Acid-related diseases (ARDs) are characterized by high incidence rates and significant disease burden. Excessive gastric acid secretion or heightened gastric acid sensitivity is the common pathogenesis of these conditions, leading to the widespread application of the principle of "treating different diseases with the same therapy" in medication management. With increasing concerns about the risks of inappropriate use of acid-suppressing drugs like proton pump inhibitors (PPIs), there is an urgent need to deepen the systematic understanding of medication therapy for acid-related diseases and to promote rational drug use. This consensus was developed by a multidisciplinary panel of experts in clinical medicine, pharmacy, and methodology. Based on evidence-based medicine, it provides a systematic elaboration on the classification of ARDs, therapeutic drugs, diagnostic methods, and pharmaceutical care services. Additionally, it offers consensus-based recommendations and management strategies for key clinical issues encountered in practice. The release of this consensus is of great significance for establishing a medication therapy management system and promoting rational drug use for acid-related diseases.
Background Sleep apnea is a high incidence sleep disorder disease in clinic.With the change of lifestyle,the incidence rate continues to rise,which can cause cardiovascular,metabolic and other multiple system damage.In recent years,it has been found that female sleep apnea patients often experience reproductive dysfunction such as menstrual disorders and infertility.However,the immune regulatory mechanism of sleep apnea induced damage to the female reproductive system,especially the abnormal immune response mediated by dendritic cells(DCs),still lacks in-depth analysis.Objective To study the effects of sleep apnea induced immune dysfunction on the reproductive system of female rats.Methods The research period was from January 2023 to December 2024.Thirty 4-6 month female SD rats(SPF grade)with regular estrous cycles were randomly divided into a blank control group,a short-term group,and a long-term group,with 10 rats in each group.The blank control group was fed normally for 6 weeks,the short-term group was fed for 3 weeks on the basis of preparing a sleep apnea model,and the long-term group was fed for 6 weeks on the basis of preparing a sleep apnea model.The estrous cycle of each group of rats,the expression levels of estrogen receptor alpha(ERα)and estrogen receptor beta(ERβ)subtypes in ovarian tissue,and the number of follicles in ovarian tissue were analyzed.The migration ability of DCs,the ability of DCs to stimulate homologous T lymphocyte proliferation response(MLR),and the changes in Toll-like receptor 4(TLR4)and RelB expression levels in DCs were observed.The fertility of each group and the growth and development of offspring mice were analyzed.Results Compared with the blank control group,the long-term groups showed an increased rate of dysregulation in the estrous cycle(P<0.017).Compared with the blank control group,the expression levels of ERα and ERβ in ovarian tissues were reduced in the short-term and long-term groups(P<0.05).Compared with the short-term group,the long-term group showed a decrease in the expression levels of ER α and ERβ in ovarian tissue(P<0.05).Compared with the blank control group,the number of primordial follicles,primary follicles,and antral follicles decreased in the short-term and long-term groups,while the number of blocked follicles increased(P<0.05).Compared with the short-term group,the long-term group showed a decrease in the number of primordial follicles,primary follicles,and antral follicles,and an increase in the number of blocked follicles(P<0.05).Compared with the blank control group,the migration rate of DCs decreased and the MLR increased in the short-term and long-term groups(P<0.05).Compared with the short-term group,the long-term group showed a decrease in the migration rate of DCs and an increase in MLR(P<0.05).Compared with the blank control group,the expression levels of TLR4 and RelB in DCs in both the short-term and long-term groups increased(P<0.05).Compared with the short-term group,the long-term group showed an increase in the expression levels of TLR4 and RelB in DCs(P<0.05).Compared with the blank control group,the pregnancy rate and live birth rate of long-term groups decreased(P<0.05).Three groups of live born offspring mice showed an increase in daily weight after 21 days of birth,but compared with the blank control group,the short-term and long-term groups showed growth retardation,especially the long-term group.Conclusion Sleep apnea can cause ovarian dysfunction and reduced fertility in female rats,suggesting that it may activate TLR4/RelB by altering the migration ability of DCs,leading to immune damage and reproductive system disorders.
