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July 2017, Volume 20, No.19 Abstracts

 Healthcare Reform of Luohu District Based on the System of "Total Fixed Expense of Health Insurance,Paying Back the Saving Cost As a Bonus"
  XIA Jun-jie1*,LU Zu-xun2,WANG Jia-ji3,SUN Huang-hui4,WU Xiao-liang5,SUN Xi-zhuo6
1.Shenzhen Center for Disease Control and Prevention,Shenzhen 518055,China
2.Tongji Medical College of HUST,Wuhan 430030,China
3.School of Public Health,Guangzhou Medical University,Guangzhou 511436,China
4.Shenzhen Municipal Human Resources and Social Security Bureau,Shenzhen 518040,China
5.Luohu District Center for Disease Control and Prevention,Shenzhen 518055,China
6.Shenzhen Luohu Hospital Group,Shenzhen 518000,China
*Corresponding author:XIA Jun-jie;E-mail:13602679063@139.com
    【Abstract】  To find a solution for the problems such as "difficulty and high cost to access medical services" and overtreatment,the healthcare reform of Luohu District in Shenzhen City is developed by means of setting up an integrated system for the management of the services delivered by hospitals and community health service centers based on the system of "total fixed expense of health insurance,paying back the saving cost as a bonus".This reform focuses on enhancing the quality of health services and promoting the development of residents′ preventive healthcare,keeping the medical cost under reasonable control and improving the health status of community residents comprehensively,by which the goal of "less illness,less hospitalization,less disease burden and more health" for the residents in Luohu District can be realized finally.
    【Key words】  Luohu model;Total fixed expense of health insurance;Community health services;Preventive healthcare
 
Gesundes Kinzigtal Integrated Care in Germany:Centering on Health Promotion
  LUO Xiu
Department of Preventive Medicine,North Sichuan Medical College,Nanchong 637007,China
    【Abstract】  Facing the great challenges of rapidly aging society and changes in disease spectrum,Germany has launched a series of health service reforms.Through centering on health promotion,developing multiple disease management programmes and service networks,innovating financial incentives,integrating health service providers and health insurance institutions,the Gesundes Kinzigtal Integrated Care(GK) has demonstrated how to achieve the aim of improved population health,reduced incidence of chronic diseases and controlled healthcare costs.The GK model is a good example for China to gain the aim of "Healthy China" in the following ways:improving the integrated prevention and control mechanism of NCDs,valuing health promotion,reforming the healthcare delivery system,and establishing a scientific health status evaluation system.
    【Key words】  Health promotion;Integrated healthcare services;Disease management;Germany
 
Status and Equity of Current Distribution of General Practitioners in China
  ZHOU Ling-li1,WANG He-ping2,XIE Long1,DING Hong1*
1.School of Public Health Administration,Anhui Medical University,Hefei 230032,China
2.Rural Cooperative Medical Management Office of Anhui Province,Hefei 230032,China
*Corresponding author:DING Hong,Professor,Master supervisor;E-mail:dinghong_cn2003@163.com
    【Abstract】  Objective  To investigate the status and equity of current distribution of general practitioners(GPs) in China.
Methods  This study was based on the data of distribution of GPs in 31 provinces(autonomous regions and municipalities) in China without Taiwan,Hong Kong Special Administrative Region and Macao Special Administrative Region.The data about population size(population),gross regional product(economy) and jurisdiction(geography) in every province(autonomous region,municipality) by the end of 2012,2013,and 2014 were from China Statistical Yearbook 2013,China Statistical Yearbook 2014,China Statistical Yearbook 2015;data about GPs were from China′s Health and Family Planning Statistical Yearbook 2013,China′s Health and Family Planning Statistical Yearbook 2014,and China′s Health and Family Planning Statistical Yearbook 2015.Gini coefficient based on the Lorenz curve and Theil index were used to assess the equity of distribution of GPs in China from the aspects of population,economy and geography.
Results  There were 172 597 GPs in China in 2014,which increased by 18.61% compared with that of 2013,and by 57.20% compared with that of 2012.In 2014,the number of GPs accounted for 5.97% of the totaled registered(assistant) physicians;the average number of GPs delivering healthcare services for 10 000 persons in China was 1.27,specifically,that was 1.71,less than 1,less than 1,for 10 000 persons in eastern China,central China,and western China,respectively.From 2012 to 2014,the Gini coefficient for assessing the equity of access to GPs dropped from 0.313 2 to 0.252 6 by population,0.230 0 to 0.204 2 by the economy,0.742 4 to 0.717 6 by the geography;the Theil index for assessing the equity of access to GPs dropped from 0.075 2 to 0.049 4 by population,0.036 6 to 0.028 2 by the economy,0.591 7 to 0.540 5 by the geography.
Conclusion  In China from 2012 to 2014,the number of GPs increased significantly,but the overall distribution of GPs was unsatisfied;the distribution of GPs was not balanced,and it varied significantly from place to place;the equity of distribution of GPs was good if by population and economy,but poor by geography.
    【Key words】  General practitioners;Resource allocation;Health care rationing;Lorenz curve;Gini coefficient;Theil index
 
Status and Influencing Factors of Hierarchical Medical System among Middle-aged and Elderly Patients in China
  LI Jia-sen,FENG Xing-lin*
School of Public Health,Peking University,Beijing 100191,China
*Corresponding author:FENG Xing-lin,Associate professor,Master supervisor;E-mail:fxl@bjmu.edu.cn
    【Abstract】  Objective  To investigate the present situation and influencing factors of the hierarchical medical system among middle-aged and elderly patients and provide policy suggestions for the reform of hierarchical medical system in China.
Methods  According to the baseline data of China Health and Retirement Longitudinal Study(CHARLS) in 2011 and tracking date in 2013,6 981 patients 45 years or above who sought outpatient care within nearly a month before the study in May 2016 were involved in the questionnaire,including 3 233(46.3%) patients in 2011 and 3 748(53.7%) in 2013,and 4 294(61.5%) patients living in rural areas and 2 687(38.5%) in urban areas.Based on the Andersen′s model,factors influencing the choice of health care providers among patients 45 years or above were chosen as gender,age,education,marital status,residence,economic level,health insurance,chronic diseases and self-rated health.The pooled Logistic regression model was used to analyze the influencing factors of middle and elderly patients in rural areas and villages when they choose the primary health care institutions.
Results  The rates of rural and urban elderly patients choosing primary health care institutions for medical help in these two years were 70.9%(3 046/4 294) and 51.3%(1 379/2 687) respectively,of which 73.5%(1 481/2 015) and 53.5%(652/1 218) were respectively in 2011,and 68.7%(1 565/2 279) and 49.5%(727/1 469) were respectively in 2013.Compared to 2011,the rates in 2013 declined 6.5% and 7.5% respectively.The results of pooled Logistic regression model analysis showed that year,age,culture level,economic level,medical insurance type and health status were the factors influencing rural middle-aged and elderly patients′ choice of primary health care institutions(P<0.05),while cultural level,economic level,the types of medical insurance,the prevalence of chronic diseases and the condition of health were the influencing factors of middle - aged and elderly patients in urban areas(P<0.05).Compared to 2011,the rates of rural patients 45 years or above with medical insurance for urban and rural residents〔OR(95%CI)=0.804(0.685,0.944)〕,chronic diseases〔OR(95%CI)=0.773(0.658,0.907)〕 and urban patients aged over 45 years with no social health insurance〔OR(95%CI)=0.446(0.217,0.915)〕 choosing primary health care institutions for medical help were less lower in 2013.
Conclusion  Since the implementation of the new medical reform,the proportion of patients above 45 years old choosing primary health care institutions for outpatient care has declined in recent years,especially for patients with chronic diseases.And social health insurance in China failed to guide patients to search medical help from primary health care institutions.In order to achieve the implement of hierarchical medical system,efforts should be made to address the double fragmentation problems both embedded in the health service system and the social insurance system.Collaboration and linkage mechanism should be established among different levels of medical institutions and the integration of the social health insurance system is expected to be implemented rapidly to achieve a reasonable diversion of patients for medical treatment.
    【Key words】  Community health services;Hierarchical medical system;Root cause analysis;Middle aged and eldly
 
