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The views and anticipated needs of women in early pregnancy

BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2000年第10期107卷 1237-1240页

作者： Jewell, D Sanders, J Sharp, D Univ Bristol Div Primary Hlth Care Bristol BS8 2PR Avon England

Objective To assess the expectations of antenatal care of pregnant women at the outset of pregnancy. Design Questionnaire study within a randomised controlled trial, comparing traditional antenatal care with a more flexible schedule. Setting Eleven primary care centres providing midwifery care in Avon. Population Five hundred and ninety-three pregnant women at low risk of obstetric complications presenting for antenatal care. Methods A questionnaire was completed by women who agreed to participate in the trial shortly after antenatal booking. The questionnaire explored women's views on their attitudes to pregnancy and antenatal care, the locus of control related to pregnancy, the planning of the pregnancy and expectations of care. Main outcome measures Comparisons between nulliparous and multiparous women in terms of their views of antenatal care, and their stated preference for a particular package of care. Results There was no difference in their views of pregnancy as an event entailing risk. On a locus of control scale that measured women's perceptions of factors which might affect their babies' health, nulliparous women rated antenatal care higher than multiparous women (P = 0.0001). However, this was not associated with any difference between the two groups in their stated preference for traditional or flexible care. Approximately half of the women expressed no preference, and of those who did 61% would opt for traditional care. Almost one-fifth of the whole sample welcomed the idea of flexible care. Discussion These data support the evidence of previous studies that there remains a strong desire among pregnant women to receive a 'traditional' pattern of care, even among those who have previously experienced normal pregnancy. However, a minority can be identified at the outset of pregnancy who may welcome a change to a more flexible pattern of care.

关键词：健康态度队列研究大不列颠卫生服务需求产妇卫生保健服务/统计学和数值数据产次妊娠/心理学产前保健/统计学和数值数据问卷调查女(雌)性人类

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Barriers to timely prenatal care among women with insurance: The importance of prepregnancy factors

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OBSTETRICS AND GYNECOLOGY 2000年第6期95卷 874-880页

作者： Braveman, P Marchi, K Egerter, S Pearl, M Neuhaus, J Univ Calif San Francisco Dept Family & Community Med San Francisco CA 94143 USA Univ Calif San Francisco Dept Epidemiol & Biostat San Francisco CA 94143 USA

Objective: This study, designed to avoid methodologic limitations of previous research, aimed to identify the important noninsurance barriers to timely prenatal care. Methods: We identified a subsample of a cross-sectional statewide representative postpartum survey conducted in California during 1994-1995, focusing on 3071 low-income women with Medi-Cal or private coverage throughout pregnancy. Results: Twenty-eight percent of those women had untimely care, although only 6% were unaware of their pregnancies during the first trimester. Controlling for numerous sociodemographic factors;knowledge, attitudes, beliefs, and behaviors;stressful life circumstances;and logistic obstacles that might deter seeking or receiving care, the following risk factors for untimely care were significant and experienced by more than one fifth of women: unwanted or unplanned pregnancy (affecting 43% and 66% of women, respectively), no regular provider before pregnancy (affecting 22% of women), and no schooling beyond high school (affecting 76% of women). Transportation problems, affecting 8% of women, appeared to be the only significant logistic barrier to timely care. Conclusion: Improving timeliness of prenatal care among low-income women with third-party coverage is likely to require broad social and health policies that focus on factors affecting women before pregnancy. Assistance with transportation could contribute to more timely care for some low-income women, but programs focusing primarily on other noninsurance barriers during pregnancy might not substantially improve the timeliness of care, at least among low-income women with third-party coverage. (Obstet Gynecol 2000;95:874-80. (C) 2000 by Obstetricians and Gynecologists).

