苏北农村耐药结核病现状及影响因素的研究

目的 探讨农村耐药结核病的流行现状与可能的危险因素及保护因素。方法 对实施直接面视下短程化疗(DOTS)的苏北某项目县2002年全部结核病患者和某非项目县同期患者的一个样本进行问卷调查和痰菌培养,对新分离株进行比例法药敏试验,以单因素及多因素非条件logistic回归方法分析资料。结果 共有152例患者的药敏结果可以分析。其中32.9％的病例耐至少1种一线药,26.3％耐异胭肼(INH),18.4％耐利福平(RIF),17.1％同时耐INH和RIF。INH耐药和RIF耐药共同的独立危险因素是结核病治疗史和来自非项目县,而不重视自身健康和就医延误1个月以上的患者更可能耐RIF。耐多药(MDR)的独立预告因素包括:就医延误1个月以上(OR=4.66,95％CI:1.26～17.24)、来自非项目县(OR=3.01,95％CI:1.10～8.22)、不重视健康(OR=5.13,95％CI:1.06～24.90)和患有慢性病(OR=0.22,95％CI:0.05～0.87)。结论 当地农村耐药结核病疫情严重,耐药性主要与人为因素有关,但可能存在一定的传播。     

江苏省扬中市社区慢性咳嗽患者结核病医疗服务可及性及其影响因素研究

目的探讨慢性咳嗽满3周的潜在结核病患者结核病医疗服务可及性及其社会经济和人口学影响因素。方法以非直接督导下的短程治疗策略(Directly observed treatment short-course,DOTS)结核病控制项目地区的江苏省扬中市为现场,通过随机整群抽样,对从20个村33549名14岁以上常住居民中识别的171例持续咳嗽和/或咳痰满3周的潜在结核病患者进行问卷调查和胸透及痰涂片检查。结果33%的对象从未就诊,其估计的就诊延误中位数为67(51~93)天,远大于已就诊者的首诊延误10(4~31)天和正式就诊延误中位数15(5~31)天(P=0·000)。无医疗保险者就诊及正式就诊的可能性仅为有医疗保险者的42·2%,且发生就诊延误和正式就诊延误的可能性较高;男性就诊的可能性比女性小;农民及距离医疗机构较远者就诊延误的可能性大。结论非结核病控制项目地区慢性咳嗽患者结核病医疗可及性较弱,有可能影响结核病的人群发现率,不健全的医疗保险制度是其重要的制约因素。     

初治涂阳肺结核社会经济学调查及延误治疗的相关因素分析

目的 调查初治涂阳肺结核社会经济学情况,了解涂阳肺结核延误治疗状况,为结核病防控提供依据。方法 随机抽取武汉市结核病防治所住院治疗的初治涂阳肺结核患者200例,调查一般人口学资料、社会经济因素、就医可行性、就医前对结核病知识了解程度等,按是否延误治疗分组,总结延误治疗影响因素。结果 女性（51.72%）、费用支出占总支出比例超过20%（24.14%）、存在高结核病经济压力患者（58.62%）、至最近综合医疗机构时间≥15min（75.86%）、不了解结核病知识宣传（72.41%）、正规治疗前就诊1~2次患者（55.17%）治疗延误发生率高于男性、费用支出占总支出比例低于20%、无结核病经济压力、至最近综合医疗机构时间＜15min、了解结核病知识宣传及就诊次数3~4次患者（〖XC小五号.EPS;P〗=4.748、4.200、7.918、4.679、3.928、4.245,P均<0.05）;多因素分析显示性别（OR=2.782,95%CI:1.635~4.731）、费用支出占总支出比例（OR=8.767,95%CI:4.380~17.546）、结核病经济压力（OR=9.728,95%CI:3.170~29.848）、至最近综合医疗机构时间（OR=4.627,95%CI:1.473~14.536）、是否了解结核病知识宣传（OR=2.678,95%CI:1.058~6.780）均为导致治疗延误的相关因素（P均<0.05）。结论 初治涂阳肺结核患者整体社会经济水平较低,女性、费用支出占总支出比例高、结核病经济压力大、至最近综合医疗机构时间长、对结核病知识知晓率低的患者治疗延误风险较大。     

