Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-31 Cooperative journals: 《中国全科医学》
Abstract：
Background The policy of coordinated development of regional health plays the purpose of truly optimizing the allocation of resources by building a regional synergy with reasonable structure and proper functions to provide continuous medical services, fully carrying out resource integration and information sharing, and giving full play to the service characteristics and expertise of regional medical centers and community hospitals. Objective Build the evaluation system of regional health coordinated development to provide scientific basis for the evaluation of regional coordinated development capacity. Methods Using literature analysis, semi-structured interview and other research methods, the elements of regional health coordinated development were collected, and the evaluation index system was preliminarily constructed. Through the objective sampling method, 19 experts familiar with the coordinated development of regional health in Shanghai (from the fields of general medicine, administrative management and public health management) were selected as the objects of correspondence. From December 2020 to March 2021, Delphi method was used to conduct two rounds of correspondence, and analytic hierarchy process was used to evaluate the weight of indicators at all levels and test the logical consistency of indicators at all levels, Finally establish the evaluation index system. Results The evaluation index system of regional health coordinated development was composed of 4 primary indicators, 12 secondary indicators and 31 tertiary indicators.Conclusion: The preliminary evaluation index system of regional health cooperation development is scientific and practical, and we can find the problems and deficiencies of the cooperation model of serving community by this system. The preliminary evaluation index system of regional health cooperation development lay a theoretical and practical foundation for guiding the practice of regional model.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-31 Cooperative journals: 《中国全科医学》
Abstract： Background Handwriting characterization techniques have been extensively studied in the field of cognitive impairment detection related to dementia and Parkinson’s disease, and handwriting characterization studies for older adults with mild cognitive impairment (MCI) still need to be expanded. Objective To explore the differences between the handwriting characteristics of elderly patients with MCI and normal elderly people, and discover the value of handwriting features in MCI screening. Methods Thirty-three older adults with MCI from January 2022 to April 2022 in the Huzhou community were selected as the observation group, while forty-three community older adults with normal cognitive function matched for age, gender and education level in the same period were included as the control group. For 6 handwriting tasks, the kinematic parameters of the subjects’ handwriting characteristics were collected by the digital pen, and the classification accuracy, sensitivity and specificity of handwriting characteristics for the diagnosis of MCI were analyzed by discriminant analysis and receiver operating characteristic curve (ROC). Results Compared with the healthy control group, the observation group had lower writing correctness, higher writing stress, longer writing reflection time, pen fall time and total task completion time in the graphical task, and the difference between groups was statistically significant (Z=-3.593, -2.122, -4.302, -3.663, t=-5.565, all P<0.05); the observation group had relatively longer writing reflection time and total task completion time in the text task (Z=-3.464, -2.94, all P<0.05). Compared with the text task, the graphical task had the highest specificity (93.02%) in the total task completion time to identify the MCI and control groups, and the area under curve (AUC) was 0.828. The summary of handwriting characteristics for the graphic writing task correctly classified 80.26% of older adults with MCI, with 87.88% sensitivity and 79.07% specificity, and had higher diagnostic efficacy for those with MCI than the MMSE scale. Conclusion Handwriting characteristics of graphical writing tasks may have potential application in screening of older adults at risk for MCI prior to conducting sets of neuropsychological tests for MCI diagnosis in community health care facilities.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-31 Cooperative journals: 《中国全科医学》
Abstract： Background Lifestyles are important modifiable risk factors for cognitive decline and dementia. Understanding the status and influencing factors of the community-dwelling middle-aged and elderly adults adherence to the lifestyles conducive to reducing the risk of dementia will be the basis for medical staffs to formulate individualized interventions for dementia primary prevention, but there are few related studies at present.Objective To explore the status and influencing factors of Dementia Risk Reduction Lifestyle in the community-dwelling middle-aged and elderly adults.Methods The 506 middle-aged and elderly adults (aged 45 years and older) from 5 communities in Shapingba District, Chongqing, who were receiving free health check-ups in a community health service center were selected by convenient sampling from January to October 2021. The self-designed general information questionnaire and the Dementia Risk Reduction Lifestyle Scale were used to investigate. Multiple ordinal Logistic regression analysis were performed to identify the influencing factors of Dementia Risk Reduction Lifestyle in the community-dwelling middle-aged and elderly adults.Results The average score of lifestyle was 88.00±13.27. The average scores of items in brain-benefiting exercise and mental leisure activity were lower than the average. Multiple ordinal Logistic regression analysis revealed that gender, educational level, personal monthly income and experience of receiving dementia health education were important influencing factors of Dementia Risk Reduction Lifestyle (P<0.05) .Conclusion The Dementia Risk Reduction Lifestyle of the community-dwelling middle-aged and elderly adults was at a medium level. There is still much room for primary prevention and intervention in mental leisure activity and brain-benefiting exercise. It is suggested that in community health management, we should focus on the middle-aged and elderly people who are male, in a weak social and economic position and have not received dementia-related health education, strengthen relevant health education and preventive intervention, and urge them to adopt a lifestyle conducive to reducing dementia risk and promoting brain health.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-31 Cooperative journals: 《中国全科医学》
