Table of Content

05 September 2022, Volume 25 Issue 25

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Editorial

Action Plans on Dementia from the WHO and 25 Countries (Regions) and Implications for China

Dan WANG, Yuehua LIU, Xuemin ZHU, Haopeng YANG, Jingdong SUO, Xianlei SHEN, Wannian LIANG

2022, 25(25):  3075-3082.  DOI: 10.12114/j.issn.1007-9572.2022.0515

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Dementia is a major public health challenge associated with population aging. This paper introduces the background of the development of WHO "Global Action Plan on the Public Health Response to Dementia 2017—2025", with a focus on targets set across seven areas: dementia as a public health priority, dementia awareness and friendliness, dementia risk reduction, dementia diagnosis, treatment, care and support, support for dementia carers, information systems for dementia, and dementia research and innovation. We found 25 countries (regions) who have developed policies, strategies, plans or action frameworks on dementia since 2009, with targets involving areas of prevention, intervention, research, support, implementation, legislation and evaluation. As China still lacks a national dementia action plan, we put forward the following recommendations on the development of a China's national action plan on dementia: referring to the action priorities and specific measures for containing dementia of the WHO and 25 countries (regions) ; appropriately drawing lessons from successful experiences of WHO Member States in early screening for dementia in high-risk groups, reducing dementia risk factors, developing long-term dementia care insurance, creating a dementia friendly social environment, and building a national dementia monitoring system.

Focus·Integration of Sports and Medicine

Exercise/Physical Activity in Individuals with Type 2 Diabetes from the American College of Sports Medicine: Interpretation and Clinical Significance

Zhihan XU, Shiqiang WANG, Dan LI, Yijie WANG, Shaokun WANG, Kailin GUO

2022, 25(25):  3083-3088.  DOI: 10.12114/j.issn.1007-9572.2022.0353

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The guidelines on physical activities in individuals with type 2 diabetes, a common chronic metabolic disease, have been updated continuously, and relevant recommendations from them are increasingly improved, but there are still difficulties in these people's daily activities need to be addressed. In February 2022, the American College of Sports Medicine and the American Diabetes Association issued the Exercise/Physical Activity in Individuals with Type 2 Diabetes (EPAIT2D) by updating the Exercise and Type 2 Diabetes, a statement jointly published by them in 2010, which provides a concise summary of new clinical recommendations on age-specific physical activity, optimal timing of activities, effectiveness of medical intervention and physical activity, and precautions regarding physical activities and diets in type 2 diabetics. We interpreted the essentials and key updated contents of the EPAIT2D, and put forward recommendations on clinical delivery of exercise/physical activity interventions targeting Chinese type 2 diabetics.

Integrating Physical Activity into Healthcare for the Prevention and Treatment of Diabetes: Insights from the U.S. Experience

Yuan GAO, Xianjuan KOU

2022, 25(25):  3089-3096.  DOI: 10.12114/j.issn.1007-9572.2022.0222

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The prevention and treatment of diabetes is booming driven by the integration of physical activity into healthcare. In China, the integration of physical activity into healthcare started late and still has many imperfections, the improvement of which relies crucially on measures explored according to the national conditions. The U.S. has formed a relatively comprehensive diabetes prevention and control system based on integrating physical activity into healthcare after years of exploratory practice, which may provide insights into the development of diabetes prevention and control in China. We introduced the development and implementation of the America's National Diabetes Prevention Program (DPP) , and summarized the wellness benefit system in health insurance for diabetes, innovative models of referral cooperation, interdisciplinary talent training programs, and the framework of integrating the data of health records and physical activities in the U.S. Then based on this, we put forward the following recommendations for integrating physical activity into healthcare to improve the current diabetic prevention and treatment (including solving problems) in China: speeding up the development of a China's national DPP, and popularizing the idea of integrating physical activity into healthcare; deepening the reform of the social security system, and resolving the conflicts between medical insurance regulations; promoting the innovation of the models of integrating physical activity into healthcare, and improving the operation of referral services; filling the gap in interdisciplinary talent training to develop a competitive heath workforce; bridging the data of health records and physical activities for information sharing with good management of the privacy and security of personal information.

Original Research·Geriatric Problems

The Self-rated Fall Risk Questionnaire and Modified Falls Efficacy Scale in Assessing the Fall Risk in Community-dwelling Older Chinese Adults: a Comparative Study

Junmin SONG, Peng YANG, Gang LIU, Zhiguang ZHAO, Danting WAN, Hairui WANG, Ziqian XU, Donghai WANG, Junjie XIA

2022, 25(25):  3097-3100.  DOI: 10.12114/j.issn.1007-9572.2022.0225

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Background

The Self-rated Fall Risk Questionnaire (FRQ) developed by the US CDC is one of the few questionnaires applied for fall risk self-assessment in community-dwelling older adults, which is thought to be simple and highly applicable. The Modified Falls Efficacy Scale (MFES) is also widely used in the fall risk assessment in older adults. Thus the comparison between the Self-rated FRQ and MFES in identifying fall risk in older adults would be meaningful.

Objective

To explore the applicability of the Chinese version of Self-rated FRQ (FRQ-C) in assessing the fall risks in community-dwelling older Chinese adults by comparing it with the Chinese version of MFES (MFES-C) .

Methods

A total of 203 seniors above 65 who received physical examination services, treatment services, or vaccination services from the community health center were selected by use of convenience sampling and invited to attend a survey for understanding their demographics, and fall risk rated by the MFES-C and the Self-rated FRQ-C. ROC analysis was conducted to assess the performance (sensitivity, specificity, positive and negative predictive values) of the Self-rated FRQ-C and MFES-C in the prediction of having at least one or two falls in the past year.

