Background:Antibiotic misuse is a key driver of antimicrobial resistance globally, with high rates of inappropriate use observed in rural China. We evaluated the effectiveness of a comprehensive package based on quantified point-of-care testing (POCT) for C-reactive protein and serum amyloid A (CRP&SAA) in reducing inappropriate antibiotic use for acute respiratory infections (ARIs) in village clinics in rural China. Methods:We conducted a pragmatic, parallel-group, cluster-randomised controlled trial at 40 village clinics in Xiantao City, Hubei Province, China, over a 6-month intervention period. Village clinics were randomly assigned (1:1) to provide a comprehensive package based on CRP&SAA POCT, or usual care. Randomisation was stratified by township. Eligible consultations were patients of all ages with a diagnosis of ARI or acute respiratory symptoms in village clinics. The primary outcome was the proportion of initial patient consultations diagnosed with ARIs resulting in any antibiotic prescriptions from village doctors in the intention-to-treat population. The 30-day hospital admission rate for ARIs or sepsis following the initial ARI consultation was measured as a safety outcome. This trial is registered with ClinicalTrials.gov, NCT06568432. Findings:Forty village clinics were randomly assigned, 20 to the intervention group (n = 17,754) and 20 to the control group (n = 17,354). A total of 7.4% consultations (1311 out of 17,754) performed the test in the intervention group. A total of 9001 (50.70%) consultations in the intervention group and 11,715 (67.51%) consultations in the control group resulted in antibiotic prescriptions (adjusted relative risk 0.80 [95% CI 0.78-0.82; p < 0.001]; adjusted risk difference -13% [95% CI -15 to -12; p < 0.001]). The 30-day hospitalisation rate for ARIs or sepsis did not differ significantly (0.32% in the control group versus 0.35% in the intervention group; adjusted relative risk 0.94 [95% CI 0.59-1.48; p = 0.78]; adjusted risk difference 0% [95% CI 0-0; p = 0.78]). Interpretation:The interventions can safely and effectively reduce antibiotic use among patients with ARIs in village clinics in rural China. Future implementation efforts should further examine the barriers and facilitators to adopting POCT within specific health system contexts and service delivery settings, and identify cost-effective strategies to scale up POCT in primary care. Funding:The University of Toronto-Huazhong University of Science and Technology JOINT SEED FUND and the Medical Young Top-notch Talent Cultivation Program of Hubei Province.

Background:As population aging accelerates, the escalating prevalence of comorbidity of chronic diseases (CCD) necessitates evidence-based preventive strategies. This study aims to examine associations between continuous participation in health examinations and the long-term CCD trajectories among Chinese adults aged 45 and older, providing evidence to optimize targeted prevention. Methods:This study used data from four waves of China Health and Retirement Longitudinal Study (CHARLS), specifically 2013, 2015, 2018, and 2020. Latent class growth analysis was used to classify trajectories of CCD. Chi-square tests and multivariate logistic regression were conducted to examine the relationship between CCD and health examination behaviors. A regression discontinuity design was also implemented to assess the impact of China's free health examination policy. Results:A total of 12,510 participants data were categorized into six latent classes. In the unadjusted model, continuous health examination participants were significantly more likely to be classified into the Health Risk (Relative risk ratio (RRR) = 2.249; 95% CI: 1.780-2.842) and Multiple Chronic Diseases Worsening groups (RRR = 7.124; 95% CI: 5.454-9.305) compared to non-participants. After adjusting for baseline burden, individuals with a low baseline burden who participated in health examination had a lower likelihood of unfavorable CCD trajectories (RRR = 0.456; 95% CI: 0.278-0.748; P < 0.01) than non-participants. Older adults were more likely to participate in continuous examinations (OR = 21.571; 95% CI: 11.732-39.662). After controlling for sociodemographic factors, the association between continuous health examinations and CCD trajectories varied by baseline burden, showing stronger effects in individuals with lower baseline burden and weaker effects in those with higher burden (P < 0.01). Conclusions:Continuous health examinations are significantly associated with CCD trajectories. However, their effectiveness remains moderated by baseline disease burden. The current free health examination policy effectively fosters CCD management, yet this association is contingent upon age and socioeconomic determinants. The extension of eligibility to individuals below 65 could maximize the potential for early chronic disease control. This may also serve as a valuable blueprint for other low- and middle-income countries for optimizing cost-effectiveness of their preventive healthcare systems before populations age into high-burden morbidity.

