Study on residents' satisfaction of basic public health services of urban and rural primary health care institutions / 中国卫生政策研究

Objective:To analyze the satisfaction degree and influencing factors of basic public health services in urban and rural areas in Hubei province,and to provide the evidence for further improvement of the quality of basic public health services. Methods:A total of 12 primary health institutions (6 urban community health service centers and 6 rural township hospitals) were selected from Wuhan,Huanggang,Jingzhou of Hubei Province. A questionnaire survey was conducted on the satisfaction,accessibility,comfort,safety and effectiveness of basic public health services among 719 residents. Results:The overall urban and rural residents'satisfaction score of basic public health service was 71.62 points,and the total satisfaction rate was 73.44%. The urban residents overall satisfaction score was 74.67 points,and the overall satisfaction rate was 75. 34%. The rural residents overall satisfaction score was 67.64 points,and the overall satisfaction rate was 71.52%. Among the specific indicators,the most satisfactory items were the convenience of visits (83.03%),privacy protection (80.25%),and indicators least satisfactory were medical technology(61.61%)and equipment facilities(64.53%). Logistics regression analy-sis showed that accessibility,comfort and safety of basic public health services had a greater impact on community residents' satisfaction;and gender and annual medical expenditure had a certain impact on residents'satisfaction. Conclusions:The over-all satisfaction of basic public health services in urban and rural residents of Hubei province is at a general level and still to be promoted. Urban residents'satisfaction is higher than that of the rural area. The basic public health services should further strengthen the quality improvement to further promote the equalization of basic public health services in rural as in urban areas.

Factors Affecting Patient Satisfaction with Community Health Service under the Gatekeeper System: A Cross-sectional Study in Nanjing, China / 生物医学与环境科学（英文）

The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service (CHS) under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor-patient relationships, information and support, organization of care, and accessibility (P < 0.001). One or more factors such as gender and self-perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients' satisfaction with CHS by strengthening their awareness of the gatekeeper policy.

Evaluation of effects of combination intervention model to men who have sex with men / 中华预防医学杂志

<p><b>OBJECTIVE</b>This study aimed to explore and evaluate the effects of combination intervention model conducted by Center for Disease Control and Prevention and activity place to men who have sex with men (MSM).</p><p><b>METHODS</b>To implement one-year combination intervention in 4 MSM venues during May, 2009 and April, 2010. Meanwhile, 3 similar MSM venues were chosen as control. MSM places introduced CDC to consumption crowds. Experts and volunteers sent by CDC undertook health education programme on site and condom, lubricant, pamphlet, consultation, test were provided at the same time. The intervention measures applied to control only included providing pamphlet, condom, lubricant by volunteers. Investigations were conducted among subjects of combination intervention group and control group before (111, 120 subjects) and after (105, 98 subjects) the intervention with questions related to knowledge and behavior of AIDS prevention.</p><p><b>RESULTS</b>After one-year intervention, among MSM with combination intervention, the awareness rate of knowledge level about acquired immune deficiency syndrome (AIDS) increased from 73.0% (81/111) to 91.7% (110/120), proportion of condom-use with male at last anal intercourse increased from 73.0% (81/111) to 85.0% (102/120), ratio of never-use condom with male decreased from 10.8% (11/102) to 1.7% (2/112), percentage of acquiring AIDS-related service and intervention improved significantly, acquiring condom (lubricant) increased from 70.3% (78/111) to 85.0% (102/120), acquiring peer education increased from 10.8% (12/111) to 24.2% (29/120), the proportion of acquiring counseling and testing of HIV increased from 69.4% (77/111) to 90.8% (109/120) (all P values < 0.05). The above index show no statistic difference before and after the intervention (all P values > 0.05) in control MSM venues.</p><p><b>CONCLUSION</b>Combination intervention model was an effective intervention model contributing to an increase in knowledge of AIDS prevention and decreasing high risk behavior in MSM population.</p>

