To comprehensively analyze the epidemiological characteristics and trends of intestinal infectious diseases among the elderly population in eastern China, providing data support for formulating regional strategies for the prevention and control of intestinal infectious diseases.

Data on intestinal infectious disease cases among people aged 60 and above in eastern China from 2008 to 2022 were collected and organized from the China National Notifiable Infectious Disease Reporting System. Descriptive methods were used to analyze the distribution characteristics of intestinal infectious diseases among the elderly, and Joinpoint regression was applied to study the dynamic trends in standardized reported incidence rates.

The annual standardized reported incidence rate of intestinal infectious diseases among the elderly in eastern China was 88.75 per 100 000, with males (95.18 per 100 000) having higher rates than females (83.85 per 100 000). The annual reported incidence rate increased with age, with the lowest in the 60-64 age group (79.82 per 100 000) and the highest in the ≥85 age group (118.05 per 100 000). From 2008 to 2022, the standardized reported incidence rate of intestinal infectious diseases among the elderly in eastern China showed a declining trend, with an average annual percentage change of -2.93% (-4.31%~-1.53%, P<0.001). For males and females, the changes were -4.03% (-5.48%~-2.56%, P<0.001) and-2.47% (-3.85%~-1.07%, P=0.001), respectively. Disease-specific trend analysis showed declining trends in the standardized reported incidence rates for bacterial and amebic dysentery, typhoid/paratyphoid, hepatitis E, and unspecified hepatitis, with average annual percentage changes of -14.39% (-16.46%~-12.26%, P<0.001), -7.87% (-10.24%~-5.43%, P<0.001),-3.33% (-5.22%~-1.41%, P=0.003), and -15.63% (-17.14%~-14.09%, P<0.001), respectively.

From 2008 to 2022, intestinal infectious diseases among the elderly in eastern China showed an overall year-by-year declining trend. Older adults and males should be prioritized in prevention and control efforts, and surveillance, prevention, and control measures for these key populations should be further strengthened.

To investigate the longitudinal association of baseline chronic kidney disease (CKD) status and estimated glomerular filtration rate (eGFR) levels with the risk of incident knee osteoarthritis (KOA) among middle-aged and older Chinese adults, and to provide epidemiological evidence for the pathological crosstalk of the “kidney-bone axis”.

This study utilized longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS, 2011—2018). A total of 4 182 participants aged 45 years and older, free of KOA at baseline and with complete covariate data, were included. Missing data were handled using multiple imputation. The association between baseline CKD [defined as eGFR <60 ml/ (min·1.73m²) ] and incident KOA was analyzed using Kaplan-Meier survival curves and multivariatble Cox proportional hazards regression models. Restricted cubic spline (RCS) modeling was employed to examine the dose-response relationship between eGFR levels and KOA risk. Subgroup analyses and lag analyses were conducted to verify the robustness of the results.

During an average follow-up of 4 years, the cumulative incidence of incident KOA was significantly higher in the CKD group compared to the non-CKD group (Log-rank P<0.001). Multivariable Cox regression analysis demonstrated that, after adjusting for demographics, lifestyle factors, body mass index (BMI), and chronic comorbidities, baseline CKD remained an independent risk factor for incident KOA [hazard ratio (HR) =1.82, 95% confidence interval (CI) : 1.30-2.55, P<0.001]. RCS analysis revealed no significant linear or non-linear dose-response relationship between baseline eGFR levels and KOA risk in the total population (P for overall association =0.348), suggesting a pathological threshold effect of renal function on KOA. Sensitivity analyses confirmed the robustness of these findings.

CKD is an independent risk factor for incident KOA among middle-aged and older Chinese adults, characterized by a potential pathogenic threshold effect at an eGFR of <60 ml/ (min·1.73m²). Integrated management of joint health in CKD patients should be prioritized, employing early screening to achieve comprehensive prevention and treatment of “kidney-bone/joint” comorbidities.

This study systematically analyzed temporal trends in the burden of spinal cord injury (SCI) attributable to falls in China from 1990 to 2021, focusing on incidence, prevalence, and years lived with disability (YLD).

Data were obtained from the Global Burden of Disease (GBD) 2021 database, using publicly available national estimates of fall-related SCI in China from 1990 to 2021. Descriptive analyses were conducted to characterize changes in incidence, prevalence, and YLD. Temporal trends were further examined using Joinpoint regression and age-period-cohort (APC) models.

In 2021, the number of prevalent cases of fall-related SCI in China was estimated at 1 480 074, with 62 724 incident cases. The age-standardized prevalence rate (ASPR) was 80.21 per 100 000 population and the age-standardized incidence rate (ASIR) was 3.76 per 100 000 population. Total YLDs reached 397 472 years, corresponding to an age-standardized YLD rate (ASYR) of 21.74 per 100 000 population. Sex-based analysis showed a substantially higher disease burden in males than in females. Joinpoint regression indicated a modest increase in ASIR during 1995—2000 (APC=1.89), a marked decline during 2000—2005 (APC=-6.12), followed by a rapid increase during 2010—2021 (2010—2015: APC=5.90; 2015—2021: APC=4.59). Similarly, ASPR showed a slight increase during 1990—2001 (APC=0.55), a significant decline during 2001—2005 (APC=-8.58), and a renewed rapid increase during 2010—2021 (APC=5.08). YLDs remained relatively stable from 1990 to 2000, declined during 2000—2007 (APC=-9.94), and increased during 2010—2021 (APC=4.68). Overall trends were comparable between males and females. APC analysis revealed a pronounced increase in SCI risk with advancing age, while period and cohort effects fluctuated but showed an overall upward pattern, suggesting that economic development, improvements in healthcare, and population aging may jointly contribute to the increasing burden.

From 1990 to 2021, the disease burden of SCI in China has increased substantially, with males and older adults experiencing markedly higher risks than females and younger populations. Targeted public health strategies addressing population aging and risk management among high-risk groups are urgently needed to mitigate the long-term health and societal impacts of SCI.

