Table of Content

05 June 2018, Volume 21 Issue 16

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Monographic Research

Differences between General Practice and Family Medicine：an Analysis Based on the Renaming of Australian Family Physician　#br#

YANG Hui1，HAN Jian-jun2，XU Yan-li2

2018, 21(16):  1910-1915.  DOI: 10.3969/j.issn.1007-9572.2018.16.002

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We reviewed the renaming of general practice/family medicine organizations and their scholarly journals around the world，in particular，detailedly analyzed the renaming of Australian Family Physician（AFP）.AFP was a scholarly journal of RACGP，which was superseded by Australian Journal of General Practice（AJGP） from 2018，giving clearer definitions of the role and responsibilities of general practice.In China，confusing use of general practice/family medicine influences the accurate perception of residents toward general practice and family medicine to a certain extent.In view of this，the definition and meaning of general practice is supposed to be determined more clearly in China based on the understandings of healthcare administrators，general practitioners and other people.


Associated Factors for Residents Signing a Contract with a Family Doctor in China：a Bibliometric Study　

PENG Xiao-qin，PU Chuan*

2018, 21(16):  1916-1922.  DOI: 10.3969/j.issn.1007-9572.2018.16.003

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Objective　To systematically evaluate the studies concerning factors associated with residents signing a contract with a family doctor in China，providing a reference for further development of family doctor system.Methods　We searched the studies about factors associated with residents signing a contract with a family doctor in China from the databases of CNKI （as of December 10，2017），Wanfang Data Knowledge Service Platform （as of December 21，2017），and VIP （as of December 15，2017）.The extracted data were stored in an Excel 2007 worksheet file.Visualization analysis （with tools offered by CNKI database） as well as bibliometric analysis of the studies were conducted.Results　62 studies were included.The annual number of studies published from 2012 to 2017 is 2，4，8，13，14，21，respectively，showing an increasing trend.Universities and institutes contributed 19 of them （30.6%）；58（93.6%） discussed the status of residents signing a contract with a family doctor；the settings for 40 （64.5%） studies are in eastern China；29 （46.8%） were funded by provincial or municipal projects；14 （22.6%） are master theses or doctoral dissertations；13 （21.0%） were published in Chinese General Practice.8 key words related to the associated factors for residents signing a contact with a family doctor were extracted based on statistical analysis of the frequency of key words，of them，"health services" "associated factors" "dual referrals" was used 25，19，13 times，respectively.Co-occurrence network analysis of the key words used 6 or more times found that，the co-occurrence frequency of "health services" and "associated factors"，"factor analysis" and "associated factors"，"associated factors" and "contract-signing rate"，"health services" and "dual referrals" was 12，12，8，8，presenting higher frequency.The main 3 aspects associated with residents signing a contract with a family doctor are individual factors，community healthcare institutions-related factors and governmental factors，with a frequency of 132，38，4，respectively，accounting for 75.9%，21.8%，2.3% of the total using frequencies （174） of the factors included in the 3 aspects.Conclusion　The number of studies concerning factors associated with residents signing a contract with a family doctor in China is increasing generally.The distribution of institutions contributing studies，types of studies，and settings for studies is uneven.The studies mainly focus on health services，associated factors，dual referrals and so on，and put forward that residents signing a contract with a family doctor in China is mostly affected by individual factors，followed by unignorable community healthcare institutions-related factors and governmental factors.


Regional Informatization Platform-based Hierarchical Diagnosis and Treatment Delivery Model for General Practitioner Team

ZANG Guo-yao，FANG Li-zheng*，CHEN Li-ying，DAI Hong-lei，ZHU Wen-hua，LU Chong-rong，CHEN Jian-hua，LI Li，CHAO Guan-qun，ZHANG Jia，QIAO Qiao-hua，HUANG Li-juan

2018, 21(16):  1923-1926.  DOI: 10.3969/j.issn.1007-9572.2018.16.004

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Hierarchical medical system is a key part of the new round of healthcare system reform.At present，its development is not standardized and very effective，and far from perfect.In 2014，Sir Run Run Shaw Hospital，Zhejiang University School of Medicine established and started to run a healthcare cloud platform，then it has launched hierarchical diagnosis and treatment delivered by the general practitioner team based on this platform.The procedure of this healthcare delivery model is as follows：general practitioners（GPs） in primary care provide first consultation for patients.When encountering difficult and complicated cases，after gaining patient consent，these GPs contact those GPs in higher-level general hospitals via the APP for the doctor side for help，then the latter offer suggestions for further treatment and examinations，as well as consultations from specialist panel or referrals if necessary.Furthermore，the operation of this model was presented.Using this model is beneficial to the closer cooperation between GPs in medical institutions at all levels participating in the platform as well as the cooperation between these institutions，ensuring that the healthcare delivered by these institutions be homogenized to certain extent，and also is contributive to the development of hierarchical medical system，offering a reference for informatization construction concerning hierarchical medical system for other regions of China.



