To explore the influencing factors of two-week morbidity among hypertensive patients in Guizhou Province, and to compare the differences and complementarities between coincidence analysis (CNA) and logistic regression in identifying complex associations.

Data were obtained from the 2022 Guizhou Provincial Health Literacy Surveillance, and participants were individuals with self-reported hypertension. CNA and logistic regression were applied for statistical analysis.

A total of 1 344 hypertensive patients from 18 counties/districts were included, with a two-week morbidity rate of 36.09%. CNA identified four configurational pathways leading to high two-week morbidity: counties with higher proportions of ethnic minorities and higher obesity rates; counties with lower educational attainment and higher income or higher obesity rates; counties with higher educational attainment, lower smoking rates, but lower health literacy. The model had a consistency of 0.808, a coverage of 0.801, and a standardized robustness score of 0.75. Multivariable logistic regression showed that education below junior high school (OR=1.586, 95% CI: 1.216-2.068) and low health literacy (OR=1.762, 95% CI: 1.141-2.721) were risk factors for two-week morbidity among hypertensive patients.

From a multi-pathway perspective, this study shows that the risk of two-week morbidity among patients with hypertension in Guizhou is characterized by combinations of low educational attainment, low health literacy, high obesity prevalence, and ethnic minority concentration, providing evidence to inform county-level chronic disease management strategies in Guizhou and other resource-limited settings.

To explore the relationship between social support and family resilience in families of dementia patients, as well as its underlying mechanisms.

A questionnaire survey was conducted among 508 primary family caregivers of elderly dementia patients in Nanjing. Descriptive statistical analysis, regression analysis, and moderated mediation analysis were performed.

Social support had a significant positive impact on family resilience (β=0.351, P<0.01); Family cohesion partially mediated the relationship between social support and family resilience, with a mediation effect value of 0.527 (95% CI: 0.399-0.666), accounting for 60.04% of the total effect. The second half of the mediation pathway, through which social support influences family resilience via family cohesion, was moderated by psychological resilience (β=-0.017, P<0.01).

This study elucidates the relationship between social support and family resilience in families of dementia patients and its underlying mechanisms, providing a theoretical foundation and practical implications for enhancing family resilience in dementia care.

To compare the incident exposure design with the prevalent exposure design in cohort studies, to systematically evaluate the performance of different analytical methods within the incident exposure design framework, using the association between hypertension and cardiovascular disease as an example.

Based on the UK Biobank cohort, we selected an elderly population aged 60-65 years at baseline. Both prevalent exposure and incident exposure designs (time-window fixed grouping, time-zero random assignment, time-zero distribution matching, and time-dependent variable) were applied to assess the association between hypertension and incident cardiovascular disease.

Using the time-dependent variable as reference [hazard ratio (HR)=1.77, 95% confidence interval (CI): 1.68-1.88], the prevalent exposure design underestimated the effect size by 23% (HR=1.36) due to selection bias. The time-window fixed grouping introduced immortal time bias, leading to an 11% underestimation (HR=1.57). The time-zero random assignment and time-zero distribution matching, by defining a valid time-zero, partially controlled for bias, yielding HRs of 1.63 and 1.66, respectively. However, some degree of underestimation persisted.

The prevalent exposure design may systematically underestimate long-term disease risk. The event-based incident exposure design is recommended, particularly the time-dependent variable method which effectively controls for bias, to provide more reliable evidence for assessing the risk of incident cardiovascular disease associated with hypertension in elderly adults.

To compare the predictive performance of seasonal autoregressive integrated moving average (SARIMA) model, Prophet model, random forest (RF) model, extreme gradient boosting (XGBoost) model, and support vector regression (SVR) model on the incidence of other infectious diarrhea diseases in Baoshan District, Shanghai, and to explore the optimal forecasting model.

Using the monthly incidence rates of other infectious diarrhea diseases in Baoshan District, Shanghai from 2014 to 2022 as the training set, the SARIMA model, the Prophet model, the RF model with and without meteorological features, the XGBoost model with and without meteorological features, and the SVR model with and without meteorological features were constructed in Python to predict the monthly incidence rates from 2023 to 2024. The optimal model was selected by comparing the mean absolute error (MAE), root mean square error (RMSE) and mean absolute percentage error (MAPE) of the predicted and actual values.

From 2014 to 2024, a total of 6 868 cases of other infectious diarrheal diseases were reported in Baoshan District, Shanghai, with an average annual incidence rate of 28.81 per 100 000 population. The cases exhibited a bimodal seasonal distribution (peaking in summer and winter-spring). By comparing the predictive performance of different time series models on the monthly incidence rate from 2023 to 2024, the XGBoost model without meteorological features showed the best comprehensive performance in terms of fitting accuracy indicators (MAE=5.089, RMSE=6.844, MAPE=54.646%).

The XGBoost model without meteorological features is the best model for short-term prediction of other infectious diarrhea diseases in Baoshan District, which can provide a scientific basis for early warning and prevention of other infectious diarrhea diseases in Baoshan District.

To analyze the trend of mortality and life expectancy (LE) among people aged 60 years and above in China and globally from 1990 to 2021, to provide scientific evidence for improving the health of the aged.

Based on the GBD 2021 data, mortality rate, rank of causes of death, LE of the aged 60 years and above in China and globally were selected to compare the changes of each index from 1990 to 2019 and 2019 to 2021. The Joinpoint model was used to calculate the average annual percentage change (AAPC), and the ARIMA model was used to predict the mortality and LE of the aged.

