Community Health Centers In Shanghai Research Articles

Effectiveness of WeChat-group-based parental health education in preventing unintentional injuries among children aged 0–3: randomized controlled trial in Shanghai

BackgroundUnintentional injuries to children are a major public health problem. The online social media is a potential way to implement health education for caregivers in online communities. Using WeChat, a free and popular social media service in China, this study evaluated the effectiveness of social online community-based parental health education in preventing unintentional injuries in children aged 0–3.MethodsWe recruited 365 parents from two community health centers in Shanghai and allocated them into intervention and control groups randomly. Follow-up lasted for one year. The intervention group received and followed their WeChat group and a WeChat official account for dissemination of reliable medical information. The control group received only the WeChat group.ResultsBetween the intervention and control groups, changes in unintentional injuries (OR = 1.71, 95% CI: 1.02–2.87, P = .04), preventability (β = 0.344, 95% CI: 0.152–0.537, P < .001), daily supervision behavior (β = 0.503, 95% CI: 0.036–0.970, P = .04), and behaviors for preventing specific injuries (β = 2.198, 95% CI: 1.530–2.865, P < .001) were significantly different, and change in first-aid skills for treating a tracheal foreign body were nearly significant (P = .06).ConclusionsThe WeChat-group-based parental health education can reduce the occurrence of unintentional child injuries by improving parents’ skills, beliefs, and behaviors. Online social communities promote health education and reduce unintentional injuries among children.Trial registrationChiCTR1900020753. Registered on January 17, 2019.

Effect of an artificial intelligence-assisted tool on non-valvular atrial fibrillation anticoagulation management in primary care: protocol for a cluster randomized controlled trial

BackgroundAtrial fibrillation (AF) is one of the most common cardiac arrhythmia diseases. Thromboembolic prophylaxis plays an essential role in AF therapy, but at present, general practitioners (GPs) are presumed to lack the knowledge and enthusiasm for AF management. Clinical decision support systems (CDSS), assisted by artificial intelligence, help primary care providers (PCPs) make quick, individualized, and correct clinical decisions. This primary aim of the study is to identify whether the promotion of the CDSS would improve the primary care provided to patients with AF. The secondary objectives are mainly to assess the health-economic and clinical benefits from using the CDSS, and the improvement of GPs’ AF management capability.MethodsThis study will be a prospective cluster randomized controlled trial, conducted among 14 community health centers in Shanghai which were randomized as the intervention group and control group in a ratio of 1:1. The intervention group will use the CDSS in the consultation of patients with AF and the control group will maintain their usual care. The trial will include 498 patients with AF and the follow-up period will be 12 months. The primary outcome is set as the proportion of antithrombotic treatment prescriptions in agreement with recommendations in the latest China’s AF-related guidelines. The secondary outcomes are the frequency of consultation, the compliance rate of international normalized ratio (INR) in patients with warfarin, stroke morbidity, treatment compliance, medication satisfaction, and the cost-benefit analysis. Per-protocol (PP) analysis and the intention-to-treat (ITT) analysis will be conducted.DiscussionThis study aims to identify whether the application of CDSS to manage patients with AF in China’s community health centers would bring benefits for patients, physicians, and health economics.Trial registrationRegistry name: 非瓣膜性房颤社区AI辅助管理工具研发及推广效果研究 (Development and promotion of an AI-assisted tool for NVAF management in primary care); registry number: ChiCTR2100052307; registration date: Nov. 22nd, 2021; http://www.chictr.org.cn/showproj.aspx?proj=133849.

Multimorbid Patient Experiences With Primary Care at Community Health Centers in Shanghai, China.

