To construct a set of MCI identification toolkit suitable for the elderly and their families, and to provide reference for guiding the elderly to self-identify MCI.

Using the corpus research method, through reviewing the literature, guidelines, books and other materials, a list of tools was formed, and the first draft of the identification toolkit wasconstructed. After expert consultation and demonstration, the final draft of the identification toolkit was formed by incorporating identification tools with an expert recognition rate of more than 70%. Descriptive statistical analysis was used to analyze the application results of the identification tool.

After expert consultation and demonstration, the effective recovery rate of the questionnaire was 83.33 %, and the expert authority coefficient was 0.875. A family identification toolkit including the mini-mental state examination (MMSE) and the elderly cognitive decline informer questionnaire (IQCODE) was formed. Among the 781 respondents, 256 elderly people had mild cognitive impairment, with an overall prevalence of 32.78 %.

The constructed family identification toolkit for MCI in the elderly is suitable for the elderly, family members and caregivers, and can provide a reference for guiding families to self-identify MCI in the elderly.

To analyze the current situation and influencing factors of two-week illness among children aged 0-6 years in Sichuan Province, and to explore the influence of family parenting styles on children’s two-week illness, so as to provide reference for improving the quality of children’s health services.

Based on data from the seventh health service survey of Sichuan Province, the relationship between family parenting style and children’s two-week illness was explored using logistic modeling.

Rural (OR=0.554, 95% CI: 0.311-0.985), left-behind families (where parents do not live permanently or are primarily cared for by someone other than the parents) (OR=1.775, 95% CI: 1.028-3.067) are more sensitive to children’s two-week illness. Indicators such as whether a parent is a permanent resident, the child’s primary caregiver, whether they have commercial insurance, whether they are placed in a childcare facility, and the number of toys they own vary among children’s two-week illness rates (P<0.05).

Different family parenting styles have a great impact on children’s two-week illness. It is recommended to further improve the mechanism of primary children’s health care services, emphasize the role of family in children’s health, and create a child-friendly environment for children to grow up.

To investigate the heterogeneous effects of Diagnosis-Intervention Packet (DIP) payment reform on the quantity distribution and cost patterns of high/low-complexity cases (measured by Case Mix Index, CMI), and to reveal hospital hierarchical response mechanisms under cost-control pressures, thereby providing policy recommendations.

Using three-year pre-and post-DIP pilot data (2018-2023), we constructed a difference-in-differences (DID) fixed-effects model with medical insurance patients as the treatment group and non-insured patients as the control group. The model incorporated diagnosis-related group (DRG) fixed effects and a policy×high-CMI interaction term to quantify heterogeneous impacts across complexity levels.

The DIP policy significantly reduced per-case medical costs (β₃=-803.570, P<0.001), per-case medical service costs (β₃=-128.434, P=0.019), and per-case material costs (β₃=-290.519, P<0.001) in the treatment group, alongside a reduction in the absolute deviation from the mean by 228.644 CNY (P=0.016) and a shortened average length of stay by 1.080 days (P<0.001). Stratified by CMI, high-CMI cases exhibited additional reductions in per-case costs (β₃=-309.400), material costs (β₃=-549.843), and hospitalization days (β₃=-0.715) compared to low-CMI cases, yet showed an increase in per-case medical service costs (β₃=273.834).

Hospitals adopted distinct response mechanisms under DIP-driven cost constraints. For high-CMI cases, cost control was achieved through technology-for-materials substitution (prioritizing technical service income while reducing material expenditures), whereas low-CMI cases relied on comprehensive cost suppression.These findings highlight the need for complexity-tiered payment adjustments to balance cost containment and care quality.

To explore the operational efficiency of primary care organizations in the pilot counties of close-knit county medical communities in Sichuan Province, and to provide a reference for continuing to promote the high-quality development of close-knit county medical communities across the country and help build a more synergistic and efficient county medical service network.

Primary care organizations in 37 pilot counties in Sichuan Province were used for the study, and data envelopment analysis and Malmquist index model were used for static and dynamic measurement of operational efficiency, respectively.

The mean values of comprehensive efficiency, pure technical efficiency, and scale efficiency of primary care organizations in pilot counties in Sichuan Province in 2022 were 0.806, 0.936, and 0.863, respectively. Among them, the operational efficiencies of Wenchuan (0.314), Jiuzhaigou (0.226), Seda (0.116), and Ganzi (0.061) were located below 0.400. Compared with 2018, their comprehensive efficiency and pure technical efficiency have improved, while scale efficiency was flat. The mean value of the total factor productivity index of primary care organizations in the pilot counties from 2018 to 2022 was 0.975. Further decomposing the total factor productivity index, the mean values of the technical efficiency index, the technical progress index, the pure technical efficiency index, and the scale efficiency index were 1.014, 0.962, 1.022, and 0.992, respectively.

