TCNCYH Phu truung 79 (2) - 2012
Summary
TREATMENT OF TRAUMATIC BRAIN INJURY (TBI) AT SAINT PAUL HOSPITAL, HANOI IN THE FIRST QUARTER OF 2010
Objectives of the study were to describe the situation and user fee payment of Traumalii Brain Injury (TBI) patients treated in Saint Paul Hospital in first quarter of 2010. The results indi eated that the total number of patients is 266, mpstly males (70.7%) and aged 21-30 (29.7%) First aid was provided to 52,6% of the patients. 82.3% of patients had Glasgow score of 12-i;
at admission. Further trauma was at 86/266 patients (32.2%). 140/266 (52.6%) patients wai confirmed with TBI on Computer Tpmpgraphy (CT). The percentage of using drug therapy was 70.7%, surgical treatment 19.9% and intensive care 9.4%. The average user fee payment foi cost recovery accounted for 11.5%-57.5% of the National average income per capita per year To raise awareness and understanding of TBI for prevention as well as benefits pf spcial health, insurance is necessary to reduce TBI and its financial burden.
Keywords: Traumatic brain injury, neurosurgery
HIEU QUA MO HINH L O N G N G H E P PHONG NGLTA
VA Q U A N LY B E N H KHONG LAY N H | £ M TAI CONG D O N G D 6 |VOI CAN BO Y Te THUOC MOT SO XA TAI HUYEN 0 6 N G ht, TINH THAI NGUYEN
Nguyin Hoing Long', Vu Ngpc Hi', Hoing Vin Minh', Lfi Dire Tnrang 'Truung Bpi hpc Y Ha Nil, 'To chire Y ti The gldi tai Vipt Nam
Nghidn cdu nhim dinh gii hiiu qui md hinh phdng ngUa vi quin If bdnh khdng liy nhiim tai cdm ddng ddi vdi kiin thdc vi thuc hinh phdng ching binh khdng liy nhiim cue ein bp yti thude mdt sd x8 tai huydn Bing Hf tlnh Thii Nguyin Kit quiche thiy tf Id cic cinbdytidcic xi dupe can thiip d kiin thire dOng vi phdng ching bdnh khdng liy nhiim cao han c6 f nghla thing kd so vdi dc cin tdy ti d cic xi dii chimg. Tf Id cic cin bd y ti tram y li xi vi cic cin bp y ti thdn bin d de xi can itii^j, tham gia vio hopt ddng kiim soit vi quin If cao huyit ip (tuang Ung 100% vi 66%; cao hon hk » vdi dc xS dii chdng (lin lupt li 88% vi 25%/ Tir dd ci thi kit luin, cin bp y ti dia phuang thdng qui du in di dupe ting cudng kiin thuc vi thpc hinh vi phing ching bdnh khdng iiy nhiim.
Tir khoa: BSnh khSng lay nhllm, kiin thyc, thyc hdnh, can bf y t l
1. OAT VAN D E ^^ jj^j^l^ J.J ^^ ^^^ j , ^ , ^ l ^ huai\g afc Cdc bgnh khing Idy nhiSm da d y g c c h i t lugng eupe s i n g cua bSnh nhdn cQj^
chirng minh Id nguySn nhdn hdng d i g gdy nhu kinh t i h i gia dinh, cpng ding va xS tii' veng trSn todn t h i gidi. Bgnh khong lay hpi [7, 8]. Cdc bSnh khdng ISy nhllmgji nhilmkhong chi gay ra gdnh ngng tir vong eae y i u t i nguy co dang cd xu hydng ff'
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TCNCYH Phu truxyng 79 (2) - 2012
tang 6- cdic nu-ac co thu nhgp th§p va trung binh [1,2, 6].
Cung nhu' 6" cac nu-ac dang phat trien khac, Vi$t Nam dang trai qua qua trinh chuyen doi djch te hpc, trong do c6 si/ gia tangdang ke ganh n^ing b^nh tgt va kinh te gay ra bm cac b$nh khong l&y nhl§m. Ty \g nh^p vien do cac b$nh khong lay nhi&m da tang tu- 39% vao nam 1986 len d i n 66,2%
vao nam 2008 va ty \g tCe vong do cac benh nay da tdng tir 42% vao ndm 1986 \in t&\
63,3% vao nam 2009 [9]. Mpt trong nhu-ng y4u t6 quan trpng c6 t h i du'a t&\ thanh cdng cua cac giai phdp phong ngi>a b?nh khong lay nhjgm la su* tham gia cua cac can bp y t l tuyen ca so".
