ABSTRACT
Objective:To explore the core competency of doctors in tertiary public hospitals in regions of different income levels in China, and provide reference for promoting such competency and related policy formulation.Methods:Using multi-stage stratified cluster sampling method, 195 tertiary public hospitals in 16 provinces of China were selected from November 2021 to March 2022. 200 doctors were sampled from each hospital. A self-designed questionnaire was used to investigate the status of doctors′ core competencies, as well as the status of their postgraduate medical education and continuing medical education. According to the per capita gross regional product of each province in China Statistical Yearbook 2022, each province was divided into high, middle and low income regions, and the questionnaire data were descriptively analyzed, while χ2 test was used to compare the differences between groups. Results:A total of 32 673 valid questionnaires were collected. There were 12 135 doctors (37.14%) in China who had received comprehensive education and training of core competency in all dimensions. Among the dimensions of self-rated core competency of the surveyed doctors, there were 10 019 doctors (30.66%) with insufficient teaching ability and 438 (1.34%) with insufficient professional quality, and there was no significant difference between regions ( P>0.05). There were 2 385 (27.08%), 2 528 (27.55%) and 3 646 (24.82%) doctors in high-, middle- and low-income regions with insufficient lifelong learning ability, respectively. The proportion of doctors in middle- and high-income regions was higher than that in low-income ones ( P<0.05). There were 1 317 (15.57%), 1 290 (14.06%) and 2 719 (18.51%) doctors with insufficient knowledge and skills in high-, middle- and low-income areas, respectively. The proportion of doctors in low-income regions was higher than that in middle- and high-income regions ( P<0.05). The proportion of doctors who did not receive any kind of postgraduate medical education or continuing medical education in low-income regions was 7.33% (1 077 people), higher than that in high-income and middle- income ones ( P<0.05); 50.44% (4 442 people) of surveyed doctors in high-income regions believed that for standardized training of resident physicians (hereinafter referred to as residential training), the clinical teachers were " overworked to take this job", which was higher than that in middle- and low-income regions ( P<0.001); In middle-income regions, 46.16% (4 235 people) and 43.46% (3 987 people) believed that the salary residents and specialized physicians in standardized training (hereinafter referred to as specialized training) was too low, while 42.47% (3 897 people) and 30.44% (2 793 people) believed that the clinical practice opportunities of students were limited, both of which were higher than those in high-income and low-income regions ( P<0.001); 34.91% (5 128 people) of surveyed doctors in low-income regions believed that the investment was insufficient for training bases of residential training, 27.81% (4 085 people) of those held that training bases for specialized training were unevenly distributed, and 33.19% (4 876 people) of those held that continuing medical education was plagued by " insufficient promotion coverage, and insufficient opportunities for primary doctors", all of which being higher than those in high- and middle-income regions ( P<0.001). Conclusions:There is an obvious need to improve the core competence of doctors in the teaching ability dimension of tertiary public hospitals in China, especially in middle- and high-income regions for lifelong learning, and in low-income regions for knowledge and skills; There are differences between postgraduate medical education and continuing medical education systems in regions of different income levels in China. It is necessary to improve the competency oriented postgraduate medical education and continuing medical education systems.
