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OBJECTIVE@#This study aimed to examine the trends in stroke mortality among young and middle-aged adults in China.@*METHODS@#Data were obtained from the China national vital registration system. Significant changes in mortality were assessed by Joinpoint regression. Age-period-cohort analysis was used to explain the reasons for the changes. Future mortality and counts were predicted by the Bayesian age-period-cohort model.@*RESULTS@#Between 2002 and 2019, a total of 6,253,951 stroke mortality in young and middle-aged adults were recorded. The age-adjusted mortality rates (AAMRs) of women showed a downward trend. The annual percent changes (APC) were -3.5% (-5.2%, -1.7%) for urban women and -2.8% (-3.7%, -1.9%) for rural women. By contrast, the AAMRs per 100,000 for rural men aged 25-44 years continued to rise from 9.40 to 15.46. The AAMRS for urban men aged 25-44 years and urban and rural men aged 45-64 years did not change significantly. Between 2020 and 2030, the projected stroke deaths are 1,423,584 in men and 401,712 in women.@*CONCLUSION@#Significant sex and age disparities in the trends of stroke mortality among young and middle-aged adults were identified in China. Targeted health policy measures are needed to address the burden of stroke in the young generation, especially for rural men, with a focus on the prevention and management of high risk factors.
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Middle Aged , Male , Adult , Humans , Female , Bayes Theorem , Urban Population , Stroke/epidemiology , Cohort Studies , China/epidemiology , MortalityABSTRACT
The main purpose of the National Nutrition and Health Systematic Survey for children 0-17 years of age in China (CNHSC) was to collect basic data on the nutrition, development, and health status for children in different regions across China using evidence-based, reliable, and cost-effective approaches. Children and their parents or guardians from seven regions (south, southwest, north, northwest, eastern, central, and northeast China) in China were recruited. A multi-stage stratified randomized sampling method was used. Two provinces were randomly sampled from each of the seven regions, from which one urban district and one rural country were also randomly sampled, resulting in a total of 28 survey counties/districts. Dietary surveys, health examinations, laboratory testing, and questionnaires were used to collect dietary intake, nutritional status, child development, and health status information. Nutrition, health, and lifestyle assessment of children and their parents was determined using the Knowledge Attitude Practice (KAP) survey. Greater than 100,000 children (38,000 children < 6 years of age and 66,000 children 6-17 years of age) completed the survey. The survey provided comprehensive data on child nutrition and health status for future studies and will serve as the basis for an integrated nutrition and health improvement strategies proposal for children in China.
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Adolescent , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Child Development , China , Health Status , Health Surveys , Nutrition SurveysABSTRACT
Objective@#To assess the follow-up situstion and changes of policies related to the prevention and control on chronic non-communicable diseases (NCDs), in various provinces from 2011 to 2017.@*Methods@#Three national assessment programs on the prevention and control capacity of NCDs were carried out from September 2012 to March 2013, September 2014 to March 2015, and July to November 2018 respectively. Data related to the capacity on policy implementation among the 31 provinces, autonomous regions, municipality directly under the central government and Xinjiang Production and Construction Corps, were collected through online surveys.@*Results@#The rate of data collection in all the provinces reached 100%, for all three surveys. In 2011, 2013, and 2017, the capacity for policy development special funding was distributed for prevention and control NCDs under the provincial fiscal revenue by 27 provinces (84.4%), 26 provinces (81.3%) and 25 provinces (78.1%), and the numbers of provincial governments leaders attended the local activities related to prevention and control NCDs was 15 (46.9%), 13 (40.6%) and 19(59.4%), respectively. From 2009 to 2011, 14 (43.8%) proposals related to the topics on prevention and control of NCDs, were raised at the provincial People’s Congress and Political Consultative Conference, while from 2011 to 2013 and2014 to 2017, 13 (40.6%) and 12 (37.5%) were respectively raised. In terms of capacity for policy development, numbers of provincial comprehensive plan which targeting prevention and control of NCDs reached 6 (18.8%), 20 (62.5%) and 27 (84.4%) in 2011, 2013, and 2017 respectively. In 2011, 2013 and 2017, numbers of provincial special plans that targeting on NCDs or the risk factors of NCDs prevention and control were 0, 1, and 3, respectively.@*Conclusions@#Under the continuous introduction of international and national policies related to prevention and control on NCDs, capacity for policy formulation in various provinces has been greatly improved. However, a slight progress has been made in the capacity for policy making. The increase of capacity building on policy making regarding prevention and control of NCDs, at the provincial government level, has become a key issue.
