Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-08-02 Cooperative journals: 《中国全科医学》
Public Health Security and Health Professional Committee of the Public Safety Science and Technology Society
General Practitioner Branch of Chinese Medical Doctor Association
Abstract： Primary health governance is a crucial part of the national health governance system and plays a key role in achieving universal health. However，primary health governance currently faces many challenges. The Expert Consensus on Primary Health Governance is led by the Public Health Security and Health Professional Committee of the Public Safety Science and Technology Society，in collaboration with experts from multiple disciplines. The aim of this consensus is to integrate evidence-based scientific evidence，practical wisdom，and experience from multidisciplinary experts in primary health-related fields. This consensus addresses the connotations，significance，objectives，basic principles，system construction elements，capacity building elements，institutional elements，and technical means of primary health governance. It provides scientific，systematic，and operable consensus opinions and suggestions to enhance the level of primary health governance，standardize primary health governance practices，promote the equalization of primary health services，strengthen the cultivation of primary health governance talents，and drive innovation in health governance. This will provide scientific basis and recommendations to support the realization of the "Healthy China 2030".
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-08-01 Cooperative journals: 《中国全科医学》
GAO Lan
ZHANG Xiangning
XIE Haotai1 ，FAN Fangfang1 ，JIA Jia1 ，LI Jianping1，2，MA Wei1 ，ZHANG Yan1，2*GAO Lan1 ，ZHANG Xiangning1 ，XIE Haotai1 ，FAN Fangfang1 ，JIA Jia1 ，LI Jianping1，2，MA Wei1 ，ZHANG Yan1，2*
GAO Lan1 ，ZHANG Xiangning1 ，XIE Haotai1 ，FAN Fangfang1 ，JIA Jia1 ，LI Jianping1，2，MA Wei1 ，ZHANG Yan1，2*
GAO Lan1 ，ZHANG Xiangning1 ，XIE Haotai1 ，FAN Fangfang1 ，JIA Jia1 ，LI Jianping1，2，MA Wei1 ，ZHANG Yan1，2*
GAO Lan1 ，ZHANG Xiangning1 ，XIE Haotai1 ，FAN Fangfang1 ，JIA Jia1 ，LI Jianping1，2，MA Wei1 ，ZHANG Yan1，2*
GAO Lan1 ，ZHANG Xiangning1 ，XIE Haotai1 ，FAN Fangfang1 ，JIA Jia1 ，LI Jianping1，2，MA Wei1 ，ZHANG Yan1，2*
GAO Lan1 ，ZHANG Xiangning1 ，XIE Haotai1 ，FAN Fangfang1 ，JIA Jia1 ，LI Jianping1，2，MA Wei1 ，ZHANG Yan1，2*
Abstract： Background At present，cardiovascular diseases still have a high incidence and mortality worldwide. Subendocardial viability ratio（SEVR）is calculated from the analysis of left ventricular and aortic pressure curves in invasive hemodynamic studies，serving as a valuable indicator of myocardial perfusion，and predictive factor for cardiovascular adverse events and mortality in different populations. Although having certain limitations，non-invasive measurements of SEVR are valuable tools for evaluating myocardial perfusion and assessing cardiovascular risk. However，large-scale epidemiological studies to explore the practical value of SEVR in primary and secondary prevention of cardiovascular diseases are scant.Objective This study aims to non-invasively measure SEVR in a large-scale Beijing community-based population and to identify the influencing factors. Methods It was a cross-sectional follow-up study involving a cohort of residents（≥ 40 years of age）with atherosclerosis in the Shougang Community，Shijingshan District，Beijing，who were treated in the Department of Cardiology of Peking University First Hospital from December 2011 to April 2012. Non-invasive SEVR measurements were conducted using Pulsepen（DiaTecne srl，San Donato Milanese，Italy）during the follow-up period in 2018. Generalized linear regression models were applied to analyze influencing factors for SEVR. Results A total of 6，568 participants followed up in 2018 were initially enrolled. After excluding those without SEVR data for arrhythmia（2.8%），6，382 eligible ones were finally included in our study. SEVR measurements were obtained from 97.2% of patients. In the cohort，there were 2，130 males and 4，252 females，with a mean SEVR of （144±22）%. The Multivariable regression analysis showed that sex（β=-11.00），age（β=-0.53），smoking（β=2.36），hypertension（β=-4.12），dyslipidemia（β=-1.45），diabetes（β=-4.36），antihypertensive drugs（β=3.72），and hypoglycemic treatment（β=-3.71）were independently associated with SEVR（P<0.05）. In males，age（β=-0.67），hypertension（β=-3.20），dyslipidemia（β=-2.73），diabetes（β=-3.42），and hypoglycemic treatment（β=-5.07）were independent influencing factors for SEVR（P<0.05）. In females，age（β=-0.48），smoking（β=9.44），hypertension（β=-4.98），diabetes（β=-4.95），antihypertensive drugs（β=5.26），and hypoglycemic treatment（β=-2.82）were independent influencing factors for SEVR（P<0.05）. Conclusion Non-invasive measurement of SEVR is feasible in large-scale community-based populations. SEVR is associated with traditional risk factors，such as sex，age，smoking，hypertension，dyslipidemia，and diabetes. The relationship between SEVR and medication needs to be explored through further research.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-08-01 Cooperative journals: 《中国全科医学》
Abstract： Background The cerebellar vermis is closely related to emotional regulation and cognitive function. There have been few reports on whether repeated transcranial magnetic stimulation（rTMS）of the cerebellar vermis can improve clinical symptoms in elderly patients with chronic schizophrenia（CSZ）. Objective Observing the effects of cerebellar vermis rTMS with theta burst stimulation（TBS）paradigm on negative symptoms，cognitive function，and serum inflammatory cytokine levels in elderly CSZ patients. Methods This study is a single blind randomized controlled trial. Fifty elderly CSZ patients in stable condition admitted to Shenyang Mental Health Center were selected between October 2022 and August 2023 as the subjects. Using a random number table method，CSZ patients were divided into an observation group and a control group，with 25 cases in each group. The patients in observation group were treated with rTMS with TBS paradigm，the stimulation site is the vermis of the cerebellum. The treatment was conducted 5 days a week，once a day，for 4 