The Association between Obstetrician Shortage and Adverse Birth Outcomes in Taiwan.
| Autor: | Jia-WenZhang, 張嘉雯 |
|---|---|
| Rok vydání: | 2015 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 103 In recent years, obstetricians / gynecologists (OB/GYN) in Taiwan has been unevenly distributed, and some of ob-gyn physicians do not provide maternity and obstetric services in particular areas. Previous researches indicated that the decreasing of accessibility of maternity care services may increase the risks of perinatal mortality and NICU hospitalization. However, the problems of human resources in obstetric care have not been indicated in current health statistics and researches in Taiwan. Therefore, the objective of this research is to investigate the number and distribution of obstetrician in Taiwan, and further explore the association between obstetrician resources and adverse birth outcomes. This research used National Health Insurance Research Databases from 1997 to 2008 and Birth Certificate Application databases of 2001, 2003, 2005, 2007, 2009 and 2011. “Obstetrician” is defined as the physician who provides prenatal cares and gives birth. All births contains both live births and stillbirths were born at more than 20 weeks or weigh over 500 grams. Descriptive statistics and geographic analysis were used to present the number and distribution of obstetrician. Trend test and multiple logistic regression model are conducted to investigate the association between obstetrician resources and adverse birth outcomes. First, this research found that Obstetricians in Taiwan present sufficiently but unevenly distributed. The number of obstetrician declines year by year, but the burden of obstetrics also declines. Besides, there is no obstetricians in over half of the towns, which affected 18.24~23.75% of the births. Second, the lack of obstetrician resources of a town increases the neonatal adverse birth outcomes, such as preterm, low birth weight, SGA, and fetal death. This is the first study in Taiwan to explore the resources of obstetricians by using large population-based database. This research expects the results can be contributed to obstetrician human resources policy and applied to decrease the differences of adverse birth outcomes. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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