Community Health Service Centers Research Articles

Social-Ecological Correlates of Physical Activity Among Older Adults With Subjective Cognitive Decline in Chinese Community: A Cross-Sectional Study.

Subjective cognitive decline (SCD) is an important time window for early prevention of Alzheimer's disease. Regular physical activity (PA) has positive effects on cognitive functions. Little is known about the actual PA levels and social-ecological correlates in people with SCD. This study aimed to describe PA level and examine the individual, interpersonal, and neighborhood environmental correlates of PA among older adults with SCD in the Chinese community. A total of 246 older adults with SCD who participated in community physical examinations in three community health service centers in Baoding City from May to July 2023 were selected as the investigation subjects through convenience sampling. Questionnaires were conducted on PA, self-efficacy, self-regulation, social support, and community environment of older adults. Multivariate logistic regression was employed to analyze the factors influencing PA in older adults with SCD. Only 25.2% of older adults with SCD were physically active enough. Multivariate logistic regression analysis showed that PA was positively correlated with self-reported health status, self-efficacy, self-regulation, social support, and community facilities. It was negatively associated with age, income, and overweight/obesity. Factors on three levels were all significantly associated with PA. Interventions that incorporate individual, interpersonal, and social factors may be considered to promote PA in older adults with SCD. However, only a few older adults achieve the goal of 150min/week of moderate activity.

Psychological problems and related factors among primary healthcare staff in major cities in China during the COVID-19 pandemic

This study aimed to explore psychological problems and related factors among frontline primary healthcare workers who belongs to community health service centers and directly provides medical security services to community residents during the COVID-19 in Shanghai. We used a cross-sectional data analysis design to investigate the anxiety and depression levels of 929 frontline healthcare staff (primary healthcare providers, nurses, village doctors, and public health workers) during the Shanghai epidemic.The prevalence of depression among frontline primary healthcare workers was 39.7% (369 cases) and that of anxiety was 30%(279 cases). There was a significant correlation between the depression symptoms and anxiety symptoms. And factors associated with depression were being female, advanced education, expecting psychological interventions, expecting vacations as a reward, and expecting financial rewards. Factors strongly associated with anxiety were being female, expecting psychological interventions, and expecting vacations as a reward. Psychological problems among frontline primary healthcare workers merit more attention during the COVID-19 outbreak, especially those who are vulnerable (e.g., females and those with an advanced education).

Development and validation of a nomogram for predicting motoric cognitive risk syndrome among community-dwelling older adults in China: a cross-sectional study

BackgroundMotoric cognitive risk (MCR) syndrome is characterized by slow gait speed and subjective cognitive complaints (SCC) and increases the risk of dementia and mortality.ObjectiveThis study aimed to examine the clinical risk factors and prevalence of MCR in community-dwelling older adults, with the goal of developing and validating a nomogram model for developing prevention strategies against MCR.MethodsWe enrolled community-dwelling participants aged 60–85 years at Guangwai Community Health Service Center between November 2023 and January 2024. A total of 1,315 older adults who met the criteria were randomly divided into a training set (n = 920) and a validation set (n = 395). By using univariate and stepwise logistic regression analysis in the training set, the MCR nomogram prediction model was developed. The area under the receiver operator characteristic curve (AUC), calibration plots, and Hosmer-Lemeshow goodness of fit test were used to evaluate the nomogram model’s predictive performance, while decision curve analysis (DCA) was used to evaluate the model’s clinical utility.ResultsEducation, physical exercise, hyperlipoidemia, osteoarthritis, depression, and Time Up and Go (TUG) test time were identified as independent risk factors and were included to develop a nomogram model. The model exhibited high accuracy with AUC values of 0.909 and 0.908 for the training and validation sets, respectively. Calibration curves confirmed the model’s reliability, and DCA highlighted its clinical utility.ConclusionThis study constructs a nomogram model for MCR with high predictive accuracy, which provides a reference for large-scale early identification and screening of high-risk groups for MCR.

Development and Validation of a Machine Learning-Based Early Warning Model for Lichenoid Vulvar Disease: Prediction Model Development Study.

