Hypertension remains a major contributor to the global disease burden and mortality, representing a critical public health challenge. While the cumulative lipid accumulation product (LAP), a marker of abdominal and visceral fat deposition, has shown cross-sectional associations with hypertension, existing studies inadequately address the impact of long-term cumulative LAP exposure on hypertension risk. Furthermore, causal relationships between cumulative LAP and incident hypertension remain underexplored.
To evaluate the association between cumulative LAP and hypertension risk and assess its predictive capacity for incident hypertension.
Data were derived from the Guizhou Natural Population Cohort Study database. Participants were enrolled from November 20, 2010, to December 19, 2012, and followed up from April 2016 to October 2020. A total of 3 548 subjects were ultimately included in the analysis. Participants were divided into four quartiles based on cumulative LAP (Q1-Q4 groups) : Q1 (cumulative LAP ≤14.54, n=887), Q2 (14.54<cumulative LAP≤24.35, n=887), Q3 (24.35<cumulative LAP≤39.21, n=887), and Q4 (cumulative LAP >39.21, n=887). Subjects were further categorized into non-hypertension group (n=2 696) and hypertension group (n=852) based on the development of new-onset hypertension. The relationship between cumulative LAP and hypertension was evaluated using the Cox proportional hazards regression model. The dose-response relationship between cumulative LAP and hypertension risk was assessed using restricted cubic splines. Time-dependent receiver operating characteristic (ROC) curves were constructed to evaluate the predictive ability of cumulative LAP for hypertension. Participants with follow-up duration <3 years and those with pre-hypertension were excluded.
Among the 3 548 adults included, 1 607 (45.3%) were men and 1 941 (54.7%) were women, with a mean age of (42.5±14.1) years. During the follow-up period, 852 (11.2%) subjects were newly diagnosed with hypertension. Significant differences were observed between the non-hypertension and hypertension groups in terms of gender, age, education level, family history of hypertension, excessive intake of oil, excessive intake of salt, insufficient intake of fresh fruits, proportion of inadequate sleep, BMI, diastolic blood pressure, fasting plasma glucose (FPG), and cumulative LAP (P<0.05). The results of the Cox proportional hazards regression model showed that, compared with the Q1 group, the risk of hypertension increased progressively in the Q2 group (aHR=1.330, 95%CI=1.053-1.681), Q3 group (aHR=1.706, 95%CI=1.364-2.134), and Q4 group (aHR=2.339, 95%CI=1.869-2.928) after adjusting for potential confounders (P<0.05). The restricted cubic spline analysis revealed a non-linear dose-response relationship between cumulative LAP and hypertension risk (Pnon-linearity<0.01), with the risk of new-onset hypertension increasing with cumulative LAP but stabilizing after cumulative LAP >65. The time-dependent ROC curves for predicting hypertension incidence showed that the area under the ROC curve (AUC) for the overall population was 0.617, 0.590, 0.603, and 0.634 for continuous average exposure of 6, 7, 8, and 9 years, respectively. The AUC for men was 0.600, 0.561, 0.571, and 0.558, and for women, it was 0.638, 0.629, 0.647, and 0.711. For urban populations, the AUC was 0.596, 0.565, 0.602, and 0.621, while for rural populations, it was 0.629, 0.592, 0.594, and 0.635.
Cumulative LAP is an independent risk factor for the onset of hypertension, but it is not an ideal indicator for predicting the onset of hypertension, and its predictive value for the onset of hypertension is relatively limited.
The triglyceride-glucose-BMI (TyG-BMI) index is a novel indicator reflecting insulin resistance and has been proven to be associated with hypertension. However, there is a lack of research on the relationship between the TyG-BMI index and nocturnal ambulatory blood pressure parameters as well as nocturnal hypertension.
To explore the relationship between the TyG-BMI index and nocturnal ambulatory blood pressure parameters as well as nocturnal hypertension.
A total of 396 patients with essential hypertension who underwent ambulatory blood pressure monitoring (ABPM) at the Affiliated Hospital of North China University of Science and Technology from June 2022 to October 2023 were selected as the study subjects. Patients were divided into four groups based on the quartiles of the TyG-BMI index: Q1 (n=99), Q2 (n=99), Q3 (n=99), and Q4 (n=99). Baseline data, laboratory test results, and 24-hour ABPM results were collected. The TyG-BMI index, triglyceride-glucose (TyG) index, and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio were calculated. A generalized linear model was used to analyze the association between different TyG-BMI index groups and nocturnal ABPM parameters. Spearman correlation analysis was employed to assess the correlations of the TyG-BMI index, TyG index, and TG/HDL-C with nocturnal blood pressure indicators. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive efficacy of the TyG-BMI index for nocturnal hypertension, and the area under the ROC curve (AUC) was calculated.
There were statistically significant differences in age, BMI, TG, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), use of renin-angiotensin-aldosterone system (RAAS) inhibitors, and proportions of stroke, diabetes, and hyperlipidemia among the Q1 to Q4 groups (P<0.05). Significant differences were also observed in 24-hour average systolic blood pressure, 24-hour average diastolic blood pressure, daytime average systolic blood pressure, daytime average diastolic blood pressure, nocturnal average systolic blood pressure, nocturnal average diastolic blood pressure, nocturnal systolic blood pressure dip, nocturnal systolic blood pressure standard deviation, and nocturnal diastolic blood pressure standard deviation among these groups (P<0.05). The results of the generalized linear model indicated that the TyG-BMI index group was a significant influencer of nocturnal average systolic blood pressure (β=6.623, P=0.002) and nocturnal average diastolic blood pressure (β=4.553, P=0.001). When stratified by the presence of hyperlipidemia or diabetes, the Q4 group was found to be a significant influencer of nocturnal average diastolic blood pressure (β=8.462, P<0.001) in subjects without hyperlipidemia or diabetes, but no correlation was observed between the TyG-BMI index group and nocturnal average systolic blood pressure (β=4.604, P=0.097) or nocturnal average diastolic blood pressure (β=1.988, P=0.285) in subjects with hyperlipidemia or diabetes. Spearman correlation analysis revealed a positive correlation between the TyG-BMI index and nocturnal average systolic blood pressure (rs=0.155, P=0.002) in hypertensive patients, and positive correlations between TG/HDL-C (rs=0.193, P<0.001), TyG index (rs=0.145, P=0.004), TyG-BMI index (rs=0.250, P<0.001) and nocturnal average diastolic blood pressure. ROC curves were plotted for TG/HDL-C, TyG index, and TyG-BMI index to predict nocturnal hypertension, with AUCs of 0.570 (95%CI=0.513-0.627, P=0.017), 0.559 (95%CI=0.502-0.616, P=0.046), and 0.618 (95%CI=0.563-0.673, P<0.001), respectively. In subjects with hyperlipidemia or diabetes, the AUCs for TG/HDL-C and TyG-BMI index predicting nocturnal hypertension were 0.578 (95%CI=0.504-0.651, P=0.043) and 0.627 (95%CI=0.557-0.698, P=0.001), respectively.
In patients with essential hypertension, the TyG-BMI index is positively correlated with nocturnal average diastolic blood pressure. The TyG-BMI index has a high predictive value for nocturnal hypertension.
The occurrence and development of obstructive sleep apnea (OSA) -associated hypertension is not only driven by traditional risk factors like obesity, the prevalence is much higher in individuals with fluid retention, suggesting the potential role of sodium in the pathogenesis.
To identify the urinary sodium excretion in patients with OSA-associated hypertension in Kunming City, and its correlation with the severity of OSA and hypertension.
A retrospective analysis was performed on 493 patients diagnosed with OSA-associated hypertension at the Hypertension Center of Yan'an Hospital Affiliated to Kunming Medical University from 2019 to 2021. According to the results of apnea hypopnea index (AHI), patients were divided into mild (5 times/h≤AHI <15 times/h), moderate (15 times/h ≤AHI <30 times/h) and severe (AHI≥30 times/h) groups. Clinical characteristics, laboratory testing, polysomnographic (PSG) data, and ambulatory blood pressure were compared among three groups. The correlation of 24-hour urinary sodium excretion with PSG data, ambulatory blood pressure, BMI, age, gender, glomerular function, urinary protein and other indicators was identified. Multivariate linear stepwise regression analysis was used to identify risk factors for 24-hour urinary sodium excretion in patients with OSA-associated hypertension.
Among 493 patients with OSA-associated hypertension, 103 were in the mild group, 187 in the moderate group, and 203 in the severe group. The 24-hour urinary sodium excretion was significantly higher in the severe group than the mild and moderate groups (P<0.05). There were significant differences in the AHI, low oxygen saturation (LSaO2), mean oxygen saturation (MSaO2), and nighttime mean systolic blood pressure (nSBP) among the three groups (P<0.05). There was a positive correlation of 24-hour urinary sodium excretion with AHI, BMI, 24-h mean systolic blood pressure (24 hMSBP), 24-h mean diastolic blood pressure (24 hMDBP), and male gender (r=0.223, 0.126, 0.109, 0.226, rs=0.177, respectively; all P<0.05), there was negatively correlated with LSaO2, MSaO2, and age (r=-0.103, -0.090, -0.098, P<0.05). Multivariate linear stepwise regression analysis showed that the increase of AHI, 24 hMSBP, BMI, and male gender were all independent risk factors for 24-hour urinary sodium excretion in patients with OSA-associated hypertension (P<0.05) .
The 24-hour urinary sodium excretion is significantly higher in patients with severe OSA-associated hypertension than those with mild and moderate condition. Urinary sodium excretion is correlated with AHI, 24-h blood pressure, BMI, male gender, among which AHI has a strong correlation. AHI and blood pressure synergistically affect urinary sodium excretion in patients with OSA-associated hypertension, with a more pronounced effect posed by AHI.
Poor control of blood pressure in patients with essential hypertension can lead to cardiovascular complications and end-organ damage. Nowadays, there are few interventions on the circadian rhythmicity of blood pressure in clinical practice and lack of effective serologic indicators to assess the risk of cardiovascular disease in hypertension patients.
To investigate the correlation between circadian rhythmicity of blood pressure and oxidized low-density lipoprotein/β2-glycoprotein I complex (ox-LDL/β2GPI complex), high-sensitivity C reactive protein (hs-CRP), interleukin-6 (IL-6) and carotid atherosclerosis (CAS) in patients diagnosed with essential high blood pressure.
A total of 208 patients who were diagnosed with essential high blood pressure and treated in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Zhengzhou University from January 2024 to June 2024 were selected to undergo the measure of 24-hour blood pressure and were categorized into three groups according to the reduction of nighttime blood pressure: dipper (83 cases), non-dipper (83 cases) and anti-dipper (42 cases) groups. We collecte the general data of patients in each group and examine levels of lipids, glucose, liver function, kidney function, thyroid function, electrolyte, IL-6, hs-CRP, ox-LDL/β2GPI complex, etc. Then the ultrasound examination was performed to evaluate the carotid plaque. Finally, data collection and statistical processing were performed to analyze the correlation between circadian rhythmicity of blood pressure and levels of ox-LDL/β2GPI complex, hs-CRP, IL-6 and atherosclerotic carotid plaque.
There was no statistically significant difference in gender, age, BMI, smoking, total cholesterol, triacylglycerol, high-density lipoprotein, low-density lipoprotein and glycated hemoglobin among the 3 groups (P>0.05). Compared with the patients with dipper pattern of hypertension, the non-dipper and anti-dipper pattern of hypertension patients had higher levels of hs-CRP, IL-6, ox-LDL/β2GPI complex, and higher incidence of atherosclerotic carotid plaque (P<0.05). Besides, the anti-dipper group had higher levels of hs-CRP than the non-dipper group (P<0.05). The Pearson correlation analysis results showed that hs-CRP, IL-6, ox-LDL/β2GPI complex were positively correlated with nSBP (r=0.424, 0.245, 0.480; P<0.05). Multivariate Logistic regression analysis showed that nSBP (OR=1.091, 95%CI=1.007-1.182), hs-CRP (OR=5.141, 95%CI=1.700-15.541), and ox-LDL/β2GPI complex (OR=1.033, 95%CI=1.023-1.044) were independent influencing factors to the CAS in patients with essential hypertension (P<0.05) .
