April 2020, Volume 23，No10 Abstracts
Author：尹鹏 Source：CGP Published： [03-30] views： 79
Developing Strategies for Primary Healthcare in Times of Epidemic of COVID-19 FU Wei，QIN Jiangmei*，HUANG Erdan，MIAO Yanqing，ZHANG Yanchun，ZHANG Lifang
China National Health Development Research Center，Beijing 100044，China
*Corresponding author：QIN Jiangmei，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Primary healthcare settings are the control and prevention network basis of COVID-19 epidemic.So improving COVID-19 control and prevention，service delivery and response levels of these institutions is crucial to the national epidemic control and prevention.Based on the analysis of related field survey results as well as information from national and local official websites，we summed up the important role of primary healthcare in dealing with the epidemic.Moreover，we proposed the following priorities for primary healthcare settings in combating the complex epidemic and delivering daily healthcare services：strengthening community-based control and prevention of COVID-19，providing assistance for other institutions in combating COVID-19，implementing daily healthcare and essential public health services，ensuring medical safety and strengthening the control and prevention of nosocomial infections，and adequately playing the role in county-based healthcare network.Furthermore，developing strategies targeting the weaknesses in combating the epidemic and inadequacies in delivering daily healthcare services of primary healthcare were also put forward：strengthening the development of general practitioner system and hierarchical medical system；improving early warning sensitivity，awareness of timely report of major epidemic，and emergency response level in primary healthcare workers；enhancing the informatization construction and application in primary care using artificial intelligence and cutting-edge technologies；promoting the development of regional medical consortiums and local healthcare networks，and exploring patterns for efficiently integrating medical and prevention services；vigorously carrying out patriotic public health campaigns，strengthening the mechanism of group-based control and prevention of communicable diseases，and facilitating the construction of healthy communities and villages.
【Key words】 COVID-19；Coronavirus infections；Epidemic；Primary health care；Primary-level medical and health care institutions；Development strategy
Research Hotspots and Evolution on Hierarchical Diagnosis and Treatment System in China WU Qinde1，2
1.School of Economics and Management，Fuzhou University，Fuzhou 350116，China
2.Fujian Medical University Union Hospital，Fuzhou 350001，China
【Abstract】 Background The hierarchical diagnosis and treatment system has become the top priority of deepening medical reform at present，and it is particularly important to understand its research hotspots and evolution.Objective To systematically summarize the development trend and evolution process of hierarchical diagnosis and treatment system in China and grasp its knowledge base，research hotspots and development trends，in order to provide scientific reference for subsequent research.Methods China National Knowledge Infrastructure（CNKI） database was used as the data source and "hierarchical diagnosis" "hierarchical treatment" "ladder network of medical prevention" "hierarchical medical system and division of labor in blocks" "hierarchical medical and service system and division of labor in blocks" "hierarchical medical system and division of labor" "initial diagnosis in community" "initial diagnosis at grassroots level" "treating acute and chronic diseases separately" "two-way referral" "cooperation between superior and subordinate medical institutions" "different division of labor in diagnosis" "different division of labor in treatment" "orderly medical diagnosis" "orderly medical treatment" "health service system+integration" "health service system+classification" and "health service system+collaboration and division of labor" were used as key words to retrieve the documents related to the hierarchical diagnosis and treatment system in China from January to July in 2019.The retrieval time was from January 1，1949 to July 31，2019.Excel was used to retain and analyze the data，and descriptive statistical analysis was made on the authors，titles，document sources，publishing institutions，and volume of publications of the included documents.CiteSpace was used to obtain published journals，institutional cooperation and author distribution of the research results of China's hierarchical medical system.Through the analysis of high-frequency keywords，research hotspots were identified.Through time zone maps，clustering words and emergent words，the frontiers and development trends of the research were determined.Results In the end，1 233 articles were included，and the journal with the largest number of publications were Chinese General Practice〔287（23.28%）〕．The top five journals with the most published articles were all from the core database of Peking University Library（a total of 729 articles） with more than half of the total published articles.The institutions with high yield of research results were mainly centered around Huazhong University of Science and Technology，Capital Medical University，National Health Commission，Fudan University and Peking University.There were 68 core authors with a total of 457 articles，accounting for 37.28% of the total literature."Community health service" "medical alliance" "influencing factor" and "general practitioner" had always been hot topics in the research field of hierarchical diagnosis and treatment.The clustering labels of "patriotic health movement" "hospital bed" and "outpatient"，and key words of "effect evaluation" "influencing factors" and "medical treatment" appeared from 1949 to 1978.The clustering labels of "medical treatment" and "medical insurance system"，and key words of "community health service" "two-way referral" and "community health service institution" appeared from 1979 to 2008.The clustering labels of "grassroots medical and health institution" "combination of medical and nursing care" "medical service system" and "medical insurance"，and key words of "medical service system" and "hierarchical diagnosis and treatment" appeared from 2009 to 2018.Conclusion The increase rate of literature of China's hierarchical diagnosis and treatment system is accelerated，but the quality of research results need to be further improved.There are a lot of cooperation among institutions，but the cooperation and communication among authors are limited，and no stable core author group has been formed.The research hotspots are gradually diversified and the research directions are continuously refined.How to find a new way of innovation from the institutional level through closer communication and collaboration is worthy of further study.
