Table of Content

05 June 2023, Volume 26 Issue 16

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Guideline·Consensus

Clinical Practice Guideline on Non-pharmacological Interventions for Older Adults with Cognitive Dysfunction: Physical Activity

China Gerontological Nursing Alliance, Xiang Ya Nursing School (Xiangya Oceanwide Health Management Research Institute of Central South University), Xiangya Hospital Central South University (National Clinical Research Center for Geriatric Disorders), Beijing Hospital (National Center for Gerontology, National Clinical Research Center for Geriatric Disorders), ZENG Xianmei, HU Mingyue, FENG Hui

2023, 26(16):  1927-1937.  DOI: 10.12114/j.issn.1007-9572.2023.0073

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Cognitive dysfunction refers to the functional impairment in one or more cognitive domains, mostly occurs in older adults. Cognitive dysfunction can commonly be divided into subjective cognitive decline (SCD), mild cognitive impairment (MCI) and dementia, depending on the degree of cognitive impairment. People with SCD or MCI have a higher risk of dementia, which seriously affects their quality of life, and imposes a huge burden on families and society. Numerous studies have demonstrated that physical activity is one effective non-pharmacological intervention for cognitive dysfunction, but there are no uniform standards for physical activity programs for cognitive dysfunction worldwide, and China still has no physical activity guidelines based on the values and preferences of older adults with cognitive dysfunction, partially impeding the dissemination and application of relevant evidence. In view of this, we developed a guideline containing eight recommendations that is applicable in China, namely the Clinical Practice Guideline on Non-pharmacological Interventions for Older Adults with Cognitive Dysfunction: Physical Activity, by the use of existing evidence, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework combined with values and preferences of Chinese older adults with cognitive dysfunction. This guideline will contribute to the reduction of the incidence of cognitive dysfunction, and preventing or slowing the progression of cognitive dysfunction to dementia.

Original Research·Foucus on Health Equity

Public Health Service Utilization and Health Equity among Elderly Migrants in China

MIN Shuhui, HU Yi, CHENG Xiaofen, GUO Ruiqi, LI Bei

2023, 26(16):  1938-1945.  DOI: 10.12114/j.issn.1007-9572.2022.0561

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Background

The increasing elderly floating people in China are prone to the risk of impaired health status and low utilization of public health services due to older age and unstable life. At present, there is a lack of research on income-related public health services utilization and health inequities in this population.

Objective

To understand the utilization of public health services and health status of elderly migrants, evaluate the utilization of public health services and health equities in them, and put forward suggestions for reducing income-related health inequalities.

Methods

In April 2022, elderly migrants aged 60 years or over (n=5 840) were selected from the China Migrants Dynamic Survey 2018 as the study population. Public health service utilization was assessed using the data related to the use of health education, health records and family doctor services. Health status was assessed based on self-rated health and morbidity in the past one year. Socio-demographic, economic and migrant characteristics were collected as explanatory variables. The Erreygers-corrected concentration index (EI) was used to measure income-related inequality in the utilization of public health services and health status. The decomposition analysis based on logit model was used to quantify the contribution of each determinant to total inequality.

Results

Among the elderly migrants, the health education acceptance rate was 72.12% (4 212/5 840), with an EI of 0.021 (P>0.05). The rate of health record establishment was 30.99% (1 810/5 840), with an EI of -0.054 (P<0.05). And the rate of contracting a family doctor was 16.83% (983/5 840), with an of EI of -0.057 (P<0.05). Self-rated good health accounted for 82.29% (4 806/5 840), with an EI of 0.199 (P<0.05). The morbidity rate in the past one year was 29.02% (1 695/5 840), with an EI of 0.123 (P<0.05). The decomposition of EI results showed that per capita income had the highest percentage contribution to the equity of public health service utilization (74.354%, 53.383%), followed by geographic range of migration (43.474%, 32.063%). And per capita income also demonstrated the highest percentage contribution to health inequity (59.561%, 66.641%), followed by the impact of household registration on self-rated health (36.347%), and the impact of geographic range of migration on the morbidity (14.153%) .

Conclusion

Low-income older migrants are prone to low rate of public health service utilization and poor health outcomes. Income is the most important cause of public health service utilization inequity and health inequity among elderly migrants. Relevant departments should do a good job in publicizing public health services in this population, and give priority to those with a low economic status.

Influencing Factors of Non-treatment-seeking Behaviors for Perceived Morbidity within Two Weeks among Rural Residents in Western China

HE Jiahui, LI Peiwen, MA Ximin, QIAO Hui

2023, 26(16):  1946-1952.  DOI: 10.12114/j.issn.1007-9572.2022.0628

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Background

Health service research has become an important research field in health industry of China recently. Existing studies mainly focus on the prevalence of perceived morbidity within two weeks and associated treatment-seeking behaviors as well as influencing factors in residents, but rarely involve in their non-treatment-seeking behaviors.

Objective

To understand the prevalence of non-treatment-seeking behaviors in rural residents with perceived morbidity within two weeks, and to explore and analyze the influencing factors, so as to put forward targeted suggestions.

Methods

In December 2019, by use of a multistage stratified cluster random sampling approach, 27 196 residents from four rural counties of Ningxia Hui Autonomous Region were selected to attend an interviewer-administered, face-to-face survey using a self-developed Two-week Morbidity Questionnaire for understanding their demographics, health characteristics, and the availability and accessibility of medical and health services. A structural equation model built based on the survey results was used to analyze and test the influencing factors of non-treatment-seeking behaviors for two-week morbidity.