ABSTRACT
Objective:To analysis the prevalence and characteristics of comorbid insomnia and sleep disordered breathing (SDB) in community population.Methods:This is a cross-sectional study. Cluster sampling was applied. Community residents in Shantou and Meizhou were investigated during April to May, 2021. Essential information collection, sleep related health investigation, and sleep study were conducted. Insomnia was defined as the insomnia severity index (ISI)≥8. A type Ⅳ wearable intelligent sleep monitor was applied for sleep study. Comorbid insomnia and SDB was defined as both diagnosis of insomnia and SDB. Statistical analysis was conducted by SPSS 25. Prevalence and characteristics of insomnia only, SDB only and comorbid insomnia and SDB were analyzed. Logistic regression was conducted to analyze the relationship between sleep disorders and unrestored sleep, abnormal glucose metabolism, hyperlipidemia, and cardiovascular disease.Results:There were 3 730 residents completed the investigation. The median age was 55.0 (46.0, 63.0) years. The prevalence of insomnia only, SDB only, and comorbid insomnia and SDB were 26.0%, 20.2%, and 10.4% respectively. The incidence of unrestored sleep in insomnia only and comorbid insomnia and SDB were 2.900 times and 3.777 times of that in no insomnia or SDB (both P<0.001); the risk of hyperlipidemia was elevated in insomnia only, SDB only and comorbid insomnia and SDB ( OR=1.553, 1.415, and 1.868; all P<0.05); the risk of cardiovascular disease increased 40.8% in SDB only ( P=0.001), and 42.1% in comorbid insomnia and SDB ( P=0.007), after adjusted by age, sex, body mass index (BMI), smoking, drinking, abnormal glucose metabolism, and hyperlipidemia. Stratified analysis revealed that young female (age<60 years) with normal BMI (<25 kg/m 2) and comorbid insomnia and SDB were associated with higher risk of cardiovascular disease. Female with normal body weight and insomnia only or comorbid insomnia and SDB were associated with higher risk of hyperlipidemia. Conclusions:The prevalence of comorbid insomnia and SDB is high in community population. Patients with comorbid insomnia and SDB present with more significant unrestored sleep, and are correlated with higher risk of hyperlipidemia and cardiovascular diseases.
ABSTRACT
BACKGROUND@#The prevalence of hypertension is high among Chinese adults, thus, identifying non-hypertensive individuals at high risk for intervention will help to improve the efficiency of primary prevention strategies.@*METHODS@#The cross-sectional data on 9699 participants aged 20 to 80 years were collected from the China National Health Survey in Gansu and Hebei provinces in 2016 to 2017, and they were nonrandomly split into the training set and validation set based on location. Multivariable logistic regression analysis was performed to develop the diagnostic prediction model, which was presented as a nomogram and a website with risk classification. Predictive performances of the model were evaluated using discrimination and calibration, and were further compared with a previously published model. Decision curve analysis was used to calculate the standardized net benefit for assessing the clinical usefulness of the model.@*RESULTS@#The Lasso regression analysis identified the significant predictors of hypertension in the training set, and a diagnostic model was developed using logistic regression. A nomogram with risk classification was constructed to visualize the model, and a website ( https://chris-yu.shinyapps.io/hypertension_risk_prediction/ ) was developed to calculate the exact probabilities of hypertension. The model showed good discrimination and calibration, with the C-index of 0.789 (95% confidence interval [CI]: 0.768, 0.810) through internal validation and 0.829 (95% CI: 0.816, 0.842) through external validation. Decision curve analysis demonstrated that the model was clinically useful. The model had a higher area under receiver operating characteristic curves in training and validation sets compared with a previously published diagnostic model based on Northern China population.@*CONCLUSION@#This study developed and validated a diagnostic model for hypertension prediction in Gansu Province. A nomogram and a website were developed to make the model conveniently used to facilitate the individualized prediction of hypertension in the general population of Han and Yugur.
Subject(s)
Adult , Humans , Asian People , China/epidemiology , Cross-Sectional Studies , Health Surveys , Hypertension/epidemiology , Nomograms , EthnicityABSTRACT
This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
ABSTRACT
Objective:To establish the reference for serum metabolomics profiles among healthy Han adults in China, and explore the variation on metabolomics profiles by geographic regions, sex, and age.Methods:Cross-sectional data and serum samples were obtained from the China National Health Survey. A total of 1 039 male and 1 032 female healthy adults(≥30 years) were included in this study. Serum metabolomics analyses were conducted with ultra-performance liquid chromatography-mass spectrometry(UPLC-MS). Orthogonal partial least squares discriminant analysis(OPLS-DA) was performed to compare the differences of metabolomics among different region, sex, and age.Results:Significant differences on metabolomics profiles were identified among region, sex, and age. A total of 114 region-related metabolites were spotted, including 53 metabolites that involved in human metabolic pathways, mainly peptides(20 metabolites) and glycerophospholipid metabolism-related(14 metabolites). Fifty-nine metabolites were pinned down to be sex-related, among which cotinine was significant in all 7 provinces. Age-related metabolites were only found in Shaanxi and Hainan, with 22 metabolites were recognized.Conclusion:Serum metabolomics varies by geographic regions, sex, and age. When metabolomics is applied for diagnosis or biomarker screening in various studies, it shall take into consideration of setting tailored references.