【Key words】 Hierarchical diagnosis and treatment；Research hotspots；Research evolution；Bibliometrics
Different Models of Social Workers Participating in Mental Health Services：a Comparative Study WANG Xun1，YAN Fang2，LUO Jianjun3，LI Changhong4，XUE Lili5，MA Ning1*
1.Peking University Sixth Hospital，Peking University Institute of Mental Health，NHC Key Laboratory of Mental Health（Peking University），National Clinical Research Center for Mental Disorders（Peking University Sixth Hospital），Beijing 100191，China
2.Beijing Anding Hospital Affiliated to Capital Medical University/Beijing Key Laboratory for Mental Disorders，Beijing 100088，China
3.Chongqing Mental Health Center，Chongqing 401147，China
4.Chongqing Dongqing Social Work Service Center，Chongqing 400055，China
5.Shanghai Mental Health Center，Shanghai 200030，China
*Corresponding author：MA Ning，Associate professor，Master supervisor；E-mail：email@example.com
【Abstract】 This article attempts to compare similarities，differences and application prospects of three typical modes in which social workers participate in mental health services.These are specialized social worker training，governmental purchases，and setting up social worker departments in mental hospitals.Beijing，Chongqing and Shanghai were selected as representative sites.The first two modes are guided by government administrative departments，while the third mode is dominated by mental hospitals.In the aspect of future development of social worker team，specialized social worker training can expand the workforce in a short time.Governmental purchases can fully tap into the potential of existing social work organizations.Setting up social worker departments in mental hospitals makes the team more stable.In terms of service orientation，the government pays more attention to continuous service provision in the community，while social workers in mental hospitals provide services within hospitals as well as take on leadership roles in community work.The three models are neither isolated nor exclusive.All localities should make comprehensive explorations in accordance with its own economic level，social work resources and capability of mental hospitals，so as to promote the development of social work in mental health services.
【Key words】 Mental health services；Social work；Governmental purchases
Effects of Quality Control Circle on Enhancing the Adhesion between Community Elderly People and Contracted Family Doctors WANG Daoqiong，BAI Yan*
Xinglonghu Community Health Service Center，Yongchuan Hospital of Chongqing Medical University，Chongqing 402160，China
*Corresponding author：BAI Yan，Chief superintendent nurse；E-mail：firstname.lastname@example.org
【Abstract】 Background The elderly are the key groups of contracted family doctor services.However，due to the insufficient number of family doctors，the lack of health awareness of the elderly，and the attention paid by community health service institutions to the number of services，there is a phenomenon of "signing but not signing".Objective To explore the role of quality control circle（QCC） activities in improving the adhesion between community elderly people and contracted family doctors.Methods A QCC of family doctors was established with the theme "improving the adhesion between the elderly and contracted family doctors" and its activities according to the steps of QCC were implemented.A total of 100 contracted elderly people received the contracted family doctor services were surveyed via telephone survey before and after the QCC activities about telephone consultation，outpatient treatment，hospitalization，physical examination and door-to-door service，so as to reflect the cohesion between the elderly and contracted family doctors by the proportion of the elderly who had received any services among all the elderly people.Results The adhesion degree after the implementation of QCC activities（67.0%） between the elderly people and contracted family doctors was significantly higher than that before the activities（35.0%）（P<0.05）.The target compliance rate was 87.2% and the progress rate was 49.2%.Conclusion QCC activities can significantly improve the adhesion between community elderly people and contracted family doctors，improve the awareness and utilization rate of contracted family doctor services，and promote the relationship between community elderly people and family doctors，which could lay the foundation for hierarchical diagnosis and treatment.
【Key words】 Contracted family doctor services；Quality control circle；Aged；Family doctor；Adhesion
Implementation of Appointment Services in Community Health Centers in Downtown Shanghai WU Shuyao1，XU Hongxia2*，HE Ming3，CHEN Liping1，WU Pengliang1
1.Department of General Practice，Huangpu District Dapuqiao Community Health Center，Shanghai 200023，China
2.Huangpu District Health Affairs Management Center，Shanghai 200025，China
3.Department of Neurology，Ruijin Hospital Luwan Branch，Shanghai Jiao Tong University School of Medicine，Shanghai 200025，China
*Corresponding author：XU Hongxia，Associate professor；E-mail：email@example.com
【Abstract】 Background Opinions on the Implementation of Appointment Services in Public Hospitals〔WYGF（2009）No.95〕 issued by the original Ministry of Health put forward that public hospitals should be scheduled for appointments，and primary health care institutions are also within the scope of implementation.So analyzing the implementation of appointment services is of great significance for optimizing the diagnosis and treatment model of primary health care institutions.Objective To explore the implementation status of appointment services in community health centers（CHCs） in downtown Shanghai，providing suggestions for optimizing the primary healthcare system.Methods The survey was conducted across all the 10 CHCs located in Huangpu District，Shanghai through August 27th to September 11th，2018，with the method of focus group discussion.Participants were directors，and representatives of information department workers，and first-line clinicians and nurses recruited from the CHCs（4-6 cases from each）．Information about current implementation of appointment services，including implementation plans，practice and evaluation were collected.Description was formed after coding，classification and condensing with content analysis.Results A total of 44 medical professionals attended.The survey that appointment services had been carried out in 9 CHCs.There were 3 major types of making appointments：making an appointment without medical record（3 CHCs），making an appointment with medical record，and consulting on the appointment date（7 CHCs），making an appointment with medical record，and having priority in consulting during the appointment period（5 CHCs）．Multiple CHCs implement different appointment modes in different departments.But only a small percentage of patients made appointments，accounting for less than 10% of the total outpatient visits.The majority of patients who frequently used the appointment system were elderly adults，mainly for regular revisits or prescriptions.Those making an general-specialty appointment were mainly for obtaining specialty treatments.Patients preferred making an appointment during their visits，and the no-show rate was relatively low.Reducing the waiting time for consultation or improving the treatment environment，could alleviate patients' anxiety during consultation.However，all the types of making an appointment helped little in terms of balancing the number of patients in peak hours and off-peak hours.Neither would doctors lengthen the time of treatment for patients with an appointment.Conclusion The three types of making an appointment used in the CHCs，making an appointment without medical record，making an appointment with medical record，and having the priority in consulting during the appointment period if making an appointment with medical record，shows that the precise treatment time distribution and binding force for both patients and healthcare providers shave been gradually enhanced.Also，from the perspective of further upgrading the allocation of medical resources，the implementation of precise specialty appointment services is more mature than that of general appointment services.Overall，delivering appointment services for featured outpatient care that is different from general services，for example，home-based health management，would be the development direction of the general appointment services in the community.
