贫困先天性心脏病患儿救治问题的调查与思考

在儿童传染病得到有效控制的今天,先天性心脏病简称(先心病)已成为威胁儿童健康和生命的重要疾病。结合我国先天性心脏病的现状,分析了贫困先心病患儿救治中存在的问题,并提出了几方面的解决的对策。     

810名离退休职工糖尿病患病情况分析

先天性心脏病（简称“先心病”）,是危害儿童特别是婴幼儿健康的“杀手”。据统计,每1000个新生儿中约有6个患先心病。按人口出生率及先心病发病率,估计我国每年有15万患儿出生。这些数字虽然令人震惊,但是让人欣慰的是,绝大部分先心病都能通过手术彻底根治,患儿术后能和正常人一样生活、工作。目前,婴幼儿先心病外科手术成功率在90％以上。     

小儿先天性心脏病手术后中心静脉导管相关性血流感染调查分析

目的 探讨小儿先天性心脏病(先心病)患儿术后,中心静脉导管相关血流感染(CLA-BSI)发生水平及病原菌分布特点.方法 对2012年1-12月心脏病治疗中心手术治疗的928例先心病患儿进行CLA-BSI目标性监测,将中心静脉导管留置时间＞48 h或拔除导管＜48 h内的先心病术后患儿作为研究对象,对CLA-BSI发生水平和病原菌检出进行分析.结果 共诊断CLA-BSI病例15例,感染率为1.62％,每千个导管日感染为3.79％;经外周静脉血或(和)中心静脉导管尖端标本共检出病原菌23株,病原菌以革兰阴性菌为主,不动杆菌属、铜绿假单胞菌以及褪色沙雷菌居前3位.结论 先心病患儿是CLA-BSI高危人群,应加强术后先心病患儿CLA-BSI的监测和干预措施,减少医院感染的发生.     

优质护理在小儿先天性心脏病术后护理中的应用

目的分析与探讨小儿先天心脏病术后应用优质护理干预的价值。方法以40例先天性心脏病患儿为研究对象,所有患儿在术后均给予优质护理,对患儿术后的FLACC疼痛评分、并发症发生率以及家长对于护理工作的满意度评分进行统计,并对比患儿护理前后的生活质量。结果患儿术后FLACC疼痛评分随着时间的推移而逐渐下降,家长对于护理工作的满意率为95.0%,患儿护理后的生活质量评分明显高于护理前(P<0.05),患儿术后并发症发生率为5.0%。结论对小儿先天性心脏病术后给予优质护理,能够显著改善患儿的生活质量,并控制其疼痛感,降低并发症的发生率,促进护患关系和谐。     

先天性心脏病患儿手术前后血BNP的变化及临床意义

目的：分析比较先天性心脏病患儿手术前后血BNP的变化及临床意义。方法：对本院从2013年1月-2014年8月收治的60例先天性心脏病患儿进行研究,30例简单先天性心脏病患儿作为对照组,30例危重症先天性心脏病患儿作为试验组,对比分析两组患儿在手术前后血BNP变化,分析BNP在危重症先心病患儿术后心功能评定中的意义。结果：试验组先天性心脏病患儿手术前血BNP水平为（19.0±9.9）ng/L,术后5 min为（23±14）ng/L,术后24 h为（32±11）ng/L,较对照组差异有统计学意义（P〈0.05）。结论：在临床中通过研究先天性心脏病患儿手术前后血BNP变化,可以得出血清BNP水平与相应心功能水平之间的内在联系,找到一种准确、快速了解心功能水平的方法,有助于保障患者的健康,值得在实际中推广。     

1例先天性心脏病介入封堵术后并发盆腔血肿的护理

先天性心脏血管病简称先心病,由胎儿心脏在母体内发育缺陷或部分发育障碍所造成,手术是治疗先心病的传统方法,与手术修补术比较,经皮导管封堵术不需体外循环,因而可减少创伤,缩短住院时间,易为患者接受,临床应用日益广泛,先天性心脏病患者接受经皮介入诊疗者逐年增加,虽然技术操作已逐渐成熟,但由于是创伤性操作,不可避免会出现一些并发症,常影响患者的心理和术后恢复状况.     