Application Status of Screening Tools for Subjective Cognitive Decline in Community  HAO Li-xiao1,2,HAN Ying2,3,4,5,6*,JIA Jian-guo2* 
1.School of General Practice and Continuing Education,Capital Medical University,Beijing 100069,China
2.Xuanwu Hospital,Capital Medical University,Beijing 100053,China
3.Center of Alzheimer′s Disease,Beijing Institute for Brain Disorders,Beijing 100069,China
4.Beijing Institute of Geriatrics,Beijing 100730,China
5.National Clinical Research Center for Geriatric Disorders,Beijing 100730,China
6.PKU Care Rehabilitation Hospital,Beijing 102206,China
*Corresponding author:HAN Ying,Chief physician,Professor,Doctoral supervisor;E-mail:13621011941@163.com
JIA Jian-guo,Chief physician,Professor,Doctoral supervisor;E-mail:jiajianguo_1@126.com
    【Abstract】  As a chronic neurodegenerative disease,Alzheimer′s disease(AD) seriously affects the health of human.Since there are no effective means of cure for AD whose prognosis is also poor,the early finding,early diagnosis and early treatment are utmost important.As the earliest stage of AD,subjective cognitive decline(SCD) has caused the attention of scholars all over the world.However,the choices of screening tools for AD are different among the international society.This paper summarizes the application status of screening tool for SCD in the community and tries to help the establishment of a broad and effective screening tool for community.
    【Key words】  Alzheimer disease;Subjective cognitive decline;Communities;Screening tool
 
Effectiveness Evaluation of the Reform in Incentive System for Healthcare Professionals Implemented
  JING Li-mei1,LIU Kun1,ZHOU Xu-hong2,SUN Xiao-ming1,3*,WANG Li2,HUANG Yao4,QU Tian-hui4,LOU Ji-quan1,FAN Jin-cheng2
1.Pudong Institute for Health Development,Shanghai 200129,China
2.Pudong New Area Health and Family Planning Commission,Shanghai 200125,China
3.School of Public Health,Fudan University,Shanghai 200032,China
4.Pudong New Area Service Center for Health Human Resources,Shanghai 200129,China
*Corresponding author:SUN Xiao-ming,Professor,Doctoral supervisor;E-mail:pdhealthpolicy@163.com
    【Abstract】  Objective  To evaluate the effectiveness of reform in incentive system for healthcare professionals implemented so as to provide references for the sustainable implementation of the incentive policies.
Methods  We surveyed the leaders of the competent department of 45 community health service centers(CHSCs) in Pudong New Area by the end of December 2014,and 2015 respectively by using three questionnaires,Data of Healthcare Professionals in CHSCs in Pudong New Area,Data of the Introduced Healthcare Professionals in CHSCs in Pudong New Area and Data of the Lost Healthcare Professionals in CHSCs in Pudong New Area.The healthcare professionals were classified into general practitioners(GPs),public health physicians and other types of physicians,nurses,and other types of healthcare professionals.We intensively analyzed the status of inward flow and outflow,number and structure of healthcare professionals during 2014 and 2015 in three types of CHSCs〔type A(12 CHSCs in remote rural areas),type B(11 CHSCs in rural areas that are not far away from the city),type C(9 CHSCs in the rural-urban fringe)〕 in which the reform in incentive system for rural healthcare professionals was implemented.
Results  In the three types of CHSCs,the overall number of healthcare professionals was 3 842 in 2014 and 3 818 in 2015;the ratio of GPs to public health physicians and other types of physicians,nurses,and other types of healthcare professionals was 21∶25∶35∶19 in 2014,and 23∶23∶35∶19 in 2015;281 and 282 healthcare professionals were introduced in 2014,and 2015 respectively;the number of introduced GPs in 2015 was increased by 62.50% compared with that of 2014(39 vs 24);the turnover rate of healthcare professionals was 4.35%(167/3 842)in 2014 and 3.77%(144/3 818)in 2015;the lost number of public health physicians and other types of physicians and nurses respectively accounted for 43.75%(63/144)and 34.03%(49/144)of the total lost healthcare professionals in 2015.
Conclusion  The reform in incentive system appeals to the healthcare professionals;the number and structure of rural healthcare professionals have achieved optimization;the stability of rural healthcare professionals is improved more significantly than before.However,the team construction of public health physicians and other types of physicians,and nurses should be strengthened.
    【Key words】  Community health services;Public policy;Incentive system;Effectiveness evaluation;Shanghai
 