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OBJECTIVE@#This study is aimed to report the development, the reliability and validity of the Chinese Children Physical Activity Questionnaire (CCPAQ) which was designed for the assessment of physical activity pattern in young population in China.@*METHODS@#The CCPAQ was administered for two times in 119 children (mean age 13.1 ± 2.4 years; boys 47%) to examine reliability by using intraclass correlation coefficients. Validity was determined in 106 participants by agreement with the CCPAQ measures and the objective method, the ActiGraph accelerometer. Data on physical activity pattern including time spent on different intensities and total physical activity, sedentary behavior as well as physical activity energy expenditure were used to assess the validity with Spearman's correlation coefficient and the Bland-Altman plots.@*RESULTS@#The reliability coefficient of the CCPAQ ranged from 0.63-0.93 (Intra-class correlation coefficient). Spearman's correlation coefficient for validity of time spent on total physical activity and sedentary behavior were all 0.32 (P < 0.001), and for physical activity energy expenditure was 0.58 (P < 0.001). Time spent on moderate-to-vigorous physical activity and light physical activity showed a relatively low correlation with the accelerometer (rho = 0.20, P = 0.040; rho = 0.19, P = 0.054).@*CONCLUSION@#The CCPAQ appears to be a promising and feasible method to assess physical activity pattern in Chinese children.
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Objective To assess the capacity of prevention and control on chronic non-communicable diseases (NCDs) in China.Methods On-line questionnaire survey was adopted by 3 395 CDCs at provincial,municipal and county (district) levels and 3 000 primary health care units,and assess on capacity of policy,infrastructure,capacity of training and guidance,cooperation,surveillance,intervention and management,assessment and scientific research from September 2014 to March 2015.Results (1) Capacity of policy:23 (71.9％) provincial,139 (40.6％) municipal and 919 (31.2％) county (district) governments or health administrative departments had existing plans for prevention and control of NCDs.(2) Capacity of infrastructure:25 (78.1％) provincial,136 (39.8％)municipal and 529 (18.0％) county (district) CDCs had set up departments dedicated to the prevention and control of NCDs,with 9 787 staff members,accounting for 5.0％ of the total CDC personnel,working on NCDs prevention and control programs.68.1％ of the CDCs had special funding set for NCDs prevention and control.(3) Capacity of training and guidance:2 485 CDCs (74.9％) held all kinds of training on prevention and control ofNCDs.2 571 (87.3％) CDCs at the county (district) level provided technical guidance for primary health care units.(4) Capacity of cooperation:42.0％ of the CDCs had experiences collaborating with the mass media.(5) Capacity of surveillance:73.8％ of the CDCs had set up programs for death registration while less than 50.0％ of the CDCs had implemented surveillance programs on major NCDs and related risk factors.In terms of primary health care units,32.4％ of them had set up reporting system for newly developed stroke case and 29.9％ of them having programs on myocardial infarction case reporting.(6) Capacity of intervention and management:69.1％ and 68.2％ of the CDCs conducted individualized intervention programs on hypertension and diabetes,while less than 40.0％ CDCs conducting intervention programs on other NCDs and risk factors.More than 90.0％ of the primary health care units carried out follow-up surveys on hypertension and diabetes.However,only 17.4％ and 13.7％ of the CDCs working on hypertension and diabetes patient management programs while 83.7％ and 80.4％,of them following the standardized guidelines for management,with successful rates of control as 59.2％ and 55.2％,respectively.(7) Capacity of assessment:32.4％ of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs.(8) Capacity of scientific research:the capacity on scientific research among provincial CDCs was apparently higher than that at the municipal or county (district) CDCs.Conclusions Compared with the results of previous two surveys,the capacity on policies set for the prevention and control programs improved continuously,at all level NCDs,but remained relatively weak,especially at both county (district) and primary health care units.
