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Chronic noncommunicable diseases are heavily burdened in China. In recent years, the digital health has developed rapidly in the medical and health industry, which provides new ways for the prevention, control and management of chronic diseases. The application of digital health includes the electronic health records, remote diagnosis and treatment, monitoring and management of the health status, the development of digital medicine and the digital medical insurance. This article reviews the connotation of digital health and its main applications in the prevention, control and management of chronic diseases, and also discusses the future directions and challenges of digital health.
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ObjectiveTo analyze the characteristics of death and premature death of 4 major chronic diseases （cardiovascular and cerebrovascular diseases， malignant tumors， chronic respiratory diseases and diabetes） in Taizhou City from 2011 to 2018，and provide data basis for the government to formulate chronic disease prevention planning. MethodsThe death data of household registration residents in Taizhou City from 2011 to 2018 were derived from the Chronic Disease Surveillance Information Management System in Zhejiang Province. The death toll ratio of chronic diseases， the mortality rate of chronic diseases， the probability of premature death of chronic diseases were analyzed. The standardization rate was calculated six times in 2010. Population composition of the census. The Joinpoint Regression Program 4.2 software was used for calculating annual percent change （APC） and its statistical test results. ResultsFrom 2011 to 2018， there were 231 724 chronic disease deaths in Taizhou City， with a mortality rate of 486.52/105 and a standardized mortality rate of 381.55/105. The proportion of chronic disease deaths to total deaths was 79.89%， of which males were higher than females and rural areas were higher than urban areas.From 2011 to 2018， the standardized mortality and early death probability of cardiovascular and cerebrovascular diseases， malignant tumors and chronic respiratory diseases in Taizhou showed a downward trend （P<0.05）， the standardized mortality of diabetes （P=0.46） and the early death probability （P=0.22） did not decline， and the mortality of all age groups of the above four types of chronic diseases in rural areas was higher than that in urban areas. The mortality of the four types of chronic diseases from high to low are cardiovascular and cerebrovascular diseases， malignant tumors， chronic respiratory diseases and diabetes， and the mortality tends to increase with age. From 2011 to 2018， the probability of premature death from four types of chronic diseases in Taizhou City showed a downward trend， from 13.49% in 2011 to 10.49% in 2018， with an average annual decrease of 2.97%. The difference was statistically significant （t=‒5.83，P<0.05）. ConclusionChronic disease death is the main cause of death in Taizhou City. In order to reduce the mortality rate of chronic diseases， effective prevention and control measures for chronic diseases should be carried out， especially the prevention and control of diabetes and male chronic diseases.
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Se realizó un estudio descriptivo y transversal de los 9 211 fallecidos por todas las causas en la provincia de Santiago de Cuba durante 2017, con vistas a describir el perfil de mortalidad en ese período. En la serie se observó un incremento de la mortalidad general con respecto a 2016; asimismo, como causas principales de muerte figuraron las enfermedades del corazón, los tumores malignos y las enfermedades cerebrovasculares. Los municipios que dominaron el perfil de mortalidad fueron Contramaestre, San Luis, Songo-La Maya, Santiago de Cuba y III Frente, principalmente por las enfermedades del corazón. Por otra parte, el mayor riesgo de morir por tumores malignos en las féminas obedeció a la localización en pulmón, mama e intestino, excepto en el recto; en los hombres, en próstata, pulmón y colon, respectivamente. Se recomienda dirigir las acciones en salud según el riesgo estratificado en esta provincia.
A descriptive and cross-sectional study of the 9 211 dead patients due to all causes was carried out in Santiago de Cuba province during 2017, with the aim of describing the mortality profile in that period. In the series an increment of the general mortality was observed when compared to 2016; also, as main causes of death there were heart diseases, malignant tumors and cerebrovascular diseases. The municipalities that prevailed in the mortality profile were Contramaestre, San Luis, Songo-La Maya, Santiago de Cuba and III Frente, mainly due to heart diseases. On the other hand, the greatest risk of dying due to malignant tumors in the female patients obeyed to the localization in lung, breast and intestine, except in the rectum; in the men, in prostate, lung and colon, respectively. It is recommended to direct the efforts in health according to the stratified risk in this province.
