To construct a structural equation model to explore the pathways of factors influencing fertility behavior among nulliparous couples of reproductive ages, providing direction for medical interventions aimed at fertility pathways.

A cross-sectional study was conducted using convenience sampling, selecting 400 nulliparous couples of reproductive ages from the permanent residents of Chengde city, Hebei Province. Data were collected through general demographic questionnaires, the Childbirth Fear Scale, the Social Support Rating Scale, the Fertility Motivation Questionnaire, and the Fertility Intention-Behavior Questionnaire. Path analysis and mediation effect testing were performed using structural equation modeling.

The constructed structural equation model demonstrated good overall fit. Childbirth fear negatively predicted fertility motivation, intention, and behavior (β values of -0.245, -0.120, and -0.123, respectively), while social support positively predicted fertility motivation, intention, and behavior (β values of 0.247, 0.145, and 0.149, respectively). Fertility motivation positively predicted fertility intention (β value of 0.816), and fertility intention positively predicted fertility behavior (β value of 0.760).

Childbirth fear and social support among nulliparous couples of reproductive ages can indirectly influence fertility behavior through fertility motivation and intention. Medical institutions should strengthen collaboration with community efforts to develop targeted intervention measures that alleviate childbirth concerns among the reproductive population and promote positive fertility behaviors.

To understand the epidemiological characteristics of cervical cancer mortality among women in Jinan city, providing reference for the prevention and control of cervical cancer.

Data on cervical cancer mortality among women in Jinan from 2011 to 2023 were collected. Using SPSS 20.0 software, mortality rates were calculated for urban and rural areas, age-standardized mortality rates for women aged 35 to 64, cumulative mortality rates for those aged 0 to 74, and years of life lost (YLL) due to premature death. The annual average percentage change (AAPC) was employed to analyze trends in cervical cancer mortality.

From 2011 to 2023, the cervical cancer mortality rate for women was 3.05 per 100 000, with a standardized mortality rate of 1.83 per 100 000 and an average age at death of 61.65 years. The truncated mortality rate was 3.36 per 100 000, and the cumulative mortality rate was 0.20%. The mortality rate, standardized mortality rate, proportion of total malignant tumors, truncated mortality rate, and cumulative mortality rate for cervical cancer all exhibited an upward trend, while the age at death showed a downward trend. Mortality rates gradually increased after the age of 30, peaking in the 75 to 79 age group. The cervical cancer mortality rate and YLL rate among women aged 45 to 59 in urban areas and those over 60 in rural areas also showed increasing trends.

The cervical cancer mortality rate in Jinan city is on the rise, with notable urban-rural disparities. Targeted tertiary prevention measures should be implemented to effectively reduce the incidence and mortality rates of cervical cancer.

To explore the relationship between sleep quality and depression among elderly individuals in Shanghai’s communities, as well as the mediating role of physical activity.

A multi-stage cluster sampling method was employed to survey 2 500 elderly individuals aged 60 and above in Hongkou District, Shanghai. A self-developed demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Physical Activity Scale for the Elderly (PASE), and the Geriatric Depression Scale (GDS) were used for data collection. Pearson correlation analysis and linear regression analysis were conducted to investigate the relationships among sleep quality, physical activity, and depression, while the mediating effect of physical activity was tested using the PROCESS macro in SPSS 27.0.

The average sleep quality score among community-dwelling elderly in Shanghai was 6.11±2.90, the physical activity level score was 156.23±96.67, and the depression score was 4.01±5.40. A positive correlation was identified between sleep quality and depression (r=0.488, P < 0.001), while a negative correlation existed between physical activity level and depressive symptoms (r=-0.414, P < 0.001). Physical activity partially mediated the relationship between sleep quality and depression, accounting for 8.79% of the total effect.

Sleep quality and depression are closely related among community-dwelling elderly in Shanghai, with physical activity playing a partial mediating role. Enhancing sleep quality and physical activity levels among the elderly may help prevent and alleviate depression.

To explore the relationship between body mass index (BMI) trajectories and cognitive impairment and cognitive function in the elderly in China.

Based on data from the China Health and Retirement Longitudinal Study (CHARLS) from 2005 to 2018, a sample of 6 423 elderly individuals was selected. Group-based trajectory modeling was employed to construct BMI trajectories, and Cox proportional hazards regression models were used to analyze the relationship between BMI trajectories and the risk of cognitive impairment. Generalized linear models were applied to examine the relationship between BMI trajectories and cognitive function.

