July 2020, Volume 23，No19 Abstracts
Author：尹鹏 Source：CGP Published： [07-01] views： 80
Reform Progress and Development Strategy of General Practitioners Training and Incentive Mechanisms in China QIN Jiangmei1*，LI Sisi2，LIN Chunmei1
1.China National Health Development Research Center，Beijing 100044，China
2.Beijing No.6 Hospital，Beijing 100007，China
*Corresponding author：QIN Jiangmei，Researcher，Doctoral supervisor；E-mail：firstname.lastname@example.org
【Abstract】 To understand the current status and implementation progress of the Opinions on Reforming and Improving the General Practitioners Training and Incentive Mechanisms（〔2018〕 No.3 issued by General Office of the State Council of the People's Republic of China），this paper systematically reviews the documents issued by provinces（autonomous regions and municipalities） in 2018 and typical cases reported in 2019 in China，and analyzes the results of field research in Shanghai，Guangdong，Anhui，Shandong，Hainan，Shaanxi and other provinces（autonomous regions and municipalities） using the relevant data of general practitioners（GPs） in the 2013—2016 China Health and Family Planning Statistical Yearbook and 2018—2019 China Health Statistics Year book.As of December 2018，provinces（autonomous regions and municipalities） in China have issued implementation opinions or plans for GPs，and some of them have made innovations and breakthroughs in policies such as the training of GPs，reforming and improving the salary system for GPs，and expanding the career development of GPs.In 2018，the number of GPs per 10 000 population in China reached 2.22，and 40.6%（13/32） of the provinces（autonomous regions and municipalities） reached the goal of two qualified GPs per 10 000 population in 2020 ahead of schedule.The GP registration rate increased from 33.9% in 2012 to 50.8% in 2018.From the aspect of GP training，the three-stage organic training system for GP college education，GP postgraduate education，and GP continuing education has been further improved in some areas in the past two years.From the aspect of salary system reform，the performance salary of primary health care institutions is approved according to the salary level of public county（district） hospitals，and GP allowance is established internally，and more than 70% of the fee from contracted family doctor service is used for internal distribution in service teams in representative areas.The salary of GPs has been raised.From the aspect of appointment management，some representative regions improve the establishment of a turnover pool system and implement "employed by county and work in township" policy for GPs who have passed the standardized training of resident physicians and practice in rural areas，and give priority to the authorized strength and position to GPs.At the same time，drawing on the experience of representative regions，this article proposes relevant policy recommendations for the weaknesses of GP training and incentive mechanisms，with a view to providing suggestions for the further improvement of the GP system.
【Key words】 General practitioners；General practitioner system；Education，medical；Salary system reform；Appointment management；Career development
Effectiveness of the Management Training Module of the "Spring Seedling Project" Zhaotong Program：a Case Study GU Jie1，ZHU Shanzhu1*，YAO Zongqiang2，ZHANG Kan3，WANG Ling4，CHEN Taojian5，TANG Juntao6，PAN Zhigang1，GONG Jian1，SHOU Juan1，YANG Hua1，DU Zhaohui7，LI Wenjiao6，MAO Xiuying8，YE Minghao9
1.Department of General Practice，Zhongshan Hospital，Fudan University，Shanghai 200032，China
2.Shanghai Charity Foundation，Shanghai 200031，China
3.Shanghai Municipal Health Commission，Shanghai 200125，China
4.Shanghai Medical College Fudan University，Shanghai 200032，China
5.Shanghai Community Health Association，Shanghai 200041，China
6.Zhaotong Municipal Health Commission，Zhaotong 657000，China
7.Shanghai Pudong Shanggang Community Health Center，Shanghai 200126，China
8.Shanghai Xuhui Kangjian Community Health Center，Shanghai 200233，China
9.Shanghai Pudong Weifang Community Health Center，Shanghai 200122，China
*Corresponding author：ZHU Shanzhu，Professor，Chief physician，Master supervisor；E-mail：email@example.com
【Abstract】 Background Training for managers and medical professionals in rural primary care institutions is an important action to achieve the "Healthy China 2030" strategic goals.Although a large number of training programs have been implemented，the research on effectiveness evaluation of such programs is very limited.Objective To evaluate the implementation effectiveness of the management training module of the "Spring Seedling Project" Zhaotong program.Methods Managers（n=150） of township/community health centers，Zhaotong who received the training with "Spring Seedling Project" Zhaotong program between June 2015 and December 2016 were enrolled.The program consists of two parts：Zhaotong face-to-face theoretical training（5 days），and Shanghai practical training（2 weeks）.The face-to-face theoretical training effectiveness was measured by quantitative analysis of trainees' pre- and post-training examination scores，and practical training effectiveness was measured by qualitative analysis of trainees' practical training reports.Results Of the 150 trainees〔mean age（38.6±6.8） years；130（86.7%） men〕，147 completed the written examination before and after the Zhaotong face-to-face training，and their average examination score after training was higher than that before the training〔（65.9±8.8） vs （57.0±8.3），t=11.945，P<0.001〕.Essential characteristics showed no significant association with the improvement in the score in the trainees（P>0.05）.The practical training reports were analyzed to the point of saturation.Altogether，13 reports were included，in which the trainees expressed that through practical training，their management views had been widened，and they would appropriately apply what they had learned in Shanghai to the practice in Zhaotong.Conclusion As an increased training form for Chinese rural primary care managers，the Zhaotong program has achieved remarkable results，which may deserve to be studied.Similar trainings are suggested to be implemented by other rural areas based on appropriate modification of the training program according to the local conditions with practical training opportunities provided.
