Objective To understand the trends of institutional delivery in recent 30 years in China and find out the main social and demographic factors. Methods Two-staged PPS method was employed for sampling; Uniform questionnaire was drafted and direct interview was adopted to collect the information. Results The institutional delivery rate was increasing rapidly with time, especially from 1990's, which had climbed to 82% in the last three years, but it was still unsatisfactory in the central and western areas. Meanwhile, most women who delivered outside the hospital were assisted only by birth attendants/village doctors or family members/friends in labor. Factor analysis showed that the women s education and occupation and their husbands, the gap of education between the couples, and the antenatal care could significantly affect their choice for where to deliver. Conclusions Great improvement had been achieved in the last several decades, and both individual characteristics, community and health facility could have influences on the women s decision on where to give birth.

OBJECTIVE To investigate the prevalence of strains producing extended-spectrum ?-lactamases (ESBLs) and AmpC ?-lactamases in Pseudomonas aeruginosa,and to supply the laboratory evidence for antibiotic rational application in clinic. METHODS Totally 105 clinical isolates of P. aeruginosa were identified with VITEK-32. Drug sensitivities were determined by Kirby-Bauer methods. ESBLs were detected by double-disc synergy test,and cefoxitin three dimensional test was applied to filter AmpC positive strains. RESULTS Among 105 strains of P. aeruginosa,28 strains (26.7%) were AmpC enzymes positive,20 strains (19.0%) were ESBLs positive,and 5 strains(4.8%)were AmpC+ESBLs positive. The detective rate of producing AmpC ?-lactamases strains was higher than that of producing ESBLs strains. There was significant difference between them. CONCLUSIONS ESBLs and AmpC ?-lactamases are two main enzyme types conferring resistance to ?-lactam antibiotics in clinical isolates of P. aeruginosa. Imipenem can be the first choice for treating infections caused by P. aeruginosa producing ESBLs or AmpC ?-lactamases.

OBJECTIVE To study resistance of Enterococcus in clinical isolates to high-level gentamicin(HLG) and investigate drug resistance of these Enterococcus.METHODS Totally 140 strains of Enterococcus were detected resistance to antibiotics by Kirby-Bauer test and agar-screening test.Data were analyzed using WHONET5.3 software.RESULTS Same result was obtained by two kinds of detecting methods,there were 73 strains of high level gentamicin resistance(HLGR,52.1%) and 67 strains of non-HLGR(47.9%),the resistance rate of HLGR was higher than that of non-HLGR,the isolation rate of vancomycin resistanct Enterococcus was 3.6%.CONCLUSIONS The most common enterococci causing hospital infection are E.faecalis and E.faecium.The drug resistance rate of E.faecium is higher than that of E.faecalis.It is imperative to select the proper method to detect HLGR of Enterococcus,and select proper antibiotic in terms of antibiotic susceptibility test during clinical therapy.

Object:To understand the situation of postpartum abuse and postpartum depression Method:This was a community-based face-to-face survey of a representative group of women who had a child aged 6 to 18 months in 32 communities of Tianjin, Liaoning, Henan and Shaanxi provinces between Nov 1, 2001 and February28, 2002 Totally 12044 subjects were found by stratified cluster sampling Results:The incidence of postpartum depression (according to result of Zung's self-rate depression scale for one week assessment during the interview) was 20 9%, while the rate of postpartum abuse was 8 3% Women often suffered abuses with many forms (physical, sexual and emotional maltreatment), and recurrently for a long time Among them, sexual abuse was the most frequent one Multiple logistic regression showed association between abuse and depression Conclusion:The incidences of postpartum depression and postpartum abuse are high Being abused has influence on depression

Objective To investigate the occurrence of cesarean section (CS) among reproductive age women in last thirty years, and explore the factors related to high CS rate. Methods Population proportional to size sampling method was employed in sampling. The sampled women were interviewed face to face. Data were double entered by EPIDATA 2.1 and analyzed by SPSS 11.5. Results The CS rate continuously increase from 0.9% in 1971-1980 to 20.2% in 2001-2002 and the speed is more and more rapid. More and more CSs were required by the women themselves and the rate increased from 19.3% in 1971-1985 to 49.7% in 2001-2002. Logistic regression analysis showed that women who were less than 30, senior high education or above and white-collar or jobless women had more than 8 times of antenatal visits, lived in eastern region and had B-ultrasound exam, were more likely to have caesarean section. Conclusions The caesarean section rate was increasing rapidly in the last thirty years especially after 1990. There are two reasons for this increase, on one hand caesa- rean sections with medical indications increase because of the progress of perinatal care and related technology; on the other hand unnecessary caesarean sections increase because of some social and demographic factors, which result in more caesarean section required by the pregnant women.

