Chinese General Practice

Principles and guidelines for diagnosis and treatment of primary osteoporosis in communities

Editorial Group of Principles and Guidelines for Diagnosis and Treatment of Primary Osteoporosis in Communities

2019, 22(10): 1125-1132. DOI: 10.12114/j.issn.1007-9572.2019.00.116

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Demands and Strategies Analysis of Family Doctors' Performance Evaluation in the Delivery of Contracted Services in China　

ZHANG Yanchun，LIU Zhihua，QIN Jiangmei，LIN Chunmei，ZHANG Lifang

2019, 22(10): 1133-1138. DOI: 10.12114/j.issn.1007-9572.2019.10.002

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Background　As the implementation of contracted family doctor services is well developing，new service delivery models are forming，it is necessary to develop a national performance evaluation system for family doctors in the delivery of such services.Objective　To investigate the status of family doctors' performance evaluation in the delivery of contracted services，and the awareness levels of the contents and indicators in the evaluation system for family doctors' performance in the delivery of such services，and implementation of incentives among the government health administrators and mangers of primary health care facilities，and to put forward solutions to existing problems.Methods　This questionnaire survey was conducted at the national training sessions of supportive policies for contracted family doctor services held in Jinan，Zhengzhou and Changsha（provincial capitals of Shandong，Henan and Hunan Provinces） and Chongqing（a province-level municipality） during June to July 2017 by the China National Health Development Research Centre.The final participants were 591 trainees，including all the administrative workers（227 cases） from 32 provincial health administrative departments and 114 prefectural/municipal health administrative departments，and a convenience sample of managers（364 cases） from primary care facilities in Jinan，Zhengzhou，Changsha and Chongqing.A self-developed questionnaire was used，which consists of basic demographic data，awareness level of the setting of evaluation indicators for family doctors' performance and incentives for the implementation of contracted family doctor services.The survey achieved a response rate of 95.3%（591/620）．Results　In terms of quantitative assessment indicators that should be included，population coverage，key population coverage，rural poverty-stricken population coverage，and coverage of special population receiving family-planning services were proposed by 70.1%（414/591），92.0%（544/591），70.1%（414/591） and 68.4%（404/591） of the respondents，respectively.Moreover，target population's satisfaction rate，completion rate of contractual service package，and eligibility rate of electronic health records of the contracted residents were put forward by 92.4%（546/591），81.6%（482/591），and 72.6%（429/591） of the respondents，respectively.What's more，rate of initial consultation in primary care，rate of visiting the contracted family doctor for medical services，referral rate of the appointed patients were recommended by 85.4%（505/591），78.3%（463/591），and 66.2%（391/591）of the respondents，respectively.As for incentive system，290（49.1%） of the respondents reported that the contracted services were delivered with a fee in their region/ facility.Among them，78.3%（227/290） reported that the service fee was used to incentivize the family doctor team，and 39.0%（113/290）reported that that the service fee was included in the total performance-related pay.The funding source for the fee was reported to come from fiscal subsidies 〔27.6%（80/290）〕，medical insurance programs 〔31.4%（91/290）〕，essential public health service funding〔80.3%（232/290）〕，and out-of-pocket money of the residents receiving contracted services〔30.0%（87/290）〕．Conclusion　Most of the health administrators and managerial workers of primary care thought that quantitative and qualitative indicators should be considered as the essential part of the system for assessing the performance of family doctors in delivering contracted services.Initial consultation in primary care should be promoted and be listed as an assessment indicator as well.Furthermore，in order to incentivize the family doctors and increase their enthusiasm for work by additional bonus payments，the funding sources for the fee for contracted services should be ensured.

Quantitative Analysis of Family Doctor Policies in China from the Perspective of Policy Tools　

ZHANG Zhaochun，HU Haiyuan，CHEN Chuan，ZHANG Yili

2019, 22(10): 1139-1146. DOI: 10.12114/j.issn.1007-9572.2018.00.465

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Background　The well-ordered development of family doctor system is inseparable from the guidance and support of government policies.Policy tools are an effective method and an important way for the government to govern the economy and society.Choosing effective and appropriate policy tools and making the best possible use of them can align policy outcomes with policy objectives.Objective　To analyze the policy tools in 22 policy texts related to family doctors issued by the central government of China，and to explore the focuses and shortcomings of these policy systems，providing a reference for the formulation and optimization of family doctor policies in China.Methods　The retrieval was carried out in 21 December 2018.The data were obtained by visiting the official websites of the relevant ministries and commissions of the State Council and its directly affiliated agencies，using the search terms of "family doctors or contracted services" in Chinese during 2015-01-01 to 2018-12-10（n=22）.Using literature review and content analysis method，the above-mentioned policy texts were analyzed from the perspectives of policy tools and utilization status during the implementation of family doctor policies.Results　Among the 142 policy text codes，supply-side policy tools，environmental policy tools and demand-side policy tools accounted for 43.66%（62/142），47.89%（68/142） and 8.45%（12/142），respectively.Among the supply-side policy tools，science and technology information support was used the most，accounting for 20.42%（29/142），and capital investment and public services were the least used，each accounted for 2.82%（4/142）．Among the environmental policy tools，regulatory controls were the most used，accounting for 16.20%（23/142），and tax incentives were used less，accounting for 0.70%（1/142）．Among the demand-side policy tools，medical insurance payments was used the most，accounting for 4.93%（7/142），and government procurement and demonstration projects were used less，each accounted for 0.70%（1/142）．Among the 142 policy text codes，policy planning tools，policy implementation tools，policy supervision tools，and policy evaluation tools accounted for 44.37%（63/142），36.62%（52/142），18.31%（26/142），and 0.70%（1/142），respectively.Among the policy planning tools，target planning was used the most，accounting for 12.68%（18/142），and public services，government procurement and demonstration projects were used less，each accounted for 0.70%（1/142）．Among the policy implementation tools，science and technology information support was the most used，accounting for 13.38%（19/142）．Talent support，capital investment，target planning，tax incentives and price subsidies were used less，each accounted for 0.70%（1/142）．Among the policy supervision tools，regulatory controls were used the most，accounting for 9.86%（14/142），and education and training and public services were used less，each accounted for 0.70%（1/142）．Only regulatory controls were used as the policy evaluation tools，accounting for 0.70%（1/142）．Conclusion　From the perspective of the basic policy tools，the most used are environmental policy tools，and the least used are demand-side policy tools.From the perspective of policy implementation and development，policy planning and policy implementation tools are more used，and policy supervision and policy evaluation tools are used less.The government needs to strengthen the incentive role of demand-side policy tools and increase the application of family doctor policy supervision and evaluation policies.

