Background As the largest developing country, China works towards reducing mortality and disability from snakebite envenoming (SBE) by 50% before 2030, as epidemiological evidences are essential.Methods A cross-sectional survey was conducted in 11 provinces in China using a multistage stratified cluster random sampling, and hospitalized snakebite victims with complete case histories from January 1, 2017, to December 31, 2021, were included.Results A total of 40,817 snakebite victims were enrolled in this study. The most common snake species were Agkistrodon halys (16.04%) and Trimeresurus stejnegeri (11.40%). However, 56.36% of the snake species remained unidentified. Furthermore, our results revealed that 60.36% of snakebite victims were males, 63.71% were older than 50 years, 59.70% were peasants, 11.14% experienced moderate envenomation on admission, and 0.64% had severe envenomation on admission. Ultimately, only 6.82% of the victims achieved complete healing, whereas 82.44% of snakebite victims demonstrated improvement in their condition upon discharge. Only 69.57% of snakebite victims received antivenom treatments. Furthermore, age, occupation, hospitalization duration, snake specie, site of bite, location, activity, envenomation on admission, clinical manifestation, and treatment significantly affected the discharge outcomes of snakebite victims.Conclusions This study is the first large-sample investigation focusing on the epidemiological characteristics of SBE in China, addressing research gaps and filling the void in the relevant the World Health Organization data. The findings call for authorities and managers to strengthen partnerships, coordination, and resources, reduce SBE incidents, and ensure that victims receive fair, safe, and effective treatments.

Existing studies on Chronic Obstructive Pulmonary Disease (COPD) relying on voluntary questionnaire surveys have inherent limitations, while spatial epidemiological research in Qingdao remains scarce. This population census study aimed to eliminate selection bias through systematic population coverage, identify high-risk clusters using spatial analysis, and provide geospatial evidence for precision public health strategies by concurrently analyzing COPD prevalence. Data were obtained from the 2023 Qingdao COPD High-Risk Population Screening Program. Using a Geographic Information System (GIS) framework, streets and towns in Qingdao City were designated as the basic spatial units for analysis. Global Moran’s I and Local Moran’s I spatial autocorrelation statistics were employed to characterize global and local spatial clustering patterns of COPD high-risk individuals and confirmed patients across the city. The 2023 screening project identified 503,119 individuals with positive COPD Population Screener Questionnaire (COPD-PS) results (high-risk population) and 55,533 confirmed COPD patients. Gender, age, and Body Mass Index (BMI) were identified as risk factors for COPD prevalence among adults aged 40 and above in Qingdao City. Global spatial autocorrelation analysis revealed significant clustering of COPD-PS positive rates in Qingdao City (Global Moran’s I = 0.13, Z = 4.27, P < 0.001), whereas spatial autocorrelation of COPD prevalence did not reach statistical significance. Local spatial autocorrelation analysis indicated that there were significant spatial clusters of COPD high-risk populations in Shibei District and Badaxia Road Subdistrict, while no obvious clusters of COPD patients were observed. This large-scale census provides the first comprehensive COPD spatial epidemiology dataset for Qingdao City. GIS-derived cluster maps enable prioritization of high-burden areas for resource allocation and targeted interventions, supporting the transition to precision public health approaches.

[This corrects the article DOI: 10.3389/ijph.2024.1606903.].

