Background: Primary care delivers most long-term diabetes management globally, yet evidence on how benefits evolve and for whom they are largest is limited in low-income and middle-income settings. China's National Essential Public Health Service Programme (NEPHSP) delivers standardized quarterly follow-up in community health centers (CHCs), providing a platform to evaluate primary care diabetes management at scale. Methods: We did a longitudinal analysis of de-identified routine data from 26572 adults with type 2 diabetes enrolled in the NEPHSP in 47 CHCs in Shenzhen, China, contributing 319566 follow-up records between Jan 1, 2018, and Dec 31, 2024. The primary outcome was fasting blood glucose (FBG) control (<7 mmol/L). We used generalized estimating equations for year-specific adjusted change, generalized additive models (GAMs) for continuous-time change, and generalized linear mixed-effects model trees (GLMM trees) for subgroup heterogeneity using routine baseline variables. Mechanistic pathways were explored in a supplementary lagged mediation analysis. Findings: FBG control improved from 45·7% at baseline to 71·8% at year 1 (absolute difference +26·1 percentage points; p<0·0001) and plateaued at 82·1% by year 7. Adjusted FBG reduction was largest at year 1 (−0·72 mmol/L, 95% CI -0·75 to -0·69) and attenuated by year 7 (-0·32 mmol/L, 95% CI -0·44 to -0·20). GAM showed fastest decline at 0·3 years and maximum improvement at 1·6 years. GLMM-tree analysis identified heterogeneity: patients with no regular exercise and current alcohol use had the largest sustained reduction (year 7 −1·52 mmol/L); those with intermediate education and current smoking rebounded (+1·39 mmol/L at year 7). Interpretation: In routine primary care, most glycemic benefit is delivered in the first 1–2 years; uniform lifelong quarterly follow-up is not optimal. Adaptive, risk-stratified delivery-front-loaded intensification and proactive re-engagement of rebound-prone subgroups-can improve effectiveness and equity without additional diagnostic burden.

Background: Primary care delivers most long-term diabetes management globally, yet evidence on how benefits evolve and for whom they are largest is limited in low-income and middle-income settings. China's National Essential Public Health Service Programme (NEPHSP) delivers standardized quarterly follow-up in community health centers (CHCs), providing a platform to evaluate primary care diabetes management at scale. Methods: We did a longitudinal analysis of de-identified routine data from 26572 adults with type 2 diabetes enrolled in the NEPHSP in 47 CHCs in Shenzhen, China, contributing 319566 follow-up records between Jan 1, 2018, and Dec 31, 2024. The primary outcome was fasting blood glucose (FBG) control (<7·0 mmol/L). We used generalized estimating equations for year-specific adjusted change, generalized additive models (GAMs) for continuous-time change, and generalized linear mixed-effects model trees (GLMM trees) for subgroup heterogeneity using routine baseline variables. Mechanistic pathways were explored in a supplementary lagged mediation analysis. Findings: FBG control improved from 45·7% at baseline to 71·8% at management year 1 (absolute difference +26·1 percentage points; p<0·0001) and plateaued at 82·1% by year 7. Adjusted FBG reduction was largest at year 1 (-0·72 mmol/L, 95% CI -0·75 to -0·69) and attenuated by year 7 (-0·32 mmol/L, 95% CI -0·44 to -0·20). GAM showed fastest decline at 0·3 years and maximum improvement at 1·6 years. GLMM-tree analysis identified heterogeneity: patients with no regular exercise and current alcohol use had the largest sustained reduction (year 7 -1·52 mmol/L); those with intermediate education and current smoking rebounded (+1·39 mmol/L at year 7). Interpretation: In routine primary care, most glycemic benefit is delivered in the first 1–2 years; uniform lifelong quarterly follow-up is not optimal. Adaptive, risk-stratified delivery-front-loaded intensification and proactive re-engagement of rebound-prone subgroups-can improve effectiveness and equity without additional diagnostic burden.

