Chinese General Practice

General Practice Workforce in China：Development，Challenges and Outlooks　

YANG Hui，HAN Jianjun，XU Yanli

2019, 22(19): 2267-2279. DOI: 10.12114/j.issn.1007-9572.2019.00.351

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The last 10 years of new healthcare reform to date is a positive stage of active and rapid exploration of human resource development of general practitioners（GPs） in China．At present，the number of GPs in China is significantly growing and the GP training has made positive progress．However，there are still some aspects that need further and continuous improvement．Based on brief review of history of the last decade and current situation of the workforceof Chinese general practice，this paper analyses the existing problems of its human resource development and gives some specific recommendations．The authors believe that identifying orientation of primary care human resource，the quality and performance management of GPs，the number and quality gaps of GPs between urban and rural areas and across regions，the structure of general practice supervisors and mentors，and medical-educational dual abilities of trainers，the discipline and academic construction of general practice，and the quality and innovation of human resource development and services of general practiceare the key concerns for further development of general practice in China． Exploring general practice in the early stage of medical education for students，comprehensive measures for the sustainable and healthy human resource development of GPs in China may consider to take the needs of multiple dimensions as the orientation to establish the blueprint and roadmap of general practice education in order to pay full attention． To strengthen the discipline academic constructionand leadership and mentor development，to enhance scientific research in areas of general practice，and to support the training of clinical supervisorsof general practiceare including but not limited to the recommendations．

Operation Efficiency and Influencing Factors of Primary Healthcare Institutions in China　

HUANG He，HU Linlin，LIU Yuanli

2019, 22(19): 2280-2285.

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Background　Primary healthcare institutions belong to primary healthcare system of China's healthcare system，which assume the responsibilities for delivering essential medical care and public health services and play an important role in improving residents' health status and reducing medical costs.At present，there is a lack of research on the efficiency of domestic primary healthcare institutions at the national level.Objective　This paper analyzed the operational efficiency and influencing factors of primary healthcare institutions in China.Methods　Data about administrative features，internal management and technical factors，and input-output indicators of 322 primary healthcare institutions participated in the project of "Comprehensive Evaluation of Service Capacity and Quality of Primary Healthcare Institutions" implemented from November 2016 to May 2017 were collected.Data envelopment analysis was used to quantify the operational efficiency value of these institutions.Multiple linear regression analysis was performed to analyze the influencing factors of the efficiency.And based on this，targeted facilitation strategies were put forward.Results　The average scale efficiency，pure technical efficiency and overall technical efficiency of the 322 primary healthcare institutions were（0.79±0.23），（0.52±0.25），（0.42±0.26），respectively.Multiple linear regression analysis showed that factors influencing the scale efficiency of the institutions were regional location，financial subsidy mode，and number of children under 6 years of age in the service area（P<0.05）．Regional location，whether setting up a surgery department，whether using an electronic medical record system，and whether using the rate of reaching the national public health performance standards as a reference parameter for calculating the performance-related pay were associated with the pure technical efficiency of the institutions（P<0.05）．Regional location，and number of children under 6 years of age in the service area，whether setting up a surgery department were associated with the overall technical efficiency of the institutions（P<0.05）．Conclusion　The current mode of financial subsidy is suggested to gradually change to the government purchasing-based mode according to specific services.Setting up a surgery department may produce negative influence on the scale efficiency，but payment reform may improve the efficiency of primary healthcare institutions.

Enlightenment of the UK Essential Healthcare System and Its Reform to General Practice Development in China　

SHEN Shili，YU Xiaosong

2019, 22(19): 2286-2292. DOI: 10.12114/j.issn.1007-9572.2019.00.373

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Primary care is the foundation of National Health Service（NHS）in the UK.Because recently there is an insufficient number of general practitioners to meet public healthcare needs，NHS launched a comprehensive reform，formulating two policies，Five Year Forward View and General Practice Forward View.On the basis of reviewing the latest related research in the UK，this paper gives a comparative analysis of the UK essential healthcare system and its reforms in recent five years，and the general practice development in China，with a view to bringing enlightenment to domestic general practice development.

The Curse of Relevance-Depletion Syndrome#br#

Leon Piterman，ZHOU Hailing，LIU Yang，YANG Hui

2019, 22(19): 2293-2295. DOI: 10.12114/j.issn.1007-9572.2019.00.242

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Problems and Countermeasures in the Development of Contracted Family Doctor Services in Achieving Healthy China Goals　

FU Yingjie，WANG Jian，YU Lexin，YAN Weihua，KONG Yuejia

2019, 22(19): 2296-2300. DOI: 10.12114/j.issn.1007-9572.2019.00.352

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As one important measure for achieving the medical reform launched in 2009 in China，the delivery of contracted family doctor services plays a key role in the realization of initial consultation in primary care，promotion of hierarchical medical system，and transformation of healthcare delivery models.On the basis of the reviewing of the development and related literature of contracted family doctor services in China，from three perspectives（supplier，demander and implementation mechanism），we analyzed the following major problems existing in the development of the services during the implementation of the Healthy China Initiative：insufficient quantity and inadequate quality of primary healthcare resources，residents' unsatisfactory acceptance of contracted family doctor services，inadequate growing and training mechanisms for general practitioners（GPs），lack of performance assessment and incentive mechanisms for GPs，insufficient strength of medical insurance payment mechanism in guiding patients' healthcare seeking in primary care，and imperfect publicizing mechanism and information construction for contracted family doctor services.Accordingly，we put forward the following suggestions：further enhancing the service capacities of primary healthcare institutions，improving the policy support for the implementation of contracted family doctor services，establishing and improving the performance assessment and incentive mechanisms for GPs，and actively promoting the development of Internet-based community healthcare.

