Hypertension and diabetes are two major chronic diseases affecting population health, and need to be controlled through chronic diseases follow-up. However, there is currently insufficient understanding of the impact of different chronic diseases follow-up forms and contents on disease control and healthy behaviors of patients.

To explore the impact of the chronic diseases follow-up on health behaviors and blood pressure/glucose control of patients with hypertension and diabetes in the context of treatment-prevention integration.

Yiyang County in Henan Province, Xianfeng County in Hubei Province and Yangqu County in Shanxi Province were selected as study sites to collect data from the basic public health information system from 2017-01-01 to 2022-06-30. Patient survey was conducted in July 2022 to collect information on basic public health follow-up receiving, health behaviors and disease control of patients. Finally, 102 769 patients with hypertension and 26 586 patients with diabetes were obtained from the basic public health information system, the data of 1 172 patients with hypertension and 456 patients with diabetes were obtained through patient surveys. Multivariate Logistic regression was used to analyze the effects of the standard-reaching frequency of follow-up, follow-up forms and contents on health behaviors and disease control of patients.

In 2021, the standard-reaching rates of follow-up frequency of patients with hypertension and diabetes were 90.83% (67 709/74 545) and 83.35% (13 390/16 065) , with frequency≥4 times/year as the standard. The follow-up forms included household follow-up〔25.74% (408/1 585) 〕, follow-up at institutional visits〔58.80% (932/1 585) 〕, telephone or network follow-up〔15.46% (245/1 585) 〕. The follow-up contents included blood pressure and blood glucose measurements〔91.15% (1 484/1 628) 〕, lifestyle guidance〔74.14% (1 207/1 628) 〕, disease inquiry〔70.02% (1 140/1 628) 〕, and drug use understanding〔69.29% (1 128/1 628) 〕. Multivariate Logistic regression analysis showed that patients with higher standard-reaching rates of follow-up frequency had higher rates of blood pressure control (OR=1.09, P<0.05) and glucose control (OR=1.31, P<0.05) , lower rates of smoking and drinking (OR=0.83, P<0.05) , and higher rates of regular exercise habits (OR=1.30, P<0.05) . The proportions of smoking and alcohol cessation (OR=2.38, P<0.05) and regular exercise habits (OR=1.62, P<0.05) were higher in the patients followed up at institutional visits than those followed up by telephone or network. The proportions of smoking and alcohol cessation (OR=2.33, P<0.05) and regular exercise habits (OR=2.54, P<0.05) of patients received household follow up were higher than those followed up by telephone or network. Patients who received lifestyle guidance, disease inquiry, and drug use understanding had higher rates of blood pressure control (OR=1.61, 1.34, and 1.62, respectively; P<0.05) , smoking and alcohol cessation (OR=3.59, 3.54, and 2.91, respectively; P<0.05) and regular exercise habits (OR=3.16, 2.15, 2.45, respectively; P<0.05) .

Receiving chronic diseases follow-up at least 4 times per year, with follow-up at institutional visits and household follow-up as the forms, provided with blood pressure and blood glucose measurements, lifestyle guidance, disease inquiry and drug use understanding as the contents in patients were positive correlated with blood pressure/glucose control, smoking and alcohol cessation, and regular exercise habits.

In the context of increasing population aging, maintaining the health of the elderly is the key to successful aging. Multimorbidity is an important factor threatening the health of the elderly, and its relationship with the health promotion behaviors of the elderly has been rarely reported.

To understand the multimorbidity patterns and distribution of health promotion behaviors among the elderly in Ningxia, analyze the relationship between multimorbidity patterns and health promotion behaviors in the elderly, so as to provide a reference for the development of management and intervention strategies for the health of elderly.

The population aged 65 years and above in Ningxia were selected as study subjects by using random cluster sampling method from January 2021 to July 2021, and surveyed by self-designed questionnaire〔including general information questionnaire, patient health questionnaire-9 (PHQ-9) , mini-mental state examination (MMSE) , health promoting lifestyle profile-Chinese version (HPLP-C) 〕. Multimorbidity patterns of the elderly was analyzed by association rules of Apriori algorithm, the correlation between multimorbidity and health promotion behaviors of the elderly was analyzed by multivariable Logistic regression analysis.

A total of 2 010 older adults aged 65 years and above were included, with the multimorbidity rate of 31.00% (623/2 010) . The most common binary multimorbidity pattern was coronary heart disease and hypertension〔25.36% (158/623) 〕, the most common ternary multimorbidity pattern was hypertension, coronary heart disease and stroke〔4.49% (28/623) 〕. The association rules revealed 16 patterns of multimorbidity, 15 of which were related to hypertension, 10 were related to coronary heart disease, and 7 were related to asthma. The multivariate Logistic regression analysis showed that compared with older adults with poor health promotion behaviors, those with general〔OR (95%CI) =0.364 (0.185, 0.714) 〕, good〔OR (95%CI) =0.488 (0.251, 0.948) 〕, excellent〔OR (95%CI) =0.426 (0.213, 0.853) 〕health promotion behaviors had a lower risk of multimorbidity (P<0.05) . HPLP-C physical activity〔OR (95%CI) =0.960 (0.925, 0.997) 〕and stress management〔OR (95%CI) =0.963 (0.938, 0.989) 〕dimension scores in older adults were negatively associated with the occurrence of multimorbidity; HPLP-C health responsibility〔OR (95%CI) =1.038 (1.013, 1.063) 〕dimension score was positively associated with the occurrence of multimorbidity.

The multimorbidity patterns of the elderly in Ningxia are complex, and there is an association between health promotion behaviors and occurrence of multimorbidity. The risk of multimorbidity can be reduced by interventions such as encouraging the elderly to practice health promotion behaviors and improve their lifestyles.

Prevention of disease in Traditionnal Chinese Medicine (TCM) is a distinguishing advantage of TCM health management services, however, the holistic health state of the patients remains to be elucidated and evaluated.

To evaluate the health-related quality of life (HRQoL) and its influencing factors in patients with prevention of disease in TCM.

From May to June 2022, a stratified cluster sampling method was used to randomly select a district-level TCM hospital from each of the four administrative regions of Guangzhou (Liwan District, Tianhe District, Baiyun District, Huadu District) as the research site. The EQ-5D-5L scale was used to investigate the patients with prevention of disease in TCM by questionnaire in primary care, and the health utility value was calculated according to the Chinese EQ-5D utility score system. The influencing factors of health utility value and EQ-VAS score were analyzed by using optimal scale regression analysis.

A total of 660 questionnaires were completed in this survey, including 630 valid questionnaires, with a effective recovery rate of 95.45%. Among the 630 investigated patients with prevention of disease in TCM, 185 patients (29.4%) visited for daily health care, 242 patients (38.4%) visited at the initial stage of disease for discomfort, 218 patients (34.6%) visited for avoiding exacerbation of current illness, 67 patients (10.6%) visited for post-illness rehabilitation physiotherapy. The top three conditions for prevention of disease in TCM were insomnia disorder, epigastric pain and arthralgia. The EQ-5D-5L health utility value for the investigated patients was 0.942 (0.893, 1.000), and the EQ-VAS score was 80 (70, 90). All five dimensions based on the ranking of difficulties frequency were pain/discomfort (50.2%), anxiety/depression (46.9%), daily activities (14.4%), mobility (9.9%) and self-care (6.0%). The influencing factors of health utility value based on the ranking of importance were the main causes of most recent prevention of disease in TCM (0.366), age (0.281), comorbidities of TCM conditions (0.145), occupation (0.111) and education level (0.098). The influencing factors of EQ-VAS score based on the ranking of importance were marital status (0.378), understanding of prevention of disease in TCM (0.353), age (0.176) and monthly income (0.092) .

