Relationship of Periodontal Status and Dental Caries Status with Oral Health Knowledge, Attitude and Behavior among Professional Students in India

Aim To find the relationship of periodontal status and dental caries status with oral health knowledge, attitude, behavior, among professional students in India. Methodology In a cross sectional study, a total of 825 students （males： 577, females： 248） fi＇om six professions were surveyed using a self administered structured questionnaire including 41 multiple choice questions and the WHO Oral Health Assessment Form （1997）. The data was analyzed using the SPSS version 13.0 to perform the Student＇s t-test, ANOVA test, Scheffe＇s test and Chi-square test, linear regression analysis. Results The mean percentage scores of the students for knowledge were 53.25 ±15.05; for attitude 74.97±20.48; and for behavior 59.09 ±18.77. The percentage of students with calculus score was found to be significantly high （43.8%）. The percentage of professional students with DMFT〉4 was 14.1% and the percentage of students with decayed teeth was 46.2%. The regression analysis showed that the oral health behavior of the students was dependent on the attitude （P〈0.001）, but showed no significant linear relation with the knowledge. Also, that the mean DMFT score was dependent on the oral health behavior （P〈0.05）, but showed no significant relationship with the knowledge and attitude of the students. The periodontal status was independent on the knowledge, but showed a significant relationship with attitude and behavior of the students. Conclusion A positive attitude and adherence to good oral hygiene behaviors is associated with better oral health.

Reproductive Health Knowledge Level of High School and University Students in Shanghai

Objective To understand the sexual and reproductive health knowledge level of high school and university students in Shanghai. Methods A total of 628 high school students and 709 college students were surveyed with anonymous self-administrated questionnaire in Shanghai. Results The median knowledge scores of students from colleges and high schools were 58 and 39, respectively. Those who had surfed the Internet, had browsed websites on reproductive health, or had communicated sex-related issues with fathers/classmates/friends had more reproductive health knowledge. In addition, the percentage of college students who had surfed the Internet, had browsed websites on reproductive health or had communicated sex-related issues with classmates/friends was higher than that of high school students. Conclusion The knowledge scores of respondents were rather low. Compared with the high school students, the college students had more reproductive health knowledge and sought the knowledge more actively.

Survey on Pre-pregnancy Health Knowledge and Service Demands among Un-pregnant Married Women

Objective To understand the pre-pregnancy health knowledge and service needs among un-pregnant married women in Shanghai. Methods A total of 968 newly-married un-pregnant women in Changqiao, Lingyun sub-districts and Huajing town of Xuhui district, Shanghai, were recruited and interviewed by structured questionnaire to collect the information on pre-pregnancy health knowledge and service demands. Results 1） Newly-married women thought the contraceptive methods suitable for them was male condom（84.4%）, followed by oral contraceptives（54%）, emergent contraceptive（52.5%） and contraceptive suppository （48.3%）. 2） The score of pre-pregnancy health knowledge was 54.7±14.5 among the subjects. The participants with junior college or a bachelor had more knowledge than those with junior or senior high school, and those who were engaged in medicine /education/science field had higher score. 3） They had higher knowing rate on the common knowledge, and the rate was above 80%. But the knowing rate on the knowledge of birth defect was low, and all below 50%. 4）A proportion of 52. 7% of the respondents knew that there was a station for reproductive health service in their communities, but only 45.5% received the service from the station, 87.0% thought they had insufficient or scarce knowledge, 73.6% planned to consult before pregnancy training courses on preparing pregnancy. and 63.6% were willing to attend the Conclusion The participants had certain pre-pregnancy health knowledge, but still need being improved,＂ in addition, they had higher needs on knowledge and service of birth defect prevention, at the same time they can＇t make full use of the existing reproductive health institution.

