Table of Content

05 February 2022, Volume 25 Issue 04

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World General Practice/Family Medicine

Cuba's Community Health Services：Introduction and Implications to China

ZHAO Runze, YU Haiyang, HAN Xu

2022, 25(04):  387-392.  DOI: 10.12114/j.issn.1007-9572.2021.00.233

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Cuba has a three-level healthcare system, and offers free universal healthcare, of which community health services occupy a decisive position. Cuba has accumulated abundant experience in implementing public health services, primary healthcare, and general practitioner training. China has gained fruitful achievements in decades of developing primary healthcare, but there is still much room for development. We introduced Cuba's development and current status of healthcare system, implementation of community health services and general practitioner trainings, as well as community-based measures taken for chronic disease management and infectious disease prevention and control, and compared theses aspects with relevant information of China, offering insights into further development of community health services in China.

The Development Status of Community Health Management in Japan and Its Enlightenment to China

WANG Zitong, FAN Yangdong

2022, 25(04):  393-400.  DOI: 10.12114/j.issn.1007-9572.2021.00.338

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Community health management is an important element in promoting the Health China initiative and health promotion. As the world's longest-living country, Japan's community health management has become increasingly mature. This paper briefly reviews the development of community health management in Japan under the guidance of the National Health Strategy, compares the assessment framework of its community health management, and summarizes its specific actions in three areas: health check-ups and cancer screening, lifestyle and behavioral interventions and health management of key populations, and proposes inspirations for Japan's community health management for China based on its successful experience.

Cancer Care

International Cancer Survivorship Care Models: Recent Advances and Implications to China

CHEN Rui, YANG Junting, YIN Shiquan, CHENG Wenjing, LIU Yuehua

2022, 25(04):  401-407.  DOI: 10.12114/j.issn.1007-9572.2021.00.274

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With the increasing number of cancer patients, how to care for cancer survivors and establish a sound cancer survivorship care model has become a hot topic in China and even the world. The development of cancer survivorship care model in China is still in its infancy. There are some deficiencies in cancer care and the management needs to be improved. We reviewed the latest developments in foreign cancer care models, and analyzed the aspects that merit attention, such as care process improvement, resource convergence and model innovation, then based on current situation of cancer care in China, we advised from five aspects to facilitate domestic development of cancer survivorship care models: using tiered diagnosis and treatment to individualizedly manage cancer survivors, developing and improving cancer care guidelines, building a strong cancer care workforce, innovating cancer care management, and strengthening policy and institutional measures to reduce the cancer burden.

A Systematic Review of Universal Supportive Care Needs Scale for Cancer Patients Based on COSMIN Guidelines

YAN Xue, LIU Qianqian, SU Yujie, DOU Xinman, WEI Siqi

2022, 25(04):  408-415.  DOI: 10.12114/j.issn.1007-9572.2021.00.349

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There are many scales used to assess the universal supportive care needs for cancer patients at home and abroad, but there is a lack of standardized evaluation research on the quality of such scales and horizontal comparison research between different scales. Few researchers have systematically integrated and evaluated the measurement characteristics of such scales.

To evaluate the quality of psychometric properties and methodological quality of the Chinese version of the universal supportive care needs scale for cancer patients.

In April 2021, CNKI, Wanfang Data knowledge service platform, Whipple Journal full-text database, Chinese Biomedical Literature database, PubMed, EmBase, Web of Science and CINAHL Complete Database were retrieved to collect the Chinese version of the universal supportive care needs scale for cancer patients from the time of database establishment to March 30, 2021. After 2 researchers independently screened the literature and extracted the data, the guidelines were systematically reviewed using the selection criteria for health measurement tools. Based on the evaluation of the measurement characteristics of the scale and the methodological quality of the research, the level of evidence for the measurement characteristics of the Chinese version of the supportive care needs assessment scale for cancer patients were comprehensively evaluated. All available studies were qualitatively summarised to formulate recommendations.

A total of 15 studies were included, involving 8 Chinese version of the supportive care needs assessment scale for cancer patients〔the 34-item Short Form Supportive Care Needs Survey (SCNS-SF34) , Supportive Care Needs Survey Screening Tool Chinese version (SCNS-ST9-C) , Comprehensive Needs Assessment Tool in Cancer for Patients (CNAT) , Career Needs Questionnaires-Short Form (CNQ-SF) , Chinese Cancer Survivor's Unmet Needs (CaSUN-C) , the Short-Form Survivor Unmet Needs Survey (SF-SUNS) , Advanced Cancer Patient Needs Questionnaire (ACNQ-41) , short version of Advanced Cancer Patient Needs Questionnaire (ACNQ-29) 〕. In terms of content validity, except that the overall rating of ACNQ-29 was evaluated as "not mentioned", the overall rating of the other seven scales was evaluated as "uncertain"; In terms of structural validity, except that the overall rating of CaSUN-C、SF-SUNS was rated as "sufficient", the overall rating of the other six scales was rated as "uncertain"; In terms of internal consistency, the overall rating of SCNS-SF34、CNQ-SF、CaSUN-C、SF-SUNS was assessed as "sufficient", the overall rating of ACNQ-41 was assessed as "insufficient", and the overall rating of the other three scales was assessed as "uncertain"; In terms of cross-cultural validity, only the overall rating of SCNS-SF34 was rated as "sufficient", and the overall rating of the other seven scales was rated as "not mentioned"; In terms of stability, except that the overall rating of ACNQ-41 was evaluated as "insufficient" and the overall rating of SCNS-ST9-C、ACNQ-29 was rated as "not mentioned", the overall rating of the other five scales was evaluated as "sufficient"; In terms of hypothesis testing, the overall rating of three scales was assessed as "not mentioned" (CNAT、CNQ-SF、ACNQ-29) and "uncertain" (CaSUN-C、SF-SUNS、ACNQ-41) , respectively, and the overall rating of SCNS-SF34、SCNS-ST9-C was assessed as "sufficient". The recommended rating of eight scales was grade B.

