To investigate the mediating role of life satisfaction in the relationship between different types of leisure activities and cognitive function among rural older adults in Guizhou Province.

In July-August 2022, a face-to-face questionnaire survey was conducted in 12 villages across 2 counties in Guizhou Province, targeting at adults aged 60 and above. Using a self-administered questionnaire, Mini-mental State Examination(MMSE), and Satisfaction With Life Scale(SWLS), data was analyzed via descriptive statistics, partial correlation, and multiple regression. Mediation was assessed using the “mediation” package in R 4.3.1 and validated via the Bootstrap method.

A total of 1 298 adults aged 60 years and above were included in this study. The average score for cognitive function was 20.29±5.96, and the average score for life satisfaction was 26.41±4.61. Leisure activities were categorized into family-oriented and non-family-oriented types, with average scores of 8.64±3.04 and 8.86±2.55, respectively. Both types of leisure activities were positively correlated with life satisfaction and cognitive function (P<0.05). Life satisfaction partially mediates the relationship between family-oriented leisure activities and cognitive function, with an indirect effect of 0.059 (95% CI: 0.032-0.090), accounting for 13.4% of the total effect. This indirect effect is significant in elderly women (0.116, 95% CI: 0.064-0.170), representing 26.3% of the total effect, but not in elderly men.

In Guizhou Province, life satisfaction mediated the link between family-oriented leisure activities and cognitive function among rural older women. Strengthening support for rural older adults’ leisure activities can enhance their life satisfaction and cognitive function.

To classify the general self-efficacy of patients with chronic comorbidities by using latent class analysis, thereby to analyze the influencing factors which affect the general self-efficacy of middle-aged and elderly patients with chronic disease comorbidities based on the results of category analysis, and to provide references for improving the mental health in the multi-dimensional health of the elderly in China and realizing “healthy aging”.

Based on the Ningxia Natural Science Foundation project in 2023, a multi-level stratified random sampling method was adopted to screen out 967 comorbidity patients. Latent class analysis and logistic regression analysis were used to explore the current situation and influencing factors of the general self-efficacy of patients with chronic comorbidities in Ningxia.

Among the 967 study subjects, the diseases with the highest prevalence rates among patients with comorbidities were hypertension, musculoskeletal disorders, and diabetes. The latent class analysis revealed that 402 individuals had low general self-efficacy, 161 had high general self-efficacy, and 403 had moderate general self-efficacy.The C2 “High Self-Efficacy Group” consisted of individuals aged 45 to 59 years (with OR values and 95% CI intervals being 0.374, 0.188; 0.208-0.671; 0.085-0.418), had lower educational levels (with OR values and 95% CI intervals being 0.192, 0.157; 0.041-0.893; 0.011-0.297), and those who received some financial support from their children (with OR values and 95% CI intervals being 0.491, 0.340; 0.328-0.736; 0.209-0.553) generally had lower general self-efficacy (all OR values <1). Among the middle-aged and elderly with two chronic diseases in their comorbidity status, those from C2 “High Self-Efficacy Group” had higher general self-efficacy (with OR values being 6.709, 3.303, both >1, and 95% CI intervals being 4.397-10.138; 2.468-4.421). In addition to the above factors, middle-aged and elderly living in rural areas (with an OR value of 0.616 and a 95% CI range of 0.402-0.944) in C1 “Moderate Self-Efficacy Group” generally had lower general self-efficacy, while those who occasionally Participated in activities from C2 “High Self-Efficacy Group” generally had lower general self-efficacy (with an OR value of 0.377 and a 95% CI range of 0.191-0.744).

In Ningxia, there are more middle-aged and elderly with moderate to low general self-efficacy. Age, educational level, residence,Participation in activities, financial support from children, and comorbidity status all affect the general self-efficacy of middle-aged and elderly in Ningxia. It is recommended to improve the elderly health service system in rural areas, establish elderly activity centers, encourage older people to Participate in more activities, form good exercise habits, and focus on rural Patients with lower educational levels. A series of health activities should be carried out in combination with the characteristics of comorbidities such as hypertension, arthritis, diabetes, etc., to helppatients manage with a positive attitude.

