Background:The COVID-19 pandemic has intensified health care worker burnout and increased their engagement with social media. However, it remains unclear whether social media is beneficial in mitigating burnout among primary health care workers (PHWs). Objective:This study aims to report the prevalence of burnout among Chinese PHWs and investigate the relationship between social media use, specifically WeChat Moments usage, and burnout, with a focus on urban-rural differences. Methods:Our nationwide cross-sectional survey was conducted between May and October 2022 and included 3769 PHWs. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey, and WeChat Moments usage was self-evaluated. Weighted data were used to report the prevalence of burnout nationwide and in urban and rural areas. Multivariate logistic regression and subgroup analyses were used to examine the association between burnout and WeChat Moments usage frequency, highlighting differences between urban and rural PHWs. Results:Urban PHWs reported a higher prevalence of burnout compared with their rural counterparts (212/1200, 17.6% vs 351/2569, 13.7%; P=.004). Overall, the frequency of social media use was negatively associated with the prevalence of burnout. With the inclusion of covariates, those who sometimes used WeChat Moments experienced a statistically significant protective effect compared with those who never used WeChat Moments in the fully adjusted model (odds ratio 0.570, 95% CI 0.348-0.933; P=.03). The association between social media use and burnout was more statistically significant in urban settings than in rural settings (urban: all odds ratios and 95% CIs <1, and all P<.05; rural: all P>.05). Conclusions:Urban and rural differences in burnout prevalence were observed among PHWs, with urban practitioners experiencing significantly higher prevalence. This study also found that increased social media use was associated with a lower likelihood of experiencing burnout, but the association did not always exist. In terms of overall burnout, the relationship between social media use and burnout was statistically significant only in urban areas. Our findings underscore the urgent need for policy makers and health care institutions to prioritize interventions addressing burnout among PHWs, particularly in underresourced and high-stress settings. Local governments could pilot platforms with moderation, allowing PHWs to showcase their work progress to the communities they serve, thereby strengthening trust and reducing emotional exhaustion. Our research also suggests that social media interventions may be particularly effective in urban settings. These findings offer actionable insights for other low- and middle-income countries navigating similar challenges. International bodies (eg, the World Health Organization) should develop digital health guidelines specific to low- and middle-income countries to help policy makers balance the benefits and risks of social media.

Primary health-care workers (PHWs) managed increased workloads and pressure during the COVID-19 pandemic. This study conducted a national survey examining burnout among PHWs at the end of the COVID-19 pandemic, and identifies related factors. By doing so, it addresses the gap in understanding the burnout situation among PHWs at a national level, taking into account urban-rural disparities. We conducted a nationwide cross-sectional survey of PHWs in China from May to October 2022, covering 31 provinces. The MBI-HSS was used to measure overall burnout and emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). We used multivariable logistic regression to identify risk factors, and subgroup analyses to identify differences between rural and urban areas. 3769 PHWs from 44 primary health-care institutions completed the survey. Overall, 16.6

Objective: To explore"1+1+1"family-doctor double contract service, to let people get real benefits, and to provide the community residents with general medical service from health to health rehabilitation which cover the whole life cycle. Methods: Changfeng Community Health Service Center actively explored the "1+1+1" family doctor double contract service, which was to further deepen the service in line with international standards on the basis of family doctor service mode. Through choosing the representative of the neighborhood committee, determining the pilot family, and selecting outstanding family doctor, the contracted services were implemented, the work processes detailed, and quality services provided. Results: Through carrying out the 1+1+1 family doctor double signing service work, we improved the level of family doctor diagnosis and health management, promoted degraded diagnosis and treatment, and made the awareness rate of residents' health knowledge higher and meanwhile made it convenient for patients to seek medical treatment, but also improved the rate of health, participation rate of activities, medical compliance and satisfaction of health knowledge among residents. Conclusion: The family doctor double contract service pilot work has not only standardized the medical service work of the family doctor team, promoted the hierarchical diagnosis and treatment, strengthened health management, but also been beneficial to the improvement of the whole population medical service level.

