February 2014, Volume 17, No.4 Abstracts

Construction of Core Competency Evaluation Index System for General Practitioner

ZHU Shun,DONG Hai-na,WANG Wei-jie.Lishui University,Lishui 323000,China

    Abstract  Objective  To construct a core competency evaluation index system for general practitioner(GP) to guide the training and competency evaluation of GP.Methods  Literature review and focus group discussion were used to formulate the primary framework of the core competency evaluation index system.Fifteen experts were consulted applying two-round Delphi method.The weight of each indicator was determined through hierarchy analysis.Results  The valid response rates of two rounds were 86.7% and 100.0%,respectively.The authority coefficient of the experts,familiarity degree and coefficient of determination were0.70,respectively.The concordance coefficients of the first-class indicators and the second-class indicators were 0.486 and 0.655,respectively (P0.05).The index system consisted of 6 first-class indicators and 36 second-class indicators.The weights of the 6 first-class indicators were 0.162 5 for ability to solve specific clinical problems,0.186 7 for patient-centered care,0.275 0 for primary care management,0.115 8 for ability of system-based practice,0.146 5  for professional capability,and 0.113 5 for ability to learn and develop their skills based on the practice.Conclusion  The core competency evaluation index system developed in this study could evaluate the GP's competency systematically and scientifically.

    Key words  General practitioner;Core competency;Evaluation;Index system


Implementation of Performance Pay in Primary Health Care Institutions

CHEN Lie-ping,LIN Ying-tao,XU Xu-liang,et al.School of Public Health,Fujian Medical University,Fuzhou 350004,China

    Abstract  Objective  To describe the status of implementation of performance pay in primary health care institutions,and explore its influencing factors.Methods  A questionnaire survey was conducted among 175 medical personnel in Xianyou,Fuding and Jianyang counties,and then,a semi-structured interview was performed for 39 of them.Results  There were 172 persons (98.3%) who known the policy of performance pay,and 143 (81.7%) who supported the implementation of the policy.After the implementation of performance pay there were 115 persons (65.7%) who said their income got increased,and 86 (49.2%) who expressed that their working enthusiasm was improved;however there were 68 (38.9%) who believed that the allocation of performance pay was unreasonable,allowance was reduced and the salary of supernumerary staff had not been guaranteed.Conclusion  It is necessary to improve the system of performance pay in improving financial security mechanisms for stable increase of salary,promoting the incentive of performance pay,increasing the wage and welfare of supernumerary staff,and strengthening the favorable policy for medical personnel to go to work with primary health care institutions.

    Key words  Primary health care institutionPerformance payImplementation


Michael Porter Diamond Model-based Analysis of Research and Education Outreach in Community Health Service Centers

SONG Hui-jiang,YANG Li-ping,ZHUANG Kang-lu,et al.Pudong New Area Sanlin Community Health Service Center,Shanghai 200124,China

    Abstract  "Fully relying on science and technology advances and education" has become one of the five policies guiding the health service development in the new era in China.The community health service centers (CHSCs),as the primary providers of health services in China,have been struggling in research and education.Outreach has emerged as an innovative approach to promote health-related research and education in communities.In the past few years,our center has devoted significant efforts to the research and education outreach program and has made encouraging progress.In this paper,we aim to utilize the Michael Porter diamond Model to analyze the past accomplishments from the following six aspects:major components of the research and education outreach program,required conditions,performances of the program-associated enterprises and supporting industries,operation strategies,infrastructure and rivalry,government policies and chances.It is highly anticipated that findings from this analysis would lay some solid foundations for improving the current research and education outreach program in communities.

