A comparison of three diagnostic criterions for metabolic syndrome applied in a Chinese population aged 35-64 in 11 provinces / 中华流行病学杂志

<p><b>OBJECTIVE</b>To compare the differences of three diagnostic criterions for metabolic syndrome( MS), issued by the National Cholesterol Education Program(NECP), International Diabetes Federation(IDF) and CDS,in a Chinese population aged 35-64 years in 11 provinces.</p><p><b>METHODS</b>A total of 29 564 Chinese resedents aged 35-64 years were recruited from 11 provinces and a survey on cardiovascular risk factors was conducted in 1992. Additionally,3129 participants were added into the study from 1996 to 1999. MS prevalence was calculated according to three definitions and results of MS components distributions and risk factor aggregation were analyzed.</p><p><b>RESULTS</b>(1)The age-adjusted prevalence of MS in Chinese population were 18.7% for ATP III criterion, 14.6% for IDF criterion and 9.0% for CDS criterion,respectively. (2)Seventy-seven point eight percent of the subjects with MS diagnosed by ATP II criterion presented central obesity. Four point six percent of subjects without MS diagnosed by IDF criterion and 11.2% of subjects without MS diagnosed by CDS criterion presented at least 3 risk factors, respectively. (3)Kappa index showed 0.795 for ATPIII criterion and 0.899 for IDF criterion when applied in Chinese population. (4)The shortest distance in ROC curve for forecasting risk factor aggregation of MS was 0.40 in male and 0.34 in female when waist circumferences were 85 cm in males and 80 cm in females respectively.</p><p><b>CONCLUSION</b>ATPIII definition could be used to detect the highest prevalence of MS and the percent of risk factor aggregation among three definitions. The appropriate cut-off points of waist circumference for Chinese were 85 cm for male and 80 cm for female respectively.</p>

Trends regarding the incidence of recurrent stroke events in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the trends and distributions of incidence on recurrent stroke events in population aged 35 to 74 in Beijing from 1984 to 2000.</p><p><b>METHODS</b>In Sino-MONICA project, acute stroke events were registered in a standardized way in men and women aged 35-74 years in Beijing from 1984-2000. Recurrent stroke event was defined as recurrence within 28 days after first stroke onset.</p><p><b>RESULTS</b>From 1984 to 2000, incidence of recurrence stroke events increased from 89.51/100 000 to 143.34/ 100 000. In the 17 years of follow-up period, rate of recurrent ischemic stroke increased by 153%, and the rate of hemorrhagic stroke decreased by 42.94%. In all events, the recurrent rate of stroke accounted for 29.8%. This rate was higher in men (31.7%) than that in women (26.9%). The event rate of recurrent stroke 1.6% of increase per year in men, higher than that in women which was 0.6%. Subjects with history of hypertension, diabetes, coronary heart disease had a higher rate of recurrent stroke.</p><p><b>CONCLUSION</b>Recurrence rates for stroke events increased significantly during the 17 years of observation, from 1984 to 2000. Subjects with history of hypertension, diabetes and coronary heart disease had a higher rate of recurrent stroke than other subjects.</p>

Distributions of high-sensitivity C-reactive protein and its association with metabolic syndrome in population aged 45-74 in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the distributions of high-sensitivity C-reactive protein (hs-CRP) and its association with metabolic syndrome (MS) in population aged 45-74 in Beijing.</p><p><b>METHODS</b>A population-based cross-sectional survey was conducted in Beijing during 2002-2004 and the component of MS and plasma hs-CRP concentration were assessed. Analysis was performed in a total of 1544 subjects with completed information. Metabolic syndrome was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans.</p><p><b>RESULTS</b>The median and geometric mean concentrations of hs-CRP among our study population were 1.00 mg/L and 0.79 mg/L, respectively, hs-CRP level showed an upward trend with increased age (P<0.05) but no statistically significant difference of hs-CRP levels between genders was observed (P>0.05). The prevalence of MS progressively increased with elevated hs-CRP quartiles (P<0.01). The prevalence rates of hypertension and central obesity were substantially higher in the highest quartile of hs-CRP levels than those in the lowest quartile. In a univariate logistic regression analysis, the risk for MS was higher in the highest quartile of hs-CRP than that in the lowest quartile. After adjusting for age, sex, smoking and drinking, the highest quartile of hs-CRP was found to be independently associated with each component of MS and 6.35-fold increased risk of MS.</p><p><b>CONCLUSION</b>The hs-CRP level appeared to be increased with age and correlated to all the components of MS.</p>

A study on the capability of dyslipidemia diagnosis and treatment among 42 community hospitals in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the use of lipidemia related assistant examinations and lipid-lowering agents, the clinical ability among physicians in district and community hospitals in Beijing, and to evaluate the capability of dislipidemia diagnosis and treatment in these hospitals.</p><p><b>METHODS</b>A survey was carried out in 42 hospitals in Chaoyang and Haidian district, including 9 district level hospitals, and the rest were at the community level. Questionnaire survey and in-depth interview were used to collect information from the leaders of related departments in those hospitals. A total number of 632 physicians in those hospitals were investigated, using a close book examination.</p><p><b>RESULTS</b>100% of the hospitals could perform TC and TG tests; 87.5% and 72.5% of the hospitals had medications as statins and bile acid, respectively; 100% of the hospitals could test ALT and 40.0% of the hospitals could test CK. The correct rates of selecting treatment strategy and determining the appropriate treatment goals were 53.7% and 17.6%, respectively.</p><p><b>CONCLUSION</b>The hardware condition of community hospitals seem to have satisfied the implicit requirements of dyslipidemia evaluation and treatment but it was essential to improve the knowledge and ability among physicians in community hospitals.</p>