SCNS-SF34 is the scale with the most comprehensive measurement characteristics with good reliability and validity and high clinical application feasibility, which can be temporarily recommended for use, but it needs further testing.

Experiences of Family Caregivers of Chinese Cancer Patients：a Qualitative Meta-synthesis

HE Longtao, WU Han

2022, 25(04):  416-423.  DOI: 10.12114/j.issn.1007-9572.2021.00.258

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Care needs of Chinese cancer patients have increased significantly, due to massive population ageing and an increasing cancer incidence rate. Family caregiving, being the most important component in meeting those care needs, comes with many kinds of care burdens for caregivers. Thus, it is vital to systematically examine caregiving experiences of family caregivers for cancer patients.

To systematically synthesize the care experiences of family caregivers for Chinese cancer patients.

All qualitative studies on the caregiving experiences of family caregivers for Chinese cancer patients were systematically retrieved from Web of Science, PubMed, EmBase, Medline, Cochrane Library, grey literature in the health sciences, CNKI, and Wanfang Data from inception to May 23, 2021 between January and May 2021. The 2016 JBI Critical Appraisal Checklist for Qualitative Research was used for quality evaluation. Meta-synthesis of the included studies was performed.

Nineteen studies (6 in Chinese and 13 in English) were finally included, involving 295 family caregivers in total. Nine were rated A with very low risk of bias, and 10 were rated B with relatively low risk of bias. Three overarching themes containing 15 subthemes emerged: patient-centered care needs, care burden and care gains.

This qualitative meta-synthesis provides a deep and comprehensive analysis of the care experiences of family caregivers of Chinese cancer patients, which may help improve the construction of medical system to meet the needs of patient-centered care, strengthen the positive factors affecting the care experience at the micro, meso and macro levels, and carry out intervention measures such as death and life education to reduce the negative impact of cultural factors on the care experience.

Original Research

The Core Competencies in Emergency Management and Areas in Demand for Improvement in Community Public Health Emergency Responders amid COVID-19 Pandemic

LIN Yongxing, ZHU Ying, LI Wenxin, LI Na

2022, 25(04):  424-431.  DOI: 10.12114/j.issn.1007-9572.2021.00.345

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Under the conditions of regular containment of COVID-19 epidemic, the levels of core competencies in emergency management of community public health emergency responders are directly associated with the effectiveness of management of public health emergencies. However, there are few studies on core competencies in emergency management of public health emergencies and areas in demand for improvement in community public health emergency responders.

To examine the core competencies in emergency management of COVID-19 pandemic, and associated factors as well as areas in demand for improvement within community public health emergency responders from Zhejiang Province.

Using the Core Response Competence Index System for Infectious Disease Emergencies among Medical Staff as a reference, we developed a questionnaire consisting of three parts: demographic and COVID-19 containment status, Core Competencies for Emergency Management of Public Health Emergencies (CCEMPHE) , and areas in demand for improvement, and used it to conduct an online survey with 749 community public health emergency responders selected from six counties (districts) of Zhejiang using stratified cluster sampling in September 2020.

The survey achieved a response rate of 93.3% (699/749) . The average score of CCEMPHE for the respondents was (118.38±27.60) , with a scoring rate of 62.3%. The scoring rates of three dimensions of the CCEMPHE from high to low were prevention ability (66.4%) , preparedness ability (63.7%) and rescue ability (62.0%) . Multiple linear regression analysis showed that education background (b=4.55) , physical quality for emergency work (b=9.26) , experiences of participating in developing emergency plan/technical proposal (b=6.43) , attending emergency training (b=6.35) , field epidemiology training (b=4.62) , on-site emergency disposal experience (b=5.32) , the number of theoretical trainings related to COVID-19 (b=4.29) , and the number of COVID-19 containment projects involved in (b=1.16) , were associated with the core competencies in emergency management of COVID-19 pandemic in community public health emergency responders (P<0.05) . In terms of areas in demand for improvement, the knowledge related to health emergency response and management (4.09±0.86) was in highest demand, on-site guidance (4.17±0.84) was the most popular training form and short-term training (3.93±0.92) was the most suitable training method.

The community public health emergency responders in Zhejiang Province had lower intermediate CCEMPHE, and a high demand for improvement. To improve the core competencies in emergency management of infectious disease emergencies of community public health emergency responders, it is suggested to health administrators to strengthen practice trainings for these responders based on their needs, especially on-site practice trainings, with a focus on practical skill training.

Fuzzy Combination of TOPSIS and RSR for Comprehensively Assessing the Quality of National Essential Public Health Services

GU Siyu, LIANG Yuanyuan, ZHANG Kaiyan, YANG Jinxia

2022, 25(04):  432-437.  DOI: 10.12114/j.issn.1007-9572.2021.00.320

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The national essential public health services have been implemented since 2009 as a key initiative of the new round of China's healthcare reform. With the development of this service program, the allotted special funds and service items are increasing. Due to large number of indicators involved and wide coverage, it is imperative to explore a method that can assess the services scientifically, objectively and comprehensively.