The HRQoL of patients with prevention of disease in TCM in primary care in Guangzhou is at a medium level. The health utility values were relatively low in patients suffered from TCM conditions such as lung cancer, stroke, chronic obstructive pulmonary disease, osteoporosis and breast cancer, aged 60 and above, comorbid with 2 or more TCM conditions, with manual labour and lower education level. The self-rated health status was relatively poor in patients absence from marriage, unaware of prevention of disease in TCM, aged 60 and above, with higher monthly income. HRQoL should be applied reasonably as an important outcome indicator. Attention should be paid to the population with poor HRQoL among patients with prevention of disease in TCM, the promotion and dissemination of the concept and connotation of prevention of disease in TCM should be strengthened.

The contribution of geriatric health examination services of national essential public health services to the detection of abnormal health conditions in the elderly and the awareness of examination results of the elderly has been rarely reported in the current studies.

To investigate the abnormal detection of several common diseases including abnormal blood pressure, abnormal blood glucose, overweight and obesity, anemia, fatty liver disease, gallstones or cholecystitis in the health examination of the older adults aged 65 years and above.

The older adults aged 65 years and above who visited 20 primary care institutions in 5 cities of 3 provinces in eastern, central and western China were selected as study subjects (excluding those with unclear health examination results in this year) from November to December 2019 by using a multi-stage stratified sampling method, and divided into the general older adults (without hypertension or diabetes), older adults with hypertension, older adults with diabetes. A one-on-one questionnaire survey was conducted on all respondents (The questionnaire included the general demographic characteristics of the respondents and the abnormal detection in the health examination of the elderly) .

Among 3 018 older adults, 2 033 (67.36%) reported abnormalities in the health examination. There were statistically significant differences in the abnormal detection rates of health examination for the older adults with different types of residence, population, and household registration (P<0.05). Among 3 018 older adults, 1 174 (38.90%) self-reported abnormal blood pressure detection, 747 (24.75%) self-reported abnormal blood glucose detection, 719 (23.82%) self-reported dyslipidemia detection, 445 (14.74%) self-reported fatty liver detection, 393 (13.02%) reported overweight and obesity detection, 238 (7.89%) reported gallstones or cholecystitis detection, and 60 (1.99%) reported anemia detection. Abnormal blood pressure was detected in 49.13% of the older adults diagnosed with hypertension during the annual health examination, with the blood pressure control rate of 50.87%. Abnormal blood glucose was detected in 60.48% of the older adults diagnosed with diabetes during health examination with the control rate of blood glucose of 39.52%. Multivariate Logistic regression analysis showed that the detection rate of abnormal blood pressure was 2.57 times〔95%CI (2.01, 3.29) 〕 higher in the older adults with diabetes than in the general older adults; the detection rate of dyslipidemia was 1.64 times〔95%CI (1.29, 2.08) 〕 and 1.42 times〔95%CI (1.10, 1.84) 〕 higher in the older adults with hypertension and diabetes than in the general older adults, respectively; the detection rate of overweight and obesity was 2.79 times〔95%CI (1.94, 4.00) 〕 and 2.64 times〔95%CI (1.80, 3.87) 〕 higher in the older adults with hypertension and diabetes than in the general older adults, respectively; the detection rate of fatty liver was 2.10 times〔95%CI (1.55, 2.85) 〕 higher in the the older adults with hypertension than the general older adults; while the detection rate of anemia was 0.25 times〔95%CI (0.13, 0.47) 〕 and 0.47 times〔95%CI (0.25, 0.86) 〕 higher in the older adults with hypertension and diabetes than in the general older adults; the detection rate of dyslipidemia, gallstones or cholecystitis was 0.76〔95%CI (0.64, 0.90) 〕and 1.32〔95%CI (1.01, 1.73) 〕 times higher in the rural older adults than the urban older adults, respectively (P<0.05) .

The physical examination program for the elderly in the national essential public health services plays an important role in early detection and wareness of health problems.

The health care and health system reform is a worldwide issue. In 2009, China launched a new round of health care and health system reform. Over the past ten years, especially since the 18th National Congress of the Communist Party of China, the reform has brought tangible benefits to nearly 1.4 billion people. The decade of the new medical reform, which concentrates the interests of all parties, is a highlight of China's medical and health services. The discussion and demonstration of the reform effectiveness has become a hot topic in the academic field.

To sort out and analyze the data changes of the health status and equity of health service utilization of rural residents in Ningxia during the process of new medical reform and the reflected development effectiveness.

The baseline data was collected from the "Family Health Interview Survey for Rural Residents" in Ningxia in 2009, and the follow-up data in 2015 and 2019. The self-rated unhealthy rate and prevalence of chronic diseases were selected as indicators to measure the health status of residents, and the two-week consultation rate and hospitalization rate were selected as indicators to measure the health service utilization of residents. The concentration index (CI) and its decomposition method were used explore the health status and equity of health service utilization of rural residents in Ningxia in the past decade of the new medical reform.

During the decade of the new medical reform, the self-rated unhealthy rate of rural residents in Ningxia decreased, and the prevalence of chronic diseases increased year by year. The self-rated unhealthy rate in 2009, 2015 and 2019 was 20.37% (4 107/20 160), 17.75% (3 216/18 114) and 19.51% (3 527/18 074) ; the prevalence of chronic diseases was 13.01% (2 623/20 160), 19.45% (3 523/18 114) and 26.28% (4 750/18 074), respectively. The overall changes in health service utilization showed an upward trend, the two-week consultation rate in 2009, 2015 and 2019 was 6.43% (1 296/20 160), 5.66% (1 026/18 114) and 8.06% (1 457/18 074) ; the hospitalization rate was 8.89% (1 792/20 160), 10.66% (1 931/18 114) and 13.23% (2 392/18 074), respectively. Equity of health and health service utilization have been improved, the CI of the self-rated unhealthy rate of rural residents in Ningxia in 2009, 2015 and 2019 was -0.024 1, -0.095 2 and -0.098 0; the CI of the prevalence of chronic diseases in 2009, 2015 and 2019 was -0.001 3, -0.081 5 and -0.081 0, respectively; the CI of two-week consultation rate was 0.068 8, -0.011 3, -0.051 2, and the CI of two-week hospitalization rate was 0.039 0, -0.029 4, -0.061 2, respectively. The main influencing factors of equity gradually evolved from the relatively single phenomenon of economic income being the dominant factor to the situation where age, economic income, chronic diseases, education level and other factors interact in multiple ways.

The health status and equity of health service utilization of rural residents in Ningxia has been improved in the past decade of the new medical reform. However, more attention should be paid to new issues and inequities caused by the aging population and changes in social structure.

China is facing an increasing number of chronic disease patients. Health-related quality of life (HRQoL) is an important indicator assessing the effect of prevention and treatment measures for chronic diseases, so it is important to select an appropriate HRQoL measurement tool for these patients.

To compare the validity, consistency and correlation of the Chinese Medicinal Quality of Life scale (CQ-11D) , Short-form 6-dimension version 1 (SF-6Dv1) , and the 3-level version of EQ-5D (EQ-5D-3L) in terms of utility values measuring HRQoL in chronic disease patients, and to identify a scale that is most applicable to Chinese chronic disease patients.

From February 2021 to April 2021, this study recruited the initial sample of Chinese people using quota sampling with quotas based on sex and age from a total of 28 representative provinces, autonomous regions or municipalities selected from seven geographical regions (north China, northeast China, east China, central China, southwest China, northwest China, and south China, with 2 to 6 selected from each of the regions) . A face-to-face survey was used to collect the sample people's basic demographic information and the situation of chronic diseases, and self-reported HRQoL measured using the CQ-11D, SF-6Dv1 and EQ-5D-3L, respectively, then according to the survey results, those with chronic diseases were selected, and the utility values of the three scales in them were analyzed. Bland-Altman chart and intraclass correlation coefficient (ICC) were used to analyze the consistency and correlation of the three scales. Kruskal-Wallis H test was used for univariate analysis to determine whether or not there is a statistically significant difference between the utility values of the scales across age or sex groups.

