Objective:To investigate the work stress and its influencing factors among hospice care physicians and nurses in medical institutions in Shanghai.Methods:It was a cross-sectional study. The study was carried out between December 2021 and January 2022. By use of multistage random sampling, 256 hospice care physicians and nurses were selected from community healthcare centers, secondary and tertiary hospitals in Shanghai to attend a WeChat-based survey using a self-designed questionnaire. The chi-square test was used to compare the differences in prevalence of work stress and stressors among all subjects with different characteristics. Binary logistic regression analysis was used to explore the major determinants associated with work stress. And the sources of work stress and the expepectd decompression countermeasures were investigated.Results:A total of 256 valid questionnaires were collected with a recovery rate of 100.0%. The median of work stress score was 7.5 (6.0, 9.0). Logistic regression analysis showed that those aged>40 years old and working for ≥5 years in hospice care service had higher level of work stress ( OR=3.78, 2.04; P=0.007, 0.039), and those with monthly income>10 000 RMB Yuan had lower level of work stress ( OR=0.34, P=0.005). The top three stressors were the death of patients (88.3%, 226/256), low income (78.1%, 200/256), difficulty in promotion (67.2%, 172/256). The top three way that doctors and nurses desired to reduce work stress were to increase income (88.3%, 226/256) and optimize performance appraisal target (78.1%, 200/256) and promotion mechanism (66.0%, 169/256). Conclusions:In general, the work stress among hospice care physicians and nurses is at a high level in Shanghai and the stressors are widely distributed. Age, monthly salary and years of working in hospice care unit are independent factors of work stress. Improving salary, optimizing performance appraisal target and promotion mechanism are the most desired strategies to reduce work stress among hospice care physicians and nurses.

Objective:To survey the status quo of hospice care service in community health service centers in Shanghai.Methods:A questionnaire survey was conducted to investigate the situation of hospice care services from January 2021 to December 2021 in 16 community health service centers selected by stratified sampling from 16 districts in Shanghai.Results:Among 16 community health service centers, 13 provided inpatient hospice care services, 16 provide home hospice care and 14 provided outpatient hospice care services; and totally 1 935 (77.93%), 158 (6.36%) and 390 (15.71%) patients received palliative care, respectively. In centers providing inpatient hospice care service, the average bed number was 12 (10, 20); the annual number of patients was 58 (29, 137); the average length of hospital stay was (29.55±11.18) days; and the bed occupancy rate was (55.51±30.02)%, which in urban districts was significantly higher than that in rural districts ((74.76±19.33)% vs.(39.00±28.32)%; t=2.61, P=0.024). The number of patients receiving home hospice care in each center was 10 (3, 19) and the average duration of home service was (66.97±29.41) days. The proportion of physician fee of inpatient hospice care and that of home hospice care were (8.61±5.27)% and (6.25±3.11)%, respectively. While the proportion of medication expenses of inpatient hospice care and that of home hospice care were (35.60±16.13)% and(49.58±9.16)%, respectively. The outpatient hospice service were opened 2.0 (1.0, 4.0) days a week in 14 centers and 95 (58, 199) patients received services. Inpatient services were mainly provided for the patients with non-malignant chronic diseases (53.23%, 1 030/1 935), while home hospice care (89.87%, 142/158) and outpatient hospice care (83.85%, 327/390) mainly provided service for malignant patients. Conclusion:There is still room for improvement about the hospice care services delivered by community health service centers in Shanghai:discrepancy of utilization of hospice care services between urban districts and rural districts, low utilization of home and outpatient hospice care services, unreasonable cost composition in inpatient and home hospice care services.

