To understand the contract signing and utilization of family doctor services among rural elderly empty nesters in eastern, central and western China and the factors influencing them, thereby providing a basis for improving the health of rural empty nesters.

A total of 2 208 rural empty nesters aged ≥ 60 years from 48 villages in six provinces/municipalities/autonomous regions (Zhejiang and Shandong in eastern China, Henan and Hubei in central China, and Chongqing and Gansu in western China) were selected by stratified random sampling from July 2023 to August 2024. A questionnaire survey was conducted to collect the information on individual characteristics, personal behaviors, interpersonal relationship, community conditions, medical insurance, and contract signing and utilization of family doctor services among rural empty nesters in eastern, central and western China. Furthermore, the factors affecting them were analyzed.

The overall contract signing and utilization rates of family doctor services among rural empty nesters were 49.82% and 42.93% in eastern, central and western China, respectively. Specifically, the contract signing and utilization rates were 39.41% and 36.97% in eastern China, 36.46% and 23.80% in central China, and 83.68% and 79.34% in western China, with differences (χ² = 358.842, 450.389, both P < 0.001) among different regions. The results of multifactorial unconditional logistic regression analyses showed that in eastern China, the contract signing and utilization rates of family doctor services were higher for rural empty nesters with annual personal income ≥ 5 000 CNY and lower for rural empty nesters with the educational background of senior high school/technical secondary school and above, frequent social participation, and retirement. In central China, the contract signing rate was higher among rural empty nesters with the educational background of senior high school/technical secondary school and above, home address 1 km to 3 km from the nearest medical service institution, and basic medical insurance for urban workers or commercial medical insurance; the utilization rate was higher among rural empty nesters with the education background of senior high school/technical secondary school and above and chronic diseases; the contract signing rate and utilization rate were lower among retired rural empty nesters. In western China, females, chronic disease patients, and smokers among rural empty nesters demonstrated higher contract signing rates, while chronic disease patients and smokers showed higher utilization rates; the contract signing rate was lower among rural empty nesters who used the Internet and had frequent social participation; the utilization rate was lower among rural empty nesters with the educational background of senior high school/technical secondary school and above and frequent social participation.

The contract signing and utilization rates of family doctor services are the highest among the rural empty nesters in western China. The factors influencing the contract signing and utilization of family doctor services among empty nesters were educational background, annual personal income, social participation, and employment in eastern China, educational background and employment in central China, and chronic diseases, smoking, and social participation in western China.

To construct an index system for health management adherence among rural older adults aged 60 and above with cardiometabolic multimorbidity (CMM), thus providing a measurement tool for understanding the current situation of health management adherence among this population.

The index system was initially determined by literature research and expert group discussion. Two rounds of Delphi expert consultation were conducted among 25 selected experts. The analytic hierarchy process was adopted to calculate the weights of indexes.

Experts in the two rounds of consultation showed the positive coefficients of 100.0% and 72.0%, the authority coefficients of 0.892 and 0.883, and the Kendall′s coefficients of concordance of 0.172 and 0.206 (all P < 0.001), which indicated good concordance of experts′ opinions. The finally established index system was composed of 6 first-level indexes and 38 second-level indexes. In the two rounds of consultation, the indexes showed the importance scores of 4.62 ± 0.23 and 4.64 ± 0.22 and the coefficients of variation within the ranges of 0.00–0.23 and 0.00–0.19. The weights of the first-level indexes and second-level indexes ranged from 0.106 6 to 0.270 0 and from 0.007 4 to 0.074 0, respectively.

The index system for health management adherence among rural older adults with CMM is scientific and reliable, providing a measurement tool for evaluating health management adherence for rural older adults with CMM and a reference for related research.

To analyze the life expectancy (LE) and healthy life expectancy (HLE) of the elderly living in different ways in China, as well as gender and urban-rural differences, thus providing data support for optimizing the living arrangements and improving the HLE of the elderly in China.

The data of 4 503 elderly people aged 65 years old and above in 2014 and 2018 of Chinese Longitudinal Healthy Longevity Survey (CLHLS) were collected. The LE, HLE, and HLE/LE ratio of the elderly living alone and living with their families were measured by the micro-simulation method and compared between different genders as well as between urban and rural areas.

