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Objective:To study the influence of different feeding patterns on mother-to-child transmission (MTCT) of hepatitis B virus (HBV) in pregnant women with high viral loads who received antiviral medication during pregnancy to the day of delivery.Methods:This prospective cohort study was conducted in Beijing You'an Hospital. From January 1, 2019, to March 31, 2020, and 574 pregnant women with positive hepatitis B surface antigen (HBsAg) and HBV DNA>2×10 5 IU/ml were enrolled. All participants received tenofovir, telbivudine, lamivudine, or propofol tenofovir from 24-28 weeks of gestation and discontinued on the day of delivery, and their neonates were postnatally given routine passive-active immunoprophylaxis. Based on the feeding patterns, the subjects were divided into three groups: breastfeeding ( n=257), bottle-feeding ( n=241) and mixed feeding groups ( n=76). The follow-up data were obtained from liver functions and HBV DNA level of the mothers at 6-8 weeks postpartum and HBV serological markers of infants at 7-12 months. One-way ANOVA, Student-Newman-Keuls, Chi-square test or Fisher exact test, and repeated measures ANOVA were used to analyze the data. Results:The average maternal HBV DNA levels before antiviral treatment did not differ significantly between the three groups [(7.90±0.67), (7.82±0.70), (7.83±0.70) log 10 IU/ml, F=0.912, P>0.05]. HBV DNA level before delivery in the mixed feeding group was slightly lower than that in the breastfeeding and bottle-feeding group [(3.87 ±1.08) vs (4.21±1.17) and (4.30±1.28) log 10 IU/ml, q= 3.052 and 3.831, both P<0.05], while the comparison between the latter two groups showed no significant differences ( P>0.05). After delivery, HBV DNA level in the bottle-feeding group was slightly lower than that in the breastfeeding group [(7.42±0.93) vs (7.69±0.90) log 10 IU/ml, q=4.583, P<0.05]. Among 580 infants (including six pairs of twins), only one bottle-fed infant (0.4%, 1/243) was infected with HBV through MTCT, and none in the breastfeeding or mixed feeding group ( P=0.553). Conclusions:For pregnant women with high viral loads of HBV who have received antiviral medication during pregnancy, although HBV DNA level will rebound after discontinuation upon delivery, breastfeeding is recommended considering it does not increase the risk of MTCT.
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Objective:To investigate the occurrence of stroke and its associated risk factors in patients with Philadelphia chromosome (Ph)-negative myeloproliferative neoplasms (MPN).Methods:The data of patients diagnosed as Ph-negative MPN in the Affiliated Yuebei People's Hospital of Shantou University Medical College from January 2016 to December 2019 were retrospectively analyzed. The occurrence of stroke in these patients and the clinical characteristics were summarized. Logistic regression was used to analyze the risk factors of stroke in MPN patients.Results:A total of 193 Ph-negative MPN patients were collected, including 103 males and 90 females. The median age of onset was 62 years old (24-93 years old). There were 129 patients (66.84%) with essential thrombocythemia, 46 patients (23.83%) with polycythemia vera, and 18 patients (9.33%) with primary myelofibrosis. In 193 patients with MPN, there were 31 patients (16.06%) with stroke, including 30 cases (15.54%) of ischemic stroke and 1 case (0.52%) of hemorrhagic stroke, and the incidence of ischemic stroke was higher than that of hemorrhagic stroke, the difference was statistically significant (χ 2 = 54.258, P < 0.01). Among the patients with stroke, JAK2V617F mutation was observed to be the most common driver mutation (80.65%, 25/31). The small-artery occlusive cerebral infarction was the most common in ischemic stroke (63.33%, 19/30). Compared with MPN patients without stroke, those with stroke displayed higher hemoglobin level [(156±35) g/L vs. (138±40) g/L] and concurrent JAK2V617F and CALR mutations rate [3.23% (1/31) vs. 0.62% (1/162)], and lower CALR mutation rate [3.23% (1/31) vs. 19.14% (31/162)], the differences were statistically significant (all P < 0.05). Logistic regression analysis revealed that hemoglobin ≥ median level (140 g/L) was a risk factor for stroke in MPN patients ( OR = 2.903, 95% CI 1.163-7.244, P = 0.022), and CALR mutation acted as a protective factor for stroke ( OR = 0.090, 95% CI 0.009-0.932, P = 0.044). Conclusions:Ischemic stroke is more common than hemorrhagic stroke in Ph-negative MPN patients, and the small-artery occlusive cerebral infarction is also more frequently found in these patients. Hemoglobin ≥140 g/L is a risk factor for stroke in MPN patients, and CALR mutation is a protective factor.
