BackgroundSports injuries are prevalent among university students, yet psychological mechanisms of post-injury exercise maintenance intention need further study. Integrating the Health Belief Model (HBM) and Theory of Planned Behavior (TPB), this study examined how risk perceptions and cognitive factors were associated with continuous exercise intention, focusing on the pivotal role of control beliefs regarding exercise rehabilitation in translating risk perception into volition.MethodsA cross-sectional survey sampled 421 university students who had a sports injury in the past 12 months. We integrated HBM and TPB, reconstructing perceived behavioral control and self-efficacy into control beliefs regarding exercise rehabilitation. SPSS 26.0 and AMOS 26.0 were used for SEM and bootstrapping mediation tests.ResultsThe model fit well (χ2/df = 2.799, CFI = 0.907, RMSEA = 0.065). Perceived susceptibility and health benefits were positively associated with attitude toward sustained exercise; perceived severity was negatively associated with attitude (β = −0.332, p < 0.001); perceived barriers had no significant direct effect. Mediation analyses revealed a dual-route pattern: perceived health benefits were associated with intention through the chain of attitude → control beliefs [95% CI (0.1135, 0.2500)]. Perceived susceptibility and barriers were indirectly related to lower control beliefs, and this relationship did not operate through attitude. Subjective norm was associated with intention, fully mediated by control beliefs (Effect = 0.3505). Control beliefs showed the largest predictive effect size on intention in the present model (β = 0.824, p < 0.001).ConclusionContinuous post-injury exercise intention was associated with a stepwise path of attitude → control beliefs → intention. Perceived health benefits were associated with intention through this chain, while the pattern for perceived severity was consistent with fear-avoidance theory. Control beliefs connected internal values and social norms. The findings suggest that interventions may benefit from shifting from risk intimidation to benefit empowerment, and from reconstructing rehabilitation control through social support networks—though these candidate directions await experimental validation.
BackgroundNeighborhood built environment (BE) is associated with physical activity (PA) and health-related conditions among local residents, particularly older adults. As an easily operational instrument, the Physical Activity Neighborhood Environment Scale (PANES) has been widely used to measure BE attributes related to PA globally. However, evidence remains limited on how older adults with different sociodemographic characteristics perceive local BE attributes in China. This study aimed to investigate the associations between sociodemographic characteristics and BE attributes among older residents in regional China.MethodsIn this cross-sectional survey conducted in Nanjing Municipality, China, in 2023, 5,484 community-dwelling adults aged 60 + years were randomly selected. Six out of seven objectively measurable PANES core items were used to assess BE attributes, and they were treated as outcome variables. Item 1 recorded the exact housing type, while each of the remaining five items was classified as “strongly/somewhat disagree” or “strongly/somewhat agree” based on a 4-point Likert scale. The explanatory variables were the classical sociodemographic characteristics. Mixed-effects multivariate logistic regression models were used to investigate the associations between sociodemographic characteristics and BE attributes.ResultsAfter adjusting for potential confounders, suburban residents were less likely to perceive PA-favorable commercial facilities, public transportation transit/stops, sidewalks on streets, shared paths for cycles and pedestrians, and free/low-cost recreational facilities. Blue-collar workers were less likely to perceive PA-supportive sidewalks on streets and shared paths for cyclists and pedestrians. Participants with middle-level educational attainment were more likely to report PA-friendly commercial facilities, sidewalks, shared paths for cycles and pedestrians, and free/low-cost recreational facilities, whereas individuals with a spouse/partner tended to report sidewalks and shared paths for cycles and pedestrians. Interestingly, participants aged 70–79 years were less likely to live in a single house, and no link was observed between sex and perceived BE attributes.ConclusionResidential location, education, occupation, and marital status were all associated with perceived BE attributes among older residents in regional China; however, age was only associated with the type of housing. This study has important public health implications, suggesting that sociodemographic characteristics may serve as helpful markers for screening older community-dwelling adults who may perceive PA-supportive BE attributes in regional China.
