This systematic review and meta-analysis contributes to the Journal's focus on clinical care improvement and evidence-based medicine by evaluating the global evidence for a scalable, person-centred intervention-health literacy-in the management of hypertension among older adults. BACKGROUND:Health literacy (HL) is the ability to access, understand, and apply health information to make informed decisions. However, evidence regarding the comprehensive effects of HL interventions on multiple outcomes in older adults with hypertension remains unclear. AIMS:This study aimed to evaluate the effectiveness of HL interventions for improving systolic blood pressure (SBP), diastolic blood pressure (DBP), medication adherence, and self-efficacy in older adults with hypertension. METHODS:We searched PubMed, Web of Science, Scopus, Embase, the Cochrane Library, and CINAHL from inception to June 2025 for relevant randomized controlled trials (RCTs). Study quality was assessed using the Cochrane RoB 2.0 tool. Pooled mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using random-effects models. Subgroup and sensitivity analyses were conducted. RESULTS:Forty-two RCTs (9,332 participants) were included; 25 studies (59.5%) had a low risk of bias. Meta-analysis revealed that HL interventions significantly reduced SBP (MD: -6.90 mmHg; 95% CI: -8.51 to -5.29; p < 0.01) and DBP (MD: -3.03 mmHg; 95% CI: -4.12 to -1.94; p < 0.01), and improved medication adherence (SMD: 0.69; 95% CI: 0.26 to 1.12; p < 0.01) and self-efficacy (SMD: 0.35; 95% CI: 0.10 to 0.60; p < 0.01). Greater benefits were observed in trials conducted in Eurasian regions and those emphasizing active participant engagement. CONCLUSIONS:HL interventions are effective in improving SBP and DBP control, medication adherence, and self‑efficacy among older adults with hypertension. The findings support the integration of structured, participatory HL strategies into routine geriatric hypertension management.

BackgroundPandemic fatigue during the prolonged COVID-19 crisis undermines sustained engagement with protective measures and public health messaging. Existing studies provide heterogeneous prevalence estimates and disparate lists of correlates but lack a unified, theory-driven synthesis.MethodsSearches were conducted in six databases up until March 2026. This study synthesized the prevalence of pandemic fatigue and factors associated with it during COVID-19 using the COM-B model and TDF theory.ResultsTwenty-three cross-sectional studies (n = 49,285) were included. The pooled prevalence of pandemic fatigue was 51% (95%CI: 0.38, 0.65), with substantial heterogeneity. Health literacy (Capability) was inversely associated with fatigue (β = −0.257, 95%CI: −0.404, −0.110). Opportunity-related stressors—including bereavement due to COVID-19 (β = 0.281, 95%CI: 0.124, 0.437), daily troubles (β = 0.296, 95%CI:0.211, 0.380), and working student status (β = 0.232, 95%CI: 0.122, 0.341)—were positively associated with pandemic fatigue. Motivation-related factors showed mixed associations, whereas negative emotional states were associated with higher odds of pandemic fatigue.ConclusionPandemic fatigue is common and was associated with diverse capability-, opportunity-, and motivation-related factors. A COM-B-informed interpretation suggests multi-level strategies that combine skills building, supportive environments, and psychosocial support.

OBJECTIVES:To culturally adapt and validate the Chinese HLS-EU-Q47 for assessing health literacy (HL) among community-dwelling older adults in Mainland China, and to contextualize limited HL rates internationally. METHODS:A cross-sectional survey was conducted among 957 adults aged ≥60 years from three community health centers in Nanjing, China. The HLS-EU-Q47 was adapted through forward-back translation, expert review, and linguistic refinement. Psychometric properties were evaluated using exploratory and confirmatory factor analyses, reliability and convergent validity testing, and floor and ceiling effect analyses. Published studies on older adults were reviewed for exploratory international contextualization. RESULTS:The adapted Chinese HLS-EU-Q47 showed acceptable internal consistency (Cronbach's alpha > 0.70; Spearman-Brown coefficient and split-half reliability both > 0.90), good structural validity (RMSEA = 0.032, GFI = 0.989, CFI = 0.968, IFI = 0.968, and TLI = 0.966), and satisfactory convergent validity (AVE > 0.50; CR > 0.80). No substantial floor or ceiling effects were observed. The mean general HL score was 29.35 ± 8.83, with the lowest score in the disease prevention domain. Overall, 66.0% of participants had limited HL, including 51.2% with problematic HL. In exploratory international contextualization, limited HL appeared common among older adults across studies, and the estimate in this sample was relatively high within the broad international range. CONCLUSION:The Chinese HLS-EU-Q47 is a reliable and valid instrument for assessing HL among community-dwelling older adults in Mainland China. The high prevalence of limited HL, particularly in the disease prevention domain, highlights the need for age-sensitive assessment and targeted nursing interventions.