Rural Healthcare Workers′ Satisfaction Levels with the Reform Incentive Polices for Rural Healthcare Professionals Implemented
  ZHOU Xu-hong1,JING Li-mei2*,LIU Kun2,WANG Li1,HUANG Yao3,QU Tian-hui3,SHU Zhi-qun2,LOU Ji-quan2
1.Pudong New Area Health and Family Planning Commission,Shanghai 200125,China
2.Pudong Institute for Health Development,Shanghai 200129,China
3.Pudong New Area Service Center for Health Human Resources,Shanghai 200129,China
*Corresponding author:JING Li-mei,Senior economist;E-mail:lmjing@live.cn
    【Abstract】  Objective  To investigate the rural healthcare workers′ satisfaction levels with the reform incentive polices for rural healthcare professionals implemented.
Methods  From 32 community health service centers(CHSCs) classified as type A(12 CHSCs in remote rural areas),B(11 CHSCs in rural areas that are not far away from the city) and C(9 CHSCs in the rural-urban fringe) CHSCs in which the policy of "Opinions on Improving the Construction of the Team of Rural Healthcare Professionals in Pudong New Area" was implemented(hereinafter referred to as the Eight Health Incentives),3 800 healthcare workers who enjoyed the benefits from the Eight Health Incentives were selected and surveyed anonymously with a self-developed questionnaire including demographic data,satisfaction level with the Eight Health Incentives,and ideas and suggestions for the Eight Health Incentives between 15 to 30 June 2015.
Results  A total of 3 295(1 020,1 206,1 069 from type A,B and C CHSCs,respectively) healthcare workers responding the survey actively were selected as the final participants,accounting for 86.7% of the initial participants.Of them,3 253 demonstrated their satisfaction levels with the Eight Health Incentives,specifically,68.4%(2 225/3 253) were satisfied with the Eight Health Incentives.Type of CHSCs,sex,educational attainment,post,and professional and technical titles were significantly associated with the differences in the satisfaction levels with the Eight Health Incentives(P<0.05).A total of 1 300 healthcare workers gave their ideas and suggestions for the Eight Health Incentives.Among them,507(39.0%) thought that the special rewards of the Eight Health Incentives should be openly,fairly,equitably and reasonably granted based on the work load and working pressure combined with narrowing the gap between urban and rural CHSCs and that between posts;286(22.0%) doubted the stability and sustainability of the Eight Health Incentives,and recommended that bonuses should be made on timely and granted on time;156(12.0%) proposed to improve the salary of nurses because the reward amount did not match their workload and occupation risk.
Conclusion  In general,rural healthcare workers′ satisfaction levels with the Eight Health Incentives is acceptable,but varies significantly by the type of CHSCs and post.In view of this,it is suggested a long-term system should be established in order to ensure the sustainability of financial subsidies and sustainable,fair,and reasonable implementation of the Eight Health Incentives,and the improvement of salary for nurses and healthcare workers with low socio-economic status should be paid more attention.
    【Key words】  Community health services;Incentive system;Medical staff;Job satisfaction;Shanghai
 
Rural Healthcare Workers′ Turnover Intention during the Reform Incentive Polices for Rural Healthcare Professionals Implemented
  LIU Kun1,JING Li-mei1*,ZHOU Xu-hong2,SUN Xiao-ming1,3,WANG Li2,LOU Ji-quan1,CHEN Ceng-ceng1,WU Juan2
1.Pudong Institute for Health Development,Shanghai 200129,China
2.Pudong New Area Health and Family Planning Commission,Shanghai 200125,China
3.School of Public Health,Fudan University,Shanghai 200032,China
*Corresponding author:JING Li-mei,Senior economist;E-mail:lmjing@live.cn
    【Abstract】  Objective  To investigate the rural healthcare workers′ turnover intention during the reform incentive polices for rural healthcare professionals implemented.
Methods  From 15 to 30 June in 2015,from 32 community health service centers(CHSCs) classified as type A(12 CHSCs in remote rural areas),B(11 CHSCs in rural areas that are not far away from the city) and C(9 CHSCs in the rural-urban fringe) CHSCs in which the policy of "Opinions on Improving the Construction of the Team of Rural Healthcare Professionals in Pudong New Area" was carried out(hereinafter referred to as the Eight Health Incentives),we selected 3 800 healthcare workers who enjoyed the benefits from the Eight Health Incentives and surveyed them anonymously with a self-developed questionnaire covering demographic data,including demographic data,turnover intention,reasons for turnover,and the intended work unit.
Results  A total of 3 295 healthcare workers(1 020,1 206,1 069 from type A,B,and C CHSCs,respectively) who positively responded the survey were selected as the final participants,accounting for 86.7% of the initial participants.Among them,3 285 completed the question concerning turnover intention,specifically,15.8%(520/3 285) had turnover intention;the rate of intention to quit varied significantly by the type of CHSCs and post(P<0.05),but not by sex,educational attainment and professional and technical titles(P>0.05);the top four reasons for turnover were the salary left after subtraction of the rewards granted based on the Eight Health Incentives〔57.1%(297/520)〕,working pressure〔50.0%(260/520)〕,rewards granted based on the Eight Health Incentives〔39.4%(205/520)〕 and space for personal career development〔19.6%(102/520)〕;the top four intended work units were work units unassociated with the healthcare industry〔43.7%(227/520)〕,other health institutions〔20.0%(104/520)〕,secondary/tertiary hospitals or specialized hospitals 〔18.5%(96/520)〕 and CHSCs in remote rural areas in which higher rewards were granted based on the Eight Health Incentives〔18.3%(95/520)〕.
Conclusion  With the intervention of the reform incentive policies,rural healthcare workers present low rate of turnover intention,and more healthcare workers are willing to work in the remote rural areas.The salary left after subtraction of the rewards granted based on the Eight Health Incentives and rewards granted based on the Eight Health Incentives are factors significantly associated with the intention to quit.It is worth noting that nearly half of the healthcare workers with turnover intention want to leave the healthcare industry.
    【Key words】  Community health services;Incentive system;Medical staff;Turnover intention;Shanghai
 
Patients′ Satisfaction Levels with the Consultation in Rural Community Health Service Centers with Reform Incentive Polices for Rural Healthcare Professionals Undertaken in Shanghai Pudong New Area
  LIU Kun1,JING Li-mei1*,ZHOU Xu-hong2,WANG Li2,HUANG Yao3,QU Tian-hui3,SHU Zhi-qun1,LOU Ji-quan1,FAN Jin-cheng2
1.Pudong Institute for Health Development,Shanghai 200129,China
2.Pudong New Area Health and Family Planning Commission,Shanghai 200125,China
3.Pudong New Area Service Center for Health Human Resources,Shanghai 200129,China
*Corresponding author:JING Li-mei,Senior economist;E-mail:lmjing@live.cn
    【Abstract】  Objective  To investigate the patients′ satisfaction levels with the consultation in rural community health service centers(CHSCs) with reform incentive polices for rural healthcare professionals undertaken in Shanghai Pudong New Area.
Methods  From 15 June to 15 August in 2015,from 32 CHSCs classified as type A(12 CHSCs in remote rural areas),B(11 CHSCs in rural areas that are not far away from the city) and C(9 CHSCs in the rural-urban fringe) CHSCs in which the policy of "Opinions on Improving the Construction of the Team of Rural Healthcare Professionals in Pudong New Area" was undertaken(hereinafter referred to as the Eight Health Incentives) after 1 July 2014,we chose 3 520 patients(110 were chosen from each of the CHSCs) who visited the above CHSCs before and after 1 July 2014 and surveyed them with a self-developed questionnaire involving demographic data,reasons for visiting the community health service center(CHSC),satisfaction levels with the consultation,self-perceived changes in the CHSC,and unsatisfied aspects of the CHSC.
Results  A total of 3 091(1 210,995,886 from type A,B,and C CHSCs,respectively) patients returned valid questionnaires were selected as the final participants,accounting for 87.8% of the initial participants.The three major reasons for visiting the CHSC were the CHSC was near to home〔86.3%(2 667/3 091)〕,consultation fee was inexpensive〔48.0%(1 484/3 091)〕 and good service attitude〔47.7%(1 474/3 091)〕.A total of 84.7%(2 568/3 032) of the participants were satisfied with the services delivered in the CHSCs,specifically,54.1%(1 625/3 003),77.1%(2 308/2 995),93.5%(2 859/3 057),94.6%(2 911/3 078),94.9%(2 915/3 071),93.8%(2 880/3 071),48.6%(1 489/3 066)were satisfied with the waiting time for consultation,consultation environment,service attitude,clarity degree of explaining things,degree of carefulness and degree of trust in the healthcare providers,and consultation fee,respectively.The type of CHSCs was significantly associated with the differences in the patients′ overall satisfaction levels with the services delivered in the CHSCs that they visited,patients′ satisfaction levels with the consultation environment,service attitude,clarity degree of explaining things,degree of trust in the healthcare providers,and consultation fee(P<0.05).Since the undertaking of the Eight Health Incentives,81.1%(2 466/3 041)of the participants felt that the access to health services became much/moderately easier,77.0%(2 311/3 001)thought that the doctors had made great/moderate process in their techniques,53.1%(1 613/3 038)considered that the consultation fee was reduced greatly/moderately.However,80.2%(2 318/2 890)of them hold that the categories of drugs were less,48.2%(1 393/2 890)inclined to the view that the medical equipment and the conditions of the CHSCs were poor,and 15.9%(459/2 887)thought that the waiting time for consultation was too long.
Conclusion  With the reform incentive policies for rural healthcare professionals undertaken in Shanghai Pudong New Area,the services delivered in CHSCs in remote rural areas have been improved to a certain extent,and patients present high overall satisfaction levels with the consultation.In order to further improve the patients′ satisfaction levels with the consultation,it is proposed that the consultation environment should be bettered,medical fee should be controlled,and the categories of drugs should be increased.
    【Key words】  Community health services;Incentive system;Patient satisfaction;Shanghai
 
