To investigate the awareness, use, and attitudes toward heated tobacco products (HTPs) among middle and college students in Guangzhou city, Guangdong province.

From January to March 2024, a stratified cluster random sampling method was used to conduct a self-administered questionnaire survey among 10 069 middle and college students in Guangzhou city. The survey collected information on demographics, smoking status, smoking severity index, HTP awareness, ever-use, current use, attitudes toward trying HTPs, and reasons for trying HTPs. Data were analyzed using descriptive statistics, comparative analysis, and association rule mining.

A total of 8 377 valid questionnaires were collected. The current smoking rate among the surveyed students was 4.64%. Regarding HTP awareness, 27.40% had "heard of" HTPs and 21.11% had "seen" them. Current smokers (38.30% "heard of", 37.53% "seen") and college students (32.26% "heard of", 24.14% "seen") had higher HTP awareness (P <0.05). The ever-use rate of HTPs was 0.13%, and the current use rate was 0.08%. Among current smokers, males with severe tobacco dependence and smoking family members or friends (5.77%) and college students with below-average economic status (8.57%) had a higher probability of current HTP use than the overall rate (1.80%). Regarding attitudes toward trying HTPs, 3.41% were "very interested" and 4.72% were "somewhat interested." The most common reasons for trying HTPs were "less harmful to health" (24.67%), "simply like it, no particular reason" (24.23%), "curiosity" (13.36%), and "can reduce smoking" (10.28%). College students (4.72% "very interested", 8.32% "somewhat interested") and current smokers (11.57% "very interested", 18.51% "somewhat interested") showed greater interest in trying HTPs (all P <0.05). Never-smokers with above-average economic status and smoking family members or friends (21.37%) and current smokers with severe tobacco dependence (25.86%) had a higher probability of being interested in trying HTPs than the overall population.

The extremely low HTP use rate among middle and college students in Guangzhou city reflects the effectiveness of tobacco control efforts in China, but challenges remain. Continued efforts are needed to prohibit the sale and promotion of HTPs and to further strengthen tobacco control efforts for students, especially specific subgroups, through school policies, teacher and school doctor training, and student-targeted interventions.

To analyze the effectiveness of school-based tobacco control interventions by comparing students′ knowledge, attitudes, and use of e-cigarettes before and after the implementation of interventions, and to provide a basis for further development of school-based tobacco control measures.

From October 2022 to May 2023, a six-month tobacco control intervention was conducted among all students in a vocational high school in Qingpu district, Shanghai. Anonymous questionnaires were administered before and after the intervention. Propensity score matching was performed using gender, grade, and smoking/vaping status of family members and friends as matching variables. Data were compared using the χ² test.

A total of 981 and 819 valid questionnaires were collected at baseline and post-intervention, respectively. After propensity score matching, baseline and follow-up data from 770 students were obtained. At the end of the intervention, 79.5% of the students expressed their hope that the school would continue to promote the construction of a smoke-free environment. After the school-based tobacco control intervention, students′ awareness of the harms of e-cigarettes improved. The proportion of students who agreed that "e-cigarettes pose safety hazards" increased significantly from 81.8% to 85.8% (χ² = 4.604, P = 0.032). Support for e-cigarette control measures increased among adolescents, especially support for banning e-cigarettes in indoor public places, which increased by 4.4% after the intervention. The proportion of students who had ever tried e-cigarettes increased from 4.4% to 5.5%, while the proportions of current e-cigarette users and those intending to use e-cigarettes decreased.

School-based tobacco control interventions are effective in improving students′ knowledge, attitudes, and intentions regarding e-cigarettes, but further efforts are needed to enhance the effectiveness of these interventions.

To investigate the relationship between secondhand e-cigarette aerosol exposure and mental health problems in adolescents, and to provide a reference for the formulation of smoke-free environment policies.

From March to June 2023, a multi-stage stratified cluster sampling method was used to conduct an online questionnaire survey of 2 112 full-time students aged ≤18 years nationwide. A χ² test was used for univariate analysis of demographic information and mental health problems. Binary logistic regression was used to analyze the relationship between secondhand e-cigarette aerosol exposure and mental health problems in adolescents. Multiple linear regression was used to analyze the relationship between secondhand e-cigarette aerosol exposure and the three dimensions of mental health problems in adolescents: somatic symptoms, anxiety/worry, and family relationships.

In this study the prevalence of mental health problems were 12.03% (254 adolescents) and 620 (29.36%) were exposed to secondhand e-cigarette aerosol. Binary logistic regression analysis showed that adolescents exposed to secondhand e-cigarette aerosol had a 1.500 times higher risk of developing mental health problems than those not exposed (OR = 1.500, 95%CI: 1.127 - 1.998). Multiple linear regression results showed that adolescents exposed to secondhand e-cigarette aerosol in the past 30 days had more severe somatic symptoms (b = 0.758, P < 0.001) and higher anxiety/worry (b = 0.691, P< 0.001).

