Objective To explore in depth the causal associations between gut flora, derived metabolites and frailty using Mendelian randomization studies. Methods Inverse variance weighted (IVW) and four MR methods based on different assumptions were used to assess the causal relationship between 207 gut flora and 126 derived metabolites and frailty using pooled data from the Gene-Wide Association Study (GWAS). Cochran's Q test, MR-Egger regression, MR-PRESSO, MR-Steiger and leave-one-out sensitivity analyses were used to verify the reliability of the results. Results IVW results of gut flora showed potential causal associations between 11 species of gut flora, including Verrucomicrobia (OR=0.980), Burkholderiales (OR=0.970), Akkermansia (OR=0.980), Akkermansia muciniphila(OR=0.979), Lactobacillus delbrueckii (OR=0.988), Eubacterium ventriosum (OR=0.978), Eubacterium biforme (OR=0.980), Flavonifractor (OR=1.022), Sutterella (OR=1.044), Sutterella wadsworthensis (OR=1.044), Bacteroides massiliensis (OR=1.031) with frailty. And MR results of gut flora-derived metabolites showed potential causal associations between six gut flora-derived metabolites, including valine (OR=2.042), kynurenine (OR=1.149), stearoylcarnitine (OR=1.194), oleoylcarnitine (OR=1.161), theobromine (OR=0.892), threonate (OR=0.922) with frailty. Conclusions A potential causal association between gut microbes and their derived metabolites and risk of frailty suggests a role in the pathogenesis of frailty.

Objective To analyze the patterns and determinants of diagnostic delays among pulmonary tuberculosis (PTB) patients in Zibo City from 2005 to 2023, providing evidence for improving case detection efficiency. Methods Data were extracted from the Infectious Disease Surveillance System of China Disease Control and Prevention Information System, encompassing 24, 792 PTB cases registered in Zibo City (2005~2023). Variables included demographic characteristics, diagnostic results, treatment classification, patient source, initial diagnosis location, registration date, and key time intervals (symptom onset, first medical consultation, and confirmed diagnosis). Temporal trends in delay rates were analyzed using curve regression. Univariate comparisons and multivariable logistic regression identified factors associated with diagnostic delays. Results The median total delay interval was 40 (IQR: 20~77) days, predominantly attributable to patient-related delays (76.95%). The annual delay rate averaged 65.87%, exhibiting an initial rise followed by a decline (Cubic regression: R²=0.787, F=18.501, P<0.001), with sustained reductions post-2020. Multivariate logistic regression analysis showed that age 45~<65 years (OR=1.115), farmers/fishermen/migrant workers(OR=1.412), industrial workers (OR=1.299), unemployed/retired individuals (OR=1.581), tracking source (OR=2.677), local county (OR=1.360) and other counties (OR=2.208), initial treatment(OR=1.290) and pathogen positivity (OR=1.086) are risk factors for delayed diagnostic delays.While the protective factors are age <45 years (OR=0.839, 0.879), with sources of health check-up (OR=0.177), active screening (OR=0.328), referrals (OR=0.632), and clinician-initiated transfers (OR=0.757). Conclusions Diagnostic delays among PTB patients in Zibo remain prevalent and severe, primarily driven by prolonged intervals to first medical consultation. Targeted interventions—particularly health education and active case-finding strategies for high-risk populations—are urgently needed to enhance healthcare-seeking behavior and reduce delays.

