Background: The cultivation and assessment of the professional competence of clinical undergraduates is essential to medical education. This study aimed to construct a scale to evaluate the professional competence of clinical undergraduates as well as its determinants. Methods: The competence scale was developed on the basis of four medical education standards, the literature, and expert interviews. A total of 288 undergraduates from two types of medical colleges in central and southeastern China were selected by a multistage sampling strategy. Factor analysis, correlation analysis, and internal consistency reliability were used to verify the validity and reliability of the scale. Results: A scale consisting of eight factors with 51 items was determined for factor analysis. Cronbach’α coefficients among the eight dimensions were over 0.800, with mean scores of 1.76, 1.38, 1.92, 1.54, 1.77, 1.25, 1.60, and 2.34. Clinical undergraduates with above average academic grades achieved a higher score in essential clinical knowledge (p < 0.05) and better professionalism was reported among females (p < 0.05). Conclusion: The competence scale showed excellent reliability and validity. Respondents in this study showed a moderate level of professional competence. This study could be a reference for medical educators and policy makers in order to improve medical education standards for clinical undergraduates in China and other countries with similar settings.

Excess healthcare utilization is rapidly rising in rural China. This study focused on excess outpatient demand (EOD) and aimed to measure its performance and sociodemographic determinants among China’s rural residents. A total of 1290 residents from four counties in central China were enrolled via multistage cluster random sampling. EOD is the condition in which the level of hospital a patient chooses is higher than the indicated level in the governmental guide. A multilevel logistic regression was used to examine the sociodemographic determinants of EOD. Residents with EOD accounted for 85.83%. The risk of EOD was 51.17% and value was 5.69. The value of EOD in diseases was higher than that in symptoms (t = −21.498, p < 0.001). Age (OR = 0.489), educational level (OR = 1.986) and hospital distance difference (OR = 0.259) were the main sociodemographic determinants of EOD. Excess outpatient demand was evident in rural China, but extreme conditions were rare. Results revealed that age, educational level and hospital distance were the main sociodemographic determinants of EOD. The capacity of primary healthcare institutions, universality of common disease judgement and understanding of institution’s scope of disease curing capabilities of residents should be improved to reduce EOD.

This study aimed to explore the health service needs of empty nest families from a household perspective. A multistage random sampling strategy was conducted to select 1606 individuals in 803 empty nest households in this study. A questionnaire was used to ask each individual about their health service needs in each household. The consistency rate was calculated based on their consistent answers to the questionnaire. We used a collective household model to analyze individuals’ public health service needs on the family level. According to the results, individuals’ consistency rates of health service needs in empty nest households, such as diagnosis and treatment service (H1), chronic disease management service (H2), telemedicine care (H3), physical examination service (H4), health education service (H5), mental healthcare (H6), and traditional Chinese medicine service (H7) were 40.30%, 89.13%, 98.85%, 58.93%, 57.95%, 72.84%, and 63.40%, respectively. Therefore, family-level health service needs could be studied from a family level. Health service needs of H1, H3, H4, H5, and H7 for individuals in empty nest households have significant correlations with each other (r = 0.404, 0.177, 0.286, 0.265, 0.220, p < 0.001). This will be helpful for health management in primary care in rural China; the concordance will alleviate the pressure of primary care and increase the effectiveness of doctor–patient communication. Health service needs in empty nest households who took individuals’ public needs as household needs (n = 746) included the H4 (43.3%) and H5 (24.9%) and were always with a male householder (94.0%) or at least one had chronic diseases (82.4%). Health service needs in empty nest households that considered one member’s needs as household needs (n = 46) included the H1 (56.5%), H4 (65.2%), H5 (63.0%), and H7 (45.7%), and the member would be the householder of the family (90.5%) or had a disease within two weeks (100.0%). In conclusion, family members’ roles and health status play an important role in health service needs in empty nest households. Additionally, physical examination and health education services are the two health services that are most needed by empty nest households, and are suitable for delivering within a household unit.

