2013年 · 第07卷第06期

Community is an important territory of health management practice. This journal has always advocated community doctors and functional community managers to pay attention to the application and research of health management in the community. This issue has specially organized the key number of community health management for readers to learn from.

International experience has proved that health management has made a fruitful contribution to "improving the health level of community residents and controlling the total medical and health expenses". On the basis of summarizing international experience, this paper puts forward the theory and practice of community health management, constructs four health management homes in community health service centers, and uses eight health management modules in each health management home to intervene. The theory of intervention is the four links (4C) of health management, which is the "4CH8" health management model^[1,2,3,4,5]。

Among cadaveric kidney donors, the age of donors has a great influence on the function of postoperative transplanted kidney^[1]Donor age>50 years was an independent risk factor affecting the survival of transplanted kidney. Donor age does not appear to be considered a serious problem affecting the survival of transplanted kidneys in kinship living donor kidney transplantation due to the preoperative stringent assessment of donor kidney function and the superior injury factors such as ischemia-reperfusion of the transplanted kidney over cadaveric kidney transplantation. However, in recent years, due to the shortage of donor kidney sources, the number of living donor kidney transplantation of elderly relatives at home and abroad has increased year by year. The influence of donor age on postoperative kidney transplantation in relatives' living donor kidney transplantation has been more and more concerned.

Stroke is a common disease that endangers human health, with a high disability rate, which has a great impact on patients' mental health and easily causes patients' quality of life to decline. The incidence of post-stroke depression (PSD) varies among scholars, up to 79%^[1]。 This paper uses the combination of health education and conventional treatment to explore the influence of medication compliance, treatment attitude and daily living activities in patients with post-stroke depression. A controlled study was conducted on this, and the report is as follows.

With the improvement of living standards, health examination has gradually attracted much attention. Our unit undertakes the physical examination work of several civil servants and health institutions in Beijing. Because of the special nature of their work, medical workers are slightly different in the incidence of diseases than other institutions. However, medical workers often neglect their own physical examination because of their busy work and the convenience of seeking medical treatment. In order to improve the awareness of medical workers' physical examination, the results of medical workers' color ultrasound physical examination are statistically analyzed.

Thyroid disease is one of the most common diseases of the endocrine system. In recent years, the incidence rate has been increasing rapidly year by year. Especially, thyroid nodules are very common in clinic and have become the most important diseases in thyroid diseases. The detection rate of thyroid nodules by hand palpation is about 5%, and the detection rate by ultrasound is 10 times higher, reaching about 50%^[1]。 Thyroid disease has seriously affected public health and consumed medical resources, which requires the concern of government departments and medical circles^[2]。 In this paper, the incidence of common thyroid diseases in adults in healthy people was retrospectively investigated by physical examination.

Diet control is one of the important measures in the comprehensive treatment of diabetes^[1]。 Clinicians all know the dietary principles of diabetic patients and the calculation methods of calories. Various textbooks and popular science readings also introduce in detail the fixation methods, coarse algorithms and fine algorithms of various nutrients and calories in diabetic patients^[2,3,4]。 Although fine algorithm is scientific and accurate, it is difficult to apply to clinical practice because of its complexity in calculation. However, the fixed method and coarse algorithm are difficult to cope with the individual complex situation of patients, which greatly reduces the effect of reasonable dietary health education for diabetic patients. Therefore, according to the existing theories of dietary treatment of diabetes, the author explored, and summarized the fast estimation method of food portion suitable for the balanced dietary needs of diabetic patients.

Chronic non-communicable disease, referred to as non-communicable chronic disease (NCD), is a general term for a class of diseases with hidden cause, long duration, slow development, complicated course and some have not been fully confirmed. Including "diabetes, malignant tumors, cardiovascular and cerebrovascular diseases (hypertension, stroke, coronary heart disease, etc.), chronic obstructive pulmonary disease (chronic tracheitis, emphysema, etc.), digestive system diseases and mental abnormalities" and other diseases, which mainly harm the heart, brain, kidney and other important organs, seriously affecting patients' working ability and quality of life. Due to the long course of disease and expensive medical expenses, it greatly increases the economic burden of society and families. These diseases are mainly caused by exposure to factors such as "occupational and environmental factors, lifestyle and behavioral patterns, individual and genetic"^[1,2]Including factors such as population aging, smoking, excessive drinking, obesity, less physical activity, and poor mental condition^[3]Many people are in a "third state" between onset and non-onset^[4]。

