Objective To analyze the changes in the disease burden of stroke attributable to low physical activity in China from 1990 to 2021, and to provide a scientific basis for the development of prevention and control strategies for stroke. Methods Data on mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for stroke attributable to low physical activity in China from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021. The disease burden of stroke attributable to low physical activity in China was analyzed by gender and age group from 1990 to 2021. The Joinpoint regression model was utilized to analyze the trends in disease burden. Results From 1990 to 2021, the number of deaths, mortality rates, YLLs, YLLs rates,YLDs, YLDs rates, DALYs, and DALYs rates attributable to low physical activity in China showed an upward trend, with increases of 129.80%, 90.48%, 97.39%, 63.26%, 216.74%, 162.17%, 112.94%, and 76.05%, respectively. The age-standardized mortality rate, age-standardized YLLs rate, and age-standardized DALYs rate showed a downward trend, with decreases of 20.14%, 25.68%, and 18.75%,respectively, while the age-standardized YLDs rate has increased by 18.26% compared to 1990. Joinpoint regression analysis results indicated that the average annual percent change (AAPC) for the age-standardized mortality rate, age-standardized YLLs rate, age-standardized DALYs rate, and age-standardized YLDs rate attributable to low physical activity from 1990 to 2021 were-0.72%, -0.96%, -0.68%, and 0.92%, respectively. Gender-stratified analysis revealed that in 2021, the age-standardized mortality rate, age-standardized YLLs rate, and age-standardized DALYs rate attributable to low physical activity were higher in males than in females. Meanwhile, the decline in the age-standardized mortality rate, age-standardized YLLs rate, and age-standardized DALYs rate attributable to low physical activity was more rapid in females compared to males. Age-stratified results indicated that the disease burden of stroke attributable to low physical activity increased with age but showed a trend toward affecting younger individuals. Conclusion The disease burden of stroke attributable to low physical activity in China remains substantial, indicating a need for targeted and comprehensive prevention and control measures, particularly for key populations such as the elderly, males, and middle-aged and young adults.

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

Objective To establish a prediction model to assess the risk of death in patients with Klebsiella pneumoniae (Kp) infection, and to provide a reference for the development of targeted prevention and control strategies for nosocomial infections. Methods Patients with Klebsiella pneumoniae(Kp) infection at the Affiliated Hospital of Guizhou Medical University from January 2020 to December 2022 were used as the training dataset. LASSO-logistic regression was applied to identify independent risk factors for death in Kp-infected patients, and a mortality risk nomogram was constructed. Patients with Kp infection from January 2023 to December 2023 were used as the validation dataset. Model discrimination, accuracy, and clinical utility were comprehensively evaluated using the area under the receiver operating characteristic curve (ROC), the calibration curve, and the decision analysis curve. Results A total of 1 972 Kp-infected patients were included in the training dataset, of which 234 Kp-infected patients died with a mortality rate of 11.87%. A total of 1 148 Kp-infected patients were included in the validation dataset, of which 126 Kp-infected patients died with a mortality rate of 10.98%. The results of LASSO-logistic regression modeling showed that patients aged >70 years, carbapenem resistance, mechanical ventilation, indwelling urinary catheter, diabetes mellitus, hematologic infections, white blood cell count >10×10⁹/L and hemoglobin <115 g/L were all associated factors for death in patients with Kp infection (OR=24.6, 95% CI: 16.56-39.38; OR=2.44, 95% CI: 1.70-3.52; OR=4.97, 95% CI: 3.08-8.21; OR=2.99, 95% CI: 1.75-5.19; OR=18.24, 95% CI: 9.27-38.12; OR=2.75, 95% CI: 1.69-4.49; OR=4.18, 95% CI: 2.88-6.09; OR=2.65, 95% CI: 1.79-3.93). The areas under the ROC curve of the training dataset and validation dataset were 0.900 (95% CI: 0.876-0.924) and 0.843 (95% CI: 0.812-0.874), respectively. The calibration curve was close to the baseline curve, and the decision analysis curve was close to the upper right corner. Conclusion By analyzing the factors related to the death of Kp-infected patients, we constructed a nomogram prediction model of the risk of death of Kp-infected patients, which has good accuracy, discrimination, and clinical utility, and according to which targeted nosocomial infection prevention and control measures can be implemented.