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Objective To assess the capacity of prevention and control on chronic non-communicable diseases (NCDs) in China.Methods On-line questionnaire survey was adopted by 3 395 CDCs at provincial,municipal and county (district) levels and 3 000 primary health care units,and assess on capacity of policy,infrastructure,capacity of training and guidance,cooperation,surveillance,intervention and management,assessment and scientific research from September 2014 to March 2015.Results (1) Capacity of policy:23 (71.9％) provincial,139 (40.6％) municipal and 919 (31.2％) county (district) governments or health administrative departments had existing plans for prevention and control of NCDs.(2) Capacity of infrastructure:25 (78.1％) provincial,136 (39.8％)municipal and 529 (18.0％) county (district) CDCs had set up departments dedicated to the prevention and control of NCDs,with 9 787 staff members,accounting for 5.0％ of the total CDC personnel,working on NCDs prevention and control programs.68.1％ of the CDCs had special funding set for NCDs prevention and control.(3) Capacity of training and guidance:2 485 CDCs (74.9％) held all kinds of training on prevention and control ofNCDs.2 571 (87.3％) CDCs at the county (district) level provided technical guidance for primary health care units.(4) Capacity of cooperation:42.0％ of the CDCs had experiences collaborating with the mass media.(5) Capacity of surveillance:73.8％ of the CDCs had set up programs for death registration while less than 50.0％ of the CDCs had implemented surveillance programs on major NCDs and related risk factors.In terms of primary health care units,32.4％ of them had set up reporting system for newly developed stroke case and 29.9％ of them having programs on myocardial infarction case reporting.(6) Capacity of intervention and management:69.1％ and 68.2％ of the CDCs conducted individualized intervention programs on hypertension and diabetes,while less than 40.0％ CDCs conducting intervention programs on other NCDs and risk factors.More than 90.0％ of the primary health care units carried out follow-up surveys on hypertension and diabetes.However,only 17.4％ and 13.7％ of the CDCs working on hypertension and diabetes patient management programs while 83.7％ and 80.4％,of them following the standardized guidelines for management,with successful rates of control as 59.2％ and 55.2％,respectively.(7) Capacity of assessment:32.4％ of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs.(8) Capacity of scientific research:the capacity on scientific research among provincial CDCs was apparently higher than that at the municipal or county (district) CDCs.Conclusions Compared with the results of previous two surveys,the capacity on policies set for the prevention and control programs improved continuously,at all level NCDs,but remained relatively weak,especially at both county (district) and primary health care units.
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Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.
