Background High occupational burnout among general practitioners (GPs) is an important challenge to China’s efforts to strengthen its primary healthcare delivery; however, data to help understand this issue are unavailable. This study aimed to investigate the prevalence of burnout and associated factors among GPs. Methods A cross-sectional design was used to collect data from December 12, 2014, to March 10, 2015, with a self-administered structured questionnaire from 1015 GPs (response rate, 85.6%) in Hubei Province, Central China. Burnout was measured using a 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS). MBI-HSS scores and frequency were analyzed by the three dimensions of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Factors associated with burnout among GPs were estimated using a multiple linear regression model. Results Of the respondents, 2.46% had a high level of burnout in all three dimensions, 24.83% reported high levels of EE, 6.21% scored high on DP, and 33.99% were at high risk of PA. GPs who were unmarried, had lower levels of job satisfaction, and had been exposed to workplace violence experienced higher levels of burnout. Intriguingly, no statistically significant associations were found between burnout and the duration of GP practice, age, sex, income, practice setting, and professional level. Conclusion This is the first study of occupational burnout in Chinese general practice. Burnout is prevalent among GPs in Hubei, China. Interventions aimed at increasing job satisfaction, improving doctor-patient relationships and providing safer workplace environments may be promising strategies to reduce burnout among GPs in Hubei, China.

Objectives: Investigation is scare on job satisfaction among general practitioners (GPs) in China. This study aimed to investigate job satisfaction of GPs in China and explore its determinants. Methods: A multistage-stratified random sampling method was used to collect data with a structured self-administered questionnaire from 3236 GPs (response rate, 99.8%) working in community health institutions in China between October 2017 and February 2018. Multiple linear stepwise regression analysis was used to analyze the associated factors with job satisfaction among GPs. Results: Among these respondents, 1215 (37.5%), 352 (10.9%), and 1669 (51.6%) GPs were dissatisfied, moderate, and satisfied for their current job, respectively. Male GPs, a higher education level, at a higher professional title, at a lower level of income, and those with heavy work stress had a lower job satisfaction. In addition, GPs who often worked overtime, who were at a higher level of emotional exhaustion, at a higher level of depersonalization, at a lower level of personal accomplishment, and who had less occupational development opportunities reported a lower level of job satisfaction. Conclusion: These findings suggest that job satisfaction among Chinese GPs is at a moderate level. Region, sex, professional title, education level, working overtime, income level, emotional exhaustion, depersonalization, personal accomplishment, work stress, and occupational development opportunities were significant predictors of job satisfaction.

目的:比较东中西部全科医生的职业倦怠现状,分析其主要影响因素,为促进全科医生心身心健康提供参考.方法:采用分层随机抽样方法,对我国东中西部社区卫生服务机构的全科医生进行问卷调查,并进行方差和多元逐步回归分析.结果:全科医生情绪耗竭为(24.80±13.17)分,去人格化为(5.76±6.36)分,个人成就感为(34.44±10.05)分,不同地区的差异有统计学意义(P<0.001).年龄、文化程度、职称、收入水平、是否加班、职业发展机会和工作压力影响情绪耗竭;年龄、工作年限、性别、收入水平、行政职务和工作压力是影响去人格化的主要因素;年龄、婚姻状况、收入水平、是否加班和职业发展机会影响个人成就感.结论:我国全科医生的职业倦怠发生率较高,不同地区存在显著性差异.应加大投入,稳定全科医生队伍,提高全科医生的工作积极性,降低职业倦怠.

Background Studies on professional identity and related factors among Chinese general practitioners (GPs) are unavailable. The objective of this study was to investigate the professional identity level of GPs in China and explore factors associated with GPs' perceptions of their professional identity. Methods A multistage stratified random sampling method was used to collect data with a structured self-administered questionnaire from 3236 GPs working in community health service institutions (CHIs) in China between October, 2017 and February, 2018. Professional identity was measured by the 13 items scale. Descriptive statistics were calculated and groups' differences were estimated using nonparametric tests. Multiple linear stepwise regression analysis was used to analyze factors associated with professional identity among GPs. Results Based on a total score of 65 on the professional identity scale, the average score for GPs' professional identity was 51.23 (SD = 6.56). Multiple linear stepwise regression analysis showed that GPs who practiced in Central China, with an administrative responsibility, at a moderate or higher income level, who frequently worked overtime, had more occupational development opportunities, with a higher level of job satisfaction and older GPs had higher levels of professional identity. Conclusions Professional identity level among GPs in China is high. Region, administrative responsibility, income level, working overtime, occupational development opportunities, age, and job satisfaction were significant predictors of professional identity.

