Table of Content

15 February 2024, Volume 27 Issue 05

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Guidelines·Consensus

Chinese Expert Consensus on the Diagnosis and Treatment of Anorexia Nervosa

Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, CHEN Han, CHEN Yan, HAN Huiqin, LI Xueni, ZHANG Lan, KONG Qingmei, QIAO Huifen, KUANG Guifang, SUN Jianqin, YU Yang, JIN Furui, JIANG Jingjing, ZHANG Darong, LI Keqing, WANG Zhen, CHEN Jue

2024, 27(05):  509-520.  DOI: 10.12114/j.issn.1007-9572.2023.0728

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Anorexia nervosa (AN) is a type of eating disorders characterized by self-starvation, significant loss of body mass, and malnutrition. AN has the highest mortality rate among all psychiatric disorders, leading to severe psychopathologic symptoms and life-threatening medical complications. However, AN cannot be recognized and diagnosed early in China, resulting in a prolonged course of the disease. Therefore, under the organization of the Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, together with the Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, this expert consensus was formulated by 16 medical experts based on evidence-based medical evidence, domestic and international guidelines and expert consensus, expert experience, etc., in order to improve the recognition, diagnosis and treatment of AN among domestic professionals.

Original Research

Types of Knowledge, Beliefs, Behaviors of Reducing Dementia Risk in Middle-aged and Elderly Adults in Community and Difference Analysis of Cognitive Function

PENG Yan, LIU Xiao, ZHANG Jinying, LI Jie, DENG Menghui, LI Yuanyuan, YANG Yanni

2024, 27(05):  521-526.  DOI: 10.12114/j.issn.1007-9572.2023.0562

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Background

Lifestyle is an important modifiable risk factor for dementia. Knowledge and beliefs are important factors affecting lifestyle. However, there is a lack of research on the types of knowledge, beliefs, behaviors of reducing dementia risk, and it remains unclear whether there are differences in dementia risk and cognitive function among residents with different types of knowledge, belief, and behavior.

Objective

To understand the current situation of knowledge, beliefs, behaviors of reducing dementia risk in the middle-aged and elderly adults in the community, explore and analyze the types of knowledge, beliefs and behaviors and the differences of cognitive function, and provide a basis for the development of targeted dementia prevention measures in the community.

Methods

From March 2021 to February 2022, middle-aged and elderly adults who participated in free health checkups at community health centers and established health management files in five communities in Shapingba District of Chongqing were selected as the survey objects by convenience sampling method. The general information questionnaire, Dementia Knowledge Assessment Scale (DKAS), Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction (MCLHB-DRR), Dementia Risk Reduction Lifestyle Scale (DRRLS), Beijing version of Montreal Cognitive Assessment (MoCA) and Cardiovascular Risk Factors, Aging and Dementia (CAIDE) scores were used for the investigation. K-means cluster analysis was used to classify the knowledge, beliefs, behaviors of reducing dementia risk of residents, and the differences in demographic characteristics, cognitive function and dementia risk among different types were compared and analyzed.

Results

A total of 232 questionnaires distributed and 211 valid questionnaires were recovered, with an effective recovery rate of 90.9%. The cluster analysis results showed that the knowledge, beliefs and behaviors of reducing dementia risk of the middle-aged and elderly adults in the community could be divided into three types of good knowledge, beliefs and behaviors type, low knowledge-poor behaviors type, low beliefs-poor behaviors type, which accounted for 39.8% (84/211), 37.4% (79/211), and 22.8% (48/211), respectively. The average years of education of middle-aged and elderly residents in good knowledge, beliefs and behaviors type were significantly higher than those in low knowledge-poor behaviors type (t=2.703, P<0.001), and low beliefs-poor behaviors type (t=1.524, P=0.022). The CAIDE scores of residents in low knowledge-poor behaviors type (t=1.431, P<0.001) and low beliefs-poor behaviors type (t=1.080, P=0.002) were significantly higher than those in good knowledge, beliefs and behaviors type. The MoCA scores of residents in low knowledge-poor behaviors type were lower than those in good knowledge, beliefs and behaviors type (t=-2.529, P<0.001) and low beliefs-poor behaviors type (t=-1.869, P=0.018) .

Conclusion

The knowledge, beliefs, behaviors of reducing dementia risk of the middle-aged and elderly adults in the community could be divided into three types of good knowledge, beliefs and behaviors type, low knowledge-poor behaviors type, low beliefs-poor behaviors type, and there are significant differences in years of education, dementia risk and cognitive function scores among the different types. Developing targeted dementia prevention measures based on the characteristics of different types of knowledge, beliefs, behaviors of reducing dementia risk, may be effective in reducing the risk of dementia and maintaining or slowing cognitive decline.

The Potential Patterns of Symptoms of Upper Respiratory Tract Infections in the Public and Their Effects on Antibiotic Use Behavior

ZHANG Xinyi, WANG Xi, WANG Dan, DUAN Lixia, LIN Rujiao, LIU Chenxi

2024, 27(05):  527-534.  DOI: 10.12114/j.issn.1007-9572.2023.0298

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Background

Antibiotic resistance caused by antibiotic abuse has become a public health issue worldwide. Reducing the irrational use of antibiotics for upper respiratory tract infections (URTIs) among the public is an important strategy to address the antibiotics abuse in China. Therefore, identifying the characteristics of URTIs in the population and their influence on the irrational use of antibiotics can help to design more targeted policies and interventions.