宁波市海曙区婴幼儿先天性心脏病监测与随访

【目的】 监测婴幼儿先天性心脏病(先心病)的发病情况和预后,为幼儿先心病的保健管理提供资料。 【方法】 2008-2010年在宁波市海曙区出生的足月活产儿8 259例中,经心脏彩超确诊为先天性心脏病的婴幼儿221例进行定期随访跟踪。 【结果】 婴幼儿先心发病率居前4位的分别为室间隔缺损(占24.89%),卵圆孔未闭(占22.62%),房间隔缺损合并动脉导管未闭(占13.57%),动脉导管未闭合并卵圆孔未闭(占13.57%);221例先心病患儿均在1岁前确诊。 【结论】 先天性心脏病是我国重要的公共卫生问题之一,开展对先天性心脏病的监测和随访,提高先天性心脏病婴幼儿的生活质量。     

婴儿先天性心脏病术后处理

由于先天性心脏病(先心病)诊治技术的进步,1岁以内婴儿手术逐渐增多.保证手术治疗的成功,在手术技巧、体外循环(CPB)技术水平的提高下,术后监护处理非常重要.先心病术后危重病情处理水平的提高,对婴儿先心病术后渡过危险期尤为关键.现介绍86例婴儿先心病处理经验如下.     

舒适护理在先心病患儿体外循环术围术期的应用效果

目的探讨舒适护理在先心病患儿体外循环术围术期中的应用效果。方法将该院2008年4月—2011年12月收治的320例复杂重症先天性心脏病患儿分为观察组和对照组,对照组采用常规护理,观察组在常规护理的基础上采用舒适护理,比较两组患儿的护理效果。结果观察组患儿的麻醉前的血压和心率显著低于对照组(P<0.05)。观察组的患儿哭闹次数、家长对护理质量的满意度、住ICU时间、并发症发生率显著优于对照组(P<0.05)。结论舒适护理有利于减轻先心病手术患儿的心理、生理应激反应,减少并发症,提高家长满意度。     

婴幼儿期先天性心脏病患者生长发育状况及对策

为研究婴幼儿先天性心脏病患者生长发育状况及对策 ,用等级评价法评估 86 3例婴幼儿先天性心脏病患者身高、体重的发育等级 ,分析其与疾病严重程度的关系 ;比较患者术前与术后生长发育的差异。结果 :本组患者中身高生长水平低下者占 6 0 .33% ,体重低下者占 6 7.32 % ;疾病严重程度是影响“先心病”患者生长发育的重要因素 ;重症患者术后 1年 ,身高正常者由术前的 2 8.38%上升到 81.98% ,体重正常者由术前的 7.2 1%上升到 88.2 9%。先心病严重影响婴幼儿的生长发育 ,婴幼儿期先心病的保健对策是早期诊断、手术治疗。     

先天性肛门直肠畸形患儿父母生活质量和社会支持研究进展

先天性肛门直肠畸形是一种常见的消化道畸形。手术治疗虽然挽救了患儿生命,但是术后肛门失禁、狭窄和便秘等并发症给患儿的身心健康带来严重影响。父母作为主要照顾者,既承担照顾患儿的繁重任务,又面临着沉重的经济和精神负担,成为亟待关注的群体。本文就先天性肛门直肠畸形患儿父母生活质量和社会支持的研究进展进行综述,以期为改善该人群生活质量提供参考依据。     

Determinants of dietary compliance among Italian children: disentangling the effect of social origins using Bourdieu's cultural capital theory

Making use of Bourdieu's threefold conceptualisation of cultural capital, this paper examines and disentangles the association between social origins and children's food consumption. The aim of the work is twofold. Using data from the Multipurpose survey on daily life conducted by Istat (2009–2012), we first show that children's compliance with dietary advice is indeed influenced by their social origins, but more so in terms of familial cultural resources than economic ones. All types of cultural capital enhance the quality of children's nutrition. Second, we concentrate on the role of the school canteen as a child‐centred investment strategy intended to reduce health inequalities by providing a wholesome lunch for all children. Although the school meal effectively improves the degree of dietary compliance, the results indicate that this public service is less often used by children from lower social origins. Moreover, we do not find any equalising effect of the school meal on the diets of disadvantaged children. These findings are discussed in light of future research on sociology of health stratification and health promotion programmes.     