Suzhou Mode for the Delivery of Contracted Family Doctor Services　

WANG Qingqing，HU Yihe，WANG linchi，ZHANG Zhengji

2019, 22(19): 2301-2307. DOI: 10.12114/j.issn.1007-9572.2019.00.180.

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The implementation of contracted family doctor services（CFDSs） is an important breakthrough initiative to promote the development of the tiered healthcare delivery system，and is a major manifestation of strategic changes in service delivery modes of community healthcare settings.On the basis of the supportive policies for promoting the development of CFDSs in Suzhou，we summarized and analyzed the primary actions for the delivery of such services in this city，such as the "531" plan of actions for the achievement of healthy citizens objectives，and the construction of regional healthcare consortiums，featured specialties，and community informatization.By the end of 2017，the overall contracting rate in Suzhou reached 31.4%，in particular，it was 62.83% in priority groups.And by the end of 2018，the city owned a total of 3 788 general practitioners（GPs），and had 3.53 GPs per 10 000 permanent residents.Meanwhile，Suzhou has formed its delivery models for CFDSs initially and has made remarkable achievements in chronic disease control and prevention.However，the incentive mechanism for the implementation of CFDSs is still not complete，and the developments of key disease screening projects for contracted residents are unbalanced，which will be improved by further efforts by Suzhou to better the development of CFDSs specifically.

Implementation Status of the "1+1+1" Type of Contracted Family Doctor Services in Shanghai：a Qualitative Study　

HUANG Cuiling，SHOU Juan，LI Yaling，LIU Yao，LI Nana

2019, 22(19): 2308-2313. DOI: 10.12114/j.issn.1007-9572.2019.00.074

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Background　In order to promote the development of the hierarchical medical system，and its synergic development with family doctor system，Shanghai launched a round comprehensive reform of the community-based health care system in March 2015，and began to facilitate the implementation of "1+1+1" type of contracted family doctor services（"1+1+1" type of contracts）．Objective　To explore the implementation status of the "1+1+1" type of contracts in Shanghai，and put forward suggestions to the existing problems，offering choices for further development of contracted family doctor services delivered by this pattern.Methods　We conducted this study in 6 community health centers（CHCs）in Shanghai from July to September 2017.We carried out semi-structured individual interviews in 6 medical section chiefs（1 from each CHC）for collecting data about the implementation status of the "1+1+1" type of contracts（including long-term prescriptions，extending of prescriptions，making an appointment with the doctor from a higher level hospital，and referrals），and in 18 family doctors from the CHCs for collecting information concerning problems encountered during the implementation of the "1+1+1" type of contracts and corresponding suggestions.Moreover，we obtained the items of the contractual services from the iPAD of the medical section chiefs after getting permission.The electronic data and interview results were summarized，inducted and classified using theme and content analyses.Results　By the end of July 2017，the rate of residents who signed a "1+1+1" type of contract with the CHCs was 9.47%，and in the group aged 60 years or over，this rate was 51.35%.Contracting was mainly conducted in the outpatient departments of all the CHCs，and also in family doctor studios in 2 of the CHCs.In order increase the contracting rate，all the CHCs publicized the preferential policies for such services mainly by informing the residents during their visiting and educating residents with the assistance of the neighborhood committees.Moreover，they wrote long-term prescriptions and extended prescriptions.And in 5 CHCs，residents could make appointments with the doctor from a higher level hospital and could be transferred.The contractual services mainly included essential diagnosis and treatment of diseases，convenient dispensing，appointment and referral，health management，chronic disease management，health counseling，and control of medical expenses.The major problems encountered during the implementation of the "1+1+1" type of contracts were difficult control of the percentage of reimbursed drugs（ratio of cost of reimbursed drugs to the total medical expenses），inefficiencies in making appointments and transferring via the green channel，incomplete supportive policies，inappropriate family doctor performance evaluation indicators，effort-reward imbalance in family doctors，and phenomenon of some contracted residents making no appointments.Conclusion　The "1+1+1" type of contracts have been implemented in various CHCs in Shanghai gradually.And some achievements have been made in increasing the contracting rate，implementation of the preferential policies and services.In order to promote the implementation of such services to facilitate the development of the hierarchical medical system，the publicity of such services should be enhanced，the supportive policies should be improved，the cooperation between higher level and lower level hospitals should be strengthened，and family doctor performance evaluation indicators should be developed reasonably.

Empirical Research on Contracted Family Doctor Services in Suburbs of Beijing in the Context of Healthy Rural Strategy　

LIU Lanqiu，CAO Wenjun，WANG Xiaoyan，DONG Yi，JIA Dongmei

2019, 22(19): 2314-2318. DOI: 10.12114/j.issn.1007-9572.2019.00.345

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At present，the contracted family doctor services in the suburbs of Beijing lacks clear and specific legal protection. Lack of attention has been paid to the characteristics of rural areas in China and the role of rural doctors.Meanwhile，it does not clearly clarify the role of township health centers and village health clinics，which embodies the poor health management for contracted residents centered by general practitioner teams in township hospitals，featured by the contracting mode of "contracting based on villages" and health management through regular simple physical examination and health lectures.It is necessary to promote legislation process for basic medical and health management in Beijing，so as to provide legal basis for the contracted family doctor services in suburbs of Beijing.Rural doctors who meet certain requirements will be included in the contract team of family doctors，to reasonably define the functions of rural doctors and community medical staff in the contract service and build a close family doctor service model in the suburbs of Beijing.