Objective

To quantify the potential patterns of symptoms of URTIs in the pulic, and explore their effect on antibiotic use behavior.

Methods

The public in three counties (districts) of Chongqing Municipality from July 20 to August 2, 2022 were selected as the survey respondents by using the cluster random sample method. The symptoms of URTIs, antibiotic use behavior, antibiotic use knowledge and demographics of the public were collected. Latent class analysis was used to identify the potential patterns of the public URTIs symptoms. Multivariate Logistic regression analysis was used to explore the influence of URTIs potential patterns on antibiotic use behavior.

Results

In this study, a total of 815 participants were included. Among them, 30.06% (245/815) of the respondents purchased antibiotics from pharmacies without a prescription, while 14.72% (120/815) of the respondents self-medicated with antibiotics for URTIs. The public knowledge level regarding rational antibiotic use was relatively low, with an average score of (2.3±1.7) points. Four symptom patterns for upper respiratory tract infections identified by latent class analysis regarding the disease pattern of URTIs, including 93 cases (11.41%) in the diverse symptoms group, 124 (15.21%) cases in the systemic symptoms group, 282 cases (34.60%) in the nasalpharyngeal symptoms group, and 316 cases (38.77%) in the mild symptoms group. The results of multivariate Logistic regression analysis showed that compared with the mild symptoms group, the nasal-pharyngeal symptoms group had a higher probability of purchasing antibiotics without a prescription (OR=1.538, P<0.05) and the association remained significant after adjusting for knowledge and demographic variables. In addition to the potential patterns of individual disease symptoms, age and medical insurance type also had a significant impact on the non-prescription antibiotic purchasing behavior of the public (P<0.05). There was a significant effect of antibiotic usage knowledge level on self-medication behavior with antibiotics (OR=0.869, P<0.05) and non-prescription antibiotic purchasing behavior of the public (OR=1.155, P<0.05) .

Conclusion

There are four potential patterns of symptoms of URTIs in the public. Patterns of disease symptoms significantly influence the rational use of antibiotics by the public. The focus should be on the irrational use of antibiotics in patients presenting with nasopharyngeal symptoms.

Acupoint Catgut Embedding Combined with Atorvastatin Calcium in the Treatment of Hyperlipidemia in the Elderly: a Randomized Controlled Trial

LIU Meiling, ZHAO Tianyi, GU Ji, GUO Yi

2024, 27(05):  535-546.  DOI: 10.12114/j.issn.1007-9572.2023.0438

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Background

The prevalence of dyslipidemia among adults in China reached 40.4% in 2012, and dyslipidemia is an independent risk factor for atherosclerotic cardiovascular diseases (ASCVD), and the elderly are at high risk for dyslipidemia and chronic diseases. The results of the previous survey showed that the prevalence of dyslipidemia among the elderly in the Malu district of Shanghai was 63%, therefore, it is of great significance to control dyslipidemia effectively.

Objective

To explore the synergistic effect of using acupoint catgut embedding combined with atorvastatin calcium to intervene in hyperlipidemia among the elderly in Malu district, so as to provide a basis for preventing and treating hyperlipidemia in the elderly and guide clinical practice.

Methods

As a single-center randomized controlled trial, a total of 120 elderly patients with hyperlipidemia recruited in the outpatient clinic of Malu Community Health Service Center of Jiading District from 2020-05-10 to 2020-08-04 were randomly divided into the treatment (n=59) and control groups (n=60) in a 1∶1 ratio by using simple random digit grouping methods. The treatment group was treated with acupoint catgut embedding combined with atorvastatin calcium, and the embedding was performed once every 2 weeks, 4 times for a course of treatment, while taking 10 mg of oral atorvastatin calcium tablets daily; the control group received only 10 mg of oral atorvastatin calcium tablets daily for 8 weeks of the intervention cycle. The main observational indexes were LDL cholesterol compliance and improvement in lipid levels, and the effect of this treatment regimen in different populations were explored.

Results

The primary outcome indicators included that the LDL cholesterol compliance rates were 79.5% and 71.4% in the two groups after treatment, respectively; there was no significant difference in the comparison of total cholesterol, triglycerides, low density lipoprotein cholesterol and high density lipoprotein cholesterol before and after treatment and 1 month of follow-up in the two groups (P>0.05). The secondary outcome indicators included that there was no significant difference in the comparison of apolipoprotein A, apolipoprotein B, lipoprotein alpha, fasting blood glucose and glycated albumin before and after treatment between the two groups (P>0.05), the comparison of the difference of BMI in the two groups before and after treatment, after treatment, and 1 month follow-up showed no statistically significant difference (P>0.05) ; the TCM evidence scores of the treatment group were higher than those of the control group after treatment (P<0.001). The adverse reactions included that the rate of abnormal elevation of glutamyl transfer in the treatment group was lower than that in the control group (P<0.05) .

Conclusion

The combination of acupoint catgut embedding with atorvastatin calcium improves lipid levels in the elderly with advantages in improving the TCM evidence scores and reducing the adverse effects of atorvastatin calcium.

