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Digital healthcare empowers optimization of medical services.This article introduced the practices and achievements of Hangzhou in the following aspects: the construction of a hierarchical medical system guided by " people-oriented integrated service" ; development of the five digital platforms, namely regional health information platform, integrated medical care platform, remote consultation platform, intelligent supervision platform and doctor-patient remote interaction platform; development of " Smart Medicine" to promote institutional cooperation, service integration, management coordination, quality improvement and doctor-patient interaction.The paper also analyzed the supporting role of digital healthcare construction in promoting the hierarchical medical system, and put forward corresponding countermeasures and suggestions.
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Reform of public hospitals is key to the healthcare system reform.This article introduced how Hangzhou implemented such a reform of " Hangzhou characteristics" by referring to the hospital reform framework of the World Bank, and the theoretical achievements and practical experiences of domestic public hospitals′reform.Led by the service concept of " Medicine has its limitations but we have the courage to overcome, service is boundaryless and we must pursue excellence" , Hangzhou has established a public hospital value system of " reorientation to public welfare".The smart healthcare system serves as a focus, to support the delicacy management of the hospitals. The construction of hierarchical medical care system functions as the pillar, to support the coordinated development of hospitals, primary health institutions and public health institutions.This way a public hospital comprehensive reform mode is established featuring " one value system, 2 levels of organization structure, 6 mechanisms, and 19 supporting measures ". Its experiences may serve as reference to streamline hospital internal operation and external cooperation mechanism.
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Objective To measure and analyze the order degree of the internal subsystems and the synergetic degree of the compound system of rural public health service in county areas based on the synergy model of the compound system. Methods According to the distribution of eastern, central and western regions in China, Xiangshan county in Zhejiang province, Wuzhi county in Henan province and Bin county in Shaanxi province were sampled. Based on the index system of synergetic degree measurement including the 52 level-2 evaluation indicators, a questionnaire survey was used to measure the synergetic degree of the compound system of rural public health service in county areas. Results The highest synergetic degrees of the compound system of rural public health service in Xiangshan county, Wuzhi county and Bin county were only 0. 18153, 0. 18068 and 0. 21312 respectively. This indicated the synergy at a low degree. And the synergy of the supply-demand system was an important influential factor for synergy of this compound system, as their development trends were consistent basically. Conclusions The synergy model of the compound system can play a useful role in rural public health service system in county areas. The demand of rural residents deserves more attention and the difference between the service supply and demand should be reduced.
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Based on synergetics, system theory and dissipative structure theory, the connotation and composition of the compound system of rural public health service in country area are described in the paper. The authors proposed that the synergy degree model of the compound system for rural public health service in county areas comprises the order degree model and the synergy degree model of the compound system, which are composed of such subsystems as functionality, service network, demand, and economy. They also probed into the evaluation method for synergy degree and built the measuring index system of synergy degree comprising 59 level-2 evaluation indicators.
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Objective To further improve the comprehensive evaluation program of patient satisfaction in view of the defective item screening and weight design short of considerations for patients'psychological expectation and rational judgment, based on the theory of bounded rationality. Methods A satisfaction measurement scale was compiled and used to survey 847 inpatients in July-August 2017. The internal consistency test, correlation and factor analysis were used to evaluate the reliability and validity of the scale. The combination weight PWi was calculated based on patients' importance of the five satisfaction dimensions and the scoring of certainty degree of their responses. The combination weight EWi was calculated based on the five-dimension importance and operability scoring of expert consultation. The indicator combination weight OWi was determined using the integrated factors scoring, TOPSIS, weight rank-sun ratio, gray correlation method, and synthetic index method were used in a general assessment of patient satisfaction of a hospital in question. Results The Cronbach α coefficient of the patient satisfaction rating scale was 0.939, and the half-reliability coefficient was 0.951. The cumulative contribution rate of the five common factors variance extracted from the factor analysis was 71. 4%. The rational weights of five dimensions of service environment, service efficiency, service attitude, service technology, and service costs were 0.220, 0.214, 0.217, 0.179, and 0.171 respectively, while the comprehensive weights of the five dimensions were 0.115, 0.233, 0.196, 0.264, and 0.192 respectively. The comprehensive evaluation results of the two correlation coefficients were greater than 0.95. Conclusions The patient satisfaction measurement scale developed based on the theory of bounded rationality can expand the index connotation and items of core elements such as service technology and cost. The design of index weights fits with the concern of medical service factors and the degree of rational judgment in the patient's medical treatment process. The evaluation results are basically consistent with the actual situation and can be used as a reference tool for the scientific rational evaluation of patient satisfaction.