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

Objective This study investigates the mediating effects of general self-efficacy and social participation on the relationship between physical function and physical resilience (PR) among older adults. Methods The elderly in five communities selected by cluster sampling in Xinxiang City were surveyed using the Simplified Physical Fitness Test Scale,Physical Resilience Scale, General Self-Efficacy Scale, and the Social Participation Scale from March to November 2024.Descriptive statistics, variance analysis, and correlation analysis were conducted, and a chain mediation effect model was constructed using Mplus 8.3. Results A total of 1 071 elderly people in the community were surveyed, the PR score of the elderly in the community was (48.81±5.66), and the PR of the elderly was positively correlated with physical function, general self-efficacy, and social participation (all P<0.05). After including control variables such as age, sleep duration, and living arrangement, general self-efficacy and social participation played a chain mediating effect between physical function and PR,with a mediating effect value of 0.311, accounting for 55.24% of the total effect. Conclusion Physical function in the elderly can directly affect PR, and can also indirectly affect PR through general self-efficacy and social participation. The PR of older adults can be improved by improving their physical functioning, self-efficacy, and social participation.

Objective Based on the Python platform, the entire process of vector-borne infectious disease mathematical models is expanded to better fit models and evaluate intervention effects, to provide new ideas for grassroots prevention and control, and to open up new perspectives. Methods The SmEmIm-SpEpIpApRp model was fitted using the lmfit library, solved with the solve_ivp function, and sensitivity analysis of key model parameters was performed. The Rt calculation was based on the next generation matrix method, and all results were visually displayed with the help of Matplotlib. Results The results showed that R²=0.98 and RMSE=2.07. Rt was 5.607 in the early stage of the epidemic, and Rt_peak was 8.439 on day 41. The period with Rt>1 lasted 81 days, and q had the highest sensitivity (S=35.435). Under a single intervention, when β_mp and β_pm<0.01, Rt<1 and the epidemic disappeared. Controlling only γ and q would not eliminate the epidemic. Under comprehensive intervention, Scenario 1 could reduce the cumulative cases by 98.64%, and Rt_peak=0.868. Scenario 2 could reduce the cumulative cases by 87.95%,and Rt_peak=1.988. For Scenario 3, Rt_peak=4.78. Although the increase in Rt was smaller and the change rate was low, the longer duration could increase cumulative cases by 161.47%. Scenario 4 could reduce the cumulative cases by 99.38%, and Rt_peak=0.28. Conclusions The high goodness of fit of the model based on the Python platform verifies the necessity of seasonal dynamic modeling, provides an integrated solution for the prevention and control of vector-borne infectious diseases, expands the practical boundaries of theoretical models, and opens a new perspective for precise prevention and control at the grassroots level.

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

Objective To investigate the association between the dietary index for gut microbiota (DI-GM) and metabolic syndrome (MetS), thereby providing a theoretical basis for preventing MetS through dietary modulation of the gut microbiome. Methods Data from 17 558 adults participating in the 2007—2018 U.S. National Health and Nutrition Examination Survey (NHANES) were analyzed, with MetS determined according to the NCEP ATP III criteria. The DI-GM score was constructed based on 14 food items or nutrients obtained from two 24 hour dietary recalls. Logistic regression models and restricted cubic spline (RCS) analysis were used to evaluate the relationship between DI-GM and MetS, and subgroup as well as sensitivity analyses were conducted. Results In the fully adjusted model, the risk of MetS decreased with increasing DI-GM scores (OR=0.94, 95% CI: 0.91-0.98). Specifically, individuals in the highest DI-GM quartile (Q4) had an 18% lower risk of MetS than those in the lowest quartile (OR=0.82, 95% CI: 0.72-0.95). RCS analysis indicated a linear inverse dose-response relationship between DI-GM and MetS (P for nonlinear=0.185). Subgroup analyses showed the inverse association was stronger in females, non-Hispanic Black individuals, and those with higher education levels(P for interaction<0.05). Sensitivity analyses confirmed the stability of the results(OR=0.94, 95% CI: 0.90-0.98). Conclusion This study demonstrates that maintaining a diet favorable to gut microbiota health can reduce the risk of MetS. These findings suggest that improving dietary patterns to modulate the gut microbiome may offer a novel strategy for the prevention and management of MetS.

