Chinese General Practice

Chronic Respiratory Disease Management in Grassroots Medical Institutions of China　#br#

PENG Bo1，ZHANG Peng-jun2，WU Si-nan3，ZHANG Yong4，TAN Ling-ling4，XU Yang1，YANG Ting5，YANG Guo-ru4，WANG Chen6*

2018, 21(13): 1513-1520. DOI: 10.3969/j.issn.1007-9572.2018.13.001

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Objective　To explore the chronic respiratory disease management in grassroots medical institutions of China.Methods　We conducted an online questionnaire survey among the managers of 48 community health centers/township hospitals as well as 413 community health stations/village clinics in Weifang，Shandong Province during December 2015 to January 2016 for collecting the data concerning screening，health record documentation，follow-up，health education，and professional trainings for health workers of 3 chronic respiratory diseases〔chronic obstructive pulmonary disease（COPD），bronchial asthma（AS），obstructive sleep apnea hypopnea syndrome（OSAHS）〕，diabetes and hypertension.The proportion of each type of institutions involved in the management of the 3 chronic respiratory diseases，diabetes and hypertension were calculated and compared.Results　Of the community health centers/township hospitals，27.1%（13/48）carried out the screening of COPD，2.1%（1/48）and 4.2%（2/48） documented health records for COPD and AS patients，12.5%（6/48）and 14.6%（7/48）provided follow-up services for COPD and AS patients，14.6%（7/48），16.7%（8/48） and 0 offered health education for COPD，AS and OSAHS patients，12.5%（6/48），12.5%（6/48） and 4.2%（2/48）conducted professional trainings for health workers for the management of COPD，AS，and OSAHS patients，and all of them were much lower than the corresponding proportions for the management of diabetes as well as hypertension（P<0.001）．Among the community health stations/village clinics，11.4%（47/413） conducted the screening of COPD，3.9%（16/413） and 3.6%（15/413） documented health records for COPD and AS patients，6.8%（28/413）and 4.1%（17/413）offered follow-up services for COPD and AS patients，11.4%（47/413），10.9%（45/413）and 5.8%（24/413）provided health education for COPD，AS and OSAHS patients，15.3%（63/413），10.9%（45/413）and 3.1%（13/413）implemented professional trainings for health workers for the management of COPD，AS，and OSAHS patients，and all of them were significantly lower than the corresponding proportions for the management of diabetes as well as hypertension（P<0.001）．Conclusion　Compared with diabetes and hypertension，the scale of standardized management of chronic respiratory diseases in grassroots medical institutions in Weifang is relatively small.In order to improve the chronic respiratory disease management，primary care providers should be trained with corresponding specialty knowledge comprehensively，lung function tests should be popularized in grassroots medical institutions，public health education should be carried out extensively，policy support for the prevention and control of chronic respiratory diseases should be further intensified and the construction of web-based prevention and control system of chronic respiratory diseases should be promoted.

Community Health Services Development Status in China and Its Role in Reasonably Controlling Health Care Cost Growth

GAO Ying，LI Li-qing*

2018, 21(13): 1521-1526. DOI: 10.3969/j.issn.1007-9572.2018.13.002

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Objective　To explore the status of community health services development and the national healthcare expenditure in China，and to analyze the role of the former in reasonably controlling healthcare expenditure growth.Methods　We collected the data concerning the annual total national healthcare expenditure，annual total healthcare expenditure，number，manpower configuration，annual total healthcare revenue，and number of services of community health centers（CHCs） in China in recent years from China National Health Accounts Report（2015），36 volumes of China's Health Statistical Yearbook（1978—2013） and 3 volumes of China's Health And Family Planning Statistical Yearbook（2014—2016） and analyzed the status of total national healthcare expenditure and community health service development.Results　From 1978 to 2015，the total national healthcare expenditure increased to 4.097 464 trillion yuan from 11.021 billion yuan，with an increase of 4.086 443 trillion yuan and an average annual growth rate of 17.35%.From 2005 to 2014，the total national healthcare expenditure increased to 3.682 498 trillion yuan from 920.414 billion yuan，with an increase of 2.762 084 trillion yuan and an average annual growth rate of 16.66%；the total healthcare expenditure for CHCs increased to 87.752 billion yuan from 7.253 billion yuan，with an increase of 80.499 billion yuan，and an average annual growth rate of 31.92%；its occupation percentage in the total national healthcare expenditure increased to 2.38% from 0.79%，with an increase of 1.59 percentage points.From 2010 to 2015，the number of community health institutions increased from 32 739 to 34 321，with an increase of 1 582 and an average annual growth rate of 0.95%；in CHCs，the number of employees increased to 504 817 from 389 516，number of registered nurses increased to 153 393 from 106 528，number of practicing physicians increased to 181 670 from 144 225，and number of health professionals increased to 431 158 from 331 322，with a growth of 115 301，46 865，37 445，99 836，respectively，and an average annual growth rate of 5.32%，7.56%，4.72%，5.41%，respectively；the total revenue of CHCs increased to 13.371 million yuan from 8.054 million yuan，with an increase of 5.317 million yuan and an average annual growth rate of 10.67%；in CHCs，the number of emergency visits increased to 559.026 million from 347.404 million，with an increase of 211.622 million and an average annual growth rate of 9.98%，its occupation percentage in the total national emergency visits increased to 12.9% from 9.6%，with an increase of 3.3 percentage points；the number of inpatient visits in CHCs increased to 3.055 million from 2.181 million，with an increase of 0.874 million and an average annual growth rate of 6.97%，its occupation percentage in the total national inpatient visits increased to 7.6% from 5.5%，with an increase of 2.1 percentage points.Conclusion　In recent years，the total national healthcare expenditure has increased significantly，and the occupation percentage of CHCs in the total national healthcare expenditure has increased with the rapid development of community health services.Promoting community health services delivery is an effective way for reasonably controlling healthcare expenditure growth.

