Table of Content

05 March 2025, Volume 28 Issue 07

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Guidelines·Consensus

Chinese Diabetes Behavior and Lifestyle Intervention Guidelines (2024)

Diabetes Prevention and Control Committee of Chinese Preventive Medicine Association

2025, 28(07):  777-796.  DOI: 10.12114/j.issn.1007-9572.2024.0548

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Behavior and lifestyle interventions (BLIs) can reduce blood glucose and blood pressure, regulate blood lipids, control obesity, reduce cardiovas cular events and are a first-line treatment for chronic diseases such as diabetes mellitus. BLIs include helping patients maintain a healthy diet, adhere to physical exercise, maintain a normal weight, ensure good sleep, avoid smoking and alcohol abuse, make good psychological adjustments, establish good social support, as well as scientific self-monitoring of blood glucose and adherence to drug therapy. Except for the severe hyperglycemia and acute complications requiring medication, patients with newly diagnosed diabetes mellitus should first undergo BLIs. BLIs should follow the principles of effectiveness-centered, mutual trust establishment, problem-solving orientation, integration, and individulization. Common strategies for BLIs include applying behavior change theories, utilizing behavior change technologies, effectively emlpoying communication strategies, improving patient behavior skills, and implementing patient-centered self-management education and support (DSMES). The steps of BLIs include evaluating behavior, lifestyle and their influencing factors, setting behavioral goals, developing intervention plans, and conducting interventions and effectiveness evaluation. The evaluation measures for the effectiveness of BLIs include process indicators, clinical outcomes, socio-psychological and behavioral outcomes, patient reports, and health outcomes. Evaluation can be performed using a combination of qualitative and quantitative methods. Common evaluation tools include the SDSCA, PAM, and DMSES.

Commentary

The Current State of Development and the Challenges of Localization in Lifestyle Medicine both Domestically and Internationally

PENG Hongye, JING Yanan, WANG Ying, LU Chunli

2025, 28(07):  797-806.  DOI: 10.12114/j.issn.1007-9572.2024.0232

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Lifestyle Medicine, which emerged in the 1980s, is an interdisciplinary discipline involving various fields such as medicine, nutrition, exercise science, epidemiology, psychology, etc. It serves as a crucial bridge between public health promotion and clinical treatment, and plays a significant role in preventing, treating, and rehabilitating various diseases. This paper presents a comprehensive review of the definition, connotation, origin, development, and evaluation tools for assessing the effectiveness of Lifestyle Medicine. The findings reveal that Lifestyle Medicine aligns remarkably well with the principle of traditional Chinese medicine (TCM) regarding disease prevention and treatment. Despite notable research advancements in chronic disease management in China, the field of lifestyle medicine is still at an early stage of development. However, there remains a lack of specific, quantified, and standardized guidelines for implementing lifestyle interventions as well as clinical protocols and evaluation systems. The localization of Lifestyle Medicine in China still needs to consider local conditions, while increasing national policy support to establish a national data monitoring system and decision support system. Emphasizing health equity and optimising resource allocation across different regions are also essential aspects to be considered. Furthermore, integrating the advantages of TCM, including of its characteristic therapies, simplicity and cost-effectiveness, will promote the application and dissemination of Lifestyle Medicine for preventing and managing chronic diseases, thereby enhancing overall population health.

Challenges and Countermeasures of Medically Unexplained Symptoms

PANG Shu, DIAO Yang, CHEN Xiangxue, JIANG Chunyan

2025, 28(07):  807-813.  DOI: 10.12114/j.issn.1007-9572.2024.0153

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The diagnosis and treatment of medically unexplained symptoms (MUS) is complex and the cost of medical resources is large. MUS is a challenging clinical problem in general practice. The field of MUS is still in the preliminary stage of exploration in China. In this review, we systematically and comprehensively discuss the current challenges of MUS in the aspects of the concept, epidemiological characteristics, pathogenesis, diagnosis and treatment. We also propose some possible countermeasures combined with the actual situation. This article shows that there is no consensus on the concept, mechanism and diagnostic of MUS, suggesting the urgent need to draft relevant clinical guidelines and construct clinical pathways. At present, general practitioners have insufficient ability in the understanding, diagnosis and treatment of MUS, therefore, it is necessary to strengthen the training of MUS competence for general practitioners. More prospective, multi-center and multidisciplinary studies are needed to explore the characteristics and treatment strategies of MUS. This article provides a reference for general practitioners to understand and manage MUS scientifically and effectively.

