Background The global population is aging rapidly, yet general practitioners (GPs) often lack adequate training in geriatric care. This study explored the implementation and perceived impact of the Extension for Community Healthcare Outcomes (ECHO) model, a tele-education approach, on the geriatric care competencies of GPs in primary care settings in China. Methods This longitudinal case study involved 22 GPs who completed the geriatrics module of the ECHO program at Tongji University between September and December 2024. Questionnaire surveys and online tests were administered before, immediately after, and three months post-training to assess changes in knowledge, self-efficacy, and clinical practice behaviors. Data were analyzed using descriptive statistics, paired t-tests, Spearman correlation, and Welch's independent samples t-test. Results Participants reported high satisfaction and perceived gains in knowledge and self-efficacy, with the item "Enhanced knowledge regarding geriatric diseases" receiving the highest rating (mean 4.45/5). Post-training test scores showed a non-significant mean increase of 5.09 ± 19.13 points (95% CI: -3.39, 13.57; p = 0.226), with a moderate positive correlation between score improvement and course engagement (r = 0.557, p = 0.007.). At three-month follow-up, participants reported significant improvements in screening for cognitive impairment (mean difference 0.69, p = 0.035, d = 0.61) and assessing caregiver burden (mean difference 1.97, p < 0.001, d = 1.63). No significant changes were observed in other practices. Conclusion The ECHO model, featuring interactive collaboration between generalists and specialists, appears feasible for delivering geriatric continuing education to GPs and may enhance perceived competence and specific clinical practices. This exploratory study provides preliminary insights for implementing such tele-education models in China.

Background Healthcare resources are necessary for individuals to maintain their health. The Chinese government has implemented policies to optimize the allocation of healthcare resources and achieve the goal of equality in healthcare for the Chinese people since the implementation of the new medical reform in 2009. Given that no study has investigated regional differences from the perspective of healthcare resource agglomeration, this study aimed to investigate China's healthcare agglomeration from 2009 to 2017 in China and identify its determinants to provide theoretical evidence for the government to develop and implement scientific and rational healthcare policies.Methods The study was conducted using 2009-2017 data to analyze health-resource agglomeration on institutions, beds, and workforce in China. An agglomeration index was applied to evaluate the degree of regional differences in healthcare resource allocation, and spatial econometric models were constructed to identify determinants of the spatial agglomeration of healthcare resources.Results From 2009 to 2017, all the agglomeration indexes of healthcare exhibited a downward trend except for the number of institutions in China. Population density (PD), government health expenditures (GHE), urban resident's disposable income (URDI), geographical location (GL), and urbanization level (UL) all had positive significant effects on the agglomeration of beds, whereas both per capita health expenditures (PCHE), number of college students (NCS), and maternal mortality rate (MMR) had significant negative effects on the agglomeration of institutions, beds, and the workforce. In addition, population density (PD) and per capita gross domestic product (PCGDP) in one province had negative spatial spillover effects on the agglomeration of beds and the workforce in neighboring provinces. However, MMR had a positive spatial spillover effect on the agglomeration of beds and the workforce in those regions.Conclusion The agglomeration of healthcare resources was observed to remain at an ideal level in China from 2009 to 2017. According to the significant determinants, some corresponding targeted measures for the Chinese government and other developing countries should be fully developed to balance regional disparities in the agglomeration of healthcare resources across administrative regions.

Background:This study aimed to examine the association between cardiopulmonary function, health-related quality of life (HRQOL) and cognitive function among nursing home residents aged 80 years and over. Methods:A nursing home-based, cross-sectional study was implemented among 677 aged over 80 years in Shanghai, China. A total of 197 participants underwent effective cardiopulmonary function examinations. Mini-Mental Status Examination (MMSE) and Short Form-36 scales (SF-36) were used to assess cognitive function and HRQOL, respectively. Results:Decline in left ventricular ejection fractions (LVEF) [adjusted odds ratio (AOR), 1.98; 95% confidential interval (CI), 1.03-3.81)] and vital capacity (VC) (AOR, 2.08; 95%CI, 1.07-4.04) was associated with cognitive impairment. After adjusting confounding factors, relationships between cognitive function and physical functioning (PF) (AOR, 0.98; 95%CI, 0.97-0.99) still existed. Conclusions:Healthcare professionals should pay more attention to cardiopulmonary health and HRQOL in the nursing home residents. Actions of public health strategies focus on the improvement of cardiopulmonary function, and PF among older nursing home residents with cognitive impairment is required.