Objective: Primary care in China is facing mounting challenges with multimorbidity as the aging population grows. Knowing how patients experience primary care may highlight the deficiencies of the care system and guide health system reform. The purpose of this study was to compare the quality of primary care experienced by patients with and without multimorbidity at community health centers (CHCs) in Shanghai, China and to examine the factors influencing these experiences.Methods: A cross-sectional survey was conducted from August to December 2019 using the validated Chinese Primary Care Assessment Tool-Adult Edition (PCAT-AE). ANOVA was performed to compare the overall and domain-specific quality of primary care for patients with and without multimorbidity. Multivariate linear regressions were used to assess the factors associated with primary care quality while controlling for patients' sociodemographic and healthcare characteristics.Results: From 2,404 completed questionnaires, patients with multimorbidity reported higher PCAT scores in the domains of first contact-utilization (3.54 ± 0.55 vs. 3.48 ± 0.56, P < 0.01), accessibility (2.93 ± 0.49 vs. 2.86 ± 0.47, P < 0.001), and ongoing care (3.20 ± 0.39 vs. 3.14 ± 0.43, P < 0.001), while reporting lower scores in coordination (information system) (2.72 ± 0.41 vs. 2.79 ± 0.35, P < 0.001) and family-centeredness (3.23 ± 0.63 vs. 3.30 ± 0.64, P < 0.01). Multimorbidity (ß = 0.355, P < 0.01), education level (ß = 0.826, P < 0.01), district (suburb: ß = 1.475, P < 0.001), and self-perceived good health status (ß = 0.337, P < 0.05) were associated with better patient experiences in primary care. Patients between the age 61 and 70 (ß = −0.623, P < 0.001; >70 years: ß = −0.573, P < 0.01), with a monthly household income ≥6,000 RMB (ß = −1.385, P < 0.001) and with more than 20 outpatient visits the previous year (ß = −1.883, P < 0.001) reported lower total PCAT scores.Conclusion: The findings of our study suggest that CHCs in China have contributed to better primary care experiences for patients with multimorbidity in certain quality domains, including first contact-utilization, accessibility, and ongoing care. However, there is still room for improvement in care coordination and family-centeredness.

Proinflammatory cytokines predict the incidence of diabetic peripheral neuropathy over 5 years in Chinese type 2 diabetes patients: A prospective cohort study

BackgroundInflammation has been implicated in the pathogenesis of diabetic peripheral neuropathy (DPN) as suggested in various cross-sectional studies. However, more convincing prospective studies in diabetes patients are scarce. Therefore, we aimed to evaluate whether proinflammatory cytokines could predict the incidence of DPN through a prospective study with a five-year follow-up.MethodsWe followed up 315 patients with diabetes who did not have DPN, recruited from five community health centers in Shanghai in 2014, for an average of 5.06 years. Based on the integrity of blood samples, 106 patients were selected to obtain the proinflammatory cytokines. Plasma markers of proinflammatory cytokines at baseline included interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), and intercellular adhesion molecule 1 (ICAM-1). Neuropathy was assessed by MSNI at baseline and during follow-up.FindingsAmong the 106 chosen patients, 63 developed DPN after 5.06±1.14 years of follow-up. The baseline plasma levels of TNF-α, IL-6, and ICAM-1 were higher in the neuropathic group (p<0.05). In multivariate models, increased plasma levels of TNF-α (hazard ratio, HR: 8.74 [95% confidence interval, CI: 1.05–72.68]; p <0.05) and ICAM-1 (HR 23.74 [95% CI:1.47–383.81]; p<0.05) were both associated with incident DPN, after adjusting for known DPN risk factors.InterpretationIncreased plasma levels of proinflammatory factors, especially TNF-α and ICAM-1, predicted the incidence of DPN over 5 years in Chinese diabetes patients, but larger longitudinal studies are required for confirmation.FundingNational Natural Science Foundation of China, Shanghai Talent Development Fund Program, Shanghai Shenkang Hospital Developing Center Clinical Scientific and Technological Innovation Program, Shanghai Science and Technology Committee Program, Shanghai General Hospital Program of Chinese traditional and Western medicine combination and Shanghai Municipal Commission of Health and Family Planning Clinical Research Project.

