Community Health Service Centers Research Articles

Effects of home medication review on drug-related problems and health-related quality of life among community-dwelling older adults in China

BackgroundThere is a lack of research on the nature of drug-related problems (DRPs) in older adult communities in China and the impact of home medication review on DRP reduction and health-related quality-of-life (HRQoL) improvement. ObjectivesTo identify and categorize DRPs in older adults in China and to assess the impact of home medication review. MethodsThe prospective study was conducted in 2 community health service centers in Shanghai, China from December 2018 to December 2019. Eligible patients received a home medication review by a clinical pharmacist to assess for DRPs and adherence, propose pharmaceutical interventions, and measure outcomes of HRQoL. All enrolled patients were followed up for 3 months. ResultsMedication use in 412 patients was analyzed. A total of 362 DRPs were identified, an average of 0.88 per patient. Treatment effectiveness was the primary DRP type (249; 68.8%). The most common causes of DRPs were patient-related (35.1%) and drug selection (31.0%). Pharmacists made 733 interventions, an average of 2 per DRP. A total of 82.1% of these interventions were accepted. At a 3-month follow-up, home medication review led to a statistically significant reduction in the mean number of DRPs (0.4 vs. 0.88, P < 0.001) and an increase in medication adherence (1.42 vs. 0.85, P < 0.001). Both HRQoL indicators also improved, EuroQol 5 Dimension scale (0.75 vs. 0.78, P < 0.001) and EuroQol–visual analog scale (70 vs. 77.65, P < 0.001). ConclusionHome medication review is a practical means to optimize drug therapy and improve patients’ HRQoL in community settings.

Public awareness of acute myocardial infarction symptoms and emergency response in community residents

Abstract Background Patient delay in seeking help has been reported to be a major factor that related to delay in care of acute myocardial infarction (AMI). Lack the knowledge of symptoms may translate to behavioral deficiencies which lead up to failing to seek medical assistant at early stage of AMI. Purpose The aim of present study is to investigate the awareness of AMI symptoms and the emergency responses among community residents over 35 years old. Methods The sample was proportionally distributed by age according to the national census data. The sex ratio was 1:1. The sample size is calculated according to the significance level of 0.05, the allowable error of 0.1, and the estimated Excellent awareness level of 10%. The final sample size is adjusted to 4200, considering non-response rate of 20%. Multi-stage stratified random sampling was used. On the first stage, two districts each in urban and rural regions were randomly selected. On the second stage, 3–10 community health service centers were randomly selected in each district. On the third stage, residents over 35 managed by the community health service center were proportionally sampled to be interviewed. A structured questionnaire was used and the survey was conducted in a face-to-face interview by clinical physicians. Logistic regression was applied to analyze factors related to Good knowledge. Results The top three symptom recognized by public is “pain or discomfort in the chest” (71.3%), followed by “difficulty breathing” (65.1%) and “pain or discomfort in the jaw, neck, or back” (60.9%). 85.0% chose to call an ambulance as first response when witness others having an AMI. Those who lives alone (OR=1.408; 95% CI, 1.005–1.972) and whose immediate family had been diagnosed with AMI (OR=1.510; 95% CI, 1.040–2.192) has better knowledge. A significant positive correlation was observed for those with hypertension (OR=1.199; 95% CI, 1.007–1.429), while a negative correlation was observed for those with diabetes (OR=0.788; 95% CI, 0.626–0.992). Public education could improve Good knowledge (OR=1.662; 95% CI, 1.388–1.990), while doctoral advise has been shown negative impact (OR=0.824; 95% CI, 0.691–0.984). Conclusions Our data provide first population-based estimates of public awareness in our country. Further promotional strategies to increase overall awareness in general public are seriously needed. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Major Science and Technology Projects of Tianjin Science and Technology Commission Multivariable logistic regression

Effect of keeping pets behavior on physical activity and depression in community elderly

