Objective: To investigate the trends in mortality of injury among elderly populations at ages of 60 years and greater in Huzhou City from 2010 to 2020, so as to provide the evidence for proposing preventive and control interventions of injury among the elderly. Methods : The death of injury among registered residents at ages of 60 years and older in Huzhou City from 2010 to 2020 were collected from Zhejiang Provincial Information Management System for Chronic Disease Surveillance. The mortality and main causes of injury were descriptively analyzed among the elderly, and the trends in mortality were analyzed using annual percent change ( APC ). Results: Totally 13 360 deaths occurred due to injury among elderly populations in Huzhou City from 2010 to 2020, and the mortality of injury appeared a tendency towards a rise with years ( APC=3.87%, P<0.05 ). The annual mean mortality and standardized mortality of injury were 199.89/105 and 192.68/105 among elderly populations in Huzhou City from 2010 to 2020. The overall mortality of injury was higher in men than in women during the period from 2010 to 2017, and higher mortality was seen in women than in men in 2020 ( P<0.05 ). The injury mortality in men and in women, and the overall mortality of injury all appeared a tendency towards a rise with ages ( P<0.05 ). The five most common causes of injury included fall ( 82.89/105 ), motor vehicle traffic accidents ( 26.45/105 ), suicide ( 18.52/105 ), drowning ( 16.88/105 ) and shipping accidents except motor vehicle ( 13.77/105 ), which accounted for 79.30% of all deaths due to injury. The mortality of fall in women ( APC=8.87%, P<0.05 ) and the overall mortality of fall ( APC=10.63%, P<0.05 ) both appeared a tendency towards a rise with years. Conclusion The mortality of injury appeared a tendency towards a rise and increased with ages among the elderly in Huzhou City from 2010 to 2020. Fall is the leading cause of death due to injury among the elderly.

Objective: To investigate the mortality and years of life lost due to drowning in Huzhou City from 2012 to 2021, so as to provide insights into drowning prevention and control. Methods: The mortality surveillance data on drowning in Huzhou City from 2012 to 2021 were collected from the Zhejiang Chronic Disease Surveillance Information Management System. The crude mortality and standardized mortality of drowning by the 2010 population census data in 2010, years of potential life lost (YPLL) and working years of potential life lost (WYPLL) due to drowning were calculated. In addition, the annual percent change (APC) was used to analyze the trends in drowning mortality and the rate of YPLL and WYPLL in Huzhou City from 2012 to 2021. Results: A total of 1 681 deaths occurred due to drowning in Huzhou City from 2012 to 2021, accounting for 9.11% of total injury deaths. The overall mortality and standardized mortality of drowning were 6.35/105 and 4.70/105, respectively, and mortality and standardized mortality of drowning were 6.95/105 and 5.44/105 in men and 5.76/105 and 3.98/105 in women, respectively. The highest mortality of drowning was found in residents at ages of 65 years and older (16.04/105 to 27.02/105), followed by in residents at ages of less than 5 years (2.54/105 to 16.37/105). The overall mortality of drowning was 5.29/105 to 7.21/105 among residents in Huzhou City from 2012 to 2021, and no significant change tendency was seen (APC=-2.18%, t=-2.085, P=0.071). The standardized mortality of drowning reduced from 6.10/105 to 3.69/105 (APC=-4.88%, t=-4.215, P=0.003). In addition, the YPLL and rate of YPLL, and WYPLL and the rate of WYPLL due to drowning mortality were 22 620.50 person-years, 0.10%, 17 956.50 person-years and 0.08% in Huzhou City from 2012 to 2021, respectively, and the rates of YPLL (APC=-6.95%, t=-3.203, P=0.016) and WYPLL (APC=-7.60%, t=-3.126, P=0.014) both appeared a tendency towards a decline from 2012 to 2021. Conclusions The standardized mortality of drowning and rate of YPLL appeared a tendency towards a decline among residents living in Huzhou City from 2012 to 2021, and residents at ages of 65 years and older and less than 5 years are high-risk populations for management of drowning mortality.

