Table of Content

02 September 2016, Volume 19 Issue 25

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Monographic Research

The Challenges of Cross-cultural Research and Teaching in Family Medicine:How Can Professional Networks Help?

Amanda Caroline Howe

2016, 19(25):  3001-3002.  DOI: 10.15212/FMCH.2016.0111

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Comparison and Study on the Models of Medical Alliance in China

2016, 19(25):  3003-3007.  DOI: 10.3969/j.issn.1007-9572.2016.25.001

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With the reform of medical and health care system deepening,it is important to establish and improve hierarchical medical system and address the problem of inadequate access to and high cost for medical services.Medical alliance is one important form of hierarchical medical system in China.The paper compared and analyzed the modes of medical alliance in more economically developed areas,such as Beijing and Shanghai,and pilot provinces of medical reform,such as Jiangsu,Fujian and Anhui;the paper also revealed the features and deficiencies of each medical alliance mode in China,and listed the advantages of medical alliance modes in representative regions including North America,Europe and Southeast Asia,so as to provide suggestions for the further development of medical alliance in China.

 Turnover Intention of General Practitioners and Its Influencing Factors

2016, 19(25):  3008.  DOI: 10.3969/j.issn.1007-9572.2016.25.002

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Objective  To understand the level of turnover intention of general practitioners and investigate its influencing factors.

 Methods  By convenience sampling method,general practitioners in 6 cities′ community health service institutions (Harbin,Daqing,Suihua,Heihe,Great Khingan and Qiqihar)were selected,and finally 215 general practitioners,who participated in the training of community health workers in Qiqihar held by Heilongjiang Provincial Health Bureau,were enrolled as research objects. In March 21,2015,field investigation was made in the scene of community health workers.The investigation included six questionnaires——basic information,career satisfaction,job satisfaction,job burnout,job embededness and turnover intention.All the questionnaires would be recovered at once after filling in.362 questionnaires were sent out,323 were effectively recovered,of which 215 were filled in by general practitioners.Univariate and multivariate Logistic regression analysis was applied to analyze the influencing factors of general practitioners′ turnover intention.

 Results  62.3% (134/215) of the general practitioners had the turnover intention.Univariate Logistic regression analysis showed that years of working,achievement of career,progress of career,occupational income,realization degree of target,skills training,job satisfaction,job burnout and job embededness significantly influenced the turnover intention of general practitioners (P＜0.05);multivariate Logistic regression analysis further presented that years of working and job embededness had negatively predictive effects on the turnover intention of general practitioners (value of b was-0.05,-0.93 respectively;P≤0.05);job burnout had a significantly positive prediction on their turnover intention(b=0.74,P＜0.05).

 Conclusion  Nearly two-thirds of the general practitioners reported that they had turnover intentions;job burnout is a risk factor that influences general practitioners having turnover intentions,years of working and job embeddedness are the protective factors of general practitioners having turnover intentions.Relieve job burnout of general practitioners and improve embededness degree can effectively reduce their turnover risk.

 Petition Risk Assessment of Community First Diagnosis System in Chaoyang District of Beijing

2016, 19(25):  3009-3013.  DOI: 10.3969/j.issn.1007-9572.2016.25.003

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Objective  To evaluate the community petition risk of residents in Chaoyang District of Beijing.

 Methods  According to the difference between the urban and rural areas,geographical locations,and distribution of intra-regional medical resources,8 community health service centers in Chaoyang District of Beijing from September to November 2014 by purposive sampling method.518 residents who were not patients were selected by convenient sampling method from these 8 community health service centers.Self-designed questionnaire was made to investigate the following main aspects of the residents:basic information,health status,community health services accessibility,whether community first diagnosis system was known or not,whether community first diagnosis system was accepted or not,and reasons for not accepting,see-a-doctor experience,cognition of importance of health services and suggestions of implementing community first diagnosis system.

