目的:分析上海市北蔡社区女性骨质疏松症(osteoporosis,OP)患者的患病情况及影响因素,为社区骨质疏松防治提供参考依据.方法:选取2014年10月—2021年12月上海市浦东新区北蔡社区卫生服务中心完成OP筛查人群中资料完整且完成双能X线骨密度测定的常住女性居民,共纳入1122名,平均年龄(60±11)岁,分别行骨密度检测和问卷调查.采用Logistic回归分析上海市北蔡社区女性患OP的影响因素.结果:社区女性骨质疏松症者共检出387例,患病率约34.5％,且患病率随着年龄增大而升高.Logis

背景 在政府推进基层控费步伐越来越快的背景下,基层医疗卫生机构亟须发展出便捷、好用、通用的管理工具,来覆盖人力成本核算、服务绩效发放、新服务开发、服务对外定价、学科建设和人才培养等方方面面机构经营过程中常见问题的解决.标化工作量作为精确测算某个服务项目人力时消耗的工具,在测算过程中,用到的参数和变量涉及前述的方方面面问题,并可以通过精确的统计将上述问题的解决清晰化、定量化,并形成决策闭环.目的 本研究拟清晰阐述标化工作量的内涵、定义、操作定义、各种应用方式,便于读者理解、把握、应用、用好这一工具,来进行机构的治理与经营,以解决上述问题,加快基层医疗卫生机构的发展,早日实现卓越经营和合理控费.方法 从标化工作量的内涵出发,整理标化工作量的计算公式,得出与之关联的关键变量和参数,将参数进行不同的、有意义的组合和分析,逐一回答标化工作量助力机构经营与发展的各种应用场景.结果 标化工作量可以用来解决人力成本核算、服务绩效发放、新服务开发、服务对外定价、学科建设和人才培养等问题.结论 标化工作量既是用于政府经费拨付、内部绩效发放的计价工具,更是在开发自身特色服务时的定价工具、在开展服务改进和效率提升时的比对工具、在开展新技术和发展新业务时的循证思维工具,用好标化工作量可以加快社区卫生学科建设和人才培养.

背景 标化工作量作为社区卫生服务机构精确测算某个服务项目人力时消耗的工具,在测算过程中用到的参数和变量涉及社区卫生服务机构发展的方方面面,因此,极具实用性,但如何将标化工作量切实完整地用于整个社区卫生机构的运行和全面考核尚缺乏可指导操作的文献.目的 以北蔡社区为例,全面系统地介绍社区卫生服务机构如何应用标化工作量完成机构全体成员绩效薪酬核算问题,并在此过程中,同时回答如何梳理机构全部服务项目、如何建立不同业务科室之间的薪酬关系、如何完成对新增服务项目进行标化工作量赋值等问题.方法 以在真实世界中进行标化工作量测算时的实施流程为时间轴,分为4个主题6个步骤逐一介绍操作实施细节.结果 整理出了使用标化工作量进行全员绩效测算和新项目服务定价时的实际操作流程、遵照原则和计算公式.结论 整个实施过程操作细节的介绍,可以直接指导社区卫生机构同行标化工作量测算和应用等相关工作的开展,并特别介绍了机构对新增服务项目进行标化工作量赋值的操作办法,以及不同科室应采取何种策略保持在标化工作量思想和框架下进行绩效测算,以维持整个机构经营战略的统一.

目的:了解绝经后女性骨量情况,探索女性不同部位骨密度检测结果之间的差异及可能规律.方法:采用与通信作者"1+1+1"签约的198名55～70岁绝经后女性为研究对象,采用双能X线骨密度检测仪检测其腰椎及左髋部位骨密度,并对检测结果进行比较分析.结果:198名绝经后女性中97人为骨量减少,70人为骨质疏松.按年龄将所有研究对象分为3组([55,60]岁组、(60,65]岁组、(65,70]岁组),3组研究对象腰椎T值均低于髋部T值,差异均有统计学意义(t/Z值分别为-2.53、-5.66和-3.99,P值均＜0.05).(60,65]岁组和(65,70]岁组髋部骨密度T值较[55,60]岁组低,差异有统计学意义(F=3.14,P＜0.05).结论:绝经后女性骨量异常比例较高,应加大对绝经后女性骨密度的筛查力度,腰椎为绝经后女性骨质疏松检测的敏感部位.评价与年龄增长有关的骨量流失情况时,髋部具有更好的代表性.

