Table of Content

05 March 2026, Volume 29 Issue 07

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Guidelines·Consensus

Artificial Intelligence Empowering Healthcare Services: Expert Consensus from the Mangrove Health Conference in 2025

Expert Panel of the Consensus on Artificial Intelligence Empowering Healthcare Services

2026, 29(07):  817-822.  DOI: 10.12114/j.issn.1007-9572.2025.0396

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Artificial intelligence (AI) demonstrates significant advantages in accelerating improvements in efficiency, accessibility, and precision of health services, thereby providing critical support for the implementation of a health-prioritized development strategy. Artificial Intelligence Empowering Healthcare Services: Expert Consensus from the Mangrove Health Conference in 2025, compiled through expert consultations and in-depth discussions, systematically elaborated on the conceptual framework, objectives, challenges, and implementation pathways of AI-enabled health services. The consensus emphasizes that the core objective of integrating AI into health services lies in achieving systemic transformation across six dimensions, including service delivery models, management mechanisms, and driving forces. It identifies four major challenges currently confronting implementation: resource constraints arising from inadequate data quality and shortages of skilled professionals; sustainability dilemmas caused by the absence of appropriate payment and reimbursement mechanisms; governance challenges resulting from gaps in legal and ethical frameworks; and limitations in application effectiveness due to underdeveloped evaluation systems.In response to these challenges, the consensus proposes a comprehensive implementation framework, encompassing the establishment of a five-dimensional support system—organization, financing, workforce, technology, and the rule of law—the development of a scientific evaluation system, a focus on strengthening primary-level capacity, and the promotion of international collaboration. This consensus provides both a theoretical foundation and practical guidance for the standardized application and large-scale deployment of AI in the health sector, offering important reference value for advancing the digital transformation of Chinese health service system.

Early Detection of Alzheimer's Disease in Primary Care: Insights from the RACGP Guidelines for Preventive Activities

HUANG Wenjing, QIU Shanjiao, CHEN Zhang, LI Anchun, HE Zhiguang

2026, 29(07):  823-829.  DOI: 10.12114/j.issn.1007-9572.2025.0436

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Alzheimer's disease and related cognitive disorders are characterized by an insidious onset and long disease course, making early identification a critical strategy for reducing disease burden. The 10th edition of the Guidelines for Preventive Activities in General Practice issued by the Royal Australian College of General Practitioners (RACGP) adopts a strong primary care orientation and emphasizes opportunistic case-finding among high-risk populations, integrating evidence-based principles on screening, selection of cognitive assessment tools, and multidimensional management of modifiable risk factors. Drawing on the 2024 Lancet Commission on Dementia Prevention, Intervention and Care, World Health Organization evidence, and the life-course management framework, this paper systematically interprets the key recommendations of the RACGP guideline from a general practice perspective, with a focus on risk identification, exclusion of reversible causes, stratified use of screening instruments, and longitudinal management. The analysis suggests that commonly used tools such as the MoCA, GPCOG, RUDAS and AD8 demonstrate complementary strengths across different community populations and clinical contexts, supporting their integration into opportunistic screening pathways in primary care. In addition, interventions targeting physical activity, metabolic control, hearing impairment, sleep disorders and medication optimization constitute a feasible life-course prevention package. In the Chinese primary care context, early identification of cognitive impairment remains constrained by insufficient linkage between screening and referral, limited workforce training and resource integration, and low public awareness. This paper proposes embedding cognitive screening into family doctor contract services and chronic disease management programmes, and leveraging integrated care networks to establish a closed-loop pathway encompassing screening, assessment, referral, intervention and follow-up, thereby advancing earlier prevention and strengthening the role of primary care in dementia risk reduction.

Commentary

Construction and Prospect of a Distinctive Medical Intervention Model for Chronic Disease Management Integrating Lifestyle Medicine and Traditional Chinese Medicine

LIU Dianchun, WANG Qianyun, CHEN Xiaoying, WEI Xuehan, WANG Runze, PENG Hongye, WANG Ying, XUE Xue, YANG Guoyan, XIAO Wei, LU Chunli

2026, 29(07):  830-838.  DOI: 10.12114/j.issn.1007-9572.2025.0286

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Facing the increasing global burden of chronic diseases, lifestyle medicine (LM) provides an important means for the management and prevention of chronic diseases by scientifically adjusting individual diet, exercise, mental health and other factors. The holistic approach, syndrome differentiation, and individualized treatment philosophy of traditional Chinese medicine (TCM) highly coincide with lifestyle medicine, both aiming to improve the overall health of patients. This article integrates the principles of TCM with LM, exploring their potential advantages and practical applications in the management of chronic diseases. By analyzing the commonalities between LM and TCM in the management of chronic diseases, this study proposes and constructs a distinctive medical intervention model for chronic disease management integrating LM and TCM, which is summarized into five core elements: diet, physical activity, sleep, risk substance-tobacco and alcohol and emotional and mental health. Based on existing evidence from evidence-based medicine, this article analyzes the research status of the five core elements, and proposes the advantages of chronic disease management after integration and the directions for future research. Finally, based on the recommendations of chronic disease-related guideline literatures, this article proposes personalized intervention plans for different chronic disease patients, aiming to provide more scientific and individualized intervention strategies to reduce the medical burden and improve the quality of life of patients.

The Modernization Path of Chinese Medicine Governance Based on the Revitalization and Development of Chinese Medicine

LI Ruifeng

2026, 29(07):  839-843.  DOI: 10.12114/j.issn.1007-9572.2024.0644

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Traditional Chinese medicine (TCM) is a unique component of China's medical and health system, and the governance of TCM based on its revitalization and development holds significant theoretical and practical implications. This study, from the perspective of TCM revitalization and development, systematically summarizes the strategic positioning of TCM, its role in full-cycle services, and the current status of the entire industrial chain development. The results indicate that the path to modernizing TCM governance should involve refining TCM governance tools and methods through standardization, advancing the modernization of the TCM governance system with a collaborative mindset, and simultaneously constructing the TCM governance system in accordance with the laws of TCM. This study aims to provide possible policy recommendations for the modernization of TCM governance.