 Results  511 valid questionnaires were collected;petition risk of the first diagnosis system of community residents was 43.1%(220/511).The comparison of petition risk of community first diagnosis system of community among residents with different genders,ages,educational levels,family monthly income per person,annual health spending,types of medical insurance was not significantly different(P＞0.05);The comparison of petition risk of first diagnosis system of community among residents with different marital status was significantly different(P＜0.05).The comparison of petition risk of first diagnosis system of community among residents of different self-evaluated physical conditions,residents whether got sick in two weeks,and residents whether suffering from chronic was not significantly different(P＞0.05).There was no significant difference in petition risk of first diagnosis system of community among residents with different distances from their home to the nearest medical institutions(P＞0.05);there was significant difference in petition risk of first diagnosis system of community among residents with different walking times to the corresponding community health service institutions(P＜0.05).The comparison of petition risk of community first diagnosis system of community among residents with different cognitions of this system was significantly different(P＜0.05).There was significant difference in petition risk of first diagnosis system of community among residents with different satisfaction degrees of comfort level of visiting doctors,medical equipments,medical environment,proportion of reimbursement and drug varieties(P＜0.05);there was no significant difference in petition risk of first diagnosis system of community among residents with different satisfaction degrees of service attitude,visiting time,distance from home,medical personnel′s technological level,medical costs,drug costs,treatment effects(P＞0.05).The comparison of petition risk of first diagnosis system of community among residents with different cognitions of importance of traffic convenience was significantly different(P＜0.05);the comparison of petition risk of first diagnosis system of community among residents experiencing different service attitudes,comfort levels of diagnosis processes,visiting times,technological levels of medical personnel,medical equipments,medical environment,medical costs,drug costs,proportions of reimbursement,referral processes,degrees of familiarity with doctors,and treatment effects was not significantly different(P＞0.05).Community residents believed that community′s capacity building and service level needed to be improved,and referral system needed to be perfected.

 Conclusion  The petition risk of community first diagnosis system in Chaoyang District is relatively high,and relevant policies and ability construction of community health service remains to be enhanced.

 Pay-for-performance in UK and the United States and Its Implications for Performance Appraisal of Community Health Service Institutions in China

2016, 19(25):  3014-3019.  DOI: 10.3969/j.issn.1007-9572.2016.25.004

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 Establish scientific and efficient performance appraisal system can improve service quality of community health service institutions and regulate service behaviors.This paper summarizes the implementation of pay-for-performance(P4P) in UK and the United States and current situation and problems of performance appraisal in China′s community health service institutions,and puts forward the implications of P4P in UK and the United States for our country,hoping to provide references for the formulation,implementation and feedback of performance appraisal in China′s community health service institutions.

Literature Analysis of Performance Appraisal of Basic Medical Institutions in China

2016, 19(25):  3020-3023.  DOI: 10.3969/j.issn.1007-9572.2016.25.005

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 Objective  To understand the research status of performance appraisal of basic medical institutions in China,and to provide references for establishing perfect performance appraisal system of basic medical institutions.

 Methods  Related literatures of performance appraisal of basic medical institutions(including community health service center/station,health clinics in towns and townships and village clinics) were included through the searching of Chinese National Knowledge Infrastructure.Literature information extraction table was made by the author to collect basic characteristics of literatures,including research time,research sources,research objects,research categories,research areas and research funds sources.On the basis of further literature screening,related contents of performance appraisal including index types,methods of establishing appraisal system,appraisal cycle,appraisal modes and dimensions were collected.Descriptive analysis was made through applying SPSS 19.0 statistical software.

 Results  According to the literature search strategies,518 literatures were obtained,and finally 92 were included in accordance with inclusion and exclusion criteria.Studies on performance appraisal of basic medical institutions in China started in 2006,54(58.7%) literatures were included from 2012 to 2014;the number of literatures with research source of scientific research institutions and community health service center/station was 28(30.4%) and 19(20.7%) respectively;while the number of literatures with research objects of health clinics in towns and townships and community health service center/station was 42(45.6%) and 39(42.4%);the number of literatures with research categories of current status analysis and index system construction were both 23(25.0%);the number of literatures with research areas of eastern region and western region was 50(54.3%) and 18(19.6%) respectively;27(29.4%) had funding supports.21 were retrieved by further screening,of which 15(71.4%) literatures′ type of performance appraisal index was mainly based on service quantity and service proportion;considering methods of establishing evaluation system,13(61.9%) adopted Delphi method and 11(52.4%) used literature analysis method;in terms of appraisal cycle of institutions,half-year and annual cycle literature numbers were both 3(14.3%);12(57.1%) applied the appraisal manner of superior examination and self-inspection;and 8(38.1%) literatures took appraisal dimension of functions.

