Table of Content

15 January 2025, Volume 28 Issue 02

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Commentary

Reflections and Strategies for Full-cycle Stroke Rehabilitation

JIA Jie

2025, 28(02):  129-134.  DOI: 10.12114/j.issn.1007-9572.2024.0212

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Post-stroke patients are often left with different degrees of functional impairment, and in the process of returning from the medical institution to the community and home, it is necessary for medical institutions at all levels to cooperate and interact, so as to form a good full-cycle rehabilitation closed loop. At present, the application of full-cycle stroke rehabilitation is progressing, but some resistance still exists. This articel is based on the concept of full-cycle rehabilitation for stroke, combined with the current situation of the development of community-based rehabilitation, we also think about the development of the full-cycle rehabilitation and community-based rehabilitation link for stroke. The article emphasizes the importance of "community-based inflection-point rehabilitation" and the need to establish standards of community-based rehabilitation. Moreover, the article also mentions the need to emphasize the full-cycle stage of rehabilitation for stroke patients, explore the development strategy of community-based rehabilitation, and effectively improve the quality of life in community and family.

Guidelines·Consensus

Chinese Expert Consensus on Artificial Intelligence General Practitioner (AIGP)

Tsinghua University Vanke School of Public Health, Peking University School of Public Health, Chinese Association of General Practitioners of Chinese Medical Doctor Association

2025, 28(02):  135-142.  DOI: 10.12114/j.issn.1007-9572.2024.0453

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The rapid development of new technologies such as artificial intelligence and large language models has brought new transformations to clinical medical practice. Both domestically and internationally, research and practical exploration of intelligent general practitioners have begun, but a consensus has yet to be formed. Against this backdrop, experts and scholars from Tsinghua University Vanke School of Public Health, Peking University School of Public Health, Chinese Association of General Practitioners of Chinese Medical Doctor Association and several other domestic institutions collaboratively developed a consensus. The background of these experts spans multiple disciplines, including general medicine, public health, artificial intelligence, and evidence-based medicine. Based on extensive literature review both domestically and internationally and through multiple rounds of expert discussions, the Chinese Expert Consensus on Artificial Intelligent General Practitioner (AIGP) was finally formulated. It includes 17 core consensus concerning the definition, characteristics, applications, challenges and recommendations of AIGP. This consensus aims to provide scientific references to promote the empowerment of general practitioners with intelligent technology and enhance the smart service level of primary healthcare.

Multimorbidity Section

Advances in Cognitive Impairment in the Multimorbidity

XIN Bo, WU Yixin, ZHANG Di, HE Yuxin, YANG Shan, LI Mengchi, JIANG Wenhui

2025, 28(02):  143-148.  DOI: 10.12114/j.issn.1007-9572.2023.0813

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Multimorbidity accelerates cognitive decline and leads to an increased risk of cognitive impairment. However, existing studies have mainly explored the cognitive status of patients with a single or specific chronic disease, and the patient with multimorbidity remains to be urgently explored. The present study describes the epidemiological characteristics of cognitive impairment in multimorbidity, summarizes the influencing factors, organizes the association patterns between multimorbidity and cognitive impairment, elucidates the mechanisms underlying their occurrence, and finally proposes preventive and control strategies. The findings of this study are intended to serve as a valuable reference for future efforts in preventing and treating cognitive impairment in multimorbidity.

Association between Comorbidity Patterns and Disability for the Older Adults: Based on a Sampling Survey in Sichuan Province

LI Xiaofeng, PEI Xingtong, YANG Chunhui, ZHAO Yang, XU Mingming

2025, 28(02):  149-158.  DOI: 10.12114/j.issn.1007-9572.2023.0928

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Background

With the population aging, the number of patients with chronic diseases and disability is increasing, which brings a heavy burden on the medical system. While it is well established that comorbidity and disability are closely interconnected, there is a noticeable scarcity of studies addressing the relationship between different patterns of comorbidity and disability.

Objective

To explore the common comorbidity patterns and their associations with disability among the older adults in China taking Sichuan as an example.

Methods

A total of 501 older adults, aged 60 and above, were selected using quota sampling in Sichuan from August to Novermber 2022. Detailed data on chronic diseases, disability, and general demographics were collected. Comorbidity patterns among the older adults were identified using a two-step clustering method that combined self-organizing maps and K-Means. The association between patterns of comorbidity and disability was explored using a logistic regression model, employing the National Disability Assessment Scale for the Long-term Care issued by the National Healthcare Security Administration of China in 2021.

Results

In this survey, The prevalence of comorbidity 62.3% (312/501) and the prevalence of disability was 74.3% (372/501). We identified six comorbidity patterns: Arthritis/Rheumatism and Hypertension diseases, Cardiovascular and Metabolic diseases, Kidney and Arthritis/Rheumatism diseases, Cancer and Arthritis/Rheumatism diseases, Asthma, Hypertension, and Gastrointestinal diseases, Emotional/Mental and Memory-related diseases. The results of binomial logistic regression showed that the risk of disability was 6.3 times higher when people suffering from two or more chronic diseases at the same time (OR=6.3, 95%CI=3.9-10.3, P<0.05). The results of multinomial logistic regression showed that the risk of disability was increased in all six comorbidity patterns (P<0.05). Compared to the population without comorbidities, the comorbid group with the emotional/mental and memory-related diseases pattern has a 10.7 times risk with more severe disability (OR=10.7, 95%CI=1.7-63.6), which had the greatest impact on disability. Next is the Cancer and Arthritis/Rheumatism pattern (OR=7.8, 95%CI=2.4-24.8) .

