目的 综合评价2017年我国各省市儿童保健工作质量,为相关政策与措施制定提供参考.方法 以《中国卫生健康统计年鉴》2018卷中的6个儿童保健指标(出生体重＜2 500克婴儿比重、围产儿死亡率、5岁以下儿童中重度营养不良比重、新生儿访视率、3岁以下儿童系统管理率和7岁以下儿童保健管理率)为评价指标,利用Excel和SPSS 19.0软件,采取TOPSIS和RSR相结合的方法对各省市儿童保健质量进行综合评价并分档.结果 上海和北京两省市儿童保健质量评为“优”(Ci＞0.472),吉林、安徽、山东、浙江、江苏、陕西、天津、江西、重庆和四川10个省市结果评为“良”(0.283≤Ci＜0.472),其余省市结果评为“中”(0.094≤Ci＜0.283).且方差分析显示各档差异具有统计学意义(F=94.462,P＜0.001).结论 儿童保健工作质量存在地区差异,要从政府责任、经费投入、服务体系建设、服务管理质量等方面来提高中西部等偏远地区、贫困地区的儿童保健工作质量,进而提高儿童身心健康水平.

乳腺癌和宫颈癌(简称两癌)是最常见的女性恶性肿瘤,发病率分别居女性恶性肿瘤的第1和6位,死亡率居第5和8位 [1].我国乳腺癌发病率以每年3％的速度递增,而宫颈癌全世界每年新增病例46万,其中我国占1/3,且发病率呈上升趋势,并趋于年轻化 [2].为有效降低两癌发病率和死亡率,依据早发现、早诊断和早治疗的原则,我国已将两癌筛查列入国家重大公共卫生项目.本研究对北京市大兴区2013～2019年适龄妇女免费两癌筛查数据进行统计分析,旨在了解本辖区适龄女性乳腺癌及宫颈癌发病特点,为今后两癌筛查工作提供参考和依据.

目的 分析北京市大兴区2013至2017年新生儿死亡情况,为降低新生儿死亡率(NMR)提供科学依据.方法 收集大兴区2013至2017年新生儿死亡监测资料,分析性别、年龄和死因别新生儿死亡率和构成情况等.结果 2013至2017年大兴区新生儿死亡占5岁以下儿童死亡的比例为55.97％,新生儿死亡中早期新生儿死亡占65.33％,24小时内的新生儿死亡占36.00％.NMR为1.60‰,男性和女性NMR分别为1.95‰和1.23‰,早期和晚期NMR分别为1.05‰和0.56‰.新生儿死亡死因前三位为早产或低出生体重(30.67％)、先天异常(25.33％)和出生窒息(22.67％),早产或低出生体重中,极早产儿、中期和晚期早产儿分别占47.83％、43.48％和8.70％.先天异常中以先天性心脏病最多,占38.89％.前三位死因的死亡率分别为0.49‰、0.41‰和0.36‰.不同年份间各率的差异无统计学意义(NMR:χ2=1.623,P=0.805;男性NMR:χ2=1.498,P=0.827;女性NMR:χ2=0.762,P=0.944;早期NMR:χ2=2.322,P=0.677;晚期NMR:χ2=3.804,P=0.426;早产低体NMR:χ2=8.010,P=0.078;出生窒息NMR:χ2=7.847,P=0.073;先天异常NMR:χ2=1.908,P=0.763;先天性心脏病:χ2=2.869,P=0.561).结论 抓住出生后第一周,加强新生儿的保健和诊治,提高极早产儿、中期早产儿、先天性心脏病和出生窒息等危重症新生儿的救治能力等是减少新生儿死亡的关键.

高血压疾病是常见的心脑血管疾病,是全球范围内的重大公共卫生问题,不仅患病率高,而且可以引起严重的心、脑、肾并发症,是脑卒中、冠心病的主要危险因素,严重危害人们的身心健康[1].社区卫生服务中心在高血压系统管理中肩负着重要的责任.我中心作为参与《北京市社区卫生家庭医生式服务模式及激励机制研究》项目的基层单位,重点开展以探索家庭医生式服务(以下简称“家医”服务)对高血压患者干预效果的系列工作,现报道如下.