Our findings suggest essential hypertension patients with abnormal circadian rhythmicity have higher levels of inflammatory factors, carotid atherosclerosis, and plasma ox-LDL/β2GPI complex. Plasma ox-LDL/β2GPI complex is expected to serve as a predictor of cardiovascular disease risk in patients with essential hypertension.
Lower extremity arteriosclerotic obliteration (ASO) is a chronic disease characterized by the formation of atherosclerotic plaques in the lower extremity arteries, leading to arterial stenosis, occlusion, and subsequently chronic ischemia of the limbs, manifesting as pain, claudication, and even ischemic necrosis of the limbs. Inflammation and lipid infiltration play pivotal roles in the development of lower extremity atherosclerosis. However, there is currently a lack of relevant indices for its diagnosis and analysis.
To explore the correlation between multiple inflammatory and oxidative stress indices and ASO, and to evaluate their diagnostic value by collecting case data from ASO patients.
A retrospective study was conducted involving 600 ASO patients who visited the Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from October 2014 to January 2024. Patients were divided into mild (n=200), moderate (n=200), and severe (n=200) groups based on the Rutherford classification. Additionally, 200 healthy individuals who underwent physical examinations at the outpatient clinic of the same hospital were randomly selected as controls. Baseline data were collected, and inflammatory and oxidative stress indices were calculated, including the pan-immune inflammation value (PIV), systemic immune-inflammation index (SIRI), systemic immune-inflammatory index (SII), monocyte-to-hdl cholesterol ratio (MHR), neutrophil-to-lymphocyte ratio (NLR), SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C. Spearman's rank correlation analysis was used to explore the correlation between these indices and ASO severity. Multivariate Logistic regression analysis was conducted to investigate the influencing factors of ASO. Receiver operating characteristic (ROC) curves were plotted to assess the diagnostic efficacy of the indices for ASO, and the area under the ROC curve (AUC) was calculated.
ASO patients had higher levels of monocyte count (MONO), platelet count (PLT), neutrophil count (NEUT), LDL-C, PIV, SIRI, SII, MHR, NLR, SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C, as well as lower HDL-C levels compared to healthy controls (P<0.05). Comparison of ASO patients across different Rutherford stages showed that the severe group had a higher proportion of males, hypertension, smoking rates, MONO, NEUT, PIV, SIRI, SII, MHR, NLR, SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C than the mild and moderate groups (P<0.05). The severe group also had lower lymphocyte count (LYMP) and HDL-C levels (P<0.05), higher age than the moderate group (P<0.05), and lower LDL-C than the mild group (P<0.05). The moderate group had a higher proportion of hypertension, MONO, NEUT, PIV, SIRI, SII, MHR, NLR, SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C than the mild group (P<0.05), as well as lower HDL-C levels (P<0.05). The mild group had a lower proportion of alcohol consumption than the moderate and severe groups (P<0.05), and lower PLT than the moderate and severe groups (P<0.05). Correlation analysis results indicated that PIV, SIRI, SII, MHR, NLR, SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C were positively correlated with ASO severity (P<0.05). Multivariate Logistic regression analysis revealed that SIRI was a protective factor for ASO (OR=0.009, 95%CI=0.000-0.181, P=0.009), while SIRI×LDL-C (OR=1.665, 95%CI=1.260-2.201, P=0.001) and PIV/HDL-C (OR=1.014, 95%CI=1.003-1.024, P=0.005) were risk factors for ASO. The AUC for predicting ASO using SIRI×LDL-C was 0.710, with a sensitivity of 0.442 and a specificity of 0.890. The AUC for predicting ASO using PIV/HDL-C was 0.761, with a sensitivity of 0.505 and a specificity of 0.975.
The comprehensive indices included in this study, namely PIV, SIRI, SII, MHR, NLR, SIRI/HDL-C, SIRI×LDL-C, PIV/HDL-C, and PIV×LDL-C, are correlated with ASO severity. SIRI is a protective factor for ASO, while SIRI×LDL-C and PIV/HDL-C are independent risk factors for ASO and have predictive value for its occurrence.
The clinical manifestations of subacute thyroiditis (SAT) vary a lot, easily leading to misdiagnosis and missed diagnosis, and seriously affect the quality of life. Therefore, it is particularly important to find a simple and accurate method to assist in the early diagnosis of SAT.
To explore the clinical application value of aggregate index of systemic inflammation (AISI) in the auxiliary diagnosis of SAT.
A total of 143 adults with newly diagnosed SAT in Zhejiang Provincial People's Hospital from July 2021 to July 2023 were retrospectively selected as the SAT group. At the same time, 142 healthy volunteers receiving physical examinations in our hospital were included in the control group. The thyroid function, blood routine and erythrocyte sedimentation rate (ESR) of the two groups were retrospectively analyzed. AISI, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated. The correlation of AISI with NLR, PLR, ESR and thyroid function indicators was analyzed. Multivariate Logistic regression was used to analyze the influencing factors of SAT, and the receiver operating characteristic (ROC) curve was plotted to analyze the diagnostic performance of AISI in SAT.
The white blood cell count, neutrophil count, monocyte count, platelet count, AISI, NLR and PLR in the SAT group were significantly higher than those of the control group (all P<0.05), and the lymphocyte count was significantly lower (P<0.05). AISI in the SAT group was positively correlated with NLR (rs=0.772, P<0.05), PLR (rs=0.531, P<0.05), ESR (rs=0.446, P<0.05), free triiodothyronine (FT3, rs=0.369, P<0.05), free thyroxine (FT4, rs=0.421, P<0.05) and thyroglobulin (Tg, rs=0.437, P=0.029), but negatively correlated with thyroid stimulating hormone (TSH, rs=-0.386, P<0.05). Multivariate Logistic regression analysis showed that AISI (OR=1.006, P<0.05), ESR (OR=1.072, P<0.05) and FT4 (OR=1.574, P<0.05) were independent predictors of SAT patients. ROC curve analysis showed that the optimal cutoff value of AISI in the auxiliary diagnosis of SAT was 223.67, with a sensitivity of 86.01%, and a specificity of 84.51%. The area under the curve (AUC) of AISI was 0.903, showing a better diagnostic performance than NLR (Z=2.953, P= 0.003) and PLR (Z=4.792, P<0.001), but equivalent to ESR (Z=0.366, P=0.715). The sensitivity of AISI combined with ESR in diagnosing SAT was 90.91%, and the specificity was 91.55%, showing a larger AUC than AISI or ESR detection alone (Z=3.164, P<0.001; Z=2.811, P=0.005). There was no significant difference in the AISI between recurrent and non-recurrent SAT patients[436.65 (269.38, 807.17) vs. 563.97 (361.51, 776.96), Z=1.083, P=0.279].
AISI significantly increases in SAT patients, serving as a simple and practical indicator used to the auxiliary diagnosis of SAT.
Carotid atherosclerosis is a degenerative disease that is a hemodynamic change caused by endothelial dysfunction and is an important cause of stroke, and the assessment of plaque stability plays an important role in predicting future clinical events. However, there is controversy in studies on the impact of calcification features on plaque stability. Previous studies have mostly categorized calcifications by their size, number, location, or shape, and explored their role in assessing plaque stability and clinical events. Based on a review of the previous literature, this article explores the correlation between calcification research and plaque stability and its value in predicting clinical events, and puts forward the existing problems and thoughts on future research directions, aiming to provide reference for research in this field.
Congenital heart defects are a common congenital malformation, which is the main cause of death in children under 5 years old with birth defects in developed and developing countries. At present, congenital heart defects are still a huge challenge to global health. At the same time, there are obvious regional differences and health inequalities. There is still room for improvement in the life cycle management of diseases. Therefore, a comprehensive assessment of the burden of congenital heart defects is needed to develop targeted prevention and treatment strategies.
To explore the changes in the burden of congenital heart defects from 1990 to 2021 and predict the development trend by 2050, so as to provide reference for formulating relevant policies and measures, and is expected to provide reference for achieving the 2030 Sustainable Development Goals.
Using the 2021 Global Burden of Disease Database (GBD 2021), the number and standardized rate of prevalence, deaths, disability adjusted life years and years lived with disability of congenital heart defects in the world, 21 regions and 204 countries were counted and analyzed. Correlation analysis, health inequality analysis and frontier analysis were combined to further comprehensively describe the disease burden and change trend of congenital heart defects, and the Bayes age-period-cohort model was used to predict the annual disease burden from 2022 to 2050.
The standardized rate of prevalence, deaths, DALYs and YLDs of congenital heart defects in 2021 were 210.70/100 000, 3.86/100 000, 345.24/100 000 and 14.25/100 000, respectively. The corresponding estimated average annual percentage change (AAPC) from 1990 to 2021 were 0.02%, -2.53%, -2.48% and 0.11%, respectively. From 1990 to 2021, the standardized rate of deaths and DALYs were the highest in the low socio-demographic index (SDI) region, while the standardized rate of prevalence and YLDs were the highest in the high SDI region. SDI was positively correlated with the standardized rate of prevalence (ρ=0.45, P<0.001) and YLDs (ρ=0.71, P<0.001) of congenital heart defects. On the contrary, SDI was negatively correlated with standardized rate of deaths and DALYs of congenital heart defects (ρ=-0.54, P<0.001). From 1990 to 2021, the absolute health inequality of congenital heart defects decreased, but the relative health inequality increased. It is predicted that by 2050, the global standardized rate of prevalence, deaths, DALYs and YLDs of congenital heart defects will reach 218.24/100 000, 0.91/100 000, 118.48/100 000 and 14.73/100 000 respectively.
From 1990 to 2021, the global burden of congenital heart defects showed a downward trend, and the regional burden decreased with the increase of SDI.
Hypertensive nephropathy, a common chronic kidney disease, is a significant contributor to end-stage renal disease. Analyzing and predicting its epidemiological trends is crucial for the prevention and control of chronic kidney disease.
This study aims to analyze the temporal trends in the incidence and mortality of hypertensive nephropathy in China from 1990 to 2021 and to provide a theoretical basis for developing prevention and control strategies.
Data on the incidence and mortality of hypertensive nephropathy in China were obtained from the Global Burden of Disease (GBD) 2021 database. Joinpoint regression models were used to analyze the average annual percentage change (AAPC) in incidence and mortality. Age-period-cohort models were applied to estimate the age, period, and cohort effects by gender. Bayesian age-period-cohort (BAPC) methods were employed to predict the standardized incidence and mortality rates for both genders from 2022 to 2032.