Objective To assess the efficacy and safety of emergency contraception (EC) interventions.Methods Literature published until 28 December 2024 was retrieved from nine databases. Randomised controlled trials (RCTs) evaluating the efficacy of copper or levonorgestrel intrauterine devices (Cu-IUDs or LNG-IUDs), oral levonorgestrel (LNG), mifepristone (MFP), ulipristal acetate (UPA) and oral EC plus cyclooxygenase inhibitor (COX) were considered eligible. A Bayesian network meta-analysis was conducted to evaluate the relative risk (RR) with a 95% credible interval (CrI) for efficacy and adverse events. Evidence certainty was graded using the CINeMA GRADE application. Pairwise meta-analyses, robustness analyses and Bayesian meta-regressions were conducted to verify the reliability of the results.Results Of 17 244 studies, 92 involving 37 260 women were included. With robustness verified, the Cu-IUD was the most effective EC treatment. No significant differences in EC efficacy were observed between LNG-IUD and all other treatments, but with low- or very-low-certainty evidence. With acceptable adverse events, co-treatment with LNG and COX (LNG-COX) was more efficacious than single-dose (RR=0.112, 95%CrI: 0.005, 0.686) or double-dose LNG (RR=0.095, 95%CrI: 0.004, 0.605) with high certainty. MFP (25 mg) and UPA had comparable EC efficacy (RR=0.782, 95%CrI: 0.425, 1.433), whereas MFP tended to induce advancement of the subsequent menstrual period.Conclusions Although the efficacy of LNG-COX was confirmed by high-certainty evidence, large-scale validation trials are required before it can be recommended clinically. Owing to within-study bias and imprecision, large RCTs are strongly recommended to assess the efficacy of ECs for interventions without direct comparisons.Trial registration number CRD42024627671.

AIM:Health literacy (HL) is pivotal to healthy aging, yet existing instruments often show suboptimal psychometric performance in older populations. This study aimed to develop and validate a concise HL instrument tailored to older adults and evaluate its psychometric properties. METHODS:A cross-sectional survey of 957 community-dwelling Chinese adults (≥ 60 years) used the Chinese HLS-EU-Q47. Unidimensional and between-item multidimensional Rasch analyses removed items with poor fit, differential item functioning (DIF), or local dependence. The retained 12-item HLS-Q12-OA was assessed via exploratory factor analysis (EFA) for its factor structure and confirmatory factor analysis (CFA) for model fit. Reliability was evaluated using Cronbach's α, McDonald's ω, and person separation reliability (PSR). Findings were compared with the original HLS-EU-Q12 and international adaptations. RESULTS:Rasch analysis revealed substantial item misfit and DIF in the original HLS-EU-Q47. The HLS-Q12-OA showed no floor/ceiling effects (rates 0.10%-6.79%). EFA suggested three factors with high inter-factor correlations; CFA supported a unidimensional structure with excellent fit (CFI = 0.991, GFI = 0.983, AGFI = 0.974, RMSEA = 0.032) and all factor loadings > 0.5. Reliability was satisfactory (Cronbach's α = 0.891, McDonald's ω = 0.894, PSR = 0.892). The HLS-Q12-OA outperformed the original HLS-EU-Q12 in the same sample; its Cronbach's α was slightly lower than Japanese/Chinese adult versions but higher than Jordanian/Turkish versions, with the best construct validity and no age-related DIF. CONCLUSION:The HLS-Q12-OA is the first unidimensional short-form HL scale developed specifically for older adults. It overcomes key psychometric limitations of the original HLS-EU-Q47 and offers a reliable, valid, and practical tool for HL screening in geriatric and community settings.