Study on Health Management of Chronic Diseases in Urban Communities Based On PRECEDE-PROCEED Model　#br#

FU Jing1，CUI Hua-qian1，XIA Yao1，ZHAO Rui-rui1，ZHOU Guang-qing2*，ZHANG Long-sheng3

2018, 21(16):  1927-1931.  DOI: 10.3969/j.issn.1007-9572.2018.16.005

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With the rapid development of healthcare industry and the advancement of chronic disease prevention，community health management has become an effective measure to strengthen the comprehensive prevention and treatment of chronic diseases.The PRECEDE-PROCEED model is a theoretical model that combines PRECEDE（predisposing，reinforcing，and enabling constructs in educational/environmental diagnosis and evaluation） with PROCEED（policy，regulatory，and organization constructs in educational/environmental development）．Under the guidance of PRECEDE-PROCEED model，this study tried to figure out the influencing factors and existing problems of community health management on chronic diseases with the example of Chebei Community Health Service Center in Tianhe District of Guangzhou.Five modules were systematically evaluated，and the intervention was carried out in five aspects with a comprehensive evaluation from three perspectives.Through multidimensional perspective analysis，this paper tried to put forward corresponding suggestions in order to provide the reference for the innovation and optimization of urban community health management of chronic diseases.



Recent Developments in the Delivery of Integrated Medical and Nursing Care for Elderly Parents Bereaved of Their Only Child　

XU Cai-ming，RONG Chao，TAN Jian-gang*

2018, 21(16):  1932-1937.  DOI: 10.3969/j.issn.1007-9572.2018.16.006

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As the number of elderly parents bereaved of their only child is increasing，the integrated medical and nursing care for them has achieved growing concern of institutions or individuals involved in elderly care.We systematically reviewed the recent developments in the delivery of care for elderly bereaved parents，concluded that the current support services can not address their economic，mental，elderly care，healthcare，and social performance problems，and put forward the following suggestions：strengthen the government accountability；boost multidisciplinary involvement（including non-governmental organizations）；enrich the support services；increase public subsidies；intensify community-based services；establish psychological assessment and support system；improve the working style of relevant workers by referring to social work methods.Moreover，we found that most of the previous studies are theoretical studies with some limitations，and quantitative studies of the needs of such a population are rare，so we recommended qualitative combined with quantitative methods for further studies.In addition，development of a systematic，comprehensive and specific delivery pattern for integrated medical and nursing care with the theories of active aging and from a developmental perspective is a recommended theme by us for future researches.



Status and Influencing Factors of Social Support among Chinese People Bereaved of Their Only Child

ZHU Chen-xi1，CHANG Ming2，ZHOU Ying3，RONG Chao2*，FAN Hong4，HE Da5，ZHENG Wen6，SUN Di-feng7

2018, 21(16):  1938-1943.  DOI: 10.3969/j.issn.1007-9572.2018.16.007

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Objective　To discuss the social support status and its influencing factors among Chinese people bereaved of their only child，providing an evidence for the development of multiple social support systems.Methods　During July to August 2017，a survey was carried out in a multi-stage sample of 235 Chinese people（≥45 years old） who were bereaved of their only child from a city under provincial jurisdiction in eastern China with a self-developed questionnaire covering questions about sociodemographic characteristics and social support〔assessed by 3 domains（subjective support，objective support，utilization of support） of the Social Support Rating Scale（SSRS）〕.Stepwise multiple linear regression analysis was performed for exploring the influencing factors for self-reported social support.Results　Totaled 192 cases returned responsive questionnaires，with a response rate of 81.7%.The total SSRS score ranged from 19.0 to 46.0.The median and quartile spacing for total SSRS score，subjective support score，objective support score and utilization of support score was 34.3（12.9），20.0（8.0），7.0（3.0），7.0（3.0），respectively.Those married rather than singles achieved higher total SSRS score，subjective support score，objective support score and utilization of support score（P<0.05）.Those earned monthly income ≥3 500 yuan achieved higher objective support score compared with those earned <3 500 yuan（P<0.05）.Those without third-generation family members scored higher in total SSRS compared with those with（P<0.05）.Both higher total SSRS score and subjective support score were found in those with good rather than fair self-reported physical status（P<0.05）.Moreover，both higher total SSRS score and objective support score were found in those with good instead of poor self-reported physical status（P<0.05）.Multiple linear regression analysis revealed that marital status was associated with total SSRS score，subjective support score，objective support score and utilization of support score（P<0.05），and monthly income was associated with utilization of support score（P<0.05）.Conclusion　In general，the bereaved Chinese people enjoy good social support.However，the level of social support differs significantly between them，mainly by marital status and monthly income.Therefore，in order to increase the social support for them，we put forward the following suggestions：actively improve the community-based integrated contractual medical and nursing services for maintaining and improving the health；deliver psychological consultation services from professional psychotherapists in forms of one-to-one or groups；strengthen the implementation of health services purchased by the government；advance the development of social support systems.


