This study applied the ecology of the medical care model to describe healthcare-seeking behaviors among community-based individuals and to examine the association between multimorbidity and various types of healthcare-seeking behaviors.

A cross-sectional survey was conducted in Fangshan District, Beijing and Wuyuan County, Jiangxi Province from July to September 2023. Community residents aged 20 years old and above were sampled by using a multistage stratified sampling approach and recruited to participate in the study. The number of individuals who had symptoms or had relevant healthcare-seeking behaviors was calculated per thousand people per month and relevant indicators were demonstrated by using the ecology of the healthcare model. Multivariate logistic regression analyses were applied to explore the association between self-reported multimorbidity and each level of healthcare-seeking behaviors, with key socio-demographic characteristics adjusted in the model.

A total of 6 004 records with completed surveys were included in the analysis (56.4% of participants were females, mean age: 50.4±14.7). On a thousand-person per month basis, about 382 participants self-report having symptoms, 162 had visited to healthcare facilities (including 61 visited to primary healthcare facilities, 47 visited to tertiary hospitals), 62 were self-medicated, 10 were hospitalized, 5 visited to emergency department, 4 had operations and 1 received tele-medicine. A higher proportion of healthcare seeking behaviors were observed among individuals with multimorbidity than those self-reported with no or one chronic condition. The results of multivariate logistic regression analyses showed that compared with individuals without chronic condition, individuals with one chronic condition or multimorbidity had higher likelihood of healthcare facility visits [(OR:1.67, 95% CI:1.38-2.02) and (OR:3.40, 95% CI:2.83-4.08)], and hospitalization [(OR:2.60, 95% CI:2.04-3.32) and (OR:5.17, 95% CI:4.10-6.51)].

Among all individuals with potential healthcare needs, less than half had healthcare seeking behaviors, and the proportion is higher among individuals with multimorbidity. Future research should further investigate the implication of findings on population medicine from the ecology of medical care model. Actions are also needed to further strengthen the healthcare system and optimize its integration and effectiveness in addressing the emerging challenge of multimorbidity and to reduce the unmet health needs.

To explore the focuses and potential issues of the current children’s health policy system for informing policy decision-making.

This study constructed a two-dimensional analysis framework of policy tools-stakeholders, and the content analysis method was used to quantitatively analyze 36 children’s health policies in China.

The study coded a total of 542 nodes for policy tools. The environment-based policy tools, supply-based policy tools, and demand-based policy tools accounted for 43.7%, 36.5%, and 19.7%, respectively. There were 464 nodes of stakeholders, and administrative agencies, hospitals, primary health care facilities, children and families, health care workers, and other agencies accounted for 61.4%, 13.6%, 3.7%, 8.0%, 3.2% and 10.1%, respectively.Two-dimensional analysis revealed that children and families focused on demand-based policy tools (16 out of 34 nodes), primary healthcare/hospitals/health care providers focused on supply-based policy tools (20 out of 26, 41 out of 85, and 10 out of 15 nodes), and administrative agencies focused on environmental policy tools (170 out of 351 nodes).

The continuous launch of children’s health policies indicates that the government ensures the principle of Children First. However, the current policies on the supply of children’s health services, the training of pediatric personnel, and PHC are inadequate. The government should focus on improving the supply of children’s healthcare services, expanding the pediatric workforce, and constructing an integrated service system for children.

To investigate the changes in health risk behaviors among high-risk groups in the lung cancer screening cohort in Ma’anshan City, and to explore the association between lung cancer screening and health risk behavior changes.

Follow-up survey was conducted among the high-risk population participating in screening.Basic data and health risk behavior information were collected at baseline and during follow-up. Univariate analysis and multivariate logistic regression analysis were used to explore the association between lung cancer screening and changes in three kinds of health risk behaviors.

The results of multivariate logistic regression analysis showed that women(OR=4.24, 95% CI: 1.80-9.96,P=0.001), those with positive pulmonary nodules(OR=1.98, 95% CI: 1.23-3.20, P=0.005) and those who consulted the doctor after screening(OR=1.65, 95% CI: 1.08-2.52, P=0.020) were more likely to quit smoking. Persistent smokers who were 60 to 69 years old(OR=1.60, 95% CI: 1.14-2.24, P=0.007), had a history of lung-related diseases(OR=1.95, 95% CI: 1.13-3.39, P=0.017), and discussed their medical condition with relatives and friends after screening(OR=1.65，95% CI: 1.16-2.33，P=0.005) were more likely to smoke less. Women(OR=2.19, 95% CI: 1.20-4.02,P=0.011), patients with a history of lung related diseases(OR=1.91,95% CI: 1.13-3.22,P=0.015), patients with a history of malignant tumors(OR=3.07,95% CI: 1.18-8.01,P=0.022), and patients receiving medical advice(OR=1.69, 95% CI: 1.04-2.75, P=0.035) were more likely to abstain from alcohol. Women(OR=1.41, 95% CI: 1.02-1.94, P=0.037), older than 70 years(OR=1.70, 95% CI: 1.07-2.68, P=0.024) and those who had annual physical examination(OR=2.03, 95% CI: 1.44-2.86, P<0.001) were more likely to start physical exercise.

