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March 2013, Volume 16, No.7 Abstracts

 Analysis on System Archetype of Developing Community Health Services:Based on A Field Research in Jiangxi Province

LI Li-qing,ZHOU Xiao-jun.School of Economics & Management,Jiangxi Science & Technology Normal University, Nanchang 330031,China

Abstract The development of community health services (CHS) can effectively alleviate the problems of "difficulty to see a doctor and higher medical expense". From the perspective of system engineering, we analyze in this paper the developing situation of CHS in urban areas of Nanchang, Jiujiang and Ganzhou cities in Jiangxi Province, taking the conditions of actual operation of CHS institutions in close connection with management theory, finding out the negative factors restricting the development of CHS. According to the theory of system dynamics and the analyzing technique of Peter Senge system archetype, we build up a typical system archetype restricting development of CHS, and analyze it quantitatively, and then we propose the targeted strategy to improve the development of CHS, and thus we provide a theoretical basis for increasing service ability in CHS.

Key words Community health services;System archetype;System dynamics

Construction of Evaluation Index System for Safety of Patients in Domestic Sickbeds

HUANG Lei,LI Li-qiang. Wuliqiao Community Health Service Center,Huangpu District, Shanghai 200023,China

Abstract Objective To explore the establishment of the index system to evaluate the safety of patients receiving home health care service.

Methods The methods of literature research and field interview were applied to draw up the security indexes for patients receiving home health care service.And then the Delphi method was taken to screen the indexes by consulting experts in two rounds.

Results All the 15 experts participated in the two rounds of consultation were averagely aged 45.8 years.Their average number of years of work experience was 23.7,and 53.3% of them had senior professional title,engaging in community health services,health administration,or public health service.In the two rounds of consultation the experts positive coefficients were 100.0% and the authority coefficient was respectively 0.70 and 0.71.The final index system established for evaluation of the safety of patients receiving home health care service included nine first-graded indexes and thirty-five second-graded indexes,and the corresponding weights were calculated.

Conclusion We primarily establish an evaluation index system for the safety of patients receiving home health service,and determine the weight of each index.Furthermore,we also put forth that the administrating idea should take the patients safety as the guidance.

Key words Domestic sickbed;Patient safety;Evaluation indexes system;Delphi method

Discussion about Application of Capitation on Outpatients in Community Health Care Institutions

DU Xue-ping,HUANG Kai.Yuetan Community Health Service Center,Fuxing Hospital Affiliated to Capital Medical University,Beijing 100045, China

Abstract With the great increase of medical care cost and gradually deep development of medical reformation,the research of payment methods of medical insurance had been taken increasingly seriously.This article mainly explored the application of capitation on outpatients in community health care institutions,and analyzed the necessity,feasibility,probably existing problems,current experiences from both at home and abroad,and relative supporting policies,so as to provide suggestions for the new payment method in community health care institutions.

Key words Community health care institution;Outpatient;Capitation;Payment method

Community Health Staffs Attitude to Traditional Chinese Medicine and Influencing Factor Analysis

YU Zhen-jie,ZHAO Yan-kui,YU Qian-qian,et al.Management Department of Weifang Medical University,Weifang 261053,China

Abstract Objective To know community health staffs attitude to traditional Chinese medicine (TCM).

Methods Questionnaire survey was used to do the investigation,and the explored factor analysis was taken to perform the analysis of dimensions for influencing factors to attitude.

Results Some 93.81% (500/533) believed that TCM had superiority over Western Medicine,however only 6.19% (33/533) held that the development condition of TCM at their local region was very good.The explored factor analysis revealed that the answered average score for importance of TCM service was 2.03,being the smallest;the average score for mastering TCM service technique was 3.22,being the highest.While the average scores for trusting,preferring,concerning and utilizing TCM service were respectively 2.25,2.28,2.23 and 2.75.By extraction of common factors through factor analysis and reduction the number of variants,finally three larger common factors were obtained,and they were respectively called behavior tendency factor,mood factor and recognition factor.

Conclusion In recognition dimension the community health staffs degree of mastering the theoretical knowledge and service skill on TCM is lower;in mood dimension the grade of trusting and concerning TCM service is higher;and in behavior tendency dimension the work done in utilizing TCM service,exchanging TCM-related information with colleagues,and recommending TCM to patient is unsatisfactory.It is suggested that training and continuing education should be enhanced,so as to improve community health staffers mastery of knowledge and service skill and promote community TCM development.