To explore an appropriate method for comprehensively assessing the quality of national essential public health services, providing a basis for improving relevant policies and the quality of such services.

By use of multistage and purposive sampling, 24 community (township) health centers were selected from southern, central and northern Z Province from February to April 2019, and qualities of national essential public health services delivered by them in 2018 were comprehensively assessed using the technique for order of preference by similarity to ideal solution (TOPSIS) , rank-sum ratio (RSR) method, and fuzzy combination of TOPSIS and RSR method, respectively. With reference to the 2018 National Basic Public Health Service Project, 12 evaluation indicators were selected.

According to the TOPSIS-based assessment, the top three community (township) health centers ranked by C_i value were A (0.917 4) , C (0.875 9) and G (0.787 9) , and the bottom three were I (0.414 2) , W (0.413 7) and N (0.407 7) . In accordance with the RSR method-based assessment, the top three community (township) health centers ranked by RSR value were A (0.890 6) , G (0.765 6) , and C (0.711 8) , and the bottom three were V (0.381 9) , W (0.362 8) , and K (0.357 6) . According to the fuzzy set theory, the top three community (township) health centers ranked by W₁C_i+W₂RSR values were A, C and G, and the bottom three were I, K and W in accordance with the "majority rule", which was basically consistent with the evaluation results of TOPSIS and RSR.

The assessment results by TOPSIS, RSR, and fuzzy combination of these two and associated factors in this study are consistent with those of other studies. Either use of TOPSIS- or RSR-based quality assessment had limitations, but fuzzy combination of the two overcame these limitations, so the combination approach is worthy of promotion as an appropriate method for assessing the quality of essential public health services.

Accessibility and Rationality of In-home Self-medication among Acute Disease Patients in Gansu Province：a Household Survey

CAO Jin, ZHANG Ming, ZHAO Junxian, ZHAO Shuaixiang, LYU Meng, ZHAO Siya, HU Ming, WANG Xiaohui

2022, 25(04):  438-444.  DOI: 10.12114/j.issn.1007-9572.2021.00.282

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Self-medication behavior often occurs in acutely ill patients, which may lead to a greatly increased risk of adverse drug events. There are few surveys on the accessibility and rationality of in-home self-medication among acute disease patients against a background of implementing multiple policies associated with China's healthcare reform initiated in 2009, and the available surveys mainly focus on central and eastern China.

To investigate the accessibility and rationality of in-home self-medication among acute disease patients in Gansu, offering evidence for standardizing in-home medication, and improving accessibility and rationality of in-home self-medication in this group.

By use of multistage stratified random sampling, 1 080 households were selected from five cities in Gansu Province from June to December 2018. They were invited to attend a survey guided by the WHO Household Survey to Measure Access to and Use of Medicines for understanding the morbidity in household members in the past two weeks, use and accessibility of medicines for treating acute diseases using a questionnaire developed by our research team. The survey results were statistically analyzed. Spearman correlation analysis was used to analyze the correlation between acute diseases, accessibility and availability of medicines for treating acute diseases and the number of drugs and antibiotics.

Out of the 1 080 households, 1 071 (99.17%) effectively responded to the survey. The prevalence of acute diseases in family members living in these households in the past two weeks was 36.32% (389/1 071) . In this study, we only included the youngest family member with acutely disease in each household, that is, 389 cases in all. Of them, 350 (89.97%) had an acute upper respiratory infection; 355 (91.26%) had the behavior of seeing a doctor or buying drugs; 355 (91.26%) were on medication for treating acute diseases. Among all cases on medication, 279 (78.59%) used combination therapy, 93 (26.20%) had four or more medications simultaneously, and 151 (42.54%) were on antibiotics. Among all antibiotics users, 133 (79.17%) took antibiotics recommended by doctors, and 136 (80.95%) used β- Lactam antibiotics. In terms of medicine accessibility, 334 (85.86%) of acute disease patients were able to reach the nearest medical facility within 15 minutes; 354 (91.00%) and 329 (84.58%) reported that the required drugs were available at the public medical facilities and pharmacy, respectively. Among all cases on medication, 349 (98.31%) had medical insurance, but only 64 (18.34%) were reimbursed; 42 (11.83%) reported that the spending on medicines accounted for over 20% of the total household spending. There were statistically significant differences between patients in urban and rural areas at the avenues of seeing a doctor or buying drugs, types of antibiotics used, 15 minutes proximity to the nearest medical facility, accessibility to drugs at pharmacies, drug reimbursement rates, and spending over 20% of total household expenditure on drugs for acute illnesses (P<0.05) . Spearman correlation analysis showed that accessibility to drugs at the pharmacy was positively correlated with the number of drugs taken (r_s=0.145, P<0.05) .

The accessibility to drugs among acute diseases patients in Gansu Province is high. However, there are also issues among patients, including high prevalence of combination therapy and antibiotics intake, low proportion of patients who are reimbursed by medical insurance, as well as urban and rural differences in medicine accessibility. Therefore, to regulate residents' self-medication behaviors, it is suggested that relevant government departments give priority to actions to raise residents' awareness levels of rational medication and health insurance, medical professionals' capabilities and supervision of antibiotics use.

