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Objective@#To analysis of the effect of strengthening management of dyslipidemia in community based on family doctor contracting service.@*Methods@#In December 2014, 1267 cases patients with dyslipidemia aged over 18 years were selected from three community health service centers in Hangzhou, including 645 in intervention group (311 males and 334 females) and 622 in control group (307 males and 315 females). In the intervention group, the management of dyslipidemia in community was strengthened by graded follow-up and personalized diagnosis and treatment based on the contracted services of family doctors, while the control group adopted the general management of dyslipidemia in the community. After 12 months of intervention, the changes of lifestyle (smoking, drinking, body mass index, waist circumference), regularly taking lipid-regulating drugs, blood lipid, blood pressure, blood sugar levels and their control rates were compared by χ2 test or t test before and after intervention between the intervention group and the control group. Non-conditional logistic regression analysis was used to analyze the influencing factors of blood lipid attainment.@*Results@#Before intervention, there were no significant differences in gender, age, cardiovascular risk stratification, the levels of lipid and other metabolic indicators, lipid compliance rate between intervention group and control group (P> 0.05). After intervention, the intervention group improved in drinking, overweight,obesity, abdominal obesity, and the rate of regularly taking lipid-regulating drugs increased,compared with the control group, the difference was statistically significant (χ2=5.923,4.765,8.587,5.341, 5.654; all P<0.05). The levels of total cholesterol, triglyceride, low density lipoprotein cholesterol, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycosylated hemoglobinin the intervention group were lower than those in the control group, the differences were statistically significant (t=-4.987,-3.207, -6.280, -3.339, -2.466, -4.052, -5.012, -2.865, -2.450; all P<0.05), while the HDL-C level in the intervention group was higher than that in the control group (t=2.294; P<0.05). The control rate of blood lipids, the control rate of blood pressure, and the combined control rates of blood lipid, blood pressure and blood sugar in the intervention group were higher than those in the control group, the differences were all significant (χ2=31.262,4.818,17.245; all P<0.05). Unconditional logistic regression analysis showed that family doctor contracted services (OR=1.961, 95%CI: 1.485-2.589), gender (OR=0.662, 95%CI: 0.471-0.930), smoking (OR=0.498, 95%CI: 0.332-0.745), obesity (OR=0.570, 95%CI: 0.359-0.904), hypertension (OR=0.353, 95%CI: 0.259-0.480), diabetes mellitus (OR=0.340, 95%CI: 0.239-0.483) was the influencing factor of blood lipid reaching the target (all P<0.05).@*Conclusion@#Intensive management of dyslipidemia in community based on family doctor's contracting service is helpful to improve the management effect of dyslipidemia.
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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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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 provide rationales for preventing and treating dyslipidemia by understanding the current status of lipids and related metabolic factors.Methods A total of 2 590 permanent residents aged ≥ 18 years were selected by random cluster sampling from three urbanized communities of Sijiqing Street.And the rate of abnormal lipid metabolism was calculated for different ages and genders.Spearman's correlation analyses were conducted for the levels of total cholesterol (TC),total triglyceride (TG),low density lipoprotein-cholesterol (LDL-C),high density lipoprotein-cholesterol (HDL-C),body mass index (BMI),waist circumference (WC),systolic blood pressure (SBP),diastolic blood pressure (DBP),fasting plasma glucose (FPG),glycated hemoglobin (HbA 1 c) and uric acid (UA) levels.Both x2 test and logisic regression were employed to examine the correlations between dyslipidemia and overweight/obesity,hypertension,hyperglycemia and hyperuricemia.Results ① The total rate of abnormal lipid metabolism was 60.0％ (1 554/2 590) with a standardized rate of 57.2％.High TC rate was 42.9％ (1 111/2 590) with a standardized