目的 探讨不同性别脑卒中患病率差异及其相关影响因素,为脑卒中的防控提供参考.方法 2013年3月至2015年4月采用整群抽样的方法选取深圳市3个社区筛查点≥40岁常住居民12 908例,结合问卷调查、体格检查和实验室检查等方法进行筛查,利用x2检验、Fisher精确概率法和logistic回归分析探讨脑卒中患病率性别差异及其主要影响因素.结果 12 908例社区居民,脑卒中粗患病率4.06％,脑卒中标化患病率3.70％,男性脑卒中的标化患病率(4.79％)高于女性(2.76％).在男性人群中,年龄越大(OR=1.65,95％CI:1.46～ 1.88);非在婚(OR=2.58 95％CI:1.57～4.24);无医疗保险(OR=1.61,95％CI:1.02～2.17);有卒中家族史(OR=2.84,95％CI:1.94～ 4.14);吸烟情况(现在吸烟:OR=1.58,95％CI:1.17～2.15;戒烟:OR=2.57,95％CI:1.74～3.79);饮酒频率(偶尔:OR=0.58,95％CI:0.40～0.85;经常:OR=0.58,95％CI,0.34～0.96);水果摄入不足(OR=1.69,95％CI:1.30～ 2.19);奶类和奶制品摄入不足(OR=1.43,95％CI:1.09～1.87);口味偏咸(OR=2.73,95％CI:2.09～ 3.55);患有高HCY血症(OR=1.82,95％CI:1.39～2.39)是影响脑卒中患病的主要因素.在女性人群中,年龄越大(OR=1.42,95％CI:1.19～1.68);文化程度(小学及以下:OR=2.12,95％CI:1.18～～ 3.79;高中:OR=1.94,95％CI:1.04～3.64);有卒中家族史(OR=3.07,95％CI..2.03～4.66);缺乏体育锻炼(OR=1.73,95％CI:1.21～2.49);水果摄入不足(OR=1.86,95％CI:1.35～2.55);口味偏咸(OR=1.87,95％CI:1.33～ 2.63);患有高血压(OR=1.40,95％CI:1.01～1.95);患有高HCY血症(OR=1.59,95％CI:1.15～ 2.20)是脑卒中患病的主要因素.结论 深圳市社区居民脑卒中患病率仍较高,不同性别之间的脑卒中患病影响因素差异较大,应针对不同性别的人群特征制定干预措施,以有效地开展脑卒中的防控工作.

目的 了解我国全科医生离职意愿现状,分析影响全科医生离职意愿的主要因素.方法 于2017年10月-2018年2月,运用分层随机抽样方法在我国东、中、西部每个调查地区的社区卫生服务中心(东部:北京市、上海市、广东省和浙江省;中部:湖北省、黑龙江省、河南省和安徽省;西部:四川省、贵州省、云南省和内蒙古自治区)随机抽取3 244名全科医生进行微信问卷调查.采用自行设计的《全科医生职业吸引力调查表》进行调查,问卷内容包括全科医生的基本情况、工作满意度、职业倦怠和离职意愿情况4个部分,离职意愿调查量表参照Mi-chael和Spector编制的医护人员离职意愿量表翻译修订.运用x2检验比较全科医生离职意愿在不同组间的分布差异,采用多因素logistic逐步回归分析全科医生离职意愿的影响因素.结果 调查结果显示,35.20％的全科医生离职意愿较高,其中东部33.69％、中部39.24％、西部33.20％.多因素logistic逐步回归分析结果显示,男性、中部地区、年龄小、学历高、合同制、物质满意度低、成长满意度低、情绪耗竭严重、去人格化程度高是离职意愿高的主要影响因素.结论 我国全科医生的离职意愿较高,影响全科医生离职意愿的因素复杂,建议拓展全科医生职业发展前景,提高全科医生薪酬待遇,增加全科医生岗位吸引力,重视全科医生职业心理健康,以降低全科医生的离职意愿.