Objective To examine the relationship between body roundness index (BRI) and depression risk in individuals with hyperlipidemia. Methods Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2005—2018, including 20 492 adults with hyperlipidemia. Multivariable logistic regression and restricted cubic spline analyses were used to analyze the association between BRI and depressive status. Results Multivariable analysis revealed a significant U-shaped relationship between BRI and depression risk (P=0.002), with an inflection point at 3.15. For BRI<3.15, each unit increase in BRI was associated with a 33% decrease in depression risk (OR=0.67, 95% CI: 0.50-0.88, P=0.004 3). For BRI≥3.15, each unit increase in BRI was associated with a 7% increase in depression risk (OR=1.07, 95% CI: 1.04-1.09, P<0.000 1). In tertile analysis, the highest BRI tertile showed a 30% increased risk of depression compared to the lowest tertile(OR=1.30, 95% CI: 1.13-1.49, P=0.000 2). Conclusion There is a U-shaped relationship between BRI and depression risk in individuals with hyperlipidemia, suggesting that both excessively low and high BRI values may increase the risk of depression.Large prospective cohort studies are needed to validate these findings.

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

Objective To explore the spatiotemporal characteristics of pulmonary tuberculosis (TB) in China and its macro influencing factors, and to provide a theoretical basis for the formulation of TB prevention and control measures. Methods The data of tuberculosis incidence in China from 2011 to 2020 were collected. A two-stage distributed lag nonlinear model (DLNM) was constructed to assess the lag effect and nonlinear relationship of meteorological factors on TB incidence, and a hierarchical Bayesian spatiotemporal model was used to analyze the relationship between population, economic factors, health services, and TB incidence. Results TB incidence in China was on a downward trend, with spatial clustering, and there were intensifying hotspots (Sichuan Province) and persistent hotspots(Liaoning Province, Shaanxi Province). The attributable fractions of low temperature(<6.7 ℃), low relative humidity(<55.59%), high wind speed(>3.00 m/s), and short sunshine duration(<2.7 hours) were 14.44%, 5.75%, 3.30%, and 7.88%, respectively. The urbanization rate(RR=1.009, 95% CI: 1.007-1.012) and the night light index (RR=1.009, 95% CI: 1.007-1.013) were positively correlated with TB incidence, while the number of hospital beds(RR=0.996, 95% CI: 0.994-0.998) and the proportion of elderly population (RR=0.973, 95% CI: 0.969-0.979) were negatively correlated with it. Conclusion The TB incidence in China has generally shown a downward trend. Attention should be paid to the prevention and control of hotspots, and the monitoring of macro influencing factors should be strengthened to take intervention measures as early as possible.

Objective To observe the effects of oxygen enrichment on blood oxygen saturation and heart rate in plateau migrants. Methods Oxygen-enriched rooms were created at altitudes of 4 200 m and 5 100 m using different enclosed spaces, maintaining oxygen volume percentages at approximately 25% and 27%, respectively. Changes in blood oxygen saturation and heart rate at different time points before and after oxygen enrichment were compared among subjects. Results Achieving 25%and 27% oxygen concentrations in various enclosed spaces at 4 200 m and 5 100 m required total oxygen volumes of 200-3 840 L, with average oxygen consumption of 32-88.7 L/m³, and maintenance oxygen flow rates of 2-18 L/min. Compared with baseline levels, subjects exhibited significantly increased blood oxygen saturation (P<0.05 or P<0.01) and significantly decreased heart rate (P<0.05 or P<0.01) after oxygen enrichment. Conclusion At 4 200 m and 5 100 m altitudes, increasing oxygen concentrations to 25% and 27%, respectively, can elevate blood oxygen saturation levels and effectively reduce heart rate in subjects. For constructing high-altitude oxygen-enriched rooms, smaller and well-sealed spaces are recommended.

