Investigation the mechanism of iron overload-induced colonic inflammation following ferric citrate exposure.

Iron overload occurs due to excessive iron intake compared to the body's demand, leading to iron deposition and impairment of multiple organ functions. Our previous study demonstrated that chronic oral administration of ferric citrate (FC) caused colonic inflammatory injury. However, the precise mechanism underlying this inflammatory response remains unclear. The current study aims to investigate the mechanism by which iron overload induced by FC exposure leads to colonic inflammation. To accomplish this, mice were orally exposed to three different concentrations of FC (71 mg/kg/bw (L), 143 mg/kg/bw (M) and 286 mg/kg/bw (H)) for continuous 16 weeks, with the control group receiving ultrapure water (C). Exposure to FC caused disturbances in the excretory system, altered colonic flora alpha diversity, and enriched pathogenic bacteria, such as Mucispirillum, Helicobacter, Desulfovibrio, and Shigella. These changes led to structural disorders of the colonic flora and an inflammatory response phenotype characterized by inflammatory cells infiltration, atrophy of intestinal glands, and irregular thickening of the intestinal wall. Mechanistic studies revealed that FC-exposure activated the NF-κB signaling pathway by up-regulating TLR4, MyD88, and NF-κB mRNA levels and protein expression. This activation resulted in increased production of pro-inflammatory cytokines, further contributing to the colonic inflammation. Additionally, in vitro experiments in SW480 cells confirmed the activation of NF-κB signaling pathway by FC exposure, consistent with the in vivo findings. The significance of this study lies in its elucidation of the mechanism by which iron overload caused by FC exposure leads to colonic inflammation. By identifying the role of pathogenic bacteria and the NF-κB signaling pathway, this study could potentially offer a crucial theoretical foundation for the research on iron overload, as well as provide valuable insights for clinical iron supplementation.

Patients' and Care Professionals' Evaluation of the Effect of a Hospital Group on Integrated Care in Chinese Urban Health Systems: A Propensity Score Matching and Difference-in-differences Regression Approach.

BACKGROUND: A hospital group is an organizational integration strategy that has recently been widely implemented in Chinese urban health systems to promote integrated care. This study aims to evaluate the effect of hospital group on integrated care from the perspectives of both patients and care professionals. METHODS: Two cross-sectional surveys were conducted in Shenzhen city of China, in June 2018 and July 2021. All thirty Community Health Stations (CHSs) in the hospital group were included in the intervention group, with 30 CHSs in the same district selected as the control group by simple random sampling. All care professionals within both the intervention and the control groups were invited to participate in the surveys. Twelve CHSs were selected from 30 CHSs in the intervention and the control groups by simple random sampling, and 20 patients with type 2 diabetes mellitus (T2DM) were selected from each of these selected CHSs to participate in the survey by systematic sampling. The Rainbow Model of Integrated Care-Measurement Tool (Chinese version) was used to assess integrated care. Propensity score matching and difference-in-differences regression (PSM-DID) were used to evaluate the effect of the hospital group on integrated care. RESULTS: After matching, 528 patients and 1896 care professionals were included in the DID analysis. Results from care professionals indicated that the hospital group significantly increased technical competence of the health system by 0.771 points, and cultural competence by 1.423 points. Results from patients indicated that the hospital group significantly decreased organizational integration of the health system by 0.649 points. CONCLUSION: The results suggests that the effect of the hospital group on integrated care over and above routine strategies for integrated care is limited. Therefore, it is necessary to pay attention to implementing professional, clinical and other integration strategies beyond establishing hospital groups, in urban Chinese health systems.

Relationships between job satisfaction, organizational commitment, burnout and job performance of healthcare professionals in a district-level health care system of Shenzhen, China.

Background: Existing research indicates that job satisfaction has effects on job performance, but little evidence exists about the mechanism through which the satisfaction-performance association operates. This study aims to examine the effect of job satisfaction on job performance in a district-level health care system of China and to explore the effect mechanism mediated by organizational commitment and burnout. Methods: Cluster sampling was used in this study. All healthcare professionals in the Nanshan Medical Group, who were at work in the last 3 months and able to complete online questionnaire independently were invited to participate the anonymous online survey. Job satisfaction, organizational commitment, burnout and job performance were measured by tools, which have been validated in China. Descriptive statistics were used for the socio-demographic variables and the four job psychological variables. Pearson correlation coefficients was used to determine associations among each of the psychological variables. Linear regression was used to examine association between job performance and other three psychological variables. PROCESS macro was used to examine the mediation effects of organizational commitment and burnout on the association between job satisfaction and performance. Results: In total, 1,200 healthcare professionals completed the anonymous online survey. Job satisfaction, organizational commitment, and job performance were positively correlated with one another, with burnout negatively correlated with them. Linear regression revealed that demographic characteristics, job satisfaction, organizational commitment, and burnout explained 5, 6, 2, and 9% of the variance in job performance. Path analysis showed that the coefficient of the direct effect of job satisfaction on job performance was 0.18, the coefficients of the indirect effects of job satisfaction on job performance through organizational commitment and burnout were 0.17 and 0.37, respectively. The coefficients of the indirect effects of organizational commitment on job performance through burnout was -0.04, but it was not significant. Conclusion: It is promising to improve job performance of providers in Chinese healthcare systems by improving job satisfaction and reducing burnout. Tailored support policies for female healthcare professionals, appropriate incentive mechanisms and improving multidisciplinary healthcare delivery are potential to improve job performance of healthcare professionals in integrated healthcare systems.

