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March 2017, Volume 20, No.7 Abstracts

 Developmental Pattern of British General Practice and Its Enlightenment to China  SHAN Hai-yan,QI Hui-meng,YU Xiao-song*
Department of General Practice,the First Hospital of China Medical University,Shenyang 110001,China
*Corresponding author:YU Xiao-song,Professor,Doctoral supervisor;E-mail:xsyu@mail.cmu.edu.cn
    【Abstract】  The construction of general practitioners team in China is a vital issue concerning people′s livelihood.The paper analyzes the developmental pattern of British general practice,makes a comparison of community medical conditions and levels between mainland China and UK,discusses the inadequacies of primary health care model in our country,and thus puts forward corresponding improvement measures so as to provide references for deepening reform on the management system of general medicine and community health care in our country.
    【Key words】  General practice;Medical model;United Kingdom
 
Implementation and Incentive Function of Contract Employment and Performance-based Payment System in Community Health Service Institutions
  WANG Yong-yi1,XU Ling2,ZHANG Ming-ji1,3,WANG Wei1,HE Lei2,YAN Fei1*
1.School of Public Health,Fudan University;Key Lab of Health Technology Assessment,Ministry of Health(Fudan University);the Innovation Center for Social Risk Governance in Health,Shanghai 200032,China 
2.Health Statistics and Information Center,National Health and Family Planning Commission of the People′s Republic of China,Beijing 100044,China
3.School of Public Health,Shanghai Jiaotong University,Shanghai 200025,China 
*Corresponding author:YAN Fei,Professor,Doctoral supervisor;E-mail:fyan@shmu.edu.cn
    【Abstract】  Objective  To understand the implementation situation and the incentive function of contract employment and performance-based payment system in community health service institutions in four provinces and cities of China.Methods  This study used a multi-stage sampling method.By purposive sampling method,Shandong Province and Shanghai City were selected from the eastern region,and Anhui Province was selected from the central region.Shaanxi Province was selected from the western region;and the provincial capital city and one prefecture-level city with good community health service development were selected from the three provinces respectively;district was selected from each city(including Shanghai) respectively and seven districts totally.According to the type of holding body and staff size of community health service institutions in each district,stratified sampling was carried out to extract three community health service institutions at most from each layer,and a total of 61 community health service institutions were selected.Using cluster sampling,all the 713 on-duty health workers at the investigation day were selected from each community health service institutions as the subjects,and 6 community health workers were selected as the interview subjects.The self-designed questionnaire included the basic situation of the community health technical personnel,the implementation of the contract employment system,and the implementation of the performance-based payment system.From August to September 2013,self-administered questionnaire was used to investigate the subjects.713 questionnaires were sent out and 656 valid questionnaires were collected.The effective response rate of the questionnaires was 92.0%.At the same time of questionnaire survey,in-depth interviews were conducted to evaluate the contract employment and performance-based payment systems.Results  Among 61 institutions,27 institutions with holding body of public ownership and 18 with holding body of private ownership had implemented the contract employment system.In these 45 institutions the annual income of off-staff personnel covered(82.9 ± 16.6)% of the in-staff personnel,while in the 16 institutions that have not implemented contract employment system,the annual income of off-staff personnel covered(53.0 ± 17.4)% of the in-staff personnel,and these two were significantly different(P<0.05).Among 34 institutions with holding body of public ownership,24 had implemented the performance-based payment system.64.7%(180/278) of the staff in the community health service center and 85.1%(63/74) of the staff in the community health service station believed that the performance appraisal had incentive function.42.1%(153/363) of community health workers believed that the fairness of income distribution of the institution is good.Conclusion  Contract employment system and performance-based payment system play an important role in ensuring the income equality and improving the enthusiasm of the employees,but further exploration in breaking the limitation of authorized strength,disaggregate links between authorized strength and welfare and establishing scientific performance-based payment system are still needed.It is recommend that improve contract employment system and increase income channels to ensure income of health workers;set the proportion of performance salary reasonably to give full play to the guiding role of performance-based payment system.
    【Key words】  Community health services;Contract employment system;Performance-based payment system;Incentive function
 
Evaluation Index System Construction of Human-centered Consultation Service of General Practitioners
  SUN Chen,LU Xiao-qin*
School of General Practice and Continuing Education,Capital Medical University,Beijing 100069,China
*Corresponding author:LU Xiao-qin,Professor,Doctoral supervisor;E-mail:xq6518@163.com
    【Abstract】  Objective  To construct a evaluation index system construction of human-centered consultation service of general practitioners.Methods  The framework and item pool of the evaluation index system were initially proposed by using the method of literature research.From June to September 2016,the improved Delphi Expert Consultation method was used to conduct a two-round consultation to 18 selected experts.The importance and operability of the indexes were scored by the experts.According to the degree of concentration and coordination of expert opinion,the index system was selected and modified.The expert grading method and the combination weighting product method were used to calculate the weight of each index.Results  18 consultation tables were sent out in the 2-round expert consultation,and all were recovered with the effective response rate of 100.0%.The average authority degree coefficient of the experts on the primary indicators(Cr) was 0.88.In the first-round consultation,the arithmetic average of the score of the importance and operability of each index was 4.00~5.00 and 3.47~4.89 respectively,the rate of full marks was 22.22%~100.00% and 11.11%~88.89% respectively.In the second-round consultation,the arithmetic average of the score of the importance and operability of each index was 4.00~5.00 and 3.17~4.88 respectively,the rate of full marks was 33.33%~100.00% and 5.56%~88.24% respectively.In the first-round consultation,the variable coefficients of the score of the importance and operability of each index were 0~0.26 and 0.07~0.27 respectively,while in the second-round consultation,the variable coefficients were 0~0.21 and 0.07~0.27 respectively.In the first-round consultation,the cooperation indexes of the score of the importance and operability of each index were 0.226 and 0.243 respectively(P<0.05),while in the second-round consultation,the cooperation indexes were 0.247 and 0.237 respectively(P<0.05).The final evaluation indicators were 37 items(5 primary indexes,32 secondary indexes).The primary indexes were inquiry,physical examination,auxiliary examination,patient management,and doctor-patient communication respectively,and their weight coefficients were 0.213,0.208,0.170,0.201 and 0.208 respectively.Conclusion  The study has constructed a evaluation index system construction of human-centered consultation service of general practitioners which is scientific,and can be used as the evaluation tool of the human-centered service in the process of consultation of general practitioners.
    【Key words】  General practitioners;Quality indicators,health care;Person-centered care;Delphi technique
 
