To analyze the associations between paternal and maternal emotional symptoms and sleep disturbances in Chinese preschoolers, providing evidence for the prevention and control of childhood sleep disturbances.

From September to October 2024, a multi-stage random sampling method was used to recruit 3 749 children from 12 kindergartens in Hefei city, Anhui province. Parents completed emotional self-rating scales, while mothers provided information on household characteristics and children′s sleep disturbances. Parent-child data were linked, and multivariate logistic regression models were established to examine the associations between paternal and maternal emotional symptoms and sleep disturbances in preschoolers.

The prevalence of sleep disturbances among preschoolers was 4.11%. Paternal and maternal symptoms of anxiety, depression, and stress were all associated with an increased risk of sleep disturbances in preschoolers (P < 0.001 for all). Co-exposure to paternal and maternal negative emotional symptoms further elevated the risk of sleep disturbances (P < 0.001). With no paternal or maternal anxiety as the reference group, regression analysis suggested increased risk of sleep disturbances for boys in the groups of no paternal anxiety and maternal anxiety (OR = 6.87, 95%CI: 4.07–11.59) and both paternal anxiety and maternal anxiety (OR=8.80, 95%CI: 3.87–20.01). For girls, elevated risks were observed in the groups of paternal anxiety and no maternal anxiety (OR = 5.01, 95%CI: 2.44–10.29), no paternal anxiety and maternal anxiety (OR = 7.57, 95%CI: 4.21–13.61), and both paternal anxiety and maternal anxiety (OR = 12.56, 95%CI: 5.11–30.90). With no paternal or maternal depression as reference, boys demonstrated higher risk of sleep disturbances in the groups of no paternal depression and maternal depression (OR = 5.26, 95%CI: 3.03–9.11) and both paternal depression and maternal depression (OR = 8.39, 95%CI: 3.17-22.22). Among girls, increased risks were found in the groups of paternal depression and no maternal depression (OR = 2.52, 95%CI: 1.02-6.22), no paternal depression and maternal depression (OR = 3.30, 95%CI: 1.74–6.27), and both paternal depression and maternal depression (OR = 19.99, 95%CI: 8.68–46.05). With no paternal or maternal stress as reference, regression analysis indicated elevated risk of sleep disturbances for boys in the groups of no paternal stress and maternal stress (OR = 5.75, 95%CI: 3.19–10.36) and both paternal stress and maternal stress (OR = 12.19, 95%CI: 3.05–48.65). For girls, higher risks were observed in the groups of paternal stress and no maternal stress (OR = 4.28, 95%CI: 2.04–8.96), no paternal stress and maternal stress (OR = 2.78, 95%CI: 1.35–5.69), and both paternal stress and maternal stress (OR = 14.09, 95%CI: 3.89–51.10).

Paternal and maternal negative emotional symptoms are associated with an increased risk of sleep disturbances in preschoolers. Special attention should be paid to children whose mothers exhibit negative emotional symptoms and those with both parents affected, particularly to girls.

To analyze the impacts of family-related factors on overweight and obesity among students in the nutrition improvement program for rural compulsory education in Henan province.

From October to November 2023, stratified random cluster sampling was conducted to include 5 835 primary and secondary school students from four key counties of the nutrition improvement program for rural compulsory education in Henan province. The body heights and body weights of the students were measured, and questionnaires were administered to their parents. Chi-square tests and logistic regression were employed to analyze the determinants of overweight and obesity, and a random forest model was constructed.