Objective: Household is a fundamental unit in many fields. This study was to analyse consistency degree and people’s health service needs from the perspective of household.Methods: A multi-stage random sampling was conducted. A total of 7293 individuals in 2715 households were interviewed, and 1606 individuals in 803 empty-nest households were enrolled in this study. A questionnaire was used to ask each individual about their health service needs in empty nest households. The consistency degree was calculated based on their consistent answers to the questionnaire, and a correlation analyse was used to study the relationship of individuals’ health service needs in the same empty nest households. A family collective model was used to analyse household-based health service needs.Results: Individual’s needs consistency rates in empty nest households, such as diagnosis and treatment service(H1), follow-up service for chronic disease(H2), telemedicine care(H3), physical examination service(H4), health education service(H5), mental healthcare(H6), and Chinese traditional medicine service(H7) were 40.30%, 89.13%, 98.85%, 58.93%, 57.95%, 72.84%, and 63.40%, respectively. Service needs of H1, H3, H4, H5, H7 for individuals in the same empty nest households had significant correlations with each other (r=0.404, 0.177, 0.286, 0.265, 0.220, P<0.001). Health service needs from a perspective of household in rural China mainly included H1 (12.4%), H4 (44.2%), H5 (26.9%) and H7(18.9%). Conclusions: Individuals in the same household are highly consistent with each other in health service needs. Individuals could affect other members’ health service needs in their households, when one of them get illness, their spouse would likely to have same health service needs to avoid getting disease or to keep health. In this study, health service needs in empty nest households are mainly concerned with health promotion and maintenance services, which could be an indicator for primary care to improve the effectiveness of service delivery, such as family doctor and family-based health insurance system. Also, more focus should be paid on households that need great help on different health services.

Background: Over the past decade, the annual incidence of multiple primary lung cancers (MPLC) has increased. There is a group of pathologically different patients with MPLC presenting as mostly having concurrent lung adenocarcinoma (ADC) and squamous cell carcinoma (SQCC). Their molecular profiles and tumor immune microenvironment (TIME) remain unknown. We aimed to clarify these factors in this patient group. Methods: We performed mutational, biomarker, and neoantigen analyses using whole-exome sequencing (WES) and differential, enrichment,and TIME analyses using RNA sequencing (RNA-Seq) for five patients with concurrent ADC and SQCC to analyze their mutational profile, expression profile, and TIME features. Results: WES of 10 lesions (five ADC and five SQCC) in five concurrent ADC and SQCC patients showed that the most frequently mutated genes in both groups were TTN, TP53, WDFY3, EGFR, ZFHX4 and TTC40, and there were no significantly different mutated genes in the comparative analysis of mutation frequencies between both groups. There were no significant differences inneoantigen analysis, including tumor mutational burden, tumor neoantigen burden, and mutant allele tumor heterogeneity. HLA genotype analysis indicated that three of five (60%) patients carried the HLA-I class B62 supertype, and seven of 10 (70%) lesions had loss of HLA heterozygosity (HLA-LOH). RNA-Seq revealed that 2231 genes were differently expressed between the ADC and SQCC groups. GSVA based on the molecular signature database (MsigDB) showed that 12 gene sets were significantly differentially expressed between the ADC and SQCC groups (p < 0.05), with four gene sets relevant to squamous cell features upregulated in the SQCC group and eight metabolism-related gene sets upregulated in ADC. GO/KEGG analysis of immune function-related pathways showed that the interleukin-12 family-related signaling pathways, TP53 and TLR2/4 signaling pathways were upregulated in the ADC group. Co-expression analysis of TIME revealed that tumor infiltrating immune cells were significantly more enriched and diverse, with tumor-infiltrating lymphocytes scoring significantly higher (p = 0.047) in ADC. Specifically, CD8+ T cells, exhausted CD8+ cells, and macrophages infiltrated significantly more frequently in ADC (p < 0.05). Moreover, immunocostimulator expression (p = 0.034) and tertiary lymphoid structure score (p = 0.017) were significantly higher in ADC than in SQCC. Conclusion: In patients with concurrent ADC and SQCC MPLC, the transcriptomic profiles and TIME features were quite different between ADC and SQCC lesions. ADC lesions exhibited a more active TIME than SQCC lesions.

Background The professional competence of clinical undergraduates is an important topic of research, and no effective instrument to measure this competence exists. We aimed to construct a scale for clinical undergraduates to evaluate their professional competence and associated determinants. Methods We developed the competence scale on the basis of four medical education standards (Global Minimum Essential Requirements [GMER], World Federation for Medical Education [WFME] standards, WHO standards, and Chinese standards) and a literature review. We used focus group discussions to complete the scale. We selected 288 undergraduates from two typical medical colleges in central and southeastern China by multistage sampling. We used factor analysis, correlation analysis, and internal consistency reliability to verify the validity and reliability of the scale.