The emergency capacity of primary healthcare institutions is critical to the effectiveness of grassroots emergency management. This study examines the relationships among organizational culture, social capital, and the emergency capacity of primary healthcare institutions using a structural equation modeling approach. A questionnaire survey was conducted among healthcare professionals, yielding 983 valid responses for analysis. The results indicate that organizational culture, as well as structural, relational, and cognitive dimensions of social capital, are significantly associated with the emergency capacity of primary healthcare institutions within the model. In addition, social capital demonstrates mediating roles in the relationship between organizational culture and emergency capacity. Multi-group structural equation modeling further reveals variations across community types: relational social capital shows stronger associations with emergency capacity in ordinary communities, whereas structural social capital is more prominent in older communities. These findings provide empirical evidence on how organizational culture and social capital are linked to emergency capacity in primary healthcare settings, highlighting the importance of both internal cultural development and external social resources in different phases of emergency management.

Aging leads to a range of adverse health outcomes and increases the economic burden of healthcare. Therefore, understanding how to achieve and maintain successful aging is crucial for ensuring the future health of older adults. This study aimed to examine the relationships between social capital, resilience, self-care, and successful aging among older adults, with the objective of fostering and promoting successful aging. This study conducted a cross-sectional study on 584 older adults in China. Data were collected using the Successful Aging Scale, Self-care Scale, Resilience Scale, and Social Capital Scale. Hierarchical linear regression and structural equation modeling were used for analysis.The results showed that Self-care had the greatest impact on successful aging (P < 0.01) ; Social capital did not have a direct impact on successful aging (standardized direct effect = 0.054, P > 0.05); The total indirect effect of social capital on successful aging was 0.594 (P < 0.01); The individual mediation effects of resilience and self-care between social capital and successful aging were 0.200 and 0.315 (P < 0.01), respectively, while the chain mediation effect was 0.079 (P < 0.01). These findings suggested that social capital influenced successful aging mainly by enhancing resilience and promoting self-care.

Air pollution (AP) profoundly impacts human health and remains a global challenge. This study examines the global and regional burden of non-communicable diseases (NCDs) attributable to AP, analyzes heterogeneity by sex, age, and Sociodemographic Index (SDI), and predicts future trends over 25 years. Data from the Global Burden of Disease (GBD) 2021 were used. Trends in NCD mortality and disability-adjusted life years (DALYs) due to AP (1990-2021) were assessed using estimated annual percentage change (EAPC). An age-period-cohort (APC) model and Bayesian APC (BAPC) model were applied to investigate spatiotemporal differences and forecast future burden. In 2021, AP-attributable NCDs caused 6.92 million deaths (ASDR 82.8/100,000) and 161.2 million DALYs (age-standardized rate 1,879/100,000). EAPC for ASDR was -2.05 and for DALY rate -1.94. Males had higher burden than females (age-standardized DALY rate: 2,326 vs. 1,486/100,000). Individuals aged >= 50 years faced significantly greater risks. In lower SDI regions, cardiovascular diseases from particulate matter and chronic respiratory diseases from ambient ozone were particularly severe. This study identifies critical inflection points in AP-attributable NCD burden across age, period, and birth cohorts in regions with different economic development levels, forecasts future trends, and highlights the need for targeted health protection policies for vulnerable regions and populations.

BackgroundThe COVID-19 pandemic revealed a stark governance paradox in China: some resource-rich cities experienced governance failures, while relatively resource-scarce cities achieved effective control. This phenomenon challenges traditional linear resource determinism.MethodsTo deconstruct this complexity, this study applies the Technology-Organization-Environment (TOE) framework and employs fuzzy-set qualitative comparative analysis (fsQCA), a configurational method capturing asymmetric causal relations, couple with Bootstrap analysis. Using data from 23 key Chinese cities from 2020 to 2022, we explore the conditions driving urban pandemic control performance.ResultsThe analysis identifies two distinct patterns leading to high performance. First, the “digital empowerment under resource constraints” pattern reveals that in resource-scarce contexts, digital governance capacity plays a core compensatory role, empowering prevention efforts despite material deficiencies. Second, the “holistic social synergy under resource abundance” pattern demonstrates that in resource-rich cities, effective resident wellbeing is the primary driver. Notably, digital governance assumes only a peripheral role in this configuration.ConclusionThese findings confirm that no single factor guarantees success; rather, performance depends on the alignment of governance strategies with local resource endowments. This study advises city managers to prioritize digital infrastructure in resource-scarce areas while focusing on social trust maintenance in affluent regions.