Nocturnal hypertension is highly prevalent among Chinese and Asian populations, which is mainly attributed to high salt intake and high salt sensitivity. Nocturnal hypertension increases the risk of cardiovascular and all-cause mortality, independent of daytime blood pressure (BP). However, it can usually be detected by 24-h ambulatory BP monitoring, rather than routine office or home BP measurement, thus is often underdiagnosed in clinical practice. Currently, no specific guidance is available for the management of nocturnal hypertension in China or worldwide. Experts from the Chinese Hypertension League summarized the epidemiologic and pathophysiologic characteristics and clinical phenotype of nocturnal hypertension and provided consensus recommendations on optimal management of nocturnal hypertension, with the goal of maximally reducing the cardiovascular disease risks. In this consensus document, 24-h ABPM is recommended for screening and diagnosis of nocturnal hypertension, especially in the elderly, patients with diabetes, chronic kidney diseases, obstructive sleep apnea and other conditions prone to high nocturnal BP. Lifestyle modifications including salt intake restriction, exercise, weight loss, sleep improvement, and mental stress relief are recommended. Long-acting antihypertensive medications are preferred for nocturnal and 24-h BP control. Some newly developed agents, renal denervation, and other device-based therapy on nocturnal BP reduction are evaluated.

The standardized residency training of general practice is a complex project, the functional departments of the training base should play an active role for its management. The functional department of education in Zhongshan Hospital constantly explores its position and role, connects relevant departments vertically and horizontally to provides management and service for general practice residency training. That means that it should not only to provide advice for leadership decision-making, but also coordinate with all functional departments of the training base. The department has participated in the teaching management and supervision, educational research and training quality control, and accomplished positive results in general practice residency training for last 35 years.

加强基层医疗卫生工作是我国医药卫生体制改革的重点.无论是推动分级诊疗体系建设,还是促进实现"医防融合",全科医师都是基层医疗卫生工作的中坚力量.随着基本医疗卫生服务需求的不断增长和家庭医生签约服务内涵的延伸,建立与住院医师规范化培训体系相衔接、符合全科医师实际需求的教学体系,已成为医学教育工作的关注要点.因此,全科医师同质化、持续化能力提升至关重要.本文在回顾上海市全科医师的同质化教学发展历程的基础上,介绍基于"云端"管理的全科医师同质化实训教学模式的实践经验,以供各地开展基层全科医师能力持续提升工作参考.

目的 对结直肠癌患者给予阿司匹林，对其产生的化学预防作用进行系统性的评价。方法 从国内国外已经发表出的病例及对照研究数据进行分析，并检索相关的数据库，以NOS评分量表进行评定。使用RevMan5.0软件对数据进行Meta分析，计算出OR值及对应的95%CI。结果 最终纳入的病例、对照研究的文章共9篇，包括研究对象17932例。分析阿司匹林暴露的比例得出，总体病例组低于对照组；且在规律服药方面总体病例组比例低，尤其是在每日服用阿司匹林的比例上更低；亚组结直肠癌及亚组结肠癌患者服用阿司匹林暴露比例均低于对照组，差异均有统计学意义。结论 服用阿司匹林能有效降低结直肠癌发生率，在结直肠癌中具有化学预防作用。

兜兜转转中《中华全科医师杂志》迎来了桃李之年，回眸过往的历程，脑海里不由自主地浮现出《道德经》里的一句话：“道生一，一生二，二生三，三生万物”。“道”生万物是由少至多、由简到繁的一个过程；杂志创刊也是从无到有，不断地发展壮大。从最初的双月刊到月刊，从编辑四处约稿到笔者竞相投稿，从一本普通杂志成为中国科技核心期刊。正是杂志社诸位同仁的孜孜矻矻、历届编委的勤勉不怠、各位笔者的勤耕不辍以及诸多专家和读者的热心指正，才慢慢铸就了杂志今日的业绩。

