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June 2017, Volume 20, No.16 Abstracts

 Analysis of American Adult-gerontology Primary Care Nurse Practitioner Program and Certification  GE Wei1,ZHANG Hong-chen1,CAO Bao-hua1,XIAO Ting1,ZONG Shu1,HUANG Nan2,XU Sha-sha1*
1.School of Nursing,the Fourth Military Medical University,Xi′an 710032,China
2.Nan Lou Healthcare Department 2,Hainan Branch of PLA General Hospital,Sanya 572000,China
*Corresponding author:XU Sha-sha,Professor,Master supervisor; E-mail:hzr2008@fmmu.edu.cn
    【Abstract】  With the acceleration of population aging in our country,the demand for health care of the elderly is increasing rapidly,which puts forward higher requirements for the nurse practitioners of the elderly primary health care.However,at present there is no system of training and certification for nurses in primary health care in China.Adult-gerontology primary care nurse practitioners in the United States have a profound impact on patients,families,communities and primary health care.In this paper,in order to provide a reference for China′s development of geriatric nursing, we take adult-gerontology primary care nurse practitioner program in School of Nursing of University of Pennsylvania as an example and try to introduce its training mode and certification system into China.
    【Key words】  Primary health care; Geriatric nursing; Nurse practitioners; Training; Certification
 
Discussion on Hierarchical Diagnosis and Treatment from the Perspective of Improving Primary Health Service Capacity  LEI Guang-he,WANG Na*
School of Humanities and Management,Guangdong Medical University,Dongguan 523808,China
*Corresponding author:WANG Na,Lecturer;E-mail:86193325@qq.com
    【Abstract】  Primary health care institutions is the main body of providing basic medical services,and the effective development of primary health care services is the initiation of implementing hierarchical diagnosis and treatment.At present,the strength of China′s primary health care institutions is so weak that the hierarchical diagnosis and treatment cannot be really realized.From the perspective of improving primary health service capacity,the paper puts forward measures such as the appropriate and reasonable way government′ control;"Training(to cultivate a number of outstanding medical workers through medical colleges and clinical teaching bases of general practitioners,)" plus "Keeping(making outstanding medical workers in primary health care institutions through seductive compensation package,liberation of their freelancing environment,enhancing the sense of medical competition and action and opening and transparent channels of promotion)" to make excellent medical worker stay in primary health care institutions,and a balance of human,property and thing;and hopes to provide scitific and effective referencing suggestions in promoting hierarchical diagnosis and treatment.
    【Key words】  Primary health care institutions;Basic medical services;Hierarchical diagnosis and treatment
 
Relative Efficiency of Basic Medical Services Delivery in Community Health Service Institutions--a Case Study Based on the Investigation in Four Provinces(Municipality) of China  GUO Min-lu1,WANG Wei1*,XU Ling2,ZHANG Yao-guang2,ZHANG Ming-ji1,3,YAN Fei1 
1.School of Public Health,Fudan University,Key Lab of Health Technology Assessment,Ministry of Health(Fudan University),Collaborative Innovation Center of Health Risks Governance,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:WANG Wei,Lecturer;E-mail:wangwei@shmu.edu.cn
    【Abstract】  Objective  To assess the relative efficiency of basic medical services delivery in the community health service institutions in four provinces(municipality) of China.Methods  Data envelopment analysis(DEA) was employed to analyze the relative efficiency of basic medical services delivery in 37 community health service institutions selected from Shandong Province,Anhui Province,Shaanxi Province,and Shanghai Municipality of China using multistage sampling in 2013.We set the total amount of fixed assets,total expenditure,number of primary care providers,and building areas of hospitals as the input indicators,and total number of diagnoses and treatments,annual benefits of medical services delivery as the output indicators(the values of these 6 indicators used in this study all investigated as of the end of 2012).Results  Totally 45.9%(17/37) of the selected community health service institutions had DEA efficient results.Shanghai had the largest proportion of community health service institutions with efficiency in both technology and scale,followed by Shandong,Anhui and Shaanxi.The percentage of community health service institutions with inefficient DEA results held by public health administrative departments and other public sectors was higher than that of those held by private institutions.In general,compared to community health service institutions that had DEA efficient results,the community health service institutions that had DEA inefficient results made use of extra 45.62% of fixed assets,spent extra 30.13% expenditure annually,used extra 42.47% of primary care providers,and 44.20% of house area for providing medical services.Conclusion  The relative efficiency of basic medical services delivery in community health service institutions was not high in these 4 provinces(municipality).The community health service institutions in Shandong,Shanghai and Anhui,and those held by private institutions had better DEA efficient results.The problems of insufficient investment and resources waste coexisted,so the resources allocation of community health service institutions should be optimized.
    【Key words】  Community health services;Basic medical services;Efficiency;Data envelopment analysis
 
Community-based Chronic Disease Management Path Exploration Based on the House of Quality  CHANG Rui,AO Qin,WU Jing,LIU Jun-an*,SUN Yi,LU Zu-xun
Department of Social Medical and Health Management,School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China
*Corresponding author:LIU Jun-an,Associate professor;E-mail:lja10_11@163.com
    【Abstract】  The house of quality is a core tool for quality function deployment(QFD),a way for identifying the relationship between customers′ demands and the product/services capabilities,and an important tool for the development and design of products/services living up to customer needs.Based on the current community-based chronic disease management(CCDM),we explored the new way for CCDM with the house of quality model under the guidance of QFD theory,with a view to providing a reference for the development of CCDM services that meet the needs of the community patients.
    【Key words】  House of quality; Quality function development; Chronic disease management; Service demand; Quality characteristics
 
Influence of Community-based Emergency Management Model on the Response Time  LIU Yu-jia1,CHEN Kai-hong2,ZHU Qing-sheng3,HU Dong-ming3,WANG Ya-dong1*
1.School of Health Management and Education,Capital Medical University,Beijing 100069,China
2.Health and Family Planning Commission of Chaoyang District,Beijing 100020,China
3.Emergency Medical Rescue Center of Chaoyang District,Beijing 100020,China
*Corresponding author:WANG Ya-dong,Professor,Master supervisor;E-mail:yadong61@ccmu.edu.cn
    【Abstract】  Objective  To evaluate the influence of community-based emergency management model on the response time and explore ways to optimize pre-hospital emergency care management.Methods  The Chaoyang District of Beijing receiving community-based emergency management model since 2014 was selected as the intervention group,and a district of Beijing without receiving the model was set as the control group.The emergency dispatching data of both groups in January 2013 and January 2014 were collected from Beijing Emergency Center Platform for Dispatching & Transferring the Cars.The difference-in-difference technique(DID) was used to calculate the effect of community-based emergency management model on the response time.Results  Compared with that in January 2013,the average response time for the intervention group in January 2014 was shortened by 1.25 min(15.84 vs 17.09),while that for the control group in January 2014 was only shortened by 0.14 min(19.18 vs 19.32).The difference in the shortened average response time between the groups was 1.11 min,which suggested that the community-based emergency management model had positive effect on shortening the average response time(P<0.05).Conclusion  The community-based emergency management model implemented in Chaoyang District,Beijing reduces the response time,which can be used as a reference for the development of pre-hospital emergency medical service system in China.
    【Key words】  Emergency medical services;Community management model;Response time;Difference-in-difference
 