To investigate the prevalence and influencing factors of comorbidity of hypertension, diabetes and dyslipidemia among residents aged 18 years and above in Wenzhou City, and to provide a reference basis for the targeted implementation of “triple management” of hypertension, diabetes and dyslipidemia.

From June 2023 to August 2024, a multi-stage random cluster sampling method was used for sampling. A total of 38 593 subjects were surveyed through questionnaires, physical examinations and laboratory tests. χ² test and multivariable unconditional logistic regression analysis were conducted using SPSS 23.0.

The prevalence of hypertension, diabetes, and dyslipidemia among residents aged 18 and above in Wenzhou was 30.61%, 12.98%, and 39.75%, respectively. The comorbidity rate of hypertension, diabetes and dyslipidemia was 5.31%. Multivariable unconditional logistic regression analysis revealed that advanced age (compared with the 18-29 age group, 30-39 years: OR=5.069, 95% CI: 2.009-12.791; 40-49 years: OR=19.138, 95% CI: 7.750-47.258; 50-59 years: OR=71.447, 95% CI: 28.777-177.391; 60-69 years: OR=298.825, 95% CI: 119.102-749.750; 70-79 years: OR=570.190, 95% CI: 225.190-1 443.740; ≥80 years: OR=549.523, 95% CI: 202.033-1 494.686), regular alcohol consumption (compared with never drinking, OR=1.461, 95% CI: 1.148-1.860), excessive salt intake (OR=1.346, 95% CI: 1.150-1.575), overweight (OR=2.332, 95% CI: 1.980-2.747), obesity (OR=4.440, 95% CI: 3.453-5.710), central obesity (OR=2.909, 95% CI:2.468-3.429), family history of hypertension (OR=2.727, 95% CI: 2.333-3.187), and family history of diabetes (OR=2.900, 95%CI: 2.438-3.450) were risk factors for the coexistence of hypertension, diabetes, and dyslipidemia. High school or technical secondary education (compared with primary school and below, OR=0.715, 95% CI: 0.552-0.926), college education or above (OR=0.401, 95% CI: 0.287-0.562), and annual household income ≥200 000 CNY (compared with <50 000 CNY, OR=0.641, 95% CI: 0.439-0.937) were protective factors against the coexistence of these three conditions.

The comorbidity rate of hypertension, diabetes and dyslipidemia among adult residents in Wenzhou City is at a relatively high level. Interventions should be strengthened for high-risk groups, and a healthy lifestyle should be advocated to control weight and waist circumference, and reduce the risk of comorbidity of the three diseases.

To understand the epidemic characteristics and predominant pathogenic bacterial groups of meningococcal meningitis in Anhui Province from 2006 to 2024, and to provide a basis for the prevention and control of meningococcal meningitis and the adjustment of immunization strategies.

Data on the incidence of meningococcal disease and pathogen detection in Anhui Province from 2006 to 2024 were collected through the Chinese Disease Prevention and Control Information System. Descriptive epidemiological methods were used to analyze the epidemiological characteristics and bacterial distribution of meningococcal disease. The Joinpoint software was used to analyze the incidence from 2006 to 2024.

From 2006 to 2024, a total of 1 014 cases of meningococcal meningitis were reported in Anhui Province, with an average annual incidence rate of 0.09 per 100 000. Joinpoint regression analysis showed that the incidence of meningococcal meningitis overall decreased from 2006 to 2024 [average annual percent change (AAPC) =-27.66%, P<0.001], with a significant decrease in the number of cases from 2008 to 2015 [annual percent change (APC) =-45.36%, P<0.001]. The top three reporting regions with the average annual incidence rate were Hefei City (0.34 per 100 000), Bengbu City (0.17 per 100 000), and Huainan City (0.12 per 100 000). The cases were mainly concentrated from November to the following April, accounting for 89% of the total. The male-to-female ratio was 1.43 (597/417); the age group with the highest incidence was 15-19 years old (26.53%), 10-14 years old (24.46%), and the 0-4 age group (15.48%); the occupation was mainly students (55.23%). From 2006 to 2024, a total of 170 cases of bacterial surveillance were reported in Anhui Province. The bacterial strain changes showed a trend of a decrease in the proportion of C strain and an increase in the proportion of B strain year by year. In terms of age distribution, the 0-4 age group was mainly dominated by the B strain (43.75%), while the 10-19 age group was mainly dominated by the W135 strain, A strain, and C strain with diversified high incidence.

The incidence of meningococcal disease in Anhui Province is currently at a low level. The peak incidence ages are concentrated in the 10-19 years old and 0-4 years old groups. The predominant strain is Group B. The prevention and control of meningococcal disease faces new challenges. It is recommended to provide an additional dose of meningococcal vaccine for adolescents aged 10-19 years old.

This study aims to investigate the association between the metabolic score for insulin resistance (METS-IR) and the risk of gallstone disease (GSD).

Data were collected from participants who underwent health examinations at four hospital health management centers in Chongqing and Beijing between 2015 and 2020. Multivariable logistic regression analysis was employed to examine the correlation between METS-IR and GSD risk across different centers, and a meta-analysis was conducted to pool the results from each hospital.

A total of 543 371 participants were included in this study, with a GSD prevalence of 8.05%. Multivariable logistic regression analysis revealed a positive correlation between METS-IR and GSD risk, with each unit increase in METS-IR associated with a 3.5% increase in GSD prevalence (OR=1.035, 95% CI:1.027-1.042). After converting METS-IR into categorical variables based on quartiles, the results indicated that the prevalence of GSD in the highest quartile group was 2.268 times that of the lowest quartile group (OR=2.268, 95% CI:1.827-2.709). In various subgroups categorized by age, gender, and gallstone subtype, METS-IR remained significantly positively correlated with the risk of GSD.

Insulin resistance significantly increases the risk of GSD. In the future, screening should be implemented for high-risk populations with insulin resistance to enable early detection and reduce the disease burden of gallstone disease.

To systematically evaluate the application effects of different types of machine learning (ML) models in predicting intensive care unit length of stay (ICULOS) in adult patients.

