Vaccination is one of the most effective measures for preventing infectious diseases. However, in recent years, vaccine hesitancy has become increasingly prominent, and the World Health Organization has identified it as one of the “top ten threats to global health” in 2019. Some developed countries have formulated targeted interventions by identifying the influencing factors of vaccine hesitancy. In contrast, systematic research on vaccine hesitancy in China remains limited.Therefore, this review aims to summarize the influencing factors of vaccine hesitancy reported both domestically and internationally, in order to provide a theoretical foundation for developing intervention strategies in China.

Objective To empirically study the core competences evaluation index system for the doctor of public health (DrPH) in China, and to test its discriminant ability, reliability and validity. Methods This study designed the corresponding questionnaire in March 2025. The stratified cluster sampling method was used to select 200 doctors of public health who were enrolled from 2021 to 2024 to conduct a questionnaire survey in China. Cronbach’s α coefficient was used to assess reliability.Pearson correlation analysis assessed internal consistency. T test and F test assessed discriminant validity. Exploratory factor analysis assessed structural validity. Results A total of 189 questionnaires were retrieved. There were 189 valid questionnaires.The effective rate of questionnaire was 100%. The overall Cronbach’s α coefficient of the ability evaluation index system was 0.969, the Cronbach’s α coefficient of the basic knowledge dimension was 0.691, and the Cronbach’s α coefficient of other dimensions were above 0.8. The correlation coefficient between each dimension and the total score was between 0.5 and 0.9.There were statistically significant differences in core competence scores of public health doctors in different grades, public health practitioner certificates, public health practice experience and parents’ occupations (P<0.05). KMO value was 0.916,Bartlett’s spherical test value P<0.001, six common factors were extracted, and the total contribution rate of factor variance was 69.9%. Common factors could basically reflect the core concepts and main dimensions of the evaluation index system for the core competence of doctors in public health. Conclusion The core competences evaluation index system for the DrPH demonstrates good reliability and validity, indicating that it can serve as a tool for the training, evaluation, and assessment of the core competences for the DrPH.

Objective To analyze the awareness of nutritional health knowledge among school-age children in Sichuan Province, identify shortcomings and related issues of nutritional health knowledge, and provide a scientific basis for nutritional intervention policies. Methods From October 2023 to May 2024, a multi-stage sampling method was used to collect nutritional health knowledge questionnaires from 12 674 school-age children in 21 districts and counties of Sichuan Province through a questionnaire survey. Descriptive statistical analysis and multivariable analysis were conducted based on survey content. Results The nutritional health knowledge scores [median (interquartile range)] of school-age children in Sichuan Province (including lower elementary school students) in 2023—2024 were 73.00 (63.00-84.00). Scores for lower elementary, upper elementary, middle school, and high school groups were 90.00 (80.00-95.00), 72.00 (62.00-82.00), 69.00 (58.00-77.00), and 66.00 (57.00-74.00), respectively. The higher the grade level, the lower the score, and this was statistically significant. The score rate ranges for the five knowledge dimensions of dietary recommendations, food classification and characteristics, food and growth development and health, food selection, and food safety were 54.82%-81.66%, 60.31%-91.40%, 69.85%-89.50%,71.65%-86.20%, and 69.38%-84.07%, respectively. The lower elementary school grade group had the highest score in each knowledge dimension, and the senior high school group had the lowest score rate. The awareness rate (excluding lower elementary grades) was 32.98%, and the awareness rates for upper elementary school grades, middle school, and high school were 41.91%, 31.12%, and 23.34%, respectively. The higher the grade level, the lower the awareness rate, and this was statistically significant (χ²=249.432, P<0.001). Univariate analysis results showed that gender, grade level, region, whether living on campus, the educational level and occupation of the parents of school-age children had statistically significant differences in the awareness rate of nutritional health knowledge (P<0.05). Logistic regression analysis results showed that the grade level, region (urban or rural), whether living on campus, father’s education and occupation were important factors affecting the awareness level of nutritional health knowledge among school-age children in Sichuan Province. Conclusion There is significant room for improvement in the awareness rate of nutritional health knowledge among school-age children in Sichuan Province. To improve the nutritional health literacy of school-age children, it is necessary to further strengthen the publicity and education of nutritional health knowledge.

