ObjectiveTo investigate the prevalence of impaired glucose regulation (IGR) and IGR combined with cardiovascular risk factors in rural areas of Chengdu City.
MethodsFrom February to October 2010, we randomly sampled 1 016 patients in a rural community 100 kilometers away from the city center as the study subjects. The investigation was carried out by using questionnaire survey, physical examination and laboratory tests. The standard 75 g oral glucose tolerance test was used.
ResultsA total of 1 016 subjects were investigated, among whom there were 431 males and 585 females with an average age of 56 years old. Of these subjects, 333 were diagnosed to have IGR with a rate of 32.77% (333/1 016). The age-adjusted standardized prevalence of pre-diabetes in rural areas in Chengdu was 32.52% (336/1 016), and the male and female prevalence were respectively 30.63% (132/431) and 34.36% (201/585) without significant difference (χ2=1.569，P=0.210). Impaired glucose tolerance (IGT) was the most common type of glycometabolism abnormality. Women had a significantly higher prevalence of IGT than men. In IGR population, major cardiovascular risk factors were overweight and obesity (40.8%), high low density lipoprotein cholesterol (38.4%), high triglyceride (30.3%), hypertension (23.7%), smoking (24.3%), and drinking alcohol (23.7%). The stratified analysis showed that the prevalence of overweight, obesity and low high density lipoprotein cholesterol in female was significantly higher than that in males, while the prevalence of smoking and drinking alcohol was significantly higher in males.
ConclusionIn rural areas, the prevalence of pre-diabetes is high and complicated with multiple cardiovascular risk factors.
Objective To investigate the attitude and its influencing factors of Henan provincial rural residents towards the partial usage of funds from the New Rural Co-operative Medical System (NRCMS) for the disease control and prevention, in order to provide evidence for policy making. Methods In Henan province, 1 117 rural residents were randomly sampled with questionnaire from the 156 villages distributing in 44 townships of 19 counties (cities, districts). The frequency analyses, the multiple linear regression analysis and the one-way analysis of variance were conducted. Results Among all the respondents, only 3.4% of the rural residents absolutely disagreed (Zero agreement degree score), 34.4% fully agreed (10 agreement degree scores), and 90.6% had agreement degree scores equal to or more than five. The agreement degree was direct proportional to NRCMS satisfaction degree. The agreement degrees from residents who were relieved from medical financial burdens by NRCMS were higher than the others. 13.2% of rural residents believed that NRCMS did not alleviate their medical financial burden. For the men and women who believed that their village general practitioner was timely at vaccination, their agreement degree was higher than the others who considered vaccination time was late or common. The “timely group” was alone a subset. The “late group” and the “common group” were homogeneous subsets. The proportion of those who answered that the vaccination timeliness at late or common reached 40.6%. Conclusion The proposition to pay funds from the existing NRCMS for disease control and prevention is in line with the will of the majority of rural residents. The combination of disease control and prevention and NRCMS is a strategy in rural healthcare management. A bettering NRCMS and disease control and prevention are the basis of this policy in the future. More attention should be paid to the timeliness of the village general practitioners’ disease control work. It is necessary to perfect the NRCMS policy focusing on residents who hasn’t been relieved from medical financial burdens, so that more population will be benefited.
Objective To quantify the potential medical preference of rural day surgery patients, and provide a policy basis for further promoting the development of day surgery in county-level hospitals. Methods Based on the discrete choice experimental design questionnaire, all rural inpatients undergoing day surgery in three departments of the First Affiliated Hospital of Fujian Medical University between September and October 2022 were selected as survey subjects, and one-to-one structured questionnaire interviews were conducted. The Mixed Logit model was used to analyze the preference size, marginal willingness to pay and average marginal effect of patients on five medical attributes and levels. Results A total of 223 copies of questionnaire were issued, and 223 valid ones were collected, with an effective recovery rate of 100%. The five medical attributes were statistically significant in the impact on the medical preference of rural day surgery patients (P<0.001), and the patient’s preference was most affected by the physician category attribute (β=1.776, P<0.001). When the medical services from experts were unavailable, patients hoped to get 4862.51 yuan in compensation; when the patients received medical services from county-level hospitals instead of higher level hospitals, patients hoped to get 3154.60 yuan in compensation; when the availability of medical equipment and drugs was low, patients hoped to get 1447.72 yuan in compensation; patients were willing to spend 1197.29 yuan more to reduce the time spent from home to hospital. When the completeness of hospital medical equipment changed from “low” to “high”, patients’ preference increased by 52.89%. Conclusion Focusing on the cultivation of health personnel and the availability of medical equipment and drugs in county-level hospitals has a positive effect on improving the development of day surgery in county-level hospitals.
