Chinese General Practice

Exploration and Implementation of Management Path of Community/Home-based Cardiac Rehabilitation　

ZHANG Zhaoguo，JIANG Hongyan，WANG Yanhui，GENG Ao，LI Ruijie

2019, 22(31): 3779-3785. DOI: 10.12114/j.issn.1007-9572.2019.00.355

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In recent years，hospital-based cardiac rehabilitation in China has developed rapidly，but community/home-based cardiac rehabilitation has hardly been carried out，and the rate of patients with acute myocardial infarction（AMI） receiving such rehabilitation is very low.We detailedly discussed how to deliver community/home-based safe and effective cardiac rehabilitation for post-discharge AMI patients，to main their exercise habit associated with treatment，develop an exercise-centered health-promoting lifestyle，adhere to use pharmacological treatment for secondary prevention of cardiovascular events，ensure a good mental state，and return to work and social life.Moreover，we discussed the community/home-based models suitable for delivering cardiac rehabilitation for AMI patients in China，including developing structured exercise prescriptions and the simplification method，and ways for maintaining diversification and amusement of community/home-based exercise training forms，by which the enthusiasm of AMI patients in participating in community/home-based cardiac rehabilitation can be increased，the recurrence rate and case fatality rate of acute cardiovascular events in AMI patients can be decreased.

Interactive Model-based Evaluation of the Implementation Effect of Contracted Family Doctor Services Policies　

ZHANG Xiaoyan，WANG Yuxuan，ZHANG Xiaona

2019, 22(31): 3786-3791. DOI: 10.12114/j.issn.1007-9572.2019.00.601

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Background　The development of contracted family doctor services（CFDSs） has gradually entered the right track after pilot implementation and continuous practice.At present，the focus of our work is to evaluate the effect of CFDSs policies implementation，and to make amendments and improvements in many aspects according to the evaluation results.Thus，it can increase policy responsiveness and ensure the sustainable development of such services.Objective　To evaluate the implementation effect of CFDSs policies，providing a reference for the establishment of appropriate objectives and implementation model of CFDSs policies.Methods　By searching and reviewing articles about CFDSs published during 2011—2018 included in databases of CNKI and WANFANG Data in January 2019，we obtained a detailed understanding of the development of such services.Then，we conducted intensive individual interviews with a judgment sample of 50 family doctors from 10 community health centers selected from Xianning，Hubei Province by simple random sampling in March 2019，to explore their perspectives of family doctor practice and the development of CFDSs.After this，we carried out a questionnaire survey in a multi-stage stratified random sample of 400 community-dwelling residents to investigate their opinions of CFDSs，contracting status and evaluation of such services.Then，based on a model developed in accordance with the above results and the framework of McLaughlin's interactive model，we performed a policy-，policy executor-，policy receiver-，and implementation environment-level analysis and evaluation of the implementation of CFDSs policies.Results　Altogether，45（90.0%） family doctors who completed interviews and 320（80.0%） residents who returned responsive questionnaires were included in the final analysis.Interactive model-based analysis found the following problems in the implementation of CFDSs.Policy-level problems：insubstantiality and simplicity of some policies，poor support for CFDSs from the medical insurance program，unsound incentive mechanism for family doctors.Policy executor-level problems：insufficient publicity of related policies，unstandardized service procedure，insufficient professional capabilities and number of family doctors.Policy receiver-level problems：inadequate perceptions of the family doctor system，and nonuse of CFDSs but contracting only due to gift giving among contracted residents.Implementation environment-level problems：some residents' traditional ideas of seeking healthcare only in secondary or tertiary hospitals，and insufficient facilities in primary hospitals.Conclusion　The implementation effect of CFDSs is unsatisfied.And during the implementation，problems such as uneven promotion of the services，and unsatisfied quality of the services and so on are found.To balance the benefits of CFDSs policies in stakeholders dynamically，policy-，policy executor-，policy receiver-，and implementation environment-level improvements need to be done to perfect the contracting system.

Impact of Family Doctor Services Delivered by the General Practitioner Team within a Regional Medical Consortium on Healthcare-seeking Experience of Contracted Residents　

