Objective:To analyze the association between continuity of consultation and the management of glycosylated hemoglobin (HbA1c) in diabetes patients contracted by family doctors.Methods:This study was a cross-sectional study. From May 2022 to October 2022, three community health service centers in the urban area of Beijing were selected by convenient sampling. A total of 360 diabetes patients were selected by simple random sampling from the selected centers. Extraction of data from electronic health records were conducted to collect patient characteristics, information on the continuity evaluation indicators for patient visits (usual provider of care, UPC) in 2021 and information of monitoring and control indicators for HbA1c in 2021. The monitoring and control of HbA1c in patients with different continuity of consultations were compared. Chi-square test and logistic regression analysis were used to determine the association between continuity of consultation and HbA1c management (i.e., HbA1c monitoring and control).Results:Of the 360 patients, 167 (46.4%) were male; the age was 68.0 (60.0, 74.0) years and the number of years since diagnosis was 11.0 (7.0, 17.0) years. One hundred and fifty-nine patients (44.1%) had UPC scores below 30%, 101 patients (28.1%) had UPC scores between 30% and 50%, and 100 patients (27.8%) had UPC scores above 50%. The compliance rate for HbA1c monitoring was 66.4% (239/360), and the compliance rate for HbA1c control was 45.8% (165/360). When the UPC score was less than 30%, between 30%-50%, and greater than 50%, the HbA1c monitoring compliance rates were 53.5% (85/159), 73.3% (74/101), and 80.0% (80/100), respectively, and the HbA1c control compliance rates were 37.7% (60/159), 51.5% (52/101), and 53.0% (53/100), respectively, and the differences were statistically significant ( χ2=22.36, 7.57, P<0.05). As the UPC score increased, the likelihood of achieving HbA1c monitoring ( OR=1.020, 95% CI:1.009-1.030 , P<0.001) and control ( OR=1.012, 95% CI:1.003-1.021 ,P=0.008) targets increased. Conclusion:There is an association between the continuity of consultation and the management of HbA1c.

Objective:To evaluate the reliability and validity of the Chinese version of Consultation and Relational Empathy (CARE) Measure in the Mandarin speaking population.Methods:From March to June 2018, patient interviews and expert consultations were conducted to explore problems of CARE in Mandarin context and preliminary revisions were made to the measure, then the final adapted tool was developed. A questionnaire survey on the validity of the measure was conducted from July to August 2018, among 373 patients from three community health service centers in Beijing Chaoyang District, selected by convenience sampling. The questionnaire included general information of participants and the revised CARE measure. The results of the survey were analyzed for the reliability and validity of Chinese version of CARE measure.Results:In the culture adaptation stage, 30 word-changes and 13 phrase-changes were made to improve the cultural adaptation of CARE. A total of 373 valid questionnaires were were collected with a valid recovery rate of 100.0%. The participants had a mean age of (60.8±13.12) years, with females of 68.6% (256/373), junior high school or high school education of 58.7% (219/373), and retirees of 71.3% (266/373). The results showed that there was a significant difference in scores of each item between the high group (top 27%) and the low group (bottom 27%) ( P<0.001). There was a positive correlation between each item and the total score, with a correlation coefficient between 0.817 and 0.868 ( P<0.001). The reliability analysis results show that the Cronbach′s α of the revised CARE was 0.960. In the content validity analysis, among the 10 items, the proportion of patients who considered the item "not applicable" was between 1.1% and 4.8%, and the proportion who considered the item "important" was between 92.8% and 96.2%. In exploratory factor analysis, KMO=0.944 and Bartlett′s sphericity test P<0.001. One common factor with an eigenvalue>1 was extracted, and the cumulative variance explained by which was 73.85%, with the load value of each item of 0.815-0.909. Conclusion:The revised Chinese version of CARE measure shows good reliability and validity and it can be applied in primary care settings for Mandarin speaking population.

