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 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 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 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 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 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 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 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 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.