Hot Topics in General Practice Research：a Bibliometrics Study

GONG Xue1，YANG Ying1，YU Xiao-song2*

2018, 21(13): 1527-1531. DOI: 10.3969/j.issn.1007-9572.2018.13.003

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Objective　To explore the hot topics in general practice research using bibliometric analysis，providing references for domestic development of general practice.Methods　On June 19，2017，we searched PubMed database for articles about general practice published between 2016 and 2017.According to the MeSHs developed by National Library of Medicine，we enrolled major key words from the included articles.BICOMB was employed to count the use frequency of these words.Those used for 20 or more times were defined as major high-frequency key words.NetDraw 2.081，a network visualization tool coming with the Ucinet 6.199，was used to draw the co-occurrence matrix.And gCLUTO 1.0 was adopted to conduct biclustering analysis.Results　A total of 952 articles were included. Among them，the 3 core key words used were general practice/family medicine（443 times），general practitioner/physicians，family（284 times） and primary health care（139 times）. Data from articles were organized into 7 themes based on the biclustering analysis：1.genreral practice health knowledge，attitude and practice；2.emergency admission and general practitioner care；3.role of general practitioners（GPs） in the diagnosis and management of cancer patients；4.clinical capabilities training for residential GPs；5.chronic disease screening and patient receptiveness in general practice care；6.general practice education in medical colleges；7.antibiotic prescribing and corresponding trainings in general practice care. Conclusion　The current general practice studies mainly focus on general practice care，the role of GPs，general practice education and so on.

2017 WONCA Asia Pacific Regional Conference of Family Physicians

PEI Lin-xi1*，WANG Jia-ji2

2018, 21(13): 1532-1535. DOI: 10.3969/j.issn.1007-9572.2018.13.004

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The 2017 WONCA Asia Pacific Regional Conference was held in Pattaya，Thailand on November 1-4，2017.The theme of this conference was "Family Medicine Innovation：Challenges Facing Family Physicians in the 21st Century".This article mainly introduces the key contents of this conference，including the challenges facing by family physicians（family medicine innovation），general practice services（role in universal health coverage），research progress（family medicine，disaster medicine and occupational medicine），achievements and experience of family medicine in the Asia Pacific region，with a view to promoting the international academic exchanges and integration between peers and providing a reference for Chinese scholars conducting general practice/family medicine researches via studying and disseminating the new viewpoints and recent developments of family medicine from WONCA.

Scope of Knowledge Sharing in a Medical Consortium

LI Ping1，2，QIAN Qiao-hui3，CUI Li4，LIN Jie5，LI Xin-ming2*，GU Sai-shan4

2018, 21(13): 1539-1545. DOI: 10.3969/j.issn.1007-9572.2018.13.006

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Objective　To explore the scope of knowledge sharing in a medical consortium，providing a reference for the development of inter-agency knowledge sharing mechanism in the medical consortium.Methods　From July 26 to August 22，2016，we conducted semi-structured interviews with 39 persons from Zhoukanghangxin Medical Consortium〔including the managers and general practitioners from 4 community health centers（CHCs） and the managers and specialty physicians from Shanghai Pudong New District Zhoupu Hospital〕 for collecting the data mainly about needed support concerning clinical，scientific and research，and other aspects from higher-level or lower-level institutions，and support can be provided for higher-level or lower-level institutions.Data from interviews were organized into two themes covered by the scope of knowledge shared in the Zhoukanghangxin Medical Consortium：CHCs-centered needs and Shanghai Pudong New District Zhoupu Hospital-centered needs.Then，based on the CHCs-centered needs，we developed a CHCs-centered Needs in the Medical Consortium Questionnaire（CNMCQ），and used it to survey 90 primary care providers from the 4 CHCs from November 15 to December 12，2016 for obtaining the importance assessment of the items and subscales.Results　Participants from Shanghai Pudong New District Zhoupu Hospital said that they could basically satisfied the needs of CHCs，such as clinical and scientific research support，cooperative training of young doctors and professional development guidance，but did not give any response to the needs of CHCs concerning the establishment of a clinical testing center，administrative and health management，and informatization construction.Participants from CHCs said that they could not yet fully meet the needs of Shanghai Pudong New District Zhoupu Hospital.The CNMCQ consists of 3 subscales，namely，clinical support〔knowledge about the standardized diagnosis and treatment of 92 diseases，doctor-patient communication（4 items），auxiliary resources（11 items）〕，scientific research support（10 items） and other support（5 items），with the importance score of 4.16-4.96，4.58-4.62，4.66-4.76，respectively.Furthermore，according to the importance score，the most needed knowledge listed in the clinical support subscale was the standardized diagnosis and treatment of 6 diseases〔hypertension（4.96），coronary atherosclerotic heart disease（4.94），chronic obstructive pulmonary disease（4.94），diabetes（4.94），cerebral infarction/cerebral embolism（4.94） and stroke（4.94）〕；the most needed doctor-patient communication skill was the communication guidance for coping with acute or critical conditions（4.91）；the most needed important knowledge about auxiliary examinations was the indications，contraindications，pre-test preparation and guidance for the auxiliary examinations（4.89）．Meanwhile，the most needed knowledge listed in the scientific research support subscale was the guidance or special training for research paper writing（4.62）；the most needed knowledge listed in the other support subscale was cooperative training of young doctors（4.76）．Conclusion　At present，the knowledge，most about the standardized diagnosis and treatment of common chronic diseases in community-dwelling residents，shared in a medical consortium is mainly for meeting the needs of CHCs.Sharing knowledge in the medical consortium is of great significance in improving the clinical service capabilities of CHCs via the consortium management of such common chronic diseases.