Objective To investigate the effects of spicy diet on male semen quality. Methods This study recruited male volunteers from Chongqing and Puyang, analyzed the impact of spicy diets on male semen quality, and further conducted a stratified analysis by region to verify the stability of the conclusions. Logistic regression evaluated spicy diet’s association with abnormal semen quality (normal/abnormal classification). Results A total of 2 128 subjects were included in the study (1 394 from Puyang and 779 from Chongqing). Linear mixed-effects model analysis revealed that duration of chili consumption was positively correlated with semen volume(β=0.05, 95% CI: 0.01-0.09, P=0.012), sperm concentration (β=1.64, 95% CI:0.35-2.93, P=0.013), total sperm count (β=6.89, 95% CI: 0.89-12.89, P=0.024), progressive motility (β=1.22, 95% CI: 0.75-1.69, P<0.001), VCL (β=0.73, 95% CI: 0.36-1.11, P<0.001), BCF (β=0.24, 95% CI: 0.15-0.32, P<0.001), STR (β=1.31, 95%CI: 0.73-1.90, P<0.001), WOB (β=0.91, 95% CI: 0.22-1.61, P=0.010), and normal morphology rate (β=0.34, 95% CI: 0.18-0.50, P<0.001), while negatively correlated with head defect rate (β=-1.11, 95% CI: -1.54~-0.67, P<0.001) and neck defect rate (β=-1.20, 95% CI: -1.62~-0.77, P<0.001). Weekly frequency of chili consumption showed positive correlations with sperm concentration (β=2.48, 95% CI: 0.05-4.92, P=0.046) and progressive motility (β=1.06, 95% CI: 0.18-1.94, P=0.019). Monthly frequency of chili consumption was positively associated with VSL (β=0.82, 95% CI: 0.32-1.31, P=0.001) and VAP (β=0.85, 95% CI: 0.25-1.46, P=0.006). Both duration and weekly frequency of chili consumption exhibited dose-response protective effects on semen quality, showing progressively decreasing risks of abnormal semen quality with increasing consumption duration and frequency (P_trend<0.001 and 0.042, respectively). Those who had maintained a spicy diet for more than 3 years had a reduced risk of abnormal semen quality. Conclusion Spicy diet is associated with improved semen quality, with long-term consumption potentially reducing abnormality risk.

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

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

Objective To understand the incidence and mortality trends of uterine cancer in tumor registration areas of Shandong Province from 2013 to 2021, and to provide a basis for the prevention and control of uterine cancer. Methods Data were obtained from the Shandong Cancer Surveillance Database. Crude incidence (mortality) rates and age-standardized rates were calculated using Excel 2010 and R 4.4.2. Joinpoint regression was used to calculate the average annual percentage change (AAPC). Results From 2013 to 2021, the crude incidence rate and the Chinese age-standardized incidence rate of uterine cancer among women in tumor registration areas of Shandong Province increased by 4.08% and 2.85% per year, respectively (crude incidence rate AAPC=4.08%, 95% CI: 2.25%-5.95%, P<0.001; Chinese age-standardized incidence rate AAPC=2.85%, 95% CI: 1.02%-4.72%; All P=0.002). Although there was a decrease in crude mortality rate and Chinese age-standardized mortality rate, the difference was not statistically significant (crude mortality rate AAPC=-1.33%, 95% CI: -4.28%-1.71%, P=0.389; Chinese age-standardized mortality rate AAPC=-2.53%, 95% CI: -5.86%-0.91%, P=0.165). The urban incidence rate and mortality were higher than those in rural areas(χ²=513.53, χ²=64.27, both P<0.01). Both the Chinese age-standardized incidence rate in urban areas and the crude incidence rate in rural areas showed upward trends, with annual increases of 3.05% and 3.90%, respectively. Conclusion From 2013 to 2021, uterine cancer among female residents in Shandong Province has shown an upward trend and is a malignant tumor that women should focus on preventing. Early diagnosis and treatment of high-risk groups for uterine cancer should be emphasized, and etiological exploration and research should be strengthened to provide reference for the prevention and treatment of uterine cancer.

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

Objective To analyze the differences in chronic disease multimorbidity trajectories and influencing factors between middle-aged and elderly agricultural and non-agricultural production operators. Methods Data from five waves of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020 were used. Group-based trajectory modeling (GBTM) was applied to fit multimorbidity trajectories for both groups, and multivariable logistic regression analysis was conducted to identify factors influencing the trajectory groups. Results A total of 9 937 participants were included, with 5 010 in the agricultural group and 4 927 in the non-agricultural group. In the agricultural group, the multimorbidity trajectories were classified into three patterns: no-multimorbidity (19.22%, 963 cases), new-onset multimorbidity (56.45%,2 828 cases), and progressive multimorbidity (24.33%, 1 219 cases). In the non-agricultural group, four patterns were identified: no-multimorbidity (18.06%, 890 cases), new-onset multimorbidity (41.10%, 2 025 cases), progressive multimorbidity (33.65%, 1 658 cases), and high-growth multimorbidity (7.18%, 354 cases). Increasing age, obesity, sleep duration ≤6 hours, and poor psychological status significantly increased the risk of multimorbidity in both groups (P<0.05). Among agricultural group, overweight (OR=1.37, 95% CI: 1.14-1.65; OR=2.49, 95% CI: 2.01-3.08) and obesity(OR=2.21, 95%CI: 1.59-3.06; OR=5.58, 95% CI: 3.93-7.92) significantly increased the risks of multimorbidity. In the non-agricultural group, higher education levels reduced the risk of new-onset multimorbidity(OR=0.75, 95% CI: 0.60-0.95), and moderate physical activity decreased the risk of high-growth multimorbidity(OR=0.68, 95% CI: 0.52-0.90). Smoking cessation was significantly associated with increased risks of multimorbidity (OR=1.55, 95% CI: 1.04-2.32; OR=2.37, 95% CI: 1.57-3.57; OR=4.02, 95%CI: 2.31-7.00). Conclusion In agricultural populations, the new-onset multimorbidity type is dominant, driven by obesity and insufficient sleep. In non-agricultural populations, the high-growth multimorbidity type is associated with poor psychological status and health deterioration after smoking cessation. It is necessary to strengthen weight and sleep management for agricultural populations and focus on mental health as well as post-cessation monitoring for non-agricultural populations to reduce the risk of multimorbidity.

