| Background:Metabolic syndrome has become a common and frequently-occurring disease in urban and rural residents in China.It is also a common soil and an important risk factor for chronic non-communicable diseases such as cardiovascular and cerebrovascular diseases and some malignant tumors.The morbidity of MS will increase at a faster rate because of the high mental pressure,high calorie diet,sedentary and necessary physical exercise.Under the background of aging,it is urgent to strengthen the prevention and treatment of MS.Objective:Based on the perspective of KABC,through literature research and analysis of community population survey data,the influencing factors of metabolic syndrome were identified,MS intervention database was established,and the correlation between different influencing factors and MS was explored,so as to provide intervention strategies for prevention and treatment of MS and health management for middle-aged and elderly people in the community.3.Research contents and methods3.1 Research Contentl Literature Study on Influencing Factors and Intervention Methods of Metabolic Syndrome3.1.1 Literature Study on the Influencing Factors of Metabolic SyndromeTo analyze and review the clinical research literature on the influencing factors of metabolic syndrome(MS)at home and abroad,to understand the research results and research methods of the influencing factors of MS at home and abroad,and to provide reference for the prevention and intervention strategies of MS based on the influencing factors of MS.Search Chinese and English periodical literature from January 1,2013 to October 1.2018.The scope of Chinese literature search is CNKI,VIP and Wanfang databases.English literature search PubMed contains articles on the influencing factors of metabolic syndrome.A total of 359 Chinese and 379 English documents were retrieved after duplication checking and deletion.Literature retrieval was completed by two people independently.By reading the abstract and the full text,the data analysis of MS and its components in the literature is summarized,including the research object,research content,research methods and relevant influencing factors of specific data analysis.In the process of literature collation,the information extracted from the above literature is classified and graded according to the main research contents and evidence levels.Each article can extract more information according to different research contents and methods.Then classify and analyze the extracted information.3.1.2 Literature Study on Intervention Methods of Metabolic Syndrome The Chinese literature on clinical intervention of metabolic syndrome(MS)in recent three years was studied,and the prevention,intervention and treatment methods of MS were summarized to provide a basis for the construction of Chinese medicine intervention strategy for MS.To retrieve the relevant literatures on clinical intervention of metabolic syndrome collected in China Academic Journal Full-Text Database(CNKI),VIP Database and Wanfang Database from 2014 to 2018.A total of 1271 literatures were retrieved in the three databases.603 non-duplicated literatures were retrieved after duplication checking and deletion.Literature retrieval was completed by two people independently.Excel 2010 is used to process and input the collected literature.The basic information of the literature,such as title,magazine name,publication period,keywords and abstracts,is extracted and the database is established.The intervention scope,intervention methods and application population included in the literature were excerpted and the frequency was analyzed.3.2 Research Content2:TCM Intervention Strategies of Metabolic Syndrome in Community Population from the Perspective of KABCBased on the perspective of KABC,through the analysis of cross-sectional survey data and physical examination data of rural community,urban community and high-end elderly community,the influencing factors and state characteristics of MS in different communities and groups with different characteristics were analyzed,and intervention strategies were provided for MS health management of community residents.The data of this study are collected from the survey data of the project "Key Technologies of Community Health Monitoring and Intervention for the Elderly Based on the Characteristics of Traditional Chinese Medicine" in the TCM industry in 2013.In 2013,the project team conducted cross-sectional surveys in rural communities of Xishui in Hubei,urban communities of Hongshan in Hubei,and elderly communities of Huichen in Beijing.Adult residents of the community were taken as subjects for questionnaires and physical examinations.After being examined by the Ethics Committee of Guang'anmen Hospital,Chinese Academy of Traditional Chinese Medicine,the project plan has passed the ethical review and signed the informed consent with all participants.The research method is cross-sectional survey.Questionnaire survey and physical examination are used to conduct cross-sectional survey on community population.Basic information,physical and mental health status information and health awareness level information of community residents are collected through Health Monitoring Questionnaire.Relevant biochemical examination data are collected through laboratory examination.In this paper,the factors affecting MS and the choice of intervention strategies are analyzed based on KABC model:KABC model is based on "knowledge,belief and practice" and combined with the overall concept of traditional Chinese medicine.The "knowledge,belief and action" model divides people's behavior change into three continuous processes:acquiring knowledge,generating beliefs and forming behaviors.However,in this continuous and dynamic complex process,individual behavior change is also affected by its own internal physiological and pathological factors and external environment such as family and society.Therefore,in combination with the overall concept of TCM,condition factors are incorporated into the"knowledge,belief and action" model to make the process more complete,thus forming KABC model.4.Research results4.1 Literature Study on Influencing Factors and Intervention Methods of Metabolic Syndrome 4.1.1 Literature Study on the Influencing Factors of Metabolic Syndrome(1)Contrast the research methods of influencing factors of MS at home and abroad:Logistic analysis model,decision tree model and structural equation model are mostly used to analyze the effects of various influencing factors on MS in China,and a model is established to eliminate the interaction between some influencing factors,thus focusing the influencing factors on a smaller range;while simple comparative analysis and number are used in the analysis of MS abroad.