Loading...

Table of Content

    05 March 2021, Volume 24 Issue 7
    Monographic Research
    The Development Process and Implementation of Policies Related to Family Doctor in China 
    SUN Caixia, LIU Tingfang, JIANG Feng, SI Sijun, CHU Shijing, WANG Pusheng
    2021, 24(7):  765-774.  DOI: 10.12114/j.issn.1007-9572.2021.00.143
    Asbtract ( )   PDF (2810KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Against the background of "strengthening grass-roots" and "greater health",the contracted family doctor services,as an important part of primary health care service system,plays an important role in promoting hierarchical system treatment,establishing a reasonable medical order,and improving medical services in China. In this paper,reference for the further implementation of contracted family doctor services in China was provided through examining the promulgation and implementation of relevant policies and analyzing their experience and shortcomings. Based on the literature review and case analysis,the development of policies and practice process of family doctors in China were reviewed. It was pointed out that family doctor policy in China had undergone four stages of development:gestation,pilot exploration,gradual promotion and full implementation. And the policy content,implementation and practice results of contracted family doctor services in each stage were analyzed and discussed. Finally,six recommendations were made in line with Chinese characteristics:promoting policy guarantees for the family medicine system and adjusting the allocation of medical resources through medical insurance payments;strengthening the development of family doctor team and encouraging the establishment of general medicine courses;establishing a reasonable incentive mechanism to enhance the enthusiasm of family doctors;accelerating the construction of a medical information sharing platform;promoting a two-way referral mechanism,relying on medical consortium;establishing a reasonable monitoring mechanism and evaluation index system.
    Interpretation(No.2) of Stroke and Transient Ischaemic Attack in Over 16s:Diagnosis and Initial Management  
    LI Zhenghuan,CHEN Yang,SONG Xueli,LIU Xin,WANG Fei,LI Hong
    2021, 24(7):  775-779.  DOI: 10.12114/j.issn.1007-9572.2020.00.473
    Asbtract ( )   PDF (1252KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    The NICE clinical guideline CG68(July 2008),Stroke and Transient Ischaemic Attack in Over 16s:Diagnosis and Initial Management,has been updated and superseded by NG128(May 2019) for there are new developments in stroke treatments,such as newly emerging evidence related to blood pressure control for people with acute intracerebral haemorrhage,decompressive hemicraniectomy,optimal positioning and early mobilisation for people with acute stroke,and so on,and for supplementing the existing suggestions on the diagnosis and acute management of confirmed or suspected transient ischaemic attack(TIA) or acute stage of a stroke in the 48 hours after onset of symptoms as the best clinical advice. The guideline includes 9 recommendations,among which the 1.1.1-1.4.8 recommendations,including rapid recognition of symptoms and diagnosis,imaging for people with suspected TIA or acute non-disabling stroke,specialist care for people with acute stroke,thrombolysis and thrombectomy for people with acute ischaemic stroke have been interpreted in our previous study,and the 1.4.9-1.9.7 recommendations,are interpreted here in the light of relevant research progress,mainly covering aspirin and anticoagulant treatment,decompressive hemicraniectomy for people with acute stroke,blood pressure and blood sugar control,nutrition and rehabilitation management. Our interpretation may provide a reference for domestic clinical practice of care involving mainly emergency and neurology for improving the clinical curative effect.
    Interpretation of Guidelines for the Investigation of Chronic Diarrhoea in Adults: British Society of Gastroenterology in 2018 
    ZHU Xinying,ZHAO Dongqiang
    2021, 24(7):  780-783.  DOI: 10.12114/j.issn.1007-9572.2020.00.432
    Asbtract ( )   PDF (1284KB) ( )  
    References | Related Articles | Metrics
    The 3rd edition of the Guidelines for the Investigation of Chronic Diarrhoea in Adults was published online in Gut by the British Society of Gastroenterology in April 2018,which updated the 2nd edition of the guidelines in 2003. This new edition of the guidelines describes the clinical assessment process,tumor and inflammation assessment,malabsorption test,and the management of common causes,structural/surgical causes and rare causes in chronic diarrhoea. Based on the updated contents of this guideline,this paper discusses the common misunderstandings in the diagnosis and treatment of adult chronic diarrhoea,including incomplete collection of medical history and difficulty in etiological diagnosis;failure to consider bile acid diarrhoea as a common cause of chronic diarrhoea;delayed diagnosis and treatment of celiac disease;failure to take biopsy in colonoscopy;missed diagnosis of colorectal cancer in young patients with chronic diarrhoea;non identification of overflow diarrhoea in the elderly;lack of awareness of the clinical significance of intestinal bacterial overgrowth detection method,and the corresponding countermeasures are proposed.
    Development of Evaluation Model of the Configuration and Construction of General Practice Department in Standardized Clinical Residency Training Bases(General Hospitals) Using the Delphi Method 
    SHEN Shili,WU Bin,QI Dianjun,CHEN Xinyue,ZHANG Xinyan,LI Yixuan,ZHANG Xu,GONG Xue,YU Xiaosong
    2021, 24(7):  784-790.  DOI: 10.12114/j.issn.1007-9572.2021.00.098
    Asbtract ( )   PDF (971KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Background The National Health Committee of the People's Republic of China claims that all clinical bases(general hospitals) responsible for standardized training of general practitioners must set up their own general practice departments. However,there is a lack of research and consensus on how to set up or develop general practice departments in general hospitals in China. Objective To establish an evaluation model for the configuration and construction of general practice department in standardized clinical residency training bases(general hospitals) by Delphi method. Methods Based on the reviewing of 15 relevant studies collected via literature retrieval,our research team〔the general practice department research team of the First Affiliated Hospital of China Medical University(composed of 9 members)〕 developed initial indices and criteria for the evaluation of general practice department in general hospitals in accordance with the discipline orientation of this department,and improved them after analyzing them intensively via panel discussion,then used them to develop a Delphi expert consultation questionnaire(the first version). After that,we selected 45 experts from different regions of China and invited them to participate in 3 rounds of E-mail-based or on-site surveys using the questionnaire for consulting their opinions on screening the indices,estimating the weight and modifying the evaluation criteria. Results An evaluation model including 6 first-level indices(basic conditions,medical technical team,medical service ability and level,medical quality,teaching and scientific research),22 second-level indices,and 78 third-level indices as well as evaluation criteria was established. The positive coefficients of experts in the three rounds of consultation were 84.4%(38/45),92.1%(35/38),91.4%(32/35),respectively. The authority coefficient of experts was 0.94. The eventual Kendall's concordance coefficient of experts reached 0.716(P<0.001). Conclusion In this study,we shared our experience of establishing and perfecting the evaluation model of general practice department configuration and construction in standardized clinical residency training bases(general hospitals)via reporting the specific development method and process completely and transparently.