ZHANG Tian，MIAO Yudong，WANG Liuyi，ZHAO Lin，LU Yuefeng，GU Jianqin

2019, 22(31): 3792-3796. DOI: 10.12114/j.issn.1007-9572.2019.00.407

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Background　Promoting the contracted family doctor services is feasible to improve the service capacities of primary healthcare institutions.Relevant studies show that contracted family doctor services delivered by general practitioner team from a regional medical consortium can improve residents' recognition of service capacities of primary healthcare institutions，but whether this model can enhance their healthcare-seeking experience needs further research and analysis.Objective　To explore the experience of patients receiving contracted family doctor services delivered by general practitioner team from a regional medical consortium.Methods　This study was conducted among 1 000 randomly selected contracted residents who received health services from two community heath centers in Zhengzhou during September to October，2018，including 500 from Linke Community Health Center（control group）and 500 from Beixia Street Community Health Center（intervention group）.The control group received healthcare services delivered by community family doctors，while the intervention group received healthcare services delivered by general practitioner team from a regional medical consortium.When the interventions ended，Picker's Patient's Experience Scale（PPE-15）was used to survey the participants in terms of general personal data，evaluation for 8 domains of PPE-15（domain scores of PPE-15），and overall evaluation of the experience（total score of PPE-15），and indicators closely associated with overall healthcare-seeking experience.Common factors for the differences in experiences between the two groups were extracted.Results　Education level distribution differed significantly between the groups（P<0.05），but mean age，sex ratio，distributions of medical insurance types and self-rated health status，and prevalence of chronic diseases did not（P>0.05）.The intervention group had higher total PPE-15 score than the control group（P<0.05）.Compared with the control group，intervention group had higher scores in two domains（involvement of family & friends，and continuity & transition）（P<0.001），but had lower score in the domain of information & education（P<0.05）.Two groups had similar scores in three domains（emotional support，respect for patient preferences，and physical comfort）（P>0.05）.The scores of four domains（information & education，emotional support，involvement of family & friends，and continuity & transition）were strongly associated with the total PPE-15 score.The difference of 15 patient experience indicators can be classified into five common factors：communication，emotional support，service continuity，information transmission，and respect for patient rights，explaining 67.669% of the total variance.Conclusion　Our study shows that contracted family doctor services delivered by general practitioner team from a regional medical consortium helps to strengthen the continuity of medical services，promotes the involvement of family members and friends，and improves the healthcare-seeking experience in contracted residents.However, information transmission and patient education need to be strengthened.

Awareness and Associated Factors of Contracted Family Doctor Services among Urban Residents in Xuzhou　

LI Qiusu，ZHAO Hongliang，HUANG Wenhao，ZHUO Lang，MIAO Chunxia，ZHAO Shihong

2019, 22(31): 3797-3804. DOI: 10.12114/j.issn.1007-9572.2019.00.460

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Background　The implementation of contracted family doctor services in China plays a vital role in deepening the reform of the pharmaceutical and healthcare system.Understanding residents' awareness of such services and its influencing factors is conducive to the promotion，and effective coverage and extension of the services.Objective　To investigate the awareness and associated factors of contracted family doctor services among urban residents in Xuzhou，providing practical and feasible suggestions for the improvement of residents' awareness level of such services.Methods　This household survey was conducted between June and September 2017 in a stratified random sample of 1 450 residents from 34 communities in 4 urban areas，Xuzhou.A questionnaire designed by our research team was used in the survey，which is composed of general sociodemographic characteristics，awareness of contracted family doctor services and contracting status.The survey achieved a response rate of 96.34%（1 397/1 450）.Results　Of the respondents，56.19%（785/1 397） knew contracted family doctor service.Most of them obtained the information from television and other media〔36.08%（504/1 397）〕 and the advocacy of community health workers〔30.85%（431/1 397）〕.Univariate analysis showed that the awareness level of contracted family doctor services varied significantly by age，education level，annual income，occupation，number of chronic diseases，self-rated heath status，history of health check-up，two-week morbidity，and history of seeking healthcare in primary care（P<0.05），but not by sex，and walking time from home to the nearest primary healthcare agency（P>0.05）.Multivariate Logistic regression analysis showed that age，education level，occupation，number of chronic diseases，self-rated health status，history of health check-up，and history of seeking healthcare in primary care were associated with the awareness level of contracted family doctor services among the residents.Conclusion　The awareness level of contracted family doctor services among urban residents in Xuzhou needs to be improved.Younger age，high education level，working in enterprises and public institutions，retired，having at least one chronic disease，poor self-rated health status，having health check-up and seeking healthcare in primary care are associated with higher awareness level of such services.More effective extension of such services can be achieved by the propaganda of the related policies by potential advocators fully identified from the urban residents..

From Medical Quality Assurance to Patient Safety：Concept Renewal and Policy Optimization of Medical Risk Management　

FENG Qian，FENG Lei，LI Luochang

2019, 22(31): 3805-3809. DOI: 10.12114/j.issn.1007-9572.2019.00.194

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In the modern management of medical risk，the concept of patient safety and the related system have attracted increasing attention gradually.Compared with medical quality assurance，patient safety places greater emphasis on rights-oriented，ethical care，and social synergy，showing its unique value.In China，although the patient safety related system develops rapidly，there are still some problems，such as lack of special patient safety policies and regulations，an effective mechanism for addressing clinical ethical issues，and a sound physician-patient communication mechanism.Suggested enhancement strategies are given as follows：further strengthening the concept of patient safety，improving patient safety related policies and regulations，establishing the patient safety event reporting system and the doctor apology system，setting up patient safety organizations and databases，and optimizing policies about medical risk management.In this way，a win-win situation can be achieved for both doctors and patients.

Legal Risks of the Internet + Cross-border Medicine：Taking Guangdong-Hong Kong-Macao Greater Bay Area as an Example　

LIU Kai

2019, 22(31): 3809-3814. DOI: 10.12114/j.issn.1007-9572.2019.00.549

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The establishment of Guangdong-Hong Kong-Macao Greater Bay Area provides a new opportunity for the coordinated development of medical and health undertakings in these three places.The coordinated development of medical care in the three places faces various obstacles in cross-border medical treatment.Internet medical treatment developed under the background of "internet +"，as one of the forms of telemedicine，has considerable advantages in optimizing medical resources and facilitating public access to medical care and health information.The combination of internet + cross-border medicine，although is able to take advantage of both，it faces certain legal risks.Based on the current situation of legislation in China，this paper takes the Guangdong-Hong Kong-Macao Greater Bay Area as the object of study to explore the legal risks of the combination of cross-border medical treatment and internet medical treatment.In this regard，we can learn from the experience of the EU and sign an agreement with uniform application effectiveness to protect the legitimate rights and interests of patients，doctors and third-party medical platforms.

