Songjiang District Research Articles

Tuberculosis in an Urban Area in China: Differences between Urban Migrants and Local Residents

BackgroundThe increase in urban migrants is one of major challenges for tuberculosis control in China. The different characteristics of tuberculosis cases between urban migrants and local residents in China have not been investigated before.Methodology/Principal FindingsWe performed a retrospective study of all pulmonary tuberculosis patients reported in Songjiang district, Shanghai, to determine the demographic, clinical and microbiological characteristics of tuberculosis cases between urban migrants and local residents. We calculated the odds ratios (OR) and performed multivariate logistic regression to identify the characteristics that were independently associated with tuberculosis among urban migrants. A total of 1,348 pulmonary tuberculosis cases were reported during 2006–2008, among whom 440 (32.6%) were local residents and 908 (67.4%) were urban migrants. Urban migrant (38.9/100,000 population) had higher tuberculosis rates than local residents (27.8/100,000 population), and the rates among persons younger than age 35 years were 3 times higher among urban migrants than among local residents. Younger age (adjusted OR per additional year at risk = 0.92, 95% CI: 0.91–0.94, p<0.001), poor treatment outcome (adjusted OR = 4.12, 95% CI: 2.65–5.72, p<0.001), and lower frequency of any comorbidity at diagnosis (adjusted OR = 0.20, 95% CI: 0.13–0.26, p = 0.013) were significantly associated with tuberculosis patients among urban migrants. There were poor treatment outcomes among urban migrants, mainly from transfers to another jurisdiction (19.3% of all tuberculosis patients among urban migrants).Conclusions/SignificanceA considerable proportion of tuberculosis cases in Songjiang district, China, during 2006–2008 occurred among urban migrants. Our findings highlight the need to develop and implement specific tuberculosis control strategies for urban migrants, such as more exhaustive case finding, improved case management and follow-up, and use of directly observed therapy (DOT).

Spatial distribution and risk factors of tuberculosis in Songjiang district, Shanghai during 2006 and 2009

To identify spatial distribution and risk factors among tuberculosis (TB) cases in Songjiang district, Shanghai, 2006 - 2009. All active TB cases and all bacteriologically confirmed TB cases diagnosed during the period from 2006 to 2009 were recruited into the study. Spatial scan statistics were used to identify spatial clusters. Using logistic regression, we compared the demographic and clinical characteristics of TB cases in spatial clusters versus TB cases not in spatial clusters. A total of 1815 active TB cases and 730 bacteriologically confirmed TB cases were recruited during 2006 - 2009. Chedun township and Xinqiao township was detected to be a spatial cluste (RR = 1.38, LLR = 16.78, P < 0.01), which was the location of the municipal industrial zone. No spatial cluster was found during 2006 - 2007, while during 2008 - 2009 Chedun township was detected to be a spatial cluster (RR = 1.70, LLR = 15.06, P < 0.01). Among resident population, the spatial cluster of TB cases was located in the southwestern part of Songjiang district, which included five townships Xinbang, Shihudang, Xiaokunshan, Maogang and Yongfeng (RR = 1.49, LLR = 10.52, P < 0.01); while among migrant population, the spatial cluster of TB cases was located in Chedun township (RR = 1.55, LLR = 15.64, P < 0.01). There were higher proportions of resident TB cases who were farmers (AOR = 4.9, 95%CI: 1.9 - 12.3) or had other occupations (AOR = 2.6, 95%CI: 1.1 - 5.9) in the spatial cluster. There were higher proportions of migrant TB cases who lived here for less than 5 years (< 1 year: AOR = 5.9, 95%CI: 1.8 - 19.5; 1 - 5 years: AOR = 3.2, 95%CI: 1.0 - 9.9) or worked at other occupations (AOR = 2.8, 95%CI: 1.5 - 5.1) and lower proportions of migrant TB cases who came from Eastern region (AOR = 0.3, 95%CI: 0.1 - 0.8) or Middle region (AOR = 0.5, 95%CI: 0.3 - 0.9) in the spatial cluster. In Songjiang district there was a spatial cluster in TB cases, which was Chedun township. Local residents with TB who were farmers or had other occupations were more likely to be in the spatial cluster. Migrants with TB who lived here for less than 5 years or came from Western region were more likely to be in the spatial cluster.

