专题导读——上海市骨质疏松社区诊疗管理规范试点探索

<正>骨质疏松症是与增龄相关的最常见骨骼疾病,是一种主要表现为骨量减少、骨强度降低、骨质脆性增加的全身性代谢性骨疾病,具有发生率高、预后严重和负担高的特点。骨质疏松性骨折是老年患者致残和致死的主要原因之一。随着人口老龄化日趋严重,骨质疏松症已成为我国面临的重要公共健康问题。前期研究发现,上海市社区人群对骨质疏松不够了解和重视,患者对疾病管理预防骨折的意识薄弱,基层医务人员也对骨质疏松缺乏认知和干预能力。     

骨质疏松症社区诊疗管理模式的探索

骨质疏松症和骨质疏松性骨折是我国面临的重要公共健康问题,但目前其防治现状却不甚乐观,存在的问题也比较突出。如何管理骨质疏松和骨质疏松性骨折患者是各国学者一直在探索的问题。为防治骨质疏松症及减少骨质疏松性骨折后再次骨折的发生,上海市开展了骨质疏松症社区诊疗管理规范试点工作,并取得了一些成果。本文对骨质疏松的流行病学和防治现状,国内外的管理模式,上海市防治网络的建立,社区诊疗管理模式的建立进行论述,并提出对骨质疏松管理模式的展望与困惑。     

上海市部分社区居民骨质疏松预防知识、自我效能、行为状况及健康宣教效果分析

目的了解上海市部分社区居民的骨质疏松知识认知、骨质疏松预防自我效能和自我管理行为状况及社区宣传干预的效果。方法在上海市20个骨质疏松诊疗管理规范试点社区开展骨质疏松危险因素、防治知识、管理行为等的宣教,宣教前后分别采用方便抽样的方法抽取2 000名居民进行问卷调查,评估宣教干预效果。结果干预后社区居民骨质疏松危险因素知识、运动知识和钙知识的平均正确率较干预前分别提升了20.7%,20.4%和14.5%(P0.01)。干预后社区居民的骨质疏松运动效能和摄钙效能,社区居民骨质疏松预防饮食行为、生活方式和运动行为也较干预前显著提升(P0.05)。结论经规范化管理和宣教干预后,社区居民对骨质疏松症认知、效能和管理水平显著提高,骨质疏松症规范化管理宣教干预切实有效。     

补肾活血中药预防骨质疏松性椎体骨折的有限元研究

骨质疏松随着人口老龄化而日益成为公共健康事业中的突出问题。据预测我国约有8800万骨质疏松症患者,预计到2050年将达到2.12亿,每年医疗费用按保守估计需要150亿人民币[1]。骨质疏松症最大的危害是骨质疏松性骨折,骨质疏松性椎体骨折是骨质疏松症患者致残致死的主要原因。目前,骨质疏松的预防和治疗主要是依赖药物,但是西药的副作用、安全性及长期的经济负担使患者难以坚持长期服用,     

上海市社区就诊居民骨质疏松病因预防情况调查

目的了解上海市社区居民对骨质疏松症相关知识的认知情况,骨质疏松预防的自我效能,骨质疏松健康促进的需求与骨质疏松预防的自我管理行为。方法在上海市20家社区卫生服务中心按就诊号顺位依次抽取40岁以上就诊居民2003人,采用自行设计的"上海社区居民骨质疏松健康促进问卷"进行调查。结果社区就诊居民骨质疏松相关知识水平较低,平均得分为10.9分(满分26分),有关运动知识的得分低于摄钙知识以及骨质疏松危险因素知识;骨质疏松自我效能平均得分为5.8分(满分10分);63.3%的社区居民有骨质疏松健康促进的需求;具有较好的骨质疏松预防自我管理行为者占比均不到50%。结论急需加强对社区居民以正确运动知识为重点的骨质疏松相关知识宣教,提高其骨质疏松预防知识和自我效能水平,最终促进其养成良好的骨质疏松预防自我管理行为。     

同步健康教育在社区居民预防骨质疏松症中的作用

目的评价同步健康教育对社区居民预防骨质疏松的作用。方法将社区居民随机分为健康教育干预组和对照组,对干预组进行同步健康教育,采用发放书面资料、健康教育讲座、个性化指导、定期复查、填写调查表等方式。对照组采用发放材料、自由就诊方式。4年后分别进行对比。结果干预组对健康知识掌握程度、行为方式、治疗效果、满意度均高于对照组。结论社区居民骨质疏松症高危人群和患者更适合面对面指导,对社区居民预防骨质疏松症实行同步健康教育干预是有效的。     

健康教育对社区绝经期妇女骨质疏松症知信行的影响

目的:探讨健康教育对社区绝经期妇女骨质疏松症知信行的影响.方法:选取218例围绝经期的妇女,随机分为对照组及观察组:观察组108例,进行健康教育干预,干预一年后通过调查问卷分析干预效果;对照组110例,不采取干预措施.结果:两组研究对象干预前在骨质疏松知识,健康信念及预防保健差异不具统计学意义(t =1.87,t=0.24 ,t=1.56;P均>0.05).干预后与对照组相比,观察组骨质疏松知识,健康信念及预防保健的分值更高且差异具有统计学意义(t =8.46,t=6.02 ,t=22.79;P均<0.01).结论:健康教育可纠正社区围绝经期妇女对骨质疏松的错误认知,树立健康理念,改善预防保健行为,可预防骨质疏松症的发生.     