Interactive Forms and Support Mechanisms for Knowledge Sharing in a Medical Consortium

GAO Xiao-yan1，XIN Wen-lin2，KANG Min3，CHU Wen-jun4，LI Ping5，6*，GU Gui-guo7

2018, 21(13): 1546-1549. DOI: 10.3969/j.issn.1007-9572.2018.13.007

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Objective　To explore the interactive forms and support mechanisms for knowledge sharing in a medical consortium，offering a reference for effectively sharing knowledge in the medical consortium.Methods　On February 28，2017，we carried out focus group interviews with 12 persons from Zhoukanghangxin Medical Consortium〔including 4 managers and 4 general practitioners（GPs） from 4 community health centers（each manager and each general practitioner from each community health center） and 2 managers，1 specialty physician，and 1 worker（from Medical Development Department） from Shanghai Pudong New District Zhoupu Hospital〕 for exploring the interactive forms and support mechanisms for knowledge sharing in this medical consortium.Results　The interactive forms for knowledge sharing in Zhoukanghangxin Medical Consortium could be divided into two categories，one was directly sharing form，mainly through face-to-face communication between GPs and specialty physicians in each of the two settings（community health centers or Shanghai Pudong New District Zhoupu Hospital），and online knowledge storage and sharing；the other was indirectly sharing form，mainly through consultations and referrals.In terms of the support mechanisms for knowledge sharing in Zhoukanghangxin Medical Consortium，in addition to maintaining the existing clinical techniques assessment mechanism，honor-based and material incentive mechanisms for GPs，assessment and incentive mechanisms for specialty physicians need to be developed，and measures such as activities for improving the friendships between GPs and specialty physicians should be carried out.Conclusion　Teaching rounds is an acknowledged form for knowledge sharing in Zhoukanghangxin Medical Consortium，which is contributive to the improvement of clinical diagnosis and treatment abilities and teaching abilities of both GPs and specialty physicians.In order to ensure the development of knowledge sharing，professional technique assessments and incentives for specialty physicians should be enhanced，and the friendships between GPs and specialty physicians should be improved.

Analysis of the Performance Evaluation of Basic Public Health Service Projects in Chongqing in 2016

PAN Lun1，LING Bin1*，HE Ping1，CHENG Sa-nuo1，HU Bin2，WU Jian-hua3

2018, 21(13): 1550-1554. DOI: 10.3969/j.issn.1007-9572.2018.13.008

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Objective　To understand the performance evaluation of basic public health service projects in 2016 in Chongqing and to provide suggestions for improving the quality of basic public health services.Methods　According to the corresponding report（Chongqing Basic Public Health Service Project Performance Appraisal）within the database of the Chongqing Community and Rural Health Association，12 items of public health service performance evaluation data of four functional areas，including the Chongqing urban functional core area + the urban function expansion area，the urban development new area，the ecological conservation area of north Chongqing，and the ecological conservation area of southeast Chongqing，were collected and compared.Results　The overall scores of basic public health services in the fourfunctional areas were（0.97±0.02）%，（0.98±0.10）%，（0.88±0.13）%，and （0.83±0.14）%，respectively，which was a statistically significant difference（P<0.05）．The scores of the urban functional core area + urban functional expansion area and urban development new area were higher than the ecological conservation area in north Chongqing and the ecological conservation area in southeast Chongqing，and the differences were statistically significant（P<0.05）．Of the 12 public health service items，there were significant differences in the following items：health education；residents' health records；vaccinations；health management of children 0–6 years of age；maternal health management；elderly health management；hypertension management；diabetes management；severe mental illness management；infectious diseases/emergency public health management；and traditional Chinese medicine management among the four functional areas（P<0.05）．There was no significant difference in health supervision（P>0.05）．Conclusion　The quality of basic public health services in Chongqing did not reach "equalization"， and there were differences in the quality of basic public health services in different functional areas.

Input-output Analysis of the Investment Fund from the Government for Community Health Service Centers in Chaoyang District of Beijing

SHI Wei1，FU Qing-yuan1，SUN Ling-li2，MENG Ya-ping3，SONG Shuang3，WU Xin3*

2018, 21(13): 1554-1559. DOI: 10.3969/j.issn.1007-9572.2018.13.009

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Objective　To investigate the input-output status of the investment fund from the government for community health service centers（CHSCs） in Chaoyang District，providing an evidence for optimizing the resource allocation in CHSCs.Methods　The enrolled 30 CHSCs were all from Chaoyang District，Beijing，including 20 receiving two-separate-line management for revenue and expenditure（CHSCs with two-separate-line management），and 10 receiving partial-subsidy management.We collected the internal input-output data of these 30 CHSCs from Community Health Service Management Center of Chaoyang District（CHSMCCD） in 2015，and explored the input-output efficiency using data envelopment analysis（DEA）．The input indicators include investment，total number of employees and area of rooms for delivering medical care.The output indicators consist essential public service workload，medical care workload and comprehensive quality score of services.Results　In 2015，the mean comprehensive technical efficiency，mean pure technical efficiency and mean scale efficiency of the 30 CHSCs were all greater than 0.900.To be specific，15 CHSCs（10 CHSCs with two-separate-line management and 5 CHSCs receiving partial-subsidy management owned mean comprehensive technical efficiency of 1.000，efficient services and constant returns to scale，but other 15 ones possessed mean comprehensive technical efficiency of <1.000，inefficient services and decreasing returns to scale.If improving the output efficiency without increasing the investment，5 CHSCs with two-separate-line management but without pure technical efficiency need to increase the essential public service workload，medical care workload，and the comprehensive quality score of services，the average points need to be enhanced are 11 371，73 072，1.60 points，respectively；4 CHSCs managed by CHSMCCD without pure technical efficiency need to enhance the essential public service workload，medical care workload，and the comprehensive quality score of services，with an average increase of 81 989，590 544，4.75 points respectively.Conclusion　In 2015，the input-output efficiency of the investment funds from the government for these CHSCs was relatively high，but 50.0% of them had input redundancy and insufficient output.So positive measures should be taken to optimize the health resource allocation，strengthen the management and service efficiency of CHSCs.

