Unmet needs in health training among nurses in rural Chinese township health centers: a cross-sectional hospital-based study / 보건의료교육평가

PURPOSE: Maintaining a sufficient and competent rural nursing workforce is an important goal of the Chinese health delivery system. However, few studies have investigated the health training status or conducted a needs assessment of rural Chinese nurses during this time of great transformations in health policy. This study was conducted to explore the current health training status of nurses working in rural Chinese township health centers (THCs) and to ascertain their perceived needs. METHODS: A cross-sectional survey using a self-administered structured questionnaire was conducted among 240 THC nurses in Guangxi Zhuang Autonomous Region, China from March 2014 to August 2014. The survey questionnaire was adapted from the Second Chinese Survey of Demographic Data and Training Demand for Health Professionals in THCs developed by the Ministry of Education. RESULTS: The nurses in THCs were young, with a low educational level. Their perceived needs for health training included further clinical studies at city-level hospitals to improve their skills and theoretical studies at medical universities in emergency medicine and general practice. Overall, 71.9% of the nurses with a secondary technical school background expected to pursue junior college studies, and 68.5% of the nurses with a junior college education expected to pursue a bachelor's degree. A decentralized program with theoretical studies at medical universities and practical studies at county hospitals was regarded as feasible by 66.9% of the respondents. CONCLUSION: Health-training programs for nurses in Chinese THCs must be improved in terms of coverage, delivery mode, and content. A decentralized degree-linked training program in which medical universities and city hospitals collaborate would be an appropriate mode of delivery.

Clasificación según nivel de morbilidad e intensidad del uso de recursos de una población con patologías crónicas en Atención Primaria de Salud utilizando “Adjusted Clinical Groups” (ACG) / Adjusted Clinical Groups Method (ACG) to allocate resources according to the disease burden of each health center

Background: Health care must be provided with strong primary health care models, emphasizing prevention and a continued, integrated and interdisciplinary care. Tools should be used to allow a better planning and more efficient use of resources. Aim: To assess risk adjustment methodologies, such as the Adjusted Clinical Groups (ACG) developed by The Johns Hopkins University, to allow the identification of chronic condition patterns and allocate resources accordingly. Material and Methods: We report the results obtained applying the ACG methodology in primary care systems of 22 counties for three chronic diseases, namely Diabetes Mellitus, Hypertension and Heart Failure. Results: The outcomes show a great variability in the prevalence of these conditions in the different health centers. There is also a great diversity in the use of resources for a given condition in the different health care centers. Conclusions: This methodology should contribute to a better distribution of health care resources, which should be based on the disease burden of each health care center.

A Cross-sectional Study Assessing Predictors of Essential Medicines Prescribing Behavior Based on Information-motivation-behavioral Skills Model among County Hospitals in Anhui, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The self-consciousness and practicality of preferentially prescribed essential medicines (EMs) are not high enough in county hospitals. The purposes of this study were to use the information-motivation-behavioral skills (IMB) model to identify the predictors of essential medicines prescribing behavior (EMPB) among doctors and to examine the association between demographic variables, IMB, and EMPB.</p><p><b>METHODS</b>A cross-sectional study was carried out to assess predictive relationships among demographic variables and IMB model variables using an anonymous questionnaire administered in nine county hospitals of Anhui province. A structural equation model was constructed for the IMB model to test the instruments using analysis of moment structures 17.0.</p><p><b>RESULTS</b>A total of 732 participants completed the survey. The average age of the participants was 37.7 ± 8.9 years old (range: 22-67 years old). The correct rate of information was 90.64%. The average scores of the motivation and behavioral skills were 45.46 ± 7.34 (hundred mark system: 75.77) and 19.92 ± 3.44 (hundred mark system: 79.68), respectively. Approximately half (50.8%) of respondents reported that the proportion of EM prescription was below 60%. The final revised model indicated a good fit to the data (χ2 /df = 4.146, goodness of fit index = 0.948, comparative fit index = 0.938, root mean square error of approximation = 0.066). More work experience (β = 0.153, P < 0.001) and behavioral skills (β = 0.449, P < 0.001) predicted more EMPB. Higher income predicted less information (β = -0.197, P < 0.001) and motivation (β = -0.204, P < 0.001). Behavioral skills were positively predicted by information (β = 0.135, P < 0.001) and motivation (β = 0.742, P < 0.001).</p><p><b>CONCLUSION</b>The present study predicted some factors of EMPB, and specified the relationships among the model variables. The utilization rate of EM was not high enough. Motivation and behavior skills were crucial factors affecting EMPB. The influence of demographic variables, such as income and work experience, on EMPB should be fully appreciated. Comprehensive intervention measures should be implemented from multiple perspectives.</p>