Associated Factors for the Identification of Frailty Syndrome in Coronary Heart Disease in the Elderly
    ZENG Zhao-xia,LIANG Jie*
Cadre Ward,No.2 VIP Ward,General Medicine Department,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China
*Corresponding author:LIANG Jie,Chief physician,Associate professor,Master supervisor;E-mail:liangjie1560@163.com
    【Abstract】  Objective  To investigate the associated factors for the identification of frailty syndrome in coronary heart disease(CHD) in the elderly,so as to provide a reference for the construction of a frailty model to develop diagnostic criteria for frailty in China.
Methods  The enrolled participants were 365 hospitalized elderly patients with CHD who received treatment in Cardiovascular Department,the First Affiliated Hospital of Xinjiang Medical University from December 1,2015 to May 30,2016.Based on the frailty status assessed by the Fried Frailty Phenotype,the participants were divided into nonfrail group(n=251),prefrail group(n=66) and frail group(n=48).The comparison of clinical data was made between the groups.Multivariate Logistic regression analysis was performed to investigate the associated factors for the identification of frailty syndrome in the participants.
Results  The three groups differed significantly in terms of age,BMI,proportion of patients with specific markers of severe CHD,ratios of patients with concomitant disorders such as diabetes,chronic obstructive pulmonary disease(COPD),congestive heart failure,chronic renal insufficiency,tumor,Alzheimer′s disease,hyperuricemia,arrhythmia,valvular heart disease in the elderly,and pulmonary infection(all P<0.05).Notable differences were found between the groups in the levels of serum interleukin-6(IL-6),C-reactive protein(CRP),fibrinogen(FIB),brain natriuretic peptide(BNP),uric acid(UA),serum creatinine(Scr),Cystatin C(Cys C),albumin(ALB),hemoglobin(Hb),white blood count(WBC) and neutrophil count(all P<0.05).Results of multivariate Logistic regression analysis showed that,age,concomitant tumor,levels of BNP,BNP,UA,Scr,ALB and neutrophil count were significantly associated with the identification of frailty syndrome in participants in prefrail group and frail group(P<0.05);concomitant COPD,concomitant tumor,levels of IL-6,UA,Scr and ALB were substantially associated with the identification of frailty syndrome in participants in nonfrail group and frail group(P<0.05).
Conclusion  Age,concomitant disorders such as COPD and tumor,levels of IL-6,BNP,UA,Scr,ALB and neutrophil count are significantly associated with the identification of frailty syndrome in elderly patients with CHD,which can be referred to in the construction of a frailty model to develop diagnostic criteria for frailty as well as making relevant personalized diagnosis and treatment decisions.
    【Key words】  Coronary disease;Frailty syndrome;Root cause analysis;Aged
 
Predictive Value of Plasma Angiotensin Ⅱ Levels for the Medication of Renin-angiotensin System Blockers in Hypertension with Atrial Fibrillation
  LIANG Jing1,LI Xu-guang2,WANG Zhi-min3,DONG Li-ya4,ZHAO Li-qun1*
1.Emergency Critical Care Department,First People′s Hospital Affiliated with Shanghai Jiao Tong University,Shanghai 200080,China
2.Cardiology Department,First People′s Hospital Affiliated with Shanghai Jiao Tong University,Shanghai 200080,China
3.Department of Genetics,Chinese National Human Genome Center at Shanghai,Shanghai 201203,China
4.Department of Cardiac Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China 
*Corresponding author:ZHAO Li-qun,Associate chief physician;E-mail:majia20130827@163.com
    【Abstract】  Objective  The purpose of this study was to investigate the predictive value of plasma angiotensin Ⅱ(AngⅡ) levels for the medication of renin-angiotensin system(RAS) blockers,angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blockers(ARB) in hypertensive patients with atrial fibrillation(AF).
Methods  The study included 114 hypertensive patients(hypertension group) and 107 hypertensive patients with AF(hypertension with AF group).They were selected from the patients who were hospitalized in the First People′s Hospital Affiliated with Shanghai Jiao Tong University from January 2010 to December 2011.Their plasma AngⅡ levels were measured by radioimmunoassay.Multivariate Logistic regression analysis was performed to investigate the effect of plasma AngⅡ levels on hypertension with AF.
Results  There were no significant differences between the two groups in sex,age,systolic blood pressure,diastolic blood pressure,left atrial diameter,left ventricular end-systolic diameter and left ventricular end-diastolic diameter(P>0.05).Hypertension with AF group had significantly higher levels of plasma AngⅡ(P<0.05).Patients in the hypertension with AF group were more likely to have elevated plasma AngⅡ levels than those in the hypertension group〔95.3%(102/107) vs. 8.8%(10/114),P<0.05〕.Multivariate Logistic regression analysis showed that plasma AngⅡ levels was significantly associated with hypertension with AF(P<0.05).
Conclusion  Hypertensive patients with AF have significantly higher plasma AngⅡ levels than those without.Plasma AngⅡ levels is an associated factor for hypertension with AF,which may be used as a marker for the medication of ACEI/ARB in these patients.
    【Key words】  Hypertension;Atrial fibrillation;Angiotensin Ⅱ;Renin-angiotensin system
 