Chinese General Practice/Community Health Service

Spatio-temporal Evolution and Trend Prediction of Coupled and Coordinated Development of Quality Medical Resources and Economy and Society in Six Central Provinces of China

LI Liqing, LIU Wenhui, YANG Jiayi, WANG Fang

2026, 29(07):  844-850.  DOI: 10.12114/j.issn.1007-9572.2025.0328

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Background

There exists the practical dilemma of uneven distribution of high-quality medical resources and uncoordinated regional development among the six central provinces in China.

Objective

The objective of this study is to explore the temporal characteristics, spatial effects, spatial correlation patterns, and dynamic evolution laws of the coordinated development of high-quality medical resources and the economy and society in the six central provinces of China from 2013 to 2023. The findings of this study will provide a scientific reference basis for the promotion of synergistic and orderly development of medical and healthcare undertakings and the economy and society.

Methods

The data of this study were sourced from the China Statistical Yearbook (2014-2024), the China Health and Family Planning Statistical Yearbook (2014-2017), and the China Health Statistics Yearbook (2018-2024). The present study introduced the theory of coupling coordination and constructs a "time + space" two-dimensional dynamic coupling coordination degree model. The spatial correlation analysis method was then employed to thoroughly examine the spatial and temporal evolution of the coupling coordination level of China's healthcare resource allocation and the economy and society from 2013 to 2023. Utilizing the gray prediction model, the subsequent section aims to dynamically predict the future development of the coupling and coordination level in the central region of China from 2024 to 2028.

Results

From a chronological perspective, from 2013 to 2023, the coupling and coordination degree of quality medical resources and economic and social economy exhibited a stepwise rise, though significant regional differentiation was observed, with only Jiangxi and Henan entering the stage of barely coordinated by 2023 (D=0.507, 0.512), and the remaining provinces are exhibiting imminent dysfunctionality (D<0.500). From a spatial perspective, the quality of medical care in central China and the economic and social coupling; From a spatial perspective, the level of coordination between quality healthcare and economic and social coupling in central China exhibits an imbalanced characteristic of "point-like breakthrough, piecewise lag". In terms of future forecasts, the coupling coordination degree of the six central provinces is expected to undergo a rapid escalation from 2024 to 2028, reaching a high-quality coordination level in general by 2026 (D=1.000).

Conclusion

The enhancement of the coordination between quality medical resources and economic and social coupling in the six central provinces of China is a systematic project, which necessitates the consideration of spatial and temporal differences, policy synergy, and mechanism innovation. In the future, it is imperative to adopt a multifaceted approach guided by the principles of "balanced, intelligent, and coordinated" and to promote the modernization of health governance through the optimization of resource allocation, the strengthening of regional linkage, and the deepening of institutional innovation. This comprehensive strategy is expected to provide a practical paradigm for the implementation of the Healthy China Strategy in the central region.

A Conjoint Experiment Study on the Factors Influencing Residents' Willingness to Choose Primary Care for First Visits in the Context of Hierarchical Medical System

KONG Chunyan, ZHAO Fang

2026, 29(07):  851-857.  DOI: 10.12114/j.issn.1007-9572.2025.0049

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Background

Despite a decade of promoting a hierarchical medical system in China, residents' willingness to seek initial care at primary healthcare settings remains low. An analysis of the factors influencing residents' first-contact preferences is therefore warranted.

Objective

To investigate the overall and relative utility of various measures within the hierarchical medical system on enhancing residents' willingness to choose primary healthcare institutions for their first visits.

Methods

A conjoint analysis experiment was conducted via an online questionnaire distributed on social media platforms between May and June 2024. Using convenience and snowball sampling, we recruited 300 adults aged 18 and above, yielding 293 valid responses (a 97.7% effective response rate). The experiment simulated patients' decision-making processes in various policy-mix scenarios. A multilevel linear regression model was employed to analyze the effects of differentiated insurance reimbursement rates, the development of medical consortia, family doctor contract services, and improvements of service capacity of primary healthcare institutions on residents' first-contact decisions. Willingness-to-pay (WTP) was estimated for different resource configurations. A conditional Logit regression model was used for robustness checks.

Results

The likelihood of residents choosing a primary healthcare institution for their first visits was significantly higher with increased insurance reimbursement rates (P<0.010), a higher level of medical technology (P<0.001), closer proximity (P<0.050), and the regular presence of visiting specialists from Grade 3A hospitals (P<0.050). Regarding patient characteristics, healthier respondents were significantly more inclined to choose primary healthcare institution for their initial diagnosis (P<0.001). Compared to a low level of medical technology, a medium level at primary healthcare institutions was equivalent to a 42.50 percentage point increase in the insurance reimbursement rate (P=0.010) in terms of its effect on patient preference. The impacts of family doctor contract services and case information sharing mechanisms were not statistically significant (P>0.05).

Conclusion

Among all experimental attributes, enhancing the healthcare service level of primary healthcare institutions holds the highest economic value. These findings provide empirical support for optimizing the hierarchical medical system, underscoring the critical role of improving service quality at the primary level. The study reveals that relying solely on differentiated insurance payments is insufficient to guide patient flow effectively and highlights the potential value of increasing the visibility and efficacy of the family doctor system and information-sharing mechanisms.

Research on the Impact of Establishing Health Records Based on Propensity Score Matching Method on the Medical Behavior of Elderly People

TANG Xinyi, HU Xinyu, LIU Shanshan, ZHANG Yimin

2026, 29(07):  858-863.  DOI: 10.12114/j.issn.1007-9572.2024.0240

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Background

The problem of population aging in China is becoming increasingly prominent, and the health of the elderly has become an important issue.