Current programming education in elementary schools faces a critical challenge: students frequently encounter algorithmic failures but lack the problem-solving abilities and efficient collaboration skills to extract meaningful insights from these impasses. To address this, this study theoretically integrates Productive Failure (PF) theory, a seminal framework on learning from failures, with collaboration scripts theory. We developed and refined platform-embedded pair programming scripts to foster a “socio-emotional supportive environment” for elementary students facing cognitive impasses. We conducted a small-scale, exploratory Design-Based Research (DBR) encompassing three iterative cycles. Participants comprised 14 fourth-grade students (7 pairs) selected via purposive and stratified sampling based on prior computational interest and basic programming experience. Utilizing a convergent mixed-methods design, the study triangulated quantitative artifact scores, qualitative Lag Sequential Analysis (LSA) of collaborative dialogues, and self-reported emotional trajectories. The results demonstrated a statistically significant improvement in programming artifact quality from Cycle 1 to Cycle 3 (p = .041, Cohen’s d = 0.606). Furthermore, LSA revealed that the optimized epistemic scripts successfully shifted peer interactions from superficial agreements to deep dual cyclic argumentation, safely activating the four core mechanisms of PF without inducing catastrophic cognitive overload. Concurrently, students exhibited a V-shaped recovery in failure attitude, ultimately fostering genuine failure resilience. While role-switching friction persisted under rigid temporal constraints, we propose a subtask-boundary-based switching rule—triggering role transitions at natural cognitive breakpoints rather than fixed temporal intervals—to preserve learners’ cognitive flow in future implementations.

Family health resources are critical elements for rural households to withstand health shocks. However, the mechanisms through which these resources are linked to the economic risk of diseases remain unclear. Grounded in the Conservation of Resources (COR) theory, this study investigates the association of family health resources with the economic risk of diseases among rural households. Utilizing data from the 2020 wave of the China Family Panel Studies (CFPS), the economic risk of diseases was quantified using the Three-Stage Feasible Generalized Least Squares (FGLS) method. Path analysis was employed to examine the direct effects and the mediating roles. The average score of family health resources among rural households was 3.34 ± 0.73. A total of 400 households (9.42

BACKGROUND:Limited studies have investigated the attitudes of Chinese adults toward the role of nurse prescribing, particularly based on population-based cross-sectional research. OBJECTIVE:To investigate the associations of socio-demographic and health-related factors with the acceptance of the role of nurse prescribing. DESIGN:A cross-sectional study. SETTING:In China. PARTICIPANTS:A total of 30,054 participants were included in this study. METHODS:We employed univariate generalized linear model and multivariable generalized linear model analyses to explore the factors that were associated with the acceptance of the role of nurse prescribing. RESULTS:Individuals of older age (β: 0.08, 95 % CI: 0.05-0.10) and residing in the Western region of China (β: 1.99, 95 % CI: 1.29-2.70), with average monthly household income per capita in the range of 3001-6000 (β: 2.58, 95 % CI: 1.84-3.32) and ≥ 6001 (β: 3.90, 95 % CI: 3.01-4.80), as well as those reporting higher levels of perceived social support (β: 0.46, 95 % CI: 0.35-0.56), better self-rated health status (β: 0.15, 95 % CI: 0.14-0.17), and increased eHealth literacy (β: 0.61, 95 % CI: 0.53-0.68), tend to demonstrate an inclination toward accepting nurse prescribing. CONCLUSIONS:These findings provide valuable insights for healthcare policymakers and practitioners aiming to promote the integration of nurse prescribing into the Chinese healthcare system. Our results emphasize the need for targeted interventions to address barriers to acceptance and enhance the accessibility and utilization of nurse-prescribing services among diverse demographic characteristics.