Given the complexity and diversity of lichenoid vulvar disease (LVD) risk factors, it is crucial to actively explore these factors and construct personalized warning models using relevant clinical variables to assess disease risk in patients. Yet, to date, there has been insufficient research, both nationwide and internationally, on risk factors and warning models for LVD. In light of these gaps, this study represents the first systematic exploration of the risk factors associated with LVD. The risk factors of LVD in women were explored and a medically evidence-based warning model was constructed to provide an early alert tool for the high-risk target population. The model can be applied in the clinic to identify high-risk patients and evaluate its accuracy and practicality in predicting LVD in women. Simultaneously, it can also enhance the diagnostic and treatment proficiency of medical personnel in primary community health service centers, which is of great significance in reducing overall health care spending and disease burden. A total of 2990 patients who attended West China Second Hospital of Sichuan University from January 2013 to December 2017 were selected as the study candidates and were divided into 1218 cases in the normal vulvovagina group (group 0) and 1772 cases in the lichenoid vulvar disease group (group 1) according to the results of the case examination. We investigated and collected routine examination data from patients for intergroup comparisons, included factors with significant differences in multifactorial analysis, and constructed logistic regression, random forests, gradient boosting machine (GBM), adaboost, eXtreme Gradient Boosting, and Categorical Boosting analysis models. The predictive efficacy of these six models was evaluated using receiver operating characteristic curve and area under the curve. Univariate analysis revealed that vaginitis, urinary incontinence, humidity of the long-term residential environment, spicy dietary habits, regular intake of coffee or caffeinated beverages, daily sleep duration, diabetes mellitus, smoking history, presence of autoimmune diseases, menopausal status, and hypertension were all significant risk factors affecting female LVD. Furthermore, the area under the receiver operating characteristic curve, accuracy, sensitivity, and F1-score of the GBM warning model were notably higher than the other 5 predictive analysis models. The GBM analysis model indicated that menopausal status had the strongest impact on female LVD, showing a positive correlation, followed by the presence of autoimmune diseases, which also displayed a positive dependency. In accordance with evidence-based medicine, the construction of a predictive warning model for female LVD can be used to identify high-risk populations at an early stage, aiding in the formulation of effective preventive measures, which is of paramount importance for reducing the incidence of LVD in women.

Influencing factor analysis of family doctor contract service among older adults: evidence from China.

Family doctor contract services are essential to primary healthcare and play a significant role in improving the health of older adults. However, contract rates among older adults vary widely. Investigating the factors influencing contract rates is crucial for optimizing policies and increasing participation in family doctor services. This study used data from Wangying Community Health Service Center, encompassing 5,684 older adults in 2018. To address the endogeneity issue arising from sample selection bias, the study utilized a 1:1 nearest-neighbor matching method for counterfactual testing, balancing potential confounding factors between the contract and non-contract groups. Subsequently, multiple logistic regression analysis was performed on the matched data to explore the impact of gender, age, number of medical visits, and the number of chronic conditions on family doctor contract behavior. Gender did not significantly impact contracting behavior. However, age, the number of medical visits, and the number of chronic diseases significantly influenced family doctor contract (β = 0.457, p < 0.01; β = 0.286, p < 0.05; β = -0.229, p < 0.1). An inverted U-shaped relationship was found between age and contracting behavior (β = -0.003, p < 0.01). The factors influencing older residents' decisions to sign up for family doctor services are complex and diverse. The conclusion of the study provides valuable reference and guidance for policymakers to further improve the family doctor contracting system and optimize contracting strategies by considering the characteristics of different older adults.

Nutritional guidance needs and influence factors for gastric cancer survivors in primary healthcare setting: a cross-sectional survey.

