目的 探讨老年人群主观认知下降问卷9(subjective cognitive decline questionnaire 9,SCD-Q9)得分的影响因素,为阿尔茨海默病(Alzheimer's disease,AD)早期筛查提供科学依据.方法 选取2016年9-11月北京市顺义区60～80岁的常住汉族居民,通过面对面询问的方式进行问卷调查.调查内容包括一般情况、社会支持、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)及SCD-Q9.结果 2 674名居民参与问卷调查,其中男1 163人,女1 511人;年龄中位数为66岁;受教育年限中位数为8年;94.3％的被访者和家人一起居住;近90.0％的被访者有健在的兄弟姐妹,有3个以上关系密切朋友的被访者占比最高,为66.4％;60.0％以上的被访者和邻居之间的关系为"很关心";HAMD与HAMA评分中位数均为1.0分.SCD-Q9总得分中位数为5.0分,其中整体记忆功能及与时间对比维度得分中位数为4.0分,日常活动能力维度得分中位数为1.0分.影响SCD-Q9得分的多因素回归分析显示,性别、年龄、受教育年限、关系密切朋友的个数、与邻居的关系、HAMA评分、HAMD评分,以及合并脑血管病、高血压、高脂血症、癫痫是SCD-Q9得分的影响因素(P＜0.05);其中HAMA评分对SCD-Q9得分影响最大,其次是HAMD评分和合并高脂血症史,年龄和合并高血压史对SCD-Q9得分影响最小.结论 北京市顺义地区SCD-Q9总得分处于中等水平,人口学因素、社区支持、精神状态及合并疾病是SCD-Q9的影响因素,不同影响因素的权重不同.可在老年人群中应用该问卷,以早期发现认知受损的高危人群,并及时干预,改善患者预后.

目的:了解北京市社区卫生服务中心康复科医疗服务现状.方法:选取北京市16区158家已开展康复的社区卫生服务中心作为样本选择,对其进行方便抽样调查,将同意配合调查的92家社区卫生服务中心作为本研究的调查对象,进行问卷调查,并对收集资料进行分析统计.结果:调查显示98.91％的北京市社区康复(CBR)患者仍以主动就医为主,康复病种以颈肩腰腿痛为主,仅有23家中心有固定上级医院进行转诊.结论:社区卫生服务中心需增加康复病种种类,大力发展慢性病的CBR,需建立有效双向转诊机制.

Objective:To develop a Beijing norm of Memory and Executive Screening (MES) scale to facilitate its further promotion and application in the future.Methods:Study subjects were selected based on the inclusion and exclusion criteria, including patients who visited the memory clinic of Xuanwu Hospital of Capital Medical University from March 20, 2017 to January 6, 2021, and normal people recruited simultaneously from community, and trained and qualified investigators conducted questionnaire surveys through face-to-face interviews. Then strict quality control, data collection and statistical analysis were performed.Results:A total of 607 participants were included, including 239 normal people, 293 individuals with subjective cognitive decline (SCD), and 75 individuals with mild cognitive impairment (MCI). There was a negative correlation between the scores of MES and age ( r=-0.19, P<0.001), but a positive correlation between scores of MES and education level ( r=0.29, P<0.001). The optimal cut-off value of this scale in Beijing was 86 points, the area under curve (AUC) of the cut-off value to distinguish MCI was 0.847 (normal people vs MCI) and 0.826 (SCD vs MCI), and after adding demographic variables, AUC showed slight increase (0.847 to 0.850 and 0.826 to 0.847), whereas the differences were not statistically significant ( Znormal peoplevsMCI=0.49, ZSCDvsMCI=1.21, P>0.05). And there was no statistically significant difference between MES and Montreal Cognitive Assessment scales in diagnostic power for normal people and people with MCI ( Zscale alone=1.03, Zafter adding demographic variables=1.13, P>0.05). Conclusions:The MES scale has a better distinguishing power for MCI, and its optimal cut-off value in Beijing is 86 points, which is different from previous studies. In the future, the sample size needs to be further expanded to verify this norm.

