This study aimed to analyze the changes in multimorbidity of eight common chronic non-communicable diseases (NCDs), including hypertension, diabetes, coronary heart disease (CHD), stroke, hyperlipidemia, obesity, chronic obstructive pulmonary disease (COPD), and asthma among rural residents in Yunnan Province between 2014 and 2024.

A multistage stratified random sampling method was used to select 9 886 and 10 012 permanent residents aged ≥35 years in rural Yunnan in 2014 and 2024, respectively. Face-to-face questionnaire surveys and physical examinations were conducted for each participant. Association rule mining (ARM) based on the Apriori algorithm was applied to identify patterns of NCDs multimorbidity.

In 2024, the prevalence of multimorbidity involving eight NCDs was 24.4%. The prevalence of multimorbidity was higher among illiterate individuals than among those with primary school education or above (χ²=7.951),higher among those with higher annual per capita household income than among those with lower income (χ²=27.653), and higher among those with good access to medical services than among those with poor access (χ²=12.160) (all P<0.05). The prevalence of NCDs multimorbidity increased with age and level of socioeconomic position (SEP) (, , P<0.001). Compared to 2014, the age-standardized prevalence of NCDs multimorbidity was increased in 2024 (22.8%vs 14.5%, χ²=225.436, P<0.001), and was also observed among subgroups categorized by gender (male: χ²=123.835;female: χ²=101.711), age (35-44: χ²=54.919; 45-54: χ²=42.635; 55-64: χ²=64.961; 65-74: χ²=47.197; ≥75: χ²=23.344), education level(illiterate: χ²=62.723; primary school or above: χ²=153.712), income (low: χ²=70.620; high: χ²=142.048), access to medical services (poor: χ²=51.375; good: χ²=167.027), and SEP (low: χ²=53.353; middle: χ²=33.151; high: χ²=132.913) (P<0.001). The average number of NCDs among multimorbid patients increased from 2.34 in 2014 to 2.40 in 2024, and was also observed among female patients, illiterate patients, and patients with poor access to medical services. A total of 8 and 13 association rules were identified in 2014 and 2024, respectively. Compared with 2014, two new binary multimorbidity patterns (diabetes + CHD,obesity + dyslipidemia) and four new ternary multimorbidity patterns (diabetes + hypertension + dyslipidemia, diabetes +hypertension + CHD, diabetes + hypertension + obesity, hypertension + dyslipidemia + obesity) have been identified in 2024.

Both the prevalence of multimorbidity and the number of NCDs in multimorbid patients have increased in rural Yunnan Province, and multimorbidity patterns were becoming increasingly complex and diverse. Targeted NCDs management strategies should be tailored according to the epidemiologic profiles of multimorbidity to improve prevention and control of NCDs.

This study aims to explore the association between the hemoglobin-to-red blood cell distribution width ratio (HRR) and the risk of diabetes mellitus (DM).

A total of 16 392 participants from the 2001—2020 National Health and Nutrition Examination Survey(NHANES) database were selected for this study. Logistic regression, subgroup analysis, and restricted cubic splin (RCS) analysis were applied to investigate the relationship between HRR and DM.

The mean HRR among the included participants was 0.27±0.98, with diabetic patients showing significantly lower HRR compared to the control group (P<0.001). Logistic regression analysis revealed that when HRR was modeled as a continuous variable, for each standard deviation increase in HRR, the risk of DM decreased by 11% (OR=0.89, 95% CI: 0.84-0.95). When HRR was treated as a categorical variable based on quartiles, the highest fourth quartile(Q4) consistently showed a significant reduction in DM risk compared to the lowest quartile (Q1) across all three models (OR<1). Subgroup analysis demonstrated that increased HRR was associated with a reduced risk of DM in most subgroups, with most P-values<0.05. The dose-response analysis indicated a linear negative correlation between HRR and the risk of DM(P-nonlinear=0.395).

HRR is associated with the risk of DM, and higher HRR levels are protective against the development of diabetes.

The aim of this study was to analyze the prevalence of multimorbidity of five chronic non-communicable diseases (hypertension, diabetes, coronary heart disease, stroke, and chronic obstructive pulmonary disease) and its influencing factors among male detoxification addicts under compulsory isolations in Yunnan Province.

The multistage random cluster sampling method was adopted to select 1 021 male detoxification addicts under compulsory isolation from compulsory detoxification centers in Yunnan Province, and each participant received on-site questionnaire surveys and physical examinations. The Structure Equation Modeling (SEM) was used to analyze the influencing factors of multimorbidity of five chronic non-communicable diseases (NCDs).

Among the study population, the prevalence of individuals who suffered from chronic NCDs mutimorbidity was 6.6%. The results of the SEM analysis indicated that age, sleep quality, and self-rated health status had both direct and indirect effects on mutimorbidity of chronic NCDs, with standardized total effects of 0.474(95% CI: 0.290-0.680), 0.257 (95% CI: 0.076-0.486), and 0.293 (95% CI: 0.130-0.483), respectively. Age had an indirect effect through mental health and self-rated health on chronic NCDs mutimorbidity, with standardized indirect effects of 0.046(95% CI: 0.016-0.095), and 0.066 (95% CI: 0.033-0.103), respectively. Sleep quality had an indirect effect through mental health and self-rated health, with standardized indirect effects of 0.043 (95% CI: 0.018-0.081), and 0.033 (95% CI: 0.015-0.058), respectively. Self-rated health status had an indirect effect through mental health, with standardized indirect effects of 0.073 (95% CI: 0.033-0.138). Mental health and central obesity had direct effect on chronic NCDs mutimorbidity, with standardized direct effects of 0.229 (95% CI: 0.111-0.348), 0.198 (95% CI: 0.085-0.310), respectively.

The findings suggest future measures to strengthen the prevention, control, and management of chronic NCDs should focus more on male detoxification addicts who are older and have poor sleep quality, poor mental health, central obesity, and poor self-rated health, to reduce the risk of NCD multimorbidity.

