ABSTRACT
Objective:To evaluate the current situation of comprehensive medical and health services of primary medical institutions in a city under the policy of family doctor contracted service, and explore the influencing factors and put forward improvement strategies, for the reference to improve the medical and health service level of primary medical institutions.Methods:In January 2021, 18 primary medical institutions in 3 counties(cities, districts) of a city in Shandong province were selected by stratified sampling method, and 60-70 contracted residents were selected from each institution for questionnaire survey. The questionnaire covered two dimensions: service provision(19 items) and metion frequency of health problems(12 items). According to the principle of information saturation, qualitative interviews were conducted with 20 family doctors and 15 contracted residents to identify the current service needs and existing problems. Descriptive analysis was used for all data, and single factor analysis of variance and multiple linear regression analysis were used for influencing factors of comprehensive service scores of primary medical institutions.Results:1 098 contracted residents were included in this study, and the comprehensive service score was 3.15±0.42. The vaccination, maternal health care and health education scored higher with 3.80±0.54, 3.70±0.64, 3.78±0.57 respectively; The dermatology, mental health counseling and family sickbed scored lower, with 2.27±1.20, 2.97±1.01 and 1.92±1.18 respectively. Contracted institution, gender, age and marital status were the influencing factors of comprehensive service scores( P<0.05). Residents′ needs for family sickbeds, psychological counseling and fall prevention had not been met. Conclusions:The primary medical institutions of the city had provided better basic public health services, while unmet needs were demand for home sickbeds, psychological counseling and fall prevention. We should take effective measures to increase the service supply based on the needs of residents, and provide more comprehensive medical and health services for residents at primary medical institutions.
ABSTRACT
Objective:To explore the relationship between soft markers found in the first trimester (11-13 + 6 gestational weeks) ultrasound screening and fetal adverse pregnancy outcomes. Methods:Single pregnancy fetuses were selected from the Multicenter Clinical Study of First Trimester Screening in China during August 2017 to August 2020. The types and detection rate of soft markers during the first trimester were compared. The correlation between positive soft markers and adverse pregnancy outcomes was analyzed by binary Logistics regression.Results:A total of 16 625 fetuses with complete follow-up outcomes were included in the group. Six hundred and seven ultrasonic soft markers were detected in 556 fetuses with positive soft markers during the first trimester, and the first four most frequently occurred were increased nuchal translucency (NT) (2.08%, 345/16 625), echogenic intracardiac focus (EIF) (0.94%, 156/16 625), hypoplasia of fetal nasal bone (0.20%, 34/16 625), single umbilical artery (SUA) (0.19%, 31/16 625). Among 556 fetuses, the incidence of adverse pregnancy outcome in fetuses with two or more positive soft markers was 32.50% (13/40), which was significantly higher than fetuses with single positive soft marker (11.05%, 57/516), and the difference was statistically significant (χ 2=5.055, P<0.001). The incidence of adverse pregnancy outcome in positive soft markers fetus associated with structural abnormalities was 80.77% (21/26), which was significantly higher than fetuses with isolated positive soft marker (12.08%, 64/530), and the difference was statistically significant (χ 2=90.310, P<0.001). Binary logistic regression analysis showed choroid plexus cyst (CPC), SUA, echogenic bowel (EB), absent/reversed a-wave of ductus venosus, hypoplasia of fetal nasal bone, increased NT, and EIF were closely related to the adverse pregnancy outcomes (all P<0.05). However, there were no significant correlations between tricuspid regurgitation (TR), pyelectasis (PYE) and fetal adverse pregnancy outcomes (all P>0.05). Conclusions:The ultrasonic soft markers during the first trimester are of great significance in predicting fetal adverse pregnancy outcomes. For multiple positive soft markers or positive soft markers combined with structural abnormalities, more attention should be paid to them and comprehensive evaluation is required to be carried out.
ABSTRACT
Broca's aphasia is a common type of aphasia after stroke. Its etiology and pathogenes belong to deficient root and excessive superficial. Deficiency of qi and blood, liver and kidney yin is the origin of the disease, and wind, fire, phlegm and blood stasis are the symptoms. Acupuncture therapy aims to refresh the brain, dredge the orifices and amplify the sound, supplemented by benefiting qi and blood, removing phlegm and blood stasis, benefiting tongue. At present, scalp acupuncture, tongue acupuncture, electroacupuncture, characteristic acupuncture and acupuncture combined with other therapies are commonly used to treat the disease. It is observed that acupuncture combined with other therapies have showed advantages in reducing the disability, and realize the optimal principle.