Patients' Satisfaction and Influencing Factors of Critical Illness Insurance Services Delivered by Different Government Outsourcing Models　

WANG Minghui，LU Guangchun

2019, 22(19): 2319-2324. DOI: 10.12114/j.issn.1007-9572.2019.00.374

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Background　China's local governments have been outsourcing critical illness insurance services for many years and it is urgent to evaluate the implementation effectiveness.Satisfaction is one of the important measurement aspects.However，domestic research about patients' satisfaction with such services is insufficient.Objective　To perform a comparative analysis of patients' satisfaction with critical illness insurance services delivered by different government outsourcing models and the associated factors，providing a reference for relevant government agencies to improve the implementation policies and strategies.Methods　Data were collected from the critically ill patients information database of T City，Hebei Province.By use of convenience sampling，813 cases who were included in the database from 2014—2016 were selected，and were given a telephone-based or WeChat survey for obtaining their satisfaction level with critical illness insurance services delivered by different government outsourcing models.Multiple linear regression analysis was used to analyze the associated factors for the satisfaction level.Results　Patients with critical illness insurance for working urban residents（CIIWUR）obtained lower mean total score of satisfaction with the insurance，lower mean scores of satisfaction with the standard for pooling funds for the insurance，and satisfaction with the reimbursement procedure，but higher mean score of satisfaction with the reimbursement ratio compared with those with critical illness insurance for urban and rural residents（CIIURR）（P<0.05）．Multiple linear regression analysis showed that mean monthly income and purchase of commercial critical illness insurance were associated with satisfaction with the standard for pooling funds for the insurance in patients with CIIWUR（P<0.05）；education level，awareness level of the critical illness insurance，and purchase of commercial critical illness insurance were associated with satisfaction with the reimbursement procedure in patients with CIIWUR（P<0.05）；mean monthly income and awareness level of the critical illness insurance were associated with satisfaction with the reimbursement ratio in patients with CIIWUR（P<0.05）；awareness level of the critical illness insurance and purchase of commercial critical illness insurance were associated with satisfaction with the CIIWUR services by the insurance company in patients with CIIWUR（P<0.05）．Mean monthly income was associated with satisfaction with the standard for pooling funds for the insurance in patients with CIIURR（P<0.05）；purchase of commercial critical illness insurance and hospitalization due to illness or injury in the past year were associated with satisfaction with the reimbursement procedure in patients with CIIURR（P<0.05）；age，mean monthly income，purchase of commercial critical illness insurance and hospitalization due to illness or injury in the past year were associated with satisfaction with the reimbursement ratio in patients with CIIURR（P<0.05）．Conclusion　The reimbursement of critical illness insurance greatly contributes to patients' total satisfaction，but different outsourcing models of governments have different dimension satisfactions.In view of this，it is encouraged to share the advantages of the two government outsourcing models and to collaboratively overcome their limitations.Moreover，the increase of insured persons' satisfaction level should be listed as one of the value goals of the government outsourcing critical illness insurance services.

Verification of a General Practitioner Services Effectiveness Evaluation in Shanghai：an Empirical Study　

HUANGFU Huihui，LI Hongyan

2019, 22(19): 2325-2331. DOI: 10.12114/j.issn.1007-9572.2019.00.195

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Background　The general practitioner （GP） is the key link to optimize the community-based healthcare system.GP services can achieve residents' approval and satisfaction，and play an important role in ensuring the improvement of residents' health.Objective　To verify a GP services effectiveness evaluation in Shanghai to investigate the effectiveness of GP services in this city，offering a reference for the improvement of GP system and GP services quality in this city.Methods　In order to ensure the scientificity and rationality of the evaluation of the effect of GP services implementation, this paper combines the analytic hierarchy process with factor analysis and uses the improved fuzzy comprehensive evaluation method to conduct an empirical study on Shanghai, a typical pilot area of the current general practitioner system.Results　The comprehensive weight of service content, service level, service attitude and service environment of the secondary indicators of the fuzzy comprehensive evaluation method are 0.207 9, 0.358, 0.279 8 and 0.153 4, respectively.According to the results of empirical research, 21.62% of the people are satisfied with the service of GP, 31.77% are satisfied, 24.87% are general, 10.04% are unsatisfactory, and 10.70% are unsatisfactory. Conclusion　The service level and attitude of GP play an important role in the effect of service implementation. The final evaluation grade of the implementation effect of general practitioner service in Shanghai is "satisfactory".The training of GP should be strengthened to improve their service ability and level, so as to enhance the quality of general practitioner services.

Construction of an Exercise Rehabilitation Program for Obese People after Bariatric Surgery　

REN Ziqi，ZHANG Tianzi，YANG Ningli，LIU Ruiping，LIANG Hui，XU Qin

2019, 22(19): 2332-2339. DOI: 10.12114/j.issn.1007-9572.2019.00.240

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Background　For severe obese people，bariatric surgery is the most effective choice，but not all patients can achieve satisfied weight loss after the surgery.As an important component of postoperative rehabilitation and lifestyle management，exercise rehabilitation is of great significance in improving postoperative weight loss related outcomes.However，in China，there is lack of a scientific and standardized exercise rehabilitation guideline or consensus to guide clinical practice.Objective　To construct a scientific and practical exercise rehabilitation program suitable for Chinese obese population after bariatric surgery.Methods　We systematically searched the articles about exercise rehabilitation after bariatric surgery from the establishment of the database to 28 December，2017，and extracted useful contents from the eligible ones after a quality assessment，then formulated an initial version of the exercise rehabilitation program for Chinese obese people after bariatric surgery.After this，we conducted two rounds of Delphi consultation among 16 experts from January to Febnary 2018，and according to the results，we revised the initial version，and developed the final version.Results　The response rates for the first，and second consultations were 88.9%（16/18）and 100.0%（16/16），respectively，and the authority coefficient of experts was 0.90.Kendall's coefficients of concordance in the first，and second consultations were 0.343 and 0.453 respectively（P<0.01）． The final program includes 3 primary indicators （screening and assessment，exercise prescription formulation，follow-up and education），10 secondary indicators and 48 tertiary indicators.Conclusion　Our exercise rehabilitation program conducted on the basis of literature review and Delphi consultation is scientific and practical，which may be useful in guiding the exercise rehabilitation of patients after bariatric surgery.