Status Analysis and Improvement Strategies of Outpatient Prescriptions in Community Health Centers in China

XU Zhijie，MAO Runyue，PAN Jianjiang，ZHU Yue，FANG Lizheng

2019, 22(10): 1147-1152. DOI: 10.12114/j.issn.1007-9572.2019.00.091

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Background　Outpatient prescribing is a major part of community health services.Irrational drug use can increase the occurrence of adverse drug reactions and aggravate the waste of health resources.Objective　To investigate the causes of irrational drug use in community health centers（CHCs） in China and put forward improvement strategies accordingly on the basis of systematically reviewing the survey articles regarding outpatient prescriptions in domestic CHCs published in the past decade.Methods　We searched the databases of PubMed，CNKI，Wanfang Data Knowledge Service Platform，and VIP for articles evaluating the rationality of outpatient prescriptions in CHCs in China published from June 30，2008 to June 30，2018.We summarized the outpatient prescribing in domestic CHCs，and put forward solutions to irrational drug use in CHCs based on related documents issued by the national government recently.Results　A total of 456 articles either in Chinese or English were searched，and 20 of them were included finally after reviewing the full contents.Analysis showed that the average percentage of irrational outpatient prescriptions in CHCs in China was 6.86%（9 079/132 350）．Problems of irrational drug use included inappropriate drugs for clinical diagnosis of conditions，incorrect dose and usage，inappropriate dosage forms and administration routes，repeated administration，possible drug interactions and incompatibilities，inappropriate selection of drugs，inaccurate or no prescription notes，and prescription writing issues.Conclusion　In general，a variety of problems related to outpatient prescribing are found in domestic CHCs，which are associated with legislative supervision，development of CHCs，community physicians and outpatients.To increase the rational use of drugs in CHCs，it is suggested that prescriptions quality assessment system should be developed and improved by relevant departments，medication trainings for community physicians should be strengthened，and e-prescribing system should be optimized.

Community Empowerment for the Prevention and Control of Non-communicable Diseases　

WANG Zhan，GONG Enying，PENG Weixia，CHEN Jiaying，TIAN Xiangyang，XIONG Shangzhi，YAN Lijing

2019, 22(10): 1153-1160. DOI: 10.12114/j.issn.1007-9572.2019.10.005

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After more than three decades of development and practice，community empowerment has become one of the important theories and approaches for health promotion，and has been applied to international disease control and prevention practices.Considering the severe challenge of non-communicable disease faced by China，community empowerment would contribute to its resolution as well.The present paper reviews the development of empowerment concept，summarizes the approaches and features of community empowerment's application in health promotion，and explores the prospect of applying community empowerment for non-communicable disease control and prevention in China，in order to contribute to future researches and interventions of non-communicable diseases.Literature review transpires that community empowerment is consisted of life-control sense and capacity improvement factors of three levels：individual，organizational and community.It would contribute to health promotion by improving mental state，enhancing socio-economic status，extending social connection and network （for community members） as well as strengthening health promotion capacity and promoting policy-making （for community as a whole）．Compared with other health promotion strategies，community empowerment emphasizes at redefining community's role in health projects，identifying health risks with "bottom-up" view and paying special attention on disadvantaged and marginalized groups.Since non-communicable disease is mainly caused by long-term unhealthy behaviors，community empowerment could facilitate its control and prevention by promoting behavior change through social network，enhancing initiative for health by collective actions，and strengthening community-level health promotion capacities by inter-organization cooperation.

Responses to the Supportive Policies for the Implementation of Contracted Family Doctor Services and Job Satisfaction in Primary Healthcare Workers　

LIU Caiyin，HE Tingting，WANG Quan

2019, 22(10): 1160-1164. DOI: 10.12114/j.issn.1007-9572.2019.10.006

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Background　Primary healthcare workers are the main providers of contracted family doctor services（CFDSs）．Their responses to the supportive policies for the implementation of CFDSs and job satisfaction are the key to steadily promote the development of such services.Objective　To investigate primary healthcare workers' responses to the supportive policies for the implementation of CFDSs and job satisfaction，to provide recommendations for the sustainable development of such services.Methods　A questionnaire survey was conducted in a multistage stratified sample of 500 primary healthcare workers from Yichang City，Hubei Province during February to May 2018.The main contents of the survey included general personal characteristics，evaluation of CFDSs，responses to the supportive policies for the implementation of CFDSs，and job satisfaction.Stepwise multivariate Logistic regression analysis was used to analyze the influencing factors of job satisfaction.Results　Overall，462 participants handed in responsive questionnaires，obtaining a response rate of 92.4%.Among them，30.5%（141/462） played a role in delivering CFDSs very/comparatively actively，25.9%（120/462） reported that current incentive mechanism can motivate their working enthusiasm.The mean overall job satisfaction score，salary satisfaction score，working conditions satisfaction score，coworker relationships satisfaction score，personal development satisfaction score，and personal achievement satisfaction score obtained by the respondents were （17.4±3.5），（2.7±0.7），（3.4±0.7），（4.1±0.8），（3.3±0.9），（3.5±0.8），from "very unsatisfied" to "very satisfied" were scored 1-5，respectively.Stepwise multivariate Logistic regression analysis revealed that mean monthly income，changes in working hours after delivering CFDSs，risks of being a family doctor，importance of family doctors，and the functions of current incentive mechanism in arousing the working enthusiasm were influencing factors for job satisfaction（P<0.05）．Conclusion　The levels of responses to the supportive policies for the implementation of CFDSs and job satisfaction in primary healthcare workers need to be improved.The suggested corresponding facilitation strategies are as follows：innovating the incentives for family doctors，improving the evaluation system of family doctors' performance in delivering CFDSs，strengthening the training of high-quality family medicine workforce，establishing a sustainable training system for family medicine workforce，and enhancing the stability of family doctor as a vocation.