目的探讨大兴区孕中期产前筛查在干预出生缺陷的价值。方法抽取4659例孕14-20w的孕妇静脉血3ml,检测孕妇血清中AFP、β-HCG和uE3三项生化指标,结合孕妇年龄、孕周、体重等因素,用贝克曼ACCESS2化学发光仪及其配套的产前筛查软件综合评估孕妇可能怀有三种缺陷的风险率。结果 4659例血清学筛查孕妇中21-三体高风险216例,NTD高风险26例,18-三体高风险15例。结果确诊NTD 3例,21-三体3例,18-三体1例。结论孕中期产前筛查结合产前诊断,是干预先天性缺陷儿发生的有效方法。

目的了解北京市大兴区流动人口孕产妇系统保健效果。方法 2012年1—3月选择2006—2010年参加北京市流动人口孕产妇管理模式研究的304名孕产妇作为研究组,把未参加该项目的 698名流动人口孕产妇作为对照组。研究组采用多种形式的健康教育、宣传、早期指导等干预措施,对照组未进行干预。结果研究组孕产妇建册率为63.49%,接受5次以上产前检查的占70.72%,住院分娩率为99.34%;对照组流动人口孕产妇建册率49.14%,接受5次以上产前检查的占54.01%,住院分娩率为85.39%,差异有统计学意义(P<0.05)。结论该项目在大兴区城市流动人口妇幼保健服务模式研究探讨出政府主导、部门合作、属地管理、社区参与的管理模式以及三级网络(区、镇、村)和四级管理(户、村、镇、区)的服务模式。对流动孕产妇获得妇幼保健服务的可及性、可获得性、可持续性和服务利用的公平性起到促进作用。

目的了解北京大兴区儿童体内铜、锌、钙、镁、铁5种微量元素含量情况,为儿童科学、合理补充微量元素提供依据。方法采用原子吸收检测方法对2010年3月至2012年3月在大兴妇幼保健院检验科进行体检的10 702例儿童全血进行铜、锌、钙、镁、铁5种微量元素检测,并进行统计分析。结果锌缺乏率为24.17%、铁锌缺乏率为14.1%、钙缺乏率为2.88%、镁缺乏率为0.23%、铜缺乏率为0.21%,不同年龄组各种微量元素缺乏差异有统计学意义(P<0.05)。结论大兴区儿童以锌、铁缺乏为主,钙、镁、铜缺乏次之。由此提示加强儿童保健意识,定期进行健康体检和微量元素检测,做到早发现、早干预、早治疗,科学、合理补充微量元素,是保障儿童健康成长的重要措施。

Objective To explore the influence of screening programme on awareness of cervical cancer prevention among 30 to 59 years old women who live in rural areas of Beijing.Methods A face-to-face cross-sectional survey on women's knowledge on cervical cancer prevention was conducted in 2008 and 2009 among subjects recurited by three-stage stratified random sampling.Results Univariate analysis showed that since the initiation of cervical cancer screening in Daxing District of Beijing,the overall awareness of cervical cancer was significantly increased among women residents,and the percentage of women with 5 or more correct answers was increased from 37.3％ to 51.0％ ( x2=62.06,P＜0.001).After adjusting confounding factors,multivariate analysis showed that cervical cancer screening programme contributed to improved awareness of cervical cancer-related knowledge ( OR =1.853,95％ CI1.590 -2.159).In addition,current place of residence,education level,household income per-capita and screening history within 5 years were major factors affecting women's awareness of cervical cancer ( OR vales were 1.766,2.580,1.350 and1.676,respectively),and higher education level and personal income were correlated with increased awareness rate.Conclusion Cervical cancer screening could improve general knowledge of cervical cancer,especially for those who have never participated in the screening programme.

