行为干预在社区老年高血压患者服药依从性中的应用研究

目的探讨行为干预在社区老年高血压患者服药依从性中的作用。方法随机选择2010年1-10月住院高血压患者172例,随机分为两组,行为干预组93例,对照组79例。对照组仅采用常规治疗和护理;行为干预组在常规治疗和护理基础上给予干预。6个月后对所有患者进行问卷调查。结果行为干预组高血压患者药物治疗依从性佳百分率为77.4%,对照组服药依从性佳百分率为54.4%,两者之间差异有统计学意义（2χ=12.9,P〈0.01）;行为干预组患者血压正常控制率为72.0%,而对照组血压正常控制率为44.3%,两者之间差异有统计学意义（χ2=15.9,P〈0.01）。结论行为干预可以明显提高老年患者服药依从性率,从而提高血压正常控制率。     

老年高血压患者药物控制期间行康复指导的临床价值

目的 探讨老年高血压患者药物控制期间行康复指导的效果。方法 选取80例老年高血压患者，依照随机抽签法分成两组，每组40例，对照组给予单纯药物治疗，观察组另外给予康复指导，比较两组血压、血糖及血脂水平、服药依从性、心理状态、坚持用药自我效能量表(MASES)及生活质量评分。结论 干预前，两组血压、血糖及血脂水平差异无统计学意义(P>0.05),干预后观察组显著降低(P<0.05);观察组服药依从性显著高于对照组(P<0.05);干预前，两组心理状态评分差异无统计学意义(P>0.05),干预后观察组显著降低(P<0.05);干预后观察组MASES得分、生活质量各评分显著升高(P<0.05)。结论 老年高血压患者药物控制期间行康复指导，可提高服药依从性，有效控制血压水平，效果良好。     

社区健康干预对老年高血压患者危险因素影响的分析

目的：分析社区健康干预对高血压患者危险因素的影响。方法2010年9月至2012年10月我社区开展针对高血压危险因素的健康干预工作,研究对象为社区内80例高血压老年患者,所有患者经医生诊断为高血压,且排除其他严重躯体疾病及精神性疾病,在知情同意的基础上进行健康教育、用药指导和生活方式干预,随访观察两年。比较健康干预前后患者危险因素的知晓率、不良生活习惯的改善,服药依从性及体质指数、血压、血脂、血糖水平的改变情况。结果社区健康干预后依从管理率、危险因素的知晓率和服药依从性明显提高,不良生活习惯得到改善,血压、血脂和血糖水平较干预前均明显下降,差异有统计学意义（ P＜0.05）。结论社区健康干预可影响高血压患者的危险因素,有效控制血压,延缓心脑血管疾病的发生发展,适合基层社区推广应用。     

老少边县社区高血压病综合干预效果分析

目的探讨老少边县社区高血压病综合干预的效果。方法将广西龙州县城东社区386例高血压患者按随机数字表法随机分为干预组和对照组,每组193例。对照组给予健康教育和药物治疗;干预组患者在对照组基础上进行合理饮食指导、戒烟限酒、适宜运动、心理干预等"四位一体"的综合性干预。比较两组患者干预前后高血压知晓率、服药依从性、血压水平、生活方式以及血脂异常情况和肥胖发生率。结果干预后干预组患者高血压知晓率、服药完全依从性显著高于对照组(P0.01),生活方式改善情况优于对照组(P0.01),收缩压和舒张压低于对照组(P0.01),血脂异常和肥胖发生率低于对照组(P0.05)。结论 "四位一体"的综合干预,能大幅度提高高血压患者的高血压知晓率和服药依从性,显著改善患者生活方式,有效降低血压、血脂水平和肥胖发生率。     

个性化家庭访视对社区高血压患者服药依从性及血压控制效果的影响

目的对社区高血压患者进行个性化家庭访视干预,评价个性化家庭访视干预对患者服药依从性及血压控制效果的影响。方法将社区高血压患者120例按随机数字表法分为对照组和观察组,每组60例。对照组患者给予分片区集中健康教育指导,观察组患者给予个性化家庭访视干预。比较两组患者干预3个月前后的服药依从性、自觉测量血压以及血压控制合格情况。结果干预前,两组患者服药依从性比较差异无统计学意义(P0.05);干预3个月后,两组患者服药依从性均明显提高(P0.01),观察组患者的服药依从性显著优于对照组(P0.01)。干预前两组患者完整记录血压率及血压控制合格率比较差异无统计学意义(P0.05)。干预3个月后,两组患者完整记录血压率、血压控制合格率明显提高(P0.05),观察组患者完整记录血压率(80.0%)、血压控制合格率(83.3%)均显著高于对照组(41.7%,50.0%),差异有统计学意义(P0.01)。结论个性化家庭访视干预能显著提高社区高血压患者的服药依从性,帮助患者有效控制血压水平。     

