BACKGROUND:Influenza vaccination rates remain low among primary school students and vary by school, even under the free School-Located Influenza Vaccination (SLIV) in Beijing, China. To improve influenza vaccination coverage, we developed multifaceted, enhanced SLIV (E-SLIV) strategies in response to factors that influenced the SLIV implementation. The E-SLIV strategies were proved with modest effectiveness in improving influenza vaccination uptake via a cluster randomized trial in the 2022-2023 influenza season. This paper reports the implementation outcomes and identifies influencing factors for the implementation of the E-SLIV strategies, which was conducted in the same settings. METHOD:The E-SLIV intervention study involved 20 primary schools in Beijing, China, which were randomly allocated in a 1:1 ratio to the intervention (i.e., E-SLIV) or control (i.e., usual SLIV practice) groups in the 2022-2023 influenza season. This study applied a convergent mixed methods design to evaluate implementation outcomes specifically for 10 schools in the E-SLIV group. Quantitative data were collected from 39 implementers via a close-ended questionnaire and a project-specific implementation checklist, and from 915 parents via a close-ended questionnaire. Qualitative data were gathered from 18 implementers and 8 parents via semi-structured interviews. Quantitative descriptive and qualitative thematic analysis were applied, with findings integrated via joint display for meta-inference based on an evaluation framework that combines the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework with Normalization Process Theory (NPT). RESULTS:E-SLIV reached 1,172 of the 1,541 targeted students in 10 intervention schools, representing an intervention coverage rate of 76.1% (95% CI [74.0%, 78.2%]). Qualitative findings indicated that the E-SLIV strategies may have limited success in reaching those with social media information overload and those who were hesitant about influenza vaccination. All 10 schools adopted the overarching E-SLIV strategies, but insufficient priority and endorsement from school administrators may have hindered the consistent adoption of specific program components. Both quantitative and qualitative findings suggested the E-SLIV strategies were flexible with adequate resources, enabling good implementation of most intervention components. However, relationships, skills, contexts, and content integration needed strengthening, and implementation was limited by COVID-19 related workload and vaccination uncertainty, and vaccine shortage, as the qualitative findings indicated. Around 83.3% (95% CI [73.4%, 93.2%]) of school implementers and 70.4% (95% CI [67.4%, 73.4%]) of parents favored maintaining E-SLIV. CONCLUSION:The multifaceted E-SLIV strategies reached most target populations and were well-implemented with high fidelity by most schools. The E-SLIV strategies strengthened collaboration, enhanced capacity, and provided tailored education, yet faced challenges including entrenched parental views, social media information overload, inadequate school leadership, low proactivity among school doctors in coordinating vaccinations, the COVID-19 pandemic, and temporary vaccine shortages. Findings inform future optimization of school-based vaccination programs and present a compelling case for measuring implementation outcomes using mixed methods.

The one-year SINEMA trial demonstrated improved blood pressure (BP) control and reduced mortality up to 72 months after the intervention. This article aims to assess between-arm differences in mean annual cumulative BP and to explore whether the associations between cumulative BP and biofunctional outcomes differed by trial arm. Post-hoc secondary analysis of the SINEMA cluster-randomized trial, which recruited 1299 adults with stroke from 50 rural villages in Hebei, China, between 2017 and 2018. The 12-month intervention was followed by observational assessments at 72 and 84 months post-baseline. BP was measured during each face-to-face follow-up, assessed by blinded assessors at baseline, 12, 72, and 84 months. Mean annual cumulative systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were calculated. Biofunctional outcomes included health-related quality of life, modified Rankin Scale, activities of daily living, physical function, and cognition function. Among 897 participants (mean age 62.7 years; 40.8% female) with complete data across all assessment, the intervention arm demonstrated significantly lower mean annual cumulative SBP (−2.2 mm Hg; 95% CI, −3.9 to −0.6), DBP (−1.6 mm Hg; 95% CI, −2.4 to −0.7), and MAP (−1.8 mm Hg; 95% CI, −2.8 to −0.8), not PP, compared with usual care. Significant associations between cumulative BP and biofunctional outcomes were observed in the control arm while not in the intervention arm. Interaction effects between trial arm and cumulative BP were significant for multiple outcomes, most prominently for cumulative SBP. The one-year SINEMA intervention was associated with lower cumulative BP burden over 72-84 months but did not improve overall biofunctional outcomes. Secondary analyses revealed that the association between cumulative BP burden and biofunctional decline differed by intervention arm, suggesting cumulative BP exposure may be an important long-term risk indicator and the intervention may modify BP-outcome relationships through mechanisms requiring further investigation.