Investigating the spatial effects of population mobility on Human Immunodeficiency Virus (HIV) epidemics provides valuable insights for effective disease control. Data on the incidence and prevalence of HIV and socioeconomic factors from 2013 to 2022 across 31 provinces in China were collected. The Baidu migration index was employed to construct inter-provincial population migration matrices for spatial lag models to evaluate spatial spill-overs and influx risks associated with HIV epidemics macroscopically. This study also analysed the impacts of socioeconomic variables, conducted robustness tests for validation, and performed subgroup analysis stratified by HIV incidence levels. Significant spatial autocorrelation of HIV morbidity was confirmed by finding a positive Moran’s I. The spatial lag model indicated that when a given province had a 1-unit increase in HIV incidence, its average outflow would cause a 0.7068-unit incidence rate increment in other destination provinces, while every unit increase of HIV incidence in other provinces would induce a 0.7013-unit HIV average incidence rise in the original one when it played the role of destination on average. Furthermore, higher population density and lower educational attainment were associated with elevated HIV incidence (p<0.001). The robustness of the findings was verified, and subgroup analysis indicated that reasons besides population mobility should be given priority consideration in regions with higher HIV incidence. The risks of population mobility related to the HIV epidemic were quantified, highlighting the necessity of developing effective and acceptable HIV prevention and control strategies specifically tailored for migrant populations.

In recent years, resistance of Klebsiella pneumoniae to the clinical last-resort drugs carbapenem and tigecycline has intensified, including Metallo-β-Lactamase-producing K. pneumoniae (MBL-KP), which demonstrated resistance to ceftazidime-avibactam (CZA), posing a significant public health threat. This study focused on the carbapenems, CZA, and tigecycline resistance mechanisms of MBL-producing Carbapenem-resistant K. pneumoniae (MBL-CRKP). A retrospective study and genomic epidemiological analysis of Carbapenem-resistant K. pneumoniae (CRKP) strains isolated from Yangzhou City, Jiangsu Province, China, between 2016 and 2023 was conducted. The detection rate of CRKP in Yangzhou City has increased significantly in recent years, with five strains carrying the Metallo-β-Lactamases (MBLs) gene, all of which exhibited resistance to carbapenems and CZA. Two strains even showed reduced susceptibility to tigecycline, with one harboring tmexCD2-toprJ2. Moreover, three CRKP strains carrying both blaKPC-2 and blaNDM-1/blaNDM-29 genes were identified. Plasmids carrying MBL genes can horizontally transfer, leading to the spread of resistance, thus further exacerbating the difficulty of clinical treatment and the spread of resistance. In conclusion, this study not only revealed the resistance of MBL-CRKP strains to clinical last-resort therapeutic drugs but also explored the resistance mechanism and horizontal transfer through genomic analysis. Moreover, this study also suggested that microbial drug resistance surveillance should be conducted from the perspective of “one health” in the future to combat this global health challenge.

Objectives. The research purpose of this article was to investigate the status of laboratory safety culture in universities, in order to carry out more targeted laboratory cultural construction activities in the later stage. Safety culture also can have a lasting impact on university students as future practitioners. Methods. With Southeast University as a case study, a sample of 8761 study participants completed the safety culture measurement questionnaire (SCMQ). The independent-sample t test, single-factor analysis of variance and multilevel logistic regression were used to analyze the general characteristic distribution of the safety culture level. Results. The overall average score of safety culture was 74.84. Among the 32 elements of safety culture, six elements scored less than 60 points. Multilevel logistic regression analysis showed that the distribution of safety culture scores varied across schools, work roles, genders, years of laboratory use and laboratory safety culture familiarity. Conclusions. University laboratories should strengthen the construction of safety culture, for the safety elements with low scores, and intervene from the organizational level (school level). The key focus groups were males, students and those who have used the laboratory for 2-4 years, and those with low awareness of safety culture.

The influenza vaccination rate among the elderly in China remains suboptimal. As key figures in effective intervention strategies, the perspectives of primary healthcare workers (PHCWs) on this issue have not been explored yet. This study aims to use the capability, opportunity, motivation-behavior (COM-B) model to identify the factors that influence influenza vaccination among the elderly from the perspective of PHCWs in China, analyze the mechanisms, and formulate targeted intervention strategies. A qualitative study used semi-structured, face-to-face interviews with PHCWs in Yangzhou, Jiangsu Province, China, conducted in September 2023, based on the COM-B model. A purposive sampling method was used, resulting in the participation of 16 PHCWs. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. The study included 16 PHCWs (7 Public health professionals [43.75%], 7 general practitioners [43.75%], and 2 nurses [12.50%]). The main barriers to influenza vaccination identified were the lack of recommendations from PHCWs (Reflective Motivation), limited knowledge of influenza or the influenza vaccine among the elderly (Psychological Capability), and the self-payment policy for the influenza vaccine (Physical Opportunity). Additionally, a clear division of professional boundaries between clinicians and public health professionals was found to discourage the elderly from receiving the influenza vaccine (Reflective Motivation). The components - capability, opportunity, and motivation - of the COM-B model interact with each other to change behavior. Improving elderly influenza vaccination rates in China requires stronger recommendations from PHCWs, better awareness of the elderly, and optimized self-payment policies.

