Objective To explore the impact of community healthcare workers’ (CHWs) knowledge, attitude and practice (KAP) on the influenza vaccination among elderly people. Methods By means of simple random sampling, 1 residential quarter of each communities, 2 communities of each districts, 5 districts of Chengdu city were randomly selected, and the elderly equal to or more than 60-year-old were on-site investigated. Meanwhile, the questionnaire survey was conducted among healthcare workers in the selected communities. Results There were 4 KAP factors played a positive role in influenza vaccination among elderly people: CHWs’ affirmation of the effectiveness of influenza vaccine, explicitly knowing the focus groups for influenza vaccination, recommendation of vaccination in flu season when the elderly visits, and participation in flu-related education activities. When the accuracy rate of each factor got improved by 1%, the influenza vaccination rate would improve by 2.747%, 1.299%, 0.864%, 0.602%, respectively. Conclusion The knowledge, attitude and practice of HCWs have impacts on the influenza vaccination rates of elderly people. They are significant to improve the influenza vaccination rates of the elderly.
Objective To explor the influence of the hospital-community-family mental rehabilitation mode on the quality of life of patients with schizophrenia. Methods We selected 101 patients diagnosed as schizophrenia according to ICD-10, who were hospitalized in mental health center of the West China Hospital and took part in rehabilitation voluntarily after discharge. Those patients were randomly assigned to two groups. Hospital-community-family mental rehabilitation mode intervention was applied to the patients based on inpatient rehabilitation in the trial group (n=52), while inpatient rehabilitation alone was applied in the control group (n=49). The total score of quality of life, psycho-social dimension, motivation and energy dimension, score of mental disability and social function, and family social care index were recorded. Then, statistical analysis was performed using SPSS 17.0 software. Results After 3 months and 6 months, the trial group had lower scores of the total score of quality of life, psycho-social domain, and motive and energy dimension than those of the control group (Plt;0.05). After 6 months, the trial group had lower scores of mental disability and social function (Plt;0.05) but a higher score of family social care index (Plt;0.05). The scores of WHO-DSA II and SQLS were positively correlated, while the scores of APGAR and SQLS were negatively correlated. Conclusion The integral mode of hospital-community-family mental rehabilitation effectively improves the quality of life of patients with schizophrenia, which also positively improves patients’ rehabilitation.
Objective To investigate the use of oral anti-diabetic drugs and sugar blood control situation in advanced aged patient with diabetic mellitus in a community health centre in order to provide references for rational drug use. Methods A cross-sectional survey about oral anti-diabetic drugs was carried out in senile diabetic patients who visited the community health centre and established complete health documents voluntarily from February 2012 to February 2013. Results There were 176 cases of advanced aged patients with type 2 diabetic mellitus, of which, 107 cases were female and 69 cases were male, whose age ranged from 80 to 94. Among 176 cases, there were 107 (60.80%) patients with type 2 diabetic mellitus combined with hypertension, chronic heart diseases, and stoke; 155 had oral anti-diabetic drugs (88.06%). 67.19% of patients who took one oral anti-diabetic drug chose α-glycosidase inhibitors, followed by sulfonylurea. 53.73% of patients who received combination therapy chose glycosidase inhibitors and sulfonylurea. For the treatment of anti-diabetic drugs, 73.68% of patients met the criteria (fasting blood sugar: no more than 8.0 mmol/L), with control rates of 73.56% for α-glycosidase inhibitors and 72.58% for sulfonylurea. More than half of the patients could not be evaluated for their glycosylated hemoglobin levels were not tested. Conclusion Doctors working in community health centres should choose oral anti-diabetic drugs according to patients’ own conditions when treating advanced aged patients with diabetic mellitus in order to avoid adverse reaction such as hypoglycemia. Glycosidase inhibitors are the mostly used drug in the community health centre because it is safe with less adverse reaction when used in senile people and it could ideally control their blood sugara.
