ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.
ObjectiveTo investigate the prevalence and associated factors of diabetic retinopathy (DR) among diabetic residents in Longyan of Fujian Province. MethodsA investigative research. From January 2022 to December 2023, a total of 10 061 diabetic patients enrolled in the chronic disease follow-up management system from 112 towns and sub-districts in 7 counties and districts of Longyan of Fujian Province were selected as the target population. A questionnaire survey, routine physical examination, vision test, and non-mydriatic fundus photography were conducted. A total of 762 cases with missing height, weight, blood pressure, fasting plasma glucose (FPG), and diabetes duration, and 507 cases with unclear fundus photography were excluded, resulting in 8 792 cases included in the final statistical analysis. DR diagnosis and classification were based on the 2019 International Clinical Classification of DR. The prevalence of DR was calculated for single-eye or double-eye DR cases as 1 case; the more severe eye was used for DR grading in double-eye DR cases. Statistical analysis was performed by grouping based on the presence or absence of DR and dividing into age groups ≤67 years and >67 years. χ2 test was used to analyze factors associated with prevalence; binary multivariate logistic regression analysis was employed to identify influencing factors of DR. ResultsAmong the 8 792 cases, 888 (10.1%, 888/8 792) were diagnosed with DR (DR group), and 7 904 (89.9%, 7 904/8 792) had no DR (non-DR group). Compared to the non-DR group, the DR group showed significant increases in FPG (Z=−12.448), diabetes duration (Z=−18.936), systolic blood pressure (Z=−4.237), diastolic blood pressure (Z=−2.881), and body mass index (BMI) ≥24 kg/m² (P＜0.001). Significant differences were also found between the two groups in hypertension (χ2=11.450), hyperlipidemia (χ2=5.100), kidney disease (χ2=7.039), family history of diabetes (χ2=5.025), and regular medication use (χ2=66.034) (P＜0.05). There were 4 688 cases in the ≤67 years group and 4 104 in the ＞67 years group. In the ≤67 years group, significant differences in DR prevalence were found for FPG levels (χ2=111.754), diabetes duration (χ2=231.658), BMI (χ2=12.404), systolic blood pressure (χ2=17.912), regular medication use (χ2=40.727), hyperlipidemia (χ2=6.816), and hypertension history (χ2=6.775) (P＜0.05). In the >67 years group, significant differences in DR prevalence were found for FPG levels (χ2=59.916), diabetes duration (χ2=128.362), systolic blood pressure (χ2=5.183), regular medication use (χ2=22.097), kidney disease (χ2=6.251), and family history of diabetes duration (χ2=4.967) (P＜0.05). No significant differences in DR prevalence were found based on sex, education level, smoking history, alcohol consumption, exercise habits, heart disease history, or other family disease history (P＞0.05). Logistics regression analysis results show that patients aged ＞67 years, FPG [odds ratio (OR)=1.074, 95%confidence interval (CI) 1.046-1.102], diabetes duration (OR=1.088, 95%CI 1.071-1.106), systolic blood pressure (OR=1.007, 95%CI 1.001-1.013), and kidney disease (OR=3.617, 95%CI 1.268-10.320) were identified as risk factors for DR (P＜0.05). In patients aged ≤67 years, FPG (OR=1.088, 95%CI 1.067-1.110), diabetes duration (OR=1.108, 95%CI 1.091-1.125), and systolic blood pressure (OR=1.008, 95%CI 1.003-1.013) were identified as independent risk factors for DR (P＜0.05), while BMI ≥24 kg/m² (OR=0.934, 95%CI 0.908-0.965) was a protective factor for DR (P＜0.05). Age, regular medication use, hypertension, and hyperlipidemia were identified as potential confounding factors for DR occurrence. ConclusionsThe prevalence of DR among diabetes patients in Longyan of Fujian Province, is 10.1%. FPG, diabete duration, and systolic blood pressure are independent risk factors for DR, while age, regular medication use, hypertension, and hyperlipidemia are potential confounding factors for DR occurrence.
