Background Expectations for health-care quality affect how populations rate primary care, influencing tolerance of poor-quality care and demand for improvement, yet how expectations align with standards of practice remains poorly understood. We aimed to measure population expectations of primary care and their determinants within and across countries. Methods In this cross-sectional analysis, we used nationally representative data from the People's Voice Survey collected between May 9, 2022, and Dec 21, 2023, in Ethiopia, Nigeria, Kenya, South Africa, Colombia, Peru, Mexico, Argentina (Province of Mendoza), Uruguay, Laos, India, China, South Korea, Romania, Greece, Italy, the UK, and the USA. Adults aged 18 years and older with at least one health-care visit in the past 12 months were included. Expectations were assessed using two anchoring vignettes, one depicting poor-quality primary care and one depicting adequate-quality primary care, administered via a mobile telephone survey, household interview, or nationally representative web panels. Respondents rated each vignette on a Likert scale: poor, fair, good, very good, or excellent. Low expectations were defined as rating the poor-quality care vignette as fair, good, very good, or excellent, and high expectations were defined as rating the adequate-quality care vignette as poor, fair, or good. Multivariable logistic regression models identified determinants of expectations, including covariates covering demographics, health status, care utilisation and experience, and system competence. Findings Among 18 312 respondents (10 000 [54·6%] female and 8312 [45·4%] male; mean age 44 years [SD 17]), 2955 (16·1%) rated poor-quality primary care as fair or better and 11 787 (64·4%) rated adequate-quality primary care as less than very good. The proportion of respondents with low expectations of primary care ranged from 70 (6·3%) of 1112 in the UK to 530 (41·1%) of 1290 in South Korea. The proportion of respondents with high expectations of primary care ranged from 563 (40·1%) of 1404 in Nigeria to 494 (85·0%) of 581 in Italy. Older age, female gender, higher educational attainment, higher income, and use of private care (vs public care) were all associated with reduced odds of low expectations. Respondents with higher self-rated health had higher odds of low expectations (vs those with poor self-rated health). Activated patients (ie, those who were confident in raising concerns with their provider and that they were responsible for managing their own health) had lower odds of low expectations and lower odds of high expectations (vs non-activated patients). And positive perceptions of government management of COVID-19 were associated with high odds of low expectations and low odds of high expectations. Interpretation Populations can often misjudge primary care quality, with substantial cross-national variation. Recognising and measuring expectations are essential for accurately interpreting health system ratings and guiding efforts to improve primary care. Policy makers should invest in strategies that strengthen health literacy and patient activation, empowering populations to recognise and demand high-quality primary care. Funding Bill & Melinda Gates Foundation, the Swiss Federal Department of Foreign Affairs, Merck Sharp & Dohme, Inter-American Development Bank, the Eckenstein-Geigy Professorship, Initiative on the Future of Health and Economic Resiliency in Africa, National Natural Science Foundation of China, WHO Regional Office for Europe, and the Taejae Foundation.

Background Across the globe, rates of depression and anxiety have risen substantially since the COVID pandemic. Consequently, poor mental health is now a top health policy priority in many countries and more people than ever are seeking treatment. While the segment of people with poor mental health is large and growing, there is a dearth of data about their demographics and health needs and their use of and experience in the health system. Health systems require this information to effectively organize and provide services.Methods and findings We investigated population prevalence of fair or poor mental health and compared health system experience and quality of care among adults with poor versus good mental health in 18 high-, middle-, and low-income countries using data from the People's Voice Survey (n = 32,419). Data were collected in 2022 and 2023 through a combination of nationally representative telephone, online, and in-person surveys. Prevalence of self-reported poor mental health ranged from 4.7% in Nigeria to 39.6% in China and was unrelated to national income per capita. More women than men reported poor mental health in most countries. Across all countries, people with poor mental health had worse self-rated overall health and more chronic illness. Between 0.9% (Lao PDR) and 52.4% (UK) of those with poor mental health had received mental healthcare in the past year. People with poor mental health reported lower patient activation, worse care quality, and lower confidence in the health system. A study limitation is that results are based on self-reported mental health rather than clinical diagnoses.Conclusions People with poor mental health have markedly different health profiles and health system experience. These findings should prompt health systems to re-assess their services to better serve this growing patient group. Comparison of user experience and quality over time and across countries with similar health systems may assist in benchmarking performance.

