Hospice care service has been practiced deeply in our country. Many cities have taken primary medical and health institutions as the prime places to carry out hospice care, such as in Shanghai. The main community hospice care service are provided by the teams which are composed of general practitioners and nursing staff. Meanwhile, there is still a lack of unified assessment standards and requirements for the abilities of community medical staff.

Based on the actual situation hospice care service, this study compilies an evaluation tool for the hospice care service ability of medical staff in community health service centers and conducts a research of the reliability and validity.

From June 2022 to March 2023, through literature review, qualitative interview and two rounds of Delphi expert consultation, the project was tested by a questionnaire and analyzed. 1 281 medical staff of community health service centers in Pudong New Area, Shanghai, China, were surveyed from 2023-04-01 to 2023-05-12. A questionnaire survey which was covering general information, knowledge and experience of hospice service. Hospice service competence evaluation tool and humanistic care competence scale were conducted to test the reliability and validity of the hospice service, and a multiple linear regression analysis was used to explore the influencing factors of hospice service competence.

Through literature search analysis and qualitative interviews with experts, 49 initial entries were formed. The Delphi expert consultation method invited a total of 15 authoritative experts in Shanghai who study and carry out hospice services, in which the expert authority coefficient was 0.87, and the Kendall harmony coefficient of the overall index system was 0.624 (P<0.01), and the evaluation tools for the 50 entries were finally formed after two rounds of Delphi expert consultation. A total of 1 300 questionnaires were distributed in the questionnaire survey part, and 1 284 questionnaires were recovered, the effective recovery rate of the questionnaires was 98.77% (1 284/1 300). The reliability coefficient of standardized evaluation tools was 0.993 with Cronbach's α coefficient. The data of Spearman-Brown's broken half reliability was 0.935, that means the overall reliability coefficient is good. Besides, KMO value was 0.987, Bartlett spherical value was 119 119.104, P<0.001, indicating that the scale had a good validity and was suitable for factor analysis. Factor analysis showed that the factor loading of all items was≥0.4 and the commonality was >0.2, so all 50 items were retained. Four common factors were selected, and the cumulative variance contribution rate was 86.517%. Correlation analysis showed that there was a significant positive correlation between the total score of the hospice care service ability evaluation tool constructed in this study and the total score of the humanistic care scale (r=0.819, P<0.001), indicating that the evaluation tool had a good calibration correlation validity. The results of multiple linear regression analysis showed that: gender, education, years of working in the community, whether or not they experienced the death of a relative, whether or not they experienced hospice training, the length of hospice service work, and whether or not they were willing to engage in hospice service were the influencing factors of hospice service competence (P<0.05) .

In this study, it proofs that the questionnaire tool for evaluating the ability of community health service center medical staff is scientific, reliability, and validity, and can be used to evaluate the various abilities of community general practitioners in hospice care services.

The aging of our population is a growing problem, and depression is one of the more common psychiatric disorders in the elderly population, leading to a significantly increased risk of disability and death. The studies found a significant association between depression and cognitive disorders, and that this association may be influenced by sex. Sex differences in the associations between depression with cognitive functions and different cognitive domains are not clear in the elderly population.

Population ageing has become a common global phenomenon, and psychiatric problems associated with ageing are of great concern. This study investigated the status of depression and cognitive function in the urban elderly and examined the associations and sex differences between depression and cognitive function.

From September to October 2022, a stratified sampling method was used to select elderly residents aged 65 years and above in a community within the city of Hefei, Anhui province as the participants. General information was collected and depression and cognitive function status were assessed using the Geriatric Depression Scale (GDS) and the Brief Screening Scale for Dementia (BSSD), respectively. We explored the factors associated with depression in the elderly and analyzed the effects of depression, sex factors and their interactions on cognitive functioning.

A total of 328 older adults were included and the overall detection rate for depression was 14.9 %. Regression analyses showed that drinking (OR=0.362, 95%CI=0.155-0.847), and living with children (OR=2.445, 95%CI=1.021-5.853) were independently associated with depression (P<0.05). Factorial design analysis of variance showed that the total score of BSSD and scores of language (command) comprehension, attention and computation, orientation in place, orientation in time, and immediate memory factors were lower in the depressed group of the elderly than in the non-depressed group. Females had a lower total score of BSSD, lower scores of general knowledge and picture and orientation in place, and a higher score of language (command) comprehension than males (P<0.05). Depression and sex had significant interactions in general knowledge and picture, language (command) comprehension, and orientation in place (P<0.05) .

The urban elderly are at a higher risk of depression, and those with comorbid depression may have a certain degree of cognitive decline, with sex differences. Increased attention should be paid to psychiatric problems such as depression and dementia among the elderly, especially for the female geriatric population. It is necessary to develop individualised and comprehensive interventions to improve the mental health and quality of life of the elderly.

Postmenopausal women with hypertension are susceptible to coronary heart disease (CHD), and their prevalence and mortality of CHD are significantly higher than those before menopause. Based on the team's previous research, this study further combined with glucose and lipid metabolism, vascular elasticity and other related indicators to diagnose CHD in postmenopausal women with hypertension, in order to provide new ideas for clinical identification of CHD risk in postmenopausal women with hypertension.

To explore the correlation and predictive value of triglyceride glucose (TyG) index, ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), pulse pressure index (PPI) and arteriosclerosis index (AI) in postmenopausal women with hypertension.

From January 2019 to December 2022, this study selected postmenopausal women with hypertension who underwent coronary angiography for the first time in the Department of Integrative Cardiology of China-Japan Friendship Hospital, and divided them into CHD group and non-CHD group according to the results of coronary angiography. The clinical data such as TyG index, ABI, baPWV, PPI, AI were collected at the time of admission. Multivariate Logistic regression analysis was used to construct a CHD risk prediction model for postmenopausal women with hypertension, and a nomogram was drawn. Calibration curve, receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate the diagnostic efficiency.

In this study, 300 postmenopausal women with hypertension who underwent coronary angiography for the first time were included, including 141 cases in non-CHD group and 159 cases in CHD group. Multivariate Logistic regression analysis showed that ABI, baPWV, TyG index, PPI and AI were the influencing factors of CHD in postmenopausal women with hypertension (P<0.05), and a nomogram was drawn according to which. The ROC curve analysis results showed that area under the curve (AUC) for ABI, baPWV, TyG index, PPI, AI and joint predictive model were 0.662, 0.687, 0.659, 0.700, 0.612 and 0.808, the sensitivity and specificity of the predictive model were 0.780 6 and 0.741 0, respectively. The calibration curve showed that the predicted results were in good agreement with the actual results. The decision curve analysis showed that the nomogram has good clinical value.

ABI, baPWV, TyG index, PPI and AI are independent influencing factors for the occurrence of CHD in postmenopausal women with hypertension. The newly developed model can better predict the risk of CHD.

With the aging population, research on elderly care has increasingly become a focal point. Previous surveys on the demand rate for elderly care have shown significant variation (8.54% to 53.15%) and lack large-scale study evidence.

To understand the prevalence and influencing factors among community-dwelling older people in three provinces of China.

