Table of Content

15 March 2025, Volume 28 Issue 08

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Commentary

Consideration on Strategies for Harmonious Growth of Community Rehabilitation and Primary Health Care

LIN Yifang, JIA Jie

2025, 28(08):  905-910.  DOI: 10.12114/j.issn.1007-9572.2024.0141

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Community rehabilitation has much in common with primary health care. While providing primary health care for key groups, primary health care institutions will be of great significance if they can accurately provide rehabilitation services to people in need, reduce their degree of dysfunction, improve their quality of life, and realize the functional positioning of "rehabilitation at the grassroots level". This paper focuses on the coordinated development of community rehabilitation and primary health care, proposes several strategies in service delivery, service cooperation, and service financing, in order to provide references for the expansion of rehabilitation capabilities in primary health care institutions, and hopes to contribute to higher general public health standards and reduced medical expenditures.

Guidelines·Consensus

Expert Consensus on Management of Common Gynecological Malignancies Combining General Practice and Specialist

Gynecological Oncology Group of the Oncology Department of Capital Medical University

2025, 28(08):  911-922.  DOI: 10.12114/j.issn.1007-9572.2024.0204

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To enhance the overall health management for patients with gynecologic malignant tumors, and to fully leverage the role of primary healthcare institutions in screening and rehabilitation, the Gynecological Oncology Group of the Oncology Department of Capital Medical University, in collaboration with experts in general medicine, nutrition, psychology, rehabilitation medicine, nursing, and health statistics, has formulated the Expert Consensus on Management of Common Gynecological Malignancies Combining General Practice and Specialist. This consensus, based on evidence from evidence-based medicine, the current status of primary medical institutions, and relevant guidelines for the management of gynecological malignancies, emphasizes the early identification of gynecological malignancies and proactive intervention in related health issues. Community management of patients with common gynecological malignancies should be centered around gynecologists or general practitioners, in collaboration with a multidisciplinary oncology rehabilitation team. The management covers aspects such as prevention, screening, follow-up and referral, psychological counseling, exercise rehabilitation, nutrition management, continuity of care, systematic health education, and social function recovery, aiming to prolong survival and enhance the quality of life for patients.

Original Research

Analysis of the Development Trajectory of Health-related Quality of Life in Middle-aged and Elderly Patients with Cardiometabolic Diseases and the Influencing Factors

FAN Jianing, CHEN Jieting, WANG Ziqi, FAN Jinhe, JING Mingxia

2025, 28(08):  923-932.  DOI: 10.12114/j.issn.1007-9572.2024.0364

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Background

As the aging of the population, the burden of chronic diseases in China has increased significantly. The majority of chronic disease patients suffer from cardiometabolic diseases (CMD) like hypertension and diabetes. The health-related quality of life (HRQoL) is a subjective evaluation index that reflects both the physical health level and mental health of patients with chronic diseases. Existing research on HRQoL in patients with CMD primarily focuses on influencing factors and the assessment of their current status. Compared to the research on the static status of HRQoL, research on its dynamic trends over time, however, remains somewhat limited.

Objective

To analyze the development trajectory of HRQoL in middle-aged and elderly patients with CMD and influencing factors, as well as to explore the contribution of each influencing factor, thus providing a scientific basis for improving HRQoL in patients with CMD.

Methods

Using time-series data from field surveys, a baseline survey in 2016 (T0) was conducted using a typical sampling in eligible patients with primary hypertension or type 2 diabetes mellitus (T2DM) from 3 urban communities and 2 rural communities in a certain division of the Xinjiang Production and Construction Corps. Four follow-up surveys were conducted in 2017 (T1), 2018 (T2), 2019 (T3), and 2021 (T4). A total of 1 599 subjects were surveyed in the baseline period, and 565 subjects completed the follow-up visits. Of them, 389 had hypertension, and 176 had T2DM. After excluding samples with missing data like HRQoL and demographic characteristics, data from 563 subjects were included in the analysis. A self-designed questionnaire was used for the survey, composing of five parts of personal basic information, social and psychological status, lifestyle, disease status, and health service utilization. The HRQoL of patients was measured using the European Quality of Life 5-Dimension 5-Level version (EQ-5D-5L). The heterogeneous HRQoL development trajectories were explored using a growth mixture model, and the influencing factors and evaluation of the development trajectories were analyzed using a logistic regression model and Shapley value decomposition, respectively.

Results

Three distinct types of heterogeneous development trajectories were identified, including a 452 (80.28%) cases in the significant growth group, 81 (14.39%) cases in the moderate decline group, and 30 (5.33%) cases in the significant attenuation group. Multivariate Logistic regressions analysis indicated that, patients who do not engage in physical exercise, possess impaired self-care abilities, experience deteriorating health conditions, have non-urban employee medical insurance, and express dissatisfaction with the outpatient chronic disease policy were more likely to enter the moderate decline group (P<0.05) ; patients who do not participate in physical exercise and express general satisfaction with the outpatient chronic disease policy were more likely to belong to the significant attenuation group (P<0.05). The Shapley value decomposition results revealed that the contribution of each influencing factor to the prediction of HRQoL varied among the different trajectory groups. In the significant growth group, the factors with the greatest contribution were changes in health status and self-care ability. In the moderate decline group, the predominant influencing factors were physical exercise and self-care ability. In the significant attenuation group, satisfaction with the outpatient chronic disease policy ranked first in the contribution analysis, followed by physical exercise.