Cardiometabolic multimorbidity (CMM) burdens aging populations. Obesity drives CMM via insulin resistance and inflammation, but their nonlinear and combined effects remain unclear. We elucidated how these factors contribute to CMM incidence. From CHARLS 2011 to 2018, 6,510 participants were enrolled. CMM was defined as ≥ 2 of diabetes, heart disease, and stroke. Cox regression, Kaplan-Meier, and Fine-Gray models were used. Restricted cubic splines (RCS) evaluated nonlinear relationships. Multiplicative and additive interactions were assessed, and mediation analysis with 1,000 bootstraps estimated indirect effects. K-means clustering based on eight standardized variables, including age, body mass index (BMI), waist circumference (WC), triglyceride-glucose (TyG), high-sensitivity C-reactive protein (hs-CRP), systolic blood pressure (SBP), high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose (FPG), identified metabolic phenotypes carried high CMM risk. Over 7 years, 212 (3.26

Objective: To summarize the key intervention characteristics and evaluate the effectiveness and safety of digital therapeutics (DTx) in patients receiving oral anticoagulation, with effectiveness evaluated using time in therapeutic range (TTR), thromboembolic events, and mortality, and safety evaluated based on bleeding events. Patients and Methods: We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to June 20, 2025, and identified 10 randomized controlled trials involving 7237 patients. The criteria required studies to assess software-based DTx supporting anticoagulation management and report effectiveness or safety outcomes. Study quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation framework, and random-effects models were applied. Results: Digital therapeutics interventions were associated with a lower incidence of major bleeding than usual care: no clear differences in TTR, thromboembolic events, or mortality. Evidence quality ranged from very low to high. Secondary analyses showed more international normalized ratio testing with DTx; rehospitalization rates did not differ significantly between the groups. Sensitivity analysis changed TTR effect after excluding a study with enhanced control, but other outcomes remained unchanged. Conclusion: Digital therapeutics interventions for anticoagulation management improve safety outcomes, particularly reducing major bleeding, and with greater monitoring intensity. Larger, long-term trials are needed to confirm the clinical benefits and evaluate cost-effectiveness. Trial Registration: PROSPERO Identifier: CRD420251107441.

BACKGROUND:Pneumococcal disease causes severe illness in older adults. This study examined the impacts of physician recommendation, vaccine hesitancy, and regional policy differences on pneumococcal vaccination uptake in China. RESEARCH DESIGN AND METHODS:A cross-sectional study was conducted among 13,363 adults aged ≥ 60 years in six Chinese cities using structural equation modeling, stratified by free and self-financed vaccination areas. RESULTS:Mean age was 69.53 years, 54.74% female, with 22.79% vaccination rate. Vaccine hesitancy had a significant negative direct effect on vaccination uptake (β = -0.387, p < 0.001), while physician recommendation exerted the largest total positive effect (β = 0.349). In self-financed policy area, vaccine hesitancy was the strongest negative predictor (β = -0.529, p < 0.001), and diverse information sources mitigated hesitancy but showed a slight negative direct effect on uptake (β = -0.059).In the free-vaccine policy area, physician recommendation had a more pronounced direct effect (β = 0.305, p < 0.001), and better perceived health status was associated with suppressed uptake (β = -0.093). CONCLUSIONS:Vaccine attitudes often reflect generalized psychological constructs. Strategies must be tailored to policy contexts: enhancing information quality in self-financed areas and addressing complacency in free-vaccine settings. Multidimensional interventions should expand healthcare worker roles and optimize organizational logistics. Key limitations include the cross-sectional design and reliance on self-reported data.

Seasonal influenza remains a significant public health concern among older adults, who face an increased risk of hospitalization and mortality. Despite the availability of free vaccination programs in many regions of China, influenza vaccination coverage among older adults remains low. Psychological antecedents play a crucial role in shaping vaccination decisions, yet few studies have explored how these factors interact with sociodemographic characteristics. A cross-sectional survey was conducted among 13,363 community-dwelling adults aged ≥60 y in six major Chinese cities between December 2024 and January 2025. The 5C scale - Confidence, Collective Responsibility, Complacency, Constraints, and Calculation - was used to assess psychological determinants of influenza vaccination. Logistic regression models, likelihood ratio tests (LRTs), and stratified analyses were performed to examine the main and interaction effects between psychological and sociodemographic factors. Overall, 34.05% of participants reported receiving an influenza vaccine within the past year. Calculation was positively associated with vaccination uptake (OR = 1.075, 95% CI: 1.057-1.093), while Complacency (OR = 0.658, 95% CI: 0.643-0.673) and Constraints (OR = 0.849, 95% CI: 0.831-0.867) were negatively associated. Significant interaction effects were observed between 5C subscales and education, income, and self-care ability, indicating that the influence of psychological factors varied across subpopulations. The psychological drivers of influenza vaccination among Chinese older adults are heterogeneous across sociodemographic groups. Precision public health strategies are essential: while high-SES individuals may benefit from data-driven information, low-income and low-literacy groups require simplified, emotionally resonant communication focused on personal protection rather than broad altruism. Furthermore, interventions should aim to reduce perceived constraints by streamlining vaccination processes and offering personalized risk-benefit assessments for older adults with chronic conditions.