Effect of Humanistic Nursing Care on Health Knowledge Mastery and Nursing Satisfaction Among Patients Undergoing Kidney Stone Surgery

Objective:To deeply understand the influence of humanistic nursing care on the health knowledge mastery and nursing satisfaction among patients undergoing kidney stone surgery.Methods:Sixty patients with kidney stone who underwent surgical treatment in our hospital from June 2019 to June 2020 were randomly divided into reference group and experimental group by random number table method.There were 30 patients in each group.The patients of reference group were given routine nursing care,and the patients of experimental groups were given humanistic nursing care.The mastery score of various health knowledge,nursing satisfaction and postoperative complications were compared between the two groups.Results:The scores of health knowledge mastery among the patients in experimental group who were treated with humanistic nursing care were much higher than those in reference group who were treated with routine nursing care.The nursing satisfaction of patients in experimental group(96.67%)was significantly higher than that in reference group(80.00%),and the incidence of complications after kidney stone surgery in the experimental group(6.67%)was higher than that in the reference group(26.67%)(P<0.05).Conclusion:Humanistic nursing care is greatly conducive to the mastery of health knowledge in patients undergoing kidney stone surgery,and this nursing mode can meet the needs for nursing work and potentially minimize postoperative complications.

Effects of Health Education with Problem-Based Learning Approaches on the Knowledge, Attitude, Practice and Coping Skills of Women with High-Risk Pregnancies in Plateau Areas

Objective: Given the unique cultural background, way of life, and physical environment of the Tibetan Plateau, this study aims to investigate the effects of health education using problem-based learning (PBL) approaches on the knowledge, attitude, practice, and coping skills of women with high-risk pregnancies in this region. Methods: 76 high-risk pregnancy cases were enrolled at Tibet’s Linzhi People’s Hospital between September 2023 and April 2024. 30 patients admitted between September 2023 and December 2023 were selected as the control group and were performed with regular patient education. 46 patients admitted between January 2024 and April 2024 were selected as the observation group and were performed regular patient education with problem-based learning approaches. Two groups’ performance on their health knowledge, attitude, practice and coping skills before and after interventions were evaluated, and patient satisfaction were measured at the end of the study. Results: There was no statistical significance (P P P Conclusions: Health education with problem-based learning approaches is worth promoting as it can help high-risk pregnant women in plateau areas develop better health knowledge, attitude and practice and healthier coping skills. Also, it can improve patient sanctification.

How does parents’social support impact children’s health practice?Examining a mediating role of health knowledge

Background Family environmental factors play a vital role in shaping children’s health practices(e.g.,obesity pre-vention).It is still unclear how parents’social support affects children’s obesity-related health practices.The present study argues that whether parents’social support positively associates with children’s obesity-related health practice depends on if it could promote parents’obesity-related health knowledge.Thus,we hypothesize that health knowl-edge mediates the relationship between parents’social support and children’s health practice regarding weight management.Methods To test the hypothesis,we conducted a questionnaire survey and collected a nationally representative sample of 1488 household responses in Singapore.The survey included questions about parents’social support,health knowledge,children’s health practices,and socio-demographic variables.All participants have at least one child 14 years old or younger.In the sample,66.1%of the respondents are female,and 93.7%are below 50 years old.Structural equation modeling(SEM)via Stata was used to examine the associations between parents’social support,health knowledge,and children’s health practice.Results The results of our analysis support our hypothesis.Specifically,(1)parents’social support shows a positive relationship with health knowledge(Coef.=0.17,p<0.001 for BMI knowledge and Coef.=0.18,p<0.001 for nutrition knowledge);(2)parents’social support(total effect of social support=0.081,p=0.071)and health knowledge positively associate with children’s obesity-related health practice(coefficient of BMI knowledge=0.10,p<0.01;coefficient of nutrition knowledge=0.31,p<0.001);and(3)the effects of parents’social support on children’s health practice is fully mediated by parents’health knowledge(mediating effect=100%,p=0.007).Conclusion The present study provides fresh evidence from a multicultural context to understand the relationships between parents’social support,health knowledge,and children’s obesity-related health practice.Our findings sup-port the argument that social support from parents’social networks does not necessarily promote health outcomes.The only social support that carries proper health knowledge can facilitate good health practice.

