Objective To investigate the patients experience in community health centers (CHCs) and explore its associated factors.Methods A cross-sectional study was conducted among 330 patients who visited CHCs in Shenzhen,China from January to March 2018.Dependent variable was patient experience.Key descriptive variables were age,gender,marital status,working status groups,visits frequency for the past 6 months,whether patients had signed a family doctor,whether trusted in family doctor,whether had chronic diseases.Results Questionnaires for 300 patients were assessed.In the univariate analysis,patients experience total score was significantly associated with marital status (P ＜ 0.1),working status groups (P ＜ 0.1),frequency of visit for the past 6 months (P ＜ 0.05),whether had signed a family doctor (P ＜ 0.05),whether trusted in family doctor(P ＜0.05),whether had chronic diseases(P ＜0.05).The multivariate analysis showed that unmarried patients (P =0.011,OR =2.96,95 ％ CI:1.24-5.43) and had signed a family doctor (P =0.023,OR =0.44,95 ％ CI:0.22-0.85) were more likely to get a higher score.Conclusions Findings of this study showed a medium-level score of patients experience in the community.Patients had a quite good experience and more interventions should be focused upon the influence factors to improve patients experience.

目前国外信息技术在延续护理中的应用较多,而我国的延续护理仍以传统的家庭访视和电话回访为主.本文通过综述美国心力衰竭患者远程延续性护理的研究进展,分析了其对我国远程延续护理发展的启示,为心力衰竭患者实施远程延续性护理提供依据,促进延续护理更好地发展.

目的 应用同位素标记相对和绝对定量技术筛选47,XYY血清样本差异蛋白质生物标志物.方法 采集血清,提取蛋白,应用iTRAQ标记和Protein Pilot搜库,确定差异蛋白.结果 与对照组相比,实验组中共鉴定出有定量信息的蛋白质106个,其中差异有统计学意义的差异蛋白有15个,包括10个上调蛋白和5个下调蛋白.其中β-肌动蛋白上调明显,高达6倍.结论 血红蛋白β亚基、β-肌动蛋白等显著差异蛋白可能作为该病潜在的临床筛查生物标志物.

随着人口的老龄化以及疾病模式的转变,医疗服务提供模式发生了相应转变,由面向患者提供服务转变为面向健康人群提供服务,从对急性疾病治疗转为预防照护,进一步提高了各类人群的基层医疗服务质量.有研究[1]表明,有效的基层医疗保健和照护服务可以改善人群尤其老年人群健康状况,进而提高生活质量.也有研究[2]表明,加强基层照护不仅要强调健康传播者的专业技能,还应关注其洞察力并提高其健康素养,这将有利于个体健康.世界卫生组织继1978年《阿拉木图宣言》后,2008年再次强调任何国家都应将基础卫生保健作为国家卫生发展的重点,以应对各种因素给人类带来的健康挑战[3].研究[4]显示,大力发展基层医疗服务,在保证医疗质量的前提下,鼓励患者到二级和一级医疗机构就诊,每年可节约卫生费用数十亿元.国外研究[5-6]表明,重视发展基层医疗服务可以促进医疗资源公平分配,人人享有医疗资源,有利于提高健康产出水平.关于基层照护测量工具目前国际上存在多个版本,本文总结了不同版本测量工具的信效度及在临床叙事护理中的应用情况,以期为进一步改善临床叙事护理质量提供理论依据.

The experience of health reform in the world shows that a suitable mode of community health services will be the inevitable result of global health system reform.The patient-centered medical home (PCMH) has been hailed by the World Health Organization (WHO) as the most economical and most appropriate community health services mode which has developed maturely in the United States.This paper introduces the concept,characteristics,development process,implementation effect,authentication and quality management of PCMH in the United States.Based on the experience of PCMH,this paper puts forward that China should establish and improve the quality certification system and incentive mechanism of community health services to promote the quality of family doctor services and attract excellent general practitioners to join the primary health care service team.