Occupational Stress and Burnout in Family Doctors in Minhang District，Shanghai　

SHEN Qi，LIU Shuai，CUI Hengqing，CHEN Chen

2019, 22(31): 3815-3818. DOI: 10.12114/j.issn.1007-9572.2019.00.439

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Background　The workload of family doctors in Minhang District，Shanghai，is increasing with the continuous promotion of the local community healthcare reform and the gradual improvement of family doctor system.High workload may induce burnout，which should not be neglected.So it is imperative to adequately understand the occupational stress and burnout in family doctors and deliver targeted and precise interventions in time.Objective　To investigate the occupational stress and burnout among family doctors in Minhang District，Shanghai，providing evidence for delivering mental health interventions for this population.Methods　From October to November，2018，by use of cluster sampling，308 eligible family doctors from Minhang District were enrolled after signing the written informed consent form.They received a self-administered survey with a self-developed General Personal Information Questionnaire，the Psychosomatic Tension Relaxation Inventory and the Maslach Burnout Inventory（MBI）for understanding general personal information，occupational stress and burnout，and the results were analyzed.Results　Among the 308 respondents，190（61.7%）had excessive stress，72（23.4%）had moderate stress and 46（14.9%）had low stress.Occupational stress did not vary significantly by gender，age，marital and childbearing status，hukou，education level，professional title，working length，and ways for achieving general practitioner qualification（P>0.05）.The prevalence rates of no burnout，moderate and severe burnout were 39.0%（120/308），49.0%（151/308）and 12.0%（37/308），respectively.The degree of burnout differed significantly by hukou and working length（P<0.05），but not by gender，age，marital and childbearing status，education level，professional title and ways for achieving general practitioner qualification（P>0.05）.Higher mean scale score and subscales（emotional exhaustion，depersonalization and low personal accomplishment）scores of MBI were found in those with excessive occupational stress than those with moderate or low occupational stress，and were found in those with moderate occupational stress instead of those with low occupational stress（P<0.05）.Conclusion　Most family doctors in Minhang District have excessive occupational stress，and moderate to severe burnout，so interventions should be delivered to them in time.In addition，special guidance should be given to those with Shanghai hukou or working length of 6-10 years，to cope with stress and relieve burnout appropriately.

Job Satisfaction and Associated Factors among General Practitioners from Primary Healthcare Institutions in Chongqing　

ZOU Wanjun，ZHANG Shaoqun，GONG Fang

2019, 22(31): 3819-3824. DOI: 10.12114/j.issn.1007-9572.2019.00.455

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Background　There has been great shortage of general practitioners（GPs） in primary hospitals in China，especially in western rural areas，where the practice environment is poor and the GPs bear heavy work tasks chronically，resulting in statistically GPs' low job satisfaction.Therefore，investigating GPs' job satisfaction and associated factors contributes to stabilizing the primary care workforce and improving the quality of primary care services.Objective　To investigate the job satisfaction and associated factors among GPs from primary healthcare institutions in Chongqing.Methods　From May to November 2015，a survey was conducted among a stratified random sample of 354 GPs from 58 primary healthcare institutions in 27 districts and counties of Chongqing.A questionnaire was used to investigate：basic personal information，practicing status，career awareness and quality，job satisfaction.Among them，a 5-level scoring method was used to evaluate job satisfaction ,ranging from "very dissatisfied" to "very satisfied" was assigned a score of 1 to 5.A total of 338 cases handed in responsive questionaires，with a response rate of 95.5%.Results　The average total score of job satisfaction in the respondents was（2.75±0.83）.Significant variations in job satisfaction score were found to be related to sex，department，weekly workload，annual salary，type of work unit，highest education level，professional title，family support and professional enthusiasm（P<0.05）.Multiple linear regression analysis showed that gender，department，weekly workload，type of work unit，highest education level，professional title，family support and professional enthusiasm were significantly associated with job satisfaction score（P<0.05）.Conclusion　In general，the job satisfaction level is not satisfactory in GPs in primary healthcare institutions in Chongqing.Female，working at department of obstetrics and gynecology，heavy weekly workload，working in township hospital，master's level education，medium-grade professional title，low family support，and low professional enthusiasm are associated with low job satisfaction.In view of this，reducing the workload and enhancing the salary and other facilitation measures need to be taken to improve job satisfaction level in GPs and to retain general practice talents in primary healthcare institutions.

Exploratory Study on the Consultation Competence of Community General Practitioners in Guiyang City　

GAN Renrong，ZHU Yan

2019, 22(31): 3825-3829. DOI: 10.12114/j.issn.1007-9572.2019.00.283

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Background　Consultation competence is one of the essential abilities that a general practitioner（GP）must have.However，at present consultation competence of community GPs in China still needs to be improved.Objective　To explore the current situation of the consultation ability of community GPs and find the existing problems in Guiyang in order to provide a scientific reference for further improving the consultation competence of GPs.Methods　A total of 112 GPs in 36 community health service centers selected by the stratified random sampling from 64 community health service centers in six urban districts of Guiyang were investigated from April to July in 2018.Observation method with a self-designed scoring table was employed to evaluate the performance of the GPs when diagnosing patients.The scoring table with a total score of 0-127 points explored and evaluated the consultation competence of GPs from four aspects，including identifying and addressing current problems（0-67），managing continuous problems（0-23），preventive care（0-28）and improving medical compliance behavior（0-9）.Results　The average scores for these 112 GPs in identifying and addressing current problems，managing continuous problems，preventive care，improving medical compliance behavior and total score were（23.69±3.22），（7.64±2.39），（3.49±3.21），（1.86±1.41），（35.65±7.29），and the proportions of good level of abilities in four aspects and overall were 15.2%（17/112），16.1%（18/112），18.8%（21/112），11.6%（13/112） and 19.6%（22/112） respectively.Conclusion　At present，all the four major consultation competence of the community GPs in Guiyang need to be improved.It is necessary to strengthen the training of thinking in general practice and make full use of health records，consultation records and various life stress scales in the actual practice.Besides，the organic integration of outpatient medical care and public health services should be adopted to further improve the consultation competence of the community GPs.

