目的:了解我国部分农村地区妇女乳腺癌筛查工作现状及效果,探讨影响筛查效果的因素,为提高乳腺癌筛查水平提供参考.方法:采用问卷调查和网络直报系统收集2018年6省(自治区)乳腺癌筛查工作的组织管理、服务提供以及筛查效果数据,采用单因素x2检验和泊松回归分析乳腺癌筛查效果及其影响因素.结果:2018年6省154个县共有1156287例农村妇女接受乳腺癌筛查,早期乳腺癌检出率为24.39/10万,贫困县(17.51/10万)低于非贫困县(40.18/10万);乳腺癌检出率为47.91/10万,贫困县(37.62/10万)低于非贫困县(71.53/10万).多因素分析显示,非贫困县中,初筛地点以及筛查服务参与机构类型是其筛查效果的影响因素;在贫困县中,经费来源途径是其筛查效果的影响因素.结论:我国农村地区特别是贫困地区乳腺癌筛查效果仍不理想,应加大对经济欠发达地区政策倾斜和经费投入,因地制宜选择筛查参与机构,多措并举加强人员能力建设,不断提高筛查质量.

BACKGROUND:Primary human papillomavirus (HPV) screening is recommended for the detection of cervical intraepithelial neoplasia (CIN) in the general population; however, the triage for HPV-positive women remains a challenge. This study aimed to evaluate the age-specific effectiveness of primary HPV screening versus primary cytology screening for identifying optimal strategies for women of different ages. METHODS:The dataset of the prevalence round screening was derived from the National Cervical Cancer Screening Program in China. Primary cervical screening protocols included cytology only, HPV testing with cytology triage, and HPV testing with HPV-16/18 genotyping plus cytology triage. The primary outcomes were age-specific detection rate, colposcopy referral rate and positive predictive value (PPV) for CIN2+. Multivariate Poisson regression was used to evaluate the relative effectiveness of HPV testing and cytology according to age groups. The I2 statistic with a random-effect model was used to test the heterogeneity in relative effectiveness of HPV testing versus cytology between age groups. RESULTS:This study included 1,160,981 women. HPV testing with HPV-16/18 genotyping plus cytology triage significantly increased the CIN2+ detection by 36% (rate ratio [RR]: 1.36, 95% confidential interval [CI] 1.21-1.54) for women aged 35-44 years and by 34% (RR: 1.34, 95% CI 1.20-1.51) for women aged 45-54 years compared with cytology only. HPV testing with cytology triage had similar CIN2+ detection rate compared with cytology only. The PPVs were substantially increased for both HPV testing groups. Among women aged 55-64 years old, HPV testing with HPV-16/18 genotyping plus cytology triage increased the colposcopy referral rate by 19% (RR 1.19, 95% CI 1.10-1.29) compared with cytology only, but did not increase the CIN2+ detection (1.09, 0.91-1.30). The effectiveness of HPV testing with cytology triage did not change in older women. The between-age-group heterogeneity in the effectiveness was statistically significant for HPV testing with HPV-16/18 genotyping plus cytology triage versus cytology only. CONCLUSIONS:Our results suggested that the effectiveness of primary HPV screening with different triage strategies differed among age groups. HPV testing with HPV-16/18 genotyping plus cytology triage could be used for women aged 35-54 years to detect more lesions, and HPV testing with cytology triage could balance the CIN2+ detection and the number of colposcopies for women aged 55-64 years. Longitudinal data including both prevalence and incidence screening rounds are warranted to assess age-specific triage strategies.

