Background: Poor medication adherence remains one of the major problems in the treatment of tuberculosis (TB) patients, while digital technologies have been proven effective to improve the treatment results. However, reports on the effectiveness of comprehensive practice integrating different intervention methods and technologies are limited. The aim of this study is to evaluate the effectiveness of an integrated digital adherence intervention for TB patients. Methods: We developed a digital adherence intervention platform integrating instant WeChat message, electronic medication monitors (EMMs), and manual reminders. The primary goal of the platform was to improve the accessibility of digital adherence technologies, and thus improve treatment adherence. TB patients were newly diagnosed at 10 TB-designated hospitals and came from 220 communities, from January to June 2022. The basic characteristics and treatment adherence of TB patients in WeChat, EMM, and conventional groups were compared, and the influencing factors of high medication adherence were analyzed by logistic regression. Results: A total of 2,498 TB patients were enrolled in the study, 14.5% were managed by digital technologies, 9.5% by WeChat, and 5.0% by EMM, respectively. After intervention, the median medication rate of TB patients was significantly higher in the WeChat group (95.3%) and EMM group (95.7%) compared with that of the conventional group (83.8%). On the contrary, the median number of missed medications among patients of the conventional group (nine times) was significantly higher than that in the WeChat (three times) group and EMM (three times) group. The proportion of high adherence (adherence medication rate ≥90%) among TB patients was 64.7%, 64.5%, and 43.2% in WeChat, EMM, and conventional group, respectively. Conclusions: The application of the integrated digital adherence intervention platform could significantly improve medication adherence among TB patients. The accessibility of digital adherence technologies could be improved by integrating complementary technologies in practice.

ObjectiveThe relationship between body composition and insulin resistance (IR) is controversial. This study aimed to thoroughly examine the correlation between adipose tissue, lean body mass, and IR as evaluated by the Homeostatic Model Assessment (HOMA-IR).MethodsIn this cross-sectional study, we utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2011 and 2018. Our study included 4981 subjects, and we employed multiple linear regression, smoothed curve fitting, threshold, and saturation effect analysis to investigate the relationship between lean body mass, visceral fat mass, and IR. Also, we used the lean body mass to visceral fat ratio (Log LM/VFM) as a proxy variable to analyze its association with IR alone.ResultsThe study discovered a negative link between lean body mass and IR, but the visceral fat mass was positively correlated after correcting for covariates. A negative correlation was observed when the alternative variable Log LM/VFM was analyzed separately for its association with IR. This association was present regardless of whether the exposure variables were analyzed as continuous or categorical. The data analysis revealed a nonlinear relationship between Log LM/VFM and IR, as evidenced by the generalized additive model. In addition, a threshold effect with a critical value of 1.80 and a saturation effect with a critical point of 2.5 were also observed. Further subgroup analysis for sex, age, BMI, active levels, hypertension, and diabetes showed considerable robustness between the relationship of Log LM/VFM and IR.ConclusionMaintaining a proper ratio of lean body mass and visceral fat is beneficial for decreasing IR.

Background Tuberculosis (TB) is a leading infectious cause of morbidity and mortality worldwide. However, delay in health care seeking has remained unacceptably high. The aim of this study was to clarify the trend of patient delay and its associated risk factors during rapid aging and urbanization in Wuhan, China from 2008 to 2017. Methods A total of 63,720 TB patients registered at Wuhan TB Information Management System from January 2008 to December 2017 were included. Long patient delay (LPD) was defined as patient delay longer than 14 days. Independent associations of area and household identity with LPD, as well their interaction effect, were tested by logistic regression models. Results Among 63,720 pulmonary TB patients, 71.3% were males, the mean age was 45.5 ± 18.8 years. The median patient delay was 10 days (IQR, 3–28). A total of 26,360 (41.3%) patients delayed for more than 14 days. The proportion of LPD decreased from 44.8% in 2008 to 38.3% in 2017. Similar trends were observed in all the subgroups by gender, age and household, except for living area. The proportion of LPD decreased from 46.3 to 32.8% in patients living near downtown and increased from 43.2 to 45.2% in patients living far from downtown. Further interaction effect analysis showed that among patients living far from downtown, the risk of LPD for local patients increased with age, while decreased with age for migrant patients. Conclusion Although the overall LPD among pulmonary TB patients declined in the past decade, the extent of reduction varied in different subgroups. The elderly local and young migrant patients living far from downtown are the most vulnerable groups to LPD in Wuhan, China.

