Objective To investigate the association between carotid intima-media thickness (cIMT) and the clustering of multiple metabolic abnormalities within a general population age 35-75 years. Methods Employing a cluster random sampling method, 938 permanent residents from five counties and two districts of Jiaxing City were enrolled as the study cohort between May 2022 and April 2025. General demographic data were collected, physical examinations and biochemical assessments were conducted, and the number of metabolic abnormality indices was recorded. cIMT values were quantitatively measured and documented. A linear regression analysis was performed utilizing the number of metabolic abnormalities as the independent variable and cIMT as the dependent variable. Furthermore, a multivariate logistic regression analysis (with cIMT thickening as the dependent variable) was conducted to evaluate the impact of the clustering of multiple metabolic abnormalities on cIMT thickening, following adjustments for confounding variables including age and sex. Results Among the 938 participants age 35-75 years from the general population, the prevalence of metabolic abnormality indices was as follows: 0 abnormalities in 339 individuals (36.14%), 1 in 276 individuals (29.42%), 2 in 186 individuals (19.83%), and ≥3 in 137 individuals (14.61%). A statistically significant, progressive increase in cIMT was observed concurrently with an escalation in the number of metabolic abnormality indices (P<0.05). Multiple linear regression analysis revealed that each single-unit increase in the number of metabolic abnormalities was associated with a mean cIMT elevation of 0.050 mm (95% CI: 0.042-0.058). Multivariate logistic regression analysis delineated that age 60-75 years (OR=1.443), male sex (OR=1.468), current smoking (OR=1.414), heavy alcohol consumption (OR=1.682), insufficient physical activity (OR=1.348), BMI≥28.0 kg/m² (OR=1.504), waist-to-hip ratio (OR=1.138 per 0.1 increment), and the number of metabolic abnormalities (2 abnormalities: OR=1.685; ≥3 abnormalities: OR=1.845) were all significantly associated factors for cIMT thickening (all P<0.05). Conclusion In the general population, the clustering of multiple metabolic abnormalities exhibits a positive correlation with elevated cIMT. The risk of developing cIMT thickening escalates progressively in tandem with the increasing number of metabolic abnormalities within an individual.

Objective To investigate the association between shift scheduling patterns and occupational injuries among healthcare professionals, and to analyze the moderating effects of department-level factors on this association. Methods A multicenter cross-sectional study design was employed. In May 2025, 630 healthcare professionals from three tertiary Grade-A hospitals in Xi'an were recruited as the study population. Data were collected via questionnaire surveys. A two-level logistic regression model (with individuals as Level 1 and departments as Level 2) was constructed to analyze the correlation between shift scheduling patterns and the incidence of occupational injuries. Results A total of 600 valid questionnaires were retrieved, yielding an effective response rate of 95.24%. The overall prevalence of occupational injuries was 82.17% (493/600), with distribution rates of 78.02% (181/232) in internal medicine, 80.93% (157/194) in surgery, 88.89% (96/108) in the emergency department (ED), and 89.39% (59/66) in the intensive care unit (ICU). Internal medicine predominantly utilized regular day shifts; surgery primarily employed regular day and two-shift systems; whereas the ED and ICU mainly implemented two-shift and three-shift systems. Multilevel logistic regression analysis revealed that, after controlling for confounding variables, the risk of occupational injury was significantly higher in surgery (OR=1.972), the ED (OR=2.254), and the ICU (OR=2.375) compared to internal medicine (P<0.05). A bed-to-nurse ratio of <1∶0.4 (OR=4.873, P<0.05) was also associated with an elevated injury risk. Furthermore, compared to regular day shifts, the two-shift system (OR=2.023), three-shift system (OR=1.988), ≥9 night shifts per month (OR=2.777), average weekly working hours >40 h (OR=2.389), and overtime frequency of ≥2 times per week (OR=2.607) emerged as independent correlates of occupational injuries (all P<0.05). Following the inclusion of fixed effects, the residual variance of the random intercept at the department level decreased to 0.208 (P=0.035). Conclusion Occupational injuries among healthcare professionals exhibit pronounced individual heterogeneity and departmental clustering. Suboptimal shift scheduling patterns are significantly associated with an elevated risk of occupational injury, and the magnitude of this association is moderated by department typology.