Online Consultation in the Department of General Practice under "Internet+"　#br#

QIU Yan1，QIU Yun-qing2，REN Wen1，LIU Ying1，REN Jing-jing1*

2018, 21(13): 1560-1563. DOI: 10.3969/j.issn.1007-9572.2018.13.010

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Objective　To explore the status of online visits in the Department of General Practice under "Internet+" in order to provide the reference for the improvement of online consultation skills of general practitioners.Methods　From February 2016 to February 2017，patients' basic characteristics，types of diseases，and treatment measures of 715 online visits were collected from the online Department of General Practice of the First Affiliated Hospital，College of Medicine，Zhejiang University.And patients who were willing to participate in the subjective satisfaction survey of the Internet evaluation system were investigated.Results　Of the 715 online outpatient visits，the top three system involved 91（12.7%）visits in the musculoskeletal system，81（11.3%）visits in the digestive system，and 66（9.2%）visits in the reproductive system.The top three treatment measures were offline treatments for 451（63.1%） visits，treatment guidance/examination appointments for 181（25.3%）visits，and follow-up for 74（10.3%）visits.And 563（78.7%）visits were diagnosed with certain diseases，and 152（21.3%）visits were undiagnosed.The top three undiagnosed diseases were joint pain〔14（9.2%）〕，abdominal pain〔13（8.6%）〕，and dizziness〔13（8.6%）〕.The top three diagnosed diseases were rash〔24（4.3%）〕，upper respiratory tract infection〔18（3.2%）〕，and gastritis〔14（2.5%）〕.Of the 378 patients who were surveyed for satisfaction，369（97.6%）were satisfied with their experience.Conclusion　Patients have high satisfaction with the online consultation of general practitioners while there are still some limitations，which demands higher online consultation skills of general practitioner.

The Relationship between Stride Time Variability and Fear of Falling in Elderly Patients with Type 2 Diabetes　

XU Zhong-mei，YU Wei-hua*，WU Meng-yu

2018, 21(13): 1564-1567. DOI: 10.3969/j.issn.1007-9572.2018.13.011

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Objective　To investigatethe effect of fear of falling（FOF） on stride time variability（STV） in elderly patients with type 2 diabetes.Methods　A total of 204 elderly patients with type 2 diabetes were enrolled from the Department of Endocrinology of the Third Affiliated Hospital of Anhui Medical University between July and December 2016.The STV was compared amongpatients of different gender，age，education level，living status，monthly income，fall history，and FOF.The correlation between STV at a normal walking speed and MMSE score，pace speed，and step length in elderly patients with type 2 diabetes was analyzed using the Spearman rank correlation.Multivariate linear regression was used to analyze the factors which influence STV in the patients.Results　There was no significant difference in the STV among patients of different gender，age，education level，living status，monthly income level，and fall history（P>0.05）．There were 104 patients（51.0%） with a FOF；the STV in patients with a FOF was significantly different from the STV in patients without a FOF（P<0.05）．Spearman rank correlation analysis showed that the STV in patients was negatively correlated with pace speed and step length（rs=-0.333， -0.253；P<0.001），and was not correlated with MMSE score（rs=-0.097，P>0.05）．Multivariate linear regression analysis showed that pace and a FOF influenced the STV in elderly patients with type 2 diabetes（P<0.05）．Conclusion　Elderly patients with type 2 diabetes are more likely to have a FOF.A FOF and slow pace speedwere shown to influence the STV in these patients.

Analysis of the Status and Influential Factors of Cardiopulmonary Function in Young Office Workers

LIN Min，LIU Geng-xing，LIN Yi-pin，ZHANG Li-jun，ZHANG Li-juan*，XIONG Yu-qin

2018, 21(13): 1568-1572. DOI: 10.3969/j.issn.1007-9572.2018.13.012

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Objective　To explore the cardiopulmonary functional status and related influencing factors among young people working in an office，and provide a scientific basis for improving the physiologic function and preventing diseases in the population.Methods　A total of 92 young people 20–45 years of age and engaged in office work in an electronic company in Xiamen City of Fujian Province between May and November 2016 were selected as the study subjects.Basic information and cardiopulmonary parameters were collected using questionnaires，physical examinations，and cardiopulmonary function tests.According to the maximal oxygen uptake of the study subjects after maximum exercise testing，they were divided into a high maximal oxygen uptake group（≥1.67 L/min） and low maximal oxygen uptake group（≤1.64 L/min）．Each group consisted of 45 patients.The general indicators including age，gender，body and mass index，and were compared between the two groups.Pearson correlation and partial correlation analysis were used to explore the correlation between general indicators and maximal oxygen uptake.Multivariate linear regression analysis was used to investigate the influencing factors for maximal oxygen uptake.Results　There were statistically significant differences in gender，body mass index，resting heart rate，smoking index，frequency and amount of alcohol consumption，percentage of regular exercisers，and daily amount of exercise between the two groups（P<0.05）．Age，sleep time，as well as the proportion of subjects having regular breakfast or anxiety mood were not significantly different（P>0.05） between the two groups.Pearson correlation analysis showed that body mass index，smoking index，frequency and amount of alcohol consumption，sleep time，and daily exercise amount were positively correlated with maximal oxygen uptake（P<0.05），and resting heart rate was negatively correlated with maximal oxygen uptake（P<0.05）．After adjusting for age，gender，and body mass index，partial correlation analysis showed that there was a positive correlation between the amount of daily exercise and maximal oxygen uptake（r=0.330，P=0.002），whereas resting heart rate was negatively correlated with maximal oxygen uptake（r=-0.305，P=0.005）．Multiple linear regression analysis showed that gender，body mass index，resting heart rate，and amount of daily exercise influenced the maximal oxygen uptake（P<0.05）．Conclusion　Young people working in an office have relatively low cardiopulmonary function.Gender，body mass index，resting heart rate，and amount of daily exercise influence the maximal oxygen uptake.Resting heart rate can be used to preliminarily assess cardiopulmonary function to guide the population and to improve physiology function and prevent disease.