 Conclusion  Basic medical institutions in China starts relatively late on studies of performance appraisal,and presents the following shortages:lack of the participation of township health institutions and health administration institutions,relatively less usage of quantitative methods,relatively single appraisal modes and dimensions,and lack of long period appraisal.The exploration of performance distribution and influence factors needs to be strengthened.

Construction of Performance Appraisal Indicator System of Family Doctors

2016, 19(25):  3024-3028.  DOI: 10.3969/j.issn.1007-9572.2016.25.006

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 Objective  To establish performance appraisal indicator system of family doctors to help perfect work patterns and standardized services of family doctors.

 Methods  20 managers (directors,directors in charge of performance appraisal) were selected by purposive sampling method from all of the 10 community health service centers of Changning District as the first-round consultant experts;relevant managers of health and family planning commission,community health management center,public health institutions and community health service centers in Changning District and family doctors of community health service centers in Changning District were selected as the second-round consultant experts with a total number of 40.Performance appraisal indicator system of family doctors was established by Delphi method after two-round expert consultation.

 Results  20 questionnaires were sent out and 19 were recovered in the first-round expert consultation,the valid response rate was 95.0%;40 questionnaires were sent out and 39 were recovered in the second-round expert consultation,the valid response rate was 97.5%.Judgment coefficient of experts was 0.894,coefficient of familiarity degree was 0.905,and coefficient of degree of authority was 0.900.Cooperation index of experts in the first round was 0.21 (χ2=12.11,P＞0.05);and cooperation index of experts in the second round was 0.42 (χ2=49.76,P＜0.05).After two-round expert consultations,7 first-grade indicators were determined,they were informatization management of data,signing of contract,basic medical services,health management,signing of contract and medical services,satisfaction degree and medical expenses,17 secondary indicators and 29 third-grade indicators.

 Conclusion  The established performance appraisal indicator system of family doctors has certain authority and operability,better covers the key points of the work of family doctors,and can be used as tools of assessing services of family doctors,improving the provision mechanism of services,and perfecting connotation of services in recent period.

 Implementation Status of Performance Appraisal in General Practitioners and Theirs Team Members in Shanghai

2016, 19(25):  3029-3033.  DOI: 10.3969/j.issn.1007-9572.2016.25.007

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 Objective  To describe the implementation status of performance appraisal in general practitioners and their team members in Shanghai.

 Methods  We stratified the areas based on the division of central city areas,rural-urban continuums and suburbs.3 areas were selected from the central city area of Shanghai (downtown of Pudong New Area,Xuhui District,Yangpu District),2 from the rural-urban continuum (rural-urban continuum of Pudong New Area,Baoshan District),and 2 from the suburb (suburb of Pudong New Area,Fengxian District) by random number table method.Numbering all the community health service centers in the five areas and extracting 2 to 3 community health service centers from the each selected central city area,1 to 2 from the selected rural-urban continuums and the selected suburbs separately through random number table method.Totally we enrolled 15 community health service centers,from which all the general practitioners,nurse teams and public health doctors that met the inclusion criteria were taken as research objects.Investigators carried their self-design questionnaire to the designated locations in the community to carry out the questionnaire survey from June to August 2015.The survey included the basic situation and the performance appraisal status of the research objects.A total of 836 questionnaires were distributed,792 valid questionnaires were recovered with the effective recovery rate of 94.7%.

 Results  There was significant difference in genders,ages,educational levels,years of working and professional titles of general practitioners,nurse and public health doctors among the 792 cases (P＜0.01).There was significant difference in the frequency of the performance appraisal of general practitioners,nurse and public health doctors (P＜0.001).There was significant difference in the feedback of the results of the performance appraisal between participants of different positions and administrative regions (P＜0.05).There was significant difference in paying out performance pay according to the results of performance appraisal among participants of different positions,professional titles,regions,administrative regions,and different regions in Pudong New Area (P＜0.01).There was significant difference in the proportion of wages of performance appraisal in total wages among participants of different positions,professional titles,and in different regions,administrative regions,and different regions of Pudong New Area (P＜0.01).

 Conclusion  The frequency of performance appraisal of Shanghai community health service centers is monthly-appraisal based with high feedback rate of performance appraisal result.However,the proportion of the results of performance appraisal results as the basis of paying out performance wages,and of the performance pay in total wages remain rather low,and the effects of performance appraisal need to be further improved.

