BACKGROUND: An increasing amount of research has supported the positive role of repetitive transcranial magnetic stimulation(rTMS) in improving functional impairments in Parkinson's patients. PURPOSE: To explore the effectiveness of using rTMS n and Balance Apparatus training to improve the balance function of Parkinson's patients. METHODS: Patients were divided into 3 groups of 20 patients in each. All patients received routine rehabilitation training. The rTMS group received low-frequency rTMS therapy, while the balance apparatus group incorporated balance apparatus exercises. The observation group received both interventions. The three groups of patients were assessed at baseline and after 8 weeks of treatment using the Unified Parkinson's Disease Rating Scale (UPDRS) motor section, Berg balance scale (BBS), Time up and go test (TUGT), and Activities-Specific Balance Confidence (ABC) scales. Additionally, all participants were tested for movement ellipse area, and Average Trace Error (ATE) using the balance apparatus. RESULTS: The observation group achieved better treatment results. The UPDRS score was better than that of the balance apparatus group after treatment, and the ABC score was superior to other two group. Moreover, the observation group outperformed the other two group in terms of motion length, and open-eye elliptical area, with statistical significance. CONCLUSION: The combined application of TMS and Balance Apparatus training effectively improves enhances balance function, and boosts self-confidence in balance perception among Parkinson's patients.

OBJECTIVE:To evaluate the effectiveness of combining intermittent catheterization with acupuncture in treating urinary retention following spinal cord injury (SCI). METHODS:Sixty-six patients were randomly assigned to either an observation group or a control group, with 33 patients in each. All underwent personalized intermittent catheterization guided by a bladder capacity scanner. The observation group received acupuncture in conjunction with catheterization, while the control group had acupuncture performed separately. Both groups were treated for 8 weeks. Daily records of catheterization frequency, volume, and spontaneous urination were maintained. Measurements, including maximum bladder capacity, detrusor pressure, residual urine volume, and quality of life scores, were taken at baseline and after 8 weeks. RESULTS:The observation group exhibited greater improvements in catheterization reduction, spontaneous urination, detrusor pressure, residual urine volume, and quality of life compared to the control group (P < 0.05). The median time to stop catheterization was shorter in the observation group (26, 17.68-34.31 days) compared to the control group (38, 32.54-43.45 days), with a significant difference (P = 0.045). CONCLUSION:Combining intermittent catheterization with acupuncture effectively improves bladder function, reduces catheterization frequency, enhances urination, and promotes better bladder storage and voiding functions in SCI patients.

ObjectivesHigh turnover intention can exacerbate the workforce shortage of nurses. This study aimed to determine the level of turnover intention of public hospital nurses in China and its associated factors.MethodsA cross-sectional questionnaire survey of 2,863 nurses was conducted in 48 public hospitals across six provinces in mainland China, measuring the sociodemographic (gender, age, marital status, and monthly basic salary) and work characteristics (professional title, workload, night sleep deprivation, and workplace violence) of respondents, their quality of working life (QWL), and turnover intention. Multivariate logistic regression models were established to determine the association between QWL and turnover intention after adjustment for variations of the sociodemographic and work characteristics.ResultsOverall, 42.8% of respondents reported turnover intention. Higher QWL scores (AOR = 0.824 for job and career satisfaction, p < 0.001; AOR = 0.894 for professional pride, p < 0.001; AOR = 0.911 for balance between work and family, p < 0.05) were associated with lower turnover intention. Workplace violence was the strongest predictor of higher turnover intention (AOR = 3.003–4.767) amongst the sociodemographic and work characteristics, followed by an age between 30 and 40 years (AOR = 1.457 relative to <30 years), and night sleep deprivation (AOR = 1.391–1.808). Senior professional title had a protective effect (AOR = 0.417 relative to no title) on turnover intention.ConclusionHigh levels of turnover intention are evident across China in nurses employed by public hospitals, in particular in those aged between 30 and 40 years. Low QWL and poor work environment are significant predictors of turnover intention.

