Objective To examine the prevalence, comorbidity patterns, and healthcare utilization determinants of chronic diseases among middle-aged and elderly agricultural workers in China, providing evidence for targeted chronic disease prevention strategies. Methods Data were extracted from the China Health and Retirement Longitudinal Study (CHARLS) for 2018 and 2020. Systematic clustering, association rule mining, and generalized linear mixed-effects models were used to analyze comorbidity patterns and healthcare utilization factors. Results Among 6 295 agricultural workers, the comorbidity prevalence increased significantly from 51.52% (95% CI: 50.27%-52.76%) in 2018 to 55.87% (95% CI: 54.63%-57.10%) in 2020 (χ²=23.98, P<0.01). Arthritis/rheumatism (2018: 33.95%→2020: 35.46%), digestive disorders (27.28%→29.29%), and hypertension (26.93%→30.10%) constituted the top three chronic conditions. Cluster analysis identified three stable comorbidity patterns: metabolic-circulatory, respiratory-hepatorenal multiorgan, and neuro-oncological complexes. Generalized linear mixed models revealed that outpatient utilization was associated with survey year (2020: OR=1.32), depressive symptoms (OR=1.21), high physical activity (OR=1.17), male sex (OR=0.84), self-rated health (fair: OR=0.53;good: OR=0.32), and comorbidity count (1 condition: OR=1.65;2: OR=2.10;≥3: OR=3.40). Inpatient service, utilization was associated with survey year (OR=1.33), age (55-<65: OR=1.18;65-<75: OR=1.51;≥75: OR=2.35), depressive symptoms (OR=1.17), high physical activity (OR=0.83), self-rated health (fair: OR=0.42;good: OR=0.25), and comorbidity count (1: OR=1.70;2: OR=2.33;≥3: OR=3.85). Conclusions The prevalence of comorbidities among middle-aged and elderly agricultural workers is increasing significantly, with arthritis/rheumatism, digestive disorders and hypertension constituting the predominant spectrum of comorbidities. Healthcare service utilization is driven by multifactorial determinants. This suggests the need to establish a prevention and control system based on comorbidity networks and risk gradient interventions. This system would enhance the effectiveness of chronic disease management through optimizing health behaviors and intelligent monitoring, and provide a theoretical basis for developing precise prevention and control strategies targeting special occupational groups.

Objective To understand the genetic characteristics of the Coxsackievirus B5 (CVB5) isolated from cases of acute flaccid paralysis (AFP) in Guangdong Province from 1995 to 2024. Methods High-throughput sequencing was used to identify non-polio enteroviruses isolated from AFP surveillance in Guangdong Province from 1995 to 2024. The VP1 gene sequences of CVB5 strains in GenBank were used to construct a phylogenetic tree and study the genetic evolution of CVB5. Results 31 CVB5 strains were identified from AFP case specimens, and their VP1 sequences were obtained.The full-length VP1 sequence was 849 bp, encoding 283 amino acids, with no insertions or deletions. The nucleotide and amino acid homology of the 31 CVB5 VP1 sequences were 88.05% (76.10%-100.00%) and 97.15% (94.30%-100.00%), respectively. Among them, there was 1 strain of genotype B, 27 strains of genotype C, and 3 strains of genotype D. Evolutionary analysis of the global CVB5 VP1 region showed that most strains isolated in Asia from 1996 to 2024 were genotype C, while strains from Europe were genotype D. Conclusions CVB5 has been circulating in many parts of the world. The CVB5 strains isolated in Guangdong Province from 1995 to 2024 included three genotypes, mainly genotype C, which is the same as the prevalent genotype in Asia. The emergence of genotype D strains indicates the need for continued monitoring and research on CVB5 in Guangdong.

