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Background: Males have accounted for a significant share of new HIV infections among young people in the recent years. This study aimed to identify the factors associated with risky sexual behaviors, including early sexual debut, multiple sexual partnership and condomless sex, among sexually active male college students and provide implications for tailored health interventions. Methods: The cross-sectional study was conducted from December 2020 to December 2021 in 16 colleges that were located in Sichuan Province, one of the high-risk areas in China. Overall 1640 male college students who reported sexually experienced were analyzed in this study. Multivariable logistic regression analysis was applied to determine factors associated with early sexual debut, multiple sexual partnership and condomless sex. Results: The average age of included male students was 19.95 ± 1.56. Of them, 27.74% initiated sexual behavior early, 48.60% reported multiple sexual partnership, and 16.52% did not use condoms at the latest sexual intercourse. Students who were younger (age ≤ 19, AOR = 7.60, 95%CI: 4.84–11.93; age20-21, AOR = 3.26, 95%CI: 2.04–5.21) and self-identified as sexual minorities (AOR = 2.38, 95%CI: 1.69–3.36) were more likely to have early sexual debut. The odds of having multiple sexual partners were higher among those who were ethnic minorities (AOR = 1.79, 95%CI: 1.33–2.41) and accepted extramarital sex (AOR = 1.33, 95%CI: 1.03–1.71). The likelihood of engaging in condomless sex at the latest sexual intercourse was lower among those who had sufficient knowledgeable about HIV (AOR = 0.63, 95%CI: 0.44–0.89), were very confident in condom use efficacy (AOR = 0.26, 95%CI: 0.16–0.43) and confident (AOR = 0.48, 95%CI: 0.34–0.69). Early sexual debut was positively associated with multiple sexual partnership (AOR = 3.64, 95%CI: 2.82–4.71) and condomless sex at the latest intercourse (AOR = 1.53, 95%CI: 1.07–2.20), respectively. Conclusion: Early sexual debut, multiple sexual partnership and condomless sex were of considerable concern among male college students. Comprehensive sex education curricula were advised by developing customized information on HIV prevention, sexuality and empowering students with assertiveness and negotiation skills with regard to condom use during and before college. [ABSTRACT FROM AUTHOR]

Background: With the increase in the number of male nursing sta, more and more highly educated male nursing sta are joining the nursing higher education industry. Nevertheless, male nursing teachers in China are still a very small group in the education industry, but they have made important contributions to nursing education in China. Work experience is a key factor in the stability of the professional team and the quality of education. However, there is little research on the professional feelings of Chinese male nursing teachers. Objective: Explore the true feelings of male nursing teachers in Chinese universities about their work, understand their actual work diffculties, their sources of work stress and methods of coping with stress under the Chinese cultural background, and combine their professional expectations to provide ways to solve these problems, and help male nursing educators better apply nursing education work. Methods: This study uses an interpretive and exploratory qualitative research design method, in which the participants of male nursing teachers are selected from 30 universities with nursing majors in Zhejiang Province by the method of purpose sampling, and semi-structured in-depth interviews were used to collect data. A Van Manen process was used for data analysis. The 10th respondents were saturated. Results: Five themes were extracted in this study, namely realistic diffculties of career, positive feelings of career, sources of occupational stress, coping methods for occupational stress, and career development expectations. Conclusions: Male nursing teachers in universities can actively adjust their thoughts and behaviors and face negative professional feelings due to gender factors. But they still need more comprehension and support from educational institutions and society. The support of leaders and universities can help them better adjust to professional development and maintain a rational and stable nursing teacher team [ABSTRACT FROM AUTHOR]

Background: The common reference intervals (RIs) for thyroid hormones currently used in China are provided by equipment manufacturers. This study aimed to establish thyroid hormone RIs in the population of Lanzhou, a city in the subplateau region of northwest China, and compare them with previous reports and manufacturer-provided values. Methods: In total, 3,123 individuals (1,680 men, 1,443 women) from Lanzhou, an iodine-adequate area of China, perceived as healthy were selected. The Abbott Architect analyzer was used to determine the serum concentration of thyroid hormones. The 95% RI was estimated using the 2.5th and 97.5th percentiles as the lower and upper reference limits, respectively. Results: The serum levels of thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), antithyroglobulin (ATG) antibody, and antithyroid peroxidase (ATPO) antibody levels were significantly correlated with sex (P<0.05). TSH, total thyroxine (TT4), and ATPO levels were significantly correlated with age (P<0.05). The serum levels of TSH, ATG, and ATPO in men were significantly lower than in women; in contrast, the serum TT3 level was significantly higher in men than in women (P<0.05). Serum TSH, TT3, TT4, and ATG levels differed across age groups (P<0.05), but no such variation was observed for ATG levels (P>0.05). The established RIs of TSH, ATG, and ATPO in this study differed between sexes (P<0.05). The thyroid hormone RIs established herein were inconsistent with the manufacturer-provided values. Conclusion: The RIs of thyroid hormones in the healthy population of Lanzhou were inconsistent with those in the manufacturer's manual. Validated sex-specific values are required for diagnosing thyroid diseases. [ABSTRACT FROM AUTHOR]

1. Due to seasonal breeding, geese breeds from Southern China have low egg yield. The genetic makeup underlying performance of local breeds is largely unknown, and few studies have investigated this problem. This study integrated 21 newly generated and 50 publicly existing RNA-seq libraries, representing the hypothalamus, pituitary and testis, to identify candidate genes and importantly related pathways associated with seasonal breeding in male Lion-Head geese. 2. In total, 19, 119 and 302 differentially expressed genes (DEGs) were detected in the hypothalamus, pituitary and testis, respectively, of male Lion-Head geese between non-breeding and breeding periods. These genes were significantly involved in the neuropeptide signalling pathway, gland development, neuroactive ligand-receptor interaction, JAK-STAT signalling pathway, cAMP signalling pathway, PI3K-Akt signalling pathway and Foxo signalling pathway. 3. By integrating another 50 RNA-seq samples 4, 18 and 40 promising DEGs were confirmed in hypothalamus, pituitary and testis, respectively. 4. HOX genes were identified as having important roles in the development of testis between non-breeding and breeding periods of male Lion-Head geese. [ABSTRACT FROM AUTHOR]

2Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China. Methods: A total of 507 male patients with schizophrenia were recruited, including 386 non-violent and 121 violent patients. The sociodemographic information and medical history of the patients were collected. Psychopathological characteristics, personality traits psychopathology, and factors related to risk management were assessed using the Brief Psychiatric Rating Scale (BPRS), the History of Violence, Clinical, Risk Assessment Scale (HCR-20), and the Psychopathy Checklist-Revised (PCL-R), as appropriate. Differences in these factors were compared between the violent and non-violent patients, and logistic regression analysis was performed to explore the risk factors for violence in male patients with schizophrenia. Results: The results showed that the violent group had a lower level of education, longer duration of illness, as well as a higher rate of hospitalization, history of suicidal attempts, and history of alcohol compared with the non-violent group. The violent group scored higher in items of symptoms in BPRS, personality traits and psychopathy in PCL-R, and risk management in HCR-20. The regression analysis showed that previous suicidal behavior (OR = 2.07,95% CI [1.06-4.05], P = 0.033), antisocial tendency in PCL-R (OR = 1.21, 95% CI [1.01-1.45], P = 0.038), H2: young age at violent incident (OR = 6.39, 95% CI [4.16-9.84], P < 0.001), C4: impulsivity (OR = 1.76, 95% CI [1.20-2.59], P = 0.004), and H3: relationship instability (OR = 1.60, 95% CI [1.08-2.37], P = 0.019) in HCR-20 were risk factors of violence among male patients with schizophrenia. Conclusion: The present study found significant differences in sociodemographic information, history of treatment, and psychopathy characteristics between male patients with schizophrenia who had engaged in violent behaviors and their non-violent counterparts in China. Our findings suggested the necessity of individualized treatment for male patients with schizophrenia who had engaged in violent behaviors as well as the use of both HCR-20 and PCL-R for their assessment. [ABSTRACT FROM AUTHOR]

In many animal species, an increase in the operational sex ratio (OSR), density or a combination of both should lead to more intensive competition among individuals of the more abundant sex. To test this, we examined pairing patterns of Minshan's toad (Bufo minshanicus) from six populations between 2008 and 2015 along the eastern Tibetan Plateau in south-west China. OSRs in breeding aggregations of Minshan's toad are normally male biased and males actively compete with each other for acquisition and retention of mates. We found evidence that deviations from random mating by size varied between populations and between years according to the magnitude of the OSR and male density. Larger males were generally more successful in pairing than smaller males when the OSR was slightly male biased and male density was high. However, the resulting size-disproportionate mating was more evident when OSR was closer to 1.99, indicating a positive correlation with the intensity of aggressive scramble competition. Thus, the intensity of male-male competition may partly explain variation in size-disproportionate mating among populations. [ABSTRACT FROM AUTHOR]

