Y HQC VigT NAM THANG 2 - Sd 1/2013 do do viec tim ra nguyen nhan de phong tranh la
rat quan trpng. Nghien ciTu cho thay rSng can thiet phai xet nghiem IgE dae hieu eho cae benh nhan may day noi rieng va cac benh nhan bi b?nh di dng noi chung de ehan doan va tim bien phap dieu trj thich hdp eho timg ti-udng hpp cu the.
TAI UEU T H A M KHAO
1. B§ mfin Da lieu, TrUdng Dat hpc Y hi Npi (1994), "M^y day va phii mach". Benh da lieu.
NXB Y hgc, trang 81-85.
2. Thao Doan, Roger Melvold, Susan Viselli (2008), "Antigens and receptors". Immunology, Wolters Kluwer health, 11-23.
3. Chang KL, Yang YH, Yu HH, Lee 3H, Wang LC, Chiang BL (2012). Analysis of serum total
IgE, specific IgE and eosinophils in children with acute and chronic urticaria. J Microbiol Immunol Infect. [Epub ahead of print].
4. Ma XL, Sun QM, Jia J, Cai L. (2012) Analysis of serum specific IgE in aeroallergen and focxj allergen In patients with allergic skin diseases.
Beijing Da Xue Xue Bao. 18;44(5):765- 3. Sudha S Deo, Kejal 3 Mistry, Amol M Kakade
(2010), "Relationship of total IgE, specific IgE, skin test reactivity and eosinophils in Indian patients with allergy". Journal, Indian academy of clinical medicine, 265-271.
6. Zeng YH, Zhang D, Shu Y, Sun L, Wei Z, Zhou B, Tang JP (2009).[Detection of semm specific IgE in 437 children with allergic disease.
Zhongguo Dang Dai Er Ke Za Zhi. 2009 Jul;ll(7):543-5.
MOT SO YEU TO LIEN QUAN DEN BIEN CHl)hG BENH DAI THAO OU&NG or CAN BO CAO TUOI QUAN LY SlJC KHOE TAI BAN BAO VE SQC KHOE T.P HAI PHONG
Bui Minh G i a m * , Trjnh Thj Ly * *
TOM
TATMyc dkii ciia nghien culi la tim hieu cac yeu to lien quan den bien chuYig benh DTD d nhijhg doi tu'dng thupc dien thanh uy Hal Phong quan ly d dp tuoi tren 60, nham khuyen cao diT phong bien chuhg ciia benh. nudng /Tfrap nghien ciTu du'pc tien hanh tren 119 benh nhan DTO la can bp da hoac dang giiJ chu'c vu pho giam doc sd, nganh ho3c cap tu'dng du'dng trd len, tuoi tiT 60 trd len, du'pc quan ly va dieu tri tai Ban Bao ve sire khoe can bp thanh pho trong nam 2012. Chan doan DTO va bien chuTng DTD du'a vao cac tieu chuan theo y v3n. Cac xet nghiem va chan doan hinh anh du'dc thUc hien taj benh vien Viet Tiep Hai Phong. Danh gia moi lien quan du'a vao so sanh ty le cac bien chiTng hoSc tinh chi so OR. Ket qua: Dp tuoi cang cao thi ty le tSng huyet ap va co bien chimg DTO cang nhieu, Thdi gian phat hien benh DTD cang dai thi ty le cac bien chiTng microalbumin nieu, benh vong mac, benh tim thieu mau cue cang cao, Ty le cac bien chiTng lien qu^an vdi mire kiem soat dUdng mau theo HbAlc. Mu'c Idem soat dUdng mau kem co nguy cd gay ra it nhat 1 bien chiTng cao 6,5 lan va co nguy cd gay bien chiTng Microalbumin nieu cao 5,8 lan, benh vong mac cao 3,8 ran, benh than kinh ngoai vi cao 1,4 lan, benh tim thieu mau cue bp cao 1,8 lan, bien chimg b^n chan DTD cao 5,9 lan so vdi ngUdi co miTc kiem soat du'dng mau theo HbAlc dat.