Original Research

The Trend Prediction of Five Subtypes of Chronic Kidney Disease in China from 2020 to 2040

WANG Shihong, DENG Xingyu, CAO Rudai, LING Yao, HUANG Cuiyi, OUYANG Dong, DING Yuanlin, YU Haibing

2025, 28(07):  814-823.  DOI: 10.12114/j.issn.1007-9572.2023.0458

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Background

Chronic kidney disease (CKD) is a public health problem that cannot be ignored in China and even in the world. At present, relevant studies on the prediction of the incidence trends of different subtypes of chronic kidney disease are rare in China.

Objective

To predict the incidence trend of five subtypes of CKD in China from 2020 to 2040, and provide reference for the prevention and control of CKD.

Methods

The age standardized incidence rate (ASIR) and cases of five subtypes of CKD in China from 1990 to 2019 were derived from the Global Burden of Disease Study (GBD) database (April 2023 to May 2023). The incidence trend of five subtypes of CKD was described and analyzed by the percentage change (%) and the average annual percentage change (AAPC). The Prophet model was used to predict the ASIR and cases of five subtypes of CKD in China from 2020 to 2040.

Results

From 1990 to 2019, The ASIR and cases of five subtypes of CKD in China showed an upward trend. The upward trend of CKD due to hypertension is the most obvious (AAPC=0.75, P<0.05). In 2019, the ASIR and cases of CKD due to diabetes mellitus type 2, diabetes mellitus type 1, glomerulonephritis and hypertension in male were higher than female, while the ASIR and cases of CKD due to other causes in female were higher than male. The cases of CKD due to diabetes mellitus type 2, hypertension and other causes is the highest in the age group of 65-74 years old. The cases of CKD due to diabetes mellitus type 1 and glomerulonephritis were mostly concentrated in the age group under 5 years old. The prediction results showed that in 2040, the ASIR and cases of CKD due to diabetes mellitus type 2 are 23.27/10⁵ (80%UI=20.64/10⁵-26.08/10⁵) and 755 375 (80%UI=702 827-811 409) respectively, the ASIR and cases of CKD due to diabetes mellitus type 1 are 0.60/10⁵ (80%UI=0.47/10⁵-0.73/10⁵) and 10 625 (80%UI=9 519-11 787) respectively, the ASIR and cases of CKD due to glomerulonephritis were 3.88/10⁵ (80%UI=3.01/10⁵-4.79/10⁵) and 87 050 (80%UI=74 470-100 460) respectively, the ASIR and cases of CKD due to hypertension were 15.35/10⁵ (80%UI=13.53/10⁵-17.29/10⁵) and 470 214 (80%UI=437 598-504 817) respectively, and the ASIR and the CKD due to other causes were 127.68/10⁵ (80%UI=102.41/10⁵-154.68/10⁵) and 3 901 317 (80%UI=3 622 415-4 198 720) respectively.

Conclusion

From 1990 to 2019, The ASIR and cases of five subtypes of CKD in China showed an upward trend. From 2020 to 2040, The ASIR and cases of CKD due to diabetes mellitus type 2, hypertension and other causes in China will still show an upward trend. Though cases of CKD due to diabetes mellitus type 1 and glomerulonephritis will increase year by year, the collective ASIR will show a downward trend. In the future, relevant prevention and control strategies should be developed for different subtypes of CKD.

Status and Influencing Factors of Reversible and Potentially Reversible Cognitive Frailty among the Community-dwelling Elderly

ZHAO Xinrui, HUANG Li, CAO Lichun, QU Huichao, ZHANG Meilin, LIU Huan

2025, 28(07):  824-830.  DOI: 10.12114/j.issn.1007-9572.2024.0244

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Background

Cognitive frailty is a prevalent clinical syndrome in the elderly, with subtypes of reversible and potentially reversible cognitive frailty. It is associated with adverse health outcomes such as falls, disability, and mortality. However, there is limited research on the current prevalence of cognitive frailty subtypes and their influencing factors in the elderly population.

Objective

To investigate the current status of cognitive frailty (CF) among community elderly in Beichen District in Tianjin, and to explore the influencing factors of different subtypes of cognitive frailty, so as to provide references for the early identification and intervention of reversible cognitive frailty (RCF) .

Methods

From June to August 2023, totally 3 916 community residents in Beichen District, Tianjin were recruited with convenience sampling, and a face-to-face questionnaire survey was conducted using the demography questionnaire, FRAIL Frailty Scale, the Brief Mental Status Examination Scale (MMSE), and the Subjective Cognitive Decline Questionnaire (SCD-Q9) to assess the incidence of different types of cognitive frailty and analyze the influencing factors among older people using a multivariate Logistic regression model.

