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Background With the development of society and the improvement of people's living standards, health issues are receiving increasing attention. The aging population and the high incidence of chronic diseases have made health management an urgent problem that needs to be addressed. Primary healthcare institutions, as the "main battlefield" for residents' health, play a crucial role in health management. However, in the current implementation of health management, primary healthcare institutions still face numerous challenges, and their proactivity remains unclear. Objective To understand the current implementation status of health management in primary healthcare institutions in Shanghai and to discuss strategies for enhancing the implementation of proactive health-oriented health management. Methods From February 2023 to May 2023, a survey was conducted on 33 primary healthcare institutions in Shanghai. The survey aimed to understand the implementation of health management, assessment of high-risk factors and disease screening, execution of health education and information dissemination, coordination of health management resources and functional services, as well as the status of online health management services and health monitoring. Additionally, interviews were conducted with institution heads to gather information on implementation difficulties and suggestions. Results The research results showed that all participating institutions carried out health management for chronic disease patients, with 93.9% (31/33) covering key populations, 72.7% (24/33) involving rehabilitation populations, and 54.6% (18/33) including healthy populations. A total of 81.8% (27/33) of institutions utilized health data platforms, with the main functions including contract management, health record management, data querying, and health indicator management. Furthermore, 97.0% (32/33) of institutions conducted high-risk factor assessments and disease screenings, as well as follow-up, diagnosis, and management. The majority of institutions carried out health education and information dissemination activities through various platforms. Additionally, 87.9% (29/33) of institutions collaborated with other units to implement health management projects, providing diverse functional services. About 63.6% (21/33) of institutions offered online services, and 42.4% (14/33) were equipped with health monitoring devices. Managers believed that primary healthcare institutions and their staff have significant advantages in implementing proactive health-oriented management, but they also face challenges due to a lack of policy and financial support. Conclusion Primary healthcare institutions in Shanghai have made positive progress in implementing proactive health-oriented management. However, comprehensive measures are still needed to address existing challenges, in order to further improve the quality and efficiency of health management services and better meet the health needs of residents.

Background Psychosomatic disorders present high prevalence and disease burden in the community. Currently, different disciplines of medical institutions possess unclear functions and inadequate process strategies for the diagnosis and treatment of psychosomatic disorders, resulting in differences in the perceptions of disease and behavioral characteristics of doctors and patients, which affects the management of disease in the community. Objective To understand and analyze the cognitive and behavioral characteristics as well as the influencing factors of psychosomatic disorders from multiple perspectives of doctors and patients, and then provide strategic directions to improve the diagnosis and management of psychosomatic patients in the community. Methods During the period from 2022-02-01 to 06-31, 5 internists from a general hospital (H1) in Yangpu District, 12 general practitioners from 2 community health centers (H2, H3) in Yangpu District, and 2 community health centers (H4, H5) in Jiading and Pudong New Districts, 2 healthcare professionals from a mental health center hospital in Yangpu District, and 10 patients and with psychosomatic disorders who had been treated in the above hospitals or their relatives. The interview was performed by WeChat, face-to-face as well as telephone and other methods, with the content including perceptions of psychosomatic disorders, healthcare seeking behaviors, disease attitudes, problems and suggestions, and lasted 15-30 min. The interview content was recorded and transcribed into text, coded, summarized to generate themes, and finally quoted from representative interviewees. Results (1) There was a high level of disease awareness among general practitioners and psychiatrists, a low level of awareness among internists, and a general lack of awareness among patients. (2) General practitioners and psychiatrists possessed more experience in the diagnosis and treatment of psychosomatic disorders, but lacking sufficient work and effective treatment results. (3) The attitudes of multiple doctors and patients were varied with an overall lack of positivity. General practitioners had the most positive attitudes toward the diagnosis and treatment of psychosomatic disorders. (4) Doctors of different disciplines faced difficulties, including large patient bases, insufficient mental health resources, lack of solid psychological perceptions, lack of standardized guidelines for diagnosis and treatment, and busy practices, etc. (5) Most patients had not received psychotherapy, but they didn't exclude it either, while there were problems such as distrust of general practitioners, fear of treatment side effects, and health seeking behavior affected by many factors. (6) Both doctors and patients offered constructive suggestions, which included strengthening publicity and policy guidance to the public, promoting the continuous development of psychosomatic medicine, improving doctors' identification of psychological disorders, opening joint clinic for chronic disease and psychology, improving the experience of medical treatment, setting up a comfortable treatment environment, and coordinating referrals, etc. Conclusion Barriers such as differences in perceptions and attitudes between doctors and patients, unequal medical resources, and irregularities in behavior exist between doctors and patients. In the community, it is necessary to strengthen the advantages and functions of general practitioners on the management of psychosomatic disorders; fully implement and utilize relevant resources; and improve the negative attitudes of both doctors and patients, so that patients can seek proper medical treatment and improve their mental health.