Importance:Longitudinal data are crucial for understanding rapid population aging in East and Southeast Asia, yet challenges in establishing and managing infrastructures remain undocumented. Objective:To investigate challenges and adaptations across longitudinal aging datasets in East and Southeast Asia and synthesize stakeholder-informed processes and recommendations to guide future study design, implementation, sustainability, and data sharing. Design, Setting, and Participants:This qualitative study used semistructured interviews conducted online and in-person from September 2024 to June 2025. Data were analyzed using a combined inductive, deductive, and abductive approach to identify themes related to the life cycle of longitudinal aging studies. Stakeholders were engaged across 13 East and Southeast Asia countries and regions (China, Japan, South Korea, and countries in the Association of Southeast Asian Nations), and experts from India, the United Kingdom, and the US. Participants were a purposive and snowball sample of 33 stakeholders involved in aging research data collection and management, including principal investigators, coordinators, and data platform leaders, and other key personnel with experience establishing or managing aging-related health datasets. Main Outcomes and Measures:Themes on challenges and strategies in the establishment, implementation, maintenance, and sharing of longitudinal aging data were identified through thematic analysis. An iterative thematic analysis to identify recurring patterns was conducted from January to June 2025. Results:Of 33 participants, 23 (72.7%) were principal investigators or co-principal investigators. Four themes emerged: (1) structural and contextual barriers, including funding instability, collaboration silos, and personnel shortages; (2) adapting research design and logistics to local contexts, addressing cultural differences, data accuracy, and biospecimen handling; (3) retaining funding and staff to ensure sustainability amid external disruptions; and (4) constraints related to data governance, privacy regulations, and limited comparability. Conclusions and Relevance:In this qualitative study of stakeholders involved in longitudinal aging research data systems, participants described structural and contextual barriers, reported adaptations to local research logistics and design, highlighted sustainability threats related to funding and retention, and identified persistent constraints in data governance and cross-study comparability. These findings suggest that building longitudinal aging data ecosystems in East and Southeast Asia requires context-specific strategies aligned with policies, strengthened multidisciplinary collaboration, improved data harmonization, and intentional inclusion of vulnerable populations to inform healthy aging policy, while yielding stakeholder-informed processes and recommendations to support future cohort development and sustainability.

Background:The association between visceral adiposity and multimorbidity in Chinese middle-aged and older adults remains underexplored. This study used data from the China Health and Retirement Longitudinal Study (CHARLS) to examine the relationship between visceral adiposity, measured by the Chinese visceral adiposity index (CVAI), and multimorbidity. Methods:This prospective cohort study analyzed data from 6,410 participants who were multimorbidity-free in the 2015 CHARLS wave, with follow-up assessments in 2018 and 2020. CVAI was calculated using age, body mass index, waist circumference, triglycerides, and high-density lipoprotein cholesterol. Latent class analysis (LCA) identified multimorbidity patterns, defined as the presence of ≥2 chronic conditions based on self-reported physician diagnoses. Cox regression and restricted cubic spline (RCS) analyses assessed the impact of CVAI on multimorbidity risk. Results:Over a median 5.0-year follow-up (interquartile range [IQR], 3.0 to 5.0), 2,809 participants (43.8%) developed multimorbidity. Each IQR increase in CVAI significantly elevated the risk of multimorbidity (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.16 to 1.24). Higher risks were observed in the second (HR, 1.16; 95% CI, 1.04 to 1.30), third (HR, 1.28; 95% CI, 1.14 to 1.43), and fourth (HR, 1.76; 95% CI, 1.58 to 1.96) quartiles compared with the first. The RCS analysis demonstrated a dose-response relationship (Pnonlinearity=0.109). LCA identified four multimorbidity clusters. CVAI increments were significantly associated with the cardio- metabolic cluster (HR, 1.51; 95% CI, 1.42 to 1.62) and the arthritis-renal cluster (HR, 1.29; 95% CI, 1.21 to 1.39). Conclusion:Elevated CVAI is a strong risk factor for incident multimorbidity among middle-aged and older Chinese adults, emphasizing its importance in the development of distinct disease clusters.