 

Status and Influencing Factors of Mental Health among Chinese People Bereaved of Their Only Child　

FAN Hong1，ZHENG Li-jie2，LENG Zhi-wei3，LI Dian-jiang1，MAO Ying-ying4*，ZHU Chen-xi5，WANG Xiang-guo6，ZHENG Wen7，SUN Di-feng8

2018, 21(16):  1944-1948.  DOI: 10.3969/j.issn.1007-9572.2018.16.008

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Objective　To explore the mental health status and influencing factors among Chinese people bereaved of their only child，and based on this，to put forward targeted interventions.Methods　From July to August 2017，we implemented a survey among a multi-stage sample of 235 Chinese people（≥45 years old） who were bereaved of their only child from a city under provincial jurisdiction in eastern China with a self-developed questionnaire covering questions about sociodemographic characteristics，social support〔assessed by Social Support Rating Scale（SSRS）〕，and depression status〔assessed by Geriatric Depression Scale （GDS）〕.Stepwise multiple linear regression analysis was performed for investigating the associated factors for self-reported depression.Results　Totaled 228 cases returned responsive questionnaires，with a response rate of 97.0%.According to the self-administered GDS score，149（65.3%） were found with no depression，but 59（25.9%） with mild depression，and 20（8.8%） with moderate-to-severe depression.Higher GDS score were found in those with junior high school or lower educational level instead of those with high school/secondary specialized school educational level，in those singles rather than married，in those without third-generation family members instead of those with，in those with poor self-reported physical health rather than those with good and fair self-reported physical health as well as in the sick but not in the healthy ones（P<0.05）.Stepwise multiple linear regression analysis showed that third-generation family members，self-reported physical heath and SSRS score were associated with the GDS score（P<0.05）.Conclusion　The prevalence of depression is high in the bereaved Chinese people.Moreover，no third-generation family members，poor physical status，and low level of social support are associated with higher prevalence of depression.In view of this，it is suggested to improve the health of the bereaved by intensively enriching the community-based integrated contractual medical and nursing services，to help them to rebuild the status of parenthood by offering assistance in having another child or adopting a child，or to regularly give consolation services by social workers，and to increase the level of social support of them through a variety of channels.In addition，attention should also be focused on those with low educational level or singles.


 

Status and Influencing Factors for Self-reported Elderly Care Options among Chinese People Bereaved of Their Only Child　

RONG Chao1，ZHAO Feng1，XIE Rong-rong1，FU Chuan-xi2，WANG Xiao-ming3，SHEN Shu-hua3，ZHENG Wei-jun2，CHEN Ru-cheng2，TAN Jian-gang1*

2018, 21(16):  1949-1953.  DOI: 10.3969/j.issn.1007-9572.2018.16.009

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Objective　To explore the status and influencing factors of the self-reported elderly care options among Chinese people who lost their only child.Methods　We conducted a survey among a multi-stage sample of 235 cases aged 45 or older who lost their only child from a city under provincial jurisdiction in eastern China between July and August 2017 with a self-developed questionnaire consisting of questions about sociodemographic characteristics，social support〔assessed by Social Support Rating Scale（SSRS）〕，mental status〔assessed by Geriatric Depression Scale（GDS）〕，as well as preferred type of elderly care and caregivers during the aging period.Multivariate Logistic regression analysis was carried out for investigating the influencing factors for self-reported elderly care options.Results　The survey achieved a response rate of 83.0%（195/235）.In terms of type of elderly care，85（43.6%） preferred community and home-based care，while 110（56.4%） preferred institution-based care.With regard to caregivers，73（37.4%） preferred family members，87（44.6%） preferred nurses/nursing assistants，and 35（18.0%） preferred nannies/ volunteers.Multivariate Logistic regression analysis showed that SSRS score was the influencing factor for the preferred type of elderly care（P<0.05）；educational level，number of comorbidities，and third-generation family members were associated with the choice of caregivers（P<0.05）.Conclusion　The bereaved parents with high educational level were more likely to choose institution-based care.Educational level，number of comorbidities，and third-generation family members were associated with the choice of caregivers.It is suggested to develop a community and home-based elderly care platform for bereaved parents with low level of social support；strengthen the training of nurses and nursing assistants for elderly care；enrich the contractual services provided by community-based physicians and incentivize them to increase the necessary service frequencies.


 

Development of an Integrated Medical and Nursing Care Model for Chinese People Bereaved of Their Only Child Based on Social Support and Polycentric Governance Theories　

RONG Chao1，SHEN Shu-hua2，CAO Wei-ming1，XU Cai-ming1*，LIU Tian-li3，XIE Rong-rong1，SUN Di-feng4

2018, 21(16):  1954-1958.  DOI: 10.3969/j.issn.1007-9572.2018.16.010

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Objective　To develop a personalized and systematic integrated medical and nursing care model for Chinese people bereaved of their only child based on social support and polycentric governance theories.Methods　We conducted in-depth interviews with a purposive sample of key informants（10 people bereaved of their only child，8 workers from relevant health administrative departments and social organizations） from a city under provincial jurisdiction in eastern China for July to August 2017 for collecting the data about physical health，mental status，healthcare needs，support status and desired elderly care support of the bereaved people.Based on the interview results organized and analyzed with MAXQDA 12 as well as the theories of social support and polycentric governance，we developed an integrated medical and nursing care model for the bereaved people.Results　The bereaved people rarely actively sought help，but they could receive some policy-based support from the relevant departments of the district government and community departments.Their mental status were poor，but it could be improved significantly by consoling from the fixed and familiar people（such as the workers from relevant community departments）.Their physical health needed increasing care with aging.Health status，self-care ability and preferences（including preferred elderly care） differed significantly.Those with severe disease burdens or needing to raise the third generation of family members were found with great economic pressures.In our integrated medical and nursing care model，the involved subjects delivering support for bereaved people include relevant governmental departments，relevant community departments，non-governmental institutions，relatives，friends，neighbors and so on；the support includes healthcare，health cultivation，elderly care，financial backing，psychological consolation，social participation and so forth.Conclusion　In order to satisfy the individualized elderly care needs and to offer long-term integrated medical and nursing care in an all-round way for the bereaved people，it is suggested to establish a government-leading multidisciplinary social support system，achieving the development from healthy aging to active aging，and from survival support to developmental support.