Conclusion

Patients with CMD exhibit varying trajectories in HRQoL, which are influenced by distinct factors associated with each trajectory. Intervention measures can be dynamically tailored in response to the evolving HRQoL trajectories and their influencing factors, thereby offering more precise medical and health services to patients with CMD. We should concentrate on CMD patients whose health status has deteriorated, whose self-care ability has impaired, and who do not engage in physical exercise. Concurrently, efforts should be made to promote awareness of chronic disease policies, medical insurance, and other pension policies. Additionally, it is essential to continue enhancing the quality of outpatient chronic disease medical services and to improve patient satisfaction with the outpatient chronic disease policies, thereby further enhancing HRQoL.

Association between Abdominal Obesity, Vitamin D Levels and Frailty in Chinese Elder Adults

YIN Dan, HE Huijuan, LI Mengying, WANG Xiangrong, LI Lin

2025, 28(08):  933-938.  DOI: 10.12114/j.issn.1007-9572.2024.0399

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Background

The incidence of frailty among the elderly in China increases with age, investigating the mechanisms by which central obesity and vitamin D levels contribute to the development of frailty is essential for effective management strategies.

Objective

A cross-lagged model was employed to investigate the longitudinal mediating role of vitamin D levels in the relationship between central obesity and frailty among the elderly, thereby offering a theoretical framework for the management of frailty in this population.

Methods

The study subjects were 1 364 elderly individuals selected from the Chinese Longitudinal Healthy Longevity Study (CLHLS) in 2011-2012 (T1) and 2014 (T2). The vitamin D levels of the study subjects were measured, and abdominal obesity was assessed using the weight-adjusted-waist index (WWI), while frailty was measured using the frailty index (FI). A cross-lagged model was implemented to analyze the causal temporal relationship and underlying mechanisms between central obesity, vitamin D levels, and frailty among the elderly.

Results

The detection rate of frailty in the elderly was 21.8% (298/1 364) at T1 and 31.2% (425/1 364) at T2. At two time points, WWI was negatively correlated with vitamin D levels (P<0.05) and positively correlated with FI (P<0.05) ; vitamin D levels were negatively correlated with FI (P<0.05). Cross-lagged model results showed that WWI at T1 could predict FI at T2 (β=1.124, P<0.05), and FI at T1 could predict WWI at T2 (β=0.125, P<0.05). Longitudinal mediation effect analysis showed that T1 WWI could not only directly predict T2 FI (β=0.040, P<0.05), but also predict T2 FI through the mediating effect of T2 vitamin D level (β=-0.131, P<0.05) .

Conclusion

Abdominal obesity can not only directly predict frailty in the elderly, but also indirectly affect frailty in the elderly through the longitudinal mediating effect of vitamin D levels. Elderly people should regularly monitor abdominal obesity and vitamin D levels, to prevent or delay the onset of debilitation.

Cognitive Function of Older Adults Relocated for Poverty Alleviation and Its Influencing Factors

YANG Le, LI Zhenhao, YAO Dianrui, YANG Yang, SUN Yufang, HE Ying

2025, 28(08):  939-947.  DOI: 10.12114/j.issn.1007-9572.2024.0201

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Background

The cognitive function of older people relocated for poverty alleviation varies. It is of great significance to focus on the cognitive function of older adults relocated for poverty alleviation and identify the influencing factors, thus improving their cognitive function.

Objective

To illustrate the cognitive function of older adults relocated for poverty alleviation in Shanxi Province, and to identify the influencing factors, thus providing a scientific basis for developing targeted intervention strategies.

Methods

A multi-stage stratified sampling method was used to survey the relocated older people in 24 resettlement sites of 8 counties in Taiyuan, Xinzhou, Lyuliang and Linfen of Shanxi Province from June to August 2023. A total of 1 882 questionnaires were collected. The cognitive function of the relocated older adults was assessed using the Chinese version of the Mini-mental State Examination (CMMSE). Based on the education level, older adults with primary school or below and CMMSE above 22 points, and those with secondary school/technical secondary school or above and CMMSE above 26 points were considered without cognitive impairment. The hierarchical linear regression model and multivariate Logistic regression analysis model were used to analyze the influencing factors of cognitive impairment from four dimensions, including social demographic characteristics, health-related behaviors, health status, and society and environment.

