BackgroundAccelerated global population aging has increased the urgency of identifying effective non-pharmacological strategies to reduce mortality risk among older adults. Although exercise serves as a key protective factor, industrial air pollution may attenuate its health benefits, and this interaction remains unclear. This study aims to investigate whether county-level industrial air pollution indicators modify the association between exercise and all-cause mortality among older adults.MethodsA longitudinal survival analysis was performed using the Chinese Longitudinal Healthy Longevity Survey (2008–2014) with multistage stratified sampling across 23 provinces. The analysis included 16,954 participants aged ≥ 65 years with three follow-up waves spanning 6 years. Self-reported current exercise habits, survival outcomes, health status, sex, smoking status, baseline age, residence, body mass index, functional status, and comorbidity count were extracted. County-level industrial air pollution indicators (annual soot and SO2 emissions, and removals) were matched to individuals according to their residence. All pollution indicators were standardized, and time-varying covariates were updated at each wave. Cox proportional hazards models were constructed sequentially: univariate models for core variables (exercise habits and industrial air pollution indicators), two-way interaction models, and multivariate models with sequential adjustment for covariates (sex, health status, baseline age, smoking status, residence, BMI, functional status, and comorbidity count).ResultsSelf-reported current exercise habits were significantly associated with lower all-cause mortality risk after multivariate adjustment (fully adjusted HR = 0.835, 95% CI: 0.773–0.902, p < 0.001). SO2 emissions showed a weak association with survival risk in univariate analysis (HR = 1.023, 95% CI: 0.942–1.111, p = 0.585). The association estimate was further attenuated after multivariate adjustment (fully adjusted HR = 1.001, 95% CI: 0.874–1.146, p = 0.992). Soot-related indicators showed no significant mortality associations. The interaction between exercise habits and each of the four industrial air pollution indicators was not significant (all p > 0.05).ConclusionSelf-reported current exercise habits were consistently associated with lower all-cause mortality among Chinese older adults, and this association was robust to adjustment for covariates. No statistically significant multiplicative interaction was detected between exercise habits and any of the four pollution indicators. Continued attention to industrial emission control remains warranted, while promoting habitual exercise among older adults may be beneficial in areas with industrial emissions.
Background:Meteorological factors are key triggers for infectious diseases in high-density cities, yet their influence on the acute disease patterns of influenza, mumps, scarlet fever, and hand-foot-and-mouth disease (HFMD) remains unclear. This study aims to reveal the variations in relative risk and secondary infection associated with meteorological factors, thereby providing clues for further confirmatory research. Methods:We analyzed city-wide incidence data from 2012 to 2020 alongside daily meteorological observations. Distributed lag non-linear models (DLNM) were used to quantify exposure-lag-response relationships. Andersen-Gill models assessed effects on disease recurrence, and Cox models evaluated risks of sequential infections between disease pairs, stratified by season. Results:The peak-risk temperatures were 14.5 °C for influenza, 18.5 °C for mumps, 17 °C for scarlet fever, and 28.5 °C for hand-foot-and-mouth disease (HFMD). Average temperature (AT) increase raised influenza recurrence risk (e.g., 1.3% higher risk per 1 °C in children aged 0-14 years). Greater temperature variability reduced sequential infection risk for influenza after HFMD in the cold season (Hazard Ratio [HR] = 0.16) and warm season (HR = 0.14). Increased diurnal temperature range also lowered this risk in the cold season (HR = 0.09). Higher AT in warm season reduced sequential infection risks from influenza to HFMD (HR = 0.61). Increased relative humidity was protective in the cold season but became a risk factor in the warm season in specific disease. Conclusion:Meteorological factors are pivotal in modulating the dynamics of common infections, and influencing both recurrence and sequential transmission. The protective effect of increased temperature variability against secondary infections highlights a complex climate-susceptibility interaction at the population level.
