摘要
目的：
1.编制女性生殖道感染知识、信念、行为量表；对所编量表进行信、效度检验。
2.通过编制的量表调查女性生殖道感染认知、信念、行为现状,分析相关的影响因素,为制定有效的预防生殖道感染的健康教育策略提供科学的、定量的评价工具。
方法：
1.以知信行理论和健康信念模式作为本量表编制的理论指导。在广泛查阅文献并参考国内外已经开发的相关问卷或量表的基础上,通过专家咨询,面对面访谈形成初选条目池。
2.采用横断面调查研究设计。于2009年6月至2009年7月对100名女性进行了预调查,以t检验法、相关系数法、因子分析法三种方法进行条目筛选,保留条目形成女性生殖道感染知信行量表。于2009年8月至2009年10月采取分层整群抽样方法,采用一般人口学资料问卷和编制的量表,分别对长沙市一、二、三级共5家医院符合入选标准的842名妇女进行调查,并对量表进行考评。选用Cronbach'sα系数、分半相关和重测信度检验量表的信度；选用内容效度、结构效度和区分效度检验量表的效度。
3.所有数据采用SPSS13.0和Amoss7.0统计软件包进行统计处理。统计方法包括：统计描述,两独立样本t检验,相关分析,探索性因子分析,验证性因子分析,单因素方差分析和多元线性回归分析。
结果：
1.共发放问卷842份,回收有效问卷800份,有效回收率为95.01%。长沙市育龄女性生殖道感染率为72.3%,其中慢性宫颈炎占58.82%。
2.编制了包含51个条目的女性生殖道感染知信行量表,包括知识、信念、行为三个分量表。
3.信度检验结果：各分量表的Cronbach's a系数介于0.851～0.878之间,总量表的Cronbach's a系数为0.908；各分量表的分半信度系数介于0.613-0.730之间(P<0.01),总量表分半信度系数为0.894(P<0.01)；一周后重复测量各个分量表得分的pearson相关系数介于0.703-0.783之间(P<0.01),总量表的重测信度系数为0.751 (P<0.01)。
4.效度检验结果：内容效度指数达到0.91；探索性因子分析符合逻辑关系,各分量表累积方差贡献率介于53.023%～69.954%之间；所有因素间相关系数为0.211-0.441,各因素与总分间的相关系数为0.631-0.873,且相关均具有统计学意义(P<0.01)；验证性因子分析显示各拟合指标均达到或接近参考值；不同年龄段、文化程度、职业、婚姻状况以及丈夫不同文化程度与职业的研究对象在量表的某些维度上得分存在显著性的差异(P<0.01)。
5.育龄女性生殖道感染知信行量表得分在中等及以下水平者占66.2%；单因素方差分析结果显示年龄、文化程度、职业、丈夫的文化程度和职业、婚姻状况、户口所在地是影响育龄女性生殖道感染知识、信念和行为的因素(P<0.01)；多元线性回归分析显示文化程度、职业、家庭收入、婚姻状况是育龄女性生殖道感染知识、态度信念和行为的主要影响因素(P<0.01),复相关系数R=0.445,决定系数R2=0.198。
结论：
1.本研究完成了女性生殖道感染知信行量表的初步编制。
2.信度研究表明,该量表同质信度、重测信度和分半信度较好,达到心理测量学要求。效度研究表明,该量表内容效度、结构效度和区分效度较好,达到量表编制的基本要求。
3.生育年龄妇女生殖道感染知信行状况不容乐观,文化程度、职业、家庭收入、婚姻状况是其主要影响因素。
4.针对育龄女性不同年龄,不同文化程度,不同家庭收入以及不同户口所在地,有计划有重点地开展健康教育,在提高全人群生殖道感染相关知信行水平的基础上,确保农村人口以及高龄、低文化程度、低收入者生殖健康水平的提高。
Objectives
(1)To develop a Knowledge-Attitude-Practice (KAP) scale of reproductive tract infections for reproductive age women. To examine the reliability and validity of the scale.
(2)To evaluate the reproductive age women's KAP status of Reproductive tract infections and explore the influencing factors. To provide an objective evidence for assessing the efficiency of the Health Education of Reproductive tract infections.
Methods
(1)The development of the KAP scale of Reproductive tract infections was based on the frame work of KAP theory and Health Belief Model, combining the extensive literature review and reference to the relevant domestic and international scale questionnaires, and form the Primary entry library through expert advice and face to face interviews.
(2) To use cross-sectional study.100 reproductive age women from Xiangya Third Hospital were carried out a pre-survey during June and July,2009. Three methods were used in item analyzing, such as t-test, correlation analysis and factor analysis. Item reserved formed the KAP scale of reproductive tract infections for reproductive age women.842 reproductive age women from five hospitals, of one, two, three different levels, were investigated by a stratified cluster sampling method during August and October,2009 in Changsha. The reliability and validity of the scale were also tested. The reliability analysis included the Cronbach's a, split-half reliability and test-retest reliability. The validity analysis included content validity, construct validity and differential validity.
(3) All datas were processed by using SPSS 13.0 and Amoss7.0 statistical software package. Statistical methods included statistical description, two independent samples t test, correlation analysis, exploratory factor analysis, confirmatory factor analysis, one-way ANOVA and multiple linear regression analysis.