The LE of 65–100 elderly living alone and living with their families in China were 20.12–4.72 years and 17.59–4.13 years, respectively. The HLE were 10.12–1.78 years and 9.26–1.70 years, respectively. The HLE/LE were 50.30%–37.71% and 52.24% –41.16 %, respectively. The LE of men living alone and living with their families for 65 years and 100 years old were 14.77–3.59 years, 16.61–4.12 years, respectively. The HLE were 7.04–1.10 years, 9.80–1.68 years, respectively. The HLE/LE were 47.66%–30.64%, 59.00%–40.78%, respectively. The LE of women living alone and living with their families for 65–100 years old were 23.93–5.21 years and 19.09–3.82 years, respectively. The HLE were 12.14–1.78 years and 8.96–1.29 years, respectively. The HLE/LE were 50.73%–34.17% and 46.96%–22.77%, respectively. The LE, HLE, HLE/LE of male elderly living alone and male elderly living with family were lower than those of female elderly. The HLE and HLE/LE of male elderly living with family were higher than those of female elderly. The LE, HLE and HLE/LE of male elderly living alone were lower than those of male elderly living with family. The LE, HLE and HLE/LE of female elderly living alone were higher than those of female elderly living with family. The LE of the elderly living alone in the city and living with their families for 65–100 years were 20.55–5.29 years and 18.52–5.13 years, respectively. The HLE were 10.02–2.85 years and 9.06–3.04 years, respectively. The HLE/LE were 48.76%–53.88% and 48.92–59.26%, respectively. The LE of the elderly living alone in rural areas and living with their families for 65–100 years were 20.13–4.53 years and 17.28–3.71 years, respectively. The HLE were 10.97–1.20 years and 9.67–0.92 years, respectively. The HLE/LE were 54.50%–26.49% and 55.96%–24.80%, respectively. The LE of the urban elderly at all ages was higher than that of the rural elderly. Except that the HLE of the urban elderly aged 65-68 and the elderly aged 65 and 66 living with their families was lower than that of the rural elderly, the HLE of the elderly at other ages was higher than that of the rural elderly. With the increase of age, the HLE/LE of the rural elderly gradually decreased, while the HLE/LE of the urban elderly gradually increased.

The LE and HLE of the elderly living alone are generally higher than those living with their families, while the HLE/LE ratio demonstrates an opposite trend. Female elderly and the elderly living alone in urban areas have higher LE and HLE, while the male elderly living with their families have higher LE and HLE than the male elderly living alone.

To analyze the relationship between social inclusion and cognitive function of older adults in China and provide a theoretical basis for future research on reducing the risk of cognitive impairment in older adults through social inclusion interventions.

Data were collected from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 (T1), 2018 (T2), and 2020 (T3), which measured cognitive function and social inclusion (economic inclusion, relational inclusion, and community inclusion) of 5 464 elderly people aged of and above 60. A cross-lagged model was adopted to analyze the effect of social inclusion on changes in cognitive function of older adults from T1 to T3.

The 5 464 people aged of and above 60 included in the analysis showed the total cognitive function scores of (14.11 ± 5.26), (12.55 ± 6.17), and (12.14 ± 5.99) and total social inclusion scores of (2.15 ± 1.06), (1.73 ± 0.85), and (1.64 ± 0.87) in T1, T2, and T3 periods, respectively. After the control of confounding factors such as sex, age, and education, the total social inclusion scores in T1 and T2 could positively predict the total cognitive function scores in T2 and T3 (β′ = 0.019 and 0.017, both P < 0.01), respectively. The community inclusion scores in T1 and T2 could positively predict the total cognitive function scores in T2 and T3 (β′ = 0.016 and 0.016, both P < 0.05), respectively. The total cognitive function score in T1 could positively predict the total social inclusion score, economic inclusion score, relational inclusion score, and community inclusion score (β′ = 0.051, 0.023, 0.025, and 0.057, all P < 0.05) in T2. The total cognitive function score in T2 could positively predict the total social inclusion score, economic inclusion score, relational inclusion score, and community inclusion score (β′ = 0.063. 0.031, 0.027, and 0.075, all P < 0.05) in T3.

Good social inclusion of older adults can protect their cognitive function, especially community inclusion, and good cognitive function of older adults can promote social inclusion.

To understand the disability index and its influencing factors among Chinese older adults from 2011 to 2018 and provide a reference for the development and adjustment of disability prevention policies.

We collected the data related to the disability index of 17 928 older adults aged 60 years and above in the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. We conducted the Mann-Kendall trend test to analyze the trend of disability index in Chinese older adults from 2011 to 2018 and adopted the generalized estimating equation (GEE) to analyze its influencing factors.

The median score of disability index was 29.17 (15.28, 44.17) among 17 928 older adults aged 60 years and above in China. The median scores of disability index in 2011, 2013, 2015, and 2018 were 28.89 (13.89, 44.44), 26.94 (14.44, 41.11), 27.22 (13.89, 43.68), and 32.22 (22.78, 46.11), respectively. From 2011 to 2018, the disability index of older adults first improved and then worsened (τ_b = 0.066, P < 0.001). The results of the GEE analysis showed that the disability index was higher among Chinese older adults with a survey time point of 2018, being female, aged ≥ 75 years, in central or western China, residing in rural areas, having no medical insurance, suffering from ≥ 1 chronic disease, and having a history of falls. Chinese older adults with a survey time point of 2013 or 2015, having a primary school education or above, being married, and having a self-rated memory as fair or good had a lower disability index.