Women's reproductive, maternal, newborn, child, and adolescent health (RMNCAH) is a cornerstone for the healthy development of the next generation and a driving force for the progress of population and society in the future, especially in this era of population ageing and low fertility in China. In past decades, China's RMNCAH has made remarkable achievements in development goals related to reducing maternal and child mortality. However, as China moves towards a thriving goal—namely, towards ensuring health and wellbeing—the country faces emerging problems and new challenges in RMNCAH. These problems and challenges relate to the rapid and continuous improvement in social and economic conditions along with changes in demographics, lifestyles, the environment, and innovations in medical and therapeutic technologies, as well as an increasing threat of emerging infectious diseases such as COVID-19. The UN Sustainable Development Goals (SDGs) have also extended the focus from maternal and child survival to improvement of health across the life span. This focus is integrated in the visions of both the SDGs and the Healthy China 2030 agenda. The years 2021–30 are crucial in ensuring that China is able to meet the goal of universal RMNCAH coverage, which is embodied by access, quality, and equity. This Lancet RMNCAH Commission aims to review past achievements and lessons, to analyse current problems and challenges, and then to prioritise steps towards the achievements of the SDGs and Healthy China 2030. Time of transition: lessons from China's progress in reproductive, maternal, newborn, child, and adolescent healthThe report of the Lancet Commission on 70 years of reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in China1 describes the country's achievements and discusses policy and socioeconomic transitions, and their impact on epidemiological and demographic transitions. Current challenges are identified by the Commission, including low fertility, the ageing population, undernutrition and overnutrition, and emerging diseases as China moves towards its final stage of ending preventable maternal2 and neonatal deaths. Full-Text PDF Gender equity, caregiving, and the 1-2-3-child policy in ChinaThe Lancet Commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China by Jie Qiao and colleagues1 clearly describes a roadmap for universal coverage by 2030. However, the gendered role of caregiving2 is overlooked in the narrow definition of maternal health.3 Full-Text PDF Gender equity, caregiving, and the 1-2-3-child policy in China – Authors' replyXiaoxiao Kwete and colleagues note the challenge of population ageing and low fertility that is happening not only in China but also in many other countries. With increasing longevity and a relaxing population policy, young couples are shouldering a growing burden of caregiving for their older family members and children. This burden is the main reason for the decreased fertility desire among young Chinese couples. Additionally, increased independence and more opportunities have empowered women to pursue their personal development, which inevitably results in a low fertility rate and the postponement of childbearing. Full-Text PDF

Objective: To evaluate the effectiveness and quality of ultrasound-based (BUS) process optimization in breast cancer screening. Methods: The program collected the first to fourth quarterly breast cancer screening statistic data and case report data from 30 provinces, autonomous regions and municipalities in 2015 by the online report system of national key service program of women and children's public health. The call rate, mammography (MG) subsequent screen rate, biopsy rate, detection rate, early diagnosis rate, carcinoma in situ rate, missing detection rate, false positive rate and positive predictive value (PPV) of breast cancer were calculated. Results: A total of 1 501 753 rural women attended the BUS process optimization screening. The nationwide recall rate was 3.01%(45 156/1 501 753), and in the eastern and central area were 3.41%(17 173/503 130) and 3.56%(14 499/407 739), respectively, higher than 2.28% (13 484/590 884) of western area (P<0.05). The nationwide MG subsequent screen rate was 2.78%(41 694/1 501 753), and in the eastern and central area were 3.19%(16 036/503 130) and 3.29% (13 421/407 739), respectively, higher than 2.07%(12 237/590 884) of western area (P<0.05). The nationwide biopsy rate was 0.23%(3 462/1 501 753), and in the central area were 0.26%(1 078/407 739), respectively, higher than 0.21%(1 247/590 884) of western area and 0.23% (1 137/503 130) of eastern area (P<0.05). The nationwide biopsy PPV was 37.00%(1 281/3 462). The biopsy PPV of eastern area was (34.30%, 390/1 137), lower than 39.33% (424/1 078) of central area (P<0.05). A total of 1 281 cases of breast cancer were detected, the detection rate was 0.85‰(1 281/1 501 753), and the detection rates of central area was 1.04‰ (424/407 739), higher than 0.79‰(467/590 884) of western area and 0.78‰(390/503 130) of eastern area (P<0.05). The BUS initiate screening positive rate from detected breast cancer cases was 96.96%(1 242/1 281), the MG subsequent screening positive rate was 2.42%(31/1 281). The nationwide early diagnosis rate was 85.25%(1 092/1 281), and in the eastern and central areas were 87.95%(343/390) and 88.21%(374/424), higher than 80.30%(375/467) of western area (P<0.05). The screening rate of on or above stage Ⅱ breast cancer in eastern area was 55.64%(217/390), lower than 64.62%(374/424) of central area and 62.31%(291/467) of western area. The missing detection rate was 0.62%(8/1 281) and false positive rate was 1.20%(17 528/1 464 149). Conclusions: The BUS process optimization of breast cancer screening scheme is reasonable and applicable to China rural women. The effectiveness and quality of eastern area are superior to those of central and western area.