After age standardization, the age-standardized incidence rates (ASIR) for both males and females showed a slight decline from 1990 to 1995, followed by a gradual increase. The age-standardized mortality rate (ASMR) for males decreased from 5.44 per 100 000 in 1990 to 4.72 per 100 000 in 2021, while for females, it decreased from 3.86 per 100 000 to 2.75 per 100 000, with a more pronounced decline in females. Joinpoint regression analysis indicated an overall increasing trend in ASIR (AAPC for males: 0.43%, females: 0.64%, P<0.05). The fastest decline in male ASIR occurred from 1990 to 1992 (APC=-1.62%, P<0.05), while the fastest increase was from 2019 to 2021 (APC=1.30%, P<0.05). For females, the fastest decline in ASIR was from 1990 to 1995 (APC=-1.31%, P<0.05). Overall, the ASMR rate showed a decreasing trend (AAPC for males: -0.51%, females: -1.09%, P<0.05), with a more significant decline in females. The fastest decline in male ASMR was from 2004 to 2007 (APC=-3.26%, P<0.05), while the fastest increase was from 1998 to 2004 (APC=1.30%, P<0.05). For females, the fastest decline in ASMR was also from 2004 to 2007 (APC=-4.47%, P<0.05). Age-period-cohort analysis revealed that males generally had higher incidence and mortality rates than females across all age groups, with rates increasing with age. The incidence growth accelerated after age 60-65, and mortality growth accelerated after age 70. The period effect on incidence risk was slightly higher in females than in males, while the cohort effect showed an overall increasing trend in incidence and a decreasing trend in ASMR for both genders. Predictions from 2022 to 2032 indicate a continued rise in ASIR and a sustained decline in mortality for both genders.
From 1990 to 2021, the ASIR of hypertensive nephropathy in China showed an overall upward trend, while ASMR decreased. Both incidence and mortality increased with age, particularly in the elderly. Over the next decade, ASIR is expected to continue rising, while ASMR will decline slowly. These findings suggest a need to focus on male and elderly patients in developing targeted prevention and control measures.
20%-30% of individuals with Preserved Ratio Impaired Spirometry (PRISm) will develop chronic obstructive pulmonary disease (COPD). However studies on characteristics of PRISm in China remain limited.
To analyze factors associated with PRISm, and to explore the difference in the distribution of risk factors between individuals with PRISm and COPD.
This study was conducted as part of health management in Shanghai communities. Elderly individuals over 60 years old from 11 communities in Putuo District, Shanghai, who participated COPD screening from July 2022 to June 2023, were surveyed and underwent lung function tests. A total of 876 participants were initially included, but 141 were excluded due to incomplete questionnaire information or poor lung function test quality, resulting in 735 valid subjects. According to the "Guidelines for Graded Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease" and GOLD 2024, participants were classified into three subgroups based on post-bronchodilator lung function: COPD group (FEV1/FVC < 70%), PRISm group (FEV1%Pred< 80% and FEV1/FVC≥ 70%), and normal lung function group. Multivariate Logistic regression analyses were conducted to identify factors associated with COPD and PRISm, using normal lung function as the control.
A total of 735 individuals aged 60~81 were included. COPD and PRISm were observed in 157 (21.36%) and 113 (15.37%) participants, respectively. COPD-SQ scores were highest in the COPD group (20.46±4.53), followed by the PRISm group (19.04±4.41) and lowest in the normal lung function group (18.03±4.26) with statistically significant differences (P<0.001). Univariate analysis showed that the PRISm group had higher proportions of males, smokers, individuals with frequent wheezing, chronic bronchitis and hypertension compared to the normal lung function group (P<0.05). Compared to COPD patients, the PRISm group had lower proportions of males, smokers, individuals with symptoms of wheezing or coughing after exercise, and those with a history of emphysema, but a higher prevalence of hypertension (P<0.05). Multivariable Logistic regression analyses revealed that increasing age, male gender, higher smoking levels, insufficient physical activity, frequent wheezing, wheezing or coughing after exercise, family history of COPD or bronchial asthma, and history of bronchial asthma or emphysema were associated with COPD (P<0.05). In contrast, higher smoking levels, insufficient physical activity, frequent wheezing, chronic bronchitis, and hypertension were associated with PRISm (P<0.05) .
PRISm is a high-risk state between COPD and normal lung function, sharing similar associated factors with COPD such as age, smoking states, physical activity, symptoms and comorbidities. However, the COPD-SQ score and the predictive performance of multivariable logistic regression model for lung function status were significantly lower for PRISm compared to COPD. Hypertension was an independent associated factor for PRISm, but not for COPD, suggesting a potential risk of cardiovascular disease independent of COPD. Further research is warranted to verify the role of PRISm characteristics in disease progression.
With the acceleration of population aging in my country, the multiple chronic conditions in the elderly has become increasingly common. This not only seriously affects the quality of life of the elderly, but also places a heavy burden on families and society. Gansu is a province with a relatively high aging population in the northwest region, and it is urgent to pay attention to the multiple chronic conditions among the elderly.
In order to understand the current status and influencing factors of multiple chronic conditions among the elderly in Gansu Province, and provide a reference basis for the prevention, treatment and management of multiple chronic conditions in Gansu Province.
From 2023-07-15 to 2023-08-10, a multi-stage stratified random cluster sampling method was used to select 20 000 elderly people aged ≥60 years old in Gansu Province for a questionnaire survey. The questionnaire was designed by the research team itself and mainly investigated the prevalence of 15 common chronic diseases among the elderly, as well as their demographic characteristics and family circumstances. In the end, 19 038 valid questionnaires were collected, and the effective questionnaire recovery rate was 95.19%.
The prevalence rate of chronic diseases among the elderly in Gansu Province was 74.78% (14 236/19 038), and the incidence rate of multiple chronic conditions was 38.97% (7 419/19 038). The top six chronic diseases with the highest prevalence were hypertension[9 693 (50.91%) ], arthritis or rheumatism[3 648 (19.16%) ], and heart disease[3 418 (17.95%) ], diabetes or elevated blood sugar[3 033 (15.93%) ], chronic lung disease[1 645 (8.64%) ], stroke[1 548 (8.13%) ]. Common comorbidity combination patterns are all related to hypertension. The top-ranked binary comorbidity pattern is hypertension + diabetes or elevated blood sugar[2 112 (11.09%) ], and the top-ranked ternary comorbidity pattern is hypertension + diabetes or elevated blood sugar + heart disease[532 (2.79%) ]. The results of multi-factor Logistic regression analysis showed that gender, age, ethnicity, pre-retirement occupation, spouse, number of children, relationship with children, self-rated health status, self-rated life satisfaction, and loneliness are influencing factors for the occurrence of multiple chronic conditions in the elderly (P<0.05) .
The incidence of multiple chronic conditions among the elderly in Gansu Province is lower than the national average. Multiple chronic conditions occurs among the elderly who are female, elderly, Tibetan, have a job before retirement, have a normal relationship with their children, have average/poor self-rated health, and have average self-rated life satisfaction. The risk of chronic disease is higher, and the risk of multiple chronic conditions is lower for the elderly who have a spouse, fewer children, and do not feel lonely. Relevant departments should focus on the prevention, treatment and management of common multiple chronic conditions in the elderly, promptly intervene in variable risk factors, strengthen the elderly's awareness of self-health management, and improve the multiple chronic conditions management system in primary medical and health institutions.
Obesity is a common metabolic disease that has become a serious public health problem worldwide. In recent decades, with the rapid development of China's economy and the acceleration of globalization and urbanization, the rate of overweight and obesity in China has shown a rapid rise, and it is urgent to carry out the prevention and control of obesity in the whole population.
To analyze the status quo and changing trend of disease burden due to high BMI in China from 1990 to 2019, and to predict the Disability-Adjusted Life Years (DALY) normalization rate of high BMI in China in the next decade, providing reference for formulating obesity prevention and control strategies in China.
The data of DALY number and DALY normalization rate attributed to high BMI in China from 1990 to 2019 were extracted from the global Burden of Disease database, and the burden of disease due to high BMI in China was analyzed from the aspects of gender, age and the burden of disease attributable to high BMI. Using the estimated annual percentage change (EAPC) to represent the change trend, a grey prediction model GM (1, 1) was established to predict the DALY normalization rate attributed to high BMI in China from 2020 to 2030.
From 1990 to 2019, the number of deaths and DALY attributable to high BMI in China increased by 225% and 215%, respectively. The standardized mortality rate (EAPC=1.21%, P<0.001) and the standardized DALY rate showed an increasing trend (EAPC=1.41%, P<0.001). The burden of DALY attributed to high BMI and its growth rate was significantly higher in men than in women over the same period. The burden of DALY caused by high BMI increased with the increase of age, and the burden of <5-19 years old increased rapidly, and the increase trend of males at all ages was increasing, and the increase trend of females at 20-54 years old was unstable, and the increase rate was accelerated at 55 years old and above. In 1990 and 2019, the top four diseases with the greatest burden of DALY attributed to high BMI were stroke, ischemic heart disease, diabetes and hypertensive heart disease, and the diseases with rapid increase of DALY normalization rate were mainly tumor and musculoskeletal diseases. The number of DALY caused by high BMI in 2019 accounted for 6.50% of the total number of DALY in 2019, ranking fifth among 69 risk factors. GM (1, 1) forecast shows that the DALY normalization rate of high BMI in China will continue to rise from 2020 to 2030. In 2030, the DALY normalization rate of high BMI in China will be 1 452.52/ 100 000, among which 1 845.81/ 100 000 for males and 1 106.74/ 100 000 for females.
The burden of diseases caused by high BMI increased significantly in China from 1990 to 2019, and targeted intervention measures should be taken for people of different genders and different age groups, focusing on the prevention of diseases and cancers caused by high BMI. The disease burden of high BMI will increase further in the next decade, and a nationwide community obesity prevention and control effort is urgently needed.
Cancer is the second leading cause of death among children. The level of health literacy of caregivers of pediatric oncology patients not only affects their ability to search for health information on the Internet, but also has an impact on the health outcomes of patients. There is a lack of study exploring the relationship between health literacy and online health information search among caregivers of pediatric oncology patients.
To explore the relationship between health literacy and online health information search among caregivers of pediatric oncology patients and to analyze the factors that influence caregivers' online health information search.
A total of 424 caregivers of pediatric oncology patients were included in the study using purposive sampling in three hospitals in Shandong Province from May to August 2021, as well as whole cluster sampling and snowball sampling in Guangdong Province through Shenzhen HengHui Public Welfare Foundation from June to August 2022 as subjects. The survey was conducted using the basic characteristics questionnaire and the health literacy questionnaire, and subjective answers from caregivers were used to confirm whether online health information searches were done. Point two-column correlation analysis was used to test the correlation between health literacy and online health information search among caregivers of pediatric oncology patients; binary Logistic regression (forward stepwise regression based on maximum likelihood estimation) was used to analyze the influencing factors of online health information search among caregivers of pediatric oncology patients.
The health literacy scores of caregivers of pediatric oncology patients were (2.60±0.30) (2.76±0.30) (2.76±0.30), and (2.76±0.30) for the four dimensions of "Perceived understanding and support from healthcare professionals""Evaluation of health information""Ability to interact with healthcare professionals", and "Know enough about health information to know what to do", respectively; the proportion of high health literacy was 56.13%, 63.21%, and 63.21%, 35.61%, respectively; negative correlation (r=-0.161), positive correlation (r=0.006), positive correlation (r=0.073), positive correlation (r=0.102), with online health information search, respectively. The education level of junior high school, high school/vocational school, or college/junior college and above, one-child family, "evaluation of health information" and "ability to interact with healthcare professionals" were facilitating factors for caregivers to conduct online health information search; and "perceived understanding and support from healthcare professionals" was a hindering factor for caregivers to conduct online health information search.
Most caregivers of pediatric oncology patients search for health information on the Internet, and a higher level of education, being a one-child family, having a better ability to assess health information, maintaining positive interactions with healthcare professionals, and rarely feeling the understanding and support of healthcare professionals can promote the occurrence of online health information searching behaviors among caregivers of pediatric oncology patients. The government and related departments should actively carry out health education initiatives for caregivers of pediatric oncology patients to improve their health literacy and ability to use the Internet to search for health information.
