Chinese General Practice

Progress in Clinical Application of Comprehensive Geriatric Assessment　

WANG Lina，JIANG Chunyan

2019, 22(9): 999-1003. DOI: 10.12114/j.issn.1007-9572.2018.00.271

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Due to the distinct pathophysiological features of the elderly，geriatric care has always been a particular concern of healthcare and other fields.Most elderly patients need physical，psychological，social and other types of care，so comprehensive understanding of their health status is a key basis for satisfying their healthcare needs via delivering the appropriate management.Comprehensive Geriatric Assessment （CGA） is widely used in recent years to assess the health conditions of the elderly from multiple perspectives，including medical，physical，cognitive，psychological，social，environmental and other components，so as to perform the diagnosis and deliver appropriate treatment.The method includes both overall assessment and targeted interventions，and advocates multidisciplinary management，fully embodying the modern health concept of holistic health.Early performing CGA and giving interventions，can delay the decline of the body function of the elderly to various degrees，shorten the hospitalization time，reduce the admission rate and mortality，and also can provide important reference for both health management and medical care.We reviewed the application of CGA in clinical practice，including the evaluation contents，application methods，application scope and limitations of CGA in different situations，providing clinical assistance for healthcare professionals.

Inspiration from Senile Dementia Caring in Austria　

LUO Caifeng，XU Jianou，LYU Fei

2019, 22(9): 1004-1008. DOI: 10.12114/j.issn.1007-9572.2018.00.333

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With the increasing number of elderly with dementia year by year，their care has become a focus in society.The elderly with dementia has higher caring need because of cognitive impairment and behavioral mental abnormalities.Based on the characteristics of dementia and the needs for humanistic care for the demented elderly，we took the care for the demented elderly in the Albert Schweitzer Geriatric Health and Care Competence Center in Austria as an example，and introduced the content and methods of care for the elderly with dementia，caring environment for the demented elderly and comprehensive care for the elderly with dementia from multidisciplinary teams in Austria.It is concluded that caring for the elderly with dementia enhances the effectiveness of caring and improves the quality of life of demented elderly.In light of national situation in China，we suggested providing proactive，personalized and professional care，creating sound environment for elderly with dementia，and improving professional ability and care quality of caregivers，so as to shed light on the delivery of humanistic and comprehensive care to the elderly with dementia in China.

Value of FIB-4 Index and Liver Stiffness Measurement in the Assessment of Significant Hepatic Fibrosis in Nonalcoholic Fatty Liver Disease with Type 2 Diabetes Mellitus　

GUO Chunmei，WU Jing，YIN Jinshu，GE Hui

2019, 22(9): 1009-1013. DOI: 10.12114/j.issn.1007-9572.2018.00.374

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Background　Patients with non-alcoholic fatty liver disease（NAFLD）and type 2 diabetes mellitus（T2DM）are prone to liver fibrosis.Objective　To explore the value of FIB-4 index and liver stiffness measurement（LSM）in the assessment of significant liver fibrosis in NAFLD with T2DM.Methods　A total of 265 patients who were diagnosed with NAFLD and T2DM in Department of Gastroenterology，Beijing Shijitan Hospital，Capital Medical University from December 2016 to December 2017 were enrolled.Data about gender，age，height，body weight，platelet count，glutamate aminotransferase（AST），aspartate aminotransferase（ALT），fasting glucose，albumin，LSM were collected，and BMI，FIB-4 index and NAFLD fibrosis score（NFS）were calculated.This study used NFS>0.676 as the golden standard for diagnosing significant hepatic fibrosis.The incidence of significant liver fibrosis was analyzed comparatively by FIB-4 index and LSM value.The ROC curves of FIB-4 index and LSM value were drawn and used to predict significant hepatic fibrosis in NAFLD with T2DM，and area under the ROC curve（AUC），sensitivity，specificity，positive predictive value，positive likelihood ratio and Youden index were calculated.Results　The incidence of significant hepatic fibrosis was significantly higher in patients with FIB-4 index>3.25 or LSM≥9.9 kPa（P<0.05）．According to previous studies，our study used FIB-4 index>3.25 and LSM≥9.9 kPa as critical values to predict significant hepatic fibrosis.ROC analysis of FIB-4 index for the prediction of the incidence of significant liver fibrosis in NAFLD with T2DM revealed that the AUC was 0.866〔95%CI（0.804，0.928）〕，the sensitivity was 44.4%，the specificity was 97.5%，the positive predictive value was 66.7%，the positive likelihood ratio was 17.8%，and the Youden index was 0.419.And ROC analysis of LSM value for the prediction of the incidence of significant hepatic fibrosis in NAFLD with T2DM showed that the AUC was 0.901〔95%CI（0.850，0.952）〕，and the sensitivity，specificity，positive predictive value，positive likelihood ratio，Youden index were 74.1%，90.7%，45.5%，8.00%，and 0.648，respectively.Conclusion　Both FIB-4 index and LSM can be used to predict significant hepatic fibrosis in NAFLD with T2DM.As LSM is simple and easy to use，it should be the first choice.But for hospitals without LSM，FIB-4 index can be used.

Prevalence and Risk Factors of Diabetes Mellitus and Impaired Fasting Glucose among Residents Aged 40-79 Years in Beijing　

FANG Kai，MA Aijuan，LI Hang，DONG Jing，XIE Jin，XIE Chen，QI Kun，ZHOU Ying，ZHAO Yue，DONG Zhong

2019, 22(9): 1014-1020. DOI: 10.12114/j.issn.1007-9572.2018.00.319

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Background　Epidemiological studies show that the prevalence of type 2 diabetes in adults in China is rising，coupled with the large population base and the increasing aging trend, it is expected that diabetes will cause a heavy disease burden in the future.Age≥ 40 years is one of the high risk factors for adult diabetes.It is necessary to pay attention to the prevalence of diabetes mellitus and impaired fasting blood glucose among high-risk groups and their influencing factors.Thus targeted prevention and control of diabetes mellitus can be carried out.Objective　To investigate the prevalence and risk factors of diabetes mellitus and impaired fasting glucose （IFG） among residents aged 40-79 years in Beijing.Methods　A total of 19 815 residents aged 40 to 79 years with an accumulated period of residence of more than 6 months in Beijing as of the survey time in 2014 were selected from 180 communities of 36 towns or streets in 16 districts of Beijing by multi-stage stratified random cluster sampling.They participated in a centralized survey or household survey conducted by our research team，during which，all of them completed a self-administered questionnaire（consisting of basic demographic characteristics，behavioral factors，history of personal diseases），performed physical examination（including height，weight and blood pressure） and laboratory examination﹝including fasting plasma glucose（FPG），total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C） and high-density lipoprotein cholesterol （HDL-C） in peripheral blood﹞．Risk factors of diabetes and IFG were analyzed using multivariate Logistic regression analysis.Results　A total of 11 889 residents aged 40-79 were included in the final analysis.Diabetes prevalence was 12.11%.The prevalence of diabetes increased with age （χ2trend=317.38，P<0.01），and gender-specific prevalence increased with age （male： χ2trend=78.05，P<0.01；female： χ2trend=292.86，P<0.01）．The age-standardized prevalence of diabetes was 13.56%.Males had a higher age-standardized prevalence of diabetes than females（P<0.01）．The age-standardized prevalence of diabetes in urban residents was higher than that in suburban residents（P<0.01）．Multivariate Logistic regression analysis showed that age，sex，location，drinking，BMI，hypertension and dyslipidemia were the influencing factors of diabetes mellitus（P<0.05）．The prevalence of IFG was 5.22%.The prevalence of IFG increased with age （χ2trend=75.84，P<0.01），and gender-specific IFG prevalence increased with age（male：χ2trend=16.53，P<0.01；female：χ2trend=70.18，P<0.01）．The age-standardized prevalence of IFG was 5.82%.Males showed higher age-standardized prevalence of IFG than females（P<0.01）．There was no significant difference in age-standardized prevalence of IFG between urban and suburban residents（χ2=2.17，P=0.14）．Multivariate Logistic regression analysis demonstrated that age，sex，education level，drinking，BMI，hypertension and dyslipidemia were the influencing factors of IFG（P<0.05）．Conclusion　The prevalence of diabetes among Beijing residents aged 40-79 years increases with age.Males and living in urban areas are associated with higher prevalence.The prevalence of IFG also increases with age，but shows insignificant difference between urban and suburban residents.Elder age，male，overweight and obesity，hypertension and dyslipidemia are independent risk factors of diabetes and IFG.

