In response to the continuously expanding debt scale and increasingly prominent debt risks of public hospitals in China, this study aims to construct a debt risk evaluation model suitable for public hospitals. This study empirically evaluates debt risk patterns across public hospitals by administrative level, type, and grade, aiming to support targeted risk mitigation policies.

Using the relevant data from the 2023 financial annual reports of 408 public hospitals under the Health Commission of Sichuan Province as the sample, this study selected 11 indicators highly correlated with debt risk and established a risk early-warning model through factor analysis.

Factor analysis identified four common factors, with a cumulative variance contribution rate of 87.026%, which collectively constitute the core determinants of debt risk. Debt risk distribution exhibited significant variations across hospitals grouped by different dimensions. At the administrative level, prefecture-level hospitals had the highest proportion of high-risk cases, standing at 28.38%. By hospital type, traditional Chinese medicine hospitals recorded the highest share of high-risk instances, reaching 31.16%. By hospital grade, secondary hospitals accounted for the largest proportion of high-risk cases, at 27.38%.

The debt risk model constructed using factor analysis demonstrates good applicability and effectiveness, enabling a scientific assessment of public hospitals’ debt risk levels. Based on the evaluation findings, we recommend a coordinated approach across multiple areas: strengthening planning constraints and government investment, deepening health insurance price reforms and enhancing internal management, establishing a monitoring and early-warning system. This comprehensive strategy aims to resolve existing debt in a tiered and categorized manner and prevent systemic risks.

To analyze the coordinated development trend and influencing factors of population, economy and medical and health service system in Qinghai Province from 2010 to 2023, and to provide reference for promoting regional coordinated development.

Based on the data of “Qinghai Statistical Yearbook” and “China Statistical Yearbook” from 2010 to 2023, a comprehensive evaluation index system was constructed, the weight was determined by entropy method, and the coupling coordination degree model, grey correlation analysis and GM (1,1) prediction model were used for dynamic evaluation and identification of key factors.

From 2010 to 2023, the coupling coordination degree of the population-economy-health service system in Qinghai Province increased from 0.455 to 0.818, and the coordination level increased from “on the verge of imbalance” to “good coordination”; the structure type has experienced the evolution of “medical lag-economic lag-population lag”. Grey correlation analysis identified the number of beds in health institutions (0.731 6) and the proportion of tertiary industry (0.716 0) as strong correlation factors. The GM (1,1) model predicts that the system will enter the excellent coordination level in 2026.

The coordinated development level of the three major systems in Qinghai Province has been steadily improved. In the future, efforts should be made to optimize the population structure, promote the service transformation of industrial structure, improve the efficiency of medical and health resources, and promote regional coordinated development.

To understand the current state of integrated medical and childcare services in Guizhou Province’s childcare institutions and propose corresponding countermeasures and recommendations.

A cross-sectional study was conducted, involving a questionnaire survey of 574 registered childcare institutions in Guizhou Province. Differences across various types of childcare institutions were examined across three dimensions: childcare provision, health and hygiene, and parenting support.

With regard to childcare and care, the compliance rate for the cumulative duration of daily outdoor activities at the centre was low, with significant differences between institutions(P<0.001). However, services such as sleep monitoring, the frequency of menu changes, and the setting of individualised development goals based on physical and mental development were generally well implemented, with no significant differences between institutions(P>0.05). The rate of regular disinfection of bedding was low, with no significant differences between institutions(P>0.05). In terms of health care:(1) The development of health care systems was inadequate, and there were significant differences between institutions(P=0.015);(2) The implementation rates for physical growth and development monitoring(P=0.002), oral health care(P=0.005) and eye care services(P<0.001) were relatively high, whilst those for psychological and behavioural assessments(P=0.012) and traditional Chinese medicine health care services(P=0.004) were relatively low, with significant differences observed between institutions(P<0.05); Conversely, the rate of establishing individual health management records was high, with no significant differences between institutions(P>0.05), whilst the rate of provision of first-aid supplies for accidental injuries was low, with no significant differences between institutions(P>0.05). Regarding parenting support, more than half of the institutions received medical guidance, and there was a widespread need for family parenting support and policy interpretation, with no significant differences between institutions(P>0.05); however, there was a significant difference in whether institutions that received medical guidance were able to meet infant and child health care needs(P=0.033).

