Evaluation of a community-based integrated care model (CIE) for frail older people in rural Foshan, China: study protocol for a stepped-wedge cluster randomized controlled trial {1}.

BACKGROUND: While community-based eldercare has proven to be effective in qualitative studies, there is limited evidence on the effectiveness of this geriatric care model in rural communities where caring for older people is traditionally the responsibility of family members, but a formal long-term care was recently introduced in China. CIE is a rural community-embedded intervention using multidisciplinary team, to provide evidenced-based integrated care services for frail older people including social care services and allied primary healthcare and community-based rehabilitation services. METHODS: CIE is a prospective stepped-wedge cluster randomized trial conducted at 5 community eldercare centers in rural China. The multifaceted CIE intervention, guided by chronic care model and integrated care model, consists of five components: comprehensive geriatric assessment, individualized care planning, community-based rehabilitation, interdisciplinary case management, and care coordination. The intervention is rolled out in a staggered manner in these clusters of centers at an interval of 1 month. The primary outcomes include functional status, quality of life, and social support. Process evaluation will also be conducted. Generalized linear mixed model is employed for binary outcomes. DISCUSSION: This study is expected to provide important new evidence on clinical effectiveness and implementation process of an integrated care model for frail older people. The CIE model is also unique as the first registered trial implementing a community-based eldercare model using multidisciplinary team to promote individualized social care services integrated with primary healthcare and community-based rehabilitation services for frail older people in rural China, where formal long-term care was recently introduced. TRIAL REGISTRATION {2A}: China Clinical Trials Register ( http://www.chictr.org.cn/historyversionpub.aspx?regno=ChiCTR2200060326 ). May 28th, 2022.

Health-related outcomes 6 months after integrated care of older people with stroke in 2 different primary care settings.

BACKGROUND: Integrated care has been proven to be effective among stroke survivors. However, in China, these services mainly focus on connecting the healthcare system (acute, primary medical, and skilled) at the individual level. Closer health and social care integration is a new concept. OBJECTIVE: This study aimed to compare health-related outcomes 6 months after the implementation of the 2 integrated care models. METHODS: It was a 6-month follow-up of an open, prospectively study comparing the outcomes of a model of integrated health and social care (IHSC) versus a usual integrated healthcare (IHC) model. Outcomes were measured by Short-Form Health Survey-36 (SF-36), Modified Barthel Index (MBI), and Caregiver Strain Index (CSI) at 3 and 6 months, respectively. RESULTS: There were no statistically significant differences in MBI scores between patients in the 2 models either after 3 months or at the end of intervention. The same trend was not seen in Physical Components Summary, an integral component of SF-36. Patients in IHSC model scored statistically significant higher points in Mental Components Summary, another integral part of SF-36 than patients in IHC model after 6 months. Average scores of CSI were statistically significant lower for IHSC model than for IHC model after 6 months. CONCLUSION: The findings suggest the need to improve the scales of integration and recognize the vital role played by social care services when designing or improving an integrated care for older people with stroke.

The Root Hair Development of Pectin Polygalacturonase PGX2 Activation Tagging Line in Response to Phosphate Deficiency.

Pectin, cellulose, and hemicellulose constitute the primary cell wall in eudicots and function in multiple developmental processes in plants. Root hairs are outgrowths of specialized epidermal cells that absorb water and nutrients from the soil. Cell wall architecture influences root hair development, but how cell wall remodeling might enable enhanced root hair formation in response to phosphate (P) deficiency remains relatively unclear. Here, we found that POLYGALACTURONASE INVOLVED IN EXPANSION 2 (PGX2) functions in conditional root hair development. Under low P conditions, a PGX2 activation tagged line (PGX2AT ) displays bubble-like root hairs and abnormal callose deposition and superoxide accumulation in roots. We found that the polar localization and trafficking of PIN2 are altered in PGX2AT roots in response to P deficiency. We also found that actin filaments were less compact but more stable in PGX2AT root hair cells and that actin filament skewness in PGX2AT root hairs was recovered by treatment with 1-N-naphthylphthalamic acid (NPA), an auxin transport inhibitor. These results demonstrate that activation tagging of PGX2 affects cell wall remodeling, auxin signaling, and actin microfilament orientation, which may cooperatively regulate root hair development in response to P starvation.