By searching China National Knowledge Infrastructure (CNKI), Wanfang Database, and English databases PubMed and Web of Science, we collected studies on machine learning to predict ICULOS in adult patients published from the establishment of the database to October 2025, screened the included literature, and performed Meta-analysis using RStudio.

A total of 40 articles were included, among which the three most frequently used models were random forest (RF), extreme gradient boosting (XGBoost), and gradient boosting machine (GBM) models. The overall prediction performance was good, with a combined area under curve (AUC) of 0.82 (95% CI: 0.79-0.85). Among the prediction models for ICULOS in adult patients with cardiovascular-related diseases, XGBoost had the best prediction effect (AUC=0.88, 95% CI: 0.86-0.93). Among the prediction models for ICULOS in adult patients with central nervous system-related diseases, mixed models showed the best predictive performance (AUC=0.90). In the prediction models of ICULOS of adult patients with other diseases and undifferentiated disease types, RF had the best prediction effect (AUC_{other specific diseases}=0.89, 95% CI: 0.84-0.94; AUC_{undifferentiated diseases}=0.95).

ML showed good performance in predicting ICULOS of adult patients. In the prediction of ICULOS of adult patients with different diseases, the appropriate ML model should be selected in combination with the specific disease and data structure.

To examine the effects of the residential built environment on obesity among adults, and to provide evidence to inform built environment optimization for the prevention and control of overweight and obesity.

This cross-sectional study included individuals who underwent health examinations at the Health Management Center of Renmin Hospital of Wuhan University between May and August 2023. Of 1 672 examinees, 1 349 participants who met the inclusion criteria and had complete data were included in the analysis. Information on long-term residential address, residential floor, sex, age, and body mass index (BMI) was collected, and spatial analysis methods were applied to quantify environmental characteristics surrounding participants’ residential locations. Least Trimmed Squares (LTS) regression and logistic regression models were used to assess the associations between environmental factors and BMI, as well as overweight/obesity status. Generalized linear mixed models (GLMMs) were employed to examine the relationship between residential floor level and the likelihood of overweight/obesity.

Among the 1 349 participants, the prevalence of overweight and obesity was 36.4% and 11.0%, respectively. Higher accessibility to transportation facilities (coef=0.324, P<0.001) and dining facilities (coef=0.233, P=0.006) were associated with increased BMI. Greater accessibility to transportation facilities (OR=1.141, 95% CI:1.000-1.302) and exercise facilities (OR=1.177, 95% CI: 1.017-1.362) were associated with a higher risk of overweight/obesity. As residential floor level increased, the probability of overweight/obesity first increased and then decreased, reaching a peak at around the 14th floor.

BMI and the likelihood of overweight/obesity were associated with multiple environmental factors. Residential floor level affected the probability of overweight/obesity, which may be related to stair-related physical activity and the indirect influence of individual characteristics across different floor levels.

To investigate the associations between single and mixed exposure to per- and polyfluoroalkyl substances (PFAS) and the metabolic score for insulin resistance (METS-IR), and to explore the modifying effects of sex, age, and body mass index (BMI).

Data on serum concentrations of perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and METS-IR were obtained from 2 345 participants aged 20-80 years in the National Health and Nutrition Examination Survey (NHANES) 2013—2018. We employed weighted linear regression and restricted cubic splines to examine linear and nonlinear associations of single PFAS exposure with METS-IR. The joint effects and key driver components of PFAS mixtures were assessed using weighted quantile sum regression, quantile g-computation, and Bayesian kernel machine regression. Subgroup analyses were conducted to assess potential effect modification by sex, age, and BMI.

All five PFAS were inversely associated with METS-IR, with PFHxS exhibiting a nonlinear relationship with METS-IR (q_nonlinear=0.021). A higher mixed PFAS exposure index was inversely associated with METS-IR (β^=-0.329, 95% CI: -0.583~-0.08, P=0.001), with PFDA being the primary driver (w=0.625). The mixture effect was significant in males, the elderly, and individuals with obesity (all q<0.05).

PFAS exposure is inversely associated with METS-IR, with PFDA being the key component driving the joint effect. Future prospective cohort studies are needed to validate these findings and elucidate the underlying mechanisms.

To analyze trends in energy and macronutrient intake among adults aged 35 years and older in Guizhou Province from 1991 to 2023, and examine their associations with demographic characteristics such as gender, urban/rural residence, and age groups, so as to provide scientific evidence for formulating targeted nutrition improvement measures.

This study utilized cross-sectional data from the China Health and Nutrition Survey (CHNS) spanning 1991—2023, focusing on adult residents aged 35 years and older in Guizhou Province. Dietary data were collected using a three-day 24-hour recall method combined with household weighing techniques. Energy and nutrient intakes were calculated based on the Chinese Food Composition Table. To control for changes in age-sex structure over time, data were weighted using direct standardization (with the 2023 age-sex distribution as the standard population). Macronutrient energy contributions were adjusted using the energy residual method. Linear regression models analyzed long-term trends in major food groups and macronutrient energy contribution ratios, estimating annual change values (β) and their 95% confidence intervals (95% CI). Interaction terms were introduced to test for trend differences across urban/rural areas, gender, and age groups. The models were adjusted for education level, smoking history, and drinking history.

A total of 8 596 adult residents aged 35 years and older in Guizhou Province were surveyed. Between 1991 and 2023, residents’ intake of vegetable oils and animal-based foods increased, while intake of animal fats and cereals/tubers decreased (P<0.001). The carbohydrate energy contribution decreased from 66.3% to 43.7% (β=-0.644, 95% CI: -0.681～-0.608), while the energy contribution from fats increased from 22.8% to 46.6% (β=0.669, 95% CI: 0.630～0.707). The energy contribution from proteins remained relatively stable (β=-0.024, 95% CI: -0.032～-0.017). Interaction analysis revealed that the rate of increase in fat energy contribution was significantly faster among rural residents than among urban residents (β=0.613, 95% CI: 0.545-0.682). Additionally, rural residents exhibited faster growth in plant oil and animal-based food intake, along with a more pronounced decline in cereal and tuber consumption (all P<0.001). Compared with adults aged 60 years and older, the 35-44 and 45-59 age cohorts exhibited more pronounced trends of increasing fat intake and decreasing carbohydrate intake (P<0.01).

