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Objective:To investigate and analyze the allocation and use of the common pediatric medical equipment and drugs in community health service centers, so as to provide decision-making reference for further strengthening the capacity-building of community children′s health services.Methods:Using multi-stage stratified random sampling method, 30 community health service centers in 14 cities were selected to investigate the basic situation of the sample centers, and the allocation and use of 21 kinds of commonly used pediatric medical equipment and 23 kinds of commonly used children′s drugs from April to August 2020.Results:The overall allocation rate of 21 commonly used pediatric medical equipment in the sample centers was 61.9%, and the overall utilization rate was 62.6%. The overall allocation rate of 23 commonly used drugs for children in the sample centers was 46.67%, and the overall utilization rate was 31.1%. There was a statistically significant difference in the utilization rate of equipment among different levels of urban community health service centers ( P<0.05); There were statistically significant differences in the allocation rate of commonly used children′s drugs among community health service centers under different regions, cities at different levels, types of jurisdictions, and institutional types ( P<0.05). Conclusions:The overall allocation and utilization rate of commonly used pediatirc medical equipment and drugs in urban community health service centers in China were relatively low, especially the drug utilization rate. The author suggested that the government should further strengthen the construction of grassroots pediatric diagnosis and treatment service capabilities, and reasonably equip commonly used pediatric medical equipment and drugs at the grassroots level.
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Objective:To provide strategic suggestions for optimizing children′s diagnosis and treatment services in the communities, by means of analyzing the overall efficiency of children′s diagnosis and treatment services in the sample community health service centers, and learning the current input and output of children′s diagnosis and treatment resources.Methods:In April 2020, a total of 27 community health service centers in 14 cities were selected by random sampling. Data such as the number of medical visits by children aged 0 to 18 years and the area of pediatric diagnosis and treatment departments in the sample centers in 2019 were collected by self-filling questionnaires. Excel was used for data sorting. Data envelopment analysis(DEA) was used for data processing. The data processing tool was DEAP 2.1.Results:The average comprehensive efficiency, the average technical efficiency and the average scale efficiency of the 27 sample community health service centers were 0.445, 0.865 and 0.494 respectively. There were five DEA efficient centers, 4 DEA weak inefficiency centers and 18 inefficient centers. Six out of 18 DEA inefficient centers had redundant input of healthcare professionals capable pediatrics; 12 centers were short of children visits, and 15 were short of visits by children aged 0-6 years.The centers where DEA was inefficient were concentrated in the central region, the suburbs and " centers with independent pediatric clinics but without pediatric wards" .Conclusions:The comprehensive efficiency of children′s diagnosis and treatment services in the sample community health service centers is relatively low. Currently, the sample community health service centers are faced with such problems as small and insufficient input of children′s diagnosis and treatment resources in the community, unbalanced development of children′s diagnosis and treatment services in the region among others. It is suggested that on the basis of making full use of the existing resources to create the maximum output value, we should consider appropriately expanding the scale of resource input to improve the efficiency of children′s diagnosis and treatment services at the primary level and further give play to the value of the " gatekeepers" at the primary level in children′s diagnosis and treatment.
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Objective@#To analyze the equity of the performance appraisal model of primary health care institutions based on the relative value index.@*Methods@#Tian Tan Community Health Service Center in Dong Cheng District of Beijing was taken as an example, while descriptive analysis and correlation analysis were conducted using the data of service equivalent per capita and monthly performance income per capita of 14 departments from April 2018 to June 2019.@*Results@#In the first half of 2019, the average monthly work equivalent of the case institution was 1 170.19±501.18, which was 13.91% higher than that of the second quarter in 2018. The average monthly performance income of the case institution was 1 183.71±175.30 Yuan, which was 6.94% higher than that of the second quarter in 2018.From April 2018 to June 2019, the monthly work equivalent per capita of 14 departments was positively correlated with the monthly performance income per capita, and Pearson correlation coefficient was 0.85(P<0.01).@*Conclusions@#The performance appraisal model based on the relative value index in case institution satisfactorily reflects the fairness of " more work and more gain" , but the effect of " better work and better gain" is not obvious.