Despite the efforts of the Surviving Sepsis Campaign over two decades, sepsis remains a leading cause of mortality worldwide, with 19–48.9 million cases and 11 million deaths annually. At present, research on sepsis is predominantly focused within the intensive care unit domain; however, the initial diagnosis of sepsis predominantly occurs in the emergency department. Thus, a national cross-sectional study is needed to assess emergency department healthcare workers’ awareness and treatment of sepsis in China and to evaluate the geographic distributions of sepsis prevalence, in-hospital mortality, and economic burden. We conducted a national cross-sectional study to evaluate the cognitive and therapeutic landscape of sepsis among emergency department healthcare workers in China. The study used purposeful sampling in tertiary hospitals across different regions of mainland China. A questionnaire was developed via the Questionnaire Star platform and administered electronically via WeChat and email to physicians across multiple Chinese medical institutions between September 27 and October 31, 2024; multicenter data on sepsis diagnosis patterns, therapeutic interventions, mortality outcomes, and associated economic burdens were collected. A total of 163 hospital datasets were collected, and after exclusions, 113 eligible hospital datasets were included in the analysis. Regarding the adoption of sepsis diagnostic criteria in emergency departments, the results indicate that northern regions have a significantly greater adoption of Sepsis-3.0 than southern regions do (P = 0.048). There is significant regional variation in the prevalence and in-hospital mortality rates of sepsis across mainland China, with the eastern coastal regions generally having lower sepsis in-hospital mortality rates than the western regions do. The number of patients in the emergency intensive care unit with expenses exceeding 80,000 RMB is nearly double that of the entire hospital. The expenditure range of 21,000–40,000 RMBs has emerged as the predominant cost bracket for hospitalized patients and has been consistently observed across both the emergency intensive care unit and hospital-wide settings. In mainland China, several emergency departments have adopted internationally recognized diagnostic criteria (Sepsis-3.0) for sepsis. However, there is still significant variation in the diagnosis and treatment outcomes of sepsis across different regions, highlighting the urgent need for standardized and homogeneous sepsis management practices. Not applicable.

ObjectivesTo analyze the spatial accessibility of antivenom immunizing agents equipped hospitals in Hainan Province.MethodsThis paper analyzes the spatial accessibility of medical institutions equipped with different types of snake antivenom using network analysis and two-step mobile search method, and evaluates the service level and spatial accessibility of medical institutions equipped with different types of antivenom immunizing agents in Hainan Province from the perspectives of both supply and demand.ResultsThe number of people in Hainan Province who need to spend more than 1 h to reach an Agkistrodon Hyalys antivenom, Naja antivenom, Bungarus Multicnctus antivenom, Agkistrodon Acutus antivenom equipped hospital, and equipped with antivenom for all species of snakes in the country is approximately 856,000, 231,300, 3,071,000, 2,666,000 and 4,721,000 people, respectively. In the results of accessibility of hospital beds/health technicians equipped with antivenom in Hainan Province, Haikou and Sanya cities had the highest accessibility.ConclusionThe accessibility of hospitals equipped with antivenom in Hainan Province is unevenly distributed, with areas of high accessibility in the southern and northern regions and accessibility in the rest of the country to be improved.

Excessive collagen production is a hallmark of cardiac fibroblasts (CFs) activation and plays a pivotal role in the pathogenesis of myocardial fibrosis (MF). Hypoxia, a key pathogenic factor in MF, induces aberrant biological responses in CFs and is closely associated with CFs activation. This study investigates the mechanisms underlying hypoxia-induced fibrogenesis from a metabolomics perspective. Neonatal rat CFs were isolated and cultured under normoxic or hypoxic conditions. Hypoxia significantly increased collagen production in CFs, as indicated by the upregulation of Collagen I and Collagen III expression. Non-targeted metabolomics profiling revealed significant alterations in the secretory metabolites of CFs under hypoxia, among which, L-glutamate levels were markedly elevated. Furthermore, L-glutamate concentrations were significantly increased in the myocardial tissues of rats with myocardial infarction. Key components of the glutamatergic transmitter system, including glutamate receptors, metabolic enzymes, and transporters, were detected in CFs, and their expression was upregulated under hypoxic conditions. Notably, exogenous L-glutamate supplementation promoted collagen production in CFs even under normoxia. Blocking glutamate receptors with CNQX and MK-801 effectively reversed hypoxia-induced increases in Collagen I and Collagen III protein expression. Additionally, both CNQX and MK-801 significantly downregulated TGF-β protein expression and Smad2/3 phosphorylation in hypoxia-stimulated CFs. These findings demonstrate that L-glutamate mediates collagen production in CFs under hypoxia, partially through activation of the TGF-β/Smad signaling pathway. Targeting the glutamatergic transmitter system may offer a novel therapeutic strategy for MF.

