2015年 · 第09卷第03期

Coinciding with the 100th anniversary of the founding of the Chinese Medical Association, this issue specially invites Wu Liuxin, Zeng Qiang, Guo Qing and Bao Yong to review and look forward to the history, current situation and prospects of academic development, discipline construction, talent training and community health management of health management.

A century of medicine has forged the soul of China, and a healthy century has realized the Chinese dream. This year marks the 100th anniversary of the founding of the Chinese Medical Association. In order to welcome and celebrate the glorious birthday of the Chinese Medical Association, the Health Management Branch of the Chinese Medical Association and the Chinese Journal of Health Management specially set up the column "Focus on the Centenary", and invited four experts in the field of health management in China to review and summarize the development process and academic achievements of health management in China in the past 10 years from different angles, and look forward to the opportunities and visions faced by health management in China in the new century of medicine. I hope that the readers who care, love and consistently support the academic and disciplinary development of health management in China will join us to absorb academic nutrition and wisdom from the review of the past, and add confidence and strength to the infinite vision of the future.

With the rapid development of life sciences, the transformation of biomedical models, the urbanization and aging of the population, the increase of the prevalence of lifestyle diseases, and the rapid development and application of science and technology and medical Internet of Things, China's health management is experiencing a rare development opportunity. In the late 1990s, health management began to spread in China. After 2003, the health management service industry, which is driven by the demand of health services and the main form of health examination, has developed rapidly. After 2005, the Health Management Branch of Chinese Medical Association, the Health Assessment and Risk Control Professional Committee of Chinese Preventive Medicine Association, the Physician Health Management and Health Insurance Professional Committee of Chinese Medical Doctors Association, and the health management societies, health management associations and health management branches of various provinces (autonomous regions) and municipalities were established one after another. The founding of Chinese Journal of Health Management marked that China's academic theoretical research and industry of health management began to enter the track of scientific, standardized and orderly development. Among them, the development of scientific research and discipline construction of health management is extremely rapid, and the two promote each other and become one. We will briefly describe the development course of health management scientific research and discipline construction in China.

In 1915, 21 pioneers of modern medicine in China, such as Wu Liande and Yan Fuqing, gathered in Shanghai and established the Chinese Medical Association, the first medical academic organization in modern Chinese history. At this point, Chinese people began to enter the door of modern medicine in an organized way. Today, a hundred years later, China has entered the 21st century, with rapid economic and social development and continuous progress in medicine, which has brought a series of major changes. Therefore, we must change our ideas as soon as possible, from the traditional biomedical model to the "bio-psychosocial" medical model, from focusing on disease to managing health.

Community health management is the whole process of comprehensively monitoring, analyzing, evaluating, predicting, preventing and maintaining health risk factors of community healthy people and disease people based on management theory and new health concept, and developing personal and family skills. Implementing community health management is a qualitative leap from passive disease treatment to active health management. Community health management puts the base of health management rooted in the community, which has the advantages of improving social fairness, promoting community initiative and solving people's livelihood problems with the greatest effort.

In ordinary clinical work, everyone is used to referring to 0.9% sodium chloride solution as physiological saline. The main reason is that the osmotic pressure of 0.9% sodium chloride solution is equal to that of human extracellular fluid (including blood).

Recently, the 2014 Global Non-communicable Disease Status Report published by the WHO shows that more than 3 million Chinese die every year before the age of 70 from chronic diseases such as cardiovascular and cerebrovascular diseases, malignant tumors and diabetes (also defined as "premature death")^[1]。 Chronic diseases have become the main problem that endangers our national health. The harm of chronic diseases is mainly the damage of important organs such as brain, heart and kidney, which can easily cause disability, affect the labor ability and quality of life, and the medical expenses are expensive, which increases the economic burden of society and families. At present, many conventional methods of prevention and treatment of chronic diseases obviously can't meet the increasingly severe situation of chronic diseases, so it is necessary to put forward new ideas of prevention and treatment of chronic diseases.

