Empathy of medical students is crucial, yet it tends to decline as students enter later academic years. Empathy appeared to be affected by the learning environment (LE), which could be a potential contributor. We conducted a cross-sectional study to investigate the association between LE and empathy. The study comprised overall 10,901 medical students from 12 Chinese medical schools. Jefferson Scale of Empathy (JSE) was utilized to assess empathy, while a 5-point question and the Johns Hopkins Learning Environment Scale were employed to evaluate LE. JSE scores were compared across LE levels using Pearson Chi-square, Welch's ANOVA, and univariable linear regression. After adjusting for covariates, multivariable linear and logistic regression were used to assess the independent connection between LE and empathy. Confounders were controlled by stratified subgroup analysis. LE was significantly associated with medical students' empathy, as shown by the Pearson Chi-square test (p < 0.001) and Welch's ANOVA (p < 0.001). In multivariable logistic regression analysis, lower JSE scores were linked to common, bad, and terrible LE (OR = 2.226, 95% CI = [2.011, 2.465], p < 0.001; OR = 2.558, 95% CI = [1.745, 3.751], p < 0.001; OR = 1.889, 95% CI = [1.131, 3.153], p = 0.015), while excellent LE was associated with higher JSE scores (OR = 0.348, 95% CI = [0.312, 0.388], p < 0.001). Linear regression and stratified subgroup analysis confirmed logistic regression's findings. LE was a significant predictor for empathy. Better LE was associated with higher empathy and worse LE was related to lower empathy. This inspired us to improve LE to enhance medical students' empathy.
AbstractBackground: Hypertension, diabetes, and high cholesterol are risk factors for stroke recurrence, referred to as the three highs, and their management in patients with cerebral infarction can reduce stroke recurrence and death. This study aimed to investigate the cognition and implementation of the three highs by neurologists in tertiary general hospitals in Southwest China. Methods: A self-designed questionnaire was used by neurologists to evaluate the cognition and implementation of the three highs. A cross-sectional questionnaire was used to investigate tertiary hospitals in Southwest China. Results: Compared with inpatient work, approximately 1/3 of the doctors could not always completely evaluate the three highs in outpatient work (P<0.001). The longer the doctors worked, the more they emphasized the importance of the three highs to patients and the more completely they evaluated the three highs. Doctors were more able to develop antihypertensive, hypoglycemic, and hypolipidemic regimens for patients with cerebral infarction according to atherosclerotic cardiovascular disease (ASCVD) risk stratification. Conclusions: Although most neurologists involved in inpatient and outpatient work knew the importance of the three highs, approximately 1/3 of the outpatient doctors could not always completely evaluate the three highs. Some doctors failed to develop antihypertensive, hypoglycemic, and hypolipidemic regimens for patients with cerebral infarction according to ASCVD risk stratification, and professional training of doctors, especially young doctors, should be encouraged.
Background: Disaster epidemiology has not attracted enough attention in the past few decades and still faces significant challenges. This study aimed to systematically analyze the evolving trends and research hotspots in disaster epidemiology and provide insights into disaster epidemiology. Methods: We searched the Scopus and Web of Science Core Collection (WoSCC) databases between 1985 and 2020 to identify relevant literature on disaster epidemiology. The retrieval strategies were TITLE-ABS-KEY (disaster epidemiology) and TS = (disaster AND epidemiology). Bibliometrix, VOSviewer 1.6.6 and SigmaPlot 12.5 were used to analyze the key bibliometric indicators, including trends and annual publications, the contributions of countries, institutions, journals and authors, and research hotspots. Results: A total of 1,975 publications were included. There was an increasing trend in publications over the past 35 years. The USA was the most productive country. The most frequent institutions and journals were Fukushima Medical University and Prehospital and Disaster Medicine. Galea S made significant contributions to this field. “Epidemiology” was the highest-frequency keyword. COVID-19 was highly cited after 2019. Three research hotspots were identified: (i) the short- and long-term adverse health effects of disasters on the population; (ii) COVID-19 pandemic and emergency preparedness; and (iii) disaster management. Conclusions: In recent decades, the USA was a global leader in disaster epidemiology. Disaster management, the short- and long-term health effects of disasters, and the COVID-19 pandemic reflected the research focuses. Our results suggest that these directions will remain research hotspots in the future. International collaboration is also expected to widen and deepen in the field of disaster epidemiology.