Objective The aim is to explore the influence of age-friendly community environments on social adaptation of urban older adults, and to test the mediating role of social participation between the two, so as to provide a theoretical basis for optimizing age-friendly community environments and promoting healthy aging. Methods Based on CLASS 2020, 5 726 urban older adults aged 60 and above were selected as the study population, with age-friendly community environments as the explanatory variable, social adaptation as the outcome variable, and social participation as the mediating variable. The relationship between the variables was explored through Pearson correlation analysis, and the mediating effect was tested using Hayes’ Process plug-in. Results The mediating effect analysis showed that the age-friendly community environments had a direct effect (β=0.036, 95% CI: 0.005-0.068) on the social adaptation of urban older adults, accounting for 90.00% of the total effect. Social participation (β=0.004, 95% CI: 0.001-0.007), which accounted for 10.00% of the total effect, played a mediating role between the two. Conclusion Age-friendly community environments can improve the social adaptation of older adults through the path of social participation, suggesting that policymaking needs to focus on optimizing community environments and stimulating social participation of older adults in order to achieve the goals of healthy ageing and active ageing.

Objective To understand the economic burden of hospitalized cases of mycoplasma p neumonia (MPP) in Wuhan in 2023, and to provide a scientific basis for the formulation and improvement of public health prevention and control policies. Methods A questionnaire survey was conducted on the hospitalized cases of MPP in Wuhan from January to October 2023. Non-parametric tests were used to analyze the differences in direct, indirect, and total economic burden among different groups of patients due to MPP. Multivariable Logistic regression was used to analyze the related factors affecting economic burden. Results A total of 342 cases of hospitalized MPP were investigated. The total economic burden was higher in severe cases and those with symptoms of fever, cough, and headache (P<0.001). Seeking medical treatment at a tertiary general hospital in a remote urban area (OR=0.156, 95% CI: 0.032-0.764), being aged 19-59 years (OR=13.706, 95% CI: 4.697-39.999), being aged ≥60 years (OR=57.661, 95% CI: 13.283-250.315), hospitalization lasting more than 7 days (OR=3.244, 95% CI: 1.624-6.479), and caregivers missing work for more than 7 days (OR=8.323, 95% CI: 4.108-16.862) were identified as factors associated with the total economic burden (P<0.05). Conclusion Visiting a children’s specialized hospital, severe cases, having symptoms of fever, cough, and headache, increasing age, length of hospital stay, and days of caregiver’s lost work all bring heavier economic burdens to patients. Public health policy interventions such as strengthening clinical diagnosis and treatment, and improving the medical security system should be strengthened to reduce the economic burden on patients.

Objective The study aims to analyze the types and causes of multiple misalignment between supply and demand of health and wellness services in China, with a view to providing novel and operable theoretical perspectives and practical paths for solving the problem of misalignment between supply and demand and breaking through the bottlenecks of current health and wellness services. Methods A meta-ethnographic approach was adopted to analyse 16 original studies, to scientifically classify the types of multiple misalignment between supply and demand of health and wellness services in China, and to systematically deconstruct their causes with the help of the ROCCIPI technology framework. Results This study summarized the significant misalignment between supply and demand of health and wellness services in China in terms of quantity matching, quality satisfaction, structural rationality and information symmetry. Then, the root causes of the misalignment were analyzed from the seven core dimensions of rule-making and enforcement, opportunity grasping, capacity provision, information exchange, benefit distribution, process optimization, and awareness enhancement. Conclusion It is suggested to focus on five core dimensions, including collaborative participation of multiple stakeholders, dynamic requirements identification, efficient resource integration, integration of digital and intelligent technologies, and cultivation of professional talents, so as to promote the precise matching and sound development of supply and demand in health and wellness services.