背景 标化工作量的计算公式中包含人力时、技术难度和风险程度三个变量,其中技术难度和风险程度是一种主观的度量,不同部门和工种的业务人员会有自己的度量衡,一般来说,相同工种的业务人员度量衡相对一致,但不同部门和工种的人员之间则难以获得相同的度量衡,这使得不同部门之间的技术难度和风险程度度量值不可比.目的 本研究拟在测算社区卫生服务项目标化工作量背景下解决跨部门的技术难度和风险程度主观度量衡均一化问题.方法 从标化工作量的内涵出发,选择专业的、有代表性的业务人员,获取其对所在科室各项目人力时、技术难度和风险程度的原始赋值,按照最小值和平均值原则进行转换,再将转换后的技术难度和风险程度取值乘以使用串联法得到的科室间转换系数,得到不同科室间可比的技术难度和风险程度最终取值,并使用排序法解决确定最终取值前的争议.结果 选择的专家权威程度基本大于0.7,结果科学可信,得到了各科室间的技术难度和风险程度转换系数,得到了各个科室所有项目可比的技术难度和风险程度最终取值.结论 标化工作量的技术难度和风险程度等参数的测量取值,需要选择有代表性的业务人员,获得其赋值结果,测得各人的原始赋值后,通过最小值及平均值原则、串联法、排序法,可以顺利地获得各个项目在全院范围内可比的技术难度和风险程度最终取值.

Objective:To investigate the bone mineral density( BMD) of young men in Shanghai Beicai area. Methods:The levels of BMD of lumber vertebra and left proximal femur in 223 healthy men,20 to 40 years old,in Shanghai Beicai area were examined using dual energy X-ray bone density instrument, and the cases were investigated by questionnaire survey. Results:The differences of the effects of weight and body mass index(BMI) on BMD were statistically significant(P<0. 05). The differences of the effects of age, educational level,diet, sport, sleep, drinking, smoking, fish, shrimp, milk, yogurt, coffee, fracture history and surgery history on BMD were not statistically significant(P>0. 05). Conclusions:The body weight and BMI have effect on the level of BMD in young men.

目的 了解上海市浦东新区北蔡地区青年女性骨密度(Bone mineral density,BMD)现状,为本地区原发性骨质疏松症的防治提供参考依据.方法 采用美国GE公司的Lunar Prodigy Advance PA+300164型双能X线骨密度仪对在北蔡地区随机募集的209例20.0～39.9岁女性进行腰椎正位和左髋正位BMD测量.结果 (1)不同部位的峰值骨密度(peak bone mineral density,PBMD)出现在女性的不同年龄段,股骨颈PBMD出现最早,在20.0～24.9岁;腰椎L1、L2、L3、L4和L2-4PBMD出现在30.0～34.9岁;大粗隆PBMD出现最晚,在35.0～39.9岁.(2)BMD在同龄人范围内的比例在30.0～34.9岁最高,达98.04％;整个20～39.9岁年龄段女性“骨密度低于同龄人”的比例为5.74％.结论 (1)上海市浦东新区北蔡地区女性不同部位PBMD出现的年龄不同,可以推断骨健康状况在30.0～34.9岁处于最佳水平.(2)20.0～39.9岁年龄段女性“骨密度低于同龄人”的比例为5.74％,应引起全社会重视.

目的 研究上海市北蔡地区健康青年男性骨密度(BMD)现状,为本地区骨质疏松症的防治提供参考.方法 募集上海市北蔡地区223名20.0～39.9岁健康男性,使用美国GE公司Lunar Prodigy Advance PA+300164型双能X线骨密度仪对其正位腰椎和左股骨近端进行BMD测定,同时进行问卷调查.结果 L1、L2、L4、L2-4和股骨颈峰值骨密度(PBMD)出现在20.0 ～ 24.9岁年龄段,L3和大粗隆的PBMD出现在25.0～29.9岁年龄段.各椎体间的BMD值整体呈依次增高趋势,L1＜L2＜L4＜L3,L3BMD值最高.BMD在同龄人范围内的比例以25.0 ～ 29.9岁最高,为90.57％.整个20.0～39.9岁年龄段BMD低于同龄人的比例高达15.25％.结论 男性在25岁左右BMD达到峰值.20.0 ～ 39.9岁年龄段男性健康人群BMD低于同龄人的比例高达15.25％.可见,健康男性的骨健康状况不容乐观,应引起全社会重视.