Disability Transition Regularity in Chinese Older Persons：an Analysis Using a Multi-state Markov Model 　

TAO Tao，ZHOU Ying，DAI Lingyan，CHEN Weiwu，YANG Zhipeng，LI Yusi，GUO Zhuoyuan，MA Jinxiang

2019, 22(10): 1165-1170. DOI: 10.12114/j.issn.1007-9572.2019.10.007

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Background　The Fourth Sample Survey on the Living Conditions of China's Urban and Rural Older Persons showed that as of 2015，there were 40.63 million disabled and semi-disabled older persons，accounting for 18.3% of the elderly population.The disability of the elderly has become an important public health problem in China.And studying the disability transition regularity in this population is crucial to solve the problem of aging.Objective　To study the disability transition regularity in Chinese older persons using a multi-state Markov model.Methods　Data stemmed from the China Health and Retirement Longitudinal Study （CHARLS） conducted in 2011 and 2013.The disability status of the involved older people aged 60 or above was classified by the National Long Term Care Survey （NLTCS） disability criteria.Disability transition regularity was analyzed with a multi-state Markov model.Results　A total of 6 615 cases were enrolled.A two-year follow-up showed that，compared with baseline，3 740 （56.54%） of the participants were found to have little changed functional state，837 （12.65%） showed improvement in functional state，1 704 （25.76%） demonstrated declined functional state，and 334 （5.05%） died.The functional state had a possibility to be improved regardless of the baseline status.Mild disability had the highest probability of improvement （0.414 0）．Those who were disabled at baseline had higher possibility of transition in functional state than those who were nondisabled at baseline.However，the possibility of improvement in functional state was negatively correlated with the level of disability at baseline，namely，it decreased successively in participants with baseline assessed mild，moderate and severe disability.The possibility of improvement in functional states was higher than that of deterioration in those with impaired health，mild or moderate disability，but in those of severely disabled，a totally opposite result was observed.Those of severely disabled also showed the highest probability of death （0.355 1）．The mean sojourn time in those with healthy，impaired health，mild disability，moderate disability，and severe disability was 3.33，1.83，1.02，1.02 and 1.52 years，respectively.Conclusion　Functional states being unchanged，improved or deteriorated during a period of time are common in older persons.The transition regularity of severe disability is different from that of impaired health，mild or moderate disability.The latter three functional states have a higher likelihood of improvement，while the former，severe disability，has longer sojourn time and a lower likelihood of recovery，and the highest probability of death.

Establishment of a Risk Prediction Model for Gestational Diabetes Mellitus in Multiparae 　

ZHAO Yan，ZHENG Wei，YAN Qi，ZHANG Lirui，LIANG Xin，LI Guanghui

2019, 22(10): 1171-1175. DOI: 10.12114/j.issn.1007-9572.2019.10.008

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Background　In China，with the implementation of the universal two-child policy，the prevalence of pregnancy in multiparae has risen dramatically，followed by an increase in the incidence of adverse pregnancy outcomes.Multiparae are at higher risk for developing gestational diabetes mellitus （GDM） than primiparas.Objective　To investigate the risk factors of GDM in multiparae，to establish a risk prediction model of GDM for this population.Methods　This prospective study was conducted in a cohort of women（including multiparae and primiparas） who delivered a singleton baby in Beijing Obstetrics and Gynecology Hospital，Capital Medical University，between January and September 2017.Basic personal information，history of pregnancy and childbirth，history of GDM，family history of diabetes，physical parameters，fasting plasma glucose （FPG），and fasting plasma lipids during the first trimester were collected.75-g OGTT was conducted at 24-28 weeks of gestation，and the results were stratified.GDM was diagnosed following the IADPSG 2010 criteria.The above-mentioned parameters and incidence of GDM were compared between multiparae and primiparas.Influencing factors of GDM in multiparae were identified with univariate and multivariate analyses，and were used to establish a risk prediction model of GDM.Results　A total of 5 110 cases were included，and 34.8% （1 779/5 110）of them were multiparae.Compared with primiparas，multiparae had an older age，more pregnancies，higher prepregnancy BMI，TG，and FPG levels，higher percentages of history of adverse pregnancy and childbirth outcomes，history of GDM，and junior college or below education level，and higher GDM incidence （P<0.05）．Among the multiparae，those with GDM showed an older age，more pregnancies，higher prepregnancy BMI，TG， LDL-C and FPG levels，lower HDL-C levels, and higher percentages of history of GDM，and of family history of diabetes than those without （P<0.05）．Logistic regression analysis showed that age，history of GDM，prepregnancy BMI，and FPG in early pregnancy were the influencing factors of GDM in multiparae （P<0.05）．The established Logistic regression model was as follows：PGDM=1/{1+exp〔-（-8.305 3+0.075 2×age+0.530 0×history of GDM+0.125 2×prepregnancy BMI+0.398 4×PFG）〕}.ROC analysis indicated that the AUC of the predictive model was 0.704，the corresponding sensitivity，specificity and Youden's index were 65.84%，68.90% and 0.347 respectively.Conclusion　Multiparae，especially those with glycemic abnormalities during the previous pregnancy，have a high risk of developing GDM，and a population should be intervened in priority.GDM risk prediction model established with variables of age，prepregnancy BMI and FPG in early pregnancy，can provide a theoretical basis for early screening，monitoring，and intervention of GDM in high-risk pregnant women.

Effects of Heart Function on Ischemic Stroke and Mortality Risks in Patients with Nonvalvular Atrial Fibrillation and Coronary Artery Stent Implantation　

WANG Ge，ZHAO Li，ZHANG Boyang，WANG Nannan，LIU Pengfei，LIU Ruchen，HUA Can，YUAN Haifeng，WANG Yubin，LI Tianchang