Job Content and Satisfaction in Community Nurses
  TAO Lin,LIU Su-zhen*,LI Ji-ping
School of Nursing,West China Hospital,Sichuan University,Chengdu 610041,China
*Corresponding author:LIU Su-zhen,Professor,Master supervisor;E-mail:yly90777@163.com
    【Abstract】  Objective  To investigate the status of job content and satisfaction in community nurses in Sichuan Province.Methods  We conducted a questionnaire survey between March and November 2014.Using convenient sampling and with the help of the members of Community Nursing Committee under Sichuan Nursing Association,we selected 56 community health service centers(CHSCs) which were willing to cooperate with us in completing the questionnaire survey,from Chengdu,and 11 prefecture-level cities in Sichuan Province.By cluster sampling,we selected all the nurses in the 56 CHSCs as the participants of this study.The questionnaire used in the survey encompasses the baseline characteristics,current job content and satisfaction of the nurses.The final participants were 969 nurses who completed the questionnaire effectively,accounting for 95.5% of the 1 015 first selected nurses.Results  The results of the questionnaire survey showed that,the job content was reported as public health and basic medical nursing by 323 nurses(33.4%),basic medical nursing by 290(29.9%),public health nursing by 280(28.9%),management work by 61(6.3%),and non-nursing work by 15(1.5%).The average total score of job satisfaction in the 969 participants was(3.39±0.41).The scores of dimensions of job satisfaction ranked from high to low are as follows:working relationship(4.03±0.63),working ability confirmed by the society(3.83±0.59),balance between family and job(3.79±0.66),work unit management(3.66±0.76),work load(3.12±0.45),personal growth and development(3.05±0.68),the job itself(3.03±0.53),wages and benefits(2.32±0.81).One-way ANOVA found that,there were significant difference in the total score of job satisfaction in community nurses as well as the scores of dimensions of wages and benefits,work unit management,working relationship,personal growth and development among different job content(P<0.05),there were no significant difference in the scores of dimensions of balance between family and job,work load,the job itself and working ability confirmed by the society among different job content(P>0.05).Conclusion  The services delivered by community nurses in Sichuan Province are comprehensive,but they are to be further developed.The job satisfaction in community nurses is not satisfactory.Therefore,in order to achieve the sustainable development of community nursing,it is suggested to vigorously develop community specific nursing,and improve the job satisfaction of community nurses especially those engaged in public health nursing and management work.
    【Key words】  Community nurses;Job content;Job satisfaction
 
Construction and Implementation of Intelligence Family Doctors Optimized Coordination Model
  GUO Xiao-ling,WU Hao*,LIU Xin-ying,JIA Hong-yan,WANG Dan,WEI Xue-juan,WANG Li,HAO Yan
Fangzhuang Community Health Service Centre;College of General Practice and Continuing Education,Capital Medical University,Beijing 100078,China
*Corresponding author:WU Hao,Chief physician,Associate professor,Master supervisor;E-mail:wushunzhe@sohu.com
    【Abstract】  Through many years of exploration and practice,the role definition of family doctors,support of "Internet +" and artificial intelligence technology,the cooperation within family doctor team(one-to-one cooperation of family doctors and nurses),and labor division and collaboration among general practice and specialist as well as other medical institutions,Fangzhuang Community Health Service Centre in Fengtai of Beijing thus achieves a new model of people-centered and intelligent resource coordination and service optimization among family doctors.This model has improved the service capacity of community health service institutions and the efficiency of various service sectors,saved the resources of social health services,improved the self-awareness of residents participating in health management,which can provide references for the development of "Internet + family doctor" service and the implementation of hierarchical diagnosis and treatment.
    【Key words】  General practitioners;Optimized coordination;"Internet+";Intelligence;Beijing
 
Path Construction of Community Specific Disease Prevention and Treatment Based on Family Doctor′s Contract Service Cloud APP Platform:A Case Study of Osteoporosis
  WANG Tian-ying,ZHUANG Kang-lu,FENG Lei,SONG Hui-jiang*
Sanlin Community Health Service Center of Shanghai,Shanghai 200124,China
*Corresponding author:SONG Hui-jiang,Chief physician;E-mail:songhj008@126.com
    【Abstract】  Osteoporosis is a metabolic bone disease characterized by decrease in bone mass,damage in bone tissue microstructure,increased bone fragility and susceptibility to fracture.The family doctor′s contract service is a kind of health management delivered by a family doctor for the people in the area for which the family doctor is responsible,and during the service delivery,the medical resources are optimized at utmost,and allocated and used most reasonably.Currently,one of the difficulties in constructing the path of community specific disease prevention and treatment is,building an osteoporosis health management path that is well associated with the regional contract service system,by which the contracted family doctor can better offer the services.The ways that we used to solve this problem are as follows:Firstly,we investigated the guidelines related to osteoporosis prevention and treatment at home and abroad included by literature search,and chose tools for screening,diagnosis,treatment and follow-up strategies of osteoporosis.Then,in accordance with the experts′ review on the literature retrieval results,we selected the appropriate screening,diagnosis and treatment tools for osteoporosis.Next,we set the related structured themes by brainstorming,in which we identified the procedure of using the tools and obtained the logical chart of community osteoporosis prevention and treatment path.And on the basis of the above,we constructed the flow chart of community osteoporosis prevention and treatment path.Finally,we developed the community osteoporosis prevention and treatment module based on all the above,and added it to Sanlin family doctor service cloud APP platform.This module was taken into practice.It can meet the needs of screening,diagnosis,treatment,rehabilitation,and informationalized management of osteoporosis with a good application prospect.
    【Key words】  Osteoporosis;Community health services;General practitioners contract services;Informationization
 
Research and Design of Validated Chronic Disease Management System
  HUAN Hua-min1,ZHANG You1*,FAN Yu-qin2,CHEN Zhi-hua3,SHEN Shi-lai4,CHANG Qing1,ZHENG Yu-qun1,JIN Yan-jie5
1.Xinbei Center for Disease Control and Prevention,Changzhou 213022,China
2.Xinqiao Health Center,Changzhou 213032,China
3.Zhonglou Center for Disease Control and Prevention,Changzhou 213015,China
4.Xinbei Health Planning Bureau,Changzhou 213022,China
5.Beijing Longteng Xinyang Information Technology Co.,Ltd,Beijing 102208,China
*Corresponding author:ZHANG You,Associate chief physician;E-mail:13961179480@126.com
    【Abstract】  By Internet,smart phone software and effective certificate authentication technologies,validated chronic disease management system has constructed a validated management system of hospital diagnosis and treatment and community management.When logging on to the doctor workstation or providing door-to-door service for residents,medical workers need to validate the valid certificate(such as health card) of the patient through a personal computer(PC) or a smart phone,and only in this way can they enter the patient management system,and carry out the on-site management information input(paperless) and real-time upload.The establishment of this system has achieved the digital mobile services for patients with chronic diseases,and ensured the authenticity of management information,and can provide new way and basis for performance appraisal,fund allocation and scientific management of patients with chronic diseases in the basic public health service projects.
    【Key words】  Chronic disease;Disease management;Computer communication networks;Artificial intelligence
 
