The Early Impact of the People-centred Integrated Care on the Hypertension Management in Shenzhen.

Objective: To evaluate the impact of the integrated care in Luohu, China on the hypertension management. Methods: Hypertensive patients aged 35-74 years were recruited by the cluster-randomized sampling method from Luohu district which adopted integrated care and another district that remained original routine care during October 2018~January 2020, with 1353 and 583 patients from integrated and routine care communities, respectively. Health information, knowledge, attitude, and practice (KAP) towards cardiovascular diseases, pharmaceutical expenditure on hypertension and its comorbidities, and healthcare-related satisfaction were collected by questionnaires, with the expenditure additionally verified by hospitals' billing records database. Continuous and categorical variables were compared by Wilcoxon test and Chi-square test, respectively. The age-standardized hypertension control rate was calculated by direct standardization. Results: The standardized hypertension management rate in the integrated care communities (45.75%) was significantly higher than that in routine care communities (14.07%) (P < 0.0001), while the age-standardized hypertension control rates were similar (integrated care: 50.3%, routine care: 52.65%, P = 0.518). The pharmaceutical expenditure on hypertension and its comorbidities in the integrated care communities was Ò°264.23 ± 357.38/month/person, lower than that in the routine care communities (Ò°354.56 ± 430.59/month/person). Patients in the integrated care had higher KAP scores (73.48 ± 11.54), compared with routine care (68.89 ± 15.51) (P < 0.0001). Moreover, the integrated care communities had higher satisfaction rates towards the convenience of dual referral (90.15% vs. 77.99%) and service quality (95.18% vs. 87.81%) than routine care communities (P < 0.0001). Conclusion: The practice of the integrated care in Luohu has substantially improved the hypertension management and the healthcare-related satisfaction while with relatively low pharmaceutical expenditure. The investigation of long-term impact of the integrated care on hypertension control and management is warranted.

A Large-Scale Screening Responding Sporadic Epidemic of COVID-19 in China by an Integrated Health-Care System.

Introduction: In the post-pandemic period of COVID-19, the majority of cities in China try to balance the normalization of epidemic prevention and social-economic development. However, the appearance of asymptomatic infected patients poses threats to public health, which might be infectious without clinical symptoms and only be detected by testing approaches. Methods: Along with the appearance of one symptomatic case, a regional large-scale screening program was carried out in Shenzhen City charged by a regionally integrated healthcare system. After describing the screening program, a retrospective cross-sectional study for the screening outcome and efficacy was conducted. Discussion: According to the screening results, the asymptomatic case was infectious and their close contacts should be quarantined cautiously as the close contacts of symptomatic cases. Besides, after integrating medical resources in Luohu district of Shenzhen, the medical capability of Luohu district improved greatly which could be demonstrated in inspection and organization abilities in this screening program. Conclusion: The large-scale screening contributed to preventing epidemic transmission. In the post-pandemic period, regular surveillance of asymptomatic cases and rapid response capability for emergent screening program are both crucial for the prevention and control of COVID-19 epidemic. The integrated healthcare system coordinating regional medical institutions and optimizing regional medical recourse has advantages to address public health emergencies.

Prevention and Control Measures for Imported SARS-CoV-2 Transmission During the Postpandemic Period in Shenzhen, China.

In China, most cities have gradually controlled the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and brought coronavirus disease 2019 (COVID-19) under control locally. This means that crucial work has shifted from internal management of the pandemic to external prevention and control, especially management of international travelers and imported goods. There is much uncertainty about variants of concern for SARS-CoV-2, which pose challenges to the steady resumption of social and economic life once the mutant strains begin to spread. The sporadic outbreaks of COVID-19 in different provinces of China caused by these mutant strains emphasizes the need for both prevention and control measures. Therefore, we introduce China's experience with preventing and controlling COVID-19 in the postpandemic period, which may serve as a reference in various settings.

Association of hypertriglyceridemic waist-to-height ratio and its dynamic status with risk of type 2 diabetes mellitus: The Rural Chinese Cohort Study.

AIMS: To evaluate the risk of type 2 diabetes mellitus (T2DM) in a prospective study with hypertriglyceridemic waist-to-height ratio (HWHtR) and its dynamic status. METHODS: We collected data for 12,248 participants ≥18 years in this study. Cox's proportional-hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for T2DM risk by baseline HWHtR. Multiple logistic regression analysis was used to estimate odds ratios (ORs) and 95% CIs for T2DM risk by transformation in HWHtR. RESULTS: We identified 839 T2DM cases during a median follow-up of 5.92 years. Compared with normal TG level and normal WHtR, T2DM risk was increased with high TG level and high WHtR (aHR 2.04, 95% CI 1.49-2.79). Similar results were observed in subgroup analyses by sex and age. During follow-up, T2DM risk was increased with stable high TG level and high WHtR (aOR 4.45, 95% CI 2.76-7.17) compared with stable normal TG level and normal WHtR. The results above were robust in sensitivity analyses. CONCLUSIONS: HWHtR phenotype and its dynamic status were associated with risk of T2DM. Our study suggests that primary prevention and avoiding the appearance of the HWHtR phenotype in the rural Chinese population may reduce the T2DM risk.

