OBJECTIVETo understand the use of lipidemia related assistant examinations and lipid-lowering agents, the clinical ability among physicians in district and community hospitals in Beijing, and to evaluate the capability of dislipidemia diagnosis and treatment in these hospitals.

METHODSA survey was carried out in 42 hospitals in Chaoyang and Haidian district, including 9 district level hospitals, and the rest were at the community level. Questionnaire survey and in-depth interview were used to collect information from the leaders of related departments in those hospitals. A total number of 632 physicians in those hospitals were investigated, using a close book examination.

RESULTS100% of the hospitals could perform TC and TG tests; 87.5% and 72.5% of the hospitals had medications as statins and bile acid, respectively; 100% of the hospitals could test ALT and 40.0% of the hospitals could test CK. The correct rates of selecting treatment strategy and determining the appropriate treatment goals were 53.7% and 17.6%, respectively.

CONCLUSIONThe hardware condition of community hospitals seem to have satisfied the implicit requirements of dyslipidemia evaluation and treatment but it was essential to improve the knowledge and ability among physicians in community hospitals.

China ; Data Collection ; Dyslipidemias ; diagnosis ; therapy ; Hospitals, Community ; statistics & numerical data ; Humans ; Practice Patterns, Physicians'

OBJECTIVETo analyze the influence of knowledge about hypertension and clinical competence among physicians in district and community hospitals on management of hypertensives.

METHODSQuestionnaire investigation was used in 9 district and community hospitals in Chaoyang and Haidian district, including 181 physicians and 204 patients with hypertension.

RESULTS(1) The hospitals involved were divided into two groups according to our evaluation on the knowledge of hypertension and clinical competence of physicians. Four hospitals were graded as high-score group and 5 hospitals as low-score group. (2) There was no significant difference on physicians' evaluation between district and community hospitals. There was higher proportion of hypertensives with instructed physical exercises, reducing salt ingestion, psychological balance and weight reduction in district hospitals than those in community ones. (3) The proportion of hypertensives who were examined with funduscopy, ambulatory pressure and instructed with physical exercises, reducing salt ingestion and weight reduction in high-score group was obviously higher than that in low-score group. The control rates of blood pressure, on the days of examination during lastest check-up or the past three months, were significantly higher in high-score group than in low-score group (P < 0.05).

CONCLUSIONKnowledge of hypertension and clinical management competence among physicians in district and community hospitals did influence the management of hypertension and education of physicians and thus should be increased.

Clinical Competence ; standards ; Delivery of Health Care ; standards ; Directive Counseling ; standards ; Education, Medical ; standards ; Hospitals, Community ; classification ; standards ; Humans ; Hypertension ; diagnosis ; therapy ; Patient Care ; standards ; Physicians ; standards

OBJECTIVE(1) Building a macroscopical systematic-dynamic model of severe acute respiratory syndrome (SARS) transmission and disease control process. (2) To determine key variables on the control of SARS epidemic through computer simulation methodology, especially to analyze the effect of "screening for fever" practice during the epidemics. (3) To provide evidence for related decision-making.

METHODSParameters in the model were collected from local hospitals and municapal CDC through interview, questionnaire survey, literature review and case analysis. A systematic-dynamic model was built under similar studies. 'What-if' analysis was used during the simulation process.

RESULTS(1) The mean duration between disease onset and hospital admission, rate of contacts of each infectious individual as well as the rate of contacts in hospital of each infectious individual appeared to be the key variables in the process of SARS transmission. (2) Physician's alertness/sense and practice of self-protection on SARS, measures on quarantine and isolation to the patients, ventilation and disinfection process in the wards appeared to be the key variables for the control of epidemics. (3) "Screening for fever" practice on each patient at the entrance of the hospital did not seem to act as an important factor to the control of the epidemics.

CONCLUSIONThe health system in Beijing can control SARS epidemic rapidly based on current applied disease control measures and plan.

China ; epidemiology ; Computer Simulation ; Disease Outbreaks ; statistics & numerical data ; Epidemiologic Methods ; Humans ; Models, Biological ; Severe Acute Respiratory Syndrome ; epidemiology ; therapy ; transmission

OBJECTIVETo estimate the knowledge level and clinical ability of hypertension treatment among physicians in district and community hospitals in big and moderate cities.

METHODS43 district and community hospitals were selected by non-random sampling in Beijing and Baotou inner-Mongolia municipality. A total of 754 physicians in those hospitals were investigated, through an examination.

RESULTSThe correct rates on blood pressure stages, risk stratification and treatment strategy were 64%, 28% and 54%, respectively. The knowledge level on non-pharmacologic treatments was insufficient among physicians. The knowledge level of special indications on the common antihypertensive drugs (such as diuretics, beta-blockers, ACE inhibitors) was even worse.

CONCLUSIONPhysicians in district and community hospitals did not have enough knowledge and ability to fulfill the task of hypertension treatment and management.