Application Effect and Countermeasures of the Family Contract Service Model Based on "the Consortium of Rural Doctors and Community Doctors" Among the Elderly Residents in the Mountainous Area of North Beijing

ZHANG Ruyi, PENG Yingchun, ZHANG Zhiying

2022, 25(04):  445-452.  DOI: 10.12114/j.issn.1007-9572.2021.00.262

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The elderly residents in the mountainous area of northern Beijing have a high incidence of chronic diseases, a weak economic foundation, limited access to health knowledge, and a long distance from community health service institutions. At present, the team of family doctors in the mountainous area of northern Beijing is composed of community doctors and rural doctors. Both of them play an important role in contracting services for elderly residents in mountainous areas.

To explore the current status of family doctor contracted services in the northern mountain areas of Beijing and put forward appropriate suggestions on family doctor contracted services with the elderly residents in mountain areas.

A combination of qualitative research and quantitative research was adopted. From September to October 2019, eight townships were selected in the northern mountain areas of Huairou District in Beijing. A total of 141 community doctors, 133 rural doctors and 345 elderly residents were selected proportionally from each township for questionnaire research. The elderly resident's questionnaires included basic information of the elderly, the way and the content of services which they want family doctor team to provide, the channels to obtain health consultation, and the satisfaction evaluation of the contracted services; the rural doctors and the community doctors' questionnaires included basic information, the use of internet in the contracted services, and the content of services provided to the elderly residents. During the same period, 16 cases of elderly residents, 24 cases of community doctors, and 24 cases of rural doctors were selected by using the purposive sampling method for personal in-depth interviews, in order to understand the level of awareness of the responsibilities of community doctors and rural doctors in the linkage contracted services, their views on the contracted services and the application of the internet in this service model, their suggestions on the development of the contracted services, etc. A content analysis method was used to analyse qualitative data.

According to the quantitative research results, the top three services that elderly residents in the northern mountain areas of Beijing want the family doctor team to provide are ranked as follows: carrying out the health education in countryside〔199 (57.7%) 〕, physical examination in countryside〔197 (57.1%) 〕, the delivery of medical service and medicine in the countryside〔169 (49.0%) 〕; the top three ways or channels of services that elderly residents want the family doctor team to provide are ranked as follows: outpatient clinicservice, in-home medical services, organizing health education lectures in the community; the top three channels that elderly residents consider most effective to obtain health information are ranked as follows: publicity by rural doctors or loudspeaker in the village〔253 (73.33%) 〕, face-to-face publicity by community doctors during consultation〔134 (38.84%) 〕, posting and distribution of publicity materials〔126 (36.52%) 〕. The results of multiple linear regression analysis showed that service attitude, service effectiveness, service items, and communication ability were the influencing factors of elderly residents' satisfaction with community doctors and rural doctors' linkage contracted services (P<0.05) . The health management service, outpatient service, drug distribution and medical guidance service, and long-term prescription service also had significant differences between community doctors and rural doctors (P<0.05) . There was no statistically significant difference between community doctors and rural doctors using the Internet to communicate with residents online (P>0.05) . The qualitative research results showed that the elderly residents had low demand for online services and high dependence on rural doctors, but the technical level of rural doctors were limited, community doctors had little communication with elderly residents, and they mainly focused on the coordination of medical resources.

The development of contracted services for elderly residents in the northern mountain areas of Beijing cannot be carried out without the joint efforts of community doctors and rural doctors. Currently, the elderly residents highly depend on rural doctors because of close-up services and show a great demand on community doctors for high-level technology and medical resources platform. It's recommended to take the needs of elderly residents as the guide, give full play to the advantages of rural doctors in terms of location and people, and the advantages of community doctors' technology and platform, and optimize the effectiveness of community doctors and rural doctors' linkage contracted services.

Original Research·Population Health

Values of Different Obesity Indicators in Predicting the Risk of Hyperuricemia：a Comparative Study

YANG Yuan, ZHOU Guangqing, LI Wanlin, ZHAO Chuangyi, Yuan Kongjun

2022, 25(04):  453-460.  DOI: 10.12114/j.issn.1007-9572.2021.00.281

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In China, hyperuricemia (HUA) is increasingly prevalent, which is often accompanied by multi-system diseases, and has become the second leading metabolic disease after diabetes mellitus. How to effectively contain its prevalence has become an important public health issue that needs to be solved urgently.

To examine relationships of different obesity indices〔waist circumference (WC) , body mass index (BMI) , waist-to-height ratio (WHtR) , body shape index (ABSI) , body roundness index (BRI) , visceral adiposity index (VAI) and lipid aggregation index (LAP) 〕with HUA, and compare their predictive values for HUA, providing a reference basis for early HUA screening and prevention.

Cluster sampling was used to recruit physical examinees from the health management center of a grade A tertiary hospital from January to December 2020. Anthropometric indices included in the analysis included WC, BMI, WHtR, ABSI, BRI, VAI and LAP. Binary Logistic regression was used to assess the correlation of HUA with different obesity indices. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive values of these indices for HUA with suggested optimal cut-off points presented.

Of the 32 344 physical examinees in total, 13 546 (41.84%) were found with HUA. Men had higher detection rate of HUA than women〔54.11% (10 026/18 530) vs 25.43% (3 520/13 844) 〕 (P<0.001) . The values of all these obesity indices were higher in male HUA patients than in female HUA patients, with statistically significant differences (P<0.001) . Binary Logistic regression showed that after correcting for confounding variables, WC, BMI, WHtR, ABSI, BRI, VAI, and LAP were all statistically associated with HUA occurrence in both men and women (P<0.001) . In men, the area under the ROC curve (AUC) of WC, BMI, WHtR, ABSI, BRI, VAI and LAP in predicting HUA was 0.612, 0.626, 0.602, 0.512, 0.602, 0.617 and 0.642, respectively, with corresponding optimal cut-off points of 80.5 cm, 24.3 kg/m², 0.48, 0.072, 3.8, 1.4 and 26.7. In women, the AUC for WC, BMI, WHtR, ABSI, BRI, VAI and LAP in predicting HUA was 0.637, 0.636, 0.637, 0.555, 0.638, 0.583, and 0.660, respectively, with corresponding optimal cut-off points of 72.5 cm, 22.7 kg/m², 0.47, 0.074, 4.2, 1.3 and 15.3. In both male and female physical examinees, the AUC of LAP predicting HUA was higher than the other six obesity indicators (P<0.05) , and the AUC of ABSI predicting HUA was lower than the other six obesity indicators (P<0.05) .

