社区干预对农村高血压患者治疗依从性的影响因素研究

目的探讨社区干预策略对农村高血压治疗依从性的影响。方法将农村社区接受高血压规范化管理的132例高血压患者按随机数字表法以及随机数余数法分为干预组和对照组,两组均给予药物降压治疗,干预组再加用社区干预手段,随访8周,分析两组的治疗效果和血压控制率。结果干预组的总有效率、依从性和血压控制率均显著高于对照组(86.36%比70.37%,86.36%比57.41%,39.39%比18.52%,均为P<0.05),高血压治疗依从性与社区干预策略等多种因素密切相关。结论农村高血压控制率明显低于全国水平,社区干预策略能够明显提高农村高血压的治疗依从性和血压控制率。     

Prevalence,awareness, treatment,control and correlates of prevalence and control of hypertension among older adults in Kerala: A mixed methods study

IntroductionWe conducted this study among older adults with the following objectives: (1) To find out the prevalence, awareness, treatment and control of hypertension, (2) To understand the factors associated with hypertension prevalence and control.MethodsA mixed-methods study employing a sequential explanatory design was conducted with a survey of 300 participants aged ≥60 years, and 15 in-depth interviews. Blood Pressure (BP) and waist circumference were measured using standard protocol. Survey data were analysed using univariate and multivariate procedures. In-depth interviews were analysed employing thematic analysis.ResultsHypertension prevalence was 72.3% (95% CI = 67.1–77.2), 68.2% (CI = 61.8–74.2) were aware, 65.4% (CI = 59.0–71.6) were treated and 24% (CI = 18.6–29.9) achieved adequate control. Inadequate physical activity [(adjusted odds ratio (AOR)] = 2.34; CI = 1.19–4.59), current alcohol use (AOR = 2.28; CI = 1.06–4.91) and self-reported diabetes (AOR = 2.02; CI = 1.15–3.52) were associated with hypertension prevalence. Those who reported diabetes (AOR = 2.72, CI = 1.34–5.55), with education level up to high school (AOR = 2.58, CI = 1.11–6.00) and who were in the age group 60–70 years (AOR = 2.14, CI = 1.09–4.20) were more likely to have controlled hypertension compared to their counterparts. From the in-depth interviews it was found that availability and accessibility of services, family support, financial wellbeing, habits and beliefs and conducive environment played a role in hypertension diagnosis and management.DiscussionPrevalence of hypertension was high in this population along with poor control. Efforts are required to improve hypertension control focussing on older adults with low education and those who are aged 70 years and above.     

农村社区高血压伴心理疾病患者个体化心理干预的临床效果观察

目的了解个体化心理干预对伴心理疾病的农村社区高血压患者的临床效果。方法将经SCL-90测评判定伴有心理疾病的农村社区高血压患者1125例随机分为心理干预组（干预组）562例和对照组563例。对照组按高血压防治指南要求予常规管理;心理干预组在同对照组常规管理的基础上进行个体化心理干预,6个月后统计疗效。结果心理干预组临床治疗效果（以血压下降为主要评判标准）总有效率为97．0％,对照组为67．3％,两组比较差异有统计学意义（P〈0．01）。干预组心血管事件发生率为1．8％,对照组为5．7％,两组比较差异有统计学意义（〈0．05）。干预组SCL-90测评判定伴有心理疾病的人数下降比对照组明显,差异有统计学意义（P〈0．01）。结论心理干预可使伴心理疾病的农村社区高血压患者的血压达标率明显升高,生活质量明显改善。     

Facilitators and barriers of heart failure care in Kerala,India: A qualitative analysis of health-care providers and administrators

