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

Header Page of 123 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 Footer Page of 123 Header Page of 123 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 Footer Page of 123 Header Page of 123 Li cam oan Tụi xin cam oan õy l cụng trỡnh nghiờn cu chớnh tụi thc hin Cỏc s liu kt qu lun ỏn l trung thc v cha c cụng b bt k cụng trỡnh no khỏc H Ni, ngy 10 thỏng 03 nm 2015 Tỏc gi Nguyn Trung Hũa Footer Page of 123 Header Page of 123 Li cỏm n Tụi xin chõn thnh cỏm n Ban Lónh o Vin V sinh Dch t Trung ng, Phũng o to Sau i hc v cỏc thy giỏo, cụ giỏo ca Vin ó giỳp , to iu kin cho tụi hc v hon thnh lun ỏn Tụi xin by t lũng kớnh trng v bit n sõu sc n GS.TS o Vn Dng, PGS.TS Nguyn Vn Tp, l nhng ngi thy ó tn tõm hng dn, ng viờn v cung cp nhng kin thc quý bỏu cho tụi sut quỏ trỡnh hc tp, nghiờn cu v hon thnh lun ỏn ny Tụi xin chõn thnh cỏm n Lónh o S Y t thnh ph H Chớ Minh, Ngnh y t qun Bỡnh Thnh, qun Gũ Vp, qun 6, qun 12 v huyn Húc Mụn c bit tụi xin cỏm n Lónh o y ban nhõn dõn, quý ng nghip trm y t v cng tỏc viờn ca cỏc phng qun Bỡnh Thnh, phng qun Gũ Vp, phng Hip Thnh qun 12 v xó Tõn Xuõn huyn Húc Mụn ó tn tỡnh tham gia v h tr tụi sut quỏ trỡnh thc hin nghiờn cu trờn thc a Vi tm lũng thnh kớnh, tụi cng xin cỏm n nhng ngi dõn ó ng ý tham gia cụng trỡnh nghiờn cu ny Xin cỏm n gia ỡnh, nhng ngi thõn ó quan tõm, ng viờn v ht lũng giỳp tụi quỏ trỡnh hc v hon thnh lun ỏn Xin gi n tt c mi ngi lũng bit n sõu sc H Ni, ngy 10 thỏng 03 nm 2015 Nguyn Trung Hũa Footer Page of 123 Header Page of 123 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 Footer Page of 123 Header Page of 123 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 Footer Page of 123 Header Page of 123 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 Footer Page of 123 Header Page of 123 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 Footer Page of 123 Header Page of 123 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 Footer Page of 123 : Xó Header Page 10 of 123 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 Footer Page 10 of 123 Header Page 142 of 123 142 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), tr 103108 Footer Page 142 of 123 Header Page 143 of 123 143 TI LIU THAM KHO Ting Vit Nguyn Th Hoi Chõu (2003), Kho sỏt mt xng v tỡm hiu nhng yu t liờn quan n bnh loóng xng ca ph n thnh ph H Chớ Minh v mt s tnh Tõy,Tp Y hc thnh ph H Chớ Minh, 7(1), tr 126129 Trn Hong Minh Chõu (2010), T l góy xng cú triu chng lõm sng v mt s yu t nguy c ngi trờn 50 tui ti qun Gũ Vp thnh ph H Chớ Minh sau nm theo dừi, K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 16-26 Cc Thng kờ thnh ph H Chớ Minh (2010), Bỏo cỏo dõn s v mt dõn s nm 2010, thnh ph H Chớ Minh Mai Th Cụng Danh (2010), Kin thc v thúi quen sinh hot cú liờn quan n loóng xng ca ph n sau kinh ti thnh ph H Chớ Minh nm 2006, K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 71-72 o Vn Dng, Hong ỡnh Hu, Vừ Vn Thng v cs (2008), Thit k nghiờn cu h thng y t, Nh xut bn Y hc, H Ni Lờ Dng, Nguyn Trung Kiờn (2012), Kho sỏt tỡnh hỡnh loóng xng ngi cao tui ti thnh ph Cn Th nm 2011, Tp Y hc thc hnh, 825(6), tr 6-9 Lu Ngc Giang (2011), Mi liờn quan gia loóng xng v thi gian kinh ca ph n thnh ph M Tho, Tp Y hc thc hnh, 751(2), tr 21-24 V Th Thu Hin v cs (2007), Xỏc nh mc ph bin v yu t liờn quan n bnh loóng xng ph n Vit Nam bng phng phỏp siờu õm nh lng, Tp Nghiờn cu Y hc, 50(4), tr 7-15 Footer Page 143 of 123 Header Page 144 of 123 144 Nguyn Trung Hũa (2008), Nghiờn cu tỡnh hỡnh loóng xng v mt s yu t liờn quan ngi trờn 45 tui ti qun Gũ Vp thnh ph H Chớ Minh nm 2008,Lun ỏn Chuyờn khoa cp 2, i hc Y dc Hu 10 Lu Ngc Hot (2008), Thng kờ Tin hc ng dng nghiờn cu y hc, Nh xut bn Y hc, H