Background Cervical cancer is the fourth most common malignant tumor among women worldwide,with persistent infection of high-risk human papillomavirus(HR-HPV)being its necessary cause.HPV vaccination can effectively prevent cervical cancer;however,the coverage rate of HPV vaccination in China remains far below the 90%target set by the WHO.Current research on factors influencing HPV vaccine coverage is insufficient.This study aims to contribute evidence to this field.Objective To explore the spatial relationships between HPV vaccine coverage and its influencing factors among the eligible population in China,and to provide a scientific basis for formulating region-specific HPV vaccination strategies tailored to the actual conditions of different provincial-level administrative regions.Methods The dependent variable was derived from the 2022 regional statistics on HPV vaccine coverage released by the Chinese Center for Disease Control and Prevention.Independent variables were obtained from the Seventh National Population Census,the China Statistical Yearbook 2022,and the National Bureau of Statistics,covering 10 continuous variables across two categories:socioeconomic level and health indicators.These included female junior high school,senior high school,and higher education rates;female illiteracy rate;female employment rate;proportion of ethnic minority women;proportion of rural women;per capita disposable income;per capita healthcare expenditure;and number of community health service centers(stations).All variables were included in the model in their original form.Data processing and general analysis were performed using R software,and a linear regression model was constructed.Global spatial autocorrelation analysis,geographically weighted regression(GWR)modeling,and hotspot analysis were conducted using ArcGIS software,with spatial distribution maps generated.Data collection and analysis were completed in April 2025.Results The HPV vaccine coverage rates across provinces ranged from 2.55%to 25.40%.Significant differences in coverage were observed among provincial-level administrative regions,exhibiting distinct spatial clustering characteristics(Moran's I index=0.198,P=0.007).Coverage was higher in southeastern regions and the Sichuan-Chongqing area,while relatively lower in western regions.HPV vaccine coverage was influenced by female education level,economic status,female sociodemographic characteristics,and the number of community health service centers(stations)(P<0.05),with varying degrees of impact across spaces.Conclusion HPV vaccine coverage in China demonstrates a pattern of higher rates in the southeast and lower rates in the northwest.Female higher education rate,per capita disposable income,and proportion of rural women are core factors contributing to this spatial disparity.A triple policy of"central government full funding,mobile vaccination units,and health education campaigns"could be implemented in western regions.Eastern regions should provide economic support for disadvantaged populations.Central regions could expand the eligibility for HPV vaccination subsidies and convert high health literacy into higher vaccination rates through behavioral incentives.Adopting precise,localized strategies will enhance HPV vaccine coverage and substantially advance the elimination of cervical cancer.
Background As China embarks on a new journey towards common prosperity, it is crucial to address the issue of preventing rural residents from falling back into poverty due to illness. This is a significant step towards achieving common prosperity. Objective This study aims to understand the distribution of health poverty vulnerability among rural out-migrant workers in Ningxia and identify the influencing factors, with the goal of providing policy recommendations for Ningxia to consolidate its poverty alleviation achievements and prevent poverty from returning due to illness. Methods Using field survey data collected by the research team in Haiyuan County, Yanchi County, Xiji County, and Pengyang County in Ningxia from June to July 2022, the study employed the three-stage feasible generalized least squares (FGLS) method to measure health poverty vulnerability. Logit regression analysis was used to identify the influencing factors. The study also used the marginal effect and Shapley value decomposition method to quantify the contribution of each factor. Results The proportion of health poverty vulnerable rural out-migrant workers in Ningxia is 4.5%. The logit model regression analysis results show that housing and kitchen separation, using electricity as living fuel, and participating in a health check in the past year can reduce the risk of health poverty vulnerability. Married status, borrowing money due to illness, and having a low level of education will increase the risk of health poverty vulnerability. The Shapley value decomposition results show that demographic characteristics contribute the most (55.93%), followed by family characteristics (16.46%) and health risk characteristics (15.34%). Conclusion The health poverty vulnerability among rural migrant workers in Ningxia is within a controllable range compared with the overall level in the western region. Having separate housing and kitchen areas, using electricity as a domestic fuel, participating in health check - ups within the past year, being in a married status, and borrowing money due to illness are key factors affecting the health poverty vulnerability of migrant workers from Ningxia. It is recommended that relevant departments establish an early warning system for the risk of returning to poverty due to illness, proactively adjust policies, and promote the effective implementation of health poverty prevention efforts.
Background Community pharmacy has significant advantages in curbing medication misuse and managing chronic diseases.Nevertheless,pharmacists encounter challenges such as complex job duties,inadequate professional knowledge,and low public awareness.Under the background of government support for innovating and expanding pharmacists'roles,the healthcare alliance has emerged as an ideal solution to the dilemma in community pharmacy.Objective This research devote to establish a community pharmacy studio to enhance the quality of community pharmacy services and the outcomes of chronic disease management based on the healthcare alliance model.Methods Three randomized controlled trials were implemented in three communities within a healthcare alliance from April 2023 to March 2024,while all control groups served as negative controls.In Trial one,254 healthcare professionals were randomly and equally divided into two groups.The experimental 1 group received pharmaceutical literacy training,after which the outcomes were compared with those of the control 1 group.In Trial two,540 residents were randomly divided into two groups,the experimental 2 group received services from the community pharmacy studio.Pharmaceutical literacy,medication adherence,pharmacist recognition,and service satisfaction were compared between the two groups.In Trial three,118 chronic disease patients were randomly divided into two groups.The experimental 3 group received individualized medication guidance,and the rates of chronic disease indicator control were compared between the two groups.Data were collected through questionnaires,interviews,and medical record reviews and analyzed by SPSS 24.0 software.Results Survey results indicated that the proportion of participants with high pharmaceutical literacy in the experimental 1 group(86.61%,110/127)was significantly higher than in the control 1 group(68.50%,87/127),showing a statistically significant difference(χ2=11.966,P<0.01).The research found that the experimental 2 group had a higher proportion of residents with high pharmaceutical literacy compared to the control 2 group(P<0.001),according to comprehensive assessment of community residents'pharmaceutical literacy and service satisfaction.Additionally,the proportion of community residents exhibiting high medication adherence was higher in the experimental 2 group compared to the control 2 group(P<0.05).Furthermore,respondents in the experimental 2 group were satisfied with the pharmacy studio,the degree of satisfaction was significantly higher than that in the control 2 group(P<0.001).Also,the experimental 2 group had a higher proportion of residents recognizing the professional the pharmacist team compared to the control 2 group(P<0.01).The experimental 3 group demonstrated a higher rate of achieving chronic disease control targets than the control 3 group,and a higher proportion of positive evaluations regarding the pharmacist's role compared to the control 3 group(P<0.05).Conclusion Supported by healthcare alliance,the community pharmacy studio model,effectively overcame the challenges of community pharmacy development,enhanced the quality of pharmacy services,improved outcomes of patient disease management,and set new standards for the future of community pharmacy.This model provides valuable insights and practical experience for the development and innovation of community pharmacy services in China.