【Key words】 Community health services；Community health centers；Appointments and schedules；Waiting time；Qualitative research；Shanghai
Changes in Medication Attitudes and Behaviors among Community-dwelling Residents after Comprehensive Medical Reform of Separating Drug Sales from Medical Treatment in Beijing CAO Ne1，GUAN Lizheng2*，XU Jian1，FU Xiaobo1，LI Peng1，SHI Yumeng2，PU Yuying2
1.Taoranting Community Health Center，Beijing 100054，China
2.School of Public Health，Capital Medical University，Beijing 100069，China
*Corresponding author：GUAN Lizheng，Associate professor，Master supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background The comprehensive reform of separating drug sales from medical treatment was launched in an all-round way in Beijing in 2017.It would inevitably have a significant impact on community-dwelling residents' healthcare-seeking behaviors，but few studies have evaluated the impact from patients' perspective.This study provides empirical basis for deepening the comprehensive reform by evaluating changes of residents' utilization of health services after the reform.Objective To assess the changes in medication attitudes and behaviors of community-dwelling residents of Beijing since the comprehensive medical reform of separating drug sales from medical treatment has been launched in 2017 to evaluate the effect of the policy reform，and to provide solutions and advice based on key findings.Methods This questionnaire survey was conducted in
1 005 participants with an experience of seeking healthcare or purchasing medicines in medical institutions in the past 6 months，recruited from 8 community health centers in Xicheng District（at least 125 from each center） by convenience and voluntary sampling in January 2018.The survey collected residents' knowledge level of zero-profit drug policy，and medication attitudes and behaviors，and preferred institutions and flow in seeking healthcare/purchasing medicines（the latter two are evaluation indicators for the effect of the policy reform）.Results A total of 969（96.42%） valid questionnaires were collected.After the reform，80.2%（777/969） of the residents were more likely to seek healthcare or purchase medicines in community health centers.Multivariate Logistic regression analysis found that those covered by free medical care were less likely to seek healthcare or purchase medicines in a community health center compared with those with basic medical insurance for urban residents〔OR（95%CI）=0.420（0.210，0.839），P<0.05〕.For the population flow of healthcare-seeking or purchasing medicines，55.7%（540/969） of the residents continued to see a doctor or purchase medicines in the community health center after the reform，and 27.2%（264/969） switched to the community health center from secondary and tertiary hospitals.Multivariate Logistic regression analysis showed that，higher possibility of changing health institutions，from a community health center to a higher level hospital，for seeking healthcare or purchasing medicines was found in residents with high education level rather than those with low education level〔OR（95%CI）=0.721（0.529，0.983），P<0.05〕，and in residents with free medical care rather than those with basic medical insurance for urban residents〔OR（95%CI）=0.383（0.194，0.757），P<0.05〕，and in residents with perceptions of drug cost reduction after the reform rather than those without such perceptions〔OR（95%CI）=0.475（0.227，0.993），P<0.05〕.Conclusion Since the comprehensive medical reform of separating drug sales from medical treatment has been launched in Beijing，a series of community-oriented measures，such as canceling drug markups and expanding the variety of drugs in the community，have effectively promoted the flow of residents to community health institutions to see a doctor or purchase drugs.It is necessary to further inform residents of drug policies，advocate zero-profit drugs and reduce medication costs，so as to encourage residents to change medication behaviors.
【Key words】 Health care reform；Separating drug sales from medical treatment；Community residents；Medication behavior；Zero-profit drugs；Community health services
Establishment and Verification of a Diabetes Risk Assessment Model Based on TCM Constitution ZHANG Ying1，ZHANG Yiying2，YANG Ruiwen3，JIN Minglan4，JI Conghua1，HUANG Qi5*
1.Clinical Evaluation Center，the First Affiliated Hospital of Zhejiang Chinese Medical University，Hangzhou 310006，China
2.School of Public Health，Zhejiang Chinese Medical University，Hangzhou 310053，China
3.Health Management Center，the First Affiliated Hospital of Zhejiang Chinese Medical University，Hangzhou 310006，China
4.Outpatient Medical Insurance Office，the First Affiliated Hospital of Zhejiang Chinese Medical University，Hangzhou 310006，China
5.Endocrine Department，the First Affiliated Hospital of Zhejiang Chinese Medical University，Hangzhou 310006，China
*Corresponding author：HUANG Qi，Chief physician，Master supervisor；E-mail：email@example.com
【Abstract】 Background Physical constitution is supposed to play an important role in the occurrence and development of diabetes mellitus in traditional Chinese medicine（TCM）.However，current models for predicting and warning diabetes only cover general demographic data，objective inspection indicators，lifestyle and so on.It is of great significance to incorporate TCM constitution into the diabetes risk assessment model for the prevention and treatment of diabetes.Objective To establish and verify a TCM constitution-based diabetes risk assessment model using the health check-up data.Methods Health checkup data during 2014 to 2017 were obtained from the physical examination center of a provincial hospital from January 2016 to December 2018.In particular，the data of those（n=30 951） undergoing health checkup during 2014 to 2015 were used as the training data.Univariate and multivariate logistic regression were adopted to explore factors associated with diabetes in this group.Then a diabetes risk assessment model was developed with the identified risk factors for diabetes incorporated，and was verified using the data of those（test data，n=24 061） undergoing health check up during 2016 to 2017.ROC curve of the model in predicting diabetes was plotted and analyzed.Results Of those undergoing health checkup during 2014 to 2015，1 315 were found with diabetes（4.25%），and 29 636（95.75%） without.Multivariate Logistic regression analysis showed that Logit（P）（prevalence of diabetes mellitus）=-4.632-0.198
×（female）+0.864×（age 45-59）+1.684×（age≥60）+0.635×（hypertension）+ 0.149×（overweight）+0.376 ×（obesity）-0.531×（underweight）-0.234×（high lymphocyte percentage）+ 0.279×（low lymphocyte percentage）+0.304 ×（abnormal RBC count）-0.430×（low hematocrit）+0.722×（abnormal mean corpuscular hemoglobin concentration）+ 0.532×（abnormal platelet distribution width）+1.016×（abnormal carcinoembryonic antigen）-0.406×（abnormal uric acid）+1.341×（low creatinine）+0.488×（high blood urea nitrogen）+0.473×（abnormal triglyceride）+ 0.257×（high cholesterol）+0.544×（low HDL）+0.290×（abnormal TP）+ 0.395×（abnormal alanine aminotransferase）+ 0.362×（abnormal glutamyl transpeptidase）+0.993×（Yin deficiency）+ 1.016×（Qi deficiency）+0.601×（Phlegm dampness）．The verification results showed that the AUC of the model was 0.792〔95%CI（0.779-0.816，P<0.05）〕，the optimal cut-off value was 0.405 with a sensitivity of 0.771，and a specificity of 0.690.The accuracy of the model in identifying diabetes in the 24 061 physical examinees reached 95.69%，Kappa coefficient=0.636（P<0.001）．Conclusion Our diabetes risk assessment model proves to be highly accurate，which may be attributed to the inclusion of TCM constitution，a major factor closely associated with diabetes，providing a basis for early TCM-based prevention and treatment of the disease.