2019, 22(10): 1176-1181. DOI: 10.12114/j.issn.1007-9572.2019.00.094

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Background　Anticoagulation therapy is often administered to atrial fibrillation（AF） patients whose risk of bleeding with such treatment is outweighed by the benefit of stroke risk reduction.And antiplatelet therapy is often given to those with coronary artery stent implantation （CASI）．However，if giving antithrombotic （anticoagulant and antiplatelet） therapies to AF with CASI patients，their risks of bleeding will be increased.Heart failure commonly coexists and interacts with atrial fibrillation，and it is a recognized risk factor for stroke in AF patients.Objective　To investigate the effect of heart function on the risk of ischemic stroke and death in patients with nonvalvular AF and CASI.Methods　A multicenter study was conducted on 2 471 AF patients with CASI recruited from 11 grade A tertiary hospitals in Beijing from January 2010 to January 2015.After excluding those with valvular AF and those who were lost to follow-up，1 987 patients were finally enrolled.The average follow-up period for them was（3.5±1.5） years.The incidence and mortality of ischemic stroke were compared according to the heart function classification of the New York Heart Association（NYHA）．Survival analysis was carried out with ischemic stroke and death as endpoints，and Kaplan-Meier survival curves were drawn.At the same time，the bleeding events were analyzed.Finally，Cox proportional hazards regression model was used to analyze the risk factors of stroke.Results　The incidence of ischemic stroke was 4.29%（n=63） in compensated heart failure group（n=1 468），and 6.17%（n=32） in decompensated heart failure group（n=519），with no difference（P=0.085）．The mortality rate was 10.35%（n=152） in compensated heart failure group，and 14.84%（n=77） in decompensated heart failure group，showing a significant difference（P=0.006）．There were significant differences in survival curves drawn with ischemic stroke and death as endpoints between the two groups （P<0.05）．Univariate Cox proportional hazards regression analysis showed that NYHA class was associated with the risk of ischemic stroke （P=0.047）．Multivariate Cox proportional hazards regression，which further included traditional risk factors for AF and major echocardiographic indicators，showed that gender，stroke history，NYHA class，left ventricular ejection fraction（LVEF），left atrial diameter，left ventricular end-diastolic diameter were factors associated with ischemic stroke （P<0.05）．The rate of anticoagulants use was higher in decompensated heart failure group than that of compensated heart failure group（P=0.001）．Patients with different NYHA classes showed significantly different mortality rate （P=0.006），but similar stroke incidence（P=0.086）．The incidence of bleeding events was 12.74%（187/1 468） in compensated heart failure group and 11.95%（62/519） in decompensated heart failure group，with no significant difference （P=0.639）．Conclusion　Nonvalvular AF patients with decompensated heart failure have increased risks of death，and the risk of death grows with the deterioration of cardiac function.

Application Effect of Chiropractic Therapy in Community-based Treatment of Cervical Spondylotic Radiculopathy　

CHEN Xuemei，LI Jianjun

2019, 22(10): 1182-1186. DOI: 10.12114/j.issn.1007-9572.2019.10.010

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Background　The incidence of cervical spondylosis in China is gradually increasing，and it has become a common disease in middle-aged and elderly people.In particular，the incidence of cervical spondylotic radiculopathy （CSR） is higher.Although there are many treatments，such as pharmacologic treatment，jaw traction and braking and so on，the therapeutic effects are different，and the treatment cycles are long in general.Objective　To explore the effect of chiropractic therapy in community-based treatment of CSR.Methods　40 patients with CSR who were treated in Department of Rehabilitation，Yuetan Community Health Center，Fuxing Hospital，Capital Medical University from January 2017 to April 2018 were recruited and divided into massage group and traction group according to the patient's self-reported preferred therapy.The former group received manual correction treatment for 6 times，while the latter received 6 times of 10-minute electric traction treatment，with an amount of traction of 7% to 10% of the body weight.The physiological curvature，angular displacement of the vertebral body and the area of the intervertebral foramen were observed before and after treatment by X-ray examinations.Therapeutic effects were evaluated by the Visual Analogue Score（VAS）．Results　There were no significant differences in gender ratio，average age，and distribution of course of CSR between the two groups （P>0.05）．The cervical physiological curvature and angular displacement of the vertebral body showed no significant differences either before or after treatment between the groups （P<0.05）．Although the average intervertebral foramen area and average VAS score were similar in both groups at baseline （P>0.05），the former was much larger and the latter was much higher in the massage group compared with traction group after treatment （P<0.05）．After treatment，both the average intervertebral foramen area and VAS score increased significantly in the massage group，but only average VAS score increased significantly in the traction group （P<0.05）．The results of correlation analysis showed that the change of intervertebral foramen was positively correlated with the change of the VAS score （r=0.564，P=0.023）．Conclusion　Massage correction therapy can effectively improve the intervertebral foramen area and symptoms of CSR patients，but traction therapy can only alleviate the symptoms，indicating that the former is superior to the latter in improving the aforementioned two aspects.Moreover，there is a positive correlation between the improvement of intervertebral foramen area and the alleviation of symptoms in CSR patients.

Drug Treatment for Heart Failure with Reduced Ejection Fraction and Chronic Obstructive Pulmonary Disease：a Retrospective Analysis　

ZHANG Kaijin，LI Xingde

2019, 22(10): 1187-1191. DOI: 10.12114/j.issn.1007-9572.2019.10.011

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Background　Heart failure with reduced ejection fraction（HFrEF） often coexists with chronic obstructive pulmonary disease（COPD），which leads to a series of problems such as increased hospitalization rate，higher financial burden，worsening conditions and raised mortality.Objective　To examine the incidence of COPD in HFrEF，and to investigate the drug treatment for HFrEF with COPD.Methods　We recruited 238 hospitalized patients with HFrEF and NYHA class Ⅱ-Ⅳ from Cardiovascular Department，First Affiliated Hospital of Kunming Medical University，including 26 with COPD（HFrEF+COPD group） and 212 without（HFrEF group） in 2017．We comparatively analyzed both groups' general personal data，drug treatment including the use of β-blockers（BBs） and resting heart rate management.Results　The prevalence of COPD in the patients was 10.9%（26/238）．HFrEF+COPD group had lower rates of using BBs，and mineralocorticoid receptor antagonists（MRAs），but higher rate of using antiplatelet drugs compared with HFrEF group（P<0.05）．Both groups had no significant differences in the rates of using angiotensin-converting enzyme inhibitors（ACEI）/ angiotensin-receptor blockers（ARB），diuretics，digoxin and statins（P>0.05）．The rates of using metoprolol succinate，bisoprolol，metoprolol tartrate and carvedilol and the average total cumulative dose of each of these drugs showed no significant differences between the groups（P>0.05）．In the HFrEF group，the rates of using over 50% of the target dose but less than the target dose of metoprolol succinate，bisoprolol，metoprolol tartrate，and carvediloda were 2.4%（5/212），9.4%（20/212），4.7%（10/212），0.5%（1/212），respectively.And only 0.9%（2/212） used the target dose of bisoprolol.In the HFrEF +COPD group，the rates of using over 50% of the target dose but less than the target dose of metoprolol succinate，bisoprolol，metoprolol tartrate，and carvediloda were 0，7.7%（2/26），0，and 3.8%（1/26），respectively.No one used the targer dose of each of these drugs during treatment.The rates of having a resting heart rate of 55-60，61-70，and over 70 beats per minute were 3.3%（7 cases），35.4%（75 cases） and 60.8%（129 cases），respectively，in the HFrEF group，and 7.7%（2 cases），38.5%（10 cases） and 53.8%（14 cases） in HFrEF+COPD group，indicating no obvious differences between the groups（P>0.05）．Conclusion　The prevalence of COPD was high in HFrEF patients.BBs were used in HFrEF patients with or without COPD，but the use rate and dose are to be improved.Moreover，the rates of meeting the target resting heart rate were low in both groups.Therefore，more attention should be paid to the diagnosis and treatment of HFrEF with COPD.