Cognitive impairment poses a major public health concern in ageing societies. This study investigated the independent and joint associations of resilience and social support with cognitive function among community-dwelling middle-aged and older Chinese adults, and explored gender-specific differences. A total of 3,058 Chinese adults aged ≥ 50 years from both urban and rural communities were included. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and social support by the 6-item Lubben Social Network Scale (LSNS-6). Logistic regression models stratified by gender were applied with adjustment for demographic, behavioral, and health-related variables. Generalized additive models were used to test non-linear associations, and joint effects were examined with combined categories. Overall, 18.4

Aim:Metabolic diseases are increasingly prevalent worldwide and often coexist. However, the patterns of metabolic multimorbidity and their long-term associations with mortality remain poorly understood. This study aimed to characterize these patterns and evaluate their associations with all-cause and cause-specific mortality. Methods:This retrospective cohort study included 123,791 adults aged 25-74 years who underwent health examinations at a large medical center in northern China between 2015 and 2022. Five metabolic diseases were assessed: diabetes, hypertension, dyslipidemia, nonalcoholic fatty liver disease, and obesity. Metabolic multimorbidity was defined as the coexistence of two or more of these conditions. Cox proportional hazards models were used to estimate associations with all-cause, cardiovascular, and cancer mortality. Results:Among 123,791 participants (mean [SD] age, 41.3 [11.9] years; 50.8% male), 38,945 (31.5%) had metabolic multimorbidity. Prevalence was higher in men than in women (46.1% vs. 16.4%; P < 0.001). Age-related patterns differed by sex (P for interaction <0.001), with men showing a higher burden at younger ages and women showing a marked rise after midlife. During a median follow-up of 6.1 years (IQR, 4.2-7.6), 724 deaths (0.6%) occurred. Increasing numbers of coexisting diseases were associated with progressively higher risks of all-cause mortality (adjusted hazard ratios [aHRs], 1.38 [95% CI, 1.09-1.76] for one disease to 2.92 [1.82-4.68] for five diseases vs none; P for trend <0.001), cardiovascular mortality (aHRs, 1.78 [1.06-2.99] to 5.13 [2.25-11.7]; P for trend <0.001), and cancer mortality (aHRs, 1.36 [0.91-2.03] to 3.84 [1.90-7.78]; P for trend <0.001). Conclusion:Metabolic multimorbidity was highly prevalent and exhibited distinct age- and sex-related patterns, with a graded association with mortality risk. These findings may reflect shared pathophysiological mechanisms and support integrated, sex-specific strategies to mitigate the growing metabolic burden.

Background Multimorbidity is rising and comorbid hypertension and type 2 diabetes is the most common among older adults. Although pharmacological therapy is the mainstay, non-pharmaceutical interventions are essential for disease control. We conducted a systematic review to synthesize evidence from randomized controlled trials in older adults on non-pharmacological approaches by intervention strategy and delivery setting. Methods Following PRISMA 2020, we searched PubMed, Embase, and Cochrane CENTRAL (until October 2024) for randomized controlled trials enrolling adults ≥60 years with both conditions. Risk of bias was assessed with RoB 2; heterogeneity precluded meta-analysis and findings were synthesized narratively. Results A total of 3449 studies were screened, and 16 trials were included in final analyses. Interventions were classified as exercise (n = 3), diet (n = 2), self-monitoring (n = 1), multi-strategy (n = 3), or comprehensive lifestyle modification (n = 7), delivered via hospital (n = 6), community (n = 6), or telehealth (n = 4) models. Most trials (∼75%) reported a statistically significant effect on their prespecified primary outcomes, mainly blood pressure or HbA1c. Effects were most consistent for comprehensive lifestyle modification, especially those combining individualized planning with technology-assisted support. By setting, hospital interventions tended to yield short-term physiological gains, whereas community and telehealth models emphasized adherence and sustained engagement. Only two trials included post-intervention follow-up. Conclusion Comprehensive behaviorally informed interventions combining individualized planning with technology-assisted support were the most effective for older adults with hypertension and diabetes multimorbidity. Studies targeting this population remain limited with no long-term follow-up. Innovations in strategy optimization and adaptation to contexts and assessment of sustained effects are needed in multimorbidity management.

