甘肃省出生缺陷1：2配对病例对照研究

为了解甘肃省出生缺陷死亡率及易患因素,为“甘肃省出生缺陷干预工程”项目的实施提供可干预的核心因素。根据甘肃地理特点及经济状况,按随机分层整群抽样方法,抽取了4个县,共42个乡为调查点。结果显示四县市婴儿总死亡率15.8‰(98例),出生缺陷死亡率7.7‰。甘肃省出生缺陷前五位的致病因素依次为:母亲孕早期接触农药史;母亲孕前一月服药史;母亲孕期接触农药史;母亲孕早期感染史;既往流产史。     

Predictors of child protective service contact between birth and age five: An examination of California's 2002 birth cohort

This study utilizes population-level birth data to describe those children who may be at greatest risk of maltreatment during the first five years of life. Based on a unique dataset constructed by linking California's administrative child welfare data to statewide vital birth records, a cohort study design was employed to track reports of maltreatment involving children born in 2002. Twelve variables captured in the birth record were selected for analysis. Generalized Linear Models were used to estimate adjusted risk ratios (RR) for each independent variable. Predicted probabilities of CPS contact were computed based on the count of risk factors present at birth. Results suggest that many of the associations previously observed between birth variables and subsequent maltreatment have sustained value in foretelling which children will be reported to CPS beyond infancy. Of the 531,035 children born in California in 2002, 14% (74,182) were reported for possible maltreatment before the age of five. Eleven of the twelve birth variables examined presented as significant predictors of contact with child protective services.     

现阶段农村青年婚姻观念的嬗变—以安徽省安庆市A县B镇为例

婚姻观念影响着人们的婚姻家庭生活。改革开放三十年来,由于各方面原因的冲击,使得人们的婚姻观念特别是青年的婚姻观念从传统向现代过渡,从封闭转向开放,从一元向多元的转变。本文以A县B镇农村青年为例,探求农村青年的婚姻观念中的择偶观、贞操观、婚俗观、生育观以及男女平等观念的嬗变。     

吕大临生卒年及有关问题考辨

本文根据方志、家谱、别集、石刻等多方面材料,证明吕大临生于宋仁宗康定元年（1040）,卒于宋哲宗元祐八年（1093）。《宋元学案》言其＂年四十七＂有误。《伊洛渊源录》卷八所载有关吕大临的《祭文》作者为吕大防无疑。并依据有关材料,补充了有关吕大临仕履。     

出生性别比影响因素的通径分析——以第五次全国人口普查数据为基础

根据我国的特殊情况,分别建立了城市和农村两个模型,并利用第五次全国人口普查的县(区)级单位数据,对出生性别比变化的直接和间接影响因素进行通径分析,发现:家庭规模和教育水平对城市的出生性别比影响较大,而医疗、经济发展和教育水平对农村的出生性别比影响显著,据此提出,降低出生性别比应采取加大现代生育观念的宣传力度、形成先进生育文化舆论环境、着力提高女性的文化程度和相应的社会地位以及加强对农村医疗服务机构的规范化管理等针对性措施。     

治理出生性别比失衡问题的再思考

针对我国20世纪80年代以来出生人口性别比持续升高现象分析认为,在我国,造成出生人口性别比升高的直接原因是非法胎儿性别鉴定的存在,深层次原因则是源于农村较低的经济发展水平和由此引起的社会保障制度不完善,以及国家在倡导男女平等的基本国策方面缺乏切实有效的政策措施。由此提出,建设社会主义新型生育文化、制定提高女性社会地位的相关政策、加强相关法规建设、完善社会保障制度以及借鉴他国成功经验等应是综合治理出生人口性别比升高的具体对策。     

“It’s like a bus,going downhill,without a driver”: A qualitative study of how postpartum haemorrhage is experienced by women,their birth partners,and healthcare professionals