Diagnostic Value of Transient Elastography Technology Combined with Serological Indicator for Liver Fibrosis in Patients with Chronic Hepatitis B

2016, 19(25):  3034-3039.  DOI: 10.3969/j.issn.1007-9572.2016.25.008

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Objective  To evaluate the diagnostic value of transient elastography technology(FibroTouch) combined with serological indicator in liver fibrosis of patients with chronic hepatitis B.

 Methods  145 patients with chronic hepatitis B were selected from January to November in 2015 in Xixi Hospital of Hangzhou.Liver stiffness(LSM) was detected by using FibroTouch,and alanine aminotransferase(ALT),aspartate transaminase(AST),total bilirubin(TBIL),prothrombintime(PT),blood platelet(PLT),four indicators of hepatic fibrosis 〔hyalaronic acid(HA),laminin(LN),type Ⅳ collagen(CⅣ),type Ⅲ collagen(PⅢNP)〕 were detected,and AST/ALT,APRI,FIB-4 were also calculated.With the results of hepatic pathology as the golden standard,the diagnostic value of FibroTouch and the above indicators in liver fibrosis of patients with chronic hepatitis B was evaluated;the influencing factors of hepatic fibrosis were screened out by using multiple Logistic regression method,and the prediction probability was obtained,and the receiver operating characteristic(ROC) curve was established by combining with double normal model to evaluate the diagnostic value of combined diagnosis of liver fibrosis in patients with chronic hepatitis B.

 Results  LSM,AST/ALT,HA,LN,CⅣ,PⅢNP,APRI and FIB-4 had significant influence on liver fibrosis(P＜0.05);but ALT,AST,TBIL,PT,PLT had no significant on liver fibrosis(P＞0.05).LSM,AST/ALT,HA,APRI and FIB-4 were positively correlated with the stages of liver fibrosis(the values of rs was 0.735,0.246,0.560,0.238 and 0.378 respectively;P＜0.05).The area under the curve(AUC) of ROC curve of the evaluation of LSM,AST/ALT,HA,APRI and FIB-4 on liver fibrosis phase(S≥2) was 0.888,0.602,0.798,0.647 and 0.693 respectively;the AUC of liver fibrosis phase(S≥3) was 0.881,0.637,0.819,0.654 and 0.702 respectively;the AUC of liver fibrosis phase(S4) was 0.876,0.647,0.735,0.609 and 0.739 respectively.Multiple Logistic regression analysis showed that LSM and HA were the influencing factors of liver fibrosis.Therefore,the prediction probability was positively correlated with liver fibrosis staging(rs=0.890,P＜0.05),and the AUC of their evaluation on liver fibrosis staging(S≥2,S≥3,S4) was 0.934,0.938 and 0.981 respectively.

 Conclusion  FibroTouch combined with HA is a simple and convenient,noninvasive and efficient diagnostic method,which can significantly improve the clinical diagnosis of liver fibrosis in chronic hepatitis B.

 Plasma 6-Ketoprostaglandin F1α Level of Patients with Coronary Heart Disease Combined with Diabetes and Follow-up Studies

2016, 19(25):  3040-3045.  DOI: 10.3969/j.issn.1007-9572.2016.25.009

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 Objective  To detect the level of plasma 6-Ketoprostaglandin F1α(6-K-PGF1α) of patients with coronary heart disease(CHD) combined with diabetes,and to investigate patients′ major adverse cardiovascular events(MACE) and occurrence of rehospitalization.

 Methods  270 CHD patients,who were in North China University of Science and Technology Affiliated Hospital from July 2013 to June 2014,were selected.According to whether combined with diabetes,patients were divided into group combined with diabetes(n=134) and group without diabetes(n=136).The clinical condition of the patients was recorded,height,weight,blood pressure,heart rate were measured,and examinations of electrocardiogram,echocardiography,and coronary angiography were carried out.Blood routine,blood clotting function,biochemical indicators were examined.6-K-PGF1α level of patients in two groups was detected.Follow-up lasted for one year,MACE events and rehospitalization situation of patients in two groups were recorded.