Comparative study of the factors in tuberculosis treatment between immigrant workers and local residents in Shenzhen / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the factors affecting the management and treatment of immigrant workers with tuberculosis, to determine the most effective measures and to provide an academic basis for tuberculosis control and prevention strategies targeting the immigrant population.</p><p><b>METHODS</b>A self-designed questionnaire was administered to 1364 immigrant workers with tuberculosis (study group) and 436 local residents (control group) with tuberculosis.</p><p><b>RESULTS</b>Whether a patient's tuberculosis status was discovered or not was related to the medical facilities initially visited, job mobility, and the individual worker's economic condition. The percentage of cases discovered was relatively low among those who made their first visit to a private clinic (39.0%), and 58.4% (796) of immigrant workers delayed their first consultation mainly due to neglecting symptoms (55.9%, 445), subjective perception of symptoms being not severe enough (19.3%, 154) to visit a physician and the inconvenience of visiting a hospital because of its being far away from home (15.8%, 47). As comparing immigrant workers with local residents, the differences of the delay reason between the two groups were statistically significant (chi(2) = 21.49, P < 0.01). And 39.9% (544) of immigrant workers and 49.1% (214) of local residents had had late confirmation. The differences of the delay reasons between the two groups were insignificant (chi(2) = 7.31, P = 0.293). And 17.6% (240) patients of immigrant workers and 13.1% (57) patients of local residents did not keep to their drug regimens in a timely fashion. The differences of the reasons between the two groups were insignificant (chi(2) = 6.66, P > 0.05). And 77.5% (1057) of immigrant workers and 31.8% (138) of local residents were considered that taking medicine in supervision spot might have impact on their lives and work. The differences of the reasons between the two groups were significant (chi(2) = 9.71, P < 0.05). All 79.2% (1080) of immigrant workers and 63.3% (276) of local residents did not obtain medicine according to prescriptions. The differences of reasons between the two groups were statistically significant (chi(2) = 24.84, P < 0.01). And 51.2% (699) of immigrant workers and 46.1% (201) of the registered population did not follow up with doctors' directions for lab tests. The differences of the reasons between the two groups were insignificant (chi(2) = 3.26, P > 0.05).</p><p><b>CONCLUSION</b>The influential factors in tuberculosis management and treatment were complex. Prevention strategies should focus on health education and promotion activities to improve awareness in seeking medical services. Also, developing and standardizing reference mechanisms for patients, and alleviating the economic burden of the workers will be critical to reduce the tuberculosis incidence.</p>

Study on the relationship between polymorphisms of XPA gene and susceptibility of esophageal cancer / 中华流行病学杂志

Objective To explore the relationships between the polyrnorphisms of xeroderma pigmentosum A(XPA) and the susceptibility of esophageal cancer (EC),as well as its interaction with environmental factors-gene in Changzhi area,Shanxi province. Methods A case-control study was conducted,including 196 cases of EC and 201 controls.XPA 23G polymorphisms were determined with polymerase chain-restriction on fragment length polymorphism (PCR-RFLP).Results The risk of EC was significantly degraded in the individuals who had been carrying the XPA heterozygote (A/G) and mutation genotype (G/G),compared to those with wild genotype (X2=16.21,P＜0.01) and the ORs were 0.58 (0.37-0.91) and 0.32 (0.18-0.56),respectively.There was negative interaction between XPA 23G mutation genotype and the consumption of pickled food (S=0.04,API=-0.77).Conclusion Genetic polymorphism in the XPA 23G might be associated with esophageal cancer in Changzhi area,and there was a negative action between XPA predisposing genotype and the consumption of pielded food.

