November 2013, Volume 16, No.31 Abstracts

 Performance Evaluation Index System for Implementation of Essential Drug System in Community Health Service Institutions

ZHANG Li-fang,JIA Yan,ZHANG Yan-chun,et al.National Health Development Research Center,Beijing 100191,China

    Abstract  Objective  To work out a more scientific and rational performance evaluation index system for implementation of essential drug system in community health service institutions.Methods  Delphi method was used for the establishment of the index system through three rounds of experts consultations,and fuzzy comprehensive evaluation method was used for confirming weights of indexes.Results  The positive coefficients of the three rounds consultations were 100%(10/10),90%(18/20) and 85%(17/20),respectively,which showed that the experts were willing to participate in this research.The means of authority modulus of the 1st,2nd and 3rd indexes were 0.75,0.76 and 0.76,respectively,which showed that the consultation results were reliable.The harmonious coefficients of second-round and third-round were 0.489 and 0.487 respectively (P=0.000),which showed that the expert opinions were highly consistent.The performance evaluation index system consisted of 3 first-leveled indexes,9 second-leveled indexes and 21 third-leveled indexes.Conclusion  The selected experts were representative,the consultation results were reliable,the construction of the evaluation index system was rational,and the setting of weights was scientific.

    Key words  Community health service institution;Essential drug system;Performance evaluation index system


Performance Evaluation of Employees in Community Health Service Center

WANG Zhao-wei,OUYANG Jian-ying,WANG Hai-wen,et al.Daliang Community Health Service Center in Shunde DistrictFoshan 528300,China

    Abstract  Objective  To analyze the implementation process of employee performance evaluation system in Daliang community health service center in Shunde district,and explore the employee incentive mechanism and the way to fire the employees enthusiasm.Methods  The employee performance evaluation system was designed with the principles of "duty based on the position,quantity based on duty,performance based on the quantity,and payment based on the performance".The employees performance was evaluated from three aspects including the quantity of their work,the service quality and patients satisfaction;and they were paid based on their performance.Results  Since the implementation of the performance evaluation system,the quantity,quality and residents satisfaction level of basic medical services and public health services in Daliang district had improved steadily.With its standardized and efficient services and outstanding performance in the two consecutive years,Daliang community health center was approved as the model of community health center in Guangdong province in 2012.Conclusion  The scientific and feasible performance evaluation system can fully motivate the employees,improve the efficiency and quality of the services,and promote the development of both the health service center and the employees.

    Key words  Performance appraisal;Community health service;Basic medical care;Public health;Performance-based remuneration allocation


Competency Model of General Practitioners:An Exploratory Factor Analysis

JIN Li-jiaoJIA Ying-leiSUN Taoet al.School of Public Health,Harbin Medical University,Harbin 150081,China

    Abstract  Objective  To explore the competence elements of general practitioners (GPs) and build a competency model.Methods  Through literature review,the analyses of GPs work,and semi-structured interviews,GP competence questionnaire was designed in April 2012.A questionnaire survey was conducted among GPs in five cities of a province.The competence elements were extracted with principal component analysis (PCA).Results  The Cronbachs  of the questionnaire was 0.93.GP competency model included 6 factors:the capability of basic public health services,the capability of comprehensive management,occupational responsibility,the capability of basic medical services,high moral values,and interpersonal communication skills.Conclusion  The GP competency model could provide some evidence in GP selection and their performance evaluation and management,and also guide the GPs education and training.

    Key words  General practitionersExploratory factor analysisCompetency model


Review of Policy on Basic Public Health Equality in Chinas New Health System Reform

XIE Zheng,LUO Xiu,JIAN Wei-yan.School of Public Health,Peking University,Beijing 100191,China

    Abstract  The review summarizes the ideology,institutional arrangements,policy measurements in governments at different levels,and the imperfectness of the policy on basic public health equality in the new round of health system reform in China.We concluded that though remarkable improvement had made in public health service equality,there were still many challenges to achieve the goal of universal health coverage by 2020.To achieve the goal,Chinese government should put more emphasis on reducing the health disparities across different regions and different social classes,increasing the service capacity of health institutions and health personnel,and improving the quality and efficiency of public health services.