ObjectiveThe study aimed to measure time trends of inequalities of the geographical distribution of health facilities and workforce in Shanghai from 2010 to 2016 and used a spatial autocorrelation analysis method to precisely detect the priority areas for optimizing health resource reallocation in metropolises like Shanghai in developing countries. MethodsThe study used secondary data from the Shanghai Health Statistical Yearbook and the Shanghai Statistical Yearbook from 2011 to 2017. Five indicators on health resources, namely, health institutions, beds, technicians, doctors, and nurses, were employed to quantitatively measure the healthcare resource in Shanghai. The Theil index and the Gini coefficient were applied to assess the global inequalities in the geographic distribution of these resources in Shanghai. Global and local spatial autocorrelation was performed using global Moran's index and local Moran's index to illustrate the spatial changing patterns and identify the priority areas for two types of healthcare resource allocation. ResultsShanghai's healthcare resources showed decreasing trends of inequalities at large from 2010 to 2016. However, there still existed an unchanged over-concentration distribution in healthcare facilities and workforce density among districts in Shanghai, especially for doctors at the municipal level and facility allocation at the rural level. Through spatial autocorrelation analysis, it was found that there exhibited a significant spatial autocorrelation in the density distribution of all resources, and some identified priority areas were detected for resource re-allocation policy planning. ConclusionThe study identified the existence of inequality in some healthcare resource allocations in Shanghai from 2010 to 2016. Hence, more detailed area-specific healthcare resource planning and distribution policies are required to balance the health workforce distribution at the municipal level and institution distribution at the rural level, and particular geographical areas (low-low and low-high cluster areas) should be focused on and fully considered across all the policies and regional cooperation to ensure health equality for municipal cities like Shanghai in developing countries.

Background Physician trust is a critical determinant of the physician–patient relationship and is necessary for an effective health system. Few studies have investigated the association between acculturation and physician trust. Thus, this study analyzed the association between acculturation and physician trust among internal migrants in China by using a cross-sectional research design. Methods Of the 2000 adult migrants selected using systematic sampling, 1330 participants were eligible. Among the eligible participants, 45.71% were female, and the mean age was 28.50 years old (standard deviation = 9.03). Multiple logistic regression was employed. Results Our findings indicated that acculturation was significantly associated with physician trust among migrants. The length of stay (LOS), the ability of speaking Shanghainese, and the integration into daily life were identified as contributing factors for physician trust when controlling for all the covariates in the model. Conclusion We suggest that specific LOS-based targeted policies and culturally sensitive interventions can promote acculturation among Shanghai’s migrants and improve their physician trust.

Importance: Different reopening plans were implemented to bring students back to schools in anticipation of school-related COVID-19 outbreaks. The hybrid reopening plan was considered a medium-risk option to mitigate greater risk than in-person and remote reopening plans. In the absence of an official in-school transmission surveillance system and the relevant data, whether hybrid reopening plan could protect students and decrease in-school transmission rates remains unknown. Objective: To estimate the case growth rates of the school districts chose remote and hybrid reopening plans compared with those chose in-person reopening plans. Design, setting, and participants: Using a validated crowdsourced dataset maintained by the National Education Association, we grouped 742 school districts in 49 states reopened between August 10, 2020 and November 12, 2020 into hybrid (46%), remote (15%), and in-person (40%) reopening plans. We used a retrospective cohort design with the three reopening plans as the exposures to assess area-risk factors and the COVID-19 case growth rates by different reopening plans. Main outcomes and measures: Factors associated with choosing remote, hybrid, and in-person reopening plans and the case growth rates among the three reopening plans. Results: School districts with a low proportion of white students, a high background risk, in an urban county, or with a Democratic governor, were more likely to choose remote or hybrid than in-person reopening plans. With the in-person reopening plan in referent, the odds ratios of the case growth rates for remote and hybrid reopening plan were 0.988 (95% CI: 0.986-0.989) and 1.014 (95% CI: 1.013-1.015), respectively. The consistent results were found among school districts with a high background risk. Conclusions: School districts reopened with the hybrid reopening plan had higher case growth rates among low and high background risk areas than those reopened with the in-person plan. In-person reopening plan may be a better option than hybrid reopening plan as far as the COVID-19 case growth rates in the beginning of the semester are concerned.