An assessment on the effectiveness of condom use in reducing the incidence of chlamydia through mathematical modelling / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine the relationship between the rate of condom use and incidence of Chlamydia amongst commercial sex worker, using a mathematical model.</p><p><b>METHODS</b>Assuming that p(%) is the rate of condom use by female sex workers, and r(%) is the incidence of Chlamydia. If the use of condom increases by delta p, then the incidence of Chlamydia will decrease by delta r. k is the relative rate of change. Then, the mathematical model established becomes dr/dp = -kr.</p><p><b>RESULTS</b>The solution of the differential equation is r (p) = r (P0) exp [-k (p - p0)]. Using the surveillance data gathered from 100% Condom Use Program in Wuhan City, the k value is calculated to be 4.36. If k indicates the contribution coefficient of reducing Chlamydia after condom use, when the rate of condom use increases by 16%, then the incidence of Chlamydia will decrease by 50%. The average difference between the actual incidence and the incidence calculated from the mathematical model is only 6.2%. This result demonstrates a good fit. The predicted result of using this mathematical model shows that at the time of lower levels of condom use, a small increment on the rate of condom use would considerably reduce the infection rate of Chlamydia.</p><p><b>CONCLUSION</b>When k remains constant, this mathematical model reflects the qualitative relationship between the rate of condom use and the incidence of Chlamydia.</p>

Prospective study on family burden following traumatic brain injury in children / 中华流行病学杂志

<p><b>OBJECTIVE</b>To collect basic information on family burdens and long-term influence of children suffered from traumatic brain injury (TBI).</p><p><b>METHODS</b>Through prospective study, child behavioral problems, and injury-related family burden were assessed longitudinally in children with TBI over 6 months during the post injury period and children's pre-injury family function rated by parents soon after injury. Post injury child behavior and family outcomes were assessed at 6-month follow-up period.</p><p><b>RESULTS</b>The mean adaptation partnership growth affection and resolve scale (APGAR) score of 113 children before TBI was 7.96 and score after TBI was 6.94, which had significantly difference through t test. The mean APGAR score after 6 months was 7.60, which was significantly different from the hospital data. Among group with severe TBI, the family APGAR score in hospital was significantly smaller than that before injury occurred, and the family APGAR score in 6 months after being discharged from the hospital had no significant difference with the score when staying in the hospital. The three leading dimensions among family burden scale of diseases (FBS) scores after TBI were dimension of family economic burden, family daily life and family entertainment. 6 months later, the three leading dimensions had changed to be as dimension of mental health status, dimension of family relationship and dimension of family economic burden. Mean score of child behavior checklist (CBCL) assessed at 6-months follow up period among 113 children was among normal range.</p><p><b>CONCLUSIONS</b>Family function of children with TBI was affected by TBI. However, family function could be recovered along with child's convalescence except among children with severe TBI. Long-term pressure of TBI on family was revealed in mental health status and family relationship. In this study, there were no evidence of association between TBI and children's behavior problem.</p>

Study on the relations between serum insulin-like growth factor-1, insulin-like growth factor binding protein-3 and colorectal cancer: a meta-analysis / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the relationship between circulating levels of insulin-like growth factor-1 (IGF-1), IGF-binding protein-3 (IGFBP-3) and colorectal cancer.</p><p><b>METHODS</b>A meta-analysis of 6 epidemiological studies on insulin-like growth factors and risk of colorectal cancer were performed.</p><p><b>RESULTS</b>The pooled odds ratio (OR) of IGF-1 and IGFBP-3 were 1.56 (95% CI: 1.14-2.13) and 0.78 (95% CI: 0.43-1.44) respectively. According to the results from different measurements (enzyme-linked immunoabsorbent assay and immunoradiometric assay), the pooled OR were 1.92 and 1.23 for IGF-1, 0.46 and 1.44 for IGFBP-3 respectively.</p><p><b>CONCLUSION</b>High serum levels of IGF-1 were independent risk factors of colorectal cancer but the OR of IGFBP-3 was not statistically significant. The heterogeneity between studies on IGFBP-3 and colorectal cancer was caused by different measurements used, but there was still a need to conduct simultaneous large size study under 2 different measurements for further conclusion.</p>