From 1991 to 2023, the dietary patterns of adults aged 35 and older in Guizhou Province underwent a rapid shift from a traditional high-carbohydrate model to a high-fat model, with the fat energy contribution ratio far exceeding the upper limit recommended by dietary guidelines. The pace of this transformation exhibited significant population heterogeneity, with rural residents and middle-aged and young adults experiencing more rapid changes. This suggests that future nutrition intervention measures require greater targeting.

To analyze the spatiotemporal trends in the global disease burden of breast cancer attributable to excessive red meat intake from 1990 to 2021, explore the causal relationship between red meat consumption and breast cancer, and provide a scientific basis for nutritional interventions in breast cancer.

Based on data from the Global Burden of Disease (GBD) study, mortality and disability-adjusted life years (DALYs) were used as evaluation indicators. Joinpoint regression and age-period-cohort models were employed to analyze trends and effects. Mendelian randomization (MR) was utilized to infer the causal association between red meat consumption and breast cancer.

The disease burden exhibited a distribution pattern characterized by “low in Africa and Asia, and medium-to-high in Europe, the Americas, and Oceania”. From 1990 to 2021, the age-standardized mortality rate and DALY rate decreased by 19.22% and 14.87%, respectively, with a slight increase observed after 2015. Between 2019 and 2021, indicators in both males and females showed a short-term increase. The average annual percentage changes in mortality and DALYs were -0.717% and -0.536%, respectively. The decline in mortality was slightly greater in females than in males, while the decline in DALYs was greater in males. The peak disease burden occurred in the 47.5-52.5 years age group, with a resurgence of risk observed in the 1992 birth cohort. MR analysis confirmed a causal relationship between high beef intake and breast cancer (univariate IVW OR=1.511; multivariable IVW OR=3.390), while no definitive association was found for pork or lamb.

The global disease burden of breast cancer attributable to excessive red meat intake has generally declined, though spatial and gender differences exist, along with a recent resurgence. Excessive beef consumption is a potential risk factor for breast cancer. Differentiated nutritional intervention strategies should be developed, focusing on controlling excessive beef intake and monitoring red meat consumption trends in younger cohorts.

To investigate the association of calcium supplementation dosage and timing with blood pressure among pregnant women aged 30 years and older in Chengdu.

Pregnant women with singleton pregnancies aged ≥30 years who delivered at a hospital in Chengdu between January 2022 and December 2024 were enrolled. Baseline characteristics, calcium supplementation information, and blood pressure data during pregnancy were collected. Multiple linear regression models were employed to analyze the association between calcium supplementation and blood pressure. Dose-response analysis was conducted within the supplementation group, and sensitivity analysis was performed using the magnitude of blood pressure increase during pregnancy as the outcome.

A total of 796 pregnant women with singleton pregnancies aged ≥30 years were included, with a median age of 32 years, and 46% received calcium supplementation during pregnancy. After adjusting for confounding factors, the calcium supplementation group showed a mean reduction of 4.29 mmHg (P<0.001) in systolic blood pressure (SBP) and 3.82 mmHg (P=0.048) in diastolic blood pressure (DBP) compared to the non-supplementation group. For every 100 mg/d increase in calcium intake, SBP decreased by 0.45 mmHg (P=0.016) and DBP decreased by 0.27 mmHg (P=0.009). Stratified analysis revealed that the most significant blood pressure-lowering effect occurred in those who initiated supplementation pre-pregnancy (SBP: β=-4.71, P<0.001; DBP: β=-4.32, P=0.031). Calcium supplementation was associated with a reduction in SBP among the 30-34 age group (β=-5.02, P<0.001), while no statistically significant difference was observed in the ≥35 age group. Furthermore, sensitivity analysis demonstrated that the magnitude of increase in SBP and DBP during pregnancy was reduced by an average of 1.09 mmHg (P=0.040) and 0.63 mmHg (P=0.037), respectively, in the supplementation group compared to the non-supplementation group.

Calcium supplementation during pregnancy is significantly associated with lower blood pressure levels among pregnant women aged ≥30 years, demonstrating a clear dose-response relationship. The blood pressure-lowering effect is more pronounced with earlier initiation of supplementation, particularly in the population aged 30-34 years.

The aim was to analyze the incidence, birth, and intervention status of fetal complex congenital heart defects (CCHDs) in Guangxi Zhuang Autonomous Region (Guangxi), providing a basis for preventing and controlling CCHDs.

Based on data from the Guangxi Birth Defects Surveillance Network (2017—2022), all fetuses and perinatal infants delivered in maternity care institutions were included. CCHDs were diagnosed according to ICD-10 standards and provincial guidelines. The incidence rate (overall, <28 weeks, and ≥28 weeks), birth rate, and intervention rate for CCHDs were calculated. Python 3.12 was utilized to perform trend tests, intergroup comparisons, and risk ratio (RR) analyses.

Between 2017 and 2022, the overall incidence rate of fetal CCHDs was 10.21 per 10 000. The incidence rate for fetuses <28 weeks of gestation (8.50 per 10 000) was significantly higher than that for fetuses ≥28 weeks (1.72 per 10 000). The birth rate was 0.79 per 10 000. Between 2017 and 2022, the overall incidence and the incidence in the <28 weeks group showed a significant increasing trend (β>0, P<0.001), while the incidence in the ≥28 weeks group showed a significant decreasing trend (β=-0.075, P<0.001). The overall incidence was significantly higher in male fetuses (11.49 per 10 000) than in females (8.04 per 10 000) (RR=1.428). The incidence was significantly higher among mothers aged ≥35 years compared to the appropriate-age group (P<0.001). The overall intervention rate for CCHDs was 88.43%. The intervention rate was significantly higher in the <28 weeks group (97.47%) than in the ≥28 weeks group (43.55%). The top 10 most frequent CCHDs subtypes were complete atrioventricular septal defect, tetralogy of Fallot, single ventricle, double outlet right ventricle, complete transposition of the great arteries, pulmonary atresia, persistent truncus arteriosus, hypoplastic left heart syndrome, coarctation of the aorta, and hypoplastic right heart syndrome.

