Y HQC VIET NAM THANG 2 - SO 1/2014

la 203,1. Cu'dng dp nhiem cac loai giun deu d miTc nhe. - Phan loai cu'dng dp nh i lm cho thay chii yeu la nhiem nhe (giun dua: 91,7%; giun tdc: 100%; giun toe: 75,4%); nhiem trung binh thap (giun dua: 8,3%; giun mdc: 22,8%); chi cd 1 tru'dng hdp nhiem giun mdc nang (1,8%).

Vt. KIEN NGH] Tuyen truyen van dpng cac hd gia dinh trong

xa, xay du'ng va sir dung ho xi ket hdp ve sinh, tien tdi tirng bu'dc xda bd thdi quen phdng ue biTa bai ra rupng, de dang ton tai d nhieu ngu'di trong xa; thu'dng xuyen sir dung giay/dep/iing khi lam dong/vu'dn; ve sinh an uong, thire hien uong thuoc tay giun djnh ky 1 - 2 lan/nam [5].., Quan trpng hdn ca la lam the nao de phong ngira khong bi nhiem giun san va dae biet fidn ca la de tranh tai nhiem vi nu'dc ta khi hau nhiet ddi, moi tru'dng thuan ldi de giun san phat trien, ben canh dd mpt sd thdi quen an cac thi/c pham song: goi ca, tiet canh, bd tai...an cac loai rau thiiy sinh cdn song, rau sa lach xoong, rau sdng. Cu'dng quyet loai bd nhUng tap quan chu'a hdp ve sinh, phai an chin, uong sdi (nu'dc nau sdi de ngudi), xir ly cac chat thai sach se (khdng phdng ue bira bai), Phai dam bao 3 sach: an sach, udng

sach, 6 sach. Rira tay thu'dng xuyen tru'dc khi an, sau khi di ve sinh, dac biet tru'dc khi che bien cac mdn an, chuan bi cdm, trai cay, tru'dc khi an nen rifa sach, got vd [6].

TAI LIEU THAM KHAO 1. Abram.S.Benenson (1995), So tay kiem scat

cac benh truyen nhiem, Hiep dong Hoa Ky, Nxb Y hoc. Ha NOI.

2. Bp mon Ky sinh trung - tru'dng Dai hpc Y Ha Npi (2007), Ky sinh triing y hoc, Nxb Y hoc, Ha Ngi.

3. Nguyen Viet Hoa (1998), Nghien c&u anh hu'dng cua nhiem giun moc tdi thieu mau d phu nif co thai, phu nO' cho con bu, Luan an thac sy y hpc. Hoc vien Quan y.

4. Dang Thj Cam Thach (2006), Bao cao hoat dong dl/ an phong chong giun sin WHO tat khoa 2004-2005, Vien Sot ret-Ky sinh triing ~ Con triing Trung u'Ong, Ha Noi.

-J. Nguyen Duy Toan (2000), Xac benh giun san chu yeu hien nay va cac hoat dong phdng chong giun san ciia Vien SR-K5T-CT Tif", Thong tin phong chong benh sot ret va cac benh ky sinh trung, Vien SR-KST&CT Ha Npi.

6. To chCrc Y te the gidi (2000), Hi/dng dan cong tac phong chdng cac benh giun truyen qua dat va tbieu mau do giun, Nxb Y hpc Ha Noi.

CAC YEU TO LIEN QUAN PHAT SINH TRAM CAM NGU^ai CAO TUOI Nguyen Van Di ing*

T6M TAT Cho den nay d Viet Nam chua co mot nghien ciru

h? thong nao ve cac yeu to lien quan den roi loan tram cam 6 ngu'di cao tuoi!. Muc tieu: Mo ta cac yeu to lien lien quan den roi loan tram cam d ngird] cao tuoi, Phu'dng ph^p: Mo ta, tien ciru cd sir dung cac trac nghiem tam ly ho trO. Ket qua: Trong 45 benh nhan tr^ m c^m d ngu'di cao tuoi tir 60 tuoi trd len. Benh nhSn trong nhom nghien ciru chii yeu song d viing n6ng thon vdi (54%). Chii yeu la benh nhan co nhan cdch hu'dng ngi - khong on dinh (80%). Cac yeu to lien quan den hoan canh song: song hai ong ba (42,2%),

