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.

背景 全科医生是保障居民健康和控制医疗费用支出的"守门人",是社区卫生服务的主要实施者和提供者,在基本医疗卫生服务中发挥着重要作用,其数量和质量直接决定着我国卫生服务提供的质量和效果.目的 调查深圳市2008—2014年开展的全科医师规范化培训情况,总结其成功经验并发现存在的问题,为改进全科医师规范化培训制度提供依据.方法 于2018年7—8月,通过自行设计的问卷,对2008—2014年已经毕业的深圳市全科专业规范化培训医师638例进行回顾性调查,调查内容包括基本情况、影响参加培训的因素、对实际工作帮助程度、效果最好的培训方式、与未参加规范化培训医生相比的优势和机会、培训满意度和需要改进的方面.结果 共发放问卷638份,回收有效问卷523份,有效回收率为82.0％.深圳市开展的全科医师规范化培训人数逐年增加,由2008年的54人增长到2014年的131人.调查对象对培训总体情况满意人数所占比例为46.8％(245/523),其中全科医师培训的理论学习(52.0％,272/523)、理论课程师资水平(56.6％,296/523)、临床基地教学师资水平(52.0％,272/523)、社区实践教学(51.4％,269/523)、社区实践教学师资水平(51.2％,268/523)5项满意度超过50.0％.在工作岗位上较未参加规范化培训的全科医生,69.2％(362/523)、57.2％(299/523)、38.8％(203/523)的调查对象认为其优势主要在诊疗能力、学习能力、医患沟通能力等方面.全科医师规范化培训需要改进的方面排在前3位的分别为独立实践机会、带教师资的能力、整体轮转科室的安排.结论 深圳市经过规范化培训的全科医生数量和质量稳步上升,培训取得初步成效.优化集中理论培训课程内容,改进临床和社区实践培训方式,有针对性地加强师资能力培养、加大带教激励力度、加强考核结果反馈等有助于进一步提升全科医师规范化培训质量.

本研究在总结英国、美国、德国、澳大利亚等国家的家庭医生签约服务现状及其经验的基础上,结合我国在家庭医生签约过程中存在的问题,提出针对性的解决措施或建议.鉴于缺乏相关制度保障、财政支持不到位、家庭医生能力不足,未建立良好医患关系等问题,本研究指出应强化相关政策倾斜力度、增加相关经费投入、加强家庭医生队伍建设、建立良好医患关系等,探索适合中国特色的家庭医生签约服务模式.

Background: Whether there is a difference in perceived social support (PSS) and related factors among college students from oneand multiple-child families was unclear. Methods: We conducted a population-based, cross-sectional study between October 2017 and February 2018, randomly selected college students with siblings (n=5875; aged 19.41 +/- 1.99 years) and their counterparts without siblings (n=5175; aged 19.88 +/- 2.38 years), and then conducted an online questionnaire survey via a multi-stage cluster random sampling method. We applied the multidimensional scale of perceived social support (MSPSS) to evaluate PSS among college students. The multivariable logistic regression models were used to predict factors associated with low perceived social support in two student groups. Results: Our study found that there was a statistical difference of PSS between the sibling groups. Sex, singleparent family, irregular daily routine, prevalence of diseases or injuries and psychological distress were significantly associated with low PSS in both college students with and without siblings. Compared with singlechild college students, single-parent family structure was associated with a higher odds ratio for low PSS in college students with siblings (ratio of odds ratio: 0.71, 95% confidential interval: 0.53-0.97). Limitations: Our study was a cross-sectional study design, and all participants in current study were from Wuhan city, Hubei Province. Hence, the sample is not representative of other regions in China. Conclusions: Although a statistical difference of PSS between the sibling groups was found in our study, singleparent family structure was more strongly associated with low PSS in multiple-child students compared with single-child students.

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.