Background: Acute pancreatitis (AP) is a common digestive disorder with different clinical outcomes, some of which develop into recurrent acute pancreatitis (RAP). This study aimed to explore the differences between AP and RAP. Methods: All patients with AP admitted to Changsha Central Hospital between January 2015 and December 2020 were included. Characteristics between RAP and non-RAP groups were compared. Independent factors associated with RAP were identified by multivariate logistic regression analyses. Results: This was a retrospective study. A total of 1567 patients, including 262 patients in the RAP group and 1305 patients in the non-RAP group, were enrolled. Compared to the non-RAP group, results indicated that the RAP group was younger (P < 0.001), had a male predominance (P < 0.001), and had higher incidences of diabetes (P < 0.001) and hypertriglyceridemia (HTG) (P < 0.001). Lower incidences of cholelithiasis (P < 0.001) and acute liver injury (P < 0.001) were also noted in the RAP group. Scores of Ranson, BISAP, SOFA, and APACHE II were significantly higher in the non-RAP group (P < 0.001 for all). Three independent factors associated with RAP, including male gender (P = 0.006), diabetes (P < 0.001), and HTG (P < 0.001), were identified by multivariate logistic regression. Conclusion: Compared to the non-RAP, the incidence of cholelithiasis and acute liver injury was lower in RAP. Three independent factors associated with RAP, namely male, diabetes, and HTG, were identified. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between the hypertensive snowbirds' length of migratory stay and their blood pressure control and blood pressure levels. Methods: This study was a cross-sectional study. A population of snowbirds with hypertension was recruited between October and November 2022, and a structured questionnaire was used to collect their self-measured blood pressure and length of stay in Hainan Province. The blood pressure control status is determined based on self-measured blood pressure. According to the self-measured blood pressure to determine whether the blood pressure was well controlled. The associations between snowbirds' length of stay and their blood pressure control as well as their self-measured blood pressure were analyzed using restricted cubic splines. Results: A total of 362 research subjects were included, 169(46.7%) of whom were male, and their age was (69.7±7.0) years old. The participants' self-measured systolic blood pressure and diastolic blood pressure were (129.1±16.2) mmHg (1 mmHg=0.133 kPa) and (78.9±10.1) mmHg, respectively. Overall, 174 (48.1%) participants attained adequate blood pressure control. The median length of stay in Wuzhishan City was 7(6, 7) months. There was an inverted U-shaped association between snowbirds' length of stay and blood pressure control (overall: P= 0.023; nonlinearity: P =0.014), where participants with a length of stay of 7 months had the highest rate of blood pressure control. There is a U-shaped curve relationship between length of stay and systolic blood pressure (overall: P= 0.001; nonlinearity: P =0.033), and a linear negative correlation with diastolic blood pressure ( β =-1.19, P =0.003). Conclusions: Compared with hypertensive snowbirds with too long or too short lengths of stay, snowbirds who stayed in Wuzhishan City for seven months have better blood pressure control, and systolic blood pressure is also lower.

Objective: To analyze epidemiology of gastric cancer five-year survival distribution in Zhejiang population-based cancer registration. Methods: The follow-up data of registrated gastric cancer cases diagnosed from 2008 to 2019 in 22 national cancer registry areas of Zhejiang Province were collected and divided into three diagnostic periods: 2008-2011, 2012-2015 and 2016-2019 to calculate five-year observed survival rates (OSRs), five-year relative survival rates (RSRs) and five-year age-standardized relative survival rates (ARSRs). The distribution of population characteristics (including gender, urban/rural, age group and occupation) and clinical characteristics (including the highest diagnostic institution, sub-site, pathological type and degree of differentiation) of gastric cancer survival rates in each period were analysed. Results: 51 663 new cases of gastric cancer in 2008-2019 in the cancer registration area of Zhejiang Province were included in the analysis, and the ARSR of gastric cancer in 2008-2011, 2012-2015 and 2016-2019 showed an increasing trend (39.2%, 41.3% and 44.7%, respectively). In 2016-2019, the ARSR was similar across gender and urban and rural areas (44.4% for men and 45.7% for women; 44.9% in urban areas and 44.2% in rural areas); Among people with different occupations, the ARSR was highest among business and service workers (55.3%), the agriculture, forestry, animal husbandry and fisheries, water conservancy production workers and domestic workers were lower (41.5% and 43.2%, respectively). The highest diagnostic institution was the provincial hospital with a higher gastric cancer survival rate (47.0%) than the municipal (43.4%) and district (43.6%) levels. The ARSR for gastric cancer was relatively high in the lesser curvature (59.7%), pylorus (50.4%), antrum (49.3%), and greater curvature (48.7%), and lowest in cardia (38.9%). Among the major pathological types, adenocarcinoma (NOS) had an ARSR of 48.1%, mucinous adenocarcinoma 41.3%, imprinted cell carcinoma 39.4%, and squamous carcinoma 33.4%. The ARSR for highly differentiated, moderately differentiated, poorly differentiated and undifferentiated gastric cancers were 80.6%, 57.9%, 43.2% and 36.8%, respectively. Conclusion: The 5-year survival rate of gastric cancer in Zhejiang Province is high and on the rise, with similar survival rates in different genders, urban and rural areas, and significant differences in the survival rates of gastric cancer patients with different occupational groups, highest diagnostic institutions, tumour sub-sites, pathological types and differentiation degrees.

Objective: We aimed to analyse the trend of incidence and mortality of stomach cancer in Shandong province from 2012 to 2022 and predict the development trend from 2023 to 2030. Methods: Data on incidence and mortality of stomach cancer in Shandong province from 2012 to 2022 were obtained from Shandong Cancer Registry. The incidence, age-specific incidence, mortality and age-specific mortality in different years, sexes and urban and rural areas were calculated, the rates were standardized based on the age composition of the Chinese standard population in 2000. The average annual percent change (AAPC) of incidence and mortality was calculated using Joinpoint software. The Bayesian age-period-cohort model was used to predict the trend of stomach cancer incidence and mortality from 2023 to 2030. Results: From 2012 to 2022, the stomach cancer age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) showed a decreasing trend. The ASIR decreased from 27.47/100 000 in 2012 to 16.06/100 000 in 2022 (AAPC=-5.10%, P ＜0.001), and the ASMR decreased from 17.69/100 000 to 11.09/100 000 (AAPC=-5.52%, P ＜0.001). The ASIR and ASMR of male, female, urban and rural population also showed downward trends. The incidence and mortality rates of men were always higher than those of women, and the difference between urban and rural areas is gradually narrowing. In 2022, the ASIR (16.09/100 000 in urban and 16.03/100 000 in rural) and the ASMR (11.10/100 000 in urban and 11.08/100 000 in rural) of stomach cancer between urban and rural areas were nearly identical. The Bayesian age-period-cohort model predicted that the ASIR of stomach cancer in Shandong would further decrease from 2023 to 2030 (AAPC=-0.51%, P =0.001), but the change tended to be smooth. The incidences in male (AAPC=-1.46%, P= 0.010) and rural areas (AAPC=-1.21%, P ＜0.001) were still expected to have a little room for decline. The trend of incidences in female and urban areas were not statistically significant. The trend of mortality was consistent with the incidence. Conclusions: The stomach cancer incidence and mortality in Shandong shows a decreasing trend and it is expected to decrease further by 2030. However, the trend tends to be smooth, and the disease burden should be reduced as early as possible for high-risk population and high-risk factors of stomach cancer.

Background: Lung cancer accounts for a significant proportion of cancer-related deaths in China, with the majority of the cases being classified as non-small cell lung cancer (NSCLC). The study aimed to investigate the expression of serum SNHG22 in patients with NSCLC, and its molecular mechanism and prognostic potential in NSCLC., Methods: Admitted 125 NSCLC patients were selected for the study, along with 125 healthy individuals in the same period. The levels of SNHG22 and miR-128-3p were quantified via RT-qPCR. Correlations between the SNHG22 level and the pathological characteristics of the NSCLC patients were investigated through the application of the chi-square test. The targeting relationship between SNHG22 and miR-128-3p was predicted by online database and confirmed by luciferase activity. The prognostic ability of SNHG22 in NSCLC was assessed by Kaplan-Meier curves and multivariate Cox analysis., Results: SNHG22 was upregulated in NSCLC and directly targeted miR-128-3p. The rate of overall survival is lower in patients with high-SNHG22 group compared to those with low-SNHG22 group. Silencing SNHG22 impaired the functionality of cells, which was restored by miR-128-3p inhibitor. SNHG22 stands as an independent predictor of poor prognosis in NSCLC patients., Conclusion: The overexpression of SNHG22 in NSCLC is related to lymph node metastasis, TNM stage and patient survival, which is expected to be a prognostic predictor of NSCLC patients., (© 2024. The Author(s).)

Objectives: Evidence suggests that environmental support, personality traits, and psychological factors can influence seasonal changes in human mood and behavior, particularly in rural middle-aged women and older people. This study aimed to quantify the associations between personality traits, seasonal affective disorder symptoms, and sun exposure in rural older people., Methods: This study is a cross-sectional analytical study, the participants were 300 rural older persons from 12 natural villages and 5 geriatric service centers in 4 different cities in Jiangxi Province, China. The Eysenck Personality Questionnaire (EPQ), the Personal Inventory of Depression and Seasonal Affective Disorder (PIDS-SA-SimpChi), and the Sunlight Exposure Scale were used to conduct follow-up interviews throughout the year. Spatial analysis was performed using ArcGIS and Geodetic Probes. The data were analyzed using SPSS 21 and Amos 23.0 mediated models., Results: Rural older people with low sun exposure exhibited higher personality trait scores (p < 0.001). Personality traits were directly associated with seasonal affective disorder symptoms(p < 0.01); Sun exposure mediated this effect in rural older people (p < 0.05)., Conclusion: High-scoring personalities are more typical of rural older people with low sun exposure, and there is a greater risk of emotional and behavioral instability. Latitudinal differences are not a determinant of SAD. Increased sun exposure is associated with symptom relief. The promotion of light therapy devices in rural areas with low sunlight is warranted., (© 2024. The Author(s).)