Results

A total of 1 848 older adults relocated for poverty alleviation in Shanxi Province were recruited, with the CMMSE score of (24.40±5.84) points. Hierarchical linear regression indicated that age (B=-2.355), education level (primary school and below: B=-2.189), marital status (B=-0.987), physical exercise (B=-0.792), body mass index (BMI, overweight: B=1.034), activity of daily living (ADL, B=0.900), depression (B=-0.089), and social capital (B=0.125) were influencing factors of cognitive function of relocated older adults of Shanxi Province (P<0.05). There were 428 (23.2%) relocated older adults with cognitive impairment. Multivariate Logistic regression showed that age (OR=1.894, 95%CI=1.398-2.566), individual monthly income (≤500 yuan: OR=0.598, 95%CI=0.380-0.943), marital status (OR=1.507, 95%CI=1.078-2.106), physical exercise (OR=1.673, 95%CI=1.276-2.193), BMI (overweight: OR=0.543, 95%CI=0.368-0.804), ADL (OR=0.805, 95%CI=0.823-0.895), and social capital (OR=0.958, 95%CI=0.934-0.983) were influencing factors of cognitive impairment of relocated older adults of Shanxi Province (P<0.05) .

Conclusion

The detection rate of cognitive impairment in older adults relocated for poverty alleviation in Shanxi Province is 23.2%. Age, education level, marital status, physical exercise, ADL, depression, BMI and social capital are important factors affecting the cognitive function of the relocated older adults in Shanxi Province. More effective interventions targeted at these factors should be taken to prevent cognitive decline among them.

Comparison of the Efficacy of Vedolizumab and Ustekinumab in Biologic-naïve Patients with Moderately to Severely Active Crohn's Disease

LIU Liu, XU Wenhang, LYU Bin, FAN Yihong

2025, 28(08):  948-953.  DOI: 10.12114/j.issn.1007-9572.2024.0148

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Background

Vedolizumab (VDZ) and Ustekinumab (UST) are both effective treatments for Crohn's disease (CD). However, there are fewer comparative studies of these biologics in biologic-naïve patients with CD.

Objective

To compare the efficacy and safety of real-world UST and VDZ in biologic-naïve patients with moderately to severely active CD and to identify predictive factors associated with clinical efficacy.

Methods

Patients treated with VDZ or UST as the primary biologic agent for moderately to severely active CD were included from the First Affiliated Hospital of Zhejiang Chinese Medical University from January 2021 to January 2023. Clinical efficacy at Weeks 14 and 52, endoscopic efficacy, and treatment persistence at Week 52 were evaluated in a retrospective cohort. Factors influencing clinical remission at Week 52 were analyzed, and adverse drug reactions during treatment were documented.

Results

A total of 72 patients with CD were included, with 27 receiving VDZ and 45 receiving UST. Of these, 67 completed 14 weeks of treatment (24 VDZ and 43 UST), and 57 completed 52 weeks of treatment (18 VDZ and 39 UST). There were no statistically significant differences in clinical response rates or clinical remission rates at 14 weeks between UST and VDZ (P>0.05). Similarly, at 52 weeks, no statistically significant differences were observed in clinical response rates or clinical remission rates between UST and VDZ (P>0.05). Endoscopic response rates and endoscopic remission rates at 52 weeks also showed no significant differences between the treatments (P>0.05). UST [86.7% (39/45) ] had a higher 52-week treatment persistence compared to VDZ [66.7% (18/27) ] (P=0.043). Multivariate Logistic regression analysis indicated that age (OR=0.965, 95%CI=0.938-0.993) and clinical response at Week 14 (OR=8.483, 95%CI=1.699-42.352) were significant factors for clinical remission at Week 52 in UST-treated patients. No multifactorial analysis was conducted for VDZ as no factors influencing clinical remission at Week 52 were identified in the univariate analysis. Adverse event rates were 7.4% (2/27) for VDZ and 4.4% (2/45) for UST, with no statistically significant difference between the groups (P>0.05) .

Conclusion

The clinical and endoscopic efficacy of UST in biologic-naïve patients with moderately to severely active CD is comparable to VDZ. However, the 52-week treatment persistence rate is higher for UST. Age and clinical response at Week 14 correlate with clinical remission at Week 52 in UST-treated CD patients. Safety profiles were similar between the two groups.

Based on Mendelian Randomization to Explore the Causal Relationship with Insomnia and Gut Microbiota

GUO Yumeng, CUI Yanglin, ZHANG Xianzhong

2025, 28(08):  954-961.  DOI: 10.12114/j.issn.1007-9572.2023.0656

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Background

As the prevalence of insomnia is gradually increasing, it is seriously affecting the mental and work status of patients. The gut microbiota is considered to be a risk factor for insomnia, but there is a relative lack of evidence to accurately recognize the relationship between gut microbiota and insomnia.

Objective

Using two-sample Mendelian randomization as a research methodology to explore the causal relationship between gut microbiota and insomnia.

