ObjectiveTo investigate the prevalence of subthreshold depression among Chinese college students and to explore the related factors.MethodsThe research subjects were Chinese college students participating in the "2022 Psychology and Behavior Investigation of Chinese Residents (PBICR-2022)". Data on respondents' general characteristics, quality of life, perceived pressure, family communication, perceived social support, self-efficacy, and depression status were gathered. To investigate the association between each variable and the risk of subthreshold depression, statistical analyses, including chi-square tests and rank sum tests were conducted. Furthermore, a binary stepwise logistic regression was employed to establish the regression model of the factors related to subthreshold depression among Chinese college students.ResultsA prevalence of subthreshold depression of about 39.7% was found among the 8934 respondents. Logistic regression analysis revealed that respondents who are female, have chronic diseases, are in debt, experience significant impacts from epidemic control policies, have lower self-assessed quality of life, experience challenges in family communication, perceive lower social support, have lower self-efficacy, and feel higher perceived pressure are more likely to develop subthreshold depression compared to the control group. (P < 0.05).ConclusionThe prevalence rate of subthreshold depression among Chinese college students was found to be approximately 40%. Female college students suffering from chronic diseases, with households in debt, greatly impacted by epidemic control policies, and experiencing high perceived stress, may be at risk for subthreshold depression among Chinese college students. On the other hand, strong family communication, perceived social support, and self-efficacy were identified as potential protective factors. In order to facilitate timely screening, diagnosis, and treatment of subthreshold depression in Chinese college students, it is crucial for the government, local communities, colleges, and families to prioritize the mental health of college students and implement targeted measures accordingly.

Background: Suboptimal health status is a global public health concern of worldwide academic interest, which is an intermediate health status between health and illness. The purpose of the survey is to investigate the relationship between anxiety statuses and suboptimal health status and to identify the central symptoms and bridge symptoms. Methods: This study recruited 26,010 participants aged <60 from a cross-sectional study in China in 2022. General Anxiety Disorder-7 (GAD-7) and suboptimal health status short form (SHSQ-9) were used to quantify the levels of anxiety and suboptimal health symptoms, respectively. The network analysis method by the R program was used to judge the central and bridge symptoms. The Network Comparison Test (NCT) was used to investigate the network differences by gender, place of residence, and age in the population. Results: In this survey, the prevalence of anxiety symptoms, SHS, and comorbidities was 50.7 %, 54.8 %, and 38.5 %, respectively. "Decreased responsiveness", "Shortness of breath", "Uncontrollable worry" were the nodes with the highest expected influence. "Irritable", "Exhausted" were the two symptom nodes with the highest expected bridge influence in the network. There were significant differences in network structure among different subgroup networks. Limitations: Unable to study the causal relationship and dynamic changes among variables. Anxiety and sub-health were self-rated and may be limited by memory bias. Conclusions: Interventions targeting central symptoms and bridge nodes may be expected to improve suboptimal health status and anxiety in Chinese residents. Researchers can build symptom networks for different populations to capture symptom relationships.

BackgroundThe number of people with diabetes is on the rise globally. Self-management and health education of patients are the keys to control diabetes. With the development of digital therapies and artificial intelligence, chatbots have the potential to provide health-related information and improve accessibility and effectiveness in the field of patient self-management. ObjectiveThis study systematically reviews the current research status and effectiveness of chatbots in the field of diabetes self-management to support the development of diabetes chatbots. MethodsA systematic review and meta-analysis of chatbots that can help patients with diabetes with self-management was conducted. PubMed and Web of Science databases were searched using keywords around diabetes, chatbots, conversational agents, virtual assistants, and more. The search period was from the date of creation of the databases to January 1, 2023. Research articles in English that fit the study topic were selected, and articles that did not fit the study topic or were not available in full text were excluded. ResultsIn total, 25 studies were included in the review. In terms of study type, all articles could be classified as systematic design studies (n=8, 32%), pilot studies (n=8, 32%), and intervention studies (n=9, 36%). Many articles adopted a nonrandomized controlled trial design in intervention studies (n=6, 24%), and there was only 1 (4%) randomized controlled trial. In terms of research strategy, all articles can be divided into quantitative studies (n=10, 40%), mixed studies (n=6, 24%), and qualitative studies (n=1, 4%). The evaluation criteria for chatbot effectiveness can be divided into technical performance evaluation, user experience evaluation, and user health evaluation. Most chatbots (n=17, 68%) provided education and management focused on patient diet, exercise, glucose monitoring, medications, and complications, and only a few studies (n=2, 8%) provided education on mental health. The meta-analysis found that the chatbot intervention was effective in lowering blood glucose (mean difference 0.30, 95% CI 0.04-0.55; P=.02) and had no significant effect in reducing weight (mean difference 1.41, 95% CI –2.29 to 5.11; P=.46) compared with the baseline. ConclusionsChatbots have potential for the development of self-management for people with diabetes. However, the evidence level of current research is low, and higher level research (such as randomized controlled trials) is needed to strengthen the evidence base. More use of mixed research in the research strategy is needed to fully use the strengths of both quantitative and qualitative research. Appropriate and innovative theoretical frameworks should be used in the research to provide theoretical support for the study. In addition, researchers should focus on the personalized and user-friendly interactive features of chatbots, as well as improvements in study design.

