25 December 2022, Volume 29 Issue 6

    

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   Research on health service utilization of the disabled and influencing factors

  Zhang Yaoguang, Wu Shiyong, Wang Shuai, Yao Qiang, Zhu Jiming

  journal1. 2022, 29(6): 401-409. https://doi.org/10.3969/j.issn.1006-5253.2022.06.001

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   Objective To understand the level of health service utilization of the disabled and its influencing factors, and provide information for relevant policy formulation and action implementation.Methods Multiple data links have been established for registered disabled persons, dynamic monitoring of disabled persons in 2018 and the Sixth National Statistical Survey on Health services, as well as a database on the health of disabled persons, utilization of health services and influencing factors, and Stata 13.0 was used for quantitative analysis.Results The proportion of the disabled who did not receive treatment within two weeks was 3.9%, and the rate of the disabled who received treatment within two weeks was 36.5%, both higher than those of non-disabled persons. The results of logistic regression analysis on the influencing factors of disabled people′s treatment showed that, taking the eastern region as the control, the OR of central region was 0.73 (95% CI: 0.64-0.83); taking males as the control, the OR of females was 1.23 (95% CI: 1.11-1.37); compared with those without medical insurance, OR of those with basic health insurance was 2.00 (95% CI: 1.23-3.26). After controlling urban and rural areas, regions, age, health insurance, and income, taking people without disabilities as the control, the OR of visual disabled was 1.28 (95%CI: 1.12-1.46), and the OR of physical disabled was 1.31 (95%CI: 1.23-1.40), the OR of mental disabled was 1.61 (95%CI: 1.37-1.90). Conclusion The level of health service utilization of disabled persons is high, but the problem of inadequate health service still exists. It is necessary to formulate targeted policies for persons with different types of disabilities. 
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   Prognostic factors of patients with invasive breast cancer undergoing total mastectomy based on the competing risk model

  Li Qianni, Xu Lingyan, Li Jian, Liu Meina

  journal1. 2022, 29(6): 410-418. https://doi.org/10.3969/j.issn.1006-5253.2022.06.002

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   Objective To analyze the prognostic factors of patients with invasive breast cancer (IBC) undergoing total mastectomy by using a competing risk model, and to draw a nomogram for individualized prediction of survival rate.Methods The clinical data of patients with a diagnosis of IBC and total mastectomy were extracted from the SEER database, and the prognostic factors were determined by univariate and multivariate analysis based on the competing risk model. The nomogram was made to predict the 3 year and 5 year survival rate of patients after the operation, and Cindex, ROC curve and calibration curve were used to validate the predictability.Results Totally 129 808 IBC patients who underwent total mastectomy were included. Univariate and multivariate analysis indicated that the independent prognostic factors were age, race, marital status, histological grade, T stage, N stage, M stage, ER status, PR status, molecular subtype, radiotherapy and chemotherapy. The nomogram was drawn using prognostic factors, the Cindex at 3 and 5 years was 0.853 and 0.823, and the AUC value of the ROC curve at 3 and 5 years was 0.821 and 0.818, respectively. The calibration curve showed excellent fit between prediction and actual situation.Conclusion The competing risk model can effectively identify the prognostic factors of IBC patients with total mastectomy, and the nomogram based on the model shows excellent predictive performance, which can provide foundation for clinicians to assess patient prognosis and develop individualized treatment plans.
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   Price prediction of antitumor drugs in Shandong Province based on LSTM and ARIMA models

  Cao Xiaoyu, Xu Bo, Zhang Huifeng, Wei Xinjiang

  journal1. 2022, 29(6): 419-423. https://doi.org/10.3969/j.issn.1006-5253.2022.06.003

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  Objective To evaluate the price level of antineoplastic drugs in Shandong Province from January 2016 to April 2021, and to scientifically predict the price trend of antineoplastic drugs.Methods Based on the purchase data of desensitized anti-tumor drugs from January 2016 to April 2021 in Shandong Province, the anti-tumor drug price index was compiled, and the ARIMA model and the LSTM model were used to predict and compare the price trend of anti-tumor drugs.Results The Laspeyres, Paasche and Fisher price indices of antitumor drugs in Shandong Province showed a decreasing trend, and the MSE of the ARIMA and LSTM models were 0.60% and 1.85%,respectively. The ARIMA model was more suitable for prediction than the LSTM model. ARIMA model was used to predict the price trend of antitumor drugs in the next 8 months, and the overall trend was decreasing.Conclusion Centralized drug procurement policy in Shandong Province can reduce the price of antitumor drugs to a certain extent, but the price of antitumor drugs fluctuates abnormally. Relevant departments such as medical security and health care should ensure the price of antitumor drugs in a reasonable range from the aspects of bulk purchase and national insurance negotiation.
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  Clinical characteristics and risk factors of secondary infection in patients with acute myeloid leukemia after chemotherapy