    Key words  Michael Porter diamond model;Community health services;Outreach of research and education


Evaluation of the Service Capacity of Village Clinics Based on the Close-value Method

ZHOU Wei,NIU Wen-ke,YUAN Zhao-kang.Shaoxing Center for Disease Control and Prevention,Shaoxing 312071China

    Abstract  Objective  To evaluate the service capacity of village clinics of 11 cities in Jiangxi.Methods  The data was collected by census.The service capacity was evaluated by the close-value method,and the evaluation indicator system was established through literature review,group discussion and expert consultation.Results  The evaluation indicator system included 5 first-level indicators and 15 second-level indicators.The Ci value of the service capacity of village clinics of 11 cities from small to large was Yingtan0.000 0,Ji'an0.223 5,Ganzhou0.545 2,Pingxiang0.554 6,Xinyu0.577 2,Yichun0.889 0,Shangrao0.926 6,Jingdezhen1.073 4,Jiujiang1.395 1,Fuzhou1.477 9 and Nanchang1.760 1.Conclusion  The service capacity of village clinics of Yingtan,Ji'an and Ganzhou was better,while the service capacity of village clinics of Nanchang,Fuzhou and Jiujiang was poorer.

    Key words  Evaluation;Service capacity;Village clinics;Close-value method


The Status Quo and Influencing Factors of Basic Public Health Services at Village Level in Jiangsu Province

ZHU Li-Guo,WANG Qi,SONG Li,et al.Jiangsu Province Center for Disease Control and Prevention,Nanjing 210009,China

    Abstract  Objective  The purpose of this study was to investigate the status quo and influencing factors of basic public health services at village level in rural areas in Jiangsu Province.Methods  A cross-sectional survey was conducted in 289 villages in six counties of Jiangsu Province between November and December,2012.Data on 11variables related to the implementation of basic public health services were collected and analyzed.Results  The actual population receiving the village-level services was 1.06 times the number of residents in the surveyed areas.Reform aiming at establishing a responsibility- and performance-dependent salary system had been implemented in 80 (29.3%) of the 273villages that responded to the survey question related to this issue.Infant health management was implemented in 191 (73.7%) of the 259 villages that responded to the survey question related to this issue.Follow-up of patients with type 2 diabetes was implemented in 260 (94.5%) of the responding 275 vilages.Digital archiving of health records was accomplished in 59.5% of the residents in the areas surveyed.The percentage of of residents whose health records were archived and the number of notice for vaccination distributed were higher in Liyang and Danyang counties,in areas with an actual service population 3 850 and in areas with a subsidiary support more than 1.56 per year.The record archiving rate was lower in villages where there was a lack of certified physicians.The number of vaccination notice distributed was higher in villages higher average annual household incomes.The implementation rate of infant health management was higher in villages where salary system reform was implemented.Conclusion  Currently,there is a big variation in the extent by which various projects of village-level health services are implemented in different areas in Jiangsu Province.To ensure project subsidiary funds in place,to strengthen primary healthcare team development,and to further implement salary reform should be considered as urgent measures to promote and improve the basic public health services at village levels.

    Key words  Basic public health servicesVillagesStatus quoInfluencing factors


Performance of Township Hospitals in Xinjiang

Gulibahaer·kaderXU Pei-lanAihemaiti·yisakeet al.College of Public Health of Xinjiang Medical University,Urumqi 830011,China

    Abstract  Objective  To evaluate the performance of township hospitals and to analyze the factors influencing the performance in Xinjiang,aiming at providing a scientific basis for government policymaking in the future.Methods  A total of 205 township hospital presidents and County Public Health Bureau directors were randomly selected from the president/director trainees who participated in the "Township Hospital President Training Program" between May,2012 and June,2013.A questionnaire survey was administered to all selected presidents and directors and personal interviews were conducted with township hospital presidents from 18 counties.Results  The basic medical services were delivered to 68.9% of the areas represented by the surveyed hospital presidents and bureau directors while the specialized medical service coverage in these areas was only 29.9%.In over 80% of these areas,resident health record archiving,physical examination,vaccination and strategic planning of management of emergency events of public health matters had been conducted.In over 70% of these areas,promotion of the public health education,management and control of chronic and infectious diseases,and health care of particular population groups had been done.60.8%,63.5% and 77.9% of these areas respectively,public health surveillance,environmental health surveillance,and health information management had been implemented.Conclusion  Some of the township hospitals in Xinjiang do not provide services as required.In these townships,the implementation rate of required programs remains low,and quality control of drinking water and food and environmental inspection and surveillance should be intensified.Increasing capital investment and the number of healthcare staff,and improving the staff professional skills are among the important measures to improve the functional performance of the township hospitals in Xinjiang.