Predictive Value of Random Forest Algorithms for Diabetic Risk in People Underwent Physical Examination　

ZHANG Zhanlin，SUN Yong，TUO Xiaoqing，YELEDAN·Mahan，GONG Zheng，TIAN Tian，CHEN Zhen，GULISIYA·Hailili，DAI Jianghong，YAO Hua

2019, 22(9): 1021-1026. DOI: 10.12114/j.issn.1007-9572.2018.00.429

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Background　China has 114 million people with diabetes，becoming the country with the largest number of diabetic patients all over the world in 2017.Early identification and effective intervention on high-risk population of diabetes can reduce the risk of diabetes mellitus.Objective　To explore the application of random forest algorithm in predicting diabetes mellitus risk in people underwent physical examination.Methods　We used the national health examination data of people at the age of 35 to 74 years who had physical examination at community health service centers in Shiyouxincun and Kaziwan，Urumqi from September 2016 to March 2017.Considering of integrity of the data，the data of 6 727 people underwent physical examination were collected （data from questionnaires，physical measurements and laboratory tests）．The contents of the questionnaire included general demographic data，physical measurements involved height，body mass，and waist circumference and laboratory tests were blood，blood glucose，and serum chemistry indicators.Dataset was divided into a training set and a test set by a ratio of 3∶1.Multivariate Logistic regression analysis and random forest algorithm was used to establish diabetes risk prediction models in the training set and model validation was done with the test set.The prediction efficiency of the model was evaluated by the predicting consistency rate and area under the receiver operating characteristic （ROC） curve.Results　There were 717 cases with diabetes or newly diagnosed with diabetes in 6 727 participants and the prevalence of diabetes mellitus was 10.7%.Among the diabetic patients，the proportion of cases at 65 years and above was 37.1%（266/717）；women were 51.0%（366/717）；Han Chinese was 94.0%（674/717）；people with education level of junior high school was 35.3%（253/717）；overweight was 48.0%（344/717）；non-smokers was 72.8%（522/717）；nondrinkers was 77.0%（552/717）．Multivariate Logistic regression analysis was used to predict the test set of the diabetes risk prediction model established in the training set.The sensitivity was 0.202，the specificity was 0.950，and the prediction consistency rate was 0.696；the Yoden index was 0.151，and the area under the ROC curve （AUC） was 0.685.Random forest algorithm was applied to predict the test set of the diabetes risk prediction model established in the training set.The sensitivity was 0.608，the specificity was 0.953，the prediction rate was 0.864，the Yoden index was 0.561，and the AUC was 0.702.Conclusion　Random forest algorithm has a higher predictive effect on the risk of diabetes for people had physical examination，but multivariate Logistic regression analysis has an intuitive explanation for the influencing factors of diabetes mellitus.We recommend to combine the advantages of the two models in practical applications to maximize their value in disease risk prediction.

Predictive Value of Risk Assessment System of Deceleration Capacity of Heart Rate for Prognosis of Patients with Heart Failure　

WANG Huanxia，SUN Ruping，QIN Qiaoyun，WANG Bole，LIAN Xianglin

2019, 22(9): 1027-1032. DOI: 10.12114/j.issn.1007-9572.2018.00.375

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Background　The number of patients with heart failure has increased because of an ever growing aging population in China，with a severe long-term prognosis.Strengthening the prognosis monitoring of patients with heart failure is of great significance in delaying disease progression and reducing mortality.Objective　To investigate the predictive value of deceleration capacity（DC） of heart rate in the prognosis of patients with heart failure，and to analyze the influencing factors of moderate-high risk patients in DC risk assessment system.Methods　A total of 122 patients with heart failure diagnosed in the Department of Cardiac Function of Henan Provincial People's Hospital were recruited as subjects from January 2015 to April 2016.Patients received 24-h long-term Holter ECG recording，echocardiography，and New York Heart Association（NYHN） grading assessment 1 week before discharge，and blood samples were taken to determine amino-terminal pro-brain natriuretic peptide（NT-proBNP），red blood cell count（RBC） and hemoglobin（Hb）．Subjects underwent a one-year follow-up and were divided into poor prognosis group and good prognosis group according to the outcome of the patient's prognosis.The ROC curves of DC risk assessment system and NYHN grades were analyzed to predict prognostic adverse events（heart failure and cardiogenic death）．The DC risk assessment system was established and the patients were divided into low risk group（n=53），moderate risk group（n=39） and high risk group（n=30） according to it.Meanwhile，patients were divided into low risk group（n=38），moderate risk group（n=44） and high risk group（n=40） according to NYHN classification.Cox proportional hazards regression model was used to analyze the influencing factors of moderate-high risk patients in DC.Results　Among 122 patients with heart failure，62 patients were in the good prognosis group and 60 patients were in the poor prognosis group.The poor prognosis rate of heart failure was 49.2%.The area under the curve（AUC） of adverse cardiac events and cardiac death predicted by the DC value and NYHN grading was 0.806 vs 0.690，0.936 vs 0.611．As DC value could predict the critical point of heart failure and cardiogenic death in patients with heart failure，a DC risk assessment system was built.According to DC risk assessment system and NYHN grading assessment，the incidence of adverse events of heart failure in moderate risk group and high risk group was higher than that in low risk group（P<0.05）．The incidence of cardiogenic death in DC risk assessment system low and moderate risk groups was lower than that in DC risk assessment system high risk group（P<0.05）．According to NYHN grading，there was no significant difference in the incidence of cardiogenic death among patients with different risk levels （P>0.05）．Diabetes mellitus，NYHN grades，left ventricular ejection fraction（LVEF）<45%，and anemia were factors influencing prognosis of moderate-high risk of DC risk assessment system in patients with heart failure（P<0.05）．Conclusion　DC value is better than NYHN grading assessment in predicting adverse events of heart failure and cardiac death in patients with heart failure.Diabetes，NYHN grade，LVEF<45%，and anemia are influencing factors of moderate-high risk prognosis of DC in patients with heart failure.