Lung cancer screening is closely related to changes in health risk behaviors of screening population such as smoking, drinking, physical exercise, etc. Health education should be strengthened to guide high-risk population to make changes in health risk behaviors.

To understand the impact and pathways of lifestyle behaviors on physiological sub-health of medical students, and to provide a basis for health management and health education in universities.

Under the use of stratified whole cluster random sampling method, 3 100 medical students from a medical university were selected as the study subjects, general situation questionnaire, lifestyle factor questionnaire and Sub-Health Measurement Scale Version 1.0 (SHMS V1.0) were used for questionnaire survey. Chi-square test, exploratory factor analysis and structural equation model were used for statistical analysis and path construction.

The total detection rate of medical students’ sub-health status was 62.2%. There were significant differences in the distribution of drinking (χ²=12.245,P<0.001), activity(Frequency of exercise(χ²=46.115, P<0.001);Frequency of activities between classes(χ²=7.179,P=0.028);Leisure promotes health(χ²=60.789,P<0.001)), dietary habits (Frequency of takeout orders(χ²=8.912, P=0.012);Frequency of consumption of sugar-sweetened beverages(χ²=23.437,P<0.001);Bad eating habits(χ²=82.863,P<0.001))and mobile phone and computer usage(Time spent on mobile phones and computers(χ²=12.350, P=0.002); Short video viewing time(χ²=9.291,P=0.026)) among medical students with different physiological health states. The direct effect of activity on physiological sub-health of medical students was 0.26(95% CI:0.137-0.366). The direct effect of dietary habits on physiological sub-health of medical students was -0.171 (95% CI:-0.233--0.035), and the indirect effect was -0.04(95% CI:-0.085--0.015). The indirect effect of mobile phone and computer usage on physiological sub-health of medical students was -0.043 (95% CI: -0.087--0.017).

The overall detection rate of sub-health status among medical students is relatively high. Physical activity is a significant influencing factor in the physiological sub-health status of medical students and serves as a mediator between dietary habits and mobile phone and computer usage with respect to the physiological sub-health status of medical students.

To explore the effect of arsenic on cell proliferation, the antagonism of PC against arsenic and the relationship associated to wnt/β-catenin signaling pathway by using Proanthocyanidins (PC) and sodium arsenite (NaAsO₂) to intervene human hepatocyte L-02.

We treated cells with different doses of PC alone or in combination with NaAsO₂. The cell activities were detected by Cell Counting Kit-8 (CCK-8) method. Cell scratch experiment and Transwell experiment were used to detect the ability of cell migration and invasion. Real-time Polymerase Chain Reaction (Real-time PCR) method and western blotting (WB) method were used to detect the expression levels of message RNA (mRNA) and protein.

NaAsO₂ increased the activity of cell proliferation (1.740±0.105), enhanced the ability of migration (556.000±3.606) and invasion (439.667±8.622). NaAsO₂ up-regulated the protein expression of proto-oncogene c-myc (0.739±0.012), cyclinD1 (0.943±0.002), Vascular Endothelial Growth Factor (VEGF) (1.020±0.019), apoptosis inhibitor gene survivin (0.571±0.033)and Matrix Metalloproteinase-7 (MMP-7) (0.695±0.059). NaAsO₂could also up-regulate the protein and mRNA levels of pathway core moleculars wnt3a (protein: 1.044±0.010, mRNA: 1.789±0.165) and β-catenin (protein: 0.958±0.037, mRNA: 1.596±0.217). Compared with NaAsO₂ group, when PC intervention was introduced, the levels of proliferation related proteins such as c-myc (0.438±0.046) decreased. The levels of mRNA and protein of wnt3a (mRNA: 1.181±0.018, protein: 0.822±0.015) and β-catenin (mRNA: 0.965±0.078, protein: 0.832±0.064) decreased. The expression of pathway inhibitors Glycogen synthase kinase-3β (GSK-3β) (0.885±0.058) and Axin (0.749±0.016) increased.

NaAsO₂ induce L-02 cell proliferation, which may be due to its activation of wnt/β-catenin signaling pathway. PC can down-regulate wnt/β-catenin pathway, thereby antagonizing the cell proliferation induced by NaAsO₂.