The study subjects were from the baseline survey of Prevention and Intervention on Neurodegenerative Disease for Elderly in China conducted in 2019. This survey employed a multi-stage stratified cluster random sampling method, selecting a total of 16 199 elderly individuals aged 60 and above from 16 districts and counties across Liaoning, Henan, and Guangdong provinces. The questionnaire covered basic demographic characteristics (gender, age, urban/rural residence, marital status, education level, occupation, weight, living situation), current care needs, chronic disease status, the Patient Health Questionnaire (PHQ-9), the Mini-Mental State Examination (MMSE), the Activities of Daily Living (ADL) scale, self-rated health status, daily exercise habits, and the number of falls. The PHQ-9 was used to assess the psychological health of the elderly, the MMSE was used to evaluate cognitive function, and the ADL scale or self-reported need for care was used to assess elderly care needs, defined as the presence of BADL or IADL disabilities, or a self-reported need for care. Logistic regression analysis was used to explore the influencing factors of elderly care needs.

The prevalence of care needs among community-dwelling older people in three provinces was 14.57% (95%CI=14.02%-15.11%), and the prevalence of care needs increased gradually with age, consistently higher among females than males in all age groups. The results of multifactorial analysis showed that the risk of care need increased 7% (OR=1.07, 95%CI=1.06-1.08) for each additional year of age. Compared with illiteracy, the ORs of care need for those with primary school, secondary school, high school and above were 0.33 (95%CI=0.29-0.37), 0.24 (95%CI=0.20-0.28), 0.17 (95%CI=0.12-0.22), respectively. Compared with daily exercise, the OR of care needs for those who did not exercise daily was 1.17 (95%CI=1.05-1.30) .Compared with those who did not suffer from chronic diseases, the ORs of care needs for those who suffered from 1-2 kinds and those 3 or more kinds of chronic diseases were 1.29 (95%CI=1.10-1.51) and 1.57 (95%CI=1.35-1.82). Compared with normal cognitive function, the OR of care need for those with abnormal cognitive function was 2.02 (95%CI=1.79-2.27). Compared with good self-assessed health status, the OR of care need for those with fair health status and those with poor health status were 1.29 (95%CI=1.14-1.46) and 2.68 (95%CI=2.27-3.16). Compared with those did not having fallen, ORs of care needs for those with 1-2 and 3 or more falls were 1.23 (95%CI=1.06-1.43) and 2.00 (95%CI=1.59-2.52). ORs of care needs for those with mild and moderately severe depression compared to those with a good mental status were 1.14 (95%CI=1.21-1.65) and 2.05 (95%CI=1.69-2.48) .

The demand for elderly care among community-dwelling older adults of China is notably high. This demand is particularly elevated among individuals who are older, have poorer physical and psychological health, and have experienced a higher frequency of falls.

The effectiveness of family physician teams under the county medical community is low, and the current status of team management is not yet clear, the perceived status of team management for members with different characteristics is not yet clear.

To understand the current situation of family doctor team management under the county medical community, and to provide a basis for further refinement and improvement of family doctor team management.

From October to December 2022, a total of 1 724 key members of 429 family doctor teams under the county medical communities in Hubei Province were surveyed using a self-developed questionnaire, which included the management of team configurations, the management of team interactions and the results of team management. Differences in perceptions of team management between family doctor team members with different characteristics were analysed using chi-squared test and ANOVA, and Pearson correlation was used to analysis the correlation between team interaction management and team management outcome factors.

Among 1 724 survey respondents, 62.9% (1 084/1 724) perceived that team assessment and incentive measures were effective, and 88.7% (1 530/1 724) perceived that they had a reasonable allocation of family doctor team personnel. The respondents had a score of (22.3±5.3) for the intensity of internal team interactions and a score of (22.0±5.3) for the perceived intensity of the team's interaction and liaison with the outside. Regarding family doctor team members' perception of team management results, team members' perceived team goal achievement, i.e., team task performance, scored (33.1±7.4), perceived satisfaction with the team scored (22.3±4.9), and perceived team's ability and potential for future development scored (27.9±6.3), while the total scores of the three dimensions were 0-36, 0-24, 0-30. Comparison of team configuration management, team interaction management, and perceptions of team management outcomes between family doctor team members of different positions, titles, and ages showed statistically significant differences (P<0.05). There was a positive correlation between team interaction management factors and team management outcome factors (P<0.05) .

Family doctor team members perceive that team configuration management is relatively good, and there is still room for improvement in team assessment and incentives; family doctor team interactions are better managed, and team interactions play an important role in improving team management results; family doctor team members have a better perception of team management results, and perceive task performance to be lower than satisfaction and development ability; there are large differences in the perceptions of team management among family doctor team members of different positions, titles, and age groups.

The increasing prevalence of chronic diseases globally poses major challenges to the health of societies and individuals. Managing chronic diseases requires long-term treatment and monitoring, placing demands on patients' lifestyles. With the aging of the population and changes in lifestyle, chronic disease prevention and control are becoming more and more important. In recent years, as scientific and technological innovation in the field of healthcare develops in depth, and the application of artificial intelligence in healthcare has gradually become one of the important strategic directions of the country, the traditional method of chronic disease management relies too much on the offline communication between the doctor and the patient, which leads to the doctor not being able to maintain long-term and effective communication and follow up with the patient, and the patient may not be able to be detected and monitored by the doctor in a timely manner when his or her condition changes. In addition, the traditional chronic disease management approach is usually a generalized approach that fails to adequately consider the individual differences of each patient. Given the limitations of traditional chronic disease management methods, this study aims to provide more convenient and efficient primary care services using intelligent robots. Through personalized health management plans, assisted medical diagnosis, and timed medication reminders, the intelligent robot is committed to improving patients' quality of life, reducing the pressure on healthcare resources, and promoting the development of intelligent healthcare management globally.

Knowledge sharing of family doctor teams under the county medical community is an important way of interaction between the county and rural institutions, which plays an important role in enhancing the quality of regional medical and health services and improving the health of residents.

To investigate the knowledge sharing among family doctor teams under the county medical community, to explore its influencing factors, and to provide a scientific basis for promoting knowledge management and capacity enhancement within family doctor teams.

From October to December 2022, multistage sampling was used for selecting 381 family doctor teams under two county medical communities were selected as study subjects in Hubei Province using the convenience sampling method, and a self-administered team knowledge-sharing questionnaire was used to investigate the knowledge-sharing level of the included subjects, and multivariate linear stepwise regression analyses were used to explore the influencing factors of the knowledge-sharing of family doctor teams, including two dimensions of explicit knowledge sharing and implicit knowledge sharing.

The total knowledge sharing score of family doctor teams under county medical communities was (27.84±3.84), and the mean item level scores of the two dimensions of explicit and implicit knowledge sharing were (5.51±0.79) and (5.61±0.77), respectively; the results of the multivariate linear stepwise regression analysis showed that the heterogeneity of academic qualifications, intensity of team communication, intensity of team activities, motivation of members to learn, the use of platform carriers, and the team leader's role were the influencing factors of knowledge sharing of family doctor teams under the county medical community (P<0.05) .

Knowledge sharing within the family doctor team under the county medical community is at a good level, and there is still room for improvement. It is recommended to improve the level of knowledge sharing among family doctor team members by increasing the frequency of family doctor team activities, improving the intensity of team communication, adopting relevant incentives, and expanding knowledge sharing channels.

The incidence of delay language development in early childhood is high, and the early recognition rate is low, which has a significant negative impact on the early childhood development of other dimensions. The family cognitive environment is a key factor affecting early childhood language development.