This study aimed to build a comprehensive understanding of the nutritional guidance needs of gastric cancer survivors in the primary healthcare setting that could be fulfilled by community health service centers as part of their primary healthcare services. Gastric cancer survivors were invited to participate in a questionnaire-based survey by convenience sampling method from the community health center. Relationships between nutritional demand and potential influence factors were examined by a multivariable logistic regression model. A total of 200 gastric cancer survivors were recruited from the community health service center in Shanghai, China, from whom we obtained 194 valid questionnaires, resulting in a 97.0% response rate. Of these gastric survivor participants, 48 individuals (24.7%) expressed a need for nutritional guidance administered by community health service centers, whereas 146 participants (75.3%) held the perspective that such guidance was unnecessary. Preferences for nutritional guidance included having a dietitian as the provider (68.8%), home-based engagement (72.9%), face-to-face consultation (68.8%), individual counseling (87.5%), and beginning immediately post-discharge (89.6%). A notable reluctance (66.7%) towards financial contribution was also observed. After adjusting for confounders, participants with higher income level (odds ratio (OR) = 4.45, 95% confidence interval (CI) = 1.39-15.50), history of food intake reduction (OR = 14.96, 95% CI = 3.49-82.28), and gastrointestinal symptoms (OR = 4.40, 95% CI = 1.35-14.33) were more likely to seek nutritional guidance. Gastric cancer survivors have a certain need for nutritional guidance administered by primary health service centers. Personal guidance by the primary health service center should be provided to gastric cancer survivors to support their dietary and nutritional intake needs. There is a need to develop and implement nutritional guidance programs in community health service centers as part of their primary healthcare services for gastric cancer survivors.

Construction and application of the emergency resilience capability evaluation scale and model for grassroots medical workers: a cross-sectional study in Guangzhou, China.

Public health emergencies pose a serious challenge to the ability of medical personnel to respond. We aimed to establish a scientific and effective resilience capability assessment scale for grassroots medical workers and explore the way to improve resilience. Developed a resilience ability assessment scale and applied it on the medical personnel who worked in community health service centers for more than 1 year. Related indicators were identified through literature review and the Delphi method. The established scale was given weight using the attribute analytic hierarchy process, and the evaluation model was built through the grey correlation analysis. A three-level indicator scale was established, which included three first-level indicators [professional quality (weight 0.346), psychological capital (weight 0.614), and emergency attitude (weight 0.040)]. The second-level indicators had 13 contents and were further subdivided into 46 three-level indicators. The overall resilience ability assessment score of 347 medical workers in Guangzhou was only 0.787. However, steady scientific-exercise habits and relative training can help improve their public health emergency resilience ability (p < 0.05). The establishment of the scale can provide a strategic basis for improving the resilience strength of grass-roots medical personnel. We should encourage this group to form a good habit of exercise, strengthen their crisis awareness by actively organizing theoretical training and practical exercises on public health emergencies, and improve their psychological capital level. In this study, 347 medical workers from 6 basic medical institutions in Guangzhou participated in the questionnaire.

Prevalence and associated risk factors of prostate cancer among a large Chinese population

Prostate cancer (PCa) is one of the most important health problems among elderly men in China, with the increasing aging of the population. A cross-sectional survey was conducted in eastern China from 2022 to 2023. Recruitment included a total of 70,342 participants aged 60 or older. Social demographic information, such as individual factors like age, education levels and behavior habits, physical examination and laboratory tests results were collected. Age-standardized prevalence rates were estimated by a direct method with a standard population. T test and chi-square test were used to compare the statistical differences. Multivariate regression models were used to identify the risk factors of PCa. Overall, the crude and age-standardized PCa prevalence is 0.93% and 0.91%, respectively in eastern China. When we adjusted all the co-variables, it showed that high age, smoking, having a higher BMI and higher CA19-9 were associated with a higher risk for a prostate cancer diagnosis. Faced with the demographic transition, innovative strategies are needed to control and prevent PCa. Conducting early screening among male population in community health service centers in eastern of China, especially among a population with associated risk factors such as high age, obesity, and conducting community-based intervention programs might be helpful to address this increasingly significant health problem.

Descriptive study of possible relation between cardio-ankle vascular index and lipids in hypertension subjects