The disability index of Chinese older adults showed a trend of first improvement and then deterioration from 2011 to 2018. The survey time point, gender, age, education background, marital status, region, residence place, medical insurance, chronic disease, history of falls, and self-rated memory were the main influencing factors of the disability index in Chinese older adults.

To understand the relationships of the number of pregnancies and lifestyle with the prevalence of cardiovascular diseases (CVD) among elderly female diabetic patients in Jiaxian county, Henan province and provide a scientific basis for developing individualized CVD prevention strategies.

From July 1 to August 31, 2023, a cluster sampling method was employed to conduct a questionnaire survey among 21 379 patients aged ≥ 65 years who had lived in Jiaxian county, Henan province for at least six months and treated in 15 township hospitals or community health service centers. After individuals with incomplete lifestyle information, males, and non-diabetic patients were excluded, a total of 4 133 elderly female diabetic patients were included in the final analysis. A multivariable unconditional logistic regression model was adopted to examine the associations of the number of pregnancies and lifestyle with the prevalence of CVD among these patients.

Among the 4 133 elderly female diabetic patients included in the analysis from Jiaxian county, Henan province, 1 712 were diagnosed with CVD, resulting in a CVD prevalence of 41.4%. A total of 1 099 (26.6%), 1 190 (28.8%), and 1 844 (44.6%) patients had ≤ 2, 3, and ≥ 4 pregnancies, respectively. Regarding lifestyle, 2 183 (52.8%) patients were classified as having an unhealthy lifestyle, while 1 950 (47.2%) had a healthy lifestyle. After adjustment for confounding factors such as age, ethnicity, education background, marital status, and annual household income, multivariable unconditional logistic regression analysis showed that the elderly female diabetic patients with an unhealthy lifestyle had a 1.521-fold higher risk of CVD compared to those with a healthy lifestyle (OR = 1.521, 95%CI: 1.341–1.726). Interaction analysis further revealed that compared to the patients with ≤ 2 pregnancies and a healthy lifestyle, those with ≤ 2 pregnancies and an unhealthy lifestyle had a 1.432-fold higher risk of CVD (OR = 1.432, 95%CI: 1.121–1.829), those with 3 pregnancies and an unhealthy lifestyle had a 1.571-fold higher risk (OR = 1.571, 95%CI: 1.237–1.996), and those with ≥ 4 pregnancies and an unhealthy lifestyle had a 1.674-fold higher risk (OR = 1.674, 95%CI: 1.340–2.091).

A multiplicative interaction was observed between the number of pregnancies and unhealthy lifestyle, contributing to an elevated risk of CVD among elderly female diabetic patients in Jiaxian county, Henan province.

To investigate the incidence and influencing factors of moderate and severe fall-related injuries among the elderly in Guangzhou, Guangdong, China, thus informing evidence-based interventions for fall prevention in the elderly population.

To analyze the incurrence of moderate and severe fall-related injuries and identify influencing factors among the elderly patients, we collected data from 13 898 injury surveillance reports between January 1, 2015 and December 31, 2021 across four National Injury Surveillance Sentinel hospitals in Guangzhou.

moderate and severe injuries accounted for 38.53% (n = 5 355) of cases. Multivariate unconditional logistic regression analysis identified the following risk factors: female, non-local household registration, age ≥ 70 years, history of falls, and activity-specific hazards emerged during walking (OR=1.118) and essential life activities, particularly in unspecified locations. Autumn occurrence and road/street environments of falls were the protective factors.

The incidence of moderate and severe fall-related injuries among elderly patients in Guangzhou is high. Key influencing factors include gender, age, household registration, history of falls, seasons, activities, and locations.

To analyze the sleep quality and associated factors among community-dwelling adults aged ≥ 60 years in the urban areas of Nanjing, China, thus providing evidence for optimizing sleep quality in this population.

From July to December 2023, a multi-stage stratified sampling method was used to randomly select 2 851 adults aged ≥ 60 years from urban communities in Nanjing. Face-to-face questionnaire surveys were conducted to systematically collect data on general demographic characteristics, daily lifestyle behaviors, and medical history. The Pittsburgh sleep quality index (PSQI) was adopted to assess sleep quality.

The older adults in the urban areas of Nanjing presented the mean PSQI score of 5.31 ± 3.27, with the poor sleep quality detection rate of 40.3%. Multivariate analysis revealed that the individuals aged 70–79 (OR = 1.24, 95%CI: 1.04–1.47) and ≥ 80 years (OR = 1.69, 95%CI: 1.30–2.19) had worse sleep quality than those aged 60–69 years. Additionally, the presence of cardiovascular diseases (OR = 1.50, 95%CI: 1.19–1.88), other chronic diseases (OR = 1.68, 95%CI: 1.19–2.38), depressive symptoms (OR = 2.04, 95%CI: 1.24–3.37), and anxiety symptoms (OR = 2.69, 95%CI: 1.88–3.86) were also significant influencing factors for poor sleep quality (all P < 0.05).