    Key words  Basic public health services;Equalization;Health system reform


Social Factors Impacting Health Education Service Equalization

LI Tong-tong,HAN Jing,WU Zhi-jun,et al.School of Public Health,Peking University,Beijing 100191,China

    Abstract  Objective  To learn the status of residents in Beijing in receiving equal health education services provided by community health service institutions so as to explore the social factors impacting the equalization of health education service.Methods  A stratified random sampling method was conducted to select 8 community health service centers(CHSCs) from Beijing,and convenience sampling was used to choose 50-90 residents from each of the 8 CHSCs.Among these people a self-design questionnaire survey was conducted in November 2012 about their social demographical feature,reception of health education,type of accepted health education service,and satisfaction on reception of health education.Logistic regression was used to analyze the influence of such social factors as household register,employment situation,education level,and income on the equalization of health education service.Results  The retrieving rate of eligible questionnaire was 99.4%(633/637).Among the 633 respondents 54.0%(342/633) had accepted health education from the CHSC and the contents of education were mainly about healthy lifestyle,accounting for 48.2%(305/633).The percentage of respondents who received health education service for locally-registered urban residents was 1.880 times that for non-locally-registered residents after controlling age,gender and distance for getting services,and the percentage for retirees was 1.998 times that for the unemployed,with a significant difference(P0.05).There was no significant difference in satisfaction on heath education service among residents with different household registrations,employment situations,education levels,and average monthly income per capita of family(P0.05).Conclusion  The equalization of community health education has primarily improved,but the type of household registration and employment situation are still the important factors influencing the realization of equality.

    Key words  Community health services;Health education;Equalization;Social factors


Status of Financially Equalized Investments of Basic Public Health Services and Its Countermeasures

WU Hai-fengHE PingLI Xue-pinget al.Chongqing Medical and Pharmaceutical CollegeChongqing 401331China

    Abstract  Objective  To analyze the status of financial investments in Chongqing for basic public health services,existing problems and their reasons so as to put forward countermeasures and suggestions from the standpoint of financial equalization.Methods  The methods of literature review,field investigation,and expert interview were used to learn the present situation of financial investments in Chongqing for basic public health services in Chongqing and the existing problems.Results  In 2009 the proportion of cost for basic public health services accounted for 34.65% over public health services,and only for 5.16% over the total health input of health,the average per capita cost for basic public health services was RMB 15.00 yuan.In 2010 the proportion of cost for basic public health services accounted for 29.36% over public health services,and only for 4.26% over the total health input of health,the average per capita cost for basic public health services in Chongqing was RMB 15.68 yuan.In 2009,in South-East and North-East parts of Chongqing where the majority of population were rural residents,the numbers of health technicians per thousand permanent residents were 3.20 and 2.71,respectively,and the numbers of assistant residents or residents were 1.49 and 1.25,respectively;while in the economically developed downtown,the corresponding numbers were 5.39 and 2.21,respectively.In 2010 the average per capita cost of basic public health service was RMB 17.78 yuan in the 9 districts of downtown,while the number was only RMB 15.00 Yuan in South-East and North-East parts of Chongqing.Conclusion  The average per capita fund of basic public health services is lower,the amount of total investment is short,and the slower increase of basic public health fund is not consistent with the increasing amplitude of total health input.It is not equal in basic health services between urban and rural areas,in health input among different counties or districts.There is a condition in which treatment is paid more attention than prevention.The mechanism of performance evaluation in basic health services needs to be improved.The application efficacy of financial found remains to be raised.It is necessary to improve the mechanism for ensuring adequate funding for basic public health services,financial system,and transfer payment system;to build up a pro-poor transfer payment system;to increase the investment for rural public health services and improve its service system;and to strengthen the performance evaluation,with a purpose of ensuring the efficacy of the financial input for basic public health services.

    Key words  Basic public health serviceEqualizationFinancial investmentCountermeasure


Value of Vascular Endothelial Function and Homocysteine in Prediction of Coronary Heart Disease

DENG Yuan-qiong,ZHANG Zhi-juan,LI Hong-xiang,et al.Department of Functions,the Fourth Affiliated Hospital of Nanchang University,Nanchang 330003,China