To analyze the impact of the outpatient mutual assistance reform of employee medical insurance on outpatient costs in medical and pharmaceutical institutions, offering valuable insights for deepening outpatient medical system reforms and optimizing chronic disease management.

Outpatient cost indicators for hypertensive patients in City L from January 2022 to December 2023 were collected. Univariate analysis and a two-group interrupted time-series model were employed to compare changes in cost indicators before and after the reform.

A total of 688 510 valid cases were included, with 158 474 (23.02%) from pharmacies, and 530 036 (76.98%) from hospitals. The overall outpatient costs in medical and pharmaceutical institutions showed statistically significant differences before and after the reform (Z/t= -3.486/6.972, P<0.05), with post-reform data showing reduced total expenditures. However, the reform also led to a decline in the average reimbursement rate per visit, with a more pronounced effect observed in retail pharmacies than in medical institutions. Furthermore, the reform was associated with increased utilization of Chinese herbal medicines, accompanied by a significant rise in related expenditures (Z/t= -4.229/-4.285, P<0.05).

The outpatient mutual assistance reform of employee medical insurance has alleviated the financial burden of hypertension patients in medical and pharmaceutical institutions, though the payment capacity of health insurance slightly declined in the early stages of reform. It is essential to coordinate the outpatient mutual assistance reform with other policies, establish a comprehensive tripartite linkage system involving medical management, insurance payment, and drug supply, and optimize outpatient management strategies for chronic diseases.

To explore the mediating role of emotional exhaustion in the relationship between workload and turnover intention among grassroots disease control and prevention staff, and the regulatory effect of policy perception.

A total of 1 108 District CDC staffs in Wuhan were selected by general survey in January 2024, and descriptive statistical analyses, regression analyses, and moderated mediated effects analyses were conducted.

(1) Workload could not directly affect the turnover intention in grassroots CDC staff (β= -0.031, P>0.05). (2) Emotional exhaustion played complete mediating roles between workload and turnover intention (95% CI: 0.269-0.371), with mediating effect size of 0.318. (3) Policy perception played a moderating role in the former half of the pathway of the aforementioned mediation model (β= -0.085, 95% CI: -0.170--0.002).

There is a moderated mediating effect between workload and turnover intention in grassroots CDC staffs, and emotional exhaustion is the mediating variable between them. Policy perception buffered the influence of workload on emotional exhaustion. Therefore, reasonably controlling working hours and task volumes, guiding grassroots disease control personnel to alleviate negative emotions, and enhancing their positive perception of the reform known as “public welfare first-class security, public welfare second-class management” can help reduce the level of intention to leave.

To explore the association ofbody mass index (BMI), body roundness index (BRI), waist circumference (WC), and waist hip ratio (WHR) with the risk of all-cause mortality in a community-based cohort.

This study was based on a prospective cohort study conducted in Pudong New Area. Obesity-related indicators were obtained at the baseline survey, mortality data was collectedduring the follow-up period.The associations between BMI, BRI, WC, WHR and the risk of all-cause mortality were assessed using cox proportional hazard model, restricted cubic spline (RCS) regression model, and receiver operator characteristic (ROC) curve.

A total of 9 448 participants was included in the analysis. The median follow-up time was 10.77 years, during which 987 deaths occurred,the all-cause mortality was 10.08/1 000 person-years.After multi-variable adjustment,the HR(95% CI) of elevated BRI, WC, and WHR were 1.07(1.01-1.14), 1.12(1.05-1.20), and 1.14(1.07-1.21), respectively.There were U-shaped dose-response relationship betweenBMI, BRI, WC and all-cause mortality; and alinear dose-response relationshipbetween WHR and all-cause mortality. BRI had the highest accuracy in predicting all-cause mortality, with the AUC of 0.62(95% CI=0.60-0.64).

Obesity is a significant risk factor for all-cause mortality, proper control of obesity and fat distribution can help reduce the risk of all-cause mortality.

To analyze the information of aquatic products that were not allowed to enter the country from 2019 to 2024, and put forward suggestions for ensuring the quality and safety of imported aquatic products.

The data of aquatic products that were not allowed to enter the country during the period from 2019 to 2024, as published by the General Administration of Customs, were sorted out and analyzed.