To analyze the trends in the burden of cervical cancer attributable to smoking in China from 1990 to 2021, and to explore the disease burden patterns across regions with different Socio-demographic Index (SDI) levels, thereby providing a scientific basis for formulating targeted tobacco control measures and cervical cancer prevention strategies.

Based on data from the Global Burden of Disease (GBD) Study 2021, mortality and disability-adjusted life year(DALY) rates of cervical cancer attributable to smoking in China and five SDI regions among individuals aged 25-94 years were extracted. Joinpoint regression was used to analyze the temporal trends in age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR). The Age-Period-Cohort (APC) model was employed to assess age, period, and cohort effects.

From 1990 to 2021, both the ASMR and ASDR of cervical cancer attributable to smoking in China decreased significantly, with average annual percentage changes (AAPCs) of -2.177% (95% CI: -2.592~-1.759) and -2.054% (95% CI:-2.280~-1.826), respectively. The overall burden in China remained consistently lower than the average of its corresponding SDI region. Regional comparisons revealed that the largest decline in mortality occurred in the middle SDI region (AAPC=-2.874%), while the fastest decline in ASDR was observed in the low SDI region (AAPC=-2.863%). The high SDI region showed the smallest declines for both metrics. In China, age-specific analyses showed that the most pronounced declines in ASMR for cervical cancer attributable to smoking were observed in the 70-74 and ≥95 years age groups. The ASDR exhibited a unimodal distribution with age, peaking at 57 years, and showed the largest decline in the 70-74 years age group. However, the disease burden in the 30-59 years age group still showed an increasing trend in some SDI regions. APC model analysis further indicated net drifts of -0.540% for ASMR and -1.946% for ASDR. Both period and cohort effects decreased significantly, with the cohort effect being the most prominent, showing an 82.97% reduction in the risk of DALY rates attributable to smoking from the 1895 to the 1990 birth cohorts.

From 1990 to 2021, the burden of cervical cancer attributable to smoking in China showed a significant overall decline, but with notable regional and age heterogeneities. Substantial improvements were observed in low and middle-high SDI regions and among older age groups, while the burden in young and middle-aged populations increased in some regions. Future prevention and control efforts should focus on the young and middle-aged population and promote tailored strategies across different regions.

To analyze the disease burden of adverse effects of medical treatment (AEMT) among Chinese residents from 1990 to 2021, thereby providing a reference for the health department to formulate patient safety policies.

The mortality,incidence, disability-adjusted life years(DALYs) data of AEMT and regional sampling data were extracted from the Global Health Data Exchange and the National Health Service and Quality Safety Report. The trends and effects were analyzed using the Joinpoint-jump model and Age-period-cohort model, and regional differences were analyzed by hierarchical clustering.

The overall trends of incidence, mortality and DALYs of AEMT from 1990 to 2021 gradually declined. The AAPCs were -1.28%, -5.59% and -6.47%,respectively. The comparability ratio (CR) values of overall incidence and mortality were 0.99 and 1.02, respectively. The number of male AEMT cases decreased from 208 100 to 170 700, while the number of female cases dropped from 224 100 to 172 700. The risk of death was the highest among residents over 95 years old (RR=10.55, 95% CI: 5.93-18.75), which was 2.27 times that of residents aged 0-4 years (RR=4.65, 95% CI: 3.83-5.64). The risk of DALYs increased among those aged 0-4 years (RR=8.56, 95% CI: 5.83-12.55),which was 14.57 times that of residents aged 50-54 years (RR=0.59, 95% CI: 0.47-0.73). In 2022, the regional clustering of AEMT reported per hospital was categorized into 2 clusters, Zhejiang (632.16 cases per hospital) belonged to the high-high cluster, while Tibet (49.23 cases per hospital) belonged to the low-low cluster.

The burden of AEMT in China is gradually decreasing. It is necessary to consider the prevention and control strategies for key populations, including those aged 0-4 years and above 80 years, as well as remote areas, leverage artificial intelligence to reduce AEMT, and promote the development of medical safety to a higher level.

To analyze the current status and trends of hypertensive heart disease burden attributable to high BMI in China and globally from 1990 to 2021, in order to provide data support for the development of obesity and cardiovascular disease prevention and control strategies in China and worldwide.

Data on disability-adjusted life years (DALYs) and deaths from hypertensive heart disease attributable to high BMI were extracted from the 2021 Global Burden of Disease database. The total DALYs and number of deaths caused by high BMI-related hypertensive heart disease in China and globally in 2021, as well as the age-standardized mortality rate and trends from 1990 to 2021, were described. The Joinpoint regression model was used to calculate the average annual percentage change (AAPC) in age-standardized DALY and mortality rates from 1990 to 2021 in both China and globally.

In 2021, the age-standardized mortality rate attributable to high BMI-related hypertension heart disease in China was 6.90 per 100 000 (AAPC=-1.09, P<0.001), and the age-standardized DALY rate was 120.03 per 100 000 (AAPC=-1.41, P<0.001), both showing a downward trend. Globally, the age-standardized mortality rate was 7.21 per 100 000 (AAPC=0.19, P<0.001), and the age-standardized DALY rate was 147.34 per 100 000 (AAPC=0.07),showing a slow upward trend.

From 1990 to 2021, the age-standardized mortality rate and DALY rate for hypertensive heart disease attributable to high BMI in China showed a downward trend, contrary to the global trend. However,the burden was heavier among women and the elderly. Therefore, it is crucial to emphasize obesity prevention and control strategies for the elderly, promote healthy lifestyle habits, and adopt targeted interventions to reduce the disease burden.

To systematically analyze the research hotspots, development trends and regional differences in the field of cognitive frailty of patients with chronic diseases at home and abroad from 2013 to 2025 through bibliometric methods, so as to provide directional guidance for future research.