A total of 692 chronic disease patients were finally included. The mean (standard deviation) of utility scores of CQ-11D, SF-6Dv1 and EQ-5D-3L scales were (0.855±0.168) , (0.793±0.132) and (0.876±0.136) , respectively. The top three prevalent chronic diseases were hypertension (n=275) , arthritis (n=128) and hyperlipidemia (n=124) . Histogram showed that EQ-5D-3L had obvious ceiling effect, and CQ-11D was more widely distributed. The Bland-Altman chart showed that the consistency between the three scales was relatively good, and the points within the 95% limits of agreement (LOA) were all about 95%. The strength of correlation between CQ-11D and visual analogue score (VAS) was the highest (P<0.001) . The ICC among the three scales ranged from 0.528 to 0.625, showing a moderate level of correlation (P<0.001) . Both Bland-Altman chart and ICC analysis showed that SF-6Dv1 and EQ-5D-3L had the best consistency. The results of analysis for the three chronic diseases in subgroups were similar to those in the total sample. Univariate analysis showed that male patients with hypertension or hyperlipidemia had higher utility scores of three scales than their female counterparts (P<0.05) . And the utility scores of three scales were the lowest in 60-year-olds and above among patients with hyperlipidemia.

The ceiling effect of EQ-5D-3L scale is obvious in patients with chronic diseases. CQ-11D demonstrated a wide range of distribution of utility values in measuring the three chronic diseases, which may be more suitable for measuring HRQoL in Chinese chronic disease population, as no ceiling effect was observed and its correlation with VAS was the strongest.

Exploring the factors affecting health service utilization is of great significance for optimizing the allocation of health services. Health-related quality of life (HRQoL) focuses on individuals' subjective self-assessment of their current health status, and may affect their health-seeking behaviors, but there are few studies on the impact of HRQoL on health service utilization of rural residents in China.

To explore the relationship between HRQoL and health service utilization of rural residents in Ningxia Hui Autonomous Region, and to provide a reference for the development of relevant policies/plans, and for the optimization health services in rural areas.

Data were collected from the Health Survey of Rural Residents Families 2019 conducted in four sample counties of Ningxia (Haiyuan, Pengyang, Xiji, Yanchi) from July to August 2019, involving 9 310 cases (≥15 years) with complete key information (gender, age, HRQoL-related indicators, health service utilization indicators). Detailed data of the residents were extracted, including socio-economic and demographic characteristics, health services accessibility, prevalence of chronic diseases, HRQoL measured using European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) and utilization of health services. The effects of health state utility values and visual analog scale (VAS) score on outpatient and inpatient health service utilization were analyzed by binary Logistic regression.

The utilization rates of outpatient and inpatient health services of rural residents in Ningxia were 10.85% (1 010/9 310) and 18.86% (1 756/9 310), respectively. The mean health state utility values and mean VAS score of them were (0.965±0.090) and (69.97±17.84), respectively. Difference testing showed that residents with impaired self-care (in the EQ-5D-3L descriptive system) had higher rates of using outpatient health services〔OR (95%CI) =3.197 (2.633, 3.883), P<0.001〕and inpatient health services〔OR (95%CI) =4.802 (4.059, 5.681), P<0.001〕compared with those with impaired mobility, usual activities, or higher level of pain/discomfort or anxiety/depression. Binary Logistic regression analysis showed that after adjusting for various confounding factors, health state utility values and VAS score were associated with the use of outpatient and inpatient health services (P<0.05). Moreover, the prevalence of chronic diseases also significantly affect the utilization of outpatient and inpatient health services (P<0.05) .

HRQoL and the prevalence of chronic diseases were leading factors affecting the utilization of outpatient and inpatient services in Ningxia rural residents. As an independent predictive factor of residents' health service utilization, HRQoL can be used to assist in the evaluation and monitoring of health service quality and effect, and provide guidance for rational allocation of health resources.

As the prevalence of hypertension in China's rural areas is very high, hypertension management in these areas is particularly important.

To summarize the characteristics and weaknesses of hypertension management in Shandong's rural areas using the Innovative Care for Chronic Conditions Framework (ICCC) proposed by the WHO, and to put forward targeted recommendations.

According to the socio-economic level and geographical distribution of hypertension prevalence, three county-level centers for disease control and prevention, 9 town health centers and 36 village clinics were selected from A county of Heze, B district of Jinan and C city of Weihai in Shandong Province, from which 84 cases (including individuals responsible for hypertension management programs, medical workers and hypertensive patients) were selected from June to July 2021 using a purposive sampling method to attend a face-to-face semi-structured interview for understanding the status of hypertension management in Shandong's rural areas. NVivo 12 and Qualitative Data Analysis Model proposed by MILES and HUBERMAN, were used to encode and analyse the interview results using the macro-, meso- and micro-level components of the ICCC.

A total of 13 themes and 51 subthemes were derived from the analysis at three levels. At the macro level, the implementation of hypertension management in Shandong's rural areas was generally in a positive policy environment, such as implementing national policies regarding chronic disease management and publicizing chronic disease management, but the policy framework was not complete, the integration within the departments in the health system was poor, and shortages of professional hypertension managers and sufficient financial support were serious. At the meso level, various medical institutions strived to promote the continuity of medical services, but the organization and deployment of family doctor teams and the promotion and use of information systems still needed to be further strengthened. At the micro level, the cooperation between patients and their families and the family doctor team needed to be improved, and the involvement of patients and their families in hypertension management should be enhanced as well.

The implementation of hypertension management in Shandong's rural areas is good generally, but the following efforts should be made for improvements: vigorously strengthening the leadership and supervision role of the government, formulating and integrating relevant policies, and promoting the integration of relevant departments; increasing financial support, and addressing the relatively shortage of health human resources and improving the weakness of informatization construction in rural areas to promote the delivery of high-quality medical services; attaching importance to the interaction between patients and families, health service team and community partners to promote patients' self-management.

Since the Internet dependence of the supply and demand sides of health popularization is increasing, eHealth literacy has become a primary skill that chronic disease patients need to master.

To analyze the current situation and existing problems of online health information usage habits and eHealth literacy in middle-aged and elderly residents, and discuss the relationship between online health information usage habits and eHealth literacy, providing a reference for improving the level of eHealth literacy and developing appropriate Internet-based health popularization services for these populations.

From June to September 2021, a questionnaire survey was conducted among 1 061 middle-aged and elderly residents in Shanghai communities selected by multistage sampling using the General Information Questionnaire and the Chinese version of the eHealth Literacy Scale (eHEALS-C) to understand their habits of using online health information and levels of eHealth literacy. Stepwise multiple linear regression was used to assess the association of habit of using online health information and other potential candidate factors with the level of eHealth literacy.

Altogether, 1 019 cases (96.04%) who effectively responded to the survey were included for analysis. Following health care accounts〔411 cases (40.33%) 〕was a major channel used for seeking online health information, followed by the search functionality or engines〔336 cases (32.97%) 〕, while the health apps or mini programs〔254 cases (24.93%) 〕, and online health communities〔65 cases (6.38%) 〕were less used. The online health information was less sourced from medical institutions〔397 cases (38.96%) 〕and medical workers〔187 cases (18.35%) 〕. The average total score of the eHEALS-C for the respondents was (27.62±8.57). The respondents scored lower in item 2〔 (3.36±1.27) points〕and item 6〔 (3.38±1.23) points〕of the eHEALS-C, indicating that they had low awareness of applying online health information to health problems, and low perceived skills at evaluating the online health information. Multiple linear regression analysis showed that age, participation in both basic and commercial medical insurance, using at least two channels for seeking online health information, having at least two sources of online health information, the habit of forwarding and sharing online health information, participation in collective online learning, and having an attitude of acceptance towards online health information were influencing factors of the level of eHealth literacy.

The eHealth literacy of these middle-aged and elderly residents is at a medium level, which is affected by online health information usage habits and other factors. To help them make better use of online health information and to improve their eHealth literacy, it is suggested to spread integrated authoritative information and retrieval platforms among these populations, give priority to supervision and elderly-oriented transformation of online health information platforms, and mobilize community, family, health associations, and commercial medical insurance institutions to co-deliver health-promotion services targeting these people.