Proinflammatory Cytokines Predict the Incidence of Diabetic Peripheral Neuropathy Over 5 Years in Chinese Type 2 Diabetes Patients: A Prospective Cohort Study

Aims: Inflammation has been implicated in the pathogenesis of diabetic peripheral neuropathy (DPN) as suggested in various cross-sectional studies. However, more convincing prospective studies in diabetes patients are scarce. Therefore, we aimed to evaluate whether proinflammatory cytokines could predict the incidence of DPN through a prospective study with a five-year follow-up. Methods: We followed up 315 patients with diabetes who did not have DPN, recruited from five community health centers in Shanghai in 2014, for an average of 5.06 years. Based on the integrity of blood samples, 106 patients were selected to obtain the proinflammatory cytokines. Plasma markers of proinflammatory cytokines at baseline included interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), and intercellular adhesion molecule 1 (ICAM-1). Neuropathy was assessed by MSNI at baseline and during follow-up. Results: Among the 106 randomly chosen patients, 63 developed DPN after 5.06±1.14 years of follow-up. The baseline plasma levels of TNF-α, IL-6, and ICAM-1 were higher in the neuropathic group (P<0.05). In multivariate models, increased plasma levels of TNF-α (hazard ratio, HR: 8.74 [95% confidence interval, CI: 1.05-72.68]; p <0.05) and ICAM-1 (HR 23.74 [95% CI 1.47-383.81]; p <0.05) were both associated with incident DPN, after adjusting for known DPN risk factors. Conclusions: Increased plasma levels of proinflammatory factors, especially TNF-α and ICAM-1, predicted the incidence of DPN over 5 years in Chinese diabetes patients, but larger longitudinal studies are required for confirmation. Funding Statement: The present study was supported by grants from the National Natural Science Foundation of China (81770807, to B Lu and 81800692, to LJ Ji), Shanghai Talent Development Fund Program (2018054, to B Lu), Shanghai Shenkang Hospital Developing Center Clinical Scientific and Technological Innovation Program (SHDC12016210, to B Lu), Shanghai Science and Technology Committee Program (17411961500, to S Zhang), Shanghai General Hospital Program of Chinese traditional and Western medicine combination (ZY(2018-2020)-FWTX-1002, to YM Li) and Shanghai Municipal Commission of Health and Family Planning Clinical Research Project (20184Y0318, to LJ Ji). Declaration of Interests: The authors declare that there is no conflict of interest. Ethics Approval Statement: The study was approved by the Human Investigation Ethics Committee of Huashan Hospital.

Detection rate and treatment gap for atrial fibrillation identified through screening in community health centers in China (AF-CATCH): A prospective multicenter study.

Atrial fibrillation (AF) is underdiagnosed and especially undertreated in China. We aimed to investigate the prevalence of unknown and untreated AF in community residents (≥65 years old) and to determine whether an education intervention could improve oral anticoagulant (OAC) prescription. We performed a single-time point screening for AF with a handheld single-lead electrocardiography (ECG) in Chinese residents (≥65 years old) in 5 community health centers in Shanghai from April to September 2017. Disease education and advice on referral to specialist clinics for OAC treatment were provided to all patients with actionable AF (newly detected or undertreated known AF) at the time of screening, and education was reinforced at 1 month. Follow-up occurred at 12 months. In total, 4,531 participants were screened (response rate 94.7%, mean age 71.6 ± 6.3 years, 44% male). Overall AF prevalence was 4.0% (known AF 3.5% [n = 161], new AF 0.5% [n = 22]). The 183 patients with AF were older (p < 0.001), taller (p = 0.02), and more likely to be male (p = 0.01), and they had a higher prevalence of cardiovascular disease than those without AF (p < 0.001). In total, 85% (155/183) of patients were recommended for OAC treatment by the established guidelines (CHA2DS2-VASc ≥ 2 for men; ≥ 3 for women). OAC prescription rate for known AF was 20% (28/138), and actionable AF constituted 2.8% of all those screened. At the 12-month follow-up in 103 patients (81% complete), despite disease education and advice on specialist referral, only 17 attended specialist clinics, and 4 were prescribed OAC. Of those not attending specialist clinics, 71 chose instead to attend community health centers or secondary hospital clinics, with none prescribed OAC, and 15 had no review. Of the 17 patients with new AF and a class 1 recommendation for OAC, only 3 attended a specialist clinic, and none were prescribed OAC. Of the 28 AF patients taking OAC at baseline, OAC was no longer taken in 4. Ischemic stroke (n = 2) or death (n = 3) occurred in 5/126 (4%), with none receiving OAC. As screening was performed at a single time point, some paroxysmal AF cases may have been missed; thus, the rate of new AF may be underestimated. We demonstrated a noticeable gap in AF detection and treatment in community-based elderly Chinese: actionable AF constituted a high proportion of those screened. Disease education and advice on specialist referral are insufficient to close the gap. Before more frequent or intensive screening for unknown AF could be recommended in China, greater efforts must be made to increase appropriate OAC therapy in known AF to prevent AF-related stroke.