Survey on Knowledge Toward Diabetic Periodontal Condition and Oral Health Among Medical Staff and Patients

The study was conducted to understand the cognitive status of medical staff and patients on the status of periodontal disease and oral health care in patients with diabetes,and to provide reference for the implementation and improvement of diabetes management and health education.Using the Diabetes Periodontal Status and Oral Health Knowledge Questionnaire,108 doctors,190 nurses,and 212 inpatients were investigated.This study demonstrated that,the total scores of doctors,nurses,and patients with diabetes periodontal status and oral health knowledge were(31.18±5.14),(28.58±4.09)and(18.67±3.45)points,respectively.The results of regression analysis showed that education level,department,and related training experience(p<0.05,p<0.01)were the influencing factors of the diabetic periodontal status and oral health knowledge level of the medical staff,meanwhile the monthly income,department,and relevant training experience(p<0.05,p<0.01)were the factors influencing the diabetic periodontal status and oral health care knowledge level of the patients.In summary,the cognitive level of diabetic periodontal status and oral health care knowledge of the medical staff and patients’needs to be improved.Medical staff should pay attention to the study of diabetic periodontal status and oral health care knowledge,further perform a good job in the relevant health education of patients,which is helpful to maintain good oral hygiene.

Knowledge levels and attitudes of health care professionals toward patients with hepatitis C infection

AIM:To study knowledge levels and attitudes of health care providers toward patients with hepatitis C virus infection in Guilan,a northern province of Iran.METHODS:This cross-sectional study was performed on 239 health care professionals from the Razi Hospital,including doctors,nurses,and operating room technicians.The questionnaires consisted of questions on demographic characteristics,knowledge levels,and attitudes toward hepatitis C patients.The questionnaire was tested in a pilot study and validated by Cronbach' s alpha coefficient.Data were analyzed using SPSS16 software.RESULTS:The mean ± SD knowledge score was 17.43 ± 2.65(from a total of 22).51.9% of the participants achieved scores higher than the mean.There was a significant relationship between knowledge score and age(P = 0.001),gender(P = 0.0001),occupational history(P = 0.0001),and educational history(P = 0.027).There was also a significant relationship between attitude level and age(P = 0.002),gender(P = 0.0001),occupational history(P = 0.0001),and educational history(P = 0.035).Physicians were significantly more knowledgeable and showed more positive attitudes.There was a positive correlation between knowledge and attitude scores(P = 0.02).CONCLUSION:Discriminatory attitudes are common among health care providers toward hepatitis C patients.It is therefore necessary to improve their knowledge level and attitude toward this disease.

Current state and influencing factors in airbag management among emergency department nurses:A multicenter study

BACKGROUND The emergency department(ED)plays a critical role in establishing artificial airways and implementing mechanical ventilation.Managing airbags in the ED presents a prime opportunity to mitigate the risk of ventilator-associated pneumonia.Nonetheless,existing research has largely overlooked the understanding,beliefs,and practical dimensions of airway airbag management among ED nurses,with a predominant focus on intensive care unit nurses.AIM To investigate the current status of ED nurses'knowledge,beliefs,and practical behaviors in airway airbag management and their influencing factors.METHODS A survey was conducted from July 10th to August 10th,2023,using convenience sampling on 520 ED nurses from 15 tertiary hospitals and 5 sary hospitals in Shanghai.Pathway analysis was utilized to analyze the influencing factors.RESULTS The scores for ED nurses'airway airbag management knowledge were 60.26±23.00,belief was 88.65±13.36,and behavior was 75.10±19.84.The main influencing factors of airbag management knowledge included participation in specialized nurse or mechanical ventilation training,department,and work experience in the department.Influencing factors of airbag management belief comprised knowledge,department,and participation in specialized nurse or mechanical ventilation training.Primary influencing factors of airbag management behavior included knowledge,belief,department,participation in specialized nurse or mechanical ventilation training,and professional title.The belief in airbag management among ED nurses acted as a partial mediator between knowledge and behavior,with a total effect value of 0.513,and an indirect effect of 0.085,constituting 16.6%of the total effect.CONCLUSION ED nurses exhibit a positive attitude toward airbag management with relatively standardized practices,yet there remains room for improvement in their knowledge levels.Nursing managers should implement interventions tailored to the characteristics of ED nurses'airbag management knowledge,beliefs,and practices to enhance their airbag management proficiency.

Role of traditional Chinese medicine in the initiative practice for health

To achieve awareness of the initiative practice for health concept in the Chinese population,traditional Chinese medicine(TCM)doctors should popularize TCM culture and knowledge among young people,people with a low level of education,in low-income populations,and in rural populations.