 Results  The comparison of gender,interventional treatment,age,BMI,systolic blood pressure,diastolic blood pressure,heart rate,number of coronary artery lesions,number of severe coronary lesions and levels of sensitivity C-reactive protein(hs-CRP),serum creatinine(SCr),uric acid(UA),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C) between two groups were not significantly different(P＞0.05).The 6-K-PGF1α level of patients in group combined with diabetes were significantly lower than that in group without diabetes(P＜0.05).The number of coronary artery lesions,number of severe coronary lesions,hs-CRP level,systolic blood pressure presented a negative linear correlation with 6-K-PGF1α level(r value was-0.218,-0.155,-0.139,-0.120 respectively;P＜0.05).For group combined with diabetes,the number of coronary artery lesions,BMI,hs-CRP level,TC level showed a negative linear correlation with 6-K-PGF1α level(r value was-0.194,-0.179,-0.146,-0.126 respectively;P＜0.05);for group combined without diabetes,the number of coronary artery lesions,systolic pressure,hs-CRP level,number of severe coronary lesions manifested a negative linear correlation with 6-K-PGF1α level(r value was-0.241,-0.193,-0.176,-0.175 respectively;P＜0.05).The occurrence rates of MACE in two groups were not significantly different(P＞0.05);the rehospitalization rate of group combined with diabetes was significantly higher than that of group combined without diabetes(P＜0.05).

 Conclusion  The 6-K-PGF1α level of CHD patients with diabetes is lower,while the risk of hospitalization again is increased.Therefore,CHD patients combined with diabetes should further strengthen anti-platelet therapy and protect vascular endothelial function.

 Plasma 6-Ketoprostaglandin F1α Level of Patients with Coronary Heart Disease Combined with Diabetes and Follow-up Studies

2016, 19(25):  3040-3045.  DOI: 10.3969/j.issn.1007-9572.2016.25.009

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 Objective  To detect the level of plasma 6-Ketoprostaglandin F1α(6-K-PGF1α) of patients with coronary heart disease(CHD) combined with diabetes,and to investigate patients′ major adverse cardiovascular events(MACE) and occurrence of rehospitalization.

 Methods  270 CHD patients,who were in North China University of Science and Technology Affiliated Hospital from July 2013 to June 2014,were selected.According to whether combined with diabetes,patients were divided into group combined with diabetes(n=134) and group without diabetes(n=136).The clinical condition of the patients was recorded,height,weight,blood pressure,heart rate were measured,and examinations of electrocardiogram,echocardiography,and coronary angiography were carried out.Blood routine,blood clotting function,biochemical indicators were examined.6-K-PGF1α level of patients in two groups was detected.Follow-up lasted for one year,MACE events and rehospitalization situation of patients in two groups were recorded.

 Results  The comparison of gender,interventional treatment,age,BMI,systolic blood pressure,diastolic blood pressure,heart rate,number of coronary artery lesions,number of severe coronary lesions and levels of sensitivity C-reactive protein(hs-CRP),serum creatinine(SCr),uric acid(UA),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C) between two groups were not significantly different(P＞0.05).The 6-K-PGF1α level of patients in group combined with diabetes were significantly lower than that in group without diabetes(P＜0.05).The number of coronary artery lesions,number of severe coronary lesions,hs-CRP level,systolic blood pressure presented a negative linear correlation with 6-K-PGF1α level(r value was-0.218,-0.155,-0.139,-0.120 respectively;P＜0.05).For group combined with diabetes,the number of coronary artery lesions,BMI,hs-CRP level,TC level showed a negative linear correlation with 6-K-PGF1α level(r value was-0.194,-0.179,-0.146,-0.126 respectively;P＜0.05);for group combined without diabetes,the number of coronary artery lesions,systolic pressure,hs-CRP level,number of severe coronary lesions manifested a negative linear correlation with 6-K-PGF1α level(r value was-0.241,-0.193,-0.176,-0.175 respectively;P＜0.05).The occurrence rates of MACE in two groups were not significantly different(P＞0.05);the rehospitalization rate of group combined with diabetes was significantly higher than that of group combined without diabetes(P＜0.05).

 Conclusion  The 6-K-PGF1α level of CHD patients with diabetes is lower,while the risk of hospitalization again is increased.Therefore,CHD patients combined with diabetes should further strengthen anti-platelet therapy and protect vascular endothelial function.

Correlation Analysis between Serum 1,25-Dihydroxyvitamin D3 of Patients with Senile Osteoporosis and Sarcopenia

2016, 19(25):  3046-3050.  DOI: 10.3969/j.issn.1007-9572.2016.25.010

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 Objective  To explore the correlation between serum 1,25-dihydroxyvitamin D3〔1,25-(OH)2D3〕 of patients with senile osteoporosis(osteoporosis,OP) and sarcopenia(sarcopenia,SAR).