Background The current training content of continuing education in general practice cannot meet the needs of clinical practice, as well as the lacking of thinking and characteristics of general practice in teaching faculty and evaluation methods. Objective To explore the training of clinical thinking in general practice through continuing education, so as to solve practical problems and improve working competence of general practitioners (GPs) . Methods The design of the 8th GPs' practice ability training workshop course was optimized based on the literature reading and feedback from the continuing education course of GPs' practice ability workshop in November 2020, and a questionnaire survey was conducted through the "wenjuanxing" platform among 200 GPs who participated in the 8th workshop course to evaluate the overall and various levels of improvement in their clinical thinking ability and working competence. Results A total of 200 questionnaires were distributed, and 172 valid questionnaires were collected, with a recovery rate of 86.0%. After the training, 52.3% (90/172) and 21.5% (37/172) of the GPs had improved and greatly improved their overall clinical thinking ability in general practice, respectively, and 56.4% (97/172) and 22.1% (38/172) showed improvement and great improvement in overall working competence. There was a statistically significant difference in the improvement of clinical thinking ability and working competence among GPs with different professional titles and job types after training (P

With the increasingly serious food safety problem and more and more attention from all walks of life today, the safety of agricultural products as the source of food raw materials should also receive more attention. Therefore, focusing on quality control in the agricultural supply chain is important in this context. This paper explores the progress of research on quality control of agricultural products supply chain from different directions: including product quality traceability system, a combination of quality supervision and new technology, and risk factor analytical methods based on mathematical algorithms; then, there is an analysis based on the specific case of Mengniu’s product supply chain. These studies and case analyses jointly demonstrate the importance of building a complete quality management system for agricultural supply chains and improving industry-related standards. Meanwhile, supply chain quality and safety management must keep pace with the times.

Objective To investigate the role of Notch1 signaling pathway in Th1/Th2 imbalance induced by neonatal Streptococcus pneumoniae pneumonia (S.pp) infection. Methods Twelve Balb/c neonatal mice (1 week old) were randomly divided into neonatal S.pp group, neonatal S.pp with Notch1 inhibition treatment group (S.pp+DAPT, a γ-secretase inhibitor) and mock-infected control group (control group) (n=4). The S.pp group and the S.pp+DAPT group were infected with 1×107 CFU of S. pneumoniae in 10 μL of PBS intranasally, while the control group received equivalent PBS. In 7 d after infection, the S.pp+DAPT groups were given 0.3 mg/kg DAPT by nasal instillation, and the S.pp and the control groups were instilled equivalent PBS. In 5 weeks after infection, airway hyperresponsiveness (AHR) was evaluated by invasive body plethysmography system. Differential cell counts in bronchoalveolar lavage fluid (BALF) were analyzed. HE staining was used to observe the histopathological changes of the lung tissue. Western blotting was used to detect the protein expression of Notch1 protein, and RT-PCR to measure the mRNA levels of T-bet and GATA3. And the percentages of Th1 and Th2 cells in the lung tissue were determined by flow cytometry and Th1/Th2 ratio was calculated. Results Notch1 expression was significantly lower in the S.pp+ DAPT group than the S.pp group (0.23±0.09 vs 1.94±0.78, P < 0.01). The total cell count and counts of neutrophils, monocytes and lymphocytes in the BALF from the S.pp+DAPT group were remarkably lower than those in the S.pp group (P < 0.01). The S.pp+DAPT mice had obviously lower histologic scores of pulmonary peribronchiolitis, pulmonary perivasculitis and pulmonary alveolitis in lung tissue than the S.pp group (0.55±0.17 vs 1.52±0.27, P < 0.01; 0.05±0.10 vs 0.88±0.25, P < 0.01; 0.18±0.35 vs 1.57±0.25, P < 0.01). The mRNA level of GATA3 and percentage of Th2 cells were significantly lower in the S.pp+DAPT group than the S.pp group [19.11±9.79 vs 177.56±65.95, P < 0.01; (0.16±0.02)% vs (0.28±0.04)%, P < 0.01]. While the mRNA level of T-bet and percentage of Th1 cells were similar between the 2 groups. The S.pp+DAPT group had significantly higher Th1/Th2 when compared with the S.pp group (14.67±2.60 vs 7.89±0.82, P < 0.01). The AHR in the S.pp+DAPT group mice was significantly decreased when inhaled different concentrations of acetylcholine (3.125~50 mg/mL) as compared with the S.pp group (P < 0.01). Conclusion Neonatal S.pp may induce Th1/Th2 imbalance by activating Notch1 signal, and thus promote airway hyperreactivity and airway inflammation.