Awareness of initiative practice for health in the Chinese population:A questionnaire survey based on a network platform

BACKGROUND In 2016,the Chinese government issued the Healthy China 2030 plan,which also produced the initiative practice for health(IPFH)concept.However,people’s knowledge and awareness of the IPFH are unclear.AIM To investigate awareness of IPFH in the Chinese population and explore the relevant influential factors.METHODS An internet-based self-designed questionnaire survey was used to collect respondents’demographic characteristics and awareness of health and the IPFH from March 26 to April 18,2020.IPFH consciousness was assessed by the scores for different related questions.The Student’s t test,the Chi-square test,and multiple logistic regression analysis were performed to analyze the differences and influencing factors.RESULTS A total of 2678 valid questionnaires were collected.Of the respondents,973(36.3%)had heard of the IPFH concept.In addition,89.5% of participants agreed with the view that the IPFH is beneficial to improving quality of life,and over half thought that a regular schedule,a reasonable diet,tobacco and alcohol control,a cheerful mood,specific life goals and plans,taking the initiative to accept health-related education and implement health knowledge,good interpersonal relationships,and regular physical examinations were closely related to the IPFH.The majority of respondents paid attention to their health and usually obtained health-related knowledge via social media and were also willing to promote the IPFH.Most of the participants underestimated the role of hospitals,family doctors,and health managers in promoting the IPFH.Age,monthly income,and medical-related work experience were the influencing factors for IPFH awareness.CONCLUSION The Chinese population has limited knowledge of the IPFH.People with strong IPFH awareness are older,earn more,and have medical-related work experience.

Stroke prevention awareness and treatment knowledge among patients' relatives

BACKGROUND： Recent research indicates that if a stroke can be effectively treated within three hours, prognosis is improved. Therefore, it is necessary to properly educate stroke patients＇ relatives about prevention and treatment. OBJECTIVE： To survey and analyze the present awareness of stroke prevention and treatment knowledge among patients＇ relatives. DESIGN： Cross-sectional study. SETTING： Beijing Hospital and Medical College of Shandong University and Harrison International Peace Hospital, the Affiliated Hospital of Hebei Medical University. PARTICIPANTS： From May 2005 to November 2006, a ＂stroke awareness＂ questionnaire survey was performed in four hospitals, including Harrison International Peace Hospital in Hengshui City （third class, first grade）, Fucheng County People＇s Hospital （second class, first grade）, Zaoqiang County Jiahui Countryside Hospital （first class, first grade） and Hengshui City Electricity Industry Bureau Infirmary. The participants provided confirmed consent. METHODS： The ＂stroke awareness＂ questionnaire included 10 questions： 1 -8 were related to the understanding of stroke, 9 and 10 were related to behavior and attitude towards medical treatment. Demographic information was also collected on each participant, including age, education level, and occupation. Each positive answer accounted for one point. A score of 8 or higher was categorized as ＂good stroke awareness＂. MAIN OUTCOME MEASURES： Scores of stroke awareness. RESULTS： A total of 4 000 ＂stroke awareness＂ questionnaires were printed and distributed. 3 597 copies were completed and 3 468 were included in the study. （1） Relative factors of stroke awareness： The survey demonstrated that the participant＇s age, educational level, occupation, grade of hospital, and the relationship with the patient had a significant effect on their stroke awareness （P 〈 0.05-0.01）. （2） Stroke knowledge： With regard to stroke awareness, 72% subjects did not know the signs indicating the onset of transient ischemic attack; 86%, 72%, and 51% did not know that diabetes, cardiopathy, or smoking and drinking were risk factors for cerebral thrombosis, respectively. With regard to awareness of cerebral thrombosis symptoms almost 60% did not know the symptoms of vertebrobasilar ischemia, such as dizziness, vomiting, and impaired eyesight. With respect to cerebral thrombosis treatment, 27% reported that when a stroke occurs, they would like to see the doctor subsequent to discussion with their families, or they would even wait a few days. They did not regard their condition as an ＂emergency＂. CONCLUSION： Relatives have little knowledge about stroke, but there are significant differences in levels of awareness with respect to occupation and educational levels.