The association of adverse childhood experiences (ACEs) with chronic disease prevalence among middle-aged and elderly people has become a research hot spot, but the association between ACEs and self-rated health in older people is still unclear, and relevant studies in Chinese population are especially rare.

To explore self-rated health in Chinese elderly people, and its association with ACEs.

The study was conducted in October 2021. Data about ACEs and self-rated health were acquired by applying from the 2014 and 2018 waves of CHARLS conducted by Peking University, involving 7 579 older people (≥ 60 years old) . The ACEs were stratified into three groups by the times of ACEs events (10 kinds in total) : high-risk (4 or more) , low-risk (1-3) , and reference (zero) . The self-rated health was divided into three levels: good, fair and poor. Ordinal logistic regression was used to analyze the correlation of self-rated health with the number and types of ACEs events.

Among the participants, the prevalence of good, fair and poor self-rated health was 22.06% (1 672/7 579) , 59.03% (4 474/7 579) , and 18.91% (1 433/7 579) , respectively, and the prevalence of experiencing ≥4, 1-3 and no ACEs events was 25.36% (1 922/7 579) , 69.71% (5 283/7 579) , and 4.93% (374/7 579) , respectively. The self-rated health differed significantly by age, gender, place of living, and types of ACEs (parental divorce, parental violence, parental depression, parental disability, living in an unsafe neighborhood, childhood loneliness, childhood famishment, bullying) (P<0.05) . The self-rated health also differed significantly across the three groups stratified by the number of ACEs events (P<0.05) . Univariate ordinal logistic regression analysis indicated that the probability of a worse self-rated health increased by a factor of 1.358〔95%CI (1.110, 1.663) 〕in those with 1-3 ACEs events, and increased by a factor of 2.151 in those with 4 or more ACEs events compared with those with no ACEs events (P<0.05) . The ordinal Logistic regression analysis indicated that results showed that parental divorce, parental violence, parental depression, parental disability, living in an unsafe neighborhood, childhood loneliness, childhood famishment, and bullying were associated a worse self-rated health (P<0.05) . The statistical results remained unchanged after adjusting for age, gender and place of living.

The self-rated health status in Chinese older people was generally fair. To improve the self-rated health to promote healthy aging in this population, interventions could be provided for them targeting reducing the negative influence caused by parental divorce, parental violence, parental depression and disability, living in an unsafe neighborhood, childhood loneliness, and childhood famishment.

Health-related quality of life (HRQoL) is a key indicator that is used for evaluating clinical outcomes. Infertility-specific HRQoL instruments have been widely used, but it is uncertain whether these instruments have good measurement properties in clinical application, and there is a lack of quality evaluation for them.

To perform a systematical review and evaluation of HRQoL instruments in infertility patients, offering a rational reference for the selection of these instruments.

In October 2020, PubMed, Web of Science, the Cochrane Library, EmBase, CNKI, WanFang Data, CQVIP, and SinoMed databases were searched from inception to October 5, 2020 to identify studies on HRQoL instruments designed for or assess HRQoL for patients with infertility. Two reviewers independently implemented literature screening, data extraction, and methodological quality assessment of the included studies in terms of the process of developing infertility-specific HRQoL instruments and measurement properties of the instruments using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Descriptive analysis was used to summarize and analyze the assessment results.

We included 229 studies on 19 HRQoL instruments, including 4 infertility-specific HRQoL instruments〔TLMK (Tübinger Lebensqualit?tsfragebogen für M?nner mit Kinderwunsch) , the Fertility Quality of Life (FertiQoL) , Quality of Life in Infertile Couples Questionnaire (QOLICQ) , Quality of Life in People with Infertility Induced by Liver Qi Stagnation Identified by Chinese Medicine Theory〕, 4 cancer-specific or other disease-specific HRQoL instruments and 11 generic HRQoL instruments. The FertiQoL was the most frequently used in existing studies〔39.1% (91/233) 〕. Regarding the development of PROMs, of the 4 infertility-specific HRQoL instruments, except for the FertiQoL instrument, whose overall development quality was considered "doubtful", the overall development quality of the other three instruments was considered "inadequate". In terms of the content validity, the methodological quality of the studies on FertiQoL and QOLICQ development was rated "very good" and "doubtful", respectively, while that of the study on the TLMK or Quality of Life in People with Infertility Induced by Liver Qi Stagnation Identified by Chinese Medicine Theory scale development was rated "adequate". In terms of the construct validity, except for the study on QOLICQ development, which was of "doubtful" methodological quality, the methodological quality of studies on the other three instruments development was considered "adequate". And the construct validity was rated "indeterminate" for all these 4 instruments. In terms of the internal consistency, the methodological quality of studies on the development of the 4 instruments was rated "very good", and the internal consistency of the 4 instruments was rated "sufficient". Regarding the test-retest reliability, the methodological quality of the study on QOLICQ development was considered "doubtful" and the test-retest reliability of the instrument was rated "indeterminate". The methodological quality of studies on the Quality of Life in People with Infertility Induced by Liver Qi Stagnation Identified by Chinese Medicine Theory scale development was rated "very good" in terms of criterion validity, and the criterion validity of the instrument was rated "sufficient". The methodological quality of the study on TLMK instrument development was rated "very good" in terms of criterion validity, and the criterion validity of this instrument was rated "sufficient". As for responsiveness/sensitivity, the methodological quality of the study on FertiQoL development was rated "very good", and the responsiveness/sensitivity of the instrument was rated "sufficient".

The methodological quality of the study on the development of FertiQoL and the measurement properties of the instrument were much higher. The number of Chinese infertility-specific HRQoL instruments is insufficient and needs more relevant studies.

The pairwise correlation among biased constitution, exercise and health-related quality of life (HRQOL) has been extensively studied, while the relationship among the three has been rarely explored.

To explore the mediating effect of exercise on the relationship of 8 kinds of biased constitution with HRQOL.

By use of convenience sampling, unpaid blood donors and their companions were selected as participants from blood donation cabins and blood collecting vehicles of Beijing Red Cross Blood Center from July to November 2015 and May to September 2016 . The exercise level was obtained by the self-report method. The biased constitution was assessed using the Constitution in Chinese Medicine Questionaire (CCMQ) . The HRQOL was evaluated by the Chinese version of the 36-Item Short Form Health Survey (SF-36) , and a higher score indicates a higher quality of life. Pearson correlation analysis was used to explore the correlation among HRQOL (score of SF-36) , exercise level and 8 kinds of biased constitution. Multiple linear regression model was applied to explore the mediating effect of exercise on the relationship between HRQOL and biased constitution.

A total of 1 828 cases attended the survey, 1 771 of them returned questionnaires, and after excluding 29 who inappropriately (incompletely or illogically) answered questionnaires, the remaining 1 742 cases (95.30%) were included for analysis. The mean SF-36 score of 1 742 subjects was (84.42±12.05) points. And the mean scores of the 8 biased constitution subscales of CCMQ for them were: qi-deficiency: (23.20±14.61) points, yang-deficiency: (20.03±18.12) points, yin-deficiency: (20.87±15.20) points, phlegm-dampness: (19.78±14.65) points, dampness-heat: (21.70±16.57) points, blood-stasis: (17.68±14.08) points, qi-depression: (19.63±15.63) points, specific-diathesis: (15.30±13.62) points. The score of each of the 8 kinds of biased constitution was negatively correlated with HRQOL (r: -0.413 - -0.612, P<0.01) . Except for specific-diathesis type, biased constitution scores were negatively correlated with exercise level (r: -0.072 - -0.176, P<0.01) . Exercise level was positively correlated with HRQOL (r=0.145, P<0.01) . Mediation analysis revealed that, exercise played a significant mediating effect on the relationship between HRQOL and biased constitution except the specific-diathesis type (P<0.05) . And the size of mediating effect in a descending order was 2.13% between HRQOL and phlegm-dampness, 2.05% between HRQOL and yang-deficiency, 1.88% between HRQOL and dampness-heat, 1.55% between HRQOL and yin-deficiency, 1.48% between HRQOL and blood-stasis, 1.37% between HRQOL and qi-depression, 1.16% between HRQOL and qi-deficiency.

