Background: Potentially modifiable risk factors (PMRFs) across the life course of dementia show a temporal progression from early-life stages to mid/late-life stages. However, an important unresolved question is whether mid/late-life factors (such as urban or rural living environments) can counteract or compensate for the effects of early-life factors (educational attainment) on the association between biological sex and dementia risk. This study aimed to investigate the three-way interaction among educational attainment, residential area, and sex in relation to dementia risk in older Chinese adults. Methods: This cross-sectional study analyzed data from a population-based dementia screening initiative in Haining City, Zhejiang Province, China. The investigation was conducted among adults aged 65–80 years between April 2021 and August 2023, with statistical analyses performed from April 2024 to March 2025. Analytical subgroups comprised four categories: the full population, cerebrovascular disease (CVD)-only, traumatic brain injury (TBI)-only, and non-CVD/TBI groups. Cognitive function was assessed using the Community Screening Instrument for Dementia (CSI-D). Moderated hierarchical regression models tested three-way interactions (sex × education × residence) and were complemented by additive interaction metrics—including relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S)—to quantify joint effects on the additive scale. Age-stratified analyses (<75 vs ≥75 years) with Benjamini–Hochberg false discovery rate correction were implemented. Findings: The study included 98,770 eligible participants (52.18% female, 30.71% illiterate, 82.80% rural residents). Significant three-way sex × education × residence interactions emerged in both the full population (β=0.162, SE=0.064, P=0.012) and the non-CVD/TBI subgroup (β=0.196, SE=0.065, P=0.003). Urban environments amplified literacy-related cognitive disparities compared with rural settings. Sex–education interactions were significant in urban populations (β=0.140, SE=0.057, P=0.014) but absent in rural populations (β=−0.016, SE=0.022, P=0.464), with effects intensifying after exclusion of CVD/TBI cases. Age-stratified analyses revealed that these effects were significant only in participants younger than 75 years (full population: β=0.235, SE=0.027, P=0.001). Interpretation: The association between sex and cognitive function in older Chinese adults is differentially modified by educational attainment and residential context. These findings establish that mid/late-life environmental factors (living environment) can partly compensate for early-life educational disadvantages, but such compensation is context-dependent—operative primarily in urban settings and among individuals without CVD/TBI, and with an apparent age threshold below 75 years. This advances mechanistic understanding of dementia pathogenesis while informing targeted, context-specific prevention strategies.

As chronic heart disease (CHD) continues to rise globally, attention is shifting beyond medical interventions to the psychological dimensions of care. This study examined whether structured psychological support, integrated within a multidisciplinary framework, could enhance clinical outcomes, promote healthier lifestyles, and improve quality of life among CHD patients. In a randomized controlled trial, 200 patients with CHD were allocated to either an intervention group—receiving psychological support, educational sessions, dietary counseling, and personalized physical activity—or a control group receiving standard care. The primary outcomes were changes in lipid profiles and cardiac imaging after 12 months. Secondary measures included cardiac events, health-related quality of life (HRQoL), medication adherence, and lifestyle behaviors assessed at 6 and 12 months. Analyses followed the intention-to-treat principle. The intervention group demonstrated better lipid outcomes at 12 months significantly, including lower LDL cholesterol (90 ± 25 vs. 100 ± 30 mg/dL) and higher HDL cholesterol (50 ± 12 vs. 45 ± 10 mg/dL). Cardiac imaging also improved, with higher left ventricular ejection fraction (56.2 ± 6.1

