2010年 · 第04卷第02期

Community health management is the whole process of personal and family skills to comprehensively monitor, analyze, evaluate, predict, prevent, maintain and develop health risk factors of community healthy people and disease people. Implementing community health management is a qualitative leap from passive disease treatment to active health management. Community health management puts the base of health management rooted in the community, and has the all-round advantages of improving social fairness, carrying forward community initiative and solving people's livelihood problems with the greatest effort.

Health records are systematic documents that record the health status of residents, and are problem-centered health records for community residents. With the in-depth development of community health services, health records are an important tool to provide us with continuous, comprehensive and coordinated healthcare services^[1]It provides community doctors with complete and systematic residents' health status data, which can help community doctors to comprehensively grasp the health status of community residents. It plays an important role in understanding the basic data of the population, comprehensively evaluating the health of community residents, carrying out individualized diagnosis and treatment activities, and promoting the standardized management of community health services. At present, many provinces, cities and regions have started or have established health records for residents. Establishing health records and carrying out effective management and utilization has become the key task of community health. In 2008, Beijing completed the work of establishing unified health records for community residents, and gradually realized the information management of health records by using the unified community health information system in the whole city.

As we all know, health is the foundation of people's all-round development and the main propeller of China's modern economy. China's healthy accumulation from 1950s to 1980s has provided abundant human resources for rapid economic development. However, in the past 20 years, the aging of the population, new and recurring infectious diseases, chronic non-communicable diseases and other problems have brought serious threats to people's health and national economy. The current mode of "seeking medical treatment after illness" has driven the medical expenses to rise day by day, resulting in the imbalance of social economy, medical and health care and people's health needs, and bringing great challenges to medical and health services. In the face of challenges, we must focus on prevention and scientifically manage national health resources. "Health protects the well-off, and the well-off depends on health". One of the keys to realize scientific development is to solve the health problems of the people reasonably, and the health resources of the people are the root of sustainable development.

Cervical cancer is the second most common cancer in women worldwide, which is a serious threat to women's health. Around 288,000 people die every year worldwide. According to WHO estimates, 510,000 new cases occur each year, about 80 percent of which are in developing countries, including 68,000 in Africa, 77,000 in Latin America and 245,000 in Asia^[1]。 The annual incidence of cervical cancer in China is estimated at 138,000^[2]The morbidity and mortality rate account for about 1/3 of the world's. Since 2003, our hospital has performed regular cervical fluid-based cell (TCT) screening on female employees aged 22-65 years in a unit in Shenzhen for seven consecutive years, and performed colposcopic biopsy on patients with cervical intraepithelial neoplasm (CIN) with precancerous lesions. To explore the application value of regular TCT screening in healthy people for early diagnosis of cervical cancer.

With the development of social economy, chronic diseases, mainly cardiovascular and cerebrovascular diseases, hypertension, diabetes and respiratory diseases, have become important public health problems in China, and the main factors affecting the health of labor force, the increase of residents' medical expenses and the return to poverty due to illness, causing huge losses to labor force and social economy. In order to understand the current health status of Jinan residents, this study collected the physical examination results of 73 402 physical examiners who came to the health examination center of Shandong Provincial Hospital for physical examination in the past 4 years. Through statistical analysis of physical examination results, we can understand the common chronic diseases and main risk factors that affect the health of residents in Jinan, and provide scientific basis for taking targeted prevention and treatment measures.

Arteriosclerosis is a multi-etiological disease, among which increasing age, hypertension, hyperlipidemia, diabetes, and smoking are considered as the five major risk factors. The development of arteriosclerosis is silent, and most people have severe artery stenosis after the onset of the disease, which progresses to advanced stage. Therefore, early prevention and early diagnosis are very important. With the advancement of the focus of clinical prevention and treatment. brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) have been used to detect the structure and function of arterial vessels^[1]。 In this study, baPWV and ABI were used to indicate subclinical arteriosclerosis. The data of patients with no history of disease and normal blood pressure and blood glucose were mainly analyzed, and patients with hypertension and diabetes were used as controls to understand the relationship between abnormal blood lipids and subclinical arteriosclerosis, and their respective possible influencing factors.