Objective To analyze the fairness and impact mechanisms of the allocation of public health physician resources in China. Methods The fairness of public health physician resource allocation in 31 provinces across the country was set as the outcome variable, and 7 indicators were selected from the government, socio-economic and individual levels as conditional variables, and a fuzzy set qualitative comparative analysis (fsQCA) was performed. Results There were large differences in the allocation of public health physician resources in 31 provinces in China. Single factors cannot constitute a necessary condition to affect the fair allocation of public health physician resources. There were 10 paths that affect the fair allocation of public health physician resources, of which 2 paths had high fairness configurations, with an overall consistency of 0.97 and an overall coverage of 0.61. There were 8 paths in low fairness configurations, with an overall consistency of 0.96 and an overall coverage of 0.83. Conclusion Population aggregation is the basic premise for determining the fair allocation of public health physician resources. Financial support and residents’ income are key guarantees to support the fair allocation of public health physician resources. Medical insurance and basic public health service subsidies are complementary support for promoting the fair allocation of public health physician resources. Multi-factor coupling is a systematic mechanism for realizing the fair allocation of public health physician resources.

Objective This study aims to explore the relationship between socioeconomic status (SES) and intrinsic capacity (IC) in older adults, as well as the mediating role of healthy lifestyle. Methods Based on data from the Hubei Memory and Aging Cohort Study (HMACS), SES was assessed based on education, occupation, and income, and then categorized into high, medium, and low groups. Healthy lifestyle score (0-6 points) was constructed based on smoking, drinking, diet, social activities, physical exercise, and intellectual leisure activities. IC was assessed according to the indicators recommended by the WHO (2015). Group differences were compared using χ² tests or variance analysis. We performed a multivariable logistic regression analysis to assess the association between SES and IC impairment, and general linear regression models were used to analyze the association between SES and IC. A mediation model was employed to assess the mediating effect of healthy lifestyles on the association between SES and IC, with comparisons across sex and SES groups. Results A total of 5 628 eligible participants aged ≥60 years were included. Older adults with high SES had significantly higher healthy lifestyle scores than those with low SES (P<0.05). The IC impairment in the middle and low SES groups was 1.507 times (95% CI: 1.289-1.762) and 6.476 times (95% CI: 5.051-8.304) than that of the high SES group, respectively, both with P<0.001. SES and IC were significantly positively correlated (β=0.530, 95% CI: 0.505-0.555, P<0.001), with the strongest association in the low SES group (β=1.004,95% CI: 0.773-1.234, P<0.001). Healthy lifestyle partially mediated the relationship between SES and IC, with a mediation effect of 9.25%. The mediation effects were 8.32% in males and 10.19% in females. The mediation effect was significant only in the medium SES group (15.03%), with no significant mediation observed in the low or high SES groups. Conclusion In older adults, SES and IC are significantly positively correlated. SES is associated with IC both directly and indirectly through a healthy lifestyle, with mediating effects varying by sex and SES. Therefore, health promotion measures for older adults should fully consider sex and SES differences, emphasize the improvement of healthy lifestyles, enhance IC in older adults, and promote healthy aging.

