Few prospective studies have investigated the joint effect of lifestyle factors and genetic susceptibility on the risk of irritable bowel syndrome (IBS). This study aims to evaluate the associations of lifestyle and genetic factors with incident IBS in the UK Biobank. We analyzed data from 481,057 participants (54% female) without prevalent IBS at enrollment in the UK Biobank. An overall healthy lifestyle was defined using six modifiable lifestyle factors, including smoking, body mass index (BMI), sleep duration, diet, physical activity, and alcohol consumption, and hence categorized into ‘favorable’, ‘intermediate’, and ‘unfavorable’ lifestyles. A Cox proportional hazard model was used to investigate the association between a healthy lifestyle and incident IBS. Furthermore, we constructed a polygenic risk score (PRS) for IBS and assessed whether lifestyle modified the effect of genetics on the development of IBS. During a median follow-up of 12.1 years, 8,645 incident IBS were ascertained. Specifically, among the six modifiable lifestyle factors, adequate sleep demonstrates the greatest protective effect (hazard ratio [HR]: 0.72, 95% CI: 0.69,0.75) against IBS.Compared with a favorable lifestyle, an unfavorable lifestyle was associated with a 56% (95% CI: 46%-67%) increased risk of IBS (P = 8.99×10-40). The risk of incident IBS was 12% (95% CI: 4%-21%) higher among those at high genetic risk compared with those at low genetic risk (P = 0.005). When considering the joint effect of lifestyle and genetic susceptibility, the HR nearly doubled among individuals with high genetic risk and unfavorable lifestyle (HR: 1.80; 95% CI:1.51-2.15; P = 3.50×10-11) compared to those with low genetic risk and favorable lifestyle. No multiplicative or addictive interaction was observed between lifestyle and genetics. The findings from this study indicated that lifestyle and genetic factors were independently associated with the risk of incident IBS. All these results implicated a possible clinical strategy of lowering the incidence of IBS by advocating a healthy lifestyle.

ObjectiveAlthough previous studies have explored the association of drinking with gout risk, we sought to explore the dose-response relationship and the evidence between subtypes of alcoholic beverages and gout risk.MethodsThe weekly alcoholic beverage consumption of patients in the UK Biobank was collected and calculated. The Cox regression model was applied to assess the effects of drinking alcohol in general and its subtypes on gout risk by calculating the hazard ratio (HR) and 95% CIs. Additionally, the restricted cubic splines were used to estimate the dose-response relationship between alcohol consumption and gout risk. To evaluate the robustness, we performed subgroup analysis across various demographic characteristics.ResultsDuring a mean follow-up period of 11.7 years, a total of 5728 new incident gout cases were diagnosed among 331,865 participants. We found that light alcohol consumption was linked to a slight decrease in gout incidence among female individuals (HR 0.78, 95% CI 0.65-0.94,P= 0.01), whereas there was no significant association in male individuals. Moreover, the dose-response relationship showed that drinking light red wine and fortified wine could reduce the gout risk, whereas beer or cider, champagne or white wine, and spirits increased the gout risk at any dose.ConclusionOur study suggested a J-shaped dose-response relationship between drinking and gout risk in female individuals, but not in male individuals. For specific alcoholic beverages, light consumption of red wine and fortified wine was associated with reduced gout risk. These findings offer new insights into the roles of alcoholic beverages in gout incidence risk, although further validation is warranted.

Introduction Patient satisfaction is a crucial metric to gauge the quality of medical services, but the psychological factors influencing patient satisfaction remain insufficiently explored.Methods This study examines these psychological factors by applying the theory of bounded rationality to 1,442 inpatients in Hangzhou, China, whose data were collected using a questionnaire. One-way ANOVA, correlation analysis, and hierarchical regression were used to analyze patient satisfaction and its associated factors. Additionally, the path analysis of the structural equation model revealed the mechanisms behind the key psychological factors that influenced patient satisfaction.Results Medical risk perception, the social cognition of the medical environment, and social desirability bias had significant positive impacts on patient satisfaction. By contrast, negative emotions had a significant negative impact on patient satisfaction. Notably, patients' negative emotions had both a suppressive effect and a positive moderating effect on the relationship between medical risk perception and patient satisfaction. Similarly, social desirability bias had a suppressive effect on the correlation between the social cognition of the medical environment and patient satisfaction, albeit with a negative moderating effect.Discussion These results suggest that when evaluating and improving patient satisfaction, accounting only for the factors that directly influence medical service quality is insufficient, as the indirect and moderating effects of patients' negative emotions and the social cognition of the medical environment must also be considered. Medical service providers should thus address patients' negative emotions, establish good doctor-patient relationships, optimize service environments, provide managers with medical risk education and training on negative emotions, and prioritize patient-centered care. Additionally, the government and relevant health departments should optimize medical policies, enhance fairness and accessibility, and create a positive social cognitive environment through public education and awareness campaigns.