Generative artificial intelligence has lowered the threshold for access to health information, but increased access does not equate to optimal use. While the new generation of older adults benefit from greater convenience, their decision-making risks have not decreased correspondingly, thereby constituting a new health decision-making paradox. To uncover the underlying mechanism by which generative AI health consultations influence decision quality, this study integrates triadic reciprocal determinism and metacognitive theory, constructing an analytical framework with “generative AI health consultation-intelligent information-health decision quality” as the core pathway. Intelligent information is divided into five stages: attention, perception, discernment, trust, and reliance. This study introduces intelligent boundary awareness, algorithmic pandering awareness, and health autonomy orientation as moderating variables, thereby characterizing differentiated effects under varying cognitive and behavioral contexts. Furthermore, this study employs a hybrid methodological approach that combines structural equation modeling and fuzzy-set qualitative comparative analysis to test the model, identifying three types of high-quality health decision-making patterns: trust-reinforced, autonomous adaptive, and cognitive adoption modes. The results indicate that: (1) Generative AI health consultation improves decision quality not merely by increasing the supply of information, but by reshaping new generation of older adults' cognition and engagement patterns with intelligent information; (2) Intelligent boundary awareness, algorithmic pandering awareness, and health autonomy orientation significantly moderate the translation of intelligent information into decision quality, thereby revealing cognitive and agentic boundaries of decision efficacy; (3) The three identified patterns transcend linear explanations based on single factors, health decision quality depends on differentiated alignment among information cognition, technological relationships, and individual autonomy. Therefore, the key to enhancing the efficacy of generative AI health consultations is to shift from tool provision to empowerment, with a primary focus on strengthening intelligent information discernment, rational trust, and autonomous decision-making capabilities in the new generation of older adults.
Walking speed predicts survival, cognitive decline, and disability in older adults with a precision comparable to that of blood pressure—yet no single discipline organizes itself primarily around walking. The result is a clinical vacuum: when walking deteriorates from the convergence of weak feet, eroding confidence, and an unwalkable neighborhood, patients have no specialist to consult and clinicians have no integrative framework to apply. We propose Gait Medicine as an interdisciplinary field organized around a three-layer model—somatic (foot structure, neuromuscular function, sensory-perceptual systems, cognition, affect, and motivation), environmental (footwear and built environment), and meaning (social participation, cultural significance, and evolutionary origin)—with autonomous mobility as its superordinate concept, explicitly encompassing those who cannot walk. We define the field’s conceptual boundaries, distinguish it from five adjacent disciplines, respond to three anticipated objections, and outline clinical implications including a Gait Clinic prototype and urban policy applications. The three-layer coupling model generates falsifiable predictions about integrative interventions that can be tested empirically. Gait Medicine does not claim to have discovered walking. It argues that medicine has not yet organized a discipline around it—and that the evidence, the patients, and the technology now make doing so both feasible and necessary.
IntroductionAdolescence is a period associated with increased risk of gambling problems. Although strict age limits should apply in modern digital gambling platforms, gambling in minors remains a challenge. The present study aimed to study high school students’ gambling both before and after the legal gambling age, and to study associations between gambling-related attitudes and screening positive for problem gambling.Materials and methodsThe study is based on a digital survey which was distributed by teachers to high school students in Lund, Sweden, in April/May, 2025 (n = 528). Self-reported history of gambling was reported for each form of gambling, and problem gambling was screened for using the three-item NODS-CLiP and combined with demographic data and gambling attitudes. Risk factors for screening positive for problem gambling were studied in multivariate logistic regression analyses, including gender and age, measures of gambling-related attitudes, and each separate gambling form.ResultsA positive screen for problem gambling (NODS-CLiP >0) was seen in 16% at age 16, 15% at age 17, and 27% at age 18–19, in total among 31% of boys and 4% of girls. Gambling on online casino was reported by 41% if 18 + years and by 20% if below 18 years of age, and sports betting by 32 and 21% before and after 18 years of age, respectively. Screening positive for problem gambling was more common in case of parental acceptance of gambling, hiding gambling from parents, and liberal attitudes towards gambling policy, and in the multivariate analysis, problem gambling was significantly associated with online casino, sports betting, and gambling within videogames.ConclusionIn the present high school survey, gambling was very common, even before legal gambling age. Participants commonly screened positive for problem gambling, with a large risk increase in boys, and most strongly associated with online casino, sports betting, and gambling within videogames. Society-level policy interventions, as well as individual prevention targeting gambling attitudes, are called for.
