Objective: Schizophrenia is a common mental disorder, and mitochondrial function represents a potential therapeutic target for psychiatric diseases. The role of mitochondrial metabolism-related genes (MRGs) in the diagnosis of schizophrenia remains unknown. This study aimed to identify candidate genes that may influence the diagnosis and treatment of schizophrenia based on MRGs. Methods: Three schizophrenia datasets were obtained from the Gene Expression Omnibus database. MRGs were collected from relevant literature. The differentially expressed genes between normal samples and schizophrenia samples were screened using the limma package. Venn analysis was performed to identify differentially expressed MRGs (DEMRGs) in schizophrenia. Based on the STRING database, hub genes in DEMRGs were identified using the MCODE algorithm in Cytoscape. A diagnostic model containing hub genes was constructed using LASSO regression and logistic regression analysis. The relationship between hub genes and drug sensitivity was explored using the DSigDB database. An interaction network between miRNA-transcription factor (TF)-hub genes was created using the Network-Analyst website. Results: A total of 1,234 MRGs, 172 DEMRGs, and 6 hub genes with good diagnostic performance were identified. Ten potential candidate drugs (rifampicin, fulvestrant, pentadecafluorooctanoic acid, etc.) were selected. Thirty-four miRNAs targeting genes in the diagnostic model (ANGPTL4, CPT2, GLUD1, MED1, and MED20), as well as 137 TFs, were identified. Conclusion Six potential candidate genes showed promising diagnostic significance. rifampicin, fulvestrant, and pentadecafluorooctanoic acid were potential drugs for future research in the treatment of schizophrenia. These findings provided valuable evidence for the understanding of schizophrenia pathogenesis, diagnosis, and drug treatment.

Objective: To analyse the construction and use of primary and secondary school clinics in China, and to provide the reference for the construction and management of infrastructure of the clinics of primary and secondary schools. Methods: By using stratified cluster random sampling method, 873 primary and secondary schools were selected in east, middle and west of China as research objects to describe the construction and management of the clinics of primary and secondary schools. Regional differences were analyzed by statistical method. Results: Among the 873 schools investigated, 294 (33.7%) schools had clinics, 177 (20.3%) schools had healthcare rooms, and 402 (46.0%) schools had no clinics or healthcare rooms. Among the 294 clinics, only 56 (19.0%) schools had medical institution licenses; 73 (24.8%) schools had a construction area of ≥40 square meters; 135 (45.9%) schools had legal clinics, and 38 (12.9%) schools was a disinfection supply room, 2 (<0.01%) schools had a laboratory, 165 (56.1%) schools was not independent between the departments; the overall standard school clinics construction rate was less than 5%. There were differences in the construction of clinics and healthcare rooms in the east, middle and west parts of China (χ2=237.33, P<0.01). Equipment allocation of the country's primary and secondary schools’ clinics were uneven among regions. The normal allocation rates of thermometer, visual acuity chart and lever weight scale were 96.6%, 83.0% and 75.9%, respectively, and the allocation rate of ultraviolet lamp was 66.7%. Less than 50% syringes and high-pressure sterilizers could be used normally. The reasons for the failure to provide health services in clinics was the absence of equipment and space, which account for 43%. Conclusion The construction of school clinics and healthcare rooms in China is insufficient, and regional differences are obvious, especially in the west. It is necessary to strengthen regional construction, allocate and use the equipment reasonably.

