Table of Content

05 July 2024, Volume 27 Issue 19

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Commentary

How to Build a Quality, Efficient and Integrated Health System

LIANG Wannian

2024, 27(19):  2301-2304.  DOI: 10.12114/j.issn.1007-9572.2024.A0015

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Building a high-quality and efficient people centered integrated care system with Chinese characteristics crucial for implementing the Healthy China strategy and essential for the high-quality development of the healthcare system. This article proposes that a people centered integrated care system should center on health, with efficient triage of urgent and non-urgent cases, linkage between different healthcare levels, and a synergy of prevention and treatment. The development of medical services requires collaboration between public medical and health institutions and societal forces. To construct such a system, transformation is necessary in seven key areas: service system, service concept, individual service decision-making, doctor-patient relationship, service mode, payment mechanism, and regulatory assessment. The key is to promote the strengthening, extension, and integration of the healthcare system and public health service system. This article highlights the importance of management system reform and the full use of information technology, stating that the core aim of building a peo-ple centered integrated care system is to meet the comprehensive health needs of the population, establish a rational and orderly medical framework, and ultimately support the creation of a robust health system in China.

Chinese General Practice/Community Health Service Research

Relationship between Effort-reward Imbalance and Job Burnout among Primary Healthcare Workers

GUAN Yan, LIN Zehua, LUO Zhenni

2024, 27(19):  2305-2311.  DOI: 10.12114/j.issn.1007-9572.2023.0251

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Background

Currently, primary healthcare staff are under high pressure and prone to effort-reward imbalance and burnout, which hinders the development of primary health services and has not been sufficiently emphasized.

Objective

To study the situation of effort-reward imbalance and burnout among primary healthcare workers, and explore the relationship between the two, so as to provide reference for improving burnout among primary healthcare workers.

Methods

Primary healthcare workers from primary healthcare institutions (including community health service institutions and township health centers) in 4 streets and 28 townships in Dongguan City, Guangdong Province, were selected for the survey from March to May 2022 using the convenience sampling method. The questionnaire included general information, the Maslach Burnout Inventory-General Survey (MBI-GS) and the Effort-Reward Imbalance (ERI) . With MBI-GS score as the dependent variable, the effort-reward ratio and degree of overload in the effort-reward imbalance model as the independent variables, stratified regression analysis was used to explore the effects of the effort-reward imbalance model on burnout.

Results

A total of 347 primary healthcare workers were included, the total score of MBI-GS for primary healthcare workers was (3.72±1.25) . Of the 347 primary healthcare workers, 93.4% were burnout, 76.7% were in effort-reward imbalance, and 35.2% were under a heavy workload. The total MBI-GS score of primary healthcare workers in effort-reward imbalance was higher than those in effort-reward balance (t=-5.20, P<0.001) ; the total MBI-GS score of primary healthcare workers under heavy workload was higher than those under normal or low workload (t=8.08, P<0.001) . The results of multivariate regression analysis showed positive predictive effects of effort-reward imbalance and heavy workload on burnout (b=0.414, 0.109, P<0.05) .

Conclusion

The condition of effort-reward imbalance is serious and job burnout is common among primary healthcare workers. The effort-reward imbalance model positively predicts burnout, it is recommended to reduce the workload of primary healthcare workers, improve their work reward and emphasize their psychological health.

Qualitative Research on Factors Influencing the Implementation of Integrated Health Services in Community Medical Institutions from the Perspective of Practitioners

LIU Xiangya, WANG Shiqiang, TANG Min, LI Dan, XIE Zijing, LIU Yao, GAO Mingzhu

2024, 27(19):  2312-2318.  DOI: 10.12114/j.issn.1007-9572.2023.0453

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Background

Physical and medical integration is essential for promoting the health of community residents and is an important guarantee for the high-quality development of community medical services, and practitioners are the foothold and focus of physical medicine integration services. However, there is currently a lack of relevant research on the impact of community medical institutions in carrying out physical medicine integration services from the perspective of practitioners.

Objective

To study the understanding and views of practitioners on how to carry out the integrated service of physical medicine in the community to provide ideas and references for the community to better carry out the integrated service of physical medicine.

Methods

In March and April 2023, 11 practitioners from 5 community health service centers in Zhuzhou city, Hunan Province, were selected as survey subjects by means of an objective sampling method. The descriptive research method was adopted to conduct "one-on-one" semistructured in-depth interviews with community practitioners. With the help of the content analysis software Nvivo 12.0, text transcription recording, analysis unit formation, content coding and theme extraction were carried out for the interview content. Finally, the interview data were logically analyzed using descriptive phenomenological analysis to capture GPs' understanding and perceptions of the influences on the development of body-health integration services in the community, and to summarize the themes of the interviews.

Results

The factors affecting the development of physical and medical integration services in communities can be summarized into 4 themes and 10 subthemes. There was an urgent need to optimize the service environment for the integration of physical medicine (insufficient site supply, lagging atmosphere, and insufficient publicity) , improve the ability of practitioners (insufficient cognitive ability for the integration of physical medicine and the ability to issue sports prescriptions) , lack of support in community hospitals (lack of training activities related to the integration of physical medicine, insufficient fund allocation and shortage of human resources) , and lack of patient cognition of the integration of physical and medicine (patients have poor cognition of the efficacy of body-medicine integration, and patients have poor cognition of the risk of body-medicine integration) .

Conclusion

There are still many shortcomings in the service ability of community practitioners. To promote better development of community integrated services, it is urgent to optimize the service environment of community integrated services, to improve practitioners' integrative cognition ability and exercise prescription ability, to strengthen the support and guarantee of community health service institutions, and to improve patients' awareness of the efficacy and risk of physical and medical integration services.

