ObjectiveTo investigate the prevalence and associated factors of diabetic retinopathy (DR) among diabetic residents in Longyan of Fujian Province. MethodsA investigative research. From January 2022 to December 2023, a total of 10 061 diabetic patients enrolled in the chronic disease follow-up management system from 112 towns and sub-districts in 7 counties and districts of Longyan of Fujian Province were selected as the target population. A questionnaire survey, routine physical examination, vision test, and non-mydriatic fundus photography were conducted. A total of 762 cases with missing height, weight, blood pressure, fasting plasma glucose (FPG), and diabetes duration, and 507 cases with unclear fundus photography were excluded, resulting in 8 792 cases included in the final statistical analysis. DR diagnosis and classification were based on the 2019 International Clinical Classification of DR. The prevalence of DR was calculated for single-eye or double-eye DR cases as 1 case; the more severe eye was used for DR grading in double-eye DR cases. Statistical analysis was performed by grouping based on the presence or absence of DR and dividing into age groups ≤67 years and >67 years. χ2 test was used to analyze factors associated with prevalence; binary multivariate logistic regression analysis was employed to identify influencing factors of DR. ResultsAmong the 8 792 cases, 888 (10.1%, 888/8 792) were diagnosed with DR (DR group), and 7 904 (89.9%, 7 904/8 792) had no DR (non-DR group). Compared to the non-DR group, the DR group showed significant increases in FPG (Z=?12.448), diabetes duration (Z=?18.936), systolic blood pressure (Z=?4.237), diastolic blood pressure (Z=?2.881), and body mass index (BMI) ≥24 kg/m2 (P＜0.001). Significant differences were also found between the two groups in hypertension (χ2=11.450), hyperlipidemia (χ2=5.100), kidney disease (χ2=7.039), family history of diabetes (χ2=5.025), and regular medication use (χ2=66.034) (P＜0.05). There were 4 688 cases in the ≤67 years group and 4 104 in the ＞67 years group. In the ≤67 years group, significant differences in DR prevalence were found for FPG levels (χ2=111.754), diabetes duration (χ2=231.658), BMI (χ2=12.404), systolic blood pressure (χ2=17.912), regular medication use (χ2=40.727), hyperlipidemia (χ2=6.816), and hypertension history (χ2=6.775) (P＜0.05). In the >67 years group, significant differences in DR prevalence were found for FPG levels (χ2=59.916), diabetes duration (χ2=128.362), systolic blood pressure (χ2=5.183), regular medication use (χ2=22.097), kidney disease (χ2=6.251), and family history of diabetes duration (χ2=4.967) (P＜0.05). No significant differences in DR prevalence were found based on sex, education level, smoking history, alcohol consumption, exercise habits, heart disease history, or other family disease history (P＞0.05). Logistics regression analysis results show that patients aged ＞67 years, FPG [odds ratio (OR)=1.074, 95%confidence interval (CI) 1.046-1.102], diabetes duration (OR=1.088, 95%CI 1.071-1.106), systolic blood pressure (OR=1.007, 95%CI 1.001-1.013), and kidney disease (OR=3.617, 95%CI 1.268-10.320) were identified as risk factors for DR (P＜0.05). In patients aged ≤67 years, FPG (OR=1.088, 95%CI 1.067-1.110), diabetes duration (OR=1.108, 95%CI 1.091-1.125), and systolic blood pressure (OR=1.008, 95%CI 1.003-1.013) were identified as independent risk factors for DR (P＜0.05), while BMI ≥24 kg/m2 (OR=0.934, 95%CI 0.908-0.965) was a protective factor for DR (P＜0.05). Age, regular medication use, hypertension, and hyperlipidemia were identified as potential confounding factors for DR occurrence. ConclusionsThe prevalence of DR among diabetes patients in Longyan of Fujian Province, is 10.1%. FPG, diabete duration, and systolic blood pressure are independent risk factors for DR, while age, regular medication use, hypertension, and hyperlipidemia are potential confounding factors for DR occurrence.
