Based on longitudinal survey data, this study aimed to explore the associations between Activities of Daily Living (ADL), depressive symptoms, and cognitive function among rural elderly individuals in Guizhou Province, so as to provide scientific evidence for promoting the health of rural elderly populations.

A multi-stage cluster sampling method was adopted to select rural elderly individuals aged 60 years and above from 12 villages in 5 townships (towns) of 2 counties (districts) in Guizhou Province. A baseline survey (T1) was conducted in 2019, and a follow-up survey (T2) was carried out in 2022. Generalized Estimating Equations (GEE) were used to analyze the associations and interaction effects between ADL, depressive symptoms, and cognitive function.

A total of 763 elderly individuals were included as participants in this study. The results showed that both ADL scores (β=-0.57, 95%CI: -0.68 - -0.47) and depression scores (β=-0.20 95%CI: -0.33 - -0.06) were negatively associated with cognitive function (assessed by Mini-Mental State Examination ［MMSE］ scores). Furthermore, a significant interaction effect was observed between these two factors on cognitive function (β=0.11, 95%CI: 0.08-0.15). Stratified analysis by depression score levels revealed that ADL scores remained negatively associated with cognitive function across all strata (all P<0.05). When stratified by ADL score levels, depression scores were negatively associated with cognitive function in the low ADL group (P<0.05), whereas no statistically significant association was found in the high ADL group (β=-0.06, 95%CI: -0.28-0.17).

Impaired ADL and depressive symptoms increase the risk of cognitive decline in elderly individuals in rural areas. Depression can moderate the association between ADL and cognitive function: elderly individuals with unimpaired ADL may be more vulnerable to the impact of depression on cognitive function. Strengthening the monitoring and intervention of ADL and depressive symptoms in the elderly is conducive to preventing or delaying cognitive decline among elderly individuals in rural areas.

To understand the current status of chronic comorbidities and impaired activities of daily living in elderly OP patients, explore the association between different comorbidity combinations and daily ADL, and provide theoretical basis for improving the quality of life of elderly OP comorbidities.

In April 2025, a stratified cluster random sampling method was used to select research subjects from two townships in Yanchi County, Ningxia, to conduct a questionnaire survey and measure bone density. Obtain association rules for chronic disease combinations in elderly OP patients through association rules, and use binary logistic regression to analyze the magnitude of the association between comorbidities in elderly OP and ADL impairment.

This study included 685 elderly OP patients, with a chronic disease comorbidity rate of 66.72%. The rates of BADL, IADL, and ADL impairment were 10.66%, 11.97%, and 16.79%, respectively. Through the Apriori algorithm, a total of 12 association rules were identified, with “hypertension and osteoporosis” being the most common comorbidity among all combinations (47.445%). Single factor logistic regression analysis shows that the comorbidity combination of “hypertension, lumbar disc disease, and osteoporosis” was significantly associated with increased impairment in BADL and ADL compared to elderly OP patients ［(OR=3.69, 95%CI：1.80-7.55), (OR=3.25, 95%CI：1.69-6.25)］. The comorbidity combination of “hypertension, heart disease, and osteoporosis” was associated with a higher likelihood of impaired IADL (OR=3.73, 95%CI：2.08-6.69). The results of multiple logistic regression showed that compared with elderly OP patients, the comorbid combination of “lumbar disc disease and osteoporosis” increased the likelihood of impaired BADL and ADL ［(OR=4.27, 95%CI：2.28-7.99), (OR=3.62, 95%CI：2.06-6.38)］, while the “hypertension, heart disease, and osteoporosis” combination was associated with a higher likelihood of IADL impairment (OR=3.02, 95%CI：1.57-5.80).

Elderly OP patients have impaired activities of daily living, and hypertension plays an important comorbidity center in elderly OP patients. Multiple comorbidity combinations significantly increase the risk of ADL impairment. The healthcare system should focus on the elderly population with comorbidities, develop effective long-term care policies for different comorbidities, and enhance the elderly’s sense of health and quality of life.

To explore the mediating role of sleep quality in the relationship between multimorbidity and depressive symptoms in patients with pneumoconiosis.

Based on the baseline data from the West China Pneumoconiosis Prospective Specialized Disease Cohort, latent class analysis was employed to categorize nine common multimorbidities among pneumoconiosis patients. Logistic regression models were used to analyze the associations between the number of multimorbidities, multimorbidity patterns, and depressive symptoms. The Bootstrap method was employed to examine the mediating effect of sleep quality.

40.97% patients with pneumoconiosis exhibited depressive symptoms. Latent class analysis identified four multimorbidity patterns: relatively healthy, cardiovascular-metabolic, respiratory system, and multimorbidity. Logistic regression showed that the number of multimorbidities (OR=1.34, 95%CI: 1.23-1.46), the cardiovascular-metabolic pattern (OR=1.82, 95%CI: 1.02-3.25), and the multimorbidity pattern (OR=3.16, 95%CI: 1.97-5.06) were positively associated with depressive symptoms. Mediation analysis indicated that sleep quality partially mediated the relationship between the number of multimorbidities and depressive symptoms (β=0.53, 95%CI: 0.41-0.66), with a mediation effect proportion of 61.63%. Regarding the multimorbidity pattern, sleep quality fully mediated the relationship with depressive symptoms, with a mediation effect value of 2.11(95%CI:1.46-2.78) and an effect proportion of 69.41%.