Background Traditional Chinese medicine (TCM) functions according to the concepts of “holism” and treatment based on syndrome differentiation, and it has achieved good clinical results in treating patients with dysmenorrhea, which is a common gynecological disorder. However, there are currently no international clinical practice guidelines involving TCM therapies for dysmenorrhea. This study aims to establish a protocol for the development of such guidelines. Objective This protocol will provide a road map for the development of the first international clinical practice guidelines on TCM therapy for dysmenorrhea. Methods The guidelines will be developed with reference to the General Rules of Preparation of Diagnosis and Treatment Guideline in Traditional Chinese Medicine and the Western Medicine Guideline and Traditional Chinese Medicine Guideline: Improving Together in Mutual Learning. They will be developed in accordance with the Appraisal of Guidelines for Research and Evaluation II and the World Health Organization guideline handbook and will make recommendations based on systematic reviews. We have established a guideline working group and will formulate clinical questions using the participants, interventions, comparisons, outcomes, and study design framework. The recommendations will be developed through evidence retrieval, synthesis, and the Delphi method. We will consider the preferences and values of patients, as well as the costs and the pros and cons of interventions. Results This work was supported by the National Key R&D Program of China (grant 2019YFC1712000) in 2019. The writing group for guidelines was formed in January 2021. The literature search and screening process began in May 2022. So far, the literature search and 2 rounds of the Delphi method have been completed. The protocol will provide a road map for the development of the first international clinical practice guidelines on TCM therapy for dysmenorrhea. Conclusions The guideline will be developed in accordance with this protocol, which may provide support and evidence for TCM treatment in patients with dysmenorrhea. There is currently a need for clinical practice guidelines in TCM for the treatment of dysmenorrhea. International Registered Report Identifier (IRRID) DERR1-10.2196/77423

Health economics evidence plays an important role in linking clinical value evidence with health resource allocation decisions in the development of clinical practice guidelines. It can not only effectively balance clinical effectiveness and economic feasibility but also avoid forming "idealized" recommendations that are detached from the affordability of the healthcare system or the burden-bearing capacity of patients. To promote guideline developers to use health economics evidence more standardizedly and fully, this paper conducts an in-depth analysis of the current application status, existing challenges, access channels, and application processes of health economics evidence in current guidelines, and on this basis, puts forward considerations and suggestions for strengthening and standardizing the application of health economics evidence in China's clinical practice guidelines.

ObjectiveTo systematically analyzed the reporting status of core elements in publicly available clinical practice guideline(hereafter referred to as "guideline") protocols published domestically and internationally over the past decade, identified existing problems, and provided evidence to inform the standardized writing and publication of future guideline protocols.MethodsA systematic search was conducted in Chinese and English databases for clinical practice guideline protocols published during the past ten years. The basic characteristics and reporting of core elements—including registration information, conflict of interest management, evidence grading, development process and timeline planning, as well as dissemination and implementation—were extracted and analyzed. Chi-square tests were performed to explore associations between protocol characteristics and the reporting of core elements.ResultsA total of 94 guideline protocols were included, of which 67 were in Chinese(71.28%) and 27 were in English(28.72%). Overall, 82.98% of the guideline protocols were registered, 92.55% reported management of conflicts of interest, 97.87% reported evidence searching, 88.30% reported evidence grading, and 89.36% described dissemination and implementation strategies. However, only 55.32% reported the guideline development process, and merely 23.40% reported timeline planning. Further analysis indicated that the reporting of registration, evidence searching, development process, and timeline planning was associated with year of publication. Differences were observed between domestic and international guidelines in reporting registration, conflict of interest management, development process, time planning, and dissemination and implementation. Guidelines intended for development exhibited higher reporting rates for registration, development process, and dissemination and implementation compared to those planned for updating or adaptation.ConclusionsAlthough current guideline protocols demonstrate relatively adequate reporting of methodological elements, deficiencies remain in development process and timeline planning. Future efforts should focus on promoting the publication and standardized reporting of guideline protocols, enhancing the international recognition of registration platforms, and strengthening the development process and timeline planning to advance the scientific rigor and transparency of guideline development.