In recent years, it has been found that the intestinal ecological environment is closely related to human health, which has attracted increasing attention of scholars at home and abroad. Intestinal flora is related to food decomposition, nutrient absorption and metabolism, endocrine function and pro-inflammatory response in the intestine. The imbalance of intestinal flora can affect the energy metabolism balance of the host, thus leading to a variety of chronic metabolic diseases, such as obesity and diabetes. Because the composition of intestinal flora and its metabolism are different due to different dietary habits, it can be seen that diet has an important influence on intestinal flora. At present, there are few studies on the influence of diet on intestinal flora and diabetes mellitus. This article reviews the related studies.

Primary osteoporosis (OP) is a systemic bone disease^[1]It is characterized by reduced bone mass and destruction of bone tissue microstructure, which in turn leads to increased bone brittleness and fracture. Numerous studies have shown that OP is closely related to many lifestyle habits. Based on this, the author investigated the current situation of OP at home and abroad, and found that there are problems such as "attaching importance to existing diseases, neglecting prevention, and failing to reflect the preventive thought of traditional Chinese medicine", which are summarized as follows.

The family doctor system has developed maturely abroad^[1]In 2010, Shanghai began to build a family doctor service model, with the goal that each family doctor is responsible for managing the health of 2,000 to 3,000 residents. The service model of family doctor system has been developed in Shanghai, Beijing and other provinces and cities one after another, but there are not many literature reports on how to evaluate the community health service of family doctor system. Therefore, the author studied the evaluation index system of community health service management mainly based on family doctors.

Medical risk management refers to the organized and systematic elimination or reduction of the harm and economic loss of medical risks in hospitals. Through the analysis of medical risks, the preventive measures of medical risks are sought to reduce the occurrence of medical care risks as much as possible, and the harm to patients and hospitals is reduced^[1]。 The nursing behavior in the physical examination center is faced with people of different age, education level and health status. The nursing work is diverse and flexible, and there are many sudden situations, which is high risk^[2]The probability of error is relatively high^[3]The risk of disputes and complaints. Since January 2011, the center has conducted investigation and analysis on the risk factors of each position, and adopted a series of risk management measures, which have achieved considerable results. The specific contents are summarized as follows.

Blood collection is the most fearful examination item for physical examination customers, and it is also the link with high incidence of occupational exposure and cross-infection of staff. Therefore, strengthening the quality management of venous blood collection is an important work for physical examination center managers. The physical examination center of our hospital began to grasp this work in June, 2012, and has gone through the theoretical study stage, standardized process stage, operation training and assessment stage, practical application stage and continuous improvement stage. The center randomly distributes 1,000 customer satisfaction questionnaires every month, involving comprehensive service evaluation of 15 jobs. The feedback results show that the average service quality rate of blood collection room is 92.37% in the first 6 months of rectification, and it reaches 98.04% in the first 3 months of rectification. The effect is obvious. The experience is introduced as follows:

Recently, a large-sample cohort study from Hong Kong, China, reported the relationship between smoking and hemorrhagic stroke (cerebral hemorrhage, subarachnoid hemorrhage). The researchers used multivariate Cox regression analysis to assess the association of baseline smoking with mortality from hemorrhagic stroke. Between July 1998 and December 2001, 66 820 aged people were admitted to 18 geriatric health centres<A 65-year-old was followed up until 31 May 2012. The results showed that a total of 648 patients died of hemorrhagic stroke after an average follow-up of 10.9 years, of which 530 (82%) were cerebral hemorrhage. Current smokers had a higher risk of hemorrhagic stroke after adjusting for factors such as age, gender, education, public support, housing type, monthly expenditure, alcohol volume, and exercise (RR=2.19,95%CI: 1.49~3.22), of which cerebral hemorrhage (RR=1.94,95%CI: 1.25~3.01), subarachnoid hemorrhage (RR=3.58,95%CI：1.62~7.94）。 After further correction for hypertension and BMI, the results showed only slight changes. Thus, smoking is strongly associated with mortality from hemorrhagic Stroke, particularly subarachnoid hemorrhage (Stroke, 2013, 44: 2144-2149).