The number of multimorbidities, cardiovascular-metabolic pattern, and multimorbidity pattern are associated with a higher risk of depression in pneumoconiosis patients. Sleep quality partially mediates the relationship between the number of multimorbidities and depressive symptoms, while it fully mediates the relationship between the multimorbidity pattern and depressive symptoms.

To explore the mediating role of frailty between grip strength and cognitive function in community-dwelling older adults and the moderating effect of age.

A convenience sample of 818 community-dwelling older adults was recruited from Qixia District, Nanjing, Jiangsu Province, between July and August 2024. Cognitive function was assessed using the Beijing version of the Montreal Cognitive Assessment (MoCA), frailty status was assessed using the FRAIL Scale (The FRAIL Scale, FRAIL), and grip strength was measured using an electronic handgrip dynamometer. Moderated mediation analysis was conducted using PROCESS 4.1 (Model 4 and Model 59).

Grip strength was negatively correlated with frailty scale scores (r=-0.252, P<0.001) and positively correlated with cognitive function scale scores (r=0.216, P<0.001). Frailty partially mediated the association between grip strength and cognitive function, with a mediation effect of 0.014 (95%CI: 0.006-0.024), accounting for 21.9% of the total effect. In the age-moderated mediation model, the interaction terms for the first path (grip strength×age group→frailty) and the second path (frailty×age group→cognitive function) were both significant (both P<0.05).

Grip strength influences cognitive function indirectly through frailty, and this mediation pathway is moderated by age. Early screening for frailty and age-specific interventions should be emphasized to preserve cognitive function.

To investigate the factors associated with intergenerational transmission of weight status in low-income families in China and to provide evidence for policies aimed at interrupting the vertical inequality in health.

Utilizing data from the 2022 China Family Panel Studies (CFPS), we employed Multinomial Logistic Regression Model(MLOGIT) models to analyze the associations.

Maternal weight status showed significant effects on offspring weight. Compared to mothers with normal weight, underweight mothers were associated with a 56.7% higher risk of offspring being underweight (OR=1.567, P<0.05) and a 41.9% lower risk of offspring obesity (OR=0.581, P<0.05). Obese mothers were associated with a 55.5% increased risk of offspring obesity (OR=1.555, P<0.05). Paternal weight status had a limited influence on offspring weight outcomes, with no significant association observed between paternal obesity and offspring obesity. Male offspring and children of younger age exhibited a higher likelihood of being overweight or obese. Higher educational attainment of both parents was significantly associated with a reduced risk of offspring overweight or obesity. Furthermore, maternal rural residency was linked to a complex pattern, potentially associated with a decreased risk of offspring underweight yet an increased risk of obesity.

In low-income families, parental weight status is strongly correlated with offspring weight status. Mothers serve as more comprehensive and direct influencers on offspring health, whereas the influence of fathers is relatively limited. Offspring characteristics and household economic factors are also important determinants of offspring health. Therefore, breaking the intergenerational transmission of weight disadvantages in low-income families requires differentiated strategies.

To identify multimorbidity phenotypes in middle-aged and older adults, examine their long-term health trajectories, and develop a predictive model for functional dependency.

This longitudinal analysis used five waves(2011-2020) of the China Health and Retirement Longitudinal Study(CHARLS) and included 298 participants with complete follow-up. Phenotype subgroups were derived by Kmeans clustering based on baseline disease count. Generalized Estimating Equations(GEE) were applied to assess health differences and trajectories across phenotypes. A care-needs prediction model was developed by integrating prior health status(2018) and pre-2018 dynamic slopes.

Three multimorbidity burden phenotypes were identified: high, moderate, and low. A higher baseline disease count was independently associated with increased risks of functional dependency(ADL: OR=2.398; IADL: OR=2.346), depression, and pain(all P<0.001). The high-burden phenotype showed faster rates of decline in cognitive function, pain accumulation, and life satisfaction(all P<0.01). The prediction model, incorporating prior functional status, depressive symptoms, phenotype, and rate of pain progression, demonstrated good discrimination(AUC for ADL dependency=0.807, 95%CI: 0.740-0.874; AUC for IADL dependency=0.765, 95%CI: 0.678-0.851).

Multimorbidity phenotypes are associated with distinct long-term health trajectories. A model combining static phenotypes and dynamic health indicators can help identify individuals at high risk of functional dependency, supporting targeted prevention and care planning.

To explore the association between accelerated phenotypic aging(PAA) and risk of osteoarthritis(OA), and to assess the modifying effect of genetic susceptibility, as well as the mediating effect of body mass index(BMI) on the PAA-OA association.

Using baseline survey, diagnostic, and genetic data from the UK Biobank(UKB), Cox proportional hazards regression models was employedto analyze the association between PAA and OA, and pathway analysis was employed to explore the mediating effect of BMI.

With an average follow-up of 13.7 years, a total of 42 977 incident OA cases were recorded. PAA acceleration was significantly associated with an increased risk of OA(HR=2.13, 95%CI:2.11-2.15). BMI mediated 77.1%(95%CI:65.5%-92.1%) of the total effect. Further subgroup analyses revealed that the PAA-OA association was significant across all subgroups, including different sex, age, and BMI levels. No gene-PAA interaction was identified for OA risk.

PAA is an independent risk factor for OA, and BMI is an important mediating variable in the PAA-OA association. This study provides novel insights and public health implications for delaying aging and preventing OA.