Introduction:Due to their comorbidities and frequent exposure to healthcare settings, patients undergoing dialysis are at a high risk of developing severe COVID - 19. However, there are no customized vaccination guidelines for this group in China. This study had two aims: to systematically evaluate the current status of COVID - 19 vaccination among Chinese dialysis patients and to offer a basis for policy - making and further research. Methods:This study was conducted across all provinces in mainland China using the stratified randomization method. Electronic questionnaires were distributed to patients undergoing dialysis. Results:Conducted as a national cross - sectional study from May to July 2022, it involved 131,149 dialysis patients from 2,865 centers. The study examined vaccination coverage, the barriers to vaccination, and the safety of vaccines. Only 21.0% received ≥1 vaccine dose, predominantly inactivated vaccines (84.5%). Adverse reactions occurred in 19.0%, with higher rates for adenovirus vector vaccines (27.3%) than for recombinant protein (19.4%) and inactivated vaccines (18.5%, P < 0.001). Among unvaccinated patients, 53.5% faced institutional barriers (e.g., site refusal or lack of recommendations), while 88.7% had no contraindications. Older age (OR = 1.32, 95% CI 1.28-1.36), female gender (OR = 1.18, 1.14-1.22), and hemodialysis (OR = 1.12, 1.06-1.19) predicted non-vaccination. Conclusion:In general, this study highlights critical barriers to COVID-19 vaccination in dialysis patients: guideline gaps, patient hesitation, and non-specific vaccination settings. Recommendations include updating guidelines to prioritize this population, training non-specialized staff, and launching dialysis center-based vaccination programs. Future research should investigate vaccine immunogenicity in dialysis patients to refine booster strategies.

INTRODUCTION This study explores the association of individual cognition and social environment of smoking with autonomy over tobacco, providing evidence and insights to help smokers effectively prevent and reduce tobacco dependence. METHODS Data were collected from 1389 participants, aged >= 15 years, by face-toface interviews from June 2018 to November 2019 in central China. We assessed autonomy over tobacco using the Autonomy Over Smoking Scale (AUTOS), including Withdrawal Symptoms (WS), Psychological Dependence (PD) and Cueinduced Cravings (CC), and examined factors of individual cognition and social environment, as well as covariates, including demographic characteristics, health status, and smoking behavior. RESULTS AUTOS total score was 16.92 +/- 9.05, WS score was the lowest (4.40 +/- 3.36) in the three subscales, and CC score was the highest (6.88 +/- 3.2). After adjustment, WS score of having a greater awareness of smoking hazards to one's own health was lower than those who had no awareness (beta=0.14; 95% CI: -0.31- 0.00), and the total score of AUTOS, the score of PD and CC for those who thought smoking was 'more helpful (high)' to interpersonal communication were higher than 'not helpful (not at all)' (beta=0.14; 95% CI: 0.01-0.28 with beta=0.16; 95% CI: 0.02-0.29; and beta=0.14; 95% CI: 0.00-0.28; respectively). Having a greater difficulty in smoking cessation was associated with higher AUTOS total and subscale scores (p<0.001). Notably, none of the social-environmental factors included had a significant association with AUTOS scores. CONCLUSIONS Interventions targeting individual cognitive factors of tobacco dependence seem to be more effective in smoking cessation. Future research may explore the influence of family and workplace among social environmental factors, which may reveal the effect of a binding force.

Due to the common characteristics of major communicable and non-communicable chronic diseases targeted by major disease prevention and control measures-such as variability and ambiguity-both face common challenges in the implementation of group strategy.Additionally,these strategies must be conducted within the units/institutions/communities where people work,study,and live,focusing on groups rather than individuals,thus inherently involving organizational behavior.This paper proposes addressing the common issues of group prevention and control of major diseases from the perspective of organizational behavior,leveraging collective power through organizational roles.Moreover,based on relevant studies,it preliminarily introduces four organizational behavior elements aimed at addressing these common issues and analyzes the interrelationships among these four elements.

With the rapid and in-depth development of medical practice and medical research, medical ethics issues are receiving more and more attention; at the same time, population-related health surveys are also facing more and more medical ethics issues. How to deal with the medical ethics is the focus and difficulty of on-site quality control in population health investigations. On the basis of expounding the four basic principles of medical ethics (beneficial principle, non-harm principle, respect principle, and fairness principle) and their interrelationships, we summarize the application of the basic principles of medical ethics in the quality control of field survey on population health from three aspects: the basic principles of medical ethics and the presentation of population health questionnaire, the recruitment of participants, and the process of inquiry, aimed to promote cross-integration and innovative development of medical ethics and public health and other related disciplines.