Objective: To analyze the effectiveness of the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in China. Methods: Data were collected in the form of quarterly statistical tables reported by NCCSPRA counties in 30 provinces (Hong Kong, Macao and Taiwan province of China were not included into the NCCSPRA, and Tibet Autonomous Region carried out the program but did not reported the data) from 2009 to 2018. The women aged 35-64 years with sexual behavior and the identity (Hukou) of rural area in these project counties were included into the NCCSPRA, and women receiving hysterectomy for non-cervical cancer or non-cervical lesions were excluded. The following indicators were analyzed: the positive rates of different screening methods, the abnormality rates of colposcopy and histopathology, the detection rate of precancerous lesions, the detection rate of cervical cancer and the rate of early diagnosis. Results: A total of 85 041 490 women aged 35-64 in rural areas received free cervical cancer screening and diagnosis if necessary. On the whole, the abnormality rate of cytology, HPV testing, VIA/VILI, colposcopy and histopathology was 3.71%(2 567 610), 9.91%(331 158), 10.10%(1 167 930), 28.85%(1 420 847), and 21.20%(303 068) respectively. The detection rate of cervical precancerous lesions was 153.88/100 000, and increased from 106.85/100 000 in 2012 to 223.89/100 000 in 2018 (P<0.001). Regionally, the east (207.37/100 000) reached higher rate than the middle (177.65/100 000), and the middle higher than the west (108.65/100 000) (P<0.001). The detection rate of invasive cervical cancer was 21.58/100 000, and increased from 18.02/100 000 in 2012 to 26.54/100 000 in 2018 (P<0.001). Regionally, the middle of China (25.46/100 000) reached the higher rate than the east (19.62/100 000) and the west (19.30/100 000) (P<0.001). The rate of early detection was 91.24%(136 140), which increased from 89.60% (11 883)in 2012 to 92.80%(26 962) in 2018 (P<0.001). Regionally, the east of China (94.02%, 37 600) reached the higher rate than the middle(91.06%, 56 488), and the middle higher than the west (89.12%, 42 052) (P<0.001). Conclusions: There are obvious difference in terms of the detection rate of cervical precancerous lesions and the rate of early diagnosis reflecting cervical cancer screening capacity among the eastern, middle and western regions,which showed service inequity among different areas indirectly. The middle and western regions, especially the western regions, are still the focus of future works.

Background Randomized controlled trials have shown a higher sensitivity and longer negative predictive value of high-risk human papillomavirus (HPV) testing than cytology for cervical cancer screening; however, little is known about the effectiveness of HPV testing in middle-income countries. Understanding the characteristics of HPV testing may increase the priority of HPV testing in health policies. The study aims to evaluate the effectiveness of HPV testing in the national cervical cancer screening programme in China. Methods We performed a nationwide, population-based study using individual data from the national cervical cancer screening programme in rural China between 2015 and 2017. The analyses included 1,160,981 women aged 35–64 years who underwent cytology alone or high-risk HPV testing with cytology or genotyping triage. The main outcome was cervical intraepithelial neoplasia 2 or worse (CIN2+). We used multivariate logistic regressions and performed sensitivity analyses with propensity score matching to compare the screening positive, colposcopy referral, detection rate, and positive predictive value (PPV). Results The screening positive rates for HPV testing and cytology were 10.1% and 4.0%, respectively. The per protocol colposcopy referral rate of HPV testing was significantly lower than that of cytology (3.5% vs 4.0%), and this difference was mostly due to the low referral threshold of cytology (≥ASC-US). Overall, HPV testing detected more CIN2+ (5.5 vs. 4.4 per 1000, adjusted odds ratio [aOR]=1.18, 95% confidence interval 1.11–1.25) and had a higher PPV (13.8% vs 10.9%, aOR 1.29, 95% CI 1.21–1.37) than cytology. The colposcopy referrals of HPV testing in comparison to cytology differed by income status; it significantly increased in lower-middle-income areas (3.7% vs 3.1%, aOR 1.21, 95% CI 1.17–1.25) and significantly decreased in upper-middle-income areas (3.4% vs 4.9%, aOR 0.69, 95% CI 0.67–0.71). Sensitivity analyses demonstrated the reliability and robustness of the results. Conclusions The introduction of HPV testing could improve both the CIN2+ detection rate and efficiency of cervical cancer screening programme, supporting the introduction of primary screening with high-risk HPV testing in China. Further study is needed to investigate the long-term effect of this change.