ObjectiveHeart failure is a leading cause of death worldwide and in India, yet the qualitative data regarding heart failure care are limited. To fill this gap, we studied the facilitators and barriers of heart failure care in Kerala, India.Methods and resultsDuring January 2018, we conducted a qualitative study using in-depth, semi-structured interviews with 21 health-care providers and quality administrators from 8 hospitals in Kerala to understand the context, facilitators, and barriers of heart failure care. We developed a theoretical framework using iteratively developed codes from these data to identify 6 key themes of heart failure care in Kerala: (1) need for comprehensive patient and family education on heart failure; (2) gaps between guideline-directed clinical care for heart failure and clinical practice; (3) national hospital accreditation contributing to a culture of systematically improving quality and safety of in-hospital care; (4) limited system-level attention toward improving heart failure care compared with other cardiovascular conditions; (5) application of existing personnel and technology to improve heart failure care; and (6) longitudinal and recurrent costs as barriers for optimal heart failure care.ConclusionsKey themes emerged regarding heart failure care in Kerala in the context of a health system that is increasingly emphasizing health-care quality and safety. Targeted in-hospital quality improvement interventions for heart failure should account for these themes to improve cardiovascular outcomes in the region.     

辽宁省农村地区高血压患病率、知晓率和控制率

目的 评估辽宁省农村地区高血压患者的知晓、治疗、控制现状以及血压分布特征,为开展有效的防控手段提供依据.方法 2008年9-11月,对辽宁省农村卫生适宜技术6个示范县626个村35岁以上农村居民共153 481人开展了高血压知晓、治疗和控制现状方面的筛查和评估.结果 辽宁省农村地区高血压患病粗率为40.6%,标化患病率为38.7%,男女年龄在35～044岁、45～54岁、55～64岁、≥65岁患病率分另0为23.9%、36.6%、49.0%、63.8%和20.7%、40.0%、55.0%、68.9%.高血压患者中,知晓率为56.9%,治疗率为39.7%,控制率为3.9%,接受治疗的高血压患者控制率仅为9.8%.治疗组高血压患者的收缩压和舒张压水平分别高于未治疗组患者8.4 mm Hg(1 nnn Hg=0.133 kPa)和3.4 mm Hg.结论 辽宁省农村高血压患病率高,知晓率、治疗率和控制率低,药物治疗效果较差,急需建立有效的农村高血压综合干预和管理的策略.     

Overweight,the major determinant of metabolic syndrome among industrial workers in Kerala,India: Results of a cross-sectional study

AimTo determine the prevalence and associated risk factors of metabolic syndrome (MS) among industrial workers in Kerala, India.Materials and methodsWe measured fasting plasma glucose (FPG), triglycerides, high density lipoprotein cholesterol, waist circumference, systolic blood pressure and diastolic blood pressure among 2287 industrial workers (mean age 46 years, men 70%) from selected industries of two southern most Kerala districts using standard protocol in 2009. MS was defined according to international diabetes federation (IDF), Adult Treatment Panel (ATP-III) and American Heart Association(AHA)/National Heart Lung and Blood Institute (NHLBI) criteria (Harmonization). Age-standardized prevalence of MS was assessed for men and women. Multivariable logistic regression models were developed to find the associated factors of MS.ResultsAge-standardized prevalence of MS was 14% (men 14%, women 15%), 19% (men 19%, women 21%) and 27% (men 30%, women 21%) as per IDF, ATP-III and Harmonization criteria respectively. Overweight adults were nine times (OR 9.41, 95% CI 7.34–12.06), twelve times (OR 11.80 CI 9.38–14.84), and four times (OR 3.56, CI 2.94–4.29) more likely to have MS compared to their counterparts according to IDF, ATP-III and Harmonization criteria respectively. Older adults and current alcohol users were more likely to have MS compared to their counterparts. Women were more likely to have MS as per IDF and ATP-III criteria.ConclusionsMS prevalence was high among Industrial workers who generally have good access to health care. Overweight and other predictors of MS need to be addressed to reduce MS prevalence in this population.     