Analysis of Influencing Factors for Critical HFMD and Construction of a Risk Scoring System

CHENG Yi-bing1，ZHOU Chong-chen1*，SONG Chun-lan1，GENG Xiang-ju1，YANG Yue-jie2，CHEN Fang1，CUI Ya-jie1，LI Peng1，ZHU Lin1

2018, 21(13): 1573-1579. DOI: 10.3969/j.issn.1007-9572.2018.13.013

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Objective　To explore the factors influencing the progression of severe hand，foot，and mouth disease（HFMD） to critical and severe HFMD，and construct a risk scoring system for critical and severe HFMD to provide a reference for the early assessment of HFMD severity.Methods　The study subjects included 157 HFMD patients（94 severe and 63 critical patients）．The general information，clinical manifestations，and laboratory tests between the two groups were compared.Multivariate Logistic regression analysis was used to analyze the factors influencing critical HFMD.A risk scoring system was constructed for predicting critical HFMD.A ROC curve was used to determine the best cut-off point of the risk scoring system.Results　The duration of disease course and fever before diagnosis in the critical HFMD children was significantly longer than the severe HFMD children（P<0.05）．The proportion of children with frequent tremors，poor peripheral circulation，increased heart rate，frequent double inhalations or long sighs，and abnormal blood pressure among the critical children was significantly higher than the severe children（P<0.05）．The fasting blood glucose，S100 protein，nerve-specific enolase（NSE），lactate dehydrogenase（LDH），and N-terminal pro-brain natriuretic peptide（NT-proBNP） among the critical children were also higher than the severe children（P<0.01）．Multivariate Logistic regression analysis showed that frequent tremors，poor peripheral circulation，rapid heart rate，frequent double inhalations or long sighs，persistent high fever，and high levels of fasting blood glucose，S100 protein，NSE，and NT-proBNP influenced the development of critical HFMD（P<0.05）．ROC analysis showed the AUC of the risk scoring system for predicting critical HFMD was 0.851〔95%CI（0.788，0.936）〕，and the best cut-off value was 13，corresponding to an 85.71% sensitivity and 85.11% specificity.Conclusion　Frequent tremors，poor peripheral circulation，rapid heart rate，frequent double inhalations or long sighs，persistent high fever，and high levels of fasting blood glucose，S100 protein，NSE，and NT-proBNP influenced the progression of severe HFMD to critical HFMD.The constructed risk scoring system can be used to assess HFMD severity.The best cut-off value to differentiate severe and critical HFMD is 13 points.

Clinical Value of the Detection of Fetal Nuchal Translucency Thickening in Pregnant Women with Advanced Maternal Age

CHEN Wen-zeng，JIN Mei-yuan*，YAO Ying-yu，XIONG Zhi-hui

2018, 21(13): 1580-1584. DOI: 10.3969/j.issn.1007-9572.2018.13.014

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Objective　To evaluate the clinical value of prenatal ultrasound in detecting the thickening of fetal nuchal translucency（NT） in women of advanced maternal age（≥35 years）．Methods　The data from 1 053 pregnant women of advanced maternal age with singleton pregnancies who underwent NT determinations in Tongde Hospital of Zhejiang Province between July 2015 and December 2016 were collected.With a NT ≥ 2.5 mm as the cut-off point，51 pregnant women diagnosed with NT thickening by ultrasound were selected as the NT thickening group.The NT normal group consisted of 204 pregnant women randomly selected from the women who were diagnosed with normal NT by ultrasound during the same period.Abnormal pregnancy outcomes，fetal malformations，and chromosome abnormalities were compared between the two groups.Results　The incidence of fetal NT thickening in this cohort was 4.84%（51/1 053）．In the NT normal group，among 204 pregnant women，there was 1 gravida who underwent medical termination of pregnancy due to a fetal malformation（a cystic hygroma was detected after induction of labor），1 intrauterine fetal death，and 2 gravidas lost to follow-up.Among the group of 51 with NT thickening，there were 20 gravidas who underwent medical termination of pregnancy due to major fetal malformations，5 intrauterine fetal deaths，1 fetal cystic hygroma，and 1 gravida lost to follow-up.The incidence of abnormal pregnancies in the pregnant women with NT thickening and advanced age was 54.0%（27/50），and the incidence in pregnant women with normal NT and advanced age was 1.0%（2/202）；the difference was significant（χ2=105.450，P<0.001）．The medical termination of pregnancy in the NT normal group was shown to have a cystic hygroma by ultrasound at 18+ weeks gestation.A subsequent amniocentesis indicated a structural abnormality of chromosome 22，thus medical termination of pregnancy was performed.In the NT thickened group，21 gravidas who underwent medical terminations of pregnancy had amniocenteses and prenatal ultrasound examinations；9 fetuses had chromosomal abnormalities，12 had severe structural malformations（7 cases also had chromosomal abnormalities），and 9 had cystic hygromas（2 also had chromosomal abnormalities）．The incidence of chromosomal abnormalities in the NT thickening group was 20.0%（9/45），and the incidence of chromosornal abnormalities in the NT normal group was 0.5%（1/202），which was significantly lower than the NT thickening group（χ2=101.589，P<0.05）．Conclusion　The incidence of abnormal pregnancies，and chromosomal abnormalities in the women of advanced maternal age and NT thickening was higher than the incidence in the NT normal women.Fetal NT thickness examinations have a predictive value for abnormal pregnancies and chromosomal abnormalities.

Serum Gastrin-17 and Pepsinogen Measurement Combined with 14C-UBT for Gastric Cancer Screening in Physical Examination