Previous research has indicated that adolescence is associated with physiological changes in sleep patterns. And there are significant variations in sleep duration among adolescents from different regions. Chinese adolescents face short sleep durations and intense academic pressures, which can lead to insomnia and affect their physical and mental health development.
To systematically review the assessment tools and influencing factors of insomnia in Chinese adolescents, and provide guidance for future research in this field.
Initiated in October 2022, this study conducted a systematic search in 5 databases: Web of Science Core Collection, PubMed, China National Knowledge Infrastructure, Wanfang Data, and VIP Database. Two researchers screened articles related to insomnia in Chinese adolescents aged 12 to 18. And then they extracted the following information independently: authors, publication year, region, type of research design, size of study sample, assessment tools, prevalence, and influencing factors.
A total of 1 440 articles were retrieved from the databases, with 39 articles ultimately included in the study-34 in English and 5 in Chinese-covering 23 studies. The sample sizes ranged from 62 to 33 692. Cross-sectional studies were the most common method (15 studies) among the included research. Analysis revealed that the 23 studies utilized 8 kinds of insomnia assessment tools. Only 1 study provided objectively measured sleep features. Three studies involved localized assessment or development of 5 self-report tools, and provided reliability and validity data. The internal consistency of the 5 tools ranged from 0.50 to 0.83, test-retest reliability after two weeks ranged from 0.40 to 0.82, and area under the curve ranged from 0.79 to 0.85. The influencing factors of insomnia in Chinese adolescents were diverse and complicated, which included demographic factors (age, gender, etc.), physiological factors (genetics, health status, etc.), psychological factors (anxiety, depression, etc.), and behavioral factors (exercise, smoking, etc.) .
The assessment tools and influencing factors of insomnia in Chinese adolescents are diverse. However, there is insufficient validation of the reliability and validity of the assessment tools. Few studies have provided objectively measured sleep features of insomnia in Chinese adolescents. And the causal relationship between insomnia and its influencing factors remains unclear. Further research is still required in the future.
General practitioners are the "gatekeepers" of residents' health, and their job satisfaction largely affects the quality and efficiency of primary healthcare service, which shows that it is of great significance to establish a job satisfaction evaluation system of general practitioners suitable for Chinese national conditions, and to improve the job satisfaction of general practitioners in order to promote the reform of the primary healthcare service system.
To conduct a systematic review of the job satisfaction of general practitioners and its influencing factors in China, to analyze the commonalities and differences in evaluation indexes and research results of the job satisfaction of general practitioners and their influencing factors in different studies, in order to provide reference for the establishment of a general practitioners' job satisfaction evaluation system suitable for Chinese national conditions.
PubMed, Web of Science, Embase, National Knowledge Infrastructure, WanFang Data and CQVIP were searched to obtain cross-sectional studies on job satisfaction and influencing factors of general practitioners from inception to June 12, 2023. Two researchers independently screened the literature and extracted the authors of the included literature, the time of the survey, the area of the survey, the sample size, the dimensions and indicators of the evaluation of job satisfaction, and the influencing factors of job satisfaction, and other information. The descriptive analysis method was adopted to summarize, analyze and compare.
We included 19 Chinese studies, including 15 354 general practitioners. The evaluation of the job satisfaction of general practitioners mainly involved four dimensions: material satisfaction, relationship satisfaction, growth satisfaction, and overall satisfaction, of which 19 articles mentioned income and interpersonal relationship, 14 articles mentioned working environment, job promotion, and personal value, and 8 articles mentioned training. The influencing factors of job satisfaction of general practitioners included income level, gender, age, title, education, work pressure, workload, promotion opportunities, employment methods, work environment, length of service, interpersonal relationship, welfare benefits, type of unit, social recognition and so on.
The overall level of job satisfaction of general practitioners in China was not high, and was affected by income level, gender, age, title, educational, workload, work pressure, promotion opportunities, employment methods and other factors.
For a long time, pediatric resources in China have been mainly concentrated in large hospitals, and the pediatrics of primary health institutions are weak. Studies about the current situation of pediatric construction and service provision in primary health institutions are mainly concentrated in a few developed areas, and studies about the latest progress in the whole country are not found.
To analyze the construction and service provision of pediatrics in primary health institutions in China.
From January to February 2022, 6 406 primary health institutions were surveyed using stratified sampling and the self-made questionnaire was used to collect relevant data on pediatric construction, pediatric human resource allocation, pediatric essential drugs, major equipment allocation, pediatric service provision in all sampled primary health institutions in 2021. Descriptive analysis and multiple linear regression analysis were used to analyze the influencing factors of the number of pediatric consultations and the rate of child health management in primary health institutions by Stata 15.0.
31.41% (1 488/4 737) and 39.07% (652/1 669) of township health centers and community health centers independently set up pediatrics, respectively. On average, the number of general practitioners providing services for children and pediatric practitioners in township health centers was (1.33±2.52) and (0.94±1.71), respectively, and the number of community health centers was (1.95±3.80) and (1.26±2.06), respectively. The proportion of institutions equipped with 1-3 kinds of pediatric essential drugs in township health centers and community health centers was relatively high, which were 38.91% (1 843/4 737) and 40.85% (694/1 669), respectively. Except CT, the equipped rates of automatic biochemical instrument, DR and B-ultrasound are more than 80%. The results of multiple linear regression analysis showed that the types of institutions, the total number of employees, the actual number of beds, independent pediatricians, the number of pediatric practitioners, the number of general practitioners providing pediatric services, the contract rate of children and the number of drugs were the influencing factors of pediatric clinical service provision (P<0.05). Region, the total number of employees, and the children contract rate were the influencing factors of the children health management rate in primary health institutions (P<0.05) .
The pediatric department of primary health institutions is insufficient and there is a certain shortage of manpower, medicine, and equipment resulting in insufficient clinical services for children and differences between urban and rural areas, and the integration of clinical service and prevention still needs to be implemented.
The role of family doctors has become more and more important as people's demand for healthcare increases. However, there are still some problems in the implementation of family doctor contracting service, such as the difficulty of finding suitable family doctors and the difficulty of data sharing.
Develop a GIS-based Family Doctor Contract Service WeChat Mini Program (hereinafter referred to as the WeChat Mini Program), and complete the usability evaluation to provide residents with a faster and more efficient family doctor contracting service, and for the promotion of the application of mHealth technology in family doctor contracting service.
From January to June in 2022 through literature review to understand the residents' demand for family doctor contracting service and the development of WeChat applet; on-site survey of 200 community residents using random sampling method to analyze the residents' demand for WeChat applet; focusing on the design ideas and function orientation of WeChat applet, four focus group interviews were conducted with the residents, family doctors, administrators, and technicians; based on the demand analysis and the development elements, the development elements of WeChat applet were constructed. Four focus group interviews were conducted; based on the demand analysis and design ideas, the development elements of the WeChat applet were constructed. From June to August in 2022, a field survey was conducted on 96 users of the WeChat Mini Program using the System Usability Scale (SUS). Additionally, usability evaluation of the WeChat Mini Program was performed through key informant interviews and expert consultations.
The main needs of residents for WeChat applets included health consultation (78.00%), quick location of nearby family doctors (75.00%), and health science popularization (71.50%). The design scheme of the WeChat applet covered the core functions of path planning and navigation, information query and display, residents' health management, online contracting and renewal, and online consultation; after the trial operation of the WeChat applet, the usability analysis was conducted, and the average score of SUS was (78.62±9.23), suggesting that the WeChat applet was practically operable and easy to learn.
The connotation of family doctor contracting service based on the GIS platform and the use of multifaceted thinking can ensure the scientificity and usability of WeChat applet development.
With the development of society and the aging of the population, the demand for community medical services is increasing. As an important part of community medical service, the informationization level and information service ability of family doctors are of great significance to improve the quality and efficiency of community medical service.
To investigate the effect of the WeChat applet "Intelligent geographic information system (GIS) Family Doctor Information Platform" based on GIS in the application of family doctor contracting service.
from March to April 2023, among 27 family doctor teams in Zhujing Town, Jinshan District, Shanghai, 185 residents served by two neighbourhood family doctor teams and two rural family doctor teams were selected as the control group using stratified random sampling method, and 186 residents served by the same two neighbourhood family doctor teams and two rural family doctor teams were selected as the intervention group; the control group adopted the existing family doctor contracting management mode, and the intervention group adopted the existing family doctor contracting management mode. The control group adopts the existing family doctor contracting management model, while the intervention group develops a contracting service management model based on the "Intelligent GIS Family Doctor Information Platform" WeChat app on the basis of the existing management model. A retrospective data collection method was used to compare the family doctor contracting service before and after the use of the "Smart GIS Family Doctor Information Platform" WeChat app in the intervention group, as well as the knowledge, belief and behaviour of the residents in the control group and the intervention group, in order to analyse the "Smart GIS Family Doctor Information Platform" WeChat app to analyse the application effect of "Intelligent GIS Family Doctor Information Platform".
The municipal contracting service assessment score of the intervention group was higher after using the "Smart GIS Family Doctor Information Platform" WeChat app (87.76±4.60) than before (63.65±4.53) (P<0.05) ; the score of the control group was higher than that of the intervention group after using the "Smart GIS Family Doctor Information Platform" WeChat app (63.65±4.53) (P<0.05) ; the score of the intervention group was higher than that of the control group after using the "Smart GIS Family Doctor Information Platform" WeChat app. The signing rate, community visit rate, family doctor visit rate, and the physical examination rate for signed individuals aged 65 and above for the control group are 41.70%, 26.67%, 3.30% and 71.43%, respectively. The contracting rate, community consultation rate, family doctor consultation rate, and contracted medical examination rate of people over 65 years old in the intervention group were 44.48%, 28.89%, 6.15%, and 74.02% respectively, and all the indicators of the intervention group were higher than those of the intervention group before the use of the WeChat applet of the "Intelligent GIS Family Physician Information Platform" (P<0.05). In the control group, the scores of knowledge, attitude and behaviour of family doctor contracting service were (8.14±1.46) (22.47±2.78) and (4.57±1.35), while in the intervention group, the scores of knowledge, attitude and behaviour of family doctor contracting service were (8.77±1.28) (23.54±1.98) and (4.97±1.17), respectively. The intervention group's scores on knowledge, attitude and behaviour of family doctor contracting service were higher than those of the control group (P<0.05) .
The application of "Intelligent GIS Family Doctor Information Platform" can improve the quality of the work of family doctor contracting service and enhance the residents'adherence to family doctor contracting service.
Recently, a new sub-branch Ⅰb of Mpox virus (MPXV) has triggered a new round of Mpox outbreak. 2024-08-14, Mpox was once again classified as a public health emergency of international concern (PHEIC) by the WHO. Early detection and diagnosis of Mpox cases is the key to interrupting the spread of Mpox in hospitals. In this article, we will review the pathogenetic features, epidemiological features, clinical features, diagnostic criteria, preventive and control measures of Mpox, with a view to providing reference for the early identification, scientific prevention and control of Mpox.
The influence mechanism of health management on self-management behavior in patients with type 2 diabetes is still unclear.
To explore the mediating effect of core attributes of general practice between the health management and self-management behavior of type 2 diabetes in basic public health services.
From April to September 2023, this study randomly selected 1-2 community health service centers from each district of 6 urban areas in Fuzhou City. Patients with type 2 diabetes from 11 community health service centers were surveyed by general situation questionnaire, Assessment Survey of Primary Care and Summary of Diabetes Self Care Activities. Descriptive analysis and correlation analysis were conducted using SPSS 26.0, and a structural equation model was constructed using AMOS 28 for mediation testing.
