常州市近郊社区高血压健康教育重点人群特征探讨和干预方向研究

[目的]了解常州市近郊社区高血压病流行的基本情况以及影响因素、健康教育现状与传播需求.[方法]以近郊社区为基础整群抽样,对20～65岁、5年以上常住居民926人进行高血压痛流行病调查及健康教育现状的调查.[结果]被调查地区人群的高血压患病率高于全国水平.高血压相关健康知识知晓率偏低.年龄、文化程度、是否吸烟等7个因素与高血压的发生关系密切.文化程度等5个因素是影响人群高血压相关知识知晓率的因素.人群健康行为形成率偏低.[结论]在近郊社区开展高血压健康教育,必须抓住高危人群的特征,从核心知识点的选择和受从需求为出发点确定干预的方向,以提高干预的针对性和有效性.     

健康教育与健康促进在社区高血压病健康管理和干预效果

目的评价冷水滩区运用健康教育与健康促进在社区进行高血压健康管理和干预的效果。方法采用随机抽样方法,抽取肖家园社区居民中健康人群和高血压患者各200名,参照《中国高血压防治指南》[1]对干预前后进行评价。结果经过3年的综合干预,健康人群和高血压患者对高血压病的相关知识知晓率显著提高,分别为65.4%、51.3%;行为改变率为50.3%、40.8%,坚持规律服药率达33.5%,血压控制率25.5%。结论健康教育与健康促进干预模式在社区高血压病管理与干预中,提高了社区居民的知晓率、行为改变率和控制率,为控制和减少高血压并发症,提高患者人群的生活质量等起到了应有的作用。     

郊区居民高血压病社区干预效果评价

[目的]探讨高血压病社区干预模式及效果评价. [方法]对房山区西潞园社区居民高血压病患者及高危人群进行综合干预,观察干预前后高血压病知识知晓率、咸食摄入率、参加体育锻炼率及干预前后血清钠、尿钠、血糖、血脂及血压等的变化. [结果]经过1年的综合干预,高血压知识的知晓率提高了23.7%,咸食摄入率降低了18.4%,参与体育锻炼率增加了28.9%,血压及部分生化指标有明显的变化. [结论]在社区开展高血压等慢病的综合干预,可明显提高患者对慢病知识的知晓率,提高患者接受健康生活方式的行为,有效防治高血压病的发病及保持血压稳定.     

姜堰市居民高血压健康教育干预效果评价

目的:评价姜堰市社区高血压健康教育综合干预效果.方法:进行健康教育社区综合干预,采用高血压KAP调查表进行效果评估.结果:社区35岁以上居民,干预后高血压相关知识知晓率由42.00%提高到80.00%,吸烟率由35.30%下降至23.60%,饮酒率由35.50%下降至24.50%,低脂饮食比例由38.80%提高至50.10%.高血压患者治疗率和控制率明显提高.结论:健康教育社区综合干预对控制社区人群高血压具有良好的效果.     

高血压人群社区综合干预的效果评价

目的探讨社区综合干预对改善高血压人群生活方式和降低血压的临床效果。方法选取2010年沪东社区243例原发性高血压患者,于2010年7月—2012年7月对患者进行社区综合干预,探讨高血压患者相关知识知晓率、生活行为的改变情况及患者血压变化。结果 (1)干预后患者高血压相关知识知晓率有显著性提高,与干预前比较差异有统计学意义(P<0.05)。(2)原发性高血压患者经干预后高盐摄入、高脂摄入、吸烟、酗酒及存在心理障碍等生活行为均有所改善。(3)干预后高血压患者的舒张压和收缩压均有显著性下降,与干预前比较差异有统计学意义(P<0.05)。结论高血压病严重威胁患者健康,积极开展社区综合干预对控制高血压有重要作用。     

深圳市福田区益田社区居民健康知识、行为调查

目的了解社区居民健康知识掌握程度和健康行为形成情况,为制定有效干预措施提供科学依据。方法采用随机抽样,对3600名社区居民进行入户问卷调查。结果社区居民的健康知识知晓率为69.4%,健康行为形成率为69.9%。预防艾滋病、肥胖、病毒性肝炎知识知晓率顺次居前3位,分别为90.4%、86.3%和77.4%;口腔保健知识知晓率最低（47.2%）。不食变质食品、勤洗手、不酗酒的健康行为形成率顺次居前3位,分别为88.7%、87.6%和84.0%,坚持体育锻炼最低（29.2%）。文化程度的高低与健康知识知晓率和健康行为形成率呈正相关;深圳户籍人群的健康知识知晓率和健康行为形成率均比流动人口和暂住人群高（P〈0.01）;不同年龄组人群健康知识知晓率存在差异（P〈0.01）,健康行为形成率差异无统计学意义（P〉0.05）。结论健康行为受多种因素影响,要针对不同人群制定切实可行的年度重点宣传专题,反复实施健康促进干预。     

