Structural changes of the frontal cortex in depressed mice are associated with decreased expression of brain-derived neurotrophic factor / 南方医科大学学报

OBJECTIVE@#To investigate the changes in gray matter volume in depressive-like mice and explore the possible mechanism.@*METHODS@#Twenty-four 6-week-old C57 mice were randomized equally into control group and model group, and the mice in the model group were subjected to chronic unpredictable mild stimulation (CUMS) for 35 days. Magnetic resonance imaging was performed to examine structural changes of the grey matter volume in depressive-like mice. The expression of brain-derived neurotrophic factor (BDNF) in the grey matter of the mice was detected using Western blotting and immunofluorescence staining.@*RESULTS@#Compared with the control mice, the mice with CUMS showed significantly decreased central walking distance in the open field test (P < 0.05) and increased immobile time in forced swimming test (P < 0.05). Magnetic resonance imaging showed that the volume of the frontal cortex was significantly decreased in CUMS mice (P < 0.001, when the mass level was greater than or equal to 10 756, the FDRc was corrected with P=0.05). Western blotting showed that the expression of mature BDNF in the frontal cortex was significantly decreased in CUMS mice (P < 0.05), and its expression began to decrease after the exposure to CUMS as shown by immunofluorescence staining. The volume of different clusters obtained by voxel-based morphometry (VBM) analysis was correlated with the expression level of mature BDNF detected by Western blotting (P < 0.05).@*CONCLUSION@#The decrease of frontal cortex volume after CUMS is related with the reduction of mature BDNF expression in the frontal cortex.

Relationship between physical activity screen time and sleep duration and overweight and obesity among children and adolescents in Beijing Tianjin Hebei region / 中国学校卫生

Objective@#To investigate the relationship among physical activity, sleep duration and screen time and overweight and obesity among children and adolescents in Beijing Tianjin Hebei region, and to provide reference for children and adolescents in Beijing Tianjin Hebei region to maintain healthy physique.@*Methods@#In November 2019, 4 262 primary and secondary school students in Beijing Tianjin Hebei region were surveyed on physical activity, sleep status and screen time according to the physical activity guidelines for children and adolescents, and the relationship between overweight and obesity was analyzed by Logistic regression.@*Results@#The prevalence of overweight and obesity among children and adolescents in Beijing Tianjin Hebei region was 22.03%. The positive rate of overweight was 12.01% and obesity was 10.02%. The prevalence of overweight and obesity in male students (26.09%) was higher than that in female students (17.88%), the difference was statistically significant ( χ 2=41.77, P < 0.01 ). The prevalence of overweight and obesity in urban children (24.09%) and Han children (22.74%) was significantly higher than that in rural areas (21.05%) and ethnic minorities (17.70%) ( χ 2=5.00, 7.63, P <0.05). The proportion of children who met physical activity, screen time and sleep duration guideline was 24.85%, 38.69% and 57.09%, respectively. A total of 21.68% of children and adolescents did not meet the guideline of physical activity, screen time and sleep duration, among which 42.80% and 28.77% met the guideline for one or two out of three behaviors, respectively. Only 6.76% of children and adolescents met the guideline of all three behaviors. Logistic regression analysis showed that the risk of overweight and obesity was negatively correlated with sleep duration ( OR=0.72, 95%CI =0.52-0.98). The risk of overweight and obesity was lower in patients with 2 criteria than in those with less sleep duration and less screen time ( OR=0.57, 95%CI =0.36-0.87).@*Conclusion@#Percentage of sufficient physical activity among children and adolescents in Beijing Tianjin Hebei region is low, and ensuring sufficient sleep duration is helpful for overweight and obesity prevention. The impact of sleep duration and screen time on overweight and obesity in children and adolescents should be considered in childhood obesity prevention and control.

Study on patient experiences of residents contracted with family doctor services in a city / 中华医院管理杂志

Objective:To evaluate and analyze the patient experience of residents contracted with primary medical institutions, for providing a basis for improving quality of contracted family doctor services.Methods:Using the Chinese version of the primary care assessment tools(PCAT), a household survey was conducted on 1 400 contracted residents in 9 community health service centers and 9 township health centers in a city from May to June 2020, and their medical experience in primary medical institutions was statistically analyzed. At the same time, interviews were conducted with institutional managers and family doctors. Descriptive statistics and one-way ANOVA were used for data analysis.Results:1 333 valid questionnaires were collected, and the effective recovery rate was 95.2%.The total PCAT scoring was 25.17. Seven dimensions of first contact, continuous, coordination, comprehensiveness, patient and family centered, community-oriented and cultural competence scored in average 3.57, 3.68, 3.54, 3.40, 3.72, 3.67 and 3.59 respectively.372 people(47.1%) had not been referred by the contracted institution before going to the superior hospital or specialized hospital. There were significant differences in the scores of four core dimensions in different types of institutions, age, education level, occupation and income( P<0.001). Conclusions:Given the initial progress of contracted family doctor services in the city, there is still room for improvement. It is suggested to further improve the comprehensiveness, coordinationand accessibility of services, and promote the high-quality development of contracted family doctor services.