SUMMARY
Research factors related to complications of diabetes in objects seniors officials managed and treated at the department of Health
Protection for municipals offidals The purpose of the study is to know fectors related to complications of diabetes in objects seniors officials managed by the Party Committee of Haiphong city, in order to recommende prevention for complications of diabetes.
The study was conducted on 119 patients senior with diabetes, who are officials having or are holding vice director of department or equivalent to it or higher, be managed and treated at the departnient of Health Protection for munidpals officials in 2012.
Diagnosis of diabetes and diabetic complications based on the criteria in the literature-medical. Analyse laboratoir and diagnostic imaging tests are implemented at the hospital Viet Tiep Hai Phong.
Evaluate the relationship based on the comparison of the rate of complications or index OR.
I.
DAT V X No i
Oai thao du'dng (OTO) la benh rat thu'dng gap. WHO u'de tfnh den nam 2025 se eo khoar^
300 den 330 trieu ngu'di mac benh OTD. Tuoi
* Ban bao ve sdc khoe can bo thanh pho Hai Phong, **SdY teHai Phong Phan bi^n khoa hoc: PGS.TS. D6 Thi Tinh
38
Y HOC VI^T NAM THANG 2 - SO 1/2013 cang eao, ty le mac OTD cang tang. Benh gay ra
nhieu bien chu'ng cap va man tinh nguy hiem.
Neu d d phong tot cac yeu to nguy ed hoac eac yeu to lien quan thi eo the han che dddc eac bien chu'ng ciia benh. Be khuyen cao diT phong cac bien chiTng cua benh, chung toi tien hanh tim hieu cac yeu t d lien quan den bien chiTng ciia benh d nhuYig benh nhan DTB eao tuoi thupc dien thanh uy Hai Phong quan ly.
II. 0 6 1 TUONG VA PHUONG PHAP NGHIEN dJTU 2 . 1 . D o i t u ' d n g n g h i e n cuTu
Gom 119 benh nhan DTD la can bp Thanh uy quan ly, tuoi tiT 60 t r d len, du'dc quan ly va d i i u tn tai Ban Bao ve siTc khoe can bo tiianh phd trong nam 2012.
Loai triT benh nhan: DTD tUd phat sau khi sir dung mpt so thude: Corticoid, Idi tieu thlazzid, hormone tuyen giap hoac do benh ly tuy tang, benh xd gan va nhiJng benh nhan khong dong y tham gia nghien ciTu.
2.2. Phu'dng p h a p n g h i e n cu'u: tien ciTu mo ta cat ngang
2.3. Cac t i e u d i u a n d u n g t r o n g nghien cuXi 2.3.1. Chan doan dai thao du'dng: DiTa vao tieu ehuan ehan doan ciia WHO-1999, chan doan DTD khi eo mpt trong 3 tieu ehuan sau:
+ Glucose huyet tu'dng luc doi (sau bCTa an cudi 8- >12gid) > 7,0mmol/l va lap lai 2-3 lan.
+ Glucose huyet tu'dng bat ky > l l , l m m o l / l , CO them dau hieu lam sang eiia DTD (an nhieu.
uong nhieu, dai nhieu, gay nhieu) va du'dng nieu du'dng tinh,
+ Glucose mau 2 gid sau lam nghiem phap dung nap Glucose theo du'dng uong
> l l , l m m o l / l .
2.3,2 Tieu chuan dung trong nghien cu'u
* T a n g h u y e t a p : theo JNC V I I , 2003
* Phan loai chi so B M I : theo WHO nam 2000 ap dung cho ngu'di Chau A- Thai Binh Du'dng.
* K i e m s o a t g l u c o s e m a u : theo WHO nam 2002 ap dung vao khu VLTC Chau A - Thai Binh DUdng.
* Chan d o a n suy t h a n m a n : du'a vao dp thanh thai creatinin npi sinh theo cong thiTe eiia Cookeroft va Gault.
