Table of Content

05 December 2025, Volume 28 Issue 34

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Guidelines·Consensus

Chinese Expert Consensus on Constipation Screening and Assessment for Community Cancer Patients (2025 Edition)

Community Rehabilitation Working Committee of Chinese Rehabilitation Medicine Association

2025, 28(34):  4249-4257.  DOI: 10.12114/j.issn.1007-9572.2025.0212

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Constipation is a common complication in cancer patients, with an incidence rate ranging from 30% to 90%. It is particularly prevalent among those using opioids and patients with advanced cancer. Currently, standardized screening and assessment systems for constipation in community-dwelling cancer patients are lacking. Unmanaged constipation may lead to severe complications such as bowel obstruction and malnutrition, significantly impacting patients' quality of life. Chinese Expert Consensus on Constipation Screening and Assessment for Community Cancer Patients (2025 Edition) developed by the Community Rehabilitation Working Committee of Chinese Rehabilitation Medicine Association with a multidisciplinary expert panel, addresses 8 core issues: definition of constipation, risk factors, screening/assessment tools, management for special populations, and referral indications. Based on relevant literature, 12 recommendations are proposed. The consensus aims to establish evidence-based standardized assessment tools, integrate risk evaluation, self-monitoring, and referral strategies, and guide community healthcare providers in early identification of high-risk patients while optimizing screening and assessment protocols.

Expert Consensus on the Effects and Efficacy Evaluation of Non-invasive Neuromodulation in Elders with Disability and Dementia

Expert Panel of the National Key R&D Program "Research on the Effects and Mechanisms of Multiple Types of Physical Stimulation on Body Function", Brain Function Detection and Regulation Rehabilitation Professional Committee of Chinese Association of Rehabilitation Medicine, Cerebral Small Vessel Disease Professional Committee of Beijing Neurology Association

2025, 28(34):  4258-4281.  DOI: 10.12114/j.issn.1007-9572.2025.0298

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With the accelerating global aging population, the burden of neurodegenerative diseases continues to rise, placing substantial economic and caregiving pressure on both society and families. Non-invasive neuromodulation (NINM) has emerged as a potential intervention, demonstrating unique advantages in mitigating functional decline. However, a scientific, comprehensive, and standardized system is still lacking in the current evaluation of effects and efficacy, as they rely heavily on subjective scales, overlook the dynamic changes of brain function, and involve ambiguous safety thresholds, thereby constraining comprehensive assessment of the long-term efficacy and clinical benefits of NINM. Based on evidence-based medicine, domestic and international guidelines, expert consensus, clinical practical experience, and technical management standards, this consensus statement proposes 11 recommendations for NINM interventions targeting elderly individuals with disability and dementia. These recommendations systematically encompass key domains including patient selection, intervention strategies, efficacy and effectiveness evaluation, and safety monitoring. The development of this consensus aims to enhance the scientific rigor and feasibility of clinical application, providing standardized guidance for NINM interventions in elderly populations with disability and dementia, thus ensuring their rational implementation and effective management in clinical practice.

General Practice Education

Policy and Practice of Use and Incentive of Rural Targeted General Practitioners in China

AO Wenhua, LIN Chunmei, ZHANG Yanchun, ZHANG Lifang, LI Sisi, QIN Jiangmei

2025, 28(34):  4282-4289.  DOI: 10.12114/j.issn.1007-9572.2024.0509

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Background

Rural targeted general practitioners (referred to as "5+3" targeted general practitioners) who have completed 5-year college education and 3-year residency training are an important source of high-level health talents in rural areas. The post attractiveness of primary care general practitioners in China still needs to be improved, and it is necessary to analyze the relevant progress in the use and incentive of "5+3" targeted general practitioners.

Objective

To understand the policy and practice of use and incentive of "5+3" targeted general practitioners in targeted rural primary medical care institutions (referred to as "targeted institutions" ) .

Methods

August 2024, we reviewed policies and typical practices in various places on use and incentive of "5+3" targeted general practitioners issued by Chinese government since 2010. A series of questionnaire surveys and semi-structured interviews were conducted among "5+3" targeted general practitioners, presidents of targeted institutions and managers ofhealth administrativedepartments in 9 counties (cities) of 8 provinces in the midwest regions through the convergent-parallel mixed methods research.

Results

From the perspective of policy progress, the ues and incentive policy of "5+3" targeted general practitioners in China before 2018 was mainly guidance document. After 2018, relevant policy requirements were more specific, mainly focusing on improving salary levels, hiring and staffing, career development and performance management. Survey data shows: From 2010 to 2015, 9 counties (cities) trained a total of 209 "5+3" targeted general practitioners, with the compliance rate of 90.0% (188/209), of which the compliance rate for the 2010-2012 level was 84.0% (63/75), and the compliance rate for the 2013-2015 level was 93.3% (125/134) ; The pre-work compliance rate was 91.4% (191/209), and the post-work compliance rate was 98.4% (188/191) ; 63 people had completed their service period, and 61.9% (39/63) had renewed their contracts after the service period expired. The annual per capita after-tax wage income of 142 on-the-job "5+3" targeted general practitioners was 54 000 CNY during the training period, and the annual per capita after-tax wage income after entering the targeted institutions was 57 000 CNY. 14.1% (20/142) of them are willing to renew their contracts after the expiration of their service period.

