IntroductionSurmang, Qinghai Province is a rural nomadic Tibetan region in western China recently devastated by the 2010 Yushu earthquake; little information is available on access and coverage of maternal and child health services.MethodsA cross-sectional household survey was conducted in August 2004. 402 women of reproductive age (15-50) were interviewed regarding their pregnancy history, access to and utilization of health care, and infant and child health care practices.ResultsWomen's access to education was low at 15% for any formal schooling; adult female literacy was <20%. One third of women received any antenatal care during their last pregnancy. Institutional delivery and skilled birth attendance were <1%, and there were no reported cesarean deliveries. Birth was commonly attended by a female relative, and 8% of women delivered alone. Use of unsterilized instrument to cut the umbilical cord was nearly universal (94%), while coverage for tetanus toxoid immunization was only 14%. Traditional Tibetan healers were frequently sought for problems during pregnancy (70%), the postpartum period (87%), and for childhood illnesses (74%). Western medicine (61%) was preferred over Tibetan medicine (9%) for preventive antenatal care. The average time to reach a health facility was 4.3 hours. Postpartum infectious morbidity appeared to be high, but only 3% of women with postpartum problems received western medical care. 64% of recently pregnant women reported that they were very worried about dying in childbirth. The community reported 3 maternal deaths and 103 live births in the 19 months prior to the survey.ConclusionsWhile China is on track to achieve national Millennium Development Goal targets for maternal and child health, women and children in Surmang suffer from substantial health inequities in access to antenatal, skilled birth and postpartum care. Institutional delivery, skilled attendance and cesarean delivery are virtually inaccessible, and consequently maternal and infant morbidity and mortality are likely high. Urgent action is needed to improve access to maternal, neonatal and child health care in these marginalized populations. The reconstruction after the recent earthquake provides a unique opportunity to link this population with the health system.
Background: Female sexual dysfunction (FSD) includes disturbances in the sexual response cycle resulting in marked distress and interpersonal difficulty capable of altering quality of life adversely. FSD is a common phenomenon affecting up to 26%-71% of the general female population worldwide. The umbrella term FSD subsumes four disorders: (1) hypoactive sexual desire disorder; (2) female sexual arousal disorder; (3) orgasmic disorder; and (4) sexual pain disorder. Objective: The aim of this pilot study was to assess immediate and longer-term effects of acupuncture quantitatively on symptoms related to female sexual dysfunction, using global-and specific-symptom instruments. Design: This was a time series study in a self-selected population of nonrandomized patients. Setting: The pilot study was conducted at a private women's health clinic in Reno, NV. Patients: Seventeen sequential subjects between ages 40 and 66 and clinically diagnosed with FSD were assessed at baseline and followed through time. Intervention: The intervention examined was a series of four acupuncture treatments. Patients were also administered five instruments to measure symptoms related to FSD before acupuncture treatment, just before the final treatment, and 3 weeks after the final treatment. Main Outcome Measures: Using internal controls, changes in symptoms over time were measured using multivariate analysis of variance for repeated measures. Results: Acupuncture promoted reductions in multidimensional symptoms related to FSD. Sexual desire improved as identified by two instruments, the Sexual Interest and Desire Inventory-Female ( p = 0.01 for shortand long-term) and the desire subscale of the Female Sexual Function Index (short-term p = 0.002 and longterm p = 0.04). Psychological symptoms were also reduced, as measured by two separate instruments, the Greene Climacteric Scale (short-term p = 0.03, long-term p = 0.008) and the Menopause Rating Scale (shortterm p = 0.04, long-term p = 0.008). Acupuncture reduced anxiety in the short ( p = 0.03) and long term ( p = 0.01), reduced sexual dysfunction over the long-term ( p = .03), improved urogenital symptoms over the short-term ( p = .04) and somato-vegatative symptoms over the short ( p = .01) and long-term ( p = 0.03). Conclusions: Acupuncture was effective for reducing some FSD problems, compared to baseline. Active research on nonpharmaceutical alternatives-including acupuncture-for treating symptoms related to FSD are ongoing, and preliminary results are promising.
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