[Research Status and Trend of Screening for Women's Common Diseases in China].

Objective To visualize the research status and hotspots of women's common disease screening based on CiteSpace 6.1.R6,and to provide a reference for the in-depth research in this field thereafter. Methods The relevant articles were retrieved from the China National Knowledge Infrastructure with the time interval from January 1,1992 to December 13,2022.The analysis was conducted on the number of annual publications,countries(regions),institutions,author collaboration networks,keyword co-occurrence,clustering,and bursts. Results A total of 900 papers that met the criteria were included,and the number of annual publications showed a trend of first increasing and then decreasing.The cross-institutional collaboration network was mature.The research hotspots mainly covered women's health,the prevalence of women's diseases,reproductive health,and breast diseases.The hotspots have evolved from an initial focus on reproductive health care to gynecological disease management,and eventually to reproductive health and holistic health care in women. Conclusions The attention should be kept on the screening of women's common diseases.It is advisable to synchronize the screening of women's common diseases with the screening of cervical and breast cancers to expand the screening coverage,promote early disease detection and treatment,and comprehensively safeguard women's health.

Developing an evaluation indicators of health literacy for cervical cancer among Chinese women: a modified Delphi method study.

BACKGROUND: Increasing women's health literacy is the key to preventing cervical cancer, and various tools have been developed to assess women's cancer health literacy. However, many of these tools come from other countries and have not been adapted to Chinese requirements. Furthermore, a system for evaluating cervical cancer health literacy among Chinese women has not been developed. Therefore, we sought to establish an evaluation index system for cervical cancer health literacy among Chinese women and to provide an effective evaluation tool for tertiary prevention of cervical cancer in China. METHODS: We invited 20 recognized experts to participate in two rounds of Delphi expert consultation, and the modified Delphi process with percentage weighting and multiplication was used. A literature review identified 67 potential indicators. Subsequent discussions within our research team led to the retention of 48 indicators following a rigorous screening process. On this basis, two rounds of Delphi expert consultation were conducted to rate and screen the indexes. Percentage weighting and multiplication were used to determine index weights. RESULTS: Twenty experts participated in the first-round Delphi consultations (95.23% recovery rate). In the second-round Delphi consultations, 20 questionnaires were returned (100%), and the expert authority coefficient was 0.93 ± 0.02. After both rounds of Delphi consultation, 4 first-level indicators, 9 second-level indicators, and 32 third-level indicators were identified for cervical cancer literacy among Chinese women. On a five-point scale, importance ratings ranged from 3.76 to 4.95 points, with variation coefficients ranging from 0.06 to 0.25, while sensitivity ratings ranged from 3.71 to 4.83 points, with variation coefficients ranging from 0.08 to 0.24. Across both rounds, Kendall's W coefficients ranged from 0.168 to 0.248. The weights of first-level indicators of basic knowledge and attitudes about cervical cancer, primary prevention of cervical cancer literacy, secondary prevention of cervical cancer literacy, and tertiary prevention of cervical cancer literacy were 0.257, 0.249, 0.251, and 0.243, respectively. CONCLUSIONS: We have developed the first tertiary prevention-based, comprehensive evaluation index system for cervical cancer literacy among Chinese women, which will provide theoretical support for cervical cancer prevention and health education programs.

Case-mix adjustment of patient-reported experience measures in National Regional Center for Pediatric.

