To explore the applicability and interventional value of integrating transfer cognition and environmental factors into the health action process approach (HAPA) model for understanding hygienic dietary behaviors associated with echinococcosis among Tibetan adolescents.

Using cluster random sampling, four schools in Nagchu Prefecture, Tibet were selected. Students from these schools completed a self-designed questionnaire. Structural equation modeling was employed to analyze the HAPA model integrated with transfer cognition and environmental factors.

This study included 2 934 adolescents. The qualified rate for hygienic dietary behaviors was 52.4%. Mediation analysis revealed that the indirect effect of action self-efficacy → intention for hygienic dietary behavior → action planning → hygienic dietary behavior was the largest (β=0.060, P<0.05), followed by action self-efficacy →maintenance self-efficacy → action planning → hygienic dietary behavior (β=0.014, P<0.05). Transfer cognition could indirectly influence hygienic dietary behaviors by affecting behavioral intention (β=0.013, P<0.05), action planning (β=0.010, P<0.05), and maintenance self-efficacy (β=0.007, P<0.05). Environmental factors influenced hygienic dietary behaviors either indirectly through action planning (β=0.008, P<0.05) or directly (β=0.15, P<0.05).

The HAPA model integrated with transfer cognition and environmental factors is applicable for explaining hygienic dietary behaviors related to echinococcosis among Tibetan adolescents. This provides a theoretical basis for the prevention and control of echinococcosis in Tibetan areas.

This study aims to assess the trends in the disease burden of birth defects (BDs) in China from 1990 to 2023, to inform evidence-based optimization of prevention and control strategies.

Data on the standardized incidence rate, standardized disability-adjusted life year (DALY) rate, and standardized mortality rate for total BDs and 10 major subtypes were extracted from the Global Burden of Disease Study (GBD) 2023 for China. Temporal trends were analyzed using Joinpoint regression to estimate the average annual percentage change (AAPC). Pairwise comparisons were conducted to examine differences by sex.

From 1990 to 2023, the disease burden of total BDs in China showed a significant downward trend,with AAPCs of -0.39%, -4.31%, and -4.84% for each indicator, respectively (all P<0.001). Stage-specific analysis showed that during the low-middle sociodemographic index (SDI) stage, all three indicators exhibited significant decreasing trends,with AAPCs of -0.92%, -2.13%, and -2.32%, respectively (all P<0.001). During the middle SDI stage, the standardized incidence rate showed a slight increase (AAPC=0.24%, P<0.05), whereas the standardized DALY rate and standardized mortality rate continued to decline more markedly, with AAPCs of -8.40% and -9.40%, respectively (both P<0.001). The disease burden of total BDs was consistently higher in males than in females; the decline in standardized incidence rate was faster in females than in males, whereas the declines in standardized DALY rate and standardized mortality rate were faster in males than in females (all P<0.001). Congenital musculoskeletal and limb anomalies had the highest standardized incidence rate in both 1990 and 2023. Congenital heart disease had the highest standardized DALY rate and standardized mortality rate in both years. The most marked declines were observed for neural tube defects (AAPCs:-3.85%, -7.87%, -8.50%) and cleft lip and palate (AAPCs: -1.58%, -9.38%, -12.89%) (all P<0.001).

The disease burden of BDs in China has declined markedly, with notable sex-based differences. Significant progress has been made in the prevention and control of neural tube defects and cleft lip and palate. Future efforts should focus on congenital musculoskeletal and limb anomalies and congenital heart disease, with an emphasis on primary prevention and life-cycle health management.

This study investigates the healthcare-seeking intentions and influencing factors related to weight loss among overweight/obese individuals in communities against the backdrop of the “Weight Management Year”.

From January to June 2025, a stratified random sampling method was used to select 535 overweight or obese residents from 4 community service centers in Cangzhou City. Sociodemographic characteristics and willingness to seek medical care for weight loss were investigated. Univariate analysis and multivariable logistic regression analysis were used to identify the influencing factors.

A total of 535 questionnaires were distributed in the study, with 528 returned, yielding an effective response rate of 98.69%. The willingness to seek medical care for weight reduction among overweight/obese individuals in the community was generally low, at only 33.71%. Univariate analysis revealed statistically significant differences in medical-seeking intentions among individuals based on gender, education level, household monthly income, BMI classification, self-reported health status, and prior weight reduction experience (P<0.05). Multivariable logistic regression analysis further demonstrated that women exhibited higher willingness to seek weight reduction-related medical care than men (OR=1.628, 95% CI: 1.323-2.041). Participants with higher education levels, including postgraduate or above (OR=2.402, 95% CI: 1.204-4.785), an associate or bachelor’s degree (OR=1.853, 95% CI: 1.256-2.745), and high school or vocational high school education (OR=1.521, 95% CI: 1.126-2.053), had significantly higher intentions than those with junior high school education or below. Obesity was associated with a higher intention than overweight (OR=2.113, 95% CI: 1.453-3.072). Prior weight reduction experience was also associated with a higher intention (OR=1.681, 95% CI: 1.156-2.465). Self-reported good health status (OR=0.584,95% CI: 0.396-0.867) and average health status (OR=0.436, 95% CI: 0.285-0.679) were associated with lower intentions compared to poor self-rated health status. Subgroup analysis revealed that the promoting effect of higher education was only significant among women and individuals with weight loss experience (P<0.05), while the inhibitory effect of self-rated good or average health was only significant in obese populations (P<0.05).