Objective This study aimed to construct an outpatient satisfaction index model (HX-CCSI) applicable to the Hexi region within the context of the new healthcare reform. The research sought to explore the determinants of outpatient satisfaction, thereby providing a theoretical foundation for enhancing regional medical service quality and optimizing physician-patient relationships. Methods Based on the Customer Satisfaction Index (CCSI) model and service encounter theory, a theoretical model (HX-CCSI) and a corresponding measurement scale were developed. A questionnaire employing a Likert 5-point scale was designed. Following a pilot test to validate its reliability and validity, a cross-sectional survey was administered to 10 634 outpatients in the Wuwei area from January to July 2024. The collected data were analyzed using structural equation modeling to verify the path relationships among the latent variables. Results The pilot test yielded a Cronbach's alpha coefficient of 0.89 for the HX-CCSI scale, with all latent variables exceeding 0.70, and a split-half reliability coefficient of 0.811. Exploratory factor analysis extracted six factors, accounting for a cumulative variance of 68.5%, which indicated good construct validity. Correlation analysis of the latent variables revealed significant positive correlations (all P<0.01) for Perceived Value (PV) (r=0.71), Patient Satisfaction (PS) (r=0.66), Loyalty (LO) (r=0.63), Doctor-Patient Communication (DPC) (r=0.60), and Medical Competence (MC) (r=0.61). Moderate positive correlations (all P<0.01) were observed for Patient Expectations (PE) (r=0.58), Process Efficiency (PEFF) (r=0.55), and Service Environment (SE) (r=0.52). Complaint Tendency (CT) was negatively correlated with satisfaction (r=-0.42, P<0.01). Cost Transparency (CTY) demonstrated a weaker correlation (r=0.30, P<0.05). Perceived Value (PV) exerted the strongest positive effect on Satisfaction (PS) (β=0.57). Satisfaction (PS) significantly enhanced Loyalty (LO) (β=0.63) but had a weaker inhibitory effect on Complaint Tendency (CT) (β=-0.28). Conclusions The HX-CCSI model constructed in this study confirms that medical competence and doctor-patient communication are pivotal factors in enhancing outpatient satisfaction. The influence of cost transparency was found to be attenuated by high medical insurance reimbursement rates. It is recommended that priority be given to improving medical technology and communication quality, optimizing service processes, and establishing a dedicated complaint mechanism. These findings provide a scientific basis for the improvement of outpatient services in the Hexi region.

Objective This study aimed to investigate the current status and influencing factors of knowledge, attitudes, and practices (KAP) regarding safe medication use among adult residents in Zibo, China, with the goal of providing a scientific basis for targeted pharmaceutical science popularization and intervention measures. This will help improve residents' rational medication use and ensure medication safety. Methods From September to December 2023, a simple random sampling method was used to select community residents in Zibo as survey subjects. A self-designed questionnaire was used to investigate their KAP regarding safe medication use. Univariate and multivariate analyses were conducted to identify factors influencing KAP scores. Results Among 2 484 community residents in Zibo, the average scores for the knowledge, attitude, and practice dimensions were (35.90±2.31), (22.39±2.61), and (30.91±2.16), respectively. Positive correlations were observed between the knowledge and attitude dimensions (r=0.923, P<0.01), knowledge and practice dimensions (r=0.956, P<0.01), and attitude and practice dimensions (r=0.901, P<0.01). Multivariate analysis showed that factors influencing the knowledge dimension included education level (college or above, β'=0.063), occupation (medical staff, β'=0.229; government officials, β'=0.159; teachers, β'=0.154), chronic diseases (β'=0.107), consulting doctors/pharmacists for medication knowledge (β'=0.117), and history of adverse drug reactions (β'=0.140) (all P<0.01). Factors influencing the attitude dimension included age (β'=0.075), education level (college or above, β'=0.168), occupation (medical staff, β'=0.345; government officials, β'=0.233; teachers, β'=0.173), chronic diseases (β'=0.174), consulting doctors/pharmacists for medication knowledge (β'=0.212), history of adverse drug reactions (β'=0.168), and knowledge dimension score (β'=0.392) (all P<0.01). Factors influencing the practice dimension included education level (college or above, β'=0.048), occupation (medical staff, β'=0.228; government officials, β'=0.136; teachers, β'=0.112), chronic diseases (β'=0.123), consulting doctors/pharmacists for medication knowledge (β'=0.095), history of adverse drug reactions (β'=0.090), knowledge dimension score (β'=0.127), and attitude dimension score (β'=0.283) (all P<0.05). Conclusions The KAP levels regarding safe medication use among adult residents in Zibo need improvement, with positive correlations among the three dimensions. Education level, occupation, health status, sources of medication knowledge, and history of adverse drug reactions are the main influencing factors. It is recommended to enhance residents' awareness and practices of safe medication use by strengthening knowledge dissemination, optimizing access to medication knowledge, and focusing on key populations, thereby reducing medication risks and ensuring health safety.

