Table of Content

05 May 2022, Volume 25 Issue 13

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Creation and Utilization of the Health Records in Residents: a Demand-side Survey in Three Eastern, Central and Western Chinese Provinces

Zhongshi JIANG, Lili YOU, Siqi YANG, Zixuan FAN, Yuanli LIU

2022, 25(13):  1539-1544.  DOI: 10.12114/j.issn.1007-9572.2022.00.010

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Background

The creation of health records for Chinese residents is a key task for deepening the reform of the pharmaceutical and healthcare system, and an important action for promoting the equity of essential public health services. However, domestic studies on resident health records are mainly using the data from a city or community, and those using the national data from a demand-side perspective are rather scarce.

Objective

To understand the creation and utilization of health records in Chinese residents.

Methods

From November to December 2019, multistage sampling was used to select three provinces/municipality (Zhejiang, Shanxi and Chongqing) from eastern, central and western China (one was extracted from each geographical region) , then from each of them, one urban district and one county were extracted. Randomly selected 2 community health centers/stations, township health centers/village clinics in the corresponding districts (counties) . Finally, 20 community health service centers/township health centers were selected, the visitors of these institutions were invited to attend a questionnaire survey for understanding their information about the creation of health records, and the access to the health records, as well as satisfaction with the services. For ease of analysis, the visitors were classified into six categories (0-6-year-olds, pregnant women, over 65-year-olds, hypertensioners, diabetics, and general population) in accordance with the population groups defined in the Essential Public Health Service Programs.

Results

Altogether, 10 067 residents were included for final analysis. Among them, 9 119 (90.58%) self-reported that they had received health records creation services. The rates of creation of health records in 0-6-year-olds, pregnant women, over 65-year-olds without hypertension/diabetes, over 65-year-olds with hypertension, under 65-year-olds with hypertension, over 65-year-olds with diabetes, and under 65-year-olds with diabetes, as well as general population were 94.09% (2 787/2 962) , 95.60% (956/1 000) , 87.87% (616/701) , 88.87% (1 414/1 591) , 92.91% (747/804) , 89.41% (895/1 001) , 92.72% (471/508) , and 82.20% (1 233/1 500) , respectively. Among those with health records created, 67.02% (5 990 / 8 938) could access to their health records at any time, and the health records accessed by most of them were printed〔75.76% (4 538/5 990) 〕. However, 12.40% (1 108/8 938) of residents reported that they had no access to their health records, and other 20.59% (1 840/8 938) indicated that they had never tried to gain access to their health records. The rate of satisfaction with health records services in residents was 83.31% (4 352/5 224) . The rate of health records creation and rate of accessing the health records differed significantly by province, district or country, household monthly income per person, education level, and category of population (P<0.05) . The rates of satisfaction with the creation of and access to health records differed significantly by province, type of visited health institution, district or country, household monthly income per person, education level, and category of population (P<0.05) .

Conclusion

Generally, the rate of creation of health records in Chinese residents has significantly increased. The rate of utilization of the records has also enhanced, but needs further improvement. Moreover, residentssatisfaction with health records services may be at a moderate level.

Rational Drug Use in the Elderly

Polypharmacy Management in Elderly Patients with Multimorbidity

Wanyu PAN, Chunhui ZHANG, Zhenxiang ZHANG, Jing CHEN, Yongxia MEI, Beilei LIN, Shaoyang WANG, Qinghua ZHAI

2022, 25(13):  1545-1550.  DOI: 10.12114/j.issn.1007-9572.2022.00.009

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Active implementation of patient-centered polypharmacy management for older adults with multimorbidity can help to identify and correct the medication errors that patients may have, avoid the occurrence of potential medication errors, reduce and control the development of drug-related diseases, improve the clinical treatment effect, and delay the disease progression, thereby facilitating the achievement of targets for disease control, and improvement of quality of life of patients. In the light of problems of polypharmacy in Chinese elderly patients with multimorbidity, we summarized relevant interventions including strengthening top-level design of management, building multidisciplinary teams, innovating medication management technologies, and meeting patients'needs of drug information, providing a reference for medication management of these patients. We found that problems of polypharmacy in Chinese elderly patients are serious, and actively exploring multiple approaches to polypharmacy management based on medication features of these patients may be a key breakthrough for addressing the problems.

Latest Advances in Coping Modes for Potentially Inappropriate Medications in Older Adults

Simeng WANG, Chen ZHANG, Xue SUN, Lina WANG

2022, 25(13):  1551-1556.  DOI: 10.12114/j.issn.1007-9572.2022.0077

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Due to susceptibility to multiple chronic diseases, polypharmacy is often needed in older adults, which may easily lead to increased risk of potentially inappropriate medications (PIM) if polypharmacy is accompanied by various alterations in pharmacokinetics and pharmacodynamics of medications. PIM are highly prevalent in older adults, which may be asociated with higher risks of frailty, falls, cognitive decline, and other adverse drug events. In China, the research on PIM is relatively weak, and PIM are insufficiently focused and often managed with non-standardized and non-intelligent approaches in primary care. We systematically reviewed recent studies in the prevalence, screening and assessment tools and management strategies of PIM in older adults, providing theoretical support and practical reference for reducing the harm of PIM and standardizing drug management.