Objective: To investigate the prevalence and influencing factors of comorbidity of chronic diseases among hypertensive patients with uncontrolled blood pressure in Huzhou City, so as to provide insights into community hypertension control. Methods: Hypertensive patients with uncontrolled blood pressure at ages of 35 to 74 years were sampled using a cluster random sampling method from 5 districts (counties) of Huzhou City. Participants' demographics, living behaviors, and development of chronic diseases were collected using questionnaires, and the height, body weight, waist circumference and blood pressure were measured. Blood glucose, blood lipid and other biochemical parameters were detected, and the number and combination of comorbidity of chronic diseases were descriptively analyzed. Factors affecting the comorbidity of chronic diseases were identified using a multivariable ordinal logistic regression model. Results: A total of 1 215 respondents were included, with a mean age of (60.83±7.76) years, and including 652 men (53.66%) and 563 women (46.34%). The prevalence of dyslipidemia, diabetes, hyperuricemia and cardiac encephalopathy was 45.10%, 30.95%, 23.05% and 5.10%, respectively. The prevalence of comorbidity of chronic diseases was 69.22% among respondents, and there were 497 respondents with one comorbidity (40.91%), 272 with two comorbidities (22.39%) and 72 with three and more comorbidities (5.93%). Hypertension+dyslipidemia (20.74%), hypertension+diabetes+dyslipidemia (9.96%) and hypertension+diabetes+dyslipidemia+hyperuricemia (4.36%) were predominant comorbid combinations. Multivariable ordinal logistic regression analysis showed that participants with overweight (OR=1.782, 95%CI: 1.390-2.286), obesity (OR=2.411, 95%CI: 1.802-3.222), grade 2 hypertension (OR=1.438, 95%CI: 1.077-1.919) had a higher risk of multiple comorbidities than those with normal body mass index and controlled blood pressure, and women (OR=0.563, 95%CI: 0.456-0.696) had a lower risk of multiple comorbidities than men. Conclusions The prevalence of comorbidity of chronic diseases was 69.22% among community hypertensive patients with uncontrolled blood pressure in Huzhou City, and the comorbidity of chronic diseases mainly included dyslipidemia and diabetes. Men, overweight, obesity and hypertension resulted in a high risk of comorbidity of chronic diseases.

Based on their inherent relationship,some independent and verifying experiments of medical immunology were intergrated into a series of comprehensive and open experiments,which was embodied in the preparations of antiserum.so as to set up a new experiment teaching system emphasizing the training of student comprehensive capability.Achievements in training students'scientific research capacity,innovative motivation and practical working ability have been obtained and the results could provide valuable experience for innovation and reform of medical immunology experiment teaching model and method.

Objective: To establish an evaluation index system for health education of hand,foot and mouth disease（HFMD）in nursery children by Delphi method. Methods: After referring to the relevant literature,an initial health education index system for HFMD of nursery children was established,including four first-level indicators,twelve second-level indicators and forty-six third-level indicators. Two rounds of expert consultation were conducted according to Delphi method. The enthusiasm of experts was evaluated by response rate,and the authority of experts was evaluated by authority and variation coefficient. The consultation questionnaire in the second round was based on the results of the first round and was scored again in the same way. Then the evaluation index system of HFMD health education for nursery children was finally determined. Results: Thirteen experts participated in two rounds of consultation,including four aged 40-49 years and nine aged 50-59 years;two of deputy senior title and eleven of senior title;one worked in the health administration department,six in the CDC,five in health education institutions and one in kindergarten. The two rounds of expert consultation were carried out effectively within the time set and the response rate reached 100%. In the first round,the judgment coefficient,familiarity coefficient and authority coefficient were 0.92±0.06,0.85±0.12 and 0.88±0.06,respectively. One first-level indicator,two second-level indicators and twelve third-level indicators were added,seven third-level indicators were deleted,and the contents of one second-level indicator and ten third-level indicators were improved in the first round. In the second round,the judgment coefficient,familiarity coefficient and authority coefficient were 0.95±0.07,0.88±0.10 and 0.91±0.06,respectively. The coordination coefficients of the first-,second- and third-level indicators in the second round were 0.170,0.166 and 0.283,respectively,and the coefficients of variation were all less than 0.25. After two rounds of discussion,five first-level indicators,fourteen second-level indicators and fifty-two third-level indicators were finally established as the evaluation index system of HFMD health education for nursery children. Conclusion The evaluation index system of HFMD health education for nursery children established by Delphi method has high authority and practicability,and it can be used to comprehensively evaluate the effects of HFMD health education on nursery children.

Objective: To investigate the effect of continuous iliac fascia space block on the placement of body position and postoperative analgesia in patients with femoral fractures. Methods: 60 patients with senile selective unilateral femoral fracture, aged 68-87 years old, weight 49-70kg, ASA grade II-III were selected, and they were randomly divided into iliac fascia block group (A group) and intravenous analgesia group (B group) according to the digital, 30 cases in each group.The two groups underwent lumbar epidural anesthesia, A group received continuous fascia iliaca compartment block 15 min before the the body position.B group was routinely given combination of lumbar and hard anesthesia.After operation, A group was connected with the automatic infusion pump continuous infusion of 0.2% ropivacaine 0.1mL·kg^-1·h^-1.B group received controlled intravenous analgesia, postoperative given loading dose of dezocine intravenous infusion of 5mg with automatic injection pump for dezocine 0.01mg·kg^-1·h^-1.When the patients entered the room (T0) and just after the placement of the body position (T1), the heart rate, diastolic blood pressure and systolic blood pressure were measured and recorded.At postoperative 2, 4, 6, 12, 24 and 48h, the VAS scores and pethidine usage during surgery, the adverse reaction were recorded. Results: The heart rate, diastolic pressure and systolic pressure at T1 in A group had no significant change compared with T0 (all P>0.05). The heart rate, diastolic pressure and systolic pressure in the control group (B group) at T1 were significantly higher than at T0(t=5.302, 7.369, 5.629, all P<0.05). At T1, T2, T4, T6, T12, T24 and T48, the pain VAS scores in A group were lower than those in B group (t₁=66.401, t₂=7.719, t₄=25.260, t₆=13.170, t₁₂=3.837, t₂₄=3.081, t₄₈=6.202.all P<0.05). The study group had no complications such as puncture hematoma, intoxication of local anesthetic and other complications. Conclusion Continuous iliofascial block can provide continuous analgesia for elderly patients with femoral fractures.It is safe and effective, and is easy to perform.It provides favorable conditions for later operative treatment.