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Objective To explore the influence of policy support on attitude of staff toward contracted service in community health service ( CHS) centers in different areas of China. Methods A multi-stage stratified cluster sampling method was used to select participants, and questionnaire survey was conducted among 192 staff (99 from Chengdu and 93 from Xiamen) from 4 community health service centers in Chengdu and Xiamen. In addition, documents on contracted service in CHS were collected and analyzed. EpiData software was used to establish database. Double input and cross-check were implemented. SAS version 9.4 was used for data analyses. Results Differences were found in goals, financial modes and insurances coverage in contracted service in the two areas. Among the 192 participants, 80.7% considered that contracted service was worth to carry out; 90.8% supported the implementation of contracted service in local settings and 78.1% were willing to take more work load on contracted service. In contrary, only 41.6% wished their child work as a family doctor. The main reasons for the negative attitudes were that the performance-based salary system had not been well established or implemented, and there was much more work load that resulted from contracted service. Conclusions The majority of the study subjects held positive attitude toward contracted service, but there were disparities between the four study sites. Relative policy and financial support, proper human resource distribution were critical determinants of contracted service.
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Objective@#To investigate the characteristics of acute myocardial infarction caused by spontaneous coronary artery dissection(SCAD) in young female patients. @*Methods@#In this casecontrolstudy,127 young(≤55 years) female patients with acute myocardial infarction onset within 1 week in Nanjing first hospital, Xuzhou central hospital, affiliated hospital of Xuzhou medical university, and Lianyungang first people's hospital were enrolled between January 2013 and February 2017,and the clinical data were retrospectively analyzed. According to their clinical manifestations and coronary angiography(CAG) results,the patients were divided into coronary atherosclerosis disease(CAD) group(CAG evidenced atherosclerosis, n=83) and SCAD group(CAG detected coronary artery dissection,n=44).The SCAD patients were subdivided into definite group (the results affirmed from intravenous ultrasound or optical coherence tomography, n=21) and probable group (the CAG results highly confirmed to characteristics of SCAD,but no intravenous ultrasound or optical coherence tomography image affirmation,n=23). Then, according to the different treatment strategies, the SCAD patients were subdivided into conservative treatment group(treated with drugs,n=19) and interventional therapy group(treated with percutaneous coronary intervention,n=25). @*Results@#(1)Compared to CAD group, patients in the SCAD group had less risk factors, such as hypertension history (25.0% (11/44) vs. 45.8% (38/83) , P=0.022) and diabetes history (6.8% (3/44) vs. 21.7% (18/83) , P=0.043),and had lower levels of fasting blood glucose (5.34(4.59,5.87) mmol/L vs. 7.12(5.18,8.60)mmol/L, P=0.001),total cholesterol((3.94±1.14) mmol/L vs. (4.91±1.50) mmol/L, P=0.001),triglyceride(1.42 (0.91,1.64) mmol/L vs. 1.89 (1.23,2.45) mmol/L, P=0.005),and low density lipoprotein cholesterol ((2.24±0.91) mmol/L vs. (2.94±1.16) mmol/L, P=0.001),CAG results showed that patients in the SCAD group had more single vessel lesion (88.6% (39/44) vs. 39.8% (33/83) , P=0.001), and their target lesion stenosis was less severe ( (79.2±22.4) % vs. (91.5±12.1) %, P=0.001). (2) The clinical risk factors such as hypertension history, diabetes history, smoking history, family history of cardiology disease, fasting blood glucose,total cholesterol,triglyceride and low density lipoprotein cholesterol were similar between definite group and probable group (all P>0.05). CAG results showed that prevalence of single vessel lesion (100% (21/21) vs. 78.3% (18/23) , P=0.050) and percent of target lesion stenosis ( (76.9±20.6) % vs. (81.2±24.1) %, P=0.529) were similar between definite group and probable group.(3)There were no significant difference in single vessel(84.0% (21/25) vs. 94.7% (18/19) , P=0.370), target lesion stenosis(85.0(70.0,100.0)% vs. 75.0(50.0,90.0)%, P=0.186),and survival rates in hospital(96.0% (24/25) vs. 100% (19/19) , P=1.000) between interventional therapy group and conservative treatment group.@*Conclusions@#Prevalence of SCAD is highin young female patients with acute myocardial infarction. Acute myocardial infarction patients with less risk factors of CAD and with CAG showing smooth lesion of narrowing segment and normal finding in the other vessels, are more likely to be diagnosed with SCAD.Acute myocardial infarction patients caused by SCAD have high survival rate either receiving percutaneous coronary intervention or drug treatment.
