Table of Content

05 October 2024, Volume 27 Issue 28

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Special Article

Technological Innovations to Address Health Challenges

LIU Jue, LIANG Wannian

2024, 27(28):  0-C4.  DOI: 10.12114/j.issn.1007-9572.2024.0210

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The accelerations of globalization, climate change, and population aging gradually increase the complex challenges to human health. Globalization-induced global health issues significantly increase the speed and range of infectious disease transmission, causing a more profound impact. Climate change not only directly affects human health but also indirectly increases the risk of infectious disease outbreaks by altering ecosystems and the distribution of disease vectors. Meanwhile, population aging has escalated the burden of chronic non-infectious diseases and highlighted complex health issues like comorbidities, posing significant challenges to healthcare systems and social service assurance systems. Technological innovations offer unprecedented opportunities to address these health challenges. Advanced techniques like precision medicine and artificial intelligence (AI) are emerging innovations to deal with current health issues. Advancements in technology are reshaping our health management paradigms. Technological innovations are not only the driving forces for the development of modern medicine, but also the key to addressing future health issues. In the future, it is essential to strengthen health system construction, innovate mechanisms for medical and preventive integration, enhance scientific and technological research and innovation, and empower primary healthcare with AI, aiming to further tackle health challenges and improve human well-being.

Guidelines·Consensus

Chinese Expert Consensus on Grassroots Prevention and Treatment of Hypertension Combined with Type 2 Diabetes Mellitus and Dyslipidemia in Adults 2024

Beijing Hypertension Association, China Association of Gerontology and Geriatrics, Beijing Community Health Service Association, Beijing Community Health Promotion Association

2024, 27(28):  3453-3475.  DOI: 10.12114/j.issn.1007-9572.2024.0116

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Hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia are collectively referred to as the "three highs", which often coexist in the same individual. It significantly increases the risk of hospitalization, death, and relevant burdens for affected people. It is necessary to jointly control the risk and standardize the treatment of hypertension, T2DM and dyslipidemia. Primary healthcare institutions have become the main battlefield for the prevention and treatment of chronic diseases. Existing clinical evidence provides important insights into the prevention, treatment, and management of the "three highs", although norms, consensus, and guidelines for the co-management of the "three highs" in primary healthcare institutions at domestic and foreign are current not available. Four academic organizations led by Beijing Hypertension Association organized primary healthcare workers and invited experts and scholars from medical fields of cardiovascular diseases, endocrine, pharmacy, and public health services to participate in the consensus. Through widely soliciting clinical practice needs of primary healthcare workers, integrating and evaluating the evidence related to the prevention and treatment of the "three highs" in primary healthcare institutions, the consensus for primary healthcare in the prevention and treatment of the "three highs" including 21 opinions was developed after multiple rounds of discussions, revisions, and voting. The recommended opinions of this consensus aim to improve the awareness and ability of primary healthcare workers in the prevention and treatment of the "three highs", provide scientific strategic support, implement management with primary healthcare characteristics, and lay a solid foundation for comorbidity co-management.

Focus on General Practice Education

A Systematic Evaluation of Research on Continuing Education for General Practitioners in China in the Last Decade

HOU Shuyu, ZENG Xin, WANG Tingting, MOU Biao, LEI Yu, WU Fuju, LUO Xiaohong, ZOU Chuan

2024, 27(28):  3476-3482.  DOI: 10.12114/j.issn.1007-9572.2023.0532

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Background

With the changing disease spectrum of the population and the advancement of the national tiered diagnosis and treatment system, general practitioners play a vital role in disease diagnosis and treatment. At the same time, the continuous updating of medical knowledge and the ongoing changes in the health service demands of the residents necessitate the ongoing participation of general practitioners in continuing education and training. This ensures they can make the best diagnostic and treatment decisions and manage diseases effectively for their patients.

Objective

To analyze the current developments, training quality and research quality of continuing education research of general practice in China in the past ten years (2013-2022) .

Methods

In January 2023, eight Chinese and English databases including PubMed, Cochrane Library, Embase, CINAHL, ERIC, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and China Biology Medicine Literature Service System were used as data sources to obtain research on the training of continuing education for general practitioners in China. The literature was read, analyzed, organized, and summarized, with the search period ranging from January 2013 to December 2022. The Medical Education Research Study Quality Instrument (MERSQI) was utilized to comprehensively evaluate the quality of the literature.

