| Objectives:To explore the support of the current policy and service providers on hypertension health management of train drivers,and the status of hypertension health self management of train drivers,to analyze the influence factors of hypertension health management of ttrain drivers,so as to provide a reference for improving the hypertension health management of train drivers.Methods:Literature study,qualitative interview and questionnaire surveys were used to study the status of hypertension health management of policy,service providers and train drivers.According to the results of literature research,the relevant policies and systems of hypertension health management are described.Cluster sampling method was used to investigate 2575 train drivers in Kunming Railway.The investigation included the knowledge of hypertension knowledge,behavior and life style,occupational factors,attitude and belief of train drivers.Chi square test and binary logistic regression model were used to explore the factors of hypertension health management on train drivers.The administrator of Kunming Railway center for disease prevention and control(CDC)were interviewed,and analyzed combine with the status of the hypertension health self management of train drivers.Results1.PolicyIn April 2014,China Railway General Corporation issued "the medical examination and health management measures for the staff of the China Railway General Corporation",which made the health examination and health management of the train drivers more standardized,but the "measure" did not refine the specific management person and their responsibilities for the health management of train drivers.2.Service provider2.1 The main body of the hypertension health management for train drivers was the Railway Centers for Disease Prevention and Control.The Railway Centers for Disease Prevention and Control carried out regular physical examination for train drivers 1 times a year,including routine health examination and occupational health examination,but lack of related tests on psychological and social adaptability.2.2 The Railway Centers for Disease Prevention and Control carried out the health knowledge lecture to train drivers,but the awareness rate of hypertension related knowledge on train drivers was 31.65%,the qualitative interview knew that most of train drivers had no time to attend or not know the lecture.2.3 The Railway Centers for Disease Prevention and Control was followed up and classified of train drivers suffered from hyperyension according to the national basic public health service standard,but the occupational factors were ignored.3.Train drivers3.1 The number of train drivers was 2575,The mean systolic blood pressure was(117.56 + 14.37)mmHg,and the mean diastolic blood pressure was(76.94 + 11.30)mmHg.The number of hypertension detected was 725,and the detection rate of hypertension was 24.23%.3.2The awareness rate of knowledge about hypertension among train drivers was 31.65%.the awareness rate of basic knowledge of hypertension was 23.88%,the awareness rate of hypertension treatment measures was 21.28%,and the awareness rate of hypertension risk factors was 40.74%.The results of Chi square test showed that statistically significant were found of age(?2 = 8.934,P<0.05)?marital status(?2=8.025,P<0.05)with the awareness rate of hypertension knowledge of train drivers.3.3 The behavior lifestyle score of train drivers were 46.70+17.07,the score were between 29.63-63.77.The different management of behavior lifestyles and the detection rate of hypertension were statistically significant(?2= 3.953,P = 0.047),and the detection rate of hypertension for train drivers with good behavior and life style(23.28%)was lower than that train drivers with poor behavior management(27.19%).3.4 The results of Chi square test showed that statistically significant were found of type of work(?2= 23.826,P<0.001),train type(x2= 22.193,P<0.001),model(x2=12.683,P = 0.005),work contract(?2= 11.885,P = 0.001),title(2 = 56.694,P<0.001),working age(P<0.001)with the detection rate of hypertension for train drivers.The results of Multiple logistic regression analysis showed that working age(OR=2.114)was the risk factor for the detection of hypertension in train drivers.and the risk of hypertension detected for train drivers by the long working age was 2.114 times that of the train drivers with short working age.3.5The results of Chi square test showed that statistically significant were found between the stress management(?2=8.797,P=0.003)and the detection rate of hypertension for train drivers.and the rate of hypertension for train drivers with good working pressure management(21.70%)was lower than that of poor working pressure management(26.71%).3.6 The physical and mental health management of train drivers were poor,only 16.24%of the train drivers were in good physic health,and 14.10%of train drivers were in good mental health.The results of Chi square test showed that statistically significant were found between physical health(?2=20.232,P<0.001)and the detection rate of hypertension for train drivers.Physical health of train drivers in the detection of hypertension was worse than that of the train drivers who had not been detected.it was not found that statistically significant between mental health(?2=1.818,P = 0.403)and the detection rate of hypertension for train drivers.There were statistically significant between role emotional dimensions(t=2.304,P = 0.021)and the detection rate of hypertension for train drivers.and the role emotional scores of dimensions(39.25+8.49)for train drivers with the detection of hypertension was lower than that of the train drivers without detected hypertension(40.17±8.74).3.7 Requirements of train drivers to the health management of hypertension were above 65%.The requirements for improving the related knowledge and skills of hypertension were higher than those of the other needs.The other kinds of requirements from high to low were in the order of guiding rational exercise,guiding rational diet,guiding the correct measurement of blood pressure,and regularly carrying out the lecture about prevention and control of hypertension.Conclusions:1.PolicyAlthough China Railway Corporation had issued a "measure" for physical examination and health management of train drivers,its perfection needs to be strengthened.2.Service providerThe Railway Centers for Disease Prevention and Control carried out hypertension health management on the basis of the national basic public health service standard.It paid attention to physical examination for hypertension health management of train drivers.Although lectures on health knowledge had been carried out,they did not have achieved good results.Train drivers still have low awareness rate of hypertension knowledge.And occupational factors were neglected in follow-up evaluation and classified intervention.3.Train drivers3.1 The awareness rate of hypertension related knowledge was relatively low,and with the increase of age,the awareness rate of hypertension knowledge of train drivers also increased,and the rate of hypertension for train drivers in married was higher than that of unmarried train drivers.3.2 The behavior and lifestyle management of train drivers were related to the detection rate of hypertension.The detection rate of hypertension in train drivers with good behavior and lifestyle management was lower than those with bad behavior and lifestyle management.The reasons for the health self management of train drivers on occupational factors were the type of work,type of train,the model,the work contract,the job title and the working age.3.3 Whether train drivers hypertension detected had a greater impact on their physical health,and also had a certain impact on mental health.3.4 The stress management status of train drivers was related to the detection rate of hypertension.The detection rate of hypertension in train drivers with good stress management was lower than those with bad stress management.Hypertension health management service demand of train drivers were high,especially the need for hypertension related knowledge and skills,and the propaganda and education of the prevention and control knowledge of hypertension should be strengthened.Suggestions:1.To strengthen the functions and responsibilities of the government and the administrative departments of the government.2.To strengthen the service providers' hypertension health management for train drivers.3.To improve the hypertension health management behavior of train drivers. |
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