The detection rate of overweight and obesity among primary and secondary school students was 30.76%. Specifically, boys had a higher rate than girls (36.05% vs. 25.29%, χ² = 79.321, P < 0.05); primary school students had a higher rate than secondary school students (34.06% vs. 25.08%, χ² = 51.243, P< 0.05); and students in urban areas had a higher rate than those in rural areas (34.30% vs. 29.60%, χ²=11.303, P < 0.05). Multivariate logistic regression analysis revealed that females (OR = 0.625, 95%CI: 0.556–0.703), secondary school (OR = 0.703, 95%CI: 0.620–0.797), rural areas (OR = 0.849, 95%CI: 0.736–0.980), non-mother primary caregiver (OR = 0.838, 95%CI: 0.739–0.950), maternal educational background (secondary school: OR = 1.240, 95%CI: 1.040–1.479; college or above: OR = 1.490, 95%CI: 1.113–1.995), family after-tax income of last year ≥ ¥100 000 (OR = 1.515, 95%CI: 1.145–2.004), students′ picky or selective eating habits (rarely: OR = 0.826, 95%CI: 0.705–0.967; sometimes: OR = 0.444, 95%CI: 0.378–0.521; often/always: OR = 0.409, 95%CI: 0.322–0.520), parental misperception of students′ body form (OR = 2.283, 95%CI: 2.029–2.568), and parental intervention measures for students′ weight (OR = 1.198, 95%CI: 1.063–1.350) were associated with overweight and obesity (P<0.05). The AUC value of the random forest model was 0.743. Moreover, the Gini index identified the two most influential variables, which were parental intervention measures for students′ weight (187.452) and parental perception of students′ body form (174.191).

The prevalence of overweight and obesity is relatively high among students in the nutrition improvement program for rural compulsory education in Henan province. Therefore, implementing prevention and control measures based on the family is of great significance.

To investigate the conditions of glasses wearing and vision correction among primary and secondary school students in Henan province, thus providing a theoretical basis for the prevention and control of myopia.

From September to October 2023, a stratified cluster sampling method was adopted to select 351 497 primary and secondary school students from 158 counties and districts in Henan province for vision screening and questionnaire surveys. The vision correction condition was analyzed according to different demographic characteristics and influencing factors.

In 2023, the glasses-wearing rate among primary and secondary school students in Henan province was 30.24% (106 292/351 497). The rate among girls was 33.63% (56 473/167 906), which was higher than that among boys at 27.14% (49 819/183 591). The rate in urban areas was 33.35% (44 597/133 707), higher than that in suburban and rural areas at 28.33% (61 695/217 790). The glasses-wearing rate showed an increasing trend as the phase of studying increased (P < 0.05). Among students with myopia, 50.34% (101 948/202 518) had their vision corrected with glasses, while the rate of uncorrected or undercorrected vision reached 64.42% (130 469/202 518). The rate of uncorrected or undercorrected vision was higher among boys at 65.71% (65 789/100 113) than among girls at 63.16% (64 680/102 405). It was also higher in suburban and rural areas at 65.53% (80 322/122 579) than in urban areas at 62.73% (50 147/79 939). The rate of uncorrected or undercorrected vision showed a decreasing trend as the phase of studying increased (P < 0.05). Logistic regression analysis showed that self-assessment of no myopia (OR = 3.940, 95%CI: 3.122–4.973), sometimes wearing glasses (OR = 2.157, 95%CI: 2.090–2.227), never wearing glasses (OR = 2.592, 95%CI: 2.488–2.701) were associated with an increased rate of uncorrected or undercorrected vision among myopic students. In contrast, visual acuity examination 1–2 times (OR=0.593, 95%CI: 0.557–0.631) and 3 times or more (OR=0.494, 95%CI: 0.462–0.529) in the past year, optometry only (OR = 0.616, 95%CI: 0.586–0.648), pupil dilation exam only (OR = 0.733, 95%CI: 0.669–0.797), optometry and pupil dilation exam (OR = 0.593, 95%CI: 0.563–0.624) before optometry were associated with an decreased rate of uncorrected or undercorrected vision among myopic students.

The glasses-wearing rate is not high among primary and secondary schools in Henan province, while the rate of uncorrected or undercorrected vision is high among in myopic students. It is necessary to strengthen the publicity and education of scientific vision correction.

To construct the evaluation indexes for adolescent medical literacy based on the core literacy framework, thus providing a scientific basis for education and health departments to formulate and implement effective health education interventions and the research on adolescent medical literacy.