Literature on the theme of cognitive frailty among patients with chronic diseases was collected from CNKI, VIP, Wanfang, and the Web of Science core collection, and a total of 691 articles(220 in Chinese and 471 in English) were visualized using CiteSpace and VOSviewer.

A total of 220 Chinese and 471 English articles were included. The annual number of publications on cognitive frailty among patients with chronic diseases globally showed an increasing trend. International research mainly focused on pathological mechanisms (such as blood-brain barrier injury, neuroinflammation-metabolic coupling mechanism) and digital health interventions (such as virtual reality training, artificial intelligence prediction model). However, domestic research focused on the early screening and risk assessment of community population and on the standardized management of patients with chronic diseases such as hypertension and diabetes (such as drug adjustment, follow-up management). The keyword burst showed that “physical activity” (English) and “influencing factor analysis” (Chinese) had emerged simultaneously since 2023, marking that intervention research had become a common focus. Compared with foreign countries, the analysis of the cooperation network between authors and institutions in China showed that the substantive cooperation between interdisciplinary and cross-team was weak.

Future research should align with international mechanistic explorations and local clinical practice needs, prioritizing breakthroughs in digital technology clinical translation and the establishment of interdisciplinary health management models. This method may provide a new way to delay cognitive frailty in patients with chronic diseases.

To investigate the correlation and potential causal association between abdominal obesity and bone mineral density(BMD) in people of different age groups.

This study combined a cross-sectional study with Mendelian randomization (MR) analysis.Cross-sectional study data were derived from the U.S. National Health and Nutrition Examination Survey (NHANES) 2011—2018. A total of 7 452 participants aged 20-60 years were included. Weighted linear regression analysis was employed to investigate the association between a body shape index (ABSI) and total body less head bone mineral density (TB-BMD). The MR study utilized a two-sample MR analysis to explore the causal relationship between genetically predicted waist circumference-adjusted for body mass index(WCadjBMI), an index of abdominal obesity, and TB-BMD.

Cross-sectional analysis revealed a significant negative correlation between ABSI and TB-BMD(β=-3.53, 95% CI: -4.146~-2.915, P<0.001), which was more pronounced in males and individuals aged 45-60 years. In the 45-60 age group, an “inverted U-shaped” non-linear relationship was observed between ABSI and pelvic BMD (inflection point=0.076). MR analysis indicated a negative causal relationship between WCadjBMI and TB-BMD (β=-0.16, 95% CI: -0.26~-0.07,P<0.01), which was significant across age groups of <15 years, 30-45 years, and >60 years.

Abdominal obesity is clearly associated with bone loss, and this negative effect varies among different age and sex groups. Maintaining abdominal fat at a low level before significant bone loss occurs is crucial for preserving skeletal health.

This study aims to investigate the mechanism by which circular RNA hsa_circ_0058493 mediates arsenic exposure-induced apoptosis in lung cells.

A549 and BEAS-2B cells were exposed to different concentrations of sodium arsenite (NaAsO₂), and the half-maximal inhibitory concentration (IC₅₀) of NaAsO₂ was determined by the CCK-8 assay. The effects of three arsenic species (NaAsO₂, MMA, DMA) on hsa_circ_0058493 expression were analyzed by real-time quantitative PCR (RT-qPCR). After silencing hsa_circ_0058493 with siRNA, cell viability, mitochondrial membrane potential, and apoptosis were evaluated using CCK-8, JC-1 staining, and Hoechst 33342/PI double staining, respectively. The JAK2/STAT3 signaling pathway and related protein expression were assessed by Western blotting.

NaAsO₂ significantly reduced cell viability(IC₅₀: 35.03 μmol/L for A549, 7.809 μmol/L for BEAS-2B) and specifically induced the upregulation of hsa_circ_0058493 (P<0.05), while MMA and DMA showed no significant effects. Downregulating hsa_circ_0058493 reduced cell viability, depolarized mitochondrial membrane potential, and increased apoptosis (P<0.05). Western blotting showed that depleting hsa_circ_0058493 suppressed JAK2/STAT3 phosphorylation and downregulated c-Myc, CyclinD1, XIAP, and BCL-2 expression levels (P<0.05).After downregulating hsa_circ_0058493, cells were treated with NaAsO₂, resulting in a further decrease in cell viability, and STAT3 protein expression differed between the two cell lines.

Downregulation of hsa_circ_0058493 induced decreased cell viability and apoptosis, which were associated with inhibition of JAK2/STAT3 pathway activity, suggesting that hsa_circ_0058493 may be involved in arsenic-induced lung cell apoptosis by regulating the JAK2/STAT3 signaling pathway.

To investigate the effects of combined exposure of benzo[a]pyrene (B[a]P) and 2,2',4,4'-tetrabromobiphenyl ether (BDE-47), which widely coexist in the environment as endocrine-disrupting chemicals, on the proliferation, migration and invasion of mammary epithelial cells and their possible tumorigenic mechanisms.

Human mammary epithelial MCF-10A cells were treated with 1 μM B[a]P and gradient concentrations of BDE-47, alone or in combination. Cell cycle and apoptosis were detected by flow cytometry. Cell proliferation, migration and invasion were detected by CCK-8 method, scratch test and Transwell chamber. Protein expression levels of epithelial-to-mesenchymal transition(EMT) related markers and β-catenin were detected by Western blot.

Compared with control group, flow cytometry results showed that exposure to B[a]P and BDE-47 alone and in combination significantly decreased the proportion of G0/G1 cells and significantly increased the proportion of S and G2/M cells(P<0.05), but did not induce apoptosis in MCF-10A cells(P>0.05). The expression of cyclin-dependent kinase 4(CDK4) and CyclinD1 increased significantly(P<0.05), and CDK6 expression level had no significant difference (P>0.05). CCK-8 results showed that B[a]P and BDE-47, both alone and in combination, significantly enhanced cell viability, with the combined exposure producing a stronger effect(P<0.05). Scratch wound and Transwell assays demonstrated that both single and combined exposures enhanced cell migration and invasion(P<0.05), with the combined exposure group showing the most pronounced effects. Western blot analysis showed that EMT-related epithelial-associated proteins E-cadherin and ZO-1 were down-regulated (P<0.05), while mesenchymal associated proteins N-Cadherin, Vimentin and Snail were up-regulated (P<0.05), and the protein level of β-catenin was also increased(P<0.05), suggesting activation of the Wnt/β-catenin signaling pathway.

