Accessibility evaluation of healthcare facilities in a city under the background of population aging / 现代医院

Objective To provide a scientific benchmark for the era of population aging and improve the medical care environment for the elderly in terms of hospital facility accessibility.Methods A random sampling method was used to select 375 individuals from 10 healthcare institutions in a specified city as survey participants from December 2022 to February 2023.A total of 375 questionnaires titled"Comprehensive Rating Scale for Patient Experience in Medical Facilities(Accessibility Category)"were distributed among the participants,with 356 valid responses received and subjected to reliability and validity assessments.The questionnaire included 6 accessibility indicators,each rated from 1 to 10,to evaluate the accessibility level of healthcare fa-cilities.The acquired data was analyzed using the Rank Sum Ratio method and the Four Quadrants model.Results The average score for building accessibility in the city's medical institutions was 35.86,with several indicators at a moderate level,indicating a need for an improvement of the facility accessibility.Meanwhile,the economic operational status of various medical institutions appeared to influence the implementation of accessibility features,which also correlated with local government construction plan-ning,staff awareness of accessible infrastructure,and other factors.Conclusion Medical facilities in cities could implement bar-rier-free modifications in parking,toilets,and other areas,improve the use of accessible AI technology,and develop intelligent medical scenarios in order to meet the challenges of an aging society,improve the medical care quality for the elderly,and reduce social security cost.The governments should accelerate the improvement of supportive policies and regulations and bolster support for the accessibility enhancements.Higher education and research institutions can collaborate with healthcare providers for innova-tive integration of industry academia,research,and application,fostering the conversion of research into practical solutions.

Dynamics of parenting styles of adolescent students from the perspective of intergenerational conflict / 中国学校卫生

Objective@#To explore dynamics of parenting styles of adolescents from 1999 to 2019 from the perspective of intergenerational conflict, to provide support for family education and adolescent healthy development.@*Methods@#Using a multistage stratified cluster random sampling method, the unified questionnaire was administered to 2 590 students in the same sampling junior and senior high schools in 1999, 2009, and 2019 using the Egna Minnen av Barndoms Uppfostran own memories of parental rearing practices in childhood(EMBU).@*Results@#Overall there were differences in the nine factors of parenting styles across generations ( F = 12.07-72.52, P <0.01), with decreasing ratings of warmth and understanding of father and mother (F1, M1), over interference of father (F3) over generations(F1:46.72±9.41, 45.87±11.33, 43.61±11.27; M1:51.56±9.38, 51.03±11.59, 46.23± 12.27 ; F3:19.03±4.00, 18.29±4.32, 17.95±4.51), and all other parenting styles rated higher in 2019 than in 2009 and 1999(except for the over protection and over interference of mother, and punishment, firm control of mother). Parenting styles across generations (except for the rejection and denial of father among girls) showed gender difference.The overall gender trend coincided with the total population trend. Parenting styles across generations varied significantly among middle and high school students( F =3.92-47.27, P <0.05 ), changes in F1 and F3 factors coincided with the overall decreasing trend. Factor analysis showed that parenting styles could be classified into two dimensions, with varied factor loading across generation.@*Conclusion@#Intergenerational decreases in parental emotional warmth and paternal interfering are observed in a sex and grade specific manner. Based on the diversity of needs and population differentiation, optimal intervention for comprehensive health development of adolescents are in great need to keep pace with the times and promoting the high quality development of adolescents.

Practice guideline for patients with ankylosing spondylitis/spondyloarthritis / 中华内科杂志

In recent years, the clinical experts consensuses or guidelines of ankylosing spondylitis (AS)/spondyloarthritis (SpA) have been constantly updated, but to better understand and practice, patient self-participation management is one of the key points to improve the level of diagnosis and treatment. Through questionnaire survey of these patients, we screened out the most concerned issues, and established the AS/SpA patient practice guideline working group with multidisciplinary physicians and patients. Fifteen opinions, as the AS/SpA patient practice guidelines, are proposed in accordance with the relevant principles of the "WHO guidelines development manual" , and with the international normative process.

Practice guideline for patients with hyperuricemia/gout / 中华内科杂志

Hyperuricemia/gout is a common metabolic disease in China, which is a serious threat to people′s health. In clinical practice, the standardization of prevention and diagnosis and the rate of treat-to-target need to be improved. There is still a lack of education for the patients about the understanding of clinical guidelines, the disease knowledge and the importance of cooperating with doctors to carry out diagnosis and treatment. From the most concerned issues of the patients, we established the hyperuricemia/gout patient practice guideline working group with multidisciplinary physicians and patients. Seventeen opinions, as the hyperuricemia/gout patient practice guidelines, are proposed in accordance with the relevant principles of the "WHO guidelines development manual" , and with the international normative process, aiming to improve the patients compliance, improve the level of health management of the disease.

Practice guidelines for patients with rheumatoid arthritis / 中华内科杂志

In recent years, the clinical guidelines for the diagnosis and treatment of rheumatoid arthritis (RA) have been constantly updated. Among the general principles, it is particularly emphasized that, in order to improve the ratio of treat to target(T2T) of RA, doctors and patients should work together to negotiate the details of the guidelines. Therefore, it is important for patients to further understand the disease and clinical guidelines of RA, and to better cooperate with doctors. This study was based on the most concerned issues of RA patients and international standard procedure of guideline study, we organized the working group and introduce the following 16 recommendations constituting the RA patients′ practice guidelines.