BackgroundNon-alcoholic fatty liver disease (NAFLD) is highly prevalent and closely linked to metabolic dysfunction, with progressive liver fibrosis driving adverse outcomes. Conventional obesity metrics such as body mass index (BMI) and waist circumference inadequately capture body-composition imbalance. The skeletal muscle-to-visceral fat area ratio (SVR) integrates muscle reserve and visceral adiposity and may better reflect metabolic risk. However, large-scale evidence on SVR and fibrosis risk in Chinese patients with NAFLD is limited. This study investigated the association between the SVR and liver fibrosis risk in patients with non-alcoholic fatty liver disease (NAFLD).MethodsA cross-sectional study was conducted involving 661 patients with fatty liver from the Health Management Center of Peking Union Medical College Hospital (Xidan Branch) between January 2021 and November 2024. SVR was measured using a body composition analyzer, and the fibrosis-4 index (FIB-4) was calculated. Because the raw FIB-4 score was right-skewed and the residuals from the raw FIB-4 linear model were not normally distributed, log(FIB-4) was used as the continuous outcome. Hierarchical multivariable linear regression was used to analyze the association between SVR and log(FIB-4), and the mediating role of BMI was tested using the bootstrap method.ResultsThe raw FIB-4 score was markedly right-skewed (skewness = 1.440, Shapiro–Wilk p < 0.001), whereas the distribution of log(FIB-4) was substantially improved after natural logarithmic transformation (skewness = −0.123, Shapiro–Wilk p = 0.444). In the unadjusted model, SVR was inversely associated with log(FIB-4) (B = −0.067, 95% CI −0.109 to −0.025, p = 0.002). In the fully adjusted model including BMI, the inverse association between SVR and log(FIB-4) became stronger. Mediation analysis revealed a significant suppression effect of BMI, with a positive indirect effect and a negative direct effect (indirect effect = 0.041, direct effect = −0.108). Subgroup analysis showed that the suppression effect was observed in the higher-BMI subgroup and in both men and women, but not in the lower-BMI subgroup.ConclusionHigher SVR was associated with lower log(FIB-4) among patients with NAFLD, and BMI appeared to suppress part of this association. These findings suggest that SVR may provide body-composition information beyond BMI in FIB-4-based risk assessment, but longitudinal studies with more precise fibrosis assessment are needed for validation.

Background Childhood and early adolescence are critical periods for promoting health literacy (HL), a foundational factor that influences health-promoting participation throughout life. Evidence-based, theory-informed interventions to improve participation in school-aged children are scarce. This study aims to clarify the HL framework and to understand its role in guiding tailored interventions.Methods Within the HL framework, this study conceptualized health participation improvement through knowledge, skills, and motivation. Two pathways, knowledge-driven and motivation-driven, were proposed and validated for their relative contributions. From January to July 2023, a multistage cluster sampling method was used to recruit 3,325 elementary school students in China, including 1,070 students in Grades 1-2, 1,190 in Grades 3-4, and 1,065 in Grades 5-6. HL was assessed using the Chinese Rapid Health Literacy Questionnaire (CRHLQ) for Elementary School Students, a validated assessment tool comprising three sub-questionnaires. Chain mediation models were constructed to examine the two pathways, with gender, academic performance, and personality included as control variables. Indirect effects were estimated using a bootstrap method with 5,000 replications.Results In Grades 1-2, health participation is primarily mediated through motivation and skills for the knowledge-driven pathway, while motivation exerts a strong direct effect in the motivation-driven pathway. In Grades 3-4, knowledge has a total direct effect on health participation, whereas motivation influences participation indirectly via knowledge. In Grades 5-6, the knowledge-driven pathway operates mainly through motivation, with no direct effect, while motivation again shows a strong direct effect on participation. To sum up, pathways for improving health participation differ across elementary grade levels: motivation-driven in lower grades, knowledge-driven in middle grades, and combined knowledge- and motivation-driven in upper grades.Conclusion Guided by the HL framework, patterns of health participation improvement differ across grade levels. HL interventions should be tailored using developmentally appropriate strategies and tools. Adapting health education content to grade level, balancing motivation-driven and knowledge-driven strategies, can maximize its educational effectiveness.