Need for a differential criteria to stop mass drug administration,based on an epidemiological perspective of lymphatic filariasis in Thiruvananthapuram,Kerala, India

ObjectiveTo determine the prevalence of any of the clinical manifestations of lymphatic filariasis, parasitological and entomological indices in Thiruvananthapuram district, Kerala, India, prior to launching mass drug administration (MDA) in the district in 2005.MethodsA cross sectional survey was conducted in 7 endemic wards of the district, in a sample of 2 472 individuals above the age of one year. The study consisted of data collection using questionnaire, night blood smear examination and mosquito collection followed by identification and dissection.ResultsThe prevalence of any of the clinical manifestations of filariasis in this endemic area was 3% (73/2 472) (95% CI between 2.3% to 3.7%). The microfilaria rate was found to be 0.38%. Culex quinquefasciatus formed the predominant mosquito species. The vector infection rate was 1.4% and infectivity rate was 0.47%. Half of the population had satisfactory knowledge regarding the disease. In almost an equal number, the knowledge was poor and only about 10% had good knowledge. Most of the people had not heard about the MDA program.ConclusionsThe prevalence of filariasis even in an area considered to be endemic in Kerala, was low. Microfilaraemia was much lower than the clinical manifestations. However, the potential risk of transmission of disease continues. For such areas which had a pre-MDA mf rate less than 1%, there needs to be more stringent criteria for evaluating the effectiveness of the programme, doing transmission assessment surveys and stopping MDA.     

社区控制技术对浙江省社区高血压人群干预效果的评价分析

目的评价以"规模化、规范化、信息化"为核心的高血压社区控制技术对高血压人群的管理效果。方法 2010年以《中国高血压防治指南》为依据,建立以"规模化、规范化、信息化"为核心的高血压社区控制技术,选择浙江省有代表性的城市、城镇、农村社区高血压人群为研究对象进行大规模社区干预试验。按照高血压社区控制技术制订实施方案,规范化培训干预组医生,按照方案要求对干预组高血压患者进行分级管理。结果截至2013年12月共管理了高血压患者20 807例。其中干预组从基线的8996例增加到12295例,规范管理率达到86.8%;干预组高血压患者平均收缩压和平均舒张压分别下降了11.21 mmHg和8.55 mmHg(均为P<0.05),治疗率和控制率由基线时的55.4%和38.6%提高到86.7%和77.8%(均为P<0.05),心血管危险因素有显著改善(均为P<0.05),急性心血管事件发生呈下降趋势。结论高血压社区控制技术能有效提高社区高血压规范管理率,有效改善社区高血压人群防治效果。     

Knowledge on arterial hypertension in general population: Results from a community pharmacy screening program

Backgrounds and aimsHypertension is a risk factor for renal, cardiovascular and cerebrovascular diseases. It is responsible for a large proportion of overall morbidity and mortality every year. Hypertension-mediated organ damage is largely not reversible. For these reasons, prevention has primary importance: sensibilization of population on hypertension-related consequences is essential for therapeutic adherence and reduction of unhealthy lifestyle behaviour. This study aimed to evaluate awareness about hypertension among community pharmacies customers.Methods and resultsA questionnaire about hypertension was collected by 2731 customers from 94 community pharmacies in North West Italy, during a hypertension screening program. Hypertension awareness was unsatisfactory in a large proportion of the sample, with only 15% of subjects having an overall good level of knowledge. Furthermore, lower awareness was associated to higher blood pressure values (132/79 ± 19/11 mmHg vs 128/78 ± 18/10 mmHg, p < 0.001) and subjects resulted hypertensive or uncontrolled despite antihypertensive therapy, presented worse questionnaire scores (4.7 ± 1.9 vs 4.9 ± 2.0, p = 0.03).ConclusionKnowledge about hypertension is largely unsatisfactory among population. Community pharmacies may play as a setting for health education and hypertension screening.     

社区健康教育对高血压患者血压控制的影响

目的：了解健康教育对社区居民高血压患者血压控制的影响。方法：在台州市采取分层整群抽样,进行高血压普查．以普查检出的高血压患者为研究对象,随机分为对照组（512人）和健康教育组（478人,以健康教育为干预措施）,进行随机对照研究,观察两组的疗效。结果：健康教育组血压控制率显著高于对照组（x^2=10．10,P〈0．01）、舒张压降低水平显著优于对照组（μ=3．90,P〈0．01）。结论：健康教育对提高高血压患者疗效有积极意义。     

Prevalence, awareness, treatment and control of hypertension in a rural Nicaraguan sample

The prevalence, awareness, treatment and control of hypertension were assessed in 1303 persons who attended a free vision care clinic in rural Nicaragua. The prevalence of hypertension was 37.8% in men and 43.2% in women. Hypertension was found to be a highly prevalent disease in this group, and presumably in the local population, with low levels of awareness and control.     