Objective
To deeply explore the care needs in parents of children with congenital pseudarthrosis of the tibia (CPT) during Ilizarov fixation.
Methods
Totally 10 parents of CPT children during Ilizarov fixation hospitalized in the Department of Orthopedics, Hu'nan Children's Hospital between March and December 2017 were selected using purposive sampling and received semi-structural interview. Colaizzi phenomenological methods were used to analyze the data.
Results
Totally 4 themes were refined, including informational support needs (needle way care, functional exercise and feeding) , psychological support needs, economic support needs, and children's educational support needs.
Conclusions
The parents of CPT children during Ilizarov fixation have many care needs. Nursing workers should pay attention to their needs and take targeted measures to accelerate the postoperative recovery of children.
Key words:
Pseudarthrosis; Tibia; Ilizarov; Parents; Home care needs; Qualitative study
Emergency medical services (EMSs) are a critical component of health systems, often serving as the first point of contact for patients. Understanding EMS supply and demand is necessary to meet growing demand and improve service quality. Nevertheless, it remains unclear whether the EMS supply matches the demand after the 2016 healthcare reform in China. Our objective was to comprehensively investigate EMS supply-demand matching, particularly among urban vs. sub-urban vs. rural areas.Data were extracted from the Tianjin Medical Priority Dispatch System (2017-2021). From supply and demand perspectives, EMS resources and patient characteristics were analyzed. First, we performed a descriptive analysis of characteristics, used Moran's I to explore the spatial layout, and used the Gini coefficient to evaluate the equity of EMS supply and demand. Second, we analyzed urban-sub-urban-rural variation in the characteristics of EMS supply and demand by using the chi-square test. Finally, we examined the association between the EMS health resource density index and the number of patients by using the Spearman correlation and divided supply-demand matching types into four types.In 2021, the numbers of medical emergency stations and ambulances were 1.602 and 3.270 per 100,000 population in Tianjin, respectively. There were gradients in the health resource density index of the number of emergency stations (0.260 vs. 0.059 vs. 0.036; P = 0.000) in urban, sub-urban, and rural areas. There was no spatial autocorrelation among medical emergency stations, of which the G values by population, geographical distribution, and the health resource density index were 0.132, 0.649, and 0.473, respectively. EMS demand was the highest in urban areas, followed by sub-urban and rural areas (24.671 vs. 15.081 vs. 3.210 per 1,000 population and per year; P = 0.000). The EMS supply met the demand in most districts (r = 0.701, P = 0.003). The high supply-high demand types with stationary demand trends were distributed in urban areas; the low supply-high demand types with significant demand growth trends were distributed in sub-urban areas; and the low supply-low demand types with the highest speed of demand growth were distributed in rural areas.EMS supply quantity and quality were promoted, and the supply met the demand after the 2016 healthcare reform in Tianjin. There was urban-sub-urban-rural variation in EMS supply and demand patterns.
Objective: This study is to investigate the constitution, mucosal inflammation, Chinese medicine syndrome types, clinical and pathological characteristics of patients with IgA nephropathy (IgA N)and to analysis their relationships in order to provide the scientfic basis and new ideas for the management of IgAN. Methods: Through the cross sectional and retrospective study, we investigated 262 patients with IgAN in the Hospital of Guangdong provincical TCM hospital and the Third Hospital of Peking Universitiy between January 2011 and January 2014. We collected the Chinese medicine syndrome types, clinical and pathological data, the constitution questionnaire and the mucosal inflammation. Results: The constitution of yin-yang harmony was the most common(40.5%), followed by qideficiency(31.3%). Upper respiratory infection, chronic periodontitis, scytitis were very common in patients with IgAN. Qi deficiency of spleen and kidney were the common type: 69.1%. Asymptomatic abnormal urinalysis(50.4% of the patients)and CKD 1(48.5%)were the most common clinical Presentation. HaasD was the most common pathological presentation(47.3%). Patients with qi deficiency of spleen and kidney and the constitution of yin-yang harmony presented with more nonmucosal inflammation, more CKD3-4, higher than the latter in the level of serum creatinine, urea nitrogen, serum CH50 and lower in GFR clinically as compared to those patients with the constitution of qi deficiency. Conclusions: IgAN onsets silently and asymptomatic abnormal urinalysis was the most common clinical type. Frequent upper respiratory infection, chronic periodontitis and recurrent scytitis were common in patients with IgAN. IgAN patients with qi deficiency of spleen and kidney and the constitution of yin-yang harmony had higher serum CH50 level, low incidence of mucosal inflammation, increased risk of declined renal function and more sever renal pathlogical changes than that of patients with qi deficiency of spleen and kidney and the constitution of qi deficiency.