目的 通过比较综合干预3年的骨质疏松症患者与对照组患者骨密度的变化趋势,探讨适合社区的骨质疏松综合干预方式.方法 选择2007-2011年在本中心多项骨质疏松症相关课题积累得到的322例60～80岁骨质疏松症患者,以建立骨健康档案为切入点,对干预组患者开展多种形式的健康教育和综合随访,成立骨质疏松症患者管理小组、沙龙,依据每位患者的具体健康状况,予以个体化的生活运动指导、药物干预等多种形式的综合干预.采用双能X线骨密度仪对全部受试者正位腰椎(L)及左侧股骨近端进行骨密度测定.检测时间为干预始、干预后3年.结果 两组患者L1、Lz、L3、L4、股骨颈、股骨粗隆和髋全部各观察部位骨密度(BMD)变化比较,干预组呈全面上升趋势,对照组呈全面下降趋势;两组患者3年前后BMD变化值(基线值～3年后)比较,干预组各观察部位BMD值均上升,其中L1～L4和股骨粗隆变化有统计学意义(P＜0.05),股骨颈、髋全部变化无统计学意义(P＞0.05);对照组各观察部位BMD值均下降,其中L3、股骨颈和股骨粗隆变化有统计学意义(P＜0.05),其余部位变化无统计学意义(P＞0.05).结论 综合干预可以取得良好的效果,但若该效果能得到持续甚至扩大至全人群,仍需相关专家的呼吁和政策支持.

OBJECTIVE To evaluate the effect of systemic health education of general practitioner based team. METHODS 322 osteoporosis patients aged between 60 and 80 years, participated in former research, 79 were randomly selected to participate in systemic health education, 103 patients did not participate were settled as the control group. Both of the two groups finished questionnaire survey of osteoporosis knowledge. RESULTS In 28 questions and answers, the intervention group had significantly higher accuracy than the control group in 23 answers(P<0.05), the results of 5 were close(P>0.05). CONCLUSIONS Systemic health education general practitioner based team contributes to improve the knowledge of osteoporosis patients, but the content and methods of health education should be further improved.

骨质疏松症(osteoporosis,OP)是临床常见病和多发病,发病与以下因素有关:种族、性别、年龄、低体重和低体重指数、家族史、营养以及性激素低下、早绝经、不良生活方式、缺乏体力活动和身体锻炼、患有影响钙代谢的疾病或长期服用影响钙代谢的药物。依据病因可分为原发性OP、继发性OP和特发性OP;依据病理特点可分为高转换型OP和低转换型OP。OP的防治策略包括基础防治和社区防治,融预防、保健、临床、康复及健康教育于一体,是全科医生的重要工作内容。

OBJECTIVE Investigate the effects of three medications on senile osteoporosis in a 2-year study.METHODS A total of 120 osteoporosis patients,selected from the candidates which were T-2 during Oct.2008 to Jun.2009,were assigned randomly into three groups.Group A(Traditional Chinese Medicine):Patients received Bugu capsule(20 g Bid p.o.) for the first 3 months,then XianlingGubao(3# Bid p.o.) only for the next 21 months.Group B(Western Medicine):Elcatonin(10u? Biw.im.)for the first 3 months,then Fosamax(70mg QW p.o.) and alfacalcidol(0.5 μg qdp.o.) for the next 21 months.Group C(integrated Chinese and Western medicine):patients were treated with both A and B protocols.Test the BMD value of lumbar spine and left hip at the beginning,the 12th month and the 24th month.RESULTS BMD value of Group B and Group C both went upward during the treatment.BMD value of Group A went down overall,but altered the trend since the 12th month.The BMD value changes of the 3 groups at L1、L2-4 and all the hip were significantly different(P0.05),but the other parts' were not(P0.05).In comparison,the differences between Group A and B,Group A and C are both statistically significant,while there is no significant difference between Group B and C.CONCLUSION All of the three medical treatments are effective in fighting against senile osteoporosis.The therapeutic efficiency of the Western Medicine was higher as compared to that of the traditional Chinese Medicine.