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<p><b>BACKGROUND</b>Passive leg raising (PLR) represents a "self-volume expansion (VE)" that could predict fluid responsiveness, but the influence of systolic cardiac function on PLR has seldom been reported. This study aimed to investigate whether systolic cardiac function, estimated by the global ejection fraction (GEF) from transpulmonary-thermodilution, could influence the diagnostic value of PLR.</p><p><b>METHODS</b>This prospective, observational study was carried out in the surgical Intensive Care Unit of the First Affiliated Hospital of Sun Yat-sen University from December 2013 to July 2015. Seventy-eight mechanically ventilated patients considered for VE were prospectively included and divided into a low-GEF (<20%) and a near-normal-GEF (≥20%) group. Within each group, baseline hemodynamics, after PLR and after VE (250 ml 5% albumin over 30 min), were recorded. PLR-induced hemodynamic changes (PLR-Δ) were calculated. Fluid responders were defined by a 15% increase of stroke volume (SV) after VE.</p><p><b>RESULTS</b>Twenty-five out of 38 patients were responders in the GEF <20% group, compared to 26 out of 40 patients in the GEF ≥20% group. The thresholds of PLR-ΔSV and PLR-Δ cardiac output (PLR-ΔCO) for predicting fluid responsiveness were higher in the GEF ≥20% group than in the GEF <20% group (ΔSV: 12% vs. 8%; ΔCO: 7% vs. 6%), with increased sensitivity (ΔSV: 92% vs. 92%; ΔCO: 81% vs. 80%) and specificity (ΔSV: 86% vs. 70%; ΔCO: 86% vs. 77%), respectively. PLR-Δ heart rate could predict fluid responsiveness in the GEF ≥20% group with a threshold value of -5% (sensitivity 65%, specificity 93%) but could not in the GEF <20% group. The pressure index changes were poor predictors.</p><p><b>CONCLUSIONS</b>In the critically ill patients on mechanical ventilation, the diagnostic value of PLR for predicting fluid responsiveness depends on cardiac systolic function. Thus, cardiac systolic function must be considered when using PLR.</p><p><b>TRIAL REGISTRATION</b>Chinese Clinical Trial Register, ChiCTR-OCH-13004027; http://www.chictr.org.cn/showproj.aspx?proj=5540.</p>
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Objective To investigate the learning curve of transesophageal echocardiography (TEE) applied in mechanically ventilated patients in intensive care unit (ICU).Methods A prospective observation study was conducted. A total of 60 consecutive patients necessary for mechanical ventilation and TEE examination admitted to the Department of Surgical ICU of the First Affiliated Hospital of Sun Yat-Sen University from December 2016 to June 2017 were enrolled. The TEE examination was performed by the same ICU physician who was skilled in transthoracic echocardiography (TTE). The TEE probe intubation (trial numbers of TEE intubation, the duration for a successful intubation at the first attempt, the total time for successful intubation), TEE examination (the scores of TEE examination, the duration of TEE examination), and the complication during examination were observed, with learning curve established. According to the date of examination, a statistical analysis was carried out for each group of 12 cases. Through the learning curve, that TEE examinations in how many cases should be performed by the ICU physician to master the skill was observed.Results With the increase of TEE examinations performed by the physician, the duration for a successful intubation at the first attempt and the total time for successful intubation were gradually reduced; the scores of TEE examination were gradually increased, and the duration of TEE examination gradually reduced. ① TEE intubation: there was no statistical significant difference among the 60 patients in the number of intubation attempts (F = 0.258,P = 0.904). After the SICU doctor completed TEE intubations in 12 cases, the duration for a successful intubation at the first attempt was significantly reduced (seconds: 22.24±18.37 vs. 34.88±1.65,P < 0.05) and then tended to stabilize in the 16 - 23 seconds. The learning curve indicated that the physician could basically master the intubation skills after performing TEE intubations in 24 cases. ② TEE examination: after the physician completed TEE intubations in 24 cases, the TEE examination scores were increased significantly (40.08±7.27 vs. 23.67±9.70,P < 0.05), and then tended to stabilize in the 40 - 47 scores; after TEE intubations were performed in 24 cases, the examination duration was significantly shortened (minutes: 39.97±6.67 vs. 58.22±14.19,P < 0.05), and after 36 cases were completed, the duration could be further shortened (minutes:31.04±7.84 vs. 39.97±6.67,P < 0.05). The learning curve indicated that the ICU physician could basically master the examination skills when TEE examinations were completed in 36 cases. In addition, no serious complications occurred during the TEE examination.Conclusions A SICU physician with skilled TTE experience can basically master the TEE technology through 36 times of examinations, and reach full mastery after 48 times, the duration for a successful intubation at the first attempt could be stabilized at 20 seconds, and the examination duration could be stabilized at 30 minutes.