From November 2024 to October 2025, through literature review, semi-structured interviews, and group discussions, the item pool of indexes was constructed. Delphi method was employed to conduct two rounds of consultation with 18 experts to determine the evaluation indexes, and the analytic hierarchy process (AHP) was adopted to calculate the weight of each index.

The questionnaire recovery rates in the two rounds of expert consultation were both 100%, and the expert authority coefficients were both 0.93, indicating a high degree of expert authority. The two rounds of expert consultation showed the Kendall′s coefficients of concordance of expert opinions being 0.316 and 0.276 and the intra-class correlation coefficients (ICC) being 0.935 and 0.961, respectively, which indicated that the expert opinions were consistent. The evaluation index system of medical literacy for adolescents was composed of 56 items in 11 second-level indexes from 3 dimensions of basic medical knowledge, medical rescue skills, and medical cognitive attitude. The first-level indexes with weights from high to low were basic medical knowledge (0.400), medical cognitive attitude (0.400), and medical rescue skills (0.200). Among the second-level indexes, cognition (0.500), disease prevention and treatment knowledge (0.391), common emergency treatment (0.351), and basic life knowledge (0.351) ranked the top four. The consistency ratios of the first-level indexes, the second-level indexes, and the third-level indexes were all less than 0.1, which met the standard requirements of consistency test, and the weight distribution of indexes was reasonable.

The evaluation indexes of adolescent medical literacy are scientific and reliable, which can provide reference for education departments and schools to formulate the curriculum contents of adolescent health education.

To explore the associations of volume and accumulation patterns (duration of sedentary bouts and breaks) of sedentary behavior with physical fitness among elementary school students.

From September to October 2023, a convenience sampling method was adopted to select 605 elementary school students (grades 1 to 5) from Wuhan city, Hubei province and Jinhua city, Zhejiang province. Accelerometers were used to measure the sedentary volume and the duration of sedentary bouts and breaks. The physical fitness were scored according to the National Student Physical Health Standards (Revised in 2014). Binary logistic regression was employed to examine the associations of volume and accumulation patterns of sedentary behavior with physical fitness.

The surveyed students spent 65.2% of the classroom time in sedentary behavior. The highest proportions were observed for the sedentary bouts of 1–19 min (47.3%) and breaks of 1–4 min (17.7%) in class. In the Q4 group with the highest proportions of sedentary bouts lasting 5–9 min and ≥ 20 min , the odds of failing to achieve good or excellent physical fitness were 0.451 times (OR = 0.451, 95%CI: 0.247–0.823) and 2.16 times (OR = 2.16, 95%CI: 1.043–4.474), respectively, those of the Q1 group. No statistically significant associations were observed between the proportion of sedentary volume or sedentary break duration and failure to achieve good or excellent physical fitness. Further analysis of physical fitness factors revealed that the odds of failure to achieve good or excellent physical fitness in the Q4 group with the highest sedentary volume proportion were 3.673 times that of the Q1 group (OR = 3.673, 95%CI: 1.085–12.434). For the sedentary bouts of 5–9 min, the Q4 group exhibited lower odds of poor speed ability (OR=0.48, 95%CI: 0.262–0.881) and strength ability (OR = 0.378, 95%CI: 0.162–0.882) than the Q1 group. In contrast, the Q4 group with the highest proportion of sedentary bouts ≥ 20 min showed 4.969 times higher odds of poor body composition (OR = 4.969, 95%CI: 1.406–17.560) and 2.717 times higher odds of poor strength ability (OR = 2.717, 95%CI: 1.120–6.593) than the Q1 group.

The sedentary behavior of elementary school students presents a fragmented pattern characterized by short terms and frequent breaks. Reducing the duration of sedentary bouts in class may be more important for the fitness of elementary school students than reducing the volume of sedentary behavior. According to the body composition, it is necessary to reduce the volume of sedentary behavior and shorten the duration of sedentary bouts in class. The quality of strength and speed can be improved by shortening the duration of sedentary bouts in class.