Secondhand e-cigarette aerosol exposure in adolescents is positively correlated with the occurrence of mental health problems, and is related to the dimensions of somatic symptoms and anxiety/worry.

To investigate the prevalence and influencing factors of household secondhand smoke (SHS) exposure among urban and rural pregnant women in Pudong New Area, Shanghai, and to provide evidence for developing targeted smoking control and intervention strategies.

A self-administered voluntary survey was conducted among 11 298 pregnant women who attended early pregnancy registration (first trimester) from January to June 2024 at 47 community health service centers in Pudong New Area, Shanghai. A self-developed questionnaire was used to collect information on participants′ socio-demographics, awareness of SHS-related health hazards, and SHS exposure at home. A multivariable logistic regression model was used to analyze factors influencing household SHS exposure among pregnant women in urban and rural areas.

Of the 11 141 valid respondents (98.6% of all respondents), 14.9% reported exposure to SHS at home in the past 30 days, and exposure was reported by 18.8% of pregnant women in suburban areas, 14.8% in rural-urban areas, and 12.1% in urban areas. Regarding awareness of SHS-related health risks, awareness of SHS-related adult heart disease was the lowest among all groups (67.1%), with urban pregnant women showing a higher awareness rate compared to the other two groups. Stepwise regression analysis identified the following statistically significant predictors of household SHS exposure: for urban pregnant women: husband smoking (odds ratio [OR] = 12.326), cohabitant smoking (OR = 10.822), and no smoking at home (OR = 5.229); for urban-rural pregnant women: husband smoking (OR = 8.809), cohabitant smoking (OR = 3.189), no smoking at home (OR = 5.674), education level (master′s degree or higher, OR = 0.608), awareness of SHS-related heart disease in adults (OR = 0.733), and awareness of lung cancer in adults (OR = 0.612); and for suburban pregnant women: husband smoking (OR = 6.562), cohabitant smoking (OR = 4.510), no smoking at home (OR = 8.266), visitors offering cigarettes (OR = 2.056), age (30 - 34 years, OR = 0.581; ≥ 35 years, OR = 0.521), and awareness of SHS-related lung disease in children (OR = 0.627).

Household SHS exposure among pregnant women in Pudong New Area cannot be ignored. The influencing factors of household SHS exposure differ between urban and rural pregnant women, suggesting that regional characteristics and awareness of the health hazards associated with household SHS exposure should be fully considered when formulating family tobacco control intervention strategies.

To investigate the effect of the triglyceride-glucose index (TyG) combined with various obesity indicators on the prevalence of comorbid hypertension and hyperuricemia among residents aged 35 years and older in Hebei province, and to provide a reference for the prevention and treatment of this comorbidity in the population.

Data from 7 859 permanent residents aged 35 years and older were collected as part of the Cardiovascular Disease and Risk Factor Surveillance Project, conducted in 10 districts/counties/cities of Hebei province between April and December 2020. A multivariable logistic regression model was used to analyze the relationship between the TyG, overweight/obesity, central obesity, and waist-to-height ratio (WHtR) with the prevalence of comorbid hypertension and hyperuricemia. The additive interaction between TyG and different obesity indicators on the prevalence of comorbid hypertension and hyperuricemia was assessed using relative excess risk due to interaction (‌RERI). The predictive value of TyG and different obesity indicators for comorbid hypertension and hyperuricemia was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.

Among 7 859 surveyed residents, 30.73% (2 415) were non-overweight/obese, while 69.27% (5 444) were overweight/obese; 43.80% (3 442) were non-centrally obese, and 56.20% (4 417) were centrally obese; 30.70% (2 413) had a normal WHtR, and 69.30% (5 446) had a high WHtR; 44.22% (3 475) had a low TyG (≤ 8.42), and 55.78% (4 384) had a high TyG (≥ 8.43). Additionally, 11.95% (939) had comorbid hypertension and hyperuricemia. After adjusting for sex, age, education, residence, physical activity, current smoking, alcohol consumption, and diabetes, multivariable logistic regression analysis revealed a significantly increased risk of comorbid hypertension and hyperuricemia among residents with central obesity (odds ratio [OR] = 1.676, 95% confidence interval [95%CI]: 1.346 - 2.087), overweight or obesity (OR = 1.440, 95%CI: 1.148 - 1.807), high WHtR (OR = 1.297, 95%CI: 1.001 - 1.679), and high TyG (OR = 2.335, 95%CI: 1.974 - 2.763), compared to residents who were not centrally obese, not overweight or obese, had normal WHtR, and had low TyG. The multivariable logistic regression results also showed significantly higher risks of comorbid hypertension and hyperuricemia among residents with both high TyG and high obesity indicators, including overweight or obesity (OR = 5.159, 95%CI: 3.916 - 6.796), central obesity (OR = 5.587, 95%CI: 4.357 - 7.164), and high WHtR (OR = 5.326, 95%CI: 4.038 - 7.026), compared to residents with low TyG and no overweight or obesity, no central obesity, and low WHtR, indicating an additive interaction between TyG and obesity indicators in comorbid hypertension and hyperuricemia. ROC analysis demonstrated that TyG combined with waist circumference (WC) had a higher predictive power for comorbid hypertension and hyperuricemia (AUC = 0.725, 95%CI: 0.715 - 0.735), indicating better diagnostic accuracy compared to TyG combined with body mass index (BMI), TyG combined with WHtR, or TyG alone.