Objective To investigate the satisfaction degree of community health services among residents in Shenzhen Pingshan New District aud its influencing factors.Methods With stratified sampling method,the 28 community health service centers in Pingshan New District were divided into three layers based on their geographic distribution,from each layer four centers were chosen and finally 12 conrnuuity health service centers.A total of 1 200 residents,who were the first 40 residents came to the community health service centers fiom 8:00 to 20:00 during the 30 survey days,were taken as the research objects.The questionnaire was designed on the basis of Patient Satisfaction Questionnaire Short Form (PSQ-18).The questionnaire included the basic information of the residents,the residents' satisfaction of the community health services (7 dimensions:overall satisfaction,technical service quality,and interpersonal communication ability of the doctors,doctor-patient communication level,economy of services,timeliness of services and accessibility of services).From July to November in 2013,the community residents who came to visit were surveyed.A total of 1 200 questionnaires were sent out,and finally 1 135 questionnaires were recovered with a response rate of 94.58％.Results The overall satisfaction score of community health service was (3.4 ± 0.7),and the satisfaction rate was 38.06％ (432/1 135).The satisfaction scores of technical service quality,interpersonal communication ability of the doctors,doctor-patient communication level,the economy,timeliness and accessibility of the services were (3.5±0.5),(3.7±0.6),(3.7±0.5),(3.5±0.6),(3.6±0.6),and (3.4±0.5) respectively.Their satisfaction rates were 24.76％ (281/1 135),61.59％ (699/1 135),54.45％ (618/1 135),47.75％ (542/1 135),49.60％ (563/1 135),and 20.35％ (231/1 135) respectively.Multivariate Logistic regression analysis indicated that the quality of technical services,the timeliness and accessibility of the services were the influencing factors of the overall satisfaction degree (P ＜ 0.05).Conclusion The satisfaction degree of community health services among residents in Pingshan New District of Shenzhen remains at low satisfactory level.The quality of technical services,the timeliness and the accessibility of the services are the influencing factors of the overall satisfaction degree.

Objective:Dentification and comparative quantification between protein samples were performed using isobaric tags for relative and absolute qutification (iTRAQ),which used to analyze gene function cluster (GO),protein classification and path analysis (Pathway).Methods:The serum sample of thrombophilia patients and normal serum samples were treated by enzyme digestion and labeling.To investigate the differentially expressed proteins in serum of patients in Thrombophilia and normal serum using isobaric tagging for relative and absolute protein quantification and gene ontology analysis.Results:Totally,50 differentially expressed proteins were identified in the test,including 29 up-regulated proteins and 21 down-regulated proteins,and sums up the development of thrombophilia risk factors,so as to provide the basis for its further research.Conclusion:The iTRAQ technology and bioinformatics methods provide the possibility to screen out the significant markers of the Thrombophilia.

肥胖已成为全世界最为关注的社会和健康问题之一,是多种疾病的危险因素.然而,近年来研究发现,体重指数与多种慢性疾病的病死率呈负相关,这一现象称为“肥胖矛盾”,并引起了人们广泛的关注.本文对“肥胖矛盾”现象进行阐释,并进一步探讨其产生机制.

目的 探讨社区康复教育联合布地奈德/福莫特罗在慢性阻塞性肺疾病(COPD)治疗中的应用价值.方法 选取2012年1—12月在深圳市坪山新区人民医院诊断为COPD的患者60例作为研究对象,按随机数字表法将其分为对照组与试验组,各30例.两组患者均按照病情需要给予合适药物治疗,在此基础上对照组患者给予社区康复教育,试验组患者在对照组基础上给予布地奈德/福莫特罗.比较两组患者一般资料、治疗前后自我评估测试问卷(CAT)评分及肺功能.结果 治疗1年后,试验组患者的CAT评分明显低于对照组,差异有统计学意义(P<0.05);治疗1年后,试验组患者的第1秒钟用力呼气容积(FEV1)占预计值百分比明显高于对照组,差异有统计学意义(P<0.05).结论 实施社区康复教育及联合使用布地奈德和福莫特罗对改善COPD患者的生命质量和肺功能有一定的积极意义.