These seven obesity indices were all significantly associated with the occurrence of HUA in men and women. The predictive values of them for HUA were different, and LAP may be the best indicator for predicting the risk of HUA in either men or women.

Longitudinal Cohort Study of the Association of Triglyceride-glucose Index with Hypertension among Teachers from a University

ZHU Yuanjing, LIU Annuo

2022, 25(04):  461-466.  DOI: 10.12114/j.issn.1007-9572.2021.00.346

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Triglyceride-glucose (TyG) index is regarded as a novel alternative to insulin resistance (IR) , a core pathophysiological mechanism of hypertension. However, it is still controversial about the association of TyG index with hypertension, and relevant longitudinal research is limited.

Attempt to examine the association of TyG index with hypertension among teachers from a university.

A retrospective cohort study was conducted from January 2015 to December 2019. Participants (n=602) were teachers from a university who had normal blood pressure and consecutively underwent the annual physical examinations. Their physical examination data were collected, including demographic characteristics, anamnesis, medication history, and biochemical indices in venous blood. The cumulative incidence of hypertension was calculated and compared across groups〔Q1-Q4 (first to fourth quartiles) 〕 of TyG index quartiles. The association of TyG index with hypertension was analyzed, and further analyzed by sex, age, and BMI using generalized estimating equation (GEE) .

A total of 174 cases were found to have hypertension during the 5 years, with 5-year cumulative incidence of hypertension of 28.9%. The 5-year cumulative incidence was 37.4% (101/270) for males and 22.0% (73/332) for females with a statistical difference (χ²=17.23, P<0.001) . The 5-year cumulative incidence of hypertension in Q1 to Q4 groups was 16.8% (25/149) , 24.7% (37/150) , 32.9% (50/152) and 41.1% (62/151) , respectively, revealing that the cumulative incidence of hypertension increased with the elevation of TyG (χ²=23.97, P<0.001) . Multivariate analysis using GEE approach showed that compared to Q1 group, the risk of hypertension significantly increased in Q3 group〔OR (95%CI) =1.546 (1.026, 2.330) 〕 and Q4 group〔OR (95%CI) =1.872 (1.209, 2.901) 〕 after adjusting for gender, age, BMI, γ-GGT, ALT, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, uric acid, urea nitrogen. Further analysis revealed that in individuals with the fourth quartile of TyG index, men had higher risk of hypertension than women (P<0.05) . In individuals aged 45-54 years, those with the third or fourth quartile of TyG index had higher risk of hypertension (P<0.05) . In individuals with normal weight, those with the third or fourth quartile of TyG index had higher risk of hypertension (P<0.05) .

Elevated TyG index may be associated with increased risk of hypertension, so it could be used as an independent predictor of hypertension in general population, especially in men, 45-54-year-olds, or those with normal weight. And measurement of TyG index may be used to early screening for hypertension.

Health Literacy Regarding Infection Disease Prevention and Treatment among Residents of Taizhou，Zhejiang：Temporal Trends and Associated Factors

JI Jialin, HU Linlin, WANG Huanqian, XIE Wenjun, LIU Yuanli

2022, 25(04):  467-474.  DOI: 10.12114/j.issn.1007-9572.2021.00.297

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Due to repeated COVID-19 outbreaks worldwide, COVID-19 containment in China has become a routine social issue, entering a new phase of containment, and residents' health literacy about infection disease prevention and treatment has obtained increasing attentions.

To explore the health literacy about infection disease prevention and treatment in residents of Taizhou, Zhejiang during 2017—2020, and to analyze the trend of changes as well as influencing factors, providing scientific evidence for the precise implementation of actions for achieving "Healthy Taizhou 2030".

This study was implemented from 2017 to 2020 with Taizhou permanent residents aged between 15 and 69 selected using multistage random sampling, for investigating their demographics, socioeconomic features and health literacy about infection disease prevention and treatment using the National Residents' Health Literacy Monitoring Questionnaire developed by us. In January 2021, the data of health literacy about infection disease prevention and treatment of residents in Taizhou City in four years was analyzed. The health literacy data during 2017—2020 were comparatively analyzed after being processed with weight standardization, and the trend of changes during the period was analyzed using a Chi-squared test for linear trend. Binary logistic regression was used for identifying factors associated with relevant health literacy of these residents in 2020.