Results

Of the residents, 21 451 (78.88%) who effectively responded to the survey were included for analysis. The two-week morbidity in the respondents was 14.97% (3 212/21 451), and the prevalence of non-treatment-seeking behaviors was 69.46% (2 231/3 212). The prevalence of non-treatment-seeking behaviors for two-week morbidity varied by gender, age, education level, occupation, self-assessed health status, prevalence of chronic diseases, the number of days of bed rest for an illness, and the time to go to secondary or higher medical institutions (P<0.05). The fitting outcome of the structural equation model showed that the total effect of demographics on non-treatment-seeking behaviors was -0.101 (β=0.110), of which the direct effect was 0.107, and the indirect effect was -0.208. Health characteristics had a direct effect on non-treatment-seeking behaviors with a total effect of -0.210 (β=-0.313) .

Conclusion

The prevalence of non-treatment-seeking behaviors is relatively high in Ningxia rural residents, which is greatly affected by the health characteristics, indicating that they have a poor awareness of proactive health. It is suggested to take measures and formulate relevant policies according to the influencing factors to optimize the allocation of medical and health resources, so as to improve the utilization level of health services in this region.

Current Status and Equity of Primary Care Resource Allocation in Tibet

WU Xiaofan, YIN Yue, GAN Yingying, ZENG Yuqi, WANG Shuping, YAN Lina

2023, 26(16):  1953-1957.  DOI: 10.12114/j.issn.1007-9572.2022.0560

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Background

The primary care facilities in a region play a vital role in maintaining the health of the local residents as the gatekeeper. At present, there is a lack of research on the allocation of primary care resources in Tibet, a remote autonomous region in northwestern China.

Objective

To analyze the current situation and equity of the allocation of primary care resources in Tibet, to provide a scientific basis for optimizing the allocation of primary care resources in Tibet.

Methods

Data used in this study were from six volumes (2015—2020) of Tibetan Health Statistics Yearbook and China Health Statistics Yearbook, as well as the human resource information in the Primary Care Direct Reporting System of Tibet Health Commission from 2015 to 2020. Descriptive analysis was used to analyze the allocation of primary care resources in Tibet from 2015 to 2020. Gini coefficient and concentration index were used to evaluate the equity of primary care resource allocation in Tibet in 2020.

Results

The number of beds in primary hospitals in Tibet increased from 3 393 in 2015 to 3 867 in 2020. The number of (assistant) practicing physicians per 1 000 people increased from 0.37 in 2015 to 0.61 in 2020. The utilization rate of beds in primary hospitals decreased from 30.9% in 2015 to 11.5% in 2020. The daily visits per primary care physician decreased from 13.80 in 2015 to 9.95 in 2020. The daily number of hospital bed days of care per primary care physician decreased from 0.44 in 2015 to 0.10 in 2020. In 2020, the Gini coefficients of health resources allocated in primary hospitals according to population in Tibet were greater than 0.3, which were better than those allocated according to geography. The difference in the concentration degree between number of beds, number of health technicians, number of (assistant) practicing physicians or number of registered nurses and population, was -6.93, -4.50, -2.50, -6.15, respectively, in Lhasa, and 0.05, -0.21, -0.80, -0.22, respectively, in Changdu, and -0.88, 0.10, 0.47, -0.05, respectively, in Shannan, but was all greater than 0 in other cities.

Conclusion

The primary health workers in Tibet showed a trend of "low growth in number, low capability and low efficiency". It is suggested to pay attention to regional characteristics to improve the allocation standards of primary care resources, promote the equity of the allocation of primary care resources based on geographical classification, reform the employment mechanism and human resource management system in primary care, innovate the system and mechanism of aiding Tibet and establish a new model of financial investment at the primary level.

Original Research·Focus on Primary Health Services

Preferences for the Use of Appropriate TCM Techniques among Primary Health Workers: a Discrete-choice Experiment-based Study

YAN Hao, CHEN Sisi, NIE Hanlin, HUANG Zhengwei, HU Hanxu, ZHAO Weihan, YANG Yong, SHI Xuefeng

2023, 26(16):  1958-1964.  DOI: 10.12114/j.issn.1007-9572.2022.0683

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Background

The promotion of appropriate traditional Chinese medicine (TCM) techniques in primary care institutions is an important measure emphasizing the co-development of Chinese and western medicine, and enhancing the inheritance and development of TCM.

Objective

To analyze primary health workers'preferences for the use of appropriate TCM techniques, providing policy recommendations for the promotion and use of such techniques in primary healthcare institutions.

Methods

This questionnaire survey was conducted between July and August 2021. A discrete choice model with seven attributes and 18 choice sets obtained through the use of an efficient orthogonal design were used to develop the questionnaire used in the survey, and the questionnaire has three versions each version with evenly allocated six choice sets (including an opt-out option). Additionally, the three versions have a common general demographic part (sex, age, education level, professional title, etc.) and one common consistency test question. A randomized multistage stratified cluster sampling was used to select 319 health workers on duty on the survey day from a total of 23 primary healthcare institutions in three counties in eastern, central and western China (one county was extracted from each region), and each worker was required to complete one version of the questionnaire extracted sequentially by themselves. Two hundred and ninety-five cases who returned a questionnaire passing a consistency test were included for analysis, resulting in a response rate of 92.5%. Primary health workers' preferences for appropriate TCM techniques were analyzed using conditional Logit models and latent class models. Furthermore, the changes in utility of primary health workers due to attribute level changes were monetized using willingness to pay and presented accordingly.