The incidence of fetal CCHDs in Guangxi has shown an increasing trend, and male fetuses and older pregnant women were identified as high-risk groups. Although early intervention (<28 weeks) was highly effective, the rate of intervention at ≥28 weeks was insufficient, suggesting a need to optimize the diagnosis and management pathway during late pregnancy.

To systematically analyze key barriers and facilitators to the implementation of community-based atrial fibrillation (AF) screening using the consolidated framework for implementation research (CFIR), thereby informing the optimization of implementation strategies for community-based AF screening in primary care.

From September to December 2024, purposive sampling was used to recruit 26 healthcare workers from Yuexiu District, Guangzhou, including 24 primary healthcare workers and 2 cardiologists from tertiary hospitals, for semi-structured interviews. A hybrid analytical strategy was adopted, combining CFIR-guided directed content analysis with frequency counts of CFIR constructs and their subdimensions, distinguishing barrier and facilitator attributes. The top 10 most frequently mentioned factors were identified separately among barriers and facilitators as key determinants of community AF screening implementation.

The barriers to implementing community-based AF screening were primarily identified at the individual level (5 factors) and in the inner setting (3 factors). The top 3 most frequently cited barriers were: insufficient primary care workforce, inadequate AF-related knowledge among primary care providers and residents’ low preference for community-based healthcare services. The facilitators primarily emerged in the inner setting (5 factors). The top 3 most frequently cited facilitators were: performance-linked incentives for screening teams, enhanced diagnostic and treatment capacity and confidence in AF management through support from tertiary hospitals, and clear delineation of responsibilities within screening teams.

The successful implementation of community AF screening is influenced by multiple factors. Implementation strategies should be developed based on the local context and targeted at key influencing factors.

To evaluate the effect of reporting immunization information by smartphone in border areas.

A total of five townships in Tengchong City, a border area of Yunnan Province, were randomly selected as project areas. All the village clinics in the project areas changed the previous computer reporting mode and used smartphones to report immunization information. Six months after the implementation of the project, the quality of information reporting and vaccination coverage rate of immunization program were compared before and after the implementation, and the satisfaction of information reporting staff was investigated.

After six months of using smartphones to report immunization information, the complete rate of children’s information reporting increased by 6.26%, the timely rate of vaccine information reporting increased by 74.59%, the complete rate of vaccine information reporting increased by 85.23%, the accuracy rate of vaccine information reports calculated on a per-child basis increased by 22.67%, the overall coverage rate of immunization program vaccines increased by 8.30%, and the vaccination coverage rates of PV4, DT, MCV2, and MenAC2 all increased, with only the HepB2 vaccination coverage rate decreasing. The satisfaction rate of information reporters towards using smartphones to report immunization information was 92.16%.

It is possible to use smartphones to report immunization information in border areas. The use of smartphones to report immunization information in village clinics with small vaccination volumes, lack of wired broadband or computers, and low computer operation skills of personnel, as well as temporary vaccination units and household vaccination, has certain applicability.

To conduct a quantitative analysis of national level suicide prevention policies and provide reference recommendations for refining and optimizing such policies.

Policies issued at the national level from January 2000 to December 2024 were retrieved from government websites, including those of the State Council, the National Health Commission, the Ministry of Education, and the Ministry of Civil Affairs, and analyzed using content analysis.

A total of 49 policy documents were included. In the X dimension, supply-oriented, environmental, and demand-oriented policy tools accounted for 37.9%, 53.9%, and 8.2%, respectively. On the Y-dimension, implementing entities were predominantly government departments (34.59%), followed by medical and mental health institutions (32.33%), social organizations (13.53%), media platforms (9.77%), and schools (9.77%). The Z-dimension policy intensity scored an average of 2.04 points.

China’s suicide prevention policies exhibit structural imbalances in tool composition (dominated by environmental and supply-side measures with weak demand-side support), uneven distribution of implementing entities, and insufficient policy intensity. Recommendations include optimizing the policy tool mix, improving coordination mechanisms among implementing entities, and elevating both the policy level and implementation intensity to provide stronger institutional support for related work.

To analyze the current status and efficiency optimization pathways of mental health resource allocation in Province S and to provide empirical evidence for optimizing provincial resource allocation and improving resource utilization efficiency.

Based on mental health resource data from 16 prefecture-level cities in Province S in 2024, this study employed Data Envelopment Analysis (DEA) to evaluate the efficiency of resource allocation and used Fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify configurational conditions associated with different efficiency levels.

Mental health resources in Province S have exhibited rapid growth but remain unevenly distributed overall. Among the 16 prefecture-level cities in Province S, only four cities, namely JN, DY, WF, and WH achieved strong DEA efficiency, with an average overall efficiency score of 0.829. Three high-efficiency configurational pathways were identified, namely the economic support-oriented, service-driven, and resource integration-oriented types, with an overall consistency of 0.808. In addition, one low-efficiency pathway, characterized by input imbalance, was identified, with an overall consistency of 0.907.

The overall efficiency of mental health resource allocation in Province S still has considerable room for improvement. Prefecture-level cities can optimize the layout and supply patterns of mental health resources according to their specific configurational characteristics and local conditions, and explore context-specific pathways to enhance the overall performance of the provincial mental health service system.

To examine the association between social activity participation and incident cognitive impairment (CI) and to quantify the delay in onset among middle-aged and older adults in China.

Using five waves of longitudinal data from the China Health and Retirement Longitudinal Study (2011—2020), 9 245 participants without baseline CI were included in the study. A multi-state Markov model was constructed, and Cox models were used to estimate the association between social activity frequency and CI occurrence. Discrete-time Markov multi-state models and cumulative transition risks were utilized to compare the onset time differences between high and low social participation scenarios.

