ObjectiveTo investigate the effectiveness of the modified Urbaniak operation to treat avascular necrosis of the femoral head (ANFH). MethodsA retrospective analysis was made on the clinical data of 38 patients (41 hips) with ANFH treated between February 2010 and October 2012 with the modified Urbaniak operation (to add lateral femoral incision based on femoral greater trochanter incision, to preserve the original fibula flap drilling, decompression and filling through trochanteric outer cortex, and to select the descending branch of lateral circumflex femoral artery as the supply vessel). Of 38 cases, 25 were male (28 hips), 13 were female (13 hips), aged 16-52 years (mean, 34 years); there were 19 cases (21 hips) of alcoholic ANFH, 9 cases (9 hips) of traumatic ANFH, 5 cases (6 hips) of hormone ANFH, and 5 cases (5 hips) of idiopathic ANFH. The disease duration ranged from 10 months to 6 years (mean, 3.7 years). According to Ficat staging criteria, 24 hips were rated as stages II and 17 hips as stage III. The preoperative Harris hip scores were 80.63±5.02 and 77.06±6.77 in patients at stage II and III respectively. The related complications were recorded after operation. According to the findings of postoperative X-ray films, 4 grades were improvement, stabilization, deterioration, and failure; improvement or stabilization was determined to radiological success. According to the Harris score to evaluate the function of hips, more than 80 was determined to clinical success. ResultsHealing by first intention was achieved in all patients after operation. Three cases had numbness and hypoaesthesia of the lateral femoral skin, 1 case had abnormal sensation of the dorsal foot, which had no effect on daily life. Thirty-eight cases (41 hips) were followed up 1 year to 3 years and 3 months (mean, 2 years and 3 months). There was no complication such as hip joint stiffness, hip or groin persistent pain, hip joint infection, or ankle instability. At last follow-up, the X-ray films showed improvement in 23 hips (56.1%), stabilization in 17 hips (41.5%), and deterioration in 1 hip (2.4%); 40 hips obtained the radiological success. According to the Harris score, the results were excellent in 17 hips, good in 20 hips, fair in 3 hips, and poor in 1 hip with an excellent and good rate of 90.2%; 37 hips achieved the clinical success. The Harris scores were 89.92±4.12 and 86.53±5.70 in patients at stage II and III respectively at last follow-up, showing significant differences when compared with preoperative ones (t=7.011, P=0.000;t=4.412, P=0.000). ConclusionThe modified Urbaniak operation has the advantages of more convenient operation, less complications, higher safety, and better hip functional recovery. It is an effective method to treat ANFH.
ObjectiveTo investigate the status and problems of facility allocation in 22 health service centers and township health centers in Fucheng District of Mianyang city, in order to provide references for improving health services in these medical units. MethodsAccording to the national guidance of facility configuration in township hospitals, the questionnaire was made to survey on the allocation of medical facilities, durable years and frequency of use in 22 medical units of Fucheng district (11 urban community health service centers and 11 township health centers) from November to December 2010. The descriptive and stratified analysis was performed for the survey results. ResultsMost equipment and facilities required in "Guide Criteria for Installation of Equipment and Facilities in Urban Community Health Service Centers" including facilities for diagnosis, treatment and health education were not installed and there were problems of poor property and low frequency of use. The medical equipment was seriously inadequate in 11 township health centers. ConclusionCommunity basic equipment resource should be improved as soon as possible.
ObjectiveTo provide policy suggestions concerning the distribution of health resources between urban and rural areas and management and education of diabetes, this study depicted the current status of access to healthcare and analyzed its determinants among Chinese diabetic patients.MethodsMultivariate ordinal logistic regression and multivariate binary logistic regression were employed to analyze the effects of socioeconomic status and urban-rural disparities on health access.ResultsMultivariate results suggested that urban patients were more likely to conduct more blood glucose tests (P<0.000 1) and receive more self-care suggestions from physicians (P=0.02). After controlling all other covariates, patients graduated from secondary schools and those with vocational school degrees or above were 1.61 and 2.44 times more possible to take more blood glucose tests.Conclusions There exists significant urban-rural disparities of access to healthcare among Chinese diabetic patients. Education may be a key factor of access to healthcare among Chinese diabetic patients. It’s highly recommended to implement education programs on diabetes management in rural areas, where the education status and demographic factors should be considered. The distribution of health resource in rural areas requires more policy and governmental support.