Results

Fifty-eight (28.6%) of them fell once or more in the past year. The mean score of the Self-rated FRQ-C for the fall group was higher than that of the non-fall group with a statistically significant difference (P<0.001) . But no significant difference in the mean score of the MFES-C was found between the two groups (P>0.05) . Those with high fall risk assessed by the Self-rated FRQ-C (≥4 points) had higher prevalence of fall (P<0.05) . However, no higher prevalence of fall was found in those with high fall risk assessed by the MFES-C (≤112 points) (P>0.05) . The AUC values in identifying having one or more falls in the past year for the Self-rated FRQ-C and MFES-C were 0.74〔95%CI (0.68, 0.81) 〕 and 0.59〔95%CI (0.50, 0.68) 〕. When identifying having two or more falls in the past year, the AUC value of the Self-rated FRQ-C increased to 0.80〔95%CI (0.70, 0.90) 〕, and that of the MFES-C increased to 0.65〔95%CI (0.52, 0.78) 〕. The sensitivity and specificity of the Self-rated FRQ-C with a threshold of 4 points were 81.0% and 51.7%, respectively, and those of the MFES-C with a threshold of 112 points were 53.5% and 60.0%, respectively.

Conclusion

Compared with the MFES-C, the Self-rated FRQ-C may have higher sensitivity in identifying fall risk in older adults with higher operability and applicability in community settings.

Association of Adverse Childhood Experiences with Self-rated Health among Chinese Elderly People

Weiwei LU, Zhihui LU, Yiming HUANG, Xiaoqiong WU, Tengfei FU, Jian ZHANG

2022, 25(25):  3101-3106.  DOI: 10.12114/j.issn.1007-9572.2022.0379

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Background

The association of adverse childhood experiences (ACEs) with chronic disease prevalence among middle-aged and elderly people has become a research hot spot, but the association between ACEs and self-rated health in older people is still unclear, and relevant studies in Chinese population are especially rare.

Objective

To explore self-rated health in Chinese elderly people, and its association with ACEs.

Methods

The study was conducted in October 2021. Data about ACEs and self-rated health were acquired by applying from the 2014 and 2018 waves of CHARLS conducted by Peking University, involving 7 579 older people (≥ 60 years old) . The ACEs were stratified into three groups by the times of ACEs events (10 kinds in total) : high-risk (4 or more) , low-risk (1-3) , and reference (zero) . The self-rated health was divided into three levels: good, fair and poor. Ordinal logistic regression was used to analyze the correlation of self-rated health with the number and types of ACEs events.

Results

Among the participants, the prevalence of good, fair and poor self-rated health was 22.06% (1 672/7 579) , 59.03% (4 474/7 579) , and 18.91% (1 433/7 579) , respectively, and the prevalence of experiencing ≥4, 1-3 and no ACEs events was 25.36% (1 922/7 579) , 69.71% (5 283/7 579) , and 4.93% (374/7 579) , respectively. The self-rated health differed significantly by age, gender, place of living, and types of ACEs (parental divorce, parental violence, parental depression, parental disability, living in an unsafe neighborhood, childhood loneliness, childhood famishment, bullying) (P<0.05) . The self-rated health also differed significantly across the three groups stratified by the number of ACEs events (P<0.05) . Univariate ordinal logistic regression analysis indicated that the probability of a worse self-rated health increased by a factor of 1.358〔95%CI (1.110, 1.663) 〕in those with 1-3 ACEs events, and increased by a factor of 2.151 in those with 4 or more ACEs events compared with those with no ACEs events (P<0.05) . The ordinal Logistic regression analysis indicated that results showed that parental divorce, parental violence, parental depression, parental disability, living in an unsafe neighborhood, childhood loneliness, childhood famishment, and bullying were associated a worse self-rated health (P<0.05) . The statistical results remained unchanged after adjusting for age, gender and place of living.

Conclusion

The self-rated health status in Chinese older people was generally fair. To improve the self-rated health to promote healthy aging in this population, interventions could be provided for them targeting reducing the negative influence caused by parental divorce, parental violence, parental depression and disability, living in an unsafe neighborhood, childhood loneliness, and childhood famishment.

Effects of Potentially Inappropriate Medications on Frailty in Older Adults with Mild Cognitive Impairment in the Community

Simeng WANG, Lian MA, Junwei ZHANG, Limei ZHOU, Yuanyuan XU, Ying ZHANG, Chenyu WANG, Lina WANG

2022, 25(25):  3107-3113.  DOI: 10.12114/j.issn.1007-9572.2022.0109

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Background

Both frailty and potentially inappropriate medication (PIM) are relatively highly prevalent in adults with mild cognitive impairment (MCI) in the community, but the association of PIM with frailty in MCI population remains to be further explored.

Objective

To examine the association between PIM and frailty in older adults with MCI in the community.

Methods

This study was conducted between March to July 2021. By use of multistage sampling, older adults with MCI (n=230) were recruited from Baohe District, Hefei City. Sociodemographics, lifestyle indicators and physical functions of the subjects were collected by using the General Information Questionnaire developed by our research team. Frailty was assessed by the Comprehensive Frailty Assessment Instrument. PIM was assessed by the 2017 Criteria of Potentially Inappropriate Medications for Older Adults in China. Logistic regression analysis was applied to analyze the association of the number and types of PIM with frailty.

Results

The prevalence of frailty and PIM in these older adults with MCI was 59.1% (136/230) and 59.1% (136/230) , respectively. The prevalence of PIM in the frailty group was much higher than that of non-frailty group〔80.9% (110/136) vs 27.7% (26/94) 〕 (P<0.05) . Multivariate Logistic regression analysis demonstrated that compared with MCI older adults without PIM, the risk of frailty was 4.591 times higher in those with only one PIM〔95%CI (1.903, 11.076) 〕, and 8.859 times higher in those with two or more PIMs〔95%CI (2.589, 30.321) 〕. Compared with MCI older adults with neurological disease but without PIM, the risk of frailty was 5.310 times higher in those with PIM〔95%CI (1.011, 27.877) 〕. The risk of frailty was 3.108 times higher in those with cardiovascular disease and PIM than that in those without PIM〔95%CI (1.173, 8.241) 〕.

Conclusion

The prevalence of frailty and PIM was higher in older adults with MCI in the community, and PIM was significantly associated with frailty. To decrease the prevalence of frailty and delay the progression of dementia in this population via reducing the prevalence of PIM, community-based health efforts should be made to strengthen the screening for frailty, enhance the identification of frailty related to medication use, and promote medication review and management.