 

Risk Factors for Cardiovascular Disease Identified by Framingham Risk Score and Endothelial Dysfunction Classification

YI Yan-shan，NONG Qing-jiao，MAO Bao-yu，PAN Xue，MO Qiu-yan，ZHONG Qiu-an*

2018, 21(16):  1959-1964.  DOI: 10.3969/j.issn.1007-9572.2018.16.011

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Objective　This study aimed to characterize the risk factors of cardiovascular disease based on Framingham risk score（FRS） and endothelial function classification in subjects with subclinical status.Methods　752 asymptomatic adults were recruited from Siding town，Rongan county and Anchui township，Rongshui county of Guangxi from August to September 2015.For the participants，the 10-year risk for cardiovascular disease was estimated by FRS and based on the estimated results，they were divided into low to moderate risk FRS group （FRS≤20%） and high FRS group（FRS>20%）；vascular endothelial function was assessed by brachial artery flow-mediated dilation （FMD），and according to the assessment results，they were assigned to normal endothelial function group （FMD ≥6%） and impaired endothelial function group （FMD<6%），respectively.Logistic regression models were used to analyze the cardiovascular risk factors of the subjects categorized by the 10-year cardiovascular disease risks and vascular endothelial function，respectively.Results　Logistic regression analysis showed that the cardiovascular risk factors for those with high FRS but normal FMD，were male，increased age，smoking，elevated systolic blood pressure，low-density lipoprotein cholesterol and triacylglycerol；male and increased age were risk factors associated with cardiovascular disease in those with low to moderate FRS but impaired FMD；male，increased age，smoking，moderate or light physical activity，elevated systolic blood pressure，total cholesterol and high-density lipoprotein cholesterol，C-reactive protein and fasting blood glucose were risk factors associated with cardiovascular disease for those with high FRS and impaired FMD.Conclusion　The cardiovascular risk factors were different for subjects with different characterization in subclinical stage.Therefore，individualized measures should be considered in preventing cardiovascular disease for the characterized subjects during the subclinical stage.



Effect of Quantitative Control of Glycemic Load of Staple Foods on Patients with Gestational Diabetes Mellitus

PAN Dan-feng*，CANG Yu-zhen

2018, 21(16):  1965-1969.  DOI: 10.3969/j.issn.1007-9572.2018.16.012

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Objective　To investigate the effect of quantitative control of glycemic load（GL） of staple foods on patients with gestational diabetes mellitus（GDM）.Methods　 We enrolled 78 cases of GDM receiving treatment in the Nutrition Clinic，Guangzhou First People'e Hospital during March 2016 to June 2017 and randomly divided them into the control group and experimental group.Both groups received the conventional nutrition therapy，the experimental group additionally received instructions about quantitative control of GL of staple foods.The interventions for both groups lasted for 4 weeks.Daily energy intake，percentage of energy supply of 3 major nutrients（protein，fat，carbohydrate），total GL，GL of per unit of energy intake，fast blood glucose（FBG），2 h postprandial blood glucose（2 hPG），weight growth rate and diabetes-related knowledge scores in two groups were compared before and after dietary treatment.Results　 Except 10 （6 in the experimental group and 4 in the control group ） failed to complete the treatment，the other cases were included in the final analysis.（1）There was no significant difference in daily energy intake，percentage of energy supply from protein，fat or carbohydrate between two groups before and after dietary treatment（P>0.05）.（2） Before treatment，there were no significant differences in total GL，GL of per unit of energy intake，FBG and 2 hPG between two groups，but after treatment，except FBG was still similar in both groups（P>0.05），the other 3 parameters decreased significantly in the experimental group（P<0.05）.（3） Two groups demonstrated no differences in weight growth rate and scores in diabetes-related knowledge before intervention（P>0.05），but after intervention，although the scores in diabetes-related knowledge were similar in both groups（P>0.05），the weight growth rate was lower in the experimental group（P<0.05）.Conclusion　Dietary intervention with quantitative control of GL of staple foods helps GDM patients reduce total GL，GL of per unit of energy intake 2 hPG effectively and weight growth rate.


Value of Estimation of Physiologic Ability and Surgical Stress in Predicting the Postoperative Complications of Esophageal Cancer　