Clinical Features and Outcome of Acute Pancreatitis in Elderly Patients
    WANG Bei-bei,LIAO Shan-ying,NIE Sheng-li,SHA Wei-hong,BU Xiao-ling,MA Juan*
Department of Gastroenterology,Guangdong General Hospital/Guangdong Academy of Medical Sciences,Guangzhou 510080,China
*Corresponding author:MA Juan,Associate chief physician;E-mail:mjlqh@163.com
    【Abstract】  Objective  To investigate the clinical features and outcome of acute pancreatitis(AP) in the elderly.Methods  The subjects enrolled in this study were 1 382 consecutive AP patients admitted to Guangdong General Hospital from November 2005 to October 2015.By checking medical records,we obtained the clinical data of them,including gender,age,etiology distribution of AP,severity staging of AP,complications,length of stay,recurrence rate and mortality.Based on age,we divided the patients into the elderly group(aged 60 or over,n=678) and the control group(younger than 60 years old,n=704).Results  Significant gender difference in the incidence of AP was found between the two groups(P<0.05).The incidence of AP due to biliary disease in the control group and elderly group was 46.4%(327/704) and 76.8%(521/678),respectively.Etiology distribution of AP differed remarkably between the groups(P<0.05),while the severity staging of AP did not(P>0.05).With regard to the incidence of local complications,the incidences of acute peripancreatic fluid collection,acute necrotic collection and pancreatic pseudocyst were significantly higher in the control group than in the elderly group(P<0.05),but the incidences of encapsulated necrosis,walled-off pancreatic necrosis,hydrothorax,gastrointestinal fistula,intra-abdominal hemorrhage,pancreatic pseudocyst bleeding,splenic/portal vein thrombosis and necrotic colitis were not(P>0.05).In terms of the incidence of systemic complications,the incidences of systemic inflammatory response syndrome(SIRS),intra-abdominal hypertension(IAH)or abdominal compartment syndrome(ACS) were significantly higher in the control group than in the elderly group(P<0.05),but the incidences of organ failure and systemic infection were not(P>0.05).Two groups had similar length of stay and mortality(P>0.05),however,the elderly group had significantly higher recurrence rate(P<0.05).Conclusion  Biliary pancreatitis was the most common to be seen in the elderly group.Elderly and control groups had similar severity staging of AP,length of stay and mortality,but the former had higher proportion of women with AP,and recurrence rate.
    【Key words】  Pancreatitis;Disease attributes;Prognosis;Aged
 
Characteristic of Patients with Climacteric Problems in Seeking Treatment
  XI Si-si1,BAI Wen-pei2*
1.Department of Gynecology and Obstetrics,Peking University First Hospital,Beijing 100034,China
2.Department of Gynecology and Obstetrics,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China
*Corresponding author:BAI Wen-pei,Chief physician,Professor,Doctoral supervisor of obstetrics and gynecology,Master supervisor of general practice;E-mail:bwp66@163.com
    【Abstract】  Objective  To study the characteristic of patients with climacteric problems in seeking treatment,and to provide data for the health work of climacteric women.Methods  A retrospective analysis of 1 031 patients with climacteric problems admitted to the climacteric general management clinic of Peking University First Hospital from September 2012 to December 2014 was carried out.Self-designed questionnaires including the basic information,menstrual and menopausal symptoms,and medical history of definite diagnosis were used to investigate the enrolled subjects.Body height,body weight and waist circumference were measured,and BMI was calculated.Results  A total of 1 007 valid questionnaires were collected,and the effective response rate was 97.7%.The median age of the patients was 51(6),609(60.5%) had a college degree or above,and 598(59.4%) had an individual monthly income equal to or over 3 000 yuan.44.3%(446 cases) of the patients were in postmenopausal period,75.8%(338 cases) of them had gone through natural menopause,and the median age of menopause was 49(5).Concerning the menopausal symptoms,807 patients(80.1%) felt tired,734(72.9%) was worried about insomnia,595(59.1%) had active attitude towards climacteric.There were 551(54.7%) patients combining with central obesity,326(32.4%) combining with overweight,132(13.1%) combining with hyperlipidemia and 132(13.1%) combining with hypertension.Conclusion  Most of the patients with climacteric problems in seeking treatment are menopausal and high educated women in upper middle income group.The proportion of patients combined with central obesity,hyperlipidemia and hypertension is relatively high.Thus we should pay attention to the menopausal health care of the whole people,and conduct chronic disease screening for menopausal women so as to improve the overall health of society.
    【Key words】  Climacteric;Menstruation;Comorbidity
 
Cut-off Points of Glycosylated Hemoglobin and Fasting Plasma Glucose for Early Diagnosis of Diabetes Mellitus
  ZHANG Jing-yi1*,GUO Jing1,DONG Zhao1,WU Shi - fang1,ZHANG Fei-fei1,ZHENG Bao-xia2
1.Department of Endocrinology,Kailuan General Hospital Affiliated to North China University of Science and Technology,Tangshan 063000,China
2.CT Room,Kailuan General Hospital Affiliated to North China University of Science and Technology,Tangshan 063000,China
*Corresponding author:ZHANG Jing-yi,Professor,Master supervisor;E-mail:zhangjingyi63@sina.com
    【Abstract】  Objective  To investigate the cut-off points of glycosylated hemoglobin(HbA1c) and fasting plasma glucose(FPG) for early diagnosis of diabetes mellitus.Methods  The subjects enrolled in this study were 766 consecutive outpatients and inpatients of Kailuan General Hospital Affiliated to North China University of Science and Technology who underwent measurement of HbA1c,FPG and oral glucose tolerance test(OGTT) between January 2012 and April 2016.We used HA-8160 Automatic Glycosylated Hemoglobin Analyzer made in Japan with high pressure liquid chromatography to determine HbA1c,and HITACHI 7600 Automatic Biochemical Analyzer with hexokinase method to determine FPG.We divided the patients into diabetic group〔2-hour postprandial blood glucose(2 hPG) ≥11.1 mmol/L,n=628〕 and non-diabetic group(2 hPG<11.1 mmol/L,n=138) based on the Definition,Diagnosis and Classification of Diabetes Mellitus and Its Complications revised by WHO in 1999.We drew the receiver operating characteristic(ROC) curves of HbA1c and FPG,and investigated the optimal cut-off points of them for the diagnosis of diabetes mellitus with analyzing the sensitivity,specificity,positive predictive value,negative predictive value,positive and negative likelihood ratios,Youden′s index and Kappa value.Results  The largest area under curve(AUC) of HbA1c′s ROC curve in the diagnosis of diabetes mellitus was 0.918〔95%CI(0.895,0.942),P<0.001〕,the cut-off point was 6.55%,with a sensitivity of 90.1%,specificity of 75.4%,positive predictive value of 90.1%,negative predictive value of 75.4%,positive likelihood ratio of 3.7,negative likelihood ratio of 0.1,Youden′s index was 0.66 and Kappa value of 0.63.The largest AUC of FPG′s ROC curve in the diagnosis of diabetes mellitus was 0.901〔95%CI(0.877,0.926),P<0.001〕,the cut-off point was 6.23 mmol/L,with a sensitivity of 85.0%,specificity of 81.9%,positive predictive value of 84.9%,negative predictive value of 81.9%,positive likelihood ratio of 4.7,negative likelihood ratio of 0.2,Youden′s index was 0.67 and Kappa value of 0.65.The cut off points of HbA1c(6.55%) and FPG(6.23 mmol/L) for the combined diagnosis of diabetes mellitus had a sensitivity of 76.6%,specificity of 95.5%,positive predictive value of 65.5%,negative predictive value of 98.3%,positive likelihood ratio of 17.0,negative likelihood ratio of 0.3,Youden′s index was 0.72 and Kappa value of 0.70.Conclusion  HbA1c(6.55%) combined with FPG(6.23 mmol/L) can be one of the methods for early diagnosis of diabetes mellitus,for it has good specificity.Moreover,it has higher Youden′s index and Kappa value than HbA1c(6.55%) or FPG(6.23 mmol/L) used alone as the early diagnosis method of diabetes mellitus.
    【Key words】  Diabetes mellitus;Hemoglobin A,glycosylated;Fasting plasma glucose;Diagnosis;Cut-off point
 