This study aimed to explore the influence of family cognitive environment on early childhood language development, and provide theoretical basis for promoting early childhood language development from the perspective of community intervention on family cognitive environment.

A retrospective case-control study was conducted on 4 307 children who were admitted to a community child healthcare department in Shanghai from 2018 to 2020. The Shanghai Pediatric Development Screening Scale Ⅱ (DenverⅡ) was used for developmental screening, which was conducted at the child's age of 1, 2, and 3 years old. A total of 172 children with delay language development were selected as the case group, and 516 children with normal language development were included in the control group, which was determined by the matching factor of age, with a ratio of the number of children in the case and control groups being 1∶3. The following information of children in both groups were collected, including children's basic birth characteristics, parental demographic characteristics, maternal pregnancy and childbirth characteristics, and family cognitive environment characteristics. The Logistic regression analysis was used to explore the influencing factors of delay early childhood language development.

A total of 172 children with delayed early language development had an incidence rate of 3.99%, among them ,1-year-old, 2-year-old, and 3-year old children accounted for 33.14% (57 cases), 53.49% (92 cases), and 13.37% (23 cases), respectively. The proportions of male children, children with premature birth, and children with maternal education of high school and below were higher in the case group than those in the control group (P<0.05). The overall family cognitive environment, emotional warmth, social adaptation, linguistic environment, and neglectful environment of the children in the case group were less favorable compared to those in the control group (P<0.05). premature birth, low maternal education, and poor family cognitive environment were risk factors of delay early childhood language development (P<0.05) .

Interventions for language development before the age of 2 were key to effectively reducing the rate of delay childhood language development. Guiding and optimizing the family caregiving environment, assisting in establishing good parent-child communication and interaction by community child healthcare doctors could be effective strategies for promoting early childhood language development. Community child healthcare doctors should pay special attention to children with young gestational age and low maternal education, and provide more targeted interventions and guidance on parent-child activities and communication.

With the deep reform of China's medical system, especially the advancement of the tiered diagnosis and treatment system, the role of general practitioners in the primary healthcare system has become increasingly significant. General practitioners are not only the first line of defense for residents' health, but also key executors of disease prevention, diagnosis, treatment, and health education. This article analyzes the classification of "major, minor, acute, chronic" diseases and the "4 virtues" positioning of general practitioners (namely adept at treating minor illnesses, identifying major illnesses, referring acute illnesses, and managing chronic illnesses), exploring the crucial functions and challenges of general practitioners in the era of new medical reform. The article points out that although the tiered diagnosis and treatment system aims to optimize the allocation of medical resources, it still faces challenges such as the ambiguity of the classification of "major, minor, acute, chronic" diseases and the uneven distribution of primary healthcare resources. General practitioners play a vital role in this system, needing comprehensive clinical diagnostic and treatment capabilities, and to establish clinical judgment standards and treatment protocols in collaboration with specialists. To address these challenges and fully leverage the role of general practitioners in the modern medical system, urgent reforms and optimizations in general medical education and practice are needed, along with strengthening the role of general practitioners, to ensure the improvement of medical service quality and efficiency while achieving a fair and sustainable health security system.

Multimorbidity pose challenges to older adults' health services. It is of great importance to explore its impact on health services utilization in the elderly. The Chinese Multimorbidity-Weighted Index (CMWI) has been developed to measure the burden of multimorbidity in Chinese middle-aged and elderly, but there is a lack of cohort studies on the association between CMWI and health service utilization.

To explore the association between burden of multimorbidity and utilization of health among older adults, which provides scientific evidence for improving the intervention and management of older adults' patients with multimorbidity.

From December 2021 to January 2024, taking Sihui City of Zhaoqing City, Guangdong Province as an example, the electronic health records of residents from 2017 to 2021 were collected from the city's national health information platform to establish a natural population cohort for health examination of the elderly. We used the time of the first health examination in this period as the baseline, the CMWI was used to measure individual's baseline burden of multimorbidity .We use the negative binomial regression to analyze the association between individual's CMWI respectively and the total number of outpatient visits, chronic disease-related outpatient visits, total number of hospitalizations and chronic disease-related hospitalizations during the follow-up period.

Among the total 39 989 participants, there were 14 991 (55.18%) cases of multimorbidity, and the CMWI was 1.3 (0, 2.3). During an average 1 268 days follow-up period, 26 141 people (65.37%) had used outpatient services, the number of total outpatient visits and chronic disease-related outpatient visits was 2 (0, 6) and1 (0, 4). In our study 7 332 (18.34%) had used hospitalization services, the number of total hospitalization and chronic disease-related hospitalization was 0 (0, 0) and 0 (0, 0). Age, genders, education levels and CMWI varied significantly by the utilization of health (P<0.05). The residential type varied significantly by the utilization of outpatient services (P<0.05) but no by utilization of inpatient services (P>0.05). After adjusting the covariates of age, gender, residence and education levels, negative binomial regression analysis showed that CMWI was a risk factor on the increase of health service utilization in the elderly (IRR>1). For each unit increase in CMWI, the total number of outpatient visits increased by 1.210 (95%CI=1.196-1.224), the number of chronic disease-related outpatient visits increased by 1.276 (95%CI=1.259-1.292), the total number of hospitalizations increased by 1.277 (95%CI=1.244-1.312), and the number of chronic disease-related hospitalizations increased by 1.286 (95%CI=1.252-1.321) .

CMWI is a risk factor for the increase of health service utilization in the elderly, and the number of health service utilization in the elderly increases with the increase of CMWI. More attention should be paid to the burden of multi-chronic diseases in the elderly, so as to provide scientific basis for improving the intervention and management of multi-chronic diseases in the elderly in China.

Promoting the construction of county-level medical communities is a crucial measure for establishing a hierarchical medical system. While the domestic academic community has conducted extensive theoretical and empirical research in this field, there is a lack of comprehensive summaries of existing research findings. This study uses bibliometric methods to systematically review the progress of related literature in this field, providing insights and references for the high-quality development of county-level medical communities.

To conduct a visual analysis of the literature on county-level medical communities in China, exploring research hotspots and frontier trends in this field.

Using the China National Knowledge Infrastructure (CNKI) database, literature related to county-level medical communities published between 2016 and 2023 was retrieved on February 25, 2024. CiteSpace software was employed for bibliometric visualization analysis of the literature, focusing on publication years, authors and institutions, keyword co-occurrence, clustering, timeline distribution, and burst detection.

A total of 481 articles were included. The publication volume in this field has been increasing, driven by policy factors, with 65 articles (13.51%) published between 2016 and 2019, 167 articles (34.72%) published between 2020 and 2021, and 249 articles (51.77%) published between 2022 and 2023. The top three authors in terms of publication volume were CHEN Yingchun, WANG Fang, and ZHENG Ying, each with 8 articles. The top two keywords in terms of centrality and cluster size are "medical community" and "hierarchical medical system". The timeline distribution indicated that "hierarchical medical system" was the earliest and most sustained research hotspot in this field. Additionally, clusters such as "integration of medical prevention" "performance evaluation" "countermeasures" and "patients" emerged as research hotspots. Burst detection revealed that "medical insurance fund" "chronic disease" "management model" "development strategy" and "rural doctors" were recent research hotspots and future directions in this field.