A total of 483 valid questionnaires were collected. The standardized health management rate for completing all prescribed service contents was 46.2%. The score of Summary of Diabetes Self Care Activities was (27.77±10.67), and the score of Assessment Survey of Primary Care was (64.33±13.90). There was a positive correlation between standardized health management, core attributes of general practice and self-management behavior (r=0.452, 0.483, P<0.01), and standardized management was positively correlated with core attributes of general practice (r=0.638, P<0.01). The mediation analysis showed that the mediating effect of the core attributes of general practice between basic public health service and patient self-management behavior was 0.403 (95%CI=0.267-0.541) .
Core attributes of general practice may be a mediator between type 2 diabetes mellitus health management in the basic public health service and self-management behaviors of patients.
The phenomenon of non-standard treatment of diabetes patients in rural areas is particularly serious. Diabetes health management is focused on preventing and controlling diabetic complications in rural areas of China, as well as lowering disability and death rates.
To explore the effects of O2O peer mentor collaborative health management on the risk perception and diabetes management self-efficacy in rural patients with non-standard diabetes treatment.
A total of 90 diabetic patients with non-standard treatment in Lamadian Town, Ranghulu District, Daqing City from April to November 2023 were selected as the study subjects by convenience sampling method, and randomly assigned 45 patients to the experimental group and 45 to the control group. The experimental group adopted O2O peer mentor collaborative health management scheme, the intervention lasted for 6 months, and the control group adopted conventional chronic disease health management. A comparison was made between the two groups' risk perception and self-efficacy in managing their diabetes.
The study was concluded with 42 cases in the experimental group and 41 instances in the control group. Following the intervention, the experimental group and control group had scores on the diabetes risk perception scale of (43.86±7.00) and (32.56±4.24), there was a statistically significant difference between them (t=8.864, P<0.001). Similarly, the experimental group and control group had scores on the diabetes management self-efficacy scale of (100.45±16.74) and (75.54±13.82), there was a statistically significant difference between them (t=7.384, P<0.001) .
The O2O peer mentor collaborative health management program can effectively improve the risk perception and diabetes management self-efficacy of rural patients with non-standard diabetes treatment, and improve their health management level.
Health management based on family doctors' contract service is an essential approach for promoting healthy aging for rural older adults in China, yet its implementation is influenced by various factors.
To summarize influencing factors of health management for older adults contracted by rural family doctors in China, providing the basis of reference for the accessibility and effectiveness.
From January to April 2023, the PRISMA-ScR checklist was used. Studies on health management by family doctor contract service were searched from databases of Web of Science, PubMed, Embase, Medline, CINAHL, CNKI, Wanfang Data, VIP, and CBM from inception to December 2022, and enrolled according to the inclusion and exclusion criteria. Relevant data were extracted, collected, summarized and reported guided by the Social Ecological Model.
A total of 27 articles were included. We extracted 5 levels of influencing factors related to health management for older adults by family doctors contracted service in rural areas, including individual, interpersonal, organizational, community and policy.
The implementation of health management for older adults contracted by rural family doctors is influenced by multiple factors. To promote the development of health management for older adults in rural areas, it is necessary to comprehensively consider these influencing factors, clarify the rights and responsibilities of relevant departments and parties, and jointly promote the improvement of the quality and efficiency of health management services based on family doctor contract services.
Since China officially entered into an aging society in 1999, the issue of population aging has escalated significantly, leading to institutional care becoming a popular option for older people. However, falls among residents are a recurring problem, and the current assessment tools have shown limited effectiveness.
To construct a comprehensive fall risk assessment tool for older people in elderly care institutions and verify its reliability and validity.
From March to December 2021, the initial item pool of the tool was developed through a literature review, semi-structured interviews and 2 rounds of expert consultation and pre-investigation. Older people and nursing assistants in elderly care facilities were randomly selected to make a survey. SPSS 26.0 and AMOS 26.0 software were used to analyze and evaluate the reliability and validity of the assessment tool. The correlation coefficient method, critical ration, internal consistency test and exploratory factor analysis were used for item analysis and screening. The intrinsic reliability, split-half reliability, scores reliability and inter-item consistency reliability were used to examine the reliability; face validity, content validity, criterion-related validity, contract validity and discriminant validity were used to examine the validity.
The assessment tools included three sub-instruments: (i) Fall risk assessment scale for older people; (ii) Fall record form for older people; (iii) Daily fall risk checklist for older people. The total Cronbach's alpha coefficient for sub-instrument (i) was 0.73 and the scorer reliability coefficient was 0.85; the exploratory factor analysis extracted three common factors with a cumulative variance contribution of 57.95%; the fit indices of the confirmatory factor model: Chi-square degrees of freedom ratio (χ2/df), Goodness of fit index (GFI), adjusted goodness of fit index (AGFI), standardized moderate index (NFI), comparative fit index (CFI), Tucker-Lewis coefficient (TLI), approximation error (RMSEA) were 2.43, 0.95, 0.91, 0.89, 0.93, 0.91, and 0.07, and discriminant validity is statistically significant (P<0.001). The results of the predictive ability analysis showed an area under the test work characteristic curve (AUC) of 0.87 for Morse Fall Scale (MFS) ≥55 and 0.84 for MFS≤25. Sub-instrument (ii) and (iii) were evaluated by a combination of experts and nursing assistants to form the final version.
This study has developed a comprehensive fall risk assessment tool for elderly people in elderly care institutions, which contains three sub-instruments that complement each other to improve the whole pathway from assessment to prevention, with good reliability, validity and predictive ability, and can provide a reference for fall prevention and management in the future.
Coronary atherosclerotic heart disease (CHD) is one of the leading causes of mortality worldwide, and research on risk assessment for CHD has been growing annually. However, the issue of data imbalance in these studies is often overlooked, despite its crucial role in enhancing the accuracy of CHD risk identification within classification algorithms.
To investigate the factors influencing CHD and to establish predictive models for CHD risk using two data balancing methods based on five algorithms, comparing the predictive value of these models for CHD risk.
Utilizing cross-sectional survey data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) in the United States, a cohort of 112 606 participants was identified, featuring 24 variables related to risk behaviors and health status, with self-reported coronary heart disease (CHD) as the outcome measure. Factors influencing the incidence of CHD were explored through univariate analysis and stepwise logistic regression to select pertinent variables for inclusion in the predictive model. A random sample comprising 10% of the participants (11 261 individuals) was drawn and then randomly divided into training and testing datasets at an 8∶2 ratio. To address data imbalance, two over-sampling techniques were employed: random oversampling and the Synthetic Minority Over-sampling Technique (SMOTE). Based on these methods, CHD predictive models were constructed using five different algorithms: K-Nearest Neighbors (KNN), Logistic Regression, Support Vector Machine (SVM), Decision Tree, and XGBoost.
Univariate analysis revealed significant differences (P<0.05) between the CHD and non-CHD groups across all input variables except for rental housing and being informed of prediabetic status. Stepwise Logistic regression identified age, gender, BMI, ethnicity, education level, income level, being informed of hypertension, being informed of prehypertension, being informed of pregnancy-induced hypertension, current use of antihypertensive medication, being informed of hyperlipidemia, being informed of diabetes, smoking status, alcohol consumption within the last 30 days, heavy drinking status, and self-assessed health as factors influencing CHD. The performance of risk models using SMOTE showed overall classification accuracies of 59.2%, 67.4%, 66.2%, 69.2%, and 85.9%; recall rates of 75.2%, 71.4%, 70.5%, 62.9%, and 34.8%; precision of 15.4%, 18.2%, 17.5%, 17.6%, and 28.7%; F-values of 0.256, 0.290, 0.280, 0.275, and 0.315; and AUC values of 0.80, 0.78, 0.72, 0.72, and 0.82, respectively. Using random oversampling, the models achieved classification accuracies of 62.5%, 68.5%, 69.0%, 60.2%, and 70.1%; recall rates of 70.0%, 69.5%, 71.9%, 69.0%, and 67.6%; precision of 15.8%, 18.4%, 19.1%, 14.8%, and 19.0%; F-values of 0.258, 0.291, 0.302, 0.244, and 0.297; and AUC values of 0.80, 0.77, 0.72, 0.72, and 0.83, respectively.
This study not only confirmed known factors affecting CHD but also identified potential impacts of self-assessed health level, income level, and education level on CHD. The performance of the five algorithms was significantly enhanced after employing two data balancing methods. Among them, the XGBoost model exhibited superior performance and can be referenced for future optimization of CHD prediction models. Additionally, considering the excellent performance of the XGBoost model and the convenience and interpretability of stepwise logistic regression, a combined use of these approaches after data balancing is recommended in CHD risk prediction models.
The imaging of COVID-19 (COVID-19) in children is different from that of adults, mainly manifested as subpleural ground glass shadows, patchy high-density shadow, and solid shadow, and rarely complicated with pneumomediastinum. The formation of a large number of emphysema can seriously affect the respiratory and circulatory function, resulting in obvious wheezing and hypoxemia, which need to be actively treated.
To analyze and summarize the imaging and clinical characteristics of COVID-19 with pneumomediastinum in children.
A retrospective analysis was conducted on 8 pediatric patients with COVID-19 complicated with pneumomediastinum admitted to the Department of Pediatrics at Jingzhou Hospital Affiliated with Yangtze University from December 1, 2022 to January 30, 2023, including age, gender, imaging, clinical characteristics, and treatment.
8 children were 3.5 years to 12 years, with a female ratio of 3∶5. High Resolution CT Scan in all children showed double lung infection combined with pneumomediastinum, and multiple emphysema involved the neck and chest wall. The pulmonary manifestations were various: subpleural ground glass shadow, consolidation, tree bud sign, vascular bronchial bundle thickening and bronchial wall thickening, grid sign, etc., no large consolidation and "white lung" found. One case was observed to have a small amount of pleural effusion. In addition to fever and cough, the clinical manifestations were obvious shortness of breath, pulmonary auscultation, but dry or moist rales were not significant. Four children with mycoplasma infection were treated with azithromycin, and one with B. catarrhalis. was treated with azithromycin. All given oxygen therapy. A patient was treated with an invasive ventilator because traditional treatment was unable to alleviate her dyspnea and hypoxemia. The patient's leucocytes and hypersensitive CRP were significantly increased. After 3 days, the symptoms improved and the machine was successfully withdrawn. 5 cases were treated with intravenous immunoglobulin (IVIG), and 3 cases were treated with glucocorticoids. a week after the review of chest CT, pneumomethinum were completely absorbed, and lung lesions significantly improved.
Children with pneumomediastinum complicated by COVID-19 were mostly pre-school or school-age children, rare in infants. Pneumomediastinum can coexist with gas accumulation in the neck and chest wall. In addition, pulmonary lesions could involve the stroma or parenchyma, and both lungs were affected, with various manifestations. At the onset of the disease, there were obvious shortness of breath, active oxygen therapy was recommended. When the white blood cell count and hypersensitivity CRP significantly increase, close attention should be paid to respiratory conditions. IVIG and glucocorticoids may have positive effects, and if necessary, a mechanical ventilation should also be used.
To support the advancement of the "Healthy China" policy, is paper delves into the significance of interprofessional collaboration between health social workers and general practitioners in the primary healthcare setting. With a focus on three vital areas, including the synergy of complementary professional knowledge, integration with hospitals and communities, and the expansion of social health research, particularly in strengthening the public health emergency response system and boosting medical alliances. Synergistic efforts between health social workers and general practitioners can serve as a vital component in promoting nationwide health initiatives and fostering healthier societies. Furthermore, this paper proposes countermeasures to address the key challenges surrounding health social work.
Given the increasing prevalence of the high incidence of bone and joint diseases in the elderly population, and significantly associated with higher mortality, more disability, decline in functional status and lower quality of life, this creates a large disease burden. There is currently no research on the prevalence and influencing factors of this disease in Henan Province.