Study on the Status of Consultations in General Medicine Departments in Tertiary Care Hospitals

ZHAO Zezhou, WANG Jieping, DU Xueping, WU Wei, YAN Wei, LI Qian, GUAN Yajie

2024, 27(19):  2319-2323.  DOI: 10.12114/j.issn.1007-9572.2023.0423

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Background

The diagnosis and treatment of general practice often involve multi-system and multi-organ diseases, resulting in a large number of consultations. However, there is limited research on the current state of general practice consultation.

Objective

This study aims to collect relevant data on general practice consultation at Fuxing Hospital Affiliated with Capital Medical University, a tertiary general hospital and analyze the current situation of general practice consultation to improve the quality of general practice consultation at Fuxing Hospital and provide insights for hierarchical diagnosis and treatment.

Methods

The data of general practice consultation in Fuxing Hospital Affiliated to Capital Medical University from 2021 to 2022 were obtained through the hospital information system, and the basic information, consultation departments, consultation reasons, consultation diagnosis, and consultation opinions were classified and summarized.

Results

From 2021 to 2022, a total of 1 441 inpatients were admitted to the general practice department at Fuxing Hospital. Among them, 908 inpatients had consultation records. A total of 2 269 in-hospital consultations were issued, 966 consultations were executed while 303 were cancelled. Among the executed consultations, there were 987 males and 979 females. The age ranged from 17 to 101 years old, with an average age of (77.4±13.9) years old. A total of 31 clinical departments were involved, among which the top 6 departments with the most consultations were rehabilitation department, otolaryngology, ophthalmology, dermatology, infectious disease department and psychiatry. The most common diagnoses among these departments included dysfunction, sensorineural deafness, cataract , dermatitis, pulmonary infection and anxiety. The reasons for consultation included formulating initial treatment plans, adjusting current treatment plans, improving specialist examinations, assisting with specialized treatment and conducting specialist evaluations. The consultation treatment opinions can be roughly divided into professional evaluation, improving examinations, clarifying diagnosis, drug therapy, clinical operations, surgical treatment, nutritional therapy and rehabilitation acupuncture.

Conclusion

The diagnosis and treatment scope of general medicine includes common diseases and frequently occurring diseases in various systems, with a large demand for consultation. The spectrum of consultation diseases reflects the clinical needs and characteristics of the general medicine department of Fuxing Hospital Affiliated to Capital Medical University. Analyzing the current situation of consultation is conducive to making up for the shortcomings of general medicine, improving the quality of general consultation, and taking the first step towards referral between general medicine and specialists.

Establishment of Assessment System for Medical Quality of General Practice in Chongqing General Hospitals

QIN Yueqi, XIE Bo, ZHANG Yu, FENG Guibo, GONG Fang

2024, 27(19):  2324-2329.  DOI: 10.12114/j.issn.1007-9572.2023.0558

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Background

General practice (GP) plays a key role in carrying out the"Healthy China initiative", but the standardized medical quality evaluation involved remains incompletely established. The establishment of an appropriate quality evaluation indicator system for GP has to be settled urgently.

Objective

To evaluate the medical quality of GP in general hospitals of Chongqing, the medical quality evaluation indicator system for GP is established, and the indicator system would also provide reference for the construction of GP and the research work of Centers for General Medical Quality Control in Chongqing.

Methods

The evaluation indexes were formulated in February-April 2022 using the literature analysis method. Based on Delphi method, the indicator system was revised according to the correspondence consultation from 25 general practice experts of 20 general hospitals (including clinical residential training bases) in Chongqing. The final draft was combined with the suggestions of experts from the Center for Medical Quality Control of GP.

Results

Among the selected experts, men accounted for 64.0%, and 76.0% had middle or senior titles. Two rounds of experts' consultation responses were 21 and 20 copies respectively, and the experts' authoritative coefficient were 84.00% and 95.24%. Corresponding degree of authority above 0.85. After two rounds of experts' consultation and the suggestions of the quality control center, the medical quality evaluation indicator system of general practice for general hospital was finally established including 5 first-class indexes, 10 second-class indexes and 28 third-class indexes.

Conclusion

The evaluation indicator system based on Delphi method is of great significance for standardizing the quality of general practice service in general hospitals, promoting the construction of general practice service in Chongqing and strengthening the supervision of medical quality control center.

A Comparison and Analysis of Chinese and German Practices in General Practitioner Training

JIN Ke, REN Jingjing

2024, 27(19):  2330-2335.  DOI: 10.12114/j.issn.1007-9572.2023.0259

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General practice in China has developed rapidly in recent years with remarkable progress, but the gap with developed countries in Europe and the United States is still large, and the training system of general practitioners still remains impefect. In Germany, the construction of the primary health care system and the training system of general practitioners have been well developed. Under the system of universal health insurance coverage and hierarchical diagnosis and treatment, a high level of health and patient satisfaction with primary healthcare services among residents have been achieved in Germany. Therefore, this study compares post-graduate education and continuing education of general practice in China and Germany, analyzes the challenges of general practice education reform in China, drawing on the conceptual framework of general practice education in Germany, and proposes targeted ideas and recommendations for solutions as follows: for the standardized residency training of general practice, increase the rotation flexibility as appropriate to facilitate the optimization of trainees' individualized competencies, incorporate the standardized curriculum of psychosomatic medicine and Balint group training to improve trainees' competence in psychosomatic medicine, establish standardized selection criteria and promote standardized training program for faculty of community hospital, and revisit the duration of general practice (including community) rotation after improving the qualifications of general practice faculty of community hospital; for the continuing education, incorporate the special interest and small specialties into the general practice continuing education system to strengthen the functional medical characteristics of general practice and promote the professional diversification of general practitioners, and establish a national unified platform for continuing education in general practice. More practical research and resources are needed to improve the training system of general practitioners in China in the future.

