摘要:目的: 了解绵竹市社区卫生服务系统震后现状,同时分析社区医疗震后居民满意度和社区卫生服务机构震后灾害干预能力,以期为社区卫生服务体系地震应急恢复和重建提供参考意见。 方法 :采用随机抽样的方法,抽取绵竹市剑南社区卫生服务中心和天河社区卫生服务中心进行访谈,采取方便抽样的方法,抽取24‰的绵竹城区居民采用面对面访谈的方式用自制问卷进行调查,并用Epidata30 进行数据录入、SPSS130进行统计分析。 结果 :共发放问卷240份,收回有效问卷229份(有效回收率954%)。当地社区卫生服务系统在地震中受损严重。社区卫生服务系统灾后工作居民满意度为454%,社区卫生服务机构对居民进行抗灾/防灾知识教育的比例为336%,灾后是否有持续而足够的常见病药品供应及是否有持续而足够的慢性病药品供应是影响当地居民对当地社区卫生服务体系灾害应急工作的满意度的影响因素(P 值分别是0033,0001)。 结论 :震后社区卫生服务居民满意度较低,服务体系地震灾害干预能力不足。居民在在灾前接受抗灾教育的比例较低,加强药品储备能提高社区卫生机构灾害应急工作的效果。在社区卫生服务体系重建的过程中,应注重社区医疗基础工作的恢复,基础设施的重建和健全社区急救体系。Abstract: Objective: To investigate the reality of community health service system after earthquake in Mianzhu, the satisfaction of community residents to the community health service as well as the postdisaster emergency response capability of community hospital in order to provide decisionmaking suggestions on better reconstruction of community health service system. Methods : Jiannan and Tianhe community hospital were randomly selected for visiting and 24‰ of community residents in the city zone of Mianzhu were selected by convenience sampling for a facetoface interview using a questionnaire. Data entry and statistically analysis were completed by Epidata30 and SPSS130 respectively. Results :A total of 240 questionnaires were conducted to facetoface interviews, and 229 questionnaires were returned (response rate 954%).The community health service system was badly injured. Residents’ satisfactory degree of the community health service after earthquake was 454%. The proportions of disaster / disaster prevention education was 336%,medicine supply for familiar diseases and the chronic were the main factors which influenced judgements of residents to the emergency response capabilities of community hospitals(〖WTBX〗P =0033,P=0001,respectively). Conclusion :The community health services after earthquake had not been widely satisfied and the emergency response capability of community hospital was far from enough. The proportions of disaster / disaster prevention education were far from enough. The effectiveness of emergency response work of community hospitals can be enhanced by reinforcing medicine preparation.In the course of the reconstruction, community health service system should pay attention to the resumance of basic community health service,reconstruction of basic establishment and construction of firstaid system.
ObjectiveTo evaluate the quality of life of residents in stricken area five years after Wenchuan earthquake, so as to explore the main influential factors such as gender, age, ethnic group, marriage status and the extent affected by the earthquake. MethodsUsing WHOQOL-BREF, 500 residents from Hanyuan county in Sichuan province were assessed in order to analyze their life quality and related factors. ResultsThe score on the overall WHOQOL-BREF and the level of each factor were significantly lower than the score on the normal people (P < 0.001). Male score in the factor of social relations significantly higher than female (t=3.963, P < 0.001). The overall score and the score of social factor were significantly lower in the minor than in the adults (t=-2.667, P < 0.01; t=-19.287, P < 0.001). And the quality score of social relationship was significantly lower in the single than in the married and cohabiting couples (P < 0.001; P < 0.01). ConclusionThe quality of life of residents in stricken area five years after Wenchuan earthquake was significantly lower than the national norm. There are significant differences in terms of gender, age, marriage status and earthquake damage on social relations. Steady intimate relationships with others help improve the quality of life of residents in stricken area. Besides, compared those with average damage or no damage, the residents with serious damage are relatively worse in the overall quality of life as well as environmental conditions.
ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.
ObjectiveTo investigate the community residents' awareness of knowledge on cardiovascular disease prevention and control and their access methods to relevant information. MethodsBetween June and August, 2013, the residents aged above 45 who came to community health center for diagnosis or treatment were investigated by questionnaires including the acknowledge of prevention for cardiovascular diseases and the access methods to relevant information. ResultsA total of 1 000 residents were involved in this study, including 394 (39.40%) males and 606 (60.60%) females aged from 45 to 98 with an average of 68.3±10.4. The highest rate of awareness of cardiovascular prevention knowledge was regular physical exercise (89.20%), followed by low salt diet (67.20%) and fried food (6.30%). The highest rate of access to the information was information provided verbally by doctors or nurses (77.50%), followed by television and radio (56.00%). ConclusionCommunity center should strengthen the health education of cardiovascular disease prevention and control. Health education should be practiced in an easy way for the residents.