Conclusion

The compliance rate of "5+3" targeted general practitioners continues to increase, and the trend of renewal rate is positive but the willingness to renew is low. There is a gap between the training of "5+3" targeted general practitioners and the actual needs of primary medical care institutions, and the working conditions and career development of "5+3" targeted general practitioners in the targeted institutions are restricted. It is suggested that the government and relevant departments proceed from the actual needs of the grassroots, coordinate and arrange "5+3" targeted general practitioners training, fully implement the incentive policies such as salary and professional title promotion, and formulate the renewal plan after the expiration of service

Research on Education of Rural-oriented Medical Students in China: a Systematic Review

HUANG Xintao, CHEN Mo, WANG Junyu, ZHANG Chen, DENG Huisheng

2025, 28(34):  4290-4299.  DOI: 10.12114/j.issn.1007-9572.2024.0581

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Background

The free training program for rural-oriented medical students (referred to as "bonded medical students" ) is a significant measure to alleviate the shortage of grassroots doctors in rural areas of China and to enhance the overall level of the grassroots medical and health workforce. Previous studies have lacked comprehensive analysis of the current state, methods, and effectiveness evaluations of educational research on bonded medical students across various institutions in China.

Objective

To explore the development status, research quality, and future trends of medical education research on five-year undergraduate bonded medical students in China from 2010 to 2023, providing references for subsequent work.

Methods

Literature on the training of bonded medical students published from January 1, 2010, to December 31, 2023, was retrieved from seven Chinese and English databases: CNKI, Wanfang, VIP, PubScholar, PubMed, Web of Science, and Cochrane Library. Two researchers independently screened the literature and extracted data according to inclusion and exclusion criteria. The quality of the literature was evaluated and comprehensively analyzed using MERSQI (The Medical Education Research Study Quality Instrument) and NOS-E (The Newcastle-ottawa Scale-education). Descriptive analysis was used to summarize and analyze the results.

Results

A total of 37 studies were included, of which 36 were in Chinese and 1 in English. In terms of research design, the pretest-posttest control design accounted for the largest proportion (46%, 17/37), while single-group posttest and randomized controlled posttest designs each accounted for 22% (8/37, 8/37), and single-group pretest-posttest accounted for 8% (3/37). A total of 97% of the studies were conducted at the undergraduate education level (36/37). The research focuses were mainly on curriculum adjustment (89%, 33/37), teaching method adjustment (81%, 30/37), and training model construction (8%, 3/37). Among them, 3 studies (8%, 3/37) on training model construction and 7 studies (19%, 7/37) on curriculum adjustment specifically designed courses targeting rural areas, primary-level institutions, or general practice. Outcome evaluation mainly focused on students' evaluation of teaching (70%, 26/37) and improvement of knowledge and skills after teaching (86%, 32/37), while fewer studies addressed actual behavior change (3%, 1/37) and benefits to patients and medical institutions (3%, 1/37). The overall research quality was not high, with a total MERSQI score of (10.4±2.4), and a maximum score of 14.0. The main items affecting low scores were the number of sample institutions, the validity of evaluation tools, and outcome indicators. The total NOS-E score was (2.5±1.5), with a maximum score of 5.0, with comparability of control groups and blinding as the main items affecting low scores.

Conclusion

The focus on educational training research for bonded medical students has increased, but there are issues such as generally low research quality, insufficient cross-institutional and cross-regional studies, insufficient incorporation of features specific to bonded medical training in research content and evaluation indicators, and limited attention to postgraduate and continuing education. Future research should strengthen multi-institutional cooperation and international exchanges, improve the quality of research design and methods, and establish a unified evaluation system with rural-oriented characteristics, and strengthen the design of rural-oriented characteristic courses related to rural and general practice, focusing on the continuity and integration of teaching design that includes post-graduate education and continuing education stages.

Article·Chinese General Practice/Community Health Service

Exploring the Concept of the Quality of Primary Health Care: a Systematic Review

LI Mingyue, TANG Haoqing, ZHENG Huixian, ZHANG Xiaotian, LIU Xiaoyun

2025, 28(34):  4300-4310.  DOI: 10.12114/j.issn.1007-9572.2023.0911

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Quality of primary health care (PHC), as an important dimension of universal health coverage, is receiving increasing attention globally. A correct understanding of the concept of PHC quality is a prerequisite for measuring, evaluating, and improving quality. PHC quality in China is not clearly defined, and there is no standardized definition and evaluation methodology. Research and policies on PHC quality face enormous challenges. This systematic review searched CNKI, VIP, Wanfang, PubMed, Embase, Google Scholar as well as official websites. Thematic analysis was used for data analysis. After screening, 31 studies/reports covering both low- and middle-income and developed countries were included. The current concepts of PHC quality can be categorized into three themes: (1) content-driven definitions, (2) goals-driven definitions, and (3) characteristics-driven definitions. The content of PHC includes basic medical services, public health services, and quality improvement. The goals of PHC include safety, effectiveness, timeliness, efficiency, equity, appropriateness, patient satisfaction, and patient-centeredness. The characteristics of PHC include access, continuity, coordination, comprehensiveness, family/community-centeredness, and integration. China should define PHC quality combining the content, goals, and characteristics of PHC that considers the stage of economic and social context and health care system context.