Combined exposure of B[a]P and BDE-47 promoted proliferation, migration and invasion of mammary epithelial cells, and the combined effect was stronger, which may induce EMT process of mammary epithelial cells through Wnt/β-catenin signaling pathway to play a tumorigenic role.

To provide scientific evidence for promoting the application of food nutrition labeling and the construction of nutritional health canteens.

Two workplace canteens in Xiamen City that received catering services from the same catering enterprise and were comparable in unit type, canteen size, meal provision, and diner number and composition were selected as study sites, with one designated as the intervention canteen and the other as the control. A traffic light catering food nutrition labeling system was designed and implemented in the intervention canteen. Over a six-month period, per capita consumption of cooking oil, salt, and sugar was monitored in both canteens. In addition, the use of condiments and cooking oil for 110 regular dishes in the intervention canteen was recorded before and after labeling implementation. Validated questionnaires were administered twice to diners in the intervention canteen to assess satisfaction before and after the implementation of the traffic light nutrition labeling.

One month post-implementation, the intervention canteen showed significantly lower per capita consumption of cooking oil, salt, and sugar than the control canteen (F=1 405.805, P<0.001; F=1 798.037，P<0.001; F=1 018.140, P<0.001). Throughout the six months, these metrics progressively decreased in the intervention canteen (P<0.001). After six months, the intervention canteen demonstrated reduced usage of salt, MSG/chicken essence, sugar, soy sauce, other condiments, and cooking oil in regular dishes (P<0.01). Post-implementation surveys indicated statistically significant improvements in diner satisfaction regarding meal quality, nutrition/health services, general services, and overall experience (P<0.01).

The traffic light food labeling system effectively facilitated the “Three Reductions” in nutritional health canteen practice.

To understand the residue levels of anticoccidial drugs in chicken meat and eggs in Henan Province and to assess the risk of dietary exposure.

A total of 323 chicken and 326 eggs were randomly collected in Henan Province from 2022 to 2024, and residues of four anticoccidial drugs were detected according to the standard operating procedures in the“National Food Contaminants and Hazardous Factors Risk Monitoring Manual”, the χ² test was used for the comparison of rates.The exposure levels of anticoccidial drugs were calculated through probabilistic assessment methods combined with the residents’ consumption data of chicken and eggs, and the health risks of exposure were evaluated using hazard quotients.

The overall detection rate of anticoccidial drugs in chicken and eggs was 18.95%, and the passing rate was 99.85%.The detection rate of chicken was higher than that of eggs (χ²=107.602, P<0.001). The detection rates of anticoccidial drugs in chicken from high to low were diclazuril, nicarbazin, and toltrazuril sulfone (χ²=188.986, P<0.001). The detection rate of diclazuril in eggs was higher than that of nicarbazin (χ²=6.500, P=0.011). Toltrazuril was not detected in chicken and egg samples. There were no statistically significant differences in the detection rates of anticoccidial drugs in bulk and prepackaged chicken and eggs (χ²=0.406, P=0.524; χ²=0.694, P=0.405). There was no statistically significant difference in the detection rates of anticoccidial drugs in chicken samples from different circulation links (χ²=5.106, P=0.078). The detection rate of anticoccidial drugs in egg samples from online stores was higher than that from farmers’ markets and shops (χ²=8.514, P=0.014). The P₉₉ exposure levels of diclazuril and nicarbazin in chicken, and diclazuril in eggs were 2.78×10^-2 [μg/(kg BW·d)],2.14×10^-3 [μg/(kg BW·d)], 6.41×10^-4 [μg/(kg BW·d)], respectively. The hazard quotients of diclazuril in chicken and eggs for 99% of adults in Henan Province were 9.27×10^-4 and 0.21×10^-4 respectively, and the hazard quotient of nicarbazin in chicken for 99% of adults was 5.35×10^-6.

The overall detection rate of anticoccidial drugs in chicken and eggs is relatively low in Henan Province, and the risk of human intake is also relatively low.

To develop a scale measuring parents’ attitudes towards their children’s dietary health and to test its reliability and validity. This study aims to provide a scientific tool for assessing parents’ attitudes towards their children’s dietary health.

According to the Health Belief Model, an initial item pool was created for the scale. A research team was assembled, and through processes such as consulting with experts, the preliminary version of the scale was established. A staged cluster sampling method was employed to select a total of 40 classes from grades 4 to 8 in primary and secondary schools in Chengdu’s Xindu District between May and October 2023. Initially, an item analysis was conducted using all 2 651 collected samples. Then, the entire sample set was randomly split into two subsets: Sample 1 (n=2 091) was subjected to exploratory factor analysis first, and Sample 2 (n=560) was subjected to confirmatory factor analysis. Finally, the total sample was used for internal consistency testing. Two weeks after the survey, parents in a random class were randomly selected to refill the questionnaire to obtain the test-retest reliability of the scale.

The final version of the scale included 24 items. EFA extracted six common factors (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action), with a cumulative variance contribution rate of 82.433%. CFA results showed: χ²/df=2.641, RMSEA=0.055,GFI=0.913, AGFI=0.890, TLI=0.964, IFI=0.969, and CFI=0.969. The overall Cronbach’s α coefficient was 0.934, the split-half reliability was 0.813, and the test-retest reliability was 0.641. Children’s dietary behavior was significantly associated with parents’ attitudes scores (P<0.05).