Methods

Single nucleotide polymorphisms (SNPs) significantly associated with the relative abundance of 196 gut microorganisms were extracted as instrumental variables (IVs) according to predefined thresholds using pooled statistics of the gut microbiota from the largest available genome-wide meta-analysis of association studies conducted by the MiBioGen consortium (n=18 340). Pooled statistics for insomnia were obtained from the UK Biobank (n=462 341). Inverse variance weighting (IVW), MR-Egger regression, weighted median (WME), and weighted multinomial (WM) were used to detect the causal relationship between gut microbiota and insomnia, with IVW being the predominant method, and the results were assessed according to the effect indicator dominance ratio (OR) and 95% confidence interval (CI). Sensitivity analysis, heterogeneity test, gene multiplicity test, MR multiplicity residual and outlier test (MR-PRESSO) were combined to verify the stability and reliability of the results. Reverse Mendelian randomization analysis was also performed on the colonies found to be causally associated with insomnia.

Results

IVW results showed that genus_Roseburia (OR=0.787, 95%CI=0.671-0.923, P_FDR=0.016), genus_Erysipelatoclostridium (OR=0.880, 95%CI=0.794-0.976, P_FDR=0.077), genus_Paraprevotella (OR=0.891, 95%CI=0.801-0.991, P_FDR=0.083), genus_Ruminococcaceae UCG014 (OR=0.818, 95%CI=0.697-0.961, P_FDR=0.072), family_Pasteurellaceae (OR=0.897, 95%CI=0.814-0.988, P_FDR=0.081), order_Pasteurellales (OR=0.897, 95%CI=0.814-0.988, P_FDR=0.094) were associated with insomnia, and no genetic pleiotropy or significant heterogeneity of IVs was found. According to the results of reverse MR analysis, insomnia had no significant causal effect on gut microbiota.

Conclusion

The abundance of six species of GM from the genus_Roseburia, genus_Erysipelatoclostridium, genus_Paraprevotella, genus_Ruminococcaceae UCG014 group, family_Pasteurellaceae, and order_Pasteurellales is negatively correlated with the risk of developing insomnia, i.e., decreased abundance increased the risk of developing insomnia and is a protective factor against insomnia.

Exosomes Regulate Epithelial Mesenchymal Transition of Endometrial Cells in Mice with Recurrent Spontaneous Abortion

LI Mengyuan, LI Guanshan, HAN Qian, LI Siyao, ZHENG Shuchang, XIN Mingwei, YIN Xiaodan, WANG Jingshang, WU Ying, HE Junqin

2025, 28(08):  962-972.  DOI: 10.12114/j.issn.1007-9572.2023.0768

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Background

Recurrent spontaneous abortion (RSA) is a common reproductive disorder closely linked with the weakened epithelial-mesenchymal transition (EMT) in the endometrium during embryo implantation. Endometrium-derived exosomes and miRNAs they transport are linked with RSA via the involvement in cellular communication and EMT, although the specific mechanisms have not yet fully revealed.

Objective

Focusing on the function of exosomes in EMT, this study aims to validate the regulatory role of endometrium-derived exosomes and miRNA-221 they transport in EMT of endometrial cells in RSA mice.

Methods

From October 2021 to May 2022, a total of 24 eight-week-old female mice in the specific pathogen-free (SPF) level were randomly assigned into the control group (n=12) and RSA group (n=12) for modeling. After RSA modeling, male and female mice were housed together. On the 4th day of pregnancy, female mice were sacrificed for isolating endometrial epithelial cells. They were cultured for extracting exosomes, which were identified by transmission electron microscopy and Western blotting. Cell proliferation, invasion, and migration abilities were evaluated using CCK-8 assay, Transwell assay, and fluorescence-activated cell sorting (FACS) before and after exosome interventions. Expression levels of EMT-related genes [E-cadherin, N-cadherin, Vimentin, matrix metalloproteinase 7 (MMP-7), matrix metalloproteinase 9 (MMP-9) ] and exosome marker proteins [CD₆₃, CD₈₁, tumor susceptibility gene 101 (TSG101) ] were measured. Expression levels of EMT marker proteins (CD₂₄^-APC, CD₄₄^- FITC) in exosome-treated cells were analyzed. Transfection of miRNA-221 mimics and inhibitors was performed to analyze the effects of exosome-derived miRNA-221 on EMT of endometrial epithelial cells in RSA mice. Relevant analyses were conducted using Western blot and dual-luciferase reporter assay.

Results

Abnormal EMT was observed in the endometrial epithelial cells of mice in RSA group, and the mouse endometrial epithelial cells were able to secrete exosomes. The proliferation rate, migration ability, invasion ability, and CD₄₄⁺/CD₂₄⁺ ratio of cells in the RSA group treated with exosomes were significantly higher than those measured in cell supernatant of RSA group without exosome intervention (P<0.05). Compared with those in the cell supernatant of RSA group, induction of exosomes significantly downregulated EMT marker protein E-cadherin, but upregulated stromal marker proteins N-cadherin and Vimentin, as well as matrix marker proteins MMP-7 and MMP-9 (P<0.05). The expression level of miRNA-221 in the RSA group was significantly lower than that of the control group (P<0.05). Compared with those transfected with miRNA negative control, transfection of miRNA-221 mimic significantly activated the phosphatidylinositol 3-kinase (PI3K) -AKT pathway, nuclear factor-kappa B (NF-κB) pathway, and p38 pathway (P<0.05), but downregulated mRNA level of PTEN (P<0.05). Transfection of miRNA-221 inhibitor significantly upregulated mRNA level of PTEN (P<0.05) .