China’s National Essential Public Health Service (NEPHS) Program was launched in 2009 to deliver population-based public health and individual health management services to all residents at 800,000 primary health-care centers nationwide. This study assessed NEPHS utilization data and evaluated usage inequities using comprehensive nationwide data. A cross-sectional study was conducted, selecting 16 indicators (out of 18) from 12 service packages to evaluate inequity. These included 4 indicators for services provided to all residents and 12 for pregnant women, new mothers, children aged 0–6 years, and patients with hypertension, diabetes, severe mental disorders, or tuberculosis. Data on service utilization and target populations for these indicators across the 31 provinces and 453 cities in mainland China were obtained from the NEPHS database and management platform for the period January 1 to December 31, 2019. Service utilization rates and bias-corrected bootstrap confidence intervals (CIs) were calculated to determine utilization. Inequities were assessed using the Gini coefficient and Sitthiyot-Holasut composite inequality index at the national and provincial levels, and the Theil index was employed to decompose overall inequity into within-region and between-region subgroups. The NEPHS collected health records for 88.25

BackgroundDiabetic foot ulcers (DFUs) constitute a significant complication among individuals with diabetes and serve as a primary cause of nontraumatic lower-extremity amputation (LEA) within this population. We aimed to develop machine learning (ML) models to predict the risk of LEA in DFU patients and used SHapley additive explanations (SHAPs) to interpret the model.MethodsIn this retrospective study, data from 1,035 patients with DFUs at Sun Yat-sen Memorial Hospital were utilized as the training cohort to develop the ML models. Data from 297 patients across multiple tertiary centers were used for external validation. We then used least absolute shrinkage and selection operator analysis to identify predictors of amputation. We developed five ML models [logistic regression (LR), support vector machine (SVM), random forest (RF), k-nearest neighbors (KNN) and extreme gradient boosting (XGBoost)] to predict LEA in DFU patients. The performance of these models was evaluated using several metrics, including the area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA), precision, recall, accuracy, and F1 score. Finally, the SHAP method was used to ascertain the significance of the features and to interpret the model.ResultsIn the final cohort comprising 1332 individuals, 600 patients underwent amputation. Following hyperparameter optimization, the XGBoost model achieved the best amputation prediction performance with an accuracy of 0.94, a precision of 0.96, an F1 score of 0.94 and an AUC of 0.93 for the internal validation set on the basis of the 17 features. For the external validation set, the model attained an accuracy of 0.78, a precision of 0.93, an F1 score of 0.78, and an AUC of 0.83. Through SHAP analysis, we identified white blood cell counts, lymphocyte counts, and blood urea nitrogen levels as the model’s main predictors.ConclusionThe XGBoost algorithm-based prediction model can be used to dynamically estimate the risk of LEA in DFU patients, making it a valuable tool for preventing the progression of DFUs to amputation.