Objective To explore the effect of kidney transplantation on chronic prostatitis-like symptoms. Methods A total of 300 male renal transplant recipients between January 2015 and January 2017 were collected in the study. All recipients received the questionnaire survey of the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) preoperatively and at 3 months after transplantation. The score and relevant risk factors were statistically analyzed. Results A total of 210 recipients (70.0%) completed questionnaire effectively, in whom 150 (71.4%) had preoperative and 90 (42.9%) had postoperative chronic prostatitis-like symptoms, respectively. In the 210 patients, the preoperative and postoperative pain score was 6.57±3.12 vs. 3.57±3.16 (P<0.001), voiding score was 3.71±2.38vs. 3.29±2.66 (P=0.116), quality of life score was 7.57±1.60 vs. 5.14±2.75 (P<0.001), and the total NIH-CPSI score was 17.86±3.81vs. 12.00±6.65 (P<0.001), respectively. The severity of chronic prostatitis-like symptoms was alleviated significantly after kidney transplantation. Conclusion Kidney transplantation can alleviate the chronic prostatitis-like symptoms significantly, and improve the quality of life in uremia patients.
Objective To assess the effect of a new educational model for evidence-based medicine (EBM), which is called "2+N" model with the main characteristic of classroom teaching plus volunteer practice. Methods Questionnaire survey was conducted to collect data. Results There were averagely 39 volunteers participated in this activity per year, with an increasing trend. Most of them were sophomore and junior undergraduates from different specialties in medical filed. All participates acquired a better understanding of EBM knowledge; more than 60% of them could handle data searching, collecting and assessing by themselves in the end of the activity. Conclusion Our five years’ experience of EBM education practice for medical students suggested that the new educational model has a promising future.
Objective To investigate the knowledge level about pulmonary rehabilitation in respiratory physicians in Shanghai. Methods A self-designed questionnaire about pulmonary rehabilitation was sent to respiratory physicians in 18 tertiary-care referral hospitals of Shanghai from June to September 2011. Results A total of 237 valid questionnaires were collected. Accuracy rate of single-answer questions was(62.1±18.3)% , while correct rate of multiple-answer questions ( more than one answer) was ( 35.5±15.6) % . Neither working years nor doctor rank had correlation with accuracy of questionnaires. Conclusion The knowledge about pulmonary rehabilitation in respiratory physicians of Shanghai was poor. We need to strengthen the relevant training and continuing education.
ObjectiveTo evaluate the method quality of systematic reviews/Meta analysis published in nursing journals. MethodsWe retrieved Chinese Biomedical Literature Database, Chinese academic literature online publishing pool and Chinese Scientific Journals Database (the duration was from the beginning to August, 2013). The systematic reviews and Meta analysis published in nursing journals were included, and were evaluated by 10 items in OQAQ (Oxman-Guyatt Overview Quality Assessment Questionnaire). ResultsA total of 74 literatures were included in the analysis, including 17 systematic reviews and 57 Meta-analyses. It showed that the mean OQAQ score was 2.92±1.63. About 4.1%, 8.1%, 31.1%, 43.2%, 29.7%, 55.4%, 16.2%, 37.8%, and 60.8% studies stated literature research methods used to find evidence; had reasonably comprehensive search; avoided bias in the selection of studies by duplicate screening; reported the criteria used for assessing the validity of the included studies; concluded the findings by the data or analysis; provided a list of studies; assessed using appropriate criteria; reported the methods used to synthesis the findings; and combined the findings of the included studies appropriately. ConclusionThe systematic reviews/Meta analysis of the overall quality in nursing field is low. The search strategy, inclusion and exclusion criteria, quality assessment and data analysis is particularly prominent, researchers should conduct rigorous methodological training.