Article

External Validation of a 10-year Cardiovascular Risk Assessment Tool Based on an Older Population

GONG Yue, HUANG Yueqing, ZHANG Liang, ZHAO Chunhua, HUANG Min

2024, 27(19):  2336-2343.  DOI: 10.12114/j.issn.1007-9572.2023.0581

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Background

Cardiovascular diseases seriously threaten the health of the elderly in our country and bring a huge economic burden to our country. Accurate screening of risk assessment tools for early cardiovascular diseases can specifically prevent and delay the development of cardiovascular diseases, studies have suggested that commonly used cardiovascular risk scoring tools are not effective in predicting risk in the elderly, but there is a lack of relevant external validation experimental studies, and there is no well-recognized effective risk prediction tool for elderly patients.

Objective

To independently validate and compare the efficacy of five commonly used cardiovascular risk assessment tools in China and abroad in predicting 10-year cardiovascular disease risk in our community elderly population, to explore the cardiovascular disease risk assessment tools suitable for our community elderly population, and to provide theoretical basis and support for the prevention and treatment of cardiovascular disease at the grass-roots level.

Methods

From January 2012 to December 2013, more than 20 000 people in the Liuyuan Community Health Service Centre and Runda Community Health Service Centre in Suzhou Province took part in community medical examinations. According to the inclusion and exclusion criteria, three hundred and forty-four people were identified, data on age, sex, region of residence, systolic blood pressure, diastolic blood pressure, BMI, waist circumference, total cholesterol, high-density lipoprotein cholesterol, triglyceride, atrial fibrillation, Left ventricular hypertrophy, cardiovascular disease, hypertension, diabetes, and smoking were collected from the start-up medical examination system In the follow-up survey of chronic diseases, the current smoking status and smoking age, whether taking antihypertensive drugs, family history of cardiovascular disease, prevalence of hypertension and drug use of hypertension, prevalence of diabetes mellitus, and whether and when cardiovascular disease occurred from January 2014 to December 2022 were improved. The outcome events were stroke and coronary heart disease, and were divided into positive group and negative group, all subjects were assessed with the Framingham Heart Risk Score (FRS-CVD) , the modified Framingham Stroke Scale (R-FSRS) , the European systemic coronary risk assessment scale 2019 (SCORE) , Chinese 10-year ischemic cardiovascular disease risk (ICVD) , and the China-PAR cardiovascular disease risk assessment, concordance Index (C-index) , Hosmer-Lemeshow χ² and calibration chart were used to evaluate the relationship between the results and actual cardiovascular disease incidence.

Results

Of the 344 enrolled investigators, with a mean age of 62 (56, 68) years, as of December 2022, 169 had developed cardiovascular disease and 175 had not. Two groups of people were carried out 5 kinds of cardiovascular disease risk score, cardiovascular disease risk assessment tool forecast and the actual incidence of the comparative analysis results are as follows, discrimination test: C-index of FRS-CVD was 0.711 (95%CI=0.658-0.764) , C-index of R-FSRS was 0.728 (95%CI=0.675-0.781) , SCORE: C-index was 0.724 (95%CI=0.671-0.777) , ICVD: C-index was 0.727 (95%CI=0.674-0.779) , China-PAR: C-index was 0.735 (95%CI=0.682-0.788) ; Hosmer-Lemeshow test calibration status: FRS-CVD: χ² =16.789 (P=0.032) , R-FSRS: χ²=11.019 (P=0.201) , SCORE: χ²=20.396 (P=0.002) , ICVD: χ²=24.311 (P=0.001) , China-PAR: χ²=15.149 (P=0.056) ; R-FSRS is the best calibration. In men, model discrimination: FRS-CVD: C-index was 0.642 (95%CI=0.577-0.707) , R-FSRS: C-index was 0.646 (95%CI=0.581-0.710) , SCORE: C-index was 0.646 (95%CI=0.581-0.711) , ICVD: C-index was 0.628 (95%CI=0.563-0.693) , China-PAR: C-index was 0.636 (95%CI=0.571-0.700) ; Hosmer-Lemeshow test calibration status: FRS-CVD: χ²=7.371 (P=0.288) , R-FSRS: χ²=8.470 (P=0.293) , SCORE: χ²=5.146 (P=0.525) , ICVD: χ²=6.103 (P=0.412) , China-PAR: χ²=9.555 (P=0.298) , SCORE was calibrated best in the calibration diagram. Model discrimination among women: FRS-CVD: C-index was 0.698 (95%CI=0.633-0.762) , R-FSRS: C-index was 0.731 (95%CI=0.666-0.795) , SCORE: C-index was 0.733 (95%CI=0.668-0.798) , ICVD: C-index was 0.747 (95%CI=0.682-0.811) , China-PAR: C-index was 0.754 (95%CI=0.689-0.818) ; Hosmer-Lemeshow test calibration status: FRS-CVD: χ²=14.515 (P=0.069) , R-FSRS: χ²=12.175 (P=0.032) , SCORE: χ²=9.611 (P=0.022) , ICVD: χ²=19.349 (P=0.007) , China-PAR: χ²=12.372 (P=0.135) , China-PAR calibration is the best in calibration chart.

Conclusion

R-FSRS model has a good performance in predicting the risk of cardiovascular disease in the elderly, especially in the elderly population. SCORE model did better in predicting cardiovascular disease risk in older men, while China-PAR model did better in predicting cardiovascular disease risk in older women. Therefore, the application of these assessment tools will help doctors to accurately predict the risk of cardiovascular disease in the elderly, and formulate corresponding prevention and treatment strategies.