Status and Solutions for the Scientific Research Capabilities in Primary Care Providers in Yangpu District,Shanghai  ZHAO Jia-yi1,2,HAN Yi-ping1,2,SHEN Lu1,KE Jun3,YUAN Peng-qun3,CHEN Xi-hui3,LIU Yan-min3*
1.Department of General Practice,Changhai Hospital,the Second Military Medical University,Shanghai 200433,China
2.Department of Respiratory Diseases,Changhai Hospital,the Second Military Medical University,Shanghai 200433,China
3.Changhai Hospital,the Second Military Medical University,Shanghai 200433,China
*Corresponding author:LIU Yan-min,Associate professor;E-mail:rayzhaojiayi@163.com
    【Abstract】  Objective  To investigate the status of the scientific research capabilities in primary care providers in Yangpu District,Shanghai,and put forward solutions for the existing problems.Methods  We searched the published articles written by the primary care providers from 11 community health service centers(CHSCs) in Yangpu District,Shanghai between 2006 and 2015 from CNKI.The articles were processed by Endnote X7 and statistically analyzed by SPSS 21.0 software.Analytical figures were drawn by GraphPad Prism 5.We studied the published time,number,research topic and publishing organizations of the articles,and the journals that they were published in.Results  A total of 324 articles were obtained by searching,of them,295 met the inclusion criteria,including 139 published in key journals,accounting for 47.12%,and 156 published in non-key journals,accounting for 52.88%.The number of published articles from 2006 to 2015 presented an upward trend generally.In the 10 years,the Yinhang Community Health Service Center published 76 articles(25.76%),while the Changbai Community Health Service Center was only 6(2.04%).With regard to the research topic,74.24%(219/295) discussed problems related to diseases/ health,9.15%(27/295) investigated community health service management,5.76%(17/295) explored psychological /behavioral and sociological problems,4.41%(13/295) involved in general practice education,3.39%(10/295) covered the surveys/needs and level of satisfaction,2.71%(8/295) focused on health education,and 0.34%(1/295)talked about other aspect.There were 48.81%(144/295) of the articles published in 10 major journals,specifically,16.95%(50/295) were published in Shanghai Medical & Pharmaceutical Journal,6.78%(20/295) were published in Chinese General Practice and 6.44%(19/295) were published in Guide of China Medicine.The number of published articles in 2011-2015 was much more than that in 2006-2010(t=-2.609,P=0.026),but there was no significant differences in the number of articles published in key journals between these two periods(t=-1.576,P=0.146).Conclusion  Although the number of published articles of primary care providers from the 11 CHSCs in Yangpu District,Shanghai increases gradually from 2006 to 2015,their levels of scientific research are not even,research topics are comparatively simple,quality of the articles are unsatisfactory,and scientific research capabilities are weak generally.Therefore,the standardized training base for general practice should explore some meaningful ways to improve the general practitioners′ education and their scientific research capabilities,such as training general practitioners(GPs) of research-based type,building the professional scientific research and teaching team,and developing the system of instructing GPs by tutors and so on.
    【Key words】  Primary hospital;General practice;Scientific ability;Yangpu District,Shanghai
 
Effect of Level of Blood Pressure Control on Cardiac Structure,Function and Atrial Fibrillation of Old Patients with Hypertension  CHAI Fang-fang,LI Xin-hua*,YAN Wen-hua,WU Li-na
Department of Cardiology,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China
*Corresponding author:LI Xin-hua,Chief physician,Professor,Master supervisor;E-mail:Linhua321@163.com
    【Abstract】  Objective  To explore the effect of level of blood pressure control on cardiac structure,function and atrial fibrillation of old patients with hypertension.Methods  A total of 226 old patients with hypertension who were hospitalized in the Fifth Affiliated Hospital of Zhengzhou University or received treatment in its outpatient from March 2012 to March 2013 were recruited,and finally 145 cases were enrolled after a trial follow-up of 6 months and a formal follow-up of 18 months.According to the level of blood pressure control,the subjects were divided into group A(n=57,SBP ≤130 mm Hg and DBP ≤80 mm Hg),group B(n=55,130 mm Hg <SBP <140 mm Hg and DBP <90 mm Hg or SBP <140 mm Hg and 80 mm Hg <DBP <90 mm Hg),group C(n=33,SBP≥140 mm Hg or DBP ≥ 90 mm Hg).Left atrial diameter(LAD),left ventricular mass index(LVMI),E/A,left ventricular ejection fraction(LVEF) before and after follow-up,and the incidence of atrial fibrillation during the follow-up were compared among 3 groups.Results  The difference value of LAD,LVMI and LVEF before and after follow-up among the three groups was significantly different(P<0.05).The difference values of E/A before and after follow-up were not significantly different(P>0.05).The difference value of LAD before and after follow-up in C group was significantly greater than that of group A and B,while the difference value of LVEF was significantly less than that of group A and B(P<0.05).The difference value of LVMI before and after follow-up in group B and C was significantly greater than that of group A(P<0.05).There was a significant difference in the incidence of atrial fibrillation among the three groups(P<0.05).The incidence of atrial fibrillation in group C was significantly higher than that in group A(P<0.05).Conclusion  For old patients with hypertension,long-term poor blood pressure control will not only damage cardiac structure and function,but also increase the incidence of atrial fibrillation.Besides,strict blood pressure control(≤130/80 mm Hg) can better relieve left ventricular hypertrophy of patients compared with convention blood pressure control(<140/90 mm Hg).
    【Key words】   Hypertension;Atrial fibrillation;Cardiac structure and function;Aged
 