【Key words】 Education，medical；Administrators；Rural health；Primary health care；Case study
Comparison of General Practice Residents' Attitudes and Perceptions about Training in Two Programmes in China：
a Mixed Methods Survey LIAN Siqing1，XIA Yu2，ZHANG Jinzhi2，HAN Xiaoning3，CHI Chunhua1*，Michael D Fetters4
1.Department of General Practice，Peking University First Hospital，Beijing 100034，China
2.Department of General Practice，Peking University Shenzhen Hospital，Shenzhen 518036，China
3.Cardiology Department，Peking University First Hospital，Beijing 100034，China
4.Mixed Methods Program and Department of Family Medicine，University of Michigan，Ann Arbor，Michigan 48109，USA
*Corresponding author：CHI Chunhua，Chief physician，Professor，Doctoral supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background China is improving the hierarchical medical system and family doctor system，during which general practitioners serve as a core supplier of hierarchical medical services and family doctor services.Currently，there is a shortage of 400 000 general practitioners，which can be solved mainly by fostering high-quality general practitioners with standard general practice residency training program.Objective To perform an extensive and in-depth comparative survey analysis of general practice（GP） residents' attitudes about their residency training in two programmes conducted by two hospitals in different cities of in China using mixed methods，and to discuss the possible benefits of different training patterns.Methods A mixed methods survey was administered cross-sectionally.Participants were GP residents selected by cluster sampling from Peking University First Hospital and Peking University Shenzhen Hospital，two bases for fostering residents.The two training programmes are similar in most regards according to current GP training policy of 5?years' undergraduate degree in medicine and 3?years of postgraduate GP residency training—but differing as the Beijing programme has adopted educational innovations （piloting the 'Four-Certificates-In-One' option） beyond the nationally prescribed standard curriculum used by the second Shenzhen programme.Results Of the 123 GP trainees，105（85.4%） were eligible，35（89.7%） in the innovative Beijing programme and 70（83.3%） in the standard training Shenzhen programme.Overall，residents felt discrimination because of specialty choice，and that they lacked competency as a general practitioner.Many residents commented faculty had negative teaching attitudes.Beijing residents were more satisfied than Shenzhen residents with their training（P=0.001），and felt teaching faculty had sufficient knowledge（P<0.001），and appropriate attitudes towards teaching（P=0.004）.Beijing residents more strongly agreed on five items about good future job prospects（all P<0.05）.Conclusion Higher satisfaction with faculty teaching and job optimism in Beijing where GP residents receive training from specifically qualified faculty，and can earn special certification，suggest that the educational innovations enhance training and promote positivity about job prospects.These findings imply that GP residents in China face many training challenges that are similar to other international reports，while also implicating benefits of using an innovative curricular approach.
【Key words】 General practitioners；Education，medical；Standardized training；Mixed methods survey
The Situation of General Practitioner Education after Graduation in Chongqing from 2015 to 2018 LIU Yan，PAN Lun*，HE Ping，LIN Yiyi，CHENG Sanuo，ZHANG Dongqing
Chongqing Medical and Pharmaceutical College，Chongqing 401331，China
*Corresponding author：PAN Lun，Associate professor；E-mail：email@example.com
【Abstract】 Background General practitioners（GPs） are the "gatekeepers" of residents' health.Establishing and improving the training system of GPs and strengthening the construction of GP team are important parts of the reform of medical and health system.Objective Through an in-depth analysis of the situation of GP education after graduation in Chongqing from 2015 to 2018，this paper tries to find out the existing problems and put forward some suggestions.Methods The age，education background，identity，certification status and job position of GPs and assistant GPs participating in training from 2015 to 2018 in 55 GP training bases in Chongqing were collected.And the training scale and situation were analyzed.
Results From 2015 to 2018，the general practitioner standardized training，and the education background of the participants was mainly undergraduate，accounting for 92.53%（1 486/1 606）of the total number.In 2018，the number of undergraduates was 95.24%（420/441），an increase of 5.82% compared with 89.42%（321/359） in 2015.The participants were mainly fresh graduates and unit personnel，accounting for 60%-70% of the total number of fresh students，and mainly rural order oriented training students，accounting for about 80%.In 2016—2018，the training of assistant general practitioners was mainly based on junior college education，accounting for 98.99%（685/692） of the total number；among the participants，the fresh graduates accounted for 58.67%（406/692） of the total number.Conclusion At present，the training of assistant GPs starts late and the scale is insufficient.In the next step，we should continue to carry out training for rural order-oriented students（undergraduates） of clinical medicine and local specialized medical students freely.At the same time，specialized training for medical students should be started as soon as possible，and the training scale of assistant GPs should be appropriately expanded.
【Key words】 General practitioners；Post-graduate education；Current situation；Chongqing
Theoretical and Practical Exploration of Multi-level，Classified and Stratified Prevention and Control of COVID-19 in Communities Based on a Seven-color-coded Population Management Model ZHANG Tao1，ZHANG Yimin2，LI Yan1，CHEN Dongdong3，4*，LI Jue5*，ZHU Shanzhu6*
1.Pudong Jinyang Community Health Service Center，Shanghai 200136，China
2.Shanghai Pudong Institute of Health Development，Shanghai 200129，China
3.Xuhui District Huajing Community Health Service Center，Shanghai 200231，China
4.Shanghai Community Health Association，Shanghai 200000，China
5.Clinical Epidemiology and Evidence-based Medicine Institute，Tongji University School of Medicine，Shanghai 200092，China
6.General Practice Department，Zhongshan Hospital，Fudan University，Shanghai 200092，China
*Corresponding authors：CHEN Dongdong，Chief physician；E-mail：firstname.lastname@example.org
LI Jue，Professor，Doctoral supervisor；E-mail：email@example.com
ZHU Shanzhu，Professor，Chief physician，Master supervisor；E-mail：firstname.lastname@example.org
【Abstract】 The "Multi-level，Classified and Stratified Prevention and Control Program of the Coronavirus Disease 2019（COVID-19） in Communities Based on a Seven-color-coded Management Model"（hereinafter referred to as "the Program"） was formulated through the joint efforts of community health experts to strengthen and standardize the prevention and control of COVID-19 on the community level.In the Program，seven levels are defined according to the potential risks of the disease：Level 6（Red） as confirmed cases；Level 5（Orange） as suspected cases；Level 4（Yellow） as close contacts；Level 3（White） as individuals under home-based quarantine；Level 2（Dark Blue） as individuals released from quarantine/under home-based health management；Level 1（Light Blue） as individuals under continuous observation after quarantine；and Level 0（Green） as non-affected individuals.Details including population definition，source of population information，responsible authorities/individuals，community-based prevention and control actions and goals，and community management procedures were described.The effectiveness of the Program implemented by Jinyang Community Health Service Center，Pudong New Area，Shanghai，was reviewed in this study.The purpose was to ensure that while devoting themselves to the sniping battle against the pandemic，primary care professionals understand the population categories under their management and care，know well the population-specific prevention and control measures on the community level，follow through the community grid management and thorough screening processes，defend the communities from further spread of the disease，ensure steady and effective control and prevention，and safeguard the health of community residents fundamentally.