目的：探讨阿司匹林在社区血栓栓塞性疾病二级预防及治疗中的应用情况。方法通过问卷调查形式，采集X城区并选取X所社区卫生服务中心从2014年10月至2015年12月在上述社区卫生机构就诊的患者的基本资料及治疗信息，从中筛选出180例具有血栓栓塞性疾病的患者，按疾病分类分为冠心病组及脑卒中组，每组90例，同时针对性收集其抗栓治疗信息。比较两组患者的相关抗栓治疗信息等。结果冠心病组患者既往服用阿司匹林81例（90.0％），通过新处方服用3例（3.3％），总体服用84例（93.3％）；脑卒中组患者既往服用阿司匹林75例（83.3％），通过新处方服用2例（2.2％），总体服用77例（85.6％）。两组患者绝大部分对阿司匹林的服用率均较高；冠心病组患者阿司匹林服用率略高于脑卒中患者；两组患者中均有近25.0％服用β受体阻滞剂；两组患者中均有近33.3％服用 ACEI或 ARB 药物、两组患者中均有近40.0％服用中药及中成药。结论阿司匹林在社区血栓栓塞性疾病二级预防实践中的应用较为广泛而显著；对于血栓栓塞性疾病患者同样可以服用例如β受体阻滞剂、ACEI 或相应中药及中成药以改善病情。

Objective To explore the relationship between social supports and post-stroke fatigue among community stroke patients.Methods A total of 164 community stroke patients in Pingshan New Area of Shenzhen City were investigated by Fatigue Severity Scale (FSS) and Social Support Rating Sale (SSRS).Results Of the 164 cases,there were 72 cases diagnosed post-stroke fatigue (accounting for 43.9％);Patients with post-stroke fatigue had lower scores of SSRS than non-fatigue patients with statistically significant difference;The scores of FSS were significantly negative related with each dimension of SSSR;Patients who signed with the family physician had lower rate of post-stroke fatigue (P＜0.01),and the total levels of subjective support,objective support and social support were higher in signed patients than those in non-signed patients (P ＜0.01).Conclusion Post-stroke fatigue may be closely related to social supports;Family physician services can improve the levels of social supports in order to reduce the incidence of post-stroke fatigue.

Objective To explore the operational efficiency of community health service centers and provide references for the development of community health service centers.Methods Data envelopment analysis ( DEA) was conducted to evaluate the fundamental operational efficiency ( including general efficiency , pure technical efficiency and scale efficiency ) of 21 community health service centers affiliated to a public hospital in Pingshan New District of Shenzhen in 2013.The evaluation indexes include input indexes , which are total expenditure and the number of staff , and output indexes , which are general income, number of outpatients , number of woman and children who have received healthcare , number of patients who have received chronic disease management and number of contract -signing family doctors.Results The average general efficiency was 0.839, with a generally effective proportion of 38.1% (8/21); the average technical efficiency was 0.929, with a technical effective proportion of 66.7% (14/21); the average scale efficiency was 0.904, with a scale effective proportion of 38.1%(8/21); there were 7 community health service centers that didn′t reach effective level in general efficiency , pure technical efficiency and scale efficiency.Conclusion Community health service centers have low operational efficiency , and problems exist in terms of the waste of medical resources and imbalance among various items of medical services .In the construction of community health service center , resources should be rationally allocated , and the best use of resources should be made.

Objective To analyze the effect of implementation of the family physician services on Knowledge-Atti-tude-Practice (KAP)of patients with hypertension and related knowledge of their family members.Methods Three com-munity health centers were extracted from the jurisdiction of a second grade hospital in Shenzhen City,collecting health re-cords of patients with hypertension,defining the patients signed the family physician service over six months as the interven-tion group,unsigned as a control group.Questionnaire survey on Knowledge-Attitude-Practice was applied for hypertension patients in both groups,and knowledge of hypertension among the members of their families.Results Scores of knowledge, attitude,behavior and medication compliance of hypertension patients in signed group knows were (21.60 ±1.49),(7.90 ±1.42),(5.89 ±2.03),and (3.56 ±0.55)respectively.Medication treatment rate was 95.5%,and blood pressure control rate was 56.4%,both of them higher than control group (P <0.05);families of hypertension patients in signed group scored (7.27 ±1.30),(6.77 ±0.96),and (4.59 ±1.07)respectively on hypertension related knowledge at the three dimensions degrees,higher than that of the control group (P <0.05).Conclusion The family physician services not only improve KAP and medication compliance in patients with hypertension,can also improve the cognitive level of hyperten-sion in families of hypertension patients.