INTRODUCTION:Despite extensive efforts, global influenza vaccination rates remain suboptimal, particularly among high-risk populations. RESEARCH DESIGN AND METHODS:We conducted a comprehensive literature search up to April 2023. Experimental studies assessing the effectiveness of interventions on influenza vaccination uptake were included, expressed as risk ratios (RR) with 95% confidence intervals (CI). Random-effects meta-analysis models were utilized for pooled estimates, with heterogeneity assessed through I2. Subgroup analyses and meta-regressions were performed. RESULTS:This meta-analysis includes 180 studies involving 2,390,119 participants and comprehensively evaluates the effectiveness of recipient-, provider-, health system-based, and multitarget interventions. Overall, interventions significantly increased vaccination rates, with a pooled RR of 1.26 (95% CI, 1.21 to 1.32). Notably, provider-based interventions were more effective for healthcare workers (RR = 1.56; 95% CI, 1.46 to 1.66), whereas recipient-based interventions were more efficacious for pregnant women (RR = 1.42; 95% CI, 1.09 to 1.85). Multitarget strategies were the most effective among older adults (RR = 2.10; 95% CI, 1.61 to 2.72) and population under age of 18 (RR = 1.53; 95% CI, 1.23 to 1.90). CONCLUSIONS:These findings provide critical insights for optimizing public health strategies, underscoring the need for innovative and tailored approaches to enhance global vaccination uptake.

This study investigated barriers to influenza vaccination among older adults with chronic diseases through a systematic review of 21 studies (391 467 participants, 13 countries) following PRISMA guidelines. According to the COM-B framework, barriers in the capability (OR = 1.47), opportunity (OR = 2.07) and motivation (OR = 1.35) dimensions significantly influenced influenza vaccination behaviors. The strongest predictors included no prior vaccination history (OR = 3.17), exposure to negative vaccine advice (OR = 2.96), and limited healthcare utilization (OR = 2.3). Findings emphasize that structural interventions targeting the opportunity dimension-particularly government-funded vaccination programs- exhibit the greatest potential for improving influenza vaccination coverage. Prioritizing policy-level initiatives over individual-level education campaigns may yield more equitable and sustainable outcomes in this high-risk group.

OBJECTIVE:This study analyzed the influence of urbanization on the effectiveness of school closures in controlling hand, foot, and mouth disease (HFMD). METHODS:Data were collected from 31 provinces in mainland China between 2010 and 2019. The effect of school closures on HFMD was estimated and synthesized for high and low urbanization groups. Discrepancies in effectiveness were hypothesized to be explained by transmission potential, which was estimated with its influencing factors identified. Considering time lags or seasons, system dynamics models were constructed to verify this hypothesis. RESULTS:The relative risk of school closures on HFMD epidemics was 0.68, with a negative correlation between urbanization and the effectiveness of school closures. Urbanization and human mobility significantly increased the transmission potential of HFMD. Controlling for the positive effects of specific humidity, school closures reduced the effective reproductive number of HFMD by 10.52% and 17.07% in the high and low urbanization groups, respectively (P < 0.0001). Timely response or school closures in autumn led to a notable decline in the number of HFMD cases. CONCLUSIONS:Increased urbanization reduced the effectiveness of school closures in controlling HFMD by greater transmission potential, highlighting the need for additional public health interventions.