After the implementation of the policy, the operational efficiency of primary care organizations in the pilot counties of Sichuan Province showed significant improvement, but there is still much room for improvement, and the differences between counties are more obvious. In the future, we should focus on the technical progress and scale efficiency, strengthen the continuing medical education of primary medical personnel, innovate and carry out the new technology of primary characteristics, and reasonably balance and effectively allocate the medical resources in the counties.

To analyze the characteristics and issues of Jiangsu’s healthcare system policies and provide optimization insights.

Using Rothwell and Zegveld’s policy tool classification, a three-dimensional framework (policy tools, development process, policy goals) was constructed to quantify 70 policy texts from the 13th and 14th Five-Year Plan periods.

Policy tools: environmental-type dominated (58.83%), followed by supply-type (34.78%), demand-type (6.38%) was minimal. Policy process: implementation (52.27%) and planning (40.24%) prevailed, while supervision (6.48%) and evaluation (1.02%) were underdeveloped. Policy goals: advancing public hospital quality (44.11%) was prioritized, whereas strengthening medical insurance (9.03%) lagged.

Structural imbalance in policy tools, fragmented policy processes, and divergent goals were observed. Recommendations: optimize tool allocation by increasing demand-type tools, integrate policy processes, and align goals systematically.

To evaluate the health economy of the whole-process management strategy of personalized lung cancer screening according to the size of lung nodules compared with the annual screening strategy and the natural development strategy.

Based on the publicly available dataset from the US NLST, a decision tree-Markov model was constructed. Incremental cost-utility analysis was used to evaluate the economic efficiency of the three strategies, and one-way sensitivity analysis and probabilistic sensitivity analysis were conducted to test the stability of the model results.

Compared with the natural development strategy, the incremental cost-utility ratios (ICER) of the whole-process management strategy and the annual screening strategy were 82 798.96 yuan/quality-adjusted life year (QALY) and 71 168.05 yuan/QALY, respectively.Compared with the annual screening strategy, the ICER of the whole management strategy was 129 227.28 yuan/QALY. Univariate sensitivity analysis showed that the proportion of lung cancer patients with stage III and IV lung cancer had a significant impact on ICER. Probability sensitivity analysis showed that when the Willingness to pay (WTP) was 89 358 yuan/QALY, the economic probability of the whole management strategy was 0.279. When WTP was 268 074 yuan/QALY, the economic probability of the whole process management strategy was 0.826.

When WTP is 1 time the Gross Domestic Product (GDP), the annual screening strategy is the best choice. When WTP is 3 times the GDP per capita, the whole-process management strategy is the best choice.

To analyze the internal structure and influencing factors of hospitalization expenses for rare disease patients at different medical levels in Jiangxi Province’s “Health Expenditure Accounting System 2011” (SHA2011) sentinel hospitals, providing references for rare disease treatment in Jiangxi Province and its healthcare institutions.

Data on rare disease patients from 2018 to 2022 were collected from the sample hospitals in Jiangxi Province. Structural variation analysis and grey correlation analysis were employed to examine changes in the internal composition of hospitalization expenses and their interrelationships, while a random forest model was used to identify factors influencing the average total cost per hospitalization case.

From 2018 to 2022, the average hospitalization costs per case were 19 082.70 yuan (provincial), 8 175.29 yuan (municipal), and 6 586.23 yuan (county/district). The random forest model revealed that medication fees and diagnostic examination fees were key factors affecting rare disease hospitalization costs, with structural variation values of -3.15, -1.79, and 5.30 for medication fees, and -3.86, 5.48, and 2.16 for diagnostic examination fees at provincial, municipal, and county/district levels, respectively. Grey correlation analysis showed that surgical fees and nursing fees had low correlation degrees with hospitalization costs across all levels, ranking between 7th and 8th.

From 2018 to 2022, hospitalization expenses at all levels exhibit fluctuating trends but remained generally high. Medication fees and diagnostic examination fees are critical influencing factors, though their structural variation trends and contribution rates differed significantly across hospital tiers. Additionally, surgical and nursing fees demonstrate consistently low correlation with hospitalization costs at all levels.