Results

This review included a total of 49 articles, of which 11 were in English and 38 in Chinese. The themes of continuing education training focused on cardiovascular and cerebrovascular diseases (22.4%), emergency-related content (6.1%), and mental health (6.1%). The training formats were relatively singular, mainly based on traditional expert lectures (69.3%), with only 6.1% adopting the form of skill training, and 4.0% of the studies using problem-based learning (PBL) or team-based learning (TBL) training formats. There was usually a lack of rigorous evaluation: 31 studies (63.2%) used questionnaires to assess the effectiveness of the training, of which 19 had not undergone validity and reliability testing. In the study design, the largest proportion was single-group pre-post comparison (53.1%), followed by randomized controlled trials with pre-post measurements (26.5%), and the smallest proportion was controlled pre-post comparison (4.1%). Only 9 studies (18.3%) explicitly mentioned ethical approval, while the majority of studies (81.7%) did not undergo ethical review. The evaluations focused on the enhancement of knowledge and skills of general practitioners before and after trainin (85.7%), with less coverage of actual behavioral changes (14.2%) and benefits to patients and healthcare facilities (22.4%) .

Conclusion

In the past decade, the attention to general practice continuing education research has been insufficient, but there is significant room for development. In the future, it is necessary to expand training themes and adopt diverse training methods based on actual needs. Utilizing assessment tools with good validity and reliability, and focusing on the actual behavioral changes brought about by training, will benefit patients and enhance the quality of continuing education for general practitioners in multiple dimensions.

Performance and Retention Intention Rates of Order-oriented Medical Students in China: a Meta-analysis

KONG Yan, ZUO Yanli, LIU Jianghua, WU Huabei, CHEN Enran, WEI Siyu

2024, 27(28):  3485-3494.  DOI: 10.12114/j.issn.1007-9572.2022.0789

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Background

In order to change the shortage of general practitioners in primary care, China has been implementing a rural order-oriented medical student training program in 2010. Currently, the overall performance intention, performance situation and retention intention of order-oriented medical students in China still remains unclear and need to be supported by more reliable evidence.

Objective

To systematically evaluate the performance intention rate, actual performance rate and retention intention rate of order-oriented medical students in China and analyze its influencing factors.

Methods

From January to June 2022, CNKI, Wanfang Data, VIP, PubMed and Embase databases were searched to collect literature related to service intention, performance intention and retention intention for primary care of order-oriented medical students in China with a time period from 2010 to 2021, and the language of the literature was limited to Chinese and English. Two investigators independently screened literature and extracted data independently to evaluate the risk of bias of the included studies. Meta-analysis of single-group rates was performed using RevMan 5.4 software.

Results

A total of 49 papers were included with a survey period of 2010-2020, involving 22 413 order-oriented medical students. The performance intention rate of order-oriented medical students was 62% [95%CI (55%-69%) ], the performance rate was 95% [95%CI (93%-96%) ], the retention intention rate was 16% [95%CI (13%-19%) ]. The results of subgroup analysis showed that the performance intention rate of the literature published in 2011 [90%, 95%CI (84%-96%) ] was higher than the other years (P<0.01), the performance intention rate was higher in North China [87%, 95%CI (84%-90%) ] than the other regions, the performance intention rate of college students [68%, 95%CI (67%-69%) ] was higher than the residents in standardization training (P<0.01) ; the performance rate of the published literature in 2020 [99%, 95%CI (99%-100%) ] was higher than the other years (P<0.01), and the performance rate [100%, 95%CI (99%-100%) ] in Central China was higher than the other regions (P<0.01) ; the retention intention rate of the literature published in 2015 [36%, 95%CI (2%-70%) ] was higher than the other years (P<0.01), the retention intention rate [23%, 95%CI (4%-41%) ] was higher in South China than the other regions (P<0.01), the retention intention rate of the college students [18%, 95%CI (13%-22%) ] was higher than the residents in standardization training and primary care providers performing contracts (P<0.01) .

Conclusion

The actual performance rate of order-oriented medical students in China is high, but the performance intention rate and retention intention rate are low. Region, time and medical education stage are the influencing factors.

Visual Analysis of the Current State of Research on the Use of Games in Medical Education

ZHANG Hongfei, ZHAO Mingyi, FENG Yiran, XIAO Guangfen, LI Qianyuan, CHENG Jie, YAO Chenjiao

2024, 27(28):  3495-3499.  DOI: 10.12114/j.issn.1007-9572.2023.0779

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Background

Games are an emerging pedagogical tool in medical education, and they are recognized as a potentially attractive form of complementary learning. Research on the application of games in medical education has gradually increased in recent years, but the development of related research in China has been slow. Reviewing the research literature related to the use of games in medical education and gaining a comprehensive understanding of the current status and hotspots of the development of this field will be conducive to promoting the development of the research field of medical education in China.

Objective

To analyze the current status of the research on the application of games to medical education, and to provide reference and information for future research related to the application of games to medical education.

Methods

From February to April in 2023, with the help of CiteSpace 6.1R6 and Microsoft Excel 2019 software, we searched the relevant literature from Web of Science Core Collection database (WoSCC) from 2013-01-01 to 2023-02-26 with the theme of "game" and "medical education", and analyzed the number of publications, authors, countries/institutions, and the number of articles.