ProblemPostpartum haemorrhage [PPH] remains a major cause of maternal morbidity and mortality. Whilst low-resource settings bear the greatest burden of deaths, women live with associated morbidities in all healthcare settings. Limited data exists regarding the experience for women, their partners, or healthcare professionals [HCPs], affected by PPH.AimTo qualitatively investigate the experience of PPH, for women (n = 9), birth partners (n = 4), and HCPs (n = 9) in an inner-city tertiary referral centre. To provide multi-faceted insight into PPH and improve understanding and future care practices.MethodsParticipants were interviewed about their experiences within two weeks of a PPH. Data were analysed using thematic analysis.FindingsFour distinct, but related, themes were identified: ‘Knowledge specific to PPH’; ‘Effective and appropriate responses to PPH’; ‘Communication of risk factors’; and ‘Quantifying blood loss’; which collected around a central organising concept of ‘Explaining the indescribable’.DiscussionPPH was viewed as a ‘crisis-style emergency’, generating respectful fear in HCPs, whilst women and partners had little-to-no prior knowledge. Specific PPH knowledge dictated HCPs’ response and risk communication. PPH risks were typically linked to quantification of blood loss, assessment of which varied with acknowledged questionable accuracy. Women’s and partners’ confidence in HCPs’ ability to deal with PPH was unquestionable. Non-verbal communication was highlighted, with HCP body language betraying professional confidence.ConclusionInformation about blood loss during childbirth must be imparted in a sensitive, timely manner. Whilst training for HCPs results in effective PPH management, consideration should be given to their non-verbal cues and the impact of dealing with this stressful, ‘everyday emergency’.     

An analysis of media reporting on the closure of freestanding midwifery units in England

ProblemDespite clinical guidelines and policy promoting choice of place of birth, 14 Freestanding Midwifery Units were closed between 2008 and 2015, closures reported in the media as justified by low use and financial constraints.BackgroundThe Birthplace in England Programme found that freestanding midwifery units provided the most cost-effective birthplace for women at low risk of complications. Women planning birth in a freestanding unit were less likely to experience interventions and serious morbidity than those planning obstetric unit birth, with no difference in outcomes for babies.MethodsThis paper uses an interpretative technique developed for policy analysis to explore the representation of these closures in 191 news articles, to explore the public climate in which they occurred.Findings and discussionThe articles focussed on underuse by women and financial constraints on services. Despite the inclusion of service user voices, the power of framing was held by service managers and commissioners. The analysis exposed how neoliberalist and austerity policies have privileged representation of individual consumer choice and market-driven provision as drivers of changes in health services. This normative framing presents the reasons given for closure as hard to refute and cultural norms persist that birth is safest in an obstetric setting, despite evidence to the contrary.ConclusionThe rise of neoliberalism and austerity in contemporary Britain has influenced the reform of maternity services, in particular the closure of midwifery units. Justifications given for closure silence other narratives, predominantly from service users, that attempt to present women’s choice in terms of rights and a social model of care.     

Preference for caesarean and attitudes toward birth in a Chilean sample of young adults

BackgroundLittle empirical research exists about what motivates birth mode preferences, and even less about this topic in Latin America, where obstetric interventions and caesareans are some of the highest worldwide.AimTo identify factors associated with caesarean preference among Chilean men and women who plan to have children and to inform childbirth education and informed consent procedures.MethodsAn online cross-sectional survey measuring attitudes toward birth was administered to graduate students at a large public university in Chile. Eligible students were under the age of 40 and had no children but intended to have children. Logistic regression modelling was used to determine which sociodemographic factors, knowledge and beliefs were associated with caesarean preference.FindingsAmong eligible students, 730 responded and 664 provided complete answers to the variables of interest. Respondents had a mean age of 28.8; 38% were male and 62% female. Positive attitude toward technological intervention (Odds Ratio 7.4, 95% Confidence Interval 3.9–14.0), high risk perception of vaginal birth (Odds Ratio 1.8, 95% Confidence Interval 1.1–2.8), family history of caesarean (Odds Ratio 1.9, 95% Confidence Interval 1.0–3.8) and high fear of birth (Odds Ratio 3.7, 95% Confidence Interval 2.0–6.8) were associated with caesarean preference.DiscussionPreference for caesarean birth was highly associated with positive attitudes toward technological intervention and may be related to a lack of knowledge about the realities of caesarean and vaginal birth.ConclusionsPatient-centered education on the relative benefits and risks of birth modes has the potential to influence preferences toward vaginal birth.