scholarly journals Early outcomes of a rural-oriented physician education programme against rural physician shortages in Guangxi province: a prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049274
Author(s):  
Ying Shen ◽  
Xing Huang ◽  
Hong Li ◽  
Enran Chen ◽  
Yan Kong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Rural Areas ◽  
Prospective Cohort ◽  
Physician Education ◽  
Early Results ◽  
Physician Shortages ◽  
Medical Undergraduate ◽  
Rural Physician

ObjectivesThis study aimed to investigate early outcomes of one of the first medical undergraduate education programmes with a goal of mitigating severe rural physician shortages in China, which was developed by Guangxi Medical University (GXMU) and was called the Rural-oriented Free Tuition Medical Education (RTME)-GXMU programme.DesignA prospective cohort study comprising a baseline investigation and follow-up research was conducted to dynamically observe the evolution of the RTME-GXMU programme that began since 2010.Participants380 RTME-GXMU graduates and 383 non-RTME-GXMU graduates from GXMU who completed trainings between 2015 and 2018 were recruited in the baseline investigation. Among them, 285 RTME-GXMU and 283 non-RTME-GXMU graduates responded to the follow-up research.Main outcome measuresGraduate practice location, registered specialty, passing rate of the National Medical Licensing Examination (NMLE), specialty of residency programme and contract compliance for the RTME-GXMU graduates.ResultsBy the end of 2018, 100% of the 2015 RTME-GXMU graduates enrolled in this study practised in rural township health centres and registered themselves as general practitioners (GPs). All the RTME-GXMU graduates had completed or were attending residency programmes of general practice (GP). The above data stood in stark contrast to that of the non-RTME-GXMU graduates among whom as few as 1.06% worked in rural areas, 2.13% registered as GPs and less than 3% chose GP residency programmes. No significant differences were detected on passing rates of the NMLE between the two groups. Only one RTME-GXMU graduate broke the contract and dropped off the programme.ConclusionsThe RTME-GXMU programme has achieved encouraging early outcomes. Reduced entry score and proper usage of urban primary care institutions are two key approaches contributing to these positive early results.

scholarly journals Influence of snoring on in incidence of metabolic syndrome: a community-based prospective cohort study in rural Northeast China

2020 ◽  
Author(s):  
Shasha Yu ◽  
Xiaofan Guo ◽  
GuangXiao Li ◽  
Hongmei Yang ◽  
Guozhe Sun ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Rural Areas ◽  
Prospective Cohort ◽  
Fast Blood Glucose ◽  
Fast Blood Glucose Level ◽  
Community Based ◽  
The Relationship

Abstract Background: There is increasing trend of metabolic syndrome (MetS) in rural areas of China in recent years. It is necessary to figure out the possible risk factors of MetS for better intervention. This community-based prospective cohort study was performed to assess the relationship between snoring status and incidence of MetS.Methods: We conducted a cohort study among residents aged ≥ 35 years without MetS in 2012-2013. Among 5,691 residents who met the inclusion criteria, 4,980 residents (2,586 men and 2394 women; follow-up proportion: 87.5%) remained available for follow-up examinations during 2015-2017. The main outcome was the incidence of MetS, defined by the unify criteria in 2009. We divided residents by snoring status and compared outcome between groups. Using a logistic regression model, we estimated the odds ratio (OR) for incidence for MetS, adjusting for confounders, ages, gender, exercise habit, sleep duration, alcohol and smoke consumption. Results: With a median follow up of 4.6 years, incidence of MetS was higher in snorers (men 26.2%, women 33.5%) than in non-snorers (men 19.7%, women 23.2%). Diastolic blood pressure increased in follow-up compared with baseline in male snorers but decreased in male non-snorers. Similarly, fast blood glucose level increased in female snorers at follow-up but decreased in female non-snorers. We found a significant association between snoring and incidence of MetS (adjusted OR=1.51, 95%CI=1.32-1.74). Besides, as the degrees of the snoring increased, the incidence of MetS increased simultaneously. And the OR for the very severe snoring was double compared with non-snorers (adjusted OR=2.10, 95%CI=1.38-3.20). Conclusion: Snoring is associated with higher incidence of MetS in rural Northeast Chinese. More emphasis should be paid to residents with snoring problem.

scholarly journals POS0647 EFFICACY, SAFETY AND CHARACTERISTICS OF IGURATIMOD-BASED THERAPY IN THE TREATMENT OF UA, ERA AND RA PATIENTS FOR 24 WEEKS: A PROSPECTIVE COHORT STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 561.2-562
Author(s):  
X. Liu ◽  
Z. Sun ◽  
W. Guo ◽  
F. Wang ◽  
L. Song ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Adverse Events ◽  
Disease Activity ◽  
Prospective Cohort Study ◽  
Early Rheumatoid Arthritis ◽  
Prospective Cohort ◽  
Combined Treatment ◽  
Serious Adverse Events