社区联防联控机制作为我国基层社区应对突发公共卫生事件的重要治理模式,在突发公共卫生事件应急管理中发挥了重要的作用.但是,我国现行立法中关于社区联防联控机制的相关规定却付之阙如,社区联防联控机制尚处于实践先行、理论与制度滞后的阶段,导致该机制停留于话语层次缺乏制度化的建构,基层社区在突发公共卫生事件应急管理中出现诸多问题.虽然党和政府具有强大的纠偏能力,但从长远看,在全面推进依法治国的背景下,建立和完善突发公共卫生事件社区联防联控机制,走向法治化道路是必然选择.探索突发公共卫生事件社区联防联控机制法治化路径需要以立法形式确立该机制的法律地位、功能与体系架构、明确各参与主体在突发公共卫生事件社区联防联控中的职责权限,同时建立与完善相关法律保障机制,以更好回应基层社区在突发公共卫生事件中法治化参与的需求.

Community health service centers (CHSC) are the first line of defense for national health. In the post-epidemic era, CHSC need to effectively play the role of the grassroots "outpost." In addition to daily medical and public health work, they should also strengthen joint prevention and control to consolidate the achievements of epidemic prevention and control. Under the new situation, the demand for talent in CHSC has also changed, and the construction of its talent team faces many challenges. This article collects relevant materials and data to analyze the changes in the work content of health personnel in CHSC in the post-epidemic era, and analyzes the changes in talent demand and key problems under the new situation, providing strategies to strengthen the construction of talent teams in CHSC in the new era. Key problems in CHSC in the post-epidemic era include unreasonable structure of health personnel, insufficient allocation of health personnel, unclear rights and responsibilities, and rigid talent training models. To improve the professional level and governance ability of health personnel in CHSC, optimize the working environment of health personnel, and address the issue of scarce positions, strategies are proposed such as relaxing recruitment conditions for scarce positions, encouraging the establishment of traditional Chinese medicine clinics, fully leveraging social collaborative forces, promoting diversified training for the capacity building of grassroots health personnel, and establishing new talent development platforms.

ObjectivesIn China, it is up to the patients to choose between hospitals and primary care facilities to initiate their medical care. This study aimed to determine the association between patient experience with community health centres (CHCs, a predominant provider of community-based primary care) and patient preference of taking community-based primary care facilities as a first choice for medical attention. MethodsA questionnaire survey was conducted on 1919 patients who sought medical care in 55 CHCs in Wuhan, China. Respondents were asked to identify their preferred first choice for medical attention and rate their satisfaction with eight aspects of CHCs (basic facility, medical equipment, medical services, nursing services, treatment process, courtesy and responsiveness, time spent with medical doctor, pharmacy services). Multivariate logistic regression models were established to determine the association between the CHC experience and the first choice of providers after adjustment for variations in sociodemographic characteristics. ResultsOver 90% of respondents were satisfied or very satisfied with the eight aspects of CHCs; but only 75% preferred to take community-based primary care facilities as their first choice for medical attention. Those who were older and had a lower income were more likely to choose community-based primary care facilities. Geographic proximity and higher levels of satisfaction with the basic facility, courtesy and responsiveness, and pharmacy services in the CHCs were associated with a higher likelihood of taking community-based primary care facilities as a first choice for medical attention. ConclusionThe consumers of CHCs are generally satisfied with the services they received. However, one quarter of the CHC patients are yet to be convinced to accept community-based primary care facilities as a preferred first provider for medical care. Geographic proximity and patient experience with CHCs are associated with the patient choice.