OBJECTIVES:To investigate the association between accelerometer-based sleep regularity and depression, and to explore whether meeting sleep duration recommendations modifies the effects of irregular sleep patterns. METHODS:In this cross-sectional study, data were analyzed from 7402 adults who participated in the 2011-2014 NHANES and wore accelerometers. Sleep regularity patterns were quantified via the Sleep Regularity Index, and participants were classified as regular, moderately irregular, or irregular sleepers. Depressive symptoms were evaluated with the PHQ-9. Survey-weighted logistic regression, survey-weighted restricted cubic splines, and survey-weighted linear regression were employed to estimate the association between sleep regularity patterns and depression risk, with sleep duration further examined in this relationship. RESULTS:Adults with irregular sleep patterns (OR 2.65; 95% CI 1.74-4.03) exhibited a higher odds of depression compared with those with regular sleep patterns. A dose-response analysis, which treated the Sleep Regularity Index as a continuous variable, indicated a linear relationship between Sleep Regularity Index and depression. Notably, individuals with irregular sleep patterns faced a higher odds of depression (OR 2.68; 95% CI 1.59-4.53) even when they met the recommended sleep duration guidelines. However, no significant multiplicative interaction (P = .727) or additive interaction (RERI -0.31; 95% CI -1.27 to 0.65) was observed between sleep regularity and sleep duration in relation to depression risk. CONCLUSIONS:Irregular sleep patterns were associated with an elevated odds of depression, even when adults met the recommended sleep durations. Evidence-based interventions designed to enhance sleep regularity could be integrated as potential strategies for the prevention and treatment of depression.

Purpose Against the backdrop of normalized COVID-19 prevention and control, this study focuses on community health service centers. Here, "Cultural values" refer to the shared beliefs, norms, and attitudes within a community or organization that shape behavior and decision-making, such as a sense of collective responsibility, mutual support, and adherence to public health guidelines. This study explores the impact of Cultural values and social capital on their COVID-19 response capabilities and proposes targeted improvement strategies. Methods A self-designed questionnaire was used to survey 983 medical staff from 15 community health service centers in each of six cities in Zhejiang Province. Differences in COVID-19 response capabilities across centers with varying demographic characteristics were compared using t-tests and variance analysis. Hierarchical linear regression was employed to analyze influencing factors, while structural equation modeling path analysis explored the impact pathways and mechanisms of Cultural values and social capital on COVID-19 response capabilities. Key findings Cultural values have a significant impact on the COVID-19 response capability. The overall effect value, direct effect value, and indirect effect value of cultural appeal on the COVID-19 response capability of community health service centers are 0.784, 0.070, and 0.070 respectively. Social capital exhibits a partial mediating effect. Among them, the overall effect value of structural social capital is 0.094, that of relational social capital is 0.260, and that of cognitive social capital is 0.241. The influence of cultural appeal on pandemic response capability is mainly transmitted indirectly through relational and cognitive social capital, while the mediating effect of structural social capital is not significant. Implications Cultural values and social capital positively influence COVID-19 response capabilities in community health service centers, with Cultural values indirectly affecting these capabilities through relational and cognitive social capital. Thus, centers can enhance their COVID-19 response capabilities by strengthening Cultural values, fostering social capital, integrating health resources, and establishing collaborative mechanisms, ensuring community residents' health and safety during crises like sudden outbreaks and natural disasters.