To explore the impact of temperature on the number of hospital admissions for stroke in Hengshui City, Hebei Province, and to provide scientific support for relevant prevention and control efforts.

We collected data on the number of hospital admissions for stroke in a region of Hebei Province, daily meteorological data, and air quality data. A distributed lag non-linear model (DLNM) was employed to analyze the effects of temperature on hospital admissions among different genders, age groups, and subgroups.

During the warm season (May to October), temperature had a significant impact on the number of hospital admissions for stroke across various populations. With a cumulative lag of 15 days, the cumulative relative risk (RR) of hospital admission for stroke at a relatively low temperature of 20 ℃ in the warm season was 1.291 (95%CI: 1.030-1.619), at 21 ℃ it was 1.216 (95%CI: 1.016-1.456), and at 22 ℃ it was 1.154(95%CI: 1.003-1.327). For females, the RR was 6.422 (95%CI: 1.910-21.588) at 10 ℃. For the population aged ≥ 65 years, the RR was 4.286 (95%CI: 1.401-13.112) at 10 ℃ and 1.117 (95%CI: 1.016-1.228) at 24 ℃. The relatively low temperature range of 20 ℃-26 ℃ in warm seasons could significantly increase the hospitalization risk of cerebral ischemia subtype (RR: 1.09-2.31). The risk peaked at 20℃, when RR was 2.315 (95%CI: 1.338-4.003).

Temperature during the warm season influences the number of hospital admissions for stroke, with relatively low temperatures (20-22 ℃) in the warm season identified as potential risk factors for stroke patient admissions. Moreover, temperature has specific impacts on females, individuals aged 65 and above, and those with cerebral ischemia.

To explore the impact of extreme temperature on the risk of non-accidental mortality in Zhangjiakou city, and to identify susceptible subpopulations.

Data on non-accidental mortality among residents in Zhangjiakou City from 2019 to 2024, as well as concurrent meteorological and air pollution data, were obtained from the Air Pollution and Health Effects Monitoring Information System. The distributed lag non-linear model (DLNM) was employed to analyze the exposure-lag-response relationships between extreme temperatures and both non-accidental mortality and cardiovascular disease mortality, with stratified analyses conducted by sex and age group.

The exposure-response relationship between daily mean temperature and both non-accidental and cardiovascular mortality exhibited a U-shaped curve. The effects of extreme cold showed persistent lag patterns, with the cumulative relative risks (cumulative RRs) peaking at lag 21 days for both non-accidental mortality (CRR=2.470, 95%CI: 1.746-3.494) and cardiovascular mortality (CRR=2.163, 95%CI: 1.379-3.394). In contrast, the effects of extreme heat were acute and short-lived, with cumulative RRs peaking at lag 6 days (CRR=1.483, 95%CI: 1.316-1.672) and lag 5 days (CRR=1.462, 95%CI: 1.236-1.729) for non-accidental and cardiovascular mortality, respectively. Stratified analysis revealed that males and individuals aged ≥65 years were at higher risk, with greater cumulative RRs during extreme temperature events.

Extreme temperatures significantly increase the risk of cardiovascular mortality in Zhangjiakou. Males and the elderly (≥65 years) are particularly vulnerable.

To investigate the contamination status and distribution characteristics of perfluoroalkyl and polyfluoroalkyl substances (PFASs) in liquid milk and livestock meat in Inner Mongolia, to assess the health risks of dietary exposure in the population, to provide a scientific basis for national food safety risk assessment, and to promote the formulation and implementation of PFASs prevention and control measures.

Samples of locally produced liquid milk and livestock meat were collected from 12 leagues and cities in Inner Mongolia. High-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was used to detect and analyze 23 PFASs in the samples. The estimated daily intake (EDI), estimated weekly intake (EWI), and hazard quotient (HQ) methods were applied to conduct an exposure assessment on the total intake of perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonate (PFHxS) through liquid milk and livestock meat consumption among the population in Inner Mongolia.

A total of 454 liquid milk and livestock meat samples were collected, including 214 liquid milk samples and 240 livestock meat samples. The detection results showed that the overall detection rate of 23 PFASs in liquid milk samples was 48.13% (103/214). The predominant compounds detected were perfluorobutanoic acid (PFBA), PFHxS, and perfluoropentanoic acid (PFPeA), with detection rates of 31.31% (67/214), 13.08% (28/214), and 11.21% (24/214), respectively. The overall detection rate of PFASs in livestock meat samples was 59.17% (142/240). The compounds with higher detection rates were PFPeA, potassium perfluorooctanesulfonate (PFOS), and PFBA, with detection rates of 23.75% (57/240), 20.83% (50/240), and 19.58% (47/240), respectively. The assessment results indicated that the HQs for the total intake of PFOA, PFOS, PFNA, and PFHxS through liquid milk and livestock meat in the Inner Mongolia population were all<1.

The contamination level of PFASs in liquid milk and livestock meat in Inner Mongolia is relatively low, and the dietary exposure risk of total PFOA, PFOS, PFNA, and PFHxS through liquid milk and livestock meat consumption is low.

To explore the chain mediating role of health information acquisition behavior and blood glucose management behavioral decision-making between risk perception and self-management in pregnant women with gestational diabetes mellitus (GDM).

