ObjectiveTo investigate the effect of lifestyle intervention on patients with hypertension or pre-hypertension, provide evidence of hyperension prevention and treatment.Method448 patients with hypertension or pre-hypertension in Jiaxing and Shaoxing communities in Zhejiang province. Control group keep the usual lifestyle without individual intervention; intervention group was given 1 year healthy lifestyle education, skill and habit training, intervention included diet management, exersice management, smoking and drinking cessation, psychological balance education.ResultThrough 12 months’ individual management including of diet and exersice management, the resluts showed that, compared with control group, taking more oil and drinking in intervention group dramaticly declined (4.31% vs 12.78%,P<0.01; 26.79% vs 35.84%,P<0.05), systolic pressure rised [(122.31±9.28) mmHg vs (118.72±14.94) mmHg,P<0.05], 6 minutes walking distance and slf-reported health markly rised [(551.09±9.46) m vs (489.63±4.48) m, (91.24±6.88) vs (88.56±7.82),P<0.01]. The difference value of intervention and control group indicated BMI and waistline slight declined [(-0.47±2.94) kg/m2 vs (3.25±4.19) kg/m2, (-0.41±7.82) cm vs (1.31±3.87) cm,P<0.01]. SBP and DBP declined in both groups, but they declined more remarkable in intervention group [(-6.61±7.74) mmHg vs (-3.62±7.54) mmHg, (-4.74±9.93) mmHg vs (-3.99±9.60) mmHg,P<0.01]. The rates of hypertension awarness, knowing the value range of pre-hypertension, knowing the associated diseases of pre-hypertension, knowing the effective treatment of pre-hypertension were high in intervention group (P<0.05).ConclusionCommunity-based lifestyle intervention could effectively improve the knowledge of patients with pre-hypertension or hypertension, and effectively control weight, lower SBP and DBP, and improve the living quality of patients.

Objective From October 2010 to explore the current situation of hypertension control and its influencing factors among geriatric patients in Hangzhou,Jiaxing and Shaoxing in Zhejiang province.Methods To April 2011,10 644 geriatric patients aged 60 years and over were included,and related questionnaire survey,physical examination and laboratory examination were carried out.The situation of hypertension control and influencing factors were analyzed.Results The control rate of hypertension was 38.6％,and its standardized rate was 27.6％.It showed that female,inhabited city,high level of education degree and regular exercise were positively correlated with hypertension control,while age,smoking,high salt diet and abdominal obesity were negatively correlated with hypertension control,and standardized treatment had a close relationship with hypertension control.Conclusions The situations of hypertensive control among geriatric patients in Hangzhou,Jiaxing,Shaoxing in Zhejiang province are still unsatisfactory.Strengthening standardization management measures for improving the control rate of hypertension is needed and has actual value.

Objective To investigate the prevalence and associated risk factors for prehypertension and hypertension among the older adults in Hangzhou,Shaoxing,Jiaxing in Zhejiang province.Methods A total of 1348 people aged 60 years and over were selected by stratified cluster random sampling in 2011,the risk factors were analyzed through SAS9.0.Results 1348 subjects were included in the survey from April to July in 2011.The prevalence of pre-hypertension and hypertension was 37.5％ and 30.6 ％,and the standardized prevalence rates were 35.6％ and 28.9％ respectively.In the elderly with hypertension versus normal blood pressure,the rates of smoking and exercising were lower (19.9％ vs.21.4％,31.8％ vs.47.1％,P＜0.05),but the rates of obesity,hypertriglyceridemiaand having 3 or more risk factors were higher (15.1％ vs.4.6％,13.8％vs.4.4％,26.2％,13.9％,P＜0.05).Among the elderly patients with pre-hypertension,less subjects had exercise compared to subjects with normal blood pressure (45.7％ vs.34.6％,P＜0.05),and the rates in male,having 2 or more than 3 risk factors were increased compared with the group with normal blood pressure (45.7％ vs.34.6％,25.2％ vs.20.2％,22.4％ vs.13.9％,P＜0.05).There were more subjects in the group with hypertension that having myocardial infarction,stroke and diabetes than the in the group with pre-hypertension,the rates were 0.5％ vs.0.0％,1.7％ vs.0.2％,5.6％ vs.2.2％(P＜0.05).Conclusions The standardized prevalence of hypertension is higher in the elderly than in ones aged 35 years and over,and the subjects with hypertension or pre-hypertension in the elderly have less exercise.The risk factors for obesity and hypertriglyceridemia are more in the hypertensive,but less smokers compared with the group of prehypertension.Guidance of sports is necessary among the elderly with hypertension and prehypertension,and more attention should be paied to the intervention of obesity,hypertriglyceridemia and other risk factors.It may be an effective way to have intervention of smoking cessation among the hypertensive elderly.

