Objective:To construct a training course system for online appointment nurses based on post competence,and to provide references for the training and development of online appointment nurses in China.Methods:From January 2021 to May 2022, based on the theory of post competence, literature review, policy research, questionnaire survey and and expert consultation were used to establish the training course system of online appointment nurses.Results:The effective recovery rates of the two rounds of expert consultation questionnaires were 18/18 and 17/18, respectively; the expert authority coefficient was 0.928 and 0.938, respectively; and the Kendall harmony coefficient was 0.185 and 0.284, respectively, the differences were statistically significant (all P<0.001). The final content of the training course system for online appointment nurses included 4 first-level indicators,which were professional knowledge, professional skills, professional abilities and traits, 19 second-level indicators and 58 third-level indicators. Conclusions:The training course system of online appointment nurses based on post competency is scientific, reasonable and prominent,which can provide reference for training of online appointment nurses in China.

Humans ; Comorbidity ; Diabetes Mellitus/genetics* ; East Asian People ; Hypertension/genetics* ; Hypertriglyceridemia/genetics* ; Obesity/genetics* ; Receptors, Calcitriol/genetics*

Objective:To survey the job satisfaction of online contracted nurses who provide " Internet plus nursing services" for reference of hospital managers in improving their management mechanism in this regard.Methods:Based on the two-factor theory, a questionnaire was designed and a purposive sampling method was used to survey the online contracted nurses in Anhui province in April and May 2022. The motivational factors included such five dimensions as workload, work content, colleague relationship, doctor-patient relationship, and their own development, and the healthcare factors included such three dimensions as salary, job recognition and social status. The questionnaire data and job satisfaction scores were analyzed descriptively, and the correlation between the overall job satisfaction of the online contracted nurses, while each dimension was analyzed by Pearson correlation analysis, and the influence of each dimension on job satisfaction was analyzed by stepwise regression analysis.Results:A total of 335 valid questionnaires were recovered. The mean score of job satisfaction of online contracted nurses was (2.26±0.38), with the highest score of (2.56±0.53) for salary satisfaction and the lowest score of (1.78±0.67) for job recognition, and each dimension was positively correlated with job satisfaction ( r=0.34-0.88, P<0.01). Regression analysis showed that workload ( B=0.07), salary ( B=0.11), job content ( B=0.23), social status ( B=0.12), and self-development ( B=0.15) were the main factors affecting their job satisfaction ( P<0.01). Conclusions:The job satisfaction of online contracted nurses was at a medium level, mainly influenced by workload, salary, job content, social status and their own development. It is recommended that hospitals implement multiple targeted measures to improve the job satisfaction of online contracted nurses and promote the healthy development of " Internet plus nursing services" .

