Demand and supply of community-based care services for the elderly in China and its influencing factors / 中华老年医学杂志

Objective:To explore the demand and actual supply of community-based care services for the elderly residents and the factors that affecting care mode for them in the context of rapid urbanization and population aging in China.Methods:Based on the cross-sectional data of the seventh China Longitudinal Survey on Health and Longevity(CLHLS)(2018), 15 854 elderly residents aged 60 and above were selected as the research population.Logistic regression method was used to analyze the patterns of community-based care services and their influencing factors.Results:Among 15 854 elderly residents, 6 912(43.60%)were male and 8 942(56.40%)were female.The results of activities of daily living(ADL)evaluation showed that 11 109 elderly residents could take care of themselves completely, and 3 889 elderly residents were disabled.The disability rate was 25.93%.The proportion of social services that elderly town dwellers expect the community to provide is higher than those living in cities and rural areas in terms of daily care, spiritual care, providing health care knowledge, and dealing with neighborhood disputes.From the perspective of social services actually provided by the community, in addition to providing home-based care, the proportion of community services available to the elderly living in towns and rural areas are similar, but significantly lower than the proportion of social services provided for elderly city dwellers.Age, marital status, residence, cultural differences, health status, source of life and living preference had significant impacts on the choice of care demand patterns.Those of older age( OR=2.29, 95% CI: 1.04-5.03 for 70-79 years old; OR=2.94, 95% CI: 1.38-6.25 for elderly 80 years old or above), having no spouse( OR=3.50, 95% CI: 2.49-4.92), and with higher levels of disability( OR=4.24, 95% CI: 3.12-5.77 for mild disability; OR=7.54, 95% CI: 5.19-10.95 for moderate disability; OR=10.50, 95% CI: 7.59-14.53 for severe disability)are more inclined to choose socialized care. Conclusions:In the process of rapid urbanization in China, the demands for care services of elderly living in towns has increased, but the actual care services provided for them by the communities are yet to be improved.Moreover, elderly town dwellers are still inclined to family care, the same as those of elderly rural dwellers.

Discussion of data problems and improvement measures in clinical trials: Based on CRC work assessment in a grade A tertiary hospital / 中华医学科研管理杂志

Objective:The Clinical Research Coordinator (CRC) is responsible for transcribing and verifying clinical trial data, and making recommendations to research institutions and sponsors on clinical trial data through analyzing and discussing data problems found in CRC work assessment, thereby improving the quality of clinical trials.Methods:Based on the ALOCA+ Principle, this study analyzed the data problems found in CRC assessment based on clinical trial quality conducted in a grade A tertiary hospital in Beijing from November 2018 to December 2021, and discussed improvement measures for clinical trial data problems.Results:Among the clinical trial data problems, data integrity is the most prominent, followed by accuracy.Conclusions:Research institutions and sponsors should improve the data management system and SOP, strengthen the training for clinical trial participants, optimize a trial plan and process design, strengthen supervision and inspection, and establish a risk-based quality control system, etc., so as to make clinical trial data conform to the international ALOCA+ principle and make clinical trial results accurate and reliable.

Study on the influencing factors of clinical trial initiation efficiency / 中华医学科研管理杂志

Objective:To analyze the time cost in the start-up stages of clinical trials and to investigate the influencing factors of the initiation efficiency.Methods:We retrospectively analyzed time-cost of the review and approval of drug clinical trials initiated in Beijing Hospital from January 2020 to June 2021.The contract signing time and trial starting time of drug clinical trials in different situations were compared.Results:The mean time to sign the contract in our hospital was 19(11~26) days, and the mean time to start experiment was 235(175~317) days. There was no significant difference in the contract signature time between clinical trials with different stages, different sponsors, different types of drugs and whether to be the leading site ( P>0.05). Compared with other phases, phase Ⅲ drug trials took the longest time to start, and the mean initiation time of clinical trials initiated by foreign pharmaceutical companies was 136 days longer than that initiated by domestic pharmaceutical companies ( P<0.05). Conclusions:Clinical trial institutions should optimize the project management process, better organize the contract review and ethics review, encourage the sponsor to use our template document. Every department may set up a GCP contact to be responsible for clinical trials; The sponsor should improve the efficiency of internal circulation and communication, submit the review materials as soon as possible according to the requirements of the institution, and establish a good communication and feedback mechanism between both sides, may shorten the start-up time of clinical trials and improve the initiation efficiency.