ABSTRACT
ObjectiveTo analyze the epidemiological characteristics of scarlet fever in Putuo District， Shanghai from 2015 to 2020， and provide a basis for formulating effective prevention and control measures. MethodsThe data of scarlet fever cases from January 1， 2015 to December 31， 2020 in Putuo District， Shanghai were obtained from the Infectious Disease Reporting Information Management System of the Chinese center for disease control and prevention （CDC）. Descriptive epidemiological method was used to analyze the epidemiological characteristics of scarlet fever cases in Putuo District， Shanghai by time， population， and region. ResultsA total of 586 scarlet fever cases were reported in Putuo District from 2015 to 2020， with an average annual reported incidence of 7.39 per 105， an average age of onset of 6.2±1.8 years， and a male/female ratio of 1.6∶1. The incidence of scarlet fever has declined significantly in 2020， which was 5.44 per 105 lower than the average reported incidence in 2015‒2020. The incidence peak was from April to June and November to January of the following year， which was characterized by high incidence in spring and winter. The age distribution of cases was concentrated at the age of 4‒9 years， mainly children in kindergarten and primary school students. Areas with high reported incidence rates were Wanli Street， Changzheng Town， Taopu Town and Changfeng New Village Street. ConclusionThe peak incidence of scarlet fever in Putuo District is from April to June and November to January of the following year， with children in kindergartens and students in primary school as the key populations. We should strengthen epidemic monitoring and guidance of prevention and control for in kindergartens and schools before the high incidence season of scarlet fever， so as to effectively prevent the epidemic of the disease.
ABSTRACT
Objective:To evaluate and analyze the patient experience of residents contracted with primary medical institutions, for providing a basis for improving quality of contracted family doctor services.Methods:Using the Chinese version of the primary care assessment tools(PCAT), a household survey was conducted on 1 400 contracted residents in 9 community health service centers and 9 township health centers in a city from May to June 2020, and their medical experience in primary medical institutions was statistically analyzed. At the same time, interviews were conducted with institutional managers and family doctors. Descriptive statistics and one-way ANOVA were used for data analysis.Results:1 333 valid questionnaires were collected, and the effective recovery rate was 95.2%.The total PCAT scoring was 25.17. Seven dimensions of first contact, continuous, coordination, comprehensiveness, patient and family centered, community-oriented and cultural competence scored in average 3.57, 3.68, 3.54, 3.40, 3.72, 3.67 and 3.59 respectively.372 people(47.1%) had not been referred by the contracted institution before going to the superior hospital or specialized hospital. There were significant differences in the scores of four core dimensions in different types of institutions, age, education level, occupation and income( P<0.001). Conclusions:Given the initial progress of contracted family doctor services in the city, there is still room for improvement. It is suggested to further improve the comprehensiveness, coordinationand accessibility of services, and promote the high-quality development of contracted family doctor services.
ABSTRACT
Objective:To explore the current status of medical preventive integration at primary medical institutions, analyze the problems of medical prevention integration, and put forward optimization suggestions.Methods:From June to July 2020, 169 primary medical institutions in a city were selected as the survey objects to conduct a questionnaire survey on the basic information of institutions and the evaluation indicators of medical preventive integration. The evaluation index system of medical preventive integration was divided into a factual survey and a sensory survey. In addition, 32 relevant personnel were interviewed on the current situation of medical preventive integration at primary medical institutions. The reliability and validity of the data were tested and analyzed, while descriptive analysis and classification extraction analysis were carried out.Results:The reliability and validity analysis proved the data reliability. The factual survey extracted three common factors, namely organization management, performance appraisal distribution and information management. The sensory survey extracted two common factors, namely working mode and personnel training. In terms of organization, management and working methods, the degree of medical preventive integration was low. Among them, 53.8% of the institutions had formulated the medical preventive integration norms, and only 41.4% of them had shared residents′ health information in time.Conclusions:The degree of medical preventive integration of primary medical institutions in the city still need to be improved. In the future, we should strengthen the top-level design, establish the norms and cooperation mechanism of medical preventive integration, improve the awareness of medical preventive integration of medical personnel, improve the information level, and to build a new service model integrating disease prevention, medical treatment and health management.