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Objective To study the participating farmers'interest demands for NRCMs in order to provide basis for the payment system reform based on the demand side perspective. Methods A cross-sectional study was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was conducted in six counties of three provinces in the eastern, middle and western regions of China. Mathematical statistics analysis was conducted to clarify the interest demands and influencing factors of the participating farmers. Results The interests claims of the 1 452 participating farmers were to improve service quality, to reduce the economic burden of disease, and to standardize the management. The medians found were 4.00, 4.00 and 3.63 respectively. Relative to the flat rate, the DRGs raised higher requirements for standardized medical behaviors offered by the medical workers. Furthermore, it called for effective medical quality supervision, rigorous control of medical costs and highly scientific and standardized management. The differences were statistically significant ( P ＜0.05 ). Conclusions The diversity of participating farmers'interest demands deserves due attention, the payment methods combination should fit local needs, the interests demands expression channel of the participants should be expanded, and the demand side deserves a due role in supervision of the funds.
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Objective To survey the cognitive attitude and participation intention for stakeholders of public hospitals,in order to provide basis for public hospitals social evaluation.Methods 621 stakeholders of public hospitals were subject to the questionnaire survey.Results 76.7%(475/619) stakeholders held it as necessary to independently launch the public hospitals social evaluation,and held that the evaluation subjects selection should be professional(83.8%),independent(67.7%),authoritative (55.6%),and proactive(46.1%).The survey also recommended that social evaluation of public hospitals should have such indexes as government investment (80.2%),social supervision (76.0%),and information disclosure system(7 1.1%).The overall willingness rate of stakeholders to participate in the public hospital social evaluation was 7 1.6%.Conclusions Development of the social evaluation index system of public hospitals and diversified evaluation subj ects are key to developing the theory and practice system of public hospitals social evaluation.
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<p><b>OBJECTIVE</b>To investigate the stages of health-related behaviors, family and peer support situation about adolescent in Wuhan, and to provide evidence for health intervention and health promotion.</p><p><b>METHODS</b>Based on the principle of multi-stage stratified cluster sampling, extracted two junior middle school and two high school in two cities in Wuhan from March 2012 to May. A total of 1 200 students, which were part of the first and second grade class in middle school and high school, toke as the investigation object. The study surveyed following content, including the demographic situation, adolescent health-related behavior (physical activity, sedentary behavior, high-fat diet behavior, fruit and vegetable intaking behavior), stages of adolescent health related behavior (precontemplation, contemplation, preparation, action, maintenance) and adolescent support got from family and peer. The questionnaire was distributed in 1 200 copies, the valid questionnaires were 1 052 and the effective rate was 87.67%. Using χ² test to compare the different stages of change in health related behavior, t test was used to compare different groups of social support and using analysis of variance and post test to analyze social support of the four types behavior.</p><p><b>RESULTS</b>In 1 052 students, there was 555 (52.8%) middle school students, 497 (47.2%) high school students, and 553 (52.6%) boys, 499 (47.4%) girls. In physical exercise and sedentary behavior, numbers of precontemplation was respectively accounting for 42.2% (444/1 200) and 28.4% (299/1 200). In high-fat diet behavior, the stages of preparation and maintain was occupied 46.7% (492/1 200). In fruit and vegetable intake behavior, there was 32.9% (346/1200) students in contemplation. Numbers in action stage was both less in the above four behavior, accounting for 6.2% (65/1 200), 8.9% (94/1 200), 14.0% (147/1 200) and 6.3% (66/1 200) separately. Adolescent peer support score respectively (2.9 ± 0.7), (2.8 ± 0.8) and (2.9 ± 0.9), which was higher than the family support scores ((2.7 ± 1.1), (2.5 ± 1.2) and (2.9 ± 1.2)) (t values were -8.72, -11.22 and -2.59, respectively. All P values were < 0.001) in physical exercise, sedentary behavior and high fat diet, but in the intake of fruits and vegetables behavior, family support score was higher than peer support (score was respectively (3.3 ± 0.9) and (3.5 ± 1.2); t < 9.97, P < 0.001). ANOVA and post hoc comparison showed that the score of family and peer support in the after-action stage was significantly higher than that the before-action stage in physical exercise, high-fat diet and fruit and vegetable intake behavior, while the differences in sedentary behavior was not significant.</p><p><b>CONCLUSION</b>Youth health-related behaviors remained in its infancy, there was a certain impact on its stages which showed that the higher social support the more advanced stages of behavior.</p>