【Key words】 COVID-19；Coronavirus infections；Communicable disease control；Community health services；Multi-level，classified and stratified management；Seven-color management method
Effectiveness Analysis of the Intelligent Family Physician-Optimized Collaborative Model of Fangzhuang Community for COVID-19 Joint Control and Prevention WEI Xuejuan，NIE Huiyao，WU Hao*，GE Caiying，WANG Li，CHEN Ying，GAO Wenjuan
Fangzhuang Community Teaching and Research Office，Capital Medical University/Fangzhuang Community Health Service Center of Fengtai District，Beijing 100053，China
*Corresponding author：WU Hao，Chief physician，Master supervisor；E-mail：email@example.com
【Abstract】 To actively fight against COVID-19，Fangzhuang Community Health Service Center，in collaboration with Fangzhuang Subdistrict Office and community committees，have established 16 family physician teams（including teams working in the community and in the center），taking charge of COVID-19 prevention and control within the working area using a gridded，categorized and hierarchical method with an intelligent family physician-optimized collaborative model （IFOCM）.The specific management measures using the innovatively applied IFOCM in combating the pandemic include：an intelligent call system is used to screen the COVID-19 in all community-living residents via telephone.Based on the population data registered by Fangzhuang Subdistrict Office and community committees for screening COVID-19，and data from China National Notifiable Infectious Diseases Reporting Information System and Fengtai Center for Disease Control and Prevention，community-living residents are divided into general population and key population（including people returning to Beijing from other countries and domestic regions，high-risk people，close contacts，suspected and confirmed cases），giving different management.The general population received various forms of popular science education on COVID-19 prevention and control measures classified as 12 topic modules，and grid management using online and offline physician-nurse care and physician-patient coordination with the help of internet-based and AI technologies（including intelligent call system，intelligent chronic disease management system and mobile intelligent terminal APP） covered in the IFOCM.The key population received three-level management of infectious diseases implemented（by healthcare workers within their working area） and one-on-one offline tracking.Fangzhuang Community Health Service Center applies IFOCM to comprehensively improve the awareness level and prevention and control ability of COVID-19 in residents from multiple perspectives and channels，to help residents prevent and control COVID-19 scientifically.This practice may be used as a reference for other urban communities.
【Key words】 COVID-19；Community health services；Information technology；Artificial intelligence；Joint control and prevention；Beijing
Bibliometric Analysis of the Research Hotspots of Hierarchical Diagnosis and Treatment in China YUAN Chengju1，YU Changyin2*，ZHANG Nian1，CHENG Mingyang1
1.School of Management，Zunyi Medical University，Zunyi 563000，China
2.Affiliated Hospital of Zunyi Medical University，Zunyi 563000，China
*Corresponding author：YU Changyin，Professor，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Hierarchical diagnosis and treatment is an important measure to realize the social division of labor in medical institutions and to solve the problem of "difficulties to access medical services".Comprehending its research hotspots and trends is helpful for the implementation of hierarchical diagnosis and treatment.Objective To identify current research hotspots and trends of hierarchical diagnosis and treatment in China，to provide a reference for sustainable research of this field.Methods 1 162 articles about hierarchical diagnosis and treatment were searched from CNKI database.SATI 3.2 was used to input the publication year，and source journal of the articles，and generated keywords co-occurrence matrix.Netdraw，a program within the Ucinet 6.0 suite，and SPSS 19.0 were applied to draw the co-occurrence network diagram and tree diagram showing hierarchical clustering using the keywords co-occurrence matrix.Results The research on hierarchical diagnosis and treatment in China started in 1993，and the amount of studies showed an increasing trend year by year.Its development can be roughly divided into foundation phase（1993—2008），slow growth phase（2009—2014） and rapid growth phase（2015—）.
The top three journals owning greatest amount of studies are Chinese General Practice（277 articles，23.84%），Chinese Hospital Management（120 articles，10.33%） and Chinese Health Economics（99 articles，8.52%）.The top three high-frequency key words were hierarchical diagnosis and treatment（424 times），two-way referral（249 times），community health services
（164 times）.The two-way referral was at the core of the co-network diagram，and is the most important link for hierarchical diagnosis and treatment.Healthcare-seeking behaviors，counterpart support，integrated medical and nursing care，medical service prices，high quality care and informatization were on the edge of the map，which are the research trends.According to the tree diagram，the high-frequency key words were summarized into five thematic clusters：influencing factors of hierarchical diagnosis and treatment within the regional medical consortium，perception of and satisfaction with first contact services in primary care，integration and optimal allocation of medical resources，health management services delivered mainly by general practitioners，and referrals，healthcare-seeking behaviors and medical costs in patients with chronic diseases.Conclusion Available studies about hierarchical diagnosis and treatment in China are summarized as follows on the basis of analyzing of the research hotspots and trends：promoting the implementation of hierarchical diagnosis and treatment via carrying out first contact services in primary care，and using the platform of regional medical consortium，referral services for hypertension，diabetes and other chronic diseases，and health management services provided mainly by general practitioners.
【Key words】 Hierarchical diagnosis and treatment；Referral and consultation；Bibliometrics；Word frequency analysis；Cluster analysis；Research hotspots
Impact of the Implementation of Contracted Family Doctor Services on Residents' Healthcare-seeking Behaviors：an Empirical Study Based on Propensity Score Matching SUN Huajun1，TIAN Hui2，DU Yue1*
1.School of Public Health，Tianjin Medical University，Tianjin 300070，China
2.School of Economics and Management，Tiangong University，Tianjin 300387，China
*Corresponding author：DU Yue，Lecturer；E-mail：email@example.com
【Abstract】 Background Vigorously promoting the implementation of contracted family doctor services and the construction of the hierarchical medical system are important tasks in deepening the reform of the pharmaceutical and healthcare system，which is conducive to basically realizing the goal of universal health coverage.The implementation of contracted family doctor services is in full swing in primary medical institutions.And it is of great significance to scientifically and accurately evaluate the effectiveness of policies concerning such services.Objective To assess the effect of the implementation of contracted family doctor services on residents' healthcare-seeking behaviors.Methods In January 2019，495 residents were selected from 10 medical institutions in five districts of Tianjin by multistage random sampling，and received a questionnaire survey on their personal basic situation，prevalence of receiving contracted family doctor services，healthcare-seeking behaviors，and utilization of referral services.Propensity score matching was used to assess the impact of receiving contracted family doctor services on healthcare seeking behaviors by comparing such behaviors between contracted residents（treatment group） and those non-contracted（control group）.Results Multivariate Logistic regression results showed that age and diabetes were associated with receiving contracted family doctor services（P<0.05）.Compared with those non-contracted，the probability of seeking healthcare in a hospital in the local district and using referral services in those contracted increased by 8.9%，and 14.5%，respectively （P<0.05）.Moreover，the probability of seeking healthcare in a hospital in the local district increased as much as 12.6% in contracted general populations in comparison with those non-contracted（P<0.05）.However，no significant differences were found in healthcare-seeking behaviors between contracted and non-contracted priority populations （P>0.05）.Conclusion The probability of seeking healthcare in a hospital in the district is higher in contracted residents compared with those non-contracted，which may be related to increased utilization of referral services in the implementation of contracted family doctor services.The general population is more likely to change their behaviors after receiving contracted family doctor services rather than the priority population.
