Search

ObjectivesThis study aims to analyse the disease composition of primary care visits rather than specialist visits, the former of which had scarcely been studied. We adopted specific disease classification (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), disease system and communicable/non-communicable/injury disease classification, and variations of sex and age were also analysed.SettingWe extracted data from all community health service centres (CHSCs) and community health service stations in Pudong, Shanghai, from 2016 to 2018 using the electronic health record systems of the Pudong health information centre.ParticipantsOur data included all 46 720 972 primary care visits from 2016 to 2018 in CHSCs in Pudong.ResultsWe found that the top five diseases in primary care visits continued to be primary hypertension, problems related to medical facilities, chronic ischaemic heart disease, unspecified diabetes mellitus and acute upper respiratory infection. Lipoprotein metabolism disorder visits continued to increase over the study years. The numbers and proportions of patients with hypertension and unspecified diabetes were higher among men than women, and other cerebrovascular diseases were higher among women than men. The top five disease systems were circulatory system diseases, respiratory system diseases, endocrine/nutritional/metabolic diseases, factors influencing health status and digestive system diseases. The rankings of respiratory system and endocrine/nutritional/metabolic diseases rose over time. Non-communicable diseases (NCDs) accounted for approximately 90% of the primary care visits—a much higher percentage than other causes. The top five NCDs in primary care visits were cardiovascular and circulatory diseases, musculoskeletal disorders, diabetes, digestive diseases and urogenital diseases. Compared with women, men suffered from cardiovascular diseases at an earlier age.ConclusionsDifferent from specialist visits, common diseases, especially NCDs, were the main disease composition of current primary healthcare visits while the former focused on intractable diseases such as tumours, indicating that primary healthcare had played the role of gatekeeper of the healthcare system.

Pedestrian evacuation simulation (PES) provides a low-cost and low-risk method to facilitate safety design and emergency management in indoor environment by describing pedestrian evacuation behaviors and predicting evacuation outcomes in what-if scenarios. The area of PES has witnessed rapid growth over the past few decades, but there lacks an up-to-date review of the existing literature that could comprehensively reflect the latest advancements in this area. To address this need, this paper proposes a three-layer analytical framework for synthesizing the abundant literature on PES approaches, PES models and PES tools, and presents a systematic review of the state of the art in the PES area. The findings point out that (1) the use of high-fidelity PES approaches has become more prevalent over time; (2) the adaptability of PES models to different evacuation scenarios is relatively limited; (3) modeling of human behavioral mechanism is the driving force for PES model advancement; and (4) verification and validation are the major challenges for PES tools. Finally, the paper outlines possible directions for future research and discusses specific challenges to address for each direction. This paper is expected to benefit academics and professionals whose work requires the use of PES tools, provoke innovative studies that would push the boundaries of this area, and advance the understanding of pedestrian evacuation behavioral mechanisms and behavioral intervention measures, which would ultimately lead to enhanced human safety in indoor emergencies.

Bone, the major structural scaffold of the human body, has recently been demonstrated to interact with several other organ systems through the actions of bone-derived cells and bone-derived cell secretory proteins. Interestingly, the brain is one organ that appears to fall into this interconnected network. Furthermore, the fact that osteoporosis and Alzheimer's disease are two common age-related disorders raises the possibility that these two organ systems are interconnected in terms of disease pathogenesis. This review focuses on the latest evidence demonstrating the impact of bone-derived cells and bone-derived proteins on the central nervous system, and on how this may be relevant in the progression of Alzheimer's disease and for the identification of novel therapeutic approaches to treat this neurodegenerative disorder.