Childcare institutions across Guizhou Province have implemented integrated medical and childcare services to varying degrees, though the standardisation and professionalism of these services remain areas for improvement. The government should expedite the formulation of local standards for integrated medical and childcare services and actively advance the “1+4+N” service model to foster high-quality development in childcare provision.

To explore the coupling-coordination relationship among the three systems of public health, medical services, and medical insurance in China, so as to provide a reference for promoting the in-depth development of the medical and health system and the modernization of governance capacity.

Based on panel data from 31 provinces in China from 2013 to 2022, a coupling coordination evaluation index system for the "Prevention-Treatment-Insurance" system was constructed. The entropy weight-TOPSIS model, kernel density estimation, Dagum Gini coefficient and its decomposition, and spatial autocorrelation model were employed to analyze the spatio-temporal evolution characteristics and regional differences of the coupling coordination degree.

The overall coupling-coordination degree of “prevention-treatment-insurance” showed an increasing trend, with a distribution pattern of “eastern>western>central regions”. The national, central and western regions exhibited different polarization phenomena, with obvious intra-regional differences but an overall convergence trend, and the differences were derived from inter-regional gaps. Moran’s scatter plot showed the existence of “low-low” and “high-low” agglomerations. Spatially, the distribution was characterized by contiguous reluctant coordination, the disappearance of near imbalance, and the increase of primary and intermediate coordination.

The coupling and coordination level of “prevention, treatment, and protection” across provinces has shown steady improvement, with a downward trend in regional disparities and significant spatial spillover effects. There is a need to further optimize the coordinated development mechanism of “prevention, treatment, and protection” and address the obstacles and challenges in its operation.

To investigate the dose-response relationship between nighttime sleep duration and fall risk among older adults with chronic diseases, and to analyze age differences, thereby informing targeted interventions.

A questionnaire survey was conducted from January to May 2024 among adults aged ≥60 years in Shandong Province. Logistic regression was used to assess fall risk across different sleep durations. Restricted cubic splines (RCS) were applied to analyze nonlinear associations, with age-stratified analysis performed.

Among 1 421 older adults with chronic diseases, the fall incidence was 18.7%. RCS analysis revealed a significant nonlinear relationship between nighttime sleep duration and fall risk (overall trend P<0.001, nonlinear P=0.019). The optimal overall sleep duration was 7-8 h. Age-stratified results showed that among individuals aged 60-70 years, those sleeping 6-7 h had the lowest fall risk (overall trend P<0.001, nonlinear P=0.011). while those aged 71-80 had the lowest fall risk with 7-8 h of sleep (overall trend P=0.003, nonlinear P=0.037). For individuals aged 81 and older, the relationship between sleep duration and fall risk was not significantly nonlinear (overall trend P=0.182, nonlinear P=0.109).

Nighttime sleep duration and fall risk exhibit a U-shaped curve in older adults with chronic diseases, with optimal duration varying by age. Appropriately managing sleep duration may help reduce fall risk.

To investigate the association between different domains of physical activity (PA) and adiposity-related indicators among rural older adults in Chengdu, offering empirical evidence to inform the design of tailored health intervention policies.

An observational analysis was conducted using data from a cluster randomized controlled trial performed in rural areas of Chengdu. The Physical Activity Scale for the Elderly was used to assess total physical activity, work-related physical activity, housework physical activity, and leisure-time physical activity levels. Body mass index (BMI), body fat percentage, waist-to-hip ratio (WHR), and waist-to-height ratio (WHTR) as adiposity-related indicators were measured. A linear mixed model was employed to analyze the relationship between different domains of PA and adiposity-related indicators. Sensitivity analyses were conducted in control group to assess the robustness of the findings.

