Status of sub-health and its influencing factors in community health care workers in Hongkou District, Shanghai / 上海预防医学

Objective To determine the sub-health status and influencing factors among medical staff in community health service centers, and to provide scientific evidence for intervention measures and strategies of health promotion. Methods A questionnaire survey was conducted in 692 community medical staff from 8 community health service centers in Hongkou District, Shanghai.Sub-health condition scale was used to identify the incidence rate of sub-health.Simple job stress questionnaire was used to identify the incidence rate of occupational stress.The correlations between sub-health status and demographic and sociological factors, living habits, occupational stress and other factors were determined by multivariate logistic regression analysis. Results The incidence rate of sub-health among targeted community medical staff was 71.4%.The following factors were shown to be related to the incidence of sub-health: women (OR=2.24, 95%CI: 1.42-3.55), per capita living area ≤ 30 m2(OR=2.19, 95%CI: 1.24-3.87), daily average sleep time < 7 hours (OR=1.64, 95%CI: 1.10-2.46), habits of drinking alcohol (OR=1.58, 95%CI: 1.04-2.40), frequent overtime work (OR=1.79, 95%CI: 1.12-2.86) and occupational stress (OR=1.73, 95%CI: 1.16-2.58). Conclusion The incidence rate of sub-health among medical staff in community health service centers is high, and unhealthy living habits and occupational stress are the influencing factors.

Surgical treatment for both-column acetabular fractures using pre-operative virtual simulation and three-dimensional printing techniques.

BACKGROUND: Surgical treatment of both-column acetabular fractures is challenging because of the complex acetabular fracture patterns and the curved surface of the acetabulum. Seldom study has compared the application of three-dimensional (3D) printing technology and traditional methods of contouring plates intra-operatively for the surgical treatment of both-column acetabular fractures. We presented the use of both 3D printing technology and a virtual simulation in pre-operative planning for both-column acetabular fractures. We hypothesized that 3D printing technology will assist orthopedic surgeons in shortening the surgical time and improving the clinical outcomes. METHODS: Forty patients with both-column acetabular fractures were recruited in the randomized prospective case-control study from September 2013 to September 2017 for this prospective study (No. ChiCTR1900028230). We allocated the patients to two groups using block randomization (3D printing group, n = 20; conventional method group, n = 20). For the 3D printing group, 1:1 scaled pelvic models were created using 3D printing, and the plates were pre-contoured according to the pelvic models. The plates for the conventional method group were contoured during the operation without 3D printed pelvic models. The operation time, instrumentation time, time of intra-operative fluoroscopy, blood loss, number of times the approach was performed, blood transfusion, post-operative fracture reduction quality, hip joint function, and complications were recorded and compared between the two groups. RESULTS: The operation and instrumentation times in the 3D printing group were significantly shorter (130.8 ±â€Š29.2 min, t = -7.5, P < 0.001 and 32.1 ±â€Š9.5 min, t = -6.5, P < 0.001, respectively) than those in the conventional method group. The amount of blood loss and blood transfusion in the 3D printing group were significantly lower (500 [400, 800] mL, Mann-Whitney U = 74.5, P < 0.001 and 0 [0,400] mL, Mann-Whitney U = 59.5, P < 0.001, respectively) than those in the conventional method group. The number of the approach performed in the 3D printing group was significantly smaller than that in the conventional method group (pararectus + Kocher-Langenbeck [K-L] approach rate: 35% vs. 85%; χ = 10.4, P < 0.05). The time of intra-operative fluoroscopy in the 3D printing group was significantly shorter than that in the conventional method group (4.2 ±â€Š1.8 vs. 7.7 ±â€Š2.6 s; t = -5.0, P < 0.001). The post-operative fracture reduction quality in the 3D printing group was significantly better than that in the conventional method group (good reduction rate: 80% vs. 30%; χ = 10.1, P < 0.05). The hip joint function (based on the Harris score 1 year after the operation) in the 3D printing group was significantly better than that in the conventional method group (excellent/good rate: 75% vs. 30%; χ = 8.1, P < 0.05). The complication was similar in both groups (5.0% vs. 25%; χ = 3.1, P = 0.182). CONCLUSIONS: The use of a pre-operative virtual simulation and 3D printing technology is a more effective method for treating both-column acetabular fractures. This method can shorten the operation and instrumentation times, reduce blood loss, blood transfusion and the time of intra-operative fluoroscopy, and improve the post-operative fracture reduction quality. CLINICAL TRAIL REGISTRATION: No.ChiCTR1900028230; http://www.chictr.org.cn.

