Chinese General Practice

Needs，Utilization and Equity of Health Services among Urban and Rural Residents in the Process toward Achieving Universal Health Coverage

XU Jianqiang，ZHENG Juan，LI Jiajia，XU Lingzhong

2018, 21(34): 4163-4168. DOI: 10.12114/j.issn.1007-9572.2018.34.001

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Objective　To analyze the needs，utilization and equity of health services among urban and rural residents during the process of achieving universal health coverage，and based on this，to put forward policy recommendations.Methods　Data stemmed from the Shandong part of the National Health Services Survey in China，2013.In Shandong，a random sample of 33 060 residents of 12 006 families participated，including 10 391 urban residents of 6 006 families，and 22 669 rural residents of 6 000 families.Quinquepartite method was used to classify the residents' income.The needs，utilization and equity of health services were compared between the urban and rural residents.Results　Compared with the rural residents，urban residents demonstrated higher two-week morbidity rate and 12-month chronic disease morbidity rate but lower rates of two-week medical consultation and patients' two-week medical consultation（P<0.05）.The difference of 12-month hospitalization rate between urban and rural residents was not significant（P>0.05）.The two-week morbidity rate，12-month chronic disease morbidity rate，two-week medical consultation rate and 12-month hospitalization rate decreased with the increase of income in rural residents，patients' two-week medical consultation rate increased of income on rural residents（P<0.05）.However，these five indicators did not differ significantly between urban and rural residents by the level of income（P>0.05）.The analysis of the needs and equity of health service utilization in urban and rural residents showed that the concentration curves lying above the equity line were two-week morbidity rate of all the residents（CI=-0.091 5），two-week morbidity rate of rural residents（CI=-0.117 9），12-month chronic disease morbidity rate of all the residents（CI=-0.118 4），12-month chronic disease morbidity rate of rural residents（CI=-0.168 2），two-week medical consultation rate of urban residents（CI=-0.006 4），utilization of hospitalization services in all the residents，urban residents and rural residents（CI=-0.094 1，-0.001 5，-0.112 4），and those lying below the equity line were two-week morbidity rate of urban residents（CI=0.012 9），12-month chronic disease morbidity rate of urban residents（CI=0.006 4），two-week medical consultation rate in urban and rural residents（CI=0.062 5，0.080 0）.Conclusion　The two-week health service needs of low-income rural residents were higher than those of high-income people，and the of two-week sickness，chronic disease and two-week visiting fairness of rural residents were worse than that of urban residents.In view of this，the investment for the construction of infrastructure in primary care should be increased，the training for general practitioners should be strengthened，the implementation of hierarchical medical system and contracted family doctor services should be promoted，in order to narrow the gap of accessibility and utilization of health services between urban and rural residents，and improve the universal access to health services.We should continue to refine the division of medical insurance compensation objects and focus on improving the compensation level of rural low- and middle- income residents，improve the protection of people's disease risk and move towards universal health coverage.

Status and Equity of Health Expenditure in Urban and Rural Residents among the Process toward Achieving Universal Health Coverage

XU Jianqiang，ZHENG Juan，LI Jiajia，XU Lingzhong

2018, 21(34): 4169-4173. DOI: 10.12114/j.issn.1007-9572.2018.34.002

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Objective　To analyze the status and equity of health expenditure among urban and rural residents in the process of achieving universal health coverage，giving policy suggestions.Methods　From the results of National Health Services Survey in China，2013，data of Shandong Province were collected，involving a total of 33 060 individuals from 12 006 families（10 391 from 6 006 urban families，and 22 669 from 6 000 rural families）.Quinquepartite method was adopted to classify the annual household income.The status and equity of health expenditure of the participants were analyzed by residency place and level of income.Results　The rural families had lower median annual healthcare expenditure but higher median total cost per outpatient visit，and median total cost per hospitalization compared with the urban families（P<0.05）.The median total cost per hospitalization differed significantly between rural families by level of annual household income（P<0.05），but median annual healthcare expenditure and median total cost per outpatient visit did not（P>0.05）.The median total cost per outpatient visit did not vary significantly between the urban families by level of annual household income（P>0.05）.Higher median annual healthcare expenditure and median cost per hospitalization were positively associated with higher annual household income in the urban families（P<0.05）.From 2003 to 2016，the Engel coefficient of rural residents dropped from 41.81% to 29.76%，and that of urban residents was 27.58% in 2016.The ratio of annual health expenditure to income rose from 4.41% to 7.36% in rural residents while it dropped from 5.29% to 4.73% in urban residents during this period.The concentration curve of median annual rural household health expenditure almost coincided with the 45-degree line（CI=0.016 4），while that of median annual urban household health expenditure was below the egalitarian line（CI=0.092 1），the concentration curve of median annual urban and rural household health expenditure was below the 45-degree line（CI=0.039 0）.The concentration curves of median annual cost of outpatient expenditure of rural residents，urban residents and all the residents were all above the 45-degree line.The CI value of paying outpatient expenditure with cash was -0.064 2，-0.094 1，-0.393 3，respectively，for all the residents，rural residents and urban residents.The hospitalization expenditure of the urban and rural residents with high income occupied most of the total hospitalization expenditure（CI=0.013 0）.The concentration curve of the median total cost per outpatient visit in rural residents almost coincided with the 45-degree line（CI=-0.002 6）.The concentration curve of the median annual hospitalization expenditure of urban residents was below the egalitarian line on the whole（CI=0.047 1）.Conclusion　Compared with urban areas，the median household healthcare expenditure is lower and median outpatient/inpatient expenditure per capita is higher in rural areas. In general，the equity of health expenditure in rural residents is worse than that of urban residents. Moreover，low income rural residents are found with higher ratio of annual household healthcare expenditure to annual household income，and higher ratios of annual outpatient and inpatient expenditure per family member to annual household income. In order to achieve universal health coverage，rural residents，especially those with low income，should be placed into priority groups whose health coverage should be enhanced，and the affordability of healthcare should be increased by improving the healthcare financing strategies and health insurance systems，and strengthening the interventions for reducing disease risks in low-income and middle-income rural residents.