Objective To examine the status and effects of keeping pets on physical activity and depression among the elderly in communities. Methods A household interview was conducted among 528 permanent residents ≥ 60 years and without severe diseases registered in a community health service center in Nanyang city of Henan province from August 2019 to January 2020. International Physical Activity Questionnaire – Short Form (IPAQ-s), the Center for Epidemiologic Studies Depression Scale (CES-D) and a self-designed questionnaire were used in the survey. Results Of all the elderly, 38.07% kept pets in home and 63.7% were assessed as having depression symptoms. The IPAQ-s scores ranged 0 – 5 664 for all the elderly. The results of multivariate linear regression analysis revealed following pet-keeping-related factors for physical activity in the elderly: feeling while walking pets (β = – 375.244), perceived attitude of neighbors and friends towards keeping pets (β = – 373.867), whether the kept pet ever attacking other pedestrians (β = 732.816), whether having their pets bathed in home (β = – 166.877), and the daily time being accompanied by their pets (β = – 343.849); the results also demonstrated that ever having pet-keeping-related conflicts with others (β = 3.139), feeling while walking pets (β = 1.476), ever being hurt by pets (β = – 4.391), the frequency of walking pets per day (β = 2.038), family members′ attitude towards pet-keeping (β = 1.989), and the daily time being accompanied by their pets (β = 2.937) were significant influencing factors for depression symptoms in the elderly. Conclusion Good pet-keeping behaviors could promote physical activities, alleviate depression symptoms, and improve health status among community elderly.

Can family doctor contracted services facilitate orderly visits in the referral system? A frontier policy study from Shanghai, China.

BackgroundChina committed to establishing a family doctor (FD)‐based referral system following the medical reform in 2009. This paper explored the effect of FD on establishing the anticipated system.MethodsTwo waves of survey were conducted in Shanghai, China. 2754 and 1995 individuals were sampled in 2013 and 2016 respectively. We compared orderly visiting behaviour between contracted and non‐contracted residents. Logistic regression models were performed to further test the effect of FD on orderly visits.ResultsMore contracted residents first‐contacted community health service centres (CHSCs; 45.48%) than non‐contracted residents (28.93%). Contracted residents were also more likely to refer to specialists via CHSCs than the non‐contracted (9.84% vs. 2.60%). The odds ratio (OR) for first‐contact at CHSCs by contract status was 1.569 in 2013, but increased to 1.675 in 2016. Being contracted with a FD was associated with referral behaviour, but the OR declined from 2.692 to 2.487 over years.ConclusionThe survey from Shanghai showed that FD had a significant effect on attracting first‐contact at CHSCs and referral via CHSCs; however, the effect on the latter decreased. The effectiveness of the FD role on referral behaviour requires a well‐established referral system, which has not yet been completely achieved in China.

Investigating the predictors of breast cancer screening behaviors (breast self-examination, clinical examination or examination by physician/midwife and mammography) based on protection motivation theory (PMT) in women.

SummaryBackgroundBreast cancer is one of the most common health problems worldwide. The mortality rate of this disease is due to the lack of knowledge about screening methods and late diagnosis of cancer.ObjectiveThe purpose of this study is to determine the predictors of breast cancer screening behaviors using protection motivation theory.Methods and materialsThe conduction of study was cross-sectional and on 400 women aged 30-59 in Kashan. The data collection instrument was a researcher-made questionnaire based on protection motivation theory. Sampling was performed from all community health service centers in Kashan and the proportional to size sampling method was used as available sampling. The statistical tests were Pearson correlation and linear regression. The software used was version 22 SPSS and the significance level was 0.05.ResultsThe results showed that the average age of women was 39.7 ± 7.9 years. There is a direct and statistically significant relationship between perceived breast cancer screening behaviors and perceived self-efficacy (P < 0.05) and there is an inverse statistically significant relationship between breast cancer screening behaviors and perceived cost (P < 0.05). There is also a direct and significant statistical relationship between motivation of protection and perceived sensitivity, intensity, self-efficacy, cost, and perceived response efficiency (P < 0.05). Perceived self-efficacy, cost, and response efficiency are the predictors of breast cancer screening behaviors. The perceived cost is the negative predictor.ConclusionOverall, health care providers can view PMT as a framework for developing educational interventions aimed at improving behaviors related to breast cancer screening of women.