Eight kinds of biased constitution (phlegm-dampness, yang-deficiency, dampness-heat, yin-deficiency, blood-stasis, qi-depression, qi-deficiency, and specific-diathesis) negatively affected the HRQOL. Although exercise partially played a role in mediating the relationship of HRQOL with the other 7 types of biased constitution except specific-diathesis, the effect size was generally little.

The prevalence of health problems in Chinese children and adolescents is high. The mention of myopia, obesity, caries, scoliosis and other health problems in adolescents in the Healthy China 2030 Initiative Indicates that these problems have become the national concerns. The establishment of a long-term, standardized disease screening and management mode by the community health center (CHC) in combination with schools in service coverage areas of the CHC will provide a new idea for strengthening the health management of children and adolescents by the CHC.

To perform posture assessment and vision screening in full-time students receiving the nine-year compulsory education in schools in the service coverage area of Chaohe Community Health Center of Zhengzhou Economic-Technological Development Area using a CHC-school-based approach, to identify problems in disease screening and management for children and adolescents, to analyze the practice and advantages of CHC-school-based disease screening and management, and to develop a CHC-school-based health management model for children and adolescents.

This study was conducted from May to November 2021. Cluster sampling was used to select grades 1-9 full-time students (n=11 318) in 225 classes of 6 primary schools and 3 middle schools in the areas covered with health services delivered by the Chaohe Community Health Center of Zhengzhou Economic-Technological Development Area. All of them received posture assessment and vision screening.

Among the participants, 6 260 were male and 5 058 were female; 7 979 were pupils, and 3 339 were junior high school students. The prevalence of abnormal posture was 41.34% (4 679/11 318) . With the increase of grade, the prevalence of uneven shoulders, thoracic kyphosis, scoliosis, O-shaped legs, and toe valgus increased, while that of knee hyperextension, flat feet and pes valgus decreased (P<0.05) . The prevalence of 1, 2, 3 and 4 or more abnormal postures was 29.13% (3 297/11 318) , 8.60% (973/11 318) , 3.01% (341/11 318) , and 0.60% (68/11 318) , respectively. Male students had higher prevalence of thoracic kyphosis, scoliosis, flat feet and toe valgus, and lower prevalence of knee hyperextension, X-shaped legs, O-shaped legs and foot valgus than female students (P<0.05) . The prevalence of abnormal vision was 74.99% (8 486/11 318) . The prevalence of myopia, hyperopia, and astigmatism was 41.75% (4 725/11 318) , 26.14% (2 959/11 318) , and 7.09% (802/11 318) , respectively. With the increase of grade, the prevalence of myopia increased and that of hyperopia decreased (P<0.05) .

At present, the abnormal posture rate of children and adolescents in Zhengzhou is about 40%, and the myopia rate exceeds 40%. With the increase of grade, the prevalence of uneven shoulders, thoracic kyphosis, scoliosis, O-shaped legs, toe valgus and the prevalence of myopia increased, but there is a lack of effective and normal screening and health management systems. As the hospital-school approach could improve the effectiveness and normalization of the health screening and management for children and adolescents, so this approach is recommended to be used in further improvement of the top-level design and efficacy assessment of health management in children and adolescents. In addition to CHC school-based management, the health management of children and adolescents also involves the efforts of themselves and their families, which is equally important as the former two.

Nephrotic syndrome (NS) is a common chronic kidney disease in children, and has a long treatment cycle with being prone to recurrence and refractoriness. Adverse effects caused by therapeutic drugs and concerns about disease prognosis may all affect the child's physical and mental health, and quality of life. Therefore, it is very necessary to understand the Health-related Quality of Life (HRQOL) of children with nephrotic syndrome.

To understand the level of HRQOL in children with nephrotic syndrome.

Children (aged 2-18 years) with nephrotic syndrome and their parents were recruited from the Department of Pediatric Nephrology Rheumatism and Immunology, Shengjing Hospital of China Medical University between October 2019 and December 2020. Data were collected on age, gender, disease duration, whether they had frequent relapses, number of relapses, and whether they were prescribed immunosuppressive agents (including cyclophosphamide, tacrolimus, etc.) , place of residence (urban, rural, urban-rural junction areas) . The PedsQL 4.0 core generic scale was used to understand the level of HRQOL (including the child self rating scale and parent report) in children with primary NS.

A total of 183 questionnaires were distributed, and 174 valid questionnaires were returned, with an effective recovery rate of 95.1%. Among the 174 children, 119 were males and 55 were females. Median age was 6 (4, 11) years. There were 100 children with recurrence (57.5%) , with a median number of 3 (1, 5) recurrences. 54 patients had frequent recurrences and 46 patients had non frequent recurrences. 31 patients were treated with immunosuppressants. The usual place of residence was urban in 86 patients, rural in 63 patients, and urban-rural junctions in 25 patients. The ICC of the concordance analysis between the children's self-rating scale and the parent-reported scale were both greater than 0.75. There were no significant differences in physiological scores, emotional scores, social scores, role scores and total scores between genders (P>0.05) . There were statistically significant differences in physiological scores, emotional scores, social scores and total scores among different ages (P<0.05) . However, there was no significant difference in the role scores at different ages (P>0.05) . There were no significant differences in the physiological scores, emotional scores, social scores, role scores, and total scores among different disease durations (P>0.05) . There were no significant differences in the physiological score, emotional score, social score, role score and total score between children with and without frequent recurrence (P>0.05) . The emotional scores, social scores, and total scores were significantly different between children who used immunosuppressants and those who did not use (P<0.05) , and those who did not apply immunosuppressants achieved a higher score. There were no significant differences in the physiological scores, emotional scores, social scores, role scores and total scores among different family residing places (P>0.05) .

The scores of children with NS in physical, emotional, social, and role functioning were reduced. When treating the disease, clinicians need to focus on the children's physical, psychological and social adaptability, and intervene in time to improve their quality of life.

In the social situation of "three child" policy opening and late marriage to become the norm, the topic of female reproduction and health has attracted increasing attention. As one of the important markers of ovarian reserve in women, the relationship between anti-Mullerian hormone (AMH) and cardiovascular disease and cardiovascular risk indicators has become a hot research issue.

To establish a reference range of AMH in healthy women of reproductive age in Urumqi region, and to investigate the association between AMH and risk factors associated with cardiovascular disease.

From May to July 2018, healthy women aged 19-50 years who met the criteria were selected from the natural population of a community-based epidemiological survey with four living residents area in Urumqi city by targeted sampling, and the serum AMH, fasting plasma glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triacylglyceride (TG), serum uric acid, and thyroid stimulating hormone (TSH) levels of the survey subjects were tested. Height, body mass, abdominal circumference, hip circumference, blood pressure, and other indicators were measured to analyze the relationship between AMH and the above indicators related to cardiovascular risk factors.

The median AMH among 855 healthy women of reproductive age was 1.58 (0.01, 8.78) μg/L. The reference range of AMH in healthy women of reproductive age in our region was established, that was, 0.89 to 10.94μg/L for 19-24 years old, 0.66 to 11.77 μg/L for 25-29 years old, 0.27 to 8.25μg/L for 30-34 years old, 0.01 to 6.87μg/L for 35-39 years old, 0.01 to 3.98μg/L for 40-44 years old, <0.01-1.87μg/L for 45-50 years old. Spearman correlation analysis showed that AMH was negatively correlated with age, body fat index (BMI), abdominal circumference, hip circumference, systolic blood pressure, diastolic blood pressure, TSH, TC, LDL-C (P<0.05), but not with blood glucose, TG, HDL-C, uric acid (P>0.05) .