Abstract： Background Mental disorders are now increasingly common in the population, however, the epidemiological survey data of mental disorders in Xinjiang are not perfect. Objective By understanding the prevalence and influencing factors of common mental disorders among people aged 15 and above in Northern Xinjiang region, and comparing the data with those in the southern Xinjiang region, the prevalence of common mental disorders in the whole Xinjiang region can provide a scientific basis for the formulation of corresponding mental health plans. Methods From November 2021 to July 2022, a multistage stratified whole-group random sampling method was used to select 3,853 residents from five regions (cities) in the Northern Xinjiang region to diagnose various types of mental disorders using the International Classification of Diseases, 10th revision (ICD-10) classification of mental and behavioral disorders as the diagnostic criteria. Chi square test and Fisher's exact probability method were used to compare the differences in prevalence between groups, and logistic regression analysis was performed to explore the factors influencing each type of mental disorder. Results (1) The point-in-time prevalence rate of common mental disorders in northern Xinjiang was 9.71% and the age-adjusted rate was 10.07%; the point-in-time prevalence rate of common mental disorders in the whole Xinjiang was 9.69% and the age-adjusted rate was 9.90%;(2) Women, illiterate and 25~34 year olds are at higher risk of developing mood disorders; Women, ≥65 year olds are at higher risk of developing anxiety disorders；Rural, unmarried, and illiterate people are at higher risk for schizophrenia; Illiterate people are at higher risk of developing organic mental disorders; Unmarried, illiterate people are at higher risk of mental retardation. (3) There was no difference between the prevalence of various types of mental disorders in North and South Xinjiang regions. Conclusion The point-in-time prevalence of mental disorders in Xinjiang is 9.69%, with a higher prevalence of mood disorders and anxiety disorders. The female, rural, low-education and unmarried people are the main groups of patients with various types of mental disorders in the northern Xinjiang region.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-31 Cooperative journals: 《中国全科医学》
Abstract： Background There is a gap in the population with severe mental illness and their ability to receive and cure, and most patients live in the community for a long time. Providing timely and effective primary mental health services to this population is significant through community health institutions. Objective To analyze the characteristics of the new increase and death of patients with severe mental illness in a community in Beijing from 2011 to 2021 so as to provide references for the prevention and treatment of community mental illness. Methods The information of community patients with severe mental illness was retrieved from the mental health information management system of Beijing, and descriptive methods analyzed the data. Results ①From 2011 to 2021, the number of new patients was more than the number of dead patients yearly. The prevalence rate increased year by year from 2012. ②Compared with the baseline, the proportion of schizophrenia decreased while those with bipolar disorder increased in 2021. The proportion of primary school education or below decreased, while those with high education increased. The constituent ratio of patients who were with a job, aged ≥ 46 years, and the duration of non-created files ≤ 5 years increased compared with the baseline, the above all had statistically significant differences(P < 0.05). ③There were 212 new patients, and schizophrenia and bipolar disorder ranked as the first two of the six types of severe mental illness from 2011 to 2021. The age of the first onset was concentrated in the age group of 19-45 years (65.57%). The number of patients with 5 years or less of the duration of non-created files was the most ( 40.57%), and the average median was 8.50 years. ④ From 2011 to 2021, there were 90 dead patients. Schizophrenia patients had the most deaths, with 78 cases; The number of patients who died over 60 was the most (74.45%). The top three causes of death were the somatic disease, suicide, and accidental death. The years of life lost (YLL) rate fluctuated between -0.250 ‰ and 1.436 ‰. Conclusion From 2011 to 2021, the number of new patients was more than the number of dead patients; the prevalence rate increased, the duration of non-created files was shortened, and the dead patients were mainly elderly with somatic diseases. Targeted measures should be taken to cope with the above changes.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-31 Cooperative journals: 《中国全科医学》