Value of Platelet-to-lymphocyte Ratio in the Diagnosis of Diabetic Retinopathy in Type 2 Diabetes
  ZHANG Xue-lin,LIU Xia,LI Dong-mei,WU Xue-yun,DING Yi,LIANG Rui-xiang,HUANG Fang*
Clinical Laboratory,Guilin People′s Hospital,Guilin 541002,China
*Corresponding author:HUANG Fang,Chief laboratorian;E-mail:1351393001@qq.com
    【Abstract】  Objective  To evaluate the value of platelet-to-lymphocyte ratio(PLR) in the diagnosis of diabetic retinopathy(DR) in type 2 diabetes.
Methods  The participants were 401 cases diagnosed with type 2 diabetes in Endocrine Department,Guilin People′s Hospital from June 2012 to November 2014,including 200 complicated with DR(DR group),and 201 without(NDR group).Levels of biochemical markers venous blood sampled in early morning fasting state were measured and PLR was calculated.The value of PLR in the diagnosis of DR was assessed by the receiver operating characteristic(ROC) curve.
Results  The value of PLR in two groups was(113.7±56.0).The area under the ROC curve(AUC) of PLR for the diagnosis of DR in type 2 diabetes was 0.70 〔95%CI(0.65,0.75)〕,the optimal cut-off value was 103.9,with a sensitivity of 63.5% and a specificity of 69.2%.DR group and NDR group differed significantly in gender,age,course of diabetes,PLR value,levels of fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),high-density lipoprotein(HDL),and urine microalbuminuria(UMA)(P<0.05).
Conclusion  PLR plays a positive role in the diagnosis of DR in type 2 diabetes.Therefore,it may be recommended as a follow-up item for diabetes.
    【Key words】  Diabetic retinopathy;Platelet-to-lymphocyte ratio;Diagnosis
 
 
Therapeutic Effect of Different Doses of Somatostatin in the Treatment of Liver Cirrhosis with Esophageal and Gastric Variceal Bleeding
  YI Sheng-yang1,ZOU Jiao-ling1,WANG Xiang1,XIE Hui-zhong2*
1.Department of Longhua Emergency,Hainan General Hospital,Haikou 570102,China
2.Department of Gastroenterology,the Second Affiliated Hospital of Hainan Medical University,Haikou 570311,China
*Corresponding author:XIE Hui-zhong,Professor;E-mail:xjxh001@126.com
    【Abstract】  Objective  To explore the clinical efficacy about different doses of somatostatin in the treatment of esophageal and gastric variceal bleeding in liver cirrhosis.
Methods  We carried out a randomized controlled clinical trial in 102 liver cirrhosis patients with esophageal and gastric variceal bleeding who hospitalized in the Emergency ICU and Department of Gastroenterology,Hainan General Hospital between 2013 and 2015 and met the inclusion criteria.They were randomized into standard-dose treatment group(group A) and double standard-dose treatment group(group B) with 51 cases in each.Based on the number of previous bleedings,group A and group B were further divided into subgroup A1(previous bleedings <2 times) and subgroup A2(previous bleedings ≥ 2 times),subgroup B1(previous bleedings <2 times),and subgroup B2(previous bleedings ≥ 2 times),respectively.The first intravenous injection dose of somatostatin was 4.1 ml,8.2 ml for group A and group B,respectively.After that,patients in group A and group B were given continuous intravenous infusion of somatostatin 4.1 ml/h,8.2 ml/h with a pump for 5 days,respectively.The success rate of first hemostasis,rebleeding rate,response rate and mortality rate were compared between group A and group B,group A1 and group B1,group A2 and group B2.
Results  Compared with group A,group B had higher success rate of first hemostasis(P<0.05),higher response rate(P<0.05),and lower rebleeding rate(P<0.05).  The success rate of the first hemostasis in group B2 was higher than that in group A2(P<0.05),and the rebleeding rate was lower than that in group A2(P<0.05).
Conclusion  Double standard-dose somatostatin treatment is effective in liver cirrhosis patients with esophageal and gastric variceal bleeding,especially in those with previous bleeding ≥ 2 times,the rebleeding rate can be significantly reduced.
    【Key words】  Liver cirrhosis;Esophageal and gastric varices;Somatostatin;Treatment outcome
 
Effects of Heart Care Network-based Abilities for Health Practice Intervention on the Quality of Life in Patients with Coronary Heart Disease 
  ZHOU Yan,HAN Hui,WANG Qing,XING Feng-mei*
College of Nursing and Rehabilitation,North China University of Science and Technology,Tangshan 063210,China
*Corresponding author:XING Feng-mei,Professor;E-mail:shanxing06@aliyun.com
    【Abstract】  Objective  To investigate the effects of Heart Care Network-based abilities for health practice intervention on the quality of life in patients with coronary heart disease,aimed at providing new methods and ideas for clinical care intervention for these patients.
Methods  We enrolled 127 participants with coronary heart disease who met the inclusion criteria and received hospitalized treatment and in Department of Cardiovascular Medicine,Tangshan Gongren Hospital from November 2015 to February 2016,and randomized them into the control group(n=63) and intervention group(n=64).Heart Care Network-based record was established after admission.Quality of life was measured by the Chinese version of Seattle Angina Questionnaire(SAQ) within 72 h after admission.Both groups received the conventional nursing in accordance with the evaluation results of conditions during hospitalization,and Heart Care Network-based lectures regularly held by the Department of Cardiovascular Medicine and outpatient follow-up after discharge.In addition,the intervention group received Heart Care Network-based abilities for health practice intervention in both the periods of hospitalization and six months after discharge,including five aspects,diet intervention,exercise intervention,stress management intervention,interpersonal intervention and health responsibility intervention.The quality of life was measured again at six months after discharge.
Results  Finally we obtained the follow-up data of 61 cases in the intervention group(three cases were lost to follow up) and those of 58 cases in the control group(one case died during the follow-up period,and 4 cases were lost to follow up).Before intervention,the scores of SAQ,and its five scales of Physical Limitation Scale,Anginal Stability Scale,Anginal Frequency Scale,Treatment Satisfaction Scale and Disease Perception Scale did not different significantly between the two groups(P>0.05).After intervention,except the scores of Physical Limitation Scale of both groups were similar(P>0.05),the scores of SAQ and its other four scales of the intervention group were much higher than those of the control group(P<0.05).The scores of SAQ and its five scales of the intervention group were significantly higher compared with those before intervention(P<0.05);scores of Anginal Stability Scale,Anginal Frequency Scale,Disease Perception Scale of control group were higher compared with those before intervention(P<0.05);there were similar scores of Physical Limitation Scale,Treatment Satisfaction Scale and SAQ in control group before and after intervention(P>0.05).
Conclusion  Heart Care Network-based abilities for health practice intervention can improve the quality of life in patients with coronary heart disease.
    【Key words】  Coronary disease;Health behavior;Quality of life
 