Compared with 1990, the mortality rate of the aged in China and globally decreased significantly in 2019 (P<0.001), and the decline was greater in China. Compared with 2019, the mortality rate of the aged in the world increased in 2021, while it decreased slightly in China. The mortality rate of the older adults in the oldest age group in China was higher than that in the world. In terms of the ranking of causes of death, cardiovascular disease was always the first cause of death both in China and globally. Compared with 1990, the LE and health-adjusted life expectancy (HALE) of the aged in China and the world increased significantly in 2019(P<0.001). Compared with 2019, the LE and HALE of the aged in China increased in 2021, while the global values decreased. The LE of the older adults in the oldest age group in China was lower than that in the world. LE was higher in women than in men. The prediction showed that the LE of the aged in China would increase in the next 15 years, while the LE of the aged in the world would decline slightly.

The LE and HALE of the aged in China increased from 1990 to 2021, but decreased from 2019 to 2021 in the world. The health deficiencies, “unhealthy longevity”, and gender differences among the older adults in the oldest age group in China are prominent, and targeted, strengthened care and intervention are needed.

To analyze the epidemiological characteristics and spatiotemporal distribution of sexually transmitted infections (STIs) including HIV/AIDS, gonorrhea and syphilis in China from 2010 to 2020, providing scientific evidence for optimizing STIs prevention and control strategies.

Case data on STIs (HIV/AIDS, gonorrhea, syphilis) from 2010 to 2020 were extracted from the Public Health Data Center. Descriptive epidemiology, standard deviation ellipse, center of gravity migration modeling, and spatial autocorrelation analysis were employed to analyze epidemiological characteristics and spatial evolution patterns.

From 2010 to 2020, a cumulative total of 6 558 885 HIV/AIDS, gonorrhea and syphilis cases were reported across 31 provinces nationwide, with an average annual incidence rate of 43.55 per 100 000 population. Syphilis accounted for the highest proportion (73.68%), followed by gonorrhea (18.31%) and AIDS (8.01%). The incidence of AIDS continued to rise (1.20 → 4.43 per 100 000), syphilis fluctuated upward (26.86 → 33.08 per 100 000), while gonorrhea slightly decreased (7.91 → 7.49 per 100 000). Gonorrhea exhibited seasonal peaks in summer and autumn (July-October), whereas other STIs showed no distinct seasonal patterns. The primary high-risk group for AIDS was individuals aged 20 and above, while gonorrhea predominantly affected those aged 15-25. The high-risk group for syphilis shifted from infants and young children to individuals aged 85 and above. HIV/AIDS clustered in the southwest region and spread toward the northwest. Gonorrhea was prevalent in eastern regions (Zhejiang, Fujian) and southern China (Guangdong, Hainan). Syphilis originated in southern China (Guangdong, Guangxi Zhuang Autonomous Region) and spread toward the northwest (Qinghai, Xinjiang Uygur Autonomous Region). Global spatial autocorrelation analysis revealed significant positive spatial correlations between HIV/AIDS (except in 2010) and gonorrhea incidence, with increasing clustering intensity annually (Moran's I values: 0.08-0.36, P<0.05). Syphilis incidence primarily exhibited random distribution patterns (Moran's I values: 0.06-0.34, P>0.05). Standard deviation ellipses and center of gravity migration models revealed that the epidemic center was located at the junction of Sichuan, Chongqing, and Hunan provinces. From 2010 to 2020, the center first shifted northward and then southward, with the greatest displacement occurring in 2012 and 2019—2020.

STIs in China from 2010 to 2020 exhibited distinct spatio-temporal clustering. Given the substantial burden of sexually transmitted infections in China and the persistent southward shift of hotspots, differentiated interventions should be implemented in high-incidence areas and key populations across Southwest and South China. Strengthening cross-regional joint prevention and control mechanisms is imperative.

To use the adjusted Serfling regression model to estimate the excess epidemic periods and excess case numbers of hand, foot, and mouth disease in various age groups in Shenzhen from 2015 to 2024, providing a scientific basis for optimizing prevention and control strategies and conducting disease burden assessments.

Using the weekly incidence of hand, foot, and mouth disease in Shenzhen from 2015 to 2024, an adjusted Serfling regression model was established to estimate the baseline and epidemic threshold of the disease by age group, identify periods of excess epidemic, and calculate the number of excess cases.

From 2015 to 2024, a total of 642 903 cases of hand, foot, and mouth disease (HFMD) were reported in Shenzhen. The periods of excess incidence were predominantly concentrated between May and July. Across the entire population, these excess-incidence periods spanned a total of 89 weeks, with a weekly average of 1 422 excess cases, accounting for 35.11% of all reported cases. By age group, the weekly average numbers of excess cases were 802, 601, 261, and 131 for the 0-3 year, 3-6 year, 6-9 year, and >9 year groups, respectively. The corresponding proportions of excess cases relative to total cases in each group were 41.03%, 40.36%, 44.57%, and 46.03%, respectively. Furthermore, the 0-3 year age group consistently experienced an earlier onset of excess-incidence periods compared to other age groups, and both the duration of these periods and the average number of weekly excess cases were higher in this group than in all others.

The adjusted Serfling regression model provided a good fit for the incidence of hand, foot, and mouth disease in Shenzhen. Children under 6 years of age bore the highest disease burden, and implementing surveillance and early warning systems specifically targeting children aged 0-3 years could effectively shift the early warning threshold forward.

This study provides data support for the scientific prevention and control of bladder cancer in Gansu Province by analyzing the incidence status, trends, and predicting the incidence trend from 2022 to 2030 of bladder cancer in Gansu Province between 2010 and 2021.

By collecting regional tumor registration data from Gansu Province between 2010 and 2021, we included data meeting tumor data quality control requirements for analysis. Descriptive analyses were conducted by gender and urban-rural regions through calculation of incidence rates and related indicators. Trend analysis of bladder cancer incidence data in Gansu Province over the past 12 years was conducted using Joinpoint. The Bayesian age-period-cohort model analysis method was applied to predict the mortality trend of bladder cancer patients in Gansu Province from 2022 to 2030.