In this study, the reference range of serum AMH in healthy women of reproductive age in Urumqi was established, which may provide a basis for the functional assessment of ovarian reserve in women of different ages. Low AMH levels in women of reproductive age are associated with cardiovascular risk factors such as increased age, obesity, abdominal obesity, hypertension, and hyperlipidemia.

The prevalence of synthetic drug abuse is high. In China, synthetic drugs have become the most commonly abused drugs characterized by strong addiction and great difficulty in quitting. The addicts are easily prone to serious psychological dependence and other psychological problems, which leading to relapse after withdrawal treatment. Therefore, exploring the influencing factors of mental health status in individuals addicted to new synthetic drugs has clinical and social significance for the prevention and management of synthetic drug addicts.

To explore the associated factors of mental health status and their intercorrelations in individuals addicted to new synthetic drugs.

One hundred and ninety-six people getting addicted to new synthetic drugs with inpatient withdrawal treatment were selected from Ankang Hospital of Tianjin Municipal Public Security Bureau from January 2018 to April 2019. Sociodemographic data and drug abuse-related clinical data were collected. The Symptom Checklist-90 (SCL-90) , Eysenck Personality Questionaire-Revised, Short Scale For Chinese (EPQ-RSC) , and Simplified Coping Style Questionnaire (SCSQ) were used to investigate the mental health. Spearman rank correlation analysis was used to analyze the inercorrelations of the influencing factors of mental health. SPSS 22.0 software was used for statistical analysis, and AMOS 22.0 was used to build a model for path analysis of data.

The average total score of SCL-90 rated by the participants was (206.62±26.66) , which was higher than that rated by Chinese norm (P<0.001) . Moreover, the average score of each domain rated by the participants was also higher that rated by Chinese norm (P<0.001) . Spearman rank correlation analysis showed that the total score of SCL-90 was negatively correlated with age (r_s=-0.285, P<0.001) , and positive coping (r_s=-0.749, P<0.001) , but was positively correlated with economic income (r_s=0.210, P=0.003) , daily dose of a new synthetic drug (r_s=0.375, P<0.001) , negative coping (r_s=0.754, P<0.001) , and dimensions of personality traits 〔psychoticism (r_s=0.915) 、introversion and extroversion (r_s=0.748) 、neuroticism (r_s=0.549) 、lying (r_s=0.979) , P<0.001) 〕. Path analysis revealed that personality traits and coping styles could directly or indirectly affect the mental health status, and coping styles played a partial mediating role in the relationship of personality traits with mental health status.

The prevalence of normal mental health was low in people addicted to new synthetic drugs, which was mainly associated with personality traits and coping styles. In view of this, it is suggested to improve the mental health of these addicts by taking actions to develop positive coping styles and reduce negative coping styles according to their personality traits.

The changing disease spectrum of Chinese residents poses great challenges to the healthcare delivery. Understanding patients' health literacy and influencing factors is helpful to improve doctor-patient communication, promote patients' health and alleviate the pressure of healthcare delivery. However, the number of studies on patients' health literacy is insufficient, and most of them focus on those with a special illness.

To understand the status of health literacy and its influencing factors among Chinese outpatients, providing a scientific basis for improving patients' health status and self-management ability, and for medical workers to perform patient education and instruction, disease management and relevant improvement.

A systematic sampling method was used to select 14 secondary or tertiary general hospitals in eight regions in eastern, central and western China as survey settings, and outpatients (≥15 years old) of them during January to May 2021 were randomly selected and surveyed using the Patient Health Literacy Scale (PHLS) 〔those with scores <41 were deemed unlikely to have health literacy; those with scores ≥55 were judged as having high level of health literacy; those with scores between 41 and 54 were regarded as having moderate level of health literacy〕. The health literacy level of outpatients was compared by various personal factors. Ordinal and multinomial Logistic regression analyses were used to analyze the influencing factors of health literacy.

Altogether, 2 808 cases who handed in responsive questionnaires were included for final analysis. The average score of PHLS in the respondents was (43.38±6.25) . The prevalence of health literacy, and high level of health literacy was 68.38% (1 920/2 808) , and 6.93% (133/2 808) , respectively. The level of health literacy varied obviously by age, education level, occupation, average household monthly income per person, prevalence of a family member working as a healthcare worker, and prevalence of using the way of acquiring health information (from medical workers, family members, friends or coworkers, activities conducted by the work unit or the community, listening to the radio, watching television, reading a newspaper/book, searching the Internet, or other approaches) (P<0.001) . Higher educational level and average household monthly income per person were associated with higher level of health literacy (P<0.001) . Being a student, worker of an industrial/mining enterprise, retailer or server was associated with higher level of health literacy (P<0.05) . Acquiring heath information from healthcare workers and searching the Internet were associated with higher level of health literacy (P<0.05) .

On the whole, the health literacy was moderate in outpatients of the 14 general hospitals. To improve the health literacy level in this population, it is suggested to improve the levels of health education and guidance for them by strengthening the key role of healthcare workers in health information delivery, giving more concerns to the low educated or low-income earners, and increasing the ways of acquiring health information.

In China, a country owning a large number of hypertensive patients, offline management is still a major approach for hypertension prevention and control, but the efficiency and effectiveness of this approach are unsatisfactory. Therefore, it is necessary to develop a closed-loop hypertension management path using online management approaches actively explored based on cognitive-behavioral models.

To assess the effect of cognitive-behavioral change model-based online health education in the management of hypertension.

A total of 122 essential hypertension outpatients and inpatients were recruited from General Practice Department, General Hospital of Medical University of Ningxia Medical University from November 2018 to October 2019, and randomly divided into online management group (n=61) and off-line management group (n=61) . Off-line management group received routine management. Online management group received online health education (including systematic courses and personalized self-management information in line with the five stages of behavior transformation of hypertension patients provided via the WeChat platform for gradually changing their health-related behaviors) based on the cognition-behavioral change model (a model built upon improved knowledge-attitudes-behavior model, health belief model, and transtheoretical model) . Systolic blood pressure (SBP) and health-related behaviors at baseline and 12 weeks after intervention were compared between the groups.

The average SBP levels at baseline demonstrated no significant difference between the groups (P<0.05) . After intervention, the average SBP level decreased significantly in both groups (P<0.05) , and it decreased more significantly in the online management group (P<0.05) . Two groups showed no significant differences in the prevalence of self-monitoring blood pressure, taking medications, eating a diet and exercising as well as taking actions to improve psychological state according to the doctor's advice at baseline (P<0.05) . After intervention, the prevalence of self-monitoring blood pressure according to the doctor's advice was significantly increased in the online management group (P<0.05) although the prevalence of other four of the above-mentioned health-related behaviors was still similar in both groups (P<0.05) .

This hypertension management approach developed based on mobile health technologies and the cognition-behavioral change model could help general practitioners to effectively manage hypertension patients, which will contribute to the improvement of work efficiency of general practitioners, and the achievement of long-term preservation and real-time analysis of patient management data. So this management is worthy of application and promotion.

China has a large baseline number of patients with hepatitis B virus (HBV) -related chronic liver disease, and it is urgently to contain HBV infection prevalence. To do this, the issue that needs to be addressed quickly is transforming the hospital-based management into community-, hospital-, patient- and society-based management.

To quantify preferences of health management in patients with HBV-related chronic liver disease from Hubei Province, providing a basis for the development of strategies for containing chronic hepatitis disease and for managing such patients.

From July 2018 to July 2019, a discrete choice experiment survey was carried out with a multistage random sample of 180 patients with HBV-related chronic liver disease recruited from three cities (Wuhan, Shiyan, and Xiangyang) of Hubei Province using a questionnaire for collecting their general information, and preferences related to health management (choice sets in the discrete choice experiment consist of place for regular health checkups, average monthly expense for health management of HBV-related chronic liver disease, followed health management, and ways of accessing health management information of HBV-related chronic liver disease with different options) . The mixed Logit model developed in 15.0 was used for data analysis.