新发涂阳肺结核病人延误诊断影响因素分析

目的 探讨涂阳肺结核病人延误诊断治疗的影响因素,为早期控制传染源提供科学依据.方法 以2007年4～10月就诊于湖南省郴州市北湖区、桂阳、宜章、永兴、安仁5县(区)结防机构新发涂阳肺结核患者为研究对象,利用调查表收集相关资料,应用COX比例风险模型进行延误诊断治疗的影响因素分析.结果 患者延误、确诊延误、治疗延误、医疗机构延误及总延误时间中位数分别21,29,3,16,62 d.患者延误的独立危险因素为不知晓结核病相关知识和首次症状有非肺结核主要症状;确诊延误的独立危险因素为首次就诊未进行痰涂片、X线电子计算机断层扫描(CT)和摄胸片检查;治疗延误的独立危险因素为农村户籍和首次就诊未进行痰涂片检查.医疗机构延误的独立危险因素为首次检查未进行痰涂片、摄胸片和CT检查、首诊医疗机构在村级或乡级医疗机构及首次无咯血症状;总延误的独立危险因素为男性、首次检查未进行胸透或CT检查.结论 患者延误诊断、治疗与患者肺结核知识、户口所在地、首诊时间、未进行痰涂片和X线检查有关.     

广州市海珠区肺结核患者就诊延误影响因素的研究

目的 分析广州市海珠区肺结核患者就诊延误情况及其影响因素,为制定减少就诊延误发生的干预措施提供科学依据。方法 采取随机抽样调查方法,应用编制的问卷对2014年1月1日~2014年12月31日登记发现的150例广州市海珠区肺结核患者进行面对面的问卷调查,并收集患者病历资料,分别从基本情况、经济因素及临床因素分析就诊延误的影响因素。结果 150例肺结核患者就诊延误率为52.0%（78/150）。多因素分析结果表明转诊（OR=0.121,95% CI:0.028~0.513）、咯血（OR=0.291,95% CI:0.098~0.860）是减少就诊延误的因素;就诊交通费支出≥50 元/月（OR=7.334,95% CI:1.729~31.113）、因症就诊（OR=3.225,95% CI:1.337~7.775）是增加就诊延误的因素。结论 广州市海珠区肺结核患者存在一定的就诊延误,提高人群结核病相关知识的知晓水平,加强转诊,改善结核病定点医疗机构服务的可及性和便利性,增强人群健康体检意识,从而减少肺结核患者就诊延误。     

沈阳市某区居民患病首诊医疗机构选择意向影响因素分析

目的 通过对沈阳市某区居民首诊医院选择意向的调查研究,了解影响其就医选择的因素,探求如何优化社区居民就医行为,发挥分级诊疗制度优势.方法 2018-06-01-2018-12-31选择沈阳某区的居民进行问卷调查,调查内容包括居民基本情况、患病时就诊首诊医疗机构和人群中选择首诊医院时考虑的主要因素等.根据首诊医院选择意向...     

河北农民患菌痢疾病意向性就医可及性研究

目的:了解河北农村村民患菌痢选择首诊就医医疗机构地理位置的可及性。方法:以调查表的形式入户询问村民患菌痢选择首诊医疗机构的原因、距离与交通工具。结果:村民患菌痢80.5%选择首诊医疗机构是“村卫生所”,13.3%选择“乡卫生院”,2.8%选择“县医院”,选择村卫生所的主要原因是地理位置“距离近”,选择乡与县医院主要是“有专家”。     

年龄与农村结核病患者诊疗可及性关系的定性研究

目的 研究年龄因素对江苏省北部农村地区结核病患者诊断与治疗可及性的影响。方法 通过焦点组访谈和个人深入访谈，以江苏省北部某结核病防治项目县和非项目县的6个乡镇部分乡结防医生、村卫生防保工作者和肺结核病病人为研究对象，从结核病患者的就医行为、治疗依从性等方面来探讨年龄因素对农村结核病患者诊断和治疗可及性的影响。结果 老年结核病患者比其他年龄组患者更多地选择低等级的村诊所为初次就诊单位，且诊断前因患者所致的就诊延误时间长。老年患者的经济地位以及对自身健康状况的关注程度可能限制了其结核病诊断和治疗的可及性。     

苏北农村地区结核病患者首诊机构选择和配置研究

目的：比较农村结核病控制项目地区和非项目地区病人对首诊机构的选择，和首诊机构在结核病诊断和转诊中存在的问题。方法：对苏北结核病控制项目县（建湖县）和非项目县（阜宁县）2002年全年登记的493名新诊断结核病人进行问卷调查。结果：首次就诊直接去县结防所的痛人比例仅为1％左右．首次就诊比例最高的机构为村诊所。项目县县市级医院和乡镇医院获得转诊的比例显著高于非项目县。结论：应着力于促使乡镇医院和县市医院及早对病人进行相应检查和及时转诊，完善转诊管理体系。     