Effectiveness of Febuxostat in the Treatment of Non-end-stage Diabetic Nephropathy with Hyperuricemia and Its Effect on Renal Function　

MIAO Yan，WU Jun，YAN Lei，DONG Yang，ZHU Qing，SHAO Fengmin

2019, 22(10): 1192-1197. DOI: 10.12114/j.issn.1007-9572.2019.10.012

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Background　Febuxostat is safe and effective for non-end-stage chronic kidney disease，which can reduce the serum uric acid and delay the progression of renal insufficiency.Diabetic nephropathy （DN）patients are more prone to hyperuricemia （HUA）．Objective　To investigate the urate-lowering efficacy and renal effect of febuxostat in non-end-stage DN with HUA.Methods　A prospective，randomized，controlled trial was conducted from February 2017 to February 2018 among non-end-stage DN with HUA inpatients and outpatients （n=140） treated in nephrology，endocrinology departments，or community health organizations of Henan Provincial People's Hospital.Participants were randomly assigned to either treatment group or control group，and received the same treatment，except that the former group received febuxostat（40 mg，once daily），while the latter received no pharmaceutical therapy for lowering uric acid.Serum uric acid （SUA），serum creatinine （Scr），albumin-to-creatinine ration （ACR） and other clinical parameters were measured at baseline and 1-6 months after treatment.The changes of SUA，ACR and estimated glomerular filtration rate （eGFR） were compared between the two groups.Results　Overall，112 cases completed the trial，including 58 in the treatment group and 54 in the control group.There were no significant differences in sex ratio，average age，body mass index （BMI），baseline blood pressure levels，SUA，Scr，ACR and eGFR between the two groups （P>0.05）．The analysis showed that the number and the rate of achieving target SUA level in the treatment group were 42 （77.8%），47 （87.0%），51 （94.4%），52 （96.3%），52 （96.3%），52 （96.3%），respectively，at the end of 1st，2nd，3rd，4th，5th，and 6th months of treatment.Compared with baseline，post-treatment eGFR level increased significantly in the treatment group 〔（56.42±14.49） ml?min-1?（1.73 m2）-1 vs （50.95±13.66）ml?min-1?（1.73 m2）-1〕.Treatment group showed much lower post-treatment HbA1c，TC，LDL-C，SUA，Scr and ACR levels compared with the control group （P<0.05）．Pearson correlation analysis showed that the duration of diabetes，SBP，HbA1c，and SUA were positively correlated with ACR，while eGFR was negatively correlated with ACR （P<0.05）；the duration of diabetes，HbA1c，LDL-C，SUA，SCr and ACR were negatively correlated with eGFR （P<0.05）．Stepwise multiple linear regression analysis showed that duration of diabetes，HbA1c and SUA were the influencing factors of ACR （P<0.05），and duration of diabetes，SUA and Scr were the independent influencing factors of eGFR （P<0.05）．Conclusion　For those also with HUA，this treatment could effectively reduce the SUA level，decrease the incidence of proteinuria，and delay the progression of renal insufficiency.

Prevalence and Influencing Factors of Hypertension among Adults in Gansu　

ZHANG Qi，WANG Dongdong，LIU Yidan，LI Yang，LI Xiao，WANG Bailing，YU Jing，LIN Wenyan，LIU Jing

2019, 22(10): 1197-1202. DOI: 10.12114/j.issn.1007-9572.2018.00.385

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Background　Hypertension is a risk factor for cardiovascular and cerebrovascular diseases，which can lead to myocardial infarction and stroke，increasing the burden of this disease. There is lack of epidemiological data of hypertension in Gansu Province.Objective　To investigate the prevalence of hypertension in adults in Gansu Province and analyze the influencing factors.Methods　From September 2013 to December 2014，34 792 residents aged 20 to 74 in Gansu Province were selected by cluster random stratified sampling.They participated in a face-to-face questionnaire survey and underwent a physical examination and a laboratory examination conducted by qualified investigators by training according to the unified standards.The prevalence of hypertension was compared among them by characteristics.The risk factors of hypertension were analyzed by stepwise multivariate Logistic regression.Results　The prevalence of hypertension in overall participants，male and female participants was 27.73%（8 712/31 417），29.78% （4 194/14 083），and 26.06% （4 518/17 334），respectively，which were higher when compared with the age-standardized population standard in China Statistical Yearbook 2013 〔age-standardized prevalence of hypertension for the whole population，males and females was 23.24% （191 862/825 712），25.87% （213 613/825 712），and 20.98% （173 201/825 712），respectively〕.The prevalence of hypertension among the participants differed significantly by sex，age，minzu，educational level，living area，altitude of living area，economic level，smoking prevalence，drinking prevalence，BMI，family history of hypertension，waist circumference，blood glucose and blood lipid levels （P<0.05）．Stepwise multivariate Logistic regression analysis showed that sex，age，educational level，living area，altitude of living area，drinking prevalence，family history of hypertension，BMI，waist circumference， blood lipid，whether diabetes were the influencing factors of hypertension （P<0.05）．Conclusion　The prevalence of hypertension in adults in Gansu Province was high.Sex，age，educational level，living area，altitude of living area，drinking prevalence，family history of hypertension，BMI，waist circumference， blood lipid and whether diabetes were the influencing factors of hypertension，