Factors associated with willingness to receive a novel community care service for older people in Foshan, China: a cross-sectional study.

BACKGROUND: In China, the majority of community care for older people is planned and offered in a few large cities. The provision of community care to the rural population is a new concept. This study aimed to assess the prevalence of willingness to receive a novel community care service that incorporates community rehabilitation among older people, and identify the possible factors influencing utilization willingness in Foshan, China. METHODS: A cross-sectional study was conducted involving 413 older people in Lishui county, China from January to March 2021. Trained staff interviewed older people using structured questionnaires. Multivariate logistic regression analysis was used to determine factors that were significantly associated with the willingness to receive this novel community care. RESULTS: The prevalence of willingness to receive community care for older people was 61.9% (n = 245) in Foshan, China. Older people who were living alone or living with spouses were about two times significantly more likely to receive community care compared to those living with children/others (OR = 2.19, 95%CI:2.44 ~ 3.19, OR = 2.015, 95%CI: 1.39 ~ 2.23, respectively). Older people who lived closer to the community care center were about two times significantly more likely to receive community care compared to those who lived far away (OR = 2.10, 95%CI: 1.61 ~ 2.41). Older people with activity of daily living disability were about three times significantly more likely to receive community care compared to those without a disability (OR = 3.13, 95%CI: 2.38 ~ 3.29). CONCLUSIONS: A majority of rural older people were willing to receive this novel community care service that includes community rehabilitation. The findings suggest the need for policies and programs to not only improve the provision of this novel community care service but also promote its uptake among older people in the study setting.

Effects of a transitional care program for individuals with limbs disabilities living in a rural community: A randomized controlled trial.

BACKGROUND: Transitional care (TC) has been proven to be effective in addressing fragmented care and preventing adverse outcomes for chronically ill patients transitioning from hospital to home, but the definitive description of TC that was used successfully for individuals with limbs disability has not been formed in the context of health care reform in China. OBJECTIVE: The aim of this study was to evaluate the effect of a TC program on health outcomes in individuals with limbs disability based on an original community for healthcare. METHOD: It was a randomized controlled trial. Individuals in the intervention group received ongoing rehabilitation both at the specialized care center and at home through multidisciplinary team, while individuals in the control group received routine follow-up visits by primary healthcare physicians. Outcomes were measured by Short-Form Health Survey-36 (SF-36), Modified Barthel Index (MBI) and Caregiver Strain Index (CSI) at 3 and 6 months respectively. RESULTS: A total of 84 participants were randomly assigned (intervention n = 42, control n = 42). Mean values of Physical Components Summary, an integral component of SF-36, was significantly better in the intervention group at 3 and 6 months (42.0 ± 2.3 and 44.3 ± 1.5 respectively). The same trend was observed in MBI (72.2 ± 6.8 and 78.6 ± 9.3 at 3 and 6 months respectively). But the significant improvement in CSI was only observed at 6 months. There were significant differences between groups in these scores except Mental Components Summary. CONCLUSION: The TC program has been proven to be feasible and improve health-related outcomes.

Prevalence and associated factors of postpartum depression among immigrant women in Guangzhou, China.

