Chinese General Practice

Evaluation Research on the Influence of Papers Written by Young and Middle-aged Authors in the Field of General Practice in China from 2013 to 2017　

WANG Haiyan1，XU Yanli2，YAN Xingmin2，WANG Yang2，SONG Yang1，ZHENG Wenwen1，WANG Fengwei2，YIN Ligang2，HAN Jianjun2*，MA Zheng1*

2019, 22(34): 4157-4165. DOI: 10.12114/j.issn.1007-9572.2019.00.782

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Background　The concept of general practice was introduced into mainland China in the late 1980s with a late start.There are relatively few systematic studies on the papers of general practice in China currently.Objective　Taking the research papers in the field of general practice in China from 2013 to 2017 as the starting point，this study analyzes the influence of the papers written by young and middle-aged authors and the characteristics of high-impact papers，and deeply explores the output of scientific research papers and its influence in the field of general practice，in order to provide references for future scientific research and discipline development of general practice in China.Methods　This study was conducted in accordance with the procedures of research data retrieval and collection，evaluation index system construction，quantitative evaluation，qualitative evaluation，and comprehensive evaluation.In July 2018，relevant papers on general practice were searched in the SCI information database and the Wanfang data database.The search strategy was based on the search terms formed by common keywords to obtain relevant papers in the field of general practice and papers published in related academic journals in the field of general practice/family medicine/primary health care at home and abroad as supplements，and papers written by authors affiliated to General Practice Department，School/College of General Practice，Community Health Service Center/Station，and General Practice Teaching and Research Institute/Center were also included in.The search time window was limited to 2013—2017，and the paper types were limited to the academic article（Article） and the review（Review）.On the basis of literature review and expert consultation，the evaluation index system of the paper impact was established with two first-level indicators（influence indicator and innovation indicator） and additional items.The analytic hierarchy method was used to determine the weight of the indicators.Quantitative，qualitative and comprehensive evaluations were conducted to papers with higher frequency of citations according to the years of publication（top 30% of foreign papers and top 2% of Chinese papers）.Results　From 2013 to 2017，SCI information database included 20 046 papers in the field of general practice globally.According to first authors and affiliations of the published papers，the authors from China published 323（1.6%） papers.Wanfang data database contained 15 553 papers in the field of general practice in China.According to the comprehensive evaluation scores of included papers，a total of 90 high-impact papers of young and middle-aged authors from 2013 to 2017 were obtained.Among them，the keyword "hypertension" appeared the most frequently（16 times），and other keywords appearing 10 times and more were primary health care，diabetes，and the elderly.The first affiliations of the first authors were mainly non-general practice schools/colleges in universities（34 papers，accounting for 37.8%），followed by non-general practice departments in comprehensive hospitals（16 papers，accounting for 17.8%）.The locations of first affiliations of the first authors were mainly in the eastern region of China（49 papers，accounting for 70.0%）.Most of the papers were supported by fund projects（64 papers，accounting for 71.1%），mainly urban-level fund projects（24 papers，accounting for 26.7%）.Conclusion　The research directions of young and middle-aged scholars who publish high-impact papers in the field of general practice are in line with its research hotspots in China.Scholars in non-general practice departments and schools/colleges actively participate in scientific research activities of general practice，which promotes the development of general practice discipline.At present，the scale of research in the field of general practice in mainland China is relatively small，while research on general practice starts early in Hong Kong，and the academic exchanges and cooperation between mainland China，Hong Kong，Macao and Taiwan should be strengthened.In order to further improve the discipline construction of general practice，it is recommended to optimize the academic resource structure and strengthen the training of scientific research personnel in the general practice cchools/colleges of universities，general practice departments of comprehensive hospitals，and community health service institutions.It is also recommended to increase investment in fund projects for general practice research and to cultivate high-quality periodicals in order to enhance the overall scientific research level in the field of general practice，and to promote the construction and development of general practice disciplines in China.

Prevalence of Comorbidity among the Elderly and Its Impact on Healthcare Expenditure in China　

JIN Xiuze，LU Yun

2019, 22(34): 4166-4172. DOI: 10.12114/j.issn.1007-9572.2019.00.616

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Background　Along with lifestyle and living environment changes as well as accelerated aging，the prevalence of comorbidities among the elderly has gradually become a social problem，putting tremendous pressure on healthcare expenditure.Objective　The purpose of this study was to investigate the prevalence of comorbidity among the elderly，and its impact on healthcare expenditure in China.Methods　We enrolled 5 265 cases aged 60 or over from the participants of China Health and Retirement Longitudinal Study（CHARLS） 2015 and collected their data of sociodemographics，healthcare，chronic disease prevalence and healthcare spending.With healthcare spending as the dependent variable，number of chronic diseases as the independent variable，and sociodemographics and healthcare information as the controllable variables，we developed a multinomial ordered Logit model to explore the impact of number of chronic diseases on healthcare expenditure.Results　About 44.46%（2 341/5 265） of the participants had comorbidity，and the prevalence in urban（48.39%，601/1 242） was significantly higher than that in rural（43.25%，1 740/4 023，P=0.001）.Hypertension plus arthritis or rheumatism was the most common binary combination（16.49%，173/1 049），while hypertension plus stomach or digestive system disease，and arthritis or rheumatism was the most common ternary combination（9.50%，67/705）.The median healthcare expenditures for those with two and three chronic diseases were 600 yuan（QR=2 640） and 1 200 yuan（QR=5 100），respectively.Univariate analysis showed that type of residence，employment status，annual household income per capita ，type of medical insurance，smoking status，BMI，body pain，accidental injury，number of falls，self-rated health status，and number of chronic diseases significantly influenced the distribution of healthcare expenditure（P<0.05）.Ordered Logit model revealed that the number of chronic diseases，highest level of education，employment status，annual household income per capita，type of medical insurance，smoking status，BMI，body pain，and number of falls influenced healthcare expenditure significantly（P<0.05）.Conclusion　The prevalence of comorbidity is high in elderly people in China.The increase in the number of comorbidities can bring about a remarkable increase in healthcare expenditures.To avoid the waste of medical resources，priorities should be given to comprehensive management of comorbidities，and efforts should be made to promote standardized diagnosis and treatment of comorbidities in this group.