Standards for the Construction of Aerosol Therapy Room in Community Heath Centers：a Consensus Statement Developed by Experts from Shanghai's Pudong New Area and Fengxian District

LI Hengtao，WANG Genzai，TIAN Mingxia，QIAO Jing，ZHUANG Cheng，LIU Fang，LIU Lixiao，LI Junxia，ZHANG Lei，LIN Shuzhu，JIN Yanliang，ZHAO Liebin，YU Jun，XU Jian，YIN Yong，GUO Yanfang，SHENG Qiuming，DAI Jinsheng

2018, 21(34): 4174-4177. DOI: 10.12114/j.issn.1007-9572.2018.00.219

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Aerosol therapy is a physical-chemical treatment that is widely applied to treat a variety of respiratory diseases in populations，especially amongst young children，by clearing excess phlegm and relieving inflammation.With the gradual development of the pediatric medical consortium，a community health center should establish a aerosol therapy room of an appropriate size for providing continuing care for children in need.However，there are no unified standards for the construction of the room in community health centers.On the basis of the reviewing of the evaluation standards，study data and management guidelines associated with aerosol therapy room published recently，we developed a consensus statement，in which the standards for the construction，management，drug allocation and quality control of a aerosol therapy room，qualities and responsibilities of the corresponding care providers，and so on are detailed，hoping to provide assistance for the standardized construction of the aerosol therapy room in community health centers in China.

Development of the Chronic Disease Management Team Consisting Mainly of Specialists and General Practitioners from the Institutions of a Medical Consortium and Its Role in the Implementation of the Hierarchical Medical System

CHENG Jie，XU Xiangtian，WANG Zhe，LIANG Guannan，CHEN Wei，CAI Yan，LIANG Jinfeng

2018, 21(34): 4178-4182. DOI: 10.12114/j.issn.1007-9572.2018.34.004

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The distribution of medical resources in China is imbalanced nowadays. Most high-quality medical resources are distributed in tertiary hospitals，but not in primary healthcare institutions. Insufficient resources hinder primary healthcare institutions from playing their due role in promoting the development of the hierarchical medical system，to satisfy the health needs of residents. Therefore，the supply-side reform in pharmaceutical and healthcare fields is imperative. The "Healthy China 2030" Planning Outline put forward goals for realizing the innovation of the patterns of healthcare provision and achieving a mature and sound hierarchical medical system in an all-round way. The construction of a medical consortium is a way to promote the development of hierarchical medical system by integrating the local medical resources and allocating high-quality resources to primary care using a guided approach. We analyzed the structure of chronic disease management teams of medical consortium of Beijing Chao-Yang Hospital，Capital Medical University，consisting mainly of specialists from general hospitals，general practitioners and health managers from community healthcare institutions，detailed the teams' delivery process of contracted family doctor services，summarized the teams' features and positive role in promoting the development of hierarchical medical system，with a view to providing a reference for facilitating the full implementation of this system.

Turnover Intention and Its Influencing Factors among Village Doctors in Central China　

SHEN Bingjie，HU Linlin，YOU Lili，LIU Yuanli

2018, 21(34): 4183-4187. DOI: 10.12114/j.issn.1007-9572.2018.34.005

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Objective　To explore the turnover intention and its influencing factors among the village doctors in central China，providing a scientific basis for stabilizing village doctors workforce.Methods　This cross-sectional survey was conducted from November 2016 to April 2017 in 991 village clinics of 27 counties（districts） of 8 provinces in central China participating the project named "The China PEACE（Patient-centered Evaluative Assessment of Cardiac Events）MPP（Million Persons Project）".All on-the-job village doctors from the clinics took part in the survey to answer a self-developed questionnaire consisting of demographic characteristics，length of service，service content，phased training，actual-to-expected wage ratio，insurance，job burnout and turnover intention.A total of 1 669 participants returned responsive questionnaires.Two-level Logistic regression models were used to analyze the influencing factors of turnover intention.Results　The overall prevalence of turnover intention was 34.03%（568/1 669）.Univariate analysis revealed that the prevalence of turnover intention differed significantly by sex，age，service length，phased training，actual-to-expected wage ratio，insurance，emotional exhaustion，depersonalization，and low personal accomplishment（P<0.05） but not by minzu，educational level，major，professional and title and service content（P>0.05）.Two-level Logistic regression analysis showed that the low actual-to-expected wage ratio（0-，OR=20.738；20%-，OR=6.101；40%-，OR=5.657；60%-，OR=4.457），lack of insurance（OR=1.769），high level of job burnout（severe emotional exhaustion，OR=2.436；severe depersonalization，OR=1.626；moderate depersonalization，OR=1.486；lowest personal accomplishment，OR=1.948） were associated with a higher prevalence of turnover intention（P<0.05）.Conclusion　High prevalence of turnover intention among village doctors in central China was found，which was associated with actual-to-expected wage ratio，insurance and job burnout.In order to stabilize and develop the village doctors workforce，the salary of them should be improved by well implementing the policies about incentive and guaranteed compensations.

Present Situation and Strategy of Popularization of Appropriate Traditional Chinese Medicine Techniques in Shanghai Primary Community Health Centers　