Objective To retrospectively delineate the whole-genome features and recombination patterns of Enterovirus group B serotype 75 (EV-B75) strains isolated from the acute flaccid paralysis (AFP) surveillance system in Guangdong Province during 1994–1999, thereby providing foundational molecular data on this emerging enterovirus in China. Methods Target viral RNA was enriched with probe-capture technology followed by high-throughput sequencing to obtain complete genomic sequences. Phylogenetic relationships were inferred using neighbour-joining trees constructed for the VP1 region and the P1-P3 coding regions. Potential recombination events between EV-B75 and other enteroviruses were evaluated and confirmed with SimPlot analyses. Results VP1 phylogenetic analysis classified EV-B75 into two major clusters: Cluster 1 and Cluster 2. All Guangdong isolates grouped with strains from Fujian, Shandong, and Yunnan within Cluster 2, displaying pronounced genetic divergence from the prototype strain and other Cluster 1 isolates, consistent with geographic specificity. Discordant clustering patterns in P1-P3 phylogenetic trees suggested recombination during molecular evolution. SimPlot analyses verified intertypic recombination with EV-B serotypes E9 and CVB2/3/4 in the 2A-2C and 3D regions. Conclusions The seven strains analysed represent the early documented EV-B75 isolates from Guangdong and belong to the sporadically circulating Cluster 2 lineage in China. Frequent intertypic recombination in non-structural protein regions underscores the capacity of EV-B75 to generate genetic diversity via genetic exchange. These findings contribute to reconstructing the evolutionary history of EV-B viruses.

Objective To evaluate the achievement of healthy aging goals in the elderly population of Conghua District, Guangzhou, and to explore differences in the achievement of these goals across various subgroups, providing a scientific basis for developing targeted health management strategies to promote healthy aging. Methods From July to September 2023, a cluster random sampling method was used to survey elderly individuals aged ≥60 years who underwent health assessments at the Aotou Town Central Health Center, Longtan Health Center, and Wenquan Town Health Center in Conghua District, Guangzhou. Logistic regression was used to assess the achievement of five health indicators (systolic blood pressure, maximum vital capacity, serum creatinine, fasting blood glucose, heart rate) and overall healthy aging status, adjusted for age and gender. Multivariate logistic regression models were employed to analyze differences in the achievement of healthy aging goals across subgroups (gender, age, annual household income, living alone status). Results A total of 1 455 elderly individuals were included, with 635 males (43.64%). The overall achievement of healthy aging goals, adjusted for age and gender, was 9.46% (95% CI: 7.92%-11.26%). Fasting blood glucose had the highest compliance rate (39.14%, 95% CI: 36.64%-41.69%), while systolic blood pressure had the lowest (27.57%, 95% CI: 25.31%-29.95%). Subgroup analysis revealed significantly lower compliance in individuals aged ≥70 years, with an annual household income ≥30 000 yuan, and those living alone (P<0.05). No significant differences were observed in gender subgroups or across all subgroups regarding the achievement of heart rate and fasting blood glucose targets (P>0.05). Conclusions The overall achievement of healthy aging goals in the elderly population of Conghua District, Guangzhou, is low. Elderly individuals who are older, have middle-to-high incomes, or live alone face greater challenges in achieving these goals. Personalized health support strategies tailored to the characteristics of different subgroups are needed to enhance the overall health and quality of life of the elderly.

Objective To develop a survival prediction model for hypertensive nephropathy patients based on Random Survival Forests (RSF) and Cox regression. Methods Data were collected from MIMIC-IV V3.0, with in-hospital mortality and post-treatment survival time as outcome variables. Predictor variables included demographics, laboratory indicators, vital signs, comorbidities, scoring metrics, acute kidney injury (AKI), and continuous renal replacement therapy (CRRT). Patients were randomly divided into training (70%) and validation (30%) sets. Important variables were extracted from the training set to construct Cox regression and RSF models. Model accuracy and discrimination were evaluated using concordance index, time-dependent ROC curves (tROC), and AUC in both training and validation sets. Results A total of 7 369 hypertensive nephropathy patients were included, with 3 543 deaths (48.1%). In the training set, the Cox model achieved AUC values of 0.783 6, 0.770 7, and 0.760 7 at 1, 5, and 10 years, respectively, with a concordance index of 0.719 0 (95% CI: 0.709 2-0.728 8). The RSF model achieved AUC values of 0.794 7, 0.783 0, and 0.769 5 at 1, 5, and 10 years, respectively, with a concordance index of 0.720 0 (95% CI: 0.710 2-0.729 8). In the validation set, the Cox model achieved AUC values of 0.794 7, 0.783 0, and 0.769 5 at 1, 5, and 10 years, respectively, with a concordance index of 0.731 0 (95% CI: 0.717 3-0.744 7). The RSF model achieved similar AUC values and concordance index as in the training set. Conclusion The survival prediction model for hypertensive nephropathy patients based on RSF and Cox regression demonstrates good predictive performance and can serve as a reference for clinical decision-making.