Background and Objectives Serum uric acid (sUA) level has been reported to be associated with arteriosclerotic cardiovascular risk, yet remains poorly defined in Chinese type 2 diabetes patients. The purpose of the current study was to evaluate gender differences in the association between sUA level and arteriosclerotic cardiovascular risk in Chinese type 2 diabetes patients. Methods The cross-sectional study was conducted in six community health service centers in Shanghai, China from December 2014 to December 2016. A stratified random sampling method was used to recruit participants. From a total of 3977 type 2 diabetic patients, 2537 were included for the analysis of the association between sUA level and arteriosclerotic cardiovascular risk. Clinical and biochemical data were obtained from participants. Arteriosclerotic cardiovascular risk was evaluated by the ten-year risk profile for arteriosclerotic cardiovascular disease. The associations between sUA level and arteriosclerotic cardiovascular risk were assessed via multiple logistic regression. Results Of the 2537 participants, the average sUA level was 317±77umol/L in men and 294±73 umol/L in women, and 54.8% (1391/2537) of participants had high ten-year risk of arteriosclerotic cardiovascular disease (ASCVD), which was ≥20%. High ten-year risk of ASCVD odds ratio was increased by 1.596 (95% CI, 1.113–2.289, p for trend 0.004) comparing fourth to first quartiles of sUA in women. However, no significant association was found between sUA and high ten-year risk of ASCVD in men. Conclusion This community-based study indicated that sUA levels were independently associated with high ten-year risk of ASCVD in women with type 2 diabetes mellitus, but not in men.

The Xidu Community Health Service Center has become the first general practice outskirt teaching site of Shanghai Zhongshan Hospital since May 2015; the Fudan University Shanghai Medical College Xidu General Practice Clinical Teaching and Training Base was formally established in May 2018. For last 6 years, with the cooperation with Zhongshan Hospital the Xidu Community Health Service Center has participated in teaching and training of general practice residents and general practitioners, which also greatly promoted the development of clinical service, disease prevention and scientific research of the center itself. This article introduces the "Fudan-Xidu" integrated model and its experiences in general practice teaching, focusing on the background, the organization, teaching implementation, achievements and future prospects, to provide a reference for talent training of general practice in grassroots institutions.

背景 目前我国儿科医疗的"供需矛盾"正逐渐凸显,全科儿科的发展是最有可能缓解儿科医疗资源紧张的突破口.在嘉定区,社区儿科服务能力明显不足.在此背景下,为了合理配置儿童医疗资源,解决常见病、多发病占用儿童专科医院资源的难题,2017年上海市嘉定区原卫生计生委开展了"全科医师儿科临床适任能力培训"项目.目的 调查第一批"上海市嘉定区全科医师儿科临床适任能力培训"项目对该区13家社区卫生服务中心开展全科儿科门诊的影响.方法 2018年1—3月,采用自主设计问卷对14名参培"上海市嘉定区全科医师儿科临床适任能力培训"项目的全科医生和社区其余未参培的部分全科医生进行调查.问卷内容包括接受调查全科医生的基本情况、社区开展儿科门诊后的现状及全科医生对儿科培训的建议.结果 共发放问卷207份,问卷全部有效回收,其中参培全科医生14名,未参培全科医生193名.50.0％(7/14)的参培全科医生认为自己能够胜任儿科门诊接诊,78.6％(11/14)能够掌握一些儿科常见危重症的急救处理,71.4％(10/14)认为已掌握了儿科用药规律.参培全科医生和未参培全科医生拟开展儿科诊疗的方式意愿、拟开展儿科门诊的时间意愿比较,差异有统计学意义(P<0.05).社区儿科开展后,多数社区接诊量均小于5人次/半天.64.3％(9/14)的参培全科医生愿意参加更多儿科培训.结论 参培全科医生认为参加培训后开展社区儿科门诊的能力有所提高,但当前实践中仍存在儿科接诊经验不足、儿科药物及检验缺乏、儿科门诊就诊量少等问题,需要进一步改进.

《基层2型糖尿病胰岛素应用专家共识》在全科医学和内分泌科专家的共同努力下执笔而成。本共识详细介绍了不同胰岛素制剂的作用特点、胰岛素治疗方案的起始和调整、治疗转换及转诊建议，强调了胰岛素治疗的注意事项，指导基层全科医生在2型糖尿病治疗中规范、安全、有效地应用胰岛素。