中西医结合治疗老年2型糖尿病合并高血压病人的临床疗效观察

目的观察硝苯地平联合补肾法对老年2型糖尿病合并高血压病人的血糖,血脂水平及临床疗效。方法收集我院老年2型糖尿病合并高血压病人50例,随机分为试验组与对照组,各25例。对照组病人给予常规治疗,硝苯地平片与二甲双胍治疗;试验组病人在对照组治疗基础上给予中药汤剂补肾生经方。比较治疗前后两组病人血糖、血脂水平及临床总有效率。结果治疗后两组病人血清三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)以及空腹血糖(FBG)、餐后2h血糖(2hBG)均降低(P0.05),高密度脂蛋白胆固醇(HDL-C)均升高(P0.05);与对照组比较,试验组病人TG、LDL-C水平较低(P0.05),HDL-C水平较高(P0.05);FBG及2hBG水平较低(P0.05);与对照组比较,试验组临床总有效率较高(P0.05)。结论硝苯地平联合补肾法可有效改善老年2型糖尿病合并高血压的临床症状,推测其机制可能与硝苯地平联合补肾法降低老年2型糖尿病合并高血压病人TG、LDL-C、FBG及2hBG水平,升高HDL-C水平有关。     

老年高尿酸血症与相关危险因素的临床观察

检测92例高尿酸血症(HUA)、88例正常的患者,对两组间的血糖、血脂、血压对比分析。结果老年HUA患者血清空腹血糖(FBG)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、血压均高于对照组,而血清高密度脂蛋白(HDL-C)低于对照组(P0.05)。结论高血压、糖尿病及血脂异常与HUA的发生密切相关。     

智慧家医结合家庭医生签约服务模式对社区中青年高血压患者的管理效果

目的观察智慧家医结合家庭医生签约服务模式对社区中青年高血压患者的血压控制效果。方法选取2017年1-6月于首都医科大学北京市丰台区方庄社区卫生服务中心进行健康服务登记的中青年高血压患者360例为研究对象,按随机数字表法分为签约组和对照组,每组各180例患者,对照组患者予以常规健康管理干预,签约组患者在此基础上,予以智慧家医结合家庭医生签约服务模式干预,于干预前、干预后6个月、12个月时测量两组患者血压指标变化;于干预前、12个月后测定血脂水平变化;干预结束时对比两组患者治疗依从性、生活方式改善和血压控制满意度情况。结果干预前两组患者血压、血脂指标差异无统计学意义(P0.05);干预后签约组血压水平、血脂指标改善程度优于对照组(均P0.05);签约组干预后遵医嘱服药率、戒烟率、戒酒率和血压控制满意率为92.8%、84.5%、95.9%和98.9%,而对照组分别为82.2%,65.2%,84.3%和93.9%,2组间的差异有统计学意义(均P0.05)。结论智慧家医结合家庭医生签约服务模式可有效降低患者血压水平,促进不良生活方式的改善,增加服药依从性和血压控制率。     

家庭医生模式下IMB模型联合远程健康管理对欠发达地区衰弱空巢老年原发性高血压患者的管理效果

目的 评价家庭医生模式下信息-动机-行为技巧(IMB)模型联合远程健康管理对欠发达地区衰弱空巢老年原发性高血压患者高血压疾病知识知晓度、血压控制效果和服药依从性的管理效果。方法 选择广西壮族自治区南宁市西乡塘区北湖南棉社区卫生服务中心的200例衰弱空巢老年原发性高血压患者,其中自愿签约家庭医生服务的患者为干预组(100例),未签约家庭医生服务的患者为对照组(100例)。给予对照组社区规范的原发性高血压健康管理服务,干预组在对照组管理措施的基础上增加家庭医生模式下IMB模型联合远程健康管理,两组均干预6个月。比较两组患者的高血压疾病知识知晓度、血压控制效果和服药依从性。结果 干预2个月、4个月、6个月后,干预组患者的高血压疾病知识知晓度问卷评分均高于对照组,服药依从情况均优于对照组,舒张压、收缩压均低于对照组(均P<0.05)。结论 家庭医生模式下IMB模型联合远程健康管理有助于提高衰弱空巢老年原发性高血压患者的高血压疾病知识知晓度、血压控制效果和服药依从性。     