Subject(s)
Humans , Male , Female , Mortality , Mortality/trends , Cause of Death/trends , Epidemiologic MeasurementsABSTRACT
Se realizó un estudio descriptivo y trasversal, en el 2016, en 350 personas con diabetes mellitus de tipo 2, pertenecientes al Policlínico Docente Julián Grimau García del municipio de Santiago de Cuba y seleccionadas por muestreo probabilístico, bietápico, sistemático en fase, a fin de caracterizarles según variables clínicas y epidemiológicas. En la casuística predominaron el sexo femenino y el grupo etario de 60-69 años, así como la hipertensión arterial y la obesidad entre las comorbilidades; la neuropatía diabética y la enfermedad vascular periférica fueron las complicaciones referidas con más frecuencia, y primaron las personas diabéticas con 10 años o menos de tiempo de evolución. El tabaquismo y la ingestión de bebidas alcohólicas resultaron más frecuentes en los hombres, mientras que la ingestión de bebidas azucaradas y el sedentarismo se manifestaron de manera similar en ambos sexos. Los hipoglucemiantes de consumo oral constituyeron el tratamiento farmacológico preponderante, en tanto los conocimientos sobre la enfermedad resultaron adecuados, pero la conducta fue incorrecta en cuanto al cumplimiento terapéutico, y existió una pobre práctica de estilos saludables, así como insuficientes percepción y práctica del autocuidado y la autorresponsabilidad.
A descriptive and cross-sectional study was carried out in the 2016 with 350 patients with diabetes mellitus type 2, belonging to Julián Grimau García Teaching Polyclinic of Santiago de Cuba municipality who were selected through systematic in phase double-staged probabilistic sampling aimed at characterizing them according to clinical and epidemiological variables. Female sex and the age group 60-69 prevailed in the case material, as well as the hypertension and obesity among the comorbilities; diabetic neuropathy and the peripheric vascular disease were the most common complications referred more frequently, and diabetic patients with 10 years or less of clinical course prevailed. The smoking habit and alcohol consumption were more frequent in the men, while the consumption of sugared drinks and sedentarism had similar patterns in both sexes. Hypoglucemics of oral consumption constituted the predominant pharmacological treatment, while the knowledge on the disease was appropriate, but the behaviour was not adequate as for the therapeutic fulfillment, and there was a poor practice of healthy styles, as well as scarce perception and practice of self-care and self-responsability.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Primary Health Care , Cross-Sectional Studies , Noncommunicable Diseases/epidemiologyABSTRACT
Resumo Estudos internacionais e nacionais têm destacado a importância da coordenação do cuidado para a organização de sistemas locais de saúde. Este estudo avaliou a coordenação do cuidado pela Atenção Primária à Saúde (APS) em um sistema local de saúde do Estado da Bahia. Trata-se de um estudo de caso em município sede de macrorregião, com dois níveis de análise: equipe e gestão municipal. Adotou-se condições traçadoras (hipertensão arterial e diabetes mellitus) e elaborou-se uma imagem-objetivo correspondente à coordenação do cuidado, a partir da revisão atualizada da literatura nacional e internacional. Foram realizadas entrevistas semiestruturadas com profissionais, gestores da APS e utilizadas outras fontes documentais. Evidenciou-se que a coordenação do cuidado não tem sido alcançada no município, onde apenas 14 dos 22 critérios propostos foram atendidos, destacando-se como principais dificuldades a ausência de protocolos assistenciais, de sistemas informatizados e de outras tecnologias de informação e comunicação. As evidências e a operacionalização conceitual de um modelo para avaliar a coordenação do cuidado são contribuições relevantes deste estudo, que podem ser aplicadas a outros contextos com características similares.
Abstract International and Brazilian studies have highlighted the importance of the coordination of care for the organization of local health systems. This study aimed to analyze the coordination of care by Primary Health Care (PHC) in a municipal health system in the State of Bahia. This study was conducted in the lead municipality of the macro-region and involved two levels of analysis: PHC team and municipal management. Outlining conditions for the study were defined (hypertension and diabetes mellitus) and an objective image corresponding to the coordination of care was developed based on current national and international literature review. Semi-structured interviews with professionals, managers of PHC services were conducted and current documentary sources were also used. It was demonstrated that the coordination of care has not been met by municipal systems, where only 14 of the 22 proposed criteria have been met. The main difficulties and reasons were: a lack of health care protocols and the non-implementation of computer systems and telecommunication technologies. The results and the conceptual framework to assess the coordination of care are relevant contributions to this study, which can be applied to other contexts with similar characteristics.