Results

Among 3 916 participants, 679 (17.34%) with RCF and 440 (11.24%) with PRCF. There were significantly differences in CF prevalence among the elderly with different genders, ages, educational backgrounds, sleep disorders, the prevalence of various types of chronic illnesses, exercise, smoking histories, drinking histories, the number of medications used for chronic illnesses, and hemoglobin levels (P<0.05). Multifactorial Logistic regression analysis showed that with no cognitive frailty as a control, being female (OR=2.186, 95%CI=1.713-2.791), age≥70 years (OR=3.056, 95%CI=2.519-3.708), smoking (OR=1.753, 95%CI=1.431-2.146), having a sleep disorder (OR=1.275, 95%CI=1.046-1.555), low hemoglobin levels (OR=1.531, 95%CI=1.026-2.284), and≥3 medications for a chronic condition (OR=2.168, 95%CI=1.490-3.156) were associated with a higher risk of RCF, and exercise (OR=0.459, 95%CI=0.382-0.551) was associated with a lower risk of RCF (P<0.05) ; being female (OR=1.941, 95%CI=1.465-2.573), age≥70 years (OR=1.830, 95%CI=1.460-2.292), drinking (OR=2.270, 95%CI=1.734-2.970), having a sleep disorder (OR=1.996, 95%CI=1.557-2.560), stroke (OR=2.114, 95%CI=1.026-4.355), low hemoglobin levels (OR=1.991, 95%CI=1.288-3.078), and ≥3 medications for a chronic condition (OR=1.626, 95%CI=1.050-2.518) were associated with a higher risk of PRCF, and exercise (OR=0.522, 95%CI=0.423-0.644) was associated with a lower risk of PRCF in the aged (P<0.05) .

Conclusion

The prevalence of reversible and potentially reversible cognitive frailty is high among the elderly in the community of Beichen District in Tianjin. It is recommended to add the assessment of CF into community physical examinations and implement multidimensional effective strategies to delay the onset and progression of CF.

Correlation between Different Obesity Metabolic Phenotypes and Atherosclerosis in a Young Population: Uric Acid as Its Potential Factor

GU Keyi, PAN Yaojia, HAN Zheng, FU Xiaoya, GU Handong, YANG Fei, WANG Weiqiang

2025, 28(07):  831-837.  DOI: 10.12114/j.issn.1007-9572.2023.0887

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Background

Obesity and metabolic abnormalities are associated with atherosclerosis, and different metabolic phenotypes of obesity have different risks of AS. The relationship between serum uric acid (SUA) levels and AS is unclear.

Objective

Using brachial-ankle pulse wave velocity (baPWV) as an early predictor of AS, we investigated the correlation between different metabolic phenotypes of obesity and the risk of AS, with a focus on metabolically healthy obese populations, and further explored whether uric acid serves as a potential influencing factor.

Methods

A total of 622 young medical check-ups at a street community health center from December 2021 to January 2022 were selected for questionnaire survey, physical examination, and laboratory tests. The study subjects were categorized into four groups based on BMI and metabolic status, metabolically healthy non-obesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy non-obesity metabolically unhealthy non-obesity (MUNO), and metabolically unhealthy obesity (MUO). Pearson's correlation was used to analyse the correlation between SUA and baPWV and various clinical indicators. Multiple linear regression models were used to analyze the correlation between SUA and baPWV and various clinical indicators, and scatter plots were drawn. Multifactorial Logistic regression models were used to analyze the correlation between different obesity metabolic phenotypes and high baPWV and hyperuricemia.

Results

After grouping according to different obesity metabolic phenotypes, the prevalence of high baPWV levels in the MHNO, MHO, MUNO and MUO groups gradually increased to 3.9%, 9.8%, 14.5% and 29.4%, respectively, with a statistically significant difference (χ² _trend=60.722, P<0.001); and the prevalence of hyperuricemia in the MHNO, MHO, MUNO and MUO groups. The prevalence rates were 3.6%, 8.9%, 10.1% and 26.9%, respectively, and the difference was statistically significant (χ² _trend=56.444, P<0.001). The results of multivariate linear regression analysis correcting for confounders showed SUA was an independent risk factor for atherosclerosis. The results of multifactorial Logistic regression modeling showed that after correcting for gender, age, current smoking, current alcohol consumption, and literacy, the risk of high baPWV was significantly higher in the four groups of MHNO, MHO, MUNO, and MUO in that order, and the risk of hyperuricemia was also significantly higher in that order.

Conclusion

In the young population, there is a significant correlation between different obesity metabolic phenotypes and atherosclerosis, and uric acid may be a potential influencing factor. In addition, we should pay attention to the young MHO population for early lifestyle intervention and health management.