    Abstract  Objective  To investigate the relationships of vascular endothelial function and Homocysteine (Hcy) with coronary heart disease.Methods  A total of 177 patients with suspected or confirmed coronary heart disease (CHD) undergoing coronary angiography in our hospital between 2011 and 2012 were included in this study.Those patients with positive result were classified as CHD group (n=95),and those with negative results were classified as the control group (n=82).Based on the vessel number of coronary lesions,the CHD group was divided into single-vessel disease subgroup and multi-vessel disease subgroup.The brachial artery flow-mediated dilation (FMD) and carotid intima-media thickness (IMT) were measured with Color Doppler,and serum Hcy level was determined with enzymatic cycling assay.Results  The FMD(%) was significantly lower in CHD group than in the control group (P0.01);and the Hcy level and the carotid IMT in CHD group were significantly higher than those in the control group (P0.01).The FMD in multi-vessel disease subgroup was significantly lower than that in single-vessel disease subgroup (P0.01);while the Hcy level and carotid IMT were significantly higher in the multi-vessel disease subgroup than in the single-vessel disease group (P0.01).In CHD group,FMD was negatively correlated with serum Hcy level and carotid IMT (r=-0.76,-0.56;P0.01);and the serum Hcy level was positively correlated with carotid IMT (r=0.62,P0.01).Conclusion  Vascular endothelial dysfunction,hyperhomocysteinemia,and carotid IMT thickening are the risk factors of coronary heart disease.Endothelial dysfunction may indicate atherosclerosis caused by hyperhomocysteinemia,which is valuable in the early detection,prevention and treatment of coronary heart disease and can also serve as an indicator in monitoring and evaluating the disease progress.

    Key words  Coronary disease;High-resolution ultrasound;Endothelial function;Homocysteine


Correlation between Delirium and White Matter Change in Elderly Patients

HUANG Jian-long,LV Xiang-xiong,ZHOU Ling,et al.Zhejiang Xiaoshan Hospital,Hangzhou 311201,China

    Abstract  Objective  To investigate the relationship between delirium and white matter changes in the elderly patients.Methods  A total of 40 elderly patients with delirium treated in our hospital between January 2010 and October 2012 were included in our study.And 40 patients aged 65 years or above without delirium admitted in our hospital during the same period were recruited as the control group.Based on MRI imaging,the white matter changes in 10 encephalic regions were evaluated with age-related white matter changes rating scale (WMLs) and compared between the delirium group and the control group.The correlation between the factors of delirium rating scale-98 revised version (DRS-R-98) and the whiter matter changes were analyzed in the delirium group.Results  There was significant difference in the WMLs scores of the left and right frontal regions,the left and right parietal-occipital regions,and the left and right basal ganglia between the delirium group and the control group (P0.05).The scores of short-term memory,visual-spatial ability,and attention were significantly positively correlated with the WMLs scores of the left and right frontal regions,the left and right parietal-occipital regions,and the left and right basal ganglia (P0.05).The scores of sleep - wake cycle disorders,perception disorders,emotional lability,and disorientation were positively correlated with the WMLs scores of the left and right frontal regions and the left and right parietal-occipital regions (P0.05),but not correlated with the WMLs scores of the left and right basal ganglia (P0.05).And the scores of the process of thinking,psychomotor agitation,and long-term memory were positively correlated only with the WMLs scores of the left and right basal ganglia (P0.05).Conclusion  Delirium in elderly patients is correlated with white matter changes,especially the changes in the left and right frontal regions,the left and right occipital regions,and the left and right basal ganglia.The occurrence of delirium in elderly patients could be predicted by the white matter changes,which is valuable in its prevention.

    Key words  Delirium;White matter;Relativity


Relationship between Insulin Resistance and Plasma Fibrinogen in Adult with Simple Obesity

ZHENG Qing,HUANG Jiao-zhen,LI Guo-dong,et al.Department of Laboratory,Haikou Peoples Hospital,Haikou 570208,China

    Abstract  Objective  To explore the relationships of plasma fibrinogen (FIB) with insulin resistance(IR) and blood lipid levels in adults with simple obesity.Methods  Seventy-eight adults with simple obesity treated in our hospital between September 2012 and March 2013 were included in this study,which were divided into three groups according to the body mass index (BMI),including Class I obesity group(n=34),Class II obesity group (n=30),and Class III obesity group (n=14).And 35 adults with simple overweight and 67 healthy adults visiting our hospital during the same period were enrolled as the control groups.The height,weight,waistline,hip circumference,fasting blood glucose (FBG) level,fasting insulin (FIN) level,blood lipid levels,and FIB level were tested,and the body mass index (BMI),waist-to-hip ratio (WHR),and IR index (HOMA-IR) were calculated.Results  With the increase of BMI,the levels of FIB,HOMA-IR,FBG,FIN,triglyceride(TG),cholesterol(TC),low density lipoprotein- cholesterol (LDL-C) increased gradually,while the level of high density lipoprotein-cholesterol (HDL-C) decreased gradually.FIB was significantly positively correlated with BMI,WRH,FBG,FIN,HOMA-IR,TC,TG,and LDL-C (P0.01),and negatively correlated with HDL-C (P0.01).Multiple stepwise regression analyses indicated that BMI and TG were the independent risk factors of FIB;and FIB,BMI,FBG,FIN,and LDL-C were the independent risk factors of HOMA-IR.Conclusion  The levels of IR and blood lipids are abnormal in adult with simple obesity,which might be due to the overexpression of FIB.