The Role and Implementation Strategy of Community Empowerment in Chronic Disease Management under Active Health Orientation

HE Liuhua, JIN Hua, GUO Aizhen, YU Dehua

2025, 28(34):  4311-4317.  DOI: 10.12114/j.issn.1007-9572.2024.0169

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In recent years, the incidence of chronic noncommunicable diseases in China has gradually increased, and how to effectively manage chronic diseases has become an urgent problem to be solved. In chronic disease management, it is not only necessary for medical personnel to provide standardized and scientific medical programs, but also for patients to have good self-health management and obtain various social support and resources to implement proactive health management. In view of China's current problems such as low health literacy level at the patient level, insufficient self-management ability, lack of active health awareness, and limitations of chronic disease management mode at the community level, this paper, from the perspective of active health management, combined with the connotation of community empowerment and its application in chronic disease management, proposed the implementation strategy of community-based chronic disease management under the guidance of active health. The aim is to provide suggestions for chronic disease management in China.

Research on the Changes of Contracted Family Doctors Services in Guangxi from the Perspective of Supply and Demand: Based on Two Cross-sectional Surveys

WANG Zhenbang, OU Yanchen, XIE Yueying, ZHANG Xin, ZHAO Yue, CHEN Dan, ZUO Yanli

2025, 28(34):  4318-4325.  DOI: 10.12114/j.issn.1007-9572.2023.0838

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Background

The "14th Five Year" Plan for National Economic and Social Development and the Long Range Obj ectives for 2035 points out the need to steadily improve the quality of contracted family doctor services. The contracted family doctor services system has been comprehensively promoted in Guangxi for six years, but there are few reports on the changes of such service.

Objective

To understand the changes of contracted family doctor services in Guangxi and analyze the reasons, so as to provide reference for the high-quality development of contracted services.

Methods

In July 2018 and October 2022, the study adopted purposive sampling method to select representative cities according to the geography, economic development level and the progress of contracted family doctor services in 14 prefecture-level cities in Guangxi as samples. The medical staff in the family doctor team and residents were selected by convenience sampling method to hand out questionnaires. In 2018, a total of 1 560 questionnaires were distributed to residents, and 1 285 valid questionnaires were returned, with an effective rate of 82.37%. A total of 627 questionnaires were distributed to family doctor team members, and 595 valid questionnaires were returned, with an effective rate of 94.90%. In 2022, a total of 1 800 questionnaires were distributed to residents, and 1 740 valid questionnaires were returned, with an effective rate of 96.67%. A total of 780 questionnaires were distributed to family doctor team members, and 775 valid questionnaires were returned, with an effective rate of 99.36%. Through literature review and expert consultation, the questionnaire of residents' cognition and satisfaction with contracted family doctor services and the questionnaire of family doctors' work situation and satisfaction were designed in combination with the actual situation in Guangxi. Multivariate Logistic regression analysis was used to analyze the influencing factors of satisfaction.

Results

Perspective of suppliers: there was no significant difference in the proportion of medical staff who thought that their work content had increased, working methods had changed, and working hours had increased in 2022 compared with 2018 (P>0.05). Among them, the proportion of medical staff who increased their working hours by more than 2 hours per working day and by more than 4 hours on weekends increased from 30.5% to 40.0% and 25.2% to 32.0%, respectively. The increase in working hours is mainly for essential public health services. The proportion of medical staff with an average monthly income of less than 4 000 yuan in 2022 was lower than that in 2018, and the proportion of medical staff with an average monthly income of 4 000-6 000 yuan and more than 6 000 yuan was higher than that in 2018, and the difference was statistically significant (P<0.05). The job satisfaction of medical staff in the family doctor team in 2022 and 2018 was "average". Perspective of the demand side: The proportion of community health service centers/township health centers as the first choice of medical institutions for residents in 2022 was higher than that in 2018 (P<0.05), from 69.3% to 78.3%. There was no significant difference in the proportion of residents who knew contracted family doctor services in 2022 compared with 2018 (P>0.05). In 2022, the proportions of residents who understood the relevant policies of contracted family doctor services, basic service packages and their free service items, and personalized service packages and their corresponding charging rates were higher than those in 2018 (P<0.05), from 35.3%, 35.6% and 26.9% to 54.0%, 53.6% and 49.2%, respectively. At present, the channels for learning about contracted family doctor services are mainly offline activities, with few online forms. The proportion of residents willing to sign contracted family doctor services and personalized service packages in 2022 was higher than that in 2018 (P<0.05), from 80.5% to 91.0% and 67.4% to 73.0%, respectively. Among them, about 70% of residents are willing to sign up for personalized service packages under 100 yuan in 2022 and 2018. In 2022, more residents enjoyed health consultation, home visits, and personalized health management services. And 94.7% of the contracted residents had a positive change in health management awareness. The overall satisfaction, trust, satisfaction with technical ability, and satisfaction with diagnosis and treatment process and results of residents in 2022 were all higher than those in 2018 (P<0.05), reaching the "satisfied" state. The results of multivariate Logistic regression analysis showed that the influencing factors of residents' satisfaction with contracted family doctor services included whether they preferred primary medical institutions for treatment, whether they understood the personalized service package and its corresponding charging standard, and whether they trusted family doctors (P<0.05) .