Children's 24-hour movement behaviors refer to the physical activity,sedentary and sleep behaviors that children experience during a 24-hour day.Many studies have shown that the combination of the above 3 different movement behaviors and their time allocation have a significant impact on children's physical and mental health.How to effectively and completely measure all of children's movement behaviors over a 24-hour period has positive implications for further epidemiological research investigations of children's time-use and the establishment of health behavioral interventions and guidelines for children.China's research on the 24-hour movement behaviors assessment tools for children is still at an exploratory stage.This paper reviews the specific content,application,advantages and disadvantages of foreign children's 24-hour movement behaviors assessment methods,aiming to draw on foreign experience and combine with China's cultural background and children's growing environment to develop assessment methods suitable for China's children's 24-hour movement behaviors,and to provide scientific and effective assessment tools for understanding China's children's 24-hour movement behaviors.
Background Community health services are important in achieving universal health coverage, with nursing workforce allocation directly impacting service accessibility and quality. While existing researches mainly focuses on the allocation of nursing resources in hospital, data on community nurses in China remain limited. Objective This study aims to evaluates trends and equity in the allocation of community nurses in China from 2012 to 2022, providing insights for optimizing resource distribution. Methods Data were sourced from the 2013-2017 China Health and Family Planning Statistical Yearbook, the 2018-2022 China Health and Wellness Statistical Yearbook, the 2013-2022 China Statistical Yearbook, and the 2023 China Health Statistics Abstract. A descriptive analysis was conducted from February to May 2024. The Lorenz curve, Gini coefficient and agglomeration degree were employed to assess the distribution and equity of community nurses. Results From 2012 to 2022, the number of community nurses increased from 128 652 to 252 568 with an average annual growth rate of 6.98%. By 2021, the proportion of community nurses with a bachelor's degree rose from 6.8% to 33.0%. The Gini coefficients for population and geographic distribution were 0.13 and 0.70, respectively, indicating significant regional disparities in nurse allocation. Conclusion The quantity and quality of community nurses in China have improved significantly, yet disparities persist. Regional variations in allocation remain, with population-based distribution being more equitable than geographical distribution. Future efforts should focus on strengthening the community nursing workforce and enhancing equity in resource allocation.
