During the 14th Five-Year Plan period, the population of China has turned into a stage of negative growth, the fertility rate gradually declined, and the infertility rate gradually increased. The most effective treatment for infertility is assisted reproductive technology (ART), which has brought hope for fertility to many patients. However, the current promotion of the utilization of ART is still fraught with many obstacles. In this context, focusing on the realistic challenges of ART on its development in China, we will take a problem-oriented approach, utilize the relevant policies of ART in foreign countries as references, and put forward policy recommendations for the further implementation of ART, such as coordinating the balanced distribution of ART resources in the region, strengthening policy safeguards for ART, enhancing the institutional functioning of professional associations in medical ethics, and standardizing the application of ART treatments.

Objective:To analyze the impact of stressful life events on the social activity participation of middle-aged and elderly adults in China, providing a scientific basis for improving their quality of life.Methods:This study was conducted in January 2024.Data were derived from the China health and retirement longitudinal study (CHARLS) conducted from 2011 to 2020. SPSS 25.0 software was used for statistical analysis.Ordered Logistic regression analysis was employed to explore the association between stressful life events experienced over the past decade and the level of social activity participation, with stratified analysis by age, gender, and place of residence.Results:A total of 10 838 middle-aged and elderly adults were included in this study. The proportions of individuals with no social activity participation, low social activity participation, and high social activity participation were 52.07%(5 643/10 838), 24.21%(2 624/10 838), and 23.72%(2 571/10 838), respectively. After adjusting for sociodemographic characteristics and health-related behaviors, individuals who experienced stressful life events were 15.2% less likely to participate in social activities compared to those who did not ( RR=0.848, 95% CI=0.786-0.915).Stratified analysis revealed that the decrease in the likelihood of social activity participation following stressful life events was significantly greater in urban residents than that in rural residents ( Pinteraction=0.004). Conclusion:Experiencing stressful life events over the past decade may reduce the level of social activity participation among middle-aged and elderly adults. It is recommended to strengthen psychological counseling for this population and encourage active social engagement.

Objective:This study aims to analyze the focus and existing shortcomings of informal elderly care policy in China,and to provide references for policy system optimization.Methods:A two-dimensional analysis framework of"policy instruments-participating actors"was constructed and a content analysis method was applied to quantitatively analyze 34 relevant policy texts on informal elderly care(2011-2025),aiming to reveal the structural features and evolution logic of the policy system.Results:The policy evolution has undergone three stages,including institutional initiation,regulated development,and systematic deepening.In terms of policy tools,supply-side,environmental,and demand-side tools accounted for 39.6%,33.6%,and 26.8%,respectively,with the structure transitioning from a"supply-dominated"to a diversified synergistic model of"supply optimization+environmental empowerment+demand stimulation".In terms of participating actors,government departments(27.7%)played a dominant role,technology enterprises showed increased participation(20.6%),while family members remained underrepresented(9.2%).Conclusion:It is necessary to further optimize the structure of policy tool,strengthen social participation and family support systems,promote the deep integration of technology and humanistic care,and enhance the systematicness and effectiveness of the policy system.

