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The current study examined the mediating role of perceived risk of COVID-19 and the moderating role of hope in the relationship between intolerance of uncertainty and job-seeking anxiety. 812 advanced undergraduate students participated in this investigation (M[subscript age] = 21.95, SD[subscript age] = 1.37; 69% female). Results indicated that intolerance of uncertainty is positively linked to job-seeking anxiety. Perceived risk of COVID-19 mediated the relationship between intolerance of uncertainty and job-seeking anxiety. Hope moderated the direct path and the indirect path from perceived risk of COVID-19 to job-seeking anxiety. Specifically, the relationship between intolerance of uncertainty and job-seeking anxiety became weaker for high-hope students. The results indicated that intolerance of uncertainty and perceived risk of COVID-19 serves as risk factors, while hope serves as a protective factor for job-seeking anxiety. Interventions, which reduce these two risk factors and increase this protective factor, might help to protect advanced undergraduate students from job-seeking anxiety.

Different from the objective risk of self-financed study-abroad behavior, the perceived risk thereof is the basis for individuals to assess the educational consumption risk from their own points of view. The perceived risk in self-financed study-abroad behavior falls into seven aspects, i.e., economic risk, functional risk, completion risk, cultural risk, psychological risk, health risk and safety risk. Individuals' perception of these types of risk is influenced by variables such as gender, education, personal experiences, family environment, etc. For students at school, completion risk, health risk and safety risk are the main factors that affect their risk assessment of studying abroad. The main consequences and hidden dangers of risk perception and assessment of studying abroad are: (1) the economic risk is not paid enough attention; (2) the risk assessment is biased; and (3) studying abroad at a younger age faces grave hidden danger. These problems are caused by the difference between perceived risk and objective risk; the dislocation between perceived risk and risk assessment; and the lack of comprehensiveness throughout the process of risk assessment.

This study examines the international risks faced by multinational enterprises to understand their impact on the evaluation of investment projects. Moreover, it establishes a 'three-dimensional' theoretical framework of risk identification to analyse the composition of international risk indicators of multinational enterprises based on the theory of an enterprise's international development path and stages as well as risk management. Using entropy weights and net present value (NPV), this study employs survey data to empirically analyse the international risk entropy evaluation model and then test the NPV evaluation model based on risk adjustment. A significant difference is found between the evaluation process of multinationals' international investment benefits with and without considering the risk factors. This study concludes that the results of the risk-adjusted NPV model are more scientific and effective than that of the traditional NPV model as the basis of decision-making. It contributes to the theoretical literature by proposing the international risk entropy model and constructing the risk-adjusted NPV model to test the impact of international risk factors on the evaluation of international investment projects. This provides a reference to multinationals in their choice of investment projects as well as to researchers in this field.

Objectives: Temporomandibular disorders (TMDs) have a relatively high prevalence among university students. This study aimed to identify independent risk factors for TMD in university students and develop an effective risk prediction model. Methods: This study included 1,122 university students from four universities in Changchun City, Jilin Province, as subjects. Predictive factors were screened by using the least absolute shrinkage and selection operator (LASSO) regression and the machine learning Boruta algorithm in the training cohort. A multifactorial logistic regression analysis was used to construct a TMD risk prediction model. Internal validation of the model was conducted via bootstrap resampling, and an external validation cohort comprised 205 university students undergoing oral examinations at the Stomatological Hospital of Jilin University. Results: The prevalence of TMD among university students was 44.30%. Ten predictive factors were included in the model, comprising gender, facial cold stimulation, unilateral chewing, biting hard or resilient foods, clenching teeth, grinding teeth, excessive mouth opening, malocclusion, stress, and anxiety. The model demonstrated good predictive ability with area under the receiver operating characteristic curve (AUC) values of 0.853, 0.838, and 0.821 in the training cohort, internal validation cohort, and external validation cohort, respectively. The calibration curves demonstrated that the predicted results were consistent with the actual results, and the decision curve analysis (DCA) indicated the model's high clinical utility. Conclusions: An online nomogram of TMD in university students with good predictive performance was constructed, which can effectively predict the risk of TMD in university students. The model provides a useful tool for the early identification and treatment of TMDs in university students, helping clinicians to predict the probability of TMDs in each patient, thus providing more personalized and accurate treatment decisions for patients. [ABSTRACT FROM AUTHOR]

Background: Existing research indicates that the Mediterranean diet has a positive impact on preventing and treating hypertension. However, its specific effect on hypertension among elderly Chinese individuals is unclear. Aims: The objective of this research was to explore the association between the Chinese version of the Mediterranean-DASH Intervention for Neurodegenerative Delay (cMIND) diet and hypertension among elderly Chinese individuals, aiming to offer novel strategies for alleviating the burden of hypertension in this demographic. Methods: In this study, we used cross-sectional data published in 2018 by the China Longitudinal Health and Longevity Survey (CLHLS) to develop a binary logistic regression model to investigate the correlation between cMIND diet and hypertension in a Chinese elderly population. Restricted cubic spline was used to test for linear associations, and further subgroup analyses were performed to test for interactions. Results: In total, 7,103 older adults were included in the study, with a prevalence of hypertension of 39.0%. When the cMIND diet score was used as a continuous variable, a significant protective effect against hypertension was present (OR = 0.955, 95% CI:0.923–0.988, p = 0.008); when used as a categorical variable, this protective effect was still present at higher levels (compared to lower levels) of the cMIND diet (OR = 0.869, 95% CI: 0.760–0.995, p = 0.042). Discussion: Although the Mediterranean diet has great potential to reduce the chance of hypertension, it should also consider the effect on the Chinese population. The results of this study provide new ways to reduce the disease burden of hypertension in Chinese older adults and improve quality of life in later life. Conclusion: The cMIND diet can considerably reduce the risk of hypertension among older adults in China. [ABSTRACT FROM AUTHOR]

Background: Patients with gastric cancer (GC) who underwent radical surgery require long-term follow-up (usually 5 years). The purpose of this study was to explore individualized follow-up strategies for patients with GC. Methods: This is a retrospective cohort study that established a clinicopathologic database of patients who underwent gastrectomy from January 2010 to December 2020 at Ningbo No. 2 Hospital. Follow-up was performed until March 2023. The rate of new-onset recurrence of patients with GC was explored annually according to different pTNM stages, defining a recurrence rate of less than 1% as adequate follow-up time. Results: Of the 1606 patients who were eligible, the total number of patients who completed the 5- and 10-year follow-up was 1107 and 586, respectively. A total of 444 cases were diagnosed with recurrence. The recurrence rate for stage IA patients was consistently less than 1% during the follow-up time. The adequate follow-up time (the rate of new-onset recurrence less than 1%) was 5 years for stage IB and IIA patients, and 8 years for stage IIB and IIIA patients, respectively. In contrast, stage IIIB patients were always at risk of recurrence during the follow-up time (>1%). Time to a new recurrence rate for stage IIIC patients was 6 years. Conclusion: Among patients who underwent radical gastrectomy, the rate of new-onset recurrence varied among patients with different pTNM stages. This study suggests that the follow-up of GC can be individualized and refer to pTNM stage. [ABSTRACT FROM AUTHOR]

Background: Carboxylesterase 1(CES1) is expressed mainly in the liver and adipose tissue and is highly hypothesized to play an essential role in metabolism. Our study aimed to investigate the association between CES1 and metabolic syndrome (MetS) and metabolic dysfunction associated steatotic liver disease (MASLD) in children with obesity in China. Methods: This study included 72 children with obesity aged 6-13years (including 25(35%) diagnosed as MetS and 36(50%) diagnosed as MASLD). All subjects were measured in anthropometry, serum level of biochemical parameters related to obesity, circumstance levels of insulin-like growth factor1, adipokines (adiponectin, leptin and growth differentiation factor 15) and CES1. Results: Higher serum CES1 level were found in the MetS group (P = 0.004) and the MASLD group (P < 0.001) of children with obesity. Serum CES1 levels were positively correlated with alanine aminotransferase, aspartate aminotransferase, triglyceride, cholesterol, low-density lipoprotein cholesterol, GDF15, Leptin and negatively correlated with high-density lipoprotein cholesterol, adiponectin and IGF1. We also found a multivariable logistic regression analysis of MASLD and MetS predicted by CES1 significantly (MASLD P < 0.01, MetS P < 0.05). The combination of CES1, sex, age and BMI Z-score showed a sensitivity and specificity of 92.7% for the identification of MASLD and 78.6% for the identification of MetS. The cutoff for CES1 of MASLD is 56.30 ng/mL and of MetS is 97.79 ng/mL. Conclusions: CES1 is associated with an increasing risk of MetS and MASLD and can be established as a biomarker for metabolic syndrome and MASLD of children with obesity. [ABSTRACT FROM AUTHOR]