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Objective@#To investigate smoking cessation behaviors and factors influencing it among adult community smokers in Beijing.@*Methods@#This was a cross-sectional epidemiological study. A questionnaire survey was administered among community smokers over 18 years old, in which information on basic demographics, tobacco use, attempts to quit smoking, tobacco-related awareness, and environmental assessment of smoking cessation support were collected. Descriptive analysis was conducted on the basic information, smoking situation, and demand for smoking cessation intervention of the respondents. Two tests were used to examine the quitting attempts of respondents. Tobacco attempts was found to be correlated with socio-demographic indicators, and factors such as tobacco use, awareness of tobacco-related issues, and the smoking cessation support environment. Dual logistic regression was used to further explore the dependence of identified factors and attempted smoking cessation behavior.@*Results@#A total of 449 respondents were enrolled in this study, 410 of them were men (91.3%). Among the respondents, 272 people (60.6%) had tried to quit smoking and 177 people (39.4%) did not try to quit smoking. Monthly income level, tobacco-related awareness, degree of surrounding people supporting smoking cessation, whether medical treatment was sought in the previous year, number of visits, whether to persuade medical staff to quit smoking in the past year, and whether smoking was given up in the past year were the identified factors. These seven factors, such as whether they have been asked about smoking, are the influencing factors in trying to quit smoking（P<0.05）. Under the logistic regression model, monthly income level (OR=1.271, 95%CI:1.081-1.493), the support of people around them to quit smoking (OR=1.251, 95%CI:1.035-1.512), and the suggestion of medical personnel in the past year (OR=2.382, 95%CI: 1.054-5.381) were found to encourage attempts to quit smoking.@*Conclusion@#Factors such as health status, environmental support, hazard perception, and economic level influence attempts to quit smoking. Lack of self-determination and other people's influence are the main reasons for failing to quit smoking. Taking community places as the basic unit of intervention combined with professional guidance of smoking cessation clinic doctors and forming an online comprehensive linkage smoking cessation hospital community intervention model is an innovative way to optimize the management of tobacco dependence.
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Objective:To investigate smoking cessation behaviors and factors influencing it among adult community smokers in Beijing.Methods:This was a cross-sectional epidemiological study. A questionnaire survey was administered among community smokers over 18 years old, in which information on basic demographics, tobacco use, attempts to quit smoking, tobacco-related awareness, and environmental assessment of smoking cessation support were collected. Descriptive analysis was conducted on the basic information, smoking situation, and demand for smoking cessation intervention of the respondents. Two tests were used to examine the quitting attempts of respondents. Tobacco attempts was found to be correlated with socio-demographic indicators, and factors such as tobacco use, awareness of tobacco-related issues, and the smoking cessation support environment. Dual logistic regression was used to further explore the dependence of identified factors and attempted smoking cessation behavior.Results:A total of 449 respondents were enrolled in this study, 410 of them were men (91.3%). Among the respondents, 272 people (60.6%) had tried to quit smoking and 177 people (39.4%) did not try to quit smoking. Monthly income level, tobacco-related awareness, degree of surrounding people supporting smoking cessation, whether medical treatment was sought in the previous year, number of visits, whether to persuade medical staff to quit smoking in the past year, and whether smoking was given up in the past year were the identified factors. These seven factors, such as whether they have been asked about smoking, are the influencing factors in trying to quit smoking（ P<0.05）. Under the logistic regression model, monthly income level ( OR=1.271, 95% CI:1.081-1.493), the support of people around them to quit smoking ( OR=1.251, 95% CI:1.035-1.512), and the suggestion of medical personnel in the past year ( OR=2.382, 95 %CI: 1.054-5.381) were found to encourage attempts to quit smoking. Conclusion:Factors such as health status, environmental support, hazard perception, and economic level influence attempts to quit smoking. Lack of self-determination and other people's influence are the main reasons for failing to quit smoking. Taking community places as the basic unit of intervention combined with professional guidance of smoking cessation clinic doctors and forming an online comprehensive linkage smoking cessation hospital community intervention model is an innovative way to optimize the management of tobacco dependence.