WANG Shu-cai1，ZHU Xi-yan2，LI Chen-cong1，LIU Qing-li1，DU Ya-qiang1*

2018, 21(13): 1585-1588. DOI: 10.3969/j.issn.1007-9572.2018.13.015

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Objective　To evaluate the effect of a combination test of gastrin-17（GAS-17） and pepsinogen measurement and 14C-UBT for gastric cancer screening in physical examination，providing a theoretical basis for the enaction of physical examination items.Methods　The enrolled 1 186 participants were employees aged 40 or over from Fourth Hospital of Hebei Medical University.They underwent a physical examination from July to October，2017.The number of participants undergoing GAS-17 measurement，pepsinogen measurement，14C-UBT，combination test（GAS-17 and pepsinogen measurement combined with 14C-UBT） and painless gastroscopy for gastric cancer screening was 471，471，440，380，130，respectively.Results　The overall positive prevalence detected by GAS-17 measurement，pepsinogen measurement，14C-UBT，combination test was 46.5%（219 cases），42.0%（198 cases），46.8%（206 cases），63.7%（242 cases），respectively，demonstrating that the combination test had higher positive rate than the other 3 methods（P<0.008 3）．Moreover，the prevalence of gastric ulcer or gastric polyps detected by combination test was still higher compared with the other 3 methods（P<0.008 3）．However，these 4 methods showed similar positive predictive value for atrophic gastritis，gastric ulcer，gastric polyps or gastric precancerous lesions（P>0.05）．By painless gastrosopy，5 were found with atrophic gastritis，30 with gastric ulcer，29 with gastric polyps，and 4 with gastric precancerous lesions.Conclusion　The combination test demonstrated higher detection rate of gastric diseases than each of its components alone，so it can be used as a screening item for high risk population for gastric cancer.

Relationship between Blood Pressure and Body Mass Index in Permanent Residents of Henan Province　

FENG Shi-xian1，FAN Lei1，QI Min-jie1，ZHOU Gang1，WANG Bao-hua2*

2018, 21(13): 1589-1593. DOI: 10.3969/j.issn.1007-9572.2018.13.016

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Objective　To examine the relationship between high blood pressure and body mass index（BMI）among 18-74 years old residents in Henan Province.Methods　Cross-sectional survey was conducted by using multi stage stratified random sampling method in all counties of Henan Province from April to July in 2012.The total number of designed respondents was 18 000.The face-to-face investigation mainly included basic characteristics （gender，age，education level，occupation and income），lifestyles（smoking，drinking history） and physical measurement （height，weight，waist circumference，hip circumference and blood pressure）．Results　18 842 were actually surveyed.The effective sample was 16 801 and the effective rate was 89.17% in this investigation.The hypertension prevalence was 27.63%（4 642/16 801），the incidence of hypertension in male was 29.90%（2 218/7 419）and 25.84% （2 424/9 382） in female.The awareness and treatment rate were 42.40% （1 968/4 642），35.95% （1 669/4 642）respectively，the control rate was only 11.44%（531/4 642）．Drawings fouding，systolic and diastolic blood pressure were increased with the increase of BMI in both genders.The correlation analysis showed that，BMI was positively correlated with systolic and diastolic blood pressure after the gender and age were adjusted，and the corresponding partial correlation coefficient were 0.230 and 0.325 （P<0.001）respectively.Multiple linear regression showed that BMI had influences on blood pressure of residents with different gender，age，education level，occupation，income smoking，drinking history and central obesity.Conclusion　The prevalence rate of hypertension in Henan was high，with a low blood pressure control rate，however.The blood pressure was closely related to BMI，so we should focus on strengthening the prevention and control measures of the overweight and obese people.

Three-ring Model for General Practitioner Training

HUANG Wen-juan，Timothy Noel Stephens*，XU Si-zhe，GUO Jing-zhu

2018, 21(13): 1594-1597. DOI: 10.3969/j.issn.1007-9572.2018.13.017

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The training system for general practitioners in Hainan Province established a "three-ring model" adapted to Chinese national conditions，which is designed on the basis of a thorough analysis of the general practitioner training outline of the Royal College of General Practitioners（RCGP）in the UK and on-site inspections.The model is introduced herein.The "three-ring model" includes outer，middle，and inner three rings and 10 training goals.The outer ring represents the "work ability of a general practitioner"，including three training goals（clinical skills，communication skills，and the ability to handle common health problems）．The middle ring represents the "working approach of a general practitioner"，including four goals（whole-person，patient-centered health care，continuous health care，scientific clinical analysis，and decision-making，safety，and cost-effective principle satisfied health service）．The inner ring represents "professionalism of a practitioner"，including three training goals（professional behaviors and responsibility，personal physical and mental health，and development and continuous self-directed learning）．It is hoped to apply the "three-ring model" in Hainan Province to train high-quality general practitioners and provide reference for the training of general practitioners in other regions of China.

Satisfaction of Trainees with the Standardized General Practitioner Training Delivered by the General Practice Department of a General Hospital　#br#

WANG Yuan-yuan，WANG Rong-ying*，ZHANG Jin-jia，ZHANG Ya-li，WANG Ya-yi，SUN Yan-jie，WANG Jin-yan

2018, 21(13): 1598-1602. DOI: 10.3969/j.issn.1007-9572.2018.13.018

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Objective　To investigate the satisfaction of trainees with the rotated specialty training and standardized general practitioner training（SGPT） delivered by the general practice department in a general hospital，exploring the role of this kind of department in delivering such trainings.Methods　In this study conducted from April to June 2017，we enrolled totaled 128 trainees receiving the SGPT delivered by General Practice Department，the Second Hospital of Hebei Medical University（TSHHMU） in 2014，2015 and 2016 and surveyed them with a self-developed questionnaire for collecting the data concerning demographic characteristics，satisfaction level with trainings in the specialty departments and General Practice Department of TSHHMU and community hospitals，as well as the SGPT.All the trainees responded positively to the survey with a response rate of 100.00%.Results　98.44%（126/128） of the respondents owned a bachelor degree or above.The average level of respondent satisfaction was found to be 47.66%（61/128），75.78%（97/128），46.09%（59/128） for trainings in specialty departments and General Practice Department of TSHHMU and community hospitals，respectively，with significant differences（P<0.05），showing that the average level of satisfaction with trainings in the General Practice Department was much higher（P<0.017）．The average level of respondent satisfaction with the SGPT was 92.19%（118/128）．Conclusion　The trainees showed high satisfaction with the training in general medical department and the SGPT.In view of this，in order to train qualified general practitioners，general hospitals，as the base for providing SGPT，should set up general practice department，and improve the standardized development of general practice teacher team.Moreover，they should participate in the management of residential general practitioner training from the beginning to the end，by which each sector of the SGPT would be characterized by ideas and clinical thinking for general practice.

