电话结合微信健康教育对低学历高血压人群服药依从性影响

目的随着诊断及治疗手段的不断进展,我国高血压的治疗率和控制率均得到提高,但形势依然严峻,治疗率和控制率相较发达国家仍有很大差距。其中,服药依从性差是导致血压控制率低的主要原因之一。健康教育作为高血压健康管理的内容之一,能够很好地提高患者服药依从性。本研究通过对比普通健康教育及电话结合微信的健康教育对低学历高血压人群服药依从性、血压控制情况及生活方式的影响,探讨电话结合微信的健康教育在低学历高血压人群治疗过程中的应用价值。方法选取2016-01-06-2016-12-11于锦州市凌西街道社区卫生服务中心就诊的初中及以下学历的既往患有高血压病且依从性差的220例患者作为研究对象,按照性别、年龄、病程组间匹配的原则,分为观察组和对照组,每组110例。对照组给予普通健康教育,观察组给予电话结合微信的健康教育。均随访1年,观察两组服药依从性、血压控制和生活方式改善情况。结果干预随访期间,两组共213例患者完成研究,其中观察组107例,对照组106例。干预1年后,观察组治疗依从性好的占有率为63.6%,高于对照组的42.5%,χ~2=9.517,P=0.002;观察组血压达标率为52.3%,高于对照组的31.1%,χ~2=9.843,P=0.002;观察组收缩压控制水平为(132.9±12.5)mm Hg,优于对照组的(143.2±12.4)mm Hg,t=-6.061,P<0.001;观察组舒张压控制水平为(80.7±8.4)mm Hg,优于对照组的(86.5±7.1)mm Hg,t=-5.339,P<0.001;对于生活方式的改善情况,对照组吸烟人数的占有率为31.1%,高于观察组的23.4%,χ~2=1.621,P=0.203;对照组饮酒人数的占有率为43.4%,高于观察组的29.0%,χ~2=4.800,P=0.028;对照组经常参加体育锻炼人数的占有率为32.1%,低于观察组的48.6%,χ~2=6.038,P=0.014。结论电话结合微信健康教育能显著提高低学历人群高血压患者的服药依从性、血压控制水平及达标率,有效促进患者形成健康的生活方式,提高非药物治疗的疗效。将电话结合微信的健康教育充分应用到低学历高血压人群的健康管理中,可有效提升其健康管理效率。     

引导式健康教育对老年高血压患者健康行为及血压控制达标率的影响

目的:探讨引导式健康教育对老年高血压患者健康行为及血压控制达标率的影响.方法:选取2018年6月至2019年6月本社区登记的老年高血压患者80例作为研究对象,以数字法随机均分为两组,对照组和观察组各40例,对照组采用常规干预,观察组在此基础上加以引导式健康教育干预,对两组患者健康行为、血压控制达标率进行观察分析.结果:干预前两组规律用药、合理饮食、控制情绪、定期复查等健康行为评分比较无明显差异(P>0.05),干预后观察组各项评分比对照组明显更高(P<0.05);观察组血压控制达标率为97.50%,比对照组75.00%的血压控制达标率明显更高(P<0.05).结论:引导式健康教育应用于老年高血压患者干预中有助于显著改善健康行为,促进血压控制达标率提高,值得推广.     

家庭健康教育对高血压患者血压控制效果的评价

目的分析开展高血压患者家庭成员健康教育对高血压患者血压控制效果,探索社区高血压患者的管理方法。方法将同一个社区的两个居委的高血压患者分别作为干预组和对照组,比较两组的行为及血压控制变化情况。结果干预组38名吸烟高血压患者中有14人（36.84%）较干预前吸烟量减少,50名对照组中有吸烟行为的高血压患者中仅7人（14.00%）较干预前吸烟量减少;干预后能坚持每周3次以上、每天运动30 min以上的有37.88%,对照组能坚持每周3次以上、每天运动30 min以上的有25.29%,干预后干预组每周3次以上中等强度运动的比例较对照组高,差异有统计学意义;干预组膳食行为中能有意识控制盐摄入的比例从70.20%提高到85.35%,药物治疗依从性好的比例从47.98%提高到58.08%,差异有统计学意义;干预组收缩压及舒张压下降幅度均高于对照组,差异有统计学意义。结论高血压患者家庭健康教育有利于提高患者血压控制水平,在社区高血压管理活动中应重视家庭成员的作用。     

优质护理干预对社区老年高血压患者血压控制及服药依从性影响

目的探讨优质护理干预对社区老年高血压患者血压控制及服药依从性的影响。方法 2009年2月铜陵市中医院阳光社区卫生服务中心选择下辖的商南新村在建立老年健康档案时发现的已确诊的原发性高血压患者78例,随机分为对照组和干预组各39例,对照组采用常规慢性病管理模式,干预组在对照组基础上进行优质护理干预。2年后比较两组患者血压控制效果及服药依从性。计数资料采用χ2检验,P<0.05为差异有统计学意义。结果血压控制良好实验组74.36%,对照组28.21%;服药依从性干预组94.87%,对照组66.67%。两组比较差异均有统计学意义(均P<0.05)。结论优质护理干预能使老年高血压患者血压控制良好,服药依从性显著提高,从而减少高血压并发症的发生。     