Objective To explore the association between intergenerational continuity of adverse childhood experiences (ACEs) and preschoolers’ cognitive performance to provide evidence for promoting healthy cognitive development in preschoolers. Methods A total of 450 children aged 3-6 years from 9 kindergartens in the rural area of Wuhu, Anhui Province were selected to enter the survey on cognitive development. The Childhood Trauma Questionnaire Short Form (CTQ-SF) and an investigator-designed questionnaire were employed to measure maternal ACEs and children ACEs, respectively. The Chinese version of the Wechsler Preschool and Primary Scale of Intelligence, Fourth edition (WPPSI-IV) was conducted to assess participants’cognitive performance. Results The detection rate was 26.7% for neither maternal nor child ACEs exposure, 18.9% for only maternal ACEs exposure, 31.6% for only child ACEs exposure, and 22.9% for both maternal and child ACEs exposure (intergenerational continuity of ACEs). Compared to children in neither maternal nor child ACEs exposure group, cognitive performance was significantly worse in children with intergenerational continuity of ACEs (103.92±10.00 vs 100.94±10.01, P=0.001). After adjusting for covariates, linear regression models showed that intergenerational continuation of ACEs was significantly associated with a 3.34-point reduction in offspring cognitive performance (95% CI: -6.54~-0.14, P=0.04). Conclusion Intergenerational continuity of ACEs is associated with cognitive impairment in preschoolers.

Objective To explore the patterns and influencing factors of multimorbidity in the elderly. Methods A total of 7 354 adults aged ≥60 years in Huai’an District, Hongze District and Lianshui County of Huai’an City were investigated for chronic diseases and their risk factors. Hierarchical clustering was used to determine the multimorbidity patterns. Apriori algorithm was used to explore the association rules between chronic diseases. Binary logistic regression analysis was used to explore the influencing factors of major multimorbidity patterns. Results The prevalence of chronic diseases was 81.93%, and the prevalence of multimorbidity was 42.62%.Hierarchical clustering grouped eight chronic diseases into three categories. The two main multimorbidity patterns were: ① hypertension, diabetes, dyslipidemia, stroke, and myocardial infarction; ② asthma and COPD. The Apriori algorithm identified hypertension, diabetes,dyslipidemia, and stroke as the multimorbidity pattern of cardiovascular and cerebrovascular diseases, and COPD and asthma as the multimorbidity pattern of chronic respiratory diseases. In the multimorbidity pattern of cardiovascular and cerebrovascular diseases,compared with those without eight chronic diseases, increasing age, former smoking and current non-smoking, increasing BMI and central obesity increased the risk of cardiovascular and cerebrovascular disease comorbidity by 0.022 (OR=1.022, 95% CI: 1.012-1.033),0.466 (OR=1.466, 95% CI: 1.081-1.987), 0.144 (OR=1.144, 95% CI: 1.117-1.172), 0.505 (OR=1.505, 95% CI: 1.283-1.766). In the multimorbidity pattern of chronic respiratory diseases, compared with those without eight chronic diseases, former smokers and current non-smokers (OR=3.851, 95% CI: 2.132-6.956), central obesity (OR=1.696, 95% CI: 1.064-2.701) were the risk factors, while being female (OR=0.366, 95% CI: 0.229-0.587) and decreased BMI (OR=0.926, 95% CI: 0.869-0.994) were the protective factors. Conclusion Hypertension, stroke, dyslipidemia and diabetes are easy to coexist, and asthma and COPD are easy to coexist. Smoking was an important risk factor for multimorbidity. Central obesity was a risk factor for both multimorbidity patterns, especially for the cardiovascular and cerebrovascular multimorbidity pattern.