ObjectiveTo investigate the clinical efficacy of Yishen Huashi Granules combined with conventional Western medicine in the treatment of stage 2-4 chronic kidney disease （CKD） and its influence on microinflammation.MethodsA total of 88 patients with stage 2-4 chronic kidney disease （CKD） who were treated at Wuhan Fifth Hospital from December 2020 to May 2022 were selected and randomly divided into the control group （44 cases） and observation group （44 cases） according to random number table method. Patients in both groups were given conventional Western medicine treatment， and those in the observation group were additionally given Yishen Huashi Granules. Interventions were performed for 12 weeks. The clinical efficacy， and changes in the blood biochemical indexes total serum protein （TP）， serum Albumin （Alb）， serum creatinine （Scr）， blood urea nitrogen （BUN）， estimated glomerular filtration rate （eGFR）， β2-microglobulin （β2-MG）and microinflammatory indexes ［（white blood cell count （WBC）， lymphocyte count （LYM）， percentage of lymphocytes （LYM%）， neutrophil count （NEUT）， percentage of neutrophils （NEUT%）， neutrophil /lymphocyte ratio （NLR）， hypersensitive C-reactive protein （hs-CRP）， interleukin-6 （IL-6）］ before and after treatment were compared. Meanwhile， patients in both groups were subgrouped into stage G2-3a and stage G3b-4 subgroups based on the eGFR. Changes in renal function indicators （Scr， BUN， eGFR， β2-MG） before and after treatment were compared.ResultsAfter treatment， the total effective rate was significantly higher in the observation group than the control group （81.82% vs. 61.36%， P<0.05）. Post-treatment Hb ［（134.13±20.87） vs （129.62±22.19） g/L］， Alb ［（43.97±4.71） vs （40.63±4.97） g/L］and TP［（73.53±5.93） vs （71.93±7.15） g/L］ were significantly higher than pre-treatment values in the observation group （P<0.05）， and their improvements were superior than the control group （P<0.05）. Renal function indexes were significantly improved after treatment in both groups， and eGFR were significantly higher in the observation group than the control group （P<0.05）. Scr， BUN and β2-MG were significantly lower in the observation group than the control group （P<0.05）. Subgroup analyses showed that renal function indexes were significantly improved after treatment in G2-3a and G3b-4 subgroups （P<0.05）， and their improvements were superior than the control group （P<0.05）. . NEUT， IL-6， WBC， hs-CRP and NLR were significantly reduced， and LYM was significantly elevated after treatment in the observation group （P<0.05）， and their improvements were superior than the control group （P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （P>0.05）.ConclusionYishen Huashi Granules combined with traditional Western medicine can effectively improve clinical efficacy， and it is also effective in patients with moderate-to-severe renal insufficiency. The mechanism of action may be related to inhibiting microinflammatory response in vivo， improving nutritional status， protecting renal function and delaying the progression of CKD.

Objective To explore the role of the "Clinical Practice Guidelines" column and others in the Medical Joumnal of Peking Union Medical College Hospital (Med J PUMCH) in promoting diseiplinary development. Methods We collected papers published by the Lanzhou University Evidence-Based Medicine Center team in the "Clinical Practice Guidelines" column and others from 2018 to 2025. These publications were analyzed across multiple dimensions, including authorship and institutional affiliations, citation metrics, and research themes and content. Results A total of 59 papers were included in the analysis, with authors representing 70 domestie and international research institutions. The cumulative citation count was 639, with the highest single-paper citation frequency reaching 101. The average citation per paper was 10.8, and total downloads exceeded 30 000. The content focused on key themes such as guideline terminology, development methodology, guideline evaluation, and dissemination and implementation. The evolution of research topics progressed from critiques of common misconceptions and hot topies in the field to multidimensional evaluations of thecurrent state of Chinese guidelines, culminating in the fommulation of industry standards for guidelines. These contributions have provided critical references for translating guideline theory into practice in China and have garnered widespread attention and discussion among scholars in the field. Conclusions The "Clinical Practice Guidelines" column and others in the Med J PUMCH has not only demonstrated substantial academic influence but has also played a pivotal role in advancing the discipline.

