Table of Content

15 July 2026, Volume 29 Issue 20

Previous Issue    Next Issue

Special Report·"Year of Weight Management" Section

Prevention and Management of Adult Obesity: Progress and Trends from Six Keywords in 2025

CHEN Xiangyang, HUANG Hongmei, LI Sheyu

2026, 29(20):  2753-2758.  DOI: 10.12114/j.issn.1007-9572.2026.0035

Asbtract ( )   HTML ( )   PDF (1216KB) ( )  

Figures and Tables | References | Related Articles | Metrics

In 2025, obesity diagnosis and management entered a new stage characterized by disease stratification and long-term care. Focusing on six key topics: obesity classification, clinical guidelines, novel pharmacotherapies, comorbidity management, weight management clinics, and nutrition labeling, this paper summarizes the major advances in obesity research and practice worldwide in 2025. The Lancet Diabetes and Endocrinology Commission proposed a new framework distinguishing pre-clinical obesity and clinical obesity. American Association of Clinical Endocrinology (AACE), European Association for the Study of Obesity (EASO), and WHO further emphasized that treatment should be determined by obesity-related complications and functional impairment. Tirzepatide, mazdutide, oral GLP-1 receptor agonists, and multi-target agents have propelled anti-obesity medications into an era of high efficacy and diversification. The management of obesity-related comorbidities and diseases, including type 2 diabetes, heart failure with preserved ejection fraction, metabolic dysfunction-associated steatohepatitis, osteoarthritis, and obstructive sleep apnea, has become a clinical priority. China is concurrently advancing the establishment of standardized weight management clinics and the implementation of digital labeling for pre-packaged foods, marking a strategic shift in obesity management from purely clinical treatment toward integrated prevention and care. This paper aims to provide an annual reference for clinical research, specialty development, and practice in the field of obesity for the year 2026.

Effect of Xiere Xingpi Yin on Eating Behaviors and Weight-related Outcomes in Patients with Obesity: a Randomized Controlled Trial

ZHANG Ke, ZENG Xianchang, ZOLZAYA Enkhzaya, ZHU Yelin, HUANG Yiwen, LIU Zhenxiu, TAO Feng

2026, 29(20):  2759-2765.  DOI: 10.12114/j.issn.1007-9572.2025.0315

Asbtract ( )   HTML ( )   PDF (1310KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Obesity is a major global public health challenge. Although intensive lifestyle intervention can induce weight loss, its effectiveness is often constrained by eating behaviors. Existing behavior-focused interventions show limited efficacy. New approaches that can improve eating behaviors are needed to enhance the weight-loss efficacy of intensive lifestyle intervention.

Objective

To evaluate the effects of Xiere Xingpi Yin on eating behaviors and weight-related outcomes in adults with obesity.

Methods

A total of 108 adults with obesity seen at the Endocrinology Department of Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, from March 2022 to March 2024 were randomized (1∶1) to an experimental group (n=54) and a control group (n=54) using simple randomization. Both groups received a 12-week intensive lifestyle intervention; in addition, the experimental group was given Xiere Xingpi Yin granules and the control group received placebo granules. At 12 weeks, between-group comparisons were made for eating behaviors—cognitive restraint, uncontrolled eating, and emotional eating; weight-related outcomes—change in body weight and BMI, and the proportions achieving≥5% and≥10% body-weight loss; body fat distribution; inflammatory markers; and glycemic and lipid indices. Adverse events were monitored throughout. Data analysis used the full analysis set (FAS) as the primary analysis set, following the intention-to-treat (ITT) principle. Sensitivity analyses for dietary behaviors and weight loss efficacy were conducted using the per-protocol set (PPS).

Results

A total of 93 patients completed the trial, with 42 in the control group and 51 in the experimental group. There were no statistically significant differences in baseline characteristics, including body weight, BMI, prior weight-loss history, and psychological status (P>0.05). At 12 weeks, the experimental group showed better eating-behavior outcomes, with lower endpoint scores for cognitive restraint [(12.9±3.2) points vs (14.3±3.8) points] and uncontrolled eating [(16.5±4.9) points vs (18.9±6.2) points] than the control group (P<0.05). The proportion of patients with ≥5% body-weight loss in the trial group [90.7% (49/54) vs 50.0%(27/54) ] and the proportion with ≥10% body-weight loss [(35.2%(19/54) vs 9.3%(5/54) ] were higher than in the control group (P<0.05), and reductions in body weight [(8.7±3.6) kg vs (5.1±3.0) kg] and BMI [(3.1±1.2) kg/m² vs (1.8±1.0) kg/m²] were greater (P<0.05). The sensitivity analyses showed that the results from the PPS were consistent with those from the FAS for all the aforementioned endpoints. In addition, improvements in body fat distribution, inflammatory markers, glycemic and lipid indices, and TCM syndrome-factor scores were greater in the experimental group (P<0.05). The incidence of adverse events did not differ between the two groups [11.1% (6/54) vs 9.3% (5/54), χ²=0.091, P>0.05].

Conclusion

Xiere Xingpi Yin improved eating behaviors, and thereby enhanced the weight-loss efficacy of intensive lifestyle intervention. It also produced coordinated benefits in body fat distribution, inflammation, and glycemic and lipid indices, with a favorable safety profile. Xiere Xingpi Yin may serve as an adjunctive TCM option to improve eating behaviors and strengthen body-weight management.

Characteristics of Policy Instrument Selection and Combination for Weight Management in China: a Content Analysis of National Policy Documents (2016-2025)

WU Zhen, XI Yaqi, HU Linlin

2026, 29(20):  2766-2774.  DOI: 10.12114/j.issn.1007-9572.2025.0552

Asbtract ( )   HTML ( )   PDF (1438KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Against the backdrop of the escalating prevalence of overweight and obesity, China has promulgated numerous weight management policies. However, the selection preferences, compositional structure, and stakeholder coupling characteristics of the policy instruments employed remain to be systematically analyzed.

Objective

To systematically analyze the selection preferences and compositional characteristics of policy instruments for weight management in China, identify structural imbalances within the current policy system, and provide evidence-based references for optimizing the nation's comprehensive obesity prevention and control strategies.

Methods

In November 2025, eleven core national-level policy documents on weight management issued from January 1, 2016 to October 31, 2025 were selected as the study objects. A "policy instrument-stakeholder" two-dimensional analytical framework was constructed, and content analysis was employed to conduct systematic coding, frequency statistical analysis, and cross-analysis of the policy texts.

Results

A total of 454 policy instrument codes and 538 stakeholder codes were extracted from 11 core policy documents. Command-and-control instruments had the highest proportion [182 (40.09%)], followed by information-based [101 (22.25%)] and capacity-building instruments [91 (20.04%)], while incentive-based [43 (9.47%)] and system-change instruments [37 (8.15%)] accounted for relatively low proportions. In the stakeholder dimension, government departments [204 (37.92%)] and healthcare institutions [139 (25.84%)] were the primary targets, while health-related industries [34 (6.32%)] and social organizations [39 (7.25%)] received relatively low policy attention.