Background: Coronavirus disease 2019 (COVID-19) has outbroken in China and subsequently spread worldwide since the end of 2019. Chest computed tomography (CT) plays an important role in the diagnosis of lung diseases, but its value in the diagnosis of cardiac injury remains unknown.Methods: We enrolled 241 consecutive hospitalized patients (aged 61 ± 16 years, 115 males) with laboratory-confirmed COVID-19 at Renmin Hospital of Wuhan University from January 11 to March 2, 2020. They were divided into two groups according to whether major adverse cardiovascular events (MACEs) occurred during the follow-up. The anteroposterior diameter of the left atrium (LAD), the length of the left ventricle (LV), and cardiothoracic ratio (CTR) were measured. The values of myocardial CT were also recorded.Results: Of 241 patients, 115 patients (47.7%) had adverse cardiovascular events. Compared with no MACEs, patients with MACEs were more likely to have bilateral lesions (95.7% vs. 86.5%, p = 0.01). In multivariable analysis, bronchial wall thickening would increase the odds of MACEs by 13.42 (p = 0.01). LAD + LV and CTR was the best predictor for MACEs (area under the curve = 0.88, p < 0.001) with a sensitivity of 82.6% and a specificity of 80.2%. Plasma high-sensitivity troponin I levels in patients with cardiac injury showed a moderate negative correlation with minimum CT value (R2 = −0.636, p < 0.001).Conclusions: Non-contrast chest CT can be a useful modality for detection cardiac injury and provide additional value to predict MACEs in COVID-19 patients.

Background: In November 2017, the American College of Cardiology/American Heart Association (ACC/AHA) updated their definition of hypertension from 140/90 mm Hg to 130/80 mm Hg. Objectives: We sought to assess the situation of hypertension and the impact of applying the new threshold to a geographically and ethnically diverse population. Methods: We analyzed selected data on 237,142 participants aged ≥40 who had blood pressure taken for the 2014 China National Stroke Screening and Prevention Project. Choropleth maps and logistic regression analyses were performed to estimate the prevalence, geographical distribution and risk factors of hypertension using both 2017 ACC/AHA guidelines and 2014 evidence-based guidelines. Results: The present cross-sectional study showed the age- and sex-standardized prevalence of hypertension was 37.08% and 58.52%, respectively, according to 2014 evidence-based guidelines and 2017 ACC/AHA guidelines. The distribution of hypertension and risk factors changed little between guidelines, with data showing a high prevalence of hypertension around Bohai Gulf and in south central coastal areas using either definition. The age- and sex-standardized prevalence of newly labeled as hypertensive was 21.44%. Interestingly, the high prevalence region of newly labeled as hypertensive was found in the north China. Conclusion: The prevalence of hypertension increased significantly on 2017 ACC/AHA guidelines compared to the prevalence when using 2014 evidence-based guidelines, with high prevalence areas of newly labeled as hypertensive now seen mainly in north China. There need to be correspondingly robust efforts to improve health education, health management, and behavioral and lifestyle interventions in the north.

Purpose: While carotid atherosclerosis (CA) biomarkers are valuable surrogates for cardiovascular events, their inadequate utility is highlighted by clinical practice. We performed an interdisciplinary systematic review and bibliometric analysis to identify the knowledge gaps and offer directions for future research. Methods: We applied a comprehensive search strategy to construct a representative dataset of the bibliographic records of CA from 1997 to 2018. A total of 31,793 retrieved articles and 407,473 cited references were included in the analysis. The co-word network and co-citation network were derived to describe the major disciplines and topics of CA research. Milestones detected by burst analysis were reviewed to delineate the evolutionary patterns and emerging trends of research on CA biomarkers. Results: CA is a multidisciplinary field of study which could be divided into 3 communities: the primary prevention of CVD, the secondary prevention of CVD and imaging techniques to characterize carotid atherosclerosis. The evolution of a CA biomarker may go through 3 stages: the conceptualization stage, the validation stage and the reclassification stage. Measurements that include different CA plaque features, rather than separately, have shown greater value for cardiovascular risk or clinical decision-making. Conclusions: Although wide variability exists in the evolutionary stages of CA biomarkers, combined evaluation of CA plaque imaging features shows potential value to improve risk prediction and clinical decision-making for CVD prevention.