目的 了解我国慢性病流行趋势,探讨影响慢性病患病的主要危险因素,并针对性提出预防慢性病的管理策略和措施,为我国慢性病的防控提供参考依据.方法 基于《2015中国卫生和计划生育统计年鉴》数据结果,采用SPSS 17.0统计学软件分析我国慢性病的变化趋势;利用Venple 5.1软件,从系统工程角度出发,借助彼得·圣吉的系统基模分析构建慢性病主要危险因素的相关基模,系统分析其因果结构,并提出相应的管理对策及建议.结果 数据显示,2013年我国慢性病患病率高达33.1％,比2003年(15.1％)高于18个百分点;从居民疾病别两周患病率数据中可以发现,高血压(2013年患病率为9.89％,2003年为1.19％)、糖尿病(2013年患病率为2.65％,2003年为0.22％)患病率增加是导致慢性病患病率增长较快的主要原因之一.慢性病已成为我国城乡居民主要死亡原因.环境、生活及行为因素、人口老龄化和遗传因素均是慢性病的主要影响因素.结论 我国慢性病患病率呈明显上升,且呈现年轻化趋势,给我国社会经济发展带来挑战.利用系统基模方法分析慢性病的危险因素,能够体现系统反馈结构和行为的动态性与整体性,这既是方法学研究的进一步拓展,也是基模分析方法在慢性病领域中的具体应用.建议加大政府的政策和资金支持,加强社区的健康教育与健康促进,促进对不良生活行为方式的健康管理工作等.

脑卒中已成为威胁全球居民生命健康的重大疾病,是我国亟需解决的重大公共卫生问题.高死亡率、高致残率、高复发率的疾病特点不仅严重影响居民的生命健康和生活质量,也给家庭和社会造成极大的经济负担.脑卒中是多种因素长期综合作用引起的疾病,分析脑卒中的流行趋势,明确脑卒中危险因素,进行积极有效的一级预防,是降低脑卒中发病的重要措施之一.本文针对国内外脑卒中的最新流行趋势和影响因素研究进展进行了综述,为全面了解脑卒中的流行情况、深入研究脑卒中相关的影响因素,为针对性地开展脑卒中早期干预提供参考依据.

We aim to quantitatively synthesise available epidemiological evidence on the prevalence rates of workplace violence (WPV) by patients and visitors against healthcare workers. We systematically searched PubMed, Embase and Web of Science from their inception to October 2018, as well as the reference lists of all included studies. Two authors independently assessed studies for inclusion. Data were double-extracted and discrepancies were resolved by discussion. The overall percentage of healthcare worker encounters resulting in the experience of WPV was estimated using random-effects meta-analysis. The heterogeneity was assessed using the I2 statistic. Differences by study-level characteristics were estimated using subgroup analysis and meta-regression. We included 253 eligible studies (with a total of 331 544 participants). Of these participants, 61.9% (95% CI 56.1% to 67.6%) reported exposure to any form of WPV, 42.5% (95% CI 38.9% to 46.0%) reported exposure to non-physical violence, and 24.4% (95% CI 22.4% to 26.4%) reported experiencing physical violence in the past year. Verbal abuse (57.6%; 95% CI 51.8% to 63.4%) was the most common form of non-physical violence, followed by threats (33.2%; 95% CI 27.5% to 38.9%) and sexual harassment (12.4%; 95% CI 10.6% to 14.2%). The proportion of WPV exposure differed greatly across countries, study location, practice settings, work schedules and occupation. In this systematic review, the prevalence of WPV against healthcare workers is high, especially in Asian and North American countries, psychiatric and emergency department settings, and among nurses and physicians. There is a need for governments, policymakers and health institutions to take actions to address WPV towards healthcare professionals globally.

