To study the factors influencing the control of high blood pressure/glucose/lipids in community patients under the strategy of "Integrated Control and Prevention of Three Highs (high blood pressure/glucose/lipids) and Six Diseases (coronary heart disease, stroke, renal lesions, retinal lesions, peripheral neuropathy, and peripheral vascular lesions)" strategy, and to provide a reference for improving the chronic disease management model.

The study included 34 500 elderly residents (≥60 years) with one or more elevated blood pressure/glucose/lipid levels who were under the management of "Integrated Control and Prevention of Three Highs and Six Diseases" strategy in Chengyang district, Qingdao city, Shandong province. Subjects′ demographics and 4 years (2019–2022) of consecutive blood pressure, glucose, and lipid monitoring data were collected from the Three Highs management information system. Generalized estimating equations were used to analyze the factors influencing the subjects′ blood pressure, blood glucose, and blood lipid control.

The overall blood pressure control rate showed a trend of first decreasing and then increasing, from 27.04% in 2019, decreasing to 26.07% in 2021, and then increasing to 27.88% in 2022. The overall blood glucose control rate also showed a trend of first decreasing and then increasing, from 60.07% in 2019, decreasing to 52.20% in 2021, and then increasing to 55.30% in 2022. The overall blood lipid control rate showed a trend of first decreasing and then increasing, from 55.20% in 2019, decreasing to 54.14% in 2020, and then increasing to 60.95% in 2022. Patients who were female, older, had local household registration, were illiterate or semi-literate, worked in agriculture, had multiple elevated blood pressure/glucose/lipid levels, and used more medications had lower blood pressure control rates. Patients who were male, aged 60–69 years, had local household registration, were illiterate or semi-literate, worked in agriculture, had multiple elevated blood pressure/glucose/lipid levels, and used more medications had a lower blood glucose control rate. Patients who were female, aged 60–69 years, had local household registration, were illiterate or semi-literate, had other occupations, had multiple elevated blood pressure/glucose/lipid levels, and used fewer medications had a lower blood lipid control rate.

Under the "Integrated Control and Prevention of Three Highs and Six Diseases" strategy-based management, the blood pressure control rate and lipid control rate of elderly community residents with elevated indicators were effectively improved in Chengyang District, Qingdao City, and the blood glucose control rate was also improved. The chronic disease management model could be further promoted by strengthening lifestyle intervention and health education in key populations and continuously evaluating its effectiveness.

To investigate the relationship between liver fibrosis score (LFS) and the incidence of cardiovascular disease (CVD) in rural Uyghur residents in Uyghur Autonomous Region (Xinjiang), and to provide a reference for the early detection and prevention of CVD.

Using a typical sampling, we recruited 13 464 rural Uyghur residents aged ≥18 years in the 51st Regiment of the Third Division of the Xinjiang Production and Construction Corps and conducted a baseline survey in August-September 2016. Five follow-up surveys were conducted in July 2019, July 2020, August 2021, June 2022, and June 2023 among 11 863 non-pregnant and non-frequent migrant participants with complete information and no CVD at baseline. The Kaplan-Meier method was used to estimate the cumulative incidence of CVD in three groups with different grades of LFS, including fibrosis-4 score (FIB-4 score), body mass index (BMI)-aspartate aminotransferase/alanine aminotransferase(AST/ALT) ratio-diabetes score (BARD score) , and Forns index. The Cox proportional hazards regression model was used to assess the relationship between the three LFSs and CVD incidence. The Framingham CVD risk score model (Framingham model) was used to assess the predictive value of LFS for CVD risk.