song Cling con chau 28,9%. Cac yeu to con cai, ngUdi than: con cai bat hoa 8,9%, ngirdi than om, chet (6,7%), Cac yeu to tir vO, chong: VO chong bat hoa, vO chong bi benh nang cung chiem 2,2%. Cac yeu to xa hgi: Kinh te khong on dinh (15,6%), ve huU (4,4%). Cac yeu to ban than: thay doi cho d (6,7%), c6 dOn, goa (22,2%). Cac benh cO the kem theo: tim mach (33,3%), CO xuong khdp (20%), tieu hoa (17,8%). Ket Luan: sang chan tam (y la nguyen nhan thu'dng gap dan den roi loan tram cam d ngudi cao tuoi. benh nhan CO trieu chirng rat da dang nen khi chan doan d l bd sot hoac nham. Can du'dc nhan biet de chan doan va dieu tri thoa dang

* Vl$n Slit khoe Tam than Benh vien Bach Mai Phan bl$n khoa hpc: PGS. TS Tran Hud Binh

Y HOC VIET NAM THANG 2 - SO 1/2014

SUMMARY FACTORS RELATED ARISE

ELDERLY DEPRESSION So far in Vietnam does not have a systematic

study of the factors related to depressive disorders in the elderlyi Objective: Descnbe the factors related to depressive disorders in the elderly. Methods: Descnption, research that uses advanced psychological testing support. Results: In 45 patients with depression in the elderly aged 50 years or older. Patients in the study group mainly living in rural areas (54%). Mainiy patients with introverted personality -not stable (80%). The factors relevant to the circumstances of life: grandparents lived two (42.2%), 28.9 % lived with children. Factors children, ioved ones: 8.9% children of discord, family illness, death (6.7%). The elements from the wife, husband, wife and discord, is seriously ill spouse for (2.2%). The social factors: Economic instability (15.6%), retired (4.4%). The elements themselves: displaced (6.7%), lonely, widowed (22.2%). The body accompanying diseases: cardiovascular (33.3%), musculoskeletal (20%), gastrointestinal (17.8%). Conclusion: Psychological trauma is a common cause leading to depressive disorders in the elderly. Patients with symptoms are varied so the diagnosis easy to miss or mistake, It should be recognized for the diagnosis and treatment satisfaction.

I. OAT VAN DE Trong Tam than hpc ngu'di gia, roi loan

thu'dng gap nhat la "trang thai tram cam" [1] [2] [3]. Tram cam chiem ti le tir 3-5% dan so, d ngu'di gia la 9,2%. Theo Kohn tram cam d ngu'di gia ehiem 10,7%. Barret (1998) nhan thay ti le tram cam d ngirdi cao tuoi tai cac cd sd cham sdc sire khoe ban dau la 15,6%.

NhiJng bieu hien roi loan cd che tam - sinh hpc da du'a den cac loai hinh benh !y tam than -cd the phong phii, da dang, gap d cae dp tuoi khac nhau ed net rieng biet, dae biet la d ngu'di cao tud'i. Thi/c te, viec chan doan tram cam d

ngu'di cao tuoi gap rat nhieu kho khan. Benh nhan va gia dinh van xem rdi loan tram cam ngu'di eao tud'i la mpt bieu hien binh thu'dng trong qua trinh lao hda, hoac du'dc coi la mpt bieu hien benh ly ciia mot benh ndi khoa nao dd va khdng den vdi thay thuoc tam than. Tren cd sd nghien ciru nguyen nhan gay roi loan tram cam d ngu'di cao tuoi muc tieu nghien cu'u ciia chung tdi: "Md ta cac yeu td Hen quan den rdi loan tram cam d ngu'di cao tud'i"