Of the 508 enrolled participants (average age: 70.93 years), 282 were female, while the remaining 226 were male. Total PA, work-related PA, and household PA levels all showed significant negative correlations with BMI, body fat percentage, WHR, and WHTR (total PA: β=-0.004 9, P<0.001; β=-0.013 5, P<0.001; β=-0.000 1, P<0.001; β=-0.000 1, P<0.001; work-related PA: β=-0.003 1, P=0.006; β=-0.012 8, P=0.005; β=-0.000 1, P=0.007; β=-0.000 1, P<0.001; household PA: β=-0.008 4, P=0.006; β=-0.017 0, P<0.001; β=-0.000 2, P<0.001; β=-0.000 2, P<0.001). However, leisure-time PA was only significantly negatively associated with WHR and WHTR (β=-0.000 1, P=0.007; β=-0.000 1, P=0.011). Sensitivity analysis further confirmed the robustness of these associations.

Higher levels of total PA, work-related PA, and household PA were associated with lower BMI, body fat percentage, WHR, and WHTR in older adults. Higher leisure-time PA was only associated with lower WHR and WHTR. These findings suggest that future physical activity recommendations for older adults should be tailored based on adiposity-related indicators to develop precise and effective intervention strategies.

To evaluate the correlation between intergenerational support and overall survival (OS) of older adults.

Using data from six waves (2010—2020) of the China Family Panel Studies, we selected older adults aged ≥60 years at baseline in 2010 who had at least one child. Cox proportional hazards regression models were employed to analyze the association between intergenerational support and OS. Proportional hazards assumption was tested using Schoenfeld residuals, and stratified Cox models were applied to correct for variables that violated this assumption. Multivariable logistic regression models were used to examine differences in baseline characteristics among older adults receiving different types of intergenerational support. All analyses were stratified by urban and rural residence, adjusting for baseline age, sex, marital status, education level, and instrumental activities of daily living (IADL). Intergenerational support included financial support and instrumental support.

A total of 5 913 older adults were included. Stratified multivariate Cox regression analysis showed no association between financial support and OS (stratified adjusted HR_{yes vs no}=1.04, 95%CI: 0.93-1.17). In contrast, receiving instrumental support was associated with worse OS (stratified adjusted HR_{yes vs no}=1.20, 95%CI: 1.07-1.34). Urban-rural stratified analyses yielded consistent results. Multivariable logistic regression showed that older adults who were advanced in age, without a spouse, had lower education, or without IADL were more likely to receive financial support and instrumental support from their children (all P<0.050), with similar urban-rural patterns.

Receiving instrumental support was associated with poorer OS among older adults, while no correlation was found for financial support. Policy implications include strengthening social security safety net and utilizing the initiation of care receipt as a community alert to trigger early health interventions, thereby mitigating health risks and promoting healthy aging.

To explore the relationship between internet use and cognitive function in older adults, and to evaluate the impact of internet use on the predictive output of cognitive impairment risk.

Based on data from the 2020 China Health and Retirement Longitudinal Study (CHARLS), propensity score matching (PSM) was used to control for confounding factors and analyze the effect of internet use on cognitive function in older adults. The XGBoost algorithm was employed to construct a risk prediction model for cognitive impairment, and the area under the receiver operating characteristic curve (AUC) was used to evaluate the predictive performance of the model. The SHapley Additive exPlanations (SHAP) method was applied to interpret the XGBoost model.

A total of 3 685 older adults was included in the study. Propensity score matching using nearest neighbor matching, radius matching, and kernel matching showed that the average treatment effects of internet use on cognitive function were 0.564, 0.580, and 0.594, respectively (P<0.001). The XGBoost prediction model incorporating internet use achieved an AUC of 0.781 (95%CI: 0.761-0.799). SHAP analysis revealed that internet use was a key predictive factor for cognitive impairment in older adults.

Internet use has a positive effect on cognitive function in older adults. The XGBoost-based risk prediction model for cognitive impairment demonstrates high discriminative ability and good interpretability, which may assist in early screening and individualized clinical intervention.

To investigate the effect of sodium arsenite(NaAsO₂) exposure on the expression of trans-spliced tissue inhibitor of metalloproteinase 2(ts-TIMP2) in A549 cells and to analyze the role of ts-TIMP2 in arsenic-induced cell viability.