Results
(1) 842 women have been surveyed in this study within which valid questionnaires are 800 and qualified rate of questionnaires are 95.01%. Female genital tract infection rate of child-bearing age in Changsha City was 72.3%, accounted for 58.82% of chronic cervicitis.
(2)A 51-item test version of KAP scale for reproductive age women was developed, including 3 domains (Knowledge, Attitude and Belief, Behavior).
(3) Reliability test:The Cronbach's a coefficients for the scale and Subscales were 0.908 and between 0.851 and 0.878, respectively. Split-half test coefficients for the scale and subscales were 0.894 and between 0.613 and 0.730(P<0.01), respectively. Test-retest coefficients for the scale and subscales were 0.751 and between 0.703 and 0.783(P <0.01), respectively.
(4)Validity test:The content validity index (CVI) for the overall scale was 0.91; Factor analysis conforms to logic relation, and the cumulative variance ranged from 53.023% to 69.954%. Correlation coefficients showed that correlations ranged from 0.211 to 0.441 between all the factors and from 0.631 to 0.873 between the subscales and total scale(P<0.01), respectively. Age, literacy, job profession, marital status and husband's job profession were also found to influence the KAP status of Reproductive tract infections(P<0.01), respectively, which descripted the scale's differential validity was good.
(5)KAP Scale scores of reproductive tract infections at the secondary level and below accounted for 66.2%. One-way ANOVA analysis showed that women's childbearing age, educational level, occupation, husband's educational level and occupation, marital status, household location affect their knowledge, attitudes, beliefs and behavior (P<0.01). Multiple linear regression analysis showed that educational level, occupation, household income, marital status are the main factors.(P<0.01),R=0.445, R2=0.198.
Conclusions
(1) KAP Scale for the female reproductive tract infections was preliminary completion.
(2) Reliability studies have shown that the scale homogeneity, test-retest reliability and split-half reliability is better, to achieve psychometric requirements.Validity studies have shown that the scale content validity, construct validity and discriminant validity is better, to achieve scale preparation of the basic requirements.
(3) KAP of reproductive tract infections for women of childbearing age is poor. The main affect factors were educational level, occupation, household income, marital status.
(4) Give priority to carriing out health education for Child-bearing age female of different ages, different educational level, different household income and the different household location and ensure that the rural population and the elderly, low education, low income levels to improve the reproductive health on the bases of improvement of the productive tract infection KAP levels of the whole population
引文
[1]邱立平,丁辉.女性生殖道感染现状及保健措施.中国妇幼保健,2006,21(12)：1695-1696.
[2]张新宇主编.妇产科护理学[M],第1版.北京：人民卫生出版社,2009：241.
[3]Lien PT, Elias C, Loi NT, et al.The prevalence of reproductive tract infections in Hue, Vietnam[J]. Studies in Family Planning,2002,33:217-226.
[4]Lan PT, Lundborg CS, Phuc HD, et al. Reproductive tract infections including sexually transmitted infections:a population-based study of women of reproductive age in a rural district of Vietnam[J]. Sexually Transmitted Infections, 2008,84:126-132.
[5]Sanjose S, Diaz M, Castellsague X, et al. World-wide cervical HPV prevalence among women without invasive cervical cancer:a review of the literature 1995-2005.22nd International Papillomavirus Conference, Vancouver, Canada (abstract),2005.
[6]Smith JS, Robinson NJ. Age-specific prevalence of infection with herpes simplex virus types 2 and 1:a global review[J]. J Infect Dis,2002,186 (suppl):23-28.
[7]UNAIDS. AIDS epidemic update 2005 [P]. Geneva:Joint United Nations Programme on HIV/AIDS and World Health Organization,2005.
[8]Gloyd S, Chai S, Mercer MA. Antenatal syphilis in sub-Saharan Africa: missed opportunities for mortality reduction[J]. Health Policy Plan,2001,16:29-34.
[9]郭素芳,张文坤.妇女生殖道感染的控制[J].国外医学妇幼保健分册,2001,12(1)：3-5.
[10]国家计生委生殖道感染干预工程办公室[P].国家计生委生殖道感染干预工程技术文汇编,2002.
[11]刘民,张孔来.改善生殖健康的综合服务-艾滋病／性病预防干预与计划生育服务相结合[J].生殖医学杂志,1999,8(3)：173-175.
[12]赵更力主编.生殖道感染防治培训手册[M],第1版.北京：人民军医出版社,2008：6-8.
[13]乐杰主编.妇产科学[M],第6版.北京：人民卫生出版社,2004：258-261.
[14]Global Prevalence and incidence of selected curable STIs overview and estimates [P]. World Health Organization,2001.
[15]杜蔚云,吕阳,周妍,等.甘南藏区已婚育龄妇女生殖道自觉感染症状及感 染现状分析[J].中国妇幼保健,2009,24(6)：827-829.
[16]王军华,张淞文,潘迎,等.北京地区社区已婚妇女生殖道感染患病情况的调查[J].北京妇幼卫生,2001：1(1)：30.
[17]吴永红,钱玲惠,冯睿等.深圳市南山区流动未婚女青年生殖健康状况调查[J].中国计划生育学杂志,2007,9：545-547.
[18]Thin RNT, FRCP MD. Genitourinary medicine and sexually transmitted infection in the 21 century[J]. International Journal of STD& AIDS,2000,11(1):1-7.
[19]Lan PT, Faxelid E, Chuc NT, et al. Perceptions and attitudes in relation to reproductive tract infections including sexually transmitted infections in rural Vietnam: A qualitative study [J]. Health Policy,2008,86:308-317.