Using a convenience sampling method, 353 pregnant women with GDM from four tertiary Grade-A hospitals in Zhengzhou City were selected as participants. They were surveyed using the Risk Perception Scale for Pregnant Women with GDM, the Diabetes Health Information Acquisition Behavior Scale, the Blood Glucose Management Behavioral Decision-Making Scale for Pregnant Women with GDM, and the Self-Management Assessment Scale for GDM. Structural equation modeling and the Bootstrap method were employed to test the mediating effects.

Risk perception was positively associated with self-management in pregnant women with GDM (β=0.676, P<0.001). Health information acquisition behavior was positively associated with self-management (β=0.097, P<0.001), and blood glucose management behavioral decision-making was also positively associated with self-management (β=0.133, P<0.001). The chain mediating effect of both variables was significant (β=0.033, 95%CI: 0.016-0.142, P<0.001), accounting for 4.88% of the total effect. The total mediating effect accounted for 38.91% of the total effect.

Health information acquisition behavior and blood glucose management behavioral decision-making play a chain mediating role between risk perception and self-management in pregnant women with GDM. This suggests that clinical interventions should start with enhancing pregnant women’s risk perception, subsequently promoting their proactive acquisition of health information and optimizing management decisions to ultimately improve self-management behaviors.

To identify the latent profiles of job demands-resources among village doctors and their association with turnover intention, and to provide references for reducing the risk of village doctors’ departure.

A questionnaire survey was conducted among village doctors in 16 prefecture-level cities of Shandong Province using a general information form, job demands scale, job resources scale, and turnover intention scale. Latent profile analysis was employed to identify latent profiles of job demands and resources, while multiple linear regression analysis explored the association between different latent profiles and turnover intention.

A total of 2 404 village doctors were included. Five latent profiles were identified: high-risk burnout profile (5.17%), imbalance risk profile (22.98%), low-strain abundant profile (13.37%), high-strain active profile (16.68%), and moderate balanced profile (41.80%). Differences across these categories in terms of gender, age, and employment type were statistically significant (P<0.05). High-risk burnout profile and imbalance risk profile were risk factors for turnover intention (β=0.218, P<0.001; β=0.199, P<0.001), while low-strain abundant profile and high-strain active profile were protective factors for turnover intention (β=-0.292, P<0.001; β=-0.067, P<0.001).

Significant heterogeneity exists in turnover intention among village doctors across different latent profiles of job demands-resources. Priority should be given to interventions targeting the high-risk burnout profile and the imbalance risk profile, while efforts should focus on stabilizing and maintaining the low-strain abundant profile and the moderate balanced profile, and providing developmental support for the high-strain active profile.

To examine the needs and utilization of home health care services among key elderly populations in China and identify factors influencing service needs, providing evidence for service improvement.

A purposive sampling survey was conducted in Beijing. Data on older adults’ needs and utilization of home health care services were collected. Descriptive analysis, univariate analysis, and multivariate logistic regression were performed using SPSS 26.0.

The need rate for home health care services was 64.1%, and the utilization rate among those with needs was 54.6%. The average need-satisfaction rate across 26 service items was 37.4%. Age, education, monthly income, caregiver type, functional ability, self-rated health, and hospitalization in the past year were significant influencing factors(P<0.05).

Although demand is high, a structural mismatch exists between service provision and needs, particularly for more specialized services. Efforts should focus on improving accessibility, expanding supply, and prioritizing high-need populations.

To investigate the role of social isolation in the long-term impact of adverse childhood experiences (ACEs) on depressive symptoms in middle-aged and older adults, and to provide empirical support for preventing and intervening in the negative effects of ACEs on mental health in this population.

Based on data from the 2014 life history survey and the 2018 and 2020 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS), a total of 12 695 middle-aged and older adults aged ≥45 years were included. ACEs were derived from the 2014 data, social isolation from the 2018 data, and depressive symptoms from the 2020 data. The relationships among social isolation, ACEs, and depressive symptoms were examined using independent samples t-tests, chi-square tests, and Pearson correlation analysis. The mediating effect of social isolation between ACEs and depressive symptoms was analyzed through mediation models, Sobel tests, and bootstrap tests.

ACEs showed a significant positive correlation with depressive symptoms (β=0.618, P<0.001). Path analysis revealed that social isolation partially mediated the association between ACEs and depressive symptoms. Specifically, ACEs positively predicted social isolation (β=0.026, P<0.001), and social isolation positively predicted depressive symptoms (β=0.913, P<0.001). Both Sobel and Bootstrap tests confirmed the robustness of this mediating effect. The influence of ACEs and social isolation on depressive symptoms was consistent across different genders and age groups within the middle-aged and elderly population.

ACEs can directly or indirectly influence depressive symptoms in middle-aged and older adults through the mediating effect of social isolation. Relevant social departments should implement life-course intervention strategies, including preventing ACEs, providing psychological counseling, and building social support networks, to alleviate depression issues among middle-aged and older adults.

Construct a core competency system for personnel providing basic public health services in grassroots medical and health institutions in Guizhou, providing a guiding basis for enhancing the capabilities of grassublic health personnel.

Through literature review and Delphi consultation, primary, secondary, and tertiary indicators were conand screened, and weights were calculated using the Analytic Hierarchy Process (AHP).

After two rounds of expert consultation (n₁=18, n₂=15), the expert authority coefficients were 0.88 and 0.90, respectively, both higher than 0.70 (P<0.01), and the coordination coefficients were significant (P<0.01). A core competency scale for grassroots public health personnel was constructed, covering 46 items across five dimensions: professional knowledge, professional skills, comprehensive ability, concepts, and values.