Background In China,the national public health emergency response system was originally established in 2003 to address emerging respiratory infectious diseases.In response to the COVID-19 pandemic,fever clinics were instituted within Primary Healthcare Centers(PHC)to serve as a supplementary measure to the existing healthcare infrastructure during public health emergencies.The final goal is leading to the subsequent development of a more sophisticated public health emergencies medical care system.Objective Over the past three years,the utilization rates and visitation numbers of fever clinics have fluctuated irregularly.This study seeks to summarize the operational processes of PHC fever clinics during this period,identify existing challenges,and propose potential strategies for improvement.Methods A convenience sampling method was employed to select 16 PHC fever clinics,with one clinic chosen from each of the 16 districts in Shanghai.Managers of these fever clinics were invited to participate in semi-structured,in-depth interviews conducted from November 23,2023,to June 18,2024.The interview guide was developed by integrating insights from existing literature,government regulations,and a preliminary survey.The interviews centered on themes related to the establishment,operation,and challenges encountered by the clinics in recent years.The framework analysis method was employed to manage the qualitative data.Quantitative data were collected on the number of patients visiting fever clinics over the past three years,alongside population statistics and jurisdictional areas of each PHC.The correlation among clinic visits,population size,and population density was examined.Additionally,the SWOT framework was applied to assess the strengths,weaknesses,opportunities,and threats associated with PHC fever clinics.Results Of the 16 participants interviewed,14 individuals(87.5%)possessed either vice-high or superior professional titles,with an average professional tenure of(20.0±6.6)years.The qualitative interviews identified five distinct themes pertaining to functions,hardware configurations,operational processes,current operational challenges,and underlying influencing factors.The fever clinics were classified into urban or suburban categories according to their geographic location.Over the past three years,the mean frequency of visits to urban fever clinics had been lower compared to their suburban counterparts.The results of the SWOT analysis revealed that PHC fever clinics had established a more advanced sentinel surveillance network for the prevention and control of respiratory infectious diseases.Nonetheless,the analysis also identified shortcomings in human resources,infrastructure,and inefficiencies in the allocation and use of medical resources.Conclusion The PHC fever clinics are strategically located closer to communities,offering a more convenient and cost-effective option for patient access.Additionally,these fever clinics play a crucial role in forming a comprehensive network for the prevention and control of infectious diseases.In Shanghai,there is a notably higher demand for fever clinics situated in suburban areas.However,when compared to the standardized requirements for fever clinic settings,there are deficiencies attributed to the structural limitations of PHC facilities.Furthermore,there was a notable inefficiency in human resource allocation due to the intermittent nature of seasonal respiratory infectious disease epidemics.It is advisable to dynamically adjust the human resource management in PHC fever clinics in accordance with sentinel monitoring data and the prevailing trends of respiratory infectious disease epidemics.Supportive governmental policies and media advocacy can enhance the operational efficiency of fever clinics.The PHC has recommended active service implementation to ensure optimal utilization of these clinics.
Traditional Chinese medicine (TCM) is a unique component of China's medical and health system, and the governance of TCM based on its revitalization and development holds significant theoretical and practical implications. This study, from the perspective of TCM revitalization and development, systematically summarizes the strategic positioning of TCM, its role in full-cycle services, and the current status of the entire industrial chain development. The results indicate that the path to modernizing TCM governance should involve refining TCM governance tools and methods through standardization, advancing the modernization of the TCM governance system with a collaborative mindset, and simultaneously constructing the TCM governance system in accordance with the laws of TCM. This study aims to provide possible policy recommendations for the modernization of TCM governance.
Background The body roundness index (BRI) is an emerging anthropometric indicator that has been increasingly associated with various cardiometabolic conditions, including hypertension and diabetes. However, its association with obstructive sleep apnea (OSA) and its potential as a predictive tool remain poorly understood. Objective This study aimed to investigate the association between BRI and OSA risk and to evaluate its predictive performance for OSA in adults. Methods A cross-sectional analysis was conducted among 638 outpatients suspected of OSA at Shenzhen University Affiliated South China Hospital between January 2024 and March 2025. All participants underwent overnight polysomnography, and OSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events per hour. Anthropometric measurements—including height, weight, waist circumference, and neck circumference were collected to calculate BRI, BMI, a body shape index (ABSI), and weight-adjusted waist index (WWI). Multivariable Logistic regression models were used to assess the association between BRI and OSA after adjusting for potential confounders. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic accuracy of each index, with subgroup analyses performed by sex. Results Of the 638 participants, 552 (86.5%) were diagnosed with OSA. The multivariable Logistic regression revealed a significant dose-response relationship between BRI and OSA risk (Ptrend<0.001). After adjusting for confounding factors, the risk of OSA in the highest quartile group of BRI (Q4: >5.744) was 6.955 times (95%CI=2.960-16.344) that of the lowest group (Q1: ≤3.931). The ROC analysis demonstrated that BRI achieved an area under the curve (AUC) of 0.740 (95%CI=0.682-0.799) for OSA detection, with an optimal cut-off value of 4.199 yielding 73.4% sensitivity and 68.6% specificity. In comparison, the AUC for ABSI, WWI, and BMI were 0.633, 0.676, and 0.717, respectively. DeLong test results confirmed that BRI's AUC was greater than those of ABSI and WWI (P<0.05). In men, the AUC of BRI in diagnosing OSA was 0.774. In women, the AUC of BRI in diagnosing OSA was 0.654. Conclusion BRI serves as a significant influencing factor for the prevalence of OSA among Chinese adults, demonstrating good predictive efficacy. Consequently, BRI can be utilized as an economical and effective tool for the early screening of OSA.
