Objective:To explore the current implementation status and challenges of family doctor contract services (FDCS) from the perspective of contracted residents.Methods:This qualitative study used purposive sampling to select contracted residents from 11 primary healthcare institutions across five cities in China. Semi-structured interviews were conducted from March to December 2024, covering topics such as awareness of contracting, service experience, health needs, service continuity, and policy recommendations. Thematic framework analysis was applied to organize, code, and summarize the data.Results:A total of 25 contracted residents were interviewed (6 men, 19 women; 11 from central urban areas, 14 from suburban or rural towns; 8 with chronic diseases). Three main themes and ten sub-themes emerged: Theme Ⅰ: Pathways to improved service accessibility (optimized chronic disease management, more efficient referrals, and improved health education). Theme Ⅱ: Structural misalignment between supply and demand (limited specialty services despite patient needs, insufficient coverage and public awareness of home-based medical care, imbalanced human resources, and service disruption due to clinician turnover). Theme Ⅲ: Challenges in service awareness and communication mechanisms (information asymmetry and public misperception regarding FDCS, perverse incentives in administrative performance evaluation, and communication barriers in building patient-doctor trust).Conclusions:While FDCS has shown progress in chronic disease management, referral coordination, and health education, structural supply-demand gaps and communication challenges continue to hinder service quality. Improvements in resource allocation and service models are needed to support high-quality development.

Objective To investigate the levels of serum Vasostatin-1 and Autotaxin and their clinical sig-nificance in patients with pre-eclampsia(PE).Methods A total of 120 patients with PE(PE group)admitted to the hospital from January 2021 to January 2023 and 60 healthy pregnant women who underwent routine prenatal examinations during the same period(control group)were selected as the research subjects.Accord-ing to the severity of the disease,the patients in the PE group were divided into the severe PE group(65 ca-ses)and the mild PE group(55 cases).According to the pregnancy outcomes,they were divided into the poor group(57 cases)and the good group(63 cases).The levels of serum Vasostatin 1 and Autotaxin were detec-ted by enzyme-linked immunosorbent assay.Multivariate unconditional Logistic regression was used to analyze the influencing factors of adverse pregnancy outcomes of PE.The receiver operating characteristic curve was drawn to evaluate the predictive value of serum Vasostatin 1 and Autotaxin levels for adverse pregnancy out-comes of PE.Results Compared with the control group,the levels of serum Vasostatin 1 and Autotaxin in the PE group increased,and the differences were statistically significant(Z=-5.924,-6.188;both P＜0.001).Compared with the mild PE group,the levels of serum Vasostatin 1 and Autotaxin in the severe PE group in-creased,and the differences were statistically significant(Z=-4.667,-4.180;both P＜0.001).Compared with the good group,the levels of serum Vasostatin 1 and Autotaxin in the poor group increased with statisti-cal significance(Z=-5.500,-5.390;both P＜0.001).The results of Logistic regression analysis showed that severe PE(OR=3.383,95％CI:1.270-9.011),high 24 h urine protein(OR=1.888,95％CI:1.199-2.972),high Vasostatin-1(OR=1.022,95％CI:1.008-1.036)and Autotaxin(OR=4.370,95％CI:1.739-10.983)were independent risk factors for adverse pregnancy outcomes in patients with PE(P＜0.05).The area under the curve for the combined prediction of adverse pregnancy outcomes in PE patients by serum Va-sostatin 1 and Autotaxin levels was 0.864(95％CI:0.790-0.920),which was greater than predicted sepa-rately,which were 0.791(95％CI:0.708-0.860),0.786(95％CI:0.701-0.855),and the differences were statistically significant(Z=2.595,2.462;both P＜0.05).Conclusion Elevated serum Vasostatin-1 and Au-totaxin levels in PE patients are associated with the aggravation of the disease and adverse pregnancy out-comes.The combined detection of serum Vasostatin 1 and Autotaxin levels has a high predictive efficacy for the pregnancy outcomes of patients with PE.