Objective:To explore the clinical significance of the MYCN gene, PHOX2B gene and plasma cell-free DNA (cfDNA) in risk stratification and predicting the prognosis of high-risk neuroblastoma (NB). Methods:This was a prospective study involving 94 high-risk NB children admitted to Beijing Children′s Hospital, Capital Medical University from August 2017 to December 2018.Relative levels of MYCN and PHOX2B and cfDNA at diagnosis, and 4 and 6 cycles of chemotherapy were detected, and their differences were compared by the Chi- square test.Kaplan-Meier survival analysis was performed to explore their prognostic potential in high-risk NB. Results:Among the 94 high-risk NB children, 14 cases (14.9%) had MYCN amplification, 76 cases (80.8%) had positive expression of PHOX2B and 56 cases (59.6%) had cfDNA level higher than 100 μg/L.The proportion of high lactate dehydrogenase (LDH, ≥1 500 U/L) level in the MYCN gene amplification group (6/14 cases) was higher than that in the normal group (9/80 cases) ( P=0.009). The proportion of multi-site metastasis (54/76 cases) and high neuron specific enolase (NSE) level (NSE≥370 μg/L, 37/76 cases) in PHOX2B positive group were significantly higher than those in the negative group (5/14 cases, 2/14 cases) ( P=0.015, 0.020). The proportion of high LDH and high NSE in high cfDNA concentration (≥229.6 μg/L)group (13/37 cases, 28/37 cases) were significantly higher than those in low cfDNA concentration group (2/48 cases, 10/48 cases) (all P<0.001). With the decreased tumor burden during the treatment, the copy number of PHOX2B gene and cfDNA level were significantly lower than those at the initial diagnosis [0 (0-719.6) copies vs.1 723.5 (0-186 000.0) copies; 19.0 (1.1-225.5) μg/L vs.200.6 (8.0-5 247.4) μg/L, all P<0.001]. The 2-year event-free survival (EFS) rate of the MYCN gene amplification group was significantly lower than that of the normal group[(33.3±13.1)% vs.(58.5±7.1)%, P=0.020]. The 2-year EFS rate of PHOX2B positive group was significantly lower than that of the negative group[(47.9±7.1)% vs.(79.1±11.1)%, P=0.043]. EFS rate in high cfDNA concentration group was significantly lower than that in cfDNA low concentration group[(38.6±9.8)% vs.( 71.7±8.2)%, P=0.001]. After 6 cycles of chemotherapy, EFS rate in the PHOX2B positive group was significantly lower than that in the negative group [(16.7±14.4)% vs.( 60.6±6.6)%, P=0.014]; which was significantly lower in the Metaiodobenzylguanidine (MIBG) positive group than that of the negative group[(35.2±11.7)% vs.(65.8±7.1)%, P=0.037]. The MYCN gene and cfDNA concentration were not correlated with the prognosis of high-risk NB.Survival analysis of the combination of PHOX2B and MYCN gene ( PHOX2B+ /MIBG + , PHOX2B+ or MIBG + , PHOX2B-/MIBG -) showed a significant difference in the survival among three groups[0 vs.(53.6±1.2)% vs.(65.5±7.4)%, P=0.003]. Conclusions:The MYCN and PHOX2B gene and cfDNA concentration are of significance in risk stratification and predicting the prognosis of high-risk NB.Compared with the MYCN gene and cfDNA concentration, the PHOX2B gene is more suitable for monitoring the curative effect of chemotherapy on high-risk NB.A combined analysis of PHOX2B gene and MIBG before treatment can be more accurate in evaluating the treatment effect and residual lesions.

Objective: To analyze the dynamic changes and influencing factors of HIV-1 DNA load in HIV-1 infected individuals under antiretroviral therapy (ART) in Dehong Dai and Jingpo autonomous prefecture, Yunnan province, and provide information support for the clinical use of HIV-1 DNA quantitative detection. Methods: The HIV infection cases in recent infection cohort from Dehong Center for Disease Control and Prevention during 2009-2018 were selected as study subjects. The dynamic curve of HIV-1 DNA load varrying with time was generated and logistic regression analysis was conducted to identify the risk factors for HIV-1 load in the recent follow up after ART and statistical analysis was performed by using SPSS 17.0. Results: Among the 113 HIV infection cases detected from the recent infection cohort, the recent HIV infection rate were 49.6%(56/113) males, sexual transmission cases and drug injection transmission cases accounted for 53.1% (60/113), 80.5% (91/113) and 19.5% (22/113), respectively. The dynamic changes curve showed that HIV-1 DNA load was relatively high (>800 copies /10⁶ PBMCs) before ART, and droped rapidly (<400 copies /10⁶ PBMCs) after ART for 1 year. However, HIV-1 DNA load decreased insignificantly from the second year of ART, and remained to be 269 copies/10⁶ PBMCs after ART for 6 years. Univariable logistic regression analysis indicated that OR (95%CI) of CD8, CD4/CD8 and HIV-1 DNA load were 1.00 (1.00-1.00), 0.30 (0.09-1.05) and 1.01 (1.00-1.01), respectively. Multivariable logistic regression analysis showed that OR value of HIV-1 DNA load base was 1.00 (1.00-1.01). Conclusions: HIV-1 DNA load decreased significantly in the first year of ART, then remained stable for years. HIV-1 DNA load base was the key factor associated with the decrease of HIV-1 DNA load, the lower the HIV-1 DNA load base, the lower HIV-1 DNA load. Therefore, earlier ART can contribute to the decrease of HIV-1 DNA load.
China/epidemiology* ; DNA/therapeutic use* ; HIV Infections/drug therapy* ; HIV Seropositivity ; HIV-1/genetics* ; Humans ; Male ; Viral Load