The willingness to seek medical care for weight reduction among overweight/obese individuals in communities is low, influenced by factors such as gender, education level, BMI classification, prior weight loss experience, and self-reported health status. It is essential to enhance awareness of the disease attributes of obesity among males, individuals with lower education levels, and those who self-rate their health as good or average, and to guide them toward scientific weight management.

To explore the association between multimorbidity trajectories and intrinsic capacity (IC) impairment among community-dwelling older adults.

Based on hospital information system (HIS) data from Jiading District, Shanghai, from 2018 to 2023 and a community survey conducted in 2024, 2 406 participants aged ≥60 years who completed the five-domain IC assessment and had ≥3 medical records cumulatively were included. Multimorbidity was defined as having ≥2 chronic diseases simultaneously. IC was assessed across five domains according to WHO recommendations, and impairment in any domain was defined as IC impairment. A group-based trajectory model (GBTM) was used to identify multimorbidity trajectories, and logistic regression was employed to analyze the association with IC impairment.

GBTM identified three trajectories: low-level stable (31.5%), medium-level slow-growth(52.8%), and high-level stable (15.6%). The prevalence of IC impairment was 55.0% in 2024. After full adjustment, multimorbidity was associated with IC impairment (OR=1.23, 95% CI: 1.03-1.48), and the risk significantly increased when the number of chronic diseases was ≥4. Compared with the low-level stable group, the risks of IC impairment were elevated in the medium-level slow-growth group (OR=1.28, 95% CI: 1.06-1.55) and the high-level stable group (OR=1.65, 95% CI: 1.26-2.18). Age significantly modified the association (P=0.036), with a more pronounced association in the group aged 70-79 years.

Multimorbidity burden is substantial among community-dwelling older adults, with heterogeneous trajectories. Higher trajectory levels are associated with greater risk of IC impairment. High-risk populations should be identified through trajectory analysis, and IC assessment should be incorporated into community follow-up to support early intervention.

To assess physician selection preferences and willingness to pay among social media users in direct-to-consumer teleconsultations for minor common conditions.

A discrete choice experiment was conducted among users of WeChat and Rednote who had used at least one medical app and logged into social media ≥3 times in the past three months.Snowball sampling covered East, South, Southwest, and Northwest China. An orthogonal design generated choice sets with five attributes: consultation price, hospital level, physician gender, professional title, and post-consultation rating. A mixed logit model estimated preference coefficients and willingness to pay.

A total of 190 valid responses from 42 cities were analyzed, of which 73.68% were from participants aged 18-24 years. Participants preferred physicians with positive ratings (vs.neutral/negative, β=0.70, P<0.001), lower consultation prices (per ￥1 increase, β=-0.52, P<0.001), associate chief physicians(vs. chief/attending, β=0.43, P<0.001), and physicians from tertiary grade A hospitals (vs. hospitals below the tertiary grade A level, β=0.30, P<0.001). Physician gender showed no significant effect (P>0.05). Willingness to pay premiums was ￥103.43(95% CI: 39.94-166.92) for positively rated physicians, ￥64.55 (95% CI: 36.01-93.09) for associate chief physicians, and￥44.60 (95% CI: 26.49-62.72) for physicians from tertiary grade A hospitals.

In teleconsultations for minor common conditions, the influence of traditional medical signals is attenuated, while post-consultation ratings become the primary determinant of user choice.

To evaluate the long-term cost-effectiveness of a Mediterranean diet compared with a conventional low-fat diet for the secondary prevention of coronary heart disease (CHD) in China.

Based on the clinical data from the CORDIOPREV trial, we developed a decision-tree Markov model to estimate the total costs and quality-adjusted life years(QALYs) associated with two dietary interventions from a societal perspective. Finally, the incremental cost-effectiveness ratio(ICER) and incremental net monetary benefit (INMB) were calculated. The willingness-to-pay (WTP) threshold was set at 1-3 times China’s per capita GDP in 2024. Model robustness was tested with one-way and probabilistic sensitivity analyses.

Over 20 years, the Mediterranean diet group incurred a cumulative total cost of 534 194.73 yuan per patient and gained 9.89 QALYs, whereas the low-fat diet group incurred a total cost of 466 877.72 yuan per patient and gained 9.55 QALYs. The ICER was 196 360.67 yuan/QALY, between 1 and 3 times the per capita GDP. At a threshold of three times China’s per capita GDP, the INMB was 31 071.64, and probabilistic sensitivity analysis demonstrated that the Mediterranean diet had a 57.68%probability of being cost-effective.

The Mediterranean diet is more cost-effective than the low-fat diet for secondary prevention of CHD in China, supporting its inclusion in secondary prevention strategies for CHD in China.

To explore the coupling coordination level and limiting factors of the health expenditure input system, the medical resource allocation system, and the health service efficiency system and to provide references for promoting the high-quality development of health services in China since the new healthcare reform.