Different Doses of Atorvastatin for the Prevention of Contrast-induced Nephropathy in Patients with Ischemic Stroke after Cerebrovascular Interventions
  FU Rui*,DAI Wei,XI Chun-jiang,ZHAO Xing-hui,ZHANG Tong
Department of Neurology,Beijing Shijitan Hospital,CMU,Beijing 100038,China
*Corresponding author:FU Rui,Associate professor;E-mail:furui20080808@sina.com
    【Abstract】  Objective  To study the effects of different doses of atorvastatin on the prevention of contrast-induced nephropathy(CIN) in patients with ischemic stroke after cerebrovascular interventions.Methods  One hundred and ninety-four consecutive patients with ischemic stroke hospitalized in Beijing Shijitan Hospital,CMU from August 2012 to December 2014 were randomly assigned into high dose of atorvastatin group(n=98) and low dose of atorvastatin group(n=96),and respectively took atrovastatin 40 mg/d,and atrovastatin 20 mg/d orally before contrast agent administration.Comparisons were made between the groups in terms of serum creatinine(SCr),serum cystatin C(CysC) measured before,and at 24 h,48 h after cerebrovascular interventions,post-procedure mean peak SCr,post-procedure increase in SCr from baseline(△SCr),incidence of CIN and incidence of adverse reactions.Results  No significant differences were found between the two groups in terms of proportion of male patients,ratio of patients aged ≥70 years old,incidence of hypertension,incidence of diabetes,percentage of patients using angiotensin converting enzyme inhibitors(ACEI) /angiotensin receptor antagonist(ARB),proportion of patients using the dose of contrast agent ≥200 ml(P>0.05).Both groups had no obvious difference in mean SCr(P>0.05),but the SCr before procedure,at 24 h and 48 h after the procedure differed significantly between the groups(P<0.05).Treatment method and duration exerted interaction effects on SCr(P<0.05).The difference in the mean CysC between the groups was distinct(P<0.05).The CysC before procedure,at 24 h and 48 h after the procedure in the high dose of atorvastatin group were significantly different from those in the low dose of atorvastatin group(P<0.05).Treatment method and duration had interaction effects on CysC(P<0.05).The levels of peak SCr and △SCr were significantly lower in high dose of atorvastatin group than in low dose of atorvastatin group after procedure(P<0.05).The incidence of CIN was significantly higher in low dose of atorvastatin group than in high dose of atorvastatin group(P<0.05).Results of routine blood,biochemical and coagulation function indicators in both groups remeasured on the 7th day after procedure showed no obvious abnormalities.Conclusion  High dose of atorvastatin offers protection against CIN in patients with ischemic stroke after cerebrovascular interventions.
    【Key words】  Stroke;Brain ischemia;Interventional diagnosis and treatment;Atorvastatin;Contrast-induced nephropathy
 
Synergic Effect of Renin and Aldosterone on the Left-sided Heart Structure and Function in Essential Hypertension with Obstructive Sleep Apnea-hypopnea Syndrome
  ZULIMIRE·Abulizi1,SUN Xiao-jing2,CHEN Yu-lan1*,ZHANG Jun-shi1,ZHULEPIYA·Simayi1,XU Xin-juan1,ZHANG Xiang-yang1
1.Department of Hypertension,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China
2.Department of ICU,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China
*Corresponding author:CHEN Yu-lan,Chief physician,Master supervisor;E-mail:sheliachen@sina.com
    【Abstract】  Objective  To study the synergic effect of renin and aldosterone on the left-sided heart structure and function in essential hypertension with obstructive sleep apnea-hypopnea syndrome(OSAHS) patients.Methods  We selected 277 inpatients who did not take any antihypertensive drugs affecting renin-angiotensin-aldosterone system(RAAS)〔197 males and 80 females with an average of(44.3±7.9) years old(ranged from 18 to 60)〕 from 546 patients hospitalized in Department of Hypertension,the First Affiliated Hospital of Xinjiang Medical University and confirmedly diagnosed with essential hypertension and OSAHS from January 2011 to January 2016,and divided them into 4 groups based on the plasma renin activity(PRA) and plasma aldosterone concentration(PAC) levels: normal PRA and PAC(N group,n=74),high PRA and normal PAC(HR group,n=113),normal PRA and high PAC(HA group,n=22),high PRA and high PAC(HRA group,n=68).Echocardiogram was used to determine the parameters of left-sided heart structure and function,including left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),and mitral ratio of peak early to late diastolic filling velocity(E/A).Left ventricular ejection fraction(LVEF) and left ventricular mass index(LVMI) were calculated according to the formula.Radioimmunoassay method was adopted to measure the PRA and PAC levels.And the multivariate Logistic regression analysis was used to study the factors affecting left-sided heart structure and function.Results  The contrast in general data between 4 groups: the differences in average 24-hour diastolic blood pressure(24 hDBP) and apnea hypoventilation index(AHI) were statistically significant(P<0.05),while those in gender,age,duration of hypertension,BMI,average 24-hour systolic blood pressure(24 hSBP),fasting plasma glucose(FPG),total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C) were not(P>0.05).The contrast in echocardiographic indicators between 4 groups: the differences in LAD,LVEDD,IVST,LVPWT,LVMI,E/A were statistically significant(P<0.05),whereas those in LVESD and LVEF were not(P>0.05).The multivariate Logistic regression analysis found that BMI〔OR=2.756,95%CI(1.604,4.738),P<0.001〕,high PRA and high PAC〔OR=2.377,95%CI(1.038,5.446),P=0.041〕 were the influencing factors of LAD;factors exerting effect on LVMI were gender〔OR=0.283,95%CI(0.134,0.601),P=0.001〕,BMI〔OR=2.058,95%CI(1.198,3.533),P=0.009〕,AHI〔OR=2.776,95%CI(1.364,5.650),P=0.005〕,and high PRA and high PAC〔OR=3.222,95%CI(1.377,7.537),P=0.007〕;E/A was influenced significantly by age〔OR=2.859,95%CI(1.943,4.206),P<0.001〕.Conclusion  The combination of renin and aldosterone determines impairment of left-sided heart structure and function in essential hypertension with OSAHS patients,especially the synergic effect of hyperreninemia and hyperaldosternism is obvious.
    【Key words】  Hypertension;Sleep apnea,obstructive;Renin;Aldosterone;Left ventricular and atrial structure;Ventricular function,left
 