Objective To develop the Chinese Version People's Voice Survey(PVS-CN)that incorporates both international comparability and local characteristics and test its reliability and validity.Methods On the basis of collaborative development of the global version of the evaluation tool,the PVS-CN was formed through localization revisions,translation-back translation,cross-cultural adaptation,and adjustments,with the scale items being tested.In October 2023,a mobile phone survey was conducted across China's mainland(excluding Hong Kong,Macao,and Taiwan),where mobile phone numbers were randomly selected.A total of 534 valid questionnaires were collected,with 42 participants undergoing retesting after a two-week interval.The reliability and validity of the scale were assessed by item analysis,exploratory factor analysis,confirmatory factor analysis,and other methods of reliability and validity testing.Results The PVS-CN scale consists of 27 items,covering five dimensions:self-assessed health status,recent healthcare experience,evaluation of the public healthcare system,overall evaluation of the health system,and expectations for the quality of the health system,explaining 67.663%of the total variance.The scale presents the item-level content validity index(I-CVI)ranging from 0.71 to 1.00,the scale-level content validity index/universal agreement(S-CVI/UA)of 0.85,and the average scale-level content validity index(S-CVI/Ave)of 0.98,demonstrating strong content validity.Confirmatory factor analysis shows that the structural validity of the scale is good,with χ2/df=2.131,normed fit index(NFI)=0.934,comparative fit index(CFI)=0.964,goodness-of-fit index(GFI)=0.910,Tucker-Lewis index(TLI)=0.960,incremental fit index(IFI)=0.964,and root mean square error of approximation(RMSEA)=0.046.The reliability test results show that the overall scale has the Cronbach's α coefficient of 0.942,the split-half reliability of 0.849,and the test-retest reliability of 0.874,indicating good internal consistency and stability of the scale.Conclusion The PVS-CN developed in this study demonstrates good reliability and validity,serving as an effective tool for assessing China's healthcare system from the public perspective,with potential for further application.

Background The ability of primary health workers (PHWs) to practice in accordance with evidence-based guidelines and norms is a critical component of improving the quality of primary healthcare. Implementation science seeks to promote the routine use of evidence-based practices in healthcare by identifying barriers and facilitators to their implementation, and by developing strategies such as audit and feedback (AnF) to overcome these barriers. However, the effects of AnF show significant heterogeneity across studies, so this research focuses on the validity of AnF components and the optimal combinations of these components through head-to-head comparisons. Methods During the preparation phase, we will conduct a preliminary exploration to optimize AnF intervention aimed at improving the quality of primary healthcare. This will involve identifying key candidate components and levels of the AnF intervention, understanding the mechanisms of action, and assessing the resource constraints associated with implementing AnF in primary healthcare (PHC) facilities. This will be achieved through expert consultation and a Best-Worst Scaling (BWS) questionnaire survey. In the optimization phase, we will use the gold standard method of Unannounced Standardized Patients (USP) to assess the quality of primary healthcare for diabetes and hypertension, focusing on the accuracy and standardization of consultation, examination, diagnosis, and treatment procedures in comparison to evidence-based practices, across Nepal, Mozambique, Tanzania, and China. A factorial design randomized controlled trial will be conducted to determine how feedback on care quality can be delivered to PHWs in order to optimize its impact on healthcare quality improvement. To achieve this, the factorial trial will incorporate three key AnF components, each at two levels, resulting in a total of eight intervention groups. PHWs will be randomly assigned to these groups. Discussion This study will provide an empirical foundation for using AnF to improve the quality of primary healthcare in developing countries, while also enhancing and complementing the existing AnF theory. This study focuses on the optimization of the important implementation strategy of AnF in implementation science, contributing a universal research paradigm to the field. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT06480487 ### Funding Statement This study is funded by the National Natural Science Foundation of China (72404118), the China Postdoctoral Science Foundation (2023M731536), the Guangdong Medical Science and Technology Research Foundation (A2023133), and the Swiss Agency for Development and Cooperation (81067392). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study obtained ethics approval under a protocol approved by the relevant authorities in China, Nepal, Mozambique and Zanzibar, Tanzania. All participants will provide written informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.