BACKGROUND:Intrinsic capacity (IC), representing an individual's full range of physical and mental abilities, is influenced by objective socioeconomic status (SES); however, the impact of subjective SES remains unclear. OBJECTIVES:This study aims to assess IC and investigate the relationship between SES and IC deficits, with a particular focus on the role of subjective SES. DESIGN:Cross-sectional study SETTING: 45 communities in two provinces in China PARTICIPANTS: Community-dwelling middle-aged and older adults aged 50 and above MEASUREMENTS: IC was assessed following the Integrated Care for Older People guideline. SES was measured through objective SES (education and occupation) and subjective SES (measured by MacArthur Scale). Ordinal logistic regression models were performed to estimate the association between SES and IC. RESULTS:Among 3,058 participants (61.3 ± 8.05 years, 54.8 % women), 2,333 (76.3 %) showed deficits in at least one IC subdomain, particularly sensory (63.5 %), vitality (25.8 %) and cognition (18.4 %). A dose-response association was observed between SES and IC deficits. Individuals with high subjective SES (OR: 0.72, 0.60-0.87), high education (OR: 0.54, 0.38-0.75), and high occupation (OR: 0.64 0.50-0.81) exhibited lower IC deficits risk compared with counterparts. Individuals with high education and middle subjective SES or high occupation and middle subjective SES had 67 % (OR: 0.33, 0.18-0.60) and 49 % (OR: 0.51, 0.35-0.74) lower risk than those with low SES. CONCLUSIONS:These findings suggest that individuals with low SES may be more vulnerable to IC deficits. Addressing social inequalities in the early assessment of IC is crucial for reducing health disparities and promoting healthy ageing.

BACKGROUND:Despite growing evidence of primary care-based interventions for chronic disease management in resource-limited settings, long-term post-trial effects remain inconclusive. We investigated the association of a 12-month system-integrated technology-enabled model of care (SINEMA) intervention with mortality outcomes among patients experiencing stroke at 6-year post-trial. METHODS AND FINDINGS:This study (clinicltiral.gov registration number: NCT05792618) is a long-term passive observational follow-up of participants and their spouse of the SINEMA trial (clinicaltrial.gov registration number: NCT03185858). The original SINEMA trial was a cluster-randomized controlled trial conducted in 50 villages (clusters) in rural China among patients experiencing stroke during July 2017-July 2018. Village doctors in the intervention arm received training, incentives, and a customized mobile health application supporting monthly follow-ups to participants who also received daily free automated voice-messages. Vital status and causes of death were ascertained using local death registry, standardized village doctor records, and verbal autopsy. The post-trial observational follow-up spanned from 13- to 70-months post-baseline (up to April 30, 2023), during which no intervention was requested or supported. The primary outcome of this study was all-cause mortality, with cardiovascular and stroke cause-specific mortality also reported. Cox proportional hazards models with cluster-robust standard errors were used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs), adjusting for town, age, and sex in the main analysis model. Analyses were conducted on an intention-to-treat basis. Of 1,299 patients experiencing stroke (mean age 65.7 years, 42.6% females) followed-up to 6 years, 276 (21.2%) died (median time-to-death 43.0 months [quantile 1-quantile 3: 26.7-56.8]). Cumulative incidence of all-cause mortality was 19.0% (121 among 637) in the intervention arm versus 23.4% (155 among 662) in the control arm (HR 0.73; 95% CI 0.59, 0.90; p = 0.004); 14.4% versus 17.7% (HR 0.73; 95% CI 0.58, 0.94; p = 0.013) for cardiovascular cause-specific mortality; and 6.0% versus 7.9% (HR 0.71; 95% CI 0.44, 1.15; p = 0.16) for stroke cause-specific mortality. Although multisource verification was used to verify the outcomes, limitations exist as the survey- and record-matching-based nature of the study, unavailability of accurate clinical diagnostic records for some cases and the potential confounders that may influence the observed association on mortality. CONCLUSIONS:Despite no observed statistically difference on stroke cause-specific mortality, the 12-month SINEMA intervention, compared with usual care, significantly associated with reduced all-cause and cardiovascular cause-specific mortality during 6 years of follow-up, suggesting potential sustained long-term benefits to patients experiencing stroke.

