This study aims to investigate the association between weight status and the atherogenic index of plasma(AIP) among adolescents in Liangshan Prefecture, with the goal of providing evidence for the prevention of atherosclerosis in this population.

In October 2021, a sample of middle school students from three schools in Liangshan Prefecture was selected. Follow-up survey was conducted in March 2023. General demographic characteristics were collected via structured questionnaires. Anthropometric measurements, including height, weight, and waist circumference(WC), were obtained. Fasting blood samples were collected to measure serum triglycerides(TG) and high-density lipoprotein cholesterol (HDL-C). The associations between baseline body mass index(BMI) and WC with follow-up atherogenic index of plasma (AIP) were assessed using a linear regression model incorporating restricted cubic splines (RCS). A mediation analysis model was employed to evaluate the potential mediating role of baseline AIP in the relationship between baseline BMI (or WC) and follow-up AIP.Furthermore, the association between baseline weight and WC categories and changes in AIP from baseline to follow-up was examined using logistic regression.

The median baseline age of the 1 023 participants was 14.0 years, with 43.7% being male. The RCS curve indicated that baseline BMI was linearly associated with follow-up AIP (P_general<0.001, P_nonlinearity=0.108). In contrast, baseline WC exhibited a nonlinear association with follow-up AIP (P_general<0.001, P_nonlinearity=0.002). Mediation analysis revealed that baseline AIP fully mediated the association between baseline BMI (or WC) and follow-up AIP (BMI: P_direct=0.06,P_indirect<0.001; WC: P_direct=0.13, P_indirect<0.001). Compared with adolescents with normal BMI, those who were overweight or obese at baseline had significantly higher odds of persistent elevated AIP levels (OR=3.570, P<0.001). Similar findings were observed when WC was used as the indicator of weight status (OR=3.388, P<0.001).

Both elevated BMI and increased WC in adolescents are associated with an increased short-term risk of high AIP. Preventive strategies targeting middle school students should be implemented to mitigate the early onset of atherosclerosis.

To explore the association between nighttime social media use, sleep duration, and executive function decline in pregnant women, as well as the isotemporal substitution effect.

Pregnant women attending the obstetric outpatient department of Qilu Hospital in Jinan, Shandong Province were recruited using the convenience sampling method for a questionnaire survey. Single-factor, partition and isotemporal substitution models were used to analyze the relationship between nighttime social media use, sleep duration, and executive function decline in pregnant women.

A total of 628 pregnant women were included in the study. After adjusting for confounding factors, both the single model and the partition model indicated that nighttime social media use duration was significantly positively correlated with scores in total executive function decline (β=0.980; β=0.965), memory (β=0.595; β=0.585), and inhibitory control dimension (β=0.385; β=0.379) (all P<0.01). In contrast, sleep duration was significantly negatively correlated with scores in total executive function decline (β=-0.414; β=-0.402), memory (β=-0.255; β=-0.248), and inhibitory control dimension (β=-0.159; β=-0.154) (all P<0.05). The isotemporal substitution model showed that increasing sleep by 30 minutes to replace an equivalent amount of nighttime social media use was associated with a decrease in the total score of executive function decline among pregnant women (β=-2.047, P<0.001). The improvement in the memory dimension (β=-1.261, P<0.001) was greater than that in the inhibitory control dimension (β=-0.786, P<0.001).

Replacing 30 minutes of nighttime social media use with sleep is associated with reduced executive function decline in pregnant women. It is recommended that sleep management and digital behavior adjustment be incorporated into clinical interventions and health education to promote cognitive health in pregnant women and improve maternal and neonatal outcomes.

To investigate the characteristic changes and co-occurrence phenomenon of oral and intestinal fungal communities in children with asthma, and to explore the relationship between fungi and metabolism in asthma pathogenesis.

Thirty asthmatic children and thirty healthy controls were enrolled. Oral swabs and fecal samples were collected for metagenomic sequencing analysis of oral and intestinal fungal communities. Untargeted metabolomics was used to detect fecal metabolites. Multivariate statistical analysis and network models were employed to decipher microbe-metabolite associations.

Compared with healthy controls, asthmatic children showed significant alterations in α-diversity and β-diversity (Bray-Curtis distance) of oral and intestinal fungi. In the oral cavity, the relative abundance of genera such as Hanseniaspora and Jimgerdemannia was elevated, while that of genera such as Beauveria was reduced. In the gut, the relative abundance of the phylum Ascomycota was elevated, while genera such as Mucor showed a reduction in relative abundance. The co-occurrence network revealed shared fungi like Candida_f_Debaryomycetac along the oral-gut axis in the asthma group. Metabolomics identified significantly elevated ceramides and decreased α-linolenic acid and lysophosphatidylcholine in the asthmatic group,with Emmonsia showing a positive correlation with ceramides.

Altered oral-gut fungal community abundance and characteristic metabolic profile changes were associated with childhood asthma. The "oral-gut" co-occurrence of fungal communities may synergistically contribute to airway inflammation in conjunction with lipid metabolism dysregulation.