Sepsis-associated encephalopathy (SAE) is a diffuse dysfunction of the nervous system resulting from sepsis originating outside the central nervous system. The elderly (≥65 years of age) are a particularly vulnerable population, and the emergency department is typically the first point of contact following onset of SAE. Clinical symptoms in elderly patients with SAE are often atypical, compounded by a high burden of underlying diseases and complications, which frequently leads to underdiagnosis or misdiagnosis. These patients are at increased risk of long-term or permanent central nervous system impairment, making rapid and accurate diagnosis and treatment especially critical. Currently, there are no standardized diagnostic or treatment guidelines tailored specifically to geriatric SAE. This expert consensus, grounded in evidence-based medicine and clinical experience, offers recommendations on the risk factors, clinical characteristics, diagnosis, and treatment of geriatric SAE. The goal is to standardize care, improve diagnostic accuracy, reduce mortality, and enhance patient outcomes.

Objective: A prospective cohort study was conducted to investigate sleep status during the first and second trimester of pregnancy in pregnant women on adverse birth outcome, such as preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). Design: Prospective cohort study. Setting: China. Population: Cases were singleton pregnant women aged 18-40 years from the prospective Tongji-Shuangliu Birth Cohort. Methods: Multivariable logistic regression models were used to analyze the associationof sleep status during the first and second trimester of pregnancy with adverse birth outcomes and generated the odds ratio (OR) and 95% confidence interval (CI). Main outcome measures: Birth outcomes. Results: Finally, 5,412 pregnant women were included in the analysis. In the multivariable model, compared with 8-9 hours/night, sleep less than 7 hours/night during second trimester increases the risk of PTB (OR: 1.80, 95% CI: 1.12,2.89), and the risk of PTB was decreased in pregnant women who slept ≥11 hours/night (OR: 0.53, 95% CI: 0.30,0.93). Sleep quality, napping and sleep changes in the first and second trimesters, and sleep duration in the first trimester were not statistically associated with PTB, LBW and SGA. Conclusions: Short sleep duration during pregnancy is associated with a higher risk of PTB, while longer sleep duration at night is associated with a lower risk of PTB. Sleep status during pregnancy was not associated with LBW and SGA. In order to reduce risk of adverse birth outcomes, sleep problems in pregnant women should be strengthened during pregnancy care.

BACKGROUND:Cholestasis, including primary sclerosing cholangitis (PSC), remains a challenging condition with limited treatment options. The gut-liver axis and FXR signaling pathways play critical roles in maintaining bile acid homeostasis and preventing liver injury. Capsaicin, a natural compound with anti-inflammatory properties, has the potential to modulate these pathways and offer therapeutic benefits for cholestasis. PURPOSE:In this study, capsaicin-loaded nanoparticles were developed and evaluated in a PSC mouse model to investigate the therapeutic effects and underlying mechanisms of action. METHODS:Capsaicin-loaded nanoparticles (CAP@NPs) were synthesized via a solvent evaporation method and thoroughly characterized. Using a DDC-induced primary sclerosing cholangitis (PSC) mouse model, we evaluated their therapeutic effects on liver injury through serum biochemistry and histopathology. TRPV1 expression in fibrotic liver tissue was assessed via qRT-PCR, immunohistochemistry, and immunofluorescence. Inflammation, immune responses, and fibrosis were analyzed using molecular, histological, and cytometric techniques. Effects on bile acid metabolism were investigated by profiling hepatic and ileal gene expression, while gut microbiota shifts and colon injury markers were examined to elucidate underlying mechanisms. Biosafety was confirmed by hematological and pathological assessments. RESULTS:Our findings revealed that administration of CAP@NPs attenuated liver injury, inflammation, fibrosis, and bile duct hyperplasia. Mechanistically, CAP@NPs activated hepatic FXR-SHP and ileal FXR-FGF15 pathways to suppress Cyp7A1 expression, modulated gut microbiota composition (increased Clostridia, decreased Bacteroidia), enhanced intestinal barrier integrity, and reduced endotoxin translocation. CONCLUSION:This study represents a novel approach to treating cholestasis through targeted modulation of bile acid metabolism and inflammatory pathways, offering hope for new therapeutic strategies in liver disease.