Overweight and obesity are associated with increased morbidity and mortality, and a pooled analysis from 16 prospective cohort studies showed that overweight is associated with double the risk of developing cardiometabolic multimorbidity and the risk increases to be more than four times in obese individuals. Another meta-analysis showed that obesity was associated significantly with higher all-cause mortality. In addition, a cohort study based on the large national registry in London also showed that obesity could increase the risk of sudden cardiac death such as sudden arrhythmic death syndrome, and the prevalence of critical and noncritical coronary artery disease was significantly higher in obese individuals (23% vs. 10% in non-obese individuals, P< 0.001). In China, rapid economic growth has led to changes in dietary and physical activity patterns, especially in the past two decades, which in turn have led to an increase in obesity and overweight prevalence. Fortunately, it is well established that appropriate control of obesity through lifestyle changes could result in a significant reduction in cardiovascular morbidity and mortality. Therefore, ongoing reliable estimations are necessary to plan effective national prevention for obesity management. Although a few studies were available to estimate the prevalence of obesity and overweight, the data from different studies were conducted in different areas or population. Only one study based on the China Health and Nutrition Surveys (CHNS) described the secular trends in general and abdominal obesity among Chinese adults from 1993 to 2009, and another two studies estimated the prevalence and trends of abdominal obesity. 12 A recent publication reported the prevalence of obesity and overweight in different ethnic groups aged 15–49 years in rural areas in China. However, few studies were conducted among middle-aged and elderly adults, who have a higher risk of chronic diseases such as hypertension and diabetes. Therefore, obtaining more accurate and comprehensive estimates of obesity and overweight is crucial for evidence-based and ethnic-specific planning and an evaluation of the currently implemented treatment strategies. The purpose of this study is to provide the most recent national estimates of obesity and overweight among Chinese adults aged 40 years and above according to the China National Stroke Screening and Prevention Project Study (CNSSPP) survey, which was carried out in 30 provinces (excluded Tibet) in China from October 2014 to November 2015 and the details have been described in previous study. Excluding 61 individuals due to missing information on height and weight, a total of 726,390 participants were included in the present study. The mean age and body mass index (BMI) was 57.2 (standard deviation

ObjectivesTo assess the relationship between metabolic syndrome (MetS) and its components and cardiovascular disease (CVD) according to different criteria of MetS, as well as whether the estimated association between MetS and CVD was affected by different definitions of MetS among the Chinese population.DesignPopulation-based, cross-sectional study.SettingData were from a large-scale national stroke screening survey, China National Stroke Screening and Prevention Project.ParticipantsA nationally representative sample of 109 551 Chinese adults aged ≥40 years in 2014–2015 were included.Primary outcome measuresCVD conditions (stroke, coronary heart disease (CHD) and atrial fibrillation (AF)) diagnosed by clinicians were self-reported.ResultsORs after adjusting for CHD, stroke, AF and CVD in those with MetS using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criterion were 1.56 (95% CI 1.48 to 1.63), 1.23 (95% CI 1.17 to 1.30), 1.14 (95% CI 1.08 to 1.21) and 1.40 (95% CI 1.35 to 1.45); 1.51 (95% CI 1.44 to 1.58), 1.20 (95% CI 1.14 to 1.26), 1.09 (95% CI 1.04 to 1.15) and 1.34 (95% CI 1.29 to 1.38) with the American Heart Association/National Heart, Lung, and Blood Institute criterion; and 1.41 (95% CI 1.35 to 1.48), 1.24 (95% CI 1.19 to 1.30), 1.12 (95% CI 1.06 to 1.18) and 1.31 (95% CI 1.27 to 1.35) with the International Diabetes Federation criterion, respectively. Elevated blood pressures were all highly related to the prevalence of stroke and AF, and reduced high-density lipoprotein-cholesterol was associated with a higher OR for CHD than other individual components of MetS.ConclusionsMetS is significantly associated with CVD, and the prevalence of CVD was more evident when MetS was defined according to the NCEP ATP III criterion. Developing effective public health strategies for the prevention, detection and treatment of MetS should be an urgent priority to reduce the burden of CVD in China.