Biofeedback Electrical Stimulation Therapy in the Rehabilitation of Pelvic Floor Function after Vaginal Delivery: a Clinical Randomized Controlled Study

LI Ya, BAI Wenpei, ZHANG Jin, ZHANG Rui

2024, 27(05):  547-551.  DOI: 10.12114/j.issn.1007-9572.2023.0354

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Background

Pregnancy and vaginal delivery are important factors leading to pelvic floor dysfunction (PFD) in women, manifested as pelvic organ prolapse (POP), stress urinary incontinence (SUI), and sexual dysfunction. Postpartum pelvic floor function rehabilitation has become a research hotspot in recent years. Stimulating the pelvic floor muscle groups through active exercise and passive contraction can improve detrusor stability and levator muscle function to prevent and treat PFD.

Objective

To investigate the clinical value of biofeedback electrical stimulation combined with pelvic floor muscle training (PFMT) therapy in the rehabilitation of pelvic floor function after vaginal delivery through a clinical controlled study.

Methods

Postpartum women with PFD after delivery implemented in Department of Obstetrics and Gynecology, Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2020 to January 2022 were selected as the research subjects, and divided into the observation group and the control group using a random number table method. The observation group was treated with biofeedback electrical stimulation combined with PFMT, while the control group was treated with PFMT alone. The muscle strength of the pelvic floor class Ⅰ and class Ⅱ muscle fibers, the ratio of SUI and POP level of the two groups before and after treatment; postpartum PFMT situation; scores of Pelvic Floor Dysfunction Questionnaire (PFDI-20), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICI-Q-SF) before and at 3 and 6 months after the treatment.

Results

A total of 327 cases were included in the observation group and 343 cases in the control group. After the treatment, the strength recovery of type Ⅰ and Ⅱ muscle fibers in the observation group was better than the control group (P<0.001). The ratio of SUI in the observation group was lower than that in the control group (P=0.005). There was no significant difference in POP level between the two groups (P>0.05). The proportion of PFMT frequency≥5 times/week in the observation group was higher than that in the control group at 3 months and 6 months after treatment (P<0.001) ; the PFDI-20, PFIQ-7, and ICI-Q-SF scores of the observation group were lower than those of the control group at 3 months and 6 months after treatment (P<0.05) .

Conclusion

Compared with PFMT alone, the patients of vaginal delivery with the treatment of biofeedback electrical stimulation combined with PFMT had better muscle strength recovery, lower SUI ratio, higher compliance with PFMT, and better quality of life score.

Study of Factors Associated with Concomitant Gastrointestinal Bleeding in Patients with Portal Vein Thrombosis in Liver Cirrhosis

DONG Wendi, YANG Jiani, ZHU Jie, QUAN Yujie, ZHANG Jinjing, LIU Yan, ZHANG Hairong

2024, 27(05):  552-556.  DOI: 10.12114/j.issn.1007-9572.2023.0201

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Background

Both portal vein thrombosis (PVT) and gastrointestinal bleeding are complications in patients with liver cirrhosis, and PVT can aggravate the risk of gastrointestinal bleeding, but the conflicting treatment of both is another challenge in clinical work.

Objective

To investigate the clinical characteristics and risk factors of concomitant gastrointestinal bleeding in patients with PVT in liver cirrhosis.

Methods

A total of 279 patients diagnosed with PVT in liver cirrhosis at the First Affiliated Hospital of Kunming Medical University from 2016-10-01 to 2021-09-30 were retrospectively collected and divided into the bleeding group (n=127) and non-bleeding group (n=152) according to the presence of gastrointestinal bleeding symptoms of hematemesis and melena in this admission. The differences in general information, complications, laboratory and imaging tests, surgical history and other relevant information between the two groups were compared. Multivariate Logistic regression analysis was used to explore the influencing factors of the complications of gastrointestinal bleeding in cirrhotic patients with PVT.

Results

A total of 5 807 patients were retrospectively investigated in the study, including 350 patients combined with PVT with a incidence of 6.0%. PVT was most common in 279 cirrhotic patients with PVT complicated by liver function Child B grade[146 (52.3%) ]. There were significant differences in etiology, vascular involvement, jaundice, internal diameter of main portal vein, gastroesophageal varices, white blood cell (WBC), blood urea nitrogen (BUN), hemoglobin (Hb), hematocrit (HCT), total bilirubin (TBiL), fibrinogen (FIB), and history of laparotomy between the bleeding group and non-bleeding group (P<0.05). Multivariate Logistic regression analysis showed that elevated WBC level (OR=2.555, 95%CI=1.318-6.542), decreased HCT level (OR=0.511, 95%CI=0.247-0.925), decreased FIB level (OR=0.085, 95%CI=0.005-0.661), and involvement of superior mesenteric vein thrombosis (OR=27.873, 95%CI=1.452-1 335.715) were independent risk factors for concomitant gastrointestinal bleeding in cirrhotic patients with PVT (P<0.05) .

Conclusion

Elevated WBC level, decreased HCT level, decreased FIB level and involvement of superior mesenteric vein thrombosis are independent risk factors for gastrointestinal bleeding in cirrhotic patients with PVT, and early intervention should be implemented to improve the prognosis.

Study on Mechanism of Myocardial Fibrosis in ApoE^-/- Atherosclerotic Mice Inhibited by Aerobic Exercise

QIN Fang, MA Tiantian, YU Zifu, LIU Xihua

2024, 27(05):  557-562.  DOI: 10.12114/j.issn.1007-9572.2023.0516

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Background

Atherosclerosis (AS) causes cardiovascular diseases such as myocardial infarction and myocardial fibrosis. Incidence of the population gradually increases with the aging of the global population. The inflammatory response is a key factor in myocardial fibrosis, and regular aerobic exercise can reduce inflammation and protect myocardial function. However, the protective mechanism of aerobic exercise against AS myocardial fibrosis is unclear.

