August 2013, Volume 16, No.22 Abstracts
LI Li-qing,XU Yue-feng,ZHOU Xiao-jun,et al.Jiangxi Science & Technology Normal University,Nanchang 330031,China
【Abstract】 Objective To investigate the satisfaction of community residents receiving community health services (CHS) in Nanchang city.
Methods The stratified randomization sampling in combination with the interception method was used to investigate the satisfaction of community residents receiving CHS in five districts of Nanchang city.And then the rough set reduction theory was taken to select the key indexes and determine their weights by calculating the importance.
Results The questionnaire analysis of the 503 cases from the five districts revealed that the satisfaction score was highest in Qingshanhu district,followed in order by Wanli, Qingyunpu, Donghu district, and Xihu district.
Conclusion The satisfactions of community residents receiving CHS in the five administrative districts of Nanchang city are different, which indicates the CHS development is uneven. In order to provide more convenient, sustained, and healthy CHS for the citizens of Nanchang city, the CHS managers take some effective measures to improve the satisfaction degree of CHS.
【Key words】 Community health services;Satisfaction degree;Rough set
Division of Labor and Cooperation between Public Hospitals and Community Health Organizations
LEI Guang-he,CHEN Qin.Department of Humanities and Management, Guangdong Medical College,Dongguan 523808,China
【Abstract】 This paper analyzes the necessity of public hospitals and community health organizations regarding their division of labor and cooperation. We provide suggestions on how to advance their division of labor and cooperation from aspects of policy improvement and policy environment.
【Key words】 Public hospital;Community health organization;Division of labor and cooperation;Function;Structure
Comprehensive Reform of Primary Health Care Institutions and Its Practice
HE Ping,LIU Ping,PAN Chuan-bo, et al.Chongqing Pharmaceutical College,Chongqing 401331,China
【Abstract】 Objective To analyze the operational aspects of primary health care institutions before and after the implementation of comprehensive reform,to summarize the successful experiences and practice and drive deep into hot and difficult problems and shortcomings,and to make policy recommendations for establishment of a scientific long-term mechanism for implementation of comprehensive reform of primary health care institutions.
Methods A questionnaire survey was conducted on the running situation of 12 community health service centers(CHSCs) of Yuzhong District before and after the implementation of "performance appraisal, zero-profit drug management, and general clinic fee", and deep interviews were performed with the principals of health bureau, drug delivery companies, and institutions,as well as the heads of departments of pharmacy to obtain quantitative and qualitative data.
Results The financial investment accounted for 56.70% of total income of CHSCs in 2011,being 6.90% higher than that in 2009.The business income in 2011 was higher by 15.69% than that in 2009,and by 48.57% than that in 2010;of which the total medicare revenue rose from 18.95% of 2009 to 22.91% of 2010 and 37.69% of 2011.The per capita average workload of employees increased by 30%,the average annual salary was 38 600 Yuan per capita in 2011,being higher by 36.88% than that in 2009.The average prescription cost in the CHSCs had had no increase for three successive years.
Conclusion The service efficiency in primary health care institutions has significantly improved,and the service capacity remarkably enhanced.New financing ways guarantee the commonweal character for CHSCs.Nevertheless,there are still some problems such as shortage of general practitioners,less efficiency of basic medical care,and untimely supply of essential medical drugs.So it is necessary to start with reforming personnel system,widen the financing channels,and improve basic drug system,and then to establish a new management system so as to promote sustainable and healthy development of primary health care institutions.
Establishment of Performance Evaluation Indicator System in Rural Community Health Service Centers in Wujiang District
XU Jing，CHEN Qiang，LI Guo-pei，et al.School of Health Policy and Management，Nanjing Medical University，Nanjing 210029，China
【Abstract】 Objective To establish a set of performance evaluation indicator system suitable for development of rural community health services and for evaluating comprehensively Rural Community Health Service Centers（RCHCs） in Wujiang District.
Methods Primary data related to performance evaluation indicators were collected by literature review and in-depth interview according to the situation of performance evaluation at local 15 RCHCs fro January to May of 2012,and then Delphi method and the analytic hierarchy process (AHP) were used for construction of final evaluation indicator system.
Results A performance evaluation indicator system that is relatively comprehensive and suitable for RCHCs of local developed areas was established,including 4 first-level indicators,13 second-level indicators and 33 third-level indicators.
Conclusion This study can provide the instrument for performance evaluation on local RCHCs,fill the lack of empirical evidence on performance evaluation of RCHCs in rural developed districts,and has a certain significance for reference and evaluation on RCHCs in the similar areas in China.
【Key words】 Community health service；Performance evaluation；Rural areas；Indicator system
Structural Equation Model for Essential Drug Intent in Community Doctor′s Prescribing Behaviour in Guangzhou
WANG Xin，ZHOU Zhi-heng，WANG Jia-ji.School of Public Health，Guangzhou Medical University，Guangzhou 510182，China
【Abstract】 Objective To build a structural equation model describing the community doctors′ behaviour in prescription to apply essential drugs,and analyze the influence of implementing national essential drug system on community doctors′ behaviour of prescription.