Effect of Plasma Homocysteine Level on the Myocardial Infarction during Perioperative Period and Prognosis of Patients with Non-ST Segment Elevation Acute Coronary Syndrome
  LIANG Hai-feng1,YANG Ming1*,LIU Yu2,HAN Ling1,LI Xiao-hong1,XIN Xiao-ming1,YAO Min3
1.Department of Cardiology,Fu Xing Hospital,Capital Medical University,Beijing 100038,China
2.Department of Pathology, Capital Medical University School of Basic Medical Sciences, Beijing 100069, China
3.Coronary Heart Disease Center,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China
*Corresponding author:YANG Ming,Professor,Master supervisor;E-mail:m13501289177@163.com
    【Abstract】  Background  Coronary slow-reflow(CSRF)/no-reflow(no-RF) is an important complication of percutaneous coronary intervention(PCI) therapy,but studies on its pathogenesis and clinical prognosis are not sufficient at present.
Objective  To observe the effects of plasma homocysteine(Hcy) levels on CSRF/no-RF phenomena in PCI,myocardial infarction during perioperative period(PMI) and prognosis.Methods  A total of 269 patients with non-ST segment elevation acute coronary syndrome(NSTE-ACS) undergoing elective PCI in Department of Cardiology of Fu Xing Hospital,Capital Medical University and Coronary Heart Disease Center of Fuwai Hospital,Chinese Academy of Medical Sciences from January 2013 to May 2015 were assigned to 2 groups according to their plasma Hcy levels:normal plasma Hcy level group(<15 μmol/L,n=172) and elevated plasma Hcy level group(≥15 μmol/L,n=97).The incidence rate of CSRF/no-RF,PMI as well as the occurrence rate of major adverse cardiac events(MACE) and all-cause mortality 1 year after PCI between the two groups were compared in the study.Results  There was no significant difference in the gender,age,smoking rate,occurrence rate of hypertension and diabetes mellitus,total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C) levels and usage rate of aspirin,clopidogrel /ticagrelor,β-blocker,ACEI/ARB and statins between the two groups(P>0.05),while there was significant difference in coronary artery disease lesion(P<0.05).The incidence rate of the CSRF/no-RF and PMI in the elevated plasma Hcy level group was significantly higher than that in the normal plasma Hcy level group(P<0.05).The incidence rates of single vessel disease in MACE between the two groups were not significantly different(P>0.05),but the incidence rates of double-vessel disease,multi-vessel disease and overall MACE in the elevated plasma Hcy level group were significantly higher than those in the normal plasma Hcy group(P<0.05),the overall all-cause mortality in the elevated plasma Hcy level group was significantly higher than that in the normal plasma Hcy level group(P<0.05).Conclusion  High plasma Hcy levels have a significant effect on CSRF/no-RF,PMI and prognosis of patients with NSTE-ACS.
    【Key words】  Acute coronary syndrome;Hemocysteine;Coronary slow reflow/no-reflow;Myocardial infarction;Prognosis
 
Association between Dietary Factors and Gingival Carcinoma in Fujian Province
  LIU Feng-qiong1,YAN Ling-jun1,CHEN Fa1,HUANG Jiang-feng1,LIU Fang-ping1,QIU Yu2,LIN Li-song2,HE Bao-chang1*
1.Department of Epidemiology and Health Statistics,Key Laboratory of Environment Factors and Cancer of Fujian Province,School of Public Health,Fujian Medical University,Fuzhou 350108,China
2.Oral and Maxillofacial Surgery,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350004,China
*Corresponding author:HE Bao-chang,Associate professor,Master supervisor;E-mail:hbc517@163.com
    【Abstract】  Objective  To explore the relationship between dietary factors and gingival carcinoma in Fujian.Methods  A total of 133 patients with gingival carcinoma in Oral and Maxillofacial Surgery in the First Affiliated Hospital of Fujian Medical University from December 2010 to June 2016 were selected as the case group;in the same period,321 healthy adults whose gender and age(±3 years) matched with those of the case group were selected from Xihu and Luoxing community of Fuzhou and taken as the control group.The investigators after unified training conducted a face-to-face survey to the subjects in two groups with the InterCHANGE Lifestyle Questionnaire.The main survey contents included the general situation,dietary habits,oral and health conditions.The effects of dietary factors on gingival carcinoma were analyzed by multivariate Logistic regression analysis,and the interaction between seafood and tea was further analyzed by taking the general situation,dietary habits,oral and health conditions as covariates.Results  The intake of meat,fish,seafood,green leafy vegetables,non-green leafy vegetables and fruits were significantly different between two groups(P<0.05).There was significant difference in the intake of processed meat,poultry meat,milk and dairy products,eggs,beans and soy products and pickled foods between two groups(P>0.05).Multivariate Logistic regression analysis showed that the intake of meat,fish,seafood,green leafy vegetables,non-green leafy vegetables and fruits was the influencing factor of gingival carcinoma(P<0.05).Stratify the subjects according to whether they drinking tea or not,and the result showed that the intake of seafood equal to or over 3 times a week among those who were not tea drinkers can reduce the risk of gingival carcinoma〔adjusted OR=0.33,95%CI(0.17,0.66)〕.There was a positive interaction between seafood and tea drinking 〔adjusted OR=0.70,95%CI(0.49,0.98)〕.Compared with those non-tea drinkers whose intake of seafood less than 3 times a week,the risk of gingival carcinoma of those non-tea drinkers whose intake of seafood equal to or over 3 times a week〔adjusted OR=0.39,95%CI(0.21,0.74)〕,tea drinkers whose intake of seafood less than 3 times a week 〔adjusted OR=0.45,95%CI(0.24,0.85)〕,and tea drinkers whose intake of seafood equal to or over 3 times a week 〔adjusted OR=0.35,95%CI(0.17,0.74)〕 had all lowered.Conclusion  Dietary factors can affect the incidence of gingival carcinoma to a certain degree,and healthy eating habits,regular intake of fresh vegetables and fruits,moderate consumption of fish and seafood can reduce the risk of gingival carcinoma.
    【Key words】  Gingival neoplasms;Diet;Fujian 
 
