Investigation and analysis of cesarean section rate and indications in Shanghai / 中国实用妇科与产科杂志

OBJECTIVE:To study the current status of cesarean section rate(CSR)and cesarean section(CS)indications in Shanghai,and to provide basic evidence for reducing the rate of CS.METHODS:Six general and maternal and child hospi⁃tals(MCH)in Shanghai were selected,and all data of childbirth of these hospitals in 2016 were collected.The total CSR was calculated for all hospitals and the Chi-square tests were used to compare the CSR among different hospitals.The constitution of CS indications were reported by using the data collected from two out of the six hospitals.RESULTS:The to⁃tal CSR of all hospitals in this study was 47.88%(95% CI 47.30%-48.46%).The CSR in suburb an hospitals was signifi⁃cantly higher than that in outer suburbs and city center(51.72% vs. 50.54% vs. 43.24%,P<0.01),The CSR in secondary hospitals was significantly higher than that in tertiary hospitals(49.73% vs. 46.36%,P<0.01).The CSR in general hospi⁃tals was higher than that in MCH(54.54% vs. 43.81%,P<0.01).The CS without medical indications or for social reasons accounted for 25.15% of all CS,while the scar uterus(36.31%),maternal pregnancy-related complications(13.17%)and abnormal fetal head position(6.33%)were the three leading medical indications of CS.CONCLUSION:The CSR in Shang⁃hai is at a high level.There are significant differences in CSR among different hospitals.The scar uterine and social rea⁃sons are the leading causes of CS in Shanghai.

Data analysis of bariatric & metabolic surgery quality control from 2012 to 2018 in Shanghai / 中国实用外科杂志

OBJECTIVE: To learn the latest developments of Shanghai's bariatric & metabolic surgery and the differences with east Asian countries according to the transverse and vertical comparison. METHODS: Through data reporting mechanism of the Shanghai Quality Control Center of General Surgery,the bariatric & metabolic surgery data were regularly collected and summarized. RESULTS: The number of hospitals developed from 11 in 2012 to 14 in 2018,and the overall surgery cases showed a progressive growth. In 2017, nineteen hospitals and 798 surgical cases had reached the highest level while decreased in 2018. The study showed that mean surgical time decreased to 112±14.8 min with no severe complication. The proportion of patients with type 2 diabetes pre-surgery decreased from 53.4% in 2014 to 30.9%in 2018. The proportion of sleeve gastrectomy(SG) increased from 68.4% in 2014 to 94.1% in 2018, which had become the most commonly bariatric surgical procedure. CONCLUSION: The amount of Shanghai metabolic and bariatric surgery increases year by year from 2012 to 2018, while increased little in 2017-2018,patients tend to be younger,mainly with obesity. The SG has become the main procedure performed in Shanghai.

Approach to the mental health service system development in Shanghai / 中华医院管理杂志

Mental health is key to public health, as building and developing a mental health service system is legally required in the Mental Health Law of China. The authors probed deep, by means of questionnaire, field survey and group interview, into the characteristics and setbacks of the resources available, organizational framework and operations of the system in China. As found in the study, given a framework in place, this system is plagued by insufficient human resources, weak infrastructure, unreasonable input and compensation mechanism, as well as poor management at community level. These problems are common nationwide. On this basis and with reference to experiences of developed countries, policy proposals are raised in terms of integrated system building, capacity building and assurance mechanism, for framework building and supportive policies of other cities in China.

Development of quality evaluation indicator system of midwifery care in Shanghai / 中华医院管理杂志