Results

Finally, 652 English-language articles were included. There was a general upward trend in the number of publications in the last 11 years, with the United States being the top country in terms of the number of publications (201), centrality (0.48), and the annual number of publications, and Canada (67, centrality 0.15) and the United Kingdom (56, centrality 0.47) in the second and third places, respectively. The University of Toronto, Canada was the institution with the highest total number of articles with 21 articles. High-frequency keywords included medical education, education, serious games, simulation, and performance. The keyword with the highest level of emergence in the keyword emergence analysis was serious games (emergence intensity 3.4) .

Conclusion

Currently, the application of games in medical education has attracted more and more attention from scholars, and the research hotspots mainly focus on the role played by different games in the process of talent cultivation, but there is no high-quality evidence to provide educators with evidence-based recommendations. China still needs further exploration in this field, and educators need to apply more in the teaching process to better validate its effectiveness and promote the development of medical education.

Article

A Preliminary Study of the Relationship between Personality Traits and Job Stress in Chinese General Practitioners: a Survey Based on the Job Demands and Resources Model

HUANG Wenjing, QIU Shanjiao, LIANG Yanchang, ZHENG Sihua, ZHAN Licheng, CHEN Miaoyuan, ZENG Yue, LYU Yun, YANG Hui

2024, 27(28):  3500-3509.  DOI: 10.12114/j.issn.1007-9572.2023.0646

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Objective

Job demands and job resources are drivers of health and wellbeing of workfoce. This study aimed to explore the influence of personality traits on job stress in the Job Demands and Resources (JD-R) model.

Methods

May 2023, self-administered questionnaires for the Brief Job Stress Questionnaire (BJSQ) and the Ten Item Personality Inventory (TIPI) were distributed online to general practitioners (GPs) of 26 public community health centres of Luohu Hospital Group, Shenzhen China. 69.6% GPs completed the questionnaires. The BJSQ included job demands (8 items), job resources (8 task-level items, 11 workgroup-level items, 8 organisational-level items) and related outcomes (10 items). The personality traits including extraversion, agreeableness, conscientiousness, emotional stability, and openness. The median as well as the 25th and 75th percentiles were used to indicate the central tendency and the degree of dispersion of the items, and Pearson's correlation coefficient and ANOVA were used to test the correlational factors of the different personality traits and the JD-R model.

Results

The personality traits of GPs, both male and female, were dominated by conscientiousness. agreeableness and conscientiousness were the dominant traits for those under 40 years of age and those in lower professional hierarchy, while emotional stability and conscientiousness were the dominant traits for those 40 years of age and over and those in higher professional hierarchy. The Big Five Personality Traits were related to interpersonal conflict, role conflict, job control, job adaptability, value of work, support from family and friends, job security, coping with organisational change, psychological stress, family satisfaction, job involvement, and job performance (P<0.01), but not to qualitative workload, or work predictability. Agreeableness (r=0.295, P<0.01) and emotional stability (r=0.196, P<0.01) were associated with workplace harassment. Correlation of emotional stability and JD-R model was evident statistically.

Conclusion

Personality traits are closely related to Chinese GPs work stress, psychosocial work environment and outcomes, and can be used as predictors with the JD-R model. Future research on professional burnout should consider personality traits as independent variable.

Recommendation

The authors suggest including personality, emotional intelligence, logical reasoning, and interpersonal relationship tests in the recruitment of students or trainees in medical schools and vocational training programs, in order to select and recruit suitable people for the delivery of medical services. Doctors with different personality traits could be supported with job demands and resources according to their individual characteristics to reduce professional burnout and improve work efficiency and patient care outcome. The authors called further studies on the relationship of Chinese doctor's personality traits and their study and working stress and performance.

The Quality Assessment of Community Children's Health Service Under the Contract Service Mode Based on PCAT

WANG Xi, YIN Tao, YANG Huimin, WANG Haoxiang, YIN Delu

2024, 27(28):  3510-3514.  DOI: 10.12114/j.issn.1007-9572.2023.0843

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Background

Primary medical institutions, with the characteristics of comprehensive, continuous, coordinated, convenient and economical, play an important role in the diagnosis and treatment of common and frequently-occurring children's diseases, planned immunization and child health management, and lay a solid foundation for children's health services. It is essential to improve the quality of child health services for children under the management of family doctor contract. There are regional differences in the ability of children's health services at primary institutions in China. Therefore, accurate evaluation of the quality of children's health services at primary institutions is helpful to find problems in time and promote the development of children's health services at a higher level.

Objective

To assess the quality of community children's health services for contracted children, analyze the quality problems and optimization strategies, and provide international vision and decision-making reference for further improving the quality.