BACKGROUND: The aim of the study was to identify case-mix adjusters for the Chinese version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) and assess the impact of case-mix adjustment on patient experience measures in China. METHODS: This study analyzed data collected from six National Regional Center for Pediatric across China retrospectively. Participants were children aged ≤17 years and their guardians who completed the survey. The Chinese Child-HCAHPS was used to measure pediatric inpatient care experience. Candidate case-mix adjusters were assessed using a summary measure of explanatory power. Changes in scores and rankings of the six centers were quantified to assess the impact of adjustment. RESULTS: A total of 2708 respondents completed the survey from January to March 2021, with a response rate of 7-15%. The child's global health status and the respondent being the child's mother were identified as case-mix adjusters, and case-mix adjustment models for 18 patient experience items were constructed. Kendall's τ correlation of hospital rankings before and after adjustment ranged from 0.73 to 1.00. CONCLUSIONS: Although the impact of case-mix adjustment may appear modest in our sample, it demonstrated the feasibility, necessity, and methodology for further development of case-mix adjustment models in pediatric healthcare facilities in China. IMPACT: Case-mix adjustment models adjust for factors that are unamendable by healthcare providers that may affect patient experience ratings, thereby improving the comparability of institutional-level ratings. Standardized case-mix adjustment protocols for quality measures need to be modified in different settings. This is the first study to identify adjustment variables and the possible impact of case-mix adjustment on pediatric inpatients' experience measures in a Chinese population. This study provided evidence on the feasibility and necessity for further development of case-mix adjustment models for pediatric healthcare facilities in China.

Clinical and imaging markers for the prognosis of acute ischemic stroke.

Background and purpose: Significant differences in the outcomes observed in patients with acute ischemic stroke (AIS) have led to research investigations for identifying the predictors. In this retrospective study, we aimed to investigate the relationship of different clinical and imaging factors with the prognosis of AIS. Materials and methods: All clinical and imaging metrics were compared between the good and poor prognosis groups according to the modified Rankin Scale (mRS) score at 90 days after discharge. Clinical factors included gender, age, NIHSS scores at admission, and other medical history risk factors. Imaging markers included the lesion's size and location, diffusion, and perfusion metrics of infarction core and peripheral regions, and the state of collateral circulation. Spearman's correlations were analyzed for age and imaging markers between the different groups. The Chi-square test and Cramer's V coefficient analysis were performed for gender, collateral circulation status, NIHSS score, and other stroke risk factors. Results: A total of 89 patients with AIS were divided into the good (mRS score ≤ 2) and poor prognosis groups (mRS score ≥ 3). There were differences in NIHSS score at the admission; relative MK (rMK), relative MD (rMD), relative CBF (rCBF) of the infarction core; relative mean transit time (rMTT), relative time to peak (rTTP), and relative CBF (rCBF) of peripheral regions; and collateral circulation status between the two groups (p < 0.05). Among them, the rMK of infarction lesions had the strongest correlation with the mRS score at 90 days after discharge (r = 0.545, p < 0.001). Conclusion: Perfusion and diffusion metrics could reflect the microstructure and blood flow characteristics of the lesion, which were the key factors for the salvage ability and prognosis of the infarction tissue. The characteristics of the infarction core and peripheral regions have different effects on the outcomes. Diffusion of infarction core has strong relations with the prognosis, whereas the time metrics (MTT, TTP) were more important for peripheral regions. MK had a more significant association with prognosis than MD. These factors were the primary markers influencing the prognosis of cerebral infarction patients.

Discrimination between progressive penumbra and benign oligemia of the diffusion-perfusion mismatch region by amide proton transfer-weighted imaging.

PURPOSE: Amide proton transfer-weighted (APTw) imaging was an effective tool to reveal the tissue acidosis of acute ischemic stroke. This study aimed to evaluate the ability of APTw MRI to distinguish progressive penumbra and benign oligemia in the diffusion-perfusion mismatch region. MATERIALS AND METHODS: 38 acute cerebral infarction patients who underwent a comprehensive MRI examination, including diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), APT imaging, and a follow-up scan in one week were recruited. There were 12 DWI/PWI match cases. The DWI/PWI mismatch patients were divided into 10 progressive cases and 16 stable cases according to the lesion size on the follow-up DWI image compared to the admission scan. Three ROIs: infarction lesion, peripheral, and contralateral normal regions were measured on each subject's MTRasym map. The Friedman test was used to compare the changes of MTRasym among three different regions within each group. The Kruskal-Wallis ANOVA test was used to compare them among the same region of different groups. The correlation between the MTRasym of the peripheral region and the lesion enlargement was analyzed by the Spearman test. RESULTS: The MTRasym at the infarction lesion of all three groups showed significant decrease to the contralateral normal tissue. In the progressive mismatch group, the MTRasym at the peripheral region within the DWI/PWI mismatch showed a significant difference with the contralateral normal region and no difference with the infarct core. Whereas both the MTRasym at the peripheral region of the stable mismatch and match groups had no significant difference with the contralateral side, but the differences were significant from those of the central core. When comparing the peripheral region of three groups, the MTRasym of the progressive mismatch group showed a significant decrease to that of the stable mismatch and match groups. The MTRasym of the peripheral region showed a negative correlation with lesion enlargement. CONCLUSION: APTw imaging is promising to stratify the heterogeneous PWI/DWI mismatch region and benefit the clinical treatment.