Analysis on the current situation of medical preventive integration at primary medical institutions in a city / 中华医院管理杂志

Objective:To explore the current status of medical preventive integration at primary medical institutions, analyze the problems of medical prevention integration, and put forward optimization suggestions.Methods:From June to July 2020, 169 primary medical institutions in a city were selected as the survey objects to conduct a questionnaire survey on the basic information of institutions and the evaluation indicators of medical preventive integration. The evaluation index system of medical preventive integration was divided into a factual survey and a sensory survey. In addition, 32 relevant personnel were interviewed on the current situation of medical preventive integration at primary medical institutions. The reliability and validity of the data were tested and analyzed, while descriptive analysis and classification extraction analysis were carried out.Results:The reliability and validity analysis proved the data reliability. The factual survey extracted three common factors, namely organization management, performance appraisal distribution and information management. The sensory survey extracted two common factors, namely working mode and personnel training. In terms of organization, management and working methods, the degree of medical preventive integration was low. Among them, 53.8% of the institutions had formulated the medical preventive integration norms, and only 41.4% of them had shared residents′ health information in time.Conclusions:The degree of medical preventive integration of primary medical institutions in the city still need to be improved. In the future, we should strengthen the top-level design, establish the norms and cooperation mechanism of medical preventive integration, improve the awareness of medical preventive integration of medical personnel, improve the information level, and to build a new service model integrating disease prevention, medical treatment and health management.

Study on contract renewal willingness and influencing factors of contracted residents to family doctor service in Shandong Province / 中华医院管理杂志

Objective:To understand the willingness of contracted residents to renew the family doctor contract service in Shandong Province, and to explore its influencing factors.Methods:From July to August 2020, 1 500 contracted residents in 3cities of Shandong Province were investigated by questionnaire survey.Descriptive statistical analysis, Mann-Whitney U test and binary logistic regression model were used to analyze the contracted residents′ cognition, utilization, satisfaction evaluation and renewal intention of family doctor contract service. Results:1 445 valid questionnaires were obtained, of which 682(47.2%)were willing to renew their contracts.The results of binary logistic regression analysis showed that marital status, educational level, time to see a doctor in contracted institutions, optimism about the development prospect of contracted service policy, whether the proportion of medical insurance reimbursement increased after signing the contract, whether follow-up work was carried out on time, satisfaction with family doctor service attitude and satisfaction with the effect of disease treatment were factors affecting the willingness of contracted residents to renew the contract.Conclusions:The contracted residents in Shandong Province have a high willingness to renew their contracts. On the basis of consolidating and improving the policy cognition and confidence of the contracted residents, we should actively optimize and improve the contracted service quality, ensure the sense of service access of contracted residents, and continuously and effectively realize the comprehensive promotion of the contracted services of family doctors.

Analysis on the implementation optimization path of family physician contract service from the perspective of supplier / 中华医院管理杂志

Objective:To analyze the cognition and willingness of family physicians on contracted service, and to explore the implementation obstacles and feasible strategies of implementing contracted service of family physicians from the perspective of suppliers.Methods:From July to October 2020, 850 family physicians in community health service centers or township health centers in three cities of Shandong Province were investigated by questionnaire survey and key person interview. Descriptive analysis and binary logistic regression model were used to analyze the willingness of family physicians to provide contracted service. Through questionnaire survey and key person interview, the implementation obstacles and service optimization strategies of family physicians were discussed.Results:791 valid questionnaires were obtained, of which 688(87.0%) approved the implementation of family physician contract service, and 679(85.8%) expressed willingness to provide family physician contract service. Marital status, recognition of service policy, satisfaction of service operation effect, optimistic degree of service development prospect and residents′ first choice of illness were the factors influencing family physician′s service willingness.Conclusions:We should effectively improve the family doctor′s service intention and promote the efficient and orderly implementation of family doctor′s contract service policy through enriching policy supporting measures, innovating the application of " Internet plus" , increasing personnel training, optimizing performance appraisal work and creating favorable public opinion environment.

Analysis of nurses′ cognition and willingness to provide Internet plus nursing service in Weifang / 中华医院管理杂志

Objective:To investigate the cognition and willingness of nursing staff to Internet plus nursing service, and analyze the related factors that affect their participation in Internet plus nursing service.Methods:From April to May 2019, 150 nurses from three hospitals in Weifang were investigated by questionnaire and key person interview. Descriptive analysis and binary logistic regression analysis were used to analyze the intention of nursing staff to participate in Internet plus nursing service. The interview mode was used to analyze the appropriate mode of Internet plus nursing service from the perspective of nursing staff.Results:142 valid questionnaires were obtained, of which 137(96.5%)indicated willingness to provide Internet plus nursing services, and 135(95.1%) realized the necessity of the service. Education, marriage, nurses′judgment on the necessity of the service and their own subjective judgment of their competence were the factors affecting nurses′ participation in the Internet plus nursing service.Conclusions:Multiple factors affect the choice of nursing staff′s behavior in Internet plus nursing service.From the perspective of nursing staff, the Internet plus nursing service mode needs joint efforts from many aspects.