农村老年肺结核病例发现延误的影响因素研究

目的了解农村老年肺结核病例发现延误状况,探讨发现延误的影响因素。方法采取横断面调查方法,运用自制的调查表,对2007—2009年到湖州市结核病定点医院接受诊治的农村老年新发涂阳肺结核患者进行面对面调查。结果 237例痰涂片阳性的肺结核患者,从症状出现到被确诊为肺结核的发现延迟时间中位数为49 d（0-1164 d）;有157例（66.24%）患者存在发现延误。发现延误的影响因素有：居住地距离最近医疗卫生机构的距离、就诊前是否接受过结防宣教、首发症状咯血、首诊胸片检查、首诊未做任何检查、确诊前就诊医疗机构的次数和是否服用民间偏方行为。结论农村地区老年结核病普遍存在发现延误的现象,发现延迟时间较长。需采取综合性干预措施,减少农村老年结核病患者的发现延误。     

Effects of health insurance and race on colorectal cancer treatments and outcomes

OBJECTIVES: We hypothesized that health insurance payer and race might influence the care and outcomes of patients with colorectal cancer. METHODS: We examined treatments received for all incident cases of colorectal cancer occurring in Florida in 1994 (n = 9551), using state tumor registry data. We also estimated the adjusted risk of death (through 1997), using proportional hazards regression analysis controlling for other predictors of mortality. RESULTS: Treatments received by patients varied considerably according to their insurance payer. Among non-Medicare patients, those in the following groups had higher adjusted risks of death relative to commercial fee-for-service insurance: commercial HMO (risk ratio [RR] = 1.40; 95% confidence interval [CI] = 1.18, 1.67; P = .0001), Medicaid (RR = 1.44; 95% CI = 1.06, 1.97; P = .02), and uninsured (RR = 1.41; 95% CI = 1.12, 1.77; P = .003). Non-Hispanic African Americans had higher mortality rates (RR = 1.18; 95% CI = 1.01, 1.37; P = .04) than non-Hispanic Whites. CONCLUSIONS: Patients with colorectal cancer who were uninsured or insured by Medicaid or commercial HMOs had higher mortality rates than patients with commercial fee-for-service insurance. Mortality was also higher among non-Hispanic African American patients.     

Perceptions and experiences of health care seeking and access to TB care--a qualitative study in rural Jiangsu Province, China

This study aims to obtain an in-depth understanding of factors that influence the health seeking behavior of TB patients, and access to tuberculosis (TB) care in counties with or without National TB Control Program (NTP) in rural China. Sixteen focus group discussions (FGDs) composed of TB patients and health care providers were held. Content analysis showed perceptions that financial difficulties influence health care-seeking behavior of TB patients in both program and non-program counties. Female and elderly patients were perceived to be more reluctant to seek health care and to seek care for cough from village health stations rather than general hospitals. Many TB patients said they could not afford the cost of TB care, even where services were subsidized. Fee-for-service incentives of health care providers and their ability to make a correct TB diagnosis were also perceived to influence patient access to TB care. Inappropriate treatment of cough patients was perceived to increase the risk of missing smear-positive diagnoses.     

Internet use for prediagnosis symptom appraisal by colorectal cancer patients

Background. This study explored the characteristics of colorectal cancer (CRC) patients who accessed Internet-based health information as part of their symptom appraisal process prior to consulting a health care provider. Method. Newly diagnosed CRC patients who experienced symptoms prior to diagnosis were interviewed. Brief COPE was used to measure patient coping. Logistic and linear regressions were used to assess Internet use and appraisal delay. Results. Twenty-five percent of the sample (61/242) consulted the Internet prior to visiting a health care provider. Internet use was associated with having private health insurance (odds ratio [OR] = 2.55; 95% confidence interval [CI] = 1.20-5.43) and experiencing elimination symptoms (OR = 1.43; 95% CI = 1.14-1.80) and was marginally associated with age (OR = 0.96; 95% CI = 0.93-0.99). Internet use was not related to delayed medical care seeking. Conclusion. Internet use did not influence decisions to seek medical care. The Internet provided a preliminary information resource for individuals who experienced embarrassing CRC symptoms, had private health insurance, and were younger.     

Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties

ABSTRACT: Context: Community health centers (CHCs) provide essential access to a primary care medical home for the uninsured, especially in rural communities with no other primary care safety net. CHCs could potentially reduce uninsured emergency department (ED) visits in rural communities. Purpose: We compared uninsured ED visit rates between rural counties in Georgia that have a CHC clinic site and counties without a CHC presence. Methods: We analyzed data from 100% of ED visits occurring in 117 rural (non‐metropolitan statistical area [MSA]) counties in Georgia from 2003 to 2005. The counties were classified as having a CHC presence if a federally funded (Section 330) CHC had a primary care delivery site in that county throughout the study period. The main outcome measure was uninsured ED visit rates among the uninsured (all‐cause ED visits and visits for ambulatory care sensitive conditions). Poisson regression models were used to examine the relationship between ED rates and the presence of a CHC. To ensure that the effects were unique to the uninsured population, we ran similar analyses on insured ED visits. Findings: Counties without a CHC primary care clinic site had 33% higher rates of uninsured all‐cause ED visits per 10,000 uninsured population compared with non‐CHC counties (rate ratio [RR] 1.33, 95% confidence interval [CI] 1.11‐1.59). Higher ED visit rates remained significant (RR 1.21, 95% CI 1.02‐1.42) after adjustment for percentage of population below poverty level, percentage of black population, and number of hospitals. Uninsured ED visit rates were also higher for various categories of diagnoses, but remained statistically significant on multivariate analysis only for ambulatory care sensitive conditions (adjusted RR = 1.22, 95% CI 1.01‐1.47). No such relationship was found for ED visit rates of insured patients (RR 1.06, 95% CI 0.92‐1.22). Conclusions: The absence of a CHC is associated with a substantial excess in uninsured ED visits in rural counties, an excess not seen for ED visit rates among the insured.     

Population study on chronic and acute conjunctivitis associated with ambient environment in urban and rural areas

The objective of this study is to evaluate whether daily clinic visits for conjunctivitis are associated with the ambient environment in urban and rural areas of Taiwan. The incidences of acute and chronic conjunctivitis (International Classification of Disease 9 Clinical Modification 372.0 and 372.1) in two urban cities and two rural counties and their relative risks (RRs) are associated with air pollutants (nitrogen oxides (NOx), sulfur dioxide, ozone, and particulate matter <10?μm in aerodynamic diameter) and/or weather statuses were assessed from the insurance reimbursement claims of a representative 1 million people from 2000 to 2007. The patients resided in rural counties were approximately eight time more likely to have acute complains and >1.3 time more likely to have chronic complaints than the patients lived in the capital, Taipei. Per 10?°C increment of the daily average temperature increased the risk of acute conjunctivitis and chronic conjunctivitis with RRs of 1.06 (95% confidence interval (CI): 1.03-1.09) and 1.05 (95% CI: 1.04-1.07), respectively. A 10-p.p.b. increase in NOx concentration also increased the risk of acute conjunctivitis (RR=1.03, 95% CI: 1.02-1.04) and chronic conjunctivitis (RR=1.06, 95% CI: 1.05-1.06). Residents in rural counties, females, the elderly, and children have higher risk of conjunctivitis. Ambient temperature and NOx concentration can cause greater significant risks on the diseases.     

广东省县域医共体建设现状分析与运行效果评价——基于二阶聚类和秩和比法

目的 分析2021年广东省县域医共体的建设现状及运行效果。方法 基于广东省县域医共体绩效评价数据,采用二阶聚类分析医共体责任、管理、服务和利益共同体的建设差异;运用秩和比法评估县域就医格局形成情况、医疗卫生服务能力、医疗卫生资源利用情况和医保基金使用效能。结果 党委政府主导的落实程度最高为81.43%,医保管理改革的落实程度最低为4.29%。聚类分析发现积极推进医共体建设的县域占34.80%,缓慢推进的县域占65.20%。秩和比结果显示就医格局形成情况的回归方程为■=0.122Probit-0.109(F=6 971.721,P<0.001)、医疗卫生服务能力的回归方程为■=0.120Probit-0.116(F=2 707.754,P<0.001)、医疗卫生资源利用情况的回归方程为■=0.122Probit-0.106(F=6 839.745,P<0.001)、医保基金使用效能的回归方程为■=0.176Probit-0.383(F=3 364.994,P<0.001)。积极推进型县域的医共体总体运行成效明显优于缓慢推进型县域。结论 不同建设程度的医共体需给予分...