Prevalence of Use of Anticoagulation Therapy and Associated Factors in Elderly Patients with Nonvalvular Atrial Fibrillation in Communities

Yuanxia DUAN, Zhigang PAN, Jie GU, Jin SU

2022, 25(25):  3114-3121.  DOI: 10.12114/j.issn.1007-9572.2022.0195

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Background

Stroke is highly prevalent in patients with atrial fibrillation (AF) , a most common cardiac arrhythmia with high morbidity, and anticoagulation therapy is a key strategy to prevent AF-related stroke. However, there is short of research on the use of anticoagulation therapy in patients with AF in the community.

Objective

To explore the prevalence of use of anticoagulation therapy and influencing factors in elderly patients with nonvalvular atrial fibrillation (NVAF) in Shanghai's communities.

Methods

A cross-sectional survey design was used. Stratified sampling was used to select elderly patients with AF who received the 2018 annual physical examination at four community health centers in Shanghai during July to December 2019, and they were surveyed using a questionnaire (consisting of three parts: demographics, CHA2DS2-VASc score and ORBIT score) compiled by our research team for collecting information on their AF prevalence and associated medication use, awareness of AF, comorbidities, and complication, as well as risk for stroke and bleeding. Based on the results of the survey, we excluded those without previous AF-related medical experience and valvular AF, then analyzed the prevalence of anticoagulation therapy in those with NVAF. Anticoagulation therapy was recommended for patients at high risk for stroke in accordance with the CHA2DS2-VASc score. Univariate and multivariate Logistic regression analyses were used to identify influencing factors of anticoagulation therapy in NVAF patients at high risk of stroke.

Results

Three hundred and two patients with NVAF were finally included, of whom the prevalence of current use of anticoagulant and antiplatelet drugs was 29.5% (89/302) , and 39.7% (120/302) , respectively, and that of non-use of anticoagulant or antiplatelet drugs was 30.8% (93/302) . By the CHA2DS2-VASc score, 279 of the 302 NVAF patients (92.4%) were assessed with high risk of stroke, among whom the prevalence of current use of anticoagulant and antiplatelet drugs was 30.5% (85/279) , 40.1% (112/279) , respectively, and the rest 29.4% (82/279) did not take anticoagulant or antiplatelet drugs. Univariate Logistic regression analysis demonstrated that age, marital status, type of AF, onset of AF symptoms, duration of AF, prescription of anticoagulants at the first visit for AF, knowledge of the harmfulness of AF, prevalence of hyperlipidemia, and risk of bleeding were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) . Multivariate Logistic regression analysis showed that age, type of AF, prescription of anticoagulants at the first visit for AF, and knowledge of the harmfulness of AF were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) .

Conclusion

The prevalence of the use of anticoagulation therapy in community-living NVAF patients at higher risk of stroke is unsatisfactory, so the use of anticoagulation therapy for this population needs to be further standardized, especially in patients with advanced age and low awareness of the harmfulness of AF.

Trajectories and Influencing Factors of Somatic Symptom Clusters in Frail Elderly People in Nursing Homes: a Longitudinal Study

Chenxi WU, Jing GAO, Qin LIAO, Jiali HE

2022, 25(25):  3122-3129.  DOI: 10.12114/j.issn.1007-9572.2022.0261

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Background

The somatic symptom clusters may be associated with increased risk of adverse outcomes in frail elderly people. Relevant studies in China have mainly adopted a cross-sectional design with neglect of the trajectory of somatic symptom clusters in this group.

Objective

To explore the characteristics of somatic symptom clusters at different time points and influencing factors in elderly people with frailty in nursing homes in Chengdu.

Methods

From November 2019 to January 2020, 206 frail elderly people were selected from 6 nursing homes in Chengdu by convenience sampling, and surveyed using the general data questionnaire and Memory Symptom Assessment Scale (MSAS) for 3 times〔at baseline (T0) , 6 (T1) , and 12 months later (T2) 〕. Exploratory factor analysis was carried out for symptoms with an incidence of ≥20% at different time points. Latent growth mixture model (LGMM) was used to identify the change trajectory of somatic symptom clusters across the above-mentioned three time points. Logistic regression analysis was used to identify the potential factors associated with the trajectory category.

Results

By exploratory factor analysis, 5 factors were extracted at each of the three time points. Neurological symptom cluster, energy deficiency symptom cluster, respiratory symptom cluster and digestive symptom cluster all appeared at the three time points. In addition, senescence-related symptom cluster also occurred at T0 and T1, and other symptom cluster occurred at T2. The MSAS score of each symptom cluster differed significantly across three time points (P<0.05) . Four heterogeneous trajectories of frailty symptom clusters were obtained by LGMM model fitting, which were named as "high decline" "low rise" "medium maintenance" and "high rise", accounting for 16.5%, 12.5%, 66.0% and 5.0%, respectively. Multivariate Logistic regression analysis showed that the number of chronic diseases was independently associated with the "high decline" or "high rise" trajectory, and the number of medications was independently associated with the "high rise" trajectory (P<0.05) .

Conclusion

There are various trajectories of somatic symptom clusters in frail elderly people in nursing homes, and each of the trajectories has a different independently associated factor. To provide more appropriate services for this population, medical workers in nursing homes can dynamically adjust nursing services according to the trajectories and associated factors of somatic symptom clusters.

Original Research·Primary Health Services

Hypertension Patients' Self-rated Improvement Gained from and Satisfaction with the National Essential Public Health Services

Linghe YANG, Meicen LIU, Xinyue CHEN, Zirui LIAO, Ziqing ZAN, Jun LIAN, Siqi YANG, Siqi ZHANG, Lili YOU, Yuanli LIU

2022, 25(25):  3130-3134.  DOI: 10.12114/j.issn.1007-9572.2022.0304

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Background

Launched in 2009, the National Essential Public Health Service Program has been conducted for 13 years. Among which the antihypertensive care ranks first among all types of antihypertensive care in terms of population coverage in China. To promote the sustainable development of the National Essential Public Health Services (NEPHSs) , it is important to understand the feedback of hypertensive population on the antihypertensive care.