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Objective To understand the current situation of health education contents as well as the differences in their requirements between clinical medical students and clinicians,and to provide reference for the optimization of health education curricula for medical students.Methods A stratified sampling method was adopted to select 511 medical students (303 females and 208 males) from a medical university,and the survey results of 436 clinicians (144 females and 292 males) were taken as reference.Differences in the degrees of need between clinical medical students and clinicians were compared by chi-square tests.Results There were statistical differences in needs between clinical medical students and clinicians regarding drug compliance,smoking cessation intervention,balanced diet,application of Chinese traditional rehabilitation medicine,mobile health technology education,exercise rehabilitation guidance,and theory of health promotion (P＜0.01).With regard to drug compliance,smoking cessation intervention,and exercise rehabilitation guidance,the proportions of clinical medical students' needs were just 87.1％,82.2％,and 81.2％,respectively,but for clinicians the proportions reached up to 96.3％,93.8％,and 92.8％,respectively.Whereas,there were no statistical differences for mental stress management,chronic infectious disease health education,and acute infectious disease health education (P＞0.05).Conclusion There is still a big gap between medical students and clinical doctors when it comes to the knowledge of chronic disease management and healthy lifestyles;clinical medical students have not yet realized the importance of such knowledge and skills.Therefore,the strengthening of course construction for clinical medical students is suggested.
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Objective@#To evalate the effectiveness and suitability of a wearable health monitoring device for community-based management of hypertension.@*Methods@#In December 2015, 400 patients with hypertension were enrolled from Beijing, Chaoyang. Subjects were divided into an experimental group (220 cases) and control group (180 cases), and baseline data were collected. The control group received follow-up with general planning while the experimental group received wearable health devices. Follow-up was performed three times using a questionnaire (April, August, and December 2016), and medical staff provided feedback and guidance. The experimental group was also classified according to risk factors and intervention measures were individually designed, and included monitor and medication compliance, self-management ability, and social support. Communication between patients and medical staff was recorded to form a case system. Evaluation indexes included accuracy and reliability, blood pressure management efficacy, behavior intervention efficacy, satisfaction, and disease burden. A t-test, non-parametric test, and chi-square test were used to compare the experimental and control groups before and after intervention.@*Results@#At 1-year follow-up, after correcting for differences in baseline information between the two groups, statistically significant differences in numerical indexes were observed for number of visits within 1 month [1(1) vs. 1(1), Z=5.42], payment within 1 month [85(141) yuan vs. 40(70) yuan, Z=-2.66], visiting time [20(20) min vs. 20(15) min, Z=-2.82], exercise times [4.79(2.24) times/week vs. 4.09(2.00) times/week, Z=9.27], medication compliance score [7.33(5.77) vs. 8.70(5.24), Z=6.86], satisfaction [9.27(0.08) vs. 8.88(0.10), Z=11.77], diastolic pressure [(78.93±0.56) mmHg vs. (81.32±0.61)mmHg, F=8.70] (1 mmHg=0.133 kPa), and body mass index [(25.55±0.27) kg/m2 vs. (27.74±0.43) kg/m2, F=-2.24]. In addition, classification indexes adjusted for normalized blood pressure and habitus were different between experimental and control groups (χ2=3.89, 8.38, P≤0.05). The equipment worked well, with performance rates of over 90% (90.9%, 97.3%, and 92.7%).@*Conclusion@#The wearable health monitoring equipment showed good stability and reliability, and was able to effectively support health management in patients with hypertension in the community. At the same time, the equipment can improve healthy lifestyle compliance and awareness or self-management of blood pressure. In this manner, the burden of disease is reduced and the quality of life is improved.