Objective To investigate the diabetic knowledge of primary hospital doctors and diabetes patients, and to explore the way to improve the capability of primary hospitals in preventing and treating diabetes. Methods Between January 2013 and June 2014, we set questionnaires to learn the profiles of diabetes knowledge of 328 internal and general medicine doctors including 43 chronic disease management workers from fifteen township hospitals and two community health centers, 152 doctors from village clinics, and 575 diabetes patients in Xindu District of Chengdu City. We made questionnaires for doctors and patients respectively to investigate their knowledge on diabetes and blood sugar control in the patients. Finally, we made plans to train doctors in primary hospitals according to the results of the investigation. Results For township hospitals, 328 questionnaires were given out with 319 retrieved, and the valid retrieval rate was 97.3%; 152 questionnaires were given out to village doctors and 149 were retrieved, with a valid retrieval rate of 98.0%; and we gave out 575 questionnaires to the diabetes patients and retrieved 539, with a valid retrieval rate of 93.7%. Primary hospitals were insufficient in their drug varieties. Among doctors in township hospitals, 7.8% had bachelor’s degree, 53.6% had received post-secondary education, and 38.6% had received secondary vocational education. Most of the village doctors had not received any professional medical education, among whom, 89.9% had a certificate of village doctors and 10.1% had a certificate of assistant doctors. The diabetes questionnaire score of primary hospital doctors was low, while the score of chronic disease management workers was relatively higher (P<0.05). For diabetes patients, medical investment was inadequate, treatment rate was low, common sense of diabetes was insufficient, and glycosylated hemoglobin control rate was only 13.5%. Conclusions Diabetes patients in primary hospitals have a poor disease control, which is probably associated with the insufficient publicity and education from doctors. It is necessary to train primary hospital doctors at all levels. In order to get the best therapeutic effect, we advocate that diabetes should be managed by doctors of chronic disease management, although they should receive systematic training for a long time.
Purpose To decribe the prevalence of age related macular degeneration (AMD) in the population aged 50 and over in Doumen County of Gunagdong Province. Methods After randomized clustering sampling,all selected individuals were enumerated according to village residence register.Visual acuity were measured by illuminated EDTRS chart. The examination of eyelid,cornea,lens and fundus were also carried out.The diagnosis of AMD was made according to the criteria of National Academic Group of Fundus Diseases combining with the visual criteria of Framingham Eye Study. Results 5 324 indivduals were axamined with participating rate of 92.8%.The ove rall prevalence of AMD was 8.4%.The prevalence of 2.9%,7.8% and 12.9% was found in the age groups of 50-,60-,70- respectively.The prevalence of male and female was 8.5% and 8.4% respctively.5% of AMD eyes were blind and 49% were low vision. Conclusion The prevalence of AMD is hight and increased with aging,but not correlated with sex.AMD can cause severe visual impairment. (Chin J Ocul Fundus Dis,1998,14:122-124)
ObjectiveTo evaluate the applicability of SF-36 scale on assessment of quality of life in patient with breast cancer. MethodsThree hundreds and seventy-one patients with breast cancer in Department of Breast of First Affiliated Hospital of Xinjiang Medical University from June 2011 to January 2014 were treated and then surveyed with SF-36 scale, evaluating the feasibility, reliability, validity, ceiling effect, and floor effect. Results①The feasibility evaluation:Completion time of SF-36 scale was (12.1±3.2) min, finishing rate was 100%. ②The reliability evaluation:All the split-half reliability coefficients and the Cronbach's α were all above 0.8. All the internal consistency coefficients were all above 0.6. ③The validity analysis:All the Pearson coefficients were all above 0.7. Tow principal component were extracted by factor analysis, which accounted for 63.22% of total variance. After the maximum variance rotation, two common factors were generated, which was almost the same with the theory structure assumption of scale. ④Ceiling effect and floor effect:There was remarkable ceiling effect on bodily pain, which was 77.35%; there was obvious floor effect on role physical and mental health, which was 20.32% and 24.88%, respectively. ConclusionThe SF-36 scale is an useful scale for the evaluation of the quality of life among the patients with breast cancer, but individual items need to be further perfected according to the actual situation.
Objective To investigate the free influenza vaccination of health care workers in major departments and explore the possible influencing factors of influenza vaccination of staff. Methods In November 2021, a questionnaire survey was conducted among health care workers who received free influenza vaccination in 19 major departments of West China Hospital of Sichuan University, and the un-vaccinated workers’ information was obtained from the registration system of staff information. Multiple logistic regression model was used to analyze the possible influencing factors of free influenza vaccination. Results The coverage rate of centralized free influenza vaccination of staff in major departments was 32.7% (1101/3369). Multiple logistic regression analysis showed that workers who were female [odds ratio (OR)=1.853, 95% confidence interval (CI) (1.481, 2.318), P<0.001], with an educational background of high school or below [OR=4.304, 95%CI (2.484, 7.455), P<0.001], engaged in nursing work [OR=2.341, 95%CI (1.701, 3.221), P<0.001], and with 11 or more years of working experience [OR=2.410, 95%CI (1.657, 3.505), P<0.001] were more likely to inject influenza vaccine, and workers who had a bachelor’s degree were less likely to inject influenza vaccine. Conclusions The rate of free influenza vaccination among medical staff is low. In order to mobilize the enthusiasm of influenza vaccination among medical staff, it is necessary to analyze the characteristics of the population and take targeted measures to improve the level of vaccination among medical staff.