Objective

To analyse the current situation of establishing health records for the elderly and explore the impact of establishing health records on their medical behavior.

Methods

Using he latest released 2020 Chinese Longitudinal Aging Social Survey (CLASS). This database contains a total of 11 398 samples. After removing missing value samples of core variables, a valid sample of 11 381 was obtained. The propensity score matching (PSM) method was used to match the elderly with or without established health records, univariate and unordered multiclass regression analyses were conducted. The dependent variable is the medical behavior of the elderly (choosing not to seek medical treatment, using regular medicine and buying medicine from pharmacies were classified as self treatment which assigned a value of 0, choosing specialized/comprehensive hospitals was assigned a value of 1 and choosing village clinics/community hospitals was classified as primary healthcare institutions which assigned a value of 2). The independent variable was whether health records have been established in the community healthcare institution. The control variables included residential area, gender, age, marital status, self-rated health, chronic disease status, hospitalization frequency within two years, utilization of elderly care services and education level.

Results

After PSM, a total of 1 244 pairs were successfully matched, a total of 2 488 participants. The results of the univariate analysis showed that there was no statistically significant difference (P>0.05) between the general situation of the study subjects who established health records and those who did not with 1 224. The regression results showed that compared with self treatment, establishing health records was a promoting factor for the elderly to seek medical treatment in specialized/comprehensive hospitals (OR=2.596, 95%CI=2.024-3.330, P<0.05) and primary healthcare institutions (OR=1.774, 95%CI=1.484-2.122, P<0.05).

Conclusion

The elderly who establish health records exhibit positive medical seeking behavior. Therefore, we need to increase efforts to carry out the construction of health records for the elderly, regularly carry out health education lectures.Taking advantage of the positive role of family doctor contract services and based on the health service demands and health levels of the contracted elderly, which regularly release health record related knowledge, continuously enhance the elderly's awareness of self health management and guide them to form good medical habits.

The Equity of Community Nurses Human Resources Allocation in China from 2012 to 2022

MA Weiping, XIE Meixiang, WEI Binguang, ZENG Pingping, JIANG Li

2026, 29(07):  864-871.  DOI: 10.12114/j.issn.1007-9572.2024.0452

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Background

Community health services are important in achieving universal health coverage, with nursing workforce allocation directly impacting service accessibility and quality. While existing researches mainly focuses on the allocation of nursing resources in hospital, data on community nurses in China remain limited.

Objective

This study aims to evaluates trends and equity in the allocation of community nurses in China from 2012 to 2022, providing insights for optimizing resource distribution.

Methods

Data were sourced from the 2013-2017 China Health and Family Planning Statistical Yearbook, the 2018-2022 China Health and Wellness Statistical Yearbook, the 2013-2022 China Statistical Yearbook, and the 2023 China Health Statistics Abstract. A descriptive analysis was conducted from February to May 2024. The Lorenz curve, Gini coefficient and agglomeration degree were employed to assess the distribution and equity of community nurses.

Results

From 2012 to 2022, the number of community nurses increased from 128 652 to 252 568 with an average annual growth rate of 6.98%. By 2021, the proportion of community nurses with a bachelor's degree rose from 6.8% to 33.0%. The Gini coefficients for population and geographic distribution were 0.13 and 0.70, respectively, indicating significant regional disparities in nurse allocation.

Conclusion

The quantity and quality of community nurses in China have improved significantly, yet disparities persist. Regional variations in allocation remain, with population-based distribution being more equitable than geographical distribution. Future efforts should focus on strengthening the community nursing workforce and enhancing equity in resource allocation.

Original Research

Correlation between Chinese Visceral Adiposity Index and Nocturnal Hypertension in Young and Middle-aged People

ZHANG Qiuyu, HU Xiaoyong, TANG Rui, LI Hongjian

2026, 29(07):  872-878.  DOI: 10.12114/j.issn.1007-9572.2025.0168

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Background

The Chinese visceral adiposity index (CVAI) is a new obesity index that has been proven to be associated with prehypertension and hypertension. Still, there is a lack of research on the relationship between the CVAI and nocturnal hypertension (NH).

Objective

To investigate the correlation between CVAI and NH in young and middle-aged adults.

Methods

A total of 981 young and middle-aged patients with essential hypertension admitted to the Department of Hypertension of the Fifth Affiliated Hospital of Xinjiang Medical University were consecutively enrolled from February to September 2023, and the general data, biochemical indexes, and 24-hour ambulatory blood pressure monitoring results of the patients were collected and the CVAI was calculated, and the patients were divided into 95 cases of the non-nocturnal hypertension (NNH) group and 886 cases of the NH group according to the whether they were combined with NH or not. Differences in age, gender, and other indicators were compared between the two groups. Correlation analysis was performed using the Pearson or Spearman method. Multivariate Logistic regression was used to analyze the correlation between CVAI and NH in young and middle-aged people.

Results

Compared with the NNH group, the NH group had higher CVAI, 24-hour average systolic and diastolic blood pressure, daytime average systolic and diastolic blood pressure, nocturnal average systolic and diastolic blood pressure, and maximum systolic and diastolic blood pressure, and the differences were statistically significant (all P<0.05). Pearson correlation analysis showed that CVAI was positively correlated with 24-hour average systolic and diastolic blood pressure, daytime average systolic and diastolic blood pressure, nocturnal average systolic and diastolic blood pressure, and maximum systolic and diastolic blood pressure (r=0.202, 0.183, 0.200, 0.171, 0.168, 0.174, 0.132, 0.157, all P<0.05). Multivariate Logistic regression showed that high CVAI was an independent risk factor for NH in young and middle-aged adults after adjustment for relevant confounders (OR=1.009, 95%CI=1.002-1.016, P=0.014). According to the CVAI quartiles, the patients were categorized into Q1 group (<103.524 3, n=245), Q2 group (103.524 3-129.714 0, n=246), Q3 group (129.714 0-156.270 4, n=245) and Q4 group (>156.270 4, n=245). The risk of developing nocturnal hypertension in the Q2 group, Q3 group and Q4 group was 1.779 (OR=1.779, 95%CI=1.002-3.157), 2.023 (OR=2.023, 95%CI=1.061-3.858), and 3.053 (OR=3.053, 95%CI=1.383-6.737) times greater than that of the Q1 group. Subgroup analysis showed that the association between CVAI and NH was more significant in the overweight/obese (BMI≥24 kg/m²) population (P=0.021).