* Phan loai r o i l o a n l i p i d m a u cua NCEP APT I I I (chu'dng trinh giao due cholesterol quoc gia My nam 2001).
* Chan d o a n b i e n chu'ng: du'a vao lam sang va xet nghiem
* D a n h g i a mo) l i e n q u a n : diTa vao so sanh ty le cac bien chiTng hoac tinh ehi sd OR
2.4. Phu'dng t i e n n g h i e n ciTu - Cac xet nghiem du'dc thiTc hien tren may sinh hoa t y dpng AU680, may Clinitek 500 (DiTc) tai khoa sinh hoa benh vien Viet Tiep;
- Chan doan hinh anh: may X-quang Toshiba (Nhat Ban), may sieu am ALOKA SSD- 1400 (Nhat Ban), may dien tim 3 can Fukuda (Nhat Ban),
2.5. Xu* ly so l i e u : phan mem EPI-INFO 6.0 III. KET QUA NGHIEN CCU
Bang 3 . 1 . Lien quan giii'a dp tuoi va tinh trang tang huyet ap Tinh trang HA
Khong THA Co THA P
60-69 tuoi (n = 38) SoBN
11 27
28,9
%
71,1
70-79 tuoi (n = 48) SoBN
6 42
12,5
%
87,5
> 80 tuoi (n = 33) SoBN
3 30
%
9,1 90,9<0,05
Nhan xet: Tuoi cang eao, ty Ie THA trong nhom benh nhan nghien ciTu cang tang ( 7 1 , 1 % ; 87,5% va 90,9%). Sir khac biet co y righia thong ke, p<0,05.
Bang 3.2. Lien quan giu'a do tuoi va bien chu'ng ehung Bien c l i u ^ g
Khonq BC C6BC P
60-69 tuoi f n = 38) SoBN
15 23
39,5
%
60,5
70-79 tuoi (n = 48) SoBN
9 39
18,7
%
81,3
> 80 tuoi (n = 33) SoBN
5 23
15,2
%
84,8
<0,05
Nhanxet:Ty le bien chuTig tang dan theo nhom tuoi (60,5%; 81,3% va 84,8 CO y nghia thdng ke, p<0,05.
H
Y HOC Vr$T NAM THANG 2 - s61/2013 Bang 3 . 3 . Lien quan giii'a thai gian phat hien BTS v6l bjgn chCrnq chung
Thdi gian phat hi^n OTD
< 1 nam (n = 10) 1 - < 5 nam (n = 67) 5 - < 10 nam (n = 31)
> 10 nam (n = 11)
Co it nhS't 1 bien chijrng
93,5 90,9
Nhiin xet: Ty le bien chiJng t i n g dan theo thSi gian phat hien benh ( 5 0 % ; 6 8 , 7 % va 93,5%).
Sy* khac biet co y nghla thdng ke, p<0,05.
Bang 3.4. Lien quan giii'a thdi gian phat hien BTO veil microalbumin nieu Tlidi gian phat hi^n DTD
< 1 nSm (n = 10) 1 - < 5 nam (n = 67) 5 - < 10 nim (n = 31)
; 10 nam (n = 11)
Microaibumin nigu ( + ) S6BN
Nh$n xet: Ty le ngu'di co microalbumin nieu du'dng tinh tSng dan theo thcJI gian phat hien benh DTB ( 3 0 % ; 44,8%; 61,3% va 81,8%). SU khac biet CO y nghia thong ke, p<0,05.
Bang 3 . 5 . Lien quan giii'a thdi qian phat hien PTO vdi benh vong mac do P T P Thdi gian pliat liien DTD
< 5 nam (n = 77) 5 - < 10 nam (n = 67)
> 10 nam (n = 31)
Benh vong mac do DTD 31,7 72,7
<0,05
<0,05 Nhan xet: Ty le benh vdng mac do OTD tang dan theo thdi gian phat hien benh PTP (31,7%;
5 8 , 1 % va 72,7%). SU khac biet cd y nghia thong ke, p<0,05.