To provide scientific basis for understanding the epidemic characteristics and influencing factors of bone and joint diseases in the elderly population in Henan Province and implementing precise prevention and control.
The multi-stage random cluster sampling method was used to obtain the demographic characteristics, past disease history, physical activity and physical indicators of permanent residents aged≥18 years old in Henan Province in 2018 through questionnaires, medical physical examination, laboratory testing and other methods. 1 055 people aged ≥60 years old were included in this study. Multivariate Logistic regression was used to analyze the characteristics and influencing factors of bone and joint diseases in the elderly population with different characteristics in Henan Province.
The incidence rate of bone and joint diseases among the elderly population in Henan Province in 2018 was 28.13% (95%CI=28.10%-28.15%). Among them, women, urban areas, those with overweight or obesity, central obesity, dyslipidemia or hyperlipidemia, snoring history, moderate intensity activity, and non-smoking history have higher incidence rates, and the differences are statistically significant (P<0.05). Multivariate Logistic regression analysis showed that males (OR=0.717, 95%CI=0.550~0.933, P=0.013) were protective factors for bone and joint diseases in the elderly population, while overweight or obesity (OR=1.329, 95%CI=1.050-1.684, P=0.018) and central obesity (OR=1.305, 95%CI=1.047-1.626, P=0.018) were risk factors for bone and joint diseases in the elderly population.
Bone and joint diseases in the elderly population in Henan Province are related to gender, BMI, and central obesity. Targeted health education and comprehensive intervention should be carried out for women, overweight or obese individuals, and central obesity in the elderly population.
Anthracyclines are fundamental in the chemotherapy treatment of breast cancer, but these treatments often lead to changes in physique, such as increased body fat and decreased cardiopulmonary function, alongside gastrointestinal reactions and bone marrow suppression, thereby impacting the patients' quality of life. Current studies on the ameliorative effects of exercise on these side effects yield inconsistent results, necessitating further research. Clinically, the efficacy and safety of exercise prescriptions in mitigating these chemotherapy side effects in breast cancer patients warrant further exploration.
This study aims to investigate the effectiveness and safety of aerobic exercise in improving the physique and quality of life of breast cancer patients during anthracycline-based chemotherapy.
This study is a randomized controlled trial involving 44 adult female breast cancer patients who received anthracycline-based chemotherapy at Beijing Chaoyang Sanhuan Cancer Hospital, from March 2022 to January 2023. They were randomly assigned to an exercise group (23 participants) and a control group (21 participants). The control group was informed about personalized exercise guidance after chemotherapy. The exercise group, under the supervision of rehabilitation therapists, engaged in workouts during their hospital stay and continued personalized exercise interventions at home with self-monitoring and remote supervision by researchers. Key outcome measures, including physique and quality of life, were collected before and after chemotherapy, along with the incidence and severity of gastrointestinal reactions, bone marrow suppression, and exercise-related adverse events. Covariance analysis, using pre-chemotherapy data as covariates, compared the physique and quality of life between the two groups.
Four participants were lost during the intervention and follow-up, leaving 40 participants (21 in the exercise group, 19 in the control group). No severe adverse events were observed during the exercise intervention. The average compliance with the exercise intervention was 81.8%; average compliance per exercise session was 91.9%, and average compliance with exercise intensity was 92.5%. Post-chemotherapy, the exercise group showed lower body fat weight, body fat percentage, visceral fat area, waist circumference, waist-to-hip ratio, and significantly higher grip strength of the dominant hand and relative peak oxygen uptake (VO2peak) compared to the control group (P<0.05). The incidence of functional impairments post-chemotherapy in the exercise group (7/20) was significantly lower than in the control group (12/16) (χ2=5.707, P=0.017). Post-chemotherapy, the exercise group reported significantly lower scores in physical condition, emotional condition, and additional scores, and higher functional condition scores than the control group (P<0.05). Post-chemotherapy, the control group's physical condition scores (P<0.001) and the exercise group's functional condition scores (P=0.017) were higher than pre-chemotherapy. The control and exercise groups underwent 84 and 94 anthracycline chemotherapy sessions, respectively, with the control group experiencing 84 gastrointestinal reactions and 71 bone marrow suppressions, and the exercise group experiencing 54 gastrointestinal reactions and 45 bone marrow suppressions, showing statistically significant differences between the groups (P<0.05) .
Aerobic exercise during anthracycline chemotherapy can improve the physique and quality of life of breast cancer patients and is safe when supervised.
Acute kidney injury (AKI) is a common complication of sepsis. Immune-inflammatory markers are commonly used to assess the prognosis of these patients. However, studies evaluating microRNAs (miR) in this context are scarce, indicating a need for further clinical investigation.
To investigate the expression of serum amyloid A (SAA), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and miR in pediatric patients with sepsis-induced AKI and analyze their prognostic assessment value.
This study included 100 pediatric patients with sepsis-induced AKI admitted to the First People's Hospital of Pingdingshan from March 2020 to March 2023 as the observation group, and 80 pediatric patients with sepsis alone as the control group. General patient data were collected, and serum levels of SAA, IL-6, and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). The relative expression of miR-21-3p, miR-182-5p, and miR-128-3p was quantified using real-time quantitative PCR. The Sequential Organ Failure Assessment (SOFA) score and the Acute Physiology and Chronic Health EvaluationⅡ (APACHE Ⅱ) score were compared between the groups. Pearson correlation analysis was used to evaluate the relationship between the levels of serum SAA, IL-6, TNF-α, and miRs and the SOFA and APACHEⅡ scores. Receiver operating characteristic (ROC) curves were plotted to explore the predictive value of these markers for mortality in pediatric patients with sepsis-induced AKI and to calculate the area under the ROC curve (AUC) .
The observation group showed significantly higher SOFA scores, APACHE Ⅱ scores, and levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p compared to the control group (P<0.05). After 28 days of hospitalization, 74 patients in the observation group survived, while 26 died. Surviving patients had lower levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p compared to those who died (P<0.05). Levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p were positively correlated with SOFA and APACHEⅡ scores (P<0.05). ROC curve results showed a combined predictive AUC of 0.926 (95%CI=0.856-0.969, P<0.05) .
The serum levels of SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, miR-128-3p are abnormally high in children with sepsis complicated with AKI. Clinical detection of these indicators has a high value and early warning effect on the prognosis of children.
Remnant cholesterol (RC) is considered a significant risk factor for atherosclerotic cardiovascular diseases, and the progression of non-culprit coronary lesions (NCCLs) is also a prominent issue affecting the prognosis of patients with coronary artery disease. However, the relationship between residual cholesterol and vulnerable plaques in NCCLs that progress to major adverse cardiovascular events (MACE) is not well understood.
To explore the predictive value of RC for vulnerable plaques in NCCLs that develop MACE and its correlation with long-term prognosis.
A total of 488 patients with coronary artery disease admitted to the Cardiac Center of the First Affiliated Hospital of Xinjiang Medical University from February 2015 to February 2022 were selected as the study subjects. Baseline data of the patients were collected through the electronic medical record system, and coronary angiography and optical coherence tomography (OCT) were performed. Enrolled patients received scheduled follow-up at 1, 3, 6, and 12 months after discharge. Spearman's rank correlation test was used to explore the correlation between RC and the characteristics of thin-cap fibroatheroma (TCFA) plaques in NCCLs. Multiple Logistic regression analysis was used to explore the influencing factors of MACE in TCFA of NCCLs. The receiver operating characteristic curve (ROC curve) was plotted, and the area under the ROC curve (AUC) was calculated to explore the predictive value of RC for MACE in TCFA of NCCLs.
A total of 488 coronary artery disease patients were included, and patients were divided into MACE group (n=38) and non-MACE group (n=450) based on whether NCCLs developed MACE. Plaque characteristics of NCCLs were identified by OCT, and a total of 749 NCCL plaques were analyzed, with 304 NCCL plaques having a minimum lumen area (MLA) <3.5 mm2. During the follow-up period, 38 patients (7.8%) experienced 41 MACE events caused by NCCL plaques, 18 patients (3.7%) developed in-stent restenosis, and 15 patients (3.1%) had deaths due to uncertain factors. The proportion of patients with hypertension, diabetes, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), RC, glycated hemoglobin (HbA1c), TCFA, and MLA <3.5 mm2 in the MACE group was higher than that in the non-MACE group (P<0.05). TCFA was detected in 105 patients, of which 22 cases developed MACE (TCFA MACE group), and 83 cases did not develop MACE (non-TCFA MACE group). The proportion of diabetes and RC in the TCFA MACE group was higher than that in the non-TCFA MACE group (P<0.05). The results of Spearman's rank correlation analysis showed that RC was negatively correlated with the thinnest fibrous cap thickness and MLA (rs=-0.665、-0.771, P<0.05), and positively correlated with the maximum lipid arc and macrophage infiltration (rs=0.806、0.481, P<0.05). The results of Multiple Logistic regression analysis showed that diabetes (OR=3.410, 95%CI=1.165~9.988, P=0.025) and high level of RC (OR=5.879, 95%CI=1.436-24.073, P=0.014) was a risk factor for MACE in TCFA of NCCLs. The ROC curve for predicting MACE in TCFA of NCCLs by RC showed an AUC of 0.695 (95%CI=0.571-0.819, P=0.005), with the optimal cutoff value of 0.606 mmol/L, and sensitivity and specificity of 0.818 and 0.518, respectively.
Elevated levels of RC may be a risk factor for the development of MACE in vulnerable plaques of NCCLs in patients with coronary artery disease, and it has certain predictive value for MACE in TCFA of NCCLs.
Ischemic heart disease (IHD) is the second leading cause of disease burden in the Chinese population, and dietary factors are considered as effective and feasible approaches to reduce the disease burden.
To analyze the trends in the disease burden of IHD attributable to dietary factors from 1990 to 2021 and future trends in China, aiming to provide a reference basis for dietary prevention and treatment of IHD in China.
Data related to the disease burden of IHD attributable to dietary factors in China, worldwide, and regions with varied socio-demographic index (SDI) from 1990 to 2021 were extracted from the Global Burden of Disease 2021 (GBD 2021) database. Using the Joinpoint model, the annual percent change (APC) and average annual percent change (AAPC) were calculated to analyze the disease burden of IHD attributable to dietary factors in China, worldwide, and regions with varied SDI. Furthermore, the model evaluated the diet-ralated disease burden by gender and age groups in China, as well as the burden of disease attributable to specific dietary factors within the Chinese population from 1990 to 2021. Additionally, the Bayesian age-period-cohort (BAPC) model was used to predict the standardized mortality rate and the standardized disability-adjusted life year (DALY) rate of IHD attributable to dietary factors from 2022 to 2031.
In 2021, the standardized mortality rate and standardized DALY rate of IHD attributable to dietary factors in China were 44.26/100 000 and 820.87/100 000, respectively, which were close to the global levels, but higher than those of high SDI regions and lower than the remaining four categories of SDI regions. From 1990 to 2021, the standardized mortality rate (AAPC=-0.17%, P<0.001) and the standardized DALY rate (AAPC=-0.50%, P<0.001) of IHD attributable to dietary factors in China showed a decreased trend, which were consistent with the global trend and those in the five categories of SDI regions. The global decrease was significantly higher than that in China, with the fastest decrease in the high SDI regions. Disease burden of IHD attributable to dietary factors was significantly higher in Chinese males than in females in 1990 and 2021. The standardized mortality rate (AAPC=0.25%, P<0.001) of IHD attributable to dietary factors in Chinese males showed an increasing trend from 1990 to 2021. The standardized mortality rate (AAPC=-0.71%, P<0.001) and standardized DALY rate (AAPC=-1.23%, P<0.001) in Chinese females both showed a decreased trend. Disease burden of IHD attributable to dietary factors showed an increased trend with age in China in 1990 and 2021, and the highest mortality and DALY rate were detected in people ≥70 years old. The mortality and DALY rate of IHD attributable to dietary factors for the residents aged 50-69 years showed a decreased trend from 1990 to 2021, while those in the 15-49 years and ≥70 years showed an increased trend (P<0.001). Among the 13 dietary factors attributed to the standardized mortality and standardized DALY rate of IHD in 1990 and 2021, the top were excessive sodium intake and insufficient intake of whole grains. Dietary factors attributed to the most significant increased trends in the standardized mortality and standardized DALY rate of IHD from 1990 to 2021 were excessive intake of sugar-sweetened beverages, excessive intake of processed meats, and red meat intake. The BAPC model showed that the standardized mortality rate and standardized DALY rate of IHD attributable to dietary factors in China will decline over the next 10 years.