Practice and Thought of Standardized Psychiatric Training for General Practice Postgraduate Students
  LYU Guang-hui1,YAO Mi1,2*,SUN Wei3,LIU Chao-zhong4,CHI Chun-hua1 
1.Department of General Practice,Peking University First Hospital,Peking University Health Science Center,Beijing 100034,China
2.Xinjiekou Community Health Service Center,Xicheng District,Beijing 100035,China
3.Department of Sleep Medicine,Peking University Sixth Hospital,Beijing 100191,China
4.Department of Outpatient,Peking University Sixth Hospital,Beijing 100191,China
*Corresponding author:YAO Mi;E-mail:755027954@qq.com
    【Abstract】  Mental health service is an integral part of primary care in China.Currently,the number of psychiatric medical staff is small,meanwhile general practitioners(GPs) are valued to play a more important role in providing mental health service.That means GPs will provide mental health service with high quality,which bases on the improvement of GPs training in psychiatry.We summarized the current situation of standardized psychiatric training for general practice postgraduate students of Peking University Health Science Center and also put forward our views on training deficiencies.All these aimed to constantly improving the psychiatric training for general practice postgraduates by which their post competency and capabilities in delivering mental health service will be strengthened,so that the needs of mental health service in China can be satisfied gradually.
    【Key words】  General practice;Education,medical,graduate;Mental health services
 
Discussion on Ophthalmological Emergency Treatment and Standardized Training for General Practitioners  JIAO Jian,HUA Wen*
Department of Ophtalmology,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China
*Corresponding author:HUA Wen,Chief physician;E-mail:huawen01@aliyun.com
    【Abstract】  Ophthalmology is the component of standardized training for general practitioners.Improvement of the ophthalmic clinical ability of general practitioners,especially their ability of dealing with ophthalmological emergency through training is of great importance for patients to acquire effective and correct diagnosis and treatment.Firstly through analysis of the ophthalmological emergency cases,the paper proposes that the pre-hospital care and referral of ophthalmological emergency should be the important part of standardized training for general practitioners.Then the paper makes a classified discussion on the possible ophthalmological emergencies from the perspective of general practitioners,and meanwhile preliminarily discusses how to carry out the patient transfer rapidly and effectively after receiving ophthalmological emergencies.In the process of standardized training for general practitioners,through improving general practitioners′ handling ability of ophthalmological emergencies to cultivate general practice talents of higher levels,so that they can better suit for the gatekeeper of health.
    【Key words】  General practitioners;Education,medical;Ophthalmology;Emergency treatment;Patient transfer
 
Medical and Caring Needs of Older People from Sociological Perspective
  HUANG Wen-jing1,2
1.School of Public Health,Guangzhou Medical University,Guangzhou 510182,China
2.Huangbeiling Community Health Service Center,Luohu District(Luohu Hospital Group),Shenzhen 518003,China
    【Abstract】  Objective  To understand the medical and caring needs of the older people,and to explore the enabling and obstructive factors that affect their perception of the medical and caring needs and their access to and use of these services.Methods  In May 2016,8 aged people were selected from 100 old people that participated in the comprehensive health assessment of Huangbeiling Community,Luohu District as the research objects.Participants were born between 1918 and 1952,aged from 64 to 98;3 males and 5 females.The ethnographic research method was applied in the study.The researchers are general practitioners who paid attention to the health and well-being of the older people in community health service centers in Huangbeiling.Results  (1) The older people had experienced and were experiencing significant social changes.(2) In the marriage relationship,the female old people mostly played the role of caregiver and conformist,neglected or denied their own needs,and most female "old people(aged≥80)" had lost support of their spouse.(3) The older people had many children,and their relationship between generations was complex.(4) Most of the older people wished to be their own master and take care of themselves,and practised what they preach.They were reluctant to let nanny go into the family for the quality of service,their own security,and balance of their own value.(5) Women had more community partners and participated in community activities,while men were most isolated from society.The sources of information for the older people were mostly from the media or by word of mouth,and the formal information is relatively less.(6) The older people showed fear and avoidance to the hospital,and more likely to choose community health services,their interaction with the community health care staff depended on the continuity and initiative of general health care services.(7) The older people most had comorbidity and in complex state of disease,but this had no necessary relation to perceiving needs and service utilization of the older people.With respect to disease type,their self-positioning and health beliefs had greater effects on the search and use of services.Conclusion  General practice should focus on the life experiences of the older people,family and friends,community and environment,health beliefs,and experiences of medical services,which are important for understanding their help-seeking behavior and service utilization.The designer and providers of aging services should observe that the older people born before the baby boom have more traditional cultures and beliefs,have specific needs for expression,behavior and interaction,and pay particular attention to the social isolation of male old people.In developing aging in place and pension service and medical service integration,attention should be given to horizontal and vertical relationships within the family of the older people,their interaction with the outside of the family,and the enabling or obstructive effects of these interactions.Fear and avoidance of services in hospitals among the older people,as well as the progressive development of their relationship with community health care workers suggest that community health care workers should enhance their ability of assessing and understanding the needs of the older people,and provide the older people with culturally sensitive and responsive services by physical psychological and social models.Ethnography is a method to observe and analyze the service object from sociological perspective,provides a unique information basis for the design of service system,meets the whole human and people-centered view of general practice,and helps to provide residents with better quality service.
    【Key words】  Aged;Health services needs and demand;Community health services;General practice;Ethnography
 