Background Many observational studies have found an association between the gut microbiome and metabolic syndrome(MetS)and its components,but the causal relationship between them is not yet clear.Objective To explore a bidirectional causal relationship between the gut microbiota and the MetS and its components.Methods This study obtained gut microbiota-associated single nucleotide polymorphisms from MiBioGen,obtained summary statistics of MetS and its components in the UK Biobank,Complex Trait Genetics(CTG),and other consortiums studies,and performed bidirectional two-sample Mendelian randomization analyses to assess the relationship between causal relationships.In addition,a series of sensitivity analyses were performed to verify the robustness of the Mendelian randomization analysis results.To obtain a more rigorous causal interpretation,Bonferroni correction was used to test the strength of the causal relationship between gut microbiota and MetS.Results Inverse variance weighted estimation showed that Bifidobacteriaceae(OR=0.96,95%CI=0.93-0.98,P=1.49×10-3)had a significant negative causal relationship with MetS.There was a significant positive causal relationship between some gut microbiota and waist circumference,such as class.Melainabacteria(OR=1.02,95%CI=1.01-1.03,P=1.90×10-3),order.Gastranaerophilales(OR=1.02,95%CI=1.01-1.03,P=1.61×10-3),order.NB1n(OR=1.02,95%CI=1.01-1.03,P=2.00×10-3),and genus..Eubacteriumhalliigroup(OR=1.03,95%CI=1.01-1.04,P=6.97×10-4),among others.However,inverse Mendelian randomization analysis did not support a causal relationship.Sensitivity analyses showed there was no heterogeneity or horizontal pleiotropy.Conclusion This bidrectional Mendelian randomization study provides evidence of a clear causal relationship of gut microbiota on MetS and components,but does not support reverse causality.This finding provides new ideas for the management of MetS.Further randomized controlled trials are still needed in the future to elucidate the relationship between the effects of microbial agents such as probiotics on MetS.
Background The continuous metabolic syndrome score (cMetS) is a weighted composite score based on five metabolic indicators: waist circumference (WC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), mean arterial pressure (MAP), and fasting plasma glucose (FPG). lthough the role of cMetS in metabolic diseases has been preliminarily recognized, its association with renal function has not yet been systematically elucidated. Given the high prevalence of chronic kidney disease (CKD) and its close link to metabolic dysregulation, elucidating the role of cMetS in this context may pave the way for novel biomarkers or therapeutic targets for early warning, risk stratification, or intervention. Objective To investigate the effectiveness of cMetS in early screening for chronic kidney disease (CKD) and to reduce the risk of CKD in the target population by controlling relevant factors. Methods From 2017 to 2021, this project screened and collected data from 2 049 elderly individuals (aged≥60 years) with high cardiovascular risks during community-based health examinations across 12 counties/cities in Anhui Province. Participants were stratified by estimated glomerular filtration rate (eGFR): the low-filtration group [eGFR <90 mL·min-1· (1.73 m2)-1] and the normal group [eGFR ≥90 mL·min-1· (1.73 m2)-1]. Multivariate Logistic regression was employed to analyze the correlation between cMetS quartiles and the risk of reduced eGFR. Results Patients in the low-filtration group (n=927) showed significantly older age, and higher body weight, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), fasting plasma glucose (FPG), serum creatinine (Scr), blood urea nitrogen (BUN), triglycerides (TG), waist-to-height ratio (WHtR), WHtR cut-off=0.5 (WHt.5R), body roundness index (BRI), and cMetS than the normal group (n=1 122) (P<0.05). Stratified by cMetS quartiles, four groups were assigned as follows: S1=-4.40 to <-0.18; S2=-0.18 to <0.30; S3=0.30 to <0.79; S4: 0.79 to 4.96. The body hight (BH), body mass, BMI, WC, SBP, DBP, MAP, FPG, Scr, TC, TG, low-density lipoprotein cholesterol (LDL-C), WHtR, WHt.5R, and BRI in the four groups increased with the increasing cMetS levels, while BUN, HDL-C, and eGFR decreased with the increasing cMetS levels (P<0.05). Compared with the cMetS S1 group, the risk of decreased glomerular filtration rate increased in S2, S3, and S4 groups (OR=1.462, 1.656, and 1.652, respectively, P<0.05). Compared with the BMI M1 group (16.51-<23.19 kg/m2), the risk of decreased glomerular filtration rate in M2 (23.19-<25.31 kg/m2), M3 (25.31-<27.61 kg/m2), and M4 groups (27.61-<40.89 kg/m2)significantly increased (OR=1.373, 1.328, and 1.385, respectively, P<0.05). Conclusion Among older adults of 60 years and above, age and BMI increase, and eGFR decreases with the increasing cMetS levels. Elevated cMetS and BMI are independent risk factors for the decreased glomerular filtration rate. Renal function gradually declines with aging, which can be accelerated by MetS. For older adults of 60 years and above, early intervention is needed to delay the deterioration of renal function.