The sudden inrush of water poses a serious threat to the safety of workers during tunnel construction in the karst region of southwest China. To mitigate this risk, a model is proposed to assess the risk of water surge through a tunnel by combining improved game theory with uncertainty measure theory. Eight indicators of risk were extracted based on the solubility of rock, its geological structure, capacity for surface catchment, and hydrogeological factors, and were incorporated into the proposed model. The subjective weights of these indicators were obtained using the analytic hierarchy process, while their objective weights were calculated through the entropy weighting method and the criteria importance through intercriteria correlation method. An improved game theory-based method of combinatorial weighting was then used to construct the corresponding weight vectors. Single-indicator measurement functions and multi-indicator measurement matrices were utilized to classify and evaluate the indicators of the risk of a surge in water level based on a confidence criterion. The proposed method was applied to five typical karst sections of the Yanjin Tunnel of the Chongqing–Kunming High-speed Railway Project, and the method was validated by comparing the recorded and estimated inflow volume ranges during the project's construction, showing consistency with the actual evaluation results. This proposed model thus offers a practical tool for assessing the risk of water inrush in karst tunnels. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the correlation between thyroid function and urinary iodine/creatinine ratio (UI/Cr) in pregnant women during different trimesters and explored potential influencing factors. Methods: In this cross-sectional study, serum levels of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), and UI/Cr were measured in 450 pregnant women. Correlations were analyzed using Pearson's correlation coefficient and multiple linear regression. Subgroup analyses were performed based on age, body mass index (BMI), parity, gestational age, education, occupation, and family history of thyroid disorders. Results: UI/Cr was positively correlated with FT4 levels in the first and second trimesters, particularly in women with older age, higher BMI, multiparity, higher education, and employment. No significant correlations were found between UI/Cr and TSH or FT3 levels. Conclusion: UI/Cr is positively correlated with FT4 levels in early pregnancy, especially in women with certain risk factors. Regular monitoring of iodine status and thyroid function is recommended for pregnant women to ensure optimal maternal and fetal health. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the association between malnutrition and early childhood caries (ECC) and caries activity among children aged 3–5 years, in order to provide a theoretical basis for preventing and blocking ECC and improving malnutrition. Methods: Children aged 3–5 years from six kindergartens in Zhao Xian, China were enrolled in this study. The decayed, missing, filled teeth (dmft) of all children were examined and recorded. The Cariostat method was used to detect dental caries activity, collect anthropometric data and measure haemoglobin concentration. Parents were asked to complete a questionnaire on the general characteristics and oral health behaviour of the participants. The "Growth Standards for Chinese Children Under 7 Years Old" was used to assess the nutritional status of all participating children. Wilcoxon rank sum test and multivariate logistic regression analysis were used to analyse and evaluate the relationship between ECC, caries activity and malnutrition. Results: A total of 635 children who met the criteria were included in this study. After adjusting for confounding factors, logistic regression showed that the risk of ECC was significantly increased in underweight children compared with normal children (OR = 5.43, P < 0. 05); compared with normal children, the risk of ECC decreased in overweight and obese children (OR = 0.31, P < 0.001); underweight children had higher caries severity than normal weight children, and the difference was statistically significant (OR = 2.69, P < 0. 05); stunted children had higher caries severity than normal weight children and the difference was statistically significant (OR = 2.28, P < 0.05); underweight was positively associated with caries activity and the association was statistically significant (OR = 2.33, P < 0. 05); stunting was positively associated with caries activity and the association was statistically significant (OR = 2.1, P < 0.05); overweight and obesity were negatively associated with caries activity and the association was statistically significant (OR = 0.61, P < 0.05). Conclusions: The risk of ECC among children aged 3–5 years was positively associated with undernutrition and negatively associated with overnutrition. The severity of ECC among children aged 3–5 years was positively associated with undernutrition. The caries activity among children aged 3–5 years was positively associated with undernutrition and negatively associated with overnutrition. [ABSTRACT FROM AUTHOR]

Introduction: Adiponectin is a factor secreted by adipocytes and has been shown to play an important role in many physiological and pathological processes. Previous studies have shown that adiponectin levels are closely related to the occurrence and prognosis of ischemic stroke, but the results of different studies are conflicting. Therefore, this study aimed to update the data in this area to explore the relationship between adiponectin levels and the occurrence and prognosis of ischemic stroke. Results: After searching 762 records, 14 studies were finally included, including 10 studies on the incidence of ischemic stroke and 4 studies on the prognosis of patients with ischemic stroke. The results of Meta-analysis showed that the correlation between the level of adiponectin and the occurrence and prognosis of ischemic stroke was not significant. The risk of ischemic stroke was not significantly changed in the population with high adiponectin levels (pooled RR=1.00, 95% CI=0.86-1.16, P=1.00). Similarly, there was no significant difference in all-cause mortality among those with high adiponectin levels compared with ischemic stroke patients with low adiponectin levels (pooled RR 0.61, 95% CI 0.47-0.80). However, significant heterogeneity was found during the meta-analysis, P<0.0001; I2=72% and P<0.0001; I2=88%, respectively. Subgroup analysis showed that factors such as study design, follow-up time and publication time could partly explain this heterogeneity. Conclusions: In conclusion, adiponectin level is not significantly correlated with the occurrence and prognosis of ischemic stroke, suggesting that adiponectin level may not be used as a potential biomarker for ischemic stroke risk assessment and patient prognosis prediction. [ABSTRACT FROM AUTHOR]

Objectives Mild cognitive impairment (MCI) is a unique indicator of underlying distress that may be strongly associated with suicide risk. Despite this, to date, no study has examined the association between MCI and suicidal ideation. Therefore, the present study aimed to examine the association between MCI and suicidal ideation among adults aged ≥65 years from 6 low- and middle-income countries (LMICs; China, Ghana, India, Mexico, Russia, and South Africa). Methods Cross-sectional, nationally representative data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Self-reported information on past 12-month suicidal ideation was collected. Multivariable logistic regression and meta-analysis were conducted to assess associations. Results Data on 13,623 individuals aged ≥65 years were analyzed. The prevalence of suicidal ideation ranged from 0.5% in China to 6.0% in India, whereas the range of the prevalence of MCI was 9.7% (Ghana) to 26.4% (China). After adjustment for potential confounders, MCI was significantly associated with 1.66 (95% confidence interval [95% CI] = 1.12–2.46) times higher odds for suicidal ideation. Discussion Mild cognitive impairment was significantly associated with higher odds for suicidal ideation among older adults in LMICs. Future longitudinal studies from LMICs are necessary to assess whether MCI is a risk factor for suicidal ideation. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to assess the impacts of China's health insurance integration reform on frailty among rural older adults. Methods Nationally representative longitudinal data with 2,751 adults aged ≥60 years were analyzed from the China Health and Retirement Longitudinal Study 2011–2015. The integration of the rural New Cooperative Medical Scheme and urban Resident Basic Medical Insurance into the unified Urban and Rural Resident Basic Medical Insurance (URRBMI). Frailty Index (FI) summarizes 32 health deficits, quantifying frailty severity with a range of 0–1. Frailty is defined as FI ≥ 0.25, prefrailty as FI: 0.10–0.25, and robustness as FI < 0.10. Frailty worsening, stability, and improvement from 2011 to 2015 were assessed. Difference-in-differences and propensity score matched difference-in-differences models assessed URRBMI integration effects on frailty severity and risk (FI ≥ 0.25) among rural older adults. Results URRBMI integration significantly reduced frailty severity by 15.16% and risk by 9.60% points among rural older adults. Reductions were greatest among initially prefrail individuals, with 27.49% lower frailty severity and a 17.62% point reduction in subsequent frailty onset risk after URRBMI integration. In contrast, no significant benefits were observed for initially robust or frail subgroups following integration. Analyses of frailty transitions corroborated selective benefits, with URRBMI integration lowering the risks of worsening frailty among prefrail but no significant reversal of frailty status among those initially frail or prefrail. Discussion China's URRBMI integration selectively ameliorated frailty progression among rural older adults with prefrail status. Targeting integrated medical insurance policies toward high-risk populations may optimize frailty prevention effects. [ABSTRACT FROM AUTHOR]

Background: Unsafe sex is recognized as an important risk factor for cervical cancer (CC). Understanding the global disease burden of CC attributable to unsafe sex can assist policymakers in allocating healthcare resources. Methods: Data were obtained from the 2019 global burden of disease database (GBD). We examined global, regional, and national levels of CC mortality, disability‐adjusted life years (DALYs), and age‐standardized rates (ASRs) caused by unsafe sex. ASRs were evaluated using estimated annual percentage changes (EAPCs). Results: Attributable to unsafe sex, there were 280,479 CC‐related deaths in 2019 and 8,955,013 CC‐related DALYs. In the period 1990–2019, the global ASRs of CC due to unsafe sex decreased around the world; for age‐standardized mortality rate (ASMR) and age‐standardized DALY rate (ASDR), the EAPCs were −0.93 and −0.95. The highest ASMRs and ASDRs were found in central sub‐Saharan Africa and the lowest in Australasia. Conclusion: In the past few decades, the ASMR and ASDR of CC caused by unsafe sexual practices have decreased over time, with significant variations observed among different countries and regions. Increased focus is needed on spreading awareness about sexual health and promoting CC prevention and screening, particularly in low‐ and middle‐income nations. [ABSTRACT FROM AUTHOR]

