Within the KABP model as a framework,the authors studied these behaviors at the following three levels,namely knowledge and learning,beliefs and attitude,and behavior.Such aspects as the education background and training,drug expertise,drug infonmation sources,personal experience and habits,attitudes,needs of physicians and patients',socio-demographic characteristics were discussed among others to probe into how physicians' personal behavior affects their prescription behavior.Recommendations raised include education and training,provision of correct drug information,greater publicity,better compensation mechanism of public hospitals,strengthened supervision,establishment of the system of prescription audit,etc.

Objective To investigate outpatients' awareness of the essential medicine system and their intention to use it at county hospitals,analyze the problems in the implementation process and give suggestions.Methods Using questionnaires to survey randomly intercepted patients.Data so acquired were keyed in twice with Epidata 3.0 and SPSS 16.0 was used for analysis featuring descriptive statistics.Results Among the 1064 patients surveyed,only 159 (14.9％)have heard of essential medicines,and the top three ways of awareness were respectively from medical staff,television and Internet; patients pay most attention to drug efficacy in their daily life and the majority of them follow doctors' advices.Conclusion It is necessary to strengthen promotions,formulate diversified publicity strategy,train doctors to guide patients to use essential medicines rationally.

Objective To explore the depression and anxiety status of patients with refractory irritable bowel syndrome (IBS)and its subtypes.Methods In this large sample,multi-center,prospective survey(Registration number in Chinese Clinical Trial Registry:ChiCTR-TRC-12001969),the patients who conformed to the Rome Ⅲ criteria for IBS were recruited from the department of gastroenterology of three hospitals in Guangdong province from June 2012 to September 2012.And 100 healthy subjects from the examination center of hospitals were recruited at the same time.The 17-item Hamilton Depression Rating Scale(HAMD) and the 14-item Hamilton Anxiety Rating Scale(HAMA) were used to analyze the depression and anxiety,respectively.Results 9802 patients were collected from department of gastroenterology,and a total of 1128 (11.5 ％) patients were diagnosed as IBS.601 of questionnaires were collected,including 142 (23.6％) of refractory IBS and 459 (76.4％) of non-refractory IBS.The incidences of depression,anxiety,depression and anxiety and the HAMD,HAMA scores were higher in refractory IBS group than those in the non-refractory IBS and control group,((66.2％ vs 23.3％ vs 9.0％),P＜0.05 ;(65.5％ vs 28.5％ vs 10.0％),P＜0.05;(58.5％ vs 17.9％ vs 5.0％),P＜0.05;(9.77 ±5.16)vs(5.48 ±4.03)vs(1.66±2.50),P＜0.05;(9.75 ±5.08)vs(5.91 ±3.80)vs(2.26 ±2.68),P＜0.05).And the incidences of moderate-severe depression and moderate-severe anxiety were higher in refractory IBS group than those in the non-refractory IBS and control group ((8.5％ vs 1.3％ vs 0),P＜0.05; (15.5％ vs 3.7％ vs 0),P＜0.05).The incidences of depression,anxiety,depression and anxiety and the HAMD scores were not obviously different among IBS-D,IBS-C,IBS-M and IBS-U subtypes of refractory IBS (P ＞ 0.05).However,the HAMA scores of IBS-D and IBS-M were higher than that of IBS-U((10.10 ± 5.03) vs(7.55 ± 3.22),P ＜ 0.05 ; (12.08 ±6.89) vs (7.55 ± 3.22),P ＜ 0.05).Conclusion The high incidences of depression,anxiety and depression and anxiety,and the serious degrees of depression and anxiety existed in the patients with refractory IBS.And these are the important causes for refractoriness in these patients.

Objective To analyze the influencing factors for doctors' prescription of essential medicines at county hospitals of Anhui province.Methods Multi-stage random sampling method was designed to conduct an investigation for doctors at nine county hospitals in Anhui province,and SPSS 1 6.0 was used to conduct descriptive statistical,chi-square test and binary logistic regression.Results 50.8% respondents reported that they had prescribed essential medicines with the rate of less than 60%. The factors of doctors'prescription for essential medicines are work experience,average monthly income, policy awareness, recognition, training willingness, training times, hospital support, medication preferences,and drug marketing.Conclusion The prescription rate of essential medicines in the sampled hospitals is low,and the targeted comprehensive intervention measures should be taken to promote prescription rate of essential medicines in county hospitals.