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Humans , Primary Health Care/organization & administration , Delivery of Health Care/organization & administration , Diabetes Mellitus/therapy , Hypertension/therapy , Telecommunications , Brazil , Computers , Interviews as Topic , Cities , Cooperative BehaviorABSTRACT
Objective To examine the prospective associations between airflow obstruction (AFO) and risks of major chronic diseases morbidity in Chinese adults.Methods Samples of this study were from the China Kadoorie Biobank.A total of 486 996 participants aged 30 to 79 years (mean 51.5 years) at the baseline study,were included after excluding those who self-reported of having heart disease,stroke and cancer at baseline.AFO was defined under the Global Initiative on Obstructive Lung Disease (GOLD) criteria and forced expiratory volume per one second in percentage of the expected one (FEV1％P).Cox regression models were used to investigate the associations of AFO with incidence rates of ischemic heart disease,cerebrovascular disease and lung cancer after adjusted for potential confounders.Results Over a period of 7 years through the follow-up program,the incident cases of ischemic heart disease,cerebrovascular disease and lung cancer appeared as 24 644,36 336 and 3 218,respectively.Compared with people without AFO,the HR (95％CI) of GOLD-1 to GOLD-4 were 0.89 (0.78-1.01),1.05 (0.98-1.12),1.29 (1.18-1.40) and 1.65 (1.42-1.91) respectively for ischemic heart disease.The HR (95％ CI) of GOLD-1 to GOLD-4 were 0.96 (0.70-1.26),1.12 (0.96-1.31),1.38 (1.14-1.65) and 1.48 (1.05-2.02) respectively for lung cancer.No statistically significant differences in the associations between GOLD level and cerebrovascular disease morbidity were found.However,each 10％ decrease in FEV1％P was associated with 7.2％ (95％CI:6.4％-8.0％),3.6％ (95％CI:3.0％-4.3％) and 10.5％ (95％CI:8.4％-12.6％) increased the risks of ischemic heart disease,cerebrovascular disease and lung cancer respectively.The results were persistant when stratified by smoking status.Conclusion Higher degree of AFO seemed to be associated with the risks of ischemic heart disease,cerebrovascular disease and lung cancer morbidity among the Chinese adults.
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Objective To examine the prospective associations between airflow obstruction (AFO) and risks of major chronic diseases morbidity in Chinese adults.Methods Samples of this study were from the China Kadoorie Biobank.A total of 486 996 participants aged 30 to 79 years (mean 51.5 years) at the baseline study,were included after excluding those who self-reported of having heart disease,stroke and cancer at baseline.AFO was defined under the Global Initiative on Obstructive Lung Disease (GOLD) criteria and forced expiratory volume per one second in percentage of the expected one (FEV1％P).Cox regression models were used to investigate the associations of AFO with incidence rates of ischemic heart disease,cerebrovascular disease and lung cancer after adjusted for potential confounders.Results Over a period of 7 years through the follow-up program,the incident cases of ischemic heart disease,cerebrovascular disease and lung cancer appeared as 24 644,36 336 and 3 218,respectively.Compared with people without AFO,the HR (95％CI) of GOLD-1 to GOLD-4 were 0.89 (0.78-1.01),1.05 (0.98-1.12),1.29 (1.18-1.40) and 1.65 (1.42-1.91) respectively for ischemic heart disease.The HR (95％ CI) of GOLD-1 to GOLD-4 were 0.96 (0.70-1.26),1.12 (0.96-1.31),1.38 (1.14-1.65) and 1.48 (1.05-2.02) respectively for lung cancer.No statistically significant differences in the associations between GOLD level and cerebrovascular disease morbidity were found.However,each 10％ decrease in FEV1％P was associated with 7.2％ (95％CI:6.4％-8.0％),3.6％ (95％CI:3.0％-4.3％) and 10.5％ (95％CI:8.4％-12.6％) increased the risks of ischemic heart disease,cerebrovascular disease and lung cancer respectively.The results were persistant when stratified by smoking status.Conclusion Higher degree of AFO seemed to be associated with the risks of ischemic heart disease,cerebrovascular disease and lung cancer morbidity among the Chinese adults.
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Se realizó una investigación observacional, descriptiva y aplicada sobre los pacientes hipertensos de Santiago de Cuba, con análisis de series temporales, que abarcó desde enero de 2001 hasta diciembre de 2014. Las variables analizadas fueron la edad y el año de ocurrencia del proceso. Toda la información utilizada se obtuvo a través de los registros de pacientes dispensarizados en el modelo 241-476, certificados de defunción y bases de datos de mortalidad MortaProf, concernientes a los años de estudio y disponibles en el Departamento de Estadísticas de la Dirección Provincial de Salud del territorio. el diagnóstico de la hipertensión arterial en Santiago de Cuba constituye un gran problema de salud, evidenciado por una disminución de la incidencia y un aumento de las tasas de prevalencia, mortalidad y letalidad atribuibles a esa afección, cuyo pronóstico en cuanto a los indicadores de morbilidad y mortalidad apunta hacia un incremento en 2015.