At the end of the surveys, 423 (3.57%) of the 11 863 participants were lost to follow-up and 1 280 CVD events were identified in the 11 440 participants finally included in the analysis, with an incidence density of 17.62/1 000 person-years and a cumulative incidence of 11.19% for the total follow-up of 72 662.30 person-years and an average of 6.35±1.28 person-years for per participant. The cumulative incidences of CVD were 9.10%, 19.28%, and 27.71% for the low (<1.30), moderate (1.30–2.67), and high (>2.67) FIB-4 score groups; 7.19%, 16.45%, and 33.81% for the low (<2), moderate (2–3), and high (>3) BARD score groups; and 1.42%, 9.89%, and 26.88% for the low (<4.2), moderate (4.2–6.9), and high (>6.9) Forns index groups, respectively, with statistically significant differences in the cumulative CVD incidence among groups with different LFS of three types (all P<0.001). After adjustment for sex, age, smoking status, alcohol consumption, hypertension, diabetes, obesity, waist circumference, high-density lipoprotein cholesterol (HDL-C), and estimated glomerular filtration rate (eGFR), the multifactorial Cox proportional hazards regression model showed that the risk of CVD was higher in the moderate and high FIB-4 score groups (hazard risk [HR]=1.26, 95% confidence interval [95%CI]: 1.09–1.45 and HR=1.91, 95%CI: 1.59–2.30) than those in the low score group; the risk of CVD was also higher in the moderate and high BARD score groups (HR=1.57, 95%CI: 1.24–1.97) and HR=2.47, 95%CI: 1.51–4.04) and Forns index groups (HR=3.00, 95%CI: 2.12–4.24 and HR=4.95, 95%CI: 3.44–7.11) than those in the low BARD score and Forns index groups, respectively. The concordance index (C-index) (95%CI) of the Framingham model analysis was 0.805 (0.794–0.815). The C-index (95%CI) after adding the FIB-4 score, BARD score, and Forns index was 0.809 (0.799–0.820), 0.810 (0.800–0.821), and 0.810 (0.799–0.820), respectively (all P<0.001). The net reclassification index (95%CI) after adding the BARD score and the Forns index was 0.239 (0.206–0.269) and 0.105 (0.070–0.137), respectively (all P<0.001). The integrated discrimination improvement index (95%CI) was 0.007 (0.003–0.011) and 0.005 (0.002–0.010), respectively (all P<0.001). The addition of the three LFSs may improve the predictive ability of the Framingham model for CVD risk.

Elevated LFS levels may increase the risk of CVD in rural Uyghur residents in Xinjiang. The addition of LFS may improve the predictive ability of the Framingham model for CVD risk.

To understand different ways of obtaining and unrestricted access to purchase cigarettes and e-cigarettes among Chinese secondary school students to provide evidence to evaluate the effectiveness of tobacco control laws and regulations.

Study participants were 273 154 students recruited using a multistage stratified cluster random sample from 912 junior high schools, 590 regular high schools, and 274 vocational high schools in 31 provincial-level administrative divisions of China. On-site, anonymous, self- administered surveys were conducted from September to December 2023 using the questionnaire developed by the Tobacco Control Office, Chinese Center for Disease Control and Prevention.

Of the 261 454 participants who provided valid responses, 14 199 (corresponding to a national estimate of 4 678 233 students) and 4 643 (corresponding to a national estimate of 1 483 681 students), based on sampling, non-response, and post-stratification weighting, self-reported having purchased cigarettes and e-cigarettes, respectively, in the past 30 days. Among cigarette purchasers, 75.8% obtained cigarettes through a single channel, while 24.2% used two or more channels. The top three access channels were retail outlets (58.7%), sharing from others (42.3%), and obtaining them at home (13.4%). Similarly, among e-cigarette purchasers, 84.4% accessed e-cigarettes through one channel, and 15.6% used two or more channels. The main access channels for e-cigarettes were online shopping (44.2%), experience shops or retail outlets (33.1%), and shopping malls, supermarkets, convenience stores, or grocery stores (28.3%). Among current school smokers surveyed, 71.7% (4 738 corresponding to a national estimate of 1 585 135 students) and 66.7% (2 333, corresponding to a national estimate of 791 337 students) reported unrestricted access to purchase cigarettes and e-cigarettes, respectively, in the past 30 days. Higher rates of unrestricted access to cigarettes were observed among female smokers compared with male smokers (76.0% vs. 70.7%, P<0.05) and among high school smokers compared with middle school smokers (75.2% vs. 66.8%, P<0.05). Similarly, unrestricted access to e-cigarettes was higher among high school smokers than among middle school smokers (69.7% vs. 64.9%, χ²=3.900; P=0.048).