<正>骨质疏松症(osteoporosis,OP)因其导致严重的致残、致死、生活质量下降及寿命缩短等原因日益受到全社会的关注。在高龄老年人中,1/3的女性和1/6的男性将会发生髋部骨折[1]。有研究预测,至2050年我国50岁以上人口髋部骨折患者数为590.8万人,椎体骨折为4850万

Objective To compare the effects of three medications on senile osteoporosis after a one-year follow up.Methods A total of 92 patients with osteoporosis selected from October 2008 to June 2009 were assigned randomly into three protocols;A group(traditional Chinese medicine):patients received Bugu capsule(20 g Bid p.o.) for the first 3 months,then changed to receive Xianling Gubao(3# Bid p.o.) for 9 months。B group(Western medicine): patients received Elcatonin(10 U Biw i.m.) for the first 3 months,then changed to receive both Fosamax(70 mg QW p.o.) and alfacalcidol(0.5μg qd p.o.) for 9 months;C group(integrated Chinese and Western medicine):patients received both A and B protocols。The outcome was the change in bone mineral density(BMD) of the lumbar spine,femoral neck,and total hip in 12 months.Results A group:Decrease in L_1,L_3,L_4,L_(2-4),femoral neck,and total hip BMD were observed before treatment.Increase in femoral neck BMD showed significant difference after treatment(P0.05 ) while other positions showed no significant difference(P0.05 ).Increase in L_2 and trochanter BMD were observed, but without significant difference(P0.05)。B group:Increase in L,,L_2,L_3,L_4,L_(2-4),femoral neck,trochanter and total hip BMD were observed,among which L_1,L_2,L_(2-4),and trochanter showed significant difference(P0.05)。C group:Increase in L_2,L_3,L_4,L_(2-4),femoral neck,trochanter,total hip BMD were observed except L_1. Significant difference was only observed in L_3 and trochater BMD(P0.05).Significant increase in L_(2-4),femoral neck BMD were observed in all patients(P0.05 ),regardless which protocols they received.Significant difference was observed in A group and B group(P0.05).Without significant difference was observed in B group and C group(P0.05 ).Significant difference of BMD(femoral neck) were observed in A group and C group(P0.05).Conclusion Western medicine treatment can significantly improve BMD in the population of T value- 2.0.But effect of western medicine can be interfered when combined with traditional Chinese medicine.

目的:比较两种诊断标准对社区老年自然人群骨质疏松症分布的影响。方法:抽取2009年上海市浦东新区北蔡社区6O岁以上人群626例进行双能X线骨密度仪(DXA)测定,分别按照国际标准,国内标准诊断。结果:国内标准,626例中共有304例诊断为OP,患病率48.6%;国际标准,626例中共有184例诊断为OP,患病率29.4%。两种标准诊断OP具有显著性差异(χ2=48.356,P=0)。结论:上海市浦东新区北蔡社区6O岁以上社区自然人群骨质疏松症患病率较高,不同诊断标准对骨质疏松症比例有明显的影响,国内诊断标准比国际诊断标准更有利于早期发现人群。

Objective To investigate the relationship between body mass index(BMI) and the incidence of chronic non-communicable diseases(CNCD) among the elderly residents in Beicai Town of Shanghai in order to provide information useful for CNCD prevention.Methods A questionnaire survey on the incidence and therapy of CNCD among the elderly was conducted. The subjects were interviewed to collect the height and the body mass recall information at age of 25 years.They were then divided into 3 groups according to the body mass index(BMI) at age of 25 years:underweight,normal weight and overweight groups.The current BMI was also calculated and the subjects were divided again into 3 groups:normal weight,overweight and obese group.Their bone mineral density(BMD) of lumber vertebra and left proximal femur were measured using dual-energy X-ray absorptiometry (DXA).Results There were significant differences in the incidence of osteoporosis and diabetes among underweight,normal weight and overweight groups at age of 25 years(P0.05).There were significant differences in the incidence of osteoporosis and hypertension among normal weight,overweight and obese group divided on the basis of current information(P0.05).Conclusion There is a close relation between BMI and the incidence of osteoporosis,hypertension and diabetes in the elderly residents at Beicai Town of Shanghai.We propose that everyone,from adolescents to the elderly,should keep a good nutrition status,control body weight,and practice appropriate physical activities to maintain BMI within a satisfactory range.