From 1990 to 2021, the standardized mortality and standardized DALY rate of IHD attributable to dietary factors decreased in China, but the decline is slower compared to high SDI regions. Disease burden of IHD attributable to dietary factors is heavier among men and the elderly. Therefore, it is essential to focus on dietary prevention and control strategies for IHD. Efforts should be made to promote healthy dietary patterns, increase the intake of whole grains, and reduce the consumption of sodium, sugar-sweetened beverages, processed meats, and red meats. Targeted measures and effective interventions are needed to further reduce the disease burden.
Intestinal infectious diseases are one of the common infectious diseases. Analysis and prediction of their epidemic status can provide certain reference for the prevention and treatment of intestinal infectious diseases.
To understand the incidence and mortality of three enteric infectious diseases, including diarrheal diseases, typhoid fever and paratyphoid fever, and invasive non-typhoidal Salmonella intestinal infections in China from 1990 to 2019, and to predict their morbidity and mortality from 2020 to 2030, so as to provide reference for the prevention and control of intestinal infectious diseases.
Based on the 2019 Global Burden of Disease Database (GBD), the incidence and mortality data of three enteric infectious diseases, including diarrheal diseases, typhoid fever and paratyphoid fever, and invasive non-typhoidal Salmonella intestinal infections in China from 1990 to 2019 were collected. The change rate (%) and estimated annual percentage change (EAPC) were used to describe the changing trends of the above three intestinal infectious diseases. The autoregressive integrated moving average model (ARIMA) was used to predict the morbidity and mortality of the above three enteric infectious diseases in China from 2020 to 2030.
There was no statistically significant change in the incidence of diarrheal diseases from 1990 to 2019 (EAPC=0.09, P>0.05), while the incidence of typhoid fever, paratyphoid fever and invasive non-typhoid salmonella intestinal infections showed a downward trend (EAPC were -4.0% and -0.64% respectively, P<0.05). The mortality rates of diarrheal diseases, typhoid fever and paratyphoid fever, and invasive non-typhoidal Salmonella intestinal infections all showed a downward trend from 1990 to 2019 (EAPC were -8.39%, -3.38%, and -1.87%, respectively, P<0.05). Among all age groups, the incidence of diarrheal disease among people aged ≥70 years in 2019 was the highest among all age groups, and it was on the rise (EAPC=0.27, P<0.05). The mortality rates of the above three intestinal infectious diseases in all age groups from 1990 to 2019 showed a downward trend (P<0.05). The ARIMA model prediction results show that the incidence of diarrheal diseases in China will be on an upward trend from 2020 to 2030, while the incidence of typhoid and paratyphoid fever and invasive non-typhoid Salmonella will be on a downward trend. The estimated incidence of the above three diseases was 58 793.04/105, 5.26/105, 0.447/105, respectively. In addition, the mortality rates of diarrheal diseases, typhoid fever and paratyphoid fever, and invasive non-typhoid Salmonella in our country will all show a downward trend from 2020 to 2030. The mortality rates of the above three diseases in 2030 were expected to be 0.214/105 and 0.039/105, 0.026/105, respectively.
The mortality rates of diarrheal diseases, typhoid fever and paratyphoid fever, and invasive non-typhoidal Salmonella intestinal infections in China will show a downward trend in 2030. Except for the incidence of diarrheal diseases, which will show an upward trend, the incidence of the other two diseases will show a downward trend. It reminds the government and relevant health departments to pay attention to diarrheal diseases and adopt different prevention and control measures for different groups of people.
Smoking cessation related behavior change techniques (BCTs) are defined as interventions that can change smokers' smoking behavior. At present, there are no studies to explore the current status of BCTs usage among outpatient healthcare workers for smoking cessation in China.
The current study aims to describe the frequency and perceived effect of medical staff using BCTs in smoking cessation clinics, and to investigate the association between the usage of BCTs by medical staff and successful quitting rate among smokers in smoking cessation clinics.
From February 2022 to March 2023, online questionnaire was distributed to medical staff in smoking cessation clinics in China through "WJX" to evaluate the frequency and perceived effect of 44 smoking cessation BCTs used, the success rate of smoking cessation, as well as the demographic characteristics such as age and gender. The hierarchical linear regression model and simple slope analysis were utilized to explore the factors affecting the success rate of quitting in smoking cessation clinics and to examine the interaction between frequency and perceived effect of BCTs used for promoting smoking cessation.
Two-hundred and eighty-five healthcare professionals who had experience in smoking cessation clinics over one year were included in this study. On average, it is reported that healthcare professionals have used (29±13) smoking cessation related BCTs. The perceived average score for effectiveness of BCTs used was (3.15±0.96). The self-reported average success rate of smoking cessation was (37.0±24.3) %. There were statistically significant differences in the number of BCTs used and the perceived effect of medical staff with different highest education level and whether tracking smoking cessation rate of smokers (P<0.05). There were also statistically significant differences in the smoking cessation rate among medical staff with different years of working in smoking cessation clinics, position in the hospital and whether tracking smoking cessation rate (P<0.05). The hierarchical linear regression showed that after controlling for three variables, including the years of working in the clinics, the position of the clinic staff, and whether tracking smoking cessation rates of smokers, the perceived effect of BCTs used could positively predict the success rate of smoking cessation in the smoking cessation clinic [b (95%CI) =10.070 (7.066-13.075), P<0.05]. While the number of BCTs used was not a significant factor in the success rate of smoking cessation (P>0.05). When the interaction item of BCTs used × effect perception was further included, the explanatory of the model for the success rate of smoking cessation in the smoking cessation clinic increased by 2.2%, and the perceived effect of BCTs [b (95%CI) =11.711 (8.548-14.874), P<0.05], the number of BCTs used × effect perception had a positive predictive effect on the success rate of smoking cessation [b (95%CI) =2.921 (0.958-4.884), P<0.05] .
The use of quitting BCTs had a significant impact on the rate of successful smoking cessation in the smoking cessation clinic, and the number of BCTs used and the perceived effect had a significant interaction effect on the success rate of smoking cessation. In the future, it is necessary to improve the training program of smoking cessation practices, and accelerate the transformation and implementation of smoking cessation related BCTs so as to help more smokers to quit smoking successfully.
In recent years, the number of diabetics in China ranks first in the world. While recommending metformin as the first-line hypoglycemic drug, the Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 edition) emphasize "patient-centere" and select appropriate second-line hypoglycemic agents for combination administration according to the clinical characteristics and preferences of patients. Because there are great differences in the prevalence rate and life behavior of type 2 diabetes between the north and the south of China, whether there is a difference in the second-line drug preference of patients with type 2 diabetes between the two places remains to be further demonstrated.
To analyze the difference of second-line drug preference among patients with type 2 diabetes mellitus in North and South China, and to provide empirical evidence for clinical and health management decision-making.
The study adopts a Discrete Choice Experimental design, Mixed Logit Model was used to analyze drug preference of patients with type 2 diabetes in the north and south of China based on Multi-stage random cluster sampling and convenient sampling, from October 2021 to January 2022.
In this study, 1 443 questionnaires were distributed, and 1 388 were valid, with an effective recovery rate of 96.19%. Logit model analysis showed that the effect of blood sugar control, the risk of hypoglycemia, the risk of gastrointestinal side effects, whether the cardiovascular system can be protected, the way of taking drugs and the out-of-pocket cost/month were the influencing factors of the second-line drug preference of southern patients (P<0.05). Patients with type 2 diabetes in South China prefer to take oral second-line hypoglycemic drugs with 0 yuan, no risk of gastrointestinal side effects, strong blood sugar control effect, no risk of hypoglycemia events, and can protect the cardiovascular system (P<0.05). When the risk of gastrointestinal side effects changes from high to no risk, patients in South China are willing to pay 408.06 yuan per month. The effect of blood sugar control, the risk of hypoglycemia, the risk of gastrointestinal side effects, whether the cardiovascular system can be protected, the way of taking medicine, out-of-pocket expenses/month, and the change of body mass within half a year are the influencing factors of the preference for second-line medication in northern patients (P<0.05). The patients with type 2 diabetes in the north prefer the second-line hypoglycemic drugs with 0 yuan, strong blood sugar control effect, no risk of hypoglycemia events, cardiovascular protection and no risk of gastrointestinal reaction, taking orally and reducing body weight by 2.0 kg within six months (P<0.05). When the blood sugar control effect is weak and changed to strong, the patients in the north are willing to pay 435.98 yuan per month.
In addition to out-of-pocket expenses/month, patients with type 2 diabetes in the south pay more attention to gastrointestinal side effects, while patients with type 2 diabetes in the north pay more attention to the effect of blood sugar control. There are differences in second-line medication preferences between the two places. Regional differences provide a basis for individualized treatment of patients with type 2 diabetes mellitus. Clinical diagnosis and treatment should be "patient-centere" and pay attention to individual preference differences.
Hypertension is a common chronic disease that seriously endangers the health of the population. The primary-care doctors are the main force in the management of hypertension. However, the doctor-induced therapeutic of inertia greatly affects the achievement of primary-care hypertension control.
The aim of this study is to investigate the current status of therapeutic inertia among primary healthcare providers in the diagnosis and treatment process of hypertension, and analyze the causes of therapeutic inertia, providing a reference basis for improving hypertension control rates in China.
A simple random sampling method was used to distribute questionnaires to primary healthcare providers in 32 primary healthcare institutions in Tianjin from July to August 2023. The therapeutic inertia in the diagnosis and treatment process of hypertension was evaluated from three dimensions: "soft reasons" and "overestimation of treatment efficacy" as well as "medical insurance policies". Binary Logistic regression analysis was employed to explore the influencing factors of therapeutic inertia.
A total of 407 questionnaires were distributed in this study, and 386 valid questionnaires were collected, yielding an effective response rate of 94.84%. The average score for primary healthcare providers' knowledge of hypertension diagnosis and treatment was 6 (0.5), with a scoring rate of 61.11% (5.50/9.00). The total score for therapeutic inertia in hypertension management was 48 (7.0), with a scoring rate of 56.55% (45.24/80.00). The scores for the "soft reasons" dimension, "overestimation of treatment efficacy" dimension, and "medical insurance policies" dimension were 26 (4.8), 10 (2.0), and 6 (2.5) respectively, with scoring rates of 51.92% (25.96/50.00), 65.40% (9.81/15.00), and 46.40% (6.96/15.00) respectively. When comparing the average scores of the three dimensions of therapeutic inertia, the "overestimation of treatment efficacy" dimension had the highest score compared to the other two groups (P<0.05). Multivariate analysis indicated that gender, region, mastery of hypertension diagnosis and treatment, and a daily voulme of hypertensive individuals treated are the main factors influencing Therapeutic inertia among primary care physicians (P<0.05) .
