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Hangzhou Sijiqing Community Health Service Center has started the precise contract service mode with the characteristics of competitive contract,regional medical alliance and team service form 2016,which improved hypertensive and diabetic patients management in community.After adopting the precision contract service mode,the contracting rate of hypertensive and diabetic patients increased from 56.1％ (2 680/4 777)to 81.6％ (5 602/6 863),the rate of referral to regional medical alliance increased from 26.1％ (2 678/10 259)to 44.4％ (5 589/12 589),consultation rate of contracted doctor increased from 47.1％ (54 603/115 986) to 56.3％ (93 219/165 725),contract renewing rate increased from 41.3％ (5 794/10 822) to 67.2％ (7 282/10 838),and the rate of home nursing care in increased from 9.5％ (47/495) to 61.5％ (392/637).The precise family doctor contract service is an effective mode for primary care,which improves the management rate of hypertensive and diabetic patients,provides continuous medical service,facilitates referral and home nursing service,and promotes the continuity of contract service.
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Objective@#To understand the dyslipidemia rate and trend of blood lipid level in an urban community in Hangzhou.@*Methods@#A total of 1 485 urban community residents aged 24 years or older who had participated in health checkup over 6 years, from 2011-2016, were selected by random cluster sampling. Fasting blood Triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) levels were measured in all subjects. A χ2 test was used to analyze the dyslipidemia rate trend, and an ANOVA of repeated measurement was conducted to observe the blood lipid level changes.@*Results@#From 2011 to 2016, the total abnormal rates of blood lipids in 1 485 residents were 33.2% (493/1 485), 30.5% (453/1 485), 30.4% (452/1 485), 26.5% (394/1 485), 26.3% (391/1 485), and 25.1% (373/1 485), respectively, which showed a declining trend year-by-year (χ2=36.051, P<0.01). Among these results, however, the high TG rate did not significantly differ from year-to-year (χ2=10.081, P>0.05). The TG, TC, LDL-C, and HDL-C levels statistically differed over the 6 years (F=4.876, 33.033, 170.254, 58.442, respectively, all P<0.01). LDL-C was the highest in 2011 [(3.02±0.29) mmol/L] and the lowest in 2016 [(2.72±0.71) mmol/L], while HDL-C was the highest in 2016 (1.44±0.33 mmol/L) and the lowest in 2011 [(1.35±0.30) mmol/L]. Time-sex group interaction effect analysis: TC and HDL-C levels showed different trends over time between men and women (F=2.556, 4.982, respectively, all P<0.05), and the TC level in the male group was significantly lower than in the female group, since 2012. Interaction effect of time age group: TC and LDL-C levels showed different trends between age groups over time, and the declining trend of TC and LDL-C in the elderly group was more significant than in the young or middle age group (F=10.328, 3.085, respectively, all P<0.01).@*Conclusions@#The community population showed an overall improvement in blood lipid levels; however, there was no significant improvement in high TG levels. It is necessary to continue monitoring blood lipid levels in the community, especially to strengthen the prevention and control of high TG levels.
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Objectives To explore the relationships between the current physical exercise behaviors and psychological factors of middle school students,so as to provide scientific evidence for improving health education and carrying out targeted health intervention measures.Methods The Multi-stage stratified sampling and cluster sampling method was adopted to choose 3600 students from 12 junior and senior middle schools in Hangzhou,Wuhan and Xi'an.The date was collected using the adolescent physical exercise behavior-psychological measurement scale(Chinese version).The structural equation model was built to explore the relationships between psychological factors(including the change of strategy,decision balance positive effect,decision balance negative effect and self-efficiency)and physical exercise.Results The change of strategy has biggest effect on physical exercise behaviors,with the standardized direct effect value of 0.344.The standardized direct effect value of decision balance negative effect,decision balance positive effect and self-efficiency were 0.071,0.093 and 0.169 respectively.The negative correlation among the four dimensions was significant statistically.Conclusion Psychological factors have direct effects on the change of the behaviors,and the change of the strategy has the largest impact on physical exercise behaviors of middle school students.The four psychological factors are closely correlated with one another,which is important in formulating middle school sports programs to promote the physical quality of middle school students.