MySQL数据仓库在骨质疏松社区-综合医院互动管理模型中应用及在线分析的实现

虽然针对糖尿病、高血压病等疾病已经有多项健康教育模式的建立和研究,但是,针对农村原发性骨质疏松症(Osteo poros,OP)的预防这个重大社会问题,社区-综合医院互动管理模型的建立还在尝试阶段。OP是一个具有明确的病理生理、社会心理和经济后果的健康问题。我们将数据仓库的基本原理和方法与骨质疏松社区干预相结合,面向社区内骨质疏松高危人群构建了专门的数据仓库。以数据仓库运行为核心探索社区-综合医院互动管理模型的实现,同时对数据进行在线分析OLAP(on-Line analysis processing),实现单一维度分析和多个维度的组合分析功能,通过在实践中的数据积累可以为下一步开展有针对性的社区健康干预做准备。     

社区综合干预骨质疏松症多元效果评估的初探

[目的]采用多元效果评估方法评价社区骨质疏松症患者不同干预阶段的综合干预效果,为防治措施提供参考依据.[方法]选择干预骨质疏松症的随访队列社区,将志愿参与研究的原发性骨质疏松症患者随机分为对照组和干预组,对照组采用社区常规防治方法进行管理,干预组采取骨质疏松治疗仪理疗、健腰密骨方联合骨化三醇治疗、健身气功易筋经、健康教...     

上海某社区提升骨质疏松症患者用药依从性的干预研究

[目的]评价社区骨质疏松症患者接受健康教育后其用药依从性及骨密度的改善效果.[方法]选择123名骨质疏松症患者为研究对象,A社区64名患者为对照组,B社区59名患者为干预组,分别给予不同的健康教育指导,2年后比较两组骨质疏松知识掌握情况、健康行为、用药依从性和骨密度变化情况.[结果]干预组在干预前后对除"锻炼身体到什么...     

面向骨质疏松社区基于WEB的数据仓库远程管理

骨质疏松症和低骨量是一种常见的慢性非传染病,需要卫生健康促进和社区干预。面向社区内骨质疏松高危人群,我们与基层社区卫生服务中心合作,分析业务管理流程,对面向的数据源进行多维度分析、选用雪花模型,将数据仓库的基本原理和方法与骨质疏松社区干预相结合,采用基于WEB的远程管理,建立完善的社区服务网站为互动管理提供良好的平台,构建了完善和高效率的数据仓库。     

肌力和体力活动与骨密度关系研究进展

骨质疏松症是一种以低骨量和骨骼微结构退化为特征的骨骼疾病 ,会导致骨骼脆性增加、骨折危险性加大 ,严重威胁人类健康 ,近年来许多研究者从不同方面探索其致病因素 ,寻求预防和治疗骨质疏松症的途径。低骨密度是骨质疏松症重要的临床特征 ,本文就近年来肌力和体力活动与骨密度关系的研究状况作一综述     

中老年居民骨质疏松高危人群筛查方法研究

目的探索适合江苏省中老年居民骨质疏松高危人群的筛查方法。方法 2013年采用多阶段分层随机抽样方法,在江苏省内抽取40~69岁常住居民,利用国际骨质疏松基金会(IOF)1分钟风险评估调查问卷和桡骨远端超声骨密度检查,进行骨质疏松高危人群筛查。结果有效调查5 537人,有效率为98.8%。骨质疏松高危人群检出率:1分钟问卷风险评估法为44.0%,桡骨远端超声骨密度检查法为42.4%,差异有统计学意义(χ2=17.53,P0.001)。2种方法筛查结果一致性较差,Kappa系数及其95%可信区间为0.048(0.022~0.074)。随着年龄的增加,骨质疏松高危人群检出率呈上升趋势,且存在地区差异(P0.05)。结论 1分钟问卷风险评估和桡骨远端超声骨密度检查法均可作为社区中老年人群骨质疏松筛查工具,但一致性较差,实际工作中建议联合运用,以便互相补充和验证。     

