Objective To understand the epidemic characteristics of diabetic nephropathy in China and to provide scientific basis for the prevention and treatment of diabetic nephropathy. Methods Data from the Global Burden of Disease (GBD) database in 2019 was selected to collect data on the incidence of diabetic nephropathy in China from 1990 to 2019. The characteristics and trends of standardized incidence rates and age-specific incidence rates in each year were described, and the Joinpoint regression model was used to analyze the temporal trend of the incidence rate of diabetic nephropathy in China. Results There was no turning point in the trend of age-standardized prevalence of type 1 diabetic nephropathy in the whole population and women in China, and the annual percent change (APC) equaled the average annual percent change (AAPC), showing an upward trend. The average annual growth rate of the whole population was 1.02% (95%CI: 0.87%-1.17%), and that of women as a whole was 1.21% (95%CI: 1.08%-1.35%). The turning point of male trend was in 1994, 2011, and 2017, with an overall average annual growth of 0.56% (95%CI: 0.20%-0.92%). The incidence rates for age groups under 20 years old showed a decreasing trend (AAPC=-0.71% to -0.12%), while those aged 20 and above showed an increasing trend (AAPC=1.06% to 3.99%), all with statistical significance (P<0.05). The standardized incidence rates of type 2 diabetic nephropathy for the whole population, males, and females in China had turning points in 1995, 2000, 2005, 2010, and 2015, with an overall annual decrease of 0.15%(95%CI: -0.17% to -0.12%) for the whole population, 0.12% for males (95%CI: -0.16% to -0.09%), and 0.18% for females(95%CI: -0.22% to -0.15%). Conclusion The epidemic trend of diabetic nephropathy in China from 1990 to 2019 is still grim, and more attention should be paid to diabetes and its complications. In particular, the prevalence rate of women has been higher than that of men, and the prevalence rate of type 2 diabetic nephropathy in the age group of 15-39 years old, 55-59 years old, and ≥ 75 years old, as well as the age group of ≥ 20 years old with the increasing prevalence of type 1 diabetic nephropathy.Strategies and measures should be promptly implemented to address these issues.

Objective To explore the pollution level and spatiotemporal characteristics of indoor dust di (2-ethylhexyl) phthalate(DEHP) in daily life and the influencing factors of potential family environment and personal living habits, providing scientific basis for the prevention and control of DEHP pollution in indoor dust. Methods Considering the factors of climate, economy and pollution level, household dust samples were collected and investigated in 9 typical cities of Lanzhou, Luoyang, Panjin,Mianyang, Qingdao, Shenzhen, Shijiazhuang, Wuxi, and Xi’an. DEHP content in the treated dust samples was measured using gas chromatography-mass spectrometry (GC-MS). The Wilcoxon rank sum test was employed to examine differences in DEHP levels across various seasons, dominant wind directions, types of home decoration, and living habits. Multiple linear regression was used to identify factors influencing DEHP content in indoor dust. Results DEHP levels in indoor dust varied significantly with season and dominant wind direction in some cities (P<0.05). Specifically, Luoyang and Mianyang exhibited higher DEHP levels during the heating season compared to other periods, while Shenzhen and Shijiazhuang showed lower levels during the heating season (P<0.05). In Mianyang, the upwind areas had significantly higher DEHP levels than the downwind areas (P<0.05). Factors influencing household dust DEHP levels included PM_2.5 (β=0.003, 95%CI: 0.001-0.005), PM₁₀ (β=-0.003,95%CI: -0.005 to -0. 001), formaldehyde (β=3.626, 95%CI: 0.195-7.057), and per capita GDP (β=-0.072, 95%CI: 0.050-0.095). Conclusion DEHP is commonly found in indoor dust in daily life. Seasonal variations and wind direction affect its levels in different cities, though no consistent pattern of pollution characteristics is observed across the cities. Additionally,DEHP content in indoor dust may be influenced by temperature, PM₁₀, xylene, computer use, carpet use, and indoor plant cultivation..