Conclusion

CVAI was associated with the risk of developing NH in young and middle-aged adults, and the association was more significant in the overweight/obese (BMI≥24 kg/m²) population, which was a risk factor for NH in this population.

Correlation between the Continuous Metabolic Syndrome Score and Glomerular Filtration Rate in Individuals Aged 60 and Above

ZHANG Rui, WANG Weiqiang, LU Hongrun, ZHAO Yu, LI Jiazhen

2026, 29(07):  879-884.  DOI: 10.12114/j.issn.1007-9572.2025.0037

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Background

The continuous metabolic syndrome score (cMetS) is a weighted composite score based on five metabolic indicators: waist circumference (WC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), mean arterial pressure (MAP), and fasting plasma glucose (FPG). lthough the role of cMetS in metabolic diseases has been preliminarily recognized, its association with renal function has not yet been systematically elucidated. Given the high prevalence of chronic kidney disease (CKD) and its close link to metabolic dysregulation, elucidating the role of cMetS in this context may pave the way for novel biomarkers or therapeutic targets for early warning, risk stratification, or intervention.

Objective

To investigate the effectiveness of cMetS in early screening for chronic kidney disease (CKD) and to reduce the risk of CKD in the target population by controlling relevant factors.

Methods

From 2017 to 2021, this project screened and collected data from 2 049 elderly individuals (aged≥60 years) with high cardiovascular risks during community-based health examinations across 12 counties/cities in Anhui Province. Participants were stratified by estimated glomerular filtration rate (eGFR): the low-filtration group [eGFR <90 mL·min^-1· (1.73 m²)^-1] and the normal group [eGFR ≥90 mL·min^-1· (1.73 m²)^-1]. Multivariate Logistic regression was employed to analyze the correlation between cMetS quartiles and the risk of reduced eGFR.

Results

Patients in the low-filtration group (n=927) showed significantly older age, and higher body weight, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), fasting plasma glucose (FPG), serum creatinine (Scr), blood urea nitrogen (BUN), triglycerides (TG), waist-to-height ratio (WHtR), WHtR cut-off=0.5 (WHt.5R), body roundness index (BRI), and cMetS than the normal group (n=1 122) (P<0.05). Stratified by cMetS quartiles, four groups were assigned as follows: S1=-4.40 to <-0.18; S2=-0.18 to <0.30; S3=0.30 to <0.79; S4: 0.79 to 4.96. The body hight (BH), body mass, BMI, WC, SBP, DBP, MAP, FPG, Scr, TC, TG, low-density lipoprotein cholesterol (LDL-C), WHtR, WHt.5R, and BRI in the four groups increased with the increasing cMetS levels, while BUN, HDL-C, and eGFR decreased with the increasing cMetS levels (P<0.05). Compared with the cMetS S1 group, the risk of decreased glomerular filtration rate increased in S2, S3, and S4 groups (OR=1.462, 1.656, and 1.652, respectively, P<0.05). Compared with the BMI M1 group (16.51-<23.19 kg/m²), the risk of decreased glomerular filtration rate in M2 (23.19-<25.31 kg/m²), M3 (25.31-<27.61 kg/m²), and M4 groups (27.61-<40.89 kg/m²)significantly increased (OR=1.373, 1.328, and 1.385, respectively, P<0.05).

Conclusion

Among older adults of 60 years and above, age and BMI increase, and eGFR decreases with the increasing cMetS levels. Elevated cMetS and BMI are independent risk factors for the decreased glomerular filtration rate. Renal function gradually declines with aging, which can be accelerated by MetS. For older adults of 60 years and above, early intervention is needed to delay the deterioration of renal function.

Analysis of Related Factors of Renal Function Impairment in AECOPD Patients

TIAN Ying, PAN Dianzhu

2026, 29(07):  885-892.  DOI: 10.12114/j.issn.1007-9572.2024.0059

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Background

Chronic obstructive pulmonary disease (COPD) is one of the major diseases that severely jeopardize the health of the Chinese population. The kidneys are extremely sensitive to low oxygen levels due to their sensitivity, patients with COPD are susceptible to renal impairment. Nevertheless, there is a paucity of research on the factors associated with COPD and renal impairment both domestically and internationally.

Objective

Analyze the clinical characteristics of patients with acute exacerbation of chronic obstructive pulmonary disease complicated by renal dysfunction, identify relevant factors, and provide theoretical basis for the prevention and treatment of renal dysfunction in clinical AECOPD patients.