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ObjectiveTo assess the value of passive leg raising (PLR) test in predicting fluid responsiveness in patients with sepsis-induced cardiac dysfunction.Methods A prospective observational cohort study was conducted. Thirty-eight patients under mechanical ventilation suffering from sepsis-induced cardiac dysfunction admitted to Department of Surgical Intensive Care Unit of First Affiliated Hospital of Sun Yat-Sen University from September 2013 to July 2014 were enrolled. The patients were studied in four phases: before PLR (semi-recumbent position with the trunk in 45°), PLR (the lower limbs were raised to a 45° angle while the trunk was in a supine position), before volume expansion (VE, return to the semi-recumbent position), and VE with infusing of 250 mL 5% albumin within 30 minutes. Hemodynamic parameters were recorded in every phase. The patients were classified into two groups according to their response to VE: responders (at least a 15% increase in stroke volume,ΔSVVE≥15%), and non-responders. The correlations among all changes in hemodynamic parameters were analyzed by linear correlation analysis, and the receiver operating characteristic curve (ROC) was plotted to assess the value of hemodynamic parameters before and after PLR in predicting fluid responsiveness.Results Of 38 patients, 25 patients were responders, and 13 non-responders. There was no significant difference in the baseline and hemodynamic parameters at semi-recumbent position between the two groups. The changes in SV and cardiac output (CO) after PLR (ΔSVPLR andΔCOPLR) were significantly higher in responders than those of non-responders [ΔSVPLR: (14.7±5.7)%vs. (6.4±5.3)%,t = 4.304,P = 0.000;ΔCOPLR: (11.2±7.5)% vs. (3.4±2.3)%,t = 3.454,P = 0.001], but there was no significant difference in the changes in systolic blood pressure, mean arterial pressure, pulse pressure, and heart rate after PLR (ΔSBPPLR,ΔMAPPLR,ΔPPPLR andΔHRPLR) between two groups.ΔSVVE in responders was significantly higher than that of the non-responders [(20.8±5.5) % vs. (5.0±3.7) %,t = 8.347,P = 0.000]. It was shown by correlation analysis thatΔSVPLR was positively correlated withΔSVVE (r = 0.593,P = 0.000),ΔCOPLR was positively correlated withΔSVVE (r = 0.494,P = 0.002). The area under ROC curve (AUC) ofΔSVPLR≥8.1% for predicting fluid responsiveness was 0.860±0.062 (P = 0.000), with sensitivity of 92.0% and specificity of 70.0%; the AUC ofΔCOPLR≥5.6% for predicting fluid responsiveness was 0.840±0.070 (P = 0.000), with sensitivity of 84.0%and specificity of 76.9%; the AUC ofΔMAPPLR≥6.9% for predicting fluid responsiveness was 0.662±0.089, with sensitivity of 68.0% and specificity of 76.9%; the AUC ofΔSBPPLR≥6.4% for predicting fluid responsiveness was 0.628±0.098, with sensitivity of 76.0% and specificity of 61.5%; the AUC ofΔPPPLR≥6.2% for predicting fluid responsiveness was 0.502±0.094, with sensitivity of 56.0% and specificity of 53.8%; the AUC ofΔHRPLR≥-1.7%for predicting fluid responsiveness was 0.457±0.100, with sensitivity of 56.0% and specificity of 46.2%.Conclusion In patients with sepsis-induced cardiac dysfunction, changes in SV and CO induced by PLR are accurate indices for predicting fluid responsiveness, but the changes in HR, MAP, SBP and PP cannot predict the fluid responsiveness.