Relationship of Diabetic Retinopathy with Severe Diabetic Foot and Diabetic Foot Amputation　

AN Jingsi，LU Lu，AN Gang，WANG Xueying，YANG Yang，CUI Wei

2019, 22(31): 3830-3835. DOI: 10.12114/j.issn.1007-9572.2019.00.548

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WANG Xueying，Professor，Chief physician；E-mail：xue5539@foxmail.com
Background　Diabetic foot（DF）is characterized by high incidence and poor prognosis.Previous studies have shown that diabetic retinopathy（DR）is positively correlated with DF.But the correlation between DR and adverse prognosis of DF is not clear.Objective　To analyze the relationship of DR with severe DF and DF amputation.Methods　96 DF patients hospitalized in Department of Endocrinology，Jinzhou Central Hospital from December 2015 to December 2018 were selected，including 47 with mild and moderate DF（mild-moderate group），and 49 with severe DF（severe group）graded by Wagner classification；22 with amputation（amputation group），and 74 without（non-amputation group）divided by the prevalence of amputation.The general data，laboratory indicators and complications/comorbidities were compared between mild-moderate and severe groups，and between amputation and non- amputation groups.The influencing factors of severe DF and DF amputation were analyzed by Logistic regression.Results　Among the participants，the rates of severe DF，and DF amputation were 51.0%（49/96），and 22.9%（22/96），respectively.Compared with mild-moderate group，severe group showed higher rate of smokers，and higher mean white blood cell count（WBC） level，and lower mean fasting blood glucose（FBG），serum albumin（ALB），triglycerin（TG），low density lipoprotein cholesterol（LDL-C） and hemoglobin（HGB） levels as well as lower rate of abnormal lipid metabolism（P<0.05）.Moreover，two groups also showed significant differences in stages of DR（P<0.05）.Compared with non-amputation group，amputation group had longer mean duration of diabetes，and higher rate of smokers，as well as lower mean TG level and hypertension prevalence（P<0.05）.Furthermore，these two groups also demonstrated significant differences in stages of DR（P<0.05）.Logistic regression analysis showed that smoking，TG level and DR stage were the influencing factors of severe DF.Smoking，DR stage and hypertension were the influencing factors of DF amputation（P<0.05）.The more advanced the stage of DR was，the higher the incidence of severe DF became（P<0.05），howere，there was no difference in the incidence of DF between the two groups．Conclusion　DR is an independent risk factor for severe DF and DF amputation.With the progression of DR lesions，the incidence of severe DF increases gradually.DR can be used as an effective predictor of severe DF.

Predictive Value of Resting Heart Rate in Combination with White Blood Cell Count and Hematocrit in Matabolic Syndrome　

WANG Xueying，GUO Jiatong，LI Nan，LENG Song

2019, 22(31): 3836-3840. DOI: 10.12114/j.issn.1007-9572.2019.00.499

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Background　Metabolic syndrome（MS） is the common pathological basis and early stage of many noncommunicable diseases，such as cardiovascular and cerebrovascular diseases.Although early identifying MS can prevent some chronic illnesses early，predictive values of indicators for MS in reports are still unclear.Objective　To explore the predictive value of resting heart rate（RHR） combined with white blood cell（WBC） count and hematocrit（HCT） for MS，to provide a reference for early MS prevention.Methods　From Health Management Center，the Second Affiliated Hospital of Dalian Medical University，24 612 physical examinees were enrolled in 2017.MS prevalence and components were evaluated in accordance with 2013 diagnostic criteria for MS by the Chinese Diabetes Society.The levels of RHR，WBC count，HCT，neutrophil-to-lymphocyte ratio（NLR） and uric acid（UA） were compared among MS patients by prevalence of MS and number of MS components（0 to 3 and more）.Impacts of RHR，WBC count，HCT，NLR and UA on MS were analyzed by multiple Logistic regression.ROC analysis was conducted to evaluate the values of RHR，WBC count，HCT and combination of the three in predicting MS.Results　The prevalence of MS was 27.71%（5 343/24 612）.MS group showed higher mean levels of RHR，WBC count，HCT，NLR and UA than non-MS group（P<0.001）.After adjusting for sex and age by propensity score matching，the above-mentioned intergroup differences were still significant（P<0.001）.Levels of RHR，WBC count，HCT，NLR and UA elevated with the increase of combined MS components（P<0.001）.Multiple Logistic regression analysis showed that increased RHR，WBC count，HCT and UA were risk factors for MS（OR=1.032 0，1.234 5，1.028 4，
1.006 7，P<0.001）.For predicting MS，AUCs of RHR，WBC count，HCT，and the combination of the three were 0.572，0.654，0.682，and 0.716，respectively.Conclusion　Joint detection of RHR，WBC count and HCT is simple and convenient，and can improve the accuracy of MS early prediction，which may be used as a reference for prophase prevention of MS.

