Early life exposure to fine particulate matter (PM2.5) is linked to child development, but limited studies have focused on the specific constituents of PM2.5, and the potential moderating role of residential greenness remains unknown. The aim of this study is to investigate the effects of constituent-specific PM2.5 on child development and explore the moderating role of greenness. This study included 8327 children aged 1–6 years from a nationwide cross-sectional survey in China. We assessed PM2.5 and its five compositions across six exposure windows, covering the preconception, prenatal, and the year before the developmental assessment. Developmental quotients (DQ) across five domains were examined using the Children’s Developmental Scale of China to assess the child development. Greenness was estimated using the Normalized Difference Vegetation Index within a 1000-m buffer (NDVI1000m). Multivariable linear regression models were used to evaluate the associations of PM2.5, its constituents, and child DQ, as well as the effect modification by NDVI1000m. PM2.5 and its constituents were negatively associated with child DQ in motor, adaptability, and social skills. These effects varied by DQ domains and constituents, fine and gross motor domains showed more consistent negative associations, and stronger associations were observed for black carbon (BC), organic matter, and sulfates. Especially, PM2.5 and all five compositions across six windows were consistently associated with lower fine motor DQ [e.g., β = − 4.66, 95

The relationship between screen exposure and early childhood development requires further investigation, especially regarding the age at screen onset, daily screen duration, and potential gender-specific vulnerabilities. This study explored the associations between screen exposure before the age of two and domain-specific developmental outcomes, with particular emphasis on to age of onset, daily exposure duration, and gender differences. This cross-sectional study was conducted as part of the China National Nutrition and Health Systematic Survey for Children Aged 0–17 Years (CNHSC, 2019–2021). A total of 4617 children under the age of two were included. Parents reported their children’s screen exposure history, and developmental outcomes were assessed using the China Development Scale for Children (CDSC, WS/T580-2017). Propensity score matching was applied to minimize potential confounding and selection bias. Three-level linear mixed-effects models were used to assess associations with age at onset, daily screen time, and gender interactions. Among participants (49.7

Background:Early childhood neuropsychological development exhibits substantial heterogeneity, yet the identification of distinct developmental profiles and their associated risk factors remains limited. This study aimed to delineate latent profiles of neuropsychological development in children aged 0-6 years and to identify factors influencing membership in these profiles. Methods:A total of 2,297 children (1,193 boys and 1,104 girls) were assessed using the Chinese Developmental Scale for Children - Second Edition (CDSC-II). Latent profile analysis (LPA) was conducted based on age-standardized percentile scores across five developmental domains: gross motor, fine motor, language, adaptive behavior, and social behavior. A one-step regression mixture model, adjusting for child age and sex, was employed to examine associations between profile membership and perinatal and demographic factors. Results:The LPA identified two distinct profiles: an Ordinary Development Group (28.6%, n = 656) and an Excellent Development Group (71.4%, n = 1,641), with good class separation (entropy = 0.818). In the regression mixture model, low birth weight (OR = 2.09, 95% CI: 1.19-3.67), preterm birth (OR = 5.23, 95% CI: 3.14-8.71), maternal pregnancy complications (OR = 1.43, 95% CI: 1.15-1.78), and older child age (OR = 1.02, 95% CI: 1.007-1.027) were significantly associated with increased odds of belonging to the Ordinary Development Group. Conversely, female sex (vs. male) was associated with lower odds of membership in the Ordinary Development Group (OR = 0.67, 95% CI: 0.54-0.83). Parenting style (parental vs. non-parental care) and the timing of complementary food introduction were not independently associated with profile membership after adjustment (both p > 0.05). Conclusion:These findings indicate that specific maternal environmental exposures during pregnancy and the postnatal period, alongside child demographic characteristics, are significantly associated with neurodevelopmental outcomes in early childhood. The results underscore the importance of early developmental screening and targeted intervention for high-risk children to optimize long-term neurodevelopmental trajectories.