Association Between Service Agreements and Frequency of Primary Care Visits in a Chinese Community Health Service Center.

To increase the utilization of Community Health Service (CHS) centers for primary care, the Central Government of China has promoted the use of contracts-known as "service agreements" (SAs)-between patients and primary care physicians. This study sought to identify factors that predict who signed SAs and the association between SAs and frequency of primary care visits in a CHS center in Beijing. Four years of electronic health record (EHR) data (2015 to 2018) were analyzed. Multivariate logistic regression analysis was performed to examine the tendency of patients to establish a SA. The pattern of the primary care visits between the SA and the non-SA groups was compared using Gamma regression models, controlling for demographic and comorbidity conditions. Contrast analysis was performed to assess the odds ratios of signing SAs among levels of a specific patient characteristic. Data from 32,682 adult CHS patients were collected. Of those, 66.4% had signed a SA. Patients who were female, older, more educated, married, employed, insured, or had comorbid conditions were more likely to sign SAs. Overall, having a SA was associated with a higher frequency of primary care visits for women and older patients, but not for the young and educated patients. The evidence provides an important consideration for reducing gaps in the use of primary care services during the nationwide transition from the fee-for-service specialty care system to the patient-centered primary care-driven medical home model.

Management strategy of a community health service center under the background of sudden epidemic situation

Management strategy of a community health service center under the background of sudden epidemic situation

Who is willing to participate in and provide Family Doctor Contract Service?: A cross-sectional study based on the medical staff's perspective in China.

China encourages medical staff from non-primary hospitals (higher-level hospitals) to participate in and provide Family Doctor Contract Service (FDCS) due to a lack of primary medical resources in community health service centers. This study aims to explore the factors affecting the willingness of family doctor contracting from the tertiary hospital medical staff's perspective.An anonymous self-administered survey was conducted among the medical staff from tertiary hospitals in Hangzhou, Zhejiang Province. Information of the socio-demographic characteristics, the willingness of participating in FDCS and its related reasons, and factors that might affect willingness were investigated. A multivariate logistic regression was used to identify the statistically significant variables associated with willingness.A total of 346 medical staff were recruited in the survey, and 37.86% of them were willing to participate in and provide FDCS. Medical staff with the following characteristics had stronger will: (1)with higher education level;(2)having better knowledge with family doctor;(3)being more attracted by the national policy of FDCS;(4)thinking it help for income increase.The majority of willing doctors (25.95%) believed that participating in FDCS could help them achieve their personal value, and the reason chosen most for unwilling reason was “low income and unrealized personal value (32.21%).”It is necessary for the government to establish the essential matching mechanisms to guarantee the development of the family doctor, including increasing the final financial support for primary health facilities, and developing the national incentive mechanism for family doctors.

Insulin Injection Knowledge, Attitudes, and Practices of Nurses in China: A Cross-Sectional Nationwide Study.

IntroductionTo evaluate insulin injection knowledge, attitudes, and practices of nurses across China in order to provide reference for the formulation of a national unified standard of insulin injection practice and the targeted implementation of standardized training on insulin injection for nurses.MethodsWe enrolled nurses who worked and injected insulin at grassroot hospitals including community health service centers and township clinics, secondary and tertiary care hospitals across China between July 28, 2019 and August 30, 2019. A nurse insulin injection knowledge, attitude, and practice questionnaire was used to evaluate the knowledge, attitude, and practice level of nurses.ResultsA total of 223,368 nurses were included in the study. The mean knowledge score was 13.70 ± 3.30 and 35.19% had a poor knowledge score. The mean attitude score was 17.18 ± 2.69 for the study nurses; merely 3.15% had a poor attitude score. The mean practice score of the study population was 83.03 ± 8.16 and only 0.88% had a poor practice score. Pearson correlation analysis showed significant correlation between the knowledge score and the attitude score (r = 0.29; P < 0.001), the knowledge score and the practice score (r = 0.27; P < 0.001), and between the attitude score and the practice score (r = 0.56; P < 0.001). A multivariate analysis revealed that nurses with higher knowledge scores were also more likely to have higher attitude scores and practice scores, and nurses with higher attitude scores were also more likely to have higher practice scores.ConclusionChinese nurses have a good attitude and behavior towards insulin injection, while their knowledge of insulin injection is insufficient. It is also revealed that knowledge of insulin injection can directly or indirectly affect insulin injection behavior through attitude, indicating that hospitals should formulate unified insulin injection norms and regularly organize relevant training and assessment so as to improve nurses’ knowledge, attitude, and behavior of insulin injection.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01122-x.