目的 分析2018年我国5省国家级贫困县农村妇女宫颈癌筛查项目的实施现状、筛查效果及影响因素,为提高贫困地区宫颈癌防控能力提供科学依据.方法 采用信函调查方法及信息网络直报系统收集贫困县农村妇女宫颈癌筛查项目的组织管理、筛查流程、服务提供及筛查效果数据,进行宫颈癌前病变检出率的单因素及多因素分析.结果 175个国家级贫困县共完成1 376 015例农村妇女宫颈癌筛查.宫颈癌前病变检出率为179.79/10万,宫颈癌检出率为27.03/10万,早诊率为91.18％.多因素分析模型显示,县级多机构参与筛查、宫颈癌筛查工作纳入县级绩效考核、获得多途径筛查经费、接受上级机构督导质控、完全配备筛查人员、多台仪器设备投入及县级机构独立承担的筛查服务模式均可提高宫颈癌前病变的检出率(RR值分别为1.41、1.35、1.25、1.64、1.23、1.17、0.89,P＜0.05).结论 现阶段我国部分贫困地区宫颈癌筛查服务质量已有一定提高,筛查工作的组织管理与服务提供能力是保障筛查服务质量和提高癌前病变检出率的重要因素.

Abstract Background Youth friendly services (YFS) was established in pilot areas in China. This study aimed to explore the promoting level on the awareness and utilization of YFS after the implementing of a multi-sectoral cooperation mechanism (MSCM) supported by social network theory (SNT) among multiple sectors related to young people reproductive health (YRH) closely. Methods A cross-sectional study with two separate self-administered questionnaire surveys was conducted before and after the implementing of a MSCM supported by SNT in both in-school and out-school unmarried young people aged 12–24 year-old in pilot areas in China. Both pre- and post- implementation surveys were conducted between December, 2008 and January, 2009, and between October, 2010 and January, 2011 respectively. The collected categorical data about the awareness on YFS in young people was described in percentage (%). χ 2 test was used to compare the differences between interventional and control areas, pre and after intervention, and changes in investigated areas after the intervention respectively. Binary logistic regression was used to analyze interventional effects after adjusting gender, in-school or out-school, and other factors. Significance level α was 0.05. Results The percentages of young people in interventional areas who could receive YRH education including that about YFS in schools, working sites and communities increased (OR = 15.485, 6.166, 3.723; 95% CI: 2.939~4.715, 4.014~9.473, 11.421~20.994 respectively) statistically significantly (P < 0.05). The percentages of young people in interventional areas who “have heard of YFS clinic” and “know that YFS clinic has been established in local area” (OR = 9.325, 11.244; 95% CI: 7.433~11.699, 8.780~14.399 respectively), and knowledge rates on YFS manner and contents also increased (OR = 14.830, 8.676; 95% CI: 9.728~22.607, 5.175~14.548 respectively) statistically significantly (P < 0.05). The increments of knowledge rates on YFS price, time, hotline number, contents on contraception, pregnancy and sexual harass/violence were statistically significant (P < 0.05). The satisfaction degree on this service has also increased (OR = 6.394, 95% CI: 2.789~14.655) statistically significantly (P < 0.05). Conclusions SNT is a helpful tool to facilitate the construction of an effective multi-sectoral cooperation mechanism to promote the awareness and satisfactory degree of YRH services.