The number of respondents for the survey conducted in four consecutive years from 2017 to 2020, was 3 595, 5 389, 5 929, and 5 847, respectively. The samples in the four yearly surveys showed basically similar demographics, with those aged 45-54 (27.42%-30.46%) , education level was junior high school (27.78%-29.93%) , occupation was farmer (44.52%-58.03%) accounting for the largest proportion. The urban to rural population ratio for the sample of four consecutive yearly surveys was 0.50∶1, 0.55∶1, 0.54∶1 and 0.52∶1, respectively. And the male to female ratio was 1∶1, 0.95∶1, 0.99∶1 and 0.94∶1, respectively. The prevalence of having health literacy about infection disease prevention and treatment for 2017—2020 was 7.86% (642/3 595) , 19.00% (1 024/5 389) , 19.51% (1 157/5 929) , and 27.14% (1 587/5 847) , respectively. After the data were processed with weight standardization, the prevalence of health literacy regarding infectious disease prevention and treatment in 15-69-year-old residents in 2017—2020 was 22.25%, 24.72%, 25.34% and 33.14%, respectively. The health literary level regarding infectious disease prevention and treatment in the residents showed a successive linear increment during the study period regardless of living in rural or urban areas, sex, age (except for 65-69 year olds) , and education level (except for illiteracy/lower illiteracy) , and occupation (P<0.05) . Multivariate Logistic regression analysis showed that gender, age, education level, out-of-pocket health care costs in the past year, and annual household income were associated with health literacy regarding infectious disease prevention and treatment (P<0.05) .

Our analysis indicates that some advances in prevention and control as well as health education regarding infectious diseases have been achieved in Taizhou, but there is still much room for improvement. In the "golden window" period for normalized prevention and control of COVID-19, it is suggested that Taizhou should strengthen health education regarding infectious disease prevention and treatment for key groups, such as those who are middle-aged and elderly, lower educated, or engage in a career as a farmer or worker, to further improve relevant heath literacy of Taizhou residents.

Original Research·Community Management of Mental Disorders

Prevalence and Influencing Factors of Receiving Regular Interviews for Patients with Severe Mental Disorders in Communities

FENG Wei, LI Shiming, YANG Queping, WU Yue, CUI Fengwei

2022, 25(04):  475-479.  DOI: 10.12114/j.issn.1007-9572.2021.00.261

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Patients with severe mental disorders pose a serious threat to social stability due to lack of insight and high recurrence and disability rates. Therefore, it is essential to conduct regular interviews with these patients to better evaluate their conditions comprehensively, so as to timely deliver appropriate interventions, thereby improving the level of severe mental disorder management.

To explore the prevalence of receiving regular interviews and associated factors in patients with severe mental disorders in the community, providing information for improving the quality of severe mental disorder management via interviews.

Basic and follow-up management data of Wuxi severe mental disorder patients with files created as of 2019 were collected from Jiangsu Severe Mental Disorder Patients Management System during October to December 2020. The prevalence of these patients receiving regular interviews was analyzed, and associated factors were examined by Logistic regression analysis.

A total of 27 778 samples were included, with a prevalence of receiving regular interviews of 81.08% (22 523/27 778) . Logistic regression analysis showed that non-local hukou〔OR (95%CI) =0.704 (0.640, 0.775) 〕, ≤44 years old〔OR (95%CI) =0.522 (0.472, 0.578) 〕, education level〔high school/secondary vocational school: OR (95%CI) =0.493 (0.446, 0.545) and junior college: OR (95%CI) =0.470 (0.415, 0.532) 〕, full-time employment〔OR (95%CI) =0.715 (0.668, 0.766) 〕, unmarried〔OR (95%CI) =0.746 (0.665, 0.838) 〕, non-poor〔OR (95%CI) =0.587 (0.517, 0.666) 〕, no antipsychotic treatment〔OR (95%CI) =0.491 (0.440, 0.548) 〕, 0-10-year medication treatment〔OR (95%CI) =0.881 (0.778, 0.998) 〕, receiving no management subsidy〔OR (95%CI) =0.807 (0.704, 0.926) 〕, not participating in community rehabilitation services〔OR (95%CI) =0.844 (0.716, 0.996) 〕were barriers to receive regular interviews (P<0.05) .

The prevalence of receiving regular interviews in Wuxi severe mental disorder patients needs to be improved. And recommended interventions include developing favorable policies for conducting regular interviews, carrying out relevant heath publicity and education, reducing the stigma of mental disorders, improving the awareness of mental disorders, and increasing social supports, with special focus on patients who are non-locals, aged≤44 years old, employed full-time, unmarried, non-poor, have high school or above education, have 0-10-year medication treatment but no antipsychotic treatment, have no subsidy for management, and do not participate in community rehabilitation services.

Social Support and Its Associated Factors among Family Caregivers of Persons with Severe Mental Illness

WANG Ruoxi, SONG Suyi, ZHOU Yongjie, LIU Yifeng

2022, 25(04):  480-488.  DOI: 10.12114/j.issn.1007-9572.2021.00.347

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Understanding the characteristics of social support of family caregivers of persons with severe mental illness, and identifying the associated factors are the preconditions of developing evidence-based intervention strategies to improve social support for this vulnerable group. Among the limited studies concerned family caregivers of patients with severe mental illness, the majority focused on their own individual factors, leaving patient- and family-level associated factors largely under-investigated.

To explore the social support and associated factors among family caregivers of persons with severe mental illness, providing a theoretical basis for the development of evidence-based strategies to enhance the level of social support in this group.

A cross-sectional design was used. Multistage sampling was used to select three tertiary grade A mental health organizations from three cities located in eastern, central, and western China, respectively (one was extracted from each city) , then from which, family caregivers of persons with severe mental illness who received outpatient services between August 2018 and December 2019 were selected, and their family caregivers (n=1 001) were recruited as participants. A self-administered survey was conducted in the family caregivers using a questionnaire〔consisting of two parts: demographics and the Social Support Rating Scale (SSRS) 〕compiled by our research team to collect their individual and family information and social support status, as well as patients' (the care receivers') information. Multiple linear regression was employed to identify associated factors for the total score and domain scores of SSRS.