BackgroundHealth Qigong is widely used for health promotion in older adults. This study aimed to systematically evaluate its effects on physical function, psychological well-being, and quality of life (QoL), alongside the moderating effects of intervention characteristics.MethodsSeven databases were systematically searched (up to May 2025). Twenty-two randomized controlled trials involving 1,791 older adults were included. Risk of bias was assessed using Cochrane RoB, and meta-analyses were performed using RevMan 5.4 and Stata 18.0.ResultsHealth Qigong significantly improved 6-min walk distance (MD = 18.05 m, p = 0.03), balance (SMD = 1.70, p = 0.004), depressive symptoms (SMD = −0.64, p = 0.004), and QoL (SMD = 0.76, p = 0.03), but showed no significant effect on activities of daily living (ADL). Subgroup analyses suggested that while Qigong’s benefits on most outcomes were comparable to conventional exercise, it may have greater potential in enhancing QoL. Additionally, regimens with high frequency (≥3 sessions/week), long duration (≥12 weeks), and moderate session length (<60 min) appeared to maximize benefits for alleviating depression and improving QoL.ConclusionHealth Qigong is an effective intervention for promoting multidimensional health in older adults. While most of its benefits are comparable to conventional exercise, Health Qigong may offer unique advantages in improving QoL. For clinical and community practice, a regular regimen of “high frequency, long duration, and moderate session length” is recommended, with flexible adaptations based on individual health conditions.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251112609.
BackgroundMicroplastics are heterogeneous environmental contaminants whose transport, persistence, and potential biological interactions may depend on particle morphology, size, geometry, and polymer composition. Environmental monitoring studies commonly describe particle occurrence within individual matrices, whereas experimental studies frequently use standardized particles that may not adequately represent environmentally observed configurations.ObjectiveThis study aimed to characterize microplastic morphology, dimensional characteristics, size distribution, and polymer composition in drinking-water and estuarine datasets and to identify environmentally observed particle profiles that may inform future musculoskeletal research.MethodsTwo publicly available environmental datasets were analyzed separately. Overall morphology was summarized across 44,221 San Francisco Bay particle records with valid classifications. For matrix-level analyses, quality-assurance samples were excluded, and sample-level morphology proportions were compared using permutational multivariate analysis of variance based on Bray–Curtis dissimilarities with 9,999 permutations. Homogeneity of multivariate dispersion was assessed using PERMDISP. Particle length and aspect ratio were analyzed using generalized estimating equations accounting for particles clustered within samples and adjusted for environmental matrix. Drinking-water records were analyzed descriptively because of heterogeneity in observational units and analytical methods.ResultsIn the complete archived particle inventory, fibers were the most frequently recorded morphology (49.8%, n = 22,012), followed by fragments (40.3%, n = 17,804). Among 266 environmental or biological samples retained for inferential analysis after exclusion of quality-assurance samples, sample-level morphology profiles differed significantly among matrices (PERMANOVA pseudo-F = 34.14, R2 = 0.344, p < 0.001), although multivariate dispersion also differed (PERMDISP F = 94.31, p < 0.001). In cluster-adjusted models, fibers were approximately 2.51 times longer than fragments (95% CI, 2.35–2.68) and had 24.76 times their aspect ratio (95% CI, 22.70–27.01).ConclusionEnvironmental microplastics occurred as heterogeneous combinations of fibers, fragments, particle sizes, and polymer categories. These environmentally observed combinations of morphology, dimensions, and material identity may provide empirically grounded parameters for selecting more representative particles in future cartilage-, synovium-, and bone-related experimental studies. However, this study does not measure human intake, internal exposure, tissue accumulation, biological responses, or musculoskeletal outcomes and therefore does not establish toxicological risk, clinical association, or causality.