    Key words  Simple obesity;Fibrinogen;Insulin resistance;Blood lipid


Influence of Bisoprolol on Brain Natriuretic Peptide and Left Ventricular Diastolic Function in Patients with Type 2 Diabetes and Left Ventricular Diastolic Dysfunction

YANG Yan-hua,HUANG Qing-ning,YE Jian-feng,et al.Department of Cardiovascular,Peoples Hospital,Dongguan 523000,China

    Abstract  Objective  To investigate the changes of brain natriuretic peptide(BNP) and left ventricular diastolic function(LVDF) after medication of Bisoprolol in patients with type 2 diabetes mellitus(T2DM) and left ventricular diastolic dysfunction. Methods  A total of 100 T2DM patients(BNP100 pg/ml,heart rate70 /min,aged 35-75) were enrolled.They were assigned to trial and control groups,with 50 in each.All the patients were conventionally given hypoglycemic agents.The patients in the trial group were additionally given Bisoprolol,orally,initial dose of 2.5-5 mg,adjusted once a week,and 2 weeks later adjusted once a month,1.25-2.5 mg for each adjustment,so that to keep the target heart rate being 60-65 /min.After 1 year follow up,the parameters between the two groups were compared in BNP,left ventricular ejection fraction(EF),ratio of peak of early diastolic and advanced diastolic mitral flow velocities(E/A),left atrial end-systolic volume index(LAVI),and rate of new cardiovascular events were measured. Results  After 1 year follow up,no significant difference in levels of BNP,EF and E/A between two groups was found(P0.05).The values of LAVI and heart rate were(17.9±2.6) ml/m2 and(62±4)/min in the trial group,being significantly lower than(20.0±4.6) ml/m2 and(81±7)/min(P0.05) in the control group.There were in the control group 2 cases of heart failure syndromes(0 case in the trial),3 cases of newly diagnosed hypertension(1 in the trial),1 case of newly diagnosed coronary heart disease(1 in the trial),and no death case occurred in both groups(P0.05).Conclusion  One year medication of Bisoprolol can significantly lower LAVI in patients with type 2 diabetes and left ventricular diastolic dysfunction,and improve the left ventricular diastolic function.

    Key words  Diabetes mellitustype 2;Left ventricular diastolic dysfunction;Bisoprolol;Brain natriuretic peptide


Association of Serum HIF-1α Level with Type 2 Diabetic Nephropathy

LIU Yun-taoJIAN LeiLI Jian-wei.Department of EndocrinologyRenhe Hospital of China Three Gorges UniversityYichang 443000China

    Abstract  Objective  To explore the correlation between serum hypoxia-inducible factor-1α (HIF-1α) and nephropathy of type 2 diabetes mellitus.Methods  A total of 45 patients with simple type 2 diabetes mellitus (SDM group),44 patients with early-staged diabetic nephropathy (EDN group) and 43 patients with clinical diabetic nephropathy (CDN group) were enrolled,with 46 healthy people selected in health care examination as the controls (NC group).ELISA was used to determine 1α hypoxia-inducible factor-1α (HIF-1α),and the parameters of blood lipid,renal function,urinary albumin excretion rate (UAER),insulin-like growth factor-1 (IGF-1),glycosylated hemoglobin A1c (HbA1c),fasting plasma glucose (FPG),and high-sensitive C-reactive protein (hs-CRP) were measured.Results  The serum HIF-1α levels of four groups were in an order of NC group 187±52ng/L SDM group 214±56ng/L EDN group256±63ng/L CDN group289±66ng/L,with significant difference (P0.05).The serum HIF-1α levels were positively correlated with FPG,HbA1c,IGF-1,hs-CRP,urinary albumin excretion rate (UAER),serum creatinine (SCr),vascular endothelial growth factor (VEGF),and course of disease r=0.5170.4970.5380.4560.5790.5250.5020.556),and negatively correlated with superoxide dismutase (SOD) r=-0.551.Multiple linear regression analysis showed that HbA1c,SOD,HIF-1α,and VEGF were the main factors of UAER.Conclusion  Serum HIF-1α level is associated with severity of type 2 diabetic nephropathy,HIF-1α plays a very important role in type 2 diabetic nephropathy.