子女收入、家庭支持与老年人健康

目的：分析子女收入对老年人健康状况的影响及群体性差异,并探究家庭支持在其中的中介效果。方法：使用2011—2018年四期中国健康与养老追踪调查(CHARLS)数据构建非平衡面板,以60岁及以上老年人作为研究对象,基于时间固定效应模型分析子女收入对老年人健康的效应水平,使用倾向得分匹配法对内生性问题进行讨论,并采用Karlson-Holm-Breen(KHB)方法对子女经济转移、时间转移以及二者组合路径的家庭支持方式进行机制检验。结果：子女收入提高分别在0.049和0.033水平上显著改善老年人自评健康和生活满意度,在修正选择性偏差后结论依旧稳健;子女提供经济支持、照料与情感支持在改善老年人健康中发挥重要的中介作用。结论：子女收入对老年人存在健康溢出效应,但在不同年龄、性别和户籍状况老年群体中存在差异;提高青年收入水平,倡导子女提供兼顾经济和时间转移的家庭支持方式有利于改善老年人健康状况,有助于实现健康老龄化战略目标。     

Where are the schools? Children,families and food practices

Reducing childhood obesity is an international priority and children's diets, food knowledge and practices have come under intense scrutiny in both policy and popular discourse. Notwithstanding evidence that health interventions which resonate with children's own views are the most effective, there is still relatively little research which mobilises children's everyday perspectives on food to inform public health policy. We report key findings from a qualitative study with 53 children aged 9–10, attending two socio-economically contrasting schools in the UK. The study explored children's understandings of food in everyday life and their ideas about the relationship between food and health. Throughout the study, despite recent attempts to position schools as key sites for public health interventions, children consistently emphasised families as the locus for enduring food practices. The research highlights the value of listening to children and applying our understanding of their perspectives to ensure that public health initiatives work with the important influences on their diet and health that they themselves identify.     

先天性心脏病患儿术后合并营养不良影响因素及其生存质量分析

目的 评估先天性心脏病(CHD)患儿术后合并营养不良的发生率,分析其营养不良的影响因素及其对患儿术后生存质量的影响。方法 选取2016年7月-2020年7月在北部战区总医院心外科、先心内科和儿科就诊且有既往心脏手术史的312例2~12岁患儿。评定研究对象是否合并营养不良,收集患儿一般资料分析其合并营养不良的影响因素。并采用中文版PedsQL^TM3.0心脏病模块量表和PedsQL4.0普适性核心量表评价CHD患儿术后的生存质量。结果 1)CHD患儿术后合并营养不良发生率为17.9%。2)多因素Logistic回归分析结果显示年龄小、复杂型CHD、外科手术治疗、家庭经济收入低、家庭居住地为农村、父母学历为小学或初中为先天性心脏病患儿术后合并营养不良的独立危险因素(P<0.05)。3)营养不良组患儿心脏问题和症状、感知身体外貌、治疗焦虑和认知心理问题维度在PedsQL^TM3.0量表中的得分均低于无营养不良组(P<0.05)。2~4岁营养不良组患儿生理功能维度在PedsQL^TM4.0量表中的得分低于无营养不良组(P<0.05)。5~12岁营养不良组患儿PedsQL^TM4.0生存质量的4个亚量表及总分均低于无营养不良组(P<0.05)。结论 CHD患儿术后发生营养不良的概率高,生存质量差,且受多种因素影响,应引起重视。     

Perceived instrumental support and children's health across the early life course