This study aimed to investigate the prevalence and determinants of overweight and obesity among students aged 6–18 years in Heilongjiang province, providing an evidence base for the development of region-specific body weight management strategies.

Between October 2024 and April 2025, a total of 50 734 students were recruited from six prefecture-level cities and their subordinate counties/districts via a multistage stratified random sampling design. Anthropometric measurements and structured questionnaires were administered. Overweight and obesity were classified according to the standard Screening for Overweight and Obesity among School-Age Children and Adolescents (WS/T 586—2018). Chi-square tests and multivariable logistic regression were employed for data analysis.

The overall prevalence of overweight and obesity was 17.45% and 23.46%, respectively. Boys (20.78% and 28.41%) had higher rates than girls (14.01% and 18.35%) (χ² = 1 486.520, P < 0.01). Across school stages, the prevalence rates of overweight/obesity were 17.30%/30.10% in primary school students, 17.22%/21.10% in junior high school students, and 18.45%/18.16% in senior high school students, with significant differences observed (χ² = 640.236, P < 0.01). Overweight and obesity rates varied by gender across age groups: Male overweight rate showed a "rise-decline-rise" bimodal pattern, while female overweight rate presented a "decline-rise" unimodal one. Both genders′ obesity rates exhibited a steady downward trend with age. Multivariate analysis indicated that shorter mealtime duration, frequent late-night snacking, being a non-only child, lower exercise frequency, shorter exercise duration, incomplete family structure, and frequent conflicts with caregivers were associated with higher odds of overweight and obesity (all P < 0.05). Stratified analysis further revealed that among primary school students, short mealtime duration and low exercise frequency increased the risk (both P < 0.05), whereas among secondary school students, short mealtime duration, frequent late-night snacking, short exercise duration, conflicts with caregivers, and incomplete family structure were predictors (all P < 0.05).

The prevalence of overweight and obesity among students aged 6–18 years in Heilongjiang remains high, underscoring the need for tailored interventions that integrate local dietary and lifestyle characteristics with gender- and school stage-specific management, strengthened family involvement, and school-based health education.

To investigate the visual health status and its trends and influencing factors among children and adolescents in Macao.

Utilizing visual acuity data from the Macao Child and Adolescent Physical Fitness Surveillance (2005–2020), this study analyzed the visual health status of 16 688 participants aged 6–18 years. The trend χ² test was conducted to assess changes in the detection rate of poor vision. Univariate analysis and multivariate logistic regression were employed to identify the factors associated with poor vision.

The overall normal vision rate declined from 39.7% in 2005 to 29.2% in 2010 (trend χ² = 108.3, P < 0.01) and then increased to 30.1% in 2015 and 30.7% in 2020. Concurrently, the severe poor vision rate exhibited a continuous upward trend, rising from 36.4% in 2005 to 46.3% in 2020 (trend χ² = 79.0, P < 0.01). Results of the 2020 vision analysis revealed that the prevalence of normal vision in males (33.0%) was higher than that (28.0%) in females (χ² = 9.9, P < 0.05). Multivariate analysis revealed that low-intensity physical education (PE) classes (OR = 1.92, 95%CI: 1.08–3.41), zero extracurricular physical activity sessions per week (OR = 2.52, 95%CI: 1.10–5.78), and sleep duration < 8 h per day (OR = 2.08, 95%CI: 1.03–4.21) were associated with an increased risk of poor vision. Conversely, limiting the daily electronic device use within 30 min (OR = 0.63, 95%CI: 0.41–0.97), moderate-intensity PE classes (OR = 0.51, 95%CI: 0.30–0.88), and shorter homework completion time (OR = 0.44, 95%CI: 0.25–0.78; reference: ≥ 180 min) were associated with a reduced risk of poor vision.

From 2005 to 2020, the visual health issues among children and adolescents in Macao were characterized by a declining normal vision rate and an increasing trend towards severity. These trends are primarily influenced by lifestyle factors, lack of physical activity, and academic pressure.