Objective To develop a quality evaluation indicator system of midwifery care in line with the modern service concept in Shanghai area under the background of over-medicalization trend of midwifery services, and to guide the improvement direction of midwifery quality. Methods Guided by the evidence-based framework of midwifery quality and indicator selection principles, the indicators for evaluating midwifery quality were preliminarily selected by literature review and theoretical analysis. Two rounds of Delphi survey among 53 experts from Shanghai were conducted to decide the final quality evaluation indicator system of midwifery care. Analytic hierarchy process ( AHP) and the importance′ sum average method were adopted to calculate weights coefficients of the indicators. Results 45 indicators for evaluating midwifery quality were preliminarily selected. The response rate of two rounds of Delphi survey were 76% and 100% , the authority coefficients were 0.90 and 0.89, expert opinion coordinate coefficients were 0.190 and 0.257, respectively. The final version of the indicator system consists of 11 structure quality indicators, 13 process quality indicators and 19 outcome quality indicators. The weight values of the three first-level indicators were 0.195 8, 0.310 8 and 0.493 4 respectively. The weight values of the 43 second-level indicators ranged from 0. 016 1 to 0. 028 6. Conclusions The quality evaluation indicator system of midwifery care developed fits evidence-based midwifery philosophy. It provides a scientific tool for midwifery quality evaluation in Shanghai, which can guide the improvement of midwifery quality.

A cross-sectional study of supervision in Shanghai mental health service industry / 中国心理卫生杂志

Objective:To understand the status of supervision of mental health service industry in Shanghai, and to provide reference for further strengthening the construction of mental health service system in Shanghai. Methods: In Shanghai, 107 mental health service agencies (including psychiatric institutions, non-specialist medical institutions, non-specialist enterprise and public institutions, social institutions) were selected from Shanghai psychological service industry association. The survey was conducted with the Questionnaire on Current Situation of Mental Health Professional Service Agencies in Shanghai (agency survey), including the "relevant information of agency" and the "management of the agency in the field of mental health services"(whether the agency had supervision requirements on the mental health service personnel, whether the agency organized supervision, the source of supervisors and payment method), and the Questionnaire on Current Situation of Mental Health Service Professionals in Shanghai (professional survey), including "basic information on demography "and" psychological professional work" (the number of hours of supervision in 2015, the cost of supervision, and the form of supervision and payment method). These two parts of questionnaire were selected and analyzed. Results: Agency survey results showed that 80％ of non-specialist enterprises had no supervision requirements for mental health service personnel, supervisor in non-specialist medical institutions were mainly from psychiatric institution (52.9％). The cost of supervision in most psychiatric institutions was paid by the agency (39.1％) and the cost of supervision in most public institutions was paid by professional (37％). The professional institutions under the jurisdiction of other departments within the unit required less supervision of the professional staff than the independent institutions (P ＜ 0.001). Professional survey results showed that the number of supervision hours of mental health service professional in social institutions was more than that in the other three types of institutions (P ＜0.001), of which 47.9％ chosen to pay the cost of supervision by themselves. The proportion of their own payment in social institutions was higher than that in the other three types of institutions (P ＜0.001). Conclusion:The social institutions in Shanghai have the best supervision of social institutions, followed by the supervision of the medical institutions. The supervision of non-medical enterprises and their personnel needs to be improved.

Risk analysis of imported schistosomiasis in Shanghai City from 2005 to 2015 / 中国血吸虫病防治杂志

Objective To understand the risk situation of imported schistosomiasis and its main influencing factors in Shang-hai City from 2005 to 2015. Methods A retrospective survey was performed,and the database was established based on the da-ta collection of imported schistosomiasis,Oncomelania hupensis snail situation and mobile population in Shanghai City from 2005 to 2015. Results From 2005 to 2015,the mobile population in Shanghai City increased by 123.92％,which reached about 9816500,and 54.70％of them were located in the inner suburban districts. The accumulated areas with snails of 7.13 hm2 were found in 16 towns of 4 outer suburbs(excluding Chongming District). A total of 23 cases of imported schistosomiasis were found in Shanghai City,and the number of the imported schistosomiasis cases was on the downward trend(rs=-0.782,P=0.004). From 2005 to 2009,11 out of 13 imported schistosomiasis cases(84.62％)were distributed in the inner suburban dis-tricts where no O. hupensis snails were found at the same time. From 2010 to 2015,9 out of 10 imported schistosomiasis cases (90％)were distributed in the outer suburban districts where O. hupensis snails were found at the same time. Conclusion The number of imported schistosomiasis cases in Shanghai is on the downward trend. However,the threat of imported schistosomiasis to the prevention and control of schistosomiasis in Shanghai City should not be ignored.