Objective This study investigates potential relationships between distinct physical activity patterns and metabolic syndrome (MS) to provide evidence for exercise-based prevention and control of MS. Methods Utilising data from 15 338 US adults in NHANES 2011—2020, participants were stratified into physical activity patterns. Metabolic syndrome (MS) was diagnosed via NCEP-ATP III criteria. Multivariable logistic regression evaluated associations between activity patterns and MS risk. Restricted cubic splines(RCS) were used to model dose-response relationships, and subgroup analyses were conducted. Results Compared with inactive individuals, both weekend warriors (aOR=0.856, 95% CI: 0.736-0.995) and regular exercisers(aOR=0.758, 95% CI: 0.690-0.833) exhibited significant inverse associations with MS risk. RCS analysis demonstrated a progressive reduction in MS risk with increasing total physical activity duration (P≤0.001). Subgroup analyses revealed enhanced protective effects for weekend warriors among adults aged >60 years(aOR=0.679, 95% CI: 0.518-0.887) and males(aOR=0.792, 95% CI: 0.639-0.979). In the regular exercise group, increases in activity duration, intensity, and frequency were significantly associated with lower MS risk. Conclusion This study demonstrates that both regular exercise and weekend warrior physical activity patterns correlate with reduced metabolic syndrome risk, highlighting the importance of physical activity in comprehensive MS prevention and intervention strategies.

Objective To describe the burden of type 2 diabetes mellitus attributable to low physical activity in China from 1990 to 2021 and to predict its trend between 2022 and 2035, and to provide a basis for the formulation of related prevention and control policies. Methods According to the relevant data from the Global Burden of Disease Study 2021, the burden of disability-adjusted life years (DALYs) and mortality for type 2 diabetes mellitus attributable to low physical activity were comparatively analyzed in China and globally using the Estimated Annual Percentage Change (EAPC). Changes in DALYs and mortality burden in China were analyzed using decomposition analysis, and trends were predicted by a Bayesian age-period-cohort model. Results Compared with 1990, DALYs, mortality, age-standardized DALYs rate (ASDR), and age-standardized mortality rate(ASMR) for type 2 diabetes mellitus attributable to low physical activity increased in China in 2021, and the burden was lower than the global level. The EAPC values for ASDR and ASMR in China were 0.63% and 0.02%, respectively, indicating stable trends. Older adults and females experienced a more severe burden. Aging and population growth were significant driving factors for changes in the burden of DALYs and mortality in China. It was predicted that from 2022 to 2035,ASDR for males and females in China would show an upward trend, with ASMR exhibiting a downward trend. Conclusion To reduce the burden of type 2 diabetes attributable to low physical activity, more proactive and comprehensive interventions should be developed to increase the level of physical activity in the entire population, especially for older adults and females.

Objective To investigate the influencing factors of anemia and anemia exacerbation in people living with HIV/AIDS (PLWHA) during antiretroviral therapy (ART), as well as the impact of anemia on the prognosis of PLWHA. Methods This retrospective cohort study collected baseline and follow-up data for PLHIV who initiated ART at a specialized infectious-disease hospital in Guangzhou from February 10, 2004 to March 29, 2019. A generalized linear mixed-effects model was used to analyze the factors influencing anemia during long-term ART in PLWHA without anemia at baseline. The Cox proportional hazards model was used to analyze both the influencing factors of anemia exacerbation in those with baseline anemia and the impact of baseline anemia and follow-up anemia on the prognosis. Results There were 11 688 PLWHA, of whom 3 853(32.97%) had anemia at baseline. Among 7 835 PLWHA without anemia at baseline, 1 695 (21.63%) developed anemia during the follow-up. Among 3 470 PLWHA with mild or moderate anemia at baseline, 845 (24.35%) had anemia exacerbation during the follow-up. Risk factors for follow-up anemia in PLWHA included being female, aged ≥50 years at ART initiation, being married/cohabiting, being divorced/separated/widowed, blood transmission, baseline opportunistic infections, higher number of baseline clinical symptoms, the initial ART regimen containing Zidovudine (AZT), CD4 cell count <200 cells/μL, and abnormal serum creatinine. Risk factors for anemia exacerbation included being female, being married/cohabiting, being divorced/separated/widowed, an interval of ≥6 months from diagnosis to ART initiation, ≥2 categories of baseline clinical symptoms, an initial ART regimen containing AZT, and abnormal serum creatinine. The risk of death in PLWHA without anemia at baseline but developing anemia during the follow-up was 5.02 times (95% CI: 2.45-10.27) than that among those without anemia at both baseline and during the follow-up. The risk of death with anemia at both baseline and during the follow-up was 6.00 times (95%CI: 3.04-11.85) than that among those without anemia at both baseline and during the follow-up. Conclusion Follow-up anemia and anemia exacerbation during ART are affected by multiple factors. Baseline anemia and follow-up anemia are important risk factors for the prognosis of PLWHA. Anemia screening for high-risk groups should be strengthened to strive for early detection, early diagnosis, and early treatment, thereby reducing the risk of death of PLWHA.