Nam 2009, Bp Y teva T 6 chu-c Y t^ thi giai da tri^n khai mo hinh phong ngCra va quan ly cac bpnh khong lay nhilm tai cpng d6ng [3]. Mo hinh can thiep bao gom cac hogt dpng nang cao kiln thii-c va thiPc hanh phong ngO'a b$nh lay nhiim cua CBYT tuyin y te CO" so va cac can thiep tai c6ng dong.
Sau hai nam thi/c hien, viec danh gia can thipp la can thilt. Nghien CLPU cua chung toi nham myc tieu:
Danh gia higu qua md hinh phdng nguy va I quan 1'^ b$nh khdng lay nhiem tgi cgng dong doi I vol kien thuc va thuc hanh phdng chSng benh ' W)dng lay nhiim ciia can bg y ti thudc mgt so ' xa tgi huyen Dong Hy. tinh Thai Nguyin.
I
, II. 0 6 ) TU'gNG VA PHU'aNG PHAP ' 1. 06i tu'O'ng nghien cu-u: Can bO tram y
t l xa va can bp y t l thon ban
2. Thilt k l nghien cu>u: Mo ta cdt ngang 3. Dja ban nghien CIPU: Nam xa can
*thipp (Linh San, Hoa Thu-p-ng, Huong
"Thu'png, Minh Lp-p va Hp'p Tiln) du'pc lu'a
^chpn cho nghien cuu nay. Nam xa khac co
"tinh trgng nhan khau hpc va kinh t l - xd hpi
tu'O'ng d6rig dupe jya lam nhom chCrng (Nam Hoa, Khe Mo', Tan Lpi, Cdy Thj, Quang San).
4. Ca m l u va cdch chpn m l u : T i t ca can bp tram y t l xa va can b0 y t l thon ban ti> muai xa niu tren,
5. Cong cu thu thap sd li$u: Bp cau hoi ban c l u true nham ddnh gid kiln thuc vd thyc hanh lien quan d i n phong chlng benh khong Idy nhilm cua can bp y t l .
6. Cac b i l n s6 nghien cu'u: G6m thong tin ca nhan (tuli, giai tinh, trinh dp, nghi nghipp, kinh nghipm lam vipc); cac khoa hpc ve phong chong bpnh khong lay nhiemda tham gia; kiln thuc va thyc hanh lien quan d i n phong chong benh khong lay nhilm .
7. Thu thgp sd lieu: Tat ca cdc cdn bp y t l du'pc mai d i n trgm y t l xa d l tham gia cdc cupc phong van nhom do cac nghien cuu vien thyc hien.
8. Quan ly va phan tich sd lieu: Phan m i m Epidata duac su dung d l nhap so lieu.
Phan tich s6 lieu bang phln mem Stata 10.
Muc 9 nghTa thong ke a = 5% duac dp dung, III. K ^ T QUA
Co ting s l 60 can bp cua 10 tram y te xa (27 cdn bp thupc 5 xa can thiep va 33 can bp tir 5 xd dli chung) vd 95 can bp y t l thon bdn (51 can b6 tu cac xd can thiep va 44 can b6 tu 5 xa doi chLcng) tham gia vdo nghien cuu ndy.
Bang 1 cho thay, trong khi 77,8% can bp a cac trgm y t l xa can thiep co the neu duac ten cua 3 benh khong Idy nhiem tra len thi ty le ndy chF Id 39,4% d cdc xa d l i chung. Co 70,6% d cac xa can thipp vd doi chung co t h i niu dupe ten cua 3 bpnh khong lay nhiimtra thi tyle nay chi la 3,1% a cdc xa d l i chu-ng, Sy khdc biet nay d l u co y nghTa thing ke {p
< 0,05, kilm dinh x^)-
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TCNCYH Phu truung 79 (2) - 2012
Bdng 1. Kien thirc cua cdn b? y t i v i b?nh khdng Idy n h l l m vd y i u t i nguy c o
Trd Idi
nhiim k§ tSn du'p'c ^ 3 S6 yiu t i nguy co
k i t§n dupe
Cdn bi) tr;m y t i xd Cdn bp y t i than bdn X i can thl^p X i d i i chu'ng X i can thISp
(%) (%) (%)
X i ddi chirng
(%)
S6 b^nh khdng Idy " ^ 22,2
24,2 13,7
41,2
Bdng 1 cDng cho thiy, t^ IS cdn bO ir cdc tr?m y t i xa can thiSp cd t h i nSu dypfc cd bin yeu to nguy co (hiit thuic Id, \pm dyng ryyu, c h i dS dn nghSo dinh dydng, khdng t$p t h i due) nhiiu hon so vdi d cdc x§ d i i chirng (33,3% so vdi 9,1 %, p < 0,05, x^). Ti^ IS cdn bi d cdc tr?m y t i xd can thISp ed t h i k i dy<?e 3 y i u t i nguy eo cDng cao hon so vdi xd d i i chirng (40,7% 50 vdi 33,3%; p < 0,05; x')- Cdc xd dyyc can thiSp oDng ed ty ISodn bO y t i thdn bdn k i tSn dypfc4 vd 3 y i u t i nguy co (diu Id 41,2%) cao hon so vdi cdc xd d i i chO'ng (tyong irng Id 2,1% va 6,4%).Sy khdc biSt ndy cd y nghTa thing k i (p < 0,05, kiem djnh x^).