Clinical Characteristics of Perimenopausal Inpatients in Department of General Practice in a Tertiary Hospital
  QI Dian-jun,HE Yi-ni,YU Xiao-song*,WANG Shuang
Department of General Practice,the First Affiliated Hospital of China Medical University,Shenyang 110001,China
*Corresponding author:YU Xiao-song,Professor,Doctoral supervisor;E-mail:xsyu@email.cmu.edu.cn
    【Abstract】  Objective  To discuss the clinical characteristics of perimenopausal inpatients in Department of General Practice in a tertiary hospital.
Methods  The enrolled participants were 763 perimenopausal women admitted in the First Affiliated Hospital of China Medical University from January 2014 to June 2016,including all the 563 perimenopausal women from Department of General Practice(24.9% of the total 2 265 inpatients in the department during the period),and 200 randomly selected inpatients from Department of Respiratory Medicine,Department of Cardiovascular Medicine,Department of Gastroenterology and Department of Endocrinology with 50 in each.Questionnaire survey combined with reviewing medical records and telephone follow-up were used to collect the clinical data of the participants,covering age,perimenopausal symptoms,chief complaints,diagnosis,history of chronic disease,and length of stay.
Results  Of the 563 participants from Department of General Practice,82.6%(465/563) had 1 or more types of perimenopausal syndromes;participants aged 40-50 were more likely to have 1 or more types of perimenopausal syndromes than those aged 51-60(P<0.05);the 5 most common perimenopausal syndrome symptoms were insomnia〔69.6%(392/563)〕,fatigue〔65.5%(369/563)〕,hot flash〔61.5%(346/563)〕,sweating〔57.0%(321/563)〕,and anxiety〔55.2%(311/563)〕;the 5 most common chief complaints were chest pain〔31.1%(175/563)〕,headache〔13.9%(78/563)〕,heart palpitations〔9.9%(56/563)〕,abdominal pain〔8.5%(48/563)〕,and dizziness〔4.3%(24/563)〕;the top 5 diagnosed diseases were hypertension〔32.0%(180/563)〕,dyslipidemia〔25.8%(145/563)〕,arrhythmia〔23.3%(131/563)〕,peripheral arteriosclerosis 〔19.5%(110/563)〕,and diabetes〔14.6%(82/563)〕;92.0%(518/563) had chronic diseases;75.1%(423/563) had multiple chronic conditions;participants in age group of 40-50 had lower incidences of chronic diseases and multiple chronic conditions than those in age group of 51-60(P<0.05);the average length of stay was(9.5±2.4)d;participants in age group of 40-50 had shorter average length of stay than those in age group of 51-60(P<0.05).Compared with those from other departments,participants from Department of General Practice had higher incidence of multiple chronic conditions and longer average length of stay(P<0.05).
Conclusion  Compared with those from other departments,perimenopausal inpatients are more common seen in Department of General Practice,they are more prone to perimenopausal syndrome,chronic diseases and multiple chronic conditions,so they should be given great attention during treatment.
    【Key words】  Perimenopause;Tertiary hospitals;General practice department;Inpatients;Clinical features
 
Relationship between HHIP Gene Polymorphism and Chronic Obstructive Pulmonary Disease Susceptibility in Kazakh Population in Xinjiang,China
  CHENG Fang-juan,GUAN Jian*,REN Xia,MA Cheng-yuan
No.2 Department of Respiratory Medicine,the First Affiliated Hospital of the Medical College,Shihezi University,Shihezi 832008,China 
*Corresponding author:GUAN Jian,Chief physician,Professor,Master supervisor;E-mail:guanjian6@163.com
    【Abstract】  Objective  To explore the relationship of two single nucleotide polymorphisms(SNPs),rs13118928 and rs1828591,of HHIP gene with chronic obstructive pulmonary disease (COPD) susceptibility in Kazakh population in Xinjiang,China.
Methods  The participants enrolled were 214 inpatients and outpatients(case group) who received treatment of department of respiratory medicine,and 350 healthy controls(control group) underwent physical examination,in Ili Kazak Autonomous Prefecture Friendship Hospital,Xinhua Hospital,and the First Affiliated Hospital of the Medical College,Shihezi University from October 2014 to May 2016.Pulmonary function measurement apparatus produced by an American company,Medgraphics Corp.was used to measure the forced vital capacity(FVC),forced expiratory volume in one second (FEV1),FEV1% predicted,and FEV1/FVC ratio.The imLDRTM technique for SNP genotyping was used to detect the polymorphisms of HHIP gene in peripheral venous blood cells.
Results  The patterns of genotype and allele frequencies of rs13118928 at the HHIP locus did not differ significantly between the groups(P>0.05).The patterns of genotype and allele frequencies of rs1828591 at the HHIP locus in the case group were not obviously different from those of in the control group(P>0.05).FEV1% predicted and FEV1/FVC ratio did not differ substantially between the patients in the case group by rs13118928 genotypes(P>0.05).No differences in FEV1% predicted and FEV1/FVC ratio were found between the patients in the case group by rs1828591 genotypes(P>0.05).The groups did not display notable differences in the patterns of haplotype frequencies for rs13118928 and rs1828591 at the HHIP locus(P>0.05).
Conclusion  The two SNPs (rs13118928 and rs1828591) at the HHIP gene locus have no significant correlation with COPD susceptibility in Kazakh population in Xinjiang,China.
    【Key words】  Pulmonary disease,chronic obstructive;HHIP gene;Polymorphism,single nucleotide
 
Development of General Practice Education from the Perspective of Healthy China
  YE Zi-hui*,SHAO Li-ming,WU Wen-jun
School of Laboratory Medicine,Hangzhou Medical College,Hangzhou 310053,China
*Corresponding author:YE Zi-hui,Aassistant;E-mail:yezihui1991@163.com
    【Abstract】  The Healthy China program proposes specific and targeted demands for the development of medical and health services delivery in China.Under the perspective of Healthy China,we summarized the role and value of the development of general practice(GP) in maintaining public health and implementing the program of Healthy China,analyzed the insufficiencies in recent developments of GP and the challenges brought by the underdevelopment of GP education in China,and put forward some means to promote the development of GP and GP education,such as understanding the current status of GP and GP education correctly,training for future healthcare providers in medical colleges should be based on the requirements of the society,implementing the college-community cooperation training mode for future healthcare providers and developing continuing education system for GP.
    【Key words】  General practice;Education,medical;Healthy China
 