Background: In this study, we aimed to assess the associations between early exposure to famine and the risks of diabetic complications in adult patients with type two diabetes., Methods: The participants in this study were selected from China National HbA1c Surveillance System (2009-13) and further stratified according to the birth year. The participants born between 1956-59, 1959-61, and 1962-64 were classified as foetal exposed group with 70 852, infant/toddler exposed group with 93 616, and unexposed group with 72 723 participants. The association between exposure to famine in early life and risks of diabetic complications were analysed by logistic regression. We assessed the attributing effects of the interaction between exposure to famine in early life and modifiable risk factors by the multiplicative and additive interactive models., Results: After adjustments for sex, famine severity, economic status in adulthood, body mass index, blood pressure, low-density lipoprotein cholesterol, glycated haemoglobin, diabetes duration, and the use of antidiabetic agents, the increased risks of coronary heart disease (odds ratio (OR) = 1.31; 95% CI (confidence interval) = 1.26, 1.36), cerebrovascular disease (OR = 1.32; 95% CI = 1.24, 1.41), and diabetic retinopathy (OR = 1.06; 95% CI = 1.02, 1.10) were observed in patients with early-life exposure to famine. The reduced risk of diabetic kidney disease (OR = 0.94; 95% CI = 0.90, 0.99) was observed in patients with early-life exposure to famine compared with those without famine exposure. The interaction analyses indicated that obesity might exacerbate the increased risk of coronary heart disease (OR = 1.26; 95% CI = 1.22, 1.30), cerebrovascular disease (OR = 1.26; 95% CI = 1.21, 1.32), and diabetic retinopathy associated with early-life exposure to famine (OR = 1.09; 95% CI = 1.06, 1.12) in patients with type two diabetes. Moreover, high economic status in adulthood might also exacerbate the increased risk of coronary heart disease (OR = 1.35; 95% CI = 1.30, 1.40) and cerebrovascular disease (OR = 1.33; 95% CI = 1.23, 1.43) associated with early-life exposure to famine in patients with type two diabetes., Conclusions: Early-life exposure to famine in patients with type two diabetes might be associated with increased risks of coronary heart disease, cerebrovascular disease, and diabetic retinopathy but a reduced risk of diabetic kidney disease in adulthood. Obesity and high economic status might further exacerbate the risk of diabetic complications associated with early-life exposure to famine. Improving early-life nutritional status may promote better risk prevention and management of diabetic complications in patients with type two diabetes., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and declare the following activities and relationships: Linong Ji has received fees for lecture presentations and for consulting from AstraZeneca, Merck, Metabasis, MSD, Novartis, Eli Lilly, Roche, Sanofi-Aventis and Takeda. No other support from any organisation for the submitted work other than that described above., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: Prior studies exploring the impact of widowhood on cognitive impairment in later life have been focussed on the USA and Europe. We aimed to explore the mediating role of social engagement, health behaviours, and subjective well-being in the association between widowhood and cognitive impairment in the Chinese population., Methods: We conducted a study on 7796 older individuals enrolled in the 2018 wave of the Chinese Longitudinal Health Longevity Study. We used logistic regression models to analyse the impact of widowhood on cognitive health among older adults and performed mediation analysis to determine possible mediating factors in this relationship., Results: Widows and widowers had a higher risk of having cognitive impairment than married older adults (95% confidence interval (CI) = 1.312, 2.279). The results from structural equation modelling (SEM) provided a good fit to the observed data (χ 2  = 24.909; P = 0.00) and indicated that the effect of widowhood on cognitive impairment was partially mediated by social engagement, lifestyle behaviours, and subjective well-being (β = 0.075; P < 0.01)., Conclusions: Our findings contribute to existing research on the mechanisms underlying the association between widowhood and cognitive impairment among older individuals, suggesting a need for policies targeted at the specific needs of this vulnerable population, such as the maintenance of social interactions, adoption of a healthy lifestyle, improvement of subjective well-being, and provision of necessary support systems., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: Previous studies have linked single metal to hemoglobin levels in children and adolescents; however, studies with regards to metal mixtures are still limited., Objective: We aimed to investigate the associations of single metal and metal mixtures with hemoglobin levels in children and adolescents., Methods: We conducted a cross-sectional study of 2064 children and adolescents aged 6 to 19 years in Liuzhou, China in 2018. The concentrations of 15 metals in urine were determined by inductively coupled plasma mass spectrometry. Generalized linear regression and weighted quantile sum (WQS) regression were used to estimate the associations of single metal and metal mixtures with hemoglobin levels, respectively., Results: The multivariable-adjusted β-values for the highest versus the first quartiles of urinary metal concentrations were - 1.57 (95 % confidence interval [CI]: -3.01, -0.13) for chromium, -2.47 (95 % CI: -3.90, -1.05) for nickel and 1.88 (95 % CI: 0.49, 3.28) for copper. In addition, we found a significant negative association between the WQS index and hemoglobin levels (adjusted β = -0.93, 95 % CI: -1.69, -0.19), with nickel contributing the most to the WQS index at 59.0 %. Subgroup analyses showed that exposure to urinary nickel or metal mixtures were associated with decreased hemoglobin levels in adolescents, but not in children (all P interation  < 0.001)., Conclusion: Among children and adolescents, urinary chromium and nickel concentrations were associated with decreased hemoglobin levels, while copper showed a positive relationship. Moreover, a negative association was observed between exposure to metal mixtures and hemoglobin levels. These findings need to be further validated in prospective studies., Competing Interests: Declaration of competing interest The authors declare they have no actual or potential competing financial interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: This study evaluates the health-related quality of life (HRQoL) of persons with diffuse large B-cell lymphoma (DLBCL) by using EQ-5D-5L and SF-6Dv2 and compares the measurement properties of the two instruments., Method: DLBCL patients were identified via a patient group and were surveyed using web-based questionnaires. Demographic information, socioeconomic status (SES), clinical characteristics, and EQ-5D-5L and SF-6Dv2 responses were collected and statistically described. The association between the EQ-5D-5L and SF-6Dv2 dimensions were analyzed using the Spearman's correlation coefficient, whereas the correlation of the utility scores was evaluated using Pearson's correlation coefficient. The agreement between the responses of the two instruments were examined using a Bland-Altman (B-A) plot. A one-way analysis of variance (ANOVA) was performed to compare the utility scores across subgroups in different clinical states (a t-test was used if there were two subgroups). In addition, the graded response model (GRM) was used to describe the discrimination ability and difficulty characteristics of the dimensions in the two instruments., Results: In total, 582 valid responses were collected, among which 477 respondents were associated with initial-treatment and 105 respondents were relapsed/refractory (RR) patients. The mean (standard deviation [SD]) EQ-5D-5L and SF-6Dv2 utility scores of the DLBCL patients were 0.828 (0.222) and 0.641 (0.220), respectively. The correlation between the EQ-5D-5L and SF-6Dv2 dimensions ranged from 0.299 to 0.680, and the correlation between their utility scores was 0.787. The B-A plot demonstrated an acceptable but not strong agreement between EQ-5D-5L and SF-6Dv2 utility scores. The GRM model results indicated that all dimensions of each instrument were highly discriminating overall, but EQ-5D-5L had suboptimal discriminative power among patients with good health., Conclusion: Both the EQ-5D-5L and SF-6Dv2 showed valid properties to assess the HRQoL of DLBCL patients. However, utility scores derived from the two instruments had substantial difference, thereby prohibiting the interchangeable use of utilities from the two instruments., (© 2024. The Author(s).)

Background: Permanent left bundle branch area pacing (LBBAP) has been established as an effective means to correct left bundle branch block. Right bundle branch block (RBBB), emerge as a distinct form of cardiac conduction abnormality, can be seen in the context of LBBAP procedure. However, the correction potential of LBBAP in patients with RBBB remains largely unexplored., Objective: The objective of this study was to evaluate the efficacy and safety of permanent LBBAP in patients with RBBB., Methods: Ninety-two consecutive patients who underwent successful permanent LBBAP were recruited from May. 2019 to Dec. 2022 in Fuwai Central China Cardiovascular Hospital. Among them, 20 patients with RBBB were included in our analysis. These patients were followed up at 1, 3, 6 and 12 months post-LBBAP. The QRS duration (QRSd) on the V1 lead of the 12-lead elctrocardiogram was measured and compared before and after the LBBAP procedure. Additionally, mitral regurgitation, tricuspid regurgitation and cardiac function were assessed using transthoracic echocardiography, specifically focusing on left ventricular ejection fraction (LVEF) and mitral regurgitation severity. The acute pitfills and delayed complications associated with the LBBAP procedure were recorded to evaluate its safety. SPSS 23.0 was used to perform statistical analysis with Student's t test or one way ANOVA or nonparametric tests (paired Wilcoxon test). A p value less than 0.05 was defined as significant., Results: The demographic breakdown of the RBBB cohort revealed a mean age of 66.35 ± 11.55 years, 60% being male. Comorbidities were prevalent, including severe atrioventricular block (AVB) in 75%, sick sinus syndrome (SSS) in 20%, heart failure in 25%, atrial fibrillation in 30%, coronary heart diseases in 45%, hypertension in 35%, and diabetes mellitus in 15%. Regarding the LBBAP procedure, the average operation time was 106.53 ± 2.72 min, with 45% of patients (9 individuals) requiring temporary cardiac pacing during the surgery. Notably, the LBBAP procedure significantly narrow the QRS duration in RBBB patients, from 132.60 ± 31.49ms to 119.55 ± 18.58 ms (P = 0.046). Additionally, at the 12-month follow-up, we observed a marked improvement in LVEF, which increased significantly from 55.15 ± 10.84% to 58.5 ± 10.55% (P = 0.018). Furthermore, mitral regurgitation severity improved, with a median reduction from 4.46 (0.9, 7.3) to 2.29 (0, 3.49) cm 2 (P = 0.033). Importantly, no cases of ventricular septum perforation or pericardial effusion were reported during the LBBAP procedure or during the follow-up period., Conclusion: LBBAP provides an immediate reduction in QRS duration for patients suffering from RBBB, accompanied by improvements in mitral regurgitation and cardiac function as evident in the 12-month follow-up period., (© 2024. The Author(s).)