Objective

To explore hypertension patients' self-rated improvement gained from and satisfaction with the NEPHSs and associated factors, providing a scientific basis for promoting the quality development of the services.

Methods

By use of multi-stage stratified sampling, 2 419 hypertensive patients (≥35 years old) were selected from 20 community (township) health centers in 10 districts (counties) of 5 cities in eastern, central and western China from November to December 2019. A questionnaire survey was conducted with them for understanding their general demographic information and management of hypertension.

Results

The prevalence of having self-rated health improvement associated with the NEPHSs in the survey respondents was 86.26% (2 072/2 402) . The prevalence of self-reported satisfaction with healthcare workers' attitudes toward patients, and their care quality, physical examination, health education, TCM treatment, follow-up service, screening for hypertension complications, blood pressure control effect and overall services was 97.15% (2 349/2 418) , 94.09% (2 275/2 418) , 88.16% (2 129/2 415) , 87.81% (2 118/2 412) , 61.36% (1 469/2 394) , 95.04% (2 297/2 417) , 83.67% (2 013/2 406) , 82.34% (1 981/2 406) , and 95.53% (2 310/2 418) , respectively. The prevalence of self-rated improvement gained from the NEPHSs varied significantly by education level, self-rated health, prevalence of blood pressure abnormalities first detected in primary care, and the number of different follow-up services received within the past year (P<0.05) . The prevalence of self-reported satisfaction with overall services differed significantly by education level, prevalence of blood pressure abnormalities first detected in primary care, and the number of different follow-up services received within the past year (P<0.05) .

Conclusion

The prevalence of self-rated improvement gained from and self-reported satisfaction with the NEPHSs in hypertension patients were high on the whole. To promote the sound and sustainable development of these services, priority should be given to the standardization of the provision of NEPHSs and the homogeneity of NEPHSs provided to both urban and rural areas.

Reliability and Validity of the Chinese Version of the People-Centered Primary Care Measure

Wenxin YAN, Jue LIU

2022, 25(25):  3135-3142.  DOI: 10.12114/j.issn.1007-9572.2022.0284

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Background

The People-Centered Primary Care Measure (PCPCM) scale has proven to be able to evaluate the quality of primary care measures in a accurate, all-round and rapid manner in foreign studies. And after being translated and revised, its Chinese version has been developed by Hong Kong scholars. However, there is not yet any report on the applicability and metrological performance concerning the Chinese version of the PCPCM (PCPCM-C) in the culture and healthcare settings in Chinese mainland.

Objective

To evaluate the reliability and validity of the PCPCM-C scale, providing evidence for its feasibility in evaluating primary care measures in Chinese mainland.

Methods

By use of convenience sampling, patients were consecutively selected from six primary care settings (community health center, community health station, township health center and village clinic) located in Henan Province, Shanghai, and Heilongjiang Province from December 8th to 20th, 2021. They received a survey using the General Information Questionnaire developed by us, and the PCPCM-C. Then the PCPCM-C was revised in accordance with the survey results, and the assessment results by 10 Chinese professionals (public health managers, general practice experts and administrators of primary care settings) invited nationwide. After that, the PCPCM-C was analyzed using item, reliability and validity analyses.

Results

Altogether, 683 cases who handed in responsive questionnaires were included for final analysis. The item-total correlation coefficients of the scale ranged from 0.843 to 0.923 (P<0.001) . The CR values of items ranged from 28.270 to 36.055 (P<0.001) . Leave-one-out analysis demonstrated that the Cronbach's α of the PCPCM-C ranged from 0.970 to 0.973 (<0.974) . The reliability analysis of the Cronbach's α, Guttman Split-half coefficient and test-retest reliability of the PCPCM-C was 0.974, 0.952, and 0.874, respectively. The inter-item correlation coefficients ranged from 0.667 to 0.913. The test-retest reliability of every item ranged from 0.724 to 0.886. The expert evaluation showed that content validity index (CVI) of every item was 0.800-1.000, the S-CVI/UA was 0.818, and the S-CVI/Ave was 0.973, the K^* was 0.79-1.00. The value of KMO (0.960) and result of Bartlett's test of sphericity (χ²=4 538.461, P<0.001) derived from the exploratory factor analysis, suggested that the data sample was appropriate for factor analysis. One common factor with an eigenvalue >1.000 was extracted, and the cumulative variance explained by which was 78.715%, with the load value of each item of 0.826-0.925. The results of confirmatory factor analysis (CFA) showed that the fitting indicators of the initial model were undesirable. After the establishment of a covariance correlation between error variables e1 and e2, e3 and e9, and e10 and e11 according to the indication, the fitting indicators of the model were modified to be acceptable (modified CMIN: χ²/df=2.983, GFI=0.934, AGFI=0.894, RMSEA=0.081, NFI=0.966, RFI=0.954, IFI=0.977, TLI=0.969, CFI=0.977, standardized regression coefficients ranged from 0.790 to 0.900) . The results of known-group validity analysis showed that the total score of PCPCM-C among patients varied significantly by age, rural or urban hukou, household monthly income per person, self-rated health, and chronic disease prevalence, and region (P<0.05) .

Conclusion

This PCPCM-C has proven to be with good psychometric quality in Chinese mainland. But further research is needed to test the cross-cultural applicability and residents' conceptualization of the scale.

The Construction of an Evaluation Index System for Operation of Fever Alertness Clinics Based on Grounded Theory

Xiaoyan ZHU, Yuncong HUANG, Qian HUANG, Jie GU, Haiying CHEN, Lan TANG, Zhaoxin WANG, Jiaoling HUANG

2022, 25(25):  3143-3149.  DOI: 10.12114/j.issn.1007-9572.2022.0111

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Background

In March 2020, the Shanghai Municipal Health Commission proposed that fever alertness clinics should be set up in primary healthcare institutions (community health service centers) to deal with multi-site sporadic outbreaks by the principle of local emergency disposal combined with standardized and regular outbreak control.