Diagnostics is one of the most important bridge courses for medical students from basic to clinical. Doctor-patient communication runs through the whole process of patient diagnosis and treatment. How to improve medical students' ability of doctor-patient communication? Our teaching team has carried out continuous reform and explored the scientific effective teaching mode. Recently, through the construction of "doctor-patient communication skills" quality online course, efforts have made to build an online and offline blended learning mode, which has gradually realize the integration with diagnostics teaching, and has achieved remarkable results. It also provides a scientific practical basis for the integration of doctor-patient communication and other clinical courses, which is worthy of promotion.

Objective: To investigate hand hygiene of children in kindergartens in Huzhou City, so as to provide basis for improving hand hygiene and conduct health education on hand hygiene related diseases. Methods: A total of 343 children in 6 kindergartens in two districts of Huzhou City were observed by stratified cluster random sampling and observation. Results: A total of 1 042 hand hygiene indications and 886 hand washing (85.03%). The overall hand-washing qualification rate was 53.35%. Within different kindergartens, children in the lowest level kindergartens had poor hand washing habits. There was a positive correlation between levels of kindergarten and children’s hand washing habits. Boys’ hand washing habits were relatively poor, 45.35 percent of boys’ had substandard hand washing habits, which was only 19.88 percent of girl. The hand hygiene behavior of children in primary class was better than that of middle class. The proportion of substandard hand washing of children in primary class and middle class was 23.13% and 39.80% respectively. Conclusion There is a big promotion space of hand hygiene habits of children in kindergartens, so it is necessary to strengthen compliance with hand hygiene and cultivate correct hand hygiene habits.

Objective: To understand knowledge and awareness of hand-foot-mouth disease (HFMD) and associated factors among parents of kindergarten children in urban district of Huzhou City and to provide a veference for making effective measure of health education of HFMD. Methods: Self-designed questionnaire was used to investigate 851 parents from 6 kindergartens by stratified cluster random sampling. Results: The overall recognition of HFMD was 8.15±3.43, and the qualified rate was 5.17%. Awareness rates of sources, transmission routes, symptoms and signs, as well as preventive measures were 34.08%, 20.80%, 3.41% and 30.32%, respectively. Multiple linear regression analysis showed that kindergarten type(B=-1.07), gender(B=0.70), age(B=-0.41), education level(B=1.60), occupation (B=-1.37) associated with awareness of HFMD (P<0.05).The top three sources of HFMD prevention and treatment were mobile messages(45.24%), kindergarten lectures (43.24%) and brochure/propaganda column(40.19%) . Conclusion The general knowledge and awareness of HFMD among parents of kindergartens children’s parents is low in urban district of Huzhou city. In order to improve the awareness and health-related behaviors among parents of kindergarten children to prevent HFMD, child care institutions and basic public health service health education programs should be relied on, to carry out appropriate health communication and intervention.

Objectives To evaluate the effects of "disease-characteristics nursing quality improvement" program(DNQIP)combined with targeted monitoring in reducing the incidence of ventilator associated pneumonia (VAP)among patients with mechanical ventilation and to provide evidence for the prevention of VAP. Methods This was a prospective intervention study. All mechanical ventilation patients admitted in stroke intensive care unit(SICU)of our hospital from 2007 to 2015 were selected as the research object. Targeted monitoring was implemented in patients admitted from 2007 to 2011,and DNQIP was formed based on the monitoring results. DNQIP combined with targeted monitoring was implemented from 2012 to 2013 as the first phase,and the second phase was from 2014 to 2015.Results From 2007 to 2015,the number of new patients per year and the total time of using breathing machine in SICU presented a tendency of increasing while the number of patients with VAP and the incidence of VAP presented a tendency of decreasing year by year. The implementation of DNQIP in the first phase from 2012 to 2013(incidence of VAP was 5.4 ‰),compared with the data before implementation from 2007 to 2011(incidence of VAP was 13.8‰),the incidence of VAP was significantly reduced(χ2=9.029,P=0.003). The incidence of VAP(5.3‰)in the second phase from 2014 to 2015,was significantly reduced compared with the incidence of VAP(13.8‰)from 2007 to 2011(χ2=9.559, P=0.002).Conclusions The implementation of targeted monitoring is helpful in finding problems existing in the prevention of VAP. DNQIP in patients with mechanical ventilation can effectively reduce the incidence of VAP and can refine professional assessment and health education. It is also good for the standardization and evidence-based care in the whole process provided for patients. DNQIP combined with targeted monitoring can realize the continuous quality improvement on the basis of evidence-based theory.