Association of ABCG1 gene methylation and its dynamic change status with incident type 2 diabetes mellitus: the Rural Chinese Cohort Study.

To explore whether DNA methylation of the ATP-binding cassette G1 (ABCG1) gene and its dynamic change are associated with incident type 2 diabetes mellitus (T2DM). We conducted a nested case-control study with 286 pairs of T2DM cases and matched controls nested in the Rural Chinese Cohort Study. Conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for incident T2DM risk according to ABCG1 methylation level at baseline and its dynamic change at follow-up examination. Spearman's rank correlation coefficients were used to analyze the association between ABCG1 methylation and its possible risk factors in the control group. We found that T2DM risk increased by 16% (OR = 1.16, 95% CI = 1.02-1.31) with each 1% increase in DNA methylation levels of the ABCG1 loci CpG13 and CpG14. DNA methylation change of the ABCG1 locus CpG15 during the 6-year follow-up was associated with increased T2DM risk: T2DM risk increased by 78% in the upper tertile group (methylation gain ≥5%) versus lower tertile group (methylation gain <1%) (OR = 1.78, 95% CI = 1.01-3.15). Furthermore, body mass index was positively correlated with the DNA methylation level of the ABCG1 loci CpG13, CpG14 and CpG15. In conclusion, DNA methylation levels of the ABCG1 loci CpG13 and CpG14 and the methylation gain of locus CpG15 were positively associated with incident T2DM risk, which may suggest a possible etiologic pattern for T2DM and potentially improve T2DM prediction in rural Chinese people.

Age and sex differences in the association between sleep duration and general and abdominal obesity at 6-year follow-up: the rural Chinese cohort study.

OBJECTIVE: The association between sleep duration and general and abdominal obesity in adults, especially in the rural Chinese population, remains unclear. Therefore, we conducted this study to evaluate the association between sleep duration and general and abdominal obesity in rural Chinese adults. METHODS: We included 12,446 adults aged 18-75 years old who completed a baseline examination during 2007-2008 and follow-up during 2013-2014. We prospectively investigated the sleep-obesity association over an average of six-year follow-up. Multivariable logistic regression was performed to assess the probability of new-onset general and abdominal obesity, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: As compared with sleep duration 6.5-7.5 h, short sleep duration (<6.5 h) was significantly associated with increased probability of abdominal obesity in men (OR = 1.60, 95% CI: 1.05-2.45) after controlling for multiple covariates. A similar association was found in men aged >60 years but not in women or in men ≤60 years. We found no significant association between sleep duration and general obesity. The results were consistent when restricting the analysis to participants without cardiovascular disease, type 2 diabetes mellitus or cancer at baseline. CONCLUSIONS: Short sleep duration was significantly associated with abdominal obesity in rural Chinese adults, and the association varied by sex and age.

Interactive Mobile Health Intervention and Blood Pressure Management in Adults.

Despite the availability of effective drugs, blood pressure (BP) control remains poor among most populations. To explore the effects of interactive mobile health (mhealth) intervention on BP management and find out the optimal target population, we performed a systematic review and meta-analysis of randomized controlled trials to estimate the pooled effects of mhealth intervention on BP control. PubMed, EMBASE, Cochrane Library, and CNKI were searched to identify eligible randomized controlled trials published between January 15, 2007 and April 28, 2019, and bibliographies of eligible articles were further reviewed. Random-effect models were utilized to pool estimates of net changes in systolic BP and diastolic BP between mhealth intervention group and control group. Eleven randomized controlled trials met the inclusion criteria, with a total sample size of 4271 participants. Compared with the control group, mhealth intervention was associated with significant changes in systolic BP and diastolic BP of -3.85 mm Hg; 95% CI, -4.74 to -2.96 and -2.19 mm Hg; 95% CI, -3.16 to -1.23, respectively. Subgroup analyses revealed consistent effects across study duration and intervention intensity subgroups. In addition, participants with inadequate BP control at recruitment might gain more benefits with mhealth intervention. Therefore, interactive mhealth intervention may be a useful tool for improving BP control among adults, especially among those with inadequate BP control.