Poor sleep quality is common among older adults in the urban areas of Nanjing, and its occurrence is associated with age, cardiovascular diseases, other chronic diseases, depressive symptoms, and anxiety symptoms.

To investigate the incidence and influencing factors of falls in the elderly of Jilin province and provide a scientific basis for further prevention and control of falls among the elderly.

From July to December 2022, 800 permanent residents aged ≥ 60 years old were selected by multi-stage stratified random sampling from Nanguan district of Changchun city, Xi′an district of Liaoyuan city, Antu county of Yanbian prefecture, and Lishu county of Siping city in Jilin province. The main influencing factors of falls in the elderly in this area were analyzed by multivariate logistic regression.

Among the 800 permanent residents aged ≥ 60 years old in Jilin province, 166 fell in the past year, and thus the incidence of falls was 20.75%. The results of multivariate logistic regression showed that age ≥ 80 years old (OR = 2.555, 95%CI: 1.390–4.659), residence in rural areas (OR = 1.685, 95%CI: 1.048–2.710), cerebrovascular disease self-reported (OR = 1.947, 95%CI: 1.262–3.004), chronic obstructive pulmonary disease self-reported (OR = 1.815, 95%CI: 1.009–3.263) and osteoarthritis self-reported (OR = 1.783, 95%CI: 1.153–2.759) were more likely to fall. Those exercising regularly (OR = 0.641, 95%CI: 0.423–0.970), self-assessing general health condition (OR = 0.292, 95%CI: 0.184–0.464) or good health conditions (OR = 0.149, 95%CI: 0.080–0.276) were not likely to fall.

The incidence of falls is high among the elderly in Jilin province. Age, place of residence, regular physical exercise, self-assessment of health status, and whether suffering from cerebrovascular diseases, chronic obstructive pulmonary disease, or osteoarthritis are the main influencing factors of falls among the elderly in this area.

To compare the performance of back propagation artificial neural network (BP-ANN) and logistic regression models in predicting the risk of cumulative fatigue among petrochemical employees and evaluate the prediction models for early identification and intervention of cumulative fatigue in these employees.

A total of 4 066 employees of a petrochemical enterprise in Jiangsu province were selected by cluster sampling for a cross-sectional study from July to October 2021. A web-based questionnaire was designed to investigate the general information, work conditions, occupational stress, and prevalence of cumulative fatigue among employees. SPSS 23.0 was used to analyze the influencing factors of cumulative fatigue among petrochemical employees through non-parametric tests. BP-ANN and logistic regression models were established and receiver operating characteristic (ROC) curves were plotted to compare the prediction performance of models based on sensitivity, specificity, Youden index, and area under the curve (AUC) value.

A total of 3 763 valid questionnaires were collected, which showed that 63.2% (2 377/3 763) of petrochemical employees experienced cumulative fatigue. The comprehensive analysis of the two models indicated that age, weekly working hours, shift work, occupational stress, and regular exercise were the key factors influencing employees’ cumulative fatigue. Both models had AUC values > 0.7. Sensitivity was comparable between the BP-ANN and logistic models (BP 75.7%, logistic 75.6%). The BP-ANN model achieved higher specificity (BP 76.3%, logistic 69.3%), Youden index (BP 51.9%, logistic 44.9%), and AUC value (BP 84.4%, logistic 79.9%) than the logistic model. Both models can be used to predict the incidence of cumulative fatigue among petrochemical employees, while the overall prediction performance of the BP-ANN model was superior to that of the logistic model.

Both BP-ANN and logistic regression models can be adopted to predict cumulative fatigue among petrochemical employees, with the BP-ANN model showing better prediction performance.

To evaluate the effectiveness of a community-based management intervention based on the Information-Motivation-Behavioral Skills (IMB) model in ameliorating non-alcoholic fatty liver disease (NAFLD), providing a reference for exploring the health management pathways for NAFLD in primary health service centers.

Between January and April 2023, 714 NAFLD patients aged 50–69 years and diagnosed during physical examinations were recruited from the Community Health Service Center of Dongzha Street in Jiaxing, Zhejiang. The participants were randomly allocated into a control group (n = 357) and an intervention group (n = 357). The control group received health education manuals, while the intervention group additional received a comprehensive lifestyle intervention based on the IMB model. The controlled attenuation parameter (CAP), liver stiffness measurement (LSM), body weight, body mass index (BMI), waist circumference, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and fasting blood glucose (GLU) were compared between the two groups before and after the 1-year intervention.