Conclusion

Endometrium-derived exosomal miRNA-221 negatively regulates the PTEN gene, activates the PI3K-AKT pathway, promotes EMT in endometrial epithelial cells, and influences the pregnant outcome of RSA mice.

Original Research·Research of Specific Population·Reproductive Health

Research on the Influencing Factors and Countermeasures of Fertility Willingness among Different Age Groups in China

LIU Xinxin, SUI Jinhui, WU Bangdong, LIU Yan, LIANG Xiaohui, ZHAO Yang

2025, 28(08):  973-979.  DOI: 10.12114/j.issn.1007-9572.2024.0139

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Background

The willingness of families to have children plays a crucial role in long-term population development. Currently, China is experiencing a significant risk of low fertility, with low fertility becoming the prevailing trend.

Objective

Under the macro background of the comprehensive liberalization of the ''three-child policy'', this study aims to analyze the willingness of the population to have children and the varying influencing factors across different age groups and establish a foundation for developing pertinent fertility policies by elucidating the concerns about fertility held by various age groups.

Methods

The data used in this study was sourced from the 2021 China Comprehensive Social Survey (CGSS). This study selected a population aged 20-44 years old, and after excluding missing variables, a total of 2 525 samples were included, including 1 444 females. A study on the entire population is conducted in order of age from young to old, with one group every 5 years old, for a total of 5 groups; Research on women was divided into two groups based on age groups of 34 and 35 and above. Using multiple variables from three dimensions of personal characteristics, family characteristics, and attitudes as possible influencing factors, an ordered Logistic regression model was used to analyze the factors affecting fertility intention in the entire population and only for women.

Results

The number of people willing to have two children accounted for 59% of the total survey population (1 491/2 525), and the group under 34 years old had a higher willingness to have zero children compared to the group over 35 years old (P<0.05). The results of Logistic regression analysis showed that, among individual characteristic variables, individuals with better health conditions were more likely to have a higher willingness to have children, which was significant in the population aged 35-39 and women over 35 years old (P<0.05). In the family characteristic variables, people with a larger family size were more likely to have a higher willingness to have children, which was significant in the population aged 25 and above and women over 35 years old (P<0.05). There was a higher likelihood of having a stable partner with a higher willingness to conceive, which was significant in women under 34 years old (P<0.05). In the concept attitude variables, all variables of the 20-24 were group were significant, and the results showed diversity in other age groups.

Conclusion

The current mainstream fertility intention is to have two children, and the fertility intention of young people (under 34 years old) is relatively high. Better physical health and larger family size are more prominent in the age group of 35 and above, and attitudes have a stronger impact on fertility intentions, with significant age differences. It is recommended to pay attention to the reproductive views of different age groups, strengthen family, social, and policy support, attach importance to women's physical health, and provide medical support for childbirth.

The Association between Female Reproductive Factors and Subjective and Objective Cognitive Function: a Cross-sectional Analysis from the Pingyin Cohort

FU Chunying, YU Ruihong, WANG Qi, LI Meiling, WANG Xiaoyi, ZHU Dongshan

2025, 28(08):  980-988.  DOI: 10.12114/j.issn.1007-9572.2024.0213

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Background

The association between female reproductive factors and cognitive function was unclear, there still lack studies on female reproductive factors and subjective cognitive function.

Objective

Exploring the relationship between female reproductive factors and subjective or objective cognitive function, and providing theoretical basis for the prevention and intervention of cognitive decline and dementia.

Methods

The baseline survey was conducted in July 2023 in Pingyin, Jinan (in three townships). After using a multi-stage cluster random sampling method, 2 165 valid participants aged 45-70 were recruited at baseline. We collected sociodemographic data, medical histories, lifestyle factors, and female reproductive factors through a self-designed comprehensive questionnaire. The subjective and objective cognitive function of participants were evaluated by the Subjective Cognitive Decline-Questionnaire 9 (SCD-Q9) and Montreal Cognitive Assessment Scale-Basic (MoCA-B), respectively. In addition, we also collected anthropometric data (included height and weight) and blood samples (to get APOE e4 alleles). Multivariate Logistic regression and Local weighted regression (Loess) were used to analyze the influence of female reproductive factors on cognitive function and to detect potential nonlinear relationships between age at menarche, age at menopause, length of reproductive period and MoCA-B scores.