    Key words  Township hospitals;Functions;Xinjiang


Clinical Features and Prognosis of Pediatric Patients with Severe Hand,Foot and Mouth Disease

FU Si-mao,LUO Xu-feng,WEN Xiao-li,et al.Department of Pediatrics,Boai Hospital of Zhongshan City,Zhongshan 528400,China

    Abstract  Objective  To study the clinical features,treatment outcome and prognosis of critically ill pediatric patients with hand,foot and mouth disease.Methods  A total of 17 children with stage-4 hand,foot,and mouth disease were admitted and treated in our department between May 2010 and June 2011.Clinical features,treatment outcomes and prognosis were analyzed.Results   The 17 patients aged (19.8±11.1) months.They were admitted (3.2±0.8) days after the onset of the underlying disease.Enterovirus 71 (EV71) infected was detected in 15 cases,and coxsackievirus A16 infection in the remaining 2 cases.Six cases were cranial MRI-positive,2 cranial CT-positive,2 spinal MRI-positive,and 14 auditory brainstem response-positive.Treatment with globulin and methyl prednisolone was effective in immune support,blood pressure and blood sugar control,and homeostatic maintenance of microenvironment.Five patients lost contact after their parents decided to give up treatment,respectively,on hospitalization day 1,3,7,30 and 50.When discharged,4 patients were completely cured,3 with legacy strabismus (abducent nerve damage),2 with facial paralysis (facial nerve injury),2 with swallowing dysfunction (glossopharyngeal nerve injury),and 4 with physical activity impairment.One patient required continuous mechanical ventilation even after 30 days of treatment and was treated to a superior hospital.At one year postdischarge,the patients with swallowing dysfunction and abducens nerve damage respectively fully recovered.Of the 2 patients with facial nerve injury,one fully recovered,but the other was still experiencing difficulty in closing eyes.At 2 years postdischarge,one patient still had physical activity impairment and was transferred to a superior hospital.Conclusion  EV71 infection is common in the most severe form of hand,foot and mouth disease.The condition develops and progresses fast,and most commonly affects 1.5 year-old children.The long-term prognosis is good after comprehensive integrated treatments.

    Key words  Severe hand,foot and mouth disease;Clinical features;Follow-up results studies


Impact of Visual Impairment Social Support on the Quality of Life in Elderly Population

SHAO Yu-hong,CHEN Xiao,ZHAO Hai-lan,et al.Ophthalmology,Zhejiang Provincial People's Hospital,Hengzhou 310000,China

    Abstract  Objective  To investigate the prevalence and etiology of visual impairment in the elderly population and to evaluate the impact of the visual impairment and social support on the health-related quality of life (QOL) in the affected individuals.Methods  This study enrolled 2 111 elderly (70 years) subjects who underwent regular physical examinations or were admitted to our hospital between June,2009 and December,2012.All subjects were subjected to an ocular examination,a functional health and well-being survey using the SF-12 questionnaire,and a social support survey using the Social Support Rating Scale.QOL and Social Support information were obtained for each participant using the rating scale.Results  In the 2 111 subjects surveyed,986 (46.70%) had visual impairment which was classified as mild in 594 (60.24%) cases,moderated in 278 (28.19%) cases and severe in the remaining 114 (11.56%) cases.The three most common causes of visual impairment were cataract,age-related macular degeneration (AMD),glaucoma.The scores for various SF-12 variables were worse in subjects with visual impairment than those without visual impairment (P0.05) and negatively associated with the impairment severity.  Social support was positively associated with QOL scores in all domains assessed and supports from different sources impacted the QOL differently.Conclusion  Approximately half of the elderly population in Hangzhou have different degrees of visual impairment.Visual impairment negatively impact the QOL in the elderly.Both treatment and prevention strategies and appropriate social supports are needed to in improving quality of life in the elderly with visual impairment.