To analyze the regional disparities and spatial distribution characteristics of human resource allocation in county-level medical and health sub-centers in Sichuan Province, and to provide a basis for optimizing the allocation of primary health resources.

The Dagum Gini coefficient, Health Resource Density Index (HRDI), and Health Resource Agglomeration Degree(HRAD) were used to evaluate the current status and regional disparities in resource allocation, combined with exploratory spatial data analysis to examine spatial distribution characteristics.

From 2021 to 2023, the overall Gini coefficient for health human resources in Sichuan’s sub-centers decreased from 0.309 to 0.280, indicating an improvement in the equity of resource allocation. However, regional disparities remained prominent. The HRDI in Northeast Sichuan was 1.757, 4.71 times that of Northwest Sichuan. Structural imbalances were evident, with the density of general practitioners in Northwest Sichuan being only 20.3% of that in the Chengdu Plain. In terms of agglomeration, a mismatch was observed between geographical and population distribution. Chengdu showed a high level of geographical agglomeration, while the three autonomous prefectures had an HRAD<1. Based on population distribution, Chengdu had an HRAD/population agglomeration degree(PAD) <1, indicating a relative shortage of resources, whereas Aba and Ganzi were relatively well-resourced. Spatial analysis further revealed significant clustering of resources, forming a polarized pattern with Ziyang-Suining-Meishan as a “High-High” clustering zone and Ganzi-Liangshan as a “Low-Low” clustering zone.

The total quantity and allocation equity of human resources in sub-centers have improved annually, but regional disparities and spatial clustering contradictions persist. Measures such as targeted financial investment, cultivation of local talent, and promotion of resource sharing can help address structural imbalances and promote balanced development of regional health services.

To evaluate the effects of China’s centralized drug procurement policy and provide references for the healthy development of the pharmaceutical industry and policy optimization.

A framework was constructed based on policy instrument theory. Content analysis was used to quantify 27 national-level policy documents from 2000 to 2024, and fuzzy-set qualitative comparative analysis (fsQCA) was applied to conduct configuration analysis of 21 typical cases.

The structure of policy instruments was imbalanced, with environmental instruments accounting for 46.69%, while demand-type instruments constituted only 26.03%. Five core necessary conditions (consistency>0.9) were identified: drug procurement,procurement behavior regulation, drug price adjustment, industry standards, and drug regulation, with consistency scores of 0.966, 0.934, 1.000, 0.963, and 0.948, respectively. Two configuration paths were distilled: a regulation-core-driven path and a comprehensive safeguard path characterized by multi-instrument synergy.

An optimization framework of"institutional rigidity-dynamic adaptation" is proposed. Recommendations include optimizing the structure of policy instruments, promoting synergy between regulation and the market, and improving incentive mechanisms to advance the continuous refinement of centralized drug procurement policies.

To investigate the influencing factors of outpatient expenses for diabetic patients and conduct case-mix grouping and expenses estimation, providing evidence for the reform of outpatient medical insurance payment methods.

Outpatient medical insurance settlement data of diabetic patients from tertiary hospitals in Lanzhou between January 2022 and December 2023 were collected. Univariate analysis and multivariable linear regression models were used to analyze the influencing factors of total outpatient medical expenses. Subsequently, a decision tree model was applied for ambulatory patient groups(APG) classification, and relevant indicators were employed to evaluate APGs and estimate expenses.

A total of 48 948 valid records were included. The total outpatient medical expenses of diabetic patients were associated with gender (Z=-5.702, P<0.001), ethnicity (Z=-2.180, P=0.029), age (Z=1 096.615, P<0.001), type of diabetes (Z=1 463.467, P<0.001), complications (Z=-13.593, P<0.001), medication use (Z=-10.370, P<0.001), diagnostic testing (Z=-4.676, P<0.001), and medical consumables usage (Z=-16.509, P<0.001). Higher outpatient expenses were observed in male patients, other ethnic groups, individuals aged <45 years, type 2 diabetes cases, and patients with complications, medication use, diagnostic testing, and medical consumables usage. Based on the decision tree model, 13 APGs were established. The number of cases per APG group ranged from 114(APG8) to 11 619(APG5), with significant differences among groups based on a nonparametric test(H=3 266.675, P<0.001). The reduction in variance (RIV) was 0.945, the coefficient of variation (CV) ranged from 0.93 (APG2)to 1.56 (APG12), the relative weight (RW) ranged from 0.44 (APG11) to 1.69 (APG1), the standardized cost ranged from 58.55 CNY (APG12) to 324.83 CNY (APG1), and the excess cost ratio ranged from 1.81%(APG1) to 8.93% (APG3).

The economic burden of outpatient diabetes in tertiary hospitals is substantial, with significant cost variations among different patient subgroups. The decision tree-based case-mix grouping performed well, demonstrating strong inter-group heterogeneity and good intra-group homogeneity. It is recommended to strengthen outpatient security and precise cost control, optimize diagnosis and treatment as well as precise classification of disease groups, and build a diversified and precise payment system, so as to promote the optimization of outpatient medical insurance payment methods and reduce the medical burden of diabetic patients.