Relationship between Socioeconomic Status and Non-alcoholic Fatty Liver Disease in Huaian's Retirees　

CHEN Yan，WANG Xiaoqing，HAO Hairong，CHENG Liang，SHAO Xiaojuan，ZHANG Yong，XIA Mingfeng，YU Weinan，HU Wen

2019, 22(9): 1033-1038. DOI: 10.12114/j.issn.1007-9572.2018.00.409

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Background　Studies have shown that the incidence of nonalcoholic fatty liver disease（NAFLD）is increasing，and it has a risk of worsening to hepatocellular carcinoma.However，available studies about the pathogenesis and progression of NAFLD are mainly from the biological perspective，few from the sociological perspective.Objective　To study the relationship between socioeconomic status（SES） and NAFLD among retirees in Huaian，Jiangsu Province，in order to find a reference for the intervention of NAFLD from the sociological perspective.Methods　From the 1 277 retirees participating in the physical examination of Diabetes Prevention Program（ChiCTR-TRC-14005029）held by the Affiliated Huaian Hospital of Xuzhou Medical University，930 were selected according to the inclusion and exclusion criteria of this study.Data concerning liver fat content（LFC）were collected，and by the tertiles of the LFC，participants were stratified into control group（LFC<9.15%，n=197），low LFC group（9.15%≤LFC≤20.00%，n=532）and high LFC group（LFC>20.00%，n=201）．General personal data and biochemical parameters were also obtained.Results　In the retirees，the prevalence of NAFLD in women was higher than that in men（P<0.05）．The prevalence of NAFLD in different age groups significantly varied（P<0.05）．Compared with the control group，low LFC group demonstrated a younger age，and lower serum creatinine（Scr），but higher rate of regular exercise，higher body mass index（BMI），and triglyceride（TG）（P<0.05），high LFC group showed a younger age，and lower Scr，but higher incidence of sleep disorder，higher BMI，fasting plasma glucose（FPG），alanine aminotransferase（ALT），aspartate aminotransferase（AST），TG，high-density lipoprotein cholesterol（HDL-C），and serum uric acid（SUA），and estimated glomerular filtration rate（eGFR）（P<0.05）．Compared with the low LFC group，the proportion of men，BMI，ALT，AST，TG and SUA in HLFC group were higher，rate of regular exercise and HDL-C were lower（P<0.05）．The rate of regular exercise，incidence of sleep disorder，and prevalence of NAFLD differed significantly by monthly income（P<0.05）．Monthly income was positively associated with age，rate of sodium intake，rate of regular exercise，and levels of TC，TG，SUA and LFC（P<0.05），but negatively associated with ALT（P<0.05）．Multivariate Logistic regression analysis showed that monthly income was a factor associated with NAFLD（P<0.05）．Conclusion　SES is closely related with NAFLD in retirees in Huaian.High monthly income is an independent risk factor for NAFLD.Increased monthly income is associated with increased SES and increased risk of NAFLD.Enhancing monthly income without improving educational level and health consciousness may increase the incidence of NAFLD.

Study on the Level of Fetuin-A and the Relationship between Fetuin-A and Insulin Resistance in Patients with Chronic Hepatitis C　

WU Lingling，ZHENG Xiaoyong，HU Lijuan，JIANG Feng，ZHANG Fan，WANG Yumin

2019, 22(9): 1039-1042. DOI: 10.12114/j.issn.1007-9572.2018.00.336

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Background　Chronic infectious liver disease caused by HCV infection is associated with insulin resistance（IR），but the study of fetuin-A in IR from patients with chronic hepatitis C（CHC） has rarely been reported.Objective　To investigate the level of fetuin-A and the relationship between fetuin-A and IR in patients with CHC．Methods　Three hundred fifteen patients with CHC admitted to the First Affiliated Hospital of Wenzhou Medical University from June 2009 to February 2011 were retrospectivly selected as CHC group.According to BMI，patients in CHC group were divided into normal BMI subgroup（BMI：18-25 kg/m2，n=78） and elevated BMI subgroup（BMI>25 kg/m2，n=237）．A hundred healthy people who underwent physical examination in the hospital during the same period were selected as healthy control group.General information （including sex，age，weight，height，BMI），ALT，AST，gamma-glutamyl transpeptidase（GGTP），HCV-RNA，total bilirubin，hemoglobin，white blood cell count，platelet count，Alb，TP，total cholesterol，HDL-C，LDL-C，triglyceride，fasting blood glucose，fasting insulin，fasting C-peptide，insulin resistance index（HOMA-IR），HBCI，FBCI，IAI，fetuin-A，AST/ALT ratio（AAR），AST/platelet count ratio（APRI） of CHC group and healthy control group were collected.Results　ALT，AST，GGTP，fasting insulin，fasting C-peptide，HOMA-IR，fetuin-A，AAR，APRI in CHC group were higher than those in healthy control group，and HDL-C was higher than that in healthy control group（P<0.05）．Fasting insulin，HOMA-IR，HBCI，FBCI，and fetuin-A in normal BMI subgroup were higher than those of elevated BMI subgroup（P<0.05）．Fetuin-A of CHC patients was positively related to BMI（r=0.210，P=0.031） and HOMA-IR（r=0.389，P=0.023），while it was not linear related to other indicators，such as ALT，AST，GGTP，HDL-C，fasting blood glucose，fasting insulin，fasting C-peptide，HBCI，FBCI，AAR and APRI（r values were 0.102，0.184，0.276，0.162，0.151，0.123，0.179，0.015，0.049，0.017，-0.038，respectively；P values were 0.335，0.181，0.104，0.124，0.154，0.337，0.327，0.883，0.645，0.923，0.830，respectively）．Conclusion　There is IR and certain lipid metabolism disorder in CHC patients，and fetuin-A is closely related to IR.

TSH Reference Interval of Childbearing Age Women from Community in Urumqi　

ADILA·Alimu，GUO Yanying，WANG Xinling，LUO Yunzhi，ZHANG Jie，JIMILANMU·Maimaitiming，LI Suli

2019, 22(9): 1043-1046. DOI: 10.12114/j.issn.1007-9572.2018.00.251

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Background　Foreign studies report that pre-pregnancy serum thyroid stimulating hormone（TSH） is associated with an increased risk of adverse pregnancy outcomes，while TSH levels are affected by age，ethnicity，iodine nutrition，etc，so it is necessary to establish a reference range for women of childbearing age in different regions，provide basic data for the eugenics.Objective　To establish reference interval of TSH in women of childbearing age in a community of Urumqi.Methods　A total of 356 women between 18-45 years with complete information from 2 080 subjects in an epidemiological survey of thyroid diseases in a community of Urumqi in May 2013 were selected.Subjects were divided into Uygur and Han groups，which included 182 of Uygur，174 of Han.The basic data of body mass index（BMI），TSH，anti-thyroglobulin（TgAb），anti-thyroid peroxidase（TPOAb），urinary iodine，total cholesterol（TC），high density lipoprotein cholesterol（HDL-C），low density lipoprotein cholesterol（LDL-C），triglycerides（TG） were recorded.Results　The Uygur group had higher BMI and TgAb than Han group，and the levels of TC and HDL-C were lower than those of Han group（P<0.05）．The reference interval of TSH in Han and Uygur women of childbearing age were 0.86-6.47 μU/ml and 0.55-6.86 μU/ml.TSH level in Uygur group was lower than that in Han group（P<0.05）．Conclusion　The reference interval of TSH level in Han and Uygur groups are 0.86-6.47 μU/ml and 0.55-6.86 μU/ml，respectively.