Objective To investigate the inpatient disease constitution of Jili Community Health Service Center (JCHSC) in Liuyang City of Hunan Province from 2008 to 2010, so as to learn about the local burden of diseases and to provide baseline data for further study. Methods Both questionnaire and focus interviews were applied to collect inpatients’ records in JCHSC between 2008 and 2010. Based on the primary diagnosis on hospital discharge record, the diseases were standardized and classified according to the International Classification of Disease, 10th Edition (ICD-10). Data including general information of the inpatients and discharge diagnosis were rearranged and analyzed by using Microsoft Excel 2003 and SPSS 13.0 software. Results a) The total numbers of inpatients were 4 804, 6 011 and 6 552 in 2008, 2009 and 2010, respectively, and males were less than famales (37.89% vs. 62.11%, 37.68% vs. 62.32%, 41.09% vs. 58.91%); b)The disease spectrum included 19 to 21 categories, accounting for 90.5% to 100% of ICD-10; c) The top 5 systematic diseases accounted for 78.91%-83.61%, including circulate, digestive, pregnancy, parturition and puerperium, genitourinary, and respiratory system diseases; d) The top 15 single diseases were coronary heart disease, urinary calculi, cholecyslithiasis or accompanied with cholecystitis, chronic gastritis, hypertension, diabetes, chronic bronchitis, pulmonary infection and inguinal hernia; and e) In these 3 years, most of the inpatients suffered from chronic diseases rather than acute diseases, mostly over 35 years old; while the acute diseases were commonly seen in patients younger than 15 years old. Conclusion a) In recent 3 years, the major inpatient systematic diseases are circulate, digestive, pregnancy, parturition and puerperium, genitourinary, and respiratory system diseases. The chronic diseases are more than the acute, and mainly focus on coronary heart disease, urinary calculi and chronic bronchitis; b) Nine common inpatient disease spectrum of the top 15 single diseases keep same in recent 3 years; and c) Further attention should be paid to the chronic patients over 35 years old and the acute patients less than 15 years old.
Based on review and practice of literature search of clinical economic evaluation, We have discussed the source and search strategy of literatures of clinical economic evaluation. A sample on antibiotics in the treatment of community-acquired pneumonia was shown concurrently.
Objective To investigate the spectrum of diseases and the current situation of antibiotic use in rural hospitals and community health service centers in Chengdu, so as to provide evidence for selecting essential medicines and promoting rational use of antibiotics. Method We selected 7 township/community health institutions, from which we collected inpatient and outpatient information. Information about antibiotic use was also collected, including categories, cost, and dosage. A standard questionnaire was used to investigate physicians’ prescription behavior for principal diseases. Result Urban and rural areas had different spectrums of diseases. The major diseases in urban areas included diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and respiratory tract infection; while those in rural areas were infectious diseases of the respiratory system, digestive system, and urinary system. The physicians’ prescription behavior was mainly based on their personal experience. Antibiotics accounted for 30-50% of the total medicine cost. The top four types of antibiotics with the highest cost were cephalosporins, penicillin, quinolones, and macrolides. Conclusion Based on the different spectrums of diseases, essential drug lists and standard treatment guidelines appropriate for rural health care should be developed to improve the rational use of drugs. Factors such as the average cost of daily dose and the course of treatment should be taken into consideration to reduce the overall cost of medicine. An antimicrobial resistance monitoring system and special training courses on rational use of antibiotics should be utilized in the rural health institutions.
It is essential to improve the practice of community healthcare service for the resolution of the problem of inadequate and overly expensive medical services, to promote the harmonization of doctor-patient relationship. From the aspects of the introduction of community healthcare service and the necessity of its standard management, the civil legal relation of community healthcare and its major problems, as well as the rights and duties of community doctors, the authors discussed the importance and necessity of scientific management, right protection by law as well as sound and orderly development of community healthcare service.