[20]Vikram Patel,Nandini Oomman. Mental Health Matters Too:Gynaecological Symptoms and Depression in South Asisa[J].Reproductive Health Matters,1999,7(14): 30-38.
[21]Anna G, Gulmezoglu AM, George PS, et al. Sexual and reproductive health: a matter of life and death[J]. The Lancet,2006,368 (1):1595-1607.
[22]张春平,朱道银,郭晓霞,等.沙眼衣原体子宫内感染途径的研究[J].中华妇产科杂志,2002,37(3)：149-151.
[23]朱云霞,龚晓红.生殖支原体与不良妊娠结局国内研究现状[J].中国优生与遗传杂志,2002,10(2)：7.
[24]王军华.生殖道感染与卫生服务对策[J].中国妇幼保健,2003,18(1)：52-54.
[25]Sami N, Ali TS.Psycho-social consequences of secondary infertility in Karachi[J].J Pak Med Assoc,2006,56:19-22.
[26]Jimenez, AL,Gotlieb, SL,Hardy E,et al.Prevention of sexually transmitted diseases in women:association with socioeconomic and demographic variables[J].Cad Saude Publica,2001,17(1):55-62.
[27]彭兰香.女性生殖道感染普查情况分析[J].中国计划生育学杂志,2002,8(10)：476-477.
[28]Schmid G,Markowitz J,Joesoef R,et al.Bacterial vaginosis and HIV infection[J].Sex Transm Infect,2000,76:3-4.
[29]刘克玲,张德荣,王临虹,等.中国部分城市已婚妇女妇科常见病流行病学研究[J].中国妇幼保健,2001,16(5)：298-301.
[30]付泽明.天津市河东区妇女生殖道感染现状及相关因素分析[J].中国妇幼保健.2007,22(13)：1815-1816.
[31]吴盛辉,徐芾.南京特困家庭妇女生殖道感染现状及影响因素研究[J].中 国妇幼保健.2003,18(10)：592-593.[136]张璐.国家计生委启动生殖感染干预工程[J].中国计划生育杂志,2000,8(8),342-343.
[32]韩献琴,马文侠,甘师秀,等.农村妇女生殖道感染干预前后的比较.中国计划生育学杂志,2002,8：473-474.
[33]迟绍琴,陈奕微,朱伟勇.农村已婚育龄妇女生殖道感染的干预现状调查[J].中国性科学,2005,14(6)：37-39.
[34]冯琪.女性生殖健康面临的问题及生殖道健康促进策略[J].中国健康教育,2002,18(2)：119-121.
[35]郭素芳,王临虹,严仁英.城乡生殖道感染妇女利用卫生服务的调查[J].中华流行病学杂志,2002,23(1)：40-42.
[36]郭素芳,Oratai Rauyajin, Vanawipha Pasandhanatorn,等.中国农村生殖道感染妇女卫生服务需求情况调查[J].中国公共卫生,2001；17(5)：441-443.
[37]范文燕,袁兆康,任金祥,等.生殖道感染干预工程对干预对象“知、信、行影响的研究[J].中国计划生育杂志,2006,(4)：209-213.
[38]程静.安徽部分农村已婚育龄妇女婚姻质量与生殖健康及相关知识、态度、行为关系的研究.硕士学位论文,2007.
[39]黄敬亨.健康教育学[M].上海：复旦大学出版社.2002,3：28-34.
[40]Becker M H, Maiman L A, Kirscht J P, et al. The health belief model and prediction of dietary compliance:a field experiment[J].J Health Soc Behav,1977,18(4): 348-366.
[41]吕姿之.健康教育与健康促进[M].北京：北京医科大学出版社,2002.41-42.
[42]黄敬亨.健康教育学[M].上海：复旦大学出版社,2003.34.
[43]Robert FD. Scale Development Theory and Applications[M].Newbury Park: SAGE Publications,1991:106.
[44]Prentice-Dunn S,Rogers R W.Protection motivation theory and preventive health:beyond the health belief model[J].Health Education Research,1986,1(3): 153-161.
[45]林丹华,方晓义,李晓铭.健康行为改变理论述评[J].心理发展与教育,2005,4：122-123.
[46]熊国强主编.医学科研设计教程[M],第3版.北京：科技出版社,2003：21.
[47]Denise FP, Chery TB. The Content Validity Index:Are You Sure You Know What's Being Reported? Critique and Recommendations [J]. Research in Nursing& Health,2006,29:489-497.
[48]孙振球主编.医学统计学[M],第2版.北京：人民卫生出版社,2007： 535-541.
[49]_艾尔·巴比著,邱泽奇译.社会研究方法(上)[M],第8版.北京：华夏出版社,2000.
[50]Jancet M. Ruane. Essentials of Research Methods-A Guide to Social Science Research[M]. Bodmin:Blackwell Publishing Ltd,2005:63-74.
[51]Stephen Sutton, Andrew Baum, Marie Johnston edited. The SAGE HANDBOOK of HEALTY PSYCHOLOGY[M]. London:SAGE Published Ltd,2004.
[52]Devellis RF. Scale development:theory and applications [M](2nd ed.). California:Sage Publications Inc,2003:60-101.
[53]Stanley P, Jennifer MR, Mick PC, et al. Methods for testing and evaluating survey questionnaire[M]. Hoboken:John Wiley& Sons Inc,2004:385-407.