High TyG, overweight/obesity, central obesity, and high WHtR are all associated with an increased risk of hypertension combined with hyperuricemia in residents aged 35 years and older in Hebei province. An additive interaction exists between TyG and different obesity indicators. TyG combined with WC could serve as an effective predictor for hypertension combined with hyperuricemia.

To investigate the prevalence and influencing factors of the comorbidity of central obesity and hyperuricemia (HUA) among adult residents in the Inner Mongolia Autonomous Region, and to provide evidence for developing prevention and control strategies.

A cross-sectional study was conducted among 5 076 permanent residents aged ≥18 years in the Inner Mongolia Autonomous Region from July to December 2018. Participants were recruited using stratified multistage cluster sampling across 8 districts, banners, counties, and cities, stratified by population size and geographic location to ensure a representative sample. Data were collected via questionnaires, physical examinations, and serum uric acid tests. The prevalence of comorbid central obesity and HUA was calculated as the proportion of participants diagnosed with both conditions. An unconditional multivariate logistic regression model was used to identify the main influencing factors of this comorbidity.

Of the 4731 participants finally included in the analysis, 2 139 (45.2%), 520 (11.0%), and 296 (6.3%) were identified as with central obesity, HUA, and comorbid central obesity and HUA, respectively. Multivariable unconditional logistic regression analysis showed that having sleep problems was a risk factor of comorbid central obesity and HUA, while being female, aged ≥ 40 years, and having rural household registration were protective factors against the comorbidity.

Although the prevalence rate of central obesity with HUA among adult residents in the Inner Mongolia Autonomous Region is relatively low, it still warrants attention. Gender, age, type of registered residence, and sleep problems are identified as the primary influencing factors for central obesity with HUA among local adult residents.

To analyze the incidence and mortality trends of male breast cancer in Anhui province from 2010 to 2020 based on cancer registry data, with the aim of developing prevention and control strategies for breast cancer in the population.

Data on male breast cancer cases registered in Anhui province from 2010 through 2020 were collected from the China Cancer Registry Platform or the CANREG 4 system. The age- and area-specific number and rate of incidence and mortality, as well as the age-standardized incidence and mortality rates of male breast cancer, were calculated. The Joinpoint model was used to estimate the annual percentage change (APC) in these indicators to analyze the trends in incidence and mortality of male breast cancer in selected areas with cancer registration in the province during this period.

For the population covered by the cancer registration in the province during the study period, the crude incidence rate (per 100 000) of male breast cancer was 0.58 (0.53 and 0.61 for urban and rural populations, respectively), and the age-standardized incidence rate was 0.44 (0.38 and 0.49 for urban and rural populations, respectively). There was no significant changing trend in the age-standardized incidence rate for the total population (APC = –1.17%, P > 0.05) or for both urban and rural populations (APC = –0.24% and –2.59%, respectively, both P > 0.05). The crude mortality rate of male breast cancer was 0.21 for the total population, with 0.20 and 0.21 for urban and rural populations, respectively. The age-standardized mortality rate was 0.14 for the total population, with 0.13 and 0.16 for urban and rural populations, respectively. There were no significant changing trends in the age-standardized mortality rate for the total population (APC = 3.08%, P > 0.05) or for the rural population (APC = 0.83%, P > 0.05), but there was a significant upward trend in the age-standardized mortality rate for the urban population (APC = 6.29%, P = 0.003).

The registered mortality rate of male breast cancer in the urban population of Anhui province showed an increasing trend from 2010 to 2020, suggesting that more attention should be given to the prevention and control of male breast cancer in urban areas.

To conduct a health economic evaluation of a community-based screening strategy for diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) in Shenzhen, Guangdong Province, and to provide evidence for implementation of this screening strategy in primary healthcare facilities in the city.