Objective To investigate the effect of aerobic exercise on blood pressure in patients with resistant hypertension through meta-analysis, aiming to identify more effective intervention strategies and provide reference for the control and treatment of resistant hypertension. Methods A systematic search was performed in CBM, CNKI, WANFANG, VIP, PubMed, OVID,Embase, and Web of Science for randomized controlled trials (RCTs) published in Chinese or English from inception to March 25, 2025. Two researchers independently conducted study selection and data extraction. Risk of bias was assessed using RoB 2,and statistical analyses were performed with RevMan 5.4. Results A total of 10 studies were included, comprising 532 cases.Meta-analysis showed that aerobic exercise significantly reduced systolic blood pressure (SBP) (SMD=0.77, 95% CI: 0.57-0.96, P<0.000 01), diastolic blood pressure (DBP) (SMD=0.83, 95% CI: 0.63-1.02, P<0.000 01), 24-hour SBP (SMD=0.48,95% CI: 0.23-0.73, P=0.000 2), and 24-hour DBP (SMD=0.43, 95% CI: 0.17-0.68, P=0.000 9). Subgroup analyses indicated greater SBP reductions among participants aged≤60 years, with BMI≤28 kg/m², exercise intensity >60% VO_2max, and intervention>12 weeks. DBP improvements were more evident in subgroups with age≤60 years, BMI≤28 kg/m², intensity ≤60% VO_2max, and duration >12 weeks. For 24-hour SBP, larger effects were found in subgroups with age>60 years, BMI≤28 kg/m², intensity≤60%VO_2max, and duration >12 weeks. In contrast, greater 24-hour DBP reductions occurred in participants aged≤60 years, with BMI≤28 kg/m², intensity >60% VO_2max, and duration≤12 weeks. Conclusion Aerobic exercise has a positive effect on reducing blood pressure in patients with resistant hypertension. Differences in participant characteristics and intervention protocols may affect the extent of this effect. The current relevant studies are limited in number and most have some risk of bias. However, the limited quantity and quality of existing studies highlight the need for further high-quality research to confirm and extend these findings.

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

Objective To explore the relationship between low grip strength and the occurrence of falling in the elderly. Methods A cohort study was conducted using the China Healh and Retirement Longiudinal Sudy (CHARLS) database, including individuals without a history of falling at the 2011 baseline. Demographic characteristics, chronic disease history, and grip strength information of the subjects were collected. Subjects were grouped based on whether they experienced falling during the follow-up from 2013 to 2020. Multivariable logistic regression analysis was used to examine the relationship between low grip strength and falling occurrence. The causal relationship between low grip strength and falling was assessed using two-sample MR based on the corresponding datasets. Datasets were sourced from the IEUGWAS database. MR analysis was conducted using inverse variance weighting (IVW), MR-Egger regression, weighted median estimation (WME), simple mode,and weighted mode methods. Cochran’s Q test, MR-pleiotropy, and leave-one-out methods were employed to evaluate pleiotropy, sensitivity, and heterogeneity. Results After adjusting for age, gender, marital status, disease status and other related confounding factors, low grip strength was still associated with the occurrence of falling. Compared with the normal grip group, the low grip group had an increased risk of falling (OR=1.29, 95% CI: 1.06-1.56, P=0.01). The results of MR also showed that low grip strength increased the occurrence of falling. Conclusion Low grip strength is associated with falling in the elderly. The elderly with low grip strength have a higher risk of falling.

Objective To establish a paper spray mass spectrometry method for the determination of 1-methoxy-2-propanol and 2-methoxypropionic acid as biomarkers of propylene glycol monomethyl ether in urine. Methods The urine sample was dropped onto the chromatographic paper, and a high voltage of 4 kV was applied to the back of the paper. After dissolution in the spray solvent, the sample formed an electrospray at the paper tip under the effect of voltage, which then entered the mass spectrometer for detection. Results The linear ranges of 1-methoxy-2-propanol and 2-methoxypropionic acid were 0.036-46.15 μg/mL and 0.029-54.25 μg/mL, respectively, with correlation coefficients ranging from 0.999 6 to 0.999 9. The detection limit (LOD) was between 0.008 8 and 0.011 μg/mL, and the quantification limit(LOQ) was between 0.029 and 0.036 μg/mL. The sample recovery rate ranged from 90.8% to 105.0%, and RSDs ranged from 3.3% to 9.7%. Conclusion This method requires no sample processing, features simplicity, rapidity and high sensitivity, making it suitable for the rapid screening of propylene glycol monomethyl ether in urine.

Objective To establish a method for the rapid detection of 15 N-nitrosamines in bacon by enhanced matrix removal dispersive solid phase extraction combined with gas chromatography-tandem mass spectrometry (GC-MS/MS). Methods The samples were extracted with acetonitrile oscillation, frozen for 30 minutes, and then centrifuged at low temperature. The extract was further purified using an enhanced lipid removal purification tube (QuEChERS EMR-lipid) and an EMR-lipid stripping tube. The N-nitrosamines were separated on a polar capillary column, detected in the multiple reaction monitoring (MRM) mode and quantified by the matrix-matched external standard method. Results The linear correlation coefficients of the method were greater than 0.990 in the range of 0.2-40.0 μg/L, with the detection and quantification limits of 0.03-0.30 and 0.1-1.0 μg/kg, respectively. The recoveries were 64.1%-106.1% at three spiked levels (2.0, 5.0, 10.0 μg/kg)，with the relative standard deviations (RSDs) ranging from 3.48% to 14.55%. Conclusion The method does not require activation, equilibration, or elution steps, consumes less solvent, is simple and rapid, and is suitable for the rapid detection of 15 N-nitrosamines in bacon.