【Key words】 Contracted family doctor services；Residents' healthcare seeking behaviors；Propensity score matching
Construction of the Health Management Path of Blood Vessel and Its Application in General Practice ZHU Wenhua，CHEN Liying，QIU Lifeng，LU Meijia，FANG Lizheng*
Department of General Practice，Sir Run Run Shaw Hospital，Zhejiang University School of Medicine/Sir Run Run Shaw Institute of Clinical Medicine，Zhejiang University，Hangzhou 310016，China
*Corresponding author：FANG Lizheng，Professor，Chief physician，Master supervisor；E-mail：firstname.lastname@example.org
【Abstract】 In order to further standardize the health management of blood vessel and give full play to the advantages of general practice in health promotion，Sir Run Run Shaw Hospital of Zhejiang University School of Medicine formulated a integrated health service plan of blood vessel according to the concept and methods of general practice.To provide a programmatic and comprehensive management model for patients with vascular health problems，a health management path of blood vessel was constructed.A closed-loop management model of medical treatment and health promotion in general practice was established with programmatic intervention methods to ensure that patients with vascular problems could obtain the best care and reduce the occurrence of vascular disease complications.It proved that constructing and implementing a vascular health management path in general practice could promote effective management of vascular problems and improve the quality of medical services.This paper mainly introduced the team organization structure and implementation steps of the vascular health management path mainly，including the screening of objects and establishment of files，hierarchical evaluation of patients and formulation of medical plans，and intervention management and corrections based on feedback.At the same time，combined with practical experience，the conditions and key points of the construction of the vascular health management path was analyzed with a view to providing a reference for the development of the vascular health management models in other regions.
【Key words】 Vessel health；Health management；Management path；General practice
Problems in the Implementation of Zero-profit Drug Policy in Primary Healthcare Institutions in Beijing LU Xueqiu1*，XU Yanling2
1.University of Chinese Academy of Social Sciences，Beijing 102488，China
2.Tiancun Community Health Center，Beijing 100080，China
*Corresponding author：LU Xueqiu，Lecturer；E-mail：email@example.com
【Abstract】 Background To China's healthcare system reform，the essential problem needs to be solved is "difficult and expensive to access healthcare services"，and the key link is healthcare costs control and medical quality improvement.Beijing had a gradual yearly increase in healthcare expenditure from 2010 to 2015，and a higher annual growth rate of outpatient visits in primary hospitals rather than tertiary hospitals during 2013—2016.By analyzing the healthcare costs in primary hospitals in Beijing，the essential problems during the healthcare system reform may be identified，which may help to control healthcare costs.Objective To identify the problems during the implementation of zero-profit drug policy in Tiancun Community Health Center，Beijing，putting forward suggestions for the reform in primary hospitals.Methods The statistical data between 2013 and 2017 of Tiancun Community Health Center，Haidian District，Beijing were obtained from HIS of the center during July，2018，including the number of outpatient visits，percentage of reimbursed outpatient drugs，average outpatient visit cost，earnings from medical and pharmaceutical services（earnings from delivering medical services，registration/diagnosis / treatment/management of medical matters，examinations/tests，health materials/others，and pharmaceutical services），number of outpatient examinations/tests（general radiological examinations，B-mode ultrasound examinations，whole blood cell tests），and corresponding earnings.The aforementioned parameters in 2013 were compared with those in 2014—2017 to find out the amount and rate of changes.Results From 2013 to 2017，the number of outpatient visits increased year by year，which increased by 105.90% in 2017 compared with 2013.The percentage of reimbursed outpatient drugs showed a trend of fluctuation，and increased by 0.40% in 2017 compared with 2013.With regard to average outpatient visit cost，a gradual yearly increase was seen between 2013 and 2016 but then a slightly decrease was seen，and it in 2017 increased by 29.89% compared with 2013.The earnings from medical services showed a trend of fluctuation during the period，and it had an increase of 149.06% in 2017 compared with 2013.The earnings from delivering registration/diagnosis/treatment/management of medical matters，examinations/tests，health materials/others，and pharmaceutical services showed an increase trend，and obtained growth rates of 1 695.32%，75.32%，957.88%，and 167.45%，respectively，in 2017 compared with 2013.The number of general radiological examinations showed a gradual yearly increase between 2013 and 2015 and then a gradual yearly decrease，so did the earnings from delivering such services.And compared with 2013，they showed an increase of 206.45%，and 10.24%，respectively，in 2017.The number of B-mode ultrasound examinations showed a gradual yearly increase between 2013 and 2016 and then a slightly decrease，and the earnings from delivering such services showed a gradual yearly increase between 2013 and 2017.Compared with 2013，they showed an increase of 74.47%，and 208.50% respectively，in 2017.The number of whole blood cell tests showed a gradual yearly increase，and the earnings from delivering such services showed a trend of fluctuation between 2013 and 2017.Compared with 2013，they showed an increase of 87.67%，and 237.69%，respectively，in 2017.Conclusion During 2013 to 2017 in Beijing，the earnings from medical services and costs of examinations/tests and others had a significant increase，among which earnings from registration/diagnosis/treatment/management of medical matters had the largest increase，followed by earnings from health materials/others，but pharmaceutical costs had a stable increase，indicating that the effectiveness of implementing zero-profit drug policy is remarkable.In view of the rapid increase in the amount of consumed health materials，a supervision and management system for health materials consuming is suggested to be established.
【Key words】 Economics，pharmaceutical；Primary healthcare institutions；Zero-profit drug policy；Beijing；Rational administration of drug；Fees，pharmaceutical
Development Prediction and Operation Research of "2+X"-type Family Doctor Team in Xinjiang's Urban Community Health Organizations MA Guofang1，WANG Xiaona1，WANG Xin2*
1.School of Public Health，Xinjiang Medical University，Urumqi 830011，China
2.School of Humanities and Social Sciences，China Medical University，Shenyang 110122，China
*Corresponding author：WANG Xin，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Background Family doctor team is a main provider of contracted family doctor services. And how to scientifically establish a family doctor team using available human resources is the key to further promote such services. Objective To predict the development and operation of "2+X"-type family doctor team（consisting mainly of family doctors and nurses in combination with re-employed specialists retired from the secondary hospital，temporarily employed specialists，pharmacists，health managers and other healthcare workers） in urban community health institutions in Xijiang，to provide a scientific basis for accelerating the development of contracted family doctor services. Methods This study was conducted in 2019. The number of urban population，practicing （assistant） physicians and registered nurses working at urban community health institutions in Xinjiang of from 2011 to 2017 were obtained from 7 volumes of Xinjiang Statistical Yearbook（2012—2018）. The urban population of Xinjiang in 2018 was derived from the 2018 Xinjiang Uygur Autonomous Region Statistical Bulletin on National Economic And Social Development.Based on the above-mentioned data from 2011 to 2017，a Grey Prediction Model GM（1，1） was developed and adopted to estimate the urban population from 2019 to 2025 and the number of healthcare workers in family doctor teams from 2018 to 2025 in Xinjiang.And the number of "2+X"-type family doctor teams in urban community health institutions from 2011 to 2025 was also calculated.And the number of people and coverage of services delivered by "2+X"-type family doctor teams were estimated based on presumed ratios of 2 000，and 3 000 people to one family doctor，respectively. Results It is predicted that during 2019—2025，the urban population of Xinjiang would gradually increase from 13.173 9 million in 2019 to 17.064 2 million in 2025. The number of practicing（assistant） physicians would increase year by year，from 3 083 in 2019 to 3 268 in 2025. The number of registered nurses would also increase year by year，from 3 256 in 2019 to 3 940 in 2025.Theoretically，the number of "2+X"-type family doctor teams（presumed to be developed based on the lowest eligibility criteria） wound increase in 2018—2025，and the teams established by urban community health organizations would number 3 268 in 2025.From 2011 to 2016，the number of registered nurses was lower than that of practicing（assistant） physicians. Until 2017，the ratio of doctors to nurses improved，which reached 1∶1.02，and was rising，with a slow speed.The ratio was predicted to reach 1∶1.08 in 2020 and 1∶1.21 in 2025. According to the prediction results of GM（1，1），the urban population of Xinjiang would be on the rise from 2011 to 2025. The coverage of services delivered by "2+X"-type family doctor teams wound be over 70%，reaching 82% up most，in 2018，estimated based on a presumed ratio of 3 000 people to one family doctor，and wound be 48% estimated based on a presumed ratio of 2 000 people to one family doctor.Theoretically，by 2025，the coverage would be 38%. Conclusion In Xinjiang，the predicted number of "2+X"-type family doctor teams wound increase gradually form 2018 to 2025，but there is still a big gap between the coverage of services provided by them estimated based on a presumed ratio of 2 000 urban people to one family doctor and universal coverage. To meet the great demand of community-based healthcare services，and realize the goals of every family has a family doctor，and everyone enjoys essential healthcare services，the training for healthcare talents in family doctor teams should be strengthened，and high-quality family doctor teams should be established.