i g 3.6. Lien quan qlUa thdi qian Thdi gian phat hien DTD
< 1 nam (n = 10) 1 - < 5 nam (n = 67) 5 - < 10 nam (n = 31)
> 10 nam (n = 11)
phat hien PTP vdi )enh tim thieu ma Benh thieu mau cue bo cO t i m
SoBN 1 20 12 6
' °/o 10 29,9 38,7 54,5
J cue bo P
< 0 , 0 5
<0,05 Nhan xet: Ty le benh tim thieu mau cue bp tang dan theo thdi gian phat hien benh DTD (31,7%; 5 8 , 1 % va 72,7%). SLT khac biet eo y nghia thong ke, p<0,05.
Bang 3 . 7 . Lien quan giij'a mu'c kiem soat glucose mau theo HbAlc vdi niicroalbumin nieu MLTC itiem soat glucose
theo HbAlc Dat
Khonq dat (kem) Tonq so
Microalbumin MAU (-)
55 3 58
nieu (MAU) M A U ( + )
46 15 61
Tong so 101 18 119
OR OR = 5,8 (CI: 1,6-21,9)
p < 0,05 Nhan xet: Mire kiem soat glucose theo HbAlc kem (khong dat) c6 nguy cd gay bien chutig lilicroalbumin nieu cao 5,8 lan ngu'di cd mire kiem soat glucose theo HbAlc dat
Bang 3.8. Lien quan qlga mire kiem soat glucose mau theo HbAlc vdi bgnh vSng mac do PTB Mu'c iciem soat glucose
theo HbAlc Khonq dat (kem) Tong so
Benh vong mac do DTD
Khong Tong 50
OR OR = 3,8 (Q: 1,3-11,5)
<0,05 Nhan xet: K<ic kiem soat glucose theo HbAlc kem (khong dat) co nguy cd gay bien chOtig benh vong mac cao 3,8 ^ n ngu'di co mire kiem soat glucose theo HbAlc dat.
Y HQC VigT NAM THAHG 2 - SO 1/2013
Bang 3 . 9 . Lien quan giu'a mu'c kiem soat glucose mau theo HbAlc vdi bien chiTng than kinh ngoai vi do PTP
Mure iciem soat glucose theo HbAlc Dat
Khonq dat (kem) Tong so
Bien chu'ng than l<inh ngoai vi Khonq
93 16 109
Co 8 2 10
Tong so 101
18 119
OR OR = 1,4 (CI: 0,3-7,5)
p > 0,05 Nhan xet: Hdc kiem soat glucose theo HbAlc kem (khong dat) co nguy cd gay bien chu'ng than kinh ngoai vi eao 1,4 lan ngu'di cd mu'c kiem soat glucose theo HbAlc dat.
Bang 3.10. Lien quan q\da mu'c kiem soat glucose mau theo HbAlc vdi benh tim thieu mau cue bo Mu'c kiem soat
glucose theo HbAlc Pat
Khong gat (kem) Tong so
Benh t i m thieu mau cue bp Khong
70
Co Tong so
(CI: 0,5-5,0) p >0,05 Nhan xet: Mu'c kiem soat glucose theo HbAlc kem (khong dat) co nguy ed gay bien chiTng benh tim thieu mau cue bg eao 1,8 lan ngu'di eo mu'c kiem soat glucose theo HbAlc dat.
Bang 3 . 1 1 . Lien quan giiJa miTc kiem soat HbAlc vdi bien chu'ng ban chan DTP Mi^c kiem soat
glucose theo HbAlc Dat
Khong dat (kem) Tonq so
Bien chu'ng ban chan DTD Khong
100 17 117
Co 1 1 2
Tong so
101 18 119
OR
OR = 5,9 (CI:0,3-98,6)
p >0,05 Nh$n xet: Mu'c kiem scat glucose theo HbAlc kem (khong dat) co nguy cd gay bien chu'ng ban chan PTP eao 5,9 tan ngu'di eo mu'c kiem soat glucose theo HbAlc dat.