 Methods  390 patients with senile OP,who received treatment in First People′s Hospital of Yunnan Province from October 2013 to April 2015 were selected.Depending on whether merging SAR,they were assigned to group combined with SAR(n=286) and group combined without SAR(n=104).All the patients received physical examination,bone density and body tissue composition testing and laboratory examination to analyze the correlation between serum 1,25-(OH)2D3 level and the evaluation indexes and influencing factors of SAR.

 Results  Gender,age and BMI of the two groups were not significantly different(P＞0.05).Serum 1,25-(OH)2D3 of group combined with SAR was significantly higher than that in group without SAR(P＜0.05).Spearman rank correlation analysis showed that male/female OP patients′ serum OP 1,25-(OH)2D3 was positively correlated with walking speed,grip strength(P＜0.05),and not correlated with arms and legs skeletal muscle mass index(ASMI);serum 1,25-(OH)2D3 presented positive correlation with estradiol(E2),testosterone(T),insulin-like growth factor-1(IGF-1)，interleukin-10(IL-10,P＜0.05),while negatively correlated with reactive oxygen species(ROS),intact parathyroid hormone(iPTH),tumor necrosis factor α(TNF-α),interleukin-6(IL-6,P＜0.05),and not correlated with BMI,homeostasis model assessment of insulin resistance(HOMA-IR),high-sensitivity C-reactive protein(hs-CRP,P＞0.05).

 Conclusion  Serum 1,25-(OH)2D3 level of OP patients is correlated with some of the evaluation indexes and influencing factors,and may be one of the indicators of early prediction.

 Influence of Course of Disease and Complement Levels on the Curative Effects of Children with Ocular Myasthenia Gravis

2016, 19(25):  3051-3055.  DOI: 10.3969/j.issn.1007-9572.2016.25.011

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 Objective  To investigate the changes of complement levels within the course of disease and its influence on the curative effects of children with ocular myasthenia gravis (OMG).

 Methods  134 children with OMG,who had been in the Neurological Clinic of Hunan Children′s Hospital or received treatment in this hospital from January 2007 to October 2013,were selected in the study.According to their onset time,patients were divided into A group (＜30 d,n=48）,B group (30 d～,n=44） and C group (3～6 m,n=42).The three groups were treated with the same treatment plan (that was pyridostigmine bromide with prednisone).Immunoturbidimetry was used to detect humoral immunity as IgG,IgA,IgM,IgE and complement 3(C3) and complement 4 (C4) levels,and quantitive MG score (QMG) was applied to evaluate the effects of OMG.

 Results  There were no significant difference in IgG,IgA,IgM,IgE and C4 levels among the three groups (P＞0.05);while there was significant difference in the C3 levels among the three groups (P＜0.05),the C3 levels of B and C group were significantly lower than those of A group(P＜0.05).There was no significant difference in clinical effect among the three groups（P＞0.05）.There was no significant difference in QMG of the three groups before and after treatment (P＞0.05);QMG of the three groups after treatment was significantly lower than that of the three groups before treatment (P＜0.05).C3 was negatively correlated with the course of the disease(rs=-0.235,P＜0.05);C4 was not correlated with the course of the disease (rs=-0.140,P＞0.05).Multiple linear regression analysis was applied to study the influencing factors of QMG before and after treatment after merging the data of the three groups,and no regression equation was got from the results.The regression equation-C3=1.064-0.001×course was got through the multiple linear regression analysis of the influence factors of the C3 groups after merging the data of the three groups.

 Conclusion  There is certain influence of course of disease on C3,but no influence are found in C4.C3 and C4 levels have little impact on the therapeutic efficacy in short term.

 Risk Factors Screening of Stroke and Health-related Physical Fitness Influence of Medical Workers

2016, 19(25):  3056-3060.  DOI: 10.3969/j.issn.1007-9572.2016.25.012

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Objective  To investigate risk factors screening of stroke and health-related physical fitness influence of medical workers.

 Methods  627 medical workers from a top three hospital were selected from January to February 2016.According to Major Project of 2011 Medical Reform Implementation Program of National High Risk Stroke Population Screening and Intervention Pilot Project,risk factors screening of stroke and health-related physical fitness tests were conducted by project implementation personnel and field personnel.