To explore the clustering of drug-resistant Mycobacterium tuberculosis (MTB) in Zigong from 2018 to 2020, analyze the genetic relationship between strains, and speculate whether there is a potential correlation between drug-resistant strains isolated from different patients, so as to provide a reference for the prevention and treatment of drug-resistant tuberculosis in Zigong.

The drug-resistant MTB strains isolated from Zigong from 2018 to 2020 were used as the research objects and the standard MIRU-VNTR 12-loci method was used for typing study. The band sizes of the amplified products were analyzed by PCR and agarose gel electrophoresis to obtain the number of replicates of different loci of the strains. The data were imported into the MIRU-VNTRplus database and the SITVIT2 website to construct the phylogenetic tree diagrams and the minimum spanning trees, and the global source analysis of the isolated strains was performed. The discriminatory ability of the 12-locus method was evaluated by locus polymorphism analysis, and the local prevalence and transmission of drug-resistant TB were analyzed by calculating the cluster formation rate and recent transmission rate.

The overall resolution HGI index of MIRU-VNTR standard 12-loci typing was 0.974. MIRU26 and MIRU31 showed high polymorphism; MIRU10, MIRU16, MIRU39, and MIRU40 showed moderate polymorphism, and the remaining loci showed low polymorphism. The most concentrated locus was MIRU2, and the most dispersed locus was MIRU26. The 120 drug-resistant strains contained 77 genotypes, with a clustering rate of 46.67 % and a recent transmission rate of 34.17 %. The minimum spanning tree showed that 120 drug-resistant strains could be divided into three clonal complexes, CC1, CC2, and CC3, according to the VNTR typing results. Among the 120 valid strains, 12 genotypes of 32 strains could be found on the SITVIT2 website, and the corresponding 12 MIT numbers were distributed in 14 countries on five continents worldwide.

The standard VNTR-12 locus method resolves drug-resistant tuberculosis strains well. There is a certain range of transmission of drug-resistant TB in Zigong, and the recent transmission rate is high, targeted surveillance is helpful in the prevention and control of tuberculosis.

To systematically review the willingness to use pre-exposure prophylaxis (PrEP) and related factors among men who have sex with men (MSM) in China.

CNKI, VIP, Wanfang Data, CBM, EMbase, CINAHL, Pubmed, The Cochrane Library and Web of Science were searched from inception to August 16, 2023.

A total of 31 articles with 31 390 participants were included. The results of meta-analysis showed that the awareness rate of PrEP was 46.70% (95% CI: 34.14-59.47), the willingness rate of PrEP use was 61.49% (95% CI: 51.58-70.95), and the use rate of PrEP was 3.41% (95% CI:0.07-10.62). Age≥40 years (OR=1.90, 95% CI:1.47-2.57), HIV testing history (OR=2.13, 95% CI:1.63-2.80), awareness of PrEP (OR=2.80, 95% CI:1.86-4.24), online sexual partner seeking (OR=1.44, 95% CI:1.04-2.00), no regular sexual partner (OR=1.69, 95% CI:1.32-2.17), oral sex/anal sex behavior (OR=1.86, 95% CI:1.32-2.61), number of homosexual anal sex partners in the past 6 months>5 (OR=1.86，95% CI:1.32-2.61), Having oral or anal sex in the past year (OR=1.40，95% CI:1.19-1.65) was the promoting factor of PrEP use, while uncertain sexual orientation (OR=0.60, 95% CI:0.41-0.89) and always using condom in the past 6 months (OR=0.47, 95% CI:0.29-0.75) were the barriers.

The rate of MSM PrEP awareness and willingness to use is high in China, but the rate of PrEP use is low; more factors influence the willingness to use PrEP.

To analyze the trend of health-care seeking delay and influencing factors among pulmonary tuberculosis patients and provide a reference basis for prevention and control measures in Yantai.

The current status and trend of health-care seeking delay among pulmonary tuberculosis patients in Yantai from 2012 to 2021 were described. Additionally, multivariate logistic regression was employed to analyze the influencing factors of health-care seeking delay.