There are 9,760 cases of elderly people over 70 years old in Sanlin Community of Shanghai. Sanlin Community Health Service Center began to establish health records for the elderly in July 2000, so as to understand the health needs and health status of the elderly and their views on community medical care charges. In October 2008, the author conducted a survey on the needs and willingness of 3164 elderly people in the community, aiming at clarifying the necessity of building a community service system for the elderly under the condition that the population is ageing continuously and the social security is not perfect, putting forward the basis for expanding the content of community health service, and carrying out various services and extended services according to the needs of the elderly in the community.

As the prevalence of hyperuricemia increases, studies have found^[1]Hyperuricemia is closely related to age, sex, blood lipid, blood glucose, blood pressure, body mass index, etc. In order to study the related indicators of on-the-job hyperuricemia in Chengdu, Chengdu Anshengmei Health Physical Examination Center conducted a survey on 1,482 on-the-job employees of a public institution in Chengdu, and comprehensively analyzed the physical examination results and health questionnaires. The report is as follows.

As an indispensable component of diabetes treatment, diabetes education and management have gradually occupied a dominant position in the long-term treatment of diabetes because it can effectively control the condition of diabetes patients, reduce the occurrence of complications, improve the quality of life and survival rate^[1]。 In recent years, there have been many studies and progress on diabetes education mode. Since 2005, our department took the lead in introducing the advanced education management mode of "diabetes self-management school" in Germany in China, and founded the first diabetes self-management school in China. The school applies an original multidisciplinary collaboration mode to educate and train diabetic patients. The construction, operation and effect evaluation of this mode are reported as follows.

With the acceleration of the world's population aging, the health status and health needs of the elderly are being paid more and more attention. How to start from the whole of people, multi-dimensional, comprehensive and scientific implementation of comprehensive health status assessment of the elderly is the key to carry out health management of the elderly and achieve the goal of healthy aging. In recent 30 years, the research on comprehensive health status assessment of the elderly has developed rapidly at home and abroad, and it has become one of the important research directions in the field of geriatrics and health management.

At present, hypertension has become an important public health problem that threatens people's life and health. The results of the 2002 Chinese Resident Nutrition and Health Survey and the 3rd National Health Service Survey in 2003 showed that there were at least 174 million hypertensive patients in China, and hypertension was the most important risk factor for coronary heart disease and stroke. Compared with the normal population, the incidence of stroke in hypertensive patients increased by 2.6 to 2.8 times, the incidence of angina pectoris increased by 2 to 2.2 times, and the incidence of congestive heart failure increased by 3 to 4 times. The economic burden of hypertension is huge, and the direct economic burden of coronary heart disease and stroke caused by hypertension accounts for nearly 50% of the direct disease burden of these two diseases^[1]。 The epidemiological results of hypertension in 14 provinces and cities in China show that the total prevalence of hypertension in China has reached 27.9%, and the prevalence of hypertension is still rising continuously. The awareness rate of hypertension was 60.7%, the treatment rate was 37.7%, and the control rate was 5.7%^[2]。 Therefore, the prevention and treatment of hypertension in China is very severe and urgent.

In recent years, with the rapid development of social economy, the aging of population and the change of people's lifestyle, the prevalence of chronic diseases in China has shown a rapid upward trend, and gradually becomes the main reason threatening the life and health of urban and rural residents in China. According to the third national retrospective sampling survey report, cardiovascular and cerebrovascular diseases, malignant tumors and chronic respiratory diseases have become the most important causes of death in urban and rural residents in China, and the proportion of these diseases has reached 82.5% of the total mortality rate^[1]。 The results of the Fourth National Health Service Survey released by the Ministry of Health also show that the prevalence rate of chronic diseases among Chinese residents in 2008 was 20%. Based on this calculation, the number of chronic diseases diagnosed by doctors in China reached 260 million^[2]。

Population aging is a major social problem in the 21st century, which is related to social stability and population security. China has entered the ranks of countries with elderly population in 1999, which is the country with the fastest aging rate in the world and the largest elderly population in the world. By the end of 2005, the population over 60 years old in China had reached 144 million, accounting for half of the elderly population in Asia and one fifth of the global elderly population. It is estimated that by 2020, the elderly population will reach 248 million, and the aging level will reach 17.17%. By 2023, the number of elderly people will increase to 270 million, equal to the number of children aged 0-14. By 2050, the total number of elderly people will exceed 400 million, and the aging level will be pushed to over 30%^[1]。 The progress of population aging not only affects the social and economic development of our country, but also brings severe challenges to health care services. Therefore, it is of great significance to study the problem of aging to construct a harmonious society in China. Through the analysis of healthy aging and health management, this paper puts forward the suggestion that the health management of the elderly should be implemented in the community in order to realize healthy aging.