ABSTRACT
Objective:To understand the willingness of contracted residents to renew the family doctor contract service in Shandong Province, and to explore its influencing factors.Methods:From July to August 2020, 1 500 contracted residents in 3cities of Shandong Province were investigated by questionnaire survey.Descriptive statistical analysis, Mann-Whitney U test and binary logistic regression model were used to analyze the contracted residents′ cognition, utilization, satisfaction evaluation and renewal intention of family doctor contract service. Results:1 445 valid questionnaires were obtained, of which 682(47.2%)were willing to renew their contracts.The results of binary logistic regression analysis showed that marital status, educational level, time to see a doctor in contracted institutions, optimism about the development prospect of contracted service policy, whether the proportion of medical insurance reimbursement increased after signing the contract, whether follow-up work was carried out on time, satisfaction with family doctor service attitude and satisfaction with the effect of disease treatment were factors affecting the willingness of contracted residents to renew the contract.Conclusions:The contracted residents in Shandong Province have a high willingness to renew their contracts. On the basis of consolidating and improving the policy cognition and confidence of the contracted residents, we should actively optimize and improve the contracted service quality, ensure the sense of service access of contracted residents, and continuously and effectively realize the comprehensive promotion of the contracted services of family doctors.
ABSTRACT
Objective:To find out the optimal ratio of tip projection to nasal length for Chinese in order to help doctors to reduce the dissatisfactory rate of rhinoplasty.Methods:The authors retrospectively reviewed the records of patients with rhinoplasty from June 2015 to June 2018. The patients were classified into satisfactory, underprojected and overprojected groups. The average, maximum, minimum of tip projection (TP), nasal length (NL) and TP/NL, median of TP/NL of each group were measured. The results were used in later patients to assess their efficacy by comparing the dissatisfactory rates of patients before and after June 2018.Results:In satisfactory group, the mean of TP/NL was 0.63 with minimum 0.56, maximum 0.69, and median 0.64 in primary cases, while the mean of TP/NL was 0.63 with minimum 0.52, maximum 0.75, and median 0.64 in secondary cases. In underprojected group, the mean of TP/NL was 0.60 with median 0.58. In overprojected group, the mean of TP/NL was 0.64 with median 0.65. The dissatisfactory rates of patients before and after June 2018 were 8% and 2.2%, respectively ( P>0.05). Conclusions:The optimal ratio of tip projection to nasal length for Chinese is near 0.63-0.64. Combined with the desire of patient, it is possible for doctors to satisfy the patients by controlling tip projections between 2.5 cm to 2.8 cm.
ABSTRACT
Objective@#To explore the effect of mental health education on the problematic social media use among college students, and to provide the basis for college mental health education in colleges and universities.@*Methods@#Problematic Social Media Use was used to select 44 college students who were randomly assigned into experimental and control group. The experimental group received psychological intervention once a week for eight weeks, and the control group did not receive any intervention. Loneliness Scale,Univesity of California of Los Angels(UCLA), Multidimensional State Boredom Scale(MSBS), Interpersonal Anxiety Scale(IAS) were administered before and after the experiment in both of the groups.@*Results@#There was no significant differences between the experimental and the control group in total score of UCLA, MSBS, IAS and AQPMS. After intervention, prevalence of problematic mobile social media use in experimental group decreased from 100.0% to 45.8%. After intervention, significant differences in total score of UCLA, MSBS, IAS and AQPMS were observed in experimental group(P<0.05), as well as between the experimental group and the control group(P<0.05).@*Conclusion@#Mental health education can effectively reduce problematic mobile social media use, as well as negative emotions of college students.
ABSTRACT
Fecal microbiota transplantation(FMT),as a special organ transplantation,can be used to reconstruct the intestinal flora.It has been concerned by clinical practice,but it has not become a routine treatment method.With the gradual deepening of the study of FMT,the refractory difficile fusiform bacillus infection,inflammatory bowel disease,irritable bowel syndrome,chronic fatigue comprehensive syndrome and some metabolic disorders related to intestinal diseases were obtained using.In recent years,there are some reports about the application of FMT in children's diseases.Combining with the relevant literature at home and abroad,this paper reviews the indications and the taboo of the application of FMT in children,the aim is to provide a reference for FMT to be better applied in pediatric clinical.