脑卒中，又称中风或脑血管意外，是一组突然起病，以局灶性神经功能缺失为共同特征的急性脑血管疾病，分为出血性和缺血性脑卒中，其中缺血性脑卒中占60%~80%。缺血性脑卒中即脑梗死，它是严重危害我国中老年人生命与健康的神经系统的常见和高发疾病，其发病率、复发率、致残率、致死率极高，其中病死率平均10%~15%，带来了沉重的社会与经济负担[1]。缺血性脑卒中患者中约4%~10%复发，复发脑卒中与首发相比其致死率、致残率更高，严重影响人类生命和生活质量[2]，因此缺血性脑卒中的防治已成为卫生工作中的一项重要课题，越来越引起业界的重视。近年研究发现，脂联素( Adpn)具有多种生物学作用[3]，参与葡萄糖和脂质代谢，与动脉粥样硬化的发生发展关系密切，由于动脉粥样硬化是缺血性脑卒中的基础病因，脂联素在缺血性脑血管病中的作用逐渐为人们所关注，现就血清脂联素与缺血性脑卒中的关联进行总结。

Objective To investigate parents′ recognition of adverse reactions (AD), their coping styles and satisfaction to vaccination,so as to increase the rate of vaccination and reduce AD after vaccination.Methods Parents who took their children to receive vaccination between April and November 2014 were investigated using a self-made questionnaire.Results More non-local parents were investigated than the locals.Among all the parents,99.46% were favor of vaccination and 92.93% parents had their children vaccinated on schedule.However,only 85.87% parents were aware of the occurrence of AD after vaccination.Among the 78 parents who didn′t know this, 92.1 9% thought follow-ups should be provided at regular intervals.There were no significant differences in consciousness of AD after vaccination between local and non-local parents.But there was significant difference between parents with different education backgrounds. Parents investigated were most satisfied with doctors′attitude,followed by the procedure,health education and waiting time.Conclusions The parents are not well aware of AD after vaccination and are of low satisfaction of the vaccination.Therefore,we should strengthen health education about vaccination and improve the procedure of vaccination to provide better vaccination service.

Objective To explore the effect of management of chronic disease: Health monitoring platform with Health coach, then giving advice for the chronic disease management. Methods 580 patients in the chronic disease management system of the 21 community health service centers were selected and divided into three groups: control group(n =282),health coach group(n =148),health monitoring platform with health coach(n =149).After 6 months,comparing the hypertension among the three groups. Results After 6 months, the results of last group are better than of the first two groups in blood pressure reduction,blood pressure value, the compliance rate of blood pressure after treatment(SBP: χ2=25.935; DBP: χ2=40.554),decreased amplitude(SBP: χ2=63.294, DBP: χ2=27.152),compliance rates(SBP: χ2=9.874; DBP:χ2=11.173) and blood pressure classification( χ2=13.584) with significance statistical differences(P0.05). Conclusion Remote blood pressure monitoring and chronic disease management mode of health coach can significantly improve the patient's blood pressure and is worth popularizing widely.