Objective:To evaluate the implementation of the China Healthcare Improvement Initiative(CHII)from 2018 to 2020 in 143 tertiary public hospitals in China.Methods:In March 2019 and from January to March in 2021, 143 tertiary public hospitals in 31 provinces of China were investigated using the unified " medical institution questionnaire Ⅰ" and " medical institution Questionnaire Ⅱ" . The data were collected by means of hospital self-report and expert on-site scoring. Descriptive and inferential statistical analysis were used to analyze the data, and the data of two cross-sectional surveys were compared and analyzed.Results:The average score rate of implementing CHII in 143 sample hospitals in 2020 was 88.9%, which was higher than that in 2018(84.4%). The appointment diagnosis and treatment system, clinical pathway management system, day service, smart hospital and humanistic service were significantly improved. In 2020, the average score rate of logistics service, high quality nursing service and clinical pathway management system was higher than 95%, while the average score rate of day service, telemedicine system and medical social work system was lower than 85%. The total score rate of general hospitals was significantly higher than that of specialized hospitals( P<0.001). In 2020, the proportion of hospitals with full marks in 29 secondary indicators(74.4%)was more than 80%, reaching the standard level. Conclusions:The implementation level of CHII in tertiary public hospitals in China has been improved continuously and made significant progress, but some dimensions and indicators need to be further improved.

Objective:To explore the change trend of patients′ recognition of the medical reform effect and medical staff′s occupation and its relationship with medical experience, since the implementation of the China Healthcare Improvement Initiative(CHII), so as to provide reference for exploring the breakthrough point of consolidating the reform effect.Methods:Four indicators of the third-party assessment of patients were selected, which were " I think the medical reform has benefited patients" , " I think the doctor-patient relationship is improving in the past three years" , " I think medical personnel deserve social respect and recognition" , and " I am willing to let my children join the medical profession" . Descriptive and trend analysis were carried out on the survey results, and correlation analysis was carried out between the survey results and patients′ medical experience.Results:Compared with the baseline evaluation results(76.9% and 69.9%for outpatients, 87.3% and 85.6%for inpatients), the patients′ recognition of the sense of medical reform and the improvement of doctor-patient relationship in the fifth evaluation(86.2% and 89.1%for outpatients, 91.4% and 92.6%for inpatients)were significantly improved. The proportion of patients who thought the medical staff was worthy of respect and willing to let their children work in the hospital in the fifth evaluation(97.4%, 79.1%for outpatients, 98.7%, 85.1%for inpatients)were higher than the baseline evaluation results(92.3%, 71.0%for outpatients, 98.1%, 81.6%for inpatients). The above indicators were positively correlated with the patient′s medical experience.Conclusions:Since the implementation of CHII, patients′ recognition of the sense of medical reform and the improvement of doctor-patient relationship has been continuously improved, and patients′ respect and recognition of professional identity of medical personnel is at a high level and continues to improve. Improving medical experience has a positive effect on the improvement of patients′ sense of medical reform.

Objective:To analyze the status quo, trend and influencing factors of patient satisfaction in tertiary maternity and child hospitals in China.Methods:Based on the survey results of five round third-party evaluations of the China Healthcare Improvement Initiative from 2016 to 2021, descriptive trend analysis was conducted on the satisfaction index in tertiary maternity and child hospitals, and the influencing factors of satisfaction were analyzed based on the results of the fifth evaluation.Results:Compared with the first round, the overall patient satisfaction in tertiary maternity and child hospitals in the fifth round was improved(inpatient: from 95.7% to 98.0%; outpatient: from 87.8% to 94.9%). Outpatient satisfaction varied significantly among gender, hospitals of different types, education level, types of treatment, medical insurance and doctors′ titles( P<0.05). Outpatient satisfaction in local hospitals was 1.502 times higher than that in hospitals under the National Health Commission. The satisfaction of referrals was 0.259 times lower than that of patients who were admitted directly. Inpatient satisfaction varied significantly among department, hospitals of different regions, household registration type and whether the admission was delayed due to the COVID-19 epidemic( P<0.05). The satisfaction of inpatients in medical ward and surgical ward was respectively 0.202 and 0.298 times lower than that of inpatients in pediatric ward. Inpatient satisfaction at the central regions was 3.311 times higher than that at the eastern regions. Conclusions:The overall patient satisfaction in tertiary maternity and child hospitals in China is improving. In the future, we should pay more attention to the hospital environment, humanistic care and other non-medical service dimensions with low satisfaction, so as to further improve the medical experience of patients in maternity and child hospitals.