Abstract： Background The incidence of dementia is gradually increasing in China. Healthy lifestyle is an important modifiable factor for dementia, and the health belief model can be widely used to explain and predict health-related behaviors. Objective To investigate and analyze the impact of public health belief on health behavior, and provide scientific basis for the development of targeted prevention strategies based on health belief model. Methods A total of 1021 adults were selected by convenience sampling. The general information, dementia prevention knowledge, dementia prevention belief and health promotion lifestyle were investigated. Results The health behaviors were affected by perceived barriers(β=-0.280，P＜0.01), self-efficacy(β=0.148，P＜0.01), perceived susceptibility (β=–0.118，P＜0.01)and perceived benefits(β=0.069，P＜0.01)，general health motivation (β=–0.093，P＜0.01)，residence（β=0.057，P＜0.05）, education level（β=0.120，P＜0.01）, contact history of dementia（β=0.080，P＜0.01） and knowledge of dementia prevention（β=0.087，P＜0.01）. Conclusion The health behavior and lifestyle of adults are partly affected by the partial dimension of health belief in dementia prevention and some sociodemographic characteristics. Therefore, health care workers can conduct health behavior intervention to prevent dementia based on the relationship between health belief mode and behavior.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-31 Cooperative journals: 《中国全科医学》
Abstract： Background Maintaining brain health is an advanced goal of healthy ageing. Nutrition has been identified as a promising approach to reduce the risk of dementia, but there is currently a lack of targeted nutritional management to promote brain health in clinical practice, resulting in lack or inadequate health guidance. Objective To search and evaluate studies about dietary nutrition management to promote brain health, and to provide evidence-based basis for clinical development of dietary nutrition management of brain health. Methods We searched UpToDate, BMJ Best Practice, JBI Library, NIA, RNAO, Cochrane Library, PubMed, CNKI, Medlive and other databases to collect clinical decisions, best practices, guidelines, evidence summaries, expert consensus and systematic reviews regarding dietary nutrition management to promote brain health from January 1, 2017 to March 29, 2022. The quality and evidence level of the literature were assessed by two researchers systematically trained on evidence-based medicine. Results A total of 28 articles were included, including 3 clinical guidelines, 5 expert consensus, 1 clinical decision and 19 systematic reviews. Their methodological qualities were rated high overall. Finally 23 pieces of best evidence involving 7 aspects were intervention timing, dietary nutrition assessment and screening, dietary patterns and components, specific nutrients, coffee intake, weight management, health education and guidance. Conclusion Dietary nutrition can promote brain health. Community medical staff should choose and apply the best evidence based on clinical situation, residents' dietary nutrition status and preferences, so as to develop individualized dietary nutrition program for brain health.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-31 Cooperative journals: 《中国全科医学》
Abstract： Background Mild cognitive impairment (MCI) is an important stage to intervene and delay the progression of dementia，and studies have shown that it is closely associated with genetic factors，among which Apolipoprotein E (APOE) ε4 is known to be an important risk allele of MCI in the medical community. Due to the lack of genome-wide association study (GWAS) summary data of MCI, existing studies calculate the polygenic risk score (PRS) of MCI based on GWAS summary data of Alzheimer's disease，which leads to the unsatisfactory effect of the existing statistical modeling of genetic risk of MCI. Objective In this study，meta-polygenic risk score (metaPRS) and APOEε4 were used as important predictors to explore and optimize the statistical modeling strategy of genetic risk in MCI from the perspective of generalized linear model and machine learning. Methods PRS for the 12 MCI-related traits were calculated and integrated into metaPRS for MCI by elastic-net logistic regression model. SCOREAPOE is calculated by weighting the APOEε4 effect size with age correction. In this study，XGBoost，GBM，Logistic regression and Lasso regression were used as statistical modeling methods to verify the inclusion strategies of different predictors based on metaPRS，SCOREAPOE and basic demographic information (age，gender，education level). AUC and F-measure were used to evaluate the predictive effect of statistical modeling of genetic risk of MCI. Results For the genetic risk of MCI，metaPRS and SCOREAPOE have high predictive value. After including metaPRS，SCOREAPOE and basic demographic information (age，gender，education level)，the predictive effect of each statistical modeling method is as follows: XGBoost (AUC=0.69，F-measure=0.88)，GBM (AUC=0.76，F-measure=0.87)，logistic regression (AUC=0.77，F-measure=0.89)，and lasso regression (AUC=0.76，F-measure=0.92). Conclusion When the sample size is not high (less than 500)，the lasso regression model constructed by including metaPRS，SCOREAPOE and basic demographic information (age，gender，education level) has the best effect on MCI genetic risk prediction，which provided a new idea and perspective for statistical modeling of genetic risk of MCI and other complex diseases.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-31 Cooperative journals: 《中国全科医学》
Abstract： As a major public health problem, dementia has attracted global attention. Early detection and interventions targeting at high risk people of cognitive impairment, can help prevent the onset and postpone the progression of dementia. The rapid increase in the number of elderly people with dementia in China poses challenges in terms of preventive care, health promotion, social support and research innovation. In this paper, we summarise the research progress in social support, risk factors interventions, person-centred care, information system development, innovative research and science and technology translation in the prevention and treatment of dementia in China from the perspective of the "Global Action Plan on the Public Health Response to Dementia: 2017—2025", and propose a "Dementia Preventive Care Action Plan" for China from the WHO Global Action perspective and the current situation of policy and practice. The list of tasks in China's "Dementia Preventive Care Action Plan" combines China's current dementia prevention and treatment priorities with reality resources, with a view to providing reference for relevant dementia policy decisions and practical responses.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-31 Cooperative journals: 《中国全科医学》