To investigate the incidence, intensity, and influencing factors of catastrophic health expenditure (CHE) among families of patients with phenylketonuria (PKU) in China and to assess the contributions of various factors to the inequity in CHE.

A cross-sectional survey was conducted among 263 PKU families from 24 provinces (autonomous regions, municipalities directly under the Central Government) in China, 2025. CHE was defined according to WHO recommended threshold of 40% of household capacity-to-pay. The incidence, mean gap (MG), and mean positive gap (MPG) of CHE were calculated. The concentration index and its decomposition were employed to evaluate equity, and logistic regression was adopted to identify influencing factors.

The overall incidence of CHE among PKU families was 52.09% (137/263). The incidence in rural families [69.57% (112/161)] was significantly higher than that in urban families [24.51% (25/102)]. Major risk factors for CHE included urban-rural disparity (OR = 11.18, 95%CI: 5.367–23.295) and the presence of complications (OR = 2.35, 95%CI: 1.122–4.941). The distribution of CHE demonstrated a pro-poor pattern, with a concentration index of –0.43 (95%CI: –0.52 to –0.33). The urban-rural disparity accounted for 65.53% of the total inequality.

Families of PKU patients in China face a high risk of CHE with substantial intensity and significant pro-poor inequality. The urban-rural disparity serves as the primary driver of this inequity.

To evaluate the effectiveness of the Asia-Pacific Colorectal Screening (APCS) questionnaire and the fecal immunochemical test (FIT), used alone and in combination,in population-based colorectal cancer screening, and to provide evidence for precision prevention and population stratification management of colorectal cancer.

Data were collected from the 2024 Shandong Province colorectal cancer screening program.The study population consisted of 6 259 community residents aged 40–74 years who had lived locally for at least 3 years, recruited from 13 regions using community-based sampling. With pathological examination results as the gold standard, the detection rate of advanced neoplasia and the colonoscopy workload were analyzed for six screening methods: APCS, FIT (50 ng/mL), FIT (100 ng/mL), APCS + FIT (50 ng/mL), APCS + FIT (100 ng/mL), and direct colonoscopy.

APCS, FIT (50 ng/mL), FIT (100 ng/mL), APCS + FIT (50 ng/mL), APCS + FIT (100 ng/mL), and direct colonoscopy showed the detection rates for advanced neoplasia being 10.50%, 46.15%, 41.14%, 57.98%, 52.05%, and 7.35%, the detection rates for colorectal cancer being 1.06%, 10.38%, 15.19%, 15.97%, 21.90%, and 0.72%, and the detection rates for advanced adenoma being 9.44%, 35.77%, 25.95%, 42.02%, 30.14%, and 6.63%, respectively. The detection rates for advanced neoplasia, colorectal cancer, and advanced adenoma differed among the screening methods (all P < 0.001). APCS + FIT (50 ng/mL) yielded the highest detection rates for both advanced neoplasia and advanced adenoma, while APCS + FIT (100 ng/mL) had the highest detection rate for colorectal cancer. Stratified analysis revealed that FIT (50 ng/mL) had the highest detection rates for advanced neoplasia and advanced adenoma in community residents aged 40–54 years. FIT (100 ng/mL) showed the highest detection rate for colorectal cancer among residents aged 40–54 and 55–64 years. APCS + FIT (50 ng/mL) achieved the highest detection rates for advanced neoplasia and advanced adenoma in males, females, and residents aged 55–64 and 65–74 years. APCS + FIT (100 ng/mL) yielded the highest detection rates for colorectal cancer in males, females, and residents aged 65–74 years (all P < 0.001). Using the number of colonoscopies required to detect one lesion as an indicator of colonoscopy workload in population screening. That APCS + FIT (50 ng/mL) required the fewest colonoscopies to detect one case of advanced neoplasia and one case of advanced adenoma, at 1.72 (95%CI: 1.41–2.03) and 2.38 (95%CI: 1.95–2.81), respectively. APCS + FIT (100 ng/mL) required the fewest colonoscopies to detect one case of colorectal cancer, at 4.56 (95%CI: 3.52–5.61).