Background Hypercholesterolemia is an independent risk factor for atherosclerotic cardiovascular diseases,exerting a profound impact on the health of the elderly.However,evidence regarding the disease burden of hypercholesterolemia in the elderly remains limited and requires further elucidation.Objective To analyze the disease burden and temporal trends of hypercholesterolemia among the elderly globally and in China from 1990 to 2021,thereby providing a reference for optimizing health resource allocation and precisely formulating management strategies.Methods Data on deaths and disability-adjusted life years(DALYs)of"High LDL cholesterol"in individuals aged≥60 years globally,in China,and across 5 sociodemographic index(SDI)regions were collected from the Global Burden of Disease(GBD)2021 database.Joinpoint regression was used to analyze temporal trends in age-standardized mortality rate(ASMR)and DALYs rate(ASDR).A three-factor decomposition method was used to quantify the relative impacts of population aging,population growth,and epidemiological changes on the burden.The Bayesian age-period-cohort model was employed to predict the number of deaths and DALYs from 2022 to 2035.Results In 2021,global and Chinese elderly experienced 2 779 100 and 692 000 hypercholesterolemia-related deaths,increasing 50.34%and 252.34%from 1990,and the DALYs were 50 226 100 and 12 170 100 person-years,rising by 46.62%and 200.96%,respectively.Globally,both ASMR and ASDR for elderly hypercholesterolemia showed a decreasing trend overall(AAPCASMR=-1.65%,95%CI=-1.81%to-1.48%,P<0.001;AAPCASDR=-1.51%,95%CI=-1.67%to-1.36%,P<0.001)from 1990 to 2021,whereas they remained relatively stable in China(P=0.089,P=0.388).The overall ASMR of elderly men in China has been on the rise,with an average annual increase of 0.71%(95%CI=0.31%to 1.11%,P<0.001).In 2021,elderly males globally and in China exhibited a higher number of deaths and DALYs,as well as higher ASMR and ASDR,than elderly females.Except for the high-SDI region,the number of deaths and DALYs of hypercholesterolemia in the total elderly population in other SDI regions in 2021 increased to varying degrees compared with 1990.Furthermore,in 2021,the 80-84 years age group accounted for the largest proportion of deaths both globally(463 100 cases,16.66%)and in China(128 300 cases,18.54%).Population growth was identified as the main driver of increasing disease burden among all regions.The Bayesian age-period-cohort model indicated that the disease burden of hypercholesterolemia among the elderly population would continue to rise globally and in China from 2022 to 2035.By 2035,the number of deaths and DALYs from hypercholesterolemia in the global elderly population would increase by 42.67%and 41.20%,respectively,compared with 2021,while in China they would increase by 82.76%and 72.18%,respectively.Conclusion The disease burden of hypercholesterolemia among the elderly is substantial both globally and in China,and is expected to grow steadily.To effectively mitigate this escalating burden,it is imperative to enhance public health consciousness,refine the allocation of health resources,and strengthen the research and development of novel lipid-lowering medications.
Background Peptic ulcer(PUD)is a common disease of the digestive system.Traditional Chinese Medicine(TCM)treatment is an effective treatment for PUD.However,in the randomized controlled trials(RCTs)of TCM treatment of this disease,there are great limitations in the selection of methodological quality and outcome indicators,which brings some challenges to efficacy evaluation and data integration analysis.Objective To systematically review the application status and experimental design points of RCTs outcome indicators of TCM intervention in PUD in the past 15 years,aiming to provide reference for the construction of core indicator set of TCM treatment of PUD and the optimization of clinical trial design.Methods Computerized searches were conducted in Chinese databases:CNKI,Wanfang Data,VIP,and SinoMed,as well as international authoritative databases:PubMed,Embase,Cochrane Library,and Web of Science for RCTs on the treatment of PUD with TCM.The search time frame was from 2010 to 2024.Cochrane bias risk assessment was performed on the included literature,and relevant outcome indicators were counted,summarized and analyzed.Results A total of 323 RCTs with 34 933 patients were included.The maximum sample size of single study was 498 cases,the minimum was 40 cases,and the average sample size was 108 cases.Among the 171 reports of TCM syndromes,the highest frequency of use was spleen and stomach deficiency cold(31 articles,18.13%);47 articles were treated with pure TCM,and 276 articles were treated with integrated Traditional Chinese and Western Medicine.The course of treatment was mostly 4 weeks(119 times,36.84%);the outcome indicators were divided into 6 categories according to functional attributes.A total of 170 outcome indicators were reported,with a total frequency of 1 962 times.The outcome indicators with higher frequency of use were total clinical effective rate(233 times,11.88%),Helicobacter pylori eradication rate(165 times,8.41%),and adverse reactions(155 times,7.90%).The risk assessment of bias in the included literature was not clear.Conclusion The RCTs of PUD treated with TCM still exist in the following aspects:the dialectical classification and disease staging of TCM are not standardized,the methodological design(blind method,distribution concealment)needs to be improved,the primary and secondary outcome indicators are not clearly distinguished,the clinical efficacy standards are not unified,the measurement time gap of outcome indicators is large,the scoring criteria of TCM syndromes/symptoms is diversified,the ethical registration needs to be paid attention to,and the report of safety indicators is not standardized.It is suggested to actively carry out the research on the core index set of TCM treatment of PUD,optimize and improve the methodological quality,and provide high scientific,reliable and practical evidence for the clinical practice of TCM treatment of PUD.