BACKGROUND:Antimicrobial resistance is a globally recognised public health threat. In rural China, antibiotic use is common for acute respiratory infections (ARIs), which include symptoms such as coughing and fever that are most likely viral infections but with a small proportion as bacterial infections. This study aims to evaluate the effectiveness of a comprehensive intervention based on C-reactive protein and serum amyloid A point-of-care testing (CRP&SAA POCT) in reducing the inappropriate use of antibiotics for ARIs in Chinese village clinics. METHODS:This is a pragmatic, parallel-group, controlled, cluster-randomised, superiority trial featuring blinded outcome evaluation and data analysis, along with unblinded treatment. This study will be conducted over a period of six months across 40 village clinics in Hubei, China. CRP&SAA POCT will be implemented in 20 village clinics within the intervention arm. This will include additional training for village doctors on the operations of CRP&SAA POCT, which encompasses centralised training, the distribution of training manuals, and desk reminders. Patient education materials will be provided to assist patients in understanding how CRP&SAA POCT can aid in their diagnosis and treatment. The control arm will not receive any intervention except the usual care. The primary outcome is the proportion of patients of all age groups who are diagnosed with ARIs and prescribed antibiotics during their initial visit in both study arms. All analyses will be conducted using the intention-to-treat approach. DISCUSSION:Our study is one of the first trials utilizing CRP&SAA POCT to address the inappropriate prescription of antibiotics for ARIs in village clinics in China. We will also evaluate the implementation process to inform future scale-up in similar resource constrained settings. TRIAL REGISTRATION:ClinicalTrials.gov Identifier - NCT06568432.

This study aims to explore the association between stress coping and primary dysmenorrhea among Chinese female adolescent students. A two-step random, stratified, cluster sampling method was employed to assess the health status of female adolescents; aged 10 to 19 years attending middle and secondary schools in the urban region of Shenzhen city. The survey utilized a structured questionnaire that addressed menstrual details, dietary and sleep habits, and psychological factors. Binary logistic regression analysis was conducted to support the research objectives, and interaction and subgroup analyses were performed. Among the 1449 adolescent females surveyed, 72% reported experiencing dysmenorrhea. The analysis identified significant associations between primary dysmenorrhea and stress coping, menstrual cycle length, dietary, sleep duration, and family history. After adjusting for potential confounders, including menstrual characteristics and family history, compared with adolescents who experienced no difficulty coping with stress, those reporting moderate difficulty were 1.66 times more likely to experience primary dysmenorrhea (95% CI 1.12-2.47), while those reporting severe difficulty were 1.97 times more likely (95% CI 1.01-3.18). Additional sensitivity analyses substantiated the robustness of these findings. Our study establishes a significant association between stress coping and the incidence of dysmenorrhea among Chinese female adolescent students, highlighting the critical need to incorporate stress management strategies to addressing menstrual pain.

The development of cities has resulted in the increasing importance of historical and cultural blocks as carriers cultural communication and valuable resources for urban and tourism development. However, there is a paucity of research on the economic resilience of historical and cultural blocks and its influencing factors in the context of tourism development. This study investigated 21 historical and cultural blocks in Beijing and employed fsQCA to identify factors influencing their tourism economic resilience. We found that:(1) the tourism economic resilience of historical and cultural blocks is jointly influenced by a combination of factors, among which high tourism element investment is necessary for high tourism economic resilience. (2) There are three high tourism economic resilience configurations of historical and cultural blocks: the cultural and creative industry empowerment-driven model, the folklore community collaborative governance model, and the cultural-resources-concentrated development model; along with two non-high tourism economic resilience configurations: the Tourism Investment Deficiency Model and the Single Tourism Resource Model. These results provide the theoretical foundation and practical guidance for strengthening the tourism economic resilience of historical and cultural blocks, updating the blocks, and improving their tourism development.