Community-based DR screening was conducted from August to December 2021 among 1200 T2DM patients recruited from 10 administrative districts in Shenzhen using a two-stage random sampling approach. A Markov model was constructed from a health care services perspective to conduct a cost-effectiveness analysis of the community-based DR screening strategy, with community-based DR screening as the intervention strategy and no screening as the control. Costs, effect sizes, and incremental cost-effectiveness ratios (ICERs) were estimated. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the results.

Of the 1 097 participants finally included in the analysis, 266 (24.3%) were diagnosed with DR. Through 20 simulated cycles of systematic screening, the control (no screening) and intervention (screening) groups incurred costs of Chinese Yuan (CNY) 38 882.05 and CNY 41 920.75, respectively, and gained 17.13 and 17.42 quality adjusted life years (QALYs), respectively. The incremental cost-effectiveness ratio (ICER) was CNY 10 478.28/QALY. The net monetary benefits were CNY 218 071.06 and CNY 219 409.58 for the control and intervention groups, respectively, with a benefit-cost ratio of 5.23 for the screening strategy (indicating an indirect return of CNY 5.23 per CNY 1 invested). After 20 simulation cycles, the blindness rate was 21.0% (no screening) versus 10.1% (screening), with screening preventing approximately 120 cases of DR-related blindness in T2DM patients. Sensitivity analyses identified the health utility of blind patients and the annual cost of DME treatment as the most influential parameters. Probabilistic analysis showed good willingness-to-pay (WTP) among T2DM patients in Shenzhen, with screening being cost-effective at WTP thresholds > CNY 10 478.28/QALY.

The results demonstrate that the community-based DR screening strategy for T2DM patients in Shenzhen City is cost-effective and can be promoted in primary healthcare facilities in similar urban settings.

To investigate the awareness, treatment, and control rates of chronic obstructive pulmonary disease (COPD) and their influencing factors among residents aged 40 years and older in Nanjing city to provide a reference for the development of COPD prevention and control strategies in the population.

A total of 2 442 permanent residents aged 40 years and older were recruited from urban communities and rural villages in four districts of Nanjing city, Jiangsu province, using a multistage cluster random sampling method. Face-to-face interviews were conducted using the China Chronic Disease and Nutrition Surveillance Questionnaire, and pulmonary function tests were performed from May 2023 to January 2024. The chi-squared test was used to compare differences in COPD awareness, treatment, and control rates, standardized by the 2020 Jiangsu Provincial Census data, across participant characteristics. Factors influencing these rates were analyzed using multivariable logistic regression models.

Of all participants, 262 (10.73%) were diagnosed with COPD, with a standardized prevalence rate of 11.39%. Of the 262 identified COPD patients, 6.87%, 4.20%, and 3.05% reported awareness, treatment, and control of the disease, with standardized rates of 7.24%, 4.41%, and 2.60%, respectively. Multivariable logistic regression revealed that chronic respiratory symptoms (odds ratio [OR] = 4.91, 95% confidence interval [95%CI]: 1.59 - 15.15), family history of COPD (OR = 18.51, 95%CI: 1.68 - 203.89), and smoking cessation (OR = 9.14, 95%CI: 2.52 - 33.15) were associated with increased odds of COPD awareness. In addition, chronic respiratory symptoms were associated with increased odds of treatment (OR = 11.59, 95%CI: 2.76 - 48.72) and COPD control (OR = 8.66, 95%CI: 1.99 - 37.65).

The prevalence of COPD among residents aged 40 and older in Nanjing is relatively high. However, the awareness, treatment, and control rates of COPD among affected residents remain low. Chronic respiratory symptoms, family history of COPD, and smoking status are the main factors influencing COPD awareness, treatment, and control in this population. Comprehensive measures should be implemented to improve the diagnosis, intervention and management of COPD.

To investigate the awareness and satisfaction of women in Jinan, Shandong Province, regarding breast and cervical cancer screening programs, and to analyze their willingness to participate in combined screening for both cancers and the influencing factors, with the aim of providing a reference for promoting combined screening for these cancers.

Using cross-sectional survey methods with a self-developed questionnaire, face-to-face interviews were conducted with 569 women aged 35 - 64 years in Jinan city, Shandong province, from May to July 2024. Participants were recruited through community-based cervical and breast cancer screening programs. The survey collected data on demographic characteristics, awareness of dual-cancer screening, willingness to participate in combined screening, and satisfaction. Data were analyzed using chi-squared tests and binary logistic regression.