BACKGROUND: Although there has been mounting research on postpartum depression (PPD), the impact of immigration on PPD has remained quite unexplored. The purpose of this study is to investigate the prevalence and associated factors of PPD among immigrant women living in Guangzhou at 6 weeks postpartum. METHODS: A cross-sectional study was conducted involving 1230 immigrant women in a tertiary hospital of Guangzhou from December 2016 to December 2017 at 6 weeks postpartum. The Chinese version of Edinburgh Postnatal Depression Scale and a structured questionnaire regarding associated factors were administered to all participants. Multivariate logistic regression was used to determine factors that were significantly associated with PPD. RESULTS: The prevalence of PPD among immigrant women at 6 weeks postpartum was 34.0%. A multivariate logistic regression model identified significant obstetric and social factors as: living in Guangzhou for less than 2 years, insufficient family income, poor social support and marital relationship. CONCLUSION: Prevalence of PPD among immigrant women from Guangzhou at 6 weeks postpartum is high. The development of PPD among immigrant women is associated with individual and social factors. There's an urgent need for healthcare providers to take a more active role in engaging immigrant women in their psychological needs.

Effects of an integrated transitional care program for stroke survivors living in a rural community: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of an integrated transitional care program on health outcomes in stroke survivors based on an original community for healthcare. DESIGN: A pilot randomized controlled trial with blinded assessment. Randomization by statistician using computer-generated, random numbers concealed in opaque envelopes. SETTING: A tertiary hospital and participants' home across Lishui, China. SUBJECTS: A total of 98 people with acute cerebral hemorrhage or cerebral infarction, eight weeks following discharge from our hospital. INTERVENTIONS: Each participant received stroke unit-based treatment including acute medical treatment, early rehabilitation and health education. Patients in the intervention group received ongoing rehabilitation at home through multidisciplinary team, while patients in the control group received secondary stroke prevention. MAIN MEASURES: Short-Form Health Survey-36, Modified Barthel Index and Caregiver Strain Index at four and eight weeks, respectively, after discharged. RESULTS: A total of 98 participants were recruited (intervention n = 49, control n = 49). Patients had an average age of 61.4 years (61.4 ± 18.3). Mean values of Physical Components Summary and Mental Components Summary, integral components of Short-Form Health Survey-36, were significantly better in the intervention group at four and eight weeks (40.2 ± 6.3 and 42.9 ± 3.7 for the former; 43.9 ± 2.6 and 46.1 ± 1.8 for the later). The same trend was observed in Modified Barthel Index (87.1 ± 9.2 and 92.5 ± 6.7 at four and eight weeks, respectively). But the significant improvement in Caregiver Strain Index was only observed at four weeks. There were significant differences between groups in these scores. CONCLUSION: The transitional care program has been proven to be feasible and improve health-related outcomes.

Incidence and risk factors associated with postpartum depression among women of advanced maternal age from Guangzhou, China.

PURPOSE: To investigate whether advanced maternal age (AMA) increases the risk of postpartum depression (PPD) at 6 weeks after birth and to explore the risk factors. DESIGN AND METHODS: A cross-sectional study was conducted at 6 weeks postpartum. The Edinburgh Postnatal Depression Scale and a self-designed questionnaire were administered to participants. Multivariate logistic regression was used to determine risk factors. FINDINGS: The prevalence of PPD in women of AMA was 18.0%. Poor relationships with mothers-in-law, female fetus, inconsistency between expected sex and actual sex and primiparae were identified as risk factors. PRACTICE IMPLICATIONS: Mothers of AMA require specialized care and support to alleviate their concerns.

Overexpression of a pectin methylesterase gene PtoPME35 from Populus tomentosa influences stomatal function and drought tolerance in Arabidopsis thaliana.

Poplar is a superior forestation species with high adaptability. The woody tissue of poplar is mainly derived from cell wall. Cell wall formation determines cell shape and woody growth. Pectin is rich in primary cell wall, but it is also involved in the regulation of wood formation. In our study, we cloned a gene from poplar (Populus tomentos), designed as PtoPME35, which encodes a putative pectin methylesterase. PtoPME35 has higher sequence similarity with Arabidopsis AtPME35. Gene expression analysis shows that PtoPME35 has a constitutive expression pattern in multiple tissues, with the highest expression in stem. Subcellular localization result indicates that PtoPME35 is localized to the cell wall. To elucidate the biological function of PtoPME35 in vivo, we generated overexpression plants in poplar and Arabidopsis. The degree of pectin methylesterification is decreased in PtoPME35-overexpressing transgenic poplar, although no obvious phenotypes were displayed. In PtoPME35-overexpressing Arabidopsis plants, stomatal opening is inhibited and water loss rate is decreased under the drought condition. Moreover, the expression levels of drought-stress responsive genes were higher with mannitol treatment in PtoPME35-overexpressing Arabidopsis plants than in wild type controls. Accordingly, these results suggest that PtoPME35 may regulate osmotic stress responses by modulating stomatal functions.