The impact of two continuing education models on competence for hypertension diagnosis and treatment of community physicians / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the impact of two different continuing education models: traditional model and a new model entitled "problem-oriented and case-based" mutual pattern and "train the trainer" course, on improving hypertension diagnosis and treatment competence of community physicians.</p><p><b>METHODS</b>A total of 632 physicians from 22 district and community hospitals in Haidian district (new model) and 20 district and community hospitals in Chaoyang district (traditional model) in Beijing were trained during July to October 2002. The survey was carried out before and 2 years after training with examination questionnaire.</p><p><b>RESULTS</b>The competence evaluated as a score (maximal 100) for hypertension diagnosis and treatment of physicians was similar in physicians before training from the two districts. Post training, the score significantly increased from 40.0 to 47.4 (P < 0.01) in physicians from Chaoyang district and from 40.5 to 70.5 (P < 0.01) in physicians from Haidian district and the final score for physicians from Haidian district is significantly higher than that for physicians from increased from Chaoyang district (P < 0.01).</p><p><b>CONCLUSION</b>The new model is more efficient for improving community physician's competence for diagnosing and treating hypertension.</p>

A cross-sectional study on the usage condition of hypertension related examinations and antihypertensive drugs among 40 district and community based hospitals in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the use of hypertension related physical examinations, laboratory tests and anti-hypertension drugs among district and community based hospitals in Beijing and to analyze the possible hardware (examination, test, drug) problems under the application of the "China Hypertension Guide" in those hospitals.</p><p><b>METHODS</b>The survey was carried out in 40 hospitals in Chaoyang and Haidian districts, including 9 district level hospitals, and the rest at community level. Questionnaire survey and in-depth interview were used to collect information from the leaders of related departments in those hospitals.</p><p><b>RESULTS</b>(1) The hardware condition of district hospital satisfied the implicit requirements of hypertension evaluation and treatment in "China hypertension Guide". (2) 64.5% of the community level hospitals had the basic equipments and routine laboratory tests for diagnosis and treatment on hypertension, but 35.5% of them lack of tests on blood chemistry (potassium, sodium, creatinine) and urine protein. (3) 71.0% of community level hospitals could not judge the patient's "target organ damage" independently. (4) Both district and community level hospitals had all major types of anti-hypertension drugs in there pharmacy except ARB.</p><p><b>CONCLUSION</b>When necessary laboratory tests for both district and community level hospitals were provided, they could accomplish the tasks of hypertension treatment and management. However, the community level hospitals should cooperate with hospitals at higher level to have a comprehensive clinical understanding of patients with high blood pressure.</p>

Study on the influence of knowledge about hypertension and clinical management competence among physicians treating hypertensives in district and community hospitals / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the influence of knowledge about hypertension and clinical competence among physicians in district and community hospitals on management of hypertensives.</p><p><b>METHODS</b>Questionnaire investigation was used in 9 district and community hospitals in Chaoyang and Haidian district, including 181 physicians and 204 patients with hypertension.</p><p><b>RESULTS</b>(1) The hospitals involved were divided into two groups according to our evaluation on the knowledge of hypertension and clinical competence of physicians. Four hospitals were graded as high-score group and 5 hospitals as low-score group. (2) There was no significant difference on physicians' evaluation between district and community hospitals. There was higher proportion of hypertensives with instructed physical exercises, reducing salt ingestion, psychological balance and weight reduction in district hospitals than those in community ones. (3) The proportion of hypertensives who were examined with funduscopy, ambulatory pressure and instructed with physical exercises, reducing salt ingestion and weight reduction in high-score group was obviously higher than that in low-score group. The control rates of blood pressure, on the days of examination during lastest check-up or the past three months, were significantly higher in high-score group than in low-score group (P < 0.05).</p><p><b>CONCLUSION</b>Knowledge of hypertension and clinical management competence among physicians in district and community hospitals did influence the management of hypertension and education of physicians and thus should be increased.</p>

A cross-sectional study on knowledge and the ability of hypertension treatment among physicians in district and community hospitals / 中华流行病学杂志

<p><b>OBJECTIVE</b>To estimate the knowledge level and clinical ability of hypertension treatment among physicians in district and community hospitals in big and moderate cities.</p><p><b>METHODS</b>43 district and community hospitals were selected by non-random sampling in Beijing and Baotou inner-Mongolia municipality. A total of 754 physicians in those hospitals were investigated, through an examination.</p><p><b>RESULTS</b>The correct rates on blood pressure stages, risk stratification and treatment strategy were 64%, 28% and 54%, respectively. The knowledge level on non-pharmacologic treatments was insufficient among physicians. The knowledge level of special indications on the common antihypertensive drugs (such as diuretics, beta-blockers, ACE inhibitors) was even worse.</p><p><b>CONCLUSION</b>Physicians in district and community hospitals did not have enough knowledge and ability to fulfill the task of hypertension treatment and management.</p>