Effect of Weight Loss by Dieting Versus Aerobic Exercise on Nonalcoholic Fatty Liver Disease  WANG Jing*,WANG Hui,DING Xiang-wu
Department of Gastroenterology,the Affiliated Puai Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430033,China
*Corresponding author:WANG Jing,Attending physician;E-mail:jessiegastro@163.com
    【Abstract】  Objective  To compare the effects of weight loss by dieting and aerobic exercise on the improvement of nonalcoholic fatty liver disease.Methods  Obese individuals〔n=30,BMI ranged from 26 to 35 kg/m2,with an average of(31.8±1.6) kg/m2〕 with clinically confirmed nonalcoholic fatty liver disease(NAFLD) admitted in Department of Gastroenterology,the Affiliated Puai Hospital of Tongji Medical College,Huazhong University of Science and Technology from May 2013 to May 2015 were recruited.They were divided into weight loss group(group A,n=15) and aerobic exercise group(group B,n=15) by the random number table.The daily calorie intake for individuals in group A was about 1 500 kcal,and they did not do any aerobic exercise.The individuals in group B did supervised 150-min aerobic exercise with the heart rate value as 45%~55% of HRmax,3 times a week,for 4 weeks without changing the eating habits and increasing the nutrient intake.Comparisons were made between the groups in terms of the ALT,fasting plasma glucose(FPG),free fatty acid(FFA),fasting insulin(INS),and homeostasis model assessment of insulin resistance(HOMA-IR) and visceral adipose tissue(VAT) area before and after the intervention.Results  The distribution of gender and age was similar in both groups(P>0.05).Before and after the intervention,the weight and BMI did not differ significantly between the groups(P>0.05).Before intervention,two groups had no significant differences in the ALT,FPG,FFA,INS and HOMA-IR(P>0.05);after intervention,ALT,FPG,INS and HOMA-IR of two groups were still similar,but the FFA in group B was substantially lower than that in group A(P<0.05).No notable differences in the VAT area were found between the groups before intervention(P>0.05);however,after intervention,group B had much smaller VAT area than group A(P<0.05).Conclusion  Compared with weight loss by dieting,aerobic exercise is more effective for NAFLD.
    【Key words】  Fatty liver;Weight loss by dieting;Aerobic exercise
 
Correlation of Serum Vitamin D Levels with Metabolic Syndrome in the Middle-aged and Elderly  TANG Ji-bin1*,JIAO Rui-bao1,LI Xu-guang1,LIU Na1,ZHANG Wen1,CHEN Ran1,SUN Yun1,HUANG Hai-quan2
1.Clinical Laboratory,Tongling People′s Hospital,Tongling 244009,China
2.Department of Endocrinology,Tongling People′s Hospital,Tongling 244009,China
*Corresponding author:TANG Ji-bin,Chief laboratorian,Master supervisor;E-mail:13705628207@163.com
    【Abstract】  Objective  To explore the role of VitD in the pathogenesis of metabolic syndrome(MS) by investigating the correlation of serum vitamin D(VitD) with MS in the middle-aged and elderly.Methods  We selected 519 middle-aged and elderly(45 years old or over) outpatients and inpatients with MS treated in Tongling People′s Hospital,Anhui Province between July 2014 and February 2016 as the MS group,and other age-matched 510 community residents without MS underwent physical examination between October and December 2015 as the control group.The measurement of height,weight,blood pressure〔systolic blood pressure(SBP),diastolic blood pressure(DBP)〕,fasting plasma glucose(FPG),total cholesterol(TC),triacylglycerol(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),apolipoprotein A1(Apo-A1),apolipoprotein B100(Apo-B100),lipoprotein a〔Lp(a)〕,free fatty acids(FFA),Homocysteine(HCY) serum calcium,phosphorus,VitD,parathyroid hormone(PTH),and fasting insulin(FINS) was performed in all the participants.BMI and homeostasis model assessment of insulin resistance(HOMA-IR) and calcium-phosphorus product were calculated.Results  The two groups showed no significant differences in terms of gender,age,height,weight,BMI,TC,TG,HDL-C,LDL-C,FFA,serum calcium and phosphorus,and calcium-phosphorus product(P>0.05).Compared with the control group,MS group had higher levels of SBP,DBP,Apo-B100,Lp(a),HCY,FPG,FINS and HOMA-IR(P<0.05) but lower levels of Apo-A1,VitD and PTH(P<0.05).The distribution of VitD levels in the control group was significantly different from that in the MS group(P<0.05).Gender,levels of HOMA-IR and PTH were obviously associated with the differences in VitD levels in MS patients(P<0.05),while age,height,weight,BMI,levels of SBP,DBP,TC,TG,HDL-C,LDL-C,Apo-A1,Apo-B100,LP(a),FFA,HCY,FPG,FINS,calcium,phosphorus,and value of calcium-phosphorus product were not(P>0.05).VitD levels decreased with the increased proportion of females,rise of BMI,levels of DBP,Apo-B100,HCY,FPG,HOMA-IR and PTH(P<0.05),whereas it grew in straight line with the elevation of levels of SBP and LDL-C(P<0.05).Conclusion  MS patients usually have metabolic disorders such as hypertension,hyperglycemia,and hyperlipidemia.Serum VitD levels are correlated with blood pressure,FPG and insulin resistance.Decreased VitD levels might play a role in the pathogenesis of MS.
    【Key words】  Middle aged;Aged;Vitamin D;Metabolic syndrome X
 
Changes of Serum HIF-1α,VEGF,vWf,IGF-1,25(OH)D3 Levels and Their Correlation in Type 2 Diabetes Mellitus Patients with Different Urinary Albumin Excretion Rates  SHAO Ying,LYU Chuan,MA Xiao-yu,WANG Qiu-yue* 
Department of Endocrinology,the First Hospital Affiliated to China Medical University,Shenyang 110001,China
*Corresponding author:WANG Qiu-yue,Professor,Doctoral supervisor;E-mail:wqycmu123@163.com
    【Abstract】  Objective  To investigate the changes of serum hypoxia-inducible factor-1 alpha(HIF-1α),vascular endothelial growth factor(VEGF),von Willebrand factor(vWf),insulin-like growth factor-1(IGF-1),25-hydroxyvitamin D3〔25(OH)D3〕 levels and their correlation in type 2 diabetes mellitus(T2DM) patients at different stages of diabetic nephropathy(DN) determined by urinary albumin.Methods  Four hundred and twenty-three outpatients and inpatients with T2DM(case group) admitted to the First Hospital Affiliated to China Medical University between June 2012 and November 2014 were included in this study.They were compared with 165 gender- and age- and BMI-matched healthy adults(control group) undergoing physical examination in the same hospital during the same period.For further and detailed study,in accordance with the level of urinary albumin excretion rate〔which is expressed with albumin/creatinine ratio(ACR)〕,we divided the case group into normoalbuminuric subgroup(ACR<30 mg/g,n=163),microalbuminuric subgroup(ACR ranges 30~300 mg/g,n=145),and macroalbuminuric subgroup(ACR>300 mg/g,n=115).The levels of serum HIF-1α,VEGF,vWf,and IGF-1 were determined by enzyme-linked immunosorbent assay(ELISA),and 25(OH)D3 was measured by chemiluminescent immunoassay(CLIA) in all the subjects.Results  Duration of T2DM,waist circumference,waist to hip ratio(WHR),fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),serum creatinine(SCr),blood urea nitrogen(BUN),uric acid(UA),fibrinogen(Fg),fasting insulin(FINS),homeostasis model assessment- insulin resistance(HOMA-IR),Ln(ACR),HIF-1α,VEGF,vWf,IGF-1 and 25(OH)D3 differed significantly between the control group,and normoalbuminuric,microalbuminuric and macroalbuminuric subgroups(P<0.05),while gender,average age,BMI,and high-density lipoprotein cholesterol(HDL-C) did not(P>0.05).Pearson correlation analysis found that,HIF-1α had linear positive correlation with VEGF,vWf as well as IGF-1(P<0.05);VEGF was linearly and positively correlated with vWf along with IGF-1(P<0.05);linear positive correlation was found between vWf and IGF-1(P<0.05);while 25(OH)D3 showed linear negative correlation with HIF-1α,VEGF,vWf,and IGF-1(P<0.05).Results of Spearman′s rank correlation coefficient analysis demonstrated that,Ln(ACR)was positively associated with the duration of T2DM,waist circumference,WHR,HbA1c,TC,TG,LDL-C,SCr,BUN,UA,Fg,HOMA-IR,HIF-1α,VEGF,vWf and IGF-1(P<0.05),while it was negatively associated with 25(OH)D3(P<0.05).Multiple stepwise regression and principal component regression analysis revealed that the duration of T2DM,TG,LDL-C,SCr,BUN,UA,HOMA-IR,HIF-1α,VEGF,vWf,IGF-1,25(OH)D3 were the correlation factors for Ln(ACR)(P<0.05),with a regression equation of Y[Ln(ACR)]=2.553+0.967×principal component +0.024×duration of T2DM +0.123×TG+0.147×LDL-C+0.018×SCr+0.195×BUN+0.003×UA+0.033×HOMA-IR-0.045×25(OH)D3,principal component =0.827×HIF-1α+0.846×VEGF+0.727×vWf +0.931×IGF-1.Conclusion  In T2DM patients,with the increase of Ln(ACR),the levels of serum HIF-1α,VEGF,vWf and IGF-1 were gradually increased,while serum 25(OH)D3 was gradually decreased.Serum levels of HIF-1α,VEGF,vWf,IGF-1 may be involved in the occurrence and progression of DN through chronic inflammation,promoting angiogenesis,endothelial injury and dysfunction.These pathogeneses interact with each other and promote each other;25(OH)D3 may have protective effect on DN,and its protective effect is realized at least in part by inhibiting the inflammatory reaction,abnormal angiogenesis and inhibiting vascular endothelial dysfunction.
    【Key words】  Diabetic nephropathy;Hypoxia-inducible factor Ⅰ alpha;Vascular endothelial growth factors;Von willebrand factor;Insulin-like growth factor Ⅰ;Calcifediol
 