Prediction model of health workforce and beds in county hospitals of Hunan by multiple linear regression / 中南大学学报(医学版)

OBJECTIVE@#To construct prediction model for health workforce and hospital beds in county hospitals of Hunan by multiple linear regression.@*METHODS@#We surveyed 16 counties in Hunan with stratified random sampling according to uniform questionnaires,and multiple linear regression analysis with 20 quotas selected by literature view was done.@*RESULTS@#Independent variables in the multiple linear regression model on medical personnels in county hospitals included the counties' urban residents' income, crude death rate, medical beds, business occupancy, professional equipment value, the number of devices valued above 10 000 yuan, fixed assets, long-term debt, medical income, medical expenses, outpatient and emergency visits, hospital visits, actual available bed days, and utilization rate of hospital beds. Independent variables in the multiple linear regression model on county hospital beds included the the population of aged 65 and above in the counties, disposable income of urban residents, medical personnel of medical institutions in county area, business occupancy, the total value of professional equipment, fixed assets, long-term debt, medical income, medical expenses, outpatient and emergency visits, hospital visits, actual available bed days, utilization rate of hospital beds, and length of hospitalization.@*CONCLUSION@#The prediction model shows good explanatory and fitting, and may be used for short- and mid-term forecasting.

Retrospective study on forty cases of medical legal dispute / 法医学杂志

OBJECTIVE@#To analyze the main causes of medical dispute and the main types of medical malpractice. The related problems were discussed in forensic expertise.@*METHODS@#Forty cases of medical dispute from 2006 to 2008 in our institute were analyzed retrospectively.@*RESULTS@#In 40 cases of medical dispute, city-level hospitals, county-level hospitals, town-level hospitals and private clinics were 11 (27.5%), 24 (60.0%), 2 (5.0%) and 3 (7.5%) cases respectively. The internal medicine departments, surgical departments, gynaecological and obstetric departments, pediatric departments and outpatient center were 16 (40.0%),10 (25.0%), 9 (22.5%), 2 (5.0%) and 3 (7.5%) cases, respectively. The amount of cases from city-level hospitals, county-level hospitals diagnosed by the medical experts as the medical malpractice showed less than that from town-level hospitals and private clinics.@*CONCLUSION@#The amount of cases of medical dispute from city-level and county-level hospitals were more than that of town-level hospitals. But the amount of cases diagnosed by the medical experts as medical malpractice from city-level and county-level hospitals were less than that of town-level hospital and private clinics.

The changing spectrum of severe falciparum malaria: a clinical study from Bikaner (northwest India).

BACKGROUND & OBJECTIVES: Recently there were reports from all over India about changing spectrum of clinical presentation of severe malaria. The present study was planned to study the same in the northwest India. METHODS: This prospective study was conducted on patients of severe malaria admitted in a classified malaria ward of a tertiary care hospital in Bikaner, Rajasthan (northwest India) during 1994 and 2001. It included adult patients of both sexes belonging to all age groups. The diagnosis of Plasmodium falciparum was confirmed by demonstrating asexual form of parasites in peripheral blood smear. All patients were treated with i.v./oral quinine. The specific complications were treated by standard WHO protocol. The data for individual complications for both the years were analysed by applying chi-square test. RESULTS: In a prospective study in 1994 the spectrum of complication was dominated by cerebral malaria (25.75%) followed by jaundice (11.47%), bleeding tendencies (9.59%), severe anaemia (5.83%), shock (5.26%), Acute respiratory distress syndrome-ARDS (3.01%), renal failure (2.07%) and hypoglycemia (2.07%) whereas in 2001 it was dominated by jaundice (58.85%) followed by severe anaemia (26.04%), bleeding tendencies (25.52%), shock (10.94%), cerebral malaria (10.94%), renal failure (6.25%), ARDS (2.08%) and hypoglycemia (1.56%). The sharp difference for presence of jaundice and severe anaemia in 2001 and cerebral malaria in 1994 was statistically significant. Similarly, the important cause of mortality in 2001 was multiple organ dysfunction syndrome (71.10%) with predominant presentation of jaundice and renal failure, whereas in 1994, it was cerebral malaria (77.96%). INTERPRETATION & CONCLUSION: The observation of changing spectrum of severe malaria in this study and a significant increase in presentation with jaundice as an important manifestation is highly essential for primary, secondary and tertiary level health care providers for proper diagnosis and management.