The Discriminative Ability of FRAX and Possible FRAX-based Intervention Thresholds for Beijing-dwelling People

LIU Yangxiaoou, SUN Yange, YU Su, DU Xueping, HUANG Kai, YAN Yan, LI Chao

2025, 28(07):  838-843.  DOI: 10.12114/j.issn.1007-9572.2023.0879

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Background

The overall diagnosis and treatment rate of osteoporotic fractures is low in our county, and there is an urgent need to find reliable prediction tools. FRAX is a predictive tool recommended by Guidelines for the Diagnosis and Treatment of Primary Osteoporosis, but its predictive value and intervention threshold in the Chinese population need to be further verified.

Objective

To evaluate the predictive value of FRAX on fracture risk in Beijing residents and explore the intervention threshold.

Methods

One thousand and eighteen participants were randomly recruited from four community health service centers in Beijing during the period between 2011 and 2012. Based on the FRAX tool, the probability of major osteoporotic fracture (MOF) and hip fracture (HF) in the next 10 years were calculated for each participant. Osteoporotic fractures that occurred during the 10-year research period were self-reported, collected from 2021 to 2022. Taking the actual occurrence of fractures as the gold standard, the receiver operating characteristic (ROC) curve of FRAX for predicting fractures was drawn; the area under the curve (AUC) was analyzed for the predictive value of FRAX on fracture and the intervention threshold was explored.

Results

Four hundred and sixty-nine subjects were followed up successfully. The median probability of MOF and HF calculated by FRAX were 2.6% (2.2%, 3.7%) and 0.5% (0.3%, 0.9%), respectively. A total of 49 (10.45%) new MOF were occurred during the 10 years, of which 5 (1.07%) were HF. ROC analysis showed the AUCs of FRAX and femoral neck bone mineral density were 0.683 and 0.662, respectively. The cut-off value at which Yoden's index is maximum was 2.95% with a sensitivity of 59.2% and a specificity of 67.6%.

Conclusion

The FRAX tool has certain predictive power for future fractures, whereas there is still room for improvement. To predict major osteoporotic fractures, the probability of FRAX-MOF is 2.95%, which is the maximum cutoff value of Yoden's Index. It can be considered as a reference for formulating intervention thresholds.

Real-World Study of Camrelizumab-based Regimen for Locally Advanced and Metastatic Esophageal Cancer

SONG Fenfen, LI Shengmian

2025, 28(07):  844-852.  DOI: 10.12114/j.issn.1007-9572.2023.0448

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Background

Camrelizumab is a PD-1 inhibitor independently developed in China, which has been approved for use in the treatment of esophageal cancer. However, its efficacy and safety data in clinical practice are still lacking.

Objective

This study is aimed at assessing the Camrelizumab-based regimens' safety and efficacy for locally advanced and metastatic esophageal cancer in the real world, and explore whether the reactive cutaneous capillary endothelial proliferation (RCCEP) could predict the efficacy of carrelizumab under different treatment modalities.

Methods

Cases of locally advanced and metastatic esophageal cancer treated with camrelizumab-based regimens in the Fourth Hospital of Hebei Medical University between 1 November 2019 and 31 May 2022 were retrospectively examined. Progression free survival (PFS), overall survival (OS), disease control rate (DCR), objective remission rate (ORR) and adverse events were evaluated. Using the Kaplan-Meier approach to compute the median and estimated 95% CI for PFS and OS. Comparing the survival function of patients in the RCCEP group and without RCCEP group.

Results

A total of 70 patients were included in the study. In all patients, the efficacy was evaluated as CR 11 (15.7%), PR 35 (50.0%), SD 17 (24.3%), PD 7 (10%), ORR 65.7% (46/70) and DCR 90.0% (63/70). In the 47 patients who receiving first-line to third-line treatment, the median PFS was 8.1 months (95%CI=6.46 to 9.74 months) and the 1-year PFS rate was 34.0%. The median OS was not reached, the 1-year OS rate of 76.3%. In the 23 patients who receiving neoadjuvant therapy, all patients achieved R0 resection, and 6 patients (26.1%) achieved pCR. In terms of safety, the most observed TRAEs included RCCEP (65.7%), nausea/vomiting (42.8%), anemia (37.1%), fatigue (37.1%) and alopecia (34.2%). The incidence of adverse reactions≥grade 3 was 21.4% (15/70), mainly including leukopenia (5.7%), neutropenia (5.7%) and thrombocytopenia (4.3%). Four patients developed immune related adverse reactions≥grade 3, including one case of grade 3 myocarditis, one case of grade 3 pneumonia, one case of grade 3 rash and one case of grade 4 nephritis. All patients were relieved after symptomatic or glucocorticoid treatment and no drug-related deaths occurred. RCCEP was associated with the efficacy of camrelizumab. The ORR (76.1% vs 45.8%, P=0.010) and DCR (97.8% vs 75.0%, P=0.009) of patients with RCCEP were higher than those without RCCEP. The median PFS (18 months vs 7.4 months, P=0.015) and OS (not reaching vs 15.7 months, P<0.001) of patients with RCCEP were significantly longer than those without RCCEP.