BackgroundWith the rapid increase in the incidence and mortality of lung cancer, a growing number of patients with lung cancer and their families are facing a tremendous economic burden owing to the high cost of treatment in China. This study aimed to estimate the long-term (5 years post-diagnosis) economic burden on patients with lung cancer newly diagnosed in 2015 in China.MethodsThis study utilized data from a multicenter survey, involving 469 patients in eastern, central, and western China. From the survey, direct and indirect economic burdens were calculated, and the number of survivors 5 years later based on the national incidence of lung cancer and the observed survival rate in 2015 were estimated. Based on this, we performed descriptive statistical analysis using Excel and calculated the long-term economic burden on patients with lung cancer across the country in 2015 during the 5 years after disease onset.ResultsThe total economic burden for the 2015 cohort 5 years post-diagnosis was $12.7 billion, equivalent to 0.13% of China's 2015 gross domestic product. Direct costs accounted for 64% ($8.1 billion), while indirect costs accounted for 36% ($4.6 billion). Among the investigated components, direct medical costs constituted the largest share (57% of the total burden), followed by indirect costs from missed work (26%), indirect costs from premature death (10%), and direct non-medical costs (7%).ConclusionThe economic burden of lung cancer in China is substantial and is dominated by direct medical costs. There is an urgent need for policy measures focusing on multi-tiered medical insurance system improvements, cost-control mechanisms, and the promotion of early screening and diagnosis to alleviate this burden on patients, families, and the healthcare system.
ObjectivesThis study examined whether past-month alcohol use after the lockdown was higher or lower than expected based on the pattern observed before the lockdown in 13 Indian states and Union Territories, with particular attention to differences by gender, socioeconomic status, and state alcohol-policy context.MethodsWe analysed National Family Health Survey data from 13 Indian states and union territories surveyed before and after the lockdown period. The primary outcome was any past-month alcohol use vs. no alcohol use. To address sparse alcohol-use categories, especially among women, we used Bayesian aggregated binomial logistic regression models estimated separately for women and men. Models included time trend, post-lockdown period, subgroup interactions, and state-level random intercepts. Subgroup-specific posterior odds ratios, predicted probabilities, 95% credible intervals, and posterior probabilities were estimated for age, residence, education, wealth, marital status, religious alcohol norms, scheduled tribe status, and state alcohol-policy category.ResultsAmong women, the odds of past-month alcohol use after the lockdown were higher than expected based on the earlier pattern. The posterior odds ratio for women was 1.83, with a 95% credible interval of 1.42–2.20, and the posterior probability of a positive association was approximately 1.00. Among men, the estimated association was smaller but still had high posterior probability, with a posterior odds ratio of 1.09, a 95% credible interval of 1.01–1.16, and a posterior probability of positive association of 0.99. Subgroup results suggested that positive associations among women were more evident among older women and socioeconomically disadvantaged groups, including rural women and women with lower education or wealth. Among men, subgroup patterns were smaller and more heterogeneous.ConclusionThe association between the post-lockdown period and past-month alcohol use differed between women and men in the 13 included states and union territories. The strongest positive association was observed among women, particularly women in socioeconomically disadvantaged subgroups such as rural women and women with lower education or wealth. These findings represent adjusted associations and should not be interpreted as causal effects of the national lockdown.