HU Qinshun，ZHAO Bin，AI Heling，XU Wen，HU Min，LUO Wei，ZHU Yu，CHEN Qi，LIU Deng

2018, 21(34): 4188-4193. DOI: 10.12114/j.issn.1007-9572.2018.34.006

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Objective　To investigate the popularization of appropriate Traditional Chinese Medicine（TCM） techniques in Shanghai primary community health service centers（PCHS），and further analyze the advantages，problems and corresponding strategy.Methods　A total of 49 PCHS were selected from 2 to 4 PCHS in each of 16 districts（couties） of Shanghai by means of purposive sampling method.Based on TCM policies in Shanghai and China，the self-designed questionnaire，including the application of appropriate TCM techniques in Shanghai PCHS in 2016，the number of projects carried out，the number of TCM doctors，the number of non-TCM doctors，departments that can operate the technique，and the number of patients served，was used for the survey during September to November 2017，and　chargers of each center filled the questionnaire.A total of 49 questionnaires were issued，and 48 questionnaires were recovered，with 98.0% of recovery rate.Results　Among 4 appropriate TCM technique projects in Shanghai PCHS in 2016，the average number of applied project was（8.17±4.33），the median number of service person was 1 914.5（5 420）.Projects with higher promotion rate were massage treatment for acute lumbar sprain，massage treatment for stiff neck，electric acupuncture treatment for lumbar disc herniation，nape eight-needle therapy for prevention and treatment of cervical spondylosis，electric needle shallow puncture treatment for facial paralysis，all>70%.Projects with low promotion rate were vitamin K3 Sanyinjiao acupoint injection　for pelvic pain，epiglottis cartilage pushing for infantile vomiting，and auricular vein acupotomy　treatment for facial planar wart，all <10%.Items operated by physicians most were electroacupuncture for lumbar disc herniation and nape eight-needle therapy for preventing cervical spondylosis，which were 3.31 and 2.85，respectively.Items operated by few physicians were vitamin K3 Sanyinjiao acupoint injection for pelvic pain and epiglottis cartilage pushing for infantile vomiting，which were 0.02 and 0.08，respectively.Items operated by most departments were electroacupuncture for lumbar disc herniation and nape eight-needle therapy for preventing cervical spondylosis，which were 1.58 and 1.46，respectively.Items operated by few departments were vitamin K3 Sanyinjiao acupoint injection for pelvic pain and epiglottis cartilage pushing for infantile vomiting，which were both 0.02.Items with most average service times were electroacupuncture treatment of lumbar disc herniation and the prevention and treatment of chronic respiratory diseases with acupoint application in communities，which were 1 081 and 727，respectively.Vitamin K3 Sanyinjiao acupoint injection for pelvic pain and epiglottis cartilage pushing for infantile vomiting had no visit.Nine out of ten　categories，including 95 items in promotion of TCM techniques during the 13th Five-year Plan has been carried out in Shanghai PCHS，excluding anorectal category.Forty-eight PCHS carried out（13.29±9.23） techniques on average，with 18 904.5
（45 410.0） median service person-time.Acupuncture and compress and fumigation were used by physicians most，which were 21.08 and 10.88，respectively.The average number of operating physicians in the category of minimally invasive TCM and other items were less，with 0.29 and 1.44，respectively.Acupuncture and compress and fumigation were used the most by departments，which were 10.71 and 4.33 on average，respectively，and technique applied by few departments was minimally invasive treatment in TCM，with 0.25 on average.Conclusion　Shanghai PCHS has made progress in popularizing appropriate TCM techniques.However，there are differences in application among different districts（couties） and PCHS.The suggestions are to improve charging items and standards，select new TCM projects and strengthen the long-term training and publicity of appropriate TCM techniques.

Hypertension Bidirectional Referral Criteria in China：a Literature Analysis

GONG Xin，SHI Jianwei，XIAO Yue，LIU Nana，BO Xiaojie，XU Kangjie，WANG Chunxu，WANG Chaoxin

2018, 21(34): 4194-4200. DOI: 10.12114/j.issn.1007-9572.2018.34.007

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Objective　To study the research status of hypertension bidirectional referral criteria in China.Methods　From June 20th to 30th，2017，we searched CNKI and Wanfang Data Knowledge Service Platform，and other electronic databases and websites for documents about hypertension bidirectional referral criteria in China.The included documents were divided to guidelines and research articles.We compared the guidelines by time of publishing for exploring the development of hypertension referral criteria in guidelines，and performed a summary analysis of the hypertension referral criteria in articles for estimating the application of such criteria.Results　A total of three guidelines and eight articles were included.The three guidelines are 2009 Guidelines for Primary Prevention and Management of Hypertension in China（2009 guidelines），2014 Guidelines for Primary Prevention and Management of Hypertension in China（Revised Edition）（2014 revised guidelines），and 2017 Guidelines for Primary Prevention and Management of Hypertension in China（2017 guidelines）.The hypertension bidirectional referral criteria contained in 2009 Guidelines and 2014 Revised Guidelines are consistent.In the 2017 guidelines，some items of the hypertension bidirectional referral criteria in these two guidelines were quantified and subdivided，and the acute upward referral criteria for hypertension were added，the downward referral criteria for hypertension were deleted.Neither guidelines nor research articles provided the evidence for the formulation of referral criteria.No articles used the same referral criteria and applied the referral criteria contained in the three above-mentioned guidelines.Moreover，no articles paid attention to the evaluation of such criteria，and specifically studied the development and application of such criteria.Conclusion　The hypertension bidirectional referral criteria contained in the three guidelines have not been fully recognized.Furthermore，there is lack of studies specifically targeting such criteria.In view of this，it is suggested to formulate evidence-based，systematic and easy-to-use hypertension bidirectional referral criteria，to ensure the smooth implementation of the hierarchical medical system.

China's Supply-side Reform in the Integrated Medical and Nursing Care Sector：an Analysis Using Michael Porter Diamond Model　

WANG Zhaoqing，XING Yanan，QU Jing，PEI Ruijuan，YAN Wenxin，SUN Xinran，LI Li

2018, 21(34): 4201-4205. DOI: 10.12114/j.issn.1007-9572.2018.34.008

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With the acceleration of China's population aging，geriatric health issues are increasing.As the traditional elderly healthcare services are often unable to satisfy the healthcare needs of the elderly，it is necessary to promote the development of integrated medical and nursing care.However，there are many problems in the supply market of integrated medical and nursing care，such as lack of professionals，insufficient integration of social capital，inaccurate demand-supply matching，unbalanced allocation of resources and unfair competitive environment，and so on.So the supply-side reform in integrated medical and nursing care sector needs to be carried out prudently.We performed a scientific analysis of China's supply-side reform in the integrated medical and nursing care sector using Michael Porter diamond model，and put forward that，to implement the reform，it is necessary to improve the efficiency and service quality of integrated medical and nursing care sector by changing the role of government involvement in the sector，strengthening the training of professionals and applying advanced technologies.