Clinical Characteristics of Hypertriglyceridemic Waist Phenotype and Its Relationship with Pre-diabetes and Diabetes Mellitus　

WANG Xiaohong，ZHU Shuangshuang，LIU Aiqun，LIU Qin，LI Yongqiang，XIONG Zhongxiang，GUO Ze，ZOU Hequn

2019, 22(19): 2340-2344. DOI: 10.12114/j.issn.1007-9572.2019.00.375

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Background　In recent years，the incidence of pre-diabetes and diabetes in China has increased year by year.But the incidence may be reduced by early detection of related risk factors and timely interventions.The relationship of hypertriglyceridemic waist phenotype（HTGW）and blood sugar has not yet been determined.Objective　To explore the relationship of HTGW with pre-diabetes and diabetes mellitus.Methods　 By use of multi-stage stratified cluster random sampling，2 142 community-dwelling residents aged 18-75 years were recruited from Wanchai Town，Xiangzhou District，Zhuhai City，from June to October 2012.By waist circumference（WC）and serum triglyceride（TG）level，they were stratified into three groups：group 1（WC≤90 cm in males or ≤85 cm in females with TG<2.0 mmol/L），group 2（WC≤90 cm in males or ≤85 cm in females with TG ≥2.0 mmol/L，WC>90 cm in males or >85 cm in females with TG<2.0 mmol/L），group 3（WC>90 cm in males or>85 cm in females with TG≥2.0 mmol/L）．Clinical features were compared between the three groups.The relationship of HTGW with pre-diabetes and diabetes mellitus was analyzed by Logistic regression.Results　 Of the 2 142 participants, 169 were excluded because of lacking data of triglyceride or waist circumference. Finally, 1 973 participants were enrolled, including 172 patients with diabetes and 143 patients with prediabetes. And 1 141 patients were in the group 1; 624 patients were in the group 2; and 208 patients were in the group 3.Compared with group 1，group 2 showed higher mean age，male ratio，rates of hypertension，pre-diabetes，diabetes mellitus，and drinking，mean systolic blood pressure（SBP），diastolic blood pressure（DBP），BMI，fasting blood glucose（FBG），C-reactive protein（CRP），total cholesterol（TC），TG，low-density lipoprotein cholesterol（LDL-C），serum creatinine（Scr），and serum uric acid，and longer mean WC，but lower percent of completing high school or higher levels of education，and lower mean high-density lipoprotein cholesterol（HDL-C）（P<0.05）．In comparison with groups 1 and 2，group 3 demonstrated higher mean age，rates of hypertension，pre-diabetes，diabetes mellitus，smoking，and drinking，SBP，BMI，FBG，TC，TG，Scr，and serum uric acid，and longer WC，but lower mean HDL-C（P<0.05）．Male ratio，percent of completing high school or higher levels of education，mean DBP and CRP levels were higher in group 3 than those of group 1（P<0.05）．Analysis with unadjusted Logistic regression models showed that age，sex，hypertension history，smoking，drinking and physical exercise were associated with pre-diabetes and diabetes（P<0.05）．Moreover，analysis with adjusted Logistic regression models indicated that age，sex，hypertension history，smoking，drinking，physical exercise，BMI，and HTGWP were associated with pre-diabetes and diabetes（P<0.05）．Conclusion　HTGWP is closely related to diabetes mellitus and pre-diabetes.So increased attention should be given to lipid and WC control in priority groups to reduce the prevalence of pre-diabetes and diabetes mellitus，and the occurrence of cardiovascular events.

Acceptance and Associated Factors of 24-hour Ambulatory Blood Pressure Monitoring in Patients with Standardized Hypertension Management　

YANG Danhong，LIU Rui，GU Liyu，GAN Chunxing

2019, 22(19): 2345-2350. DOI: 10.12114/j.issn.1007-9572.2019.00.133

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Background　24-hour ambulatory blood pressure monitoring（ABPM） can reflect the fluctuation of blood pressure during the day，which is of great significance for the diagnosis，treatment，prognosis and research of hypertension.However，it is still not widely used in residents.Objective　To examine the acceptance and associated factors of 24-hour ABPM in hypertensive patients，providing recommendations for the promotion of 24-hour ABPM in patients with standardized hypertension management.Methods　This study was conducted from June to July 2018.Participants were hypertensive patients receiving management services from Jinshan Industrial Park Community Health Center selected by convenience sampling，including 169 who received 24-hour ABPM service in the past year，and 169 hypertensive patients did not.Historical data were collected.And a questionnaire survey was used to obtain both groups' knowledge about hypertension，behavioral risk factors for hypertension，current clinical manifestations and related treatments，and attitudes toward 24-hour ABPM.Logistic regression was used to determine the factors associated with the acceptance of 24-hour ABPM.Results　Patients receiving 24-hour ABPM reported that 24-hour ABPM devices were not convenient to carry and operate，and they were not sure whether such monitoring was beneficial to blood pressure control，and they were less willing to continue to undergo 24-hour ABPM.Those not receiving 24-hour ABPM service reported that they did not receive this service mainly due to inconvenience〔58.6%（99/169）〕，having no need of such service because of owning normal blood pressure〔30.2%（51/169）〕，or having no time〔25.4%（43/169）〕.Patients' understanding of diagnostic criteria，treatment methods and treatment options for hypertension，grandfather/grandfather history of hypertension，frequency of mental stress，whether or not to carry out body mass control，and hypertension-related symptoms were associated with the acceptance of 24-hour ABPM.Conclusion　Recommended facilitation strategies are as follows：providing patient education about 24-hour ABPM from perspectives of hypertensive knowledge，daily behavioral habits associated with hypertension，clinical manifestations and treatment of hypertension，and simplifying the operating procedure of 24-hour ABPM devices.