Increased Systolic Blood Pressure Mediates the Relationship Between Urate and Gout Risk in Indonesia: A Novel Application of a Partial Least Squares-Structural Equation Model.

Most Indonesians with hyperuricemia are less than 40 years old, which suggests an increasing gout risk in the country. Meanwhile, untreated hyperuricemia was also suggested to lead to hypertension. Yet, it is unclear whether blood pressure (BP) plays a mediating role between urate and gout. We investigated the mediating effect of BP between urate and gout risk in Indonesians using a partial least squares-structural equation model. A community-based retrospective case-control study was conducted between July 1 and August 31, 2019 in Indonesia. We randomly recruited 397 participants, including 86 patients with gout and 311 healthy controls from seven community health service centers. Multivariate logistic regression was employed to analyze the adjusted odds ratios of the association between risk factors, such as urate level and BP, and gout risk after controlling for other covariates. A path analysis was utilized to analyze the mediating effect of systolic BP between urate and gout. The STROBE reporting guideline for the observational study is adopted in our reporting. We found that a 1 mg/dL increase of urate level significantly increased gout risk with an OR of 4.97 (95% CI: 3.48-7.09) and an AOR of 4.44 (95% CI: 3.07-6.42) after adjusting for covariates. The association between urate and gout was also significantly mediated by systolic BP (β = 0.05; 95% CI Bias Corrected [0.02-0.08], p < 0.001). Urate was significantly associated with gout risk and was possibly mediated by increased systolic BP in Indonesians. Controlling systolic BP could be one of the strategies to decrease the risk of gout for individuals with hyperuricemia. Health education can be carried out by community health nurses to individuals on controlling their urate level and systolic BP to decrease the gout risk among Indonesian.

Child restraint system use and its associated factors in Shenzhen

Child restraint system (CRS) is effective to protect child passenger safety in a motor vehicle crash. However, research on CRS is limited and the use rate of CRS is not high in China. We carried out a cross-sectional study to examine the use of CRS and its associated factors in Shenzhen. Via the method of cluster random sampling, parents who had at least one child aged 0 to 6 and owned a car from nine community health service centers and eight kindergartens were invited to complete the self-administered questionnaire during April and May 2014, including their knowledge of, attitude toward, and use behavior of CRS and socio-demographics. Multivariable logistic regression was used to explore the factors associated with CRS use. A total of 3768 parents participated in the survey, with a mean age of 33.94. Parents’ knowledge and attitude regarding CRS were fair, with the mean score of 3.07 and 3.33 out of 6, respectively, and only 22.8% of them used CRS for their child passengers. Children aged below 3 years, drivers owing expensive cars and wearing seatbelts, and parents with higher knowledge and attitude scores had greater likelihoods to use CRS. Moreover, trip frequency and distance were also significantly associated with CRS use. The findings indicate that the use rate of CRS is low in Shenzhen and parents have fair levels of knowledge and attitude regarding CRS use. Comprehensive public education programs and legislative interventions are urgently required to increase the use of CRS and ensure child passenger safety in Shenzhen

Effect of shift work on menopausal age and menstruation span of professional women