Background: Interactions between immune phenotypes and metabolites in sepsis pathogenesis remain poorly defined. We integrated Mendelian randomization (MR) and single-cell transcriptomics to investigate metabolic mediation in immune-sepsis associations. Methods: Bidirectional two-sample MR analyzed sepsis genome-wide association studies (11,643 cases), 1,400 metabolites, and 731 immune phenotypes. Single-cell analysis of GSE167363 (sepsis vs. controls) included clustering, differential expression and pathway enrichment. Results: CD39 expression was upregulated in sepsis immune cells. MR-identified CD3(+) CD39(+) CD8(+) T cells as risk factors for sepsis incidence (odds ratio = 1.053, P = 0.008) and 28-day mortality (odds ratio = 1.108, P = 0.037). These cells correlated with 73 metabolites, notably androsterone sulfate, which mediated 4.97% of sepsis risk (P = 0.026). Conclusion: CD39(+) CD8(+) T cells drive sepsis progression through metabolic intermediates like androsterone sulfate, highlighting immunometabolic crosstalk as a therapeutic target.

Due to climate change, the frequency and intensity of heat waves and other extreme weather events are rapidly increasing. Compared to the general population, pregnant women and fetuses are increasingly vulnerable to the effects of extreme temperatures and are associated with the occurrence of adverse birth outcomes, including preterm birth (PTB). However, its risk of preterm birth is currently uncertain. The objective of the research is to examine the effect of ambient temperature on PTB in pregnant women. This study included 6,850 pregnant women from the Tongji-Shuangliu Birth Cohort. Meteorological data for Chengdu through the European Centre for Medium-Range Weather Forecasts. The main exposure assessment was conducted during eight different exposure windows, including the first three months of pregnancy, 7 weeks periods during the first two trimesters, throughout pregnancy, 1-week preceding delivery, and 4 weeks preceding delivery. The effect of environmental temperature on PTB during different exposure windows was assessed using the logistic regression based on the percentile of the mean temperature in different exposure cycles. Additionally, the lagged effect of environmental temperature on preterm births throughout the study period was analyzed using a distributed lag non-linear model. Among the 6850 pregnant women, 301 (4.4

Bone defects, especially those complicated by infections, pose significant challenges in orthopedic surgery due to their complex healing requirements. This study aimed to develop and evaluate polydopamine (PDA)-modified polycaprolactone/β-tricalcium phosphate (PCL/β-TCP) scaffolds fabricated using 3D printing technology for their osteogenic and antibacterial efficacy. PDA was incorporated at varying concentrations (1%, 3%, and 5%) to enhance the scaffolds' drug-loading capacity and antibacterial properties through vancomycin integration. The scaffolds demonstrated excellent biocompatibility, as confirmed by cell viability, proliferation assays, and histological analyses, supporting osteoblast adhesion and growth. Mechanical testing revealed that PCL/β-TCP/PDA scaffolds exhibited sufficient compressive strength comparable to cancellous bone, with a porous structure facilitating cell infiltration and nutrient exchange. The incorporation of PDA significantly improved drug loading, achieving a vancomycin release duration of up to 144 h, effectively reducing bacterial presence as shown by fluorescence in situ hybridization (FISH) staining. In a rabbit cranial defect model, the PDA concentration does not impede bone regeneration. Micro-CT and immunofluorescence analyses confirmed increased bone formation and the upregulation of osteogenic markers, including ALP, COL-1, and RUNX2. Gene expression analysis highlighted the activation of pathways related to osteoblast differentiation and immune response, further demonstrating the scaffolds' regenerative potential. These findings underscore the dual functionality of PCL/β-TCP/PDA scaffolds in simultaneously addressing bone healing and infection control. The 3D-printed scaffolds offer a promising solution for treating infected bone defects, with potential applications in tissue engineering and regenerative medicine. Further investigations are warranted to optimize long-term drug release kinetics and validate their clinical efficacy.