    Development and Characteristics of an Evaluation Model of General Practice Department Configuration and Construction in Standardized Clinical Residency Training Bases(General Hospitals) 
    SHEN Shili,WU Bin,QI Dianjun,CHEN Xinyue,ZHANG Xinyan,LI Yixuan,ZHANG Xu,GONG Xue,YU Xiaosong
    2021, 24(7):  791-798.  DOI: 10.12114/j.issn.1007-9572.2021.00.099
    Asbtract ( )   PDF (962KB) ( )  
    References | Related Articles | Metrics
    The National Health Commission of the People's Republic of China requires that every clinical residential training base(general hospital) responsible for standardized training of general practitioners must set up a general practice department independently. However,few studies have focused on the configuration and construction of general practice department. At present,evaluation standards of configuration and construction of specialty departments,which are not suitable for general practice characteristics,are being applied to many newly established general practice departments,which must have engendered restriction on their development. Our research group has developed an evaluation model of the configuration and construction of general practice department in clinical residential training bases(general hospitals) by using literature review,focus group discussions and expert Delphi surveys,which includes 6 first-level indicators,22 second-level indicators,78 third-level indicators and their evaluation criteria. The model highlights the purpose of development of general practice department,reflects the basic principles of general practice and lays stress on the guidance and promotion of supervision towards primary care,providing ideas for guiding and standardizing the development of general practice department in general hospitals.
    Functional Orientation and Development Direction of the General Practice Department in General Hospitals:an Expert Consultation-based Study 
    CHEN Ying,YUAN Aihong,HAO Lishuang,YUAN Li,SHI Rong
    2021, 24(7):  799-804.  DOI: 10.12114/j.issn.1007-9572.2021.00.100
    Asbtract ( )   PDF (955KB) ( )  
    References | Related Articles | Metrics
    Background Since 2010,in order to promote the development of disciplines,general hospitals have actively opened general practice department. However,there are still disputes about the general practice department so far. Doubters fear it would increase the number of unnecessary upward referrals,while supporters emphasize its necessity in general practitioners training. Therefore,determining the orientation and function of this department in general hospitals is a dilemma to be solved urgently for its current development. Objective To understand medical providers' perspectives of functional orientation and requirements of the general practice department in general hospitals,to provide a reference for future establishment and development of this department in general hospitals. Methods From May 10 to 14,2019,we used a self-developed outline(consisting of 3 parts:essentials of medical education,research and management services delivered by general practice department in general hospitals,and its academic development,as well as the similarities and differences between the development of general practice departments in different types of general hospitals) to conduct semi-structured E-mail interviews with 13 representatives invited from relevant government departments,general hospitals and community health centers. Results According to the interview results,the medical services delivered by the general practice department in general hospitals,included comprehensive,coordinated and standardized diagnosis and treatment,comprehensive management of chronic diseases,health promotion,general-specialty services,and bi-directional referral services. And talent cultivation services provided by it mainly included college education,post-graduation education,continuing education and teaching interaction. Moreover,the research services that the department undertook were as follows:leading the academic development,academic construction,guidance and collaboration,technological innovation and promotion. Other responsibilities assumed by the department were social and community management public health services. Experts from different institutions differed greatly on the construction of general practice department in different types of general hospitals. Conclusion From the point of view of relevant experts,the functional orientation of the general practice department in general hospitals may generally meet relevant policy requirements,but there is a partial gap to be filled in the department development. In particular,there is no clear consensus regarding specific duties of this department in teaching among experts from different types of general hospitals,and among general hospitals with different development directions of general practice department,which needs to be explored and tested further.