Background: Although an increasing number of patients with Birt-Hogg-Dubé syndrome (BHD) are being recognized in China, clinical and genetic characteristics are not well-defined. In addition, revised diagnostic criteria for the Chinese population was proposed in 2023, we aimed to explore their utility in clinical practice at a rare lung disease center., Methods: We retrospectively analyzed the data of 100 consecutive patients with BHD diagnosed according to the revised Chinese BHD criteria, encountered at the First Affiliated Hospital of University of Science and Technology of China from Jan 2017 to June 2023., Results: There were 100 patients (including 63 females) from 65 unrelated families in Eastern China, mostly Anhui Province. The common manifestations were pulmonary cysts (99%), pneumothorax (60%), and skin lesions (77%). Renal cancer and renal angiomyolipoma were detected in 5 patients each. 37% of patients had no family history of BHD. In total, 25 FLCN germline mutations were detected, including 6 novel mutations. In addition to hotspot mutation c.1285delC/dupC (17%), the most common mutations were c.1015 C > T (16%), c.1579&#95;1580insA (14%), and exons 1-3 deletion (11%) in FLCN. Higher risk of pneumothorax was associated with exons 1-3 deletion mutation and c.1177-5&#95;1177-3de1CTC compared to the hotspot mutation c.1285dupC (91% [95% CI: 0.31, 46.82, p = 0.015] and 67% [95% CI: 0.35, 71.9, p = 0.302] vs. 30%, respectively). The average delay in diagnosis was 7.6 years after initial symptoms. Chinese diagnostic criteria were mostly consistent with typical pulmonary presentations with supportive genetic evidence., Conclusion: In the Eastern Chinese region, patients with BHD present most commonly with pulmonary cysts associated with pneumothorax and skin lesions. However, low incidence of renal cancer along with unexpected renal angiomyolipoma was observed. Genotypic spectrum differed from that reported from other global regions, and genotype association of pneumothorax warrants further research. The revised Chinese criteria for BHD seem more appropriate in diagnosing BHD in Chinese patients., (© 2024. The Author(s).)

Background: Proactive health behaviours are crucial for enhancing adolescent health. However, there is limited evidence on the potential pathways through which social support influences adolescents' proactive health behaviours. This cross-sectional study aimed to examine the relationships between social support, self-efficacy, peer relationships and proactive health behaviours in Chinese adolescents., Methods: From October to December 2023, we recruited 6075 adolescents from Shandong Province, China. They completed self-report questionnaires on social support, self-efficacy, peer relationships and proactive health behaviours., Results: Linear regression analysis indicated that social support was positively associated with proactive health behaviours among adolescents (β = 0.571, 95% CI = 0.542, 0.600). Further mediation analyses revealed that self-efficacy (β = 0.085, 95% CI = 0.069,0.101) and peer relationships (β = 0.156, 95% CI = 0.136,0.177) mediated this relationship., Conclusions: Increased social support was associated with better proactive health behaviours in Chinese adolescents. Additionally, higher self-efficacy and positive peer relationships enhanced this association. Our findings emphasised the significance of providing supportive environments at home and at school to promote proactive health behaviours in adolescents., (© 2024. The Author(s).)

Background: School bullying, a serious problem for the physical and mental health of adolescents, is presently a significant issue in China. It is essential to recognize and comprehend potential risk factors and establish efficient preventive strategies. The purpose of this study was to examine the association between childhood maltreatment and school bullying in adolescents and to assess the mediating role of peer relationships., Methods: Between March and April 2024, a cross-sectional survey was conducted among 2119 adolescents aged between 12 and 18 years in Guangdong Province, China. Self-report questionnaires were employed to collect data on childhood maltreatment, school bullying, and peer relationships. Subgroup analyses and mediating effects modeling were employed to analyze the data., Results: The results indicated that adolescents who had experienced maltreatment were more at risk of bullying victimization (OR: 2.92, 95% CI: 2.34-3.64, P < 0.001), bullying perpetration (OR: 2.84, 95% CI: 1.99-4.05, P < 0.001), and bully-victimization (OR: 2.93, 95% CI: 1.95-4.41, P < 0.001), compared to adolescents who have not. Sexual abuse showed the most significant connection with all forms of bullying. The mediating effect of peer relationships was found to mediate the association between child maltreatment and bullying behaviour. The results indicated that worse peer relationships may exacerbate the adverse effects of maltreatment experiences and increase the risk of adolescents becoming bullies, either perpetrators or victims of bullying., Conclusions: Child maltreatment has been identified as one of the most significant influences on bullying behaviour in adolescents. The quality of peer relationships has been demonstrated to play an important role in preventing and reducing the occurrence of bullying. The results underscore the crucial role of early intervention in cases of child maltreatment and the fostering of positive peer relationships in schools., (© 2024. The Author(s).)

Background: Respiratory syncytial virus (RSV), a leading cause of lower respiratory tract infection (LRTI) among children, has resurged in the form of endemic or even pandemic in many countries and areas after the easing of COVID-19 containment measures. This study aimed to investigate the differences in epidemiological and clinical characteristics of children hospitalized for RSV infection during pre- and post-COVID-19 eras in Yunnan, China., Methods: A total of 2553 pediatric RSV inpatients from eight hospitals in Yunnan were retrospectively enrolled in this study, including 1451 patients admitted in 2018-2019 (pre-COVID-19 group) and 1102 patients admitted in 2023 (post-COVID-19 group). According to the presence or absence of severe LRTI (SLRTI), patients in the pre- and post-COVID-19 groups were further divided into the respective severe or non-severe subgroups, thus analyzing the risk factors for RSV-associated SLRTI in the two eras. Demographic, epidemiological, clinical, and laboratory data of the patients were collected for the final analysis., Results: A shift in the seasonal pattern of RSV activity was observed between the pre-and post-COVID-19 groups. The peak period of RSV hospitalizations in the pre-COVID-19 group was during January-April and October-December in both 2018 and 2019, whereas that in the post-COVID-19 group was from April to September in 2023. Older age, more frequent clinical manifestations (fever, acute otitis media, seizures), and elevated laboratory indicators [neutrophil-to-lymphocyte ratio (NLR), c-reactive protein (CRP), interleukin 6 (IL-6), co-infection rate] were identified in the post-COVID-19 group than those in the pre-COVID-19 group (all P < 0.05). Furthermore, compared to the pre-COVID-19 group, the post-COVID-19 group displayed higher rates of SLRTI and mechanical ventilation, with a longer length of hospital stay (all P < 0.05). Age, low birthweight, preterm birth, personal history of atopy, underlying condition, NLR, IL-6 were the shared independent risk factors for RSV-related SLRTI in both pre- and post-COVID-19 groups, whereas seizures and co-infection were independently associated with SLRTI only in the post-COVID-19 group., Conclusions: An off-season RSV endemic was observed in Yunnan during the post-COVID-19 era, with changed clinical features and increased severity. Age, low birthweight, preterm birth, personal history of atopy, underlying condition, NLR, IL-6, seizures, and co-infection were the risk factors for RSV-related SLRTI in the post-COVID-19 era., (© 2024. The Author(s).)

Background: The COVID-19 pandemic has escalated into a severe global public health crisis, with persistent sequelae observed in some patients post-discharge. However, metabolomic characterization of the reconvalescent remains unclear., Methods: In this study, serum and urine samples from COVID-19 survivors (n = 16) and healthy subjects (n = 16) underwent testing via the non-targeted metabolomics approach using UPLC-MS/MS. Univariate and multivariate statistical analyses were conducted to delineate the separation between the two sample groups and identify differentially expressed metabolites. By integrating random forest and cluster analysis, potential biomarkers were screened, and the differential metabolites were subsequently subjected to KEGG pathway enrichment analysis., Results: Significant differences were observed in the serum and urine metabolic profiles between the two groups. In serum samples, 1187 metabolites were detected, with 874 identified as significant (457 up-regulated, 417 down-regulated); in urine samples, 960 metabolites were detected, with 39 deemed significant (12 up-regulated, 27 down-regulated). Eight potential biomarkers were identified, with KEGG analysis revealing significant enrichment in several metabolic pathways, including arginine biosynthesis., Conclusions: This study offers an overview of the metabolic profiles in serum and urine of COVID-19 survivors, providing a reference for post-discharge monitoring and the prognosis of COVID-19 patients., (© 2024. The Author(s).)

Background: While the significant association between leisure activities and frailty risk among older adults is well-established, the impact of integrated leisure activity scores and different categories of them on frailty trajectories over time remains unclear., Methods: This study utilized longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which enrolled participants aged 65 years and older between 2002 and 2018. Frailty trajectories were derived using group-based trajectory modelling, and based on these trajectories, subjects were classified into various categories. Leisure activity was measured by integrated scores as well as three distinct categories: physically, cognitively, and socially stimulating activity. The effect of leisure activity on frailty trajectories was examined using multinomial logistic regression., Results: By analysing data from 2,299 older adults, three frailty trajectories were identified: non-frail, moderate progressive, and high progressive. The results indicated that an increase in the score of integrated leisure activity was associated with 11% (odds ratio [OR] 0.89; 95% Confidence Interval [CI] 0.85-0.93) and 14% (OR 0.86; 95% CI 0.80-0.91) decrease in the likelihood of being in the moderate and high progressive frailty trajectories, respectively. Engaging in physically stimulating activity lowered the odds of belonging to the moderate and high progressive trajectory by 43% (OR 0.57; 95% CI 0.40-0.81; OR 0.57; 95% CI 0.36-0.92, respectively). Participation in socially stimulating activity showed a lower odd of being in the moderate progressive trajectory (OR 0.68; 95% CI 0.49-0.93) and the high progressive trajectory (OR, 0.61; 95% CI, 0.39-0.95). The effects of leisure activities on frailty trajectories were observed not to vary by age, education level and retirement status., Conclusions: This study suggests that older adults should be encouraged to increase both the amount and variety of their leisure activities. Physically stimulating activities should be considered the primary choice, followed by socially and cognitively stimulating activities., (© 2024. The Author(s).)