China attaches great importance to ensuring the effective implementation of the rural order-oriented medical student training program. However, the policy has encountered multiple challenges during its execution, indicating that it still requires continuous optimization and refinement. Based on the analytical framework of Smith's model, this paper comprehensively and systematically explores the constraints of the free training program for rural order-directed medical students in the process of implementation, in order to provide theoretical basis and decision-making reference for the improvement of the free training policy for rural order-directed medical students. This paper shows that inadequate policy incentives, broad policy content, lack of communication and motivation on the part of implementing agencies, lack of resources in primary health care institutions, lack of understanding of the policy by oriented students, lack of professional identity and an unstable environment impede the effective implementation of the policy. The policy of rural order-directed medical students can solve the problem of talent shortage at the grass-roots level, so the relevant departments should improve the rural order-directed policy as soon as possible in order to "retain talents".
Background Sarcopenia in patients with acute ischemic stroke (AIS) is significantly associated with poor clinical outcomes. Consequently, there is a growing research interest in identifying simple and practical clinical indicators to screen the high-risk population, forming a key intersection between stroke rehabilitation and clinical nutrition. Objective This study aimed to explore the feasibility and clinical value of temporal muscle cross-sectional area (TMA) and temporal muscle thickness (TMT) in evaluating sarcopenia in AIS patients. Methods A total of 531 AIS patients (347 males, 184 females) admitted to the Second Affiliated Hospital of Anhui Medical University between January 2022 and August 2025 were enrolled. Bilateral TMA and TMT were measured via cranial CT or MRI. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Independent predictors were identified using univariate and multivariate Logistic regression analyses. A prediction model was constructed and its performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results The prevalence of sarcopenia among AIS patients was 19.96% (106/531). Based on the diagnostic criteria, patients were categorized into a sarcopenia group (n=106) and a non-sarcopenia group (n=425). Patients in the sarcopenia group had significantly lower TMA and TMT values compared to those in the non-sarcopenia group (P<0.001). Multivariate Logistic regression analysis identified age (OR=1.717, 95%CI=1.223-2.410), NIHSS score (OR=3.213, 95%CI=1.829-5.643), NRS 2002 score (OR=1.337, 95%CI=1.045-1.711), and TMA (OR=0.781, 95%CI=0.639-0.955) as independent influencing factors for sarcopenia in AIS (P<0.05). To construct and validate the sarcopenia risk prediction model, all subjects were randomly divided into a training set (n=398) and a validation set (n=133) according to 3∶1 ratio. The final model formula, based on multivariate logistic regression analysis, was Logit(P)=46.221 22+0.082 11×age+2.078 56×(NRS 2002=1)-0.144 80×TMA+18.327 80×(NIHSS=1). A nomogram was generated to predict the risk of sarcopenia. The area under the ROC curve (AUC) of the prediction model was 0.884 (95%CI=0.782-0.947) in the training set and 0.808 (95%CI=0.679-0.882) in the validation set. The calibration curve demonstrated good consistency between the predicted and actual probabilities. Furthermore, the DCA indicated that the model provided clinical net benefits across a wide range of threshold probabilities. Conclusion Temporal muscle measurement is an effective method for evaluating the muscle wasting status of patients with AIS. The prediction model based on age, NIHSS score, NRS 2002 score, and TMA exhibits good discriminatory performance and clinical applicability, providing a practical tool for early identification of sarcopenia in this patient population.
Background Deprescribing is an intervention strategy aimed at identifying and discontinuing potentially inappropriate medications, which holds significant value in reducing medication-related risks and improving patient outcomes. However, there is a lack of comprehensive and integrated inductive analysis from the perspective of implementation science. Objective This study aims to review the barriers to and facilitators of deprescribing implementation based on the updated 2022 Consolidated Framework for Implementation Research (CFIR) to provide evidence-based recommendations for optimizing implementation strategies. Methods A systematic search was conducted in four electronic databases—China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, and Web of Science—for relevant literature published from January 2000 to September 2024, to identify studies exploring the influencing factors on the implementation of deprescribing. Two researchers independently used a predefined data extraction form to collect information on study characteristics, intervention content, and implementation determinants. The barriers and facilitators were analyzed thematically and synthesized using the updated CFIR. Results A total of 46 studies were included in the analysis. The facilitators identified included positive attitudes of patients and physicians toward deprescribing, collaboration within healthcare teams, effective doctor-patient communication, and patients' understanding of deprescribing. The barriers included resistance from patients, lack of effective collaboration between healthcare institutions, excessive use of technical jargon in doctor-patient communication, and patients' lack of knowledge about medications. Conclusion The successful implementation of deprescribing is influenced by a combination of multifaceted factors. Future research should precisely match implementation strategies based on the facilitating and hindering factors in specific scenarios, to propose targeted and feasible solutions for promoting the process of deprescribing.