From 2010 to 2021, there were 3 245 new cases of bladder cancer in Gansu Province, with incidence rates, Chinese age-standardized incidence rate, and world-standard incidence rates being 4.88/10⁵, 3.38/10⁵, and 3.31/10⁵, respectively. The overall trend showed higher incidence rates in males than females, higher urban rates than rural areas, with statistically significant differences (all P values <0.05). Incidence rates increased with age, reaching a peak in the 80+ age group (81.96/10⁵). The cumulative rates for 0-64 years and 0-74 years were 0.17% and 0.39%, respectively, while the truncated rate for 35-64 years was 4.71/10⁵. From 2010 to 2021, the incidence of bladder cancer in Gansu Province increased by an average of 4.7% annually, with statistically significant trends (all P values <0.05). The annual percent change (APC=5.0%) was higher in males than females (APC=4.6%). Predictions indicate that the standardized incidence of bladder cancer in Gansu will rise from 2.96/10⁵ in 2021 to 3.50/10⁵ by 2030, with both gender-specific and urban-rural standardized incidence predictions showing upward trends.

From 2010 to 2021, the incidence of bladder cancer in Gansu Province showed an upward trend, and it is predicted that the incidence of bladder cancer will continue to increase from 2022 to 2030. Therefore, more attention should be paid to the impact of bladder cancer on population health, medical and health investment should be increased, and prevention and treatment efforts for elderly men with a high incidence of bladder cancer should be strengthened

To understand the distribution characteristics of cardiovascular disease (CVD) deaths among permanent residents in Hainan Province from 2018 to 2024, and to explore the relationship between socio-demographic characteristics, disease-related factors, regional factors, etc. and the place of death of CVD patients.

Using Hainan Province's cause-of-death data from the National Mortality Surveillance System, we described the distribution of CVD death places, and used univariate and multivariable logistic regression models to analyze the influencing factors of CVD deaths at home.

From 2018 to 2024, a total of 136 378 CVD deaths were collected, with 86.73% occurring at home and 9.38% occurring in medical and healthcare institutions. After adjusting for other factors, the analysis revealed that females (OR=1.07, 95% CI: 1.03-1.11) were more likely to die at home than males; the likelihood of dying at home grew gradually with age; compared to the Han ethnicity, the Li ethnicity (OR=1.64, 95% CI: 1.53-1.76) was more likely to die at home; compared to married individuals, widowed individuals (OR=1.46, 95% CI: 1.38-1.54) were more likely to die at home than unmarried (OR=0.49, 95% CI: 0.45-0.53) and divorced individuals (OR=0.51, 95% CI: 0.44-0.59); the higher the educational level, the lower the likelihood of dying at home; compared to workers, farmers (OR=2.79, 95% CI: 2.56-3.04) were more likely to die at home than individuals in other occupations; compared to rheumatic heart disease, hypertension and its complications (OR=1.29, 95% CI: 1.10-1.51) were more likely to die at home than other CVD subtypes; compared to the Eastern region, the Central region (OR=0.66, 95% CI: 0.63-0.70) and the Western region (OR=0.85, 95% CI: 0.82-0.89) were less likely to die at home.

The place of death for CVD among permanent residents in Hainan Province is mainly at home, and patients who are female, elderly, Li ethnicity, widowed, with low educational level, farmers, hypertension and its complications, and patients in the eastern region are more likely to die at home. Therefore, the specific conditions of CVD patients with different characteristics should be considered comprehensively to optimize the allocation of healthcare resources and improve clinical intervention and treatment capacity; meanwhile, a care model combining clinical care and community/home should be established to improve the quality of end-of-life care.

To investigate the association between trigyceride glucose index - body roundness index (TyG-BRI) and the risk of stroke in middle-aged and older adults using the CHARLS database.

This study conducted a longitudinal study using CHARLS data from 2011 to 2020. The TyG index was calculated from baseline fasting blood glucose and triglyceride levels. TyG-BRI was developed by integrating the TyG index with baseline waist circumference and height. Stroke was identified through follow-up questionnaires. After imputing missing data using MICE, we analyzed the data by stratifying TyG-BRI according to quartile levels and conducted Kaplan-Meier survival curve analysis. Meanwhile, a multivariable Cox proportional hazards regression model was used to assess the association between different TyG-BRI levels and the risk of stroke. Restricted cubic spline (RCS) analysis was employed to examine the dose-response relationship between TyG-BRI and the incidence of stroke. Finally, subgroup analyses and interaction tests were performed to explore the heterogeneity of the association between TyG-BRI and stroke among different populations.

A total of 7 709 individuals were included in the longitudinal study throughout the entire follow-up period, and 536 developed stroke. Both Cox regression and Kaplan-Meier analyses showed that higher TyG-BRI levels were associated with increased stroke risk. Using the first quartile (Q1) as reference, the fully adjusted model (Model 3) showed significantly elevated risks for Q2 (HR=1.39, 95% CI: 1.04-1.86), Q3 (HR=1.70, 95% CI: 1.28-2.27), and Q4 (HR=1.75, 95% CI: 1.28-2.40). RCS analysis revealed a linear relationship between TyG-BRI and stroke risk with an overall positive trend. Subgroup analyses did not identify any factors independently associated with stroke. Sensitivity analyses confirmed the robustness of these findings.

TyG-BRI shows potential as a useful indicator for early detection and prevention in stroke risk management.

To explore the impact of heatwave (HW) exposure on social participation among middle-aged and older adults, and provide empirical evidence for healthy aging intervention strategies under climate change.