Objective: Subjective cognitive decline (SCD) complaints as the early manifestation of mild cognitive impairment (MCI) may be harbingers of objective cognitive decline. SCD-questinnaire9 (SCD-Q9) is developed to investigate the early sign for MCI. However, few studies have reported its power for discriminating MCI from healthy controls (HCs). Therefore, this study aims to investigate the discrimination power of SCD-Q9 as a brief screening tool for early detection of SCD in MCI.Methods: 84 HCs and 205 people with MCI were recruited. Their demographic information and scores of SCD-Q9 were compared. A binary logistic regression model was used to analyze the potential affecting factors of MCI, and the Receiver Operating Characteristic analysis was applied to test the discrimination powers of those factors, including SCD-Q9.Results: (1) Single and total scores of SCD-Q9 were all lower in the MCI group than those in the HC group. (2) Ageing, lower education and higher total scores of SCD-Q9 were associated with MCI. (3) Area Under the Curves (AUC) of SCD-Q9 for discriminating MCI from HC group was 0.815 and when integrating age and education, the AUC improved slightly and reached 0.839. Additionally, the sensitivity and specificity were 68.8% and 85.7%, respectively when a cut-off value of 3 was applied. Conclusions: SCD-Q9 may be able to detect the subjective cognitive decline in MCI early, but it may be used together with other screening questionnaires to improve its sensitivity and further verification of its power is needed.

摘 要 社区康复是指患者或残疾者经过临床治疗后为促进身心康复，由社区继续提供医疗保健服务。随着疾病谱和死亡谱的变化，康复医疗技术也在不断进步，人们对心脑血管疾病和创伤等慢性或致残疾病的康复要求日益提高，对社区康复需求也在增长。本研究对社区卫生服务中心康复服务现况、发展中存在的问题、影响其发展的相关因素进行分析探讨，为本区域社区康复的发展提出针对性建议。

Background Previous reports on APOE ε4 allele distribution in different populations have been inconclusive. The Subjective Cognitive Decline-Questionnaire 9 (SCD-Q9) was developed to identify those at risk of objective cognitive impairment [OCI; including mild cognitive impairment (MCI) and dementia groups), but its association with APOE ε4 and discriminatory powers for SCDwith subtle cognitive decline (SCDs) and OCI in memory clinics are unclear. Objectives To investigate demographic distribution of APOE ε4, its association with SCD-Q9 scores, and its ability to discriminate SCDs and OCI groups from normal control (NC). Methods A total of 632 participants were recruited (NC = 243, SCDs = 298, OCI = 91). APOE ε4 allele distribution and association with SCD-Q9 scores were calculated and the effects on cognitive impairment were analyzed. Receiver operating characteristic (ROC) analysis was applied to identify discriminatory powers for NC, SCDs, and OCI. Results Total APOE ε4 frequency was 13.1%. This did not vary by demography but was higher in patients with OCI. The SCD-Q9 scores were higher in APOE ε4 carriers than non-carriers in the OCI group. The area under the curve (AUC) for discriminating from OCI using APOE ε4 were 0.587 and 0.575, using SCD-Q9 scores were 0.738 and 0.571 for NC and SCDs groups, respectively. When we combined APOE ε4 and SCD-Q9 scores into the model, the AUC increased to 0.747 for discriminating OCI from NC. However, when OCI group was split into MCI and dementia groups, only total SCD-Q9 score was the independent affecting factor of MCI. Conclusion This study demonstrated that the distribution of APOE ε4 alleles did not vary with different demographic characteristics in a large-scale cohort from a memory clinic. APOE ε4 alleles may be associated with scores of SCD-Q9 reflecting the degree of cognitive complaints but their additional contribution to SCD-Q9 scores is marginal in discriminating between NC, SCDs, and OCI.