Background Neurological disorders severely impact patients' quality of life. These disorders have multifactorial etiologies, including genetic, infectious, and immunological factors. Emerging evidence highlights the role of gut microbiota in these disorders through the gut-brain axis. However, the research hotspots and trends in this field remain inadequately characterized. Objective This study aims to conduct a visual analysis of the literature related to neurological disorders and gut microbiota, with the goal of understanding the current research landscape both domestically and internationally. Furthermore, it seeks to explore the research hotspots and emerging trends, thereby providing a reference for future studies. Methods Relevant literature was retrieved from the Web of Science Core Collection database from January 1, 2000 to July 29, 2024. Using CiteSpace software, a visual analysis was performed from multiple aspects, including publication volume, co-citation analysis, highly cited papers, citation burst papers, keyword co-occurrence, national collaboration, institutional collaboration, and author collaboration. Results A total of 5 239 articles were included, with a steady increase in publication volume since 2012, surpassing 1 000 articles in 2022. The research hotspots primarily concentrated on Parkinson's disease, Alzheimer's disease, ischemic stroke, and amyotrophic lateral sclerosis. Citation analysis revealed that the relationship between gut microbiota and CNS diseases had become a prominent research focus in recent years. Moreover, co-occurrence analysis of keywords further highlighted the frequent appearance of important research topics such as short-chain fatty acids, the gut-brain axis, and gut microbiota dysbiosis, indicating a high level of attention to these areas. High-citation articles and citation burst analysis showed that the research trend was centered on the mechanisms through which gut microbiota influence neurodegenerative diseases and other CNS disorders, particularly focusing on the regulatory roles of short-chain fatty acids, gut microbiota diversity, and the gut-brain axis. Conclusion CiteSpace-based bibliometric analysis suggests a potential association between gut microbiota and neurological disorders such as Parkinson's disease, Alzheimer's disease, and multiple sclerosis. Modulation of gut microbiota may offer a promising therapeutic avenue for the management of these conditions. Further longitudinal studies and clinical trials are warranted to validate this hypothesis and to elucidate the underlying mechanisms by which the gut microbiota influences neurological disease pathogenesis.
Background Post-tuberculosis bronchiectasis is one of the significant sequelae of tuberculosis.At present,the specific impact on the prognosis of patients with tuberculous bronchiectasis has not been fully understood.Objective To understand the prognosis and influencing factors of patients with post-tuberculosis bronchiectasis and provide scientific basis for improving the prognosis of these patients.Methods A total of 337 patients with post-tuberculosis bronchiectasis who were hospitalized in Guiyang Public Health Treatment Center from April 2023 to April 2024 were selected.Telephone follow-up was conducted on their prognosis 6 months after discharge,and they were divided into the good prognosis group and the poor prognosis group.The random forest model and LASSO regression were used to screen and analyze the influencing factors of the prognosis and rank their importance.Results The incidence of poor prognosis in 337 patients with post-tuberculosis bronchiectasis was 41.2%(139/337).There were statistically significant differences in age,educational level,BMI,previous smoking,the percentage of forced expiratory volume in one second(FEV1%pred),alveolar lavage,combined chronic pulmonary heart disease,combined chronic obstructive pulmonary disease,combined hypertension,Pseudomonas aeruginosa infection,post-discharge smoking,post-discharge drinking,lack of daily exercise,living alone,non-compliance with medication as prescribed,and levels of interleukin-6(IL-6)and high-sensitivity C-reactive protein(hs-CRP)at discharge between the two groups(P<0.05).LASSO regression model analysis was conducted on the variables with significant differences in the univariate analysis,and a total of 9 variables were selected.The results of the random forest model showed that the order of importance of each influencing factor was as follows:non-compliance with medication as prescribed,post-discharge smoking,lack of daily exercise,educational level,combined chronic pulmonary heart disease,discharge IL-6,age,post-discharge drinking,and living alone.The results of the multivariate Logistic regression analysis showed that non-compliance with medication as prescribed(OR=8.394,95%CI=3.323-21.203),post-discharge smoking(OR=5.294,95%CI=2.313-12.116),lack of daily exercise(OR=4.555,95%CI=2.206-9.406),combined chronic pulmonary heart disease(OR=4.331,95%CI=2.012-9.323),discharge IL-6(OR=1.054,95%CI=1.018-1.091),and age≥80 years(OR=5.246,95%CI=1.097-25.077)were risk factors for the prognosis of patients with post-tuberculosis bronchiectasis(P<0.05),while primary education(OR=0.358,95%CI=0.143-0.898)and secondary education(OR=0.202,95%CI=0.074-0.554)were protective factors for the prognosis of patients with post-tuberculosis bronchiectasis(P<0.05).Conclusion Patients with post-tuberculosis bronchiectasis have a relatively high incidence of poor prognosis.Non-compliance with medication as prescribed,smoking after discharge,lack of daily exercise,combined chronic obstructive pulmonary disease,IL-6 at discharge,age≥80 years old,and educational level are important influencing factors for tuberculous bronchiectasis.Targeted measures can be taken based on these influencing factors.