ObjectiveThis single-center, cross-sectional study investigates the health management demands, service utilization patterns, and their determinants among the older adults in a community of Liuzhou City, to provide empirical evidence for optimizing community-based older adults health services. With rising retirement ages and the increasing proportion of older workers in China’s labor force, this study also examines how work status and schedule compatibility shape service utilization.MethodsUsing a convenience sampling method, a questionnaire survey was conducted among 320 older adults individuals aged 60 and above in the jurisdiction of a community health service center in Liuzhou City in 2025. Grounded in Andersen’s Behavioral Model, the survey covered predisposing, enabling, and need factors, alongside service utilization. Data were analyzed using descriptive statistics, chi-square tests, and binary logistic regression.ResultsThe chronic disease prevalence was 68.4%. While 82.5% were aware of the available community health services, only 45.6% regularly participated. The top three desired services were routine physical examinations (91.2%), chronic disease management (87.5%), and home-based medical services (65.3%). Regression analysis indicated that education level (OR = 2.35, 95% CI: 1.21–4.56), monthly income (OR = 1.98, 95% CI: 1.05–3.73), number of chronic diseases (OR = 3.11, 95% CI: 1.67–5.79), and co-residence with family (OR = 0.45, 95% CI: 0.22–0.92) were significant predictors of active participation. Need factors were the primary driver of participation, while enabling factors acted as critical facilitators or barriers.ConclusionA significant “high demand, low utilization” paradox exists. These findings highlight a need for targeted, locally-tailored strategies focusing on vulnerable groups (e.g., low-income, single-living, less-educated older adults) in Liuzhou. Strengthening health education, diversifying services (especially home-based medical services), and integrating family support may enhance the effectiveness of community health management programs. However, further research in diverse settings is required to confirm the generalizability of these conclusions.
Twentieth-century medicine was most successful against diseases sharing a particular causal architecture: a discrete lesion standing in a relation of approximate necessity and sufficiency to a clinical syndrome, amenable to specific perturbation. Mortality from acute myocardial infarction has fallen by nearly 90 percent in the United States since 1970; pediatric leukemia has become survivable; HIV has become chronic. That success has shifted the residual burden toward conditions with a different architecture—late-life neurodegeneration, multimorbidity, frailty, idiopathic neuropathy—in which pathology is distributed across scales, and no single node carries the necessity that targeted intervention requires. The failure is not that medicine has extended life. It is that biomedical institutions have not adapted to the forms of vulnerability that accompany longer lives, and the non-adaptation is structural rather than accidental. This paper asks why: why funding and evaluation systems systematically favor research on discrete diseases and individual molecular targets over integrated research on aging as a systemic, multiscale, temporally extended process. We distinguish two levels at which the apparatus fragments its object. First-order fragmentation partitions aging into separately funded age-related diseases. Second-order fragmentation partitions aging itself into hallmarks, pathways, and targets pursued independently—which is why geroscience, the framework formulated to unify the age-related diseases, is decomposed by the apparatus that funds it. We specify the funding signatures each level of fragmentation predicts—across award duration, award mechanism, intervention modality, and the ratio of disease-specific to process-directed funding—and identify the data that would test them; we distinguish the several senses of reductionism at issue, defending integrative explanatory pluralism rather than holism; and we assess whether the hallmarks framework supports integration or licenses a longer list of targets. The argument is that the conceptual case for a multiscale account of late-life disease has been adequately made, and what remains unbuilt is institutional.