This study investigated the types and distribution of rodents,and the infection status of eight pathogens in the high-altitude areas of western Sichuan,to provide a basis for control of rodent-borne diseases and pathogen surveillance in rodents in the area.From August to November of 2023,rodents were captured through the night method in high-altitude areas of western Sichuan.Nucleic acids were collected from the rodents'livers and lungs,and eight important pathogens were detected:Dabie bandavirus,Han-tavirus,Bartonella,Francisella tularensis,Anaplasma phagocytophilum,Rickettsia mooseri,Orientia tsutsugamushi,and Leptospira interrogans.The chi-square test was used to compare the composition ratios of rodent species and the difference in pathogen positivity rates among groups.A total of 114 rodents of nine species were captured.The dominant species in this area were Apodemus agrarius(22.81%),Apodemus chevrieri(18.42%),Niviventer confucianus(17.54%),Apodemus latronum(16.67%),and Apodemus peninsu-lae(13.16%).Other rodent species included Rattus nitidus(4.39%),Neodon irene(4.39%),Chodsigoa hypsibia(1.75%),and Nivi-venter excelsior(0.88%).Statistically significant differences in rodent species composition were observed among regions,altitudes,and habitats(χ2Region=112.358,P<0.05;χ2Altitude=96.843,P<0.05;χ2Habitat=48.842,P<0.05).The liver and lung pathogen results showed that the positivity rate of Bartonella was highest(29/114),whereas those of the other seven pathogens were 0%-4.39%.Five rodents were co-infected with two or more pathogens,and the composite positivity rate was 4.36%(5/114).Statistically significant differences in the positivity rates were observed for Leptospira interrogans among species(χ2=6.568,P=0.028)and Anaplasma phagocytophilum among habitats(χ2=7.596,P=0.027);however,no significant differences in the positivity rates of other pathogens were found among rodent species,regions,altitudes,habitats,and sexes(P>0.05).Thus,rodent species were abundant in the high-altitude areas of western Sichuan and carried a variety of pathogens.Multiple pathogens showed compound infections,among which the positivity rate of Bartonella was relatively high.The total infection rate of pathogens in living areas was relatively high,and the risk of pathogenesis to the population is greater.Therefore,rodent control and disease monitoring efforts should be strengthened.

Based on the Political Economic Social Technological(PEST)-Strengths Weakness Opportunity Threats(SWOT)model,by sorting out the macro-environmental factors such as politics,economy,society and technology,and combining the internal strengths and weaknesses of the hospital as well as the external opportunities and threats,it puts forward the strategies to optimize the comprehensive budget management.It is found that hospitals face problems in total budget management such as disconnection between budgeting and strategy,and low level of informatization,but they also have advantages such as resource optimization and support for decision-making.The external environment provides opportunities such as health insurance reform and financing channel expansion,while there are threats such as industry competition and data security.It is suggested to improve the budget management level and promote the high-quality development of hospitals by expanding funding sources,strengthening cost control,and promoting the integration of industry and finance.

During the 14th Five-Year Plan period, the population of China has turned into a stage of negative growth, the fertility rate gradually declined, and the infertility rate gradually increased. The most effective treatment for infertility is assisted reproductive technology (ART), which has brought hope for fertility to many patients. However, the current promotion of the utilization of ART is still fraught with many obstacles. In this context, focusing on the realistic challenges of ART on its development in China, we will take a problem-oriented approach, utilize the relevant policies of ART in foreign countries as references, and put forward policy recommendations for the further implementation of ART, such as coordinating the balanced distribution of ART resources in the region, strengthening policy safeguards for ART, enhancing the institutional functioning of professional associations in medical ethics, and standardizing the application of ART treatments.

Objective The purpose of this study is to screen the key genes and clinical characteristics related to the death or prognosis of lung adenocarcinoma(LUAD)patients based on the cancer genome atlas(TCGA)database,then construct and verify the effect of LUAD risk prediction model.Methods Clinical information and RNA sequencing data of lung adenocarcinoma patients were extracted from TCGA database.The deferentially expressed genes were screened,and hub genes were selected by protein interaction(PPI)network.70%of the data was used as the training set,and the entire data set was used as the validation set.In the training set,elastic net regression analysis was used to select prognostic genes and clinical characteristics,and Cox multivariate regression analysis was used to build a risk prediction model.The predictive performance of the model was evaluated by the area under the receiver's operating characteristic curve(AUC),C－index,and calibration curve.And the effect of the model was verified in the validation set.Results Elastic net regression analysis identified 23 factors associated with the survival status of LUAD patients.The variables that finally included in the predictive model include 6 genes(SEC61A1(P＝0.004),MAP2K1(P＝0.026),MMP1(P＝0.001),SLC2A1(P＝0.010),B4GALT1(P<0.001),ERO1A(P＝0.024)),and M stage(P＝0.003),N stage(P<0.001).In training set and test set,AUC was 0.764 and 0.710,C－ index was 0.732 and 0.704,respectively.The tdROC curve and calibration curve showed that the predicted values of the model were highly consistent with the actual observed values.The Kaplan－Meier survival curve showed that the survival time of patients in low－risk group was statistically significantly longer than that of those in high－risk group(P<0.05).Conclusion Low expression of 2 genes(SEC61A1,MAP2K1),high expression of 4 genes(MMP1,SLC2A1,B4GALT1 and ERO1A),and distant metastasis of the primary tumors and the deepening of lymph node metastasis resulted in a significantly shorter survival time in LUAD patients.The prognosis analysis model based on elastic network has satisfactory predictive ability,which can provide scientific basis for prediction of the death risk of LUAD.