Conclusion

The incidence of comorbidity among the older adults in Sichuan is high, and there is a significant association between several comorbidity patterns and disability, especially for the Emotional/Mental and Memory-related diseases pattern and Cancer and Arthritis/Rheumatism pattern. The health care system should focus on the older adults with comorbidity, formulate accurate and effective long-term care policies and strategies based on different comorbidity patterns to prevent and reduce the occurrence of disability, improve the well-being of the older adults, and save social medical resources.

Prevalence of Disability in Older Adults with Chronic Disease in China: a Meta-analysis

HE Yuxin, WU Yixin, YANG Shan, XIN Bo, LI Mengchi, JIANG Wenhui

2025, 28(02):  159-168.  DOI: 10.12114/j.issn.1007-9572.2023.0886

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Background

As global population continues to age, disability has become one of the most prominent health problems in the aging population. Chinese older adults with chronic diseases often diagnosed with multi-morbidities resulting in increased risks for disability. However, previous evidence on disability rates in this population have been inconsistent.

Objective

To systematically evaluate the prevalence of disability in older adults with chronic diseases in China.

Methods

We searched databases including PubMed, Embase, Web of Science, Cochrane Library, Scopus, CNKI, Wanfang Data, VIP, CBM and China Medical Journal Full-text Database up until August 2023 for publications on disability prevalence in Chinese older adults with chronic diseases. Literature screening, quality appraisal and data extraction were performed independently by two researchers. Meta-analysis was conducted using Stata 16.0 software.

Results

A total of 32 publications (34 studies) were included. Sample sizes ranged from 221 to 16 566 cases with a disability rate of 6.9%-82.8%. Meta-analysis showed that the prevalence of disability in Chinese older adults with chronic diseases was 43.2% (95%CI=32.9%-53.5%). Subgroup analyses showed: disability rate was higher in female (36.6%, 95%CI=27.0%-46.2%) than in male (33.9%, 95%CI=23.9%-43.9%) ; disability prevalence increased with age (60-69 years old: 24.2%, 95%CI=14.3%-34.0%; 70-79 years old: 34.9%, 95%CI=24.1%-45.7%; ≥80 years old: 47.7%, 95%CI=36.3%-59.1%) ; compared to other chronic diseases, individuals with dementia/Parkinson's disease (56.3%, 95%CI=40.9%-71.7%), mental illness (53.9%, 95%CI=46.0%-61.7%), and cerebrovascular disease (49.2%, 95%CI=33.5%-64.8%) had the highest prevalence of disability; and the prevalence of disability increased with the number of comorbidities (1 disease: 33.1%, 95%CI=20.8%-45.3%; 2 diseases: 36.3%, 95%CI=22.6%-50.0%; ≥3 diseases: 49.7%, 95%CI=31.3%-68.0%) .

Conclusion

The prevalence of disability among Chinese older adults with chronic diseases is high and can be impacted by both the type of chronic disease and the number of comorbidities. It is recommended to strengthen chronic disease monitoring and management efforts to prevent and eliminate disability and promote healthy aging in this population.

Original Research

Effect of the Remote Ischemic Postconditioning on the Prognosis of Patients with Acute Ischemic Stroke beyond Time Window: a Randomized Controlled Trial

YUAN Dan, WANG Ying, WANG Yingpeng, XU Li, XUE Jia, CHENG Jingjing, WANG Haipeng

2025, 28(02):  169-174.  DOI: 10.12114/j.issn.1007-9572.2023.0746

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Background

The incidence of acute ischemic stroke (AIS) remains high, and a timely restoration of cerebral blood flow is crucial for its prognosis. There are less therapeutic approaches to promote recovery of cerebral blood flow in AIS patients treated beyond a limited time window. The analysis of remote ischemic postconditioning (RIPostC) on the efficacy, complications and prognosis of AIS patients beyond the time window is of great significance.

Objective

To investigate the role of RIPostC on the prognosis of AIS beyond time window, thus providing a safe and effective cerebral blood flow restoration way for AIS beyond time window.

Methods

It was a randomized, parallel group, placebo-controlled trial involving AIS patients beyond time window (onset time > 6 h) of thrombolysis who were hospitalized in the Department of Neurology, Beijing Aerospace General Hospital from September 2, 2021 to August 31, 2022. They were randomly assigned into the control group and experimental group, and treated and followed up for 90 days. General treatment and conventional treatment of cerebrovascular disease were performed in both groups. RIPostC and simulated RIPostC were respectively given 28 times within 14 days in the experimental group and control group, respectively. Before the intervention, and 30 days and 90 days after the intervention, neurological function was assessed using the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Cognitive function was assessed by the Mini-mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Daily living ability was assessed by the Instrumental Activity of Daily Living (IADL). Mental status was assessed by the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). Cerebral blood flow velocity was assessed by the transcranial Doppler ultrasound (TCD). Inflammatory response was assessed by measuring interleukin 6 (IL-6) levels.

Results

Ninety-nine out of 122 AIS patients finally completed the trial and follow-up, including 49 patients in the experimental group and 50 in the control group. There were no significant differences in gender, age, underlying diseases (hypertension, diabetes, coronary heart disease) and baseline NIHSS scores between the two groups (P>0.05). Repeated measures analysis of variance showed that there was an interaction between time and group on MMSE, MoCA, mRS, NIHSS, cerebral blood flow velocity, and IL-6 (P<0.05). Specifically, the main effects of time and group on MMSE, MoCA, NIHSS, cerebral blood flow velocity, and IL-6 were significant (P<0.05), and the main effects of time on mRS, SAS, SDS, and IADL were significant (P<0.05). The MMSE and MoCA scores and cerebral blood flow velocity on 30 days and 90 days after the intervention were significantly higher in the experimental group than those of the control group, while the mRS and NIHSS scores were significantly lower (P<0.05). The SDS and IADL scores on 30, 90 days after the intervention were significantly lower than those of control group (P<0.05). On 30 days after the intervention, AIS patients in the experimental group had significantly higher SAS score and lower IL-6 level than those of control group (P<0.05). Adverse events were reported in 23 AIS patients, including 17 in the experimental group and 6 in the control group. There was no significant difference in the incidence of skin petechiae, dizziness, palpitation, chest tightness between the two groups (P>0.05). The incidence of skin ecchymosis [4.00% (2/50) vs. 12.24% (6/49) ] and the overall incidence of adverse events [12.00% (6/50) vs. 34.69% (17/49) ] in the control group were significantly lower than those of the experimental group (P<0.05) .