Diabetes Screening in High-risk Individuals in Putuo District，Shanghai 　

WU Chunxiang，YU Jie

2019, 22(10): 1203-1208. DOI: 10.12114/j.issn.1007-9572.2019.10.014

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Background　The increasing prevalence of diabetes has imposed a huge economic burden on the whole society.Screening for diabetes in high-risk population in community can find diabetes mellitus and pre-diabetic patients in time.Early intervention can help to delay or reverse the course of disease and reduce the possibility of developing diabetes-related complications.Objective　To perform a screening for diabetes in high-risk individuals in Shanghai's Putuo District and to analyze the risk factors associated with diabetes and prediabetes.Methods　From March to September 2017，residents in Putuo District of Shanghai who met the criteria of high-risk population for diabetes in the Chinese Guideline for Diabetes Prevention and Management （2013 edition） were enrolled.Basic personal characteristics，prevalence of risk factors for diabetes and related symptoms，physical parameters and glycemic parameters were collected via questionnaire survey，physical measurement and laboratory testing.The results of screening were statistically analyzed.Results　A total of 13 057 cases participated in the survey.Among them，the prevalence of diabetes and prediabetes was 10.61% （1 386/13 057） and 11.93% （1 558/13 057）.Compared with women，men showed a higher prevalence of diabetes 〔12.19% （747/6 127） vs 9.22% （639/6 930）〕（χ2=30.256，P<0.001），but similar prevalence of prediabetes 〔12.15% （744/6 127） vs 11.75% （814/6 930）〕（χ2=0.488，P>0.05）．The prevalence of diabetes and prediabetes increased with age （χ2trend=244.746，P<0.001；χ2trend=144.104，P<0.001）．Logistic regression analysis showed that age，impaired glucose regulation，overweight/obesity/central obesity，family history of diabetes mellitus in first-degree relatives，history of macrosomia or gestational diabetes mellitus，hypertension or under antihypertensive treatment，dyslipidemia or under lipid-lowering treatment，history of atherosclerotic cardio-cerebrovascular disease，and history of transient steroid diabetes were the factors associated with the diabetes identified in the residents （P<0.05）．Age，impaired glucose regulation，overweight/obesity/central obesity，family history of diabetes mellitus in first-degree relatives，hypertension or antihypertensive treatment，dyslipidemia or lipid-lowering treatment，and history of atherosclerotic cardiovascular and cerebrovascular diseases were the influencing factors for prediabetes identified in the residents （P<0.05）．The prevalence of diabetes differed significantly in the residents by the number of diabetes-related risk factors （χ2=469.623，P<0.001）．Moreover，the prevalence of pre-diabetes varied obviously in the residents by prediabetes-related risk factors （χ2=129.073，P<0.001）．The prevalence of diabetes differed significantly in the residents by risk factors associated with diabetes （χ2=469.623，P<0.001）．Moreover，the prevalence of pre-diabetes varied obviously in the residents by risk factors associated with prediabetes （χ2=129.073，P<0.05）．Those with 4 or more risk factors had a higher prevalence of diabetes or pre-diabetes compared with those with only one （P<0.05）．Conclusion　The detection rate of diabetes or prediabetes increased with the increase in the number of diabetes-related risk factors.Individuals with 40 years of age or older，hypertension，overweight or obesity or central obesity，or dyslipidemia are priority populations of diabetes screening.The diabetes screening in community-dwelling high-risk population，especially the key high-risk groups，should be continued.

Rotation Program Improvement Analysis for the Standardized Training of General Practitioners　

SONG Tongwei，YANG Hui，LIU Xiaodi，HONG Chengying，LI Xionggen

2019, 22(10): 1209-1212. DOI: 10.12114/j.issn.1007-9572.2019.10.015

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Background　Rotation is an important component of the standardized training of general practitioners（STGP） in China.However，the rotation program is developed only according to the guidance of training syllabus rather than an overall management strategy.Objective　To improve the rotation program of the STGP in Shenzhen People's Hospital，increasing the competencies of trainees.Methods　All individuals（n=42） who participated in the STGP conducted by Department of General Practice，Shenzhen People's Hospital from 2015 to 2016 were enrolled.Their evaluations and suggestions on current rotation program were collected by group interview between January and February，2017.According to the interview results，a questionnaire was made and was used in a survey for collecting the trainees' satisfaction with and improvement suggestions for current rotation program in March 2017.Rotation program was improved by the General Practice Teaching and Research Group and the Teaching Department of Shenzhen People's Hospital，according to the results of group interview and questionnaire survey，and its effectiveness after improvement was evaluated by the trainees in January 2018 in another survey with the same questionnaire.Results　The rotation program was improved as follows：rotations to wards of Hematology and ICU Departments were canceled；increasing the outpatient teaching time in Endocrinology，Rheumatism and Immunology，Gynecology and Obstetrics Departments；the learning time in both Cardiovascular and Emergency Departments was increased to 3 months；learning in Department of General Practice for a month was added；rotations to 5 surgical departments（Hepatobiliary Surgery，Thyroid and Breast Surgery，Anorectal Surgery，Spinal Surgery，and Hand Microsurgery） were canceled，but the learning time in Gastrointestinal Surgery and Orthopedics Department was increased to a month.The improved program achieved a higher level of trainees' satisfaction （P<0.05）．Conclusion　When making a rotation program，clinical training bases are suggested to give priority to general practice，and the learning in general practice department should be highlighted.In addition，the learning time in different departments should be allocated rationally.

Trainees' Satisfaction with Standardized General Practitioner Training and Associated Factors　

JI Jianxin，HAN Ying，YANG Lin，CHAI Zhikai

2019, 22(10): 1213-1217. DOI: 10.12114/j.issn.1007-9572.2019.10.016

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Background　General practitioners （GPs） make up the bulk of the participants of standardized GP training.Their satisfaction with the training is directly related to the quality and effectiveness of this training.Objective　To obtain an understanding of the trainees' satisfaction with standardized GP training and associated factors by analyzing a related survey conducted in Shanxi Province，to provide a reference for optimizing the procedure and improving the quality of the training.Methods　In this study conducted from April to June 2018，we enrolled all the trainees （n=1 009） who received the standardized GP training carried out in 12 standardized resident physician training bases in Shanxi Province in four years （2014，2015，2016 and 2017） and surveyed them using a self-designed questionnaire consisting of general demographic characteristics，level of understanding of standardized GP training，the necessity and assistance levels of receiving this training，the stress status during the training，and satisfaction with the training.The satisfaction evaluation was scored by 5 grades，form "very unsatisfactory" to "very satisfied" were scored 1-5，respectively.Overall，820 of them handed in responsive questionnaires，generating an 81.27% response rate.Results　The overall mean satisfaction score for the training evaluated by the respondents was （3.62 ± 0.73）．In terms of the mean satisfaction score，the three top-ranked items were "Trainers' personal quality" "Trainers' teaching capability level" "Trainers' teaching enthusiasm"，the corresponding scores were （3.86 ±0.73）（3.70 ±0.76）（3.61±0.82），respectively，while the bottom-ranked one was "Resident physician's salary during the period of standardized GP training"，the corresponding score was （3.02±0.99）．Multivariate Logistic regression analysis showed that age，the level of hospital expected to be employed，level of understanding of standardized GP training，the necessity and assistance levels of receiving this training，and the stress status during the training were the factors associated with the overall mean satisfaction score for the training （P<0.05）．Conclusion　In general，the level of trainees' satisfaction with the standardized GP training was "fair".And it was influenced most by trainees' level of understating of the training.In view of this，purpose and significance of the training are suggested to be added to the contents of the perception of the training，besides strengthening the GP knowledge and skills training.