Background Health literacy (HL) is associated with health outcomes, but little is known about the occupational HL (OHL) for port employees and its link to the length of service and job category. Method A cross-sectional survey was conducted on 3492 port employees from the Occupational Health Survey for Port Employees project, and a special questionnaire was utilized to measure the OHL status. Binary and ordinal logistic regressions were used to estimate the association. Result Among the participants, 72.90% had sufficient OHL with a mean score (standard deviation) of 53.10 (7.26). Binary logistic regression results indicated that the association between length of service (33–40 years group Adjusted OR = 1.11; 41–49 years group Adjusted OR = 1.14; ≥50 years group Adjusted OR = 1.19) and job category (longshoremen Adjusted OR = 0.90; driver Adjusted OR = 0.91) with OHL were statistically significant. Ordinal logistic regression results indicated that, for OHL, Adjusted OR was increased in different lengths of service level (33–40 years group, Adjusted OR = 1.50; 41–49 years group, Adjusted OR = 1.75; ≥50 years group, Adjusted OR = 2.19), and the Adjusted OR of skilled workers was 1.60. Conclusion Most port participants had sufficient OHL, and the length of service and job category could affect OHL. The effect of the length of service may be more obvious; the length of service can promote the improvement of OHL continuously.

Objectives To explore the impact of two measures of human resource management reform, namely market-oriented employment status(MOES) and equal pay for equal work(EPEW) with work performance and work-family conflicts among physicians in public hospital in China. Methods We conducted a national cross-sectional survey in 77 public hospitals across seven provinces in China between July 2014 and April 2015, and 2785 physicians involved in this study. Work performance included work engagement, career attrition and patient-centered care. Work-family conflicts were composed of affecting care for family, feeling guilty towards family and receiving complaints from family. RESULTS Participants with MOES only account for 20.25%, those with EPEW only account for 10.36% and those with MOES & EPEW account for 4.35%. After adjusted for potential confounders, compared with those who had no experience of human resource reform measures, participants who had experiences of MOES & EPEW were more likely to report positive work performance (pride in work: aOR = 4.35, 95% CI :2.60–7.28; enjoyment of work: aOR = 4.46, 95% CI :2.71–7.35; turnover intention: aOR = 0.40, 95% CI :0.25–0.65; early retirement: aOR = 0.35, 95% CI: 0.21–0.58; exhaustion: aOR = 0.50, 95% CI :0.31–0.81) and negative work-family conflicts (feeling guilty towards family: aOR = 0.45, 95% CI :0.2810.73; receiving complaints from family: aOR = 0.52, 95% CI :0.32–0.85). Analysis stratified by age ≥35y and <35y showed that the human resource reform measures would have a higher effect on participants age ≥35y compared with those age <35y. CONCLUSIONS The differences stratified by age would reveal that salary system reform may need to be accelerated further and employment system reform may need to be appropriately slowed down, and accordingly, perfecting spiritual incentives measures would be needed to overcome the decline of their effect over time in the future.

Abstract Background Although China's hospital human resource reform started more than ten years ago, studies on its impact on physicians’ work and life are relatively few. This study used data from a national survey of physicians in China to explore the impact of two aspects of human resource reform measures (namely MOES and EPEW) with work performance and work-family conflicts among physicians. Methods We conducted a national cross-sectional survey in 77 public hospitals across seven provinces in China between July 2014 and April 2015, and 2785 physicians involved in this study. Work performance included work engagement, career attrition and patient-centered care. Work-family conflicts were composed of affecting care for family, feeling guilty towards family and receiving complaints from family.RESULTS Participants with MOES only account for 20.25%, those with EPEW only account for 10.36% and those with MOES & EPEW account for 4.35%. After adjusted for potential confounders, compared with those who had no experience of human resource reform measures, participants who had experiences of MOES & EPEW were more likely to report positive work performance (pride in work: aOR = 4.35, 95% CI :2.60–7.28; enjoyment of work: aOR = 4.46, 95% CI :2.71–7.35; turnover intention: aOR = 0.40, 95% CI :0.25–0.65; early retirement: aOR = 0.35, 95% CI: 0.21–0.58; exhaustion: aOR = 0.50, 95% CI :0.31–0.81) and negative work-family conflicts (feeling guilty towards family: aOR = 0.45, 95% CI :0.2810.73; receiving complaints from family: aOR = 0.52, 95% CI :0.32–0.85). Analysis stratified by age ≥35y and <35y showed that the human resource reform measures would have a higher effect on participants age ≥35y compared with those age <35y. CONCLUSIONS The differences stratified by age would reveal that salary system reform may need to be accelerated further and employment system reform may need to be appropriately slowed down, and accordingly, perfecting spiritual incentives measures would be needed to overcome the decline of their effect over time in the future.