[54]Bentler PM, Bonett DG. Significance tests and the evaluation of fit in the analysis of covariance structures [J]. Psychological Bulletin,1980,88:588-606.
[55]史静峥,孙振球,蔡太生.良性前列腺增生症患者生活质量量表的编制与应用[J].中国卫生统计,2003,20(3)：158-161.
[56]金瑜主编.心理测量[M].上海：华东师范大学出版社,2001,266-268.
[57]Heys RD, Anderdon R, Revicki D. Psychometric consideration in evaluationg health-related quality of life measures[J]. Quality of Life Research, 1993,2(2):441-449.
[58]方积乾.医学统计学及统计软件[M].北京医科大学出版社,2000：246-250.
[59]方积乾.生存质量测定方法及应用[M].北京：北京医科大学出版社,2000：3-110.
[60]蒋艳,沈宁,邹树芳.护理研究中量表研制及测量学特征的评定方法[J].中华护理教育,2005,2(4)：174-176.
[61]Clark LA, Watson D. Constructing validity:Basic issues in objective scale development[J]. Psychological Assessment,1995,7(3):309-319.
[62]Hawley MP.Sources of stress for emergency nurses in four urban Canadian emergeney departments[J].J Emerg Nurs,1992,18(3):211-216.
[63]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2005：1.
[64]秦浩,陈景武.结构方程模型原理及其应用注意事项[J].中国卫生统计,2006,23(4)：367-369.
[65]张璐.国家计生委启动生殖感染干预工程[J].中国计划生育杂志,2000,8(8),342-343.
[66]高博,李宁秀,任晓晖.四川省农村育龄妇女生殖道感染现况研究[J].中国妇幼保健,2003,18(2)：94-97.
[67]刘克玲,张德英,王临虹等.中国部分城市已婚妇女妇科常见病流行病学调查[J].中国妇幼保健杂志,2001,16(5)：310-312.
[68]王临虹,赵更力,陈丽君等.已婚妇女生殖道感染患病情况调查[J].中华流行病学杂志,2000,6(21)：464.
[69]张学华.妇女宫颈炎、盆腔炎发病率及相关因素分析[J].中国社区医师,2009,11(13)：124
[70]冯睿,钱玲惠,吴永红,等.深圳市南山区育龄妇女RTI基线情况调查[J].中国计划生育学杂志,2002,10(9)：544-545.
[71]高燕秋.育龄妇女生殖健康知识及健康教育[J].人口研究,2000,24(6)：46-50.
[72]Guo S, Wang L, Yan R. Health service needs of women with reproductive tract infections in selected areas of China[J]. Chin Med J (Eng),2002,115(8): 1253-1256.
[74]Ahmed MU, Mirza T, Khanum PA, et al. Management of reproductive tract infections in rural Bangladesh[J]. Int J STD AIDS,1999,10(4):263-267.
[75]Makuch MY, Botega NJ, Bahamondes L. Physician-patient communication in the prevention of female reproductive tract infections:some limitations[J]. Cad Saude Publica,2000,16(1):249-253.
[76]Hashwani S, Hiran T, Fatima M. Awareness of sexually transmitted diseases in a selected sample in Karachi[J]. J Pak Med Assoc,1999,49(7):161-164.
[77]Mazhar SB, Agha MA, Shaikh MA. Knowledge and misconceptions about sexually transmitted infections in married women-perspective from Islamabad[J]. J Pak Med Assoc,2001,51(11):389-392.
[78]魏虹,程怡民.我国流动人口生殖道感染求医行为及影响因素的研究[J].中国计划生育学杂志,2007,11：698-700.
[79]刘敏,曾光,张玲华,等.女性生殖道感染流行病学调查和阴道分泌物病征处理探索性研究[J].中华流行病学杂志,2002；23(6)：422-426.
[80]Behets F, Andriamiadana J, Rasamilalao D, et al. Sexually transmitted infections and associated socio-demographic and behavioral factors in women seeking primary care suggest Madagascar's vulnerability to rapid HIV spread[J]. Trop Med Int Health,2001,6(3):202-211.
[81]Tanfer K, Aral SO. Sexual intercourse during menstruation and self-reported sexually transmitted disease history among women[J]. Sex Transm Dis,1996,23(5): 395-401.
[82]王玮,许伟,张世奇等.生殖道感染妇女利用卫生保健服务的影响因素[J].中国妇幼保健,2007,22(27)：3581-3583.
[83]孙铮,赵云霞.妇女生殖道感染的防治与干预对策[J].现代预防医学2008,35(24)：4797-4798,4805.
[84]谷菲,何亚,刘志芳,等.城市社区已婚育龄妇女生殖健康服务的调查[J].中国计划生育学杂志,2002,10(6)：348.
[85]张存红,陈涛,徐蓉,等.安徽农村地区已婚育龄妇女生殖健康现状调查[J].中国妇幼保健,2008,23(20)：2841-2844.
[86]张红杰,曾光,岑阳,等.农村已婚育龄妇女STD/AIDS的患病现状及其相关知识调查[J].中国艾滋病性病,2003,9(6)：349-351.
[87]刘英,曹丽娟.育龄妇女生殖道感染及艾滋病预防知识知晓率调查[J].中国妇幼保健,2007,22(20)：2833-2835.