Prevalence and Associated Factors of Disability in Elders Living in China　

ZHANG Xiaoning，CHEN Shuang

2019, 22(31): 3841-3844. DOI: 10.12114/j.issn.1007-9572.2019.00.508

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Background　Disability seriously impairs the quality of life of the elderly，and also poses challenges to healthcare services and long-term care.It is estimated that the number of elders with disability living in China will reach 46 million by 2020，22.5 percent of whom cannot complete daily activities.Therefore，it is necessary to explore the prevalence of disability and associated factors in Chinese elders.Objective　This study aimed to assess the prevalence and associated factors of disability in the elderly in China.Methods　We used the data of China Health and Retirement Longitudinal Study（CHARLS） conducted in 2015 and evaluated the prevalence of disability in 7 773 cases over 60 years old using Instrumental Activities of Daily Living （IADL）.We used Logistic regression models to identify the associated factors for disability in elders.Results　The prevalence of disability was 29.27%（2 275/7 773）.Sex，age，marital status，education level，place of residence（rural or urban areas），annual personal income，monthly frequency of drinking alcohol，tobacco consumption，prevalence of sleeping disorders and depression were significantly related to prevalence of IADL disabilities（P<0.001）.Logistic regression showed that advanced age，low education level，low annual personal income，drinking alcohol at least once per month，sleep disorders，and depression were risk factors of IADL disabilities（P<0.05）.Conclusion　The prevalence of disability in elders is high in China.Low annual personal income，advanced age，low education level，heavy drinking，sleep disorders，and depression are the main risk factors of disability.Optimal health education policies aiming at decreasing disability should be provided for high-risk elders.

Relationship between Residents' Behavioral Lifestyle and Common Chronic Diseases Based on Latent Class Analysis　

YANG Lin，CAO Qian，SUN Yudan，HE Lu

2019, 22(31): 3845-3849. DOI: 10.12114/j.issn.1007-9572.2019.00.196

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Background　In recent years，the incidence of chronic diseases in China has been increasing rapidly，causing a heavy burden of disease.As a controllable factor in the risk factors of chronic diseases，behavioral lifestyle is very important for prevention and control of chronic diseases.Objective　To explore the types of common chronic diseases and the association between common chronic diseases and the residents' lifestyle in Shanxi Province，so as to provide basis for intervention of chronic diseases.Methods　The multi-stage random sampling method was used to survey the residents aged 35 years and over in Shanxi Province.The contents include basic demographic characteristics, behavior and lifestyle, and chronic diseases.Latent class analysis was applied to classify the individuals into different groups.Further studies were conducted to compare the prevalence of chronic diseases among different lifestyle groups.Results　A total of 3 800 questionnaires were distributed and 3 496 valid questionnaires were recovered，with an effective recovery rate of 92.00%.The prevalence of chronic diseases in Shanxi Province was 39.99%（1 398/3 496），among which hypertension 〔20.68%（723/3 496）〕，diabetes 〔8.67%（303/3 496）〕，rheumatoid arthritis 〔6.61%（231/3 496）〕 and hyperlipidemia 〔5.84%（204/3 496）〕 were identified as common chronic diseases according to the rank of disease prevalence.Four latent classes were yielded：behavioral health group〔59.98%（2 097/3 496）〕，smoking and drinking group〔19.99%（699/3 496）〕，unhealthy diet group〔12.01%（420/3 496）〕 and unhealthy lifestyle group〔8.01%（81/3 496）〕.The prevalence of hypertension，diabetes and hyperlipidemia among the four groups were different （P<0.05）. There was no significant difference in the prevalence of rheumatoid arthritis among the four groups （P>0.05）. Conclusion　There was a clear classification of behavioral lifestyles among residents in Shanxi Province.Distribution of people with hypertension，diabetes mellitus and hyperlipidemia in different latent categories was significantly different.Different intervention strategies should be advocated for people in different categories.

Clinical Characteristics of Hypertension in Hospitalized Young Adults　

SONG Jingjing，LIU Xiaoning，CAI Jun，MA Wenjun，SONG Lei，ZHANG Huimin，ZHOU Xianliang，WU Haiying，LOU Ying，ZHANG Xue，DIAO Xiaolin

2019, 22(31): 3850-3856. DOI: 10.12114/j.issn.1007-9572.2019.00.589

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Background　Annual hypertension incidence is increasing in young adults.However，due to inadequate identification of and insufficient attention paid to this group，there are no guidelines for the prevention and treatment of hypertension in this group.Objective　To examine the clinical characteristics of hypertension in young adults，providing suggestions and references for early diagnosis and treatment of hypertension in this group.Methods　We enrolled 875 young adults（≤35 years old） who were initially hospitalized for hypertension from Hypertension Center，Fuwai Hospital from 2016 to 2017.We collected their clinical data，etiological types，complications and indicators of target organ damage.Results　Of the participants，624（71.3%） had essential hypertension，and 451（72.3%） of them were men.251（28.7%） had secondary hypertension，and 168（66.9%） of them were men.Obstructive sleep apnea（OSA） was the most common cause of secondary hypertension in 251 young adults, followed by renal artery stenosis（RAS）, primary aldosteronism（PA）, aortic stenosis, polycystic ovary syndrome and renal parenchymal hypertension. Other rare causes included thyroid dysfunction, Cushing's syndrome, Liddle's syndrome and pheochromocytoma.Compared with those with essential hypertension，secondary hypertension patients had higher mean admission blood pressure levels，and higher rates of renal insufficiency，heart failure，aortic dissection，and peripheral arterial stenosis/occlusion（P<0.05）.Conclusion　Essential hypertension is more common in young hypertensive adults，especially in males.Nearly one third of them have factors that can lead to secondary hypertension，among which OSA，RAS，and PA are three major ones.Secondary hypertension patients have higher admission blood pressure and more severe target organ damage than those with essential hypertension.