Association between Social Support and Attitude towards Aging among the Elderly in China
  JI Yun1,2,LI Jin-wei3*
1.Department of Psychology,Langfang Normal School,Langfang 065000,China
2.School of Sociology and Demography,Renmin University of China,Beijing 100872,China
3.School of Economics,Langfang Normal School,Langfang 065000,China
*Corresponding author:LI Jin-wei,Lecturer;E-mail:jinwli@126.com
    【Abstract】  Objective  To explore the association between social support and attitudes toward aging among the elderly in China.Methods  In this study,11 511 elderly people aged 60 or over in the Chinese Longitudinal Aging Social Survey(CLASS) were selected from 134 counties,districts and 462 villages.From August to October 2014,Health Self-assessment Score,Mini-mental State Examination(MMSE),Social Network Scale,and the Attitudes to Aging Questionnaire were adopted to investigate the physical health,cognitive ability,social support,and aging attitude of the elderly respectively.A total of 11 511 questionnaires were sent out and 7 225 valid questionnaires were collected.The effective response rate was 62.77%.Results  Among the 7 225 aged people,the score of family support was(10.7±5.9),the score of friend support was(8.7±7.6),the score of social support was(19.4±11.2);the score of self-attitude towards aging was(12.9±3.9),the score of general attitude towards aging was(9.7±3.0),total score of attitude towards aging was(22.5±5.4).There were no significant differences in the score of self-attitude towards aging and general attitude towards aging and total score of attitude towards aging among the elderly of different gender(P>0.05),while there were significant differences in the attitudes toward aging among the elderly of different age,marital status,educational degree,and urban and rural,personal annual income(P<0.05).The results of multiple linear regression analysis showed that the scores of friend support was the influencing factor of the score of self-attitude towards aging and general attitude towards aging of the elderly(b values were -0.102,-0.034 respectively;P<0.05).After the social demographic characteristics were included,score of friend support was also the influencing factor of the score of self-attitude towards aging and general attitude towards aging of the elderly(b values were -0.079,-0.030 respectively;P<0.05);after scores of physical health status and cognitive ability were included,score of friend support was also the influencing factor of the score of self-attitude towards aging and general attitude towards aging(b values were -0.069,-0.021 respectively;P<0.05).Conclusion  Friend support has a positive effect on the attitude towards aging of the elderly.
    【Key words】  Aged;Aging attitude;Social support
 
Development Trend and Future Prospects of Total Expenditure on Health in China  LIU Qiao1,LI Li-qing2*
1.School of Business,Jiangxi Science and Technology Normal University,Nanchang 330031,China
2.School of Economics and Management,Jiangxi Science and Technology Normal University,Nanchang 330031,China
*Corresponding author:LI Li-qing,Associate professor,Master supervisor;E-mail:liliqing_lily@163.com
    【Abstract】  The paper gets the index data that related to health expenditure based on China Health Statistics Yearbook from 2001 to 2014 and China National Health Accounts Report from 2012 to 2014.The paper compares the changing trend of China′s total health expenditure vertically by methods of literature review and contrastive analysis,and compares it with countries in Organization for Economic Cooperation and Development(OECD) and the BRICS(Brazil,Russia,India,China,and South Africa) horizontally so as to further reveal the changing rule in China′s health expenditure and the reality of excessive growth.At the same time,taking the experience of developed countries as reference,the paper puts forward relevant suggestions and future prospects of controlling China′s total health expenditure,and thus provides useful references for the currently deepening health care system reform.
    【Key words】  Fees,medical;Development trend;Future prospects
 
Current Situation of Inter-provincial Health Service Efficiency of China Based on Data Envelopment Analysis and Its Promotion Countermeasure
  HUANG Hui-qun
Xiangya School of Public Health,Central South University;Hunan University of Finance and Economics,Changsha 410078,China
    【Abstract】  Objective  To discuss current status of inter-provincial health service efficiency of China and its promotion countermeasure.Methods  Based on China Health Statistical Yearbook in 2010,18 provinces (municipalities and autonomous regions) from 31 provinces (municipalities and autonomous regions) of mainland China were selected as objects of study,including Beijing,Tianjin,Hebei,Shanxi,Heilongjiang,Shanghai,Jiangsu,Zhejiang,Fujian,Jiangxi,Shandong,Hubei,Guangdong,Yunnan,Gansu,Qinghai,Ningxia and Xinjiang,and their inclusion criteria was that they included the following input and output indicators in the statistical material of 2009.Data envelopment analysis (DEA) was used to analyze the efficiency of health services in 18 provinces (municipalities and autonomous regions).The input indicators included the following 5 items:health expenditure (yuan),the number of owned beds per thousand people,the number of owned health technicians per thousand people,the number of owned doctors per thousand people,the number of owned nurses per thousand people;the output indicators included two items-mortality (‰) and birth rate (‰).Results  There were four provinces (municipalities and autonomous regions) belonging to the first category:Hebei,Jiangxi,Yunnan,and Gansu,and their corresponding integrated technical efficiencies were 0.944,1.000,1.000 and 1.000 respectively.Three provinces (municipalities and autonomous regions) belonged to the second category:Jiangsu,Fujian,and Hubei,and their corresponding integrated technical efficiencies were 0.878,0.850,and 0.831 respectively.There were 8 provinces (municipalities and autonomous regions) belonging to the third category:Shanxi,Heilongjiang,Zhejiang,Shandong,Guangdong,Qinghai,Ningxia,and Xinjiang,and their corresponding comprehensive technical efficiencies were 0.719,0.623,0.619,0.728,0.628,0.796,0.759,and 0.688 respectively;three provinces (municipalities and autonomous regions) belonged to the fourth category:Beijing,Tianjin,and Shanghai,and their corresponding integrated technical efficiencies were 0.248,0.496,and 0.388 respectively.Further improvement of the efficiency of those 11 provinces (municipalities and autonomous regions) that belonged to the third and fourth categories showed as follows,in the case of constant output,only Qinghai Province and the Xinjiang Uygur Autonomous Region needed not have to adjust their input indicators,the remaining nine provinces (municipalities and autonomous regions) all needed to reduce health expenditure,and slightly compress or fine-adjust "the number of owned beds per thousand people","the number of owned health technicians per thousand people","the number of owned physicians per thousand people",and "the number of owned nurses per thousand people".Conclusion  There are differences in the efficiency of inter-provincial health services of China,and the efficiency of health services in some provinces (municipalities and autonomous regions) needs to be further improved from aspects of expenditure,personnel,and hardware equipment. 
    【Key words】  Health services;Data envelopment analysis;Efficiency;Promotion countermeasure;Inter-provincial
 