Objective:To investigate the patient satisfaction at tertiary cancer hospitals in China, and explore its determinants.Methods:Based on the fifth third-party evaluation of China Healthcare Improvement Initiative, an inpatient satisfaction survey was conducted from January 2021 to March 2021 in 33 tertiary cancer hospitals in China. Inpatient satisfaction was analyzed, and Chi-square test and binary multivariate logistic regression were run, using the level of overall inpatient satisfaction as a dependent variable.Results:A total of 5 417 inpatients in tertiary cancer hospitals was recruited with 49.8% men. The inpatient at the age of 35-59 accounted for 56.0%, and they were 52.8±13.9 years old. The level of overall inpatient satisfaction was 98.90%. The inpatient satisfaction rates of meal service, waiting time for admission and psychological counseling service provided by hospital were relatively poor, which were 78.75%, 92.40% and 94.11%, respectively. The regression showed that level of overall inpatient satisfaction in the central and western regions(compared with eastern area), with urban and rural residents basic medical insurance or other type(compared with urban employee basic medical insurance), of breast cancer patients(compared with other disease), with unsured postoperative metastasis(compared with non-postoperative metastasis), with low self-rated health score(compared with the score of between 81 and 100)was lower.Conclusions:The inpatients in tertiary cancer hospitals in China is highly satisfied with the care provided. In the future, more attention should be paid to the dimension of lower patient satisfaction, such as diet and psychological counseling.

Objective:To analyze the salary level, change trend and salary satisfaction of nurses in tertiary public hospitals in China.Methods:The data was derived from three round third-party evaluation of the China Healthcare Improvement Initiative at 136 tertiary public hospitals from December 2017 to January 2018, March 2019 and January to March 2021. The self-reported salary, expected salary and salary satisfaction rate of nurses were analyzed.Results:The sample sizes of the three evaluations were 27 575, 27 568 and 25 197, representing the salary situation in 2017, 2018 and 2020 respectively. In 2017, 2018 and 2020, the actual average annual salary of nurses was 81 600 yuan, 100 000 yuan and 110 000 yuan respectively, the expected average annual salary was 140 000 yuan, 160 000 yuan and 160 000 yuan respectively, and the ratio of expected salary to actual salary was 1.72, 1.60 and 1.45 respectively. In 2017, 2018 and 2020, the proportion of nurses satisfied with their current income was 34.0%, 33.7% and 43.6% respectively. In 2020, nurses in the eastern region, other specialized hospitals, senior professional titles and graduate degrees had highest annual salary.Conclusions:The salary level and satisfaction rate of nurses in tertiary public hospitals in China show a slow growth trend, and the gap between actual salary and expected salary is gradually narrowing.

Objective:To analyze the practice and experience of " patient-centered, popularizing multi-disciplinary team(MDT) mode" in medical institutions, and to put forward reasonable suggestions and opinions for medical institutions to further improve and popularize MDT mode.Methods:Based on the evaluation of China Healthcare Improvement Initiative, 40 typical cases of MDT in medical institutions were collected, and descriptive analysis and textual analysis were carried out on the cases.Results:There were more specialized hospitals carrying out MDT, the application scope of MDT services was constantly expanding, and the management system and diagnosis and treatment process were constantly optimized.Conclusions:The mode of MDT in China is in the stage of exploration and development. In the promotion process, it is necessary to give full play to the role of information means, establish scientific and reasonable cost measurement and charge standard, and improve the enthusiasm of medical institutions and medical personnel to participate in MDT.