Methods

Taking a district of Chengdu as a typical case, three community health service centers with stronger child health service ability in the district were selected as the sample institutions, and the parents of children contracted by the sample institutions were surveyed with the online questionnaire on the quality of community child health service by using the Chinese version of primary care assessment tool (PCAT) .

Results

Totally, 3 631 parents of contracted children were investigated. The total PCAT score of community child health service quality in the sample centers was (58.72 ± 13.43). The dimensions with relatively high PCAT scores of community child health service quality includes "continuity" "community first consultation (service availability and service use) " and "comprehensive service (service provision) ", while the dimensions "children and family-Centered" "comprehensive (available services) " and "coordination (referral) " had low scores.

Conclusion

It is suggested to strengthen the supply of diagnosis and treatment services for common pediatric diseases in the community, unblock the referral mechanism of Pediatrics, strengthen the awareness of parents of contracted children to be included in the contracted service team to participate in diagnosis and treatment decisions, and pay attention to the health services for children with non local registered residence.

Multiple Correspondence Analysis of the Influence of Heterogeneity in Sample Composition on the Investigation Results of Primary Chronic Disease Management Quality

YU Guo, CHEN Jinhua, WU Yuelei, LIU Shuyi, DU Wen, XIAO Zhu, WANG Yijun

2024, 27(28):  3515-3519.  DOI: 10.12114/j.issn.1007-9572.2022.0682

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Background

The assessment of chronic disease management capabilities in healthcare institutions is an important element of chronic disease management, but the researchers did not pay attention to the impact of sample heterogeneity on the scientific validity of survey results when using relevant scales, which requires our attention.

Objective

To explore the impact of the heterogeneity of sample composition on the evaluation results of the scale and put forward countermeasures based on the investigation of chronic disease management quality in primary medical institutions in Chengdu.

Methods

In February 2022, a total of 889 medical workers was selected from 46 primary care institutions in 23 prefectures and districts (counties) of Chengdu City by using multi-stage stratified cluster sampling method. The Chinese version of Assessment of Chronic Illness Care (ACIC) was used to assess the quality scores of chronic disease management in the medical institutions. Multiple correspondence analysis was used to explore the impact of sample heterogeneity caused by different genders, years of experience, professional titles, educational levels and job composition on the scale scores.

Results

The total score of chronic disease management competence of medical workers was negatively correlated with their education level and positively correlated with their professional title (P<0.05). The decision support dimension score of chronic disease management competence was negatively correlated with the working years of subjects (P<0.05), the information system dimension score of chronic disease management competence was negatively correlated with working years and positively correlated with education level (P<0.05). Multiple correspondence analysis showed that the higher educational level was correlated with lower total score of chronic disease management competence, intermediate titles tended to give the highest scores. For the decision support scoring dimension, medical workers with more working years tended to give higher scores. For the information system scoring dimension, medical workers with more working years tended to give higher score, and those with college/bachelor degree tended to give the highest score.

Conclusion

The heterogeneity of sample composition will have a definite impact on the results of the primary chronic disease management quality evaluation scale, which means that the evaluation will biased, especially not conducive to fair inter-institutional comparisons. The above suggests that the development of the scale needs to strictly regulate the scope of application. The reliability and validity test of the scale and its promotion need to attention to the composition of the sample to ensure its homogeneity, so as to ensure the objectivity and validity of the quality evaluation of primary chronic disease management.

Effects of Chronic Disease Prevalence and Comorbidity Patterns on SRH Status in Middle-aged and Elderly Populations in Rural Areas

SUBINUER Aiwaiduli, GULIBAHAER Kadeer, MUKAIDASI Taxi, LYU Yujuan, KADEERYA Nasier, SUBIDE Alimujiang

2024, 27(28):  3520-3528.  DOI: 10.12114/j.issn.1007-9572.2023.0611

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Background

With the acceleration of China's aging population, the prevalence of chronic diseases and comorbidity patterns pose significant challenges to global health. There is a close relationship between the prevalence of chronic diseases and individuals' self-related health (SRH) status. However, there is limited research on the prevalence of chronic diseases and comorbidity patterns among middle-aged and elderly populations in rural areas of Xinjiang, China, and their impact on SRH status.

Objective

To understand the prevalence of chronic diseases and comorbidity patterns among middle-aged and elderly populations in rural areas of Xinjiang and to explore the impact of chronic diseases and comorbidity patterns on SRH status, providing effective reference for improving the health level of this population.

Methods

The data for this study were derived from the survey database of the National Social Science Foundation project (17BRK030) from 2016 to 2019. A questionnaire survey was conducted on the demographic characteristics, chronic disease status, and self-rated health status of male and female heads of households. Ordered logistics regression analysis was used to screen the influencing factors of SRH status. SOM network training analysis and partial least squares method were employed to evaluate the interrelationships among 14 chronic diseases and the degree of their impact on SRH status.