The CAP, LSM, body weight, BMI, waist circumference, TC, TG, LDL-C, HDL-C, AST, ALT, and GLU in the control and intervention groups before intervention were (280.75 ± 35.45) and (287.07 ± 37.81) dB/m, (5.83 ± 2.00) and (5.66 ± 1.86) kPa, (67.85 ± 9.90) and (67.64 ± 9.61) kg, (25.99 ± 2.88) and (26.22 ± 2.98), (89.27 ± 8.12) and (88.85 ± 7.98) cm, (5.10 ± 0.97) and (5.18 ± 1.08) mmol/L, (2.35 ± 1.58) and (2.44 ± 2.45) mmol/L, (2.83 ± 0.73) and (2.88 ± 0.77) mmol/L, (1.28 ± 0.33) and (1.28 ± 0.33) mmol/L, (24.31 ± 9.39) and (24.88 ± 9.38) U/L, (26.47 ± 17.68) and (26.84 ± 15.04) U/L, and (6.29 ± 1.84) and (6.40 ± 2.27) mmol/L, respectively. After intervention, the values were (277.06 ± 43.59) and (265.34 ± 41.39) dB/m, (5.57 ± 1.76) and (5.30±1.75) kPa, (66.05 ± 9.79) and (64.11 ± 10.11) kg, (25.38 ± 2.91) and (25.10 ± 3.03), (88.01 ± 8.06) and (85.30 ± 8.93) cm, (5.17 ± 1.17) and (5.01 ± 1.08) mmol/L, (2.26 ± 1.90) and (1.98 ± 1.48) mmol/L, (2.97 ± 0.80) and (2.89 ± 0.79) mmol/L, (1.38 ± 0.34) and (1.44 ± 0.33) mmol/L, (22.80 ± 8.39) and (22.25 ± 6.74) U/L, (24.87 ± 13.52) and (23.85 ± 13.05) U/L, (6.21 ± 1.61) and (5.98 ± 1.51) mmol/L respectively. The control group of NAFLD patients showed differences in LSM, body weight, BMI, waist circumference, LDL-C, HDL-C, AST, and ALT before and after intervention (all P < 0.05). The intervention group of NAFLD patients showed differences in CAP, LSM, body weight, BMI, waist circumference, TC, TG, HDL-C, AST, ALT, and GLU before and after intervention (all P < 0.01). Before intervention, the two groups showed differences in CAP (t = −2.214, P = 0.027). After intervention, the two groups of NAFLD patients showed differences in CAP, body weight, waist circumference, TG, and HDL-C (all P < 0.05).

The community-based management intervention based on the IMB model effectively reduced hepatic steatosis, body weight, and waist circumference and recovered serum levels of lipids such as TG and HDL-C in NAFLD patients.

To investigate the willingness of middle-aged and elderly men in rural Sichuan province to undergo human immunodeficiency virus (HIV) testing and its associated factors, providing references for promoting voluntary testing.

A face-to-face questionnaire survey was conducted among 990 middle-aged and elderly men in rural Sichuan from July to August 2023. The data on demographic characteristics, HIV testing willingness, and HIV prevention protection motivation were collected. LASSO and Boruta methods were used to screen relevant variables. An XGBoost model was employed to predict HIV testing willingness, with SHapley Additive exPlanations (SHAP) for importance and interaction analyses.

The middle-aged and elderly men in rural Sichuan showed the HIV testing willingness rate of 53.13% and the HIV knowledge awareness rate of 35.56%. Among them, 62.02% held an attitude of relative stigma toward AIDS, and 6.36% had previously undergone HIV testing. Lasso and Boruta identified 10 key variables from 22 independent variable candidates. The XGBoost model achieved an area under the curve (AUC) value of 0.979 (95%CI: 0.963–0.995). SHAP importance analysis revealed the top five factors derived from protection motivation theory dimensions. The HIV testing willingness was positively associated with testing self-efficacy (SAV = 3.08), social support (SAV = 0.29), and awareness of HIV-related services (SAV = 0.27), and negatively associated with behavioral costs (SAV = 0.22) and external rewards (SAV = 0.20). Factors such as unmarried status, lack of HIV knowledge, and previous experience of HIV testing were primarily associated with willingness, while 45–49 years and high school/vocational school or above were mainly associated with unwillingness.

Middle-aged and elderly men in rural Sichuan exhibit low willingness to undergo HIV testing, which is primarily associated with insufficient HIV knowledge, inadequate social support, and prevalent AIDS-related stigma. Enhancing the awareness of testing experiences may encourage testing uptake.

To analyze the influencing factors of drug relapse among patients undergoing methadone maintenance treatment (MMT) in Fujian province and construct a risk prediction model.

A retrospective cohort study was conducted. Data were sourced from the Data Information Management System of Drug Maintenance Treatment. Patients who underwent MMT for 180 days or relapsed in Fujian from 2006 to 2023 were included. Lasso-logistic regression was employed to screen the influencing factors, and a risk prediction model was constructed.