Integrated Curriculum System Development for Competency-oriented "3+2" Assistant General Practitioner Training Program
  LIU Yan,HE Ping*,ZHANG Dong-qing,PAN Lun
Chongqing Medical and Pharmaceutical College,Chongqing 401331,China
*Corresponding author:HE Ping,Professor,Master supervisor;E-mail:heping1229@163.com
    【Abstract】  As one of the pilot colleges for implementing the Outstanding Doctor Education and Training Plan and "3+2" training mode for talents with three-year clinical medicine degree,Chongqing Medical and Pharmaceutical College have actively explored the training mode and curriculum system development for "3+2" assistant general practitioner training program in accordance with the training criteria for assistant general practitioners and the requirements of the grassroots medical institutions.In order to provide a reference for "3+2" assistant general practitioner training program,based on accurately understanding of the talents training objectives and requirements of both college education and post-graduate education,we optimized and adjusted the previous education contents and course offered,and developed the integrated curriculum system for three-year clinical medicine degree education and continuing education two years after graduation,in which we proposed the GP educational concept of "community-based education incorporating problem-based learning",focused on culturing the medical ethics,improving the basic medical and clinical practice capabilities,increasing the knowledge associated with general practice and developing the capabilities of general practitioners.
    【Key words】  Assistant general practitioners;Competency-based education;Professional competence;Curriculum
 
Effects of "3+2" Assistant General Practitioners Training Program Implemented in Beijing:a Qualitative Study
  SUN Chen,LIU Yan-li,LU Xiao-qin*,DU Juan,LIU Xiao-ping,ZHAO Ya-li
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 investigate the effects of "3+2" assistant general practitioners training program implemented in Beijing based on the status of this program and the capabilities for work in the qualified trainees assessed by the administrators from community health service centers(CHSCs) in Beijing,in order to provide references for the improvement of the development of this program.
Methods  Using purposive sampling,we selected 17 administrators from the CHSCs in Huairou District and Yanqing District in Beijing in which new medical graduates with three-year college degree were chosen to attend the "3+2" assistant general practitioners training program as the participants.The focus discussions were conducted in August 2015,which covered the views about the effects of "3+2" assistant general practitioners training program assessed from the aspects of changes in the capabilities for work,and competence for the position in the trainees,impact of the training on the development of capabilities of the talents in grassroots medical institutions,and suggestions for the improvement of the training.Content analysis was used to explore the major arguments of the interview.
Results  The assessment of the training program effects by the interviewees were summarized as follows:(1) The "3+2" assistant general practitioners training program was contribute to the improvement of capabilities for work,interpersonal skills and comprehensive qualities of the trainees.(2) The trainees showed high competence for the position after training.(3) The development of capabilities of the talents in grassroots medical institutions has been promoted actively by the training program.The suggestions put forward by the interviewees are the following:(1) Modifying the content of the training program based on the needs of the community residents and the conditions of the grassroots medical institutions.(2) Strengthening the ideas about general practice in the trainers of the training program.
Conclusion  The "3+2" assistant general practitioners training program has affirmative effects,and it can be used as an effective way for training the qualified general practitioners deployed in rural areas.However,its effects can be improved by enhancing the serviceability through modifying the contents and methods of training in accordance with the demands of the community residents and the conditions of the grassroots medical institutions.
    【Key words】  Assistant general practitioners;Training;Effect;Qualitative research
 
Level of Satisfaction with Primary Healthcare Services and Influencing Factors in Farmers and Herdsmen in Pastoral Areas of Northern Xinjiang
  HAN Lin-li1,2,LI Xin-hui1*,JIA Xue-bin3,CHEN Jiang-yun4,JIANG Pei1,WU Yan-hui5,DENG Li-xin6
1.Medical College of Shihezi University,Shihezi 832000,China
2.The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China
3.Xinjiang Tacheng People′s Hospital,Tacheng 834300,China
4.Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430000,China
5.Cooperative Medical Management Office of Xinyuan County,Yili 835000,China
6.Areletuobie Township Hospital,Yili 836200,China
*Corresponding author:LI Xin-hui,Professor,Master supervisor;E-mail:lixinhui@shzu.edu.cn
    【Abstract】  Objective  To investigate the level of satisfaction with primary healthcare services and influencing factors in farmers and herdsmen in pastoral areas of northern Xinjiang.
Methods  Using typical case sampling,we selected three sample towns from northern Xinjiang,Halabula Town in Xinyuan County,Yili Kazakh Autonomous Prefecture,Areletuobie Town in Qinghe County,Ataile District,and Qiaqia Town in Tacheng City,Tacheng District.Then using random number table,we selected 3 villages from Halabula Town,4 villages from Areletuobie Town,and 4 villages from Qiaqia Town as the sample villages,in which we selected 1 621 permanent farmers and herdsmen aged 15 or over as the participants by using cluster sampling.A self-developed questionnaire was employed to survey the participants from July 2014 to August 2015,which involved the demographic data,status of illness occurred within two weeks before the survey and level of satisfaction with the primary outpatient services,status of inpatient treatment receiving in the township hospital within one year before the survey and level of satisfaction with the inpatient services.The survey achieved a response rate of 99.6%(1 615/1 621).We selected 122 cases who received primary outpatient services within two weeks before the survey or inpatient services delivered in the township hospital within one year before the survey as the final participants.
Results  In the 122 participants,the overall level of satisfaction with primary healthcare services was 74.6%(91/122),specifically,the level of satisfaction with services delivered in the village clinic was 81.0%(17/21),and that with outpatient services delivered in the township hospital was 77.5%(55/71),and that with inpatient services delivered in the township hospital was 75.0%(48/64).The top three advantages achieving the highest level of satisfaction of services delivered in the village clinic were convenience〔100.0%(21/21)〕,service attitude 〔90.5%(19/21)〕 and consultation environment 〔85.7%(18/21)〕,and those of outpatient services delivered in the township hospital were convenience〔95.8%(68/71)〕,consultation environment 〔83.1%(59/71)〕 and service attitude 〔78.9%(56/71)〕,and those of inpatient services delivered in the township hospital were service attitude 〔92.2%(59/64)〕,hospitalization environment〔79.7%(51/64)〕 and technique skills of the primary care providers 〔70.3%(45/64)〕.The level of satisfaction with primary healthcare services in the participants varied significantly by age,annual household income per capita,annual household spending on healthcare per capita,the distance and needed time from home to the nearest medical institution,status of poor rural household,and status of household enjoying the minimum living guarantee(P<0.05).Multivariate Logistic regression analysis demonstrated that,annual household income per capita,annual household spending on healthcare per capita,status of poor rural household,status of household enjoying the minimum living guarantee and the distance and needed time from home to the nearest medical institution were significantly associated with the level of satisfaction with primary healthcare services(P<0.05).
Conclusion  The overall level of satisfaction with primary healthcare services is high in farmers and herdsmen in pastoral areas of northern Xinjiang,and it is affected by the annual household income per capita,annual household spending on healthcare per capita and status of convenience to access to healthcare services.However,it can be further improved by increasing the categories of drugs or drug quantities based on the needs of the farmers and herdsmen,controlling healthcare costs while promoting the best possible health outcomes,updating the medical equipment and enhancing the technique skills of the primary care providers.
    【Key words】  Primary healthcare services;Satisfaction;Xinjiang;Farmers and herdsmen
 