Results

A total of 3 400 middle-aged and elderly individuals were surveyed. Residents' SRH status varied significantly by geographical distribution, gender, age, education level, occupation, marital status, illness or disability, and chronic disease status (P<0.05). Geographical region as southern Xinjiang, education level of primary school below, and presence of chronic diseases were identified as risk factors for SRH status (P<0.05). Being male, aged 45-59 years, occupation as pastoralists, staff of government or public institutions, or technical workers, being divorced, and having illness or disability were identified as protective factors for SRH status. The prevalence of chronic diseases among middle-aged and elderly populations in rural areas of Xinjiang was 36.47%. The top three diseases were hypertension (17.47%), arthritis or rheumatism (8.62%), and heart disease (5.68%). The comorbidity rate of chronic diseases was 8.09%, with hypertension (6.12%), arthritis or rheumatism (5.18%), and heart disease (4.71%) being the top three comorbid diseases. The predominant comorbidity pattern was the co-occurrence of two chronic diseases (78.18%). The most common comorbidity pattern among individuals with two chronic diseases was hypertension combined with heart disease, and among those with three chronic diseases was hypertension combined with heart disease and arthritis or rheumatism. The impact of chronic disease status on SRH status revealed that individuals with chronic diseases had significantly lower SRH status than those without chronic diseases, and individuals with two or more chronic diseases had lower SRH status than those with one chronic disease.

Conclusion

The prevalence of chronic diseases and comorbidity among middle-aged and elderly populations in rural areas of Xinjiang is high. Chronic respiratory diseases, arthritis or rheumatism, heart disease, anemia, and other chronic diseases have a significant impact on SRH status. Therefore, it is necessary to further strengthen the construction of chronic disease service systems, improve the health records of middle-aged and elderly individuals, establish specialized clinics for chronic disease comorbidity to detect and control the comorbidity of chronic diseases among middle-aged and elderly populations. Additionally, efforts should be made to enhance health education for middle-aged and elderly groups, increase awareness of chronic diseases, and promote active and healthy lifestyles to improve the health level and quality of life of middle-aged and elderly populations.

A Qualitative Study on the Status of Maternal and Infant Health Services in Shanghai Communities under the New Situation

MA Xiaoxia, SHI Jishun, NIU Lihua, CHEN Ningqing, DING Yan

2024, 27(28):  3529-3534.  DOI: 10.12114/j.issn.1007-9572.2023.0807

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Background

With the precipice decline of the birth population and the successive adjustment of the fertility policy in China, it is inevitable to re-examine the breadth and depth of maternal and infant health care services. Also, it has posed great challenges to the community health service institutions, which are the important suppliers of maternal and infant health care services.

Objective

To investigate the current status of maternal and infant health services in Shanghai communities, in order to provide suggestions and evidence for upgrading the level of primary care services for mothers and infants.

Methods

From August 2022 to April 2023, using purposive sampling method, the study selected 5 community health centers in the central district of Shanghai, in which in-depth personal interviews were conducted with 10 maternal and infant health service providers during participatory observation; organized a focus group interview with 12 primary health workers in the urban-rural fringe areas. In addition, 8 obstetrics staff from tertiary hospitals participating the construction of obstetrics and gynecology medical consortium, were invited to conduct 2 focus group interviews to obtain information from different perspectives. The data were analyzed using the content analysis method.

Results

A total of 4 themes and 11 sub-themes were extracted: (1) some health care projects are poorly implemented (inadequate mental health care, ineffective contraceptive guidance, and difficulties in implementation of traditional Chinese medicine health care) ; (2) health talent team construction needs to be strengthened (inadequate human resources, limited professional knowledge and skills, poor motivation to work, and little role of the family physician teams) ; (3) the implementation process is challenging (difficulty in cross-district management and low participation of residents) ; (4) the services integration need to be improved (deviation in the positioning of higher-level medical institutions and insufficient coordination among agencies) .

Conclusion

At present, maternal and infant health care in Shanghai communities is still facing various challenges. It is necessary to make full use of the opportunity of medical union construction to strengthen talent training and establish an innovative human resource management model. At the same time, when strengthening the top-level design and clarifying the division of tasks between the various tiers of medical institutions, the performance assessment and incentive mechanism should be improved to truly stimulate the morale and service enthusiasm of community maternal and infant health service providers. Multiple measures should be taken to effectively enhance the quality of service and meet the needs of current health care tasks.