Results

The conditional Logit analysis showed that medical insurance, the average duration of each operation with the TCM technique, the influence of operation with the TCM technique on income, work burden, the promotion of professional title, and patient healthcare cost, as well as effectiveness of the TCM technique were associated with primary health workers' preferences for the use of appropriate TCM techniques (P<0.05). The latent class model revealed that the opt-out option coefficient for those holding a wait-and-see attitude toward the use of TCM techniques (16.2%) was -3.660 (P<0.001), while that for those supporting the use of TCM techniques (83.8%) was 2.189 (P<0.001). Moreover, those holding a wait-and-see attitude toward the use of techniques exhibited a stronger preference for appropriate TCM techniques that have been proven to be more efficacious (β=1.275), and those supporting the use of TCM techniques showed no significant preference for those with unchangeable effectiveness (β=0.054) .

Conclusion

Primary health workers prefer to use appropriate TCM techniques that can increase their income without workload increase, facilitate their professional title promotion, retain or reduce patient costs, and are covered by health insurance and have good efficacy. To effectively promote primary health workers' enthusiasm in the use of appropriate TCM techniques, it is suggested to add these techniques to the medical insurance reimbursement list, and make a connection between the use of these techniques and title promotion. In addition, different incentive strategies should be adopted for different types of primary health workers.

Changes in Patient Visits and Associated Determinants in Primary Healthcare Settings in Guangdong: a Grey Relational Analysis

XU Bixia, YAO Weiguang

2023, 26(16):  1965-1971.  DOI: 10.12114/j.issn.1007-9572.2022.0634

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Background

China has made some achievements in the construction of hierarchical medical system, but the development of its primary healthcare settings is still relatively slow.

Objective

To analyze the changes in patient visits and associated determinants in primary healthcare settings in Guangdong during 2013 to 2020, providing a basis for deepening the construction of hierarchical medical system.

Methods

In December 2021, this study extracted patient visits in primary healthcare institutions of Guangdong from Guangdong Health Statistics Yearbook (2013—2015), Guangdong Health and Family Planning Statistical Yearbook (2016—2017), and Guangdong's Hygiene and Health Statistical Yearbook (2018—2020) as the reference sequence, and extracted the population data and per capita disposable income from Guangdong Statistical Yearbook 2021, and the financial subsidy for primary healthcare institutions and the number of medical insurance participants from China Health and Family Planning Statistical Yearbook (2015—2017) and China's Hygiene and Health Statistical Yearbook (2018—2021) as the comparative sequence. Grey relational analysis was used to evaluate the strength of correlation between the number of patient visits and its potential associated determinants involving demographic and socioeconomic status, health resource allocation and medical insurance participation.

Results

The number of hospital visits in Guangdong increased from 334.592 million in 2013 to 401.317 million in 2019, with an average annual growth of 3.08%. The number of patient visits in primary healthcare settings in the province reached 437.317 million in 2019, and the average annual growth in these settings was 2.10% during 2013 to 2019. In 2020, the number of patient visits in hospitals and in primary healthcare settings both decreased significantly because of the COVID-19 pandemic. The number of patients visits in primary healthcare settings accounted for 50.7% of all patients visits in medical institutions in 2013, which declined to 48.1% in 2020. Grey relational analysis showed that both the number of residents (r=0.913) and the number of people aged over 65 years old (r=0.913) had the strongest correlation with the number of patient visits in primary healthcare settings, followed by the number of urban-rural resident basic medical insurance participants (r=0.899), the number of beds in primary healthcare settings (r=0.893), the number of primary healthcare settings (r=0.886) and the number of urban employee basic medical insurance participants (r=0.872) .

Conclusion

At present, many patients still choose to hospitals for medical services, which calls for actions to strengthen the first contact in primary care system. It is suggested to meet the needs of residents for nearby medical treatment by enriching the connotation of primary care services, widening the gap of healthcare expenses reimbursed by medical insurance among medical institutions and improving the service capacity of primary healthcare settings under the background of population aging.

Qualitative Study of Health Management for Hypertensive Patients in Shandong's Rural Areas Using the Innovative Care for Chronic Conditions Framework

ZHANG Shuo, FU Yingjie, CHANG Lele, SUN Xiaojie

2023, 26(16):  1972-1978.  DOI: 10.12114/j.issn.1007-9572.2022.0677

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Background

As the prevalence of hypertension in China's rural areas is very high, hypertension management in these areas is particularly important.

Objective

To summarize the characteristics and weaknesses of hypertension management in Shandong's rural areas using the Innovative Care for Chronic Conditions Framework (ICCC) proposed by the WHO, and to put forward targeted recommendations.

Methods

According to the socio-economic level and geographical distribution of hypertension prevalence, three county-level centers for disease control and prevention, 9 town health centers and 36 village clinics were selected from A county of Heze, B district of Jinan and C city of Weihai in Shandong Province, from which 84 cases (including individuals responsible for hypertension management programs, medical workers and hypertensive patients) were selected from June to July 2021 using a purposive sampling method to attend a face-to-face semi-structured interview for understanding the status of hypertension management in Shandong's rural areas. NVivo 12 and Qualitative Data Analysis Model proposed by MILES and HUBERMAN, were used to encode and analyse the interview results using the macro-, meso- and micro-level components of the ICCC.

Results

A total of 13 themes and 51 subthemes were derived from the analysis at three levels. At the macro level, the implementation of hypertension management in Shandong's rural areas was generally in a positive policy environment, such as implementing national policies regarding chronic disease management and publicizing chronic disease management, but the policy framework was not complete, the integration within the departments in the health system was poor, and shortages of professional hypertension managers and sufficient financial support were serious. At the meso level, various medical institutions strived to promote the continuity of medical services, but the organization and deployment of family doctor teams and the promotion and use of information systems still needed to be further strengthened. At the micro level, the cooperation between patients and their families and the family doctor team needed to be improved, and the involvement of patients and their families in hypertension management should be enhanced as well.