Bang 3 . 1 2 . Lien quan giija miTc iciem soat glucose mau theo HbAle vdi bien chu'ng ehung Mii'c Itiem soat
glucose theo HbAlc Dat
Khonq dat (kem) Tonq so
i t nhat 1 bien chihig Khong
28 1 29
Co 73 17 90
Tong so
101 18 119
OR OR = 6,5 (0,82-51,33)
p <0,05 Nhan xet: Mire kiem soat glucose theo HbAlc kem (khong dat) eo nguy ed gay ra it nhat 1 bien ehutig cao 6,5 lan ngu'di ed mire kiem soat glucose theo HbAle dat.
V. KET LUAN
Qua nghien ciru eac yeu t d lien quan den bien chirng ciia benh PTO tren 119 can bo cao tuoi thuoc dien Thanh iiy Hai Phong quan ly trong thdi gian tCr thang 1-2012 den thang 10- 2012 tai Ban Bao ve sire khoe can bp thanh pho, ehiing toi rut ra nhiJng ket luan sau:
- Po tuoi cang eao thi ty le tang huyet ap va ty le CO bien chu'ng PTP cang nhieu
Ty le eac bien chirng microalbumin nieu, benh vong mac, benh tim thieu mau cue bp tang dBn theo thdi gian phat hien benh PTP.
Ty le cac bien ehCTng lien quan vdi miTc kiem scat du'dng mau theo HbAlc. MiTc kiem soat du'dng mau kem eo nguy cd gay ra it nhat 1 bien chirng cao 6,5 lan va co nguy cd gay bien chirng Microalbumin nieu cao 5,8 lan, benh vong
mac eao 3,8 lan, benh than kinh ngoai vi cao 1,4 lan, benh tim thieu mau cue bo cao 1,8 lan, bien chirng ban chan PTP cao 5,9 lan so vdi ngu'di co mire kiem soat du'dng mau theo HbAle dat.
KHUYE'N NGH!
Benh nhan PTP cao tuoi thupc dien Thanh uy Hal Phong quan ly mac du da rat tich cde giu' chi so BI^I va kiem soat tot du'dng mau theo HbAle, nhu'ng van can du'dc kiem soat du'dng mau nghiem ngat, chat ehe hdn de giam nguy cd gay ra eac bien chiing, dac biet la ngu'di cao tuoi va ngu'di da mac benh keo dai. Nen kiem kiem soat du'dng mau theo HbAlc, co gang duy tri d mire dat de giam cac nguy cd gay bien chiilig d benh nhan PTP.
Y Hpc VigT NAM THANG 2 - s 6 1/2013 TAI UEU T H A M K H A O
1. Ta Van Binh va cpng sv" ( 2 0 0 5 ) , "Thi/c trang benh DTD va cac yeu to nguy cd d 4 th^nh pho I6n cua Viet Nam", Ky yeu toan vSn cac de tai khoa hoc, b?i hoi noi tiet & OTD quoc gia Viet Nam lan thir 3 tai Hue 04/2005, tr. 37-52.
2 Nguyen Van Cong (2006), "Moi lien quan giij'a Albumin ni#u va ton thu'dng dong mach canh 6 benh nhan dai thao dUdng tuyp 2", l<y yeu cdng trinh nghien cdu khoa hoc 2003-2006, Bp Y te - Benh vien HCili Nghj - Ha Noi, tr, 113-117.
3. Do Thj Tinh (2009), "Danh gia kiem soat du'dng mau va siT lien quan vdi ton thu'dng than d benh nhan D^i thao du'dng type 2" . Y hgc thut hanh
(717) - 50 5/2010, tr. 117-119.