Objective:To analyse the 3D-Flair MRI manifestations of the inner ear, vestibular function status, and their correlation with hearing treatment outcomes in patients with severe sudden sensorineural hearing loss (SSNHL), and to explore potential prognostic indicators for sudden deafness.Methods:The clinical data of adult patients with unilateral profound sudden sensorineural hearing loss were retrospectively analyzed in Otorhinolaryngology Department of Shandong Provincial ENT Hospital from March 2018 to August 2020. Patients were categorized based on the results of their inner ear 3D-Flair MRI into two groups: the normal MRI group and the abnormal MRI group. The abnormal group was further divided into three subgroups: those with non-absorbed high signal in the inner ear, those with absorbed high signal, and those with destruction of the blood-labyrinth barrier. SPSS 26.0 statistical software was applied to analyze the differences in hearing efficacy, caloric tests, vestibular evoked myogenic potentials (VEMP), video head impulse tests (vHIT), and the incidence of dizziness/vertigo among various patient groups.Results:A total of 191 patients with complete data were collected (97 males and 94 females, aged from 13 to 69 years old). There were 50 cases in the normal inner ear 3D-Flair MRI group. A total of 141 cases were found in the group with abnormal 3D-Flair MRI, including 50 cases of high signal unabsorbed, 71 cases of absorption high signal and 20 cases of blood labyrinth barrier destruction. There were no significant differences in age, sex, lateral ratio of hearing loss and course of disease among four groups (all P>0.05).The significant efficiencies of hearing recovery, in the group with normal 3D-FLAIR MRI were better than those in the abnormal group ( P<0.05) after treatment. Among the four groups, there were significant differences in the apparent efficiency and total effective rate between the normal group and the inner ear high signal absorption group ( χ2=4.007, P=0.045; χ2=6.925, P=0.009). The abnormal rates of bithermal caloric test, vHIT results and dizziness/vertigo symptoms in the abnormal group were higher than those in the normal group ( P<0.05). There were significant differences in oVEMP abnormality rate, vHIT abnormality rate and incidence of dizziness/vertigo among the three groups with 3D-FLAIR MRI abnormality ( P<0.05). There were significant differences in caloric test, oVEMP, vHIT abnormality rate and incidence of dizziness/vertigo among the four groups ( P<0.05). The positive rates of caloric test, cVEMP test and vHIT test in patients with dizziness/vertigo were higher than those in patients without dizziness/vertigo ( P<0.05). The abnormal rates of posterior semicircular canal and horizontal semicircular canal in patients with dizziness/vertigo were significantly increased ( P<0.05) than patients without dizziness/vertigo. The recovery rate, effective rate and total effective rate of patients without dizziness/vertigo were significantly better than those with dizziness/vertigo ( P<0.05). Conclusions:The 3D-Flair MRI of the inner ear and vestibular function tests have reference value for the prognosis assessment of patients with severe sudden sensorineural hearing loss. Abnormal 3D-FLAIR MRI of the inner ear, especially absorption high signal, is associated with high incidence of vestibular dysfunction and dizziness/vertigo, with poor prognosis. Patients with severe sudden sensorineural hearing loss who have symptoms of dizziness/vertigo are more likely to exhibit abnormal results in vestibular function tests, with a higher susceptibility to involvement of the posterior and horizontal semicircular canals.