Results

This study was based on a baseline population and included 1 044 postmenopausal women. The prevalence of abnormal SCD-Q9 scores was 48.37% (505/1 044), while the prevalence of abnormal MoCA-B scores was 67.43% (704/1 044). Women who had 3 or more children had a lower risk of subjective cognitive decline compared with those who had 1 or fewer children (OR=0.59, 95%CI=0.36-0.98). Women with a breastfeeding duration <6 months had a higher risk of subjective cognitive decline compared with those with a breastfeeding duration of 6-12 months (OR=3.69, 95%CI=1.03-13.16). Age at menarche >18 years (OR=1.91, 95%CI=1.09-3.35), age at menopause ≤45 years (OR=1.61, 95%CI=1.00-2.62), and reproductive period ≤30 years (OR=1.56, 95%CI=1.07-2.29) or >40 years (OR=2.22, 95%CI=1.05-4.72) were all associated with poorer objective cognitive function (P<0.05). Loess analysis revealed an inverted "J-shaped" relationship between age at menarche, age at menopause, reproductive period and MoCA-B scores.

Conclusion

Women with more children (≥3) have a lower risk of subjective cognitive decline and women with shorter breastfeeding duration (<6 months) have a higher risk of subjective cognitive decline. Age at menarche >18 years, early menopause (≤45 years), and excessively long or short reproductive periods are all associated with poorer objective cognitive function. We should pay attention to the influence of female reproductive factors on cognitive function in order to delay the process of cognitive decline.

Investigation on the Current Status of Standard Pregnancy Health Care and Self-management Behavior of Rural Women

LUO Xiaoxi, CHEN Junyu, JIA Honghong, LIU Li, LI Chunhong, YANG Nana, HAN Guangli, ZHOU Yuqiu

2025, 28(08):  989-995.  DOI: 10.12114/j.issn.1007-9572.2024.0120

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Background

The rate of participation in standard pregnancy health care in China is gradually increasing, highlighting the imbalance and insufficiency in women's and children's health development between urban and rural areas. The potential of rural women's self-management as the cornerstone of pregnancy health care has not been fully utilized.

Objective

To examine the current status of standard pregnancy health care among rural women, assess their level of self-management behavior, and identify the factors influencing their self-management behavior in pregnancy health care.

Methods

The research was conducted from January to August 2023, involving rural women in Suihua City and Daqing City in Heilongjiang Province, as well as Changchun City in Jilin Province, all selected through convenience sampling. Various tools such as the Basic Information Questionnaire, Maternal Self-Management Scale, A5-item Short Form of the Edinburgh Postnatal Depression Scale (EPDS-Dep-5), and Maternal Social Support Scale (MSSS) were employed to gather data. Data in relation to the present condition of standard pregnancy health care among rural women were counted. The self-management behavior scores of different characteristics of rural women in pregnancy health care were compared. Multiple linear regression was used to assess the factors that impact rural women's self-management behavior in pregnancy health care.

Results

A total of 493 questionnaires were distributed, and 470 valid questionnaires were collected, with a valid questionnaire collection rate of 95.33%. The findings revealed that 218 rural women (46.4%) underwent pre-pregnancy checkups, with 388 (82.6%) having their first checkups within 12 weeks. There were 303 cases (64.5%) where obstetric examinations took place in medical and health institutions at the county level or higher. Of 276 cases (58.7%), the number of obstetric examinations satisfied the requirements for the respective pregnancy week. However, only 103 cases (21.9%) adhered to the required number of obstetric examination items for the pregnancy week. The average score for self-management of health care during pregnancy was (70.18±16.42). The scoring indicators for each dimension, in descending order, were medical compliance behavior (79.75%), routine life behavior management (77.33%), self-protection behavior (76.73%), and fetal monitoring behavior management (70.43%). The findings from the multiple linear regression analysis indicated that the distance of family residence from the closest antenatal care facility (B=0.732, 95%CI=0.139-1.325), gestational week (B=-1.336, 95%CI=-2.119 to -0.553), pregnancy complications (B=3.776, 95%CI=1.532-6.019), risk of depression during pregnancy (B=-0.356, 95%CI=-0.663 to -0.049), and social support status (B=2.635, 95%CI=2.508-2.762) were identified as significant factors influencing the self-management behaviors of pregnancy health care among rural women (P<0.05) .

Conclusion

Rural women exhibited low rates of participation and eligibility for standardized pregnancy health care, along with moderate scores for self-management behaviors related to pregnancy health care. The distance of family residence from the nearest antenatal care facility, gestational week, pregnancy comorbidities, risk of depression during pregnancy, and social support were found to be the factors influencing the self-management behaviors of pregnancy health care among rural women. It is recommended that health care providers at all levels focus on rural women during pregnancy, standardize their pregnancy health care behaviors, enhance their self-management skills, and establish a scientifically sound, cost-effective, simple, and easily operable self-management intervention model for pregnancy health care among rural women.

Original Research·Epidemiological Study

Analysis of Disease Burden Trends and Forecast of Alzheimer's Disease and Other Dementias among the Elderly in China from 1992 to 2021

HAN Shukui, REN Yitao, MA Xin, SONG Panpan, MA Jinxiang, ZHANG Ziyu, CHEN Hongru

2025, 28(08):  996-1003.  DOI: 10.12114/j.issn.1007-9572.2024.0519

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Background

In the context of an aging society, the number of elderly Alzheimer's disease and related dementia (ADRD) patients in China has been increasing year by year, placing a heavy caregiving burden on their primary family caregivers and garnering extensive attention both domestically and internationally.