With the development of economy and society and the transformation of medical mode, it is an inevitable choice for cadres to take scientific and effective measures, implement cadres' health management and implement the important prevention and treatment thought of "treating disease before disease" in traditional Chinese medicine. Since 2007, we have developed a computer intelligent analysis model of TCM constitution identification by using modern information technology in cadres' health examination, and used the latest national standard of TCM constitution classification and judgment to analyze the constitution identification scale, classify the constitution of cadres for physical examination, make personalized assessment of their health status, determine their health status, analyze the tendency to be prone to diseases in a targeted way, and formulate detailed and feasible individualized care plans to slow down the natural process of disease occurrence, development and deterioration, improve the health level of cadres, promote the healthy development of cadres' health management, promote the scientific, standardized, digital, intelligent and systematic health management of cadres, and promote the modernization of TCM.

Early detection of tumor is an important link in tumor prevention and treatment. The screening of cancer types such as large intestine is relatively mature^[1]However, due to the large population, it is not possible to spend a lot of health funds on large-scale cancer screening. Through the Health Management Program in the United States, the incidence of disease among residents dropped significantly from 1978 to 1983^[2]。 Shanghai Minhang District has implemented the health management model in early detection of tumors in the community, and achieved certain results.

Pilots are a special group, their work psychological load is heavy, labor intensity is high. Epidemiological investigations indicate that^[1]The incidence of hyperlipidemia and fatty liver among pilots is increasing year by year, and scientific and reasonable diet is an important factor to control the incidence of hyperlipidemia and fatty liver, and it is also the basic guarantee to improve the combat effectiveness of pilots. In order to understand the dietary intake of our army pilots, and at the same time to further revise and adjust the nutrient supply and food quantitative standards of our army pilots, we selected four air crew stoves of flying units in the south and north of China from 2006 to 2007, and completed the dietary survey of air force pilots. The situation of this survey is introduced as follows.

Health management is a new medical model to promote people's physical and mental health^[1,2]By using oral health management technology and services to establish a health management platform that meets the characteristics and needs of health care objects, and implementing comprehensive oral health care services integrating oral health examination, health evaluation and health improvement for health care objects, the oral health level of health care objects will be improved.

maintenance hemodialysis (MHD) is the most important treatment for patients with end stage renal disease (ESRD) in China. As a special group of chronic diseases, MHD patients' self-health management is closely related to their health-related quality life (HRQOL)^[1]Kidney specialist medical staff should pay sufficient attention to self-health management education and behavior of MHD patients.

How to arrange personnel training reasonably is the emphasis of health education management departments at present. Therefore, we conducted a survey of health education personnel in disease prevention and control institutions throughout the city, and conducted a training needs assessment for them, which provided a reference for relevant departments to determine training objectives and formulate training plans.

Health management is still an emerging comprehensive discipline in China, and the discipline team is not very sound. When we reviewed the Chinese Journal of Health Management, we found that the number of references to treatise articles is generally small and irregular. The phenomenon that other articles do not indicate the source when citing other people's works often occurs, which is also a common phenomenon in the primary development stage of the discipline. Therefore, it is necessary to put forward further requirements and standards according to the description of the reference documents in this journal.

After the peaceful rise, China's health demand has skyrocketed. However, under the rule of biomedical model, China's medical and health system has not kept pace with the times, and it is not capable of comprehensively providing the health information that Chinese people urgently need. Because the supply of health information exceeds the demand, there is a phenomenon of confusion. An important reason for the existence of this phenomenon is that Chinese people's health literacy is generally not high. According to a recent survey by the China Health Education Center, less than 7% of Chinese people have passed the level of health literacy. Therefore, improving the health literacy of Chinese people is the key. We must believe in science, but we must not be superstitious about science. To improve health literacy, it is necessary to understand the framework of epidemiological judgment causality. If everyone can understand this framework, we will not be so casual when we talk, then there is no basis, and we will not sometimes make ourselves very embarrassed and embarrassed.