Many modern diseases require more than one discipline for effective treatment, making multidisciplinary teamwork (MDT) essential. However, research on MDT in tertiary public hospitals in China is limited. These large healthcare institutions require effective collaboration among various departments to manage complex cases. Therefore, this study examined the effects of hospital culture, team leadership, and participation motivation on the MDT behavior of healthcare professionals to enhance MDT and improve related services. We conducted a questionnaire survey of 425 multidisciplinary team members in tertiary public hospitals in Hangzhou. T-tests, analysis of variance, and hierarchical linear regression were used to analyze the state of healthcare professionals' MDT behaviors and the associated factors. A path analysis using a Structural Equation Model was used to explore and verify the effects of hospital culture, team leadership, and participation motivation on MDT behavior, as well as their underlying mechanisms. The findings revealed significant positive effects of hospital culture, team leadership, and participation motivation on MDT behavior. An SEM path analysis confirmed that these factors directly influence MDT behavior. Moreover, hospital culture and team leadership indirectly affected MDT behavior through participation motivation. This study demonstrated that a positive hospital culture and team leadership significantly enhanced MDT, with participation motivation mediating this relationship. These findings suggest that hospital leadership should promote a proactive and harmonious hospital culture and facilitate the development of team leaders' management skills. Furthermore, exploring diverse incentives to increase healthcare professionals' motivation for participation is essential for advancing MDT.

This study investigates the current state of career calling among medical staff and its relationship with a friendly work environment and job performance. The study also investigates how career calling mediates to offer policy suggestions for enhancing the job performance of medical personnel. A quantitative research approach was employed through a questionnaire survey to empirically examine the job performance and its influencing factors of 414 medical staff in Hangzhou, China. The direct and indirect impacts of the pleasant environment system and career calling on job performance were studied using structural equation modeling. Significant variations were observed in the friendly organizational environment across medical personnel, influenced by practice positions, years of experience, specialty, professional titles, and hospital levels. Career calling also varied significantly based on age, authorized strength, positions, and hospital levels. Work performance showed statistical significance across varying educational levels, authorized strength, departments, and hospital levels. Positive relationships were found between the friendly organizational environment, career calling, and work performance, with correlation coefficients ranging from r = 0.236 to r = 0.883. The friendly organizational environment had overall, direct, and indirect effects on work performance, with values of 0.185, 0.084, and 0.101, respectively, all with 95

BACKGROUND:There are estimated 41.77 million left-behind children (LBC) in rural China, among whom 14.26 million are under the age of 5 years. However, limited research exits on how different parental migration status affects the early development of rural LBC. The purpose of this study is to examine early child development of previous-left-behind children (PLBC), children with single parent migrating (SLBC), children with both parents migrating (BLBC) as compared to never-left-behind children (NLBC). This study also attempts to explore the factors affecting the early development levels of four types of rural children. METHODS:A questionnaire survey was conducted among 1614 child caregivers in Nanling County, Anhui Province. Ages & Stages Questionnaires-Chinese version (ASQ-C) was conducted to measure suspected developmental delay (SDD) of rural children. The parenting knowledge, depressive symptoms and parenting behaviours of caregivers were measured using the Knowledge of Infant Development Inventory-P (KIDI-P), Beck Depression Inventory-II (BDI-II) and Family Care Indicators (FCI). After controlling for the sociodemographic characteristics of children and primary caregivers, binary logistic regression was employed to assess the association between various categories of rural children and early developmental delays. RESULTS:The results showed significant differences in total SDD among the four types of rural children (p < 0.01), and the risk of total SDD in BLBC was 1.78 times that of NLBC [OR = 1.78, 95% CI (1.23-2.60), p < 0.01]. The study showed that caregivers' parenting knowledge [0.54, (0.31-0.93), p < 0.05], parenting behaviour [0.86, (0.80-0.92), p < 0.001] and caregiver depressive symptoms [1.51, (1.14-1.99), p < 0.01] were strongly associated with total SDD. CONCLUSION:In this study, BLBC exhibit the most pronounced early developmental delay. Additionally, PLBC who have experienced being left behind also face disadvantages. The findings provide valuable insights into LBC across various parental migration contexts and contribute to a better understanding of the risk factors of early childhood development. Correspondingly, the study emphasizes that family, society and government should formulate corresponding intervention measures to reduce the risk of early development for rural children.