Objective:To investigate the status quo of pain management for cancer patients in hospice care wards of community health service centers.Methods:The electronic medical records of 373 cancer patients admitted in hospice wards of Kangjian Community Health Center of Xuhui District and Jinshanwei Town Community Health Center of Jinshan District from January 2015 to July 2021 were collected. The characteristics of cancer pain, the use of analgesic drugs, the effects of analgesic drugs and its influencing factors were analyzed.Results:The incidence of cancer pain in 373 patients was 93.0% (347/373), and the proportion of moderate to severe cancer pain was 55.6% (193/347). Analgesics were used in 304 patients, among whom 233 (76.6%) patients used oral analgesics, 297 (97.7%) used on time, 97.6%(285/292) used sustained-release opioids, and 94 (30.9%) used combinedly. Breakout pain occurred in 100 cases (32.9%), all of which was controlled with immediate-release morphine. Cancer pain was not relieved in 132 cases (43.42%), and multivariate logistic regression analysis showed that the pain degree on admission (moderate: OR=3.69, 95 %CI:2.09-6.49; severe: OR=5.52, 95 %CI:2.43-12.53), the presence of burst pain ( OR=3.28, 95 %CI:1.77-6.06), the type of analgesics used (non-steroidal+weak opioids: OR=0.39, 95 %CI:0.20-0.76; nonsteroidal+strong opioids: OR=0.20, 95 %CI:0.08-0.51) and the adverse reactions ( OR=1.92, 95 %CI:1.03-3.60) were the influencing factors of pain relief in cancer pain patients (all P<0.05). Conclusion:The pain of cancer patients admitted to community palliative care wards cannot be ignored. Although most cancer pain patients use analgesic drugs in a standard way, there are still a high proportion of patients whose pain is not controlled. Various factors affect the effect of analgesic treatment.

高胡萝卜素血症(hypercarotenaemia)是由于血液中β-胡萝卜素水平升高而导致皮肤黄染的一种疾病,基层医疗机构多见,因容易被误诊为黄疸,导致进一步过度检查,给患者心理、经济造成一定的负担和压力.高胡萝卜素血症一般都是良性过程,全科医生应该熟悉该疾病,正确鉴别,实行全专合作.

目的:分析全专联合诊疗模式的实施效果,为优化区域1+1+1"签约服务,探索分级诊疗的发展提供依据.方法:以正式运行徐汇区全专云医联平台的时间作为划分依据,收集比较2017年6月1日—2018年5月31日和2018年6月1日—2019年5月31日的以下数据:(1)徐汇区"1+1+1"签约居民的签约组合内医疗机构就诊情况;(2)徐汇区65岁以上"1+1+1"签约居民健康管理情况;(3)上海市级预约转诊平台与徐汇区全专云医联平台的双向转诊情况.结果:徐汇区全专云医联平台运行前一年,徐汇区"1+1+1"签约居民的签约组合内医疗机构就诊人次数为4859064,运行后第一年为4829679,未见明显变化.徐汇区全专云医联平台运行前一年,徐汇区65岁以上居民的健康管理率为73.28％,运行后第一年为75.01％,同比上升1.73％.徐汇区全专云医联平台运行后第二年,徐汇区"1+1+1"签约居民的上转、下转人次较第一年有所增加;运行后第一年的双向转诊率为52.32％,第二年为46.46％,同比下降5.86％,但其双向转诊率均显著高于上海市级预约转诊平台的同年相关数据.结论:全专联合诊疗模式对区域分级诊疗的实施发挥了积极作用,但与实现全面转变传统就医观念、合理有序就医仍有一定差距,通过进一步推进上海市医疗行业的数字化转型,全专联合诊疗服务未来可期.

高血压是一种常见的社区慢性病,其发病率高、危害性大.高血压有效防治和管理的重心集中在社区慢性病管理中.中医传统的体质学说阐明了各种体质与疾病发生、发展的内在联系.众多调查研究发现高血压患者的发病、病情变化和疾病转归与其本身的体质有着非常密切的关系.因此,本文首先阐述了体质因素与高血压发生、发展的联系,汇总目前多数调查研究结果发现,痰湿质、阴虚质为高血压患者最常见的偏颇体质.其次,分析目前社区高血压管理模式现状的中存在的主要问题和不足:缺乏有效、科学、合理的防治,缺乏"个体化"管理.重点对目前中医体质辨识在我国社区高血压管理中的应用现状和结果进行分析,从而阐明体质辨识对社区高血压管理的重要意义.最后,说明了目前体质辨识应用于社区高血压管理和未来要健全这种模式可能存在的主要问题:缺乏政策支持、信息化标准化手段及中医人才匮乏等,并提出了需要解决和探讨的问题.由此阐明:中医的体质对高血压的发病及发展具有重要影响,根据中医体质学理论,利用体质辨识,采用中医适宜技术,及时纠正偏颇体质,将对延缓高血压病情的发生和发展,防止靶器官损害的发生具有一定的作用,中医体质管理为未来社区高血压的防控管理提供了新思路.