【Key words】 General practice；Community health centers；Community health workers；Forecasting；Xinjiang
Impact of Arterial Stiffness Level on Cognitive Function among Diabetic Patients LI Jing1，2，YUAN Jinhuan1，WANG Meng1，ZHANG Yajing3，CHEN Shuohua2，WU Shouling2，WU Yuntao2，GAO Jingsheng2*，GAO Bixia4，5，WANG Jinwei4，5
1.Graduate School，North China University of Science and Technology，Tangshan 063000，China
2.Department of Cardiovascular Medicine，KaiLuan General Hospital，Tangshan 063000，China
3.Department of Cardiovascular Medicine，Xingtai Third Hospital，Xingtai 054000，China
4.Department of Nephrology，Peking University First Hospital，Beijing 100034，China
5.Peking University Institute of Nephrology，Beijing 100034，China
*Corresponding author：GAO Jingsheng，Chief physician，Professor；E-mail：email@example.com
【Abstract】 Background Previous studies have shown that hypertension，dyslipidemia and arterial stiffness are risk factors for cognitive dysfunction，while diabetes is an aggregation of the aforementioned three and other risk factors.As the incidence of diabetes-associated cognitive impairment is increasing annually，it is necessary to determine whether arterial stiffness has an effect on cognitive function in diabetic patients.Objective To explore the association between arterial stiffness and cognitive function among diabetic patients.Methods We enrolled 3 610 employed and retired workers with diabetes of Kailuan（Group） Limited Liability Corporation who underwent annual physical examination in KaiLuan General Hospital and its affiliated 11 hospitals in 2016，and divided them into group 1（the first tertile：baPWV<16.11 m/s），group 2（the second tertile：baPWV 16.11-19.30 m/s），and group 3（the third tertile：baPWV>19.30 m/s） by the baPWV level.We collected their baseline data，Mini-Mental State Examination（MMSE） score and detection rate of cognitive impairment.We performed multivariate Logistic regression analysis to explore the influence of baPWV on cognitive function in diabetes population.Results There were significant differences in mean age，systolic blood pressure，diastolic blood pressure，mean arterial pressure，baPWV，glycosylated hemoglobin，and eGFR，prevalence of smoking，secondary and post-secondary education level，history of hypertension，treatment with antihypertensive drugs and hypoglycemic drugs among the three groups（P<0.05）.The mean MMSE score，and the prevalence of cognitive impairment in all the participants were （27.01±3.29），11.77%（425
/3 610），respectively.The mean MMSE score differed significantly in baPWV tertile groups（F=12.40，P<0.001）.Pairwise comparisons showed that group 1 had lower mean MMSE score than other two groups（P<0.05）．The prevalence of cognitive impairment also differed significantly in baPWV tertile groups（χ2=17.89，P<0.001）.In particular，group 1 had lower prevalence of cognitive impairment compared with other two groups（P<0.016 7）.Multivariate Logistic regression analysis showed that after adjusting for age，sex，mean arterial pressure，body mass index，low- and high-density lipoprotein，triglyceride，glycosylated hemoglobin，eGFR，alcohol consumption，smoking and physical exercise，the second tertile〔OR=1.49，95%CI（1.01，2.19）〕and third tertile〔OR=1.52，95%CI（1.02，2.28）〕 of baPWV（higher baPWV） were associated with increased risk of cognitive impairment.Conclusion The degree of arterial stiffness（baPWV≥16.11 m/s） is an independent risk factor for cognitive impairment in diabetic patients.
【Key words】 Arteriosclerosis；Diabetes mellitus；Cognition disorders；Brachial ankle pulse wave velocity
Prevalence of Thyroid Nodules in Health Checkups and Its Relationship with Metabolic Diseases ZOU Bing1，WANG Xin2，SUN Li1，ZHOU Yan1，CHEN Zongtao1*
1.Health Management Center，the First Hospital Affiliated to Army Medical University，Chongqing 400038，China
2.Center for Epidemiology and Biostatistics，the First Hospital Affiliated to Army Medical University，Chongqing 400038，China
*Corresponding author：CHEN Zongtao，Associate professor；E-mail：firstname.lastname@example.org
【Abstract】 Background The incidence of thyroid nodules is insidious，and most patients are asymptomatic in the early stage.With the popularization of high-resolution ultrasound，the early identification and intervention of high-risk population of thyroid nodules is feasible，which is crucial for the prevention and treatment of thyroid diseases.Objective To investigate the prevalence of thyroid nodules in health checkups and analyze its relationship with metabolic diseases.Methods The 2 309 subjects who participated in the health checkups in the Health Management Center of the First Hospital Affiliated to Army Medical University from January in 2018 to January in 2019 were included in the study．High-resolution thyroid ultrasonography was used to identify the thyroid nodules．The metabolic diseases included in the analysis were overweight/obesity，central obesity，impaired glucose regulation/diabetes，hypertension，dyslipidemia，metabolic syndrome，hyperuricemia，and fatty liver.The multivariate Logistic regression was used to analyze the relationship between metabolic diseases and incidence of thyroid nodules.Results The prevalence of thyroid nodules was 37.38%（863/2 309），and females had significantly higher prevalence of thyroid nodules than males〔44.91%（362/806） vs 33.33%（501/1 503），P<0.01〕.The prevalence of thyroid nodules increased with age（P<0.01）.Multivariable Logistic regression showed that after controlling for gender and age，fatty liver was a protective factor for thyroid nodules（P<0.05）；after controlling for age，metabolic diseases had no effect on the incidence of thyroid nodules both in females and males（P<0.05）.Conclusion The prevalence of thyroid nodules is relatively higher in the southwestern region of China，and females and older people are holding the high risk for developing thyroid nodules.The screening and management should be further strengthened in females and elderly population.Fatty liver is a protective factor for the disease of thyroid nodules.No other metabolic diseases have been found to affect the disease of thyroid nodules.