Key research hotspots in the field of county-level medical communities include the construction of hierarchical medical systems, focusing on chronic diseases and the integration of public health services, and exploring performance evaluation pathways. Future research trends indicate a strong focus on deepening policy research, using county-level medical community construction to promote the establishment of hierarchical medical systems, advancing innovation in the integration of medical prevention, enhancing performance evaluation, and optimizing internal management.

Primary health governance is a crucial part of the national health governance system and plays a key role in achieving universal health. However, primary health governance currently faces many challenges. The Expert Consensus on Primary Health Governance is led by the Public Health Security and Health Professional Committee of the Public Safety Science and Technology Society, in collaboration with experts from multiple disciplines. The aim of this consensus is to integrate evidence-based scientific evidence, practical wisdom, and experience from multidisciplinary experts in primary health-related fields. This consensus addresses the connotations, significance, objectives, basic principles, system construction elements, capacity building elements, institutional elements, and technical means of primary health governance. It provides scientific, systematic, and operable consensus opinions and suggestions to enhance the level of primary health governance, standardize primary health governance practices, promote the equalization of primary health services, strengthen the cultivation of primary health governance talents, and drive innovation in health governance. This will provide scientific basis and recommendations to support the realization of the "Healthy China 2030".

The primary healthcare system is key to achieving a health equity. In China, great obstacles are challenged by imbalanced medical resources, shortage of primary healthcare providers, and the prevention and treatment of chronic diseases. Artificial intelligence large language models have demonstrated strong advantages in the medical system. This article deeply explored the application of large language models in the primary healthcare system and the challenges. The large language models are expected to assist the diagnosis and treatment of common diseases in grassroot medical institutions, promote intelligent health education and chronic disease management, underpin primary health services in the undeveloped and remote areas, stimulate the leapfrog development of general medicine, and accelerate the industrialization of large language models in general diagnosis and treatment and primary health services, thus providing important support for the construction of healthy China.

Patients with multimorbidity often require the concomitant use of multiple medications, presenting general practitioners (GPs) with the dilemma of assessing the benefits and risks due to complex and potential interactions between diseases and medications. This article takes one case of a multimorbid patient at a community health service center to illustrate and elucidate the process by which GP employs a medication decision-making framework for multimorbidity (MDMF). Furthermore, by examining the multi-stage goals set by Ariadne principle in the process of multimorbidity management, this article analyzes the key points and considerations for GPs in the assessment, communication, and making treatment plans, thereby offering reference to improve the quality of medication decision-making for patients with multimorbidity in the community.

Primary care physicians in community settings face numerous challenges when making medication decisions for patients with multimorbidity. Enhancing their decision-making capabilities through training is an important way to address these challenges. However, there is a dearth of in-depth research on the training needs of primary care physicians in the context of medication decision-making for multimorbidity.

This study aims to explore the challenge physicians encountered in medication decision-making for patients with multimorbidity and their needs for training content and modalities, providing a reference for designing the training courses for the abilities enhancement.

From October 5th to December 21st in 2023, physicians from community health care centers in Hangzhou, Ningbo, Jiaxing, Shenzhen, and Shanghai were recruited for in-depth interviews following the principle of purposive sampling and maximum variation, which focus on the content and formats of training to enhance medication decision-making abilities. Two researchers transcribed and coded the interviews independently, and content analysis was performed on the interview data.

A total of 20 Physicians completed the interviews and 15 were females, mean age were (38.5±3.0) years. Based on the challenges faced by primary care physicians in the medication decision-making for multimorbidity, the training should cover four aspects: evaluation of medication therapy, rational selection of medication, doctor-patient communication and shared decision-making, medication education and follow-up. In terms of training form, primary care physicians are willing to accept flexible and multiple teaching approaches, and prefer case-based training that aligns with community health needs.

Primary care physicians have clear training needs of medication decision-making for patients with multimorbidity. The results of this study provide a theoretical reference for the development of training courses, which adapt to the working environment and actual requirements of primary care physicians.

The prevalence of cardiovascular disease (CVD) in China is on the rise. It is estimated that there are 330 million people with CVD, including 13 million cases of stroke, 11.39 million cases of coronary heart disease (CHD), 8.9 million cases of heart failure (HF), 5 million cases of pulmonary heart disease, 4.87 million atrial fibrillation, 2.5 million cases of rheumatic heart disease, 2 million cases of congenital heart disease, 45.3 million cases of peripheral arterial disease (PAD), and 245 million cases of hypertension. In 2021, the total number of discharges of patients with cardiovascular and cerebrovascular diseases in China was 27 649 800, accounting for 15.36% of the total number of discharges (including all inpatient diseases) in the same period, including 14 872 300 CVDs, accounting for 8.26%, and 12 777 500 cerebrovascular diseases, accounting for 7.10%. The economic burden of CVD on residents and society still increases, and the inflection point of CVD prevention and treatment has not yet arrived.

Multimorbidity refers to an individual suffering from two or more chronic diseases simultaneously. Patients with multimorbidity refers often require the concurrent use of multiple medications, posing a challenge to community general practitioners in making scientific medication decisions. This paper analyzes the reasons and influencing factors that lead to the dilemmas in medication decision-making for patients with multimorbidity in the community. It also proposes a dynamic and comprehensive decision-making framework known as the Medication Decision-making for Multimorbidity Framework (MDMF). The framework consists of five stages in the process of community general practitioners treating patients with multimorbidity, which include "Health problems review""Comprehensive medication assessment""Shared decision-making""Medication therapy recording", and "Follow-up arrangement". The MDMF facilitates the development of individualized medication therapy for patients with multimorbidity by community general practitioners, but it also places certain demands on their capabilities. Therefore, it is recommended to provide training for community general practitioners centered on the MDMF, offer decision-making support, and implement reasonable incentives and supervision measures. This is expected to promote primary care institutions to provide patient-centered medication therapy, enhance its safety and efficacy, and alleviate the treatment burden on patients.

Doctor-patient communication is one of the core abilities of general practitioners. Dophisticated doctor-patient communication skills are the basis for building a harmonious doctor-patient relationship, and help to improve patients' sense of gain and satisfaction in seeking medical treatment. However, the communication ability of general practitioners in China is generally low, it is necessary to explore a training mode of doctor-patient communication that adapts to China's national conditions and meets the communication needs of general practitioners in China to improve the communication ability between doctors and patients.

To explore the application effect of salon training based on the Calgary-Cambridge Guide in the training of doctor-patient communication ability of resident doctors in standardized training of general practitioners, and to provide reference for the construction of doctor-patient communication training system.

Forty cases of general practitioners in Chengdu Fifth People's Hospital Standardized general practice training from 2019 to 2020 were selected as the research object, and randomly divided into salon group and control group, with 20 cases in each group. Salon group used salon training mode based on Calgary-Cambridge guidelines for doctor-patient communication training, while the control group was set as blank control. Before the training and one week after the training, the standardized patient (SP) model was adopted to clinical reception in the two groups, and the doctor-patient communication evaluation scale (SEGUE) was used to evaluate the level of doctor-patient communication, and the training effects of the two groups were compared.