A total of 541 valid responses were received. Of the respondents, 87.43% were aware that the government regularly provides free screening for two cancers for women of appropriate age. In addition, 93.16% and 80.78% of respondents were aware of at least one recommended screening method for breast and cervical cancer programs, respectively. For breast cancer screening, awareness of specific methods was as follows: breast examination (79.11%), breast ultrasound (66.54%), and mammography (10.35%). For cervical cancer screening, awareness rates were: HPV testing (74.86%), cytology testing (34.01%), and colposcopy (29.57%). Regarding screening preferences, 77.63% of subjects preferred a single-visit model ("complete both screenings at the same time"), while 17.74% preferred separate visits. Multiple logistic regression identified two independent factors influencing willingness to participate in joint screening: occupation (odds ratio [OR] = 2.63, 95% confidence interval [95%CI]: 1.11 - 6.23) and prior awareness of screening (OR = 6.29, 95%CI: 3.80 - 10.40). Regarding logistics, 99.26% of subjects preferred screening every 1 - 3 years and 71.90% preferred nearby community health centers. Even with full self-payment, 53.05% remained willing to choose community screening. Satisfaction rates were high: 73.94% (process arrangement), 73.57% (technical level of staff), and 72.83% (service attitude). Finally, 98.89% reported that it was convenient to participate.

While most women demonstrate awareness and willingness to participate in combined breast and cervical cancer screening, targeted health education remains necessary. Further research is needed to assess the feasibility of implementing this model in different regional settings.

To explore the association between the ability to diagnose and treat common diseases and the capacity to provide health management services among grassroots doctors, from the perspective of integrating disease treatment and prevention, and to provide a reference for improving grassroots doctors′ health management service capacity.

An online self-administered questionnaire survey was conducted in August 2020 among 8 469 specialists, general practitioners, and rural doctors. Participants were recruited using stratified multi-stage sampling and typical sampling from primary healthcare institutions located in 11 municipalities across eastern, central, and western China. Utilizing a previously self-developed index system for evaluating the health service capabilities of grassroots doctors, the survey questionnaire was designed based on indicators related to health management service capabilities. The questionnaire assessed the health management service capabilities of primary care physicians in three areas: diagnosis and treatment of common diseases, health management, and health promotion.

Of all the participants, 5 288 (62.44%) were practicing (assistant) doctors, 2 201 (25.99%) were rural doctors, and 6 497 (76.72%) were assessed as capable of diagnosing and treating common diseases. Among all the grassroots doctors surveyed, 7 099 (83.82%) had the ability to provide nutritional guidance for children, and 7 068 (83.46%) could conduct physical examinations for children as part of children's health management. Regarding women's health management, 6 746 (79.66%) could provide family planning guidance, 6 539 (77.21%) offered prenatal health guidance, 5 921 (69.91%) provided perimenopausal health care, and 5 456 (64.42%) conducted cervical/breast cancer screening. More than 90% of the participants were assessed as able to conduct health management for the elderly and individuals with chronic conditions. However, only 6 234 (73.61%) had the ability to analyze community health issues.

The ability to diagnose and treat common illnesses significantly affects the capacity of grassroots doctors to deliver health management services. Moreover, there is a noticeable gap in the health management service capabilities among grassroots doctors in China. Therefore, it is crucial to strengthen collaborative service mechanisms between hospitals and primary care institutions.

To develop an evaluation system for assessing multidimensional social deprivation among rural older adults in China, and to provide a measurement tool for understanding the current status of multidimensional social deprivation among this population.

A preliminary multidimensional social deprivation index system for rural older adults was developed through a literature review and expert panel discussions. Eighteen experts in related fields, selected for their expertise and experience, participated in a two-round Delphi consultation to refine and validate the index system. The Analytic Hierarchy Process (AHP) was used to calculate the weights of the indicators at each level, with pairwise comparisons used to ensure consistency in the weighting process.

he expert response rates for the two rounds of consultation were 100.0% and 94.1%, respectively. The coefficient of expert authority, reflecting the experts' credibility, was 0.872 and 0.856 for the two rounds. Kendall's coefficient of concordance (W) for expert opinions was 0.216 and 0.193 (all P < 0.05), indicating moderate agreement among the experts. After expert consultation, a multidimensional index of social deprivation for rural older adults was constructed, including seven first-level indicators and 37 second- level indicators. The experts′ scores for the importance of each indicator, on a 5- point Likert scale, were 4.46 ± 0.74 and 4.52 ± 0.74 in the two rounds of consultation, with coefficients of variation ranging from 0.05 to 0.27 and 0.00 to 0.24, respectively. In the constructed index system, the weights of the first-level indicators ranged from 0.087 1 to 0.213 0, and the weights of the second-level indicators ranged from 0.017 4 to 0.087 3.

The multidimensional index of social deprivation developed for the rural elderly population demonstrates robust scientific validity and reliability. This instrument provides a comprehensive measurement framework and quantitative basis for assessing multidimensional social deprivation in rural elderly communities, while also providing valuable reference points for subsequent research in this area.