Conclusion

In the real world, camrelizumab-based regimens achieved good disease control and tolerance for treating locally advanced and metastatic esophageal carcinoma. In different treatment modalities, RCCEP could predicts the efficacy of camrelizumab.

A CiteSpace-based Analysis of Hotspots and Cutting-edge Trends in Mental Health among Middle School Students Research

CHENG Qi, YU Wenbing, LI Keke, ZUO You, JIAO Qianxin, LIU Xinhao, GAO Lili

2025, 28(07):  853-862.  DOI: 10.12114/j.issn.1007-9572.2023.0280

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Background

In recent years, mental health problems among middle school students in China have become increasingly prominent.

Objective

To explore the research hotspots, frontiers of research related to the mental health among middle school students, and provide reference for scholars involved in the research of middle school students' mental health in the future.

Methods

Papers related to the mental health of middle school students both at home and abroad from 2000 to September 30, 2022, by using Web of Science and CNKI as data sources. CiteSpace 6.1.R3 was applied to visualize and analyze the publication volume, countries, institutions, authors, literature co-citation, and keywords of the included literature.

Results

A total of 1 963 articles were eligible, including 653 articles in English and 1 310 in Chinese. The publication volume in the field of mental health among middle school students showed an increasing trend from 2000 to 2022. The research hotspots and frontiers of mental health among middle school students were mainly focused on suicidal ideation, mobile phone and internet addiction, academic achievement, psychological resilience, psychological intervention and COVID-19 epidemic. The future research trends may focus on the relationships of traditional bullying and cyberbullying with middle school students' mental health, health risk behaviors with mental health among middle school students.

Conclusion

Research hotspots about mental health among middle school students encompass suicidal ideation, mobile phone and internet addiction, academic achievement, psychological resilience, psychological interventions, as well as the impact of the COVID-19 epidemic. Future research trends will concentrate on exploring the relationships between bullying, health risk behaviors and mental health.

Original Research·Focus on Management of Family Doctor Teams

The Relationship between Leadership Effectiveness and Task Interaction of Family Physician Team: Mediated by Team Cohesion and Moderated by Team Support

QING Hua, LI Huixin, YANG En, WEI Yilin, TANG Shangfeng

2025, 28(07):  863-868.  DOI: 10.12114/j.issn.1007-9572.2023.0724

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Background

The leader of family physician team plays an important role in performing the contracted service functions and is a key player in influencing the task interaction of the members within the team.

Objective

To identify the mechanisms of the impact of leadership effectiveness on task interaction in family physician teams, and examine the mediating role of team cohesion in the relationship between the two and the moderating role of team support.

Methods

From October to December 2021, 593 family physician team members from 12 township health centers/community health service centers in Qianjiang City, Hubei Province, and Changsha City, Hunan Province, were sampled by random sampling and cluster sampling methods to conduct a questionnaire survey, which covered the basic information of the members, leadership effectiveness, task interaction, team cohesion, and team support. PROCESS was used to test the mediating effect of team cohesion in the relationship between leadership effectiveness and task interaction and the moderating effect of team support in it, and a simple slope diagram was drawn.

Results

A total of 580 cases were included with the effective response rate of 97.8%. The leadership effectiveness score of family physician team members was (4.28±0.73), the team cohesion score was (4.21±0.64), the task interaction score was (4.37±0.65), and team support score was (4.09±0.83). The Pearson correlation analysis showed that the four scale scores were linearly and positively correlated with each other (P<0.05). Team cohesion mediated the relationship of leadership effectiveness with task interaction (with a size of indirect effect of 0.08, accounting for 12% of the total effects). Team support moderated the relationship of leadership effectiveness with team cohesion (β=-0.12, P<0.01). The results of simple slope tests showed that the effect of leadership effectiveness on team cohesion was greater for family physician teams with lower team support.

Conclusion

The empirical analysis found that leadership effectiveness had a significant positive effect on task interaction; team cohesion mediated the relationship between leadership effectiveness and task interaction; and the positive effect of leadership effectiveness on team cohesion was moderated by team support.

The Job Satisfaction and Influencing Factors among General Practitioners in Primary Healthcare Institutions

ZHANG Peng, LIU Lidi, LIAO Xiaoyang, WU Jia, YANG Ziyu, ZHANG Yalin

2025, 28(07):  869-874.  DOI: 10.12114/j.issn.1007-9572.2023.0745

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Background

There is a significant shortage of general practitioners at primary healthcare institutions in China, and their low job satisfaction is a crucial factor leading to the scarcity of talents.