Representative analysis of elderly subjects in clinical trials of prostate cancer drugs / 中华老年医学杂志

Objective:To analyze whether the sample of elderly subjects in clinical trials of prostate cancer drugs is representative.Methods:From the level of trial design, the age distribution of subjects in clinical trials of prostate cancer drugs for elderly patients from January 2019 to December 2021 was inquired on the platform of drug clinical trial registration and information disclosure.From the actual enrollment level, the prostate cancer drug clinical trials initiated and completed by a hospital from January 2010 to June 2022 were collected.The age information of subjects in all centers was collected for multicenter trials with a summary report, and the age data of subjects in the center was collected for trials without a summary report or single-center trials.The average age of prostate cancer onset and the incidence of prostate cancer in different age groups were compared with the Chinese Cancer Registry System, so as to compare whether the two were consistent.Results:Most of the trials(72.1%、44/61)did not set upper age limit at the protocol design level.Phase Ⅲ and phase Ⅳ trials did not set an upper age limit for enrolled subjects in the protocol.From the actual enrollment level, a total of 19 studies were included in this study, with 1 402 subjects, and the average age of subjects was 67.1±8.6 years old, which was significantly different from the average age of prostate cancer in China and Beijing(all P<0.001). The age group with the largest number of participants was 60-64 years old(34.2%、479/1 402). The population aged ≥75 years was the least(21.5%, 301/1 402), which was different from the high incidence age group of prostate cancer in China in 2017(421.77/100 000). Conclusions:Clinical trials of prostate cancer drugs are designed to cover all age groups of elderly patients, but the actual sample representation of the enrolled elderly subjects is insufficient.Under the premise of protecting the safety of subjects, the trial population who are matched for the average age of prostate cancer onset and the incidence of prostate cancer in age groups, should be gradually increased.

Traditional Chinese Medicine excessive pattern correlation analysis of chronic obstructive pulmonary disease complicated acute exacerbation of chronic pulmonary heart disease / 国际中医中药杂志

Objective:To explore the correlation between Traditional Chinese Medicine (TCM) excessive patterns and clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease (COPD) complicated with chronic pulmonary heart disease (CPHD) in high altitude environment.Methods:Patients with acute exacerbation of COPD complicated with CPHD admitted to the Pulmonology Department of Qinghai Provincial Hospital of Traditional Chinese Medicine from December 2016 to November 2017 were selected. Demographic data and clinical medical characteristics data of the patients were collected, and TCM patterns differentiation was conducted. The correlation between each pattern type and clinical characteristics and all collected laboratory indexes were analyzed by multivariate logistic regression.Results:Phlegm obstructing lung pattern showed a negative correlation relationship with mMRC score [ OR=0.419, 95% CI (0.219-0.802), P=0.009], PCT [ OR=8.132×10 -11, 95% CI (1.632×10 -16-4.1×10 -5), P<0.001], Hb [ OR=0.971, 95% CI (0.952-0.989), P=0.002] and PaCO 2[ OR=0.914, 95% CI (0.853-0.980), P=0.011]; turbid phlegm obstructing lung pattern showed a negative correlation relationship with gender(0 male, 1 female) [ OR=0.427, 95% CI (0.204-0.892), P=0.024], Hb [ OR=0.960, 95% CI (0.945-0.975), P<0.001], and there was a positive correlation relationship with LVEF [ OR=1.061, 95% CI (1.006-1.118), P=0.028]; phlegm-heat obstructing lung pattern showed a negative correlation relationship with Hb [ OR=0.950, 95% CI (0.927-0.974), P<0.001]and cardiac function grade [ OR=0.468, 95% CI (0.248,0.881), P=0.019], and there was a positive correlation relationship with PCT [ OR=1.118×10 8, 95% CI (1.466×10 4-8.523×10 11), P<0.001] and D-D [ OR=2.283, 95% CI (1.300-4.010), P=0.004]; there was a negative correlation between phlegm and stasis blocking lung pattern with cardiac function grade[ OR=0.309, 95% CI (0.167-0.570), P<0.001], and there was a positive correlation relationship with Hb[ OR=1.060, 95% CI (1.042-1.078), P<0.001]; there was a negative correlation between wet phlegm and blood stasis heat pattern with PCT [ OR=1.266×10 -13, 95% CI (1.658×10 -21-0.1×10 -4), P<0.001], SaO 2 [ OR=0.934, 95% CI (0.892-0.979), P=0.004], LVEF [ OR=0.896, 95% CI (0.826-0.971), P=0.008], D-D [ OR=0.030, 95% CI (0.002-0.508), P=0.015], and there was a positive correlation relationship with CRP [ OR=1.042, 95% CI (1.018-1.067), P<0.001], RBC [ OR=3.411, 95% CI (1.684-6.910), P<0.001], cardiac function grade [ OR=8.573, 95% CI (2.410-30.504), P<0.001], pulmonary arterial pressure difference [ OR=2.091, 95% CI (1.243-3.516), P=0.005]. Conclusions:Male patients are more prone to phlegm and turbidities than female patients. PCT and D-D were the main risk factors of phlegm-heat obstruction syndrome. Elevated hemoglobin is a risk factor for patients with phlegm stasis and lung syndrome. Heart function classification is the main risk factor of phlegm-dampness-stasis heat syndrome.