A Study on Oral Health-Related Quality of Life and Its Influencing Factors in Elderly Diabetic Patients

Objective:To investigate the oral health related quality of life in elderly diabetic patients and analyze its influencing factors.Methods:Convenience sampling was used to select 190 elderly patients with diabetes under the Department of Endocrinology and Department of Integrated Traditional Chinese and Western Medicine in the Affiliated Hospital of Hebei University as the research subjects.The Chinese version of the Oral Health Influence Scale(OHIP-14)was used to conduct a questionnaire survey,and univariate analysis and multiple stepwise regression analysis were used to analyze the influencing factors of oral health related quality of life in elderly diabetic patients.Results:The elderly diabetic patients'oral health related quality of life score was 34.48±3.23,which is in the middle-lower range.The findings of multivariate stepwise regression analysis revealed that the course of disease,regular visits to the dentist,sleep quality,oral health knowledge,and oral health attitude together explained 58.9%of the total variance in elderly diabetic patients in terms of their oral health related quality of life(p<0.05).Conclusion:The oral health related quality of life of elderly diabetic patients is generally low,and is affected by the duration of diabetes,sleep quality,and oral health knowledge,attitude,and behavior(regular visits to the dentist).Improving patientsJ attention to oral health problems by improving sleep as well as their own oral health knowledge,attitude,and behavior is an effective way to enhance oral health related quality of life.

Bibliometrics study on the Journal of American College Health： 1994-2014

Objective： To help readers around the world comprehensively understand the development of the journal and evolution of cooperation study, we employed a bibliometrics analysis for the Journal of American College Health. Methods： One-thousand-one-hundred-forty-three articles published in this journal from 1994 were analyzed using the bibliometrics and visualization software CiteSpace. Results： The annual number of published articles and cited studies increased. The published studies by RP Keeling and H Wechsler were at the forefront. ＂College student＂ and ＂alcohol＂ were prevalent key- words. University of Wisconsin and Harvard University were the institutional leaders of contributions. Conclusions： This journal provides an important platform for sharing research achievements and promoting cooperation in this field. The level of articles published is continually improving. A research cooperative network promoted by famous scholars and institutions is developing. However, crossregional and international cooperation is relatively limited.

Ethnobotanical and Indigenous Knowledge of Important Plants in East Hararghe, Eastern Ethiopia

An ethnobotanical study was conducted in East Hararghe, Ethiopia to identify and investigate the use of various plants by the traditional healers and communities engaged in domestic, pesticide and medicinal use. A total of 78 species were observed to be used by the local inhabitants in the region for the treatments of various ailments. Out of these, herbs constitute 49% followed by trees(36%) and shrubs only 15%. However, most frequently used plant parts were leaf and aerial parts(20) followed by seed(13), fruit(12), other parts(10), rhizome(7) and bark(1). Most of the plants were found to be used for medicinal, aromatic and food flavouring(spices, condiments) purposes. Out of 78 species recorded in the present study, 11 were reported to cure stomachache, seven for cold, cough and respiratory problem, six for diarrhoea and five species were found capable of curing fever. Fabaceae was the largest family contributing to medicinal plant use with seven species followed by Solanaceae, Myrtaceae,(5 spp.), and Zingiberaceae, Asteraceae, Liliaceae(4 spp. each). Some of the important plants utilized for taking care of variety of ailments are Azadirachta indica, Brassica nigra, Balanites aegyptiaca, Maytenus ovatus, Rosmarinus officinalis and Trigonella foenum graecum. Most of these medicinal and aromatic plants(MAPs) play a significant role in the household economy and were observed to be very popular among the people. Unpopular plants were left out of the study. This study provides useful and basic information on usage of different plants for conducting further studies aimed at conservation and documentation of traditional medicine system and economic welfare of rural peoples of the East Hararghe, Ethiopia. It also revealed that indigenous practices contributed to sustainable management of plants.

A bibliometric study of the Journal of School Health:1965-2014

Background：As an important international journal in the field of school health,the Journal of School Health has drawn wide attention from researchers and readers around the world.Therefore,it is important to conduct a systematic retrospective study of the journal.With the aim of understanding the development of the journal and the evolutionary process of cooperative study of this field comprehensively,we employed bibliometric analysis using the articles published in the Journal of School Health from 1965.Methods：Using bibliometrics,5242 articles published in the journal were extracted and then analyzed using the visualization software CiteSpace Ⅲ.Results：The annual published amount of literature showed a declining tendency;however,the frequency of citation displayed an increase year by year.Among prolific authors,the number of reports published by JH Price,L Kann and RJ McDermott are at the top.Among the high frequency keywords used in the research journal, ＂adolescents＂, ＂children＂ and ＂programs＂ have become popular in the journal＇s vocabulary.CDCP,Univ Texas and Univ Calif are positioned in the forefront of the involved institutions when ranked by degree of contribution.Conclusions：The Journal of School Health provides an important platform for sharing research achievements and promoting cooperation in this field.The amount of articles published in the journal is continually improving;its cooperative research network promoted by famous scholars and institutions is forming.As more researchers and institutions join,the network will grow and relationships will become increasingly close.However,limitations to cooperation at the regional or interagency scope remain.