Study of clinical profile and antibiotic response in typhoid fever.

The objective of the present study is to evaluate the clinical profile and pattern of various drugs used in the treatment of typhoid fever. A retrospective analysis of adult patients suffering from typhoid fever was done at Kasturba Medical College hospital, Attavar during the year 1999-2001. Diagnosis of patients was based on clinical features, widal test and blood culture. The sensitivity pattern of isolates from blood culture was recorded. The mode of presentation, clinical course, treatment history, laboratory investigations reports, antibiotic administered, response to therapy and the complications were recorded. Total number of 44 cases of typhoid fever were studied. Out of these 21(47.7%) were males and 23(52.3%) were females. Average age of presentation was 23.9 years. Average duration of hospital stay was 10.8 days. Fever was present in all patients. Resistance of S. typhi to amoxicillin, chloramphenicol, ampicillin and co-trimoxazole were significantly high. Ciprofloxacin also showed resistance in 18.1% of cases. Sensitivity to cephalosporin was 100% in our study. Ciprofloxacin was the most commonly used antibiotic in our study (23 patients). Chloramphenicol alone was used in 2 patients and in 3 patients it was given after 6 days of ciprofloxacin treatment. Third generation cephalosporins (ceftriaxone) alone were used in 16 patients. Indiscriminate use of drugs in typhoid fever should be discouraged. Appropriate antibiotic as indicated by sensitivity tests should be employed to prevent the development of resistant strains of S. typhi.

Multiplex PCR on leptospiral isolates from Kolenchery, Kerala, India.

Human leptospirosis causes severe multiorgan dysfunctions that may end in multiorgan failure and death. The methods in hand for diagnosis of leptospirosis like culture, ELISA and MAT only help to confirm the disease, and are of little value in early detection. The aim of this study was to find out if the two sets of primers described earlier could detect all the isolates from the area, for the purpose of using the resultant database for early detection of leptospires in future from clinical specimens. The study was done on culture isolates from Jan 2000 to June 2002 attending the department of medicine, MOSC medical college hospital, Kolenchery, Kerala, India. DNA of 45 culture isolates were amplified by multiplex PCR using two sets of previously described primers, G1, G2 and B 64-I, B 64-II. Specific amplifications of either 285 or 563 bp size were obtained from all isolates included in the study indicating the utility of the multiplex PCR in the rapid detection of leptospires in clinical samples.

Urinary Cotinine Concentrations of Cases with Green Tobacco Sickness / 대한산업의학회지

OBJECTIVES: This study was carried out to measure the urinary cotinine concentrations of Korean tobacco harvesters with green tobacco sickness (GTS). METHODS: We conducted a questionnaire survey and measured the urinary cotinine concentrations among the cases who visited six health subcenters and the emergency room in the Health Center and County Hospital after harvesting tobacco leaves in Cheongsong-gun, from Jul 15 to Aug 15, 2002. Ten suspected GTS cases were compared to 10 controls matched for residence, age, and sex. Urinary cotinine was analyzed with a reverse-phase high performance liquid chromatography (HPLC) system and expressed as geometric mean and standard deviation. The data collected were evaluated using the SPSS/win statistical package and the urinary cotinine concentrations between the two groups were analyzed by Mann-Whitney U test. RESULTS: In both the 10 cases and controls, there were 3 males and 7 females. Ages ranged from 22 to 70 years old. Half of the cases were reported within the 6 hours between 12:00 pm and 17:59 pm. The median time from starting work to initially feeling ill was 4.3 hours (min. 2.5; max. 11.0). The GTS symptoms reported were nausea in 10 cases (100.0%), dizziness in 9 (90.0%), weakness in 8 (80.0%), headache in 7 (70.0%) and other symptoms. The geometric mean of urinary cotinine concentrations was significantly higher (p<0.01) in cases at 497.6 +/- 2.5 ng/ml (min. 73.1; max. 2,574.3) than in controls at 32.7 +/- 1.8 ng/ml (min. 13.3; max. 76.9). CONCLUSIONS: Our study suggests that many tobacco harvesters may suffer from GTS in Korea. Therefore, it is very important for doctors to diagnose exactly the GTS. Also we must develop the methods which can prevent GTS, and simple methods of analysis for urinary cotinine.

Clinical indications for penetrating keratoplasty in Maharaj Nakorn Chiang Mai Hospital, 1996-1999.