rate of 40.5％.And the edge incremental rate was 31.7％ (822/ 2 590),the standardized rate 30.5％,the incremental rate 11.2％ (289/2 590) and the standardized rate 10.0％.High TG rate was 33.0％ (855/2 590) with a standardized rate of 30.7％.And the edge incremental rate was 15.3％ (397/2 590),the standardized rate 14.3％,the incremental rate 17.7％ (458/2 590) and the standardized rate 16.4％.High LDL-C rate was 30.4％ (787/2 590) with a standardized rate of 28.4％.And the edge incremental rate was 22.9％ (594/2 590),the standardized rate 21.7％,the incremental rate 7.5％ (193/2 590) and the standardized rate 6.7％.Low HDL-C rate was 12.6％ (327/2 590) with a standardized rate of 12.8％.The rates of high TC,high TG,high LDL-C,low HDL-C and abnormal lipid metabolism among gender showed no statistically significant difference (P ＞ 0.05);② For both males & females,high TC rate,high TG rate,high LDL-C rate and total rate of abnormal lipid metabolism increased with age (P ＜ 0.01) while low HDL-C rate did not change with age (P ＞ 0.05);③Spearman's correlation analysis showed that the levels of TC,TG and LDL-C were positively correlated with BMI,WC,SBP,DBP,FBG,HbA1C and UA (all P ＜0.01) while the level of HDL-C had negative correlations with BMI,WC,SBP,DBP,FBG,HbA1 c,and UA (all P ＜ 0.05);④The total rate of abnormal lipid metabolism and various types of abnormal lipid metabolism increased with a rising level of BMI in the upward trend (trend test P ＜ 0.01),various types of abnormal lipid metabolism rate between different groups (elevated & non-elevated) of blood pressure,glucose and uric acid also were statistically significant (all P ＜ 0.05);⑤ Non-conditional logistic regression analysis showed that,after adjusting for age and gender,overweight or obesity and hypertension were risk factors of high TC and high LDL-C;overweight or obesity,hyperuricemia was a risk factor for low HDL-C;overweight or obesity,hypertension,hyperglycemia and hyperuricemia were risk factors for high TG and total abnormal blood lipid.Conclusions Urbanized community groups have a high rate of dyslipidemia.And abnormal lipid metabolism is affected by overweight or obesity,hypertension,hyperglycemia and hyperuricemia.The target population should be regularly monitored and comprehensively controlled.
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Objective To understand the trends of the prevalence of hyperuricemia of urbanized community residents Sijiqing Streets in Jianggan district in Hangzhou in the past 4 years,and analyze the correlation between hyperuricemia and metabolic factors,which provide scientific endence for prevention and treatment of hyperuricemia in communities.Methods 1 670 cases equal to or greater than 20 years old were randomly selected to analyze the trends of the prevalence of hyperuricemia in the past 4 consecutive years,which from urbanized community physical examination in 2010 to 2013 (male 749 cases,female 921 cases).Comparative analysis of age,BMI,waist circumference,systolic blood pressure,diastolic blood pressure,fasting blood glucose,glycosylated hemoglobin (HbA1C),TG,TC,LDL-C,and HDL-C levels between hyperuricemia group(male 264 cases,female 181 cases) and non hyperuricemia group (male 485 cases,female 740 cases) on 2013,and analyze the related metabolic factors to hyperuricemia by using non conditional logistic regression analysis.Results ①From 2010 to 2013,male hyperuricemia prevalence rates were 27.9％ (209/749,standardized rates were 27.4％)、29.1％ (218/749,standardized rates were 27.9％),33.2％ (249/749,standardized rates were 31.8％) and 35.2％ (264/749,standardized rates were 32.9％).The prevalence rates of female were 12.6％ (116/921,standardized rates were 11.7％),13.5％ (124/921,standardized rates were 11.9％),18.0％ (166/921,standardized rates were 15.7％) and 19.7(181/921,standardized rates were 17.2％),showed a increased tends year by year (the x2 of tends of male and female were 11.907 and 22.759,respectively,all P ＜ 0.01).In age stratified,the prevalence of hyperuricemia in middle and elder age group were increased significantly (the x2 of middle and elder aged man were 4.387、8.545,The x2 of middle and elder aged woman were 12.043、12.274,all P ＜ 0.05).The annual rate of male was higher than female (the x2 were 61.764、62.060、51.241、51.393,respectively,all P ＜ 0.01).