目的 为提高国家农村妇女乳腺癌筛查项目效果,第2个周期(2012-2014年)筛查模式调整为基于超声的乳腺癌筛查,本研究通过对2014年度农村妇女乳腺癌筛查数据进行分析,了解基于超声的乳腺癌筛查模式的质量和效果,为完善筛查流程、提高筛查质量和管理水平提供依据.方法 采用基于超声的乳腺癌筛查模式为全国35～64岁农村户籍女性进行群体性乳腺癌筛查:先为符合条件的农村女性进行乳腺临床检查联合乳腺超声检查,超声BI-RADS 0、4、5级者进行乳腺X射线检查(mammography,MG),X射线BI-RADS 0、4、5级者进行组织病理检查,乳腺超声、X射线BI-RADS 1、2、3级者进行1年随访.检查数据以统计报表和个案表(筛出乳腺癌患者)形式录入《国家妇幼重大公共卫生项目信息直报系统》.分东、中、西部地区计算乳腺癌召回率、活检率、活检阳性预测值、检出率、早诊率、原位癌比例、早期癌比例、漏检率、假阳性率等主要评估指标;使用x2检验对地区间指标结果进行比较.结果 2014年为30个省(市、区)697个项目县共1 373 524名35～64岁农村女性进行了乳腺癌筛查.检出乳腺癌1 190例,检出率为0.87‰;东、中、西部地区检出乳腺癌例数分别为404、375和411例,检出率分别为0.90‰、0.86‰和0.84‰,地区间检出率差异无统计学意义,x2=1.215,P＞0.05.共检出早期乳腺癌1 014例,早诊率为85.21％;东、中、西部地区检出早期乳腺癌例数分别为353、323和338例,早诊率分别为87.38％、86.13％和82.24％,地区间早诊率差异无统计学意义,x2=4.638,P＞0.05.检出原位癌82例,原位癌比例为6.89％;东、中、西部地区分别检出原位癌39、23和20例,原位癌比例分别为9.65％、6.13％和4.87％,原位癌比例地区间差异有统计学意义,x2=7.767,P＜0.05.检出早期癌(0+Ⅰ期)387例,早期癌比例为32.52％;东、中、西部地区早期癌例数分别为159、115和113例,早期癌比例分别为39.36％、30.67％和27.49％,地区间差异有统计学意义,x2=13.922,P＜0.01.MG复筛人数为33 129人,召回率为2.41％;东、中、西部地区MG复筛人数分别为12 827、11 616和8 686人,召回率分别为2.87％、2.67％和1.77％,地区间差异有统计学意义,x2=1 386,P＜0.01.3 088人接受活检,活检率为0.22％;东、中、西部地区接受活检人数分别为1 106、1 006和976人,活检率分别为0.25％、0.23％和0.20％,地区间差异有统计学意义,x2=25.910,P＜0.01.超声初筛漏检率为7.23％,其中BI-RADS 3级漏检率为6.89％;MG复筛BI-RADS 3级漏检率3.99％;仅超声检出乳腺癌比例为5.58％.结论 2014年中国农村妇女乳腺癌检查项目检出和早诊情况符合相关质控要求,说明基于超声的乳腺癌筛查在中国农村地区可行且有效.但本筛查流程的漏检率仍较高,需进行流程优化.应加强MG和活检设备配置及技术培训,以提高乳腺癌筛查服务能力,从而进一步提高检出率和早诊率.

目的 了解我国妇女常见病筛查工作现况,分析工作中存在的内部优势(S)、劣势(W)以及外部机会(O)、威胁(T)因素(SWOT)并提出针对性改进措施.方法 采用信函调查、现场调查与专家咨询相结合的方法进行资料收集;采用SWOT分析方法对资料进行系统分析.结果 优势:有多层面免费检查项目且覆盖范围不断扩大、三级妇幼保健服务网络运转良好、宣教力度不断增大;劣势:包括资金不足、数据来源未明确、缺乏规范化管理、专项筛查项目不足、医务人员对筛查工作的了解程度不够、基层筛查能力不足;机会:有政府重视、贫困地区的政策倾斜、信息平台的建设、各类社会医疗保险的覆盖、适龄妇女健康意识和健康需求增加;威胁:包括未建立有效的多部门合作机制、卫生服务可及性差、基层专业技术人员流动性大,人才队伍建设可持续发展不足、流动人口增加.结论 目前我国妇女常见病筛查工作内部优势与劣势同在,外部机遇与挑战并存.为促进筛查工作的开展,应加强规范化管理,多渠道筹集筛查资金,建立与社会资源合作机制、推动区域合作和优质医疗资源下沉,不断提高基层服务能力.