Objective:To explore the effect of modified reed tube moxibustion based on spleen-kidney mutual assistance theory in patients with continuous ambulatory peritoneal dialysis (CAPD) combined with spleen-kidney yang deficiency type of insomnia.Methods:From September 2020 to December 2022, 64 patients with CAPD combined with insomnia of spleen-kidney yang deficiency type were selected from the Department of Nephrology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University by the convenience sampling method. A randomized numerical table method was used to divide study subjects into a control group and a study group, with 32 cases in each group. The control group received conventional treatment and auricular needle-embedding therapy; while the study group received traditional treatment and auricular needle-embedding therapy combined with modified reed tube moxibustion. The intervention period lasted three months. Differences in Insomnia Severity Index, Chinese medicine syndrome score, and peritoneal dialysis adequacy were compared between the two groups.Results:After intervention, the Insomnia Severity Index score of the study group was lower than those of the control group, and the difference was statistically significant ( P<0.05). The urea clearance index and creatinine clearance rate of the study group were higher than those of the control group, and the differences were statistically significant (all P<0.05) . Conclusions:Modified reed tube moxibustion based on spleen-kidney mutual assistance theory has a positive effect on improving insomnia symptoms and dialysis adequacy in patients with CAPD combined with insomnia of spleen-kidney yang deficiency type.

Objective:To explore the effect of modified reed tube moxibustion based on spleen-kidney mutual assistance theory in patients with continuous ambulatory peritoneal dialysis (CAPD) combined with spleen-kidney yang deficiency type of insomnia.Methods:From September 2020 to December 2022, 64 patients with CAPD combined with insomnia of spleen-kidney yang deficiency type were selected from the Department of Nephrology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University by the convenience sampling method. A randomized numerical table method was used to divide study subjects into a control group and a study group, with 32 cases in each group. The control group received conventional treatment and auricular needle-embedding therapy; while the study group received traditional treatment and auricular needle-embedding therapy combined with modified reed tube moxibustion. The intervention period lasted three months. Differences in Insomnia Severity Index, Chinese medicine syndrome score, and peritoneal dialysis adequacy were compared between the two groups.Results:After intervention, the Insomnia Severity Index score of the study group was lower than those of the control group, and the difference was statistically significant ( P<0.05). The urea clearance index and creatinine clearance rate of the study group were higher than those of the control group, and the differences were statistically significant (all P<0.05) . Conclusions:Modified reed tube moxibustion based on spleen-kidney mutual assistance theory has a positive effect on improving insomnia symptoms and dialysis adequacy in patients with CAPD combined with insomnia of spleen-kidney yang deficiency type.

Objective:To analyze the association between continuity of consultation and the management of glycosylated hemoglobin (HbA1c) in diabetes patients contracted by family doctors.Methods:This study was a cross-sectional study. From May 2022 to October 2022, three community health service centers in the urban area of Beijing were selected by convenient sampling. A total of 360 diabetes patients were selected by simple random sampling from the selected centers. Extraction of data from electronic health records were conducted to collect patient characteristics, information on the continuity evaluation indicators for patient visits (usual provider of care, UPC) in 2021 and information of monitoring and control indicators for HbA1c in 2021. The monitoring and control of HbA1c in patients with different continuity of consultations were compared. Chi-square test and logistic regression analysis were used to determine the association between continuity of consultation and HbA1c management (i.e., HbA1c monitoring and control).Results:Of the 360 patients, 167 (46.4%) were male; the age was 68.0 (60.0, 74.0) years and the number of years since diagnosis was 11.0 (7.0, 17.0) years. One hundred and fifty-nine patients (44.1%) had UPC scores below 30%, 101 patients (28.1%) had UPC scores between 30% and 50%, and 100 patients (27.8%) had UPC scores above 50%. The compliance rate for HbA1c monitoring was 66.4% (239/360), and the compliance rate for HbA1c control was 45.8% (165/360). When the UPC score was less than 30%, between 30%-50%, and greater than 50%, the HbA1c monitoring compliance rates were 53.5% (85/159), 73.3% (74/101), and 80.0% (80/100), respectively, and the HbA1c control compliance rates were 37.7% (60/159), 51.5% (52/101), and 53.0% (53/100), respectively, and the differences were statistically significant ( χ2=22.36, 7.57, P<0.05). As the UPC score increased, the likelihood of achieving HbA1c monitoring ( OR=1.020, 95% CI:1.009-1.030 , P<0.001) and control ( OR=1.012, 95% CI:1.003-1.021 ,P=0.008) targets increased. Conclusion:There is an association between the continuity of consultation and the management of HbA1c.