Clinical Significance of Combined Detection of Serum miR-125b and Vitamin D in Female Children with Central Precocious Puberty　

TANG Jiayan，HUANG Juan，HUANG Lianhong，CHEN Yanling，ZHOU Tao，FU Simao

2019, 22(9): 1047-1051. DOI: 10.12114/j.issn.1007-9572.2018.00.342

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Background　Premature activation of hypothalamic-pituitary-gonadal axis is the main mechanism of central precocious puberty（CPP），but the mechanism of its activation is still unclear.mi-RNA may be involved in the development of precocious puberty.Objective　 To explore the relationships of serum microRNA-125b and vitamin D and hormone parameters，and analysis the clinical significance of combined detection of serum miR-125b and vitamin D.Methods　We enrolled 102 CPP female children（CPP group） and 102 age- and sex-matched physical examinees（control group） from Boai Hospital of Zhongshan Affiliated to Southern Medical University from July to September，from 2013 to 2016.The clinical parameters，such as age，height，weight，body mass index （BMI），breast development age，ovarian volume，bone age，bone age and age difference，WSDS，HSDS，and BMI SDS and distribution of Tanner stage were recorded.The expression level of miR-125b was detected by qRT-PCR.And the levels of 25-hydroxy-vitamin D（25-OH-D） and hormone parameters（free thyroxine，thyrotropin，estradiol，prolactin，luteinizing hormone and follicle-stimulating hormone）were detected using chemiluminiscence assay.Results　The expression level of serum miR-125b was higher in CPP group than that in the control group （P<0.05）．The serum miR-125b expression level was negatively correlated with 25-OH-D level in CPP group （r=-0.809 5，P<0.01）．CPP children with high miR-125b expression（high miR-125b expression subgroup，n=54） and those with low to medium miR-125b expression（low to medium miR-125b expression subgroup，n=48） showed significant differences in the mammogenesis age and distribution of Tanner stage（P<0.05），but not in the age，ovarian volume，bone age，bone age and age difference，WSDS，HSDS，and BMI SDS （P>0.05）．Moreover，high miR-125b expression subgroup had higher estradiol level than low to medium miR-125b expression subgroup（P<0.05）．After treated by gonadotropin-releasing hormone analogues（GnRHa），high miR-125b expression patients with normal vitamin D level had higher proportion of regression of breast development than those patients with decreased vitamin D level（P<0.05），but similar improvement in decreased growth velocity and early bone development（P>0.05）．Low to medium miR-125b expression patients with normal vitamin D level and those with decreased vitamin D level had no significant differences in the improvement in prepubertal mammogenesis，decreased growth velocity and early bone development（P>0.05）．Conclusion　The expression level of miR-125b was increased in CPP female children，which was negatively correlated with vitamin D level，and affected mammogenesis age.These may be related to the upregulation of estradiol.Combined detection of miR-125b and vitamin D could predicate the effect of GnRHa therapy on allometric growth of mammary parenchyma before puberty.

Performance of the FRAIL Scale in Screening Frailty among Elderly Patients with Coronary Heart Disease　

HOU Ping，XUE Huiping，LI Yongnan，MAO Xine，SUN Kaixuan，XUE Lingling，WU Linfeng，LIU Yongbing

2019, 22(9): 1052-1056. DOI: 10.12114/j.issn.1007-9572.2018.00.149

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Background　The number of elderly patients with coronary heart disease （CHD） is increasing year by year，and frailty is closely related to the prognosis of CHD．Early identification of frailty can prolong the survival time of patients and improve their quality of life．There are many methods to assess frailty，and frailty phenotype is commonly used at present．However，it requires evaluating physical fitness，which is time-consuming and inefficient．On the other hand，the FRAIL Scale is entirely based on patients' self-statement，which is simple and feasible．Objective　To explore the performance of the FRAIL Scale in screening frailty in elderly patients with CHD，with the determination of its optimal cut-off value.Methods　Participants were elderly patients with CHD who enrolled from Department of Cardiology，Affiliated Hospital of Yangzhou University from May to December in 2017.A self-developed Demographic Questionnaire was adopted to collect the demographic characteristics.Frailty was assessed by using both Fried frailty phenotype criteria and FRAIL Scale.ROC curve analysis was conducted to determine the optimal cut-off value of FRAIL Scale for screening frailty，and its clinical value was analyzed.308 of the 320 participants returned responsive questionnaires，obtaining a response rate of 96.2%.Results　For identifying frailty，the area under the ROC curve （AUC） of the FRAIL Scale for screening elderly patients with CHD was 0.858〔95%CI（0.811，0.906），P<0.01〕.When the optimal cut-off value was determined as 2 points，the Youden's index，sensitivity，specificity，positive predictive value and negative predictive value were 0.584，85.9%，72.5%，45.1% and 95.2%，respectively.Kappa statistic result （Kappa coefficient=0.438） showed a moderate level of agreement between the performance of FRAIL Scale and that of frailty phenotype （P<0.01）．Furthermore，a moderate correlation was found between the FRAIL score and the frailty phenotype score by Pearson analysis （r=0.668，P<0.01）．Conclusion　The FRAIL Scale was proved to be a good tool for the identification of frailty in elderly patients with CHD when using an optimal cut-off value of 2 points.Moreover，the assessment using it is simple and time-saving，so it is worthy of wide clinical application.

Reliability and Validity of the 12-item Short-Form Health Survey Questionnaire among the Elderly in Shanghai　

WANG Haitang，SHOU Juan，REN Limin，LIU Yao

2019, 22(9): 1057-1061. DOI: 10.12114/j.issn.1007-9572.2018.00.329

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Background　There are more than 200 different quality of life scales in China.Most of them are revised and improved on the basis of studies on foreign populations.However，due to the differences in language，culture and living habits，their reliability and validity may different from original edition when we directly applied them to the Chinese population.Objective　To assess the reliability and validity of SF-12 scale in measuring quality of life among the elderly in Shanghai.Methods　The data of 4 714 elderly people over the age of 60 years registered in the archives in Xujiahui Community Center in Xuhui District（1 493 samples），Huamu Community Center in Pudong District（1 489 samples）and Jiading Industrial District Community Center in Jiading District（1 732 samples）were randomly collected from August to October 2014.According to inclusion and exclusion criteria，a total of 4 395 elderly people were selected as respondents.The general data questionnaire and the SF-12 scale were used to investigate the collected data.Meanwhile the data of 300 elderly were randomly selected from the participants to complete the SF-36 scale through random number table method.The reliability of the SF-12 scale was assessed by internal consistency reliability and half-fold reliability.The validity of the SF-12 scale was assessed by structural validity，set validity，discriminate validity and criterion validity.Results　The correlation coefficient between each dimension in SF-12 scale was 0.485 to 0.637（P<0.05）.The Cronbach's α coefficient of the SF-12 scale was 0.828，and the Cronbach's α coefficient after deleting the corresponding dimension was also >0.700.The Spearman-Brown coefficient of the SF-12 scale was 0.797.KMO=0.847 for the SF-12 scale and χ2 of Bartlett's spherical test was 10 405.294，P<0.001 indicating that exploratory factor analysis can be performed.Two common factors（eigenvectors>1.000）were extracted through the maximum variance orthogonal rotation method and named as PCS and MCS.The contribution rates of the two factors were 32.3% and 24.8%，respectively，and the cumulative contribution rate was 57.1%.Except the RE dimension，the rest dimensions are consistent with the theoretical model results.Confirmatory factor analysis showed that NFI=0.967，CFI=0.944，GFI=0.957，and RMSEA=0.038.The correlation coefficient of SF-12 scale set validity was 0.703 to 1.000（P<0.05），and correlation coefficient of discriminate validity was 0.217 to 0.637（P<0.05）.The achievement ratio of aggregation tests and discrimination tests were both 100%.The correlation coefficient of PCS and MCS in the SF-36 scale and the SF-12 scale were 0.851 and 0.802，respectively（P<0.001）.Conclusion　The SF-12 scale has showed a good reliability and validity in measuring health status of the elderly in Shanghai.It is applicable for assessment of the health-related quality of life among elderly population in communities of Shanghai and can be promoted in the primary health care system in China.