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

Objective To analyze the duplicate reporting of hepatitis B in Guangxi from 2014 to 2023, providing data to support future research. Methods Duplicate cases of hepatitis B in Guangxi from 2014 to 2023 were identified by matching combinations of rules, including identity card number, name, sex, date of birth, contact number, and current address of patient. The duplicate reporting rates were calculated. Results A total of 499 965 hepatitis B cases were reported in Guangxi from 2014 to 2023, in which 46 439 cases were reported in duplicate, and the duplicate reporting rate was 9.29%. There was an upward trend in the duplicate reporting rate over the years (χ²_trend=6 156.939, P<0.001). The within-year duplicate reporting rate was 1.58%, and the cross-year duplicate reporting rate was 7.70%. The within-year duplicate reporting rate showed an increasing trend (χ²_trend=7.320, P=0.007). The duplicate reporting rate of each city ranged from 4.25% to 12.08% (χ²=3 284.620, P<0.001). The duplicate reporting rate increased with age group (χ²_trend=675.314, P<0.001). The duplicate reporting rate of hospitals of different levels ranged from 4.69% to 19.13% (χ²=24 388.260, P<0.001), with the highest duplicate reporting rate observed in secondary-level hospitals. After excluding duplicated records, the average annual reported incidence rate of hepatitis B in Guangxi from 2014 to 2023 was 92.60 per 100 000 population. Conclusion The report incidence rate of hepatitis B is overestimated because of the duplicate reporting. A cross-year and cross-area duplicate reporting checking system should be established to reduce the duplicate reporting, and improve the surveillance quality for hepatitis B.

Objective To evaluate the extent to which clinical doctors in Hebei Province have mastered the knowledge associated with the prevention and control of viral hepatitis C and its influencing factors, and supply a scientific basis to further improve and perfect the prevention and control strategies of hepatitis C. Methods The on-site investigation adopted the "Questionnaire on Hepatitis C Prevention and Treatment Knowledge for Clinical Doctors" devised by the National AIDS Prevention and Control Center. Its components involved demographic traits, fundamental prevention and treatment knowledge, diagnosis and treatment standards, as well as case reporting requirements, and others. Categorical variables were described using proportions and rates.The influencing factors of awareness of hepatitis C knowledge were studied by using the χ² test and multivariable logistic regression method. Results This survey obtained 2 858 questionnaires in total, and every single one of them was valid. The awareness rate of basic knowledge and professional knowledge was 95.31% (2 724/2 858) and 14.49% (414/2 858), respectively.In terms of basic knowledge content, the correct answer rate for "Hepatitis C can be cured" was the lowest, at 86.28%, while the correct answer rates for other questions were all above 90%. Regarding professional knowledge, 50% (8/16) of the questions had a correct answer rate below 50%. Among these, the question on "Diagnostic basis for diagnosing hepatitis C" had the lowest correct answer rate, at 13.89%. The educational background, department, hospital level and type of clinical doctor, as well as whether they have received hepatitis C knowledge training in the past year, all have an impact on their knowledge of hepatitis C. Doctors with a master’s degree or above had higher knowledge levels than those with a master’s degree or below (OR=2.324, 95% CI:1.706-3.166). Doctors in infectious diseases had higher knowledge levels than those in non-infectious diseases such as internal medicine (OR=0.275, 95% CI: 0.159-0.475). Doctors in tertiary hospitals had higher knowledge levels than those in secondary and lower-level hospitals (OR=1.462, 95% CI: 1.044-2.048). Doctors in provincial hospitals were better than those in county and municipal hospitals (OR=2.869, 95% CI: 1.978-4.161). Doctors who have received prevention and treatment knowledge training in the past year were higher than those who have not received training (OR=3.144, 95% CI: 2.386-4.143). Conclusion While many clinical doctors in Hebei Province have mastered the fundamental knowledge about hepatitis C prevention and treatment quite well, the level of their professional knowledge needs to be improved. Attention should be paid to strengthening the training on diagnosis, treatment and case reporting, etc. At the same time, differentiated training programs should be formulated for different groups to effectively improve the diagnosis and treatment level of clinicians.

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