Prevalence and contributing factors of osteoporosis in the elderly over 70 years old: an epidemiological study of several community health centers in Shanghai.

OP seriously affects the health status and quality of life of the elderly, even endangers life. This study aimed to investigate the prevalence and contributing factors of osteoporosis (OP) in the elderly over 70 years old of several Community Health Centers in Shanghai. A total of 565 elderly subjects were recruited and received questionnaire survey. The general characteristics, medical history and history of OP treatment were collected. Bone mineral density (BMD) was detected, and the awareness rate, prevalence and treatment rate were determined in all of the subjects. Moreover, activity of daily living and nutritional status were also evaluated. Logistic regression analysis was performed to calculate the OR and its 95% confidence interval. Bone turnover markers (BTMs) [procollagen type 1 N-peptide (P1NP), C-terminal cross-linked telopeptides of type 1 collagen (β-CTX), molecular fragment of N-terminal osteocalcin (N-MID), and 25 hydroxyvitamin D (25OHD)] were detected and their relationship with OP was further evaluated with Pearson correlation analysis. : (I) The awareness rate of OP was 89.7%, the prevalence was 39.5%, and the treatment rate was 59.5% in the elderly over 70 years old of 4 Community Health Center in Shanghai; (II) the male gender and good nutritional status were independent protective factors of OP, and aging and poor activity of daily living were independent risk factors of OP; (III) β-CTX was negatively related to BMD (r=-0.286, P=0.000), but P1NP, N-MID, and 25OHD were positively related to BMD (r=0.254, 0.349 and 0.357, P=0.000, 0.000 and 0.000). Female gender, aging, malnutrition, and inability to take care of themselves are risk factors of OP in people over 70 years old of 4 Community Health Centers in Shanghai. Some BTMs are related to the BMD. BTMs together with BMD may be used to comprehensively evaluate the bone state, identify the old people with OP at early stage, and guide the clinical treatment and early monitoring of OP.

Standardization-based research on fiscal compensation measurement for communities in Shanghai

Objective To determine the standardized workload first of all. Then based on such workload, to establish the government′s resource input and allocation mechanism, and build the post setup, a fiscal compensation system, and the salary distribution mechanism of community medical staff. Methods This study selected 65 community health centers in Shanghai′s downtown area, suburban area and outer suburbs as sample units to investigate with questionnaires such indicators as community medical and health expenditure, standardized workload among others.With the measured workload as basis, item costs of health services at Shanghai′s communities were calculated. Results That of downtown, suburban and suburban areas accounted for 71.60%, 72.13% and 73.14% respectively of the total expenditure on health care.The unit cost of standardized workload varies with areas, while that in suburban and suburban areas was significantly higher than that downtown.The actual fiscal compensation was 20% lower than the target compensation as designed in the reform. Conclusions The ideal investment of basic public health services based on standardized workload can effectively realize the equalization of services among areas and promote effective allocation of resources.At the same time, estimates of the total standardized workload from the perspective of the demand side, and determination of an ideal investment ceiling for the investment of areas′ services budgets, can effectively minimize the waste of resources. Key words: Community health; Cost accounting; Standardized workload; Fiscal input; Shanghai