Objective

To explore and construct a comprehensive and standardized evaluation index system for the operation of fever alertness clinics.

Methods

Two rounds of semi-structured in-depth interviews were conducted with 10 staff from three fever alertness clinics in downtown, suburban, and peri urban locations of Shanghai, respectively, using a purposive sampling method from January to April 2021. Raw data were obtained, interview materials were collated with the aid of the ROST CM6 software, and paradigm analyses were conducted using the Charmaz constructing grounded theory. Using a purposive sampling method, 12 experts familiar with the operating characteristics of fever alertness clinics (fever alertness clinics managers, researchers from universities, scholars from related associations, health development institutes, etc.) were invited as consulting objects to answer the correspondence questionnaire for 2 rounds from May to June 2021, and the weighting of indicators at each level was determined by hierarchical analysis to check the logical consistency of indicators at all levels, the evaluation index system of operation of fever alertness clinics was finally formed.

Results

The evaluation index system for operation of fever alertness clinics, which was constructed based on the grounded theory, consisted of 5 primary indicators, 13 secondary indicators and 29 tertiary indicators. The effective recoveries rate of the two rounds of expert consultation questionnaires was 100.0%, the expert authority coefficient of the two rounds was all 0.81, Kendall's W coefficients were 0.265 (χ²=163.768, P<0.001) and 0.320 (χ²=130.323, P<0.001) , respectively. The final developed evaluation index system for operation of fever alertness clinics consisted of 5 primary indexes (functions and responsibilities, consulting room setting requirements, staffing, workflow and work specifications) , 13 secondary indexes and 25 tertiary indexes. The weights of the five primary indexes were 0.033 7, 0.056 4, 0.392 6, 0.377 8 and 0.139 5, respectively. The consistency ratio (CR) of indicators at all levels was 0.056 5、0.032 5、0.042 4 (<0.100 0) .

Conclusion

The application of grounded theory to the construction of evaluation index system for fever alertness clinics is highly operable, and the constructed evaluation index system has a certain scientific validity and application value. Follow up with the policy iterations, the evaluation index system can be further supplemented and improved with the aid of grounded theory.

Capacity of Diagnosis and Treatment of Childhood Functional Constipation among Primary-level Doctors

Yuchun LIU, Lixia YIN, Liping GAO, Lan DING, Jing DING, Xueping DU, Shuang YU

2022, 25(25):  3150-3156.  DOI: 10.12114/j.issn.1007-9572.2022.0196

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Background

Functional constipation (FC) is a common health problem in children and a high frequency of consultations among parents of children in outpatient clinics of primary medical and health institutions. Although constipation is not an emergency, it may cause serious complications if not managed properly, which then can affect the quality of life of children and their families.

Objective

To understand the capacity of primary-level doctors' diagnosis and treatment in children's FC, and provide a basis for improving primary-level doctors' capacity of diagnosis and management of children's FC.

Methods

In July 2020, 130 doctors who had access with children's patients in their daily diagnosis and treatment were selected from primary-level medical and health institutions in Xicheng District, Beijing. A self-designed questionnaire from our research group was administered to the included physicians. The content included awareness of the common symptoms of FC diagnosis for children ≥6 months of age, and the recommended treatment methods, recommended treatment drugs, medication timing and treatment duration for children with FC.

Results

Questionnaires from 108 (83.1%) basic medical doctors were validly returned, including 34 (31.5%) from general practitioners, 30 (27.8%) from pediatricians, 30 (27.8%) from traditional Chinese medicine doctors, and the average monthly outpatient volume with pediatric patients (10.1±4.4) cases was obtained. For the diagnosis of FC in children: when children aged ≥6 months presented with less frequent bowel movements, hard stools, bleeding during defecation, fecal incontinence, difficulty in defecating, and crying symptoms before passing thick stools, 40.7% (44/108) , 39.8% (43/108) , 23.1% (25/108) , 9.3% (14/108) , 39.8% (43/108) , 23.1% (25/108) of the basic medical doctors would consider the diagnosis of FC; 51.9% (56/108) of the physicians considered FC to be diagnosed when two symptoms, including low frequency of defecation and difficulty in defecating, existed simultaneously; according to 25.0% (27/108) of the physicians, FC can be diagnosed when four symptoms including less frequent defecation, hard stools, bleeding during defecation, and difficulty in defecating were present at the same time. For the treatment of FC in children: pharmacotherapy was recommended as the main treatment of choice for FC in children by primary physicians in 37.0% (40/108) ; nonpharmacologic therapy was recommended as the preferred treatment by 63.0% (68/108) of the primary physicians, with 88.2% (60/68) recommending abdominal massage, 85.3% (58/68) recommending a high fiber diet, 82.4% (56/68) recommending toilet training, and 72.1% (49/68) recommending increased fluid intake. Lactulose therapy was recommended by 75.9% (82/108) of the primary physicians; 27.8% (30/108) of the primary physicians recommended combination therapy with microenemas of sodium citrate, sodium dodecylsulfonylacetate, and sorbitol as the rectal treatment, and 64.8% (70/108) of the primary physicians recommended rectal administration when children had particularly difficult bowel movements. According to the basic medical practitioners, the mean time from initiation of treatment to having a positive response was (4.1±2.6) days in children; the mean treatment duration of FC in children by primary physicians was (21.2±4.3) days; 88.9% of doctors believed that the average termination time of constipation treatment was (46.0±9.3) days. When the frequency and/or consistency of bowel movements returned to normal or the patient no longer had discomfort, 88.9% of physicians responded that they would consider discontinuing the treatment.

Conclusion

Although general primary doctors know some methods of diagnosis and treatment of children's constipation, their overall level of awareness still needs to be improved. It is recommended to further enhance the existing primary physicians' awareness and comprehensive management of FC in children, and to develop a comprehensive management model of FC in children in primary health facilities to improve the management level of children's functional constipation, thereby reducing the prevalence and increasing the cure rate.