Objective:To investigate the effects of cell phone dependence (CPD) on mental health among undergraduates during the COVID-19 pandemic and further identify the determinants that may affect their mental health in China. Methods:The data were collected from 602 students at a medical school in Shanghai via an online survey conducted from December 2021 to February 2022. The Mobile Phone Addiction Index (MPAI) and Depression Anxiety Stress Scale (DASS) were applied to evaluate CPD and mental health, respectively. Independent sample t-test and one-way analysis of variance (ANOVA) were employed to compare the means of continuous variables among categorical groups. Correlations between continuous variables were detected using Pearson's correlation analysis. Univariable and multivariable logistic regressions were employed to identify the determinants of mental health. Results:Among the 402 eligible students, 73.88% were women with an average age of 20.19 ± 2.36 years. On average, the DASS score was 32.20 ± 11.07, the CPD score was 36.23 ± 11.89, and the cell phone use duration was 7.67 ± 3.61 h/day. CPD was found to have a negative effect on mental health among college students in Shanghai. Additionally, cell phone use duration, age, being senior students, faculty-student relationship, insomnia, tobacco use, obesity, and life satisfaction were clarified as contributing factors to mental health among college students. Conclusion:High degree of CPD could have a negative effect on college students' mental health, which might lead to some psychological problems. Appropriate actions and effective interventions are highly needed to prevent severe psychological injuries among college students in China.

Abstract BackgroundPrevious literature has proved that the uneven distribution of healthcare resources leads to growing inequalities between the rich and the poor with respect to wellbeing and health outcomes. Reducing inequalities in healthcare resource will eliminate avoidable disparities caused by differences in geographic location, or by avoidable segmented areas in the opportunity of having adequate access to healthcare, enjoying life and pursuing one's life plans. The study, by integrating traditional methods with spatial statistics, aimed to measure time trends of inequalities in the geographical distribution of health facility and workforce ,and to detect the priority areas to optimize health resource reallocation in Shanghai, China from 2010 to 2016.MethodsThe study used secondary data from Shanghai health Statistical Yearbook and Shanghai Statistical Yearbook from 2010 to 2016. Five indicators on health resources, including the numbers of health institutions, beds, technicians, doctors and nurses were employed to quantitatively measure the healthcare resource in Shanghai. Theil index was calculated to estimate the global geographic inequalities of these resources in Shanghai. Global and local spatial autocorrelations were performed to calculate the Moran’s indices to illustrate the spatial changing patterns and identify the priority areas for healthcare resource allocation.ResultsShanghai’s healthcare resources showed generally decreasing trends of inequalities from 2010 to 2016. However, there still existed an unchanged over-concentrated distribution in healthcare facility and workforce density among different districts in Shanghai. There was a significant spatial autocorrelation in the density distribution of all resources, and some priority areas were identified for resources re-allocation policy planning.ConclusionThe findings of the study demonstrated the effectiveness of the new health reform policy on reducing the inequality of the health resrouce allocation. However, more detailed area-specific healthcare resource allocation planning and policies are required to balance the workforce distribution at district level and institution distribution at rural level. Certain geographical areas (low-low and low-high cluster areas) should be considered as policy and collaboration priorities to realize health equality in Shanghai.

Long-term potentiation (LTP) in the hippocampus of awake animals is known to be reversed by long trains of low-frequency stimulation (LFS). Here we show that a persistent LTP reversal, i.e. depotentiation (DP), can be induced in the dentate gyrus of freely moving rats by brief 7 Hz stimulations (three trains of 100 pulses, 1 min intertrain-interval) if LFS was applied 2 min after tetanization. In contrast, the same LFS protocol given 15 min after tetanization failed to induce long-lasting DP. Likewise, reduction of LFS (given 2 min post-tetanus) to two trains resulted only in short-term DP. Because naturally occurring hippocampal 7 Hz oscillatory events are correlated to new sensory input, our results might be relevant for the understanding of the mechanisms of LTP reversal induced by processing new information.