Validation of the care providers version of the Rainbow Model of Integrated Care-measurement tool in Chinese primary care systems.

BACKGROUND: The original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care. To translate and adapt the original care provider version of the RMIC-MT and evaluate its psychometric properties by a pilot study in Chinese primary care systems. METHODS: The translation and adaptation process were performed in four steps, forward and back-translation, experts review and pre-testing. We conducted a cross-sectional study with 1610 community care professionals in all 79 community health stations in the Nanshan district. We analyzed the distribution of responses to each item to study the psychometric sensitivity. Exploratory factor analysis with principal axis extraction method and promax rotation was used to assess the construct validity. Cronbach's alpha was utilized to ascertain the internal consistency reliability. Lastly, confirmation factor analysis was used to evaluate the exploratory factor analysis model fit. RESULTS: During the translation and adaptation process, all 48 items were retained with some detailed modifications. No item was found to have psychometric sensitivity problems. Six factors (person- & community-centeredness, care integration, professional integration, organizational integration, cultural competence and technical competence) with 45 items were determined by exploratory factor analysis, accounting for 61.46% of the total variance. A standard Cronbach's alpha of 0.940 and significant correlation among all items in the scale (> 0.4) showed good internal consistency reliability of the tool. And, the model passed the majority of goodness-to-fit test by confirmation factor analysis. CONCLUSIONS: The results showed initial satisfactory psychometric properties for the validation of the Chinese RMIC-MT provider version. Its application in China will promote the development of people-centered integrated primary care. However, further psychometric testing is needed in multiple primary care settings with both public and private community institutes.

People-centred integrated care in urban China.

In most countries, the demand for integrated care for people with chronic diseases is increasing as the population ages. This demand requires a fundamental shift of health-care systems towards more integrated service delivery models. To achieve this shift in China, the World Health Organization, the World Bank and the Chinese government proposed a tiered health-care delivery system in accordance with a people-centred integrated care model. The approach was pioneered in Luohu district of Shenzhen city from 2015 to 2017 as a template for practice. In September 2017, China's health ministry introduced this approach to people-centred integrated care to the entire country. We describe the features of the Luohu model in relation to the core action areas and implementation strategies proposed and we summarize data from an evaluation of the first two years of the programme. We discuss the challenges faced during implementation and the lessons learnt from it for other health-care systems. We consider how to improve collaboration between institutions, how to change the population's behaviour about using community health services as the first point of contact and how to manage resources effectively to avoid budget deficits. Finally, we outline next steps of the Luohu model and its potential application to strengthen health care in other urban health-care systems.

Dans la plupart des pays, la demande de soins intégrés pour les personnes atteintes de maladies chroniques augmente à mesure que la population vieillit. Cette demande nécessite une réorientation majeure des systèmes de soins de santé vers des dispositifs de prestation de services plus intégrés. Pour effectuer cette réorientation en Chine, l'Organisation mondiale de la Santé, la Banque mondiale et le gouvernement chinois ont proposé un système de soins de santé à plusieurs niveaux selon un dispositif de soins intégrés axés sur l'être humain. Cette approche a été utilisée pour la première fois dans le district de Luohu de la ville de Shenzhen de 2015 à 2017 en tant que modèle de pratique. En septembre 2017, le ministère chinois de la Santé a appliqué à l'ensemble du pays ce dispositif de soins intégrés axés sur l'être humain. Nous décrivons les caractéristiques du modèle de Luohu par rapport aux principaux domaines d'action et aux stratégies de mise en œuvre proposées et nous résumons les données extraites d'une évaluation des deux premières années du programme. Nous examinons les difficultés rencontrées lors de la mise en œuvre et les leçons tirées de ces difficultés pour d'autres systèmes de soins de santé. Nous réfléchissons aux moyens d'améliorer la collaboration entre les institutions, de changer le comportement de la population concernant l'utilisation des services de santé des collectivités comme premier point de contact et de gérer efficacement les ressources pour éviter les déficits budgétaires. Enfin, nous décrivons les prochaines étapes à suivre dans le cadre du modèle de Luohu et son application potentielle pour renforcer les soins de santé dans d'autres systèmes urbains de soins de santé.