Significance and Feasibility of Discharge Planning for Elderly People Receiving Integrated Medical and Nursing Care after Hospital Discharge：a Study from a Medical Social Worker's Perspective

WANG Suming，WANG Zhizhong，QI Jian

2018, 21(34): 4206-4211. DOI: 10.12114/j.issn.1007-9572.2018.34.009

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The promotion of integrated medical and nursing care is a positive initiative for addressing the health needs of the ageing population，as well as for achieving the goals of "Healthy China" and boosting the development of China's elderly care industry.Discharge planning is made by health professionals based on assessing the patient's needs，which aims to ensure the patient achieve good health and quality of life by receiving integrated and continued care from the institution to which he is admitted after discharge from hospital.It enhances the coordination of services after discharge from hospital，bridges the gap between hospital and the place to which the patient is discharged，guaranteeing the patient access to continued care for improving rehabilitation.The delivery of integrated medical and nursing care is favorable for the implementation of discharge planning，which makes the access to continued care after hospital discharge possible.Medical social workers involved in the formulation and implementation of discharge planning plays a vital role in assessing the overall health needs of older people，increasing the professional inter-institutional communication and cooperation and improving the rehabilitation after discharge from hospital.It is urgent to develop a discharge planning by professionals involving medical social workers based on the national conditions and national implementation status of integrated medical and nursing care.We discussed the importance of discharge planning whose formulation and implementation involve medical social workers，and analyzed its feasibility，hoping to offer an important reference for assessing the general health needs of the elderly，strengthening the communication and cooperation between multidisciplinary professionals，and following up geriatric rehabilitation after hospital discharge.

Exploration of Community Home Care Medical Service Mode Based on IFOC Model in Fangzhuang Community Health Service Center　

HAO Yan，WANG Li，LIU Xinying，YU Haiyang，JIA Hongyan，GUO Xiaoling，WU Hao

2018, 21(34): 4212-4216. DOI: 10.12114/j.issn.1007-9572.2018.34.010

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As a social welfare policy to solve the problem of old-age care，the community home care system has obtained a series of positive results and experiences for reference in local practice.Focusing on practical projects in Beijing and Fengtai District，we fully carried out home-based care for the aged.In the goal of meeting the need of the elderly for home care，and supported by artificial intelligence，electronic data，Internet，and Internet of Things，Fangzhuang Community Health Service Center has integrated community resources to provide fine，precise and accessible medical services for the elderly in the district.Exploring a model of community home care medical service based on the Intelligent Family Doctors Optimized Coordination（IFOC） model.This paper mainly introduces this model，and analyses its advantages and existing problems，so as to provide reference and suggestions for community home care medical service.

Overweight/Obesity and Exercise，and Their Interaction in Normal Adults with Phlegm-dampness Constitution　

SHI Muran，ZHU Yanbo，WANG Lerong，XIE Yisha，MENG Lingjie，ZHENG Kun

2018, 21(34): 4217-4222. DOI: 10.12114/j.issn.1007-9572.2018.34.011

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Objective　To investigate the relationships of overweight/obesity，exercise，and their interaction with phlegm-dampness constitution in normal adults.Methods　The physical examination data of the Beijing part during March 2015 to May 2016 were collected from the Systematic Survey of TCM Pulse Diagnosis Physiological Parameters in Normal Adult Populations with Different Constitutions Database.In Beijing，after excluding those with missing variables and very low body weight（BMI<18.5 kg/m2），970 eligible individuals were included.Of them，262 cases（27.0%） with the highest scores of Phlegm Dampness Constitution Subscale（PDCS），a subscale of the TCM Physical Constitution Scale，and 262 cases（27.0%） with the lowest scores of PDCS were assigned to high score group and low score group，respectively.Logistic regression analysis was used to analyze the impacts of overweight/obesity，exercise and their interaction on phlegm-dampness constitution after adjusting for the confounding factors of gender，age，education level，smoking preference and drinking preference.Results　Multivariate Logistic regression analysis showed that both overweight〔OR=1.981，95%CI（1.275，3.079），P<0.05〕and obesity〔OR=4.032，95%CI（1.985，8.190），P<0.05〕 increased the risk of having higher scores of PDCS，but exercise habits had no effect on the scores of PDCS（P>0.05）.When considered overweight/obesity and exercise habits as stratified factors，Logistic regression analysis demonstrated that individuals without overweight/obesity and exercise habits〔OR=2.735，95%CI（1.644，4.551），P<0.05〕and those with overweight/obesity but without exercise habits〔OR=2.154，95%CI（1.168，3.976），P<0.05〕had higher risk of having higher scores of PDCS than those with exercise habits but without overweight/obesity.Multiplicative and additive interaction analyses showed that there were no obvious interactions between overweight/obesity and exercise.Conclusion　Overweight/obesity and lack of exercise increase the possibility of having phlegm-dampness constitution，although there is no obvious interaction between the two.Exercise and weight management help to improve phlegm-dampness constitution.

Value of Vitamin D3 for the Identification of Cognitive Impairment in Elderly Patients with Hypertension　