Objective To discuss the effect of mirtazapine in depressive functional dyspepsia patients with weight loss (FD-WL).Methods As a randomized and controlled trial,seventy-two FD patients with weight loss and depression were randomly divided into mirtazapine group(n=24),paroxetine group(n=23) and conventional group(n=25),and all patients were treated for 8 weeks.The Nepean Dyspepsia Index (NDI)-symptom checklist,the Hamilton Rating Scale of Depression (HAMD),body weight were assessed before the treatment and after 2,4,6,8 week.Results (1) After 2-week treatment,the scores of NDI-symptom checklist and HAMD in mirtazapine group were significantly lower than that in paroxetine group and conventional group.After 4-week,6-week and 8-week treatment,the score of HAMD in mirtazapine group((13.34±1.52),(11.65±1.56),(10.15±1.36)) and paroxetine group((13.65±1.81),(11.34±1.21),(9.58±1.41))was significantly lower than that in conventional group((18.15±1.61),(17.20±2.14),(15.30±1.56)) (all P<0.05).But there was no statistically difference between mirtazapine group and paroxetine group (P>0.05).(2) After 6-week and 8-week treatment,the body weight in mirtazapine group((53.17±6.46)kg,(53.55±6.52)kg)was significantly higher compared with that in paroxetine group((49.47±5.72)kg,(49.57±5.81)kg)and conventional group((48.69±5.60)kg,(48.68±5.65)kg)(all P<0.05).After 8-week treatment,patients in mirtazapine group experienced a weight gain of(3.34±1.82)kg.Conclusion Mirtazapine not only can significantly improve dyspepsia symptoms and depressive scoring,but also can increase body weight.

Objective To explore the eating behaviors associated with refractory functional dyspepsia (RFD).Methods In this multicenter,prospective trial,1341 new outpatients with functional dyspepsia (FD) from three Guangdong hospitals who had been diagnosed according to the Rome Ⅲ criteria were enrolled from May to September in 2012.One hundred healthy volunteers were also enrolled as controls.A questionnaire was used to obtain data,and logistic regression analysis was used for analysis.Results ①RFD was diagnosed in 24.4％ of the FD patients.②Unhealthy eating behaviors were significantly greater in patients with RFD and non-RFD than in the normal controls.Patients with RFD skipped meals more often,ate extra meals,and preferred sweets and gasproducing foods (P ＜ 0.05).③A comparison among the non-RFD subtypes,showed that those with epigastric pain syndrome had a greater preference for spicy foods (47.5 ％ vs 35.7 ％,P ＜ 0.05),and those with postprandial distress syndrome had a greater preference for sweets(50.0％ vs 36.4％,P ＜ 0.05) and gas-producing foods (14.9％ vs 7.1％,P＜0.05).Those with both subtypes skipped more meals (30.1％ vs 17.0％,P ＜ 0.05),and ate extra meals (15.0％ vs 6.5％,P＜0.05).④Logistic regression analysis showed that meal skipping(95％ CI,1.177 ～2.272; P=0.003),eating extra meals (95％ CI,1.015 ～2.604; P =0.043),and a preference for sweets (95 ％ CI,1.040 ～ 1.757 ; P =0.024) and gas-producing foods (95 ％ CI,1.022 ～ 2.306 ; P =0.039) were risk factors for RFD.Conclusion Unhealthy eating behaviors,especially,meal skipping,eating extra meals,preferring sweets and gas-producing foods correlate with RFD and these behaviors may be the key reasons for the refractory characteristic of RFD.

The cluster sampling method was used and a retrospective survey on mortality trends of cerebrovascular diseases from 1989 to 2008 was conducted among residents from Erqi District in Zhengzhou city and Xigong District in Luoyang city. The average mortality rate of cerebrovascular diseases in these two districts was 69. 5/100 000 in 1989 to 2008. The standardized mortality rate for men was 118. 67/100 000 in 1989 to 1993, and dropped to 44. 23/100 000 in 2004 to 2008. The standardized mortality rate for women was 68.21/100 000 in 1989 to 1993, and dropped to 30. 2/100 000 in 2004 to 2008. The declining trends of cerebrovascular disease mortality rates might be related to early diagnosis and early treatment of the disease, and the extensive health education and prevention programs.