北京市城乡社区卫生服务中心高血压防治现状的对比研究

目的了解北京市城乡社区卫生服务中心的高血压防治现状,为有针对性地指导其开展高血压防治工作提供参考.方法在北京市城乡分别抽取2个社区,对主要在社区卫生服务中心就诊的高血压患者(下称社区就诊患者)进行抽样问卷调查.共调查780人,用于本研究分析的资料完整者共761人.血压、身高和体重等指标均采用国际标准化方法进行测量.结果 (1)血压控制率目前北京市社区就诊患者的血压控制率(血压<140/90 mm Hg,1 mm Hg＝0.133 kPa)城乡分别为47.4%和24.6%,农村显著低于城市.(2)相关知识知晓率社区就诊患者对高血压诊断标准的知晓率城乡分别为30.4%和8.2%;对发病危险因素的知晓率(除精神紧张外)不超过20%;对冠心病和脑卒中以外的其他高血压主要并发症很少知晓.(3)检出途径出现高血压相关症状或发生了严重并发症后到医院检查时发现的高血压城乡分别为60%和70%.(4)药物治疗情况城乡社区就诊患者95%均接受药物治疗,治疗药物均以钙拮抗剂和复方制剂为主,利尿剂使用比例极低.(5)非药物治疗情况社区就诊患者接受非药物治疗的比例城乡分别为71.6%和26.6%.农村患者自述医生曾为其提供过非药物治疗建议的比例约12%,显著低于城市患者.(6)患者随访情况城乡分别只有2.1%和3.6%,社区就诊患者的随诊是医生要求的.结论北京市城乡社区卫生服务中心在高血压的检出、治疗、随访管理和健康教育的各环节均存在很大不足,亟待加强和改善.     

Prevalence of hypertension and prehypertension in a community-based primary health care program villages at central India

ObjectiveThe objective of this study is to evaluate the effects of a community-based effort in a rural area of central India to decrease the prevalence of hypertension among the middle-aged and older population by using multiple blood pressure measurements.MethodsWith a prevalence of 16.8% (error of 3.36, and 95% confidence interval) from a recent study in a nearby district, the sample size required for this study was 495 subjects. A proportionally stratified random sample design was used. With maps of ten villages, where in a community-based health project had been in place for many years, 20 households and 20 backups were randomly selected from a list of all households. Multiple BP measurements were obtained and categorized and one-month period prevalence was calculated. Statistical analyses of frequency and percentage were performed.ResultsApproximately one-fifth of the population above 40 years of age in central India where a community-based approach is in place was hypertensive. This is significantly lower than the previously documented prevalence rate of one-third or even more prevalence rate in India. The attribute of caste and religion, a specific rural Indian characteristic did not have any significant bearing on the above results. The prevalence tended to increase progressively with age until 70 years, after which it declined. Multiple blood pressure measurements may yield an accurate prevalence of hypertension.ConclusionWith the documented evidences from India, the current reduced prevalence of hypertension could have been influenced by the community-based interventions in this population.     

Prevalence, correlates, awareness, treatment, and control of hypertension in a middle-aged urban population in Kerala