Sex-specific Prevalence Rate and Influencing Factors of Chronic Diseases in Rural Areas of Yunnan's Zhaotong

HE Li-ping，LI Xiao-mei*，YU Zhen，CHEN Ying，ZHU Feng-ming，SUN Cheng-huan

2018, 21(13): 1603-1607. DOI: 10.3969/j.issn.1007-9572.2018.00.090

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Objective　To investigate the factors associated with sex-specific prevalence rate of chronic diseases in rural areas of Yunan's Zhaotong，providing a reference for formulating targeted measures for such populations in China.Methods　This study conducted between July and November 2013，using stratified and random cluster sampling，we sampled the participants and collected their following data via a home-based face-to-face questionnaire survey：basic family information（family size，economic status，monthly household income，monthly household expenditure，monthly income of each family members），demographic characteristics（sex，age，nation，occupation，education level，marital status），and prevalence of chronic diseases.Results　Of the 3 700 questionnaires administered，3 697 responsive ones were returned with a response rate of 99.92%.The overall prevalence rate of chronic diseases was 12.7%.Males demonstrated lower standardized prevalence rate of chronic diseases compared with females（12.1% vs 16.1%）（χ2=45.220，P<0.001）．Multivariate Logistic regression analysis showed that the risk factors of chronic diseases for males included low income，older age，farmer or unemployed，married or divorced or widowed，small number of family members（P<0.05），whereas for females，they were low income，older age，low education level，minority，farmer or unemployed，divorced or widowed，small number of family members
（P<0.05）．Conclusion　Attention should be paid to rural residents who are older，farmers or unemployed，divorced or widowed and had low income.Females，especially minority and those with low education level should be intensely focused.

Epidemiology of Diabetes in Beijing's Suburb of Pinggu

LI Yu-feng1，ZHOU Xiang-hai2#，ZHANG Xiu-ying2，ZHANG Ya-jing1，FU Zuo-di1，WANG Lian-ying1，ZHAO Cui-ling1，GUO Guang-xia1，KONG Xiang-shuang1，JI Li-nong2*，LIU Li-ge3*

2018, 21(13): 1608-1612. DOI: 10.3969/j.issn.1007-9572.2018.13.020

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Objective　To investigate the epidemiology of diabetes mellitus（DM） in Beijing's suburb of Pinggu，providing evidence for the development of community health service policy for this district.Methods　We conducted this study from June 2013 to September 2014.Using stratified multistage random sampling，we first recruited 5 004 residents（2 504 rural residents，and 2 500 urban residents） from Pinggu District，Beijing.After being informed of this study by telephone，80.1%（4 006） of them participated in the study following signing the informed consent form in the survey setting.All the participants underwent a questionnaire survey，routine physical examination as well as laboratory tests.4 002 responded positively to the questionnaire survey，achieving a response rate of 99.9%.Statistical analysis of the collected data was performed with weighted approach.Results　The prevalence of DM for all the participants，male and female participants，urban and rural participants was 18.0%，19.9%，16.1%，19.4%，17.4%，respectively，indicating that it was significantly higher in males rather than females（P<0.05），in urban residents rather than rural residents（P<0.05）．Moreover，the prevalence of DM varied obviously by age（P<0.05），and it increased with age（P<0.05）．With respect to the awareness rate of DM，it was 53.0%，49.7%，56.9%，53.5%，52.8%，for all the participants，male and female participants，urban and rural participants，respectively，demonstrating that it was much lower in males rather than females（P<0.05），but was significantly higher in urban residents rather than rural residents（P<0.05）．In terms of the rate of receiving diabetes-related treatment，it was 40.9%，36.2%，46.3%，44.0%，39.4%，for all the DM participants，male and female DM participants，urban and rural DM participants，respectively，exhibiting that it was much lower in male DM residents rather than female DM residents（P<0.05），and was significantly higher in urban DM residents rather than rural DM residents（P<0.05）．The rate of achieving the control target of glycaemia for all the DM participants，male and female DM participants，urban and rural DM participants was 36.5%，37.3%，35.7%，44.6%，32.8%，respectively，showing that it was substantially higher in male DM participants rather than female DM participants（P<0.05），and was significantly higher in urban DM residents rather than rural DM residents（P<0.05）．Conclusion　In Pinggu District，the prevalence of DM is high；women aged over 55 are more prone to DM；the rates of awareness of DM，receiving diabetes-related treatment and achieving the control target of glycaemia are low，especially among DM residents aged less than 45 years.In order to improve this unfavorable status，it is suggested to strengthen the comprehensive management of DM，especially for the young and middle-aged DM residents.

Relationship of Sense of Social Responsibility with Mental Health，Coping Style and Parental Rearing Style among Chinese College Students　#br#

SHI Qiong

2018, 21(13): 1613-1617. DOI: 10.3969/j.issn.1007-9572.2018.13.021

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Objective　To investigate the status of sense of social responsibility，and its relationship with mental health，coping style and parental rearing style among Chinese college students.Methods　In April 2017，we conducted a survey among a cluster sample of 3 000 Chinese students（including freshmen，sophomores and juniors） from a college in Nanjing using the Chinese version of Big Five Inventory（C-BFI），Chinese version of University Personality Inventory（C-UPI），Chinese version of Simplified Coping Style Questionnaire（C-SCSQ） and Chinese version of EMBU（C-EMBU） for examining the relationship of sense of social responsibility with mental health，coping style and parental rearing style among this population.Results　Totaled 2 814 students positively responded to the survey，with a response rate of 93.80%.The survey showed that the degree of sense of social responsibility of this population was higher than the national level（t=2.779，P=0.005）．Male students，impoverished students and those brought up by both parents were more likely to have higher degree of sense of social responsibility than female students，non-impoverished students and those brought up by single parent（P<0.05）．The degree of sense of social responsibility varied significantly by mental health status（P<0.001）．The sense of social responsibility was positively correlated with positive coping（r=0.361，P<0.001），while negatively correlated with negative coping（r=-0.265，P<0.001）．College students' sense of social responsibility was positively associated with paternal emotional warmth（r=0.243，P<0.01），but negatively associated with paternal punishment and strictness，paternal over-involvement，paternal rejection and disapproval and paternal overprotection（r=-0.077，-0.152，-0.121，-0.092，P<0.001）．Moreover，college students' sense of social responsibility was identified to be positively associated with maternal emotional warmth（r=0.154，P<0.01），while negatively associated with maternal punishment and strictness，maternal rejection and disapproval，maternal over-involvement and overprotection（r=-0.133，-0.183，-0.199，P<0.001）．Gender，family economic status，C-UPI score，positive coping style，negative coping style，autocratic mother and understanding and caring parents could predict the sense of social responsibility of the students（P<0.001）．Conclusion　The degree of sense of social responsibility among these students was proved to be good，which was associated with gender，family economic status，parental rearing style and also closely correlated with mental health status as well as coping style.Moreover，parental understanding and caring were contributive to the development of sense of social responsibility while negative parental rearing style，especially authoritarian mother's parenting，was unfavorable for its development.

