To address regional heterogeneity in multicenter studies, and to explore the association between sleep duration and cardiovascular disease (CVD) risk in the Chinese elderly population using a federated causal learning framework.

Data was obtained from the 2020 China Health and Retirement Longitudinal Study (CHARLS). A total of 10 638 adults aged 60 and above were included. To simulate multi-center collaboration scenarios with real regional heterogeneity, the original dataset was divided into seven geographically distributed datasets. A federated augmented inverse probability weighting (AIPW) estimator was used to estimate causal effects with comparison to centralized models. Subgroup analyses by gender were conducted to explore effect heterogeneity. The robustness of the method was explored by a sensitivity analysis.

Estimations from the federated causal learning models were consistent with those from the centralized model. Abnormal sleep duration was a significant factor influencing CVD risk. Compared to normal sleepers, short sleepers had a significantly increased risk of CVD (OR=1.029, 95% CI:1.016-1.042). Long sleepers also showed elevated risk (OR=1.019, 95% CI:1.005-1.034). The subgroup analysis revealed significant gender differences, and the sensitivity analysis also validated the robustness of the model.

In multicenter research, the federated causal learning systematically controls for confounders and regional heterogeneity. It provides methodological support for future privacy-preserving cross-center collaborative research.

To investigate the association between handgrip strength (HGS), its transitions, and the decline of activities of daily living (ADL) among middle-aged and older adults in China.

This study utilized data from waves 1 to 5 (2011 to 2020) of the China Health and Retirement Longitudinal Study (CHARLS). According to the Asian Work Group for Sarcopenia 2019 consensus, low HGS was defined as <28 kg for males and <18 kg for females. Based on the changes in HGS status from baseline to the second survey, participants were classified into four groups: stable normal HGS, normal HGS to low HGS, low HGS to normal HGS, and stable low HGS. ADL disability was measured by the number of daily activities with difficulty, with higher scores indicating poorer functional ability. Linear mixed-effect models were employed to investigate the association of handgrip strength and its transition patterns with ADL decline.

Individuals with low HGS exhibited a higher level of ADL disability (β=0.607, 95% CI: 0.523-0.690, P<0.001) and a faster progression of ADL disability (β=0.085,95% CI: 0.068-0.101, P<0.001) compared to those with normal HGS. Compared with individuals with stable normal HGS, those with stable low HGS (β=0.153, 95% CI: 0.120-0.185, P<0.001) experienced the most rapid progression of ADL disability, followed by those transitioning from normal HGS to low HGS (β=0.081, 95% CI: 0.059-0.103, P<0.001).

Lower HGS is associated with accelerated ADL disability progression. Dynamic changes in handgrip strength also provide significant prognostic value for assessing the risk of ADL decline. Regular monitoring of handgrip strength and its changes may aid in the prevention and delay of ADL decline.

To investigate the association between dynapenic abdominal obesity (characterized by reduced handgrip strength combined with abdominal obesity) and the risk ofdiabetes in middle-aged and older Chinese adults.

Using data from the China Health and Retirement Longitudinal Study (China Health and Retirement Longitudinal Study,CHARLS) 2011-2015, 4 556 participants aged ≥45 years without diabetes at baseline were included. Based on handgrip strength (men <28 kg, women <18 kg) and waist circumference (men ≥90 cm, women ≥85 cm), participants were categorized into four groups:non-dynapenic/non-abdominal obesity (ND/NAO),non-dynapenic/abdominal obesity (ND/AO),dynapenic/non-abdominal obesity (D/NAO), and dynapenic abdominal obesity (D/AO).Cox proportional hazards models were employed to analyze the association between each group and diabetes risk, and subgroup analysis was conducted to explore the association between dynapenic abdominal obesity and the risk of diabetes onset under different groupings.

After a mean follow-up of 4 years, 495 new cases of diabetes mellitus were recorded，representing an incidence rate of 10.9% and an incidence density of 27.2 per 1 000 person-years. Following multivariable adjustment, compared with the ND/NAO group, the ND/AO group exhibited a 71% increased risk of diabetes onset (HR=1.709, 95% CI: 1.395-2.095), while the D/AO group showed a 123% increased risk (HR=2.226, 95% CI: 1.472-3.366). No significant difference was observed in the D/NAO group (P>0.05), with subgroup analyses yielding consistent results.

Dynapenic abdominal obesity significantly increases the risk of diabetes among middle-aged and older Chinese adults,with a higher risk than abdominal obesity alone.

With the acceleration of population aging in China, the problem of depressive symptoms in the elderly is prominent, and there is health inequity between urban and rural elderly.

To investigate the influencing factors of depressive symptoms among Chinese elderly population and their urban-rural differences, so as to provide references for preventing depressive symptoms in the elderly.

Relevant data of 4 449 elderly individuals aged ≥ 60 years were collected from the 2022 China Family Panel Studies (CFPS). The chi-square test was used to compare the differences in the detection rate of depressive symptoms between urban and rural areas. Binary logistic regression was adopted to screen for the main influencing factors, and the random forest model was applied to rank these factors by their importance.