目的 探讨成都市高脂血症患病率及合并心血管危险因素的现状及城乡差异。 方法 2010年3月－11月随机抽样选取城市和农村社区，采用问卷、体格检查和实验室检查共调查35～70岁人群2 032例，其中城市社区1 015例，农村社区1 017例。进一步调查其中高脂血症患者合并的主要心血管危险因素。 结果 ① 成都市城乡高脂血症患病率为23.53%（474/2 032）。城市高于农村，分别为27.88%（283/1 015）和18.78%（283/1 017）；② 城市高脂血症人群中合并高血压、糖尿病和冠心病均高于农村。高脂血症合并高血压人群最多，城乡分别是51.95%（147/283）和31.94%（61/191），其次是合并“糖尿病”和“冠心病”人群；③ 城市高脂血症患者合并高血压人群无论男女均高于农村，但城市男性合并糖尿病者高于农村，城市女性合并冠心病者高于农村；④ 城乡高脂血症患者在合并饮酒、脑卒中史、腹型肥胖和肥胖之间差异无统计学意义（P＜0.05）。 结论 高血压、糖尿病和冠心病是城市高脂血症患者干预的重点危险因素。其中城市男性的糖尿病和城市女性冠心病干预更为重要。
目的 了解社区人群对脑卒中危险因素及症状的知晓现状。 方法 随机抽样调查1 208名居民及112名医务人员的人口学特征、对危险因素及预警信号的知晓现状及其影响因素、信息来源及需求情况。 结果 90.1%、100.0%的居民及医务人员可辨识高血压是卒中的危险因素，而社区居民及医务人员对年龄、糖尿病、吸烟等危险因素的认识比例分别为65.0% 和85.0%，且对危险因素的控制策略缺乏了解。87.4%、100.0%社区居民及医务人员将一侧肢体的活动障碍作为卒中的第一大预警信号，其次为头晕、步态不稳、头痛、言语困难、视物模糊。卒中知识得分的单因素及多因素分析示：大学文化、已婚且在职的居民及高学历的医务人员对卒中信息的了解程度高。卒中信息的获取途径依次为电视、社区医生/讲堂、报纸、杂志、网络。 结论 西部城市社区人群卒中知识知晓率低，开展针对低学历医务者的卒中培训及低学历、独居及退休人员的居民讲堂是改善现状的必要途径。同时也为政府建立有效的院前早期识别及快速转诊技术提供了依据。Objective To assess the baseline knowledge of risk factors and warning signs of cerebral apoplexy in communities. Methods A total of 1 208 inhabitants and 112 medical personnel were selected by systematic sampling. The questionnaire included social-demographic data, knowledge of cerebral apoplexy risk and warning signs and influencing factors, the sources and requirement of information about cerebral apoplexy. Results Hypertension was a risk factor in 90.1% of residents and 100.0% of medical personnel. Age, diabetes and smoking were identified as the risk factor in 65.0% of medical personnel and 85.0% of residents. Medical therapy of risk factors was insufficient. The most common warning signs of cerebral apoplexy was hemiplegia, the following were vertigo, ataxia, headache, aphasia and double vision. Stepwise multiple regression analyses showed that residents who had higher educational background, spousal, workers and community worker with higher educational background had higher knowledge scores of cerebral apoplexy. The main sources of information about cerebral apoplexy were television, doctors, newspaper, magazine and network. Conclusions At present, the urban community residents in west China are lacking in knowledge about cerebral apoplexy. Going forward, targeted educational residents and medical workers should be directed at those who was highly educated, living alone, and retired. It is also provide a theoretical basis for establishing a prehospital identification and transfer treatment system based on community in developing countries.
目的 了解成都市社区老年慢性病患者对关爱的感知和需求，为更好地关爱老年慢性病患者提供依据。 方法 于2011年8月－10月采用随机抽样和问卷调查的方法，对成都市玉林社区、二仙桥社区、草堂街社区和驷马桥社区的180名老年慢性病患者的关爱感知和需求进行调查，并根据调查结果提出相应对策。 结果 180例老年慢性病患者中有98.89%能感受到关爱，1.11%自觉缺乏关爱；感知到的关爱主要来源于家庭成员,占91.01%，其次来源于亲戚朋友和邻居，占7.87%，最少来源于单位同事，占1.12%。关爱需求主要为家人团聚、关心体贴、尊重理解、日常照顾和心理情感支持、帮助解决困难、给予经济资助、提供情感支持等；护理关爱需求以尊重理解排在首位，其次是慢性病日常护理、慢性病的防治、老年保健和慢性病基本知识等。 结论 加强对社区卫生服务人员的能力培训，强化尊老爱老家庭氛围和社会风气，提高老年慢性病患者的关爱感知，有效地为老年慢性病患者提供关爱，更好地促进他们的健康。