Village doctors managing hypertension in rural China

Walnut peptide relieves hypertension and associated kidney and heart injury by regulating the renin-angiotensin-aldosterone system and intestinal microbiota

BACKGROUND

Hypertension is a chronic disease with high morbidity and mortality. Previously, we screened a walnut meal peptide FDWLR (PEP) with significant angiotensin-converting enzyme inhibitory activity. The present study further investigated the anti-hypertensive effects of PEP in vivo using spontaneously hypertensive rats.

RESULTS

The results indicated that PEP reduced blood pressure and the indices in the renin-angiotensin-aldosterone system (RAAS) including angiotensin-converting enzyme (ACE) (decreased by 15.36%), angiotensin II (Ang II) (decreased by 31.56%), angiotensinogen (AGT) (decreased by 58.84%) and aldosterone (ALD) (decreased by 18.27%), whereas NO levels increased by 54.96%. The pathological analysis showed that PEP relieved cardiac and renal damage. PEP also alleviated oxidative stress, inflammation and fibrosis in the heart and kidney. Mechanistically, PEP mitigated cardiac and renal damage by simultaneously regulating ACE-Ang II-AT1R and the ACE2-Ang (1-7)-MAS axis. Additionally, PEP increased the levels of short chain fatty acids by 224.16% and improved gut microbiota by increasing the abundance of Prevotella, Phascolarctobacterium, Clostridium_sensu_stricto and Bifidobacterium, at the same time as decreasing Bacteroides and Alistipes abundances.

CONCLUSION

This study indicated that PEP prevented hypertension and associated heart and kidney damage by modulating the RAAS system and gut microbiota, which is valuable in guiding future development and optimal utilization of walnut meal. © 2024 Society of Chemical Industry.

Village doctors' dilemma in China: A systematic evaluation of job burnout and turnover intention

Background

Village doctors (VDs) in China undertook arduous primary healthcare missions. However, they received little attention in comparison to doctors in urban public secondary and tertiary hospitals. There is an urgent need to explore the overall situation of turnover intention and job burnout among VDs to evaluate and adjust current health manpower policy.

Methods

In this study, seven databases like PubMed, EMBASE, Web of Science (WOS), WanFang, China Science and Technology Journal Database (VIP), Chinese BioMedical Literature Database (CBM), and China National Knowledge Infrastructure (CNKI) were systematically searched, relevant experts were consulted, and empirical research on job burnout and turnover intention among VDs in international publications was evaluated. Therefore, we evaluated the prevalence of job burnout among VDs in general, across all dimensions and different severity levels, as well as the scores of each category. For turnover intention, we assessed the prevalence of different groups and their overall situation and also identified significant contributors.

Results

In this study, we integrated 20 research evidences on job burnout and turnover intention among 23,284 VDs from almost all provinces in China, and the prevalence of turnover intention among VDs in China was as high as 44.1% [95% confidence interval (CI): 34.1-54.2], which was two to four times that of primary health workers in high-income countries, but not much different from some developing countries. Simultaneously, VDs with the highest risk of turnover intention were men [odds ratio (OR): 1.22 (1.05-1.43)], those with a monthly income below USD 163.4 [OR: 0.88 (0.78-0.98)], those with a high educational level [OR: 0.88 (0.78-0.98)], and those <40 years old [OR: 1.27 (1.16-1.40)]. Similarly, the detection rate of job burnout toward them was 59.8% (95% CI: 38.7-79.1) with the MBI-GS score being 44.44 (95% CI: 37.02-51.86) in a total of 90, while the detection rate of job burnout in moderate and above almost reached 20%. The most significant contributor that affects job burnout was low personal accomplishment (LPA), and the detection rate for moderate and higher severity was 65.2% (95% CI: 58.7-71.7).

Conclusion

Attention should be paid to the high turnover intention and severe job burnout of primary health workers in rural areas of developing countries, and targeted measures should be taken to improve the situation. Health policymakers should increase financial subsidies for VDs, set a reasonable workload, improve various health policies such as pension insurance for VDs, and encourage "targeted training" for medical students to enrich and expand their team.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021289139.