Conclusion

RIPostC can reduce the inflammatory response in AIS patients, and protect neurological function, cognitive function, depression and intracranial blood flow velocity.

Correlation of Serum Uric Acid to Serum Creatinine Ratio with the Recurrence of Cerebrovascular Events and Mortality in Patients with Acute Cerebrovascular Disease: a Prospective Cohort Study

REN Xiaoqiao, WANG Pan, WU Hao, JI Yong, SHI Zhihong

2025, 28(02):  175-182.  DOI: 10.12114/j.issn.1007-9572.2024.0073

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Background

Stroke is featured by high mortality and recurrent rate worldwide. Serum uric acid (SUA) is the product of purine metabolism that has been identified as a risk factor for cardiovascular disease. The serum uric acid/serum creatinine ratio (SUA/Scr) is a renal function-normalized SUA. The role of SUA/Scr in acute cerebrovascular disease remains controversial.

Objective

To identify the correlation of SUA/Scr with the recurrence and mortality of cerebrovascular events in patients with acute cerebrovascular disease.

Methods

This was a prospective cohort study involving patients with the initial cerebrovascular event consecutively admitted in Tianjin Huanhu Hospital from September 2006 to September 2019. All patients were followed up in the outpatient clinic combined with telephone contact until September 2020. The primary outcome was all-cause mortality. The secondary outcomes were recurrent cerebrovascular events, recurrent cardiovascular events and other vascular events (e.g., arteriovenous thrombosis of lower extremities). Cox proportional hazard models were used to explore the correlation of SUA/Scr with the recurrence and mortality of cerebrovascular events in patients with acute cerebrovascular disease.

Results

According to the quartiles of SUA/Scr levels, patients with acute cerebrovascular disease were divided into Q1 group (SUA/Scr≤3.16, n=3 520), Q2 group (3.16<SUA/Scr≤3.94, n=3 280), Q3 group (3.94<SUA/Scr≤4.92, n= 3 270) and Q4 group (SUA/Scr>4.92, n=3 243). At the end of the follow-up, 774 (5.8%) patients died, while 2 064 (15.5%) reported recurrences of cerebrovascular events. In Q1-Q4 groups, there were 302, 375, 408 and 337 male cases of recurrences of cerebrovascular events, and 99, 125, 169 and 249 female cases of recurrences of cerebrovascular events, respectively. There were 261, 314, 345 and 283 male cases of recurrences of cerebral infarction, and 90, 101, 142 and 205 female cases of recurrences of cerebral infarction in Q1-Q4 groups, respectively. There were 154, 191, 214 and 183 male cases of recurrences of large atherosclerotic cerebral infarction, and 58, 52, 45 and 31 female cases of recurrences of large atherosclerotic cerebral infarction in Q1-Q4 groups, respectively. All-cause mortality in men was 165, 128, 131 and 88 cases in Q1-Q4 groups, respectively, and 57, 63, 62 and 80 cases in women. The mortality of men due to cerebral infarction was 93, 72, 70, and 46 cases in Q1-Q4 groups, respectively, and 31, 33, 36, and 44 cases in women. The mortality of men due to large artery atherosclerotic cerebral infarction was 58, 52, 45, and 31 cases in Q1-Q4 groups, respectively, and 17, 18, 27 and 24 cases in women. After adjusting for multiple confounding factors, SUA/Scr in Q4 compared with Q1 was an influencing factor for the recurrence of acute cerebral infarction in men (HR=0.690, 95%CI=0.500-0.953, P=0.026). SUA/Scr in Q4 compared with Q1 was an influencing factor for the recurrence of large artery atherosclerotic cerebral infarction in the male cerebral infarction subgroup (HR=0.740, 95%CI=0.578-0.947, P=0.017). SUA/Scr in Q4 compared with Q1 was an influencing factor for all-cause mortality (HR=0.575, 95%CI=0.368-0.901, P=0.003) and death from cerebral infarction in men (HR=0.610, 95%CI=0.353-0.814, P=0.011). SUA/Scr in Q3 (HR=0.656, 95%CI=0.476-0.904, P=0.010) and Q4 (HR=0.582, 95%CI=0.409-0.829, P=0.001) compared with Q1 was an influencing factor for male death after discharge. SUA/Scr in Q4 compared with Q1 was an influencing factor for death due to large artery atherosclerotic cerebral infarction in the male cerebral infarction subgroup (HR=0.580, 95%CI=0.386-0.873, P=0.007) .

Conclusion

Within a certain range, the increased SUA/Scr ratio in the acute stage of cerebrovascular disease has a certain protective effect on the recurrence and death of cerebrovascular events in male patients. Low SUA/Scr ratio is associated with the increased risk of death and recurrence of male patients with large artery atherosclerotic cerebral infarction, but not correlated with small artery occlusion cerebral infarction and cardiogenic stroke. SUA/Scr is not correlated with cerebrovascular event recurrence or death in female patients.