Using two waves of data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018, the association between HW changes and decreased social participation was assessed via the generalized additive model combined with the generalized difference method. HW was defined by a city-specific threshold method: 12 HW definitions were constructed using the 90th, 92.5th, 95th, and 97.5th percentiles of daily maximum temperature as thresholds, combined with durations of ≥2, 3, and 4 days. Social participation was operationalized using social activity level, and sustained decline in social activity level and changes in social activity patterns were defined as different outcomes. Stratified analyses were conducted to examine the interaction effects of PM_2.5 and green space exposure.

In the analysis of sustained decline in social activity level, HW days (HW3: OR=1.130, 95% CI: 1.012-1.262; HW10: OR=1.056, 95% CI: 1.008-1.105) and HW events (HW10: OR=1.091, 95% CI: 1.013-1.175) were associated with sustained decline in social activity level. In the analysis of social activity pattern changes, HW days (HW1) were associated with increased risk of persistent low social activity (OR=1.069, 95% CI: 1.007-1.136). Stratified analysis showed that areas with slight decreases or increases in PM_2.5 concentration were more sensitive to HW impacts, with statistical associations observed when using HW events (HW9, P_Interaction=0.046) and HW days (HW1, P_Interaction=0.007) as exposure indicators. In contrast, areas with increased normalized difference vegetation index (NDVI) showed weakened HW impacts on social participation, with statistical associations observed when using HW events (HW3, P_Interaction=0.008) and HW days (HW9, P_Interaction=0.016) as exposure indicators.

HW is a key risk factor for reduced social participation among middle-aged and older adults. Thus, amid ongoing climate warming, integrating HW into public health and aging policies is of great significance.

To investigate the composition and distribution characteristics of bacterial communities in different parts of household air conditioners (ACs) in Chengdu, providing a basis for effective contamination control.

Using convenience sampling, 15 households in Chengdu were selected, with the most frequently used household air-conditioning unit from each household included in the study. Microbial samples were collected using sterile swabs from four key components of the air-conditioning system, including the air outlet, filter screen, heat sink, and condensate tray, resulting in a total of 60 samples. All samples underwent 16S rRNA sequencing, followed by bioinformatics analysis to assess α-diversity, β-diversity, and bacterial community composition. One-way analysis of variance (ANOVA) and the Kruskal-Wallis rank-sum test were employed to determine whether there were differences in α-diversity, β-diversity, and phenotypes among the four components.

Through high-throughput sequencing, the 60 samples collectively yielded 52 bacterial phyla and 1 618 bacterial genera. The differences in the sobs index, Simpson diversity index, and Shannon diversity index, representing the α-diversity of the four components, were all statistically significant (F=12.392, P=1.981×10^-5; F=6.290, P=1.898×10^-3; F=8.294, P=3.479×10^-4). Proteobacteria, Firmicutes, and Actinobacteria were the three dominant phyla across all samples, with Methylobacterium, Rhodococcus, Pseudomonas, and Sphingomonas being the predominant genera. Six categories of potential pathogenic genera were detected: Pseudomonas, Acinetobacter, Staphylococcus, Bacillus, Corynebacterium, and Streptococcus. PCoA analysis revealed that the bacterial community composition of air outlet samples was similar to that of filter screen samples, while the composition of heat sink samples resembled that of condensate tray samples. The differences in bacterial community composition, i.e., β-diversity, among the four components were statistically significant (H=41.135, P=3.469×10^-10). BugBase phenotypic intergroup difference testing showed that the bacteria from the four components of household air conditioners exhibited statistically significant differences in biofilm formation (H=25.772, P=7.663×10-7), stress tolerance (H=14.933, P=1.538×10^-3), pathogenic potential (H=17.606, P=2.169×10^-4), and the proportion of Gram-positive bacteria (H=17.882, P=1.737×10^-4).

High-throughput sequencing revealed differences in bacterial community composition and the distribution of potential pathogenic bacteria across four components of household ACs from 15 households sampled in Chengdu. These findings suggest that differentiated cleaning and disinfection strategies should be implemented for different components to reduce the risk of bacterial exposure.

To analyze the epidemiological characteristics of foodborne disease outbreaks caused by meat and meat products in Sichuan Province, so as to identify high-risk factors, and provide a scientific basis for developing targeted prevention and control strategies.

Based on outbreaks reported in the foodborne disease outbreak surveillance system (2010—2024) involving meat and meat products, a descriptive epidemiological analysis was conducted. Indicators such as composition ratio and rate were used for description, and χ² tests were employed to compare intergroup differences.

From 2010 to 2024, a total of 193 outbreaks caused by meat and meat products were reported in the province, involving 25 073 exposed individuals, 2 249 cases, 1 087 hospitalizations and 2 deaths. The attack rate was 8.97%, and the hospitalization rate was 48.33%. The Chengdu Plain Economic Zone reported the most outbreaks (52.85%). The highest number of outbreaks occurred in autumn (26.42%). Food service establishments were the most common settings (59.59%). Microbial pathogens were the primary causative agents (46.63%), with Salmonella being the most common (20.21%). One death each was caused by nitrite and botulinum toxin, accounting for 50.00% of fatalities respectively. Ready-to-eat meat products were implicated in the majority of outbreaks (98.96%).

Salmonella, nitrite, and botulinum toxin were the key pathogenic factors for prevention and control in our province. Summer and autumn were the key seasons, while Chengdu Plain Economic Zone and Chuannan Economic Zone were the key areas. Children and the elderly were the key populations. Health education should continue to be strengthened for key areas/places/populations during the summer and autumn seasons. The public should avoid consuming homemade or unidentified ready-to-eat meat products, and management of food service establishments should be strengthened.

To analyze the epidemiological characteristics of reported cases of Vibrio parahaemolyticus food poisoning in China, and to provide a basis for formulating prevention and control measures.

Data on Vibrio parahaemolyticus food poisoning incidents from 2015 to 2024 were extracted from the Public Health Emergency Reporting and Management System under the Chinese Disease Prevention and Control Information System. A descriptive epidemiological approach was adopted for analysis.

