A Study of Health Prescribing for Children with Tourette’s Disorders in Children’s Health Education Specialty Care Clinics

Objective:This study designs and implements the health prescription of children’s health education specialized nursing clinic based on the physical and mental characteristics of children with Tourette’s syndrome.Methods:Applying the evidence-based nursing model and nursing intervention theory based on the survey research by searching China Knowledge Network,Wanfang Database and Wipro Chinese Science and Technology Journal Database,the study collected the literature on the health prescription intervention research in children’s Tourette’s disorders health education in children’s health education of specialized nursing outpatient clinic for review and combined with the specialty characteristics to formulate“Children’s Tourette’s Disorder Health Education Prescription.”Results:Tourette’s syndrome in children is a common pediatric neurological disorder,mainly manifested as involuntary,rapid and repeated muscle twitching and vocal tics,which brings serious psychological pressure and life disturbance to the affected children.Conclusion:For children with Tourette’s syndrome,healthcare professionals should give enough care and understanding to the children and their parents,provide timely and effective health education to them,help them improve their bad behavioral habits,establish correct cognitive attitudes,enhance self-confidence,improve patient compliance,reduce the frequency of recurrence,reduce the incidence of complications and promote children’s physical and mental health development.

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.

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.

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.

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.

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.

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.

TOPSIS法与RSR法相结合对省级妇幼保健机构综合绩效评价

目的:运用本研究前期对妇幼保健机构综合绩效评价指标体系的研究结果,对省级妇幼保健机构综合绩效进行评估,并对绩效评价指标体系进行验证。方法:采用TOPSIS法与RSR法相结合对省级妇幼保健机构进行综合绩效评价和分档。结果:对8所省级妇幼保健机构综合绩效进行评价分档,4所机构被评为上档,3所被评为中档,1所被评为下档。结论:评价结果与实际情况较为吻合,评价指标体系较为合理。与疾病预防控制机构合并的妇幼保健机构绩效状况明显落后,提示政府部门应当谨慎看待将妇幼保健机构合并到疾病预防控制机构的做法。

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。

湖北省云上妇幼远程医疗平台建设情况分析

湖北省云上妇幼远程医疗平台是提升妇幼保健机构能力建设的重点内容,是借助互联网+落实分级诊疗的重要途径。文章在简要分析妇幼资源现状及需求的基础上介绍了云上妇幼远程医疗平台的架构和功能,阐述了应用成效,并基于目前应用过程中存在的问题对后期发展提出了相关建议。

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.

最低工资标准提升对女性育儿时间的影响研究

当前我国经济面临着较为复杂的外部发展环境和内部多重挑战,这使我国低收入家庭尤其女性家庭成员存在较大的收入不确定性,这些变化将会对女性的工作(有酬劳动)和育儿(照料子女)的选择产生深刻影响。尽管已有研究广泛探讨了女性所面临的工作-育儿冲突问题,但现实生活中我国女性在二者之间究竟会作何选择并可能引致何种后果则少有文献涉及。文章借助最低工资政策的实施,构建理论模型刻画女性在面临增收机会情境下育儿时间的选择机制,以期加深理解低收入女性在工作和育儿之间的权衡难题。文章还利用子女的未来健康状况变化进一步考察女性育儿时间决策的后果,为上述问题的分析提供补充证据。在此基础上,采用2004—2015年中国健康与营养调查数据和同期各区县的最低工资标准进行系统的实证检验。结果显示最低工资标准提升对低收入女性育儿时间具有显著负向影响,该结论在经过一系列内生性分析和稳健性检验后依然成立。机制分析表明最低工资标准提升主要通过提高女性参与劳动的概率和工作时间产生作用,这一结论为低收入女性用工作替代育儿的事实提供了直接证据。异质性分析表明:处于生育平稳期、子女年龄为4~6岁或父辈健康状况较好的女性因具有更高的育儿弹性,育儿时间受到的负向影响更强,同时技能水平更低或工作搜寻难度更小的女性育儿时间同样也更容易受到最低工资政策的不利影响。进一步研究发现最低工资标准提升对短期内子女的身心健康具有显著负向影响,且均可归因于女性育儿时间的减少,这也为文章中的核心结论提供了补充性证据。据此建议政府部门推动建立父亲育儿假制度,加强对托儿机构的普遍监管和支持,鼓励企业为女性群体提供灵活的工作时间和工作模式,聚焦低技能、低学历女性群体的职业技能培训和教育提升,增强其就业竞争力,同时加强最低工资政策的执行力度,确保小时工资标准得到遵守,防止企业延长工作时间。这些措施有助于弥补女性育儿时间减少导致的不利后果,构建合理的生育支持政策体系。