The Effectiveness of Supportive Policies for the Implementation of Contracted Family Doctor Services in China：Current Status and Potential Problem Analysis

SUN Huajun1，ZHANG Lingling1，TIAN Hui2，LI Di1，WEI Keshuai1，DU Yue1*

2019, 22(34): 4172-4178. DOI: 10.12114/j.issn.1007-9572.2019.00.539

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1.300070天津市，天津医科大学公共卫生学院　2.300387天津市，天津工业大学经济与管理学院
*通信作者：杜汋，讲师；E-mail：duyue@tmu.edu.cn
Background　At present，the contracted family doctor services are in full swing in the national primary medical institutions，and it is of great significance to scientifically and accurately evaluate the effect of the contracted family doctor services policy.Objective　To analyze the current situation and potential problems of supportive policies for the implementation of contracted family doctor services in China.Methods　In November 4，2018，the family doctor was used as the key word to search the literature related to the evaluation of the policy effect of the contract service of Chinese doctors in CNKI，and the retrieval time was from the establishment of the database to 2018.The publishing time，research object，data，research content，statistical methods and conflicts of interest were collected，and the existing problems from the macro and micro levels were analyzed.Results　Finally，27 articles were included to evaluate the effect of contracted family doctor services policy.Among them，16（59.3%） were community residents，10（37.0%） were chronic patients；17（63.0%） were in Shanghai and 6（22.2%） were in Beijing；22（81.5%） were using data from questionnaires which were not open to access，and 5（18.5%） were from internal data of government，hospitals and other relevant departments.Literature research mainly involves the impact of promoting contracted family doctor services on controlling the unreasonable growth of medical expenses，promoting the formation of hierarchical diagnosis and treatment pattern，and improving residents' satisfaction.Macro-level problems include unbalanced geographical distribution of the studies，and insufficient level of causal reasoning.Micro-level problems include significant differences between contracted and non-contracted groups，unrepresentative samples，inappropriate regression model construction and nonstandard research designs.Conclusion　In the future，the causal reasoning of relevant research should be strengthened，and the balance and sufficiency of related research should be emphasized.

Teaching Model and Evaluation System of General Practice Training in Germany and Its Enlightenment to China　

ZHANG Yong，HUANG Rongcai，JIANG Pin，LI Jiehua，TANG Haiqin

2019, 22(34): 4179-4184. DOI: 10.12114/j.issn.1007-9572.2019.00.618

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After years of exploration and improvement，the general practice（GP） training system of Germany has formed a systematic，standardized and scientific feedback system of teaching and assessment evaluation.GP training in China starts late and needs to be standardized，improved and developed urgently.This paper summarized the model and assessment system of general practice training in Germany，and found that the Germany general practitioners used a learning model based on the Canada Medical Education Direction System（CanMEDS）．It adopted feedback-training mechanism and implemented core competence-oriented medical education training and evaluation by Entrustable Professional Activities（EPAs）．Standardized patient（SP） assessment and direct observation of procedural skills（DOPS） are commonly used in medical education training and evaluation，which can be used for reference to improve the general practice training system in China.

Australian Chronic Disease Management Plan and Its Enlightenment to China　

YING Liang，YANG Hui

2019, 22(34): 4184-4189. DOI: 10.12114/j.issn.1007-9572.2019.00.538

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Chronic disease has become the foremost cause of disease burden，and is also a priority for global primary and preventive health care.Chronic disease management plays an important role in improving the outcome，and quality of life in such patients.On the basis of studying chronic disease management in general practice and documentary research，this paper introduces two kinds of general practice chronic disease management plans in Australia，namely，general practice management plan（GPMP）and team care arrangements（TCAs）.Compared with the management of chronic diseases in China，it is suggested that China should improve the quality of general practice team，choose the chronic disease management mode according to local conditions，develop "Internet +" technology to provide technical support for chronic disease management，so as to constantly explore the chronic disease management mode that is in line with domestic conditions.

Incentive Policies for Allocating High-quality Health Resources to Primary Healthcare Institutions: an Analysis from the Perspective on Policy Tools　

ZHANG Jiarui，ZHANG Shu'e，YIN Dong，FAN Lihua，HUANG Ying，ZHAI Chuncheng，SHI Lei，SUN Tao