Conclusion

The implementation of hypertension management in Shandong's rural areas is good generally, but the following efforts should be made for improvements: vigorously strengthening the leadership and supervision role of the government, formulating and integrating relevant policies, and promoting the integration of relevant departments; increasing financial support, and addressing the relatively shortage of health human resources and improving the weakness of informatization construction in rural areas to promote the delivery of high-quality medical services; attaching importance to the interaction between patients and families, health service team and community partners to promote patients' self-management.

Original Research·Focus on Population Health

Relationship between Time in Range and Long-term HbA_1c Glycemic Variability in Elderly Male Patients with Type 2 Diabetes

FANG Fusheng, LIU Xingyu, YAN Shuangtong, WANG Ning, LI Chunlin, TIAN Hui

2023, 26(16):  1979-1983.  DOI: 10.12114/j.issn.1007-9572.2022.0547

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Background

As a new indicator of glycemic management, time in range (TIR) is significantly related to short-term glycemic variability, but whether it is also associated with long-term glycemic variability is still unclear.

Objective

To investigate the relationship of TIR with coefficient of variability (CV) of HbA_1c and HbA_1c variability score (HVS) during a long-term follow-up in elderly male patients with type 2 diabetes.

Methods

Two hundred elderly male type 2 diabetic inpatients from the Second Medical Center of PLA General Hospital were enrolled from January 2007 to January 2011. All of them underwent continuous glucose monitoring (CGM) during hospitalization, and by the baseline TIR derived from CGM, they were divided into TIR≥85% group (n=141) and TIR<85% group (n=59), and followed up for (12.5±1.1) years. The CV of HbA_1c and HVS in the follow-up were compared between the groups. The relationships of TIR with the CV of HbA_1c and HVS were analyzed using Pearson correlation analysis and multivariate linear regression analysis.

Results

The long-term CV of HbA_1c〔 (9.7±3.8) % vs (8.2±4.5) %, P=0.028〕 and HVS〔 (48.7±20.4) vs (32.5±20.8), P<0.001〕 in TIR<85% group were both significantly higher than those in TIR≥85% group. Pearson correlation analysis suggested that TIR showed a significant linear negative correlation with CV of HbA_1c (r=-0.239, P<0.001) or HVS (r=-0.400, P<0.001). Multiple linear regression analysis indicated that TIR had an impact on long-term CV of HbA_1c〔b (95%CI) =-0.07 (-0.12, -0.03), P<0.05〕or HVS〔b (95%CI) =-0.44 (-0.67, -0.21), P<0.05〕after adjusting for confounding factors.

Conclusion

TIR was independently associated with long-term CV of HbA_1c or HVS in elderly male patients with type 2 diabetes. With the decrease of TIR, the long-term HbA_1c glycemic variability increased gradually during follow-up.

Value of Reduced Taste Recognition Ability in Early Warning of Mild Cognitive Impairment

MA Yunyun, SONG Yulei, LIANG Xiao, GAO Jiaojiao, QI Xinru, WANG Ye, XU Guihua, BAI Yamei

2023, 26(16):  1984-1988.  DOI: 10.12114/j.issn.1007-9572.2022.0898

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Background

There is no effective cure for Alzheimer's disease. Early identification of mild cognitive impairment (MCI) and determination of its sensitive warning indicators are current research hotspots.

Objective

To explore the relationship between taste recognition decline and cognitive function, and to clarify the value of taste recognition decline in early recognition of MCI.

Methods

From July to August 2022, 30 older adults with MCI were recruited from a Nanjing community by convenience sampling method, and were compared to age-, sex-, and years of education-matched 32 healthy controls. The General Information Questionnaire, the Montreal Cognitive Assessment-Beijing Version (MoCA-Beijing), the Mini-Mental State Examination (MMSE), the Activities of Daily Living (ADL), and the Clinical Dementia Rating (CDR) were used to assess demographics, cognitive function, status of activities of daily living, and severity of dementia, respectively. The taste function was examined by the whole mouth test. Correlation analysis and the receiver operating characteristic (ROC) curve were used to determine the value of taste recognition decline in early warning of MCI.

Results

Two groups had no significant differences in average age, gender ratio and average years of education (P>0.05), but significantly differed in the average MoCA-Beijing score and MMSE score (P<0.05). Compared with healthy controls, MCI patients had much lower average scores in overall taste recognition, sweet taste recognition, salty taste recognition and bitter taste recognition (P<0.05). In MCI patients, the overall taste recognition score was positively correlated with overall cognitive function, attention, orientation (r=0.433, 0.540, 0.392, P<0.05), salty taste recognition score was positively correlated with delayed recall ability (r=0.379, P<0.05), bitter taste recognition score was positively correlated with attention (r=0.471, P<0.05), umami taste recognition score was positively correlated with language ability (r=0.408, P<0.05). The AUC of the total score of taste recognition ability in predicting MCI was 0.781, with 0.844 sensitivity, 0.600 specificity, and an optimal cut-off value of 18.5.

Conclusion

Decreased abilities of sweet, salty and bitter recognition were found in MCI patients. The decreased ability of taste recognition was closely related to cognitive function. The decrease in the total score of taste recognition ability may partially predict MCI, and is a key early warning indicator of MCI.

Habits of Using Online Health Information and eHealth Literacy in Middle-aged and Elderly Residents

YUAN Cheng, WEI Xiaomin, WU Xiaoyu, LIU Huilin, JIANG Zongmin

2023, 26(16):  1989-1994.  DOI: 10.12114/j.issn.1007-9572.2022.0782

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Background

Since the Internet dependence of the supply and demand sides of health popularization is increasing, eHealth literacy has become a primary skill that chronic disease patients need to master.