Finally, 28 cases were included, including 15 cases in the salon group and 13 cases in the control group. After the training, the score of the SEGUE scale of the training doctors in the salon group increased from (11.80±4.36) to (18.07±4.11), and that of the training doctors in the control group increased from (12.15±4.63) to (14.46±3.71). The score of SEGUE scale in Sharon group after training was significantly different from that before training (t=3.250, P< 0.001). There was no significant difference in the score of SEGUE scale between the control group after training and before training (t=2.582, P=0.624). After training, 25 items in the SEGUE scale were analyzed, and the difference between the salon group and the control group was statistically significant (P<0.05). The results of the following five items in the salon group were better than those in the control group: "Establishing personal trust relationship" (93.3% vs. 7.7%) and "Protecting patients' privacy/respecting patients' right to choose" (53.3% vs. 15.4%) in the preparation stage; Understand the patient's stage of "recognizing the patient's efforts, changes and difficulties" (33.3% vs. 23.1%) and "expressing concern and making the patient feel warm/confident" (100.0% vs. 69.2%) ; At the end of the consultation stage, "Ask the patient if there are any other questions to discuss" (66.7% vs. 23.1%) .

Salon training mode based on Calgary-Cambridge guidelines can enhance students' interest and enthusiasm in participating in the training, which has a good training effect on improving the communication ability between doctors and patients, and is worth learning and popularizing.

The clinical thinking of general medicine is based on the characteristics of the general medicine profession and has its uniqueness, requiring general practitioners to have "patient-centered" clinical diagnosis and treatment skills. In order to better reflect the clinical thinking ability of clinical residents in general practice, it is necessary to establish a set of effective evaluation criteria that can reflect all aspects of their ability. At present, there is no suitable method to evaluate the clinical thinking ability of residents in general practice.

To construct a post competency oriented clinical thinking ability evaluation system for general practice residents by Delphi method.

From December 2021 to February 2022, based on literature research, we preliminarily constructed the evaluation system framework of clinical thinking ability of general residents. Delphi method was used to conduct two rounds of in-depth communication with 12 experts to give objective evaluation on the importance of the indicators in the framework. Futher, we use analytic hierarchy process to determine the weight of each indicator.

Through two rounds of expert consultations, we developed a comprehensive evaluation system consisting of 5 first-level indicators (clinical knowledge learning and extension, data collection and utilization, diagnostic analysis and utilization, treatment decision making ability, communication and collaboration ability) and 30 second-level indicators. The effective response rate of the two rounds of questionnaire was 100.0%, the expert authority coefficient was 0.85, and the expert coordination coefficient of the first and second indexes were 0.299 and 0.189 respectively (P<0.01). And the weight of 5 first-level indicators were 0.198, 0.198, 0.227, 0.227, 0.150 respectively.

Delphi method was used in this study to establish a comprehensive evaluation system of clinical thinking ability of residents. Through the analysis of the result data, it can be seen that the evaluation system is highly authoritative and scientific, which can provide reference for training high-quality general residents and improving the teaching quality of general practice in the future.

As China's Traditional medicine is included in the ICD-11 code, the rational allocation of basic TCM medical resources is the guarantee to promote the integration of traditional Chinese medicine and western medicine and the universal coverage of high-quality medical resources. The uneven layout and service capabilities of grassroots medical institutions have led to a widespread imbalance in the supply and demand of medical resources in urban and rural areas.

Understand the development status of traditional Chinese medicine services in rural areas of China, scientifically evaluate the coverage and accessibility of grassroots traditional Chinese medicine diagnosis and treatment, provide new ideas for optimizing the spatial resource allocation of grassroots traditional Chinese medicine services, and propose optimization strategies accordingly.

Based on the seventh national population census data and path planning data, the concept of medical service radius is introduced to calculate the diagnosis and treatment scope of different levels of traditional Chinese medicine medical institutions under walking mode. Using methods such as spatial kernel density index and spatial standard deviation ellipse to reveal the spatial fairness of the supply and demand capacity of traditional Chinese medicine medical services. Based on the above results, propose types and measures for optimizing the layout of traditional Chinese medicine medical resources.

As of 2022, there are a total of 699 medical institutions in Zengcheng District, including 18 traditional Chinese medicine medical institutions with beds. There were significant differences in the distribution of beds in traditional Chinese medicine medical institutions in different townships and streets. Meanwhile, the number of beds per thousand population in Zhongtan Town was 14.31, ranking first among all streets. The number of beds per thousand people in Yongning Street ranks last, with only 0.89 beds. Traditional Chinese medicine medical institutions in Zengcheng District had shown a clear dual center pattern, with weak accessibility to traditional Chinese medicine services for residents in the central part of Zhongxin Town, the northern part of Paitan Town, and the southwestern part of Shitan Town. The supply capacity of traditional Chinese medicine services varies greatly among different townships. There was still a certain degree of inconsistency between the spatial distribution of traditional Chinese medicine medical institutions and the overall spatial clustering of urban residents. There were differences in the radius of traditional Chinese medicine services between different townships.

Since the implementation of the development strategy of traditional Chinese medicine, China's Traditional medicine has been protected and developed. We should adopt a more scientific strategy to closely integrate traditional Chinese medicine services with the development of the city and the needs of residents. We should actively adopt a differentiated strategy of increasing facility points, combining resource transfer and sinking, and integrating traditional Chinese medicine information technology for diagnosis and treatment across regions, gradually achieving a true strategy of full coverage and equal emphasis on traditional Chinese and Western medicine.

Healthcare workers have played a crucial role in preventing and controlling the COVID-19 pandemic. However, the heightened risk of infection and intense work schedules have not only induced occupational burnout among them but also significantly impacted their mental health and lifestyles. A large number of foreign studies have shown that the COVID-19 pandemic has led to unreasonable diet, reduced exercise, irregular work and rest, and decreased sleep quality among HCWs, increasing the risk of overweight and obesity. Despite this, research on weight and lifestyle changes among Chinese healthcare workers during the pandemic is limited, and the key lifestyle factors contributing to these weight changes remain unclear.

To analyze the predictors of overweight and obesity in Chinese healthcare workers by constructing a Bayesian network model, and to provide a scientific basis for the prevention and control of overweight and obesity.

In August 2022, Chinese healthcare workers in 100 medical institutions from five provinces/autonomous regions/municipalities were randomly sampled, and the questionnaire (Cronbach's α=0.820, AVCR=63.55%) was prepared by the researchers to collect data. All respondents were required to scan QR code generated by the "Wenjuanxing" to answer the e-questionnaire and submit. The "bnlearn" package of R 4.3.0 software was used to construct a Bayesian network model, and Netica 6.09 software was used for Bayesian network risk prediction.

The study surveyed a total of 20 261 healthcare workers, of whom females accounted for 67.57% (13 690/20 261) ; The average age was (40.2±9.2) years old; 73.28% (14 848/20 261) had a college or undergraduate education level. In 2019 and 2022, the overweight/obesity rates were 43.06% (8 726/20 261) and 45.71% (9 262/20 261), respectively. From 2019 to 2022, 12.64% (1 458/11 535) of survey respondents' BMI changed from underweight/normal to overweight/obese. The Bayesian network model included a total of 15 nodes, and the amount of consumption of vegetables and fruits, breakfast frequency, alcohol drinking, and appetite were the parent nodes of BMI changing from underweight/normal to overweight/obesity, and when there were "a reduction" in the consumption of vegetables and fruits, "no change" in frequency of eating breakfast, alcohol drinking consumption "no change", and "a great increase" in the appetite the risk of BMI changing from underweight/normal to overweight/obese was the highest (75.00%). And when there were "a great increase" in consumption of vegetables and fruits, "an increase" in the frequency of eating breakfast, "never or rarely" in alcohol drinking and "a reduction" in appetite, the risk of becoming overweight/obese was the lowest (2.04%) .