Objectives To assess the quality of working life (QWL) of medical doctors and associated risk factors.Setting and participants A cross-sectional questionnaire survey of 2915 medical doctors from 48 hospitals was conducted in China.Methods The QWL-7–32 scale was adopted to assess seven domains of QWL: physical health, mental health, job and career satisfaction, work passion and initiative, professional pride, professional competence, and balance between work and family.Primary and secondary outcome measures Data were analysed using SPSS V.19.0. Analysis of variance tests and multivariate linear regression analyses were performed to identify the sociodemographic characteristics and job factors associated with overall QWL and its seven subdomain scores.Results On average, the respondents reported an overall QWL score of 92.51 (SD=17.74) of a possible 160. Over 35% of respondents reported more than 60 hours of weekly working time; 59.9% experienced night sleep deprivation frequently; 16.6% encountered workplace violence frequently. The multivariate regression models revealed that the eastern region (β≤−2.887 for non-eastern regions, p<0.001), shorter working hours (β≤−2.638 for over 40 hours a week, p<0.01), less frequent night sleep deprivation (β≤−5.366 for sometimes or frequent, p<0.001), higher income (β≥2.795 for lower income, p<0.001) and less frequent encounters of workplace violence (β≤−9.267 for sometimes or frequent, p<0.001) were significant predictors of higher QWL. Night sleep deprivation and workplace violence were common predictors (p<0.05) for all seven domains of QWL.Conclusion The low QWL of medical doctors working in public hospitals in China is evident, which is associated with high workloads, low rewards and workplace violence. There are also significant regional differences in the QWL of medical doctors, with the eastern developed region featuring better QWL. Public hospitals in China are facing serious challenges in occupational health and safety, which needs to be addressed through a systems approach.

目的:观察联合运用体外冲击波和局部类固醇注射治疗腕管综合征的远期疗效.方法:将腕管综合征患者按随机数字表法分为联合组、冲击波组和注射组3组,每组20例.其中冲击波组1例脱落,共19例完成研究,注射组3例脱落,共17例完成研究.所有患者均接受常规治疗,冲击波组在常规康复治疗的基础上采用体外冲击波治疗,注射组在常规康复治疗的基础上采取类固醇药物的局部注射,联合组患者联合采用体外冲击波和局部类固醇注射治疗.3组患者均治疗满4周.分别于治疗前、治疗4周后、治疗8周后进行VAS评定和波士顿腕管综合征评分量表(BCTQ)症状及功能评定,应用肌电图进行患侧正中神经诱发电位测定.结果:治疗4周后,3组患者VAS评分、BCTQ症状及功能评分及DML均较治疗前有明显降低(P＜0.05),CMAP、SCV及SNAP均较治疗前明显升高(P＜0.05);组间比较,联合组VAS评分、BCTQ功能评分低于其他2组(P＜0.05),SNAP明显高于其他2组(P＜0.05),CMAP指标明显高于冲击波组(P＜0.05).治疗8周后,联合组VAS评分、BCTQ症状及功能评分较治疗前明显降低(P＜0.05),CMAP、SCV结果较治疗前明显升高(P＜0.05),冲击波组VAS评分、BCTQ症状评分、DML较治疗前明显降低(P＜0.05),注射组VAS评分、DML较治疗前明显减低(P＜0.05),SNAP较治疗前明显升高(P＜0.05),此外注射组VAS评分、BCTQ功能评分较治疗4周后有明显回升(P＜0.05),SCV、SNAP较治疗4周后有明显下降(P＜0.05),组间比较,联合组CMAP、SCV、SNAP明显高于其他2组(P＜0.05),VAS评分、BCTQ症状评分和功能评分明显低于注射组(P＜0.05).结论:联合使用冲击波治疗和局部注射不仅能在较短的时间内获得较好的症状及功能改善,与单独应用其中一种治疗方法比较也拥有更好的远期疗效.

IntroductionWith more than 120 million rural-to-urban migrants, urbanization of the rural population requires deeply exploration in China. ObjectiveThis study focused on settled citizens who obtained urban Hukou (household registration) during urbanization and investigated their perceptions of health services in China. MethodA cross-sectional comparison study with an original, closed questionnaire was conducted in two major cities of Hubei, central China, covering health status and both the satisfaction with and utilization of health services. In total, 863 residents with urban Hukou participated in this study; migrants formed the study group and original city residents formed the control group. Propensity score matching (PSM) was used to reduce choice bias in the analysis steps. Besides basic description of the data, ordinary least squares regression (OLS regression) was used to discover the relationship between basic demographic indicators and health expenditure. ResultsPSM yielded 290 effective pairs for analysis. The results indicated an improvement in health status for migrant residents (study group) with a higher average score of self-reported health status and lower prevalence of chronic diseases than the control group. These scores were also better than the standard urban level in central China. The study group showed a higher clinic visit utility (69.63%), lower hospitalization utility (8.28%), less convenience of health service utility, and lower health expenditure than the control group. For the study group, the biggest difference was observed in satisfaction with health service costs, which was the least improved aspect after they obtained urban Hukou. The regression results demonstrated that age, family size, living expenditures, and marital status impacted health costs in the overall model and the influences of these factors differed between the study and control groups. ConclusionsObtaining urban Hukou helps migrant residents to meet their health service needs and receive equal access to health services. However, after obtaining urban Hukou, migrants also face great pressure in terms of health consumption. This study therefore offers guidance on the next steps for progressing China's urbanization.