In 2023, a significant proportion of secondary school student smokers in China reported easy access to purchasing both traditional cigarettes and e-cigarettes, primarily through retail stores and online platforms. This concerning trend highlights the urgent need to strengthen regulatory measures and enforcement in tobacco retail operations and e-commerce channels to effectively prevent underage tobacco use among secondary school students.

To understand the influencing factors of digital literacy and the difficulties of integration into the digital society among older adults in Qiqihar city in order to provide a reference for enhancing the adaptability of older adults in the digital society and promoting the realization of healthy aging goals.

Using stratified cluster sampling and a self-developed questionnaire, face-to-face interviews were conducted in October 2023 with 390 residents aged 60 years and older from 3 urban and 4 rural communities in Qiqihar city, Heilongjiang province. Multiple linear regression models were used to analyze the main factors influencing older adults' digital literacy. Older adults' difficulties in using digital devices were also analyzed.

For all participants, the crude and standardized total digital literacy scores were 17.72±14.08 and 1.11±0.88, with crude and standardized dimensional scores of 7.31±4.68 and 1.83±1.17 for cognition, 6.07±6.55 and 0.86±0.94 for information acquisition skills, and 4.35±4.61 and 0.87±0.92 for operational skills, respectively. Of the 390 participants, 191 (49.0%) were classified as high digital literacy and 199 (51.0%) as low digital literacy. Multiple linear regression analysis showed that higher education level (β=3.476), average monthly personal income (β=5.213), perceived usefulness (β=4.452), and perceived ease of use of digital devices (β=5.330) were associated with higher digital literacy among the participants, while older age (β= –2.303) was associated with lower digital literacy (all P<0.05). For participants with low digital literacy, the main difficulties in using digital devices were scanning codes to enter or exit public places (the selected number accounted for 23%), registering for medical care (22.4%), buying tickets for commuting or travel (18.4%), and making mobile payments (18.4%); for participants with high digital literacy, the main difficulties were registering for medical care (28.8%), buying tickets for commuting or travel (26.3%), and using a ride-hailing service online (22.2%).

Digital literacy among older adults in Qiqihar City is relatively low and was mainly influenced by age, education, average monthly personal income, and perceived usefulness and ease of use of digital devices. The older adults have greater difficulties in registering for medical care and buying tickets for commuting or travel. The results suggest that several measures should be taken to improve the adaptability of older adults in the digital society.

To understand the influence of family, school, and community social environments on children′s perceived well-being, to explore the key indicators that affect children′s well-being, and to provide suggestions and references for building child-friendly cities and creating friendly social environments.

Using stratified multistage cluster sampling and a self-developed questionnaire, we recruited 3 511 students in grades 4–6 from 12 primary schools in 6 districts of Xiamen city, Fujian province for on-site online surveys conducted from October 2023 to January 2024. Independent samples t-tests and analysis of variance were used for univariate analysis. Multiple linear regression models were used to analyze the influence of the friendliness of the family, school, and community social environments on children′s perceived well-being. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to screen key indicators of family-school-community social environments that influence perceived well-being, and regression coefficient estimation and significance tests were performed.

For the 3 289 participants (54.03% boys and 45.97% girls, mean age 10.38±0.96 years) with valid responses, the mean perceived well-being score was 64.29±9.21. Based on Model 1 (which included only demographic variables), Model 8, which included family, school, and community social environment variables, increased the explanatory power of perceived child well-being by 44.6%. Compared to the school social environment (β=0.12, B=0.16, P<0.001) and the community social environment (β=0.59, B=0.22, P<0.001), the family social environment (β=0.66, B=0.39, P<0.001) had a greater impact on children′s perceived well-being. From the perspective of family-school-community synergy, five key indicators of the family environment, six key indicators of the school environment, and three key indicators of the community environment that affect children′s perceived well-being were selected. Among the key indicators in the family dimension, children′s feeling that “talking with parents is relaxing” (B=0.12, P<0.001) and “my family knows what is going on in this school” (B=0.12, P<0.001) had a greater impact on children′s perceived well-being. In the school dimension, “the subjects learned in school are all very interesting” (B=0.13, P<0.001) had the greatest impact on the perceived well-being. In the community dimension, children′s perception that “the people in this community are warm and caring” had a greater impact on children′s perceived well-being (B=0.08, P<0.001).