The Current Status and Factors Influencing Long-term Proton Pump Inhibitor Use and Deprescribing among Community Residents

JING Guanning, ZOU Ying, ZHUO Xiaoqi, SHI Siyan, SONG Yingliu, YAO Mi, CHI Chunhua, LI Junxia

2024, 27(19):  2344-2351.  DOI: 10.12114/j.issn.1007-9572.2023.0527

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Background

The potential risks of long-term use of proton pump inhibitor (PPI) and the potentially inappropriate medication are gradually being taken into account, and PPI deprescribing has been widely recognised, but the situation of long-term use of PPI and the willingness to deprescribing of PPI among the community residents in our country are not yet clear.

Objective

To understand the current situation of long-term PPI use and PPI deprescribing among community residents, explore its influencing factors and propose improvement measures.

Methods

From April 2018 to January 2020, a survey was conducted among 389 residents of the Shichahai Community Health Service Center in Xicheng District, Beijing, who had been taking proton pump inhibitors (PPIs) chronically. Data on participants' demographics, PPI usage patterns, concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or antiplatelet agents, presence of comorbid chronic diseases, medication quantities, potential for PPI deprescribing, and polypharmacy status were collected via the community electronic health information system and telephone-administered questionnaires. Subsequently, between June and December 2020, telephone interviews were conducted with 92 residents still using PPIs long-term to assess their perceptions regarding prolonged PPI use and attitudes toward deprescribing. Multivariate Logistic regression analysis was employed to identify factors influencing the continuous PPI use exceeding six months among those deemed eligible for deprescribing.

Results

After excluding individuals who declined to participate, could not be reached, or had not taken PPIs continuously, the final study population consisted of 318 residents who were chronically using PPIs. The mean age of long-term PPI residents was (63.9±12.5) years, 61.0% were female, the mean number of types of comorbid chronic diseases was (3.3±1.4) , and the mean number of medications was (6.1±3.3) , and the majority of the residents were able to carry out PPI deprescribing (231, 72.6%) . The prescribing indications for PPIs to prevent nonsteroidal anti-inflammatory drugs (NSAIDs) and antiplatelet drugs for gastrointestinal damage were the most frequent (202, 63.5%) . Multifactorial Logistic regression analysis showed that residents' age and number of medications were influential factors for taking PPIs continuously for >6 months[OR=1.044, 95%CI (1.016-1.073) ; OR=1.175, 95%CI (1.009-1.376) , P<0.05]. Residents who were still taking PPIs chronically between June and December 2020 and were available to carry out deprescribing was available for a total of 92 residents, 82.6% of respondents were aware of the indications for medication use, 70.7% (65/92) of respondents were unaware of the potential risks of long-term PPI use, 71.7% (66/92) were willing to deprescribe PPI with the help of their GP, and the main concern about deprescribing was recurring symptoms.

Conclusion

Long-term PPI residents in community health services are older and predominantly female, with a high proportion of multiple medication use; attention should be paid to the use of PPI medication by residents who are older and use a larger number of medications, and there is a need to strengthen the education on the potential risks of long-term use of PPIs, and long-term PPI users have a positive attitude towards PPI deprescribing, and there is a need to strengthen the management of long-term use of PPIs.

Study of the Effectiveness of General Practice Clinical Pathway for Medically Unexplained Disease Manifested by Low Back Pain

ZHU Xiaodan, LI Yanhua, WANG Jinghua, CHEN Fayu

2024, 27(19):  2352-2356.  DOI: 10.12114/j.issn.1007-9572.2023.0489

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Background

Low back pain is a common cause of consultation for patients in primary care, however, there is a lack of unified diagnostic and treatment guidelines for the management of patients with low back pain in China. This paper initially establishes a general practice clinical pathway based on patients with low back pain through the preliminary research, and verifies its effectiveness through the adjustment of the management program.

Objective

To explore the clinical outcomes of general practice clinical pathway for medically unexplained diseases manifested by low back pain.

Methods

A total of 80 patients with low back pain attending the general practice outpatient clinic of Mishixiang Health Service Center in Gongshu District, Hangzhou City were selected as the study subjects and randomly divided into the control group and experimental group, with 40 cases in each group, by single and double visiting numbers. The experimental group was managed by the general practice clinical pathway for low back pain, and the control group was managed routinely. After six months of intervention, the Roland-Morris dysfunction score, Visual Analogue Pain Scale (VAS) score before and after intervention, and satisfaction of patients were compared between the two groups.

Results

There was no statistically significant difference in Roland-Morris dysfunction score and VAS pain score between the two groups before the intervention (P>0.05) ; Roland-Morris dysfunction score and VAS score of the experimental group were lower than those of the control group after the intervention (P<0.05) . The difference in Roland-Morris dysfunction score difference and VAS score difference before and after intervention between the two groups were statistically significant (P<0.05) . The satisfaction score of the experimental group was higher than that of the control group (P<0.05) .

Conclusion

The management of general practice clinical pathway for low back pain can effectively improve the functional situation of low back pain and enhance patient satisfaction, and provide research ideas for the management of other medically unexplained diseases.

Prevalence and Root Cause Analysis of Adiposity-based Chronic Disease in Older Adults Aged 65 Years and Older

LIAO Yanping, LI Yunyi, ZHOU Zhiheng, WANG Haoxiang

2024, 27(19):  2357-2363.  DOI: 10.12114/j.issn.1007-9572.2023.0712

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Background

The American Association of Clinical Endocrinologists and the American Society of Endocrinology have proposed an adiposity-based chronic disease (ABCD) model for evaluating obesity, and there has been very few studies of ABCD in China, and the efficacy of its application is unclear.

Objective

To understand the prevalence of ABCD and its root cause in the Chinese elderly population aged 65 years and above using ABCD, a new obesity evaluation index.