Conclusion

China's weight management policy system exhibits significant structural imbalances in instrument configuration, presenting a "center-periphery" governance structure centered on administrative leadership and medical intervention. The intervention logic prioritizes micro-level individual behavior regulation and health education, with insufficient attention given to structural interventions regarding the obesogenic environment and multi-stakeholder coordination mechanisms. There is an urgent need to address deficiencies in fiscal incentives and legal regulations, strengthen inter-sectoral coordination and social mobilization mechanisms, and promote the transformation of the policy system toward legalization, incentivization, and collaborative governance.

General Practice/Community Health Service

International Experience in the Development of Mental Health Special Interest in General Practice and Its Implications for China

ZHANG Zhenglu, WU Yihan

2026, 29(20):  2775-2780.  DOI: 10.12114/j.issn.1007-9572.2024.0245

Asbtract ( )   HTML ( )   PDF (1270KB) ( )  

Figures and Tables | References | Related Articles | Metrics

General practitioners (GPs) play a pivotal role in mental health services, with the ability to identify and manage mental health issues at an early stage and provide ongoing support through long-term doctor-patient relationships. However, there is a disparity in the development of GPs with a special interest in mental health between China and other countries, with domestic practices lagging behind. There is an urgent need to draw on international experience to foster local development. This paper reviews the progress of GPs with a special interest in mental health both domestically and internationally, analyzes the content of primary health care mental health services in different countries, and summarizes the exploration and achievements in the training and practice of GPs in mental health in China. The paper suggests that China needs to increase government support, promote routine screening and early intervention, advocate for multidisciplinary team collaboration, and develop telemedicine and information services. At the same time, it is recommended to formulate mental health service strategies that are suitable for local medical, social, and cultural environments and social cognition, in order to enhance the development level of GPs with a special interest in mental health in China and improve the quality and overall effectiveness of primary mental health services. Future research will focus on evaluating the long-term effects of mental health training for GPs, optimizing multidisciplinary team collaboration models, and studying the application effects of information technology in mental health services.

The Necessity and Training Strategies for Expanding the Responsibilities in General Practice Niche in China: a Study on the Continuous Development of General Practitioners' Sub-specialties Based on the Delphi Method

LIU Hongya, GUO Aizhen, JIN Hua, FU Qiangqiang, SHI Jianjun, ZHANG Hanzhi, YANG Sen, YU Dehua

2026, 29(20):  2781-2789.  DOI: 10.12114/j.issn.1007-9572.2026.0003

Asbtract ( )   HTML ( )   PDF (1460KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The expansion of responsibilities in general practice niche in China is still in early stages, facing challenges such as insufficient standardized training and a lack of unified assessment and certification mechanisms. There is no consensus within the industry regarding the necessity, pathways, and models for developing sub-specialty capabilities in general practitioners across management, teaching, and clinical practice.

Objective

Taking the expanded role in the international general practice niche as a reference, combined with the domestic model of combining general practice and specialization, this study adopted the Delphi expert consultation method and questionnaire survey method to explore the necessity, main paths, and training methods of cultivating sub-specialty capabilities of general practitioners.

Methods

Based on the literature analysis and the previous research results on the development of the integrated general and specialized medical capabilities of community health service centers in Shanghai, we had initially proposed the subspecialty capability item pool for the training of general practitioners. From March to July 2024, we adopted the Delphi expert consultation method, with 60 experts as the research subjects for consultation and argumentation. Through two rounds of consultation, we determined the items regarding the role and necessity of cultivating subspecialty capabilities among general practitioners. At the same time, we surveyed the experts' tendencies regarding the training paths and models, designed the questionnaire dimensions, and the contents included: the training methods for the sub-specialization capabilities of general practitioners, the training time stages, the knowledge and skills categories, the preference for professional direction selection, and the assessment and recognition institutions, etc.

Results

The effective response rates for both rounds of expert consultation questionnaires were 100.0%, with expert authority coefficients of 0.92 and 0.94, and expert coordination coefficients of 0.146 and 0.165, respectively (P<0.001). After two rounds of expert consultation, a set of items regarding the role and necessity of subspecialty competencies for general practitioners were finally formed, consisting of 3 first-level items and 15 second-level items. In terms of the role and necessity of cultivating subspecialty abilities among general practitioners: the mean importance scores for the 3 first-level items (the role of developing subspecialty abilities among general practitioners in primary healthcare; the coordination and complementarity between general medical basic work and specialized disease/subspecialty work; the necessity of developing subspecialty competencies for general practitioners) were all between 4.90 and 4.93, with full-score rates ranging from 88.3% to 91.7%, and coefficients of variation ranging from 0.05 to 0.06; the mean importance scores for the 15 second-level items were all between 4.42 and 4.98, with full-score rates ranging from 45.0% to 98.3%, and coefficients of variation ranging from 0.03 to 0.13. In terms of the pathways and modes for developing subspecialty competencies for general practitioners: 96.7% (58/60) of the experts chose specialist training in tertiary medical institutions with training qualifications for general practitioners, 93.3% (56/60) chose apprenticeship training (supervised by experts from tertiary medical institutions with training qualifications); 78.3% (47/60) of the experts chose the stage of attending physician title, and 11.7% (7/60) chose the stage of resident work after standardized training as the timing for entering subspecialty training.

Conclusion

The cultivation of expanded responsibilities in general practice niche is a practical logic that must be promoted for the development of primary healthcare. It is advisable to establish the "attending physician stage" as the starting point for the development of niche, and adopt the current strategy of "advanced training in tertiary hospitals combined with a mentorship system". Prioritize the development of subspecialties in dermatology and rehabilitation, and focus on stimulating and cultivating niche outside of hospital departments.

Study on the Diagnosis and Treatment Capacity for Depressive Disorders in Community Health Service Institutions in Shanghai

YAN Wen, ZHANG Hanzhi, JIN Hua, QIAN Jie, YU Dehua

2026, 29(20):  2790-2799.  DOI: 10.12114/j.issn.1007-9572.2025.0523

Asbtract ( )   HTML ( )   PDF (1684KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The actual capacity of community health service institutions in Shanghai for the diagnosis and treatment of depressive disorders has not been systematically evaluated, and there is a lack of empirical research on the urban-suburban differences.

Objective

To assess the current capacity of community health service institutions in Shanghai in the screening, diagnosis, treatment and management of depressive disorders, investigate the knowledge mastery and practical difficulties of community general practitioners, focus on analyzing urban-suburban differences, and provide evidence for optimizing the primary mental health service system.

Methods

A cross-sectional questionnaire survey was conducted among 244 community health service centers across 16 administrative districts in Shanghai from July to August 2025. A total of 2 222 valid questionnaires were collected from institutional managers and general practitioners (244 and 1 978 questionnaires from institutions and doctors, respectively). The institutional survey mainly covered: screening tools for depressive disorders, relevant laboratory/examination items, drug allocation, psychotherapy, related management, and the establishment of specialized clinics in medical institutions. The survey for community general practitioners mainly focused on: knowledge of diagnosis and treatment of depressive disorders, cognition of screening tools for depressive disorders, cognition of differential diagnosis between depressive disorders and bipolar disorder, cognition of follow-up for depressive disorders, and difficulties in the diagnosis, treatment and management of depressive disorders.