2019, 22(34): 4190-4196. DOI: 10.12114/j.issn.1007-9572.2019.00.446

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Background　Incentives for quality health resources to sink depend on government policies.Policy tools are designed and appropriately selected by the government to drive a series of health sector reforms，so interpreting these tools can best reflect the healthcare reform process.Objective　To explore the characteristics and blind spots of 30 policy documents issued by the central government and the provinces and cities focused on model medical reform，so as to provide a good guide for the effective subsidence of quality health resources.Methods　Using content analysis，from three dimensions of policy classification framework，core competitiveness of medical institutions and policy targets，we selected and interpreted 30 policies incentivizing the allocation of high-quality health resources to primary care issued by the central government，and the provincial and municipal governments of the focus demonstration provinces and cities during the ten years from January 2009 to December 2018 as research objects.With "quality health resources sinking and incentive policy analysis" as the key words，the paper searched through the government portal website，Chinese reform information database and other channels，and analyzed based on the policy classification framework，the core competitiveness of medical institutions and the target of policy action.Results　Among the 150 text units，environmental policy tools were more widely used，accounting for 61.3%（92/150），supply policy tools 24.7%（37/150），and demand policy tools were less used，accounting for only 14.0%（21/150）.Among environmental policy tools，institutional mechanisms are more frequently used than other tools，accounting for 22.8%（21/92） and 21.7%（20/92），respectively.Among the supply-oriented policy tools，the application frequency of training assistance and information platform is relatively high，accounting for 32.4%（12/37） and 27.0%（10/37），respectively.Among the demand policy tools，the traditional medicine service policy tools only account for 14.3%（3/21） of the demand policy tools.In addition，in the dual dimension，the policy items were mostly focused on diagnosis and treatment（60.0%），followed by preventive screening（33.3%），and the least involved rehabilitation and health care stage（6.7%）.Conclusion　We found some core problems existing in the policies，such as the overuse of mandatory environmental policy tools，insufficient effectiveness of supply policy tools in meeting the public health needs，weak interactions between the environmental policy tools，and lack of functionally optimized complementarity between the policy tools.To further incentivize the allocation of high-quality health resources to primary care in China，we put forward the following suggestions：appropriately weakening or reducing the use frequency of mandatory environmental policy tools，increasing the use frequency of supply and demand policy tools，exploration of the optimal combination of policy tools，and appropriately using policy tools according to the specific time and local conditions.

Comorbidity Management Model in Elderly in China Based on the Theory of Complexity Science　

WU Tingting，LU Yun，AI Dandan，CHEN Chen，CHANG Feng

2019, 22(34): 4197-4201. DOI: 10.12114/j.issn.1007-9572.2019.00.629

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Currently，clinical research on comorbidity is still insufficient in China，and there is no systematic，scientific and effective management path for managing comorbidity patients.As aging continues and the problem of comorbidity in the elderly becoming more serious，the management of comorbidity in the elderly has become a major challenge in the medical field.This paper combined the complexity science theory with the management of comorbidity care.From the perspective of system management of complexity theory and the international experience of comorbidity care，it designed a management model of comorbidity based on the national conditions of our country.The aim was to provide ideas and opinions for the research and development of the management scheme to meet the caring needs of comorbidity patients，and reference for health policy makers and health service providers.

Current Situation of Human Resources System Construction in Primary Health Care and Its Influencing Factors in Beijing　

Zhang Kai，Wang Meiqing

2019, 22(34): 4202-4208. DOI: 10.12114/j.issn.1007-9572.2019.00.546

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As a valuable resource of medical institutions at all levels，health human resources not only fundamentally determine the overall professional level of medical institutions，but also are valuable wealth for the long-term development of medical institutions in the future，especially grass-roots medical institutions.There is a long-term shortage of health human resources at the grass-roots level in China.The causes of relevant systems determine the systematicness and complexity of solving this problem.Based on the contents of the Regulations on the Registration of Doctors implemented by the former National Health and Family Planning Commission in April 2017 and the spirit of the Opinions on Reforming and Improving the Training for General Practitioners and Use of the Incentive Mechanism issued by the General Office of the State Council in January 2018，and the current situation of the construction of the grass-roots health human resources system in Beijing，this paper applied a questionnaire survey.By means of in-depth interviews，the occupational status and expectations of general practitioners in Beijing were investigated and analyzed.Five factors that seriously affected the rational distribution of health human resources at the grass-roots level were summarized：（1）the limitation of the scope of practice in the registration of doctors；（2）the limitation of the promotion system of professional titles；（3）the limitation of "human-governing factors" in the old personnel system in public institutions；（4） subjective restrictions on the main body of managerial standard caused by the long-term shortage of health personnel at the grass-roots level；（5）unique household registration constraints in Beijing.Five countermeasures and suggestions were put forward：（1）standardizing training，improving salary and establishing good career expectations；（2）reforming personnel management system and establishing two-way position transfer mechanism；（3）perfecting relevant legal system and defining the boundary of personnel rights；（4）increasing the scope of practice in accordance with the law and opening the access of talents；（5）drawing lessons from the experience of tertiary medical institutions to construct the mechanism of talent flow.

The Weekend Outpatient Services Delivered by Community Healthcare Institutions in Shanghai　

ZHANG Jingya，WAN Heping，QIN Yan，TAO Lei，WANG Hong，SU Lina，LIU Jingjing，SUN Xinran