Effects of Resistance Band Exercises on Lower Limb Muscle Strength and Quality of Life in Pre-frail Elderly People　

CHEN Rujie，WU Qingwen，WANG Dongyan，GE Yujie，GAO Zhipeng

2019, 22(31): 3857-3860. DOI: 10.12114/j.issn.1007-9572.2019.00.457

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Background　Frailty develops dynamically.Effective interventions may delay the process of frailty and improve lower limb muscle strength and quality of life in pre-frail elderly people.Objective　To discuss the effects of resistance band exercises on lower limb muscle strength and quality of life in pre-frail elderly people.Methods　From September 2017 to April 2018，70 pre-frail elderly people from Yuyang Community，Wenzhou City were enrolled，and were divided into the control group and intervention group by a random number table,with 35 cases in each group.The control group maintained normal daily activities，while the intervention group did resistance band exercises.Lower limb muscle strength and quality of life were respectively measured by the five-times-sit-to-stand test（FTSST） and the the Mos 36-item Short Form Health Survery（SF-36） at pre-intervention，4 and 8 weeks after intervention to assess the effects of the intervention.Results　33 pre-frail elderly people in each group completed the intervention.The overall mean time taken for FTSST and overall mean scores for role limitations due to physical health problems（RP），bodily pain（BP），and general health perceptions（GH）were significantly different in two groups（P<0.05）.The mean time taken for FTSST and mean scores for RP，BP，and GMH were significantly different in two groups at different measurement times（P<0.05）.Intervention contents and duration had substantial interaction on time taken for FTSST and scores for all dimension of the SF-36（P<0.05）.After 4-week intervention，compared with control group，the mean time taken for FTSST reduced and mean scores for three dimensions（PF，BP，and GH） in SF-36 increased in the intervention group（P<0.05）.After 8-week intervention，the mean time taken for FTSST decreased，and the mean scores in all dimensions of SF-36 improved in the intervention group compared with control group（P<0.05）.Self-controlled comparisons showed that in the intervention group，the mean time taken for FTSST decreased with the increase of intervention time（P<0.05），mean scores for physical functioning（PF），RP，and BP increased with the increase of intervention time（P<0.05），mean score of GH increased more significantly after 8-week intervention compared with at pre-intervention and after 4-week intervention（P<0.05），mean score of vitality dimension improved after 8-week intervention compared with at pre-intervention（P<0.05）；while no significant changes in all the aforementioned aspects were found in the control group（P>0.05）.Conclusion　Resistance band exercises can improve the lower limb muscle strength and quality of life in pre-frail elderly people.

Case-based Teaching in Short-term Obstetrics and Gynecology Training for General Practitioners　

LI Luochang，CHEN Hongyan，HE Jingke，LI Qiaoya，HE Ying，ZHOU Yongfen，DENG Huisheng，LUO Tianyou，HUANG Ying，WEI Jingjing，WANG Hui

2019, 22(31): 3861-3865. DOI: 10.12114/j.issn.1007-9572.2019.00.507

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Background　In the continuing education for general practitioners（GPs），short-term specialty trainings for improving GPs' clinical diagnostic and therapeutic skills account for a large proportion.However，difficulties in concentrating energies on learning can easily occur if such trainings are mainly based on traditional teaching.So it is essential to use case-based teaching in such trainings to improve the training effect.Objective　To explore the effect of case-based teaching in short-term obstetrics and gynecology training programs for GPs.Methods　A total of 110 GPs who participated in the short-term training on standardized diagnosis and treatment of common diseases and frequently-occurring diseases in obstetrics and gynecology in Chongqing General Medicine Education Center in 2018 were enrolled.At the time of enrollment，they were randomly divided into the first phase（control group） and the second phase（study group）.According to inclusion and exclusion criteria，six cases who asked for leave during the training and failed to complete the relevant examinations were excluded.Finally，52 cases were included in each of the groups.Both groups received the same training program，namely，the same teaching content（diagnosis and treatment of common and frequently-occurring diseases in obstetrics and gynecology），the same training time（one week），and the same evaluation （an examination of the same difficulty before and after the training，and a questionnaire survey on training effectiveness and satisfaction），but received different teaching mode，case teaching was used in training for the study group，while traditional teaching was used in training for the control group.Pre- and post-training test score，self-rated clinical diagnostic and therapeutic skills，clinical thoughts，mastery of basic knowledge，learning interest and training satisfaction were compared between the two groups.Results　The mean pre-training test scores of the control group and the study group were similar〔（62.6±14.6） vs （61.6±18.6），P>0.05〕.After training，the mean test score increased significantly in both groups（P<0.05），but better improvement was found in the study group instead of the control group〔（95.6±2.0） vs （86.5±8.7），P<0.05〕.Moreover，mean post-training self-rated scores for clinical diagnostic and therapeutic skills，clinical thoughts，mastery degree of basic knowledge，learning interest and training satisfaction of the study group were significantly higher than those of the control group（P<0.05）.Conclusion　In short-term training for GPs with obstetrics and gynecology programs，case-based teaching is superior to traditional teaching in terms of improving the teaching effectiveness，and GPs' skills in diagnosing and treating obstetrical and gynecological conditions.