Results

Among the 244 community health service institutions in 16 districts of Shanghai, 80 (32.8%) and 164 (67.2%) subjects were urban and suburban institutions, respectively; among 1 978 general practitioners, 505 (25.5%) and 1 473 (74.5%) subjects were urban and suburban practitioners, respectively. Regarding screening tools for depressive disorders, the allocation rate of Self-rating Depression Scale (SDS), Patient Health Questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D) in urban institutions was 47.5%, 43.8% and 12.5%, respectively, compared with 44.5%, 38.4% and 7.3% in suburban institutions. In terms of examinations, the availability rate of electroencephalography and echocardiography in urban and suburban community health service centers was 17.5% vs 4.3% and 70.0% vs 51.8%, respectively; the proportion of electroencephalography and echocardiography was higher in urban areas than in suburban areas (P<0.05). In terms of therapeutic drugs, the allocation rate of benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) in urban and suburban community health service centers was 95.0% vs 91.5% and 38.8% vs 33.5%, respectively. In terms of specialized clinics, the availability rates of psychosomatic disease clinics and psychological counseling clinics in urban and suburban community health service centers were 17.5% vs 4.3% and 15.0% vs 28.0%, respectively; the rate of psychosomatic disease clinics was higher in urban areas, while the rate of psychological counseling clinics was lower in urban centers than in suburban centers (P<0.05). The main difficulties in the management of depressive disorders in community health service centers included: limited medical resources, limited dedicated managerial staff and time (95.1%), lack of therapeutic drugs and psychotherapy skills (87.7%), and poor patient compliance with distrust in community medical staff (60.2%). The awareness rate of the diagnostic duration of depressive symptoms (minimum duration of depressive symptoms for diagnostic significance) among urban and suburban general practitioners was 52.3% and 57.6%, respectively, indicating the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The awareness rates of PHQ-9 and SDS among urban and suburban general practitioners were 64.0% vs 57.8% and 65.9% vs 59.5% respectively, indicating the urban community general practitioners were higher than the suburban community general practitioners (P<0.05). The awareness rates of decreased sleep need, distractibility and inflated self-esteem were 61.2% vs 67.3%, 41.2% vs 49.6% and 57.2% vs 64.3%, respectively, indicating the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The awareness rate of monthly follow-up was 73.9% in urban areas and 82.1% in suburban areas, indicating that the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The suburban general practitioners reported the higher rates of difficulties in diagnosis and treatment (including insufficient suicide risk assessment ability, insufficient non-pharmacological treatment ability and insufficient post-treatment efficacy evaluation ability) than the urban general practitioners (P<0.05). In management difficulties, suburban practitioners also reported the higher rates of insufficient health education capacity on depressive disorders, lack of expert guidance in communities, and lack of two-way referral channels with higher-level hospitals (P<0.05).

Conclusion

Community health service institutions in Shanghai, especially those in suburban areas, should strengthen the allocation of screening tools, relevant examinations and medications. It is necessary to improve general practitioners' mastery of depressive disorder knowledge, health education ability and psychotherapy skills. Institutional construction, resource allocation and capacity improvement should be strengthened to promote an integrated management system and enhance the efficiency of primary mental health services.

Article·Multimorbidity Section

Analysis of Socioeconomic and Demographic Challenges in Chronic Disease Management

CHENG Yu, HAN Shiyao, SUN Ping, XIANG Juan, YANG Hui, LI Dongze, ZHENG Li, LIAO Xiaoyang

2026, 29(20):  2800-2807.  DOI: 10.12114/j.issn.1007-9572.2025.0485

Asbtract ( )   HTML ( )   PDF (1510KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Chronic diseases have become a major health burden in China. The management of chronic diseases extends beyond clinical care and is profoundly shaped by structural social determinants. This research adopts a narrative review approach and applies Fundamental Cause Theory (FCT) to analyze disparities in chronic disease management across three key dimensions: socioeconomic status (SES), gender, and age. Individuals with lower SES face systemic disadvantages in accessing health information, exercising self-efficacy, and securing necessary health resources. Gender disparities are shaped not only by female-specific disease burdens but also by socially constructed roles and institutional biases. Older adults encounter additional challenges in managing multiple chronic conditions due to physiological decline, digital exclusion, and weakening social support networks. Rather than narrowing these gaps, technological advancements may inadvertently exacerbate inequalities due to unequal capacity to mobilize resources. This paper proposes a three-tiered intervention framework and advocates the integration of 'social prescribing' into chronic care models. It calls for coordinated action across structural equity, service delivery, and digital inclusion to advance health equity in chronic disease management.

Research on Treatment Burden and Influencing Factors of Patients with Multimorbidity in Rural Township Health Centers in Guangxi Zhuang Autonomous Region

WANG Xuan, SHEN Ying, XI Qian, ZHAO Can, MO Yunjian, ZHANG Wenting

2026, 29(20):  2808-2815.  DOI: 10.12114/j.issn.1007-9572.2025.0422

Asbtract ( )   HTML ( )   PDF (1588KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The prevalence of multimorbidity among Chinese residents is high, yet current researches predominantly focus on urban populations. The current situation and influencing factors of treatment burden in patients with multimorbidity in rural primary health care institutions remain unclear.

Objective

This study aims to investigate the current situation and associated factors of treatment burden in patients with multimorbidity in township health centers in Guangxi, and to provide research evidence from the viewpoint of treatment burden for improving multimorbidity prevention and treatment in rural primary health care institutions.

Methods

A multi-stage stratified random sampling was performed based on geography and 2022 Township health centers income in Guangxi, to select 8 township health centers in 4 cities, including Wuzhou, Nanning, Yulin, and Guilin, in Guangxi as sample institutions. Then, a random systematic sampling was conducted to recognize multimorbidity patients who visited the outpatient department or were admitted to the inpatient department of each sample institution from January to June 2024 as study subjects. Eight investigators were recruited to implement on-site investigations using the Multiple Chronic Diseases Treatment Burden Scale for collecting treatment burden data. According to the percentiles of the total scale score and dimension-specific total scores, treatment burden was categorized into three levels: high, medium, and low. A multiple linear regression analysis was employed to identify influencing factors of treatment burden.

Results

A total of 484 questionnaires were distributed and 452 valid responses received, yielding a valid response rate of 93.4%. The median total treatment burden score among 452 patients was 67 (55, 78), indicting a high burden. Scores on the self-management, economic, and psychological dimensions, as well as scores on eight individual items, were also classified as high burden. Of the 452 patients, 24 (5.3%) were identified as having low treatment burden, 197 (43.6%) as having medium burden, and 231 (51.1%) as having high burden. Multiple linear regression revealed that Han nationality (B=-5.288, 95%CI=-8.341 to -2.235), married individuals (B=-8.489, 95%CI= -12.598 to -4.380), and those involving in self-care (B=-4.999, 95%CI= -8.738 to -1.261) were associated with lower treatment burden (P<0.05). In addition, the following factors were associated with higher treatment burden (P<0.05): per capita monthly household income <1 000 yuan (B=10.817, 95%CI=5.091-16.543) or 1 000-2 999 yuan (B=6.372, 95%CI=1.624-11.119), primary school education or below (B=6.081, 95%CI=1.547-10.615), multimorbidity course ≥5 years (B=3.233, 95%CI=0.122-6.343), ≥2 hospitalizations in the past year (B=9.225, 95%CI=6.170-12.281), and enrollment in the urban-rural resident basic medical insurance (B=8.193, 95%CI=0.279-16.108).