Development of Suicide Risk Assessment Scale of Cancer Patients　

ZHOU Shuang，ZHANG Jing，YE Ying，ZHANG Qin，FU Jing

2019, 22(9): 1062-1067. DOI: 10.12114/j.issn.1007-9572.2018.00.229

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Background　For various reasons，cancer patients are at high risk of suicide.At present，the research mainly focuses on the causes and nursing of suicide in patients with malignant tumors.There are few studies on suicide theory and evaluation methods，and there is no unified standard for suicide risk assessment of patients.Objective　To develop Cancer Suicide Risk Scale（CSRS） and examine its reliability and validity.Methods　Items of CSRS was initially developed based on literature reviews，expert interview and semi-structured questionnaire survey from January to December 2017.The draft scale was formulated by expert consultation and pre-survey.A total of 355 cancer patients admitted to the Affiliated Hospital of Southwest Medical University and Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University were selected for investigation by convenience sampling to test the reliability and validity of the scale，and SPSS 22.0 was used to analyze the data.Results　The variation coefficient of items were greater than 15%，and the item score of the high score group was higher than that of the low score group，and the difference were statistically significant（P<0.001）.CSRS had 19 items，including 4 factors，negative emotion，suicide attitude，suicide preparation，and suicide motivation，and the cumulative variance contribution rate was 54.796%.The correlation coefficient between each dimension was 0.370-0.556，between scale and each dimension was 0.635-0.891（P<0.05）.The score of CSRS was positively correlated with the score of Self-rating Depression Scale（SDS）（r=0.708，P<0.001）.The content validity of CSRS was 0.919，Cronbach's α coefficient was 0.876，split-half reliability was 0.874.Conclusion　Cancer suicide risk scale includes four dimensions and 19 items，which basically consistents with the theoretical assumption and has good reliability and validity，so it can be used to evaluate suicide risk of cancer patients in Chinasuicide risk of cancer patients in China.

Efficacy and Mechanism of Different Facial Catgut Embedding Methods Combined with Comprehensive Acupuncture Therapy on Adult Female Acne　

TIAN Qianmo，LU Wen，ZHU Ligang，BAI Xinyu，KUANG Weiwei，REN Hong，WU Yuanyuan

2019, 22(9): 1068-1073. DOI: 10.12114/j.issn.1007-9572.2018.00.368

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Background　Acne is a chronic inflammatory disease of the hair follicle sebaceous glands that is common in adolescence.There are many female patients after puberty，and the rash lasts for a long time，which seriously affects the appearance and health of the patient.Conventional catgut embedding has a good effect on postpubertal acne in women，and smooth catgut embedding is a method of catgut embedding based on the theory of superficial fascia.At present，there is no comparison of the efficacy of two methods of catgut embedding.Objective　To explore the efficacy and mechanism of different facial catgut embedding methods combined with comprehensive acupuncture therapy on adult female acne.Methods　Sixty-one female patients with adult acne were enrolled from acupuncture clinics of the First People's Hospital of Lianyungang from July 2015 to July 2017.They were divided into smooth catgut embedding group（31 cases） and conventional catgut embedding group（30 cases）．Both groups had comprehensive acupuncture therapy.In smooth catgut embedding group，smooth catgut was embedded in face one week after two times of body acupoints embedment.In conventional catgut embedding group，catgut was embedded in face one and seven weeks after two times of body acupoints embedment.Both groups were intervened for 8 weeks as one course.After 12 weeks，the efficacy for acne skin lesions and accompanying symptoms，scores of acne skin lesions and accompanying symptoms and adverse effects were assessed in both groups.Results　The efficacy for acne skin lesions and accompanying symptoms in smooth catgut embedding group was significantly better than that of conventional catgut embedding group（P<0.05）．There were no significant differences in acne lesion score and accompanying symptom score between two groups before and after treatment（P>0.05）．The acne lesion score and accompanying symptom score after treatment were lower than those before treatment in the two groups（P<0.05）.There were no obvious adverse effects in both groups.Conclusion　Different facial catgut embedding methods combined with comprehensive acupuncture therapy has better clinical efficacy on acne lesions and accompanying symptoms in adult female acnes.The mechanism of facial catgut embedding is closely related to the theories of meridians，superficial fascia and defensive Qi.Smooth catgut embedding has less painful than routine catgut embedding and has better wrinkle improvement effect.Therefore，smooth catgut embedding is superior to routine catgut embedding，which is worthy of clinical popularization and application.

Clinical Effectiveness of Shuganziyin Granules Combined with Auricular-plaster Therapy for Simple Premature Thelarche in Girls with Ganyuyinxu Syndrome　

WANG Chunrong，WANG Haiping，ZHANG Lina，MAO Liming，TAO Hong

2019, 22(9): 1074-1077. DOI: 10.12114/j.issn.1007-9572.2018.00.289

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Background　At present，there are no targeted drugs for simple premature thelarche（SPT） in girls in Western medicine.Both at home and abroad，regular follow-up and dietary guidance are used as intervention means，lacking of targeted treatment measures.In traditional Chinese medicine，individualized treatment should be emphasized.Objective　To explore the effectiveness of Shuganziyin granules combined with auricular-plaster therapy for SPT in girls with Ganyuyinxu syndrome.Methods　Thirty-eight participants with SPT were recruited from Department of Pediatrics，Shanghai Jiading Hospital of Traditional Chinese Medicine from May 2016 to November 2017.They were randomized into the treatment group（21 cases） and control group（17 cases），receiving Shuganziyin granules combined with auricular-plaster therapy，Zhibaidihuang pills combined with Xiaoyao pills via the oral route，respectively.The scores of Tanner stage of breast development in girls and TCM-based Ganyuyinxu syndrome pattern differentiation scale scores before and after treatment，and clinical response were compared between the two groups.Results　Two groups showed similar scores of Tanner stage of breast development in girls and TCM-based Ganyuyinxu syndrome pattern differentiation scale before treatment（P>0.05）．After treatment，although the scores of Tanner stage of breast development in girls were still similar in both groups（P>0.05），TCM-based Ganyuyinxu syndrome pattern differentiation scale scores decreased significantly in the treatment group（P<0.05）．The treatment group demonstrated much better clinical response compared with the control group（P<0.05）．Conclusion　Auricular-plaster therapy is simple and convenient to use.Moreover，it has no side effects and the adherence to it is high in girls.Shuganziyin granules combined with auricular-plaster therapy is effective for SPT in girls with Ganyuyinxu syndrome by reducing the concomitant symptoms.