GENG Shasha，JIANG Hua，GE Jianli，LI Qingqing，NIU Xianping，LIU Yue

2018, 21(34): 4222-4226. DOI: 10.12114/j.issn.1007-9572.2018.34.012

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Objective　To investigate the value of vitamin D3 in the screening of cognitive impairment in elderly hypertensive patients.Methods　A total of 113 elderly hypertensive patients（>60 years） were recruited from Dongfang Hospital of Tongji University during June 2013 to June 2017.Plasma 1，25-（OH）2D3 level，Mini-Mental State Examination（MMSE） score，and other clinical data were collected.Cognitive impairment was evaluated by MMSE score.Clinical characteristics were compared between those with cognitive impairment and those without.Multivariate Logistic regression was used to analyze the influencing factors of cognitive impairment.The receiver operating characteristic（ROC） curve analysis was performed to evaluate the value of 1，25-（OH）2D3 level for the identification of cognitive impairment in these participants.Results　Of the 113 cases，28（24.8%） were found with cognitive impairment，and other 85（75.2%） without.Compared with those without cognitive impairment，elderly hypertensive patients with cognitive impairment had shorter average duration of education，lower average 1，25-（OH）2D3 level，and higher average age，higher rate of smoking history，higher prevalence of higher systolic blood pressure，and coronary heart disease（P<0.05）.Multivariate Logistic regression analysis showed that age，and 1，25-（OH）2D3 level were the influencing factors of cognitive impairment in elderly hypertensive patients（P<0.05）.The AUC of 1，25-（OH）2D3 level for the identification of cognitive impairment was 0.891，the optimal cut-off point was 66.32 nmol/L，with 69.4% sensitivity and 96.4% specificity.Conclusion　Vitamin D3 can identify cognitive impairment in elderly hypertensive patients to some extent.When it is less than 66.32 nmol/L，vitamin D should be supplemented in time.

Prevalence of Type D Personality and Distribution of TCM Syndromes in Unexplained Recurrent Spontaneous Abortion Patients　

FENG Xiaoling，CHANG Zhuo，ZHAO Xiaoxuan，WANG Wei，LI Wenwen，CHEN Lu

2018, 21(34): 4227-4231. DOI: 10.12114/j.issn.1007-9572.2018.34.013

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Objective　To investigate the prevalence of type D personality and distribution of TCM syndromes in patients with unexplained recurrent spontaneous abortion（URSA）.Methods From First Affiliated Hospital，Heilongjiang University of Chinese Medicine，we enrolled 200 outpatients and inpatients with URSA（study group），and 200 patients with childbearing history（≥1 time） and other diseases（control group） during January 2013 to February 2014.Type D Scale-14（DS14） was used to assess the prevalence of type D personality in both groups.On the basis of literature review and expert consultation，we developed the "Diagnostic Criteria of TCM Syndromes for Unexplained Recurrent Spontaneous Abortion" and used it to assess the TCM syndromes in the study group.Results　Compared with the control group，the study group demonstrated higher prevalence of type D personality〔59.0%（118/200） vs 15.5%（31/200），P<0.05〕，and higher mean scores of DS14 and its two dimensions（negative affectivity and social inhibition）（P<0.05）.The top common TCM syndromes in the study group were simple kidney deficiency（101 cases，50.5%） and kidney deficiency and liver stagnation（39 cases，19.5%）.In the 118 URSA patients with type D personality，the TCM syndromes found were simple kidney deficiency（85 cases，72.0%），kidney deficiency and liver stagnation（29 cases，24.6%） and blood stasis（4 cases，3.4%）.Conclusion　URSA patients are prone to have type D personality.In URSA patients with type D personality，simple kidney deficiency is the main TCM syndrome.

Risk Factors for Hospital-acquired Acute Kidney Injury in Patients Died During Hospitalization　

YAO Lan，YANG Huayu，CHEN Haiping

2018, 21(34): 4232-4236. DOI: 10.12114/j.issn.1007-9572.2018.34.014

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Objective　To investigate the risk factors of hospital-acquired acute kidney injury（AKI） in patients who died during hospitalization.Methods　The participants were recruited from Internal Medicine Department，Beijing Friendship Hospital ，Capital Medical University，from January 2016 to January 2018.All of them died during hospitalization，including 193 aged ≥85（aged ≥85 group） and 91 aged 18-64（aged 18-64 group）.By reviewing the medical records and hospitalization records，their general clinical data，prevalence of comorbidity，laboratory findings and so on were collected.Logistic regression analysis was used to study the risk factors of hospital-acquired AKI in both groups.Results　The prevalence of AKI was 58.5%（113/193） in the aged ≥85 group，and 54.9%（50/91） in the aged 18-64 group.In the aged ≥85 group，significant differences were found in the prevalence of coronary heart disease（CHD），chronic kidney disease（CKD），anemia，heart failure and sepsis，and mean levels of hemoglobin，serum creatinine（Scr），blood urea nitrogen（BUN） and estimated glomerular filtration rate（eGFR） between individuals with AKI and those without（P<0.05）.In the aged 18-64 group，the prevalence of hyperlipidemia，anemia and heart failure，and mean levels of hemoglobin and serum albumin differed significantly between individuals with AKI and those without（P<0.05）.Multivariate logistic regression analysis showed that the prevalence of heart failure，sepsis and increased baseline BUN were risk factors of AKI in the aged ≥85 group（P<0.05）；the prevalence of anemia and heart failure were risk factors of AKI in the aged 18-64 group（P<0.05）.Conclusion　The prevalence of comorbidities of heart failure，sepsis and increased baseline BUN are independent risk factors of AKI in aged ≥85 patients who died during hospitalization，and the prevalence of comorbidities of anemia and heart failure are independent risk factors of AKI in aged 18-64 patients who died during hospitalization.Early assessment and active intervention of risk factors may improve the prognosis and reduce the risk of death.

Changes in Ventricular Rate during the 6-minute Walk Test in Patients with Atrial Fibrillation Treated with Bisoprolol versus Metoprolol　