【Key words】 Physical checkup population；Thyroid nodule；Prevalence；Metabolic diseases
Osteoporotic Fracture Risk Prediction Value of Fracture Risk Assessment Tool（FRAX?） in Middle-aged and Elderly People in Shanghai ZHAO Xiao1，2，ZHANG Zhenlin2*
1.Department of Endocrinology，Shanghai Changning Tianshan Traditional Chinese Medicine Hospital，Shanghai 200051，China
2.Department of Osteoporosis and Osteopathy/Bone Metabolism and Genetics Laboratory，Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University，Shanghai 200233，China
*Corresponding author：ZHANG Zhenlin，Chief physician，Professor，Doctoral supervisor；E-mail：email@example.com
【Abstract】 Background Osteoporotic fractures are one of the main causes of disability and death in elderly patient，and early prediction and timely intervention are important links of prevention and treatment.The Fracture Risk Assessment Tool（FRAX?） recommended by WHO is used to assess the 10-year major osteoporotic fracture probability（MOFP） and hip osteoporotic fracture probability（HOFP）.The fracture-related risk factors have been identified based on a number of independent large-sample prospective population studies and meta-analysis of large-sample studies in Europe，North America，Asia，Australia，etc，so they are representative.However，as large-scale epidemiological studies on the incidence of osteoporotic fractures and their influencing factors in Shanghai are ongoing，whether FRAX? predictions can accurately assess fracture risk in middle-aged and elderly people in Shanghai remains to be confirmed by further research.Objective To predict the risk of osteoporotic fractures in middle-aged and elderly people in Shanghai using the Chinese version of FRAX?.Methods Participants were 1 520 middle-aged and elderly Chinese people〔mean age was（65.5±9.6） years，range between 45 and 90〕 recruited from Department of Osteoporosis and Osteopathy，Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from January to October 2013.The Chinese version of FRAX? was used to calculate the 10-year MOFP and HOFP.The diagnostic criterion for high-risk of osteoporosis fracture was defined as 10-year MOFP≥20% or 10-year HOFP≥3%.Results Compared with men，women had higher median 10-year MOFP〔3.60%（2.80%） vs 2.10%（1.10%）〕，higher median 10-year HOFP〔0.80%（1.50%） vs 0.60%（0.70%）〕，and higher percentage of cases at high-risk for 10-year HOFP〔11.28%（87/771） vs 2.94%（22/749）〕（P<0.05）.But the percentage of cases at high-risk for 10-year MOFP in women was similar to that of men〔0.13%（1/771） vs 0.13%（1/749）〕（P>0.05）.Age-specific analysis showed that in men，the 10-year MOFP in age group of 50-59 was lower than that of age groups of 60-69，70-79 and 80-90（P<0.05）.The 10-year HOFP in age group of 50-59 was also lower than that of other three older age groups（P<0.05）.The 10-year HOFP in age group of 60-69 was lower than that of other two older age groups（P<0.05）.In women，either the 10-year MOFP or HOFP increased successively in age groups of 45-49，50-59，60-69，70-79 and 80-90（P<0.05）.BMI-specific analysis demonstrated that in men，the 10-year MOFP was lower in those with BMI≥28.0 kg/m2 compared with those with BMI<18.5，18.5-23.9 or 24.0-27.9 kg/m2.The 10-year HOPF decreased successively in those with BMI<18.5，18.5-23.9，24.0-27.9 and ≥28.0 kg/m2（P<0.05）.In women，the 10-year MOFP was lower in those with BMI≥28.0 kg/m2 compared with those with BMI<18.5 or 18.5-23.9 kg/m2（P<0.05）.Those with BMI 24.0-27.9 kg/m2 had lower 10-year MOFP than those with BMI <18.5 kg/m2（P<0.05）.Those with BMI 24.0-27.9 had lower 10-year HOFP than those with BMI<18.5 or 18.5-23.9 kg/m2（P<0.05），as did those with BMI≥28.0 kg/m2（P<0.05）.Those with BMI 18.5-23.9 kg/m2 showed lower 10-year HOFP than those with BMI<18.5 kg/m2（P<0.05）.Female was associated with higher age- and BMI-specific 10-year MOFP and 10-year HOFP（P<0.05）.Conclusion High risk of osteoporotic fractures was observed in older postmenopausal women who had lower BMI.So special attention needs to be paid to this group.The Chinese version of FRAX? has clear value to predict osteoporotic fractures in middle-aged and old people in Shanghai.However，there may be a possibility that the detection rate of high-risk people is low and the risk is underestimated.