2019, 22(34): 4209-4212. DOI: 10.12114/j.issn.1007-9572.2019.00.501

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Background　Shanghai issued a notice in 2011 requiring community healthcare institutions to deliver weekend outpatient services.At present，there is a lack of research on the delivery and utilization of weekend outpatient services.Objective　 To investigate the implementation status of weekend outpatient services in community healthcare institutions in Shanghai，to provide a reference for relevant departments to formulate policies.Methods　This survey was conducted between August and September，2018.Managers from all（282） community healthcare institutions〔243 community health centers（CHCs） and 39 community health sub-centers〕 in Shanghai were invited to participate in the survey and to fill in a self-administered questionnaire on the implementation of weekend outpatient services in their own institution during January to June，2018，involving the prevalence of delivery，outpatient visits，workers，and overtime allowance.The survey achieved a response rate of 100.0%.Results　Among the community health institutions，95.7%（270/282） delivered outpatient services on weekend，of them those delivering such services on Saturday morning accounted for the largest proportion〔95.0%（268/282）〕 of the total.The average daily outpatient visits on weekend of community healthcare institutions in Shanghai were 81 980.The top three districts（448.50 in Qingpu District，445.75 in Minhang District，437.79 in Pudong New District） owing the most average daily outpatient visits on weekend of CHCs and top two districts（248.60 in Qingpu District，156.67 in Minhang District） owing the most average daily outpatient visits on weekend of community health sub-centers were suburbs.CHCs showed more average daily visits on weekend than community health sub-centers（321.99 vs. 151.03）.Community healthcare institutions delivering outpatient services only on Saturday morning had an average daily outpatient visits on weekend of 307，and lower average visits on other weekend hours.Of those delivering outpatient services on both Saturday and Sunday，30.4%（82/270） thought that the number of health workers could not satisfy the healthcare needs of patients；15.2%（41/270） paid weekend overtime allowances to health workers.Conclusion　Outpatient services delivered on Saturday morning can be found in most community healthcare institutions in Shanghai，and are well utilized.The services are better utilized in suburban districts than in urban districts，and in CHCs than in community health sub-centers.However，the number of health workers can't meet the healthcare needs of patients in those delivering such services on Saturday and Sunday.It is suggested that community healthcare institutions should allocate medical resources reasonably，increase the number of health workers to alleviate the pressure of weekend outpatient workloads，and take incentive measures to raise the workers' enthusiasm in offering such services.

Neutrophil-to-lymphocyte Ratio and 5-year All-cause Mortality in Patients with Heart Failure　

LUO Faxin，YE Ziliang，ZHU Jijin

2019, 22(34): 4213-4219. DOI: 10.12114/j.issn.1007-9572.2019.00.632

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Background　The mortality rate of heart failure（HF） remains high.And there are limited clinical studies on the relationship between neutrophil-to-lymphocyte ratio（NLR） and 5-year all-cause mortality in such patients.Objective　To investigate the correlation between NLR and 5-year all-cause mortality in patients with HF.Methods　This study was a single-center retrospective study.418 adult patients with symptomatic HF（NYHA class Ⅲ-Ⅳ） hospitalized in the First Affiliated Hospital of Guangxi Medical University from August，2012 to July，2013 were enrolled.Clinical data and telephone-based follow-up results were collected to understand the 5-year all-cause mortality.The relationship between NLR and 5-year all-cause mortality was analyzed across quartile subgroups stratified by NLR value.Results　The 5-year all-cause mortality in the participants was 55.3%（231/418）．Univariate analysis showed that urea，creatinine，cystatin C，creatine kinase isozyme，plasma N-terminal B-type natriuretic peptide precursor，higher NYHA classes，and elevated NLR increased the risk of 5-year all-cause mortality in HF patients（P<0.05），whereas high weight and triglyceride，the use of β receptor blockers，and women decreased the risk（P<0.05）．After adjusting for other covariates，NLR remained an independent predictor of 5-year all-cause mortality（P<0.05）．Conclusion　NLR is an independent predictor of 5-year all-cause mortality in HF patients.The higher the ratio，the higher the risk.

Incidence and Influencing Factors of Hyperuricemia in Hypertensive Populations　

LIU Weida，ZHANG Licheng，WANG Yong，LUO Yanxia

2019, 22(34): 4219-4224. DOI: 10.12114/j.issn.1007-9572.2019.00.547

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Background　Hyperuricemia（HUA）and hypertension are important controllable risk factors for cardiovascular and cerebrovascular diseases.They often coexist with other cardiovascular risk factors，and accelerate the progression of cardiovascular disease.Objective　To investigate the incidence and influencing factors of HUA in hypertensive populations.Methods　We enrolled 3 930 physical examinees with hypertension from a physical examination center of Beijing from 2012 to 2016，and followed up them for 1 to 4 years.We analyzed the incidence of HUA in these participants，and compared the demographic，physical and laboratory data between non-HUA and HUA groups，and analyzed the influencing factors of HUA by using Logistic stepwise regression.Results　The incidence of HUA in the participants was 23.31%（916/3 930）．Sex-specific analysis showed that the incidence of HUA was higher in males than that in females〔24.76%（742/2 997） vs 18.65%（174/933），χ2=14.853，P<0.001〕．Age-specific analysis indicated that the incidence of HUA was 25.67%（295/1 149），21.76%（363/1 668），21.44%（149/695） and 26.08%（109/418） in age groups of <45，45-<60，60-<75 and ≥75，respectively.There was no significant difference in the cumulative incidence of HUA among different age groups（χ2=0.467，P=0.495）．Compared with non-HUA group，HUA group showed higher proportion of males，higher mean levels of WBC，GGT，creatinine，triglyceride，uric acid，BMI，and waist-hip ratio，and lower mean ALT，HDL-C and FBG levels（P<0.05）．Stepwise Logistic regression analysis showed that creatinine，HDL-C，triglyceride，FBG，erythrocyte sedimentation rate and obesity were factors associated with HUA in hypertensive populations（P<0.05），and hemoglobin，creatinine，HDL-C，triglyceride，FBG and obesity were factors associated with HUA in hypertensive men（P<0.05），and age，total cholesterol and obesity were factors associated with HUA in hypertensive women（P<0.05）．Conclusion　The incidence of HUA does not increase with age in hypertensive populations.Factors associated with HUA in this group include creatinine，HDL-C，triglyceride，FBG，erythrocyte sedimentation rate，and obesity .Sex differences are also found in factors affecting the incidence of HUA.

