社区妇女健康Community-and-women-health-社区护理学-演示稿-07.ppt

,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Learning Objectives for Community Health Nursing-Womens Health,认识妇女健康所包括的层面,理解目前妇女健康国际现况,认识中国妇女健康的现况与挑战,讨论妇女健康所面对的挑战,思考妇女健康研究所应探讨的方向,Dimension of Womens Health,Consider：,Womens Role（stress,、,role function）,Health care for womens health needs,Health needs and change across lifespan,What are the womens Health？,Maternal-child health？,Reproductive health？,Menarche Health？,Mental Health?,Gynecological Health？,General Health Well-being？,Gender difference in health?,Factors impacts on womens Health,Accessibility in health care,Role equality,Womens work and income,Career women and family life,Family member and marital relationship,Unexpected accident or injury,Disability women,Family and sexual violence,Occupational Health,Overview for Community Health Challenge in Womens Health Issues,Duty and Responsibility of Community Health Practice in Nursing,Womens Health Challenge,Reduce the maternal mortality rate：every year,in the world,520,000 maternal death(20,年来未改变），98,death occurred in developing countries,due to unable to provide proper antenatal care during delivery,距离2015 年达到开罗（1994）会议的目标降低死亡率75，尚远。,Chronic Disease among Women,Cardiac Disease,Hypertension,DM,Arthritis,Cancer,Chinese Womens Mental Health,Among 1534y/o females,suicide is the leading cause of death,Rural and farm areas,women has the highest suicide rate(WHO）,Women is 25%more likely to committed suicide than men,50,of women in rural area committed suicide by pesticide.,(,WHO,2004),Womens Health Data in China,孕产妇死亡率每十万人口：48.3（2004）,熟练生产医务人员生产 97（2003）,女性较男性儿童小学入学比例 1：1，初级中学入学率 0.92（2002）,女孩入小学比例 95.8%(2002),1525岁妇女识字率 98（2004）,小于一岁以下婴儿死亡率：千分之 30（2003）,五岁以下儿童死亡率：千分之 37（2003）,国会议员女性比例：20（2004）,UN-2005,Womens Disease Data in China,现有宫颈癌患者40万人，死亡率达11.30%,目前的乳腺癌发病率也已经达到了每10万人口3540。,宫颈癌每年新发病例约13.15万；,2007年中国糖尿病人约有3000万。据,WHO,最新数据预测，到2010年中国糖尿病人将达到目前的4倍。,世界卫生组织预测，中国每年确诊的新增结核病例为880万。,Womens Health Data in Shanghai,孕产妇死亡率每十万人口:1.4 (2005),新生儿死亡率每千人口：2.5,围产儿：3.16（2004）,流动人口每千人口婴儿死亡率：15.11,新生儿死亡率：9.15,孕产妇死亡率：68.55（2003）,Womens Health Indicators in China,Incidence of breast cancer,Incidence of Cervical cancer,Lung Cancer,Maternal mortality rate,Health Challenges in Womens Lifespan,Teenage：stress from school,Body image,anoxia,depression,drug abuse,STD,suicide,Childbearing age:Maternal role change,fatigue postpartum,new mother role,Elderly age：adopt to physical and psychological change,empty nest,depression,suicide,Challenges of Teenage Mothers,Health Problem:STD、unexpected pregnancy,maternal and infant nutritional status,pregnancy care,Social Support:pregnancy and child care,Social economic challenges,Violence and drug abuse,Lack of self-protection and prevention,Violence and Maternal Health,Homicide is the second most common cause of injury-related death among pregnant women and new mothers,CDC,2005,American Journal of Public Health,美国妇女健康调研结果（2005）,5,妇女认为心脏病是影响健康的主要因子。