Consumption of vegetables and fruits, eating breakfast frequently, drinking alcohol and appetite are the direct predictors of overweight/obesity of Chinese healthcare workers. During the epidemic of major infectious diseases such as the COVID-19, on the premise of ensuring the normal operation of medical and health institutions, a reasonable rotation system is implemented to provide psychological support and lifestyle behavior intervention services, which is conducive to the prevention and control of obesity of healthcare workers.

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.

Hypertension is a growing public health problem in China. In recent years, more and more studies have begun to focus on the quality of life of hypertensive older adults, and explore the factors affecting their quality of life, which is of great significance for the development of effective health management programs for hypertension.

To measure the health state utility (HSU) of hypertensive older adults in Northwest China using the EQ-5D-5L scale and the 15D scale, evaluate the health-related quality of life (HRQoL) of them, and explore the main factors affecting HRQoL in the elderly.

A total of 2 000 older adults were randomly recruited in Lanzhou City, Gansu Province in 2021, the clinical data were collected through questionnaires, basic physical examination and laboratory tests, and HSU was measured using the EQ-5D-5L and 15D scales. Subgroup analysis, Tobit regression analysis and multiple linear regression analysis were used to evaluate the factors affecting HRQoL.

A total of 1 784 older adults participated in this study, 50.9% of them had normal blood pressure, 676 (37.9%) had stage 1 hypertension, 152 (8.5%) had stage 2 hypertension, 48 (2.7%) had stage 3 hypertension, the HSU of these older adults were 0.949, 0.942, 0.933, and 0.921 in the EQ-5D-5L, and 0.875, 0.863, 0.851, and 0.840 in the 15D scale, respectively. Tobit regression analysis showed that gender, age, years of education, occupational status, and annual income were associated with HSU in older adults in the EQ-5D-5L scale (P<0.05), multiple linear regression analysis showed that gender, age, years of education, hypertension, and alcohol consumption were associated with HSU in older adults in the 15D scale (P<0.05) .

The HSU of older adults in both EQ-5D-5L scale and 15D scale gradually decrease with the increase of blood pressure level, indicating a progressive impairment of HRQoL. Factors affecting HRQoL in older adults include gender, age, hypertension, years of education, marital status, occupational status, annual income and alcohol consumption.

The incidence of acute ischemic stroke (AIS) remains high, and a timely restoration of cerebral blood flow is crucial for its prognosis. There are less therapeutic approaches to promote recovery of cerebral blood flow in AIS patients treated beyond a limited time window. The analysis of remote ischemic postconditioning (RIPostC) on the efficacy, complications and prognosis of AIS patients beyond the time window is of great significance.

To investigate the role of RIPostC on the prognosis of AIS beyond time window, thus providing a safe and effective cerebral blood flow restoration way for AIS beyond time window.

It was a randomized, parallel group, placebo-controlled trial involving AIS patients beyond time window (onset time > 6 h) of thrombolysis who were hospitalized in the Department of Neurology, Beijing Aerospace General Hospital from September 2, 2021 to August 31, 2022. They were randomly assigned into the control group and experimental group, and treated and followed up for 90 days. General treatment and conventional treatment of cerebrovascular disease were performed in both groups. RIPostC and simulated RIPostC were respectively given 28 times within 14 days in the experimental group and control group, respectively. Before the intervention, and 30 days and 90 days after the intervention, neurological function was assessed using the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Cognitive function was assessed by the Mini-mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Daily living ability was assessed by the Instrumental Activity of Daily Living (IADL). Mental status was assessed by the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). Cerebral blood flow velocity was assessed by the transcranial Doppler ultrasound (TCD). Inflammatory response was assessed by measuring interleukin 6 (IL-6) levels.

Ninety-nine out of 122 AIS patients finally completed the trial and follow-up, including 49 patients in the experimental group and 50 in the control group. There were no significant differences in gender, age, underlying diseases (hypertension, diabetes, coronary heart disease) and baseline NIHSS scores between the two groups (P>0.05). Repeated measures analysis of variance showed that there was an interaction between time and group on MMSE, MoCA, mRS, NIHSS, cerebral blood flow velocity, and IL-6 (P<0.05). Specifically, the main effects of time and group on MMSE, MoCA, NIHSS, cerebral blood flow velocity, and IL-6 were significant (P<0.05), and the main effects of time on mRS, SAS, SDS, and IADL were significant (P<0.05). The MMSE and MoCA scores and cerebral blood flow velocity on 30 days and 90 days after the intervention were significantly higher in the experimental group than those of the control group, while the mRS and NIHSS scores were significantly lower (P<0.05). The SDS and IADL scores on 30, 90 days after the intervention were significantly lower than those of control group (P<0.05). On 30 days after the intervention, AIS patients in the experimental group had significantly higher SAS score and lower IL-6 level than those of control group (P<0.05). Adverse events were reported in 23 AIS patients, including 17 in the experimental group and 6 in the control group. There was no significant difference in the incidence of skin petechiae, dizziness, palpitation, chest tightness between the two groups (P>0.05). The incidence of skin ecchymosis [4.00% (2/50) vs. 12.24% (6/49) ] and the overall incidence of adverse events [12.00% (6/50) vs. 34.69% (17/49) ] in the control group were significantly lower than those of the experimental group (P<0.05) .

RIPostC can reduce the inflammatory response in AIS patients, and protect neurological function, cognitive function, depression and intracranial blood flow velocity.

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.

The 6-minute walk test (6MWT) is extensively used to assess the exercise capacity of obese populations and offers a reference for devising intervention measures. While reference equations for the 6MWT distance for various populations have been proposed internationally, there is a scarcity of studies on reference equations for the 6MWT distance among Chinese obese subjects aged 17 to 45 years with a BMI ≥ 30 kg/m².

To develop reference equations for the 6MWT distance for outpatient obese subjects aged 17 to 45 years and to assess its influencing factors.

Following the American Thoracic Society guidelines, from June 2022 to September 2023, 143 adults aged 17 to 45 years with a BMI ≥30 kg/m² (71 males and 72 females) who visitied the Department of Endocrinology, Northern Jiangsu People's Hospital, were prospectively selected for anthropometric measurements and the 6MWT. A stepwise multiple regression model was employed to establish reference equations for the 6MWT distance, and the newly developed equations were compared with existing prediction equations.

The average 6MWT distance for the 143 subjects was (506.1±49.8) m, with males averaging (515.7±50.14) m, which was greater than the females' average of (496.6±47.9) m (P<0.05). Across age groups 17-23, 24-30, 31-37, and 38-45 years, differences in 6MWT distances between males and females were statistically significant (P<0.05). In males, weight, BMI, HR_max, resting heart rate difference (ΔHR), waist circumference, diastolic blood pressure difference (ΔDBP), and Borg scale score difference (ΔBorg) were related to 6MWT distance (P<0.05), whereas in females, weight, BMI, and waist circumference were related to 6MWT distance (P<0.05). Incorporating potential influencing factors into a stepwise multiple linear regression equation, the final reference formulas were established as follows: for males, y=494.463+1.414×ΔHR-3.903×BMI+0.874×HR_max, R²=0.429; for females, y=670.448+0.299×ΔHR-4.342×BMI-0.195×HR_max, R²=0.312.