BACKGROUND:To explore the specific role and underlying mechanisms of lifestyles in the socioeconomic inequalities in depression. MATERIALS AND METHODS:A total of 299,310 participants from the UK Biobank were included. Cases of depression were identified based on electronic health records. Socioeconomic status (SES) was assessed using the Townsend Deprivation Index. Smoking, alcohol consumption, physical activity, sleep duration, leisure activities, dietary score, and obesity were used to construct the overall lifestyle risk score. Cox proportional hazard regression models, mediation and moderation analysis and multiple sensitivity analyses were used. RESULTS:During a median follow-up of 8.94 years, 13,344 participants (4.46 %) developed depression. Compared with the highest SES group, the lower-middle and the lowest SES group had a 13 % (HR = 1.13, 95%CI: 1.08-1.19) and 49 % (HR = 1.49, 95%CI: 1.42-1.57) increased risk of depression, respectively. Lifestyles included in this study could explained approximately one-third of the socioeconomic disparity in depression. A significant interaction between lifestyle categories and SES were found (Pinteraction < 0.01). In the groups with the highest, upper-middle, lower-middle, and lowest SES, participants with the least healthy lifestyle had a 50 % (HR = 1.50, 95%CI: 1.37-1.65), 53 % (HR = 1.53, 95%CI: 1.40-1.68), 73 % (HR = 1.73, 95%CI: 1.59-1.88), and 74 % (HR = 1.74, 95%CI: 1.62-1.86) increased risk of depression, respectively, compared to those with the healthiest lifestyle in the same SES category. CONCLUSIONS:The association between SES and depression was significantly mediated by lifestyles. Reducing socio-economic inequalities is equally important as promoting healthy lifestyles among the population. Particular attention should be paid to the impoverished.

Objective:This study was aimed at exploring the real-world self-care experiences and challenges encountered by hospice nurses caring for terminally ill patients at general hospitals in mainland China. Methods:Semi-structured interviews were conducted with 15 hospice care nurses at 10 general hospitals in China from June 2022 to February 2023. Using Colaizzi's seven-step method, we analyzed and distilled the data into key themes. Results:Three themes were identified: 1) benefits of self-care (personal growth and self-worth affirmation); 2) effective self-care strategies (physical health management, psychological resilience building, support resource mobilisation, and gaining spiritual consolation); and 3) challenges in self-care (professional development-related challenges and work environment-related challenges). The participants consisted of 14 women and 1 man, with the nurses having a maximum of 5 years of hospice experience. Despite efforts to balance participant numbers from different levels of hospital-based hospice care units, more hospice nurses from provincial tertiary general hospitals were recruited. This imbalance may limit the generalizability of the findings to other health care settings. Conclusions:This study highlighted the importance and benefits of self-care for hospice nurses. Implementing effective self-care strategies can strengthen hospice nurses' well-being and psychological resilience, expand their access to support resources, and ultimately improve the quality of care. Health care institutions and hospice providers should prioritize understanding and promotion of self-care practices among hospice nurses.

Introduction The prevalence of postpartum depression in China has been steadily increasing, and community-based interventions are considered an important measure to address this issue. This study aims to design a community intervention programme for postpartum depression based on positive psychology, tailored to the characteristics of postpartum depression and the intervention needs, while integrating primary healthcare practices in the community setting. A cluster randomised controlled trial will be employed to evaluate the effectiveness of the intervention in reducing the risk of postpartum depression among women.Methods and analysis This study will develop and refine the positive psychology-based intervention programme through the integration of qualitative interviews and a literature review. A cluster randomised controlled trial will be conducted, with community primary healthcare service centres as the unit of randomisation and pregnant women as participants. The control group will receive usual primary healthcare support, while the intervention group will receive positive psychology intervention—including six structured online positive psychology intervention sessions with videos and materials, and optional one-on-one consultations—in addition to usual primary healthcare. The Edinburgh Postnatal Depression Scale will be used to assess the risk of postpartum depression in participants, with variables including postpartum depressive symptoms, anxiety and stress. Outcome measures will be evaluated using questionnaires and data from maternal and child electronic health records. Data will be analysed based on both the intention-to-treat principle and the per-protocol principle.Ethics and dissemination This study was approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (approval no. S127). The findings will be disseminated through presentations at relevant academic conferences and publications in peer-reviewed journals.Trial registration number NCT06770244.