Deprescribing for Older Adults in the Community: Recent Developments and Implications for China

Yuanyuan XU, Zhijie XU, Yating NI, Xujian LIANG, Xueting HU, Zheming FANG, Yue ZHU, Lizheng FANG

2022, 25(13):  1557-1563.  DOI: 10.12114/j.issn.1007-9572.2022.0160

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It is a great challenge to ensure medication safety in healthcare for older adults, since polypharmacy in this group may increase the risk of potentially inappropriate medications, leading to adverse drug reactions, drug-drug interactions, hospitalizations, increased medical costs, and even deaths. Deprescribing improves patient prognosis and reduces adverse drug events through patient participation, and shared decision-making. The prevalence of multimorbidity and polypharmacy in older adults is notably in community care, the frontline for the management of use of multiple drugs. As primary care physicians have a deep understanding of patients' past and current diagnoses and treatments, they play a vital role in reviewing and managing patients' medications. However, there are few reports on deprescribing in primary care in China. We described the definition of deprescribing, and reviewed its recent advances, with a focus on the implementation process of deprescribing in the community, and the impact of deprescribing on chronic disease management by primary care physicians. This review may provide a reference for further study and policy making regarding deprescribing in the community in China.

Original Research·Population Health & Epidemiological Study

Age-Period-Cohort Analysis of Secular Trends of Cervical Cancer Incidence and Mortality in China, 1993—2017

Jinyao WANG, Nianping ZHANG, Zhiqiang BAI, Zhenkun WANG

2022, 25(13):  1564-1568.  DOI: 10.12114/j.issn.1007-9572.2022.0074

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Background

Cervical cancer is the seventh most common cancer globally, and the fourth most common cancer in women, accounting for about 12% of all cancers diagnosed among females. Cervical cancer and liver cancer are similar with respect to high prevalent region, with about 85% of the sufferers are from less developed regions.

Objective

To assess the long-term trends of cervical cancer incidence and mortality in China.

Methods

Data about cervical cancer incidence and mortality in Chinese adult females were extracted from the Institute for Health Metrics and Evaluation. Joinpoint regression was used for analyzing the trends of cervical cancer incidence and mortality during 1993—2017. The age-period-cohort model and intrinsic estimator method were adopted for analyzing the effects of age, period, and cohort on cervical cancer incidence and mortality.

Results

Overall, the trends of cervical cancer incidence and mortality totally experienced a significant decrease during 1993—1998, and showed an increasing trend during 2008—2015. Joinpoint regression analysis showed that from 1993 to 2017, the standardized incidence ratio of cervical cancer increased from 9.54/100 000 to 10.88/100 000〔AAPC (95%CI) =0.6 (0.3, 0.9) , P<0.05〕, while its standardized mortality ratio decreased from 4.88/100 000 to 4.48/100 000〔AAPC (95%CI) =-0.3 (-0.5, -0.1) , P<0.05〕. Moreover, cervical cancer incidence increased significantly with age before the age of 59, and the period effect exhibited a general upward trend for both incidence and mortality. The incidence and mortality risks by birth cohort showed a declining trend except for some periods and the risks all peaked in the cohort born in 1916—1920, then leveled off and slightly decreased in younger generations.

Conclusion

Taken together, the decrease in the cohort effect might contribute to the decrease in cervical cancer incidence and mortality rates, while the increase of age and period effects might lead to the increase in its morbidity and mortality rates.

Household Economic Burden of HIV/AIDS and Associated Factors in Four Regions, China

Yaping WANG, Wenzhan JING, Yu WU, Guiying CAO, Hai LONG, Lirong LIU, Lili DAI, Wanxian CAO, Min LIU

2022, 25(13):  1569-1575.  DOI: 10.12114/j.issn.1007-9572.2022.0130

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Background

The promotion of use of antiretroviral therapy (ART) prolongs the life expectancy of people living with HIV. But age-related diseases are increasingly common, and the risks of opportunistic infections, coinfections and poor health condition are also increased significantly in this group, resulting in high medical costs and heavy economic burden. However, there are few studies on the household economic burden of HIV/AIDS patients.

Objective

To investigate the household economic burden in HIV/AIDS patients and associated factors in four regions (Beijing, Henan, Guizhou and Anhui) of China.

Methods

From December 2020 to May 2021, by use of typical sampling, three medical institutions (one in Beijing, another in Guizhou and another in Anhui) , and a center for disease control and prevention (located in Henan) were selected, where HIV/AIDS patients who received health services in 2020 were chosen by convenient sampling. A questionnaire developed by our research team was used to collect information on the patients' sociodemographic and economic features, disease-related conditions, and treatment. Household economic burden was defined as ratio of out-of-pocket medical expenses to annual household income (OME/AHI) in 2020 exceeded 25%.

Results

A total of 1 446 patients were included. The patients were classified into two major groups by the OME/AHI ratio: ≤1% group (n=400, 27.7%) , and >1%-5% group (n=418, 28.9%) . Two hundred and thirty-seven cases (16.4%) had household economic burden. The prevalence of household economic burden differed significantly by region, sex, age, marital status, education level, occupation, urban or rural hukou, floating or permanent population, type of medical insurance, annual household income level, route of infection, CD₄⁺ T cell count level, and type of medical treatment (P<0.001) . Stepwise multinomial Logistic regression analysis revealed the following: women had higher risk of household economic burden than men〔OR (95%CI) =1.729 (1.050, 2.853) 〕; Sixty-five-year-olds and above had higher risk of household economic burden than 18-24-year-olds〔OR (95%CI) =3.445 (1.188, 10.227) 〕; The divorced had higher risk of household economic burden than those unmarried〔OR (95%CI) =2.241 (1.073, 4.678) 〕; Public institution employees had lower risk of household economic burden than housekeepers, jobseekers, or those unemployed〔OR (95%CI) =0.287 (0.081, 0.898) 〕; Individuals with low〔OR (95%CI) =29.614 (12.348, 79.211) 〕 or low-to-middle annual household income〔OR (95%CI) =3.556 (1.471, 9.428) 〕 had higher risk of household economic burden compared with those with high annual household income; Heterosexual individuals had lower risk of household economic burden than homosexual individuals〔OR (95%CI) =0.356 (0.186, 0.670) 〕; ART non-recipients had lower risk of household economic burden than ART recipients〔OR (95%CI) =0.241 (0.055, 0.835) 〕; Individuals with CD₄⁺ T cell count 201-350 cells/μl〔OR (95%CI) =2.347 (1.237, 4.515) 〕 or ≤200 cells/μl〔OR (95%CI) =2.365 (1.200, 4.702) 〕 had higher risk of household economic burden compared with those with CD₄⁺ T cell count >500 cells/μl; Inpatient service recipients〔OR (95%CI) =12.492 (5.592, 27.818) 〕, and both outpatient and inpatient services recipients〔OR (95%CI) =23.69 (14.519, 39.933) 〕 had higher risk of household economic burden compared with outpatient service recipients.