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Adolescent , Female , Humans , Male , Adolescent Behavior , Diet, High-Fat , Exercise , Family , Feeding Behavior , Fruit , Health Behavior , Peer Group , Schools , Social Support , Students , Surveys and Questionnaires , VegetablesABSTRACT
<p><b>OBJECTIVE</b>To learn the dietary fat intake behavior status and influencing psychological factors in teenagers.</p><p><b>METHODS</b>According to the multi-stage stratified cluster sampling method, students were recruited from middle and high schools in Hangzhou, Wuhan and Xi'an from March to May, 2012. Chinese version of adolescent dietary fat intake behavior of psychological measurement scales was utilized in field investigations with 3 448 effective questionnaires. Under the transtheoretical model, the status quo of teenagers fat intake behavior was analyzed and it shows the relationship between stages and psychological variables, including strategy of change, decision balance and self-efficacy.</p><p><b>RESULTS</b>In the 3 448 participants, the proportion of girls were 52.4% (1 806/3 448) and boys were 47.6% (1 642/3 448), while the mean age was (14.85 ± 1.46). There are significant differences among distributed stages of behavior change, grouped by gender, grade and region (χ(2) values were 33.59, 20.53, 27.92, P < 0.001). In different gender groups, the number of boys in precontemplation came to the first and accounted for 24.2% (438/1 806), and the number of girls were more in contemplation and preparation stage, which accounted for 49.5% (813/1 642), and it was the least both in the action stage with the ratio 12.1% (218/1 806) and 14.7% (241/1 642) respectively; in different grade groups, the numbers of student in middle school and high school were the largest in contemplation and precontemplation stage, accounted for 24.9% (494/1 986) and 23.4% (343/1 462); and among different regions, the proportion in precontemplation, contemplation and preparation stage was not a few, and this ratio in Hangzhou, Wuhan, Xi'an area was 70.6% (801/1 135), 61.7% (649/1 052) and 68.8% (867/1 261), respectively. The number in action stage was the least of all, which were 144, 147, 168, respectively. Ordinal logistic mode showed that the four variables, including the scores of process of change, decision balance (pros), decision balance (cons) and self-efficacy, were factors which significantly affected the stages of behavior change, which showed a significant difference (F values were 155.12, 19.86, 44.59, 94.27, P < 0.001) in different stages. From precontemplation stage to action stage, the score of the process of change, decision balance (pros) and self-efficacy showed an upward trend, and achieved the highest score in the action stage (from 32.6 ± 12.8, 8.4 ± 2.9, 19.7 ± 6.9 to 48.4 ± 12.6, 10.1 ± 2.5, 25.9 ± 6.9, respectively); contrarily, the decision balance (cons) decreased with the development of behavioral stage (from 14.7 ± 4.4 to 12.2 ± 3.9). Post hoc comparison also found that the score of process of change, decision balance (pros) and self-efficacy after action stages were higher than those before action, while the score of decisional balance (cons) in the precontemplation stage was higher than that in the other 4 stages.</p><p><b>CONCLUSION</b>Fat intake behavior in teenagers showed different stages, whose psychological factors had significant influences, with decision balance (pros) hindered the progress of stages of behavior change, while other three factors played a positive role.</p>
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Adolescent , Female , Humans , Male , Adolescent Behavior , Decision Making , Dietary Fats , Models, Theoretical , Self Efficacy , Students , Surveys and QuestionnairesABSTRACT