The Influence of Environmental Factors on Self-efficacy in the Community Stroke Patients

LI Shirui, ZHANG Zhenxiang, WANG Wenna, ZHANG Jie, ZHAO Zhixin

2024, 27(28):  3535-3539.  DOI: 10.12114/j.issn.1007-9572.2023.0699

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Background

With China's aging population, the incidence of stroke is increasing year by year, and the high disability rate places a significant burden on patients, families, and society. It is extremely important to strengthen the rehabilitation self-efficacy of home-based stroke patients in order to assist them return to society as soon as feasible. Currently, less emphasis is being paid to the influence of environmental factors on rehabilitation self-efficacy in stroke.

Objective

To investigate the current status of rehabilitation self-efficacy of stroke patients in community, and explore the influence of different environmental factors on rehabilitation self-efficacy of stroke patients.

Methods

Using convenience sampling, from December 2019 to September 2020, 262 stroke patients in the subordinate communities of 4 community health service centers in Zhengzhou, Henan Province were enrolled in the survey. The Demographic Information Questionnaire was used to collect general data, the Modified Rankin Scale was used to assess the physical function of stroke patients, the Measure of Stroke Environment was used to assess the current situation of stroke environment, and the Chinese Version of Stroke Self-efficacy Questionnaire was used to assess the rehabilitation self-efficacy of stroke patients. The effects of various environmental factors on rehabilitation self-efficacy of stroke patients were investigated by hierarchical regression analysis.

Results

A total of 285 questionnaires were distributed, a total of 262 valid questionnaires were collected, with an effective response rate of 91.93%. The rehabilitation self-efficacy score of 262 stroke patients was (76.1±26.3). Receptivity, physical environment and communication environment accounted for 30.9% of the total variation in rehabilitation self-efficacy (P<0.05) .

Conclusion

The rehabilitation self-efficacy of community stroke patients is in the medium level. Receptivity, physical environment and communication environment are the important influence factors for self-efficacy of stroke patients. In the future, we should attach importance to the environmental construction of stroke patients, explore positive stroke environmental construction models, effectively guide the rehabilitation of stroke patients, enhance rehabilitation self-efficacy, improve prognosis, and help them return to society as soon as possible.

Correlation Analysis between Depressive, Cognitive Symptoms and Nutritional Metabolism in the Elderly in Community

YU Haidong, PAN Miaomiao, GU Hongqin, LIU Tao, DAI Jie, LIU Linghua, HOU Junping, YANG Li, SHI Meifang, ZHAO Chao

2024, 27(28):  3540-3545.  DOI: 10.12114/j.issn.1007-9572.2023.0591

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Background

With the increase of the aging population, age-related health problems have garnered increasing attention. Compared to physiologic diseases with significant clinical symptoms, the mental health issues of the elderly are often overlooked. The underlying depressive states and high incidence of chronic diseases collectively contribute to a decline in quality of life in old age. Moreover, metabolic diseases, more prevalent in the elderly, significantly impact brain health, potentially leading to neurological damage and cognitive decline.

Objective

This study aims to investigate the relationship between depression, cognitive status, and nutritional and metabolic status among elderly individuals in the community.

Methods

We selected 3 767 elderly individuals who participated in physical examinations at the Youyi Street Community Health Service Center in Baoshan District, Shanghai. The demographic data on sex, age, BMI and waist-to-hip ratio were collected. The evaluations included the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), and Activities of Daily Living Scale (ADL). Metabolic syndrome-related diseases and the 10-year cardiovascular disease risk were assessed using clinical metabolic indicators, and Pearson correlation analysis was used to explore the correlations among these indicators.

Results

This research showed that significant differences were found in age, MNA, MMSE scores, the proportion of people at high risk of cardiovascular disease and the 10-year cardiovascular disease risk grade among the different groups (P<0.05). Correlation analysis indicated that the GDS score was negatively correlated with the total MMSE score and its sub-item scores, except for the repetition ability score. MNA and ADL were positively correlated with the total MMSE score (P<0.05). Additionally, GLU and HbA_1c levels were negatively correlated with immediate recall ability in the MMSE (P<0.05) .

Conclusion

Our findings suggest that depression in the elderly is associated with cognitive decline, while better nutritional status is linked to improved cognitive performance. Focusing on and improving metabolic health in the elderly may enhance their mental state and overall mental health.

Consistency Analysis of Imaging and Histological Diagnosis of Non-alcoholic Fatty Liver Disease

HU Yifan, CHEN Miaoyang, XIONG Qingfang, ZHONG Yandan, LIU Duxian, GU Aidong, YANG Yongfeng

2024, 27(28):  3546-3551.  DOI: 10.12114/j.issn.1007-9572.2023.0539

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Background

Nonalcoholic fatty liver disease (NAFLD) is a common digestive system disease, which is often diagnosed by imaging methods in clinical work. At present, there is a lack of research on the effectiveness evaluation of imaging diagnostic methods with histology as the gold standard.

Objective

To study the consistency of imaging and histological diagnosis of NAFLD, and to analyze the influencing factors of gallstone disease (GD) complicated with NAFLD.