II. P H i r a N G PHAP NGHIEN CU'U 2 . 1 . Doi tu'dng: Chiing tdi thu nhan cac

benh nhan (BN) tir 60 tuoi t rd len dap irng dii tieu chuan chan doan tram cam theo ICD 10 dieu tn noi tri i tai Vien Sire khoe Tam than Benh vien Bach mai, ma 'benh F06.32, F31.3,F31.jt, F32, F33, dong thdi tham khao tieu chuan chan doan trong DSM - IV thdi gian t ir thang 8/2012 den thang 10/2013

2.2. PhiTdng phap nghien cu'u mo ta, tien cu'u: Chiing tdi ed sir dung cac trac nghiem tam ly de danh gia mirc do lo au va tram cam ngu'di gia. Sir dung thdng ke toan hpc, ed sir trd giiip cua phan mem SPSS 10.5.

III. KETQUA Qua nghien cu'u 45 benh nhan ngu'di cao tuoi

(tir 60 tuoi trd len) dirPc ehan doan tram cam, dieu tri npi tri i tai Vien sire khde Tam than. Cd 2^,5% la F32.1 giai doan tram cam vira. F32.2 giai doan tram cam nang khong cd loan than 8.9%, giai doan tram cam n 6.6% nang cd loan than, roi loan tram cam tai dien F33,l la 31 ,1%. F33.2tram cam tai dien giai doan nang 26,7%. Tram cam tai dien giai doan nang cd loan than 2.2%, va cd den 83,9% sd BN den ed sd siTc khde tam than mudn sau mdt nam ke t ir khi benh khdi phat.

_3-A'_Cac Y^ eu to lien quan den hoan canh song

Tac nhan

Song mot minh Song hai ong ba Song hai ong ba Song mot minh c Goa bya, iy hon

cunc Ling

CO :on

Tuoi

T chau_ chau

60-64 So lu'dng Ti le

(nj , (%) - 1 1 5

12 ! 60

4 1 20 0 i 0

>65 So lu'dng

(nj 0 7 i 10 7 \ 1

Tile (/oj

0 28 40 28 4

Ton] So lu'dng (ni

1 19

1

Tile (%) 2,2 42,2 2 8 J 1 24,4 2,2

Y HOC VIET NAM THANG 2 - SO 1/2014

3.2 Cac yeu to sang chain tam iy tir con cai

~^~"~~--~...._^ ^^ Tuoi Tac nhan ^ . , . ^ ^ ^ ^

Con cai bat hoa Con bat hieu Con that nghiep, di lam an xa Con cai chu'a lap gia dinh Con bi benh nang, con chet Con cai l^honq CO con Nqi/cJi than 6m nang hoac chet

6 0 - 6 4 So lu'dng

( n j 1 0 0 0 1 1 0

T i le (%) S 0 0 0 5 5 0

> 65 1 Tong so So lu'dng T i l e So lu'dng

Cnj ! ( % ) (n) 3 1 12 2 1 1 1 0 3

8 4 4 4 0 12

4 2 1 1 2 1 3

T i le (%) 8,9 4,4 2,2 2,2 4,4 2,2 6,7 \

3.3. Cac yeu to sang chan tam ly tu' vd, chong ^^~~'~~-~-~....,_^^^ Tuoi

Tac nhan ^"~^'~~~~~-.-..^^^

Vd, chdng bat hda Vd^ chong bd nha di, di lam an xa Vd, chdng bj benh nang Vd chong khong ed eon

60-64 So lu'dng

(n j 0 1 0 0

T i le (/o)