The relapse rate of patients undergoing MMT was 75.58% (5 745/7 601). Female gender (OR = 0.801, 95%CI: 0.695–0.923), longer drug use duration (OR = 0.985, 95%CI: 0.974–0.996), and older enrollment age (OR = 0.988, 95%CI: 0.981–0.997) were protective factors for drug relapse. The risk factors for drug relapse were injection drug use in the month before enrollment (OR = 1.156, 95%CI: 1.034–1.293), being employed (OR = 1.184, 95%CI: 1.059–1.326), being referred to MMT by drug-using friends (OR = 1.273, 95%CI: 1.026–1.582), more frequent daily drug use in the month before enrollment (OR = 1.018, 95%CI: 1.005–1.033), longer travel time to the clinic (OR = 1.004, 95%CI: 1.002–1.008), previous participation in MMT (OR = 1.217, 95%CI: 1.095–1.355), coming to MMT by bus (OR = 1.429, 95%CI: 1.193–1.712), and using other means of transportation to MMT (OR = 2.890, 95%CI: 2.033–4.106). The area under curve (AUC) of the constructed risk prediction model was 0.602 (95%CI: 0.588–0.617).

The drug relapse rate of patients undergoing MMT is high in Fujian, and the constructed risk prediction model can be used to identify high-risk populations of drug relapse.

To understand the utilization of community health services and its influencing factors among young and middle-aged working populations in a district of Shanghai city, and to provide a reference for improving the utilization rate of local community health services.

From July to August 2023, a stratified convenience sampling method was used to select 17 000 residents aged 18 years and the above from 10 communities in a district of Shanghai city for a questionnaire survey. Among them, 2 103 young and middle-aged working individuals aged 18–59 who had been ill in the past two weeks and sought medical treatment at medical institutions were included in the analysis of community health service utilization and its influencing factors.

Among the 2 103 young and middle-aged working individuals aged 18–59 who had been ill in the past two weeks and sought medical treatment at medical institutions in a district of Shanghai city, 934 visited community health service centers, with a community health service utilization rate of 44.41%. Multivariable unconditional logistic regression analysis showed that young and middle-aged working individuals aged 30 years and the above and those with respiratory and digestive system diseases had a higher utilization rate of community health services. Those who had purchased commercial health insurance and whose distance to the nearest community health service center was 3 to < 4 and ≥5 km had a lower utilization rate of community health services.

The utilization rate of community health services among young and middle-aged working populations in this district of Shanghai city is relatively low. Age, disease type, purchase of commercial health insurance, and distance to the nearest community health service center are the main factors influencing the utilization rate of community health service centers among the local young and middle-aged working population.

To analyze the composition and influencing factors of hospitalization costs for stroke patients, providing data support for rational control of medical expenses and alleviating the economic burden on patients.

The data of 66 524 stroke patients discharged from January 1, 2020 to December 31, 2022 were collected from the medical expense accounting management reporting system of a province in central China. The grey relational analysis and degree of structural variation analysis were performed to analyze the hospitalization cost composition for stroke and its subtypes. A Generalized Linear Model (GLM) and an eXtreme Gradient Boosting (XGBoost) model were constructed to explore the key influencing factors.

Among 66 524 stroke patients, 85.80%, 10.84%, and 3.36% had ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), respectively. The M (P₂₅, P₇₅) of the hospitalization cost for stroke patients was 6 992.32 (3 997.76, 13 475.91) CNY. The hospitalization cost for SAH patients was the highest, reaching 88 389.28 (12 494.50, 151 711.34) CNY. The top three categories of hospitalization expenses for stroke patients were drug costs, other costs, and treatment costs, with the average proportions of 29.29%, 24.61%, and 19.43%, respectively. The hospitalization costs of IS and ICH patients were mainly attributed to drug costs. For SAH patients, other costs accounted for the largest proportion of hospitalization expenses. The grey relational analysis results showed that the top three factors correlated with total hospitalization costs were Western medicine costs, other costs, and treatment costs, with correlation coefficients of 0.951 8, 0.936 2, and 0.900 4, respectively. The degree of structural variation analysis showed that the contribution rates of structure variation (CSV) for medication costs, examination costs, and other costs were 24.34%, 19.50%, and 27.74%. The GLM results indicated that longer hospital stays (≥ 7 days), emergency admission, surgery, intensive care, ICH, SAH, and for-profit medical institutions were associated with higher hospitalization costs. The XGBoost model analysis revealed that the top five factors influencing hospitalization costs for stroke patients were the type of medical institution, length of stay, whether surgery was performed, the level of medical institution, and the subtype of stroke.

IS is the most common stroke subtype, and hospitalization costs for stroke patients are primarily driven by drug expenses. SAH patients have higher hospitalization costs, mainly due to other expenses. By implementing appropriate admission assessments, improving medical efficiency, shortening hospital stays, and optimizing treatment plans, the economic burden on stroke patients can be reduced.

To explore the application of the prevention, preparation, response, and recovery (PPRR) theory in the cross-departmental collaboration in the prevention and control of infectious diseases in the China International Import Expos (CIIEs) held in every November in Shanghai from 2018 to 2024, thus providing an empirical basis and theoretical reference for optimizing the cross-departmental collaboration mechanism under regular prevention and control.