Therapeutic inertia is prevalent among primary healthcare providers in the diagnosis and treatment process of hypertension. Low levels of hypertension treatment cognition, "overestimation of treatment efficacy", and "soft reasons" are the primary factors contributing to therapeutic inertia among primary healthcare providers. It is recommended to strengthen education on therapeutic inertia in hypertension, conduct diversified training on diagnostic and management knowledge, and promote clinical informatization and artificial intelligence decision-making systems to effectively improve the therapeutic inertia of primary healthcare providers in hypertension management.
The incidence of Parkinson's disease (PD) is increasing year by year, which has increased the disease burden of medical insurance, and the current chronic disease management model has not played a role in the community management of PD patients.
To explore the effect of PD management model led by a movement disorders specialist and centered on community doctors, in order to improve the comprehensive management ability of community doctors for PD patients and improve the quality of life of PD patients.
One hundred and two PD patients who were treated at the Neurology Department of the Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology from January 2022 to May 2023 were selected as the research subjects and were divided into the control group and the active intervention group by random digit table method, with 51 cases in each group. The control group received conventional community management, while the active intervention group received proactive management by community doctors specializing in PD. The management content included drug adjustment, exercise rehabilitation, dietary nutrition, cognitive function and psychological function management. Evaluations were conducted for the patients within one week of their return to the community (before intervention) and six months later (after intervention). The evaluation included a single day equivalent dose of levodopa, UPDRS-Ⅲ, UPDRS-Ⅳ, Hoehn-Yahr (H-Y) staging, and 39-item Parkinson's Disease Quality of Life Questionnaire (PDQ-39) .
At 6 months, the levodopa equivalent dose in the active intervention group was higher than before management, and the UPDRS-Ⅲ score, other complication dimensions of UPDRS-Ⅳ, and PDQ-39 score were lower than before (P<0.05). The Spearman rank correlation analysis results showed that the difference in PDQ-39 scores between the active intervention group and the control group before and after management was positively correlated with their scores in mental health, humiliation, cognition, social support, communication, and physical discomfort (rs values ranged from 0.651 to 0.893, P<0.05), positively correlated with the score of other complication dimensions of UPDRS-Ⅳ (rs=0.338, P<0.05), but not correlated with the UPDRS-Ⅲ score (P>0.05). The results of the univariate Logistic regression analysis showed that the probability of PDQ-39 reduction in the active intervention group was 11.769 times that of the control group (95%CI=4.340-31.918, P<0.001) .
The PD management model led by movement disorder specialists and centered on community doctors can improve the quality of life of patients, which provides a reference for PD community management.
With the continuous development of society and technological innovations, the average life expectancy of human beings has gradually increased, leading to the gradual increase in the number of perimenopausal women. This trend poses a serious challenge to the management of perimenopausal health in the community.
To understand the health characteristics and health needs of perimenopausal women in the community, explore the relationship between the two, and provide evidence to support the development and improvement of perimenopausal health management in community health service organisations.
Perimenopausal women (n=260) who attended or were accompanied to the Huamu Community Health Service Centre and its subordinate stations in Pudong New Area, Shanghai, from February to March 2023 were selected as study subjects. Questionnaires were used to collect information on the health characteristics of the study subjects (related to physiological stage, social characteristics, disease status, lifestyle, and quality of life), their knowledge of menopause and attitudes toward treatment, as well as their needs for knowledge related to menopause and preventive health care for menopausal diseases.
Fifty percent (130/260) of perimenopausal women had a current history of chronic disease, 51.9% (135/260) of perimenopausal women had a past history of chronic disease, 73.8% (192/260) of perimenopausal women had fair/poor quality of sleep, 33.5% (87/260) of perimenopausal women did little exercise. 58.5% (152/260) of perimenopausal women were completely unaware or had only heard of menopause, 41.9% (109/260) of perimenopausal women had a negative attitude towards menopause treatment, 45.0% (117/126) of perimenopausal women needed menopause-related knowledge, and 66.6% (173/260) of perimenopausal women needed preventive health care for menopausal diseases. The results of ordered multicategorical Logistic regression analyses showed that literacy, the number of menopausal symptoms in the last 3 monthss, and attitudes toward menopause treatment were the factors influencing perimenopausal women's need for menopause-related knowledge (P<0.05), and literacy and attitudes toward menopause treatment were the factors influencing perimenopausal women's need for preventive health care for menopausal diseases (P<0.05) .
This study reveals the influence of health characteristics (e.g., literacy level, symptom severity) on health needs of perimenopausal women. Community health service providers should optimise health management programmes for perimenopausal women based on accurate data and provide comprehensive and personalised health management services for perimenopausal women in the community.
The memory and self-care abilities of older adults with chronic diseases are gradually declining, and relying solely on their personal strength for disease self-management is difficult to achieve good results, requiring more help from others. When providing health education to older adults with chronic diseases, it is not only necessary to focus solely on the elderly, but also to fully utilize the patient's social network and involve social network members in the disease management of the patients, to more effectively improve their self-management ability.
To explore the impact of social network-based health education on the self-management ability of older adults with chronic diseases in community.
From March 2021 to June 2022, older adults with chronic diseases who visited Beijing Fangzhuang Community Health Service Center, Clinic of Tsinghua Changgeng Hospital and Endocrinology Clinic of Beijing Hospital, Hongliancun Community were recruited. Using a computer-generated random number table, the older adults were assigned numbers in the order of recruitment, with odd numbers being intervention group and even numbers being control group. They were randomly divided into an intervention group and a control group in a 1∶1 ratio. The older adults in the intervention group received health education with their social network members, while those in the control group received health education alone. The Chronic Disease Self-Management Study Scale (CDSMS) was used to evaluate the effectiveness of chronic disease self-management before intervention, at the 6th and 12th months of intervention, meanwhile the Lubben Social Network-6 (LSNS-6) was used to assess their social network level.
Eighty older adults with chronic diseases were enrolled, of which 1 patient (in control group) withdrew from the study due to two hospitalizations during the study period. Finally, 79 older adults completed the study: 40 older adults in the intervention group+40 members of their social network, and 39 older adults in the control group. The exercise dimension, cognitive symptom management dimension of self-management behavior subscale, and self-efficacy subscale of CDSMS had an interactive effect on time and grouping (Finteration-values were 7.174, 8.488, and 9.939, respectively, P<0.05) ; The main effect of time on the two subscales of CDSMS was significant (Ftime-values were 13.527, 12.188, 7.576, 5.058, respectively, P<0.05) ; The main effects of grouping on three dimensions of CDSMS self-management behavior subscale were significant (Fgroup-values were 12.324, 7.383, 5.927, respectively, P<0.05). At the 6th month of intervention, the CDSMS exercise dimension score in the intervention group was higher than that in the control group (t=2.852, P=0.006), the difference was statistically significant. At the 12th month of intervention, the CDSMS exercise dimension score in the intervention group was higher than that in the control group (t=4.473, P<0.05), the score of cognitive symptom management dimension was higher than that in the control group (t=-2.780, P=0.005), the self-efficacy subscale score was higher than that in the control group (t=2.993, P=0.004), the differences were statistically significant.
A 12-month social network-based health education can improve some of the self-management behaviors and self-efficacy with chronic diseases.
The construction of medical alliance is important measure for deepening medical reform. It aims to move the focus and resource to primary health care institutions, and improve service capabilities. Studies have shown that the medical alliance can improve the service capabilities of primary health care institutions, but the exact reason for this is not clear.
To analysis the service capabilities of the of primary health care institutions, and explore the impact of service capabilities in the context of medical alliance.
In December 2019, we survey on staffing, outpatient and inpatient service and medical alliance construction of 381 primary health care institutions which participated in medical alliance in Chengdu by structured questionnaire. Local administrative departments of public health gave out and recovered questionnaire. With the number of staff, registered generals, beds, outpatient and emergency visits, admission, and the use rate of the beds as the indicator of the service capabilities, we used rank sum ratio to analyze the comprehensive medical service capabilities and divide them to 3 gear. Using orderly Logistic regression to explore the influencing factors of integrated medical services.
The median number of staff in 381 primary health care institutions was 54 (48), registered generals was 4 (8), beds was 50 (50), outpatient and emergency visits was 49 460 (60 317), admission was 1 440 (2 071), the use rate of beds was 68.43% (45.18%). According to the rank and ratio, there were 61 (16.0%), 260 (68.3%), and 60 (15.7%) institutions with good, medium and poor comprehensive medical service ability, respectively. The analysis of orderly Logistic regression analysis showed that institutional building area, teaching rounds and remote film reading are the influencing factors of the comprehensive medical service capabilities of primary health care institutions (P<0.05) .
The medical service capacity of primary health care institutions in Chengdu, Sichuan Province are relatively good. Institutional building area, teaching rounds and remote film reading in the medical assistance method significantly affect the comprehensive medical service capabilities.
As the gatekeepers for rural residents' health, rural doctors are the main providers of health management services for rural populations. Their community health management ability directly affects the health level of rural residents.
This study aims to investigate the current status of health management ability of rural doctors in China and explore strategies for enhancing their community health management ability, thus providing a basis for strengthening the building of a rural doctor team.
In August 2020, a multi-stage stratified cluster sampling and purposive sampling methods were used to select 3 916 rural doctors from five provinces in east, central, and western China. Rural doctors were surveyed using an online questionnaire platform called "Wenjuanxing". The questionnaire content included the rural doctors' ability to manage the health of children, women, elderly, and chronic disease patients, and the degree to which these needs were met, all of which were self-evaluated by the rural doctors.
Of the 3 916 rural doctors surveyed, 3 494 (89.22%), 3 175 (81.08%), 3 775 (96.40%), and 3 738 (95.45%) were found to had the ability to manage the health of children, women, the elderly, and patients with chronic diseases, respectively. The ability of female rural doctors to provide family planning guidance, prenatal health guidance, prevention and treatment of menopause-related diseases, and screening for common gynecological diseases was better than that of male rural doctors (P<0.05) ; while the male village doctors had a higher rate of identifying and handling common chronic disease critical conditions, stable and regular treatment of common chronic diseases, prevention of complications, and health management abilities for chronic disease patients compared to female village doctors (P<0.05). Rural doctors with qualifications of medical practitioners or assistant medical practitioners had a higher proportion of those with the ability to prevent and treat menopause-related diseases than those with qualifications of rural practitioners and other qualifications (P<0.008 3). Rural doctors with qualifications of medical practitioners or assistant medical practitioners had a higher proportion of those with the ability to manage women's overall health than those with qualifications of rural practitioners (P<0.008 3). Rural doctors with qualifications of general practitioners had a higher proportion of those with the ability to manage the functional decline of the elderly among than those with qualifications of rural practitioners (P<0.008 3). Rural doctors with a bachelor's degree or above had a higher proportion of those with the ability to provide stable-period treatment and prevention of chronic diseases than those with a junior college diploma (P<0.017). Rural doctors in the eastern region of China had a higher proportion of those whose ability to guide the physical examination and screening for common diseases of the elderly meets the actual work needs than those in the central and western regions, and the proportion in the central region was higher than that in the western region, with statistically significant differences (P<0.017). Rural doctors in the eastern and central regions of China had a higher proportion of those whose ability to assess the health and self-care ability of the elderly, identify and intervene with negative emotions, and prevent functional decline met the actual work needs than those in the western region (P<0.017) .
At present, rural doctors in China basically had the ability to manage health, and female rural doctors had an advantage in providing women's health management services. However, rural doctors with qualifications of rural practitioners lack the ability to manage the health of some specific key populations, and the ability of rural doctors in the western region to manage the health of the elderly is relatively poor. Therefore, active measures should be taken to improve the quality of rural doctors and promote the stability and sustainable development of the rural doctor team.