To evaluate the performance of the Prophet model in predicting the daily incidence of hand, foot, and mouth disease (HFMD) in Shenzhen city, to analyze the impact of the COVID-19 pandemic, public holidays, and school vacations (summer/winter) on HFMD predictions, and to provide new insights for HFMD surveillance and early warning systems.

Using daily incidence rate data of hand, foot, and mouth disease (HFMD) in Shenzhen city from 2011 to 2023 as a training set, we constructed different Prophet models based on two factors: (1) whether data from the COVID-19 epidemic period were included, and (2) whether holiday effects were adjusted. These models were then used to predict the daily incidence rate from January to July 2024, and the predictions were compared with the actual observations. Model performance was evaluated using four metrics: mean square error (MSE), mean absolute error (MAE), root mean square error (RMSE), and symmetric mean absolute percentage error (SMAPE).

Compared to the Prophet model trained on data during the COVID-19 pandemic, the baseline Prophet model (without pandemic data) achieved reductions in daily average MSE, MAE, RMSE, and SMAPE of 45.64%, 27.63%, 25.89%, and 7.97%, respectively. After controlling for holiday effects, the MAE, RMSE, and SMAPE values remained unchanged. When the prediction horizon exceeded 4 months, the daily MSE decreased by 3.81%. For predictions within 4 months, the model yielded MSE, MAE, RMSE, and SMAPE values (with 95% confidence intervals) of 0.42 (0.33, 0.90), 0.51 (0.45, 0.75), 0.65 (0.57, 0.95), and 0.42 (0.24, 0.44), respectively. In contrast, the predictions at 7 months showed higher errors: MSE 1.78 (0.39, 29.61), MAE 0.94 (0.48, 3.05), RMSE 1.33 (0.63, 5.44), and SMAPE 0.40 (0.33, 0.43).

During the COVID-19 pandemic (2020 - 2022), the daily HFMD incidence rate significantly affected the performance of the Prophet model. While controlling for holidays and school vacations (winter/summer) had a limited effect on short-term predictions, it improved the model′s accuracy for long-term predictions.

To analyze the disease burden and trends of type 2 diabetes mellitus (T2DM) in China from 1990 to 2021, and to predict the T2DM disease burden from 2022 to 2026, providing data support and a scientific basis for the development and evaluation of diabetes prevention and control strategies.

Data on the disease burden of T2DM in China were obtained from the Global Burden of Disease Study 2021 database. The trends in the prevalence, mortality, and disability-adjusted life years (DALYs) rates of T2DM in China from 1990 to 2021 were analyzed. Autoregressive integrated moving average (ARIMA) models, neural network autoregression (NNAR) models, and combined ARIMA-NNAR models for the prevalence, mortality, and DALYs rates of T2DM in China were established based on data from 1990 to 2016 (training set). Model evaluation was performed using data from 2017 to 2021 (test set). The mean absolute percentage error (MAPE), mean absolute error (MAE), and root mean square error (RMSE) were used to compare the fitting and prediction performance of the models, and the best model was selected to predict the disease burden of T2DM in China from 2022 to 2026.

By calculating the rate of change of T2DM in China from 1990 to 2021, the prevalence, mortality, and DALYs rates of T2DM in China in 2021 showed a significant upward trend compared with 1990, and the disease burden was higher in males than in females. The dynamic trends of the predicted values of the ARIMA model, NNAR model, and combined ARIMA-NNAR model were basically consistent with the actual situation, but the values of each evaluation index of the combined prediction model showed that the prediction effect was better than that of the single prediction model. The prevalence, mortality, and DALYs rates of T2DM in China from 2022 to 2026 predicted by the ARIMA-NNAR model were 8 353.71/10⁵, 8 565.00/10⁵, 8 776.30/10⁵, 8 987.60/10⁵, and 9 198.90/10⁵; 12.55/10⁵, 12.78/10⁵, 12.99/10⁵, 13.20/10⁵, and 13.41/10⁵; and 826.79/10⁵, 846.22/10⁵, 864.49/10⁵, 881.86/10⁵, and 898.54/10⁵, respectively.

The combined ARIMA-NNAR model has a good effect in predicting the disease burden of T2DM in China and can provide a reference for short-term prediction of the T2DM disease burden. The prevalence, mortality, and DALYs rates of T2DM in China will continue to increase from 2022 to 2026, indicating that the disease burden of T2DM in China will continue to increase, and the situation of disease prevention and control remains severe.

To analyze the trends in incidence and mortality of stroke, including ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), among Chinese residents from 1990 to 2021, and to provide a reference for stroke prevention and control strategies in China.