consecutive weeks. The patients in control group were intervention with pseudo stimulation，and the treatment time and parameters were the same as those in the observation group. Use the Positive and Negative Symptom Scale（PANSS）to evaluate overall psychiatric symptoms，and use the Negative Symptom Scale（SANS）to evaluate negative symptoms. Evaluate cognitive function using the MATRICS Recognized Cognitive Set Test （MCCB）. Detecting serum interleukin-1β（IL-1β），Interleukin-6（IL-6）and tumor necrosis factor α（TNF-α）.Results Compared with the control group，the observation group had lower PANSS negative symptom scores ［（17.11±2.00）scores vs （19.21±2.76）scores］，general psychopathological symptom scores ［（17.11±2.00）scores vs 19.21±2.76）scores］，total scores after treatment ［（29.33±4.27）scores vs （58.99±5.53）scores］，and lower SANS scale scores ［（54.00±3.78）scores vs （57.83±4.15）scores］（P<0.05）. Compared with the control group，the observation group had higher post-treatment information processing speed scores ［（39.78±2.45）scores vs （37.24±1.10）scores］，attention alertness scores［（47.07±4.27）scores vs（40.01±2.17）scores］，working memory scores［（45.12±3.20）scores vs（41.89±4.11）scores］，and social cognitive scores ［（46.40±4.29）scores vs （41.42±7.45）scores］（P<0.05）. Compared with the control group，the observation group had lower levels of IL-1β ［（41.09±7.34）μg/L vs （47.03±12.45）μg/L］，IL-6［（35.03±10.23）μg/L vs （41.28±7.32）μg/L］，and TNF-α ［（53.28±14.15）μg/L vs （61.35±12.79）μg/ L］ after treatment（P<0.05）. During the rTMS treatment process，only 4 cases in the observation group experienced dizziness and headache symptoms during the first treatment，which gradually became tolerable with prolonged treatment time. All other patients have no complaints of discomfort. Conclusion The rTMS with TBS paradigm can improve negative symptoms，cognitive function，and serum inflammatory factor levels in elderly patients with CSZ.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-08-01 Cooperative journals: 《中国全科医学》
Abstract： Background Insomnia disorder is a common mental health condition that significantly impacts patients' lives and well-being. Traditional cognitive-behavioral therapy for insomnia（CBT-I） is an effective non-pharmacological treatment method，but its complexity，time-consuming nature，and low compliance limit its real-world application. Brief behavioral therapy for insomnia（BBT-I），based on CBT-I principles，offers comparable efficacy while being more suitable for real-world dissemination. However，the applicability of BBT-I to the Chinese population with insomnia disorder remains unclear，and research on BBT-I conducted online is lacking. Objective This study aims to investigate the efficacy of online e-aid brief behavioral therapy for insomnia（eBBT-I） delivered via WeChat Mini Program in improving insomnia symptoms among Chinese patients with insomnia disorder. Additionally，the study explores its impact on patients' sleep beliefs and attitudes. Methods This study employed a prospective non-randomized controlled design. Insomnia disorder patients from the Sleep Clinic at the First Affiliated Hospital of Jinan University between February and November 2023 were assigned to the intervention group. Insomnia disorder volunteers recruited online and offline were assigned to the control group. The intervention group received a 2-week eBBT-I（e-aid brief behavioral therapy for insomnia）treatment，while the control group received a sham intervention of mental health education. The severity of insomnia was assessed using the Insomnia Severity Index（ISI）and the Dysfunctional Beliefs and Attitudes about Sleep-16（DBAS-16） questionnaire before and after the intervention to evaluate its effectiveness. Results The study ultimately included 35 patients in the intervention group and 30 patients in the control group. Key outcome measures：There was a significant interaction effect between group and time for Insomnia Severity Index（ISI）scores（P<0.05）. Group and time separately had significant main effects on ISI scores（P<0.05）. No statistically significant difference in ISI scores was observed between the two groups at baseline（pre-intervention）（P>0.05）. After 14 days of intervention，the intervention group had lower ISI scores than the control group（P<0.05）. Within the intervention group，ISI scores decreased after 14 days compared to baseline（P<0.05）. Secondary outcome measures：There was no interaction effect between group and time for DBAS-16 scores（P>0.05）. Time had a significant main effect on DBAS-16 scores（P<0.05）. Group did not have a significant main effect on DBAS-16 scores（P>0.05）. No statistically significant difference in DBAS-16 scores was found between the two groups at baseline or after 14 days（P>0.05）. However，within the intervention group，DBAS-16 scores increased after 14 days compared to baseline（P<0.05）. This indicates that eBBT-I effectively improved insomnia symptoms and negative impact in patients with insomnia disorder，but further improvement in sleep beliefs and attitudes is still needed. Conclusion This study supports the feasibility and effectiveness of eBBT-I in the treatment of insomnia disorder among Chinese patients. It provides a more economical and efficient approach for both healthcare providers and patients，offering a new non-pharmacological option for insomnia treatment. Additionally，it contributes to the exploration of digital tools in the field of sleep.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-31 Cooperative journals: 《中国全科医学》