Prior research has observed reciprocal associations between sleep and mood. However, these findings are primarily based on the examination of one or two aspects of sleep behaviors (e.g., duration, quality), neglecting how multiple dimensions of sleep (particularly indicators pertinent to adolescence, e.g., sleep variability) are linked to adolescent mood both daily and longitudinally. Drawing on a multidimensional framework for sleep, this study addressed the knowledge gap by examining the directionality of and differential effects for associations between multiple dimensions of sleep and mood during early adolescence. Participants were 273 Chinese early adolescents (34.39% girls; Mage = 11.57, SD = 1.31), who filled out a pre-survey on demographics (T1) and 7-day diaries on sleep (i.e., duration, quality, disturbance, and latency) and mood (i.e., positive and negative mood). Adolescents completed another wave of diary reports 1 year later (T2). Findings revealed both bidirectional and unidirectional, within-person effects depending on specific sleep parameters, suggesting differential associations between multiple dimensions of sleep and mood. Specifically, on days when adolescents had longer sleep latency and greater disturbance than usual, they reported higher negative mood the next day, whereas higher negative mood was linked to poorer sleep quality the next day. The longitudinal investigation found that greater variability in sleep quality at T1 was associated with higher negative mood at T2. These findings underscore the importance of understanding the complex interplay between sleep and mood by examining the directionality of and differential effects for the daily and longer-term associations between multiple dimensions of sleep and mood among early adolescents. [ABSTRACT FROM AUTHOR]

Depression is a common health issue among college students, and its prevalence has been increasing in recent years. Numerous studies have indicated that experiences of childhood abuse may be a contributing factor to the development of depression. However, the underlying mechanism in this relationship remains unclear. The current study aimed to investigate the mediating effect of regulatory emotional self-efficacy in the relationship between childhood abuse and depression and to identify the moderating effect of subjective social status. A cross-sectional study was conducted with 1105 college students from several universities in Sichuan Province, China. A survey questionnaire was employed to collect information on childhood abuse, subjective social status, regulatory emotional self-efficacy, and depression. Pearson correlation analysis was used to explore the correlation between childhood abuse and depression. The bootstrap method was employed to test the mediating effect of regulatory emotional self-efficacy and the moderating effect of subjective social status. The results showed that childhood abuse was significantly positively correlated with depression (p < 0.001), regulatory emotional self-efficacy mediated the relationship between childhood abuse and depression, and subjective social status moderated the mediating path. Childhood abuse could affect depression by reducing subjective social status and regulatory emotional self-efficacy. These findings indicated that enhancing regulatory emotional self-efficacy and subjective social status may prevent or reduce depressive symptoms in college students, especially in those with left-behind experiences. [ABSTRACT FROM AUTHOR]

Background: The safety and efficacy of robotic liver resection (RLR) for patients with hepatocellular carcinoma (HCC) have been reported worldwide. However, the exact role of RLR in HCC patients with liver cirrhosis is not sufficiently determined. Methods: We conducted a retrospective study on consecutive patients with cirrhosis or non-cirrhosis who received RLR for HCC from 2018 to 2023. Data on patients' demographics and perioperative outcomes were collected and analyzed. Propensity score matching (PSM) analysis was performed. Multivariate logistic regression analysis was performed to determine the risk factors of prolonged postoperative length of stay (LOS) and morbidity. Results: Of the 571 patients included, 364 (64%) had cirrhosis. Among the cirrhotic patients, 48 (13%) were classified as Child–Pugh B. After PSM, the cirrhosis and non-cirrhosis group (n = 183) had similar operative time, estimated blood loss, postoperative blood transfusion, LOS, overall morbidity (p > 0.05). In addition, the intraoperative and postoperative outcomes were similar between the two groups in the subgroup analyses of patients with tumor size ≥ 5 cm, major hepatectomy, and high/expert IWATE difficulty grade. However, patients with Child–Pugh B cirrhosis had longer LOS and more overall morbidity than that of Child–Pugh A. Child–Pugh B cirrhosis, ASA score > 2, longer operative time, and multiple tumors were risk factors of prolonged LOS or morbidity in patients with cirrhosis. Conclusion: The presence of Child–Pugh A cirrhosis didn't significantly influence the difficulty and perioperative outcomes of RLR for selected patients with HCC. However, even in high-volume center, Child–Pugh B cirrhosis was a risk factor for poor postoperative outcomes. [ABSTRACT FROM AUTHOR]

The present study aims to develop an effective risk-prediction score (RPS) to improve screening efficiency and contribute to secondary prevention of colorectal cancer (CRC). Screening for colorectal lesions. 14,398 high-risk individuals aged 50–65 years were included. The baseline characteristics of participants with and without colorectal lesions (CL) were compared using a Chi-squared test. The overall population was randomly split into a training set and a test set in the ratio of 80% and 20%. One-factor and multifactor logistic regression analyses were performed in the training set to construct the RPS (scores of 0–9.62). Area under curve (AUC) was calculated as an estimate of predictive performance using the receiver-operating characteristic (ROC) curve in the test set. In the study population, being male, advanced age, current or previous smoking, weekly alcohol consumption, high body mass index (BMI ≥24 kg/m2), and previously detected colonic polyp were associated with higher risk of CL. Compared to the low-risk group (0–2.31 points), the ORs and 95% confidence intervals (CIs) for the moderate-risk group (2.31–3.85 points) and high-risk group (3.85–8.42 points) were 1.58 (1.44, 1.73) and 2.52 (2.30, 2.76), respectively. For every 1-point increase in score, participants had a 27% increased risk of CL (OR:1.27, 95% CI: 1.24, 1.30). For participants with CL predicted by RPS, the area under the working characteristic curve was 0.61 (P < 0.001). Our RPS can quickly and efficiently identify multiple lesions of the colorectum. Combining RPS with existing screening strategies facilitates the identification of very high-risk individuals and may help to prevent CRC. [ABSTRACT FROM AUTHOR]

This study aimed to assess the burden of early-onset gastrointestinal (GI) cancers in China over three decades. A comprehensive analysis was performed using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Data on early-onset GI cancers in 2020 and from 1990 to 2019 were extracted from GLOBOCAN 2020 database and GBD 2019, respectively. The average annual percent change (AAPC) was calculated to analyze the temporal trends using the Joinpoint Regression Program. The Bayesian age-period-cohort (BAPC) model was used to predict future trends up to 2030. In China, there were 185,980 incident cases and 119,116 deaths of early-onset GI cancer in 2020, with the highest incidence and mortality observed in liver cancer (new cases: 71,662; deaths: 62,412). The spectrum of early-onset GI cancers in China has transitioned over the last 30 years. The age-standardized rates of incidence, mortality, and disability-adjusted life years for colorectal and pancreatic cancers exhibited rapid increases (AAPC >0, P ≤ 0.001). The fastest-growing incidence rate was found in colorectal cancer (AAPC: 3.06, P < 0.001). Despite the decreases in liver, gastric, and esophageal cancers, these trends have been reversed or flattened in recent years. High body mass index was found to be the fastest-growing risk factor for early-onset GI cancers (estimated annual percentage change: 2.75–4.19, P < 0.05). Projection analyses showed an increasing trend in age-standardized incidence rates for almost all early-onset GI cancers during 2020–2030. The transitioning pattern of early-onset GI cancers in China emphasizes the urgency of addressing this public health challenge. [ABSTRACT FROM AUTHOR]

Fear of childbirth not only brings negative psychological experiences to expectant fathers and affect their ability to prepare for parenthood but can even affect children's emotional and cognitive development. It is essential to identify men with a more severe fear of birth and its related risk factors for the better transition of fathers' role. The objective of this study was to investigate the prevalence of fear of childbirth among Chinese expectant fathers, identify its contributing factors and explore the association among fear of childbirth, resilience and dyadic coping. A cross-sectional survey was conducted in the obstetric department of two tertiary hospitals in Wuhan, China. The socio-demographic questionnaire, the father's version of the Wijma Delivery Expectancy/Experience Questionnaire version A (W-DEQ A), the Connor-Davidson Resilience Scale-10 (CD-RISC), and the Dyadic Coping Inventory (DCI) were used to explore the correlation of fear of childbirth, resilience and dyadic coping of participants. Ultimately, a total of 1176 expectant fathers were included in this study. The prevalence of fear of childbirth was 32.1%. Gestational weeks of pregnant women, monthly income, adverse birth experience, gravidity and parity of pregnant women were considered risk factors for the expectant fathers with fear of childbirth. Furthermore, there was a weak negative correlation between fear of childbirth and resilience and dyadic coping. In conclusion, the prevalence of fear of childbirth in expectant fathers in China was high. Adequate identification of factors influencing the fear of childbirth among expectant fathers is necessary to reduce the fear of childbirth and to develop appropriate interventions in preparing fathers for their new parenting role [ABSTRACT FROM AUTHOR]