Methods

A total of 100 patients with acute exacerbation of chronic obstructive pulmonary disease complicated by renal dysfunction who were hospitalized in the Respiratory Department of the First Affiliated Hospital of Jinzhou Medical University from December 2020 to July 2023 were selected.At the same time, 92 patients with AECOPD who were admitted and had complete examination data during the same period were collected, totaling 192 cases. According to the glomerular filtration rate (eGFR) of patients, they were divided into a normal renal function group (92 cases), a mild impairment group (66 cases), and a severe impairment group (34 cases). Collect general data of the subjects and laboratory data: white blood cell (WBC), hemoglobin (Hb), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), albumin (ALB), brain natriuretic peptide (BNP), troponin I (CTnI), glucose (GLU), pH Arterial oxygen partial pressure (PaO₂), arterial carbon dioxide partial pressure (PaCO₂), lactate (cLac), creatinine (Cr), Cystatin C (Cys C), β₂-Microglobulin (β₂-MG), Urea, uric acid (UA), percentage of forced expiratory volume per second (FEV₁%), and percentage of forced vital capacity per second (FEV₁/FVC). Multivariate Logistic regression analysis of predictive factors for renal dysfunction in AECOPD patients; Pearson correlation analysis shows the correlation between eGFR, Cys C, and other indicators; Draw ROC curves and evaluate the predictive value of various factors on renal function damage in AECOPD patients.

Results

Three inter group analysis, age, hypertension, coronary heart disease, Hb, CRP, ALB, BNP, CTnI, IL-6, Cr, UA, Urea, Cys C, β₂-MG, FEV₁% and PaO₂ were statistically significant (P<0.05) ; Cys C is negatively correlated with PaO₂ and FEV₁% (r=-0.379, -0.254, P<0.01), and positively correlated with IL-6 (r=0.641, P<0.01). eGFR is positively correlated with PaO₂ and FEV₁% (r=0.470, 0.286, P<0.01), and negatively correlated with IL-6 (r=-0.456, P<0.01). Multivariate Logistic regression analysis showed that age, hypertension, PaO₂, IL-6, UA, β₂-MG and Cys C were predictive factors for renal dysfunction in patients with acute exacerbation of COPD (P<0.05). Further ROC curve analysis showed that UA (AUC=0.646, 95%CI=0.569-0.724), Cys C (AUC=0.895, 95%CI=0.852-0.939), β₂-MG (AUC=0.822, 95%CI=0.764-0.879), IL-6 (AUC=0.743, 95%CI=0.674-0.812), and PaO₂ (AUC=0.676, 95%CI=0.601-0.751) had certain predictive value for renal function damage in AECOPD patients (P<0.05).In terms of concurrent renal dysfunction in AECOPD patients, the sensitivity, specificity, accuracy, and area under the ROC curve of Cys C were all higher than those of β₂-MG, IL-6, and PaO₂, with statistically significant differences (P<0.05).

Conclusion

Age, hypertension, PaO₂, IL-6, UA, β₂-MG and Cys C are related predictive factors for renal dysfunction in patients with acute exacerbation of chronic obstructive pulmonary disease.Cys C has a high diagnostic value in predicting renal function impairment in AECOPD patients, and is an indicator for predicting the risk of renal injury in AECOPD patients.

Impact of Childhood Adverse Experiences on Health-related Quality of Life in Adulthood: a Mediating Role of the Number of Chronic Diseases

JIANG Xuan, CHEN Yinhai, LU Yuanwei, ZHANG Jiali, LIN Congxuan, KE Xiong

2026, 29(07):  893-899.  DOI: 10.12114/j.issn.1007-9572.2024.0600

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Background

The impact of adverse childhood experiences (ACE) on individual health is enormous. However, the association among ACEs, health-related quality of life (HRQOL), and the number of chronic diseases remain poorly explored.

Objective

The aim is to explore the relationship between ACEs and HRQOL, as well as whether the number of chronic diseases has a mediating role between ACEs and HRQOL in adulthood. The research provides a theoretical basis for improving the HRQOL of Chinese residents.

Methods

Based on data from the 2023 Psychology and Behavior Investigation of Chinese Residents (PBICR) conducted between June and September 2023, this study included a total of 1 932 sample. The European 5 dimensional 5 level health assement (EQ-5D-5L) scale and Adverse Childhood Experiences Questionnaire (ACE-Q) conduct a survey; and Model 4 of the Process plugin was employed for simple mediation model testing.

Results

A total of 611 subjects (31.63%) suffered from chronic diseases, and 555 subjects (28.73%) experienced at least one type of Adverse Childhood Experiences (ACEs), among whom 255 subjects (13.20%) had experienced 3 or more ACEs.The results indicate that ACEs were negatively correlated with HRQOL (r_s=-0.271, -0.127, P<0.01) and positively associated with the number of chronic diseases (r_s=0.223, P<0.01). The results of bootstrap test showed that the mediation effect between the number of chronic diseases in adverse experience and health utility value was -0.049, accounting for 26.20% of the total effect, and the mediation effect between childhood adverse experience and self-rated health was -0.023, accounting for 16.08% of the total effect.

Conclusion

The number of chronic diseases is partially mediated between adverse childhood experiences and health-related quality of life in adulthood. Therefore, timely screening and intervention for chronic diseases in the ACEs-exposed population is essential to promote healthy aging.

The Childhood Trauma and Adolescent Internet Addiction: the Chain Mediation of Depression Symptoms and Academic Burnout and the Moderating Role of Gender

LI Juexi, LI Liyuan, GUO Yuxuan, XIAO Xiaoqiang, TANG Peiqi, PU Ting, ZUO Haixi, YANG Ting, FAN Xiaoxia, ZHOU Bo

2026, 29(07):  900-906.  DOI: 10.12114/j.issn.1007-9572.2025.0050

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Background

The detection rate of internet addiction among Chinese adolescents is high, and its harmful effects are increasingly prominent. Previous studies have indicated strong associations between childhood trauma, depressive symptoms, and academic burnout with internet addiction, while gender factors may also play a moderating role. However, the underlying mechanisms among these variables remain to be further investigated.

Objective

This study aims to construct a moderated chain mediation model to examine the relationships among childhood trauma, depressive symptoms, academic burnout, gender, and internet addiction, providing a theoretical basis for prevention and intervention.