Ty IS edn bp d cdc tr^m y t i xd can thiSp trd Idi dCing mO'C BMI t i t nhit (18,5 - 22,9) cao hon so vdi d xa doi chirng (lin luyt la 92,5% vd 72,7%). Ty IS cdn bp y t i t h i n b i n d ode xd can thiSp biit mire BMI t i t yu (80,3%) cao honnhliu so vdi ty IS d ede xd d i i chirng(34%). Sy khac biSt ndy cd y nghTa thing kS (p < 0,05, kiem djnh x') (bdng 2).
Bdng 2. T;^ If can bg Y te xa trd Idi dung mipc BMI toi i r u va lyq'ng m u i i tiSu thv t i l y u mfil ngay
Trd Idi Oiing mire BMI toi uu
Cdn bp Y t i Cdn b$ Y t i thSn ban Xicanthi^p X i d i i chirng X i c a n t h l ^ p Xidilchumg
92,5% 73,0% 80,3% 34,0%
Diing lupng muii tii uu mii ngdy
Bdng 2 t h i hipn 77,7% edn b i y t i d tr?m y t i ede xd can thiip biit d y y c lyyng muii tii mi m i i ngdy (it hon 5 gam), trong khi ty IS ndy chl Id 36,3% d cdc xd d i i chO'ng. T;^ IS cdn bO y t^
thdn bdn cd kiin thirc t i t v i v i n d i ndy d cdc xd can thi§p Id 68,6% vd d cdc xd d i i chOng la,j 36,3%. Sy khdc bISt Id cd ^ nghTa thing k i (p<0,05, kiim djnh x')
!S(,'mi ho V te .\ii
_ i ~ . . . , . , , ^ I'ruiboVtii
• • • • llioiiL>^i
liiUuvp X;i don-luuiji
Hinh 1. Ty 1$ cdn bp y t l xa tham gia hoat d$ng qudn ly cao h u y l t dp 138
TCNCYH Phu tnjxyng 79 (2) - 2012
Hinh 1 cho thdy, ty Ip can bo tram y t l va cdn bp y t l th6n band cdc xa can thiep tham gia vdo cac hogt dpng quan ly cao huyet dp (100% va 66,6%) cao han han so vdi ty le tyang i>ng d cdc xd d l i chi>ng (88% va 25%), Sy khdc biet co y nghTa thong ke (p <
0,05, kiem dinh x^).
IV. BAN LUAN
Bpnh khong lay nhilm dang Id mOt v l n d l noi cpm d r l t nhilu q u i c gia tr§n t h i gidi, nhdt Id d cac nu-dc co thu nhgp t h i p va trung binh. Theo WHO, s6 ca t d vong xay ra do bpnh khong lay nhilm d cdc nu'dc nay chilm tdi 80% so ca t d vong do cdc b^nh khong lay nhilm trdn todn t h i gidi [7]. Benh khong Idy nhiem c6 the phong trdnh du-ac mpt each dan gian nhu vipc eo mpt c h l dO an hap ly, t^p t h i due hdng ngay va khong hut thulc Id s§ lam giam it nhlt 80% cdc benh ve tim mach, ddi thdo du-dng type 2 va han 40%
cdc ea ung thu- [7]. Tuy nhien, d l ngudi dan CO t h i thyc hien t i t cac bipn phdp d y phong nay, vai tro cua nhdng ngu-di lam cong tac y t l Id hit su-c quan trong, do ngudi ddn thu'dng tim den cdn bp y t l de xin khdm hoge tu vln [4]. Kit qua nghien cuu eua Le Thi Thanh Hiln vd cpng sy eho thay sde khoe cua ngudi dan du-pc cai thien eo lidn quan chat che vdi viec nang eao kiln thue vd ky ndng eua can bp y t l [5]. Do do, ndng cao kiln thdc vd thyc hanh cua cac can bp y t l trpng viec phong chong cae benh khong lay nhilm Id rat can thilt.