The scale developed in this study demonstrates good reliability and validity, and is suitable for assessing parents’ attitudes towards the dietary health of school-aged children in community family settings.

To examine whether adverse childhood experiences(ACEs) predict frailty in middle-aged and elderly Chinese adults, and whether social participation or education level moderates this association.

Four waves (2011—2018) of the China Health and Retirement Longitudinal Study were combined with the 2014 life-history module to construct panel data. Based on the Hausman test(χ²=261.490, P<0.001), a fixed-effects model was applied to examine the association between ACEs and frailty, with particular attention to social participation and educational attainment and potential moderating effects.

A total of 9 354 individuals were retained, 61.71% had experienced two or more ACEs, and the prevalence of frailty was 15.01%. A significant positive correlation was observed between ACEs and frailty, with the effect intensifying as the number of ACEs increased (ACEs=2: β=1.45, 95% CI: 0.64~-2.26; ACEs=3: β=2.90, 95% CI: 2.00-3.86; ACEs=4: β=3.52,95% CI: 2.48-4.56). Social participation (β=-0.50, 95% CI: -0.63-0.30) and high school or vocational education (β=-1.71, 95% CI: -2.62-0.80) were cross-sectionally associated with lower frailty. However, neither social participation nor education level significantly moderated the relationship between ACEs and frailty (P>0.05).

Within the middle-aged and elderly population in China, ACEs had been identified as a significant risk factor for the development of frailty. Although both social participation and high school or vocational education were negatively associated with frailty, neither of these factors significantly moderated the relationship between ACEs and frailty.

To investigate the association between Li ethnicity and the risk of delivering small for gestational age(SGA).

Based on data from 1 472 940 live births recorded in the Hainan Provincial Birth Certificate System between 2010 and 2021, generalized linear models were employed to analyze the associations between different combinations of Han and Li parental ethnicity and the risk of SGA and its subtypes. Statistical interactions were assessed to examine the influence of demographic characteristics and perinatal factors on these associations.

The SGA rate among Li parents was 22.99%,followed by Li father/Han mother (17.96%) and Han father/Li mother pairs (16.22%), all significantly higher than that of Han pairs (15.05%, P<0.001). The patterns for different SGA subtypes were generally consistent with the overall trend. Adjusted models showed a graded increase in SGA risk relative to Han pairs: Han father/Li mother (RR=1.041, 95% CI: 1.026-1.057), Li father/Han mother (RR=1.115, 95% CI: 1.094-1.136) and Li pairs (RR=1.385, 95% CI: 1.371-1.400). Multiplicative interaction models showed the association was significantly modified by parental age, multiplicity, residence, neonatal sex, and delivery hospital (P<0.05).

Our findings suggest that Li ethnicity may be an independent risk factor for SGA.Targeted interventions and optimized perinatal care tailored to the Li population are needed to improve maternal and infant health outcomes.

This study aimed to investigate the effects of childhood trauma, classmate support and school connectedness on psychological distress, thereby providing an empirical basis for developing preventive interventions for mental health problems in adolescents.

A questionnaire survey was conducted among 2 500 middle school students. Multiple linear regression analysis was employed to examine the effects of childhood trauma, classmate support, and school connectedness on psychological distress, and their interactive effects.

The total detection rate of psychological distress was 43.9%, with moderate, and severe cases accounting for 13.5%, and 5.0%, respectively. Childhood trauma positively predicted psychological distress (β=0.271, P<0.05), while classmate support (β=-0.089, P<0.05) and school connectedness (β=-0.260, P<0.05) negatively predicted psychological distress. After including the three-way interaction term (childhood trauma × classmate support × school connectedness), the model’s explanatory power for psychological distress increased by 0.4%(△R²=0.004, P<0.05). Childhood trauma remained a positive predictor of psychological distress(β=0.289, P<0.05), whereas classmate support (β=-0.105, P<0.05), school connectedness (β=-0.282, P<0.05), and the three-way interaction term (β=-0.103, P<0.05) negatively predicted psychological distress. Results of the simple slope analysis showed that there were significant differences between Slope 1 and Slope 3, as well as between Slope 3 and Slope 4(both P<0.05).

The occurrence of psychological distress in middle school students is associated with childhood trauma,classmate support, and school connectedness. Notably, these three factors demonstrate significant interactive effects on students’ psychological distress. Moving forward, greater emphasis should be placed on screening adolescents for childhood trauma experiences while simultaneously addressing peer relationships and school culture.

To investigate the impact of parent-child relationship on adolescent smoking frequency and to analyze the chain mediating effect of life satisfaction and social support seeking.

Based on the survey data from the Adolescent Health Database for the 2020—2021 academic year, Spearman correlation analysis was used to explore the correlations among parent-child relationship, life satisfaction, social support seeking, and smoking behavior. The chain mediation model was constructed using the PROCESS 4.1 program, Model 6.

A total of 22 345 samples were included in the study. Parent-child relationship positively influenced adolescents’ life satisfaction and social support seeking (β=0.604, P<0.001; β=0.258, P<0.001). Life satisfaction also positively influenced social support seeking (β=0.306, P<0.001). Parent-child relationship, life satisfaction, and social support seeking were all significantly associated with lower adolescent smoking frequency (β=-0.212, P<0.001; β=-0.039, P<0.001; β=-0.080, P<0.001). The chain mediating effect of life satisfaction and social support seeking between parent-child relationship and smoking frequency was significant (β=-0.015, 95% CI: -0.018~-0.011).

Life satisfaction and social support seeking play a significant chain mediating role between parent-child relationship and adolescent smoking frequency. Parents should create a positive family atmosphere, establish a harmonious parent-child relationship, and promptly correct adolescents’ misconceptions to reduce the occurrence of smoking behavior.

This study aimed to analyze the current status of sleep quality and its impact on the quality of life among rural residents in Fumin County, Yunnan Province.