Clinical and epidemiological features of patients with clonorchiasis

AIM:To study the clinical and epidemiological features of patients with clonorchiasis so as to provide scientific evidences for the diagnosis and prevention of clonorchiasis. METHODS:Stools from 282 subjects suspected of having clonorchiasis were examined for helminth eggs with modified Kato's thick smear and sedimentation methods,and their sera were tested for HAV-DNA,HBV-DNA,HCV-RNA,HDV- RNA and HEV-RNA with polymerase chain reaction (PCR). Clinical symptoms of patients with clonorchiasis only were analyzed,and their blood samples were tested for circulating antigen (CAg) with Dot-ELISA,esoinophilic granulocyte count, and alanine aminotransferase (ALT).Meanwhile,they were asked to provide data of occupation,eating habit,hygienic habit and knowledge of donorchiasis.In addition,the ecosystem of the environment in epidemic areas was surveyed. RESULTS:Among the 282 patients,61 (21.43%) were infected with clonorchis sinensis only,97 (34.64%) were co-infected with clonorchis sinensis and other pathogens, 92 (32.86%) were infected with hepatitis virus only and 31 (11.07%) neither with clonorchis sinensis nor hepatitis virus. Among the 61 patients with clonorchiasis only,there were 14 (22.95%) subjects with discomfort over hepatic region or epigasfrium,12 (19.67%) with general malaise or discomfort and inertia in total body,6 (9.84%) with anorexia,indigestion and nausea,4 (6.56%) with fever,dizziness and headache (6.56%),and 25 (40.98%) without any symptoms;sixty one (100%) with CAg (+),98.33% (59160) with eosinophilic granulocytes increased and 65.00% (39/60) with ALT increased.B-mode ultrasonography revealed 61 cases with dilated and thickened walls of intrahepatic bile duct,and blurred patchy echo acoustic image in liver.Twenty-six cases had stones in the bile duct,39 cases had slightly enlarged liver with diffuse coarse spots in liver parenchyma.Twenty cases had enlarged gallbladder with thickened coarse wall and image of floating plagues,9 cases had slightly enlarged spleen.By analysis of epidemiological data,we found that the ecologic environment was favorable for the epidemiology of clonorchiasis.Most patients with clonorchiasis were lack of knowledge about the disease.Their living environment, hygienic habits,eating habits and their occupations were the related factors that caused the prevalence of the disease. CONCLUSION:The clinical symptoms of clonorchiasis are non-specific,and the main evidences for diagnosis of clonorchiasis should be provided by etiologic examination, B-mode ultrasonography and clinical history.The infection of clonorchis sinensis is related to occupations,bad eating habits and lack of knowledge about prevention of the disease.

Assessing attitudes toward elderly among nurses working in the city of Ilam

Objective:Several factors affect the quality of care in the elderly,such as nurses'attitudes.This study aimed to assess nurses'attitude toward elderly in the city of Ilam.Method:This cross-sectional study was conducted among 230 nurses working at public hospitals in the city of Ilam.Participants were selected using simple random sampling from the list of staff.The Kogan's attitude questionnaire was used to measure nurses'attitudes toward the elderly.Results:The mean age of respondents in this study was 32.65(SD=7.67),and the score of attitudes toward the elderly was 144.96(SD=51.75)in average.More than half(54.3%)of the nurses had negative attitudes toward the elderly.The results of ANOVA analysis showed significant differences(P<0.05)were observed in the attitudes toward the elderly among the nurses as their ages,marital status,work experiences,and ward types differed.Conclusion:In conclusion,nurses in this study have marginally negative attitudes toward the elderly.Therefore,promoting nurses'attitudes toward the elderly is important to provide high-quality care.