Methods

From January 2021 to July 2022, 53 patients with GD who underwent simple cholecystectomy and liver biopsy were selected from the Department of Hepatobiliary surgery, Nanjing Hospital affiliated to Nanjing University of traditional Chinese Medicine. The demographic characteristics, BMI, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the subjects were collected, and the laboratory indexes, imaging and histological results were collected. The consistency of imaging and histological diagnosis of NAFLD was evaluated by Kappa consistency test. According to the histological diagnostic criteria, the subjects were divided into NAFLD group (n=15) and non-NAFLD group (n=38). Multivariate Logistic regression analysis was used to explore the influencing factors of NAFLD in patients with GD.

Results

The imaging detection rate of NAFLD in GD patients was 20.7% (11/53), which was lower than that of histology (28.3%) (15/53) (Kappa=0.404, P=0.001). The sensitivity of imaging diagnosis was 60.0% (9/15), the specificity was 94.7% (36/38), and the rate of missed diagnosis was 40.0% (6/15). There were 8 cases of nonalcoholic fatty liver (NAFL), 7 cases of nonalcoholic steatohepatitis (NASH) and no NASH associated cirrhosis in 15 patients with histological manifestation of NAFLD. The proportion of fibrosis in the NASH group was higher than that in the NAFL group. There were significant differences in the levels of BMI, SBP, fasting blood glucose (FPG) and aspartate aminotransferase (AST) between NAFLD group and non-NAFLD group (P<0.05). Multivariate Logistic regression analysis showed that BMI (OR=1.500, 95%CI=1.084-2.075, P=0.014) and FPG (OR=2.163, 95%CI=1.246-3.756, P=0.006) were the influencing factors of GD patients with NAFLD.

Conclusion

Compared with histological diagnosis, the missed diagnosis rate of imaging diagnosis of NAFLD is higher, and the incidence of NAFLD may be underestimated by imaging diagnosis as a means of epidemiological investigation. High BMI and high FPG are the main risk factors of GD complicated with NAFLD.

Development and Validation of a Cloud Follow-up Service Experience Scale for Patients with Chronic Diseases

HAN Shuai, ZHU Xuejiao, SHU Jie, CHEN Guoling

2024, 27(28):  3552-3559.  DOI: 10.12114/j.issn.1007-9572.2023.0445

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Background

Follow-up is a necessary step in the management of chronic disease patients. Cloud follow-up as a new form of follow-up may improve the quality of follow-up. However, there is currently a lack of patient-oriented evaluation tools for cloud follow-up service quality.

Objective

To develop a scale for evaluating the service experience of chronic disease patients in cloud follow-up and to examine its reliability and validity, in order to provide a tool for evaluating the quality of cloud follow-up services.

Methods

Guided by the service quality evaluation model, the scale was developed by using methods including literature review, semi-structured interview, expert consultation. During August to October 2022, a survey was conducted among chronic disease patients (n=480) discharged from a tertiary hospital and lived under the network of a community service center in Hangzhou, China. Item analysis and tests of reliability and validity were test on the developed scale.

Results

The developed scale for evaluating the service experience of chronic disease patients in cloud follow-up had 37 items distributed in 5 dimensions. Patients' perceptions and expectations to each item were evaluated simultaneously. The overall Cronbach's α coefficient of the developed scale was 0.962, with split-half reliability of 0.732 and test-retest reliability of 0.844. The content validity index of the scale was 0.980. The correlation coefficient between the scale and satisfaction scores was 0.754 (P<0.01). Confirmatory factor analysis showed good fit of the scale. The factor loading coefficients of the scale items ranged from 0.514 to 0.988 (P<0.001), the composite reliabilities of the dimensions ranged from 0.947 to 0.987, and the average variance extracted (AVE) ranged from 0.693 to 0.947. The correlation coefficients between dimensions were all smaller than the square root of the corresponding AVE.

Conclusion

The scale for evaluating the service experience of chronic disease patients in cloud follow-up, developed in this study, demonstrated good reliability and validity. It can be used to evaluate the experience of chronic disease patients in cloud follow-up services.

Health China·Health Management Research

Status of Implementation of Active Health-oriented Health Management in Primary Health Care Organizations

LI Wanyu, ZHANG Hanzhi, JIN Hua, YU Dehua

2024, 27(28):  3560-3566.  DOI: 10.12114/j.issn.1007-9572.2024.0178

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Background

With the development of society and the improvement of people's living standards, health issues are receiving increasing attention. The aging population and the high incidence of chronic diseases have made health management an urgent problem that needs to be addressed. Primary healthcare institutions, as the "main battlefield" for residents' health, play a crucial role in health management. However, in the current implementation of health management, primary healthcare institutions still face numerous challenges, and their proactivity remains unclear.