Using the method of stratified random cluster sampling,8 996 elderly hypertensive patients in community were selected in the study.Patients entered the community-based hypertension program receiving stratified management,individualized treatment and health education.After 3 years of intervention,the disease awareness rate,treatment compliance rate and hypertensive control rate were increased from 68.30％,55.40％ and 38.60％ to 98.90％,86.70％ and 77.80％,respectively (P ＜0.05).The systolic and diastolic pressure,body mass index,triglyceride levels and other hypertensionrelated indicators were improved significantly,the number of individuals with obesity/overweight,smoking and drinking were decreased and those with regular exercise increased (all P ＜ 0.05).The results indicate that community-based comprehensive hypertension management is effective for hypertension control for elderly patients in community.

Objective To evaluate the effects of hypertension community control technique, which centered on ‘scalization, standardization, informatization ' , on community hypertension management in Zhejiang Province. Methods We established the hypertension community control technique based on 2005 Chinese guidelines for the management of hypertension, and conducted a large-scale community-based intervention trial. The selected communities were representative communities from city, town and countryside in Zhejiang province. An implement scheme was developed according to the hypertension community control technique. Grass-roots doctors in intervention group were trained standardly and required to manage hypertentives based on the implement scheme. Hypertension community standardized management rate, hypertensives' blood pressure, cardiovascular risk factors, awareness rate, treatment rate, control rate, and incidence of acute cardiovascular events were investigated. Results Till December 2013, 20 807 hypertensives were enrolled in the management, and the number was increased from 8 996 to 12 295 in intervention group. Among hypertensives in intervention group, the standardized management rate was 86. 8%, as well as the average systolic blood pressure ( SBP) and diastolic blood pressure ( DBP) declined 11. 21 mmHg and 8. 55 mmHg, respectively ( both P﹤0. 05). The treatment rate improved from 55. 4% to 86. 7% (P﹤0. 05), and the management rate from 38. 6% to 77. 8% in the intervention group. Also, the intervention was effective in significantly ameliorated cardiovascular risk factors while the incidence rate of acute cardiovascular events had decreased. Conclusions Hypertension community control technique can improve standardized management rate, and effectively prevent and control hypertension at community level.

目的：评价以“规模化、规范化、信息化”为核心的高血压社区控制技术对高血压人群管理的效果。

OBJECTIVE:To investigate the prevalence and related risk factors of prehypertension in Hangzhou, Shaoxing,Jiaxing city, Zhejiang province.METHODS:3200 people were selected by stratified cluster random sampling method, and statistical methods including chi-square test, and logistic regression through SAS 9.0 were used.RESULTS:The prevalence of pre- hypertension was 45.9%, higher for males and urban population, with significant differences seen between males and female(49.0% vs. 48.0%, P < 0.05), urban and rural areas(59.31% vs. 44.15%, P < 0.05). Data from the multiple factor logistic analysis showed that risk factors of prehypertension would include: older age, types of profession, under low education level, being urban residents, overweight and obesity, hyper triglyceride, and family history of hypertension, with ORs and 95% CI as 0.99 (0.98-0.99), 1.28(1.07-1.28), 1.31(1.10-1.56), 1.50(1.11-2.02), 1.33(0.98-1.81), 1.60 (1.19-2.16)and 1.18(1.00-1.39), respectively.CONCLUSION:Prehypertension prevalence was found high in the studied district, especially in urban residents with low education level. Strategies including reduction on risk factors as obesity and hyper triglyceride through health education as well as lifestyle modification should be taken to hold back the increasing trend on prehypertension in Zhejiang.