目的:了解绵竹市社区卫生服务系统震后现状,同时分析社区医疗震后居民满意度和社区卫生服务机构震后灾害干预能力,以期为社区卫生服务体系地震应急恢复和重建提供参考意见。方法:采用随机抽样的方法,抽取绵竹市剑南社区卫生服务中心和天河社区卫生服务中心进行访谈,采取方便抽样的方法,抽取2.4‰的绵竹城区居民采用面对面访谈的方式用自制问卷进行调查,并用Epidata 3.0 进行数据录入、SPSS13.0进行统计分析。结果:共发放问卷240份,收回有效问卷229份(有效回收率95.4%)。当地社区卫生服务系统在地震中受损严重。社区卫生服务系统灾后工作居民满意度为45.4%,社区卫生服务机构对居民进行抗灾/防灾知识教育的比例为33.6%,灾后是否有持续而足够的常见病药品供应及是否有持续而足够的慢性病药品供应是影响当地居民对当地社区卫生服务体系灾害应急工作的满意度的影响因素(P值分别是0.033,0.001)。结论:震后社区卫生服务居民满意度较低,服务体系地震灾害干预能力不足。居民在在灾前接受抗灾教育的比例较低,加强药品储备能提高社区卫生机构灾害应急工作的效果。在社区卫生服务体系重建的过程中,应注重社区医疗基础工作的恢复,基础设施的重建和健全社区急救体系。
Objective To investigate the health status of residents in rural areas of China as well as their needs for health service, and to explore the effective way to improve the health status of rural residents so as to provide a basis for the training of community healthcare professionals. Methods Using the method of stratified cluster random sampling, we investigated 4190 rural residents from 1200 families, which were sampled from 13 provinces of China according to the geographical distribution. Results The 2-week prevalence rate was 27.9%. 32.7% of the patients saw a doctor, and 20.5% did not take any measures. Among those who did not take any measures, 78.4% thought their illness was mild and did not need any treatment; and the second reason for no treatment was lack of money (accounting for 36.5%). The prevalence rate of chronic diseases during the past half year was 24.9%, among which lumbar and leg pain was the most prevalent (accounting for 7.8%), followed by hypertension (accounting for 5.5%). The rates of visiting a doctor were 43.9% and 61.5% in township level and village level health institutions, respectively, during the past one year. 70.0% of the patients looked for treatment, 8.4% chose to ignore, and 20.8% took medicine by themselves. Among those who visited a doctor, 61.0% preferred hospitals near their houses, and 34.0% preferred those with lower expenses. More than half of the residents (accounting for 57.3%) did not have any physical examination during the past 3 years, and 28.3% did have a check-up but not regularly. Among the rural residents investigated, 64.2% obtained health care knowledge from television, newspapers, books and radio broadcasting, and 67.3% were desirous of regular physical examination. 56.3% and 33.1% of the rural residents considered the skill of the healthcare professionals in town-level institutions to be acceptable and satisfactory, respectively; and 61.7% and 24.6% evaluated the skill of those in village-level institutions to be acceptable and satisfactory, respectively. Conclusion The health status of rural residents is not optimistic, and their health behaviors need to be correctly guided, and the medical facilities and healthcare service quality of primary healthcare institutions should be improved. It is suggested that the government and medical colleges take the responsibility to train healthcare professionals for the primary health care in rural areas.
ObjectiveTo investigate the prevalence and risk factors for chronic obstructive pulmonary disease (COPD) in Dayi County of Chengdu. MethodsRandomly cluster sampled residents between 40 and 70 years of age from two natural villages in the rural communities from February to December, 2010 were included in our study. We used questionnaire survey, physical examination and portable spirometry to collect data. Post-bronchodilator forced expiratory volume in 1 second/forced vital capacity of less than 70% was defined as the diagnostic criterion of COPD. Univariate analysis and logistic regression mode were used to define the risk factors. ResultsA total of 1 017 residents were enrolled in this survey, and 782 participants were valid for analysis, with a valid response rate of 76.89%. There were 330 males and 452 females, with an average age of (51.97±8.17) years old. The overall prevalence of COPD was 10.61%. After population standardization, the prevalence rate was 12.37%, and the overall prevalence increased with increment of age. The prevalence in male (13.33%) was higher than that in female (8.62%) with significant difference (P<0.01) and the prevalence increased with age. Univariate analysis showed that sex, age, education level, smoking and amount of smoking (pack-years) were the risk factors for COPD with significant difference. Logistic regression analysis showed that age, amount of smoking (pack-years) were the main risk factors for COPD. ConclusionCOPD is highly prevalent in Dayi County of Chengdu and it is important to prevent COPD by controlling smoking and improving education level.