Data on the incidence and mortality of stroke, IS, ICH, and SAH among Chinese residents in 1990 and 2021 were obtained from the Global Burden of Disease (GBD) 2021 study. Descriptive analyses were performed using the number of incident cases, incidence rate, number of deaths, and mortality rate. Statistical analyses were conducted using R 4.1.0 software. Trends in the incidence and mortality of stroke and its three subtypes from 1990 to 2021 were analyzed using the overall percentage change and estimated annual percentage change (EAPC).

The number of incident stroke cases, incidence rate (per 100 000), number of deaths, and mortality rate (per 100 000) among Chinese residents increased from 1 685 762, 143.29, 1 530 590, and 130.10 in 1990 to 4 090 480, 287.51, 2 591 647, and 182.16 in 2021, with overall relative percentage changes of 142.65%, 100.64%, 69.32%, and 40.01%, respectively. Both the incidence and mortality rates of stroke showed a significant increasing trend from 1990 to 2021 (EAPC = 2.02% and 1.01%, both P < 0.001). For IS, the number of incident cases, incidence rate, number of deaths, and mortality rate increased from 761 191, 64.70, 427 970, and 36.38 in 1990 to 2 772 053, 194.84, 1 176 952, and 82.72 in 2021, with overall relative percentage changes of 264.17%, 201.13%, 175.01%, and 127.40%, respectively. Both the incidence and mortality rates of IS showed a significant increasing trend (EAPC = 3.56% and 2.74%, both P < 0.001). For ICH, the corresponding figures increased from 774 012, 65.79, 913 023, and 77.61 in 1990 to 1 173 288, 82.47, 1 322 893, and 92.98 in 2021, with overall relative percentage changes of 51.59%, 25.34%, 44.89%, and 19.81%, respectively. Both the incidence and mortality rates of ICH showed a significant increasing trend (EAPC = 0.40% and 0.50%, both P < 0.01). In contrast, for SAH, the figures decreased from 150 559, 12.80, 189 598, and 16.12 in 1990 to 145 138, 10.20, 91 802, and 6.45 in 2021, with overall relative percentage changes of –3.60%, –20.29%, –51.58%, and –59.96%, respectively. Both the incidence and mortality rates of SAH showed a significant decreasing trend (EAPC = –1.69% and –4.02%, both P < 0.001). In both 1990 and 2021, male residents had higher incidence and mortality rates of stroke, IS, and ICH, as well as a higher incidence rate of SAH compared to females, except for the SAH mortality rate. From 1990 to 2021, the incidence and mortality rates of stroke, IS, and ICH increased in males (EAPC = 2.33% and 1.51%, 3.98% and 3.25%, 0.70% and 1.01%, respectively; all P < 0.05), while the incidence and mortality rates of SAH decreased (EAPC = –1.59% and –3.44%, respectively; both P < 0.05). In females, the incidence and mortality rates of stroke and IS increased (EAPC = 1.61% and 0.40%, 3.15% and 2.12%, respectively; all P<0.05), while the incidence and mortality rates of SAH decreased (EAPC = –1.69% and –4.69%, respectively; both P < 0.05). In both 1990 and 2021, the incidence and mortality rates of stroke and its three subtypes increased with age. The incidence rate of stroke decreased in all age groups from 1990 to 2021 (all P < 0.05), except for the 75 - 79 age group, where the difference was not statistically significant. The incidence rate of IS increased in all age groups (all P < 0.05), except for the age group under 20, which showed a decreasing trend, and the 20 - 24 age group, where the difference was not statistically significant. The mortality rate of IS decreased in all age groups (all P < 0.05), except for the 80 - 84 and ≥ 85 age groups, where the differences were not statistically significant. The incidence and mortality rates of ICH and SAH decreased in all age groups (all P < 0.05).

From 1990 to 2021, the incidence and mortality rates of stroke, IS, and ICH increased among Chinese residents, while the incidence and mortality rates of SAH decreased. Males and the elderly are high-risk groups for stroke incidence and mortality.

To analyze the trend in the burden of pancreatic cancer among Chinese residents from 1990 to 2021, providing reference data for the prevention and control of pancreatic cancer in China.

Data related to the burden of pancreatic cancer among Chinese residents from 1990 to 2021 were collected from the Global Burden of Disease (GBD 2021) database. Standardized incidence rates, standardized mortality rates, and disability-adjusted life years (DALYs) were extracted for descriptive analysis. The Joinpoint regression model was used to analyze trends in the burden of pancreatic cancer, and the age-period-cohort (APC) model was applied to assess the effects of age, period, and birth cohort on the burden of pancreatic cancer.