背景  为了推进国家基本公共卫生服务考核评估从过程到结果的转变，课题组前期从理论上构建了“效果导向的基本公共卫生服务综合评价指标体系”，但该指标体系实践应用尚不充分。目的  为了进一步完善该指标体系的实践应用，本研究利用该指标体系对深圳市2017—2022年基本公共卫生服务实施效果进行回顾性评价。方法  于2022年7月—2023年4月通过文献资料法、函调法收集指标数据，采用综合指数法，计算2017—2022年深圳市基本公共卫生服务综合指数及各维度指数。结果  指标体系的54个指标，共收集到49个，完成率为91.8%。2017年至2022年，深圳市基本公共卫生服务综合指数从46.62增加到51.37，项目投入指数从3.75增加到10.40，项目执行指数从11.23增加至的19.36，项目效果指数31.65降低至21.61。单从各子项目的效果指数来看，健康教育效果指数有较大增幅，从2017年的0.067增加到2022年的4.079；慢性病患者健康管理效果指数从2017年的13.469降低至2022年的3.571，最低为3.223（2021年），最高为14.970（2019年），儿童健康管理、知晓率与满意度效果指数最低值分别为3.374、1.987，均出现在2019年。孕产妇健康管理效果指数最低值在2022年（4.052）。结论  以效果为导向的基本公共卫生综合评价指标体系应用于评价市级层面基本公共卫生服务具有一定的可行性和科学性，但部分反映人群健康危险因素及健康状况的指标还存在可获得性低的问题。信息化全量考核能解决数据虚报的问题，提高项目的督导效率。但在服务覆盖率趋近饱和的情况下，其促进作用是有限的，未来基本公共卫生服务应该以提高服务质量、增进人群健康效益为目标，特别要以知晓率与满意度为重点，不断提升居民的获得感。

Background:This study aimed to develop and validate test-based physical literacy scales (PLSs) for primary school students across different grades. Methods:Data were collected through a field survey conducted from June 1 to July 31, 2022, involving 3,275 primary school students from four provinces in China. The questionnaires assessed four domains: physical knowledge, physical competence, physical motivation, and physical behavior. The Rasch model was employed for psychometric analysis. Results:The variance explained by measures for the PLSs was 53.1%, 50.3%, and 54.7%, all exceeding the 50% threshold, confirming unidimensionality and robust internal consistency. This enabled effective differentiation among students with varying proficiency levels. The item-person map demonstrated optimal alignment between item difficulty and participant ability levels. Most items showed favorable fit statistics, with Infit mean square (MNSQ) and Outfit MNSQ values ranging between 0.5 and 1.5. Conclusions:The PLSs demonstrate validity and reliability in measuring physical literacy among Chinese primary school students across four components: physical knowledge, physical competence, physical motivation, and physical behavior. The scales measure a unidimensional construct, supporting the use of summed total scores for assessment.

OBJECTIVE(S):Recent studies have suggested that circadian eating behaviors play a significant role in metabolic diseases and their related complications. However, the impact of daily eating frequency (DEF) and nighttime fasting duration (NFD) on diabetic kidney disease remains poorly understood. This study aims to investigate the potential association between DEF and NFD with the development of diabetic kidney disease. METHODS:Data from the NHANES dataset (1999-2018) were collected to obtain information on diabetes and circadian eating behaviors. Using the recorded start and end times of each meal throughout the day, we calculated the NFD. And the frequency of eating episodes was used to evaluate DEF. Meanwhile, diabetic kidney disease was diagnosed in diabetic patients according to the criteria of impaired estimated glomerular filtration rate (<60 mL/min/1.73 m2) and/or the presence of albuminuria (urinary albumin to urinary creatinine ratio >30 mg/g). Weighted logistic regression models were used to assess the associations between DEF and NFD in relation to the diabetic kidney disease. RESULTS:Our study encompassed a total of 7,336 adult participants. We found that the prevalence of diabetic kidney disease has a nonlinear relationship with DEF and NFD, plateauing at 3 meals per day and minimizing when NFD is between 10 and 11. Based on this result, the entire population was divided into 5 subgroups according to the quantiles of DEF and NFD. Compared to DEF at 3 times, participants with DEF fewer than 3 times had a higher diabetic kidney disease prevalence even after adjusting for covariates (odds ratio [OR] = 1.59, 95% confidence interval [CI]: 1.16-2.18). Furthermore, participants with an NFD exceeding 12 hours demonstrated a higher prevalence of diabetic kidney disease (12-13.5 hours OR = 1.30, 95% CI: 1.04,1.65); >14 h: OR = 1.45, 95% CI: 1.09, 1.91), compared to those with an NFD of 10 to 11 hours. CONCLUSION(S):Our findings indicate that a DEF of fewer than 3 times per day and an NFD of more than 12 hours are associated with an increased prevalence of diabetic kidney disease. Modifying circadian eating patterns may hold potential for improving renal outcomes in individuals with diabetes.