In regions with limited medical resources, APCS + FIT is recommended to rapidly identify individuals at high risk of colorectal cancer. However, in regions with sufficient medical resources and funding, direct colonoscopy is recommended to achieve more comprehensive and precise lesion detection.

To predict the incidence trends of hand, foot and mouth disease (HFMD) in Shenzhen city, Guangdong province based on the meteorological lag effect and the long short-term memory (LSTM) model, thereby providing methodological support for establishing a more scientific and accurate meteorological disease risk early warning system.

Data from 523 weeks (January 1, 2015 to December 31, 2024) of HFMD case reports in the China Disease Control and Prevention Information System were collected. A total of 353 046 HFMD cases in children aged ≤5 years were aggregated weekly. Meteorological parameters, including average weekly temperature (Temp), relative humidity (RH), temperature-humidity index (THI), apparent temperature (AT), and wind speed (WS), were integrated. Significant correlated variables were screened by Spearman rank correlation analysis to construct three types of LSTM models: a baseline model (case count only), single-factor models (case count + Temp/RH lagged 1–3 weeks), and composite models (case count + THI/AT lagged 1–3 weeks). Model performance was evaluated and compared via the root mean square error (RMSE), mean absolute error (MAE), and coefficient of determination (R²).

Comparative analysis on the test set showed that all the models incorporating meteorological factors outperformed the baseline model (RMSE = 211.109, MAE = 117.654, R² = 0.942). Among the single-factor models, the model with Temp lagged by 2 weeks (Temp-lag2) performed best (RMSE = 179.915, MAE = 108.290, R² = 0.958), and the model with RH lagged by 2 weeks (RH-lag2) was optimal among all the models (RMSE = 177.457, MAE = 97.873, R² = 0.959). Among the composite models, the model with THI lagged by 2 weeks (THI-lag2) performed best (RMSE = 185.061, MAE = 103.817, R² = 0.956) but was slightly inferior to the RH-lag2 model. The RH-lag2 model predicted a bimodal pattern (peaks at weeks 10 and 15) for the HFMD incidence trends in the first 20 weeks of 2025, which closely matched the spring peak pattern of 2024 and showed a significant overall shift forward compared to the average peak period (weeks 9–35) from 2015 to 2024.

The LSTM model constructed based on RH lagged by 2 weeks effectively characterizes the promoting effects of a hot and humid environment on the survival and transmission of enteroviruses, significantly improving the prediction accuracy of HFMD incidence trends.

To analyze the effects of meteorological factors on the incidence of scarlet fever in Guangzhou from 2014 to 2022.

The epidemiological characteristics of scarlet fever in Guangzhou were described. The effects of meteorological factors on the risk of scarlet fever were evaluated via Spearman correlation analysis, distributed lag non-linear models, and bivariate response models.

The incidence of scarlet fever had correlations (P < 0.05) with mean temperature (rs = −0.255), wind speed (rs = −0.126), air pressure (rs = 0.116), and sunshine duration (rs = −0.177). Mean temperature exhibited risk effects at lower temperatures and protective effects at higher temperatures, with the relative risk (RR) peaking at 1.41 (95%CI: 1.09–1.83) when the temperature was 12 ℃. The relationships of wind speed and sunshine duration with incidence of scarlet fever followed a wave-like pattern, with the strongest risk effect observed at a wind speed of 4.3 m/s (RR = 5.67, 95%CI: 1.61–19.84). When sunshine duration exceeded 8 h/d, the risk effect increased markedly, albeit not statistically significant (95%CI: 0.97–4.95). Air pressure demonstrated protective effects at low levels and risk effects at high levels on the incidence of scarlet fever, with the RR peaking at 2.26 (95%CI: 1.70–3.02) when the air pressure was 1 016.5 hPa. The interactions of meteorological factors such as low temperature, high wind speed, long sunshine duration, and high air pressure further contributed to an increase in scarlet fever incidence in Guangzhou.