Survey of Rural Domestic Sewage Treatment Systems of Songjiang District in Shanghai, China

Due to the relatively unprogressive economic and social development of Songjiang rural areas of Shanghai city in China, the degree of rural domestic sewage treatment was relatively weak and hysteretic. The rural sewage treatment systems of Songjiang district were investigated through field survey. Finally, the systems of soil infiltration-constructed wetland and combinatorial biofilter, with obvious advantages, were proposed to popularize in Songjiang rural areas more suitably.

Investigation of prescription evaluation at public hospitals in Songjiang district,Shanghai

Objective To learn and evaluate the present prescriptions from outpatient departments of 21 public hospitals in Songjiang district,and to promote rational drug use.Methods A total of 75,600 outpatient prescriptions from 21 public hospitals in Songjing district were collected monthly from January 2008 to October 2010 and analyzed statistically using indexes for prescription evaluation.Results of the 75,600 prescriptions,the types of drugs in each prescription averaged 2.35,the ratio of antibiotics use and injection agents use were 35.77％ and 17.40％,respectively.The percentage of essential drugs without added profit accounted for 41.91％ of the total drug use,and the average drug cost per prescription was RMB 85.99.Comparison of indexes for prescription evaluation showed that the ratio of antibiotics use and injection agents use as well as the average cost per prescription in secondary hospitals were significantly higher that those in community health centers (P＜0.01),while the percentage of essential drugs without added profit and the average number of drugs in each prescription were statistically smaller than those in community health centers (P＜0.01).Conclusion Drug use in outpatient departments of 21 public hospitals was rational in general,especially noteworthy is the significant improvement made at community health centers in recent three years. Key words: Songjiang district; Prescription evaluation; Rational drug use; Investigation

Exploration of compensatory mechanism in public medical institutions in Shanghai SongJiang District

The paper introduced the exploration made by Shanghai SongJiang District in its compensation mechanism for public hospitals and community health centers.This attempt aimed at increasing government financial support,identifying public health needs in the development of public medical institutions,developing the compensatory measures to fit the task completed,and the service provided and individual items.It took such factors as the present personnel,workload,population and area taken into account.All these are designed to make the mechanism more appropriate and fair. Key words: Shanghai; Public medical institution; Input; Compensation mechanism

Research on the Function and Performance Evaluation Systems of Community Health Services

As the constantly deepening development of the public health reform, community health services research will inevitably involve scientific and rational performance evaluations and the benchmarks of governments’ investment to community health services in order to make the community's welfare and health services better. This research established a set of reasonable and simple performance evaluation indicator system to evaluate the functions and performance of community health services based on qualitative and quantitative methods. The evaluation indicator system can measure the actual efficiency and effectiveness. Furthermore, it can provide a basis for governments’ investment to purchase public health services and services for the discovery and improvement of the problems and deficiencies in community health services so as to improve its service level. Simultaneously, the paper has made empirical research on the two community health services in Songjiang district as to test the effectiveness and feasibility of the evaluation system.

What should the government do regarding health policy-making to develop community health care in Shanghai?

What should the government do regarding health policy-making to develop community health care in Shanghai?

Cases analysis of irrational use of antibacterials

Objective:To investigate the utilization of antibacterials in Central Hospital of Shanghai Songjiang District,and provide reference for regulating the application of antibacterials and controlling the proportion of medicine income.Methods:A retrospective investigation on medical records of the in-patients was performed in this hospital.The general condition of patients,disease diagnosis,laboratory examination results,operation and medication information were recorded.Rationality of antibacterials use were analyzed and evaluated.Results:One thousand one hundred and seventy-six in-patient medical records were investigated,of which,857 used antibacterials(72.87%).The utilization of antibacterials in 517 cases(60.33%) was irrational.Conclusion:The rate of antibacterials use in this hospital was high and various kinds of irrational use exist.Potent countermeasures need to be adopted in order to decrease the abuse and irrational use of antibacterials.