Objective

To investigate the mechanism of the effect of aerobic exercise on myocardial fibrosis in AS mice.

Methods

From February to August 2022, twenty-seven 8-week-old male ApoE^-/- mice were selected as the experimental subjects and randomly divided into the control group, model group and aerobic exercise group, with 9 mice in each group. The mouse model of AS was prepared, and the mice were trained with exercise. The myocardial tissue was observed by hematoxylin-eosin (HE) and Masson staining. The protein expressions of NOD receptor 3 (NLRP3), interleukin1β (IL-1β) and transforming growth factor β1 (TGF-β1) in myocardial tissue were detected by Western blotting. The expressions of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were detected.

Results

Masson staining results showed that myocardial fibrosis in the model group was significantly worse than that in the control group. Myocardial fibrosis in the aerobic exercise group was significantly improved compared with the model group. HE staining showed that myocardial cells in the model group were disorganized, with abnormal cell morphology and size, enlarged cell gaps and inflammatory cell infiltration. Cardiomyocytes of mice in the aerobic exercise group were still neatly arranged, with abnormal cell morphology and size, and the cell gap was basically normal. The expressions of NLRP3, IL-1β and TGF-β1 in the model group were higher than those in the control group, while the expressions of NLRP3, IL-1β and TGF-β1 in the aerobic exercise group were lower than those in the model group, and higher than the control group (P<0.05). The expressions of SOD and GSH-Px in the model group were lower than those in the control group, and the expressions of SOD and GSH-Px in the aerobic exercise group were higher than those in the model group, and lower than those in the control group (P<0.05) .

Conclusion

Aerobic exercise significantly improved myocardial fibrosis in ApoE^-/- AS mice, and the mechanism may be related to inhibiting myocardial inflammatory response and activating antioxidant levels.

Practice and Reflection on Diabetes Community Management Model from the Perspective of Value Co-creation

NIU Luyao, YING Xinyu, ZHANG Shuqin, AN Zhixin, JI Jingya, LIU Yuehua, GAO Yuexia

2024, 27(05):  563-569.  DOI: 10.12114/j.issn.1007-9572.2023.0513

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China is one of the countries with the fastest growing prevalence of diabetes in the world, and also has the largest number of people with diabetes. The "Health China 2030" plan clearly proposes to further prevent and control major diseases, implement diabetes prevention and control, and guide patients with diabetes to strengthen health management and delay or prevent the development of diabetes. In the past 20 years, value co-creation theory has been well developed in the field of health services, and different countries (regions) have explored programs to prevent and control diabetes at low cost and high effectiveness, but it is currently lacking in the field of chronic disease management in China. Based on the perspective of value co-creation, this paper further summarizes the domestic and international experience of chronic disease management taking community as the research and analysis point, proposes the prospect from four aspects of active health, organizational guidance, digital technology, and incentive assessment, which provides references for optimizing and improving the service system of diabetes management at primary health care, establishing a model of collaborative participation of multiple subjects in community chronic disease management based on value co-creation, and realizing co-creation, co-management and sharing of chronic disease management.

A Study of Root Causes and Countermeasures for Clinical Inertia in Type 2 Diabetes Patients in Community Based on Healthcare Failure Mode and Effect Analysis Framework

LI Dianjiang, PAN Enchun, WANG Miaomiao, SUN Zhongming, WEN Jinbo, FAN Hong, SHEN Chong

2024, 27(05):  570-576.  DOI: 10.12114/j.issn.1007-9572.2023.0369

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Background

Since 2009, community health management for type 2 diabetes mellitus (T2DM) has been significantly promoted and implemented as a national public health service program. However, the impact of clinical inertia, defined as failure to take timely interventions when therapeutic goals are unmet, hinders the achievement of long-term optimal glycemic control in T2DM patients. Therefore, addressing clinical inertia to improve glycemic control rates is an important and urgent task for optimizing diabetes health management.

Objective

To identify the key failure modes of clinical inertia in community health management for T2DM, systematically analyze the underlying causes of these failure modes, and propose corresponding intervention measures.

Methods

Based on community realities and guided by the Healthcare Failure Mode and Effect Analysis (HFMEA) framework, a foundational comprehension of community health management processes for T2DM, the root causes of clinical inertia, and prospective intervention measures were obtained through field research, interviews, and literature review from 2020-01-01 to 2023-06-30. The Delphi method was employed based on this basis to engage 16 experts in two rounds of expert consultation during 2022-01-10—02-25, to delineate the key failure modes, their root causes, and intervention measures concerning clinical inertia in community health management for T2DM.

Results

The expert authority coefficients for the first and second rounds were 0.791 and 0.729, respectively, ten key failure modes of clinical inertia in community health management for T2DM were quantitatively identified by calculating the risk priority number (RPN) metric and ranked in descending RPN value as follows: untimely insulin treatment, untimely alcohol cessation, untimely routine referral, untimely smoking cessation, untimely emergency referral, untimely triple therapy, untimely weight control, untimely dietary modification, untimely dichotomous therapy, and untimely detection of hypoglycemia. The root causes of these key failure modes were explored from the perspectives of patients, physicians, and the healthcare system, enabling the formulation of targeted intervention measures.

Conclusion

The devised intervention measures to address clinical inertia exhibit substantial scientific validity and authority, providing a robust foundation for enhancing the community health management model for T2DM.