Conclusion

The family doctor team members have a heavy workload. It is necessary to accelerate the construction of information technology and gradually expand the team. Performance appraisal and incentives should be improved to enhance the enthusiasm of medical staff. Residents' willingness to seek medical treatment in primary care has increased, and their trust and cognition of contracted services have been improved. In the future, we should increase the publicity and improve the service capacity of contracted family doctor services. Residents' willingness to sign personalized services has increased. It is necessary to improve the supporting mechanism according to local conditions.

Article·Focus on Chronic Disease Comorbidity

Meta-analysis of Factors Influencing the Prevalence of Multimorbidity among the Elderly in Different Regions of China: a Comparative Study between the North and the South

YIN Jiajia, YAO Li, ZHOU Zihan, LI Qinqin, WANG Tingrui, LIU Yan

2025, 28(34):  4326-4336.  DOI: 10.12114/j.issn.1007-9572.2025.0068

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Background

The multimorbidity in the elderly has become an important issue that needs urgent attention in the field of public health. Therefore, it is of great significance to explore the influencing factors of multimorbidity in the elderly.

Objective

To investigate the prevalence of multimorbidity and related influencing factors in the elderly population in northern and southern China, in order to better manage and intervene the development and prognosis of multimorbidity in the elderly in different regions.

Methods

PubMed, Embase, Web of Science, Cochrane Library, Scopus, China Biology Medicine Disc, China National Knowledge Infrastructure, Wanfang Data Knowledge service platform were searched for relevant studies on influencing factors of multimorbidity in the elderly. Two researchers independently searched, screened, extracted data, and cross-checked. Any disagreements were resolved through consultation with a third researcher for arbitration. The search time limit was from the establishment of the database to July 2024. Stata 18.0 software was used for meta-analysis.

Results

The research incorporated 10 articles from the southern region and 10 from the northern region, with sample sizes of 2 342 507 and 75 871 cases, respectively. The prevalence of multimorbidity among elderly patients in the southern and northern regions was 34% (95%CI=29%-38%, P<0.001) and 36% (95%CI=22%-50%, P<0.001), respectively. Among them, the influencing factors of elderly patients with multimorbidity in southern China were age (OR=1.92, 95%CI=1.26-2.94, P=0.003), gender (OR=1.51, 95%CI=1.03-2.21, P=0.034), and household per capita monthly income (OR=1.62, 95%CI=1.03-2.54, P=0.036), education level (OR=1.47, 95%CI=1.25-1.73, P<0.001), BMI (OR=1.72, 95%CI=1.52-1.96, P<0.001), smoking (OR=1.53, 95%CI=1.11-2.11, P=0.009), drinking (OR=1.39, 95%CI=1.26-1.54, P<0.001), regular physical exercise (OR=0.67, 95%CI=0.55-0.80, P<0.001) ; age (OR=1.67, 95%CI=1.00-2.79, P=0.048), BMI (OR=2.39, 95%CI=1.80-3.18, P<0.001), drinking (OR=1.63, 95%CI=1.32-2.02, P<0.001), regular physical exercise (OR=0.84, 95%CI=0.71-0.99, P<0.037) were the influencing factors of elderly patients with multimorbidity in northern China. Sensitivity analysis showed that the results of Meta-analysis were stable, and Egger's test (multimorbidity prevalence: P=0.826; influencing factors: P=0.841) suggested that the risk of publication bias of the included literature was not significant.

Conclusion

The prevalence of multimorbidity among the elderly was relatively high in both the northern and southern regions. The risk factors for multimorbidity in both regions included: age≥70 years, overweight or obese BMI status, and alcohol consumption. Conversely, regular physical exercise served as a protective factor. In southern China, male sex, household per capita monthly income≥¥2 000, education below college level, and smoking were the risk factors for multimorbidity. These disparities may stem from dietary habits, economic levels, lifestyle pace, and uneven medical resource distribution. Enhancing inter-regional medical resource coordination and sharing is advised to improve health equity and resource balance, boosting elderly health overall. Additionally, healthcare providers should tailor interventions based on these factors to optimize disease management in elderly with multimorbidity.

The Prevalence of Multimorbidity and Complex Multimorbidity in Patients with Chronic Diseases and Patterns in Urumqi City, 2016-2022

ZHOU Yiran, SU Yinxia, YIN Feng, WU Yun, GULIJIAYINA Aiken, LU Yaoqin

2025, 28(34):  4337-4343.  DOI: 10.12114/j.issn.1007-9572.2024.0489

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Background

Currently, the prevalence of multimorbidity among patients with chronic diseases in China is increasing, resulting in a growing burden of disease. However, research on complex multimorbidity is relatively limited in China, underscoring an urgent need for a substantial body of evidence to inform the development of comprehensive and coordinated strategies for the control of persistent impacts of multimorbidity and complex multimorbidity.

Objective

The present study aims to investigate the prevalence of, and patterns of, multimorbidity and complex multimorbidity among patients with chronic diseases in Urumqi City between 2016 and 2022.

