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Xu Y, Wang Q, Zou J, Chen Y, Zhou J, Dai W, Liu R, Liu M, Li X, Jiang S. CHD-related/specific mortality of 3.17 million people in a transitioning region: trends, risk factors, and prevention. Aging Clin Exp Res 2023; 35:3147-3156. [PMID: 37985650 DOI: 10.1007/s40520-023-02618-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Demographic shifts cause uncertain changes in the burden of coronary heart disease (CHD) in transitioning regions. We aimed to analyze the trends of CHD burden and its risk factors in Pudong, Shanghai, and explore prevention strategies for transitioning regions. METHODS We analyzed CHD-related and CHD-specific deaths in Pudong from 2005 to 2020, including the crude mortality rate (CMR), age-standardized mortality rate worldwide (ASMRW), years of life lost (YLL), and age-specific proportions. We also examined the impact of population aging on the burden of CHD. The Joinpoint Regression Program was used to analyze trends, and the decomposition method was used to evaluate the impact of demographics on the mortality rate. RESULTS Of the 86,171 CHD-related deaths, 52,152 (60.52%) were CHD-specific deaths. For both CHD-related and CHD-specific deaths, there was a significant increase in the CMR, ASMRW, and YLL rate, except in the 70-79-year age group, which exhibited a distinctive and statistically significant decline in these rates (all P < 0.05). There were steadily increasing trends in the rates caused by aging from 2005 to 2020, with average annual percent changes (AAPCs) of 42.59% and 41.43%, respectively (all P < 0.05). CONCLUSIONS Our results indicate that the CHD burden in Pudong has been persistently increasing, but in the age group of 70-79 years, substantial declines were observed. The quality of primary healthcare services may be a critical point in addressing the overwhelming CHD burden.
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Affiliation(s)
- Yaxin Xu
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
- Department of General Practice, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Qizhe Wang
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
- Department of General Practice, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Jian Zou
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Yichen Chen
- Office of Scientific Research and Information Management, Centres for Disease Control and Prevention, Pudong New Area, Shanghai, 200136, China
- Office of Scientific Research and Information Management, Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai, 200136, China
- School of Public Health, Fudan University, Shanghai, 200032, China
| | - Jing Zhou
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Wei Dai
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Ru Liu
- Department of General Practice, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Ming Liu
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China.
- Shanghai Engineering Research Centre of AI Technology for Cardiopulmonary Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Xiaopan Li
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China.
- Office of Scientific Research and Information Management, Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai, 200136, China.
| | - Sunfang Jiang
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China.
- Department of General Practice, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China.
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Su Q, Hu D, Lin X, Zhao T. Preparing future general practitioners: the effects of individual, familial, and institutional characteristics. BMC MEDICAL EDUCATION 2023; 23:850. [PMID: 37946150 PMCID: PMC10636867 DOI: 10.1186/s12909-023-04857-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND There is a substantially increasing need for general practitioners (GPs) for future unpredictable pandemic crises, especially at the community-based health services (CBHS) level to protect the vast and varied grassroot-level population in China. Thus, it is crucial to understand the factors that affect Chinese medical students' GP career choices and commitments to CBHS. METHODS Leveraging the self-administered data collected across the country, this study conducted logistic regressions with 3,438 medical students. First, descriptive statistics of outcome variables and independent variables were provided. Then, stepwise logistic regression models were built, starting from adding individual characteristics, and then familial and institutional characteristics. Last, post-estimation was conducted to further assess whether there were significant marginal effects. RESULTS Results showed that women students were 24% less likely to choose GP careers but were 1.25 times more likely to commit to CBHS than their men peers, holding other individual, familial, and institutional characteristics constant. In addition, students who major in GP-orientated were more likely to choose GP careers and commit to CBHS, respectively, than those who major in clinical medicine. Furthermore, familial characteristics like annual income and mother's educational level only significantly predicted commitments to CBHS. Notably, sex-related differences in GP career choices and commitments to CBHS - by different regions - were observed. CONCLUSIONS Understanding the factors that affect medical students' GP career choices sheds light on how medical education stakeholders can make informed decisions on attracting more medical students to GP-orientated majors, which in turn cultivates more GP professionals to meet the nation's demand for GPs. In addition, by understanding the factors that influence medical students' commitment to CBHS, policymakers could make beneficial policies to increase medical students' motivations to the grassroot-level health institutions, and devote to CBHS as gatekeepers for a large population of residents' health.
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Affiliation(s)
- Qiang Su
- Zhejiang Academy of Higher Education, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Dan Hu
- China Center for Health Development Studies, Peking University, Beijing, 100083, China
| | - Xiaoru Lin
- School of Marxism, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Teng Zhao
- Zhejiang Academy of Higher Education, Hangzhou Dianzi University, Hangzhou, 310018, China.
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Wu L, Tong Y, Yu Y, Yu X, Zhou Y, Xu M, Guo Y, Song Z, Xu Z. General practitioner residents' experiences and perceptions of outpatient training in primary care settings in China: a qualitative study. BMJ Open 2023; 13:e076821. [PMID: 37714679 PMCID: PMC10510923 DOI: 10.1136/bmjopen-2023-076821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/01/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES The implementation of outpatient training in primary care settings is an essential part of residency training for general practitioner (GP) residents. However, limited research exists on their experiences and perceptions of this training. This study aimed to explore the experiences and perceptions of GP residents regarding outpatient training in primary care settings in China and provide insights and recommendations to enhance training quality. DESIGN A qualitative descriptive study employing in-depth interviews. SETTING Two community healthcare centres (CHCs) that implement outpatient training programmes for GP residents in Zhejiang Province, China. PARTICIPANTS In total, 20 GP residents affiliated with 14 CHCs and two hospitals across Zhejiang Province and Guizhou Province who had completed outpatient training in either CHC for over 1 month. RESULTS Of the 20 participants in this study, 11 (55%) were women, and the mean age was 28 years. GP residents completed the process of consultation, physical examination and therapy independently; subsequently, the community preceptors provided feedback based on their clinical performance and modelled their clinical skills. The benefits perceived by GP residents included improved clinical skills and confidence in practice, and they learned approaches to maintaining good relationships with patients. They preferred dealing with complex cases, discussions with peers and the indirect supervision of community preceptors in the training session. Residents recommended that measures be taken to improve the training quality regarding patient selection and recruitment, clinical skills in the training session, and assessment of clinical performance. CONCLUSIONS The outpatient training in primary care settings provides constructive opportunities for GP residents to improve their professional competencies. Although the current training sessions and the abilities of community preceptors largely satisfy the needs of GP residents, further research is needed to evaluate the effectiveness of training and explore approaches to improve its quality.
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Affiliation(s)
- Lingyan Wu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuling Tong
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yingying Yu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyan Yu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yening Zhou
- Xiaoying District Community Healthcare Center, Hangzhou, China
| | - Meiqun Xu
- Nanxing District Community Healthcare Center, Hangzhou, China
| | - Yi Guo
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenya Song
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhijie Xu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Wang HJ, Han Y, Guan H. A comment on attitudes of medical students to general practice: implications for Healthy China 2030. Fam Pract 2022; 39:775-777. [PMID: 34747440 DOI: 10.1093/fampra/cmab137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hong-Jia Wang
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yin Han
- Department of Pathology, Chengdu Fifth People's Hospital, Chengdu 611130, China
| | - Hua Guan
- Department of Health Management Center & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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