Effect of Exercise Interventions Based on Community Health Workers' Management on Type 2 Diabetes Mellitus: a Meta-analysis

DONG Chenyang, LI Ran, LIU Ruoya, HUANG Zhiyang, YANG Yang

2024, 27(05):  577-588.  DOI: 10.12114/j.issn.1007-9572.2023.0550

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Background

Patients with type 2 diabetes usually lack sufficient awareness of safe exercise and have poor exercise compliance, which requires the management of exercise interventions by professionals to improve the health status of patients with type 2 diabetes. A strategy worth considering is the management of exercise interventions for patients by community health workers. Currently, there is a lack of research on the management of exercise interventions, and studies on the health management of patients with type 2 diabetes usually only mention exercise without specific exercise management measures. Additionally, there is a lack of quantitative systematic reviews.

Objective

To systematically review the health effects of exercise interventions based on community health workers' management for patients with type 2 diabetes and specific exercise intervention programs.

Methods

Eight Chinese and English databases, including PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang Data, VIP and CBM were searched by computer from inception to October 17, 2022, to screen randomized controlled trials on the effects of exercise interventions based on community health workers' management for patients with type 2 diabetes, in which the intervention group adopted an exercise intervention program based on community health workers' management and the control group adopted conventional care. Literature screening, quality assessment, and data extraction were performed independently by 2 investigators. Meta-analysis was performed using RevMan 5.4 and Stata 15.1 software. Sensitivity and subgroup analyses were carried out to find sources of heterogeneity. Pre-identified subgroups were intervention duration (3 months; 6 months; >6 months), frequency of exercise (3 times/week; >3 times/week), and duration of the single exercise session (≤30 min/session; >30 min/session) .

Results

A total of 1 079 subjects from 11 articles were finally included in this review, of which 550 were in the intervention group and 529 in the control group. The results of the Meta-analysis revealed that the exercise interventions based on community health workers' management were more effective than the control groups in reducing glycated hemoglobin (MD=-1.07, 95%CI=-1.31 to -0.83, P<0.000 01), fasting blood glucose (MD=-1.26, 95%CI=-1.57 to -0.96, P<0.000 01), 2-hour plasma glucose (MD=-1.47, 95%CI=-1.90 to -1.04, P<0.000 01), total cholesterol (MD=-1.02, 95%CI=-1.52 to -0.51, P<0.000 1), low-density lipoprotein (MD=-0.62, 95%CI=-0.87 to -0.37, and P<0.000 01) and triglyceride levels (MD=-0.71, 95%CI=-1.13 to -0.28, P=0.001), whereas there was no significant difference in the improvement of high-density lipoprotein (MD=0.09, 95%CI=-0.02 to 0.21, P=0.11). Subgroup analysis showed more significant improvements in total cholesterol with exercise frequency of more than three times/week compared with three times/week (P=0.02) ; improvement in 2-hour plasma glucose was more significant with >30 min/session compared with ≤30 min/session (P=0.001) ; single exercise session of three months duration showed more significant improvements in glycated hemoglobin (P<0.000 01) and triglycerides (P=0.008) compared with duration of six months and longer. Egger's test indicated that glycated hemoglobin (P=0.34), and fasting blood glucose (P=0.281) did not show any significant publication bias. The quality of evidence evaluation demonstrated that glycated hemoglobin and fasting blood glucose were low-level evidence, and 2-hour plasma glucose and lipid-related outcomes were very low-level evidence.

Conclusion

Exercise interventions based on community health workers' management could significantly improve blood glucose and lipid levels in patients with type 2 diabetes. Community health workers are recommended to develop an exercise program based on aerobic exercise intervention of >30 min/session, >3 sessions/week, and duration of ≥3 months in future exercise intervention management for type 2 diabetes. If the patients with type 2 diabetes mellitus have concurrent dyslipidemia, it is recommended that the duration of the exercise intervention should ideally last for more than 6 months.

Analysis of the Factors Impacting the Awareness and Utilization of Traditional Chinese Medicine Guidelines for Diabetes among Primary Care Practitioners

JIA Liyan, ZHAO Nengjiang, YAN Bing, ZHANG Zhihai, ZHAN Na, LIN Yuanbing, LIU Jianping, YANG Shuyu

2024, 27(05):  589-596.  DOI: 10.12114/j.issn.1007-9572.2023.0361

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Background

Primary care physicians (PCPs), who play a crucial role in providing primary healthcare services, utilize clinical practice guidelines as valuable tools for guiding their practice. By investigating these physicians' awareness and usage of guidelines, we can offer innovative strategies for promoting guideline adherence and enhancing physicians' training. This, in turn, can ultimately improve the quality of primary healthcare.

Objective

To explore the level of awareness and the current status of reference use of traditional Chinese medicine (TCM) guidelines for diabetes among PCPs, and to identify the influencing factors.

Methods

From September 22 to October 29, 2021, an online questionnaire survey was conducted among physicians affiliated with the Specialist Committee for Primary Diabetes Care of China Association of Chinese Medicine, using the snowball sampling method to ensure a broader representation of physicians. The questionnaire consists of three parts: basic information, current status and needs of physicians in using TCM for diabetes prevention and treatment, and a survey on physicians' current awareness and needs regarding diabetes guidelines. Ordered multiclass Logistic regression analysis was used to identify the influencing factors of PCPs' awareness and usage of TCM guidelines for diabetes.