Form 2019 - 2024, there were a total of 3 798 batches of aquatic products were not allowed to enter the country; and they involved 62 importing countries and regions, with products from Ecuador accounting for as high as 21.94% of the total.The number of involved production enterprises reached 1 190, among which the enterprises from Vietnam, India, Indonesia, Ecuador and Pakistan accounted for more than 48% of the total.The main types of aquatic products that were not allowed to enter the country were crustaceans (HS0303) and frozen fish (HS0306), accounting for 64.98% of the total.There are 11 reasons for nonconformity, with the top three being inspection and quarantine (35.27%), certificates (27.80%) and food additives (17.52%). There are 7 nonconformity indicators related to food safety, with the top three being food additives (17.60%), quality (4.12%) and heavy metals (2.68%).

From 2019-2024, the number of batches of aquatic products that were not allowed to enter the country showed an overall increasing trend. The source countries, production enterprises, food categories, reasons for non-compliance, and non-compliance items related to food safety of the aquatic products that were not allowed to enter the country showed relatively concentrated distribution characteristics.

To evaluate the spatial accessibility of various types of healthcare institutions in an urban district of a prefecture-level city in the Yangtze River Delta, in order to provide a basis for optimizing healthcare service allocation.

This study obtained 2024 healthcare facility data and population data for each subdistrict (town) through secondary data collection, and gathered population spatial distribution data and road traffic data from public service platforms. The Two-Step Floating Catchment Area (2SFCA) method based on a Gaussian decay function was used to assess the accessibility levels of different healthcare institutions within the district.

Within a 15-minute drive, 42.5% of demand points cannot access primary healthcare institutions and are classified as inaccessible areas. Comprehensive specialty healthcare institutions exhibit a clustered distribution in the southeastern region, indicating significant regional disparities in development. Dental service institutions demonstrate overall good accessibility; however, resource levels remain notably insufficient in the northwestern region. Accessibility to rehabilitation service institutions is relatively balanced overall, though areas requiring improvement still exist in the northwest.

The distribution pattern of medical institutions in city districts is “dense in urban areas and sparse in suburbs”, and the results of the accessibility of various types of medical institutions are different, so the results of this study can provide a reference for other cities to evaluate the spatial allocation of medical resources.

To analyze the current situation of job burnout among family doctors in primary medical and health institutions in Sichuan Province and its influencing factors.

From July to September 2024, through the stratified random cluster sampling method, 588 family doctors from 15 primary medical and health institutions in 5 counties (cities and districts) in Sichuan Province were selected as the survey subjects. The basic information and job burnout of family doctors were investigated by using maslach burnout inventory human service survey.The χ² test or Fisher’s exact probability method was used to analyze the detection rates of job burnout amongfamily doctors with different characteristics, and the influencing factors of job burnout among family doctors were analyzed by using binary logistic regression.

The M-values of the scores of the three dimensions of emotional exhaustion, emotional alienation and personal achievement among family doctors in primary medical and health institutions in Sichuan Province were 25 points, 8 points and 41 points respectively. Job burnout was detected in 430 family doctors, with a detection rate of 73.13%.The detection rates of mild, moderate and severe were 34.69% (204 doctors), 35.88% (211 doctors) and 2.55% (15 doctors), respectively. Binary logistic regression analysis showed that compared with those aged 20-29, family doctors aged 40-49(OR=0.312,95% CI:0.178-0.548) and 50-59(OR=0.473,95% CI:0.242-0.926) had a lower risk of job burnout. Compared with those with contracted service numbers ≤2 000, family doctors with contracted service numbers ≥5 001 had a higher risk of job burnout(OR=2.345, 95% CI: 1.276-4.308). Frequent overtime work was a risk factor for job burnout in family doctors(OR=1.587, 95% CI: 1.042-2.418).Family doctors with an average annual total income of more than 50 001 yuan had a lower probability of being detected job burnout than those with an average annual total income of no more than 50 000 yuan (OR=0.558,95% CI:0.370-0.842).

The current situation of job burnout among family doctors in primary medical and health institutions in Sichuan Province is not optimistic. Effective measures should be taken from multiple dimensions to alleviate the job burnout of family doctors, and continuous dynamic monitoring should be carried out at the same time.