0 5 0 0

> 6 5 SolUdng

( n j 1 0 1 1

T i l e (%j 4 0 4 4

Tong SolUdng

( n j 1 1 1 1

T i le (/oj 2,2 2,2 2,2 2,2

3.4. Cac yeu to sang chan tam ly tCr xa hoi _ ... 60-64 ' Tuoi _.., ,.. ,

Tong Tac nhan ^~"'~---...,^^^^

^ ( n j Kinh te I 65 tuoi So lu'dng

(n) 12 0 7 2 1 6 1

T i l e

(%) 48 0

28 8 4

24 4

( n j , 7 1 2 1

(/o) 15,6 2,2 4,4 2,2

Tong So lu'dng

(n) 1

10 3

T i le

(%) 2,2

22,2 6,7

Tong so So lUdng Ti le

(n) 15 0 8 3 1 9 4

(%) 33,3 0

17,8 6,7 2,2 20 8,9

Y HOC VIET NAM THANG 2 - SO 1/2014

IV. BAN LUAN 4 . 1 . Cac yeu to lien quan den tram cam

d nhom benh nhan nghien cu'u Trong tram cam d ngirdi cao tudi, yeu to

stress trong cupc sdng thu'dng nhat cd vai trd quan trpng trong sir xuat hien va tien trien cua benh. Dieu nay phu hdp vdi nhan xet eiia Brice Pitte, Kaplan Sadock khi eho rang, yeu td stress tam ly ddng vai trd quan trpng trong benh nguyen, benh sinh ciia tram cam d ngu'di cao tud'i. [1]

4.1.1. Yeu to lien quan den hoan canh song, con cai va ngu'di than

Trong nghien ciru ciia chung tdi, song goa bua chiem 22,2%. Nhdm benh nhan tir 60 - 64 tud'i sang ehan tam li xuat hien d con cai bat hda 5%. Nhdm benh nhan > 65 tudi, sang ehan eon cai bat hda va co ngu'di than dm, chet ciing chiem 12%. Cae mau thuan, xung dot trong gia dinh, dae biet la eac mau thuan lien quan den phan chia tai san cho con chau, va mdi quan tam, irng )di tam ly trong cham sdc, nudi du'dng bd me CLia eon chau trong gia dinh keo dal ma khdng giai quyet du'dc, deu du'dc coi nhu' la cac nhan td dan den tram cam d ngu'di cao tuoi. Theo Nguyen Thj Phu'dng Loan (2012) thi mau thuan trong gia dinh chiem tdi 37,8%. Mat ngu'di than, mat ban ddi 24,4% la mdt trong nhu'ng nguyen nhan lam cho ngu'di eao tuoi ludn cam thay cd ddn va hut hang trong cupc song. [2]

4.1.2. Yeu to Hen quan den ban than benh nhan

Trong nghien ciTu cua chiing tdi, sang chan ve hu'u la 4,4%. Sang chan ve khd khan kinh te la 15,6%. Nghi hu'u la sang chan tam ly rat thu'dng gap, la mot giai doan vd ciing khd khan ddi vdi ngu'di cao tudi. Ngu'di cao tuoi phai chju nhieu sir mat mat ca ve ngu'di than, quan he xa hoi, viec lam va benh tat. Khd khan kinh te lam tang them ap lu'c trong cupc sdng, lam cho ngu'di cao tud"i phai dieu chinh lai eac mdi quan he trong xa hdi, dieu chinh nhu cau vat chat... Chinh nhu'ng dieu nay bien cupc sdng ciia ngu'di eao tudi trd nen buon te, am dam va vd vi. Dieu nay phii hdp vdi nhan xet eiia C3C tac gia Kuruvilla, Spadon khi cho rang nhu'ng mau thuan ndi tam trong gia dinh keo dai, bat hoa vd chdng, con cai, ngu'di than gia dinh dm, mat, khd khan ve kinh te.. deu du'dc eoi la nhu'ng nhan td dan den tram cam d ngu'di gia.[3]