BACKGROUND:Influenza poses a major public health threat, with persistently low adult vaccination coverage in China. Traditional behavioral frameworks fail to explain vaccine fatigue, a distinct emotional desensitization mechanism that fundamentally differs from complacency. This novel construct, integrated with perceived risk and trust, constitutes an unquantified motivational triad within the Capability-Opportunity-Motivation-Behavior (COMB) model, necessitating validation in influenza contexts. OBJECTIVE:To identify the key behavioral determinants of influenza vaccination using the COM-B model, with a specific focus on validating the roles of vaccine fatigue, perceived risk, and trust within the motivational component. METHODS:A cross-sectional survey enrolled adults through convenience sampling in Jiangsu, China. Key COM-B constructs-capability (vaccine literacy), opportunity (structural/social barriers), and motivation (vaccine fatigue, risk perception, and trust)-were measured using structural equation modeling analyze the direct/indirect effects. RESULTS:A total of 2604 participants (mean age 28.91 ± 7.59 years) were analyzed. The prevalence rate of influenza vaccination was 24.4 %. The structural equation model demonstrated an acceptable fit. Vaccine fatigue significantly reduced uptake (β = -0.05, p = 0.026). Perceived risk emerged as the strongest barrier (β = -0.28, p < 0.001). Conversely, trust promoted vaccination (β = 0.09, p < 0.001). Opportunity barriers indirectly reduced vaccination by heightening perception risk (β = -0.22, p = 0.011). Vaccine literacy demonstrated dual pathways: a direct positive effect on uptake (β = 0.16, p < 0.001); beneficial indirect effects via reduced vaccine fatigue (β = 0.01, p = 0.017) and enhanced trust (β = 0.02, p = 0.001); yet a countervailing negative indirect effect via increased perception risk (β = -0.04, p = 0.027). CONCLUSIONS:Vaccine fatigue is a novel motivating factor. Notably, vaccine literacy exhibits dual, paradoxical effects. The recommended multi-level interventions include enhanced structural accessibility, tailored risk communication, precision vaccine literacy education, and clinician-mediated trust reinforcement.

OBJECTIVES:To estimate human papillomavirus (HPV) vaccination coverage and vaccination willingness among women in mainland China and identify the influencing factors using the Capability, Opportunity, and Motivation model of Behavior (COMB). METHODS:PubMed, Web of Science, Cochrane Library, Embase, and Chinese databases including CNKI, Wanfang Data, VIP, and CBM were searched. Pooled HPV vaccination coverage and willingness were calculated using a random-effects model with 95 % confidence intervals (CIs). Subgroup analyses and meta-regression were performed to explore heterogeneity. The COM-B model and the Theoretical Domains Framework (TDF) were employed to identify factors associated with vaccination coverage and willingness. Dichotomous outcomes were presented as odds ratios (OR) with the corresponding 95 % CIs. RESULTS:A total of 155 articles, including 10,965,863 mainland Chinese women, were included. The pooled vaccination coverage in 80 included studies was 9.5 % (95 % CI: 7.6 %-11.6 %). Subgroup analysis indicated a higher vaccination rate among women undergoing HPV or cervical cancer screening (16.9 %, 95 % CI: 10.5 %-24.4 %) and among healthcare workers (13.4 %, 95 % CI: 5.6 %-23.8 %). Vaccination willingness, based on 126 studies, was 70.6 % (95 % CI: 66.8 %-74.3 %). Furthermore, the three dimensions of the COM-B model were found to significantly influence both vaccination coverage and willingness (P < 0.05), with capability showed the strongest correlation with HPV vaccination coverage (OR = 2.96, 95 % CI: 2.20-3.99). CONCLUSIONS:There was a significant gap between vaccination willingness and actual coverage among mainland Chinese women. HPV vaccination status of family members or friends and knowledge of HPV and its vaccines were associated with higher vaccination rates.

BACKGROUND:Human papillomavirus (HPV) vaccination coverage in Chinese female adolescents aged 9-15 remains inadequately reported. This study explored the behavioral mechanisms that influence vaccination decisions among female adolescents. METHODS:An anonymous online cross-sectional investigation was conducted with 1627 eligible female students in Wuxi City, China. A structural equation model (SEM) was used to identify factors that directly or indirectly influenced or moderated HPV vaccination. Theory of Planned Behavior (TPB) was adopted to illustrate the hypotheses of the behavioral mechanism. RESULTS:The HPV vaccination rate was 3.9 % (63/1627). Participants demonstrated high trust in the benefits of the HPV vaccine but comparatively low trust in its safety. No significant correlation was found between intention and behavior. Both attitudes (ATT) and perceived behavioral control (PBC) were positively correlated with intentions, but did not significantly influence behavior through intentions. Subjective norms (SN) had a significant direct impact on vaccination behavior, particularly when PBC was high. PBC also positively and negatively moderated the relationship between trust and intention and concern and intention, respectively. HPV vaccination uptake was directly influenced by subjective norms in participants from non-medical families but could be indirectly influenced by attitudes through intentions in those from medical families. CONCLUSION:SN and PBC were significant predictors of HPV vaccination among adolescent females. Interventions should primarily aim to reduce the external barriers to vaccination and focus on activities within schools and communities.

