[Factors influencing the use of health care services from patients with COPD in Chengdu].

OBJECTIVE: To investigate the use of health care services by COPD patients and to identify factors that shape the pattern of services utilization. METHODS: All of the COPD patients who lived in the six randomly selected communities with community health services in 2003 were surveyed. A total of 446 patients completed the interview-administered questionnaires. The medical records of those patients were also reviewed and abstracted if possible. The questions asked in the survey included: social and demographic information, COPD related knowledge and attitudes, use of health care services and medical expenditure associated with the services in the past year. RESULTS: About half (53.04%) of the COPD patients used the outpatient services, with an average visits of 6.04 +/- 4.05 per year. Eighteen percent of the patients had been hospitalized, with an average of 6.10 +/- 2.61 episodes of hospitalizations in one year and an average of length of stay of (51.65 +/- 15.91) days. The COPD patients used large comprehensive hospitals (45.33%) more often than the community health services (18.22%). Age, past experiences and attitudes towards COPD, severity of illness and out of pocket payment had significant impact on patients' choice of outpatient services. Occupation, past experiences, out of pocket payment, severity of illness and family attitudes had significant impact on patients' choice of hospital services. Education, income, occupation, out of pocket payment and attitudes towards COPD had significant impact on patients' choice of community health services. CONCLUSION: Underutilization of community health services by COPD patients is obvious in Chengdu. Given the diverse range factors that influence patients' choice of services, governmental intervention is needed to encourage the use of community health services.

[Antimicrobial resistance and molecular epidemiology of coagulase-negative Staphylococci in Chengdu].

OBJECTIVE: To investigate the antimicrobial resistance and molecular prevalence of coagulase-negative Staphylococcus (CONS) in Chengdu. METHODS: Disk diffusion method was used to test antimicrobial resistance of 2038 CoNS isolated from 15 hospitals and 6 CDCs (center for disease control and prevention) in Chengdu, the results were interpreted according to the guideline of National Committee for Clinical Laboratory Standards. CoNS were typed with plasmid and PFGE (pulsed field gel electrophoresis) profiles. RESULTS: (1) S. epidermidis, S. haemolyticus, and S. saprophyticus accounted for 82.2% of the CoNS isolated from Chengdu, with different constituent ratio of CoNS among patients, medical staff, sick children and normal people. (2) CoNS resisted to one or more antimicrobial agents with resistance rate of 80.4% . CoNS resisted highly to SMZ, penicillin-G, ampicillin, erythromycin, TMP-SMZ and tetracycline, but were susceptible to vancomycin, norfloxacin and amikacin. 25 antimicrobial resistance profiles were acquired, and Amp + Ery + P-G + SMZ, Amp + Gen + Str + Tet, Amp + P-G + Tet, Chl + Ery + P-G + SMZ + TS, Ern + Nov + P-G + SMZ + TS, as well as P-G + SMZ + TS were main profiles. The main antimicrobial resistance profiles of CoNS isolated from patients, medical staff, sick children and normal people had some differences, but the antimicrobial resistance of main biochemical subtypes was similar a lot. (3) Plasmid prevalence of CoNS was 72.9%, with 12 plasmid profiles ( I -H ) of all CoNS. The main profiles were I , U , and MI type, which accounted for 80.1% of 1485 CoNS with plasmid. (4) 29 PFGE genotypes and 112 subtypes were found in 2038 strains. Genotypes A, B, C, D and E were the predominant types in CoNS from patients, medical staff, sick children and normal people and contributed 89.1% to 2038 CONS. Genotypes A was the major type and had similar constituent ratio in CoNS from 4 sources, and no enough similarity of constituent ratio in other dominant genotypes. CONCLUSION: Antimicrobial resistance rate of CoNS was very high in Chengdu and multi-resistance existed in various populations generally. High homology was found in CoNS from different sources, especially from medical staff as well as sick children and infant, and a latent inter-transmission may occur in these populations. So it was no time to delay the monitoring and investigation of antimicrobial resistance and molecular epidemiology for CoNS in Chengdu.

[Study on the resistance of Escherichia coli O157:H7 to disinfectants in relationship with its plasmid pO157 and chromosome DNA].

OBJECTIVE: To study the change of Escherichia coli O157:H7 resistance to disinfectants in continuous disinfection and the relationship between the resistance and pO157, chromosome DNA. METHODS: Using 4 disinfectants in a separate manner to disinfect 5 Escherichia coli O157:H7 50 generations continuously, we made a before-after comparison of their resistibility and analyzed the change of the structure of pO157 and chromosome DNA. RESULTS: After the 50-generation-continuous disinfection, the bacteria resistance to sodium dichloroisocyanurate, iodophor and quaternary ammonium increased, but the resistance to chlorhexidiniacetas did not any change; the maps Cal I and Rsr II cutting pO157 revealed some changed after disinfection by sodium dichloroisocyanurate and quaternary ammonium, but the maps showed no change after disinfection by iodophor and chlorhexidiniacetas; the chromosome DNA PFGE maps change considerably after 50 generations of disinfection by sodium dichloroisocyanurate, iodophor and quaternary ammonium, but the chromosome DNA PFGE maps were similar after 50 generation of disinfection by chlorhexidiniacetas. CONCLUSION: The Escherichia coli O157:H7 resistance to disinfectants will increase after the 50-generation-continuous disinfection by sodium dichloroisocyanurate, iodophor and quaternary ammonium. There may be genes both in chromosome DNA and in pO157 which resist sodium dichloroisocyanurate and quaternary ammonium, the reason for increase of resistance may be related with the change of chromosome DNA and pO157. There may be genes in chromosome DNA which resist iodophor, the reason for increase of resistance to iodophor may be related with the change of chromosome DNA, but not related with pO157.