    Community Residents' Needs of General Medical Services and Preferred Healthcare Institutions for Treatment during the Implementation of a Three-tiered Healthcare System 
    WANG Xiaolu,HUANG Zhe,QIAN Yanjuan,YUAN Li,YUAN Aihong
    2021, 24(7):  805-811.  DOI: 10.12114/j.issn.1007-9572.2021.00.041
    Asbtract ( )   PDF (979KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Background The three-tiered healthcare system is implemented to meet the residents' healthcare needs and establish an orderly environment for medical treatment. Understanding the preferred healthcare institutions for treatment in residents may partially contribute to establishing a tiered mechanism for effectively diverting patients. However,few studies have discussed community residents' preferred healthcare institutions for treatment. Objective To investigate community residents' needs of general medical services and selection of healthcare institutions for treatment,providing suggestions for developing a sound bi-directional referral system. Methods During July to October 2019,healthcare seekers were randomly invited from Shanghai TCM-Integrated Hospital Affiliated to Shanghai University of TCM and all community health centers(n=8) in Hongkou District of Shanghai to attend a questionnaire survey for acquiring the information regarding demographics,needs of 28 kinds of general medical services and the preferred healthcare institution for seeking each kind of services. Results The survey obtained a response rate of 98.05%(1 961/2 000). The rates of respondents having needs of these services ranged from 67.82% to 86.18%. The top three needed services were personal medical file establishment〔1 690(86.18%)〕,the priority of patients with advanced appointment for treatment〔1 688(86.08%)〕,and first contact services for common diseases and frequently-occurring diseases〔1 664(84.85%)〕. The three needed least were hospice care for patients with cancer,advanced chronic disease or ineffective treatment〔1 330(67.82%)〕,inpatient services for patients with an unclear specialty disease needing hospitalization〔1 464(74.66%)〕,further diagnostic,therapeutic and rehabilitation services for patients with discontinuation of secondary or tertiary care due to economic,family or other personal reasons〔1 519(77.46%)〕. The first three services that residents tend to accept in general hospitals are diagnosis and treatment when other hospitals or departments are unable to make clear diagnosis;when other hospitals/departments are unable to treat;and when complicated and difficult diseases occur,the first step of diagnosis and treatment is provided. The first three services that residents tend to accept in community health service centers are signing contracts and providing comprehensive and continuous contract services, establishing personal health records and formulating targeted health management programs. Residents of different ages have different demand rates for 26 general practice services,and the choice of healthcare institutions for 14 general practice services is different(P<0.05). Residents with different knowledge of general practice have different demand rates for 26 general practice services,and the choice of healthcare institutions for all general practice services is different(P<0.05). Conclusion The selection of healthcare institutions for initial treatment among residents differed by age and level of familiarity with general medical services. To promote orderly healthcare-seeking,the general practice department in general hospitals should work at its full capacity,the general medical services for residents should be improved in according to their needs and the capacities of community health centers,and residents' understanding of general practice should be enhanced.
    Scale for Service Quality Evaluation of Rural Family Doctors:Development,Reliability and Validity 
    ZHAO Panpan,WANG Yiting,LIN Zhenping,HE Xiaojing,LIU Rugang,QIAN Dongfu
    2021, 24(7):  812-817.  DOI: 10.12114/j.issn.1007-9572.2021.00.122
    Asbtract ( )   PDF (1397KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Background The service quality of rural family doctors in China has aroused increasing attention. Scientific evaluation is a prerequisite for further targeted improvement of service quality. However,the current evaluation system of service quality of family doctors in China is regionally fragmented,and there is a lack of authoritative,reliable and guided evaluation tools. Objective To develop a scale for service quality evaluation of rural family doctors,to apply to appropriately assess the service quality of family doctors in China. Methods Under the guidance of the essence and profile of rural family doctor services in China in combination with useful information drawn from related global evaluation systems,on-site interviews and expert consultations,the primary scale was formulated. In June 2019,a pre-test was done using the primary scale and then the formal scale was formed after some modifications were done to the primary scale according to the results of analysis of pre-test items(n=308). In July 2019,the modified scale was used for formal investigation,and the valid sample(n=1 746) was randomly divided into two parts. Sample 1(n=843) was used for item analysis,exploratory factor analysis and internal consistency test,and sample 2(n=903) was used for dimension correlation analysis and confirmatory factor analysis. Results The formal scale includes 24 items in 6 dimensions:accessibility,horizontal continuity,vertical continuity,comprehensiveness,technology and affordability. The Cronbach's α of the scale was 0.910,and that for each dimension ranged from 0.755 to 0.912. The Bartlett's sphericity test result was significant(approximateχ2=12 492.540,P<0.05),and KMO test value was 0.880. The total variance explained by factors revealed by exploratory factor analysis was 70.347%. The interdimensional correlation coefficients were lower than dimension-total correlation coefficients. Results of confirmatory factor analysis were as follows:χ2/df=7.877,RMR=0.041,RMSEA=0.087,CFI=0.870,GFI=0.840,NFI=0.854. Conclusion The scale developed in this study has good reliability and validity,which can be used as an effective tool to evaluate the service quality of rural family doctors in China.
    Self-rated Health Status and Utilization of Health Services in the Elderly 
    HAO Aihua,CHEN Chutian,LANG Lingling,XU Ning
    2021, 24(7):  818-823.  DOI: 10.12114/j.issn.1007-9572.2021.00.032
    Asbtract ( )   PDF (975KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Background The aging rate of Chinese population has greatly exceeded the average global level. More than 180 million Chinese elderlies are suffering from one or more chronic diseases,accounting for 75% of the total elderlies,subjecting them to be the key population for health services utilization. Objective To explore the relationship between self-rated health status and utilization of health services of the elderlies,providing a reference for the construction of a healthcare system ensuring the health of elderly people. Methods China Health and Retirement Longitudinal Study(CHARLS) is a large-scale interdisciplinary follow-up survey project conducted by Peking University. The survey sampled around 18 000 middle-aged and old Chinese people residents(≥45 years old) from 450 villages of 150 districts/counties in 28 provinces(municipalities) across China,serving as a set of survey database representing this group of Chinese people. The CHARLS questionnaire includes the basic demographic information,family structure and financial support,health status,physical measurement,health service utilization and medical insurance,work,retirement and pension,income,consumption,assets as well as essential community conditions. In this study,we selected part of the surveyees(≥60 years old) of the 2015 CHARLS as the participants,and studied their demographic information(gender,age,marital status,education level and residence),income(including asset income) and consumption,anthropometric parameters(height and weight),health status(general health status and medical history),lifestyle habit(physical exercise,social activities,smoking and drinking),and utilization of health services(outpatient and inpatient services). We used the framework of Anderson's behavioral model to explore the impact of self-rated health status on health services utilization. We performed statistical analysis using chi-square test and multivariate Logistic regression in SPSS 20.0. Results  Of the 4 089 responders for self-rated health status in the survey,3 266(79.87%) rated their health as poor,and 265(8.11%) of them should have used inpatient services in the past year. Among the 8 340 responders for use of outpatient services in the past 4 weeks,1 681(20.16%) used such services. Of the 8 344 responders for use of inpatient services in the past year,1 382(16.56%) used such services. Logistic regression analysis showed that the utilization rates of outpatient services in smokers who had quit smoking and those who had poor self-rated health status were 1.505 and 2.636 times higher than those who were still smoking and those with good self-rated health status(P<0.05);the utilization rates of inpatient services in elderly people aged over 80 was 1.666 times of those aged 60-69 years,and those who did not drink alcohol were 1.613 times as much as those who drank more than once a month,the utilization rates of inpatient services in smokers who had quit smoking and never smokers were 2.204 and 1.698 times higher than those who were still smoking,the utilization rates of inpatient services in patients with poor self-rated health status were 2.630 times higher than those in those with good self-rated health status(P<0.05). Conclusion The overall self-rated health status of the elderly was relatively poor,which may significantly affect their utilization of health services. To improve the health management of the elderly,the monitoring and research of self-rated health status should be further strengthened for delivering health services,and the construction of primary healthcare system should be strengthened.