Effectiveness of one-year community management for patients with chronic obstructive pulmonary disease

Objective To evaluate effectiveness of prevention and treatment for patients with chronic obstructive pulmonary disease (COPD) for one year at community health-care service (CHS)centers. Methods A quasi-experiment design was used to evaluate effectiveness of community management for patients with COPD who visited and registered at Xiaokunshan and Xinbang CHS centers in Songjiang district of Shanghai in 2008, with COPD patients from Xiaokunshan community CHS center as management group and those from Xinbang as control. Measures for community management included training for local general practitioners in essential knowledge of COPD prevention and treatment, allocation of necessary drugs for COPD treatment, and health education for COPD patients and their family members. No special measures were taken for control group except routine treatment. Results A total of 132 patients were diagnosed as COPD according to their pulmonary function on 2008, 61 at Xiaokunshan and 71 at Xinbang CHS canters.One hundred and two patients, 47 at Xiaokunshan and 55 at Xinbang, finished one-year follow-up. Five patients from Xiaokunshan who were smokers at their first visits and three of them quitted smoking after oneyear management. Meanwhile, none of nine smoked patients from Xinbang quitted smoking in the same period. There was no statistically significant difference in symptom scores, pulmonary function, and forced expiratory volume at the first second (FEV1) between patients in the two groups during one-year follow-up.Average score of quality of life in patients at Xiaokunshan dropped to 39. 12 after one-year management from 46. 96 at their first visits, and that in patients at Xinbang increased to 62. 11 from 56. 55 (P＜0.01).Average six-minute walking distance (6-MWD) in patients at Xiaokunshan reduced to 354. 26 meters after one-year management from 361.66 meters at their first visits, meanwhile that in patients at Xinbang reduced to 351.18 meters from 398.07 meters (P =0. 008). Scores of functional dyspnea in patients at Xiaokunshan fell to 0.34 from 0.40 at their first visit, meanwhile that in patients at Xinbang increased to 1.00 from 0.95(P =0.038). During the one-year follow-up, 13 patients at Xiaokunshan and 53 at Xinbang visited emergency departments for treatment, and four at Xiaokunshan were hospitalized and none died, and five at Xinbang were hospitalized due to acute exacerbation of COPD and four of them died. Conclusions The study suggests that strengthening prevention and treatment for COPD patients at community level by general practitioners, patients themselves and their family members can improve their quality of life, reduce emergency visits and hospitalization, alleviate dyspnea symptoms and delay the decline of 6MWD. Key words: Pulmonary disease, chronic obstructive; Community health centers; Disease management

Evaluation and analysis of prescriptions in outpatient and emergency departments of Sijing Hospital in Songjiang District of Shanghai

Evaluation and analysis of prescriptions in outpatient and emergency departments of Sijing Hospital in Songjiang District of Shanghai

Pilot study of using GIS to visualize health status distribution: case study of Songjiang District, Shanghai.

The aim of this study was to investigate the geographic variation in mortality indicators in Songjiang District of Shanghai under rapid change with urbanization. Geographic Information System (GIS) was used to visualize the distributions of health status and to test the extent of spatial auto-correlation in the indictors. In 2001, total crude mortality was 687/100,000 for the district; the rates for the townships (N=15) in the district ranged from 444/100,000 to 805/100,000. GIS maps indicated that the mortality was higher in the marginal areas of the district. Significant positive auto-correlations were found in total crude mortality rates, death rate for infectious diseases, and death rates for digestive diseases. The measures that consider intra-region inequality in health needs will be required in the regions under urbanization.

The Guangfulin Site in Songjiang District, Shanghai in 1999–2000

The Guangfulin 广富林 Site is located at the Guangfulin Village, Sheshan 佘山 Township, Songjiang 松江 District, Shanghai 上海. The landscape is plain with an altitude of 2-3 m. As part of the project to investigate the formation process of the ancient civilizations aroundthe Lake Tai 太湖 area, we conducted excavation and coring at this site in 1999-2000. The remains of the Liangzhu Culture 良渚 are primarily from burials. We also found a new kind of late Neolithic remains, which we temporarily name them as the “Guangfulin Remain.”