Objective:To survey the needs and requirements of the general practice department in general hospitals from the perspective of grassroots health care personnel.Methods:From July 2020 to February 2022, a qualitative study on needs and requirements for the general practice department in general hospitals was conducted. Twenty eight participants from community health service centers in Beijing, Xi′an and Guangzhou were selected for the in-depth interviews.Results:The participants expressed their opinions and suggestions on the community needs and requirements for general practice department in general hospitals as follows. (1) The necessity of establishing department of general practice in general hospitals: the general hospitals had advantages to meet the medical needs of the community; the teaching and training should be focus on the way of thinking in the general practice, while the training needs for research ability was less required. (2) The cooperation between general hospital and its community teaching base: to implement the joint teaching rounds and joint home visits were effective ways for collaboration, which may ensure the quality of clinical faculty in the community bases. (3)The training needs of the community: rational use of drugs was most required, sub-specialty training was another concern for general practitioners in grassroots level. (4) The requirements for general practice department in the general hospital: in addition to complete organizational structure, daily teaching work needs to be implemented, and horizontal and vertical connection to relevant health institutions also need to be strengthened. Meanwhile, the teaching work should be a considerable part in the department performance assessment, and excellent clinical ability was also required to facilitate the effective referral of patients from the community.Conclusions:The study shows the necessity of establishing department of general practice in general hospitals, and various needs from the community teaching base, which providing reference for improving the construction of general practice department in the future.

新型冠状病毒肺炎疫情已进入常态化防控阶段,防控形势依然十分严峻.军队退休干部休养所门诊部所服务保障的对象是离退休老干部,这些老人年老体弱、慢性病高发,而且其中还有很多空巢老人、失能失智老人.该人群是新冠病毒感染的高危人群,所以防控工作尤为重要.通过对疫情发生以来保障工作的回顾总结、经验梳理,发现了工作中的一些问题和不足.提出常态化疫情防控下医疗保健工作要注重发展智能医疗、关注心理健康、培养结合人才等方面工作建议,以期为退休干部休养所门诊部做好精准医疗服务提供借鉴参考.

目的:了解北京市社区卫生服中心康复人员及其收入现况.方法:采用自设问卷对北京市16区92家社区卫生服务中心进行调查,并对收集资料进行分析统计.结果:92家社区卫生服务中心康复科从业人员共计780人;执业类别以中医类专业人数最多,职称以初级及以下为主,学历以本科学历为主,工作年限以6-10年人员最多;康复从业人员平均收入为8.16万元/年.结论:社区机构康复科专业人才缺乏,技术力量薄弱,收入有待提高.

目的:调查边远农村老年高血压患者的生活质量及影响因素,为促进农村老年高血压患者的健康提供数据支持.方法:采用整群抽样的方法纳入461例单纯老年高血压患者,采用SF-36量表评价其生活质量现状.结果:生理机能得分在不同年龄组和不同性别组有差异.生理职能、情感职能得分仅在性别组有差异,并且二者得分男性均高于女性.结论:边远农村老年单纯高血压患者生活质量相对较好.生理机能、生理职能、情感职能得分与性别有关,男性优于女性.生理机能得分随年龄增长而降低,但各生活质量评价指标与血压水平无明显差异.

背景 主观认知下降(SCD)是阿尔茨海默病(AD)患者的早期表现之一,其早期简易筛查工具的研发有利于帮助临床早期识别AD,但部分轻度认知障碍(MCI)患者主观认知下降问卷9(SCD-Q9)为0分,可能与该问卷未涵盖所有SCD主诉有关.目的 对筛选出SCD-Q9的上位条目池即主观认知下降问卷21(SCD-Q21)进行汉化,找出可识别SCD风险的SCD主诉条目并进一步优化SCD-Q9.方法 2020-07-01至2020-08-31,参考国外问卷本土化标准程序,经原作者授权、同意后获得英文版原版问卷,采用Brislin"两人直译·回译"法对SCD-Q21进行汉化,并通过专家小组讨论及小样本预调查进行条目修订及文化调适.结果 本研究经严格的翻译、回译、对比回译、条目修订、文化调适及小样本预调查而形成中文版SCD-Q21终稿.中文版SCD-Q21终稿由21个条目组成,其中条目4、5、7、10、20、21为三分类选项,其余均为二分类选项;条目11、19为反向条目,其余均为正向条目;总分21分.