ObjectivesIn order to provide baseline data for the establishment of urban health indicator system in China and other cities, the indicators, characteristics and problems of 24 urban health indicator systems in China were researched.MethodsCNKI, Wan Fang Data, VIP, as well as China’s all provinces and cities’ websites of government and family planning commission and patriotic health campaign commission were searched to collect literatures and government documents on " Healthy city” and its index system. They were then been extracted, classified and summarized.ResultsThe final search involved 24 healthy city indicators system in China, including 1 531 indicators and 14 dimensions, 5 operations and 8 special operations. Seven dimensions (health, health services, environmental health, social indicators, indicators of policy, indicator of health promoting) were widely used. 38 indicators were used above five times, while 441 indicators were used merely once.ConclusionsThe structure of urban health indicator systems in China are almost consistent with WHO’s. They all have the characteristics of diversity, characteristic, national policy, civilian etc. However, there still exists problems with indicators of quantity, definition, classification and lack of indicators on mental health, children health, pregnant woman health as well as elderly health. It is urgent to develop the principles, methods, processes and standards for urban health indicators.
ObjectiveTo investigate the prevalence of hypertension and to find the cardiovascular risk factors in the urban residents of Chengdu city. MethodsBy cluster sampling, a population of 994 inhabitants were selected from 14 urban communities in Chengdu city between February and October 2010. They were 35-70 years old and had resided in the area for over 2 years. Hypertension questionnaire was used and physical examinations were taken to investigate. The definition of hypertension was determined by the Guidelines of Hypertension Prevention and Control made by National Revision Committee in 2010. Logistic regression model was used to define the risk factors for hypertension. ResultsThe prevalence rate of hypertension was 44.87%, and the standardized prevalence rate was 39.21% (male:41.07%, female:38.20%). The difference of prevalence rate between males and females was not significant (P>0.05). The prevalence rate of hypertension increased significantly with age. By multi-factor logistic regression analysis, age (OR=1.103, P<0.001), serum uric acid (OR=1.003, P=0.001), heart rate (OR=1.014, P=0.027), and waist circumference (OR=1.624, P<0.001) were the risk factors for hypertension. ConclusionThe prevalence rate of hypertension is high in urban communities of Chengdu city, and age, serum uric acid, heart rate, and waist circumference are the risk factors for hypertension.
There are more than 6 800 urban public hospitals in China, which are the main subject of our country's medical service, but the process and efficiency need to be improved because of the siphon effect of resources and the limit of service scope. The use of internet thinking and technology will solve this problem effectively. Based on the fact, Deyang People's Hospital planned "internet+" system according to the requirement of the medical and health system reform, to solve the problems such as service efficiency, doctor-patient communication, multi-spot disciple, hierarchical medical system, delicacy management, etc. Through the concrete practice of elevating the efficiency of outpatient and emergency care services, it is recognized that the application of internet thinking and technology can not only accelerate the medical and health system reform, but also subvert the traditional medical pattern, integrate the regional medical resource, and enlarge the scope of medical services. It provides a sharp weapon to push forward the reform of urban public hospitals.
