Đánh giá hiệu quả một số biện pháp can thiệp cộng đồng phòng chống loãng xương ở người từ 45 tuổi trở lên tại thành phố Hồ Chí Minh

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1 B GIO DC V O TO B Y T VIN V SINH DCH T TRUNG NG -* NGUYN TRUNG HềA NH GI HIU QU MT S BIN PHP CAN THIP CNG NG PHềNG CHNG LONG XNG NGI T 45 TUI TR LấN TI THNH PH H CH MINH LUN N TIN S Y HC Chuyờn ngnh: V SINH X HI HC V T CHC Y T Mó s: 62 72 01 64 H NI - 2015 B GIO DC V O TO B Y T VIN V SINH DCH T TRUNG NG -* NGUYN TRUNG HềA NH GI HIU QU MT S BIN PHP CAN THIP CNG NG PHềNG CHNG LONG XNG NGI T 45 TUI TR LấN TI THNH PH H CH MINH LUN N TIN S Y HC Chuyờn ngnh: V SINH X HI HC V T CHC Y T Mó s: 62 72 01 64 Hng dn khoa hc PGS.TS NGUYN VN TP GS.TS O VN DNG H NI - 2015 MC LC Mc lc i Danh mc cỏc ch vit tt v Danh mc cỏc bng vii Danh mc cỏc biu x Danh mc cỏc hỡnh, s xi T VN Chng TNG QUAN 1.1 Mt s khỏi nim v bnh loóng xng 1.1.1 nh ngha loóng xng v gim mt xng 1.1.2 Cu trỳc v chc nng ca xng 1.1.3 Sinh lý xng v bnh loóng xng 1.1.4 Nguyờn nhõn v phõn loi loóng xng 1.1.5 Cỏc du hiu lõm sng loóng xng nguyờn phỏt v bin chng 1.1.6 Cỏc xột nghim thm dũ hỡnh nh v chn oỏn loóng xng 1.1.7 iu tr v phũng bnh loóng xng 1.2 T l v mt s yu t liờn quan n loóng xng trờn th gii v Vit Nam 10 1.2.1 T l loóng xng mt s nc trờn th gii 10 1.2.2 T l loóng xng ti Vit Nam 15 1.2.3 Mt s yu t liờn quan n loóng xng 17 1.3 Cỏc bin phỏp phũng chng loóng xng trờn th gii v ti Vit Nam 25 1.3.1 Cỏc bin phỏp phũng chng loóng xng trờn th gii .25 1.3.2 Cỏc bin phỏp phũng chng loóng xng ti Vit Nam 31 1.4 Mt s c im v thnh ph H Chớ Minh 34 Chng I TNG V PHNG PHP NGHIấN CU 35 2.1 i tng nghiờn cu 35 2.1.1 i tng nghiờn cu mụ t ct ngang 35 2.1.2 i tng nghiờn cu can thip .35 2.1.3 Tiờu loi tr chn mu nghiờn cu 35 2.2 a im v thi gian nghiờn cu 35 2.2.1 a im nghiờn cu 35 2.2.2 Mt s c im ca a phng nghiờn cu 36 2.2.3 Thi gian nghiờn cu 37 2.3 Phng phỏp nghiờn cu 37 2.3.1 Thit k nghiờn cu 37 2.3.2 Phng phỏp chn mu 45 2.4 T chc thc hin nghiờn cu 48 2.4.1 Nghiờn cu mụ t 48 2.5 Bin s v cỏc ch s nghiờn cu 50 2.5.1.nh ngha cỏc bin s 50 2.5.2 Cỏc ch s nghiờn cu 55 2.6 K thut hn ch sai s nghiờn cu 57 2.6.1 Hn ch sai s chn mu 57 2.6.3 Hn ch sai s thu thp thụng tin 57 2.7 X lý v phõn tớch s liu 58 2.8 Vn o c nghiờn cu 59 Chng KT QU NGHIấN CU 60 3.1 T l loóng xng v mt s yu t liờn quan ngi dõn t 45 tui tr lờn 60 3.1.1 c im chung ca ngi dõn nghiờn cu trc can thip 60 3.1.2 T l loóng xng ca ngi dõn t 45 tui tr lờn 66 3.1.3 Mt s yu t liờn quan n mt xng ca ngi dõn 67 3.1.4 So sỏnh mt s c im ca ngi dõn nghiờn cu cỏc phng, xó nghiờn cu can thip v i chng 78 3.2 Xõy dng v ỏnh giỏ hiu qumt s bin phỏp can thip cng ng Phũng chng loóng xng 79 3.2.1 Kt qu xõy dng mt s bin phỏp can thip 79 3.2.2 ỏnh giỏ hiu qu mt s bin phỏp can thip 83 Chng BN LUN 93 4.1 T l loóng xng v mt s yu t liờn quan ngi t 45 tui tr lờn ti thnh ph H Chớ Minh trc can thip 93 4.1.1 c im chung