ABSTRACT
Objective To provide reference basis for clinical ,it is necessary to analyse the distribution and drug resistance of pathogenic bacteria isolated from intensive care unit .Methods The bacterial specimens from patients that treated in intensive care unit from January to December in 2013 ,had been collected and cultivated .The VITEK automatic bacterial identification system was performed to identify pathogens and drug susceptibility test .The software of Whonet5 .6 was used for statistically analysis .Results 1261strainsofpathogenicbacteriawereisolated,including900strainsofgramnegativebacilli,348strainsofgrampositivebac‐teria and 13 of fungi .Conclusion Gram negative bacillus is the main pathogenic bacteria in the critical patients .In order to improve the clinical efficacy ,clinical treatment should be based on the pathogenic bacteria culture and drug sensitivity test results to reasona‐bly apply antibacterial drugs .
ABSTRACT
Objective To predict the length of peripherally inserted central venous catheters(PICC) with electronic chest radiograph scale measurement techniques, and observe its clinical effect. Methods A total of 185 breast cancer patients from October 2012 to December 2013 who were treated by PICC combined with MST guided by ultrasonic technology were as control group. A total of 192 breast cancer patients from January to November 2014 were as observation group. Control group adopted from the puncture point to right sternoclavicular joints impreaaion nip down again to the third floor of PICC in vitro measurement method. Observation group used to right sternoclavicular joints from the puncture point plus right sternoclavicular joints to subcarinal 1 vertebral body length, right sternoclavicular joints to subcarinal 1 vertebral body length measurement by electronic chest radiograph scale technology directly measured from the electronic chest radiographs. The accuracy rates and complications between the two measurement methods were compared. Results The accuracy rate in observation group was 97.92%(188/192), which was higher than that in control group (68.11%,126/185 ),and there was significant differencek,χ2=60.15, P<0.01. The complication rate in observation group was 6.77%(13/192), which was lower than that in control group (20.54%, 38/185) ,and there was significant difference,χ2=9.58, P<0.01. Conclusions The electronic chest radiograph scale measurement techniques could effectively improve the accuracy of PICC catheter placed, improve the quality of venipuncture, decrease the complications .
ABSTRACT
Objective To study the clinical effect of tacrolimus combined with small dose of prednisolone in treatment of IgA nephropathy.Methods 84 cases with IgA nephropathy were randomly divided into study group and the control group in accordance with the digital table method.The control group was given simple hormone treatment, while the study group was treated with tacrolimus combined with small dose of prednisolone.The clinical efficacy and safety were compared between the two groups.Results The treatment effective rate (100.00%)and complete remis-sion rate (73.81%)of the study group were significantly higher than those in the control group (76.19%, 23.81%),and the differences were statistically significant (χ2 =21.01,11.35,P 0.05).When patients lighter (Lee's Ⅱ level),the team for complete response rate was significantly higher than the control group,and the difference was statistically significant (χ2 =5.01,P 0.05).The incidence rate of adverse reactions in the study group (19.05%)was not significantly different from that of the control group (16.67%)(χ2 =0.08,P >0.05 ).Conclusion Tacrolimus combined with small dose hormone for the treatment of IgA nephropathy has high clinical value,it can significantly reduce the level of IgA nephropathy 24h nephropathy,and adverse reactions.
ABSTRACT
Objective Several surgical procedures are available for treatment the prominent mandibular angle. But in some patients, only one procedure is not likely to obtain satisfactory results. This study was to evaluate the effect of curved osteotomy combined with sagittal splitting osteotomy of the mandibular angle by an intraoral approach for treatment the broad lower face. Methods 21 patients with broad lower face were treated with mandibular angle osteotomy plus mandibular angle splitting osteotomy under general aesthesia by intraoral approach. Changes of the distance between the mandibular angles were observed during follow up phase. Questionnaires were used to assess the patents level of satisfaction after operation. Results All the wounds healed without complications of bleeding and infection. After 7 months to 12 months follow up, the distance between the mandibular angles was effectively reduced, the deformity of broad lower face were improved markedly, the curve of the mandibular angle was smooth and the shape was natural. Conclusion This method is worthy to be applied widely because of the good result with effective reduction of the width of the lower face, smooth and gentle outline of the face.