ABSTRACT
Objective@#To investigate the self-reported prevalence, clinical characteristics, complications of allergic rhinitis (AR) and the sensitization of outdoor air pollen allergens in children in the Inner mongolia grassland region.@*Methods@#A multistage, stratified and random clustered sampling with a face-to-face interview survey study in children from 0 to 17 years old was performed together with 10 common allergen skin prick tests (SPT) and measurements of the daily pollen count in 6 regions in the Inner mongolia grassland region from May to August of 2015. SAS 9.4 software was used for data analysis.@*Results@#A total of 2 443 subjects completed the study. The self-reported prevalence of AR was 26.6%. The prevalence of boys was higher than that of girls (28.8% vs 24.3%, χ2=6.157, P<0.05). Subjects from urban areas showed higher prevalence than rural areas (34.7% vs 18.8%, χ2=79.107, P<0.05). There was significant regional difference in the prevalence of AR among the six areas investigated (χ2=221.416, P<0.05). The main clinical symptoms of AR were sneezing (88.2%) and nasal congestion (78.6%). Among combined diseases, asthma accounted for 16.5% (107/650), rhinoconjunctivitis accounted for 47.9% (311/650). The peak season of AR was April and July, with the top SPT positive allergens of Artemisia species and chenopodium in this area.@*Conclusions@#The prevalence AR in children in the Inner mongolia grassland region is extremely high. Sneezing is the main clinical symptom. Rhinoconjunctivitis is the most common combined disease. High summer and autumn pollen exposure is the main cause of AR.
ABSTRACT
Incidence of thyroid cancer has continuously increased in the last three decades globally. A similar trend of thyroid cancer incidence appeared in China. New cases and deaths of thyroid cancer in China accounted for 15.6% and 13.8% of the global new cases and deaths in 2012. The incidence in East China was the highest while that in Middle China was the lowest. Thyroid cancer was more common in urban areas than in rural counterparts. The incidence was substantially higher in female patients than male. Thyroid cancer occurred most commonly in middle age. Radiation exposure, iodine suffciency or deifciency, sex hormone and genetic mutations were risk factors for thyroid cancer. To prevent it, potassium iodide should be taken to prevent radiation fallout in nuclear accidents, unnecessary exposure to radiation from medical imaging is reduced, iodine surveillance system is improved and appropriate standards for iodized salt are established.
ABSTRACT
<p><b>OBJECTIVE</b>To understand the fast plasma glucose (FPG) level and the epidemiologic characteristics of diabetes in ethnic Han residents of Guizhou province.</p><p><b>METHODS</b>The survey was conducted among the ethnic Han residents aged 20-80 years, who were selected through multi stage cluster sampling in Guizhou. Basic laboratory test, physical examination were performed for each subject.</p><p><b>RESULTS</b>A total of 2 967 subjects were surveyed. The average FPG level was 5.21 mmol/L for urban residents and 5.03 mmol/L for rural residents, (P<0.001) and the average FPG level was higher in males than in females (5.23 mmol/L vs. 5.09 mmol/L, P=0.003). The FPG level increased with age (P<0.001). In urban residents, the standardized prevalence of diabetes was 6.01% (crude prevalence: 7.45%), higher in males than in females (P<0.001) and increased with age. In rural residents, the standardized prevalence of diabetes was 3.47% (crude prevalence: 3.77%) and increased with age, but there was no sex specific difference in diabetes prevalence. The awareness rate of self diabetes status was 56.59%, the treatment rate was 84.47% and the plasma glucose control rate was 41.38%. Multiple logistic regression analysis indicated that risk factors for diabetes included being male, older than 40 years, family history of diabetes, frequent physical exercise, hypertension, high triglycerid level.</p><p><b>CONCLUSION</b>The prevalence of diabetes was high in ethnic Han residents in Guizhou, the differences in diabetes prevalence between urban area and rural area was statistical significant. More than half of the patients' FPG level had not been under control after treatment. The awareness rate of self diabetes status, the treatment rate and the control rate of diabetes should be improved.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , China , Epidemiology , Diabetes Mellitus , Epidemiology , Ethnicity , Exercise , Hypertension , Prevalence , Risk Factors , Rural Population , Surveys and QuestionnairesABSTRACT