目的:构建区域医联体医养结合服务评价指标体系,为后续医养结合服务评价工作的开展和政策的拟定提供参考.方法:通过理论研究和文献研究构建区域医联体医养结合服务指标体系框架,采用德尔菲法修订指标,运用层次分析法确定指标权重.结果:区域医联体医养结合评价指标体系包括6个一级指标、24个二级指标和48个三级指标.一级指标权重为0.0667-0.3507,二级指标组合权重为0.0054-0.2630,三级指标组合权重为0.0004-0.1617.结论:本研究构建的区域医联体医养结合评价指标体系具有一定的科学性和可靠性,可为推动医养结合服务向纵深发展提供客观依据.

ObjectivesWork-related fatigue is a serious safety risk to nurses and their patients. This study aimed to assess self-reported work-related accumulative fatigue of nurses and its associated factors.MethodsA questionnaire survey of 2,918 clinical nurses conveniently sampled from 48 public hospitals across six provinces in China was conducted. The “Self-diagnosis Checklist for Assessment of Workers' Accumulated Fatigue” was adopted to assess the level of work-related accumulative fatigue of the study participants. Chi-square tests and ordinal regression analyses were performed to determine the sociodemographic characteristics associated with work-related accumulative fatigue.ResultsAbout one third of respondents reported low work-related accumulative fatigue, compared with 23.1% reporting high and 24.6% reporting very high levels of work-related accumulative fatigue. Higher levels of work-related accumulative fatigue were associated with female gender (AOR = 0.614 for male relative to female, p = 0.005), age between 30 and 40 years (AOR = 1.346 relative to >40 years, p = 0.034), 5–10 years of work experience (AOR = 1.277 relative to >10 years, p = 0.034), and bachelor or above degree qualifications (AOR = 0.806 for associate degree relative to bachelor or above degree, p = 0.007). Those who worked in rural county hospitals (AOR = 0.816 for metropolitan relative to rural county hospitals, p = 0.006) and resided in central China (AOR = 1.276 relative to western China, p = 0.004) had higher odds of reporting higher levels of work-related accumulative fatigue.ConclusionHigh levels of work-related accumulative fatigue are evident in nurses of public hospitals in China. The problem is more serious in the female nurses in their mid-career and those who worked in the central region and rural setting.

目的:了解我国分级诊疗制度实施现状及存在的阻碍,为完善分级诊疗制度提供参考.方法:于2019年3-6月,采用目的抽样法在武汉市选取12家社区卫生服务中心,每家社区卫生服务中心选取2名医生,共对24名医生进行专题访谈,并采用质性研究方法进行分析.结果:调查对象认为,分级诊疗制度实施的整体成效有待提升,分级诊疗制度实施过程中存在的三大阻碍:一是基层医疗卫生机构缺乏优质的卫生资源,二是上下级医疗机构间双向转诊工作落实难,三是医疗保险制度需进一步完善.结论:为助力分级诊疗制度的有效实施,政府有关部门需要加大对基层医疗卫生机构的投入力度,制定明确统一的双向转诊制度,实行与疾病种类相结合的医疗保险差别报销模式,以及加快推进医疗联合体建设.

目的:探究围刺法配合温针灸治疗对肩周炎患者日常活动、压痛感及怕冷程度的影响.方法:收集2017年1月～2019年1月我院收治的肩周炎患者200例,按随机数表法分为观察组和对照组,各100例.对照组给予普通针刺配合温针灸,观察组在对照组基础上对主穴给予围刺法,观察比较各组临床疗效、日常活动功能评分、压痛评分、怕冷程度评分、实验室指标.结果:观察组临床疗效优于对照组,差异有统计学意义(P＜0.05);观察组日常活动功能评分低于对照组,差异有统计学意义(P＜0.05);观察组压痛评分低于对照组,差异有统计学意义(P＜0.05);两组治疗后怕冷程度评分均降低,观察组降低更为明显(P＜0.05);两组治疗后PGE2、IL-6水平均降低,观察组降低更为明显(P＜0.05).结论:围刺法配合温针灸治疗肩周炎临床治疗效果显著,能改善患者日常活动、减轻压痛感、缓解怕冷程度,提高生活质量,值得推广应用.