BACKGROUND: Hypertension is an important cause of cardiovascular morbidity and mortality. METHODS AND RESULTS: We conducted a cross-sectional survey of 314 middle-aged subjects (163 men; age range 40-60 years, mean 49 years) in urban Thiruvananthapuram City. Kerala, to estimate the prevalence of hypertension, examine its correlates, and assess the degree of awareness, treatment, and control of high blood pressure. Blood pressure was measured by a nurse graduate using a mercury column sphygmomanometer and a standardized technique. We used multivariable analyses to examine the sociodemographic and clinical correlates of hypertension. The overall prevalence of hypertension in our sample was 54.5% (men 56.3%, women 52.3%). The factors associated with an increased prevalence of hypertension were higher body-mass index (odds ratio for a value in the top tertile of 2.33, 95% confidence interval: 1.2-4.4), and older age (odds ratio for the age group 55-60 years of 2.65, 95% confidence interval: 1.3-5.6). An occupation involving moderate or greater physical activity was inversely associated with the prevalence of hypertension (odds ratio 0.35, 95% confidence interval 0.13-0.94). Among hypertensives, 39% were aware of the condition, while 29% were treated with blood pressure-lowering medications. Adequate control of elevated blood pressure was achieved in only 30.6% of treated hypertensives. In our community-based sample, over half of all middle-aged individuals were hypertensive, but less than a third were under treatment. Adequate control of hypertension was achieved in less than a third of the treated individuals. CONCLUSIONS: These observations re-emphasize the need for hypertension awareness programs targeting the general public and the increased use of opportunistic blood pressure screening, and underscore the importance of measures to increase the knowledge of current guidelines for the detection and treatment of hypertension among healthcare providers.     

网络信息化管理对提高基层医师高血压诊治水平及社区高血压防治效果评价

目的评价网络信息化管理对提高基层医师高血压诊治能力以及社区高血压防治效果的作用。方法以《中国高血压防治指南》为依据制定了《高血压社区综合干预信息化管理规范》(简称《规范》),根据此方案建立信息化管理网络。于2007—2010年,对干预组医务人员进行网络跟踪临床指导,对干预组≥35岁居民实施全人群分类及高血压分级管理、综合干预,评价其干预效果。结果干预组运用专家网络跟踪指导模式培训社区医师,3年后高血压知识和病例诊治能力均明显提高,平均总分由47.3提高到78.1(P<0.05);干预组实施高血压社区信息化管理后效果显著(P<0.05):全人群管理率由36.0%提高至63.1%;人群收缩压(SBP)、舒张压(DBP)分别下降5.5 mmHg和1.7 mmHg;一、二、三级高血压管理级别比例变化明显,一级管理的比例由干预前67.2%提高至93.8%,二级、三级管理的比例由干预前19.8%、11.8%下降到5.3%、1.9%;高血压知晓率、治疗率和控制率分别由58.7%、48.5%、33.4%提高到89.7%、77.0%和72.6%;不良生活方式及行为有所改善,人群吸烟率、饮酒率、饮食偏咸以及少运动比例由19.7%、24.3%、23.5%、74.2%下降至14.5%、17.5%、15.5%、34.1%;心脑血管病急性事件发病、死亡率呈下降趋势。与对照组比较有统计学意义(P<0.05)。结论网络信息化管理能有效提高社区医师的诊治能力和社区高血压防治效果。     

北京市基层医生高血压诊疗能力及其影响因素的研究

目的:分析北京市基层医院医生高血压诊疗能力的影响因素,探索阻碍医生诊疗水平提高的原因;为卫生行政部门的医学继续教育工作提出政策建议。方法:北京市海淀区和朝阳区42家基层医院(包括二级医院9家,一级医院17家,乡卫生院16家)共计632名内科系列的医生,采用问卷调查方式,进行继续医学教育和临床能力调查。结果:1.41%的基层医生具有大学本科及以上学历,35%为大专学历,24%是中专学历,不同级别医院的医生学历构成有明显差异(P<0.01)。2.在基层医生中,高级职称占14%,中级职称占31%,有55%是初级职称,不同级别医院的医生职称构成也存在明显差异(P<0.01)。3.在总分为37分的高血压诊疗能力测试中,632名医生中最高28分,最低0分,平均(13.94±5.16)分。4.大学及以上学历、应用或阅读过高血压指南、女性、在内科或全科工作的医生测试成绩较好(P<0.05)。5.32.3%和31%的医生认为"缺乏学习时间"和"缺乏专家实际指导"是影响自身水平提高的主要原因。结论:1.北京市基层医生高血压诊疗水平存在不足。2.学历、工作科室、性别、对高血压指南的应用情况均为医生高血压诊疗能力的独立影响因素。3.影响医生水平提高的原因为"缺乏学习时间"和"缺乏专家实际指导"。