Abstract： Background With the improvement of economic level and changes in lifestyle of residents，the obesity among children and adolescents has become increasingly severe，threatening the healthy growth of children and adolescents.BMI was used as an evaluation index of obesity in most previous studies，which may underestimate the prevalence of central obesity. Therefore，it is urgent to evaluate the waist circumference（WC）and trend of the prevalence of central obesity among children and adolescents in Putuo District，in order to provide scientific basis for targeted proposed intervention. Objective To analyze WC and the trend in the prevalence of central obesity among children and adolescents aged 7-18 years in Putuo District，Shanghai，from 2018 to 2023. Methods Data on medical examinations of primary and secondary school students in Putuo District in 2018 and 2020-2023 were used to analyze the WC，the prevalence of central obesity and the trends. The 90th percentile（P90）age-specific children and adolescents of different genders was used as the cut-off point of high WC，and WC exceeding the P90 value was defined as central obesity. SPSS 22.0 and SAS 13.1 were used for statistical analysis and Excel 2021 was used for graphic plotting. Results A total of 280 648 primary and secondary school students participated in the medical examination in Putuo District，Shanghai，from 2018 to 2023，of which 146 334（52.1%）were male students and 134 314（47.9%）were female students，with an average age of 10.9±2.6 years. WC of male and female students from 2018 to 2023 showed fluctuating downward trends with a statistically significant difference（Hmale=209.785，Hfemale=373.076；P<0.001）. WC of male students decreased from 65.2（58.0，74.0）cm in 2018 to 64.8（56.9，74.0）cm in 2023 and female students decreased from 60.5（55.0，67.0）cm to 59.8（53.8，66.2）cm. Comparison of the prevalence of central obesity among male and female students in each year showed statistically significant differences（χ2 male=264.123，χ2 female=448.289；P<0.001）. The results of Cochran-Armitage trend test showed decreasing trends in prevalences of central obesity among male and female groups from 2018 to 2023（Ztrend male=-10.974，Ztrend female=-15.218；Ptrend<0.001）. The prevalence of central obesity among male students decreased from 28.8% to 24.6%，while that among female students decreased from 21.9% to 15.5%. WC and the prevalence of central obesity increased in 2022 for both sexes. Prevalence of central obesity showed increasing trends with age for both sexes（Ztrend male=35.167，Ztrend female=6.533；Ptrend<0.001）. Conclusion This study suggests that WC and the prevalence of central obesity among children and adolescents aged 7-18 in Putuo District are fluctuating and decreasing. WC and the prevalence of central obesity of male students are high than those of female students of the same age. The prevalence of central obesity is increasing with age. Results of this study provide theoretical support for the targeted intervention of central obesity in children and adolescents.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-31 Cooperative journals: 《中国全科医学》
Abstract： Background With the aging population，the incidence of pressure injuries（PI）is gradually increasing. This not only severely impacts the quality of life for patients but also increases healthcare expenditures. However，the early detection and accurate staging of PI heavily depend on specialized training. Objective To construct and validate an artificial intelligence model for the automatic detection and staging of pressure injuries（PI）aimed at enhancing the real-time nature，accuracy，and objectivity of PI diagnostics. Methods A total of 693 pressure injury images from the electronic management system of pressure ulcers at Changshu City First People's Hospital were selected from January 2021 to February 2024，categorized into six stages according to guidelines：Stage Ⅰ（154 images），Stage Ⅱ（188 images），Stage Ⅲ（160 images），Stage Ⅳ（82 images），unstageable（52 images），and deep tissue injury（57 images）. A deep learning object detection model for PI was established using five different versions of the YOLOv8 neural network and transfer learning. The model evaluation metrics included accuracy，sensitivity，specificity，false positive rate，and detection speed. Finally，the model was deployed to a mobile application via the Ultralytics Hub platform，facilitating the application of the AI model in clinical practice.Results During the evaluation of a test set containing 142 PI images，the YOLOv8l version demonstrated high accuracy（0.827） and fast inference speed（68.49fps），achieving the best balance between precision and speed among the YOLO versions. Specifically，it achieved an overall accuracy of 93.18% across all categories，a sensitivity of 76.52%，a specificity of 96.29%，and a false positive rate of 3.72%. Among the six stages of PI，the model achieved the highest accuracy for Stage Ⅰ at 95.97%.The accuracies for Stage Ⅱ，Stage Ⅲ，Stage Ⅳ，deep tissue injury，and unstageable were 91.28%，91.28%，91.95%，95.30%，and 93.29%，respectively. In terms of processing speed，YOLOv8l took a total of 2.07 seconds to process 142 images，averaging 68.49 PI images per second. Conclusion The AI model based on the YOLOv8l network can quickly and accurately detect and stage PI. Deploying this model to a mobile app allows for portable use in clinical practice，demonstrating significant potential for clinical application.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background Empirical research and evidence on the relationship among the medical insurance system reform，health status and life satisfaction of the elderly are scant. Objective To analyze the effects of the integration of the urban and rural residents basic medical insurance （URRBMI） on the self-evaluation of health status and life satisfaction of the Chinese elderly. Methods Based on the follow-up data of China Health and Retirement Longitudinal Study （CHARLS） from 2015 to 2018，elderly people over 60 years old with complete information were included as the research subjects. The demographic information，health status and function，medical care and insurance were extracted from the CHARLS questionnaire. According to the integration of URRBMI or not，subjects were assigned into URRBMI integration group and non integration group. Logistic regression model was used to analyze the effects of the integration of URRBMI on the self-evaluation of health status and life satisfaction of the elderly. In addition，a structural equation model was constructed to analyze the mediating effect with the URRBMI integration as an independent variable，self-evaluation of health status as a mediating variable，and life satisfaction as a dependent variable. Results A total of 4,364 subjects were analyzed in this study，including 694（15.90%） in the URRBMI