ObjectivePrompt care-seeking after rabies exposure is essential for effective post-exposure prophylaxis (PEP). This study aimed to identify independent factors associated with care-seeking delay and to map the full PEP pathway.MethodsWe retrospectively enrolled 27,930 patients attending the rabies PEP clinic at Santan Hospital, Tianjin, between February 2022 and January 2026. Delay was defined as >12 h from exposure to registration. Multivariable logistic regression, combined with XGBoost and SHAP, identified independent factors for delay and quantified their relative importance. Restricted cubic splines examined the non-linear relationship between age and delay. Subgroup analysis assessed the stability of the association of grade III exposure with more prompt care-seeking. A Sankey diagram traced the PEP pathway.ResultsThe delay rate was 29.7%. Eight independent factors were identified. Adults had a 34% higher risk of delay than children (aOR = 1.34, 95% CI: 1.22–1.47, P < 0.001). Grade III exposure was associated with more prompt care-seeking (aOR = 0.69, 95% CI: 0.65–0.73, P < 0.001). Previous rabies vaccination (aOR = 1.17, 95% CI: 1.11–1.23, P < 0.001) and inadequate wound management (aOR = 1.57, 95% CI: 1.31–1.88, P < 0.001) were associated with higher delay risk. Age showed a non-linear relationship with delay risk, with adults at highest risk. The Sankey diagram showed that inadequate wound management was rare in the PEP pathway, and the two-dose booster schedule achieved a much higher completion rate than the standard schedule.ConclusionsOur findings suggest that adults may face the highest risk of care-seeking delay, and that improving healthcare access for adults and promoting simplified vaccination schedules may be key to improving PEP quality.
ObjectiveTo explore the factors influencing the screening behavior of first-degree relatives of lung cancer patients toward low-dose computed tomography (LDCT) screening based on the Theory of Planned Behavior (TPB), gain deeper insights into their subjective experiences and core demands, and provide a theoretical basis and improvement measures for enhancing screening participation rates among this high-risk population.MethodsEmploying a descriptive phenomenological approach, semi-structured interviews were conducted with 14 first-degree relatives of lung cancer patients at a hospital from May to July 2025. Thematic analysis was performed using directed content analysis.ResultsGuided by the TPB, 11 themes across 3 dimensions were identified: Behavioral Attitudes (affirming screening value, family environment influence, cognitive biases hindering screening), Subjective Norms (influence of others’ behavior, healthcare professional recommendations, rural cognitive limitations), and Perceived Behavioral Control (financial constraints, work-time conflicts, cumbersome screening procedures, negative psychological perceptions, policy reference effects).ConclusionScreening behaviors among first-degree relatives of lung cancer patients are influenced by multidimensional factors. Healthcare providers should integrate the TPB framework and implement multi-level improvement measures—including enhanced health education, optimized screening services, and improved policy support—to increase screening adherence.
BackgroundCongenital aniridia is a rare disorder characterized by partial or complete absence of the iris and is usually associated with other ocular and systemic complications. Its lifelong and multisystem nature creates challenges that extend beyond clinical management and require coordinated, multidisciplinary, and equitable healthcare delivery.MethodsA scoping review was conducted using the Arksey and O'Malley framework and Joanna Briggs Institute methodology and reported in accordance with PRISMA-ScR. PubMed, Scopus, and Google Scholar were searched for English-language publications from January 2015 to May 2025 addressing organizational models of care, patient-management strategies, and quality-of-life assessment in congenital aniridia. Included sources were descriptively classified by study design and evidence category. Findings were synthesized using a combined deductive and inductive thematic approach.ResultsFourteen sources met the inclusion criteria and represented different geographical and healthcare settings. The evidence was predominantly observational, retrospective, descriptive, or based on expert and organizational recommendations. Across the reviewed literature, recurrent themes included multidisciplinary coordination, access to specialized expertise, structured referral pathways, registries, telemedicine, lifelong monitoring, genetic counseling, rehabilitation, and patient support. However, direct comparative and longitudinal evaluations of organizational models were lacking. Quality-of-life studies used heterogeneous assessment instruments, limiting direct comparison, although poorer visual function, advanced ocular complications, ocular pain, and broader psychological or systemic burden were generally associated with less favorable patient-reported outcomes.ConclusionThe available evidence supports the principles of lifelong, multidisciplinary, coordinated, and patient-centered care for congenital aniridia. Future health-system development may benefit from strengthened centers of expertise, standardized referral pathways, registry infrastructure, digital consultation, and improved access to specialized services. Prospective multicentre and longitudinal studies are needed to determine the comparative effectiveness of different organizational models and to standardize patient-reported outcome assessment.