A systematic review reveals that sitting is associated with an increased risk of cardiovascular disease, type 2 diabetes, and cancer regardless of exercise levels. The study suggests that people who think they have enough exercise must pay more attention to the risks of sedentary.

Published inJAMA Internal MedicineBoth men and women are more likely to make similar positive changes when their partners make some healthy lifestyle behavior changes such as quitting smoking and exercising, according to a report in the report.

Breast cancer is one of the most common malignant tumors in women, and its incidence is on the rise, and it is getting younger and younger^[1]。 The main caregivers of female breast cancer patients are mostly their husbands, children, parents and other immediate family members. Because of their worries about the patient's condition and prognosis, long-term care, huge economic burden and other reasons, the main caregivers face greater mental pressure, and the incidence of mental illness is equal to or greater than that of patients^[2]。 Some domestic researchers call the primary caregivers of cancer patients "hidden patients"^[3]They are co-affected by the disease. Under the holistic nursing model, the objects of nursing services should not be limited to the patients themselves, but also include their caregivers. Helping caregivers of breast cancer patients can improve their care efficiency, and it is also indirect care for breast cancer patients. We intend to study the psychological depression status and its influencing factors of primary caregivers of breast cancer patients, so as to provide a basis for formulating psychological intervention measures for primary caregivers of breast cancer patients.

The incidence of osteoporosis (OP) is on the rise, which seriously endangers people's health. Therefore, it is of great significance to know the factors related to its disease. At present, domestic research on this area has been reported^[1,2,3]However, no OP related reports were found in western Inner Mongolia with different eating habits in alpine regions. Therefore, this paper studies its disease and its related factors in order to prevent and treat.

Diabetes mellitus DM is a group of metabolic diseases caused by the interaction of genetic and environmental factors. Its basic characteristic is that the blood glucose level is increased for a long time, which can lead to damage to blood vessels, heart, nerves, kidneys, eyes and other tissues and organs. The overall prevalence of diabetes in China is 9.7%, and there are currently about 92.4 million adults in China who suffer from diabetes. Diabetes has seriously threatened the health of our people, and also led to high medical expenses^[1]。 In a 2008 survey of 10,000 people in Shanghai, the prevalence rate of diabetes among community residents was 10.2%, and the incidence rate was increasing^[2]However, the blood sugar control of diabetic patients in China has been unsatisfactory and harmful. The high incidence rate, high complications and high disability rate bring heavy economic burden to patients, families and society. The medical expenses and economic losses caused by diabetes and its complications are also increasing year by year. Through the survey and statistics of the diagnosis and treatment cost of diabetes in 11 provincial capitals across China, it is estimated that the total cost of diagnosis and treatment of diabetes and its complications in Chinese cities is about 23.3 billion yuan, while the direct medical expenses are 18.8 billion yuan, accounting for 3.95% of the total health expenses^[3]。 How to effectively manage and intervene in diabetic patients is a question worth exploring. The classified management mode of community diabetes families under the family doctor responsibility system is introduced as follows.

With the development of social economy and the change of people's lifestyle, the prevalence of chronic non-communicable diseases is increasing rapidly^[1]。 Among them, hypertension has become the most common chronic disease in China, and the complications of hypertension are fatal and disabled, which is serious. Patients with hypertension mainly develop from high-risk groups of hypertension. Therefore, through the continuous and planned implementation of intervention services in the outpatient clinic of hypertension intervention technology in our hospital, the effectiveness of intervention services for the prevention and treatment of hypertension is determined.