关键词：加利福尼亚卫生服务易得程度卫生服务需求卫生服务研究产前保健/统计学和数值数据社会经济因素女(雌)性人类妊娠

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The immunization programme in Bangladesh: impressive gains in coverage, but gaps remain

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HEALTH POLICY AND PLANNING 1999年第1期14卷 49-58页

作者： Jamil, K Bhuiya, A Streatfield, K Chakrabarty, N USAID Bangladesh Amer Embassy Dhaka Bangladesh Johns Hopkins Univ Dept Populat Dynam Baltimore MD 21218 USA Int Ctr Diarrhoeal Dis Res Dhaka Bangladesh Populat Council Dhaka Bangladesh

The paper reviews the achievements in tetanus immunization coverage and child immunization in Bangladesh. It uses data from the 1993-94 Bangladesh Demographic and Health Survey to identify and examine the programmatic and non-programmatic factors that influence the coverage of tetanus (TT) immunization during pregnancy, and full immunization among children 12-23 months old in rural Bangladesh. The purpose of this analysis is to identify the areas that need further programme attention. The logistic regression results show that the coverage of TT immunization was significantly associated with proximity to outreach clinics and the presence of a health worker in the community. Home visits by health/family planning fieldworkers and the proximity to outreach clinics had larger influences on TT coverage of poorer households compared to those better-off. The effect of distance to static clinics varied by regions. Among children, full immunization coverage (coverage of all of BCG, DPT1, DPT2, DPT3, Polio1 Polio2, Polio3) was significantly associated with distance to outreach clinics, the greater the distance to the clinics, the less the likelihood of immunization.

关键词：孟加拉国社区卫生服务/组织和管理发展中国家卫生服务研究免疫接种规划/组织和管理免疫接种规划/发展趋势免疫接种规划/利用 Logistic模型病人接受卫生保健的程度/统计学和数值数据产前保健/标准产前保健/统计学和数值数据方案评价农村人口社会经济因素破伤风类毒素/投药和剂量成年人儿童女(雌)性人类婴儿妊娠

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Trends in births at and beyond term: evidence of a change?

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BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999年第9期106卷 937-942页

作者： Roberts, CL Taylor, L Henderson-Smart, D Univ Sydney NSW Ctr Perinatal Hlth Serv Res Sydney NSW 2006 Australia Univ Sydney Dept Obstet & Gynaecol Sydney NSW 2006 Australia Univ Sydney Dept Publ Hlth & Community Med Sydney NSW 2006 Australia New S Wales Hlth Dept Surveillance Methods Publ Hlth Div Sydney NSW Australia

Objective To examine trends in the distribution of births at and beyond term in New South Wales and in particular, to determine whether any changes are associated with changes in the obstetric practices of induction and elective caesarean section. Design Cross-sectional analytic study. Setting New South Wales, Australia. Population All 540,162 women delivering a singleton cephalic-presenting infant of gestational age greater than or equal to 37 weeks from 1 January 1990 to 31 December 1996. Methods Data were obtained from the New South Wales midwives data collection, a population-based surveillance system covering all births in New South Wales. The data were analysed to examine changes over time and associations between gestational age, maternal factors and onset of labour. Main outcome measures Induction of labour and elective caesarean section rates. Results From 1990 to 1996 there was a significant decrease in births reported as 40 weeks of gestation, from 35,670 (46.3%) to 30,651 (40.3%). These declines were offset by significant increases in births at 38 and 39 weeks. Births greater than or equal to 42 weeks declined from 3321 (4.6%) to 2132 (2.8%). The decline in prolonged pregnancies was associated with increasing induction rates at 41 weeks. The re-distribution of some births from 40 to 38-39 weeks was associated with increasing rates of elective caesarean sections and induction at 38 and 39 weeks, and increasing maternal age. Conclusions Clinicians appear to be implementing the recommendations of randomised controlled trials to offer induction after 41 weeks of gestation. However the trend of performing elective caesarean sections at earlier gestational ages may be unnecessarily putting some infants at increased risk of respiratory morbidity.