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Health Impact Assessment (HIA) is an important tool for promoting health in all policies.HIA helps decision-makers foresee how different factors can affect health,and to make choices between alternatives and improvements to prevent disease/injury,as well as to actively promote health.The Healthy China 2030 Planning Outline proposed the establishment of overall health impact assessment systems to systematically assess the potential health effects of various economic and social development programs and policies and important engineering projects on a population.This paper introduces international research on the definition,origin,development,function,contents,and implementation of HIA,as well as two typical practical examples,namely the HIA in Urban Design and Planning of Manukau,NZ,and the HIA of the Healthy Families Act of 2009,USA.Finally,the authors put forward suggestions for exploring and establishing the Chinese HIA system.Specifically,to strengthen the guidance of HIA to the direction of law and regulation,to promote the publicity and awareness of the HIA concept,and carry out research on HIA evaluation methodology and technical tools.
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Objective To analyze the choice preferences and factors influencing the long-term care (LTC)of disabled elderly in Beijing and to provide a reference for the development of aging service industry based on the present supply situations. Methods This cross-sectional study included the sociodemographic and disability information and the need for LTC.Statistical analysis was performed using the chi-square test and multivariate logistic regression analysis. Results About 75.5% (1 169) of respondents preferred household-based LTC,whereas only 0.8%(12)preferred community-based LTC.In a single factor analysis,gender,age,educational level,living conditions,marital status,income,medical and pension insurances,chronic diseases,vision,hearing,sense of taste and touch,and self-evaluation of health had statistically significant difference (χ2= 35.19, 195.58, 295.21, 245.88, 10.89, 30.33, 230.62, 277.87, 77.09, 51.07, 131.03, 124.50, 23.18, and 37.51,respectively, P<0.05). Multivariate analysis showed that educational level, marital status, medical and pension insurances, self-evaluation of health were correlated with household-based LTC,(odds ratio and 95%confidence interval,0.69(0.54-0.89),51.61(21.55-123.59), 0.29(0.09-0.94),0.40(0.22-0.73),and 0.63(0.45-0.88),respectively).Conclusions The services in the old-age caring industry have become inevitably diverse, and many factors affect the choice of LTC. Therefore,LTC insurance and community-based care should be established to meet the needs of the elderly.
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Objective To learn current status of health management services in the elderly individuals living in rural areas of Beijing,so as to provide evidence for healthcare improvement.Methods The elderly residents aged 60 or above from several rural districts of Beijing were selected by using multistage random sampling method in January 2013.The health management programme those participants obtained and their satisfactory scale were evaluated.Results A total of 719 of 1 023 (71.3％) individuals had health check-up over the past years.Only 4 subjects (0.4％) obtained mental health management,and 35 (4.9％) finished follow-up studies for chronic diseases.The percent of the elderly who received physical examination,profiles of medical record,health education,medical consultation,health evaluation,cancer screening or vaccination showed statistically significant difference of regional distribution (x2 values were 15.7,39.4,30.5,25.2,24.1,18.4 and 19.3,respectively; all P＜0.05).Sites for health check-up,profiles of medical record and health education were also found to have statistically significant regional distribution difference (all P＜0.05).In ordinal logistic regression analysis,age,occupation,health insurance,self health assessment and health medical affected satisfaction of the respondents with health management.Conclusions Our investigation shows a gap between current health management programme and national standard requirement for equal public health services,and the elderly's satisfaction with health management needs to be improved.