AbstractObjectiveTo evaluate the effectiveness of the Spring Seedling Project‐Zhaotong program, a novel continuing medical education program, to improve the knowledge and skills of rural doctors in China.DesignAn uncontrolled single‐group pre‐ and post‐intervention design based on quantitative and qualitative methods.SettingZhaotong is a prefecture‐level city located in Yunnan, China.ParticipantsA total of 1866 country doctors practising in Zhaotong were enrolled.InterventionsThe Zhaotong program consisted of three stages: remote education, workshops conducted in Zhaotong and field training in Shanghai.Main outcome measuresThe effectiveness of the remote education and Zhaotong workshop stages was assessed based on differences between pre‐ and post‐training test scores. Qualitative comments were collected to assess the experience of country doctors following the Shanghai field training stage.ResultsIn total, 1866 country doctors (46.9% males; mean age: 38.2 ± 9.2 years) participated in the program. The average score of the post‐training test was higher than that of the pre‐training test, both online (P < .001) and offline (P < .001). In regard to the Zhaotong workshops, with the exception of incisions/suturing, the average scores of cardiopulmonary resuscitation, gynaecological examinations and child growth/development were improved after training (P < .001). Qualitative analysis showed that Shanghai field training enhanced understanding of general practice, with the majority of country doctors indicating that they would apply what they learned in daily practice.ConclusionThis study introduced an comprehensive form of continuing medical education for rural doctors in Zhaotong and proved the effectiveness of this program and also provided a reference point for the future development of continuing medical education.

Objective:To survey the status of antihypertensive therapy knowledge and hypertension management among general practitioners in community health centers (CHCs) in China.Methods:Based on the eastern, western, southern and northern regions of the country, 350 CHCs were selected from 11 cities across the country with stratified sampling method for study sites, and one general practitioner was selected from each CHC. The questionnaire survey was conducted from March 12 to April 20, 2018 among 350 participants. The content of the questionnaire included the proportion of hypertensive patients in the consultation, treatment target rate, antihypertensive drugs and protocol, the medication compliance, follow-up, blood pressure self-measurement, and the impact of hierachical medical system on CHC.Results:Total 350 valid questionnaires were recovered. The survey showed that: (1) Among the patients treated by general practitioners, 46% (30%, 60%) were hypertensive patients including 41% (40%, 55%) with primary hypertension and 42% (40%, 50%) with secondary hypertension; 72% (60%, 80%) of the patients had comorbidities, including dyslipidemia, diabetes, and coronary heart disease. (2) Western medicine was the main antihypertensive treatment [90% (82%, 100%) ], calcium channel blockers were the most commonly used antihypertensive drug [46%(30%,60%)], the therapeutic protocol was mainly single agent [35% (25%, 50%) ]or free combination [50% (40%, 60%) ]; the stable(9.1±0.8), long-acting (9.0±0.9) and high standard reaching rate (8.1±1.1) antihypertensive drugs were first considered, and the standard reaching rate of hypertension treatment was 61% (50%, 75%) . (3) The regular follow-up rate, adherence to blood pressure self-test rate and long-term regular medication rate was 60%(50%,70%), 51%(40%,70%) and 65%(50%,70%), respectively. The factors affecting patients′ compliance were history of cardiovascular diseases (8.4±1.1)and patients′ cognition of disease(8.3±1.1). General practitioners believed that the positive effects of the hierarchical diagnosis and treatment system include helping to establish a closer relationship with patients [62.6% (219/350)] and improving patient compliance for community preferential reimbursement policies[58.6% (205/350) ]. The challenges faced by CHC included higher patient expectations [52.8% (185/350)] and increased outpatient visits [52.6% (184/350)]. Insufficient diagnostic equipment [68.3% (239/350)], inadequate dispensing [52.3% (183/350)] and other issues restricted the development of CHC, and the clinical competence of general practitioners [51.7% (181/350)] need to be improved.Conclusion:Patients with hypertension account for about half of the total number of visits in community health service centers, and most of them are comorbid with cardiovascular and cerebrovascular diseases or risk factors. The long-term treatment compliance and self-management of blood pressure need to be further improved.

2020年冬春之交的新型冠状病毒肺炎疫情中,基层全科医生全力参与流行病学调查、患者的诊断和治疗、公众教育及社区抗疫指导,使人们再次聚焦全科医生及时、快速、长期、持续的医疗照顾.但此过程中也暴露出推进适当转诊、分诊和维持有效的分级诊疗体系依然挑战重重.笔者认为,新冠肺炎之役充分体现了全科医学在分级诊疗和公共卫生中的重要作用,全科医生的职业素养和专业能力至关重要,应将更多资源投入到全科医学的毕业后教育,在全国范围内广泛培养合格的全科医生.由此引发相关的思考和建议:(1)医学人文教育应与专业教育相结合,重视医学史的系统教育;(2)加强全科医生基层医疗服务能力的培养;(3)优化培训方式,适当延长毕业后医学教育的社区实践时间.