  Liu Min， Li Linjie

  journal1. 2022, 29(6): 424-427. https://doi.org/10.3969/j.issn.1006-5253.2022.06.004

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   Objective To explore the clinical characteristics and risk factors of secondary infection in patients with acute myeloid leukemia (AML) after chemotherapy.Methods Patients with AML undergoing chemotherapy in a hospital from March 2021 to April 2022 were enrolled as the research objects. The secondary infection after chemotherapy was statistically analyzed. The infection characteristics and clinical characteristics in both groups were analyzed. Multivariate regression was used to analyze the risk factors of secondary infection in AML patients after chemotherapy.Results Among 186 AML patients, 114 cases were infected after chemotherapy, and the infection rate was 61.29%. Among 114 patients with AML secondary infection, 46 strains of pathogenic bacteria were isolated, In the 114 AML patients with secondary infection, there were 46 strains of pathogens, including 12 strains of Gram-positive bacteria (26.09%), 25 strains of Gram-negative bacteria (54.35%) and 9 strains of fungi (19.57%). Logistic regression analysis showed that age>40 years old (OR=2.265, 95%CI:1.155-4.441), diabetes mellitus (OR=4.529, 95%CI: 1.48-13.863), WBC≤1×10⁹/L (OR=2.818, 95%CI: 1.246-6.375), agranulocytosis time>7 d (OR=2.454, 95%CI: 1.232-4.891) and ratio of bone marrow blast cells>50% (OR=2.908, 95%CI: 1.189-7.109) were all independent risk factors of secondary infection.Conclusion The incidence of secondary infection is high in AML patients after chemotherapy. Clinically, early prevention and symptomatic treatment can be carried out for patients with age>40 years old, diabetes mellitus, WBC ≤1×10⁹/L, agranulocytosis time>7 d and ratio of bone marrow blast cells>50%.
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   Analysis of the accuracy and influencing factors of the data reported by the hospitals of notifiable infectious diseases in Binzhou

  Zhang Yunlan，Wang Junhua， Luo Weihua，Ding Yuanjiang， Guo Hui

  journal1. 2022, 29(6): 428-434. https://doi.org/10.3969/j.issn.1006-5253.2022.06.005

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  Objective  To understand the status quo of reporting quality and management of the notifiable infectious diseases in Binzhou, and to find out problems in the work, so as to provide theoretical basis for standardizing reporting management and improving the reporting quality.Methods Stratified random sampling method was used to select 97 medical institutions in Binzhou City to investigate the reporting quality and management status of notifiable infectious diseases. Qualitative data were described by frequency and constituent ratio/rate (%), and differences between groups were analyzed by chi-square test. Multivariate logistic regression was used for multivariate analysis.Results From 2017 to 2020, more than 90% of medical institutions carried out self-examination of infectious disease reporting every year, and the proportion of medical institutions carrying out training related to infectious disease increased year by year.  There were statistical differences among different levels and different categories of medical institutions in terms of the under-reporting rate, timeliness rate, integrity rate, accuracy and the integrity rate of valid identification of infectious disease reporting (P＜0.05). Full-time staff, regular training of infectious disease management knowledge for medical staff, regular self-examination of infectious disease reporting quality, implementation of electronic medical record management, abnormal results feedback records in imaging departments, abnormal results feedback record in laboratory departments were independent influencing factors of infectious disease reporting quality (P<0.05).Conclusion The important measures to improve the quality of infectious disease reporting are to provide special funds, ensure the stability of professional team, strengthen the training of infectious disease reporting standards and diagnostic standards, strengthen the standardized management of infectious disease network direct reporting, perfect the infectious disease reporting system, and accelerate the construction of surveillance reporting information.
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   Disease characteristics of hospitalized children in southern Xinjiang from 2017 to 2021

  Yang Haixia，Yang Xuhu，Ma Xin，Liu Jiancheng，Gao Liang，Chen Yao，Liu Qing，Luo Jia，Pei Haifeng

  journal1. 2022, 29(6): 435-438. https://doi.org/10.3969/j.issn.1006-5253.2022.06.006