In the medical field, value co-creation involves patients’ active involvement. By collaborating with service providers, patients can contribute to the creation of more targeted and effective value. Patients’ self-efficacy and behavior are crucial in this process, as their active participation and support can enhance their service experience. This study investigated the impact of chronic disease patients’ self-efficacy and value co-creation behaviors on the outcomes of value co-creation. Relevant data were acquired through a questionnaire survey using statistical methods, such as the t-test, analysis of variance, and stratified linear regression. This approach was used to examine the current conditions and factors influencing value co-creation outcomes among community-dwelling patients with chronic diseases. Additionally, a structural equation model was employed to systematically investigate and validate the impact pathways and mechanisms related to the influence of self-efficacy and value co-creation behaviors on value co-creation outcomes. We also explored the moderating effect of digital health technology application capabilities on the relationship between self-efficacy and value co-creation behaviors. Self-efficacy, information search, interactive collaboration, feedback provision, and shared decision-making exert significant positive influences on the value co-creation outcomes among individuals with chronic diseases. The path analysis of the structural equation model indicates that self-efficacy and value co-creation behaviors may directly impact value co-creation outcomes. Concurrently, value co-creation behaviors partially mediate the association between self-efficacy and value co-creation outcomes. Furthermore, the digital health technology application capability exhibits a negative moderating effect in the pathway from self-efficacy to value co-creation behaviors. The implementation of health education and social support measures by healthcare institutions and communities may augment patient self-efficacy, facilitate doctor-patient interactions, and promote shared decision-making. These initiatives could enhance the value of chronic disease services and optimize patient experiences. Additionally, healthcare institution managers are encouraged to focus on optimizing internet hospital platforms, organizing digital health training for patients, and bolstering patients’ proficiency in digital health technology applications. This strategy aims to instill a sense of health responsibility among patients with chronic diseases by fostering positive behaviors in interactive collaboration, information search, feedback provision, and other dimensions.

Background:Outcome experiences have been recognized as a prominent predictor of physical activity engagement and maintenance in adults with obesity, while the underlying mechanisms remain unclear. This study aims to investigate and elucidate whether and how growth mindset and self-control strategies serve as modifiable mediators in this relationship. Methods:A cross-sectional study was conducted using stratified sampling, enrolling 209 adults with obesity. Logistic regression, structural equation modeling, system dynamics modeling, and simulation interventions were employed to test the hypothesized mediation model. Results:Outcome experiences were directly and significantly associated with physical activity (β = 0.247, P < 0.01). This association was significantly mediated by growth mindset (indirect effect =0.055, 95% CI [0.034, 0.122]), whereas the mediation role of self-control strategies was not statistically significant (indirect effect = 0.011, 95% CI [-0.027, 0.059]). Notably, a chained mediating effect was observed, with growth mindset and self-control strategies jointly mediating the relationship between outcome experiences and physical activity (indirect effect = 0.011, 95% CI [0.004, 0.038]). Together, these mediators explained 23.77% of the total variance in physical activity. Simulation intervention further evidenced that reinforcing growth mindset and self-control strategies, particularly in combination, can generate sustained improvement in the trajectory of PA engagement. Conclusion:Although outcome experiences are resistant to change, their impact on physical activity can be modulated through adaptive psychological mechanisms, including growth mindset and self-control strategies. Interventions targeting these modifiable factors offer a promising pathway to promote physical activity among adults with obesity, especially those affected by negative past experiences. However, given the cross-sectional design of this study, causal inferences are limited, and the intervention recommendations remain preliminary, necessitating further validation through longitudinal and experimental research.

Over the past three decades, oral disorders have emerged as a pressing global public health issue, affecting more than 3.5 billion people by 2021. Despite being largely preventable, the burden of oral disorders remains disproportionately high in low- and middle-income countries (LMICs), where fragile healthcare systems, limited access to oral health professionals, and increased consumption of unhealthy products exacerbate existing inequalities. The Global Oral Health Action Plan and the Bangkok Declaration underscore the importance of addressing commercial determinants as key drivers of oral health inequities. We utilized data from the Global Burden of Disease 2021 (GBD 2021) study to analyze the burden of oral disorders—including incidence, prevalence, and disability-adjusted life years (DALYs)—across 204 countries and territories, stratified by Socio-demographic Index (SDI). Temporal trends were examined using the Age-Period-Cohort (APC) model, and spatial heterogeneity in social and commercial determinants (e.g., income, urbanization, dentist density, sugar and alcohol consumption) were assessed using Geographically Weighted Regression (GWR). In 2021, oral disorders accounted for 23.24 million DALYs globally, with LMICs experiencing the most pronounced increase in burden, particularly in South Asia and Latin America. Middle-SDI regions exhibited the highest annual growth in incidence (EAPC = 0.3274), associated with rapid socioeconomic transitions and adoption of Westernized lifestyles. The APC model revealed divergent age effects: incidence peaked in younger cohorts (0–9 years), whereas DALYs increased with age and peaked in middle-aged adults in LMICs. GWR analysis identified substantial spatial variation in determinants. Among social factors, higher income and urbanization were associated with reduced burden in LMICs, while dentist density was more effective in high-income countries (HICs). Among commercial factors, sugar and tobacco consumption significantly increased risk in LMICs—especially in East Asia and Africa—whereas the effects of alcohol consumption were mixed. Oral health inequities are driven by unequal exposure to social and commercial determinants, with LMICs shouldering the greatest share of preventable burden. Policy efforts should prioritize intersectoral actions to regulate harmful commercial practices, strengthen primary oral health care in underserved regions, and integrate oral health into universal health coverage frameworks. Addressing upstream determinants—rather than focusing solely on clinical care—is essential to reducing global disparities in oral health.