Objective:To assess the concept and clinical practice of general practitioners in community health service centers (CHCs) on the use of antiplatelet drugs (APD) to prevent cardiovascular diseases(CVD).Methods:Based on the eastern, western, southern and northern regions of the country, 350 CHCs were selected from 11 cities across the country with stratified sampling method for study sites, and one general practitioner was selected from each CHC. The questionnaire survey was conducted from March 12 to April 20, 2018 among 350 participants. The content of the questionnaire included the situation of CVD patients, application of APD in primary/secondary prevention of CVD (schemes and regimes), the prescription concept of APD, and influencing factors.Results:Total 350 valid questionnaires were recovered. The survey showed that among all patients general practitioners routinely took care, 46% (30%, 60%) were hypertensive patients; 96.6% (338/350) of the general practitioners said that they had carried out primary prevention, mainly for patients with hypertension, diabetes, dyslipidemia or carotid artery plaque, and 34% (20%, 45%) of the patients had taken primary prevention drugs; the use of APD only accounted for 47% (35%, 60%) , among which 87% (80%, 95%) was aspirin. The main impediments were lack of awareness of disease from patients[ (8.0±1.4) points] and lack of awareness of primary prophylaxis from general practitioners[ (7.3±1.4) points]. The survey also showed that 28% (20%, 35%) and 17% (10%, 20%) patients were diagnosed as coronary heart disease and stroke, respectively; 83% (80%, 95%) of patients with coronary heart disease or stroke used APD for secondary prophylaxis; for coronary heart disease patients, 82% (70%, 95%) taking aspirin or clopidogrel, 18% (5%, 30%) taking aspirin and clopidogrel for 11 months; for stroke patients, 85% (80%, 95%) taking aspirin or clopidogrel, 15% (5%, 20%) taking aspirin and clopidogrel for 9 months. Compared with clopidogrel, aspirin had a relatively high score for clinical experience (8.3±1.1) and reasonable cost of treatment (8.3±1.3) .Most coronary heart disease patients (68%±15%) and stroke patients (70%±17%) took APD regularly. The lack of knowledge of disease [(8.4±1.1) points] and awareness of regular medication [(8.2±1.2) points] were the main factors affecting compliance of patients.Conclusion:The use of APD in primary prevention of CVD for general practitioners is insufficient, and there is still a big gap between the standardization and the practice in secondary prevention; in particular, the selection of APDs and treatment course should strictly follow the guidelines.

背景 农村地区基层医疗卫生机构和人员培训是实现"健康中国2030"战略的重要一环,与庞大的培训数量相比,针对实施效果的评估却极为有限.目的 分析和总结"春苗计划"昭通站基层医疗卫生机构管理人员培训版块的实施效果.方法 以2015年6月—2016年12月参加"春苗计划"昭通站培训的乡镇卫生院或社区卫生服务中心管理人员为研究对象(n=150).培训分昭通面授(5 d)和上海实训(2周)两阶段实施.定量分析昭通面授学员的考核成绩,定性分析上海实训学员的实训报告.结果 150例参培学员的平均年龄为(38.6±6.8)岁,男130例(86.7％).147例参培学员完成了昭通面授培训前和培训后的笔试,培训后平均成绩高于培训前〔(65.9±8.8)分比(57.0±8.3)分,t=11.945,P<0.001)〕.不同特征参培人员的培训前后成绩提升比较,差异无统计学意义(P>0.05).以信息饱和为原则,共定性分析13份实训报告,结果显示:上海实训拓宽了参培人员的管理思路,且参培人员表示将结合昭通实际情况学以致用.结论 "春苗计划"昭通站拓宽了中国农村地区基层医疗卫生机构管理人员的培训形式,取得明显效果的同时也具有借鉴意义.建议拟在农村地区开展的同类培训项目,应充分结合当地实际需要设计培训方案,并提供基于实践的培训机会.

In order to improve the quality of clinical teaching, Xidu Community Health Service Center of Shanghai Fengxian District established a teaching clinic for training of general practitioners in 2015. The clinic served as a suburban teaching station of Department of General Practice of Zhongshan Hospital, a tertiary university hospital. This article introduces the implementation methods, achievements, practical experiences and work prospects of the clinic. The issues of system evaluation and the generalization of this teaching model for training of general practitioners are also discussed in the article.