The objective of this study was to investigate self-medication behavior among Chinese adolescents aged 12-18 years and explore the factors associated with whether adolescents prioritize drug efficacy or safety when engaging in self-medication behavior. In 2021, a questionnaire investigation was conducted in the Chinese mainland using a multi-stage sampling approach. After a statistical description, logistic regression was used to analyze the factors associated with considering drug efficacy and safety. The self-medication rate among Chinese adolescents aged 12-18 years was 96.61%. Of these, 65.84% considered drug safety to be essential, while 58.72% prioritized drug efficacy. Regression analysis showed that individuals with better healthcare were more likely to consider drug efficacy an important factor. Additionally, those with a healthier family lifestyle were more likely to prioritize efficacy. When individuals engage in self-medication, those residing in urban areas and possessing advanced preventive health literacy and ample family health resources tend to prioritize drug safety to a greater extent. Conversely, those with higher monthly household incomes and only children exhibit a decreased inclination towards prioritizing safety during self-medication. Self-medication is a frequently observed practice among Chinese adolescents aged 12-18. Several factors, such as demographic and sociological characteristics, health literacy, and family health status, have been found to be associated with the extent to which adolescents prioritize medication safety and efficacy when engaging in self-medication practices. Higher levels of health literacy and better family health status were positively correlated with considering both the efficacy and safety of drugs as important factors when self-medicating.

Background Lumbar disc herniation (LDH) is a frequent and multiple disease that imposes a heavier global economic burden. As China's diagnosis related group (DRG) payment system for Chinese medicine health insurance has entered the initial stage. Our study explored the factors influencing the hospitalization costs and established DRG cases classification scheme of LDH patients in Chinese medicine hospitals. Methods A total of 2,857 LDH patients were hospitalized in Qingyang City Hospital of Chinese Medicine from January 2017 to June 2022. Using univariate analysis and multiple linear regression model to determine the primary factors influencing hospitalization costs for LDH patients. These factors were then utilized as classification node variables in a decision tree model to categorize LDH patients into diagnosis related groups (DRGs). The outcomes of these groupings were evaluated, and standard costs were computed for each DRG. Results Hospitalization costs of patients with LDH were mainly affected by age, admission pathways, diagnosis and treatment based on Chinese medicine evidence, complications and comorbidities, surgery and operation, and length of stay, with the latter being the most crucial one. The decision tree model resulted in 10 DRGs with corresponding standard costs. The intra-group evaluation metric coefficient of variation (CV) was appropriate (required to be less than 1, actual range:0.23–0.91), and the inter-group evaluation metric reduction in variation (RIV) was suitable (needed to be greater than 0.4, actual value is 0.48). Significant variations exist in disease related weight (RW) and standard costs across all groups. Conclusions The E-CHAID decision tree model grouping results are reasonably robust, showing good homogeneity within each DRG and notable heterogeneity between DRGs. Based on these groupings, scientifically formulate standard costs for each DRG and set upper limits, providing valuable insights to advance reforms in Chinese medicine DRG-based healthcare payment methods.