In outpatient obese patients aged 17 to 45 years, males had a longer average 6MWT distance than females, with significant differences across different age groups. Factors such as weight, BMI, HR_max, ΔHR, wait cirumference ΔDBP, and ΔBorg were associated with 6MWT distance in males, while weight, BMI, waist cirumference and ΔSBP were related to 6MWT distance in females. Through multiple linear regression analysis, reference equations predicting 6MWT distance were established for males and females, providing valuable references for assessing individual physical fitness levels.

As global population continues to age, disability has become one of the most prominent health problems in the aging population. Chinese older adults with chronic diseases often diagnosed with multi-morbidities resulting in increased risks for disability. However, previous evidence on disability rates in this population have been inconsistent.

To systematically evaluate the prevalence of disability in older adults with chronic diseases in China.

We searched databases including PubMed, Embase, Web of Science, Cochrane Library, Scopus, CNKI, Wanfang Data, VIP, CBM and China Medical Journal Full-text Database up until August 2023 for publications on disability prevalence in Chinese older adults with chronic diseases. Literature screening, quality appraisal and data extraction were performed independently by two researchers. Meta-analysis was conducted using Stata 16.0 software.

A total of 32 publications (34 studies) were included. Sample sizes ranged from 221 to 16 566 cases with a disability rate of 6.9%-82.8%. Meta-analysis showed that the prevalence of disability in Chinese older adults with chronic diseases was 43.2% (95%CI=32.9%-53.5%). Subgroup analyses showed: disability rate was higher in female (36.6%, 95%CI=27.0%-46.2%) than in male (33.9%, 95%CI=23.9%-43.9%) ; disability prevalence increased with age (60-69 years old: 24.2%, 95%CI=14.3%-34.0%; 70-79 years old: 34.9%, 95%CI=24.1%-45.7%; ≥80 years old: 47.7%, 95%CI=36.3%-59.1%) ; compared to other chronic diseases, individuals with dementia/Parkinson's disease (56.3%, 95%CI=40.9%-71.7%), mental illness (53.9%, 95%CI=46.0%-61.7%), and cerebrovascular disease (49.2%, 95%CI=33.5%-64.8%) had the highest prevalence of disability; and the prevalence of disability increased with the number of comorbidities (1 disease: 33.1%, 95%CI=20.8%-45.3%; 2 diseases: 36.3%, 95%CI=22.6%-50.0%; ≥3 diseases: 49.7%, 95%CI=31.3%-68.0%) .

The prevalence of disability among Chinese older adults with chronic diseases is high and can be impacted by both the type of chronic disease and the number of comorbidities. It is recommended to strengthen chronic disease monitoring and management efforts to prevent and eliminate disability and promote healthy aging in this population.

Central precocious puberty (CPP) is a common endocrine disease in children, which shows an increasing trend year by year in recent years. It can be divided into fast-progressing central precocious puberty (RP-CPP) and slow-progressing central precocious puberty (SP-CPP) through pubertal development. RP-CPP has great harm, but it is difficult to distinguish it from SP-CPP in early clinical stage, mainly relying on the progress of adolescent development and bone age during follow-up. At present, there is a lack of effective laboratory indicators to predict RP-CPP.

To investigate the relationship between luteinizing hormone (LH) /follicle-stimulating hormone (FSH) ratio and pubertal development.

CPP girls aged 4-10 years old (n=380) admitted to the Children's Hospital Affiliated to Zhengzhou University from January 2020 to May 2022 were regression selected and divided into RP-CPP group (n=130) and SP-CPP group (n=250 cases) according to indicators such as puberal development process. Clinical characteristics of the two groups were compared and analyzed. Univariate and multivariate Logistic regression analysis of the influencing factors of RP-CPP was performed, and ROC curve of LH/FSH ratio on the predictive value of RP-CPP was drawn.

The height, weight, BMI, IGF-1, difference between bone age and actual age, bilateral ovarian volume, LH base value, estradiol level, LH base value /FSH base value, and LH peak /FSH peak value of girls in RP-CPP group were all higher than those in SP-CPP group, with statistical significance (P<0.05). Regression analysis showed that CPP patients progressed to RP-CPP related serological indexes when LH base value and LH peak /FSH peak were detected. LH base /FSH base value and LH peak /FSH peak were positively correlated with height, IGF-1, LH base value, estradiol level, LH peak, ovarian volume and bone age (P<0.05). ROC curve showed that the LH base /FSH base value and LH peak /FSH peak value were more sensitive and specific than other indexes to the predictive value of RP-CPP. When the LH base /FSH base value was 0.63, the Yoden index reached a maximum of 0.258 (sensitivity 43.1%, specificity 82.7%, AUC=0.644). When the LH peak /FSH peak was 1.39, the maximum Jorden index was 0.276 (sensitivity 74.6%, specificity 53.0%, AUC=0.655). The combined prediction model is better than the single index prediction model (AUC=0.668). The basal gonadotropin levels of children without clinical intervention were analyzed after 6 months of follow-up. It was found that the height increase, ΔLH, ΔFSH, bone age increase and ovarian volume increase in RP-CPP group were significantly higher than those in SP-CPP group after 6 months of follow-up, and the difference was statistically significant (P<0.05) .

LH base /FSH base value and LH peak /FSH peak are early predictors of RP-CPP. When LH/FSH base value ≥0.63 or LH peak/FSH peak ≥1.39, the possibility of RP-CPP should be considered, and the combined predictive value of the two indicators is better than that of a single indicator. It can be used as an auxiliary reference index for clinical application of gonadotropin-releasing hormone analogue therapy.

Multimorbidity accelerates cognitive decline and leads to an increased risk of cognitive impairment. However, existing studies have mainly explored the cognitive status of patients with a single or specific chronic disease, and the patient with multimorbidity remains to be urgently explored. The present study describes the epidemiological characteristics of cognitive impairment in multimorbidity, summarizes the influencing factors, organizes the association patterns between multimorbidity and cognitive impairment, elucidates the mechanisms underlying their occurrence, and finally proposes preventive and control strategies. The findings of this study are intended to serve as a valuable reference for future efforts in preventing and treating cognitive impairment in multimorbidity.

Palliative care is one of the effective means to protect the rights of good death and improve the quality of life in end-stage patients. Palliative care in Singapore is developing rapidly and a comprehensive palliative service system has been gradually established, ranking in the top of Asia in the latest national quality of death ranking. This paper proposes that the social awareness, education and training of palliative care should be strengthened, the power of charities and NGOs should be utilized, the existing palliative care carrying capacity should be improved, palliative care related system and legal protection should be established in China, by sorting out the current situation of hospice care, the practical experience in public education, personnel training, charitable support, related policies and legal protection in Singapore, in order to achieve the hospice needs of end-stage patients.

With the acceleration of the aging process in society, the demand for hospice services is increasing. The development of hospice care in China started relatively late, and relevant institutional construction standards and management norms are still in the trial stage. As one of the important integrated medical and nursing service institutions, elderly care institutions currently lack an effective and homogeneous model and service system for hospice services.

To establish a scientific, standardized and feasible hospice service model for elderly care institutions.