Objective To evaluate the health risk of heavy metal concentration, source analysis and inhalation pathway of PM_2.5 in ambient air of Huai’an city. Methods The ambient air PM_2.5 samples were collected regularly at a monitoring site in Huai’an city from 2020 to 2022. The contents of 10 heavy metals in PM_2.5 were determined by ICP-MS, and the traceability analysis of heavy metals was carried out by enrichment factor method and principal component analysis. According to the national“Technical Standard for Assessing Population Health Risk”, the health risk of heavy metals to the population was evaluated. Results The annual average values of Al, Mn, Pb, Cr, Ni, As, Se, Sb, Cd and Tl in PM_2.5 of Huai’an city from 2020 to 2022 were 131.11, 28.52, 20.61, 8.09, 5.95, 4.11, 2.62, 1.84, 0.76, and 0.18 ng/m³, respectively. The concentration levels of these metals in winter and spring were higher than those in summer and spring (Z=2.390-7.182, P < 0.05). The results of enrichment factor analysis showed that the elements EF of Se, Cd, Sb, As, Pb, and Tl 6 were more than 100. The principal component analysis showed that the heavy metals in PM_2.5 in Huai’an city mainly came from mixed pollution of traffic, industrial production, coal combustion, and natural emission. For non-carcinogenic effects, Sb, Al, As, Cd, Cr, Mn, Ni, and Se 8 were lower than the screening concentration, and the risk of non-carcinogenic effects (HQ) was less than 1. For carcinogenic effects, the excess carcinogenic risks of As, Cd, and Cr were 1.77 × 10^-5,1.37 × 10^-6, and 9.70 × 10^-5, respectively. Conclusion The sources of heavy metals in PM_2.5 in Huai’an city are multiple compound pollution. The non-carcinogenic effects of Sb, Al, As, Cd, Cr, Mn,Ni, and Se 8 are acceptable, but As, Cd and Cr have potential carcinogenic risk.

Objective To analyze the effects of air pollutants on male semen quality and different stages of sperm development in Taiyuan. Methods Totally 7 614 men who were admitted to the Reproductive Department of the First Hospital of Shanxi Medical University from January 1 to December 31, 2019 were enrolled. Their age, semen collection season, and semen parameters were recorded. At the same time, the monitoring data of six air pollutants (SO₂, NO₂, CO, O₃, PM_2.5, and PM₁₀) were collected, and the exposure of air pollutants in the whole developmental period (0 to 90 days before semen collection) and three critical developmental periods (0-9 days, 10-14 days, and 70-90 days) were calculated. Nonparametric Mann-Whitney U test was used to compare the data difference between qualified and unqualified semen parameters. The generalized estimation equation was used to explore the effects of six kinds of air pollutants on the quality parameters of each sperm at different stages of sperm development. Results During the whole period of sperm development, the exposure concentrations of SO₂, NO₂, O₃, and PM_2.5 were different between the qualified and unqualified groups of normal sperm morphology. The exposure to PM₁₀ at 10 and 14 days before semen collection was positively correlated with semen volume (OR=1.245, 95%CI: 1.057-1.467), sperm concentration (OR=1.247, 95%CI: 1.027-1.514), total sperm count (OR=1.385, 95%CI: 1.167-1.643), total motility (OR=1.236,95%CI: 1.085-1.409), and forward movement (OR=1.207, 95%CI: 1.059-1.376). The O₃ exposure was positively correlated with sperm concentration (OR=1.250, 95%CI: 1.002-1.558; OR=1.173, 95%CI: 1.025-1.343), total sperm count (OR=1.255,95%CI: 1.026-1.537; OR=1.218, 95%CI: 1.074-1.380), and normal sperm morphology (OR=1.295, 95%CI: 1.047-1.602; OR=1.229, 95%CI: 1.076-1.404). Conclusion Exposure to air pollutants increases the risk of unqualified semen parameters at all stages of sperm development, and the critical window period focuses on 10-14 days before semen collection, which is the developmental stage of sperm motility. PM₁₀ and O₃ are the main reproductive toxins affecting the decline of male sperm quality in Taiyuan, which need to be paid attention to.

Objective To understand the correlation between food cooking methods, dietary preferences of residents in southwest China, and their body mass index (BMI), providing references for local residents’ nutritional health education and scientific dietary choices. Methods A convenient sampling method was used to survey 7 948 residents in Southwest China, and an unordered multinomial logistic regression model was employed to analyze the influencing factors of BMI. Results The majority of residents in Southwest China preferred slightly spicy and light flavors, each accounting for 41.1%. The fried, sautéed, and stir-fried foods (59.2%) and steamed, boiled, blanched, stewed foods (51.8%) were most frequently consumed by residents. In Southwest China, lower frequency of consuming fried, sautéed, and stir-fried foods was associated with a decreased risk of overweight and obesity (OR=0.658, 95%CI: 0.559-0.775), similar results were found in Sichuan, Chongqing, and Guizhou. In Guizhou, lower frequency of consuming steamed, boiled, blanched, stewed foods was associated with an increased risk of overweight and obesity (OR=1.411, 95%CI: 1.025-1.943). In Guizhou and Yunnan, preference for sour flavors was associated with a reduced risk of overweight and obesity (Guizhou: OR=0.512, 95%CI: 0.271-0.965; Yunnan: OR=0.475, 95%CI: 0.246-0.915). Conclusion Dietary preferences and food cooking methods vary among residents in Southwest China and are correlated with BMI. Sour flavors and high frequency of consuming steamed, boiled, blanched, stewed foods are protective factors against overweight and obesity, while frequent consumption of fried, sautéed, and stir-fried foods is a risk factor. It is recommended to strengthen nutritional education and promote residents to make informed choices in dietary preferences and cooking methods to improve public nutrition and health.