UKPDS ( 1 9 9 8 ) , "Intensive blood glucose control with sulphonylureas or Insulin compare with conventional treatment and nek of complication in patients with types 2 diabetes (UKPDS 33)", UK Pmspecdve Diabetes Study Croup, Lancet 1998; 352: 837-853
WHO ( 1 9 9 9 ) , "Definition, diagnosis and dasiflcation of diabetes mellitus and Its complications", Report of World Health Organization consultation 1999.6. Amencan Diabetes Association (2011), Standards of medical care in diabetes-2011. Diabetes Care. 2011 Jan;
34 Suppl 1:511-61.
Sir HAI LONG DOI VOI CONG VIEC CUA NHAN VIEN BENH VIEN THANH PHd BUON MA THUOT
TOM TAT
Su" hai long doi vdi cong viec cua nhan vien y te se dam bao duy tri du nguon nhan lUc va nang cao chat lUdng cac djch vu y te tai cac benh vien, dac biet trong boi canh dang cd sy thieu hut nguon nhan li/c y te d ca benh vien cong va tu'. NNghien ciru nay nham danh gia si/ hai long va xac dinh moi lien quan doi vdi cong viec cua nhan vien y te tai benh vien. Tong so 179 nhan vien y te hien dang lam viec tai Benh vien da khoa Thanh pho Buon Ma Thuot tinh OakLak tham gia vao nghien cuU. Chung toi sd dung bp cau hoi gom 5 yeu to vdi 35 tieu muc co gia tr; di/ doan ty le hai Idng vdi dp tin cay cao. Ket qua nghien CLTU cho thay nhan vien y te chu'a hai long vdi ca 5 yeu to giao dpng tir 51,4% den 68,7%, trong dd ty le hai long chung la 40,8. Ty le nhan vien y te hai long vdi tiTng yeu to la khdng cao lam: cao nhat la yeu to ve moi quan he vdi dong nghiep 67,6%, yeu to moi quan he vdi lanh dao va yeu to lUOng va phiic Ipi dat ty le 53,1%, yeu to cO sd vat chat 52%, yeu to ve cP hoi hoc tap, phat trien 51,4%. Xac djnh moi lien quan doi vdi cac yeu to ve xa hdi va nhan khau/nghe nghiep va 8 yeu to ve si/ hai Idng doi vdi lanh dao ket qua cho thay: nhij'ng nhan vien hai long ve each giai quyet ciia lanh dao ndi chung cao gap 6,23 lan; nhin chung hai long ve su' iing hd ciia lanh dao cao gap 7 fan; hai long ve sU chia se ciia lanh dao cao gap 7,11 fan; hai long v'e viec xir ly ky luat cua lanh dao doi vdi nhan vien cao gap 2,55 lin, so vdi nhom chu'a hai long.
Tdkhoa: Hai long vdi cong viec, nhan vien y te, quan ly benh vien, lanh dao, Buon Ma Thupt
*SdY tS'tinh Dak Lak; ** TrUdng Dai hoc Y teCong cong. Ha Ngi Phan bien khoa hgc: PGS. Kim Bao Giang
42
Hoang Hai Phue *, Le CiTLinh * *
JOB SATISFACTION I N HEALTH WORKERS AT BUON MA THUOT PROVINCIAL HOSPITAL
Job satisfaction of the health workers will maintain sufficient human resources and improve the quality of medical services in hospitals, particularly in the context of a shortage of human resources in the health care in both public and private hospitals. This study aims to evaluate and explore the job satisfection of the health workers at Buon Ma Thuot hospital hospital, Dak Lak province. A total of 179 healtli workers involved in the study are currently working at this hospital. This cross-sectional study utilized an instrument of five elements with 35 sub-section items predicted satisfaction rate with high reliability. The results showed that health workers are not very satisfied with all 5 elements (ranged from 51.4% to 68.7%), in which the overall satisfacbon rate is 40.8.
The highest rate (67.6%) of health worker's satisfaction is with regard to the relationship with co- workers. The rate of respondents satisfied with, leaders' factors as well as wages and benefits achieved was 53.1%, with the infrastructure: 52%, career advancing and teaming opportunities was 51.4%.
Further analysis shows some factors related to the satisfaction about leadership: the staffs who agreed with the leader's problem solving was 6.23 times more likely to be satisfied with the leadership in general, Other factors are; satisfaction with the support of the leader; with the sharing of the leader (OR of 7.11);