Ten-year Average Risk Assessment of Cardio-cerebrovascular Diseases and Fundus Lesions in Chronic Disease Patients　

ZHANG Jiasheng，ZHANG Lili，ZHOU Weiguo，YUAN Jianmei，WANG Haizhou，XU Jufang，ZHENG Xiaoying

2019, 22(19): 2351-2355. DOI: 10.12114/j.issn.1007-9572.2019.00.282

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Background　Cardiovascular and cerebrovascular diseases seriously threaten people's health.There are a few studies on ischemic cardiovascular disease，but few studies about atheroselerotic cardiovascular disease and fundus lesions.Objective　To investigate the relationship between 10-year risk of cardio-cerebrovascular diseases（CCVD）and fundus lesions in chronic disease patients from a community.Methods　From February to August，2017，by using stratified random sampling，2 080 patients with chronic diseases（consisting mainly of hypertension and diabetes）who received management from a community health center in Suzhou were enrolled.Risk of CCVD was assessed by the CCVD risk prediction model in the Chinese Guidelines for the Prevention of Cardiovascular Diseases（2017）．According to the assessment results，patients were divided into low-risk group（n=227），medium-risk group（n=919） and high-risk group（n=934）．The relationships between different levels of risks for CCVD and fundus lesions were analyzed.Results　The rates of smoking，overweight or obesity，hyperlipidemia，hypertension and diabetes were 22.74%（473/2 080），67.74%（1 463/2 080），35.58%（740/2 080），94.28%（1 961/2 080） and 24.76%（515/2 080），respectively.Males had higher prevalence rates of smoking，and overweight or obesity than females（P<0.05）．The prevalence rates of smoking，overweight or obesity，hypertension，and diabetes differed significantly by age group（P<0.05）．The prevalence rates of 10-year risk of CCVD in low-，medium- and high-risk groups were 10.91%（227/2 080），44.18%（919/2 080） and 44.90%（934/2 080），respectively.The prevalence rate of risk of CCVD varied obviously by sex，age，smoking，BMI，blood lipid level，hypertension history，and diabetes history（P<0.05）．Keith-Wagener-Barker classification showed that fundus was normal in 93 cases（4.47%），grade Ιin 899 cases（43.22%），grade Ⅱ in 950 cases（45.67%），grade Ⅲ in 127 cases（6.11%） and grade Ⅳ in 11 cases（0.53%）．The overall prevalence rate of fundus abnormalities was 52.31%（1 987/2 080）．And the prevalence rates of fundus abnormalities in low-，medium- and high-risk groups were 45.37%（103/227），51.25%（471/919），and 55.03%（514/934），respectively，showing significant difference（χ2=7.564，P=0.023）．The 10-year risk of ASCVD in chronic disease patients was 22.7%（10.91%），91.9%（44.18%） and 93.4%（44.90%） respectively.The detection rate of fundus abnormalities in high-risk group was higher than that in low-risk group〔OR=1.473，95%CI（1.101，1.972），P=0.009〕.Conclusion　Chronic diseases are associated with higher 10-year risk of CCVD.Medium-risk and high-risk of CCVD are associated with increased risk of fundus lesions.

Fall Efficacy and Its Influencing Factors among the Elderly in Nursing Homes　

YAN Wen，ZHANG Xuemei，CHEN Qian

2019, 22(19): 2356-2360. DOI: 10.12114/j.issn.1007-9572.2019.00.324

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Background　The incidence of fear of falling is high among the elderly in nursing homes and inpatient department.Because of fear of falling，the elderly may impose restrictions on their activities and form a sedentary lifestyle，which will reduce their physical function and increase the probability of falling，social isolation，anxiety，depression and hospitalization.Objective　To investigate the fall efficacy and its influencing factors among the elderly in nursing homes in Chengdu.Methods　A total of 300 elderly people from 3 nursing homes in Chengdu were selected by convenience sampling method from August to September，2017.General information questionnaire，Modified Fall Efficacy Scale，Barthel Index Scale，Elderly Fall Environmental Safety Factor Scale and the 12-items Short Form Health Survey（SF-12）were used to investigate subjects.Multivariate linear stepwise regression analysis was used to analyze the influencing factors of fall efficacy of the elderly in nursing homes.Results　A total of 278 questionnaires were collected，with effective recovery rate of 92.7%.The elderly fall efficacy were（106.62±34.22）points；Multiple linear stepwise regression analysis showed that fall history in the past one year，activity restriction in daily life，living with or without spouse，24-hour sleep time，Barthel index score，toilet environment score of Elderly Fall Environmental Safety Factor Scale，PCS score and MCS score of SF-12 were influencing factors of fall efficacy among the elderly.Conclusion　The fall efficacy of the elderly in nursing homes in Chengdu is moderate.Individualized intervention should be formulated for different elderly to improve their fall efficacy，thus preventing falls.