A multi-stage stratified random sampling method was adopted to select 2 503 rural permanent residents aged 35 and above in Fumin County for face-to-face questionnaire surveys. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), while the short form 36 (SF-36) scale was used to assess quality of life (QOL) scores.

The prevalence of sleep disorders in the surveyed population was 19.70%, and was higher in females than in males (24.40% and 14.70%, P<0.001). Prevalence of sleep disorders increased progressively with age (P<0.001). Individuals with lower levels of education had higher prevalence of sleep disorders (P<0.001). Multiple linear regression analysis showed that individuals with sleep disorders had significantly lower scores in domains of Physical Component Summary(PCS) and Mental Component Summary (MCS) than their counterparts (P<0.001).

The prevalence of sleep disorders among rural residents in Fumin County of Yunnan Province is relatively high. Health education regarding sleep-related knowledge should be enhanced, particularly targeting females, the elderly, and individuals with lower educational levels.Furthermore, taking measures to reduce the occurrence of sleep disorders could help improve their QOL.

To understand the public’s preferences and willingness to pay for digital therapeutics (DTx) products for chronic disease management.

Based on a discrete choice experiment, an online questionnaire survey was administered via Wenjuanxing in February to March 2025, targeting the adult working population with independent spending capacity across the country. The preference outcomes were analyzed using a mixed logit model.

Higher product accuracy (β=1.006), greater ease of use (β=0.349), superior product efficacy (β=0.569), higher product risk (β=-2.104),significant long-term health benefits (β=0.670), and inclusion in the medical insurance reimbursement list (β=1.458)demonstrated substantial influence on respondents’ preferences (P<0.001). Specifically, compared with low-risk products,respondents’ willingness to pay for high-risk products decreased by 7 891 yuan, and coverage by the medical insurance reimbursement list increased willingness to pay by 5 466 yuan compared with no coverage.

It is necessary to improve the regulatory system for DTx, establish a multi-payment pattern with medical insurance payment as the core and a climate of paying for health value, enhance the usability of products, and ultimately promote the improvement of chronic disease management levels and the promotion of DTx.

To explore the relationship between health literacy and quality of life of rural residents in Changzhou City, and to examine the mediating effect of health protective behavior.

A multi-stage random sampling method was employed to select 605 rural residents in Changzhou for the survey. The questionnaire comprised sections on general information, short-form health literacy scale, health protective behavior scale, and the EQ-5D-5L scale. Descriptive statistics and correlation analysis were performed using SPSS software. A structural equation model was constructed using Amos software, and the mediating effect of health protective behavior was examined through bootstrap analysis (with 5 000 resamples).

The score of the health literacy index for rural residents in Changzhou City was 35.77±7.42, the average utility score was 0.95±0.09, and the average EQ-VAS score was 83.88±12.13. A positive correlation was observed between health literacy and health protective behavior among rural residents in Changzhou (β=0.463, P<0.001). Similarly, health protective behavior was positively correlated with quality of life (β=0.244, P=0.006), and health literacy also showed a positive correlation with quality of life (β=0.157, P=0.037). Mediating effect analysis revealed that the direct effect of health literacy on quality of life among rural residents in Changzhou was 0.157, with an indirect effect of 0.113, resulting in a total effect of 0.270. The confidence interval for the path of health literacy → health protective behavior → quality of life was [0.038, 0.201]. The mediating effect of health protective behavior between health literacy and quality of life accounted for 41.85% (P=0.004).

Efforts should be continuously made to enhance the health literacy of rural residents, facilitating the transformation of their health knowledge and beliefs into health protective behaviors, so as to further improve the quality of life among rural residents.

To evaluate the fairness and efficiency of health supervisor allocation in Yunnan Province from 2020 to 2024,providing a basis for optimizing human resource allocation and enhancing the effectiveness of the health supervision system.

Based on relevant statistical and supervision data of Yunnan Province from 2020 to 2024, the allocation of health supervisor resources was assessed from three dimensions of current status, fairness, and efficiency, utilizing comprehensive quality scores of health supervisors, the Gini coefficient, and Data Envelopment Analysis (DEA) efficiency scores.

The number of health supervisors in Yunnan Province decreased from 1 762 in 2020 to 1 688 in 2024, while the supervised entities per supervisor increased from 189.78 to 257.25. The comprehensive quality score improved from 6.34 to 6.47, whereas the professional title score decreased by 13.1%. The Gini coefficients for the quantity of health supervisors, calculated based on the permanent resident population and the number of supervised entities, remained below 0.18, indicating a high level of equity. In contrast, the corresponding Gini coefficient for quality was close to the 0.4 warning line. The comprehensive efficiency score decreased initially and then increased over the five years, reaching its lowest point 0.797 in 2022. Scale efficiency was lower than pure technical efficiency each year. Prefectures(cities) exhibited regional differentiation in efficiency, characterized as highly efficient and stable, medium efficiency with fluctuation, or low efficiency with fluctuation, and these patterns were primarily influenced by scale efficiency.

The number of health supervisors in Yunnan Province has decreased, leading to a heavier workload, although their overall quality has improved. The fairness of quantity allocation is good, but the fairness of quality allocation requires improvement. Efficiency fluctuations are mainly attributable to scale efficiency. It is recommended to reform the professional title evaluation system, implement differentiated regional allocation strategies, and strengthen technical empowerment to enhance the overall efficiency and fairness of human resource allocation.

To explore the underlying mechanisms among mental health variables, including perceived stress, psychological resilience, depression, anxiety, and insomnia, within the medical staff population.

Between November 1 and December 31,2023, a convenience sampling method was used to survey healthcare workers in Beijing via an electronic questionnaire. We used internationally validated scales to measure stress perception and psychological resilience. Hypothesized relationships between the variables were tested using a structural equation model (SEM) developed based on existing literature.