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Objective To survey the perspectives from primary health workers on the building and management of interdisciplinary family doctor team in urban community health service.Methods Primary health workers from 24 community health centers of 14 provinces were selected to participate in a questionnaire survey on March 2016.The attitude and satisfaction of participants with interdisciplinary family doctor team in urban community health setting were surveyed and analyzed.Results There were 765 questionnaires were distributed and 738 valid ones were returned with a retrieve rate of 96.5％.The survey showed that 70.73 ％ (522/738) of participants supported the interdisciplinary family doctor teamwork,while the overall satisfaction with items regarding its building and management was 48.61％ (2 870/5 904).Participants were mostly dissatisfied with performance appraisal and incentive mechanism (32.25％),autonomy of team (40.92％),job division of team members (44.44％) and rationality of professional allocation in the team (48.78％).There were significant differences in overall satisfaction rate among primary health workers in different positions and from different regions (x2 =176.86 and 57.17,both P ＜ 0.05).The overall satisfaction of participants in western regions was only 35.65 ％ (636/1 784) and that of public health workers was 43.91％ (534/1 216).Conclusion Currently,the building and management of interdisciplinary family doctor team in urban community health service are in a initial stage,although its importance has been recognized.Team composition,responsibility of various team members and effective incentive mechanism should be further improved,and more attention should be paid to western regions and for public health workers.
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Objective To investigate the expressions of T cell immunoglobulin and mucin-domain contain-ing moleculesfamily-3(Tim-3)and CD4+ and CD8+ T cells in peripheral blood from patients with coronary heart disease (CHD). Methods 51 CHD patients were divided into two groups:stable angina pectoris group (27 patients)and acute coronary syndromes group(24 patients). Another 25 healthy subjects confirmed by coronary angiography were selected as a control group. Peripheral blood was drawn on admission. Enzyme-linked immunosor-bent assay was used to detect the concentration of Tim-3. Flow cytometry was applied to detect the expressions of CD4+and CD8+. Results As compared with the healthy control group ,the concentration of Tim-3 and the propor-tion of CD8+ in stable angina pectoris group and acute coronary syndrome group were reduced ,and those in acute coronary syndrome group were lower. The differences were statistically significant (P < 0.05). As compared with the healthy control group,the proportion of CD4+ and the ratio of CD4+/CD8+ of stable angina pectoris group and acute coronary syndrome group were increased ,while those in acute coronary syndrome group were higher. The differences were statistically significant(P<0.05). Conclusions At the onset of CHD,the concentration of Tim-3 and the proportion of CD8+ in peripheral blood are reduced ,but the proportion of CD4+ is increased. The more severe the disease,the greater changes the values.