Background:Workplace violence (WPV) was a global public health issue worldwide. Given the specificity of emergency department physicians' professional roles, the incidence of WPV was significantly higher than that of practitioners in other healthcare groups. Investigating the association between exposure to WPV and psychological health can provide a scientific basis for managers to implement precise interventions on violent incidents, thereby effectively reducing the adverse impacts of WPV. Methods:A multi-stage random sampling method was employed to conduct a questionnaire survey among 14 848 emergency department physicians across 31 provincial-level administrative regions in China from July to September 2019. This survey utilised the WPV Scale, the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the Center for Epidemiological Studies Depression Scale (CES-D) to investigate the levels of WPV, burnout, and depressive symptoms among respondents. Data analysis were performed using STATA 17.0 and Amos 26.0 software. Results:A total of 90.40% of emergency department physicians reported experiencing at least one incident of WPV in the past year. The mean score for depressive symptoms was 16.80 ± 14.78, and the mean score for burnout was 82.94 ± 26.11. The correlation coefficients between WPV and depressive symptoms, WPV and job burnout, and depressive symptoms and job burnout were 0.444, 0.347, and 0.562, respectively (all P < 0.01). Structural equation analysis indicated that the total effect of WPV on depressive symptoms was 0.471, with a mediating effect of burnout at 0.421, accounting for 89.38% of the total effect. Conclusions:Emergency department physicians had a severe level of depressive symptoms and burnout, with burnout playing a mediating role between WPV and depressive symptoms. Therefore, future policy efforts are warranted to build a supportive work environment for emergency department physicians and consequently enhance their well-being.

Sepsis-induced cardiomyopathy (SIC), as a common complication in the intensive care unit, not only increases the complexity of patient care but also greatly enhances the risk of death. Currently, clinical management of SIC remains challenging, mainly due to the complexity of its pathogenesis and the lack of targeted therapies. Although the specific etiology of SIC is not yet fully understood, existing studies have revealed several vital pathological processes that are intertwined and contribute to the progression of the disease. This narrative review summarizes the existing pathogenesis of SIC, which involves multiple aspects including the inflammatory response, mitochondrial dysfunction, cell death mechanisms, immune regulation, and calcium homeostasis imbalance. Given the multifactorial pathogenesis of SIC, future studies need to explore the interactions between these mechanisms and how to intervene to develop more precise and effective therapeutic strategies to reduce mortality and improve prognosis in patients with SIC.

Snakebite envenoming remains poorly understood in terms of long-term health-related quality of life (HRQoL), particularly in China where standardized assessments are lacking. This study is the first to comprehensively evaluate HRQoL impairments in discharged snakebite patients using the EuroQol 5-Dimension 5-Level (EQ-5D-5 L) instrument in China, addressing a critical methodological gap. A multicenter cross-sectional study enrolled 6,528 snakebite patients. HRQoL was assessed via EQ-5D-5 L (Chinese value set) and customized surveys. Generalized linear models and XGBoost machine learning identified predictors. The mean utility score (0.76 ± 0.27) was significantly lower than China’s general population (0.95). Pain/discomfort (53.6

