 (11.6 0 % ) ,其余的则使用率均不足 6 % ;平均妊娠 2 .6 6次 ,有人流史者占 4 8.6 2 % ;仅有 2 0 .0 3%的被调查对象能接受到医生关于避孕方法的讨论 ,6 2 .6 9%的妇女能定期接受到生殖健康 /计划生育检查 ,5 9.94 %的妇女能定期接受生殖道疾病普查 ,避孕节育服务满意率为 4 6 .6 4 %。结论 :贫困地区农村妇女避孕节育知识严重缺乏 ,同时计划生育优质服务可获得性存在不足 ,直接影响其避孕节育知情选择。因此应改善避孕节育的宣传途径、扩大其宣传效力 ,提高农村妇女的社会地位 ,强化计划生育机构优质服务 ,以增进农村育龄妇女的生殖健康。

流产后关爱延续服务对改善人工流产患者生殖健康相关知识的效果观察

目的探讨对人工流产患者实施流产后关爱延续服务的效果。方法对因意外怀孕要求人工流产的患者500例实施流产后关爱延续服务,建立电子档案,实施流产后关爱服务流程,进行"一对一"咨询和集体健康教育,提供避孕知识,指导避孕方法。结果人工流产患者术后6个月和12个月随访率、避孕知识掌握和满意度均提高(P<0.01),避孕措施选择更加有效,12个月内非意愿妊娠重复性流产发生率降低(P<0.01或P<0.05)。结论流产后关爱延续服务可有效指导人工流产患者术后选择更好的避孕方法,有助于提高生殖健康水平,值得推广应用。

关注男性生殖健康发展生殖保健服务

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