ca ngi dõn nghiờn cu trc can thip 93 4.1.2 T l loóng xng ca ngi dõn nghiờn cu trc can thip 94 4.1.3 Mt s yu t liờn quan n mt xng 95 4.1.4 Yu t khụng liờn quan n loóng xng 107 4.2 Xõy dng v ỏnh giỏ hiu qu mt s bin phỏp can thip 108 4.2.1 Kt qu xõy dng mt s bin phỏp can thip 108 4.2.2 ỏnh giỏ hiu qu mt s bin phỏp can thip cng ng 114 4.2.3 Kt qu trỡ hot ng mụ hỡnh can thip 123 4.2.4 Hn ch ca ti 124 KT LUN 125 KIN NGH 127 TI LIU THAM KHO PH LC NHNG CH VIT TT BMC : Bone Mineral Concent - Khi lng khoỏng xng BMD : Bone Mineral Density - Mt khoỏng xng BMI : Body Mass Index - Ch s c th BT : Bỡnh thng CB-CCVC : Cỏn b - Cụng chc viờn chc CBYT : Cỏn b y t C-H : Cao ng-i hc CI : Confidence Interval Khong tin cy CLB : Cõu lc b Cs : Cng s CSHQ : Ch s hiu qu CT : Can thip CTV : Cng tỏc viờn DXA : Dual-Energy X-ray AbsorptiometryHp th nng lng kộp X quang H : Huyn HQCT : Hiu qu can thip HRT : Hormon Replacement TherapyLiu phỏp hormon thay th KT : Kin thc KTX : Khụng thng xuyờn LX : Loóng xng MX : Mt xng NVYT PTH : Nhõn viờn y t : Parathyroid Hormone - Hormone tuyn cn giỏp P : Phng Q : Qun OR : Odd Ratio- T sut chờnh RLHTéR : Ri lon hp thu ng rut SD : Standard Deviation - lch chun SE : Standard Error Sai s chun SL : S lng STT : S th t TB : Trung bỡnh TDTT : Th dc th thao TH : Thc hnh THCS : Trung hc c s THPT : Trung hc ph thụng TPHCM : Thnh Ph H Chớ Minh TX : Thng xuyờn IU : International Unit n v Quc t UNICEF : United Nations Children's FundQu nhi ng Liờn Hip quc USD : United State Dollars ụ la M WHO : World Health OrganizationT chc Y t th gii X : Xó 10 DANH MC CC BNG Bng Ni dung Trang 1.1 Nhng yu t nguy c gõy bnh loóng xng 17 2.1 a im nghiờn cu mụ t v can thip 36 2.2 Ni dung bin phỏp can thip trờn cỏc nhúm i tng 43 2.1 Tiờu chun chn oỏn loóng xng theo mt xng 50 2.2 Tiờu chun chn oỏn xp t sng theo phng phỏp Genant 51 2.3 Phõn loi BMI theo WHO nm 2000 khu vc Chõu 52 3.1 Phõn b t l ngi dõn nghiờn cu theo gii v nhúm tui 60 3.2 Phõn b trung bỡnh cõn nng, chiu cao, BMI theo gii 60 3.3 Phõn b t l ngi dõn nghiờn cu theo c im nhõn trc .61 3.4 Phõn b t l ngi dõn nghiờn cu theo tin s bnh v chiu cao .62 3.5 Phõn b t l ngi dõn nghiờn cu theo li sng 63 3.6 Phõn b t l ph n nghiờn cu theo kinh nguyt v s 63 3.7 Phõn b t l ngi dõn tr li ỳng v kin thc bnh loóng xng 64 3.8 Phõn b t l ngi dõn nhn thụng tin v loóng xng v ngun nhn .65 3.9 Phõn b t l ngi dõn thc hin hnh vi cú li v cú hi cho xng 65 3.10 Phõn b t l kin thc v thc hnh ca ngi dõn nghiờn cu 66 3.11 Phõn b t l loóng xng ca ngi dõn nghiờn cu theo gii tớnh 67 3.12 Phõn b tỡnh trng mt xng theo trung bỡnh BMD v gii tớnh 67 3.13 Liờn quan loóng xng vi gii tớnh ngi dõn nghiờn cu 67 3.14 Liờn quan loóng xng vi nhúm tui theo gii tớnh ca ngi dõn 68 3.15 Liờn quan loóng xng vi vi BMI ca ngi dõn 69 3.16 Liờn quan loóng xng vi yu t a d 70 3.17 Liờn quan loóng xng vi yu t ngh nghip v hc 71 3.18 Liờn quan loóng xng vi kinh nguyt v s ph n