护理人员是医疗卫生工作的重要组成部分,直接关系到医疗质量和病人生命安危,是医疗安全的基础.频发的涉医暴力事件不仅危害护理人员生命安全,对其心理健康产生不良影响,也严重影响了医疗安全.国内外研究提示,超过一半的护理人员遭受过工作场所暴力,其中最常见的工作场所暴力类型为言语暴力,其次为身体暴力和性骚扰.医疗卫生法律法规不健全、涉医暴力事件处置不完善、护患沟通不畅和患者就医体验差是导致工作场所暴力事件的主要因素.建议完善医疗工作者工作场所暴力预防指南,建立健全医疗场所工作暴力处理规范;提高护理人员对工作场所暴力事件的预见与应急处理能力;加强与患者之间的有效沟通,改善患者就诊体验,从而有效减少涉医暴力事件的发生.

背景目前我国全科医生面临着工作压力较大、社会认可度不高、薪酬激励机制有待完善等问题,容易产生职业倦怠,分析其职业倦怠的影响因素,可以为稳定全科医生队伍、提升基层医疗卫生服务质量和水平提供依据.目的 探讨我国全科医生的职业倦怠状况及影响因素.方法 于2017年10月—2018年2月,采用多阶段分层随机抽样法在我国东、中、西部抽取社区卫生服务机构工作年限≥1年的全科医生3244例进行问卷调查,内容包括全科医生的基本情况、职业倦怠状况,其中职业倦怠调查量表参照马斯勒倦怠量表-服务行业版(MBI-HSS)翻译修订而来,包括情感耗竭、去人格化、个人成就感降低3个维度.采用二分类Logistic逐步回归分析全科医生各维度倦怠程度的影响因素.结果3236例(99.75％)全科医生的问卷被有效回收.在情感耗竭、去人格化、个人成就感降低维度,处于高度倦怠的全科医生占比分别为43.17％(1397/3236)、22.93％(742/3236)、41.19％(1333/3236).二分类Logistic逐步回归分析结果显示,地区、文化程度、每日工作时间、加班情况是全科医生情感耗竭维度是否发生高度倦怠的影响因素(P<0.05);地区、性别、从事全科医生工作年限、收入水平是全科医生去人格化维度是否发生高度倦怠的影响因素(P<0.05);地区、年龄、每日工作时间是全科医生个人成就感降低维度是否发生高度倦怠的影响因素(P<0.05).结论 我国全科医生的职业倦怠较为严重,尤其是情感耗竭、个人成就感降低维度.影响全科医生职业倦怠的因素较多,建议优化全科医生工作时间、减少全科医生工作强度、提高全科医生薪酬待遇、重视全科医生的职业发展,从而缓解全科医生职业倦怠.

全科医生作为全科医学理论的践行者和全科医疗服务的提供者,其数量和质量直接决定着基层医疗卫生服务体系的服务质量和水平.了解全科医生职业吸引力的研究进展,探索影响全科医生职业吸引力的主要因素,对于稳定全科医生队伍建设、加强基层医疗卫生机构服务能力至关重要.本文将从全科医生职业吸引力的逆向角度出发,分别从工作满意度、职业倦怠、离职意愿及职业意愿等方面分析国内外全科医生职业吸引力的研究现状,以期为相关政府部门有针对性制定提升全科医生职业吸引力的顶层设计提供决策依据.

目的 比较分析东中西部全科医生的工作满意度现状及影响因素.方法 采用分层随机抽样方法抽取3 244名社区卫生服务机构全科医生对其进行匿名问卷调查.结果 共纳入3 236例全科医生,其工作满意度平均得分为(34.12±6.56)分,其中东部(34.14±6.17)分、中部(33.99±6.89)分、西部(34.21±6.70)分.地区(中部:β=-0.795;西部:β=-0.600)、性别(女:β=0.509)、文化程度(本科:β=-0.897;硕士及以上:β=-1.549)、职称(中级:β=-0.704;高级:β=-0.804)、收入水平(中等:β=2.425;中等以上:β=2.708)、任职方式(合同工:β=0.532)、是否加班(经常:β=-1.142)、职业发展机会(一般:β=3.821;多:β=7.711)、工作压力(中:β=-0.795;高:β=-1.727)、情绪耗竭(β=-0.110)、去人格化(β=-0.076)和个人成就感受损(β=0.064)是影响全科医生工作满意度的主要因素,不同地区的影响因素不同.结论 我国全科医生工作满意度处于中等水平,不同地区差异显著.建议针对不同地区特点,制定相应措施,以提高全科医生的工作满意度,稳定全科医生队伍建设.