Objective:To investigate the relationship between serum insulin-like growth factor-1 (IGF-1) levels and intracranial or extracranial atherosclerosis in patients with cerebral small vessel disease (CSVD).Methods:A total of 407 patients with CSVD admitted to Xiangya Hospital of Central South University between July 2021 and September 2023 were enrolled in the study. Carotid duplex ultrasound was used to measure the internal diameter, intima-media thickness (IMT), vascular wall thickness, plaque property score, stenosis index, and stenosis ratio of the bilateral common carotid arteries, internal carotid arteries, external carotid arteries, and vertebral arteries. Magnetic resonance angiography was used to assess the degree of stenosis in intracranial arteries. Patients were divided into 4 groups based on the serum IGF-1 levels (low level group:≤5.21 ng/ml, medium level group:>5.21 ng/ml and ≤10.73 ng/ml, high level group:>10.73 ng/ml and ≤24.26 ng/ml, extremely high level group:>24.26 ng/ml). The IMT of the common carotid artery, carotid plaques, diameters of various cervical vascular lumens, carotid artery diameter stenosis, and intracranial artery stenosis in 4 groups of the patients were compared. The relationship between IGF-1 and intracranial and extracranial atherosclerosis was analyzed by univariate Logistic regression analysis and multivariate Logistic regression analysis.Results:There were inter group differences among the 4 groups in internal carotid artery diameter [low level group 5.45 (0.50) mm vs medium level group 5.32 (0.55) mm vs high level group 5.30 (0.55) mm vs extremely high level group 5.30 (0.50) mm; H=8.210, P=0.042]. The carotid IMT [low level group 0.80 (0.05) mm vs medium level group 0.80 (0.05) mm vs high level group 0.83 (0.03) mm vs extremely high level group 0.83 (0.09) mm; H=8.107, P=0.044], the proportion of carotid artery vascular wall thickening [low level group 52.9%(54/102) vs medium level group 48.0%(49/102) vs high level group 68.3%(69/101) vs extremely high level group 60.8%(62/102); χ2=9.889, P=0.020], the carotid artery plaque property score [low level group 1 (2) vs medium level group 2 (2) vs high level group 2 (2) vs extremely high level group 2 (2); H=8.913, P=0.030] and the proportion of anterior cerebral artery stenosis [low level group 2.9%(3/102) vs medium level group 2.0%(2/102) vs high level group 4.0%(4/101) vs extremely high level group 10.8%(11/102); χ2=10.473, P=0.014] had inter group differences among the 4 groups, and the differences were statistically significant. Univariate Logistic regression analysis indicated that carotid artery vascular wall thickening ( OR=1.197, 95% CI 1.003-1.429, P=0.046), anterior cerebral artery stenosis ( OR=1.814, 95% CI 1.148-2.867, P=0.011), and basilar artery stenosis ( OR=1.530, 95% CI 1.084-2.159, P=0.015) were correlated with IGF-1 levels. Multivariate Logistic regression analysis revealed that after adjusting for age, gender, low-density lipoprotein cholesterol (LDL-C), and C-reactive protein, IGF-1 was positively correlated with the carotid artery vascular wall thickening ( OR=1.311, 95% CI 1.014-1.696, P=0.039); after adjusting for age, IGF-1 was positively correlated with the anterior cerebral artery stenosis ( OR=2.130, 95% CI 1.201-3.776, P=0.010); after adjusting for gender, low-density lipoprotein cholesterol, and cholesterol levels, IGF-1 was positively correlated with basilar artery stenosis ( OR=1.688, 95% CI 1.063-2.681, P=0.027). Conclusions:There is an association between IGF-1 levels and intracranial and extracranial atherosclerosis in patients with CSVD. IGF-1 may play a role in the development and progression of atherosclerosis in CSVD.

Objective:To explore the potential types of body image disorders in patients with polycystic ovary syndrome (PCOS) and to analyze the influencing factors of each category, so as to provide a basis for clinical formulation of targeted intervention programs.Methods:A total of 275 patients with PCOS who visited the outpatient clinic of the Center for Reproductive Medicine of Fenyang Hospital of Shanxi Province from April 2023 to April 2024 were selected by convenience sampling, and the general information questionnaires, Body Image Scale, Sociocultural Attitudes Towards Appearance Questionnaire-3, and Adaptation, Partnership, Growth, Affection and Resolve were used to conduct a cross-sectional survey. The potential profile analysis of body image disorders in PCOS patients was carried out, and the influencing factors of different categories were explored by multivariate Logistic regression analysis.Results:A total of 260 patients with PCOS were surveyed in this study, and 113 patients (43.5%) were aged 25-35 years old. The score of the Body Image Scale for PCOS patients was 11.00 (7.25, 14.00) points, the score of the Sociocultural Attitudes Towards Appearance Questionnaire-3 was (44.80 ± 4.65) points, and the score of Adaptation, Partnership, Growth, Affection and Resolve was (5.80 ± 1.43) points. PCOS patients were divided into three potential categories: low body image impairment group (37.3%, 97/260), intermediate body image level-high cognitive impairment group (38.1%, 99/260), and high body image impairment group (24.6%, 64/260). Body mass index, acne, alopecia, reproductive history, course of disease, whether medical staff have carried out detailed education, social media attention and internalization, and family care were the influencing factors of potential types of body image disorders in PCOS patients ( OR values were 0.339-19.099, all P<0.05). Conclusions:There is obvious group heterogeneity in patients with PCOS body image disorders, and medical staff should formulate targeted interventions according to the characteristics and influencing factors of each category to improve patients′ lifestyle, reduce the level of body image disorders.