Methods The questionnaire survey on knowledge,attitude and practice (KAP) was conducted among 444 community doctors in Guangzhou City about their prescription of essential drugs.The collected primary data were estimated by maximum likelihood and parameter test,and a final structural equation model（SEM）was determined by comprehensive evaluation and necessary modification.
Results Among the 444 participants there were 290(65.32%) who believed that they were very familial with the national essential drug system,and 410 (92.34%) who participated in the training on the relative knowledge of essential drugs once or more.Some 89.19% (396/444) of them were very willing or willing to use essential drugs in their prescription.The analysis of structural equation model showed that the model was of good fitness,the positive factors influencing the prescription behaviour of using essential drugs were training on,cognition and recognition of the essential drugs,and active external factors;while the negative factors were less sorts of essential drugs,and apperception of shortage and substitutability of the essential drugs.
Conclusion The intent of the community doctors′ behaviour to prescribe the essential drugs is high in Guangzhou.And its main influencing factors are their training,cognition,attitude on the essential drugs,and the conditions of essential drug system.It is suggested to further strengthen the propaganda and training of national essential medicine system so as to establish a scientific and economic idea of medication and create a positive policy-environment for prescription.
【Key words】 Essential drug system；Community doctor；Prescribing behaviour；Structural equation model
Operation Situation of A City′s Health Records in Xinjiang Based on Community Health Service Center/Township Hospital
MA Guo-fang， ZHANG Jing， CHEN Shuang-hong.Department of Public Health， Xinjiang Medical University， Urumqi 830011， China
【Abstract】 Objective To analyze the operation situation of health records in 65 community health service centers/township hospitals in a city of Xinjiang through the investigation,so as to scientifically and comprehensively discover and explore the influential factors about the establishment and implementation of health records,and thus to provide a evidence to realize a systematization of implementing health records completely in communities of Xinjiang.
Methods A questionnaire survey about related work of health records was conducted among community health service centers/township hospitals,using descriptive statistical analysis and nonparametric test and other statistical methods for data processing and analysis.
Results The archiving rate（50.9%） and its filing rate for focus population groups（60.0%） were lower in the community health service centers than those（70.4% and 69.3%） in the township hospitals.And in terms of the use of health records， 52.3% of the community health centers/townships hospitals believed it is moderate.As to the enthusiasm of the residents and their cooperation,the cognitive differences between community health service centers and township hospitals showed a statistically significance（P＜0.05）.
Conclusion The rates of archive and utilization of health records based on the community health service centers/township hospitals are moderate in a city of Xinjiang,there are different types of difficulties during the work of the health record.Accordingly the compound measures need to be performed so as to achieve series of the goal of community health records.
Feature of Blood Glucose Excursion in Patients with Nonalcoholic Fatty Liver Disease in Normal Glucose Tolerance
JIANG Tao,SHANG Wen,WEN Zhen,et al.Department of Endocrinology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China
【Abstract】 Objective To use investigate the feature of blood glucose excursions (BGE) in patents with non-alcoholic fatty liver disease (NAFLD) in normal glucose tolerance level (NGT).
Methods A total of 30 employees in Railway Bureau of Beijing who underwent physical checkup in November of 2011 were randomly enrolled.They were divided as NAFLD and impaired glucose tolerance (NAFLD-IGT) group,and NAFLD-NGT group according to their results of oral glucose tolerance test (OGTT),with 15 in each.And 10 concurrent subjects with non-NAFLD and NGT were randomly recruited as the controls.All the subjects were given collection of clinical history,physical examination,routine laboratory tests,and B-ultrasonography.The continuous glucose monitoring system (CGMS) was used to evaluate the glucose levels,and diurnal and daily BGEs.
Results （1）There were significant differences among the three groups in body mass index (BMI),waist circumference（WC）,alanine transaminase（ALT）,aspartate transaminase（AST）,triglyceride（TG）,half-hour and two-hour postprandial blood glucose（0.5 hPG,2 hPG）,two-hour postprandial serum insulin（2 hINS）,and homeostasis model of assessment for insulin resistance index （HOMA-IR）（P＜0.05）.The differences in BMI,WC,ALT,AST,TG,0.5 hPG, 2 hPG,2 hINS,HOMA-IR between the NAFLD-IGT group and control group were statistically significant （P＜0.05）.The differences in AST and 2 hPG between the NAFLD-IGT and NAFLD-NGT groups were statistically significant （P＜0.05）.And the differences in BMI,WC,and TG between the NAFLD-NGT group and control group were statistically significant （P＜0.05）.（2） There were significant differences among the three groups in mean blood glucose (MBG),three-hour post-breakfast blood glucose (3 hPBG),one-hour pre-supper blood glucose (1 hPSG),three-hour post-supper blood glucose (3 hPSG),percentage of time of BG≥7.8 mmol/L (PT7.8),largest amplitude of glycemic excursions(LAGE),mean amplitude of glucose excursions (MAGE),and standard deviation of mean blood glucose fluctuations (SDBG) （P＜0.05）.The differences in MBG,3 hPBG,1 hPSG,3 hPSG,PT7.8,LAGE,MAGE,and SDBG between the NAFLD-IGT group and control group were statistically significant （P＜0.05）.The differences in 1hPSG and 3 hPSG between the NAFLD-IGT and NAFLD-NGT groups were statistically significant （P＜0.05）.And the differences in 3 hPBG and SDBG between the NAFLD-NGT group and control group were statistically significant （P＜0.05）.