Prevalence and risk factors for chronic kidney disease among patients with type 2 diabetes mellitus managed in community health centers in Shanghai

Objective To estimate the prevalence of chronic kidney disease and to identify influencing factors among patients enrolled in diabetes management by the community health centers in Shanghai. Methods A questionnaire survey and physical examination were conducted in patients with type 2 diabetes through a random sampling method. Eligible date of 1 618 subjects were enrolled in the study. Estimated glomerular filtration rate was calculated according to equation of the Modification of Diet in Renal Disease Study for serum creatinine. Logistic regression was performed to examine the association between risk factors and chronic kidney disease. Results The prevalence of chronic kidney disease was 43.4%, of which 16.1% were in Stage 1, 14.8% in Stage 2, 11.6% in Stage 3, and 1.0% in Stage 4/5 in the total of 1 618 patients, but only 3.6% of the patients as defined in this study were aware of their condition. A higher prevalence of chronic kidney disease in females than that in males(47.3% vs 37.8%). The prevalence of chronic kidney disease increased with age (χtend2=38.663, P<0.01). Female gender, older age, lower education, lower monthly income per capital, long duration of diabetes, uncontrolled glycosylated hemoglobin, uncontrolled systolic blood pressure, and uncontrolled triglycerides, were influencing factors of chronic kidney disease. Conclusion The patients under diabetes management in community health centers had higher prevalence of chronic kidney disease with lower awareness. Patients with type 2 diabetes should be encouraged to control blood glucose, blood pressure and blood lipids, to reduce the risk for chronic kidney disease. (Chin J Endocrinol Metab, 2018, 34: 485-489) Key words: Chronic kidney disease; Diabetes mellitus, type 2; Prevalence; Risk factors

The Implementation and First-Round Results of a Community-Based Colorectal Cancer Screening Program in Shanghai, China.

The incidence and mortality rate of colorectal cancer (CRC) have increased dramatically over the past 3 decades in China due to changes in lifestyle factors. Early detection and treatment guidelines for asymptomatic cases have shown to improve CRC control in developed countries. In response to these challenges, the Shanghai Municipal Government launched a community-based CRC screening program in 2012. Free initial screening, inclusive of immunochemical fecal occult blood and risk assessment (questionnaire), was provided by community health centers in Shanghai. Participants with positive results were referred to a specialist for a colonoscopy. In 2013, 828,302 Shanghai residents were registered; 97.7% (809,528) of the registrants completed initial screening. Among 180,094 initial screening-positive participants, 71,733 underwent colonoscopy. The proportion of compliance to colonoscopy was 39.8%; the proportion decreased with age and educational level. A total of 6,668 adenomas were detected, and 1,630 CRC cases were diagnosed. The CRC detection rate of the program was 201.35/100,000; among the detected CRCs, 51.6% were in stage 0-I. The screening program achieved great progress, especially on initial screening completion and CRC early stage rate, although particular intervention is still needed to improve the compliance of colonoscopy. Due to socioeconomic transitions and lifestyle changes, colorectal cancer is now becoming one of the most common cancers in developing countries, as it is in developed countries. While most developed countries have now initiated national colorectal cancer screening programs based on recommended country-specific colorectal cancer screening guidelines, colonoscopy has become the most commonly used screening method. This is a challenge in developing countries due to limited resources. Based on the analysis of the Shanghai colorectal cancer screening program, with immunological fecal occult blood test and risk assessment as initial screening, followed by a diagnostic testing of colonoscopy for individuals with positive results, this article provides the basis and suggestion for similar program in other regions of China and other developing countries.