Objective To investigate the causal relationship between metabolic factors and fracture risk utilizing a two-sample Mendelian randomization (MR) approach, based on publicly available genome-wide association study (GWAS) summary statistics from the China Kadoorie Biobank (CKB). Methods Body mass index (BMI), waist-hip ratio (WHR), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and type 2 diabetes mellitus (T2DM) were designated as exposure variables, with overall fracture incidence serving as the outcome variable. Independent single nucleotide polymorphisms (SNPs) strongly associated with the exposures were selected as instrumental variables. The inverse-variance weighted (IVW) method was utilized as the primary analytical approach, complemented by MR-Egger regression and the weighted median method to evaluate causal effects. Multivariable MR was employed to adjust for confounding variables, and bidirectional MR was conducted to rule out reverse causation. The robustness of the findings was assessed using Cochran's Q test, the MR-Egger intercept test, and the MR-PRESSO method. Results The IVW analysis revealed no significant causal association between fracture risk and either BMI (OR=0.999, P=0.932) or WHR (OR=1.003, P=0.783). Conversely, significant causal associations with fracture risk were observed for LDL-C (OR=1.105, P=0.039), HDL-C (OR=0.902, P=0.029), TG (OR=1.082, P=0.044), FBG (OR=1.153, P=0.034), HbA1c (OR=1.121, P=0.021), and T2DM (OR=1.180, P=0.009). Following adjustment for BMI and WHR via multivariable MR, the independent causal effects of the aforementioned metabolic parameters remained statistically significant (all P<0.05). Bidirectional MR yielded no evidence of reverse causality (all P>0.05). Sensitivity analyses indicated an absence of heterogeneity and horizontal pleiotropy (all P>0.05). Conclusion Impaired glucose metabolism and dyslipidemia constitute independent causal factors for fractures within the Chinese population, whereas adiposity indices such as BMI and WHR demonstrate no independent causal association with fracture risk. These findings suggest that distinct metabolic pathways exert differential effects on fracture susceptibility.

Objective To investigate the prevalence of meeting physical activity (PA) guidelines and its association with major chronic diseases in the population of South China. Methods This study utilized baseline data (2018-2020) from the South China Cohort (SCC). The International Physical Activity Questionnaire-Short Form (IPAQ-SF) was used to assess PA levels. The presence of major chronic diseases was determined through self-reported medical history, medication use, and biochemical indicators. A multivariate logistic regression model was employed to analyze the association between physical activity and the prevalence of major chronic diseases. Results A total of 68 247 participants aged 25-89 years were included in the analysis. After adjusting for age and sex, the prevalence of meeting the moderate-to-vigorous-intensity physical activity (MVPA) guidelines was 22.4% (95% CI: 21.7%-23.2%), and the prevalence of achieving the total metabolic equivalent (MET) recommendation was 71.4% (95% CI: 70.6%-72.2%). Higher rates of meeting MVPA guidelines were observed among middle-aged and older adults and individuals of Zhuang ethnicity, whereas lower rates were found among young adults and smokers. The logistic regression model indicated that meeting MVPA guidelines was significantly associated with a lower prevalence of obesity (OR: 0.82-1.00), diabetes (OR: 0.76-0.94), hypertension (OR: 0.85-0.98), and dyslipidemia (OR: 0.80-0.90). Conclusion The prevalence of meeting physical activity guidelines in the South China population is comparable to the national average, and adherence to these guidelines is associated with a protective effect against major chronic diseases. Targeted interventions are necessary to promote physical activity of varying intensities to further improve the health status of this population.

Objective To elucidate the prevalence and symptomatic profile of allergic rhinitis (AR) in children aged 6-12 years in Bayannur City, thereby providing an evidentiary basis for regional prevention, control, and clinical intervention strategies. Methods A multi-stage, stratified, cluster sampling methodology was employed. Data were collected using parent-completed questionnaires, physician-administered examination checklists, and Visual Analog Scales (VAS). Descriptive statistics were utilized to characterize the prevalence and symptom spectrum. Univariate analysis was conducted using the chi-square test, followed by multivariate logistic regression to identify independent risk factors. Results A total of 4 936 children were enrolled, among whom 1 925 were diagnosed with AR, yielding a crude prevalence of 38.99%. The core symptoms, in descending order of frequency, were nasal obstruction (89.51%), sneezing (86.81%), nasal pruritus (86.60%), and rhinorrhea (78.70%). Symptoms of moderate severity constituted the largest proportion of cases (49.09%). Seasonal AR was predominant, accounting for 84.00% of cases, with a peak incidence observed between June and August (53.35%). The symptom duration was primarily persistent, defined as >4 weeks or occurring on >4 days per week (57.25%). The most common symptomatic dyad was the combination of nasal obstruction and rhinorrhea (76.26%). Among associated complaints, ear discomfort exhibited the highest rate of occurrence (77.71%). Multivariate analysis revealed that male gender (OR=1.403), urban residence (OR=3.818), a history of food allergy (OR=3.575), a history of drug allergy (OR=1.928), and frequent antibiotic use (OR=1.684) were independent risk factors for allergic rhinitis in this pediatric cohort (all P<0.05). Conclusion The prevalence of allergic rhinitis among children aged 6-12 years in Bayannur City is at a high level. The clinical presentation is predominantly characterized by mild-to-moderate, seasonal symptoms. Male gender, urban residency, a history of allergies, and frequent antibiotic use were identified as significant independent risk factors.