 Results  Among the 627 medical workers,173(27.6%) were in high risk stroke population,454(72.4%) were in non-high risk stroke population.There was significantly difference in gender and age between medical workers of high risk stroke population and of non-high risk stroke population(P＜0.05).The comparison of BMI,grip strength,lung capacity,step index,sit-and-reach distance,time of standing on one foot,vertical-jump height,sit-ups/push-ups frequency,body fat percentage was significantly different between medical workers of high risk stroke population and of non-high risk stroke population(P＜0.05);while their time of choosing and reaction showed no significant differences(P＞0.05).Among the male medical workers,the comparison of BMI,lung capacity and body fat percentage was significantly different between medical workers of high risk stroke population and of non-high risk stroke population(P＜0.05);the comparison of grip strength,step index,sit-and-reach distance,time of standing on one foot,time of choosing and reaction,vertical-jump height,push-ups frequency was not significantly different(P＞0.05).Among the female medical workers,the comparison of BMI,grip strength,lung capacity,step index,sit-and-reach distance,time of standing on one foot,sit-ups frequency,body fat percentage was significantly different between medical workers of high risk stroke population and of non-high risk stroke population(P＜0.05);while time of choosing and reaction and vertical-jump height showed no significant differences(P＞0.05).Among the medical worker aged between 22 and 40,the comparison of BMI,grip strength,lung capacity,step index,sit-and-reach distance,time of choosing and reaction,vertical-jump height,sit-ups/push-ups frequency,body fat percentage was significantly different between medical workers of high risk stroke population and of non-high risk stroke population(P＜0.05);while their time of standing on one foot showed no significantly differences(P＞0.05).Among the medical workers aged 41 to 60,the comparison of BMI,grip strength,step index,sit-and-reach distance,time of standing on one foot and body fat percentage was significantly different between medical workers of high risk stroke population and of non-high risk stroke population(P＜0.05);while lung capacity and time of choosing and reaction showed no significantly differences(P＞0.05).

 Conclusion  The proportion of high risk stroke population of medical workers is rather high,and health-related physical fitness has certain influence on them.It is suggested that strengthen the health-related physical fitness tests of medical workers.

Expression of Chemokine CCL20 and Its Receptor CCR6 in Lung Adenocarcinoma and Their Relationship with Recurrence or Metastasis

2016, 19(25):  3061-3065.  DOI: 10.3969/j.issn.1007-9572.2016.25.013

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 Objective  To observe the expression status of CCL20 and CCR6 in cancer tissue of patients with recurrent and non-recurrent lung adenocarcinoma and explore the effects of CCL20 and CCR6 in the development of the disease.

 Methods  162 lung adenocarcinoma patients who received treatment in Hebei General Hospital from February 2009 to December 2011 were selected.The patients were divided into recurrent group(n=50) and non-recurrent group(n=112) according to their recurrence and metastasis conditions.The expression,the mRNA expression and the protein expression of CCL20 and CCR6 were detected by immunohistochemistry staining,real-time PCR and Western-blot method respectively.

 Results  CCL20 was mainly expressed in cell membrane and cytoplasm of lung adenocarcinoma tissue,while CCR6 expressed in cytoplasm of lung adenocarcinoma tissue.The two had no significant expression in para-carcinoma tissue of lung adenocarcinoma.The high-expression ratio and the staining index of CCL20 and CCR6 in recurrent group was significantly higher than those of the non-recurrent group(P＜0.05).The high-expression ratio of CCL20 and of CCR6 between recurrent and non-recurrent group were 38(76.0%) to 9(8.0%) and 33(66.0%) to 7(6.3%) separately;and the staining index of CCL20 and CCR6 between the two groups were(150.4±10.2) to(62.5±8.5) and(134.4±11.3) to(58.0±9.5) respectively.Compared with non-recurrent group,the mRNA expression of CCL20 and CCR6 in recurrent group increased by 82.3% and 56.4% respectively,the protein expression of CCL20 and CCR6 increased by 292.0% and 188.0% respectively,showing significant differences(P＜0.05).

 Conclusion  Presenting high expression in lung adenocarcinoma tissue,CCL20 and CCR6 are related with the development of lung adenocarcinoma.