A total of 2 014 valid questionnaires were collected from 83 medical and health institutions. The scores of the mental health scales were as follows: PSS 16.00 (10.00, 18.00), CD-RISC 63.00 (48.00, 77.00), PHQ-9 3.00 (0.00, 7.25), GAD-7 1.00 (0.00, 6.00), and ISI 5.00 (1.00, 9.00).Psychological resilience showed a potential mediating effect of 5.5%-9.3% on the associations between perceived stress and each psychological symptom. In addition, anxiety symptoms played a stronger mediating role in the pathways from perceived stress to depressive symptoms and insomnia symptoms, accounting for 55.0% and 79.4% of the total effects, respectively. The direct effect of perceived stress on anxiety symptoms was the most prominent (94.5%). The structural equation model demonstrated good overall fit (χ²/df=2.829, RMSEA=0.030), and the hypothesized interrelationships among the variables were supported by the data.

This study demonstrates that psychological resilience and anxiety symptoms are key mediators in the impact of stress perception on mental health, suggesting that optimizing mental health management in healthcare professionals requires integrated strategies focusing on stressor control, early identification of anxiety, and resilience enhancement.

To explore the mediating role of activities of daily living (ADL) and depression between chronic disease comorbidity and self-rated health in empty-nest elderly, and to provide a reference for improving the self-rated health and quality of life of empty-nest elderly.

A total of 3 542 empty-nest elderly aged 60 years and older from the 2020 China Health and Retirement Longitudinal Study were selected as study subjects. Spearman’s correlation analysis was employed to explore the associations between chronic disease comorbidity, ADL, depression, and self-rated health among empty-nest elderly. The Process 4.1 plugin model 6 in SPSS was used to analyse the mediating effects of ADL and depression on the relationship between chronic disease comorbidity and self-rated health among empty-nest elderly.

The direct effect of chronic disease comorbidity on self-rated health among empty-nest elderly individuals was statistically significant (β=-1.2397, 95% CI: -1.4139~-1.0655), the separate mediating effect of ADL was statistically significant (β=-0.159, 95% CI: -0.278~-0.079), the separate mediating effect of depression was statistically significant (β=-0.160, 95% CI: -0.214~-0.115), and the chain mediating effect of ADL and depression was statistically significant (β=-0.073, 95% CI:-0.094~-0.056).

Chronic disease comorbidity can directly negatively impact the self-rated health status of empty-nest elderly individuals. It may also influence their self-rated health through the independent or chain mediating effects of activities of ADL and depression. Consequently, it is recommended that policy measures prioritise empty-nest elderly individuals within health interventions to reduce their risk of chronic disease comorbidity. This should involve establishing a comprehensive support system centred on functional assessment and psychological intervention, thereby improving the self-rated health status of this demographic.

To explore the relationship between smartphone addiction and resilience of college students, and the chain mediating effect of sleep quality and perceived social support.

A total of 843 college students from a university in Shandong Province were selected as the research objects. The general information questionnaire, smartphone addiction scale,resilience scale, Pittsburgh Sleep Quality Index Scale and Perceived Social Support Scale were used to investigate. AMOS 26.0 software was used to establish structural equation model and bootstrap method was used to verify the mediators.

Among the college students, 37.25% had smartphone addiction, and smartphone addiction had a significant direct negative effect on college students’ resilience. The effect value was -0.51 (95% CI: -0.59~-0.43), accounting for 60.71% of the total effect. In addition, the mediating effect of sleep quality was -0.12 (95% CI: -0.17~-0.07), accounting for 14.29% of the total effect. The mediating effect of perceived social support was -0.14 (95% CI: -0.20~-0.10), accounting for 16.67% of the total effect. At the same time, the chain mediating effect of sleep quality and perceived social support between smartphone addiction and resilience was -0.06 (95% CI: -0.10~-0.03), accounting for 7.14% of the total effect.

There is a significant negative correlation between smartphone addiction and college students' psychological resilience. By improving their sleep quality and the ability to understand social support, they can reduce negative emotions such as anxiety and depression, and improve their ability to maintain physical and mental health in the digital age.

To establish a QuEChERS-gas chromatography-mass spectrometry method for the simultaneous determination of seven parabens in beef tallow hotpot seasoning.

To an accurately weighed quantity of the homogenized sample, water, the internal standard and acetronitrile were added, and the analytes were extracted and purified by QuEChERS, analyzed by gas chromatography-mass spectrometry and quantified by internal standard method.

Good linearity was observed for all seven analytes over the range of 0.05 to 5.00 μg/mL, with r≥0.999. The limits of detection (LODs) were between 0.05 and 0.06 mg/kg, and the limits of quantitation (LOQs) were between 0.15 and 0.20 mg/kg.The average recoveries of the method were between 91.4% and 108%, with the relative standard deviations (RSDs) between 0.6% and 7.2%.

The method is simple, accurate and sensitive, and is suitable for the simultaneous determination of seven parabens in beef tallow hotpot seasoning.

To develop and validate a nomogram prediction model for assessing drug resistance risk in patients with pulmonary tuberculosis and diabetes mellitus comorbidity (PTB-DM), identify associated risk factors, and provide a scientific basis for preventing and controlling drug resistance in this population.

A retrospective study was conducted on 546 PTB-DM patients hospitalized in the Department of Pulmonary Medicine at Shenzhen Third People’s Hospital between January 1, 2019, and December 31, 2024. Data collected included sex, age, marital status, smoking, alcohol use, hypertension, hepatitis B, admission type,pulmonary cavity formation, sputum smear results, drug resistance status, diabetes duration, glycated hemoglobin (HbA1c),hemoglobin (Hb), and albumin (ALB).

The indicators filtered by the lasso regression model were included in the multivariate logistic regression analysis, identifying age, admission type, diabetes duration, HbA1c, Hb, and ALB as six predictive factors. A predictive risk nomogram model was developed based on these risk factors. Internal validation using the bootstrap method demonstrated that the model exhibited good discrimination and calibration, with a corrected AUC of 0.781 (95% CI: 0.768-0.789). The calibration slope and intercept were 1.020 and -0.003, respectively, and the Hosmer-Lemeshow test indicated good model fit (χ²=4.06,P=0.852). The Brier score was 0.113 (95% CI: 0.111-0.116). This model may serve as a reference for clinical assessment of drug resistance risk in patients with PTB-DM.