Objective To characterise the contamination profile of chromium (Cr), arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) in commercially available rice in Hubei Province, China, and to evaluate the attendant health risks arising from rice consumption. Methods Rice samples were collected from various retail markets in Hubei Province. Following microwave digestion pretreatment, the concentrations of Cr, As, Cd, Hg, and Pb were determined using inductively coupled plasma mass spectrometry (ICP-MS) in accordance with National Food Safety Standard: Determination of Multi-Elements in Food (GB 5009.268-2016). The measured levels were evaluated against the maximum permissible limits specified in National Food Safety Standard: Maximum Levels of Contaminants in Food (GB 2762-2022). Dietary exposure was calculated using the point-estimate model recommended by the Joint FAO/WHO Expert Committee on Food Additives (JECFA), while health risks were assessed via the exposure assessment model proposed by the U.S. Environmental Protection Agency (USEPA). Results Among 246 rice samples, the detected concentration ranges were as follows: Cr (ND-0.279 mg/kg), As (0.040-0.204 mg/kg), Cd (ND-0.211 mg/kg), Hg (ND-0.044 62 mg/kg), and Pb (ND-0.666 mg/kg). The non-carcinogenic hazard quotients (HQ) for each heavy metal followed the order As>Cd>Hg>Cr>Pb, with only As exceeding the threshold (HQ>1). The cumulative lifetime excess cancer risks of the three heavy metals (Cr, As, Cd) for different population groups were 2.02×10^-4, 1.62×10^-4, 1.13×10^-4, 8.29×10^-5, 3.55×10^-4, and 3.10×10^-4, respectively. Conclusion While the overall heavy metal contamination in commercially available rice from Hubei Province remains within safe limits, certain elements-particularly arsenic-warrant regulatory attention due to their elevated risk potential.

Objective To investigate the hepatitis B virus (HBV) screening rates, infection prevalence, and spatiotemporal distribution patterns among pregnant women in Lanzhou from 2012 to 2020, providing data support and decision-making references for eliminating mother-to-child transmission (MTCT) of HBV. Methods Data on HBV infection among pregnant women were extracted from the National Prevention of Mother-to-Child Transmission of HIV, Syphilis, and HBV Management Information System. Trend chi-square tests were used to analyze temporal changes in HBV screening rates and infection prevalence. Spatial autocorrelation analysis was conducted using GeoDa 1.22, and spatiotemporal scan analysis was performed with SaTScan 9.4 to identify clustering patterns. Results From 2012 to 2020, the HBV screening rate among pregnant women increased significantly from 86.52% to 99.09%, while the HBV infection rate exhibited a fluctuating decrease from 2.98% to 2.78% (all P<0.05). Global spatial autocorrelation analysis indicated no significant spatial clustering of HBV infections, suggesting a random distribution. Local autocorrelation identified one high-high cluster, one high-low cluster, and three low-high clusters. Spatiotemporal scan analysis detected one primary cluster (Class I) and seven secondary clusters (Class II). The primary cluster was located in Qilihe District (LLR=121.25, RR=1.57, P<0.05) during February 2012 to July 2014. Conclusions HBV screening coverage among pregnant women in Lanzhou improved steadily, with a declining trend in infection rates. Most regions showed no significant spatiotemporal clustering of HBV infections, indicating a random distribution. Strengthening health education on HBV prevention and expanding antiviral therapy for HBV-infected pregnant women are critical measures to further reduce MTCT of HBV.