Conclusion

HIV/AIDS patients had relatively low OME/AHI ratio generally, but some of them had household economic burden. Factors associated with household economic burden may include sociodemographic and economic factors such as sex, age, marital status, occupation, annual household income, and features related to HIV/AIDS and treatment such as route of infection, use of ART treatment, CD₄⁺ T cell count level, and type of medical treatment. To tangibly reduce the household economic burden of in this group, more attention should be paid to women, the elderly, those with very poor condition or low annual household income. Besides, it is essential to continue to implement and improve relevant medical insurance policies.

A Longitudinal Cohort Study on the Effect of Serum Bilirubin on the Progression of Carotid Atherosclerosis in Healthy People

Lu QIN, Yongsheng GU, Lin LI, Kaihua ZHANG, Wentao YAO, Zongkai WU, Weiliang HE, Xiaoli NIU, Litao LI, Hebo WANG

2022, 25(13):  1576-1581.  DOI: 10.12114/j.issn.1007-9572.2022.0050

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Background

Cross-sectional studies have shown that the level of bilirubin in vivo is related to the progression of atherosclerosis, but the data from large-scale studies in China and even in the world are very limited.

Objective

To investigate the effect of serum total bilirubin (TBIL) and indirect bilirubin (IBIL) on the progression of carotid atherosclerosis in healthy people.

Methods

Retrospective cohort study was adopted to select 11 394 healthy people who had continuous physical examination and carotid intima-media thickness (cIMT) ≤1 mm displayed by carotid artery ultrasound examination as the research subjects in Hebei General Hospital from January 2010 to December 2019. Demographic characteristics, past medical history, physical examination, laboratory examination results of previous physical examination, carotid artery ultrasound and other information of subjects were collected. The subjects were divided into the progressive carotid atherosclerosis group and the non-progressive group according to whether cIMT increased during follow-up. The Cox proportional regression model was used to explore the effect of bilirubin on the progression of carotid atherosclerosis, and Cox regression analysis was performed by gender, age, body mass index (BMI) , hypertension, diabetes, smoking and alcohol consumption.

Results

1 586 cases of carotid atherosclerosis progression were detected in 10 years, with a cumulative incidence rate of 13.9%. The results of Cox regression analysis showed that for every 1 standard deviation increase in TBIL and IBIL levels, the risk of carotid atherosclerosis progression decreased by 6.6% and 17.4%, respectively〔HR (95%CI) =0.934 (0.881, 0.990) ; HR (95%CI) =0.826 (0.777, 0.877) 〕 after adjustment for age, sex, BMI, smoking, alcohol consumption, hypertension, diabetes, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, triglyceride, alanine aminotransferase and estimated glomerular filtration rate. Subgroup analysis showed that there was no statistical difference in the protective effects of TBIL and IBIL on different subgroups.

Conclusion

TBIL and IBIL levels are independent protective factors for the progression of carotid atherosclerosis in healthy subjects. Elevated bilirubin levels reduce the risk of carotid atherosclerosis progression, with IBIL being more potent in preventing carotid atherosclerosis progression.

Epidemiological Characteristics and Hospitalization Costs of Haemorrhagic Stroke in Jiangxi, 2015—2019

Shujuan YIN, Jie KUANG, Jibiao CHEN, Xiaolin ZHANG, Mengqi HAN, Yifan WU, Weijie JIA, Yingping YI

2022, 25(13):  1582-1588.  DOI: 10.12114/j.issn.1007-9572.2022.0134

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Background

There is no epidemiological survey of hemorrhagic stroke with a large sample size in China. Jiangxi Province faces high and rapidly increased prevalence of cerebrovascular disease in its resident population.

Objective

To understand the epidemiological characteristics and hospitalization costs of hemorrhagic stroke inpatients in Jiangxi, offering a scientific basis for preventing and controlling the disease.

Methods

Through the management system of Diagnosis Related Groups, Informaion Center, Health Commission of Jiangxi Province, the information of patients with a primary diagnosis of hemorrhagic stroke (ICD-10 code I60-I69) discharged during 2015—2019 was collected. Based the data, the epidemiological characteristics and hospitalization costs associated with hemorrhagic stroke were anayzed.

Results

Of the 128 788 cases, 115 254 (89.49%) had cerebral hemorrhage and 13 534 (10.51%) had subarachnoid hemorrhage. During the period, the overall rate of hospitalization attributed to hemorrhagic stroke increased from 64.36/100 000 to 86.05/100 000, showing an upward trend (χ²=1 144.969, P<0.001) . The overall rate of hospitalization attributed to cerebral hemorrhage increased from 58.96/100 000 to 75.22/100 000, demonstrating an upward trend (χ²=727.089, P<0.001) . And the overall rate of hospitalization attributed to subarachnoid hemorrhage increased from 5.41/100 000 to 10.83/100 000, presenting an upward trend (χ²=659.513, P<0.001) . The top five comorbidities and complications of hemorrhagic stroke were hypertension, pulmonary infection, cerebral infarction, other cerebrovascular diseases, and diabetes. The median length of stay for hemorrhagic stroke was 14 (14) days. The median total hospitalization cost increased from 14 300.61 yuan to 15 982.47 yuan, and it varied significantly by year (H=834.590, P<0.001) . Drug cost accounted for the largest proportion of the total hospitalization cost in 2017—2019 (greater than 35% each year) , showing no significant difference across the three years (H=3.323, P=0.190) .