Changing Level of Catecholamine,S-100 Protein and D-lactic Acid of Children with Hand-foot-and-mouth Disease Infected by Different Enterovirus and Its Clinical Significance  WANG Mei-fen1*,CHEN Tao2,GU Tao3,LUO Yun-jiao4,DU Zeng-qing4,WANG Ming-ying1
1.Department of Gastroenterology,the Children′s Hospital Affiliated to Kunming Medical University/Kunming Children′s Hospital,Kunming 650228,China
2.Hospital of Yunnan Normal University,Kunming 650031,China
3.Kunming Centers for Disease Control and Prevention,Kunming 650034,China
4.Department of Infection,the Children′s Hospital Affiliated to Kunming Medical University/Kunming Children′s Hospital,Kunming 650228,China
*Corresponding author:WANG Mei-fen,Associate chief physician,Associate professor,Master supervisor;E-mail:wangmeifen@etyy.cn
    【Abstract】  Objective  To investigate the changing level of catecholamine(CA),S-100 protein and D-lactic acid of children with hand-foot-and-mouth disease(HFMD) infected by different enterovirus and its clinical significance.Methods  A total of 129 children with HFMD hospitalized in Kunming Children′s Hospital from April to July 2014 were enrolled.With GC-2016γ radioimmunoassay counter,CA 〔including noradrenaline(NE),adrenaline(AD) and dopamine(DA)〕 was measured by radioimmunoassay;with the American Boxlight ELx800NB microplate reader,the S-100 protein was measured by enzyme-linked immunosorbent assay;and D-lactic acid was measured by enzyme-linked immunosorbent assay.With 7500PCR amplifier produced by ABI company in Germany,the real-time quantitative PCR method was used to detect and classify fecal pathogens.Results  Of the 129 children with HFMD,57(44.2%) were enterovirus 71(EV71)-positive,26(20.2%) were 16-type coxsackievirus A(CoxA16)-positive,the detection of 20(15.5%) was positive in other enteroviruses,and the detection of 26(20.1%) was negative in enteroviruses.There were no significant differences in NE,AD,DA and S-100 protein levels among children with HFMD infected by different enterovirus(P>0.05).The levels of D-lactic acid in the subjects were significantly different(P<0.05).The level of D-lactic acid in HFMD children of EV71-positive was higher than that in children of other enteroviruses-positive and enteroviruses-negative.Conclusion  There are no differences in levels of CA and S-100 protein among children with HFMD infected by different enterovirus.The level of D-lactic acid in children with HFMD by EV71 is higher and the permeability of intestinal barrier is increased.
    【Key words】  Child;Hand,foot and mouth disease;Enterovirus infections;Catecholamines;S100 proteins;D-lactic acid
 
Efficacy and Safety of Low-dose Ticagrelor in Patients at Six Months after Percutaneous Coronary Intervention  SONG Min1,2,YAO Zhu-hua2*,MEN Jian-long3,CAO Ming-ying2,LI Wen-ting2,CHEN Ying2
1.Graduate School,Tianjin Medical University,Tianjin 300070,China
2.Deparment of Cardiology,Tianjin People′s Hospital,Tianjin 300121,China
3.Medical Laboratory,Tianjin Medical University General Hospital,Tianjin 300052,China
*Corresponding author:YAO Zhu-hua,Chief physician,Master supervisor;E-mail:tjyzhpci@163.com
    【Abstract】  Objective  To evaluate the efficacy and safety of low-dose ticagrelor in patients at six months after percutaneous coronary intervention(PCI).Methods  Nine-five patients underwent postoperative review at 6 months after PCI in Tianjin People′s Hospital between July 2015 and February 2016 were selected as the participants and divided into the ticagrelor group(n=33) and clopidogrel group(n=62) based on the P2Y12 adenosine diphosphate-receptor antagonist type that the postoperatively orally taken drug belongs to.Patients in the ticagrelor group received standard dose of ticagrelor(90 mg,twice daily),and those in the clopidogrel group took clopidogrel(75 mg,once daily) after PCI.At six months after PCI,the ticagrelor group changed to low-dose ticagrelor(45 mg,twice daily),but the clopidogrel group continued to take the same dose of clopidogrel.Both groups were given aspirin(100 mg,once daily).Light transmission aggregometry(LTA) was used to measure the platelet aggregation rate at the time that they completed 1-week,and 3-month administration following the reviewing.Comparisons were made between the two groups′ two measurement results of platelet aggregation rate,major adverse cardiac events(MACE) and adverse reactions occurred during the 6-month follow-up.Results  The platelet aggregation rates measured at the time that the patients completed 1-week,and 3-month administration following the reviewing in ticagrelor group were all dramatically lower than those in clopidogrel group(P<0.05).In both groups,little difference was observed between the two measurement results of platelet aggregation rate(P>0.05).The follow-up results showed that,the incidence of MACE was significantly lower in the ticagrelor group than that in the clopidogrel group(P<0.05),but there were no significant difference in the incidence of mild hemorrhage and dyspnea between the two groups(P>0.05).Conclusion  Inhibitory effect on platelet aggregation of low-dose ticagrelor administered at 6 months after PCI was significantly stronger than that of clopidogrel.Low-dose ticagrelor can reduce the incidence of ischemic events in the patients after PCI,without increasing the risk of bleeding.
    【Key words】  Angioplasty,balloon,coronary;Ticagrelor;Clopidogrel;Treatment outcome
 