Conclusion

Multimorbidity patients in township health centers of Guangxi reported a high level of treatment burden experience, with particularly pronounced burdens in the self-management, economic, and psychological dimensions. The influencing factors of treatment burden exhibited complex and multifaceted interactions. Rural primary healthcare institutions should pay attention to treatment burden of patients with multimorbidity, implement comprehensive, multi-level interventions to reduce its level, and improve the outcomes of multimorbidity care.

Progress in the Study of Influencing Factors and Intervention Strategies of Mental Health in Elderly Patients with Multiple Chronic Conditions

LI Feng, HU Changhao, LUO Xu

2026, 29(20):  2816-2828.  DOI: 10.12114/j.issn.1007-9572.2024.0617

Asbtract ( )   HTML ( )   PDF (1980KB) ( )  

References | Related Articles | Metrics

The accelerated aging of China's population has contributed to the increasing prominence of chronic disease comorbidities, significantly increasing the medical burden and threatening patients' physical and mental health. Elderly patients with chronic disease comorbidities are more likely to have psychological problems such as anxiety and depression due to multiple comorbidities, and their symptom detection rate is significantly higher than that of the healthy or single chronic disease population. Although the pathogenesis is unclear, demographic (age, gender, education), socioeconomic (household income, place of residence), social support, health status, and lifestyle factors are strongly associated with mental health, and elucidation of these factors is essential for the development of precise intervention strategies. Existing interventions are classified as both pharmacological and non-pharmacological. Although medications provide symptomatic relief, the risk of polypharmacy limits how they're used. Non-pharmacological interventions show unique advantages through diversified means: group psychological intervention strengthens the social support network, cognitive behavioral therapy corrects negative cognition, exercise therapy improves both physical and psychological health, music/nostalgia/narrative therapy regulates emotional states, Internet+ technology breaks through time and space constraints to increase accessibility of interventions, traditional Chinese medicine therapy realizes physical and mental co-treatment, and health education and co-psychological care enhance self-management ability through knowledge and empowerment. These interventions have been shown to be effective in improving the mental health of comorbid patients. This article reviews national and international studies focusing on the epidemiology, influencing factors, and intervention strategies of elderly multimorbid patients to provide a basis for mental health promotion. In the future, it is necessary to deepen research on the mechanism of multidisease interaction, establish a personalized intervention system based on risk assessment, and verify the effect of intervention through multicenter long-term follow-up, in order to achieve the goal of healthy aging.

Article

Prevalence and Associated Factors of Subjective Cognitive Decline among Older Stroke Patients in China

LIU Ying, LIU Shiwei, ZHANG Chi, SHEN Ji, ZHANG Yushan, ZHANG Jie, SANG Yingchen, WANG Youjiao, WANG Lei, ZHOU Houguang, SHI Hong

2026, 29(20):  2829-2835.  DOI: 10.12114/j.issn.1007-9572.2025.0484

Asbtract ( )   PDF (1681KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Dementia imposes a substantial burden in China, Subjective cognitive decline (SCD) represents an early warning sign of dementia. Interventions initiated during this stage, prior to the onset of objective cognitive impairment, are significantly more effective than treatments administered after a formal dementia diagnosis, offering potential to delay or even prevent disease progression.

Objective

To investigate the prevalence, epidemiological characteristics, and determinants of SCD among older adults (aged≥65 years) with a history of stroke in China, thereby providing a scientific basis for early intervention strategies.

Methods

This study utilised data from the 2024 China Aging and Health Survey (CAHS), conducted from May 2023 to June 2024. We included 2 647 older adults with stroke from 31 provinces (autonomous regions, municipalities). SCD was assessed using the validated Subjective Cognitive Decline-9 (SCD-9) scale. A weighted complex sampling design was applied to account for the survey structure, and multivariable Logistic regression analysis was employed to identify factors associated with SCD.

Results

The weighted data showed that the rate of SCD among elderly stroke patients in China was 62.53%, and there were significant regional differences. The rates in the central region are 74.74%, in the northeast 72.37%, in the west 58.75%, and in the east 50.14%. Multivariate Logistic regression analysis showed that, compared with the eastern region, elderly stroke patients in the northeastern region had the highest risk of subjective cognitive decline (OR=1.289, 95%CI=1.189-1.398), followed by those in the central and western regions (central: OR=1.123, 95%CI=1.065-1.184; western: OR=1.069, 95%CI=1.012-1.129). Age (≥75 years: OR=1.901, 95%CI=1.805-2.001; 70-74 years: OR=1.260, 95%CI=1.192-1.330), residence (rural: OR=1.072, 95%CI=1.023-1.122), education level (high school and above: OR=0.835, 95%CI=0.787-0.887; junior high school: OR=0.766, 95%CI=0.726-0.808), monthly household income (≥10 000 yuan: OR=0.828, 95%CI=0.764-0.897; 6 000-9 999 yuan: OR=0.875, 95%CI=0.819-0.936; 3 000-5 999 yuan: OR=0.810, 95%CI=0.764-0.858), anxiety (yes: OR=1.258, 95%CI=1.184-1.338), and depression (yes: OR=3.239, 95%CI=3.063-3.425) were identified as influencing factors for subjective cognitive decline in elderly stroke patients (P<0.05).

Conclusion

The prevalence of SCD is high among older adults with stroke in China, with marked regional disparities. Depression and anxiety are major modifiable influencing factors. There is a need to develop regionalized early intervention strategies targeting high-risk populations to delay the progression of cognitive impairment.

Association between Novel Obesity Indicators and Cardiovascular Disease Risk in Hypertensive Patients

REYILAI· Maimaiti, ZHOU Yiran, WU Yun, LIU Zhencheng, LU Yaoqin, WU Haiyan

2026, 29(20):  2836-2845.  DOI: 10.12114/j.issn.1007-9572.2025.0414

Asbtract ( )   HTML ( )   PDF (2343KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Hypertension is an important risk factor for cardiovascular disease (CVD). Traditional body mass index (BMI) has limitations in identifying high-risk patients, and the predictive value of new obesity indicators in the hypertensive population remains to be clarified.

Objective

To explore the relationship between novel obesity indicators, such as the Chinese visceral adiposity index (CVAI), body roundness index (BRI), relative fat mass index (RFM), weight-adjusted waist index (WWI), triglyceride-glucose index (TyG), and its related indices TyG-BMI, TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR) and the risk of CVD in patients with hypertension, and to compare their predictive performance, thereby providing a basis for the prevention and management of cardiovascular disease in the hypertensive population.

Methods

A retrospective cohort study design was adopted, including 69 627 hypertensive individuals in the public health surveillance database in Urumqi, Xinjiang Uygur Autonomous Region from 2016 to 2022 as the study population. Patient baseline characteristics, general physical examination indicators and laboratory test indicators were collected, and CVAI, BRI, RFM, WWI, TyG, TyG-BMI, TyG-WC, and TyG-WHtR were calculated accordingly.The follow-up endpoint was defined as the first diagnosis of CVD in patients or the end of the study period. Cox proportional hazards regression models and restricted cubic spline models were constructed to assess the risk of cardiovascular disease associated with different indicators. Time-dependent C indices and the area under the ROC curve (AUC) were used to compare the predictive performance of different indicators.