Conclusion

From 2015 to 2019, the rates of hospitalization attributed to hemorrhagic stroke and its two subtypes (cerebral and subarachnoid hemorrhage) demonstrated an upward trend in Jiangxi, with hypertension and lung infection as the most common comorbidities, and relatively heavy burden of hospitalization costs. Reducing the risk of complications and drug cost may contribute to the decrease of financial burden of these patients.

Original Research·Clinical Practice and Improvement

Validity of the Duke Activity Status Index (DASI) and General Practice Physical Activity Questionnaire (GPPAQ) Walking Pace Question in Chinese and British Hemodialysis Patients

Yan SONG, Yan ZHUANG, Huan LIU, Jing WANG

2022, 25(13):  1589-1594,1602.  DOI: 10.12114/j.issn.1007-9572.2022.0027

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Background

Exercise capacity is a strong predictive factor of mortality in hemodialysis patients. Hence, it is urgently needed to explore convenient and effective assessment tools to evaluate exercise capacity.

Objective

To validate the Duke Activity Status Index (DASI) and General Practice Physical Activity Questionnaire (GPPAQ) walking pace question in Chinese and British hemodialysis patients.

Methods

From January 2018 to September 2020, 40 hemodialysis patients from a Chinese tertiary hospital and 39 patients from Leicester Renal Network in the United Kingdom were assessed exercise capacity and walking speed using DASI and GPPAQ walking pace question, respectively. Meanwhile, the shuttle walking test (SWT) and gait speed test in short physical performance battery (SPPB) were conducted with the two cultural groups to validate the DASI and the GPPAQ walking pace question. The validity of DASI was tested by correlation analysis, and the validity test of GPPAQ pace problem was by analysis of variance, respectively.

Results

There was a positive correlation between DASI and the incremental shuttle walking test (ISWT) in hemodialysis patients in China and the United Kingdom (r_China=0.39, r_sUK=0.60; P<0.05) , but no correlation with the endurance shuttle walking test (ESWT) (P>0.05) . According to the self-assessment results of the pace problem in the GPPAQ, Chinese hemodialysis patients were classified into four categories: slow pace, steady pace, brisk pace, and fast pace, the objectively measured SPPB pace range of the 4 types of patients overlapped, and there was no significant difference in the average SPPB pace (P>0.05) . British hemodialysis patients were classified into three categories: slow pace, steady pace, and brisk pace, there was a statistically significant difference in the average SPPB pace measured objectively among the three types of patients (P<0.05) . Among them, the average SPPB pace of self-assessed slow pace patients was lower than that of self-assessed steady pace and brisk pace (P<0.05) .

Conclusion

DASI can effectively measure the exercise capacity of hemodialysis patients in China and the United Kingdom. In the two cultural groups, GPPAQ walking pace question could not assist patients inaccurately assessing their gait speed. However, it has potential utility for distinguishing between "slow" and "not slow" gait speed.

Development, Reliability and Validity of the Dementia Risk Reduction Lifestyle Scale

Jinying ZHANG, Hua LI, Xiao LIU, Li WANG, Yan PENG, Yanni YANG

2022, 25(13):  1595-1602.  DOI: 10.12114/j.issn.1007-9572.2022.0083

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Background

Lifestyle factors are important modifiable risk factors for cognitive decline and dementia. The lifestyle intervention based on scientific assessment will be an important strategy and an orientation towards the implementation of primary prevention of dementia. So far, there is no special instrument to evaluate whether a lifestyle can help to reduce the risk of dementia in community-living residents.

Objective

To develop the Dementia Risk Reduction Lifestyle Scale (DRRLS) and test its reliability and validity, providing an instrument for scientifically evaluating whether a lifestyle is conducive to reducing the risk of dementia in community-living Chinese residents.

Methods

The item pool of the DRRLS was created based on the review of related theories of health promotion and literature analysis, then was used to form the initial version of the scale after the revision in accordance with the results of expert consultations and group discussion. After this, the initial version of the scale was pretested in a convenience sample of 30 middle-aged and elderly people in the community in January 2021, and was developed to be a revised version after revising items according to the pretest results. Then from January to October, 2021, the revised scale was tested in a large convenience sample of 506 community-dwelling middle-aged and elderly individuals. After screening items using item analysis of the test results of all 506 cases, exploratory factor analysis and confirmatory factor analysis were carried out with the test results of two randomly subdivided subsamples of the sample, subsample 1 (n=253) and subsample 2 (n=253) , respectively. Finally, the test results of the total sample were used for examining internal consistency and test-retest reliability, and the formal scale was formed eventually.

Results

The formal Dementia Risk Reduction Lifestyle Scale consists of 32 items. Eight common factors were extracted by exploratory factor analysis (Health responsibility, Brain strengthening exercise, Brain healthy diet, mental activity, smoking control behavior, interpersonal relationship, stress management, spiritual growth) , explaining 60.189% variance of the total. Confirmatory factor analysis showed that the goodness-of-fit indices of the formal scale were acceptable: χ²/df=1.657, RMSEA=0.051, GFI=0.852, AGFI=0.819, NFI=0.743, TLI=0.858, IFI=0.880 and CFI=0.876. The content validity index, Cronbach's α, split-half reliability (odd-even) , and test-retest reliability of the formal scale were 0.943, 0.862, 0.909, and 0.864, respectively.