LUO Xiao，HUANG Qingxia，XU Jinsong，YU Yun，XIE Feng，ZHOU Wei，LIU Yue，SUN Xiaopei

2018, 21(34): 4237-4240. DOI: 10.12114/j.issn.1007-9572.2018.34.015

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Objective　To evaluate the changes in ventricular rate in patients with atrial fibrillation（AF） treated by Bisoprolol versus Metoprolol during the 6-minute walk test（6MWT）.Methods　This retrospective study was conducted in 50 AF patients and 42 controls with normal sinus rhythm from September 2015 to September 2017.All of them underwent two rounds of 6MWT，first without taking drugs，then took drugs〔28 AF patients took Metoprolol（Metoprolol-treated AF subgroup） and 22 used Bisoprolol（Bisoprolol-treated AF subgroup），23 controls used Metoprolol（Metoprolol-treated control subgroup），and 19 took Bisoprolol（Bisoprolol-treated control subgroup）〕.The changes in ventricular rate in all the participants during the 6MWT under these two conditions were analyzed.And based on this，the impact of Metoprolol versus Bisoprolol on ventricular rate was compared.Results　During the 6MWT，the ventricular rate of all participants first increased but later decreased under the conditions of taking drugs or not.In general，the controls reached their maximal ventricular rate when the 6MWT was conducted for 5 minutes，while the AF patients reached their maximal ventricular rate when the 6MWT was conducted for 3 minutes，under the conditions of without taking drugs.The controls taking Metoprolol and those taking Bisoprolol attained their maximal ventricular rate when the 6MWT was conducted for 5，6 minutes，respectively.For AF patients using Metoprolol and those using Bisoprolol，the mean maximal ventricular rate was attained when the 6MWT was conducted for 3，5 minutes，respectively.5 minutes after the end of the 6MWT，the mean ventricular rates of controls taking Metoprolol and those taking Bisoprolol basically recovered to the baseline level without significant difference（P>0.05）.However，the mean ventricular rates of the AF patients using Metoprolol and those using Bisoprolol did not recover to the baseline level and showed significant difference（P<0.05）.Conclusion　Compared with Metoprolol，Bisoprolol produced a stronger impact on decreasing the maximal ventricular rate during the 6MWT，and it delayed the reappearance of the maximal ventricular rate，indicating that it may have greater potential for ventricular rate control.

Somatostatin plus Ulinastatin and/or Gabexate for Severe Acute Pancreatitis　

WANG Guiliang，QIU Ping，XU Linfang，GONG Min，WEN Ping，WEN Jianbo

2018, 21(34): 4241-4245. DOI: 10.12114/j.issn.1007-9572.2018.34.016

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Objective　To evaluate the effectiveness of Somatostatin（SM） plus Ulinastatin（US） or/and Gabexate（GB） for the treatment of severe acute pancreatitis（SAP）.Methods　A total of 266 consecutive patients with SAP who received treatment during July 2008 to January 2018 were enrolled.Based on table of random number，they were divided into 4 groups，receiving SM，SM plus GB，SM plus US，SM plus US and GB，respectively.Clinical parameters including abdominal pain and distention relief time，normal autonomous respiration recovery time，normal heart rate recovery time，normal serum amylase recovery time，blood glucose recovery time，white blood count（WBC），C reaction protein（CRP），blood urea nitrogen（BUN），serum creatinine（Scr），hospitalization costs，length of stay（LOS） and cure rate，incidences of adverse reaction and mortality were analyzed.Results　Both SM plus GB，and SM plus US groups needed less time for abdominal pain and distention relief，recovery of normal autonomous respiration，normal heart rate，normal serum amylase and normal blood glucose，and showed decreased WBC and CRP compared with SM group（P<0.05），as did SM plus US and GB group when compared with SM plus GB group or SM plus US group（P<0.05）.SM plus GB，and SM plus US and GB groups also showed decreased BUN in comparison to SM group，as did SM plus US and GB group when compared with SM plus US group（P<0.05）. Compared with SM group，both SM plus US group and SM plus US and GB group had higher hospitalization costs（P<0.05）. SM plus US and GB group had higher hospitalization costs than SM plus US group（P<0.05）. Furthermore，SM plus GB group and SM plus US group had shorter LOS compared with SM　group（P<0.05）. In comparison with SM plus GB group or SM plus US group，the LOS was shorter in the SM plus US and GB group（P<0.05）.　Significant differences in the cure rate，incidence of adverse reactions and mortality were detected by the overall comparison among the four groups（P<0.05）. However，pairwise comparisons did not find obvious differences in the cure rate，incidence of adverse reactions and mortality（P>0.008 3）. Conclusion　SM is effective for SAP.Moreover，the effectiveness will be better if it is used in combination with US or GB，and far better if used in combination with both the two.

Continuing Education in Common Diseases in Primary Care for General Practitioners：a Learning Needs Analysis　

LI Ying，YANG Huiming，YIN Delu

2018, 21(34): 4246-4249. DOI: 10.12114/j.issn.1007-9572.2018.34.017

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Objective　To assess the status of general practitioners' learning needs for continuing education in common health problems seen in primary care，providing a reference for the development of policies related to continuing medical education（CME） in this population.Methods　In June 2017，from the 54 primary healthcare facilities in 13 regions of China（including 11 provinces，1 autonomous region and 1 municipality） sampled in the previous studies of our research group，670 licensed clinicians and clinician assistants were enrolled.They were surveyed with a questionnaire composed of personal characteristics，needed CME content（common diseases in primary care and preferred aspects for improvement）.The differences in the needed CME contents among the GPs were analyzed by single disease.And the differences in the needed CME contents of a single disease among the GPs were further explored by personal characteristics.Results　Of the top 10 common diseases in primary care，GPs reported that they mainly needed to learn knowledges about "drug therapy" and "risk identification" concerning hypertension and diabetes，"risk identification" "diagnosis and differential diagnosis" "drug therapy" and "emergency management" concerning coronary heart disease and stroke and other cerebrovascular disease，"drug therapy" for chronic obstructive pulmonary disease，"diagnosis and differential diagnosis" and "drug therapy" for gastritis，bronchitis，urinary tract infection，upper respiratory tract infection，and other inflammatory diseases，and "non-drug therapy" "diagnosis and differential diagnosis" and "Chinese medicine techniques" for lumbar disc herniation.The needed CME contents of single diseases，such as hypertension（top 1 common chronic disease in primary care） and upper respiratory tract infection（top 1 common acute disease in primary care），differed significantly among the GPs by region，type of medical institution，educational level and professional and technical title.Conclusion　For different common diseases，the needed CME contents among the GPs were significantly different.Moreover，for one specific disease，the needed CME contents changed according to personal characteristics.In view of this，the contents of CME for GPs are suggested to be targeted for achieving better outcome.