Effectiveness of Three-point System Model in Teaching Introduction to General Practice　

SHEN Ying，ZUO Yanli，KONG Yan，LIU Jianghua，CHEN Enran

2019, 22(31): 3866-3870. DOI: 10.12114/j.issn.1007-9572.2019.00.356

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Background　One focus and difficult problem in general practice education research is how to make students effectively learn and assimilate the difficult theoretical knowledge in Introduction to General Practice，and use it to improve their general practice ideas and clinical performance capabilities.This study attempted to explore a model to improve the teaching effectiveness of Introduction to General Practice by integrating class teaching，self-learning and flipped classroom.Objective　To investigate effect of three-point system model in teaching Introduction to General Practice.Methods　This study was carried out from February to July 2018.Participants were 100 undergraduate students（who enjoy five-year free education in clinical medicine and will work for rural health centers in central and western China upon graduation），including 50 from Class 46（study group） and 50 from Class 47（control group）.For teaching Introduction to General Practice（Fourth Edition） within 48 class hours，traditional teaching model（lecture style） was used for the control group，while three-point system model（consisting of class teaching，self-learning and situational performance） was used for the study group.Subjective-evaluated teaching effectiveness and final examination scores were compared between the two groups.Results　Compared with the control group，study group gave higher mean total score for the overall teaching effectiveness，and gave higher mean scores for teaching effectiveness on sparking the interest in learning，cultivating self-study ability，promoting communications between classmates，enhancing teacher-student interactions，cultivating team cooperation ability，problem-solving ability and expressive language ability（P<0.05）.But in terms of teaching effectiveness on cultivating critical thinking and creative ability，both groups gave similar mean scores（P>0.05）.The study group achieved higher mean final examination scores than did the control group（P<0.05）.Conclusion　The three-point system teaching model is effective in teaching Introduction to General Practice，which can improve the teaching effectiveness，spark the interest in learning general practice and primary care，and promote the cultivation of multiple qualities required by medical education for students.

Theoretical Research and Practice Development in Regional Healthcare Consortiums in China　

SUN Tao，YIN Dong，ZHANG Jiarui，WANG Zhen，ZHAI Chuncheng，SHI Yu，XIE Fengzhe，WANG Jinghui，ZHANG Shue

2019, 22(31): 3871-3875. DOI: 10.12114/j.issn.1007-9572.2019.00.130

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Recently，the in-depth construction of regional healthcare consortiums of different forms in China，has aroused increasing attention from all walks of life.On the basis of literature review and data analysis，we systematically summarized the theoretical research and practice progress in the construction of regional healthcare consortiums（RHCs） in China，in particular，detailed the organization forms of RHCs，operation management within the RHCs，external supports from multiple bodies and environment，as well as the constricted factors during development.Moreover，from multiple perspectives，we analyzed the management structure，competition and cooperation forms of RHCs，improvement ways for health promotion and healthcare services delivered by RHCs，interests and divergences of the government，market and third-party organizations when they collaboratively run the RHCs.All these are expected to further facilitate the health development of RHCs，a kind of organization assuming the roles of a supplier of healthcare，responsible party for healthcare delivery，stakeholder and manager of healthcare delivery，and collaborator in healthcare delivery.

Regional Healthcare Consortium Symbiotic Network: an Introduction of a Conceptual Framework　

WANG Zhen，ZHANG Shue，YIN Dong，ZHANG Jiarui，ZHAI Chuncheng，ZHANG Min，YIN Hongyan，SUN Tao

2019, 22(31): 3876-3880. DOI: 10.12114/j.issn.1007-9572.2019.00.135

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The metaphor of regional healthcare consortium symbiotic network is carried out from the perspective of ecosystem，which aims at providing a new perspective for explaining and further exploring the operation principles of the regional healthcare consortium. Based on the ecological theoretical framework and social bionic research paradigm，the study identified and determined four intrinsic characteristics of the regional healthcare consortium symbiotic network：intensive symbiosis，dynamic competition，self-adaptability and network openness. Then，we interpreted the formation，circulation，symbiosis and governance mechanism of the regional healthcare consortium symbiotic network. Finally，with regard to problems in the development of regional healthcare consortium in China，we put forward that to realize the healthy and sustainable development of regional healthcare consortium symbiotic network，individualized characteristics of the members in the consortium and their own speed of development should be respected. Moreover，competitions and cooperations between the members should be handled appropriately.

Development of a Health Evaluation System for the Regional Healthcare Consortium Symbiotic Network　

ZHANG Jiarui，YIN Dong，ZHANG Shue，WANG Zhen，ZHAI Chuncheng，ZHANG Min，YIN Hongyan，SUN Tao

2019, 22(31): 3881-3886. DOI: 10.12114/j.issn.1007-9572.2019.00.131

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On the basis of the bionic model of the social ecological system，we introduced the 3 domains（organization structure，vitality and stability） of the natural ecosystem health assessment framework into the comprehensive health evaluation system for regional healthcare consortiums.Then，by use of evaluation indicator screening methods and principles，we derived a system with organizational structure，operation management，stability，vitality，external environment and service efficiency as the core.Finally，based on the theories of organizational immunity，organizational adaptability，ecological niche and information resource sharing，combining with the practice and exploration of the regional healthcare consortiums，we endowed the indicators with corresponding meaning and characteristics.We hope that our study can help better interpret and evaluate the health status of the regional healthcare consortium symbiotic network.

