Xinyuan Zhao

Objectives: This study aimed to investigate the role of the body mass index (BMI) as a mediator between gout and hypertension in older adults. Methods: A total of 33,778 older adults (aged 65 years and over) in Wuhan, China, were surveyed. The propensity score matching (PSM) method was used to control for confounding factors, and logistic regression was performed on the above three variables using the mediation package in the R language program. Results: The PSM method successfully matched 14,717 pairs. Mediation analysis revealed that, when controlling for the mediating variable “BMI”, the association coefficients of the independent variable “gout” on the dependent variable “hypertension” and of the mediating variable were statistically significant. This indicates the existence of a mediating association. Bootstrapping was used to quantify the stability of the observed indirect association, but temporal precedence or causality could not be established in this cross‐sectional study. Conclusions: Gout is associated with hypertension, both directly and indirectly through BMI‐related pathways. Therefore, monitoring and controlling the BMI of elderly gout patients to improve the progression of hypertension is of great significance.

Patient satisfaction is associated with both individual (patients and health workers) and organizational (health facilities) characteristics. This study aimed to establish a link between patient satisfaction and gender composition of physicians in community health service (CHS) organizations. Participants were selected through multistage stratified random sampling: 36 CHS centers were selected from six municipalities in Hubei, China. All physicians on duty and patients visiting the CHS during the study period (from April to October in 2015) were invited to participate in this study: 324 physicians and 865 patients completed a questionnaire survey. Multilevel linear regression analyses were performed to determine the associations of patient satisfaction (scored from 1 to 5) with patient characteristics (gender, age, education, income, medical expense, frequency of visits to the CHS) and organizational features of the CHS (sex ratio of physicians, and gender differences of physicians in education and job satisfaction). Older patients and those with a higher medical bill had a lower degree of satisfaction (p < 0.05). At the organizational level: a higher proportion of male physicians weakened the negative association between patient age and patient satisfaction (p < 0.05); a larger gap in university qualifications between male and female physicians exacerbated the negative association between patient age and patient satisfaction (p < 0.05). The gender composition of physicians in CHSs is associated with patient satisfaction in the Chinese context: a larger gap (in number and qualifications) between male and female physicians is associated with higher patient satisfaction. Further studies are needed to explore the cultural roots of such an association.