Sex Specificity of Metabolic Changes in Hypertensive Patients with Primary Aldosteronism　

RONG Liwei，LUO Qin，WANG Menghui，ZHANG Delian，NUERBIYA·Abudusailamu，TAO Weijun，LI Nanfang

2019, 22(34): 4225-4233. DOI: 10.12114/j.issn.1007-9572.2019.00.636

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Background　Many studies have reported that primary aldosteronism（PA） is associated with the development of glycometabolic disorders and metabolic syndrome（MS）．However，some studies have not found differences in metabolic disorders between patients with PA and essential hypertension（EH）．Recent studies have reported that aldosterone is not associated with insulin sensitivity in obese men，and blockade of aldosterone action via mineralocorticoid receptor antagonists（MRA） appears to be more effective in women.There may be exist sex-specific differences in metabolic changes in PA patients.Objective　To compare and analyze retrospectively the characteristics and differences of metabolic disorders in PA patients and EH patients with different genders.Methods　Patients with hypertension who were hospitalized continuously in Hypertension Center of the People's Hospital of the Xinjiang Uygur Autonomous Region from 2009 to 2010 were included in this study.According to the guidelines of the American Endocrine Society，127 patients were diagnosed as PA；259 patients were diagnosed as undetermined PA；and 672 patients were diagnosed as EH.According to the matching criteria of sex and age（±1 year old），PA patients and EH patients were matched in a ratio of 1∶3 and finally 124 PA patients were matched with 372 EH patients.Metabolic indicators of PA patients and EH patients with different genders were compared，and the effect of PA on related metabolic indicators was analyzed by linear regression.Results　The blood pressure of PA patients was significantly higher than that of EH patients in males〔（151±19）/（101±12） mm Hg vs.（142±20）/（97±15） mm Hg，P<0.05〕，but no significant difference was found between PA patients and EH patients in females〔（139±14）/（91±10）mm Hg vs.（139±19）/（92±12）mm Hg，P>0.05〕．The levels of total cholesterol in PA patients were significantly lower than those in EH patients in females（P<0.05）．Overall，there was no significant difference in the prevalence of MS and glycometabolic disorders between PA patients and EH patients with different genders.However，the prevalence of hyperglycemia in PA patients was significantly higher than that in EH patients in obese females（60.0% vs. 25.0%，P<0.05）．There were no significant differences in metabolic disorders between PA patients and EH patients in males（P>0.05）．Multivariate linear regression analysis showed that aldosterone in post-saline infusion test was independently associated with blood glucose only in obese females in the model which age，systolic blood pressure，diastolic blood pressure，creatinine，uric acid and triglyceride were included as independent variables.Conclusion　The blood pressure of PA patients is significantly higher than that of EH patients in males，while the blood lipid level is lower.The proportion of abnormal glucose metabolism in obese female PA patients is significantly higher than that in EH patients，but no difference is found in male patients.Aldosterone level in post-saline infusion test is independently associated with hyperglycemia in obese females.There may be sex-specific differences in metabolic changes in PA patients.

Mechanism of Dietary Management for Lactating Mothers in the Prevention and Treatment of Infant Eczema　

LIU Yanan，LI Zhongyuan，WANG Yu，LI Yanmei，LIU Xiao，HU Xiaohong

2019, 22(34): 4234-4239. DOI: 10.12114/j.issn.1007-9572.2019.00.341

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Background　Eczema is the most common allergic skin inflammation in infants.The symptoms of this disease can be delayed by pharmacological treatment，but it still occurs repeatedly，seriously affecting the quality of life and healthy growth of infants.Eczema in exclusively breastfed infants is associated with mothers eating sensitive food.Objective　To investigate the relationship between infant eczema and the food-specific IgG antibody level in serum of lactating mothers，effectiveness and possible mechanism of lactating mothers' avoidance of sensitive foods on preventing and treating infant eczema，and to explore non-pharmacological preventive interventions and treatments for the disease.Methods　The levels of 14 food-specific IgG antibodies in serums of lactating mothers of 142 eczema infants（observation group）and 35 healthy infants（control group）were measured by ELISA from March 2016 to September 2018.According to the personal test result，the mothers were given dietary guidance on eating a diet with a list of foods to be avoided.And the eczema improvement was followed up by telephone calls three months later.Results　The positive rate of the eczema infants group〔95.7%（132/138）〕 was higher than that of the control group〔82.9%（29/35）〕，showing a significant difference between the two groups（P<0.05）．The total effective rate of eczema remission was 93.0%（107/115），in which the remission rate of eczema was 93.4%（85/91） in the complete avoidance group and 91.7%（22/24） in the incomplete avoidance group.Conclusion　Increased food-specific IgG antibody levels in lactating mothers of infants with eczema suggests that the mothers may be sensitive to related foods.The mothers' intentional avoidance of sensitive foods can prevent and treat the infant eczema，and the mechanism may be related to IgG-mediated delayed-type hypersensitivity.

Long-term Effect of Peer Support Intervention on Diabetes-related Knowledge Level and Self-management in Type 2 Diabetic Patients　

