ABSTRACT
Objective To determine the sub-health status and influencing factors among medical staff in community health service centers, and to provide scientific evidence for intervention measures and strategies of health promotion. Methods A questionnaire survey was conducted in 692 community medical staff from 8 community health service centers in Hongkou District, Shanghai.Sub-health condition scale was used to identify the incidence rate of sub-health.Simple job stress questionnaire was used to identify the incidence rate of occupational stress.The correlations between sub-health status and demographic and sociological factors, living habits, occupational stress and other factors were determined by multivariate logistic regression analysis. Results The incidence rate of sub-health among targeted community medical staff was 71.4%.The following factors were shown to be related to the incidence of sub-health: women (OR=2.24, 95%CI: 1.42-3.55), per capita living area ≤ 30 m2(OR=2.19, 95%CI: 1.24-3.87), daily average sleep time < 7 hours (OR=1.64, 95%CI: 1.10-2.46), habits of drinking alcohol (OR=1.58, 95%CI: 1.04-2.40), frequent overtime work (OR=1.79, 95%CI: 1.12-2.86) and occupational stress (OR=1.73, 95%CI: 1.16-2.58). Conclusion The incidence rate of sub-health among medical staff in community health service centers is high, and unhealthy living habits and occupational stress are the influencing factors.
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Objective To analyze the change in cost reduction for tuberculosis (TB) patients in Tilanqiao community of Shanghai from 2006 to 2016,and to evaluate the implement effect of TB remission policy in Shanghai.Methods The data were collected on treatment costs for 309 TB patients who had completed treatment and participated in the cost remission reimbursement by outpatient registration.The trend of deductible expenses and the remission costs were analyzed by SPSS.Results During the implementation of the original remission policy(ORP),the deductible expense was 1 021.06±457.67 yuan.And it changed to 2 320.64±1 544.73yuan under the new remission policy (NRP),which had an increase of 1.27 times and the new remission fee ratio was 45.19%.The deductible expenses change curve shown a trend of rising.The new remission fee ratio was 27.62% in 2009 and increased to 46.62% in 2010,then became 51.05% in 2016.The new remission fee ratio for outpatients was significantly lower than that for the hospitalized.During the implementation of the ORP,the remission cost was 931.05±465.47 yuan,and it was 1 507.80±974.15 of the NRP,which increased 61.95%.The remission ratio was 17.55% of the ORP,when it was 15.91% of the NRP which decreased by 1.64 percent.The remission ratio curve showed a trend of downward.The remission ratio for outpatients was significantly higher than that for the hospitalized.Conclusion From 2006 to 2016,the implement effect of remission policy on treatment costs of tuberculosis had improved.However,it had not effectively reduced the disease burden of TB patients.So in the follow-up remission policy,we must strengthen improvement on the settings of deductible project and control disease treatment.
ABSTRACT
<p><b>BACKGROUND</b>The insufficiency of the proximal landing zone (PLZ) is a frequent factor challenging the applicability and efficacy of endovascular repair (EVR) for thoracic aortic disorders. This study discusses two strategies for conquering this challenge.</p><p><b>METHODS</b>Ten patients underwent EVR for thoracic aortic diseases during a one-year period ending June 30, 2004. Nine patients had DeBakey type III dissecting aortic aneurysm (DAA), and one had descending thoracic aortic aneurysm (DTAA). The PLZ, defined as the distance from the origin of the left subclavian artery (LSA) to the primary entry tear of the dissection or to the proximal aspect of DTAA, was less than 15 mm in all instances. EVR with intentional coverage of the LSA without any supportive bypass was employed in 6 patients with DAA, and the preliminary right-left carotid and left carotid-subclavian bypass combined with EVR in the DTAA and other 3 DAA cases.</p><p><b>RESULTS</b>Technical success was achieved in all the patients. The patient with DTAA died from hemispheric cerebral infarction and subsequent multiple system organ failure following an uneventful recovery from the cervical reconstruction performed 1 week previously. In cases receiving the EVR with intentional coverage of the LSA, in two patients dizziness occurred, which noticeably resolved after intravenous administration of mannitol for 4 to 5 days, and a drop in blood pressure of the left arm was noted in all the cases, but remained clinically silent. No neurological deficits or limb ischaemia developed perioperatively or during the followup, ranging from 3 to 12 months, and complete thrombosis of the thoracic aortic false lumen was revealed on CT at 3 months in the 9 patients with DAA.</p><p><b>CONCLUSIONS</b>Both the intentional bypass absent coverage of the LSA and the adjunctive surgical bypass appear to be feasible and effective in managing the insufficiency of the PLZ during the endovascular thoracic aortic repair.</p>