Effect of Marital Communication Patterns on Depression：a Comparison between Clinical and General Population Samples　

LI Qiang1，2，JIN Ling1，2，CHEN Chen1，2，ZHOU Yi-xin1，2，ZHOU Ming-jie1，2*

2018, 21(13): 1618-1623. DOI: 10.3969/j.issn.1007-9572.2018.13.022

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Objective　To explore the relationship between marital communication patterns and depression in a clinical sample versus a general sample.Methods　This study was conducted between two samples recruited in 2016，including 148 outpatients with marriage problems from a mental health hospital in Beijing（clinical group），and 400 normal married participants（control group）.A self-developed Demographic Questionnaire，Chinese version of PHQ-9（PHQ-9-C）and Chinese version of CPQ-SF（CPQ-SF-C）were used to measure the demographic information，depression and communication patterns of the participants.Hierarchical regression analysis was used to examine the moderate effect of different types of samples on the relationship between marital communication patterns and depression.Results　（1）Compared with the control group，clinical group scored higher in depression，male demand/female withdraw，female demand/male withdraw，total demand/ withdraw and criticize/defend，but scored lower in constructive communication （P<0.05）.（2）Two groups achieved similar scores in alternative demand/ withdraw（P>0.05）.（3） Hierarchical regression analysis showed that，male demand/ female withdraw，female demand/male withdraw，total demand/withdraw，alternative demand/withdraw，criticize/ defend could positively predict depression（P<0.05），when gender，educational attainment，and if the participant has a child were controlled，while constructive communication could negatively predict depression （P<0.05）.（4） After bringing the product terms of male demand/female withdraw，female demand/ male withdraw，total demand/ withdraw，alternative demand/withdraw criticize/ defend，constructive communication with sample type into the regression model，respectively，the results demonstrated that the interaction between male demand/ female withdraw and sample type，as well as that between constructive communication and sample type were significant（P<0.05）.The type of the sample played a moderate role in the relationship between male demand/female withdraw and depression，and the relationship between constructive communication pattern and depression（△R2=0.011，P<0.05；△R2=0.019，P<0.05）.Conclusion　Sample type plays a moderating role in the relationship between marital communication pattern and depression，especially in the relationship between male demand/female withdraw and depression，as well as that between constructive communication pattern and depression.

Anti-Jo-1 Syndrome：Report of Two Cases and Literature Review　

YANG Jie，SU Juan*，CHAI Ke-xia

2018, 21(13): 1624-1628. DOI: 10.3969/j.issn.1007-9572.2018.13.023

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Anti-Jo-1 antibody syndrome is a rare chronic autoimmune disorder associated with diverse clinical manifestations.The pathogenesis of this disease is unknown.Lack of understanding of the disease and misinterpretation of symptoms can lead to misdiagnosis，and opportunities for treatment and support would be delayed，which in turn deteriorates the prognosis.We reported two patients with anti-Jo-1 antibody syndrome and reviewed the recent developments in the clinical features，pathogenesis，diagnosis and treatment of anti-Jo-1 antibody syndrome in order to improve the outcome and decrease the mortality of such patients by reducing the probabilities of missed diagnosis and misdiagnosis via enhancing clinicians' understanding of the disease.

Clinical Characteristics Analysis of Tumor-induced Osteomalacia：a Case Report and Literature Review　

WEI Wei-ping，LIU Hai-wei*，QUAN Hui-biao，ZHANG Yu-hai，CHEN Dao-xiong，CHEN Kai-ning

2018, 21(13): 1629-1632. DOI: 10.3969/j.issn.1007-9572.2018.13.024

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Tumor-induced osteomalacia（TIO） is a rare paraneoplastic syndrome in the clinic setting.TIO is caused by excessive phosphorus excretion induced by the tumor，and is thus categorized as an acquired hypophosphatemic osteomalacia.TIO has an occult onset and is associated with a high rate of misdiagnosis，although TIO has some typical clinical features，such as amyosthenia，progressive ostealgia，and loss of height.Practitioners should have increased awareness of TIO.Early diagnosis，correctly positioning of the tumor，and surgical resection can achieve good outcomes.For those patients suspected to have TIO，a thorough physical examination combined with laboratory testing and imaging are sufficient for the detection and positioning of the tumor.We report herein a patient who was diagnosed with TIO and successfully treated.The relevant literature is reviewed to improve the knowledge of the disease and provide reference for clinical work.

Application of Mobile Health on Cardiovascular Diseases　

PENG Jian-jun*，NAN Jing

2018, 21(13): 1633-1638. DOI: 10.3969/j.issn.1007-9572.2018.13.025

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Mobile health has emerged as a global trend with the popularity of new mobile device and the rapid development of information exchange technologies.In the meantime，the cardiovascular disease is one of the most severe diseases affecting human health.Hence，there is a growing demand for applying mobile health to cardiovascular diseases.This article reviews the progress of applications of mobile health in cardiovascular diseases in order to boost the further development of mobile health in its clinical practice.

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