Abstract： Objective Through constructing the diagnostic terminology and coding set of General Practice(GP) in community health care service, the standardization of community general practice diagnosis could be promoted. Methods This study constructs a set of diagnostic terms and codes of GP based on ICD-10 by using literature research, field research, expert consultation and other research methods, combined with the spectrum of common health problems and diseases in the community, And the diagnostic terms and codes of GP have been piloted in 259 community health service centers in two administrative districts of Shenzhen from September 2021 to February 2022. By extracting and sorting out the diagnostic data of the community health service information system and issuing questionnaires to community general practitioners, the implementation of the pilot was analyzed. Results A set of general practice diagnostic terms and codes was compiled, including 41 general practice diagnostic categories, and 6,629 standardized general practice diagnostic terms and codes. The pilot results of the two districts in Shenzhen indicate that the amount of standardized diagnostic names in the standardized intervention areas is 86.13%-95.38% higher than that in the non-pilot areas.The number of diagnostic names involved in this period in the pilot area decreased by 96.60% year-on-year. Standardized intervention focuses on common diagnoses in general practice, and is basically consistent with the disease spectrum in the community, with a high degree of collection of common disease diagnoses in the community.87.3% (227/260) of the respondents believed that the code set can promote the standardization of community diagnosis, and 77.3% (201/260) of the respondents supported the online application of the code set. Conclusion The research preliminarily established standardized general practice diagnostic terms and codes, and formed a community general practice diagnostic term dictionary to solve the problem of multiple meanings in data analysis, while taking into account upper and lower referrals and medical insurance docking. It has effectively improved the efficiency and standardization of community diagnosis and treatment, and played a positive role in promoting the development of grass-roots health services.
Subjects: Psychology >> Social Psychology submitted time 2022-10-30
Abstract：
Intertemporal choice is an important and ubiquitous concept that refers to decisions involving tradeoffs among outcomes at different points of time. It is not only a unique feature of human behavior but also relevant to policymaking and national welfare. Dimension-based models, such as tradeoff model, equate-to-differentiate theory, and similarity model, assume that individuals tend to compare the difference between dimensions of delay and outcome before deciding on a single dimension when choosing between a smaller-sooner option and a larger-later one. Considerable empirical evidence from behavioral and process data supports the use of dimension-based models. The existing dimension-based models provide qualitative explanations for an individual’s intertemporal choice and focus on “which dimension is the greater difference dimension”, but ignore the preference of dimension-based difference (i.e., “how much different of the difference between the two dimensions”). In the present study, we used eye-tracking technology to examine the relationship between the preference of dimension-based difference, which is estimated by the tradeoff model, and the information searching process, which is reflected by eye-tracking measures.
Two experiments were conducted to test the hypotheses. A total of 75 college students (61 females; mean age = 20.9 ± 2.4 years) participated in Experiment 1. Participants were told to complete two tasks. In the intertemporal choice task, participants chose their preferred option between the two intertemporal options, and their eye movements were recorded in the task. In the analogue scale task, participants were asked to indicate their subjective dimension-based difference judgment by using numbers 1~7. In Experiment 2, we recruited 59 college students (33 females; mean age = 21.9 ± 2.1 years) to participate in the experiment. The tasks and procedures were similar to Experiment 1 except that the participants were asked to repeat the intertemporal choice task twice.
The results indicated that preference of dimension-based difference (PDD), which is estimated by the tradeoff model, correlated with the subjective dimension-based difference judgment measured by the analogue scale task (Experiment 1) and could negatively predict the choice reversals (Experiment 2). These findings proved the validity of the estimation of PDD. The results in the two experiments consistently revealed that decision time, gaze transition entropy (a measure of visual scanning efficiency), and stationary gaze entropy (a measure of the level of even distribution across different areas of interest) could negatively predict the PDD, indicating that the information searching process during intertemporal choice could reflect the preference of dimension-based difference. We also found that the outcome gaze proportion (a measure of attention allocation) could predict the dimension-based difference judgment, which is consistent with previous research.