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Objective To investigate the expressions of T cell immunoglobulin and mucin-domain contain-ing moleculesfamily-3(Tim-3)and CD4+ and CD8+ T cells in peripheral blood from patients with coronary heart disease (CHD). Methods 51 CHD patients were divided into two groups:stable angina pectoris group (27 patients)and acute coronary syndromes group(24 patients). Another 25 healthy subjects confirmed by coronary angiography were selected as a control group. Peripheral blood was drawn on admission. Enzyme-linked immunosor-bent assay was used to detect the concentration of Tim-3. Flow cytometry was applied to detect the expressions of CD4+and CD8+. Results As compared with the healthy control group ,the concentration of Tim-3 and the propor-tion of CD8+ in stable angina pectoris group and acute coronary syndrome group were reduced ,and those in acute coronary syndrome group were lower. The differences were statistically significant (P < 0.05). As compared with the healthy control group,the proportion of CD4+ and the ratio of CD4+/CD8+ of stable angina pectoris group and acute coronary syndrome group were increased ,while those in acute coronary syndrome group were higher. The differences were statistically significant(P<0.05). Conclusions At the onset of CHD,the concentration of Tim-3 and the proportion of CD8+ in peripheral blood are reduced ,but the proportion of CD4+ is increased. The more severe the disease,the greater changes the values.
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Objective To measure and analyze the staffing standards of family doctor interdisciplinary team by means of the WHO workload indicator of staffing need (WISN)method,for reference of the government in building family doctor interdisciplinary teams.Methods 150 community health centers in 16 provinces were selected.The related data from 150 centers were collected to analyze the population served by each family doctor,and the staffing standards of family doctor interdisciplinary team by means of the WHO workload indicator of staffing need(WISN)method.Results There were 10 721 community health professionals in the sample centers which provide 132.14 million standard equivalents of service to the public.1 9 6 1 6 community health professionals were needed to ensure the quality of service and no extra workload after work for professionals.Averagely,each family doctor can serve 1 558 residents,who needs 1.3~1.5 nurses or public health workers.Conclusions A huge gap was found for community health professionals.The population served by each family doctor should be lowered compared to the governmental requirement and more nurses should be introduced to the family doctor interdisciplinary team.
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Objective To understand the status of service contract signing conducted by primary medical and health institutions.Methods A questionnaire survey and in-depth interview methods were used to study the service contract signing at primary health care institutions.Results The contract signing rate of the institutions surveyed was 1 9.1%,and valid contract signing rate was 76%.Senior people above 65 years old accounted for 33.5% of those signers,while hypertension patients accounted for 1 9.5% and diabetes patients for 10.6%.Interviews to the general practitioners team at the primary health institutions found that main factors affecting residents′ intention to sign were drug availability, attraction for signing the services,treatment habits among others.Interviews to the staff the primary health institutions found that contracted services are facing such difficulties as medical staff shortage,lack of motivation,lack of competence among others.Interviews to leaders of the primary health institutions found that the lack of publicity and support of medical insurance also has great influence to service contract signing.Conclusions The enthusiasm of general practitioners and residents to sign up for the service remains to be improved.
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Objective To measure the gap of community health staffing and establish new norms for community health facilities by means of the WHO Workload indicator of staffing need (WISN) method,for reference of the government in evaluation and decision making of community health staffing. Methods With Xicheng District of Beijing as an example,we collected data on community health staffing and calculated the total demand,measuring the total demand and supply,and gap or surplus in the staffing.Results in 2013,the demand of community health staffing was about 1 7.18 million standard equivalents in Xicheng,while the supply was 10.5 12 million.The WISN ratio was 0.67 for community health supply and demand,in which the ratio of physicians was close to 1,while that of nurses and public health workers was far below 1.850 extra community health staff was needed to reach the total of 2 602 persons.Conclusion The demand and supply of community health service in Xicheng District was seriously unbalanced,a huge gap featuring overstaffing of nurses and inadequate public health workers.This results from the enhancement of primary public health services and rising utilization of community healthcare services in recent years,which deserves high attention from government of all levels,by increasing the staffing of community health staffing standards.