Three BMI trajectory groups were identified among males: “Normal-Stable Group (57.59%)”, “Normal-Overweight Group (36.27%)”, and “Overweight-Stable Group (6.13%)”. Among females, three BMI trajectory groups were identified:“Normal-Stable Group (68.14%)”, “Normal-Overweight Group (26.70%)”, and “Overweight-Obese Group (5.16%)”. Using the Normal-Stable Group as reference, after adjusting for confounding factors, the risk of cognitive impairment for males in the Normal-Overweight Group and Overweight-Stable Group was [HR (95%CI)] 0.76 (0.64-0.91), P<0.01 and 0.65 (0.43-0.99), P<0.05,respectively. For females, the risk of cognitive impairment in the Normal-Overweight Group and Overweight-Obese Group was [HR(95%CI)] 0.74 (0.63-0.87), P<0.001 and 0.70 (0.50-0.99), P<0.05, respectively. Cognitive function scores for males in the Normal-Overweight Group and Overweight-Stable Group increased by 0.66 (0.42-0.89) points, P<0.001 and 0.78 (0.32-1.24) points, P<0.01,respectively. For females, cognitive function scores in the Normal-Overweight Group and Overweight-Obese Group increased by 1.19(0.91-1.46) points, P<0.001 and 1.44 (0.91-1.96) points, P<0.001, respectively.

There is heterogeneity in the BMI trajectories of the elderly in China, and the classification of BMI trajectories is significantly associated with cognitive impairment and cognitive function. Trajectories of increasing BMI are associated with a reduced risk of cognitive impairment, and cognitive function is generally higher in populations where BMI remains at normal levels.

To clarify the current status of diabetes management and services in primary healthcare institutions, explore the factors influencing their diabetes service capacity, and provide theoretical references for enhancing this capacity.

In-depth interviews were conducted involving 28 participants, including administrators, medical staff, and diabetic patients from four primary healthcare institutions in a district of Chengdu. Grounded theory was employed to summarize and refine the factors affecting diabetes service capacity in these institutions.

Through three-level coding, 24 initial categories, 7 main categories, and 3 core categories were identified, leading to the construction of a theoretical framework for the"Influencing Factors Model of Diabetes Service Capacity in Primary Healthcare Institutions." The current status of the sample institutions was analyzed across three dimensions: resource allocation, policy support, and daily operations.

The diabetes service capacity of primary healthcare institutions in the studied district of Chengdu is influenced by resource allocation, policy support, and daily operations. To enhance this capacity, measures such as strengthening daily operations, improving policy support mechanisms, and optimizing the allocation of human and material resources should be implemented.

To analyze the impact of smart healthcare on the health of middle-aged and elderly individuals and to provide references for exploring pathways to healthy aging.

The smart city pilot programs were treated as a quasi-natural experiment for smart healthcare. Utilizing data from the China Health and Retirement Longitudinal Study, this research employed the difference-in-differences approach and an improved mediation effect model to examine the impact of smart healthcare on the health of middle-aged and elderly individuals and the mechanisms involved.

Smart healthcare significantly improved the health levels of middle-aged and elderly individuals (P<0.05). Enhancing self-health management and promoting the utilization of medical services were important mechanisms through which smart healthcare improved health outcomes.

Smart healthcare has a positive impact on the health of middle-aged and elderly individuals, with variations observed among different subgroups. It is essential to eliminate barriers to the application of smart technologies, bridge the digital divide among the elderly population, and advance equitable access to healthcare services.

To explore the effects of self-rated health and self-care ability, as well as their interaction, on depression symptoms in the elderly.

Based on data from the 2020 China Health and Retirement Longitudinal Study, relevant data from 8 948 individuals aged 65 and above were collected. Statistical analyses were conducted using chi-square tests and multivariate logistic regression, followed by interaction analysis using an additive model.

Among the elderly, 3 616 (40.41%) exhibited depression symptoms. After adjusting for gender, age, education level, marital status, living area, exercise habits, and sleep conditions, the regression model indicated that self-rated health (OR=2.60, 95%CI: 2.34-2.89) and self-care ability (OR=2.32, 95%CI: 2.10-2.56) were independent risk factors for depression symptoms in the elderly (P<0.001). The interaction analysis revealed a synergistic additive interaction between self-rated health and self-care ability (OR=5.98, 95%CI: 5.27-6.79),with the excess relative risk, attributable proportion of interaction, and interaction index being 1.92 (95%CI: 1.65-2.71), 0.32(95%CI: 0.21-0.41), and 1.63 (95%CI: 1.34-1.97), respectively.