LIU Hongjie，SHI Hongmei，XING Lili

2019, 22(34): 4240-4245. DOI: 10.12114/j.issn.1007-9572.2019.00.695

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Background　The prevalence of diabetes in China is increasing year by year with the advance of society.Moreover，diabetes-related complications cause serious economic burden.Peer support can improve the patients' ability of prevention and management of diabetes and reduce the workload of medical workers.Diabetes requires long-term interventions.However，the long-term（36 months） impact of peer support interventions on diabetes has been rarely studied.Objective　To explore the changes in diabetes-related knowledge level and self-management in type 2 diabetic patients with long-term peer support.Methods　This study started in 2013 and ended in 2016，lasting for 36 months.Participants were patients with a definite diagnosis of type 2 diabetes recruited from 5 community health centers in the southern area of Dongcheng District（formerly Chongwen District），Beijing.By use of sequentially numbered，opaque，sealed envelopes according to the random allocation sequence generated by the SAS，80 and 74 cases were assigned to the intervention group（intervened with peer support and standardized diabetic management） and control group（intervened with standardized diabetic management），respectively.Diabetic patients' data were collected before the intervention，and at the end of 6-month intervention in 2013 via the questionnaire survey，and at the end of 36-month intervention in 2016 via a follow-up.Changes in diabetes-related knowledge level，self-management behaviors，glycated hemoglobin and fasting blood glucose of two groups were evaluated.Results　76 in the intervention group and 68 in the control group who completed the follow-up were included in the final analysis.After 6 months of intervention，the awareness rates of the intervention group on the reference range of fasting blood glucose，diabetes hazard，diabetes prevention and control measures，unit value of food exchange，carbohydrate proportion，sequence of daily food intake，overweight standard of body mass index and recommended daily intake of edible oil for adults were higher than those of the control group（P<0.05）.At 36 months of intervention，the awareness rates of the intervention group on the reference range of fasting blood glucose，the hazard of diabetes，the proportion of carbohydrate，the daily recommended salt intake of adults and the daily recommended edible oil intake of adults were higher than those of the control group，with statistical significance（P<0.05）.Furthermore，higher percentages of patients improving their conditions by diet and exercise were also found in the intervention group（P<0.05）.At the end of 6-month intervention，mean levels of glycosylated hemoglobin and fasting blood glucose decreased more significantly in the intervention group，but at the end of 36-month intervention，mean levels of these two glycemic parameters became similar in both groups（P>0.05）.Conclusion　The results of this study show that community-based peer support interventions plus standardized diabetic management is effective in improving the self-management ability of type 2 diabetic patients，and the intervention effect may last for a long time，but the shorter-term effect is better，suggesting that to maintain the effect as long as possible，patients should maintain and consolidate glycemic control behaviors continually after a 6-month intervention with the assistance of further improved procedure.

Home Blood Pressure Monitoring and Health Education Analysis in Hypertensive Patients of Different Ages　

FENG Guofei，JI Yutong，YUAN Hui，XIE Zhiquan，CHEN Yingyi

2019, 22(34): 4246-4250. DOI: 10.12114/j.issn.1007-9572.2019.00.634

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Background　Home blood pressure measurement is an important means of blood pressure management.Standardizing home blood pressure measurements is the basis for adjusting antihypertensive drugs.Age and hypertension health education have significant impacts on home blood pressure measurement.Objective　To investigate home blood pressure monitoring and health education in hypertensive patients of different ages in General Hospital of Southern Theatre Command.Methods　A total of 385 hypertensive patients who had health examination in a community of Guangzhou were selected from March to May 2017.The research content included baseline data（sex，age，vital signs，history of past diseases，test results，etc.）and the frequency，time of home blood pressure monitoring and hypertension related health education.According to age，they were divided into middle-aged group（age<65 years），elderly group（65-79 years），and senile group（over 80 years），to compare the home blood pressure measurement and health education of hypertension patients in different age groups.Results　The rate of home blood pressure monitoring was 62.9%（78/124），66.5%（119/179）and 68.3%（56/82），and there was no significant difference among the three groups（χ2trend=0.689，P=0.406）．There was no significant difference in the frequency of home blood pressure measurements among the three groups（P=0.100）．There was no significant difference in home blood pressure measurement time among the three groups（P=0.639）．There was a significant difference in receiving health education in recent one year（P=0.002）．There was a significant difference in recording blood pressure data and reporting it to doctors in follow-up visits between the middle-aged group，the elderly group and the senile group（P=0.005）．There was no significant difference in the awareness rate of anti-hypertensive targets among the three groups of hypertension patients（P=0.402）．Conclusion　The frequency and time of home blood pressure measurement in Guangzhou were not standardized and the awareness of hypertension education was poor.In the future，doctors and nurses need to provide patients with treatment scheme for blood pressure，strengthen health education for patients，formulate different prevention and treatment programs and health education according to age and promote the formation of correct blood pressure monitoring behavior pattern.

Effects of Fasudil and Different Doses of Rosuvastatin on Coronary Slow Flow　

LI Lizhuo，ZHENG Mei，LI Weicong，ZHAO Qingzhen，ZHEN Yuzhi

2019, 22(34): 4251-4255. DOI: 10.12114/j.issn.1007-9572.2019.00.693

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Background　With the popularity of coronary angiography，coronary slow flow（CSF） has been paid more and more attention.CSF might lead to acute coronary syndrome and even acute myocardial infarction.However，the occurrence mechanism of CSF is still unclear.Objective　To observe the effects of fasudil combined with different doses of rosuvastatin on CSF.Methods　From June 2016 to December 2017，117 patients who sought healthcare due to chest pain in the First Hospital of Hebei Medical University and were diagnosed with CSF by coronary angiography were enrolled and were equally randomized into the control group（receiving routine treatment），normal dose group（receiving routine treatment plus fasudil and normal dose rosuvastatin） and high dose group（receiving routine treatment plus fasudil and high dose of rosuvastatin）.The number of attacks of angina pectoris，serum high-sensitivity C-reactive protein（hs-CRP），serum tumor necrosis factor-α（TNF-α），interleukin-1（IL-1），nitric oxide（NO），and coronary flow status measured by coronary angiography were compared before treatment and at the end of two-week treatment.The overall clinical response rate was also compared between the groups.Results　The overall response rate differed significantly between the groups（χ2=9.709，P=0.008）.In particular，high dose group showed much higher overall response rate compared with the control group（χ2=9.047，P=0.003）.Serum hs-CRP，TNF-α，and IL-1 decreased while NO increased obviously in normal and high dose groups after treatment（P<0.05），but these four parameters showed insignificant changed in the control group（P>0.05）.The levels of hs-CRP，TNF-α，IL-1 were lower but the level of NO was higher in both normal and high dose groups than the control group（P<0.05），There were no significant differences in post-treatment levels of hs-CRP，TNF-α，IL-1 and NO between the normal dose group and the high dose group（P>0.05）.The blood flow velocity in all coronaries improved significantly in both normal and high dose groups after treatment（P<0.05），and the improvement in both normal and high dose groups was better than the control group（P<0.05），and the improvement was similar in both groups（P>0.05）.Conclusion　Routine vasodilator therapy in combination with fasudil and rosuvastatin may effectively improve the coronary blood flow velocity，and the response rate in angina pectoris.However，use of normal or high dose of rosuvastatin may be not associated with significant changes in short-term efficacy for CSF.