ObjectiveUniversity students often experience challenges in maintaining healthy eating behaviors despite possessing adequate nutrition knowledge. This study assessed nutrition knowledge, eating habits, dietary practices, food-label use, and perceived barriers to healthy eating among female nutrition students in Saudi Arabia.MethodsA cross-sectional study was conducted among 343 undergraduate and postgraduate female students enrolled in nutrition programs at King Abdulaziz University, Saudi Arabia. Data were collected using a self-administered questionnaire assessing nutrition knowledge, eating habits, dietary practices, food-label and calorie on menu use, and perceived barriers to healthy eating. Descriptive statistics, Pearson correlation analyses, and multiple linear regression models were performed.ResultsOver 90% of students recognized the health benefits of a healthy diet; however, dietary behaviors were only moderately healthy. The most commonly reported barriers were fast food availability (67.3%), the high cost of healthy foods (63.0%), social media influences on food choices (63.6%), and limited time for food preparation (52.8%). Healthier eating habits, healthier dietary practices, and greater use of nutritional information were associated with lower perceived barriers to healthy eating, particularly student-related and food-related barriers. Healthier eating habits were independently predicted by dietary practices (β = 0.311, p < 0.001), age (β = 0.248, p < 0.001), and lower perceived student- and food-related barriers. Healthier dietary practices were independently predicted by food-label use (β = 0.412, p < 0.001), healthier eating habits (β = 0.259, p < 0.001), and marital status (β = 0.110, p = 0.031).ConclusionDespite enrolling in nutrition programs, students demonstrated only moderately healthy dietary behaviors, highlighting a knowledge–behavior gap. Interventions targeting practical, environmental, and social barriers may help promote healthier eating behaviors among future nutrition professionals.
ObjectiveTo understand the current status and associated factors of pain catastrophizing in patients with knee osteoarthritis.MethodUsing the method of convenient sampling, 341 patients with knee osteoarthritis were recruited from 4 tertiary hospitals in Sichuan Province. From August 2023 to October 2024, data such as social demographic characteristics, Oxford Knee Score, and social support were collected through paper questionnaires.ResultThe results of this study showed that the pain catastrophizing score of patients with knee osteoarthritis was (33.70 ± 10.30). The intensity of pain during activity, Oxford knee score, anxiety, and social support (p < 0.05) jointly explained 44.1% of the variance in pain catastrophizing.ConclusionPatients with knee osteoarthritis have a high degree of pain catastrophizing. Clinical personnel should implement interventions in aspects such as social support for these patients to reduce the level of pain catastrophizing, optimize the pain trajectory, promote the rehabilitation process, and improve the quality of life.
BackgroundFamily caregivers are important sources of support for people with epilepsy (PWE), particularly in rural settings where formal services may be limited. However, less is known about caregivers' perceptions of the community and the informational and service conditions that support the inclusion of PWE.ObjectiveThis study described caregivers' perceptions of epilepsy-related support and enabling environments and examined the caregiver and contextual factors associated with these perceptions in selected rural communities in Limpopo and Mpumalanga, South Africa.MethodsA cross-sectional study was conducted among 384 family caregivers of PWE in Collins Chabane Local Municipality, Limpopo, and Bushbuckridge Local Municipality, Mpumalanga. Data were collected using a self-developed questionnaire covering stigma, caregiving burden, barriers, and support or enabling conditions. The instrument underwent an exploratory ordinal psychometric assessment. Perceived epilepsy-related support and enabling conditions were measured using a four-item continuous score ranging from 4 to 20. The score demonstrated acceptable preliminary ordinal reliability (ordinal α = 0.723; McDonald's ω = 0.729). Multivariable linear regression with heteroscedasticity-robust standard errors was used to identify associated factors.ResultsThe mean age of respondents was 49.4 years (SD = 14.6; median = 49; IQR = 39–60; range = 18–86). The mean support and enabling-environment score was 6.52 (SD = 2.77), indicating limited availability of the measured support structures. Caregivers at the Mpumalanga study site had scores that were, on average, 1.13 points lower than those at the Limpopo site after adjustment (B = −1.13; 95% CI −1.71 to −0.54; p < 0.001). A greater emotional and safety-related caregiving burden was associated with a lower support-environment score (B = −0.31; 95% CI = −0.44 to −0.18; p < 0.001). Age was not independently associated with the continuous outcome (B = −0.010; 95% CI = −0.032 to 0.012; p = 0.377). The positive association between barriers and the support-environment score was not interpreted substantively because shared item wording and response style may have contributed to this relationship.ConclusionCaregivers reported limited access to support groups, epilepsy management information, community leadership support and organized community inclusion mechanisms. The findings describe perceptions of the contextual support environment rather than direct family acceptance of PWE. Further development and independent validation of the questionnaire are required.