Trend of Onset Time of Diabetes Mellitus and Its Correlation with Chinese Visceral Adiposity Index: a Prospective Cohort Study

LIU Qingping, KE Juzhong, SONG Jiahui, GAO Jiaojiao, LI Zhitao, WANG Xiaonan, QIU Hua, ZHOU Yi, RUAN Xiaonan, WU Kang

2025, 28(02):  183-192.  DOI: 10.12114/j.issn.1007-9572.2024.0177

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Background

Diabetes mellitus is a global public health issue. Cross sectional studies have found that visceral fat is closely related to the prevalence of diabetes mellites, while prospective cohort studies on the trend of onset time of diabetes mellitus and its correlation with Chinese visceral adiposity index (CVAI) are scant.

Objective

To analyze the trend of onset time of diabetes mellitus and its correlation with CVAI in Pudong New Area, Shanghai, residents by the prospective cohort study, thus providing evidence for the scientific prevention and treatment of diabetes mellitus.

Methods

This was a prospective cohort study involving 5 236 residents from 12 townships and 35 village committees who participated in the chronic disease risk factor monitoring project in Pudong New Area, from January to July, 2013. Baseline data were collected, including CVAI, visceral adiposity index (VAI), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), a body shape index (ABSI), and body adiposity index (BAI). Follow-up was conducted in 2016 and 2019. By the end of follow-up in October 2019, the incidence of new onset of diabetes mellitus in this cohort was calculated through questionnaire survey, laboratory testing, medical system visit information and vital statistics information system. According to the baseline quartile, the CVAI, VAI, BMI, WC, WHR, WHtR, ABSI, and BAI of the included population were divided into Q1 to Q4 quartiles. The number of cases in CVAI Q1-Q4 groups was 1 306, 1 307, 1 307, and 1 307, respectively. The number of cases in VAI Q1-Q4 groups was 1 300, 1 316, 1 306, and 1 306, respectively. The number of cases in BMI Q1-Q4 groups was 1 305, 1 302, 1 312, and 1 311, respectively. The number of cases in WC Q1-Q4 groups was 1 302, 1 273, 1 287, and 1 367, respectively. The number of cases in WHR Q1-Q4 groups was 1 180, 1 203, 1 332, and 1 514, respectively. The number of cases in WHtR Q1-Q4 groups was 1 199, 1 393, 1 400, and 1 237, respectively. The number of cases in ABSI Q1-Q4 groups was 1 316, 1 302, 1 302, and 1 308 respectively. The number of cases in BAI Q1-Q4 groups was 1 310, 1 304, 1 308, and 1 307, respectively. The multivariable Cox regression analysis was used to analyze the correlation of CVAI and other obesity indicators with the onset of diabetes mellitus. The predictive potential of CVAI and other obesity indicators in diabetes mellitus was assessed using receiver operator characteristic (ROC) curves.

Results

The incidence density of diabetes mellitus in Pudong New Area was 33.55/1 000 person-years from 2013 to 2016, and 23.25/ 1 000 person-years from 2017 to 2019. With aging, the total incidence density of diabetes mellitus showed an increasing trend (2013-2016: χ²=28.503, P_trend<0.001; 2017-2019: χ²=25.600, P_trend<0.001). By 2016, the baseline CVAI quartile was positively correlated with the cumulative incidence of diabetes mellitus (CVAI: χ²=131.865, P_trend<0.001) and the incidence density (CVAI: χ²=100.105, P_trend<0.001). Mutivariable Cox regression analysis after adjusting for relevant confounders showed that compared with CVAI in Q1, the risk of diabetes mellitus in men with CVAI in Q4 increased by 79.4% (HR=1.794, 95%CI=1.044-3.083, P<0.05). Women had a 371.2% increased risk of diabetes mellitus (HR=4.712, 95%CI=2.601-8.538, P<0.05). ROC curve results showed that in predicting the incidence of male diabetes, the area under the ROC curve (AUC) of CVAI for male diabetes was 0.600 (95%CI=0.561-0.640), with the Youden index of 0.181, and the cutoff value of 104.118. Delong test showed that CVAI had the highest accuracy in predicting female diabetes mellitus (AUC=0.699), with the Youden index of 0.317, and the optimal cutoff value of 104.609.

Conclusion

From 2013 to 2019, the incidence density of diabetes mellitus increased with the increased age in Pudong New Area, Shanghai. Compared with other obesity indicators, CVAI can be used as an indicator to predict the risk of diabetes mellitus.

Effects of Balance-strengthening Training on Balance Ability in Elderly Inpatients with Schizophrenia: a Randomized Controlled Trial

QIN Wei, TU Gangying, WAN Xiaomei, WANG Fang

2025, 28(02):  193-199.  DOI: 10.12114/j.issn.1007-9572.2024.0215

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Background

The incidence of falls among elderly inpatients with psychiatric disorders is on the rise. A lack of adequate physical activity and a sedentary lifestyle have become prevalent among hospitalized elderly patients. Balance training has been demonstrated to be efficacious in reducing the occurrence of falls, yet its application within psychiatric care remains limited.

Objective

To explore the effect of balance intensive training on balance ability of hospitalized elderly patients with schizophrenia.

Methods

Seventy-two elderly patients with schizophrenia from a tertiary psychiatric hospital in Jiangxi Province were selected as objects for this research in 2023. Participants were randomly assigned into experimental group (n=36) and control group (n=36). The control group received standard rehabilitation training, whereas the experimental group was provided with a balance-strengthening training program in addition to the standard regimen. The Berg Balance Scale (BBS), the Chinese version of the Barthel Index (BI), and the International Falls Effectiveness Scale (FES-I) were utilized to assess patients at baseline and after 4 and 12 weeks of intervention.