    Key words  Visual impairment;Aged;Quality of life;Social support


Clinical Significance of Serum Copeptin on as Potential Prognostic Factor in Patients with Respiratory Failure

BIAN Miao,AN Lian-hua,ZHANG Hong-tao,et al.Department of Respiratory,Qianwei Hospital of Jilin Province,Changchun 130012,China

    Abstract  Objective  To evaluate the prognostic value of serum copeptin levels in patients with respiratory failure.Methods  A total of 132 patients who were admitted consecutively between December,2010 and December,2012 at Department of Respiratory,Qianwei Hospital of Jilin Province and Emergency ICU,the First Hospital of Jilin University were recruited.At admission,blood samples were obtained and serum levels of copeptin were measurement with values of various clinical and laboratory variables recorded.On hospitalization day 28,acute physiology and chronic health evaluation (APACHE ) scores and simplify acute physiology score Ⅱ(SAPS Ⅱ) scores were obtained for survivors and non-survivors.The correlation of serum levels of copeptin with APACHE and SAPS scores and mortality rate on day 28 was analyzed.Results  By hospitalization day 28,41 patients died.Serum levels of copeptin at admission were significantly higher in non-survivors than survivors〔(44.5±9.0) pmol/L vs.(29.2±12.0) pmol/L,P0.01.Both APACHE and SAPS scores on hospitalization day 28 were positively correlated with serum levels of copeptin at admissionr=0.562 and r=0.550 respectively).Serum levels of copeptin had an area under the receiver operating characteristic (ROC) curve (AUC) of 0.840 for predicting 28-day mortality,with 95%CI(0.7720.907);the optimal cut-off level of copeptin for mortality prediction on day 28 was 34.5 pmol/L.Serum levels of copeptin higher than 34.5 pmol/L at admission,APACHE score higher than 17.5 and SAPS score higher than 30.5 on hospitalization day 28 were independent predictors of mortality.Conclusion  Serum levels of cpeptin at admission are closely correlated with APACHE and SAPS scores on hospitalization day 28 in patients with respiratory failure,thereby having a clinical significance as a potential prognostic factor in this disease population.

    Key words  CopeptinRespiratory failurePrognosis


Relationship between Serum Glycated Albumin Level and Severity of Coronary Artery Disease in Percutaneous Coronary Intervention Patients

CHEN Qing,MI Shu-hua,ZHOU Yun,et al.VIP Department of CardiovascularCapital Medical University Affiliated Beijing Anzhen HospitalBeijing 100029China

    Abstract  Objective  To define the relationship between glycated albumin(GA) and the severity of coronary artery lesions in patients undergoing percutaneous coronary intervention(PCI).Methods  Totally,180 patients who underwent PCI for coronary heart disease were consecutively enrolled.The number of coronary artery lesions were recorded.The severity of the lesions were determined by Gensini score,based on which patients were categorized into severity different subgroups.Levels of GA were measured.The correlation of serum levels of GA with both the severity and number of coronary lesions was analyzed.Results  Serum levels of GA increased with the number of coronary arteries involved (P0.05) and with the Gensini score(P0.05).Conclusion  The number of coronary arteries involved and the disease severity are both significantly correlated with serum levels of GA in patients requiring PCI.

    Key words  Coronary artery disease;Glycated albumin;Angioplasty,transluminal,percutaneous coronary;Relationship


Outcome and Prognosis of Patients with Cancer-associated Acute Pulmonary Thromboembolism following Anticoagulation Therapies

LIU Fan,FENG Chen-ye,LIU Ting-wei,et al.Institute of Respiratory Disease,First Affiliated Hospital,China Medical University,Shenyang 110001,China