OBJECTIVES:The family physician contract service (FPCS) policy has been implemented for several years within primary healthcare (PHC) institutions in China. However, the specific impact of the FPCS on patients' perceived quality of primary child healthcare remains unclear. Therefore, this study investigates the effect of the FPCS on the perceived quality of primary child healthcare in urban China. STUDY DESIGN:A cross-sectional survey was conducted across twelve community health centers (CHCs) in four provinces of urban China in April 2022. METHODS:A multistage stratified convenience sampling method was employed to recruit parents of children under the age of 16 who had visited CHCs at least once to participate in the study. A validated Mandarin Chinese version of the Primary Care Assessment Tool (PCAT) was utilized to gather information from parents regarding their experiences with primary child healthcare services. To address selection and confounding bias, propensity score matching (PSM) was applied to estimate the average treatment effect on the treated (ATT), followed by a weighted one-way analysis of variance to compare each primary care attribute score reported by the two groups. RESULTS:A total of 7429 respondents were surveyed, with 1976 (26.6 %) in the contracted group and 5453 (73.4 %) in the control group. Following PSM, 3942 participants (1971 in each group) were analyzed, revealing significant pre-matching disparities in demographic and health characteristics, which were balanced post-matching. The analysis indicated that the average total PCAT score notably increased by 6.44 points for those with a contract with a family physician team, with a reduction of 6.25 points would occur if contracted participants discontinued their contract. Each domain score of primary care attributes was significantly higher in the contracted group compared to the control group, both before and after PSM, with notable differences in first-contact utilization, accessibility, continuity of care, coordination of services, and community orientation. CONCLUSIONS:This study underscores the importance of family physician contract services in enhancing the quality of primary child healthcare and emphasizes the need for policy interventions to broaden access and equity in health service provision.

BACKGROUND:Emerging evidence suggests that exposure to particulate matter (PM) may exert neurotoxic effects, but its impact on neurodevelopment during early life remains poorly understood. This study aims to investigate the association between prenatal and postnatal exposure to PM with varying sizes and neurodevelopmental outcomes. METHODS:This study was based on a nationwide survey of 11,439 children residing in 16 provinces in China. The concentrations of PM with aerodynamic diameters of < 1 μm, 2.5 μm, and 10 μm (PM1, PM2.5, PM10) at the children's residences were estimated using spatial-temporal models. Neurodevelopment was assessed using the China Developmental Scale for Children (0-6 years), which evaluates total developmental quotient (DQ) and DQ across five domains. Multi-variable linear regression models were used to estimate the association between PM exposure and DQ. RESULTS:Both prenatal and postnatal exposure to PM was associated with a reduction in total DQ and DQ in domains including gross motor, fine motor, adaptive behavior, and social behavior. Particles with smaller size showed stronger adverse effects. For instance, a 10 μg/m³ increase in the concentrations of PM10, PM2.5, and PM1 throughout pregnancy was associated with reductions in total DQ of 0.44, 0.52, and 0.74, respectively. Corresponding reductions related to the postnatal exposure during the first two years after birth were 0.46, 0.58, and 0.97, respectively. The fine motor domain was most strongly affected by PM exposure, followed by gross motor. The associations were particularly pronounced among children aged ≥ 24 months, those breastfed for less than 6 months, and those residing in northern China. CONCLUSIONS:Our findings provide robust evidence of the adverse neurodevelopmental effects of early-life exposure to PM. This research identifies the most impacted developmental domains, highlights the most harmful particle size, and underscores vulnerable subgroups， which have significant implications for public health and pollution control.

Objective: The aim of this study was to explore the relationship between breastfeeding duration and neurodevelopment in children aged 2 to 3 years in a Chinese population. Methods: This study was based on a cross-sectional survey. The data were from the National Nutrition and Health Systematic Survey for children in China which was conducted from 2019 to 2020. Characteristics of parents and children and the breastfeeding duration were obtained using interview-administered questionnaires. Children's neuropsychological development was assessed by a trained child health care physician using the Child Psychological Development Scale. A multivariable linear regression model was used to analyze the association between breastfeeding duration and neuropsychological development. Results: A total 1290 children aged 2-3 years were included in the present analysis. In multivariable linear regression models, after adjustment for potential confounders, children who were breastfed for 7-12 months had a 3.59-point increase in gross motor development ((3 = 3.59; 95% confidence interval [CI]: 1.23 to 6.34), a 3.73-point increase in fine motor development ((3 = 3.73; 95 % CI: 1.09 to 6.47), and a 2.87-point in language development ((3 = 2.87; 95 % CI: 1.12 to 5.31) compared with those who were never breastfed. Children who were breastfed for > 12 months had a 3.77-point increase in fine motor development ((3 = 3.77; 95 % CI: 0.98 to 6.86) compared with those who were never breastfed. Conclusions: Longer breastfeeding duration was associated with increased gross motor, fine motor, and language scores in our study population. Mothers in China should be encouraged to initiate and continue breastfeeding.