Relationship of Depression and Anxiety with Cognitive Emotion Regulation Strategies among the Elderly in the Community　

SUN Junjun，LUO Yanyan，ZHANG Ruiqin

2019, 22(31): 3887-3892. DOI: 10.12114/j.issn.1007-9572.2019.00.441

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Background　Depression and anxiety are the most common mental health problems among the elderly in the community.Management of emotions by use of cognitive strategies is closely related to the life of older people.At present，research on cognitive emotion regulation strategies and negative emotions among the elderly is rare.Objective　To examine the relationship of depression and anxiety with cognitive emotion regulation strategies in the elderly in the community，to provide insights to deliver interventions for depression or anxiety in this population.Methods　By use of convenience sampling，550 community-dwelling residents aged 60 or over were selected from Xinxiang，Henan Province from March to April 2018，and were surveyed with the General Demographic Questionnaire developed by our research team，15-item Geriatric Depression Scale（GDS-15），Generalized Anxiety Disorder-7（GAD-7） and the Cognitive Emotion Regulation Questionnaire（CERQ）.Spearman rank correlation was used to analyze the relationship of depression and anxiety with cognitive emotion regulation strategies.And stepwise multiple linear regression was used to analyze the influencing factors of depression and anxiety.Results　A total of 514 cases returned responsive questionnaires，indicating that the survey obtained a response rate of 93.5%.The prevalence rates of depression，and anxiety were 26.5%（136/514），and 9.9%（51/514），respectively.Correlation analysis showed that depression scores were positively correlated with self-blame，rumination，catastrophization，and blaming others（P<0.05），and negatively correlated with acceptance，self-consolation，refocus on planning，positive refocusing，and positive reappraisal（P<0.05）；anxiety scores were positively correlated with self-accusation rumination，catastrophization，and blaming others（P<0.05），and negatively correlated with self-consolation acceptance，refocus on planning，positive refocasing，and positive reappraisal（P<0.05）.Stepwise multiple linear regression analysis showed that age，education level，number of chronic diseases，number of good friends，family relationship，physical condition and rumination，catastrophization，blaming others，self-comfort and positive reappraisal were the influencing factors of depression among the elderly in the community（P<0.05）；age，number of chronic diseases，family relationship，average monthly income and rumination，catastrophization，blaming others，and positive reappraisal were the influencing factors of anxiety among the elderly in community（P<0.05）.Conclusion　The incidence rates of anxiety and depression among the elderly in the community are high.The use of cognitive emotion regulation strategies is closely related to depression and anxiety.Those who more frequently use non-adaptive strategies such as rumination，catastrophization，blaming others，and less frequently use positive reappraisal and other adaptive strategies，may be more likely to experience depression and anxiety.

Borderline Personality Disorder: One Case Study of Mental Health in the Chinese Community　

YAN Fengwu，ZHAO Ameng，CAI Zhenzhen，WU Shaochang，LI Jianzhong

2019, 22(31): 3893-3896. DOI: 10.12114/j.issn.1007-9572.2019.00.447

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Borderline personality disorder（BPD） is a personality disorder characterized by unstable emotions，impulsiveness，intense interpersonal relationships，and unstable self-image.BPD patients usually have negative emotional reactions，and impaired emotion regulation，and are prone to impulsiveness，emotionalization，stress-induced emotional dysfunction，and suicide or nonsuicidal self-injury and other poor adaptive behaviors，bringing great mental pain.This article reports the psychotherapy process of a 21-year-old woman with BPD，in order to improve community doctors' ability of using comprehensive psychological counseling and treatment in clinical practice.

Advances in Research on Association between Sleep Duration and Stroke and Its Risk Factors　

WANG Weihua，CUI Shibei，JI Xiaowen，ZAHNG Yongbao

2019, 22(31): 3897-3901. DOI: 10.12114/j.issn.1007-9572.2019.00.631

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Stroke is a leading cause of death and disability worldwide.While numerous traditional risk factors（such as hypertension，diabetes，dyslipidemia，atrial fibrillation and obesity） have been identified for stroke，inappropriate sleep duration has only been considered as a risk factor in recent years.Various epidemiologic studies have associated stroke with sleep duration.The purpose of this review is to provide an update on the relationship between sleep duration and risk factors of stroke in order to increase doctors' awareness of sleep duration and to provide a reference for stroke prevention in the people who have high-risk factors of stroke.

Research Progress on Depression Fatigue　

LI Miao，WANG Qunsong，JIA Hongxiao

2019, 22(31): 3901-3904. DOI: 10.12114/j.issn.1007-9572.2019.00.321

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The relationship between fatigue and depression is very complex.As a symptom of depression，fatigue is a common premonitory symptom especially at the first attack of the depression.Fatigue is also a residual symptom of depression which is more prone to become chronic disease than other depressive symptoms and is highly related to patients' work and social function defects.Therefore，paying attention to fatigue of depressive patients has important significance for their clinical treatment，the improvement of their quality of life and the reduction of recurrence rate of depression.This article reviews the definition，clinical manifestation，adverse outcomes，mechanism，diagnosis and treatment of depression fatigue in order to provide a reference for doctors.

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