背景 在人口老龄化日益加剧的社会背景之下,家庭养老功能不断减弱,机构养老成为今后发展的必然趋势.据报道,很多养老机构的老年人营养不合理,严重影响老年人的健康状况与生活质量.目的 通过调查北京市养老机构老年人营养现状及其影响因素,为全科医师营养教育及老年人生活质量提升提供理论依据.方法 2014年10月—2015年12月,采用方便整群抽样的方法,抽取了北京市7家养老机构,对符合纳入标准的老年人进行面对面问卷调查,问卷内容包括:一般情况、微型营养评定量表(MNA)、日常生活活动能力指数(BI)、老年人抑郁量表(GDS).采用二元Logistic回归分析养老机构老年人营养状况的影响因素.结果 本研究共发放问卷258份,回收有效问卷258份,有效回收率为100％.被调查的258例老年人中,存在营养不良及存在营养不良发生风险的老年人共计75例(29.1％).不同年龄、性别、婚姻状况、体质指数(BMI)、医疗费用支付方式、生活自理能力及精神状态的老年人营养状况比较,差异有统计学意义(P<0.05).二元Logistic回归分析结果显示:年龄[OR(95％CI)=2.349(1.070,5.156)]、BMI[OR(95％CI)=0.092(0.036,0.239)]、医疗费用支付方式[OR(95％CI)=0.208(0.083,0.522)]、日常活动能力[OR(95％CI)=10.214(3.099,33.669)]、患病种数[OR(95％CI)=2.682(1.248,5.763)]及精神状态[OR(95％CI)=4.822(2.005,11.600)]是老年人营养状况的影响因素(P<0.05).结论 北京地区养老机构的老年人面临着营养不良及营养不良发生风险的健康威胁,高龄、低BMI、抑郁、合并多种疾病、日常活动能力低下及无医保是其独立危险因素,需要对老年人加强个性化营养教育和营养治疗.

职业生涯规划对于职业生涯的成功起着重要的作用,而成就动机则是阻碍职业生涯发展的内在因素之一.分析某高校直属医院2018级新入学研究生的成就动机和职业生涯规划情况,并探讨如何结合其实际情况通过成就动机和职业生涯规划教育提高学生的职业生涯规划能力,帮助其更好地规划适合自身发展的职业生涯道路.

Objective:To investigate the knowledge status of Alzheimer′s disease (AD) and its influencing factors among community medical and nursing staff in Beijing.Methods:By using a convenient sampling method, 5 community health service centers in Beijing (3 in the urban area and 2 in the suburbs) were selected for survey sites from September 2016 to December 2017. A face-to-face questionnaire survey on the awareness and knowledge of AD was conducted among 270 health care staff of above 5 centers. The Alzheimer′s Disease Knowledge Scale (ADKS, 7 dimensions) and the self-designed questionnaire (influencing factors) were used for survey.Results:The mean score of 270 participants was 19.6±2.7, and the passing rate (≥18) was 80.7% (218/270). The scores of the seven dimensions ranged from low to high were care 45.4±22.7, symptoms 57.0±22.3, risk factors 60.7±19.4, life effects of AD 65.6±24.9, assessment and diagnosis 66.9±18.3, duration of disease 77.9±20.6, treatment and management 82.5±18.2. Multivariate analysis showed that the experience of caring for patients with dementia (β=1.072, P=0.03) was the influencing factor of the total ADKS scores. For single dimension of AKDS, the experience of caring for patients with dementia (β=0.348, P=0.01) and participating in dementia training (β=0.233, P=0.03) were the influencing factors of the dimension "life effects of AD"; the experience of caring for patients with dementia (β=0.459, P=0.01) and the visiting frequency of patients with dementia (β=0.154, P=0.02) were the influencing factors of the dimension "symptoms". Finally, the working years (β=0.124, P<0.01) of the staffs was the influencing factor of the dimension "duration of disease". Conclusion:In Beijing community health service centers, the knowledge of AD among medical and nursing staff is not sufficient, which are associated with the lack of the experience of taking care for dementia patients, not participating in dementia training, low visiting frequency of dementia patients and the less working years. Targeted training should be taken to improve their knowledge of AD.