Objectives: To evaluate the relationship between depression and the risk of dementia. Design: A real-world longitudinal study. Setting: This comprehensive study involved elderly adults in Yichang, China, who were dementia-free at baseline from 2016 to 2023. Participants: Participants were followed until the onset of all-cause dementia, Alzheimer's disease, vascular dementia and unspecified dementia until December 31, 2023. Exposure: Depression was identified using the International Classification of Diseases, 10th Revision codes, based on linked electronic health records. Measures: Multivariable-adjusted hazard ratio (HR) and 95% confidence intervals (CI) from the Cox proportional hazards regression models to evaluate the risks of all-cause dementia and its subtypes associated with prevalent depression. Results: During an average follow-up of 3.63 years, we observed a total of 1 493 individuals developing dementia among 4 341 depressed and 43 214 matched non-depressed individuals (62.4% female; mean [SD] age at baseline 64.4 [11.1] years). Notably, a stronger association was observed between depression and the onset of Alzheimer's disease (adjusted HR, 4.96; 95% CI, 2.95-8.34) compared to vascular dementia (adjusted HR, 1.92; 95% CI, 1.18-3.11). Moreover, our study intriguingly revealed a U-shaped association between the risk of Alzheimer's disease and the duration of time an individual has been diagnosed with depression. Conclusions: Our findings unveil a significant association between depression and all-cause dementia, Alzheimer's disease and vascular dementia. The unique temporal association suggests that depression may serve as both a risk factor and a prodromal symptom for Alzheimer's disease, and solely as a risk factor for vascular dementia.

BACKGROUND:Despite the established link between chronic conditions and depressive symptoms in recent decades, research into the temporal dynamics between multimorbidity and the occurrence of depressive symptoms remains scarce. METHODS:A total of 15,882 Chinese middle-aged and older adults with 63,246 observations from the China Health and Retirement Longitudinal Study were included in the present study. Depressive symptoms were evaluated using a 10-item CESD scale, with a threshold set at 12 points. Group-based trajectory modeling was used to examine the multimorbidity developmental trajectories. The risk of depressive symptoms was analyzed using mixed effect logistic regression models. RESULTS:Among the final included 15,896 participants, 37.6 % reported states of multimorbidity, and 25.7 % were detected as depressive symptoms. In the fully adjusted model, those with multimorbidity were 2.36 (2.24 to 2.49) times more likely to present depressive symptoms, and the likelihood increased 1.38 (1.36 to 1.40) times with each additional chronic condition. Four distinct multimorbidity trajectory groups were identified: no-new-condition group (32.6 %), slow growth group (42.9 %), steady growth group (19.7 %), and rapid growth group (4.9 %). Compared to the no-new-condition group, the likelihood of developing depressive symptoms was greater in the subsequent three groups, with ORs of 1.53 (1.39 to1.71), 2.54 (2.24 to 2.89), and 4.40 (3.62 to 5.34), respectively. CONCLUSION:Our results highlight the substantial health effects of accumulating multimorbidity on depressive symptoms, showing a direct link between risk and accumulation rate. We urge focusing on depressive symptoms in those with multimorbidity to tackle the significant healthcare challenges arising from concurrent physical and mental health issues.

Objective The magnitude and persistence of diseases and multimorbidity between females and males are different. This study comprehensively quantified sex differences in the onset and progression of 108 major physical and mental diseases to multimorbidity through adulthood in Chinese population.Design Quantitative analysis of real-world linked electronic health records.Setting Linked health records from 160 health facilities across primary, secondary and tertiary healthcare, comprising routinely collected electronic health records from the whole urban residents of Yichang, China between 1 January 2016 and 31 December 2019.Participants 684 455 urban residents aged 20 years and above with documented health records during the study period.Main outcomes measures The cumulative incidence, relative risks (RR) and 95% CIs, period prevalence, median age at disease diagnosis and the prevalence of multimorbidity of 108 major physical and mental diseases were computed. All analyses were stratified by sex and age groups.Results The analysis included 684 455 individuals (54.8% females, mean age: 46.9), among whom 46.3% had multimorbidity, with a higher prevalence in females (47.6%) than males (44.9%). The chronological disease map revealed stark differences between females and males, with notable lower risk of obstructive sleep apnoea-hypopnoea syndrome (OSAHS, RR: 0.03, 95% CI: 0.01 to 0.11) for young adults, oesophageal cancer (RR: 0.02, 95% CI: 0.0 to 0.17) for mid-age adults and remarkable higher risk of lupus (RR: 8.8, 95% CI: 2.7 to 29.0) for older adults of females. Males exhibited an incidence surge in hypertension, diabetes, coronary disease and chronic obstructive pulmonary disease a decade earlier than females, while females had a life-long higher prevalence in immune-mediated diseases and urinary disorders. For the new incident diseases, the manifestation of eating disorders, anaemia and urinary incontinence was recorded 20 years earlier in females; whereas, males were diagnosed with hyperuricaemia, OSAHS and schizophrenia at younger ages.Conclusions The significant variations in disease nature and trajectory between sexes underscore the urgent needs for tailored prevention strategies and appropriate health resources allocation. Sex differences in disease profile should be considered to delay disease and multimorbidity progression, ultimately promoting health equity.