Key wordsCommunity health service staff; Traditional Chinese medicine; Attitude; Influencing factor

Influence of Zero-profit Drug Policy on Medical Costs of Hypertensive Patients in Rural Area of Beijing

DU Juan,ZHENG Shu-mei,XU Jun-jie,et al.School of Public Health and Family Medicine,Capital Medical University,Beijing 100069,China

Abstract Objective To study the influence of the policy "Zero-profit Drugs" on the medical costs of hypertensive patients in rural Beijing basing on the econometric model.

Methods By using the typical sampling two community health service (CHS) centers were chosen from Fangshan district and Daxing district respectively.A random sample of prescriptions for hypertensive patient was selected,including 200 prescriptions from Fangshan district before the implementation of the policy of "Zero-profit Drugs" and 200 after the implementation,and 200 from Daxing district after the implementation.

Results After the implementation of the policy,the average drug number of the prescription for the hypertensive patients reduced from 2.12 to 2.00 in a CHS center in Fangshan district while the number was 4.05 in a CHS center in Daxing district.The median of average cost per prescription for the hypertensive patients reduced from RMB 96.5 Yuan to 25.9 Yuan in the CHS center in Fangshan district while the median was 158.9 Yuan in the CHS center in Daxing district.by establishing the econometric model the average cost per prescription for the hypertensive patients after the implementation of the policy of "Zero-profit Drugs" decreased by 41.9% under the condition that the other factors unchanged.

Conclusion The implementation of "Zero-profit Drugs" policy reduces the average cost per prescriptions for the hypertensive patients in rural area of Beijing.However only the supporting policy of "Separated Management of Income and Expenditure" be truly implemented,can the patients benefit really.

Key words Community health services;Zero-profit drugs;Rural area;Hypertension

Status of Resource Allocation of Community Health Center in Main Labor Distribution Regions of Shenzhen

QIU Chuang-liang,XU Xing,WANG Hong-rui,et al.Community Health Service Management Center of Fuyong Peoples Hospital in Baoan District,Shenzhen 518103,China

Abstract Objective To analyze the present situation of resource allocation of community health centers (CHC) and the existing problems so as to provide a reference to improve the service ability of CHC.

Methods Baoan and Longgang districts were taken as main labor distribution regions (MLDR) and Futian and Luohu as secondary labor distribution regions (SLDR).The indicators for service ability of CHC between MLDR and SLDR were comparatively analyzed.

Results By 2010,there was no significant difference in area of business houses between MLDR and SLDR P0.01.The houses of CHC were mainly rented.No statistical difference in total income was found between P0.01.The drug income accounted for more than 45% of the clinic income in all the districts.The actual amount of human resource allocation in all districts was lower than the standard.The number of doctors in MLDR were higher than that of SLDR,with a significant difference P0.01.The number of traditional Chinese doctors and public health doctors were of the most shortage,especially in MLDR like Baoan.

Conclusion The financial subsidy to CHC is limited.The human resource allocation of CHC of MLDR is unreasonable and thus it influences the utilization of health service by laborers.And the traditional Chinese medicine in CHC remains to be allowed to play its service function fully.

Key words Community health services;Community health service centers;Labor;Resource allocation

Public Health Service Capacity of Chongqing:A Human Resources Perspective

WU Hai-feng,HE Ping,PAN Lun, et al. Chongqing Medical and Pharmaceutical College, Chongqing 401331,China

Abstract Objective To investigate the status quo of public health service capacity of Chongqing.

Methods A self-made questionnaire was used to carry out surveys in Health Bureaus,Financial Bureaus,public health organizations, and grass-root health organizations in 4 districts of Chongqing.We interviewed the directors and managers in these organizations and conducted a literature review.

Results Public health personnel were insufficient.They accounted for 20.35%,20.61%,and 11.03% of the total medical staff in maternal and child health centers,health inspection agencies, and psychiatric hospitals,respectively.Most of the public health personnel were junior college or technical secondary school graduates without or with only junior professional titles. Only 7.16% of the public health personnel held a medical practitioners license. In grass-root health organizations, there was only 0.84 public health personnel in 10 000 people, and public health personnel accounted for 7.07% of the health technical staff.

Conclusion The quantity and quality of public health personnel in Chongqing are insufficient to accomplish the national public health service tasks. How to attract and retain high-quality public health personnel is the problem needs to be solved.

Key words Basic public health service;Service ability;Chongqing

Evaluation on Reliability of the Chinese Version of Functional Assessment of Cancer Therapy-Ovary Cancer by Classical Test Theory and Generalizability Theory

LI Wei, LUO Jia-hong, WAN Chong-hua, et al.School of Public Health, Kunming Medical University, Kunming 650031, China

Abstract Objective To evaluate the reliability of the Chinese version of Functional Assessment of Cancer Therapy-Ovary Cancer (FACT-O).