Each 1 SD increase in social activity frequency was associated with a 10.36% lower risk of CI (HR=0.896, 95% CI: 0.864-0.928). Compared with low participation, high participation delayed the first CI occurrence by 0.81 years (95% CI: 0.64-1.13 years). Stratified analysis showed that males, those aged <65 years, those with higher education levels, urban residents, and those without chronic diseases were associated with longer delays in onset; whereas among females, those with higher education levels, and those with chronic diseases, the delay benefit of more frequent social participation was more pronounced.

Higher social participation is associated with both a lower CI risk and a later onset, with particularly notable delay among older adults with chronic conditions. Integrating social participation with chronic disease management may be a useful public-health strategy to prevent cognitive impairment among middle-aged and older adults in China.

To explore the impact of combined trajectories of sleep duration and sleep quality on diabetes risk among middle-aged and older adults, providing evidence for precision prevention and control of diabetes.

Data of the China Health and Retirement Longitudinal Survey from 2011 to 2015 were analyzed to identify the combined trajectories of sleep duration and sleep quality, employing group-based multi-trajectory modeling (GBMTM). The prevalence of diabetes among middle-aged and older adults was tracked using data from 2015 to 2020. The effect of different combined trajectories of sleep duration and sleep quality on diabetes risk was examined using Cox proportional hazards regression models. Meanwhile, subgroup analyses were conducted.

A total of 8 735 middle-aged and older adults were included. Four combined trajectories of sleep duration and sleep quality were identified: increasing sleep duration-limited improvement in sleep quality trajectory (n=1 200, 13.74%, trajectory group 1), stable short sleep duration-stable poor sleep quality trajectory (n=828, 9.48%, trajectory group 2), stable normal sleep duration-stable good sleep quality trajectory (n=5 505, 63.02%, trajectory group 3), and decreasing sleep duration-deteriorating sleep quality trajectory (n=1 202, 13.76%, trajectory group 4). Cox proportional hazards regression modeling showed that, compared with the trajectory group 3, trajectory group 1 (HR=1.29, 95% CI: 1.03-1.63), trajectory group 2 (HR=1.54, 95% CI: 1.19-1.98), trajectory group 4 (HR=1.42, 95% CI: 1.14-1.78) had a higher risk of diabetes. In the subgroup analyses, there was an interaction between sleep duration and sleep quality trajectories and gender (P=0.047).

Among middle-aged and older adults, individuals in trajectory group 1, trajectory group 2, and trajectory group 4 had an increased risk of diabetes.

To analyze the prevalence and usage of smart health and eldercare devices among middle-aged and older adults in Yunnan Province, and to compare disparities across different groups.

A stratified random cluster sampling method was employed. Face-to-face questionnaire surveys were conducted among adults aged 45 and above from 6 prefectures (cities) in Yunnan Province, yielding 2 595 valid questionnaires. Data were analyzed using Stata 15.1.

The prevalence of devices ranked as follows: smartphones (83.55%), smart TVs (77.88%), video surveillance (36.30%), etc., with fall alarms being the lowest (1.19%). A notable decline was observed from device ownership rate to usage rate and proficiency rate, indicating an “ownership-usage-proficiency” efficacy decay. Smartphones had the highest prevalence (83.55%) and regular usage rate (60.42%), while smart TVs had the highest proficient usage rate (49.83%). Fall alarms had the lowest rates in prevalence (1.19%), regular usage (0.35%), and proficient usage (0.19%). Significant differences in device prevalence, regular usage rate, and proficient usage rate were found across ethnic and age groups, whereas no significant differences were observed between genders.

The prevalence and use of smart health and eldercare devices (except for smart cell phones and TVs) among the middle-aged older adults in Yunnan Province are low overall, and there are significant ethnic and age differences.

To explore the longitudinal evolutionary trajectories of active health behaviors among older adults with multiple chronic conditions, analyze the impact of different evolutionary patterns on healthcare utilization, and provide evidence for formulating healthy aging policies.

Based on the China Health and Retirement Longitudinal Study (CHARLS, 2011—2020), participants who were aged ≥60 years at baseline, had ≥2 comorbid chronic diseases, and provided complete follow-up data were included. A 5-dimensional active health index (AHI), covering physical activity, social participation, and other dimensions, was constructed, and latent transition analysis (LTA) was used to classify the trajectories. Generalized linear mixed models (GLMMs) and multivariable logistic regression were employed to analyze the associations, and subgroup and sensitivity analyses were conducted to verify the robustness of the results.

A total of 96 628 participants were enrolled and categorized into three AHI trajectory groups: 19.9% in the “sustained improvement group”, 32.5% in the “long-term stable group”, and 47.6% in the “gradual decline group”. Compared with the gradual decline group, the sustained improvement group had fewer outpatient visits (negative binomial regression coefficient β=-0.21, P<0.001), a lower hospitalization risk [odds ratio (OR) =0.82, 95% confidence interval (CI) : 0.78-0.86, P<0.001], and reduced annual medical expenses (log-normal regression coefficient β=-0.33, P<0.001). A similar trend was observed in the long-term stable group (outpatient visits: β=-0.13;hospitalization: OR=0.87, 95% CI: 0.83-0.91; medical expenses: β=-0.20;all P<0.001). These associations remained robust after stratified analysis, with slightly stronger effects observed in females and urban residents.

Significant heterogeneity exists in the evolution of active health behaviors among older adults with multiple chronic conditions. Long-term stability or improvement of these behaviors can reduce healthcare utilization and alleviate economic burden. Behavior-based health promotion strategies are feasible approaches to achieve healthy aging and optimize the allocation of medical resources.

To investigate the prognostic value of cytoplasmic poly (A)-binding protein 1 (PABPC1) expression, alone and in combination with Ki-67 and P53, in evaluating chemotherapy prognosis in patients with triple-negative breast cancer (TNBC).