Aim: The cardio-ankle vascular index (CAVI) is a new evaluation indicator for arteriosclerosis. This study investigated the relationship between the CAVI and lipid levels in patients with hypertension in a real clinical environment. Methods: This descriptive study enrolled 2,656 patients (male/female: 1,016/1,640) from the Outpatient Department of Vascular Medicine of Peking University Shougang Hospital and Jinding Street Community Health Service Center. CAVI was measured using a VaseraVS-1000 vascular screening system (Fukuda Denshi, Tokyo, Japan). Results: Age, body mass index (BMI), waist circumference, hip circumference, CAVI, systolic blood pressure (SBP), diastolic blood pressure (DBP), creatinine, fasting plasma glucose (FPG), uric acid (UA), hypersensitive C-reactive protein (hs-CRP), homocysteine, HbA1c, and triglyceride (TG) were significantly higher in the hypertension group than in the non-hypertension group. The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were significantly lower in the hypertension group than in the non-hypertension group. The CAVI value was significantly higher in patients with hypertriglyceridemia and normal LDL-C than in those with normal TG and hyper-LDL-C. Age, waist circumference, UA, FPG, HDL-C, hs-CRP, HbA1c, BMI, SBP, and DBP were independently associated with CAVI in all patients. Beta blockers were negatively correlated with CAVI (β = –0.411, P = 0.011). Sex (male) and history of hypertension and diabetes mellitus were positively correlated with CAVI (β = 0.419, P &lt; 0.001; β = 0.247, P = 0.011; β = 0.638, P &lt; 0.001; respectively). Conclusions: The CAVI was significantly higher in patients with hypertension and exhibited differences based on sex. Although we did not find a significant correlation between CAVI and TG, it remains crucial to maintain blood pressure to prevent the development of arteriosclerosis.

Expert consensus on the passive immunization prevention of infant respiratory syncytial virus infection in China

Respiratory syncytial virus (RSV) infection, which has the very heavy disease burdens, is the most common viral pathogen that seriously threatens the health of infants and young children. In order to better guide and standardize the clinical diagnosis, treatment, monitoring and immunization prevention and control of RSV infection in China, the Chinese Preventive Medicine Association jointly organized multidisciplinary experts to form a special working group, drawing on the implementation experience of foreign passive immunization prevention of RSV, integrating the existing evidence and the latest progress as a problem oriented, and putting forward the expert consensus on the passive immunization prevention of infant RSV infection in China in the future. The aim is to answer some professional questions about RSV infection and its immunoprophylaxis, especially passive immunoprophylaxis, in order to provide reference for the practice of immunoprophylaxis for professionals in medical institutions, disease prevention and control institutions and community health service centers at all levels.

Expert consensus on the passive immunization prevention of infant respiratory syncytial virus infection in China

Respiratory syncytial virus (RSV) infection, which has the very heavy disease burdens, is the most common viral pathogen that seriously threatens the health of infants and young children. In order to better guide and standardize the clinical diagnosis, treatment, monitoring and immunization prevention and control of RSV infection in China, the Chinese Preventive Medicine Association jointly organized multidisciplinary experts to form a special working group, drawing on the implementation experience of foreign passive immunization prevention of RSV, integrating the existing evidence and the latest progress as a problem oriented, and putting forward the expert consensus on the passive immunization prevention of infant RSV infection in China in the future. The aim is to answer some professional questions about RSV infection and its immunoprophylaxis, especially passive immunoprophylaxis, in order to provide reference for the practice of immunoprophylaxis for professionals in medical institutions, disease prevention and control institutions and community health service centers at all levels.

Efficacy of Qingying decoction and Wuling powder in the treatment of renal hematuria: A traditional Chinese medicine approach

Purpose: To investigate the efficacy of combining Qingying decoction with Wuling powder in the treatment of renal hematuria. Method: Seventy-six patients diagnosed with renal hematuria in the Emergency General Hospital and Nanmofang Community Health Service Center in Chaoyang District of Beijing, China were randomized equally into study and control groups. Control group received standard Western treatment in addition to Shenyan Rehabilitation tablets while study group received a combination of Qingying decoction and a modified Wuling powder alongside standard treatment for eight weeks. Treatment effectiveness was evaluated using urinary red blood cell count (URBC), urinary albumin-to-creatinine ratio (UACR), urinary β 2-microglobulin (β2-MG) and α 1-microglobulin (α1-MG) levels, serum levels of complement components 3 (C3) and 4 (C4), immunoglobulin A (IgA), and Traditional Chinese Medicine (TCM) syndrome scores. Results: There was a significant difference in total therapeutic effectiveness between study and control groups (p &lt; 0.01). Study group showed significantly improved hematuria and total syndrome scores (p &lt; 0.01). The study group showed significantly lower URBC, UACR, β 2-MG, α 1-MG, IgA, and C3 levels compared to the control group (p &lt; 0.05). Conclusion: Treatment with Qingying decoction and Wuling powder demonstrates efficacy in managing renal hematuria, regulates urinary red blood cell counts, reduces symptoms, and lowers early renal impairment. Future studies in multiple centers using larger number of patients to determine the mechanisms of these drug actions and interactions and other related factors would be required.