Objectives: This study aims to examine the impact of Diagnosis-Related Group (DRG) payment on medical costs, efficiency, and quality of healthcare services in public hospitals, providing policy recommendations for further health insurance payment reforms in China. Methods: Utilizing inpatient medical insurance settlement data from 2020 to 2023 in the selected city, we constructed a regression discontinuity design (RDD) and an interrupted time series (ITS) model to evaluate the causal effects of the DRG reform. The analysis includes 66,533 inpatient settlement records. Results: Following the reform, the average length of stay (LOS) decreased by 2 days (95% CI: -3.43 to -0.70, p < 0.01), total hospitalization expenditures dropped by 13% (95% CI: -0.26 to -0.00, p < 0.05), and expenditures from the medical insurance fund declined by 25% (95% CI: -0.39 to -0.12, p < 0.01). Additionally, examination and consultation fees were reduced by 23% (95% CI: -0.41 to -0.05, p < 0.05), although patients' out-of-pocket burden increased by 8% (95% CI: 0.05 to 0.10, p < 0.01). In terms of healthcare quality, the 30-day readmission rate decreased by 1% (95% CI: -0.01 to -0.00, p < 0.01), and the mortality rate among low-risk patients declined by 4% (95% CI: -0.04 to -0.03, p < 0.01). We found no evidence of patient selection or denial of admission. Heterogeneity analysis revealed that the reduction in hospital stay was concentrated among enrollees under the Urban and Rural Resident Basic Medical Insurance and those treated in secondary hospitals. The policy's effects peaked shortly after implementation but gradually attenuated over time. Conclusions: Our study offers hospital-level evidence indicating that the initial stage of DRG implementation achieved its preliminary goals of optimizing medical resource allocation and improving the efficiency of medical insurance fund utilization. However, the reform still faces several challenges. These findings may offer valuable references for developing countries pursuing reforms in primary healthcare and health insurance payment systems.

Aims To compare the prognostic implications of the newly proposed clinical obesity classification against traditional body mass index ( BMI) ‐defined obesity in a population‐based cohort. Materials and Methods Using UK Biobank, we compared the impact of newly defined obesity, including clinical obesity (obesity status with obesity‐related comorbidities) and pre‐clinical obesity (obesity status with preserved organ function), with traditional BMI ‐defined obesity on death, cardiovascular disease ( CVD ), chronic kidney disease ( CKD ), and liver‐related events ( LREs ). To further delineate heterogeneity within the clinical obesity group, we performed stratified analyses based on comorbidity burden (number of comorbidities), severity of adiposity, and presence of diabetes or hypertension. Results A total of 502 129 participants were enrolled. About 375 585 (74.8%) had non‐obesity, 126 544 (25.2%) had BMI ‐defined obesity (including 93 410 [73.8%] with clinical obesity and 13 875 [11.0%] with pre‐clinical obesity). During a median follow‐up of 15.8 years, clinical obesity was associated with significantly higher risks of death ( HR = 1.097, 95% CI : 1.071–1.125, p < 0.001), LRE ( HR = 1.103, 95% CI : 1.040–1.169, p < 0.001), CVD ( HR = 1.118, 95% CI : 1.091–1.146, p < 0.001), and CKD ( HR = 1.111, 95% CI : 1.081–1.141, p < 0.001) compared to BMI ‐based obesity. Conversely, pre‐clinical obesity showed significantly lower risks across these outcomes. High‐risk clinical obesity subgroups with multiple comorbidities or severe adiposity showed particularly increased risks. Conclusion The clinical obesity classification helps to define a high‐risk phenotype with substantially increased risks of mortality and major comorbidities, while pre‐clinical obesity defines a distinct subgroup with more favourable outcomes.