Effect analysis on remission policy for TB treatment fee in Tilanqiao community of Shanghai / 上海预防医学

Objective To analyze the change in cost reduction for tuberculosis (TB) patients in Tilanqiao community of Shanghai from 2006 to 2016,and to evaluate the implement effect of TB remission policy in Shanghai.Methods The data were collected on treatment costs for 309 TB patients who had completed treatment and participated in the cost remission reimbursement by outpatient registration.The trend of deductible expenses and the remission costs were analyzed by SPSS.Results During the implementation of the original remission policy(ORP),the deductible expense was 1 021.06±457.67 yuan.And it changed to 2 320.64±1 544.73yuan under the new remission policy (NRP),which had an increase of 1.27 times and the new remission fee ratio was 45.19%.The deductible expenses change curve shown a trend of rising.The new remission fee ratio was 27.62% in 2009 and increased to 46.62% in 2010,then became 51.05% in 2016.The new remission fee ratio for outpatients was significantly lower than that for the hospitalized.During the implementation of the ORP,the remission cost was 931.05±465.47 yuan,and it was 1 507.80±974.15 of the NRP,which increased 61.95%.The remission ratio was 17.55% of the ORP,when it was 15.91% of the NRP which decreased by 1.64 percent.The remission ratio curve showed a trend of downward.The remission ratio for outpatients was significantly higher than that for the hospitalized.Conclusion From 2006 to 2016,the implement effect of remission policy on treatment costs of tuberculosis had improved.However,it had not effectively reduced the disease burden of TB patients.So in the follow-up remission policy,we must strengthen improvement on the settings of deductible project and control disease treatment.

Strategies for managing the insufficiency of the proximal landing zone during endovascular thoracic aortic repair / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The insufficiency of the proximal landing zone (PLZ) is a frequent factor challenging the applicability and efficacy of endovascular repair (EVR) for thoracic aortic disorders. This study discusses two strategies for conquering this challenge.</p><p><b>METHODS</b>Ten patients underwent EVR for thoracic aortic diseases during a one-year period ending June 30, 2004. Nine patients had DeBakey type III dissecting aortic aneurysm (DAA), and one had descending thoracic aortic aneurysm (DTAA). The PLZ, defined as the distance from the origin of the left subclavian artery (LSA) to the primary entry tear of the dissection or to the proximal aspect of DTAA, was less than 15 mm in all instances. EVR with intentional coverage of the LSA without any supportive bypass was employed in 6 patients with DAA, and the preliminary right-left carotid and left carotid-subclavian bypass combined with EVR in the DTAA and other 3 DAA cases.</p><p><b>RESULTS</b>Technical success was achieved in all the patients. The patient with DTAA died from hemispheric cerebral infarction and subsequent multiple system organ failure following an uneventful recovery from the cervical reconstruction performed 1 week previously. In cases receiving the EVR with intentional coverage of the LSA, in two patients dizziness occurred, which noticeably resolved after intravenous administration of mannitol for 4 to 5 days, and a drop in blood pressure of the left arm was noted in all the cases, but remained clinically silent. No neurological deficits or limb ischaemia developed perioperatively or during the followup, ranging from 3 to 12 months, and complete thrombosis of the thoracic aortic false lumen was revealed on CT at 3 months in the 9 patients with DAA.</p><p><b>CONCLUSIONS</b>Both the intentional bypass absent coverage of the LSA and the adjunctive surgical bypass appear to be feasible and effective in managing the insufficiency of the PLZ during the endovascular thoracic aortic repair.</p>