BACKGROUNDIn fall 2020, all public K‐12 schools reopened in broadly 3 learning models. The hybrid model was considered a mid‐risk option compared with remote and in‐person learning models. The current study assesses school‐based coronavirus disease 2019 (COVID‐19) spread in the early fall using a national data set.METHODSWe assess COVID‐19 case growth rates from August 10 to October 14, 2020 based on a crowdsourcing data set from the National Education Association. The study follows a retrospective cohort design with the baseline exposures being 3 teaching models: remote learning only, hybrid, and in‐person learning. To assess the consistency of our findings, we estimated the overall, as well as region‐specific (Northeast, Midwest, South, and West) and poverty‐specific (low, mid, and high) COVID‐19 case‐growth rates. In addition, we validated our study sample using another national sample survey data.RESULTSThe baseline was from 617 school districts in 48 states, where 47% of school districts were in hybrid, 13% were in remote, and 40% were in‐person. Controlling for state‐level risk and rural‐urban difference, the case growth rates for remote and in‐person were lower than the hybrid (odds ratio [OR]: 0.963, 95% confidence interval [CI]: 0.960‐0.965 and OR: 0.986, 95% CI: 0.984‐0.988, respectively). A consistent result was found among school districts in all 4 regions and each poverty level.CONCLUSIONSHybrid may not necessarily be the next logical option when transitioning from the remote to in‐person learning models due to its consistent higher case growth rates than the other 2 learning models.

Background: The distribution of health-care resources is a critical component of health-care access, and equity is a basic principle of health-resource allocation, and foundational to achieving fairness in the provision of health services. China and its local Shanghai’s government has implemented measures to allocate health-care resources with the equity as one of the major goals since 2009.The aim of this study was to analyze differences in regional distribution and inequality in health-resource allocation on institutions, beds, and workforce in Shanghai over 7 years. Methods: A longitudinal survey using 2010–2016 data, which were collected for analysis. The study was conducted health-resource allocation on institutions, beds, and workforce in Shanghai, China. Five health-resource indicators were used to measure health-resource distribution at the city and district levels. Furthermore, the Theil index was calculated to measure inequality of health-resource allocation. Results: All quantities of health-care resources per 1000 people increased across Shanghai districts from 2010 to 2016. Compared with suburban districts, the central districts had higher ratios on five health-care resource indicators, and faster average growth in the bed and nurse indicator, and slower growth in the institution, technician and doctor indicator. The Theil indices of the technicians, doctors, nurses and beds had higher values than that of institutions every year from 2010 to 2016; furthermore, the Theil indices of the indicators, except for doctors in hospitals, all exhibited downward time trends. Conclusions : Increased health-care resources and reduced inequality of health-resource allocation in Shanghai during the 7 years indicated that the measures taken by the Shanghai government in the new round of healthcare reform in China since 2009 had been successful. Meanwhile there still existed regional difference between urban and rural areas and inequality between institution and workforce, especially doctors.

At Tongji University School of Medicine we established affiliation relationships with community health centers (CHCs) in Shanghai, which was unprecedented in China. During the process, we assisted CHCs in strengthening their portfolio through the improvement of public trust, working environment,

This article describes characteristics of the humanities and social science curriculum at University of Nebraska Medical Center (UNMC) and Tongji University school of medicine from the perspectives of students and medical education researchers. The background, design, format, teaching content, target population of students are compared and implications are discussed. The major differences are curriculum format and teaching content regarding health system science. Based on the comparison, following motions are proposed to optimize the curriculums of humanities and social science at Tongji University. Multidisciplinary collaboration is needed to design competency-based curriculum, while the learning objectives should address the specific issue of patient-physician relationship in China. Faculty development program and teaching assistants program are potential solutions to the shortage of small group facilitators. Furthermore, projects to improve health-care environment in affiliated teaching hospitals should be encouraged to build a better working and learning culture.

Nebraska births between 1995 and 2005 were followed until 2018 to look for intergenerational associations of low birth weight (LBW) and preterm birth (PTB). Results from generalized estimating equations revealed that mothers born LBW preterm were more likely to deliver LBW (adjusted OR 1.94, 95% CI 1.39-2.71) or preterm (adjusted OR 1.65, 95% CI 1.20-2.27) than mothers born with normal weight or at term. In addition, mothers who had an LBW sibling were 44% more likely to have an LBW infant (OR 1.44, 95% CI 1.04-2.00). A consistent finding was also observed for mothers who had a PTB sibling (OR 1.47, 95% CI 1.10-1.95). Mothers who were LBW at birth or had any LBW siblings, especially two or more siblings, were more likely to repeat this adverse birth outcome. The same association was also observed in mothers who were born preterm.