Health co-prosperity is the conceptual interpretation and application extension of the logic of common prosperity in the field of health.Building a digital collaborative health governance model between Chinese and western medicine based on the advantages of digital reform is the"Zhejiang Model"of health co-prosperity and helps to achieve the goal of high-quality full life cycle medical and health services.This article is based on the collection of relevant policies on the digital collaboration between Chinese and western medicine during the construction of the Common Prosperity Demonstration Zone in China and Zhejiang Province.It elaborates on the definition and connotation of health co-prosperity,and selects the digital Chinese and western coordinated health governance model of provincial,grassroots platforms,and medical institutions in Zhejiang Province as a specific case to explain the theme and path of the system design logic,grassroots platform logic,and institutional service logic of health co-prosperity,to provide reference and suggestions for the innovative construction and optimization of the collaborative health governance model between Chinese and western medicine.

PURPOSE: This study aims to investigate the current state of career calling among medical personnel and its connection to traditional culture and work performance. METHODS: By analyzing data from 414 medical staff members in Hangzhou through a questionnaire survey and structural equation modeling, the research explores the direct and indirect impacts of traditional culture and career calling on job performance. RESULTS: The results show significant variations in traditional culture, career calling, and job performance across different demographics and hospital levels. The correlation between traditional culture, career calling, and job performance is statistically significant, indicating a strong relationship. CONCLUSIONS: The findings suggest that the traditional culture of medical personnel not only directly influences work performance but also has an indirect effect through career calling.

Purpose:Healthcare professionals' participation is crucial for the efficient implementation of multidisciplinary team (MDT) collaboration models. We identified the key factors influencing healthcare professionals' preference to participate in MDTs in tertiary hospitals. Methods:To clarify the attributes and levels of the discrete choice experiment (DCE), we conducted a targeted literature review and conducted in-depth interviews with MDT service providers. Following this, a DCE was designed to evaluate healthcare professionals' preferences for MDT participation, and the influence of factors such as salary subsidies, leadership attention, patient participation, quality assessment, working intensity, and case complexity. A conditional logit model estimated the utility of each attribute. Willingness-to-pay estimates were derived by taking the negative ratio of the coefficients of non-economic and economic attributes. A series of policy simulation analyses were conducted. Results:Two hundred healthcare professionals completed the questionnaire, with 180 valid responses used for analysis. All attributes were statistically significant. Leadership attention and working intensity were the primary factors influencing staff willingness to participate in MDTs, followed by quality assessment and salary subsidies. Significant preference differences were observed between respondents; compared with mid-level staff, senior-level healthcare professionals believed patient engagement would be more helpful in boosting participation. The policy simulation showed that changing leadership attention from "neglect" to "emphasis" would increase the probability of staff choosing to participate in MDTs from 24.4% to 66.98%. Conclusion:Leadership attention was the primary concern for healthcare professionals in MDTs. To effectively motivate staff participation in MDTs, policymakers should adopt a holistic approach that considers work motivation and individual backgrounds, including competitive salary packages and a positive work environment. They should concurrently introduce MDT case complexity measurement tools to optimize resource allocation. Addressing staff members' unique needs and career aspirations by creating targeted training programs, pathways for advancement, and personalized career development plans are also crucial.

