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December 2013, Volume 16, No.34 Abstracts

Feasibility Analysis on the Construction of Performance Evaluation System for Community Health Service Units in China

CHEN Quan,HUANG Wei,LEI Xing-yun,et al.Institute of Medical Information,Chinese Academy of Medical Sciences,Beijing 100020,China

    Abstract  The performance evaluation system for community health service units based on information technology is an important tool to increase the service capacity of community health service units and their levels of scientific management,and is also the key to further improve Chinas medical and health system.This paper stated the theoretical feasibility of constructing performance evaluation systems for community health service,and analyzed the current situation and demands on performance evaluation systems based on on-site investigation,and then discussed the operational feasibility of constructing performance evaluation system for community health service units in China.This paper also put forward specific recommendations based on the problems of performance evaluation systems in community health service units.

    Key words  Community health services;Performance evaluation;Information system;Feasibility

 

Construction of Risk-sharing Mechanism for Rural Doctors Practice in China

LIU Lan-qiu,ZHAO Ran.School of Health Administration and EducationCapital Medical UniversityBeijing 100069,China

    Abstract  Objective  To explore the necessity of establishing risk-sharing mechanism for rural doctors practiceand put forth the suggestion on concrete system design.Methods  The cluster sampling method was used to choose 133 rural doctors from 7 townships in Changping District of Beijing.And a questionnaire survey was conducted among them.Results  There were 75.2% 100/133 of the subjects who held that the risk of medical practice was biggerand 90.2% 120/133 of them who were anxious about encountering medical disputes.Some 96.2%128/133 held that a risk-sharing mechanism for rural doctors practice should be establishedthe main found-providers should be diversifiedand the motivation to provide fund was higher in 68.4% 91/133 of them.Conclusion  Establishing a risk-sharing mechanism in rural doctors practicing is urgent.In combination with the integration of policy environment in rural health servicesunder the guidance of the township hospitalsand adhering to the principle of "full coverageclassified treatment"it is necessary to explore a flexibleeffectiveand feasible risk-sharingand improve the mechanism to settle rural medical dispute so as to ensure healthy development of rural health cause.

    Key words  Rural doctorRisk-sharing mechanismsConstruction

 

Appropriate Technology for General Practice in Township Hospital

LIU Dong-ying,HOU Qing-chun,ZHOU Hai-yan.Tianjin Medical College,Tianjin 300222,China

    Abstract  Objective  To developing appropriate technology training for raising the health service abilities in township hospital.Methods  A series of appropriate technologies were selected and used for practical training based on the conditions of baseline investigation,demands for medical training and construction of township hospital.The training result was evaluated in time and investigated after half a year.Results  One hundred percent trainees were satisfied with the majority of the training items.More than 75% of the total training items were demanded by the trainees.The rate of correctively mastering was less than 90% for 3 items of the technologies,and more than 90% for all the rest items of the technologies.Conclusion  The basic levels of knowledge and skills the medical stuff have had,precisely designed plan on training process,and training conditions will influence the training results.

    Key words  Rural healthAppropriate technologyTrainingTownship hospital

 

Intetion of Service Providers to Obstacles in Carrying out Equalization of Basic Public Health Services

LI Hao-hanLI Xiao-hongLV Junet al.Research Institute of Health Development StrategiesFudan UniversityShanghai 200032China

    Abstract  Objective  To investigate the obstacles in carrying out equalization of basic public health services from the view of service providers.Methods  A questionnaire survey was taken among 1 059 persons from the service provide about their evaluation on the obstacles in carrying out 9 programs of services and 2 key projects,and their consent rate of each obstacle in different services.Results  The consent rate for "lack of financing support" was the highest among all projects of services,that for "quantitative shortage of service providers" ranged second in 6 programs of services,and that for "lower coordination of the residents" went second in 5 programs of services (P0.05).The highest consent rate for "lack of financing support" was 80.1%,and the lowest was 55.3%.The highest consent rate for "quantitative shortage of service providers" was 57.0% and the lowest was 34.8%.The highest consent rate for "lower coordination of the residents" was 58.2% and the lowest was 36.9%.Conclusion  It is so far still the most difficult to deal with the "lack of financing support",and the "quantitative shortage of service providers" and "lower coordination of the residents" should also be paid attention.The implementation on equalization of basic public health services concerns provider,demander and manager.So it requires a solution that is objective,systemic and involved all sorts of parties to achieve the aims of equalization of basic public health services.