Effect of Low-glycemic-load Dietary Intervention during Pregnancy on Gestational Weight Gain，Birth Weight and Length：a Randomized Controlled Trial　

LING Yike，LI Li，WANG Haiqing，XIE Dongqin，MA Wanwan

2019, 22(19): 2361-2364. DOI: 10.12114/j.issn.1007-9572.2019.00.191

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Background　Gestational weight gain is increasingly prevalent，yet the effects of various nutritional management regimens remain contentious.It has been suggested that low-glycemic-index diet or low-glycemic-load（LGL） diet may stimulate greater weight loss than other weight reduction diets.Objective　To observe the effects of LGL diet on gestational weight gain，to provide a reference for rational diet selection during pregnancy.Methods　200 pregnant women undergoing antenatal examinations in a maternal and child health hospital in Anhui Province from November 2015 to July 2016 were enrolled.They were evenly divided into intervention group and control group by a random number table，receiving LGL diet based on the prepregnancy BMI and amount of reasonable weight gain at each stage of pregnancy from the first antenatal examination to the delivery，and receiving no interventions，respectively.Baseline data，and dietary intake at each stage of pregnancy were collected by a survey with self-administered Basic Information Questionnaire，and Three-day Food Intake Form developed by our research group，respectively.According to the survey results，glycemic index（GI）and glycemic load（GL）were calculated.Gestational weight gain，and the newborn's birth length and weight，and Apgar score were recorded.Results　Six cases were lost in the control group, and three in the intervention group.Finally 94 cases and 97 cases were included in the control group and the intervention group, respectively, in the study.Both average GI and GL were similar in the two groups in the early pregnancy（P>0.05），but during middle and late pregnancy，they were much lower in the intervention group（P<0.05）．There was no significant difference in weight gain between the two groups before（26±2）weeks of gestation（P>0.05）．Compared with the control group，intervention group showed less average total weight gain，lower percentage of having excessive gestational weight gain，lower average amounts of weight gain before（34±2）weeks of gestation，and before delivery（P<0.05）．There were no significant differences in average birth weight，length and Apgar score between the two groups（P>0.05）．Conclusion　LGL dietary intervention can slow down the rate of weight gain in the middle and late pregnancy，and reduce the total gestational weight gain.

Rehabilitation Needs and Influencing Factors in Community-dwelling Schizophrenia Patients in Shanghai　

GE Congcong，ZHANG Weibo，YANG Li，ZHANG Qiong，CAI Jun

2019, 22(19): 2365-2369. DOI: 10.12114/j.issn.1007-9572.2019.00.376

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Background　Most patients with schizophrenia return to the community to continue to recover when the symptoms during an acute schizophrenic episode being relieved or improved.However，in China，the utilization rate of community mental health resources is not high，community-based rehabilitation services can not meet the growing rehabilitation needs of patients，and patients are dissatisfied with such services.Objective　To investigate the rehabilitation needs and influencing factors among community-dwelling schizophrenic patients in Shanghai，providing a basis for theoretical research and implementation of mental health rehabilitation.Methods　From December 2016 to July 2017，a survey was conducted in a multi-stage stratified cluster random sample of 2 285 registered schizophrenic patients receiving community-based mental health management from 249 residential（village）committees in 18 districts of Shanghai.Survey tools include self-developed General Personal Information Questionnaire，and Disease Characteristics and Treatment Questionnaire，and Wuxi version of the Rehabilitation Needs Questionnaire for People with Schizophrenia（PRNQ-S-WX）．The total score of rehabilitation needs was compared by personal characteristics.Influencing factors of rehabilitation needs were analyzed by stepwise multiple linear regression.Results　The mean total score of rehabilitation needs assessed by all the participants was（2.93±1.07）．The top-ranked six factors in terms of mean evaluation score were social security（3.57±1.42），emotional management（3.50±1.42），treatment compliance（3.47±1.43），symptom management（3.39±1.39），mental health knowledge（3.33±1.34），psychosocial care（3.12±1.49）．The total score of rehabilitation needs varied significantly by gender，place of residence（urban or suburban area），education level，living status（independent or not），main caregivers，employment status，financial support from family，mean monthly expenditure on schizophrenia，prevalence of having disability certificate，family history，schizophrenia，medication status，outpatient follow-up and psychiatric symptoms relief（P<0.05）．The total score of rehabilitation needs was negatively correlated with age and duration of schizophrenia（r valuces were -0.230，0.139；P<0.05），but was positively correlated with the number of schizophrenia relapses，the number of rehabilitation services received and the score of service satisfaction（r valuces were 0.113，0.469，0.330；P<0.05）．Stepwise multiple linear regression analysis showed that place of residence，employment status，financial support from family，mean monthly expenditure on schizophrenia，outpatient follow-up，age，number of schizophrenia relapses，number of rehabilitation services received，and satisfaction with rehabilitation services were associated with the rehabilitation needs in schizophrenia patients（P<0.05）．Conclusion　Schizophrenic patients in the community in Shanghai have many various domains of rehabilitation needs.Their rehabilitation needs are influenced by place of residence，employment status，financial support from family，monthly expenditure on schizophrenia，outpatient follow-up status，age，number of schizophrenia relapses，number of rehabilitation services received，and satisfaction level with rehabilitation services.In view of this，social and government departments should make full use of the existing resources to provide personalized and diversified services according to the patient's situation.