Our findings proved the validity of the estimation method of PDD, which could quantitatively estimate the PDD when making an intertemporal choice based on their choices without extra inquiry. The current research highlighted the correlation between the preference of dimension-based difference and the information searching process, providing further process evidence for dimension-based intertemporal models. Future studies that focus on developing intertemporal models involving eye movements should consider replicating the pattern between PDD and eye-tracking measures as revealed in the present study when running data simulations. Our findings also suggest that compared to the determinant models, the probabilistic models can better describe an individual’s intertemporal choice, thereby highlighting the direction of the development of intertemporal models.
Peer Review Status:
Awaiting Review
Subjects: Information Science and Systems Science >> Methodology of System Engineering Subjects: Mathematics >> Applied Mathematics submitted time 2022-10-30
Abstract： Multifactor impact analysis is an important part of economic quantitative analysis, and there are many methods. Among them, structural decomposition analysis (SDA) is widely used in the application of input-output techniques. In this paper, the defects of SDA are explained in depth, and the new multifactor and multi-order impact analysis (MMIA) technique is fully described. Firstly, the basic concepts of multifactor impact analysis and multifactor-multi-order impact analysis are defined. Secondly, the relationship between multifactor- multi-order impact analysis and Taylor series is clarified. Thirdly, the concepts and techniques of forward analysis and reverse analysis are proposed. Finally, several applications of MMIA under the input-output techniques framework are briefly described.
Peer Review Status:Awaiting Review
Subjects: Medicine, Pharmacy >> Preclinical Medicine submitted time 2022-10-28 Cooperative journals: 《中国全科医学》
Abstract： Background Global population epidemiology research shows that by 2019, the number of hypertensive patients worldwide has reached 1.28 billion, and there are about 59.7 million patients with atrial fibrillation (AF). Hypertension greatly increases the risk of atrial fibrillation, especially the incidence of atrial fibrillation in elderly hypertensive patients will be higher than 60%. At the same time, atrial fibrillation increases the risk of ischemic stroke, heart failure, myocardial infarction, chronic kidney disease and dementia. For a large hypertensive population, whether atrial fibrillation increases the risk of new myocardial infarction is still less studied, and whether the risk interacts with age is still unclear. Objective To investigate whether atrial fibrillation (AF) increases the risk of new-onset myocardial infarction(MI) in hypertensive patients. Methods A prospective cohort study was conducted to select 47101 hypertensive patients from the health examination population of employees of Kailuan Group in Tangshan City, Hebei Province from June 2006 to October 2007. Excluding 860 patients with missing ECG data, 773 patients with atrial fibrillation during follow-up, 2443 patients with previous cardiovascular and cerebrovascular history and 192 patients with malignant tumors, At last 42833 patients were included in the research. According to whether they suffered from AF, they were divided into AF group and non AF group, including 270 patients with AF and 42563 patients with non AF. Follow-up survey was conducted annually, and the end point was new-onset MI. The last follow-up date was December 31, 2019, with a median follow-up of 13.01 years. Among them, 15 new-onset MI occurred in AF group and 1119 MI occurred in non AF group. To statistically analyze whether the incidence of AF in hypertensive population has an impact on the risk of new-onset MI. Results (1) 42833 people were brought into the research, and were divided into AF group and non AF group according to whether they suffered from AF. among them, 270 patients with AF were 67.24±10.60 years old, and 241 were male (89.26%); 42563 non AF patients (55.57±11.59 years old, male 36132 (84.89%). The patients were followed up once a year with a median follow-up of 13.01 years; There were significant differences in age, Triglycerides (TG), Diastolic blood pressure (DBP),Low density lipoprotein cholesterol (LDL-C) ,Total cholesterol (TC) and glomerular filtration rate (eGFR) between AF group and non AF group (P < 0.05); There was no significant difference in male, Fasting blood glucose (FPG), Systolic blood pressure (SBP),Body mass index (BMI),High-density lipoprotein cholesterol (HDL-C), smoking, drinking and history of diabetes between AF group and non AF group (P≥0.05); (2) The quantity and proportion of new-onset MI in AF group and non AF group were 15 (5.56%) and 1119 (2.63%) respectively. The quantity of follow-up person years in the two groups were 2737.20 person years and 547156.40 person years, respectively. The cumulative incidence rate was 7.06% and 2.60%, respectively. The difference was statistically significant (x2 = 15.48, P < 0.01). The incidence density was 54.80‱ and 20.50‱ ; In the population aged≤60 years, the number and proportion of new-onset MI in AF group and non AF group were 6 (8.21%) and 612 (2.07%) respectively. The number of follow-up person years were 890.82 person years and 393762.61 person years, respectively. The cumulative