Results

A total of 62 patients completed the study, with 30 in the experimental group and 32 in the control group. Two-factor repeated measurement ANOVA showed that there was interaction between group and time on BBS and BI scores (P<0.05), group had significant main effect on BBS scores (P<0.05), but had no significant effect on BI scores (P>0.05), and time had significant effect on BBS and BI scores (P<0.05). After 12 weeks of intervention, the BBS and BI scores of experimental group were higher than those of control group (P<0.05). Intra-group comparison showed that the BBS and BI scores of the experimental group were higher at 4 weeks of intervention than before intervention, and the BBS and BI scores after 12 weeks of intervention were higher than before intervention and 4 weeks of intervention, with statistical significance (P<0.05). Group and time had interaction effects on the total score of FES-I and indoor and outdoor activity scores (P<0.05). The main effect on FES-I indoor activity score was significant (P<0.05), but the main effect on FES-I total score and outdoor activity score was not significant (P>0.05). The main effects of time on the total score of FES-I and indoor and outdoor activity scores were significant (P<0.05). After 12 weeks of intervention, the total score of FES-I and indoor and outdoor activity scores of experimental groups were higher than those of control group (P<0.05). Intra-group comparison showed that the total score of FES-I and indoor and outdoor activity scores of experimental groups were higher than before intervention at 4 weeks (P<0.05) ; the total score of FES-I and indoor and outdoor activity scores at 12 weeks of intervention were higher than those before and after 4 weeks of intervention (P<0.05) .

Conclusion

Implementing a balance-strengthening training program among elderly inpatients with schizophrenia can lead to significant improvements in balance, self-care, and fall self-efficacy, thereby potentially reducing the risk of falls.

Health-related Quality of Life of Elderly Hypertensive Population in Northwest China

QI Mingrui, WANG Wenjuan, TIAN Limin

2025, 28(02):  199-207.  DOI: 10.12114/j.issn.1007-9572.2023.0302

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Background

Hypertension is a growing public health problem in China. In recent years, more and more studies have begun to focus on the quality of life of hypertensive older adults, and explore the factors affecting their quality of life, which is of great significance for the development of effective health management programs for hypertension.

Objective

To measure the health state utility (HSU) of hypertensive older adults in Northwest China using the EQ-5D-5L scale and the 15D scale, evaluate the health-related quality of life (HRQoL) of them, and explore the main factors affecting HRQoL in the elderly.

Methods

A total of 2 000 older adults were randomly recruited in Lanzhou City, Gansu Province in 2021, the clinical data were collected through questionnaires, basic physical examination and laboratory tests, and HSU was measured using the EQ-5D-5L and 15D scales. Subgroup analysis, Tobit regression analysis and multiple linear regression analysis were used to evaluate the factors affecting HRQoL.

Results

A total of 1 784 older adults participated in this study, 50.9% of them had normal blood pressure, 676 (37.9%) had stage 1 hypertension, 152 (8.5%) had stage 2 hypertension, 48 (2.7%) had stage 3 hypertension, the HSU of these older adults were 0.949, 0.942, 0.933, and 0.921 in the EQ-5D-5L, and 0.875, 0.863, 0.851, and 0.840 in the 15D scale, respectively. Tobit regression analysis showed that gender, age, years of education, occupational status, and annual income were associated with HSU in older adults in the EQ-5D-5L scale (P<0.05), multiple linear regression analysis showed that gender, age, years of education, hypertension, and alcohol consumption were associated with HSU in older adults in the 15D scale (P<0.05) .

Conclusion

The HSU of older adults in both EQ-5D-5L scale and 15D scale gradually decrease with the increase of blood pressure level, indicating a progressive impairment of HRQoL. Factors affecting HRQoL in older adults include gender, age, hypertension, years of education, marital status, occupational status, annual income and alcohol consumption.

Correlation between Upper Limb Motor Function and Attention after Stroke: a Multicenter Cross-sectional Study

LIN Jiali, ZHANG Shuyang, LIN Jiaying, ZHOU Yuxin, ZHAO Yuehua, CHEN Yun, JIA Jie

2025, 28(02):  208-213.  DOI: 10.12114/j.issn.1007-9572.2024.0180

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Background

Upper limb motor dysfunction is a common functional disorder after stroke. Attention may have an impact on the recovery of upper limb motor function, but there is little evidence of correlation between upper limb motor function and attention.

Objective

To explore the correlation between upper limb motor function and attention after stroke, and to provide a new perspective for clinical rehabilitation of upper limb function.

Methods

A total of 480 stroke patients who were hospitalized in the Department of Rehabilitation Medicine of 26 units in China from March to October 2023 were selected as the study subjects. The Fugl-Meyer Assessment Upper Limb (FMA-UL) and Montreal Cognitive Assessment (MoCA) were used to evaluate the upper limb motor function and attention of the patients, respectively. Pearson correlation analysis was used to explore the correlation between the total score of FMA-UL and the scores of attention assessment items in MoCA.

Results

Among the 480 patients, 105 patients did not finish the complete evaluation, so finally, 375 patients with stroke were included. The average FMA-UL score was (31.26±22.49) points. The average MoCA-Attention score was (4.74±1.60) points. The average Attention-Forward Digit Span and Backward Digit Span task score was (1.62±0.63) points; the average Attention-Vigilance task score was (0.74±0.45) points; the average Attention-Serial 7s task score was (2.39±0.95) points. The total FMA-UL score of male patients was higher than that of female patients (P<0.05). The total score of FMA-UL in all patients was positively correlated with the total score of MoCA-Attention, the score of Forward Digit Span and Backward Digit Span task, the score of Vigilance task, and the score of Serial 7s task (r=0.226, 0.146, 0.195, 0.182, P<0.05). The total score of FMA-UL in male patients was positively correlated with the total score of MoCA-Attention, the score of Forward Digit Span and Backward Digit Span task, the score of Vigilance task, and the score of Serial 7s task (r=0.236, 0.128, 0.213, 0.197, P<0.05) .