Objective To explore the influencing factors of adolescent runaway and its correlation with family health so as to provide epidemiological evidence for future comprehensive interventions. Methods Using the quota sampling method, 1 065 adolescents aged 12-18 years old were surveyed by Questionnaire Star in 120 cities in China from July to September 2021. A well-developed electronic questionnaire was used to collect information about demographic characteristics, psychological characteristics, family health, social support, and behavior of running away from home. Univariate analysis and Logistic regression were used to explore the influencing factors of adolescent runaway and its correlation with family health. Results A total of 1 065 adolescents were investigated, among whom 334 were the only children（31.36%） and 442 were boys（41.50%）. Univariate analysis revealed that 7.6% of teenagers had the experience of running away from home in the last 30 days. Participants who were ethnic minorities（P=0.031） and had education of technical school or junior college（P=0.029） and a low family income（P＜0.001） were more likely to have running away behavior. Adolescents with low self-efficacy（P=0.005）, depression（P＜0.001）, anxiety（P＜0.001）, and more stress had higher detection rates of runaway behavior. However, adolescents with higher family health and social support were less likely to run away from home（P＜0.01）.Multivariate analysis showed that compared with adolescents with low family health, adolescents with high（OR=0.16, 95% CI: 0.06-0.46） and moderate（OR =0.27, 95% CI: 0.14-0.55） family health had a significantly lower risk of runaway behavior. Conclusion The family is of great significance in preventing teenagers from running away from home. Parents should build a good parent-child relationship and create a happy family atmosphere to reduce the occurrence of teenagers running away from home.

BackgroundHPV vaccine can block the infection of high-risk human papillomavirus and is an important measure to effectively reduce the incidence of cervical cancer and precancerous lesions. However, the HPV vaccination rate is still low in China. There are many factors. Therefore, it is important to study the influencing factors to provide basis for promoting the formulation of vaccination strategies.MethodsThis study used a multi-stage sampling method to conduct a face-to-face questionnaire survey on women in different regions of China. The new general self-efficacy scale was used to measure the self-efficacy of the respondents. The short form of family health scale measured their family health. The t-test and binary Logistic regression analysis were used to screen the influencing factors of HPV vaccination. Restricted cubic spline model was used to analyze the influence trend of self-efficacy and family health on HPV vaccination rate.Results(1) The HPV vaccination rate was low, especially in the ≤18 group. The place of residence, capita household income/month, individual self-efficacy and family health had a significant impact on HPV vaccination. (2) The restricted cubic spline model showed that self-efficacy positively promoted HPV vaccination, the correlation strength was statistically significant (χ2 =27.64, P<0.001) and non-linear (χ2 = 12.49, P = 0.0004); The poor family health hindered HPV vaccination, and the association strength was statistically significant (χ2 = 47.81, P < 0.001) and non-linear (χ2 = 9.96, P = 0.0016).ConclusionIt is necessary to strengthen the health education of HPV vaccination knowledge in the population to eliminate the hesitancy of vaccination. Free HPV vaccination strategies should be developed and encourage people of appropriate age to receive as early as possible. Self-efficacy and family health should be enhanced to increase HPV vaccination rate, so as to achieve the goal of reducing the incidence of cervical cancer and protecting women's health.

Introduction:Lung function tests are valuable in assessing respiratory health and disease, and the Healthy China Initiative clearly states that people over 40 years of age should have a lung function test once a year. To explore the influence of propensity factors, ability factors, and need factors on lung function detection behaviors of middle-aged and elderly Chinese, the following studies are conducted.Method:A questionnaire was designed using Anderson's model, and multi-stage sampling was used to conduct a nationwide questionnaire survey based on geographical subdivisions and population distribution. Frequency and percentages were used for descriptive statistical analysis of lung function testing among middle-aged and elderly people in China, and chi-square tests and binary logistic regression analyses were used to investigate the factors influencing lung function testing behavior among middle-aged and elderly people in China.Result:A total of 404 study participants were included in this study. Education level (relative to primary school and below, middle school and high school and secondary school OR = 2.652, P = 0.018; college and above OR = 4.566, P = 0.002), mode of health care affordability (relative to those who paid for the test, non-payers OR = 2.205, P = 0.004), dimensions of the European Five Dimensional Health Scale (mobility OR = 4.571, P = 0.006; pain or discomfort OR = 0.397, P = 0.003; anxiety or depression OR = 0.511, P = 0.028), and self-efficacy (medium group 0R = 0.294, P < 0.001; low group OR = 0.162, P = 0.003) had a significant impact on lung function testing behavior in our middle-aged and older adults.Conclusion:This study found that there is still room for improvement in the participation of middle-aged and elderly people in lung function testing. Among the propensity factors, the factor that affects the rate of lung function tests is the highest degree of education, which determines the degree of patients' attention to lung function tests. Among the need factors, the factors affecting the rate of lung function detection are the physical conditions of middle-aged and elderly people, and those with poor physical conditions need medical detection. Among the ability factors, the factor that affects the rate of lung function tests is the way of bearing medical expenses, and economic status is the key factor that determines whether patients can accept lung function tests.