Studies on turnover intention among Chinese general practitioners (GPs) at the national level are limited. This study aimed to assess intention to leave and its associated factors among a nationally representative sample of GPs. The participants were selected using a multistage stratified random sampling method. A self-administered structured questionnaire was used to collect data from 3236 GPs in China between October 2017 and February 2018. A multiple linear stepwise regression analysis was used to identify factors associated with turnover intention. Over 70.0% GPs had a moderate or high turnover intention. GPs who were male, were younger, had a higher education level, had a lower professional title, had a lower income level, and had a temporal work contract had higher turnover intention. In addition, GPs who worked night shifts, had low job satisfaction, and had few opportunities for professional development reported higher turnover intention. Substantial gender and regional differences in predictors of turnover intention among GPs were observed. The study showed that turnover intention in Chinese GPs is high, and the factors influencing turnover intention were low professional title and income level, high education level, having a temporary work contract, working night shifts, and limited opportunities for professional development.

目的 探讨深圳市中老年人群脑卒中的患病率及其相关因素,为脑卒中的防控研究提供依据. 方法 于2013年3月-2015年4月,采用整群抽样的方法选取深圳市3个社区筛查点12 908例40岁及以上常住居民为研究对象,结合问卷调查、体格检查和实验室检查等方法进行筛查,利用logistic逐步回归分析探讨脑卒中患病率主要相关因素. 结果 深圳市中老年人群脑卒中粗患病率为4.06％,男性脑卒中的患病率(5.46％)高于女性(2.89％)(x2=48.79,P＜0.001).年龄(50岁组:OR=1.72,95％CI:1.23～2.40;60岁组:OR=2.23,95％CI:1.60～3.09;70岁组:OR=3.93,,95％CI:2.81～5.48)、男性(OR=1.74,95％ CI:1.38～2.18)、非在婚(OR=1.90,95％ CI:1.27～2.84)、无医疗保险(OR=1.51,95％CI:1.21～1,88)、有卒中家族史(OR=2.92,95％ CI:2.21～3.86)、饮酒频率(偶尔:OR=0.55,95％ CI:0.39～0.79;经常:OR=0.55,95％CI:0.33～0.91)、吸烟(现在吸烟:OR=1.59,95％CI:1.19～2.14;戒烟:OR=2.53,95％CI:1.74～3.70)、口味偏咸(OR=2.41,95％CI:1.96～2.96)、水果摄入不足(OR=1.75,95％CI:1.44～2.14)、奶类及奶制品摄入不足(OR=1.28,95％CI:1.04～1,58)、缺乏体力活动(OR=1.32,95％CI:1.04～1,58)、高血压(OR=1.31,95％CI:1.07～1,61)及高同型半氨酸血症(OR=1.69,95％CI:1.37～2.04)与中老年人脑卒中患病密切相关. 结论 深圳市中老年人群脑卒中患病率较高.影响中老年人脑卒中患病的因素较多,建议针对不同人群特征制定干预措施,以有效地开展脑卒中的防控工作.

The relationship between long working hours and body weight outcomes remains inconclusive; thus, we conducted a meta-analysis to assess the effect of long working hours on weight-related outcomes. PubMed and Embase databases were searched from their inception to June 2019. A random-effects model was used to assess the pooled odds ratio (OR) and corresponding confidence interval (CI). Subgroup analyses and sensitivity analyses were conducted to explore sources of heterogeneity. Publication bias was evaluated by the Begg's and Egger's tests. A total of 29 articles involving 374 863 participants were included. The pooled OR of long working hours on weight-related outcomes was 1.13 (95% CI, 1.07-1.19). In subgroup analysis stratified by definition of outcomes, the pooled ORs of long working hours on "weight gain/BMI increase," "BMI ≥ 25 kg/m2 ," and "BMI ≥ 30 kg/m2 " were 1.19 (95% CI, 1.02-1.40), 1.07 (95% CI, 1.00-1.14), and 1.23 (95% CI, 1.09-1.39), respectively. We found evidence of publication bias, but correction for this bias using the trim-and-fill method did not alter the combined OR substantially. There was evidence to suggest that long working hours are associated with adverse weight-related outcomes. Preventative interventions such as improved flexibility and healthy working schedules should be established for employees.