目的 探讨中国11～14岁儿童视屏时间与近视的关系,为儿童近视防控工作提供科学依据.方法 利用科技基础资源调查专项"中国0～18岁儿童营养与健康系统调查与应用"数据,采用多阶段分层随机抽样方法,在中国七大区域14个省、28个区/县调查点,对12 397名11～14岁儿童进行问卷调查并收集每日视屏时间和视力信息.结果 中国11～14岁儿童自我报告近视率为45.0％,其中女童高于男童、城市高于农村,且随年龄增加而增长(x2值分别为178.82,79.25,495.96,P值均＜0.01);12 397名儿童的平均每日视屏时间为40.0(30.0,60.0)min,男童[40.0(30.0,70.0)min]长于女童[35.0(30.0,70.0)min],城市儿童[40.0(30.0,70.0)min]长于农村儿童[33.0(30.0,60.0)min](x2 值分别为20.86,102.68,P值均＜0.01).每日视屏时间≥60 min男童自我报告近视率(42.5％)高于视屏时间＜60 min的男童(36.4％),每日视屏时间≥60 min女童自我报告近视率(55.6％)高于视屏时间＜60 min的女童(48.0％)(x2值分别为23.62,34.15,P值均＜0.01).经调整年龄、性别、地区、中高强度身体活动时间、含糖食品、含糖饮料摄入量和平均每日睡眠时长后,多因素Logistic回归模型分析显示,与每日视屏时间＜60 min比,≥60 min(OR=1.14,95％CI=1.03～1.27)的女童近视风险较高(P=0.01).调整混杂因素后,每日视屏时间和男童或女童的近视程度均无相关性(P值均＞0.05).结论 每天≥60 min视屏时间可能是11～14岁青春期女童近视的正性相关因素之一.鉴于影响视力的因素复杂,需要进一步研究验证两者之间的关系.

目的 了解0～23月龄婴幼儿大运动发育情况及其影响因素.方法 采用"儿心量表-Ⅱ"对全国20省市3 739名0～23月龄婴幼儿大运动发育商进行测查,同时采用问卷调查收集婴幼儿及其抚养人的相关信息.结果 出生体质量(β=-0.666,P=0.002)、主要抚养人(β=-0.395,P=0.000)、喂养方式(β=-0.250,P=0.011)、添加辅食(β=0.441,P=0.000)及家庭月均收入(β=0.189,P=0.005)与儿童大运动发育商的差异有统计学意义(P＜0.05).结论 低出生体质量不利于儿童大运动发育,母亲作为主要抚养人且家庭月均收入较高对孩子的大运动发育具有一定的促进作用.在喂养方面,坚持纯母乳喂养、适时添加辅食有助于大运动发育.

Objective The purpose of this survey was to explore the association of delivery mode with overweight and neurodevelopment of Chinese infants aged 1–5 months. Materials and methods This study was based on a cross-sectional survey. Data for this study were obtained from the Children’s Nutrition and Health System Survey in China which was conducted from 2019 to 2020. Characteristics of parents and children and the delivery mode were obtained using interview-administered questionnaires. Body mass index-for age z-score (BMI z) was calculated using World Health Organization (WHO) child growth standards. Children’s neurodevelopment was assessed by a trained child health care physician using the Child Psychological Development Scale. The association of delivery mode with infant overweight was analyzed using a multivariable logistic regression model. We conducted a multivariable linear regression model to explore the relationship between delivery modes with neurodevelopment. Results In total, the present analysis included 1,347 children aged 1–5 months, 35.61% were born via cesarean section, of which 15.21% were overweight. After adjustment for infant characteristics and parental factors, the cesarean section was significantly related with the likehood of being overweight [OR = 1.95; 95% confidence interval (CI): 1.27 to 2.98]. Children born via cesarean section had a 3.41-point decrease in gross motor development (β = −3.41; 95% CI: −5.77 to −1.05), a 3.65-point decrease in fine motor development (β = −3.65; 95% CI: −6.03 to −1.28), and a 2.96-point in language development (β = −2.96; 95% CI: −5.20 to −0.73), a 1.65-point in total development (β = −1.65; 95% CI: −3.17 to −0.14) compared with those who were vaginal birth. Conclusion In our study population, cesarean section was associated with overweight and neurodevelopment outcomes. The cesarean section might increase the likehood of infant overweight, and might decrease the developmental scores of gross motor, fine motor and language. Further studies should be conducted to verify the associations and explore the possible mechanisms.