Objective To survey the learning resources of knowledge and problem solving of chronic disease prevention and treatment in community physicians.Methods A questionnaire survey was carried out among 891 community physicians who attended the Training course of Hypertension Community Control Technology from January 2011 to December 2012 in Zhejiang Province; to survey the influencing factors of their clinical ability and the problems of routine training.Results Total 855 effective questionnaires were returned.The main findings:35.2％ (301/855) obtained the knowledge of chronic disease diagnosis and treatment from routing training courses,17.8％ (152/855) from reading professional books and 17.2％ (147/855) from the guidance from senior doctors.Different level hospitals and community doctors knowledge acquisition ways of title was different,and there was a statistically difference between them (P ＜0.05).When encountering clinical problemn,36.5％ (23/63) senior physicians would seek answer from professional books and 31.7％ (20/63) from clinical guidelines; 27.1％ (68/251)doctors with middle title and 29.4％ (159/541) junior doctors would mainly consult senior doctors.30.1％(257/855) doctors thought heavy work load prevented them from further improvement of clinical skills,28.3％ (242/855) attributed it to difficulty to obtain advices from experts,13.5％ (115/855) attributed to difficulty in understanding the clinical practice guidelines,and 13.1％ (112/855) attributed to less opportunity to attend professional conferences.The main defects of routine training were the contents not relevant to clinical practice,training time and place inappropriate.Conclusions Routine training is the leading way for primary care physicians to get professional knowledge about chronic disease,but the existing training mode and content need to be improved.

目的 探讨制定规范化的糖尿病社区管理模式,提高糖尿病的社区防治水平.方法 选择3个不同的社区,对社区医师进行糖尿病规范化管理的培训,对这三个研究社区医院随访的387名糖尿病患者作为研究对象,进行为期一年的管理.结果 通过一年的规范化管理,对糖尿病诊断标准及糖尿病知识的知晓率均得到不同程度的提高;坚持1年正规治疗的比例较管理前明显上升;管理后朝晖社区患者血糖、血压、血脂没有明显改善(P＞0.05),马山社区患者空腹血糖、收缩压明显下降,差异有统计学意义(P＜0.05);洪合社区患者空腹血糖和餐后2小时血糖无明显变化(P＞0.05),血压明显下降,差异有统计学意义(P＜0.05).结论 进行社区糖尿病规范化管理,能提高糖尿病的知晓率、治疗率,为最终提高糖尿病控制率提供保障.

目的分析社区高血压随访管理质量控制结果。方法按《中国高血压防治指南》要求,建立并培训绍兴市直镇(街道)质量控制队伍,制定质量控制实施方案,采用单纯随机抽样方法抽取调查样本,采取随访现场观察、网络核查和电话核实的方式,对随访表填写、社区医生血压测量技能和随访管理的真实性进行质量控制。结果随机抽查电子随访表1521张,主要项目填写完整率78.37%;81.26%的表格填写无逻辑错误。现场观察152个慢性病随访管理现场,社区医生血压测量操作过程合格率75.20%;80.26%的社区医生无血压尾数偏爱现象,身高、体重和腰围测量规范率74.19%。经电话与患者核实结果,随访时间符合率92.24%;血压值符合率93.04%;服药符合率85.02%,规律服药率68.80%;伴随危险因素符合率78.86%;240例患者随访时未进行生活方式干预。高血压管理分级正确率87.50%,患者转诊率16.67%,居民满意率90.50%。结论随访表格填写不完整、血压测量操作不规范、心血管危险因素调查不全、药物与非药物治疗不规范及患者转诊不及时是目前社区高血压管理的重点质量问题,必须列入质量管理的重点。

Objective To evaluate the application of “expert-guided network tracking system” in training community general practitioner for hypertension management.Methods Total 855 general practitioners (GPs) from 20 community health service centers in Hangzhou,Jiaxing and Shaoxing of Zhejiang province were divided into two groups: 430 GPs from 10 community health centers received training for hypertension management using “ expert-guided networking tracking system” (intervention group) in December 2008 and 425 GPs from another 10 health centers received conventional training (control group).Questionnaire surveys about the knowledge and skill of hypertension management were conducted before and 3 y after training.Results The awareness rates of knowledge about hypertension prevention and control,non-drug therapy and drug therapy increased from 37.0％ (159/430),45.6％ (196/430),42.8％ (184/430) to 66.8％ (284/425),81.4％ (346/425),77.6％ (330/425),respectively and the accuracy of case analysis increased from 38.4％ (490/1290) to 73.3％ (946/1290) (P ＜0.01) after training in intervention group.Meanwhile the knowledge and case management abilities in control group were also improved after conventional training,but the degree was significantly lower than that in the intervention group.Conclusions “Expert-guided networking tracking system” can significantly improve the knowledge and skills for hypertension management in community general practitioners.