Conclusion

There is a significant and positive correlation between upper limb motor function and attention after stroke. The correlation between sustained attention and upper limb motor function is higher, and the correlation between attention span and upper limb motor function is lower. After grouping according to gender, the correlation between upper limb motor function and attention in male patients is the same as the above, while the correlation between upper limb motor function and attention in female patients is not significant, and gender may have an impact on the correlation between upper limb motor function and attention.

Study on the Infection and Related Factors of High-risk HPV in Cervical Cancer Screening Women: Based on 450 000 Participants in Chengdu

SHU Ting, LAN Zhipeng, WU Xia, LUO Yingjuan, YANG Liu

2025, 28(02):  213-219.  DOI: 10.12114/j.issn.1007-9572.2024.0269

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Background

Cervical cancer, a prevalent malignancy in women, has a well-established etiology and can be effectively prevented through standardized screening. The WHO recommends HPV testing as the primary method for cervical cancer screening. Understanding the status of high-risk human papillomavirus (hrHPV) infection in Chengdu is crucial for optimizing primary hrHPV screening.

Objective

To investigate the hrHPV infection status among cervical cancer screening participants aged 35-64 years in Chengdu, and explore the related factors affecting the positive detection rate of hrHPV.

Methods

We retrospectively analyzed data from 459 433 women who received free cervical cancer screening in Chengdu in 2023, sourced from the "Chengdu Reproductive Health Database of Women of Childbearing Age". We analyzed the overall distribution of different hrHPV genotypes and the distribution of hrHPV subtypes in patients with cervical lesions, and compared the hrHPV infection in different populations. Multivariate Logistic regression models identified factors affecting the positive detection rate of hrHPV.

Results

The hrHPV prevalence among participants was 11.65% (53 509/459 433), with an increase observed with age (χ²=1 501.082, P<0.001). Among cervical cancer patients, 82.39% (131/159) were infected with HPV 16 or 18, predominantly with simple HPV 16 infection (52.20%, 83/159). Multivariate Logistic regression analysis revealed that age, education level, marital status, menopausal status, contraceptive method, gravidity, and parity were significant factors influencing the positive detection rate of hrHPV (P<0.05) .

Conclusion

The hrHPV infection prevalence in Chengdu is slightly lower than the national average. The findings suggest a need for targeted health education and follow-up, particularly for patients positive for HPV 16 or 18. Emphasis should be placed on carrying out related publicity to groups such as the elderly, less educated, unmarried or divorced/widowed, postmenopausal women, those not using contraception or using methods other than condoms, and women with gravidity and parity more than twice, so as to strengthen the publicity of the core knowledge of cervical cancer prevention and control and reproductive health knowledge, and improve women's health literacy.

Interpretable Analysis of Influencing Factors and the Current State of Social Frailty in Patients with Chronic Heart Failure

LU Jing, SUN Guozhen, WANG Jie, GAO Min, YU Tianxi, SUN Shuyi, WANG Qin, WEN Gaoqin

2025, 28(02):  220-227.  DOI: 10.12114/j.issn.1007-9572.2023.0917

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Background

The comprehensive management of heart failure in conjunction with frailty necessitates a multidimensional approach to frailty assessment. However, the social frailty, despite being an incremental predictor of negative health outcomes in heart failure patients, has not been adequately addressed.

Objective

To understand the current status of social frailty in patients with chronic heart failure and analyze its influencing factors.

Methods

From September 2022 to July 2023, convenience sampling was used to select patients with chronic heart failure from the First Affiliated Hospital with Nanjing Medical University as the research objects, the general information questionnaire, the HALFT Scale, the Loneliness Scale, the Brief 2-Way Social Support Scale, Personal Mastery Scale, and the Patient Health Questionnaire were used to investigate. Univariate analysis and support vector machine-feature recursive elimination were used to filter the feature, SVM classification model was constructed, and SHAP value was introduced to analyze the influencing factors.

Results

A total of 228 patients were screened in this study, of which 8 patients refused to fill in. A total of 220 questionnaires were distributed and 213 valid questionnaires were returned, with an effective recovery rate of 96.81%. The proportion of pre-social frailty and social frailty in patients with chronic heart failure was 46.0% (98/213) and 17.8% (38/213), respectively. Statistically significant differences were observed among chronic heart failure patients with different degrees of social frailty in terms of education level, place of residence, working status, economic burden of disease, personal monthly income, course of disease, exercise habits, medical satisfaction, traffic, the UCLA Loneliness Scale score, the Brief 2-Way Social Support Scale score, the PMS score, and the PHQ-9 score. When the SVM-RFE model play the best performance, the optimal feature subset was used to construct the SVM classification prediction model and perform SHAP interpretability analysis. The accuracy of the model was 0.73 in the training set and 0.63 in the test set, respectively. At this time, the ranking of feature importance from high to low was no exercise habit (+), personal mastery (-), heavy economic burden of disease (+), 2-way social support (-), depression (+), loneliness (+), unemployment (+) .

Conclusion

Patients with chronic heart failure experiencing severe social frailty. Healthcare providers should prioritize identifying and addressing the resource deficits of patients and the underlying factors contributing to social frailty. Targeted interventions should be implemented to mitigate social frailty in patients with heart failure by enhancing external support systems, fostering positive beliefs, addressing negative emotional experiences, developing comprehensive management plans, coordinating medical resources, and implementing strategies to delay or reverse social frailty progression. These interventions aim to enhance the prognosis and quality of life for patients with heart failure.