Objective To analyze the results of genetic metabolic disease screening and gene mutation characteristics in newborns in Haikou, Hainan. Methods A retrospective analysis was conducted on 185 660 newborns born at the Haikou Maternal and Child Health Hospital from March 2017 to March 2021 who underwent genetic metabolic disease screening. All newborns underwent tandem mass spectrometry screening for genetic metabolic diseases within 7 days after birth. The positivity rate of genetic metabolic disease screening in newborns was statistically analyzed, and the specific gene mutation characteristics of the metabolic diseases were investigated. Results Among 185 660 newborns in Haikou, 88 were diagnosed with genetic metabolic diseases, with a total prevalence rate of 1 in 2 110 (47.40 per 100 000). Among the 88 cases, the prevalence rates of organic acidemia, amino acid metabolism disorders, and fatty acid oxidation disorders were 1/3 640, 1/10 921, and 1/9 283, respectively, with methylmalonic acidemia, medium-chain acyl-CoA dehydrogenase deficiency, and citrin deficiency ranking the top three.Genetic testing revealed that in 42 cases of methylmalonic acidemia, MUT and MMACHC mutation genes were detected, with the c.609G>A mutation in the MMACHC gene being the most common（37.97%）. The ACADM mutation genes in 15 cases of medium-chain acyl-CoA dehydrogenase deficiency were mainly detected at c.387+1delG (25.00%), c.449_452delCTGA(16.67%), and c.1076C>T (16.67%). The SLC25A13 mutations in 8 cases of citrin deficiency were mainly detected at c.154C>T(37.50%) and c.1638_1660dup (25.00%). Other detected mutation genes in genetic metabolic diseases mostly had 2 or 1 mutation sites. During treatment and follow-up, 49 children were normal (55.68%), 36 children experienced developmental delays(40.90%), and 3 children died (3.41%). Conclusion Haikou, Hainan has a certain incidence of genetic metabolic diseases in newborns, with medium-chain acyl-CoA dehydrogenase deficiency, methylmalonic acidemia, and citrin deficiency having the highest prevalence. These diseases exhibit specific characteristics in mutation sites.

Objective To study the impact of exposure to green space during pregnancy on low birth weight (LBW) and preterm birth (PTB) in pregnant women, and to explore the susceptible window period of green space exposure, providing data support for related research fields. Methods This study recruited pregnant women and their infants in the Sichuan multi-level infant and early life (SMILE) cohort study as the research subjects, and information on sociodemographic characteristics, lifestyle habits, and birth outcomes were collected. A 250m buffer zone was delineated based on the pregnant women’s residential addresses, and the average normalized difference vegetation index (NDVI) during pregnancy was calculated. Cox proportional hazards regression models were used to analyze the impact of green space exposure during pregnancy on LBW and PTB and to identify the key window period of green space exposure affecting LBW and PTB. Results In total 6 612 pregnant women were included in this study, and the prevalence rates of LBW and PTB were 3.36% and 3.43%, respectively. It was found that the fourth quartile of NDVI was negatively correlated with LBW and PTB (LBW:HR=0.38, 95%CI: 0.24-0.59, P=0.012; PTB: Q4:HR=0.33, 95%CI: 0.21-0.51, P < 0.001). In the third trimester of pregnancy, NDVI had a protective effect on LBW (Q2: HR=0.28, 95%CI: 0.19-0.42, P=0.003; Q3: HR=0.17, 95%CI: 0.11-0.27, P<0.001; Q4: HR=0.07, 95%CI: 0.04-0.12, P<0.001)and PTB (Q2: HR=0.19, 95%CI: 0.13-0.28, P < 0.001; Q3: HR=0.10, 95%CI: 0.07-0.16, P<0.001; Q4: HR=0.03, 95%CI:0.02-0.06, P<0.001), and as the level of NDVI increased, the protective effect became stronger. Conclusion Green space during pregnancy is negatively correlated with LBW and PTB. Late pregnancy may be a key window period of exposure, and higher levels of green space are more beneficial for maternal and child health.