【Key words】 Diabetes mellitus；Pathogenesis（TCM）；Physical constitution；Risk assessment model
Effect of Cumulative Total Cholesterol Exposure on the Onset of Stroke：a Prospective Cohort Study HUANGFU Chunmei1，SONG Yongjian2，YAN Lili1，LI Xuemei1，YUAN Jianxin3，YANG Na1，WU Shouling4*
1.Division 1 of Department of Neurology，Kailuan General Hospital，Tangshan 063000，China
2.Graduate School of North China University of Science and Technology，Tangshan 063000，China
3.College of Psychology，North China University of Science and Technology，Tangshan 063000，China
4.Department of Cardiovascular Medicine，Kailuan General Hospital，Tangshan 063000，China
*Corresponding author：WU Shouling，Chief physician，Master supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background Baseline total cholesterol（TC） is an influencing factor of new-onset stroke，but no studies have been conducted on the effect of cumulative total cholesterol exposure（cumTC） on new-onset stroke.Objective To explore the effect of cumTC on new-onset stroke.Methods Using prospective cohort study method，52 427 working and retired employees of Kailuan Group who had physical examination in 11 hospitals including KaiLuan General Hospital from 2006 to 2010 were selected as the study objects.The starting point of the follow-up was when the objects completed the physical examination in 2010，and the end point was when new-onset stroke or deaths happened or the end of the follow-up（2017-12-31）.Baseline data and the incidence of new-onset stroke in each group were observed after all objects were grouped according to the cumTC quartile.The cumulative incidence was calculated by Kaplan-Meier method and tested by Log-Rank method.Cox regression model was used to analyze the effect of different cumTC on new-onset stroke.The fitting degree of different models was compared by likelihood ratio test.Results There were significant differences in age，male proportion，systolic blood pressure（SBP），diastolic blood pressure（DBP），BMI，cumTC，TC，high-density lipoprotein cholesterol（HDL-C），fasting blood glucose（FBG），stroke，ischemic stroke，smoking，drinking，hypertension and diabetes detection rates，taking lipid-lowering drugs proportion among groups with different levels of cumTC（P<0.05）.During a mean follow-up year of（6.89±0.72），there were 1 611 new cases of stroke（1 415 cases of ischemic stroke and 229 cases of hemorrhagic stroke）.The cumulative incidence of stroke was 2.53%（331/13 089），2.92%（384/13 148），4.18%（547/13 085） and 4.36%（571/13 105） in the first to the fourth quartile group，respectively，and the cumulative incidence of ischemic stroke was 2.17%（284/13 089），2.51%（330
/13 148），3.71%（485/13 085） and 3.99%（523/13 105），respectively.The difference was statistically significant by Log-Rank test（χ2=73.15，P<0.001；χ2=109.13，P<0.001）.Cox regression analysis showed that after adjusting age，gender，BMI，hypertension，diabetes，smoking，drinking，physical exercise，HR（95%CI） of stroke and ischemic stroke in the fourth quartile group were 1.27（1.10，1.48） and 1.37（1.16，1.60） and those in the third quartile group were 1.22（1.05，1.41） and 1.27（1.08，1.50） compared with that in the first quartile group of cumTC.Increasing the factors of baseline TC level and taking lipid-lowering drugs，after likelihood ratio test，the fitting degree of the model was not optimized（P>0.05）.After adjusting age，gender，BMI，hypertension，diabetes，smoking，drinking，physical exercise，HR（95%CI） of stroke and ischemic stroke in the group with cumulative exposure for more than 4 years were 1.20（1.02，1.40） and 1.28（1.08，1.50），compared with the group with cumulative exposure to hypercholesterolemia for 0 years.Increasing the factors of baseline TC level and taking lipid-lowering drugs，the cumulative exposure of hypercholesterolemia had no statistical correlation with the new-onset stroke，ischemic stroke and hemorrhagic stroke.After the likelihood ratio test，the fitting degree of the model was not optimized（P>0.05）.Conclusion High cumTC is a risk factor of new-onset stroke and ischemic stroke.