This study aims to investigate the association of organizational and patient behaviors (reflecting the internal and external environment of hospital, respectively) with physician well-being. A national cross-sectional survey was conducted in 77 hospitals across seven provinces in China between July 2014 and April 2015. Physician well-being was assessed with job satisfaction, career regret and happiness. Organizational behaviors were assessed with organizational fairness, leadership attention and team interaction; patient behaviors were assessed with patient trust and unreasonable requests from patients. Of a study sample of 3,159 physicians, 1,788 were men (56.6%) and 1,371 were women (43.4%). Overall, positive organizational and patient behaviors reported by physicians were relatively low. Negative organizational behaviors and patient behaviors including lower organizational fairness, lower leadership attention, lower team interaction and lower patient trust were associated with lower job satisfaction and lower life satisfaction, and higher career regret. The association between organizational behaviors and physician well-being exhibited some gender differences, while no clear gender difference was found for the relationship between patient behaviors and physician well-being. Given the importance of physician well-being for the healthcare system, interventions for improving internal and external hospital environments (e.g., organizational fairness, leadership attention, team interaction and patient trust) may benefit physician well-being.

Objective To determine the impact of smoking on disease-specific health care utilization and medical costs in patients with chronic non-communicable diseases (NCDs). Methods Participants were middle-aged and elderly adults with chronic NCDs from a prospective cohort in China. Logistic regressions and linear models were used to assess the relationship between tobacco smoking, health care utilization and medical costs. Results Totally, 1020 patients with chronic obstructive pulmonary disease (COPD), 3144 patients with coronary heart disease (CHD), and 1405 patients with diabetes were included in the analysis. Among patients with COPD, current smokers (β: 0.030, 95% CI: −0.032–0.092) and former smokers (β: 0.072, 95% CI: 0.014–0.131) had 3.0% and 7.2% higher total medical costs than never smokers. Medical costs of patients who had smoked for 21–40 years (β: 0.028, 95% CI:−0.038–0.094) and ≥41 years (β: 0.053, 95% CI: −0.004β0.110) were higher than those of never smokers. Patients who smoked ≥21 cigarettes (β: 0.145, 95% CI: 0.051–0.239) per day had more inpatient visits than never smokers. The association between smoking and health care utilization and medical costs in people with CHD group was similar to that in people with COPD; however, there were no significant associations in people with diabetes. Conclusion This study reveals that the impact of smoking on health care utilization and medical costs varies among patients with COPD, CHD, and diabetes. Tobacco control might be more effective at reducing the burden of disease for patients with COPD and CHD than for patients with diabetes.

Patients’ perceptions of healthcare vary over time and by setting, and previous studies have rarely focused on these factors. We aimed to measure patients’ perceptions of hospital care in China and to examine how patients’ perceptions of hospital care vary by hospital characteristics (differences in setting) and previous hospitalization-related experiences (changes with time). We conducted a national cross-sectional survey of 7267 inpatients between July 2014 and April 2015 in China. Hospital characteristics measured were hospital technical level, hospital type, teaching status, and the ratio of doctors/nurses to ward beds. Previous hospitalization-related experiences measured were current admission length, number of previous admissions, and hospital selection (hospital advertisements or personal recommendations). Patients’ perceptions of hospital care included perceptions of doctors, nurses, and hospital organization. Scores were highest for perceptions of nurses, followed by perceptions of doctors, and hospital organization. Of the five hospital characteristics rated, the technical level was most strongly associated with patient perceptions of healthcare. The effect of hospital admission length and frequency of hospitalization on patients’ perceptions was represented by a √-shaped dose–response curve (scores were initially high, then decreased, then rebounded to higher than the initial scores). Patients who selected a hospital with hospital advertisements gave lower scores than those without hospital advertisements, and patients who selected a hospital with personal recommendations gave higher scores than those without If the observed √-shaped dose–response curves indicate a causal relationship between patients’ perceptions and hospital admission length or frequency of hospitalization, this may help to guide the timing of patient satisfaction assessments. The negative association between patient perception and advertising, and the positive association with personal recommendations (word-of-mouth) and hospital technical level, could provide important information for clinicians and hospital administrators.