Anxiety Status and Influencing Factors among Family Members of Patients with Mood Disorders　

LYU Hao，WAN Ailan，YU Junhai，SUN Weiming，YANG Zhaoxi，WU Guojiang

2019, 22(19): 2370-2374. DOI: 10.12114/j.issn.1007-9572.2019.00.197

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Background　The number of people with mood disorders is increasing.Family member who are closely related to them are subject to both material and mental pressures and are prone to negative emotions such as anxiety，depression and so on.Objective　To investigate the anxiety status of family members of patients with mood disorders and analyze its influencing factors.Methods　We conducted a questionnaire survey from November 2016 to October 2017.Participants were 128 cases selected from the family members of the mood disorders patients from Department of Psychosomatic Medicine，the First Affiliated Hospital of Nanchang University by convenience sampling.We used the Zung Self-Rating Anxiety Scale（SAS），Simplified Coping Style Scale（SCSQ），family APGAR index，and self-made General Information Questionnaire to collect the corresponding data.Results　56.2%（72/128） of the family members of patients had different degrees of anxiety，with an average score of SAS of（56.00±11.47）．The level of anxiety differed significantly in them by sex，place of residence，education level，medical treatment form and expense payment form of the patient，family APGAR index，family care and coping style（P<0.05），but not by the type of mood disorder suffered by the patient，and their relationship with the patient（P>0.05）．Multivariate Logistic regression analysis showed that male and positive coping styles were associated with decreased risk of anxiety in family members of the patients，while low education level，paying out-of-pocket for medical care， and very low family APGAR index were associated with increased risk of anxiety in them（P<0.05）．Conclusion　More than half of the family members of patients with mood disorders have anxiety.Male and positive coping style are protective factors of anxiety，low education level，whereas paying out-of-pocket for medical care， and very low family APGAR index are its risk factors.

Effectiveness of Learning with Mobile "100-day Training" APP among General Practitioners in Beijing：an Empirical Study　

ZHANG Lei，ZHANG Ruiying，MA Li，WANG Chen

2019, 22(19): 2374-2379. DOI: 10.12114/j.issn.1007-9572.2019.00.377

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Background　The mode of continuing medical education for general practitioners（GPs）in China is not perfect enough.But to find a new mobile terminal micro-learning mode，which can be used as an effective alternative mode of continuing medical education for GPs，many problems need to be solved.Objective　To explore whether mobile micro-learning mode can be used as an effective means for continuing medical education for GPs.Methods　A database was established based on the learning data of 5 033 GPs from Beijing who participated in the micro-learning with mobile "100-day Training" APP from 18 September to 26 December，2018.Data were collected through content analysis and questionnaires.We analyzed hourly and diurnal variations of participants' logging in to the APP and answering questions.We performed Person correlation and partial correlation analyses of the relationship of the participants' education level and professional title with the correct answer rate.We also analyzed the attending and implementation of PK competition module of "100-day training" APP of the participants from different districts.Questionnaire data were used to analyze participants' satisfaction with the micro-learning with mobile "100-day Training" APP.Results　The rush hours of participants' daily login were 6：00-9：00，11：00-13：00 and 18：00-22：00.
The average number of participants who logged in to the app daily was（3 636.32±174.61）．The number of participants with the correct answer rate of 60%-80% was 2 915，accounting for 57.92% of the total number.The correct rate of answering questions was positively correlated with participants' education level and professional title（r=0.24，P<0.01；r=0.12，P<0.01）．Enthusiasm in attending the PK competition among participants coming from different districts fluctuated greatly.The results of 2 435 responsive questionnaires showed that 1 172（48.13%） participants were relatively satisfied and 918（37.70%）were very satisfied with the "100-day Training" APP teachers survey.And 1 203（49.40%），779（31.99%）and 413（16.96%）were relatively，very，and fairly satisfied with the course design of the APP，respectively.Conclusion　As a micro-learning model，mobile "100-day Training" APP can be used as an effective means of continuing medical education for GPs.However，using it also faces some problems，such as ineffective learning supervision mechanism，incomplete contents，and insufficient learning situations.So the APP needs to be improved constantly to better integrate into current continuing medical education system for GPs，by which it can play its full role in promoting the learning effectiveness.

Effectiveness of Supervised Outpatient Teaching Model in Standardized Hematology Training for General Practitioners　

TIAN Ying，ZHANG Zhiyao，CHEN Wenming

2019, 22(19): 2380-2383. DOI: 10.12114/j.issn.1007-9572.2019.00.323

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Background　Outpatient teaching plays an ever-growing role in medical education.However，limitations of the routine general practice teaching mode restrict the transform of learned medical knowledge into clinical practice，so a novel better teaching model is urgently needed.Objective　To explore the effectiveness and feasibility of supervised outpatient teaching model in standardized hematology training for general practitioners（GPs）．Methods　A total of 45 GPs who received standardized training in the hematology department of a hospital from December 2017 to August 2018 were enrolled.They were randomly divided into the control group（n=22）and the study group（n=23），receiving the training about standardized routine care for hematology inpatients（including regular encountering，inquiry，physical examination，development of preliminary diagnosis and treatment plan，monitoring of the condition changes in the treatment，and so on），the training about standardized routine care for hematology inpatients plus the care training for hematology outpatients taught in the morning，twice a week，in a supervised model，respectively.Pre- and post-training clinical theoretical and skills evaluation results，and subjective-assessed teaching effectiveness in both groups were compared.Results　After the 2-month training，GPs in the study group obtained a higher mean score in the clinical theoretical examination〔（91.4±2.3）vs（87.8±3.7）〕（t=3.933，P<0.05）than those of the control group，and also achieved a higher mean score in the clinical skill examination〔（88.4±2.4）vs（84.5±3.7）〕（t=4.267，P<0.05）．The overall teaching effectiveness score in improving learning initiative and strengthening doctor-patient communication ability and so on assessed by the study group was much better than that assessed by the control group（P<0.05）．Conclusion　The supervised outpatient teaching model used in standardized hematology training for GPs may improve the training effectiveness，enhance the clinical diagnostic and therapeutic ideas and performance for common diseases，promote the comprehensive understanding of the whole course of a chronic disease，arouse the learning interest，and facilitate the ommunications between trainers and trainees.