BackgroundFew studies explored the association between high-sensitive cardiac troponin T (hs-cTnT) and long-term mortality for patients after surgery. This study was conducted to assess the association of hs-cTnT with long-term mortality and to investigate the extent to which this association is mediated via myocardial injury after noncardiac surgery (MINS). MethodsThis retrospective cohort study included all patients with hs-cTnT measurements who underwent non-cardiac surgery at Sichuan University West China Hospital. Data were collected from February 2018 and November 2020, with follow-up through February 2022. The primary outcome was all-cause mortality within 1 year. As secondary outcomes, MINS, length of hospital stay (LOS), and ICU admission were analyzed. ResultsThe cohort included 7,156 patients (4,299 [60.1%] men; 61.0 [49.0-71.0] years). Among 7,156 patients, there were 2,151 (30.05%) with elevated hs-cTnT(>14 ng/L). After more than 1 year of follow-up, more than 91.8% of mortality information was available. During one-year follow-up after surgery, there were 308 deaths (14.8%) with a preoperative hs-cTnT >14 ng/L, compared with 192 deaths (3.9%) with a preoperative hs-cTnT <=14 ng/L(adjusted hazard ratio [aHR] 1.93, 95% CI 1.58-2.36; p < 0.001). Elevated preoperative hs-cTnT was also associated with several other adverse outcomes (MINS: adjusted odds ratio [aOR] 3.01; 95% CI, 2.46-3.69; p < 0.001; LOS: aOR 1.48, 95%CI 1.34-1.641; p < 0.001; ICU admission: aOR 1.52, 95%CI 1.31-1.76; p < 0.001). MINS explained approximately 33.6% of the variance in mortality due to preoperative hs-cTnT levels. ConclusionPreoperative elevated hs-cTnT concentrations have a significant association with long-term mortality after noncardiac surgery, one-third of which may by accounted for by MINS.