Ni, tr 36-63 11 Nguyn Th Kim Hng (2003), Can-xi v dinh dng phũng nga loóng xng, K yu cỏc bỏo cỏo khoa hc hi ngh khoa hc chuyờn loóng xng v bnh ct sng,thnh ph H Chớ Minh, tr 21-24 12 Th Khỏnh H (2008), Tỡm hiu mt xng, tỡnh trng loóng xng v mt s yu t nh hng ph n sau kinh, Tp Nghiờn cu Y hc, 58(5), tr 75-81 13 o Th Võn Khỏnh, Nguyn Hong Thanh Võn, Nguyn Th Huyn Trang (2009), Kho sỏt tỡnh hỡnh loóng xng ph n ln tui bng mỏy siờu õm nh lng, Tp Y hc thc hnh, 644, 645(2), tr 20-22 14 Nguyn Thy Khuờ (2008), Loóng xng glucocorticoid, K yu cỏc bỏo cỏo khoa hc Tm nhỡn Chõu v loóng xng, thnh ph H Chớ Minh, tr 25-27 15 H Phm Thc Lan v cs (2008), n chay trng v loóng xng: mt nghiờn cu trờn cỏc ni cụ pht giỏo, K yu cỏc bỏo cỏo khoa hc Tm nhỡn Chõu v loóng xng, thnh ph H Chớ Minh, tr 16 16 H Phm Thc Lan v cs (2011), Chn oỏn loóng xng: nh hng ca giỏ tr tham chiu,Thi s y hc - Tp Y khoa ca Hi Y hc thnh ph H Chớ Minh, 1-2(57), tr 3-10 17.H Phm Thc Lan v cs (2011), Chn oỏn góy xng t sng: Phỏt trin giỏ tr tham chiu cho ngi Vit Quy mụ góy xng t sng ngi Vit, Thi s Y hc-Tp Y khoa ca Hi Y hc thnh phH Chớ Minh, 8(63), tr 3-16 18 H Phm Thc Lan, Nguyn Vn Tun (2011), Sinh lý hc loóng xng, Thi s Y hc-Tp Hi Y hc thnh ph H Chớ Minh, 7(62), tr 22-28 Footer Page 144 of 123 Header Page 145 of 123 145 19 H Phm Thc Lan (2011), Cm nang iu tr Loóng xng, Nh xut bn Y hc, H Ni, tr 100-107 20 Nguyn Th Lc, Hu Th Chung (2003), ỏnh giỏ mt xng 840 ph n bng phng phỏp siờu õm, K yu cỏc bỏo cỏo khoa hc chuyờn loóng xng v bnh ct sng, thnh ph H Chớ Minh, tr 25-28 21 Marlena C Kruger v cs (2010), Tỏc dng ca sa tng cng can-xi v vitamin D i vi tỡnh trng vitamin D v chu chuyn xng ph n sau kinh ụng Nam , K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 55-70 22 Trn Vn Nam, Nguyn Vn Cụng (2010), BMD v góy xng, K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 34 23 Nguyn ỡnh Nguyờn (2010), Vai trũ ca cỏc yu t nguy c tiờn oỏn góy xng, K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 35-40 24 Ninh Th Nhung, Phm Ngc Khỏi, Phm Ngc Chõu (2010), Loóng xng v gim mt xng ca ph n 40-65 tui ti mt s khu vc ca tnh Thỏi Bỡnh, Tp Dinh dng v Thc phm, 6(1) 25 Ninh Th Nhung, Phm Ngc Khỏi, Phm Ngc Chõu (2010), Hiu qu ca mt s bin phỏp can thip d phũng loóng xng cho ph n 40-65 tui ti Thỏi Bỡnh, Tp Dinh dng v Thc phm, 6(1) 26 Nguyn Vn Quang (2008), Bỏc s chnh hỡnh v loóng xng, K yu cỏc bỏo cỏo khoa hc Tm nhỡn Chõu v loóng xng, thnh ph H Chớ Minh, tr 65-66 27 Trung Quõn (2005), Bnh ni tit chuyn húa thng gp, Nh xut bn Y hc, H Ni, tr 481-496 28 S Y t TPHCM (2013), Hng dn chn oỏn, iu tr v d phũng bnh loóng xng, Ban hnh theo Quyt nh s 1983/Q-SYT, thnh ph H Chớ Minh Footer Page 145 of 123 Header Page 146 of 123 146 29 Nguyn Vn Thỏi, ng Th Bộ Thu, Phm Thanh Tõn (2010), Góy u di xng quay, c xng ựi, c phu thut xng cỏnh tay, iu tr v phũng nga ti Bnh vin Chn thng chnh hỡnh TPHCM, K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 27-29 30 Trn c Th (2005), Bnh loóng xng ngi cao tui, Nh xut bn Y hc, H Ni 31 Nguyn Vn Th, Lờ Nguyn Thy Khanh, Lờ Th Tuyt Lan (2010), Nghiờn cu mt xng bng o hp th nng lng tia X kộp ngi s dng corticoides kộo di, Tp Y hc thnh ph H Chớ Minh, 14(1), tr 2127 32 Nguyn Huy Thụng, Nguyn Ngc Chõu, Nguyn Th Phi Nga, on Vn (2010), ỏnh giỏ mt xng v t l loóng xng cỏc bnh nhõn khỏm v iu tr ti 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Xây dựng đánh giá hiệu qu một số biện pháp can thiệp cộng đồng Phòng chống loãng xương 79 3.2.1 Kết xây dựng số biện pháp can thiệp 79 3.2.2 Đánh giá hiệu số biện pháp can thiệp. .. tài: Đánh giá hiệu số biện pháp can thiệp cộng đồng phòng chống loãng xương người từ 45 tuổi trở lên thành phố Hồ Chí Minh với mục tiêu nghiên cứu sau: Xác định tỷ lệ số yếu tố liên quan đến loãng