广西边境农村高血压社区健康教育干预效果评价

[目的]探索在边境农村社区人群中通过控制高血压和健康教育等措施来预防心脑血管疾病的可行性和效果.[方法]对高血压病人采取建立档案、随访管理、分级干预等措施,比较干预前后261名高血压患者的管理率、治疗率及控制率,同时对该人群实施健康教育,应用自制的量表对35岁以上的533名农村居民的高血压知识知晓率、高血压相关态度及不良生活行为改变率进行干预前后的比较并对其效果进行评价.[结果]高血压患者管理率、治疗率及控制率分别由干预前的25.3%、32.6%、29.9%提高至干预后的83.1%、55.6%、49.8%;高血压相关知识知晓率显著提高(P<0.01),干预后高血压相关态度及行为显著改变,如经常吸烟、高盐饮食、经常饮酒等行为,态度信念方面改变最明显的是:认为应该戒烟,其次是认为应遵医服药.[结论]对高血压病人实行分级管理,综合个体化干预后,可提高患者对自己疾病的知晓及重视程度,并增加管理依从性,同时对该人群进行健康知识教育和健康促进干预,可提高该人群防病治病的意识,对进一步预防及控制高血压,最终从根本上减少农村心脑血管病等并发症的发生都起着积极的作用.     

2007年西藏中央补助地方健康教育试点健康知识及健康相关行为调查

目的探索西藏中央补助地方健康教育试点居民健康知识及健康相关行为状况。方法采用多阶段、随机抽样的方法,对西藏自治区中央补助地方健康教育试点15岁以上400名居民进行了健康知识问卷调查。结果高血压相关知识：“高血压临界值”知识知晓率为10.5%,“每年应测量一次血压”的知晓率为22%,“每日盐摄入不应超过6克”的知晓率为31.5%,城市试点对“每周至少3次30分钟以上运动”的知识知晓率为36%,“半年内测量过高血压”的行为形成率为65%,农村试点为20%,“半年内盐摄入减少”的行为形成率为26.5%,农村试点为13.5%,“城市试点对每周至少3次30分钟以上运动”的行为形成率为33.5%;其他知识：“吸烟可能导致肺癌”农村居民知识知晓率为31.5%,文化程度与知晓率和行为形成率成正相关,城市居民的知晓率、行为形成率高于农村居民,男性知晓率高于女性。各种知识的主要来源依次为宣传栏、宣传材料、知识讲座、健康咨询。结论农村居民和女性是接受健康知识的重点人群,应将健康教育工作重点放在农牧区,并针对不同人群、因地制宜地采取不同的传播方式和形式开展健康教育工作。     

宁波市西门街道高血压干预效果评价

目的评价以健康教育为主要手段的社区干预对高血压的干预效果.方法干预前后均采用多阶段随机抽样的方法抽取调查对象;干预方法为对居民通过分发宣传手册、进行专题讲座、开健康处方的方式进行健康教育,对高血压病人采取分类管理、定期随访.结果人群吸烟率、经常饮酒率、食盐摄入超标率、高血压患病率的变化无统计学显著性意义,肥胖超重率下降,经常锻炼率、高血压病人的知晓率、服药率和控制率上升.结论西门街道高血压干预已经初见成效,为其他社区的干预工作提供了可借鉴的经验.     

广州市黄埔街社区健康状况调查

目的为掌握辖区社区主要健康问题及原因,确定目标干预人群,为社区制订慢性非传染性疾病防治干预措施提供依据。方法采用多阶级分层整群抽样方法,在所管辖的街道随机抽4个居委,抽中的居委按整群抽样确定调查户,每个居委110户,抽中户的所有人均作为调查对象。本次调查人数共1603人,血糖、血脂检测235人。结果居民获取健康知识的主要途径依次为:报刊书籍(27.72%)、广播电视(20.39%)、宣传栏(16.58%)、就诊时医务人员的讲解(8.82%)。高血压的粗患病率为11.3%,糖尿病患病率为3.2%,超重占25.29%,肥胖占4.57%,中风患病率占0.35%,血脂异常的粗患病率为13.19%,肿瘤患病率0.80%,冠心病患病率0.18%,慢性阻塞性肺部疾病患病率0.09%,社区居民1年内伤害发生率为0.72%,患病后希望得到社区卫生服务人员给予服务的比例88.02%。结论社区居民慢性非传染性疾病流行不容乐观,辖区居民人群主要健康问题为高血压、糖尿病、高血脂、超重和肥胖、恶性肿瘤、伤害、中风等。主要行为危险因素为吸烟、过量饮酒、肥胖、超重、缺少体育锻炼、口味偏咸等。有效开展社区卫生服务工作,积极倡导健康科学的生活方式,切实加强社区健康干预工作,是改善社区健康问题的有效途径。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.