Background:The growing burden of non-communicable diseases (NCDs) in Europe has intensified the need for timely, comparable, and policy-relevant health indicators derived from increasingly heterogeneous health data ecosystems. The European Health Data Space (EHDS) represents a major policy initiative to facilitate the secondary use of health data while preserving privacy, security, and national data sovereignty. In this context, federated analytics can foster international comparisons without requiring the transfer of person-level data. Objectives:This scoping review aimed to map federated analytical approaches relevant to the production of NCD indicators within the EHDS and to develop a conceptual framework linking distributed statistical methods, privacy-preserving infrastructures, and policy-oriented surveillance requirements. Materials and methods:A scoping review was conducted following the PRISMA Extension for Scoping Reviews. Searches were structured into three complementary conceptual domains: (a) federated analytical approaches, (b) distributed statistical inference methods, and (c) governance and health-data infrastructures relevant to the EHDS. Searches were performed in PubMed, Scopus, and IEEE Xplore, for studies published between 2010-26. Records were exported with abstracts and full bibliographic metadata. Deduplication and metadata-aware merging were conducted across databases using DOI and normalized-title matching. Results:We retrieved a total of 2,362 records, of which 1,285 were unique records and 104 were finally retained. The literature revealed a heterogeneous but rapidly expanding ecosystem of distributed analytical approaches. We identified three major domains: (1) distributed regression; (2) federated or distributed analytical infrastructures; and (3) privacy-preserving federated epidemiological analysis. Discussion:An increasing range of solutions for federated analytics is available for policy-grade NCD indicators. Longitudinal and survival models remain methodologically complex because of covariance structures and globally coupled risk sets. A modular approach is needed to incorporate public-health intelligence and a dynamic set of interoperable tools in the EHDS, with the active support of a decentralized network of active stakeholders. Conclusion:Federated analytics is shifting the paradigm from centralized data pooling to computation-to-data architectures. The successful implementation of NCD surveillance in the EHDS require integrating statistics with legal, IT, policy and governance mechanisms. The review outlined a conceptual framework that can couple technical innovation with the best architecture for public-health knowledge production.
BackgroundHypertension remains a major global public health challenge, with high levels of undiagnosed and poorly controlled disease contributing substantially to morbidity and mortality. Effective self management is critical for achieving optimal blood pressure control, particularly in resource constrained settings where healthcare access and continuity of care may be limited.ObjectiveTo explore self management strategies among hypertensive patients receiving treatment at primary healthcare clinics in Ga-Dikgale, Capricorn District, Limpopo Province, South Africa.MethodsA qualitative, exploratory, descriptive, and contextual research design was employed. Data were collected through in-depth individual interviews with hypertensive patients and analyzed using Tesch's open coding method of thematic analysis.ResultsFour themes emerged: (1) hypertension self management practices; (2) knowledge and understanding of hypertension management; (3) challenges affecting treatment adherence and blood pressure control; and (4) support systems for self-management. The findings revealed gaps between patients' knowledge and the implementation of recommended self-management behaviors, inconsistent medication adherence, reliance on both biomedical and traditional health practices, and the important influence of family support and healthcare system factors on hypertension management.ConclusionHypertension self management is shaped by complex interactions between individual behaviors, social support networks, and healthcare system factors. Strengthening patient centered education, ensuring consistent availability of antihypertensive medication, and enhancing family and community based support are essential strategies for improving hypertension control in rural primary healthcare settings.