To analyze the impact of pain intensity on depression levels among rural elderly individuals, and to explore the mediating role of Activities of Daily Living (ADL) and the moderating effect of internet use.

This study was based on the 2020 China Health and Retirement Longitudinal Study (CHARLS). Partial correlation analysis was used to explore the relationships between pain intensity, ADL, depression levels, and internet use among rural elderly individuals. The Bootstrap method (Model 4,58) was used to analyze the mechanisms through which ADL and internet use affect the relationship between pain intensity and depression levels.

Pain intensity had a significant direct effect on depression levels among rural elderly individuals (β=1.537, 95% CI: 1.347-1.728). ADL played a significant mediating role between pain intensity and depression levels (β=0.319, 95% CI: 0.262-0.380). Internet use weakened the negative effect of pain intensity on ADL (β=0.508, P<0.01) and strengthened the negative effect of ADL on depression levels (β=-0.224, P<0.01).

Pain intensity positively influences depression levels among rural elderly individuals. ADL partially mediates the relationship between pain intensity and depression levels. Internet use moderates the effects between pain intensity and ADL, as well as between ADL and depression levels. Therefore, it is recommended to guide rural elderly individuals at the personal, family, and community levels to utilize internet technologies to disrupt the "pain-ADL decline-depression" chain reaction.

To explore the relationship between smartphones usage, internet usage and subjective, objective cognitive functions.

Multi-stage cluster random sampling method was used to select 45-70 year old permanent residents from 7 sample villages in Pingyin County, Shandong Province who meet the standards. The subjective cognitive decline-questionnaire 9 (SCD-Q9) and the montreal cognitive assessment basic scale (MoCA-B) were used to evaluate the subjective and objective cognitive functions, respectively. The logistic regression model was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) of the relationship between smartphones usage, internet usage and subjective, objective cognitive function. Furthermore, the non-linear relationship between smartphones usage, internet usage and cognitive function scores was explored.

This study included 1 654 participants. Compared with those who did not use mobile phones, those who used mobile phones had a 42% lower risk of experiencing abnormal objective cognitive scores (OR=0.58, 95% CI: 0.46-0.73), and the risk of abnormal objective cognitive scores was relatively low when using a mobile phone for less than or equal to 2 hours per day or more than 2 hours per day (0.65, 0.51-0.82; 0.69, 0.55-0.88). Compared to those who did not use the internet, internet users had a 41% lower risk of experiencing abnormal objective cognitive scores (0.59, 0.47-0.74), and people who spent less than 1 hour online or more than 2 hours online had a lower risk of experiencing abnormal objective cognitive scores compared to those who spent less than or equal to 1 hour online (0.65, 0.52-0.83; 0.66, 0.52-0.83). Nonlinear correlation showed that as the duration of mobile phone use and internet usage gradually increased, the objective cognitive score showed a trend of first increasing and then decreasing.

People who use mobile phones and the internet have a lower risk of experiencing objective cognitive score abnormalities. As the duration of mobile phone use and internet usage increases, the objective cognitive score shows a non-linear trend of first increasing and then decreasing. Overuse of mobile phones and the internet (such as>5.5 h/d) may have adverse effects on cognitive function.

To explore the relationship between intergenerational emotional support and depression of migrant elderly following children and its mechanism of action.

A total of 210 migrant elderly following children participated in this study. And they completed the Intergenerational Emotional Support Questionnaire, Flow Centre Depression Scale, Short boredom proneness scale and Seff-Rating Scale of Sleep.

(1) Intergenerational emotional support significantly and negatively predicted depression in migrant elderly following children (β=-0.354, P<0.001); (2) Boredom proneness played a mediating role between Intergenerational emotional support and depression of migrant elderly following children. The mediation effect value was -0.129 (95% Bootstrap CI=［-0.215，-0.068］), the mediating effect accounted for 36.44% of the total. (3) Sleep problem moderated the relationship between boredom proneness and depression of migrant elderly following children (β=0.137, P=0.009). Specifically, moderated mediation analysis showed that the impact of boredom proneness on depression strengthened with sleep problem getting worse among the migrant elderly following children (simple slope=0.384, 95% CI: 0.235-0.533, P<0.001). When there was mild sleep problem, the influence of boredom proneness function on depression was weaker (simple slope=0.110, 95% CI: -0.044-0.263, P=0.160).

This study highlights the mediating and moderating mechanisms linking intergenerational emotional support to depression of migrant elderly following children. More importantly, it has prominent implications for the prevention and intervention of depression among migrant elderly following children.