Pharmacological Analysis and Antihypertensive Effect of Xiaoyao Powders in Treating Menopausal Hypertension　

LIU Xinqiao，WANG Ling

2019, 22(19): 2384-2387. DOI: 10.12114/j.issn.1007-9572.2019.00.289

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Background　Hypertension is one of the common complications of menopause in women.Changes in hormone levels affect blood pressure control，and conventional western medicine treatment is not ideal.Therefore，the treatment of senile hypertension with traditional Chinese medicine has gradually become a research hotspot.Objective　To investigate the pharmacological analysis and clinical curative effect of Xiaoyao Powders in the treatment of menopausal hypertension.Methods　A total of 90 postmenopausal patients with hypertension who were admitted to Beijing Anzhen Hospital，Capital Medical University from April 2015 to April 2016 were selected.The patients were divided into two groups according to the numerical randomization method，each with 45 cases.In the control group，patients were treated by oral western medicine according to the disease stage，and patients in the observation group were added with Xiaoyao Powders.With 4 weeks as a course of treatment，both groups were treated for 2 consecutive courses.The efficacy of treatment，blood pressure variability（BPV），TCM symptom score，C-reactive protein（CRP），homocysteine（Hcy） and angiotensin Ⅱ（Ang Ⅱ） levels were compared between the two groups before and after the treatment.Results　The effective rate of treatment in the observation group was higher than that in the control group〔95.6%（43/45） vs 80.0%（36/45），P<0.05〕.There were no significant differences in BPV of 24 h systolic blood pressure（SBP），daytime SBP，nighttime SBP，24 h diastolic blood pressure（DBP），daytime DBP，and nighttime DBP between the two groups before treatment（P>0.05）．The above indicators of the observation group were lower than those of the control group after treatment（P<0.05）．There was no significant difference in the scores of TCM syndrome between the two groups before treatment（P>0.05）．After the treatment，the scores of TCM syndrome in the observation group were lower than those in the control group（P<0.05）．There were no significant differences in CRP，Hcy and Ang Ⅱ levels between the two groups before treatment（P>0.05）．The levels of CRP，Hcy and Ang Ⅱ in the observation group were lower than those in the control group after the treatment（P<0.05）．Conclusion　Xiaoyao Powders can have a significant antihypertensive effect in the treatment of menopausal hypertension.It can improve the patient's psychological status and symptoms.Its pharmacological effect canreduce inflammation and destroy angiotensin-mediated effects to decrease blood pressure through suppressing hyperactivity of liver，benefiting liver and kidney，clearing away heat and detoxicating.

Self-massage with Enzyme-rich Ginger Oil in the Treatment of Primary Dysmenorrhea：a Randomized，Double-blind，Controlled Clinical Trial　

DENG Yun，YI Wei，YE Xiaoxin，ZHANG Lu，XU Zhirui，WU Danna，LI Zhaoxia，LIN Xiaoyang，GUO Shuailiang

2019, 22(19): 2388-2392. DOI: 10.12114/j.issn.1007-9572.2019.00.134

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Background　Primary dysmenorrhea（PD）is characterized by high incidence and low treatment rate.Massage has obvious effect on PD.Moreover，self-massage can be performed without restrictions in time or space，helping to motivate patients to undergo treatment.Massage medium has multiple influences on massage treatment，but related studies are limited.Objective　To examine the effects of self-massage with Enzyme-rich Ginger Oil（EGO）in treating PD.Methods　A block-randomized，double-blind，placebo-controlled clinical trial approach was applied in this study.From November 2016 to June 2017，sixty-five PD patients were enrolled and randomly divided into EGO group（n=32）and placebo group（n=33），receiving three consecutive cycles of treatment with self-massage with EGO，self-massage with placebo（each cycle started from the first day of the menstrual period，and lasted for 7 consecutive days，during which the intervention was performed twice daily），respectively.Dysmenorrhea symptom and PD-induced pain were measured by Symptoms Scoring Criteria for Dysmenorrhea（SSCD）and numerical rating scale（NRS），respectively，before and after treatment for efficacy evaluation.Results　During the intervention period，2 cases and 1 dropped out of the treatment group，control group，respectively，so 62 cases were included in the final analysis.After treatment，average SSCD scores decreased significantly in both groups（P<0.05），but showed no obvious intergroup difference（P>0.05）.Average NRS scores decreased significantly in both groups after treatment（P<0.05）．EGO group showed much lower post-treatment average NRS score than placebo group（P<0.05）.Syndrome-based efficacy analysis of self-massage with EGO found that，the alleviation in PD-induced pain was much better in those with cold syndrome than that of those with heat syndrome（P<0.05），while the relief in PD symptoms showed no differences between the two subgroups（P>0.05）．Conclusion　Self-massage with EGO and self-massage with placebo therapies could reduce PD-induced pain and PD symptoms，but self-massage with EGO achieved better result in reducing pain degree.Furthermore，self-massage with EGO is more suitable for patients with cold syndrome.

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