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					   Non-infectious Chronic Diseases
Control & Prevention in Zhabei District




                  Jane Xiong
     Zhabei District CDC, Shanghai, China
                  Aug 29,2006
      Brief Introduction of Myself (1)


 Jane Xiong

 Shanghai Zhabei CDC

 2002.4-       Community Disease Management

  1997.7-2002.4 Anti-epidemic

 2004          M.S. , Epidemiology, Fudan University

  1997          B.M. , Preventive medicine, Fudan University
                         (formerly Shanghai Medical University)


                                                                  2
           Brief Introduction of Myself (2)

 Researching on policy supporting for disease control and
  prevention in community
 Researching on how the general team in community health
  service(CHS) provide rapid, economic, sustained service for
  residents
 Designing the model community's chronic diseases’ standardized
  and comprehensive management
 Designing health promotion for all people in community, developing
  suitable intervention measures




                                                                       3
           Brief Introduction of Myself (3)

 Surveilling and managing infectious disease in community

 Responsible for AIDS defending program, attending program
  planning, implementing and evaluating

 Constructing HIV primary screening lab of Zhabei District

 Drafting " Medium and long-term plans of AIDS defending in
  Zhabei district (2001-2015) "




                                                               4
   Brief Introduction of Zhabei District

 Northern of central Shanghai
 29.18 sq. Km.
 8 communities
 800,000 residents
  150,000 floating people
 ≥ 60 Ages is 19.7%
 Life expectancy 80.72



                                           5
                         The Order of Death Causes in Zhabei
                                     (2000-2005)
                  2000                   2001                       2002                   2003                   2004                   2005
ORDER
          CAUSE           %      CAUSE           %          CAUSE           %      CAUSE           %      CAUSE           %      CAUSE           %

 1                       38.97                  36.57                      36.49                  39.45                  39.10                  40.33

 2                       28.47                  29.39                      29.12                  28.13                  28.84                  28.53

 3                       9.54                   11.16                      11.81                  10.58                  9.93                   10.79

 4                       5.33                   5.13                       5.19                   5.13                   5.19                   4.64

 5                       3.75                   4.31                       4.08                   4.41                   4.16                   3.38

 6                       2.20                   2.37                       2.58                   2.24                   2.90                   2.63

 7                       2.20                   1.94                       2.14                   1.94                   1.40                   1.55

 8                       2.02                   1.57                       1.09                   0.70                   1.31                   1.06

 9                       0.97                   0.76                       0.98                   1.08                   0.96                   0.85

 10                      0.60                   0.71                       0.64                   0.77                   0.77                   0.82

        circulatory system                              lunacy
        cancer                                          digestive system
        respiratory system                              infectious disease and verminosis
        poisonings and injuries                         urogenital disease
        endocrinopathy                                  neuropathy                                                                                 6
       The Death Rate of Leading Diseases in Zhabei
                       (1955-2005)
DEATH RATE(1/100,000)
 350

 300                                            circulatory
                                                system
 250                                            tumor
 200
                                                respiratory
 150                                            system
                                                poisonings and
 100                                            injuries
                                                endocrinopathy
  50

   0
         1960   70      80   90   2000   YEAR
                                                                 7
The Incidence Rate of Main Cancers in Zhabei
                   (2003)

                                                  1/100,000


ORDER            MALE                     FEMALE

  1     lung cancer      87.23   breast cancer      59.41

  2     stomach cancer   48.37   lung cancer        39.42

  3     liver cancer     33.27   stomach cancer     28.56

  4     colon cancer     26.84   colon cancer       28.28

  5     rectum cancer    21.53   rectum cancer      14.85



                                                              8
                    Network of Chronic Diseases
                       Control & Prevention                           Professional
                                                                       guidance
                            District
                                                                    Administration
                           Government
                                                                     Management

                              District   Shanghai
                           Health Bureau   CDC
Planning and organizing
Instruction and training                              Other
    Quality control              Zhabei CDC         Departments       Cooperation
   Statistic analysis
                                                     Concerned
      & evaluation


 Hospitals level 2 or 3                         System of CHS



    Chronic Diseases Registering & Reporting                 Chronic Diseases
                                                            Control & Prevention
                                                              in Communities
                                                                                   9
         System of CHS in Zhabei District