Abstract Objective This study aimed to examine prospective associations of different intensity levels and types of physical activity (PA) in early pregnancy with premature rupture of membranes (PROM) among Chinese pregnant women. Methods A total of 6284 pregnant women were included from the Tongji-Shuangliu Birth Cohort. Household/caregiving, occupational, sports/exercise and transportation activities during early pregnancy were investigated by the pregnancy physical activity questionnaire (PPAQ), and the diagnosis of PROM was ascertained during the whole pregnancy. Multivariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence interval (CI) for the associations between PA and PROM. Results Among the 6284 pregnant women, 1246 were identified to have PROM (19.8%). Women undertaking the highest level (3 third tertile) of PA during pregnancy appeared to have a lower risk of PROM [OR = 0.68, 95%CI 0.58–0.80) when compared to those at the lowest tertile of PA. Similarly, women with increased levels of light intensity activity, moderate-vigorous intensive, household/caregiving activity and meeting exercise guidelines during pregnancy were associated with reduced risks of PROM (OR = 0.69, 95% CI 0.59–0.81, OR = 0.70, 95% CI 0.60–0.82, OR = 0.62, 95% CI 0.53–0.73 and OR = 0.82, 95% CI 0.70–0.97, respectively). Conclusions High levels of PA of different intensities and PA of household/caregiving activities and meeting exercise guidelines during the first trimester were associated with a lower incidence of PROM. Trial registration The data of human participants in this study were conducted in accordance with the Helsinki Declaration. This study has been approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China ([2017] No. S225). All participants provided written informed consent prior to enrollment. A statement to confirm that all methods were carried out in accordance with relevant guidelines and regulations.

BackgroundIn sepsis, the lung is one of the worst affected organs, often leading to acute lung injury (ALI). More and more evidence suggests that macrophages are also involved in the pathogenesis of ALI. In our previous study, we successfully synthesized Iron-capsaicin-based nanoparticles (Fe-CAP NPs) and found that it could inhibit the secretion of inflammatory cytokines to alleviate ALI. Here, we further explore the anti-inflammatory mechanism of Fe-CAP NPs.MethodsBone marrow-derived macrophages (BMDM) and C57 mice were divided into four groups: control group, lipopolysaccharide (LPS) group, CAP + LPS group and Fe-CAP + LPS group. Western blot and Immunofluorescence were used to detect the expression of macrophage phenotypic markers CD86 and CD206 in BMDM and lung tissue. Fluorescence microbeads, Transwell and ROS kit were used to detect the phagocytosis, migration and ROS clearing capability of BMDM. Western blot was used to detect the expression of JAK2/STAT3 pathway and apoptosis proteins in BMDM. TUNEL kit and H&E staining were used to evaluate apoptosis and pathological changes in lung tissue.ResultsIn vitro, CD86 expression was increased in LPS, but decreased after Fe-CAP pretreatment. CD206 expression was the opposite. Fe-CAP reduced phagocytosis, migration and scavenged ROS in LPS-treated BMDM. Fe-CAP inhibited P-JAK2 and P-STAT3 expression and reduced apoptosis. In vivo, Fe-CAP improved lung histopathology and reduced apoptosis in lung tissue of LPS group. CD86 expression was increased in lung tissue of LPS group, but decreased in Fe-CAP preconditioning, and CD206 expression was reversed.ConclusionFe-CAP NPs could alleviate sepsis-induced ALI by regulating the polarization and function of macrophages, reducing ROS level and apoptosis.

Purpose: Acute lung injury (ALI) is a severe pulmonary disease characterized by damage to the alveoli and pulmonary blood vessels, leading to severe impairment of lung function. Studies on the effect of capsaicin (8-methyl-N-geranyl-6-nonamide, CAP) on lipopolysaccharide (LPS)-induced ALI in bronchial epithelial cells transformed with Ad12-SV40 2B (BEAS-2B) are still limited. This study aimed to investigate the effect and specific mechanism by which CAP improves LPS-induced ALI. Methods: The present study investigated the effect of CAP and the potential underlying mechanisms in LPS-induced ALI in vitro and vivo via RNA sequencing, Western blotting (WB), quantitative real-time reverse transcription PCR (qRT-PCR), enzyme-linked immunosorbent assay (ELISA), and transmission electron microscopy (TEM). The TRPV1 inhibitor AMG9810 and the AKT agonist SC79 were used to confirm the protective effect of the TRPV1/AKT axis against ALI. The autophagy agonist rapamycin (Rapa) and the autophagy inhibitors 3-methyladenine (3-MA) and bafilomycin A1 (Baf-A1) were used to clarify the characteristics of LPSinduced autophagy. Results: Our findings demonstrated that CAP effectively suppressed inflammation and autophagy in LPS-induced ALI, both in vivo and in vitro. This mechanism involves regulation by the TRPV1/AKT signaling pathway. By activating TRPV1, CAP reduces the expression of P-AKT, thereby exerting its anti-inflammatory and inhibitory effects on pro-death autophagy. Furthermore, prior administration of CAP provided substantial protection to mice against ALI induced by LPS, reduced the lung wet/dry ratio, decreased proinflammatory cytokine expression, and downregulated LC3 expression. Conclusion: Taken together, our results indicate that CAP protects against LPS-induced ALI by inhibiting inflammatory responses and autophagic death through the TRPV1/AKT signaling pathway, presenting a novel strategy for ALI therapy.