Conclusion NAFLD patients have a variety of metabolic disorders.Their levels of BMI,WC,lipids,and blood glucose are higher than those of non-NAFLD patients.NAFLD patients at normal glucose tolerance stage have increased amplitude of glycemic excursions,their levels of SDBG and 3hPBG are higher than those of non-NAFLD patients.
【Key words】 Fatty liver,nonalcoholic;Blood glucose excursion;Continuous glucose monitoring system
QEEG Wave Frequency Differences between Alzheimer′s Disease and Vascular Dementia
XU Qing，XU Wen-wei，ZHANG Yu-qi，et al.Department of Senile Psychiatry,Wuxi Mental Health Center,Wuxi 214151,China
【Abstract】 Objective To explore the differences of QEEG wave frequency between Alzheimer′s disease (AD) and vascular dementia (VD),and the relation between slow / fast wave ratio and cognitive function in patients with AD and VD.
Methods 30 patients with AD,30 patients with VD,and 30 healthy aged people (control group) were measured with QEEG and Visual EEG.Power spectrum was classified into the delta waves (0.8-4.0 Hz),theta waves (4.0-7.8 Hz),alpha waves (7.8-12.8 Hz),and beta waves (13.0-20.0 Hz).Values of (δ+θ)/(α+β) were compared as an evaluation index.The (δ+θ)/(α+β) power ratios and Visual EEG scores of the whole brain,frontal lobe,temporal lobe,parietal lobe,occipital lobe,central lobe,left frontal lobe,left temporal lobe,left parietal lobe,left occipital lobe,left central lobe,right frontal lobe,right temporal lobe,right parietal lobe,right occipital lobe and right central lobe were compared,respectively.Pearson correlation analysis was used to explore the relationship between the mini-mental state evaluation (MMSE) score and the (δ+θ)/(α+β) value of the AD and VD patients.
Results The AD group had higher (δ+θ)/(α+β) value and visual EEG score in the whole brain,the frontal lobe,temporal lobe,parietal lobe,occipital lobe,central lobe,left frontal lobe,left temporal lobe,left parietal lobe,left occipital lobe,left central lobe,right frontal lobe,right temporal lobe,right parietal lobe,right occipital lobe,and right central lobe than the control group (P＜0.05).The VD group had higher (δ+θ)/(α+β) value of the above regions except the right temporal lobe and right central lobe than the control group (P＜0.05).However,no significant difference was observed in visual EEG score between the VD group and the control group (P＞0.05).No significant difference was observed in (δ+θ)/(α+β) value of all the regions between AD and VD group (P＞0.05).The (δ+θ)/(α+β) values of the left regions were higher than the corresponding right regions (except occipital lobe) (P＜0.05).That bilateral difference of (δ+θ)/(α+β) value was not found in the AD group and the control group.The MMSE score and visual EEG score of the AD and VD group was negatively correlated with the (δ+θ)/(α+β) value of the corresponding region (P＜0.05).
Conclusion QEEG is an objective and quantifiable brain function test,and may contribute to early diagnosis,differential diagnosis,and monitoring of AD and VD,as well as evaluation of cognitive function of AD and VD patients.
【Key words】 Alzheimer′s disease；Dementia，vascular；Quantitative electroencephalography；Cognitive function
Early Warning of Low Body Mass Index on Airway Obstruction and Hypercoagulability in Acute Exacerbation of Chronic Obstructive Pulmonary Disease
LI Wei-guo， LIU Hong， WANG Jing.The Second Department of Respiratory， the First Affiliated Hospital of Zhengzhou University， Zhengzhou 450052,China
【Abstract】 Objective To investigate the impact on airway obstruction and prognostivation on hypercoagulability by lower body mass index(BMI) in patients with acute exacerbation of Chronic obstructive pulmonary disease(AECOPD).
Methods Totally 136 AECOPD patients were divided into 3 groups by BMI: underweight, normal and overweight.FEV1%pre, prognostivation/FVC were compared between all three groups.Multiple linear regression method was used to analyze the predictive role of BMI and FEV1%pre on D-dimmer.
Results Among the 136 subjects aged 40 to 87 years of age 106 were male and 30 were female. The values of FEV1/FVC and FEV1%pre were significant higher in overweight and normal patients compared with underweight patients（all P＜0.05）; however, no significant difference was found in FEV1%pre and FEV1/FVC between overweight and normal patients（P＞0.05）.In a multiple linear regression model, BMI was significant predictors of plasma D-dimmer（P＜0.05）.
Conclusion Low BMI can aggravate airway obstruction.BMI has a certain predictive effect on D-dimmer.High BMI is a protective factor for hypercoagulability.
【Key words】 Pulmonary disease，chronic obstructive；Body mass index；Airway obstruction；D-dimer；