Poor self-rated health and impaired self-care ability both increase the risk of depression in the elderly, and there is a synergistic additive interaction between the two. Efforts to prevent and treat depression in the elderly should focus on improving their self-rated health and self-care ability.

To investigate the current situation of resource allocation for early diagnosis and treatment of upper gastrointestinal cancers in public hospitals at different levels in Sichuan Province, and to provide suggestions for further promoting the early diagnosis and treatment projects of upper gastrointestinal cancers and improving the screening quality.

A questionnaire survey was conducted on public hospitals in Sichuan Province that undertook opportunistic screening for upper gastrointestinal cancers in 2023, and the diagnosis and treatment capabilities, hardware capabilities and staffing situations of upper gastrointestinal cancer early diagnosis and treatment in hospitals at different levels were compared and analyzed.

The average annual total number of gastroscopy diagnosis and treatment in 78 hospitals was 8 400.82 person-times. In total 96.15% of the hospitals had an independent endoscopy department, and 87.18% of the hospitals had an independent pathology department. On average, there were 3.29 endoscopy hosts, 10.19 gastroscopes, with an average of 6.97 endoscopy physicians, 4.14 pathologists and 5.41 endoscopy nurses. The higher the hospital level, the higher the relevant indicators of diagnosis and treatment capabilities, hardware capabilities and staffing.

The overall situation of resource allocation for early diagnosis and treatment in public hospitals in Sichuan Province is good, but it is necessary to strengthen the construction of pathology departments and focus on optimizing the resource allocation for early diagnosis and treatment of upper gastrointestinal cancers in secondary hospitals.

To explore the impact of follow-up management on blood pressure control in hypertensive patients in Sichuan Province, so as to improve the blood pressure control rate in the population.

Based on the data of the Seventh National Health Service Survey in Sichuan province, 3 587 hypertensive patients were included. Descriptive statistical analysis was used to analyze the follow-up management situation, demographic characteristics, lifestyle behaviors and health status of patients. Combined with the multivariate logistic regression model, the follow-up management factors affecting blood pressure control were explored.

The blood pressure control rate was 68.9%. Among the effectively controlled patients, the rate of taking medications regularly as prescribed was 84.6%, the proportion of those with a follow-up frequency of ≥4 was 71.4%, and the rate of family doctor-signed home visits was 48.1%. Among the patients not effectively controlled, the rate of taking medications regularly as prescribed was 73.4%, the proportion of those with a follow-up frequency of ≥4 was 67.6%, and the rate of family doctor-signed home visits was 45.2%. Multivariate Logistic regression analysis showed that not taking medications regularly as prescribed (OR=1.742, 95%CI:1.453-2.089), a follow-up frequency of <4 (OR=1.287, 95%CI: 1.057-1.567) and other follow-up methods (OR=1.286, 95%CI:1.092-1.516) had significant negative impacts on the blood pressure control effect of patients.

Follow-up management of hypertension is beneficial to blood pressure control. The follow-up frequency should be optimized, drug compliance should be improved, and the interaction between the signed doctor and the patient should be enhanced.

To explore the bidirectional relationship between depression symptoms and physical functional impairment trajectories in Chinese elderly individuals.

Utilizing data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, and 2018, we employed group-based trajectory modeling to identify distinct trajectory groups for depression symptoms and physical functional impairment among the elderly. A dual trajectory model was then used to assess the degree of association between these trajectory groups.

The group-based trajectory model categorized depression symptoms into four groups: consistently low depression symptoms, decreasing depression symptoms, increasing depression symptoms, and consistently high depression symptoms. Physical functional impairment was classified into four groups: no physical functional impairment, worsening physical functional impairment, improving physical functional impairment, and high physical functional impairment. Dual trajectory analysis revealed that 44.86% of individuals in the decreasing depression symptoms group followed the improving physical functional impairment trajectory; conversely, 37.58% of individuals in the increasing depression symptoms group followed the worsening physical functional impairment trajectory. Among those in the worsening physical functional impairment group, 47.8% followed the increasing depression symptoms trajectory, while 41.9% of individuals in the improving physical functional impairment group followed the decreasing depression symptoms trajectory.

In most cases, there is a positive correlation between the trajectories of depression symptoms and physical functional impairment. A decrease in depression symptoms is typically associated with an improvement in physical functional impairment, while an increase in depression symptoms corresponds with a worsening of physical functional impairment, and vice versa.