Results

A total of 2 466 (3.54%) individuals developed CVD by the end of follow-up. Multivariate Cox regression analysis showed that after adjusting for confounding factors, the following indicators were associated with an increased risk of cardiovascular disease: CVAI (HR=1.122, 95%CI=1.072-1.175), BRI (HR=1.104, 95%CI=1.061-1.149), RFM (HR=1.236, 95%CI=1.141-1.338), WWI (HR=1.073, 95%CI=1.029-1.118), TyG-BMI (HR=1.099, 95%CI=1.054-1.146), TyG-WC (HR=1.105, 95%CI=1.058-1.154), TyG-WHtR (HR=1.113, 95%CI=1.066-1.161)(P<0.05). Restricted cubic spline analysis indicated a significant nonlinear dose-response relationship between RFM and CVD risk (P_nonlinear<0.05). Time-dependent C-index analysis showed that the discriminative ability of each indicator remained generally stable over the follow-up period. ROC curve analysis showed that the AUCs of TyG, CVAI, BRI, WWI, TyG-BMI, TyG-WC and TyG-WHtR in predicting the risk of CVD were 0.512, 0.568, 0.558, 0.566, 0.518, 0.531 and 0.553, respectively. Subgroup analysis showed that BRI, RFM, WWI and TyG-WHtR showed obvious sex interaction (P_interaction<0.05).

Conclusion

Among hypertensive patients, novel obesity indices such as CVAI, BRI and WWI were associated with the risk of incident CVD and had certain reference value for CVD risk assessment, but their independent predictive performance was limited.

Identification of Factors Associated with Persistent Atrial Fibrillation and Development of a Classification Model

LI Chaohui, LIU Hui, WANG Kai

2026, 29(20):  2846-2853.  DOI: 10.12114/j.issn.1007-9572.2025.0360

Asbtract ( )   HTML ( )   PDF (1963KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Atrial fibrillation (AF) severely impairs patients' quality of life, leads to high morbidity and mortality, and increases healthcare costs. Current classification methods for atrial fibrillation primarily rely on clinical symptoms and examination results, but they struggle to quantify the underlying pathophysiological burden, often leading to treatment strategies that do not match patients' actual risks.

Objective

To investigate the factors associated with persistent AF and to develop a classification model based on these factors.

Methods

Patients diagnosed with paroxysmal and persistent AF at the First Affiliated Hospital of Xinjiang Medical University between April 2012 and September 2023 were enrolled in this study. Clinical data, including demographic characteristics, biochemical parameters, renal function indices, and cardiac function-related metrics, were collected for analysis. Initially, univariate Logistic regression analysis was performed to screen for variables associated with the type of AF. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied for further feature selection to reduce model complexity and prevent overfitting. A multivariate Logistic regression model was then constructed to identify factors independently associated with persistent AF. Utilizing the bootstrap resampling method, the significant variables were incorporated into six machine learning algorithms—Random Forest (RF), Decision Tree (DT), Naive Bayes (NB), Support Vector Machine (SVM), K-Nearest Neighbors (KNN), and eXtreme Gradient Boosting (XGB)—to establish classification models. The discriminative performance of these models was evaluated using receiver operating characteristic (ROC) curves. Finally, the SHapley Additive exPlanations (SHAP) method was employed to evaluate the contribution of each variable to the classification models.

Results

A total of 6 938 patients were enrolled, including 5 085 with paroxysmal AF and 1 853 with persistent AF. Univariate Logistic regression analysis initially identified 19 statistically significant independent variables. Following LASSO regression selection, 13 key variables were retained for multivariate Logistic regression analysis. The results indicated that the following were independently associated with persistent AF (all P<0.05): gender (OR=1.248, 95%CI=1.086-1.435), surgical history (OR=0.809, 95%CI=0.706-0.926), BMI (OR=1.028, 95%CI=1.012-1.045), mean platelet volume (MPV) (OR=1.121, 95%CI=1.059-1.186), serum magnesium (Mg_plus2 ) (OR=0.098, 95%CI=0.046-0.208), cardiac output (CO) (OR=1.115, 95%CI=1.009-1.233), left ventricular posterior wall thickness (LVPW) (OR=0.777, 95%CI=0.665-0.909), left atrial diameter (LAD) (OR=1.144, 95%CI=1.123-1.166), left ventricular ejection fraction (LVEF) (OR=0.955, 95%CI=0.938-0.972), right atrial diameter (RAD) (OR=1.031, 95%CI=1.005-1.057), triglycerides (TG) (OR=0.821, 95%CI=0.751-0.898), uric acid (UA) (OR=1.003, 95%CI=1.002-1.003), and left ventricular end-diastolic diameter (LVEDD) (OR=0.903, 95%CI=0.879-0.927). ROC curve analysis demonstrated that the XGB model achieved the best performance (mean AUC=0.823), followed by the SVM model (mean AUC=0.820) and the RF model (mean AUC=0.814). SHAP analysis of the XGB model revealed that LAD and RAD had the highest SHAP values, suggesting that atrial structural parameters exert the greatest influence on model classification.

Conclusion

Increased BMI, male sex, elevated MPV, higher UA, decreased TG levels, decreased Mg_plus2, reduced LVEF, decreased LVEDD, no surgical history, and enlarged RAD and LAD were all closely associated with the occurrence of persistent AF. These clinical parameters can be readily obtained through routine examinations, most of which are non-invasive, and may serve as important clinical indicators for identifying patients with persistent AF, thereby supporting early clinical risk stratification and the development of targeted intervention strategies.

Relationship between Remnant Cholesterol and Non-alcoholic Fatty Liver Disease as well as Progressive Liver Fibrosis in Patients with Type 2 Diabetes Mellitus

GE Dan, WANG Zhi, DING Qun, GUO Tonglan, XU Tongdao

2026, 29(20):  2854-2859.  DOI: 10.12114/j.issn.1007-9572.2025.0313

Asbtract ( )   HTML ( )   PDF (1943KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The prevalence of nonalcoholic fatty liver disease (NAFLD) is significantly higher in patients with type 2 diabetes mellitus (T2DM). However, there are few studies on the relationship between serum remnant cholesterol (RC) and NAFLD and liver fibrosis in T2DM patients.

Objective

To investigate the relationship between serum RC level and NAFLD and progressive liver fibrosis in patients with T2DM.

Methods

316 patients with T2DM hospitalized in the Second People's Hospital of Lianyungang from 2022 to 2024 were selected and divided into NAFLD group (195 cases) and Non-NAFLD group (121 cases) according to whether they were complicated with NAFLD. According to NAFLD fibrosis score (NFS), NAFLD group was divided into progressive liver fibrosis subgroup (92 cases) and non-progressive liver fibrosis subgroup (103 cases). General information and laboratory findings of patients were collected and RC levels were calculated. ROC curves were drawn to explore the diagnostic efficacy of RC for NAFLD and progressive liver fibrosis, and the area under ROC curve (AUC) was calculated.