Conclusion

Our scale has been tested with good reliability and validity, which could be used as a suitable instrument for evaluating whether a lifestyle helps to reduce the risk of dementia in middle-aged and elderly people in the community.

Establishment of the Norms of Exercise Self-efficacy Scale for Lung Cancer Patients in Anhui Province

Aimei WANG, Xinqiong ZHANG, Tingting WANG, Liang ZHANG, Xuewei LIU, Jingwen WANG, Ying MA, Wenxiu ZHOU, Dawei YIN

2022, 25(13):  1603-1611.  DOI: 10.12114/j.issn.1007-9572.2022.0018

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Background

The level of exercise self-efficacy of lung cancer patients affects the establishment of exercise goals and the belief of overcoming difficulties. Understanding the current situation has a good predictive effect on the exercise behavior of lung cancer patients, but there is no norm for exercise self-efficacy assessment tools for lung cancer patients in China, which makes the measurement results lack of reference standards.

Objective

To establish the norm of Exercise Self-efficacy Scale for lung cancer patients in Anhui Province.

Methods

Anhui Province was divided into northern, central and southern regions according to its geographical location. A total of 1 600 lung cancer patients were selected by regional stratified random sampling from January to August in 2021, and Exercise Self-efficacy Scale was used to investigate them, the mean, percentile and demarcation norm of the scale were established.

Results

A total of 1 600 questionnaires were distributed, 1 459 valid questionnaires were recovered, with an effective recovery rate of 91.19%. The total score of Exercise Self-efficacy Scale for lung cancer patients in Anhui Province was (67.66±14.90) , and the score of efficacy expectation dimension was (63.09±18.13) , the outcome expectation dimension score was (73.48±14.10) . In this study, the mean norm of Exercise Self-efficacy Scale for lung cancer patients in Anhui Province was established according to gender and age groups (young group of 19-35 years old, middle-aged group of 36-59 years old, and elderly group of ≥60 years old) . The results of multiple linear regression analysis showed that gender, age, education level, occupation, regular exercise habits, concomitant diseases, hospital level, department, BMI and regional division were the influencing factors for the total score of exercise self-efficacy in lung cancer patients (P<0.05) . Therefore, the classification norm was established based on the above variables. With 5% as the interval, the percentile norm of the Exercise Self-efficacy Scale for lung cancer patients from 5 to 95 was established. With (-s) , (-0.5s) , (+0.5s) , (+s) as the boundary point, the exercise self-efficacy level of lung cancer patients was divided into five states according to the total score of the scale from low to high: very low, low, medium, high and very high.

Conclusion

This study preliminarily constructed the norm of Exercise Self-efficacy Scale for lung cancer patients in Anhui Province, which can provide a reference standard for the study of exercise self-efficacy level of this population, and also provide a theoretical basis for further exploring the influencing factors of exercise self efficacy in lung cancer patients.

Stroke Pre-hospital Delay Behavioral Intention and Associated Factors in Guangdong Residents

Xinglan SUN, Yimin HUANG, Fen WANG, Fengyin QIN, Qishan ZHANG, Guoyin HAN, Jinjia LAI, Yibing TAN

2022, 25(13):  1612-1617,1635.  DOI: 10.12114/j.issn.1007-9572.2022.0049

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Background

Stroke severely influences the quality of human life, and imposes a great burden on the society, patients and their families. Although China has vigorously promoted the prevention and treatment of stroke, the prevalence of pre-hospital delay in stroke patients is still relatively high. The stroke pre-hospital delay behavioral intention may predict the possibility of stroke pre-hospital delay to some extent, but theassociated factors have rarely been studied.

Objective

To investigate the stroke pre-hospital delay behavioral intention and associated factors in residents.

Methods

Convenience sampling was used to select 645 Guangdong residents as the participants from July to September 2021. The Demographic Information Questionnaire developed by us, Chinese version of Ten-Item Personality Inventory, Chinese version of Perceived Social Support Scale, Simplified Coping Style Questionnaire and Stroke Pre-Hospital Delay Behavior Intention scale (SPDBI) were used in a survey for understanding the participants' personality characteristics, social support, coping styles and stroke pre-hospital delay behavioral intention. Multiple linear regression was used to explore the influential factors of stroke pre-hospital delayed behavioral intention.

Results

A total of 645 valid questionnaires were collected (92.1%) . Of the 645 respondents, 312 (48.4%) knew nothing about stroke, and 262 (40.6%) had heard of the formula "stroke 120". The stroke pre-hospital delay behavior intention of the participants was in the intermediate level〔mean SPDBI score (71.3±18.7) 〕. Compared with the Chinese norm, these respondents had higher mean dimension score of warning of stroke symptoms, but lower mean total score of SPDBI, and lower mean scores of four dimensions (rationalization of non-healthcare seeking behavior, symptom attribution, habitual response style, emergency system use) (P<0.001) . Multiple linear regression analysis indicated that age, living with a spouse, awareness level of the "stroke 120" mantra (through assessing symptoms to early identify stroke) , extraversion, emotional stability, social support and negative response were associated with stroke pre-hospital delay behavior intention (P<0.05) .

Conclusion

The Guangdong residents had relatively poor level of stroke pre-hospital delay behavioral intention, and insufficient cognition of stroke symptoms. The community should strengthen the education of "stroke 120", and use personalized and diversified stroke education patterns according to individualized features of residents, so as to effectively improve their stroke pre-hospital delay behavior intention and reduce the stroke pre-hospital delay rate.

Original Research·Primary Health Services

Factors Associated with Community-dwelling Chronic Disease Patients' Experience of Integrated Medical-elderly-nursing Services

Xuejiao ZHU, Min YANG

2022, 25(13):  1618-1623.  DOI: 10.12114/j.issn.1007-9572.2021.00.341

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Background

The integrated medical-elderly-nursing (IMEN) services are promising to be very effective in addressing healthcare problems in multiple chronic disease patients in an aging society, but the quality of the services has been less focused.