Objective To investigate the status of medication safety knowledge, attitudes, and practices (KAP) among residents in Zhongshan and to identify associated influencing factors, thereby providing an evidence base for enhancing regional medication safety standards. Methods Between January and February 2024, a stratified sampling method was employed to survey the medication safety KAP of residents in Zhongshan. Descriptive statistics were used to analyze the current status of medication safety KAP. Univariate and multivariate logistic regression analyses were conducted to determine the influencing factors. Results A total of 720 questionnaires were distributed, and 683 valid responses were collected, yielding a response rate of 94.86%. The prevalence of adequate knowledge regarding medication safety was 72.62% (496/683). Areas of strength included high adherence to prescribed medication (96.30%) and a high rate of reading drug information leaflets (89.50%). However, significant deficiencies were observed, including low awareness of medication precautions (58.20%) and insufficient understanding of administration methods for special dosage forms (61.70%). The prevalence of favorable attitudes towards medication safety was 68.37% (467/683). Although there was high approval for the national essential medicine system (91.40%), awareness of its specific policies was merely 49.80%. Consciousness regarding reporting adverse drug reactions and periodically organizing home medicine cabinets was relatively low, at 62.10% and 65.30%, respectively. The prevalence of appropriate medication practices was 65.01% (444/683). The compliance rate for correct drug storage was 52.40%, while the rate of improper disposal of expired medications was 58.90%, and 63.20% of participants did not maintain medication records. The rate of reading drug information leaflets, however, was high at 85.70%. Multivariate logistic regression analysis indicated that adequate medication safety knowledge was negatively associated with increasing age (OR=0.784) but positively associated with higher educational attainment (college or above: OR=2.504), urban residence (vs. rural: OR=1.751), and a history of chronic disease (vs. no history: OR=2.056). Favorable attitudes were more prevalent in females (vs. males: OR=1.536), decreased with age (OR=0.894), increased with higher education levels (OR=1.762), and were higher among urban residents (vs. rural: OR=1.441) and those with medical insurance (OR=2.301) or new rural cooperative medical scheme coverage (OR=2.056) compared to self-paying individuals; industrial and agricultural workers exhibited less favorable attitudes than other occupational groups (OR=0.911). Similarly, appropriate practices were more common in females (vs. males: OR=2.013), decreased with age (OR=0.840), improved with higher education (OR=1.652), and were more prevalent among those living with family (vs. living alone: OR=1.843) and those with medical insurance (OR=2.337) or rural cooperative medical coverage (OR=1.926) compared to self-payers. Conversely, individuals with a history of chronic disease demonstrated poorer practices (OR=0.842). Conclusions Utilizing the KAP framework, this study confirms through survey and multivariate regression analyses that individuals who are elderly, have lower educational attainment, live alone, and suffer from chronic diseases should be the primary focus of interventions. The findings suggest that establishing a closed-loop intervention model that integrates digital guidance with health insurance coordination is imperative for achieving a comprehensive enhancement of medication safety levels among the residents of Zhongshan.

Objective To retrospectively analyze the trend and influencing factors of hepatitis B surface antigen (HBsAg) positivity rate among blood donors in Changsha from 2020 to 2023, and to construct an autoregressive integrated moving average (ARIMA) model based on monthly data for prediction. Methods A total of 629 721 blood donors in Changsha from 2020 to 2023 were included. Demographic characteristics of HBsAg-positive donors were analyzed using χ² tests and binary logistic regression. An ARIMA model was developed with EViews 12.0 to predict HBsAg positivity rates from January to March 2024, and its performance was evaluated. Results The overall HBsAg positivity rate among blood donors was 4.6 per 1 000 (2 874/629 721), showing an initial increase followed by a decrease. Lower HBsAg positivity rates were associated with donation year 2023 (OR= 0.578), birth year ≥2002 (OR=0.654), age 18-30 years (OR=0.529), non-Han ethnicity (OR=0.734), education level of bachelor's degree or higher (OR=0.821), repeat donations (OR=0.188), apheresis platelet donations (OR=0.787), and voluntary individual donations (OR=0.883) (all P<0.05). The ARIMA(2, 1, 0) model passed validation tests, with a mean absolute percentage error (MAPE) of 12.79% for predictions from January to March 2024, indicating moderate predictive accuracy. Conclusions The HBsAg positivity rate among voluntary blood donors in Changsha remained low from 2020 to 2023. Younger donors, non-Han ethnic groups, repeat donors, individuals with higher education levels, and apheresis platelet donors exhibited lower HBsAg positivity risks. Blood collection agencies should prioritize recruiting and retaining these populations to further reduce HBsAg positivity and enhance blood safety. The ARIMA(2, 1, 0) model demonstrated moderate predictive performance; future studies should incorporate additional variables to develop more precise prediction models.