From 2012 to 2021, the median of health-care seeking days was 28 (10, 61) days. The health-care seeking delay rate was 66.47% and exhibited an upward trend (, P<0.001). Multivariate logistic regression analysis revealed that compared with the age group over 61 years old, the following factors were associated with reduced risk for delayed treatment: individuals under 20 years old (OR=0.65, 95% CI: 0.56-0.75), aged 21-40 years (OR=0.80, 95% CI: 0.74-0.88), serving public places and businesses (OR=0.66, 95% CI: 0.49-0.90), children and students (OR=0.73, 95% CI: 0.61-0.87), employees of enterprises and institutions (OR=0.80, 95% CI: 0.66-0.97), engaged in other physical labor (OR=0.83, 95% CI: 0.74-0.92), and belonging to the native population (OR=0.68, 95% CI: 0.60-0.78). On the other hand, the age group of 41-60 years old (OR=1.12, 95% CI: 1.03-1.22), symptomatic treatment (OR=4.30, 95% CI: 3.63-5.10), referral (OR=3.40, 95% CI: 2.87-4.03), follow-up (OR=5.59, 95% CI: 4.69-6.66), and pathogen positive results (OR=1.33, 95% CI: 1.24-1.43) were identified as risk factors for delayed treatment.

The health-care seeking delay rate among tuberculosis patients showed an upward trend from 2012 to 2021 in Yantai. Medical institutions should pay attention to the wrinkly or elderly, passive detection, and pathogen positive patients regarding the health-care seeking delay.

To understand children’s parents’ cognition and behavior of antibacterial drugs, so as to provide reference for promoting rational use of antibacterial drugs in children, reducing bacterial drug resistance and adverse drug reactions.

From April 2022 to April 2023, 517 parents of pediatric inpatients at Pingshan District People’s Hospital in Shenzhen were surveyed on the cognition and behavior of antibacterial drug use. Descriptive analysis, univariate analysis and multiple linear regression analysis were used to explore the possible factors affecting parents’ cognition and behavior of rational use of antibiotics.

A total of 517 questionnaires were collected, of which 482 were valid, with an effective recovery rate of 93.23%. The scores of parents’ knowledge and practice on antibacterial drugs were (7.06±3.91) and (28.02±4.32), and the scoring rates were (44.11±24.46)% and (80.06±12.34)%, respectively. The cognitive score was positively correlated with senior high school or technical secondary school (β=0.180, 95% CI: 0.677-2.569), junior college (β=0.244,95% CI: 1.177-3.125), undergraduate degree or above (β=0.353, 95% CI: 2.035-4.333), and was negatively correlated with parents’ with medical background (β=-0.109, 95% CI: -2.800--0.371). The behavioral score was positively correlated with the mother (β=0.123, 95% CI: 0.358-2.198) and parents’ with medical background (β=0.090, 95% CI: -0.006-2.874).

The overall awareness of antimicrobial drugs among parents of children in this urban area is relatively low, and the score rate for rational use of antibiotics is relatively high. However, there are still some misconceptions. It is recommended that relevant departments should strengthen the education of antimicrobial knowledge to the public, strengthen the management of grassroots medical institutions and retail pharmacies, strictly regulate access channels, standardize medication behavior, and try to eliminate the hidden dangers of unreasonable use of antibiotics.

To investigate the survival situation and influencing factors of patients receiving antiretroviral therapy (ART) in Jinjiang district, Chengdu, and to evaluate the effect of ART and optimize follow-up management mode.

The follow-up data of HIV/AIDS patients were collected from the National HHART reporting system during 2012-2022. Life table method was used to describe the survival status, and Cox proportion hazard regression model was used to identify the factors related to survival time.

A total number of 2 113 cases was enrolled, the average age of the study subjects was (38.65±15.65) years old, and the average survival time was 132.41 months. By the time of the follow-up observation was terminated, 71 cases died. The accumulated survival rates of 1, 3, 5 and 10 year after initiating ART were 97.86%, 96.78%, 96.43% and 95.73%, respectively. The multivariable Cox proportional hazards regression analysis indicated that the risk of death. The HR of 40-49 years, 50-59 years, and ≥60 years group were 4.233(95% CI: 1.608-11.139), 3.997(95% CI: 1.265-12.623), 19.994(95% CI: 7.424-53.846) relative to <30 years group, respectively. The HR of unmarried group was 3.359(95% CI: 1.495-7.546) relative to married group. The HR of interval time between diagnosis and treatment 31-60 days, 61-90 days group were 2.337(95% CI: 1.311-4.165), 3.430(95% CI: 1.608-7.319) relative to ≤30 days group. The HR of 200-349 cells/μl and ≥350 cells/μl baseline CD₄⁺T cells counts group were 0.262(95% CI: 0.135-0.509), 0.206(95% CI: 0.080-0.530) relative to <200 cells/μl group. The HR of related symptoms before treatment group was 2.088(95% CI: 1.051-4.148) relative to no related symptoms before treatment group.

The effect of patients receiving ART in Jinjiang District is remarkable. ART coverage should be extended, and corresponding follow-up management measures and intervention means should be developed according to the actual situation in Jinjiang District.