Background This study aimed to investigate attitudes towards health education on snakebites and to identify the influencing factors among Chinese residents. Additionally, we proposed effective health education strategies for snakebite management. Methods Between May 2022 and February 2023, we conducted a nationwide cross-sectional questionnaire survey using a multistage sampling method with supplementary snowball sampling. We used descriptive analysis, chi 2 tests, and univariable and multivariable binary logistic regression models to analyse the data. Results We included 56 669 respondents in the analysis. The average score for snakebite knowledge was 12.13 +/- 5.26 points, with a maximum score of 28. Among the respondents, 72.66 and 63.03% of the residents believed that it was necessary to disseminate knowledge about snakebites and expressed a willingness to receive snakebite training, respectively. Respondents from the northeast region, respondents with a higher education level, and respondents with higher scores for snakebite knowledge, health knowledge, health skills, and social-psychological adjustment skills exhibited more positive attitudes towards snakebite knowledge dissemination and training. Conversely, respondents from eastern or southern China, respondents older than 60, and respondents who lived in rudimentary housing conditions showed a lower perception of the need for snakebite knowledge dissemination and were less willing to participate in snakebite knowledge and skill training. Conclusions Generally, Chinese residents have positive attitudes towards snakebite knowledge dissemination and training. However, the public lacks sufficient knowledge about snakebites. Therefore, we should pay close attention to areas south of the Yangtze River to strengthen snakebite health education using engaging formats that align with residents' interests, such as short videos or television programmes, in an attempt to and ultimately improve health literacy and prevention awareness.

AIM:To evaluate the prospective associations of nighttime sleep duration, midday napping, and sleep quality during early pregnancy with gestational diabetes mellitus (GDM) risk among Chinese pregnant women. METHODS:Sleep-related information was assessed by the Pittsburgh Sleep Quality Index in baseline surveys during the 6-15 (mean 10.3) gestational weeks. GDM was diagnosed during 24-28 gestational weeks according to the Chinese Guidelines on Diagnosis and Management of Hyperglycemia in Pregnancy (2022). Multivariable logistic regression models with adjustments for socio-demographic and lifestyle factors were used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for the associations of sleep traits with GDM risk. RESULTS:We identified 503 incident GDM cases among 6993 participants. Compared with women who slept for 7-9 hours/night in early pregnancy, those who slept <7 hours/night showed a higher risk of GDM (OR, 1.75; 95 % CI: 1.20-2.54), whereas those who slept >9 hours/night showed no significant association for GDM risk (OR, 1.01; 95 % CI: 0.78-1.30). Compared with women with absolutely no napping, those with ≤60 and > 60 min/day midday napping showed no significant association for GDM risk (OR, 0.82; 95 % CI: 0.64-1.05 for ≤60 min/day midday napping; OR, 0.87; 95 % CI: 0.66-1.15 for >60 min/day midday napping). Poor sleep quality was not associated with GDM risk compared with good quality (OR, 0.90; 95 % CI: 0.72-1.12). CONCLUSION:A short nighttime sleep duration during early pregnancy was associated with a higher risk of GDM, which was independent of midday napping, sleep quality and lifestyle factors.