Prevalence and factors associated with postpartum depression in women from single-child families.

OBJECTIVE: To investigate the prevalence of postpartum depression (PPD) and its associated factors among women without siblings from south China. METHODS: A cross-sectional study was conducted involving 468 mothers from single-child families who were assessed at 6 weeks after childbirth at a tertiary hospital in Guangzhou, China, from June 2015 to July 2016. The Chinese version of the Edinburgh Postnatal Depression Scale and a self-designed questionnaire regarding risk factors were administered to all participants. RESULTS: The prevalence of PPD in women from single-child families was 56.2%. A multivariate logistic regression model identified the following pregnancy-related and psychological risk factors: unplanned pregnancy (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.73-3.32), being a first-time mother (OR 3.00, 95% CI 1.73-4.93), poor mother-in-law relationship (OR 3.15, 95% CI 2.93-3.36), and poor family support (OR 2.13, 95% CI 1.84-2.45). Sociodemographic characteristics were not associated with the development of PPD. CONCLUSION: The development of PPD in women from single-child families is an important public health concern. Health practitioners should offer psychoeducation and culturally sensitive counseling during the postpartum period, and the screening of mood disorders from the prenatal to the postpartum period should be covered by maternity insurance.

[Application of precision medicine in the field of surgery].

Precision medicine, based on personalized medicine, is to provide personalized and precise treatment. The emergence of 3D printing technique as well as genome sequencing provides an effective way to realize precise and personalized treatment. The application of 3D printing technique in the field of surgery is listed as following: optimize operation plan to achieve precise and personalized surgery; design personalized navigation template; personalized prosthesis production; design of personalized tissue and organ. With the development of tissue engineering, new material technology and genome sequencing and the improvement in related polices and regulations, precision medicine will step on a higher level in the field of surgery. This review introduces the application of precision medicine in the field of surgery.

Association between lipid ratios and insulin resistance in a Chinese population.

AIM: To explore the association of lipid ratios and triglyceride (TG) with insulin resistance (IR) in a Chinese population. We also provide the clinical utility of lipid ratios to identify men and women with IR. METHODS: This cross-sectional study included 614 men and 1055 women without diabetes. Insulin resistance was defined by homeostatic model assessment of IR > 2.69. Lipid ratios included the TG/ high density lipoprotein cholesterol (HDL-C), the total cholesterol (TC)/HDL-C and the low density lipoprotein cholesterol (LDL-C)/HDL -C. Logistic regression models and accurate estimates of the area under the receiver operating characteristic (AUROC) curves were obtained. RESULTS: In normal-weight men, none of lipid ratios nor TG was associated with IR. In overweight/obese men, normal-weight women and overweight/obese women, the TG/HDL-C, the TC/HDL-C and TG were significantly associated with IR, and the associations were independent of waist circumference. All of the AUROCs for the TG/HDL-C and TG were > 0.7. The AUROCs for TC/HDL-C ratio were 0.69-0.77. The optimal cut-offs for TG/HDL-C were 1.51 in men and 0.84 in women. The optimal cut-offs for TG were 1.78 mmol/L in men and 1.49 mmol/L in women, respectively. In men, the optimal cut-off for LDL-C/HDL-C is 3.80. In women, the optimal cut-off for LDL-C/HDL-C is 3.82. CONCLUSION: The TG/HDL-C, the TC/HDL-C and TG are associated with IR in overweight/obese men, normal-weight and overweight/obese women. The LDL-C/HDL-C is only associated with IR in normal-weight women. The TG/HDL-C and TG might be used as surrogate markers for assessing IR.