Methods The Chinese version of FACT-O was developed through translation,back-translation and cultural adaptation,and seventy-three patients with ovarian cancer completed the questionnaires.The data were analyzed by correlation analysis,paired t-test and generalizability theory (GT).

Results Test-retest reliability analysis showed that score differences of the first and second measurements for all domains were not statistically significantP0.05;and the test-retest correlation coefficients for all the four domains except of the specific module were all above 0.80P0.05.Internal consistency analysis showed that the value of Cronbachs alpha for each domain was above 0.6.D research of GT showed the item number of general module was appropriate,and the item number of the specific module can be appropriately increased to 15.

Conclusion The results of evaluation on reliability of the Chinese version of FACT-O by Classical Test Theory and GT were basically consistent,indicating the Chinese version of FACT-O had a good reliability.

Key words Ovarian neoplasms; Quality of life; FACT-O scale; Generalizability theory; Reliability

Impact of Complicated Hypertension in Type 2 Diabetes Mellitus on Autonomic and Peripheral Neuropathy

ZHANG Yong-hong, ZHAO Ren-hua, XUE Yuan-ming. The First Peoples Hospital of Yunnan Province, Kunming 650032,China

Abstract Objective To investigate the impact of concurrent hypertension in patients with type 2 diabetes on autonomic and peripheral nerve lesions.

Methods A total of 156 patients with type 2 diabetes mellitus were recruited. They were divided as hypertension group (n=76) and non-hypertension group (n=80) according to the hypertension diagnostic criteria,At the same period,60 healthy persons in healthy medical examination were enrolled as control group.The general data of all the subjects were collected,and their autonomic and peripheral nerve functions were tested.

Results (1) The heart rate variability (HRV) parameters of the three groups showed statistically significant difference (P0.05).The HRV parameters were significantly lower in the hypertension and non-hypertension groups than in the control group (P0.05);and the HRV parameters were significantly lower in the hypertension group than in the non-hypertension group (P0.05).(2) The vibration perception threshold (VPT) parameters of the three groups showed statistically significant difference (P0.05).The VPT parameters were significantly higher in the hypertension and non-hypertension groups than in the control group (P0.05);however the VPT parameters between the hypertension group and the non-hypertension group showed no significantly difference (P0.05).

Conclusion The hypertension complication in type 2 diabetes mellitus may have a certain influence on the autonomic nerve function,but have little effect on peripheral nerve function.So the type 2 diabetes patients complicated by hypertension need to be given autonomic nerve function test and active control of blood sugar and blood pressure as early as possible.

Key words Diabetes mellitus,type 2;Hypertension;Autonomic nervous system function;Central nervous system function

Influence of Frightening Audio Frequency based on Regulation of ANS by Emotion on Heart Rate and Heart Rate Variability

WANG Ji-zhou,CHEN Jun-qi,HUANG Huan-lin,et al.The First Clinical Medical School,Southern Medical University,Guangzhou 510515,China

Abstract Objective To investigate the impact of frightening audio frequency on heart rate and its variability.

Methods Seventy healthy volunteers were recruited and divided into two groups with 35 in each according to random number table. Volunteers in group 1 received neutral audio stimulation and those in group 2 received frightening audio stimulation. The heart rate and its variability of each subject were recorded during the stimulation through Actiheart device.

Results Compared with group 1,in group 2 the root mean square of successive differences (RMSSD) was lower (37.5±14.7) ms vs. (53.8±30.3) ms,the heart rate was higher (70.2±8.1) /min vs. (65.2±8.2) /min,and the ratio of low frequency over high frequency (LF/HF) (1.52±0.96) vs. (1.03±0.58) increased ,the differences were statistically significant (P0.05).

Conclusion The fright emotion could result in the inhibition of vagal activity and produce a sympathetic dominance, and thus reduce RMSSD, increase heart rate and LF/HF.

Key words Fright emotionHeart rateHeart rate variabilityAutonomic nerve

Value of Von Willebrand Factor and P-selectin in Assessing Severity of Illness in Lupus Nephritis Patients

YANG Jun,GUO Ming-hao,LIU Yun,et al.Department of Nephrology,the First Affiliated Hospital of Xinxiang Medical College,Weihui 453100,China

Abstract Objective To explore the value of von Willebrand Factor (vWF) and P-selectin in assessing severity of illness in lupus nephritis patients.