BACKGROUND:Functional disability has been identified as a risk factor for depressive symptoms (DS). However, most studies have measured functional disability at only one time point, and functional disability is dynamic and changeable over the life course, and can vary between individuals. Therefore, we aimed to examine the longitudinal association between conversion patterns of functional disability and the risk of DS. METHODS:Based on the China Health and Retirement Longitudinal Study (CHARLS) participants in 2013, we retrospectively assessed their functional disability from 2011 to 2013 through activities of daily living ability (ADLs) and instrumental activities of daily living ability (IADLs), which were categorized as ten conversion patterns. A total of 2057 participants who met the inclusion criteria were included in the final analysis and were followed from 2013 to 2018 to determine the incidence of DS, measured by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Cox proportional hazards regression models were applied to estimate association between conversion patterns of functional disability and the risk of DS. RESULTS:Over the 61 months follow-up period, 508 incident DS cases were identified. Three conversion patterns of functional disability were more likely to develop DS than those with never both ADLs and IADLs disabilities: relieved both ADLs and IADLs disabilities (adjusted HR = 2.01, 95% CI = 1.21-3.32), persistent only IADLs disability (adjusted HR = 1.81, 95% CI = 1.04-3.12), and persistent both ADLs and IADLs disabilities (adjusted HR = 4.75, 95% CI = 2.19-10.31). CONCLUSIONS:Older adults with persistent both ADLs and IADLs disabilities may be at a greater risk of DS. Meanwhile, those with relief should not be ignored for functional disability. Attention should be paid to psychological monitoring of older adults with a history of or current functional disability.

ObjectiveTo sort, summarize, and introduce key terms related to guideline reporting, evaluation, dissemination, implementation, and updating.MethodsWe systematically searched guideline development manuals and methodological literature from database inception to October 25, 2024. Terms related to guideline reporting, updating, evaluation, and implementation were extracted, standardized, and finalized through a structured consensus process.ResultsA total of 13 guideline manuals and 32 methodological articles were included, yielding 14 core terms with standardized definitions.ConclusionsThis article introduces key terms such as reporting standards, external review, and research gaps across guideline development phases to promote concept application and deepen readers' understanding of guideline development.

CD4+ T lymphocytes are an important part of human immune cells and the main target cells of human immunodeficiency virus (HIV) infection. Acquired immune deficiency syndrome (AIDS) is a chronic infectious disease that usually takes 2–8 years from infection to onset. Research has found that only a small number of CD4+ T cells in HIV infected individuals are in an HIV infected state, and the dynamic changes of HIV-infected CD4+ T lymphocytes (HICTLs) at different stages of HIV infection are still unclear. Meanwhile, HICTLs are the source of the HIV reservoir. Therefore, analyzing the percentage and dynamic changes of infected cells in infected individuals is of great significance for AIDS research. However, due to the high variability of the HIV gene and the lack of highly sensitive detection methods, the standard method for distinguishing HIV infected and uninfected CD4+ T cells has not been established so far. This article summarizes the markers and detection methods of HICTLs at present.

ObjectivesCommunity pharmacies play a crucial role in China's primary health care system. This study aimed to assess the impact of stringent COVID-19 policy responses - such as lockdowns, travel restrictions and operational closures - on unannounced standardized patients' (USPs) satisfaction with community pharmacy services.MethodsA cross-sectional study was conducted from April 2021 to September 2022, using an USPs approach in community pharmacies across China. USPs' satisfaction was measured using validated tools, with closure policies related to COVID-19 as the primary exposure variable.ResultsThe study included 1076 eligible USP visits to community pharmacies. Results indicated that stricter closure policies had a significant negative impact on USPs' satisfaction (β = -0.18, p = 0.019). This negative effect may be attributed to worsened capability of pharmaceutical service providers (β = -0.17, p = 0.002) and accessibility (β = -0.12, p = 0.019). Subgroup analyses demonstrated a negative correlation between stricter closure policies and lower satisfaction levels with regard to accessibility, capability, and communication.ConclusionsCOVID-19 closure policies in China had adverse consequences for the quality of pharmacy services. These findings highlight that governments must act with urgency when addressing abrupt infectious diseases or public health emergencies. Enhancing access to pharmacy services and capability of providers are critical strategies to ensure an effective response to sudden public health crises.