From 2015 to 2024, a total of 162 Vibrio parahaemolyticus food poisoning incidents were reported across 20 provinces in China, involving 7 721 poisoned individuals. The months of July to September were the peak period, accounting for 69.1% (112/162) of the total incidents and 64.5% (4 982/7 721) of the total poisoned population. The top 5 provinces with the highest number of reported incidents were all coastal provinces, contributing 56.2% (91/162) of the total incidents. Restaurants were the main responsible units, accounting for 61.1% (99/162) of all incidents, followed by canteens (29.6%, 48/162). Among the 93 incidents with identified suspicious contaminated foods, 69 involved single-food contamination. Among these, meat and meat products were the primary category, accounting for 22.8% (37/162), followed by aquatic products and their derivatives (14.8%, 24/162). Among the 78 incidents where the pollution causes were clearly identified, 59 were attributed to a single factor. Among these single-factor cases, cross-contamination between raw and cooked foods was the lead ing single factor, accounting for 45.8% (27/59); this was followed by improper storage (20.3%, 12/59) and improper processing (15.3%, 9/59).

The main contaminated foods in Vibrio parahaemolyticus food poisoning incidents are meat and meat products, as well as aquatic products and their derivatives. Catering service units are the main responsible entities, and cross-contamination between raw and cooked foods, improper storage, and improper processing are the key risk links. It is recommended that supervision over catering units in high-incidence areas be strengthened in summer, with strict implementation of operating standards. Specifically, seafood raw materials and cooked foods should be stored and processed separately, containers for raw and cooked foods should be distinguished, and the heating temperature and duration of food ingredients should meet safety standards.

To investigate influencing factors of influenza virus infection among hospitalized pregnant and postpartum women during influenza season in Suzhou City.

Based on the established active surveillance system for influenza-associated acute respiratory or febrile illness (ARFI) hospitalizations among the maternal population in Suzhou, we used rates/percentages to describe population distribution characteristics. Logistic regression analyses were performed to identify factors associated with laboratory-confirmed influenza infection in hospitalized pregnant and postpartum women during influenza season.

During 2018—2023 influenza seasons, 1 774 pregnant and postpartum women hospitalized with ARFI were included, with 479 cases (27.0%) testing positive and 1 295 negative by reverse transcription polymerase chain reaction (RT-PCR). Multivariable analysis confirmed that elevated risks persisted in first (aOR=2.49, 95% CI: 1.52-4.11) and third trimesters (aOR=1.83, 95% CI: 1.27-2.68). Influenza like illness (ILI) exposure increased risk by 86.0% (aOR=1.86, 95% CI: 1.36-2.55). Asthma was associated with an 83.0% lower risk (aOR=0.17, 95% CI: 0.03-0.56). Having ILI symptoms within the past 1 year (aOR=0.70, 95% CI: 0.51-0.94) and having children (aOR=0.77, 95% CI: 0.62-0.96) were also associated with a reduced risk of hospitalization with influenza infection.

Pregnant women in first and third trimesters should strengthen self-protection measures against seasonal influenza. Attention to health-related behaviors significantly reduces infection risks.

To explore the relationship between family functioning and non-suicidal self-injury (NSSI) among adolescents in a specific western region of China, and to examine the chain mediating role of internet addiction and depression in this relationship.

A cross-sectional study was conducted among 1 331 seventh and eighth-grade students from a middle school in a western region of China. Assessments were carried out using the Internet Addiction Test (IAT), the Center for Epidemiological Studies Depression Scale for Children (CES-DC), the Chinese version of the Family Assessment Instrument (C-FAI), and the Deliberate Self-Harm Inventory (DSHI).

The detection rate of NSSI among adolescents was 32.5%. Statistically significant differences in NSSI were found across gender (χ²=39.539), history of smoking (χ²=29.838), history of alcohol use (χ²=35.042), academic burden (χ²=49.824), and sleep duration (χ²=54.838), with all P<0.001. Mediation analysis indicated that family dysfunction not only directly influenced NSSI but also exerted indirect effects through three pathways: internet addiction alone (accounting for 13.2%), depression alone (accounting for 39.7%), and the sequential chain of internet addiction followed by depression (accounting for 7.4%). The total indirect effect accounted for 58.8% of the overall influence.

Family dysfunction is a significant risk factor for adolescent NSSI in the studied region. Its mechanism of action involves exerting influence through the chain mediating effects of internet addiction and depression. Interventions aimed at improving family functioning, promoting healthy internet use habits, and addressing depressive symptoms may help reduce the risk of NSSI among adolescents.

To investigate rural women's willingness to undergo cervical cancer screening and its influencing factors based on the Health Belief Model (HBM), and to provide theoretical support for improving screening participation rates in this population.

From April to May 2025, a multi-stage cluster sampling method was used to select rural women in Shimian County, Ya'an City, Sichuan Province for a questionnaire survey. The questionnaire collected information on sociodemographic characteristics, health beliefs related to cervical cancer screening, and screening willingness. Univariate analysis was used to examine associations between demographic variables, HBM dimensions, and screening willingness. Structural equation modeling (SEM) was employed to identify influencing factors and pathways affecting screening willingness.

Among the 431 valid questionnaires collected, 74.0% of respondents expressed willingness to participate in cervical cancer screening. Univariate analysis showed statistically significant differences in screening willingness across age, ethnicity, and occupation (P<0.05). SEM results indicated that self-efficacy (direct effect=0.541, P<0.001) and perceived susceptibility (direct effect=0.177, P<0.001) had direct positive effects on screening willingness. Cues to action (indirect effect=0.237), perceived severity (indirect effect=0.199), and perceived benefits (indirect effect=0.024) exerted indirect positive effects, while perceived barriers had an indirect negative effect (indirect effect=-0.164).