Methods The level of vWF and P-selectin in 46 cases of lupus nephritis were determined.Disease activity index,renal histological activity index,and disease chronicity index were compared between the study group (lupus nephritis patients) and the control group (10 cases of health checkups).

Results There were 5 cases of type lupus nephritis,12 cases of type ,20 cases of type ,and 9 cases of type .Patients of type lupus nephritis had the highest disease activity index,renal histological activity index,and disease chronic index,while type II had the lowest.The expression of vWF and P-selectin in type and lupus nephritis patients were higher than that of type and type (P<0.05) and that of the control group (P0.05).Correlation analysis showed that vWF was positively correlated with renal histological activity index,and nearly correlated with disease activity index.P-selectin was positively correlated with disease activity index,renal histological activity index,and disease chronicity index.

Conclusion The expression of vWF and P-selectin indicates disease activity and severity in lupus nephritis patients,therefore can be used as a marker to guide clinical therapy.

Key words Lupus nephritisVon willebrand factorP-selectin

Comparison on Prevalence Features of Adult Metabolic Syndrome by Different Diagnosing Creteria in Nanchang

TU Ping, LI Sheng-jian, DUAN Peng, et al.Department of Endocrinology and Metabolism, the Third Hospital of Nanchang,Nanchang 330009,China

Abstract Objective To compare the prevalence of the metabolic syndrome (MS) by different diagnosing criteria in adults in Nanchang city and the consistency of various diagnosing criteria.

Methods The stratified cluster random sampling was used to select 1 491 residents aged20 years.They were given questionnaire survey,physician check-up and laboratory test.The MS prevalence was respectively calculated according to the definitions proposed by National Cholesterol Education Programs Adult Treatment Pane l (NCEP-ATP),International Diabetes Federation (IDF),and Chinese Diabetes Society (CDS).The results were compared and the consistency was tested.

Results The MS prevalence was respectively 24.8%370/1 491,20.1%299/1 491,and 16.7%249/1 491 according to the definitions of NCEP-ATP,IDF,CDS;and all the 3 criteria indicated that the MS prevalence gradually increased as the age went up.Statistical analysis showed that the consistency was respectively 95.4% between IDF and NCEP-ATP,86.2% between CDS and NCEP-ATP,and 86.8% between CDS and IDF;and the Kappa coefficients respectively were 0.870,0.586,and 0.565 respectively.

Conclusion The MS prevalence is high in Nanchang.The concordance between NCEP-ATP and IDF is the highest,but the practicability and evaluation remain to be tested by prospective follow-up study.

Key words Metabolic syndrome;Prevalence;Diagnostic criteria;Concordance

Comparative Study on Colonoscopy Data of Old and Non-old Peoples with Colonic Diverticulum in Han and Uygur Nationalities of Xinjiang Region

LI Ke-xue,Bu HailiqiemuNuer,Gu LibahaerSimayi.Department of Gastroenterology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China

Abstract Objective To investigate the colonoscopy features of and differences between old and non-old peoples with colonic diverticulum in Han and Uygur Nationalities of Xinjiang Region.

Methods From June 2009 to June 2012,the data of patients with colonic diverticulum diagnosed by colonoscopy,including 38 non-old and 47 old peoples of Han nationality,and 14 non-old and 20 old peoples of Uygur nationality.the colonoscopy characteristics of the patients were analyzed and compared.

Results 1For patients of Han nationality the total detectable rate of colon diverticula,as well as detectable rates of male,female,single,right,transverse colon diverticulum,and diverticula accompanied with polyps were higher in the old than in the non-old,with statistically significant differences (P0.05).For patients of Uygur nationality the total detectable rate of colon diverticula,male detectable rate of colon diverticula,and detectable rate of multiple colon diverticula were higher in the old than in the non-old,with statistically significant differences (P0.05).2Compared with Uygur nationality,for Han nationality the detectable rate of left colon diverticula in the non-old,and detectable rates in the old of male,multiple,left colon diverticula were lower,with statistically significant differences (P0.05).

Conclusion The detectable rate of colon diverticula increases as the age of people goes up,but with no significant difference between Han and Uygur nationalities.For the non old,the incidence of left colon diverticula is higher in Uygur than in Han nationality.For the old,the incidence of male,multiple,and left colon diverticula is higher in Uygur than in Han nationality.

Key words Diverticulum;Senile;Non-senile;Colonscope

Nursing Interventions Affect Quality of Life of Bladder Carcinoma Patients after Radical Cystectomy and Abdominal Stoma

XIONG Zhu-feng,CHEN Zhao,TANG Li-ping,et al.Department of Urology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China

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