The age-standardized incidence rate of pancreatic cancer in China′s overall, male, and female populations increased from 4.54/100 000, 5.55/100 000, and 3.64/100 000 in 1990 to 5.64/100 000, 7.29/100 000, and 4.18/100 000 in 2021, respectively. The average annual percentage changes (AAPCs) were 0.72%, 0.89%, and 0.48%, respectively, with statistically significant increasing trends for the overall, male, and female populations (all P < 0.001). The age-standardized mortality rates increased from 4.83/100 000, 5.91/100 000, and 3.90/100 000 in 1990 to 5.72/100 000, 7.37/100 000, and 4.29/100 000 in 2021, respectively, with AAPCs of 0.56%, 0.55%, and 0.33%, respectively. Statistically significant increasing trends were observed for the overall, male, and female populations (all P < 0.001). The age-standardized disability-adjusted life years (DALYs) rates increased from 123.16/100 000, 151.33/100 000, and 95.37/100 000 in 1990 to 137.23/100 000, 179.36/100 000, and 96.89/100 000 in 2021, respectively, with AAPCs of 0.36%, 0.55%, and 0.07%, respectively. Statistically significant increasing trends were observed for the overall and male populations (all P < 0.001). The risk of pancreatic cancer incidence increased with age for both males and females. The age effect coefficients were lowest for the 15 - 19 age group (–3.638 and –3.406, respectively), highest for males in the 85 - 89 age group (1.623), and highest for females in the 80 - 84 age group (1.582). The risk of pancreatic cancer incidence increased over time, with period effect coefficients increasing from –0.477 and –0.388 in 1992 - 1996 to 0.488 and 0.382 in 2017 - 2021 for males and females, respectively. The risk of pancreatic cancer incidence decreased with birth cohort, with the lowest cohort effect coefficients observed in 2002 - 2006 (–1.719 and –1.877 for males and females, respectively) and the highest in 1897 - 1901 (1.374 and 1.504, respectively). The risk of pancreatic cancer mortality generally increased with age for both males and females. The age effect coefficients were lowest for the 15 - 19 age group (–3.658 and –3.428, respectively), highest for males in the 90 - 94 age group (1.751), and highest for females in both the 80 - 84 and 85 - 89 age groups (1.686 for both). The risk of pancreatic cancer mortality increased over time, with period effect coefficients increasing from –0.465 and –0.384 in 1992 - 1996 to 0.477 and 0.366 in 2017 - 2021 for males and females, respectively. The risk of pancreatic cancer mortality decreased with birth cohort, with the lowest cohort effect coefficients in 2002 - 2006 (–1.794 and –1.964 for males and females, respectively) and the highest in 1897 - 1901 (1.456 and 1.594, respectively). The risk of pancreatic cancer burden generally increased with age for both males and females. The age effect coefficients were lowest for the 15 - 19 age group (–3.069 and –2.834, respectively) and highest for the 70 - 74 age group (1.049 and 1.286 for males and females, respectively). The risk increased over time, with period effect coefficients increasing from –0.358 and –0.252 in 1992 - 1996 to 0.364 and 0.260 in 2017 - 2021 for males and females, respectively. The risk of pancreatic cancer burden decreased with birth cohort, with the lowest cohort effect coefficients in 2002 - 2006 (–1.334 and –1.513 for males and females, respectively) and the highest in 1897 - 1901 (1.000 and 1.114, respectively).

From 1990 to 2021, the age-standardized incidence, mortality, and DALY rates of pancreatic cancer in the Chinese population, as well as the age-standardized DALY rate in males, showed an increasing trend. The risk of pancreatic cancer burden increased with age and period but decreased with birth cohort.

To analyze the influencing factors of exercise deficiency disorder (EDD) in children and adolescents, with the aim of providing a reference for promoting physical activity and improving physical fitness in Chinese children and adolescents.

Seven Chinese and English databases, including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database, were searched to identify relevant Chinese and English studies on EDD in children and adolescents published from database inception to August 2023. A systematic literature review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to analyze the factors influencing EDD.

A total of 53 articles with 245777 participants were included. Gender, race/ethnicity, self-efficacy, perceptual ability, motivation to be active, cognitive ability, motor skills, parental support, parental involvement, socio-cultural factors, family support, parental education, parental marital status, peer support, role model, school environment, availability of sports facilities, built environment around the home, urban built environment, geographic region, urban-rural differences, weather conditions are positively correlated with EDD in children and adolescents. Age, weight, sedentary behavior, socioeconomic level, and household income are negatively correlated with EDD in children and adolescents. There is no significant correlation between parenting style, school performance, and EDD in children and adolescents.

EDD in children and adolescents is influenced by factors in five dimensions: demographic and biological factors, psychological cognition and emotions, behavioral characteristics and skills, social and cultural factors, and the physical environment. Relevant authorities should use these factors to guide targeted prevention and intervention efforts to improve the physical activity and health levels of Chinese children and adolescents.