The metabolic syndrome (MetS) is related with cardiovascular disease. However, its relationship with diabetes mellitus (DM) has not been examined in Chinese population with a larger sample. We aimed to assess the relationship between metabolic syndrome (MetS) and its components, and DM, and to determine the best one from the available definitions of Mets when assessing the risk of DM. This was a cross-sectional survey in a nationally representative sample of 109,551 Chinese adults aged ≥40 years in 2014–15. MetS was defined according to three criteria including the updated International Diabetes Federation (IDF) criterion, the National Cholesterol Education Program Third Adult Treatment Panel (NCEP ATP III) criterion and American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criterion. Logistic regression models were used to estimate the odds of DM. MetS as defined by three criteria including IDF, NCEP ATP III,and AHA/NHLBI all increased the prevalence of DM, and the adjusted ORs with 95% CI was more higher using NCEP ATP III (3.65, 3.52–3.79) than IDF (2.50, 2.41–2.60) and AHA/NHLBI (3.03, 2.92–3.24). The odds of DM was highest in hyperglycemia with cut-off glucose≥6.1 mmol/L (14.55, 13.97–15.16), and other components were also associated significantly with DM. There was heterogeneity for OR of DM associated with various trait combinations. The NCEP ATPIII MetS definition may be more suitable for assessment of DM risk in Chinese population. Hyperglycemia, as previous study reported, are important risk factors of DM. Besides, other traits of Mets are also significantly associated with DM and should therefore be of greater concern.

BackgroundCarotid atherosclerosis (CA) is a reflector of generalized atherosclerosis that is associated with systemic vascular disease. Data are limited on the epidemiology of carotid lesions in a large, nationally representative population sample. We aimed to evaluate the prevalence of CA detected by carotid ultrasonography and related risk factors based on a national survey in China. Methods and ResultsA total of 107 095 residents aged ≥40 years from the China National Stroke Prevention Project underwent carotid ultrasound examination. Participants with carotid endarterectomy or carotid stenting and those with stroke or coronary heart disease were excluded. Data from 84 880 participants were included in the analysis. CA was defined as increased intima–media thickness (IMT) ≥1 mm or presence of plaques. Of the 84 880 participants, 46.4% were men, and the mean age was 60.7±10.3 years. The standardized prevalence of CA was 36.2% overall, increased with age, and was higher in men than in women. Prevalence of CA was higher among participants living in rural areas than in urban areas. Approximately 26.5% of participants had increased IMT, and 13.9% presented plaques. There was an age‐related increase in participants with increased IMT, plaque presence, and stenosis. In multiple logistic regression analysis, older age, male sex, residence in rural areas, smoking, alcohol consumption, physical inactivity, obesity, hypertension, diabetes mellitus, and dyslipidemia were associated with CA. ConclusionsCA was highly prevalent in a middle‐aged and older Chinese population. This result shows the potential clinical importance of focusing on primary prevention of atherosclerosis progression.

BACKGROUND:Metabolic syndrome (MetS) is a cluster of major risk factors for cardiovascular diseases. We aimed to estimate prevalence and distribution of MetS among middle-aged and elderly adults in China. METHODS:The present analysis used data from a national study in 2014-2015. We defined MetS by different definitions, and compared results of the present study and previous nationally representative studies to illustrate possible temporal changes in MetS prevalence. RESULTS:The estimated prevalence of MetS was 18.4% by the ATP III criteria, 34.0% by the revised ATP III criteria, and 26.9% by IDF criteria. The prevalence was higher in women, older adults, those with lower education level, and in economically developed regions. Contrasting with previous national studies, adults in urban areas had a lower rate of MetS than those in rural areas (odds ratio 0.94; 95% CI 0.92-0.97). Rural adults had worse deterioration or less improvement in abdominal obesity, overweight, hypertension, and high fasting plasma glucose, than urban adults, which was particularly striking for women. CONCLUSION:While measures to prevent and control cardiovascular diseases need to be strengthened in China, rapid increasing risk factors among rural residents and women should be prioritized in making public health policy decisions. KEY MESSAGES Our study assessed prevalence and temporal changes of MetS among Chinese population with the most recently completed and the largest sample size. The current prevalence of MetS was higher in women, older adults, those with lower education level, and in economically developed regions and the CVD risk factors among rural residents and women should be prioritised in making public health policy decisions. A comparison of results of the present study and previous national studies showed that rural adults had worse deterioration or less improvement in abdominal obesity, overweight, hypertension, and high fasting plasma glucose, than urban adults, which was particularly striking for women.