Objective To investigate the correlation between senile female osteoporosis(OP) and female physiological factors at Beicai Township of Shanghai.Methods The bone density was detected in lumbar spine and left proximal femur in 398 senile women(age range:60～79 yr) by GE DEXA machine.Results According to the results of bone density detection,the senile women were divided into three groups:OP group,normal bone mass group and bone mass loss group.There was no significant difference in the menarche age among the three groups(P0.05),however,there were significant differences in the amenorrhea age,menorrhea duration,menorrhea days and gravidity among the three groups(P0.05),and there were significant differences in the amenorrhea age,menorrhea duration and gravidity between normal bone mass group and OP group(P0.05),however,there was no significant difference in the menorrhea days between the two groups(P0.05).There were significant differences in the amenorrhea age,menorrhea duration and menorrhea days between normal bone mass group and bone mass loss group(P0.05),and there were significant differences in the amenorrhea age,menorrhea days and gravidity between bone mass loss group and OP group(P0.05),however,there was no significant difference in the menorrhea duration between the two groups(P0.05).Conclusion There is a close correlation between OP and female physiological factors at Beicai Township of Shanghai,especially,for the elderly women with earlier amenorrhea age,shorter menorrhea duration,less menorrhea days and more gravidity,who should pay much attention to the prevention and treatment of OP.

<正>骨质疏松症系以骨强度下降而易于骨折为特征的骨骼系统疾病。骨质疏松因其严重的致残、致死、生活质量下降及寿命的缩短,日益受到全社会的关注。在高龄老年人中,1/3的女性和1/6的男性将会发生髋部骨折[1]。有研究预测,至2050年

目的了解上海市北蔡镇老年人群身高、体重及体质指数(body m ass index,BM I)与腰椎和髋部骨密度(bone m ineral density,BMD)的关系,为本地区骨质疏松症的防治提供参考。方法使用美国GE公司双能X线骨密度仪对626例上海市北蔡镇60～80岁老年人正位腰椎和左股骨近端进行BMD测定。测量老年人的身高和体重,计算出目前BM I,分为体重正常组(BM I 18.5～23.9)与超重组(BM I≥24)。让老人回忆25岁时的身高和体重,计算出25岁时BM I。有443位老人可回忆25岁时的身高和体重,分为低体重组(BM I<18.5)、体重正常组(BM I 18.5～23.9)与超重组(BM I≥24)。结果 (1)老年男性身高与腰椎和髋部BMD无相关性,老年女性身高与髋部BMD有明显正相关性(P<0.01)。(2)体重正常组与超重组腰椎、髋部BMD均差异有显著性(P<0.05)。(3)25岁女性身高、体重及BM I均与现在腰椎和髋部BMD有明显正相关性(P<0.01)。结论体重和BM I皆为老年人腰椎和髋部BMD的重要影响因素。老年女性身高亦是髋部BMD的重要影响因素。体格瘦小的老年人应注意骨质疏松的诊断和防治,尤其瘦高的中老年女性。

Objective It is to observe the effects of integrated Chinese and western medicine on senile osteoporosis in a 1-year study. Methods Thirty patients with osteoporosis were selected and received both Bugu capsule and Elcatonin for the first 3 months,then received Xianling Gubao,Fosamax and alfacalcidol for the next 9 months.The BMD value of lumbar spine,neck of femur and all the hip were tested before and after the therapy. Results All the T value and BMD value of L1,L2,L3,L4,L2—4,neck of femur,trochanter of femur and all the hip went upward except the BMD value of L1.Compared with prior treatment,the changes of T value and BMD value of L3 and trochanter of femur in post treatment were both statistically significant(P<0.05),while there was no significant difference in other parts. Conclusion Integrated Chinese and western medicine is effective in fighting against senile osteoporosis,and can improve the BMD value obviously.