ObjectiveTo encourage development of county-level hospitals by building a performance appraisal indicator system for such institutions. Methods Using the PATH model ( a performance appraisal tool for hospital ) quality improvement, an appraisal system was built for such institutions. Centering on patients, this system encompassed such dimensions as public benefits, quality of care and safety, staff and hospital development. Results This system consisted of six level-1 indicators, 21 level-2 indicators and 70 level-3 indicators, each given due weight. Conclusions This indicator system centers on patients, follows guidance of public benefits, and aims at continuous quality improvement, making it an effective in evaluating hospital performance and providing reference for the decision-makers to promote and adjust medical reform policies.

Objective To explore the clinical application value of high-resolution magnetic resonance imaging (HR-MRI) in the differential diagnoses of moyamoya disease (MMD) and vasculitis-related moyamoya syndrome (V-MMS). Methods A prospective study of clinical data of 22 patients with MMD and 24 patients with V-MMS, admitted to our hospital from January 2014 to September 2016, was performed. HR-MRI and 3D-time of flight-magnetic resonance angiography (3D-TOF-MRA) were performed in all the patients. The proximal middle cerebral artery performance on HR-MRI was recorded: the max-vessel area, min-vessel area, max-lumen area, min-lumen area, wall max-thickness, styles of stenosis of the proximal middle cerebral artery lumen (eccentric stenosis or concentric stenosis), and wall enhancement or not. Results The max-vessel area, min-vessel area, and wall max-thickness of the V-MMS group were significantly larger than those in the MMD group (P<0.05). As compared with patients from MMD group, those from V-MMS group displayed higher distinct and concentric enhancement in the proximal portion of middle cerebral artery (M1 portion) and perforator vessels in basal ganglia region and small vessels in meninges or groove, with statistically significant differences (P<0.05). The sensitivity, specificity and accuracy of M1 portion wall distinct enhancement in diagnosing V-MMS were 75.0％ (18/24), 86.4％ (19/22), and 80.4％ (37/46). The sensitivity, specificity and accuracy of M1 portion wall distinct enhancement combined with perforator vessels in basal ganglia region or small vessels in meningeal or groove in diagnosing V-MMS were 63.6％(15/24), 90.9％(20/22), and 76.1％(35/46). The sensitivity, specificity and accuracy of M1 portion wall distinct enhancement combined with perforator vessels in basal ganglia region or small vessels in meningeal or groove in diagnosing V-MMS were 63.6％ (15/24), 90.9％ (20/22), and 76.1％ (35/46). Conclusion HR-MRI is a good tool in the differential diagnoses of MMD and V-MMS.

Objective: To describe digital media use in college students during the coronavirus disease 2019(COVID-19) outbreak. Methods: A structured self-administered electronic questionnaire was designed and admin istered during February 4 to 12, 2020, collecting information on the use time of digital media and anxiety symptoms of college students in China during the COVID-19 outbreak. Data was analyzed by Chi-square test, univariate and multivariate Logistic regression models. Results: A total of 11 787 university students were recruited. The detection rate of anxiety symptoms was 17.8%. The percentages of screen time ≤2, >2-4 and >4 h/d were 21.3%, 31.4% and 47.3%. The proportions of mobile phone use time ≤2, >2-4 and >4 h/d were 14.6%, 33.2% and 52.3%. The proportion of browsing information regarding COVID-19 ≤1, 1-2 and >2 h/d were 66.6%, 19.4% and 13.9%. The results of Logistic regression analysis revealed that the detection rate of anxiety symptoms was lower among the students having 2-4 h/d of screen time(OR=0.70, 95%CI=0.61-0.81), but higher among the students having more than 4 h/d of screen time(OR=1.13, 95%CI=1.00-1.28) compared with those having ≤2 h/d of video usage time. Compared with the mobile phone usage ≤2 h/d group, the detection rate was lower among >2-4 h/d group(OR=0.78, 95%CI=0.66-0.91). However, anxiety symptoms were more likely to occur in the group of > 4 h/d(OR=1.20, 95%CI=1.04-1.39). The detection of anxiety symptoms was higher in the group with more browsing time. The OR for anxiety symptoms detection rate was 1.55(1.38-1.75) among the students with >1-2 h/d of browsing information regarding COVID-19 and 2.15(1.89-2.44) among the students with >2 h/d of browsing information regarding COVID-19 compared with those with ≤1 h/d of browsing information regarding COVID-19. Conclusion During the epidemic period, the use of >2-4 h/d digital media helps to reduce the occurrence of anxiety symptoms. But the use of computers and mobile phones for more than 4 h/d is associated with higher level of anxiety symptoms among college students. Less screen time spent on fact-checking on COVID-19 might help reduce anxiety sympotoms among college students.