Since the 1990s, the acceleration of population aging has led to an increased prevalence of chronic diseases and enhanced public health awareness. Numerous countries have proposed healthcare reforms, with a focus on creating an “integrated care” model that aims to improve the quality of medical services and reduce costs (1–2). In 2008, the World Health Organization (WHO) put forward the concept of Integrated Delivery Systems (IDS), advocating for continuous, timely and integrated medical services. In 2016, the WHO introduced the people-centered and integrated healthcare (PCIC) global health strategy model, which is highly compatible with the core concept of “shifting from disease treatment to overall health promotion” in the “Healthy China” strategy. Medical prevention fusion (MPF) represents the practical application of PCIC in China and serves as a significant goal for the country’s ongoing healthcare system reform. Furthermore, MPF is a crucial initiative for implementing the Healthy China Strategy. Following China’s reform and opening up, the economic system shift led to an increased focus on the market within public health. The public healthcare system experienced challenges while the orientation of public health work transitioned from “prevention” to “treatment”. This separation between prevention and medical treatment has made it difficult for China’s public healthcare system to address the increasingly complex public health issues and meet the rising health care demands of the general population (3). Consequently, the Chinese government has successively proposed strategies including medical prevention combination (MPCom), medical prevention integration (MPI), medical prevention collaboration (MPCol), and MPF. Analyzing the hotspots and trends in MPF may help clarify its conceptual connotations and related theoretical research. The data for this study were collected from three major Chinese databases: China National Knowledge Infrastructure (CNKI), Wanfang, and VIP. A comprehensive search was conducted using the keywords “MPCom,” “MPI,” “MPCol,” and “MPF” in order to identify relevant studies published between January 1, 2000, and December 31, 2022. Data from the three databases were imported into NoteExpress (version V3.7; Beijing, China), a literature management software, to ensure the completeness of relevant literature and remove duplicates. The final dataset was then exported from NoteExpress in Refworks-CiteSpace format to CiteSpace for formal data analysis. The detailed screening process is depicted in Figure 1. CiteSpace (version 6.1.R6; Drexel University, Philadelphia, PA, USA) is a tool utilized for examining current research hotspots and this analysis allows for a comprehensive understanding of the research directions within focal areas (4–5). In our study, we employed CiteSpace to analyze the co-occurrence and clustering of authors, institutions, and keywords, which we subsequently represented in the form of knowledge graphs. Within the network diagram, distinct nodes symbolize the analyzed elements. The size of these nodes reflects the number or frequency of publications (6). The connecting lines between nodes signify mutual relationships, including collaboration, co-occurrence, or co-citation (7). The number of studies published annually serves as an indicator of the activity within a specific research area (8). Supplementary Figure S1 (available in https://weekly.chinacdc.cn/) illustrates the temporal distribution of annual publications in the field of MPF. During these two decades, research on MPF can be divided into two distinct phases. Prior to 2016, fewer than twelve articles were published annually, suggesting that the field was in its nascent stage. However, following the WHO’s call for PCIC in 2016, China has progressively acknowledged the significance of MPF. Consequently, this phase has exhibited a consistent upward trend in the number of publications. The visual analysis map of the author collaboration network can be found in Supplementary Figure S2 (available in https://weekly.chinacdc.cn/). The map China CDC Weekly

医院重大疑难手术行政审批管理对于提升医疗质量、保障医疗安全、防范医患纠纷、促进医患和谐均具有重要意义.作者在解析重大疑难手术行政审批概念内涵的基础上,阐释医院开展重大疑难手术行政审批管理的必要性,然后从审批的管理对象→审批的基本流程→核查的关键信息→谈话的核心要点等方面阐释医院重大疑难手术行政审批管理的关键环节及要点.在此基础上提出实践启示,旨在为各类医院重大疑难手术行政审批管理工作及学术研究提供参考依据.

AbstractPurposePsychological well-beings of left-behind children (LBC) in rural areas of China remain under-studied. In this cross-sectional study, we aimed to explore the subjective well-being (SWB) in LBC and its associated factors in a rural area in eastern China.MethodsStratified random cluster sampling was used to select middle school and high school students in Qingyuan County of Zhejiang Province. Relevant information including sociodemographic characteristics was collected from each participant using an organized questionnaire. SWB was measured using the modified scale developed for Chinese adolescents. Univariable and multivariable regression analyses were performed using R version 3.3.0.ResultsA total of 1086 children were recruited and examined in the current analysis, with 365 (33.61%) being left-behind. Compared with non-left-behind children (NLBC), LBC had significantly lower scores in family satisfaction (P = 0.003) and environment satisfaction (P = 0.020). Multivariable regression analysis uncovered that frequent parent–child communication was associated with high positive affect (P = 0.003) and life satisfaction (P < 0.001), and the type of caregivers was associated with negative affect among LBC (P = 0.037).ConclusionsOur results suggest SWB was lower in LBC, and targeted interventions including strengthening parental-child communication should be developed and implemented to improve LBC’s SWB in rural areas of China.

Further healthcare system reform calls for desirable pathway design. This paper introduced the logical framework of the new healthcare system reform pathway design and typical practical experience in Hangzhou.Known for " Internet+Smart healthcare" forerunner, Hangzhou has pioneered the reform of public hospitals and the construction of smart handy service for the public.With the aim of fully protecting the health rights and interests of urban and rural residents, comprehensive policy has been taken to deepen the reform of public hospitals; with the comprehensive promotion of contracted services and the primary level sharing of resources as a carrier, we will build a hierarchical medical service system of vertical linkage.We will also innovate and practice the governing philosophy of " Medicine has its limitations but we have the courage to overcome, service is boundaryless and we must pursue excellence".Promotion of party building in the industry also ranks high.Deepening the reform of " one visit for all" in the field of medical and health services as a measure to enhance people′s sense of gain; The " public-private partnership" to encourage the development of the social governance system and legalization in healthcare proves successful at this stage. However, there are still many challenges in the information security maintenance of smart healthcare, the balance of stakeholder interests in public hospitals, the all-round advancement of hierarchical medical service, standardizing and streamlining the reform of " one visit for all".