Exploration and Practice of Community Health Assistance and Teaching between Desheng Community Health Service Center in Beijing and Wulanchabu Community Health Service Center in Inner Mongolia Autonomous Region　

LIU Juhong，HAN Chengcheng，WEN Xiuqin，HE Zhihong，ZHANG Lei

2018, 21(34): 4250-4253. DOI: 10.12114/j.issn.1007-9572.2018.34.018

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As medical assistance between Beijing and Mongolia has been further developed during the 12th Five-year Plan，the relationship between community health service centers in Beijing and Inner Mongolia has been established.Since June 2015，Desheng Community Health Service Center in Xicheng District of Beijing has started to provide medical assistance to seven community health service centers in Ulanchabu，Inner Mongolia Autonomous Region for six months.Departments in Beijing were twined with the departments in Inner Mongolia，to carry out appropriate teaching and operation training on basic clinical skills，electrocardiogram，type-B ultrasonic，X-ray，drug management，prescription review，and network construction through remote video，telephone，Wechat，e-mail，QQ group and other means.Six months after assisting and teaching，outpatient visits，medical income，the number of medical examinations and doctor's income in Wulanchabu Community Health Service Center have been significantly increased compared with those before assisting.The medical staff's diagnostic and therapeutic skills have also been improved.Medical assistance has been recognized by government departments，medical institutions and residents，so it can be applied and popularized.This paper introduces the specific methods of community health assistance and teaching between Desheng Community Health Service Center in Beijing and Wulanchabu Community Health Service Center in Inner Mongolia Autonomous Region，hoping to provide reference for other areas to carry out assistance and teaching projects.

Development of an Integrative Long-term Care Services Classification Model for the Elderly　

SHI Ya，WANG Xiuhua，LIU Yongbing

2018, 21(34): 4254-4261. DOI: 10.12114/j.issn.1007-9572.2018.34.019

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Objective　To develop an integrative long-term care services grading model for the elderly receiving home-based care，community-based care，or nursing facility-based care. Methods　Item pool was established on the basis of literature review，theoretical analysis and qualitative interview. Delphi method was used to screen the items to form the Integrative Long-term Care Services Grading Questionnaire for the Elderly（ILCSGQE）.Then the questionnaire was used to a survey，and according to the results，its items were revised，then the item system was determined finally，and the reliability and validity of the model〔Integrative Long-term Care Services Grading Model for the Elderly（ILCSGME）〕 with the item system derived from the questionnaire was tested. Comprehensive scoring method，trisection method，and cluster analysis were used to calculate the total score，item grading of the ILCSGME，and dependency state grading covered by the ILCSGME，respectively. Results　The final item system of the ILCSGME consists of 7 first-tier items and 119 second-tier items. The Cronbach's α for the 7 first-tier items ranged from 0.782 to 0.986，and the re-measured Pearson correlation coefficients were 0.917-0.980（P<0.05）. 4 first-tier items，activities of daily living，cognitive ability，fall risk and pressure ulcer risk were selected from the most widely used and mature scales. But other 3 first-tier items，medical and nursing services，abnormal manifestations/symptoms and needs of self-care knowledge were developed by our research team. The results of Bartlett's sphericity test ranged from 0.745 to 0.883. The common factors extracted by principal component analysis were 4，3 and 1 in turn，explaining 68.044%，59.492% and 65.395% of the total variance，respectively. After confirmatory factor analysis，the revised common factors were 4，4 and 3，respectively. The weights of the 7 first-tier items were 0.24，0.15，0.15，0.12，0.12，0.11 and 0.11，respectively. The total score calculated by the comprehensive scoring method were divided into 5 grades：independent，low dependency，medium dependency，high dependency and very high dependency. The higher the grade，the lower the total score was，indicating the intensity or difficulty of care for the elderly is greater.Conclusion　The 7 first-tier items in the ILCSGME were proved to have good reliability and validity. The comprehensive scoring method was easy to use when calculating the total score of the model，and the division of assessment for all grades of dependency state was good. So the model can comprehensively，concretely and accurately assess the dependence state of elderly people，and can provide an aid for the study of the classified pricing system of long-term care insurance.

Reliability and Validity of the Chinese Version of SF-12v2 among the Elderly with Community Home-based Care　

SU Shuwen，WANG Dong

2018, 21(34): 4262-4265. DOI: 10.12114/j.issn.1007-9572.2018.34.020

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Objective　To evaluate the reliability and validity of the second Chinese version of Short-Form 12 Item Health Survey（SF-12v2） in elderly people with community home-based care. Methods　By use of two-stage sampling，a total of 451 older adults with community home-based care were recruited from Guangzhou from July to November 2017. They were surveyed with the Chinese version of SF-12v2. The criterion validity the Chinese version of SF-12v2 was determined by comparison with the ordinal response data of the Chinese version of the Euroqol Group's 5-Domain 5-Level Questionnaire（EQ-5D-5L）. Cronbach's α and Spearman-Brown prophecy formula were used to measure the reliability of the Chinese version of SF-12v2. The validity analysis of the Chinese version of SF-12v2 consisted of content validity（convergent validity and divergent validity），construct validity and criterion validity. Results　The Cronbach's α and split-half reliability with Spearman-Brown adjustment of the Chinese version of SF-12v2 were 0.876，0.873，respectively. The convergent validity and divergent validity for the 8 domains of the Chinese version of SF-12v2 were all 100.0%. Two factors were extracted，explaining 65.94% of the total variance. The scores of physical functioning domain of the Chinese version of SF-12v2 showed a medium correlation with the scores of 4 domains of the Chinese version of EQ-5D-5L，mobility，self-care，usual activities，and pain/discomfort（r=0.591，0.436，0.606，0.590； P<0.01） . The scores of mental health domain of the Chinese version of SF-12v2 had a medium correlation with the scores of the domain of anxiety/depression of the Chinese version of EQ-5D-5L（r=0.517，P<0.01） . Conclusion　The Chinese version of SF-12v2 has good reliability and validity in objectively assessing the health status of older adults with community home-based care.

