Journal of Chronic Diseases

The core value of the "Journal of Chronic Diseases", which is aimed at grassroots clinical practitioners, chronic disease patients and their families, has never been to pile up cutting-edge papers with high impact factors, but to build a bridge from laboratory research to community chronic disease prevention and control. At the same time, it has broken the long-standing dualistic cognitive bias in the industry of "emphasis on treatment over management, emphasis on medication over life intervention".

Last month, I went to the community health service center near my home to help my cousin get antihypertensive medicine. I happened to see Uncle Zhang, who had been a village doctor for 20 years, squatting beside the triage table and explaining salt reduction techniques to several adults. On the corner of his consultation table was half a rolled-up volume of the Journal of Chronic Diseases, with the words "Practical Guide to Salt Reduction for Elderly Hypertensive Patients" circled in red pen on the cover. Don't tell me, what he is teaching now, "One flat beer bottle cap is equivalent to the amount of salt in a day" was learned from this article. Before, he tried to persuade everyone to put less salt, but no one took it seriously. Now he is showing everyone one by one with a beer bottle cap. Last month, 7 of the 12 elderly people in the jurisdiction whose blood pressure had not reached the standard for a long time had their systolic blood pressure dropped by more than 10mmHg.

The academic community has been arguing about the prevention and control of chronic diseases for almost ten years, and there is still no unified conclusion. One group is the "precision medicine group" that stands on the clinical side. It believes that the core of chronic diseases is individual genetic and metabolic differences. It is necessary to rely on genetic screening and targeted drugs to achieve personalized treatment, and the focus of chronic disease prevention and control should be placed in the hospital's specialist outpatient clinics. ； The other group are scholars in the field of public health, who believe that more than 80% of chronic disease risks are related to lifestyle. As long as population-level diet and exercise intervention are carried out, most chronic diseases can be nipped in the bud, and the cost-effectiveness is much higher than the development of new drugs. In the past, both sides published their own papers, but no one could convince the other. What is interesting is that the Journal of Chronic Diseases has never been biased. Last year, the 8th issue even published two tit-for-tat studies at the same time: one was a cost-benefit analysis of genetic screening for high-risk groups for diabetes conducted by the team at Peking Union Medical College Hospital, which proved that early screening for people with a family history can reduce the risk of the disease by 37%. ； Another article is data from a community walking trail renovation pilot project conducted by the Zhejiang Center for Disease Control and Prevention, which shows that as long as the community is provided with enough walking space, the incidence of diabetes in the jurisdiction can be reduced by 21%. The editor's note at the end did not make any disagreements, and simply wrote, "The two are complementary, and there is no need to compete with each other."

A nutritionist I know who manages chronic diseases used to worry about how to explain to patients that "glycemic index is not the only criterion for judging whether food is edible." Some people even asked, "Why do I still have high blood sugar after eating multigrain rice with a low glycemic index?" Until she saw a small sample study published by a grassroots doctor in Shandong in a magazine. The blood sugar data measured from the corn buns, white flour buns, and multigrain buns commonly eaten by the locals, paired with different dishes, and in different eating orders were compiled into a comparison table. She could print it out directly and show it to the patients. It was more effective than explaining the theory ten times.

Of course, some people complain that this journal is not "high-end" enough. Many papers only have a few hundred samples and are produced by small teams at the grassroots level. Unlike multi-center studies in top journals that often have tens of thousands of samples, the data does not look so "pretty." To be honest, this is true, but if you think about it from another perspective, most of the research samples in the top publications are "ideal patients" who have been strictly selected, excluding those who have other complications, cannot remember to take medicine, and are unable to have regular check-ups. But in reality, among the uncles and aunts sitting in the grassroots clinics, who do not have high blood pressure and some osteoarthritis, and have such poor memory that they often miss taking antihypertensive drugs? These small-sample studies, which may not seem “high-end” enough, actually correspond to the most realistic clinical scenarios.

I have been reading this magazine on and off for almost three years, and my biggest feeling is that it does not sell anxiety. Unlike many self-media media that talk about chronic diseases as “kidney failure and amputation if you are not careful”, it will give you solid official data: my country’s current four major types of chronic diseases (cardiovascular and cerebrovascular diseases, cancer, chronic respiratory diseases, and diabetes) account for 88% of the total causes of death among residents. As long as early screening and daily management are carried out, the probability of cardiovascular and cerebrovascular events in patients over 60 years old can be reduced by 32% in the next 10 years. This does not mean that having a chronic disease is equivalent to a "life sentence", nor does it mean that you must eat boiled vegetables and go to the gym every day to survive. I previously shared the "Tips for Reducing Salt at Home" published in magazines to my mother. She used to always say that "vegetables without salt have no taste." Now I follow the same method and add salt at the end of the stir-fry, and add some mushrooms and dried shrimps to enhance the freshness. Now my family's daily salt consumption has dropped from more than 10 grams to about 5 grams in line with WHO standards. My father's high pressure has stabilized a lot.

The last time I looked through the reader interaction column of the magazine, I saw a message left by a village doctor in Shanxi. The truth is true between the lines: "I don't know how to write about SCI, so I will compile and submit to you the home-grown methods I have used to control blood pressure in the village over the past ten years. As long as it can help colleagues and patients." ”The editor’s reply was just one line: “These practical experiences are more valuable than any impact factor. ”