Results

Fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), aspartate aminotransferase (AST), uric acid, triglyceride (TG), and serum RC levels were significantly higher in patients of NAFLD group than those in Non-NAFLD group (P<0.05), while high density lipoprotein cholesterol (HDL-C) was significantly lower in patients of NAFLD group than those in Non-NAFLD group (P<0.05). Compared with the non-progressive liver fibrosis subgroup, the patients in the progressive liver fibrosis subgroup were older, had longer diabetes duration, higher levels of FINS, HOMA-IR, AST, uric acid, TG, RC, and lower levels of alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) (P<0.05). Spearman correlation analysis results showed that the serum RC level was positively correlated with BMI, FINS, HOMA-IR, glycosylated hemoglobin (HbA_1c), total cholesterol, TG, low density lipoprotein cholesterol, AST, GGT, uric acid and risk of NAFLD (P<0.05), and negatively correlated with age and HDL-C (P<0.05). Logistic regression analysis results showed that elevated RC was a risk factor for NAFLD (OR=1.879, 95%CI=1.026-3.443, P=0.041) and progressive liver fibrosis (OR=4.365, 95%CI=1.952-9.760, P<0.001) in patients with T2DM after adjusting for age, gender, duration of diabetes, BMI, systolic blood pressure, diastolic blood pressure, HOMA-IR and HbA_1c. The AUC for RC diagnosis of NAFLD was 0.604, with a sensitivity of 67.69% and a specificity of 49.59%. The AUC for RC diagnosis of progressive liver fibrosis in NAFLD patients was 0.629, with a sensitivity of 39.13% and a specificity of 91.26%.

Conclusion

Elevated serum RC is an independent risk factor for NAFLD and progressive liver fibrosis in patients with T2DM. It has certain diagnostic value for NAFLD and progressive liver fibrosis.

Research on the Differences in the Clinical Characteristics and Basic Pattern Distribution of 2 340 Lung Cancer Patients in Different Regions of China

FENG Zhenzhen, LIU Wenrui, LI Jiansheng, GUAN Xutao, QUAN Jianfeng, GAO Hong, TIAN Jianhui, RONG Zhen, HOU Wei, ZHOU Xun

2026, 29(20):  2860-2866.  DOI: 10.12114/j.issn.1007-9572.2025.0170

Asbtract ( )   HTML ( )   PDF (1887KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Traditional Chinese medicine (TCM) theory suggests a close relationship between syndromes and geographical regions. However, clinical research investigating regional variations in clinical characteristics and TCM syndrome distributions among lung cancer patients remains insufficient.

Objective

To analyze regional differences in clinical characteristics and TCM syndrome distributions among lung cancer patients across various regions in China, providing evidence to support clinical syndrome differentiation.

Methods

A cross-sectional survey was conducted, distributing questionnaires to outpatient or inpatient lung cancer patients from June 2020 to June 2024 in 11 hospitals: the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Longhua Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan Provincial Hospital of Traditional Chinese Medicine, Henan Cancer Hospital, the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, and the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine. Patients were grouped into seven geographical regions: Northeast, North China, East China, South China, Central China, Northwest, and Southwest. General characteristics among the seven regions such as age, gender, ethnicity, tumor node metastasis (TNM) staging, pathological type, treatment methods, and distribution of fundamental Traditional Chinese Medicine syndromes (lung qi deficiency syndrome, blood stasis syndrome, lung yin deficiency syndrome, etc.) were compared.

Results

A total of 2 340 patients with lung cancer were enrolled in this study. There were significant regional differences among seven regions of patient age, gender, ethnicity, TNM stage, pathological type, treatment modality, smoking history, chronic respiratory diseases, family history of tumors, living environment, and patient self-assessment scores (pain, quality of life, functional status, physical condition, anxiety, depression) (P<0.05). The overall frequency of basic lung cancer syndromes across the seven regions ranked from highest to lowest as follows: lung qi deficiency, blood stasis, lung yin deficiency, spleen qi deficiency, phlegm dampness, and phlegm heat syndrome, with significant regional differences (P<0.05). Specifically, the predominant syndromes were lung qi deficiency (37.11%), lung yin deficiency (33.51%), and phlegm-dampness (20.10%) in the Northeast region, lung qi deficiency (85.19%), blood stasis (72.84%), and lung yin deficiency (44.44%) in North China, lung qi deficiency (69.15%), lung yin deficiency (44.47%), spleen qi deficiency (19.15%), and blood stasis (19.15%) in East China, lung qi deficiency (58.50%), lung yin deficiency (37.00%), and phlegm dampness (21.00%) in South China, lung qi deficiency (51.51%), blood stasis (35.92%), and spleen qi deficiency (35.92%) in Central China; lung qi deficiency (74.00%), spleen qi deficiency (58.00%), and blood stasis (51.00%) in Northwest China; and blood stasis (31.34%), lung qi deficiency (28.26%), and lung yin deficiency (18.41%) in Southwest China.

Conclusion

Regional variations exist in the clinical characteristics and TCM syndrome distributions among lung cancer patients in China. TCM syndrome differentiation and treatment should therefore consider both geographical and individual factors to enhance clinical efficacy.

Association of Serum Vascular Endothelial Cadherin Levels with the Risk of Post-stroke Cognitive Impairment in Patients with Acute Ischemic Stroke

YANG Xiaofeng, LI Xianwen, WU Yanfeng, ZHANG Qian, CHEN Juan, ZHAO Fengjiao

2026, 29(20):  2867-2873.  DOI: 10.12114/j.issn.1007-9572.2025.0366

Asbtract ( )   HTML ( )   PDF (1917KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Cognitive dysfunction is a frequent consequence of acute ischemic stroke (AIS). Early detection of post-stroke cognitive impairment (PSCI) is critical for optimizing the prognosis of stroke patients. To date, however, there remains a lack of widely accepted blood-based biomarkers for PSCI.

Objective

This study aimed to examine the association between serum levels of vascular endothelial cadherin (VE-Cad) and the development of PSCI in individuals with AIS.

Methods

The present study enrolled patients with AIS who were admitted to the Department of Neurology, the Second Affiliated Hospital of Nanjing Medical University, between July 2023 and May 2024. Patients completed the MoCA and the MMSE at admission and three months after discharge, respectively. In this study, a MoCA score ≤26 was used as the criterion for determining cognitive decline, while the MMSE served only as an auxiliary assessment. Patients with persistent cognitive decline for three months or longer were assigned to the post-stroke cognitive impairment group (PSCI group), and the remaining patients were assigned to the post-stroke non-cognitive impairment group (PSNCI group). Demographic characteristics and laboratory parameters were compared between the two groups. Multivariate Logistic regression analysis was performed to explore the association between serum VE-Cad levels and the risk of PSCI. Restricted cubic spline (RCS) regression was employed to visualize the dose-response relationship between VE-Cad levels and PSCI risk.

Results

A total of 261 patients with AIS were included in the final analysis, with a mean age of (66.6±10.9) years. Based on cognitive assessments conducted during hospitalization and at 3-month follow-up, 176 patients were classified into the PSCI group and 85 into the PSNCI group. Multivariate Logistic regression analysis identified serum VE-Cad as an independent influencing factor for PSCI (OR=1.119, 95%CI=1.024-1.223, P<0.05). Restricted cubic spline analysis revealed a nonlinear association between VE-Cad levels and the risk of PSCI (χ²=28.10, P<0.001), with the risk increasing significantly when VE-Cad concentrations exceeded 13.87 μg/L.