目的:了解深圳市口腔科医务人员的工作压力和付出回报满意度及其影响因素.方法:对深圳市36家医疗机构的口腔科医务人员展开问卷调研,采用描述性统计、卡方检验和二元逻辑回归分析数据.结果:20.67％的医务人员认为平时工作压力比较大,29.57％的医务人员对付出回报持有不满意态度.性别、机构性质是工作压力的影响因素,岗位类别、工作年限、机构性质和工作压力是付出回报满意度的影响因素.公立机构医务人员的工作压力是民营机构的2.61倍(P=0.006);不满意概率是民营机构的5.36倍(P<0.001),工作压力大的医务人员的不满意概率是压力小的2.83倍(P<0.001).结论:深圳市口腔科医务人员呈现一定程度的负面工作状态,公立医疗机构医务人员在工作压力和工作回报满意度方面均差于民营医疗机构,建议在加大对口腔医师的引进和多层次培养力度的同时关注医务人员身心健康.

To evaluate the attendance and determinants of organized cervical and breast cancer (two-cancer) screening, especially higher-level factors, we conducted a cross-sectional survey in central China from June 2018 to November 2019 among 1949 women (age ≥ 35 years). We examined organizer-level factors, provider-level factors, receiver-lever factors and attendance and participation willingness of screening. The results indicate that the attendance and participation willingness of organized two-cancer screening was 61.19% and 77.15%, respectively. After adjustment for potential confounders, women who received screening notification were more likely to have greater participation willingness and higher attendance than those who received no notification (adjusted odds ratio [aOR] = 1.59, 95% confidence interval [CI]: 1.27–1.99; aOR = 98.03, 95% CI: 51.44–186.82, respectively). Compared with being notified about screening by GPs, being notified by community women’s leaders and other community leaders were more likely to lead to greater willingness to participate again (aOR = 2.86, 95% CI: 1.13–7.24; aOR = 3.27, 95% CI: 1.26–8.48, respectively) and recommending screening to others (aOR = 2.18, 95% CI: 1.02–4.65; aOR = 4.14, 95% CI: 1.84–9.30, respectively). The results suggest that notification of women about screening by community leaders is an important organizer-level factor. As a part of public health services, the design and implementation of optimal cancer screening strategies may require public-sector involvement at the organizer level instead of a one-man show by the health sector.

Background and Aims:Elevated serum uric acid (SUA) is associated with an increased risk of nonalcoholic fatty liver disease (NAFLD); however, whether this association is causal is undetermined.Methods:Each participant from the Dongfeng-Tongji cohort study based on 27,009 retirees was interviewed face-to-face following a clinical examination. Covariance, logistic regression analysis, and instrumental variables were used to assess associations between SUA and (severity of) NAFLD and the causal link.Results:Among 8,429 subjects free of NAFLD at baseline, 2,007 participants developed NAFLD after 5 years of follow-up. The multivariable-adjusted odds ratio (OR) for NAFLD for individuals in the fourth quartile of SUA level versus those in the first was 1.71 (95% CI: 1.45-2.01, P for trend <0.001) and was more dramatic in women or normal-weight persons. Furthermore, SUA was materially associated with greater mean markers of hepatic necroinflammation and greater probabilities of fibrosis. In genetic analyses, both single nucleotide polymorphisms (rs11722228 to SLC2A9 and rs2231142 to ABCG2) were pronouncedly associated with increased SUA concentrations, ranging from 0.19 to 0.22 mg/dl. No significant associations were observed between SNPs and potential confounders. No association was observed between the SUA-increasing allele and NAFLD, with an OR of 0.98 (95% CI: 0.90-1.08) per genetic score. This was not significantly different (P = 0.25) from what was expected (1.03, 95% CI: 1.03-1.03).Conclusions:SUA was positively associated with NAFLD incidence especially in female and normal-weight individuals and the suspected progression risk of newly developed NAFLD. However, the Mendelian randomization analyses lend no causal evidence, suggesting high SUA as a marker and not a cause of NAFLD.