Methods

In February 2022, students from all 10 secondary schools in a district of Chengdu were selected as the study subjects. General information was collected through questionnaires, and childhood trauma, depressive symptoms, academic burnout, and internet addiction levels were assessed using the Childhood Trauma Questionnaire Short Form (CTQ-SF), Patient Health Questionnaire Depression Scale (PHQ-9), Adolescent Academic Burnout Scale (AABS), and Internet Addiction Diagnostic Scale for Adolescents (IADDS), respectively. Spearman correlation analysis was used to examine the relationships between the scores of the scales. Moderated chain mediation model analysis was performed using the SPSS macro program Process 3.5, and Bootstrap method was used to test the mediation and moderation effects. Simple slope analysis was applied to compare the interaction effects.

Results

A total of 34 534 valid questionnaires were collected, with an effective response rate of 84.60%. Among them, 5 869 adolescents self-reported childhood trauma experiences and completed the CTQ-SF scale, which were included in the final analysis. Correlation analysis showed that the CTQ-SF score was positively correlated with the PHQ-9 score (r_s=0.266, P<0.01), AABS score (r_s=0.203, P<0.01), and IADDS score (r_s=0.156, P<0.01). The PHQ-9 score was positively correlated with both the AABS score (r_s=0.307, P<0.01) and the IADDS score (r_s=0.184, P<0.01). The AABS score was positively correlated with the IADDS score (r_s=0.278, P<0.01). PHQ-9 scores and AABS scores partially mediated the relationship between CTQ-SF scores and IADDS scores, accounting for 13.51% and 16.22% of the total effect, respectively. The chain mediation effect of both was 10.81% of the total effect. Gender moderated the relationship between CTQ-SF scores and PHQ-9 scores (β=0.020, P<0.01) and IADDS scores (β=-0.013, P<0.01). The simple slope analysis showed that the predictive effect of CTQ-SF scores on male IADDS scores (β=0.029, P<0.001) was significantly higher than on females (β=0.016, P<0.001); whereas the predictive effect of CTQ-SF scores on female PHQ-9 scores (β=0.085, P<0.001) was significantly higher than on males (β=0.064, P<0.001).

Conclusion

Depression symptoms and academic burnout play a chain mediating role in the relationship between childhood trauma and internet addiction. Childhood trauma predicts internet addiction more strongly in males, while its predictive effect on depression symptoms is stronger in females.

Knowledge, Attitudes, and Practice Toward Polypharmacy and Potentially Inappropriate Medication among General Practitioners: a Cross-sectional Study

BAI Ruirui, LU Xiaoqin, DU Fengdong

2026, 29(07):  907-913.  DOI: 10.12114/j.issn.1007-9572.2024.0494

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Background

Polypharmacy and potentially inappropriate medication (PIM) are common among older adults. While current research has extensively focused on patient-related aspects, studies concerning general practitioners' knowledge, attitudes, and practice (KAP) in this regard remain limited.

Objective

This study aimed to investigate general practitioners' KAP regarding polypharmacy and PIM in older adults in urban Beijing, and to provide references for improving medication management in this population.

Methods

Employing a convenient sampling approach, we conducted a cross-sectional survey among general practitioners with independent prescribing authority in urban Beijing in August 2022. Electronic questionnaires were distributed through WeChat-based platforms targeting primary care practitioners. After screening, 150 respondents from 85 community health service centers were included in the final analysis. Participants were evaluated on their KAP related to polypharmacy and PIM in older adults. Scores for each domain were converted to a percentage system (calculated as actual score divided by total possible score × 100) and were categorized into two groups based on the conventional pass criterion of 60 points: ≥60 and <60.

Results

Among the 150 general practitioners, the knowledge scores regarding polypharmacy and PIM in the elderly were below 60 in 140 participants and as 60 or above in 10. In terms of medication attitudes, 142 scored as or above 60 and 8 scored under 60. Regarding prescribing behaviors, 115 scored as or above 60 and 35 scored under 60. The scoring distribution (≥60 and <60) for knowledge or medication attitudes showed no statistically significant differences (P>0.05) when being compared among participants in terms of age, gender, education level, professional title, Traditional Chinese Medicine (TCM) Practitioner or Medical Doctor (MD) position, years of practice, or participation in medication training. For the scoring distribution (≥60 and <60) for prescribing behaviors, no significant differences (P>0.05) were found among participants regarding gender, education level, professional title, type of clinical practice (TCM or MD), or training attendance. However, significant differences (P<0.05) in scoring distribution (≥60 and <60) were identified among participants in terms of age and years of practice.

Conclusion

General practitioners in urban community settings demonstrate positive attitudes toward the management of polypharmacy and PIM among elderly patients. However, their knowledge remains inadequate, and prescribing behaviors show potential for improvement. There is hence a compelling need to enhance their continuing medical education focused on geriatric pharmacotherapy. Furthermore, efforts should be made to strengthen the management of PIM and to provide medication-related education for older adults. These measures are expected to facilitate the management of polypharmacy and PIM in the aging population.

Original Research·Focus on Health Poverty Vulnerability

Dynamic Monitoring and Analysis of Influencing Factors of Health Shocks in Rural Middle Aged and Elderly People in Ningxia: Empirical Research Based on 14 Years and Four Periods of Follow-up Data before and after Poverty Alleviation

YANG Juan, LIU Shan, LI Fei, MENG Haodong, QIAO Hui, XIE Yongxin

2026, 29(07):  914-921.  DOI: 10.12114/j.issn.1007-9572.2024.0419

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Background

With the continuous advancement of the aging process in our country, the health problems of the middle-aged and elderly population has increasingly become a social problem which cannot be overlooked.

Objective

To comprehensively understand the prevalence trend of health shock in rural middle-aged and elderly people in Ningxia during the 14 years before and after poverty alleviation, identify the dynamic changes of related influencing factors, and provide data support for effective identification and intervention of health shock.