Evidence regarding the combined effects of green space and air pollutants on hypertension remains limited and complex. This study aims to investigate the varying effects of greenness under different air pollution levels in China, using data from the wave 2018 China Health and Retirement Longitudinal Study (CHARLS) involving 17 468 adults (aged ≥ 45 years). As a result, the prevalence rate of hypertension was 42.04%. Logistic regression analyses revealed the positive associations between air pollution concentrations at the city level and prevalent hypertension and the negative associations between NDVI and prevalent hypertension, all of which were more prominent in the populations of the eastern and rural regions. Notably, the negative effect of green space was greater at the lowest quartiles of each air pollutant (OR for PM2.5 quartiles = 0.724, 0.792, 0.740, and 0.931). Improving air quality and greenness could potentially reduce hypertension risk, and minimizing air pollution might optimize the protective effects of greenness. [ABSTRACT FROM AUTHOR]

Existing evidence suggested that the risk of tuberculosis (TB) infection was associated to the variations in temperature and PM2.5. A total of 9,111 cases of TB were reported in Ningxia Hui Autonomous Region, China from 2013 to 2015 on a daily basis, and 57.2% of them were male. The TB risk was more prominent for a lower temperature in males (RR of 1.724, 95% CI: 1.241, 2.394), the aged over 64 years (RR of 2.241, 95% CI: 1.554, 3.231), and the high mobility occupation subpopulation (RR of 2.758, 95% CI: 1.745, 4.359). High concentration of PM2.5 showed a short-term effect and was only associated with an increased risk in the early stages of exposure for the female, and aged 36–64 years group. There were 15.06% (1370 cases) of cases of TB may be attributable to the temperature, and 2.94% (268 cases) may be attributable to the increase of PM2.5 exposures. Low temperatures may be associated with significantly increase in the risk of TB, and high PM2.5 concentrations have a short-term association on increasing the risk of TB. Strengthening the monitoring and regular prevention and control of high risk groups will provide scientific guidance to reduce the incidence of TB. [ABSTRACT FROM AUTHOR]

The present study aimed to examine the spatial characteristics of myopia and identify the socioeconomic and environmental factors influencing its prevalence. Myopia prevalence among children of school age of Han ethnicity in China was 56.6% in 2019, with the highest and lowest prevalence's in Shandong (66.8%) and Guizhou (47.3%), respectively. There was a spatial aggregation of myopia prevalence in China. Environmental factors (atmospheric PM2.5 concentration and forest coverage) and socioeconomic factors (gross domestic product per capita, per capita disposable income, hospital beds per thousand people, and Engel coefficient) have significant influences on myopia prevalence. The interaction of each factor on myopia showed nonlinear enhancement. Myopia prevalence among children of school age was spatially clustered, and environmental and socioeconomic conditions are associated with myopia prevalence. Our findings provide novel perspectives for the comprehensive prevention and control of myopia. [ABSTRACT FROM AUTHOR]

Background: Pneumonia has a high incidence in traumatic brain injury (TBI) patients and lacks effective treatments. Early mobilization (EM) may be a potentially effective treatment. Aim: To explore the impact of EM on TBI‐related pneumonia in the neurosurgical intensive care unit (NICU). Study Design: This study was a historical control study. 100 TBI patients who received EM intervention were prospectively included as the experimental group (EM cohort), and 250 TBI patients were retrospectively included as the control group. The propensity score matching (PSM) method was employed to balance baseline and minimize potential bias. The relationship between EM and TBI‐related pneumonia was investigated by univariate and multivariate logistic regression, then further determined by subgroup analysis. The influence of other variables was excluded by interaction analyses. Finally, the effect of EM on the prognosis of TBI patients was analysed by comparing the Glasgow Coma Scale (GCS) and the hospital stay. Results: After screening, 86 patients were included in the EM cohort and 199 patients were included in the control cohort. There were obvious differences between the two cohorts at baseline, and these differences were eliminated after PSM, when the incidence of pneumonia was significantly lower in the EM cohort than in the control cohort (35.0% vs. 61.9%, p <.001). Multivariate logistic regression showed that EM was an independent risk factor for TBI‐related pneumonia and was significantly associated with a decreased incidence of pneumonia. This correlation was present in most subgroups and was not affected by other variables (p for interaction >.05). Patients in the EM cohort had shorter length of ICU stay (6 vs. 7 days, p =.017) and higher GCS at discharge (12 vs. 11, p =.010). Conclusion: EM is a safe and effective treatment for TBI patients in NICU, which can reduce the incidence of pneumonia, help to improve prognosis and shorten the length of ICU stay. Relevance to Clinical Practice: Although the utilization rate of EM is low in TBI patients for various reasons, EM is still an effective method to prevent complications. Our study confirms that a scientific and detailed EM strategy can effectively reduce the incidence of pneumonia while ensuring the safety of TBI patients, which is worthy of further research and clinical application. [ABSTRACT FROM AUTHOR]

A worrying phenomenon has emerged recently: more people are deliberately avoiding rather than seeking information regarding acquired immunodeficiency syndrome (AIDS). This is the first study to explore behaviors related to AIDS information avoidance and the potential influential factors among older men who have sex with men (MSM). We enrolled 11 older MSM from Wuhan, the largest city in central China, from January to March 2023 using a phenomenological method. This qualitative research was conducted using face-to-face semi-structured interviews. AIDS information avoidance was commonly observed among the respondents. Behaviors related to AIDS information avoidance included avoiding AIDS-related information, ignoring known AIDS information, and avoiding medical care. The main factors associated with AIDS information avoidance included information overload, high-risk sexual behaviors, over-optimism, fear of disclosure, and age. China should provide AIDS information in a manner suitable for older MSM, pay more attention to MSM over the age of 70 years, those who are not open about their sexual orientation and those who are too optimistic, and strengthen the censorship of AIDS information. [ABSTRACT FROM AUTHOR]

Objectives: To determine the characteristics of lumbar foraminal stenosis (LFS) on magnetic resonance (MR) images and their association with back pain and radiating leg pain in a population-based sample of Chinese subjects. Methods: This study was an extension of the Hangzhou Lumbar Spine Study, a cross-sectional study focusing on back pain and lumbar spine MR imaging findings. Questionnaire data, including demographics, lifestyle, occupational exposures, back pain and radiating leg pain were included. On lumbar spine MR images, disc degeneration was assessed using Pfirrmann grade and Modic changes were evaluated. Using Lee's scale, the L3-S1 intervertebral foramina were evaluated, with grade 2–3 representing substantial LFS and grade 0–1 no LFS. Characteristics of LFS were noted, and associations of LFS with back pain and radiating leg pain were examined. Results: Among the 644 study subjects, 141 (21.9%) had at least one LFS, and its occurrence was associated with greater age (OR = 1.93 for each 10 years, p < 0.001). Substantial LFS was associated with the presence of back pain (OR = 1.92, p = 0.001) and the intensity of the worst back pain (Coef = 8.30, p < 0.001) over the past 12 months, and disabling back pain during their lifetime (OR = 2.25, p < 0.001). Substantial LFS was also associated with leg pain (OR = 14.27, p < 0.001), with a sensitivity of 75.7% for the presence of radiating leg pain and a specificity of 81.4%. Conclusion: Substantial LFS on MR images was a common age-related degenerative phenotype in adults, and appears to be an independent risk factor for back pain and leg pain. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to identify the risk factors for gingival invagination during orthodontic treatment after premolar extraction. Materials and Methods: The medical records of 135 patients who had undergone interdental space closure after premolar extraction were collected, and cone beam computed tomography was performed to determine the presence of gingival invagination. The risk factors were examined using mixed‐effects models and generalized propensity score weighting (GPSW) to develop a predictive model. Results: Univariate analysis revealed that the extraction site, buccal bone thickness 4 mm apical to the cemento‐enamel junction (MB1), mid‐root buccal bone thickness (MB2) and vertical skeletal relationships were related to gingival invagination (p <.05). Furthermore, a subsequent multivariable mixed‐effects model analysis indicated a significantly increased risk of gingival invagination at MB1 < 1 mm (p <.001; odds ratio [ORMB1≤0.5mm] = 29.304; 95% confidence interval [CI]: 8.986–93.807; OR0.5

Context.--Noninvasive self-sampling is a convenient option that may be highly accepted by women for home- based detection, which could increase the screening rate for cervical cancer (CC) and reduce its incidence and mortality. Objective.--To compare the distribution of high-risk human papillomavirus (hr-HPV) between the vulva and cervix and to explore the clinical value of vulvar HPV detection in CC screening. Design.--The study was nested within a clinical trial on a recombinant HPV 9-valent vaccine for women ages 20 to 45 years. Women with paired vulvar and cervical specimens were included and underwent cytology and HPV detection. The consistency of HPV detection between vulvar and cervical specimens was evaluated using Cohen K statistics. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to evaluate the diagnostic accuracy of primary CC screening. The primary end points were cervical intraepithelial neoplasia (CIN) grade 2/3 or worse (CIN2+/3+). Results.--A total of 7999 women were enrolled, and 83/33 cases were diagnosed as CIN2+/CIN3+. The HPV- positive rate in vulvar specimens (1785 of 7999; 22.32%) was higher than that in cervical specimens (1390 of 7999; 17.38%), and there were no significant differences in the distribution of hr-HPV genotypes between the vulva and cervix in patients with CIN2+/CIN3+. Vulva-based HPV primary screening showed sensitivity, specificity, PPV, and NPV comparable to those for cervix-based HPV primary CC screening in the detection of CIN3+. Conclusions.--The distribution of vulvar and cervical HPV was similar in patients with CIN2+/CIN3+. Vulva-based HPV primary CC screening had acceptable diagnostic efficacy and might be used as a modality for primary CC screening. [ABSTRACT FROM AUTHOR]