integration group and 3,670（84.10%） in the non-integration group. The self-evaluation of health status in the URRBMI integration group was significantly better than that of the non-integration group（20.74% vs 17.41%，P=0.038），and the improvement rate was significantly higher（5.74% vs 3.12%）. The self-evaluation of health status in the URRBMI integration group was significantly superior（OR=1.281，95%CI=1.038-1.581）. The life satisfaction of the URRBMI integration group was significantly higher than that of the non-integration group（94.80% vs 91.87%，P=0.009）. The life satisfaction was better in the URRBMI integration group（OR=1.378，95%CI=1.037-1.831）. There was a partial mediating effect of the self-evaluation of health status on the impact of URRBMI integration on the life satisfaction，with the mediating effect value of 0.050（P=0.043），and the proportion of mediating effect in the total effect accounted for 46.66%. Conclusion The URRBMI integration is beneficial to improve the self-evaluation of the health status and life satisfaction of the elderly，which has a positive practical significance. In the future，further efforts should be made on strengthening the publicity of the URRBMI，constantly improving the medical insurance treatment level for urban and rural residents，establishing a more reasonable financing mechanism，promoting the quality of medical services in rural areas，and finally improving the health level of the elderly population.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background With the development of the integration of sports and medicine，as well as the increasingly severe situation and harm caused by knee osteoarthritis（KOA），the sports intervention for KOA has received widespread attention. Community settings are considered the optimal location for KOA sports interventions，but existing community-based KOA interventions suffer from issues such as non-standard processes，unclear regulations，and incomplete content，highlighting the urgent need for standardized models. Objective To construct a community KOA intervention model based on the integration of sports and medicine，and to apply and evaluate this model. Methods Through literature review and on-site observation，a conceptual framework for community KOA intervention model based on the integration of sports and medicine was initially proposed. This framework underwent refinement via expert interviews to establish its constituent elements and application processes，resulting in the establishment of the final model. The model was then applied to 62 KOA patients treated at the Maigaoqiao and Xigang Community Health Service Centers in Nanjing from July to October 2022. Patients were randomly divided into a sports intervention group and a health education group，both receiving an 8-week standardized treatment protocol. Outcome measures included the Visual Analogue Scale（VAS），Western Ontario and McMaster Universities Osteoarthritis Index Questionaire（WOMAC），EuroQol Five Dimensions Questionaire（EQ-5D），30-second chair stand test，and time up and go test（TUGT）. Results The community KOA intervention model based on the integration of sports and medicine established an interactive relationship between "sports" and "medicine" in terms of departments，personnel，technical means，etc.，including 5 primary elements and 24 secondary elements. Application of the model yielded the following outcomes：in the sports intervention group，post-treatment WOMAC total score and scores across all dimensions，VAS score，and TUGT time were significantly reduced compared to pre-treatment（P<0.05），while EQ-5D health index and 30-second chair stand repetitions were significantly increased（P<0.05）. In the health education group，post-treatment WOMAC total score and scores across all dimensions，as well as VAS score，were significantly lower than pre-treatment（P<0.05），with a higher EQ-5D health index（P<0.05）. Comparison between groups post-treatment revealed that the sports intervention group had significantly lower WOMAC total score，WOMAC joint function score，and VAS score compared to the health education group（P<0.05）.Conclusion The community KOA intervention mode based on the integration of sports and medicine effectively alleviates，pain and joint stiffness symptoms，improves lower limb muscle strength and balance ability，improves joint function，and enhances quality of life for KOA patients.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background Ethnic medicine holds numerous advantages in the treatment of premature ventricular complexes（PVCs）. However，there is a concerning trend of abuse of ethnic medicine，particularly in the absence of tailored clinical drug recommendations specifically designed for this purpose. Consequently，it is of crucial importance to standardize the diagnosis and treatment of PVCs within the context of ethnic medicine. Objective To establish the clinical problems and outcome indicators of the Expert Consensus on Clinical Application of Ethnic Medicine in the Treatment of Palpitation（ArrhythmiaPremature Ventricular Complexes）. Methods The inquiring experts were members of the consensus expert group，encompassing experts in the fields of cardiology，evidence-based medicine，and pharmacology. Specifically，within cardiology，they comprised multi-ethnic medical experts in traditional Chinese medicine，Tibetan medicine，Mongolian medicine，Uyghur medicine，Dai medicine，Korean medicine，and Zhuang medicine. Drawing from the available literature and expert interview reports，the research team conducted a comprehensive search of relevant literature on the treatment of PVCs using various ethnic medical practices. In April 2023，a series of one-on-one online interviews were conducted with 14 multi-ethnic medical experts. Following the integration of the interview results and expert experiences，the consensus steering committee and working group jointly drafted the initial proposals for clinical questions and outcome indicators，subsequently designing a survey questionnaire. Between May and July 2023，two rounds of questionnaire surveys were conducted，rigorously evaluating the positivity，concentration，coordination，and reliability of the questionnaire