目的 掌握马山镇老年人高血压发病情况及其特点.方法 结合农民健康体检,对马山镇60岁及以上老年人高血压发病及其相关特点进行分析.结果 共调查60岁及以上老年人6987人,高血压患病率为42.35%,不同年龄、性别的患病率有统计学差异(年龄:X2= 69.68,P＜0.01;性别:x2= 45.27,P＜0.01),发病随年龄的增长而上升,进入80岁后人群的血压水平略有下降,但仍维持在较高水平.多因素分析结果表明,饮酒、高盐饮食和高血压家族史是高血压发病的主要危险因素.结论 高血压是老年人的主要心血管疾病,开展社区老年人生活行为干预,是控制高血压的重中之重.

Objective To investigate the effects of information management network on prevention,diagnosis and treatment of hypertension in community physicians.Methods Based on China guideline in prevention and treatment of hypertension,the information management criteria for comprehensive intervention of hypertension in community were made and information management network was set up according to the predefined criteria Physicians in randomized selected communities(intervention group) received training on hypertension management and communicated with cardiovascular specialist through the information management network.Matched communities were selected as control group and received conventional intervention.Data of community population hypertension management and the rates of awareness,treatment and control of hypertension were collected before and 3 years after the intervention.Results The population management rate in intervention group was increased from 35.98%to 66.18%.And average population systolic blood pressure(SBP) and diastolic blood pressure(DBP) were decreased by 2.2 mm Hg and 1.7 mm Hg respectively after intervention.The rates of awareness,treatment and control of hypertension in intervention group were increased from 58.7%to 89.7%,from 48.5%to 77.0%,and from 33.4%to 72.6%respectively,and the changes were significantly greater than in control group.Compared with control group,there was a lower trend in the incidence and mortality rate of cardiovascular disease in intervention group.Conclusions Information management network can effectively help community physicians improve prevention,diagnosis and treatment of hypertension.

目的分析社区开展《中国高血压防治指南2009(基层版)》(以下简称基层《指南》)培训促进社区高血压规范管理的效果。方法实施四级培训方式,并对实施基层《指南》社区和未实施社区进行高血压随访管理效果评估。结果 2010年全市举办123期基层《指南》培训班,培训师资259名,培训社区医生3528名,培训率99.58%,考试合格率99.72%。实施基层《指南》以后,社区医生的血压测量尾数偏爱发生率由2009年的35%下降至12%,门诊≥35岁首诊测压率由2009年的90.52%上升至93.18%。全市高血压检出率7.53%,其中52个乡镇发现率≥8%,分别比2009年上升12.05%和85.71%。44个实施《指南》社区的规范管理率、规范服药率和血压控制率分别为79.74%、74.61%、66.58%,与未实施指南社区比较,有显著差异(均P<0.01)。结论基层《指南》为基层医生提供了实用、可行的技术指导,成为规范社区高血压综合防治的有效保障。

<正>乙型病毒性肝炎(乙肝)是当前威胁人类健康的重要传染病,被WHO列为要加强控制并最终消灭的传染病。目前医学界尚无根治乙肝的良药,疫苗接种是预防乙肝病毒感染最经济、最有效的方法,也是降低乙肝危害的根本措施。现在实施新生

AIM:To evaluate the effect factors of amlodipine-based combination amiroride or telmisartan antihypertensive therapy on blood pressure uncontrol in hypertensive patients. METHODS:700 hypertensive patients from 11 centers in Zhejiang province from Mar.to Oct.2008 were included in this multi-centre randomized controlled clinical trial.Patients were randomly assigned to receive amlodipine plus amiroride(group A,n=354) or amlodipine plus telmisartan(group B,n=346).All patients were followed-up for 8 weeks.RESULTS:Blood press control rates reach 81.9% and 78.6% in group A and group B,respectively.In group A,systolic blood pressure(SBP),diastolic blood pressure(DBP) and body mass index(BMI) in blood pressure uncontrol patients were significantly higher than those in blood pressure control(P0.01).Heart rate(HR) and cerebrovascular disease history in blood pressure uncontrol patients were higher than those in blood pressure control(P0.05).In group B,urine acid and proteinuria in blood pressure uncontrol patients were significantly higher than those in blood pressure control(P0.01).The levels of SBP and DBP were higher than those in blood pressure control(P0.05).Results from multivariate logistic regression model showed that odds ratio of BMI,HR and DBP were 1.136,1.047,1.074,respectively in group A,the odds ratio of UA and proteinuria were 1.004,1.536,respectively in group B.CONCLUSION:DBP,HR and obesity are main clinical factors of blood pressure uncontrol in amlodipine plus amiroride,UA and proteinuria are main clinical factors of blood pressure uncontrol in amlodipine plus telmisartan.