Background Patients with hormone receptor-positive (HR+), human epidermal growth factor receptor-2 negative (HER2−) early breast cancer (EBC) with high-risk clinicopathological features face an increased risk of recurrence. This study explored the evolving treatment landscape and clinical outcomes in patients with EBC using a nationwide database. Patients and Methods The study cohort comprised HR+/HER2−, stages 1-3, patients with EBC who underwent surgery and received adjuvant endocrine therapy (AET) from January 2013 to March 2021. High-risk patients were defined by ≥4 positive axillary lymph nodes, or 1-3 positive lymph node(s) with at least one high-risk feature (histologic grade 3, tumor size ≥5 cm, or Ki-67 ≥20%). A low-risk cohort included patients not meeting the criteria. Survival analysis was conducted with a cutoff of September 2021. Results The study included 4088 eligible patients (1310 high-risk patients and 2778 low-risk patients). High-risk patients were more likely to receive adjuvant chemotherapy and radiotherapy compared to low-risk patients. From 2013 to 2021, an increasing proportion of patients received aromatase inhibitors and ovarian function suppression as part of their AET. The 2-, 5-, and 7-year invasive disease-free survival for high-risk cohort were 90.67%, 75.26%, and 57.10%, respectively, these rates were notably higher for low-risk cohort at 97.14%, 89.85%, and 84.83%. High-risk patients demonstrated a higher risk of recurrence or death compared with low-risk patients (hazard ratio, 2.38; 95% CI, 1.82-3.12). Conclusion In the setting of standard or even intensive AET, patients with EBC with high-risk features still present high recurrence risk, highlighting the urgent need for innovative adjuvant treatment strategies. [ABSTRACT FROM AUTHOR]

Mining activities have resulted in a substantial accumulation of cadmium (Cd) in agricultural soils, particularly in southern China. Long-term Cd exposure can cause plant growth inhibition and various diseases. Rapid identification of the extent of soil Cd pollution and its driving factors are essential for soil management and risk assessment. However, traditional geostatistical methods are difficult to simulate the complex nonlinear relationships between soil Cd and potential features. In this study, sequential extraction and hotspot analyses indicated that Cd accumulation increased significantly near mining sites and exhibited high mobility. The concentration of Cd was estimated using three machine learning models based on 3169 topsoil samples, seven quantitative variables (soil pH, Fe, Ca, Mn, TOC, Al/Si and ba value) and three quantitative variables (soil parent rock, terrain and soil type). The random forest model achieved marginally better performance than the other models, with an R2 of 0.78. Importance analysis revealed that soil pH and Ca and Mn contents were the most significant factors affecting Cd accumulation and migration. Conversely, due to the essence of controlling Cd migration being soil property, soil type, terrain, and soil parent materials had little impact on the spatial distribution of soil Cd under the influence of mining activities. Our results provide a better understanding of the geochemical behavior of soil Cd in mining areas, which could be helpful for environmental management departments in controlling the diffusion of Cd pollution and capturing key targets for soil remediation. [ABSTRACT FROM AUTHOR]

Background This study was designed to assess stress levels and related factors during the coronavirus disease 2019 (COVID-19) epidemic among individuals in centralized quarantine camps in Wenzhou, China. Methods The survey was conducted using a questionnaire. The questionnaire included questions on sociodemographic characteristics, life events related to the COVID-19 and stressful situations, as well as Perceived Stress Scale-14. Participants included close contacts of patients with COVID-19 or at-risk individuals in quarantine camps. Multivariate logistic regression was used to analyze different factors affecting perceived stress. Results The prevalence of high stress among quarantine camp participants was 37.45%. Of the 881 respondents, 51.99% were concerned about the difficulty of controlling the epidemic, 46.20% were concerned about the health of themselves and their family members and 39.61% were concerned about not being able to leave their homes. Multivariate logistic regression analysis revealed statistically significant differences in the prevalence of stress among different groups for certain variables, including occupation, education level and knowledge of COVID-19 (all P  < 0.05). Our study found that at-risk individuals and close contacts experienced high levels of stress in quarantine camps during the COVID-19 pandemic. Conclusions These findings suggest that centralized quarantine policies should be adapted and optimized to minimize negative psychological effects on quarantined individuals. [ABSTRACT FROM AUTHOR]

Background Limited research has explored the impact of mosquito repellents exposure during early life on ADHD symptoms. This study aimed to explore the associations of exposure to mosquito repellents from pregnancy to 3 years old and the prevalence of ADHD-like behaviours among children aged 3–9 years, and further identify the sensitive exposure period. Methods A cross-sectional study was conducted, including 12 275 children in Hefei City, China. Exposure was self-reported via primary caregivers. ADHD-like behaviours were measured by the Swanson, Nolan and Pelham, version IV scale (SNAP-IV), and Conners' Parent Rating Scale (CPRS). Cross-over analysis, binary logistic regression and linear regression were employed. Results After adjusting for confounding variables, early-life exposure to mosquito repellents was associated with a higher risk of ADHD-like behaviours (OR = 1.81, 95% CI = 1.49–2.19). By comparing the strength of the association for each subgroup, we found exposure during 1–3 years old was a sensitive period (OR = 1.89, 95% CI = 1.25–2.87) by the cross-over analysis. Furthermore, we found a dose–response relationship in which the likelihood of ADHD-like behaviours increased with children's early-life mosquito repellents exposure dose. Conclusions Early-life exposure to mosquito repellents is linked with an elevated risk of ADHD-like behaviours in children, with a sensitive period identified during 1–3 years old. [ABSTRACT FROM AUTHOR]

Purpose: To explore associations among psychological resilience, self-esteem, social support, and non-suicidal self-injury (NSSI) behaviors in adolescents receiving inpatient psychiatric care. Method: In this cross-sectional study, 505 Chinese adolescents (aged 10 to 19 years) receiving inpatient psychiatric care completed a general characteristics questionnaire, the Psychological Resilience Scale (PRS), Self-Esteem Scale (SES), and Child and Adolescent Social Support Scale (CASSS). Statistical tests were used to compare NSSI incidence, scale scores, and factors influencing NSSI. Results: The incidence rate of NSSI was 77.82% (n = 393). Total and dimension scores on the PRS, SES, and CASSS in the NSSI group were significantly lower than those in the non-NSSI group (p < 0.01). Binary logistic multifactorial regression analysis showed that participants who were female and aged 10 to 14 years were more prone to NSSI behavior (p < 0.05). Having close friends, high parental expectations, and moderate to high self-esteem were protective factors for NSSI behavior (p < 0.05). Conclusion: Nursing personnel should prioritize enhancing psychological resilience, self-esteem, and social support in adolescents receiving inpatient psychiatric care to mitigate the risk of NSSI and ensure the safety of hospitalized individuals. [Journal of Psychosocial Nursing and Mental Health Services, 62(9), 47–54.] [ABSTRACT FROM AUTHOR]

Objectives. Although some studies have shown role stressors can lead to unsafe behaviors, it is unclear how role stressors induce delivery riders' unsafe behaviors. We found that delivery riders suffered from tremendous role stressors during the delivery process and had to conduct frequent smartphone interactions. This study aimed to explore the effects of role stressors and smartphone interactions on delivery riders' unsafe behaviors. Methods. First, a questionnaire survey (N = 326) was used to collect data, and correlation and regression analyses were conducted to explore the relationship between role stressors, smartphone interaction frequency and delivery riders' unsafe behaviors. Second, a scenario survey (N = 35) was conducted, and comparative analysis was used to further explore how smartphone interactions affect delivery riders' unsafe behaviors. Results. The questionnaire survey revealed that role stressors, smartphone interaction frequency and delivery riders' unsafe behaviors were positively correlated. In addition, the role stressors forced delivery riders to conduct necessary and unnecessary smartphone interactions. The scenario survey found that smartphone interactions reduced delivery riders' motion speed and motion ability, and increased their psychology, so they had a risk-taking mentality, which led to an increase in unsafe behaviors. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of vitamin A (VA), vitamin D (VD), and homocysteine (Hcy) on cardiometabolic multimorbidity (CMM). Methods: This study is a cross-sectional study conducted in Ningxia Province, China. A total of 5000 participants aged 25–74 were recruited and divided into two groups based on the definition of cardiometabolic multimorbidity: the CMM group and the Non CMM group. Demographic, lifestyle, and laboratory data were collected to investigate the correlation between vitamin A, D, Hcy levels and CMM risk. The association was analyzed using multiple logistic regression and restricted cubic spline method. Results: CMM incidence increased with age, being higher in females (20.05%) compared to males, Hypertension was present in 96.20% of CMM cases. Reduced VD levels correlated with an elevated CMM risk (OR = 1.799, 95% CI: 1.466–2.238), showing an inverse dose-response relationship, even after adjusting for confounders (OR = 1.553, 95% CI: 1.233–1.956). However, VA and Hcy levels were not significantly associated with CMM risk. The inverse correlation between VD status and CMM risk was more pronounced in males, obese individuals, and those with normal blood lipid profiles (P < 0.05). Conclusions: The risk of CMM increases with age, especially in women. Inadequate VD status increases vulnerability to CMM, suggesting that optimising VD reduces the risk of CMM. [ABSTRACT FROM AUTHOR]

