| Objective To carry out community-based comprehensive intervention of different model each in urban and rural communities of Tianjin, in order to promote balanced diet, regular exercise and other core health knowledge, guide residents to adopt a healthy lifestyle and reduce the burden and harm of chronic diseases. Analyze the implementation effect of each intervention program to seek more suitable and integrated intervention model for chronic disease prevention and control and lay the foundation of anti-control health policy improvement. Compare the implementation effect of the two programs to find the difference in measures and effects of urban and rural community intervention projects, in order to explore the pros and cons of the different intervention model, offer data and practical experience and effectively find intervention model for chronic disease prevention and control respectively for urban and rural communities with chronic diseases.Methods3030residents were rolling into the study of "Healthy weight and blood pressure management program from2009and comprehensive intervention of standardized management of patients with high blood pressure, overweight and obesity were carried on until2011.After chronic disease risk factors and other health-related assessment, residents were divided into patients of chronic disease, high-risk group of chronic disease and plain group. Hypertension patients (n=897) were divided into low-risk, medium risk group, the high-risk group, and very high-risk group in accordance with the risk factors and given frequency of management. For overweight and obese patients (n=720), they attended the standardized follow-up management to maintain healthy weight. Baseline survey on the prevalence of chronic diseases and risk factors was described, and management effect of the general population was analyzed after1year’s intervention. Analyze the changes in blood pressure, pulse pressure, food intake, food ingredients intake after standardized follow-up management of hypertension patients and also the management effect of overweight and obese patients and patients with dual-management. In2008-2009, comprehensive nutrition intervention of balanced diet and regular physical activity was given in intervention group (n=388) of rural community of Jinnan District while a control group was selected in Wuqing District of Tianjin. Physical examination, biochemical tests, nutritional knowledge tests and diet survey were taken both in intervention and control group before and after intervention. By comparing the measures and effects of the implementation of the two projects, improvements and policy suggestions were given. Data management, analysis was done by using computer management system, EpiData3.0and SPSS18.0software, based on the purpose and data type, the t-test, chi-square test, univariate and multivariate regression analysis and other statistical analysis methods was using.Results Results of urban community intervention project have shown that after one-year intervention management, waist circumference of people in project was decreased by1.49cm, systolic blood pressure and diastolic blood pressure were decreased by1.36mmHg and1.55mmHg, daily salt intake was decreased by1.61g, dietary patterns tends to healthy, time and intensity of exercise had increased (all p<0.05). Waist of patients in Management of blood pressure was decreased by2.27cm, systolic blood pressure, diastolic blood pressure and pulse pressure were decreased by7.74mmHg,3.79mmHg and3.96mmHg and control rate of blood pressure was increased by37.3%. Divided according to risk factors, blood pressure, pulse pressure and control rate of blood pressure had significantly decreased in every group. In every group, blood pressure and pulse pressure showed a downward trend with times of follow-up increasing.After statistic analyze, we got the most appropriate frequency of follow-up. Patients’ dietary intake of staple food, vegetables, livestock and poultry meat, eggs and salt was significantly decreased with times of follow-up increasing, daily intake of fat, carbohydrates, niacin, vitamin E and other ingredients showed a downward trend (all p<0.05); blood pressure prediction equation of food intake was drawn by results of multivariate regression analysis. In overweight and obese patients, actual dietary intake reduced and actual amount of exercise increased significantly, and with the times of follow-up increasing,the trend of change became stable. Systolic blood pressure, diastolic blood pressure and pulse pressure of patients involved in "double" standardized management were reduced by8.53mmHg4.10mmHg and4.42mmHg respectively. In nutrition intervention programs of rural communities, after education and intervention, related knowledge of nutrition and health of the intervention group was improved significantly much more than the control group. Compared with the control group, BMI, hip circumference, systolic blood pressure, diastolic blood pressure, total blood cholesterol and homocysteine of intervention group, were decreased respectively by1.19kg/m2,1.74cm,2.70mmHg2.82mmHg,0.57mmol/L and0.49μmol/L. Ddaily intake of cereal and salt were significantly reduced, and intake of fruits and vegetables were increased significantly. Fiber, vitamin C, potassium were increased significantly while cholesterol and sodium were significantly decreased (p<0.05).Conclusion After the implementation of the urban community intervention projects, related dangerous factors of chronic disease were well-controlled, the condition of blood pressure management was improved, management of overweight and obese patients were quite effective. Nutrition and health-related knowledge was increased after implementation of nutritional intervention project in rural community. The level of risk factors of chronic diseases was reduced in intervention group. The two project of comprehensive intervention and prevention for chronic diseases gained quite good results. Comparison between comprehensive interventions for chronic diseases between urban and rural communitieswas done in order to find different measures for chronic disease prevention and control in both urban and rural community. Several policy suggestions were put forward for nutrition intervention and guidance, comprehensive prevention and control of chronic diseases. |
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