Comparative analysis of malaria detection ability of laboratories in Shang-hai City from 2012 to 2015 / 中国血吸虫病防治杂志

Objective To compare the application effects of three methods,namely microscopic examination,antigen detec-tion(RDT)and nucleic acid test(PCR)in malaria detection between municipal and districts/counties centers for disease con-trol and prevention in Shanghai,and analyze the malaria detection ability of the laboratories in Shanghai. Methods The blood smears,whole blood samples,case review confirmation records and case data of malaria cases and suspected cases in Shanghai from 2012 to 2015 were collected by Shanghai Municipal Center for Disease Control and Prevention,and the detection results were analyzed and compared. Results A total of 212 samples with complete data were submitted by all districts(counties)in Shanghai from 2012 to 2015,the samples submitted by Jinshan Districts were the most(41.98%),and among the first diagnosis hospitals,those submitted by the tertiary hospitals were the most(82.07%). The submitted samples in the whole year were in-creased gradually from January to October. All the 212 samples were detected by three methods(the microscopic examination, RDT and PCR)in the laboratory of Shanghai Municipal Center for Disease Control and Prevention,and 167 were tested and con-firmed comprehensively as positives,accounting for 78.77%,and 45 were confirmed as negatives,accounting for 21.23%. The samples were detected by the method of microscopy and domestic RDT in the laboratories of the centers for disease control and prevention at district/county level,totally 153 were tested as positives,accounting for 72.17%,41 were unclassified,account-ing for 19.34%,53 were negative,accounting for 25.00%,and 6 were undetected,accounting for 2.83%. The coincidence of microscopic examination between the report hospitals and the centers for disease control and prevention at district/county level was 78.16%,and the coincidence between centers for disease control and prevention at district/county level and municipal level was 93.20%. The utilization rate of RDT in the laboratory of district/county level was 73.58%. The coincidence of RDT tests be-tween those domestic and imported was 93.59%. Compared with the detection results by municipal center for disease control and prevention,37 samples were misjudged by the laboratories of district/county level. Almost all(99.37%)of the confirmed malar-ia cases were imported overseas,including Africa(85.44%),Asia(13.92%)and America(0.63%). Conclusion The surveil-lance after malaria elimination in Shanghai should be carried out by combining with different detection methods and resource in-tegration.

Investigation on Cognition of the Clinical Pharmacists on the Clinical Pharmacy Practice and Their Profes-sion in the Medical and Health Institutions in Shanghai / 中国药房

OBJECTIVE:To investigate the cognition of clinical pharmacists on the clinical pharmacy practice and their profes-sion,and provide reference for further developing clinical pharmacy practice. METHODS:A questionnaire was designed,and ran-dom sample was conducted for the clinical pharmacists from 30 secondary and tertiary hospitals in Shanghai,and the investigation results were analyzed statistically. RESULTS:Totally 130 questionnaires were sent out,and 102 were effectively received with valid response rate of 78.46%. 94.11% of the investigated subjects were willing to be a clinical pharmacist,but 17.65% of them consid-ered that they were incompetent for their work;29.41% of them thought the current situation of clinical pharmacy practice was not ideal;all the respondents considered that the clinical pharmacist system should be implemented in medical and health institu-tions;the cognition and evaluation of investigated subjects in tertiary hospitals on clinical pharmacy practice and their profession was generally higher than those in secondary hospitals(P<0.05). CONCLUSIONS:The clinical pharmacists in medical and health institutions in Shanghai showed high cognition on their profession,and the clinical pharmacy practice has already made some achievements,but many work still need to be improved. Therefore,clinical pharmacists should continuously study their profession-al knowledge and improve their professional skills and quality;hospitals and universities should strengthen the subject construction and personnel training of clinical pharmacy and deeply carry out the clinical pharmacist system;health administration departments should strengthen the related laws and regulations of clinical pharmacy;colleges and universities should strengthen the discipline construction and personnel training.