Objective Aging is a common starting point for many diseases, and homeostatic dysregulation (HD) is an important intervention indicator of aging. This study investigates the association between Tibetan noodle consumption and HD. Methods Using baseline survey data from the China Multi-Ethnic Cohort study (CMEC), HD was constructed on the basis of clinical biomarkers and anthropometric indices. Dietary information was obtained from the Food Frequency Questionnaire (FFQ). Multivariable linear regression analysis was used to explore the association between Tibetan noodle consumption and HD.Stratified analyses were conducted by sex, age, and BMI to explore the heterogeneity of the association effect. Results A total of 4 485 study participants were included. Compared with non-consumption of Tibetan noodles, a weekly consumption frequency of more than 7 times was associated with lower HD (β=-0.304, 95% CI: -0.593~-0.015). Similarly, a weekly intake exceeding 1 050 grams of Tibetan noodles demonstrated reduced HD (β=-0.130, 95% CI: -0.245~-0.014). Additionally, sex might act as a potential effect modifier. Conclusion Tibetan noodle consumption was inversely associated with HD, suggesting that consumption of Tibetan noodles, a specialty diet, has potential value in improving HD and slowing down aging.

Objective To accurately evaluate the influencing factors and urban-rural differences in the well-being among the elderly in Guizhou Province, so as to provide scientific basis and practical strategies for enhancing the well-being of the elderly. Methods Using stratified and convenience sampling methods, 1 500 elderly aged 60 and above who met the survey requirements were selected from six prefectures in Guizhou Province. The well-being of Older People Scale (WOOP) was applied for questionnaire surveys. Combined with the random forest model and the ordered logistic regression analysis, the importance evaluation and the urban-rural differences of the influencing factors on the well-being of the elderly in Guizhou Province were analyzed. Results The overall well-being level of the elderly in Guizhou Province was relatively high, and that in urban areas was slightly higher than that in rural areas. The mean value of subjective well-being among urban elderly was 4.21±0.65, while that of rural elderly was 4.11±0.75. The results of the random forest model and the ordered logistic regression analysis showed that physical health, mental health, social life, receiving support, acceptance and resilience, feeling useful, independence, and making ends meet were important influencing factors for the well-being of the elderly. The regression coefficient values of these factors all showed significance at the 0.001 level. Among them, the making ends meet (with a weight value of 0.231) was the core driving factor for the well-being of rural elderly. Meanwhile, mental health (with a weight value of 0.136) and physical health (with a weight value of 0.122) were the core driving factors for the well-being of urban elderly.Living situation (β=0.880, z=6.751, P<0.001) had a significant impact on the well-being of urban elderly but has no significant impact on that of rural elderly. Conclusion There are significant urban-rural differences in the influencing factors of the well-being of elderly in Guizhou Province. To enhance the well-being of elderly, it is necessary to start from multiple dimensions and implement precise policies. In rural areas, priority should be given to increasing the income of rural elderly. While in urban areas, efforts should be focused on optimizing the living situation of the elderly and building a comprehensive and multi-level medical and elderly care service support system.