产后抑郁最早是由Pitt(1968年)首次提出,是抑郁症的一种亚型,是在产后4周内明显的抑郁症状或典型的抑郁发作,与产后心绪不宁和产后精神病同属产褥期精神综合征[1].产后抑郁不仅会使产妇本身出现食欲下降、情绪低落、失眠、焦虑,严重者出现自杀等严重心身障碍,也会导致母乳喂养困难、婴幼儿生长发育迟缓、亲子关系紧张等,对子代造成不良影响.

Background:Cascade analysis is an effective method to analyze the processing data of an event, such as a provided service or a series of examinations. This study aimed to develop a primary cervical cancer screening cascade in China to promote the quality of the screening process.Methods:We designed a cervical cancer screening cascade in China according to the program flow chart. It had three stages, each with two steps and one result. Data from 117,522 women aged 35 to 64 years in the Rural Cervical Cancer Surveillance Project from January 1, 2014, to December 31, 2014, were collected to analyze the main results of the cascade. The data and proportion are used to describe the follow-up of cervical cancer and pre-cancer detection rate.Results:In 2014, 117,522 (80.94% of all cases reported by the Rural Cervical Cancer Surveillance Project) women aged 35 to 64 years had not received cervical cytology in the previous 3 years. The pre-cancer and cancer detection rates were 256.12/100,000 and 16.16/100,000, respectively. A total of 3031 cases failed to follow-up through the screening process, and 1189, 1555, and 287 cases were lost at cervical cytology, colposcopy, and histopathological screening stages, respectively. The estimated cases of pre-cancer and cancer cases would have been 544 and 34, respectively, and the estimated detection rates of pre-cancer and cancer would have been 462.89/100,000 and 28.93/100,000, respectively.Conclusion:In order to increase the detection rate of cervical cancer, cervical cancer screening staff should focus on increasing the rate of follow-up of those who are positive for cervical cancer screening (ie, those with positive cytology results), especially for the 40 to 44 years age range.

目的 了解我国妇女常见病筛查数据上报情况,为提高我国妇女常见病筛查数据质量提出建议.方法 在全国30个省按照2016年妇女常见病筛查率最高、中等、最低进行抽取,每个省3个县(区),共90个县(区)进行信函调查.结果 从2013年到2016年,筛查率分别为37.64％,49.23％,58.88％和60.90％,呈逐年上升趋势.筛查率分布东部高于中部、中部高于西部.2016年妇女常见病筛查率仍旧偏低,大于80％的县(区)仅占40％. 64.44％的调查县(区)能正确理解应查人数的定义.妇女常见病筛查数据来源多样,其中“两癌”检查项目、妇女常见病项目及孕前优生项目为主要的数据来源,而来自体检的数据普遍收集不足.结论 目前我国妇女常见病筛查数据质量值得关注,急需对我国妇女常见病筛查数据来源以及应查人数的定义进行统一要求和质控.