Background:Compassion satisfaction and compassion fatigue are critical to nurses' well-being and patient care. In China, factors such as high workloads and healthcare reforms may elevate nurses' risk for compassion fatigue. Aims:To assess the prevalence and influencing factors of compassion satisfaction and compassion fatigue among Chinese clinical nurses. Methods:In this cross-sectional study, 581 registered nurses completed surveys on demographics, work-related factors, Pittsburgh Sleep Quality Index, Psychology Capital Questionnaire, Perceived Social Support Scale, and Professional Quality of Life Scale. Data were analyzed using descriptive statistics, nonparametric tests, and multiple linear regression. Results:The prevalence of low, average, and high levels was 5.7%, 79.2%, and 15.1% for compassion satisfaction; 31.0%, 67.6%, and 1.4% for burnout; and 34.8%, 63.5%, and 1.7% for secondary traumatic stress, respectively. Multiple linear regression analysis revealed that compassion satisfaction (R 2 = 54.3%), sleep quality (β = -0.09, p = 0.005), psychological capital (β = 0.540, p < 0.001), and social support (β = 0.215, p < 0.001) were significant predictors. Similarly, burnout (R 2 = 46.9%), sleep quality (β = 0.224, p < 0.001), psychological capital (β = -0.329, p < 0.001), and social support (β = -0.289, p < 0.001) were significant predictors. Secondary traumatic stress (R 2 = 8.0%), sleep quality (β = 0.231, p < 0.001), and social support (β = -0.13, p = 0.009) were also significant predictors. Conclusions:Chinese clinical nurses experience significant compassion fatigue. Sleep quality, psychological capital, and social support are key factors associated with their professional quality of life, highlighting targets for intervention by nursing management. Implications for Nursing Management:It is important for nursing managers to recognize the susceptibility of nurses to compassion fatigue and develop specific strategies to alleviate burnout and secondary traumatic stress while fostering compassion satisfaction.

OBJECTIVES:The study aimed to clarify the mechanism linking health shocks, health insurance utilization and poverty vulnerability among households of rural elderly in China, and explore the effect of household structure on the mechanism. STUDY DESIGN:Cross-sectional study. METHODS:Data were obtained from an on-site survey supported by China's National Natural Science Foundation in 2022, targeting rural elderly with chronic diseases and their families. In total, 2169 Chinese rural residents aged ≥60 years with chronic diseases and their families were interviewed. Health shocks were represented as a latent variable comprising five specific variables. Health insurance usage was categorized into three options. Poverty vulnerability was assessed with a poverty line standard of $1.9 per capita daily consumption. Household structures were classified into three types. A structural equation model was constructed to explore the mechanism between these factors in the total study population and different household types. Entropy weight method assessed health shock scores. The Karlson-Holm-Breen (KHB) mediation decomposition method was applied to decompose the mediating effect of health insurance utilization in empty-nest and left-behind children's households. RESULTS:Findings showed that health insurance utilization mediates the link between health shocks and poverty vulnerability (a = 0.061, b = -0.01, c = 0.119; all P < 0.05). No mediation was observed in expand core households; however, in empty-nest and left-behind children's households, significant effects were seen (for empty-nest elder households, a = 0.032, b = -0.043, c = 0.078; for left-behind children's households, a = 0.066, b = -0.025, c = 0.123; all P < 0.05). The utilization of basic health insurance and medical financial assistance exhibits the highest mediation decomposition values among empty-nest and left-behind children's households, reaching 87.31 % and 64.89 %, respectively. CONCLUSIONS:Health insurance utilization is crucial for countering health shocks and poverty vulnerability among rural households; however, its efficacy differs among household structures.