A retrospective analysis was conducted on the clinicopathological data of 155 patients diagnosed with and treated for TNBC at the Affiliated Hospital of Southwest Medical University between January 2014 and December 2021. Immunohistochemistry was employed to detect the expression levels of PABPC1, Ki-67, and P53 in tumor tissues. Their correlations with patient overall survival (OS) and disease-free survival (DFS) were subsequently analyzed.

Among the 155 patients included in the study, high PABPC1 expression was observed in 59 cases (38.1%), Ki-67 positivity in 119 cases (76.8%), and P53 positivity in 70 cases (45.2%). PABPC1 expression, patient age, and pathological stage significantly influenced the postoperative survival of TNBC patients. In contrast, tumor location, clinical stage, lymph node metastasis, HER-2 expression, Ki-67 expression, and P53 expression were not significantly associated with survival. In the patient subgroup with high PABPC1 expression, those who received postoperative chemotherapy demonstrated improved OS compared to those who did not, although this difference did not reach statistical significance. However, within the subgroup of patients exhibiting both high PABPC1 expression and Ki-67 positivity, those who received postoperative chemotherapy had a significantly longer OS compared to their counterparts who did not undergo chemotherapy.

TNBC patients with low PABPC1 expression exhibit favorable survival outcomes, irrespective of whether they receive chemotherapy. Conversely, patients with high PABPC1 expression have a poorer prognosis. The combined assessment of PABPC1 and Ki-67 holds clinical significance, as patients displaying both high PABPC1 expression and Ki-67 positivity may derive substantial benefit from postoperative adjuvant chemotherapy.

Based on the social cognitive theory, this study aimed to examine the mediating role of outcome expectations in the relationship between physician-patient trust and medication adherence among older adults living with HIV, so as to provide evidence for developing effective intervention strategies.

A cross-sectional survey was conducted from July to October 2024 in six districts (counties, county-level cites) of Xiangyang City, using a stratified random sampling method. Data were collected using the Morisky Medication Adherence Scale, the Physician-Patient Trust Scale, and the Outcome Expectations Scale. Hierarchical regression analysis was employed to test the mediating effect of outcome expectations.

A total of 203 valid samples were obtained. The analysis revealed that factors such as gender, place of residence, average monthly household income, occupational status, alcohol consumption, and adverse drug reactions had significant effects on medication adherence (P<0.05). Physician-patient trust and outcome expectations were significantly positively correlated with antiretroviral medication adherence (r=0.37, P<0.001). Outcome expectations played a partial mediating role between physician-patient trust and medication adherence, with a mediation effect of 10%.

Physician-patient trust can significantly improve medication adherence in older adults with HIV by enhancing their positive outcome expectations. It is recommended that antiretroviral therapy programs for this population focus on strengthening patients’ positive perceptions of treatment benefits to improve their medication adherence.

Based on the surveillance data of brucellosis in Hubei from 2010 to 2023, this study explores its epidemiological characteristics and contributing factors. The findings may serve as a decision-making reference for developing targeted prevention and control mechanisms and optimizing current intervention strategies.

The data in this research were obtained from the National Notifiable Infectious Disease Surveillance Platform (China CDC Information System). Data organization and preliminary analysis were carried out using Excel, statistical analyses were performed with SPSS 25.0, and spatial geographic distribution maps were generated via ArcGIS 10.2 to visually present the epidemic distribution.

In 2010, the first case of human brucellosis was reported in Hubei. A total of 2 176 cases were reported from 2010 to 2023. The incidence showed a phased fluctuation trend: a budding phase in the initial period (2010—2013), followed by a significant increase in the early stage (2013—2016), a gradual decline in the mid-term (2016—2020), and a resurgence in the later period (2020—2023). The cases exhibited distinct seasonal clustering, and 67.2% of cases occurred between March and August. In terms of spatial distribution, except for Shennongjia, cases were reported in the other 16 cities (prefectures) of the province, and core high-incidence areas included Suizhou City, Jingmen City, Xiangyang City, Xianning City, and Huanggang City. The coverage rate of cases in counties and districts reached 93.2%. Demographic analysis revealed that people aged 40 to 69 accounted for 72.6% of cases, with a male-to-female ratio of 2.4:1. Occupational distribution was dominated by farmers (69.1%). The median diagnostic delay period (interval from symptom onset to diagnosis) was 9 days, showing a gradual shortening trend over the years. Suspected cases were most concentrated in Guangshui City and Suixian. A structural shift in case reporting sources was observed: the proportion of cases reported by municipal medical institutions increased, while the share from county-level institutions increased initially before declining. In contrast, the contribution from disease control centers saw a significant drop.

From 2016 to 2020, the incidence of human brucellosis in Hubei continued to decline, indicating partial success in its ovine brucellosis eradication campaign launched in early 2015. However, a significant resurgence occurred post-2020, with the epidemic demonstrating geographical expansion from northern Hubei to southern Hubei and from eastern Hubei to western Hubei. It is imperative to establish a coordinated mechanism for zoonotic diseases through cross-sectoral collaboration to enhance the surveillance, prevention, and control of brucellosis.

To understand the epidemiological characteristics of syphilis among people aged 60 years and above in Hebei Province from 2015 to 2024, and to provide a basis for formulating prevention and control strategies.

Data on syphilis cases reported in Hebei Province from 2015 to 2024 were collected through the Chinese Disease Prevention and Control Information System, and descriptive epidemiological methods were used for analysis.

The number of syphilis cases reported among people aged 60 and above in Hebei Province increased from 2 261 to 3 570, and the reported incidence rate rose from 21.32 per 100 000 to 22.19 per 100 000. The reported incidence rate of primary syphilis showed a downward trend, while that of secondary syphilis showed an initial increase followed by a decrease. The reported incidence rate of tertiary syphilis did not show a linear trend change. The number of reported cases of latent syphilis showed an upward trend. The proportion of primary and secondary syphilis decreased from 26.54% to 6.00%, while the proportion of latent syphilis cases increased from 72.76% to 93.56%. During the ten years, the number of reported cases and the incidence rate among men were higher than those among women each year. The highest average annual incidence rate was observed in the age group of 85 years and older (34.19 per 100 000 population).