Background: Previous studies only focused on the individual social factors, without considering the overall social health patterns. The present study aimed to develop an integrated social health score (SHS) and investigate its associations with all-cause, cardiovascular disease (CVD), cancer mortality. Methods: A total of 330,716 participants (mean age 56.3 years; 52.4 % female) from UK Biobank was included between 2006 and 2010, and thereafter followed up to 2021. SHS was calculated by using information on social connections, social engagement and social support. Cox proportional hazards models was used to estimate the hazard ratios and 95 % confidence intervals (CIs) of the association between SHS and all-cause and cause-specific mortality and the 4-way decomposition was used to quantify the mediating effect of lifestyle factors. Results: During a median follow-up period of 12.4 years, 37,897 death cases were recorded, including 4347 CVD and 10,380 cancer cases. The SHS was inversely associated with the risks of all-cause, CVD and cancer mortality in a dose-dependent manner (P for trend <0.001). The association between SHS with all-cause mortality was mediated by lifestyle factors including diet score, smoking status and alcohol consumption. Conclusion: Integrated SHS was inversely associated with risks of all-cause, CVD and cancer mortality, and the associations were partially mediated by lifestyle factors. Our study highlights the importance of maintaining high levels of social health by jointly enhancing social involvement, expanding social networks, and cultivating enduring intimate relationships across the life course.

ObjectivePatient satisfaction reflects the social benefits of hospitals and is an important indicator of hospital performance. This study explores the mechanism through which inpatients’ trust in physicians, self-efficacy, and participation in medical decision-making impact their satisfaction with medical services.MethodsA questionnaire was administered to 814 inpatients in 10 randomly selected tertiary hospitals and 10 randomly selected secondary hospitals in Hangzhou, China. A correlation analysis and hierarchical linear regression were conducted to analyze the factors influencing inpatient satisfaction.ResultsThe outcome measures of trust in physicians and participation in medical decision-making behaviors had significant positive effects on inpatient satisfaction.Trust in physicians was shown to directly influence inpatient satisfaction, while inpatient participation in decision-making partially mediated this relationship. Inpatient participation in medical decision-making fully mediated the relationship between self-efficacy and inpatient satisfaction.ConclusionWhile inpatients were relatively satisfied, there is room for improvement. Healthcare providers should improve patient trust by actively listening to their needs and providing feedback, establishing effective communication mechanisms. Patient self-efficacy can be enhanced through health education, special lectures, and case sharing. Patients should also be encouraged to actively participate in medical decision-making.Practical implicationsBased on inpatient feedback during a preliminary survey, we refined this study’s questionnaire to enhance its feasibility for future research. This article shares key findings for healthcare managers and providers, advising that patient satisfaction can be enhanced through trust, self-efficacy, and participation.

Introduction Patient satisfaction is a crucial metric to gauge the quality of medical services, but the psychological factors influencing patient satisfaction remain insufficiently explored.Methods This study examines these psychological factors by applying the theory of bounded rationality to 1,442 inpatients in Hangzhou, China, whose data were collected using a questionnaire. One-way ANOVA, correlation analysis, and hierarchical regression were used to analyze patient satisfaction and its associated factors. Additionally, the path analysis of the structural equation model revealed the mechanisms behind the key psychological factors that influenced patient satisfaction.Results Medical risk perception, the social cognition of the medical environment, and social desirability bias had significant positive impacts on patient satisfaction. By contrast, negative emotions had a significant negative impact on patient satisfaction. Notably, patients' negative emotions had both a suppressive effect and a positive moderating effect on the relationship between medical risk perception and patient satisfaction. Similarly, social desirability bias had a suppressive effect on the correlation between the social cognition of the medical environment and patient satisfaction, albeit with a negative moderating effect.Discussion These results suggest that when evaluating and improving patient satisfaction, accounting only for the factors that directly influence medical service quality is insufficient, as the indirect and moderating effects of patients' negative emotions and the social cognition of the medical environment must also be considered. Medical service providers should thus address patients' negative emotions, establish good doctor-patient relationships, optimize service environments, provide managers with medical risk education and training on negative emotions, and prioritize patient-centered care. Additionally, the government and relevant health departments should optimize medical policies, enhance fairness and accessibility, and create a positive social cognitive environment through public education and awareness campaigns.