Objective To explore the influencing factors on delayed healthcare seeking behavior in adult patients with dental caries based on the health belief model. Methods A convenience sampling method was employed to select adult patients with dental caries who visited a county-level hospital in Linqun County, Fuyang, from June 2022 to September 2025. Data were collected via questionnaires on general demographic characteristics, clinical information, and a self‑designed Caries Health Belief Questionnaire. Multivariate logistic regression analysis was conducted to identify the factors associated with delayed healthcare seeking behavior. Results among the 430 participants, 133 (30.93%) delayed their dental healthcare seeking by less than three months, while 297 (69.07%) delayed by three months or more. The delayed healthcare seeking group had a significantly higher proportion of deep caries compared to the non-delayed group, with statistically significant differences (P<0.05). Factors identified as significant predictors of delayed healthcare seeking behavior included educational level (OR=2.938), type of medical insurance (resident medical insurance OR=1.463, self-paid OR=3.728), number of carious lesions (2 lesions OR=1.084, 3 or more lesions OR=3.191), monthly income (OR=0.953), perceived susceptibility (OR=0.857), perceived severity (OR=0.818), perceived benefits (OR=0.747), perceived barriers (OR=3.992), self-efficacy (OR=0.811), and cues to action (OR=0.751) (all P<0.05). Structural equation modeling revealed that perceived barriers had a significant positive direct effect on delayed healthcare seeking behavior (β=0.421). Perceived barriers also negatively influenced self-efficacy (β=-0.380), which in turn negatively affected delayed behavior (β=-0.350) (all P<0.01). Cues to action positively predicted perceived severity (β=0.293) and negatively predicted perceived barriers (β=-0.221). Perceived severity was found to have a negative effect on delayed behavior (β=-0.150), all with statistical significance (all P<0.01). Conclusion The incidence of delayed healthcare seeking behavior is high among patients with dental caries. And various dimensions of the health belief model, including perceived barriers, self-efficacy, perceived severity, cues to action, perceived susceptibility, and perceived benefits, collectively exert both direct and indirect influences on this behavior.

Objective To investigate the incidence of unintentional injuries and its correlation with mental health symptoms among middle school students in Yunnan Province, so as to provide a scientific basis for the formulation of targeted health education measures for injury prevention and for the promotion of child and adolescent health. Methods A multi-stage stratified random cluster sampling method was employed from October to November 2023 to select 4 172 middle school students aged 12-18 from eight counties (districts) in four prefectures (cities) of Yunnan Province as research subjects. A self-compiled questionnaire was used to collect data on students' general demographic characteristics and injury-related information. The Center for Epidemiologic Studies Depression Scale (CES-D) was utilized to assess mental health symptoms. Spearman correlation and multivariate logistic regression were used to analyze the correlation between mental health symptoms and the occurrence of unintentional injuries. Results Scores on the dimensions of depressive affect (r_s=0.112), somatic symptoms (r_s=0.119), and interpersonal relations (r_s=0.088) were positively correlated with the occurrence of unintentional injuries, whereas the positive affect dimension score (r_s=-0.043) was negatively correlated (all P<0.01). After controlling for gender and academic stage, multivariate logistic regression analysis indicated that the somatic symptom dimension score was associated with the occurrence of unintentional injuries (OR=1.060). After further controlling for factors such as region and family, and categorizing psychological symptoms by their mean levels, it was found that high levels of depressive affect (OR=1.394) and somatic symptoms (OR=1.701) were correlated with the occurrence of unintentional injuries among middle school students. Conclusion The occurrence of unintentional injuries in middle school students is closely associated with specific mental health symptoms. The risk of unintentional injury increases significantly when students' depressive affect and somatic symptoms reach high levels. Comprehensive intervention measures should be implemented targeting the risk factors for injuries, a multi-tiered support system should be constructed, and adolescents' self-regulation abilities should be enhanced to reduce the risk of unintentional injury.