Economic Burden and Correlation of 4 Common Chronic Diseases with Obesity in Rural Residents of Yunnan Province  LI Qing1,2,CAI Le1*,WANG Wen-li3,LI Shao-mei3,YOU Ding-yun1,CUI Wen-long1
1.Department of Public Health Management and Health Economics,School of Public Health,Kunming Medical University,Kunming 650500,China
2.Department of Nephrology,First Affiliated Hospital of Kunming Medical University,Kunming 650032,China
3.Department of Hospital Management,the First Hospital of Yiliang,Kunming 652100,China
*Corresponding author:CAI Le,Professor,Doctoral supervisor;E-mail:caile002@hotmail.com
    【Abstract】  Objective  The aim of this study was to analyze the relationship between obesity and 4 common chronic diseases,hypertension,diabetes,coronary heart disease(CHD) and stroke,in rural residents of Yunnan Province,and to calculate the economic burden caused by the 4 diseases and to estimate the economic burden attributable to obesity.Methods  Using multistage stratified random sampling procedure,we selected 5 040 residents from 12 administrative villages of Yunnan Province between January to September 2015.We collected the general data of the residents by a survey with self-developed questionnaire.The final participants of this study consisted of 4 979 residents who completed the questionnaire.A physical examination was performed in the participants by strictly trained medical examiners.Two-step modeling method was used to measure direct economic burden caused by the diseases,whereas human capital approach combined with disability adjusted life years(DALY) was applied to measure indirect economic burden.And population attributable risk(PAR) combined with the above was adopted to estimate the cost attributable to the combination of systemic obesity and central obesity.Results  In the study region,the prevalence of general obesity and central obesity was 6.8%(337/4 979) and 38.4%(1 912/4 979),respectively.The prevalence of hypertension,diabetes,CHD and stroke was 35.3%(1 757/4 979),9.9%(491/4 979),3.8%(191/4 979) and 1.7%(83/4 979),respectively.Results of multivariate Logistic regression analysis showed that,after adjusting for other confounding factors,the prevalence risk of hypertension,diabetes,CHD and stroke in subjects with general obesity was 1.71,3.81,3.53,4.70 times than that in non-general obese subjects,separately.And the prevalence risk of hypertension,diabetes,CHD and stroke in subjects with central obesity was 2.21,1.92,1.61 and 2.10 times than that in non-central obese subjects,separately.Based on PAR,our study estimated that the prevalence of hypertension,diabetes,CHD and stroke accounted for 4.61%,17.51%,14.68%,20.10% attributable to general obesity,respectively,as well as 32.50%,26.80%,19.53%,29.70% attributable to central obesity,respectively.The average cost of hypertension,diabetes,CHD and stroke per person was 6 667.4 yuan,9 126.1 yuan,9 270.0 yuan and 16 187.2 yuan,respectively,and the total costs were 108 185.2 million yuan for hypertension,41 529.5 million yuan for diabetes,16 192.0 million yuan for CHD,and 12 649.0 million yuan for stroke.Of this,the cost of hypertension,diabetes,CHD and stroke attributable to general obesity was 8 167.6 million yuan,6 876.6 million yuan,3 491.7 million yuan,and 2 740.2 million yuan,respectively,and that of the four chronic diseases attributable to central obesity was 34 370.2 million yuan,10 696.1 million yuan,3 232.4 million yuan,and 3 177.0 million yuan,respectively.The total costs of the 4 chronic diseases were 178 555.7 million yuan,in which 11.9%(21 276.1 million yuan/178 555.7 million yuan) was attributable to general obesity and 28.8%(51 475.7 million yuan/178 555.7million yuan) attributable to central obesity.Conclusion  The costs of obesity and 4 obesity-related diseases are substantial in rural residents of Yunnan Province.Reducing the prevalence of general obesity and central obesity is helpful to decrease economic burden of the 4 obesity-related chronic diseases.
    【Key words】  Chronic disease;Obesity;Cost of illness;Rural health;Yunnan
 
Establishing and Evaluation of the Item Pool of Xiaoke Eye Disease Patients Reported Outcomes Scale Based on TCM Syndrome Elements
  NI Lin-lin1,XU Yun-sheng2*
1.The First Clinical College,Shandong University of Traditional Chinese Medicine,Ji′nan 250014,China
2.General Office,Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Ji′nan 250001,China
*Corresponding author:XU Yun-sheng,Professor,Doctoral supervisor;E-mail:xys65@126.com
    【Abstract】  Objective  To establish and preliminarily evaluate Xiaoke Eye Disease(diabetic retinopathy) Patients Reported Outcomes(PRO) Scale based on TCM syndrome elements.Methods  The literatures related to the syndromes of Xiaoke eye disease were retrieved systematically from January 2006 to December 2015 from China National Knowledge Infrastructure and VIP Network,and the types of Xiaoke eye disease were collected and summarized,and the composite syndromes were decomposed into single syndrome factor.From July to October 2015,semi-structured depth interview was conducted to the 30 patients with diabetic retinopathy,5 relatives of patients,and 5 medical workers in endocrinology department in endocrinological ward of Shandong Provincial Hospital of Traditional Chinese Medicine.Combining the research results of literatures with the interviewed results,we established the initial item pool of the PRO scale of Xiaoke eye disease.By the lottery method,280 patients with diabetic retinopathy who were admitted to the Department of Endocrinology and Ophthalmology of Shandong University of Traditional Chinese Medicine,Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine and Ji′nan Municipal Hospital of Traditional Chinese Medicine were selected in the study.In order to assess the scale,the initial item pool of PRO scale of Xiaoke eye disease was used to investigate the subjects.A total of 280 questionnaires were sent out and 270 valid questionnaires were recovered.The effective response rate was 96.4%.Results  A total of 42 qualified articles were included through literature retrieval,and 15 kinds of syndrome elements were separated,combined with the interviewed results,31 items,including 18 items of physical dimension(9 syndrome effect indicators,9 specific symptom indicators),6 items of psychological dimension,5 items of social dimension,2 items of satisfaction dimension were in the initial PRO scale of eye disease.There were significant differences in syndrome effect indicators and specific symptom indicators in physiology dimension,psychological dimension,social dimension and total scores among patients with different disease classification(P<0.05).The Cronbach′s α coefficient of the total scale was 0.944,and the Cronbach′s α coefficients of syndrome effect indicators and specific symptom indicators in physiology dimension,psychological dimension and social dimension were 0.909,0.901,0.890 and 0.857 respectively.Five common factors were obtained by factor analysis,and the cumulative variance contribution rate was 66.755%.Conclusion  The preliminarily established PRO scale of Xiaoke eye disease has good reliability and validity,and can be used in the evaluation of curative effects of traditional Chinese medicine on Xiaoke eye disease.It is recommended to be applied in clinic.
    【Key words】  Excess eating-drinking-urine;Diabetic retinopathy;Patient reported outcomes;Symptom complex 
 
Preliminary Development and Evaluation of the Short-version Constitution in Chinese Medicine Questionnaire
  ZHU Yan-bo1*,YU Xiao-han2,WANG Qi2,SHI Hui-mei2
1.School of Management,Beijing University of Chinese Medicine,Beijing 100029,China
2.School of Basic Medicine,Beijing University of Chinese Medicine,Beijing 100029,China
*Corresponding author:ZHU Yan-bo,Professor,Doctoral supervisor;E-mail:yanbo0722@sina.com
    【Abstract】  Objective  To develop and preliminarily evaluate the short-version of Constitution in Chinese Medicine Questionnaire(CCMQ).Methods  The total sample size of this study included 4 940 subjects,and they were from 6 different areas to by convenience sampling method,namely:1 632 personnel underwent physical examination in Kaifeng City,He′nan Province from September 2007 to May 2008,466 personnel underwent physical examination in Ruijin City,Jiangxi Province from July 2012 to October 2012,519 personnel underwent physical examination in Hefei,Anhui Province from September 2012 to August 2013,595 personnel underwent physical examination in Zhuhai City,Guangdong Province from February 2013 to January 2014,1 044 personnel underwent physical examination in Beijing from January 2015 to December 2015,684 unpaid blood donors in Beijing from July 2015 to December 2015.Two thirds

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