Changes of the perceived quality of care for older patients with hypertension by community health centers in shanghai

BackgroundMonitoring and evaluating changes of quality of primary care for older adult hypertensive patients is part of effective delivery of primary care. This study aimed to investigate changes of older adult hypertensive patients’ perceived quality of primary care over time in Shanghai.MethodsTwo rounds of cross-sectional questionnaire surveys were conducted in Shanghai in November 2011 and June 2013. A total of 437 patients participated in the first Round survey and 443 in the second. Primary care attributes were collected from Community Health Center users through on-site face-to-face interview surveys using the validated Primary Care Assessment Tool. Multiple linear regressions were used to determine whether there was any difference in primary quality of care scores between 2011 and 2013 surveys.ResultsCompared with those in the first Round, participants in the second Round reported higher scores in total primary care quality (28.73 vs. 27.75, P < 0.001), as well as primary care attributes including first-contact utilization (2.81 vs. 2.60, P < 0.001) and accessibility (2.48 vs. 2.44, P < 0.05), continuity of care (3.38 vs. 3.27, P < 0.001), coordination of information (3.82 vs. 3.67, P < 0.001), comprehensiveness of service availability (3.51 vs. 3.39, P < 0.001) and provision (2.69 vs. 2.43, P < 0.001), and cultural competence (2.67 vs. 2.49, P < 0.05), but a lower score in coordination of services (2.45 vs. 2.55, P < 0.05).ConclusionOlder adult hypertensive patients perceived better primary care quality from 2011 to 2013 in Shanghai. This may be associated with the general practitioner team service in Shanghai where hypertensive patients were targeted.

Rationale and Design of the Randomized Controlled Trial of Intensive Versus Usual ECG Screening for Atrial Fibrillation in Elderly Chinese by an Automated ECG System in Community Health Centers in Shanghai (AF-CATCH)

Objective: The randomized controlled trial (ClinicalTrials.gov identifier NCT02990741) will investigate whether more frequent electrocardiographic (ECG) recordings and analyses with an automated ECG system would improve detection of atrial fibrillation compared with a single annual ECG screen in elderly Chinese in community health centers. Design: Men and women (≥65 years) will be randomized into intensive (n=3500) and usual (n=3500) screening groups, and within the intensive screening group into intensive screening (n=2625) and more intensive screening (n=875) subgroups. ECG recordings will be performed with an automated ECG analysis system (AliveCor® heart monitor) at 1 year in the usual screening group, at 3, 6, 9, and 12 months in the intensive screening subgroup, and at 1, 2, 3, and 4 weeks and 3, 6, 9, and 12 months in the more intensive screening subgroup. The primary outcome is the detection rate of atrial fibrillation between the usual screening group and the intensive screening group. Sample size estimation was based on a projected detection rate of atrial fibrillation of 2.0% by a single ECG recording at 12 months, an improvement of 50% with more frequent ECG recordings, a=0.05, power of 80%, and a one-sided test. Conclusions: The trial will provide evidence on the clinical effectiveness of more frequent ECG recordings by a handheld automated analysis system in the detection of atrial fibrillation.

Effect of Short Message Service on Infant Feeding Practice

Appropriate infant feeding practices have the potential for long-term health effects. However, research findings on improving early infant feeding practices are limited. The wide use of mobile phone short message service (SMS) provides new opportunities for health promotion and services. To assess the effect of an SMS intervention on infant feeding practices. Quasiexperimental design with follow-up measures scheduled at 4, 6, and 12 months at 4 community health centers in Shanghai, China. Two community health centers represented the intervention group, and 2 other community health centers represented the control group. In total, 582 expectant mothers were recruited during the first trimester. Expectant mothers were eligible to participate if they owned a mobile phone, were first-time mothers, conceived a singleton fetus, were older than 20 years and less than 13 weeks' gestation, had completed at least a compulsory junior high school education, and had no illness that limited breastfeeding after childbirth. Mothers in the intervention group received weekly SMS messages about infant feeding from the third trimester to 12 months' post partum. The primary outcome was the duration of exclusive breastfeeding (EBF). Survival analysis was used to compare the duration of EBF between the intervention group and the control group. Compared with the control group, the intervention group had a significantly longer median duration of EBF at 6 months (11.41 [95% CI, 10.25-12.57] vs 8.87 [95% CI, 7.84-9.89] weeks). The hazard ratio for stopping EBF in the intervention group was 0.80 (95% CI, 0.66-0.97). The intervention resulted in a significantly higher rate of EBF at 6 months (adjusted odds ratio, 2.67 [95% CI, 1.45-4.91]) and a significantly lower rate of the introduction of solid foods before 4 months (adjusted odds ratio, 0.27 [95% CI, 0.08-0.94]). An SMS intervention may be effective in promoting EBF, delaying the introduction of solid foods, increasing awareness of the World Health Organization breastfeeding guidelines, and improving knowledge of appropriate infant feeding practices for new mothers.