Methods

In June 2023, a comprehensive data set encompassing general demographic information and the prevalence of chronic diseases among patients with 27 chronic diseases was retrieved from the Urumqi City Public Health Surveillance Database and Electronic Medical Record Information Database from 2016 to 2022. The prevalence trends of multimorbidity (suffering from≥2 chronic diseases) and complex multimorbidity (suffering from ≥3 chronic diseases) in patients with chronic diseases were analyzed. Multifactorial logistic regression was used to This analysis sought to elucidate the factors that influence the occurrence of both chronic disease multimorbidity and complex multimorbidity. Additionally, the Apriori association rule algorithm was employed to identify the common patterns underlying chronic disease multimorbidity and complex multimorbidity.

Results

A total of 45 150 cases of study subjects were included during the seven-year period, comprising 12 969 (28.72%) cases of patients with a single chronic disease and 27 992 (62.00%) cases of patients with Additionally, 4 189 cases (9.28%) were identified as patients with complex multimorbidity, and the mean number of concomitant diseases per patient increased from (1.73±0.86) to (2.56±1.15). The results of the multifactorial Logistic regression analysis indicated that advancing age, male gender, and urban residence were significant risk factors for the development of comorbidities and complex multimorbidity in patients with chronic diseases. Of the 27 chronic diseases included in the study, the top three chronic disease prevalence rates were 33 675 cases of hypertension (74.58%), 32 942 cases of dyslipidemia (72.96%) and 12 408 cases of diabetes mellitus (27.48%). The most common binary co-morbidity patterns were "dyslipidemia+hypertension" "diabetes+hypertension" and "diabetes+dyslipidemia". The most common ternary co-morbidity patterns were "dyslipidemia+diabetes mellitus+hypertension" "oronary heart disease+dyslipidemia+hypertension" and "dyslipidemia+renal cyst+hypertension". Coronary heart disease was the preceding disease in all directional association rules. All rules appeared as antecedent diseases. The circulatory system was the most common co-occurring system, and the antecedents of several association rules directed to the circulatory system were all related to the endocrine system.

Conclusion

The prevalence of chronic disease multimorbidity and complex multimorbidity in Urumqi City has been increasing annually, with age, gender, and urban/rural differences playing a significant role. Hypertension, dyslipidemia, and diabetes mellitus are the most prevalent multimorbidity, while the most affected organ systems are the circulatory, digestive, and endocrine systems. The most common aggregation pattern is cardiometabolic disease.

Study on the Current Situation and Influencing Factors of Comorbidities among Urban-rural Elderly Hypertensive Patients

MA Nian, WANG Ziyun, TENG Xiaoyan, CHEN Yun, SUN Zhengyong

2025, 28(34):  4344-4350.  DOI: 10.12114/j.issn.1007-9572.2024.0543

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Background

The prevalence of hypertension is high and the control rate is low. It is also a basic disease of comorbidity in the elderly. However, previous studies have mainly focused on the comorbidity of the elderly, and less consideration has been given to studying the comorbidity based on hypertension. Therefore, understanding the comorbidity of hypertension in urban and rural elderly is of great significance for the management of elderly patients with hypertension at the grass-roots level.

Objective

In order to understand the current situation and influencing factors of comorbidity in urban and rural elderly hypertension patients in Anshun City, and to improve the management strategy for elderly hypertension patients comorbidity in urban and rural areas.

Methods

The elderly hypertension patients who participated in physical examination in primary medical and health institutions in Anshun City in 2023 were selected as the research objects. After variable screening and transformation, missing values and outliers processing, 44 571 samples were finally included in the analysis. Demographic characteristics were selected from the basic information of elderly hypertension patients, including age, gender, marital status, etc. Behavioral habits and existing major health problems were collected from physical examination data. Apriori algorithm was used to mine common comorbidity patterns, and multi-classification Logistic regression analysis was used to explore the influencing factors.

Results

A total of 44 571 valid samples were included, including 19 270 (43.23%) in urban and 25 301 (56.77%) in rural areas. There were statistically significant differences in the number of comorbidities among elderly hypertension patients in urban and rural areas, different genders, age groups, exercise status, smoking status, drinking status, medication status, medication compliance, and different educational levels (P<0.001). The comorbidity rate of elderly hypertensive patients in Anshun City was 70.44% (31 397 cases), of which the urban comorbidity rate was 74.45% (14 346 cases) and the rural comorbidity rate was 67.39% (17 051 cases). The co-morbidity patterns of urban and rural males and females were mainly "obesity + hypertension, dyslipidemia + hypertension, obesity + dyslipidemia + hypertension". The support of "obesity + hypertension" in urban areas is much higher than that in rural areas, while the support of "anemia + hypertension" in urban areas is lower than that in rural areas. There were strong association rules of "kidney disease + hypertension" in urban and rural males. Male medication in urban and rural areas, high school education and above, and women 's medication in urban and rural areas were all related to the coexistence of one disease (P<0.05). The age and exercise of women in urban and rural areas, the medication of men in urban and rural areas, and the education level of high school and above were related to the coexistence of the two diseases (P<0.05). The age, exercise status, medication status of urban males and urban and rural females, and the education level of high school and above of urban and rural males were all related to the coexistence of three or more diseases (P<0.05) .