Background: The American Heart Association concluded that waist circumference was a better predictor of blood pressure risk than BMI in Asians. However, data are inconsistent and information in Chinese, the largest global population group, is limited. Methods: Data was obtained from the Chinese National Stroke Prevention Project Survey of a nationally representative sample of middle-aged and older Chinese adults. A total of 135 825 individuals not taking any antihypertensive drugs were included in this study. Multiple linear regression analyses were conducted to examine the association between blood pressure and parameters of general adiposity, including BMI, height-adjusted weight, and parameters of central adiposity, including waist circumference, hip circumference, waist-hip ratio, and waist-height ratio. Results were shown as mean difference in blood pressure associated with one standard deviation higher level of adiposity. Results: The overall means +/- standard deviation of BMI and waist circumference were 24.3 +/- 3.18 kg/m(2) and 84.0 +/- 8.88 cm, respectively. BMI seemed more strongly associated with SBP/DBP (4.22 mmHg/SD; 2.60 mmHg/SD) than central adiposity markers. In addition, there were sex differences. For men, waist circumference showed a stronger association with SBP/DBP than BMI (4.04 vs. 3.79, P<0.05; 2.26 vs. 2.13, P<0.05). For women, BMI was more closely related to SBP/DBP than central adiposity parameters, such as waist circumference (4.59 vs. 3.41, P<0.05; 2.98 vs. 2.24, P<0.05). Additionally, in both urban and rural areas, waist circumference was mostly associated with SBP/DBP among men, whereas it was BMI among women. Conclusion: Compared with central adiposity, blood pressure is more strongly associated with general adiposity in Chinese adults. Interestingly, there are significant sex differences in the relationship of blood pressure with general and central adiposity. Waist circumference is the strongest predictor for men but suboptimal for women, and BMI tend to a better predictor of blood pressure for women. In addition, our results for men are consistent with the recommendation of the American Heart Association in 2015 that waist circumference could be used for assessing the risk of blood pressure.

BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. This study aimed to estimate the prevalence of AF in different socioeconomic regions of China and identify its association with stroke, through a national survey.MethodsThe study included 726,451 adults aged ≥40 years who were participants of the China National Stroke Screening and Prevention Project, a nationally representative cross-sectional study. Stepwise logistic regression analyses were conducted to investigate the association between AF and stroke.ResultsThe overall standardized prevalence rate of AF was 2.31%. The prevalence of AF was highest in high-income regions (2.54%), followed by middle-income regions (2.33%), and lowest in low-income regions (1.98%). Women had a higher prevalence of AF than men in all regions (low-income regions, 2.30% vs 1.65%; middle-income regions, 2.78% vs 1.89%; and high-income regions, 2.96% vs 2.12%). Compared with urban residents, the prevalence of AF among rural residents was higher in low- (2.03% vs 1.91%) and middle-income regions (2.69% vs 1.90%), but lower in high-income regions (2.44% vs 2.58%). Participants with AF were more likely to have a stroke than those without AF (9.48% vs 2.26%). After adjusting for age, sex, location, overweight or obese, smoking, drinking, physical inactivity, hypertension, diabetes, dyslipidemia, and a family history of stroke, results showed that AF was significantly associated with stroke.ConclusionsThe prevalence of AF has increased in recent years, and it was positively correlated with socioeconomic status, sex (women), location (rural areas), and stroke.

An increasing number of original studies suggest that exposure to shift work could be associated with the risk of overweight and obesity, but the results remain conflicted and inconclusive. This study aimed to quantitatively synthesize available epidemiological evidence on the association between shift work and the risk of overweight and obesity by a meta-analysis.The authors searched PubMed, Embase and the reference lists of all included studies up to April 2017, with a verification search in December 2017. Inclusion criteria were original studies that reported odds ratios, relative risks or hazard ratios (ORs, RRs or HRs, respectively) of at least one outcome of overweight or obesity. Summary risk estimates were calculated by random-effect models.Twenty-six studies (7 cohort studies, 18 cross-sectional studies and 1 case-control study) involving 311 334 participants were identified. Among these studies, the cut-off points of overweight and obesity varied greatly, so the heterogeneity was substantial; however, the results were stable. Shift work was found to be positively associated with the risk of overweight [RR: 1.25; 95% confidence interval (95% CI): 1.08-1.44] and obesity (RR: 1.17; 95% CI: 1.12-1.22).Individuals involved in shift work are more likely to become overweight or obese. Appropriate preventive interventions in the organization of shift schedules according to ergonomic criteria would allow shift workers to avoid potential health impairment.