Results

A total of 382 questionnaires were collected from PCPs, 35.34% (135/382) of the physicians were very familiar or fairly familiar with TCM guidelines for diabetes, while 28.80% (110/382) of the physicians referred to these guidelines regularly for diabetes management. The results of the univariate analysis showed that, PCPs with differences in gender, specialty, department, number of diabetic patients treated per week, evaluation of TCM treatment efficacy, availability of TCM herbs and Chinese patent drugs in physicians' institutions, and physicians' awareness of guidelines, showed statistically significant differences in their reference status of TCM guidelines for diabetes (P<0.05). The results of the ordered multinomial Logistic regression analysis showed that, the factors influencing PCPs' awareness of TCM guidelines for diabetes included PCPs' evaluation of TCM treatment efficacy (OR=5.783, 95%CI=1.283-26.102), availability of TCM herbs and Chinese patent drugs in physicians' institutions (OR=2.399, 95%CI=1.548-3.717), and their previous participation in specialized training on diabetes prevention and control guidelines (OR=1.751, 95%CI=1.149-2.667). The factors influencing PCPs' reference to TCM guidelines for diabetes included the physicians' level of familiarity with the guidelines [very or fairly familiar (OR=15.721, 95%CI=7.584-32.557), somewhat familiar (OR=5.392, 95%CI=2.841-10.237) ], work experience less than 5 years (OR=14.083, 95%CI=1.390-142.594), different specialties [TCM (OR=6.869, 95%CI=1.483-31.849), integrated Chinese and western medicine (OR=6.613, 95%CI=1.551-28.219) ], and geographical regions [northeast (OR=2.962, 95%CI=1.064-8.240), southeast (OR=2.686, 95%CI=1.004-7.178) ].

Conclusion

The awareness and reference usage of TCM guidelines for diabetes among PCPs need to be improved. Factors such as guideline awareness, work experience, professional orientation, and geographical region play a significant role in influencing physicians' utilization of the guidelines. In the future, training for PCPs should be strengthened, particularly focusing on the northwest and southwest regions, and PCPs with a background in TCM should receive more training on TCM-related guidelines for diabetes prevention and treatment.

Management Standards of Polypharmacy in Type 2 Diabetes Combined with Atherosclerotic Cardiovascular Diseases in the Elderly

ZENG Senxiang, YANG Rui, DENG Xun, YANG Ruitao, YANG Xiaoyan

2024, 27(05):  597-603.  DOI: 10.12114/j.issn.1007-9572.2023.0665

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Type 2 diabetes mellitus (T2DM) is one of the common chronic diseases among the elderly. Persistent hyperglycemia damages blood vessels throughout the body, affecting organs and tissues such as heart, kidneys, eyes, and nerves, leading to various complications. Atherosclerotic cardiovascular diseases (ASCVD) are the main cause of death in T2DM patients. Such patients need comprehensive treatment such as glucose-lowering, lipid-regulation, antihypertensive, antiplatelet, and urinary protein-lowering treatments. Polypharmacy plays a good role in disease control in older adults with multiple comorbidities, but it also poses a number of problems such as potential drug interactions and adverse drug reactions if applied in an irrational and unscientific manner. This paper analyses the management of polypharmacy in elderly T2DM patients combined with ASCVD, with a particular emphasis on the interactions among hypoglycemic, antihypertensive, lipid-regulating, and antiplatelet medications, as well as precautions, so as to improve the rationality, safety and standardization of medication under the premise of ensuring the efficacy of medication, reduce the occurrence of adverse reactions and provide reference for clinicians in the use of drugs.

Preliminary Development of Self-assessment Scale for the Ability of Outpatients with Chronic Diseases to Participate in Medication Safety Based on the Delphi Method

FENG Zhengwen, CHEN Xiaolei, LI Hui, ZHU Chenli, SHAO Shuang, DU Juan

2024, 27(05):  604-611.  DOI: 10.12114/j.issn.1007-9572.2023.0283

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Background

Patient medication safety has become a global priority in healthcare, and patients play an important role in promoting their own medication safety.

Objective

To develop a Self-assessment Scale for the Ability of Outpatients with Chronic Diseases to Participate in Medication Safety based on the Delphi method and provide objective criteria for assessing and promoting their abilities to participate in medication safety.

Methods

A literature review and semi-structured interviews were used to formulate the initial entries of scale for the ability of outpatients with chronic diseases to participate in medication safety. According to the study objectives, 28 experts from Beijing, Shanghai, Guangdong, Tianjin, Zhejiang, and Inner Mongolia participated in two rounds of correspondence using the Delphi method, and were asked to rate their familiarity and judgement basis of the dimensions, and the importance and feasibility of the items were rated using a five-point Likert scale. The first round of expert correspondence was conducted from 30 September to 12 October 2021, and the second round was conducted from 5 to 15 November 2021. Final items of the scale were determined through an expert panel discussion. The questionnaire recovery rate was calculated as a reflection of expert motivation; the degree of authority of the correspondence results was measured using the authority coefficient; the degree of coordination of expert opinions was evaluated using the coefficient of variation and the coordination coefficient Kendall's W. The arithmetic mean of importance and feasibility scores≥3.5 and coefficient of variation<0.25 were used as the initial reference for items selection, the adjustments of the items were decided after the thorough discussions among the members of research team and the expert panel combining with the opinions of experts.