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Objective To assess the policies and programs on the capacity of prevention and control regarding non-communicable diseases (NCDs) at the Centers for Disease Control and Prevention(CDCs)at all levels and grass roots health care institutions,in China. Methods On-line questionnaire survey was adopted by 3 352 CDCs at provincial,city and county levels and 1 200 grass roots health care institutions. Results 1)On policies:75.0% of the provincial governments provided special fundings for chronic disease prevention and control,whereas 19.7%city government and 11.3% county government did so. 2) Infrastructure:only 7.1% county level CDCs reported having a department taking care of NCD prevention and control. 8 263 staff members worked on NCDs prevention and control,accounting for 4.2% of all the CDCs’personnel. 40.2% CDCs had special fundings used for NCDs prevention and control. 3)Capacity on training and guidance:among all the CDCs,96.9%at provincial level,50.3%at city level and 42.1%at county level had organized trainings on NCDs prevention and control. Only 48.3% of the CDCs at county level provided technical guidance for grass-roots health care institutions. 4) Capacities regarding cooperation and participation:20.2%of the CDCs had experience in collaborating with mass media. 5)Surveillance capacity:64.6% of the CDCs at county level implemented death registration,compare to less than 30.0% of CDCs at county level implemented surveillance programs on major NCDs and related risk factors. In the grass roots health care institutions,18.6% implemented new stroke case reporting system but only 3.0%implemented program on myocardial infarction case reporting. 6)Intervention and management capacity:36.1% and 32.2% of the CDCs conducted individualized intervention on hypertension and diabetes,while less than another 20%intervened into other NCDs and risk factors. More than 50% of the grass roots health care institutions carried follow-up survey on hypertension and diabetes. Rates on hypertension and diabetes patient management were 12.0% and 7.9%,with rates on standard management as 73.8%and 80.1%and on control as 48.7%and 50.0%,respectively. 7) Capacity on Assessment:13.3% of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs in their respective jurisdiction. 8)On scientific research:the capacity on scientific research among provincial CDCs was apparently higher than that at the city or county level CDCs. Conclusion Policies for NCDs prevention and control need to be improved. We noticed that there had been a huge gap between county level and provincial/city level CDCs on capacities related to NCDs prevention and control. At the grass-roots health care institutions,both prevention and control programs on chronic diseases did not seem to be effective.
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Objective To assess the policies and programs on the capacity of prevention and control regarding non-communicable diseases (NCDs) at the Centers for Disease Control and Prevention(CDCs)at all levels and grass roots health care institutions,in China. Methods On-line questionnaire survey was adopted by 3 352 CDCs at provincial,city and county levels and 1 200 grass roots health care institutions. Results 1)On policies:75.0% of the provincial governments provided special fundings for chronic disease prevention and control,whereas 19.7%city government and 11.3% county government did so. 2) Infrastructure:only 7.1% county level CDCs reported having a department taking care of NCD prevention and control. 8 263 staff members worked on NCDs prevention and control,accounting for 4.2% of all the CDCs’personnel. 40.2% CDCs had special fundings used for NCDs prevention and control. 3)Capacity on training and guidance:among all the CDCs,96.9%at provincial level,50.3%at city level and 42.1%at county level had organized trainings on NCDs prevention and control. Only 48.3% of the CDCs at county level provided technical guidance for grass-roots health care institutions. 4) Capacities regarding cooperation and participation:20.2%of the CDCs had experience in collaborating with mass media. 5)Surveillance capacity:64.6% of the CDCs at county level implemented death registration,compare to less than 30.0% of CDCs at county level implemented surveillance programs on major NCDs and related risk factors. In the grass roots health care institutions,18.6% implemented new stroke case reporting system but only 3.0%implemented program on myocardial infarction case reporting. 6)Intervention and management capacity:36.1% and 32.2% of the CDCs conducted individualized intervention on hypertension and diabetes,while less than another 20%intervened into other NCDs and risk factors. More than 50% of the grass roots health care institutions carried follow-up survey on hypertension and diabetes. Rates on hypertension and diabetes patient management were 12.0% and 7.9%,with rates on standard management as 73.8%and 80.1%and on control as 48.7%and 50.0%,respectively. 7) Capacity on Assessment:13.3% of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs in their respective jurisdiction. 8)On scientific research:the capacity on scientific research among provincial CDCs was apparently higher than that at the city or county level CDCs. Conclusion Policies for NCDs prevention and control need to be improved. We noticed that there had been a huge gap between county level and provincial/city level CDCs on capacities related to NCDs prevention and control. At the grass-roots health care institutions,both prevention and control programs on chronic diseases did not seem to be effective.