This study aims to explore the association between social relationships and the risk of death among older adults in China.

The research subjects were 5 642 older people aged 65 and above who participated in the China Longitudinal Healthy Longevity Survey from 2011 to 2018. Social relationships were defined using the social relations model and its subdimensions: social activities, social networks, and social support. The Cox proportional hazards regression model was used to estimate the association between social relationships and the risk of death among older adults.

Compared with a medium-level social relationship, a high-level social relationships (HR: 0.73, 95% CI: 0.64-0.84) was inversely associated with the risk of death among older adults in China. Compared with moderate levels of social activities and social support, high-level social activities (HR: 0.64, 95% CI: 0.40-0.96) and high-level social support (HR: 0.91, 95% CI: 0.74-0.98) were inversely associated with the risk of death among older adults in China, but the relationship between social networks and the risk of death among older adults in China was not significant.

A high level of social relationships is significantly inversely associated with the risk of death among older adults in China. Policy interventions should create and promote social activity platforms suitable for the elderly, and support and consolidate family-based social support systems.

To explore the mediating role of sleep duration and anxiety in the association between dietary diversity and depression in older adults, so as to inform improvements in their mental health.

This study utilised data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), selecting 7 744 participants. Spearman’s correlation analysis was employed to investigate the relationships between dietary diversity, sleep duration, anxiety, and depression among older adults. The mediating effects of sleep duration and anxiety on the association between dietary diversity and depression were analysed using Model 6 of the Process 4.2 plugin in SPSS.

There was a statistically significant direct effect of dietary diversity on depression in older adults (β=-0.348，95% CI: -0.408~-0.288), a statistically significant separate mediated effect of sleep duration (β=-0.027，95% CI: -0.037~-0.018), a statistically significant separate mediated effect of anxiety (β=-0.181，95% CI: -0.220~-0.142), and a statistically significant chain mediated effect of sleep duration and anxiety (β=-0.016，95% CI:-0.022~-0.011).

Dietary diversity can directly and negatively affect the level of depression in older adults, or it can affect the level of depression in older adults through the separate or chain-mediated effects of sleep duration and anxiety.Therefore, it is recommended that the dietary structure of the elderly should be improved, nutritional intake should be guaranteed, and attention should be paid to sleep regulation to alleviate the anxiety of the elderly, thereby alleviating their depressive conditions.

To construct an evaluation index system for fall management capability in elderly care institutions and evaluate its applicability, aiming to provide a reference for assessing and improving fall management in such settings.

Guided by the 4R crisis management theory, a preliminary evaluation index system was constructed through qualitative research, literature research, Delphi expert consultation, and analytic hierarchy process(AHP). Subsequently, a survey was conducted in six elderly care institutions in Guangdong to evaluate the applicability of the index system.

Two rounds of expert consultations were conducted, with questionnaire response rates of 83.3% and 92.0%, and the expert authority coefficients were 0.892 and 0.896. Kendall W values ranged from 0.175 to 0.237 in the first round, and from 0.217 to 0.339 in the second round (P<0.001). The final index system consisted of four first-level indicators, including reduction, readiness,response, and recovery management capabilities, as well as 13 second-level indicators and 41 third-level indicators. Fourteen managers from the six institutions participated in the study and considered the system comprehensive and practical.

The constructed evaluation index system for fall management capability in elderly care institutions is comprehensive, scientific and practical, providing a valuable reference for relevant health authorities and elderly care institution managers to periodically assess fall management capability.

To explore the influencing factors and pathways of 13-valent pneumococcal conjugate vaccine (PCV13) vaccination intention among parents of eligible children in China.

A multi-stage stratified random sampling method was used to conduct an electronic questionnaire survey among parents of age-eligible children in China. Based on the Behavioral and Social Drivers(BeSD)framework, descriptive statistics, univariate χ² test, Wilcoxon rank-sum test, analysis of variance, multivariable logistic regression, and partial least squares structural equation modeling(PLS-SEM) were applied to analyze vaccination intention, its determinants, and the pathways through which these determinants influence vaccination intention.

The PCV13 vaccination intention rate among parents was 64.0%. Notably, 29.8% of parents believed vaccination could impair immune function, and 51.4% perceived the newer PCV13 as riskier than PCV7. Binary Logistic regression and PLS-SEM identified the following promoting factors: single-child families, prior influenza vaccination in the past three years, higher parental knowledge and education, stronger perceived disease susceptibility and severity, social recommendations (from healthcare providers or peers), and greater perceived benefits of vaccination and sense of responsibility. PLS-SEM showed that perceived benefits and parental responsibility exhibited the strongest direct effects on vaccination intention.

Parental distrust in vaccine safety persists. Perceived benefits and responsibility are the most critical drivers of vaccination intention, while external social influences (e.g., peer behavior) outweigh internal factors (e.g., education level) in shaping decision-making.