Dopaminergic D4 receptors have been hypothesized to be involved in neuropsychiatric disorders and substance abuse. In mice, repeated ethanol administration may induce behavioral sensitization, a phenomenon of increased sensitivity to the drug's stimulant properties. This study aimed to analyze brain D4 receptors binding in mice with different levels of behavioral sensitization to ethanol. Male Swiss mice received 2.2 g/kg ethanol (n = 64) or saline (n = 16) intraperitoneally daily for 21 days and were weekly tested for locomotor activity and for blood ethanol levels. According to the locomotor scores presented across test days, ethanol-treated mice were classified as "sensitized" or "nonsensitized." Twenty-four hours after the last administration, mice were sacrificed and brains were processed for autoradiography. Brain D4 binding was assessed by quantitative autoradiography using [3H]nemonapride + raclopride in three groups: saline-treated controls (n = 10), ethanol-sensitized (n = 11), and ethanol-nonsensitized (n = 9) mice. Both sensitized and nonsensitized mice showed higher D4 binding densities than saline-treated controls in the posterior caudate-putamen and the olfactory tubercle (p < .02), but only sensitized mice presented higher D4 binding than controls at the lateral septal nucleus (p < .02). However, there were no differences between sensitized and nonsensitized mice in any of the brain regions analyzed. Furthermore, sensitized and nonsensitized mice presented similar blood ethanol levels during the treatment. The higher D4 binding levels observed in both ethanol-treated subgroups (sensitized and nonsensitized) suggest that chronic ethanol treatment may induce upregulation of D4 receptors in specific brain regions. However, this mechanism does not seem to be associated with the differential ability to develop behavioral sensitization to ethanol in mice.

This study aimed to examine how organizational behavior is associated with work engagement (WE) and work-home conflicts (WHCs) of physicians. The data were from a national cross-sectional survey of 3255 Chinese physicians. We examined organizational fairness, leadership attention, and team interaction for organizational behavior. The results indicate that greater organizational fairness is associated with higher WE and lower WHCs. High task fairness was associated with greater pride, and more enjoyment in work, lower sense of guilt towards their family, and less complaints from family members. Physicians reporting higher levels of leaders' attention to their opinions reported experiencing more enjoyment of their work, and less effects on their care for family. A greater number of dinners with colleagues per month was associated with higher WE and lower WHCs, whilst a greater number of clinical case meetings per month was associated with higher WE and higher WHCs. The results suggest that the behavior of organizations could be an important intervention to improve the wellbeing of physicians.

ABSTRACT Background Public health workers at the Chinese Centre for Disease Control and Prevention (China CDC) and primary health care institutes (PHIs) were among the main workers who implemented prevention, control, and containment measures. However, their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of front line public health workers in China during the COVID-19 epidemic. Methods Between 18 February and 1 March 2020, we conducted an online cross-sectional survey of 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We surveyed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health using a self-constructed questionnaire and standardised measurements (i.e., Patient Health Questionnaire and General Anxiety Disorder scale). To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders. Results The prevalence of depression, anxiety, and poor self-rated health was 21.3, 19.0, and 9.8%, respectively, among public health workers (27.1, 20.6, and 15.0% among CDC workers and 17.5, 17.9, and 6.8% among PHI workers). The majority (71.6%) made immense efforts in both field and non-field work. Nearly 20.0% have worked all night for more than 3 days, and 45.3% had worked throughout the Chinese New Year holiday. Three risk factors and two protective factors were found to be independently associated with all three health outcomes in our final multivariate models: working all night for >3 days (multivariate odds ratio [ORm]=1.67~1.75, p<0.001), concerns about infection at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), initiating COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and ability to persist for > 1 month at the current work intensity (ORm=0.44~0.55, p<0.001). Conclusions Chinese public health workers made immense efforts and personal sacrifices to control the COVID-19 epidemic and faced the risk of mental health problems. Efforts are needed to improve the working conditions and health status of public health workers and thus maintain their morale and effectiveness during the fight against COVID-19.