BackgroundMyopia is an important public health concern among schoolchildren. This study described the prevalence of screening-defined myopia and its associated factors among schoolchildren in Urumqi using data from two independently sampled cross-sectional surveys conducted in 2012 and 2019.MethodsThe 2012 survey included 1,938 students from Xinshi and Shayibake districts, whereas the 2019 survey included 9,503 students from Xinshi, Shayibake, Tianshan, and Shuimogou districts. Information on visual status and individual and environmental factors was collected. Crude and internally standardised prevalence estimates were calculated. Because the two surveys differed in geographic coverage and sample composition, comparisons between survey years were interpreted descriptively.ResultsThe crude prevalence of myopia was 39.7% in the 2012 survey and 37.1% in the 2019 survey. After equal-weight standardisation by school stage, the corresponding estimates were 45.9 and 43.7%, respectively. Descriptive prevalence patterns differed across school stages; however, because the two surveys did not have identical geographic coverage or sampling frames, these differences should not be interpreted as evidence of a population-level temporal trend. Myopia was higher in females than males and lower in Han than other ethnic groups (all p < 0.05). Multivariable logistic regression for 2012: risk factors - reading <30 cm from books (OR = 1.51, 95%CI = 1.28–1.78), poor reading/writing habits (OR = 1.55, 95%CI = 1.26–1.91), daily computer use (OR = 1.21, 95%CI = 1.00–1.46), parental myopia (OR = 2.11, 95%CI = 1.65–2.71); protective factors - eye exercises (OR = 0.66, 95%CI = 0.53–0.81), daily outdoor time (OR = 0.84, 95%CI = 0.71–1.00), daily sleep time (OR = 0.75, 95%CI = 0.60–0.95). For 2019: risk factors - reading <30 cm (OR = 1.69, 95%CI = 1.56–1.82), poor habits (OR = 1.22, 95%CI = 1.09–1.36), parental myopia (OR = 2.22, 95%CI = 2.03–2.43); protective factors—resting eyes after 1 h reading/writing (OR = 0.79, 95%CI = 0.74–0.84), eye exercises (OR = 0.87, 95%CI = 0.79–0.95), daily TV hours (OR = 0.85, 95%CI = 0.79–0.92), frequent distance viewing (OR = 0.85, 95%CI = 0.74–0.98), daily outdoor time (OR = 0.90, 95%CI = 0.83–0.98), daily sleep time (OR = 0.84, 95%CI = 0.75–0.94), weekly frequency of eating zhuafan (OR = 0.85, 95%CI = 0.77–0.95).ConclusionMyopia represented a substantial public health burden among schoolchildren in both surveys. Several behavioural and familial characteristics were associated with myopia, although the cross-sectional design precluded causal inference. Because the two surveys used different sampling frames, the observed between-survey differences should not be interpreted as definitive evidence of a temporal change in population prevalence.
BackgroundDrowning is the leading cause of injury-related deaths among teenagers in our country. High-risk swimming behaviors show strong correlational linkage with adolescent drowning incidents.MethodsA survey was conducted with 3,239 teenagers with an average age of 12.73 ± 1.54. The swimming self-efficacy scale, water safety knowledge scale, water safety skills scale, and swimming high-risk behavior scale were used. The latent profile analysis was employed to explore differences in high-risk swimming behaviors across subgroups of swimming self-efficacy, and a chain mediation model was constructed.ResultsThe results indicate that swimming self-efficacy comprises four latent categories: fear-avoidant Swimmer (58.6%), Tentative Swimmer (20.7%), Assertive Swimmer (14.9%), and Overconfident Swimmer (5.8%). High-risk swimming behaviors increased sequentially across profiles (all P < 0.001). Compared with the Fear-Avoidant Swimmer, the Tentative Swimmer [β = 0.005, 95%CI (0.002, 0.008), P < 0.001] and the Assertive Swimmer [β = 0.006, 95%CI (0.004, 0.010), P < 0.001] exerted statistically significant chain-mediated effects on high-risk swimming behaviors through water safety knowledge and skills. In contrast, the chain mediation effect did not hold for Overconfident Swimmer [95% CI (−0.001, 0.008)]; water safety skills alone had a statistically significant mediating effect on high-risk swimming behaviors [β = 0.036, 95% CI (0.021, 0.055), P < 0.001].ConclusionThe model indicates that adolescents exhibit group heterogeneity in swimming self-efficacy, which is characterized by a dual association with high-risk swimming behaviors: as self-efficacy increases, the frequency of high-risk behaviors also rises. However, groups with high swimming self-efficacy that are supported by water safety knowledge and skills can reduce the risk of injury due to their comprehensive safety preparedness. In contrast, excessive self-efficacy not grounded in cognitive and skill-based support is prone to inducing reckless risk-taking behavior. At the same time, a bias-corrected self-help method mediation analysis revealed that, within this mediation chain, the mediating effects of “Tentative swimmer” and “Assertive swimmer” were relatively weak. This suggests that the risk-mitigating effects of traditional, comprehensive water safety education—which relies on a chain of knowledge and skills—are very limited. Implementing stratified interventions targeting adolescents' swimming self-efficacy is a crucial measure for reducing the risk of drowning.