基于《黄帝内经》“养阳”理论探析小儿养生

阳气贯穿人生命全过程,小儿体质特殊,养阳对小儿养生尤为关键。故基于《黄帝内经》“养阳”理论,结合小儿生理病理特点,论述了阳气与小儿生长发育关系,探讨万物之生由乎阳、小儿以阳为本之理,认为小儿养阳应循时序,养护当“顺阳”“补阳”“护阳”,以达五脏调顺、阴平阳秘、驱邪防病的目的,对现今育儿保健有着积极的意义。

江苏省妇幼保健机构感染管理工作现况调查

目的:了解分析妇幼保健机构感染管理部门配置及工作开展情况现状,并针对存在问题提出改进措施。方法:从江苏省内苏南、苏中、苏北地区妇幼保健机构分层抽样,对感染管理部门配置及工作开展情况进行问卷调查。结果:共纳入17份问卷,所有医疗机构均已成立院感委员会;76.5%的医疗机构院感委员会每年召开4次例会;94.1%的医疗机构医院感染管理部门独立设置。感染管理部门专职人员数量配置充足,院感专职人员以护理人员为主,占64.2%,学历以本科学历为主占75.5%,从事院感工作不满3年的占41.5%,高级职称人员占47.1%。93.3%的医院开展院感病例监测;57.1%的医院开展了手术部位感染目标性监测;设置新生儿监护室的医院100%开展了新生儿监护室医院感染目标性监测;设置重症监护室的医院71.4%开展了重症监护室(非新生儿)医院感染目标性监测;64.7%的医疗机构内检验科可自行开展微生物检测,其中81.8%的医院开展了多重耐药菌感染目标性监测;91.4%的医院开展了手卫生监测;80%的医院配备了信息化院感监测系统;94.1%的医院复用诊疗器械清洗、消毒和灭菌方式为消毒供应中心集中管理。结论:妇幼保健机构仍需完善医院感染管理三级组织,进一步优化专职人员专业结构,提升医院感染管理工作水平,促进妇幼保健机构医院感染管理高质量发展,确保医疗质量和医疗安全。

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.

Health Promotion Model: An Integrative Literature Review

Background: The Health Promotion Model (HPM) indicates that each person is a biopsychosocial creature that is partially shaped by the environment, but also seeks to create an environment in which inherent and acquired human potential can be fully expressed. The HPM is proposed as a holistic predictive model of health-promoting behavior for use in research and practice. Purpose: The purpose of this review is to examine how the HPM has been applied in various research studies. Methods: An integrative review was used to find studies that were guided by the HPM. Data search was between 2008 to 2018 using Google Scholar, Scopus, Web of Science, Science Direct, PubMed, Medline, CINAHL, EBSCO, Cochrane, ERIC, Joanna Briggs Institute and EBSCO host. The keywords used were Pender’s and Health Promotion Model. Results: Seventeen studies were reviewed;most of them were quantitative studies. These studies discussed variables from the HPM. Most of the study variables were measured using instruments derived from the HPM. The results of the reviewed studies revealed that the HPM had predictive value in estimating health-promoting behaviors. Conclusion: The HPM was widely established in the nursing community and was implemented in nursing practice, education, and research. In addition, the HPM constructs were used to hypothesize conceptual frameworks in many studies to predict health-promoting behaviors in many chronic diseases.

以妇女儿童为主体 发挥妇联网络优势开展HIV/AIDS预防教育与关怀活动

以妇女儿童为主体,发挥妇联网络优势,与联合国儿基会合作通过层层培训及大众传媒,深入开展了艾滋病预防知识宣传培训的社会动员工作,包括培养骨干,将宣传材料翻译成11种少数民族文字,利用各种途径传播相关知识,开展针对辍学女童等不同人群为目标人群的HIV/AIDS预防教育培训。通过以上措施,提高了广大妇女儿童有关预防和控制HIV/AIDS知识。

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.