社区-家庭支持对高血压患者治疗依从性的影响

目的探讨社区-家庭支持对原发性高血压患者治疗依从性影响,发现潜在的正向影响因素,以提高高血压患者的治疗依从性。方法将某社区卫生服务中心管理的原发性高血压患者随机分为干预组和对照组,干预组采用"医院-社区-家庭"管理模式,对照组给予常规的社区诊疗管理。随访6个月观察患者按照服药和血压控制情况。结果符合纳入标准共120例患者,干预前对照组和干预组的按时服药率分别是85. 0%、83. 3%,血压控制达标率分别是83. 3%、81. 7%;干预后对照组和干预组的按时服药率分别是83. 3%、95. 0%,血压控制达标率分别是85. 0%、96. 7%;对照组干预前后服药及血压控制达标率差异均无统计学意义(χ~2值均为0. 063,P均0. 05),干预组干预前后服药及血压控制达标率差异均有统计学意义(χ~2值=4. 227、4. 904,P均0. 05)。结论社区支持、家庭支持能有效提高高血压患者的治疗依从性。     

社区中老年高血压患者中医药健康管理干预的效果评价

目的探讨在社区中老年高血压患者中实施中医药健康管理干预的效果。方法 2014年9月—2015年7月,选取100例高血压患者,并对其实施定期随访、健康教育、中医药个性化用药指导等干预手段,采取自身对照的方法,比较干预前后患者的血压控制情况、高血压病防治知识知晓情况、自我管理行为情况、服药依从性、生活质量情况等的差异变化。结果干预后,调查对象的平均收缩压从干预前的(160.1±3.4)mm Hg下降到(113.0±1.6)mm Hg(t=12.392,P=0.000),舒张压从(97.0±1.3)mm Hg下降到(77.0±0.7)mm Hg(t=13.136,P=0.000);高血压病防治知识知晓率从64.0%上升到93.0%(χ2=7.116,P=0.000);高血压自我管理行为形成率从18.0%上升到76.0%(χ2=7.543,P=0.000);服药依从性从36.0%上升到85.0%(χ2=51.849,P=0.000);生活质量情况也有显著改善。结论在社区中,对高血压患者开展中医药干预健康管理服务具有积极的作用,是有效、可行的社区健康管理形式之一。     

电话回访式健康教育对社区老年高血压患者的效果分析

目的通过电话回访式健康教育对社区老年高血压患者进行干预,以提高老年人控制高血压的依从性及效果。方法将219例老年高血压患者随机分成电话回访组(111例)和对照组(108例),电话回访组在给予药物治疗的同时,进行每月两次的电话回访式健康教育,并监测血压;对照组在服药期间不采取任何干预措施。结果经治疗及健康教育1年后,电话回访组血压控制优良及尚可的人数比对照组多,血压控制不良的人数比对照组少,差异有统计学意义(2χ=6.48,P<0.05)。结论在社区的老年高血压患者药物治疗的同时,对其进行有效的电话回访式健康教育是控制高血压切实有效的措施。     

基于潜在剖面分析的高血压患者自我管理行为与血压控制的关联研究

目的 运用潜在剖面分析了解高血压患者自我管理行为特征,分析其与血压控制的关联。方法 于2016年5~7月在北京市顺义区8个社区卫生服务中心募集595名患者,进行问卷调查（基本信息、自我管理行为）和体格检查（血压测量）。结果 基于潜在剖面分析将患者分为2个类别:行为较差组100人（16.8%）,行为较好组495人（83.2%）。两组以吸烟（均分0.15 vs 6.94）、饮酒（均分2.32 vs 6.43）为主要的剖面分类特征。两组在性别（χ2=163.290,P<0.001）、高血压服药年限（Z=-2.567,P=0.010）方面差异有统计学意义,行为较差组以男性、服药年限<5年为主,而较好组以女性、服药年限10~19年为主。Logistic回归分析显示:相对于新农合患者,城镇居民和超转（OR=2.618,95%CI:1.549~4.423）、城镇职工和公费医疗（OR=3.449,95%CI:2.196~5.415）患者血压控制更好;相对于行为较好组患者,较差组患者（OR=0.495,95%CI:0.311~0.788）血压控制更差。结论 高血压患者自我管理行为以吸烟、饮酒为主要剖面分类特征,应提高对男性、服药年限较短患者的自我管理行为干预,加强对新农合患者、自我管理行为较差患者的关注和管理。     

对社区老年高血压患者实施健康教育的效果分析

目的探讨健康教育对改善老年高血压患者认知水平、卫生行为和治疗效果的作用。方法对广州市越秀区某街道60岁以上高血压患者有计划地实施系统的健康教育,随访2a后比较健康教育干预前后患者认知水平、卫生行为和血压控制程度。结果共调查高血压患者183例,男性79例,女性104例;年龄61～82岁,平均(67.66±7.15)岁;均为原发性高血压。干预前高血压患者的高血压知识得分为(15.78±5.04)分,低于干预后〔(21.67.±2.84)分〕,经t检验,差别有统计学意义(t=13.44,P<0.01)。干预后,高血压患者食盐摄入量、吸烟量、饮酒量比干预前降低,运动频率和服药规律性增加,经χ2检验,差别有统计学意义(P<0.05)。干预后血压为(133.05±10.36)mm Hg/(83.42±8.02)mm Hg,低于干预前〔(154.20±10.54)mm H g/(95.61±9.83)m m H g〕,经t检验,差别有统计学意义(P<0.01)。结论健康教育是社区开展高血压防治的有效手段。     

高血压待出院患者类集体健康教育最佳方案的探讨

目的 探讨应用类集体健康教育方案对高血压待出院患者的作用效果.方法 选择高血压待出院患者90例,随机分为干预组与对照组各45例;对照组给予出院健康教育模式,干预组采用类集体健康教育方案.比较2组患者血压控制、治疗效果、教育效率及满意度.结果 术后1个月,干预组患者主诉症状(15.56%)、降压药服用依从性(46.67%)优于对照组,收缩压低于对照组,差异均有统计学意义(P<0.05);干预组教育效率、教育满意度显著高于对照组(P<0.05).结论 类集体健康教育能明显提高高血压出院宣教效率,稳定血压,提升治疗效果.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.