Objective To explore the effect of the utilization of National Basic Public Health Service (NBPHS) on the regular medication behavior and glycemic control of patients aged 35 and over with type 2 diabetes, and to provide support for the health management practice of type 2 diabetes patients in China. Methods Based on the multi-stage stratified sampling method, a questionnaire survey was conducted in 10 community health service centers or township health centers in Zhejiang Province, Shanxi Province and Chongqing City in China from November to December 2019. The data of socio-demographic characteristics, utilization of NBPHS in the last year, regular medication in the last six months and glycemic control were collected. The effect of NBPHS utilization on the regular medication rate and glycemic control rate of type 2 diabetes patients was analyzed by logistic regression. Sensitivity analysis was carried out using the multilevel logistic method and the total score calculation method for basic public health services in different countries. Results A total of 1 527 patients with type 2 diabetes aged 35 and over were recruited, 41.00% were male, 66.08% were aged 65 years old and above, and 39.64% were ill for 10 years and over. The survey showed that the regular medication rate was 89.26%, the glycemic control rate was 65.23%, and the score on utilization of NBPHS was 11.83±2.246 (range 0-15). With the more utilization of NBPHS, regular medication rate in patients with type 2 diabetes increased (χ²_trend=4.816, P<0.05), but there was no statistical difference in the trend of glycemic control rate (χ²_trend=0.080, P>0.05). The multivariate regression analysis showed that secondary school and above (OR=2.20), longer duration of disease (OR_{5-9 years}=1.62, OR_{10 year and above}=3.92) and higher utilization score of NBPHS (OR_Q3=2.01) were protective factors for the regular medication. Compared with the local household registration population, the local resident population (OR=0.54) was a risk factor for regular medication. Unmarried or divorced or widowed (OR=0.61) and longer course of disease (OR_{10 year and above}=0.60) were risk factors for satisfactory glycemic control, while increased monthly income per household (OR_{2000-5000 yuan}=1.52, OR_{More than 5000 yuan}=1.76) was a protective factor for satisfactory glycemic control. Conclusion The utilization of NBPHS has promoted the regular medication rate of patients with type 2 diabetes, and the higher utilization takes better effect. Emphasis should be paid on patients with low education level, non-local household registration, short course of disease, and no partner. At the same time, it is necessary to strengthen the utilization of NBPHS to promote the change of their health awareness and health behavior..

Objective: To carry out the 4^th round of third-party evaluation on the implementation and effect of the 1^st year of the 2^nd Phase National Healthcare Improvement Initiative(abbreviated as Initiative)since 2015. Methods: The 4^th round of the evaluation survey adopted the same methods, organization and execution, and technical roadmap as the former three rounds of evaluations. Results: The 4^th round of evaluation was carried out from 18 March to 9 April, 2019 at 185 public hospitals in 31 provinces(autonomous regions, municipalities directly under the Central Government)and Xinjiang Production and Construction Corps.Facility survey, health professional survey and patient survey were conducted at each of the sample health facilities. A total of 120 782 valid questionnaires were collected from 144 non-psychiatric health facilities, 16 246 valid questionnaires were obtained from 41 psychiatric health facilities, and 252 cases of outstanding departments/hospitals in healthcare improvement were also collected. The average overall scoring of the 12 dimensions to assess Initiative implementation at 144 non-psychiatric health facilities was 84.4%. The overall outpatient satisfaction scoring was 91.1%, 96.7%for the inpatients. The overall inpatient satisfaction(family members inclusive) at 41 psychiatric health facilities was 93%. Areas remaining to be improved include day-surgery, telemedicine and medical social work. Compared with technical services, non-technical care should be further strengthened. The compensation, workload and work environment of the healthcare providers are still to be improved. Conclusions The implementation of the Initiative by health facilities has been greatly improved. The percentage of health facilities and patients who had positive perceptions of improved doctor-patient relationship has been increasing. Patient care experiences at public hospitals have been generally improved, and the implementation of promoting traditional Chinese Medicine practices also made progress. However, work satisfaction of healthcare providers was found to be rather low, compared to the high level of patient satisfaction.