[88]钟细华.已婚育龄妇女生殖道感染与相关知识态度行为的现况研究.硕士学位论文(复旦大学),2003.
[89]杜蔚云,吕阳,张文辉,等.藏区妇女生殖道感染的就医现状及影响因素[J].卫生职业教育,2006,24(12)：104-106.
[90]李晓梅,张开宁,时犁,等.农村妇女生殖道感染症状求医行为的影响因素初探[J].中国公共卫生,2002,18(5)：554.
[91]张晓辉,邱丽倩,邵温群,等.妇科门诊就诊者生殖道感染知识调查[J].中国妇幼保健,2008,23(8)：1112-1113.
[1]张璐.国家计生委启动生殖感染干预工程[J].中国计划生育杂志,2000,8(8)：342-343.
[2]Sobel JD. What is new in bacterial vaginosis and trichomoniasis? Infect Dis Clin NAm,2005,19:387-406.
[3]0'Brien RF. Bacterial vaginosis:many questions-any answers? Curr Opin Pediatr,2005,17:473-479.
[4]曹泽毅,主编.中华妇产科学[M],第2版,人民卫生出版社,2004：1352-1358.
[5]Gravert MG, Nelsen HP. Independent associations of bacterial vaginosis and t rachomatis infection with adverse pregnancy outcome[J] JAMA,2001,256:1899-1902.
[6]Westrom L, EvaldsonG, HolmesKK etal.Taxonomy ofvaginosis; bacterial vaginosis-a definition.In:M? rdh P-A, Taylor-RobinsonD, eds. Bacterial vaginosis. Uppsala, Sweden:Almqvist and W iksel,1984:259-260.
[7]MyerL, DennyL, TelerantR,etal. BacterialVaginosis and Susceptibili-ty to HIV Infection in South African Women:A Nested Case-Control Study[J]. J InfectDis,2005,192(8):1372-1380.
[8]ReinMF, M shihM, et allUse of a lactoferrin assay in the differentiat diagnosis of female genital tract infections and imp licatious for the pathophysiology of bacterial vaginosis [J] 1Sex Transm Dis,1996,23(6):517-521
[9]Mead PB. Epidemiology of bacterial vaginosis[J]. Am J ObstetGyne-co,1 1993,169:446-449.
[10]BiswasMK. Bacterial vaginosis[J]. Clin ObstetGyneco,1 1993, 36(1):166-176.
[11]刘志强,张玲华,谷学英,等.不同育龄妇女人群细菌性阴道病调查及临床分析[J].中国妇幼保健,2005,20：394-395.
[12]王晓燕.530例BV患者的革兰氏染色涂片分析[J].中原医刊,2005,32(24)：79
[13]刘志强,张玲华,谷学英,等.不同育龄妇女人群细菌性阴道病调查及临床分析[J].中国妇幼保健,2005,20(11)：1394-1396.
[14]侯春玉.细菌性阴道病及其合并症检测结果分析[].中国妇幼保健,2005,20(15)：1916.
[15]马丽,沙玉成.细菌性阴道病的临床研究进展[J].安徽医学,2007,28(1)：78.
[16]张海霞.细菌性阴道病的诊治进展[J]河北医药,2002,24(7)：589-590.
[17]张铁娟,关海军,于丽江,等.女性性病患者细菌性阴道病的感染情况分析[J].中国妇幼保健,2008,2：3431.
[18]林子刚,刘忠绪,陈宏,等.不同人群细菌性阴道病检测结果分析[J].中国艾滋病性病,2007,13(5)：453.
[19]李沂轩,纪岩文.性病门诊的细菌性阴道病患病情况调查[J].天津医药,2006,34(7)：445-446.
[20]林子刚,刘忠绪,陈宏,等.不同人群细菌性阴道病检测结果分析[J].中国艾滋病性病,2007,13(5)：453.
[21]贾艳丽.妇科体检3140例检出细菌性阴道病情况分析[J].中国误诊学杂志,2008,8(21)：5181.
[22]毛淑芳,刘晓燕,刘岩.承德市已婚育龄职业妇女细菌性阴道病调查[J].中国皮肤性病学杂志,2006,20(6)：370-371.
[23]李俊,金先富,纪东辉.120例阴道分泌物检查及BV检测结果分析[J].中国卫生检验杂志,2008,8(11)：2339-2340.
[24]黄敏,滕奔琦,周水生,等.800例妇科门诊妇女阴道感染及微生态状况分析[J].中国微生态学杂志,2008,20(5)：498-499.
[25]陈卫斌,周英.1000例阴道分泌物检测细菌性阴道病的探讨.中国社区医师,2006,11(综合版)：73
[26]汤翔群,罗永慧.1842例细菌性阴道病检测结果分析[J].实验与检验医学,2008,26(5)：567.
[27]林子刚,刘忠绪,陈宏,等.不同人群细菌性阴道病检测结果分析[J].中国艾滋病性病,2007,13(5)：453.
[28]Pereira L, Culhane J,McCollum K, et al. Variation in microbiologic profiles among pregnantwomenwith bacterialvaginosis[J]. Am Jobstet Gyneco,1 2005,193(3):746-751.
[29]顿艳波,冯睿,高伟.人型支原体与细菌性阴道病的相关性研究[J].中华皮肤科杂志,2003,36(9)：525.