responses. Results The expert panel was characterized by its multidisciplinary collaboration，authority，and geographical representation. The two rounds of the Delphi method yielded a positive coefficient of 99.1%. For the five background questions，the mean score was greater than 4，with the full scale exceeding 40%. For the ten prospective questions，the mean score was greater than 3.9，with the full scale surpassing 35%. Additionally，the nine outcome indicators achieved a mean score greater than 7，with the full scale exceeding 30%. The mean coefficient of variation for these metrics was 14.9%，16.3%，and 17.6%. The Kendall harmony coefficients for clinical questions and outcome indicators were 0.267 and 0.316. The chi-square test showed a P-value of less than 0.05. The Cronbach's α coefficients were 0.913 and 0.905，both exceeding 0.7，suggesting high reliability. Overall，the quality control results were satisfactory，indicating a high degree of credibility in the questionnaire design. Conclusion Utilizing the Delphi method，we have identified the clinical problems and outcome indicators that need to be addressed in the development of the Expert Consensus on Clinical Application of Ethnic Medicine in the Treatment of Palpitation（Arrhythmia-Premature Ventricular Complexes），laying a solid foundation for the subsequent formulation of the consensus.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background Lumbar disc herniation is one of the most common causes of low back pain，and the number of cases has been increasing year by year in recent years. High-quality guidelines can standardize clinical diagnosis and treatment behaviors and improve medical quality，and screening and formulating high-quality guidelines are of great significance for standardizing the clinical practice of lumbar intervertebral disc herniation. Objective To systematically evaluate the methodological quality of clinical practice guidelines and expert consensus for lumbar intervertebral disc herniation，and to analyze the high-quality guidelines and consensus recommendations，in order to provide reference for the prevention and treatment of lumbar intervertebral disc herniation. Methods Clinical practice guidelines and expert consensus on lumbar intervertebral disc herniation were searched from the establishment of each database to October 31，2023. At the same time，Dangdang.com and others were manually searched to obtain the guidelines for lumbar intervertebral disc herniation published in the form of monographs. After the consistency evaluation was passed by two researchers，the methodological quality of the included guidelines and consensus was evaluated using the AGREE Ⅱ tool，and the high-quality guidelines and consensus recommendations were analyzed. Results A total of 15 guidelines and consensus were included，and the final recommendation level of 9 guidelines was B（can be recommended after modification），and 6 guidelines and consensus were C（not recommended for the time being）.Recommendations mainly include bed rest，medication，surgical treatment，etc. Conclusion The methodological quality of the clinical practice guidelines and expert consensus for lumbar intervertebral disc herniation needs to be further improved，and some treatment methods are controversial，and the recommendations of the guidelines need to be further improved and unified to optimize clinical practice.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background For a long time，“emphasizing medicine over prevention” has fragmented China's medical and health service system，making it difficult for residents to obtain comprehensive，coordinated，high-quality and efficient health services. The integration of medicine and prevention plays an essential role in enhancing the continuity and coordination of medical and health services and improving the health of residents. As the providers of the integration of medicine and prevention services，the enthusiasm and initiative of medical staff directly affect the integration of medicine and prevention services.Objective To explore the current status and problems during the integration of medicine and prevention from the perspective of medical and public health service providers and to put forward appropriate countermeasures. Methods Three counties（districts）were selected using typical and stratified sampling methods from northern，central，and southern Anhui. The job satisfaction of the integration of medicine and prevention from medical staff was analyzed by binary logistic regression. Results 71.2% of medical staff expressed understanding of the integration of medicine and prevention，18.6% expressed very good understanding，50.4% considered the integration of medicine and prevention very important，and 48.5% considered it necessary. The primary way to provide services of integration of medicine and prevention was to guide healthy lifestyles，which accounted for 92.0% of the total，83.3% of the total for education on health knowledge，and 84.1% for guidance on the rational use of medication. The main factors that affected the implementation of the integration of medicine and prevention included financial support，lack of human resources，lack of incentive mechanisms，etc. The satisfaction score of medical staff with the integration of medicine and prevention was（4.02±0.78）. The regression results showed that career development，salary，and work pressure significantly affected overall satisfaction with the integration of medicine and prevention（P<0.05），while job fulfilment did not. Conclusion This paper found that there are insufficients of the integration of medicine and prevention concerning service providing scope，ability，and guarantee mechanism. Therefore，to better provide residents with a high-quality integration of medicine and prevention，further expansion of the ways of service providing，optimizing the capacity and quality of the service team，and improving the guarantee mechanism are suggested.