OBJECTIVE:To investigate preoperative predictors for selecting different surgical approaches in patients with renal cell carcinoma with inferior vena cava (IVC) tumor thrombus (RCC-IVCTT), and to establish and validate corresponding predictive models. METHODS:Clinical data of 583 RCC-IVCTT patients were retrospectively analyzed. Of these, 465 cases were used to construct predictive models, and 118 cases were used for validation. Univariate and multivariate analyses identified independent predictors for surgical strategies. Two nomogram prediction models were established based on relevant independent factors to predict surgical approach. RESULTS:In the development cohort, 342 patients underwent IVC thrombectomy (IVCT), 91 underwent IVC cavectomy (IVCC), and 32 underwent IVC reconstruction (IVCR). Multivariate logistic regression analysis identified the following predictors for inability to perform IVCT: higher Mayo classification of tumor thrombus (TT), IVC wall invasion, presence of bland thrombus, pan-immune-inflammation value (PIV) > 358 × 109, and maximum anteroposterior (AP) diameter of IVC at renal vein ostium (RVo) > 24 mm. Platelet >170 × 109/L and inadequate collateral circulation were predictors for IVCR. The developed model predicted capacity of the nomogram was evaluated in terms of its calibration, discrimination, and clinical utility. The validation set confirmed these findings. CONCLUSION:The comprehensive preoperative predictive model for RCC-IVCTT patients aids in preoperative determination of the required surgical approach and necessity for IVC angiography, facilitating perioperative preparation and reducing unnecessary invasive examinations.

BACKGROUND:Previous studies have suggested the dual sensory loss (DSL) is linked to depression, and that they are associated with higher healthcare expenditures, respectively. However, the association between DSL, depression and healthcare expenditures remains ambiguous. OBJECTIVES:The current study aims to examine the association between DSL, depression and healthcare expenditures as well as catastrophic health expenditures (CHE) among Chinese people aged 45 and above. METHODS:We first utilized the China Health and Retirement Longitudinal Survey (CHARLS) 2018 to obtain data from a total of 13,412 Chinese individuals aged 45 and above to conduct a cross-sectional study. DSL was defined as a combined variable of self-reported vision loss and hearing loss. Depression was measured using The Center for Epidemiologic Studies Depression Scale (CESD-10). The healthcare expenditures, including outpatient out-of-pocket cost and inpatient out-of-pocket cost, were obtained from the Harmonized CHARLS section. CHE were defined as out-of-pocket (OOP) health spending equal to or higher than 40 % of a household's capacity to pay. A Tobit linear regression with three models and a path analysis were conducted to estimate the association between DSL, depression and healthcare expenditures and CHE. Then we utilized 2011CHARLS and 2018CHARLS to present a longitudinal analysis. A path analysis was conducted to estimate the association between 2011DSL, 2018depression and 2018healthcare expenditures and CHE. RESULTS:Depression has a significant mediating effect between DSL and healthcare expenditures. (For outpatient OOP cost: a = 0.453, b = 23.559, c = 25.257, the proportion of mediating effect in total effect = 29.71 %; for inpatient OOP cost: a = 0.453, b = 13.606, c = 15.463, the proportion of mediating effect in total effect = 28.50 %; all P < 0.05). The mediating effect of depression also exists in the association between DSL and CHE (a = 0.453, b = 0.018, c = 0.043, the proportion of mediating effect in total effect = 15.90 %; P < 0.05). The mediation effect of depression on healthcare expenditures and CHE also exists in the longitudinal analysis using CHARLS 2011 and CHARLS 2018 (all P < 0.05). LIMITATIONS:The DSL status were based on self-report and we used 2018CHARLS to conduct the study, which may cause some bias. CONCLUSION:Significant mediating effect of depression exists between DSL and higher healthcare expenditures and CHE. The mental health of elder people with DSL should be focused on, and we should have an overall viewpoint on the topic of healthcare expenditures and CHE.