Methods

Five thousand five hundred and sixty-two elderly people aged 65 years and above who participated in medical checkups at 28 community health centers in Pingshan District, Shenzhen City, Guangdong Province, from January to December 2021 were selected to obtain the basic characteristics of the study subjects through questionnaires, physical examinations, and laboratory tests, and to stage the sample population according to the diagnostic criteria of the ABCD model, and calculate the prevalence rates of ABCD and the individual stage, and multifactorial Logistic regression analysis was used to explore the relationship between ABCD staging and different cardiometabolic risk factor risks.

Results

The prevalence of ABCD in this study was 71.0%, and the prevalence of stage 0, 1, and 2 were 4.8% (267/5 562) , 32.5% (1 808/5 562) , and 33.7% (1 874/5 562) , respectively. The results of multifactorial Logistic regression analysis showed that, using ABCD normal as the reference group, diabetes mellitus, hypertension, high triacylglycerol, low HDL-C, high LDL-C, and cigarette smoking, in addition to high total cholesterol and alcohol consumption, were associated with the stage of ABCD (P<0.05) ; The risk of developing hypertension, high triacylglycerol, low HDL-C, and high LDL-C in ABCD stage 1 was 2.393, 1.515, 1.940, 1.688, and 1.376 times higher than that of the normal population, respectively; The risk of diabetes, hypertension, high triacylglycerol, low HDL-C, and high LDL-C in ABCD stage 2 was 2.918, 4.231, 9.282, 4.128, 2.970, and 1.672 times higher than that of the normal population, respectively. Smoking was a protective factor for ABCD stage 1 and 2, with OR (95%CI) of 0.577 (0.480-0.693) and 0.752 (0.633-0.893) , respectively.

Conclusion

In this study, there were male-female differences in the prevalence of ABCD in the elderly aged 65 years and older, and the prevalence was associated with cardiometabolic risk factors such as hypertension, diabetes, and smoking, and the ABCD model has been well applied in the Chinese elderly population.

Study on the Predictive Value of Different Insulin Resistance Replacement Indices for Hyperuricemia in Middle-aged and Elderly Patients with Type 2 Diabetes

HUANG Shuwei, ZHOU Zhiheng, FENG Tianyuan, LIU Li, DENG Guangpu, LI Yaotian, ZHU Hong

2024, 27(19):  2364-2374.  DOI: 10.12114/j.issn.1007-9572.2023.0472

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Background

In China, there is a significant prevalence of type 2 diabetes patients (T2DM) , who also have an increased risk of developing secondary hyperuricemia (HUA) . Patients with T2DM who develops HUA are at increased risk of developing further problems, which could have detrimental effects on their health. Consequently, it is crucial to promptly identify individuals who have a high risk of developing secondary HUA and to begin early prevention and therapy.

Objective

Exploring the predictive value of common insulin resistance (IR) surrogates for the HUA in middle-aged and elderly T2DM patients. And employ a subset of these metrics as predictive metrics for the occurrence and progression of HUA.

Methods

Using stratified random sampling, 479 individuals with type 2 diabetes mellitus (T2DM) and 1 528 patients with non-hyperuricemia (NHUA) were chosen from seven community health service centers in Shenzhen between January and March 2023. Multivariate Logistic regression analysis was used to evaluate the effects of various insulin resistance (IR) metrics and their quartiles on the incidence of HUA in middle-aged and older type 2 diabetic patients. Triglyceride-high density lipoprotein cholesterol (TG/HDL-C) index, non-high density lipoprotein cholesterol ratio (Non-HDL-C/HDL-C) index, triglyceride glucose (TyG) index, triglyceride glucose body mass (TyG-BMI) index, triglyceride glucose waist circumference (TyG-WC) index, and insulin resistance metabolism (METS-IR) index are some of these metrics. The predictive efficacy of several IR substitution measures for HUA in middle-aged and older T2DM patients was assessed using the ROC curve. The CHARLS database's cohort data from 2011 and 2015 were filtered in order to create a nested case-control that would validate the predictive power of different IR alternative indicators for the likelihood of HUA.

Results

Multivariate Logistic regression study revealed that the METS-IR index, TG/HDL-C index, Non HDL-C/HDL-C index, TyG index, TyG-BMI index, TyG-WC index, and TG/HDL-C index were independent influencing factors for the occurrence of HUA (P<0.05) . The ROC curve indicates that the TyG-WC index, the Non-HDL-C/HDL-C index, and the METS-IR index, with AUCs of 0.811, 0.796, and 0.791, respectively, have good value in predicting the occurrence of HUA. According to the results of the nested case-control study, there was a higher risk of developing HUA at 2.083, 2.152, and 2.263 times, respectively, for high levels of the TyG-WC index, Non-HDL-C/HDL-C index, and METS-IR index compared to low levels (P<0.05) .

Conclusion

TyG index, TyG-BMI index, TyG-WC index, TG/HDL-C ratio index, Non-HDL-C/HDL-C index, and METS-IR index all predicted HUA occurrence, and Non-HDL-C/HDL-C index can be used as tools to predict the occurrence of HUA in middle-aged and elderly patients with T2DM.

Trend and Prediction Analysis of the Changing Disease Burden of Ischemic Heart Disease in China and Worldwide from 1990 to 2019

SU Wei, ZHANG Ying, MA Shuang

2024, 27(19):  2375-2381.  DOI: 10.12114/j.issn.1007-9572.2023.0498

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Background

Ischemic heart disease is recognized as the most common cardiovascular disease with the highest mortality rate worldwide, resulting in an increasing burden of disease on our population. Conducting trend and predictive analysis of the changing burden of disease is an important topic of concern for health care policy.

Objective

To compare and analyze the burden of disease and risk factors of ischemic heart disease in China and globally from 1990 to 2019, to predict the trend of change, and to provide a basis for carrying out the prevention and treatment of ischemic heart disease.