PURPOSE: To determine the leading indication for penetrating keratoplasty. MATERIAL AND METHOD: The authors retrospectively performed a chart review of the hospital records of all patients who underwent penetrating keratoplasty at Maharaj Nakorn Chiang Mai Hospital between January 1996 and December 1999. RESULTS: A total of 45 corneal transplants were performed. The leading indications for penetrating keratoplasty, in order of decreasing frequency, were bullous keratopathy (28.9%), corneal scar (22.2%), corneal dystrophy and degeneration (20.0%), corneal ulcer (17.8%), regraft (8.9%), and trauma (2.2%). CONCLUSION: Bullous keratopathy was the leading indication for penetrating keratoplasty at Maharaj Nakorn Chiang Mai Hospital from 1996 to 1999, followed by corneal scar. The major cause of bullous keratopathy was associated with posterior chamber intraocular lens implantation.

Microbiology of cerebral abscess at the neurosurgical unit of the National Hospital of Sri Lanka.

OBJECTIVES: To determine the microbial pathogens responsible for cerebral abscess, ascertain the most suitable antibiotic for treatment and to determine the predisposing causes of cerebral abscess. DESIGN: Prospective study with microbiological investigation of pus aspirated from cerebral abscesses. SETTING: Neurosurgical Unit, National Hospital of Sri Lanka, Colombo. STUDY GROUP: 41 patients with cerebral abscess. PERIOD OF STUDY: 18 months (May 1997 to December 1998) RESULTS: Of the 41 samples of pus 26 (63.1%) gave a positive microbial culture. The Gram stain of the direct smear was positive in 77% of the 26 positive cultures. The most frequently occurring species were Streptococcus milleri group (35%) followed by Staphylococcus aureus (10%). Anaerobes accounted for 23% of positive cultures. All Streptococcus milleri isolates were penicillin and cefotaxime, and all anaerobic isolates except one were susceptible to sensitive to metronidazole. 75% of Gram negative bacilli isolated were sensitive to cefotaxime. All Staphylococcus aureus isolates were methicillin resistant, but sensitive to vancomycin and chloramphenicol. Common predisposing conditions were congenital heart disease (30%), trauma (25%), middle ear disease (7%), and meningitis (7%). CONCLUSIONS: Organisms of the Streptococcus milleri group were most frequently found in cerebral abscesses. The present empirical therapeutic regime adopted in the unit which consisted of cefotaxime 1 g intravenously three times daily and metronidazole 500 mg intravenously three times daily was found to be satisfactory as a majority of the organisms isolated were sensitive to these antimicrobials. In the case of methicillin resistant Staphylococcus aureus (MRSA), it is recommended that chloramphenicol be added to the current regime in management until the antibiotic sensitivity pattern is available.

Cognitive Function in Older Patients with Diabetes Mellitus

BACKGROUND: The relationship between type II diabetes and congnitive function has been explored in several studies. But the result was controversial. The purpose of the study was to determine whether diabetes mellitus in older patients(>or=65 years) is assiciated with cognitive dysfunction and to discover the related factors with th cognitive dysfunction. METHOD: Twenty patients with type 2 diabetes and twenty subjects with non-diabetes are studied with cognitive function test at Hwachun health center and county hospital. Cognitive function was assessed using Mini-Mental State Examination and Clock Drawing test and the score was analyzed. The diabetes groups were subdivided with duration of diabetes, HbAlc, chronic diabetic complications and then analyzed. RESULTS: A total of 6(30%) diabetic subjects scored below 24 on mini-mental state examination, compared with 3(15%) of controls(p=0.2560). The mean socres were 20.1+/-2.7 and 19.0+/-3.5 respectively. Clock drawing test demonstrated that 13(65%) diabetic subjects inconectly placed the numbers and hands, compared with 7(35%) of controls(p=0.0578>0.05). The duration of diabetes mellitus, HbAlc, chronic diabetic com- plications were not associated with cognitive dysfun- ction among diabetic subjects. CONCLUSIONS: The study showed that type 2 diabetes mellitus in the elderly is not associated with cognitive dysfunction, but further study should be done.

Epidemiology of sickle cell disease in a rural hospital of central India.

