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 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.
Objective To explore the distribution of bacteria among community acquired lower respiratory tract infection (LRTI) inpatients with underlying chronic respiratory tract diseases.Methods The clinical data，sputum culture and drug susceptibility results of 212 community acquired LRTI patients who were hospitalized during the period 2001-2005 were retrospectively analyzed.All patients had various underlying chronic respiratory tract diseases.Results A total of 229 strains of pathogens were detected，with the majority being gram negative bacteria.In pathogens of acute exacerbation of chronic obstructive pulmonary disease，gram negative bacteria occupied 73.9%.And Pseudomonas aeruginosa and Klebsiella pneumoniae were the most common pathogens，with each occupying 18.2% and 13.6% respectively.Gram positive bacteria occupied 23.8%，mainly Staphylococcus aureus (10.2%) and Streptococcus pneumoniae (9.1%).In patients with bronchiectasis exacerbated by bacterial infection，86.2% were caused by gram negative bacteria，the top three being，in descending order，Pseudomonas aeruginosa (27.5%)，Haemophilus parainfluenzae (13.7%)，and Haemophilus influenzae (11.8%).Bronchiectasis was the major risk factor of getting Pseudomonas aeruginosa infection (OR=5.590，95%CI 2.792~11.192).The risk factors of getting Acinetobacter baumanii infection were antacid usage within 1 month (OR=9.652，95%CI 2.792~11.192) and hypoalbuminemia (OR=2.679，95%CI 1.108~6.476).For enterobacters infections，including Klebsiella pneumoniae，Enterobacter cloacae and Escherichia coli，the risk factors were antibiotic usage within 1 month (OR=4.236，95%CI 1.982~9.057)，having renal diseases (OR=4.305，95%CI 1.090~17.008) and diabetes mellitus (OR=2.836，95%CI 1.339~6.009).Conclusions Gram negative bacteria were the main pathogens of community acquired LRTI in hospitalized patients with underlying chronic respiratory tract diseases.The pathogens were influenced by underlying diseases，severity of diseases and drug usage history of patients.
Objective To detect the levels and study the significance of serum soluble intercellular adhension molecule-1(sVCAM-1),soluble vascular cell adhension molecule-1 (sVCAM-1) in patients with community-acquired pneumonia(CAP).Methods sICAM-1 and sVCAM-1 were detected by enzymelinked immunosorbent assy（ELISA）in 25 patients with CAP before and after treatment as well as in 10 healthy controls.Results Before treatment, the levels of serum sICAM-1 and sVCAM-1 in the patients with CAP[（2.658 4±0.259 7）ng/mL,(2.680 9±0.255 4）ng/mL)] were significantly higher than those in controls[(2.472 8±0.077 6)ng/mL,（2.426 3±0.307 2)ng/mL](Plt;0.01,Plt;0.05). After treatment, the levels of serum sICAM-1, sVCAM-1 significantly decreased [(2.518 3±0.205 2)ng/mL,(2.523 0±0.279 4)ng/mL](Plt;0.01,Plt;0.01) and were not different from those in controls（Pgt;0.05）.The levels of sICAM-1 were positively associated with neutrophil counts（r=0.602，Plt;0.001）rather than the levels of sVCAM-1（r＝0.036，Pgt;0.05）.Conclusion The changes of sICAM-1 and sVCAM-1 before and after treatment are predictive to the prognosis in patients with CAP.
Objective To investigate clinical characteristics of community acquired pulmonary crypyococcosis（PC）.Methods A total of 30 cases of PC diagnosed at Zhongshan Hospital of Fudan University from Jan 2003 to Dec 2007 were retrospectively analysed.All cases were identified by pathological study.Results The patients consisted of 19 males and 11 females，with median age of 44 years（16 to 70 years），66.7% of whom without underlying deseases and with normal immune function.9 patients（30%） were asymptomatic，and 21 patients（70%） had respiratory and/or constitutional symptoms.The most common symptoms were dry cough（16.7%），expectoration（46.7%），fever（23.3%），chest pain（13.3%） and dyspnea on exertion（13.3%）.All symptoms were mild and often showed a self-limiting trend.The common imaging features were nodule and mass，either solitary or multiple（53.3%），infiltrates and consolidation（40%） or diffused and mixed lesions.Non-caseous granulomas was the main character of patholgical study（96.7%），in which 93.1% with multinucleated giant cells containing abundant vacuolus yeast forms with the periodic acid schiff（PAS） reaction and/or Grocott Gomori’s methenamine silver（GMS） staining postive.Only one case found Cryptococcus neoformans spores in biopsy tissue smear and another in sputum smear.16.7% of the patients had positive biopsy tissue cultures for Cryptococcus neoformans，and 3.3% were positive of sputum cultures.15 patients underwent latex agglutination test for pulmonary cryptococcosis，and 93.3% were positive.Conclusions Some immunocompetent healthy people may compromised with community acquired PC with mild symptoms or even not at all and heterogeneous imaging appearance.Pathology，etiology，and serology were valuable diagnostic tools.
Objective To explore the application value of Mycoplasma pneumoniae （MP） rapid culture technique for diagnosis of lower respiratory tract infections （LRTIs ） inpatients. Methods 120 LRTIs inpatients in respiratory ward，Anzhen hospital from January 1，2010 to December 31，2010，were recruited in this study. Their pharynx swabs were obtained for rapid MP culture and the serum antibody detection of MP was performed by Gelatin particle agglutination method. Results There were 33 positive yields in 120 LRTIs patients by rapid culture method and 24 positive yields by serological assay. The positive rates were 27.5% and 20.0% respectively. There was no significant difference in the two detecting methods （Pgt;0.05）. Conclusions MP rapid culture method is a better early diagnostic method at the present. MP rapid culture method combined with serological detection can improve the positive yield and avoid missed diagnosis.