Objective:To analyse the degree of equality of New Rural Cooperative Medical Scheme (NRCMS) in different economic regions. We provide a reference for equal development of the NRCMS and the reform of the political system and mechanism under the provincial-controlled county fiscal system. Methods:A typical province was chosen with provincial-controlled county fiscal system was fully implemented several years. We collected data on coverage, financing and compensation for the NRCMS from 2005 to 2011. We used the variable coefficient, uniformity coefficient, Theil Index for comprehensive evaluation. Results:Per capita financing has not reached the bottom line. From 2005 to 2011, inter-re-gional and intra-regional variation coefficient, Theil index of service coverage, financing level and hospital actual compen-sation has declined year by year. The degree of inequality in economically developed regions was greater than in less eco-nomically developed regions and economic medium region. Conclusion:The degree of equalization of the NRCMS in the province continuously improved. Innovation of provincial-controlled county fiscal system and mechanism provides a favora-ble environment and forming conditions for equalizing the development of the NRCMS. The paper suggested exploring and building fiscal classification step transfer payment institution and dynamic prediction model of the NRCMS, further optimi-zing financing mechanism, promoting the provincial management system of the NRCMS as soon as possible in order to pro-mote the equalization development.
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<p><b>OBJECTIVE</b>To develop a suitable fat intake behavior of psychological measurement scales for the Chinese adolescents and evaluate its validity and reliability.</p><p><b>METHODS</b>According to the multi-stage stratified cluster sampling principle, a total of 3 600 junior students were recruited from the classes in 12 selected high schools in Hangzhou, Wuhan and Xi'an from March to May, 2012. Based on introducing and translating the original scale abroad, Chinese version of adolescent fat intake behavior of psychological measurement scales was utilized in field investigations. The reliability was assessed, using Cronbach's α and split-half reliability; while exploratory factor analysis used to test its validity, with entries-dimension correlation coefficient (IIC), correlation coefficient between the scores and the dimension, and the dimension of correlation coefficient test content validity.</p><p><b>RESULTS</b>The valid subject of the study was 3 448(of whom males were 52.4% (1 806/3 448) and female were 47.6% (1 642/3 448)), while the mean age was (14.85 ± 1.46) years old. The internal consistency reliability (Cronbach's α) for total scale score and four domains were 0.922,0.933, 0.660, 0.773 and 0.869 respectively, whose split-efficacy reliability were separately 0.927, 0.933, 0.790, 0.624 and 0.889. Data from the exploratory factor analysis revealed the following dimensions:the entries were all inclusive, with the cumulative contribution rate at 59.453%, 56.062% and 52.668%, respectively. The results of IIC showed that in the four dimensions, the contained entries between Spearman correlation coefficient have statistically significant, with the r value range of 0.584-0.793, 0.665-0.818, 0.654-0.765 and 0.622-0.747 severely, while other dimensions from weak to moderate relationships, the r value ranged from -0.028 to 0.614.</p><p><b>CONCLUSION</b>The reliability and validity of the adolescent fat intake behavior of psychological measurement scales (Chinese version) were good, and could be used to measure the fat intake behavior of psychological conditions in Chinese adolescents.</p>
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Adolescent , Female , Humans , Male , Dietary Fats , Eating , Psychology , Feeding Behavior , Psychological Tests , Students , Psychology , Surveys and QuestionnairesABSTRACT
<p><b>OBJECTIVE</b>To study the situation of sports and its influencing factors among students in order to improve health related education and promotion programs.</p><p><b>METHODS</b>A multistage random sampling method was used on 3 600 students from three cities to understand their physical exercise behavior. Both t and χ(2) test were used to measure the scale of psychology and to describe the time spent on exercise. Single variance factor was used to measure the levels of change on behavior of physical activities, psychological and physical exercise behaviors.</p><p><b>RESULTS</b>The weekly exercise time for students was 2.66 ± 1.801 days, with 81.4% of the students less than four days. Data showed that 37.3%, 23.6%, 20.5% of the high school students were in pre-contemplation stage, in contemplation stage, or in preparation stage respectively, with only 18.6 percent of the high school students in the action phase and maintaining phase. Students in the stages of change increase the amount of physical exercises. Scores with statistically significant differences were seen in the following areas: between five stages of behavior change on strategies (F = 77.442, P < 0.001), forward effects on the balance of decision-making (F = 29.498, P < 0.001), having negative effects (F = 14.784, P < 0.001)and self-efficacy (F = 135.544, P < 0.001). Changing strategy on the intention stage of front maintenance phase, positive effects on decision-making balance and self-efficacy scores were increasing along with the increasing stages of changing. The effect of balancing the negative effects increased when the change of phase decreased.</p><p><b>CONCLUSION</b>Students were in lack of physical exercise per week. The differences related to the behavior on physical exercise did exist but most of the high school students were in the primary stage. Psychological factors played important role in the different stages of changing, suggesting that high school students should receive different health education and psychological intervention measures to enhance the effectiveness of physical exercise.</p>