Job Competencies and Satisfaction in Grassroots General Practitioners　

LIU Shanshan，WU Jun，LI Ming，HUANG Xuan，YAN Hua，LOU Jiquan，LIANG Hong，ZHANG Yimin

2019, 22(10): 1218-1222. DOI: 10.12114/j.issn.1007-9572.2019.10.017

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Background　As the "gatekeepers" of residents' health and control of medical expenses，general practitioners（GPs） play an important role in the delivery of essential medical services.GPs' service capabilities，incentives for GPs and GP workforce stability are of great significance in the promotion of contracted family doctor services（CFDSs） and in the development of hierarchical medical system.Objective　To obtain a deep understanding of the job competencies and satisfaction in grassroots GPs.Methods　In July 2016，by use of stratified cluster sampling，440 GPs（including TCM GPs） were recruited from 15 community health centers（CHCs） in urban and suburban areas and urban-rural fringe in Shanghai's Pudong New Area，and were surveyed with a questionnaire composed mainly of implementation of CFDSs，job competencies and satisfaction.Results　The survey obtained a response rate of 100.0%.Among the respondents，95.2%（419/440） reported that they could fully/basically deliver first contact services，81.0%（350/432） considered that they were fully/ basically competent for their job in terms of medical knowledge and skills，and 70.2%（302/430） reported that they worked under very/relatively high pressure.GPs' assessments for the level of working pressure and the role of a regional medical consortium in the development of hierarchical medical system differed significantly by the location area of CHCs（P<0.05）．GPs' assessments for the abilities in the management of difficult basic medical problems，challenging chronic conditions，and working pressure，and for the fulfillment of potential as a GP varied obviously by the type of CHCs（P<0.05）．The mean satisfaction scores evaluated by the GPs for the value of a GP，and payment for GP，as well as for collaborative diagnosis and treatment were all less than 3.0 points，but those for working environment，job supports provided by community（residential） committees and teams were greater than 3.0 points.Conclusion　 GPs in Pudong New Area showed high level of competencies for being a GP，which is conducive to attracting residents to community healthcare facilities to receive first contact services，and to chronic disease prevention and treatment and health management.However，in order to promote the development of family doctor system，GPs self-perceived value as being a GP，and payment for GPs should be improved，and regional differences in these two aspects should be narrowed.

Family Doctor Team Burnout and Influencing Factors：a Survey　

LU Huimin，HUANG Qi，YANG Dandan，MIAO Chunxia，GAO Xiuyin

2019, 22(10): 1223-1228. DOI: 10.12114/j.issn.1007-9572.2019.10.018

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Background　The implementation of family doctor system is an important initiative for improving the primary care services.Family doctor teams take primary responsibilities for delivering family doctor services（FDSs），so the physical and mental health of the team members and quality of their services are the key factors affecting the development of FDSs.There is a lack of domestic research on family doctor system from the perspective of service providers.Objective　To investigate family doctor team burnout and associated factors，providing a theoretical basis for delivering corresponding scientific interventions.Methods　From May to October 2017，all the members（n=600） of family doctor teams in 28 community health centers offering FDSs in Xuzhou were recruited by typical sampling and participated in a questionnaire survey.The Chinese version of Maslach Burnout Inventory-General Survey was adopted to investigate their burnout status.Multivariate stepwise Logistic regression analysis was used to analyze the influencing factors of burnout.Results　Overall，568 cases（94.7%） returned responsive questionnaires，including 165 general practitioners，272 nurses，and 131 public health physicians.The prevalence of burnout was 75.4%（428/568）．Low personal accomplishment was the most common problem〔66.0%（375/568）〕，followed by emotional exhaustion〔51.8%（294/568）〕，then depersonalization〔34.7%（197/568）〕．Multivariate stepwise Logistic regression analysis showed that monthly income，employment form，occupational preference，self-assessed value of being a healthcare worker，and work pressure were the influencing factors of burnout（P<0.05）．Conclusion　The prevalence of job burnout among family doctor team members was high，which was more often manifested as emotional exhaustion and low personal accomplishment.In order to reduce the prevalence of burnout and ensure the stability and development of family medicine workforce，performance evaluation system for family doctors should be improved，social supports should be given to them，and guidance should given to them to innovate the traditional management patterns of health problems.

Intention of Delivering Home-based Healthcare Services and Influencing Factors in Community Healthcare Workers　

SONG Shuang，WU Xin，HU Lingjuan，WANG Shan

2019, 22(10): 1229-1234. DOI: 10.12114/j.issn.1007-9572.2019.00.090

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Background　Some healthcare workers are not willing to deliver home-based healthcare services，due to medical risks and disputes easily occur during the process，and inappropriate staffing，leading to insufficient supply of such services to meet the demand.Objective　To investigate the intention of delivering home-based healthcare services and influencing factors in community healthcare workers，to provide suggestions for the sound development of such services.Methods　From January to February 2018，we conducted a survey in healthcare workers from 30 government-run community health organizations in A District of Beijing.We used a questionnaire in the survey developed by our research group on the basis of review of related studies，which consisted of 4 parts（sociodemographic characteristics，institutional allocation of resources for delivering home-based services，intention of and concerned issues during delivering home-based services）．Binary Logistic regression analysis was used to analyze factors associated with the intention of healthcare workers to provide home-based healthcare services.Results　Overall，275 of the 300 healthcare workers returned responsive questionnaires，obtaining a response rate of 91.7%.The prevalence of intending to deliver home-based healthcare services was 66.5%（183/275）．Logistic regression analysis showed that gender，position，years of working levels of attentiveness in physician-patient disputes，subsidies for delivering home-based healthcare services，and performance evaluation were the factors significantly associated with healthcare workers' intention of providing home-based healthcare services （P<0.05）．Conclusion　The level of intention to provide home-based healthcare services is high in community healthcare workers，but it needs to be improved.In view of this，we put forward the following suggestions：rationally allocating medical resources；increasing the supply of home-based healthcare services；improving the legal protection system，enhancing the healthcare workers' awareness of legal protection，and avoiding the occurrence of physician-patient disputes；improving the incentive and assessment mechanisms for home-based healthcare services.