[30]毛淑芳,刘晓燕,刘岩.承德市已婚育龄职业妇女细菌性阴道病调查.中 国皮肤性病学杂志,2006,20(6)：370-371
[31]张铁娟,关海军,于丽江,等.女性性病患者细菌性阴道病的感染情况分析[J].中国妇幼保健2008,23：3431-3432.
[32]康白.微生态学[M].大连：大连出版社,1998：22-24.
[33]Yen SC, JaffeRB, BarbieriRL. ReproductiveEndocrinology.4th ed. Philadelphia:Saunders,1999.124.
[34]MacNeillC, Umstead TM, PhelpsDS, et al. Surfactant protentA, aninnate immune factor, is expressed in the vaginal mucosa and is present in vaginal lavage fluid. Immunology,2004,111(1):91-99.
[35]侯朝晖,杨琳,杨景云.细菌性阴道病阴道菌群失调与局部sIgA含量的关系[J].军医进修学院学报,2004,25(4)：17-18.
[36]Eschenbach DA,Davick PR, Williams BL, et al. Prevalence of hydrogen peroxide-producing Lactobacillus species in normal women and women wit h bacterial vaginosis. J Clin Microbiol,1989,27:251-256.
[37]Mijac VD, Dukic SV, Opavski NZ, et al. Hydrogen peroxide producing lactobacilli in women wit h vaginal infections. Eur J Obstet Gynecol Reprod Biol,2006,129:69-76.
[38]Hawes SE, Hillier SL, Benedetti J, et al. Hydrogen peroxide p roducing lactobacilli and acquisition of vaginal infections[J]. J InfectDis,1996,174:1058-1063.
[39]Panoff SJ. The relationship of hydrogen peroxide p roducing lactobacilli to bacterial vaginosis and genital micro flora in p regnant women [J]. Obstet Gynecol,1992,79:369-373.
[40]刘佳明,孙晶,袁杰利.细菌性阴道病患者与健康妇女阴道乳杆菌生态学特征的比较[J].现代妇产科进展,2006,15(1)：18-19.
[41]Olmsted SS, Meyn LA, Rohu LC,et al. Glycosidase and proteinase activity of anaerobic gram-negative bacterialsolated from women with bacterial vagiruosis[J]. SexTransm Dis,2003,30 (3):257-261.
[42]崔茜.细菌性阴道病阴道局部sIgA含量与菌群失调的关系[J].湖北民族学院学报(医学版),2005,22(2)：26-27.
[43]楼永良,刘佳明.阴道液中唾液酸酶活性、阴道加德纳菌及其IgA水平的相关性研究[J].中国微生态杂志,2006,16(8)：176-178.
[44]CauciS, Guaschion S, DriussiS, etal. Correlation of local interleukin-8with immunoglobulin againstGardnerella vaginalis hemolysin and with prolidase and sialidase levels in women with bacterial vaginosis[J]. J InfectDis,2002,185(11):1614-1620.
[45]刘佳明.细菌性阴道病hBD-2 mRNA表达的变化及微生态制剂、中药对其影响[J].中国微生态学杂志,2007,19(2)：135-136.
[46]Mead PB. Epidemiology of bacterial vaginosis[J]. Am J ObstetGyne-co,1 1993,169:446-449.
[47]林子刚,刘忠绪,陈宏,等.不同人群细菌性阴道病检测结果分析[J].中国艾滋病性病,2007,13(5)：453.
[48]Yen S, ShaferMA, Moncada J, et all Bacterial vaginosis in sexually experienced and non2sexually experienced young women entering the militaryl Obstet Gynecol,2003,102 (5):927-932.
[49]Chiaffarino F, Parazzini F, De Besi P, et all Risk factors for bacterial vaginosisl Eur J Obstet Gynecol Rep rod Biol,2004,117 (2): 222-226.
[50]T. R. Nansel, Prevention Research Branch, Division of Epidemiology, Statistics, and Prevention Reseach, National institute of child Health and Human Development,6100 Executive Blvd, Bethesda, MD 20892-7510, United States-AM. J. OBSTET. GYNECOL.2006,194(2):381-386.
[51]Mead PB. Epidemiology of bacterial vaginosis[J]. Am J ObstetGyne-co,1993,169:46-449.
[52]毛淑芳,刘晓燕,刘岩.承德市已婚育龄职业妇女细菌性阴道病调查[J].中国皮肤性病学杂志,2006,20(6)：370-371.
[53]陈会波,周兰英,李会庆.山东省农村地区已婚育龄妇女细菌性阴道病患病现状及危险因素[J].中国医学科学院学报,2006,28(3)：378-381.
[54]GotoA, NguyenQV, Pham NM, etal. Prevalence ofand factors associat-ed with reproductive tractinfections among pregnantwomen in ten com-munes in Nghe An Province, Vietnam[J]. J Epidemio,1 2005, 15(5):163-172.
[55]Mead BP1Ep idemiology of baelerial vaginasislAm J Obslel Gynecol,1993,169:460
[56]赵文,应群华.妊娠合并细菌性阴道病检测结果分析[J].中国妇幼保健,2008,23：1896-1897.
[57]汪萍,傅彭燕,顾光华.妊娠期细菌性阴道病筛查分析.中国妇幼保健,2008,2：4551
[58]田志红,黄醒华.妊娠期细菌性阴道病的研究[J].中国妇幼保健,2007,22：437.
[59]段纯,吴华良,曾月娥,等.实用预防医学.2008,15(6)：1879-1880.