Objective To analyze the incidence of osteoporosis in schizophrenia patients and explore its influencing factors, providing a reference for developing preventive strategies. Methods Schizophrenia patients aged 60 or older admitted to the Seventh People's Hospital of Hengshui from January 2021 to October 2024 were surveyed. Bone mineral density (BMD) was measured using a dual-energy X-ray absorptiometry (DXA), and additional questionnaires were administered. Descriptive analysis was used to evaluate the incidence of osteoporosis, and univariate and multivariate logistic regression analyses were performed to identify influencing factors. Results Among 2 725 schizophrenia patients aged 60 or older, 298 cases of osteoporosis were identified, with an incidence rate of 10.94%. Multivariate logistic regression analysis revealed that age 75-85 years (OR=2.452), underweight (OR=4.125), male gender (OR=2.787), hyperprolactinemia (OR=2.404), 25-hydroxyvitamin D [25(OH)D] deficiency (OR=2.855), hypocalcemia (OR=2.542), combined antipsychotic medication use (OR=3.056), and antipsychotic medication use for ≥10 years (OR=2.596) were independent risk factors for osteoporosis (all P<0.05). Conclusions Elderly patients with schizophrenia face a certain risk of osteoporosis, influenced by factors such as age, underweight, gender, hyperprolactinemia, 25(OH)D deficiency, hypocalcemia, antipsychotic medication use, and duration of use. Early identification and management of these risk factors can effectively reduce the risk of osteoporosis.

Objective To examine the incidence and associated factors of unintended pregnancy among adolescent females within one year following receipt of post-abortion care (PAC) services, with a view to providing empirical evidence for strategies to reduce unintended pregnancy rates in this population. Furthermore, to explore the significance of multi-sectoral collaboration in adolescent sexuality education, and to provide reference points for policy formulation and implementation of targeted interventions. Methods Adolescent females who underwent induced abortion at Zhengzhou Maternal and Child Health Hospital between January 2020 and April 2023 were enrolled. All participants received individualized PAC services delivered in a one-to-one manner by designated nurses. A follow-up was conducted one year post-discharge to assess the incidence of unintended pregnancy. Descriptive statistics were used to analyze the incidence, and both univariate and multivariate analyses were performed to identify factors associated with the occurrence of unintended pregnancy. Results Of the 1 149 participants, 105 experienced an unintended pregnancy within one year, yielding an incidence rate of 9.14%. Cox regression analysis revealed that age (20-24 years, HR=0.201), contraceptive adherence (consistent use, HR=0.246), knowledge-behavior disparity (HR=2.498), unplanned sexual activity (HR=2.706), underestimation of pregnancy risk (HR=2.191), lack of perceived need for sexual education (HR=3.047), reliance on internet/television for sexual health information (HR=3.434), and irregular menstruation (HR=2.373) were significant correlates of unintended pregnancy one year post-intervention (all P<0.05). Conclusions Despite PAC provision, adolescent females exhibited a persistently high unintended pregnancy rate, underscoring the need for targeted interventions. Enhancing sexual education quality, improving contraceptive accessibility and adherence, and addressing knowledge-behavior disparities are critical to reducing unintended pregnancy incidence in this population.