Methods

Based on the Global Burden of Disease Study 2019 (GBD 2019) , the log-linear model in Joinpoint was used to analyze the changing trends of the burden of disease of ischemic heart disease in China and globally from 1990 to 2019, and trend tests were performed to predict the burden of disease of ischemic heart disease in China from 2020 to 2035 with the help of R 4.3.0.

Results

From 1990 to 2019, the standardized incidence rate, standardized mortality rate, and standardized DALY rate of ischemic heart disease in China were lower than the global level, but all of them showed an overall increasing trend, while all of them showed a decreasing trend globally. The high incidence, mortality, and DALY rates of ischemic heart disease in China and globally are mostly in the elderly population, and the overall burden of ischemic heart disease in China is expected to decrease from 2020 to 2035 (AAPC for morbidity, mortality, and DALY rates are -0.400, -1.167, and -1.318, respectively; P<0.001) , with greater decreases in all indicators in men than in women in both China and globally.

Conclusion

The situation of ischemic heart disease prevention and treatment in China is severe, and the disease burden is particularly heavy in the male and elderly populations; the disease burden caused by disability is high; high systolic blood pressure and high-density lipoprotein are important risk factors. In the future, we should pay attention to the increasing trend of disease burden of ischemic heart disease in China, and focus on strengthening preventive interventions in men and the elderly population.

Study on the Spatial Distribution and Influencing Factors of Basic Endowment Insurance for Uban and Rural Residents in China Under the Background of Healthy Aging

CHEN Junli, WANG Lu, REN Jianxue, JING Qi, SHENG Hongqi, GAO Qianqian, CAI Weiqin, MA Anning

2024, 27(19):  2382-2387.  DOI: 10.12114/j.issn.1007-9572.2023.0258

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Background

The "Fourteenth Five-Year Plan for Healthy Aging" proposes to promote the realization of healthy aging, which not only requires the elderly to be healthy, but also pays attention to the security. With the deepening of the aging society, there is a significant gap in the level of participation of the current pension insurance system for urban and rural residents in various provinces. Under this background, it is of great significance to study the endowment insurance system.

Objective

To describ the spatial distribution of the basic old-age insurance participation level of urban and rural residents in 31 provinces in China from 2013 to 2020, to observe the spatial correlation and difference of the participation level among provinces, to analyze the relevant influencing factors, and to provide suggestions for the government and medical and health administrative departments to formulate the old-age insurance policy.

Methods

The data for this study is sourced from the China Statistical Yearbook from 2014 to 2021. The level of participation in urban and rural residential insurance is calculated based on the ratio of the number of urban and rural residents participating in basic pension insurance by region in the public management, social security, and social organization modules to the end of year population in the population clump. The various indicators of influencing factors are all from the 2014-2021 China Statistical Yearbook. Using ArcGIS 10.8 statistical analysis software, the basic pension insurance participation levels of urban and rural residents in 31 provinces were matched with provincial administrative divisions in China. Descriptive research and analysis were conducted on the differences in pension insurance participation levels among 31 provinces. Using methods such as global spatial autocorrelation and Getis Ord Gi * local hotspots, the spatial correlation and hot and cold spots of participation levels were studied, Study the relevant influencing factors by combining geographic detectors.

Results

Overall, from 2013 to 2020, the number and level of urban and rural resident insurance participants in China had been continuously increasing year by year; from a vertical structure perspective, there were significant differences in the level of insurance participation among provinces; from a horizontal perspective, from 2013 to 2020, the growth rate of most provinces was positive. The participation level of basic pension insurance for urban and rural residents in 31 provinces of China from 2013 to 2020 had spatial correlation. The central provinces were hot areas, while Shanghai is a cold area. The influencing factors on the participation rate were economic development factors, social development factors, policy factors, and cultural and educational factors in descending order.

Conclusion

The overall level of participation in basic pension insurance for residents has been increasing year by year, but there are differences in the level of participation and growth rate among provinces. The level of economic development is an important factor affecting the level of participation in basic pension insurance for residents.

How is the Psycho-Cardiology Developing: from Theoretical Research to Disease Diagnosis and Screening

CHEN Shuyan, ZHAO Taihong, XU Jing

2024, 27(19):  2388-2394.  DOI: 10.12114/j.issn.1007-9572.2023.0726

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There is an induced or concurrent relationship between cardiovascular disease and psychological illness, which occurred and developed into Psycho-Cardiology. It is necessary to assist the treatment of cardiovascular disease from the perspective of psychology, the resulting is the Psycho-Cardiology. This article briefly summarized the research status at home and abroad about Psycho-Cardiology. Firstly, analyzing the internal mechanism and external influencing factors to establish theoretical mechanism, and determine the high incidence risk index of the Psycho-Cardiology disease. Baseline information, including age, gender, BMI, diet, smoking, alcohol consumption, physical exercise, social status, family history, comorbidity including hypertension. Hematological indicators, including ion concentration, blood cell, inflammatory factor, hormone. Biochemical indicators, including myocardial enzyme spectrum, blood glucose, blood lipid, uric acid, cysteine. Structural and functional indicators, including resting heart rate (RHR) , heart rate variability (HRV) , left ventricular ejection fraction (LVEF) , left ventricular end diastolic diameter (LVDd) . These factors have a relevance between cardiovascular disease and psychological illness. Then, exploring two diagnosis models of this disease, including a traditional model of multi-axis, multi-grade, and multi-scale diagnosis methods, and a intelligent diagnosis section system based on the risk indexes. From the clinical practice, aiming to help clinicians achieve early psychological screening and accurate diagnosis of Psycho-Cardiology disease patients, and implement effective intervention measures.