Objective

To understand the job satisfaction and related factors among general practitioners (GPs) from primary healthcare institutions in Chengdu.

Methods

From December 2018 to January 2019, a questionnaire survey was conducted on all registered general practitioners working at primary healthcare institutions in Chengdu (n=1 549). The questionnaire included their basic information, job satisfaction, and their suggestions for improving job satisfaction. Multivariate Logistic regression was used to analyze the factors influencing job satisfaction among GPs.

Results

A total of 1 539 valid questionnaires were collected, with an effective response rate of 99.35%. The overall job satisfaction of general practitioners was (114.0±17.2), indicating a "moderate" level. The average score of job workflow dimensions was the lowest (10.6±2.5), indicating "dissatisfaction". Other dimensions scored at a "moderate" level. The scores for salary and welfare dimension were relatively low at (11.8±2.8) and (11.6±2.8) respectively. There were statistically significant differences in overall job satisfaction among GPs of different genders and age groups (P<0.05) ; however, no statistical significance was found among GPs with different educational backgrounds, titles, and years of work experience (P>0.05). The results of multivariate Logistic regression analysis showed that age was a significant factor affecting overall job satisfaction of GPs (P<0.05). GPs aged 30-39 [OR (95%CI) =0.132 (0.035-0.494) ] and 40-49 [OR (95%CI) =0.207 (0.065-0.664) ] had lower job satisfaction compared to those aged 50 and above (P<0.05). A total of 419 individuals made suggestions for improving their job satisfaction, resulting in a total of 427 suggestions. Among these, "improving benefits" ranked the highest (25.53%, 109/427) .

Conclusion

The overall job satisfaction of GPs in primary healthcare institutions in Chengdu is generally moderate, with the least satisfaction regarding workflow and the greatest desire for improved benefits. Age is a factor influencing job satisfaction among GPs. It is recommended to take effective measures to enhance job satisfaction among GPs by addressing their areas of dissatisfaction, such as streamlining workflow and implementing a system of "fair distribution according to work performance".

Study on Village Clinic Doctors' Organization Identification to Family Doctor Team and Its Influencing Factors

YU Yuncong, SHAO Jiaxian, GAO Min, LI Xiaona, MA Dongping, YIN Wenqiang, CHEN Zhongming

2025, 28(07):  875-879.  DOI: 10.12114/j.issn.1007-9572.2023.0801

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Background

The organizational identity that rural doctors have towards the family doctor team will exert an impact on the work enthusiasm of rural doctors and the work quality of the family doctor team, which is related to the quality of the family doctor contracted service enjoyed by rural residents.

Objective

To explore the influencing elements of the organizational identity of rural doctors with respect to the family doctor team, and to provide practicable measures for the better operation of the family doctor team in rural districts and the improvement of the quality of the family doctor contracted service in rural areas.

Methods

From November to December in 2021, through the use of the stratified random sampling approach, a total of 1 004 rural doctors in 3 cities in Shandong Province were selected. By employing a self-designed questionnaire, the demographic characteristics, work situation and the organizational identity situation towards the family doctor team of rural doctors were investigated. Pearson correlation analysis was utilized to explore the correlation between the organizational identity of rural doctors and work-family conflict, work stability, business training and organizational isolation, and multiple hierarchical regression analysis was adopted to explore the influencing factors of the organizational identity of rural doctors.

Results

The organizational identity of rural doctors towards the family doctor team was relatively high, with a score of (3.757 ± 0.713) points. The results of the correlation analysis showed that there is a positive correlation between business training and organizational isolation (r=0.156, P<0.01), and a negative correlation between organizational isolation and organizational identity (r=-0.287, P<0.01). The regression analysis results indicated that business training (β=0.154, P<0.001) and organizational identity (β=-0.262, P<0.001) were the influencing factors of the organizational identity of rural doctors towards the family doctor team.

Conclusion

Rural doctors have a relatively strong sense of identity towards the family doctor team. Doing a good job in the business training of rural doctors and reducing the degree of organizational isolation among family doctor team members will help to further strengthen the organizational identity of rural doctors towards the family doctor team.

Original Research·Focus on Community Diabetes Management

The Impact of Contracted Family Doctors Services on the Cognitive, Behavioral, and Health Outcomes of Diabetes Patients

LONG Chao, LI Jia, YANG Zhikai, HEI Luping, LI Zhansheng, YUAN Beibei

2025, 28(07):  880-887.  DOI: 10.12114/j.issn.1007-9572.2023.0937

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Background

China's primary health care system is advancing family doctor contract services, aiming to provide integrated and continuous services for residents, which are essential characteristics needed by chronic disease patients such as those with diabetes. Existing studies have largely focused on descriptive analyses of the coverage rate of family doctor contract services, with insufficient assessment of their actual effects in chronic disease services.