Methods

This study selected the health follow-up data of four periods: the early stage of the new medical reform (2009), the promotion period of health poverty alleviation (2015), the poverty alleviation period (2019), and the transition period of rural revitalization and health poverty alleviation (2022). The research subjects were obtained by adopting the method of multi-stage stratified cluster random sampling. Firstly, all the towns and townships in the sample counties (Yanchi, Haiyuan, Pengyang, Xiji) were counted. The administrative villages of each town and township were divided into three levels according to the high, medium and low economic levels. 40% of the natural villages were randomly selected from each level, and 33 rural households were selected from each village by the method of systematic sampling. The middle-aged and elderly people aged 45 and above in the household were taken as the research subjects and a questionnaire survey was conducted. The contents of the questionnaire survey include general demographic characteristics, indicators related to family economic status, health-related indicators, indicators related to the utilization of health services, and indicators related to health poverty alleviation policies. After excluding subjects with missing values for important variables, 6 351, 8 035, 8 566, and 9 337 research subjects were included in the four phases of the survey, respectively. The prevalence trend changes in the incidence of health shocks were analyzed using the χ² test. The single factors influencing the occurrence of health shocks were explored using the χ² test or t-test. The fixed binary Logit regression model was used based on Grossman's theory of health needs to identify the effect magnitudes of the related influencing factors.

Results

In 2009, 2015, 2019 and 2022, the incidence of health shock in the rural elderly in Ningxia was 29.74% (1 889/6 351), 27.18% (2 184/8 035), 31.27% (2 679/8 566) and 25.00% (2 334/9 337). The difference was statistically significant (χ²_trend=22.520, P<0.001), respectively. The regression results showed that before poverty alleviation, higher per capita annual income and larger family size were the main positive influencing factors of health shocks (P<0.001), while poor self-rated health status, debt due to illness and older age were the main negative influencing factors (P<0.001). After poverty alleviation, higher per capita annual income, larger family size and medical consultations within two weeks were the main positive influencing factors (P<0.001), while poor self-rated health status, debt due to illness and annual hospitalization were the main negative influencing factors (P<0.001). The impact of smoking on health was not significant (P>0.05).

Conclusion

In the 14 years before and after poverty alleviation, the incidence of health shock of the middle-aged and elderly people in rural Ningxia has decreased significantly. The main factors affecting the occurrence of health shock are higher per capita annual income, larger family size, medical consultations within two weeks and debt due to illness. It is necessary to increase the policy support of government funds, improve the level of residents' income, and improve the medical security system to reduce the incidence of health shocks among the middle-aged and elderly people in rural Ningxia.

The Health Poverty Vulnerability and Its Influencing Factors of Chronic Diseases in Rural Ningxia in the Post-poverty Era

WANG Youyun, SONG Mingsha, LI Chunsheng, QIAO Hui

2026, 29(07):  922-928.  DOI: 10.12114/j.issn.1007-9572.2024.0371

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Background

In the post-poverty alleviation era, in-depth research on the health poverty vulnerability of chronic disease patients can help effectively prevent the recurrence of poverty or new poverty caused by illness at its root.

Objective

To understand the Ningxia of health poverty vulnerability among rural residents with chronic diseases and its influencing factors, and to provide theoretical support and practical suggestions for formulating more precise and effective poverty alleviation policies and measures.

Methods

From June to July 2022, a multistage stratified cluster random sampling method was used to select participants from four counties (Yanchi, Haiyuan, Xiji, and Pengyang) in Ningxia Hui Autonomous Region. The questionnaire, designed based on literature research and expert consultation, covered demographic characteristics, health status and behaviors, medical security, and family economic conditions. The health poverty vulnerability index for chronic disease patients was calculated using the three-stage feasible generalized least squares (FGLS) method. Binary Logistic regression was employed to explore influencing factors, and Shapley value decomposition was used to quantify the contribution of each factor.

Results

A total of 4 778 chronic disease patients were included. Using a threshold of health poverty vulnerability index > 0.5, 253 were classified into the health poverty vulnerable group and 4 525 into the non-vulnerable group. Logit regression showed that age and seeking care at township health centers or county hospitals were risk factors for health poverty vulnerability (P<0.05). Protective factors included primary or junior high school education, self-rated general or good health, longer disease duration, ≥6 conscious exercise sessions per week, participation in urban-rural integrated basic medical insurance or employee medical insurance, and risk-based health expenditures (P<0.05). Shapley value decomposition indicated that individual characteristics contributed the most (43.51%), followed by health status (21.26%) and disease burden (18.81%).

Conclusion

The health poverty vulnerability of chronic disease patients in Ningxia remains relatively high nationwide. Key factors include age, catastrophic health expenditure, self-rated health, weekly exercise frequency, education level, and disease duration. Governments should increase investments, strengthen health education and promotion campaigns, improve medical service systems and healthcare security mechanisms for chronic disease patients, and foster cross-sector collaboration to establish an early warning platform for health poverty vulnerability.

The Vulnerability of Health Poverty and Its Influencing Factors of the Migrant Workers in Ningxia in the Post-poverty Era

LIU Shan, LI Fei, MENG Haodong, YANG Juan, QIAO Hui

2026, 29(07):  929-935.  DOI: 10.12114/j.issn.1007-9572.2024.0370

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Background

As China embarks on a new journey towards common prosperity, it is crucial to address the issue of preventing rural residents from falling back into poverty due to illness. This is a significant step towards achieving common prosperity.

Objective

This study aims to understand the distribution of health poverty vulnerability among rural out-migrant workers in Ningxia and identify the influencing factors, with the goal of providing policy recommendations for Ningxia to consolidate its poverty alleviation achievements and prevent poverty from returning due to illness.