Conclusion

Serum VE-Cad levels are associated with the risk of post-stroke cognitive impairment in patients with AIS, exhibiting a nonlinear dose-response relationship.

Study of Maternal Risk Factors Associated with Neonatal Asphyxia in Late Preterm and Term Infants

SONG Zhenzhen, CHEN Yang, WANG Jiwen, LIU Huishan, SHEN Simeng, SUN Ying, CHEN Xing

2026, 29(20):  2874-2878.  DOI: 10.12114/j.issn.1007-9572.2025.0344

Asbtract ( )   HTML ( )   PDF (1652KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Neonatal asphyxia can cause multi-organ damage and is one of the main causes of neonatal death. Early identification of antenatal high-risk factors can effectively reduce the neonatal asphyxia rate and decrease the occurrence of adverse neonatal outcomes.

Objective

To analyze the maternal high-risk factors for asphyxia in late preterm and full-term infants.

Methods

A retrospective analysis was conducted on 155 asphyxiated live-born neonates delivered in the Department of Obstetrics, the First Affiliated Hospital with Nanjing Medical University from 2022 to 2024, including late preterm infants (34 weeks ≤ gestational age < 37 weeks) and full-term infants (gestational age ≥ 37 weeks). Neonatal asphyxia was diagnosed based on Apgar scores combined with umbilical artery blood gas pH values. A total of 620 non-asphyxiated live-born neonates delivered during the same period were randomly enrolled as the control group at a 1:4 ratio. General maternal data and prenatal related data of the two groups were collected. Binary Logistic regression analysis was used to explore maternal high-risk factors for asphyxia in late preterm and full-term infants.

Results

From 2022 to 2024, a total of 15 801 live births were delivered in the Department of Obstetrics, the First Affiliated Hospital with Nanjing Medical University, with 377 cases of asphyxia, resulting in a neonatal asphyxia (NA) rate of 2.38% (377/15 801). The neonatal asphyxia rate among late preterm and term infants was 0.98% (155/15 801). Among them, high maternal age, assisted reproductive technology, multiple pregnancies, preeclampsia, uterine scars, Group B Streptococcus carriage, and anemia were associated with higher neonatal asphyxia rates, with statistically significant differences (P<0.05). Binary Logistic regression analysis showed that uterine scars (OR=2.19, 95%CI=1.08-4.43) and Group B Streptococcus carriage (OR=27.28, 95%CI=16.91-44.01) were independent risk factors for asphyxia in late preterm and full-term infants (P<0.05).

Conclusion

Strengthen the management of pregnant women with scarred uterus and those carrying Group B Streptococcus during pregnancy, early screening and standardized management of preeclampsia and anemia, with a focus on managing high-risk pregnancies such as advanced maternal age, pregnancies achieved through assisted reproductive technology, multiple pregnancies, along with strengthening prenatal health education and implementing preventive measures, are of great significance for reducing neonatal asphyxia.

Construction and Clinical Value of the Hemorrhoids Severity and Surgical Risk Prediction Score

SUN Songpeng, XU Fangfang, LONG Junhong, WANG Zhanjun, CAO Qiaorong, WAN Weiping, LI Tianyu, LIN Mei, TIAN Ying, SHI Bin, WU Yao, WANG Jianguo, LI Xinjian, HUO Xingxiao, LIANG Longyu, CHU Hongchuan, ZHOU Yangyang, ZHANG Zhiyun, ZHANG Shuxin, JIA Shan

2026, 29(20):  2879-2886.  DOI: 10.12114/j.issn.1007-9572.2024.0534

Asbtract ( )   HTML ( )   PDF (2181KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

There are many methods for the treatment of hemorrhoids. In principle, drug treatment should be the first and surgical treatment can be further selected if there is no response to drug treatment. Accurately assessing the severity of hemorrhoids and predicting the risk of surgical treatment is key to avoiding ineffective medication.

Objective

The purpose of this study was to develop the hemorrhoids severity and surgical risk prediction (HSSP) score, and evaluated its validity and the value of guiding treatment.

Method

During the period from November 2021 to November 2022, a cross-sectional study was conducted in 6 hospitals including Dongzhimen Hospital of Beijing University of Chinese Medicine. The self-made questionnaire, self-made hemorrhoid symptom questionnaire, Goligher classification, position acute tone external system(PATE), Giordano severity of hemorrhoid symptom questionnaire(GSQ), Chinese version of HEMO-FISS-QoL Questionnaire(HF-QoL-C) were used to investigate the enrolled patients. Multivariate Logistic regression analysis was used to screen variables and construct the HSSP score. The differences between the surgical treatment group and the drug treatment group and the HSSP score of Goligher gradeⅠtoⅣ were compared. The Hosmer-Lemeshow test was used to assess the fit of the model. The receiver operating characteristic (ROC) curve of HSSP score predicting surgical risk was drawn, and the area under the ROC curve (AUC) was used to evaluate the predictive value of HSSP score. The differences of HF-QoL-C and Goligher classification in patients with different HSSP score groups were compared, and the discriminant validity of HSSP score was evaluated.

Results

A total of 707 questionnaires were distributed, and 491 valid questionnaires were collected, the recovery rate was 69.45%. A total of 491 patients with hemorrhoids were included, dividing 172 cases in the drug treatment group and 319 cases in the surgical treatment group. Six variables were obtained via multivariate Logistic regression analysis, including age, course of disease, frequency of hematochesis, frequency of anal pain, removal of hemorrhoids and the impact of hemorrhoids on daily life to construct the HSSP score. The score of HSSP ranged from 6 to 19.5. The higher the score, the more serious the disease was. Hosmer-Lemeshow test results showed that the model fitted well(χ²=11.193, P=0.191). There were significant differences in HSSP scores between the drug group and the surgical treatment group, and among the Goligher classification(P<0.05). The AUC of HSSP for predicting surgical risk was 0.808 (95%CI= 0.769-0.846), the best cut-off value was 12.25, the sensitivity was 0.78, and the specificity was 0.67. Patients were divided into two groups based on the optimal cut-off value and the HSSP score: HSSP score < 12.5 group and HSSP score ≥ 12.5 group. There were significant differences in the scores of each dimension of HF-QoL-C and Goligher grade between two groups (P<0.05).

Conclusion

HSSP has good validity and the ability to guide treatment. It can evaluate the severity of hemorrhoids and predict the risk of surgical treatment. Patients with hemorrhoids with HSSP score≥12.5 should be advised to take surgical treatment.

A Mixed Study of Fertility Intention and Its Influencing Factors among the Childbearing-age Women in Anhui Province

HUANG Haili, LI Yuhong, YU Yang, GUO Ping, HAN Changzheng, LIU Ping

2026, 29(20):  2887-2894.  DOI: 10.12114/j.issn.1007-9572.2025.0085

Asbtract ( )   HTML ( )   PDF (2212KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Reduced fertility intention is an important prerequisite for fertility decline, and exploring its influencing factors is of great significance in promoting the long-term balanced development of the population, whereas most of the existing researches are confined to quantitative analysis and lacks exploration at the subjective level.

Objective

Under the backdrop of the three-child policy, to explore the influencing factors of the three-child fertility intentions of women of childbearing age and the underlying reasons for their unwillingness to have children, in order to provide a basis for improving the supporting measures for the fertility policy.