Free-to-play games have transformed the economics of digital play, shifting revenue from upfront sales to continuous microtransactions. Research on the free-to-play model has largely focused on specific mechanics such as loot boxes or pay-to-win systems. However, little is known about how adolescents’ spending behaviour relates to problematic engagement. Drawing on survey data from 2,308 Austrian students aged 10–19 years (48.8% male; M = 14.3 years, SD = 2.1), the present study examined the distribution of in-game expenditure and its association with gaming disorder, gambling disorder, and socioeconomic status. Expenditure was highly unequal: 10% of players accounted for 61.4% of all spending, and heavy spenders showed higher prevalences of gaming disorder and gambling disorder than casual spenders. Expenditures were not significantly associated with socioeconomic status, suggesting that high spending is not limited to adolescents with greater family affluence. The concentration of spending resembles patterns observed in other highly unequal expenditure markets, including gambling, suggesting potential structural similarities between the two industries. These findings raise questions about the assumption that microtransactions are harmless optional features and suggest that policy efforts targeting only loot boxes may not fully address potential risks associated with broader monetization practices among adolescent gamers.
ObjectiveTo explore the correlation between the type and duration of moderate-to- vigorous physical activity (MVPA) and mobile phone dependence among adolescents, so as to provide a scientific basis for intervention strategies for mobile phone dependence.MethodsA total of 971 eighth-grade junior high school students in Dalian were selected by mixed sampling. The Chinese version of the Children’s Leisure Activities Study Survey was used to measure the type and duration of MVPA, and the Adolescent Mobile Phone Dependence Scale was used to assess the level of mobile phone dependence. Data were analyzed using independent samples t-test, generalized linear model, and stratified regression analysis.ResultsOpen-skill MVPA was significantly negatively correlated with physical and mental impacts caused by mobile phone dependence (β = −0.777, 95%CI: −1.268 to −0.287, p < 0.01). Meeting the MVPA duration standard was significantly positively correlated with withdrawal symptoms of mobile phone dependence (β = 1.469, 95%CI: 0.574 to 2.364, p < 0.01). Among participants in open-skill PA, the negative association between meeting the duration standard and withdrawal symptoms was stronger (β = −1.890, 95%CI: −3.046 to −0.733, p < 0.01). By contrast, closed-skill PA showed no significant correlation with any dimension of mobile phone dependence, regardless of whether the duration standard was met (all p > 0.05).ConclusionSimply meeting the daily recommended duration of MVPA fails to alleviate adolescents’ mobile phone withdrawal symptoms; only combining sufficient MVPA duration with open-skill PA yields a protective effect against mobile phone dependence. The findings of this study can provide a reference for PA arrangements in primary and secondary schools. It is recommended to promote open-skill PA and ensure that students meet the daily recommended duration of MVPA. Nevertheless, all data in this study were collected via self-reported questionnaires. Future research may integrate objective monitoring tools to further verify the findings of the present study.