HUA Ke-sheng

2018, 21(16):  1970-1973.  DOI: 10.3969/j.issn.1007-9572.2018.16.013

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Objective　To study the value of estimation of physiological ability and surgical stress（E-PASS） in predicting the postoperative complications of esophageal cancer.Methods　We enrolled 740 cases of esophageal cancer treated in Department of Oncology，Heze Municipal Hospital from June 2008 to June 2016，and 139 of whom with postoperative complications during the perioperative period and 601 without were assigned to complication group and control group，respectively.We collected and compared their data possibly related to the risk for post complications（sex，age，previous history of heart disease，whether having lung diseases，wether having diabetes，performance status classification，ASA physical status classification，intraoperative blood loss/body weight，duration of surgery and size of incision），and calculated preoperative risk score（PRS），surgical stress score（SSS） and comprehensive risk score（CRS）．Logistic regression analysis was carried out to explore the factors associated with postoperative complications.And receiver operating characteristic（ROC） curve analysis was implemented to investigate the predictive value of CRS for postoperative complications.Results　Significant differences were found between the groups in terms of the distribution of sex，age，past history of heart disease，prevalence of diabetes，distribution of performance status classification and ASA physical status classification，blood lose/bady mass，average PRS，SSS and CRS（P<0.05），but not in terms of prevalence of lung disease，average duration of surgery and average size of incision（P>0.05）．The results of Logistic regression analysis suggested that ASA physical status classification was a risk factor for postoperative complications in patients after esophageal cancer surgery.For predicting postoperative complications of esophageal cancer patients by CRS，its AUC was 0.870〔95%CI（0.823，0.891）〕，and the optimal cut off point was 0.588，corresponding sensitivity and specificity were 91.4% and 65.6%，respectively.Conclusion　E-PASS can well predict the incidence of postoperative complications in patients with esophageal cancer.


Predictive Value of Serum Uric Acid on the Depression after Acute Ischemic Stroke　

YUAN Jie1，LU Yue-ying1，GUO Xin1，JIA Na-na1，WANG Li-ping2，WANG Gang2，WANG Jing3*

2018, 21(16):  1974-1979.  DOI: 10.3969/j.issn.1007-9572.2018.16.014

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Objective　To investigate the value of serum uric acid（UA） levels on admission to predict the occurrence of post-stroke depression（PSD） at 6 months after acute ischemic stroke（AIS）．Methods　The study cohort included 498 patients with AIS who were hospitalized in the Affiliated Hospital of North China University of Science and Technology from August 2015 to December 2016.Six months after AIS，the Hamilton Rating Scale for Depression（HAMD） was used to evaluate the patients.Patients with a total HAMD score of <7 were assigned to the non-PSD group（283 cases） and those witha total HAMD score of ≥7 were assigned to the PSD group（168 cases）．General clinical data，neurological assessment results，and serum biochemical indicators were collected and compared between the two groups.Logistic regression was used to analyze the influencing factors of PSD and the predictive value of serum UA levels for PSD was assessed.Results　The proportion of males was lower in the PSD group than in the non-PSD group，while the average age of the patients，proportion of the patients with a family history of mental illness，complication of coronary heart disease or hyperlipidemia，proportion of the patients with first onset of the condition were higher in the PSD group than in the non-PSD group（P<0.05）．Moreover，National Institutes of Health Stroke Scale（NIHSS）score，Activities of Daily Living（ADL）score and the modified Rankin scale（mRS） score，were higher in the PSD group than in the non-PSD group（P<0.05）．In terms of biochemical indicators，cholesterol and triacylglycerol levels were higher and serum UA levels were lower in the PSD group than in the non-PSD group，while there were significant differences in the constitutions of patients with different UA levels（P<0.05）．Logistic regression analysis showed that sex，age，history of coronary heart disease，number of strokes，mRS，and UA level were influencing factors for PSD（P<0.05）．Conclusion　Serum UA level is an independent risk factor for PSD and is predictive of the occurrence of PSD among 6 months after AIS.


Blood Pressure Variability in Patients with Essential Hypertension from the Community　

WANG Wei1，CAI Shang-lang2*

2018, 21(16):  1980-1983.  DOI: 10.3969/j.issn.1007-9572.2018.16.015

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Objective　To analyze blood pressure variability（BPV） in patients with essential hypertension from the local community health service center.Methods　A total of 130 patients with essential hypertension who had visited the local community health service center（Yan'an Rd，Shibei District，Qingdao） were selected as study samples from December 2016 to June 2017.Each patient was followed up in the community health service center once a month with more than three times of follow-up in total.Systolic blood pressure coefficient of variation（CV） was selected to represent BPV and was calculated during follow-up.Comparison was conducted among patients with different mean systolic blood pressure，comorbidities，medication intake and between patients with and without complications.Results　There was no statistical significance in systolic blood pressure CV among patients with different comorbidities and between patients with and without complications（P>0.05）．Statistical significance could be found in systolic blood pressure CV when comparing patients with different mean systolic blood pressure and medication intake（P<0.05）．Lower systolic blood pressure CV could be found in patients with mean systolic pressure<160 mm Hg comparing with those with mean systolic blood pressure≥160 mm Hg（P<0.05）．Patients who took medicine regularly showed lower systolic blood pressure CV than those who did not take medicine regularly（P<0.05）．Conclusion　Mean systolic blood pressure and medication intake have an impact towards long term BPV.Medical workers in community health service centers shall not only pay attention to the mean blood pressure of patients with essential hypertension，but also pay attention to their BPV.