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Objective To compare the effects of health education on fat intake behavior and its psychology in students with different BMI,provide evidence for improving individual healthy education.Methods A experimental epidemiology was used,Twenty-nine secondary school classes were randomly selected by multi-stage cluster sampling from two cities in Zhejiang province.Overweight or obesity group included all students who were judged overweight or obesity,normal group included students who were judged normal and basic matched by age,grade,sex and stage of baseline.Intervention based on transtheoretical mode was conducted on two groups and intervention results were measured by the adolescent fat intake behavior of psychological measurement scales (Chinese version).Chi-square tests,T-tests,non-parameters tests and binary logistic regression were performed for data analyses.Results Stage of students with overweight or obesity and with normal BMI all moved forward after intervention,while the proportion of stage advance for students with overweight or obesity was further than students with normal BMI.Change strategy(2.60±0.79),pros(3.58±0.90) and self-efficacy(3.01±0.72) of students with overweight or obesity better than students with normal BMI in baseline((2.34±0.86),(3.08±0.91),(2.79±0.81)) while difference was not significant after intervention.Logistic regression analysis discovered that the promotion of change strategy moved stage forward for students with normal BMI(OR=2.168,95％ CI:1.560-3.014)and promotion of self-efficiency moved stage forward for students with overweight or obesity (OR=1.801,95％ CI:1.026-3.159).Conclusion The intensity and duration of psychological intervention is essential to be reinforced for students with normal BMI,while for students with overweight and obesity,psychological intervention should be promoted in combination with social support.
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Objective To explore the key techniques used for surveillance and disposal of infectious diseases,food poisoning and hospital infection to improve the ability of surveillance and disposal on public health emergency.Methods Framework on surveillance and disposal of infectious diseases,food poisoning and hospital infection was set up,based on literature review and expert group discussion.Delphi method and technique for order preference by similarity to ideal solution comprehensive evaluation method were used for ordering preference by similarity,to screen key techniques set for surveillance and disposal of the above said events.Results Framework to be used for selecting key techniques was designed,based on the classification of emergency events,processing cycle of emergency events and level of techniques.Twenty six public health experts were selected for a 2-round consultation,with their authority as 0.796.Ten key techniques with important significance for surveillance and disposal of infectious diseases,food poisoning and hospital infection were selected from each event.Among these key techniques,the early-warning system was recognized as the key technique,important for the surveillance and disposal of all three emergency events.Items as technology used for unknown pathogenic microorganism detection,personal protection,gene sequencing and tracing technology,microorganism molecular typing technology,nucleic acid detection technology etc.were the key techniques and need to develop for the surveillance and disposal of infectious diseases and iatrogenic infection.Data regarding key technologies on security and privacy,early warning and forecasting,field rapid detection were sorted out that all in need to improve the surveillance programs on disposal of infectious diseases and food poisoning.Data exchange appeared another key technique on infectious diseases,with toxin detection and other 5 techniques the key techniques for food poisoning.Data collection,standardization and other 3 techniques appeared as the key techniques on iatrogenic infection.Conclusions Key techniques were selected in this study to meet the requirements of surveillance,disposal of infectious disease,food poisoning and iatrogenic infection.Authority of the experts got improved in the two-round consultation,ensuring the reliability of the results of screening and providing a scientific basis for the further research and priority development of the key techniques.
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Objective To explore the key techniques used for surveillance and disposal of infectious diseases,food poisoning and hospital infection to improve the ability of surveillance and disposal on public health emergency.Methods Framework on surveillance and disposal of infectious diseases,food poisoning and hospital infection was set up,based on literature review and expert group discussion.Delphi method and technique for order preference by similarity to ideal solution comprehensive evaluation method were used for ordering preference by similarity,to screen key techniques set for surveillance and disposal of the above said events.Results Framework to be used for selecting key techniques was designed,based on the classification of emergency events,processing cycle of emergency events and level of techniques.Twenty six public health experts were selected for a 2-round consultation,with their authority as 0.796.Ten key techniques with important significance for surveillance and disposal of infectious diseases,food poisoning and hospital infection were selected from each event.Among these key techniques,the early-warning system was recognized as the key technique,important for the surveillance and disposal of all three emergency events.Items as technology used for unknown pathogenic microorganism detection,personal protection,gene sequencing and tracing technology,microorganism molecular typing technology,nucleic acid detection technology etc.were the key techniques and need to develop for the surveillance and disposal of infectious diseases and iatrogenic infection.Data regarding key technologies on security and privacy,early warning and forecasting,field rapid detection were sorted out that all in need to improve the surveillance programs on disposal of infectious diseases and food poisoning.Data exchange appeared another key technique on infectious diseases,with toxin detection and other 5 techniques the key techniques for food poisoning.Data collection,standardization and other 3 techniques appeared as the key techniques on iatrogenic infection.Conclusions Key techniques were selected in this study to meet the requirements of surveillance,disposal of infectious disease,food poisoning and iatrogenic infection.Authority of the experts got improved in the two-round consultation,ensuring the reliability of the results of screening and providing a scientific basis for the further research and priority development of the key techniques.