Original Research·Community-based Management of Osteoarthritis

Problems and Addressing Strategies in Community-based Management of Osteoarthritis: a Systematic Review

Qian LIU, Hanzhi ZHANG, Mengsi QIU, Dehua YU

2022, 25(25):  3157-3164.  DOI: 10.12114/j.issn.1007-9572.2022.0137

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Background

Osteoarthritis is a common chronic disease in middle-aged and elderly people, which seriously affects their quality of life. Carrying out community-based management of osteoarthritis is conducive to the optimization of healthcare resource allocation and the improvement of the overall prevention and treatment level of osteoarthritis. However, current community-based management of osteoarthritis has many problems and is not effectively.

Objective

To perform a review and comparative analysis of the developments in foreign and domestic community-based management of osteoarthritis, and strategies addressing the existing problems, providing evidence for improving strategies regarding community-based management of osteoarthritis to improve the treatment and prognosis of osteoarthritis patients in China.

Methods

From October 2020 to January 2021, Studies related to osteoarthritis management in Chinese published from January 1, 2010 to January 1, 2020 were searched from databases of CNKI, Wanfang Data and CQVIP using "骨关节炎" plus "管理", "骨关节炎" plus "模式", "骨关节炎" plus "策略" as the search terms, and those in English published during the same period were searched from databases of PubMed, Web of Science, and the Cochrane Library using osteoarthritis and management, mode or strategy as the search terms. After excluding duplicates or those about self-management of osteoarthritis, the enrolled studies about community-based management of osteoarthritis were analyzed using systematic analysis.

Results

Altogether, 2 695 studies were retrieved, 2 642 of them were excluded, and the other 53 were included. Five studies were about surveys on the management of osteoarthritis in the community, all of which revealed the lack of coordination and purpose in community-based management of osteoarthritis at home and abroad, and the key treatments are relieving symptoms, delaying cartilage degradation, and reducing the possibility of developing deformities, but the efficacies of such treatments were unsatisfactory, and symptoms often recurred. Moreover, community-based management modes of osteoarthritis in China were undiversified, mostly were various types of health education. Six studies proposed that the management of osteoarthritis in the community may be influenced by insufficient understanding of osteoarthritis in patients and their families, insufficient understanding and undervaluing of osteoarthritis in some primary care physicians, and uncoordinated healthcare resources, and put forward that a variety of factors led to the lack of coordination and purpose in the management of osteoarthritis in the community. There were three articles referring the significance of community-based osteoarthritis management, which highlighted that community-based osteoarthritis management could relieve pain, delay disease progression, and improve the quality of life in patients, and improve patients' satisfaction with treatment and services by healthcare professionals, as well as optimize the use of healthcare resources. There were 39 studies related to the strategies for community-based osteoarthritis management, 22 of which involved systematic management strategies, including 18 studies of multi-disciplinary or integrated management models and four studies of hierarchical management. As a whole, China's successful experience of managing diabetes and hypertension in the community has provided new ideas for the prevention and treatment of osteoarthritis, but most of the strategies were in the developmental stage, and their applications in practice needed further research. The remaining 17 studies involved various non-systematic community-based management strategies of osteoarthritis, including eight centering on health education, three focusing on internet-based management approaches, two involving telephone-based management, two focusing on non-drug management, and two focusing on written guidance.

Conclusion

There are problems in the community-based management strategies of osteoarthritis, including uncoordinated management, unsound methods, and imperfect systems. The referential community-based management strategies for osteoarthritis include: multidisciplinary or comprehensive management, hierarchical management and other systematic management strategies; making full use of medical techniques and tools (such as e-health, remote management, and health manuals) ; optimizing resource allocation (such as adding osteoarthritis management as a national essential public health project, and increasing government policy support for osteoarthritis management) .

Healthcare-seeking Perceptions and Behaviors and Behavior-related Factors in Community-living Osteoarthritis Patients: a Mixed-methods Study

Mengsi QIU, Qian LIU, Hanzhi ZHANG, Jiupeng TIAN, Lizhi ZHANG, Dehua YU

2022, 25(25):  3165-3170.  DOI: 10.12114/j.issn.1007-9572.2022.0138

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Background

Osteoarthritis is a chronic disease commonly seen in community settings, and the management of which is associated with numerous inter-related factors. Due to lack of appropriate healthcare-seeking perceptions and behaviors in osteoarthritis patients, it is difficult to diagnose, treat and manage osteoarthritis.

Objective

To understand healthcare-seeking perceptions and behaviors in community-living osteoarthritis patients, providing evidence for improving the diagnosis and treatment of such patients in the community.

Methods

This was a mixed-methods study. From May to June 2019, interviews for understanding osteoarthritis patients' healthcare-seeking perceptions and behavior-related factors, as well as management were conducted with a purposive sample of five orthopedic physicians and five general practitioners (GPs) from a general hospital in a regional healthcare consortium in Shanghai's Yangpu District, and a convenience sample of 12 GPs and 12 osteoarthritis patients from six community health centers (CHCs) in the same consortium. Then from June 2019 to December 2020, 425 patients with osteoarthritis were chosen from three randomly selected CHCs of the above-mentioned six ones to attend a survey using a quantitative questionnaire developed based on the themes derived from the above-mentioned interviews (excluding some highly subjective and less quantifiable indicators) for understanding their socio-demographic information, disease status, healthcare-seeking perceptions and behaviors, self-management and utilization of the APP for chronic disease management. Binary Logistic regression was used to analyze the influencing factors of healthcare-seeking behaviors in patients with osteoarthritis.

Results

The following themes were extracted from the interviews: patients' insufficient awareness of osteoarthritis, lack of management of osteoarthritis and influencing factors of patients' healthcare-seeking behavior. Three hundred and ninety-seven of the 425 cases (93.4%) who effectively completed the questionnaire were included for quantitative analysis. One hundred and fifty-two (38.3%) respondents understood osteoarthritis, and 79 (52.0%) of them acquired relevant knowledge from the media, and other 50 (32.9%) from ward-mates. Two hundred (50.4%) respondents knew the treatments for osteoarthritis, including 91 (45.5%) knowing exercise and physical therapies, and 105 (52.5%) knowing treatment with painkillers. The healthcare-seeking behaviors in osteoarthritis patients varied significantly by sex, BMI, pain level, impact of pain on sleep quality, and previous healthcare-seeking experience (P<0.05) . The results of regression analysis demonstrated that sex, BMI, pain level, previous treatment experience and impact of pain on sleep quality were associated with healthcare-seeking behavior (P<0.05) .