    Key words  Basic public health serviceEqualizationObstacle

 

Narrow Coverage:The Obstacle of Service Equality of Chronic Disease Prevention and Control

TANG Shu-nv,FANG Ren-fei,XIE Zheng,et al.School of Public HealthPeking University,Beijing 100191,China

    Abstract  Objective  To study the status of chronic disease management in investigated area,and to find the factors impeding the service equalization of chronic disease prevention and control.Methods   Relevant information of chronic disease management in community health service institutions in an east city of China was collected from October to December in 2012.The actual discovery rate and actual management rate of hypertension and diabetes were calculated.Data of the permanent residents of the city who received the community health service was collected to analysis the difference of chronic disease management among communities and different income groups.Results  The numbers of registered hypertension and diabetes in the investigated area increased from 2009 to 2011;but the discovery rates were very low,the discovery rates of hypertension and diabetes were 22.7% and 32.6% respectively in 2011.The actual management rate were also lower,and the actual management rate of hypertension and diabetes were 1.7% and 3.6%,respectively in 2011.There was no significant difference in receiving chronic disease management between the urban-rural integration areas and urban areas (χ2=0.048,P=0.827),but the proportion of receiving chronic disease management was significantly lower in the higher income group than in the lower income group (χ2=33.223P0.001).Conclusion  Income is still an important factor affecting the accessibility of chronic disease management services.Moreover,narrow coverage of chronic disease management,excluding many patients with chronic disease from the chronic disease management services,is a serious obstacle to achieve service equality of chronic disease prevention and control.

    Key words  Basic public health service;Equalization;Chronic disease;Management;Obstacle

 

Evaluation on Utilization of Postpartum Health Service Based on Equalization

YU Zhen-jie,LIU Xiang-yu,LI Xiang-yun,et al.Department of Management,Weifang Medical College,Weifang 261053China

    Abstract  Objective  To investigate the utilization of postpartum health service and evaluate the equity of its utilization.Methods  A total of 2 021 participants from Shandong,Henan and Gansu were selected through multi-stage random sampling from August 2010 to September 2011.Questionnaire covering demographic information,family members,incomes,and the information on the utilization of postpartum health service was administrated.The indicators of postpartum health service included the rates of postpartum care guidance,postpartum visits,postpartum physical examination,and the utilization of their health management cards;and the concentration curve and index were used to do equity evaluation.Results  The rates of postpartum care guidance,7-day postpartum visit,14-day postpartum visit,28-day postpartum visit,42-day postpartum physical examination,and the utilization of their health management cards were 52.75% (1 026/1 945),20.00% (389/1 945),29.77% (579/1 945),23.24%(452/1 945),47.15%(917/1 945),and 35.32%(687/1 945),respectively.The comprehensive utilization rate of postpartum health service were 39.88%.The utilization rates of postpartum health service in urban areas were higher than those in the rural areas(P0.05),and the concentration curves of the utilization of groups with different income and different education levels were all below the absolute equity line.Conclusion  The utilization rate of postpartum health service was low;and inequity existed,in which the utilization rate in women with higher income and higher education level was high.Postpartum health services should be strengthened,and focus more on rural women,especially the low-income and low-education groups.

    Key words  Postpartum health service;EqualizationUtilization

 

Application of Vectorcardiography for Prevention and Treatment of Hypertesive Left Ventricular Hypertrophy in Community

WANG Sheng-pingZHAO LongWANG Kun.The Heart Center of the First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054China

    Abstract  Objective  To explore the diagnostic significance of vectorcardiographyVCG for hypertensive left ventricular hypertrophyLVH and the related risk factorsso as to provide a reference for screening and follow-up of LVH in prevention and control of hypertension in community.Methods  From February 2012 to February 2013 a total of 770 essential hypertension patients in our hospital were examined with ultrasonic cardiogramUCG for measurement of left ventricular mass index as a diagnostic criterion for LVHand the VCG test results of 770 patients were analyzed.Then the relevant factors for diagnosis of LVH with UCG and VCG were analyzed using univariate and multivariate Logistic regression analyses.Results  Taking UCG as the golden criteriathe sensibility of VCG for detection of LVH was 70.94%376/530),the specificity was 74.17%178/240),and the accuracy was 71.95%554/770.The univariante Logistic regression analysis showed than for both VCG and UCG there were 13 screened risk factors to LVH.According to the diagnostic results with VCGthe multivariate Logistic regression analysis revealed 6 independent significant factors including courseregularly taking in the medicinestandard deviation of systolic blood pressurehyperhomocysteinemiathickness of common carotid artery intima-mediaand conduction velocity of ankle-brachial pulsationOR=3.2992.0211.8011.0191.3211.062.Conclusion  The VCG has a high sensibility and no limit in both instruments and operators in screening LVH of hypertension in communityso it is suitable for screening and follow-up of LVH in prevention and control of hypertension in community.

