目的:测算和分析深圳市坪山新区社区健康服务中心(以下简称“社康中心”)运行效率,为提高社康中心运行效率提供参考.方法:采用Bootstrap-DEA方法测算坪山新区21家社康中心2012-2014年社区健康服务效率,使用Malmquist-DEA指数分析社康中心全要素生产率及其分解指数变化趋势.结果:2012-2014年21家社康中心的效率值经过Bootstrap纠偏后均低于纠偏前;Bootstrap-DEA效率值低于均数的分别有6家、8家、8家,效率值属于“差”(＜0.600)的社康中心分别有0家、2家、3家.2012-2014年样本社康中心全要素生产率整体呈进步趋势(年增幅9.4％),技术效率整体呈下降趋势(年降幅4.3％),技术进步与全要素生产率变化趋势一致(年增幅14.3％).结论:Bootstrap-DEA方法较传统DEA方法提高了效率测算的精度.整体上坪山新区社康中心全要素生产率的提高主要源自技术进步,但技术效率下降.社康中心一方面需要增加高水平的医务人员,激发规模效率;一方面需要开展绩效评价、绩效标杆、跨组织学习,通过提升内部管理,提升纯技术效率.

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.