Background: Influenza vaccination reduces morbidity and mortality in older adults. This study identifies characteristics and reasons for vaccination uptake among the elderly to inform strategies to improve coverage. Methods: We conducted a cross-sectional survey in December 2024 among community-dwelling adults aged ≥ 60 years across six Chinese cities. Data collected included socio-demographic and health characteristics, influenza vaccine awareness and uptake, reasons for vaccination or non-vaccination, and intentions for future vaccination. Univariate and multivariable logistic regression were used to identify factors associated with vaccination. To explore motivation patterns, co-occurrence networks of vaccination reasons were constructed, and k-medoids clustering was applied. Results: Among 13,363 adults aged ≥ 60 years, influenza vaccination coverage was 34.0%. Higher education and income, being married, having health insurance, poor self-care ability, and chronic obstructive pulmonary disease were independently associated with vaccination. Vaccinated individuals reported more positive attitudes and were mainly motivated by family and doctor recommendations as well as perceived vaccine effectiveness, with four motivation profiles discovered: social recommendation, comprehensive confidence, clinician-guided, and self-reliant confidence. Among unvaccinated participants, the main reasons for non-vaccination were mild influenza symptoms and the influence of family and friends, forming four motivation profiles: safety concern, low-perceived risk, social influence, and perceived ineffectiveness. Conclusions: Influenza vaccination among older Chinese adults remains suboptimal. Tailored interventions leveraging healthcare provider endorsement, family and social support, and policy-driven strategies such as free or subsidized vaccination are needed, particularly for high-risk populations.

Health literacy (HL) is critical for shaping health behaviors in children and adolescents. Though children and adolescence are marked by increased involvement in health decision-making, most HL studies and measures of HL have focused on adults. There is a lack of an appropriate test-based validated tool for measuring comprehensive health literacy employing grounded theory approaches. This study aimed to develop and validate a rapid health literacy questionnaire for primary and secondary students to address gaps in exiting tools. Firstly, a health literacy indicator system was constructed through literature analysis, Delphi method, and expert interviews. Secondly, for each domain indicator, items were generated. Finally, a stratified sampling survey with 3,325 primary school students and 2,788 secondary school students was conducted, Rasch model approach was applied to evaluate reliability and validity. Reliability analysis confirmed consistent results, demonstrating favorable overall fit between observed data and the model. Validity results showed internal consistency. We developed a robust assessment tool tailored to Chinese primary and secondary students, which is expected to comprehensively measure the health literacy of students aged 6 to 15 years. Future cross-cultural validation is recommended to enhance its global applicability. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement the National Natural Science Foundation of China under Grant [number 71904205] ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of the Chinese Academy of Medical Sciences & Peking Union Medical College I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

ObjectivesThis study aimed to develop a patient-reported questionnaire to assess service utilization and patient satisfaction among older adults with hypertension and diabetes in primary health-care centers operating under China’s National Essential Public Health Service Program (NEPHSP).MethodsThe questionnaire’s item pool was constructed on the basis of a logic model. A cross-sectional survey was conducted in three provinces of mainland China between November and December 2019. The questionnaire was evaluated using Cronbach’s alpha coefficients and confirmatory factor analysis (CFA) to refine items and assess internal consistency, construct validity, convergent validity, and discriminant validity.ResultsThe final questionnaire adopted a second-order factor model comprising three domains: essential services for all older adults, follow-up services for older adults with hypertension or diabetes, and patient satisfaction assessment. Through a two-step refinement process, nine factors encompassing 29 items were selected, including elements such as “health records and health education,” “blood pressure/glucose monitoring,” and “health education in follow-up.” Cronbach’s alpha coefficients indicated excellent reliability, with values of 0.899 and 0.906. The 29-item instrument had robust model fit for both hypertension and diabetes cohorts. The fit indices for the hypertension model included a Bollen–Stine bootstrap chi-square to degrees of freedom ratio (χ2/df) of 1.78, root mean square error of approximation (RMSEA) of 0.03, and goodness-of-fit index (GFI) of 0.97. Similarly, for the diabetes model, the fit indices were a Bollen–Stine bootstrap χ2/df ratio of 1.38, RMSEA of 0.02, and GFI of 0.97. CFA revealed factor loadings ranging from 0.516 to 0.940 for the hypertension model and from 0.504 to 0.943 for the diabetes model. All three first-order factors were significantly correlated with each other (p < 0.01), and their correlation coefficients were lower than the square root of the average variance extracted. The models demonstrated strong structural validity, convergent validity, and discriminant validity.ConclusionA valid and reliable questionnaire for evaluating service utilization and patient satisfaction among older adults with hypertension and diabetes in primary health-care center was developed in China. This instrument will serve as a practical tool for patient-reported assessments within the NEPHSP framework at primary health-care centers.