目的 测定北京某社区T2DM患者足背经皮氧分压(TcPO2)水平现状.方法 选取2017年12月至2018年11月于北京市某社区卫生服务中心门诊连续就诊的T2DM无糖尿病足(DF)、年龄≥50岁患者313例,测量左右两侧足背TcPO2并收集患者临床资料.结果 测量仰卧位平放双下肢足背TcPO2平均值为(55±15)mmHg;按照两侧足背TcPO2≥60 mmHg为正常,所有患者中250例(80％)TcPO2降低,其中TcPO251～59 mmHg、41～50 mmHg和≤40 mmHg患者分别为95例(30％)、87例(28％)和68例(22％).结论 社区≥50岁T2DM无DF患者足背TcPO2数值普遍低于正常水平,测定TcPO2能早期发现亚临床状态足部组织灌注不足,为社区T2DM患者防治DF提供新方法.

Background: Sepsis is a main cause of morbidity and mortality in critically ill patients. The epidemiology of sepsis in high-income countries is well-known, but information on sepsis in middle- or low-income countries is still deficient, especially in China. The purpose of this study was to explore the prevalence, characteristics, risk factors, treatment, and outcomes of sepsis in critically ill patients in tertiary hospitals in China. Methods: A multicenter prospective observational cohort study was performed with consecutively collected data from adults who stayed in any intensive care unit (ICU) for at least 24 h; data were collected from 1 January 2014 to 31 August 2015, and patients were followed until death or discharge from the hospital. Results: A total of 4,910 patients were enrolled in the study. Of these, 2,086 (42.5%) presented with sepsis or septic shock on admission to the ICU or within the first 48 h after admission to the ICU. ICU mortality was higher in patients with sepsis (13.1%) and septic shock (39.0%) and varied according to geographical region. Acinetobacter, Pseudomonas, and Staphylococcus infections were associated with increased ICU mortality. In addition, age, Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores, pre-existing cardiovascular diseases, malignant tumors, renal replacement therapy (RRT), and septic shock were independent risk factors for mortality in patients with sepsis. The prompt administration of antibiotics (OR 0.65, 95% CI 0.46–0.92) and 30 mL/kg of initial fluid resuscitation during the first 3 h (OR 0.43, 95% CI 0.30–0.63) improved the outcome in patients with septic shock. Conclusions: Sepsis was common and was associated with a high mortality rate in critically ill patients in tertiary hospitals in China. The prompt administration of antibiotics and 30 mL/kg fluid resuscitation decreased the risk of mortality.

背景 我国目前全科医生还有很大缺口,文献对于基层全科医生短缺的原因和对策研究相对较多,但是尚缺乏全科医学研究生就业去向调查分析的相关研究,可能与全科医学研究生尤其是并轨培养全科医学研究生开始较晚,当前毕业人数尚少有关.高校医学毕业生尤其是全科医学专业的毕业生到基层医疗卫生机构就业,对填补我国全科医生长期缺乏的现状具有重要意义.目的 了解全科医学研究生就业现状,分析减少和避免基层医疗卫生机构人才流失的策略.方法 对北京市某高校自招生以来所有2011-2018届全科医学研究生就业去向进行调查和分析,统计总体就业结果和相关信息,比较不同性别、学位类型、届别研究生在就业单位性质、医疗机构等级、工作岗位的差异.结果 2011-2018届全科医学专业毕业研究生共116名,其中科学学位博士研究生8人、科学学位硕士研究生16人、专业学位硕士研究生92人,毕业当年就业率(含升学)为100.0%.不同性别毕业生就业单位性质、医院级别、工作岗位比较,差异有统计学意义(P<0.05).科学学位研究生和专业学位研究生就业单位性质、医院级别和工作岗位比较,差异有统计学意义(P<0.001).2018届研究生医疗机构就业率达到100.0%,各级医院就业率维持在一个相对稳定状态,作为全科医生从事全科医疗者占比达到82.9%.结论 全科医学研究生就业期望偏高,总体就业率较好,但到基层就业的形势仍不乐观.应继续加强和改善政策引导和激励机制,增强基层医疗卫生机构的吸引力,不断提高基层医疗卫生机构的人员素质和服务水平,形成"政策引导-人才下沉-医疗服务水平提升-待遇地位机会实现"的良性循环.

