社区围绝经期，绝经后期女性生殖健康现状调查及干预性研究

发布时间：2018-08-18 12:05

【摘要】：背景:绝经是每个妇女必经的一个特殊生理过程,由于卵巢功能逐渐衰竭可以引起各种不适症状以及远期并发症,严重影响了绝经妇女的生活质量及健康结局。然而目前中老年人群对于绝经所引起的相关症状及疾病普遍认识不多,随着社会老龄化的加剧,针对该人群的生殖健康特点给予专项管理和健康指导,提高她们的认知水平及重视程度,形成健康的行为方式,从而实现正确的自我评估和自我预防,对提高该人群的健康素质和生活质量,减少重大生殖相关疾病的发生具有十分重要的意义。目的:1)获得最新的上海市地区围绝经期、绝经后期女性人群生殖健康统计数据;2)通过各种干预手段提高围绝经期、绝经后期女性人群对该时期生殖健康的认知与重视程度;3)提出上海市围绝经期、绝经后期女性生殖健康管理与促进模式,并进行试点应用,完善社区生殖健康服务预防和干预体系。方法:1)采用多阶段整群随机抽样法在上海市随机抽取四个区内围绝经期及绝经后期女性3320例,通过基本信息表,女性生殖健康相关知识,态度,行为(Knowledge-Attitude-Practice,KAP)问卷,生殖健康自我评估表等对该人群的生殖健康现状,KAP水平及需求情况进行全面评估,了解她们目前的生殖健康状况;2)3320例居民随机分为干预组和对照组,现况调查后对干预组人群采取生殖健康教育讲座,健康咨询,发放生殖健康保健读本等干预方法,而对照组不接受干预。一个月后对两组人群的KAP水平,生殖健康现状等进行二次评估,评价其变化情况及干预手段的有效性。结果:1)被调查者的平均自然绝经年龄为:50.06±3.82岁。人群在常规妇科体检,围绝经期综合症及炎症方面具有较高的认知,态度及行为水平,对于子宫肌瘤及人乳头瘤病毒(Human Papilloma Virus,HPV)的认知率较差,而对盆腔脏器脱垂,尿失禁的认知及行为预防方面得分较低。所有被调查者中,相关症状出现的频率从高到低依次是:围绝经期综合症,性功能,生殖道炎症,生殖系统肿瘤,尿失禁和盆腔脏器脱垂。2)通过本次干预,与对照组相比,试验组在生殖相关知识,态度方面均有显著的提高,在行为方面的提高无明显的统计学意义。与对照组相比,生殖道炎症与围绝经期综合症及性功能的改善率具有统计学意义。但性功能症状的改善率与就医率均最低。结论:通过本次干预发现,人群对各项保健知识的知晓率及态度上的重视都有显著的提高,一些症状也得到了明显的改善,提示干预效果较好,值得推广。在干预方式的选择上,应根据人群的特点,选择广播电视,报刊杂志等相应传统并更形象的手段;另外,要重视基层社区卫生服务人员在干预过程中的作用。而在干预对象上,更应重视低收入,低学历及老龄人群。干预内容方面,人群对压力性尿失禁,性功能障碍等症状的认知水平较差,改善率低,却因羞于启齿,不重视等原因不愿就医,故在干预的过程中要引起重视。
[Abstract]:BACKGROUND: Menopause is a special physiological process that every woman has to go through. Ovarian failure can cause various discomfort symptoms and long-term complications, which seriously affects the quality of life and health outcomes of menopausal women. However, there is little knowledge about the related symptoms and diseases caused by menopause in the middle-aged and elderly population. In view of the aggravation of social aging, special management and health guidance should be given to the population in accordance with their reproductive health characteristics, so as to improve their cognitive level and attach importance to it and form healthy behavior patterns, so as to realize correct self-evaluation and self-prevention, improve the health quality and quality of life of the population and reduce major reproductive-related diseases. Objective: 1) To obtain the latest statistical data of reproductive health of perimenopausal and postmenopausal women in Shanghai; 2) To improve the awareness and attention of women in perimenopausal period and postmenopausal period to reproductive health by various interventions; 3) To propose perimenopausal and postmenopausal women in Shanghai. Methods: 1) 3320 perimenopausal and postmenopausal women were randomly sampled from four districts in Shanghai by multi-stage cluster random sampling method. Through basic information table, knowledge, attitude and behavior of women's reproductive health were analyzed. (Knowledge-Attitude-Practice, Reproductive Health Self-Assessment Questionnaire, etc.) for the population's reproductive health status, KAP level and demand for a comprehensive assessment, to understand their current reproductive health status; 2) 3320 residents were randomly divided into intervention group and control group, the status of intervention group after the population to adopt reproductive health education lectures. One month later, the KAP level and reproductive health status of the two groups were assessed to evaluate the changes and the effectiveness of intervention methods. Results: 1) The average age of natural menopause was 50.06 (+ 3.82) years old. Gynecological examination, perimenopausal syndrome and inflammation have higher cognitive, attitude and behavioral level, hysteromyoma and human papillomavirus (HPV) awareness rate is poor, and pelvic organ prolapse, urinary incontinence awareness and behavioral prevention score is low. All respondents, related symptoms appear. Frequency from high to low is: perimenopausal syndrome, sexual function, genital tract inflammation, reproductive system tumors, urinary incontinence and pelvic organ prolapse. 2) Through this intervention, compared with the control group, the experimental group in reproductive related knowledge, attitude has significantly improved, there is no significant statistical significance in the improvement of behavior. Conclusion: Through this intervention, we found that the awareness rate of health care knowledge and attitudes of the population have been significantly improved, and some symptoms have also been significantly improved. In the choice of intervention methods, we should choose the corresponding traditional and more vivid means, such as radio and television, newspapers and magazines, according to the characteristics of the population. In addition, we should pay attention to the role of grass-roots community health service personnel in the intervention process. In the intervention object, we should pay more attention to the low-income, low-education and elderly population. In terms of intervention content, the people's awareness of stress urinary incontinence, sexual dysfunction and other symptoms is poor, and the improvement rate is low. However, they are reluctant to seek medical treatment because of shyness and neglect of attention, so attention should be paid to the intervention process.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R711.75

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