Objective:To explore the potential types of body image disorders in patients with polycystic ovary syndrome (PCOS) and to analyze the influencing factors of each category, so as to provide a basis for clinical formulation of targeted intervention programs.Methods:A total of 275 patients with PCOS who visited the outpatient clinic of the Center for Reproductive Medicine of Fenyang Hospital of Shanxi Province from April 2023 to April 2024 were selected by convenience sampling, and the general information questionnaires, Body Image Scale, Sociocultural Attitudes Towards Appearance Questionnaire-3, and Adaptation, Partnership, Growth, Affection and Resolve were used to conduct a cross-sectional survey. The potential profile analysis of body image disorders in PCOS patients was carried out, and the influencing factors of different categories were explored by multivariate Logistic regression analysis.Results:A total of 260 patients with PCOS were surveyed in this study, and 113 patients (43.5%) were aged 25-35 years old. The score of the Body Image Scale for PCOS patients was 11.00 (7.25, 14.00) points, the score of the Sociocultural Attitudes Towards Appearance Questionnaire-3 was (44.80 ± 4.65) points, and the score of Adaptation, Partnership, Growth, Affection and Resolve was (5.80 ± 1.43) points. PCOS patients were divided into three potential categories: low body image impairment group (37.3%, 97/260), intermediate body image level-high cognitive impairment group (38.1%, 99/260), and high body image impairment group (24.6%, 64/260). Body mass index, acne, alopecia, reproductive history, course of disease, whether medical staff have carried out detailed education, social media attention and internalization, and family care were the influencing factors of potential types of body image disorders in PCOS patients ( OR values were 0.339-19.099, all P<0.05). Conclusions:There is obvious group heterogeneity in patients with PCOS body image disorders, and medical staff should formulate targeted interventions according to the characteristics and influencing factors of each category to improve patients′ lifestyle, reduce the level of body image disorders.

Objective:To explore the current implementation status and challenges of family doctor contract services (FDCS) from the perspective of contracted residents.Methods:This qualitative study used purposive sampling to select contracted residents from 11 primary healthcare institutions across five cities in China. Semi-structured interviews were conducted from March to December 2024, covering topics such as awareness of contracting, service experience, health needs, service continuity, and policy recommendations. Thematic framework analysis was applied to organize, code, and summarize the data.Results:A total of 25 contracted residents were interviewed (6 men, 19 women; 11 from central urban areas, 14 from suburban or rural towns; 8 with chronic diseases). Three main themes and ten sub-themes emerged: Theme Ⅰ: Pathways to improved service accessibility (optimized chronic disease management, more efficient referrals, and improved health education). Theme Ⅱ: Structural misalignment between supply and demand (limited specialty services despite patient needs, insufficient coverage and public awareness of home-based medical care, imbalanced human resources, and service disruption due to clinician turnover). Theme Ⅲ: Challenges in service awareness and communication mechanisms (information asymmetry and public misperception regarding FDCS, perverse incentives in administrative performance evaluation, and communication barriers in building patient-doctor trust).Conclusions:While FDCS has shown progress in chronic disease management, referral coordination, and health education, structural supply-demand gaps and communication challenges continue to hinder service quality. Improvements in resource allocation and service models are needed to support high-quality development.