【Key words】 Total cholesterol；Cumulative exposure；Stroke；Root cause analysis；Prospective studies；
The Sleep Quality of Patients with Peptic Ulcer and Its Influencing Factors LIU Mengqi，LI Ying，LIU Xingchen，LIU Dehua，LU Xin，ZHU Xiuli*
School of Nursing，Medical College of Qingdao University，Qingdao 266000，China
*Corresponding author：ZHU Xiuli，Associate professor，Master supervisor；E-mail：email@example.com
【Abstract】 Background The prevalence of peptic ulcer（PU） ranks tenth among the common chronic non-communicable diseases in China.The lengthy course of the disease and the changes in patients' life mode make patients have an urgent need for community/home care.However，the current community/home care management mode for chronic non-communicable diseases such as PU is not completed in China.Objective To understand the sleep quality of PU patients and analyze its influencing factors，so as to provide a theoretical basis for improving the relevant community health service system.Methods Twenty-three PU patients who were treated in four tertiary hospitals in Qingdao were selected from May in 2018 to February in 2019，and 213 PU patients were also included through the social platform from December in 2018 to February in 2019.The patients were investigated online and offline.The questionnaires mainly included General Information Questionnaire，Occupational Stress Analogue Scale，Pittsburgh Sleep Quality Index（PSQI），Social Support Rating Scale（SSRS），Self-rating Anxiety Scale（SAS），Self-rating Depression Scale（SDS），and pain Numerical Rating Scale（NRS）.Results A total of 223（94.5%） questionnaires were received effectively.The average PSQI score of PU patients was（8.04±2.77），and 53.8%（120/223） patients had poor sleep quality.There were significant differences in PSQI scores among PU patients with different age，education level，family per capita monthly income，personality type，presence of negative emotions，occupational stress，anxiety level and depression level（P<0.05）.Spearman rank correlation analysis showed that there was a negative correlation between the score of use of support in SSRS and the PSQI score among PU patients（P<0.05）.The results of multiple linear stepwise regression analysis showed that personality type，negative emotions，the score of use of support in SSRS and anxiety level were the influencing factors of sleep quality in PU patients（P<0.05）.Conclusion The sleep quality of PU patients is not good.It is important to pay attention to the sleep quality of PU patients with depressive character，negative emotions，low social support and high anxiety level.Community medical staff should provide more individualized and multi-dimensional nursing interventions for PU patients，such as body-psycho-social nursing including understanding the social support of PU patients in depth，establishing healthy social relations，and conducting psychological guidance.
【Key words】 Peptic ulcer；Sleep disorders；Root cause analysis；Community health services
Investigation of Pulmonary Function Outcomes of 146 Patients with Suspected Positive Results in Bronchial Provocation or Dilation Test after 6-month Follow-up XIE Han，CHEN Yuanbin*，ZHOU Mingjuan，LIN Lin，WU Lei
Department of Pulmonary and Critical Care Medicine，the Second Affiliated Hospital of Guangzhou University of Chinese Medicine，Guangzhou 510120，China
*Corresponding author：CHEN Yuanbin，Attending doctor，Associate professor；E-mail：firstname.lastname@example.org
【Abstract】 Background Bronchial asthma is a common disease of respiratory system，and positive results of bronchial provocation or dilation test are important evidence in the diagnosis of bronchial asthma.However，suspected positive bronchial provocation or dilation test results associated with symptoms are often observed in clinical practice.At present，there is no literature report on analyzing the influencing factors of the prognosis outcome of such patients.Objective To investigate the prognostic outcomes of patients with suspected positive results in bronchial provocation or dilation test and its influencing factors.Methods From August 2015 to February 2018，320 patients with suspected positive results in bronchial provocation or dilation test accompanied by at least one symptom of cough，expectoration，itching throat，wheezing，dyspnea and chest tightness were followed up for six months.The pulmonary function was reviewed and the symptoms and TCM syndrome scores were recorded to analyze the outcomes of the patients.Significant difference of clinical symptom proportion and TCM syndrome scores before and after follow-up was considered to be the remission of the disease.A transfer from suspected positive results to negative results in bronchial provocation or dilation test after six months was considered to be the improvement of the disease.Factors influencing the outcome of suspected positive patients with bronchial provocation or dilation test were analyzed by Logistic regression analysis.Results A total of 146 patients completed the 6-month follow-up，of which 49 patients were tested with suspected positive results in bronchial provocation test and 97 patients were tested with suspected positive results in bronchial dilation test.Among those 49 cases with suspected positive results in bronchial provocation test，20（40.8%） patients were tested with negative results；2（4.1%） patients were tested with positive results；4（8.2%） patients remained the same results，and 23（46.9%） patients underwent bronchial dilation test after six months.Among those 97 cases with suspected positive results in bronchial dilation test，44（45.4%） patients were tested with negative results；4（4.1%） patients were tested with positive results；10（10.3%） patients remained the same results，and 39（40.2%） patients underwent bronchial provocation test after six months.After 6-month of follow-up，the patients' TCM syndrome scores decreased（P<0.05）.Among the patients enrolled，major symptoms（cough，expectoration，itching throat，wheezing，dyspnea，and chest tightness） were relieved with significant difference after six months（P<0.05）.Analysis which was carried out on 84 patients who used bronchial provocation or dilation test before and 6 months after the follow-up showed that，there was a significant difference in the outcome of suspected positive patients in different age groups（P<0.05），and the improvement rates of pulmonary function were higher in patients applying acupoint application of traditional Chinese medicine or without allergic rhinitis and inhaled glucocorticoid（P<0.05）.The Logistic regression analysis results showed that under the condition of multiple factors acting at the same time，there was no significant factor affecting the prognosis of patients suspected to be positive in bronchial provocation or dilation test.Conclusion Most patients with suspected positive results in bronchial provocation or dilatation test have reversible airway inflammatory responses.Patients may benefit from acupoint application of Chinese traditional medicine.