Background: In November 2017, the American College of Cardiology/American Heart Association (ACC/AHA) updated their definition of hypertension from 140/90 mm Hg to 130/80 mm Hg. We sought to assess the situation of hypertension and the appropriateness of applying the new threshold to a geographically and ethnically diverse population.

Data presented in this article are supplementary material to our research article entitled " Prevalence of Atrial Fibrillation in Different Socioeconomic Regions of China and Its Association with Stroke: Results from a National Stroke Screening Survey" (Wang et al., 2018) [1]. This data article summarizes previous studies of Atrial Fibrillation (AF) prevalence in China, and estimates the association between AF and stroke in different socioeconomic regions of China through a national survey.

Background: An increasing number of original studies suggest that exposure to shift work could be associated with the risk of overweight and obesity, but the results remain conflicted and inconclusive. This study aimed to quantitatively synthesize available epidemiological evidence on the association between shift work and the risk of overweight and obesity by a meta-analysis.Methods: The authors searched PubMed, Embase and the reference lists of all included studies up to April 2017, with a verification search in December 2017. Inclusion criteria were original studies that reported odds ratios, relative risks or hazard ratios (ORs, RRs or HRs, respectively) of at least one outcome of overweight or obesity. Summary risk estimates were calculated by random-effect models.Results: Twenty-six studies (7 cohort studies, 18 cross-sectional studies and 1 case-control study) involving 311 334 participants were identified. Among these studies, the cut-off points of overweight and obesity varied greatly, so the heterogeneity was substantial; however, the results were stable. Shift work was found to be positively associated with the risk of overweight [RR: 1.25; 95% confidence interval (95% CI): 1.08-1.44] and obesity (RR: 1.17; 95% CI: 1.12-1.22).Conclusions: Individuals involved in shift work are more likely to become overweight or obese. Appropriate preventive interventions in the organization of shift schedules according to ergonomic criteria would allow shift workers to avoid potential health impairment.

BackgroundRabies is invariably a fatal disease. Appropriate wound treatment and prompt rabies post-exposure prophylaxis (PEP) are of great importance to rabies prevention. The objective of this study was to investigate the prevalence and influencing factors of improper wound treatment and delay of rabies PEP after an animal bite in Wuhan, China.MethodologyThis cross-sectional study was conducted among animal bite victims visiting rabies prevention clinics (RPCs). We selected respondents by a multistage sampling technique. A face-to-face interview was conducted to investigate whether the wound was treated properly and the time disparity between injury and attendance to the RPCs. Determinants of improper wound treatment and delay of rabies PEP were identified by a stepwise multivariate logistic regression analysis.Principal findingsIn total, 1,015 animal bite victims (564 women and 451 men) responded to the questionnaire, and the response rate was 93.98%. Overall, 81.2% of animal bite victims treated their wounds improperly after suspected rabies exposure, and 35.3% of animal bite victims delayed the initiation of PEP. Males (OR = 1.871, 95% CI: 1.318-2.656), residents without college education (OR = 1.698, 95% CI: 1.203-2.396), participants liking to play with animals (OR = 1.554, 95% CI: 1.089-2.216), and people who knew the fatality of rabies (OR = 1.577, 95% CI: 1.096-2.270), were more likely to treat wounds improperly after an animal bite. Patients aged 15-44 years (OR = 2.324, 95% CI: 1.457-3.707), who were bitten or scratched by a domestic animal (OR = 1.696, 95% CI: 1.103-2.608) and people who knew the incubation period of rabies (OR = 1.844, 95% CI: 1.279-2.659) were inclined to delay the initiation of PEP.ConclusionsOur investigation shows that improper wound treatment and delayed PEP is common among animal bite victims, although RPCs is in close proximity and PEP is affordable. The lack of knowledge and poor awareness might be the main reason for improper PEP. Educational programs and awareness raising campaigns should be a priority to prevent rabies, especially targeting males, the less educated and those aged 15-44 years.

College students are the backbone of the current and future social development, so it is the bounden duty of colleges and universities to cultivate college students' innovation spirit and innovation capacity. As an important part of colleges and universities, independent colleges bear the responsibility and task of cultivating application-oriented talents for higher education, so it is particularly important to research how to improve the innovative practical ability of students at independent colleges so as to better cultivate application-oriented innovation talents.