Effects of Active Components of Lichong Shengsuiyin on Regulating Genes of Ovarian Cancer Stem Cells and Cisplatin Resistance and Its Mechanism　

FU Yang，XIA Ji，HAN Fengjuan

2019, 22(9): 1078-1083. DOI: 10.12114/j.issn.1007-9572.2019.00.005

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Background　The first stage of this research is focused on the anti-tumor in human ovary based on the active component of Lichong Shengsuiyin.According to the result of the survey，the Chinese herbal compound is effective in inhibiting cell proliferation of ovarian cancer，contributing to the decrease of cancer cells，alleviating their adhesion and restraining angiogenesis.On this basis，the hypothesis of whether active components of Lichong Shengmuiyin can reverse the drug resistance of ovarian cancer stem cells is put forward.Objective　To investigate the effect of active components of Lichong Shengsuiyin on regulating genes of ovarian cancer stem cell and cisplatin resistance and analyze its mechanism.Methods　A tumor-bearing mouse model was gradually set up using 48 nude mice of BALB/C between October 2017 and April 2018 which were divided into four groups——12 in the blank group（given 0.9% of sodium chloride solution）；12 in the cisplatin group（given cisplatin）；12 in the herbal group（given mixed active component of Lichong Shengsuiyin）；and 12 in the herb-cisplatin group（given the active component of Lichong Shengsuiyin combined with cisplatin）．On day 8 after the establishment of the model，drug was used for 18 d.In the end，4 nude mice in the blank group died，3 in the cisplatin group died，1 in the herbal group died and 1 in the herb-cisplatin group died.At the same time，the growth curve of the tumor in all groups were drawn.Once the drug use was over，the mice were killed，and the pathological feature of the tumors was observed by HE staining.CD44+，CD117+，CD44，CD117 and CD133 of tumor cells was also observed by immunofluorescent staining.The expression levels of tumor Nanog，Oct4，and ABCC1 mRNA were tested by Polymerase Chain Reaction（PCR）．Nanog，Oct4 and ABCC1 expression levels in tumors were detected by immunohistochemistry.Results　In the first 7 days after the drug use，the growth speed of tumor of all group increased gradually.In the next three days，however，the growth speed of tumor in herbal group and herb-cisplatin group decreased noticeably，while continued fast growth occurred in the blank group and cisplatin group.And the 13th day witnessed the maximum increase of the growth volume of tumors in herbal group and herb-cisplatin group，which was later followed by a gradual decrease，while that in the blank group and cisplatin group continued to grow.In the cisplatin group，the number of tumor cells reduced obviously，the volume shrank，the mitotic figure was noticed，a large number of cells died and interstitial fiber proliferated.In the herbal group，the tumor cells reduced，patchy necrosis was common among tumor tissues，while fiber tissues and cells proliferated.In the herb-cisplatin group，the number of tumor cells decreased dramatically with large quantities of cells dying and obvious proliferation among fiber tissues.Besides，a few CD44+，CD117+，CD133，CD44 and CD117 cells were noticeable among tumors.The expression level of tumor Nanog and Oct4 mRNA was higher in the cisplatin group，herbal group and herb-cisplatin group than that in the blank group（P<0.05）；expression level of tumor Nanog mRNA was higher in the herbal group than that in the cisplatin group and herb-cisplatin group（P<0.05）；expression level of tumor ABCC1 mRNA in the herb-cisplatin group was lower than that in others（P<0.05）；expression level of tumor Nanog in the cisplatin group and herb-cisplatin group was lower than that in the blank group（P<0.05）；expression level of tumor Oct4 was higher in the herbal group than that in the blank group and cisplatin group（P<0.05）；expression level of tumor ABCC1 was higher in the blank group and the cisplatin group than that in the herbal group and herb-cisplatin group（P<0.05）.Conclusion　The active component of Lichong Shengsuiyin，once deduced in the expression level of ABCC1 and its mRNA，can slow down the flow of drug，hence raising its concentration in tumor cells.In addition，it can help to reverse the cisplatin drug resistance of ovarian cancer by affecting the traits of its stem cells and the sensitivity of cisplatin.

Family Medical Coping Mode for Children with Special Needs and Its Influencing Factors　

YU Jufen，WEI Xin，SU Cheng

2019, 22(9): 1084-1089. DOI: 10.12114/j.issn.1007-9572.2018.00.372

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Background　Children with cerebral palsy，autism and intellectual disability need constant rehabilitation training throughout their growth，in which family plays a vital role.Family medical coping mode can influence the rehabilitation process and efficacy for these children.Objective　To understand family medical coping mode for children with special needs and its influencing factors，so as to provide references in health education and rehabilitation guidance for people concerned.Methods　Respondents were selected by taking three-stage sampling method from June to August，2017：in the first stage，8 cities/prefectures were selected from Sichuan Province by simple stochastic sampling method；in the second stage，two schools and/or rehabilitation institutions for children with cerebral palsy，autism and intellectual disability were selected within each of the 8 cities/prefectures by simple stochastic sampling method；in the third stage，those children's parents from these schools or rehabilitation institutions were selected as respondents by cluster sampling method.The survey was conducted through questionnaires for basic information of children with special needs and their families and questionnaires for medical coping modes.A total of 320 questionnaires were distributed，and 292 valid questionnaires were recollected，with 91.3% of recovery rate.The scores of family medical coping modes for children with special needs and norms were compared to analyze the status quo of family medical coping mode for children with special needs.The influencing factors of medical coping modes were studied by multiple linear stepwise regressions.Results　Among all respondents，142 tended to be confronting（48.6%），30 tended to be avoiding（10.3%），and 120 tended to be yielding（41.1%）．Families with children of special needs scored lower than families with norms in the dimensions of confrontation and avoidance，and higher in the dimension of yielding（P<0.05）．The results of multiple linear stepwise regressions showed that the diagnosis，disability grading，self-care ability，rehabilitation assistance，educational level of mother and parents' marital status were factors influencing the score of confrontation mode dimension（P<0.05）；educational level of father and annual household income were influencing factors of the score of avoidance mode dimension（P<0.05）；and disability grading，rehabilitation assistance，educational level of father，parents' marital status and annual household income were factors influencing the score of yielding dimension（P<0.05）．Conclusion　Family medical coping modes for children with special needs is still to be improved.The diagnosis，disability grading，self-care ability，rehabilitation assistance，parents educational level and their marital status，and annual household income are main influencing factors for family coping mode.Targeted psychological health assistance based on fore mentioned influencing factors should be implemented among parents to change the passive family coping mode and improve the rehabilitation efficacy of children with special needs.

