广西鼻咽癌高危人群社区防治点的初步建立

发布时间：2018-09-08 11:47

【摘要】：研究背景：发展社区卫生服务(community health service,CHS),是21世纪我国卫生服务的发展方向,我国正式公布的新医改方案中明确了社区卫生服务的地位和任务,并且明确指出了下一步社区卫生服务建设的方向,社区卫生服务对于维护居民健康具有不可取代的作用。要强化社区卫生服务应加大政府扶持力度,合理配置卫生资源,加大宣传力度,促进人们转变观念,建立优势互补的“双向转诊”制,做好人才引入和培养高素质的人才,以全科医生为骨干,并通过政策手段激励人们到社区就诊。作为社区服务重要内容的社区肿瘤防治工作,越来越引起社会的关注,肿瘤即为社区重点防治疾病之一。随着社会城市化、工业化的加速,环境污染物和新化学物质的日趋增多,加之不良生活方式和行为习惯的影响,恶性肿瘤已成为危害人类生命与健康的重大疾病之一。在各类死因的疾病谱中恶性肿瘤居第一(城市)、二位(农村)。我国城市人口的老龄化尤其突出,随着城市化的进程,慢性非传染性疾病特别是恶性肿瘤,日益严重威胁着我国居民的身心健康,在我国大力推进的新医改大背景下,作为社区卫生服务重要内容之一的社区肿瘤防治工作,越来越引起社会的关注。在社区建立肿瘤社区防治点是社区肿瘤防治工作中一项重要的工作。鼻咽癌(nasopharyngeal carcinoma,NPC)是一个流行特征非常明显的肿瘤,在我国分布具有明显的地区性,是南部和东部人群高发的恶性肿瘤特别是我国的广东、广西、福建、海南、湖南等地为多发区,由于病变隐蔽、早期症状不明显,常易误诊和漏诊,导致晚期病例仍占多数。在鼻咽癌高发地区的自然人群中筛查高危人群是早期诊断、早期治疗争取最佳治疗效果及预后的关键。但因为健康知识的缺乏等原因部分筛查出的肿瘤高危人群并末按时复查、定期体检。所以在社区建立肿瘤防治点,对广大居民进行健康教育及肿瘤初筛是一项投入少、收益大的保健对策。广西地处鼻咽癌高发区,在广西某社区建立鼻咽癌高危人群防治点是针对广西鼻咽癌高发的现状,就社区肿瘤防治工作做的一些有益尝试。大量研究认为EB病毒(EBV)感染与鼻咽癌密切相关,本文将EB病毒VCA-IgA抗体阳性者(=1：5)列为鼻咽癌高危人群。目的：1.建立广西鼻咽癌高危人群社区防治点,对社区居民开展防癌知识宣教,开展自然人群筛查工作,并动员筛查出的鼻咽癌高危人群定期随访复查,增强人群健康知识水平。2.探讨建立防治点在筛查鼻咽癌高危人群中的作用,摸索出适合社区肿瘤筛查的一套可行性强,经济效益及社会效益良好的建设方案。3.对社区居民的EB病毒VCA-IgA抗体感染情况进行分析,探讨病毒感染与性别、年龄的关系,为后期的鼻咽癌筛查工作提供基础。方法：1.研究对象：广西社区单位职工和居民。2.地点的选择：选择广西某社区医疗机构。3.前期工作：在得到该社区医疗机构相关领导的支持及配合下,派经过培训的专业人员至体检科进行前期宣传,发放防癌健康教育资料,动员在该社区医疗机构体检的单位职工及居民进行鼻咽癌的初筛。4.初筛工作：由专业人员于体检科收集在该社区医疗机构体检的自然人群的外周静脉血,并登记人群信息,将血样于实验室分离后,进行EB病毒VCA-IgA抗体的检测,登记VCA-IgA抗体阳性人群的完整相关信息,将结果告知体检科,并由体检科通知该职工或居民,定期对其随访复查。结果：1.筛查社区人群11584例,目前已建成681人的鼻咽癌高危人群队列,并给予发放防癌健康教育资料及健康教育指导。2.筛查的11584例自然人群具备完整的相关资料,并在该社区医疗机构建立了健康档案,定期进行复查随访,初步建成了广西鼻咽癌高危人群的社区防治点。3.在筛查的11584例自然人群中,VCA-IgA抗体阳性681例,阳性率为5.88%,EB病毒VCA-IgA抗体的阳性检出率男女之间差别无统计学意义(P0.05),在不同年龄段EB病毒VCA-IgA抗体阳性检出率不同,差异有统计学意义(P0.05)。4.建立的鼻咽癌社区防治点已完成鼻咽癌初筛11584人,筛查指标(VCA-IgA)阳性681例,纳入鼻咽癌高危人群管理681例。结论：了解社区肿瘤的流行病学特征,有助于针对性地开展肿瘤社区防治工作。本研究在以社区医疗机构为依托的前提下,初步建立了鼻咽癌高危人群社区防治点,该防治点的建立为社区鼻咽癌高危人群的筛查提供了便捷,通过该防治点对社区居民进行防癌健康教育,可帮助广大职工及居民克服恐癌心理,掌握基本的肿瘤预防知识,树立良好的生活方式和生活习惯,提高防癌抗癌的自觉性和能力,积极参加肿瘤的初筛,定期参加体检。在社区中进行肿瘤防治的健康教育是有现实意义的,要提高居民对肿瘤防治的知识,提高早诊率还有许多工作要做。在此基础上,要抓好社区高危人群的复查、随访等相关工作,特别是对于年龄在40岁以上、有家族史的居民及之前确诊的那8例鼻咽癌病人的家属是肿瘤防治健康教育的重点人群。
[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.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.63

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