Objective

To understand the impact of family doctor contract services on the cognition, behavior, and health outcomes of diabetic patients.

Methods

From February 22 to 25, 2023, a multi-stage stratified random sampling method was used to survey 716 registered diabetic patients in a city in Shandong Province. The questionnaire included demographic information, disease and medical conditions, acceptance of diabetes management services, and patients' disease cognition, health management behaviors, and health outcomes. Descriptive analysis was conducted on the coverage rate of diabetes management services accepted by patients to reflect the integration of family doctor team services. Multifactorial Logistic regression analysis was used to explore the impact of contracting with a family doctor on patients' disease cognition, health management behaviors, and health outcomes.

Results

The contract rate of diabetic patients was 80.9% (579/716). Among them, 47.8% (277/579) felt that the family doctor understood their psychological condition.The rate of receiving follow-up recently was 89.8% (643/716). Among them, 76.0% (489/643) received diabetes health education, and 43.9% (282/643) received the complication-related examination items such as fundus, ECG, and dorsalis pedis artery pulsation. Of the patients with sudden worsening/acute complications, 37.7% (32/85) contacted the family doctor, among which 37.5% (12/32) received emergency treatment, and 25.0% (8/32) received referral services. The correct rate of patients' cognition on diabetes diagnosis was 19.8% (142/716), and the correct rate of cognition on intervention methods other than drug treatment was <70.0%. The results of the multifactorial Logistic regression analysis showed that the probability of contracted patients having a disease cognition score >5.5 was higher [OR (95%CI) =1.80 (1.23-2.62), P<0.05], the probability of undergoing glycosylated hemoglobin testing was higher [OR (95%CI) =2.67 (1.75-4.18), P<0.05], the probability of regular self-monitoring of blood glucose was higher [OR (95%CI) =4.28 (2.57-7.09), P<0.05], the probability of dietary control was higher [OR (95%CI) =0.46 (0.28-0.80), P<0.05], and the acceptance rate of diabetes-related expenses was lower [OR (95%CI) =1.58 (1.04-2.39), P<0.05] .

Conclusion

Family doctor contracted services have shown a significant impact on enhancing the quality of management services for chronic diseases. However, there is still a need for further improvement in implementing patient health education and psychological care components within the service package. Establishing a robust referral mechanism and improving the screening of diabetes complications are essential steps towards enhancing these services. Meanwhile, greater attention should be given to the health services of patients who have not enrolled in the contracted services.

Influencing Factors of Grassroots Medical Care Seeking Behavior of Patients with Type 2 Diabetes Mellitus Who Received Contracted Family Doctor Services Based on Anderson Model

CHEN Cong, ZHU Haihong

2025, 28(07):  888-892.  DOI: 10.12114/j.issn.1007-9572.2024.0246

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Background

Shanghai has been implementing the "1+1+1" combined family doctor contract service for nearly a decade, and its effectiveness in promoting graded diagnosis and treatment and guiding residents to seek medical treatment at the grassroots level needs to be verified. Existing related studies mostly focus on the number of visits to primary clinics and patients' willingness to visit primary clinics as key analysis variables. However, these two indicators cannot comprehensively and truly reflect the actual utilization of primary healthcare services by residents.

Objective

To investigate the influencing factors of family doctors' signing up for type 2 diabetes patients to see doctors at the grass-roots level, so as to provide a scientific basis for further optimizing the allocation of community health service resources.

Methods

In May 2023, 550 patients with type 2 diabetes who have signed a contract with family doctors were selected by random sampling in Jinshanwei Town, Jinshan District, Shanghai. By accessing the medical data of patients enrolled in the regional health information platform in 2022, if the proportion of patients' visits to community health service institutions in that year to the total number of visits is less than 90%, it is considered that the compliance with grassroots medical treatment is poor, and if it is greater than or equal to 90%, it is considered that the compliance with grassroots medical treatment is good. Conduct a "face-to-face" questionnaire survey on the included patients, covering their basic information, disease and treatment status, health policy awareness and service utilization, etc. According to the Anderson model, the indicators are divided into three categories: propensity factors, ability factors, and need factors. The influencing factors of compliance of contracted type 2 diabetes patients with primary care were analyzed by binary logistic regression.