The response rate of the survey was 89.4% (161/180) . Patients were more tended to choose a management pattern with lower average monthly expense, a hospital as the place for regular medical examinations, self-management or accessing health management information using offline approaches (P<0.05) . The amount of an additional monthly expense that the patients were willing to pay was 256.75 yuan if the place for regular health checkups was changed to a hospital from a community, 96.87 yuan if the management pattern was changed to self-management from a patient support group-based management, and 52.94 yuan if the approaches for accessing health management information were changed to offline from online. Compared with other choices, the change in the place for regular health checkups from a community to a hospital was the most popular in the patients (willingness increased by 87.29%) .

Patients with HBV-related chronic liver disease preferred to undergo regular health checkups and access health management information in hospitals, but were less likely to contract a family doctor or invest in health. To improve the containment of chronic liver disease, we put forward the following recommendations: strengthening hospitals' capabilities in treating HBV-related chronic liver disease, and their services delivered by a family doctor team, guiding patients to change the idea of "focusing on treatment rather than prevention", and delivering integrated online and offline services.

The mental health of trainees receiving the three-year standardized general practice residency program (SGPRP) has been valued recently, and psychological problems are considered to be one major type of causes of their failure to complete the full training. So understanding the mental health status and associated factors of psychological problems in these GP trainees are of important significance for the development of residency training policies and programs.

To explore the mental health status and causes of psychological problems in GP trainees of SGPRP, improving the attention of SGPRP managers and the society given to the mental health of GP trainees.

This was a mixed-method sequential explanatory study. In January 2021, by use of convenience sampling, all in-service GP trainees of SGPRP were recruited from Peking University Shenzhen Hospital to attend a self-administered survey to complete the Demographic Questionnaire compiled by our research team and the Symptom Checklist 90 (SCL-90) . The total score and domain scores of the SCL-90 were analyzed overall, then were compared among the trainees by grade. For understanding the main life events triggering emotional or psychological problems and their associations with residency training program or specialty, and GP trainees' preferred assistance as well as suggestions for the development of SGPRP, from February to June 2021, purposive and heterogeneous sampling were used to recruit GP trainees with mental health assessment to attend an in-depth, semi-structured interview using phenomenological research procedure. The interview results were recorded, and transcribed, then coded using NVivo 12, and analyzed using Colaizzi's seven-step analysis and thematic analysis.

All GPs (n=84) responded to the survey, with a 100% response rate. The mean total SCL-90 score and the mean total symptom index for 84 GP trainees were (149.61±50.55) , and (1.66±0.56) , respectively. Of them, 29 (34.5%) had a total score≥160. The prevalence of obsessive-compulsive, depression, interpersonal sensitivity, anxiety, paranoid ideation, anger-hostility, psychoticism, somatization and phobic-anxiety (prevalence of symptoms in each domain was defined as domain score≥2) was 53.6% (45/84) , 39.3% (33/84) , 34.5% (29/84) , 26.2% (22/84) , 22.6% (19/84) , 21.4% (18/84) , 19.0% (16/84) , 14.3% (12/84) , and 14.3% (12/84) , respectively. The depression domain score varied significantly across GP trainees by grade (P<0.05) . The prevalence of depression was 48.4% (15/31) in grade 2 GP trainees. In total, 21 GP trainees attended the interview, 14 (66.7%) of whom had a total SCL-90 score≥160. Four themes emerged from the analysis: impact of personal problems on psychological status; harm and benefits caused by interpersonal interactions at work; psychological stress related to the residency base; lack of confidence related to specialty choice.

The high prevalence of psychological problems in GP trainees may be closely related to personal factors and problems encountered during residency training. In view of this, psychological guidance and crisis intervention should be listed as an important part of residency training management, and efforts should be made to enhance the trainees' sense of existence and belonging as well as self-confidence, thereby helping them to successfully complete the training.

Cross-sectional studies have shown that the level of bilirubin in vivo is related to the progression of atherosclerosis, but the data from large-scale studies in China and even in the world are very limited.

To investigate the effect of serum total bilirubin (TBIL) and indirect bilirubin (IBIL) on the progression of carotid atherosclerosis in healthy people.

Retrospective cohort study was adopted to select 11 394 healthy people who had continuous physical examination and carotid intima-media thickness (cIMT) ≤1 mm displayed by carotid artery ultrasound examination as the research subjects in Hebei General Hospital from January 2010 to December 2019. Demographic characteristics, past medical history, physical examination, laboratory examination results of previous physical examination, carotid artery ultrasound and other information of subjects were collected. The subjects were divided into the progressive carotid atherosclerosis group and the non-progressive group according to whether cIMT increased during follow-up. The Cox proportional regression model was used to explore the effect of bilirubin on the progression of carotid atherosclerosis, and Cox regression analysis was performed by gender, age, body mass index (BMI) , hypertension, diabetes, smoking and alcohol consumption.

1 586 cases of carotid atherosclerosis progression were detected in 10 years, with a cumulative incidence rate of 13.9%. The results of Cox regression analysis showed that for every 1 standard deviation increase in TBIL and IBIL levels, the risk of carotid atherosclerosis progression decreased by 6.6% and 17.4%, respectively〔HR (95%CI) =0.934 (0.881, 0.990) ; HR (95%CI) =0.826 (0.777, 0.877) 〕 after adjustment for age, sex, BMI, smoking, alcohol consumption, hypertension, diabetes, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, triglyceride, alanine aminotransferase and estimated glomerular filtration rate. Subgroup analysis showed that there was no statistical difference in the protective effects of TBIL and IBIL on different subgroups.

TBIL and IBIL levels are independent protective factors for the progression of carotid atherosclerosis in healthy subjects. Elevated bilirubin levels reduce the risk of carotid atherosclerosis progression, with IBIL being more potent in preventing carotid atherosclerosis progression.

The creation of health records for Chinese residents is a key task for deepening the reform of the pharmaceutical and healthcare system, and an important action for promoting the equity of essential public health services. However, domestic studies on resident health records are mainly using the data from a city or community, and those using the national data from a demand-side perspective are rather scarce.

To understand the creation and utilization of health records in Chinese residents.

From November to December 2019, multistage sampling was used to select three provinces/municipality (Zhejiang, Shanxi and Chongqing) from eastern, central and western China (one was extracted from each geographical region) , then from each of them, one urban district and one county were extracted. Randomly selected 2 community health centers/stations, township health centers/village clinics in the corresponding districts (counties) . Finally, 20 community health service centers/township health centers were selected, the visitors of these institutions were invited to attend a questionnaire survey for understanding their information about the creation of health records, and the access to the health records, as well as satisfaction with the services. For ease of analysis, the visitors were classified into six categories (0-6-year-olds, pregnant women, over 65-year-olds, hypertensioners, diabetics, and general population) in accordance with the population groups defined in the Essential Public Health Service Programs.

Altogether, 10 067 residents were included for final analysis. Among them, 9 119 (90.58%) self-reported that they had received health records creation services. The rates of creation of health records in 0-6-year-olds, pregnant women, over 65-year-olds without hypertension/diabetes, over 65-year-olds with hypertension, under 65-year-olds with hypertension, over 65-year-olds with diabetes, and under 65-year-olds with diabetes, as well as general population were 94.09% (2 787/2 962) , 95.60% (956/1 000) , 87.87% (616/701) , 88.87% (1 414/1 591) , 92.91% (747/804) , 89.41% (895/1 001) , 92.72% (471/508) , and 82.20% (1 233/1 500) , respectively. Among those with health records created, 67.02% (5 990 / 8 938) could access to their health records at any time, and the health records accessed by most of them were printed〔75.76% (4 538/5 990) 〕. However, 12.40% (1 108/8 938) of residents reported that they had no access to their health records, and other 20.59% (1 840/8 938) indicated that they had never tried to gain access to their health records. The rate of satisfaction with health records services in residents was 83.31% (4 352/5 224) . The rate of health records creation and rate of accessing the health records differed significantly by province, district or country, household monthly income per person, education level, and category of population (P<0.05) . The rates of satisfaction with the creation of and access to health records differed significantly by province, type of visited health institution, district or country, household monthly income per person, education level, and category of population (P<0.05) .