The increasing need for healthcare services in rural areas cannot be satisfied because of the lack of healthcare professionals, and poor medical education and training. These result in the low competency of rural healthcare workers. Therefore, the medical education system needs to be reformed in order to improve healthcare human resources in rural areas.
ObjectiveTo understand the treatment status and economic burden of convulsive epilepsy patients in Hailin City, Heilongjiang Province, who had received an epilepsy management program that was terminated for 6 years, and to estimate the long-term effect of the epilepsy management program.MethodsFollow up the 234 patients in the program of epilepsy prevention and management in rural areas at the end of December 2011 by standardized questionnaire and interview.ResultsAmong the 234 patients who received antiepileptic drugs (AEDs) and follow-up management at the end of epilepsy prevention and management program in rural areas, 172 patients received Phenobarbitone (PB) and 62 patients received Sodium valproate (VPA). 86 patients completed the survey. Among them, 46 (53.49%) were still taking original drugs, 31 (36.05%) changed to other AEDs, 9(10.47%) gave up the treatment due to the closure of the program. The treatment costs of patients in adherence group were also lower than that of other patients, and the average cost was only 43.61% of that of the replace group. There were statistical significant differences in annual household income, drug costs, offset seizure frequency and current seizure frequency between the two groups.ConclusionThe epilepsy management program had remarkable long-term effects and short-term effects, it had advantages in treatment effect and reducing drug costs. It could be recommended throughout rural China.
Objective To understand the current situation of Chengdu primary health workers’ performance baseline, and to provide decision-making proof and policy recommendations for Chengdu Coordinated and Balanced Urban-rural Development as well as improve primary health workers’ performance in China. Method See the second study in this series. Result The number of the patients of the Chengdu seven Rural Hospitals / Centers showed a trend of slow increase, and all was higher than the national rural hospital average level except the 2 most remote rural hospitals(“Renhe” and “Bailu”). The seven Rural Hospitals / Centers could provide data about the “Six in One” work, and the performance was generally better than that of the world and the national average level , but showed a decreasing trend from the first circle to the third circle in Chengdu. The rate of patients’ satisfaction and very satisfaction for the Rural Hospitals / Centers “Six in One” work reached 65%-80%, but the rate of health workers’ job satisfaction and very satisfaction only reached 9%-46%, and also showed a decreasing trend from the first circle to the third circle. Conclusion The Chengdu primary health workers provide “Six in One” health service with a higher quality than the world and the national average levels. However, the number of the workers is less than enough; the human managerial structure is irrational; the educational and professional levels are low; their treatment and the work environment are poor. The distribution density , the academic qualification and the structure rationality of professional ranks of health personnel show a decreasing trend, and the difficulty of the service is gradually increasing from the first circle to the third circle, which causes the satisfaction rate of the workers’ job to decrease gradually from the first circle to the third circle. Suggestion: ① To make special performance assessment standard for special health institutions or personnel, and to give the continual oriented training chance for current health personnel. ② To integrate the regional health resources; to establish long-term and stable regional bilateral appointment help policy, technical and rational two-way referral system and indicator systems. ③ To take measures to solve the problems affecting the professional promotion and improvement of the grass-root health personnel.
Objective To understand the situation of commonly-used drugs, medical device and their storages in rural households among model well-off township hospitals in eastern, central and western China, and to provide the basis for the guidance of reasonably using and scientifically storing drugs. Methods The methods of combining simple random sampling and cluster sampling were used to investigate and analyze the situation of commonly-used drugs, medical device and their storages in 162 households from three well-off township hospitals in Shanghai, Zhejiang, and Sichuan provinces, respectively. Results The storage rates of commonly-used drugs of rural households in well-off towns were cold medicine (72.2%), wound paste (51.9%), cooling oil (39.5%), essential balm (36.4%), antihypertensive (27.8%), iodine tincture (14.2%), anti-diabetic drugs (13.0%) and other drugs (17.3%). The storage rates of medical devices were thermometer (50.0%), cotton swab (47.5%), sphygmomanometer (9.3%), injector (1.2%) and other devices (22.2%). A total of 66% of respondent families stored drugs and medical devices in a fixed drawer. Only 3.1% families stored drugs and medical devices in the special portable medical kit. Conclusion Rural families have a higher rate of household drugs among model well-off township hospitals in eastern, central and western China, and most drugs are OTC drugs. The storage rates of medical devices are not high. Many rural family-owned medical devices are linked with special chronic diseases in the family. A lot of rural families place drugs and medical devices randomly. There are many security risks, and it may affect the rational utilization of drugs.