Objective

To understand the current implementation status of health management in primary healthcare institutions in Shanghai and to discuss strategies for enhancing the implementation of proactive health-oriented health management.

Methods

From February 2023 to May 2023, a survey was conducted on 33 primary healthcare institutions in Shanghai. The survey aimed to understand the implementation of health management, assessment of high-risk factors and disease screening, execution of health education and information dissemination, coordination of health management resources and functional services, as well as the status of online health management services and health monitoring. Additionally, interviews were conducted with institution heads to gather information on implementation difficulties and suggestions.

Results

The research results showed that all participating institutions carried out health management for chronic disease patients, with 93.9% (31/33) covering key populations, 72.7% (24/33) involving rehabilitation populations, and 54.6% (18/33) including healthy populations. A total of 81.8% (27/33) of institutions utilized health data platforms, with the main functions including contract management, health record management, data querying, and health indicator management. Furthermore, 97.0% (32/33) of institutions conducted high-risk factor assessments and disease screenings, as well as follow-up, diagnosis, and management. The majority of institutions carried out health education and information dissemination activities through various platforms. Additionally, 87.9% (29/33) of institutions collaborated with other units to implement health management projects, providing diverse functional services. About 63.6% (21/33) of institutions offered online services, and 42.4% (14/33) were equipped with health monitoring devices. Managers believed that primary healthcare institutions and their staff have significant advantages in implementing proactive health-oriented management, but they also face challenges due to a lack of policy and financial support.

Conclusion

Primary healthcare institutions in Shanghai have made positive progress in implementing proactive health-oriented management. However, comprehensive measures are still needed to address existing challenges, in order to further improve the quality and efficiency of health management services and better meet the health needs of residents.

Problems of Community Health Management in Prediabetic State and Corresponding Recommendations

CHEN Kaiyue, LI Xianglong, FENG Yuheng, LI Xiaohong, GUO Ying

2024, 27(28):  3567-3573.  DOI: 10.12114/j.issn.1007-9572.2023.0672

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Background

Type 2 diabetes is a major public health problem that jeopardizes the health of the population in China. The prediabetic state population is a huge reserve force for diabetes, for which appropriate intervention can prevent or delay diabetes, but community health management is ineffective at this stage.

Objective

To investigate the problems and influencing factors in community health management practice in prediabetic state, and propose systematic and operable strategies and recommendations on health management measures.

Methods

A systematic search was conducted from March to April 2023 to retrieve literature related to community health management of prediabetes in CNKI, Wanfang Data, CQVIP, PubMed, and Web of Science. The key informant interviews based on multiple perspectives were conducted from April to May 2023 in Shanghai communities, hospitals, and CDCs, which included 20 community health service center staff, health administrators, clinical endocrinologists, CDC health management staff, diabetes patients or prediabetes and their family members, and people with diabetes risk factors. The interviews content covered the current status of community health management of prediabetes, related attitudes and perceptions of prediabetes, and acceptance of relevant services. Fishbone diagram analysis were used for data analysis to sort out the hierarchy between the problems related to community health management of prediabetes.

Results

14 relevant literature were eventually included to summarize 22 existing problems in community health management of prediabetic state based on literature and interviews, derive the problems in 4 dimension: patients, intervention scope, service ability and information system, and propose 8 influencing factors: disease risk perception level, self-management skill level, funding budget, work experience, workload, service accessibility, electronic health record construction level and information sharing scope level.

Conclusion

The prediabetic state population is an important target of community health management, and the process of policy change reflects the strengthening of attached to the them, but multiple sources of evidence prove that it is still a weak link at present. In view of the problems in the current practice, it is necessary to improve the knowledge, skills and other management capabilities of community health service personnel, optimize the information system platform based on the medical treatment combination, and further develop a more feasible and continuous health management model for prediabetic state integrating screening, management and intervention.

Research Progress on the Concept and Framework of an Integrated Health Management Service Model for Children at Home and Abroad

LIU Changming, ZHANG Zhi, ZHANG Yong, ZHAO Qian, YU Kelin, XUE Linmei, SU Yanling, YANG Xudong

2024, 27(28):  3574-3580.  DOI: 10.12114/j.issn.1007-9572.2024.0129

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The imbalance between the supply and demand of pediatric medical resources and health management services in our country has been a long-standing issue, primary healthcare institutions are particularly prominent in this context. How to achieve integration and optimization of pediatric medical resources at the grassroots medical and health institutions is an urgent problem that needs to be addressed. This article primarily summarizes and analyzes the concept and framework of integrated health management services for children, including children's health assessment, early intervention, long-term follow-up, and case studies and practical experiences. Through a review of domestic and international literature, it concludes feasible models of integrated health services for children. This review suggests that integrated health management services have broad potential and promising applications, providing personalized and efficient health management and intervention for children.