The younger generation has experience utilizing Artificial Intelligence (AI) for learning and working as it progressively permeates society. AI-based medication counseling services may help people take medications more accurately and reduce adverse events. However, it is not known which AI-based medication counseling service will be preferred by young people. This study aims to assess young people's preferences for AI-based medication counseling services. A discrete choice experiment (DCE) approach was the main analysis method applied in this study, involving six attributes: granularity, linguistic comprehensibility, symptom-specific results, access platforms, content model, and costs. A mixed logit model was employed to evaluate participants' preferences for AI-based medication counseling services, the relative importance (RI) of attributes, and their willingness to pay (WTP). 340 participants were included in the analysis of this study, generating 8160 DCE observations. The results demonstrate that participants exhibited a strong preference for receiving 100% symptom-specific results (β=3.18, 95%CI 2.54-3.81, P<.001). Regarding content modes, video was significantly favored over text (β=0.86, 95%CI 0.51-1.22, P<.001). Participants also showed a clear preference for linguistic comprehensibility that was easy to understand compared to the difficult alternatives (β=0.81, 95%CI 0.46-1.16, P<.001). When considering the granularity, refined content was preferred over the general information (β=0.51 95%CI 0.21-0.8, P<.001). Finally, participants exhibited a notable preference for accessing information through WeChat applets rather than websites (β=0.66, 95%CI 0.27-1.05, P<.001). In terms of RI, symptom-specific results (RI=36.99%) and cost (RI=30.24%) occupied the largest portion. Participants' WTP for AI-based medication counseling services from high to low were 100% of the results for symptom-specific results, easy-to-understand language, video content mode, WeChat applet access platform, and refined medication counseling. In which the WTP of participants for 100% symptomatic was 24.01 CNY (95%CI 20.16-28.77) which occupies the highest value among all levels. This study conducted an in-depth investigation of the preference of young people for AI-based medication counseling services. Service providers should pay attention to the symptom-specific results, support more convenient access platforms, and optimize the language description, content models that add multiple digital media interactions, and more refined medication counseling to develop AI-based medication counseling services. Ethical approval for this study was obtained from Dongying People's Hospital, Approved No. of Ethics Committee: DYYX-2023-168

BACKGROUND:Medical personnel, particularly emergency department (ED) physicians, face a variety of occupational hazards. However, the current state of occupational injuries among ED physicians remains unknown. This study aimed to assess the occupational injury of Chinese ED physicians and to identify its associated factors. METHODS:From July to August 2018, a cross-sectional survey was conducted in Chinese emergency departments. A structured questionnaire covering sociodemographic characteristics, individual health behaviours, and work-related characteristics was completed by 10,457 ED physicians. Binary logistic regression was used to analyse the factors associated with occupational injuries. RESULTS:In this study, 81.13% of ED physicians reported occupational injuries in the previous 12 months. All participants who had experienced occupational injuries had suffered verbal violence. Among physicians who experienced at least one injury, 76.57% and 71.30% reported injuries sustained while moving patients and from falls, slips, and sprains during office visits, respectively. Occupational injuries were significantly associated with gender, education level, drinking behaviour, sleep quality, the frequency of night shifts per month, self-perceived physician shortage, and work-family conflict. Physicians who experienced effort-reward imbalance were at a higher risk of occupational injury. CONCLUSION:In China, occupational injuries are common among ED physicians. Individual factors as well as work-related factors are independently linked to occupational injuries. To reduce the rate of occupational injuries among ED physicians, health policymakers and healthcare facility managers should consider multi-injury interventions.

Decline in cognitive function poses a substantial burden on individuals, families, and society. However, the longitudinal potential mechanism underlying the link of pain and cognitive function remains unclear. Using data of 4247 participants aged 60 years and over from the China Health and Retirement Longitudinal Study in 2011, 2013, 2018, and 2020, we discussed the longitudinal predictive effect of pain on cognitive function and the mediating effects of depressive symptoms and social participation. The longitudinal mediation model analysis revealed that pain could not directly influence cognitive function, but it could indirectly predict cognitive function through the independent mediation effects of depressive symptoms and social participation. Moreover, the association between pain and cognitive function was serially mediated by depressive symptoms and social participation. Diversified interventions aimed at relieving pain and depressive symptoms, and increasing social participation in older adults would be beneficial for their cognitive function.