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background The construction of medical alliance is important measure for deepening medical reform. It aims to move the focus and resource to primary health care institutions，and improve service capabilities. Studies have shown that the medical alliance can improve the service capabilities of primary health care institutions，but the exact reason for this is not clear. Objective To analysis the service capabilities of the of primary health care institutions，and explore the impact of service capabilities in the context of medical alliance. Methods In December 2019，we survey on staffing、outpatient and inpatient service and medical alliance construction of 381 primary health care institutions which participated in medical alliance in Chengdu by structured questionnaire. Local administrative departments of public health gave out and recovered questionnaire. With the number of staff，registered generals，beds，outpatient and emergency visits，admission，and the use rate of the beds as the indicator of the service capabilities，we used rank sum ratio to analyze the comprehensive medical service capabilities and divide them to divide it for 3 gear. Using orderly Logistic regression to explore the influencing factors of integrated medical services. Results The median number of staff in 381 primary health care institutions is 54（48），registered generals is 4（8），beds is 50（50），outpatient and emergency visits is 49 460（60 317），admission is 1 440（2 071），the use rate of beds is 68.43%（45.18%）. According to the rank and ratio，there are 61（16.0%），260（68.3%），and 60（15.7%） institutions with good，medium and poor comprehensive medical service ability，respectively. The analysis of orderly Logistic regression analysis shows that institutional building area、teaching rounds and remote film reading are the influencing factors of the comprehensive medical service capabilities of primary health care institutions（P<0.05）. Conclusion The medical service capacity of primary health care institutions in Chengdu, Sichuan Province are relatively good. . Institutional building area、teaching rounds and remote film reading in the medical assistance method significantly affect the comprehensive medical service capabilities.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background In the context of "comprehensively promoting the construction of a healthy China" and "actively responding to the national strategy of aging population"，scientific evaluation of the performance of community embedded integrated medical and nursing care with characteristics of TCM is the key to improving the quality of integrated medical and nursing care. Objective Evaluate the performance of community embedded integrated medical and nursing care with characteristics of TCM and analyze main obstacles，providing practical basis for government departments to formulate relevant policies and carry out performance evaluation of it. Methods In November 2022，the performance evaluation index system for community embedded integrated medical and nursing care with characteristics of TCM was transformed into three questionnaires：basic information of the institution，satisfaction of staff and the elderly. From November 2022 to January 2023，a questionnaire survey method was used to collect basic data from 10 sample institutions，as well as satisfaction data from staff and the elderly. From February to March 2023，the TOPSIS method was used to evaluate the performance of community embedded integrated medical and nursing care with characteristics of TCM，and the obstacle degree model was used to analyze the main obstacle factors of service performance. Results The overall embeddedness, structural embeddedness，relationship embeddedness，and embedded performance Cn of the 10 institutions are ranked consistently，7 institutions have the same ranking of cognitive embedding and embedding performance Cn，and the ranking is consistent with the service performance Cn of each institution. The main obstacles to the performance of community embedded integrated medical and nursing care with characteristics of TCM are C33（number of TCM health care guidance services），C44（elderly satisfaction），C8（institutions and partners adhere to win-win cooperation），C37（the proportion of TCM non pharmacological therapy rehabilitation nursing personnel），C39（number of elderly people served）. Conclusion The embeddedness，structural embeddedness，and relational embeddedness of community embedded integrated medical and nursing care with characteristics of TCM have a positive impact on its embedding performance. Cognitive embedding has a basic positive impact on embedding performance. Government departments should clarify their functional positioning，strengthen policy support，improve the evaluation system，pay attention to dynamic evaluation，and guide and promote the high-quality development of community embedded integrated medical and nursing care with characteristics of TCM. Institutions with characteristics of TCM should strengthen their structural embedding，relationship embedding，and cognitive embedding with partners，in order to continuously improve their service performance，to meet the diversified and multi level health care service needs of the elderly in home communities. At the same time，should grasp the degree of embedding，so as not to produce the negative effect of embedding.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background General practitioners are the "gatekeepers" of residents' health，and their job satisfaction largely affects the quality and efficiency of primary healthcare service，which shows that it is of great significance to establish a job satisfaction evaluation system of general practitioners suitable for Chinese national conditions，and to improve the job satisfaction of general practitioners in order to promote the reform of the primary healthcare service system. Objective To conduct a systematic review of the job satisfaction of general practitioners and its influencing factors in China，to analyze the commonalities and differences in evaluation indexes and research results of the job satisfaction of general practitioners and their influencing factors in different studies，in order to provide reference for the establishment of a general practitioners' job satisfaction evaluation system suitable for Chinese national conditions. Methods PubMed，Web of