Rapid detection of depression by volatile organic compounds from exhalation

Depression is a pervasive and often undetected mental health condition, which poses significant challenges for early diagnosis due to its silent and subtle nature. To evaluate exhaled volatile organic compounds (VOCs) as non-invasive biomarkers for the detection of depression using a virtual surface acoustic wave sensors array (VSAW-SA). A total of 245 participants were recruited from the Hangzhou Community Health Service Center, including 38 individuals diagnosed with depression and 207 control subjects. Breath samples were collected from all participants and subjected to analysis using VSAW-SA. Univariate and multivariate analyses were employed to assess the relationship between VOCs and depression. The findings revealed that the responses of virtual sensor ID 14, 44, 59, and 176, which corresponded respectively to ethanol, trichloroethylene or isoleucine, octanoic acid or lysine, and an unidentified compound, were sensitive to depression. Taking into account potential confounders, these sensor responses were utilized to calculate a depression detection indicator. It has a sensitivity of 81.6% and a specificity of 81.6%, with an area under the curve of 0.870 (95% CI = 0.816-0.923). Conclusions: exhaled VOCs as non-invasive biomarkers of depression could be detected by a VSAW-SA. Large-scale cohort studies should be conducted to confirm the potential ability of the VSAW-SA to diagnose depression.

Analysis of the Current Situation of Service Capacity of Medical Social Workers in Shanxi Province and the Conception of Cultivation Pathway

Objective: This study aims to analyze the current status of service competence of medical social workers in Shanxi Province and to conceptualize the cultivation path. Methods: A questionnaire survey was conducted among 88 staff members and 120 residents of eight community health service centers in Shanxi Province to understand the population’s knowledge of the connotation of medical social workers and their needs. Results: Currently, the staff and residents of the community health service centers in Shanxi Province have a low level of knowledge and a high demand for medical social workers. It is recommended to expand the scope of practice of medical school students and design a series of training programs for medical social workers to better meet the needs of community healthcare and promote the implementation of the Healthy China Strategy.

Recovery From Severe Mental Illnesses: The Influence of Personal and Psychosocial Factors in Community Settings.

Severe mental illnesses (SMIs) represent a significant public health challenge with substantial personal, economic and societal burdens. Despite treatment advances, recovery outcomes for SMI patients remain variable. This study aimed to investigate the influence of personal and psychosocial factors on recovery among SMI patients in community health settings. This cross-sectional study was conducted in 23 community health service centres in Nanjing, China. We recruited 924 participants diagnosed with SMIs, using a random sampling method. The relationships between individual, psychosocial factors and patients' recovery status were analysed by multiple linear regression. The mediation effect of medication adherence was further tested by the Sobel test with bootstrapping. The mean score of the Morningside Rehabilitation Status Scale (MRSS) of 924 patients with SMIs was 49.82 ± 41.52. The main influencing personal factors of recovery status were age, marital status, education, average annual income and duration of illness. Patients who were accepted by their families tended to have better recovery outcomes, while stigma and social impairment may hinder recovery. Medication adherence played a mediating role between psychosocial factors and recovery status. This study highlights the crucial role of psychosocial factors in the treatment and recovery of SMI patients. Furthermore, medication adherence emerged as a mediating factor. Implementing targeted interventions and policies addressing identified psychosocial barriers can offer promising avenues for improving recovery outcomes for SMI patients in community settings.