Objective To analyse both micro level and macro level factors influencing maternal mortality in order to set the priority to lowering maternal mortality. Method The results of an analysis of maternal mortality were reported, based on a conceptual model that combines micro level and macro level variables taken from demographic, sociological and epidemiological research. Multi level analysis techniques were used to analyse the 1997 linked county level maternal death data and related county level social demographic and health resources data in 114 counties of 5 remote and poverty stricken provinces. Results The maternal mortality rate in research areas was as high as 159.3/100 000. The main factors influencing maternal mortality were institutional delivery rate, population density, percentage of minority population, and percentage of village without village doctor. Conclusion To advocate institutional delivery rate, to pay greater attention to minority and low population density area, and to standardised village doctors' responsibility are recommended strategies to lowering maternal mortality in remote and poverty stricken areas of China.

Objective To investigate the status of breastfeeding rate at discharging hospital and analyze influence of obstetrical service quality on breastfeeding rate, in order to improve the quality of obstetrical service and increase the breastfeeding rate. Methods A total number of 1 123 mothers who have 6~12 months babies were investigated through questionnaire including obstetrical service accepted, situation of breastfeeding rate at discharging hospital, mother's breastfeeding knowledge and behaviors with across-sectional method from August to October in 2000. Seven cities were chosen as the research site including Beijing, Changchun, Huhehaote, Xi'an, Luoyang, Kunming and Xiamen. The data were analyzed with SPSS/PC 10.0 statistical software. Results The exclusive breastfeeding rate was 52%, the full breastfeeding rate was 73% at discharging hospital. The influencing factors of breastfeeding rate at discharging hospital include mother's age, medical expenditure type, caesarean section, breastfeeding on demand, neonatal status, having milk bottle, feeding milk-powder and sweeten water in obstetrical wards, mother's breastfeeding knowledge and behavior, et al. Conclusions Breastfeeding rate at discharging hospital was low and it was related with quality of obstetrical service. So it is important to improve the quality of obstetrical service and health education on breastfeeding, in order to enhance the breastfeeding rate.

Objective To analyze the descending trend of maternal mortality ratio (MMR) and its related influencing factors in order to improve the descending speed of MMR. Methods The influencial factor analysis and u test were made on data collected from 232 rural counties of eight provinces in China. Results MMR had shown remarkable reduction from 1995 to 2000, a drop by 51.33%. However, there was still a gap if compared with the ratio of the whole country. Major causes influencing the descending speed of MMR include the high speed of economic development, more expenditure of health, quality of maternal service, such as the ratio of hospital delivery, cleaning delivery, prenatal and postnatal health care. Conclusion In order to accelerate the descending speed of MMR, attempts to increase the improvement speed of maternal health care, quality of maternal service and more expenditure of health should be made.

Objective To characterize the growth curve of Brucella in Bact/Alert blood culture system which may be helpful to predict the growth of Brucella strain for earlier clinical diagnosis of brucellosis.Methods The epidemiological,clinical and labo-ratory data including growth curve of Brucella were reviewed and analyzed retrospectively for 15 cases of brucellosis as con-firmed by positive serological test and brucellosis agglutination test.Results All the 15 patients had irregular fever and history of animal exposure,even though their clinical feature and signs varied greatly.The growth curve of Brucella in blood culture showed the same chracteristics in the 15 patients,including:the time to positive alarm was about 72 hours,a longer lag phase, shorter logarithmic phase,a shorter vertical axis corresponding to the logarithmic phase,and a flat stable phase.Conclusions The clinical manifestation of brucellosis is variable and non-specific.Lack of awareness of this disease makes the clinicians mis-diagnose it easily.Therefore,blood culture is critical for clarifying the etiology in febrile patients.The growth curve of bacteria during blood culture is useful for early diagnosis of brucellosis and prevention of laboratory infections.

Objective To study the expression of HGF , RAGE in placentas of patients with gestational diabetes mellitus and its relationship with maternal and neonatal prognosis .Methods The complete clinical datas of late pregnancy,GDM treated group 40 cases,GDM untreated group 23 cases,the control group 30 cases.Immunohisto-chemical method was used to detect HGF and RAGE in the placentas of three groups ,the maternal and neonatal prog-nosis were recorded.Results In GDM untreated group,GDM treated group and the controlled group placenta ,HGF and RAGE expressed.The expression of HGF was gradually increased ,and any comparative differences between two groups were statistically significant ( F =7.56, P <0.05 );the expression of RAGE in placentas was gradually declined ,the differences among the control group and GDM untreated ,GDM treated group were statistically significant (F=11.62,P<0.05).The rates of maternal and neonatal complications in the GDM untreated group were signifi-cantly higher than that of the GDM treated group and the control group (χ2 =7.34,13.21,9.75,6.67,15.23, 12.53,all P<0.05).Conclusion HGF and RAGE may participate in the occurrence and development of GDM and maternal and neonatal prognosis closely ,regular treatment can improve the prognosis of mothers and infants .