I n China, a growing and aging population has challenged the health care system. It is expected that China’s population over 65 years old will reach 487 million, or nearly 35% of inhabitants, in 2050. The burden on the health care system will be exacerbated by difficulty in accessing medical resources, especially in rural areas. The training of physicians who are qualified, respected, and trusted to serve in rural and urban communities must be increased to meet this need. The concept of graduate medical education is relatively new in China. Traditionally, medical school graduates work directly as junior physicians without residency training after finishing medical school. With theoretical knowledge and clinical clerkships obtained in medical school, junior physicians’ practical skills and knowledge were gradually acquired through an apprenticeship model, learning from senior physicians in the same department over an indefinite number of years. The training experience is variable in terms of length and quality, as there is no standardization or oversight. This inconsistency has led to a devaluation of physicians practicing in the community, away from teaching hospitals. Many patients prefer to be treated in tertiary centers as the physicians there learned from the experts. Patients may self-refer to specialists or physicians with more experience, resulting in an overloading of tertiary hospitals and underutilization of physicians practicing in community and rural areas. Given this social stigma, early career physicians tend to choose tertiary hospitals at the start of their medical career and are reluctant to work in community health care centers or regional hospitals, because they have insufficient social recognition and resources. Thus, reform in health care service delivery, particularly in the medical education system, is warranted to cultivate more primary care physicians and community-based and rural providers through standardized medical training. These reforms would need to incorporate improved standardization and quality while being timely and cost-effective to encourage institutional implementation and student recruitment. In 2009, the Chinese government launched a national health care reform policy, of which medical education reform is a key part. In 2010, Shanghai was chosen to be the pilot city for the national reform because it had relatively mature medical and educational resources. Several local health and education departments united and formed a special health reform leadership group to formulate plans and supervise the implementation. Shanghai’s reform aims to create a better physician training system, enhance professional prestige, and promote a more harmonious medical care environment with better physician-patient relationships and improved learning environments for trainees. The 2 pillars of Shanghai’s medical education reform are standardized residency training and standardized specialist training, with the aim of cultivating medical personnel of homogenized quality and high-level standards through a well-functioning postgraduate medical education system. There are 5 essential parts to Shanghai’s health care reform: the ‘‘5þ3þ3’’ model (5-year bachelor’s degree in medical school, plus 3year residency training, plus 3-year specialty training), a standardized residency training, a primary care system, a health information project, and vertical integration of medical resources. After graduation from the standardized residency training (SRT), trainees obtain a certificate that is recognized throughout the country, indicating that they have completed residency training and can be recruited by health care institutes of different levels all over the nation as registered physicians. In this article, we describe the 5þ3þ3 model and its potential for dissemination throughout China’s medical education system. DOI: http://dx.doi.org/10.4300/JGME-D-20-00069.1

Objective: Neoadjuvant chemotherapy has increased the survival benefit of non-small cell lung cancer (NSCLC) patients. The effects of different neoadjuvant therapies are still controversial. We carried out the study to evaluate the efficacy and safety of neoadjuvant therapy. Methods: We performed a search of electronic databases (PubMed, Embase, MEDLINE, Cochrane) for randomized controlled trials (RCTs) comparing neoadjuvant treatment. After literature screening and data extraction, efficacy, and safety were analyzed by the Bayesian network meta-analysis (NMA). Results: A total of 19 RCTs were included, covering 3276 patients and six kinds of neoadjuvant therapies, including immunotherapy, targeted therapy, chemotherapy drugs and radiotherapy. Erlotinib, the first-generation epidermal growth factor receptor tyrosine inhibitors (EGFR TKIs), neoadjuvant targeted therapy is best for improving overall survival (OS) and progression-free survival (PFS), which is superior to other neoadjuvant therapy, such as neoadjuvant chemotherapy with platinum drugs [hazard ratio (HR) 0.39, 95% confidence intervals (CIs) 0.16–0.96], neoadjuvant chemoradiotherapy (HR 0.37, 95% CI 0.14–0.96) and neoadjuvant chemotherapy with non-platinum drugs (HR 0.25, 95% CI 0.07–0.90). OS of all neoadjuvant therapies is superior to surgery alone, but only neoadjuvant chemotherapy with platinum drugs showed a significant advantage (HR 0.76, 95% CI 0.59–0.93). Besides, for the stage IIIA N2 NSCLC patients, no significant difference was found between neoadjuvant therapies. Conclusions: Targeted neoadjuvant therapy is the best treatment for prolonging PFS. The neoadjuvant chemotherapy with platinum drugs was associated with the better OS benefits for patients with NSCLC, compared with surgery alone. There is no significant difference in the efficacy of neoadjuvant therapy for the stage IIIA N2 NSCLC.