Comparative Analysis of Impulsivity and Cognitive Function in Suicide Attempters and Their First-degree Relatives　

ZHANG Linna，HUANG Binhui，CHU Chengjing，YU Zhenjian

2019, 22(9): 1090-1095. DOI: 10.12114/j.issn.1007-9572.2018.00.284

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Background　Suicide is an autonomous and complex behavioral disorder for death，cognitive function has gradually become a key target for assessing and identifying suicide risk in recent years，the endophenotype between genotype and phenotype provides a new perspective for exploring the mechanism of suicide.Impulsivity and specific cognitive functions are closely related to suicide attempted，however it can be further verified as an endophenotype.Objective　To investigate the characteristics of impulsivity and cognitive function in suicide attempters（SA）and their first-degree relatives，so as to provide theoretical basis for future endophenotype study of suicidal behaviors.Methods　A total of 47 suicide attempters admitted to the Psychology Department of Affiliated Hospital of Guangdong Medical University or Kailuan Mental Health Center from 2015 to 2017，their 47 first-degree relatives，and 55 healthy people were selected as attempted suicide group，relative group and control group，respectively.The general data of the study subjects were collected，their impulsivity were evaluated using the Chinese version of Barratt Impulse Scale（BIS-Ⅱ），and immediate and delayed memory（memory function）were evaluated by the logical memory test in the Wechsler Memory Test.The number of errors subjects made in the Stroop experiment，and the time required to complete each task（attention inhibition function）were recorded.Results　Scores of attention impulsiveness，motor impulsiveness and the Chinese version of BIS-Ⅱ total score of relative group were higher than those of control group，while scores of immediate memory and delayed memory were lower than those of control group；time of reading black words，reading paradoxical words，naming colors of conflict words，naming colors of irrelevant words，naming font colors，naming paradoxical colors were longer than those of control group（P<0.05）．Scores of attention impulsiveness，motor impulsiveness，unplanned impulsiveness and the Chinese version of BIS-Ⅱ total score and the number of errors of attempted suicide group were higher than those of control group，while scores of immediate memory and delayed memory were lower than those of control group；time of reading black words，reading paradoxical words，naming colors of conflict words，naming colors of irrelevant words，naming font colors，naming paradoxical colors were longer than those of control group（P<0.05）．Scores of motor impulsiveness and Chinese version of BIS-Ⅱ in attempted suicide group were negatively correlated with the scores of immediate memory and delayed memory，and positively correlated with the time required for naming font colors and naming paradoxical colors（P<0.05）；scores of unplanned impulsiveness in attempted suicide group were negatively correlated with scores of immediate memory and delayed memory，and positively correlated with the time required for reading paradoxical words and naming paradoxical colors（P<0.05）．The results of one-dimensional linear regression analysis showed that there was a linear regression relationship between scores of immediate and delayed memory，naming font colors，naming paradoxical colors with BIS-Ⅱ total score（P<0.05）．Results of multivariate logistic regression analysis showed that the time required for motor impulsiveness，unplanned impulsiveness，immediate memory and naming paradoxical colors were influencing factors of committing suicide（P<0.05）．Conclusion　Suicide attempters and their first-degree relatives have higher impulsiveness，and their memory and attention inhibition function are impaired；the impulsiveness is related to the memory and attention inhibition function；impulsiveness，immediate memory and attention inhibition may be potential endophenotypes of suicide attempters.

Effects of Perceptional and Behavioral Analysis Therapy on Major Depressive Disorder　

TONG Ping，BU Ping，DONG Liping，YANG Yang，SUN Ting，GAO Xia，SHI Yuanhong

2019, 22(9): 1096-1100. DOI: 10.12114/j.issn.1007-9572.2018.00.314

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Background　Major depressive disorder（MDD）patients often suffer from severe stigma and low treatment compliance，which leads to the failure of effective control of the disease and even aggravates the symptoms of depression.Psychotherapy should be carried out to reduce the stigma of patients and improve treatment compliance while treating depression.Objective　To observe the effects of perceptional and behavioral analysis therapy（PBAT）on the treatment compliance，stigma and depressive symptoms in patients with MDD．Methods　Seventy-five MDD outpatients were selected from Department of Clinical Psychology，Subei People's Hospital Affiliated to Yangzhou University from January 2017 to January 2018.They were divided into study group（38 cases）and control group（37 cases）by use of a random number table method，receiving personalized 50-minute PBAT（totaled 8 times，performed according to the treatment regimen），conventional psychological education，respectively，on the basis of treatment with citalopram（an antidepressant drug belonging to the selective 5-serotonin reuptake inhibitors）．Basic demographic characteristics were collected.Treatment adherence，stigma，and depressive symptoms were assessed by the 8-item Morisky Medication Adherence Scale（MMAS-8），Scale of Stigma（SS），24-item Hamilton Depression Scale（HAMD-24），respectively，at baseline and the end of 8-week treatment.Treatment effect was evaluated by the HAMD-24 when the 8-week treatment ended．Results　The scores of MMAS-8 were much higher in the study group than those of the control group（P<0.05）．The scores of MMAS-8 were higher in the study group after treatment than before treatment（P<0.05）．The treatment compliance after treatment of the study group was better than that of the control group（P<0.05）．The treatment compliance improved significantly in both groups（P<0.05）．After treatment，the scores of SS and its 3 dimensions（sociality，ability and therapeutic dimensions）decreased significantly in the study group compared with baseline（P<0.05），and they were much lower in the study group compared with those of the control group（P<0.05）．After treatment，the scores of HAMD-24 decreased significantly in both groups compared with baseline（P<0.05），and they were much lower in the study group compared with those of the control group（P<0.05）．The treatment effect of the study group was better than that of the control group（P<0.05）．Conclusion　PBAT can effectively increase the treatment compliance of MDD patients，relieve the depressive symptoms and improve the treatment effects.

Diagnosis，Treatment and Prevention Services for Common Cold in Children Provided by General Practitioners in Xi'an：a Survey Analysis　

FAN Liping，MI Man，LI Xueping，LIU Manling

2019, 22(9): 1101-1105. DOI: 10.12114/j.issn.1007-9572.2018.00.325

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Background　Community health centers（CHCs）are often the first medical institution that support children with common cold.However，it has been found that nonstandardized treatment and overtreatment of the disease are quite common in CHCs.Objective　To investigate the diagnosis，treatment and prevention services for common cold in children provided by community general practitioners（GPs）in Xi'an，and analyze the issues related to nonstandardized diagnosis and treatment of the disease.Methods　From February to March 2017，a total of 121 community GPs（delivering primary care to all populations）were selected from 49 CHCs in six urban districts of Xi'an City.They were surveyed with a self-designed questionnaire consisting of general demographic data and diagnosis，treatment and prevention services provided by community GPs for common cold in children.Results　Of the 121 questionnaires distributed，118 were returned after being completed effectively，achieving a response rate of 97.5%.Of the 118 respondents，74（62.7%）believed that although common cold in children is a self-limited disease，adequate symptomatic treatment can effectively reduce symptoms and improve the quality of life，and timely medical consultation is necessary if the conditions become aggravated.In terms of treating the disease，46.6%（55/118）of the respondents reported that they generally prescribed antiviral drugs（including Chinese herbal preparations），21.2%（25/118）used dexamethasone via intravenous drip or atomized inhalation for the management of fever signs and symptoms； 14.4%（17/118）prescribed antibacterials according to the requirement of the child's family members； 85.6%（101/118）rejected to prescribe antibacterials，despite of the requirement of the child's family members，and 98.0%（99/101）of them explained the reasons to the child's family members，in order to increase their awareness of common cold in children.With regard to the knowledge of antibacterial drug therapy for common cold，90.7%（107/118）reported that they sometimes or often taught the child's family members the needlessness of antibacterial drug therapy to common cold，but 9.3%（11/118）rarely or never did so.90.7%（107/118）of the respondents approved the effectiveness of such health education，while 42.4%（50/118）were uncertain of the effectiveness of such education or thought that it was ineffective.In respective of the knowledge of preventing common cold，68.7%（81/118）reported that they frequently taught the child's family members such knowledge，27.1%（32/118）sometimes did this，4.2%（5/118）seldom did this，but no one never did this.Conclusion　There were inadequacies in the diagnosis，treatment and prevention services provided by community GPs in Xi'an：nearly 40% of the GPs held incorrect therapeutic concept； irrational drug use was severe in some CHCs，such as abuse of antiviral drugs and dexamethasone； some community GPs positively publicized knowledge about the treatment and prevention of common cold in children but the results were proved to be ineffective generally.In view of this，the capabilities of primary care practices should be improved by formulating and applying the standards for clinical diagnosis and treatment in primary care as soon as possible，strengthening the continuing education for GPs and enhancing the safety of drug use in children.