Hepatitis B (Hep B) remains a critical public health issue globally, particularly in Tibet, where vaccination rates and influencing factors among college students are yet understudied. This study applies a cross-sectional design to investigate the Hep B vaccination rate among 1,126 college students in Tibet and utilizes the expanded theory of planned behavior (ETPB) to identify vaccination behavior intention (BI) and vaccination behavior (VB). Stratified cluster sampling across three universities was used to assess behavioral attitudes (BA), subjective norms (SN), perceived behavioral control (PBC), past vaccination history (PVH) and vaccination knowledge (VK), and used structural equation modeling (SEM) for model validation and multi-group comparison. Results indicated that 16.3% of students had received the Hep B vaccine. VK notably improved BA toward vaccination (β = 0.518, p < .001). BA (β = 0.232, p < .001), PBC (β = 0.239, p < .001), SN (β = 0.385, p < .001) positively influenced BI. However, PVH failed to predict BI. BI (β = 0.448, p < .001) and PVH (β = 0.127, p < .001) were significant predictors of VB. Significant ethnic variations were noted. The positive effect of PVH on VB (β = 0.151, p < .001) and the mediating role of PBC in VB (β = 0.076, p < .05) were significant among Tibetan students. The effect of VK on BA was stronger among Tibetans (β = 0.503, p < .05),while the impact of attitude on BI was more pronounced among Han students (β = 0.366, p < .05). The vaccination rate for Hep B among college students in Tibet is relatively low, and the ETPB model effectively explains their vaccination intentions and behaviors. Tailored intervention strategies for Tibetan and Han students are recommended to boost vaccination rates effectively.

Background:SARS-CoV-2 Omicron lineages continue to evolve, driving recurrent infection waves since 2022 through immune escape in populations with diverse immunological histories. Understanding cross-variant neutralization capacity, especially against emerging variants like JN.1, is critical for optimizing protection strategies. Methods:We conducted genomic surveillance in Jiangsu Province (December 2022-February 2024) to identify circulating variants and stratified 150 participants into six cohorts based on immune histories (BA.5/XBB breakthrough infections, JN.1 infections, and sequential exposures). Pseudovirus neutralization assays were employed to evaluate serum responses against ancestral (WT), early Omicron (BA.4/5, BF.7, BQ.1), recombinant (XBB/XBB.1.5/XBB.1.22/EG.5.1), and JN.1 variants. Results:Sera from BA.5/XBB breakthrough infections showed significantly reduced neutralization against JN.1 and EG.5.1 (vs. WT). In contrast, recent JN.1 infection induced broad-spectrum neutralization, with cross-protection comparable across variants. Sequential Omicron exposures (e.g., BA.5 → JN.1/XBB) enhanced cross-neutralization versus single infections, notably generating potent, broad antibodies even during acute phases-a previously unreported finding. Conclusions:Heterogeneous immune backgrounds necessitate vigilant monitoring of emerging variants, and sequential Omicron exposures confer robust cross-protection that can guide vaccine design and long-term public health strategies-all within a One Health framework that integrates human serosurveillance with animal and environmental monitoring to preempt cross-species transmission and future zoonotic spillover.

ABSTRACTAs the COVID‐19 pandemic continues, increasingly complex vaccination and infection histories have made it urgent to investigate the antibody dynamics in populations with hybrid immunity. This study aimed to explore the multi‐time‐point dynamics of SARS‐CoV‐2 IgG antibody levels in a community‐based population in Jiangsu Province, China, following the Omicron BA.5 wave, as well as the long‐term persistence of IgG antibodies nearly 2 years postinfection. A total of 2737 participants across Jiangsu Province were followed up at three different time points over a 6‐month period (December 2022–June 2023). Additionally, a cross‐sectional serological survey was conducted in October 2024, involving 230 participants to assess long‐term antibody persistence. We used generalized additive models to fit antibody dynamics curves, generalized linear mixed models to explore factors influencing antibody levels, and Kaplan‐Meier survival analysis to estimate cumulative seroreversion rates. Our findings revealed that, following the large‐scale Omicron BA.5 infections, over 85% of the population initially exhibited seropositive IgG levels. Older individuals (> 65 years) had significantly lower antibody levels and faster rates of decline compared to younger participants. Booster immunization reduced the risk of seroreversion by 59.79% (95% CI: 29.63%–76.46%), while individuals with multiple infections experienced slower antibody decay. In the cross‐sectional survey conducted 22 months postinfection, the IgG seropositivity rate remained high, exceeding 98%, indicating sustained immunity at the population level. This study provides valuable insights into the dynamics and persistence of IgG antibody levels following large‐scale infection. The results underscore the importance of tailored booster immunization strategies to sustain long‐term immunity, especially in vulnerable groups like the elderly. Additionally, ongoing serological monitoring is essential for assessing population immunity and informing future vaccination strategies.