Analysis of types and medication of common chronic diseases in the elderly visiting primary medical institutions in eight provinces and cities / 中华老年医学杂志

Objective To investigate the types of common chronic diseases and common drugs in the elderly visiting primary medical institutions in China.Methods Cluster sampling was adopted in eight provinces/cities/autonomous region of Zhejiang,Jilin,Henan,Shanghai,Chongqing,Gansu,Guangxi and Jiangsu.Sampling sites were selected and information was collected through the online reporting system of common diseases and drug costs of the elderly in primary hospitals at all levels in China.On these grounds,the basic situation of primary medical institutions,the common chronic diseases and common drugs for people aged 65 years and above were investigated.Results Primary hypertension(65.7％ or 46/70)and arthropathy(10.0％ or 7/70)were the most common chronic diseases in the elderly visiting primary medical institutions.The consultation rate of primary hypertension was highest both in rural areas(58.3％,i.e.the ratio of 21 over 36 primary medical institutions)and in urban areas(73.5％,i.e.the ratio of 25 over 34 primary medical institutions).The primary medical institutions with consultation rates of hypercholesterolemia/hyperlipidemia (x2 =5.137,P=0.023),diabetes(x2 =3.868,P =0.049)and dyspepsia(Fisher's exact test,P =0.026)as the top 3 chronic diseases were more often seen in urban areas than in rural areas,while the primary medical institutions with consultation rates of cerebrovascular diseases as the top 3 chronic diseases were more often seen in the rural areas than in urban areas(x2=9.974,P =0.002).More primary medical institutions with consultation rates of benign prostatic hyperplasia and primary osteoporosis as the top 10 chronic diseases were found in urban areas than in rural areas(x2 =4.054 and 3.861,P =0.044 and 0.049,respectively),while more primary medical institutions with consultation rates of heart failure as the top 10 chronic diseases were found in rural areas than in urban areas(x2 =3.865,P =0.049).Aspirin,nifedipine and simvastatin one by one were most commonly used in people aged 65 years and over in primary medical institutions.Conclusions Primary hypertension is the most common chronic disease among the elderly visiting primary medical institutions in both rural and urban.Common chronic diseases in primary medical institutions are different between the urban and rural areas.Regional differences and urban-rural differences should be taken into account in drug preparation.There are some irregularities in the use of drugs and insufficient stocks of essential drugs in basic-level medical institutions.

Clinical trial investigators′ satisfaction with clinical research coordinators and discussion on managing strategy / 中华医院管理杂志

Objective To learn the investigators′ satisfaction with CRCs and to identify the shortcomings with the CRC industry or institutional management for improvement. Methods A questionnaire survey was conducted among 120 clinical trial investigators at three tertiary general hospitals in January 2018. The questionnaire covered the basics, satisfaction with CRC, and comments of the investigator on other works of the CRC. The data acquired were subject to descriptive analysis, and the count data comparison method was Fisher precise test. Results The investigators were satisfied with CRCs in general. Specifically, their satisfaction with the " sense of responsibility" , " work hours" , and " command of GCP protocols"ranged 72.6% to 83.2% . That with " initiative" , " work stability" , and " rich clinical trial experience" fell below 60.0%. Affiliation of CRCs was correlated to "initiative"(P=0.007), and "command of clinical trial schemes and trial procedures" ( P =0.043), while investigators′ satisfaction with CRCs of uncertain affiliation fell significantly. Investigators′ experience was correlated to the " command of GCP protocols" of CRCs(P=0.035 ), as the more experienced the investigator, the less their satisfaction with the CRC. Conclusions Hospitals are expected to build a CRC standardized training system and hierarchical certification system; to standardize their CRC recruitment mechanism for overall management; to enhance their budgeting capability for sufficient CRC expenses, higher investigator efficiency and assured clinical trial quality.