关键词：剖宫产术/统计学和数值数据剖宫产术/发展趋势横断面研究引产/统计学和数值数据引产/发展趋势母亲年龄新南威尔士/流行病学妊娠过期产前保健/统计学和数值数据产前保健/发展趋势成年人女(雌)性人类妊娠

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Birth Outcomes to Rural Illinois Residents: Is There a Crisis?

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The Journal of Rural Health 1994年第2期10卷 122-130页

作者： Rock, Steven M. Straub, LaVonne A. Department of Economics Western Illinois University Macomb Illinois United States

In recent years, the supply of obstetric services in rural areas has been a concern. At the same time, the demand for such services has been affected by the reduction in population and economic base. This article explores the extent of these trends in Illinois and whether they have led to a deterioration in amount of prenatal care and birth outcomes. Using birth certificate and infant death data for residents of rural Illinois counties in 1983 and 1988, prenatal care and birth outcomes for each year are compared within rural areas and to the rest of the state, as well as between the two time periods. Although rural residents began prenatal care later, they obtained similar qualities of care as their urban counterparts. The data revealed no adverse impact on birth outcomes of residing in increasingly rural areas, nor was there a deterioration during the time period. An attempt was made to identify rural counties that lost providers and/ or facilities and those that gained them. Although such a classification scheme is subjective, similar results ensued. While indirect costs such as time and effort to obtain care may have increased, at 1988 levels of care availability there was no crisis in Illinois. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：数据收集欧洲大陆世系人群/统计学和数值数据卫生服务易得程度/统计学和数值数据伊利诺伊/流行病学产妇卫生保健服务/供应和分配产科学/人力妇产科医院妊娠结局/流行病学产前保健/标准产前保健/统计学和数值数据产前保健/利用农村卫生/统计学和数值数据女(雌)性人类婴儿新生妊娠

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Process measures in an antenatal smoking cessation trial: another part of the picture

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HEALTH EDUCATION RESEARCH 2000年第4期15卷 469-483页

作者： Walsh, RA Redman, S Byrne, JM Melmeth, A Brinsmead, MW Univ Newcastle Fac Med & Hlth Sci Discipline Behav Sci Relat Med Newcastle NSW 2308 Australia John Hunter Hosp Dept Obstet & Gynaecol New Lambton Hts NSW 2305 Australia

Data on provider and patient compliance can be crucial in understanding the degree of a health education program's effectiveness, as well as in identifying areas where the program requires modification. However, such data are rarely systematically reported in randomized trials. This report assesses the degree to which doctors and midwives complied with intervention protocols in a hospital antenatal smoking cessation trial, and also examines the program's acceptability to patients. Provider compliance was assessed principally via consultation audiotapes and provider-completed checklists. The audiotape analysis identified substantial compliance problems. For example, in relation to six specific smoking-related pregnancy risks, the proportions of Experimental Women informed about each individual risk ranged from 26 to 38% and the proportions receiving counselling items ranged from 52 to 79%. Doctors only informed a minority of Experimental Women of the increased risk of Sudden Infant Death Syndrome (28%) and of the presence of toxic chemicals in tobacco (21%). Comparison of compliance data from audiotapes and provider checklists revealed there was no significant agreement in three of four cases tested. Experimental Patients completed questionnaires to assess recall of smoking advice and to rate 12 program features. Of specific Experimental Program elements, the videotape (85%) received the highest level of positive patient ratings and the lottery (42%) the lowest. The process evaluation indicated that the Experimental Program needed some modification to increase its suitability for routine application. The findings also support the value of including an objective measure of provider compliance.

关键词：坚持准则/统计学和数值数据回忆新南威尔士助产士病人依从病人教育(主题)/统计学和数值数据产前保健/方法产前保健/统计学和数值数据过程评价(卫生保健) 方案评价研究设计吸烟/副作用戒烟女(雌)性人类妊娠

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