社区护理干预对糖尿病治疗依从性的影响

目的探讨社区护理干预对于糖尿病治疗依从性的影响。方法选择本院接诊的社区糖尿病患者120例,纳入对象有完整临床资料,签署知情同意书愿意配合本次研究,按照随机数字法分为对照组和研究组,每组60例。对照组以常规护理处理,研究组加用社区护理干预,比较两组患者治疗依从性、血糖控制率及护理前后空腹血糖(FBG)、餐后2 h血糖(P2h BG)、糖化血红蛋白(HbAlc)。结果研究组治疗依从率、血糖控制率显著高于对照组;护理干预后研究组FBG、P2h BG、HbAlc显著低于对照组(P0.05)。结论糖尿病治疗依从性应用社区护理干预不仅可以提高治疗依从率,同时可以改善疗效。     

Should the Reorganization of Addiction‐Related Research Across All the National Institutes of Health Be Structural?—The Devil Is Truly in the Details

The recent proposal to dissolve the National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse and create a new institute for substance use, abuse, and addiction will require significant effort by the staff of both institutes, the Advisory Councils, and outside experts to overcome complex challenges that could threaten its success. Although integration of the grants portfolios can be achieved, harmonization of goals and policies related to legal use of alcohol versus illegal consumption of drugs will present serious challenges. Consolidating the infrastructure of the 2 existing institutes would entail avoiding encroachment on grant funding. A new institute for substance use, abuse, and addiction would require an enormous amount of cooperation from other institutes as the portfolios of research on alcohol, tobacco, and other drug abuse should logically be transferred to the new institute. In the near term, a structural reorganization would be less efficient and more costly than the individual institutes are currently. Increasing efficiency and reducing costs over time will necessitate careful strategic planning. Success in this difficult task would be made easier and less costly by first implementing carefully placed building blocks of increasing functional reorganization. The newly created institute should increase opportunities for specialization within disorders of addiction, attract new leadership, and build a novel strategic plan that will energize scientists and staff and incorporate ideas of stakeholders to advance the public good in preventing and treating alcohol, tobacco, and all addictions. Attention must be paid to the devil in the details.     

Perceived health problems in elderly residents of Jordan

Jordan is typical of many developing countries in that the improving health services have significantly reduced child and infant mortality. A high fertility rate coupled with this reduction in mortality has increased the numbers of those living to adulthood and into old age. This paper identifies, in broad terms, areas where service delivery might be considered for implementation thereby improving the well-being in the elderly person. 965 residents of Jordan 55 to 95 years of age were sampled from Amman, Irbid and the surrounding suburbs. All subjects were designated, from a medical examination, as having or not having a chronic illness. Student's t-test comparing the Jordan subjects' mean scores on the six dimensions of the NHP with previously reported data suggested that although the instrument was faithfully translated there might exist significant cultural differences. Similarly, differences between males and females suggested a possible gender bias in the interpretation of the items. All chronically ill subject groupings had higher (poorer) mean scores on all dimensions. Healthy elderly males and females have a better perceived well-being than their chronically ill counterparts.     

The attrition of young physician-scientists: problems and potential solutions

Physician-scientists have played a prominent role as thought leaders in American medicine over the past century. This group has produced many basic scientific advances and pioneered the translation of these advances into clinical practice. Now that we are in the post-genomic era, there is a greater need than ever for the continued participation of this group because of their unique ability to bridge the "bench to bedside." However, the number of physicians pursuing this career is static and their average age is rising. Recent data indicate that the many benefits of this career path are seen as being outweighed by so many negative factors, as to prompt the question, "Is this a career that a reasonable person should undertake in 2007 and beyond?" The following analysis suggests that the current answer is "no." We have identified the lack of professional security as a major factor that prompts young physicians to abandon the physician-scientist track. Because this problem has not been sufficiently emphasized, we believe current efforts are unlikely to reverse this disturbing trend. We propose strategies that seek to address this problem and help sustain young physician-scientists at career transition points at which they are most vulnerable to give up.     