En la mayoría de los países, la demanda de atención integrada para las personas con enfermedades crónicas aumenta a medida que la población envejece. Esta demanda requiere un cambio fundamental de los sistemas de atención sanitaria hacia modelos de prestación de servicios más integrados. Para lograr este cambio en China, la Organización Mundial de la Salud, el Banco Mundial y el gobierno chino propusieron un sistema escalonado de prestación de servicios sanitarios de acuerdo con un modelo de atención integrada centrada en las personas. El enfoque se introdujo en el distrito de Luohu de la ciudad de Shenzhen de 2015 a 2017 como modelo para la práctica. En septiembre de 2017, el Ministerio de Salud de China introdujo este enfoque de atención integrada centrada en las personas en todo el país. Se describen las características del modelo de Luohu en relación con las áreas centrales de acción y las estrategias de implementación propuestas y se resumen los datos de una evaluación de los dos primeros años del programa. Se exponen los desafíos enfrentados durante la implementación y las lecciones aprendidas de la misma para otros sistemas de atención sanitaria. Se considera cómo mejorar la colaboración entre las instituciones, cómo cambiar el comportamiento de la población sobre el uso de los servicios sanitarios comunitarios como primer punto de contacto y cómo gestionar eficazmente los recursos para evitar déficits de presupuesto. Por último, se esbozaron los próximos pasos del modelo de Luohu y su posible aplicación para fortalecer la atención sanitaria en otros sistemas urbanos de atención sanitaria.

The Luohu Model: A Template for Integrated Urban Healthcare Systems in China.

INTRODUCTION: Emerging from the epidemiological transition and accelerated aging process, China's fragmentated healthcare systems struggle to meet the demands of the population. On Sept 1st 2017, China's National Health and Family Planning Commission encouraged all cities to learn from the Luohu model of integration adopted in Luohu as an approach to meeting these challenges. In this paper, we study the integration process, analyze the core mechanisms, and conduct preliminary evaluations of integrated policy development in the Luohu model. POLICY DEVELOPMENT: The Luohu hospital group was established in Aug 2015, consists of five district hospitals, 23 community health stations and an institute of precision medicine. The group adopted a series of professional, organizational, system, functional and normative strategies for integrated care, which was provided for the residents of Luohu, especially for the elderly population and patients with chronic conditions. According to a preliminary evaluation of the past two years, the Luohu model showed improvement in the structure and process towards integrated care. New preventive programs conducted in the hospital group resulted in changes of disease incidence. Residents were more satisfied with the Luohu model. However, spending exceeded the global budget for health insurance because of short-term increases in the demand for health care. LESSONS LEARNED: First, engagement of multiple stakeholders is essential for the design and implementation of reform. Second, organizational integration is a prerequisite for integrated care in China. Third, effective care integration requires alignment with payment reforms. Fourth, normative integration could promote collaboration in an integrated healthcare system. CONCLUSION: Core strategies and mechanisms of the Luohu model will promote integrated care in urban China and other countries facing the same challenges. However, it is necessary to study the effects of the Luohu model over the long term and continue to strive for integrated care.

[Observation on therapeutic effect of cervical spondylosis of vertebral artery type treated with both acupuncture and mild moxibustion].

OBJECTIVE: To observe the clinical therapeutic effects on cervical spondylosis of vertebral artery type treated with both acupuncture and mild moxibustion and investigate the mechanism of action. METHODS: Sixty cases were randomly divided into the combined therapy group of acupuncture and mild moxibustion (combined therapy group) and the acupuncture group, 30 cases for each group. In combined therapy group, Baihui (GV 20), Fengchi (GB 20) and cervical Jiaji (EX-B 2) were punctured, and Baihui(GV 20), Dazhui (GV 14), Mingmen (GV 4), Shenque (CV 8) and Guanyuan (CV 4) were treated with mild moxibustion; in acupuncture group, acupuncture was simply applied, the acupoints selection and manipulation were the same as those in the combined therapy group. The average velocity meter and the resistive index of vertebral and basal arteries were observed before and after treatment by TCD examination, the therapeutic effects and clinical symptom-sign scores were observed too. RESULTS: The total effective rate was 93.3% (28/30) in combined therapy group, and 73.3% (22/30) in acupuncture group. The therapeutic effect in combined therapy group was superior to that in acupuncture group (P < 0.05). The improvements of symptom-sign scores in two groups after treatment were more significant than that before treatment, and the score in the combined therapy group was superior to that in acupuncture group (P < 0.05). The average velocity meter and the resistive index of vertebral and basal arteries after treatment were improved in both groups, in which, the improvement in combined therapy group was more apparent (all P < 0.05). CONCLUSION: The therapeutic effects on cervical spondylosis of vertebral artery type treated with both acupuncture and mild moxibustion are preferable; by this therapy, the average velocity meter of vertebral and basal arteries are accelerated and the resistive index is decreased.