ObjectiveTo investigate the use of anti-hypertensive drugs among hypertension patients in examination medical center. MethodThis was a cross-sectional survey. Data of 3 000 cases of medical examination center health records from December 2012 to December 2013 were sampled, and 1 310 patients with hypertension were screened for analysis of medication. ResultsIn the 1 310 hypertension patients, 959 used antihypertensive drugs before, among whom 423 (44.11%) accepted only one anti-hypertensive drug and 536 (55.89%) accepted compound anti-hypertensive drugs or combined medicine. In patients of the previous kind, calcium channel blocker classes of antihypertensive drugs were used the most (n=244, 25.44%). Among the second kind of patients, 359 (37.43%) were treated with a two-compound drug or a combination of two drugs, and most of them used the combination of calcium channel blocker with angiotensin receptor blocker or calcium channel blocker with angiotensin converting enzyme inhibitor. ConclusionsThe current using of anti-hypertensive drug is in accordance with the recommendation of anti-hypertensive treatment guidelines in some way, but there are still some gaps between real clinical practice and guidelines.
Objective To understand the situation of commonly-used drugs, medical device and their storages in rural households among model well-off township hospitals in eastern, central and western China, and to provide the basis for the guidance of reasonably using and scientifically storing drugs. Methods The methods of combining simple random sampling and cluster sampling were used to investigate and analyze the situation of commonly-used drugs, medical device and their storages in 162 households from three well-off township hospitals in Shanghai, Zhejiang, and Sichuan provinces, respectively. Results The storage rates of commonly-used drugs of rural households in well-off towns were cold medicine (72.2%), wound paste (51.9%), cooling oil (39.5%), essential balm (36.4%), antihypertensive (27.8%), iodine tincture (14.2%), anti-diabetic drugs (13.0%) and other drugs (17.3%). The storage rates of medical devices were thermometer (50.0%), cotton swab (47.5%), sphygmomanometer (9.3%), injector (1.2%) and other devices (22.2%). A total of 66% of respondent families stored drugs and medical devices in a fixed drawer. Only 3.1% families stored drugs and medical devices in the special portable medical kit. Conclusion Rural families have a higher rate of household drugs among model well-off township hospitals in eastern, central and western China, and most drugs are OTC drugs. The storage rates of medical devices are not high. Many rural family-owned medical devices are linked with special chronic diseases in the family. A lot of rural families place drugs and medical devices randomly. There are many security risks, and it may affect the rational utilization of drugs.
Objective To investigate the disease constitution and cost of inpatients in Gaozha Central Township Health Center (GzC) in Wuzhong City of Ningxia Hui Autonomous Region from 2008 to 2010, so as to provide baseline data for further research. Methods A questionnaire combined with a special interview was carried out, and case records and cost information of GzC inpatients in 2008, 2009 and 2010 (from January to November) were collected. The diseases in discharge record were classified according to International Classification of Diseases (ICD-10) based on the first diagnose and the cost was analyzed. Data including general information of the inpatients, discharge diagnosis, hospitalization expenses, and drug cost etc. were rearranged and analyzed by Excel software. Results a) The total number of the inpatients was 1124, 642 and 747 in 2008, 2009 and 2010, respectively. The female was more than the male in both 2008 (59.34% vs. 40.66%) and 2009 (60.75% vs. 39.25%), and their disease spectrum included 17 categories, which accounted for 81% of ICD-10; b) The top six most commonly seen systematic diseases with a constituent ratio from 86.63% to 92.06% in recent three years were as follows: the respiratory system, digestive system, circulatory system, genitourinary system, injury and toxicosis, skeletal musculature and connective tissue disease. Except the injury and toxicosis, the other five systematic diseases were commonly seen in females rather than in males; c) The top 15 monopathies in recent three years were pulmonary infection, tracheitis or bronchitis, coronary heart disease, soft tissue injury, gastritis or chronic gastritis, upper respiratory infection, hypertension, urinary tract infection, prolapse of lumbar intervertebral disc, pelvic inflammation, fracture, pneumocardial diseases, superficial injury, chronic cholecystitis and arthritis; d) The main burdens of disease for inpatients focused on 35-54 age groups, then followed by the age groups above 55 in 2008 and 2009. Except the injury and toxicosis, the other diseases were commonly seen in females rather than in males. Pulmonary infection focused on the age groups above 35; the onset of hypertension increased obviously and a sharp rise of hypertension existed in the 45-54 age groups in 2008, but the hypertention focused on 35-44 age groups in 2009; e) The total inpatients with top 15 monopathies accounted for 64.06% to 71.21%, including 8-9 chronic diseases ranking higher in 2010, and 6-7 acute diseases focusing on infection and injury; and f) The average costs of chronic diseases were higher than those of acute diseases. Conclusion a) There is a big gap between GzC and Yong’an Central Township Health Center (YaC) regarding the level of the regional economic development, the situation of disease burden and cost of inpatients. The former is demonstrated as general Central Township Health Center, while the latter as affluent Central Township Health Center in western China; b) In recent three years, the main systematic diseases are in respiratory, circulatory and digestive system; the inpatients suffer from more chronic diseases rather than acute diseases in their young age; the acute diseases mainly include infection and injury, and the pulmonary infection has ranked as the first during the past three years; c) The inpatients in 2008 and 2009 are mainly in ages of 35 to 54, and then are over 55 years old. Except the injury and toxicosis, the other diseases were commonly seen in females rather than in males; d) The patients’ average costs of chronic diseases for hospitalization and drug in 2010 were lower than those of YaC. Consideration on reasonable constitution of the cost for hospitalization should be paid attention to; and e) It is urgent to strengthen the construction of infrastructure and informatization in GzC.