Objective

To analyze the current situation and existing problems of online health information usage habits and eHealth literacy in middle-aged and elderly residents, and discuss the relationship between online health information usage habits and eHealth literacy, providing a reference for improving the level of eHealth literacy and developing appropriate Internet-based health popularization services for these populations.

Methods

From June to September 2021, a questionnaire survey was conducted among 1 061 middle-aged and elderly residents in Shanghai communities selected by multistage sampling using the General Information Questionnaire and the Chinese version of the eHealth Literacy Scale (eHEALS-C) to understand their habits of using online health information and levels of eHealth literacy. Stepwise multiple linear regression was used to assess the association of habit of using online health information and other potential candidate factors with the level of eHealth literacy.

Results

Altogether, 1 019 cases (96.04%) who effectively responded to the survey were included for analysis. Following health care accounts〔411 cases (40.33%) 〕was a major channel used for seeking online health information, followed by the search functionality or engines〔336 cases (32.97%) 〕, while the health apps or mini programs〔254 cases (24.93%) 〕, and online health communities〔65 cases (6.38%) 〕were less used. The online health information was less sourced from medical institutions〔397 cases (38.96%) 〕and medical workers〔187 cases (18.35%) 〕. The average total score of the eHEALS-C for the respondents was (27.62±8.57). The respondents scored lower in item 2〔 (3.36±1.27) points〕and item 6〔 (3.38±1.23) points〕of the eHEALS-C, indicating that they had low awareness of applying online health information to health problems, and low perceived skills at evaluating the online health information. Multiple linear regression analysis showed that age, participation in both basic and commercial medical insurance, using at least two channels for seeking online health information, having at least two sources of online health information, the habit of forwarding and sharing online health information, participation in collective online learning, and having an attitude of acceptance towards online health information were influencing factors of the level of eHealth literacy.

Conclusion

The eHealth literacy of these middle-aged and elderly residents is at a medium level, which is affected by online health information usage habits and other factors. To help them make better use of online health information and to improve their eHealth literacy, it is suggested to spread integrated authoritative information and retrieval platforms among these populations, give priority to supervision and elderly-oriented transformation of online health information platforms, and mobilize community, family, health associations, and commercial medical insurance institutions to co-deliver health-promotion services targeting these people.

Family Management Styles and Associated Factors for Children after Palliative Surgery for Complex Congenital Heart Disease

XIA Yuxian, FU Lijuan, LUO Wenyi, SHEN Xiaoyi, NI Ping

2023, 26(16):  1995-2003.  DOI: 10.12114/j.issn.1007-9572.2022.0241

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Background

The family management style directly affects the prognosis of children with complex congenital heart disease (CCHD) after palliative surgery. But it is still unsatisfactory for these children in China. Research on family management of these children based on the Family Management Style Framework in foreign countries has achieved certain achievements while domestic research is still in its infancy.

Objective

To explore the family management style and its factors in children with CCHD after palliative surgery.

Methods

This study is a cross-sectional study. From May to September 2021, a total of 245 children after palliative surgery for CCHD and their families were selected from Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 1, 2016 to August 31, 2021 by convenient sampling. The following questionnaires were used for collecting information from the major caregiver of the children (father or mother) : the Chinese version of the Family Management Measure (FaMM-C), the Chinese version of the Family Assessment Device (FAD-C), the Chinese version of the Parenting Stress Index Short Form (PSI-SF-C), and the socioeconomic status index. The children's height and body weight were measured to assess the prevalence of malnutrition, and their cardiac functions were also evaluated. The family management style of the children's families was classified by clustering the score of each dimension of FaMM-C using clustering analysis. Multinomial Logistic regression was used to analyze the factors associated with different types of family management style.

Results

Four types of family management style were identified: the normal-perspective and collaborative〔28.6% (70/245) 〕, the chaotic and strenuous〔11.0% (27/245) 〕, the confident and concerning〔21.6% (53/245) 〕and the laissez faire〔38.8% (95/245) 〕. When the normal-perspective and collaborative group compared to the other three groups: the higher the score of the PSI-SF-C, the more inclined the family management was to the normal-perspective and collaborative style (P<0.05). Meanwhile the higher the score of the FAD-C, the less inclined the family management was to the normal-perspective and collaborative style (P<0.05). Moreover, compared the laissez faire group with the normal-perspective and collaborative group: the family of male children was more inclined to the normal perspective and collaborative style (P<0.05) ; the older the children were at follow-up or the time from surgery to follow-up of those children was less than one year, the less inclined the family management was to the normal perspective and collaborative style (P<0.05) .

Conclusion

Family caregivers cope with the situation of children with CCHD after palliative surgery through four different management styles, which are shaped by multiple factors from children and families. Findings of this study suggest the necessity to carry out long-term care for the children adopting a family-centered care model, and to develop individualized interventions for the families to establish a scientific and effective family management style based on the type of family management style and its related factors.

Influence of Parent-grandparent Coparenting Conflict on Grandparents' Depression Mediated by Grandparents' Sense of Mastery and Moderated by Their Sense of Valued Elder

MENG Huilin, GUO Fei, CHEN Zhiyan

2023, 26(16):  2004-2012.  DOI: 10.12114/j.issn.1007-9572.2022.0626

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Background

In China, 80% of the grandparents are taking part in caring for grandchildren. However, it has been found by available studies that involvement in taking care of grandchildren may increase the risk of depression among grandparents, which would seriously harm their quality of life, and the risk of depression is associated with parent-grandparent coparenting conflict, grandparents' sense of valued elder and sense of mastery, but the underlying mechanism still requires further investigation.