【Key words】 Bronchial provocation tests；Bronchial dilation tests；Suspicious positive results；Pulmonary function；Prognosis；Root cause analysis
Factors Influencing Hearing Loss of Young People PAN Hongran1，YANG Lei1，2*，ZHUANG Yizhen2，LEI Song1
1.Department of Preventive Medicine，Shihezi University School of Medicine，Shihezi 832002，China
2.Department of Preventive Medicine，School of Medicine，Hangzhou Normal University，Hangzhou 311121，China
*Corresponding author：YANG Lei，Professor，Doctoral supervisor；E-mail：email@example.com
【Abstract】 Background Hearing loss is the most popular sensory organ disability in the world，and its negative impact ranks at the top of the global disease burden list.Therefore，prevention of deafness and hearing loss has become a public health project with common concern all over the world.Objective To understand the main influencing factors of hearing loss among young people in Hangzhou.Methods From June to September 2017，1 100 young people aged 18-28 from Hangzhou Hospital for the Prevention and Treatment of Occupational Disease were selected by convenient sampling method to conduct questionnaire survey and pure tone hearing test.The questionnaire included general demographic characteristics，family history of hearing loss，ear symptoms，use of mobile phones and earphones，frequency of access to entertainment places，attitude to hearing protection，and self-perceived hearing status.The pure tone hearing test used clinical audiological diagnostic criteria.The influencing factors of hearing loss were analyzed by χ2 test and multivariate Logistic regression analysis.Results A total of 1 100 questionnaires were distributed，and 1 049 effective questionnaires were recovered with an effective recovery rate of 95.4%.And 71（6.8%） cases had low-frequency hearing loss in the left ear； 47（4.4%） cases had medium-frequency hearing loss；and 127（12.2%） cases had high-frequency hearing loss.And 40（3.8%） cases had low-frequency hearing loss in the right ear； 32（3.1%） cases had medium-frequency hearing loss，and 116（11.1%） cases had high-frequency hearing loss.There were statistically significant differences in hearing loss among young people in terms of gender，education level，tinnitus，earache，ear nausea，maximum volume of music release，ways of telephone answering，attitude towards hearing protection，and self-perceived hearing status（P<0.05）.The results of multivariate Logistic regression analysis showed that moderate volume〔OR（95%CI）=0.361（0.160，0.816）〕，low volume〔OR（95%CI）=0.418（0.219，0.797）〕，college and above degree〔OR（95%CI）=0.466（0.235，0.924） or 0.323（0.140，0.747）〕，female〔OR（95%CI）=0.478（0.277，0.827）〕，answering telephone with earphone〔OR（95%CI=0.448（0.236，0.852）〕 were the protective factors of hearing loss.The risk factors of hearing loss were poor self-perceived hearing status〔OR（95%CI）=2.050（1.067，3.940）〕，negative attitude towards hearing protection〔OR（95%CI）=3.350（1.782，6.300）〕，and earache〔OR（95%CI）=3.347（1.185，9.449）〕（P<0.05）.Conclusion The prevalence of hearing loss among young people in Hangzhou is high.The music volume，education level，gender，ways of telephone answering，self-perceived hearing status，and attitude to hearing protection are the influencing factors of hearing loss.Comprehensive prevention and treatment should be conducted according to the influencing factors of hearing loss.
【Key words】 Young people；Hearing disorders；Hearing loss；Root cause analysis
Correlation between Serum hs-CRP，Homocysteine and Nocturnal Blood Pressure Variability in Patients with Essential Hypertension LIU Fangfang1，ZHANG Qiang1*，YANG Lihong2，SUN Caihong1，XU Xiaoting1，FANG Shijie1，LIU Ying1，YAO Fang1
1.Department of Cardiology，the Second Affiliated Hospital of Zhengzhou University，Zhengzhou 450014，China
2.Department of Cardio-Pulmonary Function Examination，Henan Provincial People's Hospital，Zhengzhou 450003，China
*Corresponding author：ZHANG Qiang，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background The 24 h Blood pressure variability（24 hBPV），serum high-sensitivity C-reactive protein（hs-CRP） and homocysteine（Hcy） are independently associated with the target organ damage and increased risk of cardiovascular events in patients with essential hypertension.Several studies have shown that hs-CRP and Hcy are positively correlated with blood pressure variability（BPV） in hypertensives，especially the nocturnal blood pressure variability（nBPV） which is associated with the increased target organ damage and risks of cardiovascular events.However，the relationship between serum hs-CRP，Hcy and nBPV has not been fully identified in patients with essential hypertension.Objective To investigate the correlation between serum hs-CRP，Hcy and nBPV in patients with essential hypertension.Methods A total of 210 hypertensive patients who visited the Second Affiliated Hospital of Zhengzhou University from January 2016 to December 2018 were enrolled in the study and divided into three groups according to the serum hs-CRP tertile value with the cut-off value of 4.217 mg/L and 7.450 mg/L.Similarly，these patients were divided into three groups according to the different levels of Hcy：106 cases with Hcy<15.0 μmol/L（group A），45 cases with 15.0 μmol/L≤Hcy<20.0 μmol/L（group B），and 59 cases with Hcy≥20.0 μmol/L（group C）.The 24-hour ambulatory blood pressure monitoring was performed on all patients.The mean and standard deviations（as the index of BPV）of systolic and diastolic blood pressure in the periods of 24 hours and at nighttime were recorded.The correlations between hs-CRP，Hcy and nBPV were analyzed by Pearson correlation analysis and multiple linear regression analysis.Results Grouped by hs-CRP level，24 hBPV and nBPV in the third tertile group were significant higher than those in the first tertile group，24 hBPV in the second tertile group was significant higher than that in the first tertile group（P<0.05）.Grouped by Hcy level，24 hBPV and nBPV in group B and group C were significant higher than that in group A，nBPV in group C was significant higher than that in group B（P<0.05）.Pearson correlation analysis indicated that the serum hs-CRP and Hcy levels were positively correlated with the standard deviation of systolic blood pressure at nighttime（nSSD） linearly（r valus were 0.564 and 0.501，P<0.05）.Multiple linear regression analysis showed that hs-CRP and Hcy were the influence factors of nBPV（P<0.05）.Conclusion Serum hs-CRP and Hcy are positively correlated with nBPV independently in patients with essential hypertension，suggesting that they may play a role in the pathogenesis of nBPV，possibly aggravate the abnormality of nBPV，and they may be the mediators between nBPV and the terminal target organ damage and cardiovascular endpoint events of essential hypertension.