Introduction: Existing studies suggest that the number of night shifts may impact the occurrence of adverse events. However, while this relationship is well-documented, previous research has not thoroughly examined the non-linear associations between night shifts and adverse events among nursing staff, which remains a gap in our understanding. Methods: Participants were 1,774 Chinese nurse staff. Psychosocial characteristics were screened by The Chinese version of the multidimensional scale of perceived social support (MSPSS) for social support, the 9-item Patient Health Questionnaire (PHQ-9) for depressive symptoms, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms. Binary logistic regression and restricted cubic splines were applied to analyze the data. The statistical software used were R version 3.6.2 and SPSS version 22.0. Results: Over the past year, 325 cases (18.3%) were classified as adverse events. Logistic regression unveiled that social support played a protective role against adverse events, with an OR of 0.991 (95% CI: 0.983, 0.999). Furthermore, night shifts continued to surface as a substantial risk factor for adverse events, with an OR to 1.300 (95% CI: 1.181, 1.431). The restricted cubic spline regression model highlights a nonlinear relationship between night shifts and adverse events (P for non-liner < 0.001). The probability of adverse events increases with the number of night shifts, but compared to individuals working 3–4 night shifts per month, those working 5–6 night shifts per month have a lower probability of adverse events. Conclusion: Our findings indicate a non-linear relationship between the frequency of night shifts and adverse events, suggesting a complex interplay of factors. This highlights the need for nursing practice and policy to consider the intricacies of night shift scheduling and explore more reasonable rostering strategies to mitigate the probability of adverse events. [ABSTRACT FROM AUTHOR]

Objective: Patients with mild oral and maxillofacial space infection (OMSI) usually need only antimicrobial therapy. However, surgical intervention is eventually needed after using antibiotics for a period. The objective of this study was to explore the risk factors for drug therapy failure in OMSI. Subjects and methods: A retrospective case‒control study was designed. From August 2020 to September 2022, patients at Shanghai Jiao Tong University Affiliated Ninth People's Hospital who were diagnosed with OMSI were retrospectively reviewed. The outcome variable was surgical intervention after the use of antibiotics. We collected common biological factors, including demographic characteristics, routine blood test results, C-reactive protein (CRP) levels and composite indicators, such as neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). The χ2 test and binary logistic regression were used to examine the association between biological factors and the outcome variable. Results: Forty-six patients were included in this study. Further surgical intervention was needed in 20 patients (43.5%). The NLR showed a significant association with further surgical drainage (p = 0.01). A binary logistic regression equation was found by using stepwise regression based on the Akaike information criterion (R2 = 0.443), which was associated with sex (odds ratio [OR], 0.216; p = 0.092), NLR (OR, 1.258; p = 0.045), red blood cell (RBC) count (OR, 4.372; p = 0.103) and monocyte (MONO) count (OR, 9.528, p = 0.023). Receiver operating characteristic analysis produced an area under the curve for NLR of 0.725 (p = 0.01) and for the binary logistic regression model of 0.8365 (p < 0.001). Conclusion: Surgical interventions are needed in some mild OMSI patients when antimicrobial therapy fails to stop the formation of abscesses. The binary logistic regression model shows that NLR can be used as an ideal prognostic factor to predict the outcome of antimicrobial therapy and the possibility of requiring surgical intervention. Statement of clinical relevance: Using simple, inexpensive, and easily achieved biological parameters (such as routine blood test results) and composite indicators calculated by them (such as NLR) to predict whether surgical intervention is needed in the future provides a reference for clinical doctors and enables more cost-effective and efficient diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: Community-acquired pneumonia (CAP) is a significant health issue among the elderly, with severe cases (SCAP) having high mortality rates. This study assesses the predictive significance of the stress hyperglycemia ratio (SHR) in elderly SCAP patients and its impact on outcomes in both diabetic and non-diabetic patients. Methods and materials: This retrospective study included 406 SCAP patients aged 65 or older from the Second People's Hospital of Lianyungang (January 2020 to December 2023). Data collected included demographics, medical history, vital signs, and lab results. SHR was calculated from initial blood glucose and estimated average glucose (HbA1c). Statistical analyses, including Cox regression and Kaplan-Meier analysis, evaluated SHR's impact on mortality. Mediation models explored the effects of neutrophil-lymphocyte ratio (NLR) and SHR. Results: The 28-day mortality rate was 21.67%. Deceased patients had higher age, Charlson Comorbidity Index, procalcitonin, NLR, glucose, and SHR levels compared to survivors (P < 0.05). Both SHR and NLR significantly increased mortality risk, particularly in non-diabetic patients. Combining NLR and SHR improved ROC AUC to 0.898, with 89.80% sensitivity and 81.10% specificity. Kaplan-Meier analysis showed higher cumulative survival for SHR < 1.14, regardless of diabetes status (P < 0.05). NLR mediated 13.02% of the SHR-survival relationship, while SHR mediated 14.06% of the NLR-survival relationship. Conclusion: Elevated SHR is a significant mortality risk factor in elderly SCAP patients, independent of diabetes status. Stringent glucose control and careful monitoring of SHR may improve outcomes in elderly patients with acute respiratory conditions. [ABSTRACT FROM AUTHOR]

Purpose: To identify the key risk factors for venous thromboembolism (VTE) in urological inpatients based on the Caprini scale using an interpretable machine learning method. Methods: VTE risk data of urological inpatients were obtained based on the Caprini scale in the case hospital. Based on the data, the Boruta method was used to further select the key variables from the 37 variables in the Caprini scale. Furthermore, decision rules corresponding to each risk level were generated using the rough set (RS) method. Finally, random forest (RF), support vector machine (SVM), and backpropagation artificial neural network (BPANN) were used to verify the data accuracy and were compared with the RS method. Results: Following the screening, the key risk factors for VTE in urology were "(C1) Age," "(C2) Minor Surgery planned," "(C3) Obesity (BMI > 25)," "(C8) Varicose veins," "(C9) Sepsis (< 1 month)," (C10) "Serious lung disease incl. pneumonia (< 1month) " (C11) COPD," "(C16) Other risk," "(C18) Major surgery (> 45 min)," "(C19) Laparoscopic surgery (> 45 min)," "(C20) Patient confined to bed (> 72 h)," "(C18) Malignancy (present or previous)," "(C23) Central venous access," "(C31) History of DVT/PE," "(C32) Other congenital or acquired thrombophilia," and "(C34) Stroke (< 1 month." According to the decision rules of different risk levels obtained using the RS method, "(C1) Age," "(C18) Major surgery (> 45 minutes)," and "(C21) Malignancy (present or previous)" were the main factors influencing mid- and high-risk levels, and some suggestions on VTE prevention were indicated based on these three factors. The average accuracies of the RS, RF, SVM, and BPANN models were 79.5%, 87.9%, 92.6%, and 97.2%, respectively. In addition, BPANN had the highest accuracy, recall, F1-score, and precision. Conclusions: The RS model achieved poorer accuracy than the other three common machine learning models. However, the RS model provides strong interpretability and allows for the identification of high-risk factors and decision rules influencing high-risk assessments of VTE in urology. This transparency is very important for clinicians in the risk assessment process. [ABSTRACT FROM AUTHOR]