Background: Over-the-counter (OTC) drugs facilitates residents self-medication. However, inappropriate self-medications have become a serious problem in China and even all over the world.Objectives: To make an investigation on the current status of Chinese residents’ self-medication behaviors and important considerations, and to explore the factors related to the considerations of drug efficacy and safety.Design: A quantitative, cross-sectional study.Methods: Multi-stage sampling was used to conduct a cross-sectional investigation in China 22 provinces, 5 autonomous regions and 4 municipalities directly under the Central Government. State that an interviewer-administrated questionnaire, was used for data collection. The questionnaire that was used in the investigation included demographic sociological characteristics, health literacy scale-short form (HLS-SF), the 10-item Big Five Inventory (BFI-10), the EuroQol-5D visual analogue scale (EQ-5D VAS), self-medication status and important considerations when self-medicating. Descriptive statistics were performed, and the Chi-square test was used for univariate analysis. Log-binomial regression was used for multivariate analysis on whether residents regard drug efficacy or safety as an important consideration.Results: 9256 respondents were included in the data analysis. The self-medication rate of Chinese adults was as high as 99.1%. Paracetamol and other analgesics were the most common types of OTC medication that respondents purchased, followed by vitamins/minerals. Medical staff recommendations, drug safety and efficacy were the top three important considerations. The residents in the east, central and western regions who consider safety is 63.5%, 61.5%, and 66.8% respectively. The proportion of curative effect was 60.2%, 55.7%, and 61.4% respectively. Log-binomial regression showed that western respondents, retired people, those who mainly used ways including basic medical insurance for employees, commercial medical insurance, free medical treatment to cover their medical cost, respondents with high neuroticism, high health literacy were more likely to consider drug safety as an important factor (p < 0.05). Eastern respondents, employed, main way of medical expenses borne was Out-of-pocket Payment, those with chronic disease were more likely to consider drug efficacy as an important factor (p < 0.05). Female, respondents with high levels of agreeableness, conscientiousness, openness, and self-rated health status were more likely to regard both drug safety and efficacy as important considerations (p < 0.05).Conclusion: Self-medication is practiced by most Chinese adults. Whether Chinese adults take drug efficacy or safety as an important consideration is related to their demographic and sociological characteristics, Big Five personality characteristics, health literacy and self-assessed health status. There is a need to strengthen the management of OTC drugs and public education about self-medication.

Background The obesity rate in the Chinese population is increasing and there is a lack of short and reliable scales for measuring obesity-related eating behavior in China. The EBS-SF (Sakata Eating Behavior Scale short form) has only 7 entries and has shown good reliability in studies such as those in Japan. Objective To translate the EBS-SF into Chinese, check its reliability, validity and explore the related factors. Method The EBS-SF was translated into Chinese. 3,440 residents were investigated and 34 respondents were retested. Item analysis and reliability and validity tests were carried out. Personality characteristics, family health status and depression were investigated using the BFI-10, FHS-SF and PHQ-9 to investigate the factors associated with EBS-SF. The t -test, ANOVA and Pearson correlation was used to explore the related factors of its scores. Result Among 3,440 residents, 1,748 (50.81%) were male and 1,692 (49.19%) were female; 1,373 (39.91%) were aged 36–50 years. All 7 items were qualified in the item analysis. As for reliability, the Cronbach's α was 0.870, the split-half reliability was 0.830, the test-retest correlation coefficient was 0.868. As for the structural validity, the standardized factor loadings were above 0.50, χ 2 / df = 2.081,GFI = 0.999; NFI = 0.999; RFI = 0.996; RMSEA = 0.018, all qualified. The characteristics, personality, family health and depression were correlated with the score of the Chinese version of EBS short form. Conclusion The structural validity and reliability of the Chinese version of the EBS-SF are good and it can be used as a measurement tool to evaluate the eating behavior of Chinese. The scores of the EBS-SF may be related to the sociological characteristics, personality, family health, and depression status.