Objective To investigate the current status and influencing factors of the utilization of medical assistance policy resources by difficult groups with chronic diseases and economic difficulties in urban villages, analyze the existing problems, and propose corresponding strategies to promote precision management of diseases for vulnerable groups and facilitate health poverty alleviation in the new era. Methods Firstly, using a questionnaire survey, two out of four urban village streets in a certain district of Chengdu were randomly selected to investigate the existing problems in the utilization of medical assistance by difficult groups. Secondly, telephone interviews were conducted to analyze the reasons for not utilizing medical assistance even though meeting the conditions, and countermeasures were proposed. Results Difficult groups utilized the policy of subsidizing and participating in insurance the best, while the utilization of outpatient, inpatient, and supplementary medical assistance policies was the worst. The results of multivariate Logistic regression analysis showed that having more than three comorbidities (OR=0.134) was a risk factor for assistance utilization. Having disabilities (OR=2.625), higher educational level (OR=3.500), and higher average monthly medical expenses (OR=4.148) were protective factors for utilization of assistance. The follow-up results indicated that factors such as patients’ lack of policy awareness, misunderstandings about policies, not seeking treatment at designated hospitals, some Chinese medicine not being reimbursed, and complex application procedures were the main causes leading to their non-utilization of policies. Conclusion Difficult groups with diseases utilize well the government assistance policies obtained through direct help, but the utilization of policies requiring proactive application is poor. The characteristics of patients’ own diseases, inadequate explanation of policies, high reimbursement thresholds, and limited reimbursement scope are the main reasons for difficult groups not applying for medical assistance.

Objective To explore the construction of technical evaluation index system of primary children’s health management services, and to provide reference basis for improving the technical aspects of health management services for children at the grassroots level. Methods By means of literature analysis, policy induction and expert discussion, a preliminary framework and content pool for the evaluation index system of technical assessment for primary children’s health management services were established. The Delphi expert consultation method was then used to determine the content of each index. Results After two rounds of expert consultations, a two-level index system with 2 primary indicators and 5 secondary indicators, two of which had 2 tertiary indicators under each, was constructed. Specific content was assigned to this index system, and corresponding scores were allocated on a percentage basis. The positive coefficient of the experts in the two rounds of consultations were 92% and 100% respectively, and their authority coefficients were both 0.88. The coordination coefficients for the rationality assessment of the index in the two rounds of expert consultation were all between 0 and 1 (P < 0.05). Conclusion The constructed evaluation index system for technical assessment of primary children’s health management services using the improved Delphi method is reasonably effective, and this evaluation index system can provide a reference for the technical assessment of health management services for children at the grassroots level..

Objective To analyze the the current status and deficiencies of the county medical community construction policy and proposes policy recommendations to optimize the construction of the county medical community. Methods Based on the perspective of policy tools, a three-dimensional analysis framework was constructed combining policy evolution and stakeholder dimensions, and content analysis was used to quantitatively analyze the policy text in three dimensions. Results A total of 29 policy documents were included after screening. The overall utilization of policy tools showed an imbalance, with the utilization of capacity-type policy tools as high as 35.38%, but sub-tools such as financial investment (3.07%) and technical support(2.83%) were less used. Incentive-type policy tools were the least used, accounting for only 8.96%, with sub-tools such as price adjustment and promotion further education accounting for only 0.71% and 0.47%, respectively. The distribution of stakeholders was uneven, with primary medical and health institutions and county hospitals being the main targets, accounting for 27.77% and 25.52%, respectively. With the evolution of policies, the number and variety of policy tools used showed a rapid increase, but capacity-type policy tools still dominated, and there was an imbalance in the internal structure of policy tools. Additionally, the involvement of two key stakeholders including medical personnel and the public, was relatively low. Conclusion There is significant differentiation in the utilization of policy tools, with insufficient use of symbolic, incentive-type policy tools.It is suggested to improve the internal structure of policy elements, enhance the balance of policy tool utilization, continuously optimize policy tools, increase the use of incentive-type and symbolic policy tools, and strengthen the participation of two key stakeholders: medical personnel and the public.