Higher service efficiency and better medical experience are main goals of the healthcare system reform.The article explained the logical framework, main actions, initial results of the " one visit for all" reform, which aims at promoting the efficiency of medical services and management in Hangzhou.Policy suggestions are raised, namely involving more people into the governance mechanism, collaboratively optimizing the working process of medical staff, improving the information security mechanism, and perfecting the effectiveness evaluation system.These measures are designed to accelerate the construction of modern hospital management system, and to build a scientific and orderly hierarchical medical system.

Objective To further improve the comprehensive evaluation program of patient satisfaction in view of the defective item screening and weight design short of considerations for patients'psychological expectation and rational judgment, based on the theory of bounded rationality. Methods A satisfaction measurement scale was compiled and used to survey 847 inpatients in July-August 2017. The internal consistency test, correlation and factor analysis were used to evaluate the reliability and validity of the scale. The combination weight PWi was calculated based on patients' importance of the five satisfaction dimensions and the scoring of certainty degree of their responses. The combination weight EWi was calculated based on the five-dimension importance and operability scoring of expert consultation. The indicator combination weight OWi was determined using the integrated factors scoring, TOPSIS, weight rank-sun ratio, gray correlation method, and synthetic index method were used in a general assessment of patient satisfaction of a hospital in question. Results The Cronbach α coefficient of the patient satisfaction rating scale was 0.939, and the half-reliability coefficient was 0.951. The cumulative contribution rate of the five common factors variance extracted from the factor analysis was 71. 4%. The rational weights of five dimensions of service environment, service efficiency, service attitude, service technology, and service costs were 0.220, 0.214, 0.217, 0.179, and 0.171 respectively, while the comprehensive weights of the five dimensions were 0.115, 0.233, 0.196, 0.264, and 0.192 respectively. The comprehensive evaluation results of the two correlation coefficients were greater than 0.95. Conclusions The patient satisfaction measurement scale developed based on the theory of bounded rationality can expand the index connotation and items of core elements such as service technology and cost. The design of index weights fits with the concern of medical service factors and the degree of rational judgment in the patient's medical treatment process. The evaluation results are basically consistent with the actual situation and can be used as a reference tool for the scientific rational evaluation of patient satisfaction.

现代公共治理和社会参与理念催促政府及医疗机构越来越重视患者满意度与就医获得感,其是提升医疗机构服务质量与社会效益的重要考量指标.文章通过系统分析患者满意度概念阐释、评价指标构建、评价主体遴选、调查方式确立、统计方法选择、评价结果运用等内容及存在的主要问题,为科学制定患者满意度测评指南、建立区域性或全国评价标准、完善调查过程方案设计、改善调查结果表达方式、促进测评结果的合理利用等提供理论学术争鸣与展望.

Objective To build a social evaluation index system of public hospitals,for their social evaluation to be carried out timely and provide the theory basis for governance practices.Methods Comprehensive literature analysis method,focus group discussion and individual in-depth interviews were used to collect the initial index system.The Delphi method was used to screen the evaluation index system and to calculate the index weight.Results Based on the theory of public hospitals′social evaluation model,an index system was built comprising 3 level-1 indexes,10 level-2 indexes,and 32 level-3 indexes.Conclusions In view of social systems,establishment of an evaluation index system highlighting public hospitals′social responsibility is in line with the social collaborative governance strategy,which can help with exploration and enriching the social evaluation theory and practice of public hospitals.