Dysmenorrhea is a common gynecological condition that is further divided into two categories, namely primary and secondary dysmenorrhea. Traditional Chinese Medicine (TCM) gives good clinical results for the treatment of dysmenorrhea based on the basic principles of holistic view and syndrome differentiation. However, presently, the clinical practice guidelines in TCM for dysmenorrhea treatment are required. The guideline is formulated in strict accordance with the principles of evidence-based medicine with reference to the General Principles for the Compilation of International Guidelines for Diagnosis and Treatment of Traditional Chinese Medicine Syndromes and General Principles for the Compilation of International Clinical Practice Guidelines for Traditional Chinese Medicine Diseases and accordance with the principles and methods of The Appraisal of Guidelines for Research and Evaluation in China (AGREE-China) and World Health Organization guidelines. This guideline includes clinical issues by literature search and questionnaire survey, and eight background questions and 23 prospect questions were finally created. Based on the evidence retrieval, synthesis, consideration of patient preferences and values, intervention costs, advantages, and disadvantages, recommendations are created using the Delphi method and expert consensus method. This guideline clarified the definition, diagnosis, and TCM syndrome classification for dysmenorrhea, and recommends different TCM treatments based on the level of evidence, including Chinese herbal medicine, Chinese patent medicine, acupuncture, and other auxiliary therapies. The present guideline is an international clinical practice guideline for the treatment of dysmenorrhea using TCM. This guideline will provide substantive evidence and standardized guidance for the treatment of dysmenorrhea using TCM, improve the quality and safety of medical services, and standardize diagnosis and treatment plans for dysmenorrhea.

Objective To promote the development of high-quality health standards in China and summarize the characteristics of global health standards management systems and development processes. Methods We conducted a systematic search of relevant databases and the websites of standardization institutions. A descriptive method was used to analyze the basic characteristics of the standard management systems and development processes. Results The majority of the investigated countries and organizations primarily implement voluntary standards, with the exception of Chinese and the European Committee for Standardization that enforce compulsory standards. All countries and organizations have health standards at the national, group, and enterprise levels. In China and Japan, standards authorities are subordinate to the government, while in other countries or organizations, they operate as independent civil societies. The development process for health standards generally involves five stages: 'Project/Proposal → Draft → Enquiry → Review → Publication'. However, the specific steps in the development of health standards vary across different countries and organizations. Furthermore, China ranks high in the number of both standards and health standards issued, but the proportion of health standards is only 2.06%. Conclusions There are significant differences between China and other countries in terms of the management system and development process of health standards. To promote the management and development of high-quality health standards in China, we recommend promoting the coordination mechanism for standard development, increasing efforts to publicize standards and evaluate the implementation effect, strengthening the construction of personnel for the development of health standards, optimizing the efficiency of standard development and improving the internationalization level of health standards.

High-quality Traditional Chinese Medicine (TCM) guidelines can standardize the clinical practices of relevant healthcare professionals, enhance medical quality, reduce healthcare costs, and promote the standardization of TCM. This article provides a summary and analysis of the status and quality of guidelines in the TCM. Additionally, it briefly introduces the reporting standards for three types of TCM guidelines, aiming to serve as a reference for those involved in the development and reporting of TCM guidelines.