BackgroundHealth literacy is closely related to health status. Measuring public health literacy levels helps to warn of health status and manage health problems through timely interventions. The items of relevant evaluation tools are complex and numerous in China, and there is no recognized health literacy brief scale for the whole population. To translate the 12-item short-form health literacy scale (HLS-SF12) and test the validity and reliability of the Chinese version of the HLS-SF12 in the Chinese population.MethodsThe HLS-SF12 was translated into Chinese using the procedures of translation, back translation, and cultural debugging. 10,951 residents were selected by quota sampling method to test the validity and reliability of the scale, and 33 people were selected to retest after 2 weeks. The reliability was tested by using internal consistency coefficient and test-retest reliability. The validity was tested by using confirmatory factor analysis, content validity, convergent validity and discriminant validity.ResultsThe Cronbach's Alpha coefficient for the total scale was 0.94, and the test-retest reliability was 0.89. The Cronbach's Alpha coefficients for the three subscales of health care, disease prevention, and health promotion respectively were 0.86, 0.86, 0.87, and the test-retest reliability respectively were 0.91, 0.79, 0.63. The confirmatory factor analysis identified a three factors model and showed nice goodness of fit indices for Chinese HLS-SF12 (GFI = 0.96, CFI = 0.97, IFI = 0.97, TLI = 0.96, and RMSEA = 0.07).ConclusionThe Chinese version of the HLS-SF12 has good reliability and validity, and can be used as a tool to evaluate the health literacy of Chinese people.

Background:Aflibercept has been approved for the treatment of metastatic colorectal cancer for more than a decade, but its antiangiogenesis adverse effect profile during treatment remains unclear. This study is conducted to systematically review the risk of antiangiogenic adverse events in patients with metastatic colorectal cancer receiving aflibercept plus chemotherapy.Methods:We searched databases, including PubMed, Embase and the Cochrane Library up to September 9, 2021. Relevant randomized controlled trials (RCTs) and single-arm studies were included in the review. Statistical analyses were performed using R to calculate the summary incidence rate of antiangiogenic-related adverse events, odds ratios and 95% CIs. Heterogeneity among the included studies was assessed by subgroup analysis. Publication bias analysis and sensitivity analysis were performed to confirm the reliability of the results.Results:A total of 2889 patients from 10 studies met the inclusion criteria. The quality of the included studies was evaluated as qualified for further quantitative synthesis. In part of single-arm studies, the occurrence rates were 44.2% (95%CI, 39.7-48.7%) for hypertension, 31.3% (95% CI, 19.3-43.3%) for proteinuria, 27.3% (95%CI, 21.2-33.4%) for epistaxis, 22.5% (95%CI, 7.8-37.3%) for hemorrhage events, 8.0% (95%CI, 2.0-14 .0%) for venous thromboembolic event in all grades and 22.6% (95%CI, 19.1-26.2%) for grade III/IV hypertension, 7.4% (95%CI, 6.2-8.5%) for grade III/IV proteinuria. In part of RCT, compared to its counterpart, aflibercept containing arm was associated with the increased incidence rate in hypertension (OR:6.30, 95%CI: 3.49-11.36), proteinuria (OR:4.12, 95%CI: 1.25-13.61), epistaxis (OR:3.71, 95%CI: 2.84-4.85), III/IV hypertension (OR:7.20, 95%CI: 5.23-9.92), III/IV proteinuria (OR:5.13, 95%CI: 3.13-8.41). The funnel plot, Begg test and Egger test were carried out on the primary endpoints, III/IV hypertension rate and III/IV proteinuria rate, the result of which detected no obvious publication bias. No significant difference was observed in subgroup analysis in the primary endpoint between the subgroups stratified by treatment line (firstline or non-firstline), chemotherapy regime (FOLFIRI or others) and study design (RCTs or single-arm trials).Conclusion:The available evidence suggests that using aflibercept is associated with an increased risk of antiangiogenic adverse events compared with controls. Further studies are needed to investigate this association. In the appropriate clinical scenario, the use of aflibercept in its approved indications remains justified. However, the results of this study should be interpreted with caution, as some of the evidence comes from single-arm clinical trials.