目的通过对出生缺陷发生情况、类型分析,及时掌握北京市大兴区近10年来出生缺陷发生趋势,探寻降低该地区出生缺陷发生的干预措施,为今后的预防、控制工作提供科学依据。方法以医院为基础,对2001年-2010年在大兴区出生的围产儿进行出生缺陷监测,并用分类变量的统计描述与推断方法进行分析。结果 "十五"期间出生缺陷发生率9.78‰与"十一五"期间出生缺陷发生率19.85‰差异有统计学意义,且两个五年出生缺陷顺位有所改变,"十五"期间出生缺陷前三位的顺位:为肢体畸形、神经管畸形、总唇腭裂;"十一五"期间出生缺陷前三位的顺位为:先心病、肢体畸形、总唇腭裂。结论依托妇幼保健三级网络,加强三级预防措施,提高产前筛查覆盖率以及产前诊断技术水平,是目前降低出生缺陷发生率的有效手段。

目的:探讨对流动人口提供妇幼保健服务的工作模式,促进服务的可及性和公平性。方法:分层抽样确定流动人口集中的4个镇,通过定量调查、定性访谈、专家论证、分层干预、数据对比等方法进行研究。结果:影响流动人口利用妇幼保健服务的主要因素是文化程度、认知程度、经济水平。通过项目研究与干预,流动人口对妇幼保健服务利用情况有所提升;项目初步确立了流动人口妇幼保健管理与服务模式。结论:项目探讨确立的流动人口妇幼保健服务模式,在促进流动孕产妇和儿童妇幼保健服务质量提升中有实用价值。

Objective To explore influence factors on compliance to colposcopy in cervical cancer screening and propose corresponding strategies.Methods The multistage,stratified,randomly,non-probability sampling was used to choose one street and four towns from Daxing District of Beijing and a cervical cancer screening cohort was established for two years.Women with positive result at first screening stage were given a face to face interview and then were required to have further colposcopy tests with reservation within 6 months.Results Of 458 women with positive result in the first screening procedure,301(65.7%)women had taken colposcopy screening test in given period under instruction,while 157(34.3%) failed.The multiple logistic regression showed that,compared to younger women aged 30~,women aged 40~ had 1.958(1.207-3.176) times the odds,of taking colposcopy examination.Besides,compared to women living in the most remote rural areas with poor transportation,women living in areas close to testing site for colposcopy had 2.014(1.097-3.695) times the odds,of taking follow-up colposcopy examination.Women with good awareness of four aspects of knowledge including "More than 1 of 3 of all lives lost to cancer could be saved by early detection followed by early diagnosis and treatment","early stages of cervical cancer","HPV is a necessary cause of cervical cancer","treatment of early stage cervical cancer",were more likely to take colposcopy test in given period than women with little awareness,with 1.817(1.078-3.060),2.061(1.220-3.482),2.539(1.254-5.143),1.820(1.123-2.949) times the odds,respectively.Women not fear of pain during screening tests had higher compliance rate,with 2.159(1.266-3.681) times the odds of taking colposcopy test than those who were.Conclusion In women,extensive health education projects focusing on cervical cancer prevention and cure knowledge and the great significance of screening should be vigorously implemented.

[Objective] To investigate birth defects of Beijing Daxing district and discuss the effect of corresponding intervention methods.[Method] According to requirements of monitoring birth defects in Beijing,detect perinatal infants born in the whole district by using descriptive study.[Results] Mean rate of birth defects reached to 146.26 per ten thousand,upwards;The top four defects were:congenital heart disease,639 cases;limb deformity,224 cases;cheilopalatognathus,125 cases;neural tube defects,88 cases;Infants diagnosed to defects before birth were 307(22.86%),and 889 cases(66.20%)by ultrasonic diagnosis.[Conclusion] Rate of birth defects is rising;5-3-5 intervention methods are getting effects by using three-level network of maternal and child health care and by combination of clinic and care.

Objective To investigate the awareness status of knowledge on cervical cancer prevention and cure as well as relevant influencing factors to provide basis for developing corresponding intervention measures.Methods An epidemiological questionnaires survey was conducted among 2000 women recruited by the stratified cluster sampling after distributing propaganda materials in Daxing District,Beijing.Results The awareness rate about cervical cancer among women was rather low ranged from 15.8%(HPV infection was the main cause of developing cervix cancer) to 75.5%(keeping sexual hygiene was good for cervix cancer prevention).Multifactorial analysis indicated educational level,district,uptake of cervical cancer screening test or gynecologic examination in the past 5 years and annually average income of family members were major factors influencing awareness of women.The higher level of education the women were,the higher knowledge awareness rate the women had and so were the women with higher annually average income of family members.Among the 2000 women,the screening rate in past five year was 36% and no significant difference were found between urban and rural groups.Lack of knowledge or wrong perception towards cervical cancer screening and the subsequent physical and mental fear were the main factor influencing the screening rate among women in Daxing District.Conclusion Intelligible health education pattern should be applied to improve women's awareness of cervical cancer related knowledge especially among women with low education and low income in rural areas,which will help raise screening rate and contribute to the success of any cervical cancer prevention program.