Objective

To identify the factors associated with community-dwelling chronic disease patients' experience of IMEN services, so as to provide a reference for improving the quality of IMEN services and the experience of this group.

Methods

From June to September 2020, a questionnaire survey was conducted with a convenience sample of 525 community-dwelling chronic disease patients with IMEN services selected from Hanghou, Zhejiang Province, to collect their individual characteristics, process of IMEN services, and experience of IMEN services. The Chinese version of SERVQUAL developed based on the GAP Model of Service Quality was used to measure the discrepancy between patients' expectations for IMEN services and their perceptions of the services. With referring to the structure-process-outcome model, a structural equation model was developed, assuming that the features of IMEN services (process factors) were influenced by patients' individual characteristics (structure factors) , and both of them affected patients' experience of IMEN services (outcome factors) .

Results

The total average score of feeling and expectation of IMEN services for community patients with chronic diseases in Hangzhou was (5.14±0.44) , (6.80±0.01) , and the total average score of the gap between feeling and expectation was (-1.65±0.44) . Multiple linear regression analysis showed that gender, monthly income, payment method of medical expenses, number of illnesses suffered, prevalence of changing the service team, service items and number of service delivery patterns were associated with the discrepancy between patients' expectations for IMEN services and their perceptions of the services (P<0.05) . The analysis based on the structural equation model revealed that patients' experience of IMEN services was mainly directly affected by the features (duration of contracting the IMEN services, service items, and delivery patterns, smart medical care) of IMEN services (path coefficient=-0.51, P<0.001; direct effect size=-0.51, P=0.002) . Moreover, patients' experience of IMEN services was also directly influenced by individual characteristics (age, education level, self-care ability, number of illnesses) (direct effect size=-0.14, P=0.026) , and indirectly influenced by such individual characteristics through features of IMEN services (indirect effect size=-0.24, P=0.002) .

Conclusion

Community-dwelling chronic disease patients accepted the IMEN services, but their service experience needed to be improved further by interventions such as improving the utilization of IMEN services, enriching the service delivery patterns, making full use of smart medical care and providing more personalized services.

Hospice Care Pilot Program Independently Pioneered by Community Health Centers in Shanghai: a Cross-sectional Survey

Xueying LI, Limei JING, Yifan XU, Tianshu CHU, Yunjia ZHAO, Ruiyang CHEN, Xiaohan TENG, Shuijing LI

2022, 25(13):  1624-1628.  DOI: 10.12114/j.issn.1007-9572.2022.0132

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Background

Survival assessment, psychological counseling and other services included in the comprehensive hospice care program conform to the hospice care philosophy, and may be independently delivered to patients to satisfy their needs in a pioneering approach by some health institutions, but the expenses of them could not be reimbursed by health insurance due to lack of an official basis for charging, which may be a bottleneck restricting the development of hospice care.

Objective

To systematically assess the hospice care services whose expenses are ineligible for reimbursement by health insurance independently provided by community health centers (CHCs) in a pioneering approach, offering a basis for improving the services and price system of hospice care.

Methods

From July to October 2020, by use of typical sampling, one or two CHCs with relatively heavy workload of hospice care were selected from each district of Shanghai, then from which 30 were selected to attend a survey for understanding the implementation status of hospice care using a self-developed questionnaire named Pilot Hospice Care Services Pioneered by Shanghai Community Health Centers, involving inpatient and home hospice care (35 services belonging to five types) . Individuals in charge of hospice care delivery completed the questionnaire according to the status of hospice care implemented in their CHCs in the past year.

Results

The survey obtained a response rate of 96.7% (29/30) . Among the respondent 29 CHCs, 28 (96.6%) delivered inpatient palliative care services, and the median number of services available was 27 (15) ; 25 (86.2%) provided home hospice care services, with 25 (15) as the median number of services available. There was no significant difference in the number of services belonging to five types delivered for inpatients and at home (P>0.05) . There were also no significant differences in the number of inpatient and home hospice care services delivered by CHCs in central urban, suburban, and exurban districts (P>0.05) . Among the hospice care services delivered for inpatients, the average proportions of five types of services, namely assessment services, comfort care, appropriate technology of hospice care, psychological support and humanistic care were 85.7%, 78.6%, 48.6%, 88.4% and 67.5%, respectively. Among the hospice care services delivered at home, the average proportions of above-mentioned five types of services were 86.3%, 60.0%, 42.0%, 84.0% and 62.0%, respectively.

Conclusion

Hospice care services have been widely implemented in Shanghai's CHCs with good availability and insignificant inter-district differences. To incentivize the CHCs and medical workers to provide hospice care, there is an urgent need to further standardize the hospice care services, develop relevant quality criteria, improve the price system, and reform the payment method.

Level and Associated Factors of Job Satisfaction in General Practitioners in Guangdong's Primary Care Settings

Aihua HAO, Chutian CHEN, Donghua WAN, Qun HE

2022, 25(13):  1629-1635.  DOI: 10.12114/j.issn.1007-9572.2022.0057

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Background

The improvement of the overall health of residents and the sound development of the hierarchical medical system require the support of a large number of qualified general practitioners (GPs) . As of the end of 2020, the GPs-population ratio in Guangdong reached 3.13/10 000, but the job satisfaction of GPs has not received enough attention.

Objective

To assess the level and determinants of overall job satisfaction among GPs in Guangdong's primary care settings.