Comparative Study of Noninvasive High-frequency Oscillatory Ventilation and Bilevel Positive Airway Pressure Ventilation for Preterm Infants with Respiratory Distress Syndrome　#br#

LOU Wu-bin，ZHANG Wei-Xing*，YUAN Li，ZHANG Bing

2018, 21(16):  1983-1988.  DOI: 10.3969/j.issn.1007-9572.2018.16.016

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Objective　To compare the efficacy of nasal noninvasive high-frequency oscillatory ventilation （NHFOV） and duo positive airway pressure ventilation（DuoPAP） for premature infants with respiratory distress syndrome （RDS）.Methods　From June 2016 to May 2017，we enrolled 65 preterm infants with RDS who received medical care from NICU，Xinxiang Central Hospital and divided them into NHFOV group（33 cases receiving NHFOV） and DuoPAP group （32 receiving DuoPAP） by a random number table.We compared both groups' baseline characteristics，arterial partial pressure of oxygen （PaO2），arterial partial pressure of carbon dioxide （PaCO2），and oxygenation index （OI） at 0，1，12，24，48，72 h after receiving respiratory support，incidence of apnea within 72 h after receiving respiratory support，rate of invasive respiratory support，duration of noninvasive respiratory support，total duration of oxygen inhalation，repeated use of poractant alfa injection，incidence of pulmonary air leak （PAL），bronchopulmonary dysplasia（BPD），neonatal necrotizing enterocolitis （NEC），periventricular leukomalacia （PVL） and mortality.Results　Sex，birth weight，onset time of RDS，gestational age，maternal use of hormone before delivery，duration of using poractant alfa injection，prevalence of birth by cesarean section，and RDS classification did not differ significantly between the groups（P>0.05）.Moreover，mean PaO2 and OI were similar in both groups （P>0.05）.However，significant differences between the groups were found in mean PaCO2（P<0.05）.PaO2、PaCO2、OI differed at different time point（P<0.05）.Treatment regimen and duration produced significant interaction effect on PaCO2（P<0.05），but not on PaO2 and OI（P>0.05）.The incidence of apnea was much lower in NHFOV group compared with DuoPAP group（P<0.05）.In addition，both groups showed no significant differences in the rate of invasive respiratory support，duration of noninvasive respiratory support，total duration of oxygen inhalation，repeated use of poractant alfa injection and incidence of PAL，BPD，NEC，PVL and mortality（P>0.05）.Conclusion　Compared with DuoPAP，NHFOV is more safe and effective for initial treatment of preterm infants with RDS，for it can better reduce CO2 retention and decrease the risk of having apnea without increasing the incidence of adverse events.


Medical Science Undergraduate Free Training Programs Specifically Designed for Rural Practice in China　

LI Yu-hua1，HAO Ting2，CHEN Li-zhang1*

2018, 21(16):  1989-1992.  DOI: 10.3969/j.issn.1007-9572.2018.16.017

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Objective　To identify the challenges and areas for improvement in medical science undergraduate free training programs specifically designed for rural practice in China，providing support for the reform of rural general practitioner training mode.Methods　From April to June 2016，we conducted a survey in a purposive sample of managers responsible for educational administrative affairs from 19 medical universities（4 in eastern China，6 in central China and 9 in western China） offering free training programs for medical science undergraduates specifically designed for rural practice with a self-developed questionnaire for collecting the data concerning curriculum structure，general medical courses，training mode and practical training courses.All of the 19 questionnaires were completed.Results　The total credit hours of medical science undergraduate free training programs specifically designed for rural practice ranged from 2 748 to 3 736，averaged 3 259.84.The ratio of theoretical and practical training courses ranged from 1∶0.80 to 1∶0.21，averaged 1∶0.43.The average credit hours for common and humanities courses，basic medical science courses，clinical medical science courses，and public health and general medical science courses was 1 051.32，919.79，1 031.37，257.37，respectively，accounting for 32.25%，28.22%，31.64%，7.90% of the total credit hours，respectively.The number of general medical courses offered by these 19 universities was 0-4，with credit hours of 0-168（mean 80.32），accounting for 0-5.14% of the total credit hours （mean 2.46%），and credits of 0-9 （mean 4.66）.11 universities employed “4+1” training mode（4-year theoretical learning and 1-year practical training），while other 8 universities adopted “3.5+1.5” training mode （3.5-year theoretical learning and 1.5-year practical training）.16 universities offered integrated experimental courses，8 offered courses about introduction to medicine，10 offered clinical skill training courses，4 offered interning in CDC schemes，13 offered interning in community healthcare settings schemes，and 2 offered social practice schemes，but all of them offered clinical teaching and practice schemes.Conclusion　The current medical science undergraduate free training programs specifically designed for rural practice need to be improved in some aspects such as the number and credit hours of general medical courses are to be increased.


 

Intention and Associated Factors of Participating in the Standardized General Practitioner Training among Clinical Medical Undergraduates　

