ObjectiveTo systematically review the willingness rate of the first consultation in primary health care institutions among Chinese residents.MethodsCNKI, WanFang Data, VIP, PubMed, Web of Science and EMbase databases were electronically searched to collect cross-sectional studies on the willingness rate of the first consultation in primary health care institutions of residents in China from January 2006 to November 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; meta-analysis was then performed using Stata 14.1 software.ResultsA total of 26 cross-sectional studies involving 36 430 subjects were included. The results of meta-analysis showed that the willingness rate of Chinese residents for the first consultation in primary health care institutions was 61.4% (95%CI 54.5% to 68.3%). The results of subgroup analysis showed that for the willingness rates of the first treatment at the grassroots level in male and female residents were 65.6% and 64.9%; urban and rural residents were 49.9% and 58.9%; <60 and ≥60 years old residents were 60.5% and 71.6%; primary school and below, junior high school, high school or technical secondary school, junior college or above educational level residents were 72.8%, 68.1%, 64.2%, and 52.8%; employees, residents, and other types of insurance residents were 74.1%, 75.9%, and 64.4%; residents with monthly income <3 000, 3 000-5 000, and >5 000 yuan were 65.8%, 65.3%, and 58.5%; high, medium, and poor levels of health status residents were 56.8%, 52.6%, and 48.8%; with and without chronic diseases residents were 61.0% and 56.9%; with and without spouse residents were 63.9% and 64.6%; with and without contracted family doctor residents were 87.1% and 62.6%; on duty, retired, and other employment status residents were 70.7%, 69.9% and 71.5%; primary medical institutions residents those were satisfied, average, and dissatisfied were 77.3%, 60.7%, and 49.4%.ConclusionsCurrent evidence suggests that it remains room for improvement in the level of willingness of Chinese residents for first consultation in primary health care institutions. Residence, age, educational level, type of medical insurance, income level, health level, family doctors contracted status, and satisfaction with primary medical institutions have an impact on residents' willingness to receive first treatment at primary hospitals. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.
ObjectiveTo explore the clinical characteristics, neuroimaging, diagnosis and treatment process of inpatients with Juvenile Myoclonic Epilepsy (JME).Methods83 inpatients with JME in the Epilepsy Center of Lanzhou University Second Hospital from January 2016 to August 2020 were analyzed retrospectively. Their clinical features, seizure types, inducing factors, MRI and EEG, first consultation hospital, reason for visit and drug treatment were summarized.ResultsAmong the 83 patients, there were 43 males and 40 females, with an average age of (18±5.6) years. 21 patients had family history of epilepsy or history of febrile convulsion. the average age of onset was 11.5 years old, which was earlier than those without family history and history of febrile convulsion (P<0.05). The results of cranial nuclear magnetic resonance examination were abnormal in 14 patients, including hippocampal sclerosis and local small cysts. The first symptom of 62.7% JME patients is myoclonic seizures, followed by tonic-clonic seizures, sleep deprivation was the most common inducing factor, and tonic-clonic seizures was the most common cause of treatment in JME patients, accounting for 78.3%. 80.7% of patients choose local primary hospitals for their first consultation, and there was a non-standard use of ASMs in treatment, and the seizure free rate of epilepsy after ASMs treatment was 6%, which was lower than that in provincial hospitals (P<0.05). 88% of JME inpatients can effectively control their seizures through monotherapy, among which valproic acid is the most commonly used monotherapy and combination therapy. The new oral ASMs lamotrigine and levetiracetam tablets were mostly used in female patients.ConclusionA family history of epilepsy and history of febrile convulsion may be associated with an earlier age of onset in patients with JME. Neuroimaging abnormalities can be found in a small number of patients with JME, including hippocampal sclerosis and local small cysts. Tonic-clonic seizures is the main treatment cause of JME patients, and most of them are first diagnosed in local hospitals, but the seizure free rate of epilepsy in local hospitals after ASMs treatment is low, so the training of epilepsy related knowledge for doctors in primary hospitals is helpful to the diagnosis of clinical JME and improve its control rate.