    Prevalence and Influencing Factors of Visiting Primary Healthcare Institutions in 16 Districts of Beijing 
    GUO Ran,HU Linlin,LIU Meicen,WANG Huanqian,CHEN Xinyue,QIAN Jie,LIU Yuanli
    2021, 24(7):  824-828.  DOI: 10.12114/j.issn.1007-9572.2020.00.478
    Asbtract ( )   PDF (943KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Background In recent years,the three-tier healthcare delivery system in Beijing has been taking shape. Of the system,primary healthcare institutions,which are responsible for delivering first-contact care,making important contributions to improving the operational efficiency of the system. Studying the intention and influencing factors of visiting primary healthcare institutions among patients,the demander of medical services,is of great significance to the achievement of first-contact care in primary care. Objective To investigate the choice of healthcare institutions for treating minor illness and influencing factors among patients in Beijing,to put forward targeting suggestions for guiding patients to seek healthcare in primary care appropriately. Methods In May 2019,by convenient sampling,inpatients and outpatients were sampled from 48 secondary and tertiary hospitals in 16 districts of Beijing and received a survey regarding their intention of seeking healthcare in primary care,health status and awareness of the policies about hierarchical medical system and family doctor system. Stepwise,multivariate regression analysis was performed to identify factors associated with patients' choice of primary healthcare institutions for treating minor illness. Results Of the 3 732 cases included,1 541(41.29%) had chronic diseases,1 509 cases(40.43%) knew the family doctor system,and 1 641 cases(43.97%) knew the hierarchical medical system,but only 12.43%(464/3 732) had a contracted family doctor. 1 349 cases(36.15%) of them indicated that they would visit a primary healthcare institution for treating minor illness. Multivariate analysis found that hukou,household registration,age,education level,social and medical insurances,monthly family income,self-assessed health,number of chronic diseases,awareness of family doctor system,contracting for family doctor services,and awareness of hierarchical medical system were associated with the selection of medical institutions(P<0.05). Conclusion Older age,Beijing hukou,social and medical insurances,lower education level,lower income level,awareness of the policies of hierarchical medical system and family doctor system and having a contracted family doctor are associated with higher possibility of choosing a primary healthcare institution for treating minor illness.Therefore,for those without Beijing hukou and social and medical insurances,medical security and health education should be strengthened.Furthermore,to guide more patients to seek healthcare in primary care,efforts should be made to improve professional levels of primary care physicians and the environment of primary care,to strengthen the publicity of policies of the healthcare reform launched in 2009 and to expand the coverage of contracted family doctor services.
    The Perceptions of Grief Counseling in General Practitioners from Wuhan and Countermeasures 
    GAO Xudong,WANG Zhenkun,KONG Chan,WANG Simei
    2021, 24(7):  829-833.  DOI: 10.12114/j.issn.1007-9572.2020.00.534
    Asbtract ( )   PDF (969KB) ( )  
    References | Related Articles | Metrics

    Background Although the concept of grief counseling has been introduced into China in recent years,it has developed slowly in China. Many general practitioners(GPs) have not received relevant training and do not know how to comfort the bereaved scientifically. Therefore,the purpose of this study was to analyze GPs' perceptions of grief counseling,and find out the deficiency of grief counseling in community. Objective To investigate the perceptions of grief counseling of GPs in Wuhan,to provide a reference for improving community health services. Methods From October to December 2019,a total of 263 GPs from 23 community health centers,Wuhan,were sampled by convenience sampling and investigated using a questionnaire consisting of demographic information,skills and attitudes of grief counseling scales. Multiple linear stepwise regression was used to analyze the influencing factors of skills and attitudes of grief counseling. Results Altogether,241 GPs(91.6%) who returned responsive questionnaires were included for final analysis. The average score of grief counseling skills was(19.05±4.76),with a scoring rate of 59.5%. Multiple linear stepwise regression analysis showed that influencing factors of grief counseling skills included roles and responsibilities,training,and frequency of contact with the bereaved family member(P<0.05). The average score of grief counseling attitudes was(32.70±9.36),with a scoring rate of 65.4%. The influencing factors of grief counseling attitudes included other skills of grief counseling,education level,communication ability,and working experience seniority(P<0.05). Conclusion The skills and attitudes of grief counseling of GPs should be improved. The community should set up a group of grief counseling and build a related long-term and comprehensive training system.