Research on the Evaluation of an Age-Friendly Layout of Medical Service Facilities in Wuhan City Based on Accessibility

Accessibility is an important indicator for measuring the level of medical facility services in cities. Traditional studies on healthcare accessibility for the elderly have typically focused on the capabilities of emergency services while overlooking the daily independent healthcare needs of the elderly. Taking Wuhan City as an example, the Gaussian two-step floating catchment area method is used in this study to measure the accessibility of urban elderly residents with respect to general hospitals, specialized hospitals, and community health service centers. It also analyzes the appropriateness of the medical facility layout for the elderly in Wuhan City. The research findings indicate the following: (1) The accessibility evaluation method for urban medical facilities established with the Gaussian two-step floating catchment area model can accurately assess the supply–demand relationship between the elderly and various levels of medical facilities. (2) The overall coverage of medical service facilities in Wuhan City is relatively high, but there are significant differences in accessibility for elderly residents in different areas. (3) The appropriateness of daily healthcare access for elderly residents in the central urban areas of Wuhan City is mainly influenced by the layout of general hospitals, while, in the peripheral areas, it is mainly influenced by the layout of specialized hospitals and community health service centers. (4) Improving the appropriateness of urban medical facilities for elderly individuals requires differentiated improvement measures tailored to the characteristics of different zones.

Association analysis between serum asprosin and metabolic characteristics, Complications in type 2 diabetic patients with different durations.

To investigated the association between serum asprosin and metabolic characteristics in type 2 diabetes mellitus patients with different durations. A total of 436 patients with type 2 diabetes mellitus were enrolled in this study from the community health service center in southeastern Shanxi Province. All the patients were divided into two groups according to their diabetes duration: diabetes duration ≤5 years group (n = 132) and diabetes duration ≥10 years group (n = 304). Fasting blood samples were gathered and serum asprosin was tested. Pearson/Spearman correlation analysis was carried out. Asprosin was comparable between the two groups. Asprosin was positively correlated with systolic blood pressure (SBP), triglycerides, creatinine, serum uric acid and low-density lipoprotein cholesterol in the diabetes duration ≤5 years group (P < 0.05). In the diabetes duration ≥10 years group, asprosin was independently correlated with SBP, diastolic blood pressure, body mass index, total cholesterol, triglycerides, low-density lipoprotein cholesterol, creatinine, serum uric acid, fasting plasma glucose and glycosylated hemoglobin (P < 0.05). Asprosin was associated with alanine aminotransferase and estimated glomerular filtration rate (P < 0.05). Multiple linear regression analysis found that SBP and diastolic blood pressure is an independent factor related to serum asprosin in the group with diabetes duration ≤5 years (P < 0.05). Fasting plasma glucose, SBP, total cholesterol and serum uric acid is an independent factor related to serum asprosin in the group with diabetes duration ≥10 years (P < 0.05). Serum asprosin was significantly increased in the group with diabetes duration ≥10 years, and glycosylated hemoglobin, blood pressure and estimated glomerular filtration rate were independent risk factors in long-duration type 2 diabetes mellitus.

Development and validation of frailty risk prediction model for elderly patients with coronary heart disease

ObjectiveTo analyze the influential factors of frailty in elderly patients with coronary heart disease (CHD), develop a nomogram-based risk prediction model for this population, and validate its predictive performance.MethodsA total of 592 elderly patients with CHD were conveniently selected and enrolled from 3 tertiary hospitals, 5 secondary hospitals, and 3 community health service centers in China between October 2022 and January 2023. Data collection involved the use of the general information questionnaire, the Frail scale, and the instrumental ability of daily living assessment scale. And the patients were categorized into two groups based on frailty, and χ2 test as well as logistic regression analysis were used to identify and determine the influencing factors of frailty. The nomograph prediction model for elderly patients with CHD was developed using R software (version 4.2.2). The Hosmer–Lemeshow test and the area under the receiver operating characteristic (ROC) curve were employed to assess the predictive performance of the model. Additionally, the Bootstrap resampling method was utilized to validate the model and generate the calibration curve of the prediction model.ResultsThe prevalence of frailty in elderly patients with CHD was 30.07%. The multiple factor analysis revealed that poor health status (OR = 28.169)/general health status (OR = 18.120), age (OR = 1.046), social activities (OR = 0.673), impaired instrumental ability of daily living (OR = 2.384) were independent risk factors for frailty (all P < 0.05). The area under the ROC curve of the nomograph prediction model was 0.847 (95% CI: 0.809 ~ 0.878, P < 0.001), with a sensitivity of 0.801, and specificity of 0.793; the Hosmer- Lemeshow χ2 value was 12.646 (P = 0.125). The model validation results indicated that the C value of 0.839(95% CI: 0.802 ~ 0.879) and Brier score of 0.139, demonstrating good consistency between predicted and actual values.ConclusionThe prevalence of frailty is high among elderly patients with CHD, and it is influenced by various factors such as health status, age, lack of social participation, and impaired ability of daily life. These factors have certain predictive value for identifying frailty early and intervention in elderly patients with CHD.