BACKGROUND: Shenyankangfu Tablet (SYKFT) is a Chinese patent medicine that has been used widely to decrease proteinuria and the progression of chronic kidney disease. OBJECTIVE: This trial compared the efficacy and safety of SYKFT, for the control of proteinuria in primary glomerulonephritis patients, against the standard drug, losartan potassium. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: This was a multicenter, double-blind, randomized, controlled clinical trial. Primary glomerulonephritis patients, aged 18-70 years, with blood pressure ≤ 140/90 mmHg, estimated glomerular filtration rate (eGFR) ≥ 45 mL/min per 1.73 m MAIN OUTCOME MEASURES: The primary outcome was change in the 24-hour proteinuria level, after 48 weeks of treatment. RESULTS: A total of 735 participants were enrolled. The percent decline of urine protein quantification in the SYKFT group after 48 weeks was 8.78% ± 2.56% (P = 0.006) more than that in the losartan 50 mg group, which was 0.51% ± 2.54% (P = 1.000) less than that in the losartan 100 mg group. Compared with the losartan potassium 50 mg group, the SYKFT plus losartan potassium 50 mg group had a 13.39% ± 2.49% (P < 0.001) greater reduction in urine protein level. Compared with the losartan potassium 100 mg group, the SYKFT plus losartan potassium 100 mg group had a 9.77% ± 2.52% (P = 0.001) greater reduction in urine protein. With a superiority threshold of 15%, neither was statistically significant. eGFR, serum creatinine and serum albumin from the baseline did not change statistically significant. The average change in TCM syndrome score between the patients who took SYKFT (-3.00 [-6.00, -2.00]) and who did not take SYKFT (-2.00 [-5.00, 0]) was statistically significant (P = 0.003). No obvious adverse reactions were observed in any group. CONCLUSION: SYKFT decreased the proteinuria and improved the TCM syndrome scores of primary glomerulonephritis patients, with no change in the rate of decrease in the eGFR. SYKFT plus losartan potassium therapy decreased proteinuria more than losartan potassium therapy alone. TRIAL REGISTRATION NUMBER NCT02063100 on ClinicalTrials.gov.

Objective: To explore the prospective effect of dietary intake of total fat and fatty acids on menarcheal timing among girls,and to provide a theoretical basis for preventing the early puberty development of Chinese children. Methods: Using the data from 1997-2015 China Health and Nutrition Survey (CHNS), 1 240 girls aged 6-13 with menarche information, baseline dietary survey data and at least one follow up assessment were selected. Cox regression analysis was performed to examine the prospective effect of dietary intake of total fat and fatty acids before menarche on age at menarche. Results: The mean baseline age of the participants was (8.3±1.8). After adjustment for year of birth, residence, household income, dietary energy intake and body mass index Z score at baseline, girls in the highest quartile of intake of total fat and polyunsaturated fatty acid (PUFA) had a 30% and 34% higher probability of experiencing menarche at an earlier age than those in the lowest quartile [ HR(HR 95%CI )=1.30 (1.01~1.68)，1.34(1.05~1.70)]. After adjusting for the confounders, there were no correlations between the intake of saturated fatty acid (SFA) and monounsaturated fatty acid (MUFA) and the onset of menarche [ HR(HR 95%CI )=1.24(0.98~1.58),1.25(0.97~ 1.62 )]( P >0.05). Conclusion Higher dietary intake of total fat and PUFA before menarche may lead to earlier age at menarche and no correlation between intake of SFA and MUFA before menarche with age at menarche is found among Chinese girls.

Objective To explore the differences and correlation of imaging parameters of occipital-C2 angle (OC2A) and posterior occipitocervical angle (POCA) between sex and age, so as to provide theoretical reference for fixing the position of head and neck in occipitocervical fusion. Methods The imaging data of 473 cases (339 males and 134 females) were collected and divided into 2 groups according to sex. Each group was subdivided into 6 groups according to age: ≤29 year-old, 30-39 year-old, 40-49 year-old, 50-59 year-old, 60-69 year-old and ≥70 year-old. OC2A and POCA were measured in Mimics software, and their differences with sex and age were statistically analyzed. Results There was no significant difference in OC2A and POCA between sexes (P<0.05). In the OC2A male group, except for the male group aged 30-39 year-old and ≤29 year-old, there were significant differences among the other groups (P<0.05), but there was no significant difference among all age groups in the female group (P>0.05); There were significant differences in POCA between the male group of 30-39 year-old and ≤29 year-old (P<0.05), but between the group of 40-49 year-old and each group (P<0.05). In the female group, there was significant difference between the group of ≤29 year-old and all age groups (P<0.05), but there was no significant difference among the other groups (P<0.05). Pearson correlation analysis showed that there was a positive correlation between OC2A and POCA (r= 0.038, P<0.05), that is, there was no correlation between them. Conclusion There is no difference in OC2A and POCA values between sexes; there are differences in OC2A and POCA values in males among different age groups, suggesting that clinical attention should be paid to the age differences in males, while there is no difference in OC2A values in females, but POCA is different in different age groups. The changes of OC2A and POCA values in different age groups and sex provide a parameter basis for fixing the anatomical reduction angle of head and neck in occipitocervical fusion.