Expression of Human Leucocyte Antigen G in Tibetan and Han Patients with Preeclampsia at Different Altitudes of Qinghai Area  XIE Ying-ying1*,ZHAO Hai-ning1,PEI Qing-qing1,QU Xin-xia1,ZHANG Zhen-ping1,ZHAO De-xiong2
1.Department of Obstetrics,Affiliated Hospital of Qinghai University,Xining 810001,China
2.Department of Obstetrics,Qinghai Red Cross Hospital,Xining 810000,China
*Corresponding author:XIE Ying-ying,Chief physician,Master supervisor;E-mail:xyy09001@163.com
    【Abstract】  Objective  To investigate the expression of human leucocyte antigen G(HLA-G) in Tibetan and Han patients with preeclampsia at different altitudes of Qinghai Area.Methods  30 Han puerperas delivered in Affiliated Hospital of Qinghai University(an altitude of 2 200 m) from January 2015 to January 2016 were selected,and among them 16 with preeclampsia,14 of normal pregnancy;another 21 Tibetan puerperas delivered in Yushu Tibetan Autonomous Prefecture Hospital(an altitude of 3 700 m) during the same period were also selected,and among them 10 with preeclampsia,11 of normal pregnancy.The expression of HLA-G mRNA and protein in maternal placenta was detected by real-time quantitative polymerase chain reaction(RT-PCR) and western blotting.Results  There were significant differences in expression of HLA-G mRNA and protein among puerperas in different situations(P<0.05).The expression of HLA-G mRNA and protein among Han puerperas with preeclampsia at low altitudes,Tibetan puerperas of normal pregnancy at high altitudes and Tibetan puerperas with preeclampsia at high altitudes was significantly lower than that of Han puerperas of normal pregnancy at low altitudes(P<0.05).The expression of HLA-G mRNA and protein of Tibetan puerperas with preeclampsia at high altitudes was significantly lower than that of Tibetan puerperas of normal pregnancy at high altitudes(P<0.05).The expression of HLA-G protein of Tibetan puerperas with preeclampsia at high altitudes was significantly lower than that of Han puerperas with preeclampsia at low altitudes(P<0.05),while there was no significant difference in the expression of HLA-G mRNA and protein between Han low-altitude puerperas with preeclampsia and Tibetan high-altitude puerperas of normal pregnancy(P>0.05).There was no significant difference in the expression of HLA-G mRNA between Han low-altitude puerperas with preeclampsia and Tibetan high-altitude puerperas with preeclampsia(P>0.05).Conclusion  The chronic hypoxia environment in plateau may affect the expression of HLA-G gene.The differential expression of HLA-G in Tibetan and Han nationalities at different altitudes may play an important role in the pathogenetic process of preeclampsia in Qinghai plateau area,and is one of the causes of high incidence of preeclampsia in the plateau region.
    【Key words】  Pre-eclampsia;HLA antigens;Altitude;Zang nationality;Han nationality
 
General Written Test Paper Analysis and Evaluation for Rural General Practice Assistant Physician Licensing Examination  YANG Fang-li,ZOU Jie-wen,LI Qiang*
National Medical Examination Center,Beijing 100097,China
*Corresponding author:LI Qiang,Associate professor;E-mail:liqiang0605@sina.com
    【Abstract】  Objective  To assess the quality of general written test paper for Rural General Practice Assistant Physician Licensing Examination(pilot) conducted in China in 2016.Methods  We analyzed the general status,difficulty,discrimination,reliability and validity of the general written test paper for Rural General Practice Assistant Physician Licensing Examination(pilot) conducted in China in 2016,and the scores,rate of mastering the knowledge covered by the test paper and passing rate in the examinees.Results  The Rural General Practice Assistant Physician Licensing Examination(pilot) was conducted in 6 provinces,1 municipality and 2 autonomous regions in China in 2016.A total of 14 137 persons participated in the general written test,51.51%(7 282/14 137) of thempassed it;the scores of the examinees ranged from 37 to 255,averaging(169.64±25.16),with a rate of mastering the knowledge covered by the test paper of 56.55%;the average scores of the examinees in modules of medical humanities,public health and general practice were (11.36±2.45),(35.98±5.53),(122.30±20.55) respectively,suggesting that the rate of mastering the knowledge covered by the above modules in the examinees were 63.12%,57.11%,55.85%,respectively.The difficulty of the test paper was 0.2~0.9,averaging (0.57±0.23),the average discrimination of the test paper was 0.2.The internal consistency reliability of this test paper measured by KR20 was 0.886;the correlation coefficient between scores of medical humanities and total scores of the test,scores of public health and total scores of the test,scores of general practice and total scores of the test respectively were 0.663,0.739,0.979(P<0.05).Conclusion  The scores of the examinees present normal distribution with a slightly positive skewness;the items arranged in the test paper have similar difficulty with good discrimination,construct validity and content validity;the overall quality of the test paper meets the basic requirements of the criterion-referenced test.
    【Key words】  Rural general practice assistant physician;Qualified doctor tests;Educational measurement
 