What is already known about this topic?:Uncontrolled diabetes can result in severe clinical complications, significantly increasing the risk of functional limitations in instrumental activities of daily living (IADL) and activities of daily living (ADL). What is added by this report?:This study investigates the association between the Cascade of Care (CoC) for diabetes and functional limitations, providing evidence on the critical need for strengthening diabetes care to prevent functional limitations and improve quality of life. What are the implications for public health practice?:The findings provide critical insights to guide public health strategies and interventions aimed at enhancing diabetes management across all stages of the CoC, with the goal of reducing functional limitations and their associated burden, ultimately improving long-term health outcomes for individuals with diabetes.

The increasing prevalence of multimorbidity and an ageing society present a major challenge for China’s health system. The co-management of hypertension and type 2 diabetes—one of the most common and clinically significant multimorbidity clusters—has been placed in the forefront of China’s national health policies. A substantial evidence base exists for lifestyle practices and treatment plans for managing this multimorbidity. Yet, implementation challenges persist within the existing structure and resources of primary health care in China. Behavioural science frameworks hold great potential to address these implementation challenges via identifying the behavioural barriers and rendering tailored implementation strategies. However, existing multimorbidity interventions often do not explicitly link behavioural influences with intervention design. This paper is a case report on the application of the Behaviour Change Wheel (BCW) framework to rapidly develop an intervention for hypertension and diabetes co-management. The resulting evidence-based, people-centred, integrated care (EPIC) intervention restructures the standard of care by delivering three core features: personalised lifestyle prescriptions, digital tool assistance, and caregiver engagement. The BCW framework enables seamless integration of multiple intervention components and informs tailored design. Specifically, the EPIC intervention can be readily implemented during the routine follow-up of older adults with hypertension and diabetes at primary health care facilities in Kunshan, China. In this case study, we highlight the potential of behavioural science frameworks to address the complex challenge of multimorbidity. To fully realise this potential, empirical evidence is urgently needed to link mechanisms of change and implementation outcomes in theory-informed interventions.

This study aims to evaluate the bidirectional relationship between family functioning and depressive symptoms, considering life satisfaction as a potential mediator and gender, age and income as a moderator of these associations. A longitudinal study was conducted with 708 Chinese adults with diabetes and hypertension (51.6% women; mean age: 64.1 +/- 7.7 years) recruited from 12 community health services. Data were collected at baseline (T1), one-year follow-up (T2), and two-year follow-up (T3) using self-reported assessments of family functioning, depressive symptoms, and life satisfaction. Depressive symptoms negatively predicted family functioning from T1 to T2, and family functioning negatively predicted depressive symptoms from T2 to T3. Furthermore, life satisfaction mediated the relationship between family functioning and depressive symptoms from T1 to T3, and vice versa. Differences in gender, age, and income showed distinct patterns. Life satisfaction at T2 mediated the effect of family functioning at T1 on depressive symptoms at T3 for men, women, middle-aged and low-income adults, whereas life satisfaction mediated the effect of depressive symptoms at T1 on family functioning at T3 only among women and low-income adults. This study explores the relationships among family functioning, life satisfaction, and depressive symptoms, noting potential differences based on gender, age and income. Family-level interventions targeting life satisfaction could a helpful approach to addressing depressive symptoms among Chinese adults aged 45 and older with type 2 diabetes and/or hypertension.