Background Health education and health promotion are at the top of the list of population health promotion strategies. It is essential to provide community-dwelling residents with health education to improve their health literacy. However, few studies focus on the needs of health education (including the contents, acquisition methods and forms) in community-dwelling residents. Objective To investigate the perceived needs of health education and associated factors in community-dwelling residents, providing a scientific basis for meeting their health education needs and improving their health literacy level. Methods From January 19 to March 12, 2020, 2 846 residents aged >12 years were selected from 10 cities of China using multistage sampling to attend a questionnaire survey. The questionnaire used contains two parts: the first part is socio-demographic characteristics. And the second part is the perceived health education needs of community-dwelling residents, with 5-point Likert scale items belonging to three dimensions (contents, forms, and acquisition methods) . The total score for each dimension was obtained by summing the score of items in the dimension. Residents' needs of the contents, forms or acquisition methods were graded as "low", "moderate", or "high" by the average total score of each dimension. Univariate and multivariate ordinal Logistic regression were used to explore the associated factors of level of health education needs in community-dwelling residents. Results Altogether, 2 679 cases (94.13%) who handed in responsive questionnaires were finally included. The average total score for dimensions of contents, acquisition methods and forms were (21.49±5.91) , (15.11±5.48) and (13.61±4.41) , respectively. Among the content items of health education, the top three relatively strongly needed/strongly needed were food safety〔2 081 (77.68%) 〕, disease prevention and control〔2 020 (75.44%) 〕, and rational medication〔1 963 (73.28%) 〕. Among the acquisition methods of health education, the top two relatively strongly needed/strongly needed were health education columns in the community built using digital media technologies〔1 519 (56.70%) 〕 and interactive health education〔1 518 (56.66%) 〕. In terms of the health education form, the proportions of residents who needed various forms of health education were similar. Specifically, the proportion of residents who relatively strongly needed/strongly needed video-based health education was the highest〔64.91% (1 739/2 679) 〕, while that of residents who relatively strongly needed/strongly needed written health educational materials was the lowest〔50.84% (1 362/2 679) 〕. Multivariate ordinal Logistic regression analysis showed that age and current occupation were associated with residents' needs of the content of health education (P<0.05) . Moreover, gender, the highest educational attainment, current occupation, and current place of residence were associated with residents' needs of methods for acquiring health education (P<0.05) . And age, the highest educational attainment, current occupation, and current place of residence were associated with residents' needs of the form of health education (P<0.05) . Conclusion Community-dwelling residents showed high demand for the contents, acquisition methods, and forms of health education, which presented a diversified trend. They paid special attention to the content about food safety and disease prevention and treatment, and preferred interactive and video-based health education in terms of form.

BackgroundThis study explored the effects of personality factors on public behavioral decision-making.MethodsWe examined the literature on personality theory based on triadic interaction decision theory, and summarized and compared the findings with studies of the Big Five personality characteristics. A literature review method was used to explore the implications of personality theory for public decision-making in Chinese communities.ResultsIndividuals with high neuroticism can be targeted by influential communicators. Individuals with high extraversion can influence decision-making through interpersonal relationships. Individuals with high levels of openness can be influenced by the development of novel activities. Conscientious individuals respond to scientific and rational knowledge. Individuals with high agreeableness can be influenced by groups.ConclusionsPersonality traits can influence behavioral decisions and can have positive or negative effects on behavioral outcomes. For people with different personality traits, social actors and social activity communicators should formulate targeted measures according to the classification of personality traits. The current findings have implications for enriching research perspectives and approaches to public community decision-making.

Background: Malignant melanoma is a highly aggressive cancer that spreads and metastasizes quickly. In recent years, the antiangiogenic drug bevacizumab has been trialed to treat malignant melanoma. We conducted the first meta-analysis to examine the efficacy and safety of bevacizumab combined with other drugs in malignant melanoma.Methods: We searched for randomized controlled trials (RCTs) and non-comparative clinical studies of bevacizumab combined with chemotherapy, targeted medicine, and interferon to treat malignant melanoma in PubMed, Embase, the Cochrane Library, and Web of Science. Meta-analysis of RCT was performed using Review Manager (version 5.4), and non-comparative meta-analysis was performed using R (version 4.0.3). The primary outcome was the objective response rate. Depending on the heterogeneity of the included studies, the pooled outcomes and 95% CI were calculated using either random-effects or fixed-effect models. Subgroup outcomes were calculated with possible relevant variables. Sensitivity analyses were carried out by excluding each study from the highly heterogeneous pooled results in turn. Funnel plot and Begg’s test were used to test the included studies' potential publication bias. The level of significance was set at p < 0.05.Results: This meta-analysis included 20 trials: five RCTs and 15 non-comparative clinical studies with a total of 23 bevacizumab intervention arms. In 14 treatment arms, bevacizumab was combined with chemotherapy drugs such as fotemustine, dacarbazine, carboplatin/paclitaxel, and temozolomide. In six treatment arms, bevacizumab was combined with targeted medicines such as imatinib, everolimus, sorafenib, erlotinib, and temsirolimus. There were also six treatment arms that used bevacizumab in combination with interferon. The pooled objective response rate was 15.8% (95% CI, 11.4%–20.2%). Bevacizumab plus carboplatin/paclitaxel significantly increased the overall survival compared to carboplatin/paclitaxel (HR = 0.64, 95% CI, 0.49-0.85, p < 0.01). Fatigue, nausea, leukopenia, thrombocytopenia, and neutropenia were the most common adverse events. The pooled incidence of hypertension of all bevacizumab arms in malignant melanoma was 32.4% (95% CI, 24.5%–40.3%).Conclusion: This study showed that bevacizumab combined with chemotherapy might be effective and well-tolerated in patients with stage III or IV unresectable malignant melanoma.Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=304625], identifier [CRD42022304625].