Investigative analysis of the workload of family beds run by community health centers in Shanghai

Objective To probe into the present family bed workloads at community health centers in Shanghai,for bettering the service mode.Methods 41 community health centers in 17 districts or counties in Shanghai were randomly sampled with questionnaires,to learn the profile of the family beds and analyze the workloads provided by the institutions from 2010 to 2012.Results For the 41 institutions surveyed,patients aged 60 or above accounted for 95.07％ of the total patients,of whom the seniors over age 80 accounted for 51.00％; 3-year family bed setup rate is 4.45‰,5.09‰ and 5.51‰ respectively;the family bed checkup interval is 6.26 days,6.08 days and 5.84 days respectively.The average monthly payment from medical insurance per person is 441.86 yuan in 2010,433.41 in 2011,and 401.26 in 2012.Diseases makeup:Cardiovascular diseases accounting for 51.16 ％of the total,stroke patients for 31.02 ％,chronic bronchitis for 4.81％,and cancer patients for 1.10％.Among those patients withdrawn from family beds,86.54％ were cured,steady plus improvements.Conclusion Further improvement of the family bed service for better elderly chronic care management; preferential policies to further enhance the family bed service capabilities; emphasis of internal management to continuously improve the social benefits. Key words: Shanghai; Community health centers; Family bed workload

Efficiency of community health service in urban and suburban areas of Shanghai: based on production function

Objective To analyze the efficiency of community health service in urban and suburban areas of Shanghai. Methods Fifty community health centers in Shanghai that registered to create “National Demonstration Community Health Center” in 2013 were included in our study. The service efficiency was analyzed with the methods of econometrics based on Cobb-Douglas production function. Results Two production functions were formulated for urban community health services and those in suburban areas; the equation for urban areas was: lnY=7.778+0.450lnL+0.350lnK+μ; and the equation for suburban areas was: lnY=6.329+0.728lnL+0.350lnK+μ. The results showed that among the inputs, labor had more effect on output than capital did. It also showed that marginal benefit of labor was different in urban and suburban areas. Urban community health centers were in the interval of decreasing returns to scale, while suburban community health centers were in the interval of constant returns to scale. Conclusion Increasing human resource investment is a key factor for increasing community health service output. Due to the difference of scale merit between urban and rural areas, government or other policy makers should make the development policy for them accordingly. Those community health centers in urban areas should pay more attention to the service efficiency and service innovation.

Effects of Ginkgo biloba extract in improving episodic memory of patients with mild cognitive impairment: a randomized controlled trial