    Key words  VectorcardiographyCommunity preventionHypertensionLeft ventricular hypertrophy

 

Changes of Endothelial Function and the Risk Factors in Persons with Isolated Impaired Fasting Glucose

LV Yi-peiCHE Hong-yingHUANG Wen-pinget al.The Second Peoples Hospital of QinzhouQinzhou 535000China

    Abstract  Objective  To explore the changes of endothelial function and the characteristics of risk factors in persons with isolated impaired fasting glucoseI-IFG.Methods  Based on the diagnosing criteria of obesity set by International Diabetes FederationIDF in 2005 waistline90 cm for males and waistline80 cm for females),60 I-IFG persons were divided as non-obesity subgroupC1 groupn=28 and obesity subgroupC2 groupn=32);while 142 person with normal glucose tolerance were divided as non-obesity subgroupN1 groupn=75 and obesity subgroupN2 groupn=67.Of all the subjects oral glucose tolerance test and insulin release test were measureddetecting blood sugar contents at 0 min10 min20 min30 min60 min and 120 minas well as the contents of immunoreactive insulinat the same timethe parameters of their fasting blood lipidsfree fatty acidsadiponectinhigh-sensitivity C-reactive proteinhs-CRP),serum endothelin-1SET),urine endothelin-1UET and urea-microalbuminMUA were also measured.Their family histories of diabetes were recordedand their blood pressureheight and weight were observed.And the changes of arteria brachialis diameter were tested at restunder the pressure and after medication of glyceryl trinitrate.Results  After adjusting for sex and agethere were significant differences between the CC1 and C2 groups and the NN1 and N2 groups in MUAhs-CRPendothelium-dependent vasodilatationEDD and endothelium-independent vasodilatationEID)(P0.05);and in SET and UETP0.01.There were significant differences between the C2 and the N2 groups in EDDEID and MUAP0.05);and in SET and UETP0.01.And there were significant differences between the C1 and the N1 group only in SET and UETP0.01.The multivariate regression analysis showed that family history of diabetes mellitusobesityblood pressurelipid metabolismblood glucoseand insulin secretion were significant independent predictors for the index of endothelial function.Conclusion  The endothelial changes of macro-vessels and microvessels may found in I-IFG person with obesitybut only endothelial changes of microvessels can be found in I-IFG person with no obesity.The family history of diabetes mellitus and such metabolic factors as obesityraised blood pressuredyslipidemiahyperglycemia and decline of insulin secretion are of independent risk.

    Key words  Impaired fasting glucoseObesityEndothelial functionRisk factorMetabolism

 

Assessment of Early Cognitive Impairment of Patients with First Attack of Small Artery Occlusion

JIANG Cai-xiaZHANG Xin-hongBU Fan-yanet al.Department of NeurologyAffiliated Hospital of Inner Mongolia University for the NationalitiesTongliao 028000China

    Abstract  Objective  To evaluate the early cognitive impairment of patients with first attack of small artery occlusion (SAO).Methods  Totally 82 inpatients with first attack of SAO were enrolled from January 2010 to June 2012 as the subjects,and 55 healthy persons were concurrently recruited as the controls.The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess their cognitive functions.Results  The MMSE score was (28.08±1.12) in the patients and (28.78±1.99) in the controls,with no significant difference (P0.05).But a significant difference in MoCA score between the two groups was found,(16.25±6.08) vs (26.33±1.94) (P0.05).In MoCA,the scores of visuospatial function and executive function,attention and delayed memory showed statistically significant differences between the two groups (P0.05);but no significant difference was found at naming,speech,abstracting,and origination power (P0.05).Conclusion  The SAO patients had some cognitive impairment at the early stage of the disease.MoCA was more sensitive than MMSE in detecting cognitive impairment,was more suitable for screening the SAO patients early cognitive impairment.