Based on the Health Belief Model, targeted measures should be implemented to improve rural women's perceptions of susceptibility, severity, and screening benefits, enhance cues to action and self-efficacy, and reduce perceived barriers, thereby increasing cervical cancer screening willingness.

To investigate the mediating effect of healthy lifestyle between personality traits and obesity among primary school students in grades 4-6, so as to provide evidence for targeted obesity interventions.

A cross-sectional survey and physical examinations were conducted among 3 519 primary school students in grades 4-6 from 14 schools in Changzhou in 2024 by stratified cluster random sampling method. The personality traits were measured by the Big Five Inventory-10. The healthy lifestyle was assessed across four dimensions: healthy diet, moderate exercise, adequate sleep and reasonable screen time. A structural equation model was constructed to analyze the association between personality traits and obesity in primary school students and the mediating effect of the healthy lifestyle.

The detection rate of obesity among primary school students in grades 4-6 was 20.60%, significantly higher in boys (25.16%) than girls (15.49%) (χ²=50.127, P<0.001). The detection rate of obesity decreased significantly with the increase of education level of father and mother (all P<0.05). The total score of healthy lifestyle and the score of conscientiousness were negatively correlated with obesity (r_s=-0.066, P<0.001; r_s=-0.058, P<0.001). After controlling for gender and parental education, the model results showed that the indirect effect of conscientiousness on obesity through healthy lifestyle was -0.010 (95% CI: -0.018~-0.002), and the mediating effect accounted for 18.87% of the total effect.

Conscientiousness can directly or indirectly affect obesity among primary school students in grades 4-6 in Changzhou through healthy lifestyle. Personalized intervention programs for childhood obesity should be designed in combination with personality traits to promote healthy lifestyle.

To examine the bidirectional dynamic relationship between activities of daily living (ADL) and depressive symptoms among older adults with dual sensory impairment (DSI), identify key driving symptoms, and provide targets for precision interventions.

This study used longitudinal data from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS), including 2 674 participants aged≥60 years with DSI. Depressive symptoms were assessed using the short form of the Center for Epidemiologic Studies Depression Scale, and ADL limitations were measured using the ADL scale. A cross-lagged panel network (CLPN) model was applied to examine time-lagged effects and symptom network characteristics.

A significant cross-lagged pathway was identified from ADL item A11 “Managing money” to depressive symptom A1 “Being bothered by little things” (OR=1.19, 95% CI: 1.07-1.28), followed by D3 “Felt depressed” to A4 “Getting in, out of bed” (OR=1.16, 95% CI: 1.00-1.32), and D2 “Felt fearful” to A1 “Dressing” (OR=1.14, 95% CI: 1.00-1.35). Centrality analysis revealed that D3 “Felt depressed” (BEI=0.73) and A11 “Managing money” (BEI=0.59) were key bridge symptoms. D3 “Felt depressed” showed the highest out-expected influence (OEI=1.03), while A10 “Taking medication” was most susceptible to influence (IEI=0.77).

In older adults with DSI, ADL limitations and depressive symptoms may influence each other through specific pathways, and the CLPN indicates reciprocal prospective predictive associations between them, potentially forming a bidirectional vicious cycle via these pathways. Targeted interventions focusing on core bridge symptoms may help disrupt this cycle, thereby improving functional independence, enhancing psychological well-being, promoting healthy aging, and carrying important public health significance.

To analyze the influencing factors of cognitive impairment and construct a risk assessment model for illiterate elderly individuals.

Based on the 2020 China Health and Retirement Longitudinal Study (CHARLS) database, illiterate elderly individuals aged≥60 years were taken as the research subjects. Ten-fold cross-validated LASSO regression was used to identify the optimal predictor variables. Logistic regression was further applied to explore the risk factors of cognitive impairment in this population, and an assessment model was further constructed. The performance of the model was evaluated using the receiver operating characteristic (ROC) curve, area under the curve (AUC), sensitivity, specificity, Hosmer-Lemeshow test, calibration curve, decision curve analysis (DCA), categorical/continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

A total of 1 575 illiterate elderly individuals were included in this study, with a prevalence of cognitive impairment of 39.75%. Lasso regression screened potential predictor variables, including age, marital status, residence type, alcohol consumption, physical activity, social engagement, and internet use. Multivariable logistic regression analysis showed that advanced age (70-79 years: OR=1.509, 95% CI: 1.120-2.032; ≥80 years: OR=2.178, 95% CI: 1.341-3.537), rural residence (OR=1.631, 95% CI: 1.159-2.295) were the risk factors. In contrast, being married (OR=0.607, 95% CI: 0.450-0.817), alcohol consumption (OR=0.647, 95% CI: 0.471-0.888), social engagement (OR=0.683, 95% CI: 0.524-0.891), moderate-to-high intensity physical activity (moderate intensity: OR=0.633, 95% CI: 0.428-0.937; high intensity: OR=0.628, 95% CI: 0.439-0.898), internet use (OR=0.327, 95% CI: 0.184-0.581) were protective factors. An assessment model was established based on the seven factors. The areas under the ROC curves of the assessment model in the training and validation sets were 0.670 and 0.655, respectively. The Hosmer-Lemeshow χ²=11.977, P=0.152, and χ²=7.977, P=0.436. Brier scores were 0.216 and 0.227, respectively. The calibration curve revealed good consistency between the predicted values and the actual values, and the DCA indicated that the model had good net benefit and assessment accuracy. Additionally, the model showed a significant incremental improvement in terms of risk reclassification.

The risk assessment model for cognitive impairment in illiterate elderly individuals, based on seven influencing factors including age and residence type, can provide support for the early identification of cognitive impairment in this population.