As a professional engaged in health management, health managers' career directions involve many fields. At present, they mainly include medical institutions, enterprises, insurance companies and community health service institutions in China. It is foreseeable that with our government's policy support for health management^[1]In the future, the practice scope of health managers will gradually expand to other industries. At present, health examination institutions are still the main body providing health management services^[2]It is also the main field of health managers' practice^[3]。

The history of mental disorders is with humanity. In the long river of history, as the human spiritual world becomes increasingly complex, abnormal forms of spiritual activities gradually appear. In ancient times, since the natural sciences were not fully developed, people usually used a natural way to explain mental disorders. For example, in mysterious religious legends, insanity displayed by people with mental disorders is often viewed as an evil force. The Old Testament believes that people with mental disorders are people who are possessed by demons. In Hinduism, it is said that Grahi, a demon who controls the mind, is the culprit of epileptic convulsions. Ancient Babylonian and Mesopotamian cultures regarded mental disorders as manifestations of soul possession, caused by witchcraft, magic, or the violation of taboos^[1]。 Thus, in medieval Europe under the rule of religious theology, punishment became a means of "treating" the sufferers of mental disorders. During the "witch hunt" wave between the late 15th and mid-17th centuries, more than 200,000 people with mental disorders died^[2]。 By the Renaissance, although the understanding of mental disorders remained the same, the situation of people with mental disorders improved slightly, and eviction and confinement became the common approach. At that time, most cities in Europe had special internment centers for madmen, such as Fort Châtelet in Melun and Madman's Tower in Cannes. Its purpose is not to "cure" but as a means of managing "law and order", which can also be understood as a means of "eliminating evil"^[3]。

At present, chronic diseases such as cardiovascular and cerebrovascular diseases and cancer are the most important causes of death in our country, accounting for about 70% of the total causes of death^[1]。 The incidence of chronic diseases is increasing year by year, which seriously affects the quality of life of the people and brings huge economic losses to the country. Therefore, the early prevention of chronic diseases has become one of the important research topics in the field of public health.

In order to reduce the health and social burden caused by the rising incidence of non-communicable diseases, the World Health Organization recommends reducing the intake of animal fats, sugars and salts, and consuming more fruits, vegetables, cereals and nuts while ensuring a balanced energy and nutrition^[1]。 Studies such as Oxford University have shown that vegetarians have lower rates of morbidity and mortality from several chronic diseases than omnivores^[1,2,3]。 Although non-dietary factors such as abstinence from tobacco and alcohol may play a role in vegetarians' corresponding lifestyle habits^[3]But diet is undoubtedly an important factor^[4]。

Thyroid dysfunction is a common disease of the endocrine system, and hyperuricemia is a common metabolic disease. Research on the effect of hyperuricemia on thyroid dysfunction was first seen in 1955, KUZZEL et al.^[1]Thyroid function was tested in 520 patients with gout, and the prevalence of hypothyroidism (hypothyroidism) was found to be 20% in men and 30% in women. In 1989, a link between hyperuricemia and hyperthyroidism (hyperthyroidism^[2]。 In recent years, people have begun to pay attention to the effect of abnormal thyroid function on blood uric acid, because abnormal thyroid function will have a significant impact on purine nucleotide metabolism, and hyperuricemia exists in patients with hypothyroidism and hyperthyroidism. This paper summarizes the epidemiological reports of thyroid dysfunction and hyperuricemia, and summarizes the relationship between them, as well as the possible mechanisms of the influence of the former on the latter.

On March 23, 2010, Obama signed the "Patient Protection and Affordable Health Services Initiative"^[1]。 This bill, commonly referred to as the Affordable Care Act and also known as the Obamacare Act, was further ruled by the U.S. Supreme Court on June 28, 2012 to be constitutional and enforceable^[2]。 By expanding public and private health insurance coverage and reducing the proportion of people in the United States without health insurance, this bill aims to reduce the growing trend of total health care costs in the United States. The Congressional Budget Office projects that the SERVICES Act will increase health insurance coverage to 95 percent for people under 65 in the United States, benefiting 32 million previously uninsured people by 2016^[2]。 Thus, the future U.S. federal government's deficit and the growing expenditure on national health service costs can be reduced.