Objective To investigate the safety of thoracic surgery for high-altitude patients in local medical center. MethodsWe retrospectively collected 258 high-altitude patients who received thoracic surgery in West China Hospital, Sichuan University (plain medical center, 54 patients) and People's Hospital of Ganzi Tibetan Autonomous Prefecture (high-altitude medical center, 204 patients) from January 2013 to July 2019. There were 175 males and 83 females with an average age of 43.0±16.8 years. Perioperative indicators, postoperative complications and related risk factors of patients were analyzed. ResultsThe rate of minimally invasive surgery in the high-altitude medical center was statistically lower than that in the plain medical center (11.8% vs. 55.6%, P<0.001). The surgical proportions of tuberculous empyema (41.2% vs. 1.9%, P<0.001) and pulmonary hydatid (15.2% vs. 0.0%, P=0.002) in the high-altitude medical center were statistically higher than those in the plain medical center. There was no statistical difference in perioperative mortality (0.5% vs. 1.9%, P=0.379) or complication rate within 30 days after operation (7.4% vs. 11.1%, P=0.402) between the high-altitude center and the plain medical center. Univariate and multivariate analyses showed that body mass index≥25 kg/m2 (OR=8.647, P<0.001) and esophageal rupture/perforation were independent risk factors for the occurrence of postoperative complications (OR=15.720, P<0.001). ConclusionThoracic surgery in the high-altitude medical center is safe and feasible.
Objective To observe the changes and influencing factors on pulse oxygen saturation and hemoglobin in Tibetan residents of 4 200 meters above sea level. Methods The health examination data of the Tibetan village residents were collected in Rerong Country, Shannan Prefecture of Tibet autonomous region from January 4 to February 4, 2012. And the information of pulse oxygen saturation was recorded at the same time. The residents were categorized by sex, age and smoking history to observe the difference in each group. Results The clinical data of 234 healthy Tibetan residents were collected with average age of (37.9±13.9) years old, and 97 were male (41.5%). There were no difference in pulse oxygen saturation [(86.1±3.4)% and (86.0±4.7)%, P=0.784) between male and female residents, and heart rate of the male was less than that of the female [(77.9±9.8) bpm and (81.1±12.1) bpm, P=0.036], while the hemoglobin content was higher in male residents [(164.5±15.4) g/L and (139.1±19.2) g/L, P=0.000). With the increase of age, especially in the group older than 60 years, the pulse oxygen saturation significantly decreased (P=0.003), while hemoglobin content showed a gradual increase trend (P=0.000). And in the group which smoking history more than 20 pack-years, the pulse oxygen saturation was lesser than the other groups, and the hemoglobin content increased (P=0.000). Conclusions The pulse oxygen saturation level of Tibetan residents of 4 200 meters above sea level is negatively correlated with age and smoking history, and the level of hemoglobin is positively correlated with age and smoking history. In resting state, there is no significant difference in heart rate between the groups divided by ages.
Objective To survey the current status of residents’ health examination in township medical units in Shuangliu county, so as to provide references for exploring the residents’ health examination mode suitable for the well-off rural hospitals, and for improving the effects of physical examination. Methods The self-designed questionnaires were made to survey the current situation of health examination for the residents in 24 township medical units in Shuangliu County, including 3 central township hospitals, 3 community health centers and 18 general township hospitals; and the outline was designed to interview the people responsible for managing and implementing the resident’s examination work. The Epidate 3.1 was used for data input, the SPSS 17.0 was used for descriptive statistics and stratified analysis, and the classification method was adopted for qualitative research of personal interview data. Results The number of primary health care units for carrying out residents’ health examination got gradually increased year by year from 2008 to 2010; and all 24 township-level medical units had already carried out that examination by 2010. But some issues still existed such as lower participation rate and ineffective utilization of the archives. Conclusion a) It is necessary to prepare well, enhance organizing, expand publicity, and increase participation rate when primary health care units carry out the health examination for residents; b) It is necessary requires to fasten the informatization construction of health archives, and to quicken the process and analysis of examination information; and c) It is advisable to constantly optimize the examination items according to exam information, to improve the qualification of medical staffs, and to fasten the construction of exam team.