Background: Remnant cholesterol (RC), a potent atherogenic lipid, has been shown to be strongly correlated with insulin resistance and the pathogenesis of diabetes mellitus. However, the relationship between RC and normoglycemia reversal in individuals with impaired fasting glucose (IFG) is crucial and remains unclear. This investigation, which aimed to clarify this association, is important for understanding and potentially improving the management of diabetes., Method: This study, which included 15,019 IFG participants from 11 Chinese cities between 2010 and 2016, was conducted with a rigorous research process. Cox regression analysis revealed intriguing findings regarding the relationship between RC and normoglycemia reversal in individuals with IFG. Potential nonlinear associations were further explored via smooth curve-fitting techniques and 4-knot restricted cubic spline functions, ensuring a comprehensive analysis. To examine the validity of the results, an array of subgroup and sensitivity analyses were conducted, further bolstering the robustness of the findings., Results: By the end of the 2.89-year median follow-up period, 6,483 of the 15,019 IFG participants (43.17%) had reverted to normoglycemia. The findings, which reveal that increased RC levels are inversely associated with the likelihood of normoglycemia reversal, are novel and significant. According to the fully adjusted Cox proportional hazards model analysis, an increase of one standard deviation in RC was associated with a 20% decrease in the likelihood of normoglycemia reversal among IFG participants (HR: 0.80, 95% CI: 0.77-0.82). A nonlinear association between RC and normoglycemia reversal was observed, with an inflection point at 41.37 mg/dL. This suggests that the growth rate of the likelihood of reversion decreased and stabilized after the inflection point was reached. Moreover, significant interactions were observed between the age groups, providing a more nuanced understanding of this complex relationship., Conclusion: Among Chinese adults with IFG, RC exhibited a negative nonlinear relationship with the probability of normoglycemia reversal. When RC levels reached or exceeded 41.38 mg/dL, the probability of achieving normoglycemia progressively diminished and subsequently stabilized. Maintaining RC levels below 41.38 mg/dL can significantly improve the probability of normoglycemia reversal among individuals with IFG, especially those aged 60 years or older., (© 2024. The Author(s).)

Background: Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia., Methods: Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19-30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels., Results: Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information., Conclusions: Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks., (© 2024. The Author(s).)

Background: Preoperative visit-care for transcatheter aortic valve replacement (TAVR) plays a crucial role in improving the quality of care and patient safety. However, preoperative care for TAVR patients is still in its early stages in China, with the care often being experience-based. The application of relevant evidence in nursing practice is necessary. Little is known regarding the facilitators and barriers to apply and compliance to the evidences about preoperative visit-care for TAVR in nursing., Methods: The Nurse's Compliance Checklist was used to investigate the evidence-based compliance of nurses (n = 21) who worked in the TAVR team in the evidence-based implementation setting. Meanwhile, an Evidence-Based Practice Beliefs Scale, and Influencing Factors Checklist were used to investigate all nurses (n = 66) who work in the same setting. Stakeholders (Middle and senior-level nursing administrators, frontline clinical nurses, and patients) interview was carried out to further disclose the barriers and facilitators in the process of evidence-based practice., Results: The results of this study showed that only 1 evidence implemented fully (100%) by nurses, 3 evidences with 0% implementation rate, and implementation rate of the other evidences were 9.5∼71.4%. The overall score of nurses' evidence-based nursing belief level was (3.52 ± 0.82). Three domains of barriers were identified: the Context Domain included lack of nursing procedures, inadequate health education materials, insufficient training; the Practitioner Domain included insufficient attention, lack of relevant knowledge, high work pressure and uncertainty of expected results, and Patient Domain included lack of relational knowledge. Facilitating factors included leadership support, nurse' high evidence-based nursing belief, high executive ability and enthusiasm for learning., Conclusion: The study indicated that the nurses' compliance of evidence-based practice in preoperative visit-care for TAVR was in lower level. There were some factors influencing the application of the evidences. The study revealed potential modifiable barriers to the successful implementation of evidence-based preoperative visit-care, including a lack of preoperative visit- care routine, related knowledge and training. Leadership support and nurse training should be considered to improve nurses' compliance with evidence-based practice., (© 2024. The Author(s).)

Background: By analysing the deaths of inpatients in a tertiary hospital in Hangzhou, this study aimed to understand the epidemiological distribution characteristics and the composition of the causes of death. Additionally, this study aimed to predict the changing trend in the number of deaths, providing valuable insights for hospitals to formulate relevant strategies and measures aimed at reducing mortality rates., Methods: In this study, data on inpatient mortality at a tertiary hospital in Hangzhou from 2015 to 2022 were obtained via the population information registration system of the Chinese Center for Disease Control and Prevention. The death data of inpatients were described and analysed through a retrospective study. Excel 2016 was utilized for data sorting, and SPSS 22.0 software was employed for data analysis. The statistical inference of single factor differences was conducted via χ2 tests. The SARIMA model was established via the forecast, aTSA, and tseries software packages (version 4.3.0) to forecast future changes in the number of deaths., Results: A total of 1938 inpatients died at the tertiary hospital in Hangzhou, with the greatest number of deaths occurring in 2022 (262, 13.52%). The sex ratio was 2.22:1, and there were significant differences between sexes in terms of age, marital status, educational level, and place of residence (P < 0.05). The percentage of males in the groups aged of 20 to 29 and 30 to 39 years was significantly greater than that of females (χ 2  = 46.905, P < 0.001). More females than males died in the widowed group, and divorced and married males experienced a greater number of deaths than divorced and married females did (χ 2  = 61.130, P < 0.001). The proportions of male students with a junior college and senior high school education were significantly greater than that of female students (χ 2  = 12.310, P < 0.05). The primary causes of mortality within the hospital setting included circulatory system diseases, injury, poisoning, tumours, and respiratory system diseases. These leading factors accounted for 86.12% of all recorded deaths. Finally, the SARIMA (2, 1, 1) (1, 1, 1) 12 model was determined to be the optimal model, with an AIC of 380.23, a BIC of 392.79, and an AICc of 381.81. The MAPE was 14.99%, indicating a satisfactory overall fit of this model. The relative error between the predicted and actual number of deaths in 2022 was 8.02%. Therefore, the SARIMA (2, 1, 1) (1, 1, 1) 12 model demonstrates good predictive performance., Conclusions: Hospitals should enhance the management of sudden cardiac death, acute myocardial infarction, severe craniocerebral injury, lung cancer, and lung infection to reduce the mortality rate. The SARIMA model can be employed for predicting the number of deaths., (© 2024. The Author(s).)

The revisit intention of tourists has long been a focal point of academic inquiry. However, there is still insufficient research on the antecedents of revisit intention from the perspectives of historical storytelling, destination image and perceived value. Taking the Mogao Grottoes in Dunhuang, a UNESCO World Heritage Site, as a case study, this paper, based on stimulus-organism-response (SOR) theory, examines the impact of historical storytelling on the destination image, perceived value, and revisit intention. Additionally, it further explores the mediating role of destination image and perceived value, as well as the moderating effect of place attachment in this chain. The research findings indicate that: (1) Historical storytelling significantly enhances tourists' perception of the tourism experience and revisit intention; (2) The study supports the mediating effect of destination image and perceived value; (3) Place attachment has a significant positive moderating effect between historical storytelling and revisit intention. Effective historical storytelling can significantly enhance destination image and perceived value, improve tourists' participation and satisfaction in tourism, stimulate revisit intention, and promote the sustainable development of tourist destinations. These findings enrich the research content of cultural heritage tourism, providing valuable suggestions for improving the management level of cultural heritage tourism attractions and increasing visitors' revisit intention., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yuxin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Adverse childhood experiences (ACEs) are known to be associated with depression. However, the extent to which such association varies by age at the first occurrence of ACEs remains unexplored. The objectives of this study are: (1) To describe the association between ACEs and depression among university students in China, and; (2) to assess the extent to which the mentioned association varied by age at first ACE., Methods: We conducted a self-administered survey among university students in southern China and analyzed the data using descriptive statistics and multivariate logistic regression., Results: We found significant associations between ACEs and depression prevalence, particularly when comparing students with three or more ACEs vs. students with no ACEs (62% vs. 36%; Adjusted OR = 3.49; 95% CI = 1.99, 6.12). Stratified analyses showed that the association was particularly strong among students who first experienced ACEs at age 0-6 years (66% vs. 36%; Adjusted OR = 4.05; 95% CI = 1.90, 8.59), but was non-significant among those who first experienced ACEs at age 13-18 years (31% vs. 36%; Adjusted OR = 0.99; 95 CI = 0.24, 4.08)., Conclusion: The strength of the associations between ACEs and depression varied by the age at first ACE. However, the cross-sectional study design, potential information bias, and lack of generalizability should be considered as caveats in the interpretation of the study findings., (© 2024. The Author(s).)

Background: As global aging continues to intensify, the health status of the older people requires urgent attention, and health education provides a pathway for active aging. However, the current outlook on health education for older people in rural areas of China is not optimistic. This study used Social Ecosystems Theory and explored the deep-rooted influencing factors on the acceptance of health education from the perspective of the rural older people., Methods: In this study, a purposive sampling method was adopted, and eligible rural older individuals were selected from Hebi city, Henan Province, China, from March to May 2023 as the research participants. A semistructured interview method was used to explore the factors affecting the acceptance of health education by older people. The interview data were analyzed using the qualitative content analysis method to obtain relevant themes and subthemes., Results: A total of 14 participants were recruited for the interviews; 8 were male, 6 were female, most had an elementary school education, and most were farmers. The results of the thematic analysis revealed a total of nine facilitators and nine barriers in micro, meso and macro levels. Among the findings, our important and unique finding is that inadequate intergenerational support somewhat hinders older adults' exposure to health education., Conclusion: There are numerous and complex facilitators of and barriers to accessing health education for rural older adults; of these, a lack of intergenerational support is particularly important. In the future, health education needs to be centered on the families of older people with the assistance of village committees so that older people and their children can learn and communicate together., (© 2024. The Author(s).)