Conclusion

Community-living patients with osteoarthritis had insufficient awareness of healthcare-seeking and weak self-management awareness, and their healthcare-seeking behaviors were affected by multiple factors. To improve these patients' healthcare-seeking perceptions and behaviors, priority should be given to take actions to enhance patients' healthcare-seeking perceptions, train patients' self-management ability, better GPs' diagnostic and therapeutic skills, improve doctors and patients' negative attitude toward osteoarthritis treatment, and promote patients seeking healthcare actively.

Construction and Application of an Informatics Based Multidisciplinary Management Model for Osteoarthritis Patients in Community

Qian LIU, Mengsi QIU, Hanzhi ZHANG, Lizhi ZHANG, Rongan JIANG, Jie QIAN, Zhetun FU, Haiyan YU, Xiaodong LIU, Dehua YU

2022, 25(25):  3171-3177.  DOI: 10.12114/j.issn.1007-9572.2022.0136

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Background

Osteoarthritis has a high rate of disability and deformity, and can be combined with several physical and mental diseases. However, the early symptoms of the disease are not obvious. At present, there are problems in the management of osteoarthritis in the community such as uncoordinated management, inadequate methods and imperfect systems.

Objective

To construct and evaluate an informatics-based multidisciplinary management model for osteoarthritis patients in community, to promote the management of community osteoarthritis patients and improve the prognosis of the patients.

Methods

First a multidisciplinary management model of osteoarthritis patients in the community was constructed, including hierarchical management process of patients based on risk factor stratification, the multidisciplinary management team and its division of diagnosis and treatment, then an informatics based multidisciplinary management process was constructed, and information software development was completed. From July 2019 to July 2020, 80 patients with knee osteoarthritis who attended the general outpatient clinics of Dinghai and Daqiao Community Health Service Centers in Shanghai, and the orthopedics outpatient clinics of Yangpu District Central Hospital were randomly assigned into multidisciplinary management groups and general management group, with 40 patients in each group. The patients in general group were given conventional treatment, while the patients in multidisciplinary group were adopted information-based multidisciplinary management. Visual analogue scale (VAS) scores, Western Ontario McMaster University (WOMAC) osteoarthritis index score, the simplified scale of Arthritis Quality Of Life Measurement Scale (AIMS2) scores, Health Literacy Management Scale (HeLMS) scores, and body mass index (BMI) were assessed before and after 12 weeks of management, respectively.

Results

Before treatment, there were no significant differences in VAS score, WOMAC osteoarthritis index score, AIMS2 score, Helms score, and BMI between patients with knee osteoarthritis in the multidisciplinary and general groups (P>0.05) . After 12 weeks of treatment, the VAS and WOMAC score of both the multidisciplinary and general groups went down, and the health literacy AIMS2 scores and Helms total score were higher after treatment than those before. The difference was statistically significant (P<0.05) . After 12 weeks of treatment, the AIMS2 total score and Helms total score of patients in the multidisciplinary group were higher than those in the general group, and the VAS score, WOMAC osteoarthritis index, and BMI were lower than those in the general group, with significant differences (P<0.05) .

Conclusion

The implementation of an informatics based community multidisciplinary management model for patients with osteoarthritis of the knee can effectively reduce the patients' joint pain and control their weight, improve their ability of daily living and health literacy, improve the quality of life of patients, and delay the progress of the disease.

Original Research·General Practice Education

Employment Status and Associated Factors among Non-targeted Admission Medical Graduates Completing the Standardized General Practice Residency Program in Henan Province

Bing LI, Shan YANG, Cong WANG, Jinjing CHEN, Zhiwei XU, Xiaoyu LIU, Hongyan DUAN, Liuyi WANG

2022, 25(25):  3178-3183.  DOI: 10.12114/j.issn.1007-9572.2022.0092

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Background

Both the quantity and quality of general practitioners (GPs) are two important aspects in human resource management in healthcare, among which the increase, maintaining and loss of the number of GPs is an important indicator for assessing the dynamic planning, management and evaluation in human resource management for GPs, and also is an indicator for assessing the effectiveness of the standardized general practice residency program (SGPRP) . Studying the employment status and associated factors in trainees of the SGPRP will be references for the development of policies and incentives regarding the SGPRP. But there is a lack of such studies in non-targeted admission medical graduates completing the SGPRP.

Objective

To understand the employment status of non-targeted admission medical graduates finishing the SGPRP in Henan Province, and to identify the causes of choosing other careers instead of being a GP, providing a reference for the improvement of SGPRP management and incentive mechanisms for human resource management.

Methods

In August 2021, multistage random sampling was used to select non-targeted admission medical graduates (n=326) who had been admitted to the SGPRP during 2014 to 2017 and had completed it in Henan Province. They were invited to complete a self-administered survey questionnaire through the platform of wjx.cn for understanding their general information, and self-perceived status of training with SGPRP, current job, and causes of being a GP or choosing other careers.

Results

The survey obtained a response rate of 83.1% (271/326) . Among the respondents, 77 (28.4%) chose GP as a career, and other 194 (71.6%) chose other careers after completing the SGPRP. Multivariate Logistic regression analysis showed that age, education level, type of source and the location of the general practice residency training base were associated with the career choice (P<0.05) . Compared with respondents with a non-GP career choice, those with a GP career choice had higher prevalence of having general practice as the registered major 〔70.1% (54/77) vs 32.0% (62/194) , P<0.05〕, and working at township health centers or community health centers〔49.4% (38/77) vs 6.2% (12/194) , P<0.05) 〕. Among those with a non-GP career choice, the top three careers were internal medicine practitioners〔40.2% (78/194) 〕, emergency and critical care practitioners〔17.0% (33/194) 〕, and surgical care practitioners〔8.8% (17/194) 〕. The three major causes of choosing a non-GP career were appointed by the employed hospital〔34.5% (67/194) 〕, lack of general practice department in the employed hospital〔29.9% (58/194) 〕 and low salary〔26.8% (52/194) 〕.