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Adolescent , Female , Humans , Male , Exercise , Psychology , Health Behavior , Students , PsychologyABSTRACT
Objective:To find out the key demand and connection point of health quality education for students of different stages by analysis of their health quality characteristics and the main contribution path, and then explore strategies to improve health quality. Methods:The stratified random cluster sampling method was carried out to select the sample population in Hangzhou. The variance analysis, curve fitting and multivariate linear regression analysis were used to analyze health quality characteristics and the main contribution path. Results:The health quality of pri-mary school students was best;the difference in quality between college students and junior high school students was not statistically significant ( P>0. 05 );and high school students had the worst health quality. The high school stage is the weakest link of health quality education. The order of the health education path and the means for improving the health quality of college, high school, and primary school students differ. With the improvement of students’ lev-el, the students that require physical quality promotion gradually decreases; the moral quality demand remains sta-ble;and the psychological quality and social adaptation ability present the tendency of a gradual increase. Conclu-sion:Student health quality shows a tendency to decreases with the rise of learning phase. The education departments should foster health consciousness and habits for students, form a healthy lifestyle behavior and ways of thinking for high school students, shape healthy personalities to improve health literacy and social adaptation abilities for college student, which is the key strategy for promoting the health quality of all-round development of the students and a-chieve the primary education goal of “health education”.
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Objective To investigate the association of the LIPC-C480T (rs1800588) and lipid levels and dyslipidemia in different age-and-sex groups in Han Chinese population.Methods The serum TC,TG,LDL-C and HDL-C were detected by automatic biochemical analyzer in 2420 health adults (1527 men and 893 women).The genotypes of rs1800588 were detected by M ALDI-TOF MS.According to the age difference (≤44,45-59 and ≥60-year-old),the total samples were divided to young (241 men and 201 women),middle-aged (652 men and 360 women) and older (634 men and 332 women) groups.The effects of genotypes on 4 serum lipid indicators in each age-and-gender group were analyzed by one way analysis of variance (ANOVA),and the odd risk of genotypes on dyslipidemia was estimated by binary Logistic regression analysis.The P value less than 0.05 was considered statistically significant.Results The frequence of allele T for LIPC rs1800588 in this population is 39.4％.In each age group the lipid parameters are quite different between males and females.Compared with those with CC genotype,middle-aged and elder men with CT or TT genotype have higher TC and HDL-C levels,and elder men with TT genotype also have higher TC level ; young women bearing CT genotype have higher TC level,and the CT and TT genotypes have higher HDL-C levels,middle aged women with CT or TT genotype have higher TC and TG levels,and CT genotype also have higher HDL-C level,the elder women with TT genotype have higher HDL-C level.Compared with those CC genotype individuals,the risk for mixed hyperlipidemia and hypercholesterolemia increases 2.318 folds (P =0.004) and 2.571 folds (P ＜ 0.001) respectively,while the risk for low HDL-C decreases 1.908 folds (P =0.029) for TT genotypes individuals among elder males; the hypercholesterolemia risk increasc 1.688 (P =0.036) and 2.099 times (P =0.040) in CT and TT genotypes respectively,and the risks for hypertriglyceridemia and mixed hyperlipidemia are 2.060 (P =0.038) and 2.381 (P =0.019) times higher than those with CC genotype among middle-aged females.Conclusions The LIPC rs1800588 site associates with the lipid levels and dyslipidmia risk in Han Chinese in an age-and-sex model.This SNP site has higher impact on lipid levels and dyslipidemia among elder males and middle-aged females,and the T allele is the risk factor.