Objective: To explore the main factors affecting early dental caries among preschool children aged 3–6 years in Xingtai City to formulate effective preventive measures. Methods: A cross-sectional study was conducted on 570 preschool children aged 3–6 years in Xingtai City through questionnaire surveys and oral examinations to understand their dental caries situation. Multifactorial logistic regression analysis was used to analyse the main influencing factors for the occurrence of dental caries in preschool children. Results: Univariate analysis showed statistically significant differences in age (χ2 = 2.636, p = 0.008), father's education level (χ2 = 4.207, p < 0.001), mother's education level (χ2 = 4.217, p < 0.001), daily tooth brushing frequency (χ2 = 3.160, p = 0.002), age of starting tooth brushing (χ2 = 8.756, p < 0.001), mouth rinsing after meals (χ2 = 89.401, p < 0.001), Streptococcus mutans positivity (χ2 = 133.503, p < 0.001), non-sweet snack consumption frequency (χ2 = 5.962, p < 0.001), snack flavour preference (χ2 = 116.119, p < 0.001), use of fluoridated toothpaste (χ2 = 75.639, p < 0.001), regular oral examinations (χ2 = 98.711, p < 0.001), sugary drink consumption frequency (χ2 = 10.370, p < 0.001) and sweet food consumption frequency (χ2 = 9.261, p < 0.001) between the caries and non-caries groups. Multifactorial analysis revealed that older age (odds ratio [OR] = 5.342, 95% confidence interval [CI]: 1.434–6.631), later initiation of tooth brushing (OR = 3.244, 95% CI: 2.413–5.424), S. mutans positivity (OR = 5.357, 95% CI: 4.529–8.563), high snack consumption frequency (OR = 3.452, 95% CI: 2.634–5.442), high sugary drink consumption frequency (OR = 4.414, 95% CI: 2.534–6.451) and high sweet food consumption frequency (OR = 4.531, 95% CI: 3.421–6.354) were risk factors for dental caries. Higher father's educational level (OR = 0.724, 95% CI: 0.564–0.891), higher mother's educational level (OR = 0.641, 95% CI: 0.601–0.813), high daily tooth brushing frequency (OR = 0.572, 95% CI: 0.423–0.864), mouth rinsing after meals (OR = 0.743, 95% CI: 0.643–0.813), use of fluoridated toothpaste (OR = 0.657, 95% CI: 0.553–0.931) and regular oral examinations (OR = 0.443, 95% CI: 0.352–0.747) were protective factors against dental caries (all p < 0.05). Conclusion: Multiple factors result in early dental caries in preschool children aged 3–6 years; however, the most influential factors are older age and high snack consumption, as well as high sugary and sweet food/drink consumption. [ABSTRACT FROM AUTHOR]

Aims: Glioma patients are at high risk for postoperative delirium (POD), yet studies focusing on this population in general neurosurgical ward settings are limited. This paper investigates the incidence of POD and related risk factors in glioma patients hospitalized in general wards. Design: Prospective observational study. Methods: This prospective study included 133 adult glioma patients hospitalized in the general neurosurgery ward. In addition to collecting routine perioperative general clinical data, patients' psychological status was assessed preoperatively using the Hospital Anxiety and Depression Scale (HADS). POD was assessed within 3 days postoperatively using the Confusion of Consciousness Assessment method, twice daily. The incidence of POD was calculated, and risk factors were identified using logistic regression analysis. Results: The incidence of POD in glioma patients admitted to the general ward was 31.6% (40/133). Multivariate regression revealed advanced age (age > 50 years), frontal lobe tumour, presence of preoperative anxiety or depression, retention of a luminal drain, postoperative pain, indwelling catheter these six factors were independent risk factors for the development of delirium in patients after surgery. Conclusion: In general ward settings, supratentorial glioma patients exhibit a high risk of POD. Critical risk factors include preoperative psychological conditions, as well as postoperative pain, drainage and catheterization. Rigorous preoperative evaluations, effective pain management strategies and the integration of humanistic care principles are essential in mitigating the risk of POD for glioma patients. Relevance to Clinical Practice: In general ward settings, this study reveals the high occurrence of POD in glioma patients and identifies preoperative psychological states, age, tumour location and several postoperative factors as significant risk factors for POD, which provides a framework for targeted interventions. By integrating these insights into clinical practice, healthcare teams can better identify glioma patients at risk for POD and implement preventive measures, thereby enhancing recovery and overall care quality for glioma patients in general neurosurgical wards. Reporting Method: This study adheres to the STROBE guidelines, ensuring a transparent and comprehensive reporting of the observational research methodology and results. Patient or Public Contribution: Patients involvement was limited to the provision of data through their participation in the study's assessments and the collection of clinical information. The study did not involve a direct patient or public contribution in the design, conduct, analysis, or interpretation of the data, nor in the preparation of the manuscript. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the duration of subsyndromal delirium (SSD) in intensive care unit (ICU) patients and the factors associated with SSD duration. Methods: This retrospective study included adult patients admitted to the ICU of Affiliated Hospital of Nantong University between December 2019 and June 2020. All patients with Richmond Agitation Sedation Scale scores of ≥−2 were evaluated every 8 h using the confusion assessment method of the intensive care unit (CAM‐ICU) until the patients with SSD were negative, progressed to delirium, fell into a coma, died, or were discharged from the ICU. Multivariable Cox regression analyses were performed to determine the factors associated with SSD duration. Results: Of the 388 patients, 53.6% had SSD, and 20.7% progressed from SSD to delirium. The duration of SSD ranged from 8 to 248 h, and the median duration was 48 h (interquartile range, 24–72). Age (hazard ratio [HR] = 0.985, 95% confidence interval [CI], 0.971–0.999, p = 0.035), surgery or not (HR = 0.514; 95% CI, 0.310–0.850; p = 0.010), duration of ventilation (HR = 1.003; 95% CI, 1.000–1.006; p = 0.044), duration of hypoxia (HR = 0.212; 95% CI, 0.103–0.438; p < 0.001), and adapted cognitive exam scores (HR = 1.057; 95% CI, 1.030–1.085; p < 0.001) were independently associated with the duration of SSD. Conclusions: The duration of SSD was associated with age, surgery, duration of ventilation, duration of hypoxia, and cognitive function. SSD has a high incidence among ICU patients, and many patients progress to delirium. Patient or Public Contribution: The study team met with public members of the evaluation teams throughout the project in a series of workshops. Workshops informed study design, data collection tools and data interpretation. Relevance to Clinical Practice: ICU staff should pay attention to SSD patients with older age, history of surgery, longer duration of ventilation, prolonged duration of hypoxia, and lower ACE scores. [ABSTRACT FROM AUTHOR]

Introduction: Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, is a common and potentially fatal post-surgery complication. Research has shown that 50% of VTE causes are intraoperative, with the risk of occurrence highest during and immediately post-surgery. Therefore, strategies for early assessment and prevention should be established. Objective: To identify optimal equipment selection, compression protocols, and strategies for complication prevention and management during intraoperative intermittent pneumatic compression (IPC), this study aims to synthesize the best available evidence. The objective is to inform accurate risk assessment and facilitate early mechanical prophylaxis against venous thrombosis. Methods: The Practical Application to Clinical Evidence model proposed by the Joanna Briggs Institute was utilized. Indicators were identified using the available best evidence from January 2023 to October 2023, and a baseline review was conducted. Negative factors were identified based on clinical evidence-based practice. The implementation rates of different indicators before (n = 372) and after (n = 405) evidence-based practice, the incidence rates of intraoperative IPC-related adverse events and VTE, and the risk of venous thrombosis before (n = 50) and after (n = 50) practice were identified and compared. Furthermore, medical staff's knowledge of best practices for intraoperative IPC was assessed through pre- and post-intervention surveys involving 109 operating room personnel. Results: All review indicators significantly improved (P < 0.01) after the evidence-based practice, and 9 reached 100%. Two intraoperative venous thrombosis events occurred before the evidence-based practice, with an incidence rate of 0.53%; no intraoperative venous thrombosis event occurred after the evidence-based practice, with no significant difference (X2 = 2.171, P = 0.141 > 0.05). However, there were significant differences in intraoperative venous blood hemodynamics before and after the practice (P < 0.05). Moreover, 9 IPC-related adverse events, including 4 cases of skin pressure, 3 cases of skin allergy, and 2 cases of lower limb circulation disorders, were reported before the evidence-based practice, with an incidence rate of 2.4%. Notably, no intraoperative IPC-associated adverse events occurred after the evidence-based practice(X2 = 9.913, P < 0.01). Meanwhile, the score of comprehension of the standard utilization of IPC for preventing venous thrombosis by medical staff in the operating room was 93.34 ± 3.64 after the evidence-based practice, which was higher than that (67.55 ± 5.45) before the evidence-based practice. Overall, the clinical practice was significantly improved the evidence-based practice. Conclusions: Applying intraoperative IPC utilization standards based on the best evidence in clinical practice effectively reduces the intraoperative IPC-associated adverse event rate and the risks of intraoperative venous thrombosis. It also improves the execution rates and compliance with mechanical prevention standards in the operating room by medical staff. Future research should prioritize the development and refinement of best clinical practices for intraoperative venous thrombosis prevention, with a particular emphasis on the integration of mechanical prophylaxis strategies. [ABSTRACT FROM AUTHOR]