Background Patients with chronic respiratory disease (CRD) face an increased risk of severe influenza complications. However, limited studies offer estimates of vaccine effectiveness (VE) against influenza within these CRD populations in China.Methods A multicenter, retrospective, test-negative, case-control study was conducted to estimate the VE in 37 medical institutions in Shanghai, China, during the 2023/2024 and 2024/2025 seasons. We included patients with CRD who presented with acute respiratory infections and received nucleic acid amplification tests and/or rapid antigen tests. Patients with CRD with a positive test were assigned to the case group, and those with a negative test were assigned to the control group. Multivariable unconditional logistic regression was used to control potential confounders and to determine 95% confidence intervals (CIs).Results A total of 10 711 participants, including 1650 influenza cases (5.8% vaccinated) and 9061 influenza-negative controls (7.9% vaccinated), were eligible for analysis. The combined VE over the 2 seasons was estimated to be 44.23% (95% CI: 30.45-55.75) for the study population. The VE was 42.91% (95% CI: 27.13-55.78) in the 2023/2024 season and 51.51% (95% CI: 17.70-73.61) in the 2024/2025 season. The combined VE for influenza subtypes A and B were 38.49% (95% CI: 21.75-52.27) and 62.64% (95% CI: 39.91-78.28), respectively.Conclusions Influenza vaccination provides consistent and moderate protection to patients with CRD against medically attended influenza, regardless of the dominant circulating subtypes. Nevertheless, vaccination coverage remains suboptimal, underscoring the need to improve annual influenza vaccination uptake among patients with CRD , even amid ongoing viral antigenic evolution through shifts and drifts.

Background Cognitive impairment poses a major public health concern in ageing societies. This study investigated the independent and joint associations of resilience and social support with cognitive function among community-dwelling middle-aged and older Chinese adults, and explored gender-specific differences. Methods A total of 3,058 Chinese adults aged ≥ 50 years from both urban and rural communities were included. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and social support by the 6-item Lubben Social Network Scale (LSNS-6). Logistic regression models stratified by gender were applied with adjustment for demographic, behavioral, and health-related variables. Generalized additive models were used to test non-linear associations, and joint effects were examined with combined categories. Results Overall, 18.4% of participants (20.1% women, 16.3% men) had cognitive impairment. Higher resilience and social support were independently associated with lower odds of impairment. Curvilinear associations were observed in generalized additive models. Compared with low resilience and low support, participants with moderate resilience and high support had the lowest risk (OR = 0.25, 95% CI: 0.11–0.51). Conclusions Resilience and social support were independently and jointly associated with better cognitive function. Promoting psychosocial resources, especially among women, may represent an important gender-sensitive strategy for cognitive health promotion in ageing populations.

Comprehensive, life-course multimorbidity data derived from linked outpatient and inpatient electronic health records (EHRs) remain scarce globally. We analyzed integrated EHRs (2016-2023) from approximately 3.2 million individuals in Yichang, a prefecture-level city in Central China, to characterize disease co-occurrence during this observation window by identifying both the most frequent combinations and significant non-random associations across all ages. Multimorbidity was defined as the presence of ≥ 2 distinct lifetime conditions recorded for an individual. We identified the 50 most common disease triads and constructed disease networks using partial correlation analysis, ranking hub conditions with the Multimorbidity Coefficient (MMC). Overall, 74.5% of the population experienced multimorbidity (mean 5.29 conditions; women 5.59, men 4.98), with the burden rising steeply with age. Triad analysis revealed a clear life-course pattern, beginning with respiratory clusters in childhood and diverging by sex in young adulthood, female gynaecological versus male musculoskeletal/urological clusters, followed by cardiometabolic and cardiovascular dominance in mid-to-late life. Gastritis (K29) and sleep disorders (G47) were notably frequent components in adult triads. Network analysis identified K29, heart failure (I50), hypoproteinaemia (E88), anaemia (D64), and dermatitis (L30) as the top five hubs. Hub importance also varied by sex, with conditions such as osteoporosis (M81) being more central for women and benign prostatic hyperplasia (N40) for men. This study details a high multimorbidity burden and reveals a distinctive architecture characterized by a diverse, multi-system core where digestive, cardiometabolic, and systemic conditions co-dominate. Mapping these constellations provides critical insights for clinical anticipation, public health prevention, and research into shared pathways.