4.1.3. Cac benh li cd the kem theo Trong nghien ciTu cua chiing tdi nhdm benh

tim mach chiem nhieu nhat vdi 33,3%, ed xu'dng khdp 20%, tieu hda 17,8% va khong cd benh nhan nao mac benh hd hap. Tuy nhien, trong nghien eiTu nay benh li tim mach chi chiem 5,4%. Thap hdn rat nhieu so vdi ket qua eiia chung toi la 33,3%. Cd the cd su" lien quan giO'a benh cO the (tim mach) va tram cam. Khi cd benh cd the, nhat la benh man tinh va gay nen eac bien chu'ng hoac anh hu'dng tdi sire khde ngu'di benh. Day chinh la mpt stress ddi vdi ngu'di benh, no c6 the la nguyen nhan hoac yeu to thuc day va lam eho sir tien trien eiia benh nang ne hdn. Dieu nay eo le la do, trong thdi gian gan day so ngu'di mac ' benh tim mach rat nhieu, ke ca ngu'di tre tuoi va ngu'di gia. Nen trong mau gap nhieu benh nhan mac benh tim mach. Mpt phan niJa la do y hpc phat trien da giup phat hien benh tim mach sdm.

Trong nghien ciru ciia chiing toi nhan thay tud'i cang cao thi ti le mac cac benh tim mach, tieu hda, cd xu'dng khdp cang tang. Ve mat sinh li la phu hdp, ve benh hpe tam thancd the benh tat cd the kem theo se lam thiic day benh tram cam. Nhir George S.Alexopoulos (1987) nhan dmh tud'i cao va benh li eO the du'dng nhu' ddng vai trd quan trong trong sif phat sinh tram cam d ngu'di gia [4] [5] .

4.2. >ac diem lam sang nhom benh nhan nghien cu'u

Trong nghien ciru chiing tdi thu du'dc ket qua 100% benh nhan cd khi sac tram va roi loan giac ngii. Cac trieu chirng tram cam theo ICD io deu xuat hien vdi ti le eao vdi met mdi 97,8% giam tap trung chii y 82,2%, chan an siit can 84,4%. Day cung la bleu hien ciia hdi chirng suy nhu'dc. Trieu chirng xuat hien it nhat la de cau gat vdi 40%.

Theo ICD 10 de chuan doan benh nhan dang d giai doan tram cam ed cae trieu ehifng du'dc xep thanh 2 nhdm la trieu ehirng chinh (3 trieu chirng) va trieu chu'ng pho bien (7 trieu chirng). Cac trieu chu'ng pho bien cung xuat hien vdi tl le cao nhV rdi loan giac ngu, an it ngon mieng 100%. Giam tap trung chu y 93,3%. Thap nhat la y tu'dng t ir t i , bi tdi 13,3%.

Trong nghien ciru ciia chung toi co 86,7% benh nhan thay tu'dng lai am dam va 22,2% cd y tu'dng hanh vi tir sat. Ket qua nay la phii hdp ndi nghien ciru eiia Bruce Boman [5] , tu'dng lai am dam chiem 94%. Day la nhu'ng eon so cao, bao ddng ve tinh trang cd y tu'dng hanh vi hiiy hoai ban than, tir sat. Ket qua nay la phu hdp vdi nghien ciTu eiia Kuruvilla [4] la y tu'dng va' hanh vi tir sat d tram cam ngu'di^cao tud'i eao hdn so vdi tram cam d ngu'di tre tuoi.[7]

Y HQC VIET NAM THANG 2 - SO 1/2014

V. Kfr LUAN Qua nghien cihj 45 benh nhan ngu'di cao tuoi

(tir 60 tudi trd len) du'dc chan doan tram cam, dieu tT! npi tri i tai Vien sii'c khde Tam than chiing toi riit ra mpt sd ket luan sau.

Cac yeu to lien quan den tram cam 6 nhom benh nhan nghien cu'u

Ti le benh nhan nir/ nam la 10/1: Tram cam d ngu'di cao tuoi gap d niT nhieu hdn nam. Cac yeu td lien quan den hoan canh song: sdng hai dng ba 42,2%, sdng ciing con chau 28,9%. Cac yeu to con cai, ngu'di than: con cai bat hda 8,9%,

,ngu'di than dm, chet 6,7%. Cae yeu td tir vd, chong; Vd chong bat hoa, vd chong bi benh nang cung chiem 2,2%. Cac yeu td xa hdi: Kinh te khdng dn dinh 15,5%, ve hu'u 4,4%. Cac yeu to ban than: thay doi cho d 6,7%, cd ddn, gda 22,2%. Cac benh cd the kem theo: tim mach 33,3%, cd xu'dng khdp 20%, tieu hda 17,8%. '

TAI LI^U THAM K H A O 1. Frans verhey (1993), "Rationale of the need for

an early (diagnosis of dementia". Dementia

Depression and foget fulness, Universitaire press, Maastncht, pp 10 -12.