Objective: To explore the relationship between shift work and menopausal age and menstruation span of retired women. Methods: During July 2017 and October 2018, the research was performed by using cluster sampling in nine districts of Shenzhen City to select all permanent residents (3518 people) with Shenzhen household registration in which was equal to or over 60 years old from the Community Health Service Centers. The data of age, marital status, menopausal age, smoking, drinking, shift experience and shift years were collected. The relationship between shift work and menopausal age as well as menstruation span of professional women were analyzed by multivariate linear regression model. Results: There were 359 people (10.2%) in the shift experience group, the menopausal age was (49.71±3.63) years, and the menstrual period was (34.27±3.92) years. The non-shift experience group were 3159 people (89.8%) , the menopausal age was (50.20±3.60) years, and the menstrual period was (34.86±4.13) years. The differences of menopausal age and menstrual years between the two groups were statistically significant (P<0.05) . After adjusting for factors such as passive smoking and drinking, the results of the multiple linear regression model showed that menopausal age, menstrual years were negatively correlated with shift work (β=-0.493, -0.575, P<0.05) . Conclusion: Shifts are related to women's menopausal age and menstrual years, and attention should be paid to the impact of work intensity and circadian rhythm on the occupational health of female employees.

The Awareness and Attitude of Contracted Service Among General Medical Practitioners in Community Health Service Centers in Urban China: A Cross-Sectional Study.

This study aims to explore the attitude, willingness, and satisfaction with contracted service (CS) among staff in community health service (CHS) centers in urban China and to explore the associated factors of satisfaction with CS. From August 2016 to July 2017, five CHS centers in three provinces of China were selected. Setting-level information was collected by official document review; and personal information on demographic characteristics, awareness, willingness, and attitude of CS among staff was collected by questionnaire survey. Univariate and multivariable logistic regression models were fitted to explore the associated factors of satisfaction with CS. Multiple correspondence analysis (MCA) was used to visually demonstrate the correlations among category data related with satisfaction with CS. The CS signing rates were 30.78, 12.72, 22.20, 14.32, and 21.19% in the five CHS centers. A total of 286 staff included family doctors (40.91%), nurses (31.12%), and others (27.97%) completed the survey. For the sense of self-worth, 86.01% (246/286) participants hold a positive attitude. The predominant barrier of CS signing was caused by the work pressure due to CS performance assessment (48.60%, 139/286). About 30% of family doctors and nurses reported a heavy work pressure, and more than 30% of doctors had great feeling of fatigue. Notably, 51.69% family doctors would like to change their job in the future. Compared with other staff, family doctors were more likely to be unsatisfied with CS (OR: 2.793, 95% CI: 1.155–6.754, p = 0.022). Participants in Sichuan province have lower satisfaction than other places. The MCA yielded similar factors consistent with multivariable results of clustering with different levels of CS satisfaction. Our study revealed that the CS coverage and satisfaction among staff from the primary healthcare system varied geographically and are associated with professional field, workload, and pressure. Measures that aim to promote the stability of primary care human resource should be considered in the future.

Poor Dietary Diversity Is Associated With Postpartum Depression: A Cross-Sectional Study

ObjectivesPostpartum depression (PPD), a major maternal health concern, gives negative effects on women health, child development and family well-being. Recently, diet quality has emerged as a possible preventative measure in ameliorating PPD, however the evidence-base exploring this association is immature. The aim of this study was to investigate the association between diet diversity and depression of postpartum women. MethodsA cross-sectional study was conducted on 554 postpartum women who set up files after delivery within 2 years at 10 community health service centers in Beijing from July to September 2017. The Edinburgh Postnatal Depression Scale(EPDS) in Chinese version was used to access the status of depression. Dietary intake was determined using a semi-quantitative food frequency questionnairea (FFQ). Dietary diversity score (DDS) was calculated based on scoring to the eight-food groups with frequency according to the Chinese Dietary Guidelines (2016). DDS ranged from 0–32, and was classified into two groups: low (≤26.5) and high (>26.5). Logistic regression models were used to estimate relationships between DDS and PPD. ResultsA total of 163 women (29.4%) were depressed above the EPDS cut-off score (≥ 13 scores). Mean (±-s.d.) of DDS was 27.9 ± 3.4. 28.7% of the subjects (n = 159) had low DDS and 71.3% (n = 481) had high DDS. After statistical adjustment for age and society correlation factors, lower DDS was significantly associated with PPD ([aOR] = 1.81, 95% [CI] = 1.13 - 2.89). ConclusionsThe present study found that low DDS, which means poor dietary diversity was associated with PPD in Chinese women after delivery within 2 years. Funding SourcesThis study was funded by grants from Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2019-I2M-2-007).