Objective:To evaluate the reliability and validity of the Chinese version of Consultation and Relational Empathy (CARE) Measure in the Mandarin speaking population.Methods:From March to June 2018, patient interviews and expert consultations were conducted to explore problems of CARE in Mandarin context and preliminary revisions were made to the measure, then the final adapted tool was developed. A questionnaire survey on the validity of the measure was conducted from July to August 2018, among 373 patients from three community health service centers in Beijing Chaoyang District, selected by convenience sampling. The questionnaire included general information of participants and the revised CARE measure. The results of the survey were analyzed for the reliability and validity of Chinese version of CARE measure.Results:In the culture adaptation stage, 30 word-changes and 13 phrase-changes were made to improve the cultural adaptation of CARE. A total of 373 valid questionnaires were were collected with a valid recovery rate of 100.0%. The participants had a mean age of (60.8±13.12) years, with females of 68.6% (256/373), junior high school or high school education of 58.7% (219/373), and retirees of 71.3% (266/373). The results showed that there was a significant difference in scores of each item between the high group (top 27%) and the low group (bottom 27%) ( P<0.001). There was a positive correlation between each item and the total score, with a correlation coefficient between 0.817 and 0.868 ( P<0.001). The reliability analysis results show that the Cronbach′s α of the revised CARE was 0.960. In the content validity analysis, among the 10 items, the proportion of patients who considered the item "not applicable" was between 1.1% and 4.8%, and the proportion who considered the item "important" was between 92.8% and 96.2%. In exploratory factor analysis, KMO=0.944 and Bartlett′s sphericity test P<0.001. One common factor with an eigenvalue>1 was extracted, and the cumulative variance explained by which was 73.85%, with the load value of each item of 0.815-0.909. Conclusion:The revised Chinese version of CARE measure shows good reliability and validity and it can be applied in primary care settings for Mandarin speaking population.

Objective:To explore the current status of the post competency evaluation index systems of Chinese general practitioners (GPs), and to summarize the post competency evaluation index systems of GPs in China.Methods:This study was a systematic review. We searched China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, China Science and Technology Journal Database (CQVIP), SinoMed, PubMed and other databases using "general practitioner" or "family doctor" or "standardized training for residents" or "post competency" or "evaluation system" or "core capability" or "assessment" or "evaluation" etc. as search terms and adding free words. The search was conducted from data establishment to October 2022. Literature screening and data extraction were carried out independently by 2 researchers using strict inclusion and exclusion criteria. The Ekman quality evaluation tool was used to evaluate the quality of the included literature. Excel was used to extract data information, including basic information of literatures, basic information of index systems and index content.Results:A total of 1 284 literatures were retrieved and 33 studies were included. A total of 15 research methods were used, and 28 (84.8%) applied 3 or more methods. There were 14 studies (42.4%) with good reliability and validity, and 17 studies (51.5%) with index weights. There were 12 applied theoretical bases, of which 20 studies (60.6%) used mature foreign competency models as a reference, 14 studies (42.4%) combined the job analysis and position requirements of GPs, and 11 studies (33.3%) interpreted policy documents. The content analysis method yielded 1 537 initial indicators, 1 268 indicators after eliminating repeated indicators, and 6 first-level indicators and 31 second-level indicators after combining and summarizing. Among the first-level indexes, "patient care" appeared most frequently (36.4% (462/1 268)); the secondary index with the highest frequency in this dimension was "master medical theoretical knowledge" followed by "community-oriented care ability" and "treatment and follow-up of common and frequently-occurring diseases"; the indicators "family-based care ability" and "human-centered care concept" reflected the characteristics of general medical practice. The frequency of "professional spirit and moral quality" (16.3%(207/1 268)), "clinical teaching and learning ability" (14.3%(181/1 268)) and "system-based practical ability"(11.1%(141/1 268)) ranked second, third and fourth among the first-level indicators respectively. The frequency of "basic public health service ability" (11.0%(139/1 268)) ranked the fifth, and the secondary indicator "health management of key community groups" reflected the concept of the whole life cycle of residents and the basic principle of continuity of care in general medicine. The frequency of "interpersonal and communication skills"(10.9%(138/1 268)) ranked sixth.Conclusions:There have been numerous researches on the post competency index evaluation system of GPs in China, but more research is still needed. There are many research methods with rich theoretical basis and Chinese characteristics. This study summarized the post competency evaluation index systems of GPs in China, generalized 6 first-level indicators and 31 second-level indicators that reflect the basic principles and characteristics of general medicine.