The mean total score of SSRS for the family caregivers was (34.4±9.1) . And the mean score for its three domains, subjective social support, objective social support, and social support utilization was (20.3±6.2) , (7.5±2.8) , (6.6±2.3) , respectively. The type of occupation of the caregivers, and the type of mental diseases and stability of symptoms of patients cared by them, as well as mean household monthly income per person were associated with the total score of SSRS for the family caregivers (P<0.05) . Furthermore, marital status and religious belief of caregivers, as well as their relationship with the patients cared by them also affected the total score of SSRS of the family caregivers (P<0.05) . As for the scores of domains of SSRS, they were found to be influenced by the type of occupation of the caregivers, the type of mental diseases and stability of symptoms of patients cared by them, and mean household monthly income per person (P<0.05) . Besides that, gender, marital status, living area (rural or urban) , and religious belief of caregivers, their relationship with patients cared by them, and the amount of family subsidies also affected the score of subjective social support of family caregivers (P<0.05) ; the amount of family subsidies also affected the objective social support score of family caregivers (P<0.05) ; gender and living area (rural or urban) of caregivers, and the amount of family subsidies also affected the score of social support utilization of family caregivers (P<0.05) .

Family caregivers of patients with severe mental illness possessed a low level of social support, had limited access to social support, perceived insufficient support, and used social support rather insufficiently. There were differences in factors associated with their overall social support and domain-specific social support. More attention should be paid to family caregivers who are single, unemployed, have low household monthly income per person, care for patients with schizophrenia or unstable mental symptoms, and provide them with support in accordance with their needs, by which their care burden can be alleviated, and their physical and mental health will be improved eventually.

Original Research·Methods and Tools

Development，Reliability and Validity of a Concise，Prediction Model-based Nutritional Risk Assessment Scale for Nursing Home-dwelling Older People

ZHU Dan, XIE Hong

2022, 25(04):  489-496.  DOI: 10.12114/j.issn.1007-9572.2021.00.333

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The Malnutrition Risk Assessment for Elderly Adults (WS/T 552-2017) , a malnutrition risk assessment scale issued by the National Health Commission has proven to have unsatisfied reliability and validity, with some inappropriate items in nursing home-dwelling older people. There is a lack of nutritional risk assessment scale for nursing home-dwelling Chinese older people.

To establish a reliable, concise, prediction model-based nutritional risk assessment scale applicable for nursing home-dwelling older people, and test its reliability and validity.

A survey using a questionnaire consisting of general demographic information and the Malnutrition Risk Assessment for Elderly Adults (WS/T 552-2017) was conducted with a convenience sample of 1 411 elderly people in 12 nursing homes of 6 cities, from November 2019 to January 2020. Variables screened by item analysis were included in an ordinal, multinominal Logistic regression model, and the statistically significant ones of them were then incorporated into a decision tree model. After that, ROC analysis was used to estimate the AUC of Logistic regression model and decision tree model in predicting nutrition status to select a better model to develop a concise nutritional risk assessment scale, and to determine the diagnostic threshold for nutrition status. Cronbach's α, exploratory factor analysis, estimation of AUC, sensitivity, specificity, Youden index and Kappa coefficient were used to evaluate the reliability and validity of the scale.

For predicting good nutrition, malnutritional risk, and malnutrition, the AUC of Logistic regression model was 0.962, 0.942, 0.989, respectively, and that of the decision tree model was 0.914, 0.868, and 0.968, respectively, indicating that the Logistic regression model was better, and suitable for developing the nutritional risk assessment scale. The final concise Nutritional Risk Assessment Scale for Nursing Home-dwelling Older People is composed of 10 items: BMI, changes in weight in recent 3 months, ability of engaging in daily activities, dental status, nervous and mental diseases, number of illnesses, types of drugs used, time spent on doing outdoor activities independently, eating ability, and the circumference of the shin. The total score of the scale for nursing home-dwelling older people can be 0-14.5 points, with 0-3.0 stands for good nutrition, 3.5-7.5 for nutritional risk, and 8.0-14.5 for malnutrition. The Cronbach's α of the scale was 0.463. Exploratory factor analysis obtained five common factors with eigenvalues greater than 1, explaining 69.9% of the total variance. When predicting the malnutritional risk, the AUC of the scale was 0.902, with 0.799 sensitivity, 0.870 specificity, and 0.670 Youden index. When predicting malnutrition, the AUC of the scale was 0.976, with 0.809 sensitivity, 0.953 specificity, and 0.761 Youden index. The Kappa coefficient for the scale was 0.627. The nutritional status of the 1 411 participants assessed by the scale was: 634 (44.93%) had good nutrition, 639 (45.29%) had malnutritional risk, and 138 (9.78%) had malnutrition.

The concise, Nutritional Risk Assessment Scale for Nursing Home-dwelling Older People developed using a Logistic regression model has proven to have good reliability and validity, which could be used as a tool to identify malnutrition risk or malnutrition in nursing home-dwelling older people.

Reliability and Validity of the Chinese Version of the Partners in Health Scale in Patients with Chronic Heart Failure

WANG Xiaonan, JIANG Ying, KANG Xiaofeng, JI Shiming, ZHANG Jian

2022, 25(04):  497-504.  DOI: 10.12114/j.issn.1007-9572.2021.00.319

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Chronic heart failure (CHF) is a common cardiovascular disease. Improving the self-management ability of CHF patients will contribute to quality of life improvement and reduction of rehospitalization and mortality rates. The Partners in Health (PIH) Scale is a measure designed by Flinders University, Australia, to assess the generic knowledge, attitudes, behaviors, and impacts of self-management in chronic disease patients, and is mainly used to assess the implementation effect of self-management projects in chronic disease patients.