Combined management can decrease blood pressure: an investigation of health-seeking behaviors among hypertensive patients in urban communities in China

BackgroundHypertensive patients can freely choose informal medical facilities, such as pharmacies, community health service centres, and cardiology clinics in secondary or tertiary hospitals, as routine places for medical treatment in China currently. The proportions, influencing factors and effects of different health-seeking behaviours on blood pressure (BP) among hypertensive patients in urban communities are not clear. The aim of the study was to investigate health-seeking behaviours and the effects of different health-seeking behaviours on BP among hypertensive patients in urban communities in China.MethodsA cross-sectional survey of hypertension was conducted in urban communities in Chengdu. A total of 437 hypertensive patients seeking medical help regularly were sequentially enrolled to complete a the questionnaire on health-seeking behaviours.ResultsThe average age was 67.1 ± 7.5 years old. The control rate of BP was 41.0%, and the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 144.2 ± 17.9 mm Hg and 75.4 ± 10.4 mm Hg, respectively. Among the hypertensive patients investigated, 62.8% chose community health service centre, 5.2% chose informal medical facilities, 21.5% chose cardiology clinics in secondary or tertiary hospitals, and 10.5% chose both community health service centre and cardiology clinics as the usual places for medical treatment. There were significant differences in education levels, proportions of home BP monitoring, establishment of chronic disease archives in the community, medication adherence and side effects of drugs among the four groups. The control rates of BP were 39.4%, 23.8%, 43.0% and 54.8% (P = 0.100), respectively. The SBPs were 145.1 ± 18.0, 150.9 ± 19.8, 143.8 ± 17.5 and 136.3 ± 15.1 mm Hg (P = 0.007), respectively, and it was significantly lower in the combined management group than in the other three groups. Compared with patients choosing community health service centre, patients in the combined management group had a significantly lower BP level (β = −0.119, P = 0.038) adjusting for age, sex, education level, establishment of chronic disease archives, medication adherence and number of antihypertensive drugs.ConclusionsCombined management with both community health service centre and higher-level hospitals can decrease BP.

Decreased Sexual Desire among Middle-Aged and Old Women in China and Factors Influencing It: A Questionnaire-Based Study.

Objective This survey was designed and conducted with an aim to present data on sexual desire and activity in Chinese women. Methods Between October 2013 and December 2013, we surveyed 3000 women (aged 40–65 years) at Beijing No. 2 Hospital and the Yuetan Community Health Service Center using a questionnaire. The primary outcomes included determination of sexual desire in the past 4 weeks, reasons for stopping sexual activity, and postmenopausal syndrome. The secondary outcome was determination of factors for low sexual desire. Results A total of 2400 women (mean age 54.33 ± 6.25 years; mean menopausal age 50.11 ± 3.31 years) returned the questionnaire, with 58% of women reporting lowered sexual desire and 39.3% reporting stoppage of sexual activity. Compared with the postmenopausal group, the incidence of anxiety, depressive, somatic, and vasomotor symptoms was higher in the perimenopausal group. Muscle and joint pain (45.8%) and vaginal pruritus (21.5%) were the most commonly reported menopausal and vulvovaginal symptoms, respectively. The odds of decrease in sexual desire were significantly higher with older age, menopause, presence of gynecological disease, menopausal depression symptoms, menopausal vasomotor symptoms, and vulvovaginal atrophy; only cesarean delivery (odds ratio = 0.887, P=0.018) was associated with lesser reduction in sexual desire compared with the aforementioned factors. Conclusion This survey showed that a high proportion of Chinese middle-aged and old women have lowered sexual desire and activity. Lack of sexual desire is associated with multiple factors and affects the quality of life of women.