BACKGROUND:The research and development of HIV drugs is very important, but at the same time it is a long cycle and expensive system project. High-throughput drug screening systems and molecular libraries of potential hit compounds remain the main ways for the discovery of hit compounds with anti-HIV activity. OBJECTIVE:The aim of this study was to screen out the hit compounds against HIV-1 in the natural product molecule library and the antiviral molecule library, and elucidate the molecular mechanism of their inhibition of HIV-1, so as to provide a new choice for AIDS drug research. METHODS:In this study, a drug screening system using HIV Rev-dependent indicator cell line (Rev-A3R5-GFP reporter cells) with pseudoviruses (pNL4-3) was used. The natural drug molecule library and antiviral molecule library were screened, and preliminary drug mechanism studies were performed. RESULTS:Ten promising hit compounds were screened. These ten molecules and their drug inhibitory IC50 were as follows: Cephaeline (0.50 μM), Yadanziolide A (8.82 μM), Bruceine D (2.48 μM), Astragaloside IV (4.30 μM), RX-3117 (1.32 μM), Harringtonine (0.63 μM), Tubercidin (0.41 μM), Theaflavine-3, 3'-digallate (0.41 μM), Ginkgetin (10.76 μM), ZK756326 (5.97 μM). The results of the Time of additions showed that except for Astragaloside IV and Theaflavine-3, 3'-digallate had a weak entry inhibition effect, and it was speculated that all ten compounds had an intracellular inhibition effect. Cephaeline, Harringtonine, Astragaloside IV, Bruceine D, and Tubercidin may have pre-reverse transcriptional inhibition. Yadanziolide A, Theaflavine-3, 3'-digallate, Ginkgetin and RX-3117 may be in the post-reverse transcriptional inhibition. The inhibitory effect of ZK 75632 may be in the reverse transcriptional process. CONCLUSION:A drug screening system using Rev-A3R5-GFP reporter cells with pseudoviruses (pNL4-3) is highly efficient. This study provided potential hit compounds for new HIV drug research.

Abstract Background An English version of the Patient Perception of Patient-Centeredness (PPPC) scale was recently revised, and it is necessary to test this instrument in different primary care populations. Aim This study aimed to assess the validity and reliability of a Chinese version of the PPPC scale. Design A mixed method was used in this study. The Delphi method was used to collect qualitative and quantitative data to address the content validity of the PPPC scale by calculating the Content Validity Index, Content Validity Ratio, the adjusted Kappa, and the Item Impact Score. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were used to assess the construct validity of the PPPC scale through a cross-sectional survey. The internal consistency was also assessed. Setting/participants In the Delphi consultation, seven experts were consulted through a questionnaire sent by email. The cross-sectional survey interviewed 188 outpatients in Guangzhou city and 108 outpatients in Hohhot City from community health service centers or stations face-to-face. Results The 21 items in the scale were relevant to their component. The Item-level Content Validity Index for each item was higher than 0.79, and the average Scale-level content validity index was 0.97 in each evaluation round. The initial proposed 4-factor CFA model did not fit adequately. Still, we found a 3-factor solution based on our EFA model and the validation via the CFA model (model fit: $${\chi }^{2}=294.573$$ χ 2 = 294.573 , P < 0.001, RMSEA = 0.044, CFI = 0.981; factor loadings: 0.553 to 0.888). Cronbach's α also indicated good internal consistency reliability: The overall Cronbach's α was 0.922, and the Cronbach's α for each factor was 0.851, 0.872, and 0.717, respectively. Conclusions The Chinese version of the PPPC scale provides a valuable tool for evaluating patient-centered medical service quality.

Abstract Background Psychodrama (PD), supported by extensive global research, is increasingly becoming a vital method for alleviating psychological symptoms and promoting mental well-being in diverse populations across China. However, comprehensive evidence based on rigorous interventions is currently lacking. Methods This article systematically reviews the literature on randomized controlled experimental intervention studies of PD in the Chinese Mainland from 1982 to 2023. Findings Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, this article included seven studies (N = 332, 25 effect sizes). The results demonstrate that PD interventions have a promotional effect (standardized mean difference SMD = 0.768, 95% CI [0.591, 0.946]) across different age groups and settings in randomized controlled trial interventions. In accordance with previous literature, we categorized the effect sizes into two major groups: illness reduction (IR) and health promotion (HP). Subgroup analysis based on these two categories revealed consistent findings. In the IR category, the overall effect size was notably significant (SMD = −0.711, 95% CI [−0.976, −0.446]), and in the HP category, the overall effect was also highly significant (SMD = 0.889, 95% CI [0.705, 1.074]). This finding aligns with previous research in other nations, supporting the significant effectiveness of PD as a counseling method in alleviating psychological illnesses and promoting mental health within the Chinese context. Conclusion PD serves not only as a therapeutic tool but also as a preventive and developmental intervention. Moving forward, there is a call for increased emphasis on standardized and randomized controlled experimental studies to further the advancement of PD within China.