Background: Patients with type 2 diabetes (T2D) in rural China frequently exhibit inadequate diabetes self-management (DSM) and a reduced quality of life (QoL). Social support and self-efficacy are known to influence DSM and QoL. However, the pathways through which social support and self-efficacy impact DSM and QoL among patients with T2D in rural China has yet to be fully elucidated., Objective: This study offers a foundation for developing policies in rural chronic disease management, thereby, contributing to the improvement of T2D prevention and control in China and other transitional countries., Methods: This study used a cross-sectional design, collecting data from a survey conducted between May and July 2021 on DSM and QoL among rural patients diagnosed with T2D in 2 townships in East China. All patients with T2D were enrolled through cluster sampling from the township health center database, and a questionnaire survey was administered by investigators. Structural equation modeling and multiple regression analyses were used to explore the pathways through which social support influences DSM and QoL, as well as the mediating role of self-efficacy., Results: It was found that the DSM score (mean 37.42, SD 7.70) was less than half of the maximum theoretical score. The QoL score (mean 48.92, SD 8.88) accounted for 36% of the maximum theoretical score. Social support directly and positively affected the DSM and QoL of Chinese rural patients with T2D (P<.01); an increase of 1 unit in social support was associated with a direct increment of 0.339 units in DSM and 0.397 units in QoL. Self-efficacy played a positive mediating role (P<.01), further increasing DSM and QoL by 0.147 and 0.159 units, respectively. The mediating effect of self-efficacy accounted for 30.2% and 28.6% of the total effect of social support on DSM and QoL. Furthermore, the family and friend dimension of social support, along with the symptom and disease management dimensions of self-efficacy, were significantly associated with DSM or QoL (P<.01)., Conclusions: The study confirmed the direct and indirect influences of social support on DSM and QoL and elucidated the mediating effect of self-efficacy among rural patients with T2D in eastern China. Interventions should be developed to enhance both social support and self-efficacy, creating a positive cycle of mutual reinforcement to improve DSM and QoL among this group., (©Lizhu Wang, Li Li, Yang Qiu, Sihan Li, Zhonghua Wang. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 19.09.2024.)

Background: We concurrently developed a prospective study to assess clinical outcomes among patients receiving 9-month bedaquiline (BDQ)-containing regimens, aiming to provide valuable data on the use of this short-course regimen in China., Methods: This open-label, randomized, controlled, multicenter, non-inferiority trial was conducted at sixteen hospitals, and enrolled participants aged 18 years and older with pulmonary rifampicin/multidrug tuberculosis. Participants were randomly assigned, in a 1:1 ratio. Individuals within the standard-regimen group received 6 months of BDQ, linezolid, levofloxacin, clofazimine, and cycloserine plus 12 months of levofloxacin, and any three potentially effective drugs from clofazimine, cycloserine pyrazinamide, ethambutol and protionamide, whereas individuals within shorter-regimen group received 9 months of BDQ, linezolid, levofloxacin, clofazimine and cycloserine. The primary outcome was the percentage of participants with a composite unfavorable outcome (treatment failure, death, treatment discontinuation, or loss to follow-up) by the end of the treatment course after randomization in the modified intention-to-treat population. The noninferiority margin was 10%. This trial was registered with www.chictr.org.cn , ChiCTR2000029012., Results: Between Jan 1, 2020, and Dec 31, 2023, 264 were screened and randomly assigned, 132 of 264 participants were assigned to the standard-regimen group and 132 were assigned to the shorter-regimen. Thirty-three (12.55%) of 264 participants were excluded from the modified intention-to-treat analysis. As a result, 231 participants were included in the modified intention-to-treat analysis (116 in the standard-regimen group and 115 in the shorter-regimen group).In the modified intention-to-treat population, unfavorable outcomes were reported in 19 (16.5%) of 115 participants for whom the outcome was assessable in the shorter-regimen group and 26 (22.4%) of 116 participants in the standard care group (risk difference 5.9 percentage points (97.5% CI - 5.8 to 17.5)). One death was reported in the standard-regimen group. The incidence of QTcF prolongation in the shorter-regimen group (22.6%, 26/115) was similar to the standard-regimen group (24.1%, 28/116)., Conclusions: The 9-month, all-oral regimen is safe and efficacious for the treatment of pulmonary rifampicin/multidrug-resistant tuberculosis. The high incidence of QTc prolongation associated with the use of BDQ highlights the urgent need of routine electrocardiogram monitoring under treatment with BDQ-containing regimens in the Chinese population., (© 2024. The Author(s).)

Background: This study aims to review the clinical characteristics, therapeutic response and outcome of idiopathic pulmonary hemosiderosis (IPH), and discover the risk factors for recurrence in children with IPH, which will be helpful for the early diagnosis and reasonable treatment of this disease., Methods: Children with a diagnosis of IPH were enrolled in the study. Clinical data of the children were collected and analysed., Results: A total of 32 patients with regular follow-up after diagnosis were included in this study. Anaemia, cough and haemoptysis constituted the most common initial symptoms of the disease, and the incidences were 90.6%, 75% and 56.2%, respectively. The mean gap between the onset of symptoms and diagnosis was 5 (0.25-36) months. Most of the children experienced remission (complete and partial remission) over the course of 6 months of treatment, but 19 of the children experienced relapse. The causes of disease recurrence included respiratory tract infection (37.5%), corticosteroid (CS) reduction (18.8%), and irregular medication (6.3%). Interestingly, we found that children with history of allergy (HR 4.255, 1.107-16.356) tended to experience disease recurrence (p = 0.01)., Conclusions: Cough and anaemia are the most common symptoms in children with IPH. The recurrence rate of this disease is high, and respiratory tract infection is the most common cause of its recurrence. High-dose CS impluse therapy cannot reduce the recurrence rate of the disease. Allergic history was an import factor associated with disease recurrence., Trial Registration: This study is a retrospective and observational study, which does not involve human specimens or clinical intervention. Therefore, clinical trial registration is not required, and there is no clinical trial number. However, the study was approved by the Institutional Review Board/Ethics Committee affiliated with West China Second University Hospital, Sichuan University (Ethics review number 2022074)., (© 2024. The Author(s).)

We report the isolation of Helicobacter cholecystus from a positive blood culture of a 58-year-old male with bacteremia and acute cholecystitis, in China. The patient's condition improved after symptomatic support treatment and subtotal cholecystectomy. This suggests that H. cholecystus should be considered a potential human pathogen.

Background: The existing predictive models for metabolic-associated fatty liver disease (MAFLD) possess certain limitations that render them unsuitable for extensive population-wide screening. This study is founded upon population health examination data and employs a comparison of eight distinct machine learning (ML) algorithms to construct the optimal screening model for identifying high-risk individuals with MAFLD in China., Methods: We collected physical examination data from 5,171,392 adults residing in the northwestern region of China, during the year 2021. Feature selection was conducted through the utilization of the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Additionally, class balancing parameters were incorporated into the models, accompanied by hyperparameter tuning, to effectively address the challenges posed by imbalanced datasets. This study encompassed the development of both tree-based ML models (including Classification and Regression Trees, Random Forest, Adaptive Boosting, Light Gradient Boosting Machine, Extreme Gradient Boosting, and Categorical Boosting) and alternative ML models (specifically, k-Nearest Neighbors and Artificial Neural Network) for the purpose of identifying individuals with MAFLD. Furthermore, we visualized the importance scores of each feature on the selected model., Results: The average age (standard deviation) of the 5,171,392 participants was 51.12 (15.00) years, with 52.47% of the participants being females. MAFLD was diagnosed by specialized physicians. 20 variables were finally included for analyses after LASSO regression model. Following ten rounds of cross-validation and parameter optimization for each algorithm, the CatBoost algorithm exhibited the best performance, achieving an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.862. The ranking of feature importance indicates that age, BMI, triglyceride, fasting plasma glucose, waist circumference, occupation, high density lipoprotein cholesterol, low density lipoprotein cholesterol, total cholesterol, systolic blood pressure, diastolic blood pressure, ethnicity and cardiovascular diseases are the top 13 crucial factors for MAFLD screening., Conclusion: This study utilized a large-scale, multi-ethnic physical examination data from the northwestern region of China to establish a more accurate and effective MAFLD risk screening model, offering a new perspective for the prediction and prevention of MAFLD., (© 2024. The Author(s).)

Background: This study aims to assess the associations of admission systolic blood pressure (SBP) level with spontaneous reperfusion (SR) and long-term prognosis in ST-elevation myocardial infarction (STEMI) patients., Methods: Data from 3809 STEMI patients who underwent primary percutaneous coronary intervention within 24 h, as recorded in the Chinese STEMI PPCI Registry (NCT04996901), were analyzed. The primary endpoint was SR, defined as thrombolysis in myocardial infarction grade 2-3 flow of IRA according to emergency angiography. The second endpoint was 2-year all-cause mortality. The association between admission BP and outcomes was evaluated using Logistic regression or Cox proportional hazards models with restricted cubic splines, adjusting for clinical characteristics., Results: Admission SBP rather than diastolic BP was associated with SR after adjustment. Notably, this relationship exhibits a nonlinear pattern. Below 120mmHg, There existed a significant positive correlation between admission SBP and the incidence of SR (adjusted OR per 10-mmHg decrease for SBP ≤ 120 mm Hg: 0.800; 95% CI: 0.706-0.907; p<0.001); whereas above 120mmHg, no further improvement in SR was observed (adjusted OR per 10-mmHg increase for SBP >120 mm Hg: 1.019; 95% CI: 0.958-1.084, p = 0.552). In the analysis of the endpoint event of mortality, patients admitted with SBP ranging from 121 to 150 mmHg exhibited the lowest mortality compared with those SBP ≤ 120mmHg (adjusted HR: 0.653; 95% CI: 0.495-0.862; p = 0.003). In addition, subgroups analysis with Killip class I-II showed SBP ≤ 120mmHg was still associated with increased risk of mortality., Conclusion: The present study revealed admission SBP above 120 mmHg was associated with higher SR,30-d and 2-y survival rate in STEMI patients. The admission SBP could be a marker to provide clinical assessment and treatment., Trial Registration: ClinicalTrials.gov (NCT04996901), 07/27/2021., (© 2024. The Author(s).)