A large, venerable literature demonstrates the importance of social relationships and social support for health, though much less research examines whether the benefits of social support to mothers extend to children. This paper examines the relationship between mothers' perceptions of instrumental support and children's health using longitudinal data from the U.S. Fragile Families and Child Wellbeing Study (N = 4342), a cohort of American children born in urban areas to mostly unmarried parents. Results suggest mothers' perceptions of instrumental support is positively associated with children's overall health, and this finding persists despite controlling for a host of individual-level characteristics of mothers and children (including a lagged indicator of children's health) and in fixed-effect models. Mothers' economic security and mothers' wellbeing attenuate some, but not all, of the association between perceived instrumental support and children's overall health. In addition, the link between perceived instrumental support and three specific indicators of health – asthma, overweight/obese, and number of emergency room visits – falls to statistical insignificance after accounting for individual-level characteristics, suggesting these associations result from social selection processes. Taken together, these findings suggest the beneficial health consequences of social support may extend to children across the early life course and demonstrate the need to better understand mothers' reports of children's overall health.     

家庭健康循环视角下的健康代际传递研究——基于CHNS 2015的实证分析

目的:基于家庭健康循环视角与家庭生态系统理论,探究健康状况、健康行为及健康认知的代际传递,为制定精准健康促进政策提供依据。方法:基于2015年CHNS数据,采用多分类Logistic、有序Logistic以及OLS模型探讨母亲主客观健康状况,健康行为及认知对子代主客观健康状况,健康行为及认知的影响。结果:母亲BMI显著影响子代BMI,母亲超重或肥胖,则子代超重、肥胖的相对风险高;母亲自评健康显著影响子代自评健康;母亲饮食得分与锻炼得分显著影响子代饮食得分与锻炼得分;母亲健康认知显著影响子代的健康认知。结论:健康状况、行为及认知均显著代际传递,建议开展亲子健康促进行动,并建设健康家庭环境。     

Are children rational decision makers when they are asked to value their own health? A contingent valuation study conducted with children and their parents

Despite the importance of including children's preferences in the valuation of their own health benefits, no study has investigated the ability of children to understand willingness‐to‐pay (WTP) questions. Using a contingent valuation method, we elicit children's and parents' WTP to reduce children's risk of an asthma attack. Our results suggest that children are able to understand and value their own health risk reductions, and their ability to do so improves with age. Child age was found to be inversely related to parents' and children's WTP. The results also suggest that non‐paternalistic altruism is predictive of children's WTP. For parents, care for their own health was found to be inversely related with their WTP for children's risk reductions. Comparison of parents' and children's WTP suggests that parents are willing to sacrifice for their child's health risk reduction an amount that is approximately twice that of their children. The analysis of matched pairs of parents and children suggest that there are within‐household similarities as the child's WTP is positively related to parents' WTP.     

How do children perceive health to be affected by domestic water carrying? Qualitative findings from a mixed methods study in rural South Africa

Background Nearly 50% of South African children lack access to clean safe water and many regularly carry water loads. The health effects of carrying water have not been well researched or considered when estimating the burden of disease due to suboptimal water supply. Improved access to safe water has potential to create important health and economic benefits, by reducing childhood exposure to risk factors for injury or disease. The aim of this study was to identify which domains of health children perceive as affected by water carrying. Methods Qualitative research was used within a broader mixed methods design to investigate children's perceptions about health and water carrying in Limpopo Province, South Africa. Qualitative data from eight semi‐structured interviews and three ‘natural group meetings’, involving a sample of 30 children, were analysed using the framework approach of Ritchie and Spencer. The results were mapped to the International Classification of Functioning Disability and Health (ICF). Results Children broadly conceptualize and describe health to include the functions they perform and activities in which they participate. They perceived water carrying as impacting upon health in various ways, for example to make life better by facilitating water usage, or to make life worse through accidents and pain. Children's accounts demonstrate that they can identify and explain complex interactions between activities, participation and health. Conclusions The ICF framework facilitates the communication of children's perceptions of health and of relationships between health and water carrying. The model thus derived from their views incorporates not only commonly accepted conceptualizations of health condition, body structure and physiological function, but also of functioning through activities and social participation. Children's accounts suggest a possible association between water carrying and symptoms typical of musculoskeletal disorders. However, further research into the strength of association between water carrying and musculoskeletal disorders is needed.