An observational, descriptive and applied investigation on hypertensive patients in Santiago de Cuba was carried out with temporary series analysis that spanned from January, 2001 to December, 2014. The analyzed variables were the age and the year when the process occurred. All the used information was obtained through the patients records categorization in the 241-476 pattern, death certificates and MortaProf mortality databases, concerning the years of study and available in the Health Provincial Direction Statistics Department of the territory. The hypertension diagnosis in Santiago de Cuba constitutes a great health problem, evidenced by a decrease of the incidence and an increase of the prevalence, mortality and fatality rates attributable to that disorder whose prognosis as for the morbidity and mortality indicators points toward an increment in 2015.
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Noncommunicable Diseases , Hypertension/mortality , Health Statistics , PrevalenceABSTRACT
La diabetes mellitus, enfermedad crónica no transmisible, es considerada un grave problema de salud por resolver en todo el orbe. A tales efectos se realizó una revisión bibliográfica exhaustiva para exponer algunos aspectos relacionados con esta afección (definición, patogenia, factores de riesgo, aspectos vitales para el diagnóstico, clasificación, complicaciones y cuadro clínico, entre otros) y se puntualizó tanto en el tratamiento de los afectados como en la conducta a seguir en la atención primaria de salud.
Diabetes mellitus, a chronic non-communicable disease, is considered a serious health problem to be solved in the whole world. To such effects, an exhaustive literature review was carried out to expose some aspects related to this disorder (definition, pathogenia, risk factors, vital aspects for the diagnosis, classification, complications and clinical pattern, among other) and the treatment of the affected patients as the behaviour to continue in the primary health care were emphasized.
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Diabetes Mellitus , Noncommunicable Diseases , Primary Health CareABSTRACT
Se realizó un estudio descriptivo, longitudinal y prospectivo de 216 pacientes que acudieron a la consulta de medicina del Hospital "Sominé Dolo" de la región de Mopti (Mali), con cifras tensionales elevadas, desde enero hasta diciembre de 2009, a fin de caracterizarles clínica y epidemiológicamente. Entre las variables analizadas figuraron: edad, sexo, actividad que desarrollaban, etnia y tipo de hipertensión arterial. La mencionada enfermedad (sobre todo la moderada) predominó en adultos maduros y el sexo femenino, sin diferencias étnicas relacionadas con la afección, si bien se hallaron valores similares a los informados en regiones de alta prevalencia, por lo cual convenía proceder a la dispensarización de las personas hipertensas en ese territorio.
A descriptive, longitudinal and prospective study was carried out in 216 patients attending the outpatient department of "Sominé Dolo" Hospital in the region of Mopti (Mali) with high pressure values, from January to December 2009, in order to characterize them clinically and epidemiologically. Among the analyzed variates were age, sex, activities, ethnicity and type of hypertension. The aforementioned disease (mainly moderate) prevailed in mature adults and females, without ethnic differences related to the condition, although the values were similar to those reported in high prevalence regions, so that it was advisable to carry out measures for prevention and rehabilitation of hipertensive individuals in the territory.
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Se efectuó un estudio descriptivo y retrospectivo de 50 adultos mayores con diabetes mellitus, pertenecientes al consultorio médico de la familia No. 6 del Policlínico Universitario "Francisca Rivero Arocha" de Manzanillo, desde abril de 2008 hasta enero de 2010, con vistas a describir los factores de riesgo para padecer dicha afección. Se realizó un muestreo no probabilístico al azar. En la casuística primaron las féminas entre 70-79 años, bebedoras de café, con hipertensión arterial asociada e insuficiente práctica de ejercicios físicos, quienes incumplían con la dieta establecida y consumían regularmente sus medicamentos.
A descriptive and retrospective study of 50 aged adults with diabetes mellitus, belonging to the doctor's office No. 6 of "Francisca Rivero Arocha" University Polyclinic in Manzanillo was carried out from April, 2008 to January, 2010, aimed at describing the risk factors to suffer this disorder. A randomly non probabilistic sampling was carried out. Females between 70-79 years, coffee drinkers, who suffered associated hypertension and scarce practice of physical exercises and who did not follow the established diet and took their medications regularly prevailed in the case material.