BackgroundThe standardized training of general practitioners is a crucial component of postgraduate medical education and a strategic initiative in China’s healthcare workforce planning.ObjectiveTo evaluate the effectiveness of an innovative teaching model-flipped classroom (FC) combined with case-based learning (CBL) under the BOPPPS (Bridge-in, Objective, Pre-assessment, Participatory Learning, Post-assessment, Summary) framework-in the standardized training of general practice residents.MethodsThirty-eight resident trainees participating in general practice standardized training in the First People’s Hospital of Huzhou City were randomly assigned to the FC combined CBL (BOPPPS/FC-CBL) group under the BOPPPS model or the LBL group with traditional teaching. Theoretical tests, practical skills assessments, clinical thinking evaluations, and teaching satisfaction surveys were used to evaluate the teaching effects of the two groups.ResultsThe BOPPPS/FC-CBL group demonstrated significantly higher scores than the LBL group in theory tests (82.46 ± 8.34 vs. 76.82 ± 7.13, p = 0.03, d = 0.76), practical skills (101.46 ± 3.23 vs. 99.26 ± 1.62, p = 0.01, d = 1.02), and clinical case evaluations (89.73 ± 2.34 vs. 86.34 ± 1.28, p < 0.001, d = 1.80). More importantly, large to very large effect sizes were observed for teaching satisfaction (d = 1.48) and self-directed learning capacity (d = 1.62), indicating a substantively meaningful educational impact beyond statistical significance. All measures of learning engagement and competency enhancement were significantly higher in the intervention group (p < 0.05).ConclusionThe BOPPPS/FC-CBL group significantly enhances learning outcomes and satisfaction in general practice residency training, supporting its strategic scaling in China.
BackgroundTo assess the knowledge, attitudes, and practices (KAP) of healthcare professionals (HP) regarding palliative care family meetings and to identify factors independently associated with practice level.MethodsThis multicenter cross-sectional study was conducted among 401 healthcare professionals across four institutions in Fujian Province between January and February 2026. Data were collected using a validated self-designed questionnaire encompassing demographic characteristics and KAP scores. Multivariable logistic regression identified factors independently associated with practice level, and structural equation modeling (SEM) examined whether attitude mediated the knowledge-practice relationship.ResultsThe mean scores were 14.35 ± 5.95 for perceived knowledge (55.2% of maximum), 42.63 ± 5.92 for attitude (85.3%), and 24.96 ± 8.93 for practice (71.3%). Multivariable analysis identified knowledge score (OR = 1.088, 95%CI: 1.046–1.132, p < 0.001), attitude score (OR = 1.063, 95%CI: 1.023–1.104, p = 0.002), and monthly income <5,000 RMB versus >10,000 RMB (OR = 0.448, 95%CI: 0.217–0.923, p = 0.029) as independent associates of proactive practice. SEM indicated that attitude partially mediated the perceived knowledge-practice relationship (indirect effect β = 0.052, p = 0.003), with knowledge also showing a significant direct association with practice (β = 0.277, p = 0.010).ConclusionHealthcare professionals in Fujian Province demonstrated limited perceived knowledge but positive attitudes and proactive practices toward palliative care family meetings. Both perceived knowledge and attitude were independently associated with practice, with attitude serving as a partial mediator. Targeted training programs and institutional support are needed to translate positive attitudinal endorsement into consistent, high-quality practice.