Conclusion

The comorbidity rate of elderly hypertensive patients in urban areas was higher than that in rural areas in Anshun city. The main comorbidity mode was "obesity+dyslipidemia / diabetes+hypertension". Age, medication, exercise and d education level are the influencing factors of hypertension comorbidity in the elderly. Strengthen the health monitoring of elderly patients with hypertension, strengthen the patient 's awareness of comorbidities, implement urban and rural differentiated comorbidity prevention strategies and measures, and improve the level of comorbidity prevention and treatment.

Article

Pathway Analysis of the Impact of Diabetes Knowledge and Self-efficacy on Self-management and Quality of Survival among Rural Patients with Type 2 Diabetes Mellitus Based on ITHBC Modeling

WANG Lizhu, LI Sihan, WANG Xinyi, MAO Sunxi, QIU Yang, WANG Zhonghua

2025, 28(34):  4351-4358.  DOI: 10.12114/j.issn.1007-9572.2024.0239

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Background

The elderly population in rural China is substantial, and health services are insufficient, leading to a lower level of self-management and a higher risk of mortality among patients with type 2 diabetes mellitus (T2DM). Improving diabetes knowledge can enhance self-efficacy, diabetes self-management (DSM), and quality of life (QoL). Therefore, diabetes knowledge and self-efficacy are pivotal for DSM and QoL of T2DM patients.

Objective

To elucidate the pathways through which diabetes knowledge and self-efficacy influence DSM and QoL among rural T2DM patients.

Methods

A cross-sectional study design was used to sample 2 193 rural T2DM patients from Binhai County, Jiangsu Province, in August 2022, employing randomized whole-cluster sampling. The Diabetes Patient Knowledge Scale (ADKnowl), the Self-Efficacy Scale for Chronic Diseases (SECD6), the Self-Management Behavioral Scale for Diabetic Patients (SDSCA), and the Diabetes Survival Quality Specificity Scale (DSQL) were utilized to assess the participants. A total of 2 010 (91.66%) valid questionnaires were obtained. A model was developed based on the Integrated Theory of Health Behavior Change (ITHBC), and multiple linear regression analyses were conducted to explore the impact of the ADKnowl and SECD6 scores on the SDSCA and DSQL scores.

Results

The ADKnowl, SECD6, SDSCA, and DSQL scores of rural T2DM patients were (52.5±16.5), (6.4±1.2), (37.9±6.9) and (48.3±8.6). The results of multiple linear regression analysis showed that the direct effect of ADKnowl scores on SDSCA scores was 0.156 (P<0.05), the mediating effect of SECD6 scores in it was 0.012 (P<0.05), and the indirect effect accounted for 7.1% of the total effect; the direct effect of ADKnowl scores on DSQL scores was -0.048 (P<0.05), in which the indirect effects of SECD6 score and SDSCA score were -0.041 and -0.012 (P<0.05), accounting for 40.6% and 11.9% of the total effect, respectively. In addition, foot care (β=0.352) and diet (β=0.161) dimension scores in ADKnowl had a positive effect on SDSCA scores (P<0.05), and reducing the risk of complications (β=-0.213), exercise (β=-0.117), and diet (β=-0.197) dimension scores had a negative effect on DSQL scores (P<0.05). Symptom management self-efficacy (β=-0.115), and disease co-management self-efficacy (β=-0.397) dimension scores in SECD6 had a negative effect on DSQL scores (P<0.05) .

Conclusion

Diabetes knowledge improves the level of DSM and QoL in rural T2DM patients, with a positive mediating effect of self-efficacy and self-management. Additionally, the acquisition of diabetes-related knowledge, such as diet, exercise, and foot care, significantly improves the level of DSM and QoL of patients. It is recommended that multisectoral collaboration, long-term health education, and social support resources be provided to enhance healthcare professionals' attention to the knowledge and self-efficacy of diabetic patients, effectively improving DSM and QoL of rural T2DM patients.

Study on the Correlation between the Course of Hypertension and Autonomic Nervous System Damage in Elderly Patients in Primary Care Institutions in Ningxia Hui Autonomous Region Based on Single Lead Wearable Electrocardiogram Device

YU Xinyan, YANG Jianyun, JIANG Qingru, CHEN Tao, SU Peng, WANG Siyang, LUO Zhanwu, ZHANG Haicheng

2025, 28(34):  4359-4370.  DOI: 10.12114/j.issn.1007-9572.2024.0506

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Background

Hypertension is a major chronic disease managed by primary healthcare institutions in China. Cardiac autonomic dysfunction is a key cause of blood pressure regulation imbalance and adverse cardiovascular events. Therefore, in primary healthcare institutions, the use of efficient and portable single lead wearable electrocardiogram (ECG) devices can help explore the relationship between elderly hypertensive patients and the autonomic nervous system, providing a simple, efficient, low-cost, and sustainable suitable method and objective basis for the management and prevention of cardiovascular disease in primary hypertensive patients.

Objective

To investigate the correlation between the duration of hypertension and autonomic nervous system damage in elderly patients in Primary Care institutions in the Ningxia Hui Autonomous Region using a single lead wearable ECG device.