Current Status of Research on Fall Risk Perception and Its Implications for Active Fall Prevention in Older Adults

NIE Zuoting, CHEN Long, ZENG Kai, TAO Lu, YANG Rumei

2024, 27(19):  2395-2400.  DOI: 10.12114/j.issn.1007-9572.2022.0890

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Falls are the important causes of morbidity and mortality in older adults. Although clinical staff have paid attention to the management of falls, adherence to fall interventions is not satisfactory, resulting in the high incidence of fall. Understanding the older adults' own perception of fall risk from their perspective may be the key to fall prevention, especially active fall prevention. In this paper, we reviewed the concept of fall risk perception, behavioral consequences and influencing factors of fall risk perception in older adults from the perspective of "the first person responsible for health", and found that there are fewer studies on fall risk perception in older adults at home and abroad, the conceptual connotation still needs to be further explored. Subjective perceptions of fall risk in older adults can lead to different patterns of fall risk coping behaviors that influence fall risk. The influencing factors of fall risk perception mainly focus on the emotional psychology, physiological conditions, social culture, and physical environment, with the influencing process through subjective cognition. Empirical studies can be used to further validate the psychological cognitive mechanisms of fall risk perception in conjunction with the risk perception formation process in the future, in order to provide empirical evidence for proactive fall prevention.

Analysis of the Quality of Diagnosis and Treatment of Helicobacter Pylori Infection in Shanghai Community Health Service Institutions

MA Le, JIN Hua, SHI Ling, YI Chuntao, HOU Jin, CHEN Chen, HUAN Hongmei, NI Hengru, YU Dehua

2024, 27(19):  2401-2408.  DOI: 10.12114/j.issn.1007-9572.2023.0872

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Background

The level and quality of diagnosis and treatment of Helicobacter pylori (Hp) infections in Shanghai's community health service institutions is unclear, and there is a lack of systematic evaluation and monitoring.

Objective

To understand the current status of diagnosis, treatment and management of Hp infection in community health centers in Shanghai, to evaluate the quality of diagnosis and treatment, and to explore the problems and improvement measures.

Methods

A questionnaire was distributed to a total of 249 community health centers in 16 administrative districts of Shanghai and 3 875 general practitioners (GPs) working in the community health centers from May to June 2022 to investigate the standardization of prescriptions for the eradication of Hp infections in the community health centers, the detection of Hp infections, the provision of drugs for the eradication of Hp infections, the management of Hp infections, the difficulties of Hp infections in the treatment of Hp infections, as well as the knowledge of community-based GPs on the diagnosis and treatment of Hp infections.

Results

The result of the prescription eradication program for Hp infection in primary health care facilities in Shanghai was only 32.0 percent correct. The proportion of health service centers with the ability to conduct Hp infection testing in primary healthcare institutions in Shanghai is high, nearly 80.0%. Most of the community health service centers were able to equip the basic medicines needed for the eradication of Hp, but the rate of bismuth equipment was low, 54.6%. The rate of Hp diagnosis and treatment standard supervision was 80.0%. The demand for the training of standardized diagnosis and treatment of Hp infections was high, accounting for 66.7%. The main difficulties in Hp infection diagnosis and treatment were incomplete drug provision, insufficient doctor's diagnosis and treatment ability and insufficient equipment. Community general practitioners do not have enough basic knowledge about the diagnosis and treatment of Hp infection.

Conclusion

The capacity to conduct Hp testing needs to be further strengthened in primary care organizations in Shanghai, especially in remote community health service centers, including the purchase of more Hp-related testing equipment and reagents, and the completion of related medications needed for the eradication of Hp. In addition, it is necessary to further strengthen the standardized diagnosis and treatment training of Hp infection for community health centers, improve the diagnosis and treatment ability of general practitioners on Hp infection, and at the same time, strengthen the supervision of Hp diagnosis and treatment standardization, so as to further improve the diagnosis and treatment ability of community general practitioners on Hp infection.

Article·Breast Cancer Screening Section

Focus Issues Analysis of Breast Cancer Screening in Community Health Service Centers Based on the Mixed Method

LU Xinlin, LIU Xuewei, GAO Bei, WANG Yanbo, LU Wenli

2024, 27(19):  2409-2414.  DOI: 10.12114/j.issn.1007-9572.2023.0196

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Background

Community health service center is the main gatekeeper for breast cancer screening, while its efficacy of screening is difficult to guarantee for the re-striction of screening process by various factors.

Objective

To analyze the focus issue of breast cancer screening program in the real world and explore corresponding solutions.

Methods

A mixed-methods convergent design was used to collect quantitative and quali-tative data. In the quantitative study, typical sampling method was used to select one community health service center in each of the four districts of Tianjin as the investigation institution from April 2021 to November 2022, accidental sampling method was used to select age-eligible women within 3 km of the four institutions as resident survey respondents, so as to explore the issues existing in the on-site operation of breast cancer screening. In the qualitative study, 9 residents, 12 physicians participating in the screening and 4 leaders were selected through purposive sampling from June to November 2022 for semi-structured in-terviews. The grounded theory was used to analyze the interview content, and the grounded theory framework of the focus issues of breast cancer screening was plotted. Combined with literature and typical investigation data, a mixed methods study was conducted to determine the focus issues of breast cancer screening.

Results

The quantitative study showed that in the advocacy work, the promotion method is traditional, the awareness rate and participation rate of residents was 46.3% (143/309) and 32.4% (100/309) , respectively; in the screening work, the institutions invested different human and material resources, and the average waiting time of screening residents accounted for 62.2% (40.5/65.1) of the total time; in the follow-up and referral work, the invested human and material resources were little, the mammography referral compliance of residents was 29.9% (59/197) . The qualitative study showed that a total of 38 comprehensive open codes were formed in the interview and converged into 10 axial codes and 3 core codes, including advocacy organization, screening organization, follow-up and referral. The mixed methods study showed that 3 focus issues were identified in final, including how to improve residents' participation rate, how to ensure adequate human and material resources in screening institutions, and how to improve residents' mammography referral compliance.