Objective To investigate residents' health-related quality of life in Zhuhai based on the EQ-5D and analyze the influencing factors of health-related quality of life in order to provide a reference for relevant departments to formulate health policies and interventional measurements. Methods Using the multi-stage random sampling method, a total of 3 380 residents who were more than 15 years old were selected from Xiangzhou district, Doumen district and Jinwan district in Zhuhai from March to May in 2015 and a self-designed questionnaire was used. The main contents of the questionnaire were residents' basic information, lifestyles, and EQ-5D scores. Multiple linear regression analysis was used to analyze the influencing factors of the total score of EQ-5D . Results A total of 1 528 households were investigated and 3 380 questionnaires were given out. In addition, 3 175 questionnaires were collected with a response rate of 93.9%. The total score of EQ-5D of residents in Zhuhai was (9.8±0.8). Multiple linear regression analysis revealed that age, educational level, per capita monthly income, and physical activities were influencing factors of total score of EQ-5D (P<0.05). Conclusion Residents in Zhuhai have a relatively good health-related quality of life. Corresponding health guidance and measurements should be taken to improve the health-related quality of life among the elderly and individuals with low educational level, low income and less physical activities.

OBJECTIVES:To assess the prevalence and factors associated with physical and nonphysical violence in a sample of general practitioners (GPs).METHODS:We used a cross-sectional design to collect data from December 2014 to March 2015 with a structured self-administered questionnaire from 1015 GPs in Hubei Province, Central China (response rate, 85.6%). We used a multivariable logistic regression model to identify the predictors associated with workplace violence toward GPs.RESULTS:Of the respondents, 62.2% of respondents reported exposure to workplace violence in the preceding year, including 18.9% and 61.4% who encountered physical and nonphysical violence, respectively. Multivariable logistic regression analysis suggested that GPs who were male, at a higher professional level, and who had a lower average monthly income were more likely to experience physical violence. Male GPs, less-experienced GPs, and those with administrative responsibility were more likely than their counterparts to encounter nonphysical violence.CONCLUSIONS:This study shows that the prevalence of workplace violence against GPs is high in Hubei, China. Creating a prevention strategy and providing safer workplace environments for GPs should be urgently prioritized.

The effect of maternal smoking during pregnancy on strabismus in offspring remains unclear. We conducted a meta-analysis to summarize epidemiological evidences on the association between maternal smoking during pregnancy and the risk of offspring strabismus. Eligible studies were searched from the PubMed, Ovid, Embase and CNKI databases up to May 2018. The qualities of included articles were assessed with the Newcastle-Ottawa Scale and the assessment scale recommended by the Agency for Healthcare Research and Quality. Odds ratios (ORs) corresponding with its 95% confidence intervals (CIs) were pooled to estimate the effects of maternal cigarette smoking on the risk of offspring strabismus. Subgroup analyses and meta-regression were performed to explore the potential sources of heterogeneity. The Begg's test and Egger's test were used to assess the publication bias. Eleven articles involving 4,833 patients with strabismus were included. The pooled OR showed that maternal smoking during pregnancy was significantly associated with strabismus in offspring (OR = 1.46, 95% CI = 1.32-1.60). Compared with less than 10 cigarettes per day (OR = 1.17, 95% CI = 1.06-1.29), maternal smoking 10 cigarettes or more per day during pregnancy significantly increased the risk of offspring strabismus (OR = 1.79, 95% CI = 1.39-2.31). The risk of developing esotropia and exotropia for smoking pregnant women, respectively, increased by 65% (OR = 1.65, 95% CI = 1.31-2.09 and OR = 1.65, 95% CI = 1.24-2.19) than those who did not smoke during pregnancy. Additionally, the increased risk of maternity smoking associated with offspring strabismus was stable across all subgroup analyses. Overall, maternal smoking during pregnancy was associated with a significantly increased risk of offspring strabismus and the result was persistent in subgroup analyses, suggesting the importance in changing smoking habit or smoking cessation for women who are pregnant or preparing to.