BackgroundThe application of virtual reality (VR) in gastroscopic operation teaching can be safe and effective, but the advantages can be realized only when students accept and use it. This study aims to identify the factors influencing Chinese clinical medical postgraduates on their intention to use the 3D gastroscopic model constructed based on VR technology using Unified Theory of Acceptance and Use of Technology (UTAUT) model. Students' demographic factors are also taken into consideration.MethodsAll methods were carried out in accordance with relevant guidelines. Data were collected from clinical medical postgraduates students in China using stratified sampling. A total of 292 questionnaires including valid responses were used in this study. Data were processed using Amos 24.0 and SPSS 26.0 software and the statistical analysis technique was based on structural equation modeling (SEM).ResultsThe results showed that different from the mediator of home location and year of clinical learning, mediator of gender, university kind and graduate degree did not affect the behavioral intention. In addition, performance expectancy, facilitating condition, and social influence directly and indirectly have effect on behavioral intention. Also, the significance between social influence and performance expectancy, social influence and effort expectancy were verified.ConclusionsThis study manifested that the proposed framework based on the UTAUT had explanatory power to identify the factors influencing the students' behavioral intention to use the 3D gastroscopic model constructed based on VR technology. Whereas, an important variable of effort expectancy in the frame of the SEM were not certified, thereby indicating that particular attention should be paid to this variable by universities and teachers before applying 3D gastroscopic model constructed based on VR technology in teaching. Added preparatory work is required such as explaining the basic knowledge of the operating steps of VR model and make students adequately understand its accessibility, which can probably improve the intentions of them to use it. The positive effects of social influence on performance expectancy and effort expectancy we proposed was also verified in this study, which provided a direction for future research.

BACKGROUND:Non-smoking college students are starting to smoke in increasing numbers, which shows that their tobacco control situation seems not optimistic. The UTAUT and e-HL are commonly used models and theories to predict health behaviors, while there are few studies on tobacco control. This paper aims to study the influencing factors of tobacco control intention and behavior of non-smoking college students in China by combining the UTAUT and e-HL.METHODS:Based on the stratified sampling method, 625 college students from 12 universities were selected. Data were collected using a self-made questionnaire designed based on the UTAUT and e-health literacy scales. Data were analyzed by SPSS 22 and AMOS 26, including descriptive statistics, one-way variance analysis and structural equation model analysis.RESULTS:The results of one-way variance analysis showed that there were significant differences in the score of non-smoking college students' tobacco control intention or behavior by hometowns, monthly living expenses, and parents' smoking history. Performance expectancy, effort expectancy, social influence had direct positive effects on behavioral intention. Facilitating condition, behavioral intention had direct positive impacts on use behavior and e-HL had an indirect positive impact on use behavior.CONCLUSIONS:The combination of the UTAUT and e-HL can be used as an appropriate framework to predict the influencing factors of non-smoking college students' intention and behavior of tobacco control. Improving performance expectancy, effort expectancy, and e-HL among non-smoking college students, creating positive social environments, and providing facilitating condition are key aspects of increasing their tobacco control intention and behavior. It is also beneficial to promote the implementation of smoke-free campus and smoke-free family projects.