Original Research·Quality Improvement in Health Services

Current Status of Implementation of Patient Involvement in Health Care to Improve Quality of Care among Chronic Obstructive Pulmonary Disease: a Scoping Review

CHU Hongling, LI Shurun, LI Xinlin, CHEN Yahong

2025, 28(02):  228-233.  DOI: 10.12114/j.issn.1007-9572.2024.0082

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Background

In patient involvement, patients are transforming from mere recipients to collaborators in medical services by integrating their experiences and needs throughout the entire healthcare process into medical practice. This aims to enhance the effectiveness, efficiency, and quality of healthcare services. However, the implementation of proven patient-centered strategies for patient involvement in the quality improvement among chronic obstructive pulmonary disease (COPD) in our country remains to be explored.

Objective

This scoping review systematically reviews and analyzes the existing strategies for patient involvement among patients with COPD to provide a reference for implementation that in China.

Methods

Employing the scoping review guidelines of Joanna Briggs Institute in Australia as the methodological framework, the relevant studies on patient involvement among patient with COPD were searched by computer on PubMed, Embase, Cochrane Library, CNKI, Wanfang Data, China Biology Medicine disc, from the establishment of the database to November 29, 2022. A thematic analysis was methodically applied to distill and synthesize findings.

Results

A total of 37 articles were included in this review. The categorization of patient involvement was divided into three types: direct involvement in medical care, organizational-level, and clinical research. Based on the intensity of involvement, categories were further classified into three levels: consultation, engagement, and collaborative leadership. A nine-category matrix of patient involvement behaviors was constructed through intensity and type. The implementation of COPD patient engagement was primarily reflected in five categories encompassing eight behaviors, including: integration in direct medical care (patients expressing their preferences and wishes regarding treatment plans) ; consultation at the organizational management level (assessing patient treatment experiences and organizing discussions around patients' concerns) ; as well as involvement in clinical research, including consultation (listening to patient needs) and engagement (expressing preferences and wishes for interventions, involved in the development of assessment tools, and in discussions about research design and implementation). Assessing patient treatment experiences (10 articles, 27.03%) and expressing patient preferences and wishes regarding interventions (10 articles, 27.03%) were the two most frequently implemented behaviors of patient involvement in COPD.

Conclusion

There are numerous measures for patient involvement in the improvement of medical quality, but there is still limited practice in the field of COPD. Very few studies have assessed the impact of patient involvement on clinical outcomes and quality of life, indicating that the practice of patient involvement in China requires further exploration.

A Study of Space Allocation and Optimization of Traditional Chinese Medical Institutions Based on Medical Service Radius: a Case Study of Zengcheng District, Guangzhou City

LI Chengcheng, ZHOU Shangcheng, HE Kaiyue, LIU Ailing, LIANG Shanshan, GAO Jing, ZHONG Ailin

2025, 28(02):  234-241.  DOI: 10.12114/j.issn.1007-9572.2023.0624

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Background

As China's Traditional medicine is included in the ICD-11 code, the rational allocation of basic TCM medical resources is the guarantee to promote the integration of traditional Chinese medicine and western medicine and the universal coverage of high-quality medical resources. The uneven layout and service capabilities of grassroots medical institutions have led to a widespread imbalance in the supply and demand of medical resources in urban and rural areas.

Objective

Understand the development status of traditional Chinese medicine services in rural areas of China, scientifically evaluate the coverage and accessibility of grassroots traditional Chinese medicine diagnosis and treatment, provide new ideas for optimizing the spatial resource allocation of grassroots traditional Chinese medicine services, and propose optimization strategies accordingly.

Methods

Based on the seventh national population census data and path planning data, the concept of medical service radius is introduced to calculate the diagnosis and treatment scope of different levels of traditional Chinese medicine medical institutions under walking mode. Using methods such as spatial kernel density index and spatial standard deviation ellipse to reveal the spatial fairness of the supply and demand capacity of traditional Chinese medicine medical services. Based on the above results, propose types and measures for optimizing the layout of traditional Chinese medicine medical resources.

Results

As of 2022, there are a total of 699 medical institutions in Zengcheng District, including 18 traditional Chinese medicine medical institutions with beds. There were significant differences in the distribution of beds in traditional Chinese medicine medical institutions in different townships and streets. Meanwhile, the number of beds per thousand population in Zhongtan Town was 14.31, ranking first among all streets. The number of beds per thousand people in Yongning Street ranks last, with only 0.89 beds. Traditional Chinese medicine medical institutions in Zengcheng District had shown a clear dual center pattern, with weak accessibility to traditional Chinese medicine services for residents in the central part of Zhongxin Town, the northern part of Paitan Town, and the southwestern part of Shitan Town. The supply capacity of traditional Chinese medicine services varies greatly among different townships. There was still a certain degree of inconsistency between the spatial distribution of traditional Chinese medicine medical institutions and the overall spatial clustering of urban residents. There were differences in the radius of traditional Chinese medicine services between different townships.

Conclusion

Since the implementation of the development strategy of traditional Chinese medicine, China's Traditional medicine has been protected and developed. We should adopt a more scientific strategy to closely integrate traditional Chinese medicine services with the development of the city and the needs of residents. We should actively adopt a differentiated strategy of increasing facility points, combining resource transfer and sinking, and integrating traditional Chinese medicine information technology for diagnosis and treatment across regions, gradually achieving a true strategy of full coverage and equal emphasis on traditional Chinese and Western medicine.