Evaluation of the Effect of Skills Training for General Practitioners by Leicester Assessment Package  GAO Qing1,ZHU Xun2,GAO Ya1,GENG Xiao-lu3,CHEN Lu1,WANG Yu1,CHEN Shao-xian1*
1.School of Public Health,Sun Yat-sen University,Guangzhou 510080,China
2.Haihua Community Health Service Center,Shenzhen Bao′an People′s Hospital,Shenzhen 518000,China
3.Haiwan Community Health Service Center,Shenzhen Shekou People′ Hospital,Shenzhen 518067,China
*Corresponding author:CHEN Shao-xian,Professor,Master supervisor;E-mail:chshaox@mail.sysu.edu.cn
    【Abstract】  Objective  To assess the effect of international skills training program for general practitioners(GPs) conducted in Shenzhen so as to provide references for training for GPs and assessment of the training effect.Methods  This study was conducted between 2 groups from June to July 2016.The trainee group we assigned were the 22 GPs attending the first training course of international skills training program for GPs conducted in Bao′an District,Shenzhen,and the control group were 22 GPs who did not attend the training,but were well-matched with the trainee group in the ratio of 1∶1.Every participant was hypothesized to consult 8 patients,and the consultation competence of them was evaluated on the spot by a member from the research group of this study and a well-qualified general practitioner by using the Leicester assessment package(LAP) covering 7 categories,interviewing/history taking,physical examination,patient management,problem solving,behavior/relationship with patients,anticipatory care and record keeping.Results  The final participants were 20 in the trainee group as well as in the control group.The 20 trainees and their paired doctors were finally assessed for 263 consultations in total,129 and 134 consultations for control and training group respectively.The average consultation length of the trainee group was significantly longer than that of the control group(P<0.05).The scores for every category and total points of the trainee group were all higher than those of the control group(P<0.05).Stepwise multiple linear regression analysis of the associated factors for the scores allocated to the participants by LAP criteria found that,grouping was the factor associated with the scores for categories of interviewing/history taking,patient management,problem solving,behaviour/relationship with patients,record keeping and total points(P<0.05).After excluding the weightings,it was found that the significant differences between the two groups in the categories of interviewing/history taking,patient management,record keeping,problem solving,behavior/relationship with patients appeared a decreasing trend.Besides the factor "grouping",professional and technical title was also a factor affecting the scores for categories of interviewing/history taking,patient management,problem solving and total points(P<0.05),and "the registered major of qualification certificate of practicing doctor" was the associated factor of categories of patient management and anticipatory care(P<0.05).Conclusion  The program is beneficial for the improvement of the consultation competence of GPs,especially for the "interviewing/history taking","patient management" and "record keeping ",though the effects vary with professional and technical title and the registered major.Therefore,it is suggested that the training of GPs should pay attention to the general practice-based thinking and physician-patient communication skills,and using the methods of real consultation,case discussion and academic salons to promote overall quality of training;the assessment for consultation performance of GPs should be focused on the actual clinical effects,and the LAP can be used as a reference assessment tool.
    【Key words】  General practitioners;Clinical competence;Educational measurement;Leicester assessment package
 
Doctor-patient Relationship Under the Mutual Damage Mode Based on the Analysis of "WEI Ze-xi Event" and "CHEN Zhong-wei Case"  SUN Gang1*,LI Hui-teng2
1.Department of Health Management,School of Health Services Management,Southern Medical University,Guangzhou 510515,China
2.Department of Law,School of Health Services Management,Southern Medical University,Guangzhou 510515,China
*Corresponding author:SUN Gang,Associate professor,Master supervisor;E-mail:sunhoney163@163.com
    【Abstract】  We analyzed the fundamental causes of medical disputes in China from the aspects of hospital management system,social security system and medical resources allocation system,media report,legal system related to treat medical disputes,medical ethics and social morality,status of doctors and patients,and doctor-patient communication based on the analysis of "WEI Ze-xi Event" and "CHEN Zhong-wei Case",then put forward the solutions to these causes,such as improving the medial system,formulating and enacting the supporting medial measures,establishing professional medical accident appraisal institutions independent from the state administration system,strengthening the doctor-patient trust by good oral communication,and correctly guiding the public opinion by the internet and mass media.
    【Key words】  Physician-patient relations;Mutual damage mode
 
Assessment of Physician-patient Communication Skills in Practicing Physicians by SEGUE Framework  SHEN Li-jun1,SUN Gang2*
1.Institute for Hospital Management of Tsinghua University,Shenzhen 518055,China
2.Department of Health Management,School of Health Services Management,Southern Medical University,Guangzhou 510515,China
*Corresponding author:SUN Gang,Associate professor,Master supervisor;E-mail:sunhoney163@163.com
    【Abstract】  Objective  To investigate the status of physician-patient communication skills in practicing physicians,and put forward the corresponding countermeasures based on the deficiencies identified during the medical encounter.Methods  Between April and May 2016,from a tertiary grade A hospital in Guangzhou,320 selected visitors were surveyed by a questionnaire covering the demographic data,basic problems in physician-patient communication,and SEGUE Framework(25 items are covered in 5 dimensions of Set the stage,Elicit information,Give information,Understand the patient′s perspective,and End the encounter),and other selected 31 visitors were interviewed about the common problems in physician-patient communication,and the organized and analyzed results of interviewing were considered as the additional explanations for the discussion and recommendations of the study.Results  The 97.2%(311/320) of the 320 visitors who received the questionnaire survey and completed it effectively were selected as the final participants for the survey.The average scores for SEGUE Framework,5 dimensions of Set the stage,Elicit information,Give information,Understand the patient′s perspective,and End the encounter respectively were(15.5±5.2),(2.8±1.3),(6.5±2.2),(2.6±1.2),(2.4±1.3) and(1.3±0.8).The scoring rate for 5 dimensions of Set the stage,Elicit information,Give information,Understand the patient′s perspective,and End the encounter respectively were 56.6%(176/311), 64.5%(201/311), 64.8%(202/311), 60.0%(187/311),and 64.0%(199/311).Educational attainment was significantly associated with the scores of SEGUE Framework,and dimensions of Give information,Understand the patient′s perspective(P<0.05),but not with the scores of dimensions of Set the stage,Elicit information,and End the encounter(P>0.05).The physician-patient communication was assessed as very satisfied in 2.9%(9/311),satisfied in 33.4%(104/311),fair in 53.4%(166/311) and unsatisfied in 10.3%(32/311).The level of satisfaction with physician-patient communication was obviously associated with the items of "Greet pt appropriately","Establish reason for visit","Outline agenda for visit","Make a personal connection during visit","Maintain pt′s privacy","Explore physical/emotional factors","Discuss antecedent treatments","Discuss how health problem affects pt′s life","Discuss lifestyle issues/prevention strategies","Avoid directive/leading questions","Give pt opportunity/time to talk","Listen.Give pt undivided attention","Check/clarify information","Explain rationale for diagnostic procedures","Teach pt about his/her own body & situation","Encourage pt to ask questions","Adapt to pt′s level of understanding","Acknowledge pt′s accomplishments/progress/challenges","Maintain a respectful tone","Express caring,concern,empathy","Ask if there is anything else pt would like to discuss","Rview next steps with pt"(P<0.05),but not associated with items of "Elicit pt′s view of health problem and/or progress","Explore physical/physiological factors","Discuss the importance of pt′s role in treatment/prevention"(P>0.05).Multinomial and ordinal Logistic regression analysis found that,greetmg patient appropriately,making a personal connection during visit,avoiding directive/leading questions,listening and giving patient undivided attention,maintaining a respectful tone were the factors associated with the level of patient satisfaction with physician-patient communication skills in practicing physicians(P<0.05).Conclusion  The scores of SEGUE Framework,especially those of the dimensions of Set the stage and Understand the patient′s perspective,assessed by the patients are low.Educational attainment is positively correlated with the requirements for physician-patient communication skills.During the medial encounter,greeting patient appropriately,making a personal connection during visit,avoiding directive/leading questions,listening and giving patient undivided attention,maintaining a respectful tone are the factors associated with the level of patient satisfaction with physician-patient communication skills in practicing physicians.
    【Key words】  Physician-patient relations;Health communication;SEGUE Framework
 