[Pelvic floor muscle strength screening and analysis of its related factors among migrant women in the Pearl River Delta].

OBJECTIVE: To investigate the prevalence and related factors of abnormal pelvic floor muscle strength and provide theoretical evidence for the prevention and treatment of pelvic floor dysfunction. METHODS: A total of 1008 migrant women in hospitals of Guangzhou and Foshan were screened for pelvic floor strength at 42 days postpartum from Oct, 2013 to July, 2014. EMG biofeedback equipment was employed to assess the strength of type I and II muscle fiber and a questionnaire was designed to record its related factors. RESULTS: The incidence of abnormal type I and II muscle fiber strength was 49.21% and 49.60%, respectively. No statistical significance was observed in the abnormal rates among women with different ages or occupations. Compared with women who chose vaginal delivery, women with cesarean section had significantly reduced abnormal rates. A negative correlation was found between parity and type I and II muscle fiber strength. CONCLUSION: The delivery mode and parity are factors affecting pelvic floor muscle strength among migrant women in the Pearl River Delta, suggesting the necessity of health education and promotion of family planning policy.

[Postoperative rehabilitation strategy for acetabular fracture: application of 3D printing technique].

OBJECTIVE: To explore the value of 3D printing technique in the surgical management and strategy of rehabilitation therapy of acetabular fracture. METHODS: For a patient with acetabular fracture, the pelvis model was printed preoperatively by 3D printing technique for surgical simulation to determine the optimal position of the screw, measure the screw length, and design the route of screw entry. Laparoscopic assisted internal fixation was performed, and a gradual and systematic rehabilitation plan was carried out after the surgery based on the results of simulation. RESULTS: The operation was completed successfully with a shortened postoperative recovery time. CONCLUSIONS: The application of 3D printing allows more accurate and safer surgical management of acetabular fracture to promote postoperative recovery of the patient and lower the medical costs.

Prevalence and risk factors of postpartum depression in a population-based sample of women in Tangxia Community, Guangzhou.

OBJECTIVE: To investigate the prevalence and analyze the risk factors of postpartum depression (PPD) in Tangxia Community, Guangzhou, a community representative of the process of urbanization in China. METHODS: A total of 1 823 delivery women in Tangxia Community, Guangzhou were screened with the Chinese Version of Edinburgh Postnatal Depression Scale, Hamilton Depression Scale and Social Support Rating Scale. The risk factors were evaluated by self-made questionnaire based on literature interview combined with expert consultation. The data collected were analyzed using Student's t test and logistic regression in SPSS16.0. RESULTS: The prevalence of PPD in Tangxia Community, Guangzhou was 27.37%. Mutivariant logistic regression analysis identified mode of delivery, puerperant from one-child family, relationship between mother-in-law and daughter-in-law and fetus gender as the risk factors of PPD while housing condition was negatively correlated with the incidence of PPD with OR value of 0.82.The the total score of social support rating scale, the score of objective support, subjective support and social utilization degree were significantly reduced in women with PPD in contrast with women without PPD. CONCLUSIONS: The incidence of PPD was slightly higher than other regions of China. It's of great importance to distinguish risk factors in regional culture context and develop health promotion program in order to enhance the well-being of delivery women.

[Prevalence and risk factors of postpartum depression in Tianhe District of Guangzhou].