nghiờn cu 71 3.19 Liờn quan loóng xng vi s dng ru bia, hỳt thuc lỏ theo gii 72 3.20 Liờn quan loóng xng vi ung sa, th dc th thao theo gii .73 3.21 Liờn quan loóng xng vi tin s cỏ nhõn, gia ỡnh v chiu cao 73 11 3.22 Liờn quan tỡnh trng xp t sng vi BMD ca ngi b loóng xng .74 3.23 Liờn quan loóng xng vi kin thc v thc hnh ca ngi dõn .75 3.24 Liờn quan loóng xng trờn mụ hỡnh hi quy a bin 76 3.25 Liờn quan loóng xng trờn mụ hỡnh hi quy a bin n gii 77 3.26 S ngi dõn phng xó can thip c t nm ti n v t chung 80 3.27.S ngi dõn phng, xó can thip c t nm ti cỏc trm y t .81 3.28 S lt ngi dõn c truyn thụng trc tip ti cng ng cỏc phng xó can thip sau nm 81 3.29 S h v ngi dõn nghiờn cu c cng tỏc viờn thm v t sau nm can thip .82 3.30 Phõn b t l ngi dõn nghiờn cu c truyn thụng, t trc tip v bnh loóng xng 82 3.31 Phõn b t l ngi dõn can thip v i chng theo gii tớnh, tui, ngh nghip, trỡnh hc vn, tin s gia ỡnh loóng xng v BMI .83 3.32 Phõn b t l ph n can thip v i chng v kinh nguyt v s 84 3.33 Hiu qu can thip v ngun v thụng tin nhn c ca ngi dõn 85 3.34 Hiu qu can thip v cỏc ni dung thc hnh ca ngi dõn .86 3.35 Hiu qu can thip v kin thc ỳng ca ngi dõn 87 3.36 So sỏnh trung bỡnh BMD, im kin thc v thc hnh ca ngi dõn trc v sau can thip 88 3.37 Hiu qu can thip v mt xng, kin thc v thc hnh ca ngi dõn nghiờn cu trc v sau can thip 88 3.38 Hiu qu can thip v nhn thụng tin bnh loóng xng ngi cú mt xng thp 90 3.39 Hiu qu can thip v ngun thụng tin nhn c ngi cú mt xng thp .90 3.40 Hiu qu can thip v kin thc ỳng ngi cú mt xng thp 91 3.41 Hiu qu can thip v thc hnh phũng chng loóng xng ngi cú 12 mt xng thp .91 3.42 So sỏnh trung v BMD, im kin thc, im thc hnh ngi cú mt xng thp trc v sau can thip 91 3.43 Hiu qu can thip v mt xng ngi cú mt xng thp 92 3.44 Hiu qu can thip v kin thc, thc hnh ngi mt xng thp 92 142 DANH MC CC CễNG TRèNH KHOA HC CễNG B Nguyn Trung Hũa, Nguyn Vn Tp, o Vn Dng, Nguyn Th Thựy Dng (2013),T l loóng xng v mt s yu t liờn quan ngi 45 tui tr lờn ti thnh ph H Chớ Minh nm 2011, Tp Y hc d phũng, XXIII, s 7(143), 2013, tr.93-98 Nguyn Trung Hũa, Nguyn Thanh Bỡnh, Nguyn Vn Tp, Phm Thanh Bỡnh (2014), Kin thc, thỏi phũng chng loóng xng ngi 45 tui tr lờn ti thnh ph H Chớ Minh, Tp Y hc Cng ng, s 8, 2014, tr 8-13 Nguyn Trung Hũa, Nguyn Vn Tp, o Vn Dng (2014), Hiu qu mt s bin phỏp can thip cng ng phũng chng loóng xng ngi t 45 tui tr lờn ti thnh ph H Chớ Minh,Tp Y hc d phũng, XXIV, s (155), 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Xem thêm: Đánh giá hiệu quả một số biện pháp can thiệp cộng đồng phòng chống loãng xương ở người từ 45 tuổi trở lên tại thành phố Hồ Chí Minh, Đánh giá hiệu quả một số biện pháp can thiệp cộng đồng phòng chống loãng xương ở người từ 45 tuổi trở lên tại thành phố Hồ Chí Minh, Đánh giá hiệu quả một số biện pháp can thiệp cộng đồng phòng chống loãng xương ở người từ 45 tuổi trở lên tại thành phố Hồ Chí Minh

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