                             Prevention & Control ¥8→30
                             Health Care        per capita
                             Primary Medical Treatment
    director                 Handicapped Healing
                             Health Promotion
                             Family Planning Guiding
Community
Government

                 Other       Cooperation
               departments

                 NGOs        Cooperation

                                                             Center for Community Health
                                                             Service (CHS)
                                                             Workstation of CHS
                                                                                     10
Work Station of CHS in Zhabei District
                              CHS general team



                            General practitioners



                                 Public health
                                 practitioner


                              Community nurses




                      1   Offer health service to 10,000-20,000
                                                              11
    The Strong Points of General Teams
 Convenient
    shorten the service radius

 Advantageous to organize suitable, effective health
  promotion
     giving chronic disease patients continuous service

 Economic
      the elementary medicine has kept in community, and
  the expenditure is lower

      The system of CHS has provided a good
  platform for community chronic disease
  prevention, control and management
                                                           12
     Our Works of Chronic Diseases
         Control & Prevention


 What to do?
 How to do?
   Information Garthering and Patients Finding
   Health promotion
   Patient Management




                                                 13
Information Gathering and Patient Registering
Epidemiology                                Risk
Following-up   Community diagnosis        factors
   Clinic                                               Quality control
 Screening        Surveillance           High risk
                                          people          Analysis
Free medical                                              Evaluation
examination
                 health records
Other ways                                Patients


                                        Reporting
               System of CHS                                 Zhabei CDC
                                        Feedback



                                     Intervention strategy


                                                                          14
            Cancer Finding and Registering
                                                        Quality control
                       Zhabei CDC                         Analysis
                                                          Evaluation


                   Prevention&health care            Inputing information
                           section                    & reporting to CDC



                   In-patient Department
Hospitals level                                     Filling in Cancer Report
                   Out-patient Department
2 or 3 in zhabei                                    Cards of New Patients
                   Emergency Department



                                    Information Department
                                     Assistant Department      Cooperation
                                       (CT/Pathology/…)
                                       Other Department
                                                                               15
Information Interchange with other CDC


                      Shanghai CDC



                                     CDC of Other
        Zhabei CDC
                                      18 Districts



Interchange the Cancer Report Cards by Patients’ Address




   Health Services for Cancer Patients in Communities

                                                           16
           Public Health Intervention


Policy intervention    Health screening       Education
                      Biologic prevention   intervention


Improve environment     Detect earlier      Health belief
supporting ability      Biologic Barrier    & behavior




                        Idea changed



                                                            17
                      Intervention (1)

The theme of Cancer control and prevention Week 1999~2005


    2006 Proper diet, cancer prevention
    2005 Health life, cancer prevention
    2004 Delivering cancer prevention knowledge to communities
    2003 Detect earlier, diagnose earlier and treat earlier
    2002 Health life says “no” to cancer
    2001 Preventing cancer scientifically and treating standardly
    2000 Preventing cancer correctly
    1999 Cancer can be prevented and cured


                                                                     18
                     Intervention(2)
Cancer Week(4.15-21) Activity




    Poster
                                Lecture




                   Counseling             Pamphlet   19
        Intervention(3)



Diabetes board

                 Community Sports Meeting

                 “I Know My Own blood Pressure”




                                                  20
                  Intervention(4)

Strictly implementing the policy made by shanghai health bureau




                         Measuring
                    blood pressure
                    for every patient
                    aged≥35 when
                    he/she goes to
                    hospital for the
                    first time every
                    year


                                                                  21
                     Intervention(5)
         The 1st Cancer Helping Center in Shanghai




 Organizing a professional union
 Professional training
 Keeping from physical & mental
  pressure
 Instructing family members
  offering help to patients




                                                     22
Intervention(6)




The Diabetic Club



                    23
                                                 Patient Management
   Hospital Level 2 or 3


deteriorating                               mending
                                                             feedback
   General teams of CHS                                                              Zhabei CDC

Different level management
                                                                                   Quality control
 from diagnosis to death
                                                                                Professional guiding
                                                                            Statistic analysis& evaluation
                                                         Chronic disease
                                              Hospice
      General management

                           Family sickbed




                                                        management system




                                                                                                       24
              My goal in EHIB


 To know the model about community disease control &
  prevention in U.S.A

 To make some progress on community health
  promotion’s planning, practicing and evaluation




                                                        25
`
    Thank you!




             26

				
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