Objective To investigate the the status of Health manpower resources of rural hospitals, Health service, health personnel ’s reflection for the hospital’ current issues in Pingshan Xibaipo town in Hebei province, so as to provide baseline data for the establishment of a rural hospital’s comprehensive model. Method We conducted the survey which using questionnaires to collect the information of the rural hospital staff’s self-evaluation of health services, the reflecting of the problems of the current hospitals ,the views of the future building, village health humen resources for health, etc. SPSS 17.0 sofewarewas used for data analysis. Result The following problems are existing in Xibaipo town hospitals. (1) The rural hospital infrastructure is poor: 14 beds, housing a total area of 832 square meters is far below the national average. (2) The quality of the health personnel in the rural hospital is low.The proportion of doctors and nurses (1?0.75) is higher than the Ministry of Health’s standard (1?1), less educated (only 2 person’s first degree is college), low-level professional titled (the proportion of health officer of no professional title is 42.86%), etc. (3) Health resources in village are scarce: the quality of rural doctors is low (90.91% are non-formal school graduation), village clinics is lack of facilities (16 villages have only a total of 10 village clinics, 5 beds). Conclusion The infrastructure of the rural hospital was poor,while the situation of the personnel allocation in the rural hospital was irrational ,and the integrated management of the hospital in town and village is not good . The health personnel proposed recommendation about construction of health personnel, departments, information technology , etc .The rural hospital should introduce equipment and personnel, improve health care services and strengthen the integrated management of the hospital in town and village .
ObjectiveTo investigate the health technologies on diabetes prevention and management used in rural China and the assessment results of these health technologies, and to provide references for the selection and using of health technologies on diabetes prevention and management in rural China.
MethodsWe searched VIP, CNKI, CBM and WanFang Data to collect survey studies and assessment reports of health technologies on diabetes prevention and management in rural China. The search date was up to July 15th, 2014. Two reviewers independently screened literature, and then the qualitative analysis was performed for the included studies.
ResultsA total of 15 studies were included. The results of qualitative analysis showed that:the targeted populations were patients and ordinary villagers who had received the service or treatment of diabetes health technology in rural, as well as the grassroots medical technical personnel and promotion staffs who had developed the health technologies. Diabetes health technology studies in rural mainly included medical personnel health technology related knowledge training. The contents of health technology assessment involved effectiveness, acceptability, economic characteristics, requirements and technical specific property.
ConclusionThere was limited researches on the investigation and analysis of health technologies on diabetes prevention and management in rural China, and evaluation content remains insufficient.
ObjectiveTo evaluate the disease characteristics,medical consultation model and barrier to get basic medical service rural patients with chronic obstructive pulmonary disease(COPD) in Chinese western.
MethodsThe subjects were collected from a COPD epidemiology study conducted in Western rural district.The factors which were associated with disease characteristics,medical consultation model,and barrier to get basic medical service were analyzed by questionnaire,individual conversation,and laboratory tests.
ResultsThis study enrolled 343 COPD patients confirmed by spirometry test.118 subjects consulted their doctors frequently because of apparent symptom.73(62%) subjects had symptom with 5 to 10 years,while 22(19%) subjects with more than 10 years.Among the symptomatic COPD subjects,only 2(2%) cases were diagnosed as COPD previously,15(13%) subjects with chronic bronchitis,and only 1(1%) subject underwent spirometry test.110(93%) subjects were prescribed as antibiotics,68(58%) subjects with theophylline,5(4%) subjects with ICS+LABA.COPD education was acceptable in most subjects(98%),however,the regular follow-up was acceptable in only 26% of subjects.
ConclusionLack of disease information,inappropriate medical consultation model,and irregular COPD management in primary care are the major factors which influence diagnosis and treatment of COPD in Western rural area of China.