Results

In both rounds of correspondence, 28 questionnaires were sent out and 28 questionnaires were returned, with a positive coefficient of 100% and the expert authority coefficient of 0.877. The expert coordination coefficient Kendall's W of the importance and the feasibility of items in the second round of correspondence increased compared to the first round of correspondence. The mean importance scores of items in the two rounds of the consultation ranged from 3.964 to 4.964 and 4.321 to 5.000, with coefficients of variation from 0.038 to 0.211 and 0 to 0.168. The mean feasibility scores of the items in the two rounds of the consultation ranged from 3.964 to 4.821 and 4.036 to 4.893, with coefficients of variation from 0.081 to 0.265 and 0.064 to 0.186, respectively. The final Self-assessment Scale for the Ability of Outpatients with Chronic Diseases to Participate in Medication Safety was determined after two rounds of expert correspondence and an expert panel discussion, including 4 dimensions of medication knowledge, medication belief, participation in medication decision-making, and medication self-management, with 33 items.

Conclusion

A Self-assessment Scale for the Ability of Outpatients with Chronic Diseases to Participate in Medication Safety containing four dimensions of medication knowledge, medication belief, participation in medication decision-making, and medication self-management, with 33 items, was constructed in the study, which can assess the ability of outpatients with chronic diseases to participate in medication safety and provide a reference for developing appropriate measures to promote patient participation in the medication process and improve medication safety.

Translation of the Patient-reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life and Its Validation in Elderly Patients with Polypharmacy

XU Huijing, WU Shanyu, JIANG Jiawei, WU Yuanhong, WANG Xiaohui, GAO Ge, WANG Zhe, WANG Yuyu

2024, 27(05):  612-621.  DOI: 10.12114/j.issn.1007-9572.2023.0281

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Background

There is a high prevalence of polypharmacy among elderly patients with severe situation. There is an urgent need for more comprehensive and objective tools to assess the benefits and risks of medication use in patients to ensure maximum length of life and quality of life for patients.

Objective

To translate the Patient-reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) Scale into Chinese and evaluate its reliability and validity among elderly patients with polypharmacy.

Methods

With the authorization of the original author, Brislin's translation model of forward-back translation, cultural adaptation, and cognitive interviews were used to develop a test draft of the Chinese version of the PROMPT-QoL. Elderly patients with polypharmacy who visited outpatient clinics, received health checkups and took medicine at community health centers of Gongyuan street, Beishan street and Henan street, Yanji Hospital and Yanbian University Hospital from June to August in 2022 were selected as the survey respondents. Item analysis was conducted using the item-dimension correlation analysis and the critical ratio (CR). The content validity of the scale was evaluated using the item-level content validity index (I-CVI), universal agreement scale-level CVI (S-CVI/UA) and average scale-level CVI (S-CVI/AVE). Structural validity was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency tests (Cronbach's alpha coefficient) and the split-half coefficient were used to assess reliability.

Results

A total of 590 patients were investigated and 564 valid data were recovered, with a recovery rate of 95.8%. Among them, 234 data were applied to the item analysis and EFA in the first stage, and 330 data were applied to the CFA in the second stage. The correlation coefficients between the scores of each item and the scores of each dimension ranged from 0.504~0.915 (P<0.01), and the CR value of each item was >3.0 (P<0.05). The I-CVI ranged from 0.89 to 1.00, the S-CVI/UA was 0.91>0.80, and the S-CVI/Ave was 0.99>0.90. A total of 8 common factors were extracted from EFA, which were basically consistent with the results of the source questionnaire, among which item G34 had a loading of <0.40 on the common factor to which it belonged, so this item was deleted. CFA was performed on the remaining 41 items as follows: χ²/df=2.160, goodness of fit index (GFI) =0.791, normed fit index (NFI) =0.848, incremental fit index (IFI) =0.912, comparative fit idex (CFI) =0.911, Tucker-Lewis index (TLI) =0.902, root mean square error of approximation (RMSEA) =0.059. In the reliability test, Cronbach's α coefficient for the scale was 0.839, Cronbach's α coefficient for each dimension ranged from 0.823 to 0.955, and the split-half coefficient of each dimension ranged from 0.815 to 0.957.

Conclusion

The Chinese version of the PROMPT-QoL scale has good reliability and validity, and can be applied to evaluate the pharmaceutical therapy-related quality of life of elderly patients with polypharmacy in China.

Sleep Time and Risk of Senile Dementia: a Dose-response Meta-analysis

LIU Peipei, ZHAO Zhenxue, ZHAO Chunshan

2024, 27(05):  622-627.  DOI: 10.12114/j.issn.1007-9572.2023.0500

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Background

With the accelerated aging of the national population, the rapid increase of the elderly with dementia has become an increasingly prominent problem. Sleep is the basic need of the human body, and sleep problems have become an independent risk factor for the cognitive function of the elderly. Moderate sleep duration is essential for the removal of brain wastes, synaptic plasticity, and the maintenance of normal function of the nervous system. However, the current sleep problems of the elderly have not attracted widespread attention, and the sleep time of the elderly needs to be further studied.

Objective

To explore the dose-response relationship between sleep duration and risk of senile dementia.

Methods

CNKI, Wanfang Data, VIP, CBM, PubMed, Cochrane Library, Embase and Web of Science databases were searched for prospective cohort studies on the relationship between sleep duration and risk of senile dementia from inception to June 2023. Literature data were independently extracted by two researchers, and literature quality evaluation was performed. Dose-response Meta-analysis was performed by applying restricted cubic spline regression model in Stata 16.0 software.