Awareness and Satisfaction Related to Zero-markup Drug Policy in Shandong Residents
  YU Qing1*,LI Gang2
1.School of Management,Taishan Medical University,Taian 271016,China
2.Linyi People′s Hospital,Dezhou 251500,China
*Corresponding author:YU Qing,Associate professor;E-mail:yuyuqing@163.com
    【Abstract】  Objective  To investigate the awareness and satisfaction related to zero-markup drug policy in Shandong residents,in order to provide a reference for comprehensively assessing the effect of implementation of zero-markup drug policy.
Methods  Using convenient sampling,the rural areas and towns in 15 prefecture-level cities in Shandong Province were selected as the survey area,and 280 adult residents who had been living in the local area for more than 3 years were selected as the participants from January 2012 to February 2015.A self-designed questionnaire was used to survey the participants,which involved the demographic data,awareness of the essential drug system and zero-markup drug policy,changes in healthcare-seeking behavior after the implementation of zero-markup drug policy,attitude toward the essential drug system and satisfaction with zero-markup drug policy.A total of 269 residents who responded the survey positively were selected as the final participants,accounting for 96.1% of the initial participants.
Results  In the participants,61.9%(166/268)were aware of the essential drug system,and 49.4%(132/267)were aware of the zero-markup drug policy.Educational attainment,occupation,annual personal income and type of health insurance were significantly associated with the differences in the status of awareness of the essential drug system(P<0.05).After the implementation of the zero-markup drug policy,less residents bought drugs at the drugstore〔53.4%(143/268)vs 55.8%(150/269)〕;more residents selected the place for buying drugs for convenience 〔63.1%(169/268)vs 62.5%(168/269)〕;53.0%(142/268)sought first-contact services delivered in village clinics;86.1%(230/267)thought that the categories of essential drugs provided in grassroots medical institutions could basically satisfy their needs,but 14.6%(39/267)hold that they often could not buy the needed drugs,and 56.2%(150/267)considered that they occasionally could not buy the needed drugs;less residents thought drug expenses making up the largest percentage of the total medical expenses〔21.9%(54/247)vs 42.4%(105/248)〕;only 32.2%(85/264)thought the total medical expenses were reduced;among the 132 residents who were aware of the zero-markup drug policy,4.6%(6/132)were very satisfied,and 42.4%(56/132)were relatively satisfied with the effect of implementation of the policy.
Conclusion  The awareness rate of the zero-markup drug policy in Shandong residents is not satisfied.The residents who are aware of it are basically satisfied with its effect of implementation,but the satisfaction needs to be improved.
    【Key words】  Zero-markup drug policy;Awareness;Satisfaction;Community residents
 
Characteristics of Development and Influential Factors of the Helping and Sharing Behavior in 3-5-year-old Preschool Children
  BI Ke1,2,WU Li-yun3,SHI Jian-nong1,4,ZHANG Zhen1*
1.Key Laboratory of Behavioral Science,Institute of Psychology,CAS,Beijing 100101,China
2.University of Chinese Academy of Sciences,Beijing 100191,China
3.State Key Laboratory of Cognitive Neuroscience and Learning,School of Brain and Cognitive Sciences,Beijing Normal University,Beijing 100875,China
4.Department of Learning and Philosophy,Aalborg University,Aalborg 9220,Denmark
*Corresponding author:ZHANG Zhen,Assistant researcher;E-mail:zhangzhen@psych.ac.cn
    【Abstract】  Objective  This study investigated the developmental diversity of the helping and sharing behavior in 3-5-year-old children,as well as parenting style and children′s temperament influence on them,so as to offer some explanations for the diversity between two specific prosocial behavior categories.
Methods  From May to July 2013,108 3-5-year-old children were sampled from 2 kindergartens of a private education group for helping task(picking up something for others) and sharing task(dictator game),and their parents received a questionnaire survey,filling out the Children′s Behavior Questionnaire Short Form(CBQ) and Parenting Styles and Dimensions Questionnaire(PSDQ).The final participants were 94 children participating in the task and their parents returned responsive questionnaires.
Results  In the participants,the average scores of children′s helping behavior,sharing behavior,surgency,negative affectivity and effortful control were 2.5,1.2,4.6,4.2 and 5.0,respectively;and those of mother′s authoritative parenting style,mother′s authoritarian parenting style,father′s authoritative parenting style,father′s authoritarian parenting style were 3.9,2.0,3.7 and 1.8 respectively.Children′s helping behavior scores had no linear correlation with sharing behavior scores(r=-0.08,P=0.64).Analyses with three-level hierarchical regression models found that age positively predicted children′s helping behavior(β=0.46,0.45,0.43,P<0.05);analysis based on the third hierarchical regression model revealed that father′s authoritarian parenting style positively predicted children′s helping behavior(β=0.26,P<0.05),while mother′s authoritarian parenting style positively predicted children′s sharing behavior(β=0.25,P<0.05).
Conclusion  Helping and sharing behavior display different characteristics of development in early childhood and only can be affected by father′s or mother′s authoritarian parenting style respectively in this study,which imply that these two prosocial behavior categories have relatively unique developmental trajectories.
    【Key words】  Children;Prosocial behavior;Sharing behavior;Helping behavior;Parenting style;Temperament
 
Mental Health Status of Minor Children of Land-lost Farmers under the Background of New-type Urbanization
  YANG Mei-rong1,MA Jian-feng2,SUN Shu-yu1,WANG Qiang1,SUN Xiao-mei1,YUAN Jie1*
1.College of Psychology,North China University of Science and Technology,Tangshan 063000,China
2.The Second Middle School in Tangshan City,Tangshan 063000,China
*Corresponding author:YUAN Jie,Professor,Chief physician,Master supervisor;E-mail:tsphyj@126.com
    【Abstract】  Objective  To explore the mental health status of minor children of land-lost farmers under the background of new-type urbanization.
Methods  From March to May in 2016,by cluster sampling method and taking class as a unit,1 200 minor children of land-lost farmers from 4 national and provincial pilot areas of new-type urbanization including Shijiazhuang,Dingzhou,Zhangbei and Qian′an of Hebei Province were selected as the observation group,and meanwhile,1 200 the minor children of non-landless farmers according to the distribution of important variables such as area,gender and learning stage were selected as the control group.By questionnaire survey method,the minor children′s basic situation and mental health status were investigated,and the mental health status was tested by mental health test(MHT),including 8 dimensional scales,namely learning anxiety(A),anxiety to people(B),loneliness tendency(C),self-accusation tendency(D),allergic tendency(E),physical symptoms(F),panic tendency(G),impulsive tendency(H).A total of 1 200 questionnaires were sent out in both groups.1 150 effective questionnaires were collected in observation group and the effective response rate was 95.8%.While 1 038 effective questionnaires were collected in control group and the effective response rate was 86.5%.
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