BackgroundAs higher education increasingly shifts toward online models, nursing education has also widely adopted digital learning formats, one of the key theoretical foundations of which is the self-regulated learning model. Existing research has confirmed that academic self-efficacy is significantly and positively associated with the development of students’ self-regulated learning abilities. However, its mediating mechanism between online real-time teaching interaction and self-regulated learning ability in nursing students has not yet been systematically explored.MethodsThis study adopted a cross-sectional survey design. From September 30th, 2025 (with a data collection period of one week), a questionnaire survey was conducted among nursing students from four nursing undergraduate programs in Jilin Province. Using the convenience sampling method, a total of 813 valid questionnaires were collected. Data were collected through questionnaires, utilizing the following instruments: the online real-time teaching interaction (ORTTI), the academic self-Efficacy (ASE), and the self-regulated learning (SRL) scales. All data were processed using the SPSS AU statistical analysis platform. Analytical methods encompassed descriptive statistics, correlation analysis between variables, path analysis with Bootstrap mediation testing, and mediation effect testing for academic self-efficacy.ResultsThe results indicate that, the online real-time teaching interaction was significantly and positively related to self-regulated learning ability in nursing students (r = 0.809, p < 0.01). Academic self-efficacy appears to partially mediate the relationship between online real-time teaching interaction and self-regulated learning ability. Its mediating effect value is 0.478, accounting for 56.7% of the total effect.ConclusionThese findings suggest that online real-time teaching interaction is directly and positively associated with the self-regulated learning ability of nursing students, and may also be indirectly associated with it through higher academic self-efficacy. The results highlight the importance of intentionally designing interactive components in online nursing education that support academic self-efficacy. These findings may inform the design of interactive online courses that support nursing wstudents’ academic self-efficacy and self-regulated learning.
Screening for text-implied structural gaps in policy documents is an important component of public health policy review, particularly when implementation relies on online portals, digital identity verification, remote-care platforms, or self-service processes. However, existing text classifiers, large language model prompting methods, and retrieval-based approaches often provide document-level predictions or general explanations without explicitly representing key elements, relations, and potentially missing links in policy implementation. This study proposes Policy Review Process-Knowledge Graph (PRP-KG), a large language model-enhanced knowledge graph framework for identifying structural-gap review signals across policy clauses, implementation processes, and target populations. PRP-KG segments policy documents into clauses, extracts implementation-related elements using a predefined policy-execution schema, and grounds the extracted entities and relations in source evidence spans. The validated elements are then organized into a three-layer knowledge graph. A graph-consistency feedback mechanism revises missing or schema-inconsistent triples, after which structural-gap patterns identify text-implied gaps in execution specification, accessibility safeguards, and service-support coverage. Experiments on policy-text annotation benchmarks constructed from public sources show that, under the evaluated settings, PRP-KG achieves lower prediction error and more accurate identification of high-priority text-implied review signals than most comparison methods. Controlled analyses indicate comparatively stable performance under the evaluated perturbations and provide evidence-linked outputs that can be inspected by policy reviewers.