Methods

A mixed study method was used. From January to May 2024, the childbearing-age women in urban and rural areas in the south (Chizhou City and Ma'anshan City), central (Hefei City and Lu'an City), and north (Fuyang City and Bozhou City) of Anhui Province were selected by convenience sampling method and surveyed with a questionnaire (including personal, family economic, social, and marital factors). Multivariate Logistic regression was used to analyze the factors affecting the childbearing-age women's intentions to have a third child. During the same period, the phenomenological research method was used to purposively and heterogeneously extract the childbearing-age women who were unwilling to have a third child in the quantitative study for semi-structured interviews. Colaizzi's seven-step analysis was used to refine the interview themes.

Results

A total of 2 400 questionnaires were distributed, and 2 234 valid questionnaires were finally collected, with a valid recovery rate of 93.1%. 186 (8.3%) of the 2 234 childbearing-age womenintended to have a third child. The results of multivariate Logistic regression analysis showed that the degree of housing pressure (mild stress: OR=0.651, 95%CI=0.442-0.959; moderate stress: OR=0.473, 95%CI=0.303-0.740), the spouse's attitude towards having a third child (unsupportive: OR=0.594, 95%CI=0.375-0.941; indifferent: OR=0.465, 95%CI=0.299-0.723), the spouse's sharing of household chores (moderate sharing: OR=0.371, 95%CI=0.239-0.577; occasional sharing: OR=0.534, 95%CI=0.354-0.805), the place of residence (town: OR=0.578, 95%CI=0.384-0.871), and the number of children (one: OR=0.554, 95%CI=0.328-0.934) were the influencing factors of the intention of childbearing-age women to have a third child (P<0.05). A total of 22 childbearing-age women were finally interviewed, and four themes of deep-seated reasons for childbearing-age women's unwillingness to have a third child were distilled: the high cost of childbearing, the weak support within the family, the difficulty in balancing work and family, and imperfect supporting measures for childbearing policies.

Conclusion

The intention of childbearing-age women to have a third child is less than 10% in Anhui Province, with the degree of housing pressure, the spouse's attitude towards having a third child, the spouse's sharing of household chores, the place of residence, and the number of children being the main factors influencing the childbearing-age women's intention to have a third child. The high cost of childbearing, the weak support within the family, the difficulty in balancing work and family, and imperfect supporting measures for childbearing policies are the deep-rooted reasons why childbearing-age women are unwilling to have a third child. It is recommended that the fertility support policy be further improved to enhance the fertility enthusiasm of the childbearing-age group, to effectively solve the problem of low fertility rate.

Article·Epidemiological Study

Analysis of the Disease Burden of Parkinson's Disease in China and Globally from 1990 to 2021 and Prediction of Future Trends

WU Yixuan, XIAO Liangman, LIU Xin, YAN Ziqi, WANG Yuting, LIN Shumin, ZHUANG Lixing

2026, 29(20):  2895-2902.  DOI: 10.12114/j.issn.1007-9572.2025.0319

Asbtract ( )   HTML ( )   PDF (2799KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Parkinson's disease (PD) is a common neurodegenerative disorder, and its global disease burden continues to increase. Due to China's large population base and rapid aging process, the country faces even more severe challenges.

Objective

Based on the Global Burden of Disease (GBD) 2021 database, this study analyzes the differences and trends in the disease burden of PD between China and the global level from 1990 to 2021, predicts future changes in disease burden, and provides a scientific basis for optimizing PD prevention and treatment strategies.

Methods

Using data from GBD 2021, indicators such as PD incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for China and the global level from 1990 to 2021 were extracted. An age-period-cohort model was employed to analyze epidemiological trends, and a Bayesian age-period-cohort model was applied to predict the disease burden from 2022 to 2035.

Results

From 1990 to 2021, the number of PD incident cases in China increased by 455.7% (compared to a 220.1% increase globally). The age-standardized incidence rate (ASIR) showed an upward trend, rising from 12.83 per 100 000 to 24.34 per 100 000, with an estimated annual percentage change (EAPC) of 2.16% (compared to 1.09% globally). The number of prevalent cases increased by 678.9% (compared to 273.8% globally). In China, the age-standardized mortality rate (ASMR) exhibited a declining trend, decreasing from 6.11 per 100 000 to 5.03 per 100 000, with an EAPC of -0.76%. In contrast, the global ASMR showed an upward trend (EAPC=0.18%). The age-period-cohort model revealed that the growth rate of the PD burden in China was higher than the global average, particularly among males and individuals aged 75-79 years. Predictions from the Bayesian age-period-cohort model indicated that by 2035, China's ASIR (32.26 per 100 000) and age-standardized prevalence rate (ASPR) (332.67 per 100 000) for PD would far exceed global levels.

Conclusion

The disease burden of PD is growing rapidly, primarily driven by population aging. However, China demonstrates a more favorable trend in mortality control compared to the global average. PD shows a higher incidence among elderly individuals and males. Future efforts should focus on strengthening management, optimizing policies, and emphasizing comorbid disease management to reduce the overall burden. This study provides data-driven support for formulating targeted PD prevention and control strategies.

Ischemic Heart Disease Burden Attributable to Second-hand Smoke in China from 1990 to 2021

ZHANG Zeyu, LI Chunhui

2026, 29(20):  2903-2912.  DOI: 10.12114/j.issn.1007-9572.2024.0320

Asbtract ( )   HTML ( )   PDF (2920KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Ischemic heart disease (IHD) is the second leading cause of death in China, and second-hand smoke is a major risk factor for IHD deaths.

Objective

To analyze the disease burden and its change trends of IHD attributable to second-hand smoke in China and five social demographic index (SDI) regions from 1990 to 2021, providing scientific reference for reducing the risk of death from IHD attributable to second-hand smoke.

Methods

The data was collected from the Global Burden of Disease (GBD) 2021. Population attribution fraction (PAF) was used to evaluate the impact of second-hand smoke on IHD deaths; The annual average percentage change (AAPC) of mortality and disability adjusted life years (DALYs) were calculated by Joinpoint regression among the population aged 25-94 years during 1990-2021. The age-period-cohort model was performed to analyze the age, period, and cohort effects of mortality and DALYs rates.

Results

Second-hand smoke was a risk factor for IHD in China, and the PAF for deaths and DALYs were higher compared to the five SDI regions, with a decrease of 0.66% and 0.67% from 1990-2021, respectively. The age-standardized mortality rate (1990: 12.27/100 000; 2021: 11.62/100 000) and age-standardized DALYs rate (1990: 284.58/100 000; 2021: 239.26/100 000) of IHD attributable to second-hand smoke presented a slight downward trend, with the AAPC values of -0.20% (95%CI=-0.65% to 0.24%) and -0.58% (95%CI=-0.98% to -0.19%), respectively. The age effects of IHD death and DALYs attributable to second-hand smoke increased with age in China, with a significant rise after the age of 75 years. The period effects showed a downward trend, while the cohort effects increased first and then decreased. However, both the period and cohort effects of IHD deaths and DALYs were on a rise trend among males.

Conclusion

The disease burden of IHD attributable to second-hand smoke is relatively heavy in China, and the overall downward trend may be explained by the decline in the disease burden of IHD among women. More attention should be paid to the control of second-hand smoke in men and the status of disease in the elderly.