Mild cognitive impairment is a transitional stage between normal aging and dementia. It is important in terms of recognizing memory loss in older people as well as identifying a group of individuals at high risk of developing dementia and who may benefit from preventive strategies. Ginkgo biloba extract has been shown to possess polyvalent properties, such as anti-oxidation, anti-apoptosis and anti-inflammation. Ginkgo biloba extract appears to have a neuroprotective effect against neurodegenerative diseases. To observe the efficacy of Ginkgo biloba leaf tablet in improving episodic memory of mild cognitive impairment. This is a multicenter, randomized, controlled trial. The authors enrolled generally healthy, ambulatory or ambulatory-aided amnestic subjects with MCI, 60 to 85 years old, who expressed a memory complaint from Huadong Hospital, seven Community Health Centers in Shanghai, and Shanghai First Welfare Institution. A total of 120 MCI patients were randomly assigned to the Ginkgo biloba leaf tablet group (treatment group, 60 cases) and control group (60 cases). The patients in the treatment group took Ginkgo biloba leaf tablets 3 times a day, 19.2 mg each dose. The control group did not receive any intelligence-promoting or vasodilator reflex treatment except some health care. The patients were tested with nonsense picture recognition of the clinical memory scale and the logical memory test based on the Wechsler memory scale before and after treatment. After 6 months of treatment, the scores of the logical memory test and nonsense picture recognition were increased significantly in the treatment group (P<0.01, P<0.05), while the scores of the two tests from the control group had no statistically significant difference (P>0.05). After treatment, the positive rate of nonsense picture recognition was 55.17% in the treatment group, which was significantly higher than that of the control group at 32.73% (P<0.05). The efficacy rate of logical memory was 58.62% in the treatment group, also higher than 38.18% in the control group (P<0.05). Ginkgo biloba leaf tablet showed good efficacy in promoting episodic memory function in MCI patients.

Awareness, Intention, and Needs Regarding Breastfeeding: Findings from First-Time Mothers in Shanghai, China

Despite efforts, a decline in breastfeeding rates has been documented in China recently. This study explored the awareness of the World Health Organization (WHO) guidelines for breastfeeding and intention to breastfeed among first-time mothers and identified the gap between mothers' needs and perinatal care provision regarding breastfeeding promotion. In total, 653 women at 5-22 gestational weeks were recruited from four community health centers in Shanghai, China. They completed a self-administered questionnaire at recruitment. Two focus group discussions were held among third-trimester pregnant women who had received prenatal education. Twenty-four in-depth interviews were conducted among postpartum mothers. During early pregnancy, a substantial proportion of mothers were not aware of the nutritional value of breastmilk (40%) or the value of exclusive breastfeeding for 6 months (80%) or any breastfeeding for 24 months (98%). The awareness of the WHO guidelines for breastfeeding was associated with intention to breastfeed (adjusted odds ratio [OR] 2.67, 95% confidence interval [CI] 1.88, 3.78) or intention to breastfeed exclusively (adjusted OR 3.31, 95% CI 1.81, 6.06). In late pregnancy and postpartum, most mothers were still not fully aware of the breastfeeding recommendations and nutritional value of breastmilk. Limited communications with healthcare providers and lack of support for dealing with breastfeeding difficulties were reported. Low awareness of the WHO breastfeeding guidelines was found among first-time mothers in Shanghai. Awareness of breastfeeding guidelines was independently associated with mothers' intention to breastfeed and intention to breastfeed exclusively. The health benefits of breastfeeding and the recommended duration of breastfeeding should be emphasized in prenatal education programs.

Research on Shanghai resident satisfaction of primary healthcare after new health reform

Objective The research was to achieve Shanghai resident satisfaction of primary health service after new health reform.Methods During self-compiled questionnaire survey,the research adapted stratified random sampling to select 9 community health centers in Shanghai urban,rural and suburb areas.Results Shanghai resident satisfaction rate of new health reform was 85.2％.Satisfaction rate of basic medical security system was 85.0％.Satisfaction rate of basic medical service was 96.5％.Satisfaction rate of basic public health service was 95.1％.Age,region,job,education and income were main factors to satisfaction of primary health service.Conclusion From an overall point of view,Shanghai resident satisfaction of primary health service after new health reform was high.However,the level of basic medical security and convenience of reimbursement were not high.Medical expenses of primary health care institution had not been effectively controlled.Basic medicine could not fully meet the medication needs of primary health care institutions. Key words: Health reform; Satisfaction; Medical security; Basic medical service; Public health; Essential medicine