Methods

A self-administered questionnaire survey was conducted with 8 710 GPs selected from Guangdong's primary care settings by use of stratified, multistage cluster sampling from July 5th to 31st, 2021. The information collected include GPs' demographics, and services of GPs' teams as well as job satisfaction assessed using Minnesota Satisfaction Questionnaire-Short Form (MSQ-SF) . The determinants of job satisfaction were identified using the multiple linear regression model and analyzed using SPSS Statistics 24.0.

Results

The survey obtained a response rate of 68.96% (6 006/8 710) . The overall satisfaction score of the respondent GPs was (3.70±0.87) points. The three highest-ranked items in terms of score were "The chance to do things for other people"〔 (4.03±0.64) points〕, "The chance to work aloneon the job"〔 (4.02±0.69) points〕, and "The way my co-workers get along with each other"〔 (3.99±0.61) points〕. The items scored relatively lower were "My pay and the amount of work I do"〔 (2.98±1.04) points], "The chances for advancement on this job"〔 (3.19±0.92) points〕, and "The praise I get for doing a good job"〔 (3.39±0.93) points〕. Multiple linear regression analysis found that annual income, administrative position, having a core position in the team, having privileged access to getting an appointment with experts working in secondary or tertiary medical institutions, providing long-term prescribing services for chronic diseases, delivering home sick-bed services, studying occupation-specific knowledge by oneself, and communicating with other teams for exchanging experience were associated with the job satisfaction of GPs (P<0.05) .

Conclusion

In a word, the overall job satisfaction level of GPs in Guangdong's primary care settings was relatively high. High annual income, administrative position, having privileged access to getting an appointment with experts working in secondary or tertiary medical institutions, delivering home sick-bed services and long-term prescribing services for chronic diseases, having a core position in the team, studying occupation-specific knowledge by oneself, communicating with other teams for exchanging experience, were associated with higher level of job satisfaction.

Development of a Qualitative Model Explaining the Association of Informatization with Physicians' Intentions and Behaviors Related to Bi-directional Referrals

Yue ZHANG, Ju HUANG, Tao DAI

2022, 25(13):  1636-1641.  DOI: 10.12114/j.issn.1007-9572.2022.0175

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Background

The implementation of bi-directional referrals may be affected directly by physicians since they play a crucial role in the process, but their performance in which will be facilitated by an orderly, efficient and interconnected referral system. So exploring the impact mechanism of informatization on physicians' performance in bi-directional referrals will greatly promote the implementation of such referrals and the development of hierarchical diagnosis and treatment.

Objective

To develop a qualitative model explaining the influence of informatization on physicians' intentions and behaviors regarding patient referrals, laying a foundation for relevant empirical research.

Methods

In April to October 2021, we performed a systematical review of studies about the influence of informatization on patient referrals collected from databases of CNKI, Wanfang Data, PubMed and Web of Science, then based on this and the framework of the Theory of Planned Behavior (TPB) , we developed a theoretical model explaining the impact of informatization on physicians' intentions and behaviors concerning patient referrals with self-defined latent variables and self-selected observed variables incorporated. After that, we used the theoretical model and the technology acceptance model to analyze patient referrals, then developed a corresponding business model.

Results

The theoretical model contains six latent variables including behavior, intention, attitudes, subjective norm, perceived behavior control and informationization control-related factors, and observed variables for measuring each of the latent variables. The relationships between latent variables could be divided into correlation/covariance relationship and causality relationship. The business model could clearly reflect the influence of different levels of informatization on physicians' intention and behavior related to patient referrals. The business model indicates that the implementation of bi-directional referrals could be promoted with reduced difficulty only when information support sustains referral services delivered by hospitals in a collaborative way with patient information linked and shared, information system is further improved, and referral standards and information platforms are deeply integrated.

Conclusion

The development of this qualitative model may be a reference for constructing a quantitative model, and for the development of a bi-directional referral assessment system and the formulation of relevant policy documents in China, and may expand the applicable scope of the TPB.

Evidence-based Nursing and Rehabilitation

Associated Factors of Cognitive Impairment in Chronic Heart Failure: a Systematic Review

Huifeng YANG, Weihua NIU, Yuexian SHI, Lijuan ZHANG, Ting YANG

2022, 25(13):  1642-1650.  DOI: 10.12114/j.issn.1007-9572.2022.0053

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Background

Cognitive impairment (CI) is a common complication of chronic heart failure (CHF) , which may significantly increase the risk of poor prognosis, so early identification of associated factors of CI in CHF is of great significance. Although there have been many relevant studies recently, their conclusions are inconsistent.

Objective

To perform a systematic review of the influencing factors of CI in CHF.

Methods

In August 2021, studies relevant to influencing factors of CI among patients with CHF were searched in databases including PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, PsychINFO, CNKI, Wanfang Data, CQVIP, and SinoMed from inception to August 2021. Two researchers independently screened studies based on the inclusion and exclusion criteria, extracted data, and performed risk of bias assessment using the Newcastle-Ottawa Scale and The Agency for Healthcare Research and Quality methodology checklist, then conducted a descriptive analysis of the factors associated with CI in CHF. RevMan 5.3 was adopted for meta-analysis.

Results

Fourteen studies were included, involving 6 324 cases of CHF, and 1 753 of them also with CI. Descriptive analysis indicated that five factors decreased the risk of CI in CHF, and 22 factors increased the risk, but the influence of sex and systolic blood pressure on CI is still far from inclusive. Meta-analysis demonstrated that education level〔OR=0.45, 95%CI (0.30, 0.70) 〕, age〔OR=1.17, 95%CI (1.10, 1.24) 〕, diabetes〔OR=2.17, 95%CI (1.17, 4.01) 〕, anemia〔OR=3.03, 95%CI (1.80, 5.10) 〕and left ventricular ejection fraction〔OR=0.91, 95%CI (0.88, 0.94) 〕were associated with CI in CHF.