目的探讨与分析不同模式高血压社区综合防治效果。方法全市实施三种模式:模式1(一般管理):78个社区执行农村公共卫生任务。模式2(综合管理):6个社区按疾控中心制定的《社区高血压综合防治方案》实施。模式3("三化"管理):32个社区按心脑血管病防治机构制定的《高血压社区综合干预规范》执行,实施规模化、规范化、信息化。结果模式1～模式3地区的高血压平均检出率分别为5.56%、5.97%、8.11%;高血压检出率≥8%的社区分别占11.69%、33.33%和56.25%。模式3地区的高血压控制率和服药率为79.41%、86.31%,均高于模式1和模式2地区。结论普及社区高血压综合干预的信息化管理和规范实施,强化质量控制,是提升防治效果的重要措施。

Objective To analysis the major death causes and life loss of malignant tumors in Shaoxing residents.Methods These indices,including standardized mortality rate,years of potential life lost(YPLL),index of life lost and working years of potential life lost(WYPLL) were used to analysis the death data on malignant tumors collected between July 1st 2006 and June 30th 2007 from Shangyu,Xinchang and Yuecheng districts of Shaoxing.Results The standardized mortality of malignant tumors was 161.85/100,000 in the residents,which lies on the top of death causes.The ratio of mortality for male to female was 1:0.5.The top five mortality of malignant tumors were stomach,lung,liver,esophageal and colorectal cancers.The mortality was different by areas and ages.There was positive correlation between mortality of malignant tumors and ages.The malignant-tumor-eliminated life expectancy was 79.73 years,increasing 3.3 years than life expectancy.YPLL was 40995.96,contributing to 40.56% of all potential life lost.Index of life lost was 16.29,taking up 19.89‰ for the potential rate of life lost,and WYPLL was 10.97 years.Conclusions Enhancing tumor prevention and control will be the focus in community-based comprehensive prevention task for the severity of malignant tumors on public health.

Objective Analyze hepatitis B virus(HBV)infection condition in adults,and provide scientific basis for building immune effects of HB vaccine in adults.Methods In Shaoxing city,randomly select 1309 adults between the age of 18 and 50,draw their venous blood and test HBsAg,anti-HBs and anti-HBc.Results 1236 adults completed the test and the testing rate was 94.42%.The positive rate of HBsAg was 7.61%,9.92% in men and 4.53% in women.Positive rates of HBsAg of different genders and ages showed significant difference(χ2=12.49,P<0.01).The positive rate of anti-HBs was 48.38%,46.60% in men and 50.75% in women.Anti-HBc positive rate was 53.12%%.Anti-HBs and anti-HBc levels of different ages and genders,according to statistical analysis,were on the whole identical.The infection rate of HBV three indexes was 72.01%,with a significant difference(χ2=8.05,P<0.05)among people of different ages.Conclusions The infection rate of HBV among people in Shaoxing is pretty high,suggesting that adults are the focal point against HBV infection.Our society should strengthen HBV immunization for adults,build effective immune barrier among people,and finally advance the control over Hepatitis B.

目的探讨质量控制在高血压社区综合干预中的作用。方法制定质量控制方案和流程,建立质量控制队伍,对质控员和社区医生进行分阶段、分层次的业务培训。采用网上抽查、电话问询、表格核对和现场督导等方式,对基线调查和随访阶段的血压、人体形态测量、表格填写、数据网络输入等重点环节进行质量控制。结果试点社区责任医生的业务水平和整体素质得到有效提高,调查表格填写的完整率、正确率和真实性显著上升,血压正确测量率由40.83%上升到90.10%,尾数偏爱现象明显减少,2周内体检和随访结果网络输入率上升至90%以上,随访率由35.21%提高到80.31%,个体化健康教育处方接收率75.23%,高血压病人的规律服药率由45.32%上升至76.32%,高血压病人的知晓率由26.52提高到95.32%,治疗率由29.14提高到80.62%,控制率由10.31%提高到61.12%,高血压社区综合干预成绩显著。结论质量控制是提升高血压社区综合干预效果的重要措施。