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ObjectiveTo explore the key problems facing health record management and put forward effective strategies.Methods Questionnaires survey was performed among county medical staff,country doctors and rural residents who had medical records.Fishbone diagram was used to justify the results.Results At Chongyi count,rural residents got 20-Yuan subsidy per person for medical examine,although the establishment of a health file cost at least 55.5 Yuan,including 42.7 Yuan for medical examination.Only 60 of 108 villages were equipped with computers.Medical staff account for 1.49/1000.The awareness and use of health records were insufficient.ConclusionOur data suggest that it should be necessary to increase financial investment,enhance knowledge on health records,put electronic information system into practice,and strengthen personnel training in the future.
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Objective To explore the interaction model of social capital, mental health,occupational burnout, turnover intention and the related influence factors on nurses. Methods By random cluster sampling, investigated 723 nurses with Nurses' Turnover Intention Inventory, the Maslach Burnout Inventory, Social Capital Questionnaire and Chinese Health Questionnaire, then explored the interaction model by path analysis. Results Nurses' position can influence their social capital(the path coefficient was 0. 124), social capital and occupational turnout can influence nurses' mental health(the path coefficient were -0. 231,0. 151), the mental health and occupational turnout both can influence nurses' turnover intention directly(the path coefficient were 0. 088,0. 151 ), the model is acceptable(CMIN/DF 1. 645, GFI 0. 984, AGFI 0. 966, IFI 0. 941, CFI 0. 937, RMSEA 0. 037).Conclusion Social capital can provide a new perspective for nurses' management, developing the social capital resources can relieve nurses' mental problems effectively; relieving the turnout and mental problem can decrease nurses' turnover intention finally.
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Social governance is a novel form of public administration made based on the analysis and judgment for the power pattern in the course of social administration, a model advocated in the premise of a clearly positioned relationship among the government, marketplace, society and citizens.Social evaluation is an effective carrier and means leveraging the social governance theory, which has found extensive and outstanding use in such issues as expression of public interests and responsibilities,and in tackling sharp social problems. The authors called into play the scenario analysis based on public hospital management reforms with the social governance theory. In addition, they explored social governance at home and abroad as well as the theories, meaning and progress of social evaluation, and analyzed the pathways and probes in social evaluation and governance in the fields in question. On such basis, the paper proposed to explore and develop the social evaluation strategies and study framework for public hospitals in terms of healthcare management, aiming at building the social governance system and policies for public hospitals.
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Objective: To deeply investigate the influential factors of mental health in medical students by structural equation modeling.Methods: 480 medical students were tested with SCL-90,adolescent self-rating life events check list and simplified coping style questionnaire,then theoretical model were established and confirmed for the relationships of life events,satisfaction degree with their profession,coping styles and mental health.Results: Study stress,human relations,satisfaction degree towards their profession and coping styles closely correlated with mental health status,and the structural equation modeling fitted the data very well,GFI and AGFI were both larger than 0.90.Conclusion: Use of structural equation modeling has more advantages than the traditional statistical methods,but it should combine with professional knowledge when it is used.