【Key words】 Osteoporotic fractures；Hip fractures；Fracture Risk Assessment Tool；Middle aged and aged；Shanghai
Relationship between Non-high-density Lipoprotein Cholesterol Goal Attainment and Prognosis in Patients with Coronary Heart Disease after Percutaneous Coronary Intervention LIU Yuting1，2，MA Huan2，3，4，YIN Han1，2，YU Xueju1，2，LIU Guihao3，5，WANG Ping2，3，4，GUO Lan2，3，4，GENG Qingshan2，3，4*
1.School of Medicine，South China University of Technology，Guangzhou 510080，China
2.Department of Cardiovascular Medicine，Guangdong Provincial Hospital Affiliated to South China University of Technology，Guangzhou 510080，China
3.Guangdong Academy of Medical Sciences，Guangzhou 510080，China
4.Guangdong Cardiovascular Institute，Guangzhou 510080，China
5.Guangdong Provincial Hospital Affiliated to South China University of Technology，Guangzhou 510080，China
*Corresponding author：GENG Qingshan，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Low-density lipoprotein cholesterol（LDL-C） is one of the important risk factors for coronary heart disease（CHD）.Most international guidelines consistently recommend LDL-C as the main treatment target for patients with hypercholesterolemia.However，whether LDL-C and non-high-density lipoprotein cholesterol（non-HDL-C）should be used simultaneously as indicators of secondary prevention of cardiovascular diseases is still controversial at home and abroad.Objective To investigate the relationship between goal attainment of non-HDL-C and recurrence of adverse cardiovascular events in patients with CHD after percutaneous coronary intervention（PCI），and to compare the predictive value of the goal attainment of non-HDL-C and LDL-C in the long-term prognosis of patients with CHD.Methods A total of 665 patients who underwent PCI for CHD from 2002 to 2008 were followed up for three years in April 2019.The patients were divided into groups according to the goal attainment of blood lipid indicators（non-HDL-C，LDL-C） after six months of secondary prevention.Kaplan-Meier survival curve，Log-Rank test and Cox proportional hazards regression model were used to analyze the relationship between goal attainment of blood lipid indicators and major adverse cardiovascular events（MACE）.Results In the real world，a relatively small number of CHD patients could meet the standard of blood lipid indicators after six months of secondary prevention after PCI.25.71%（171/665） and 27.07%（180/665） of patients met the criteria recommended in the guidelines for LDL-C and non-HDL-C，and only 17.29%（115/665） of patients met the criteria of both LDL-C and non-HDL-C at the same time.The incidence of MACE was 32.7%（56/171） in LDL-C standard group and 35.8%（177/494） in LDL-C non-standard group.The incidence of MACE was 25.6%（46/180） in non-HDL-C standard group and 38.6%（187/485） in non-HDL-C non-standard group.There was no significant difference in risk curve between the LDL-C standard group and the non-standard group（P=0.545）；the cumulative incidence rate of MACE in the non-HDL-C standard group was significantly lower than that in the non-HDL-C non-standard group（P=0.010）；there was no significant difference between the only non-HDL-C standard group and only LDL-C standard group（P=0.127）.After adjusting the traditional risk factors such as age，gender，BMI，smoking history，coronary heart disease type and comorbidity by Cox proportional risk regression analysis，it was found that compared with LDL-C standard group，HR of LDL-C non-standard group was 1.16〔95%CI（0.83，1.61），P = 0.386〕；compared with non-HDL-C standard group，non-HDL-C non-standard group had higher risk of mace in the long term，HR was 1.61〔95%CI（1.12，2.30），P=0.009〕.Conclusion Non-HDL-C goal attainment is significantly associated with long-term MACE of CHD patients after PCI，while LDL-C has nothing to do with this.Therefore，non-HDL-C may be a more suitable monitoring indicator for dyslipidemia therapy in CHD patients after PCI than LDL-C.
【Key words】 Coronary disease；Angioplasty，balloon，coronary；Major adverse cardiovascular event；Non-high-density lipoprotein cholesterol；Low-density lipoprotein cholesterol
Heart Rate and β-blocker Use in Young and Middle-aged Hypertensive Patients in Shenzhen LI Xiaoling，MIN Min，QIU Yanxia，Ren Li，XU Chao，JIA Nan*
Community Health Service Management Center，the Eighth Affiliated Hospital，Sun Yat-sen University，Shenzhen 518033，China
*Corresponding author：JIA Nan，Chief physician，Master supervisor；E-mail：email@example.com
【Abstract】 Background Shenzhen，as a first-line city with rapid development，the fast-paced work and fierce competition environment increase a lot of pressure on young and middle-aged people.Long-term pressure will accelerate the heart rate of individuals leading to the rise of blood pressure.It is of great significance to study the heart rate of young and middle-aged hypertensive patients for the effective management of hypertension in Shenzhen.Objective To understand the current status of heart rate and the use of β-blockers in young and middle-aged hypertensive patients in Shenzhen，in order to provide evidence for the prevention and treatment of hypertension in young and middle-aged people.Methods A cross-sectional survey was conducted using a self-designed questionnaire from March to June in 2017.Using convenience sampling method，32 hospitals/community health service centers were selected in 9 administrative districts of Shenzhen and a total of 2 152 hypertensive patients were enrolled.Among them，1 639 young and middle-aged hypertensive patients were included in this study.The survey included gender，age，past medical history，blood pressure，heart rate and medication situation of patients.Results The mean heart rate of 1 639 young and middle-aged hypertensive patients was（81.0±11.0） beats/min，and 610（37.22%） of them with blood pressure up to standard and 1 029（62.78%） of them with blood pressure not up to standard.There were significant differences in the blood pressure，heart rate，coronary heart disease，hyperlipidemia and use of β-blockers between the blood pressure up to standard group and blood pressure not up to standard group（P<0.05）.Pearson correlation analysis showed that there was a linear positive correlation between heart rate and systolic blood pressure（r=0.411，P<0.001） and diastolic blood pressure（r=0.455，P<0.001）.Among patients with blood pressure not up to standard，compared with those with heart rate<80 beats/min，the patients with heart rate≥80 beats/min had higher prevalence of coronary heart disease，diabetes and hyperlipidemia（P<0.05）；compared with those who used β-blockers，the patients without β-blocker use had faster heart rate，higher systolic pressure and diastolic pressure（P<0.05）.Among young and middle-aged hypertensive patients who used β–blockers in the blood pressure not up to standard group，compared with those whose heart rate was less than 80 beats/min，patients with heart beats≥80 beats/min had a higher incidence of coronary heart disease，diabetes and hyperlipidemia（P<0.05）.Conclusion The young and middle-aged hypertensive patients in Shenzhen have a fast heart rate，and those with faster heart rate are more likely to have other chronic diseases at the same time.In order to reduce the incidence of complications and mortality，doctors in community health service centers should enhance their awareness of heart rate management，and related diagnosis and treatment training of heart rate treatment indications，its control range，drug selection and individualized treatment should also be strengthened.
【Key words】 Hypertension；Blood pressure；Heart rate；Young and middle-aged patients
The Relationship between Serum LRG1 Level and Urinary Albumin-to-creatinine Ratio in Patients with Type 2 Diabetes ZHANG Jun1，YU Jing2*，HAN Yanqiu2，REN Huijuan2，SU Xiaotian2
1.Department of Radiotherapy，the Affiliated Hospital of Inner Mongolia Medical University，Hohhot 010050，China
2.Department of Hematology，the Affiliated Hospital of Inner Mongolia Medical University，Hohhot 010050，China
*Corresponding author：YU Jing；E-mail：firstname.lastname@example.org
【Abstract】 Background The threat of diabetic kidney disease to human health has always been a concern of medical workers.However，the clinical diagnosis of diabetic kidney disease is still relatively limited currently.Leucine-rich-alpha-2-glycoprotein-1（LRG1） may become an accurate，simple and less risky biomarker for early detection of diabetic kidney disease，but there are few relevant research in China.Objective To investigate the relationship between serum LRG1 level and urinary albumin-to-creatinine ratio（ACR） in patients with type 2 diabetes，in order to explore the role of LRG1 in the pathogenesis of diabetic kidney disease.Methods A total of 290 patients with type 2 diabetes were enrolled in this study and divided into three groups according to the different ACR，normal albuminuria group（group D1），microalbuminuria group（group D2），and macroalbuminuria group（group D3）.And 128 healthy volunteers matched the experimental group for the level of age and gender were selected as the control group（group N）.The clinical data of the research subjects were collected，and serum LRG1 level，inflammatory markers，and fibrosis markers were detected for statistical analysis.Results The difference of LRG1 levels between groups was statistically significant（P<0.001）.The serum LRG1 level in group D3 was higher than that in group D2，group D1 and group N；the serum LRG1 level in group D2 was higher than that in group D1 and group N；the serum LRG1 level in group D1 was higher than that in group N（P<0.05）.Correlation analysis showed that the serum LRG1 level was positively correlated with FPG（r=0.578），HOMA-IR（r=0.632），CRP（r=0.834），LRG1（r=0.930），TGF-β1（r=0.739），FN（r=0.920），and VEGF（r=0.691），while it was negatively correlated with HDL-C（r=-0.328）（P<0.01）.Conclusion The serum LRG1 level in patients with type 2 diabetes may become a new biological marker for early detection of diabetic kidney disease，and it is related to the inflammation，fibrosis and abnormal angiogenesis of kidney injury caused by type 2 diabetes.