Conclusion

In these non-targeted admission medical graduates finishing the SGPRP, the prevalence of choosing a GP career was relatively low, which may be associated with age, education level, type of source, and the location of the general practice residency training base. To increase the attractiveness of GP as a career, it is recommended to expand the publicity of the concept of general medicine, accelerate the construction of the general practice department in general hospitals, and improve the salary of GPs.

Turnover Intention and Associated Factors in Guizhou's Targeted Admission Medical Graduates Trained with the "5+3" Standardized General Residency Program: an Online Questionnaire Survey

Xiao LUO, Qian HE, Haibing LI, Li TU, Hailing ZHANG, Qiong MU

2022, 25(25):  3184-3190.  DOI: 10.12114/j.issn.1007-9572.2022.0170

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Background

The turnover intention level of general practitioners (GPs) in primary care in China is relatively high, and identification of its associated factors will offer insights into the curbing of outflow of health talents in primary care. The targeted admission medical graduates (TAMG) who completed the "5+3" standardized general residency program (5-year undergraduate medical education plus 3-year standardized residency training) have gradually entered primary care to fulfill their preadmission commitments, but research on their turnover intention after the tenure is few.

Objective

To explore the turnover intention and associated factors in Guizhou's TAMG trained with the "5+3" standardized general residency program after fulfilling their preadmission commitments in primary care, providing a basis for improving the policies about retaining the in-service health talents and developing the general practice workforce.

Methods

Participants were TAMG who were working in primary hospitals of Guizhou for fulfilling their preadmission commitments after finishing the "5+3" standardized general residency program at the end of 2020 (with a starting time for the 3-year standardized residency training of 2015—2017) . An online questionnaire survey was conducted with them from January 20 to February 10, 2021 for understanding their general information, self-assessed job satisfaction, turnover intention and planned career development after the expiration of services. Three hundred and eleven (89.6%) of the 347 cases who returned responsive questionnaires were selected as the final participants. Univariate and stepwise multiple linear regression analyses were used to explore the factors related to turnover intention.

Results

The average turnover intention score for the respondents was (3.98±0.98) points. The prevalence of having turnover intention was 73.6% (229/311) . The level of turnover intention differed obviously by sex, hospital location, and daily workload (P<0.05) . Stepwise multiple linear regression analysis found that the way leaders treating their subordinates, sense of work-related, the level of satisfaction with current income, family's support for their job, the implementation of local incentive policies accomplishment were associated with turnover intention (P<0.05) . In terms of the post-expiration development, 12 (3.9%) planned to continue working at the current hospital, 21 (6.7%) planned to work at another primary care setting, 196 (63.0%) planned to work at a higher level hospital, and 60 (19.3%) planned to study full-time to get a master's degree.

Conclusion

The level of turnover intention was high in TAMG working as a GP in primary care in Guizhou, and it is estimated that many of them would outflow after the expiration of services. To improve this, it is suggested to value their needs, take actions to increase income and optimize trainings and employment forms for them, and to further develop primary care hospitals, as well as to strengthen the publicity of general practice.

Advances in Tools

Strategy for the Choice of Appropriate Mild Cognitive Impairment Screening Scales for Community-dwelling Older Adults

Ming CAI, Qingru HU, Shihao JIA, Ruoyu YANG, Liyan WANG, Jingyun HU, Xiaojun WANG, Xiaoyan CHEN, Hongbiao WANG

2022, 25(25):  3191-3195.  DOI: 10.12114/j.issn.1007-9572.2022.0274

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With the deepening and acceleration of the aging process, an increasing prevalence of mild cognitive impairment (MCI) is found in China's elderly population. To reduce MCI prevalence in this group, early screening and diagnosis are approaches having great social significance. To provide support for the choice of appropriate tools for early screening and identifying MCI in community-dwelling Chinese older adults, we comprehensively reviewed the commonly used scales in clinical MCI screening and assessment〔Informant Questionnaire on Cognitive Decline in the Elderly Individuals (IQCODE) , Cambridge Neuropsychological Test Automated Battery, Montreal Cognitive Assessment, Clock Drawing Test, Clock Reading Test, Clock Setting Test, Consortium to Establish a Registry for Alzheimer's Disease, Ascertain Dementia 8 (AD8) , Addenbrooke's Cognitive Examination-Revised (ACE) , and General Practitioner Assessment of Cognition〕, and put forward a strategy after analyzing the advantages and disadvantages of each of the above-mentioned scales, namely, combined use of the quick and highly effective AD8, IQCODE, and the sensitive and comprehensive ACE, for these three scales may make up for each other's shortcomings when they are used together.

Recent Advances in Tools for Early Identification of Patients with Potential Palliative Care Needs

Chunwei LI, Renli DENG, Cui SU, Bisang ZHUANG

2022, 25(25):  3196-3202.  DOI: 10.12114/j.issn.1007-9572.2022.0162

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Early recognition of patients who may gain benefits from palliative care will help medical service providers to provide such patients with targeted, patient-centered care, therebyreducing the provision of meaningless overtreatment, and improving negative emotional distress and quality of life of patients as well as the quality of life of patients' families. Many tools developed by foreign scholars for early identifying patients with potential palliative care needs, are mostly consisted of predictors of death risk and early warning signs of deterioration. In particular, some of them have been iteratively updated during the process of global application and verification, and could recognize those who could benefit from palliative care, although their applicability and accuracy levels need to be improved further. In contrast, in China, related research is scarce, and the development and application of such tools are still in the preliminary stage. In accordance with the classification of applicable diseases and people, we classified the tools for early identifyingpatients with potential palliative care needs, reviewed their main contents, characteristics and applications, thenmade a comparative analysis of the common tools in terms of basic essentials and application, with a view to providing a reference for the development and localization of such tools, and for accurateassessment and provision of potential palliative care for those who can benefit from such care.