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Objective To understand current status and influencing factors of long-term care for elderly people who lived in rural areas of Beijing.Methods A total of 1022 elderly people (age＞60 years old) were enrolled in this cross-sectional study during December,2012 and January,2013.Demographic information,health status and needs of and intent to long-term care were learned through a questionaire survey.Chi-square test and muhiple non-conditional logistic regression analysis were used to identify the factors that were related to the respondents' selection.Results Nearly 6.6％ (61/1016) participants showed needs for long-term care.82.3％ (841/1013) respondents preferred household-based long-term care,while 7.53％ (77/1013) preferred community-based long-term care.In single factor analysis,education level,occupation,household income,living conditions,number of children living together,medical insurance,pension insurance,chronic diseases and self-report hearing ability,taste and touch were related with longterm care needs (x2values were 33.03,136.17,99.32,88.83,58.07,147.71,108.11,9.85,33.78,30.45 and 22.22,respectively; all P＜0.05).Multivariate analysis showed that occupation,income per capita,spouses living conditions,new corporative medical systems and self-report visual status were correlated with household-based long-term care (odds ratio (OR) were 2.48 (95％ confidence interval (CI) 1.21-5.10),0.82(0.71-0.95),1.64 (1.08-2.49),4.78 (2.93-7.82) and 0.72 (0.59-0.89),respectively).Conclusion Householdbased long-term care and health management system may be needed and chosen by the elderly living in rural areas of Beijing.
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Objective To evaluate the risk factors of electrocardiographic abnormality in patients with acute cerebral infarction.Methods The clinical data of patients with acute cerebral infarction were collected,including the National Institutes of Health Stroke Scale (NIHSS),electrocardiogram (ECG),lipid,glucose,glycosylated hemoglobin,body mass index,homocysteine,high-sensitivity C-reactive protein,white blood cells,and medical history.Logistics regression was used to search the risk factors of ECG abnormality in patient with acute cerebral infarction.Results ECGs of 189 cases of patients with acute cerebral infarction were divided into normal (n =83) and abnormal (n =106).The rate of abnormal ECG was 56.09％,and abnormal ECG ST-T change was the most common.NIHSS,systolic blood pressure,total cholesterol,and white blood cells were correlated with the ECG abnormality with the one-way Logistic regression analysis.In addition,NIHSS,systolic blood pressure,and white blood cells were correlated with the ECG abnormality with the multiple Logistic regression analysis (r =1.18,P ＜0.01 ; r =1.02,P ＜0.01 ; r =1.19,P ＜ 0.05).Conclusions NIHSS,systolic blood pressure,and white blood cells were independent risk factors in patients with acute cerebral infarction.ECG monitoring should be performed especially in patients with high NIHSS,systolic blood pressure,and white blood cells count.
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Objective To learn current needs of and satisfaction with health management among liver or kidney transplant recipients.Methods Our data,including needs of and satisfaction with physical or mental management and social supports,were from China Transplant Recipients Health Research Project.Chi-square test was used for data analysis.Results There was a gap between needs of and satisfaction with knowledge management of surgical operation and medication (x2 values were 22.2 and 34.2,respectively ; both P ＜0.05).No significant difference was found between needs of and satisfaction with knowledge management of appetite,energy status and physical comfort (x2 values were 25.5,30.7 and 26.3,respectively; all P ＜0.05).Difference between needs of and satisfaction with respection or understanding and support from family numbers,trust by colleagues and friends,stress release,personal performance and success,social support,friend making,leisure and entertainment activities,and improved quality of life was statistically significant (x2 values were 46.5,43.4,39.2,19.2,31.9,23.7,117.7,258.4,59.6 and 33.3,respectively ; all P ＜0.05).Conclusion Management of disease,medication,and physiological-psychological-social supports may affect health outcomes of transplant recipients,and current health management system could not meet the needs of this population.
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Objective To investigate the awareness and trainning needs of health management knowledge in primary healthcare professionals in Beijing.Methods Six hundred primary healthcare staff from Daxing,Fangshan,Miyun,Pinggu and Huairou District of Beijing were selected in 2012 through muhiphase random sampling method and required to complete a standardized questionnaire.The survey included the average awareness rates of health management(tobacco,body weight and alcohol consumption control and daily physical exercises),the rates of application and conception awareness of risk assessment tools of chronic diseases,the awareness rates of normal levels of blood pressure and serum glucose as well as training needs.Differences in different regions were analyzed.Chi-square test was used for data analysis.Results The average awareness rates of tobacco,body weight and alcohol consumption control and daily physical exercises were 94.1％ (513/545),95.3％ (522/548),94.0％ (515/548) and 85.9％ (470/547),respectively.However,the rates of application and conception awareness of risk assessment tools of chronic diseases were only 55.1％ (295/535) and 59.8％ (329/550),respectively.Those who knew the normal levels of blood pressure and serum glucose accounted for 85.4％ (475/556) and 92.4％ (514/556),respectively; although only 23.6％ (131/556) and 21.2％ (118/556) were completely familiar with the major risks of these conditions.About 57.4％ (308/537) or 56.7％ (305/538) participants reported urgent needs for health education on diabetes and hypertension management.Conclusion The awareness of health management of primary healthcare professionals in rural areas of Beijing remains lower and may need to be raised by education or training.
