廣西鼻咽癌高危人群社區(qū)防治點的初步建立
發(fā)布時間：2018-09-08 11:47
【摘要】：研究背景：發(fā)展社區(qū)衛(wèi)生服務(community health service,CHS),是21世紀我國衛(wèi)生服務的發(fā)展方向,我國正式公布的新醫(yī)改方案中明確了社區(qū)衛(wèi)生服務的地位和任務,并且明確指出了下一步社區(qū)衛(wèi)生服務建設的方向,社區(qū)衛(wèi)生服務對于維護居民健康具有不可取代的作用。要強化社區(qū)衛(wèi)生服務應加大政府扶持力度,合理配置衛(wèi)生資源,加大宣傳力度,促進人們轉變觀念,建立優(yōu)勢互補的“雙向轉診”制,做好人才引入和培養(yǎng)高素質的人才,以全科醫(yī)生為骨干,并通過政策手段激勵人們到社區(qū)就診。作為社區(qū)服務重要內容的社區(qū)腫瘤防治工作,越來越引起社會的關注,腫瘤即為社區(qū)重點防治疾病之一。隨著社會城市化、工業(yè)化的加速,環(huán)境污染物和新化學物質的日趨增多,加之不良生活方式和行為習慣的影響,惡性腫瘤已成為危害人類生命與健康的重大疾病之一。在各類死因的疾病譜中惡性腫瘤居第一(城市)、二位(農村)。我國城市人口的老齡化尤其突出,隨著城市化的進程,慢性非傳染性疾病特別是惡性腫瘤,日益嚴重威脅著我國居民的身心健康,在我國大力推進的新醫(yī)改大背景下,作為社區(qū)衛(wèi)生服務重要內容之一的社區(qū)腫瘤防治工作,越來越引起社會的關注。在社區(qū)建立腫瘤社區(qū)防治點是社區(qū)腫瘤防治工作中一項重要的工作。鼻咽癌(nasopharyngeal carcinoma,NPC)是一個流行特征非常明顯的腫瘤,在我國分布具有明顯的地區(qū)性,是南部和東部人群高發(fā)的惡性腫瘤特別是我國的廣東、廣西、福建、海南、湖南等地為多發(fā)區(qū),由于病變隱蔽、早期癥狀不明顯,常易誤診和漏診,導致晚期病例仍占多數(shù)。在鼻咽癌高發(fā)地區(qū)的自然人群中篩查高危人群是早期診斷、早期治療爭取最佳治療效果及預后的關鍵。但因為健康知識的缺乏等原因部分篩查出的腫瘤高危人群并末按時復查、定期體檢。所以在社區(qū)建立腫瘤防治點,對廣大居民進行健康教育及腫瘤初篩是一項投入少、收益大的保健對策。廣西地處鼻咽癌高發(fā)區(qū),在廣西某社區(qū)建立鼻咽癌高危人群防治點是針對廣西鼻咽癌高發(fā)的現(xiàn)狀,就社區(qū)腫瘤防治工作做的一些有益嘗試。大量研究認為EB病毒(EBV)感染與鼻咽癌密切相關,本文將EB病毒VCA-IgA抗體陽性者(=1：5)列為鼻咽癌高危人群。目的：1.建立廣西鼻咽癌高危人群社區(qū)防治點,對社區(qū)居民開展防癌知識宣教,開展自然人群篩查工作,并動員篩查出的鼻咽癌高危人群定期隨訪復查,增強人群健康知識水平。2.探討建立防治點在篩查鼻咽癌高危人群中的作用,摸索出適合社區(qū)腫瘤篩查的一套可行性強,經濟效益及社會效益良好的建設方案。3.對社區(qū)居民的EB病毒VCA-IgA抗體感染情況進行分析,探討病毒感染與性別、年齡的關系,為后期的鼻咽癌篩查工作提供基礎。方法：1.研究對象：廣西社區(qū)單位職工和居民。2.地點的選擇：選擇廣西某社區(qū)醫(yī)療機構。3.前期工作：在得到該社區(qū)醫(yī)療機構相關領導的支持及配合下,派經過培訓的專業(yè)人員至體檢科進行前期宣傳,發(fā)放防癌健康教育資料,動員在該社區(qū)醫(yī)療機構體檢的單位職工及居民進行鼻咽癌的初篩。4.初篩工作：由專業(yè)人員于體檢科收集在該社區(qū)醫(yī)療機構體檢的自然人群的外周靜脈血,并登記人群信息,將血樣于實驗室分離后,進行EB病毒VCA-IgA抗體的檢測,登記VCA-IgA抗體陽性人群的完整相關信息,將結果告知體檢科,并由體檢科通知該職工或居民,定期對其隨訪復查。結果：1.篩查社區(qū)人群11584例,目前已建成681人的鼻咽癌高危人群隊列,并給予發(fā)放防癌健康教育資料及健康教育指導。2.篩查的11584例自然人群具備完整的相關資料,并在該社區(qū)醫(yī)療機構建立了健康檔案,定期進行復查隨訪,初步建成了廣西鼻咽癌高危人群的社區(qū)防治點。3.在篩查的11584例自然人群中,VCA-IgA抗體陽性681例,陽性率為5.88%,EB病毒VCA-IgA抗體的陽性檢出率男女之間差別無統(tǒng)計學意義(P0.05),在不同年齡段EB病毒VCA-IgA抗體陽性檢出率不同,差異有統(tǒng)計學意義(P0.05)。4.建立的鼻咽癌社區(qū)防治點已完成鼻咽癌初篩11584人,篩查指標(VCA-IgA)陽性681例,納入鼻咽癌高危人群管理681例。結論：了解社區(qū)腫瘤的流行病學特征,有助于針對性地開展腫瘤社區(qū)防治工作。本研究在以社區(qū)醫(yī)療機構為依托的前提下,初步建立了鼻咽癌高危人群社區(qū)防治點,該防治點的建立為社區(qū)鼻咽癌高危人群的篩查提供了便捷,通過該防治點對社區(qū)居民進行防癌健康教育,可幫助廣大職工及居民克服恐癌心理,掌握基本的腫瘤預防知識,樹立良好的生活方式和生活習慣,提高防癌抗癌的自覺性和能力,積極參加腫瘤的初篩,定期參加體檢。在社區(qū)中進行腫瘤防治的健康教育是有現(xiàn)實意義的,要提高居民對腫瘤防治的知識,提高早診率還有許多工作要做。在此基礎上,要抓好社區(qū)高危人群的復查、隨訪等相關工作,特別是對于年齡在40歲以上、有家族史的居民及之前確診的那8例鼻咽癌病人的家屬是腫瘤防治健康教育的重點人群。
[Abstract]:BACKGROUND: Developing community health service (CHS) is the development direction of China's health service in the 21st century. The status and tasks of community health service are defined in the new health reform program officially announced in China, and the direction of community health service construction in the next step is clearly pointed out. People's health plays an irreplaceable role. To strengthen community health service, the government should strengthen its support, rationally allocate health resources, increase publicity, promote people to change their ideas, establish a "two-way referral" system with complementary advantages, introduce and cultivate high-quality talents, with general practitioners as the backbone, and stimulate them through policy means. As an important part of community service, cancer prevention and treatment in community has attracted more and more social attention. Cancer is one of the key diseases in community prevention and treatment. Sexual cancer has become one of the major diseases that endanger human life and health. Malignant tumors rank first (urban) and second (rural) in the spectrum of various causes of death. Health, in the context of the new medical reform vigorously promoted in China, cancer prevention and treatment in community, as one of the important contents of community health services, has attracted more and more social attention. Tumors with distinct symptoms are highly localized in southern and Eastern China, especially