ObjectivesTo investigate Chinese health practitioners’ usage and demand for clinical practice guidelines in general so as to improve the development and implementation of guidelines.MethodsWe conducted a cross-sectional questionnaire survey that covered health practitioners from different levels of medical institutions in 17 provinces in China. Attitudes, adherence, usage barriers and demands for clinical practice guidelines were investigated.ResultsA total of 953 health practitioners were involved in the survey in which 931 completed the questionnaires. Respondents generally held positive attitudes toward guidelines and agreed that they improved quality of care and standardized diagnosis and treatment. More than 80% of the respondents reported a fine adherence to guidelines. The most reported barriers to follow the guidelines were " several guidelines are competing” and " lack of facilities and medical resources”. Most respondents agreed that it was necessary to establish a national guideline database, appraise implementation effect of guidelines, develop evaluation tools for guidelines that are applicable for Chinese clinical practice, and provide guidelines training.ConclusionsThis study finds favorable attitudes and fine adherence towards clinical guidelines in general in China. However, internal barriers, such as authority of guidelines, and external barriers, such as supplying system and patients’ preference, can affect guideline dissemination and implementation. It is suggested that establishing a national guidelines database, developing evaluation tools for guidelines that fit for Chinese clinical practice, and provision of guideline training, would facilitate the use of guidelines.
ObjectiveTo investigate the status-quo of urban and rural residents' depression in the communities of Chengdu city and its influencing factors. MethodsA multi-stage stratified cluster sampling survey was carried out from February to October 2010. Residents aged from 35 to 70 years in 4 urban and rural communities of Chengdu were investigated in the incidence of depression. The health survey questionnaire and PHQ-2 Depression Screening Scale were used for the household investigation. Data was analyzed using SPSS 18.0 software, and the risk factors were also analyzed using multivariate logistic methods. ResultsA total of 2 027 residents were interviewed, including 1 015 urban (616 women and 399 men, with mean age of 58.90 ±9.48 years) and 1 012 rural residents (582 women and 430 were men, with mean age of 54.94 ±9.64 years). The results showed that the overall depression prevalence rate of residents aged from 35 to70 years old in Chengdu was 2.91% (59/2 027); and the prevalence was 4.33% (44/1 015) in urban and 1.48% (15/1 012) in rural. The prevalence was significantly higher in urban areas than that in rural areas (χ2=13.296, P < 0.001). The results of multivariate analysis showed that a significant difference was found in the prevalence of depression among the different marital status groups, and more divorced people suffered from depression. No statistically significant correlation was found between the factors (including occupation, education level and family income status) and depression. ConclusionThe prevalence of depression among residents in urban and rural communities of Chengdu was high, and the divorced population should be paid more attention to in the prevention and treatment of depression.
Objective To explore the type and frequency of oral care practice in intensive care units (ICUs) in Mainland China, and to provide evidence and suggestions for improving oral care practice. Methods Three survey methods, including mailing questionnaires to ICUs of Grade 3A hospitals, consulting experts in this field and visiting accessible ICUs, were used to survey current oral care practice in Mainland China. Results A total of 184 questionnaires were given to the subjects, of which 79 effective ones were collected, and the response rate was 42.93%. All 79 respondents considered oral care very unimportant, and 98.7% of the ICUs performed oral care in different ways. Currently, the cotton ball wipe-off method was the most frequently used for oral care (62.5%), with an average (9.1± 5.1) min per time, twice or three times daily. The mouthwashes often used were saline (76.1%), solutions containing sodium bicarbonate (22.8%), furacilin (13.9%), and hydrogen dioxide (13.9%). Conclusion The oral care practice for the critically-ill patients in ICUs of China is unsatisfactory, although it is perceived as an important item in nursing care. More evidence–based training should be given and it is necessary to establish a national oral care guideline for critically-ill patients.
ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.
Objective To explore the factors which influence the doctor-patient relationship and to provide evidence to help decision makers improve hospital management and construct a harmonious doctor-patient relationship. Methods Discharged patients of West China Hospital from 2003-2006 were randomly selected and asked to complete a specially designed questionnaire. Results In total, 8 000 questionnaires were distributed and 2 526 were returned. The retrieval rate was 31.57%. The responses showed that non-medical factors have became the main factors affecting the doctor-patient relationship (91.8%). Other important factors included medical cost (21.5%) and doctor-patient communication (11.51%). Conclusion We should boost hospital management level, train non-medical staff, save costs and improve doctor-patient communication.