Gap between evidence and physicians＇ knowledge and practice regarding hypertension and its drug treatment： a survey in a Chinese city

Background Evidence-based medicine has come into its second decade. How prepared clinicians are in practicing it in particular in developing countries remains unclear. Thus we conducted this survey of physicians in urban hospitals in China to determine the size of the gap between research evidence and physicians＇ knowledge and practice regarding antihypertensive drugs for primary prevention of cardiovascular diseases in China.Methods A cross sectional survey by a face-to-face interview was conducted in 20 tertiary general hospitals in China in 2005. A total of 444 physicians （mostly cardiologists） in internal medicine who had treated at least one hypertensive patient in the past 12 months were invited for the interview on their perception of the cardiovascular risk of hypertension,the magnitude of the benefit of antihypertensive drugs, knowledge on the overall risk approach, first-line drugs used, the risk above which drug treatment is recommended, and knowledge on evidence-based medicine.Results A total of 444 of the 468 eligible physicians were successfully interviewed with a response rate of 94.9%. They estimated that a hypertensive man with an actual 5-year cardiovascular risk of 8.4% would have a 5-year cardiovascular risk of 40% （95% CI： 38% to 42%） if not treated, and have an absolute risk reduction and relative risk reduction from drug treatment by 20% （95% CI. 18% to 22%） and 39% （95% CI： 37% to 42%） respectively, as compared to 3.3% and 33%respectively shown in research evidence. On average, the physicians would recommend drug treatment at a number needed to treat （NNT） of 368 or smaller, as compared to the actual NNT of 50 for drug treatment in an average hypertensive Chinese. Fifty-five percent （95% CI： 50% to 59%） of them had never intently used the national hypertension guidelines. The majority still prescribed drugs primarily based on blood pressure alone by ignoring other risk factors or the overall risk and 78% （95 % C/. 76% to 83%） used new expensive drugs such as calcium channel blockers and angiotensin converting enzyme （ACE） inhibitors as first-line treatment. Only 13% （95% CI：9% to 18%） could correctly interpret the NNT. Forty-three percent （95% CI： 39% to 48%） did not know the randomized controlled trial was scientifically the most rigorous among other study designs for evaluating the effectiveness of anti-hypertensive drugs.Ninety-two percent （95% CI： 90% to 94%） did not know they could start by searching systematic reviews when looking for evidence on the effectiveness of anti-hypertensive drugs as opposed to trials. Ninety-six percent （95% CI： 94% to 98%）did not know the Cochrane Library was an important source of systematic reviews.Conclusions The surveyed physicians significantly over-estimated the cardiovascular risk of hypertension and the benefit of drug treatment, and had insufficient knowledge on the overall risk approach. They recommended drug treatment at a cardiovascular risk which was even much lower than the cutoff suggested for western populations, which would make many more people eligible for drug treatment. They also tended to prescribe new expensive drugs although the older cheaper ones may be more appropriate in many patients. They showed inappropriate knowledge on the basics of evidence-based medicine.

Delivery of acupuncture in clinical trials:Research acupuncturists’perspectives

Delivery of acupuncture in the setting of a clinical trial is a unique practice that diverges significantly from the delivery of acupuncture in a real-world clinical setting. Research acupuncturists, particularly those trained in traditional Chinese medicine(TCM), are often required to set aside valued precepts of traditional care, including diagnosing imbalances, individualizing treatment, and forging a therapeutic relationship with patients. TCM-trained acupuncturists express mixed feelings about participating in clinical trials. Many are eager to play a vital role in the advancement of acupuncture science and appreciate the need for strict protocol adherence to minimize bias. However, the acupuncturist(s) may also have concerns about clinical trial methodology, including but not limited to the delivery of a control condition, e.g., sham acupuncture. Investigators should anticipate certain questions and even a level of resistance to the requirements of research among acupuncturists and be prepared to address them. This manuscript presents a brief review of the subjective experience of the research acupuncturist within the available scientific literature as it pertains to the delivery of active and sham clinical research protocols. Our goals are to better understand the perspectives of acupuncturists who may participate in clinical research, so that their concerns may be addressed in study design and methodology. To that end, we suggest the creation of a novel training program specifically for clinical trial acupuncturists, intended for qualified TCM-and Western-trained practitioners, that would help to standardize the research acupuncturist’s role and help to strengthen the design and execution of acupuncture studies.