To promote children′s well-being, families, schools, and communities must work together to create a child-friendly social atmosphere, especially by promoting relaxed and happy parent-child communication, parental involvement in children′s lives, and the interest in school curricula.

To investigate the prevalence of chronic obstructive pulmonary disease (COPD) and its influencing factors among residents aged 40 years and older in Hebei province, and to provide a reference for the development of local COPD prevention and control strategies.

Study participants were 6 600 permanent residents aged 40 years and older recruited from urban/rural communities of 11 county-level COPD surveillance sites (counties/districts) in Hebei province using multistage random sampling. Face-to-face interviews with a standardized questionnaire developed by the Chinese Center for Disease Control and Prevention, physical examinations, and pulmonary function tests were conducted among the participants from July 2019 to May 2020. The prevalence of COPD was estimated using complex weighting adjustments, and a multivariate unconditional logistic regression model was used to analyze the main factors influencing COPD among the participants.

Of the 6 228 participants finally included in the analysis, 565 cases of COPD were identified. After complex weighting, the prevalence of COPD was 9.10%. Multivariate survey logistic regression analysis showed that age ≥50 years, current smoking, previous smoking history, history of respiratory diseases, family history of respiratory diseases, and chronic respiratory symptoms were risk factors for COPD in the participants; while, female gender, ethnic minority, and residence in central and southern Hebei province were protective factors against COPD.

The prevalence of COPD among residents aged 40 years and older in Hebei province is relatively low. Gender, age, ethnicity, geographic region, smoking status, history of respiratory diseases, family history of respiratory diseases, and chronic respiratory symptoms are the main influencing factors of COPD among residents of the province.

To understand the influence of activities of daily living (ADL) on feelings of uselessness among older adults in China, and the role of attitudes toward aging and age on this relationship, to provide a reference for developing health education and intervention strategies for older adults, and to effectively address the challenges of population aging.

Study data on 10 883 residents aged 60–98 years were collected from a wave of the China Longitudinal Aging Social Survey (CLASS) conducted in 2020 in 28 provincial-level administrative divisions across China in 2020. A moderated mediation model was used to analyze the relationships among ADL, attitudes toward aging , age, and feelings of uselessness. Statistical analysis and moderated mediation effect tests were conducted using SPSS 26.0 and its PROCESS 4.1 plug-in (Model 5).

For all the participants with a mean age of 71.5±6.6 years, the number (percentage) of individuals who reported feeling useless often, sometimes, and never were 1 729 (15.89%), 4 582 (42.10%), and 4 572 (42.0%), and the mean scores for feelings of uselessness, ADL, and attitudes toward aging were 0.739±0.715, 0.238±1.075, and 14.311±3.638, respectively. Correlation analysis showed that the mean score of feelings of uselessness was positively correlated with the mean scores of ADL (r=0.140), attitudes toward aging (r=0.148), and mean age (r=0.163) (all P<0.001). Poorer ADL, more negative attitudes toward aging, and older age were associated with a greater feelings of uselessness. After controlling for gender, education, marital status, number of cohabitants, household registration, and self-rated economic status, the moderated mediation model analysis showed that ADL had a direct effect on feelings of uselessness (β=0.082, P<0.001); attitudes toward aging had an indirect effect on feelings of uselessness (β=0.010, P<0.001); and age played a negative moderating role on the influence of ADL on feelings of uselessness (β= –0.003, P=0.001).

Poorer ADL was associated with greater feelings of uselessness among older adults in China. Attitudes toward aging became more negative as ADL declined, indirectly increasing feelings of uselessness. However, the influence of ADL on feelings of uselessness gradually decreased with increasing age.