Background High burnout has been reported in physician populations. Although the standardized residency training (SRT) in China includes components that might put residents at a higher risk for burnout, the burnout of Chinese medical residents is unknown. This study aimed to evaluate the prevalence of burnout and the associated risk and protective factors for medical residents in the SRT program in Shanghai, China. Methods This study was a prospective cross-sectional design. A random sampling strategy was used to recruit 330 resident physicians from four SRT sites in Shanghai, and 318 completed questionnaires were returned. Respondents completed a self-made questionnaire including demographic and work characteristics, four burnout and wellness-specific surveys. Bivariate analyses and hierarchical multiple regression models were used to analyze factors associated with three sub-scales of burn out separately. Results The overall burnout rate was 71.4%. Low level rate of personal accomplishment (PA) was extremely high at 69.5%. Night shift experience, high occupational stress, and low social support were significant predictors, which explained 49.1% variance of emotional exhaustion (EE) (F = 26.528, P < 0.01). Factors that significantly predicted depersonalization (DP) included male gender, senior residents, night shift experience, high occupational stress, and low psychological empathy, which explained 51.5% variance totally (F = 29.004, P < 0.01). Senior residents, high income, low occupational stress, and high empathy were also significant predictors of decreased personal achievement (PA), which explained 18.4% variance totally (F = 12.897, P < 0.01). Conclusions There was a high burnout rate among SRT residents in Shanghai. Occupational stress and several work-related factors were significant and strong risk factors for burnout, while empathy and social support were mild protective factors. Decreased work-related demands and increased access to resources could assist residents in reducing their work stress and improving their well-being.

INTRODUCTION:Effective collaboration between public health and the health care system is essential for connecting medical and community health-related resources and improving population health. We investigated the linkages between local health departments and primary care clinics in Nebraska.METHODS:We conducted a mixed-method study by using semistructured in-person and telephone interviews and surveys in 2017 and 2018 with directors of 19 Nebraska local health departments. Interviews and surveys assessed activities and programs that health departments implemented or planned with clinics in their jurisdictions. Barriers, benefits, and opportunities for building the linkages were identified.RESULTS:Strong linkages existed between local health departments and primary care clinics. Linkages focused on the control and prevention of chronic diseases and on traditional public health programs, including screening for cancer and other chronic diseases, vaccinations, worksite wellness programs, home visits, clinic and medication assistance referrals, health message development, electronic health records data analyses, staff education, and improvements in policies and procedures. The most frequently reported barrier was funding, and the most frequently reported benefit was patient behavior change. The opportunity most frequently reported was chronic disease health coaching.CONCLUSION:Extensive linkages exist between Nebraska local health departments and the health care systems in their areas. Additional funding, effective workforce management, community needs assessments, and program evaluation can support joint initiatives to address community health priorities.

全科人才培养是全科医学发展的关键任务,目前我国的全科医生教育培养工作已经取得一定进展,但仍存在合格的全科医生数量不足、全科医生培养体系不完善等问题.英国和美国的全科医生培养起步较早,现已形成较为完善的人才培养体系.本文介绍了英国全科医生培养的“5+2+3”模式、美国全科医生培养的“4+4+3”模式,并将其与我国目前的“5+3”全科医生培养模式进行对比.认为我国的全科医生培养应进一步明确培养目标,提升全科医生的综合素养,全面提高全科医生的岗位胜任力;同时,应建设标准化的全科医学住院医师培训体系,包括培训大纲、带教师资、培训基地、考核评价等方面.