Objective To explore the prevalence of anemia,iron deficiency and iron deficient anemia (IDA),and to identify their risk factors in 3 to 6 months infants in Dongcheng District of Beijing.Methods All the 845 infants aged 3 to 6 months who received bacille calmette guerin (BCG) vaccine during December 2010 and October 2011 in Hepingli Hospital of Beijing were invited to complete the investigation.Data (months,gender,birth weight,birth height,etc) were collected through a questionnaire survey.Infants were tested for hemoglobin (Hb),mean corpuscular volume (MCV),mean corpuscular hemoglobin (MCH),mean corpuscular hemoglobin concentration (MCHC),serum ferritin (SF) and zinc protoporphyrin (ZPP) and mothers underwent measurement for Hb,SF and serum iron (SI).Descriptive epidemiology and non-conditional logistic regression model were used to analyze the prevalence of nutritional anemia.Results The prevalence of anemia,iron deficiency and IDA was 12.06％,7.38％ and 2.11％,respectively.Non-conditional logistic regression analysis showed that the associated factor of anemia in infants was month age (vs.3-4 months age group,4-5 months age group:odds ratio (OR) =0.496,95％ confidence interval (CI) 0.272-0.905 ; 5-6 months age group:OR =0.494,95％ CI 0.234-1.043).The factors associated with iron deficiency were month age (vs.3-4 months age group,4-5 months age group:OR =0.539,95％ CI 0.266-1.088 ; 5-6 months age group:OR =0.334,95％ CI 0.125-0.891) and time of first breast-feeding (vs.the first day,the second day:OR =2.359,95％ CI 1.191-4.675; the third day:OR =1.154,95％ CI 0.450-2.963).Conclusions Our data show that iron nutrition in 3 to 6 months-old infants in Dongcheng District of Beijing was in good situation.The influencing factors of iron nutrition in infants may be month age and the time of first breast feeding.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate trends of overweight and obesity prevalence between 1996 and 2007 in Yi farmers and Yi migrants.</p><p><b>METHODS</b>An Yi migrant study was conducted in Liangshan Yi Autonomous Prefecture, Sichuan Province, China from 1996 to 2007. Data were collected with identical methods, including standardized questionnaire and body measurements.</p><p><b>RESULTS</b>Age- and sex-specific body mass index (BMI) significantly increased from 20.02 in 1996 to 22.36 in 2007, among Yi farmers, which was significantly different from those among Yi migrants (23.67 in 2007 and 20.90 in 1996) (P<0.05). Prevalence of obesity rose from 1.21 % in 1996 to 4.55 % in 2007 (OR=1.15, P<0.001) in Yi migrants, while that in Yi farmers from none in 1996 to 0.12 % in 2007 (P>0.05). Prevalence of overweight rose significantly to 26.24 % in 2007 from 17.24 % in 1996 (OR=1.06, P<0.001) in Yi migrants, while that in Yi farmers from 1.29 % in 1996 to 4.45 % in 2007 (OR=1.14, P>0.001). Yi migrants appeared to have a 5.52-fold higher risk on developing overweight and obesity than Yi farmers have.</p><p><b>CONCLUSION</b>The Yi migrants had a steeper increase of overweight with year and consequently caused more obesity. Change in lifestyle may contribute most likely to higher prevalence of overweight and obesity in Yi migrants.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Agriculture , Body Mass Index , China , Epidemiology , Obesity , Epidemiology , Overweight , Epidemiology , Prevalence , Rural Population , Transients and Migrants , Urban PopulationABSTRACT
Objective To investigate the awareness of HIV/AIDS and risk behaviors among migrant workers at construction sites in Beijing. Methods The methods of cluster sampling was employed,a questionnaire survey was administered among 1000 migrant workers from two construction sites and a face-to-face interview with the informed consent was conducted in a limited scope.Results There was considerable disparity in the awareness of the routes of AIDS transmission;66.8% of the migrant workers were aware that the condom could reduce the risk of infection,but 51% of them had never used it.Only 2.3% of the migrant workers had sexual intercourse with female sex workers.Conclusion Although the migrant workers under survey have some basic knowledge on HIV/AIDS,their essential understanding was mostly vague,and financial condition have restricted to a great extent their risk behaviors.