Objective To understand the nutritional status and influencing factors among primary and secondary school students in rural areas of four counties in Guangdong Province, and to provide a basis for formulating nutritional intervention measures. Methods A multi-stage stratified cluster random sampling method was used to select students aged 6-16 years from rural compulsory education areas under the Student Nutrition Improvement Program in Guangdong Province in 2021. Questionnaire surveys and physical examinations were conducted, and the influencing factors of nutritional status were analyzed using a multinomial logistic regression model. Results Among the 501 rural primary and secondary school students in four counties of Guangdong Province, the undernutrition rate was 11.60%, and the overweight/obesity rate was 9.40%. Multinomial logistic regression analysis showed that, compared with students with normal nutritional status, students from pilot counties (OR=0.167) and those with good lung capacity (OR=0.292) had a lower risk of malnutrition (all P<0.05), while students who sometimes exhibited picky eating habits (OR=3.439) had a higher risk of undernutrition (P<0.05). Students who consumed beverages 3-6 times per week had a significantly higher risk of overweight/obesity compared to those who consumed beverages ≤ 2 times per week (OR=3.959, P<0.05). Conclusions Undernutrition and overweight/obesity are prominent issues among rural students in the four counties of Guangdong Province. Targeted nutritional interventions should be strengthened, with a focus on dietary behaviors and physical fitness, to improve students' nutritional health levels.

Objective To analyze the long-term epidemic trends of hand-foot-mouth disease (HFMD) in Jiangyin from 2008 to 2023, and to provide a scientific basis for prevention and control strategies. Methods Joinpoint regression model was applied to analyze trends in reported incidence rate by year, month, gender and age. Results The annual incidence rate showed a significant upward trend from 2008 to 2018 (β=25.44, t=3.85, P<0.01), a non-significant downward trend from 2018 to 2021(β=-114.54, t=-1.35, P=0.22) and a non-significant upward trend from 2021 to 2023 (β=146.12, t=1.22, P=0.26). The overall annual incidence rate trend was higher in males than in females (P<0.01). The ≤2 years age group exhibited a non-significant increase in annual incidence (APC=94.72%, t=0.65, P=0.53), the 2-15 years age group showed a significant decline (APC=-45.03%, t=-5.33, P<0.01), and the ≥15 years age group displayed a significant decline (APC=-9.31%, t=-6.10, P<0.01). The monthly incidence rate significant increased from January to May (MPC=86.53%, t=2.71, P=0.03) and non-significant decreased from May to December (MPC=-15.18%, t=-1.69, P=0.13). Conclusions From 2008 to 2023, the annual incidence of HFMD in Jiangyin followed a "rise-decline-rise" pattern, with monthly incidence showing rapid increases followed by gradual declines. Age-specific trends were characterized by sharp rises, rapid declines, and long-tail effects. Prevention and control efforts should prioritize children aged ≤15 years, particularly males and those ≤2 years old, with heightened vigilance during summer months.

Objective To establish epidemic threshold and to classify the epidemic intensity for hand, foot, and mouth disease (HFMD) in Guangdong Province by using Moving Epidemic Method(MEM). Methods The weekly incidence data of HFMD in Guangdong Province from 2012 to 2020 were collected from the Chinese Center for Disease Control and Prevention Information System. The MEM model was used to calculate the epidemic intensity thresholds for each year. Considering the distinct epidemiological characteristics of HFMD in Guangdong Province, which has two epidemic peaks in summer and autumn, a segmentation strategy was adopted to divide the epidemic season into two parts and calculate the intensity thresholds separately. The application effect of this method was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value. Results For the spring-summer epidemic season of HFMD in Guangdong Province, the lowest pre-epidemic threshold was in 2014 (5.60/100 000), and the highest was in 2017 (6.04/100 000). The lowest value of moderate, high, and very high epidemic thresholds were all in 2014 (15.36/100 000, 19.72/100 000, and 22.02/100 000, respectively). The highest value of moderate epidemic threshold was in 2018 (16.66/100 000), and the highest value of high and very high epidemic thresholds were both in 2013 (22.74/100 000 and 26.39/100 000, respectively). For the autumn-winter epidemic season, the pre-epidemic threshold was 3.22/100 000. The lowest value of moderate, high, and very high epidemic thresholds were in 2017/2018 (8.75/100 000, 12.82/100 000, and 15.18/100 000, respectively), and the highest were in 2016/2017 (9.96/100 000, 17.59/100 000, and 22.63/100 000, respectively). Except for the autumn-winter season of 2015/2016, the very high epidemic threshold in the spring-summer season was higher than that in the autumn-winter season in other years. Model validation results showed that sensitivity and specificity were both above 80%, except for 2014/2015. Conclusion For HFMD in Guangdong Province, which exhibits a bimodal epidemic pattern within one epidemic season, the epidemic intensity thresholds for different epidemic seasons can be determined separately by segmenting the epidemic seasons and applying the MEM model.