MA Lin-lin，LU Yuan*

2018, 21(16):  1993-1997.  DOI: 10.3969/j.issn.1007-9572.2018.16.018

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Objective　To examine the intention and associated factors of participating in the standardized general practitioner training （SGPT） among senior clinical medical students from Tongji University.Methods　From November to December 2016，we conducted a survey in a cluster sample of totaled 117 Chinese senior clinical medical students （13 foreign students were excluded） from Tongji University with a self-designed questionnaire for collecting the demographic data，understanding level of general medicine before and after learning Introduction to General Practice，benefits from learning Introduction to General Practice，intention of participating in the SGPT after graduation，and reasons for becoming a general practitioner or not after graduation.All of them （100.0%） responded to the survey positively.Results　The understanding level of general medicine improved significantly among the students after learning Introduction to General Practice （P<0.001）.The greatest benefit from learning Introduction to General Practice for 65.0% （76/117），33.3% （39/117），1.7% （2/117） of the participants was "understanding the difference between general and specialty medicine" "understanding the basic theory of general medicine" "changing the view of career selection"，respectively.During the learning of Introduction to General Practice，48.7% （57/117），37.6% （44/117），13.7% （16/117） of the students showed interest in "visiting community healthcare settings" "general practitioner's clinical thinking" "chronic disease management"，respectively.The proportion of students who were very willing，comparatively willing，fairly willing，very reluctant，to participate in the SGPT after graduation was 2.6% （3/117），15.4% （18/117），55.5% （65/117），26.5% （31/117），respectively.The intention of participating in the SGPT after graduation did not differ significantly by sex，hometown location，medicine as the first-choice major，and higher level of parents' educational attainment （P>0.05）.The top 3 reasons for becoming a general practitioner after graduation were" low working pressure " 〔91.5% （107/117）〕，"harmonious doctor-patient relationship in primary care" 〔90.6%（106/117）〕，"good pay-for-performance" 〔74.4% （87/117）〕．For not to be a general practitioner after graduation，the top 3 reasons were "comparatively low payment" 〔92.3% （108/117）〕，"poor hardware configuration in community healthcare settings" 〔90.6% （106/117）〕，and "the career of the general practitioner aiming at knowing all fields but mastering none" 〔87.2% （102/117）〕.Conclusion　The understanding level of general medicine was deepened through the learning of Introduction to General Practice and the students gained a lot during the process.However，only a small number of them were willing to receive the SGPT after graduation，and most of them had inadequate understanding of the career of general practitioner and primary care.In view of this，general medicine should be publicized further，and the importance of improving the general practice education for clinical medical undergraduates should be emphasized.


 

Community-based Multidisciplinary Systematic Interventions for the Improvement of Symptoms，Social Performance and Quality of Life in Patients with Chronic Schizophrenia　

YIN Hua-qing

2018, 21(16):  1998-2002.  DOI: 10.3969/j.issn.1007-9572.2018.16.019

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Objective　To explore the effect of community-based multidisciplinary systematic interventions on the improvement of symptoms，social performance and quality of life of chronic schizophrenia patients.Methods　From March to May 2016，using convenient sampling，we enrolled 128 patients with a confirmed diagnosis of schizophrenia who registered in Pudong New Area Huamu Community Health Service Center located in Shanghai and randomized them into the control group and the intervention group with 64 in each.Both groups received 1-year conventional interventions based on the ways for the management of patients with mental disorders in Pudong New Area delivered by health professionals involved in the prevention and control of mental disorders，the intervention group concurrently received 1-year interventions offered by neighborhood offices，police stations，disabled persons federations，private non-enterprise units （organizations） and so on.Before and at the end of interventions，Positive and Negative Syndrome Scale （PANSS） was used to assess the severity of schizophrenia symptoms，Personal and Social Performance Scale（PSP） was adopted to evaluate the social performance，World Health Organization Quality of Life-Brief（WHOQOL-BPRS） was employed to examine the quality of life，and Family Assessment Device （FAD） was applied to measure the family functioning of the patients.Results　Prior to the intervention，the mean scores of PANSS，PSP，WHOQOL-BPRS，and FAD were not significantly different between the two groups （P>0.05）.After intervention，compared with the control group，the intervention group demonstrated much lower mean scores of General Psychopathology Scale and PANSS，but significantly higher mean scores of PSP and its items，mean scores of WHOQOL-BPRS and its 2 domains of physiology and social relationship，mean scores of FAD and its 3 domains of problem solving，communication and affective responsiveness （P<0.05） except the scores of other parts of the 4 tools （Negative Scale and Positive Scale，mental and environmental domains of WHOQOL-BPRS，roles，affective involvement and behavioral control domains of FAD） were still similar （P>0.05）.Conclusion　Community-based multidisciplinary systematic interventions play a positive role in improving the rehabilitation of schizophrenia patients via enhancing the symptoms，quality of life as well as social performance.


 

Effect of Computer-assisted Cognitive Remediation Therapy on the Improvement of Cognitive Function，Level of Self-esteem and Social Performance in Schizophrenia Patients during Recovery Period

ZHU Chun-yan1，SUN Ji-jun2，TANG Jian-ping1，JIANG Chang-wang1，ZHANG Zhi-wen1，SHI Jian-fei1*