To explore the coupling coordination degree and relative development degree between traditional chinese medicine (TCM) healthcare resource allocation and socioeconomic development in Guizhou Province from 2021 to 2023.

The entropy method, coupling coordination degree model, relative development degree, and Moran's I were used to evaluate the coupling coordination relationship between TCM healthcare resource allocation and socioeconomic development across 88 counties in Guizhou Province during 2021—2023.

From 2021 to 2023, the overall comprehensive score increased from 0.169 8 to 0.205 2, representing an increase of 20.85%. Both the coupling coordination degree and the relative development degree showed an overall upward trend, and the coordination status shifted from mild imbalance to near imbalance. Moran's I was greater than 0 in 2021—2023 (P<0.05), increasing from 0.041 in 2021 to 0.056 in 2023.

The overall comprehensive score between TCM healthcare resource allocation and socioeconomic development in Guizhou Province increased markedly, with an overall improving coordination trend and strengthened spatial clustering. Further efforts are needed to enhance the coordination between TCM healthcare resources and socioeconomic development and to promote balanced development across counties.

To develop a medication adherence scale for tuberculosis (TB) patients and to validate its reliability and validity.

The initial scale was constructed based on a multi-theory model (MTM) through literature review, expert consultation, and a pilot survey with TB patients. A survey was conducted among 310 TB patients from Yangzhou Third People's Hospital between October 2024 and March 2025 to assess the scale's reliability and validity.

The final scale contained 6 dimensions (perceived benefits, perceived barriers, emotional transformation, self-efficacy, social support, and behavioral transformation) with a total of 48 items. The item-total correlations ranged from 0.592 to 0.884 (all P<0.001). Exploratory factor analysis identified 6 common factors, which collectively explained 85.234% of the total variance. Confirmatory factor analysis demonstrated good model fit. The overall Cronbach's α coefficient was 0.978, with subscale coefficients ranging from 0.959 to 0.982, and the split-half reliability was 0.831.

The MTM-based medication adherence scale for tuberculosis patients shows good reliability and validity, and can be used as a specific assessment tool for medication adherence in patients with tuberculosis.

To assess the current level of medical-service resistance across prefectures in Sichuan and to provide evidence for building a highly resilient healthcare system.

Using panel data for 21 prefectures from 2013 to 2022, an evaluation index system for medical service resistance in Sichuan Province was constructed. CRITIC-Entropy Weight Method and TOPSIS were applied to calculate resistance scores, while kernel density, Moran's I and Markov-chain models were employed to analyze spatiotemporal evolution and state-transition probabilities.

Resistance rose from 0.431 to 0.477, with 90.48% of prefectures recording positive growth. The resistance level shifted from medium to high, and the high level was the dominant category. LISA maps revealed “high-low”, “low-high” and “low-low” clusters. Transition probabilities showed a gradient effect and a pronounced lock-in, making leapfrog upgrades difficult.

Overall resistance in Sichuan is improving, but significant regional disparities persist, local spatial clustering is evident, and a strong lock-in effect governs state transitions.

To explore dynamic bidirectional associations among cognitive frailty symptoms in Chinese older adults and identify core symptoms within the cognitive frailty network.

Older adults from the baseline and two follow-up waves (2011—2018) of the Chinese Longitudinal Healthy Longevity Survey were included. The longitudinal network structure of cognitive function and physical frailty was analyzed using cross-lagged panel network analysis.

A total of 2 377 older adults were included. The T1→T2 network contained 63 non-zero predictive effects (57.27%), with the strongest prediction being the negative impact of instrumental activities of daily living on general ability (β=-0.47) and attention-based calculation ability (β=-0.39). The T2→T3 phase showed an increase to 71 non-zero effects (64.55%), revealing a feedback loop: instrumental activities of daily living→health status evaluation→verbal comprehension and self-coordination→instrumental activities of daily living. The centrality analysis showed that the language comprehension and self-coordination ability in the T1-T2 stage had the strongest outward influence (out-EI=0.98), and the basic activities of daily living in the T2-T3 stage became the strongest output node (out-EI=1.35). Physical function manifested as the introverted core (in-EI=1.43, 0.86) that was most susceptible to other nodes in both stages.

Priority should be given to improving basic activities of daily living and language comprehension abilities, implementing early comprehensive intervention, and strengthening the dynamic monitoring and management of physical functions and chronic diseases to delay the process of functional decline and promote healthy aging.

To explore the latent classes and influencing factors of community nursing needs in elderly patients with type 2 diabetes mellitus (T2DM) in Chengdu, providing a reference for optimizing community diabetes care.

In 406 community-dwelling elderly patients with T2DM sampled by stratified convenience sampling, we administered general information questionnaire, community nursing needs scale, health literacy questionnaire and self-care ability scale. Latent class analysis identified need subtypes, and multinomial logistic regression identified their influencing factors.

Community nursing needs were moderate overall, categorized into three latent classes: low-level needs (52.2%), high multidimensional needs (37.7%), and high health promotion-low disease management and psychosocial support needs (10.1%). Age, monthly household income, complications, comorbidities, exercise, health literacy, and self-care ability were influencing factors for different subtypes (all P<0.05).

Three latent classes exist for community nursing needs in elderly T2DM patients, influenced by multiple factors. Community nursing services should implement targeted interventions based on need classification, rationally allocate elderly nursing resources, and improve the quality of diabetes management and patient satisfaction.

To assess elderly care vulnerability within the Intergovernmental Panel on Climate Change (IPCC) framework and examine its effects and heterogeneity in the choice of care modes, and provide evidence for the optimization of elderly care policies.

Using data from China longitudinal aging social survey (CLASS) 2020 and including 8 221 elderly individuals, this study constructed an evaluation index system for elderly care vulnerability based on the entropy method and conducted K-means cluster analysis. Univariate tests and multinomial logistic regression were then employed to examine the impact of elderly care vulnerability and its heterogeneity on the choice of care modes.