The detection rate of depressive symptoms among Chinese elderly was 25.20%, with rural elderly showing a higher rate (30.58%) than urban elderly (19.80%) (χ²=68.542, P<0.05).

of the regression analysis indicated that gender, chronic disease, self-rated health, napping, nighttime sleep time, interpersonal relationships, education level, retirement status, regional distribution, and income level are common influencing factors of depressive symptoms among the urban and rural elderly populations. The random forest model showed that, for the urban elderly population, the factors ranked in descending order of influence on depressive symptoms are good self-rated health (OR=0.396, 95% CI: 0.312-0.503), secondary school (OR=0.639, 95% CI: 0.473-0.862), and being retired (OR=0.726, 95% CI: 0.541-0.975). For the rural elderly population, the factors are good self-rated health (OR=0.472, 95% CI: 0.383-0.581), having chronic diseases (OR=1.918, 95% CI: 1.552-2.370), and nighttime sleep time <7h (OR=1.697, 95% CI: 1.365-2.110).

The higher detection rate of depressive symptoms among rural elderly warrants special attention to self-rated health, with particular focus on education level and retirement status for urban elderly, and chronic disease and nighttime sleep time for rural elderly, so as to formulate differentiated intervention strategies.

To analyze the current status of perceived risk of recurrence among patients with first-time upper gastrointestinal bleeding due to liver cirrhosis and to explore the impact of risk perception on bleeding recurrence within one year.

Patients hospitalized at a tertiary hospital from December 2023 to April 2024 with first-time upper gastrointestinal bleeding due to liver cirrhosis were enrolled. Baseline data and scores from the Perceived Risk of Recurrence Scale were collected. Logistic regression analyzed the effect of perceived risk levels on 1-year recurrence. ROC curves assessed the predictive value of risk perception for 1-year recurrence, and decision curve analysis evaluated its practical utility.

A total of 221 patients was enrolled, with 47 experiencing rebleeding during one-year follow-up. The risk perception score was 72.0 (65.0, 90.5). Logistic regression indicated that, after adjusting for confounding factors, risk perception was an independent protective factor against rebleeding. The AUC for predicting one-year rebleeding using risk perception was 0.847 (95% CI:0.779-0.915). The net benefit ratio for predicting 1-year bleeding recurrence risk was 0.03-0.80.

Patients with cirrhosis experiencing their first upper gastrointestinal bleeding event exhibit a low to moderate perception of recurrence risk, and this risk perception is significantly associated with bleeding recurrence.

To examine the association between anemia and hypertension among middle-aged and older Chinese women.

Baseline data of 5 575 women aged ≥45 years from the 2015 China Health and Retirement Longitudinal Study (CHARLS) were collected, with anemia in 2018 as the outcome. Multivariable logistic regression was used to assess cross-sectional and longitudinal relationships between anemia and hypertension. Restricted Cubic Splines (RCS) were used to analyze the dose-response relationship between hemoglobin and the risk of hypertension in middle-aged and elderly women.

Anemia was inversely associated with hypertension. In 2015, anemic women had a 25-35% lower prevalence of hypertension (Model 1: OR=0.65, 95% CI: 0.57-0.74; Model 4: OR=0.75, 95% CI: 0.63-0.88; both P<0.01). Over 2015—2018, baseline anemia reduced 3-year hypertension incidence by 42-50% (Model 1: OR=0.58, 95% CI: 0.43-0.79; Model 4: OR=0.50, 95% CI: 0.35-0.71; P<0.001). RCS showed a linear inverse relationship between hemoglobin level and hypertension risk. BMI influenced the strength of association, but no interaction was detected (all P > 0.05). Sensitivity analyses confirmed robustness.

Anemia is associated with lower prevalence and incidence of hypertension in middle-aged and older Chinese women.

This study aimed to characterize the epidemiology of HIV/AIDS through expanded screening to provide evidence for epidemic assessment and response.

Data were obtained from an expanded HIV screening program conducted in a district of Chengdu between 2019 and 2024. After collection and cleaning, datasets were analyzed using Excel 2019 and R 4.5.0. Categorical variables were summarized using frequencies and composition ratios, with between-group differences assessed by chi-square tests. Analyses focused on HIV positivity rates and seroconversion rates.

During the six-year period, the screening program reached 1 025 356 individuals, representing 76.17% of the target population, with a total of 1 901 438 tests performed. A total of 2 419 HIV-positive cases (1 463 cases were infected previously) and 221 seroconversion cases were identified. Most cases were male (75.86% and 69.23%, respectively) and aged 50 years or older (56.72% and 65.16%, respectively). The overall HIV positivity rate (, P<0.001) showed a significant increasing trend, whereas the seroconversion rate showed no significant trend (, P=0.241). The HIV positivity rate was highest in the 60-69 age group (376.92 per 100 000), while the seroconversion rate was highest in the 50-59 age group (81.56 per 100 000). The seroconversion rate among males was approximately 3.5 times that of females.