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。

紫色尿袋综合征在临床并不多见,多发生于基层医疗机构老年护理病房和养老院,由于患者长期留置导尿管,相关尿路感染以及体内色氨酸的复杂代谢导致该现象的发生.本文报道1例紫色尿袋综合征病例,并对其病因、发病机制、临床特点以及预防和治疗进行文献复习,为全科医生今后面对此类病例提供借鉴和参考.

目的:探讨Markov模型在社区骨质疏松人群健康状态预测中的应用.方法:以社区专病数据库中2199名有骨密度数据的人群为对象,年龄40～99岁,平均年龄为(70.97±9.03)岁;其中男性572例,女性1627例.根据骨密度测定结果将其划分为健康、低骨量、骨质疏松三种状态,并进行Markov模型模拟,分析不同骨密度人群未来状态分布的发展趋势.结果:通过建立Markov模型的结果发现,健康转换为低骨量的概率为11.8％,低骨量转化为健康概率为4.2％,低骨量转化为骨质疏松概率为17.7％,骨质疏松转化为低骨量的概率为10.4％.该模型预测未来30年间,低骨量病例所占比例将减少,骨质疏松病例所占比例将增加,健康人数所占比例将基本保持不变.结论:Markov模型适用于骨质疏松健康状态预测研究,对临床工作有实际指导意义.

Objective: To investigate the diabetes management ability of community nurses to provide evidence for improving the overall level of nursing practice ability of community nurses. Methods: In November 2017, 398 community nurses from 13 community health service centers in Xuhui District were investigated with a self-designed questionnaire on diabetes management ability, and the survey included the basic situation of nurses, diabetes knowledge, community nursing practice, diabetes management exercise guidance and dietary guidance. A total of 398 questionnaires were distributed and 390 were recovered. Results: The average score of diabetes knowledge was (33.16±6.48), and the difference of diabetes knowledge scores among community nurses with different professional titles, positions and departments was statistically significant(P<0.01). The average score of nursing practice was (4.24±1.19). The scores of nursing practice of community nurses in different age groups and departments were statistically significant(P<0.05). The average score of exercise guidance was (31.31 ± 10.77) and that of diet guidance was (28.75±9.80). The scores of nurses in different departments in sports and diet guidance were statistically significant(P<0.01). Conclusion: There is a lack of diabetes knowledge among community nurses in Xuhui District, the nursing practice ability of young and ward nurses needs to be improved, and knowledge training, health coaching awareness training and nursing practice training should be strengthened to help improve the diabetes management ability of community nurses.

Objective:To study the effect of art therapy combined with drug on schizophrenic patients in the com-munity.Methods:A total of 78 schizophrenia patients were involved;Patients were randomly divided into two groups, training group with 38 cases and control group with 40 cases.Art therapies were given to training group for 6 months.Positive and negative symptom scale(PANSS),General Self-Efficacy Scale(GSES),Life Satisfaction Index A(LSIA)were used in both group patients.Results:The total scores of PANSS,SANS and GPS in the training group were significantly superior to those in the control group(t =-3.81,4.07,-3.12;P <0.01 ).The score of SAPS in the two groups had no statistically significant difference.The total scores of GSES and LSIA in the training group were significantly superior to those in the control group(t =2.63,3.17;P <0.05).Conclusion:Art therapies combined with drugs are beneficial in the rehabilitation of patients with schizophrenia in community.