To investigate the genetic relationship between end stage renal disease (ESRD) and human leukocyte antigen (HLA) alleles in the Guangxi Zhuang population. We performed polymerase chain reaction reversed sequence-specific oligonucleotide (PCR-rSSO) in 325 patients with ESRD and genotyped the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci. The direct counting method was used to determine the frequencies of HLA alleles, and Arlequin software (version 3.5.2.2) was used for haplotypic frequency analyses to compare the included ESRD patients with 350 healthy donors from the Guangxi Zhuang population. In our study, 120 HLA alleles, 284 HLA-A-B-DRB1 haplotypes, and 332 HLA-A-C-B-DRB1-DQB1 haplotypes were detected. We found that only A*11:01-B*15:02-DRB1*12:02 had a positive association with ESRD (P = 0.001, P c  = 0.020, OR = 3.106, 95% CI = 1.497-6.446) after Bonferroni correction; thus, individuals with this haplotype may be susceptible to ESRD. A*11:01-B*15:02-DRB1*12:02 is a potentially valuable haplotype for evaluating the risk of ESRD in the Guangxi Zhuang population., (© 2024. The Author(s).)

Background: Physical resilience is known to minimize the adverse outcomes of health stressors for older people. However, validated instruments that assess physical resilience in older adults are rare. Therefore, the purpose of this study was to translate the Physical Resilience Scale (PRS) into Chinese and to validate its psychometric properties in a population of community-dwelling older adults following SARS-CoV-2 infection., Methods: This study used a cross-sectional design and translated the Physical Resilience Scale into Chinese. A total of 426 older adults who had recovered from SARS-CoV-2 infection were chosen for assessment through convenience sampling. The measurement data were analyzed using the Rasch analysis., Results: Rasch analysis indicates that the Physical Resilience Scale demonstrates excellent reliability, validity, and unidimensionality. The Infit MNSQ and Outfit MNSQ of each entry were 0.77 ~ 1.19, and the degree of fit of each entry to the scale was good. Person and item separation reliability support the internal consistency of the studied samples and PRS items., Conclusions: The Physical Resilience Scale has good reliability and is suitable for the assessment of physical resilience tests in older people. However, the overall difficulty of the scale is not suitable for older adults of all ability ranges, and it is possible to add higher and lower difficulty items and adjust the difficulty spacing between items in a later study., (© 2024. The Author(s).)

Background: In recent times, a number of new indices for measuring visceral obesity have been developed. This research sought to investigate the relationship between four visceral obesity indices and prediabetes and diabetes., Methods: Conducted in 2011 as a cross-sectional analysis in Dalian, China, this study utilized logistic regression models to explore the relationships between four visceral obesity indices and prediabetes and diabetes. It also assessed the dose-response relationships using restricted cubic splines (RCS), performed subgroup analyses, and conducted interaction tests. The predictive values of four visceral obesity indices were evaluated using receiver operating characteristic (ROC) curves., Results: The study enrolled 10,090 participants, with prediabetes and diabetes prevalence at 80.53%. Multifactorial logistic regression revealed positive relationships between the four visceral obesity indices and prediabetes and diabetes. The results of the RCS analysis revealed a linear relationship between the body roundness index (BRI), cardiometabolic index (CMI) and prediabetes and diabetes. Conversely, a non-linear relationship was observed between Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP) and prediabetes and diabetes. Subgroup analyses demonstrated stronger relationships of CMI, CVAI, and LAP with prediabetes and diabetes among females. ROC curves suggested that LAP could be an effective predictor of these conditions., Conclusion: This research confirmed that four visceral obesity indices are linked with a higher risk of prediabetes and diabetes in middle-aged and elderly individuals in Dalian. Importantly, LAP could be an effective predictor of prediabetes and diabetes. Effective weight management significantly reduces the risk of both prediabetes and diabetes., (© 2024. The Author(s).)

Background: Internet gaming disorder (IGD), recognized by the World Health Organization (WHO), significantly impacts adolescent mental and physical health. With a global prevalence of 3.05%, rates are higher in Asia, especially among adolescents and males. The COVID-19 pandemic has exacerbated IGD due to increased gaming time from isolation and anxiety. Vulnerable groups include adolescents with poor academic performance, introverted personalities, and comorbid mental disorders. IGD mechanisms remain unclear, lacking prospective research. Based on Skinner's reinforcement theory, the purpose of this study is to explore the mechanisms of IGD from individual and environmental perspectives, incorporating age-related changes and game features, and to develop intelligent monitoring models for early intervention in high-risk adolescents., Methods: This prospective cohort study will investigate IGD mechanisms in middle and high school students in Shenzhen, China. Data will be collected via online surveys and Python-based web scraping, with a 3-year follow-up and assessments every 6 months. Unstructured data obtained through Python-based web scraping will be structured using natural language processing techniques. Collected data will include personal characteristics, gaming usage, academic experiences, and psycho-behavioral-social factors. Baseline data will train and test predictive models, while follow-up data will validate them. Data preprocessing, normalization, and analysis will be performed. Predictive models, including Cox proportional hazards and Weibull regression, will be evaluated through cross-validation, confusion matrix, receiver operating characteristic (ROC) curve, area under the curve (AUC), and root mean square error (RMSE)., Discussion: The study aims to understand the interplay between individual and environmental factors in IGD, incorporating age-related changes and game features. Active monitoring and early intervention are critical for preventing IGD. Despite limitations in geographic scope and biological data collection, the study's innovative design and methodologies offer valuable contributions to public health, promoting effective interventions for high-risk individuals., (© 2024. The Author(s).)

Background: Body roundness index (BRI) is an anthropometric measure related to obesity, combining waist circumference (WC) and height to more accurately reflect body fat. This study aims to investigate the relationship between BRI and the risk of hypertension using data from a prospective cohort study in Southwest China., Methods: Data for the study were derived from Guizhou Population Health Cohort Study (GPHCS), established in 2010. A total of 9,280 participants (aged 18 to 95 years, mean 41.53 ± 14.15 years) from 48 townships across 12 districts/counties were surveyed at baseline through multistage stratified random cluster sampling. Cox proportional risk models were employed to analyze the association between BRI and the risk of hypertension, estimating hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for confounding factors. The relationship between BRI and the onset time of hypertension was analyzed using the time failure acceleration model., Results: Over a median follow-up period of 6.64 years, 1,157 participants were diagnosed with hypertension. After adjusting for confounding variables, each unit increase in BRI was associated with a 17% increase in hypertension risk (HR = 1.17, 95% CI: 1.11, 1.24, P for trend < 0.001). Compared to participants in the first quartile (Q1) of BRI, the risk of hypertension for those in the third quartile (Q3) and fourth quartile (Q4) was 1.31 (95% CI: 1.10, 1.56) and 1.53 (95% CI: 1.28, 1.84), respectively. Each unit increase in BRI advanced the onset of hypertension by 0.26 years (95% CI: 0.16, 0.35)., Conclusion: This study indicates that BRI has a positive association with hypertension and can accelerate the onset of hypertension in the Chinese population. It is suggested that reducing BRI by controlling abdominal fat may be one of the effective measure to prevent hypertension., (© 2024. The Author(s).)

Background: The aim was to investigate the clinical characteristics, treatment and prognosis of neonatal influenza., Methods: The clinical data of 21 neonates who were diagnosed with influenza and admitted to the neonatal intensive care unit of Henan Provincial Children's Hospital, China, between January 2023 and January 2024 were retrospectively analyzed., Results: A total of 21 patients were admitted, including 14 with influenza A and 7 with influenza B. Eighteen of these patients were reported to have been exposed to family members with respiratory symptoms before hospitalization. Among all the patients' mothers, only 1 received the influenza vaccine during pregnancy. Fifteen newborns had fever, 13 appetite loss, 10 cough, 9 shortness of breath, 9 nasal obstruction, 3 runny nose, 3 vomiting, 2 severe wheezing, 2 choking, 2 diarrhea, 1 bloating, and 1 sputum in the throat. The pulmonary auscultation sounds were coarse in 19 neonates, weak in 2, moist rales were appreciated in 5 and wheezing in 4 of them. The peripheral total white blood cell count was normal in 18 patients and elevated in 3. The C-reactive protein level was normal in all subjects, and the procalcitonin level was elevated in 1. Nineteen patients had pneumonia on chest imaging. All patients were treated with oseltamivir and finally recovered., Conclusion: Influenza A is the most common type of neonatal influenza. The clinical symptoms are atypical, and fever is the main symptom. Treatment with oseltamivir is safe and effective, and the prognosis is mostly favorable., (© 2024. The Author(s).)

Background: The comorbidity of tuberculosis (TB) and diabetes mellitus (DM) is a significant global public health issue. This study aims to explore the recurrence risk and related factors of active pulmonary TB, specifically focusing on the impact of DM., Methods: A retrospective cohort study was conducted in Lianyungang City, Jiangsu Province, Eastern China by recruiting 12,509 individuals with newly diagnosed pulmonary TB between 2011 and 2019. The Cox proportional hazards models were performed to identify risk factors of recurrence and assess the association between DM and recurrence. The hazard ratio (HR) and 95% confidence interval (CI) were used to estimate the strength of the association., Results: After a median follow-up period of 5.46 years, we observed 439 recurrent cases (incident recurrence rate: 6.62 per 1000 person-years). Males (HR: 1.30, 95% CI: 1.03-1.64), patients aged ≥ 60 years (HR: 1.39, 95% CI: 1.15-1.70), DM (HR: 2.40, 95% CI: 1.68-3.45), and etiologic positivity in the initial episode (HR: 2.42, 95% CI: 2.00-2.92) had a significantly increased risk of recurrence., Conclusions: Recurrence of pulmonary TB patients who have completed treatment, especially those who also suffer from DM, should be a concern. Enhanced follow-up and targeted surveillance of these high-risk groups are needed., (© 2024. The Author(s).)