(2)Comparing the research focus of MS influencing factors at home and abroad:MS influencing factors are mainly divided into three aspects:behavior and lifestyle factors,environmental factors and biological factors.Domestic research focuses on biological factors,with abnormal metabolic indicators,chronic disease history and medication status as the main factors,while foreign research focuses on lifestyle such as diet,exercise and so on.Therefore,prevention and intervention based on the influencing factors of MS should not only pay attention to the status of metabolic abnormalities related to MS.such as blood pressure,dyslipidemia and obesity,but also to the characteristics of MS disease itself,as well as to the behavioral and environmental factors causing these abnormalities,that is,to pay attention to the "sick people",including MS high-risk population and MS patients,and then expand to sub-healthy population.Prevention.4.1.2 Literature Study on Intervention Methods of Metabolic Syndrome(1)MS intervention methods are diverse:at present,MS intervention methods mainly include drug intervention,lifestyle intervention,traditional Chinese medicine characteristic intervention methods,drug intervention includes traditional Chinese medicine.Chinese patent medicine,western medicine for oral use,lifestyle intervention mainly focuses on diet,exercise,diet recuperation,dietary therapy,health-preserving method,smoking cessation and alcohol restriction,etc.Intervention methods include acupuncture,massage,acupoint application.acupoint catgut embedding,etc.Others also involve living adjustment,psychological recuperation,etc.Intervention methods are diverse,which fully reflects the characteristics of multi-channel,multi-target and complex intervention of traditional Chinese medicine.(2)MS preventive intervention is mainly drug intervention,combined with multiple methods:Among the 304 articles in the literature,the total number of MS interventions included in the statistics is 669,of which 317 were drug intervention,accounting for 47.39%.Among them,223 articles,accounting for 73.36%of the total literature,used two or more interventions at the same time.(3)TCM intervention has advantages and great potential for development:This literature study shows that TCM intervention methods are diverse,such as acupuncture,massage,acupoint catgut embedding,diet,medicine and traditional methods can play a role in MS prevention and intervention,and can be flexibly combined with other intervention methods.Under the guidance of TCM theory.TCM intervention method can also improve blood pressure,blood sugar,lipid metabolism and other related indicators.The treatment method is safe,with less adverse reactions and significant clinical effect.However,there are few TCM intervention methods in this literature study.Only 21 articles(3.14%)and 8 articles(1.2%)were included in acupuncture and moxibustion intervention.It is clear that TCM intervention methods need further study and have great potential to be explored.4.2 Research Content2:TCM Intervention Strategies of Metabolic Syndrome in Community Population from the Perspective of KABC(1)Cross-sectional survey:According to inclusion exclusion criteria,a total of 802 residents were included in this study,including 268 in rural communities,371 in urban communities and 163 in high-end elderly communities.According to the diagnostic criteria of CDS metabolic syndrome in 2004,97 MS patients were screened out,accounting for 12.10%of the total.The prevalence of MS was 8.21%,14.29%and 13.50%in rural community,urban community and high-end pension community,respectively.The prevalence of MS was 12.87%in males and 11.70%in females.The prevalence of MS increased with age.The prevalence of MS was 11.11%,11.78%,12.16%and 12.57%under 45 years old,45-60 years old,60-75 years old and over 75 years old,respectively.(2)Composition of MS population:There were significant differences in the composition of MS population among communities(P<0.05).The combination of hypertension+dyslipidemia+central obesity is the most common type of MS population in rural and urban communities.The combination of hypertension+central obesity+hyperglycemia is the most common type of MS population in high-end old-age community.(3)KABC situation analysis of different community groups:Questionnaire information and laboratory examination data were classified according to knowledge,attitude,behavior,condition and other four dimensions.Chi-square test was used to analyze KABC differences among different community groups.Intellectual factors:Chi-square test included the education level(K1),whether to agree that disease-free is health(K2),whether to agree that bad living habits lead to chronic disease(K3),whether to know to keep health in accordance with seasonal seasons(K4),and whether to know the diagnostic criteria for hypertension(K5).Statistical analysis showed that all five knowledge factors were found in different communities.There were statistical differences(P<0.05).Attitudinal factors:Chi-square test included the following variables:whether to take regular physical examination(A1),whether to take weight control measures(A2),whether to change bad habits(A3),whether to accept health education(A4),and the degree of satisfaction with living conditions(A5).Statistical analysis showed that among the five attitudinal factors,except the degree of satisfaction with living conditions.Other attitudinal factors were different in different communities(P<0.05).Behavioral factors:taking nutrition,drinking,drinking tea,smoking,health care in peacetime,regular physical examination and regular living and rest were included in Chi-square test.Statistical analysis showed that among the 13 behavioral factors,except for tea consumption(B2)and smoking(B4),other behavioral factors were different in different communities(P<0.05).?State conditional factors:Chi-square test included health knowledge accessibility(C1),health maintenance accessibility(C2),health expenditure pressure(C3),living conditions(C4),insurance status(C5)and main source of medical expenses(C6).Statistical analysis showed that six state conditional factors had statistical differences in different communities(P<0.05).