With continuous development of the Chinese health care system, the doctor–patient relationship is increasingly tense in recent years. China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This study aimed to help to theorize the doctor–patient relationship based on the game theory, and analyze the current situation and influencing factors for medical disputes among different hospitalsA total of 17 hospitals were randomly selected in Xiamen city, including 8 tertiary hospitals and 9 secondary hospitals. All medical dispute cases, between 2012 and 2014, were collected through questionnaires. Multiple logistic regression analyses were used to identify risk factors associated with medical disputes.In total, 896 medical dispute cases happened in 2012 to 2014, 733 (81.8%) of which occurred in tertiary hospitals. Medical disputes mainly were reported in the departments of obstetrics and gynecology (24.9%). The main causation of medical disputes was improper communication (24.0%) in tertiary hospitals and lower therapeutic skills (43.7%) in secondary hospitals, respectively. The negotiated rate (91.4%) in secondary hospitals was significantly higher than the tertiary hospitals (54.8%). The patients’ age, occupation and the doctor's medical location, professional title were the main risk factors for the occurrence of medical violence.Relationships between doctors and patients have become worse increasingly, whereas doctor–patient disputes or conflicts and their compensation have aggrandized year by year. The game relationship of doctor–patient is noncooperation, dynamic, and incomplete information game, and the advantages of cooperation are far greater than the competition between doctors and patients. Therefore, we need to take targeted measures to prevent and control the medical disputes by establishing a harmonious doctor–patient relationship in different levels of medical institutions.
The aim of this study was to investigate the impact of maternal hepatitis B virus (HBV) status on pregnancy complications and neonatal outcomes for women undergoing assisted reproductive technology (ART). A total of 7,011 pregnancies achieved by ART were included from a population‐based database involving 523,111 pregnancies. Exposures of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) among pregnant women were routinely tested at the first antenatal visit for all pregnancies. We collected pregnancy complications (e.g., gestational diabetes mellitus [GDM], intrahepatic cholestasis of pregnancy [ICP]), neonatal outcomes and confounding variables from the same database. Univariate and multivariate analyses by adjusting confounders were conducted to evaluate the impact of maternal HBV infection. Prevalence of HBsAg seropositivity (HBsAg+) was 11.34% (95% CI 10.6–12.1) and that of HBsAg and HBeAg co‐seropositivity (HBsAg+HBeAg+) was 2.55% (2.1–3.0) among included population. Compared with HBsAg−group, ICP risk in the HBsAg+group was higher (4.03% vs. 1.79%; adjusted odds ratio [aOR] 2.49, 1.65−3.77). Similarly, ICP prevalence in the HBsAg+HBeAg+ group was higher than that in the HBsAg−HBeAg− group (6.47% vs. 1.61%; aOR 4.78, 2.28–9.98). No associations were found between maternal HBV infection (i.e., HBsAg+, HBsAg+HBeAg+, or HBsAg+HBeAg−) and other adverse outcomes for women undergoing ART (i.e., GDM, pre‐eclampsia, placental previa, premature separation of placenta, premature rupture of membranes, preterm birth and low birthweight) in this study. In conclusion, maternal HBV infection (HBsAg+or HBsAg+HBeAg+) probably increase ICP risk, but may not associate with other pregnancy complications or neonatal outcomes for pregnant women who underwent ART.
Background
The prevalence of diabetes is increasing worldwide. Our study aimed to estimate the changing trends in the prevalence and incidence of diagnosed type 2 diabetes mellitus (T2DM) among Xiamen residents and the floating population using real-world data.
Method
We used real-world data from the System of Xiamen Citizens Health Information from 2014 to 2019 to estimate the changing trends in the prevalence and incidence of diagnosed T2DM. The System included the diagnosis of diabetes and the prescription of hypoglycemic drugs. Prevalent cases of T2DM were individuals who were diagnosed with T2DM and/or using hypoglycemic drugs. Incident cases were individuals with diagnosed T2DM and/or using hypoglycemic drugs in 2014 or 2019 who had not been diagnosed and/or did not use hypoglycemic drugs in the past.
Results
In 2014 and 2019, the prevalence of T2DM in Xiamen was 4.04 and 4.84%, respectively. In 2014 and 2019, the incidence rate of T2DM in Xiamen was 14.1 per 1000 person-year and 15.0 per 1000 person-year, respectively. There was a significant increase in both the prevalence (Prevalence difference: 0.80, 95%CI 0.76–0.83%, P < 0.001) and the incidence of T2DM (Incidence difference: 0.9, 95%CI 0.7–1.1, P < 0.001). in Xiamen. The prevalence and incidence of T2DM in people aged 18–39 increased significantly (P < 0.001), while the prevalence and incidence of T2DM in people aged 40–69 reduced significantly (P < 0.001).
Conclusions
There was a significant increase in the prevalence and incidence of T2DM in Xiamen from 2014 to 2019 especially among those with younger age.
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