The epidemic is characterized by an increasing trend in the overall HIV positivity rate coupled with fluctuating seroconversion rates. Men over 50 years represent a key population at elevated risk, underscoring the need for targeted prevention and screening strategies in this demographic.

To identify risk factors for secondary fungal infection in patients with pneumoconiosis complicated by bacterial pneumonia and to develop a nomogram prediction model.

Clinical data of patients admitted to a tertiary occupational disease hospital between December 2021 and July 2024 were retrospectively analyzed and randomly divided into training and testing sets (7:3). Variables were selected using LASSO and multivariable logistic regression to construct a nomogram. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA).

Among 641 patients, 213 developed secondary pulmonary fungal infection. Multivariable analysis showed that invasive procedures (OR=3.440, 95% CI:2.111-5.699), elevated immature granulocyte percentage (OR=2.294, 95% CI:1.254-4.402), systemic glucocorticoid use (OR=2.196, 95% CI:1.114-4.327), repeated hospitalization (OR=2.094, 95% CI:1.280-3.464), and increasing age (OR=1.059, 95% CI:1.034-1.085) were associated with increased risk, whereas higher large platelet count was associated with reduced risk (OR=0.980, 95% CI:0.968-0.992). The nomogram achieved AUCs of 0.818 (95% CI:0.777-0.858) in the training set and 0.797 (95% CI:0.688-0.906) in the testing set. Calibration and DCA demonstrated good agreement and clinical net benefit.

The nomogram accurately predicts secondary fungal infection risk in this population, demonstrating favorable performance and potential for early risk stratification and targeted intervention.

To analyze the contamination characteristics of multiple mycotoxins in cornand corn products across districts and counties in Jinan City during 2022—2023, and to assess the cumulative exposure risk among different age groups.

We collected 173 samples of maize and products from 12 districts and counties in Jinan City from 2022 to 2023, and simultaneously detected 12 mycotoxins by isotope dilution liquid chromatography tandem mass spectrometry, and evaluated the cumulative exposure risk of the population of different age groups based on the data of dietary consumption of residents in Shandong Province by using compositional analysis combined with the equivalence factor (EF) and the exposure boundary value (MOE).

Fumonisins (FBs) were the most contaminated (detection rate, 91.3%, mean, 1 506.1 μg/kg), followed by deoxynivalenol and metabolites (tDON, detection rate, 89.6%, mean, 91.7μg/kg) and zearalenone (ZEN, detection rate,72.8%, mean,41.1μg/kg). 91.9% of samples contained two or more toxins concurrently, with FB+tDON+ZEN being the predominant co-contamination pattern. Contamination characteristics varied across districts: Laiwu District exhibited relatively higher FB detection levels(2 653.7 μg/kg), while Huaiyin District showed relatively higher tDON levels (259.6 μg/kg). No distinct high-risk areas for ZEN contamination were identified citywide. The MOE values for all population groups fell below the safety threshold (100),indicating potential health risks. At the same time, it is necessary to consider the uncertainty of evaluation caused by sample size and consumption data. The younger age group exhibited relatively higher risks. No statistically significant differences in exposure risk were observed between genders. FBs contributed the most (93.6%) to cumulative exposure risk and were identified as the primary risk factor. Corn milling products served as the main exposure source (Contribution rate 67%), with consumption levels positively correlated to mycotoxin exposure.

Mycotoxin contamination in Jinan exhibits a spatial distribution pattern characterized by higher levels in peripheral areas and lower levels in central areas. The population faces potential health risks from cumulative exposure to mycotoxins through the consumption of corn and corn products. Younger age groups, due to their higher intake per unit of body weight, should be prioritized as key targets for prevention and control.

To analyze the intervention effectiveness of the Integrated Maternal and Mental Care Model (I2Mcare) for perinatal depression (PND) in primary maternal and child health institutions and explore its implementation process’s facilitators and barriers.

A hybrid type 1 randomized effectiveness-implementation trial was conducted. PND high-risk pregnant women were randomly assigned to an intervention group (receiving I2Mcare) or a control group (receiving routine maternal care). Four times of depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. We use generalized linear mixed models to analyze the effect of intervention. Semi-structured interviews based on the Consolidated Framework for Implementation Research (CFIR) were administered to pregnant women and healthcare providers (n=27) to collect data on implementation factors. Qualitative data were analyzed by the thematic framework method.

A total of 153 pregnant women completed all 4 depression assessments, including 41 in the intervention group and 33 in the control group. No statistically significant differences in depression scores were found between the two groups during the first three assessments. However, in the fourth assessment, the depression score of the intervention group was significantly lower than that of the control group (P<0.05). Results from the Generalized Linear Mixed Models analysis indicated statistically significant effects for both the group difference (P=0.033) and the time effect (P<0.001). Key facilitators included the model’s relative advantages, China’s well-established maternal and child health system, strong foundational work from mental health departments and so on. Barriers encompassed insufficient public awareness, inadequate policy support and high clinical workload in obstetric departments.

The I2Mcare effectively alleviates depressive symptoms in high-risk pregnant women. Future scale-up should prioritize policy refinement, staff training, interdisciplinary collaboration, and public education.