(4)Univariate Logistic regression analysis of MS influencing factors:Knowledge factor:For "whether to know the diagnostic criteria for hypertension",the MS risk of those who do not know the diagnostic criteria for hypertension is 0.322 times that of those who know it;for those who do not agree with the view that disease-free is health,the MS risk of those who do not know the answer is 0.139 times that of those who do not agree with disease-free or healthy.Attitudinal factors:According to the willingness to receive health education,there was a statistical difference between MS and non-MS(p<0.05).Compared with those who were very unwilling to receive health education,those who were willing to participate in health education had a 2.474-fold risk of MS.Behavioral factors:Statistical analysis showed that there was significant difference between MS and non-MS subjects in daily meditation time(hour/day)(P<0.05).The risk of MS for 2-3 hours/day meditation time was 0.224 times higher than that for those who meditated for more than 4 hours.Conditional factors:According to the analysis of the medical insurance situation of residents,it was found that the medical insurance situation of MS and non-MS patients had statistical significance(P<0.05).The risk of MS for new rural cooperative medical insurance is 0.126 times that of those who do not know their insurance status.(5)Traditional Chinese Medicine Intervention Strategies for Metabolic Syndrome in Community Population from the Perspective of KABCStratified and progressive intervention according to individual conditions:The intervention objects were identified and evaluated,and divided into healthy population,high-risk group and MS patients according to whether they had MS risk factors and met MS diagnostic criteria.Different groups have different intervention strategies.Trinity,give full play to the characteristics of traditional Chinese medicine:combined with the characteristics of syndrome differentiation and treatment of traditional Chinese medicine,selective physical identification,syndrome differentiation and treatment,disease differentiation and treatment for different groups of people.In view of the healthy population,we mainly carry out physical identification to adjust biased constitution and disease tendency;MS high-risk population and MS patients can choose appropriate intervention methods according to the results of syndrome differentiation and treatment;MS development process often causes or merges other diseases,so we need to combine the results of disease differentiation and treatment,targeted intervention.According to local conditions,community comprehensive intervention:residents of the same community because of their living aggregation,to a certain extent,determine their state conditions are similar;secondly,individual behavior is not only related to internal factors such as individual psychology and physiology,but also closely related to group behavior.Therefore,community-based comprehensive intervention can not only meet the health needs of different levels of residents in the community,especially the prevention needs of high-risk MS population and the long-term treatment and prevention of complications of MS population,but also effectively improve the utilization rate of community health resources.5 Research conclusions(1)KABC model is suitable for MS health management.The study of intervention strategies from the perspective of KABC not only conforms to the complexity and pluralism of MS.but also embodies and develops the overall concept of traditional Chinese medicine.The condition factor is added to the "knowledge,belief and practice" model,which improves the whole process from health cognition,health behavior to health status change,and is also a bridge between individual health management and group health management.(2)The choice path of MS intervention strategy is summarized as the following three steps:group level:local conditions,community comprehensive intervention;individual level:individual level:individual conditions,KABC whole-course intervention;and intervention method selection:body differentiation,dialectics and disease differentiation,three in one,giving full play to the characteristics of traditional Chinese medicine.(3)TCM intervention in MS has obvious advantages and great potential.TCM intervention methods are diverse,and can be flexibly combined with other methods.It can improve blood pressure,blood sugar,lipid metabolism and other related indicators as a whole.The treatment method is safe,with less adverse reactions and significant clinical effects.Based on the advantages of holistic concept and differentiation of symptoms and signs,Chinese medicine intervention can adopt different and targeted methods for different groups of people,such as MS prevention for healthy people,intervention by choosing appropriate methods in dietary therapy,medicinal diet and traditional Gong methods;physical identification and living intervention for high-risk groups of MS can also be carried out on the basis of the above;for MS patients,the dialectical theory can be used.The results of treatment were comprehensively adjusted.The results of literature research on MS intervention methods show that although the traditional Chinese medicine intervention methods are diverse and effective,they are still used less.It is obvious that the traditional Chinese medicine intervention of MS needs further study and has great potential to explore. |
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