[目的]初步分析2015年我国农村妇女基于超声优化流程的乳腺癌筛查数据的成本效果.[方法]利用2015年国家妇幼重大公共卫生服务项目信息直报系统中全国30个省(区、市)706个县上报的乳腺癌筛查项目季度统计表和阳性个案报表,计算乳腺癌检出率、早诊率和早期发现成本系数等指标,并对不同筛查模式、不同年龄组,以及不同地区筛查项目的成本效果进行比较分析.[结果] 2015年我国农村妇女基于超声优化流程的乳腺癌筛查项目中,乳腺癌检出率为0.85‰,早期癌检出率为0.73‰,早诊率为85.25％.总筛查成本11 954.00万元,检出1例乳腺癌成本9.33万元,检出1例早期乳腺癌成本10.95万元,全国总体早期发现成本系数为2.19;基于超声检查的乳腺癌筛查模式的早期发现成本系数(2.19)与仅超声初筛(2.13)几乎一致;35～39岁年龄组的早期发现成本系数为3.97,40～64岁年龄组介于1.87～2.66;不同地区的早期发现成本系数为东部(1.65)、中部(2.12)低于西部(3.21)(x2=15.8835,P＜0.0001;x2=26.6755,P＜0.0001).[结论]我国农村妇女基于超声优化流程的乳腺癌筛查项目具有较好成本效果,其中40岁以上年龄组成本效果更好,东部和中部地区的成本效果优于西部地区.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的分析中国部分省份宫颈癌、乳腺癌（以下简称两癌）检查项目机构服务现状,为制定下一步两癌检查方案提供参考。方法利用自行设计的医疗机构调查表,于2014—2015年,在全国12省19县参与两癌检查项目的123家医疗保健机构进行调查,了解其项目开展、人员构成等现状。结果项目开展方面,县级开展乳腺临床、乳腺彩超检查、阴道镜检查、液基/薄层细胞学检查、醋酸和卢戈碘液染色肉眼观察（VIA/NILI）检查、宫颈细胞伯塞斯达系统（TBS）分类诊断、病理检查、乳腺X线检查和人类乳头瘤病毒（HPV）检测的机构比例远高于乡级;东中部地区开展妇科检查、阴道/宫颈分泌物实验室检查、宫颈细胞TBS诊断、阴道镜检查和乳腺临床检查的机构比例高于西部;医务人员构成方面,东部以县级医务人员为主（63.7%）,中、西部则以乡级为主（70.0%、77.1%）;医务人员职称方面,县级医疗机构以中级职称为主（30.8%）,乡级则以初级职称为主（43.1%）,东部地区以中级职称为主（27.1%）,中、西部则以初级职称为主（41.4%、54.6%）。结论两癌项目地区工作流程符合要求,不同级别机构和不同地区机构及人员能力发展不均衡,基层服务人员能力有待进一步提高。</span>

青少年是全生命周期中的重要时期,为其健康投资可获得三重健康效益.目前青少年仍面临较多健康问题,且卫生服务领域对青少年的重视程度有待提高.近几年,国际组织连续颁布多部指南和行动框架,以期推动全球各国积极投资青少年的健康与发展.本文拟对最新4部指南文件的核心内容做一简要综述并结合现阶段我国青少年健康促进工作的开展情况,为下一步工作重点提供启示和借鉴.

Objective To learn the personality disorder prevalence,severity and possible influencing factors of ethnic minority freshmen.Methods In September 2014,2 823 freshmen of class 2014 were selected by using the cluster sampling method in a university in Beijing.Personality diagnostic questionnaire(PDQ-4)was used as a personality disorder screening tool and a self-designed questionnaire was used to collect the general information of the students.Results The total PDQ-4 score of the freshmen was 23.34 ± 10.44.For the subscales,types of schizotypal(t=15.46,P=0.000),paranoid(t=12.49,P=0.000),dependent(t=6.69,P=0.000),histrionic(t= 12.92,P= 0.000),and borderline(t= 2.83,P= 0.005)had higher score than the general population,and the difference was significantly.The positive rate of overall personality disorder was 25.67%(666).The top three types were obsessive compulsive,avoidant,and paranoid.The positive rates for these three were 44.29%(1 149),31.84%(826) and 30.30%(786),respectively.The lowest was borderline,and the rate of which was 5.74%(149).The overall positive rate of personality disorder in male was higher than in female(χ2= 6.42,P= 0.011).Male students had higher rates on schizotypal, histrionic,narcissistic,borderline and antisocial than female peers(all P<0.05).Meanwhile,the later had higher rate on avoidant than the former(χ2= 17.65,P< 0.05).The positive rate of paranoid type in the ethnic minority students was higher than in students of Han nationality(χ2=4.76,P=0.029),while students of Han nationality had higher rate on histrionic than the ethnic minority students(χ2= 5.75,P= 0.016).Both differences were statistically significant.Conclusion Freshmen,ethnic minority students,and male students are key groups in which personality disorders occur.It is necessary to conduct targeted research and intervention so as to reduce the incidence of personality disorders in the key period before the personality is fully developed and avoid further impact.