Objective

To investigate the influence of parent-grandparent coparenting conflict on grandparents' depression, and to explore the mediating and moderating mechanisms that grandparents' sense of mastery and sense of valued elder may play in it.

Methods

This study used two surveys. Grandparents (totally 626 cases) who participated in caring for grandchildren were selected by snowball sampling to attend an online survey or by convenience sampling to attend an offline survey from August to November 2021 using four questionnaires, namely the Coparenting Relationship Scale (CRS), the Pearlin Mastery scale (PMS), Grandparent Meaning Scale (GMS), and the 9-item Chinese version of the Center for Epidemiological Studies Depression Scale (CES-D-C). Pearson correlation was used to analyze the relationship of mother-grandparent coparenting conflict score, father-grandparent coparenting conflict score, PMS score, score of the valued elder dimension of the GMS and CES-D-C. PROCESS was used to examine the mediating effect of grandparents' sense of mastery and the moderating effect of their sense of valued elder between parent-grandparent coparenting conflict and grandparents' depression, and to draw a simple slope diagram.

Results

A total of 626 cases returned responsive questionnaires, with a response rate of 99.2%. The prevalence of depression tendency was 12.0% (75/626) in this study. The score of CES-D-C〔 (5.36±4.14) 〕 was found to be significantly positively correlated with mother-grandparent coparenting conflict score〔 (9.87±3.08), r=0.28, P<0.05〕, and father-grandparent coparenting conflict score〔 (7.34±3.25), r=0.35, P<0.05〕, but was negatively correlated with the PMS score 〔 (12.61±5.48), r=-0.25, P<0.05〕and the score of valued elder dimension〔 (84.13±8.58), r=-0.21, P<0.05〕. Grandparents' sense of mastery partially mediated the relationship of grandparents' depression with mother-grandparent coparenting conflict (with a size of indirect effect of 0.05, accounting for 17.2% of the total effects) and father-grandparent coparenting conflict (with a size of indirect effect of 0.04, accounting for 11.4% of the total effects). Grandparents' sense of valued elder moderated the relationship of grandparents' depression with mother-grandparent coparenting conflict (b=-0.06, P<0.05), and father-grandparent coparenting conflict (b=-0.07, P<0.05). The results of simple slope tests showed that among those with lower sense of valued elder, father-grandparent or mother-grandparent co-parenting conflict had a stronger influence on their depression than their counterparts with higher sense of valued elder.

Conclusion

Parent-grandparent (either mother-grandparent or father-grandparent) coparenting conflict is an important associated factor for grandparent's depression In this association, grandparent's sense of mastery plays a mediating role, while grandparent's sense of valued elder exerts a moderating effect. To reduce the risk of depression and promote the metal health among elders who take part in coparenting, efforts can be made to reduce coparenting conflicts and enhance the elders' sense of mastery and sense of valued elder.

Diabetes in China: Burden Analysis between 1990 and 2019 and Incidence Prediction between 2020 and 2030

LIANG Shanshan, ZHOU Zhihua, LI Chengcheng, CHEN Huijing, ZHOU Shangcheng

2023, 26(16):  2013-2019.  DOI: 10.12114/j.issn.1007-9572.2023.0009

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Background

Diabetes is highly prevalent in China, the prevention and treatment of it and its related complications need a lot of medical resources. Local reports have revealed that although the mortality of diabetes is declining, the burden of diabetes is still increasing.

Objective

To understand the epidemiological characteristics and burden of diabetes in China from 1990—2019, forecast the incidence of diabetes in China from 2020 to 2030, to provide data for evaluating and formulating diabetes-related prevention and treatment policies and measures.

Methods

In August 2022, this study used data from the Global Burden of Disease Study 2019. Temporal trends of the incidence, mortality, disability-adjusted life years (DALY), years of life lost (YLL), and years lost due to a disability (YLD) of diabetes in China from 1990 to 2019 were described. The Bayesian-age-period-cohort analysis was used to predict the incidence of diabetes in China from 2020 to 2030.

Results

Compared with 1990, in 2019, the crude prevalence of diabetes increased to 265.45/100 000, with an increase of 63.12%, the standardized prevalence of diabetes increased to 204.31/100 000, with an increase of 15.93%, the crude mortality rate of diabetes increased to 12.16/100 000, with an increase of 105.41%, and the standardized mortality rate of diabetes increased to 9.44/100 000, with an increase of 2.61%. The YLL rate decreased from 204.71/100 000 in 1990 to 178.45/100 000 in 2019. The YLD rate increased from 260.74/100 000 in 1990 to 316.30/100 000 in 2019. The DALY rate increased from 465.46/100 000 in 1990 to 494.76/100 000 in 2019. Compared with 1990, the DALY rate of diabetes increased by 21.08% in males and decreased by 6.68% in females. The YLL rate, YLD rate and DALY rate increased with age in 2019. According to the prediction of the standardized incidence of diabetes in China from 2020 to 2030, the overall standardized incidence of diabetes would present a decreasing trend during the period, and the standardized incidence of diabetes in 2030 would decrease by 11.45% in men and 18.60% in women compared with 2020.

Conclusion

The burden of diabetes in China is still heavy, with a large number of illness cases and decreased cases, mainly manifested by a high burden caused by diabetes-related disability. Attention should be paid to early prevention of diabetes to reduce the occurrence of complications. The disease burden of males and middle-aged and elderly people is heavy, so sufficient attention should be paid to them. Although the predicted diabetes incidence will reduce between 2020 and 2030, the number of patients is still increasing, so the prevention and control of diabetes should not be slack.