目的:定量评价浙江省全民基本医疗保险受益与补偿及均等化水平,探讨其均等化问题及改进策略.方法:选取东部经济活跃和发达的浙江省为典型研究现场,采集2008-2012年该省6个不同经济类型市(县)所在统筹地区城乡基本医疗保险住院受益及补偿的数据资料,运用平均系数、差异系数、泰尔指数和基尼系数法,综合测评其均等化程度及趋势.结果:近5年来,各统筹地区间基本医保间、基本医保内及总体住院受益与补偿水平及均等化程度均呈现不断优化提高的发展态势,但实际住院补偿比及均次住院补偿费用尚未达到底线均等水平.2012年基本医保间均次住院补偿费用差异对总体差异的贡献率为84.999％.结论:实现全民享有均等化发展的实际补偿待遇应是当前城乡基本医保统筹发展的主要观测点.相比基本医保内各统筹地区间实际补偿待遇差异的逐年减小,基本医保的不均等实际待遇的差距仍然较大.建议该省深入探究全民基本医保筹资均等化现状及预测发展趋势,为其实际补偿待遇均等化提供基础性保障条件.

Objective To survey the cognitive attitude and participation intention for stakeholders of public hospitals,in order to provide basis for public hospitals social evaluation.Methods 621 stakeholders of public hospitals were subject to the questionnaire survey.Results 76.7%(475/619) stakeholders held it as necessary to independently launch the public hospitals social evaluation,and held that the evaluation subjects selection should be professional(83.8%),independent(67.7%),authoritative (55.6%),and proactive(46.1%).The survey also recommended that social evaluation of public hospitals should have such indexes as government investment (80.2%),social supervision (76.0%),and information disclosure system(7 1.1%).The overall willingness rate of stakeholders to participate in the public hospital social evaluation was 7 1.6%.Conclusions Development of the social evaluation index system of public hospitals and diversified evaluation subj ects are key to developing the theory and practice system of public hospitals social evaluation.

目的:定量评价浙江省城乡全民基本医疗保险筹资均等化程度及发展趋势.方法:采集2008-2012年浙江省6个不同经济类型市(县)所在统筹地区城乡全民基本医保险资水平等数据资料,运用差异系数、平均系数、泰尔指数和基尼系数综合测评其均等化程度及趋势.结果:近5年来,浙江全民基本医疗保险人均筹资水平均等化程度不断提高,其总泰尔指数由0.150下降到0.105,总基尼系数由0.435下降到0.381;2012年全民基本医疗保险的人均筹资水平和人均缴费占人均收入比例均未达到均等化底线标准,基本医保间人均筹资水平差异对总体差异的贡献率为75.238％;按照一定科学预设条件,预测到2020年该省全民基本医疗保险人均筹资水平可达到底线均等状态.结论:目前全民基本医疗保险在人均筹资水平上尽管存在较大差距,但其均等化发展态势强劲.建议该省应加强对省直管县财政体制,以及现行省级公共财政转移支付制度对全民基本医疗保险筹资均等化的促进效应实证分析,为进一步优化调整均等化的筹资结构及水平提供定量依据.

Objective To identify appropriate subjects for public hospitals social evaluation which fit and match the public hospital social evaluation index system.Methods The methods of literature review,expert consulting and comprehensive evaluation were used.SWOT analysis,appropriateness ranking and classification were made to such six evaluation subj ects as civil servants,medical workers, professional organizations,patients and their family,the public at large and mass media representatives. Results For the support dimension,the top three appropriate evaluation subj ects are professional social organizations,the public at large and medical workers in turn.For the process dimension,the top three subj ects are social professional organizations,civil servants and the public at large.For the result dimension,the top three are professional organizations,the public at large and civil servants.Conclusions Diversified evaluation subj ects independently represented and guided by non-government third-party professional organizations seem a better solution for China′s present specifics.Such a mechanism is authorized by the government,involving patients and their family,the public and social observers,and mass media representatives,supported and coordinated by government departments and public hospitals.

Social evaluation governance strategy was introduced to study the social management path for public hospitals.On the basis of definition of social governance and social evaluation theory, clarification of the concepts and relationship logic of public hospital′s social evaluation,and analysis of the context analysis of their social evaluation policy,the paper discussed the establishment of social evaluation and governance theory logic framework of public hospitals.In terms of such realization paths as the purposes,indexes,entities,and methods of the evaluation,as well as result release and application of the evaluation,recommendations were made.