BackgroundArtificial intelligence (AI) is increasingly used in healthcare, with tools such as ChatGPT, which enhances access to health information. Understanding public awareness, trust, and perceived usefulness, along with demographic influences, is essential for responsible AI adoption. This study aimed to evaluate awareness, trust, and perceived usefulness of ChatGPT in healthcare communication among adults in the Asir Region, Saudi Arabia.MethodsA cross-sectional study was conducted among adults (≥18 years) in the Asir Region from November 2025–January 2026. A validated Arabic questionnaire assessed sociodemographics, prior ChatGPT use, awareness, trust, perceived usefulness, risks, and willingness. Data were analyzed using descriptive statistics and multiple linear regression to identify predictors of willingness (p < 0.05).ResultsA total of 429 adults participated in the study. Most participants reported prior use of ChatGPT (70.40%). Awareness of ChatGPT and AI in healthcare was moderate, with higher scores among younger and more educated participants (p < 0.05). Participants generally reported favorable perceptions of the usefulness of ChatGPT, particularly for patient education and access to information, although trust remained moderate. Perceived risks included misinformation, privacy concerns, and overreliance. Overall, 61.77% of participants were willing to use ChatGPT, with significant variation by age (p = 0.030). Regression analysis showed that higher awareness (β = 0.41, p < 0.001) and trust (β = 0.36, p < 0.001) were positively associated with willingness, while risk perception was negatively associated (β = −0.12, p = 0.019). Gender and education were not statistically significant predictors.ConclusionThis study highlights generally high awareness and positive perceptions of ChatGPT among adults in the Asir Region of Saudi Arabia, with moderate levels of trust and perceived usefulness and concerns related to misinformation, privacy, and safety. Higher awareness and greater trust and perceived usefulness were associated with increased willingness to use ChatGPT, while perceived risks were associated with lower willingness to use ChatGPT. Variations across age and educational levels indicate differences in familiarity and confidence in AI tools. Overall, the findings reflect cautious but favorable openness toward AI in healthcare and emphasize the need for improved AI literacy, trust-building strategies, and regulatory oversight to support safe and informed engagement with generative AI technologies. The use of convenience sampling may limit the generalizability of the findings.
BackgroundPatients with type 2 diabetes mellitus (T2DM) commonly experience reduced muscle strength and impaired physical function, which may complicate long-term disease management. Elastic-band resistance training is inexpensive, portable, and suitable for home-based exercise; however, evidence regarding its effects on glycemic control, muscle strength, physical function, and muscle mass has not been comprehensively synthesized. This systematic review and meta-analysis evaluated the effects of elastic-band resistance training on these outcomes in adults with T2DM.MethodsPubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Database were searched from inception to June 5, 2026 for randomized controlled trials (RCTs) in adults with T2DM. Intervention effects were summarized using mean differences (MDs) or standardized mean differences (SMDs), and certainty of evidence was assessed using GRADE.ResultsFourteen RCTs involving 684 participants were included. Elastic-band resistance training was associated with reductions in HbA1c (MD = −0.41, 95% CI −0.62 to −0.20) and fasting plasma glucose (FPG; MD = −0.79, 95% CI −1.01 to −0.56), with moderate-certainty evidence for both outcomes. Leave-one-out sensitivity analyses yielded consistent results, supporting the robustness of the primary findings. Handgrip strength also improved (MD = 2.67, 95% CI 1.07 to 4.26; I2 = 0%), with moderate-certainty evidence. Muscle-mass outcomes favored elastic-band resistance training (SMD = 0.24), although the confidence interval approached the null value and the certainty of evidence was low. Walking ability and sit-to-stand performance also showed favorable trends; however, substantial heterogeneity reduced confidence in these estimates. Adverse events were inconsistently reported, precluding firm conclusions regarding intervention safety.ConclusionElastic-band resistance training may improve glycemic control and muscle strength in adults with T2DM, whereas its effects on walking ability, sit-to-stand performance, and muscle mass remain uncertain. Given its low cost, portability, and suitability for home-based exercise, it may represent a practical adjunct to comprehensive exercise management, particularly for individuals with limited access to conventional resistance-training equipment. Safety remains insufficiently characterized because adverse-event reporting was incomplete. Further high-quality randomized controlled trials are warranted to strengthen the evidence base and refine optimal training prescriptions.Systematic review registrationwww.crd.york.ac.uk/prospero, CRD420261417541.