Results

A total of 9 papers with 58 342 study subjects and 9 887 exposures were included. Meta-analysis showed that sleep duration was associated with the risk of senile dementia (RR=1.32, 95%CI=1.17-1.48, P<0.05). The results of the subgroup analysis showed that the risk of senile dementia was increased by 19.2% in those with ≤6 h/d of sleep (RR=1.19, 95%CI=1.07-1.33, P<0.05) ; sleeping duration≥8 h/d increased the risk of senile dementia by 55.02% (RR=1.55, 95%CI=1.32-1.82, P<0.05). Dose-response meta-analysis results showed a U-shaped nonlinear relationship between sleep duration and risk of senile dementia (P<0.001). Compared with the reference sleep duration of 7 h/d, the risk of morbidity at each time point was as follows 5 h/d: RR=1.024, 95%CI=0.928-1.130; 5.5 h/d: RR=1.036, 95%CI=0.938-1.143; 6 h/d: RR=1.034, 95%CI=0.952-1.124; 6.5 h/d: RR=1.015, 95%CI=0.973-1.059; 7.5 h/d: RR=1.014, 95%CI=0.993-1.035; 8 h/d: RR=1.056, 95%CI=1.023-1.091; 8.5 h/d: RR=1.124, 95%CI=1.062-1.190; 9 h/d: RR=1.212, 95%CI=1.098-1.338; 9.5 h/d: RR=1.316, 95%CI=1.133-1.528; 10 h/d: RR=1.431, 95%CI=1.169-1.752.

Conclusion

There is a U-shaped nonlinear dose-response relationship between sleep duration and the risk of senile dementia, and the daily sleep duration ≥8 h will increase the risk of senile dementia.

Efficacy and Safety of Manipulative Therapy for Frozen Shoulder: a Meta-analysis

FANG Yide, HU Hao, XU Jinhai, DING Xing, MA Qingshan, ZHANG Yayun, WANG Yanni, MO Wen

2024, 27(05):  628-636.  DOI: 10.12114/j.issn.1007-9572.2023.0357

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Background

In recent years, there have been many randomized controlled trials (RCTs) featuring manipulation for frozen shoulder, but there is a lack of new systematic reviews on the efficacy and safety of manipulation for frozen shoulder.

Objective

To evaluate the efficacy and safety of manipulation in the treatment of frozen shoulder by Meta-analysis, and understand whether "rotation shoulder joint" could affect the effect of manipulative therapy by subgroup.

Methods

PubMed, Cochrane Library, Embase, Medline, CNKI, China Biomedical Literature Database, Wanfang Data were searched for RCTs on the efficacy and safety of manipulative therapy for frozen shoulder, with manipulative therapy as the intervention of experimental group and non-pharmacological therapy as the intervention of control group from inception to 2023-03-01. Two investigators extracted data and evaluated the quality. Meta-analysis was performed using Revman 5.3 software.

Results

A total of 12 RCTs were included in this Meta-analysis, with a total of 893 patients with frozen shoulder, including 451 patients in the experimental group and 442 cases in the control group. Results of Meta-analysis showed that the improvement of VAS by manipulative therapy was better than physical therapy, acupuncture therapy and conventional therapy (SMD=1.09, 95%CI=0.81-1.37, P<0.000 01; SMD=1.05, 95%CI=0.31-1.79, P=0.006; SMD=0.96, 95%CI=0.67-1.26, P<0.000 01) ; subgroup analysis of manipulative therapy compared with physical therapy showed a significant difference in effect between those with and without "rotation shoulder joint" (Z=4.39, P=0.04). The improvement of Constant-Murley score in manipulative therapy was better than that in physical therapy (MD=2.79, 95%CI=2.27-3.32, Z=10.41, P<0.000 1). The improvements of passive flexion (SMD=1.40, 95%CI=0.10-2.70, P=0.03), passive abduction (SMD=1.45, 95%CI =0.18-2.71, P=0.02) and passive external rotation (SMD=1.77, 95%CI=0.18-3.36, P=0.03) by manipulative therapy were better than those in the physical therapy group; subgroup analysis showed a significant difference between the effects of the manipulative therapy with and without "rotation shoulder joint" in improving passive flexion and passive abduction (Z=7.34, P=0.007; Z=2.25, P=0.03). The overall effective rate of manipulative therapy was higher than that of physical therapy (RR=1.16, 95%CI=1.02-1.32, P=0.03) ; there was no statistically significant difference in the overall effective rate between the manipulative therapy and acupuncture therapy (RR=1.24, 95%CI=1.00-1.54, P=0.05). The cure rate of manipulative therapy was better than that of physical therapy group (RR=3.71, 95%CI=1.29-10.67, P=0.01) and acupuncture group (RR=1.79, 95%CI=1.09-2.94, P=0.02). Egger's test and Begger's test suggested no significant publication bias (P=0.66, 0.66). Cases of fractures and other traumas caused by manipulative therapy were not reported in the included studies.

Conclusion

The existing literature evidence shows that manipulation can effectively reduce the pain and shoulder joint dysfunction in patients with frozen shoulder, improve the mobility of shoulder joint, overall effective rate and the cure rate of patients, the manipulative therapy with "rotation shoulder joint" can further improve the efficacy in terms of VAS improvement, passive flexion and passive abduction, the overall safety of manipulative therapy is relatively high, but more large samples and high-quality RCTs are still needed to further confirm the results.