Methods

A total of 2 137 elderly hypertension patients aged 65 years or older from 20 primary medical institutions in the Ningxia Hui Autonomous Region were enrolled in this study. ECG data of 72 hours, along with basic information, psychological health, and lifestyle data, were collected and uploaded to the cloud platform using a single-lead wearable ECG device from January 2022 to December 2022. Based on the heart rate variability (HRV) time-domain parameter standard deviation of all sinus rhythm RR intervals (SDNN), subjects were divided into two groups: a normal group (SDNN>100ms, n=470) and an abnormal group (SDNN<100 ms, n=1 667). Propensity score was used to match subjects on a 1∶1 basis, adjusting for confounding factors with a caliper value of 0.02, and the matching effect was verified using inverse probability weighting. Single-factor and multivariate Logistic regression analyses were conducted to investigate the relationship between the onset of hypertension and autonomic nerve damage, and the matching effect was further verified. Subgroup analyses were performed using propensity score matching based on the onset of hypertension and autonomic nerve damage, with sensitivity analyses conducted before and after matching. Additionally, a nonlinear association between the duration of hypertension and autonomic nerve damage was examined using restricted cubic splines (RCS) analysis to test interaction effects.

Results

Among the patients, 479 had grade 1 hypertension, and 1 658 had grade 2 hypertension. Disease duration was categorized as follows: 1 203 patients had less than 5 years of disease duration, 753 had 5-<10 years, 110 had 10-<15 years, 41 had 15-<20 years, 26 had 20-<30 years, and 4 had more than 30 years. The multivariate Logistic regression analysis showed that the relationship between autonomic nerve damage and hypertension duration was positive after matching (P<0.001). Subgroup analysis showed that the relationship between hypertension duration and autonomic nerve damage was stronger in the 80-year-old and younger, lower-educated, no comorbidities of coronary heart disease, female, and those with obstructive sleep apnea (OSA) subgroups before and after matching, with statistically significant differences (P<0.05) and interaction effects (P<0.05). However, the RCS analysis showed no nonlinear relationship between the course of hypertension and autonomic nerve damage in matched patients.

Conclusion

There was a positive correlation between the course of hypertension and autonomic nerve damage in elderly hypertension patients from the primary healthcare centers of the Ningxia Hui Autonomous Region. Primary healthcare facilities should strengthen health education for patients to improve their treatment adherence, which can delay autonomic nerve damage in hypertensive patients.

Evaluation of the Clinical Application Value of Domestic New-type MeHow MeAir 9000 in Diffusing Capacity of the Lung Tests for Chronic Respiratory Diseases

YAO Shihua, HUANG Ruibo, FU Tuping, WU Zhongping, CHEN Shubing, XIE Yanqing, SHEN Beilan, ZHONG Liping, AN Jiaying, WANG Xudong, LIU Wenting, YU Xinxin, ZHENG Jinping, GAO Yi

2025, 28(34):  4371-4377.  DOI: 10.12114/j.issn.1007-9572.2024.0220

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Background

Pulmonary diffusing capacity testing is widely used in clinical practice for assisting in the diagnosis and quantitative evaluation of interstitial lung diseases, differentiating emphysema, and assessing whether other pulmonary diseases are complicated with pulmonary diffusing capacity impairment, among other applications. In recent years, several new domestic pulmonary diffusing capacity testing instruments have been successively developed, registered and launched on the market; however, their reliability in clinical use remains to be verified.

Objective

To evaluate the clinical reliability of the pulmonary diffusing capacity measurement results obtained by the new domestic MeHow MeAir 9000.

Methods

From June 15 to September 1, 2023, among patients who underwent examinations in the Pulmonary Function Laboratory of the First Affiliated Hospital of Guangzhou Medical University, 68 subjects with clinically diagnosed chronic obstructive pulmonary disease (COPD) and 68 with interstitial lung disease (ILD) were randomly selected, and divided into the ILD group and the COPD group. A cross-over design was adopted, where the subjects were randomly assigned to use two types of pulmonary diffusing capacity testing instruments in sequence: the experimental group (MeHow MeAir 9000) and the control group (Jaeger MasterScreen Diffusion). Professional pulmonary function examiners performed pulmonary diffusing capacity and vital capacity tests on the subjects in accordance with the procedural and quality control standards specified in the standards for single-breath carbon monoxide uptake in the lung guideline issued by the European Respiratory Society/American Thoracic Society (ERS/ATS). The collected indicators included: diffusing capacity of the lung for carbon monoxide (DLCO), inspiratory vital capacity (IVC), alveolar ventilation (VA), ratio of diffusing capacity of the lung for carbon monoxide to alveolar ventilation (DLCO/VA), forced vital capacity (FVC), forced expired volume in one second (FEV₁), and percentage of predicted diffusing capacity of the lung for carbon monoxide (DLCO%pred). Consistency analysis was conducted on the measurement results obtained by the two groups of instruments and the results of the grading of pulmonary diffusing capacity impairment severity.