白藜芦醇抗骨质疏松的研究机制进展

骨质疏松是一种随着年龄增长或病态而骨质不断流失、骨微结构不断恶化且易致骨折的全身代谢性疾病。随着人口的老龄化,全世界的发病率都在持续上升,这严重的影响了老年人群的健康和生活质量。白藜芦醇具有雌激素样作用且在骨骼中具有多向靶点,能促进骨髓间充质干细胞成骨分化、增加成骨细胞增殖生长及抑制破骨细胞,白藜芦醇治疗骨质疏松的研究日益增多并有一定的进展。本文将对近年来白藜芦醇防治骨质疏松症的研究进展作一综述。     

Nutrition et ostéoporose

Osteoporosis is a global public health problem which currently affects approximately 40% of caucasien women and 13% of men, and is increasing, as the population is living longer. Moreover, osteoporosis fractures are a significant cause of disability and premature death. This disease is a complex, multifactorial chronic disorder in which a variety of pathophysiologic mechanisms lead to skeletal fragility. Because hypoestrogenemia after menopause is an important cause of osteoporosis, hormone replacement therapy was recommended. However, because of side effects, women and health professionals became reluctant to this prophylaxis. Thus, increased research into alternatives, in particular nutritional strategies, for optimising bone health is of clinical, scientific and health policy importance. In general, the two key nutrients to consider for bone health are the mineral calcium and vitamin D. However, it has been recognised that the human diet contains, in addition to essential macronutrients (protein, lipids…), a complex array of naturally occurring bioactive molecules, the phytochemicals endowed with ostrogenic, antioxidant and anti-inflammatory properties, which could play an important clue in osteoporosis prevention.     

Exercise interventions: defusing the world's osteoporosis time bomb

Osteoporosis is a major public health problem, affecting millions of people worldwide. The associated health care costs are growing in parallel with increases in elderly populations, and it is expected that the number of osteoporotic fractures will double over the next 50 years. The best way to address osteoporosis is prevention. Some interventions to maximize and preserve bone mass have multiple health benefits and are cost-effective. For example, modifications to diet and lifestyle can help to prevent osteoporosis, and could potentially lead to a significant decrease in fracture rates; and exercise is a valuable adjunct to programmes aimed at alleviating the risks and symptoms of osteoporosis. Practising exercise at a young age helps maximize the mineral density of bones while they are still growing and maturing, and continuing to excercise minimizes bone loss later in life. Not only does exercise improve bone health, it also increases muscle strength, coordination, balance, flexibility and leads to better overall health. Walking, aerobic exercise, and t'ai chi are the best forms of exercise to stimulate bone formation and strengthen the muscles that help support bones. Encouraging physical activity at all ages is therefore a top priority to prevent osteoporosis.     

The silent thief: osteoporosis and women's health care across the life span

Osteoporosis is a skeletal disease characterized by loss of bone mass and density, which results in an increased risk of fractures. The disease is referred to as the "silent thief," because it is often not until a person falls and breaks a bone that patients and their physicians become aware of weakening bones. An estimated 1.5 million bone fractures occur each year in the United States and cost nearly dollar 17 billion in health care costs and lost productivity. The perception that osteoporosis is an older person's disease is an erroneous one. Osteoporosis does not discriminate by age; in fact, it is a geriatric disease with an adolescent onset. Social workers in health care and other practice settings working with female clients across the life span are in prime positions to influence patient outcomes and reduce health care costs by raising awareness of the risk factors and complex biopsychosocial aspects of this debilitating disease. This article presents social work interventions within the conceptual framework of primary, secondary, and tertiary disease prevention.     

Osteoporosis prevention education: behavior theories and calcium intake

Osteoporosis is a worldwide health concern. Preventing osteoporosis, and subsequent fractures, has become a goal of many health care practitioners, especially dietetics professionals. However, few prevention models have proven effective. The goal of this project was to determine whether an educational, theory-based osteoporosis prevention program would significantly impact calcium intake. This project used a convenience sample of 42 women who participated in an 8-week educational intervention, similarly to a community class. The program included hands-on activities to increase self-efficacy and was based on the Health Belief Model and Theory of Reasoned Action (TRA). The main outcome measures were calcium intake and constructs from the Health Belief Model and TRA. Significant changes in the Health Belief Model and TRA constructs at postintervention included increased perceived susceptibility to osteoporosis ( P <.001), perceived benefits to increasing calcium intake ( P <.001), and increased self-efficacy related to calcium intake ( P 相似文献   

Where now for the management of osteoporosis?

Osteoporosis is a metabolic bone disorder, leading to bone fragility and fracture. Recent guidance from the National Institute for Clinical Excellence (NICE) emphasizes the importance of secondary prevention of fragility fractures in postmenopausal women. What impact can the expanding range of treatments make on the growing and costly burden of osteoporosis?