Intelligent Personalized Exercise Prescription Based on an eHealth Promotion System to Improve Health Outcomes of Middle-Aged and Older Adult Community Dwellers: Pretest–Posttest Study

BackgroundA scientific, personalized, and quantitative exercise prescription that has the potential to be an important therapeutic agent for all ages in the prevention of chronic disease is highly recommended. However, it is often poorly implemented, as clinicians lack the necessary knowledge and skills while participants have low adherence due to design defects (eg, prescriptions fail to take individual willingness, the appeal of exercise, and complex physical conditions into account). Intelligent personalized prescription is thus worth exploring.ObjectiveThe aim of this study was to investigate whether a year-long cloud platform–based and intelligent personalized exercise prescription intervention could improve Chinese middle-aged and older adult community dwellers’ health outcomes.MethodsA total of 177 participants (aged 52-85 years; mean 67.93, SD 7.05) were recruited from 2 Chinese community health service centers in Anhui Province, China. The exercise intervention was delivered over 12 months with a single-group pretest–posttest design. After being assessed in terms of physical activity, health-related lifestyle, history of chronic diseases and drug use, family history of disease and cardiovascular function, body composition, bone mineral density, and physical fitness through an eHealth promotion system, participants with relative contraindications for exercise were personally prescribed the health care exercise mode by an intelligent system, while those without relative contraindication and who had a regular exercise habit were prescribed the scientific fitness mode. Paired t tests were used for the analysis.ResultsA total of 97 participants were classified into the health care mode, and the remaining 80 participants were assigned to the scientific fitness mode. Significant changes in heart rate (mean difference [MD] 2.97; 95% CI 1.1-4.84; P=.002), subendocardial viability ratio (MD –0.13; CI: –1.19 to –0.63; P<.001), weight (MD 0.99; CI 0.29-1.69; P=.006), BMI (MD 0.38; CI 0.11-0.64; P=.006), body fat rate (MD 0.88; CI 0.24-1.51; P=.007), fat mass (MD 0.92; CI 0.33-1.53; P=.003), and brachial-ankle pulse wave velocity (MD: –0.72; CI –1.17 to –0.27; P=.002) were observed among participants with the health care mode exercise prescriptions at the 12-month postintervention versus the baseline assessment, while no changes in systolic blood pressure, diastolic blood pressure, muscle mass, bone mineral density, t value, z value, balance, or ability were discerned. The results showed a functional decline in the physical fitness of both groups, including in handgrip strength (healthcare mode: MD 4.41; scientific fitness mode: MD 3.11), vital capacity (healthcare mode: MD 261.99; scientific fitness mode: MD 250.78), and agility (healthcare mode MD=–0.35; scientific fitness mode: MD=–0.39) with all P values <.001, except handgrip strength in the scientific fitness mode (P=.002). There were no significant differences in other parameters among participants with scientific fitness mode exercise prescriptions.ConclusionsThe observations suggest that our exercise prescription intervention program might promote certain health outcomes in Chinese middle-aged and older adult community dwellers, yet we are unable to recommend such a program given the existing limitations. Future randomized controlled trials with diverse samples are warranted to confirm our findings.

Do Chinese Parents Deny to Vaccinate Their Children? An Analysis of Vaccine Hesitation and Influencing Factors