目的 了解北京市大兴区近年出生缺陷发生情况及变化趋势,探寻出生缺陷的干预措施.方法 运用描述性统计学方法 回顾性地分析2004～2008年大兴区以医院为基础的出生缺陷监测资料.结果 大兴区2004～2008年5年间出生缺陷发生率为18.73‰,2008年与2004年的发生率比较差异有统计学意义(χ2=31.79,P<0.01),出生缺陷年发生率有所上升;出生缺陷排在前3位的依次为先天性心脏病、肢体畸形、唇腭裂.结论 依托妇幼保健三级网络,加强三级预防措施和提高产前筛查覆盖率以及产前诊断技术水平是目前降低出生缺陷发生率的有效手段.

目的:了解大兴区流动孕产妇和儿童妇幼保健服务现状与需求。方法:分层整群抽样确定4个镇,进行问卷调查与定性访谈。结果:共调查700例孕产妇,723例儿童。儿童看护人文化程度普遍低,保健知识缺乏,对卫生保健服务知晓率存在差异,计划免疫率98.9%、定期体检率59.1%、新生儿访视率19.9%,对呼吸急促、大便带血严重的疾病危险症状识别率较低为15.5%、15.2%;流动孕产妇70%以上来京后妊娠,孕期系统管理率明显低于户籍人口(P<0.01),产前检查少于4次占49.44%;产前检查总费用,在正规医院78.13%500元以上,在私人诊所90.72%在200元以下;孕妇对危险因素识别能力不足,大多数人认为只有阴道出血和肚子疼的时候再找医生;91.60%的孕产妇期望接受产前检查,85.8%的儿童看护人认为需要定期体检。结论:现有妇幼保健服务利用率较低;对私人接生打击力度不够;妇幼保健服务需求依然存在,应加强宏观管理,细节管理,摸索区域管理模式。

目的 探索流动人口妇幼保健服务网格化管理模式.方法 采取基线调查、问卷调查和小组访谈、专家论证和预实验等在试点地区进行网格化管理模式研究.结果 网格化管理模式实施后,区-镇-村(居)三级妇幼保健管理网络进一步延伸;建立了监测与部门联动机制;拓展了流动人口妇幼保健人群信息监测的途径;2009年试点地区流动孕妇和0～6岁流动儿童建册率分别为55.05%和65.56%,相对于2008年的32.05%(χ2=257.81,P<0.01)和58.86%(χ2=49.95,P<0.01)有了较大的提高.结论 妇幼保健网格化管理模式可行有效,且需进一步巩固,以保障运行.

目的 评价醋酸/碘染色后直接肉眼观察并结合阴道镜筛查方法在宫颈癌筛查中的应用效果,为现阶段宫颈癌高发且经济不发达地区制定宫颈癌及其癌前病变的筛查方案提供依据.方法 对筛查对象用5%醋酸/碘染色后肉眼观察、阴道镜镜下定点活检病理组织学诊断,同时进行宫颈癌危险因素的调查.结果 在筛查的2 000例30～59岁人群中,对于5%醋酸/碘染色后肉眼观察阳性结果病例进行阴道镜病理组织学活检,诊断为宫颈上皮内瘤变Ⅱ级及以上患者12例,现患率为6‰(12/2 000);5%醋酸/碘染色后肉眼观察的灵敏度、特异度、约登指数、阳性似然比、阴性似然比、阳性预测值、阴性预测值分别为:66.7%、94.2%、0.61、11.50、0.35、6.7%、99.7%(醋酸肉眼观察);91.7%、92.0%、0.84、11.46、0.09、6.6%、99.9%(碘染色肉眼观察).结论 5%醋酸/碘染色涂抹法用于宫颈癌初筛能早期发现宫颈癌及癌前病变,方法简便、廉价、易学,对设备要求很低,在目前宫颈癌筛查中仍然具有应用价值.