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<p><b>OBJECTIVE</b>To assess the policies and programs on the capacity of prevention and control regarding non-communicable diseases (NCDs) at the Centers for Disease Control and Prevention (CDCs) at all levels and grass roots health care institutions, in China.</p><p><b>METHODS</b>On-line questionnaire survey was adopted by 3 352 CDCs at provincial, city and county levels and 1 200 grass roots health care institutions.</p><p><b>RESULTS</b>1) On policies: 75.0% of the provincial governments provided special funding for chronic disease prevention and control, whereas 19.7% city government and 11.3% county government did so. 2) Infrastructure:only 7.1% county level CDCs reported having a department taking care of NCD prevention and control. 8 263 staff members worked on NCDs prevention and control, accounting for 4.2% of all the CDCs' personnel. 40.2% CDCs had special funding used for NCDs prevention and control. 3)Capacity on training and guidance:among all the CDCs, 96.9% at provincial level, 50.3% at city level and 42.1% at county level had organized training on NCDs prevention and control. Only 48.3% of the CDCs at county level provided technical guidance for grass-roots health care institutions. 4) Capacities regarding cooperation and participation: 20.2% of the CDCs had experience in collaborating with mass media. 5) Surveillance capacity: 64.6% of the CDCs at county level implemented death registration, compare to less than 30.0% of CDCs at county level implemented surveillance programs on major NCDs and related risk factors. In the grass roots health care institutions, 18.6% implemented new stroke case reporting system but only 3.0% implemented program on myocardial infarction case reporting. 6) Intervention and management capacity: 36.1% and 32.2% of the CDCs conducted individualized intervention on hypertension and diabetes, while less than another 20% intervened into other NCDs and risk factors. More than 50% of the grass roots health care institutions carried follow-up survey on hypertension and diabetes. Rates on hypertension and diabetes patient management were 12.0% and 7.9% , with rates on standard management as 73.8% and 80.1% and on control as 48.7% and 50.0%, respectively. 7) Capacity on Assessment: 13.3% of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs in their respective jurisdiction. 8) On scientific research: the capacity on scientific research among provincial CDCs was apparently higher than that at the city or county level CDCs.</p><p><b>CONCLUSION</b>Policies for NCDs prevention and control need to be improved. We noticed that there had been a huge gap between county level and provincial/city level CDCs on capacities related to NCDs prevention and control. At the grass-roots health care institutions, both prevention and control programs on chronic diseases did not seem to be effective.</p>
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Humans , China , Chronic Disease , Community Health Services , WorkforceABSTRACT
Objective To evaluate the capacity for noncommunicable diseases(NCDs)prevention and control in the Centers for Disease Control and Prevention(CDCs)in China. Methods All CDCs in China, including provincial, city and county CDCs were surveyed by questionnaires designed by China CDC including resource provided, capacity and efforts for NCDs. Results(1)Resource: 7483 staff members worked on NCDs prevention and control, only accounting for 4.0% of all the CDCs' personnel; 23.6% of the staff members devoted their time to NCDs control less than 6months in 2008. Fundings for NCDs prevention and control only accounted for 2.29%, 1.70% and2.69% of the total funds of provincial, city and county CDCs, respectively.(2)Capacity: The proportions of CDCs that had professional institutes of NCD at provincial, city and county level were 100.0%, 62.8% and 43.7% respectively. CDCs mainly cooperated with health agencies regarding NCDs prevention and control programs. 34.7% of the staff members had educational background of college undergraduate or higher, 12.1% had senior professional titles, 61.7% of them worked for NCDs less than 5 years. The average person-times of continuing education in NCDs were 21.90,4.60and 1.68 at the provincial, city and county CDCs respectively. 8.7% of the CDCs sent their staff members for advanced studies on NCDs. All provincial CDCs carried out surveillance but only 4.2%of them published reports of NCDs in all the CDCs during the past three years.(3)Efforts: 43.5% and 30.8% of the county CDCs carried out surveillance and intervention of NCDs respectively in 2008.Conclusion Resources for NCDs prevention and control were quite limited in CDCs. Fundings and staff members for NCDs were not enough, compared to the heavy disease burden of NCDs. Capacityfor NCDs prevention and control need to be improved.