Adult ; Antihypertensive Agents ; therapeutic use ; Clinical Competence ; standards ; Cross-Sectional Studies ; Education, Medical ; standards ; Female ; Hospitals, Community ; classification ; standards ; Humans ; Hypertension ; diagnosis ; therapy ; Male ; Patient Care ; standards ; Physicians ; standards

OBJECTIVETo study the use of hypertension related physical examinations, laboratory tests and anti-hypertension drugs among district and community based hospitals in Beijing and to analyze the possible hardware (examination, test, drug) problems under the application of the "China Hypertension Guide" in those hospitals.

METHODSThe survey was carried out in 40 hospitals in Chaoyang and Haidian districts, including 9 district level hospitals, and the rest at community level. Questionnaire survey and in-depth interview were used to collect information from the leaders of related departments in those hospitals.

RESULTS(1) The hardware condition of district hospital satisfied the implicit requirements of hypertension evaluation and treatment in "China hypertension Guide". (2) 64.5% of the community level hospitals had the basic equipments and routine laboratory tests for diagnosis and treatment on hypertension, but 35.5% of them lack of tests on blood chemistry (potassium, sodium, creatinine) and urine protein. (3) 71.0% of community level hospitals could not judge the patient's "target organ damage" independently. (4) Both district and community level hospitals had all major types of anti-hypertension drugs in there pharmacy except ARB.

CONCLUSIONWhen necessary laboratory tests for both district and community level hospitals were provided, they could accomplish the tasks of hypertension treatment and management. However, the community level hospitals should cooperate with hospitals at higher level to have a comprehensive clinical understanding of patients with high blood pressure.

China ; Clinical Laboratory Techniques ; statistics & numerical data ; Cross-Sectional Studies ; Diagnostic Services ; statistics & numerical data ; Hospitals, Community ; statistics & numerical data ; Humans ; Hypertension ; diagnosis ; drug therapy ; Pharmaceutical Services ; statistics & numerical data ; Surveys and Questionnaires

OBJECTIVETo explore the association of metabolic syndrome with CVD in a cohort study involving 11 provinces.

METHODSA cohort study was carried out in a population of 27 739 subjects (age 35 - 64 years). A baseline survey on the risk factor of cardiovascular disease was done in 1992. Incidence rate and relative risk were calculated for metabolic syndromes.

RESULTS(1) The age-standardized incidence rate of cardiovascular disease for metabolic syndromes (MS) was higher than those without (MS) in this cohort (MS 652.3/100,000, not MS 206.7/100,000, RR = 3.12, P < 0.001). (2) The incidence rate of cardiovascular disease for patients with hypertension but low HDL cholesterol and high waist was the highest (910.2/100,000 in man, 930.7/100,000 in woman) among all metabolic syndromes patients. (3) The predictive risk factors for cardiovascular disease were age, cigarette smoking, BMI, total cholesterol and metabolic syndrome in men, with age, BMI and metabolic syndrome in women.

CONCLUSIONThe incidence rate of cardiovascular disease on the metabolic syndrome was high in 11 provinces in China. Age, BMI and metabolic syndrome were the predictive risk factors of cardiovascular disease (especially of cerebrovascular disease). It is essential to prevent risk factors of cardiovascular disease in primary and secondary prevention programs in general population.

Adult ; Body Mass Index ; China ; epidemiology ; Cohort Studies ; Coronary Disease ; epidemiology ; etiology ; Female ; Humans ; Incidence ; Male ; Metabolic Syndrome ; complications ; epidemiology ; Middle Aged ; Proportional Hazards Models ; Risk Factors ; Smoking ; adverse effects ; Stroke ; epidemiology ; etiology

OBJECTIVETo analyse the trends of body mass index (BMI) and overweight in a population aged 25 through 64 years in Beijing.

METHODDuring 1984 to 1999, five cross-sectional surveys on cardiovascular disease (CVD) risk factors were carried out in the CVD monitoring population in Beijing. The mean levels and trends of BMI as well overweight in different sexs, age groups and areas were analysed.

RESULTS(1) In the period of 1984 to 1999, the mean BMI increased from 23.3 to 24.0 (kg/m(2)) in population aged 25 to 64 years, and overweight increased from 27.5% to 35.9%. (2) From 1984 to 1999, the prevalence of overweight increased from 23.5% to 43.3% in males. This increasing trend was seen in both urban and rural populations and in all age groups. Prevalence of overweight decreased from 36.0% to 23.3% in urban females, but increased from 28.4% to 46.0% in rural females. (3) From 1984 to 1999, prevalence of overweight increased from 29.1% to 31.8% in urban population, while 22.1% to 49.6% in rural population. BMI and prevalence of overweight were higher in urban than in rural (P < 0.05) in 1984 to 1985 but the levels in rural were approaching and exceeding the levels in urban (P < 0.05) in 1999.

CONCLUSIONTrends of BMI and overweight increased in the urban males and both males and females in the rural, while the increase of both BMI and overweight was seen more rapid in rural than in urban.

Adult ; Body Mass Index ; Body Weight ; Cardiovascular Diseases ; prevention & control ; China ; epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Male ; Mass Screening ; Middle Aged ; Obesity ; epidemiology ; prevention & control ; Prevalence ; Risk Factors ; Sampling Studies

BACKGROUNDOur previous studies suggested that low-dose gossypol combined with steroid hormones has a reversible antifertility role in adult male rats, and the course of treatment was shorter than that of either gossypol or steroid hormones alone. This result suggested that low-dose gossypol and steroid hormones have a drug synergistic effect on antifertility. The aim of the study was to find the target organs of the antifertility synergistic effect of the combined regimen.