Background: Decision fatigue is a new concept in the field of psychology and refers to a state of fatigue alongside impaired cognitive processing and emotional regulation ability. Previous studies have confirmed that nurses are prone to decision fatigue, and nurses who experience decision fatigue may implement nursing measures that are inconsistent with clinical evidence, thus affecting patients' benefits. COVID-19, as a large-scale global public health emergency, increased the workload and burden of nurses and aggravated decision fatigue. However, the factors leading to decision fatigue among nurses have not yet been identified. Methods: This study is guided by interpretative phenomenology. During the epidemic period of COVID-19: From November 2022 to February 2023, a one-to-one, semi-structured in-depth interview was conducted among nurses with decision fatigue experience who were participating in front-line work in Jilin Province using homogenous sampling. The interview recordings and related data were transcribed into text within 24 h, and data analysis was assisted by NVivo 12.0 software. Results: After a total of 14 front-line nurses were analyzed in this study, The thematic level reaches saturation, the findings present a persuasive and coherent narrative, and the study is terminated, and finally extracted and formed three core themes: "Cognition, influence and attitude of decision fatigue", "Approaching factors of decision fatigue" and "Avoidant factors of decision fatigue". Conclusion: This study confirmed that decision fatigue was widespread in the work of front-line nurses, affecting the physical and psychological health of nurses, the quality of nursing work, the degree of benefit of patients and the clinical outcome. However, nursing staff do not know enough about decision fatigue, so the popularization and research of decision fatigue should be strengthened. Improve the attention of medical institutions, nursing managers and nursing staff.Some suggestions are put forward for the intervention of decision fatigue through personnel, task, tool and technology, organization and environment. [ABSTRACT FROM AUTHOR]

Background and objective: The prevalence of thyroid cancer (TC) has exhibited an upward trajectory in recent years. An accelerating amount of evidence shows a significant association between Hashimoto's thyroiditis (HT) and TC. The present study encompasses a meticulously designed systematic review and meta-analysis with the aim of scrutinizing the risk of TC and clarifying sex disparities in HT. Methods: A comprehensive search was conducted across reputable online databases, including PubMed, Cochrane Library, EMBASE, and Web of Science. English-language publications on the correlation between HT and TC were examined without temporal restrictions. Two authors independently screened the articles and extracted pertinent data. The collected data underwent statistical analysis using the STATA software, enabling the calculation of the pooled Odds Ratio (OR) and 95% confidence intervals (CI). Additionally, a supplementary analysis was conducted on studies incorporating sex-specific data to determine the OR (female vs. male) and the sex-based prevalence of TC in HT. Results: A total of 2,845 records were obtained, and 26 retrospective studies were included in this meta-analysis. The results indicated a significant role for HT in TC (OR: 2.22, 95% CI: 1.85–2.67). Supplementary analysis indicated that the prevalence of TC in HT patients was lower in women (0.31, 95% CI: 0.17–0.45) than in men (0.37, 95% CI: 0.21–0.53). However, the result was not statistically significant. Conclusion: This systematic review and meta-analysis provide evidence that HT is associated with increasing odds of TC. Regular review of HT patients holds positive clinical significance. [ABSTRACT FROM AUTHOR]

Background: This study aims to comprehend the levels of dry mouth and thirst in patients after general anesthesia, and to identify the factors influencing them. Methods: The study included all patients transferred to the Post Anesthesia Care Unit (PACU) at the Second Affiliated Hospital of Dalian Medical University between August 2021 and November 2021 after undergoing general anesthesia. A thirst numeric rating scale was utilized to conduct surveys, enabling the assessment of thirst incidence and intensity. Statistical analysis was performed to explore patient thirst levels and the associated factors. Results: The study revealed a thirst incidence rate of 50.8%. Among the thirst intensity ratings, 71.4% of patients experienced mild thirst, 23.0% reported moderate thirst, and 5.6% expressed severe thirst. Single-factor statistical analysis of potential risk factors among the enrolled cases indicated that gender, history of coronary heart disease, surgical duration, intraoperative fluid volume, intraoperative blood loss, intraoperative urine output, and different surgical departments were linked to post-anesthetic thirst in patients undergoing general anesthesia. Multifactorial Logistic regression analysis highlighted age, gender, history of coronary heart disease, fasting duration, and intraoperative fluid volume as independent risk factors for post-anesthetic thirst in patients undergoing general anesthesia. Moreover, age, gender, history of coronary heart disease, and intraoperative fluid volume were also identified as risk factors for varying degrees of thirst. Conclusion: The incidence and intensity of post-anesthetic thirst after general anesthesia are relatively high. Their occurrence is closely associated with age, gender, history of coronary heart disease, fasting duration, and intraoperative fluid volume. [ABSTRACT FROM AUTHOR]

Background: Exposure to a high-altitude environment is a risk factor for cerebral venous thrombosis (CVT) probably due to hypercoagulability. The study aims to explore the unique characteristics of CVT patients in high-altitude areas of China by comparing them with those in plain areas. Methods: We retrospectively included consecutive patients with CVT admitted to Tibet Autonomous Region People's Hospital (altitude 3650 m) and Peking Union Medical College Hospital (altitude 43.5 m) between January 2015 and December 2023. Patients from the plateau and the plain were considered two independent groups in this study. The risk factors, clinical and radiological presentations, treatment, and outcomes were analyzed and compared between the two groups. Results: A total of 169 patients with CVT were included in the study, 48 patients from plateau and 121 patients from plain. The median age was 27 and 34 years old, and women accounted for 66.7% and 54.5% respectively. Headache (91.7% vs. 71.1%, P = 0.004), altered consciousness (31.3% vs. 16.5%, P = 0.033), hemorrhage (41.7% vs. 19.0%, P = 0.002), and venous infarction (50.0% vs. 25.6%, P = 0.002) on imaging were more common in patients from plateau than those from plain. Pregnancy or puerperium was significantly more common in highland patients (25% vs. 5.8%, P < 0.001). The levels of D-Dimer (1.7 vs. 0.8 mg/L FEU, P = 0.01), fibrinogen (3.7 vs. 3.0 g/L, P < 0.001), hemoglobin (157 vs. 129 g/L, P = 0.01), white blood cells (9.6 vs. 7.5*1012/L, P < 0.001) and highly sensitive C-reactive protein (20.2 vs. 3.2 mg/L, P = 0.005) were remarkably higher in highland patients. The percentage of receiving anticoagulant therapy was lower in high-altitude patients (70.8% vs. 93.4%, P < 0.001). Favorable outcome at follow-up was observed in 81.4% of highland patients and 90.7% of lowland patients, with a median follow-up time of 330 days and 703 days respectively. Conclusions: The more severe clinical and imaging manifestations along with prominent inflammatory and hypercoagulable states were observed in plateau CVT patients, probably due to exposure to the hypoxic environment at high altitude. Pregnancy or puerperium were more common in highland patients. The overall prognosis of CVT patients from both groups were favorable. [ABSTRACT FROM AUTHOR]

Purpose: Analyzing the correlation between patients' basic information, three-dimensional parameters after calcaneal fractures, and the prognosis of calcaneal fractures. Methods: A retrospective analysis was conducted on 43 patients with calcaneal fractures who underwent surgical treatment in the Foot and Ankle Surgery, Xi'an Honghui Hospital, from September 2019 to August 2022. Patient demographics including gender and age were collected, as well as the preoperative posterior articular surface collapse area, number of fracture fragments, length, width, height, and volume of the calcaneus obtained from preoperative three-dimensional imaging. Patients were followed up for VAS, AOFAS, and SF-36 scores. Correlation analysis was performed on the obtained data. Results: All 43 included patients received complete follow-up, including 40 males and 3 females, with an average follow-up time of 35.37 ± 10.73 months, and an average age of 43.98 ± 12.08 years. All patients' VAS, AOFAS, and SF-36 scores at the last follow-up showed no correlation with patient age, gender, or the area of posterior articular collapse, number of fracture fragments, length, width, height, or volume of the calcaneus. Conclusions: The prognosis of calcaneal fractures is unrelated to three-dimensional factors such as patient age, gender, length, width, height, volume of the calcaneus, area of the posterior joint, and number of fracture fragments. [ABSTRACT FROM AUTHOR]

Anterior talofibular ligament injuries and osteochondral lesions of the talus present unique challenges to orthopedic surgeons. This study aimed to investigate the relevant relationship between them by analyzing the Magnetic resonance imaging (MRI) results of clinical patients and single-cell RNA sequence (scRNA seq) results of healthy talus cartilage to discuss the risk factors. Data from 164 patients from 2018 to 2023 was retrospectively analyzed. The correlation analysis between ATFL injury grade and the Hepple stage of OLT determined by MRI was performed. Publicly available single-cell RNA datasets were collected. Single-cell RNA datasets from five volunteers of healthy talus cartilage were analyzed. ATFL injury grade was relevant with the Hepple stage of OLT (P < 0.05). The results of multivariate logistic regression analysis showed that injured area was the independent influencing factor of the incidence rate and the severity of OLT (P < 0.05). The Hepple stage of OLT was relevant with AOFAS and VAS (P < 0.05). Single-cell RNA sequence results showed that among the 9 subtypes of chondrocytes, the interaction strength between HTC-A and HTC-B is the highest. Their physical interactions are mainly achieved through the CD99 signaling pathway, and factor interactions are mainly achieved through the ANGPTL signaling pathway. Anterior talofibular ligament injury may lead to osteochondral lesions of the talus. Early medical intervention should be carried out for ligament injuries to restore joint stability and avoid cartilage damage. [ABSTRACT FROM AUTHOR]