2018, 21(16):  2003-2008.  DOI: 10.3969/j.issn.1007-9572.2018.16.020

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Objective　To investigate the effect of computer-assisted cognitive remediation therapy （CCRT） on the improvement of cognitive function，levels of self-esteem and social performance in schizophrenia patients during recovery period.Methods　Eighty-six schizophrenia patients during recovery period from Hangzhou Seventh People's Hospital，Zhejiang Province，were included during March to December 2016 and were randomized into the CCRT group and control group with 43 in each.The previous conventional drug treatment was continued for 8 weeks in both groups，but 8-week CCRT was given to the CCRT group additionally.Before treatment and at the end of 8-week treatment，Wisconsin Card Sorting Test （WCST），Trail Making Test（TMT） and digit span and coding subtests of the Wechsler Adult Intelligence Scale-Revised in China（WAIS-RC） were used to measure the cognitive function，Self Esteem Scale（SES） was employed to measure the level of self-esteem，and Personal and Social Performance Scale （PSP） was adopted to examine the social performance of the patients.Results　Cognitive function：There were no significant differences between the groups in terms of WCST performance （including the mean number of trials，correct classification，perseverative errors，non-perseverative errors，and categories achieved），TMT performance （mean time needed for completing parts A and B of TMT） and scores of digit span and coding subtests of WAIS-RC at baseline（P>0.05）．After 8-week treatment，the CCRT group demonstrated less mean number of trials，more number of correct classification，perseverative and non-perseverative errors，needed shorter mean time for completing parts A and B of TMT，and achieved higher mean score of digit span subtest（P<0.05）．However，both groups still showed similar mean number of categories achieved and mean score of coding （P>0.05）．The level of self-esteem and social performance：The scores of SES and PSP were similar in the two groups at baseline（P>0.05），but after 8-week treatment，both of them were significantly higher in the CCRT group compared with the control group （P<0.05）．Conclusion　CCRT can effectively improve the cognitive function，the level of self-esteem and social performance in schizophrenia patients during recovery period.


Prevalence and Severity of Chronic Multimorbidity among Older People in an Urban-village of Shenzhen City：a Preliminary Study　

HUANG Wen-jing1，2，QIU Shan-jiao2，GONG Wei-hong2，HUANG Ze-jun2，WANG Jia-ji1*，YANG Hui1，3，4

2018, 21(16):  2009-2012.  DOI: 10.3969/j.issn.1007-9572.2018.16.021

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Objective　To investigate the prevalence and severity of chronic multimorbidity among the elderly people from an urban-village of Shenzhen，providing evidence for the allocation of medical resource in aging communities in Shenzhen，and for the improvement of management of elderly people in primary care.Methods　This preliminary study was conducted in Shenzhen.A random sample of 100 elderly people from Huangbeiling village who underwent physical examination in Huangbeiling Health Service Center or received home-based primary care from May 2016 to July 2017 participated.Assessment tools used include the Comprehensive Health Assessment（CHA） scale for identifying the number of chronic diseases，and Cumulative Illness Rating Scale（CIRS） for evaluating the prevalence and severity of multiple chronic diseases.Results　All the elderly people were found with one or more chronic diseases，in particular，92（92.0%） had multiple chronic diseases.The prevalence of chronic multimorbidity was 96.9%（31/32） for females，95.6%（65/68） for males，91.7%（44/48） for those aged 60-69，100.0%（27/27） for those aged 70-79 and 100.0%（25/25） for those aged ≥80.All the participants achieved an average CIRS score of（6.6±4.1）．Males aged 70-79，females aged 70-79，males aged ≥80，and femalesaged≥80，were found with the same average CIRS score of≥5，while those females aged ≥80 with an average CIRS score of ≥10.Compared with females aged 60-69，males of the same age group had much higher average comorbidity score（P<0.05），but similar average severity index and average CIRS score（P>0.05）．However，for age groups of 70-79 and≥80，the average co-morbidity score，average severity index and average CIRS score did not differ significantly by sex（P>0.05）．Conclusion　Chronic multimorbidity is mainly found in people aged 70 or over.Moreover，its prevalence does not vary significantly by sex.

 

Consultation Status in Community Healthcare Settings in Urban and Inner Suburban Areas of Beijing's Chaoyang District：a Comparative Study　

DENG Ming，ZHANG Ning*

2018, 21(16):  2013-2016.  DOI: 10.3969/j.issn.1007-9572.2018.16.022

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Objective　 To investigate the chronic disease consultation status in community healthcare settings in urban and inner suburban areas of Beijing's Chaoyang District，and put forward solutions for the existing problems，promoting the development of seeking healthcare in a hierarchical manner.Methods　In June 2016，we conducted a survey among chronic disease patients from 4 community health centers（CHCs） from 2 medical consortiums in Beijing's Chaoyang District（2 were selected from a medical consortium mainly consisting of CHCs in urban areas，and other 2 from a medical consortium mainly consisting of CHCs in inner suburban areas） with a self-developed questionnaire for obtaining the data concerning consultation in CHCs.320 of the 341 returned responsive questionnaires，achieving a response rate of 93.8%.Results　The educational attainment，annual household income per capita，type of medical insurance，occupation differed significantly between chronic disease patients from urban CHCs and those from inner suburban CHCs（P<0.05）．Moreover，these two groups had significant differences in seeking medical care in CHCs first and supporting initial consultation in CHCs（P<0.05）．However，the level of satisfaction with medical care in CHCs was similar in both groups（P>0.05）．The priority of the top 5 reasons for seeking medical care in CHCs ordered by the two groups was similar，which are short distance between home and the community health center，followed by not too many visits，short waiting time for consultation，good service attitude，and easy access to the prescribed medicines.Both groups demonstrated similar percentage of patients seeking medical care in CHCs for short distance between home and the community health center，not too many visits，short waiting time for consultation，or good service attitude（P>0.05）．Higher percentage of inner suburban patients sought medical care in CHCs for easy access to the prescribed medicines or inexpensive medical expense compared with urban patients（P<0.05）．Conclusion　The consultation status in CHCs differed significantly between these two groups due to medical cost，habit and convenience of medical care seeking.Urban chronic disease patients were less likely to seek medical care in CHCs.