2. Miiller-Spahn & Hock (1994), "Clinical Presentation of Depreesion in the Elderly", International Journal of Exprimental and Clinical Gerontology, S. Karger Medical and Scientific Publishers, pp 10 -13.

3. Ken Laidlaw (2004), "Depression in older adutfs. Mood disorder: A handbook of science and practive", Edited by i^.Power, jonh Wiley & Sons, Ltd, pp 337 - 348,

4. Kohn R& Epstein-Lubow (2006), "Course and outcomes of depression in the elderly". Current Psychiatry Report, Feb, 8(1), pp 34-40.

5. James Ellison (2003 / Depression in late life, pp 1 - 12.

6. World Health Organization, Diagnostic and management guidelines for mental disorders in primary care, ICD- 10 primary care version Chapter V. Getting World Health Organization 1996.

7. Katon W, Von Korff M, Lin E et al (1990), Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs. General Hospital Psychiatr/, 12{6), pp 355-62.

MOT SO YEU TO LIEN QUAN DEN VIEC SU DUNG BAO CAO SU TREN DOI TUgNG PHU NU MAI DAM TAI HAI PHONG NAM 2011

Pham Minh Khue*

T6M TAT Nghien ciTu Ccit ngang cd phan tfch vdi muc tieu

danh gia cac yeu to lien quan den thi/c hanh sir dung bao cao su (BCS) tren doi tu'dng phu niT mai dam (PNMD) tai Hai Phong nam 2011. Cac doi tUong la PNMD t?l 4 quan npi thanh la Le Chan, Hong Bang, Ngo Quyen va Hai An du'dc lua chpn vao nghien ciru thong qua he thdng giao due vien dong dang, Ket qua dieu tra tren 262 PNMD, dp tuoi trung binh la 27,3 tuoi cho thay mirc do thu'dng xuyen sir dung BCS ciia PNMD trong QHTD vdi khach hang la 81.3%. Sir dung BCS nira chutig trong QHTD ciia PNMD vdi khach hang 6 tSt c i cic ran ehiem 0.4%. Cac yeu to dirpc thay lien quan cd y nghTa thdng ke den viec khong sir dung BCS ciia PNMD khi QHTD vdi khach hang la PNMD du'dng pho, cong vien cd nguy cd khdng sir dung BCS cao hon PNMD nha hdng khach san (OR=2,21); PNMD c6

* Tnj&ng Dai hpc Y Du\?c Hal Phong Phin bi^n khoa hgc: GS. TSKH Nguyen Van Hieu

thu nhap thap du'di 5 trieu dong/thang co nguy cO cao hon nhom thu nhap tren 5 tneu dong (OR=3,17). Cac yeu to nhu tuoi, trinh do hpc van, tinh trang hon nhan, so lupng khach hang, co chii chira quan ly, co vay nd khong cho thay moi lien quan co y nghia thdng ke vdi viec sir dung BCS vdi khach hang ciia PNMD, Do do, chu'dng trinh can thiep can chii y hdn den cac nhdm PNMD dudng phd va c6 thu nhap thap.

SUMMARY FACTORS ASSOCIATED W I T H CQNDOIVI USE

COMPLIANCE AMONG FEMALE SEX WORKERS I N HAIPHONG CITY I N 2011

This IS a cross-sectional and analytic study aiming at assessing factors related to the condom use compliance among female sex workers (FSWs) dunng sex-intercourse with clients in Haiphong City in 2011. Female sex workers in 4 inner distncts of Haiphong that indude Le Chan, Hong Bang, Ngo Quyen and Hai An districts was recruited in the study through the peer