Objective To investigate the inpatients’ disease constitution and cost in Xintian Central Township Health Center (XtC) in Lintao County of Gansu Province from 2008 to 2010, so as to provide baseline data for further research. Methods The questionnaire and the focus interview were carried out, the case records and the cost information of XtC inpatients in 2008, 2009 and 2010 were collected. The diseases were classified according to ICD-10 based on the first diagnosis and the cost was analyzed. Data including general information of the inpatients, discharge diagnosis, hospitalization expenses, and drug cost etc. were rearranged and analyzed by Excel software. Results a) The total number of inpatients was 1 212, 1 425 and 1 857, respectively, in 2008, 2009 and 2010. The female was more than the male in 2010 (57.68% vs. 42.32%), and their disease spectrum included 19 categories, which accounted for 90% of the disease classes of ICD-10; b) The constituent ratio of the top seven systematic diseases that inpatients suffered from in recent three years accounted for 89.18% to 92.21%, which included the digestive, respiratory, circulatory, urogenital, musculoskeletal and connective tissues disease, pregnancy, labor and puperium disease, and injury and toxicosis. Except for the injury and toxicosis, the female was more than the male in most of the rest main systematic diseases; c) The top 15 single diseases were acute upper respiratory infection, chronic tracheitis or bronchitis, gastritis or chronic gastritis, coronary heart disease, hypertension, pulmonary infection, urinary tract infection, lumbar vertebra disease, fracture, superficial injury, acute appendicitis, normal labor, cervical spondylosis, acute gastroenteritis, and cholecystolithiasis or cholecystitis; d) The main disease burden of inpatients focused on the age groups as above 65, 15 to 24 and 35 to 54 in 2010. Except for the fracture, acute tracheitis or bronchitis, and lumbar vertebra disease, the female was more than the male in most of the rest main single diseases; gastritis or chronic gastritis and lumbar vertebra disease focused on the age group above 35; acute upper respiratory infection covered all ages in 2010 and has ranked as the first during the past three years; e) In recent three years, the aggregate constitutional ratio of the top 15 single diseases accounted for 67.53% to 71.36%, including six to seven chronic diseases, and eight to nine acute diseases focusing on infection and trauma; and f) The inpatients’ average costs of chronic diseases were higher than those of acute diseases in 2010 (RMB 1 311.81 yuan vs. RMB 906.85 yuan), and were also higher than those of either Yong’an Central Township Health Center (RMB 1 150.59 yuan) or Gao Zha Central Township Health Center (RMB 1 002.99 yuan). Conclusion?a) In the recent three years, the main systematic diseases are in digestive, respiratory and circulatory system; the incidence of acute disease which mainly focuses on infection and injury is more than that of the chronic; and the acute upper respiratory infection has ranked as the first during the past three years; b) The inpatients in 2010 are mainly at the age of 15 to 24, 35 to 54, and over 65 years old as well. Except for injury and toxicosis, the female inpatients are more than the male in most of the other diseases; c) The inpatients’ average costs of chronic diseases in 2010 are higher than those of acute diseases, and also higher than those of either YaC or GzC. Consideration on rationality of hospitalization cost should be paid attention to; and d) It is urgent to strengthen the construction of infrastructure and informationization in XtC.