Objective To explore the effect of physical exercise on semen quality in order to provide basic data and theoretical basis for the improvement of male reproductive health.Methods A cross-sectional study was conducted on 1 059 males who visited the Reproductive Medicine Center of Shandong Maternal and Child Health Hospital for medical treatment and physical examination during July 2022 and April 2023.Their demographic data and physical exercise data were surveyed with questionnaires.Total sperm count,sperm concentration,total sperm motility,forward movement and normal sperm morphology were analyzed with computer aided analysis.Logistic regression model and multiple linear regression model were applied to analyze the effects of physical exercise on semen quality.Results After adjustment for confounding factors such as age,body mass index,alcohol consumption and smoking,logistic regression analysis showed that the risk of abnormal semen quality was increased in patients with moderate and heavy exercise intensity(OR=2.103,OR=2.229).Compared with the participants with physical exercise ≤10 min per session,those with＞20 min per session had a lower risk of abnormal semen quality(OR=0.357,0.256,0.289 for exercise time for＞20～30,＞30～60,＞60 min,respectively).There was no statistical significance between physical exercise frequency and semen quality(P＞0.05).The participants having exercise well were at a lower risk for abnormal semen quality(OR=0.711).Multiple linear regression analysis revealed that the frequency of physical exercise was an influencing factor of sperm concentration(β=7.474,95％CI:4.800～10.149,P＜0.05);the time of physical exercise per session was an influencing factor for total sperm count(β=20.632,95％CI:7.634～33.629);the intensity of physical exercise(β=-1.461,95％CI:-2.392～-0.530)and time of physical exercise per session(β=2.608,95％CI:1.404～3.812,P＜0.05)were influencing factors for percentage of forward motility sperm(P＜0.05);and physical exercise intensity(β=-1.934,95％CI:-3.238～-0.630),time of physical exercise per session(β=4.211,95％CI:2.525～5.897)and frequency of physical exercise(β=-2.008,95％CI:-3.480～-0.536)were influencing factors of total sperm motility(P＜0.05).Conclusion Physical exercise may affect semen quality,greater intensity of physical exercise may be a risk factor for abnormal semen quality,and longer physical exercise time may be related to improving semen quality.Therefore,proper physical exercise can help improve semen quality.