    Key words  Diabetes mellitustype 2Hypoxia-inducible factor-1α;Diabetic nephropathy


Correlation between Carotid Plaque Type and Visfatin in Patients with Acute Cerebral Infarction

DU Ai-lingZHAO Hai-gangLU Honget al.Neurology Department of the Second Affiliated HospitalXinxiang Medical UniversityXinxiang 453002China

    Abstract  Objective  To investigate the relationship between carotid artery plaque of different characteristics and visfatin in patients with cerebral infarction,and to explore the action of visfatin in atherosclerosis and the development of cerebral infarction.Methods  Totally 113 patients with acute cerebral infarction and 31 healthy persons were enrolled.According to the characteristics of carotid artery ultra-sonography the patients were sub-divided as no-plaque (NP) (n=39),stable plaque (SP) (n=34) and variable plaque (VP) (n=40) groups.The serum visfatin levels of all the subjects were measured with ELISA within 48 hours of onset and the 14th day,and the correlation between visfatin and carotid artery plaque was analyzed.Results  The serum level of visfatin within 48 hours of onset was significantly higher in the VP group than those in the rest 3 groups (P0.05),and the visfatin level was higher in the SP group than those in the NP and control groups,and the 14th day was significantly higher than NP and control groups(P0.01).The serum visfatin level was correlated positively with the body mass index (r=0.190) and the level of fasting blood glucose (r=0.215).Conclusion  Visfatin may play a critical role in the development of carotid atherosclerosisplaque and cerebral infarction.

    Key words  VisfatinAtherosclerosis plaqueAcute cerebral infarction


Correlation between Bacterial Infection and Blood Gas Analysis in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease

FENG Min,JI Ying-qun,ZHANG Zhong-he.Department of Respiratory,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China

    Abstract  Objective  To investigate the distributive characteristic of strains isolated from the sputum of patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD),and to study its correlation with arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2) of the patients,so as to guide the clinical treatment of empirical anti-infection.Methods  Among all the 214 AECOPD inpatients admitted,from Dec 2008 to Mar 2010,in the Department of Pulmonary Medicine,the First Hospital of Dalian Medical University,there were 184 patients from whom the qualified sputum specimens were collected for conventional culture and identification of bacteria.PaO2 and PaCO2 level of these patients were simultaneously tested.Results  A total of 56 trains of bacteria were isolated from the 184 sputum specimens,the positivity rate of sputum culture was 30.4%.Among them 34 strains (60.7%) isolated were Gram-negative bacilli,including 16 strains (28.6%) of non-fermenter bacilli;8 (14.3%) were Gram-positive cocci;and 14 (25.0%) were fungi.The level of PaO2 in the positivity group of sputum culture was (63±25) mm Hg,being lower than (74±18) mm Hg in the negativity group (P0.05);but the level of PaCO2 in the positivity group was (60±19) mm Hg,being higher than (48±14) mm Hg in the negativity group (P0.05).The ratio of mechanical ventilation in the positivity group was 28.6% (16/56),being significantly higher than 6.2%(8/128) in the negativity group (P0.05).Conclusion  Pathogens of inpatients with AECOPD are mainly Gram-negative bacilli in our area.The dysfunction of pulmonary ventilation in patients with positivity of sputum culture is more serious.

    Key words  Pulmonary disease,chronic obstructive;Sputum;Pathogen;Blood gas analysis;Correlation


Effects of Citalopram and Venlafaxine on Pain Perception Threshold in Patients with Depressive Disorder

SUN Ji-junZHU Chun-yanSUN Yu-yonget al.The Seventh Peoples Hospital of HangzhouHangzhou 310000China

    Abstract  Objective  To explore the effects of new antidepressants Citalopram and Venlafaxine on electrical pain perception threshold PPT in patients with depression disorder.Methods  Totally 67 depressive patients were randomly divided into two groups treated with Citalopram and Venlafaxine respectively for 4 weeks.The parameters of somatosensory perception thresholdSPT,PPT and Hamilton Depression Rating Scale-17 items (HAMD-17) were measured for the patients before and after the treatment and the results were contrasted with those of 35 health controls.Results  Before the treatmentcompared with controlsthe SPT levels were significantly higher in both Citalopram and Venlafaxine groupP0.05),and the PPT levels were significantly higher in both groupsP0.05.After the treatmentthe SPT levels showed no significant difference among the three groupsP0.05,but the PPT levels showed significant difference among the three groupsP0.05.The change percentage of PPT level was higher in Citalopram grouip than than in Venlafaxine group〔(15.76±11.19% vs.10.14±10.64%,Z=-2.784,P=0.005,but no significant difference was found in change percentage of SPT level between the two groups〔(9.59±26.43% vs.6.48±22.77%,Z=-1.367,P=0.172.Conclusion  Depressive


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