To explore the connotations of community self-organization efficiency from the perspective of public health crisis governance, to provide theoretical support and practical guidance for improving the efficiency of community self-organization in responding to public health emergencies.

Based on the public health resilience cycle analysis framework, this study used a combined method of literature review and qualitative interviews. From July to September 2023, a total of 22 interview transcripts were collected and qualitatively analyzed using NVivo 12 software.

A total of 194 valid initial nodes were sorted and 96 conceptual labels, 24 initial categories, 10 major categories, and 4 core categories were identified. The core categories included efficiency of community organization in resource acquisition, mobilization, efficiency of social services, and restoration of order in response to public health emergencies.

To ensure that community self-organization can effectively respond to public health emergencies, it is necessary to strengthen and enhance the positive aspects of "community self-organization efficiency", improve the overall risk resistance and efficiency of the community, and thus build a resilient public health system.

To establish an index system to evaluate the public health security of the province and provide a reference for the government to promote the construction of a public health security system.

Based on the decision-making arrangements and relevant policies issued by the national and provincial governments to promote public health security, a preliminary framework for the evaluation index system of public health security was established through literature review and brainstorming methods. The Delphi method was used to construct the evaluation index system of public health security, and finally, the analytical hierarchy process and percentile weight method were used to calculate the weight coefficients of the indicators.

A total of 21 experts participated in two rounds of consultation, and the positive coefficients of the two rounds of expert consultation were 96.9% and 100%. The expert authority coefficients of the two rounds of first-level indicators were 0.76 and 0.81. The coordination coefficients of expert opinions were divided into two aspects: importance and applicability. The coordination coefficients of the first round were 0.180 and 0.194, and those of the second round were 0.334 and 0.316, respectively (all P<0.05), indicating good coordination of expert opinions. After two rounds of expert consultation, a public health security evaluation index system was established. This index system includes six first-level indicators, including policy guarantee, resource support, healthy environment, surveillance and early warning, emergency response, and vulnerable population, and 66 second-level indicators. The weights of the first-level indicators ranged from 0.101 2 to 0.275 7, and the weights of the second-level indicators ranged from 0.008 2 to 0.026 7.

The established public health security evaluation index system can serve as a reference for the government to evaluate the level of public health security and analyze its weak points, and promote the construction of the public health security system nationwide.

To develop an index system to assess the functioning of community (village) health committees and test its applicability through a pilot assessment.

A preliminary evaluation index system for community (village) public health committees was developed based on literature review and group discussions. A two-round Delphi expert consultation was conducted with 26 experts in relevant fields. The analytical hierarchy process was used to determine the weights of the indicators at different levels. Ten community/village public health committees from one of the four districts with different levels of economic development in Guangzhou city were selected by stratified random sampling for a questionnaire survey to evaluate the reliability and validity of the constructed index system.

For the two rounds of expert consultation, the positive coefficients were 100% and 92.3%, the authority coefficients were 0.83 and 0.85, and the Kendall′s W coefficients of expert′s opinions were 0.46 and 0.54 (both P<0.05), respectively. The coefficients of variation of the included indicators were 0.08–0.32 and 0.07–0.23, respectively, indicating good agreement among the experts. After two rounds of consultations, an index system for evaluating the functioning of community (village) health committees was developed, consisting of four primary indicators related to mechanism establishment, organizational guarantee, service delivery and management, and operational effectiveness, as well as 14 secondary indicators and 33 tertiary indicators. The combined weights ranged from 0.121 to 0.417 for the primary indicators, 0.016 to 0.163 for the secondary indicators, and 0.009 to 0.072 for the tertiary indicators. Analysis of data from a sample survey of 40 community (village) health committees showed that the established index system could effectively differentiate the functional levels of different committees, and the reliability and validity of the index system were good (Cronbach′s alpha was 0.864, and the cumulative variance contribution rate of common factors reached 87.721%).

The constructed three-level index system for evaluating community (village) public health committees passed the Kendall′s W coefficient and coefficient of variation tests, and the pilot evaluation showed good reliability and validity of the index system, which can provide a reference for relevant departments to improve relevant policies and conduct evaluations.