Background::T-cell-mediated immunity is crucial for the effective clearance of viral infection, but the T-cell-mediated immune responses that are induced by booster doses of inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in people living with human immunodeficiency virus (PLWH) remain unclear.Methods::Forty-five PLWH who had received antiretroviral therapy (ART) for more than two years and 29 healthy controls (HCs) at Beijing Youan Hospital were enrolled to assess the dynamic changes in T-cell responses between the day before the third vaccine dose (week 0) and 4 or 12 weeks (week 4 or week 12) after receiving the third dose of inactivated SARS-CoV-2 vaccine. Flow cytometry, enzyme-linked immunospot (ELISpot), and multiplex cytokines profiling were used to assess T-cell responses at the three timepoints in this study.Results::The results of the ELISpot and activation-induced marker (AIM) assays showed that SARS-CoV-2-specific T-cell responses were increased in both PLWH and HCs after the third dose of the inactivated SARS-CoV-2 vaccine, and a similar magnitude of immune response was induced against the Omicron (B.1.1.529) variant compared to the wild-type strain. In detail, spike-specific T-cell responses (measured by the ELISpot assay for interferon γ [IFN-γ] release) in both PLWH and HCs significantly increased in week 4, and the spike-specific T-cell responses in HCs were significantly stronger than those in PLWH 4 weeks after the third vaccination. In the AIM assay, spike-specific CD4 + T-cell responses peaked in both PLWH and HCs in week 12. Additionally, significantly higher spike-specific CD8 + T-cell responses were induced in PLWH than in HCs in week 12. In PLWH, the release of the cytokines interleukin-2 (IL-2), tumour necrosis factor-alpha (TNF-α), and IL-22 by peripheral blood mononuclear cells (PBMCs) that were stimulated with spike peptides increased in week 12. In addition, the levels of IL-4 and IL-5 were higher in PLWH than in HCs in week 12. Interestingly, the magnitude of SARS-CoV-2-specific T-cell responses in PLWH was negatively associated with the extent of CD8 + T-cell activation and exhaustion. In addition, positive correlations were observed between the magnitude of spike-specific T-cell responses (determined by measuring IFN-γ release by ELISpot) and the amounts of IL-4, IL-5, IL-2 and IL-17F. Conclusions::Our findings suggested that SARS-CoV-2-specific T-cell responses could be enhanced by the booster dose of inactivated COVID-19 vaccines and further illustrate the importance of additional vaccination for PLWH.

BACKGROUND: T-cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif domains (TIGIT), an inhibitory receptor expressed on T cells, plays a dysfunctional role in antiviral infection and antitumor activity. However, it is unknown whether TIGIT expression on T cells influences the immunological effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) inactivated vaccines. METHODS: Forty-five people living with HIV (PLWH) on antiretroviral therapy (ART) for more than two years and 31 healthy controls (HCs), all received a third dose of a SARS-CoV-2 inactivated vaccine, were enrolled in this study. The amounts, activation, proportion of cell subsets, and magnitude of the SARS-CoV-2-specific immune response of TIGIT + CD4 + and TIGIT + CD8 + T cells were investigated before the third dose but 6 months after the second vaccine dose (0W), 4 weeks (4W) and 12 weeks (12W) after the third dose. RESULTS: Compared to that in HCs, the frequency of TIGIT + CD8 + T cells in the peripheral blood of PLWH increased at 12W after the third dose of the inactivated vaccine, and the immune activation of TIGIT + CD8 + T cells also increased. A decrease in the ratio of both T naïve (T N ) and central memory (T CM ) cells among TIGIT + CD8 + T cells and an increase in the ratio of the effector memory (T EM ) subpopulation were observed at 12W in PLWH. Interestingly, particularly at 12W, a higher proportion of TIGIT + CD8 + T cells expressing CD137 and CD69 simultaneously was observed in HCs than in PLWH based on the activation-induced marker assay. Compared with 0W, SARS-CoV-2-specific TIGIT + CD8 + T-cell responses in PLWH were not enhanced at 12W but were enhanced in HCs. Additionally, at all time points, the SARS-CoV-2-specific responses of TIGIT + CD8 + T cells in PLWH were significantly weaker than those of TIGIT - CD8 + T cells. However, in HCs, the difference in the SARS-CoV-2-specific responses induced between TIGIT + CD8 + T cells and TIGIT - CD8 + T cells was insignificant at 4W and 12W, except at 0W. CONCLUSIONS TIGIT expression on CD8 + T cells may hinder the T-cell immune response to a booster dose of an inactivated SARS-CoV-2 vaccine, suggesting weakened resistance to SARS-CoV-2 infection, especially in PLWH. Furthermore, TIGIT may be used as a potential target to increase the production of SARS-CoV-2-specific CD8 + T cells, thereby enhancing the effectiveness of vaccination.
Humans ; Antibodies, Viral ; CD8-Positive T-Lymphocytes ; COVID-19/complications* ; COVID-19 Vaccines/immunology* ; HIV Infections/complications* ; Receptors, Immunologic ; SARS-CoV-2