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   Objective To analyze the disease characteristics of children aged 0-14 years old in a second-class hospital in southern Xinjiang from 2017 to 2021, and to provide a basis for the prevention and treatment of children′s diseases and the rational allocation of medical resources in this area.Methods According to International Classification of Diseases (ICD-10), the medical records of 2 130 hospitalized children aged 0-14 years old from 2017 to 2021 were retrospectively analyzed, and the trend of admission volume, constituent ratio of disease incidence, nationality, gender, age and other constituent ratio changes were summarized.Results The most inpatients were 7-14 years old, male and Uygur, and the disease spectrum was mainly neonatal jaundice, inguinal hernia (unilateral), chronic tonsillitis, acute appendicitis and chronic gastritis.Conclusion The hospitals in southern Xinjiang should focus on the prevention and treatment of children′s diseases originating from perinatal diseases (neonatal jaundice) and inguinal hernia, respiratory and digestive diseases, strengthen the construction of pediatric specialty and improve the technical level. Local health departments and medical institutions should formulate corresponding medical resources according to the characteristics of children′s diseases.
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  Disease composition and medical quality evaluation of inpatients in the neonatal department of a hospital from 2015 to 2020

  Zhou Li，Wang Yige， Wang Ruijuan， Yu Shuxia， Wang Jie，Sun Yanwen

  journal1. 2022, 29(6): 439-442. https://doi.org/10.3969/j.issn.1006-5253.2022.06.007

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  Objective To evaluate the disease composition and medical quality of inpatients in the neonatal department of a maternal and child health care hospital from 2015 to 2020, and to provide a scientific basis for the subsequent prevention of neonatal diseases.Methods The medical records of inpatients from 2015 to 2020 were collected, and the information such as gender, discharge diagnosis, hospitalization time, and treatment outcome were extracted. The order of disease composition and gender distribution characteristics were analyzed, and the TOPSIS method was used to evaluate the medical quality.Results From 2015 to 2020, the top five diseases among hospitalized patients were neonatal jaundice (55.31%), neonatal infection (8.75%), premature infants (7.25%), neonatal pneumonia (6.53%), and multiple organ function impairment (4.42%). The male-female gender ratio was 1.13∶1, the malefemale of hospitalized patients was the same as the top five diseases.The order of ABO hemolytic in newborns increased the fastest. From 2015 to 2020, the quality of neonatal medical care increased year by year.Conclusion Neonatal diseases are mainly neonatal jaundice, infection and pneumonia, which should be paid attention to in future disease prevention. It is necessary to strengthen the hospital management, improve the level of disease treatment, and further improve the quality of neonatal care.
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  Hospitalization expenses and influencing factors of the top ten diseases in a dermatology hospital

  Lin Jinxiong， Ren Yitao，Liao Yuehua，Shen Shuqun

  journal1. 2022, 29(6): 443-447. https://doi.org/10.3969/j.issn.1006-5253.2022.06.008

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  Objective To explore the application of generalized estimating equation (GEE) in hospitalization expenses of patients with dermatosis, and to provide scientific guidance for reasonable control of the excessive increase of hospitalization expenses of patients with dermatosis.Methods Univariate analysis and GEE modeling analysis were performed on the medical record data of inpatients in a large tertiary dermatology hospital in Guangdong Province from 2015 to 2019 to explore the costs of the top 10 diseases and their influencing factors.Results Totally 9 588 patients were included in the study for empirical analysis. Univariate analysis showed that gender, age, marital status and other 11 variables had significant differences on the total hospita-lization costs (P<0.05), and gender, age, marital status and other 11 variables had significant differences on hospitalization days (P<0.05). GEE analysis showed that age, marital status, medical insurance, complications, surgery, use of antibiotics, case classification and disease type were the influencing factors of hospitalization expenses (P<0.05).Conclusion Surgery, medical insurance and case classification are important factors affecting the hospitalization expenses of patients with dermatosis. It is necessary to strengthen the management of day surgery and carry out the payment reform according to the score of disease groups, so as to reduce the hospitalization expenses of patients with dermatosis and reduce their economic burden.
  
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  Epidemiological analysis of inpatients with malignant tumors in a tertiary Chinese medicine hospital from 2017 to 2021

  Zeng Luqing

  journal1. 2022, 29(6): 448-453. https://doi.org/10.3969/j.issn.1006-5253.2022.06.009