Objectives: Response capacities for public health emergencies (PHEs) amongst healthcare workers play important roles in the prevention and control of PHEs. This study assessed the attitudes and response capacities of PHE workers in primary healthcare (PHC) institutions. Methods: An online anonymous questionnaire survey of 803 healthcare workers sampled from 13 PHC institutions in Wuhan, China, was conducted from April to June 2020. The Kruskal–Wallis test and linear regression model were used to analyze the response capacities of PHE workers and associated factors. Results: The healthcare workers with longer working years, particularly 30 years and above, had higher knowledge (OR = 7.323, p < 0.001) and practical ability scores (OR = 8.012, p < 0.001) when compared to those with less than 5 working years. The nurses had higher practical ability scores (OR = 2.188, p = 0.049), and pharmacists had lower practical ability scores (OR = 0.166, p = 0.007), when compared to doctors. Moreover, the healthcare workers who had never participated in educational activities related to PHE management in the past two years (OR = 0.540, p = 0.038; OR = 0.282, p = 0.001), had not participated in a PHE drill activity (OR = 0.327, p < 0.001; OR = 0.340, p = 0.004), and had never been involved in emergency management of PHEs (OR = 0.254, p < 0.001; OR = 0.174, p < 0.001) had lower knowledge and practical ability scores. Conclusion: The healthcare workers with longer working years had better response capacities, and nurses had better practical abilities when compared to doctors. More emergency management education and chances to be involved in PHE drill activities were encouraged amongst healthcare workers in PHC institutions for better prevention and control of PHEs. Moreover, inter-institution cooperation, a flexible response system, and dynamic adjustment of healthcare workers were suggested during PHEs.

医联体建设是国家医改的一个重点内容,通过资源整合提高基层医疗卫生机构服务能力,落实分级诊疗制度.近几年国家也在不断推进中医医联体建设,以提高中医药服务水平,满足居民中医药服务需求.文章通过分析中医医联体建设现状,强调在中医医联体建设中要发挥中医药优势,探析目前国内中医医联体建设存在的问题,并提出相关建议.

基层医疗卫生机构作为整个医疗卫生服务体系的网底,在突发公共卫生事件应对中起着至关重要的基础性稳定作用.虽然随着医改的不断深入,基层医疗卫生机构基本服务能力有了明显改善,但是在突发重大疫情防控方面,其应对能力仍有待提高.文章通过SWOT分析基层医疗卫生机构应对突发重大疫情的优势、劣势、机会与威胁,探析基层医疗卫生机构应对工作的发展策略,提出相关建议.

To understand the development status of Traditional Chinese Medicine(TCM) hospitals in Northwest China under the background of the Belt and Road initiative(B&R), this study analyses the health resource index of TCM hospitals in Northwest China, and finds that the development of TCM hospitals in Qinghai and Ningxia is relatively slow, the recognition of ethnomedical services is relatively low among the residents. Regional linkage could be used to co-ordinately facilitate the development of TCM hospitals in Northwest China. B&R could be taken advantage of to promote the high-quality development of local ethnic medicine. Cultivating composite TCM talents, promoting poverty alleviation with TCM services, advocating TCM culture could all be utilized to build the People-to-people bonds along the new Silk Road.

基层医疗卫生机构的建设和运转状态关系到居民基本医疗卫生服务和公共卫生服务的提供,也影响着医疗卫生资源的有效利用."十三五"期间,在国家的高度重视与政策的支持下,我国基层医疗卫生服务得到快速发展,但也存在诸多问题.本文通过对"十三五"期间我国基层医疗卫生机构发展状况进行回顾分析,探析"十四五"期间基层医疗卫生机构重点发展领域及相关对策.