    Evaluation of Sub-Health Status of Chinese Urban Residents Using the Sub-health Measurement Scale Version 1.0 
    XUE Yunlian,XU Jun,LIU Guihao,HUANG Chen,FENG Yefang,XU Mengyao,JIANG Lijie,WANG Xiaohui,XIE Juan,CHEN Xiaomou
    2021, 24(7):  834-841.  DOI: 10.12114/j.issn.1007-9572.2020.00.530
    Asbtract ( )   PDF (1205KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Background In the process of achieving Healthy China 2030,one target of urbanization promotion is healthy urbanization. The national evaluation and prevention of sub-health of urban residents is of great significance for healthy urbanization. Although there have been some regional studies on sub-health status of Chinese urban residents,similar national studies are rather sparse. Objective To explore the reliability and validity of Sub-health Measurement Scale Version 1.0(SHMS V1.0) in assessing the sub-health status of urban residents in China,and to analyze the sub-health status of this population. Methods Multi-stage stratified sampling was used to select 17 339 urban residents from 6 geographical regions of China (East China,North China,Northeast China,South-central China,Southwest China and Northwest China) from December 2017 to October 2018. All participants attended a survey with the SHMS V1.0 scale,by which reliability and validity of the scale was assessed,and the sub-health status of this group was measured. The response rate of the survey was 86.89%(15 066/17 339). Results The Cronbach's α coefficient of the SHMS V1.0 was 0.922,and that of each of its three subscales was higher than 0.800,and that of every dimension was higher than 0.690. The odd-even reliability and front-rear reliability of the SHMS V1.0 were 0.955 and 0.822,respectively. Also,we found the scale had good discriminant validity and convergent validity. Exploratory factor analysis found that the cumulative variance explained by nine common factors was 64.16%,and these factors were completely consistent with the theoretical structure of the scale. Confirmatory factor analysis revealed good fitting effect. The detection rates of general,physical,mental and social sub-health were 68.06%(10 254/15 066),67.47%(10 165/15 066),65.96%(9 938/15 066) and 70.76%(10 660/15 066),respectively. There was significant regional difference in the detection rate of general,physical or social sub-health among the urban residents(P<0.05). Women had a higher detection rate of mental sub-health,but a lower detection rate of social sub-health than men(P<0.05). The detection rate of mental sub-health differed significantly across age groups(P<0.05). And that of social sub-health also varied significantly across age groups(P<0.05). Conclusion The SHMS V1.0 scale demonstrated high reliability and validity for sub-health assessment of Chinese urban residents. The detection rate of sub-health differed by region,sex and age group,hence,targeted interventions are needed to improve sub-health.
    Depression and Risk of Stroke among Middle-aged and Older Chinese Adults:a Cohort Study 
    LIAN Zhiwei,ZHU Chunsu,LIU Yuanli
    2021, 24(7):  842-846.  DOI: 10.12114/j.issn.1007-9572.2020.00.405
    Asbtract ( )   PDF (1001KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Background Stroke has become a leading cause of death in China. Whether depression is an independent risk factor for stroke remains controversial,and it is noteworthy to determine the relationship between them. Objective To assess the association of baseline depressive symptoms with stroke risk among middle-aged and older Chinese adults. Methods Data derived from the CHARLS conducted in 2011,2013 and 2015 were obtained from March to December 2019. 12 645 respondents aged 45 or over were enrolled and their demography,lifestyle,health status,depression and stroke history were collected. According to the prevalence of depression,they were divided into depression and non-depression groups. Multivariate Logistic regression analyses were carried out to assess the relationship between stroke outcome and baseline depression detected in 2011. Results 4 675(36.97%) participants had depressive symptoms at baseline. 174 cases(1.38%) reported stroke incidents during the follow-up period,including 77(1.65%) with baseline depressive symptoms and 97(1.22%) without. Multivariate Logistic regression analyses showed that the OR with 95%CI of stroke risk in those with baseline depression was〔1.489(1.084,2.046),P=0.014〕 with adjustment of age,sex,marital status,education,and income. After adjusting for smoking,drinking,BMI,hypertension,blood lipid abnormality,depression was the risk factor of stroke, and the difference was statistically significant〔OR(95%CI)=1.444(1.009,2.065),P=0.044〕. After adjusting for all potential confounders, moderate and severe depression was not a risk factor for stroke compared with no/ground depression risk〔OR(95%CI)=1.374(0.938,2.011),OR(95%CI)=1.834(0.994,3.833),P>0.05〕. Conclusion Depressive symptom may be an independent risk factor of stroke risk. Closely focusing on the depressive symptoms and incentivizing the screening of depression in primary care may be useful ways to reduce the incidence of stroke in middle-aged and elderly people.
    Impact of Shared Decision Making on Quality of Life in Breast Cancer Patients Partially Mediated by Functional Exercise Adherence 
    ZENG Jie,JIN Lei,LI Qian,WU Wenjing,SHI Baoxin
    2021, 24(7):  847-854.  DOI: 10.12114/j.issn.1007-9572.2021.00.095
    Asbtract ( )   PDF (1130KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Background Shared decision making(SDM) can improve the quality of life and treatment compliance of breast cancer patients,but there is no study on whether functional exercise compliance as a mediator variable between SDM and quality of life. Objective To investigate the perceived level of involvement in SDM of breast cancer patients with modified radical mastectomy,and discussed the correlation of SDM,exercise adherence and life of quality. Methods During the period from January to April 2019,277 breast cancer patients who accepted modified radical mastectomy in Tianjin Medical University Cancer Institute & Hospital were enrolled by means of convenience sampling. A set of questionnaires including socio-demographic questionnaire,the Chinese version of the 9-item Shared Decision Making Questionnaire(SDM-Q-9),the Postoperative Functional Exercise Compliance Scale-Breast Cancer(PFECS-B),and the Chinese version of Functional Assessment of Cancer Therapy-Breast(FACT-B) were used to collect data in a survey. Spearman correlation analysis was used to explore the relationships between SDM,functional exercise adherence and quality of life. AMOS 25.0 was applied to analyze the mediating effect of functional exercise adherence between SDM and quality of life,and to establish a structural equation model containing these three indicators. Results The median scores of SDM-Q-9 and PFECS-B,and average score of FACT-B for these breast cancer patients were 27(18,34),49(46,53),and (89.38±9.073),respectively. The score of SDM-Q-9 showed a statistically significant positive correlation with that of PFECS-B and FACT-B(P<0.05). The partial mediating effect of functional exercise compliance between SDM and quality of life was significant(P<0.05). The direct effect of SDM on quality of life was 0.391 and the mediating effect was 0.299(accounting for 43.3% of the total effect),the total effect was 0.690. Conclusion Breast cancer patients with modified radical mastectomy may have a low perceived level of involvement in SDM. SDM may directly affect their quality of life,and also may affect it indirectly through the mediating effect of functional exercise adherence.