Generally, the rate of creation of health records in Chinese residents has significantly increased. The rate of utilization of the records has also enhanced, but needs further improvement. Moreover, residentssatisfaction with health records services may be at a moderate level.

Bigu is a health-preserving regimen with a long history advocating appropriately reducing food intake in China, whose efficacy has been confirmed in practical treatment of some diseases currently. However, the applicability of Bigu in human experiments is poor due to nonforcible control of dietary intake in the participants.

To assess the effect of medicine-qi intake type of Bigu in healthy people using real-world data.

Two hundred and eighty healthy volunteers were recruited from Sichuan Nursing Vocational College from November 2018 to September 2020, and equally divided into two groups (A and B, with 140 cases in each) after being matched using k-nearest neighbor propensity score approach based on their demographics, and received a two-round Bigu trial: in the first round, group A received 10-day diet-restriction type of Bigu, while group B received 10-day medicine-qi intake in combination with diet-restriction type of Bigu. Then, after one-month washout period, the second round was conducted, during which group A received 10-day medicine-qi intake in combination with diet-restriction type of Bigu, while group B received 10-day diet-restriction type of Bigu. Comparisons were performed between two groups in terms of incidence of adverse reactions and number of dropouts in two rounds of Bigu, and subjective hunger sensation, weight, BMI, morning blood pressure, and fasting fingerstick glucose on the first and 10th days of two rounds of Bigu.

After being assigned by PSM, there were 72 males and 80 females in group A; 61 males and 67 females in group B. In the first round, the incidence of adverse reactions in group A was 65.7% (92/140) , and the trial discontinuation rate was 48.6% (68/140) ; the incidence of adverse reactions in group B was 42.9% (60/140) , and the trial discontinuation rate was 20.0% (28/140) . The incidence of adverse reactions and trial discontinuation rate in group A were higher than those in group B, and the difference was statistically significant (P<0.05) . In the second round, the incidence of adverse reactions in group A was 29.2% (41/140) , and the trial discontinuation rate was 13.6% (19/140) ; the incidence of adverse reactions in group B was 60.0% (84/140) , and the trial discontinuation rate was 42.1% (59/140) . The incidence of adverse reactions and trial discontinuation rate in group A were lower than those in group B, and the difference was statistically significant (P<0.05) . The subjective hunger sensation score at the end of the first round was higher than that before the beginning, and the subjective hunger sensation score in group B at the end was lower than that before the beginning, and the difference was statistically significant (P<0.05) . The subjective hunger sensation score at the end in the second round of group A was lower than that before the beginning, and the difference was statistically significant (P<0.05) . The body weight, BMI, systolic blood pressure, diastolic blood pressure, and fasting blood glucose of groups A and B at the end of the 2-round test were all lower than those before the start of the test, and the difference was statistically significant (P<0.05) .

This real-world trial demonstrates that the medicine-qi intake type of Bigu may reduce the subjective hunger sensation, and incidence of adverse reactions as well as enhanced the completion rate of Bigu in healthy population, which may be used as a recommended scheme for the promotion of Bigu.

All levels of China gevernment departments have attached importance to community health management services, an important way for disease prevention and resident saveealth improvement, and successively promulgated relevant management policies. However, there is a lack of systematic review and research on the diffusion paths and characteristics of these policies, which are still unclear due to the diversity of promulgating agencies and types of polices.

To explore the process and features of the diffusion of China community health management policies, providing a reference for the formulation and promotion of these kinds of policies.

From June to September 2021, we searched policy documents related to community health management services published from January 1997 to September 2021 in the official websites of all levels of government and health administrative departments, as well as authoritative databases such as PKULAW.com and so on, then quantitatively analyzed the process and features of diffusion of them in terms of four aspects (intensity, breadth, speed, and direction of diffusion) using policy network analysis and keyword analysis by time series.

A total of 1 540 policies related to community health management were retrieved (including 159 central policies and 1 381 local policies) . The development of community health management services in China may be divided into five stages: germination (1997—2004) , formation (2005—2008) , transition (2009—2012) , initial development (2013—2015) and innovation and development (2016—2021) . Policies which were diffused more intensively and widely were promulgated by central agencies of higher administrative levels, and mainly classified as planning, opinions, and laws. The absolute diffusion breadth of the top 10 policies in terms of diffusion intensity exceeded 30, and the absolute diffusion breadth of the top 10 policies in terms of spreading breadth exceeded 20. The diffusion speed of most policies showed a trend of first increasing and then slowing down over time. The diffusion of Chinese medicine health management policies mainly presented parallel diffusion among policy promulgating agencies at the same level, and top-to-bottom diffusion from the central policy promulgating agencies to the local ones.

Through policy diffusion research, we had a comprehensive understanding of the process and characteristics of diffusion of China's community health management policies, and drew a number of conclusions, including the five-stage development of these policies, and the policy diffusion process may be affected by the attributes of the administrative level of the promulgating agencies and types of policies. In addition, the diffusion of these policies could be achieved via multiple paths, with many mechanisms of action such as learning and imitation, with a speed of "first increasing, then slowing down" over time.

As life expectancy increases, the number of elderly patients with osteoporosis rises as well. Many factors affect the development of osteoporosis, and good physical fitness may contribute to having better social adaptability in older people. So it is very important to pay attention to osteoporosis and ensure physical fitness in this group.

To explore the factors associated with osteoporosis, and analyze physical fitness in elderly men, providing a theoretical basis for preventing osteoporosis, improving physical fitness and developing health management programs for this group.

This study was conducted from January 2018 to December 2020. A total of 250 elderly men who underwent bone mineral density (BMD) examination were selected from Health Management Center, Inner Mongolia People's Hospital, and divided into normal BMD, osteopenia and osteoporosis groups by BMD examination results. Data were collected, including baseline information, laboratory results, physical fitness test results〔 including muscular strength (number of elbow bending within 30 seconds, 30-second sit-to-stand test results) , flexibility (shoulder and arm stretches, sitting flexion test) , balance (stand on one foot with eyes closed) , aerobic capacity (2-minute step test) , agility/mobility (timed up go test with a minimal space of 2.5 meters) 〕.

Of the 250 subjects, 76 (30.4%) had normal BMD, 123 (49.2%) had osteopenia, and 51 (20.4%) had osteoporosis. Multivariate Logistic regression analysis demonstrated that abdomen circumference〔OR=0.710, 95%CI (0.566, 0.891) 〕, body mass index 〔OR=0.685, 95%CI (0.474, 0.990) 〕, high-density lipoprotein cholesterol〔OR=74.182, 95%CI (3.738, 1 472.125) 〕, 25 (OH) D₃〔OR=0.745, 95%CI (0.619, 0.897) 〕, and estradiol〔OR=0.784, 95%CI (0.665, 0.924) 〕were associated with osteoporosis in elderly men (P<0.05) . All the subjects successfully completed physical fitness tests, without adverse events. The number of repetitions of sit-to-stands within 30 seconds, results of shoulder and arm stretches, sitting flexion test, and 2-minute step test, duration for stand on one foot with eyes closed, as well as time used for timed up go test with a minimal space of 2.5 meters differed significantly across normal BMD, osteopenia and osteoporosis groups (P<0.05) . The number of elbow bending within 30 seconds showed no significant differences across the three groups (P>0.05) .

In elderly men, abdomen circumference, body mass index, high-density lipoprotein cholesterol, 25 (OH) D₃, and estradiol may independently associated with osteoporosis. Physical fitness indices varied significantly by BMD, especially flexibility, balance, aerobic capacity and agility/mobility.