Objective:To investigate the relationship between serum insulin-like growth factor-1 (IGF-1) levels and intracranial or extracranial atherosclerosis in patients with cerebral small vessel disease (CSVD).Methods:A total of 407 patients with CSVD admitted to Xiangya Hospital of Central South University between July 2021 and September 2023 were enrolled in the study. Carotid duplex ultrasound was used to measure the internal diameter, intima-media thickness (IMT), vascular wall thickness, plaque property score, stenosis index, and stenosis ratio of the bilateral common carotid arteries, internal carotid arteries, external carotid arteries, and vertebral arteries. Magnetic resonance angiography was used to assess the degree of stenosis in intracranial arteries. Patients were divided into 4 groups based on the serum IGF-1 levels (low level group:≤5.21 ng/ml, medium level group:>5.21 ng/ml and ≤10.73 ng/ml, high level group:>10.73 ng/ml and ≤24.26 ng/ml, extremely high level group:>24.26 ng/ml). The IMT of the common carotid artery, carotid plaques, diameters of various cervical vascular lumens, carotid artery diameter stenosis, and intracranial artery stenosis in 4 groups of the patients were compared. The relationship between IGF-1 and intracranial and extracranial atherosclerosis was analyzed by univariate Logistic regression analysis and multivariate Logistic regression analysis.Results:There were inter group differences among the 4 groups in internal carotid artery diameter [low level group 5.45 (0.50) mm vs medium level group 5.32 (0.55) mm vs high level group 5.30 (0.55) mm vs extremely high level group 5.30 (0.50) mm; H=8.210, P=0.042]. The carotid IMT [low level group 0.80 (0.05) mm vs medium level group 0.80 (0.05) mm vs high level group 0.83 (0.03) mm vs extremely high level group 0.83 (0.09) mm; H=8.107, P=0.044], the proportion of carotid artery vascular wall thickening [low level group 52.9%(54/102) vs medium level group 48.0%(49/102) vs high level group 68.3%(69/101) vs extremely high level group 60.8%(62/102); χ2=9.889, P=0.020], the carotid artery plaque property score [low level group 1 (2) vs medium level group 2 (2) vs high level group 2 (2) vs extremely high level group 2 (2); H=8.913, P=0.030] and the proportion of anterior cerebral artery stenosis [low level group 2.9%(3/102) vs medium level group 2.0%(2/102) vs high level group 4.0%(4/101) vs extremely high level group 10.8%(11/102); χ2=10.473, P=0.014] had inter group differences among the 4 groups, and the differences were statistically significant. Univariate Logistic regression analysis indicated that carotid artery vascular wall thickening ( OR=1.197, 95% CI 1.003-1.429, P=0.046), anterior cerebral artery stenosis ( OR=1.814, 95% CI 1.148-2.867, P=0.011), and basilar artery stenosis ( OR=1.530, 95% CI 1.084-2.159, P=0.015) were correlated with IGF-1 levels. Multivariate Logistic regression analysis revealed that after adjusting for age, gender, low-density lipoprotein cholesterol (LDL-C), and C-reactive protein, IGF-1 was positively correlated with the carotid artery vascular wall thickening ( OR=1.311, 95% CI 1.014-1.696, P=0.039); after adjusting for age, IGF-1 was positively correlated with the anterior cerebral artery stenosis ( OR=2.130, 95% CI 1.201-3.776, P=0.010); after adjusting for gender, low-density lipoprotein cholesterol, and cholesterol levels, IGF-1 was positively correlated with basilar artery stenosis ( OR=1.688, 95% CI 1.063-2.681, P=0.027). Conclusions:There is an association between IGF-1 levels and intracranial and extracranial atherosclerosis in patients with CSVD. IGF-1 may play a role in the development and progression of atherosclerosis in CSVD.