Medication Adherence and Perceived Social Support of Hypertensive Patients in China: A Community-Based Survey Study.

Purpose: Previous studies suggested perceived social support has impact on medication adherence among hypertensive patients, but did not simultaneously elucidate the different contents or key providers of social support that patients perceived. This study was to identify the contents and providers of perceived social support beneficial for improving medication adherence among hypertensive patients in China, which could prove important for targeted interventions. Patients and Methods: Following a multi-stage stratified sampling framework, a total of 903 hypertensive patients from 12 primary health institutions across a middle-income city were recruited from April to June 2021. Medication adherence was measured using the Chinese version of the Morisky, Green and Levine scale; perceived social support was determined using the name generator method. A binary logistic regression model was performed to identify the association between medication adherence and perceived social support. The contents of support included informational, emotional, and instrumental support (finances and caregiving). The support providers included spouse/partner, children, parents, siblings, other relatives, and friends. Results: A total of 506 (56.04%) patients optimally adhered to their antihypertensive medication. Female, older, urban patients, patients with shorter duration of hypertension and antihypertensive medications used showed better adherence (P<0.05). Optimal medication adherence was positively associated with the overall score of caregiving support (adjusted odds ratio [AOR] = 1.128; 95% confidence interval [CI] = [1.013-1.257]), informational support from the spouse/partner (AOR = 1.574; 95% CI = [1.112-2.227]), emotional support from the spouse/partner (AOR = 1.430; 95% CI = [1.032-1.981]), financial support from the spouse/partner (AOR = 1.439; 95% CI = [1.069-1.937]) and caregiving support from the spouse/partner (AOR = 1.652; 95% CI = [1.130-2.414]), whereas optimal medication adherence was negatively associated with caregiving support from friends (AOR = 0.499; 95% CI = [0.286-0.872]). Conclusion: Informational, emotional, financial and caregiving support from spouses/partners have positive impacts on optimal medication adherence of hypertensive patients of community-level. Community-based interventions designed to improve medication adherence of hypertensive patients should target both patients and their spouses/partners; spouses/partners could be encouraged to provide various support to improve the medication adherence of hypertensive patients.

Integrating Health and Care in China: Lessons Learned and Future Outlook.

BACKGROUND: An aging population is one of the key drivers reshaping health care systems. In China, the complex needs of its huge aging population require integration across the health and care sectors. POLICIES AND PROGRESS: Over the past decade, the central government of China promulgated a series of policies to promote the establishment of aftercare facilities, specify approaches to integrate health and care service delivery at institutional and community levels, pilot long-term care insurance (LTCI) as a funding mechanism, and reform administrative structures in favor of integration. Progress has been made towards organizational and clinical integration of service delivery both at institutional and community levels. LTCI has been introduced as the financing mechanism covering long term care services. DISCUSSIONS AND CONCLUSIONS: The experiences of China in the integration of health and care could be summarized as a top-down approach in policy formulation and implementation, the significant employment of pilots and demonstrations, and the activation of market forces. However, China is still in the initial stage of integrating health and care and is faced with system-level challenges in its financing, management, and workforce, and faces technical challenges, such as a lack of tools, and standards. In the future, these issues need to be addressed.