We collected the epidemic prevention and control work plans, emergency response plans, technical guidelines, summary reports, and relevant epidemic cases handled by Shanghai Center for Disease Control and Prevention during the CIIEs from 2018 to 2024. The case analysis method was used to analyze the practices and achievements of cross-departmental collaboration in the prevention, preparation, response, and recovery phases based on the PPRR model.

An efficient information collaboration mechanism was established based on an innovative "1+6+N" cross-departmental command architecture. The work in the prevention phase encompassed establishing a cross-departmental and multi-dimensional risk assessment model, adopting a layered monitoring strategy, and strengthening health monitoring. In the preparation phase, a modular prevention and control plan library was established, consisting of work plans, emergency plans, and technical guidance or operation manuals. In addition, cross-departmental joint training and exercises were conducted, and emergency material reserves were reasonably allocated to improve the response speed. In the response phase, a "4 h plus 12 h" disposal requirement was strictly implemented. Public health, security and CIIE bureau teams were mixed as an emergency response group and divided into several units. The interval between risk identification and risk confirmation as well as between risk confirmation and risk management was strictly controlled through risk hierarchical management. During the recovery phase, full-process post evaluation was conducted to solidify experience and promote optimization of resource allocation and disposal processes while assessing the effectiveness of the response. Upon evaluation, the above measures are expected to be effective to increase the risk warning time to within 30 minutes and reduce the overall emergency decision-making and response time to 10% of that under the conventional model. Therefore, Shanghai achieved "zero infection" of epidemics and "zero transmission" of imported diseases.

The collaborative mechanism architecture constructed based on the PPRR model can be used for the research of cross-departmental collaborative mechanisms in mass gatherings. In the future, cross-departmental collaboration on infectious disease prevention and control in mass gatherings can be further promoted in three dimensions: mechanism innovation, technological empowerment, and collaborative governance.

To explore the relationship between hypertension prevalence and sleep among adult residents in Guangdong province, providing scientific evidence for the control and prevention of hypertension.

Data were collected from 4 982 adult residents aged ≥18 years in 11 monitoring sites of Guangdong province in the 2022 Chinese Nutrition and Health Surveillance. The unconditional multivariate logistic regression model was employed to analyze the relationships of sleep problems and sleep duration with hypertension prevalence among adult residents in Guangdong province.

Among the 4 982 adult residents in Guangdong province, there were 2 393 (49.41%) residents without sleep problems and 2 589 (50.59%) residents with sleep problems. Among them, 1 084 (19.65%), 3 168 (66.54%), and 730 (13.81%) residents had insufficient sleep, adequate sleep, and excessive sleep, respectively. There were 1 611 residents with hypertension, and the complex weighted prevalence of hypertension was 30.04%. After adjusting confounding factors such as gender, age, educational background, marital status, place of residence, current smoking, frequency of alcohol consumption, physical activity, family history of hypertension, body mass index, and central obesity, the results of the unconditional multivariate logistic regression analysis showed that the risk of hypertension among adult residents with sleep problems in Guangdong province was 1.237 times (95%CI: 1.122–1.364) that of adults without sleep problems. The risk of hypertension among adult residents aged ≥ 60 years and with sleep problems in this province was 1.468 times (95%CI: 1.183–1.823) that of those without sleep problems. The risk of hypertension among adult residents with excessive sleep was 1.228 times (95%CI: 1.046–1.442) that of those with adequate sleep. For female adult residents with excessive sleep, the risk of hypertension was 1.340 times (95%CI: 1.006–1.786) that of those with adequate sleep. For female adult residents aged ≥ 60 years and with excessive sleep, the risk of hypertension was 1.446 times (95%CI: 1.001–2.088) that of those with adequate sleep.

The risk of hypertension increased in adults with sleep problems in Guangdong province, especially in those aged ≥ 60 years. Excessive sleep duration was also associated with increased risk of hypertension, especially in females and the adults aged ≥ 60 years.

To analyze the opportunistic screening results for upper gastrointestinal cancer in Sichuan province from 2019 to 2023, thus providing a reference for promoting opportunistic screening for upper gastrointestinal cancer in this region.

Data were collected from the Early Diagnosis and Treatment Management Platform of the Sichuan Cancer Prevention and Control Center. The study included 844 844 high-risk individuals aged ≥ 40 years who underwent gastroscopy at 88 secondary or higher-level hospitals across 18 cities (prefectures) in five major economic regions (Chengdu Plain Economic Zone, Southern Sichuan Economic Zone, Northeastern Sichuan Economic Zone, Panxi Economic Zone, and Northwestern Sichuan Ecological Demonstration Area) of Sichuan province from July 2019 to May 2023. The biopsy rate, lesion detection rate, and early diagnosis rate of upper gastrointestinal cancer in Sichuan province were analyzed.