To translate the PIH Scale into Chinese, then test the reliability and validity of the Chinese version in CHF patients, providing CHF patients with a tool for precisely assessing their self-management abilities.

The PIH was translated into Chinese with the guidance of the Brislin's translation model, then was revised according to the results of the review of a panel of experts, and a pre-test, and then the Chinese version of PIH (C-PIH) was developed. The demographic questionnaire, C-PIH, and Minnesota Living with Heart Failure Questionnaire (MLHFQ) were used in two surveys (one was conducted between April and June 2010, and another between April and June 2011) with 410 CHF patients selected from two grade A tertiary hospitals in Beijing using convenience sampling. Measurement of ceiling and floor effects, and item-total correlation were used for item analysis. Expert evaluation was used to evaluate the content validity analysis. Spearman's rank correlation coefficient was used to measure the criterion-related validity. KMO test, Bartlett's test of sphericity, exploratory factor analysis and confirmatory factor analysis were used for construct validity analysis. Monofactor analysis was used for validity analysis of known-groups. Reliability analysis was estimated by using the Cronbach's α.

Item analysis indicated that only item 3 (level of adhering to medication) of the C-PIH showed ceiling effect. Item-total correlation coefficients of the scale ranged from 0.424 to 0.761 (P<0.001) . The scale-level content validity index of the scale was 0.966. Item-level content validity indices ranged from 0.800 to 1.000. C-PIH was positively correlated with MLHFQ in terms of total score (r_s=0.200, P<0.05) . The KMO value was 0.872 and Bartlett's test of sphericity was χ²=1 139.142 (P<0.001) , indicating that the sample size was appropriate for factor analysis. By exploratory factor analysis, 3 factors with an eigenvalue greater than 1.000 were extracted, including knowledge (7 items) , coping (3 items) and adherence (2 items) , explaining 66.514% of the total variance. The loadings of items on each factor ranged from 0.571 to 0.869. The original model fit indices did not reach the critical value. After adding the suggested covariance correlation between errors-in-variables e1 and e2, e6 and e7, the fitting indices of the modified model were acceptable (χ²/df=2.393, RMSEA=0.0851, CFI=0.968, NFI=0.953, NNFI=0.963, GFI=0.905, AGFI=0.854, RFI=0.932, IFI=0.966) . Known-groups analysis demonstrated that the C-PIH total score varied significantly by level of education, economic income, NYHA class, and treatment (inpatient or outpatient) in CHF patients (P<0.001) . Good internal consistency was indicated with a scale Cronbach's α of 0.890, and three factors' (knowledge, coping and adherence) Cronbach's α of 0.894, 0.807, and 0.511.

The C-PIH exhibited good reliability and validity, which may be used as a general self-management assessment tool in patients with CHF.

Factors Associated with the Implementation of Integrated Medical-elderly-nursing Services：a Review Using the Consolidated Framework for Implementation Research

YANG Min, ZHU Xuejiao, ZHANG Chenyue, XING Mengting

2022, 25(04):  505-509.  DOI: 10.12114/j.issn.1007-9572.2021.00.210

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The problem of health and pension in an aging society is becoming increasingly acute. Under the promotion of Chinese policy of combining medical care with nursing care and the hierarchical diagnosis and treatment system. Hangzhou City, Zhejiang Province, has pioneered integrated medical-elderly-nursing services to meet the healthcare needs of an aging society. The initial effects of the services have been shown, but there are so many influencing factors associated with the delivery. And the relevant influencing factors are lack of systematic and comprehensive analysis. Therefore, summarizing the factors associated with the implementation of the services and described them in terms of five aspects (intervention characteristics, outer setting, inner setting, characteristics of individuals, process) with the help of Consolidated Framework for Implementation Research. The major facilitators to implementing IMSs were as follows: diversified and individualized services, close and long-term cooperation between the healthcare institution delivering IMSs and other institutions in the regional medical consortium, clear determination of the duties of each member in the service team, incentives from hospital or other institutions. The major barriers were: lack of flexibility and ignoring individual characteristics in delivering some services, for example, health management; inadequate levels of diagnosis and treatment; insufficient workers, equipment, and drugs.

Community-based Emergency Care for Older Adults: Current Status in China and International Research Advances

LI Ruyue, WU Chao

2022, 25(04):  510-514.  DOI: 10.12114/j.issn.1007-9572.2021.00.276

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Due to high chronic disease prevalence and attacks as well as high incidence of injuries, the needs of emergency care resources are growing in the increasing number of older people. The traditional hospital-based emergency care in China has many limitations, such as high rate of invalid ambulance attendance in prehospital emergency care, long ambulance response time, and the occupation of a great amount of emergency care resources by non-urgent callers. Against the background of advocating tiered diagnosis and treatment, communities have been increasingly appreciated for their roles in prehospital emergency care for older adults, including monitoring and early warning, emergency dispatch and on-site treatment, and health education. In foreign countries, communities have demonstrated better practice. In China, despite many scholars' implementation recommendations, communities still have a lot of room for development. We reviewed the advances in above-mentioned three roles of communities in prehospital emergency care for older people, providing insights into the use of communities for emergency care in an aging society.