Conclusion

The efficacy of breast cancer screening is influenced by advocacy organization, screening organization, follow-up and referral. It is necessary to rationally allocate resources to ensure adequate human and material resources for screening institutions; innovate promotion methods, expand coverage of promotion and improve residents' health literacy, participation rates and mammography referral compliance, to ensure the substantial progress of breast cancer screening and provide reference for opti-mizing the efficacy of breast cancer screening.

Development of a Breast Cancer Screening Capacity Assessment System for Primary Care Institutions

LIU Xuewei, LU Xinlin, ZHONG Xinyuan, RUAN Zhanliang, WANG Yanbo, WANG Yuan, LU Wenli

2024, 27(19):  2415-2420.  DOI: 10.12114/j.issn.1007-9572.2023.0057

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Background

Due to many barriers, it is difficult for primary medical institutions to ensure substantial achievements in breast cancer screening. So it is particularly important to establish a system for scientifically and effectively assessing the capacities of primary care institutions in conducting breast cancer screening.

Objective

To construct a system for assessing the capacities of primary care institutions for conducting breast cancer screening.

Methods

From September to October 2022, through literature review and group discussion, we developed an item pool of the initial version of Breast Cancer Screening Capacity Assessment System for Primary Care Institutions (BCSCASPCI) . Then we conducted an online Delphi survey between November and December 2022 using a self-developed questionnaire with a purposive sample of 21 experts for understanding their views regarding the initial version of BCSCASPCI, and the response coefficient, authority coefficient, and the Kendall's W of the survey were calculated. Finally, based on the results of the survey and a group discussion, the final version of the BCSCASPCI was determined. The Analytic Hierarchy Process was used to determine the weight coefficients of its indicators and to examine the logical consistency of indicators.

Results

All the experts returned effective questionnaires, achieving a response rate of 100.0%, and the authority coefficient was 0.812, and the Kendall's W was 0.209 (P<0.001) . The final version of the BCSCASPCI consists of 3 primary indicators (structure, process, and outcome) , 10 secondary indicators, and 56 tertiary indicators. The weight coefficients of the 3 primary indicators were 0.310 8, 0.195 8 and 0.493 4, respectively. The consistency ratios of indicators at each level were <0.100.

Conclusion

Our BCSCASPCI has proven to be highly authoritative and scientific, and is expected to provide guidance and reference for studies related to breast cancer screening capacity assessment. But the applicability and application effects of the system still needs further verification.

Simulation Analysis of Breast Cancer Screening Coverage Rate Promotion Strategies Based on System Dynamics

WANG Yanbo, ZHOU Jiangtao, WANG Bingyi, LU Wenli

2024, 27(19):  2421-2428.  DOI: 10.12114/j.issn.1007-9572.2023.0836

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Background

The low coverage rate of breast cancer screening has affected the prevention and control effect of breast cancer in China. Factors related to the screening coverage rate include multiple aspects of the screening implementation process.

Objective

Based on the implementation process of breast cancer screening in China, this study aims to simulate the changes in the breast cancer screening coverage rate before and after the implement optimization measures to provide suggestions for optimizing the breast cancer screening coverage rate in China.

Methods

From July to September 2022, we systematically searched the journal literature on female breast cancer screening in four databases, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Data to collate and summarize the relevant influencing factors of women's screening behaviors. Collating and analysing the breast cancer screening pathways and systematic subjects of breast cancer screening in China based on the official documents of the relevant governmental websites on breast cancer screening. Based on China's breast cancer screening pathways, screening subjects and screening behavioral correlates, we constructed the causality diagram of the breast cancer screening coverage and the stock flow diagram of the system dynamics of the breast cancer screening coverage. Simulating the effects of some optimisation strategies for breast cancer screening coverage in China, 2010-2040.

Results

The model simulates previous screening strategies and policy resource environment. Breast cancer screening coverage gradually increased to 40% between 2010 and 2013. From 2013 to 2040, it fluctuates between 40% and 45%, showing a trend of slow decline at first and then a slow rise. Policy intervention scenarios, based on the improved population's screening intention and screening accessibility strategy, respectively simulated five kinds of optimization measures of breast cancer screening coverage rate from 2024. The five measures are as follows: (1) focusing on publicity and education, (2) standardizing the quality of screening services, (3) controlling per-case screening costs, (4) doubling the number of special breast cancer screening slots, (5) standardizing the quality of screening services and controlling per-case screening costs. The measure of focusing on publicity and education will increase rapidly coverage rate during 2024-2030 to 60.38%, then increase slowly to 66.04% during 2031-2040. The screening coverage rate will rapidly increase to 60.27% before 2029, after standardizing the quality of screening services. Then it will slowly increase to 66.04% from 2030 to 2040. After controlling per-case screening costs, the screening coverage rate will increase from 46.95% to 54.17% in 2024-2026. Then the screening coverage rate up to 58.95% in 2027-2040. Compared with no optimization measures during 2024-2040, doubling the number of special breast cancer screening slots will only increase the screening coverage rate by 1%-2%. The screening coverage rate in 2024-2040 increased from 46.95% to 86.79%, after standardizing the quality of screening services and controlling per-case screening costs.

Conclusion

Breast cancer screening coverage is projected to fluctuate from 41.7% to 46.0% in China from 2024 to 2040. Improving screening intention or accessibility can improve screening coverage, but the two optimization measures have their own upper limits. Meanwhile, in the Chinese population, the optimization measures to improve screening intention are better than the optimization measures to improve screening accessibility. Combined optimization measures to improve population's screening intention and screening accessibility can break through the upper limit of their respective promotion and have a better effect on improving screening coverage.