OBJECTIVE: To study the epidemiology of sickle cell disease in pediatric age group in a rural hospital of Central India. DESIGN: Prospective descriptive hospital based study. SUBJECTS: 99 admitted patients of sickle cell disease were studied for a period of 1 year. RESULTS: Prevalence of sickle cell disease was 5.7% (99/1753) hospitalizations of which 61.6% (n=61) had homozygous sickle cell disease (HbSS) whereas 38.4% (n=38) had heterozygous state (HbAS). Of these, 62 (63%) were below five years of age. Male : Female ratio was 1.65:1 in HbSS cases and 1.71:1 in HbAS cases. History of consanguinity was present in 7 (7%) of which 5 (8.2%) had HbSS and 2 (5.2%) had HbAS. Incidence was maximum in the Mahar community (70%) followed by Kunbi (8 %) and Teli (6%). Vascular occlusive crisis (23. 3%) was the commonest crisis encountered followed by hyperhemolytic crisis (16.3%). There was no correlation between hemoglobin levels and the occurrence of vascular occlusive crisis. Maximum cases required their first blood transfusion between second and third year of age. Requirement of blod transfusion was more in HbSS cases. Four patients died of which three had HbSS and were below five years of age. Splenic sequestration crisis was the commonest cause of death. CONCLUSION: Sickle cell disease is prevalent in this area and most cases present before 5 year of age. VOC is the commonest crisis seen, but death often occurs due to sequestration crisis and usually below 5 years of age.

Embolism and atrial fibrillation. A longitudinal follow-up.

Six hundred and forty-nine patients with proven chronic atrial fibrillation were followed for a total of 1,436 patient-years without anticoagulation. The patient were divided into 7 disease groups with each having an average age ranging from 39 to 69 years. Eleven per cent of the patients had systemic embolism prior to being registered for the follow-up. The diseases which had the highest incidence of embolism prior to being followed were the same as those producing the highest rate of systemic embolism while under observation. The disease groups were rheumatic valvular (predominantly mitral stenosis) and ischemic heart diseases. Their embolic rate were 3.9 to 5.1 emboli per 100 pt-yr. Other disease groups with lower embolic rates of 0 to 0.9 per 100 pt-yr were heart failure, non-rheumatic mitral regurgitation, atrial septal defect and thyrotoxicosis. Since the incidence of systemic embolism varied according to the primary disease, and since the hemorrhagic complication of anticoagulant therapy is finite, it is advised that low risk group may not benefit greatly from anticoagulation. However, the true low risk group has still to be properly determined.

Estreptoquinasa intravenosa en el infarto agudo del miocardio en un hospital comunitario

El beneficio de la terapia con trombolisis en el infarto agudo del miocardio ha sido ampliamente documentado en muchos estudios multicéntricos. Aquí se demuestra que la terapia con estreptoquinasa intravenosa en dosis más pequeñas obtiene beneficios similares con complicaciones menores y que este tratamiento se puede practicar en unidades de cuidado intensivo de hospitales de la comunidad, sin equipos de hemodinamia sofisticados. En la unidad de cuidado intensivo del Hospital Bocagrande en Cartagena se estudiaron 19 pacientes con infarto agudo del miocardio, de menos 6 horas de evolución desde el comienzo del dolor. recibieron estreptoquinasa en dosis de 750.000 unidaes en infusión intravenosa siguiendo un protocolo previamente establecido. La evaluación de la respuesta al tratamiento se hizo tomando en consideración parámetros de carácter no invasivo. La tasa de mortalidad en estos pacientes fue de 5 por ciento. La tasa de reperfusión fue de 68.4 por ciento y hubo una alta tasa de angina post-infarto, la cual respondió satisfactoriamente a tratamiento farmacológico

The Type of Medical Service Desired by Those Communities Which at Present have None / 예방의학회지

To try to determine the type of medical service wanted by the rural population, in Chungnam Province, a survey amongst the populations of 6 counties was conducted; Within the 6 counties, 2 local communities, which had no access to local medical services, were surveyed. The 12 communities were actively involved in Sae-Maul activities, and total number of households surveyed, was 822. The survey was conducted over a 1 month period, from July 16th, 1976, thru August 20th, and the followings are the results, summarized. 1. The largest number of respondents desired a combination of Public Health Center and Country Hospital, followed in order by Private Clinic and Modern Medical Facility. 2. The respondents, aged under 40 years, desired the Private Clinic type medical service, whilst those over 40 years of age, wanted the County Hospital, and as the numbers in this age bracket, were larger, so the ratio was much higher. 3. Sex, educational background, and occupation did not play any particular emphasis in the decisions. 4. Monthly income affected the responses to the survey. These in the lower-income bracket, wanted the County Hospital, and the ratio was high. These in the high income bracket desired the Modern Medical Service, accordingly. Those with an income of 50,000 won or less, amongst the low-income bracket, favored the Public Health sub-center type of service. The ratio for this service was very high.