This indicator system provides a practical tool for evaluating the core competencies of grassroots public health personnel in Guizhou Province, and its methodological framework and policy recommendations significant reference value for similar regions.

To identify the health science popularization demand attributes of middle-aged and elderly people in Henan Province, analyze the impact of different demand attributes on satisfaction, and analyze the differences in health sciencepopularization needs of middle-aged and elderly people with different characteristics.

A total of 423 middle-aged and elderly people were randomly selected from the health literacy monitoring points in Henan, and the general information sheet, the national residents' health literacy monitoring questionnaire and the self-made health science popularization demand Kano questionnaire were used for survey. The demand attributes and their differences were analyzed by frequency statistics, Better-Worse analysis and chi-square test.

Among the 34 items, there were 3 expected needs, 13 attractiveness needs, 15 indifferent needs, and 3 reverse needs. Expected needs were primarily concentrated in the dimensions of communication institutions and personnel, specifically large hospitals, community hospitals, and healthcare professionals. Attractiveness needs mainly focused on the dimensions of science popularization content, formats, and delivery channels. The Better-Worse quadrant distribution chart showed 18 items in the first quadrant, 15 in the third quadrant, and 1 in the fourth quadrant. Differences in health science popularization needs were observed among middle-aged and elderly individuals based on gender, residential location, and health literacy levels.

Middle-aged and elderly populations exhibit significant demand for health science popularization. It is essential to clarify the core role of hospitals and healthcare professionals in science popularization to meet expected needs, promote innovation in formats and content to stimulate attractiveness demands, and implement targeted stratified science popularization based on the characteristics of this demographic.

To explore intervention strategies aimed at improving community residents’ knowledge of colorectal cancer screening, their health beliefs, and screening rates.

A randomized controlled trial was conducted from December 2024 to March 2025, recruiting eligible community residents in Chengdu, Sichuan Province, for the intervention study. The navigation intervention protocol was developed based on the Health Belief Model and the Transtheoretical Model.

A total of 113 community residents participated in the study, comprising 56 in the intervention group and 57 in the control group. Prior to the intervention, there were no statistically significant differences between the two groups in terms of demographic characteristics, colorectal cancer screening knowledge scores, scores on the various dimensions of health beliefs, screening intention scores, or colonoscopy screening status (P>0.05). Three months after the intervention, there were group effects, time effects, and interaction effects between the two groups regarding colorectal cancer screening knowledge scores, health belief scores (perceived susceptibility, perceived severity, perceived benefits, and perceived barriers), and screening intention scores (P<0.001). At the end of the first and third months of the intervention, the intervention group’s community residents had higher scores for colorectal cancer screening knowledge (P<0.001), perceived susceptibility (P<0.001), perceived severity (P<0.05), perceived benefits (P<0.05), and screening intention (P<0.001) than those in the control group, while perceived barriers were lower (P<0.001). At the end of the first month of the intervention, there was no statistically significant difference in colonoscopy screening rates between the intervention group and the control group (P>0.05); however, by the end of the third month of the intervention, the difference became statistically significant (P<0.05).

The navigation intervention program based on the “HBM+TTM” theory can effectively improve community residents’ knowledge of colorectal cancer screening, their health beliefs, and screening rates, and it serves as a model for other regions to follow.

To systematically investigate the healthcare facility selection preferences and characteristics of insurance participation among basic medical insurance enrollees in Guangxi, with a focus on the influencing mechanisms of residents’ selection preferences, so as to provide empirical evidence and optimization pathways for advancing the integration of urban-rural medical insurance and deepening the implementation of the tiered diagnosis and treatment system.

A cross-sectional field survey was conducted among insured residents in 14 prefecture-level cities in Guangxi using a multi-stage random sampling method. A multinomial logit regression model was employed to systematically analyze the influence of demographic characteristics and medical insurance service factors on healthcarefacility selection preferences.

After incorporating variables with statistical significance in univariate analysis into multivariate Logit regression, household registration type(non-agricultural household registration, OR=0.410) and education level(high school or technical secondary school, OR=0.252; junior college and above, OR=0.273) were facilitators for choosing higher-level medical institutions. In contrast, medical insurance type(urban and rural resident medical insurance, OR=2.325) and hospitalization experience(no history of hospitalization, OR=3.151) were facilitators for choosing primary medical institutions. Payment pressure level was a facilitator for choosing high-level medical institutions. Patients who perceived payment pressure as “relatively high”(OR=0.330) or “general”(OR=0.203) were more inclined to choose tertiary medical institutions.

Household registration type and medical insurance type jointly influence insured residents’ choice of medical institution level. Hospitalization experience is a key health-related factor affecting such choices. Variations in perceived premium payment pressure lead to different preferences among insured residents in selecting medical institutions. Therefore, policies related to medical insurance and the tiered diagnosis and treatment system should be optimized accordingly.

To evaluate the implementation effectiveness of medical cluster policies and promote high-quality primary healthcare.

Using a “policy tools-policy objectives-policy effectiveness” framework, text analysis and the PMC index model were applied to policy texts on medical clusters issued by China’s central government and Shanxi and Zhejiang provinces from 2014 to 2024.

Current policies showed imbalanced policy tools, vague policy objectives, and weak incentive-constraint mechanisms.

Optimizing policy instruments, refining quantitative targets, and strengthening incentive and constraint measures can improve the effectiveness and quality of medical cluster policies, promoting high-quality primary healthcare development.