Knowledge and Evaluation of Hierarchical Diagnosis and Treatment System among Outpatients　

WANG Ye，QIAN Dongfu，CAO Jiangling，ZHAO Panpan，WANG Meinan

2019, 22(9): 1106-1111. DOI: 10.12114/j.issn.1007-9572.2018.00.457

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Background　As an important form of allocation optimization of health resources，hierarchical diagnosis and treatment system has been fully recognized and explored nationwide.Jiangsu Province has comprehensively promoted the construction of hierarchical diagnosis and treatment system since 2015.Objective　By investigating the awareness and willingness of outpatients in Jiangsu Province about the hierarchical diagnosis and treatment system，this paper explored the knowledge and evaluation of hierarchical diagnosis and treatment system and its influencing factors，so as to provide evidence-based decision-making basis for reasonably guiding the flow of patients to medical treatment and promoting the implementation of hierarchical diagnosis and treatment system.Methods　Six cities in Jiangsu Province were selected by stratified sampling and four medical institutions were selected in each city by typical sampling.And outpatients in the medical institutions were interviewed face-to-face through occasional sampling from November to December 2017.The self-designed questionnaires were used to investigate the awareness of hierarchical diagnosis and treatment system，patients' willingness to have primary treatment at the community level，and the evaluation of two-way referral system.Results　42.5%（738/1 738）of outpatients had a certain knowledge of hierarchical diagnosis and treatment system and 39.9%（694/1 738）of outpatients had a certain knowledge of initial diagnosis at the community level.There were significant differences among outpatients in terms of different education level，work status，occupation type，type of medical insurance，average monthly income，residence and region （P<0.05）．The results of multivariate Logistics regression analysis showed that education level，type of medical insurance and area were the main factors influencing the knowledge of hierarchical diagnosis and treatment system （P<0.05）．48.6%（845/1 738）of outpatients showed a willingness to have the primary treatment in community health service centers and 51.4%（893/1 738）of outpatients showed a willingness to have the primary treatment in the hospital.There were significant differences in the choice of primary medical treatment institution among outpatients with or without the knowledge of the initial diagnosis at the community level （P<0.05）．Conclusion　Outpatients in Jiangsu Province have a low awareness of hierarchical diagnosis system and low willingness to have primary treatment at the community level.Problems on two-way referral are prominent.Therefore，the health administration should step up publicity and guidance on policies，strengthen the capacity building of primary health care institutions，and regulate two-way referral system process.They should also provide more support and improve hierarchical diagnosis and treatment system.

Health Management at Home and Abroad：a Comparative Literature Review Using Knowledge Mapping Technique　

ZHANG Yiqing，WANG Gaoling

2019, 22(9): 1112-1118. DOI: 10.12114/j.issn.1007-9572.2018.00.190

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Objective　To compare the status，hotspots and frontiers of health management research at home and abroad.Methods　On September 20，2017，we searched Web of ScienceTM and CNKI for articles concerning health management included between 2007 and 2017.Bibliometric method and knowledge mapping technique were used to quantitatively and qualitatively analyze the included articles in terms of number，research hotspots，frontiers and trends，distribution of prolific authors and institutions.Results　Number of the included articles：totaled 3 258 articles were included，including 2 407 published abroad，and 851 published in China.The most prolific author：YASUMURA was the most prolific foreign author（34 articles），and XUE Fu-zhong and LU Jian-hua were the most prolific domestic authors（each published 13 articles）．The most prolific institution：Fukushima Med Univ，School of Health Policy & Management，Nanjing Medical University，were the most prolific foreign institution，domestic institution，respectively，publishing 52，16 articles，respectively.Research hotspots：the top 5 hotspots in foreign studies were about care，management，disease，health and system，while those in domestic studies were about chronic disease，hypertension，diabetes，elderly people and influencing factors.Research frontiers：foreign articles mainly focused on post-epidemic/disaster follow-up survey，chronic disease management，and health management in different industries from different perspectives.Domestic articles mainly concentrated on health management in grassroots medical institutions，satisfaction analysis of health management，rural health management，and health literacy.Conclusion　The number of articles about health management published domestically is increasing rapidly，but the cooperations between prolific authors are not close.Foreign and domestic studies are different in terms of hotspots，frontiers and perspectives，and the former's advanced strengths are worthy of reference，for they can promote the further development of domestic health management research.

Research Hotspots of Long-term Care for the Elderly in China and Abroad：a Co-word Cluster Analysis　

XIE Lingli，JI Yunan，LI Chenyang，HOU Zhenhua，LIU Yanhui

2019, 22(9): 1119-1124. DOI: 10.12114/j.issn.1007-9572.2018.00.446

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Background　With a growing number of the elderly，China is in the developmental stage of population aging rapidly.Providing effective care for the elderly will be a key issue in promoting healthy ageing.At present，the long-term care service for the elderly in China is still developing，and a systematic and complete care system has not been formed.Objective　To analyze and compare the research hotspots of long-term care for the elderly in China and abroad in the past 5 years，in order to provide some reference and guidance for the development of long-term care research for the elderly in China.Methods　The CNKI and Pubmed databases were searched in both Chinese and English by “long-term care” from June to July 2018.Literature inclusion criteria：journals，dissertations，theses and conference papers.By reading the subject，abstract or full text，the researchers excluded studies that was inconsistent with the topic and content of “long-term care for the elderly”.The domestic literatures retrieved by PubMed were all eliminated.Search period：from January 2013 to June 2018.In the end，1 750 foreign literatures and 739 domestic literatures were included.Bicomb and gCLUTO were used to perform word frequency analysis and graph cluster analysis on high frequency key words.Results　The study of long-term care for the elderly abroad started at an early stage，and research on the long-term care of the elderly has declined slightly in the past five years.The number of relevant research literatures in China，on the other hand，is on the rise.There were 61 high-frequency key words in foreign studies，with the highest frequency of 808 and the lowest frequency of 17；and 35 high-frequency key words in Chinese researches，with the highest frequency of 338 and the lowest frequency of 10.Overseas research on long-term care for the elderly was divided into five categories：the research on physical and mental health and nutritional status of the elderly，long-term care policy and care needs of the elderly，long-term care medication management，chronic disease management of the elderly，and palliative care for the elderly and care quality.There were four types of research on long-term care for the elderly in China：the status quo and enlightenment of long-term care，long-term care insurance system，long-term care demand and its influencing factors，and long-term care system.Conclusion　The hot topics of long-term care research for the elderly in China（long-term care status and implications，insurance system，long-term care needs and their influencing factors，long-term care system research）and abroad（study on health and nutritional status of the elderly，policy and elderly care needs，medication management，elderly chronic disease management，elderly palliative care and quality of care）have certain similarities and differences.The research hotspots at the current stage of foreign countries，including optimization of long-term care services，improvement of care quality and inspection of long-term care strategies，can provide reference for the development of long-term care research for the elderly in China.

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