The quality of published health economic analyses in digestive diseases: a systematic review and quantitative appraisal

BACKGROUND & AIMS: Health economic analyses are increasingly common in the digestive diseases literature and often are cited to frame practice guidelines. Although clinical trials are subjected routinely to critical appraisal, there has been no attempt to appraise the quality of health economic analyses with a validated instrument. We sought to appraise the quality of health economic analyses in digestive diseases, and to identify predictors of study quality. METHODS: We performed a systematic review to identify digestive disease health economic analyses published since 1980. We assessed these studies using the Quality of Health Economic Studies (QHES), a validated quality-scoring instrument (score range = 0-100; >75 = high quality). We conducted regression analysis to identify predictors of high quality. RESULTS: Of 186 identified analyses, 29% were high quality, 71% failed to address potential model biases, 52% failed to disclose conflicts of interest, and 74% failed to describe methods for deriving the model assumptions. Four factors predicted high quality in logistic regression: (1) one or more authors had an advanced degree in health services or a related field (odds ratio for high quality, 5.0; 95% confidence interval, 2.6-9.3); (2) the study used decision-analysis software package (odds ratio, 2.4; 95% confidence interval, 1.2-4.7); (3) the study was federally funded (odds ratio, 2.2; 95% confidence interval, 1.2-4.1); and (4) the study cited the National Panel on Cost Effectiveness guidelines (odds ratio, 2.1; 95% confidence interval, 1.1-4.2). CONCLUSIONS: Less than one third of health economic analyses in digestive diseases meet criteria for high quality. Study quality is limited by factors that potentially can be remedied. These data may be used to focus the attention of journal editors and peer reviewers to ensure the future high quality of health economic analyses in digestive diseases.     

Does the content of primary care visits differ by the racial composition of physicians' practices?

Purpose

The study compared the content of primary care visits between physicians with larger and smaller African American practices.

Methods

We compared the content of primary care adult visits between physicians with larger and smaller African American practices using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey 1997 to 2002. Larger African American practice (>14% of primary care visits by African Americans) was empirically defined to conform with previous studies.

Results

Larger African American practices comprised 24% of all practices but accounted for 80% of all visits by African American patients. In adjusted analyses, physicians with larger African American practices were less likely to refer patients to specialists (adjusted odds ratio 0.77; 95% confidence internal 0.61-0.98) and marginally less likely to perform rectal examinations (adjusted odds ratio 0.84; 95% confidence interval 0.56-1.00) but were more likely to schedule a return appointment (adjusted odds ratio 1.25; 95% confidence interval, 1.02-1.52). However, there were no other significant differences in the reported content of the office visits. Results were not altered when different cutoffs for larger African American practices were used or when obstetricians-gynecologists were excluded from the analyses.

Conclusion

There are few differences in the content of office visits between physicians with larger and smaller African American practices.     

长沙市城乡老年人日常生活能力调查

目的 调查长沙市城乡老年人日常生活能力损害情况,分析其影响因素.方法 采用问卷调查法,对2339名60～91岁的老年人进行日常生活能力调查,分析其性别、年龄、婚姻状况、家庭结构、教育程度、职业、常见慢性病、医疗保健意识对老年人日常生活能力的影响.结果 躯体生活自理能力中,损害率最高的是定时上厕所(18.2%),工具性日常生活能力损害率最高的是购物(26.3%).年龄、丧偶、独居、患病、医疗保健意识缺乏是影响日常生活能力的主要因素.结论 日常生活能力是反映老年人健康状况的重要指标,对高龄、丧偶、独居、患有多种慢性疾病、医疗保健意识缺乏者等老年高危人群应加强健康教育和老年保健,提高其生活质量.     

Adolescent health and Healthy China 2030: a cross-sectional study

Background

The Chinese government approved the Outline of the Healthy China 2030 (HC2030) Plan in 2016, and made public health a priority for all future economic and social development. Studies have demonstrated the importance of investment in health care throughout the 8000 days that it takes for a human to develop, on reducing the disease burden in this group. Therefore, as well as children, adolescents should be recognised as an essential target population for health-care investment, and HC2030 plans to achieve key goals in adolescent health. This study aims to explore the gaps in adolescent health care that must be bridged, and to examine experiences from previous policies for lessons that will help the goals of HC2030 in adolescent health to be realised.

Media access and anaemia prevalence in children from ethnic minorities aged 6–23 months in central and western China: a cross-sectional study

Background

Reducing anaemia is an important component of children's health. Studies have shown that different media can provide information about safe health practices. However, it is uncertain how amenable ethnic minority parents are to receiving information about health care in China. We aimed to determine the use of media by Chinese parents in rural, under-served regions, and to inform technology-based interventions in diverse populations.