In response to the continuously expanding debt scale and increasingly prominent debt risks of public hospitals in China, this study aims to construct a debt risk evaluation model suitable for public hospitals. This study empirically evaluates debt risk patterns across public hospitals by administrative level, type, and grade, aiming to support targeted risk mitigation policies.

Using the relevant data from the 2023 financial annual reports of 408 public hospitals under the Health Commission of Sichuan Province as the sample, this study selected 11 indicators highly correlated with debt risk and established a risk early-warning model through factor analysis.

Factor analysis identified four common factors, with a cumulative variance contribution rate of 87.026%, which collectively constitute the core determinants of debt risk. Debt risk distribution exhibited significant variations across hospitals grouped by different dimensions. At the administrative level, prefecture-level hospitals had the highest proportion of high-risk cases, standing at 28.38%. By hospital type, traditional Chinese medicine hospitals recorded the highest share of high-risk instances, reaching 31.16%. By hospital grade, secondary hospitals accounted for the largest proportion of high-risk cases, at 27.38%.

The debt risk model constructed using factor analysis demonstrates good applicability and effectiveness, enabling a scientific assessment of public hospitals’ debt risk levels. Based on the evaluation findings, we recommend a coordinated approach across multiple areas: strengthening planning constraints and government investment, deepening health insurance price reforms and enhancing internal management, establishing a monitoring and early-warning system. This comprehensive strategy aims to resolve existing debt in a tiered and categorized manner and prevent systemic risks.

To analyze the coordinated development trend and influencing factors of population, economy and medical and health service system in Qinghai Province from 2010 to 2023, and to provide reference for promoting regional coordinated development.

Based on the data of “Qinghai Statistical Yearbook” and “China Statistical Yearbook” from 2010 to 2023, a comprehensive evaluation index system was constructed, the weight was determined by entropy method, and the coupling coordination degree model, grey correlation analysis and GM (1,1) prediction model were used for dynamic evaluation and identification of key factors.

From 2010 to 2023, the coupling coordination degree of the population-economy-health service system in Qinghai Province increased from 0.455 to 0.818, and the coordination level increased from “on the verge of imbalance” to “good coordination”; the structure type has experienced the evolution of “medical lag-economic lag-population lag”. Grey correlation analysis identified the number of beds in health institutions (0.731 6) and the proportion of tertiary industry (0.716 0) as strong correlation factors. The GM (1,1) model predicts that the system will enter the excellent coordination level in 2026.

The coordinated development level of the three major systems in Qinghai Province has been steadily improved. In the future, efforts should be made to optimize the population structure, promote the service transformation of industrial structure, improve the efficiency of medical and health resources, and promote regional coordinated development.

To understand the current state of integrated medical and childcare services in Guizhou Province’s childcare institutions and propose corresponding countermeasures and recommendations.

A cross-sectional study was conducted, involving a questionnaire survey of 574 registered childcare institutions in Guizhou Province. Differences across various types of childcare institutions were examined across three dimensions: childcare provision, health and hygiene, and parenting support.

With regard to childcare and care, the compliance rate for the cumulative duration of daily outdoor activities at the centre was low, with significant differences between institutions(P<0.001). However, services such as sleep monitoring, the frequency of menu changes, and the setting of individualised development goals based on physical and mental development were generally well implemented, with no significant differences between institutions(P>0.05). The rate of regular disinfection of bedding was low, with no significant differences between institutions(P>0.05). In terms of health care:(1) The development of health care systems was inadequate, and there were significant differences between institutions(P=0.015);(2) The implementation rates for physical growth and development monitoring(P=0.002), oral health care(P=0.005) and eye care services(P<0.001) were relatively high, whilst those for psychological and behavioural assessments(P=0.012) and traditional Chinese medicine health care services(P=0.004) were relatively low, with significant differences observed between institutions(P<0.05); Conversely, the rate of establishing individual health management records was high, with no significant differences between institutions(P>0.05), whilst the rate of provision of first-aid supplies for accidental injuries was low, with no significant differences between institutions(P>0.05). Regarding parenting support, more than half of the institutions received medical guidance, and there was a widespread need for family parenting support and policy interpretation, with no significant differences between institutions(P>0.05); however, there was a significant difference in whether institutions that received medical guidance were able to meet infant and child health care needs(P=0.033).

Childcare institutions across Guizhou Province have implemented integrated medical and childcare services to varying degrees, though the standardisation and professionalism of these services remain areas for improvement. The government should expedite the formulation of local standards for integrated medical and childcare services and actively advance the “1+4+N” service model to foster high-quality development in childcare provision.

To explore the coupling-coordination relationship among the three systems of public health, medical services, and medical insurance in China, so as to provide a reference for promoting the in-depth development of the medical and health system and the modernization of governance capacity.

Based on panel data from 31 provinces in China from 2013 to 2022, a coupling coordination evaluation index system for the "Prevention-Treatment-Insurance" system was constructed. The entropy weight-TOPSIS model, kernel density estimation, Dagum Gini coefficient and its decomposition, and spatial autocorrelation model were employed to analyze the spatio-temporal evolution characteristics and regional differences of the coupling coordination degree.