METHODSThirty-two adult male rats were divided into four groups randomly: group GH, rats were fed orally with gossypol acetic acid (GA, 12.5 mg×kg(-1)×d(-1)) and desogestrel (DSG, 0.125 mg×kg(-1)×d(-1))/ethinylestradiol (EE, 0.025 mg×kg(-1)×d(-1))/testosterone undecanoate (TU, 100 mg×kg(-1)×d(-1)); group G, a single dose of GA (12.5 mg×kg(-1)×d(-1)) was given; group H, the same dosage of DSG/EE/TU as in group GH were administered; group C, rats were treated with vehicle (1% methyl cellulose) as control. Testes and epididymis were removed at 8 weeks post-treatment for evaluating their weight, volumes, volume fraction, and total volume of testicular tissue structures and the seminiferous tubule diameter using stereological assay. Sperm cell numbers and the motility of epididymal sperm were quantitated by flow cytometry and morphological methods.

RESULTSCompared with group C, spermatogenesis was normal in group G and suppressed in groups H and GH. Similar changes of testicular tissue structures and sperm number were found in groups H and GH. The decreases of epididymal sperm number and motility in group GH were greater than that of the low-dose gossypol or steroid hormones alone group.

CONCLUSIONSThe suppression of spermatogenesis was induced by steroid hormones in the combined regimen, and the epididymis was the target organ of low-dose gossypol. Combined use of low-dose gossypol and steroid hormones played a comprehensive antifertility role in their synergistic effect on reducing the number and motility of epididymal sperm.

Animals ; Desogestrel ; pharmacology ; Epididymis ; drug effects ; Ethinyl Estradiol ; pharmacology ; Flow Cytometry ; Gossypol ; analogs & derivatives ; pharmacology ; Male ; Random Allocation ; Rats ; Sperm Motility ; drug effects ; Spermatogenesis ; drug effects ; Spermatozoa ; drug effects ; Testis ; drug effects ; Testosterone ; analogs & derivatives ; pharmacology

OBJECTIVETo compare the impact of two different continuing education models: traditional model and a new model entitled "problem-oriented and case-based" mutual pattern and "train the trainer" course, on improving hypertension diagnosis and treatment competence of community physicians.

METHODSA total of 632 physicians from 22 district and community hospitals in Haidian district (new model) and 20 district and community hospitals in Chaoyang district (traditional model) in Beijing were trained during July to October 2002. The survey was carried out before and 2 years after training with examination questionnaire.

RESULTSThe competence evaluated as a score (maximal 100) for hypertension diagnosis and treatment of physicians was similar in physicians before training from the two districts. Post training, the score significantly increased from 40.0 to 47.4 (P < 0.01) in physicians from Chaoyang district and from 40.5 to 70.5 (P < 0.01) in physicians from Haidian district and the final score for physicians from Haidian district is significantly higher than that for physicians from increased from Chaoyang district (P < 0.01).

CONCLUSIONThe new model is more efficient for improving community physician's competence for diagnosing and treating hypertension.

Adult ; Clinical Competence ; Education, Medical, Continuing ; methods ; Female ; Hospitals, Community ; Humans ; Hypertension ; diagnosis ; therapy ; Male ; Physicians ; Practice Patterns, Physicians' ; Surveys and Questionnaires

OBJECTIVETo evaluate the association between serum total cholesterol (TC) and the risk of cardiovascular diseases (CVD) in subjects aged 35-64 years.

METHODSThis prospective study was performed from 1992 to 2002 in 11 provinces of China and the association between baseline TC level and the development of cardiovascular diseases was analyzed in 30 384 subjects aged 35-64 years using Cox multivariate proportional hazards regression.

RESULTS(1) Compared with the group of TC < 3.64 mmol/L (140 mg/dl), multivariate-adjusted relative risk of ischemic cardiovascular disease (ICVD, including CHD and ischemic stroke) increased continuously with increasing TC level. (2) TC level was positively related to the occurrence of ischemic stroke, but not to hemorrhagic stroke. The risk of CHD increased by 74% (RR = 1.743) and the risk of ischemic stroke increased by 12% (RR = 1.119) in the group with TC > or = 5.72 mmol/L compared with the group with TC < 5.72 mmol/L (220 mg/dl). (3) High serum cholesterol was responsible to 5.9% of ICVD, 11.7% of the acute CHD and 2.9% of the acute stroke. (4) At each TC level, the 10-year risk of ICVD increased in the presence of other risk factors.

CONCLUSIONStarting from TC of 3.64 mmol/L, the risk of ICVD increases continuously with increasing TC level. Multiple risk factor intervention should be strengthened to reduce the overall risk of CVD.

Adult ; Blood Chemical Analysis ; Cardiovascular Diseases ; blood ; epidemiology ; China ; epidemiology ; Cholesterol ; blood ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Factors