[60]吴钟琪,林平.妊娠妇女细菌性阴道病检出结果分析[J].现代预防医学,2006,33(4)：539.
[61]段纯,吴华良,曾月娥.围产期女性细菌性阴道病筛查与分析[J].实用预防医学,2008,15(6)：1879-1890.
[62]汪萍,傅丹,彭燕.妊娠期细菌性阴道病筛查分析[J].中国妇幼保健2008,23：4551-4552.
[63]李红艳,黄雪芹,那娜.妊娠期合并细菌性阴道病患者妊娠结局分析[J].中国健康教育,2008,24(3)：216-217.
[64]宋晶哲,卢丹,朱网娣.细菌性阴道病对妊娠结局影响的研究[J].实用临床医药杂志.2008,12(6)：93-95.
[65]Donders,GG;Van,Bulck-B;Caudron,J;et al. Relationship of bacterial vaginosis and mycop lasmas to the risk of spontaneous abortion. American Journal of Obstetrics and Gynecology,2000,183 (2):431-437.
[66]Oakeshott P, Hay P. Association between bacterial vaginosis or chlamydia I'refection and miscarriage before 16 weeks'gestation'p rospective community based cohort studyl BMJ,2002,325 (7376):1334
[67]韩茜,韩阳,陈黎明.细菌性阴道病感染与先兆流产关系的研究[J].中国优生与遗传杂志,2005,13(7)：86-87.
[68]杨蔚.细菌性阴道病与早产的关系研究进展[J].中国妇幼保健,2007,22：3458-3459.
[69]田志红,黄醒华.妊娠期细菌性阴道病的研究[J].中国妇幼保健,2007,(22)：437-478.
[70]郭玉芬,杨文东,高向玲.细菌性阴道病与胎膜早破的关系[J].中国优生与遗传杂志,2006,14(10)：57-58.
[71]马宁,苑春莉,盛辉.妊娠合并细菌性阴道病对妊娠结局影响的临床研究[J].中国优生与遗传杂志,2006,14(6)：73-74.
[72]任华,王俏霞,郭凌岑.细菌性阴道病与流产关系的探讨.中国优生与遗传杂志,2003,11(6)：103-107
[73]Hillier S, Nugent P, Eschenbach A, et all Association between bacterial vaginosis and p reterm delivery of low birth weight in fantl Int J Gynecol Obstet,1999,54 (1):887-881.
[74]陈祥生,尹跃平,王千秋.性传播疾病的实验室诊断[M].北京：人民卫生出版社,2001.68-74.
[75]Holzman C, Leventhal JM, QuiH, etal. Factors linked to bacteria vagi-nosis in nonpregnantwomen[J]. Am J Public Health,2001, 91(10):1664-1670.
[76]Schmid G, MarkowitzL, KoumansE. Bacterial vaginosis andHIV infec-tion(editorial)[J]. SexTransm Infect,2000,76(1):3-4.
[77]Spandorfer SD, Neuer A, Giraldo PC, et al. Relationship of abnormal vaginal flora, proinflammatory cytokines and idiopat hicinfertility in women undergoing IVF. J Reprod Med,2001,46:8062810.
[78]王蕊,李春霞,邵幸曙.女性不孕症患者下生殖道细菌性阴道病感染状况初探[J].中国妇产科临床杂志,2008,9(2)：121-122.
[79],徐淼,于亮.细菌性阴道病与不孕的关系1 320例分析.中国误诊学杂志,2008,8(12)：2902-2803.
[80]W ilson JD, Ralph SG, Rutherfo rd AJ. Rates of bacterial vagino sisin women undergo ing in vitro fertilisation fo r different types ofinfertility[J]. BJOG,2002,109 (6):714-717.
[81]Watts DH, Fazarri M, Minkoff H, et al. Effects of bacterial vaginosis and other genital infections on the natural history of human papilloma2virus infection in HIV212infected and high risk HIV-1 uninfected women[J]. J Infect Dis,2005,191 (7):1129-1139.
[82]Sewankambo N, Gray RH, Wawer MJ, et al. HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis [J].Lancet,1997,350 (9077):546-550.
[83]Cohen CR, Duerr A, Pruithithada N, et al.Bacterial vaginosis and HIV seroprevalence among female commercial sex workers in Chiang Mai,Thailand[J]. AIDS,1995,9 (9):1093-1097.
[84]Sha BE, Zariffard MR, Wang QJ, et al. Female genital tract HIV loadcorrelates inversely with Lactobacillus species but positively with bacte2rial vaginosis and Mycoplasma hominis[J]. J Infect Dis,2005,191 (1):25-32.
[85]Mbizvo ME, Musya SE, Stray2Pedersen B, et al. Bacterial vaginosis and intravaginal practices:association with HIV[J]. Cent Afr J Med,2004,50 (526):41-46.
[1]张红杰,曾光.妇女生殖道感染及其危害.中国计划生育杂志,2001,6(74)：372-374.
[2]乐杰主编.妇产科学.第6版.北京：人民卫生出版社,2003.
[3]Lien PT, Elias C, Loi NT, et al.The prevalence of reproductive tract infections in Hue, Vietnam. Studies in Family Planning, 2002,33:217-226.
[4]Lan PT, Lundborg CS, Phuc HD, et al. Reproductive tract infections including sexually transmitted infections:a population-based study of women of reproductive age in a rural district of Vietnam. Sexually Transmitted Infections 2008,84:126-132.