Kit qua nghidn cuu cho thiy, ty 1$ can bp y t l d cdc xa can thiep co kiln thdc vd thyc hanh dung v l phong ngda vd kilm sodt bpnh m khdng lay nhiem eao han nhieu so vdi d cdc
^ J d o i chdng. Co the thdy, kiln thdc va thyc Flhdnh cua edn BO Y t l d cac xd sau khi can thipp da du-ac nang eao ro rpt vd dieu nay cung CO the Id nguyen nhan gop phdn cai
thien tinh trgng sdc khoe cua ngudi dan khi triln khai dy an l l n dau tien trudc nam 2009 [3], phu hap vdi nhan djnh eua Le Thj Thanh Hiln vd cOng sy [5] Day co the dupe coi la thdnh cdng cua md hinh l6ng ghep nay.
Tuy nhien, nghien cdu nay eung eo mpt s6 gidi hgn nhlt djnh. Trong qua trlnh nghidn cdu, chCing tdi khdng tim thiy nghien cdu nao tuang t y d l c6 the so sdnh, nham ddnh gid hi$u qua thyc sy cua dy an can thipp nay. Ngodi ra, chung toi chua khlng c h l dupe mdt so cdc y i u t l ndm ngodi chuang trinh cua dy an co the anh hu-dng d i n kiln thuc vd thu-c hanh cua cdc can bd y t i .
V. K^T LUAN
K i t qua nghidn cdu cho thay, kiln thue vd thyc hdnh phong chlng bdnh khdng lay nhilm cua can bp y t l d eae xa can thi$p t i t han dang ke so vdi cdc edn bd y t l d cdc xa d l i chdng. Dilu nay cho thdy md hinh phong ngua vd quan ly bdnh khong lay nhiem tgi cdng ddng da dgt thanh cdng.
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disease, 13 (2 Suppl 2)' S13 - 8,
2. Bonita, R., et al.. Surveillance of risk factors for noncommunicable disease: The WHO STEPvi/ise approach, 2002, World Health Organization: Geneva.
3. Research and Training Centre for Community Development (2009), Evaluate the model in Thai Nguyen after 12 months inter- vention for the integrated model for NCDs,
4. Flax, V.L. and J.L. Earp, (1999). Coun- seled women's perspectives on their interae- 139
TCNCYH Phu truung 79 (2) - 2012
tions with lay health advisors: a feasibility study diseases 2010, 2011, World Health Organiza- Health education research 14 (1): 15-24. tion: Geneva,
5. Hien LTT, et al., (2008). Effeclveness 7. World Health Organization, Prevent- of a eapacitybuilding prpgram for community '"^9 ciironic diseases - a vital investment, leaders in a healthy living environment: A 2005, World Health Organization: Geneva, randomized community-based intervention in 8. Strong K, e.a., (2005) Preventing mral Vietnam. Health Prom Int. 23 (4):
354-364.
chronic diseases: how many lives can we save? Lancet, 366 (9496): 1578 -1582.
9. Vietnam Ministry of Health, Health 6. World Health Organization (2010). Statistics Year Book, 2009, National Cancer Global status report on noncommunicable Institute:: Hanoi.
Summary
EFFECTIVE NESS OF THE INTEGRATED MODEL FOR PREVENTION AND CONTROL OF NON-COMMUNICABLE DISEASE HEALTH STAFFS FROM
SOME COMMUNES IN DONG HY DISTRICT, THAI NGUYEN PROVINCE The study was to evaluate the effective wasof the prevention and control NCDs model in community forknowledge and practice relevant to NOD prevention and control among commune health staffs in Dong Hy district, Thai Nguyen prpvince The results showed that the percentage of health staffs from the intervention communes having correct knowledge of preventipn and control NOD was significantly higher than that from the control communes. The prppprtion of- health staffs (both commune health system staffs and village health workers) from the inten/en- tion communes took part in hypertension management and control activities in 2010 (100% and 66%, respectively) much higher than that from the control communes (88% and 25%, respec- tively). In conclusion, through the project, local health staffs have t}een strengthen knowledge and practice on prevention of NCDs. This showed that the model has achieved considerable successes.
Keywords: Non-communicable disease, knowledge, practice, health staff
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