The coupling coordination model and obstacle degree model were used to analyze the coupling coordination degree and the evolution of obstacle factors among the three systems in 31 provinces of China from 2010 to 2023.

The average coupling coordination degree increased from 0.06 in 2010 to 0.52 in 2023, showing a slow upward trend but not reaching a moderate coordination level (<0.6). Qinghai only increased from 0.02 to 0.31. The average obstacle degree of the key obstacle factors rose from 0.10 to 0.32. The key obstacle factors gradually shifted from multiple input-related indicators, such as limited government investment and inadequate development of the healthcare workforce, to two efficiency-related indicators: relatively high average outpatient and inpatient costs.

The coupling coordination level of the three systems needs further improvement. The key obstacle factors have evolved from multiple input-based indicators to two efficiency-based ones. It is necessary to further enhance the coordinated development of those systems by diversifying strategies, such as perfecting adaptive policies to address shortcomings in coordinated development, optimizing the structure of medical services to reduce medical costs, and improving health expenditure input and utilization mechanisms through market mechanisms.

To delineate the evolutionary trajectory of China’s mental health policies from 2001 to 2025 and to further explore the underlying driving forces behind this evolution.

Taking 298 policy documents as the research object, a “three-stage independent latent Dirichlet allocation (LDA) + cosine similarity + Sankey diagram” analytical framework was constructed to identify the key focus areas and evolutionary pathways of mental health work across three stages, combined with a literature review to analyze the driving factors of policy change.

A total of 7, 6, and 4 latent topics were extracted from the three stages, respectively. The policies exhibited a transition from system exploration to legal standardization and then to psychological services. The driving forces behind policy changes primarily stemmed from multiple dimensions, including resource allocation, institutional changes, public events, and social demands.

Over the past 25 years, China’s mental health policy has undergone a paradigm shift from disease treatment to social psychological services. Resource allocation (e.g., the 686 Program, professional institution construction) directly gave rise to early policy themes. Major institutional events (the enactment of the Mental Health Law, the elevation of mental health to a national strategy)promoted the formation of legal standardization and social psychological service themes. Public events (SARS, the Wenchuan earthquake)catalyzed the transformation of service models. Changes in social demands (the shift from focusing on the management and control of severe mental disorders to the promotion of mental health for the entire population) constituted the most fundamental driving force.

This study aims to construct age-stratified parametric survival models of disability risk based on intrinsic capacity (IC) using nationwide longitudinal data and to establish a simplified IC grading system.

Using longitudinal data from CHARLS 2011—2020 for individuals aged 60 years and older, IC scores were calculated using six commonly used methods, and five parametric survival models were constructed within each age group. The optimal model was selected based on the concordance index (C-index) and Akaike Information Criterion (AIC), and reference thresholds for IC grading were determined according to the quartiles of predicted disability risk.

A total of 3 272 older adults were included, with a median age of 65.00 (62.00-70.00) years. IC scores calculated by the 100-score scaling method combined with the log-normal parametric survival model showed the best predictive performance in most age groups, particularly for the 60-69 years (AIC=13 497.80, C-index=0.648 7), 70-79 years (AIC=5 306.87, C-index=0.624 8), and ≥80 years (AIC=804.73, C-index=0.643 9) age groups. The survival risk model revealed that IC grading thresholds decreased with increasing disability risk, with variations observed across age groups, sexes and numbers of chronic diseases. Older adults, females and those with more chronic diseases had lower IC thresholds. For instance, at the median disability risk level among those without chronic diseases, IC thresholds were 55.80 and 51.60 for males and females aged 60-69 years, respectively, decreasing to 45.10 and 34.80 for those aged ≥80 years.

IC scores calculated using the 100-score scaling method combined with the log-normal parametric survival model showed the best predictive performance for disability risk among Chinese older adults. The established IC grading thresholds may provide a reference for health assessment and graded interventions among Chinese older adults.

To explore the association between hearing impairment and depressive symptoms among middle-aged and older adults, as well as the moderating role of sleep duration.

Data from four waves of the China Health and Retirement Longitudinal Study (2013—2020) were analyzed. Multivariable Cox regression was used to conduct interaction tests and stratified analyses to verify the association and moderating effect.

In the overall population, hearing impairment was associated with a significantly higher risk of depression (HR=1.29, 95% CI: 1.08-1.55). Stratified analysis revealed that such association existed in the short sleep group (HR=1.35) and long sleep group (HR=1.78), whereas no significant association was observed in the normal sleep group. Interaction analysis indicated that only prolonged sleep significantly exacerbated the association between hearing impairment and depression (HR=1.69). Subgroup analysis showed that the association was more prominent in females with short sleep and males with long sleep, and the effect was significant among individuals aged 60 years and above.

Hearing impairment is a significant risk factor for depressive symptoms among older adults, and sleep duration plays a moderating role in this relationship. Maintaining a normal sleep duration may alleviate and offset the increased risk of depression attributable to hearing impairment, thereby providing a novel intervention target for the mental health protection of middle-aged and older adults with hearing impairment.