Drug Use Guide

Pre-treatment and Acquired Antiretroviral Drug Resistance among People Living with HIV in Southwest China

KONG Linghong, XIE Xiaoxin, FU Yanhua, GAN Lin, YANG Xiaoyan, MA Shujing, LONG Hai

2025, 28(02):  242-249.  DOI: 10.12114/j.issn.1007-9572.2024.0038

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Background

The prevalence and epidemiology of pre-treatment drug resistance (PDR) and acquired drug resistance (ADR) among HIV-infected individuals vary considerably in different regions of China. Both types of drug resistance have adverse effects on the antiviral treatment outcomes for patients, potentially exacerbating their poor prognosis. Currently, there is a paucity of research on the prevalence and epidemiology of PDR and ADR among HIV-infected individuals in Southwest China.

Objective

This study investigated the prevalence and epidemiology of pre-treatment drug resistance and acquired drug resistance among people living with HIV (PLWH) in Southwest China.

Methods

This was a large cross-sectional study that enrolled PLWH who visited Guiyang Public Health Clinical Center between January 1, 2021, and June 30, 2023, and underwent drug resistance gene testing. HIV-1 genotype and drug resistance were analyzed using HIV-1 pol sequence. The Stanford University HIV Drug Resistance Database was used to analyze major drug resistance mutations in the reverse transcriptase and protease Sanger sequences. Risk factors associated with pre-treatment drug resistance were evaluated using a Logistic regression model.

Results

A total of 1 613 individuals were included in the study, with 824 ART-naive and 789 ART-experienced. The most common genotype among ART-naive patients was B+C (47.0%), and the drug resistance rate was 18.7% (154/824) with non-nucleoside reverse transcriptase inhibitors (NNRTIs) accounting for 14.9% (123/824), nucleoside reverse transcriptase inhibitors (NRTIs) accounting for 1.7% (14/824), protease inhibitors (PIs) accounting for 2.7% (22/824), and integrase strand transfer inhibitors (INSTIs) accounting for 1.9% (16/824). Among the ART-experienced patients, the most common genotype was CRF01-AE (37.4%), with a drug resistance rate of 27.8% (219/789). The mutation rates for NNRTIs, NRTIs, PIs, and INSTIs were 7.7% (61/789), 19.3% (152/789), 2.7% (21/789), and 1.1% (9/789), respectively. Furthermore, multivariate Logistic regression modeling revealed that transmission route, CD₄⁺ T-cell count, viral load, and the time interval between diagnosis and ART initiation were associated with an increased risk of pre-treatment drug resistance (P<0.05) .

Conclusion

The incidence of pre-treatment drug resistance and acquired drug resistance mutations among PLWH in Southwest China is relatively high, 18.7% and 27.8% respectively. Transmission route, CD₄⁺ T-cell count, viral load, and the time interval between diagnosis and ART initiation are associated with an increased risk of pretreatment drug resistance. Therefore, to prevent the development of resistance, there is an urgent need for routine baseline genotypic resistance testing and adequate intervals for viral load monitoring.

Clinical Observation of the New Antiepileptic Drug Perampanel in the Treatment of Refractory Epilepsy in Children Aged 0-18 Years

MA Huping, REN Rong, HOU Mei, YUAN Aiyun

2025, 28(02):  250-256.  DOI: 10.12114/j.issn.1007-9572.2024.0031

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Background

Currently, the treatment of refractory epilepsy (RE) in children is still a difficult point in epilepsy treatment. In China, pirenzapine (PER) is still a new drug for treating RE in children, and there is currently a lack of recommendations for adding PER to the treatment of RE in children. And in Chinese reports, the sample size of RE patients treated with PER is relatively small. Therefore, the efficacy of PER for pediatric RE, especially for young children with RE, still needs to be further studied with a large sample size.

Objective

To explore the efficacy, possible indications, adverse reactions, and tolerability of PER addition therapy for RE in children.

Methods

A self-control and retrospective analysis was conducted on children with RE aged 0-18 who were treated at the Women and Children's Hospital, Qingdao University from January 2022 to January 2023. The frequency of seizures at different observation points before and after the addition of PER treatment was compared, and the effective rate of PER was evaluated. Adverse drug reactions and drug retention rates were recorded, and the clinical characteristics of the effective and ineffective groups of PER were analyzed.

Results

A total of 192 study subjects were included. After adding PER treatment, the effective rates at 12, 24, and 36 weeks were 56.3% (108/192), 62.1% (113/182), and 69.7% (122/175), respectively, and the seizure free rates were 19.3% (37/192), 21.4% (39/182), and 24.6% (43/175). The incidence of adverse reactions was 16.1% (31/192), mainly including dizziness, irritability, weakness, and drowsiness. The last follow-up drug retention rate was 91.1% (175/192). There was a statistically significant difference in the onset age, duration of anti-epileptic treatment, type of origin, seizure form, frequency of seizures before the addition of PER, number of combined anti-epileptic drugs (ASMs), and ketogenic diet/surgical treatment between patients with RE who received continuous medication for 12 weeks (P<0.05). In addition, 178 children underwent EEG examination, and 167 children underwent cranial magnetic resonance imaging examination. There was a statistically significant difference in the electroencephalogram (EEG) and head magnetic resonance imaging (MRI) results between patients who received effective and ineffective treatment. In the results of electroencephalogram examination, the effective rate of discharge in the anterior (anterior, middle, temporal anterior, and middle) part of the brain was higher (P<0.05) ; In the results of cranial imaging examination, the normal group had a higher effective rate, followed by children with mainly white matter damage.

Conclusion

The overall effective rate and retention rate of PER addition therapy for RE in children are high, with mild adverse reactions and good drug tolerance. It is more effective for children with RE who have a late onset age, seizures in the form of motor seizures, focal origin, short course of anti-epileptic treatment, fewer combination medications, and less frequency of seizures. In electroencephalography, patients with normal discharge in the anterior (anterior, middle, anterior temporal, and middle temporal) of the brain and normal results in cranial magnetic resonance imaging have a higher effective rate.