Conclusion

High education level lowered the risk of CI in CHF, while older age, diabetes, anemia and decreased left ventricular ejection fraction increased the risk. Due to limited number and quality of included studies, the above-mentioned conclusion still needs to be verified by more high-quality studies.

Meta Analysis of the Effect of Resistance Training on Cardiovascular Risk Factors in Middle-aged and Older People

Yalin YU, Ruiying GUO, Xueyan ZHANG, Bo DONG

2022, 25(13):  1651-1658.  DOI: 10.12114/j.issn.1007-9572.2022.0150

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Background

As the main cause of death in the world, the morbidity and mortality of cardiovascular diseases are increasing year by year. Chronic inflammation of circulatory system is common in middle-aged and older people, which is closely related to the pathogenesis of various cardiovascular diseases. Dyslipidemia is also one of the age-specific cardiovascular risk factors. Exercise has attracted much attention as an important intervention method, among which resistance training can reduce the risk of cardiovascular diseases in middle-aged and older people, but the regulation effect of inflammation and dyslipidemia is still controversial.

Objective

To explore the effect of resistance training on cardiovascular risk factors in middle-aged and older people, and to provide a basis for formulating exercise prescriptions for middle-aged and elderly people.

Methods

PubMed, Cochrane, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Chinese Science and Technology Journal Full-text Database were retrieve by computer for randomized controlled trials on the effects of resistance training on cardiovascular risk factors in middle-aged and older people published from the date of establishment to 2021-08-31. The retrieved literatures were screened and data extracted, including the first author, the year of publication, general characteristics of the study population, resistance training protocols and outcome indicators. The bias risk assessment tool of Cochrane system evaluation manual was used to evaluate the bias risk of literature. Meta-analysis was performed using RevMan 5.3 software, including the statistics of combined effect size, heterogeneity test, sensitivity analysis, and subgroup analysis. Publication bias of included studies was analyzed using Stata 16.0 software, using Egger's test.

Results

Fifteen papers with 476 observations were included. Meta-analysis showed that, resistance training were superior to control group in decreasing C-reactive protein〔SMD (95%CI) =-0.67 (-0.89, -0.46) , P<0.01〕, total cholesterol〔SMD (95%CI) =-0.37 (-0.66, -0.08) , P=0.01〕, triglyceride〔SMD (95%CI) =-0.29 (-0.53, -0.05) , P=0.02〕, low-density lipoprotein cholesterol〔SMD (95%CI) =-0.37 (-0.67, -0.06) , P=0.02〕 and improving high-density lipoprotein cholesterol levels〔SMD (95%CI) =0.33 (0.09, 0.57) , P<0.01〕. Subgroup analysis showed that C-reactive protein and total cholesterol levels were lower in the resistance training group than in the control group at training duration ≤12 weeks, with statistically significant differences (P<0.05) . In both the training intensity of high intensity and the chronic disease population, C-reactive protein levels were lower in the resistance training group than in the control group and high-density lipoprotein cholesterol levels were higher, with statistically significant differences (P<0.05) .

Conclusion

Resistance training has been shown to be effective in reducing cardiovascular risk factors, reducing chronic inflammation and improving dyslipidaemia in the middle-aged and older population.

Effectiveness of Telerehabilitation Applied to Functional Recovery after Stroke: an Overview of Systematic Reviews

Qi LI, Ruiqing LI, Jing GAO, Kaiqi SU, Xiaodong FENG

2022, 25(13):  1659-1666.  DOI: 10.12114/j.issn.1007-9572.2022.0156

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Background

Telerehabilitation (TR) is an emerging model of rehabilitation service delivery based on communication technology, remote sensing and control technology, virtual reality technology and computer technology to to achieve cross-regional rehabilitation medical services. However, the effectiveness of TR in functional rehabilitation after stroke is still unclear, the methodological quality of related studies is uneven, and few researchers have systematically evaluated it.

Objective

To re-evaluate the systematic reviews/meta-analyses on the effectiveness of TR for functional rehabilitation after stroke.

Methods

In August 2021, PubMed, Web of science, the Cochrane Library, VIP, WanFang Data, CNKI and CBM were retrieved by computer for systematic reviews/meta-analyses on the effectiveness of TR applied to functional rehabilitation after stroke from the establishment of the database to August 2021. After the literature screen and data extract by two researchers independently, the methodological quality of the included literature was evaluated by AMSTAR 2 scale, and the evidence quality of the outcome index was graded by GRADE system. Descriptive analysis was used to analyze the effectiveness of TR in functional rehabilitation after stroke.

Results

A total of 10 systematic reviews/meta-analyses were included, and the results of the AMSTAR 2 review showed that 2 systematic reviews were of high quality, 3 were of low quality, and 5 were of very low quality. The main reasons for the low methodological quality were the failure to report the preliminary study protocol, the list and reasons for excluded studies, the publication bias of the original study and the funding sources. The GRADE evidence quality assessment resulted in 10 systematic reviews addressing seven outcome measures, 41 bodies of evidence, with eight grade graded as intermediate, 23 grade graded as low, and 10 grade graded as very low. TR promoted the improvement of activities of daily living, motor function, quality of life, depressive symptoms and speech function of stroke patients to a certain extent, and had the same curative effect as face-to-face rehabilitation therapy or routine treatment, and even some TR rehabilitation effects were better than traditional rehabilitation therapy.

Conclusion

TR can promote the functional rehabilitation of stroke patients, but considering that the methodological quality and reliability of outcome measures of current systematic reviews/meta-analyses on the effectiveness of TR applied to functional recovery after stroke are mostly low, strict, standardized and comprehensive high-quality randomized controlled trials are still needed to provide evidence support; The results of this study can provide reference for the topic selection, research design and results report of future TR research.