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Objective:To investigate changes in the self-management ability of chronic diseases in elderly diabetic patients during the novel coronavirus pneumonia pandemic.Methods:A multi-stage cluster sampling method was used to retrospectively collect diabetes management information from elderly diabetic patients treated in five community health service centers in Beijing in June 2022, including 295 elderly diabetic patients, and changes in management of their self-care practices such as diet, exercise, medical treatment and medication, blood glucose monitoring, complication management, and psychological states before and after the outbreak(2019-2022)were analyzed.Results:In 295 elderly diabetic patients, increased glycated hemoglobin( P<0.05)and body mass index(BMI)( P<0.05)were observed during the pandemic.Among 115 patients with underlying diabetic complications, 75.7%(87)of patients had worsening symptoms of chronic complications of diabetes and a shortened weekly exercise time[124(60, 300)min vs.140(60, 300)min, Z=6.00, P<0.05].The number of weekly blood glucose tests was reduced(5.6±4.2 vs.5.8±4.3, t=3.17, P<0.05).The weekly time spent interacting with family members increased( P<0.05).There were no significant differences in body weight, sleep time, and number of times of forgetting to take medication per week before and after the outbreak( P>0.05).21.0% of patients had a decrease in the number of hospital visits, and 72.2% of patients experienced low mood and increased adverse psychological emotions during the pandemic. Conclusions:The pandemic has had a negative impact on the management of chronic diseases in elderly diabetic patients, mainly reflected in the reduction of exercise time and blood glucose monitoring.It also affected regular hospital visits of patients, resulting in negative psychological emotions, poor blood glucose control, increased BMI, and aggravated symptoms of chronic complications, compared with their pre-pandemic conditions.

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BACKGROUND: Both stroke and depression are multi-factorial diseases, with both genetic and environmental factors likely to participate in their pathogenesis. Post stroke depression (PSD) is a common complication after stroke leading to poor functional outcome, increased physical disability and mortality. Although several genes have been associated with PSD, the genetic basis of PSD remains poorly understood. METHOD: A 2-stage candidate gene study by targeted sequencing was conducted involving stroke patients with or without depression and health controls. In the discovery stage (121 PSD, 131 non-PSD and 639 HC), logistic regression was used to test associations respectively in PSD and non-PSD groups. In the replication stage (200 PSD, 218 non-PSD and 983 HC), 54 selected SNPs were again genotyped in an independent cohort. Fixed-effects inverse variance-weighted meta-analysis was used in the combined samples. RESULTS: The study identified 2 novel genes associated with PSD [HTR3D (rs55674402, p = 0.002512, odds ratio (OR) = 0.7431); NEUROG3 (rs144643855, p = 0.00325, OR = 0.6523)] and 3 risk SNPs in one risk gene associated with non-PSD [PIK3C2B (rs17406271, p = 0.0006801, OR = 1.446; rs2271419, p = 0.0005836, OR = 1.497; rs2271420, p = 0.001031, OR = 1.431)] in the Chinese sample. NEUROG3 shows highest expression level in hippocampus. Functional enrichment analysis shows that susceptibility genes for PSD are mostly enriched in chemical synaptic transmission and regulation of lipid synthetic process. LIMITATIONS: The sample size was not sufficient to reach a genome-wide p value level. To overcome this shortage, some unique strategies were applied during the selection of SNPs for replication. Secondly, the age, gender composition and depressive severity between two stages were not well-matched. Different sample sources should be blamed, and to minimizing the influence, gender was corrected as co-variant in logistic regression. CONCLUSION: This study identified that HTR3D and NEUROG3 were linked with the susceptibility of PSD and PIK3C2B with stroke in the Chinese Han population. Further replication of these findings in a larger and better matched sample is warranted. Functional analysis suggests that the pathogenesis of PSD may be implicated in 5-HT synaptic transmission, neural plasticity and lipid metabolism, and therapeutic interventions targeting these pathways may be effective approaches for PSD treatment.

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Trastorno Depresivo/genética , Accidente Cerebrovascular/genética , Anciano , Pueblo Asiatico/genética , Estudios de Casos y Controles , Fosfatidilinositol 3-Quinasas Clase II/genética , Estudios de Cohortes , Trastorno Depresivo/epidemiología , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/epidemiología

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Patients with multiple diseases have a variety of medical needs,especially in elderly patients with senile syndrome.The conventional specialty care model is not suitable for patients with comorbidities and multidisciplinary intervention and management are required.The article introduces the concept and practice of a general practitioner (GP)-led multidisciplinary team in management of comorbidities in the community.Using one case of elderly patient with multiple diseases as example,the article shows how this model worked and how the patient benefited,and the related issues and reflections are also discussed in the article.

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In order to improve the professional competence of in-service general practitioners and improve the effectiveness of standardized residency training, it is necessary to carry out training with the specific problems encountered in the practice. Taking Gaobeidian Community Health Service Center as an example, the characteristics, process and precautions of the general practice case discussion model based on the real scene of the community health institutions are introduced in the article. It would provide reference for improving the teaching effectiveness and efficiency in the training base of general practice.