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Objective To learn current status of health management provided by primary health professionals working in rural areas of Beijing.Methods Health professionals in township hospitals in Beijing were selected by multi-phase random sample method in 2012 and surveyed by a standardized questionnaire to gathering the data on various health management contents,including health checkup,chronic disease management et al,the action location,its collaborative persons and sectors.Statistics description and inference were conducted to describe and compare the distribution of health management implementation across rural areas by descriptive methods and test,respectively.Results Nearly 66.3％ (321/484) of subjects provided health check-up,and 19.1％ (92/481)involved in follow-up study of mental diseases.The main targets population of health management were chronic diseases and the elderly,with response rate of 44.7％ (214/479) and 38.0％ (182/479),respectively.Health check-up,health education and follow-up of chronic diseases were performed in 62.1％ (298/480),52.4％ (251/479) and 42.8％ (206/481) of the township health centers.About 66.1％ (292/442) township health centers had cooperation with general practitioners; however,cooperation with administrative personnels was only 10.6％ (47/443).More than 41.4％ (201/463) township health centers cooperated with community administrative sectors,and cooperation with the propaganda department was only 10.6％ (49/464).The statistical difference across regions shows in the following,including health management action (health checkup,chronic disease patients following-up,et al),the target population covered (youth,elder person,children,and chronic disease patients),health management location(health checkup,education and chronic disease patients following-up in township hospital and village clinic),cooperation with General Practitioner.Conclusions Our results suggest that the actual situation on health management service in Beijing rural areas and the standards of public health equalization of China are still disjoined,even difference exists across regions.In order to improve the health management service quality,we should strengthen the health management personnel training,increase the general practitioner in proportion,establish the performance evaluation mechanism,increase governmental finance to support those service.
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Objective To evaluate the effectiveness of health management on quality of life of hypertensive patients living in underdeveloped rural regions. Methods Minqin County of Gansu Province was taken as research field, and health education covered all the population. Individual follow-up was adopted by quasi-experiment,and SF-8 scale was used to evaluate the change of scores of quality of life at baseline and the end of the study. Results The score of various dimension of quality life of interventive group showed a significant decrease at the end of follow-up ( P < 0. 05) , and the net score of general health status was 10. 92,the net score of impact to social role exerted by physical function was 9. 59,and the net score of social function was 4.61. Moreover, there was statistical difference between the intervention group and the control group for their quality of life(P <0. 05) , which showed in detail that each dimension of quality of life of the intervention group had higher score than that of the control group, after adjusting baseline difference by analysis of covariance. Conclusions All these results suggest that the active screening, following up and health education, conducted by the primary health care staff of township hospitals, under the idea of health management, can improve the quality of life of hypertension patients effectively in the rural area of underdeveloped region.
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In the light of such basic concepts as yin-yang, Sanjiao, five elements, and eight trigrams in TCM, the left forearm is selected as the treatment area to enhance treatment results. This method is extensively accepted by both doctors and patients.
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Objective To evaluate the feasibility and clinical application of two stents insertion via single tract for treatment of hepatic hilar cholangiocarcinoma. Methods Eighteen patients with hepatic hilar cholangiocarcinoma who had left and right bile duct obstruction were treated with stents insertion via right bile duct puncturing routeway. These two stents were implanted between right and left bile duct, and between right bile duct and common bile duct. Results Eighteen patients obtained successful two stents placement by right bile duct puncturing tract and succeeded with internal drainage for all bilialy tree jaundice subsided distinctly. Conclusions The technique of two stents insertion via single tract could predigest interventional drainage procedure of high bile duct obstruction ,reduce operation trauma, shorten handling time and possese promising application value.