The overall coupling-coordination degree of “prevention-treatment-insurance” showed an increasing trend, with a distribution pattern of “eastern>western>central regions”. The national, central and western regions exhibited different polarization phenomena, with obvious intra-regional differences but an overall convergence trend, and the differences were derived from inter-regional gaps. Moran’s scatter plot showed the existence of “low-low” and “high-low” agglomerations. Spatially, the distribution was characterized by contiguous reluctant coordination, the disappearance of near imbalance, and the increase of primary and intermediate coordination.

The coupling and coordination level of “prevention, treatment, and protection” across provinces has shown steady improvement, with a downward trend in regional disparities and significant spatial spillover effects. There is a need to further optimize the coordinated development mechanism of “prevention, treatment, and protection” and address the obstacles and challenges in its operation.

To investigate the dose-response relationship between nighttime sleep duration and fall risk among older adults with chronic diseases, and to analyze age differences, thereby informing targeted interventions.

A questionnaire survey was conducted from January to May 2024 among adults aged ≥60 years in Shandong Province. Logistic regression was used to assess fall risk across different sleep durations. Restricted cubic splines (RCS) were applied to analyze nonlinear associations, with age-stratified analysis performed.

Among 1 421 older adults with chronic diseases, the fall incidence was 18.7%. RCS analysis revealed a significant nonlinear relationship between nighttime sleep duration and fall risk (overall trend P<0.001, nonlinear P=0.019). The optimal overall sleep duration was 7-8 h. Age-stratified results showed that among individuals aged 60-70 years, those sleeping 6-7 h had the lowest fall risk (overall trend P<0.001, nonlinear P=0.011). while those aged 71-80 had the lowest fall risk with 7-8 h of sleep (overall trend P=0.003, nonlinear P=0.037). For individuals aged 81 and older, the relationship between sleep duration and fall risk was not significantly nonlinear (overall trend P=0.182, nonlinear P=0.109).

Nighttime sleep duration and fall risk exhibit a U-shaped curve in older adults with chronic diseases, with optimal duration varying by age. Appropriately managing sleep duration may help reduce fall risk.

To investigate the association between different domains of physical activity (PA) and adiposity-related indicators among rural older adults in Chengdu, offering empirical evidence to inform the design of tailored health intervention policies.

An observational analysis was conducted using data from a cluster randomized controlled trial performed in rural areas of Chengdu. The Physical Activity Scale for the Elderly was used to assess total physical activity, work-related physical activity, housework physical activity, and leisure-time physical activity levels. Body mass index (BMI), body fat percentage, waist-to-hip ratio (WHR), and waist-to-height ratio (WHTR) as adiposity-related indicators were measured. A linear mixed model was employed to analyze the relationship between different domains of PA and adiposity-related indicators. Sensitivity analyses were conducted in control group to assess the robustness of the findings.

Of the 508 enrolled participants (average age: 70.93 years), 282 were female, while the remaining 226 were male. Total PA, work-related PA, and household PA levels all showed significant negative correlations with BMI, body fat percentage, WHR, and WHTR (total PA: β=-0.004 9, P<0.001; β=-0.013 5, P<0.001; β=-0.000 1, P<0.001; β=-0.000 1, P<0.001; work-related PA: β=-0.003 1, P=0.006; β=-0.012 8, P=0.005; β=-0.000 1, P=0.007; β=-0.000 1, P<0.001; household PA: β=-0.008 4, P=0.006; β=-0.017 0, P<0.001; β=-0.000 2, P<0.001; β=-0.000 2, P<0.001). However, leisure-time PA was only significantly negatively associated with WHR and WHTR (β=-0.000 1, P=0.007; β=-0.000 1, P=0.011). Sensitivity analysis further confirmed the robustness of these associations.

Higher levels of total PA, work-related PA, and household PA were associated with lower BMI, body fat percentage, WHR, and WHTR in older adults. Higher leisure-time PA was only associated with lower WHR and WHTR. These findings suggest that future physical activity recommendations for older adults should be tailored based on adiposity-related indicators to develop precise and effective intervention strategies.

To evaluate the correlation between intergenerational support and overall survival (OS) of older adults.

Using data from six waves (2010—2020) of the China Family Panel Studies, we selected older adults aged ≥60 years at baseline in 2010 who had at least one child. Cox proportional hazards regression models were employed to analyze the association between intergenerational support and OS. Proportional hazards assumption was tested using Schoenfeld residuals, and stratified Cox models were applied to correct for variables that violated this assumption. Multivariable logistic regression models were used to examine differences in baseline characteristics among older adults receiving different types of intergenerational support. All analyses were stratified by urban and rural residence, adjusting for baseline age, sex, marital status, education level, and instrumental activities of daily living (IADL). Intergenerational support included financial support and instrumental support.

A total of 5 913 older adults were included. Stratified multivariate Cox regression analysis showed no association between financial support and OS (stratified adjusted HR_{yes vs no}=1.04, 95%CI: 0.93-1.17). In contrast, receiving instrumental support was associated with worse OS (stratified adjusted HR_{yes vs no}=1.20, 95%CI: 1.07-1.34). Urban-rural stratified analyses yielded consistent results. Multivariable logistic regression showed that older adults who were advanced in age, without a spouse, had lower education, or without IADL were more likely to receive financial support and instrumental support from their children (all P<0.050), with similar urban-rural patterns.

Receiving instrumental support was associated with poorer OS among older adults, while no correlation was found for financial support. Policy implications include strengthening social security safety net and utilizing the initiation of care receipt as a community alert to trigger early health interventions, thereby mitigating health risks and promoting healthy aging.