Objective To investigate the impact of work and lifestyle factors on the malignant transformation of benign thyroid nodules in young and middle-aged patients. Methods Patients pathologically confirmed to have thyroid cancer via biopsy or surgery from January 2023 to December 2024 at the Suqian Hospital Affiliated to Xuzhou Medical University were selected as the case group. For the control group, thyroid nodule patients undergoing health check-ups at the hospital were selected at a 1∶3 ratio, matched by gender, age (±3 years), and nodule duration (±1 year). Questionnaires surveyed work and lifestyle factors, with univariate and multivariate analyses comparing the two groups. Results The study included 213 case group patients (41 males, 172 females, mean age 41.98±9.54 years, mean nodule duration 5.56±2.32 years) and 639 control group patients (123 males, 516 females, mean age 41.77±9.47 years, mean nodule duration 5.44±2.29 years). No significant differences were found in gender, age, or nodule duration between groups (χ²=0.005, 0.492; t=0.724; all P>0.05). Multivariate logistic regression identified BMI (overweight OR=2.015, obese OR=5.533), work stress (OR=1.454), daily sleep <6 h (OR=1.808), consumption of fried/grilled foods >5 times/month (OR=1.932), seafood/fish >5 times/month (OR=2.076), iodized salt use (OR=1.503), annual CT/X-ray exposure (OR=1.702), history of thyroid dysfunction (OR=3.681), and family history of thyroid cancer (OR=2.008) as significant risk factors (all P<0.05). Conclusions Malignant transformation of benign thyroid nodules in young and middle-aged patients is influenced by multiple factors. Risks increase with overweight/obesity, work stress, insufficient sleep, frequent consumption of fried/grilled and seafood/fish, iodized salt use, radiation exposure, thyroid dysfunction history, and family history of thyroid cancer. Interventions targeting these factors, such as lifestyle adjustments and reduced radiation exposure, may lower transformation risk.

Objective To understand the prevalence of overweight, obesity and high blood pressure among primary and secondary school students in Henan Province and explore their correlation, so as to provide a scientific basis for preventing high blood pressure in children and adolescents. Methods A stratified cluster sampling method was adopted. Primary and secondary school students from 158 counties and districts in Henan Province were selected. Height, weight and blood pressure were measured using standard instruments. Chi-square test and logistic regression analysis were employed to analyze the correlation between overweight, obesity and blood pressure. Results In 2022, a total of 337 710 primary and secondary school students were surveyed in Henan Province. The detection rates of overweight, obesity and high blood pressure were 17.85% (60 269), 19.26% (65 059) and 23.87% (80 617) respectively. After controlling for age, gender and region variables, logistic regression revealed the risk of high blood pressure in the overweight group and obesity group was 1.378 times (OR=1.378) and 1.971 times (OR=1.971) higher than that in the non-overweight and obesity group, respectively (both P<0.05). When BMI was standardized to Z-scores, it was found that compared with the BMI-Z <1 group, the 1≤BMI-Z<2 group (OR=1.425) and BMI-Z≥2 group (OR=2.072) exhibited an increased risk of high blood pressure (both P<0.05). Conclusions Overweight and obesity might increase the risk of high blood pressure in primary and secondary school students. Scientific and effective measures should be taken to improve weight health and reduce the occurrence and development of high blood pressure.