BACKGROUND:Ghrelin is a newly discovered brain-gut peptide from the stomach of human and rats. As an endogenous ligand for growth hormone secretagogue receptor (GHSR), ghrelin can notably stimulate the release of growth hormone. Although GHSR is expressed in many peripheral tissues, little is known about the influence of ghrelin on bone metabolism and GHSR expression in bone tissue. OBJECTIVE:To review the research progress of ghrelin in bone metabolism.METHODS:The first author retrieved CNKI, WanFang, PubMed, and Springerlink databases with the keywords of"Ghrelin, bone metabolism"in Chinese and English, respectively. The studies regarding ghrelin and its involvement in bone metabolism were included, and repetitive ones were excluded. A total of 53 eligible literatures were selected through skimming abstracts. RESULTS AND CONCLUSION:Ghrelin is a peptide composed of 28 amino acids discovered in gastric endocrine cells and hypothalamic arcuate nucleus in mice and human, which makes a great effect on digestive, nervous, immune and endocrine systems, and also plays a role in hormone secretion, glucose metabolism, immunity, cell proliferation, and inflammation. Serum ghrelin makes a certain influence on bone growth and development, and promotes the differentiation and proliferation of osteoblasts, and inhibits its apoptosis. Additionally, ghrelin suppresses the early osteogenic differentiation of C3H10T1/2 cells by upregulating the expression of Runx2 protein, and attenuates adipogenic differentiation by downregulating PPARγ2 expression, thus inducing osteogenic differentiation. However, few studies have addressed the expression of GHSR in bone tissue.

目的 :调查糖尿病患者对糖尿病视网膜病变(DR)的认知状况,寻找健康教育的切入点。方法 :采用问卷对来我中心眼科就诊的糖尿病患者进行调查。结果 :362名对象对糖尿病视网膜病变的认知情况较差,除对DR危害性完全了解为66.5%外,其他知识项完全和部分了解所占的比例均在50.0%以下。结论 :要重视糖尿病眼部并发症的健康教育,降低糖尿病视网膜病的发病率。

对上海一城区和农村65岁以上老人的健康体检结果进行分析.高血压、高血糖、高血脂均是城市与农村检出疾病谱的前三位.

Objectives To probe into the knowledge of health status of elderly in this community,to provide a basis for further chronic disease management and health education.Methods The main items of physical examinations(PE) were blood pressure,blood glucose,alamine amonotransfer enzymes(AAT),blood urea nitrogen,serum creatinine,blood fat,etc.determined by District Board of Health.All of the elderly voluntarily participating in PE had the right to choose specific items.GP teams distributed conclusions of health evaluation and gave health propaganda and education.Results In 1273 subjects,the detection rate(DR) of hypertension was 57.0%,no hypotension detected.Hypertension DR was 64.9%(523/806) in 806 patients with previous history of hypertension(63.3%),and 43.3%(202/467)in 467 patients without(36.7%).Hyperglycemia DR was 11.4%(65/569),high uric acid 21.8%(147/674),high cholesterol 11.1%(75/674),TG 35.5%(239/674),HDL and LDL 46.29%(312/674).DR of high cholesterol,HDL and LDL was higher in females(15.5%,50.0%,respectively) than in males(4.7%,40.9%,respectively),the difference was significant(P=0.000 and 0.021,respectively).Conclusions By PE results,DRs of hypertension,high blood sugar,high cholesterol,high uric acid are high.So there are a lot to do for GPs.

[Objective]To understand the recent trends of malignant tumor incidence and morbidity in Tianping community of Shanghai to make recommendations on the community cancer prevention and control work.[Methods]Used Excel to establish the data about malignant tumor incidence of residents in Tianping community between 2000 and 2008,statistically analysed the data with SPSS software.[Results]The cancer incidence in the community from 2000 to 2008 was an upward trend,incidence increased with the growth of age.The incidence of lung cancer ranked first,followed by stomach cancer,breast cancer.[Conclusion]Malignant tumor is major disease which is harmful to the health of community residents.Community health service centers should do the work on prevention and treatment of cancer well.