Results

The questionnaire of 508 patients (92.4%) was effectively collected. Among them, 371 cases (73.0%) had good compliance with grassroots medical treatment, and 137 cases (27.0%) had poor compliance. The average scores of patients on the four dimensions of policy awareness, institutional trust, medical expenses, and medical services are (11.0±3.6), (17.6±2.6), (12.8±1.9), and (17.0±2.3) points, respectively. The results of binary Logistic regression analysis showed that the occupation and the nature of residence in the propensity factors, the type of medical insurance, the per capita monthly income of families, the medical service score in the ability factors, and the institutional trust score in the need factors were the influencing factors of type 2 diabetes patients' compliance with grassroots medical treatment (P<0.05) .

Conclusion

The patients with type 2 diabetes didn't have enough knowledge of the service policy signed by family doctors. Higher quality medical services and more reliable institutional trust were the promoting factors for the grassroots medical behavior of contracted residents with type 2 diabetes. It is suggested to strengthen the policy promotion of family doctor contract services, further enhance the capacity of community health services, and optimize the quality of community health services.

The Characteristics of Outpatient Visits in Diabetic Patients and the Influencing Factors of Frequent Visits by Contracted Patients

XU Xiaoli, XU Huilin, LIU Xiaohua, YU Dandan, CAI Yizhou, DONG Linjuan, LIU Nian, HE Dandan

2025, 28(07):  893-899.  DOI: 10.12114/j.issn.1007-9572.2023.0900

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Background

With the comprehensive implementation of the family doctor system in China, community health service resources have been widely utilized. However, there is a lack of research on the utilization tendency of primary outpatient medical resources for adult diabetic patients using objective medical visit data.

Objective

To understand the characteristics of outpatient visits for diabetic patients in the community, analyze the factors influencing frequent visits by patients enrolled in family doctor services, correctly identify the utilization tendency of primary outpatient medical resources by enrolled patients, and provide a basis for promoting the high-quality development of family doctor contract services.

Methods

In August 2023, outpatient visit records of adult diabetic patients from 13 community health service centers in Minhang District, Shanghai, for the year 2021 were retrieved. Personal information such as names and contact details were forcibly anonymized, while data on sex, age, enrollment in family doctor services, triggered diagnosis records, frequency of medical treatment, department of medical treatment, and Chinese medicine services during visits were collected. The characteristics of outpatient visits for adult diabetic patients in the community were analyzed, and multiple logistic regression and decision tree models were used to analyze the factors influencing frequent visits by enrolled patients.

Results

There were 66 838 adult patients, resulting in 1 281 972 outpatient records. Among them, 48.96% (32 723) were male; the median age of the patients who visited the hospital was 71 (66, 77) years old; the median number of diagnosis types was 6 (3, 10) ; the median frequency of visits was 15 (9, 26), 10.28% (6 871) of the adult patients frequently visited the hospital for 362 068 times; 1-2 departments were the main ones (60.38%), and 9.33% (6 233) of the patients with≥5 departments involved; 39.53% (26 423) visited Chinese medicine services. During the year, Contracted patients accounted for 92.77% (62 005) of all the patients, while non-contracted patients only accounted for 7.23% (4 833). There were significant differences between contracted patients and non-contracted patients in sex, age, complexity of illness, frequency of medical treatment, department of medical treatment, Chinese medicine service (P<0.05). The results of multivariate Logistic regression analysis showed that sex, age, complexity of illness, department of medical treatment, Chinese medicine service were the influencing factors of frequent visits by contracted patients (P<0.05). The results of decision tree model analysis showed that the complexity of the disease was the most important factor affecting the frequent visits of contracted patients.

Conclusion

The signing rate of adult diabetic patients in community primary clinics in Minhang District of Shanghai was high, the effect of family doctor signing system was remarkable, the aging of adult diabetic patients in community primary clinics was prominent, the contracted patients' condition was more complicated, and the demand for Chinese medicine treatment was stronger. The frequent visits of contracted patients were affected by many factors, especially the complexity of their condition. Therefore, it is suggested that relevant departments identify frequent patients efficiently according to the patients' condition, so as to make more rational use of medical resources in primary clinics.

Consulting Room of General Practitioner

Diagnosis and Treatment of Halitosis: a General Practice Perspective

YAO Dingye, LUO Guiping, SUN Junsheng, REN Jingjing

2025, 28(07):  900-904.  DOI: 10.12114/j.issn.1007-9572.2023.0650

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Halitosis is a common clinical disease, which seriously affects the social and mental health of patients. General practitioners play a key role in the diagnosis and treatment of halitosis. Based on the review of the literature, this paper puts forward a set of ideas for the diagnosis and treatment of halitosis from the perspective of general medicine, including medical history inquiry, physical examination, detection methods and treatment strategies. This paper emphasizes the importance of personalized diagnosis and treatment, and points out that general practitioners should pay more attention to and manage patients with halitosis.