Effects of retinopathy on visual function in type 2 diabetes mellitus

Objective: To study the influence of the severity of diabetic retinopathy (DR) on the visual function of patients with type 2 diabetes, to provide scientific basis for the early prevention and control of DR. Methods: This study was designed as a cross-sectional study, recruiting already-diagnosed type 2 diabetes patients in four community health service centers in Guizhou Province between February and September 2022. Employing the Chinese version of the Visual Function Index-14 (VF-14), assess the participants' near vision, visual adaptation, subjective visual perception, and stereo vision, with higher scores indicating poorer visual function. Categorize the severity of each eye's damage into no diabetic retinopathy (DR), mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy (PDR), and use a 5-level DR grading system to evaluate the overall severity of diabetic retinopathy in both eyes. Employing linear regression analysis to investigate the linear relationship between DR and visual function index. Local weighted regression evaluates the nonlinear relationship between the DR composite score and the scores of visual function, with a steeper slope indicating poorer visual function for that level. Results: A total of 542 patients with type 2 diabetes were investigated, including 244 (45.02%) males, 298 (54.98%) females, and 162 (29.89%) patients with DR. After adjusting for confounders, compared with those without DR, patients with binocular DR Had overall scores (β=0.136, P=0.003), near vision (β=0.163, P<0.001), visual adaptation (β=0.092, P=0.042), subjective vision (β=0.120, P=0.009) and stereo vision (β=0.094, P=0.044) were higher than those without DR. There were no differences in visual functions between DR And monocular DR. The local weighted regression curve showed that near vision (slope: 23.78) and overall score (slope: 58.37) increased sharply from mild to moderate NPDR in both eyes. Visual adaptation (slope: 5.37, 7.72), subjective vision (slope: 6.53, 7.93), stereovision (slope: 0.74, 0.91) increased slowly in mild to moderate NPDR in both eyes and in moderate to severe NPDR/PDR in both eyes. Conclusion: Binocular DR is associated with impaired visual function, but there is no difference between monocular DR And non-DR visual function. The early damage of DR To visual function is mainly manifested in near vision. In the prevention and control of DR, more attention should be paid to visual function, especially the change of near vision, and retinal damage should not be assessed solely by visual status.

Patient Participation in Medication Safety for Noncommunicable Diseases: A Qualitative Study of General Practitioners, Pharmacists, and Outpatients' Perspectives in Beijing.

Our study aimed to explore the current status of patient participation in medication safety from the perspectives of general practitioners (GPs), pharmacists, and outpatients in Beijing, China. A qualitative study using semi-structured in-depth individual interviews with GPs, pharmacists, and outpatients. Subjects were identified by purposive sampling until code saturation. Semi-structured qualitative interviews were conducted with GPs, pharmacists, and patients from community health service centers in three urban districts of Beijing, China. The interviews were transcribed verbatim and the text was analysed using thematic analysis techniques including familiarising with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. A total of eight GPs, seven pharmacists, and 18 outpatients were interviewed. Data analysis led to the generation of five key themes: (1) mutual trust between patient and GP, (2) communication with healthcare professionals, (3) acquisition of knowledge about medication safety, (4) implementation of medication self-management at home, and (5) different attitudes toward participation in medication decisions. Patients participated in medication safety in multiple ways. However, insufficient knowledge about medication safety, lack of awareness of the patient's role in ensuring medication safety, shortage of consultation lengths, and being misled by some information were problems with patient participation in medication safety. This exploratory study contributes to our initial understanding of patient participation in medication safety. There were still many issues and barriers in the process of patient participation. Appropriate policies and measures, such as providing various forms of patient education, ensuring sufficient physician-patient communication, giving full play to the role of pharmacists, and making judicious use of digital health tools should be taken to improve medication safety by fully utilising the role of patients.