ABSTRACT
Objective:To identify the influencing factors for community elderly health services provided by general practitioners (GPs) using the social ecological theory, for reference in improving their participation and satisfaction.Methods:According to the social ecological theory, an ecological model for GPs to carry out community elderly health services was constructed from four levels: public policy ecology, community health service ecology, interpersonal relationship ecology, and individual characteristics ecology of general practitioners. A survey questionnaire was designed with six latent variables: public health policy support, public health service and basic medical service supply, doctor-patient relationship, individual participation and individual satisfaction. The questionnaire was distributed to 220 GPs from 11 primary healthcare institutions in Jiangsu province, China, who were randomly selected between October and November 2021. Exploratory and confirmatory analyses of the model were conducted using AMOS 25.0.Results:A total of 207 valid questionnaires were collected, and all the KMO values of the six latent variables were greater than 0.7, while the composite reliability values and average variance extracted values greater than 0.7 and 0.5, respectively. Both the reliability and validity of the data met the analysis requirements. Exploratory analysis revealed that public health policy support had a direct positive effect on both public health service and basic medical service supply (both effect sizes being 0.37). Public health service had a direct positive effect on doctor-patient relationship, individual participation and individual satisfaction (effect sizes being 0.52, 0.22, and 0.31, respectively). The direct effect of basic medical service supply on doctor-patient relationship was not significant (effect size being 0.03), but it had a direct positive effect on public health service (effect size being 0.46). Doctor-patient relationship had a direct positive effect on individual participation (effect size being 0.51), but its direct effect on individual satisfaction was not significant (effect size being 0.06). Individual participation had a direct positive effect on individual satisfaction (effect size being 0.52). Conclusions:By optimizing the public policy ecosystem, community health service ecosystem, and interpersonal relationship ecosystem, the participation and satisfaction of general practitioners can be systematically improved.
ABSTRACT
Objective To investigate the expression and clinical significance of DNMT1 and CCNA1 in different grades of cervical lesions. Methods Cervical tissues were selected from normal cervical(NC),low-grade cervical intraepithelial lesion(LSIL),high-grade cervical intraepithelial lesion(HSIL)and cervical squa-mous cell carcinoma(SCC)from each thirty patients.The expression of DNMT1 and CCNA1 mRNA and protein was examined by Western Blot analysis and qRT-PCR in cervical tissues. Results The expression of DNMT1 mRNA and protein in LSIL,HSIL and SCC was higher than in NC(F=117.93,P<0.05;F=61.24,P<0.05). Expression of DNMT1 mRNA and protein was increased steadily according to severity of cervical lesions(χ2trend=26.25,P<0.05;χ2trend=26.60,P<0.05).The expression of CCNA1 mRNA and protein in HSIL and SCC was lower than that in NC and LSIL(F = 77.04,P < 0.05;F = 57.15,P < 0.05). Expression of CCNA1 mRNA and protein was decreased steadily according to severity of cervical lesions(χ2trend=64.19,P<0.05;χ2trend=60.24,P<0.05). There was a negative correlation between expression of DNMT1 and CCNA1 protein in LSIL,HSIL,SCC (r=-0.75,-0.56,P<0.05). Conclusion In DNMT1 mRNA there is high expression of protein and in CCNA1 mRNA there is low expression of protein,but both may be related to the occurrence and development of cervical cancer.