in Guangdong, Guangxi, Fujian, Hainan, Hunan and other places. Because of the hidden lesions, early symptoms are not obvious, often misdiagnosed and missed diagnosis, leading to the majority of advanced cases of nasopharyngeal carcinoma. Screening high-risk population is the key to early diagnosis and early treatment for the best therapeutic effect and prognosis. However, due to lack of health knowledge and other reasons, part of the screened high-risk population of cancer and end on time re-examination, regular physical examination. Guangxi is located in a high incidence area of nasopharyngeal carcinoma. To establish a prevention and control point for high-risk population of nasopharyngeal carcinoma in a community of Guangxi is a beneficial attempt to prevent and control the high incidence of nasopharyngeal carcinoma in the community of Guangxi. Patients with positive VCA-IgA antibody (= 1:5) were classified as high-risk population of NPC. Objective: 1. To establish a community prevention and treatment center for high-risk population of NPC in Guangxi, to educate community residents on cancer prevention knowledge, to carry out screening work for natural population, and to mobilize regular follow-up and reexamination of screened high-risk population of NPC, so as to enhance the health knowledge level of the population. The role of prevention and treatment sites in screening high-risk population of nasopharyngeal carcinoma was explored to find a set of feasible, economic and social benefits for community cancer screening program. 3. To analyze the infection of EBV VCA-IgA antibody in community residents, to explore the relationship between virus infection and gender, age, for the later stage of nasopharyngeal carcinoma screening work. Methods: 1. Subjects: Workers and Residents of Guangxi Community Units. 2. Location Selection: A Community Medical Institution in Guangxi. 3. Preliminary Work: With the support and cooperation of the leaders of the community medical institutions, trained professionals were sent to the Physical Examination Department for propaganda and health education materials on cancer prevention. Initial screening of nasopharyngeal carcinoma was carried out among the staff and residents of the medical institutions in the community. 4. Initial screening of nasopharyngeal carcinoma was carried out by collecting peripheral venous blood from the natural population of the medical institutions in the community by professional staff in the physical examination department, registering the information of the population, isolating the blood samples in the laboratory, testing the antibody against EBV VCA-IgA, and registering VCA. Results: 1. Screening of 11 584 community population, 681 high-risk groups of nasopharyngeal carcinoma were established, and health education materials and health education guidance were given to 115 screening population. 84 cases of natural population with complete relevant information, and in the community medical institutions established health records, regular follow-up, preliminary establishment of Guangxi nasopharyngeal carcinoma high-risk population community prevention and control points.3. In the screening of 11584 cases of natural population, VCA-IgA antibody positive 681 cases, positive rate of 5.88%, EBV VCA-IgA antibody positive detection. There was no significant difference between men and women (P 0.05). The positive rate of EBV VCA-IgA antibody was different in different age groups. The difference was statistically significant (P 0.05). 4. 11 584 people had been screened for nasopharyngeal carcinoma and 681 cases had positive screening index (VCA-IgA). 