Objective To investigate the prevalence of hyperuricemia and the current status as well as differences of cardiovascular risk factors in hyperuricemia patients between urban and rural areas in Chengdu. Methods We randomly sampled 2 032 patients aged from 35 to 70 years age in urban and rural communities, using a questionnaire, physical examination and laboratory tests. Results a) The prevalence of hyperuricemia was 17.77%, which was higher in urban residents (21.38%) than that in rural residents (14.16%). b) The prevalence of hyperuricemia associated with hypercholesterolemia was higher in urban residents (34.10%) than that in rural residents (13.98%); urban women (39.06%) were higher than rural women (16.13%) and urban men (26.97%) were higher than rural men (12.20%). c) The prevalence of hyperuricemia associated with hypertension which was higher in urban residents (58.06%) than that in rural residents (32.64%); urban women (59.38%) were higher than rural women (35.48%) and urban men (56.18%) were higher than rural men (30.49%). d) The prevalence of hyperuricemia associated with impaired glucose tolerance (IGT) in urban women (28.91%) were lower than that in rural women (45.16%). Conclusion Hypercholesterolemia and hypertension are the most commonly seen cardiovascular risk factors accompanied in patients with hyperuricemia in urban areas, which has obviously higher prevalence than in rural areas. IGT is the most commonly seen cardiovascular risk factors accompanied in patients with hyperuricemia among rural women. But in aspects of hyperuricemia associated with impaired fasting glucose (IFG), hypertriglyceridemia, low high-density fetoprotein cholesterol, abdominal obesity and obesity, there is no difference between urban and rural areas.
ObjectiveTo investigate the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) in urban and rural male residents of Chengdu city. MethodsA cross-sectional survey about the incidence of COPD using cluster random sampling methods was carried out from February to December 2010 among male residents aged 40 to 70 years in four communities in Chengdu city, which was conducted by applying questionnaire survey, physical examination, portable spirometry, etc. Data was analyzed by using SPSS 18.0 software, and the risk factors were also analyzed by using the multivariate logistic methods. ResultsA total of 631 male residents were included, 301 urban and 330 rural. The results showed that: after population standardization, among male residents aged 40 to 70 years in four communities in Chengdu city, the overall prevalence of COPD was 7.95%, and the prevalence was 12.07% in rural area and 7.05% in urban area (P < 0.001). The results of multivariate logistic regression analysis showed that area, age, BMI and smoking volume were the main risk factors of COPD among male. ConclusionThe prevalence of COPD in Chengdu city is relatively higher, which is much higher in rural area than that in urban area. The risk factors are various, and thus comprehensive prevention and treatment of COPD should be emphasized.
ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.
Objective To investigate pre-hypertension in aspects of its incidence, accompanied cardiovascular risk factors, and difference between urban and rural areas in Chengdu. Methods By cluster random sampling method, a total of 2 011 patients aged 35-70 years from urban and rural communities in Chengdu were selected as respondents. The investigation was conducted through questionnaire, physical examination and laboratory tests, so as to find out the main cardiovascular risk factors of pre-hypertension. All data were dual input into computer by a specially-assigned person. SPSS 13.0 software was used for analysis, Chi-square test was adopted for categorical data, and Plt;0.05 was taken as an index for significant difference. Results a) The incidence rate of pre-hypertensive in Chengdu was 33.6%, and it was 45.67% and 46.31% in urban and rural areas, respectively. In rural area, more male (51.04%) were affected than female (42.83%). b) The smoking population with pre-hypertension were mainly the male, and the ratio of rural male was 60% (132/220), far higher than that of urban male which was 32.6% (59/181). c) The pre-hypertensive population accompanied with diabetes was higher in urban (27.97%) than rural (14.01%). d) The pre-hypertensive population accompanied with hypercholesterolemia or low HDL was 33.04% (150/454) in urban, as twice as that in rural which was 16.41% (76/471). e) The pre-hypertensive population accompanied with abdominal obesity was far higher in urban (28.41%) than rural (12.74%). Conclusion Smoking is the risk factor which needs to be primarily intervened for male hypertensive patients in rural area. Impaired glucose tolerance is the common risk factor for both urban and rural residents, and hyperlipidemia is the most primarily risk factor for urban pre-hypertensive patients, followed by diabetes, and abdominal obesity.