目的 了解我国东中西部不同地区农村妇女对宫颈癌防治相关知识及最终参与检查的情况.方法 在全国东中西部地区分别选取4个省7个农村妇女宫颈癌检查项目县(区),采取多阶段分层随机抽样的方法抽取358名35 ～64岁的农村妇女进行问卷调查.结果 2.2％的妇女未听说过宫颈癌,30.1％不了解宫颈癌可能出现性交后阴道出血,有14.0％的调查对象表示不知道宫颈癌发病危险因素,35.5％不了解高危型HPV感染是宫颈癌发病原因.认为宫颈癌是不可预防的占7.8％,仅有16.1％的妇女了解首次性行为前注射HPV疫苗可以预防宫颈癌.调查对象知识获取途径≤3种、4～6种、≥7种的分别为47.2％、32.1％及20.7％.多因素Logistic回归分析显示,宫颈癌防治知识的影响因素主要有职业(OR=1.519,95％CI:1.083 ～2.129)、文化程度(OR=1.407,95％CI:1.011～1.957)、获取知识的途径(OR=2.056,95％CI:1.453～2.909)和得到专业人士讲解(OR=1.967,95％CI:1.136 ～3.405).有91.1％的调查对象曾经接受过宫颈癌筛查,8.9％未进行.主动寻求筛查的妇女宫颈癌防治相关知识得分高于被动筛查的妇女(P＜0.001).结论 农村妇女宫颈癌防治相关知识缺乏,宫颈癌防治相关知识水平与最终筛查行为密切相关,应采取各种有效的手段对农村妇女及社会公众进行更广泛的健康教育.

目的 了解多民族大学一年级(大一)新生的焦虑抑郁状况,分析其可能的影响因素,为未来有针对性开展心理健康教育和干预提供依据.方法 用整群抽样方法,入选北京某高校2014级全部本科新生进行焦虑自评量表(SAS)、抑郁自评量表(SDS)自填问卷调查.结果 调查对象的焦虑和抑郁检出率分别为9.7％和15.5％.焦虑合并抑郁检出率为5.47％.SAS平均分为(39.66±7.23);SDS平均分为(42.86±8.84),焦虑和抑郁平均分均高于全国常模(P＜0.05).东部省份学生焦虑总分(38.59 ±7.33)低于中部省份学生(39.49 ±7.6),西部省份学生焦虑总分最高(40.18 ±6.91).差异有统计学意义(P =0.000 1).蒙古族学生的焦虑总分(38.21 ±6.77)低于其他民族学生,且不同民族学生焦虑总分有统计学差异(P=0.005).男性抑郁和焦虑检出情况均高于女性,南方学生抑郁和焦虑检出情况均高于北方,但差异没有统计学显著性.结论 大一入学这一生活事件和民族性格特质是引起多民族大学生焦虑抑郁可能的影响因素,应在入学之初有针对性地开展心理健康教育,并进行积极的心理疏导,帮助多民族新生顺利度过大一适应阶段,开始大学生活.

Objective To learn the prevalence of pregnancy-specific stress in early pregnant women.Methods Altogether 961 early pregnant women (at 13 weeks±6 days) visiting Zhuhai Maternal and Child Health Care Hospital, Shanxi Maternal and Child Health Care Hospital, Haidian Maternal and Child Health Care Hospital of Beijing and Jilin Maternal and Health Care Hospital from August 2015 to February 2016 were selected as study objects.Basic situation surveying form and pregnancy stress rating scale (PSRS) were used in questionnaire and results were analyzed.Results Prevalence of pregnancy-specific stress in early pregnant women was respectively listed as follows: none stress in 5.52% of cases, mild stress in 83.14%, moderate stress in 10.82% and severe stress in 0.52%.The main source of stress was from pressure caused by striving to ensure health and safety of both mother and baby.The most commonly stressing items were as follows: infirmity of baby (73.99%), delivery safety of baby (72.42%), delivery safety of mother (71.07%), cesarean delivery and unforeseen circumstance (70.76%) and delivery pain (64.72%).Conclusion Overall prevalence of pregnancy-specific stress in early pregnant women is relatively high, and mild stress is most common.Main source of stress is related to concern of health and security for both mothers and babies.