Specific primers were designed to amplify ts-TIMP2, and their specificity was validated via qRT-PCR, agarose gel electrophoresis, and DNA sequencing. CCK-8 assays were used to determine appropriate NaAsO₂ concentrations and exposure duration. mRNA levels of TIMP2 and ts-TIMP2 were quantified by qRT-PCR. siRNA-mediated knockdown and lentiviral overexpression systems(carrying GFP and 3×Flag tags) were established to modulate ts-TIMP2 expression, and CCK-8 assays were performed to assess cell viability under various conditions.

The results from all three methods confirmed the specific amplification of ts-TIMP2 by these primers. NaAsO₂ reduced A549 cell viability in a dose-dependent manner, with an IC₅₀ of 48.48 μM. TIMP2 mRNA was significantly upregulated at 30 and 45 μM NaAsO₂(P<0.01), while ts-TIMP2 expression increased significantly only at 45 μM(P<0.05), indicating concentration-dependent regulation. Knockdown of ts-TIMP2 decreased cell viability by 13.18% compared to the negative control(P<0.01), co-treatment with NaAsO₂ further significantly suppressed cell viability(P<0.01). Conversely, ts-TIMP2 overexpression enhanced cell viability by 24.66%(P<0.01) and maintained significantly higher viability than the NaAsO₂-only group even under co-treatment conditions(P<0.05).

Sodium arsenite(NaAsO₂) can induce the expression of trans-spliced TIMP2(ts-TIMP2), thereby enhancing the viability of A549 cells.

To analyze the consistency between the Mycobacterium tuberculosis loop-mediated isothermal amplification (Mycobacterium tuberculosis loop-mediated isothermal amplification, TB-LAMP) and the tuberculosis T-cell spot test (tuberculous infection of T cells spot test, T-SPOT.TB) in the diagnosis of tuberculosis (tuberculosis, TB), as well as the influencing factors of the accuracy of combined diagnosis.

A total of 556 suspected TB patients hospitalized in our hospital from January 2022 to December 2024 were selected. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic values of the two methods used alone and in combination. The Kappa test was employed to assess the consistency between the two methods and Mycobacterium tuberculosis (MTB). Univariate and multivariate Logistic regression analyses were conducted to identify the factors influencing the combined diagnostic accuracy of the two methods.

The positive rates of TB-LAMP in the three groups were 87.32%, 75.00%, and 12.23% respectively, those of T-SPOT.TB were 92.39%, 71.74%, and 23.40% respectively, and those of the combined detection were 93.48%, 85.87%, and 18.09% respectively, with significant differences among the groups (P<0.001). There was a high consistency between T-SPOT.TB, TB-LAMP, and their combined detection and MTB culture (Kappa=0.747, 0.733, 0.751). The sensitivities of TB-LAMP, T-SPOT.TB, and the combined detection were 84.24%, 87.23%, and 91.58% respectively, the specificities were 92.63%, 90.43%, and 83.51% respectively, the diagnostic accuracies were 87.41%, 88.31%, and 88.85% respectively, and the AUCs were 0.840, 0.910, and 0.930 respectively. Age≥60 years, CD4⁺ T lymphocyte count<350 cells/μL, albumin<35 g/L, diabetes, number of specimen submissions<3 times, time from collection to processing>2 h, and failed microscopic examination were independent risk factors affecting the combined diagnostic accuracy (P<0.05). Genderstratified analysis showed that except for age which was not significant in the female subgroup, all other risk factors remained independently significant in both male and female subgroups. Gender did not substantially interfere with the effects of these risk factors.

The combined detection of TB-LAMP and T-SPOT.TB can significantly improve the diagnostic accuracy. Age≥60 years old, CD4⁺ T lymphocyte count<350 cells/μL, albumin<35 g/L, diabetes, number of tests sent for examination<3 times, collection-to-processing time>2 hours, and insufficiently qualified for microscopic examination are all independent risk factors affecting the accuracy of the combined diagnosis.