Health Literacy Knowledge，Health Education-related Attitude and Practice among GPs in Zhejiang　

QIU Yan，WU Linfei，REN Wen，LIU Ying，LIU Juanjuan，TANG Hongmei，QIN Hongli，ZHU Lu，REN Jingjing

2019, 22(34): 4256-4260. DOI: 10.12114/j.issn.1007-9572.2019.00.623

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Background　Delivering health education is one of the duties of general practitioners（GPs）.Health literacy is the evaluation index of effectiveness of health education delivery.Although Chinese residents' health literacy has been assessed several times at the national level，GPs' health literary knowledge is still unknown.Objective　To explore health literacy knowledge，and health education-related attitude and practice in GPs，providing a theoretical basis for further implementation of health promotion activities by GPs.Methods　An online survey was conducted in March 2018 in GPs Alliance，the First Affiliated Hospital，Zhejiang University via a third-party platform with a self-developed questionnaire on basic information，health literacy knowledge，practice of health education，status of reaching the minimum health education practice targets performed by GPs in the national standards for the delivery of essential public health services，and health education-related attitude.Results　The prevalence of having health literacy knowledge in GPs was 56.2% generally.The prevalence of knowing the definition，contents and classification of health literacy was 60.6%（126/208），97.6%（203/208） and 93.8%（195/208），respectively.65.9%（137/208） of the GPs often delivered health education in daily work，mainly using the traditional lecture model and outpatient health education is the most common（91.8%，191/208）.The highest rate of meeting the minimum requirements of the national public health standard was 78.8%（164/208）.97.6%（203/208） of the GPs thought it is necessary to perform health education and they preferred to carry out health promotion activities.Conclusion　General practitioners have a high awareness rate of health literacy，a single form of health education，and the standard of health education is still acceptable.The internet can be used in novel models for implementing health education.

General Practitioners' Turnover Intention and Related Factors in Pudong New Area，Shanghai during the Implementation of the "Eight Incentive Policies"：a Cross-sectional Survey　

LI Youzi，ZHANG Tao，WANG Hongxing，ZHAO Qingfang，MA Shaozhuang

2019, 22(34): 4261-4265. DOI: 10.12114/j.issn.1007-9572.2019.00.453

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Background　To solve the problem of difficulty in recruiting and retaining general practitioners（GPs） in remote suburbs，Former Shanghai Pudong New Area Health and Family Planning Commission issued the "Eight Incentive Policies" to attract and retain GPs in rural areas.Paying attention to the level of GPs' turnover and related factors is of great significance to the improvement of talent incentive policies.Objective　To evaluate the level of turnover intention and influencing factors in GPs in Shanghai's Pudong New Area，so that to provide a reference for the improvement of regional health talent incentive policies.Methods　During the period from June to December 2016，all GPs working in community health centers（CHCs） in Pudong New Area were invited to participate in the questionnaire survey，involving personal characteristics，position and CHC characteristics，GP's family support and local community support，and turnover intention（scores ranged from 1 to 6，the higher the score，the stronger the turnover intention）.1 145 of the 1 261 GPs returned responsive questionnaires，achieving a response rate of 90.80%.Results　Analysis of the survey results showed that the average total turnover intention score for the respondents was（2.26±0.95）．Personal characteristics were not significantly associated with turnover intention score（P>0.05）．Turnover intention score differed significantly by type of position and geographical location of the CHC（in the domain of position and CHC characteristics）（P<0.05）．Moreover，turnover intention score varied obviously by GP's family support and local community support besides local residents' cooperation with GPs（in the domain of GP's family support and local community support）（P<0.05）．Conclusion　The overall level of GPs' turnover intention in Pudong New Area is low，which is significantly influenced by position and CHC characteristics，GP's family support and local community support.Therefore，to reduce GPs' turnover intention，priorities should be given to reasonably narrowing the income gap between managerial and professional health workers，increasing GP's family support，enhancing health education among the local residents，and improving the propaganda and implementation of the incentives for GPs.