    Abstract  Objective  To evaluate the outcome and prognosis of patients with cancer-associated acute pulmonary thromboembolism following a monotherapy with a low molecular weight heparin.Methods  Clinical records of 90 patients with cancer-associated acute pulmonary thromboembolism,who were treated in the First Affiliated Hospital of China Medical University consecutively between March,2003 and March,2013,were reviewed.Data on the outcome and prognosis of these patients after a combination treatment involving a sequential administration of a low molecular weight heparin and warfarin (n=53) and a monotherapy with heparin only (n=37) were comparatively analyzed.Results  There were no differences in age,gender,weight,smoking status,underlying diseases and disease severity between the two treatment groups.At post-treatment day 60,while the rate of thrombocytopenia (24.3% vs.22.6%) and bleeding events18.9% vs.24.5% was similar(P0.05),the improvement of hypoxemia was more pronounced (P0.05),the rate of recurrent embolism (2.7% vs.20.8%,P0.05) and the rate of mortality (8.1% vs.26.4%,P0.05) were significantly lower in the monotherapy group than in the combination treatment group .Conclusion  Monotherapy with a low molecular weight heparin is more effective than heparin and warfarin in combination in treating cancer-associated acute pulmonary thromboembolism.

    Key words  Acute pulmonary thromboembolism;Neoplasms;Heparin,low-molecular-weight;Prognosis


The Difference of Nuchal Translucency Thickness in Difference Ethnic Groups

WANG Fang,HU Rong,XIANG Hong.Department of Gynecologic and Obstetric Ultrasoundthe First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China

    Abstract  Objective  To study the differences of nuchal translucency(NT) thickness  between Han nationality and Uighurs,and figure out its normal value.Methods  Eight thousand one hundred and sixty-one pregnant women with health fetus taking NT examination in our department between August 2009 and August 2012 were enrolled in the study.There were 5 025 woman in Han group and 3 136 women in Uighur group.The fetal NT thickness in the two groups at different gestational weeks was measured and analyzed.And the normal ranges of fetal NT thickness were analyzed with linear regressions.Results  There was no significant difference in the age of the pregnant women and the NT thickness at 11-13+6 weeks  between the two groups (P0.05).The 95th percentiles of fetal NT thickness at 11-13+6 weeks in Han group and Uighur group were both 0.22 cm.Conclusion  There was no ethnic difference in fetal NT thickness at 11-13+6 gestational weeks.The normal value of fetal NT thickness might be 0.22 cm in Xinjiang.

    Key words  Fetus;Nuchal translucency;Normal value


Relationship between Napkin-ring Sign on Coronary Computed Tomography Angiography and Acute Coronary Syndrome:A Retrospective Analysis

YAO Wei-gen,HUANG Guo-lai,YAN Yang,et al.Department of Radiology,Yuyao People's Hospital,Yuyao 315400,China

    Abstract  Objective  To determine the relationship between napkin-ring sign (NRS) on coronary computed tomography angiography (CCTA) and acute coronary syndrome (ACS) through a retrospective analysis.Methods  Medical records of 499 patients who underwent coronary CCTA examination in our hospital between January 1,2008 and May 31,2013 were reviewed.Data on various plaque-associated variables (e.g.,non-calcified plaque,calcified plaque,mixed plaque,nonobstructive plaque and obstructive plaque,low-attenuation plaque,positive remodeling plaque,and plaque with NRS),and data on patient survival rate estimated with the Kaplan-Meier method were analyzed.The relationship between ACS and PNRS were analyzed using the Cox proportional hazards model.Results  A total of 7 119 segments and 749 plaques were included in the analysis.PNRS was present in 26 (3.5%) of the 749 plaques.Of these 26 plaques,11 (42.3%) were positive remodeling plaques and 16 (61.5%) were low-attenuation plaques,20 (76.9%) were positive remodeling or low-attenuation plaques,and 7 (26.9%) were overlapping positive remodeling and low-attenuation plaques.At the end of follow-up,ACS events were observed in 16 cases.Culprit lesions associated with ACS events had an increased prevalence of obstructive plaques,positive remodeling,low-attenuation or NRS than lesions not associated with ACS events.Cox proportional hazard analysis suggested that positive remodeling,low-attenuation,and NRS were good predictors of culprit lesions or ACS events.ACS-free survival curves were significantly different between NRS-positive and NRS-negative groups.Conclusion  NRS on CCTA is closely related with the characteristics of ACS events,independently of positive remodeling plaque and low-attenuation plaque.NRS detection may help identify patients in high-risk of ACS events.