Mean temperature, wind speed, air pressure, and sunshine duration demonstrate non-linear relationships and lag effects with the incidence of scarlet fever, with interactions among each other. Therefore, adjusting these meterological factors can be taken as a focus of prevention and control efforts for scarlet fever.

To construct and validate a risk diagnostic model for diabetes in rural elderly individuals with both hypertension and dyslipidemia, thus providing a scientific basis for the prevention and control of the co-morbidity of hypertension, hyperglycemia, and dyslipidemia in rural elderly people in China.

With the data of 583 rural elderly individuals with hypertension and dyslipidemia from the 2015 China Health and Retirement Longitudinal Study (CHARLS) as the training set, a multivariate unconditional logistic regression model was adopted to analyze the influencing factors of diabetes in rural elderly individuals with hypertension and dyslipidemia and construct a risk diagnostic model. The goodness-of-fit of the model was tested via the Hosmer-Lemeshow method. The physical examination data of 1 185 elderly individuals who aged 65 and above and had both hypertension and dyslipidemia and complete outcome variables and key variables in Anfeng town, Dongtai city, Jiangsu province were used for external validation. Receiver operating characteristic (ROC) curves, calibration curves, and decision curves were established. The restricted cubic spline (RCS) model was employed to analyze the dose-response relationships of the Chinese visceral adiposity index (CVAI) and white blood cell count with the prevalence of diabetes in rural elderly individuals with both hypertension and dyslipidemia.

The results of the analysis on CHARLS data showed that CVAI, alcohol consumption status, and white blood cell count were the main factors influencing the prevalence of diabetes among rural elderly individuals with both hypertension and dyslipidemia (all P < 0.05). The results of the RCS model analysis showed that CVAI and white blood cell count were linearly positively correlated with the risk of diabetes (non-linear test P = 0.964 and 0.755), and the risk of diabetes increased linearly with the increase in CVAI and white blood cell count. The Hosmer-Lemeshow goodness-of-fit test (P = 0.739), the ROC curve of the external validation set [AUC (95%CI): 0.924 (0.910–0.939)], the calibration curve, and the decision curve all indicated that the risk diagnostic model constructed in this study for diabetes has good performance.

The risk diagnostic model for diabetes in rural elderly individuals with both hypertension and dyslipidemia, which is constructed in this study, has excellent performance and clinical benefits. In this population, drinkers as well as those with higher CVAI and white blood cell count should be regarded as the key groups for diabetes prevention.

To improve the normality, effectiveness, and rationality of China′s management system for products in contact with drinking water and proposed corresponding measures and suggestions.

The horizontal comparison analysis was conducted to compare the domestic and foreign management systems for products in contact with drinking water from two dimensions of management basis and management process. Then, according to the comparison results, SWOT analysis was performed to elucidate the strengths, weaknesses, opportunities, and threats in China′s management system.

The United States, the European Union, and Japan started early in the management of such products, and they mostly appointed the third-party testing organizations for product safety evaluation and certification and adopted the market for supervision after product marketing. Third-party certification organizations in these countries and regions are generally mature, have sound testing standards, and produce reliable test results. China started late in building the management system but developed rapidly in this field, establishing a management system within a short period of time. In China, the health administrative department is responsible for the management of products in contact with drinking water throughout the whole chain. Meanwhile, China actively introduces relevant regulations and standards to maximize the protection of people′s health.

The United States, the European Union, and Japan mainly rely on the market to manage products in contact with drinking water, with the government responsible for post-mortem supervision. China′s management system of products in contact with drinking water is characterized by government-guided standard formulation and implementation and emphasizes access mechanism but is weak in content updating. In the context of rapid development, new ideas should be incorporated into the management of products in contact with drinking water, thereby safeguarding the safety of drinking water.