Background:Experts emphasize early diagnosis and treatment in RA, but the widely used diagnostic criterias fail to meet the accurate judgment of early rheumatoid arthritis. In 2012, Professor Zhanguo Li took the lead in establishing ERA “Chinese standard”, and its sensitivity and accuracy have been recognized by peers. However, the optimal first-line treatment of patients (pts) with undifferentiated arthritis (UA), early rheumatoid arthritis (ERA), and rheumatoid arthritis (RA) are yet to be established.Objectives:To evaluate the efficacy and safety of Iguratimod-based (IGU-based) Strategy in the above three types of pts, and to explore the characteristics of the effects of IGU monotherapy and combined treatment.Methods:This prospective cohort study (ClinicalTrials.gov Identifier NCT01548001) was conducted in China. In this phase 4 study pts with RA (ACR 1987 criteria[1]), ERA (not match ACR 1987 criteria[1] but match ACR/EULAR 2010 criteria[2] or 2014 ERA criteria[3]), UA (not match classification criteria for ERA and RA but imaging suggests synovitis) were recruited. We applied different treatments according to the patient’s disease activity at baseline, including IGU monotherapy and combination therapies with methotrexate, hydroxychloroquine, and prednisone. Specifically, pts with LDA and fewer poor prognostic factors were entered the IGU monotherapy group (25 mg bid), and pts with high disease activity were assigned to combination groups. A Chi-square test was applied for comparison. The primary outcomes were the proportion of pts in remission (REM)or low disease activity (LDA) that is DAS28-ESR<2.6 or 3.2 at 24 weeks, as well as the proportion of pts, achieved ACR20, Boolean remission, and good or moderate EULAR response (G+M).Results:A total of 313 pts (26 pts with UA, 59 pts with ERA, and 228 pts with RA) were included in this study. Of these, 227/313 (72.5%) pts completed the 24-week follow-up. The results showed that 115/227 (50.7%), 174/227 (76.7%), 77/227 (33.9%), 179/227 (78.9%) pts achieved DAS28-ESR defined REM and LDA, ACR20, Boolean remission, G+M response, respectively. All parameters continued to decrease in all pts after treatment (Fig 1).Compared with baseline, the three highest decline indexes of disease activity at week 24 were SW28, CDAI, and T28, with an average decline rate of 73.8%, 61.4%, 58.7%, respectively. Results were similar in three cohorts.We performed a stratified analysis of which IGU treatment should be used in different cohorts. The study found that the proportion of pts with UA and ERA who used IGU monotherapy were significantly higher than those in the RA cohort. While the proportion of triple and quadruple combined use of IGU in RA pts was significantly higher than that of ERA and UA at baseline and whole-course (Fig 2).A total of 81/313 (25.8%) pts in this study had adverse events (AE) with no serious adverse events. The main adverse events were infection(25/313, 7.99%), gastrointestinal disorders(13/313, 4.15%), liver dysfunction(12/313, 3.83%) which were lower than 259/2666 (9.71%) in the previous Japanese phase IV study[4].The most common reasons of lost follow-up were: 1) discontinued after remission 25/86 (29.1%); 2) lost 22/86 (25.6%); 3) drug ineffective 19/86 (22.1%).Conclusion:Both IGU-based monotherapy and combined therapies are tolerant and effective for treating UA, ERA, and RA, while the decline in joint symptoms was most significant. Overall, IGU combination treatments were most used in RA pts, while monotherapy was predominant in ERA and UA pts.References:[1]Levin RW, et al. Scand J Rheumatol 1996, 25(5):277-281.[2]Kay J, et al. Rheumatology 2012, 51(Suppl 6):vi5-9.[3]Zhao J, et al. Clin Exp Rheumatol 2014, 32(5):667-673.[4]Mimori T, et al. Mod Rheumatol 2019, 29(2):314-323.Disclosure of Interests:None declared

scholarly journals The Correlation of Stress in Residency With Future Stress and Burnout: A 10-Year Prospective Cohort Study

2018 ◽  
Vol 10 (5) ◽  
pp. 524-531 ◽  
Author(s):  
John Raimo ◽  
Sean LaVine ◽  
Kelly Spielmann ◽  
Meredith Akerman ◽  
Karen A. Friedman ◽  
...  
Keyword(s):  
Cohort Study ◽  
Correlation Coefficient ◽  
Emotional Distress ◽  
Prospective Cohort Study ◽  
Professional Practice ◽  
Prospective Cohort ◽  
Response Rate ◽  
Initial Assessment ◽  
Survey Instruments

ABSTRACT Background  Residents and practicing physicians displaying signs of stress is common. It is unclear whether stress during residency persists into professional practice or is associated with future burnout. Objective  We assessed the persistence of stress after residency and its correlation with burnout in professional practice. We hypothesized that stress would linger and be correlated with future burnout. Methods  A prospective cohort study was conducted over 10 years using survey instruments with existing validity evidence. Residents over 3 academic years (2003–2005) were surveyed to measure stress in residency. Ten years later, these residents were sought out for a second survey measuring current stress and burnout in professional practice. Results  From 2003 to 2005, 143 of 155 residents participated in the initial assessment (92% response rate). Of those, 21 were excluded in 2015 due to lack of contact information; follow-up surveys were distributed to 122 participants, and 81 responses were received (66% response rate and 57% of original participants). Emotional distress in residency correlated with emotional distress in professional practice (correlation coefficient = 0.45, P &lt; .0001), emotional exhaustion (correlation coefficient = 0.30, P = .007), and depersonalization (correlation coefficient = 0.25, P = .029). Multivariate linear regression showed that emotional distress in residency was associated with future emotional distress (β estimate = 0.57, P = .005) and depersonalization (β estimate = 2.29, P = .028). Conclusions  We showed emotional distress as a resident persists into individuals' professional practice 10 years later and has an association with burnout in practice.

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