Abstract Background Since SCD (plus) was standardized, little is known about its demographic characteristics and its outcomes of neuropsychological assessments, including the SCD questionnaire 9 (SCD‐Q9). Objective To characterize SCD (plus) by comparing the neuropsychological features among its subgroups and with normal controls (NC). Also, to explore its demographics and to understand the relation of the chief complaints and the scores of SCD‐Q9. Methods Multistage stratified cluster random sampling was conducted to select participants. As a result, 84 NC and 517 SCD (plus) were included. SCD (plus) was further classified into several subgroups (SCD‐C: concerned cognitive decline; SCD‐F: complaints about SCD within the past five years; SCD‐P: feeling performance being not as good as their peers; SCD+: presented> 3 of SCD (plus) features; SCD‐: presented ≤ 3 of SCD (plus) features (see the diagnostic criteria for the details)) and between‐group comparisons of neuropsychological scores were conducted. Point‐biserial correlation and binary logistic regression analyses were performed to investigate the demographic characteristics of its subgroups. Finally, Spearman correlation was used to better understand the relation of SCD (plus) to SCD‐Q9. Results (1) Scores of AVLT‐LR (AVLT‐LR: Auditory Verbal Learning Test‐Long Delayed Recall) and MoCA‐B (MoCA: Montreal Cognitive Assessment‐Basic) were lower in the SCD‐P group than those in the NC group, and the SCD+ group scored lower in the MoCA‐B and CDT(CDT: Clock Drawing Test) than the SCD‐ group. (2) Females were more concerned than male participants. Individuals with lower education level felt that their cognitive performance were worse than their peers. Also, younger people might express concerns more than the more elderly. People who had complaints of SCD‐P might be more likely to report SCD‐C, but less likely to report SCD‐F. (3) Positive correlations were found between the chief complaints of SCD (plus) and some items of SCD‐Q9. Conclusions SCD (plus) may be related to demographic factors. Individuals with SCD (plus) already exhibited cognitive impairment, which can be detected by SCD‐Q9.

Resident standardized training is the indispensable way to develop the medical and health services in China, and the construction of resident standardized training base is the basis of this work. Under the current situation of the supply and demand of the resident standardized training base and the resident who need to participate in the standardized training, the cooperative base development plays a very good auxiliary role in the work of the national standardized training base for residents. In the process of coordination, the hospital leaders should attach great importance to the development, and we also should promote effective communication among base managers, integrate the training base management system, improve the teaching quality, establish the mechanism of training and supervision, and build a systematic construction bridge between the bases. The most important part of the base coordination is to integrate the advantageous residential training base, professional base, department and professional group, explore the new management model, actively learn from the excellent experience of other bases, as well as increase the training quality and the number of residents.

背景 "社区医疗新世界-社区卫生及基层医疗管理培训计划"项目作为国家大力推进的全科医生重点培训项目,该项目通过香港师资运用列斯特评估量表(LAP)评估套件对北京社区的8名全科医生进行集中培训,其培训效果如何对未来同类项目的开展具有重要的指导意义.目的 了解社区全科医生对LAP的看法,为后续该评估套件在社区临床实践中的运用提供参考依据.方法 2018年1—3月选取"社区医疗新世界-社区卫生及基层医疗管理培训计划"项目中的8名全科医生为访谈对象.采用焦点小组访谈法对其进行访谈.结果 通过对8名全科医生的访谈,在LAP培训反馈方面提炼出5个主题,包括对培训项目的赞同感、培训内容的实用性、培训形式的多样性、带教师资的影响性及培训项目的推广性;在培训带来的改变方面提炼出2个主题,分别为观念的改变、临床应诊及带教方式的转变.结论 LAP作为临床实践中全科医生考评体系的评估套件,其实用性、多样性得到了学员的一致认可,可以继续推广及运用.