IntroductionThis repeated cross-sectional retrospective study examined between-class variation in university students’ physical-fitness scores and whether annual composite-score trends were concordant with changes in BMI-defined abnormality.MethodsAnnual surveillance records collected from 2020 to 2024 at one public university in Sichuan Province, China, were analysed. The dataset included 106,461 records from 2,591 class-year units (44,240 male, 62,221 female; mean age 20.67 ± 1.54 years; mean BMI 21.64 ± 3.52 kg/m2). Multilevel models quantified between-class variation and examined individual- and class-compositional correlates, with calendar year entered categorically. A complementary temporal analysis compared annual composite scores with the prevalence of underweight, overweight, or obesity using Chinese national cut-points.ResultsThe null-model intraclass correlation coefficient was 0.178, indicating meaningful between-class clustering. After adjustment, higher within-class BMI, older age, and male sex were associated with lower composite scores. At the class level, higher mean BMI was associated with lower scores, whereas the class-size association was statistically significant but practically negligible. The within-class BMI–fitness association varied across class-year units, although heterogeneity was modest and the association was negative in almost all units. Composite scores increased in 2021, declined in 2022, and increased again in 2023–2024. In contrast, BMI-defined abnormality rose every year, from 23.3% in 2020 to 31.4% in 2024.DiscussionUniversity fitness data have a meaningful clustered structure, and improvement in a weighted composite score does not necessarily imply parallel improvement in the BMI distribution. Surveillance reports should therefore account for clustering and present composite scores alongside BMI categories and component-specific outcomes.
BackgroundWhile conventional lipid parameters are linked to gallstone disease, the specific role of small dense low-density lipoprotein cholesterol (sdLDL-C)—a highly atherogenic subfraction—remains unexplored. We aimed to evaluate the independent association between estimated sdLDL-C and gallstone risk, and to map potential cross-population dose-response relationships.MethodsThis dual-source cross-sectional study integrated a strictly defined Chinese clinical sample (n = 730, comprising 334 symptomatic surgical cases and 396 healthy controls from routine health check-ups) and the US NHANES database (n = 6,799). To facilitate large-scale, cost-effective screening, serum sdLDL-C was estimated using the internationally validated Sampson equation, strictly excluding subjects with extreme hypertriglyceridemia (TG ≥ 800 mg/dL). Multivariate logistic regression and two-piecewise models were utilized to evaluate independent associations and potential non-linear patterns. Sensitivity analyses rigorously excluded patients with major metabolic comorbidities (hypertension, diabetes, and clinical dyslipidemia).ResultsIn the multivariable-adjusted models, when analyzed as a continuous variable, elevated estimated sdLDL-C was significantly and positively associated with gallstone risk in both the Chinese sample (OR = 1.12, 95% CI: 1.08–1.15) and the NHANES cohort (OR = 1.03, 95% CI: 1.01–1.04). Sensitivity analysis excluding individuals with diabetes and hypertension confirmed the stability of this positive association (OR = 1.11, 95% CI: 1.07–1.15). Dose-response analysis revealed a non-linear threshold effect in the Chinese sample, with an inflection point at 34.51 mg/dL (sdLDL-C ≥ 34.51 mg/dL: OR = 1.27, 95% CI: 1.20–1.34, p < 0.001), whereas a steady linear association was observed in the NHANES population. Stratified analyses indicated that this positive association was particularly prominent in females and diabetic individuals.ConclusionEstimated sdLDL-C exhibits an independent and positive association with gallstone disease, suggesting it might be more than merely a secondary manifestation of late-stage metabolic syndrome. The identification of a specific non-linear threshold in the Chinese population, juxtaposed with a linear pattern in the US, suggests the potential value of exploring sdLDL-C for risk stratification in biliary diseases, though these cross-sectional findings require prospective validation.