目的 了解脑卒中患者对家庭医生服务的需求及对家庭医生服务的知晓及满意度,为改善家庭医生制服务提供参考.方法 采用自行设计的问卷,对深圳某医院2013年8月-2014年8月脑卒中患者或家属开展调查.结果 调查共发放491份问卷,有效问卷483份.按是否签订家庭医生服务分为签约组和未签约组,2组在性别、婚姻状况、文化程度、职业、疾病情况及居住方式等维度差异无统计学意义(P＞0.05),在年龄(t=2.54)、家庭收入(x2 =8.39)、医疗保险类型(x2 =84.62)维度差异有统计学意义(P＜0.05),签约组年龄(58.94 ±7.66)岁小于未签约组(63.86±7.16)岁,家庭收入和医保覆盖率优于未签约组;对未签约组进行分析显示未签约原因前三位为“不了解”41例,“社康中心医疗设备不足”17例,“医生技术水平有限”15例.对签约组进行满意度调查显示家庭医生服务态度满意率84.08％、技术满意78.98％,主动服务满意率63.06％,医患沟通满意率47.13％;签约组84.28％的患者希望家庭医生能与专科医生一起,提供综合性医疗服务.结论 脑卒中患者家庭医生签约率低,与其对家庭医生制服务模式的不了解和现行家庭医生制服务的不健全有关,应加大家庭医生服务的推广,改进现有的家庭医生服务模式,从而真正做到为患者及社区居民服务.

The health monitoring platform is used to monitor the physical signs of the chronic disease. It will contribute to integrate various medical resources to offer the continuous and personalized health service,then improve the management effect of the chronic disease. This paper introduces the construction of health monitoring platform which is designed by Pingshan People' s Hospital and its applications in chronic disease management in the community.

Objective To investigate the correlated between disease cognition and uncertainty of family members and recurrence risk in patients with ischemic stroke. Methods From January 2013 to February 2014,389 patients with ischemic stroke and their family members were chosen by convenience sampling method admitted in 3 secondary hospitals of Shenzhen,and they were divided into control group ( n =288 ) and recurrence group ( n =101 ) according to the recurrence of ischemic stroke. Then investigated the disease cognition and uncertainty of family members by self-made general information questionnaire, stroke knowledge questionnaire and disease uncertainty scale. Results The score of disease cognition of family members of re-currence group was higher than that of control group,while the scores of disease uncertainty dimension,lack of information di-mension and the total dimensions of disease uncertainty were lower than those of control group(P﹤0. 05). Linear correlation a-nalysis showed that,the score of disease cognition of family members of recurrence group was negatively correlated with the recur-rence frequency of ischemic stroke(r= -0. 245,P=0. 014),while the score of disease uncertainty was positively correlated with the recurrence frequency of ischemic stroke(r=0. 220,P=0. 010). Conclusion Disease cognition and uncertainty of family members are influencing factors of recurrence of ischemic stroke,thus measures should be take to improve the disease cog-nition of family members,reduce disease uncertainty,to reduce the recurrence of ischemic stroke.

Objective To investigate the changes of serum interleukin -1β( IL-1β) level in patients with post stroke fatigue ( PSF) and effect of early nursing intervention , to provide references for prevention and treatment .Methods From December 2013 to June 2014, 105 patients with ischemic stroke were selected in our hospital , and they were randomly di-vided into control group (n=52) and intervention group (n=53) .Control group given routine treatment and nursing , while intervention group given early nursing intervention based on routine treatment and nursing.After 2 weeks of intervention , fatigue severity scale (FSS) was used to judge PSF, and blood glucose, HbA1c, IL-1β, HDL-C, LDL-C, TC, TG were detec-ted.Results The total score of FSS of intervention group was (2.9 ±1.5), was lower than that of control group of (3.8 ± 1.7) (P<0.05) .In the intervention group, 13 cases occurred PSF (intervention-PSF group), 40 cases did not (interven-tion-non PSF group ); in the control group , 13 cases occurred PSF ( control-PSF group ) , 29 cases did not ( control -non PSF group) .Blood glucose, HbA1c, IL-1β, HDL-C of intervention -PSF group were higher than those of control -PSF group and intervention-non PSF group , and those of control -PSF group were higher than those of control -non PSF group ( P<0.05).Conclusion Serum IL-1βlevel is higher in patients with PSF , which plays a important role in the onset and devel-opment of PSF , and early nursing intervention is helpful to reduce and postpone PSF .