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  Objective To analyze the epidemiological characteristics of inpatients with malignant tumors in a tertiary Chinese medicine hospital from 2017 to 2021, and to provide scientific evidence for the prevention and treatment of malignant tumors.Methods According to the International Classification of Diseases ICD-10, the information system of the homepage of hospital medical records was used to collect the information of inpatients with malignant tumors in a hospital from 2017 to 2021 for retrospective analysis. SPSS software was used for difference analysis and trend analysis.Results In 5 years, 6 377 eligible inpatients with malignant tumors were admitted including 3 758 male patients, accounting for 58.93%, and 2 619 female patients, accounting for 41.07%, with the gender ratio of male to female 1.43∶1. The most inpatients with malignant tumors were 60-69 years old, accounting for 25.81%. There were significant differences in the age distribution of malignant tumor patients with different genders (χ² =101.91, P＜0.001). The distribution of main malignant tumors in different age groups was different, and the difference was statistically significant (χ²=1 137.60, P＜0.001). The average hospitalization days of malignant tumor patients were 13.14 days, with an average growth rate of 1.05%; the average cost per time was 24 728.74 yuan, with an average growth rate of 4.17%; the average daily hospitalization cost was 1 881.16 yuan, with an average growth rate of 3.02%. Among 6 377 patients with malignant tumors, 2 991 cases (46.90%) were in the top 10, which were as follows:  hepatocellular carcinoma, upper lobe lung cancer, bronchial or lung cancer, thyroid cancer, breast cancer, prostate cancer, rectal cancer, and lower lobe lung cancer, sigmoid colon cancer, and multiple myeloma. In the top 10 malignant tumors, the longest average hospital stay was 15.26 days for multiple myeloma,and the highest average cost was 30 015.57 yuan for multiple myeloma.Conclusion There are gender and age differences in the composition of malignant tumors. Attention should be paid to male and elderly people,and different prevention and control measures should be adopted to reduce the incidence of malignant tumors, strengthen cost control, improve the quality of life, and reduce the burden on patients.
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  Study on organ donation intention and influencing factors of medical students and non-medical students in a local area

  Chen Minghao，Han Xuemei，Fang Yuan，Han Keping，Xu Xingyu，Zhang Yulong

  journal1. 2022, 29(6): 454-458. https://doi.org/10.3969/j.issn.1006-5253.2022.06.010

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  Objective To explore the factors influencing the cognition and intention of organ donation among university students in a city, and to compare and analyze the attitude of medical students and non-medical students towards organ donation.Methods Self-made questionnaire was used to compare and analyze the data of medical students and non-medical students. The questionnaire data of 988 undergraduate students from three universities were collected by the methods of quota sampling and the combination of online and offline questionnaire survey. SPSS 26.0 was used to sort out and analyze the questionnaire data.Results Among the 988 college students, 503 were medical students and 485 were non-medical students. Among the 988 college students surveyed, 542 were females and 446 were males. On the cognitive level, 97.6% of medical students knew about organ donation, which was higher than that of non-medical students(95.9%). On the willingness level, 622 college students (62.9%) were willing to donate organs after death, and 69.0% of medical students were willing to donate organs after death. Logistic regression analysis showed that gender, family support, medical students, understanding of organ or body donation process, and the discussion of organ donation with family members were the main influencing factors affecting the willingness of college students to donate organs after death (P<0.05).Conclusion The awareness of organ donation among medical students is higher than that among non-medical students, but the difference is not significant. The awareness of organ donation, the support of family members and the discussion of organ donation with family members are the factors that affect the willingness of organ donation of college students. Traditional ideas are still the main obstacle to organ donation among college students.
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  Experience and support of secondary victims of clinical nurses after adverse medical events and the impact on job insecurity

  Chen Feifei， Miao Dahong， Xu Yangyang

  journal1. 2022, 29(6): 459-465. https://doi.org/10.3969/j.issn.1006-5253.2022.06.011

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  Objective To explore the second victim experiences of nurses in medical adverse events and its impact on job insecurity.Methods There were 283 second victim nurses selected from 3 tertiary hospitals from a city from June to August 2022 with convenience sampling method. The basic information questionnaire, Chinese version of the Second Victim Experience and Support Tool and Job Insecurity Scale were used in the investigation.Results The average score of the second victim's experience and support was （73.35±16.49）, among which the average score of distress subscale was （41.42±11.12） and that of support subscale was （31.38±6.35）. The average score of job insecurity items was （2.98±0.77）, among which the average score of job quality insecurity items was （3.21±0.82）, and the average score of job quantity insecurity items was （2.68±0.70）. Multiple linear regression analysis showed that gender and secondvictim distress affected the job insecurity of clinical nurses. The way of employment affected the job quantity insecurity of clinical nurses. Second victim experience and support influenced overall job insecurity of clinical nurses.Conclusion Nursing managers should pay attention to the influence of adverse events on the second victim nurses, especially male nurses, and formulate support and management programs from the risk management, organizational support, emotional guidance and other levels, eliminate the concerns about influence of adverse events on career development, and reduce their job insecurity.
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  Investigation and analysis of online testing to improve the cognition and comprehension of statistical charts