目的 探讨母乳持续时间与学龄前儿童神经心理发育水平的相关性,为促进母乳喂养提供依据.方法 2019年9月—2021年5月选取北京市东城区、吉林省通化市东昌区、山西省晋中市榆次区、河南省周口市川汇区、湖南省长沙市岳麓区、江西省南昌市青山湖区、陕西省渭南市临渭区、广西壮族自治区桂林市七星区及青海省格尔木市990名3～4岁的城市儿童.采用《儿心量表-Ⅱ》对儿童的神经心理发育水平进行测查.儿童及其父母的人口学特征采用面对面问卷调查收集.结果 多元线性回归方程在调整了父母年龄、文化程度、家庭月均收入、孕期增重、生产方式及产次因素后,与母乳持续时间＜6月的儿童相比,母乳持续时间＞12月儿童的大运动发育水平β(95％CI)值为2.51(1.11～3.57),语言发育水平β(95％CI)值为3.62(1.21～4.84),差异均有统计学意义(均P＜0.05).与母乳持续时间＜6月的儿童相比,母乳持续时间6～12月儿童的语言发育水平β(95％CI)值为2.47(1.10～3.28),差异有统计学意义(P＜0.05).结论 母乳持续时间与学龄前儿童大运动、语言发育水平呈正相关关系.因此,鼓励母乳喂养并延长母乳喂养时间有益于儿童神经心理发育.

Aims: The child restraint system (CRS) for vehicles is designed to provide specialized protection for children in the event of a crash. The aim of the study was to investigate the rate of CRS use and analyze the factors associated with CRS use among children aged under six years in China, and to provide further insight into developing strategies for promoting public health education. Methods: This is a cross-sectional study. The study sites were 36 primary healthcare institutions in 12 provinces across China, and the participants were 34,503 guardians of children aged 0–6 years. Guardians who owned private cars were included and completed surveys about their experience using CRS. Odds ratios and 95% confidence intervals were calculated using multivariate logistic regression models. Results: The overall rate of CRS use among children aged under six years in China was 17.3%. Multivariate logistic regression analysis revealed that living in an urban area, low age of the child, guardians having higher education and being looked after by parents had a significant positive association with CRS use among children aged under six years. Conclusions: This study confirms that there is a low rate of CRS use among children aged under six years in China, highlighting the considerable need for CRS use education, advocacy and promotion of increasing use.

目的 分析中国学龄前儿童贫血现况及其与不同能区及总体神经心理发育状况的相关关系.方法 数据来源于"中国0～18岁儿童营养与健康系统调查与应用"项目,以14省28个调查点的3 261名2～6岁儿童及其家长为研究对象.儿童相关人口学特征由经过统一培训的调查员进行面对面调查.采用血红蛋白检测方法(Hemocue法)测定儿童全血血红蛋白,儿童的神经心理发育水平由经过培训的儿童保健人员采用《0～6岁儿童发育行为评估量表》(WS/T 580-2017)进行测查.结果 儿童血红蛋白平均水平为(125.23±11.49)g/L,贫血率为10.30％.调整性别、年龄、民族、地区、喂养方式、母孕期情况等混杂因素之后,2～6岁贫血儿童在大运动(β=-2.15,95％CI=-3.89～-0.41)、精细动作(β=-2.46,95％CI=-4.12～-0.79)、适应能力(β=-2.59,95％CI=-4.42～-0.76)、语言(β=-3.65,95％CI=-5.53～-1.78)和社会行为(β=-3.11,95％CI=-4.94～-1.28)5个能区以及全量表(β=-2.79,95％CI=-4.10～-1.49)发育商水平均低于非贫血儿童(P值均＜0.05).结论 2～6岁儿童贫血与其总体发育商以及大运动、精细动作、适应能力、语言和社会行为五大能区发育商水平均呈负相关,建议积极开展学龄前儿童贫血监测、干预工作,进一步提高儿童的神经心理发育水平.