Species composition and distribution of medical mollusca in Shanghai City / 中国血吸虫病防治杂志

Objective To investigate the species diversity and distribution of medical mollusca in Shanghai City. Methods From August 2012 to October 2013,all kinds of habitats in 8 districts and counties in Shanghai City,namely Jiading,Qingpu, Baoshan,Minhang,Songjiang,Jinshan,Chongming,Pudong,were selected for the field survey according to the distribution characteristics of the river system,and all the specimens of medical mollusca in the investigation sites were collected and classi?fied by morphological identification. Meanwhile,the species composition,habitats as well as the fauna of the medical mollusca collected were analyzed. Results A total of 5 211 specimens were collected,which belonged to 2 classes,14 families,18 gen?era and 25 species,including Oncomelania hupensis hupensis,Pomacea canaliculata,Parafossarulus striatulus,Alocinma longicornis,Physa acuta,Galba pervia,Hippeutis cantori,etc. The species numbers of medical mollusca in Chongming,Jin?shan,Pudong new area and Qingpu districts(counties)were 22,22,21 and 20,respectively,which were more than those of other areas. The habitat analysis suggested that the species numbers in the river and wetland were the most,both of which were 14 species. The main faunas of the medical mollusca in Shanghai were the cosmopolitan and oriental species. Conclusions The freshwater gastropod species are paucity in Shanghai City,but almost of them can be served as the intermediate hosts of certain parasites to transmit snail?related parasitic diseases,so the surveillance of medical mollusca should be strengthened.

Investigation on schistosomiasis japonica infection and preventive knowledge of immigration population in Jinshan District,Shanghai / 中国血吸虫病防治杂志

Objective To investigate the schistosomiasis japonica infection and preventive knowledge of immigration popula-tion in Jinshan District,Shanghai so as to provide the evidence for improving the control work. Methods The immigration popula-tion from schistosomiasis endemic provinces and local people were screened by serum IHA screening for schistosome infection, and the positives were further examined by Kato-Katz technique and the miracidium hatching method. The schistosomiasis preven-tive knowledge and behaviors were investigated by questionnaires. Results A total of 579 were investigated with 348 immigration people and 231 local people,and among them,the male accounted for 72.0%and female accounted for 28.0%. In the immigration population,the main age group was 20-29(56.0%),and 56.6%of the immigration had an education level at senior middle school or higher. The most proportion of immigration was from Anhui Province(36.2%). There were 4 IHA positive persons(1.15%)in the immigration,and 1 was positive in the stool test,and the schistosome infection rate was 0.29%. There were no positives in the local people. The schistosomiasis preventive knowledge of the immigration was generally poor,and some people’s behaviors of see doctor and medication were incorrect. Conclusion There are schistosome infected persons among the immigration population from schistosomiasis endemic provinces,and their schistosomiasis prevention knowledge was poor,thus there is a schistosomiasistransmission risk.

An epidemiological investigation on the cases of Shanghai pre-hospital care in 2007 / 中华急诊医学杂志

Objective To analyze the epidemiologieal characteristics of the pre-hospital care cases in Shanghai in the year 2007. Method Based the demographic records in the year 2007, the cases which from the database of Shanghai pre-hospital care center with full items were analyzed. Chi-square test and exact probabilities were used to compete the consfituent ratio; and the method of circular distribution was used to calculate the peak time, date and month. Results There were 86 815 patients with pre-hospital care well documented from the ur-ban districts of Shanghai. The ratio of male to female was 3.89: 1. The senile patients accounted for 84.95% of all the pre-hospital care ones. The major causes of disease in patients with pre-hospital care were trauma, eere-brovascular disease,cardiac diseases, coma, high fever, tumor emergency, acute abodomen emergency,OB/GYN emergency and upper G1 tract bleeding in turn. During the daytime, the occurrence of those emergency patients with pre-hospital care usually peaked at 2:15 o' clock with the high frequency in the period of 5:45 to 17:45 o' clock.The top nine diseases had their own peak time and high frequency period, respectively. Within a year, no peak date occurrence of patients with prehospital care, in tolal, was found. Howerer, the occurrence of patients with high fever, acute abdomen and upper GI bleeding had specific peak dates within a year, respectively. Conclusioes The pre-hospital care eases in the urban of Shanghai have own epidemiologieal characteristics. Perfect the construc-tion of pre-hospital emergency care system, improving the professional training, and thereby meeting the require-ments are factors in the fundamental guarantee of improving the rescue full success rate of severe patients.