Objective:To analyze the impact of stressful life events on the social activity participation of middle-aged and elderly adults in China, providing a scientific basis for improving their quality of life.Methods:This study was conducted in January 2024.Data were derived from the China health and retirement longitudinal study (CHARLS) conducted from 2011 to 2020. SPSS 25.0 software was used for statistical analysis.Ordered Logistic regression analysis was employed to explore the association between stressful life events experienced over the past decade and the level of social activity participation, with stratified analysis by age, gender, and place of residence.Results:A total of 10 838 middle-aged and elderly adults were included in this study. The proportions of individuals with no social activity participation, low social activity participation, and high social activity participation were 52.07%(5 643/10 838), 24.21%(2 624/10 838), and 23.72%(2 571/10 838), respectively. After adjusting for sociodemographic characteristics and health-related behaviors, individuals who experienced stressful life events were 15.2% less likely to participate in social activities compared to those who did not ( RR=0.848, 95% CI=0.786-0.915).Stratified analysis revealed that the decrease in the likelihood of social activity participation following stressful life events was significantly greater in urban residents than that in rural residents ( Pinteraction=0.004). Conclusion:Experiencing stressful life events over the past decade may reduce the level of social activity participation among middle-aged and elderly adults. It is recommended to strengthen psychological counseling for this population and encourage active social engagement.

The management of chronic diseases at the county-level faces the problems of low degree of standardized manage-ment,weak management capacity of chronic diseases at the grassroots level,and shedding management of chronic disease patients.The"county-level chronic disease management center"proposed in the"Thousand Counties Project"can promote the county-town-ship-village medical institutions to jointly provide integrated and continuous chronic disease management services for county resi-dents.The study conducted in-depth interviews and analyses on the construction of the centers in 10 county(district)hospitals.Con-clusion:Firstly,the construction of the centers is in its infancy,and the support of government investment,performance incen-tives,and informatization construction is insufficient;secondly,the service content of the current centers is not clear enough,and the collaborative management model of chronic diseases in counties and villages is not stable.Enlightenment:The county-level med-ical community has built an effective path for the centers and the construction of chronic disease management centers needs to be fur-ther strengthened in terms of finance,medical insurance,interest mechanism,informatization construction and awareness of chronic diseases.

Objective:Time trade-off was employed to measure health state utilities associated with treatment attributes of hemophilia A patients to provide parameters for economic evaluations.Methods:Patients were recruited through patient organization and blood center of Shandong to measure health state utility values for 10 health states.Results:The utility values of preventive treatments for severe,moderate,and mild hemophilia A were 0.644,0.738,and 0.815,respectively.Compared with injections at 2-day intervals,the utility values were increased by 0.044 and 0.092 at 3-and 4-day intervals,respectively.Taking"severe hemophilia A patients injected every 2 days"as the base state,the disutility values for spontaneous bleeding and traumatic bleeding were 0.226 and 0.172.The disutility values for mild,moderate,and severe bleeding were 0.052,0.159,and 0.476,respectively,and the magnitude of the decrease gradually increased.Conclusion:Treatment attributes have an impact on patient preferences and more attention should be paid in pharmacoeconomic evaluations.