目的 研究分析0～24月龄婴幼儿贫血对不同能区神经心理发育状况的影响.方法 数据来源于"中国儿童心理发育数据分析及报告和图集制作"课题,共4 903名0～24月龄婴幼儿及其家长纳入本研究.儿童及其家长的人口学特征由经过统一培训的调查员进行面对面调查.采用血红蛋白检测方法(Hemocue法)测定全血血红蛋白,儿童的神经心理发育水平由经过培训的儿童保健人员采用"儿心量表-Ⅱ"进行测查.结果 0～24月龄婴幼儿血红蛋白水平是(116.96±13.15)g/L,贫血率为15.56％.在调整性别、月龄、民族、区域、喂养方式、母孕期情况和父母亲年龄、职业和文化程度等因素之后,贫血婴幼儿在精细动作(β值=-2.23,95％CI:-3.54～0.92)、语言(β值=-2.34,95％CI:-3.61～1.06)和全量表(β 值=-1.31,95％CI:-2.17～0.46)的发育商得分显著低于非贫血儿童.在大运动、适应能力和社会行为3个能区,贫血婴幼儿低于非贫血儿童,但差异无统计学意义(P＞0.05).结论 0～24月龄婴幼儿贫血对于婴幼儿总发育商有一定的影响,并且主要表现在精细动作和语言两个能区上.

This study aims to explore the attitude, willingness, and satisfaction with contracted service (CS) among staff in community health service (CHS) centers in urban China and to explore the associated factors of satisfaction with CS. From August 2016 to July 2017, five CHS centers in three provinces of China were selected. Setting-level information was collected by official document review; and personal information on demographic characteristics, awareness, willingness, and attitude of CS among staff was collected by questionnaire survey. Univariate and multivariable logistic regression models were fitted to explore the associated factors of satisfaction with CS. Multiple correspondence analysis (MCA) was used to visually demonstrate the correlations among category data related with satisfaction with CS. The CS signing rates were 30.78, 12.72, 22.20, 14.32, and 21.19% in the five CHS centers. A total of 286 staff included family doctors (40.91%), nurses (31.12%), and others (27.97%) completed the survey. For the sense of self-worth, 86.01% (246/286) participants hold a positive attitude. The predominant barrier of CS signing was caused by the work pressure due to CS performance assessment (48.60%, 139/286). About 30% of family doctors and nurses reported a heavy work pressure, and more than 30% of doctors had great feeling of fatigue. Notably, 51.69% family doctors would like to change their job in the future. Compared with other staff, family doctors were more likely to be unsatisfied with CS (OR: 2.793, 95% CI: 1.155–6.754, p = 0.022). Participants in Sichuan province have lower satisfaction than other places. The MCA yielded similar factors consistent with multivariable results of clustering with different levels of CS satisfaction. Our study revealed that the CS coverage and satisfaction among staff from the primary healthcare system varied geographically and are associated with professional field, workload, and pressure. Measures that aim to promote the stability of primary care human resource should be considered in the future.

Objective:To provide strategic suggestions for optimizing children′s diagnosis and treatment services in the communities, by means of analyzing the overall efficiency of children′s diagnosis and treatment services in the sample community health service centers, and learning the current input and output of children′s diagnosis and treatment resources.Methods:In April 2020, a total of 27 community health service centers in 14 cities were selected by random sampling. Data such as the number of medical visits by children aged 0 to 18 years and the area of pediatric diagnosis and treatment departments in the sample centers in 2019 were collected by self-filling questionnaires. Excel was used for data sorting. Data envelopment analysis(DEA) was used for data processing. The data processing tool was DEAP 2.1.Results:The average comprehensive efficiency, the average technical efficiency and the average scale efficiency of the 27 sample community health service centers were 0.445, 0.865 and 0.494 respectively. There were five DEA efficient centers, 4 DEA weak inefficiency centers and 18 inefficient centers. Six out of 18 DEA inefficient centers had redundant input of healthcare professionals capable pediatrics; 12 centers were short of children visits, and 15 were short of visits by children aged 0-6 years.The centers where DEA was inefficient were concentrated in the central region, the suburbs and " centers with independent pediatric clinics but without pediatric wards" .Conclusions:The comprehensive efficiency of children′s diagnosis and treatment services in the sample community health service centers is relatively low. Currently, the sample community health service centers are faced with such problems as small and insufficient input of children′s diagnosis and treatment resources in the community, unbalanced development of children′s diagnosis and treatment services in the region among others. It is suggested that on the basis of making full use of the existing resources to create the maximum output value, we should consider appropriately expanding the scale of resource input to improve the efficiency of children′s diagnosis and treatment services at the primary level and further give play to the value of the " gatekeepers" at the primary level in children′s diagnosis and treatment.