Survey on KAP of Patients with Hypertension in Urban and Rural Areas in Chronic Disease Management System of Chongqing　

XIAO Meng，SUN Zhenxing，XIANG Hui，TANG Xiaojun，QIU Jingfu

2018, 21(34): 4266-4271. DOI: 10.12114/j.issn.1007-9572.2018.34.021

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Objective　To know and analyze the status of knowledge，attitude，and practice（KAP） of patients with hypertension in urban and rural areas in chronic disease management system of Chongqing，so as to provide some suggestions for prevention and treatment of hypertension in the future.Methods　Multistage stratified random sampling was employed to select a total of 900 patients with hypertension in three districts and counties in Chongqing from July to December 2017，and a self-made questionnaire including general characteristics and survey of KAP was used.Comparison of knowledge，attitude and practice between patients with hypertension in urban and rural areas in chronic disease management system was analyzed by chi-square test and Wilcoxon rank sum test.Results　A total of 831 effective questionnaires were collected，including 421 rural patients and 410 urban patients.The passing rate of knowledge，attitude and practice survey of hypertensive patients in urban areas were significantly higher than those in rural areas（P<0.05）.The overall and individual score of KAP survey of hypertension patients in urban areas were significantly higher than those in rural areas（P<0.05）.Conclusion　The status of KAP of patients with hypertension in urban areas in the chronic disease management system is better than those in rural areas in Chongqing，yet the overall level of KAP in both areas should be improved.We should give full play to medical staff to carry out the prevention and treatment of hypertension by adopting different health education methods for hypertensive patients in urban and rural areas.

Factor Analysis of Prevalence of Hypertension and Health-related Behaviors among Floating Population in a City from the Perspective of "Healthy Shandong"　

YIN Yanling，WANG Shasha，WANG Xiang，BI Yuqing，ZHANG Jiping，LIU Yijun，YU Huihui，LI Aijiao，CHANG Jia，LUO Sheng，LI Wei

2018, 21(34): 4272-4277. DOI: 10.12114/j.issn.1007-9572.2018.00.224

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Objective　To understand the prevalence of hypertension and health-related behaviors among floating population in a city in Shandong Province with factor analysis of health-related behaviors in order to provide a scientific basis for the effective prevention and control of hypertension and its policies of floating population.Methods　Using the multi-stage sampling method in 2015，three counties/districts were selected randomly in a city of Shandong Province according to their economic level（good，medium，poor），and each county/district randomly selected six communities/villages.Around 100 floating people aged 18 or older were randomly selected in each community/village.A total of 1 705 questionnaires were distributed，and the recovery rate was 100.00%.Questionnaire surveys and physical examinations were conducted among selected subjects to collect their basic information，health-related behaviors，and information on the prevalence of hypertension.Descriptive analysis and factor analysis were performed by SPSS 17.0 software.Results　The prevalence of hypertension among floating population in a city of Shandong Province was 8.97%（153/1 705）.c2 value of Bartlett's test was 3 223.347 with the probability value <0.01，and KMO value was 0.590，which was suitable for factor analysis.A total of 10 common factors were extracted（the cumulative contribution rate was 59.524%）.F1 was named as medical satisfaction（the variance contribution rate was 7.967%）；F2 was named as the choice of medical institutions（the variance contribution rate was 7.933%）；F3 was named as dietary rules（the variance contribution rate was 6.652%）；F4 was named as psychological factors（the variance contribution rate was 6.470%）；F5 was named as passive smoking（the variance contribution rate was 5.647%）；F6 was named as sleep status（the variance contribution rate was 5.628%）；F7 was named as eating habits（the variance contribution rate was 5.349%）；F8 was named as diet mix（the variance contribution rate was 4.814%）；F9 was named as medical security（the variance contribution rate was 4.567%）；F10 was named as active smoking（the variance contribution rate was 4.496%）.Among them，the top four influencing factors of health-related behaviors were medical satisfaction，the choice of medical institutions，dietary rules，and psychological factors.Conclusion　The prevalence of hypertension in the floating population is 8.97%.Influencing factors of health-related behaviors related to hypertension include medical satisfaction，the choice of medical institutions，dietary rules，psychological factors，and so on.Therefore，in order to reduce the prevalence of hypertension among floating population，medical institutions need to improve their medical technology and service quality，and floating people need to balance their diet and pay attention to their psychological issues to change their health-related behaviors.

Recent Advances in the Economic Evidence Abroad of Early Detection and Treatment of Type 2 Diabetes：a Review from the Health Management Perspective　

RAN Xuerong，WU Hongyan，WANG Long，YANG Xing，LONG Chen，CHEN Xiong，ZHANG Man，LU Xiaolong

2018, 21(34): 4278-4282. DOI: 10.12114/j.issn.1007-9572.2018.00.245

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Diabetes has become one of the four major non-communicable diseases in various countries.Type 2 diabetes mellitus（T2DM） is the most common form of diabetes，which is found in more than 90% of diabetic patients.Comprehensive treatment and management can effectively reduce the risk of T2DM and delay its development，so such interventions should be taken as soon as possible.We defined early comprehensive interventions for T2DM patients and high-risk populations，analyzed the studies published overseas concerning economic analysis of early screening，early glycemic control，early diagnosis and treatment for complications，and early comprehensive interventions for T2DM，with a view to providing a reference for the economic studies about early diagnosis and treatment of Chinese T2DM patients as well as for the promotion of comprehensive health management of such patients.

Recent Developments in Sedentary Behavior Interventions for Populations with or at High Risk for Type 2 Diabetes

WANG Ya，SUN Juan，DENG Nan，ZHANG Xiaoyi，HE Hong

2018, 21(34): 4283-4288. DOI: 10.12114/j.issn.1007-9572.2018.34.0024

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Sedentary behavior is significantly associated with the incidence of metabolic diseases including type 2 diabetes mellitus（T2DM）.In foreign countries，the measurement of sedentary behavior，the relationship between sedentary behavior and disease，and intervention strategies have attracted much attention.At home，the study of sedentary behavior is still in its infancy.We reviewed the studies about sedentary behavior interventions in populations with or at high risk for T2DM，at home and abroad，with a view to providing a new idea for reducing the sedentary behaviors in such populations.

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