incidence rate was 9.30% and 2.31%, respectively. The difference was statistically significant (x2 = 15.43, P < 0.01), and the incidence density was 67.35‱ and 15.54‱; In the population aged > 60 years, the number and proportion of new-onset MI in the AF group and the non AF group were 9 (4.57%) and 507 (3.86%) respectively. The number of follow-up person years was 1846.38 person years and 155393.79 person years, respectively. The cumulative incidence rate was 7.08% and 4.62%, respectively. The difference was not statistically significant (x2 = 1.20, P = 0.28). The incidence density was 48.74‱ and 33.05‱ ; (3) According to multivariate Cox proportional hazards regression analysis, after further adjusting for age, male, TC, BMI,history of diabetes, TG,drinking liquor history,tobacco consumption history and other factors, it is concluded that AF in hypertensive population is a risk factor for new-onset MI, and its HR value is 2.89 (95% CI: 1.74 ~ 4.82), and the relevant risk still exists (P < 0.01). Because of the interaction between age and AF, the multivariate Cox proportional hazards regression analysis in different age groups shows that for the population aged≤60 years, after further adjusting for gender (male), BMI, TC, TG, history of diabetes, drinking liquor history, tobacco consumption history and other factors, it is concluded that AF is a risk factor for new-onset MI in the hypertensive population, and its HR value is 4.72 (95% CI: 2.11 ~ 10.56), and the relevant risk is obvious (P < 0.01); For the population aged > 60 years, after further adjusting the factors such as gender (male), BMI, TC, TG, history of diabetes, drinking liquor history, tobacco consumption history, etc., it is concluded that AF is a risk factor for new-onset MI in the hypertensive population, and its HR value is 1.65 (95% CI: 0.85-3.20). The relevant risk still exists, but the difference is not statistically significant (P = 0.14); Conclusion AF is a risk factor for new-onset MI in hypertensive population, especially in hypertensive population≤60 years old, AF is an independent risk factor for new-onset MI.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-28 Cooperative journals: 《中国全科医学》
Abstract： Background Esophageal and gastric variceal bleeding (EGVB) is one of the most common and dangerous complications of liver cirrhosis. However, whether EGVB affect the mortality of patients with cirrhosis during 1 year remains unclear. Objective To illustrate the influence factors of EGVB on the death of patients with liver cirrhosis within 1 year and further provide guidance for follow-up. Methods The clinical data of cirrhotic patients admitted to the Affiliated Changsha Central Hospital were collected from January 2015 to May 2021. Patients with liver cirrhosis were divided into two parts: EGVB group and control group without bleeding. Logistic Regression Analysis was conducted for screening factors affecting the death of patients during 1 year. Furthermore, the covariates of equilibrium between the two group were balanced by 1:2 Propensity Score Matching (PSM). Then, Univariate and Multivariate Logistic Regression were applied to identify the risk factors of death. Results Among 812 patients with cirrhosis included, 158 (19.5%) cases were diagnosed with EGVB, and other 654 (80.5%) cases had no EGVB. The 1-year mortality of EGVB and control group was 13.3% and 13.9%. There was no difference in 1-year mortality between the two groups. Before matching, Logistic regression analysis showed that serum sodium level [OR=0.95, 95%CI(0.90-0.99)] and Albumin level [OR=0.95, 95%CI(0.91-0.99)] were associated with decreased risk of 1-year death (P<0.05), while age [OR=1.04, 95%CI(1.02-1.06)] and hepatic encephalopathy (grade III-IV) [OR=3.72，95%CI(1.21-11.37)]were associated with increased risk (P<0.05). After matching, there was 145 cases in EGVB group and 290 cases in control group, and that 1-year mortality of both groups was 12.4%. Logistic regression analysis revealed that blood urea nitrogen (BUN) [OR=1.15, 95%CI(1.02-1.29)] was an independent risk factor for death during 1 year in EGVB group, while age [OR=1.09, 95%CI(1.04-1.14)] and neutrophil count/lymphocyte count (NLR) [OR=1.09，95%CI(1.00-1.18)] acted as the independent risk factor in control group without bleeding. Conclusion Whether EGVB happens or not has no obvious effect on the 1-year mortality of cirrhosis patients. However, there were considerable discrepancies of risk factors affecting the 1-year death between the two groups, which provides a new reference for clinical follow-up and treatment of patients with liver cirrhosis.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-28 Cooperative journals: 《中国全科医学》