Among the 844 844 high-risk individuals who underwent opportunistic screening for upper gastrointestinal cancer from 2019 to 2023, 182 133 individuals underwent biopsies, with a total of 190 852 biopsy sites, yielding a biopsy rate of 22.59%. A total of 20 647 cases of lesions were detected, with a lesion detection rate of 2.44%. Among the detected cases, 5 258 were early-stage lesions, resulting in an early diagnosis rate of 25.47%. The esophagus, cardia, and stomach showed the bioscopy rates of 3.80%, 1.09%, and 17.71%, lesion detection rates of 1.37%, 0.29%, and 0.78%, and early diagnosis rates of 28.29%, 20.44%, and 22.37%, respectively. Comparative analysis by demographic characteristics revealed that males had higher biopsy rate and lesion detection rate but lower early diagnosis rate than females (all P < 0.001). Both the biopsy rate and lesion detection rate increased with age, while the early diagnosis rate decreased with age (all P < 0.001). Differences were observed in biopsy rate, lesion detection rate, and early diagnosis rate across different regions (all P < 0.001). Individuals who underwent painless gastroscopy had higher biopsy rate, lesion detection rate, and early diagnosis rate than those who underwent conventional gastroscopy (all P < 0.05). The examination with the use of chemical staining methods resulted in higher biopsy rate, lesion detection rate, and early diagnosis rate than the examination without the use of chemical staining (all P < 0.001). In addition, differences were also observed in biopsy rate, lesion detection rate, and early diagnosis rate among individuals with different Helicobacter pylori test results (all P < 0.05).

The biopsy rate, lesion detection rate, and early diagnosis rate in opportunistic screening for upper gastrointestinal cancer in Sichuan province were low from 2019 to 2023. Efforts are still required, with particular attention needed for male and elderly populations.

To analyze the cause ranking and trends of injury-related deaths among residents in Shaanxi province from 2015 to 2023, providing a reference for formulating injury prevention and control strategies.

The injury-related death data were sourced from the Population Death Information Registration Management System of Shaanxi Province from January 1, 2015 to December 31, 2023. The Joinpoint regression model was adopted to analyze the trends in mortality rates of all injuries and the top four death causes, and the average annual percentage change (AAPC) was calculated.

From 2015 to 2023, the top four causes of injury-related deaths among residents in Shaanxi province were road traffic injuries, falls, suicide, and poisoning. During this period, the mortality rates from overall injuries, road traffic injuries, and suicide showed a downward trend (all P < 0.05), while the mortality rate from falls presented an upward trend (AAPC = 3.32%, P = 0.014). Among male residents, the mortality rates from overall injuries and road traffic injuries showed a downward trend (both P < 0.05). Among female residents, the mortality rate from suicide showed a downward trend (P < 0.05), whereas that from falls showed an upward trend (AAPC = 6.34%, P = 0.001). The mortality rates from overall injuries and road traffic injuries among the residents aged < 15 years and 15–44 years showed a downward trend (all P < 0.01), and that from suicide among residents aged < 15 years showed an upward trend (AAPC = 14.76%, P = 0.039). The mortality rates from road traffic injuries and suicide among residents aged 45–64 years and those from suicide and poisoning among residents ≥ 65 years showed a downward trend (all P < 0.01). Among urban residents, the mortality rates from overall injuries and road traffic injuries showed a downward trend (both P < 0.01). Among rural residents, the mortality rates from road traffic injuries and suicide showed a downward trend (both P < 0.01), while that from falls showed an upward trend (AAPC = 5.35%, P = 0.001).

From 2015 to 2023, the mortality rates from overall injuries, road traffic injuries, and suicide among residents in Shaanxi showed a downward trend, while that from falls showed an upward trend. The mortality rate trends varied across different injury types among residents of different genders, ages, and residential areas.

To analyze the cost-effectiveness per case of different screening methods for latent infection of mycobacterium tuberculosis (MTB) in the student population in Chongqing, thus providing a scientific basis for optimizing large-scale tuberculosis screening among students.

The tuberculin skin test (TST) and recombinant MTB fusion protein skin test (EC-ST) were adopted to conduct tuberculosis examination and close contact screening among 46 531 students in grades one and two of 46 senior high schools in Chongqing from January to December 2024. The positive detection and cost-effectiveness of TST and EC-ST in tuberculosis examination and close contact screening were compared.

The infection rates of MTB detected by TST and EC-ST were 35.74% (8 132/22 751) and 5.73% (1 304/22 748), respectively. The average detection cost per case of MTB infection was 83.93 CNY for TST and 872.24 CNY for EC-ST. In the close contact screening, the infection rates of MTB detected by TST and EC-ST were 46.36% (210/453) and 6.74% (39/579), respectively. The average detection cost per case of MTB infection was 64.71 CNY for TST and 742.31 CNY for EC-ST. Among the 39 MTB-infected patients detected by EC-ST, 8 tuberculosis patients were detected, and the average detection cost was 7 237.50 CNY. Among the 210 MTB-infected patients detected by TST, no tuberculosis patient was detected.

EC-ST is suitable for accurate screening of high-risk close contacts, and TST with a low cost is still a reasonable choice for large-scale tuberculosis examination in the general student population.