背景 随着"二孩"政策的开放,我国儿童人口数量逐步增加,儿童健康服务需求呈现快速增长态势,但当前我国社区卫生服务中心儿童健康服务能力尚不清晰.目的 了解当前我国部分城市社区卫生服务中心儿童健康服务能力的现状.方法 2020年4月,采用多阶段分层抽样的方法,在全国抽取了35家社区卫生服务中心及样本中心的全部儿童相关服务人员作为研究对象.采用自制的样本中心调查表及儿童相关医务人员调查问卷以线上调查的形式,调查社区卫生服务中心的基本情况、人员设备设施配置、业务开展情况及儿童健康服务人员知识水平和满意度等.结果 本次调研共包含全国的14个城市的35家社区卫生服务中心,样本中心卫生技术人员总数8009人,儿科医生〔执业范围含儿科学的执业(助理)医师〕191人(2.38％),看儿科的全科医生(通过儿科转岗培训并从事儿科诊疗工作)488人(6.09％),儿保医生320人(4.00％);其中儿科医生154人(80.63％)具有本科及以上学历、112人(58.64％)具有中级及以上职称,看儿科的全科医生293人(65.37％)具有本科及以上学历、355人(79.30％)具有中级及以上职,80.00％以上儿保医生具有执业医师证和培训合格证.共计999人接受满意度和知识水平调查,人员的平均满意度为(61.38±9.11)％,平均知识水平测试正确率(50.40±21.93)％.儿科相关诊疗科室面积平均占比不足1％,超过90％的机构配备了8种儿童常见设备,但仍有超过一半机构的儿童常用的诊疗设备配备不足7种;23种儿童常用药品中仅有10种超过50％的机构进行了配备.2019年度机构平均儿童诊疗人次占2.91％,儿童入院人次占1.48％;国家基本公共卫生项目开展率达85％以上;管理数量最多的重点儿童是单纯性肥胖儿童,最少的是先天性髋关节脱位的儿童.结论 社区卫生服务中心儿童相关服务人员数量不足,学历及职称较高但理论知识水平不高,人员满意度较低;社区卫生服务中心儿童医疗相关类设施设备及药品配备不足;儿童健康服务水平空间分布不均衡.为提升社区儿童健康服务能力水平,应加强指导培训以提高基层工作人员的能力水平,建立有效的考核机制以提升基层工作人员的满意度;增加儿童药品种类及数量的配备、合理配置儿童诊疗设备实施.

目的 了解城市地区社区管理的6～12月龄婴儿贫血患病率,并从供给侧角度探讨贫血危险因素,为更好地制定贫血干预措施提供依据.方法 采用横断面研究方式收集3个城市6家社区卫生服务中心进行常规健康管理的婴儿相关数据,归纳整理后运用单因素及Logistic回归从多个层面探讨贫血的危险因素.结果 1 411名婴儿贫血患病率为17.4％,北京最低为10.1％,合肥最高为22.7％,头包为21.4％.Logistic回归分析显示,婴儿分娩方式为顺产(OR=0.658,95％ CI:0.485～0.892)、母亲贫血知识知晓率高(OR=0.610,95％CI:0.436～0.864)以及机构有贫血治疗药物(OR=0.440,95％CI:0.304～0.638)是婴儿贫血的保护因素,而母亲孕期患有贫血(OR=1.711,95％CI:1.247～2.348)以及社区医务人员平均每人管理儿童数多(OR-2.636,95％CI:1.822～3.815)是婴儿贫血的危险因素.结论 城市地区6～12月龄婴儿贫血患病率较高,应从医疗机构供给侧角度配备贫血治疗药物以及增加医务人员,并加大婴儿喂养知识行为宣传力度,以降低婴儿贫血率.