To investigate the policy effects and underlying mechanisms of the Beijing Sub-Center construction on the allocation of medical resources.

Panel data from 16 districts in Beijing spanning 2005 to 2022 was analyzed. The entropy weight method was utilized to assess healthcare resource allocation, while the regression control method was applied to estimate policy effects.

The Beijing Sub-Center construction significantly enhanced hospital capacity and staffing in Tongzhou District, yielding average annual treatment effects of 732.168 additional hospital beds and 1 998.943 healthcare personnel. These impacts were statistically significant (P<0.1) across multiple years. However, the policy showed no notable effect on the number of hospital beds per 1 000 people or the total number of healthcare institutions.

The construction of the Beijing Sub-Center has effectively bolstered hospital capacity and increased healthcare personnel in Tongzhou District. Nevertheless, a gap persists between resource availability and the rising demand fueled by population growth. It is recommended to moderately expand medical service facilities, optimize the spatial distribution of resources, and enhance the efficiency and equity of healthcare resource allocation across Beijing.

To analyze and compare the characteristics of comorbidity patterns in skeletal fluorosis patients across different endemic regions, laying the foundation for further research on influencing factors, while providing references for healthcare systems to develop more targeted, effective, and cost-efficient chronic disease management plans for this special population.

This study adopted a cross-sectional design, selecting patients over 40 years old with skeletal fluorosis from Nayong County, Guizhou Province (a coal-burning fluorosis endemic area), Jishan County, Shanxi Province (a water-drinking fluorosis endemic area), and Ruoergai County, Sichuan Province (a tea-drinking fluorosis endemic area) as research subjects. The Apriori algorithm was used to analyze the dataset, and indicators such as the minimum conditional support were set to derive disease association rules. Additionally, Yule’s Q method was applied for systematic cluster analysis, and a dendrogram was drawn to explore the comorbidity patterns of chronic diseases in the elderly.

In the coal-burning type disease area, patients aged over 70 accounted for the highest proportion (43.55%), and the prevalence rates of chronic kidney disease (12.61%), hypertension (33.24%), and cholelithiasis/cholecystosis (11.89%) were higher than those in the drinking-water type and tea-drinking type disease areas. The tea-drinking type disease area was dominated by individuals aged 50-60 years (38.57%), with the highest prevalence of other bone diseases (68.93%). The drinking-water type disease area had the largest proportion of patients aged 60-70 years (43.04%).Comorbidity analysis showed that the coal-burning type disease area had the highest comorbidity rate (43.98%). In terms of comorbidity patterns, the most typical combination of two concurrent diseases was diabetes-coronary heart disease, while the combination of three concurrent diseases was mainly diabetes-coronary heart disease-hypertension. The tea-drinking type disease area had a comorbidity rate of 34.29%, with the main two-disease comorbidity pattern being coronary heart disease-cholelithiasis/cholecystosis, and the three-disease comorbidity pattern adding other bone diseases to the above combination. The drinking-water type disease area had the lowest comorbidity rate (21.43%), with the main two-disease comorbidity being cholelithiasis/cholecystosis-stroke, and the three-disease comorbidity pattern being stroke combined with diabetes and hypertension.Cluster analysis independently showed that the coal-burning type disease area could be clustered into 6 categories (dominated by metabolic cardiovascular diseases), the tea-drinking type disease area into 4 categories (highlighting metabolic skeletal diseases), and the drinking-water type disease area into 5 categories (characterized by multi-system metabolic inflammatory diseases).

There are significant differences in the comorbidity patterns of skeletal fluorosis patients among coal-burning, tea-drinking, and water-drinking fluorosis endemic areas. The coal-burning endemic area is dominated by metabolic and cardiovascular diseases such as diabetes, coronary heart disease, and hypertension. In the tea-drinking endemic area, there is a significant association between coronary heart disease and gallstones/gallbladder cysts, as well as a comorbidity pattern of diabetes and pulmonary tuberculosis. The water-drinking endemic area is characterized by the association between gallstones/gallbladder cysts and stroke; meanwhile, the combination of kidney disease and metabolic diseases highlights multisystem damage.