② The male and female hyperuricemia group of age,BMI,waist circumference,systolic blood pressure,diastolic blood pressure,TG,TC,LDL-C levels were higher than those in non hyperuricemia group (the t of male were-2.052,-8.624,-8.772,-3.932,-4.380,-5.006,-3.564,-3.834,respectively; The t of female were-6.021,-8.839,-7.586,-4.702,-4.431,-6.334,-5.317,-5.119,respectively,all P ＜ 0.01),HDL-C levels were lower than those of non hyperuricemia group(the t of male and female were 6.097 and 3.170,respectively,all P ＜ 0.01),fasting blood glucose,HbA1c levels of non hyperuricemia group in female were also higher than the non hyperuricemia group (t =-2.750,-3.711,all P ＜ 0.01),however,Nor was statistical significance in male between the two groups (t =0.432,1.315,all P ＞ 0.05).③The non conditional Logistic regression analysis showed that,independent risk factor for male hyperuricemia were overweight (OR:2.151,95％ CI:1.439-3.215) or obese (OR:2.882,95％ CI:1.541-5.389),hypertension (OR:1.564,95％ CI:1.100 -2.224),dyslipidemia (OR:1.678,95 ％ CI:1.165-2.417) and abdominal obesity (OR:1.708,95 ％ CI:1.146-2.547),independent risk factors for hyperuricemia in women were overweight (OR:2.067,95％ CI:1.290-3.313) or obese (OR:2.843,95％ CI:1.523-5.309),hypertension (OR:1.530,95％ CI:1.042-2.248),dyslipidemia (OR:1.784,95 ％ CI:1.191-2.672) and hyperglycemia (OR:1.768,95％ CI:1.221-2.561).Conclusions The community people have a higher prevalence of hyperuricemia,which showed a increased trend,especially in the middle and old age year by year; overweight or obesity,abdominal obesity,hypertension and dyslipidaemia influence male prevalence rate of hyperurieemia,overweight or obesity,hypertension,hyperglycemia and dyslipidemia influence female prevalence rate of hyperuricemia,we should strengthen the comprehensive prevention and treatment of hyperuricemia in this community.
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<p><b>OBJECTIVE</b>To evaluate the feasibility of developing brain-targeted nasal delivery system of scutellarin by the passage between nase and brain in nasal olfactory area.</p><p><b>METHOD</b>The samples of cerebrospinal fluid (CSF) and blood were prepared by cranial puncture and femoral artery catheterization methods respectively according to the certain sampling time after drug administered. The scuteIlarin concentration of samples were determined by 125 marked method. Pharmacokinetic parameters were calculated by trapezoidal rule. The brain-targeted trendence were evaluated by the value of the index AUC(brain)/AUC(plasma).</p><p><b>RESULT</b>The distribution of scutellarin in brain following intranasal administration was different between tissues. Drug concentration in olfactory bulb achieved to peak at 5-15 min after intranasal administration, while in brain tissue was 30-60 min. Above all, peak concentration in olfactory bulb and olfactory region respectively were (574.8 +/- 205.), (323.4 +/- 128.3) ng x g(-10, both are higher than CSF, which is (123.2 +/- 29.3) ng x g(-1). Moreover, the distribution of scutellarin given by intranasally in brain was: olfactory bulb (OB) > olfactory region (OR) > cerebrospinal fluid (CSF) > cerebellum(CB) > medulla oblongata (MO) > cerebrum (CR); AUC(0-240) of olfactory bulb, olfactory region and CSF after scutellarin intranasal administration were 5.54, 5.07 and 5.51 times of that after intravenous injection, respectively. And the AUC(0-240) of other brain tissues after intranasal administration were also higher than that after intravenous injection. AUC(brain tissue)/ AUC(plasma) of every brain tissues by intranasally are all higher than that by intravenously remarkably. For instance, 5 min after intranasal administration, the value of AUC(CSF)/ AUC(plasma), AUC(OB)/AUC(plasma), and AUC(CR)/AUC(plasma) were 30.34, 56.93, and 6.14 times of that by intravenously.</p><p><b>CONCLUSION</b>Part of scutellarin could be straightly transported into brain by the intranasal administration. Its absorption pathway was: the molecule of Scutellarin throughed olfactory mucosa in nasal cavity into olfactory bulb in arachno-hypostegal cavity, and then entered into olfactory region, CSF, cerebrum and cerebellum gradually. It showed that olfactory bulb was the only way for drug molecule to go through nasal cavity into brain. It had a significant trendence of brain-targeted when compared to oral administration and intravenous injection, which indicated a certain feasibility to develop a brain-targeted nasal delivery system for scutellarin.</p>