【Key words】 Diabetes mellitus，type 2 ；Diabetic nephropathies；Leucine-rich-alpha-2-glycoprotein-1；Urinary albumin excretion rate；Urinary albumin-to-creatinine ratio
The Overall Support of Medical Social Work Intervention in Chronic Disease Self-management WANG Suming*，WANG Zhizhong，YAO Shangman，QI Jian
School of Humanities and Social Sciences，Shanxi Medical University，Taiyuan 030001，China
*Corresponding author：WANG Suming，Lecturer；E-mail：email@example.com
【Abstract】 Chronic disease self-management means that chronic disease is controlled by self-management.Chronic disease self-management plays a positive role in reducing medical costs，enhancing patients autonomy and promoting their healthy lifestyle.The professional support for chronic disease self-management is mainly focused on the narrow sense of patient empowerment and education and training，and lack of attention to the patients social，psychological，economic and other aspects of the overall support.Medical social work plays an important role in the psychological and social support of patients with chronic diseases，and it can provide holistic care and support for the self-management of patients with chronic diseases.Medical social work can provide more comprehensive support by helping patients realize the link between economy and resources，enhancing patients' self-care knowledge and skills，alleviating psychosocial pressure，and promoting the healthy lifestyle change of patients.According to the present situation of chronic disease self-management in our country，it is urgent to pay attention to the whole human care and support for chronic disease patients，and to promote the participation of medical social work.This paper studies the role and strategy of medical social workers in providing whole person care and overall support for self-management of chronic diseases，hoping to promote the development of medical social work in self-management support of chronic diseases through research and provide better service quality for patients.
【Key words】 Chronic disease；Self-management；Social support；Medical social work
Effects of Hospital-Community-Family Model on Weight Management of Obese Children and
Adolescents LIU Fang1，LI Xin1*，YE Minghao1，ZHOU Lulu1，MA Mengyao1，ZHANG Qiao1，YAO Rong1，ZANG Bei1，HONG Li2，LIU Yunman2，YU Xiaodan3
1.Weifang Community Health Service Center，Pudong New Area，Shanghai 200122，China
2.Nutrition Division，Shanghai Children's Medical Center，Shanghai Jiao Tong University School of Medicine，Shanghai 200127，China
3.Behavioral Development Division，Shanghai Children's Medical Center，Shanghai Jiao Tong University School of Medicine，Shanghai 200127，China
*Corresponding author：LI Xin，Associate chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Compared with that in 1985，the obesity rate of school children over seven years old in China increased from 0.5% to 7.3% in 2014.Currently，there is no specialized and professional continuous weight management of obese children and adolescents.Clinical interventions from hospitals would be provided only when obesity causes diseases，which increases the psychological burden of the individual and the economic burden of the family and society.There is an urgent need for the management of obesity in children and adolescents.Objective To explore the effects of hospital-community-family model on weight management of obese children and adolescents.Methods Obesity clinic was set up in Weifang Community Health Service Center in September 2017.BMI was used to screen children over six years old for obesity.Selected obese children and adolescents were management according to the hospital-community-family model，and the differences of height，body weight，abdominal circumference，BMI and body fat percentage were evaluated after six months of management.Results There were significant differences in the height of 65 children and adolescents increased，body weight，waist circumference，BMI and body fat rate decreased after intervention（P<0.05）.Conclusion Hospital-community-family model has a significant effect on the weight management of obese children and adolescents so as to optimize the medical treatment process and enable the regional obese children and adolescents to have professional and continuous weight management.
【Key words】 Obesity；Weight management；Child；Adolescents；Hospital-community-family model ；Shanghai
Application of Health Coaching in Self-management of Hypertensive Patients MA Lin1，WANG Fuli2*，LI Yachai1，BI Lingli3
1.Cardiovascular Department，the First Affiliated Hospital of Xinxiang Medical University，Xinxiang 453100，China
2.Clinical Training Center，the First Affiliated Hospital of Xinxiang Medical University，Xinxiang 453100，China
3.Department of Orthopedics，the First Affiliated Hospital of Xinxiang Medical University，Xinxiang 453100，China
*Corresponding author：WANG Fuli，Chief superintendent nurse，Master supervisor；E-mail：email@example.com
【Abstract】 Background Hypertensive patients' self-management is an important method to delay disease progression and reduce the risk factors of complications.However，in China，such patients have unsatisfactory self-management level and lack of continuous efforts on changing unhealthy behaviors.To improve their self-management level，health coaching，a type of technique focusing on providing self-management support，may contribute greatly.Objective To evaluate the impact of health coaching on the self-management of patients with hypertension.Methods 106 hypertensive inpatients were recruited from a grade A tertiary hospital in Xinxiang City from January to April 2018，and were equally randomized into the experimental group and control group，receiving health coaching-based interventions，routine hypertension-related health education，respectively.The primary endpoints were systolic blood pressure（SBP），diastolic blood pressure（DBP），blood pressure control rate，and self-management score〔assessed by LIU Ning's Self-management Scale （SMS）〕，and secondary endpoints were body weight，BMI，and self-efficacy score 〔assessed by Lorig's Self-efficacy for Managing Chronic Disease 6-item Scale（SMCDS）〕 at 3 months after interventions.Results A total of 104 cases completed the results evaluation，including 53 in the experimental group and 51 in the control group.Mean SBP，DBP，blood pressure control rate，self-management level，SMCDS score，body weight and BMI were similar in both groups at baseline（P>0.05）.After intervention，mean SBP，DBP，blood pressure control rate，and SMCDS score improved significantly in both groups（P<0.05）.Moreover，mean scale and subscales scores of SMS improved significantly in the experimental group（P<0.05），and also in the control group（P<0.05） except the mean subscale score of life habits.The experimental group showed lower mean post-intervention SBP，DBP and body weight and higher mean blood pressure control rate，scale and subscales scores of SMS，and SMCDS score compared with the control group（P<0.05）.Conclusion Health coaching may improve the self-management level，effectively reduce SBP and DBP，and improve blood pressure control rate.
【Key words】 Hypertension；Health coaching；Health promotion；Health self-management