Progress of Traditional Chinese Medicine Appropriate Techniques in Community-based Treatment of Hypertension Due to Phlegm-dampness Syndrome　

WEI Sining，PENG Wei，ZHANG Qian，GUO Dong，WEI Jianliang，LU Ying，SUN Mi，SUN Zhongyi，LI Nana

2019, 22(10): 1235-1238. DOI: 10.12114/j.issn.1007-9572.2019.00.076

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Hypertension is a chronic disease frequently seen in community-based healthcare settings.Studies show that patients with hypertension associated with phlegm-dampness syndrome accounts for a large proportion of the hypertension cases.Traditional Chinese medicine（TCM） appropriate techniques are easy-to-use and flexible，which help to reduce the adverse effects of western treatment，and improve the constitution and rehabilitation of the patients during stabilizing the blood pressure.In this paper，TCM appropriate techniques for hypertension caused by phlegm-dampness syndrome are summarized on the basis of the review of the related studies.

Curative Effect of Scrapping Combined with Chinese Herbal Hot Compress Therapies on Morning Blood Pressure Surge in Patients with Intermingled Phlegm-blood Stasis Syndrome　

WEI Yehong，XU Min，CHEN Xufeng，DUAN Xiaoqing

2019, 22(10): 1239-1242. DOI: 10.12114/j.issn.1007-9572.2019.10.021

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Background　Comprehensive regulation of the qi-blood to promote yin-yang balance by a kind of medical intervention of scrapping combined with Chinese herbal hot compress therapies and nursing services，may produce good effect on controlling increased morning blood pressure surge（MBPS）．Objective　To explore the effect of scrapping combined with Chinese herbal hot compress therapies on the difference between peak morning systolic blood pressure（SBP） and nocturnal sleep-time SBP，difference between peak morning diastolic blood pressure（DBP） and nocturnal sleep-time DBP，incidence of increased MBPS and clinical TCM syndrome in patients with intermingled phlegm-blood stasis syndrome.Methods　We enrolled 90 hospitalized patients from Department of Geriatrics and Department of Spine Diseases of the Second Affiliated Hospital of Zhejiang Chinese Medical University from June 1，2017 to April 1，2018.They were equally divided into the control group and experimental group by the random number table，receiving once-daily oral administration of amlodipine besylate tablets 5 mg，once-daily oral administration of amlodipine besylate tablets 5 mg combined with scrapping therapy（on every Tuesday，Thursday and Saturday mornings） and Chinese herbal hot compress therapy before going to bed every day.Ambulatory blood pressure monitoring was performed before treatment and at the end of the 1st，2nd and 3rd weeks of treatment.The difference between peak morning SBP and nocturnal sleep-time SBP，difference between peak morning DBP and nocturnal sleep-time DBP，and clinical TCM syndrome were recorded.Results　The mean difference between peak morning SBP and nocturnal sleep-time SBP and that between peak morning DBP and nocturnal sleep-time DBP differed significantly between two groups（P<0.05）．The difference between peak morning SBP and nocturnal sleep-time SBP and that between peak morning DBP and nocturnal sleep-time DBP between the groups varied significantly by time point（P<0.05）．Treatment regimen and duration had interactive effects on the difference between peak morning SBP and nocturnal sleep-time SBP and that between peak morning DBP and nocturnal sleep-time DBP （P<0.05）．The experimental group showed lower incidence of increased MBPS at the end of the 1st，2nd and 3rd weeks of treatment compared with the control group（P<0.05）．The mean TCM syndrome score varied significantly between the groups（P<0.05）．The TCM syndrome score differed significantly between the groups by time point（P<0.05）．Treatment regimen and duration had interactive effects on the TCM syndrome score（P<0.05）．Conclusion　For patients with intermingled phlegm-blood stasis syndrome and increased MBPS，oral administration of amlodipine besylate tablets in combination with scrapping and Chinese herbal hot compress therapies can significantly reduce the blood pressure，and decrease the incidence of increased MBPS as well as improve the clinical TCM syndrome.

Social Network Status and Influencing Factors in Community-dwelling Elderly Stroke Patients　

YANG Jing，CHEN Xin，BAI Zhongliang，TAO Shengsheng，PAN Xinxiang，HU Zhi，QIN Xia

2019, 22(10): 1243-1246. DOI: 10.12114/j.issn.1007-9572.2019.00.092

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Background　As a disease with high prevalence and disability rate，stroke seriously impairs the patients' quality of life，leading to a smaller social network.Objective　To explore the social network status and influencing factors in community-dwelling elderly stroke patients.Methods　By multistage random sampling，350 elderly stroke patients and 350 age-matched healthy adults were selected and received a questionnaire survey from September to December，2017.General Information Form was used to investigate the sociodemographic characteristics.The Chinese version of Stroke Impact Scale（SIS） was adopted to assess the impact of stroke on quality of life.The Chinese version of Social Network Scale was employed to measure the number and frequency of social contacts with friends and family members and social organizations，and the perceived social support received from these sources.Multiple linear regression was used to analyze the influencing factors of the above-mentioned three aspects.Results　The average scores of the number and frequency of social contacts with friends and family members and social organizations，and the perceived social support received from these sources in the stroke participants were significantly lower than the healthy participants （P<0.05）．Multiple linear regression analysis found that educational attainment，average monthly household income，and emotion status were influencing factors of the number of social contacts with friends and family members and social organizations.Marital status，average monthly household income，memory and thinking，and mobility were influencing factors of the frequency of social contacts with friends and family members and social organizations.Average monthly household income，mobility，and communication were influencing factors of perceived social support received from the sources.Conclusion　Stroke may cause changes in the social network of elderly patients in the community，and the influencing factors of different type of social network are dissimilar.In order to improve the mental status and quality of life of elderly stroke patients，national，social and hospital organizations should co-deliver targeted interventions to them according to the specific factors affecting their social network.

Case Studies of Mental Health in Chinese Communities：Love and Depression in Adolescents 　

ZHAO Haohao，LIANG Junping，LI Jianzhong

2019, 22(10): 1247-1250. DOI: 10.12114/j.issn.1007-9572.2019.00.093

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After entering puberty，there are some new patterns of relationships between boys and girls.They both begin to realize gender differences and gradually become interested in their opposite sex and even fall in love with them.In addition，with the development of mental abilities and the expansion of life experience，their emotional feelings and forms of expression are no longer as monotonous as before，and they are prone to have larger emotional fluctuations under the stimulation of social and psychological factors.The paper aims to report the psychological treatment process of a 17-year-old male patient with depression in his love，in order to improve community doctors' ability of psychological counseling and treatment.

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