Objective To explore the independent and combined mediating effects of sleep quality and food addiction on the relationship between family environment and adolescent depression, providing evidence for the development of intervention strategies for adolescent depression. Methods From September to December 2022, a stratified random cluster sampling method was used to select adolescents from grades 4 to 12 in Yixing, Jiangsu Province. An online self-administered monitoring system was employed to survey adolescents using the Depression-anxiety-stress Scale (short version), Family Environment Scale, Insomnia Severity Index, and Yale Food Addiction Scale. Mediation models were constructed to analyze the mediating roles of insomnia and food addiction between family intimacy and depression. Results Among 4 180 students, 2 141 (51.2%) were male and 2 039 (48.8%) were female. The distribution across educational levels was 1 154 (27.6%) primary school students, 1 644 (39.3%) middle school students, and 1 382 (33.1%) high school students. The prevalence of depression was 16.6%. Students with low, moderate, and high family intimacy accounted for 414 (9.9%), 1 398 (33.44%), and 2 368 (56.65%), respectively. The prevalence of insomnia was 13.8%, and the prevalence of food addiction was 7.7%. Mediation model results showed that insomnia (mediating effect: -0.747, 95% CI: -0.841 - -0.659, accounting for 39.1% of the total effect) and food addiction (mediating effect: -0.098, 95% CI: -0.139 - -0.070, accounting for 5.1% of the total effect) had independent mediating effects. Additionally, insomnia and food addiction had a chain-mediated effect (mediating effect: -0.064, 95% CI: -0.091 to -0.043, accounting for 3.3% of the total effect). Conclusion Family intimacy directly affects adolescent depression and indirectly influences its development through the mediation of insomnia and food addiction.

Objective To investigate the prevalence of visual fatigue among occupational populations and analyze its associated risk factors, thereby providing evidence for targeted prevention and treatment strategies. Methods A cross-sectional study was conducted from January 2023 to June 2024 using convenience sampling to recruit occupational individuals undergoing vision examinations at two hospitals in Beijing. The prevalence of visual fatigue across different demographic groups was evaluated, and multivariate logistic regression was employed to identify significant risk factors. Results The prevalence of visual fatigue among the occupational population was 61.84% (329/532). Multivariate analysis revealed that age ≥30 years (30-<40 years: OR=1.397; 40-<50 years: OR=1.449; 50-60 years: OR=1.474), occupations such as IT professionals (OR=2.408) and drivers (OR=2.179), moderate (OR=1.511) and high-intensity (OR=1.622) visual workload, duration of myopia (<1 year: OR=1.118; 1-<3 years: OR=1.136; ≥3 years: OR=1.178), prolonged electronic device use (5-10 h: OR=1.710; >10 h: OR=1.946), screen use in dim lighting (OR=1.902), limited outdoor activity (2-3 h: OR=1.493; <2 h: OR=1.571), and insufficient sleep (<8 h: OR=1.264) were significant risk factors for visual fatigue (all P<0.05). Conclusions The prevalence of visual fatigue is notably high among occupational groups. Age, occupation type, visual workload, prolonged myopia, poor visual habits, and lifestyle factors such as limited outdoor activity and inadequate sleep contribute to the development of visual fatigue. Targeted interventions should address these modifiable risk factors to mitigate visual fatigue in occupational settings.