The nomogram model, developed based on LASSO and Logistic regression analyses, demonstrated satisfactory performance in internal validation. It provides an initial predictive tool for assessing the risk of drug resistance in PTB-DM patients. However, its clinical applicability requires further validation with external data.

To analyze the reported incidence of pulmonary tuberculosis (TB) in Qinghai Province from 2005 to 2024, and to provide a scientific basis for developing adaptive TB prevention and control strategies.

Data on reported TB cases in Qinghai, categorized by year, sex, occupation, age group, and region, were extracted from the infectious disease surveillance module of the China Information System for Disease Control and Prevention. The joinpoint regression model was used to analyze the temporal trends in the reported incidence under different categories.

From 2005 to 2024, a total of 119 984 TB cases were reported in Qinghai Province, with an average of approximately 5 999 cases annually. The average annual reported incidence rate was 104.12 per 100 000 population. Joinpoint regression analysis indicated no significant overall trend for the entire period. However, the reported incidence showed a slow upward trend from 2005 to 2018 [Annual Percent Change (APC)=4.24%, P<0.001], followed by a significant downward trend from 2018 to 2024 (APC=-10.89%, P=0.001). A turning point occurred in 2018 for both males and females: incidence increased during 2005—2018(male: APC=2.91%, P=0.005; female: APC=6.17%, P<0.001) and decreased markedly during 2018—2024 (male: APC=-11.85%, P<0.001; female: APC=-10.00%, P=0.003). By age group, the 0-14 years group showed a significant increasing trend [Average Annual Percent Change (AAPC)=5.05%, P<0.001], while the ≥65 years group showed a significant decreasing trend (AAPC=-2.47%, P=0.042). Regarding occupational distribution, farmers constituted the highest proportion at 42.16%,followed by herdsmen (24.08%), and students (11.93%). The reported incidence among herdsmen and students showed increasing trends from 2005 to 2024. Among the prefectures, Xining City and Haixi Prefecture showed decreasing trends(Xining: AAPC=-4.84%, P<0.001; Haixi: AAPC=-5.23%, P<0.001), while Huangnan Prefecture showed an increasing trend(AAPC=3.87%, P=0.003).

The reported incidence of pulmonary tuberculosis in Qinghai Province showed an initial increase followed by a decrease between 2005 and 2024. Sustained efforts are needed to enhance etiological detection capacity,strengthen active screening in key regions and high-risk populations, and improve TB surveillance and early warning capabilities among students/children to further reduce the disease burden.

To investigate the distribution and pathogenic characteristics of Vibrio cholerae in aquatic products (such as soft-shelled turtles), aquatic environments and humans in Shaanxi Province.

Vibrio cholerae strains reported through the National Pathogen Identification Network from 2021 to 2024 were collected. The distribution of strains from humans and environmental sources was described and analyzed. Serogroup identification and virulence gene detection were performed.Core-genome multilocus sequence typing(cgMLST) and core-genome single nucleotide polymorphism (cgSNP) analyses were performed.

A total of 198 Vibrio cholerae strains were collected from 2021 to 2024, including 14 clinical isolates (9 cases of diarrhea and 5 blood samples) and 184 environmental isolates. The overall environmental positivity rate was 34.65% (184/531), with the highest rate in Xi’an City (66.35%), followed by Ankang City (32.66%) and Hanzhong City (21.93%). The positivity rate in sales part was 42.07%, higher than that in farming part (26.92%). The positivity rate in soft-shelled turtle samples was 46.56%, significantly higher than that in other aquatic products (23.77%). Serotyping revealed 3 O1 strains, 13 O139 strains, and the remainder as non-O1/non-O139. Nine strains were positive for the ctxA gene. cgMLST analysis identified 26 MST Clusters, with all ctxA-positive strains clustering in a single lineage: three ST69 strains formed one cluster and five ST168 strains formed another, while the remaining strains were genetically distant. cgSNP analysis of the 9 ctxA-positive strains showed that ST69 and ST168 strains belonged to distinct lineages, differing by 8 100 SNPs, whereas strains of the same ST type exhibited minimal SNP differences, indicating high genetic stability. The patient isolate from Hanzhong City and the soft-shelled turtle isolate from Ankang City differed by only 2 SNPs.

In Shaanxi Province, Vibrio cholerae in the environment poses a relatively high risk at the farming and sales stages of soft-shelled turtles and other aquatic products, and a small proportion of isolates carry the ctxA virulence gene. Core-genome analysis indicates that toxigenic strains are genetically stable and may be indirectly linked to clinical cases. Surveillance and early warning for diarrheal cases and along the soft-shelled turtle-related production and supply chain should be strengthened to ensure the timely prevention and control of outbreaks.

Triple-negative breast cancer (TNBC) is a highly aggressive breast cancer subtype characterized by its propensity for metastasis and poor prognosis, with pathogenesis closely linked to oxidative stress, metabolic reprogramming, and tumor microenvironment. As a key regulator of antioxidant responses, nuclear factor erythroid 2-related factor 2 (Nrf2) promotes TNBC progression by orchestrating antioxidant defense mechanisms, ferroptosis-protective systems, metabolic reprogramming, and remodeling of the tumor microenvironment. This review summarizes current advances in the mechanisms by which Nrf2 drives TNBC progression, with a particular focus on the molecular pathways through which it regulates oxidative stress,metabolic reprogramming, and the tumor microenvironment to promote tumor progression. Additionally, it evaluates the potential applications of Nrf2 in preventive medicine and public health, providing a theoretical foundation for early intervention and targeted therapy in TNBC.