Science，Embase，National Knowledge Infrastructure，WanFang Data and CQVIP were searched to obtain cross-sectional studies on job satisfaction and influencing factors of general practitioners from inception to June 12 2023. Two researchers independently screened the literature and extracted the authors of the included literature，the time of the survey，the area of the survey，the sample size，the dimensions and indicators of the evaluation of job satisfaction，and the influencing factors of job satisfaction，and other information. The descriptive analysis method was adopted to summarize，analyze and compare. Results We included 19 Chinese studies，including 15 354 general practitioners. The evaluation of the job satisfaction of general practitioners mainly involved four dimensions：material satisfaction，relationship satisfaction，growth satisfaction，and overall satisfaction，of which 19 articles mentioned income and interpersonal relationship，14 articles mentioned working environment，job promotion，and personal value，and 8 articles mentioned training. The influencing factors of job satisfaction of general practitioners included income level，gender，age，title，education，work pressure，workload，promotion opportunities，personal development，employment methods，work environment，length of service，interpersonal relationship，welfare benefits，type of unit，social recognition and so on.Conclusion The overall level of job satisfaction of general practitioners in China is not high，and is affected by income level，gender，age，title，educational，workload，work pressure，promotion opportunities，employment methods and other factors.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： The role of a general practitioner is to serve as the gatekeeper of community health，maintaining long-term doctor-patient relationships and having a comprehensive and continuous understanding of the health status of residents in their jurisdiction. Therefore，general practitioners not only need to address common health issues but also require the ability to identify and manage uncommon diseases. In the case of uncommon diseases，general practitioners face two challenges. Firstly，the symptoms of some unusual diseases are often not rare or specific，and if there are underlying diseases，they are easily missed in the community. Secondly，even when patients return to the community after receiving treatment at a higher-level hospital，general practitioners may not have enough knowledge about certain diseases and lack the capacity for comprehensive management. As general practitioners，we need to assess patients comprehensively on multiple dimensions，including biological，psychological，social，and familial aspects，to provide more holistic care. This article describes a rare case of primary central nervous system lymphoma. The patient's onset was insidious. Through the coordinated efforts of multiple departments under the leadership of general medicine，including surgery，postoperative rehabilitation，pain management，and nutritional assessment，the patient gradually improved. After formulating home care and follow-up treatment strategies，the patient was discharged. The article shares the experience of general medicine in managing uncommon diseases through a "comprehensive specialist collaboration" approach，aiming to enhance the comprehensive management capabilities of general practitioners.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
CAO Yulong
SHAN Jiao
WANG Bin
WANG Yan
WANG Yanbin
HUAI Wei
BAO Xiaoyuan
JIN Meng
KUANG Jiqiu
GAO Yan
Abstract： Background Postoperative infection outbreak（PIO）is a concentrated manifestation of the harmfulness of hospital-acquired infections，and how to effectively control the occurrence of PIO promptly is currently the focus of infection control. At present，some infection prevention personnel lack emergency response experience and ability to investigate suspected sources of infection in the face of infection clusters. Objective To develop an investigation form for postoperative infection outbreak（PIO），and identify the sources of infection in the early stage to prevent outbreaks. Methods From January to May 2023，Worldwide Database for Nosocomial Outbreaks（WDNO），PubMed，CNKI，and other databases were searched for studies related to PIO. Data extraction and annotation were performed. After cleaning the title and abstract text information of infection control literature downloaded from the PubMed database，a large-scale training set was constructed to build a word vector model based on the Skip-Gram method. Preliminary identification of risk factors for PIO was summarized based on the classification results of the word vector model constructed. Subsequently，15 consulting experts were invited to evaluate the importance of PIO risk factors using a modified Delphi method. The Analytic Hierarchy Process（AHP）was adopted to calculate weight and combined weight for the primary and secondary indicators to determine the possible sources of infection outbreaks.Based on this，an investigation form for PIO was constructed. Results A total of 203 PIO-related studies were finally included.A total of 15 experts were consulted by the modified Delphi method，and all the questionnaires for the two rounds of expert consultation were returned with a positive coefficient of 100.00%. The average authoritative coefficient（Cr）of 15 experts was（0.86±0.10），the average familiarity（Cs）was（0.81±0.10），and the average judgment（Ca）was（0.92±0.10）.Kendall's W coefficient（Kendall's W）of concordance after two rounds of expert consultation was 0.351（P<0.005），which showed that the consensus of expert opinion was good，indicating a good consensus among expert opinions. After two rounds of the modified Delphi method，4 primary indicators and 19 secondary indicators were constructed. Within the indicator system，the weights of the 7 primary indicators ranged from 22.23% to 27.50%，and the combined weights of the secondary indicators ranged from 3.32% to 6.29%. Based on this，the PIO investigation questionnaire was developed，primarily including five aspects of patient basic information，infection status，perioperative factors，personnel，and environment. Conclusions Based on epidemiological characteristics and expert consultation，a form used for PIO investigation was constructed. The content covers the main risk factors and critical points that may lead to outbreaks，providing a reference for identifying potential sources of PIO.