ABSTRACT
Township and Village Health Services Integration Management (TVHSIM) is an essential form of China's two-tiered health service integration plan at the township and village level.Its main purpose,also one of the target goals in China's new healthcare reform,is to gradually integrate rural health services and appropriately allocate rural health resources.This study aims to assess the village doctors' satisfaction with the TVHSIM and provide scientific base to further improve TVHSIM.A cross-sectional study was carried out in which 162 village doctors from Qinghai,Inner Mongolia and Xinjiang in western China were interviewed.Descriptive analysis,independent t-test,one-way ANOVA,Spearman rank correlation and multiple linear regression were used to analyze the difference and relevance between village doctors' personal characteristics and their satisfaction with TVHSIM and six subscales.Village doctors with different years of practice,social insurance status and essential medical knowledge level showed statistically significant differences in their satisfaction levels (all P＜0.05).Age (P＜0.05) and years of practice (P＜0.01) were negatively correlated with Drug and Medical Device Management and Financing Management.Essential medical knowledge level (P＜0.05) was negatively correlated with Operations Management as well.However,social insurance status (P＜0.05) was positively correlated with Human Resources Management and Drug and Medical Device management.Gender,age and years of practice respectively had significant influence on village doctors' satisfaction with TVHSIM (P＜0.01).In conclusion,in order to further promote TVHSIM policy in rural China,a well-rounded social insurance model for village doctors is urgently needed.In addition,the development of TVHSIM is regionally imbalanced.Efficient and effective measures aiming at rationalizing gender and age structure and enhancing essential medical training should be carefully considered.
ABSTRACT
Objective:To observe the clinical curative effect of anti-reflux treatment in the elderly patients with laryngopharyngeal reflux and obstructive sleepapnea hypopnea syndrome (OSAHS) and to explore the related influencing factors. Method:The cross-sectional area of the narrowest plane in the nasopharyngeal region, velopharyngealregion, glossopharyngeal region, and hypopharynx region were measured using Spiral CT combined with Müller's experiment and computer processing system. All the elderly patients were administered with proton pump inhibitors (rabeprazole sodium, 20 mg/d) and domperidone tablets (10 mg×3/d) for 3 months. After treatment, repeat tests were performed to evaluate the therapeutic effects. Result:Before and after 3 months of treatment, significant difference was found in the total number of reflux, total reflux time, reflux symptom index and reflux symptoms scale (P<0.05), however, there's no significant difference in respiratory disorder index (P>0.05). After 3 months treatment, the cross-sectional area of those four structural regions was increased in different degrees in the patients with reduced OSAHS. However, no significant changes in the cross sectional area was observed in the patients with unchanged OSAHS. Conclusion:Anti-reflux therapy has curative effect in only 60% of the elderly patients with laryngopharyngeal reflux and OSAHS. In addition to the laryngopharyngeal reflux disease, age, BMI and medical history might be the reasons that lead to the failure of the improvement in the other 40% of the elderly patients.