,拉丁民族（,44,）、亚裔（,37,）、及非裔美国人（,34,）中，乳癌是重要健康影响因子。,低收入者评价自己的健康较差、且每年健康状况下降，,亚裔妇女对健康的筛查及促进健康的行动不如其它族裔的妇女，尤其是乳癌防治及子宫颈涂片检查。,个人健康行为相关指标,身体活动度,体重过重、肥胖,吸烟,物质滥用,有责任的性行为,Healthy People 2010,USA,比较性别及不同年龄群的差异,与健康促进相关指标,精神心理健康,外伤、暴力,环境质量,免疫接种,医疗可及性,Healthy People 2010，USA,比较性别及不同年龄群的差异,Womens Health Problem that Require Community Health Nursing Intervention,导致孕产妇死亡原因,产后出血,难产,妊高症,不安全流产,在非州撒哈拉沙漠区，艾滋病成为孕产妇死亡主因,受限于区域医疗限制，许多合并症无法早期发现，地风险的妇女也常出现高风险问题,Home Birth-prevention of postpartum hemorrhage,Post Delivery:,1.,Prophylaxis Oxytocin for uterus contraction,2.,Clip the umbilicus cord,3.Avoiding inadequate umbilicus tracking,Safe Motherhood,How Community Nursing Can Help?,医护比对妇女健康的影响,在医师极为缺乏的地区，紧急的妇产科手术需要专科医师及麻醉师配合。,在非洲部分国家：建立外科技术员角色，训练处理紧急情况，如紧急剖宫产。或训练护士、助产士施行麻醉。,公共政策及立法规定保护合法性,上海城乡结合处建立产院提供外来妇女安全生产,妇女,HIV,感染及艾滋病,在非州撒哈拉地区，,HIV/AIDS,感染极为严重，预计每10位,HIV,阳性男性就有13位妇女感染,HIV，,尤其是青春期女孩（早婚，性侵犯、暴力）。其中,1525,岁年轻妇女，75感染,HIV,病毒,过去45年，非洲预防妇女,HIV,感染及母婴传播项目,PMTCT Prevention of Mother-To-Child-Transmission,因受限于经费与资源,艾滋孤儿陷非洲于困难之境,2002年哥伦比亚大学,MTCT-Plus,项目针对妇女艾滋病提供援助,中国女性,HIV,感染的发病率,女性是艾滋病的高危人群：注射吸毒、性工作者、地下卖血者,异性间性接触传播的发病率上升,性传播性疾病从1997年的5.5上升到2002年4月的11,很多的吸毒者为女性,年轻妇女早婚与性安全问题,在许多发展中国家，早婚不是选择而是强迫。超过1千万妇女在发展中国家选择早婚，嫁给年长许多的男性。,非洲莫三鼻（,Mozambique），57,女性在18岁前结婚，在30个发展中国家，约80的婚后性行为是没有任何保护预防,HIV,感染措施。,南非：71%的妇女经历非意愿的性关系，30的妇女初次性接触是受到强迫。,部分国家的文化与传统容许对年轻男性与女性的早期性侵犯,HIV,感染、怀孕、安全,Impact of Chronic Illness,据上海市卫生局资料显示：目前全市糖尿病患者将近30万，全市由糖尿病及其并发症导致的死亡率已达到40/10万；糖尿病患病率由1978年的0.93上升到2.33；近10年来，糖尿病死亡率市区年均递增4.42，郊县年均递增10.385。,(2007),中国青春期少女人流率(2006),北京：5%,上海：7.8%,生殖健康及性健康生育计划,生育计划关键妇女健康,降低非计划怀孕及流产,降低,HIV,感染,提供合法流产管道及流产后照顾，及治疗合并症,降低非计划怀孕所引发的孕产妇死亡率,生殖健康与流产,统计显示，根据不同区域而言，合法安全的流产管道可降低孕产妇死亡率 1015（,WHO，2004）,在所有孕产妇死亡的因素中，不安全流产是最能预防及避免的因素,。,生殖健康与,HIV/AIDS,预防,2004 年瑞士“,Glion Call to Action”by UN,呼吁在开放中国家设立可及的避孕套或其它的避孕方法获取管道，及提供咨询与讯息如何使用,预防,HIV,感染,避免非计划怀孕,女性的死亡三大原因为何？,心脏病（40岁以上妇女）,癌症,脑血管意外,女性癌症盛行顺序（2002,US）,乳癌,直肠癌,子宫癌（宫体）,肺癌,皮肤黑色素瘤,卵巢,子宫颈癌,600倍增加吸烟人口群，2003年，妇女死于肺癌，2004 年肺癌为首要女性癌症致死原因,妇女与吸烟,在过去10年有二千万中国妇女开始吸烟,日本妇女吸烟人数在10年间增加2倍,20世纪美国快速的增加肺癌情况将重复侵袭发展中国家，如果禁烟不执行,。,妇女与结核,Among all women with TB,81%of TB cases affect minority women.Of these cases,26%are among Asian American/Pacific Islander women(second only to African American women,who make up 30%of TB cases among minority women).,（2005 NWHIC,USA),女性停经后骨质疏松,As many as 90%of Asian Americans are lactose intolerant or cannot easily digest dairy products,荷尔蒙疗法的效益,钙质的补充,日常的锻炼,健康促进活动,UN,千年发展目标2015年妇女健康相关目标,Millennium Development Goals,的达成与下列问题息息相关：,1。性别平等,Gender Equality，,协助女孩完,成基础教育,2。妇女赋权,Womens Empowerment,3。与重大疾病抗争：艾滋病、结核、疟疾,4。生殖健康与权利,Sexual and Reproductive Right/Health：,降低75 孕产妇死亡率,Community Projects Initiated by Community Nurses,Elderly safety program,preventing falls.,Womens Heart Program to prevent heart attack,Mental health program for stress reduction and suicide prevention,High risk pregnant home visit,Health Promotion for smoking ceasing,life style modification,diet control,weight control,Asthma prevention program,Post-Stroke rehabilitation,谢谢问题与讨论！,