Prediabetes is associated with higher risk of chronic kidney disease (CKD), however studies investigating the prognostic index for incident CKD in patients with prediabetes are lacking. Thus, the present study aims to find the risk factors for CKD in prediabetic population. We included 1220 prediabetic participants without CKD in the REACTION study and examined the associations of clinical indicators with CKD incidence with 3.6 years of follow-up using logistic regression analyses. To explore the nonlinear relationship between the Urine Albumin-To-Creatinine Ratio (UACR) and the hazard ratio (HR) of CKD, a Restricted Cubic Spline (RCS) analysis was conducted. Logistic regression analysis was employed to assess the association between UACR categories and the risk of CKD incidence. There were 78 (6.4

Background The growing approval and use of digital therapeutics (DTx) for managing chronic diseases, such as diabetes, has prompted questions about their effectiveness. Objective This systematic review and meta-analysis aimed to report the effectiveness of DTx interventions in the management of patients with type 1 diabetes, type 2 diabetes, and prediabetes. Methods Data sources, including Web of Science, MEDLINE, Embase, and the Cochrane Library, were searched from inception to July 30, 2023. We included randomized controlled trials assessing the effectiveness of DTx interventions in the health management of individuals with prediabetes and those diagnosed with type 1 diabetes and type 2 diabetes. Our primary outcomes were glycated hemoglobin (HbA1c) levels, fasting blood glucose (FBG) levels, BMI, and weight. Trials that met the eligibility criteria were scored for risk of bias using the Cochrane Risk of Bias Tool 2.0. A narrative synthesis and meta-analysis of included studies were also conducted. Results A total of 19 studies were included in the meta-analysis (n=3264). The DTx intervention produced a noteworthy reduction in HbA1c levels among individuals with diabetes (weighted mean difference [WMD] −0.54%, 95% CI −0.72 to −0.36), as well as decreases in FBG levels (WMD −0.56, 95% CI −0.76 to −0.37) and BMI (WMD −0.84, 95% CI −1.23 to −0.45). In addition, it contributed to the increases in low-density lipoprotein cholesterol (WMD −0.13, 95% CI −0.22 to −0.03) and triglyceride levels (WMD −0.18, 95% CI −0.34 to −0.02). Subgroup analyses revealed a beneficial impact of DTx on improving HbA1c levels in patients with type 2 diabetes mellitus (mean difference −0.66, 95% CI −0.92 to −0.41). However, this intervention did not elicit a comparable improvement in HbA1c levels for patients with type 1 diabetes mellitus (mean difference −0.45, 95% CI −0.89 to −0.00). DTx did not significantly affect weight reduction (WMD −1.07, 95% CI −2.33 to 0.20), systolic and diastolic blood pressure, total cholesterol levels, or high-density lipoprotein levels. Conclusions The DTx intervention holds promise for enhancing health management among individuals with diabetes, potentially attenuating HbA1c levels, FBG levels, and BMI, especially in individuals with type 2 diabetes. Trial Registration PROSPERO CRD42023473743; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023473743

Physical literacy (PL) is pivotal for improving sedentary behaviors, enhancing intrinsic motivation for physical activity, and supporting the growth and development of adolescents. This study aims to measure the current situation and internal pathway of PL among Chinese elementary school students. This study was conducted from June to July 2022 and used multistage cluster sampling to select the study subjects. Questionnaire measurements were used to report the levels of PL among elementary school students and to explain the internal association among the various PL dimensions. The average PL score among primary school students was 63.46 points. The qualification rates for PL in the three academic stages were 76.35