OBJECTIVE: To investigate the prevalence and risk factors of postpartum depression (PPD) in Tianhe district of Guangzhou. METHODS: A total of 1428 postpartum women in 3 hospitals in Tianhe District of Guangzhou were screened with Edinburg Postnatal Depression Scale (EPDS), Social Support Rating Scale (SSRS) and a self-designed questionnaire of PPD-related factors during the period from May to September, 2013. RESULTS: The prevalence of PPD was 20.03% in these women. Unconditional logistic regression analysis showed a significant correlation of PPD with education, delivery mode, only daughter, relationship between mother-in-law and daughter-in-law, newborn gender satisfaction and housing condition (P<0.05). Multivariate logistic regression analysis identified education, delivery mode, only daughter, relationship between mother-in-law and daughter-in-law, and newborn gender satisfaction as the risk factors for PPD, and housing condition was negatively correlated with the incidence of PPD with an OR value of 0.900. Compared with healthy postpartum women, the patients with PPD exhibited significantly reduced total score of social support rating scale, score of objective support, score of subjective support, and social utilization degree. CONCLUSION: The prevalence of PPD is high in Tianhe District of Guangzhou, and health education and psychosocial intervention should be offered to prevent PPD.

Electroenterogram manifestations and significance in hypokalemia.

OBJECTIVE: To study the electroenterogram manifestations and their significance in patients with hypokalemia. METHODS: Electroenterogram was recorded in 20 normal control subjects and 24 patients with hypokalemia using computerized electrogastroenterography. RESULTS: The frequencies and amplitudes of the electroenterogram in patients with hypokalemia were significantly lower than those in the normal control subjects (P<0.05), and the frequencies, amplitudes and their coefficients of variation varied significantly in patients with hypokalemia before / after treatment (P<0.001). CONCLUSION: Electroenterogram may serve as an objective means for evaluating the therapeutic effect and estimating intestinal motility of patients with hypokalemia, with also important value in predicting and diagnosing hypokalemic intestinal paralysis.

[Effect of power-frequency electromagnetic fields on stroke during rehabilitation].

OBJECTIVE: To explore the effects and mechanism of power-frequency electromagnetic fields on lipoprotein metabolism and homodynamic during stroke rehabilitation. METHODS: One hundred fifteen patients with stroke were divided into 2 groups, 55 cases of them were treated by exposure to power-frequency electromagnetic fields, 60 cases were treated as control group. Barthel index and Functional Independence Measure (FIM) were used to evaluate rehabilitation outcome. The lipoprotein and its subclasses, homodynamic parameters were compared at pre- and post-rehabilitation. RESULTS: The treatment group showed a statistically significant better prognosis compared with the control group(P<0.01). The score of Barthel index also increased after treatment(P<0.001). Total cholesterol(Tc), triglycerides(TG), low-density lipoprotein cholesterol(LDL-c) levels dropped and high-density lipoprotein cholesterol(HDL-c) increased significantly. The Tc/HDL-c, LDL-c/HDL-c ratio along with the blood and plasma viscosity decreased significantly compared with the controls (P<0.01). The ratio of stroke recurrence decreased significantly after the treatment compared with the control group (P<0.05). CONCLUSION: The power-frequency electromagnetic fields can improve lipoprotein metabolism and homodynamic parameters. It can improve the ADL and FIM of stroke patients, which may have significant implications for stroke patients.

[Rehabilitation therapy in early stage following spinal cord injuries].

OBJECTIVE: To investigate the effects of rehabilitation therapy in early stage following spinal cord injury on the patients' activities of daily living (ADL) and functional independence measure (FIM). METHODS: Ninety-two patients with spinal cord injuries were divided into early rehabilitation group (n=48) and control group (n=44) according to the timing of the rehabilitation therapy. Rehabilitation assessment of the patients with Barthel index and FIM was carried out before and 6 months after the rehabilitation therapy respectively for comparison. Different rehabilitation regimens were adopted for specific clinic stage of the patients, lasting for a total of 6 months. RESULTS: Barthel index and FIM score were all improved after the rehabilitation therapy in both of the two groups, but the improvements were more significant in early rehabilitation group (P<0.01). CONCLUSION: Early rehabilitation treatment is crucial for patients with spinal cord injuries in that it improves the patients' motor function, ADL and functional independence after the injury.