Results

Statistical analysis and comparison of the consistency of measurement values of DLCO, IVC, VA, DLCO/VA, FVC, and FEV₁ between the two instruments: in the interstitial lung disease group, the ICCs were 0.981 6, 0.944 9, 0.916 8, 0.969 8, 0.984 4, and 0.982 4 respectively; in the COPD group, the ICCs were 0.990 7, 0.917 9, 0.920 9, 0.960 2, 0.979 8, and 0.989 7 respectively. The analysis results of both disease groups showed high consistency, and the results were statistically significant (P< 0.05). In the Bland-Altman scatter plots of the measurement values of DLCO, IVC, VA, DLCO/VA, FVC, and FEV₁ from the two instruments, the proportions of data points falling within the 95% confidence interval (95%CI) in the interstitial lung disease group were 95.5%, 94.0%, 94.0%, 95.5%, 92.5% and 94.0% respectively; in the COPD group, the proportions were 92.4%, 93.9%, 93.9%, 95.5%, 97.0% and 95.5% respectively. These results indicated that the consistency of diffusing capacity measurement values between the experimental group instrument and the control group instrument was good. In terms of the comparison of the two instruments regarding the grading of diffusing capacity impairment (classified into 4 grades: normal, mild, moderate, and severe based on DLCO%pred) in both disease groups, the ICCs in the interstitial lung disease group and the COPD group were 0.939 7 and 0.975 0 respectively, with statistically significant results (P< 0.05). The weighted kappa values from Cohen's weighted kappa test for consistency strength were 0.896 9 and 0.837 2 respectively, and the analysis results were statistically significant (P< 0.05), suggesting that the experimental group instrument and the control group instrument have good consistency in evaluating the grading of pulmonary diffusing capacity impairment.

Conclusion

The pulmonary diffusing capacity testing of the new domestic MeHow MeAir 9000 shows high measurement accuracy in chronic respiratory diseases and good reliability in evaluating the severity of pulmonary diffusing capacity impairment, making it suitable for clinical promotion and application.

Based on Real-world Data Analysis about Clinical Application of Bronchial Provocation Test

LIU Shuyi, LI Yun, YE Peitao, TAN Lunfang, XIE Yanqing, GAO Yi, ZHENG Jinping

2025, 28(34):  4378-4384.  DOI: 10.12114/j.issn.1007-9572.2023.0517

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Background

The bronchial provocation test (BPT) is a widely utilized method for assessing airway hyperreactivity (AHR) and serves as a crucial tool for both the diagnosis and therapeutic evaluation of asthma. Despite its significance, BPT is often underutilized outside the field of respiratory medicine.

Objective

This study aims to analyze the application of BPT across various hospital departments, as well as the BPT positive rate and AHR severity grades, using real-world data from a large sample of BPT cases.

Methods

BPT reports from the First Affiliated Hospital of Guangzhou Medical University, spanning March 2017 to April 2022, were systematically collected for analysis. Reports pertaining to children (under 18 years of age) and those lacking critical indicators were excluded from the study. The analysis focused on the distribution of BPT applications across various departments, the rate of positive BPT results, and the classification of clinical diagnoses. Positive BPT data were categorized into two groups: those positive prior to methacholine inhalation and those positive post-inhalation. The former group was designated as the "very severe" category, while the latter was further subdivided into "very mild" "mild" "moderate" and "severe" categories based on PD₂₀ values. Comparative analyses of age, height, weight, and baseline lung function indices were conducted across these groups. Additionally, multivariate Logistic regression analysis was employed to identify risk factors associated with positive BPT outcomes.

Results

In this study, a total of 24 034 BPT reports were analyzed. The distribution of report outcomes was as follows: 27.91% were positive, 67.83% were negative, and 4.22% were suspected positive. Additionally, 8 cases did not complete the test. The internal and surgical BPT reports constituted 86.50% and 3.07% of the total, respectively, with corresponding positive rates of 28.30% and 18.70%. The study included only 2 gynecological patients, of whom 1 tested positive. Significant differences were observed in age, body weight, forced expiratory volume in the first second (FEV₁), percentage of predicted FEV₁ (FEV₁%pred), forced vital capacity (FVC), FEV₁/FVC ratio, and percentage of predicted FEV₁/FVC (FEV₁/FVC%pred) among the BPT positive groups (P< 0.05). Notably, FEV₁, FEV₁%pred, FEV₁/FVC, and FEV₁/FVC%pred values decreased progressively with increasing severity of AHR (P< 0.05). Multivariate Logistic regression analysis identified several risk factors for positive BPT results, including age over 40 years, female gender, body mass index (BMI) ≥24 kg/m², clinical diagnosis of asthma, FEV₁%pred < 80%, and FEV₁/FVC%pred < 92% (P< 0.05). A total of 51 adverse events associated with BPT were recorded, all of which were classified as very mild or mild. Among these, 8 cases were unable to complete the test due to intolerance.

Conclusion

BPT remains the gold standard for the rapid clinical diagnosis of AHR, offering significant value for clinical guidance. The positive rate of BPT in patients with suspected AHR is high not only in the respiratory department but also among other medical departments, warranting increased attention to BPT. Particular vigilance is advised for patients with low baseline FEV₁ and FEV₁/FVC, especially in females, people over 40 years old or with a high BMI. BPT is generally considered safe, but it is crucial to closely monitor changes in FEV₁ and any adverse reactions during provocation tests.