【Key words】 Essential hypertension；Hypertension；High-sensitivity C-reactive protein；Homocysteine；Blood pressure variability
Epidemiological Analysis of the Surveillance Data of Birth Defects among Perinatal Infants in Shanxi Province，2012—2017 ZHANG Zhili1，HU Xianming2，FAN Huixia2，ZHANG Juan1，LI Yufeng2，SONG Zhijiao2，LI Rude3*
1.School of Management，Shanxi Medical University，Taiyuan 030001，China
2.Children's Hospital of Shanxi Province/Women Health Center of Shanxi，Taiyuan 030013，China
3.Health Commission of Shanxi Province，Taiyuan 030000，China
*Corresponding author：LI Rude，Professor；E-mail：email@example.com
【Abstract】 Background Birth defects have become a major global public health concern.In Shanxi Province，a high-incidence region of birth defects，the quality of birth population is seriously affected by the rate of birth defects.Objective To explore the trend in the incidence of birth defects and associated factors in Shanxi Province from 2012 to 2017，to provide evidence for the development of targeted prevention and control measures.Methods Surveillance data of perinatal birth defects covering 11 cities in Shanxi Province during 2012 to 2017 were collected from 37 monitoring institutions.Analysis was performed on the overall incidence of birth defects，prevalence of birth defects by sex，incidence of birth defects by maternal residential area（rural or urban），and maternal age at delivery，changes in major birth defects and the incidence rank in descending order of them，and the diagnosis and outcome of birth defects.Results In 2012—2017，the overall incidence of perinatal birth defects was 1.39%（6 316/455 374），and the average annual incidence of perinatal birth defects was 138.70/10 000.The annual incidence of perinatal birth defects showed an overall upward trend（χ2trend=97.68，P<0.001）.The incidence of birth defects in males（149.56
/10 000） was significantly higher than that of females（124.65/10 000）（χ2=51.96，P<0.001）.The incidence of birth defects（142.58/10 000） in urban areas was significantly higher than that of rural areas（134.84/10 000）（χ2=51.96，P<0.001）.There were differences in the incidence of birth defects in different age groups（χ2=41.12，P<0.001）.The incidence of birth defects in the age group >35（172.65/10 000） was higher than that in the 20-, 25-, and 30-year-old（χ2 values were 24.32，39.14，28.02，P<0.001）.The top five major birth defects were congenital heart disease（37.31
/10 000），polydactyly（19.39/10 000），cleft lip with or without cleft palate（14.05/10 000），neural tube defects（7.71
/10 000），and other deformities of the outer ear（7.01/10 000）.The incidence of congenital heart disease increased from 13.23/10 000 in 2012 to 58.27/10 000 in 2017，with a significant difference（χ2=404.54，P<0.001）.Conclusion The incidence of birth defects in Shanxi Province in 2012—2017 was generally on the rise.In particular，the incidence of congenital heart disease ranked first.The implementation of three-level preventive measures need to be strengthened to reduce birth defects and improve the quality of birth population.
【Key words】 Congenital abnormalities；Peripartum period；Prevalence；Surveillance；Shanxi
Maternal-infant Health Information Needs among Pregnant and Postpartum Women：a Correspondence Analysis of the Target Group Index Data CHENG Xiaoyun1，ZHANG Zhili1，PEI Suyun1，YUE Zheyu1，GUO Xiaoqin2，WANG Qian2，ZHANG Juan1*，HU Xianming3*
1.School of Management/Health Management and Policy Research Center，Shanxi Medical University，Taiyuan 030001，China
2.School of Nursing，Shanxi Medical University，Taiyuan 030001，China
3.Children's Hospital of Shanxi/Women Health Center of Shanxi，Taiyuan 030013，China
*Corresponding authors：ZHANG Juan，Associate professor，Master supervisor；E-mail：firstname.lastname@example.org
HU Xianming，Chief physician，Professor；E-mail：email@example.com
【Abstract】 Background As an important part of maternal and child health care receiving increased attention，understanding and mastering maternal health information needs is of great significance for improving maternal and child health and safety.Objective The aim of this study was to investigate maternal-infant health information needs，and the association of health information with acquiring methods in pregnant and postpartum women in Taiyuan，providing a reference for effective delivery of maternal-infant health education.Methods A survey was conducted with 1 100 pregnant and postpartum women who sought outpatient care in a provincial maternal and child health hospital，a private hospital and a township hospital in Taiyuan from November 2016 to August 2017 using a self-made questionnaire.Analysis of maternal-infant health information needs by target group index（TGI） and correspondence analysis.1 048（95.27%） of the participants responded effectively.Results Among the respondents，the data about prenatal care（70.90%，743/1 048），nutrition during pregnancy（68.42%，717/1 048） and neonatal care（52.29%，548/1 048） were the most needed，and information concerning maternity insurance（23.85%，250/1 048） and labor analgesia（28.53%，299/1 048） was least needed.It is more difficult for them to get maternal psychological health care（31.77%，333/1 048），labor analgesia（25.19%，264/1 048），common physical discomforts during pregnancy（24.90%，261/1 048） and maternity insurance（24.24%，254/1 048） information.Age（χ2=18.331，P=0.787） and education level（χ2=20.139，P=0.065） were not associated with the differences in needs of maternal-infant health information content in the respondents.However，the respondents had different TGI requirements for various types of information.Place of residence（χ2=23.288，P=0.025） and gestational period（χ2=56.181，P=0.017） were associated with the differences in needs of various types of information content.Conclusion The TGI of various maternal-infant health information needs was different in pregnant and postpartum women with different characteristics.And these women also had different preferences when acquiring maternal-infant health information.Hence，maternal-infant health education should be delivered in accordance with the needs of pregnant and postpartum women，namely，it is should be precisely delivered to them according to their needed contents via their preferred ways.