An elderly care vulnerability assessment system was constructed comprising three primary indicators and seventeen secondary indicators, with vulnerability scores ranging from -0.083 to 0.529. Clustering classified respondents into high (7.05%), medium (75.28%), and low (17.67%) vulnerability groups. Univariate analysis showed that vulnerability was associated with care-mode choice (χ²=109.821, P<0.001). Multinomial logistic regression showed that, relative to self-care, high vulnerability increased the likelihood of community care (OR=2.729, 95% CI: 1.645-4.527) and institutional care (OR=5.150, 95% CI: 3.115-8.515), and decreased the likelihood of care by children (OR=0.631, 95% CI: 0.481-0.828). Heterogeneity analysis indicated that effects were stronger among the oldest-old and urban respondents. Highly vulnerable women were more likely to choose self-care, whereas highly vulnerable men were more likely to choose institutional care.

Elderly care vulnerability in China is moderate overall. As vulnerability increases, preferences for elderly care modes show a trend of “care by children < self-care < community care < institutional care”. Strengthening the socialized care system, delivering targeted services, and building resilient support networks are recommended.

To construct a medical literacy evaluation index system for patients with chronic kidney disease (CKD), aiming to assess and enhance their ability to acquire, understand, and apply relevant medical information.

An indicator pool was initially established through literature analysis and semi-structured interviews. The Delphi method and analytic hierarchy process were employed to finalize the evaluation index system and determine the weights.

The questionnaire recovery rates for the two rounds of expert consultation were 94.44% and 88.24%. The expert authority coefficients for the two rounds were 0.915 and 0.927. The Kendall's coefficient for the second round of expert consultation ranged from 0.130 to 0.215, and the intraclass correlation coefficient ranged from 0.326 to 0.906. Ultimately, a medical literacy evaluation index system for patients with CKD was established, comprising 4 first-level indicators, 10 second-level indicators, and 42 third-level indicators.

The medical literacy evaluation index system for patients with CKD constructed in this study is necessary and practical. It can objectively assess and improve patients' level of medical literacy, thereby providing support for clinical diagnosis, treatment, and medical communication practices.

To investigate the treatment outcome and influencing factors of subclinical tuberculosis (STB) in Guizhou Province, and to provide a reference for further prevention and treatment of STB.

The STB patient information in Guizhou Province from 2021 to 2023 was derived from the National Tuberculosis Management Information System. Baseline characteristics of patients were described, and factors influencing patient treatment outcome were analyzed using χ² test and multivariable logistic regression, and subgroup analysis was performed.

A total of 4 406 STB patients were registered in Guizhou Province from 2021 to 2023, 190 (4.3%) cases had adverse outcomes, and 4 216 (95.7%) cases were successfully treated. Among them, 2 600 (59.0%) were male, 3 069 (69.7%) were Han, and 2 146 (48.7%) were farmers. 3 532 (80.2%) cases were found after referral and follow-up. Multivariable logistic regression analysis showed that age≥60 years old (OR=2.892, 95% CI: 1.143-7.317), comorbidities (OR=1.632, 95% CI: 1.114-2.392), hematogenous pulmonary tuberculosis (OR=9.618, 95% CI: 1.047-88.317), positive etiology (OR=2.164, 95% CI: 1.539-3.043), and retreatment (OR=5.338, 95% CI: 2.011-14.167) were risk factors for adverse outcomes in STB patients. Primary management (OR=0.124, 95% CI: 0.039-0.392) and use of standard protocols (OR=0.372, 95% CI: 0.262-0.527) were protective factors. The impact of treatment regimen on the treatment outcome of STB patients had interactions in different comorbidities and diagnostic subgroups (interaction P<0.05). Among them, patients with STB without comorbidities (OR=0.22, 95% CI: 0.15-0.31) and patients with secondary STB (OR=0.23, 95% CI: 0.17-0.31) had better treatment effects with the standard regimen.

The majority of subclinical tuberculosis patients in Guizhou Province are male, young and middle-aged, Han nationality, farmers, and secondary pulmonary tuberculosis, and the main source is passive detection. Patients with STB aged≥60 years old, comorbidities, hematogenous pulmonary tuberculosis, positive etiology, retreatment, no primary management, and no use of standard treatment options will increase the risk of adverse outcomes. For the above types of patients, we should focus on the occurrence and development of their clinical treatment outcomes, and take corresponding treatment and management measures to reduce the occurrence of adverse outcomes.

To investigate the association between 24-hour physical activity and the risk of metabolic syndrome using functional data analysis.

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2011—2014. A total of 1 110 eligible participants were included in the analysis. Parametric and nonparametric generalized propensity score methods with functional exposures were used to adjust for potential confounders, including age and sex. Inverse probability weighting in conjunction with a functional linear model was employed to estimate the association between 24-hour physical activity and the risk of metabolic syndrome and to examine sex-specific differences.

Physical activity during the periods of 10:15-11:15 and 16:35-19:45 (parametric method: F=4.969, P<0.001; nonparametric method: F=6.313, P<0.001) was associated with a reduced risk of metabolic syndrome. Sex-stratified analyses indicated that, among males, physical activity between 16:45 and 19:40 (parametric method: F=3.573, P<0.001; nonparametric method: F=4.816, P<0.001) was negatively associated with metabolic syndrome risk, whereas among females, a significant negative association was observed during 09:05-10:15 (parametric method: F=3.076, P=0.003; nonparametric method: F=3.008, P=0.004).

The association between 24-hour physical activity and the risk of metabolic syndrome exhibits both time-specific patterns and sex differences, suggesting that prevention strategies should incorporate activity timing and recommend exercise periods aligned with individuals' circadian rhythms to optimize health benefits.