11Degree of Trust in Medical Care and Associated Factors in Community Residents  SUN Gang1,CHEN Ya-di2*,ZHOU Meng-yao1
1.Department of Health Management,School of Health Services Management,Southern Medical University,Guangzhou 510515,China
2.School of Law of Hainan University,Haikou 570228,China
*Corresponding author:CHEN Ya-di;E-mail:76263004@qq.com 
    【Abstract】  Objective  To investigate the degree of trust in medical care and associated factors in community residents,and based on this,put forward the effective measures for increasing their degree of trust in medical care and improving the physician-patient relationship.Methods  In April 2016,using convenience sampling,460 community residents were sampled and given the online survey or field survey via the Demographic Data Questionnaire for Community Residents,Chinese version of Wake Forest Physician Trust Scale(dimensions of benevolence and competence are assessed in this article),Associated Factors for the Degree of Trust in Medical Care Questionnaire for Community Residents(DTMCQCR),including 8 items of medical environment,patient′s awareness level of the doctor′s essential information,level of patient satisfaction with consultation duration,level of patient satisfaction with the treatment outcome,overall strength of the hospital,status of the doctor explaining the illness to the patient,level of respect to the patient paid by the doctor,and level of concern for the patient expressed by the doctor.Results  About 98.7%(454/460) of the respondents who responded the survey effectively were selected as the final participants.The results of the survey showed that,the scores of average degree of trust in medical care were (31.6±6.7),scores of benevolence and competence respectively were (16.0±3.7),and(15.7±3.6).Gender,educational attainment,and medical insurance status were not significantly correlated with the total scale score of DTMCQCR,and scores of benevolence and competence(P>0.05).Age was found to be a factor associated with the differences in the total scale score of DTMCQCR,and scores of benevolence(P<0.05),but not associated with the scores of competence(P>0.05).Stepwise multiple linear regression found that,level of patient satisfaction with the treatment outcome,overall strength of the hospital,status of the doctor explaining the illness to the patient,level of concern for the patient expressed by the doctor were the factors affecting the total scale score of DTMCQCR(P<0.05);the overall strength of the hospital,status of the doctor explaining the illness to the patient,level of respect to the patient paid by the doctor,and level of concern for the patient expressed by the doctor were the factors associated with the scores of benevolence(P<0.05);medical environment,level of patient satisfaction with the treatment outcome,status of the doctor explaining the illness to the patient,and level of concern for the patient expressed by the doctor were the factors associated with the scores of competence(P<0.05).Conclusion  The degree of trust in medical care in community residents in China is unsatisfactory,which are affected by the status of the doctor explaining the illness to the patient,level of concern for the patient expressed by the doctor,overall strength of the hospital,level of patient satisfaction with the treatment outcome,level of respect to the patient paid by the doctor and medical environment.Therefore,in order to increase the degree of trust in medical care in community residents,it is suggested that managers of medical institutions should pay attention to improve the competence of the health care providers,enhance humanistic care for the patients during treatment,advance the skills used by the health care providers to communicate with patients,and better the medical environment.
    【Key words】  Physician-patient relations;Degree of trust in medical care;Root cause analysis
 
11Residents′ Awareness and Requirements for the Third-party Mediation Mechanism for Medical Disputes  MIAO Jia-qing1,SUN Gang2*
1.Institute for Hospital Management of Tsinghua University,Shenzhen 518055,China
2.Department of Health Management,School of Health Services Management,Southern Medical University,Guangzhou 510515,China
*Corresponding author:SUN Gang,Associate professor,Master supervisor;E-mail:sunhoney163@163.com
    【Abstract】  Objective  To investigate the residents′ awareness and requirements for the third-party mediation mechanism for medical disputes(hereinafter referred to as TMMMD).Methods  In April and May 2016,using convenience sampling,460 residents in Guangzhou were sampled to attend the online survey or field survey via a self-developed questionnaire covering the aspects of the demographic data,attitude toward the TMMMD and suggestions to the People′s Conciliation Committee for Medical Disputes(PCCMD).Results  About 90.0%(414/460) of the respondents who responded the survey effectively were selected as the final participants.Among them,37.0%(153/414) had not heard of the TMMMD,50.0%(207/414) heard of it,but did not know the details,11.8%(49/414) knew that it can conciliate the medical disputes and knew that the PCCMD is a kind of TMMMD,only 1.2%(5/414) deeply understood it;residents aged ≤30 had lower awareness of the TMMMD than those aged 31~50(P<0.05);residents with the experience of medical disputes had higher awareness of the TMMMD than those without(P<0.05);62.1%(257/414)were in favor of conciliating the medical disputes by the TMMMD;78.3%(324/414)worried that the conciliator might build long-term cooperation with the hospital and favor the hospital when settling the disputes;28.5%(118/414)preferred the members from health administrative departments to conciliate the medical disputes;53.4%(221/414)thought that it would be the best if the expense for conciliating medical disputes was financed by the government;73.2%(303/414) considered that the best procedure for conciliating medical disputes was face-to-face confrontation between doctors and patients in publicly conciliating;in terms of the causes associated with unchoosing the TMMMD,62.8%(260/414) hold that the public awareness for the TMMMD was weak due to poor publicity,and 43.2%(179/414) were inclined to that the conciliation conducted by it was unneutral and unfair.Conclusion  In the participants,the awareness for the TMMMD was weak,but it was supported mostly after being introduced briefly;the procedure of face-to-face confrontation between doctors and patients in publicly conciliating was preferred;the expense for the conciliating was hoped to be financed by the government;the TMMMD was not trusted mainly due to poor publicity,distrusting the neutrality and fairness of the conciliation done by it and lack of guarantees for bringing the conciliation results into practice.In view of these points,the following suggestions are put forward:strengthening the publicity of the TMMMD targetedly;improving the qualities of the conciliators;perfecting the avoidance system;standardizing the nature of ownership of the TMMMD;stabilizing the funding for the conciliating;demonstrating the legal effect of the conciliation results by signing the special civil contract and establishing an insurance compensation mechanism for medical accidents.
    【Key words】  Physician-patient relations;Third-party mediation mechanism;Cognition;Requirement
 