681 cases were included in the management of high risk population of nasopharyngeal carcinoma. The epidemiological characteristics of cancer in the community are helpful to carry out the work of community prevention and treatment of cancer.Based on the premise of community medical institutions,a community prevention and treatment center for high-risk population of nasopharyngeal carcinoma has been established preliminarily.The establishment of this prevention and treatment center provides convenience for screening high-risk population of nasopharyngeal carcinoma in the community. Health education for cancer prevention can help workers and residents to overcome their fear of cancer, master basic knowledge of cancer prevention, establish good lifestyle and living habits, improve their consciousness and ability of cancer prevention and anti-cancer, actively participate in cancer screening and regular physical examination. There are still many tasks to be done to improve the residents'knowledge of cancer prevention and treatment and to increase the rate of early diagnosis.On this basis, we should pay more attention to the review and follow-up of high-risk groups in the community, especially for the residents over 40 years old with family history and the family members of the 8 patients with nasopharyngeal carcinoma who were diagnosed before. The focus group.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R739.63
本文編號：2230424
[Abstract]:BACKGROUND: Developing community health service (CHS) is the development direction of China's health service in the 21st century. The status and tasks of community health service are defined in the new health reform program officially announced in China, and the direction of community health service construction in the next step is clearly pointed out. People's health plays an irreplaceable role. To strengthen community health service, the government should strengthen its support, rationally allocate health resources, increase publicity, promote people to change their ideas, establish a "two-way referral" system with complementary advantages, introduce and cultivate high-quality talents, with general practitioners as the backbone, and stimulate them through policy means. As an important part of community service, cancer prevention and treatment in community has attracted more and more social attention. Cancer is one of the key diseases in community prevention and treatment. Sexual cancer has become one of the major diseases that endanger human life and health. Malignant tumors rank first (urban) and second (rural) in the spectrum of various causes of death. Health, in the context of the new medical reform vigorously promoted in China, cancer prevention and treatment in community, as one of the important contents of community health services, has attracted more and more social attention. Tumors with distinct symptoms are highly localized in southern and Eastern China, especially in Guangdong, Guangxi, Fujian, Hainan, Hunan and other places. Because of the hidden lesions, early symptoms are not obvious, often misdiagnosed and missed diagnosis, leading to the majority of advanced cases of nasopharyngeal carcinoma. Screening high-risk population is the key to early diagnosis and early treatment for the best therapeutic effect and prognosis. However, due to lack of health knowledge and other reasons, part of the screened high-risk population of cancer and end on time re-examination, regular physical examination. Guangxi is located in a high incidence area of nasopharyngeal carcinoma. To establish a prevention and control point for high-risk population of nasopharyngeal carcinoma in a community of Guangxi is a beneficial attempt to prevent and control the high incidence of nasopharyngeal carcinoma in the community of Guangxi. Patients with positive VCA-IgA antibody (= 1:5) were classified as high-risk population of NPC. Objective: 1. To establish a community prevention and treatment center for high-risk population of NPC in Guangxi, to educate community residents on cancer prevention knowledge, to carry out screening work for natural population, and to mobilize regular follow-up and reexamination of screened high-risk population of NPC, so as to enhance the health knowledge level of the population. The role of prevention and treatment sites in screening high-risk population of nasopharyngeal carcinoma was explored to find a set of feasible, economic and social benefits for community cancer screening program. 