Number and Costs of Hospitalizations Due to Hypertension and Related Comorbidities and Complications in County-level Healthcare Institutions in a Poverty-stricken County in Henan from 2017 to 2019

LIU Rongmei, MAO Yanna, LIU Gendang, ZHAO Yukun, YU Mingyang, ZHAO Qiuping

2023, 26(16):  2020-2026.  DOI: 10.12114/j.issn.1007-9572.2022.0599

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Background

In 2018, the weighted prevalence rate of hypertension among adults aged ≥18 years was 27.5%. Rural areas demonstrated a faster increase in the prevalence rate of hypertension, but lower awareness rate, treatment rate and control rate of hypertension compared with urban areas. Hypertension is the primary risk factor for cardiovascular diseases, and also a major contributor to the disease burden in the population. Understanding the costs of hospitalizations due to hypertension and related comorbidities and complications in rural areas can provide data support for the development of hypertension management and containment strategies in counties.

Objective

To analyze the costs of hospitalizations due to hypertension and related comorbidities and complications in county-level healthcare institutions.

Methods

This study selected inpatients with a diagnosis of hypertension via checking the home page of medical records in two county-level hospitals (people's hospital and TCM hospital) of a poverty-stricken county in Henan Province from 2017 to 2019. Patients' clinical information was collected from the medical records, and their healthcare costs were collected from the municipal and county medical insurance information systems.

Results

A total of 36 565 hospitalizations related information was obtained. During the period, these county-level healthcare institutions had 139 169 hospitalizations in total, 36 565 of them (26.27%) were due to hypertension and related comorbidities and complications. Age, occupational type, marital status, and payment method differed significantly across inpatients due to hypertension and related comorbidities and complications (P<0.05). The severity of disease varied significantly among patients hospitalized due to hypertension and related comorbidities and complications by gender, age, occupational type, marital status, year of admission, and payment method (P<0.05). The average cost of hospitalization due to hypertension and related comorbidities and complications was 7 364.88 yuan in 2017, 6 724.36 yuan in 2018, and 7 134.09 yuan in 2019. And total costs of hospitalizations due to hypertension and related comorbidities and complications in the three years were 62 653 116.87 yuan, 84 394 889.48 yuan and 109 633 058.60 yuan, respectively, showing an increase trend, and the percent of which reimbursed by health insurance was 24.86% in 2017, 31.41% in 2018, and 33.25% in 2019, demonstrating an increasing trend year by year. The average hospitalization expenses, treatment expenses, and drug expenses due to hypertension and related comorbidities and complications differed significantly by year (P<0.05), while the average examination expenses did not (P>0.05). Moreover, the average hospitalization cost, treatment cost, drug cost and examination cost due to hypertension and related comorbidities and complications differed significantly by the severity of disease during the period (P<0.05) .

Conclusion

In these county-level healthcare institutions during the period, the number of hospitalizations due to hypertension and comorbidities and complications accounted a large percent of the total hospitalizations, and the percentages of relevant hospitalization costs and reimbursed costs showed an increase trend gradually. In view of this, it is suggested to strengthen the standardized management of people with a definite diagnosis of hypertension, enhance the capacities of primary medical institutions in identifying, diagnosing and managing hypertension, and reduce healthcare costs by delaying the progression of hypertension. Moreover, priority should be given to special groups to improve their health status to reduce the disease burden of hypertension, and multiple measures should be taken to improve people's awareness rate of hypertension and self-health management abilities.

Original Research·Focus on Hot Topics

Visualization Analysis of Primary Healthcare Research during the COVID-19 Pandemic

YAN Yuge, HUANG Jiaoling

2023, 26(16):  2027-2035.  DOI: 10.12114/j.issn.1007-9572.2022.0690

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Background

Primary healthcare is the first line of defense for the containment of COVID-19 pandemic. Primary healthcare has been studied extensively by academic circles in various countries during the pandemic, but the focuses vary across these studies due to differences in primary healthcare systems in different countries.

Objective

To understand the advances, hotspots, trends and differences of primary care-related research at home and abroad during the COVID-19 epidemic, and to provide a reference for further research in this field.

Methods

Primary healthcare-related studies published during the COVID-19 pandemic (between January 1, 2020 and June 30, 2022) were searched in databases of CNKI and Web of Science Core Collection on July 5, 2022, and 282 from the former database and 1 755 from the latter were included. CiteSpace was used for visualization analysis to provide a graphic visualization of co-occurrence networks of authors, keywords and keywords clusters, to perform a timeline analysis, and to detect keywords with bursts.

Results

The number of publications in China grew fast at the beginning of the pandemic, then the growth gradually decreased, and tended to level off at the late stage. In contrast, relevant research started later in foreign countries, but the number of relevant publications maintained high-speed growth as of the study time. The major author cooperation forms were inter-small teams cooperation and inter-individual cooperation, and no large-scale inter-team cooperation was found. The hotspots of domestic research focus on the systems, the exploration of mechanisms and management practices related to pandemic prevention and control, while international research focuses on changes in healthcare-seeking patterns and the satisfaction of patients' medical needs under the influence of the pandemic. Psychological problems related to the pandemic were concerned by both domestic and international research.

Conclusion

Domestic and foreign studies have similarities and different focuses. To continuous refine and diversify domestic research, it is suggested to learn international experience, pay attention to the construction of relevant research forces, improve the knowledge system in this field, and actively use information technology to improve the primary care system amid the pandemic.