BackgroundCommunity-acquired pneumonia poses a significant threat to children's health. Traditional respiratory rehabilitation often suffers from poor adherence due to children's limited cognitive abilities. This study aimed to evaluate the effects of a fun game-based intervention on respiratory function, exercise capacity, and rehabilitation compliance in children with pneumonia.MethodsA single-center, two-arm, parallel-group randomized controlled trial was conducted. A total of 170 children recovering from pneumonia and meeting the inclusion criteria were recruited from a tertiary hospital in Shenzhen and randomly allocated to either an intervention group or a control group. Ultimately, 154 participants (77 per group) completed the study. The control group received conventional respiratory training and health education. The intervention group participated in an 8-week fun game-based program, including respiratory training games (e.g., “Blow Out the Little Candle”), physical activity games (e.g., “Rhythmic Breathing Run”), along with interactive feedback mechanisms and personalized adjustments. Pulmonary function (FEV1/FVC ratio), exercise capacity (6-min walk distance, 6MWD), and rehabilitation compliance (Frankl and Houpt scale scores) were measured in both groups before and after the intervention.ResultsNo statistically significant differences were found in baseline characteristics or outcome measures between the two groups before the intervention (P > 0.05). After the 8-week intervention, the intervention group showed significantly greater improvement in pulmonary function (FEV1/FVC: 84.69 ± 2.34 vs. 74.43 ± 2.27, P < 0.001) and exercise capacity (6MWD: 593.63 ± 19.91 m vs. 556.35 ± 30.48 m, P < 0.001) compared to the control group. Regarding compliance, post-intervention Frankl scores (3.87 ± 0.34 vs. 3.10 ± 0.60) and Houpt scores (2.91 ± 0.86 vs. 3.19 ± 0.78) indicated significantly better cooperation willingness and treatment completion in the intervention group (P < 0.05).ConclusionThe fun game-based intervention significantly improves pulmonary function and exercise capacity, while effectively enhancing compliance and completion rates in the rehabilitation of children with pneumonia. This approach is economical, feasible, and effective, offering a novel strategy for clinical nursing and rehabilitation practice in pediatric pneumonia.Clinical trial registrationhttps://www.chictr.org.cn/showproj.html?proj=269965
BackgroundIn 2010, Kenya’s Constitution created a devolved governance structure, with county governments assuming responsibility for health service delivery after 2013. Eye health carries a burden, with blindness prevalence at 0.37% and vision impairment affecting 11.0–37.5% across regions. Policy and financing mechanisms shaping service availability remain poorly understood. Kenya has advanced through seven strategic plans, the latest being the National Eye Health Strategic Plan (NEHSP, 2020–2025). While plans provide direction, they have operated without a policy framework, limiting financing, accountability, and sustainability. The Ministry of Health is developing Kenya’s first eye health policy, offering an opportunity to address gaps. We conducted documentary analysis of national and county documents to assess eye health integration and financing in Kenya’s devolved health system.MethodsSources included national strategic plans and disease-specific policies, county policies and draft policies, and documents: County Integrated Development Plans (CIDPs), Annual Development Plans (ADPs), and Budget Review and Outlook Papers (BROPs) aligned with the 2023–2027 cycle. Two researchers coded policy documents using indicators from the Walt and Gilson policy triangle framework, reaching consensus on items. Findings apply to seven selected counties.ResultsNationally, the NEHSP provides direction but does not mandate budget allocations. At county level, one county had a validated policy and strategic plan; two had strategic plans; and four had draft policies. All seven County CIDPs mention eye health, with four establishing budget lines. Six counties included budget estimates in CIDPs or ADPs. However, actual expenditure could not be traced as resources may be embedded within broader allocations. Budget estimates exist, but disbursement or expenditure cannot be confirmed. Moreover, most policies are dated 2025-2026, while fiscal documents were prepared earlier in the 2023–2027 cycle. This temporal mismatch limits linkage between policy adoption and documented allocations.ConclusionCounty-level policy adoption and fiscal visibility remain limited in the seven purposively selected counties. Most evidence is confined to budget estimates rather than documented allocations or expenditure. Kenya’s first national eye health policy is an opportunity to embed financing and accountability provisions. Findings underscore the need for vertical coherence in decentralized systems and suggest an inductive adaptation of the Walt and Gilson policy triangle to capture multilevel governance dynamics.