Objective To understand the prevalence and epidemiological characteristics of hepatitis C virus (HCV) co-infection among newly reported HIV-infected patients from 2016 to 2017 in Dehong Prefecture of Yunnan Province. Methods A cross-sectional survey was conducted to detect HCV antibodies in 2 196 newly reported HIV-infected persons in Dehong Prefecture, Yunnan Province, from 2016 to 2017. Results A total of 694 cases(31.6%) were detected antibodies against HCV during HIV-infected persents. The prevalence of HCV co-infection among newly reported HIV-infected patients in Chinese and Burmese was 14.4% (112/780) and 41.1% (582/1 416), respectively. Moreover, the prevalence of HCV co-infection was higher in male, ethnic minorities such as Dai and Jingpo minority, primary school and below and farmers in both Chinese and Burmese. Multivariate Logistic regression model showed that HCV infection was associated with male, Dai minority, HIV infection by injecting drug and famers among Chinese and Burmese reported HIV-infected patients. Conclusions The prevalence of HCV co-infection was high among newly reported in Dehong Prefecture of Yunnan Province. Meanwhile, the epidemiological characteristics of HIV/HCV co-infections in Chinese and Burmese are different, thus different prevention and control measures are needed for patients of different nationalities.

OBJECTIVE： To investigate the awareness and attitude of medical representative registration system among pharmaceutical marketers in Guiyang city.  METHODS： A self-designed questionnaire survey about the awareness （full point 100） and attitude （total points ranged 17-85） of medical representative registration system was conducted among pharmaceutical marketers selected by the stratified random sampling in the six districts of Guiyang city， and the difference of awareness and attitude scores were compared among pharmaceutical marketers with different characteristics （12 aspects）， and relevant suggestions were made. RESULTS & CONCLUSIONS： A total of 220 questionaires were sent out， and 220 questionaires were collected among which there were 205 valid questionaires （effective rate of 93.2％）. Total awareness score of 205 pharmaceutical marketers was（55.17±21.20）points， with average correct rate of 55.17％. Pharmaceutical marketers from pharmaceutical companies scored significantly higher than those from other pharmaceutical companies； pharmaceutical marketers who mainly promoted prescription drugs scored significantly higher than those who mainly promoted other types of pharmaceutical products； pharmaceutical marketers who set up city public hospitals as the target market scored significantly higher than those who set up other markets； pharmaceutical marketers who learned about the system from media reports scored significantly higher than those who learned about the system from other sources， above 4 were with statistical significance （P＜0.05）. Meanwhile， overall attitude scores （higher score means higher recognition） of 205 pharmaceutical marketers were （58.76±12.84） with average score rate of 69.13％； the score of pharmaceutical marketers who learned about the system from media reports was significantly lower than other pathways， the score of pharmaceutical marketers who had received training was significantly higher than those who hadn’t， the score of pharmaceutical marketers in the enterprises where formulated countermeasure plans was significantly higher than those in the enterprises where hadn’t formulated， above 3 were with statistical significance （P＜0.05）. The knowledge level of Guiyang pharmaceutical marketers on the registration system of medical representatives needs to be improved. The marketers generally took positive attitude towards the policy， and believed that medical institutions， pharmaceutical companies and medical representatives would benefit from it. To promote the construction of pharmaceutical marketing compliance， medical institutions， pharmaceutical companies and pharmaceutical marketers should take the initiative to cooperate with the formulation and implementation of medical representative  registration system.