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Sleep health is a novel concept，a multidimensional sleep-wakefulness pattern that adapts to individual，social，and environmental demands to promote physical and mental well-being. Current research has found that sleep health is not only associated with physiological health issues such as diabetes，overweight/obesity，and cardiovascular risks but also has significant impacts on mental health issues such as anxiety and depression. Previous sleep-related studies have primarily focused on identifying and treating sleep disorders and problems，with less attention to the positive attributes of sleep health. This review summarizes studies on sleep health，including its definition，measurement tools，and correlations with health outcomes，aiming to foster a more comprehensive understanding of sleep health and provide a reference for research on sleep health among Chinese residents.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background China's economy and health synergy has gradually come to the fore with development.Grassroots health and health work is the forefront of safeguarding people's health，and upgrading the capacity of primary health care services is the main task of China's health undertakings in the 14th Five-Year Plan period and even in the future.The rural economy of Ningxia in the period 2015-2020 has maintained a rapid growth trend，and investment in primary health care organizations has been increasing. Objective To study the coupling coordination and spatial distribution of grassroots medical service capacity and regional economic development in Ningxia，and explore its driving forces. Methods By constructing an evaluation index system for grassroots medical service capacity and regional economic development in Ningxia，entropy method，coupled coordination model，geographic detector，etc. were used to study the coordination between the service capacity of 203 township health centers in 22 counties （districts） of Ningxia and regional economic development from 2015 to 2020. Results The comprehensive evaluation index of regional economy in Ningxia was higher than the comprehensive evaluation index of grassroots medical service capacity. The coupling coordination degree of the two subsystems shows an upward trend in time series，and a gradually decreasing distribution pattern in spatial layout from south to north. Factors such as health resources and medical service volume have become important factors driving the coordinated development of the two systems，while regional economic factors are gradually weakening. Conclusion There is significant room for improvement in the coupling and coordination between the grassroots medical service capacity and regional economy in Ningxia，with significant regional differences. It is necessary to continuously improve the grassroots medical service capacity by increasing health investment and strengthening medical prevention integration. Focusing on the high-quality development of regional economy，we will gradually strengthen the level of grassroots medical services and promote the coordinated development of the two systems.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Community rehabilitation has much in common with primary health care. While providing primary health care for key groups，primary health care institutions will be of great significance if they can accurately provide rehabilitation services to people in need，reduce their degree of dysfunction，improve their quality of life，and realize the functional positioning of "rehabilitation at the grassroots level". This paper focuses on the coordinated development of community rehabilitation and primary health care，proposes several strategies in service delivery，service cooperation，and service financing，in order to provide references for the expansion of rehabilitation capabilities in primary health care institutions，and hopes to contribute to higher general public health standards and reduced medical expenditures.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-07-29 Cooperative journals: 《中国全科医学》
Abstract： Background Hypertension as a risk factor can significantly increase the morbidity and mortality of cardiovascular and cerebrovascular diseases，and effective control of hypertension is the key to prevent and treat cardiovascular diseases. Objective Collect literature on the evaluation of the effectiveness of hypertension management models in China. Evaluate the management effects of different models and provide a reference for further optimization of hypertension management models. Methods Using StataSE-64，a network Meta-analysis of the 18 included hypertension management model papers was performed using blood pressure control rates as an evaluation metric. The models included five models：joint hospital-community management，community management，hospital treatment management，general management，and combined Internet management. Results Joint hospital-community management，community management，hospital management，and combined Internet management are all effective for hypertension control. The order is joint hospital-community management ≈ combined Internet management> hospital treatment management>community management>blank control. Among them，the joint hospitalcommunity management model has significant effect on hypertension control; the joint hospital-community management model and combined Internet management has similar effect；and hospital management has better effect than community management. Conclusion In order to improve the hypertension management model，the construction of hospital-community-family management model in primary health care institutions should be promoted，and the combination of chronic disease management model and combined Internet model should be guided to strengthen the whole-life，whole-cycle management of chronic disease patients.
Hits
Hits
Downloads
Comment