    Key words  Small artery occlusion;Cognitive impairment;Mini-mental state examination;Montreal cognitive assessment

 

Correlation between Serum 25-hydroxyvitamin D Level and Early Renal Damage in Patients with Essential Hypertension

CHEN Yu-lan,SUN Li,Zhulepiya·Simayi,et al.Department of Hypertension,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China

    Abstract  Objective  To explore the correlation between serum 25-hydroxyvitamin D level and early renal damage in patients with essential hypertension.Methods  Retrospective study was performed in 280 inpatients diagnosed as having essential hypertension from May 2010 to March 2013.According to the serum 25-hydroxyvitamin D level,all the patients were divided as 25-hydroxyvitamin D deficiency (trial) group (n=174) (serum 25-hydroxyvitamin D20 μg/L) and 25-hydroxyvitamin D sufficiency (control) group (n=106).The clinical data and laboratory test results of the patients were collected and analyzed so as to investigate the correlation between serum 25-hydroxyvitamin D levels and clinical indexes.Results  There were no significant differences between the two groups in gender,age,course of hypertension,fasting blood glucose triglyceride,total cholesterol,average systolic and diastolic blood pressure (P0.05).The average pulse pressure in the trial group was (49±10)mm Hg,being higher than (46±8) mm Hg in the control group (P0.05).No significant differences between the two groups were found in 24-h proteinuria,serum urea,creatinine,uric acid and cystatin C (P0.05).But the value of 24-h urinary microalbumin was 13.8 (3.4,38.2)mg in the trial group,being significantly higher than 9.0 (1.7,19.3)mg in the control group(P0.05).The multiple linear regression analysis showed 25-hydroxyvitamin D level was negatively correlated with 24-h microalbumininurine (r=-0.135P=0.032) and pulse pressure (r=-0.174P=0.004).Conclusion  Serum 25-hydroxyvitamin D deficiency is associated with early renal damage in patients with essential hypertension,especially with impairment of the glomerulus.

    Key words  Hypertension;25-hydroxyvitamin D;Renal damage;Relationship

 

Correlation between Trace Elements and Immune Functions in Children with Severe Bronchiolitis

LIAO Chuan-sheng,CHAI Wan-xin,ZENG Lu-fei,et al.Department of Pediatrics,He Xian Memorial Hospital Affiliated to Southern Medical University,Guangzhou 511400,China

    Abstract  Objective  To detect the levels of trace elements and humoral and cellular immune functions in children with severe bronchiolitis in order to understand whether there is a trace element deficiency and immune dysfunction,and to analyze the correlation between trace elements and immune functions.Methods  A total of 68 children inpatients with severe bronchiolitis,from January 2010 to January 2013,were chosen as trial group,and 60 healthy children in child care examination were concurrently recruited as control group.The parameters of trace elements and immune functions were assyed and the correlation between the two kinds of indexes was analyzed.Results  The serum levels of copper,zinc,iron,calcium of the trial group were lower than those of the control group,and so were the IgA,IgG,C3,as well as CD8;but CD4/CD8 was higher in the trial group than that in the control group,with statistically significant differences (P0.05).For the children with severe bronchiolitis the serum zinc level was positively correlated with level of IgA (r=0.85,P0.05) and IgG and (r=0.98,P0.05),respectively;the serum iron level was positively correlated with IgA (r=0.92,P0.05).Conclusion  Children with severe bronchiolitis have trace elements deficiency and humoral immunity and cellular immune dysfunctions,their low humoral immune function is associated with the lack of trace elements zinc and iron.These findings provide a theoretical basis for clinical treatment of severe bronchiolitis by supplementation of zinc and iron preparation and application of immunoglobulin therapy.

    Key words  Bronchiolitis;Child;Trace element;Immunoglobulin;T-lymphocyte subset;Correlation

 

Quality of Life in Surgical Treatment of Refractory Ulcerative Colitis

YANG Fu-na,HAN Hong-qiu,LIU Gang,et al.Department of General Surgery,Tianjin Medical University General Hospital,Tianjin 300052,China

    Abstract  Objective  To evaluate the effects of two-stage restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) on quality of life(QoL) in patients with refractory ulcerative colitis (UC).Methods  40 patients with refractory UC,who met the inclusion criteria and underwent RP-IPAA surgery between September 2008 and March 2012,were included in our study.The Chinese version of the Inflammatory Bowel Disease Quality of Life Questionnaire (IBDQ) survey was administrated before the first stage of RP-IPAA,before the second stage of ileostomy closure,and 12 months after ileostomy closure,respectively.The effects of the surgery on QoL were analysed,and data were compared with the reference values of 40 healthy people.Results  Before the first stage of RP-IPAA,the scores of the overall QoL and its four dimensions in refractory UC patients were significantly lower than those of the healthy people (P0.01).Before the second stage of ileostomy closure,no significant difference between the patients and the healthy population was noted in intestinal symptoms,constitutional symptoms and emotional capaci


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