3. To analyze the infection of EBV VCA-IgA antibody in community residents, to explore the relationship between virus infection and gender, age, for the later stage of nasopharyngeal carcinoma screening work. Methods: 1. Subjects: Workers and Residents of Guangxi Community Units. 2. Location Selection: A Community Medical Institution in Guangxi. 3. Preliminary Work: With the support and cooperation of the leaders of the community medical institutions, trained professionals were sent to the Physical Examination Department for propaganda and health education materials on cancer prevention. Initial screening of nasopharyngeal carcinoma was carried out among the staff and residents of the medical institutions in the community. 4. Initial screening of nasopharyngeal carcinoma was carried out by collecting peripheral venous blood from the natural population of the medical institutions in the community by professional staff in the physical examination department, registering the information of the population, isolating the blood samples in the laboratory, testing the antibody against EBV VCA-IgA, and registering VCA. Results: 1. Screening of 11 584 community population, 681 high-risk groups of nasopharyngeal carcinoma were established, and health education materials and health education guidance were given to 115 screening population. 84 cases of natural population with complete relevant information, and in the community medical institutions established health records, regular follow-up, preliminary establishment of Guangxi nasopharyngeal carcinoma high-risk population community prevention and control points.3. In the screening of 11584 cases of natural population, VCA-IgA antibody positive 681 cases, positive rate of 5.88%, EBV VCA-IgA antibody positive detection. There was no significant difference between men and women (P 0.05). The positive rate of EBV VCA-IgA antibody was different in different age groups. The difference was statistically significant (P 0.05). 4. 11 584 people had been screened for nasopharyngeal carcinoma and 681 cases had positive screening index (VCA-IgA). 681 cases were included in the management of high risk population of nasopharyngeal carcinoma. The epidemiological characteristics of cancer in the community are helpful to carry out the work of community prevention and treatment of cancer.Based on the premise of community medical institutions,a community prevention and treatment center for high-risk population of nasopharyngeal carcinoma has been established preliminarily.The establishment of this prevention and treatment center provides convenience for screening high-risk population of nasopharyngeal carcinoma in the community. Health education for cancer prevention can help workers and residents to overcome their fear of cancer, master basic knowledge of cancer prevention, establish good lifestyle and living habits, improve their consciousness and ability of cancer prevention and anti-cancer, actively participate in cancer screening and regular physical examination. There are still many tasks to be done to improve the residents'knowledge of cancer prevention and treatment and to increase the rate of early diagnosis.On this basis, we should pay more attention to the review and follow-up of high-risk groups in the community, especially for the residents over 40 years old with family history and the family members of the 8 patients with nasopharyngeal carcinoma who were diagnosed before. The focus group.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R739.63
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