    Key words  Coronary CT angiogram;Acute coronary syndrome;Napkin-ring sign


Serum Levels and Clinical Significance of Interleukin-9 in Patients with Ankylosing Spondylitis

WANG Qian-qianWEI PingMENG Jing-hong.Department of Immunology and Rheumatologythe Third Hospital of Hebei Medical UniversityShijiazhuang 050051China

    Abstract  Objective  To determine serum levels of interleukin-9 (IL-9) in patients with ankylosing spondylitis (AS) in association with the disease activity.Methods  A total of 40 outpatients and inpatients with AS undergoing treatments in the Department of Rheumatology of the Third Hospital of Hebei Medical University between October,2012 and April,2013,and 24 age- and sex-matched health subjects undergoing regular physical examinations during the same time period were recruited.Patients in the disease group were categorized as an active subgroup (n=28) and a stable subgroup (n=12),based on the Bath AS Disease activity index (BASDAI).Blood was collected from all subjects.Serum levels of IL-9 were measured with a double antibody sandwich enzyme linked immunosorbent assay (ELISA).The correlation between serum IL-9 levels and disease activities was analyzed.Results  Serum levels of IL-9 were significantly different between the active disease subgroup(691±57) ng/L,the stable disease subgroup (534±80) ng/L,and the control group (432±56) ng/L (P0.05).Serum IL-9 levels in AS patients were positively correlated with C-reactive protein(r=0.529,P=0.000),the erythrocyte sedimentation rate (r=0.339,P=0.033),and BASDAI (r=0.623,P=0.000),but not with the course of the disease (r=0.233,P=0.148).Conclusion  Circulating levels of IL-9 in patients with AS increase in association with the disease activity and may thereby serve as novel indicator of AS disease progressiion.

    Key words  SpondylitisankylosingInterleukin-9C-reactive proteinBlood sedimentation


Current Status of Job-transfer Training for General Practitioners in Southwest Henan Province

MA Yu-hong,LI Ling,HOU Yan-li,et al.Nanyang Medical College,Nanyang 473003,China

    Abstract  Objective  To assess the current status and influencing factors of job-transfer training for general practitioners in southwest Henan Province,in a hope of providing the basis for developing a better training program,optimizing the infrastructure of training bases,and thus improving the training outcome in this area.Methods  A total of 150 student trainees who participated in general practitioner's job-transfer training program in Nanyang Medical College in 2012 were subjected to a self-designed questionnaire survey and personal interviewsm in November,2012.Results  Out of the 150 respondents,97.3% considered the training helpful.What the trainees expected to improve most through the training were the knowledge and skills pertaining to diagnosis and treatment of common non-communicable diseases,professionalism,and communication skills.Half(50.7%) of the trainees expressed their satisfaction with the teaching materials used in this training.Medical colleges with affiliated teaching hospitals were considered as the most appropriate place for the training to be hold and intensive non-degree training was considered as the best training approach.Conclusion  Students' educational level,professional title and capacity is low and uneven.Students think "disease diagnosis and treatment knowledge" and "common disease diagnosis and treatment technology" is the most important.Further efforts are needed in the future to improve the outcome of job-transfer training for general practitioners in Southwest Henan Province through optimizing the infrastructure of the training bases,developing an ability improvement-oriented training framework,adopting diversified teaching methods,utilizing qualified teaching staff and most appropriate teaching materials,and establishing a scientific evaluation system.

    Key words  General practitionerJob-transfer trainingTraining model


Evaluation on Effect of Training on Job-transfer for General Practitioners in Henan Province

CAO Ji-xuanGAO Ai-hongSHI Jian-minget al.Henan Medical College,Zhengzhou 451191,China