  Sun Hongwei， Wang Jiu，Han Chunlei，Liu Haixia，Zhang Zhongwen，Zhang Jun， Li Kaixin

  journal1. 2022, 29(6): 466-471. https://doi.org/10.3969/j.issn.1006-5253.2022.06.012

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  Objective To investigate the cognitive understanding of medical college students on statistical indicators and statistical charts, and to examine the effect of online testing tools on improving students′ ability to understand statistical charts.Methods The subjects were undergraduates majoring in statistics, clinical medicine, anesthesiology, imaging and laboratory science in a medical university. The survey was conducted by online questionnaire (questionnaire url, test one: https://ks.wjx.top/jq/92107364.aspx, test two: https://ks.wjx.top/jq/92106453.aspx). Frequency, rate and mean were used to describe qualitative and quantitative data. Quantitative data were compared by paired- t- test or rank sum test.Results Five hundred and forty-six students completed test one and 476 completed test two. We found that quite a few students were wrong about basic statistical charts. And 70% of medical students misunderstood the composition ratio of the two grouping factors, while 50% of medical students misunderstood the constituent ratio of a grouping factor. Between 30% and 50% of medical students misunderstood the rate, the difference between case mortality and mortality, and the correlation shown in the scatter plot.Conclusion If statistical charts can only be understood and mastered by classroom explanation， due to the limitation of class hours, the goal of accurate understanding can not be achieved. Through online testing and cases, combined with answer analysis, this part of knowledge can be mastered in a limited period of time. If students only understand and master statistical charts through classroom explanation, they cannot achieve the goal of accurate understanding due to the limitation of class hours. In the ways of online tests and the design of cases and questions, combined with the way of answer analysis, can students master this part of knowledge in a limited period of time.
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  Relationship between atmosphericPM _2.5 and outpatient visits of respiratory diseases in China:a meta-analysis

  Wang Xibei， Zhou Zhehua，Wu Yikang，Hu Zan， Zhu Ze，Meng Pan,，Wu Daming， Hong Weiwei

  journal1. 2022, 29(6): 472-480. https://doi.org/10.3969/j.issn.1006-5253.2022.06.013

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  Objective systematically review the short-term exposure effects of atmospheric PM_2.5 and respiratory disease outpatient visits in China.Methods Databases including CNKI, WanFang Data, VIP, PubMed, EMbase, The Cochrane Library and Web of science databases were electronically searched to collect studies on the association between atmospheric PM_2.5 and outpatient visits of respiratory diseases from January 2000 to August 2022 in China. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Metaanalysis was performed by using Stata 14.0 software.Results Forty-eight articles were included. The random effect model was used for meta-analysis. The results showed that the increase of PM_2.5  concentration by 10 μg·m^-3 was associated with an increase of 0.66%(95%CI: 0.56%-0.76%) in the number of respiratory disease outpatient visits. Subgroup analysis was conducted according to population (age, gender), season, study area, urban economic level, PM_2.5 concentration and effect type. The results showed that for every 10 μg·m^-3  increase in atmospheric PM_2.5 concentration, the increase of outpatient visits for respiratory diseases was the highest in the 0-14 years group 0.61%(95%CI: 0.50%-0.73%), followed by ≥65 years old group 0.50% (95%CI:0.35%-0.66%) and 15-64 years old group 0.44%(95%CI: 0.32%-0.56%). In spring, the highest increase was 0.61% (95%CI: 0.12%-1.11%). Compared with the second and third-tier cities, the increase of outpatient clinics for respiratory diseases in firsttier cities was the highest by 0.63% (95%CI: 0.50%-0.75%). The increase of outpatient clinics for respiratory diseases in southern China was 0.75%(95%CI: 0.63%-0.88%), higher than that in northern China 0.37%(95%CI: 0.28%-0.47%). PM_2.5 <75 μg·m^-3  groups of respiratory disease outpatient increment of 0.78% (95%CI: 0.63%-0.88%) was higher than PM_2.5 ≥75 μg·m^-3  group-0.26% (95%CI: 0.17%-0.36%). There was no significant difference in the increase of outpatient visits for respiratory diseases by gender and effect type. Sensitivity analysis showed that the results of this study were relatively robust and reliable. The funnel plot and Egger′s test showed that there was a certain publication bias.Conclusion There is a positive correlation between PM_2.5 and the number of respiratory diseases in China. With the increase ofPM_2.5 concentration in the atmosphere, the risk of respiratory diseases will increase, especially in children, the elderly, in spring, first-tier cities and the southern region, and the number of respiratory diseases outpatients increases.