Job Satisfaction and Influencing Factors among General Practitioners in Western China　

ZHOU Xiaogang，CHEN Shuilin，LI Liqing，GAN Yong

2019, 22(34): 4266-4271. DOI: 10.12114/j.issn.1007-9572.2019.00.540

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Background　As a major provider of general medical services，general practitioners（GPs） play a pivotal role in delivering primary health care services.Analyzing their job satisfaction and influencing factors are important for improving GPs' quality and service levels，and stabilizing the GPs workforce.Objective　To examine job satisfaction and influencing factors among GPs in western China.Methods　By use of multistage stratified random sampling，1 050 GPs were selected from community healthcare institutions（including community health centers and community health stations） in western China from October 2017 to February 2018.They received a questionnaire survey covering basic demographic conditions and job satisfaction.The Job Satisfaction Scale revised by SONG Kuimeng was adopted to measure job satisfaction，which includes four dimensions of income，work relationship，growth and overall satisfaction.Binary Logistic regression was used to analyze the influencing factors of job satisfaction.Results　The survey obtained a response rate of 98.67%（1 036/1 050）．The average total score of job satisfaction was（37.39±7.35）．63.13%（654/1 036） of the respondents had higher total scores of job satisfaction（≥36 points）.The average scores for four dimensions of income，work relationship，growth and overall satisfaction were（11.86±2.71），
（13.18±2.52），（9.17±2.37），（3.18±0.79），respectively.Univarate analysis showed that gender，education level，mode of employment，overtime and income level were associated with significant differences in job satisfaction level（P<0.05）．Binary Logistic regression analysis revealed that mode of employment，overtime and income level were significantly associated with job satisfaction（P<0.05）．Conclusion　The job satisfaction level of GPs in western China is relatively high，which is mainly associated with mode of employment，overtime and income level.To further motivate GPs' enthusiasm at work and increase their job satisfaction，it is recommended to improve the salary structure，reduce the workload appropriately，alleviate the work pressure effectively，and implement the policy of non-lifetime employment.

Correlation between Chronic Constipation and Mental Disorders　

FAN Wenbin，LAN Haibo，XIE Yanpeng，YANG Xiangdong

2019, 22(34): 4272-4276. DOI: 10.12114/j.issn.1007-9572.2019.00.456

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Chronic constipation is closely related to mental disorders.Constipation can induce depression，anxiety disorders，sleep disorders，somatic disorders，obsessive-compulsive disorders，cognitive dysfunction and other mental disorders.We discussed the symptoms of chronic constipation and mental disorders，and the pathogenetic correlation between the two diseases.At present，the following reasons are considered for mental disorders caused by chronic constipation：effect of metabolites，changes of 5-hydroxytryptamine and short-chain fatty acids caused by intestinal gut microflora，regulation of the hypothalamic-pituitary-adrenal axis，and the application of the theory of evolution.Special cases include chronic constipation are associated with psychosocial disorders caused by long-term opioid application.We reviewed the correlation between chronic constipation and mental disorders，aiming to emphasize the necessity of assessment and treatment of mental disorders in chronic constipation patients，and to provide a reference for the multidisciplinary team model，and for the prospect development of treatment ideas and methods of chronic constipation with mental disorders.
Chronic disease；Constipation；Mood disorders；Mental disorders；Correlation

Effects of Anxiety on Blood Pressure Variability，Endothelin-1 and Nitric Oxide in Elderly Patients with Hypertension　

WANG Shujuan，CUI Jianguo，QI Jie，YANG Yang，YANG Qianqian，ZHANG Qingtan

2019, 22(34): 4277-4282. DOI: 10.12114/j.issn.1007-9572.2019.00.406

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Background　Hypertension is a high-risk disease of cardiovascular system with complicated and diverse causes.Anxiety and hypertension are closely related and affect each other.The effects of anxiety on hypertension may be mainly manifested in the fluctuation of blood pressure，that is，the influence on blood pressure variability（BPV）．Endothelin-1（ET-1）and nitric oxide（NO）are considered to be the most potent factors affecting vasomotor function，and anxiety can affect the secretion of ET-1 and NO.Objective　To analyze the effects of anxiety on BPV，ET-1 and NO in elderly patients with hypertension，and to explore the correlation among BPV，ET-1 and NO in order to provide a theoretical basis for the early intervention and treatment of elderly hypertensive patients with anxiety.Methods　A total of 120 elderly hypertensive patients（51 males and 69 females）hospitalized in the Binzhou Medical University Hospital from November 2016 to June 2017 were selected as the study subjects.The general condition of the patients was recorded and ET-1 and NO were measured.All patients were monitored by ambulatory blood pressure monitoring and assessed by Zung Self-rating Anxiety Scale（SAS）．The patients were divided into hypertension-no anxiety group（EH group），hypertension-mild anxiety group（EH＆LA group）and hypertension-severe anxiety group（EH＆SA group）according to the scores of SAS.The levels of BPV，ET-1 and NO in three groups were compared，and the correlation between BPV and ET-1 and NO was analyzed.BPV was expressed as standard deviation（SD）of blood pressure.Results　The 24 h，diurnal and nocturnal systolic blood pressure standard deviation（24 hSBPSD，dSBPSD，nSBPSD）and nocturnal diastolic blood pressure standard deviation（nDBPSD）were highest in EH & SA group followed by EH & LA group and EH group（P<0.05）．ET-1 level in EH & SA group was highest followed by EH & LA group and EH group，while NO level in EH & SA group was lowest followed by EH & LA group and EH group（P<0.05）．Serum ET-1 level was positively correlated with BPV index（24 hSBPSD，dSBPSD，nSBPSD，nDBPSD）in elderly hypertensive patients with anxiety（r=0.506，0.443，0.666，0.642；P<0.05），while NO level was not correlated with BPV index（P>0.05）．Conclusion　Anxiety has an effect on BPV，ET-1 and NO in elderly patients with hypertension and the greater the degree of anxiety，the higher the level of serum ET-1 and the lower the level of NO.Anxiety may further aggravate vascular endothelial damage in patients with hypertension by increasing BPV.Early identification of anxiety in elderly patients with hypertension and selection of antianxiety therapy according to anxiety level may delay the damage of endothelial function and improve the progress and prognosis of elderly patients with hypertension.

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