    Overall Status and Urban-suburban Comparative Analysis of Outpatient Management of Undifferentiated Diseases by Community General Practitioners,Shanghai 
    ZHANG Hanzhi,HAN Yiping,JIN Hua,CHEN Yuge,SHI Jianwei,CHEN Yang,MA Le,YU Dehua
    2021, 24(7):  855-863.  DOI: 10.12114/j.issn.1007-9572.2020.00.408
    Asbtract ( )   PDF (994KB) ( )  
    References | Related Articles | Metrics
    Background Community-based management of undifferentiated diseases embodies the level of professional abilities of community general practitioners(GPs) and the management quality of community healthcare institutions for the diseases. The differences of primary care needs between urban and suburban areas are becoming less,indicating that healthcare services have great development potentials in suburban areas. Objective To perform a comparative analysis of the perceptions,outpatient management interventions,and level and associated factors of management of undifferentiated diseases,as well as required supports among GPs from community health centers(CHCs) in urban and suburban areas of Shanghai,offering guidance for promoting the development of primary care,and optimizing the distribution of primary care resources. Methods November 2018,an online survey was conducted using a self-developed questionnaire A(CHC administrators) in administrators extracted from 244 CHCs in 16 districts(7 urban and 9 suburban) of Shanghai at a ratio of 1∶1. And another online survey was carried out using a self-developed questionnaire B(CHC GPs) among 4 047 professional title composition-matched community GPs randomly selected from these 244 CHCs(from each CHC,50% of the GPs were randomly selected according to professional title). Data obtained from the surveys included perceptions and management of undifferentiated diseases,required help and self-rated management abilities. Urban and rural status was compared. And multivariate Logistic regression analysis was used to identify the factors associated with GPs' management abilities of undifferentiated diseases. Results The response rates of the two surveys were 100.00%(244/244) and 96.98%(3 925/4 047),respectively. The proportions of GPs surveyed working in urban and suburban areas were 32.71%(1 284/3 925) and 67.29%(2 641/3 925),respectively. The percentages of specialists and assistant GPs in suburban CHCs were higher than those in urban CHCs. The percentages of ophthalmologists and ENT doctors in urban CHCs were higher than those of suburban CHCs. The percentages of requiring trainings for undifferentiated diseases,first management procedure of undifferentiated diseases,and requiring to be informed of designed referral rate in urban CHCs were higher than those of suburban CHCs. GPs in suburban CHCs showed higher rate of consulting less than 50 outpatients daily compared with those in urban CHCs. There were significant differences in daily outpatients volume,ability to deal with undifferentiated disease and refferal rate to higher level hospitals between GPs in urban and suburban. The factors affecting GPs' ability for managing undifferentiated diseases included title,working years,daily outpatient workload,procedure for first management of undifferentiated diseases,and rate of transferring patients with undifferentiated diseases,which were also associated with significant differences in the ability of managing the undifferentiated diseases between GPs in urban and suburban CHCs(P<0.05). Conclusion In Shanghai,the management of undifferentiated diseases by CHCs is relatively poor,which is more obvious in suburban areas. Community GPs have relatively insufficient perceptions of undifferentiated diseases,as well as insufficient ability for managing these diseases. Relatively speaking,compared with those working in urban CHCs,GPs in suburban CHCs have higher rates of owning less professional qualifications and less sufficient practice,requiring the training of standardized procedure for managing these diseases,and transferring undifferentiated disease patients to higher level hospitals. In view of this,relevant guidelines should be improved,and first management procedure development as well as trainings and clinical management of undifferentiated diseases should be strengthened.
    Effect of Closed-loop Management by Family Physician Team on Patients with Chronic Insomnia 
    JI Yan,DING Jing,DING Lan
    2021, 24(7):  863-868.  DOI: 10.12114/j.issn.1007-9572.2021.00.013
    Asbtract ( )   PDF (963KB) ( )  
    References | Related Articles | Metrics
    Background Chronic insomnia is a common type of sleep disorder,which has a negative impact on daily life,work,and even leads to accidents. Community-based interventions play an important role in managing it effectively.  Objective To estimate the effect of the closed-loop management by family physician team on patients with chronic insomnia. Methods From January to June in 2018,420 patients with chronic insomnia who had contracted family doctors in Yuetan Community Health Service Center and its subordinate health service stations were selected by convenience sampling method. The patients were equally assigned and followed up for 6 months by single blind and random allocation method. The patients who could not complete the study and lost the follow-up due to diseases and other reasons were excluded. Finally,203 cases in the control group and 178 cases in the intervention group were included. The intervention group received closed-loop management ofamily physician team,while the control group received "medical care prevention" team management. The Pittsburgh Sleep Quality Index(PSQI) and PHQ-9 scores were compared between the two groups before and after the intervention. Results The mean scores of PSQI and PHQ-9 showed no significant intergroup differences either before or after treatment(P>0.05). But self-controlled comparisons revealed that the control group had significantly different PSQI and PHQ-9 scores(P<0.05),and so did the intervention group(P<0.05). Conclusion The closed-loop management by family physician team improved the quality of sleep and reduced depression in patients with chronic insomnia,which may be a promising community service delivery model.