Practice guideline for patients with osteoporosis / 中华内科杂志

In recent years, osteoporosis (OP) has become one of the main diseases affecting the health of middle-aged and elderly people in China, and the prevalence of OP has increased significantly. The clinical diagnosis and treatment guidelines for this disease are also constantly updated. The overall principles speciallyemphasise that doctors and patients need to work together to negotiate the details of the diagnosis and treatment guidelines, in order to improve the OP clinical diagnosis and treatment rate. Therefore, patients′ knowledge of the disease, understanding of clinical guidelines, and cooperation with doctors to implement diagnosis and treatment plans are very important. In this study, from the most concerned issues of the patients, we established the OP patient practice guideline working group. 14 recommendations, as the OP patient practice guidelines, are proposed in accordance with the relevant principles of the "World Health Organization guidelines development manual" and the international normative process.

A single decline of FEV3/FVC in determine the application potential of early lung disease / 中国医师杂志

Objective To explore the application potential of forced expiratory volume in three second/forced vital capacity (FEV3/FVC) in early lung diseases,such as early airway obstruction and mild gas trap.Methods A total of 288 patients (excluding those with restrictive ventilation dysfunction) who underwent pulmonary function examination in the pulmonary function room of our hospital from January 2014 to October 2017 were collected.288 patients were divided into three groups.Group A:FEV3/FVC and forced expiratory volume in one second/forced vital capacity (FEV1/FVC) were normal;Group B:FEV3/FVC decreased alone;Group C:FEV1/FVC decreased.The general data and pulmonary function indexes of the three groups were compared.Results Compared with group A,group B had lower FEV1 ％ and diffusion capacity for carbon monoxide of the lung (DLCO％),but higher total lung capacity (TLC％),residual volume (RV％) and RV/TLC.Compared with group B,group C had higher TLC ％,RV％,RV/TLC％,while FEV1％,DLCO％ reduce more remarkably.There were significant differences in the three groups of small airway function (P ≤ 0.01).FEV3/FVC was positively correlated with max expiratory at 50％ FVC (MEF50％),max expiratory at 75％ FVC (MEF25％) and maximal mid expiratory flow (MMEF％).The correlation coefficients were respectively 0.613,0.610,0.608 (P ≤0.01).When FEV3/FVC serves as an indicator to determine airway obstruction,the specificity of it is 45.7％,sensitivity 98.5％,and negative predictive value 99％,positive predictive value 35.5％.Conclusions FEV3/FVC individual decline is the indication of early lung diseases such as mild airway obstruction,mild gas trap and diffuse disorder.

Expressions of serum TSLP, SAA, and CRP in COPD patients / 中国医师杂志

Objective To value different stages of chronic obstructive pulmonary disease (COPD) patients with the detection of the levels of serum thymic stromal lymphopoietin (TSLP),serum amyloid A (SAA),and C-reactive protein (CRP).Methods A total of 33 patients with COPD during and after hospitalization and 16 healthy controls were enrolled in the study from the 3rd affiliated hospital of SYSU.Differences and correlations of the level of serum TSLP,SAA and CRP were analyzed to value the veracity of those factors in different stages of COPD.Results The levels of CRP and SAA were higher in acute exacerbation of COPD (AECOPD) group than stable COPD group,TSLP was lower in the AECOPD group than the healthy control group (P ＜ 0.05).CRP had a positive correlation with SAA (correlation r =0.546,P =0.000),CRP [area under curve (AUC) =0.797] and SAA (AUC =0.815),and they were statistically significant in identity of different stages of COPD (P ＜ 0.05).Conclusions Serum TSLP level is decreased in acute exacerbation phase of COPD.CRP and SAA are increased in AECOPD.SAA is more confident in identity of different phases of COPD.

Difference of the clinical characteristics and outcome between interstitial lung disease with dermatomyositis and idiopathic pneumonia fibrosis / 中国医师杂志

Objective To compare the clinical features and prognosis between dermatomyositis-associated interstitial lung disease (DM-ILD) and idiopathic pulmonary fibrosis (IPF).Methods Patients with interstitial lung disease with dermatomyositis (DM-ILD) or idiopathic pneumonia fibrosis (IPF) from January 2003 to March 2014 in the third affiliated hospital of Sun Yat-sen University were included.Results Among the 64 patients enrolled,44 were DM-ILD and 20 were IPF.IPF was more common in the elderly (P =0.000),men (P =0.004) and smokers (P =0.000),and its high-resolution computed tomography (CT) mostly showed grid shadow (P=0.014) and honeycomb shadow (P=0.000).DM-ILD usually had cough symptoms (P =0.025).High-resolution CT showed patchy (P =0.048) and banded (P =0.000).Glucocorticoid (P =0.000) and immunosuppressive agents (P =0.000) were commonly used in the treatment of DM-ILD.However,there was no significant difference in 90d mortality between the two groups (P ＞ 0.05).Conclusions IPF is more common in the elderly,men and smokers,and its high-resolution CT mostly shows grid shadow and honeycomb shadow,distribution is diffuse.DM-ILD often has cough symptoms,and its high resolution CT is mostly plaques and streaky shadows.Glucocorticoids and immunesuppressants are commonly used in DM-ILD,but there is no significant difference in 90-day mortality between them.

Advances in brain network model of Parkinson's disease tremor mechanism / 中国综合临床

Objective Parkinson's disease( PD) is a common chronic neurodegenerative disease,with four major symptoms of resting tremor, muscle rigidity, slow motion and postural balance disorder?The pathogenesis of Parkinson's disease is still unknown?A large number of studies suggested that may be the result of the interaction of genetic factors,environmental factors,aging,immune factors,specifically involved in oxidative stress,mitochondrial damage,and other mechanisms?There were 50% patients characterized by tremors,tremor is the most difficult symptoms to treat of PD, but the mechanism is still under controversial, so it ’ s of great significance to understand the generation of PD tremor, which helps to promote the clinical treatment and diagnosis.