    Abstract  Objective  To evaluate the effect of training on job-transfer for general practitioners in Henan Province.Methods  Totally 66 participates were randomly chosen as the subjects from 326 trainees who participated in training on job-transfer given by the Training Center of General Practitioners in Henan Province in the first half of 2013.The item-scoring method was used to evaluate the effects in six respects.Results  In terms of training achievement,the participates had understood the importance of general practitioners in the future health care,learned new skill communicating with patients,known basic feature of general practitioners and their service subjects,and got the certificate for general practice.With regard to the motivation and purpose of training,it had med the demand for the job of general practitioner,raised the level of professional skills,and passed tests of all the subjects.As to the total effect of training,the results were satisfactory,the trainees had greatly raised their professional levels,and learnt a lot in analyzing approach and treatment of commonly-encountered diseases,as well as in self-protection.Conclusion  The trainees of job-transfer training for general practitioners are satisfied with the total training results.However,during the training period they met difficulties of having lower income and rough accommodations.The management of training base should be enhanced to raise the training quality,and the health department of the government needs to pay more attention to the assessment,enlarge the investment of training,take a series of measures to supervise the training effects and improve the training model.

    Key words  General practitioners;Job-transfer training;Effect;Evaluation


Transregional Patient Referral from Secondary Hospitals in A District of Shanghai from 2011 to 2013

LU Jia-fa,DAI Zhen,GU Jian-hua,et al.Jiading District Medical Emergency Center,Shanghai 201808,China

    Abstract  Objective  To analyze the characteristics of the transregional or cross-district patient referral performed by hospitals of a second tier in a district in Shanghai from 2011 to 2013 with a hope of providing a scientific basis for improvement of the referral system in the future.Methods  Data on the cross-district  referrals (including total number of referral,type of the disease requiring referral,and the type and tier of the receiving hospital) made by secondary hospitals in a district in Shanghai in the first six months between 2011 and 2013 were extracted and analyzed.Results  In the first six months of 2011,2012 and 2013 respectively,1 655,1 686 and 1 491 transregional referrals were made by secondary hospitals in this studied district.Trauma,pediatric diseases,neurological diseases,and cardiovascular diseases were the major types of diseases that required referral,accounting for 30.53%,17.40%,17.65%,and 10.87% of the total number of referral respectively.The number of pediatric and cardiovascular disease patients referred was declining with time during the three year period and the number of trauma patients referred was decreasing in 2013.In contrast,the number of neurological disease patients requiring referral was gradually increasing during the three years analyzed.There were significant differences in the distribution of diseases types and  receiving hospitals between years (P0.001,P=0.008).Children's Hospital,Changzheng Hospital,the Sixth People's Hospital,Tongji Hospital,Huashan Hospital and Ruijin Hospital were the major receiving hospitals in this district.Conclusion  There are significant differences in the total number of referral made,in the disease types requiring referral,and in the distribution of receiving hospitals in the past three years in the district analyzed.It is highly anticipated that our findings would provide supplementary information on which specialty areas need to be strengthened in secondary hospitals in the district analyzed in Shanghai in order to reduce the referral-associated inconvenience and economic burden of the patients.

    Key words  Referral;Secondary hospitals;Characteristics of cases


Allocation and Utilization of Home Health Measurement Tools and Equipment in Fengtai District in Beijing

REN Xu-kai,LI Jing-lin,ZHAO Jian-zhong,et al.Fengtai District Disease Prevention and Control Center,Beijing 100071,China

    Abstract  Objective  To Understanding basement of Fengtai District resident households' health measurement tools' equipment and using as to cultivate resident the habit of consciously using measurement tools and to provide the basis for making relevant health promotion programs and Targeted promotional,so that more targeted health education can be put into effect,and reached more means of health education.we can achieve the aim that controlling the health of the region's people by improving the residents' awareness and prevention of chronic disease in the final.Methods  A questionnaire survey was administered to 215 families selected from two communities in Fengtai District of Beijing through a cluster random sampling approach between April and May,2013.The questionnaire consisted of questions regarding the basic information of residents in the community,allocation and utilization of home health monitoring tools and equipment,and health knowledge and health habits.Results  Of the 215 questionnaires distributed,200 (93.0%) were returned with all questions answered.Among the equipment and tools allocated,thermometer had the highest allocation rate (87.0%),followed by graded salt spoon (57.5%),sphygmomanometer (55.0%),and edible oil measuring device (45.5%);vision exam chart had the lowest allocation rate (12.5%).There was no difference in basic health knowledge between men and women (P0.05).There were significant differences in the use of salt s


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