Methods

Using field survey data collected by the research team in Haiyuan County, Yanchi County, Xiji County, and Pengyang County in Ningxia from June to July 2022, the study employed the three-stage feasible generalized least squares (FGLS) method to measure health poverty vulnerability. Logit regression analysis was used to identify the influencing factors. The study also used the marginal effect and Shapley value decomposition method to quantify the contribution of each factor.

Results

The proportion of health poverty vulnerable rural out-migrant workers in Ningxia is 4.5%. The logit model regression analysis results show that housing and kitchen separation, using electricity as living fuel, and participating in a health check in the past year can reduce the risk of health poverty vulnerability. Married status, borrowing money due to illness, and having a low level of education will increase the risk of health poverty vulnerability. The Shapley value decomposition results show that demographic characteristics contribute the most (55.93%), followed by family characteristics (16.46%) and health risk characteristics (15.34%).

Conclusion

The health poverty vulnerability among rural migrant workers in Ningxia is within a controllable range compared with the overall level in the western region. Having separate housing and kitchen areas, using electricity as a domestic fuel, participating in health check - ups within the past year, being in a married status, and borrowing money due to illness are key factors affecting the health poverty vulnerability of migrant workers from Ningxia. It is recommended that relevant departments establish an early warning system for the risk of returning to poverty due to illness, proactively adjust policies, and promote the effective implementation of health poverty prevention efforts.

Evidence-based Medicine

Barriers and Facilitators to the Implementation of Deprescribing: a Scoping Review Based on the Updated Consolidated Framework for Implementation Research

YAN Ming, XIA Yu, ZHOU Pengxiang, ZHOU Xinmei, FANG Lizheng, ZHAO Yang, XU Zhijie

2026, 29(07):  936-944.  DOI: 10.12114/j.issn.1007-9572.2025.0032

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Background

Deprescribing is an intervention strategy aimed at identifying and discontinuing potentially inappropriate medications, which holds significant value in reducing medication-related risks and improving patient outcomes. However, there is a lack of comprehensive and integrated inductive analysis from the perspective of implementation science.

Objective

This study aims to review the barriers to and facilitators of deprescribing implementation based on the updated 2022 Consolidated Framework for Implementation Research (CFIR) to provide evidence-based recommendations for optimizing implementation strategies.

Methods

A systematic search was conducted in four electronic databases—China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, and Web of Science—for relevant literature published from January 2000 to September 2024, to identify studies exploring the influencing factors on the implementation of deprescribing. Two researchers independently used a predefined data extraction form to collect information on study characteristics, intervention content, and implementation determinants. The barriers and facilitators were analyzed thematically and synthesized using the updated CFIR.

Results

A total of 46 studies were included in the analysis. The facilitators identified included positive attitudes of patients and physicians toward deprescribing, collaboration within healthcare teams, effective doctor-patient communication, and patients' understanding of deprescribing. The barriers included resistance from patients, lack of effective collaboration between healthcare institutions, excessive use of technical jargon in doctor-patient communication, and patients' lack of knowledge about medications.

Conclusion

The successful implementation of deprescribing is influenced by a combination of multifaceted factors. Future research should precisely match implementation strategies based on the facilitating and hindering factors in specific scenarios, to propose targeted and feasible solutions for promoting the process of deprescribing.

Systematic Review of the Quality and Application of Patient Decision Aids in Cardiovascular Disease Based on IPDAS 4.0 Criteria

PEI Zhiyi, ZHANG Xiaoxin, LIN Jiayi, ZHANG Xiangyi, KANG Xiaofeng

2026, 29(07):  945-952.  DOI: 10.12114/j.issn.1007-9572.2024.0339

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Background

Cardiovascular disease (CVD) is a major threat to human health, and its prevention and treatment largely depend on evidence-based and rational medical decision-making. With the development of the shared decision-making (SDM) model, patient decision aids (PDAs) have increasingly been used to facilitate clinician-patient communication and enhance patient engagement in decision-making. However, the quality of cardiovascular PDAs varies considerably and lacks standardized regulation. The International Patient Decision Aid Standards (IPDAS 4.0) provide an evidence-based framework for the design and evaluation of PDAs. This study systematically evaluated PDAs in the cardiovascular field using the IPDAS 4.0 framework to provide evidence for clinical practice.

Objective

To evaluate the effectiveness of PDAs in SDM among CVD patients.

Methods

A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, CBM, and Wanfang Data, covering publications up to October 31, 2023. Randomized controlled trials (RCTs) evaluating the effects of PDAs in patients with CVD were included. Two researchers independently screened the studies, extracted data, and assessed methodological quality. Intervention groups received PDAs in any format, while control groups received routine treatment or care. The quality of PDAs development was assessed using IPDAS 4.0, and meta-analysis was performed with RevMan 5.4.

Results

A total of 16 RCTs involving 4 861 patients were included. According to IPDAS 4.0, the top three scoring domains were disclosure, information and values, while the lowest three were test, plain language, and decision support technology evaluation. Meta-analysis indicated that PDAs significantly improved patients' knowledge (SMD=0.88, 95%CI=0.52-1.24, P<0.001) and reduced decisional conflict (SMD=-0.21, 95%CI=-0.40--0.03, P<0.001). Reductions in decisional conflict were observed across the informed (SMD=-0.36, 95%CI=-0.48--0.25, P<0.001), values clarity (SMD=-0.24, 95%CI=-0.35--0.13, P<0.001), support (SMD=-0.19, 95%CI=-0.31--0.08, P<0.001), and effective decision (SMD=-0.20, 95%CI=-0.31--0.08, P<0.001) subscales.

Conclusion

PDAs interventions are effective in improving knowledge, decisional satisfaction, and reducing decisional conflict among CVD patients, though their impact on decision regret requires further investigation. Future studies should integrate China's healthcare context to develop PDAs tailored to CVD patients based on the IPDAS 4.0 framework, thereby promoting the implementation of SDM in clinical practice.