Background: China has the largest number of vaccinated population around the world. However, there has been little research on the prevalence and associated factors of vaccine hesitation among Chinese parents of preschool child, and further research is urgently needed. Therefore, we carried out a survey to evaluate the status of vaccine hesitation and its associated factors among children’s parents and provided an reference for relevant research and policy-making. Methods: A cluster random sampling method was adopted to select 6 community health service centers of Shenzhen, and parents of preschool children who were immunized in the vaccination outpatient department in the selected community health centers were recruited and surveyed using a structured questionnaire. Vaccine hesitation was assessed by the Parent Attitudes about Childhood Vaccines (PACV) scale. A multi-variable analysis assessed the relationship between demographics characteristics and scores of hesitance scale. Results: A total of 1,025 parents filled out the questionnaires with effective recovery rate of 93.18%. The average score of vaccine hesitancy was 43.37 (43.37±10.34) points, with 58.50% of parents have delayed having their child get a shot, and 74.73% of parents concerned that their child might have a serious side effect from a shot. The results of multiple linear regression showed the number of children in the family (β=-0.93, 95%CI: -1.31 – -0.54), the health status of the child (β=0.47, 95%CI: 0.07 – 0.87), the education level of the parents (Father:β=-0.84, 95%CI: -1.37 – -0.31; Mother: = -1.59, 95%CI: -2.13 – -1.05), and the annual family income (β=1.64, 95%CI: 1.13 – 2.16) were significant associated with vaccine hesitation. Conclusions: The average score of parents' vaccine hesitation in Shenzhen was 43.37. The results showed that the number of children in the family, the health status of the children, the educational level of the parents and the annual family income were important factors influencing the parents' vaccine hesitation. Funding Information: This study was supported by the National Social Science Foundation of China (18ZDA085) and Science and Technology Innovation Commission of Shenzhen. Declaration of Interests: We declare that we have no conflict of interests. Ethics Approval Statement: This study was approved by the Research Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China and performed in accordance with the principles of the Declaration of Helsinki. Respondents were informed that their participation was voluntary, and consent was implied on the completion of the questionnaire.

Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders.

Few studies have examined predictors of recurrent high ED use. This study assessed predictors of recurrent high ED use over two and three consecutive years, compared with high one-year ED use. This five-year longitudinal study is based on a cohort of 3121 patients who visited one of six Quebec (Canada) ED at least three times in 2014–2015. Multinomial logistic regression was performed. Clinical, sociodemographic and service use variables were identified based on data extracted from health administrative databases for 2012–2013 to 2014–2015. Of the 3121 high ED users, 15% (n = 468) were recurrent high ED users for a two-year period and 12% (n = 364) over three years. Patients with three consecutive years of high ED use had more personality disorders, anxiety disorders, alcohol or drug related disorders, chronic physical illnesses, suicidal behaviors and violence or social issues. More resided in areas with high social deprivation, consulted frequently with psychiatrists, had more interventions in local community health service centers, more prior hospitalizations and lower continuity of medical care. Three consecutive years of high ED use may be a benchmark for identifying high users needing better ambulatory care. As most have multiple and complex health problems, higher continuity and adequacy of medical care should be prioritized.

Correlation between Sarcopenia and Arteriosclerosis in Elderly Community Dwellers: A Multicenter Study.

Evidence suggests that arteriosclerosis and sarcopenia (decreased muscle mass) share some of their many causes. However, after controlling for confounding factors, it is unclear whether the presence of arteriosclerosis correlates with sarcopenia. The aim of this paper is to explore whether sarcopenia is associated with arteriosclerosis. A multicenter cross-sectional community-based study. A total of 2511 elderly subjects from six Chinese community health service centers in Anhui province were surveyed through an e-health promotion system to collect basic data and measurements of brachial-ankle pulse wave (baPWV), body composition, and handgrip strength (HGS). Pearson's correlation and binary logistic regression analyses were performed to identify associations between sarcopenia and high baPWV. The prevalence rates of sarcopenia were 12.9% in men and 15.3% in women according to the 2019 standard of Asian Working Group for Sarcopenia. Among subjects with high baPWV, the proportion of sarcopenia was higher compared to those with normal baPWV (men: 17.7% vs. 3.7%; women: 20.4% vs. 4.9%, both p<0.001). Binary logistic regression analysis revealed that sarcopenia was associated with high baPWV (p<0.0001, odds ratio=1.619) after adjusting for confounding factors. HGS slightly and negatively correlated with baPWV (-0.19 in men and -0.18 in women). The intertwined pathophysiological mechanisms shared by arteriosclerosis and sarcopenia are potential targets for future interventions to reduce morbimortality in subjects with both disorders. Upcoming prospective studies and clinical trials are expected to advance these findings.