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Objective:To investigate the effects of sign-contract services on hypertension patient disease control and the satisfaction of medical staff. Methods:a face-to-face questionnaire survey was conducted among hypertension patients selected from 20 primary health centers in 10 provinces in China. Results:This paper collected 1 ,881 valid questionnaires, and the average age of the population was 65. 72 ± 10. 88. Respondents that received sign-contract services accounted for 53. 88%, and there was no difference between patients who signed the service contract and who did not in terms of demographics. In self-reporting of blood pressure controls, respondents who signed the service contract, aged 40~50 years old, enjoyed the free medical care, preferred to seek medical services from primary a-gencies ( i. e. community health centers and township hospitals) for minor illnesses, controlled their blood pressure better ( P<0. 05 ) . Respondents enjoyed the civil resident medical insurance, preferred to seek medical care from community health centers for minor illnesses and signed the service contract were more likely to be satisfied with their medical practitioner (P<0. 05). After adjusting for age, gender, education level, medical insurance style, patient willingness to seek medical care for minor illnesses, signing service contracts was found to be an independent factor both associated with blood pressure self-control and attitudes towards medical service providers, with the odds ratio of 3. 007 (95%CI:2. 572 -3. 517) and 1. 814 (95%CI: 1. 563 -2. 105) respectively. Conclusion: Contracts are correlated with blood pressure control and satisfaction toward medical practitioners, which means that patients who signed the service contract control their blood pressure better and are more satisfied with their medical deliverers.
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<p><b>OBJECTIVE</b>To analyze the impact of implementation on health management programs among the community-based 0-36-month-olds regarding their growth and development.</p><p><b>METHODS</b>18 Monitoring Bodies in 8 pilot areas were selected to enroll this study, using a multistage stratified cluster sampling method. All the children aged 0 to 36 months were followed, according to the health management specification, and their health archives were collected.</p><p><b>RESULTS</b>A total of 13 464 children were involved in the specified management program with a total of 59 648 person-time under follow-up, with 54.26% of them were boys. Results from the multi-layer linear model indicated that the average height of children in the specified management group was higher than that in the non-standardized management group. Children in the specification management group, their weight gain had also been more effectively controlled. At the same time, with the increasing number of follow-ups according to the specification, the prevalence rates of under weight, stunt, emaciation and overweight were all significantly decreased (P < 0.05).</p><p><b>CONCLUSION</b>The implementation of the community-based programs on 0-36-month-olds regarding their health management specification had improved children's growth and development.</p>
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Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Community Health Services , Emaciation , Epidemiology , Follow-Up Studies , Growth Disorders , Epidemiology , Overweight , Epidemiology , Prevalence , Program Evaluation , Thinness , EpidemiologyABSTRACT
Objective To learn the policy outcomes of the management of category-B large medical instruments deployed in Beijing.Methods Call into play the data from the surveys made in 2005,2007 and 2010 on the five types of category-B large medical instruments deployed in the city.Summarize and analyze the outcomes of such instruments in terms of their total configuration volume,and the growth,distribution and use.Results From 2005 to 2010,CT scored the fastest growth of these five types of instruments,with 48 units deployed; SPECT was the lowest,with 8 units deployed.Conclusion The volume growth,instruments distribution,and use efficiency of such instruments in Beijing are rationally evolving,which proves that the deployment and management of category-B large medical instruments is compliant with conditions of the city.
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After acute myocardial infarction, how realizes revasculadzation of the infarct area as well as prolongs the postponement left ventricle reconstruction and restores heart normal contraction function has been the hot spot. The research demonstrated that the transplanted stem cells may be in field planting of the heart infarct region, simultaneously through nutrition effects of secreting vascular endothelial cells and differentiation into myocardial cells, vascular endothelial calls, and can improve ventricle reconstitution and recovery cardiac function. However, stem call effects on myocardial infarction have close correlation to stem call tissue source. Various preconditioning also can affect repair of stem cells. Meanwhile, choice of suitable stem cell donors and recipients, correction of transplanted window and pathway are key factors for obtaining good clinical curative effects.