Quality evaluation of Meta-analyses published on Chinese journals of geriatrics / 中华老年医学杂志

Objective To evaluate the reporting quality of Meta-analyses published on Chinese journals of geriatrics.Methods Papers of Meta-analyses on geriatrics published in nine major Chinese journals of geriatrics before November 21,2013 were retrieved,their basic information were abstracted and evaluated through system assessment and preferred reporting items for systematic reviews and Meta-analyses (PRISMA) statement.Statistical analyses were performed with the SPSS17.0 software.Results Among the 71 internalized papers,1 was from 《Geriatrics & Health Care》,1 from 《Practical Geriatrics》,10 from 《Chinese Journal of Geriatric Care》,45 from 《Chinese Journal of Gerontology》,3 from 《Chinese Journal of Multiple Organ Diseases in the Elderly》,1 from 《Chinese Journal of Geriatric Dentistry》,5 from 《Chinese Journal of Geriatric Heart Brain and Vessel Diseases》,5 from 《Chinese Journal of Geriatrics》.55 papers (77.5％) were published in recent 3 years.The mean overall PRISMA score was(16.75±3.04)ranged from 4 to 24.The main influencing factor for the quality of Meta-analyses was the year of publication (adjusted β=-0.342,P=0.003).Conclusions The quantity and quality of Meta-analyses published on Chinese journals of geriatrics are increased and improved in recent years,but there are still some problems on the writing norms.We should promote PRISMA statement and standardize reporting format to improve the quality of Meta-analyses in the field of geriatric medicine.

Analysis of the treatment institution selection and its influencing factors in elderly patients with chronic diseases in a community in Changsha / 中华老年医学杂志

Objective To investigate the status of treatment institution selection and its influencing factors in elderly patients with chronic diseases in a community in Changsha.Methods By using systematic sampling,400 elderly patients with chronic diseases from June to August 2012 were included in the investigation by questionnaires.The influencing factors were analyzed by binary logistic regression model or multinomial logistic regression model on the basis of the numbers of response variables.Results In mild conditions in self-consciousness,more than half of the elderly patients with chronic diseases (206 cases,51.5％) preferred community health service centers including private clinics (67 cases,16.8％),municipal hospitals (92 cases,23.0％),third-grade class-A hospitals (35 cases,8.8％).In serious conditions in self-consciousness,patients preferred third-grade class-A hospital (238 cases,59.5％) and municipal hospitals (162 cases,40.5％),no one selected the private clinics or community health service center (x2=443.240,P＜0.001).The analysis of impact factors for the first treatment institution selection in patients with serious conditions in self-consciousness showed that,compared with patients selecting the municipal hospital,the following personnel preferred to choose third-grade class-A hospital:patients in the staff remaining in positions (OR=32.38) and retirees (OR=15.17),patients with monthly income more than 5,000 yuan (OR=134.28),rural cooperative medical patients (OR=661.42),patients with highly trusting in community health service centers (OR=4.23),patients with BP and serum glucose determination at a frequency of once a month to every three months (OR=83.93),patients unknowing the telephone numbers of community health service centers(OR=3.02)and patients living far away from community health service centers (OR=15.70),patients with little information about community health service centers (OR=1.62).The analysis of impact factors for the first treatment institution selection in patients with mild conditions in self-consciousness showed that,compared with patients selecting the private hospitals,the following personnel preferred to choose community health service centers:patients with primary education level (OR=0.15),retired persons (OR=0.14),patients with higher health attention (OR=0.26),while persons with less health attention (OR-10.65) and patients living far away from community health service center (OR =5.22) were more willing to choose the private hospitals.Conclusions Patient selection for treatment agencies is affected mainly by the perceived severity,in addition,age,education level,employment status,income,health insurance type,trust and understanding on community health services centers,and the emphasis on health and the distance from community health services centers.

Strengths and Difficulties Questionnaire in 737 primary and middle school students aged 6 -17 in Changsha / 中南大学学报(医学版)

OBJECTIVE@#To explore the mental health condition of primary and middle school students in Changsha and to provide reference for future evaluation or intervention.@*METHODS@#Strengths and Difficulties Questionnaire (SDQ) (the edition for parents) was used to investigate 737 primary and middle school students aged 6-17 in Changsha.@*RESULTS@#The prevalence of difficulty was 14.11%. The males showed higher scores of problem, hyperactivity and impact, while the females scored higher in emotional symptom as well as prosocial behaviors. Students aged 11-13 and 14-17 showed higher scores of total difficulties, peer problems and emotional symptom than those aged 6-10. Apart from higher scores of total difficulties and peer problems, the other scores were similar to the normal scores in China. there was significant difference in the normal scores between china and other countries.@*CONCLUSION@#mental health problems have divergent characters in gender and age. This study also highlights the importance of establishing local norms of SDQ and the need for appropriate measures in practical situations.