Abstract： Background: Acute pancreatitis (AP) is a common acute abdominal disease with considerable morbidity and mortality. Early and accurate identification of AP is of great significance for the prevention and treatment of AP and prognosis evaluation. Studies have shown that obesity affect the incidence and clinical outcome of AP. However, there is a lack of obesity-related quantitative body fat indicators for the diagnosis and evaluation of AP. Objective: To investigate the relationship between abdominal fat content and Acute Pancreatitis (AP) and its severity, and provide scientific basis for the prevention and treatment of AP. Methods: 100 patients with AP and 100 patients with non-AP acute abdomen by computed tomography (CT) in general surgery department of our hospital were collected. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) areas were measured at the level of lumbar 2 and 3. The differences of SAT, VAT, Total Adipose Tissue (TAT), VAT/SAT and VAT/TAT between AP group and non-AP group as well as between different severity groups were statistically analyzed, and multivariate logistic regression analysis was conducted. The diagnostic value and efficiency of the above indicators were evaluated by Receiver Operating Characteristic (ROC) curve. Results: There were significant differences in VAT, TAT, VAT/SAT and VAT/TAT between AP group and non-AP group as well as between severe AP group and non-severe AP group (P<0.05), but there was no significant difference in SAT (P>0.05). Multivariate logistic analysis showed that VAT (OR=1.126, 95%CI=1.088-1.165, P=0.000) and TAT (OR=1.028, 95%CI=1.019-1.038, P=0.000) were independent risk factors for AP. TAT (OR=1.074, 95%CI=1.038-1.111, P=0.000) was an independent risk factor for severe AP. ROC curve indicated that VAT and TAT had high sensitivity and specificity, and had high diagnostic efficiency for AP and severe AP. Conclusion：There was significant relationship between the content and distribution of abdominal fat and AP and its severity. CT quantitative examination of abdominal fat content and distribution can provide important reference information for diagnosis, prediction of AP and severe AP, and can be considered into the evaluation system for diagnosis, evaluation of AP and severe AP in the future, providing scientific basis for the prevention, diagnosis and treatment of AP.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-28 Cooperative journals: 《中国全科医学》
Abstract： Background China is the country with the largest number of diabetics in the world. Insulin resistance has formed the main pathogenesis of type 2 diabetes mellitus, and studies have shown that the triglyceride and Glucose Index (TyG) and its derivative index may have a certain correlation with the development of type 2 diabetes, but the existing studies are mostly cross-sectional studies or longitudinal studies alone, and there are fewer related studies in northeast China. Objective To explore the relationship between TyG and its derivative index triglyceride-glucose-body mass index (TyG-BMI) and type 2 diabetes mellitus, and to compare the predictive power of TyG and TyG-BMI, to provide a scientific basis for early screening of people at high risk of type 2 diabetes. Methods Using a nested case-control study method, 209 patients with new-onset type 2 diabetes mellitus were enrolled in the follow-up period from January 2018 to April 2021; Among those who did not have new type 2 diabetes, endocrine system diseases and malignant tumors during the same period of follow-up, a tendency score was matched according to the same sex, age ±2 years old, and 418 cases were selected as the control group, and a total of 627 people were finally included in the nested case control study. Collect baseline data, including epidemiological information, physical examination information, biochemical testing information, TyG, TyG-BMI. The relationship between TyG, TyG-BMI and type 2 diabetes mellitus was studied using cox-fitted conditional logistic regression model. The dose-response relationship between different levels of TyG and TyG-BMI and type 2 diabetes was analyzed by restrictive cubic spline regression model. The diagnostic value of TyG and TyG-BMI for type 2 diabetes was analyzed by the Receiver Operating Characteristic Curve (ROC). Results Compared with the control group, the BMI, AC, SBP, DBP, FPG, TG, TC, LDL-C, TyG, TyG-BMI of the new case group were higher than those of the control group, and the HDL-C was lower than that of the control group (P<0.05）. Taking the Q1 reference group, the risk of type 2 diabetes in the Q4 group with TyG and TyG-BMI was 3.18 (95% CI: 1.76-5.75) times and 5.34 (95% CI: 2.39-11.95) times, respectively, in the Q1 group. The correlation between the continuous changes of TyG and TyG-BMI and type 2 diabetes mellitus showed a linear dose-response relationship (nonlinear test, P>0.05), and the dose-response relationship showed an increasing shape, and the risk of developing type 2 diabetes gradually increased when TyG and TyG-BMI were higher than 8.838 and 229.364. The area under the Curve (AUC) of TyG and TyG-BMI was 0.696 (95% CI: 0.658-0.732) and 0.725 (95% CI: 0.688-0.760), respectively. The best cut points for TyG and TyG-BMI to predict type 2 diabetes were 8.650 and 224.859, respectively. Conclusions The high levels of TyG and TyG-BMI are independent risk factors for type 2 diabetes mellitus, and they have a linear dose-response relationship with type 2 diabetes mellitus, and both have predictive value for type 2 diabetes. TYG-BMI may be a better predictor if the risk-related intensity, AUC, and clinical impact of screening results are taken into account.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-28 Cooperative journals: 《中国全科医学》