Mediating Effect of Coping Styles and Self-help Capabilities on the Factors Affecting the Mental Health of Urban Empty-nesters  WANG Li-na1,CAO Jia-ying2,SU Hong3,ZHOU Yu-qiu3*
1.Schools of Medicine & Nursing Sciences,Huzhou University,Huzhou 313000,China
2.Songshan District Zhenxing Subdistrict Office,Chifeng 024005,China
3.School of Nursing,Harbin Medical University(Daqing),Daqing 163319,China
*Corresponding author:ZHOU Yu-qiu,Professor,Master supervisor;E-mail:aring2000@163.com
    【Abstract】  Background  Many variables are associated with the mental health of empty-nesters.However,few studies have brought multiple associated variables of the mental health into the influential system at the same time,and investigated the ways by which they interacting each other.
Objective  To explore the mechanism of copy styles and self-help capabilities on the factors affecting the mental health of empty-nesters.Methods  From January 2014 to September 2015,by multi-stage sampling,365 empty-nesters living in the urban area of Chifeng,Inner Mongolia Autonomous Region were selected and surveyed by the Chinese version of EPQ-RSC,SCSQ,Self-help Capabilities for Mental Health in the Empty-nesters Scale and Chinese Mental Health Scale(aged).Three hundred and fifty(95.89%) of them effectively responding to the survey were selected as the final participants of this study.The structural equation modeling was developed and used to analyze the internal relations and transmission mechanisms between the factors associated with the mental health of urban empty-nesters.PRODCLIN program 2 described by Mackinnon was used to verify the mediating effect of the factors.Results  The effect of personality traits on the mental health partly fitted the mediation model(χ2/df=1.971,GFI=0.955,AGFI=0.911,RMSEA=0.068).Introversion and extroversion indirectly exerted obvious mediating effect by positively coping with and self-help management of the factors affecting the mental health(Z=5.675,P<0.01).When the overall indirect effects in the SEM were substantial,the indirect effect of every variable was verified.Significant individual indirect effects between two variables were identified if their 95%CI respectively were (0.127,0.364),(0.168,0.471)analyzed by the PRODCLIN program 2 described by Mackinnon.Nervosity indirectly produced significant mediating effect by positively coping with and self-help management of the factors affecting the mental health(Z=-5.353,P<0.01).The indirect effect of every variable was verified when the overall indirect effects in the SEM were significant.Notable individual indirect effects between two variables were identified if their 95%CI respectively were(0.127,0.203),(0.186,0.492)processed by the PRODCLIN program 2 described by Mackinnon.Conclusion  The positive coping styles and self-help capabilities significantly mediate the relationship between personality traits and mental health among urban empty-nesters.In order to maintain good mental health of the urban empty-nesters,it is suggested that intervention methods should be developed in accordance with the relationships between the factors affecting the mental health,then,based on the personal psychological and sociological assessment results,the optimal one is selected to use.In this way,good effects can be achieved by the individualized intervention,and the intervention burden,such as the waste of manpower and material resources caused by combined intervention can be reduced.
    【Key words】  Empty-nesters;Mental health;Structural equation model
 
Effect of Group Psychological Intervention on the Loneliness and Quality of Life in Urban Empty-nesters  LI Sha-sha1,WANG Mi2,WANG Li-na1*,SU Hong3,CAO Jia-ying4
1.School of Medicine & Nursing Sciences,Huzhou University,Huzhou 313000,China
2.Nursing Department,Ningbo Hospital of TCM,Ningbo 315010,China
3.School of Nursing,Harbin Medical University(Daqing),Daqing 163319,China
4.Songshan District Zhenxing Subdistrict Office,Chifeng 024005,China
*Corresponding author:WANG Li-na,Associate professor,Master supervisor;E-mail:aring2000@163.com
    【Abstract】  Background  The factors associated with the loneliness and quality of life in urban empty-nesters have been explored many times,but the maintaining and promotion of mental health in them have rarely been studied.
Objective  To explore the appropriate group psychological intervention for improving the loneliness and quality of life in urban empty-nesters based on the associated factors.Methods  Multi-stage sampling was used in this study.By drawing lots,we selected the intervened communities governed by 2 subdistrict offices,and the control communities governed by other 2 subdistrict offices,in Hongshan District,Chifeng,Inner Mongolia Autonomous Region.Then,using convenience sampling,from the intervened communities and the control communities,we respectively selected 38 empty-nesters as the intervention group and control group.Both groups received the conventional community-based nursing intervention,the intervention group additionally received 3-month group psychological intervention.UCLA Loneliness Scale(UCL-LS) and MOS 36-Item Short Form Health Survey(SF-36) were used to survey the respondents before and after receiving intervention.Before intervention,all the participants(100.0%) responded to the survey effectively.Due to 7 participants withdrawing from the intervention,the rest of the 69 received the complete intervention and they responded to the survey after intervention effectively with a response rate of 100.0%.Results  Two-way ANOVA(grouping and timing) was used to analyze the intervention effect in both groups and between the groups based on comparing the status of loneliness and quality of life before and after intervention.The results of analysis showed that,grouping exerted significant main effect on the scores of loneliness and quality of life(P<0.05);timing had obvious main effect on the scores of loneliness and quality of life(P<0.05);grouping and timing had notable interaction effect on the scores of loneliness and quality of life(P<0.05).By using simple effect analysis,it was found that,two groups presented no significant differences in scores of loneliness and quality of life before intervention(P>0.05),but after intervention,they showed substantial differences in the two aspects(P<0.05);compared with those before intervention,score of loneliness life improved a little in the control group after intervention(P>0.05),but score of quality of life improved significnatly in the control group and both of them improved significantly in the intervention group(P<0.05).Conclusion  Targeted group psychological intervention can reduce the loneliness and improve the quality of life in urban empty-nesters,and it can be used as a reference for primary care providers to maintain the mental health in this population.
    【Key words】  Empty-nesters;Group psychological intervention;Loneliness;Quality of life
 
Research Progress of Frailty  LIU Chang-hu,HU Song,MAO Yong-jun,XING Ang*
Department of Geriatric Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266003,China
*Corresponding author:XING Ang,Professor,Chief physician,Master supervisor;E-mail:xingang2005@sina.com
    【Abstract】  Frailty refers to a complex clinical condition of the elderly,and the core of it is the decline of the physiological reserve and stress adaptability of the elderly.To a certain extent,frailty can reflect the chronic health problems and medical needs of the elderly more accurately and objectively,and it also can explain the differences of the disease prognosis,rehabilitation and quality of life before and after frailty.However,the exact pathogenesis of frailty is unclear and there is no definite gold standard of its diagnosis and evaluation.Through the systematic review of domestic and foreign literature published in recent years,this paper described the progress of research on the frailty of the elderly mainly from the aspects of risk factors,pathophysiology,evaluation,prevention and treatment in order to help the development and spread of geriatric medicine in China and further promote the standardized treatment of geriatric diseases.
    【Key words】  Aged;Frailty;Risk factors;Pathogenesis;Assessment tool;Review
 
Research Progress of Elder Abuse  LIU Li,WANG Xiu-hua*,GU Can,LIU Dan,YANG Chen
Xiang Ya Nursing School,Central South University,Changsha 410013,China
*Corresponding author:WANG Xiu-hua,Professor,Master supervisor;E-mail:xiuhua203@163.com
    【Abstract】  This paper revie

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