Background: With the extensive use of chromosomal microarray analysis (CMA), an increasing number of variants of uncertain significance (VOUS) have been detected. The objective of the present study was to elucidate the pathogenicity and clinical variability associated with isolated recurrent 4q35.2 microduplications within the Chinese population., Methods: The present study involved 14 cases of isolated recurrent 4q35.2 microduplication (including 12 fetuses and 2 cases of pediatric patients) out of 5,188 subjects who sought genetic consultation at our hospital and received CMA detection. WES technology was subsequently utilized to identify additional sequence variants in a patient with multiple clinical anomalies., Results: All 14 cases exhibited isolated recurrent 4q35.2 microduplications spanning a 1.0-Mb region encompassing the ZFP42 gene. Among the 12 fetuses, 11 displayed normal clinical features, while one was born with renal duplication and hydronephrosis. Additionally, in the two pediatric patients, WES was performed for Case 1, who presented with congenital cataracts, severe intellectual disability, and seizures. This patient inherited the 4q35.2 microduplication from his phenotypically normal mother. WES identified a novel NM&#95;000276:c.2042G > T (p.G681V) variant in the OCRL gene, which is associated with Lowe syndrome and may account for the observed phenotypic variability within this family., Conclusion: A series of 14 cases with isolated recurrent 4q35.2 microduplications were investigated, highlighting a potential association with increased susceptibility to renal abnormalities. Further, the present findings may expand the mutation spectrum of the OCRL gene associated with Lowe syndrome and provide valuable insights for the genetic etiological diagnosis of patients with unexplained copy number variants., (© 2024. The Author(s).)

Objectives: This study aims to calculate the national prevalence of smoking among Chinese adults and to describe the hazard of smoking initiation by age during their adolescence, as well as the disparities in sex, residence and age groups., Design: A cross-sectional study., Setting: The data were derived from a multistage sampling study conducted in 120 cities in China Mainland., Participants: A total of 9963 participants aged ≥19 years were included., Primary Outcome Measures: Survival analysis was used to quantify the hazards of smoking initiation by a single year of age during adolescence, and the log-rank test was used to compare the hazard curves across subgroups., Results: The prevalence of current smoking among males and females was 27.7% and 2.0%, respectively, and 56.2% of current smokers began smoking at or before the age of 18. The hazard of smoking initiation during adolescence for females was less than 0.5%, and the hazard for males increased gradually before 14 years of age and increased sharply at age 15 (4.34%), then peaked at age 18 (6.24%). Males in rural experienced a higher hazard of smoking initiation than those in urban (χ 2 =5.35, p=0.02) and no such difference was found in females. By the age of 18 years, 11.7% of participants (1.8% for females and 23.4% for males) had ever smoked., Conclusions: The prevalence of smoking among Chinese adults was lower than once reported. Males experienced higher hazards of smoking initiation at all ages than females. The hazard pattern suggests that the key focus for smoking prevention are males and adolescents aged 15-18 years, and future interventions should be delivered to the right target population at the appropriate time., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The study explore the influencing factors and healthy self-management of MS patients with bereaved relatives after Wenchuan and Yushu Earthquake of their real life; explore difficulties and challenges in the process of self-management; and supply information that could not be sought in quantitative studies. Purposive sampling was used to recruit 36 MS patients who are bereavement population in two earthquakes, and those patients met the inclusion criteria for semi-structured focus group interview. The Nvivo11 software was used to collate and analyze the transcribed data. The main influencing factors of health self-management behavior for MS patients are as follows: the degree of understanding of disease prevention knowledge, emotion management induced by earthquake trauma, the source of disease-related information, access and identification are very limited; ethnic traditional culture, religious beliefs, and production activities and routines before and after the earthquake is an important factor in their healthy self-management behavior. The lack of health beliefs and self-efficacy of MS patients among bereaved families after Wenchuan and Yushu earthquake are key obstacle in their self-management. The overall level of the knowledge of patients' MS prevention, self-efficacy and self-management behaviors are still low. Some positive factors that can be changed including MS prevention knowledge, self-efficacy, social support, and family function. Some negative factors which can be improved afterwards, including negative coping style, traumatic life experiences from earthquake and smoking., (© 2024. The Author(s).)

Nutrition support is an important care component for patients on hemodialysis. Also, patient self-management is important to maintaining proper nutritional intake during hemodialysis. This cross-sectional study investigated the knowledge, attitude, and practice (KAP) towards nutrition support and management among hemodialysis patients treated at the West China Hospital of Sichuan University between January and March 2023. Among 445 (95.91%) valid questionnaires, 58.43% were filled out by male patients. The knowledge, attitude, and practice scores were 11.44 ± 1.80 (possible range: 0-13), 30.29 ± 3.22 (possible range: 8-40), and 31.27 ± 5.67 (possible range: 8-40), respectively. Age > 60 years (OR = 0.487, 95%CI: 0.260-0.913, P = 0.025) and junior college or undergraduate or above (OR = 2.606, 95%CI: 1.621-4.189, P < 0.001) were independently associated with adequate knowledge. The knowledge (OR = 1.151, 95%CI: 1.024-1.294, P = 0.018) and female gender (OR = 0.632, 95%CI: 0.419-0.953, P = 0.029) were independently associated with positive attitude. The knowledge (OR = 1.404, 95%CI: 1.221-1.614, P < 0.001), attitude (OR = 1.146, 95%CI: 1.069-1.227, P < 0.001), age 51-60 years (OR = 1.879, 95%CI: 1.093-3.229, P = 0.022), and BMI of 24.0-27.9 kg/m 2 (OR = 0.434, 95%CI: 0.269-0.700, P = 0.001) were independently associated with proactive practice. Hemodialysis patients showed adequate knowledge, positive attitudes, and proactive practice; however, there were also several gaps in knowledge and misconceptions regarding proper nutritional self-management. Accordingly, addressing these gaps and misconceptions through carefully designed and effectively implemented education is crucial for providing comprehensive guidance on optimal nutrition and self-management strategies., (© 2024. The Author(s).)

Background: Weight misperceptions are common in children and adolescents, which is related to the engagement of weight loss behaviors. The aim of this study was to investigate the association between body weight perception and weight loss behaviors of lower-calorie diets and increased levels of physical activity (PA)., Methods: The Ningbo Youth Risk Behavior Survey was conducted from 2007 to 2022. A multistage, stratified cluster sampling procedure was utilized to draw target adolescents aged 12 to 18 years participating in each survey wave (2007, 2012, 2017, 2022). Data of anthropometry, weight perception, and weight loss behaviors were collected through self-administered questionnaires. A binary generalized linear model was used to examine associations between body weight perception and weight loss behaviors of lower calorie diets and increased levels of PA., Results: The sample sizes for each survey wave were 777, 885, 1588 and 2638. The prevalence of overweight (OW)/obesity (OB), self-perception of OW/OB and overestimated perception increased from 7.6%, 27.0% and 29.1% in 2007 to 16.3%, 39.9% and 41.4% in 2022, respectively. Adolescents that perceived themselves as OW/OB had higher odds of lower-calorie diets (OR: 4.2, 3.3-5.4) and increased level of PA (OR: 3.8, 2.9-5.0), whereas adolescents that perceived themselves as underweight had lower odds of lower-calorie diets (OR: 0.371, 0.253-0.542) and increased levels of PA (OR: 0.381, 0.295-0.559)., Conclusion: OW, self-perception of OW/OB and overestimated perception were prevalent in Chinese adolescents. Self-perception of OW/OB was positively associated with lower-calorie diets and increased levels of PA. The results can support public health specialists to promote health education of body perception and improve self-esteem in Chinese children and adolescents., (© 2024. The Author(s).)

The COVID-19 pandemic has critical implications for mental health in children. This study examined how the COVID-19 lockdown affected sleep duration and anxiety symptoms in Chinese school-aged children and the bidirectional association between sleep and anxiety before and during the COVID-19 lockdown. A school-based longitudinal cohort study was conducted to examine the relationship between sleep duration and anxiety scores before and after the COVID-19 lockdown from January to May 2020. Generalized estimating equations model was used to identify variables that contributed to the changes in sleep duration. The bidirectional relationship between sleep duration and anxiety symptoms was explored by cross-lagged analysis. 7681 children completed two waves of surveys were included in the analysis. The daily exercise duration, anxiety symptoms, and sleep duration decreased significantly during the lockdown compared with that before the lockdown. Based on generalized estimating equations model, older age, secondary school, and higher anxiety scores of participants were positively associated with sleep duration, while female and no COVID-19 infection history were negatively associated with it. Cross-lagged analysis showed higher anxiety score of children before the lockdown was significantly associated with shorter sleep duration during the lockdown; and shorter sleep duration of children before the lockdown was also significantly associated with a higher anxiety score during the lockdown. Under the context of the COVID-19 pandemic, there were longitudinal, bidirectional associations between children's anxiety symptoms and sleep duration. For school students, mental health services and sleep education should be considered in the daily health education curriculum., (© 2024. The Author(s).)

Purpose: To explore the knowledge, attitudes, and practices of Chinese nurses in promoting physical activity among cancer survivors and the relationships between these attributes and to identify the factors hindering nurses' clinical practice., Methods: Nurses from oncology-related departments of 10 public tertiary hospitals in Shandong Province completed self-administered questionnaires that included information about demographics; knowledge, attitudes, and practices of physical activity promotion; and barriers to clinical practice. The STROBE statement for observational studies was applied., Results: A total of 502 valid questionnaires were obtained. The average standardized scores of knowledges, attitudes, and practice were 75.33%, 82.36%, and 62.60%, respectively. Oncology specialist nurses and nurses who had received relevant training had higher levels of knowledge, nurses from general hospitals reported higher levels of practice, and nurses who had learned the relevant guidelines were better in terms of knowledge, attitude, and level of practice. Attitude had a statistically significant mediating effect between knowledge and practice. Lack of time, lack of multidisciplinary clinical teams, and lack of clear guidelines were the most frequently reported barriers to practice., Conclusion: In China, nurses have a moderate level of knowledge and practice in promoting physical activity among cancer survivors, but a positive attitude. Numerous barrier factors present challenges in nurses' clinical practice. Attitude plays a partial mediating role between knowledge and practice., (© 2024. The Author(s).)