Abstract： Objective Cognitive interview was used to adjust the items of the help seeking Motivation Scale for schizophrenic patients. Methods A purposive sampling method was used to select 30 patients who attended a tertiary care psychiatric hospital in Daqing City from December 2021 to January 2022 as interviewees, and three rounds of cognitive interviews were conducted. Two researchers independently coded the interview data using the QAS-99 Question Assessment System, and after the coding results were collated, the scale entries were adjusted by integrating respondent feedback and expert panel comments. Results The results of the 1st round of interviews showed that 10 entries had vague and unclear sentences, which were revised after discussion. The results of the 2nd round of interviews showed that 1 entry was assumed to be inappropriate and was revised after discussion. The results of the 3rd round of interviews showed that the respondents were able to understand the entries correctly. Conclusion The cognitive interview effectively solved the problem of understanding differences and measurement errors in the development of the Schizophrenia Help-seeking Motivation Scale, thus improving the accuracy and applicability of the scale.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-28 Cooperative journals: 《中国全科医学》
Abstract： Objective To explore the relationships of different personality traits to postpartum depression. Methods Databases including Web Of Science, PubMed, EBSCOhost, Embase, PsycInfo (Proquest), CNKI, VIP and Wanfang were searched for studies regarding the relationships between personality traits and postpartum depression from inception to June 4, 2021. After literatures quality evaluation, relevant data were extracted. Stata 16.0 was used to meta-analysis. Subgroup analysis and publication bias were performed on the relationship between neuroticism and postpartum depression. Sensitivity analysis of the relationships between different personality traits and PPD was conducted using random effect model and fixed effect model. Results 19 literatures were included in this meta analysis. Meta-analysis showed that the pooled OR values of the relationships of neuroticism, vulnerability, extraversion, openness, avoidant personality and dependent personality to postpartum depression were 1.30 (95%CI: 1.20,1.40), 1.39 (95%CI: 1.10,1.76), 0.86 (95%CI: 0.77,0.97), 0.94 (95%CI: 0.9,0.98), 6.27 (95%CI: 2.55,15.40) and 7.71 (95%CI: 1.62,31.14) respectively. Subgroup analysis showed that the different cut-off points of Edinburgh Postpartum Depression Scale (EPDS) and the different survey time of postpartum depression were the sources of heterogeneity. The pooled results were reliable except for obsessive-compulsive personality disorders. Conclusion Neuroticism and vulnerable personality were risk factors for postpartum depression. Openness and extraversion were protective factors for postpartum depression. Postpartum women with neuroticsm may have more severe postpartum depression and may be more likely to develop postpartum depression after 12 weeks postpartum. Due to the inconsistent results of domestic and foreign research, the correlations of avoidance, dependent and obsessive-compulsive personality with postpartum depression need to be further explored in the future.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-28 Cooperative journals: 《中国全科医学》
Abstract： Early diagnosis of frailty is of great value in helping elderly to regain their health, as it is a non-specific state of reduced physiological reserve, reduced resistance to shock and reduced ability to recover from stress. In recent years, technological advances in histological research have provided new avenues for the discovery of potentially specific, stable and reliable appropriate biomarkers of pre-frailty. After gathering and analyzing relevant studies, this paper reviews advances in research on biomarkers of pre-frailty in blood samples from the perspective of epigenomics, transcriptomics, proteomics and metabolomics, which can assist in assessing the risk of frailty, exploring potential mechanisms of frailty and developing targeted interventions to support healthy aging.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-28 Cooperative journals: 《中国全科医学》
Abstract： As a common arrhythmia in clinic, atrial fibrillation has been proved to be related to serious adverse cardiovascular events (heart failure, severe stroke and myocardial infarction). At present, the number of patients in the world exceeds 33 million, and it is expected that the prevalence rate will increase more than twice in the next 40 years. Over the years, a lot of efforts have been made in exploring the physiological and pathological mechanism of atrial fibrillation and creating and improving its treatment methods. At present, the treatment and management of atrial fibrillation is still a difficult problem in clinical medicine. There is no consensus on the best treatment mode of atrial fibrillation and the choice of ablation energy. In recent years, in view of the close cooperation between cardiac surgeons and electrophysiologists, combined with catheter and minimally invasive surgical ablation, a new strategy for the treatment of atrial fibrillation - hybrid ablation mode was born. The hybrid ablation mode overcomes the disadvantages and adverse outcomes of catheter ablation and minimally invasive surgery, and has achieved considerable results in the treatment of persistent atrial fibrillation, especially long-term persistent atrial fibrillation. This article reviews the pathogenesis, classification and development history of ablation therapy of atrial fibrillation, summarizes and analyzes the current research results of hybrid ablation mode in the treatment of atrial fibrillation, and briefly analyzes and summarizes this new treatment strategy for atrial fibrillation.
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