【Key words】 Maternal and child health care；Access to information；Health education；Pregnant and postpartum women
Preferences for Acquiring Maternal and Infant Health Information in Pregnant Women and Parturients ZHANG Juan1*，PEI Suyun1，CHENG Xiaoyun1，ZHANG Zhili1，WANG Qian2，ZHANG Chichen1，HU Xianming3
1.School of Management/Health Management and Policy Research Center，Shanxi Medical University，Taiyuan 030001，China
2.School of Nursing，Shanxi Medical University，Taiyuan 030001，China
3.Children's Hospital of Shanxi/Women Health Center of Shanxi，Taiyuan 030013，China
*Corresponding author：ZHANG Juan，Associate professor，Master supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background The promotion of maternal and infant health is a priority for National Action Plan to Improve Women and Children' Health Literacy，and is also a measure for achieving Health China goals.Disseminating maternal and infant health information，and developing healthy behaviors and life styles，are specific initiatives for increasing health literacy in pregnant women and parturients.Objective To identify the preferences for acquiring maternal and infant health information in pregnant women and parturients，providing a reference for effective delivery of maternal and infant healthcare services.Methods A cross-sectional study was conducted in 1 100 pregnant women and parturients seeking outpatient healthcare in 3 hospitals in Taiyuan from November 2016 to August 2017 for exploring their preferred ways，forms，time and sites for acquiring maternal and infant health information.Results A total of 1 048 cases returned responsive questionnaires，achieving a response rate of 95.27%.The ways most frequently used to get maternal and infant health information were searching the web from mobile devices（768，73.28%），consulting physicians delivering antepartum care（503，48.00%），and searching the web from computers（474，45.23%）.The rates of expected utilization of maternal school，consulting physicians delivering antepartum care，and consulting community healthcare workers were higher than those of actual utilization，while rates of expected utilization of computers and mobile phones to search the web，and interpersonal channels were lower than those of actual utilization.Maternal and infant health information is mainly selected according to levels of reliability（620，59.16%），need（533，50.86%） and access convenience（473，45.13%）.Conclusion The information acquisition methods currently used by pregnant women differ from their expectations，and reliability and access convenience of information are the most concerned issues among pregnant women and parturients during acquiring maternal and infant health information.Therefore，the construction of maternal and infant health information system should attach importance to these two aspects.
【Key words】 Maternal and child health care；Health promotion；Health communication；Access to information；Channel of information transmission
Advances in the Effect of Donepezil in Cardiovascular Therapy LONG Jieni，XUE Yazhi，MA Yusheng，RAO Jiahuan，GUO Zhigang*
General Practice Training Base，Huiqiao Medical Center，Nanfang Hospital，Southern Medical University，Guangzhou 510515，China
*Corresponding author：GUO Zhigang，Chief physician，Professor，Doctoral supervisor；E-mail：email@example.com
【Abstract】 Alzheimer's disease（AD）is the main type of dementia，and the reduction of cholinergic neurons in the central nervous system is one of its important pathogenesis.Donepezil，as a highly selective and reversible cholinesterase inhibitor，improves cognitive function of dementia patients by elevating acetylcholine level in cortex through inhibiting cholinesterase，and now is one of the front-line treatment drugs for dementia.A large number of clinical studies have confirmed the effectiveness and safety of the clinical application of donepezil.Many AD patients also suffer from cardiovascular diseases，and current researches have indicated a therapeutic effect of donepezil on cardiovascular diseases.This article aims to review the current clinical use of donepezil and its effects on cardiovascular system，and to explore its mechanism.This article compares the effects of donepezil with galantamine and rivastigmine on cardiovascular diseases in order to provide feedback to guide the further use of donepezil in the clinical practice.
【Key words】 Donepezil；Cholinesterase inhibitor；Cardiovascular disease；Review
Impact of Labor Analgesia on Labor Outcomes：Recent Advances FU Qiupeng1，HE Yinfang2*，GAO Lianfeng2，ZHANG Yuhong2
1.School of the First Clinical Medical，Shanxi Medical University，Taiyuan 030001，China
2.Department of Obstetrics，the First Affiliated Hospital of Shanxi Medical University，Taiyuan 030001，China
*Corresponding author：HE Yinfang，Chief physician，Master supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Labor pain is a major cause for increased cesarean section rate and adverse pregnancy outcomes，but it can be controlled by interventions，among which labor analgesia is the most effective.Besides，it can also maintain maternal and infant safety and promote natural childbirth.In various labor analgesic methods，non-pharmacological analgesia produces less adverse reactions，but the analgesic effect remains to be confirmed.Drug-induced analgesia can relieve the labor pain，but with certain adverse reactions.So there are studies recommend the combination use of both drug- and non-drug-induced analgesia.Among different forms of drug-induced analgesia，epidural analgesia has a definite analgesic effect and a more flexible analgesic time，but requiring higher level of technique and costing more，with some controversies about the impact on maternal and neonatal outcomes.At present，the prevalence of domestic labor analgesia is far lower than that in foreign countries，wherefore it is necessary to strengthen the publicity，promotion and development of labor analgesia in China.
【Key words】 Labor pain；Analgesia，obstetrical；Pregnancy outcome；Cesarean section；Review
Research Progress on Influencing Factors of Cognitive Management Compliance among People with Mild Cognitive Impairment in the Community ZHEN Xueting1，WANG Lina1*，CHEN Haiqin2，ZHAO Xia1，LIU Xiaoshen1，ZHANG Chen3
1.School of Medicine，Huzhou University，Huzhou 313000，China
2.Huzhou Third People's Hospital，Huzhou 313000，China
3.Binhu Community Health Service Center，Wuxing District，Huzhou 313000，China
*Corresponding author：WANG Lina，Associate professor；E-mail：email@example.com
【Abstract】 Cognitive management is an important means to delay the disease progress of mild cognitive impairment（MCI）.However，the compliance of cognitive management among people with MCI at home and abroad is still at a low level at present，which greatly affects the intervention effect of cognitive management.In this paper，the influencing factors of cognitive management compliance among people with MCI were summarized from three aspects of biology，social psychology and methodology.Gender，marital status，education level，disease awareness，ideation and self-efficacy，social support，cognitive management development form，intervention content and effectiveness，and cognitive management environment were main factors affecting the cognitive management compliance of people with MCI.The relationship between depression and cognitive management compliance was still controversial.Based on the above factors，this paper formulated corresponding improvement strategies so as to provide theoretical guide for community medical staff to target high-risk groups of cognitive management and then carry out the compliance-oriented project of cognitive management.
【Key words】 Mild cognitive impairment；Cognitive management；Compliance；Community health services；Root cause analysis；Review