Objective

This study aims to analyze the burden of ADRD among Chinese elderly individuals, explore the influence of age, period, and cohort factors on its incidence and prevalence, and predict its incidence post-2021, providing a basis for the development of preventive and curative measures by relevant authorities.

Methods

Using ADRD data from the Global Burden of Disease Study 2021 (GBD 2021), we extracted the crude incidence rate, crude prevalence rate, crude mortality rate, and crude DALY rate of ADRD among Chinese elderly individuals from 1992 to 2021. After age standardization, we analyzed trends using the Joinpoint regression model and calculated the annual percentage change (APC) and average annual percentage change (AAPC). Age-period-cohort models were used to analyze the effects of age, period, and cohort factors on the incidence and prevalence of ADRD, while Bayesian age-period-cohort models were employed to predict incidence rates from 2022 to 2030.

Results

The age-standardized incidence and prevalence of ADRD among China's elderly population from 1992 to 2021 showed an overall increasing trend (incidence: AAPC=0.57%, 95%CI=0.41%-0.72%; prevalence: AAPC=0.64%, 95%CI=0.60%-0.68%). The growth rate of standardized incidence was higher in men than in women (AAPC: 0.63% vs. 0.60%), while the growth in standardized prevalence was higher in women than in men (AAPC: 0.68% vs. 0.66%). The standardized mortality rate decreased across three intervals (1992-2019: APC of -0.11%, -0.41%, and -0.08%) but increased from 2019 to 2021 (APC=1.96%, 95%CI=0.78%-3.15%). The effects of age, period, and cohort factors on ADRD incidence and prevalence were significant. Specifically, the risk of incidence and prevalence increased with age in both men and women over 60 years old, with individuals aged 95 years and older having 13.24 and 13.53 times higher risk of incidence in men and women, respectively, compared to the 60-64 age group. The corresponding prevalence risks were 13.55 and 16.05 times higher. Over time, the risk increased, peaking during 2017-2021. In contrast, cohort effects revealed a progressive decrease in risk with later birth cohorts. By 2030, the standardized incidence rate is projected to increase by approximately 43.62% in women (from 1 267.77 to 1 820.80 per 100 000) and by 36.52% in men (from 920.22 to 1 256.30 per 100 000). Additionally, the number of ADRD cases among men and women was expected to rise significantly, with increases of 89.74% and 105.06%, respectively, between 2021 and 2030.

Conclusion

The increasing burden of ADRD in China's elderly population highlights the need for effective measures, particularly to protect elderly women.

The Disease Burden, Risk Factors and Predictive Analysis of Early-onset Colorectal Cancer of Different Genders between China and the World from 1990 to 2021

LIAO Xingyu, TIAN Siyu, CHEN Min

2025, 28(08):  1004-1011.  DOI: 10.12114/j.issn.1007-9572.2024.0447

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Background

In recent years, the incidence of colorectal cancer has been on the rise in low- and middle-income countries. Early-onset colorectal cancer (EOCRC), defined as colorectal cancer occurring in patients under 50 years of age, continues to see an increasing incidence. However, there is currently a lack of relevant epidemiological trends, which may hinder precise prevention, control strategies, and resource allocation for EOCRC.

Objective

To analyze the trends in the disease burden of EOCRC and the major risk factors for EOCRC in China and Global across different genders from 1990 to 2021 and predict the incidence and mortality rates of EOCRC for different genders in China and global from 2022 to 2046.

Methods

The incidence, mortality and disability adjusted life year (DALY) rate of colorectal cancer diagnosed between the ages of 14 and 49 in China and Global from 1990 to 2021 were collected using the Global Burden of Disease Database 2021. Age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized disability-adjusted life years (ASDR) were utilized to analyze the disease burden of EOCRC and its major risk factors by gender in China and global. The Joinpoint model was used to calculate the annual percentage change (APC) and the average annual percentage change (AAPC) to reflect the trends in disease burden changes. Furthermore, the Bayesian age-period-cohort (BAPC) model was used to predict the incidence and mortality rates of EOCRC for different genders in China and globally from 2022 to 2046.