The number of syphilis cases reported among people aged 60 and above in Hebei Province has been increasing year by year from 2015 to 2024, with a high proportion of latent syphilis showing an upward trend. This suggests that we should further pay attention to the sexual health of the elderly, and implement targeted prevention and control measures based on their disease characteristics.

To analyze the epidemiological and etiological characteristics of influenza-like illness (ILI) in Jinhua City, Zhejiang Province, during the 2017—2024 surveillance years, and to provide a scientific basis for influenza prevention and control in the city.

ILI surveillance data from sentinel hospitals in Jinhua City during 2017—2024 surveillance years (from week 14 of the current year to week 13 of the following year) were collected through the Chinese Influenza Surveillance Information System and analyzed using descriptive epidemiological methods.

During the 2017—2024 surveillance years, a total of 7 748 309 outpatient and emergency visits were reported, including 426 013 ILI cases, with an overall ILI proportion (ILI%) of 5.50%. The highest ILI% was observed in the 2022 surveillance year (8.75%), while the lowest was recorded in the 2024 surveillance year (2.66%). Marked inter-annual fluctuations in ILI activity were noted: single winter peaks occurred in the 2017—2019 surveillance years. The 2021 surveillance year exhibited multiple cross-seasonal peaks. The 2022 surveillance year showed two peaks, one in summer and the other in late winter and early spring. A single winter peak reappeared in the 2023 surveillance year, and no significant epidemic peaks were detected in the 2020 or 2024 surveillance years. ILI cases were predominantly concentrated in the 0-4 years age group, accounting for 53.45% of all reported cases. A total of 18 911 ILI specimens were tested for influenza virus, of which 3 025 were positive, yielding an overall positive rate of 16.00%. Influenza A and B viruses accounted for 71.17% and 28.56% of positive detections, respectively. Among the identified subtypes and lineages, A (H3N2) accounted for 40.89%, followed by A (H1N1) pdm09 (30.28%), B/Victoria lineage (27.17%), and B/Yamagata lineage (1.39%). No B/Yamagata virus was detected after the 2020 surveillance year. Mixed infections accounted for 0.26%. The ILI% was significantly positively correlated with the influenza virus positivity rate in the 2017, 2018, 2019, 2022, and 2023 surveillance years (P<0.001).

Influenza activity in Jinhua City during the 2017—2024 surveillance years exhibited distinct seasonal fluctuations and pronounced inter-annual variability. Influenza activity was markedly suppressed during the implementation of non-pharmaceutical interventions (NPIs) against COVID-19 and rebounded following their relaxation. The predominant strains alternated across surveillance years, with A (H3N2) accounting for the highest proportion, while B/Yamagata lineage was no longer detected after 2020. Further optimization of the influenza sentinel surveillance system, including strengthening multi-pathogen co-surveillance and integrated data analysis, is needed to provide scientific evidence for precision influenza prevention and control.

To analyze the association between empirical dietary inflammatory pattern (EDIP) and breast cancer risk in women.

From 2013 to 2014, 718 patients with primary breast cancer diagnosed in Wuxi City, Jiangsu Province were included in the case group, and 849 women from the same area, age-matched within ±5 years and with no history of cancer, were included in the control group. A food frequency questionnaire was used to collect information on the types, frequencies, and quantities of food consumed by the subjects in the past 12 months. This study used a multivariable conditional logistic regression model to assess the influence of EDIP on the risk of breast cancer among females, and to calculate the corresponding odds ratio (OR) and 95% confidence interval (CI). The restricted cubic spline (RCS) method was also applied to explore the potential dose-response relationship between EDIP and breast cancer risk. Subgroup analyses were conducted to assess the interactions between EDIP and stratification variables such as age and physical activity.

The median age of the case group was 53 years, with 74.1% of the participants being postmenopausal; while the median age of the control group was also 53 years, and 58.2% of the participants in this group were postmenopausal. Following adjustment for potential confounders, the multivariable conditional logistic regression analysis indicated that the risk of breast cancer increased by 17% (OR=1.17, 95% CI: 1.05-1.31) for each one-standard deviation increase in EDIP. Using the T1 group as the reference, the risk of breast cancer increased by 35% in the T3 group (OR=1.35, 95% CI: 1.03-1.76). There was a positive linear dose-response relationship between EDIP and breast cancer risk (P for overall <0.05, P for nonlinearity >0.05). The association between EDIP and breast cancer was stronger in the subgroups of individuals with low levels of physical activity (P for interaction <0.05).

Elevated EDIP was associated with an increased risk of breast cancer in Chinese women, but further validation in prospective studies is still needed.

To investigate the association between the high-density lipoprotein cholesterol to cystatin C ratio (HDL-C/CysC) and the risk of chronic kidney disease (CKD) in middle-aged and older Chinese populations.

Utilizing demographic statistics, disease history, physical examination, and blood test data from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2020, we excluded individuals with missing key indicators, pre-existing CKD at baseline, or renal dysfunction. Participants were categorized into quartiles based on HDL-C/CysC ratios. A Cox proportional hazards regression model was employed to examine the relationship between HDL-C/CysC ratio levels and CKD risk, with subgroup analyses conducted by age, sex, and body mass index (BMI).

The study included 6 429 subjects with an age distribution of 59.00 (53.00-66.00) and a 9-year follow-up period. During follow-up, 1 007 incident CKD cases were identified, yielding an incidence density of 20.46 per 1 000 person-years. After adjusting for potential confounding factors, using the lowest quartile (Q1) of HDL-C/CysC ratio as reference, the hazard ratios (HRs) and 95% confidence intervals (CIs) for CKD risk in Q2, Q3, and Q4 were 0.81 (0.68-0.97), 0.50 (0.41-0.61), and 0.22 (0.16-0.29), respectively. A significant inverse association was observed between increasing HDL-C/CysC quartiles and CKD risk (P<0.001).

In middle-aged and older Chinese adults, the HDL-C/CysC ratio is independently and significantly associated with CKD risk. A higher HDL-C/CysC ratio may be a protective factor for CKD.