[5]郭素芳,张文坤.妇女生殖道感染的控制.国外医学妇幼保健分册.2001；12(1)：3-5.
[6]刘民,张孔来.改善生殖健康的综合服务—艾滋病／性病预防干预与计划生育服务相结合.生殖医学杂志,1999,8(3)：173-175.
[7]de Sanjose S, Diaz M, Castellsague X, et al. World-wide cervical HPV prevalence among women without invasive cervical cancer:a review of the literature 1995-2005.22nd International Papillomavirus Conference, Vancouver, Canada (abstract),2005.
[8]Smith JS, Robinson NJ. Age-specific prevalence of infection with herpes simplex virus types 2 and 1:a global review. J Infect Dis 2002; 186 (suppl):23-28.
[9]UNAIDS. AIDS epidemic update 2005. Geneva:Joint United Nations Programme on HIV/AIDS and World Health Organization,2005.
[10]Gloyd S, Chai S, Mercer MA. Antenatal syphilis in sub-Saharan Africa:missed opportunities for mortality reduction. Health Policy Plan, 2001,16:29-34.
[11]Global Prevalence and incidence of selected curable STIs overview and estimates. World Health Organization.2001.
[12]杜蔚云,吕阳,周妍,等.甘南藏区已婚育龄妇女生殖道自觉感染症状及感染现状分析.中国妇幼保健。2009,24(6)：827-829.
[13]Thin RNT, FRCP MD. Genitourinary medicine and sexually transmitted infection in the 21 century. International Journal of STD & AIDS,2000,11(1):1-7
[14]Lan PT, Faxelid E, Chuc NT, et al. Perceptions and attitudes in relation to reproductive tract infections including sexually transmitted infections in rural Vietnam:A qualitative study. Health Policy,2008,86: 308-317.
[15]郭素芳,王临虹,严仁英.城乡生殖道感染妇女利用卫生服务的调查.中华流行病学杂志,2002,23(1)：40-42.
[16]Vikram Patel, Nandini Oomman.Mental Health Matters Too :Gynaecological Symptoms and Depression in South Asisa, Reproductive Health Matters,1999,7(14):30-38.
[17]Anna G, Gulmezoglu AM, George PS, et al. Sexual and reproductive health:a matter of life and death. The Lancet 2006,368 (1):1595-1607.
[18]张春平,朱道银,郭晓霞,等.沙眼衣原体子宫内感染途径的研究[J].中华妇产科杂志,2002,37(3)：149-151.
[19]王军华.生殖道感染与卫生服务对策.中国妇幼保健,2003,18(1) ：52-54.
[20]Sami N, Ali TS. Psycho-social consequences of secondary infertility in Karachi. J Pak Med Assoc 2006,56:19-22.
[21]Jimenez, AL, Gotlieb, SL, Hardy E, et al. Prevention of sexually transmitted diseases in women:association with socioeconomic and demographic variables. Cad Saude Publica.2001,17(1):55-62.
[22]彭兰香.女性生殖道感染普查情况分析.中国计划生育学杂志,2002,8(10)：476-477.
[23]Schmid G, Markowitz J, Joesoef R, et al. Bacterial vagi-nosis and HIV infection. Sex Transm Infect,2000,76:3-4.
[24]范文燕.生殖道感染干预工程对农村已婚育龄妇女生殖道感染的干预效果研究.硕士学位论文,2008.
[25]Jane Schade Henderson. Nurses'attitude, belief, practice, and knowledge regarding urinary incontinence in adults:Lisrel analysis of a model.1996硕士学位论文。
[26]胡萍,何瑞敏,杨玉坤,等.黄浦区已婚妇女生殖道感染患病情况及其认知、态度、行为调查.实用预防医学,2007,14(6)：1835-1836.
[27]武俊青,王瑞平,李玉艳,等.上海市徐汇区核心家庭妇女生殖健康知识及行为调查.生殖与避孕,2007,27(5)：354-359.
[28]游丽琴,王倩,冯琪,等.育龄妇女生殖道感染知识及求医行为调查.中国妇幼保健,2008,30(23)：4319-4320.
[29]薛仲.树立健康信念增进自我效能---浅谈健康信念模式在公共卫生社会工作中的应用[J].山西高等学校社会科学学报,2005,17(5)：110-112.
[30]蒋汝刚,吴秋萱,农村已婚育龄妇女生殖道感染相关知识及求医行为调查.中国妇幼保健。2006,19(21)：2718-2719.
[31]王才康,刘勇.一般自我效能感与特质焦虑、状态焦虑和考试焦虑的相关研究。中国临床心理学杂志,2000,8(4)：229-230.
[32]靳雪征.健康信念理论的建立和发展[J].中国健康教育,2007,23(12)：945-946.
[33]黄敬亨.健康教育学[M].上海：复旦大学出版社,2003：34.
[34]张红杰,陈占良,刘梅云,等.山区育龄妇女生殖道感染患病及知识现状分析.中国妇幼保健,2005,8(20)：926-928.
[35]马骁.健康教育学[M].北京：人民卫生出版社,2004：61-88.
[36]张鼎昆,方俐洛,凌文 .自我效能感的理论及研究现状.心理科学进展,1999,7(1)：39-43.
[37]魏虹,程怡民.我国流动人口生殖道感染求医行为及影响因素的研究.中国计划生育学杂志,2007,11：698-700.6(4)：377-378.