Results

In 2021, the ASIR, ASMR, ASDR for Chinese males in EOCRC were 13.39/100 000, 4.26/100 000, 220.59/100 000, the ASIR, ASMR, ASDR for Chinese females in EOCRC in were 5.75/100 000, 1.68/100 000, 87.29/100 000. In 2021, the ASIR, ASMR, ASDR for global males in EOCRC were 6.11/100 000, 2.29/100 000, and 115.58/100 000, the ASIR, ASMR, ASDR for Chinese females in EOCRC were 4.17/100 000, 1.57/100 000, and 79.49/100 000. The AAPC for ASIR of males in China and global was 2.09% (95%CI=1.76%-2.43%) and 0.73% (95%CI=0.61%-0.84%), while for females in China, it was 0.31% (95%CI=0.04%-0.59%), all indicating an upward trend (P<0.05). The AAPC for the ASMR for males in China and global was -0.28% (95%CI=-0.51% to -0.05%) and -0.54% (95%CI=-0.68% to -0.40%), the AAPC was -2.22% (95%CI=-2.47% to -1.97%) in Chinese female and -1.25% (95%CI=-1.37% to -1.13%) in global female, all indicating a downward trend (P<0.05). The trend of ASIR trend for global females exhibited fluctuations, with AAPC of -0.09% (95%CI=-0.22% to 0.04%) (P>0.05). The trend of ASDR for Chinese male showed an inverted "V" shape, with AAPC of -0.20% (95%CI=-0.45% to 0.04%) (P>0.05). By 2046, the predicted ASIR and ASMR for Chinese male are expected to be 28.46/100 000 and 4.80/100 000. For females in China, these rates are projected to be 7.41/100 000 and 1.23/100 000. Globally, the ASIR and ASMR for males are forecasted to be 5.90/100 000 and 1.62/100 000, while for females, the rates are expected to be 3.06/100 000 and 1.05/100 000.

Conclusion

The disease burden of EOCRC in both males and females in China is severe and exceeds the global average, exhibiting significant gender disparities. There is a need to deepen the focus on the gender disparities associated with EOCRC and to implement targeted prevention and control measures. Additionally, drawing on global prevention and treatment experiences can provide a valuable reference for policy formulation.

Review & Perspectives

New Progress in the Application of Infrared Thermal Imaging in Pulmonary Diseases

YANG Jianuo, WANG Guanli, YANG Jiafu, HE Jiahao, CHEN Shumin, SHEN Yi, LI Juan, REN Ni, LIU Chunli, DENG Fangge

2025, 28(08):  1012-1016.  DOI: 10.12114/j.issn.1007-9572.2024.0114

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As a non-invasive and non-radiative non-contact clinical detection technology, infrared thermography can identify various diseases early by detecting the body surface temperature and reconstructing the temperature distribution image, and achieve early diagnosis and intervention. This article focuses on reviewing the application and related research progress of infrared thermography in the fields of acute respiratory infectious diseases, sleep apnea syndrome, traditional Chinese medicine lung disease research, neonatal intensive care, and early screening of pulmonary embolism, which has important clinical guidance significance. As a Functional imaging technology, the core advantage of infrared imaging is "Early". Unlike structural changes in the course of a disease, the early stages of a disease are often Hemodynamics, the functional changes of local abnormal temperature distribution caused by local inflammation and so on can be early diagnosed, early intervention and dynamic monitoring by means of infrared thermography technology based on thermal sensitivity.

Research Progress in Metabolomics for HCC Diagnosis and Treatment

MA Xiaoxuan, WANG Rongqi

2025, 28(08):  1017-1022.  DOI: 10.12114/j.issn.1007-9572.2024.0410

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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. It is characterized by high morbidity and mortality. Therefore, early detection, early diagnosis and early treatment are very important. Sensitive and convenient serological biomarkers play a key role in the diagnosis and treatment of HCC. However, traditional biomarkers such as alpha-fetoprotein fall far short of the clinical needs. Liver is an important organ of metabolism in the body. The occurrence and development of HCC are closely related to metabolism. Metabolomics is a newly developed subject. It has certain advantages in the screening diagnosis, mechanism exploration, precise treatment, prognosis judgment and efficacy evaluation of HCC. As an important part of systems biology, metabolomics technology can screen differentially expressed metabolites in the tissues, blood and urine of HCC patients. On the one hand, these metabolites can be used as biomarkers for early diagnosis and prognosis evaluation of HCC. On the other hand, these metabolites can also clarify the metabolic mechanism in the development and progression of HCC, which can be used to develop new drugs and new targets for the treatment of HCC. This article reviews the research progress of metabolomics in the diagnosis and treatment of HCC, in order to provide a theoretical basis for the screening of HCC biological diagnostic markers and potential therapeutic targets.

Research Methodology

MetaDTA: an Online Application for Diagnostic Test Accuracy Meta-analysis

YANG Shuihua, YAO Guiying, TIAN Chen, YAN Yilong, LIU Jiayi, WANG Jiajia, TIAN Jinhui, NIU Meng, GE Long

2025, 28(08):  1023-1032.  DOI: 10.12114/j.issn.1007-9572.2024.0083

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MetaDTA is an online, interactive application for Meta-analysis of diagnostic test accuracy studies, which calls on the lme4 and shiny packages in R software to perform the statistical analyses and create an interactive user interface. The application does not require any knowledge of statistics and programming, nor does it require any specialized software to be installed, making it easy to use for users with no specialized statistical knowledge. In this paper, we will focus on the quantification of diagnostic test accuracy, visualisation of results and interactive functions of the MetaDTA platform, and introduce users to the specific operation of the application with examples, aiming to help relevant researchers to complete Meta-analysis of diagnostic accuracy studies, plot summary receiver operating characteristic (SROC) curves, draw the results of the evaluation of the quality of the included studies, and carry out sensitivity analysis.