Visualization Analysis of Global Advances and Hot Spots in Intermittent Fasting

GUO Xian, ZHOU Yanbing, LIU Jingying, MU Jinhao, CAO Hui

2023, 26(16):  2036-2046.  DOI: 10.12114/j.issn.1007-9572.2022.0811

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Background

Intermittent fasting refers to the eating pattern in which the individual abstains from eating food for a certain period during a day or week. As research deepens, intermittent fasting has been shown to play an important role in the prevention and treatment of chronic diseases.

Objective

We aimed to provide a visualization analysis of the research hot spots and trends in international intermittent fasting studies over the past decade, in order to provide references and basis for future relevant research.

Methods

Existing studies on intermittent fasting published from January 2010 to April 2022 were retrieved from the Web of Science Core Collection on April 26, 2022. CiteSpace was used to examine the distribution of disciplines, authors and institutions cooperation, high-frequency keywords, and keywords with citation bursts of the included literature, and finally relevant maps were created.

Results

A total of 2 786 articles were ultimately included. The number of these publications showed an increasing trend year by year from 2010 to 2022, although the global research level remained uneven. The country with the highest number of publications was the United States (n=650), the institution with the highest number of publications was the University of Illinois (n=49), and the author with the most publications was Professor Krista A Varady of the University of Illinois (n=26). The high-frequency keywords included weight loss, intermittent fasting, obesity, insulin resistance, metabolism, caloric restriction, gene expression, circadian rhythms, and diet. The research themes were renamed as food intake restriction, circadian rhythms, weight control, metabolic-related diseases and other diseases, and related mechanisms after the cluster analysis. Burst keywords included time-restricted feeding, suprachiasmatic nucleus, mice, growth, and mortality.

Conclusion

The research hot spots of intermittent fasting are mainly focused on its relationship with biological rhythms/circadian rhythms, its effect on improving chronic diseases and other diseases, and sensitive genes and related mechanisms. Future research should focus on intermittent fasting in different populations such as children/adolescents, pregnant women, the elderly, and professional athletes/fitness enthusiasts, and clinically evaluate and compare the intervention effects and safety of different intermittent fasting patterns, ultimately forming a personalized intermittent fasting intervention model and exploring its biological mechanism.

Original Research·Focus on Research Tools

Development, Reliability and Validity of the Chinese Version of Primary Care Team Dynamics Scale

PAN Shasha, MA Chengcheng, CUI Lu, LI Chanjiao, NI Ziling

2023, 26(16):  2047-2054.  DOI: 10.12114/j.issn.1007-9572.2022.0388

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Background

The family doctor team dynamics mainly refer to inter-member interaction state of the family doctor team in the process of providing services. Improving the team dynamics among family doctors can help promote the enhancement of team effectiveness. The Primary Care Team Dynamics Scale (PCTDS) developed by Sara J. Singer's team at Harvard University, which can be used to comprehensively assess the primary care team dynamics.

Objective

To translate the PCTDS into a Chinese version, and test the reliability and validity of the Chinese version.

Methods

The Brislin's model for translation, back translation and cross-cultural adaptation was utilized to translate the PCTDS into a Chinese version (PCTDS-C) strictly following the principle of scale introduction, and the PCTDS-C was revised in accordance with an email-based expert consultation and a pre-test. Then a total of 569 family doctor team members were selected from 17 cities (including Guangdong's Shenzhen, Hubei's Wuhan, Zhejiang's Hangzhou, and so on) by the convenience sampling method from November 2021 to February 2022 to attend a survey using a self-developed Demographic Questionnaire and the PCTDS-C. The critical ratio (CR) method and item-total correlation were used for item analysis. The content validity of the scale was assessed by the expert consultation. The structural validity of the scale was tested by the KMO test, Bartlett's test of sphericity, exploratory factor analysis, and confirmatory factor analysis. And the reliability of the scale was evaluated by the Cronbach's α.

Results

Three hundred and nine of the 569 cases (54.3%) who returned responsive questionnaires were included for analysis. The absolute CR value for each of the entries was greater than 3.000 (P<0.001), and the average r-value of the correlation between each item score and the total scale score was greater than 0.300 (P<0.001). The I-CVI was 0.692-1.000, and S-CVI was 0.896. A significant KMO value of 0.946 and a significant value of Bartlett's test of sphericity〔χ²=4 488.198 (df= 406, P<0.001) 〕indicated that the scale was suitable for factor analysis. Four common factors with an eigenvalue greater than 1.000 were extracted, including the conditions of team effectiveness (4 items), team shared understanding (6 items), team collaboration process (9 items), and team effectiveness (9 items), explaining 74.2% of the total variance. The load value of each item on the common factor was 0.561-0.802. Confirmatory factor analysis indicated that the performance of fit indices of the initial model was not satisfactory. After the correlations between the error variables e20 and e31, e6 and e7, e19 and e31, e24 and e25, e18 and e23, e4 and e10, e3 and e9 were added according to the indicator prompts, except for χ²/df, IFI and CFI, the performance of the other fit indices of the modified model was still unsatisfactory (χ²/df =2.313, RMSEA=0.091, GFI=0.748, AGFI=0.699, NFI=0.866, IFI=0.919, CFI=0.919). The Cronbach's α for the total scale was 0.978. And the Cronbach's α was 0.826 for the conditions of team effectiveness, 0.945 for team shared understanding, 0.957 for team collaboration process, and 0.956 for team effectiveness.

Conclusion

The PCTDS-C has proven to have a good reliability and a fair validity, which can be used as a tool to evaluate the family doctor team dynamics in China. However, there is still much room for the scale improvement. Future research can focus on in-depth exploration of the dimensions and item classification of the scale, and the adding of dimensions in line with the actual situation of family doctor teams in China.