To explore the relationship between internet use and cognitive function in older adults, and to evaluate the impact of internet use on the predictive output of cognitive impairment risk.

Based on data from the 2020 China Health and Retirement Longitudinal Study (CHARLS), propensity score matching (PSM) was used to control for confounding factors and analyze the effect of internet use on cognitive function in older adults. The XGBoost algorithm was employed to construct a risk prediction model for cognitive impairment, and the area under the receiver operating characteristic curve (AUC) was used to evaluate the predictive performance of the model. The SHapley Additive exPlanations (SHAP) method was applied to interpret the XGBoost model.

A total of 3 685 older adults was included in the study. Propensity score matching using nearest neighbor matching, radius matching, and kernel matching showed that the average treatment effects of internet use on cognitive function were 0.564, 0.580, and 0.594, respectively (P<0.001). The XGBoost prediction model incorporating internet use achieved an AUC of 0.781 (95%CI: 0.761-0.799). SHAP analysis revealed that internet use was a key predictive factor for cognitive impairment in older adults.

Internet use has a positive effect on cognitive function in older adults. The XGBoost-based risk prediction model for cognitive impairment demonstrates high discriminative ability and good interpretability, which may assist in early screening and individualized clinical intervention.

To investigate the effect of sodium arsenite(NaAsO₂) exposure on the expression of trans-spliced tissue inhibitor of metalloproteinase 2(ts-TIMP2) in A549 cells and to analyze the role of ts-TIMP2 in arsenic-induced cell viability.

Specific primers were designed to amplify ts-TIMP2, and their specificity was validated via qRT-PCR, agarose gel electrophoresis, and DNA sequencing. CCK-8 assays were used to determine appropriate NaAsO₂ concentrations and exposure duration. mRNA levels of TIMP2 and ts-TIMP2 were quantified by qRT-PCR. siRNA-mediated knockdown and lentiviral overexpression systems(carrying GFP and 3×Flag tags) were established to modulate ts-TIMP2 expression, and CCK-8 assays were performed to assess cell viability under various conditions.

The results from all three methods confirmed the specific amplification of ts-TIMP2 by these primers. NaAsO₂ reduced A549 cell viability in a dose-dependent manner, with an IC₅₀ of 48.48 μM. TIMP2 mRNA was significantly upregulated at 30 and 45 μM NaAsO₂(P<0.01), while ts-TIMP2 expression increased significantly only at 45 μM(P<0.05), indicating concentration-dependent regulation. Knockdown of ts-TIMP2 decreased cell viability by 13.18% compared to the negative control(P<0.01), co-treatment with NaAsO₂ further significantly suppressed cell viability(P<0.01). Conversely, ts-TIMP2 overexpression enhanced cell viability by 24.66%(P<0.01) and maintained significantly higher viability than the NaAsO₂-only group even under co-treatment conditions(P<0.05).

Sodium arsenite(NaAsO₂) can induce the expression of trans-spliced TIMP2(ts-TIMP2), thereby enhancing the viability of A549 cells.

To analyze the consistency between the Mycobacterium tuberculosis loop-mediated isothermal amplification (Mycobacterium tuberculosis loop-mediated isothermal amplification, TB-LAMP) and the tuberculosis T-cell spot test (tuberculous infection of T cells spot test, T-SPOT.TB) in the diagnosis of tuberculosis (tuberculosis, TB), as well as the influencing factors of the accuracy of combined diagnosis.

A total of 556 suspected TB patients hospitalized in our hospital from January 2022 to December 2024 were selected. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic values of the two methods used alone and in combination. The Kappa test was employed to assess the consistency between the two methods and Mycobacterium tuberculosis (MTB). Univariate and multivariate Logistic regression analyses were conducted to identify the factors influencing the combined diagnostic accuracy of the two methods.

The positive rates of TB-LAMP in the three groups were 87.32%, 75.00%, and 12.23% respectively, those of T-SPOT.TB were 92.39%, 71.74%, and 23.40% respectively, and those of the combined detection were 93.48%, 85.87%, and 18.09% respectively, with significant differences among the groups (P<0.001). There was a high consistency between T-SPOT.TB, TB-LAMP, and their combined detection and MTB culture (Kappa=0.747, 0.733, 0.751). The sensitivities of TB-LAMP, T-SPOT.TB, and the combined detection were 84.24%, 87.23%, and 91.58% respectively, the specificities were 92.63%, 90.43%, and 83.51% respectively, the diagnostic accuracies were 87.41%, 88.31%, and 88.85% respectively, and the AUCs were 0.840, 0.910, and 0.930 respectively. Age≥60 years, CD4⁺ T lymphocyte count<350 cells/μL, albumin<35 g/L, diabetes, number of specimen submissions<3 times, time from collection to processing>2 h, and failed microscopic examination were independent risk factors affecting the combined diagnostic accuracy (P<0.05). Genderstratified analysis showed that except for age which was not significant in the female subgroup, all other risk factors remained independently significant in both male and female subgroups. Gender did not substantially interfere with the effects of these risk factors.

The combined detection of TB-LAMP and T-SPOT.TB can significantly improve the diagnostic accuracy. Age≥60 years old, CD4⁺ T lymphocyte count<350 cells/μL, albumin<35 g/L, diabetes, number of tests sent for examination<3 times, collection-to-processing time>2 hours, and insufficiently qualified for microscopic examination are all independent risk factors affecting the accuracy of the combined diagnosis.