    Outpatient Use of Domperidone Tablets and the Contributive Role of Intelligent Knowledge Base 
    WU Xiaowei,YANG Yaofang,ZHU Jianping,ZHANG Li
    2021, 24(7):  869-874.  DOI: 10.12114/j.issn.1007-9572.2020.00.600
    Asbtract ( )   PDF (975KB) ( )  
    References | Related Articles | Metrics
    Background Domperidone is a gastrointestinal prokinetic drug that has been on the National Essential Drugs List since 2012. In 2012—2014,reports from Canada,the United States and the United Kingdom put forward that domperidone may be associated with increased risk of sudden cardiac death and sudden ventricular arrhythmia,especially in those older than 60 years and those using domperidone greater than 30 mg as a total daily dose. In view of this,in September 2016,the former China Food and Drug Administration issued the Notice on the Revision of the Instructions for Use of Domperidone Preparations,requiring the revision of the package insert for domperidone preparations. Since then,domperidone manufacturers have revised the contents of "adverse reactions,contraindications,precautions,usage and dosage",and the updated package insert includes relevant warnings and risk warnings. Objective To explore outpatient use of domperidone tablets in the treatment of various diseases,to provide a reference for safe and appropriate use of medicines in clinical practice. Methods A total of 515 patients with a diagnosis of single illness who were prescribed Domperidone Tablets at Wujing Community Health Center,Minhang District of Shanghai,between March and August 2019,were selected. Data concerning gender,age,clinical diagnosis,and usage and dosage were collected. A drug use management system using the intelligent knowledge base was developed in accordance with the characteristics of drug use in community hospitals. Results The 515 patients consisted of 197(38.3%) men and 318(61.7%) women,ranging in age from 26 to 98(mean 72.0±12.4) years,and those aged 60 or over accounted for the largest proportion〔86.0%(443/515)〕. The diagnoses involved 19 illnesses,with dyspepsia,peptic ulcer,chronic gastritis,and gastroesophageal reflux disease as the 4 top-ranked,accounting for 81.4%(419/515) of all diagnoses. The daily dose of all patients conformed with the package insert information. Conclusion Current outpatient use of domperidone tablets is appropriate generally. With the help of knowledge base,information technology can be used to "escort" patients with medication.
    Current Situation and Recommendations for Continuing Medical Education for General Practitioners:Online Training of Diagnosis and Treatment of Common Diseases in Primary Care 
    SUN Xinran,WAN Heping
    2021, 24(7):  875-880.  DOI: 10.12114/j.issn.1007-9572.2021.00.023
    Asbtract ( )   PDF (987KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Background Continuing medical education is a significant way for general practitioners(GPs) to improve the skills of diagnosis and treatment,however,the design of the education programs should satisfy the needs of GPs and should be suitable for GPs with different professional skills. Objective To investigate the factors associated with results of a training as a continuing medical education program in GPs and their training needs based on a survey,providing a reference for developing appropriate continuing education programs for GPs. Methods Data of GPs who participated in an online continuing education program of diagnosis and treatment of common diseases in primary care conducted in Shanghai from October to December 2019 were collected,including demographics,score of test of the training contents,needs of contents and forms of training,and satisfaction with training. The associations of training test score with years of attending consecutive trainings,geographical location of the working area,and professional title were analyzed. The associations of needs of training contents with geographical location of the working area,and professional title were analyzed. Spearman's correlation was used to analyze the correlation between satisfaction with training contents and training test score. Results A total of 3 344 GPs completed this training,whose average test score was(4.80±2.67). GPs with two consecutive years(2018 and 2019) of trainings had much higher test score than those with one-year training(2019)〔(5.09±2.60)vs(4.15±2.71),P<0.05〕. Suburban GPs had much higher test score than urban GPs〔(4.97±2.68)vs(4.30±2.58),P<0.05〕.The test score〔(3.77±2.73)〕 of GPs with no professional title was much lower than that〔(4.82±2.65)〕 of those with a junior professional title or intermediate title 〔(4.85±2.65)〕(P<0.05). Suburban GPs were in more need of trainings regarding guidance on residents' self-management of hypertension and diabetes,home-based stroke rehabilitation,emergency knowledge and skills,gynecology and obstetrics and pediatrics treatment,and coronary heart disease prevention and treatment,while urban GPs were in more need of trainings regarding the skills of imaging and electrocardiogram diagnosis(P<0.05). GPs with no professional title had greater needs for trainings regarding nutrition knowledge,psychological knowledge and doctor-patient communication skills(P<0.008),while those with junior professional title had greater needs for trainings regarding the skills of imaging and electrocardiogram diagnosis(P<0.008),and those with an intermediate professional title had greater needs for trainings regarding emergency knowledge and skills(P<0.008). GPs were highly satisfied with the training content(92.54%,844/912). The test scores was positively correlated with the satisfaction evaluations of the training content (r=0.098,P<0.05). Mobile phone-based training was the most popular form of training(92.16%,762/1 198). Conclusion In comparison,the effect of regular trainings of general practitioners continuously is better, and there are differences in the training content needs of general practitioners in suburban areas and different titles. We put forward the following suggestions in accordance with the survey: carrying out regular trainings continuously as continuing medical education for GPs;modifying the difficulty degree of trainings and compiling training contents according to geographical location of the working area and professional title;recruiting professionals who are familiar with primary care as the teachers for trainings,and compiling training contents according to the needs of primary care workers;promoting the application of the form of mobile phone-based training.