BACKGROUND:To bridge the gap between clinical guidelines and suboptimal stroke management in rural settings, we conducted an implementation trial using evidence-based, mobile health-enabled strategies to empower primary care providers in rural China. The system-integrated and digital technology-enabled model of care (SINEMA) model was shown to significantly reduce blood pressure and mortality among people with stroke in rural China. OBJECTIVE:This study aimed to evaluate the cost-effectiveness of the SINEMA intervention within both the active trial and the post-trial observational periods and its budget impact for potential nationwide scalability. METHODS:In the cluster-randomized implementation trial (the SINEMA trial), 50 villages were randomized to either a 1-year intervention (2017-2018) or usual care, with 1299 patients with stroke followed up until 2022-2023-6 years after the trial baseline. The incremental cost-effectiveness ratios (ICER) for systolic blood pressure reduction and quality-adjusted life year gains were estimated from a health sector perspective. Both probabilistic and deterministic sensitivity analyses were conducted to assess the robustness of the findings. Additionally, a budget impact analysis was performed from a public payer perspective to estimate the per-capita and total costs of national scale-up under 2 scenarios: a standalone intervention and integration into the existing basic public health service system. RESULTS:The ICER per 1 mmHg systolic blood pressure reduction was $8.4 for the within-trial estimation. The ICER per quality-adjusted life year gained was $837.9 within-trial and $727.9 post-trial, both highly cost-effective relative to any commonly adopted thresholds and robust in sensitivity analyses. The first-year budget impact ranged from $115.6 million to $197.7 million in the 2 scenarios, reducing to $46.6 million to $78.7 million by year 5, with a per-capita cost of $0.03-$0.06. CONCLUSIONS:Our findings demonstrate that the SINEMA intervention was cost-effective during the trial period and remained so throughout the 6-year sustainability observation period. These results highlight the potential of adopting similar health system-integrated, mobile health-enabled strategies to enhance the management of stroke and other chronic diseases in resource-limited settings. TRIAL REGISTRATION:ClinicalTrials.gov NCT0318585, ClinicalTrials.gov NCT05792618; https://clinicaltrials.gov/study/NCT03185858 and https://clinicaltrials.gov/study/NCT05792618. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.3389/fneur.2023.1145562.

Introduction Task-shifting and task-sharing strategies show promise for managing chronic diseases especially in low-income and middle-income countries (LMICs), though their effectiveness in multimorbidity management remains unclear. This study synthesised evidence on task-shifting and task-sharing strategies globally and assessed the impact on core health outcomes in multimorbidity management.Methods We conducted a systematic review and meta-analysis of global studies evaluating task-shifting and sharing interventions for individuals with multimorbidity. Six databases, including PubMed, Embase, Web of Science, Ovid (Medline), CINAHL and Cochrane Library, were searched for studies reporting the core outcomes of multimorbidity management in quality of life, mortality, hospitalisation, emergency department visits and symptoms of depression and anxiety. Random-effects models were used to calculate pooled effect sizes with heterogeneity assessed through subgroup and meta-regression analyses.Results From 8471 records, 36 studies from 14 countries were included, with only 5 conducted in LMICs. Twenty-one studies, encompassing 20 989 participants, were eligible for meta-analysis. More than half of the studies involved nurses as delegates, with some sharing the tasks with health professionals and about 10% of studies involved non-health professionals, including community healthcare workers as delegates to share the responsibility in caring for individuals with multimorbidity. Most studies were multicomponent, with 16.7% addressing all guideline-recommended aspects of multimorbidity management. By pooling the findings, task-shifting and task-sharing interventions were associated with a 27% reduction in mortality (OR: 0.73, 95% CI: 0.55 to 0.97, I²=0%), a modest improvement in quality of life (standardised mean difference (SMD): 0.1, 95% CI: 0.03 to 0.17, I²=47%) and reduced symptoms of depression (SMD: 0.27, 95% CI: −0.52 to –0.02, I²=90%), but showed no significant effect on hospitalisation, emergency visits or anxiety-related symptoms.Conclusions Some evidence, although limited in existing research, indicates the great potential of task-shifting and task-sharing strategies in supporting management of multimorbidity. Further research is needed to optimise and adopt these interventions, particularly in LMICs where evidence remains scarce.PROSPERO registration number CRD42024526845.