To investigate the support of residents in China for the provision of AEDs in public places and the factors affecting support. A cross–sectional study was conducted with questionnaires among residents of 120 sampled cities, and ANOVA analysis and stepwise regression were used to assess the factors related to the public’s intention for the provision of AEDs in public places. 11,031 valid questionnaires. In the overall population, the mean score of public support for the provision of AEDs was 80.31. Female (β=0.070, P<0.001), highly educated groups[undergraduate (β=0.066, P<0.001), and graduate (β=0.042, P=0.002)], and those who had higher scores on social support (β=0.050, P=0.002), family health (β=0.238, P<0.001) and health literacy (β=0.073, P<0.001), had higher support for provision of AEDs in public. In a subgroup analysis of gender and place of residence, gender, literacy, presence of emergency necessities in the household, family type, social support, family health, and health literacy were factors that influenced support for AEDs. Residents’ willingness to support the provision of AEDs was generally high. Gender, education level, social support, family health, and health literacy were the main factors influencing their willingness to support. The government can develop AED-related policies based on the findings of the study.

Objective To investigate the status of Chinese residents' self-medication behavior and the important factors to consider when purchasing OTC drugs, and to explore the related factors of the possibility that Chinese residents take medical staff's suggestions as important factors to consider when purchasing OTC drugs. Study design A cross-sectional survey. Methods A questionnaire was developed for exploring the sociodemographic characteristics of the respondents, their self-medication status, and important considerations. The questionnaire includes several scales including Health Literacy Scale-Short Form (HLS-SF), EQ-5D Visual Analog Scale (EQ-5D-VAS), Big Five Inventary-10 Items (BFI-10), and New General Self Efficacy Scale (NGSES). After carrying out a multi-stage sampling method, the questionnaire was conducted nationwide from July 10 to September 15, 2021. Next, descriptive statistics were conducted to analyze the general features. Logistic regression was then used to analyze the related factors of the possibility that the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs. Results Nine thousand two hundred fifty-six qualified questionnaires were received. 99.06% of Chinese adults had self-medication behaviors. The types of OTC drugs purchased most by the respondents were NSAIDs (5,421/9,256 people, 58.57%) and vitamins/minerals (4,851/9,256 people, 52.41%). 86.2% of the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs. The results of multi-factor logistic regression showed that women, those living in the central and western regions of China, those suffering from chronic diseases, those with high agreeableness, high conscientiousness, high neuroticism and openness, high health literacy, high EQ-5D-VAS, and those with high self-efficacy are more likely to take medical staff's suggestions as important factors to consider. Conclusion The vast majority of Chinese adults have self-medication behavior. Important considerations when purchasing OTC drugs include medical staff's suggestions, drug safety and drug efficacy. Whether residents take the suggestions of medical staff as an important consideration is related to their sociological characteristics, agreeableness, conscientiousness, neuroticism, openness, health literacy, self-assessment health status, and self-efficacy. When purchasing and using OTC drugs, residents should carefully listen to the suggestions from medical staff. They should also carefully consider their own conditions before buying OTC drugs.

Objective: This study aims to investigate the differences in public vaccination preference for the COVID-19 vaccine with different personality characteristics. Methods: Based on the Big Five Personality Inventory (BFI-10), a total of 1200 respondents were categorized by personality characteristics using Latent Profile Analysis (LPA). The preference of members the public with different personality characteristics for COVID-19 vaccination was investigated based on a discrete choice experiment (DCE). Results: All respondents were divided into three groups, named the General and Stable type (79.67%), Conscientious and Agreeable type (9.5%), and Open and Extroverted type (10.83%). For the percentage importance of vaccine attributes, both the General and Stable type and Conscientious and Agreeable type respondents considered cost to be the most important (41.93% and 34.95% respectively). However, the Open and Extroverted type respondents considered efficacy as the most important (31.05%). In our conditional logit model (CLOGIT), for vaccine adverse effects, the General and Stable type and Conscientious and Agreeable type respondents preferred “very mild”, while the Open and Extroverted type preferred “mild” (OR:1.108, 95%CI 0.977–1.256). The Open and Extroverted type had a higher willingness to pay (WTP) for the most preferred vaccine level compared to the other types. Conclusions: The Open and Extroverted respondents have the highest willingness to vaccinate. The General and Stable type and Conscientious and Agreeable respondents think that the cost of the vaccine is the most important attribute, and prefer the mildest side effects. The Open and Extroverted type think that vaccine efficacy is the most important attribute, prefer “mild” side effects, and have higher willingness to pay for their favorite vaccine level.