    Status of and Solutions to the Problems during the Implementation of the Special Scheme for Recruiting TCM General Practitioners to Work in Remote Areas with Harsh Conditions 
    DENG Guoxing1,ZENG Xingshui,CHEN Lingxuan,HAN Yunpeng,CHEN Zhiquan,WANG Chaonan
    2021, 24(7):  881-885.  DOI: 10.12114/j.issn.1007-9572.2021.00.011
    Asbtract ( )   PDF (959KB) ( )  
    References | Related Articles | Metrics
    Background To gradually solve the shortage of general practitioners(GPs) and licensed physicians in primary care,China has implemented the special scheme of recruiting GPs to work in remote areas with harsh conditions since 2013 to guide and encourage highly qualified medical and health professionals to deliver general care in primary care. At present,there are few investigations on the implementation of this kind of special schemes of recruiting TCM GPs. Objective To investigate the implementation of the special scheme for recruiting TCM GPs to work in remote areas with harsh conditions,to promote the development of TCM workforce in primary care. Methods From July 1 to 20,2019,participants were recruited from 14 provinces of China in which the special scheme for recruiting GPs to work in remote areas with harsh conditions has been implemented as a pilot project. Of them,administrators(n=970) of 970 township hospitals (one administrator from each township hospital) attended an online questionnaire survey,and specially recruited TCM GPs(n=258) working at township hospitals attended another online questionnaire survey,and other 32 informants (4 leaders from county-level administrative institutions of Chinese medicine,4 leaders of county-level TCM hospitals,8 directors of township hospitals and 16 representative TCM GPs) attended group interviews. Results According to the survey,793(81.8%)of the responded administrators thought there was a shortage of TCM medical professionals,and 915(94.3%)thought that the special recruitment scheme was an appropriate project for their hospital,and 851(87.7%) thought the total specially recruited TCM GPs should be increased.Among the 258 TCM GPs,173(67.0%)had junior college degree or below,112(43.4%) had an annual salary of less than 50 000 yuan. Their main difficulties and demands were as follows:access to continuing medical education and training (94.2%,243/258),access to an officially budgeted post(91.1%,235/358),improving the salary (73.6%,190/258),access to the guidance from highly qualified physicians from higher level hospitals during practice(64.3%,166/258). 255(98.8%) of them considered it was necessary to carry out the special recruitment scheme in township hospitals,and 249(96.5%) thought it was necessary to increase the number of special recruited TCM GPs. All the group interviewees were in support of increasing the number of special recruited TCM GPs. Conclusion The specially recruited TCM GPs in township hospitals had solved the shortage of GPs to some extent,and their services had obtained favorable comment from concerned primary care departments and patients. However,on the whole,they were not well-paid,had relatively low education level,limited career development and less training opportunities. To address the needs of TCM GPs in primary care,a set of actions are required such as promoting the pilot implementation of this special recruitment scheme,increasing the number of recruited cases,strengthening continuing medical education for recruited TCM GPs and safeguarding their vital interests via increasing financial investment.
    Recent Progresses on Osteoporotic Refractures in the Elderly 
    ZHANG Huaguo,SONG Mi,XU Yue,PI Hongying
    2021, 24(7):  886-889.  DOI: 10.12114/j.issn.1007-9572.2020.00.529
    Asbtract ( )   PDF (966KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Osteoporosis is a prevalent disease in the elderly. It has become a prominent public health problem in China with rapid population aging. Fracture is the most serious outcome of osteoporosis. Elderly patients with osteoporotic fractures are prone to recurrent fractures,which are major barriers to healthy aging due to induced difficulty in functional recovery,reduced quality of life and increased morbidity and mortality. The purpose of this review is to systematically examine recent literature regarding the risk factors,risk assessment and intervention for recurrence of osteoporotic fractures in the elderly,providing a basis for developing strategies for osteoporotic refractures in this group.
    Advances in Postprandial Hypotension and the Impact of Diabetes Mellitus on Its Pathogenesis and Treatment 
    ZHOU Xiaoying,SUN Zilin
    2021, 24(7):  890-894.  DOI: 10.12114/j.issn.1007-9572.2020.00.580
    Asbtract ( )   PDF (1443KB) ( )  
    References | Related Articles | Metrics
    Postprandial hypotension(PPH) is defined as a drop in systolic blood pressure of over 20 mm Hg within 2 hours after a meal,which is common among older adults as well as patients with diabetes mellitus,Parkinson disease,and other chronic diseases. It is associated with falls,cardiovascular events,and all-cause mortality in the elderly. In addition to being considered to have associations with the pathogenesis of PPH,decreased autonomic function and accelerated gastric emptying are common pathological changes in diabetes mellitus. Glucose-lowering drugs have also been shown to affect PPH. This review discusses the epidemiology,risk factors,pathogenesis,clinical manifestations,and treatment of PPH,mainly focusing on the possible association of diabetes and PPH pathogenesis as well as therapeutic efficacies of glucose-lowering drugs,aiming to provide guidance for the prevention and treatment of PPH in diabetics.
    Latest Advances in the Effects of Caloric Restriction on Gut Microbiota in Healthy,Aged and Diseased Populations 
    YE Jiamei,ZHONG Dongling,LI Juan,ZHANG Huiling,JIN Rongjiang,ZHANG Anren
    2021, 24(7):  895-900.  DOI: 10.12114/j.issn.1007-9572.2020.00.472
    Asbtract ( )   PDF (969KB) ( )  
    References | Supplementary Material | Related Articles | Metrics
    Caloric restriction(CR) plays a part in promoting health and longevity,delaying aging,and preventing the development of metabolic disorders and age-related diseases. Recent studies have found that gut microbiota play a key role in healthy,aged and diseased hosts,and changes in diet can significantly affect the balance of beneficial and pathogenic bacteria in the gut. CR is one of the most commonly used dietary interventions,whose benefits may be produced via the modification of gut microbiota. This article reviews the latest advances in the effects of CR on gut microbiota in healthy,aged and diseased populations,providing microbiological evidence for clinical application and promotion of CR.