Objective To analyze the epidemiological characteristics and spatiotemporal clustering of human brucellosis in Dongguan City from 2015 to 2024, thereby providing a scientific basis for the formulation and refinement of prevention and control strategies. Methods Data pertaining to reported cases of human brucellosis in Dongguan City from 2015 to 2024 were collected. The epidemiological characteristics were described using descriptive statistics. Joinpoint regression analysis was employed to assess incidence trends. Global spatial autocorrelation and hotspot analyses were conducted using ArcMap 10.8.2, while spatiotemporal clustering analysis was performed with SaTScan 10.1. Results A total of 221 human brucellosis cases were reported in Dongguan City from 2015 to 2024. The annual reported incidence exhibited no significant trend (AAPC=1.54%, P=0.624). However, the monthly reported incidence revealed two periods of significant increase: January 2015 to April 2016 (MPC=8.10%, P=0.037) and February to May 2024 (MPC=70.44%, P=0.004). Case incidence was concentrated between March and August, accounting for 72.85% (161/221) of the total annual cases. The male-to-female ratio was 2.88∶1. The principal exposure risk factor for both occupational and non-occupational populations was contact with sheep/goats and their products. Serological surveillance of 1 672 occupationally exposed individuals from 2018 to 2024 revealed a positivity rate of 0.54% (9/1 672). Global spatial autocorrelation analysis indicated a random distribution of cases for all years except 2018. Hotspot analysis identified Qiaotou Town as the most frequent hotspot. Spatiotemporal scan statistics detected a primary cluster in Qiaotou and Xiegang towns and a secondary cluster in Shilong and Chashan towns over the 2015-2024 period. Conclusion The overall incidence of human brucellosis in Dongguan City is relatively stable; however, the disease demonstrates significant spatiotemporal clustering in specific locales. Enhanced prevention and control measures should be prioritized in these identified hotspot and clustered areas.

Objective To investigate the molecular subtyping of Kashin-Beck disease (KBD) based on metabolomic profiling and to elucidate the impact of gene-environment interactions on disease pathogenesis and its distinct subtypes. Methods A total of 106 patients with KBD and 106 healthy controls (recruited from both endemic and non-endemic areas) were enrolled in this study. Untargeted metabolomic profiling was conducted utilizing liquid chromatography-mass spectrometry (LC-MS). Molecular subtyping was executed via K-means clustering, while the specific characteristics of each subtype were delineated through multivariate statistical modeling and pathway enrichment analyses. Furthermore, multivariate logistic regression was employed to evaluate gene-environment interactions. Results The KBD cohort was stratified into three distinct metabolic subtypes. Subtype 1 is primarily characterized by lipid metabolism dysregulation; Subtype 2 exhibits aberrant oxidative stress and extracellular matrix degradation; and Subtype 3 is associated with the reprogramming of amino acid and energy metabolism. Interaction analyses demonstrated a significant synergistic effect between low environmental selenium exposure and the rs1050450(ProLeu) allele, an association that was particularly pronounced within Subtype 2 (P_interaction=0.006). Conclusion This study reveals the existence of heterogeneous KBD subtypes from the perspective of metabolic phenotypes for the first time. By establishing a comprehensive "environment-genetics-metabolic phenotype" association framework, this research provides a novel scientific basis for the precision subtyping and early risk prognostication of KBD.

Objective To analyze the epidemiological characteristics, transmission dynamics, and effectiveness of control measures of a hand, foot, and mouth disease (HFMD) outbreak at Z Primary School in Futian District, Shenzhen, to provide a scientific basis for the management of school-based outbreaks. Methods Field epidemiology, RT-PCR etiological testing, a retrospective cohort study, and transmission dynamics analysis were employed. Case finding, individual interviews, and investigation of risk factors were conducted among all students, faculty, and patients' families at Z school. The R₀ and R_t were calculated. Results A total of 24 cases were identified (18 students from Z school and 6 from other schools). The morbidity rate in the affected classes at Z school was 6.41% (18/281). The etiological investigation identified Coxsackievirus A16 (CVA16) and other enteroviruses as the primary pathogens. The outbreak comprised six generations of transmission, with close contact among friends (56.17%) and within families (37.50%) as the main transmission routes. The secondary attack rate within families was 88.89%, leading to cross-class and cross-school transmission. Close contact with an HFMD patient within 10 days prior to onset was a significant risk factor for transmission (RR=13.33, 95% CI 1.81-98.04). The classroom attack rate increased significantly with a longer interval from symptom onset to isolation (P<0.01). Following the implementation of case isolation and class suspension, the reproduction number decreased from an R₀ of 2 to an R_t of 0 (P=0.01). Conclusion This was an HFMD outbreak in a primary school caused by CVA16 and other enteroviruses. Insufficient school medical personnel and underreporting of cases were significant factors in the delayed detection of the outbreak. Close contact within families and among friends should be emphasized as a key factor in the spread of the epidemic. Shortening the time from onset to isolation, strengthening home-school collaboration and prevention, increasing the number of school medical staff, and enhancing symptom surveillance are critical measures for the early interruption of outbreaks.