Objective:To analyse the 3D-Flair MRI manifestations of the inner ear, vestibular function status, and their correlation with hearing treatment outcomes in patients with severe sudden sensorineural hearing loss (SSNHL), and to explore potential prognostic indicators for sudden deafness.Methods:The clinical data of adult patients with unilateral profound sudden sensorineural hearing loss were retrospectively analyzed in Otorhinolaryngology Department of Shandong Provincial ENT Hospital from March 2018 to August 2020. Patients were categorized based on the results of their inner ear 3D-Flair MRI into two groups: the normal MRI group and the abnormal MRI group. The abnormal group was further divided into three subgroups: those with non-absorbed high signal in the inner ear, those with absorbed high signal, and those with destruction of the blood-labyrinth barrier. SPSS 26.0 statistical software was applied to analyze the differences in hearing efficacy, caloric tests, vestibular evoked myogenic potentials (VEMP), video head impulse tests (vHIT), and the incidence of dizziness/vertigo among various patient groups.Results:A total of 191 patients with complete data were collected (97 males and 94 females, aged from 13 to 69 years old). There were 50 cases in the normal inner ear 3D-Flair MRI group. A total of 141 cases were found in the group with abnormal 3D-Flair MRI, including 50 cases of high signal unabsorbed, 71 cases of absorption high signal and 20 cases of blood labyrinth barrier destruction. There were no significant differences in age, sex, lateral ratio of hearing loss and course of disease among four groups (all P>0.05).The significant efficiencies of hearing recovery, in the group with normal 3D-FLAIR MRI were better than those in the abnormal group ( P<0.05) after treatment. Among the four groups, there were significant differences in the apparent efficiency and total effective rate between the normal group and the inner ear high signal absorption group ( χ2=4.007, P=0.045; χ2=6.925, P=0.009). The abnormal rates of bithermal caloric test, vHIT results and dizziness/vertigo symptoms in the abnormal group were higher than those in the normal group ( P<0.05). There were significant differences in oVEMP abnormality rate, vHIT abnormality rate and incidence of dizziness/vertigo among the three groups with 3D-FLAIR MRI abnormality ( P<0.05). There were significant differences in caloric test, oVEMP, vHIT abnormality rate and incidence of dizziness/vertigo among the four groups ( P<0.05). The positive rates of caloric test, cVEMP test and vHIT test in patients with dizziness/vertigo were higher than those in patients without dizziness/vertigo ( P<0.05). The abnormal rates of posterior semicircular canal and horizontal semicircular canal in patients with dizziness/vertigo were significantly increased ( P<0.05) than patients without dizziness/vertigo. The recovery rate, effective rate and total effective rate of patients without dizziness/vertigo were significantly better than those with dizziness/vertigo ( P<0.05). Conclusions:The 3D-Flair MRI of the inner ear and vestibular function tests have reference value for the prognosis assessment of patients with severe sudden sensorineural hearing loss. Abnormal 3D-FLAIR MRI of the inner ear, especially absorption high signal, is associated with high incidence of vestibular dysfunction and dizziness/vertigo, with poor prognosis. Patients with severe sudden sensorineural hearing loss who have symptoms of dizziness/vertigo are more likely to exhibit abnormal results in vestibular function tests, with a higher susceptibility to involvement of the posterior and horizontal semicircular canals.

Objective To retrieve,evaluate and summarize the best evidence summary for prevention and nursing care of pregnancy-induced diastasis recti abdominis and to provide references for clinical practice.Methods We systematically searched computer decision support systems,guideline websites,association official websites and databases for evidence on prevention and nursing care of pregnancy-induced diastasis recti abdominis,including guidelines,expert consensuses,clinical decision-making,systematic reviews and randomized controlled trials.The retrieval period was from the inception of databases to January 2024.There were 4 researchers who evaluated the quality of the included literature independently,extracted and summarized the evidence according to the subject.Results A total of 18 articles were included,including 2 clinical decisions,4 guidelines,5 expert consensuses,3 systematic reviews,and 4 randomized controlled trials.24 pieces of best evidence were summarized from 5 aspects,including the antenatal prevention,team building,nursing assessment,intervention strategies,and effecti-veness evaluation.Conclusion This study summarizes the best evidence summary for prevention and nursing care of pregnancy-induced diastasis recti abdominis,which can provide a reference basis for nurses to manage diastasis recti abdominis and improve the life quality of maternal woman.