From April to May in 2020, Chinese/English databases were systematically searched to obtain the literature related to hospice services. Five experts in the field of hospice care were invited to carry out semi-structured interviews, and the initial index system was constructed based on the results of literature retrieval and semi-structured interviews. In May 2020, a purposive sampling method was used to select fifteen experts in the field of hospice care to conduct two rounds of correspondence, and the indicator system was determined based on the analysis of the research group and expert suggestions. After two rounds of correspondence, an expert group interview was conducted to further optimize and adjust the formed indicator system.

In both rounds of correspondence, the questionnaire response rate was 100.0%, with expert authority coefficients of 0.89 and 0.94, respectively. The Kendall's W coefficients for the first level indicator were 0.54 and 0.59, respectively, and the Kendall's W coefficients for the second level indicator were 0.18 and 0.10, respectively. The final constructed indicator system for the hospice service model of elderly care institutions included three primary indicators of necessary resources and conditions, content and processes, assessment indicators, and 36 secondary indicators. In the second round of inquiry, the average importance score of the indicator was 3.87 to 5.00 points, the coefficient of variation was 0 to 0.25, and the full score rate was 63.0% to 100.0%.

The scientificity and reliability of the model hospice service model for elderly care institutions constructed in this study are good, which can provide reference for elderly care institutions to provide high-quality medical services for elderly patients at the end of their lives.

Community-based intervention is an important part of palliative care for advanced cancer patients. However, its role in the health management of advanced cancer patients remains to be supported by medical evidence.

To evaluate the efficacy of community-involved hospice care for patients with advanced cancer.

Wanfang Data Knowledge Service Platform, CNKI, VIP were searched by using Chinese keywords such as "community" "medical model" and "advanced cancer", Cochrane Library, PubMed and Web of Science were searched by using English keywords such as "Community-based" "Model of Palliative Care" "Advanced Cancer" "Quality of Life", to obtain randomized controlled trials (RCTs) related to the efficacy of community-involved hospice care from 2007-01-01 to 2022-05-10 by using Cochrane system evaluation method on 2022-05-22. The quality of RCTs meeting the inclusion criteria was evaluated, and the valid information was extracted for meta-analysis.

A total of 11 RCTs in English and 9 RCTs in Chinese were included in the study, involving 2 356 and 1 238 patients, respectively. Meta-analysis showed that compared with routine cancer care, community-involved hospice care could improve quality of life and symptom severity in patients with advanced cancer, demonstrated by increasing Functional Assessment of Chronic Illness Therapy-Palliative Care scale socre〔MD (95%CI) =3.77 (0.83, 6.71) , P=0.01〕and Quality of Life Instruments for Cancer Patients scale total score〔MD (95%CI) =12.53 (2.36, 22.69) , P=0.02〕, reducing Functional Assessment of Cancer Therapy scale total score〔MD (95%CI) =-2.61 (-3.53, -1.70) , P<0.01〕 and Edmonton Symptom Assessment System score〔MD (95%CI) =-2.45 (-4.70, -0.20) , P=0.03〕. However, the improvement of community-involved hospice care on depressive symptoms and overall survival rates of patients remains controversial, and its effect on economic indicators such as admission rates, hospitalization days/numbers needs to be further explored.

Community-involved hospice care can improve the quality of life and symptom severity of patients with advanced cancer, however, its improvement in hospice care in the depressive symptoms and overall survival rates of the patients remains controversial, and its improvement in economic indicators such as admission rate and hospital stay/inpatients admissions remains to be further explored.

In the initial promotion of pilot hospice care services (HCS) in China, there is an urgent need to evaluate the quality and effectiveness of HCS comprehensively in pilot institutions.

The purpose of this study was to establish a meso-level comprehensive assessment system of hospice care, and to provide a scientific measurement tool for assessing and comparing hospice care in various pilot institutions.

An item pool for establishing a comprehensive assessment system for HCS was constructed through a literature review and small-scale expert interviews from April to May 2021, then the items were rated using a 9-1 grading scheme (the highest grade is 9, while 1 is the lowest) in terms of three aspects (relevance, measurability and feasibility) during two rounds of expert consultation conducted using the RAND/UCLA modified Delphi panel method from June to July 2021.

The Comprehensive Assessment System of Hospice Care (CASHC) was established finally after the items were revised and improved according to the results of two rounds of expert consultation, which consists of 3 primary indicators (structure, process and outcome), 9 secondary indicators (policy guarantee, service provision, patient burden, etc.), 25 tertiary indicators (institutional system guarantee, number of services, per capita cost, etc.) and 81 quaternary indicators (inclusion of institutional development plan, number of hospital discharges and per capita medical cost, etc.). The first round of consultation achieved a response rate of 93.3%, an authority coefficient of 0.900, with values of Kendall's W for the quaternary indicators calculated as 0.194, 0.115, and 0.126, respectively. The second round of consultation achieved a response rate of 92.9% and an authority coefficient of 0.900, with values of Kendall's W for the quaternary indicators of 0.417, 0.241, and 0.322, respectively.

The CASHC consisting of four-level indicators established using the Donabedian's structure-process-outcome framework is an innovative and practical tool, which can be used to quantify and compare the quality and effectiveness of HCS among different pilot institutions or different regions, contributing to the promotion of the standardization and homogenization of HCS in pilot regions.

Survival assessment, psychological counseling and other services included in the comprehensive hospice care program conform to the hospice care philosophy, and may be independently delivered to patients to satisfy their needs in a pioneering approach by some health institutions, but the expenses of them could not be reimbursed by health insurance due to lack of an official basis for charging, which may be a bottleneck restricting the development of hospice care.

To systematically assess the hospice care services whose expenses are ineligible for reimbursement by health insurance independently provided by community health centers (CHCs) in a pioneering approach, offering a basis for improving the services and price system of hospice care.

From July to October 2020, by use of typical sampling, one or two CHCs with relatively heavy workload of hospice care were selected from each district of Shanghai, then from which 30 were selected to attend a survey for understanding the implementation status of hospice care using a self-developed questionnaire named Pilot Hospice Care Services Pioneered by Shanghai Community Health Centers, involving inpatient and home hospice care (35 services belonging to five types) . Individuals in charge of hospice care delivery completed the questionnaire according to the status of hospice care implemented in their CHCs in the past year.

The survey obtained a response rate of 96.7% (29/30) . Among the respondent 29 CHCs, 28 (96.6%) delivered inpatient palliative care services, and the median number of services available was 27 (15) ; 25 (86.2%) provided home hospice care services, with 25 (15) as the median number of services available. There was no significant difference in the number of services belonging to five types delivered for inpatients and at home (P>0.05) . There were also no significant differences in the number of inpatient and home hospice care services delivered by CHCs in central urban, suburban, and exurban districts (P>0.05) . Among the hospice care services delivered for inpatients, the average proportions of five types of services, namely assessment services, comfort care, appropriate technology of hospice care, psychological support and humanistic care were 85.7%, 78.6%, 48.6%, 88.4% and 67.5%, respectively. Among the hospice care services delivered at home, the average proportions of above-mentioned five types of services were 86.3%, 60.0%, 42.0%, 84.0% and 62.0%, respectively.

Hospice care services have been widely implemented in Shanghai's CHCs with good availability and insignificant inter-district differences. To incentivize the CHCs and medical workers to provide hospice care, there is an urgent need to further standardize the hospice care services, develop relevant quality criteria, improve the price system, and reform the payment method.