The hospital medical treatment process can be modeled as a queuing problem.If the allocation of medical devices and resources is not well optimized, then the passing rate will be low and patients have to be waiting in the queues for a long time.This paper analyzes the hospital medical process and proposes a simulation model based on the queuing theory.An optimization strategy is also proposed to improve the passing rate.According to the simulation results, the optimization significantly reduces the patients' waiting time and increases the passing rate.
Abstract Background The aim of our study was to examine potential differences in the assessment of neurocognitive impairment (NCI) using cognitive screening tools between PLWH and HIV-negative individuals, as well as to compare the neurocognitive profiles. Methods This was baseline evaluation of Pudong HIV Aging Cohort, including 465 people living with HIV (PLWH) and 465 HIV-negative individuals aged over 50 years matched by age (± 3 years), sex and education. NCI was assessed using the Chinese version of Mini-mental State Examination (MMSE), the International HIV Dementia Scale (IHDS) and Beijing version of Montreal Cognitive Assessment (MoCA). Results In total, 258 (55.5%), 91 (19.6%), and 273 (58.7%) of PLWH were classified as having NCI by the IHDS, MMSE, and MoCA, compared to 90 (19.4%), 25 (5.4%), 135 (29.0%) of HIV-negative individuals, respectively (all p < 0.05); such associations Only MMSE revealed sex difference in NCI prevalence among PLWH. PLWH showed a larger overlap of NCI detected by IHDS, MMSE, and MoCA than HIV-negative people. Regarding cognitive domains, IHDS-motor and psychomotor speeds and MoCA-executive function showed the greatest disparities between two groups. In multivariable analysis, older age and more depressive symptoms were positively associated with NCI regardless of the screening tools or HIV serostatus. Conclusion PLWH display a higher prevalence of NCI and distinct neurocognitive profiles compared to HIV-negative individuals, despite viral suppression. Our data support that older PLWH tend to have deficits in multiple cognitive domains simultaneously. It is advisable to utilize the cognitive screening tools in conjunction to reveal complex patterns of cognitive deficits among PLWH, especially older PLWH.
Abstract The objective was to evaluate the association between serum carotenoid levels and respiratory morbidity and mortality in a nationally representative sample of US adults. We assessed the association of serum carotenoid levels with respiratory morbidity and mortality using logistic regression and proportional hazards regression models. Meanwhile, a series of confounders were controlled in regression models and restricted cubic spline, which included age, sex, race, marriage, education, income, drinking, smoking, regular exercise, BMI, daily energy intake, vitamin E, vitamin C, fruit intake, vegetable intake, diabetes, hypertension, asthma, emphysema and chronic bronchitis. Compared with participants in the lowest tertiles, participants in the highest tertiles of serum total carotenoids, β -cryptoxanthin and lutein/zeaxanthin levels had a significantly lower prevalence of emphysema (OR total carotenoids = 0·61, 95% CI: 0·41–0·89, OR β -cryptoxanthin = 0·67, 95% CI: 0·49–0·92), chronic bronchitis (OR β -cryptoxanthin = 0·66, 95% CI: 0·50–0·87) and asthma (Q2: OR lutein/zeaxanthin = 0·78, 95% CI: 0·62–0·97); participants in the highest tertiles of total carotenoids, α -carotene, lutein/zeaxanthin and lycopene had a lower risk of respiratory mortality (hazard ratio (HR) total carotenoids = 0·62, 95% CI: 0·42–0·90, HR α -carotene = 0·54, 95% CI: 0·36–0·82, HR lutein/zeaxanthin = 0·48, 95% CI: 0·33–0·71, HR lycopene = 0·66, 95% CI: 0·45–0·96) than those in the lowest tertiles. Higher serum total carotenoids and β -cryptoxanthin levels is associated with decreased prevalence of emphysema and chronic bronchitis, and higher serum total carotenoids, α -carotene, lutein/zeaxanthin and lycopene levels had a lower mortality of respiratory disease.
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