Abstract Aim: This study aimed to evaluate the effectiveness of hypertension management and analyse the factors associated with blood pressure reduction within China’s primary healthcare system. Background: Hypertension is one of the leading risk factors for global disease burden and is strongly associated with cardiovascular diseases. In China, hypertension is a serious public health problem, but few studies have evaluated the effectiveness of hypertension management in China’s primary healthcare system. Methods: The study sites were 24 primary healthcare institutions, selected using multistage stratified random sampling method. In each institution, hypertension patients aged at least 35 years who agreed to participate and had no disabilities or mental health problems were enrolled for hypertension management. Participants received comprehensive interventions in the primary healthcare system via a team. After a one-year intervention, data from 6575 hypertension patients were analysed to check the effectiveness of hypertension management and examined factors associated with hypertension control. Findings: There was an overall mean reduction of 4.5 mmHg in systolic blood pressure (SBP) and 1.9 mmHg in diastolic blood pressure (DBP). The blood pressure reduction after one year was greater in rural patients than in urban patients, 6.6 mmHg versus 3.4 mmHg for SBP and 2.6 mmHg versus 1.6 mmHg for DBP, respectively. The hypertension control rate also increased more in rural areas (22.1%) than in urban areas (10.6%) after the one-year intervention. Age, body mass index, region and being in an urban area had a significant negative association with the reduction of SBP (P < 0.05). Education level and baseline SBP showed a significant positive association (P < 0.05). Conclusions: Community-based hypertension management by general practitioners was feasible and effective. The effectiveness of hypertension management in rural areas was greater than in urban areas. Intervention strategies should pay more attention to patients in rural areas and western China.

The objective of this study was to examine the association between patient satisfaction with community health service (CHS) and self-management behaviors in patients with type 2 diabetes mellitus (T2DM). In all, 1691 patients with T2DM from 8 community health centers in 5 provinces in China participated in the present study. The dependent variables included 4 measures of self-management behaviors: regular self-monitoring of blood glucose (SMBG), prescribed medication adherence, recommended dietary changes, and regular exercise. The independent variable was patient satisfaction with CHS. Multivariable logistic regression models were performed to examine the association between patient satisfaction with CHS and self-management behaviors. The mean satisfaction score in the participants was 3.14 (out of a maximum of 5). After adjusting for covariates including demographic factors, health status, health knowledge, and socioeconomic status (SES), diabetic patients with high CHS satisfaction had better medication adherence (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.02-1.55), increased exercise management (OR 1.19, 95% CI 1.06-1.35), and more SMBG (OR 1.16, 95% CI 1.03-1.32); all these associations varied across SES groups. The association between satisfaction and medication adherence was significant among participants younger than 65 years with lower education (OR 2.15, 95% CI 1.37-3.37), income (OR 1.62, 95% CI 1.13-2.32), and lower-status occupations (OR 1.69, 95% CI 1.16-2.47). Among participants younger than 65 years and had lower education attainment, the association between satisfaction and diet management was observed. There were positive associations between satisfaction and regular exercise among subgroups of participants younger than 65 years, except for lower education group. A significant association between satisfaction and SMBG among participants >= 65 years old, who also had lower SES and higher-status occupations, was also observed. The study findings suggested that T2DM patient satisfaction with CHS was moderate. High satisfaction with CHS indicated better medication adherence, exercise management, and SMBG, and these associations varied by SES.

目的 了解3岁以下儿童精细动作发育情况,探讨影响儿童精细动作发育的相关因素,为促进儿童精细动作发育提供科学依据.方法 选取2014年5-11月在全国东中西部7个城市的7家医院的儿童保健科进行保健的3岁以下的健康儿童4 307名作为研究对象.采用自行设计的儿童基本情况调查表调查儿童的基本情况.神经心理发育测查采用首都儿科研究所编制的《0 ～6岁儿童神经心理检查量表》进行测查,并计算大运动、精细动作、适应能力、语言及社会行为五大能区的智龄和发育商.该研究主要对儿童的精细动作发育情况进行分析.结果 4 307名儿童精细动作发育商均值为(95.62±18.33)分,单因素分析显示儿童精细动作发育商在性别、地区、父母亲文化程度及主要抚养人这几个变量间差异有统计学意义(P＜0.05),儿童在月龄组6～、12～及24～的智龄均数均低于实际月龄.多元线性回归分析结果显示影响儿童精细动作发育商的因素为儿童性别、母亲文化程度及主要抚养人.结论 儿童家长在日常的养育过程中要加强儿童精细动作的培养,有意识地进行多种精细动作训练是促进儿童精细动作发展的一个重要手段.