ObjectiveTo evaluate the public health governance capacity in Jiangsu Province and provide an optimized pathway for the construction of a “strong, rich, beautiful, and high-quality” new Jiangsu. MethodsA total of 806 policy documents, 658 public information reports, and 148 research literatures related to public health governance capacity in Jiangsu Province from January 1995 to December 2023 were collected. The status of current public health goverance was assessed based on the evaluation criteria suitable for public health systems, and the strengths and the weaknesses of the system were identified. ResultsThe public health governance capability of Jiangsu Province was scored at 738.3 points, ranking 3rd nationally. Maternal health care and emergency response capacities achieved leading positions nationwide, both ranking 2nd. Jiangsu had exhibited a standardized guidance in the strategic level, a well-established management mechanism, an extensive coverage in information collection, and a scientifically established health targets setting. However, bottlenecks remained, including an unclear division of responsibilities across organizational departments, an insufficient public-health workforce, the absence of a stable growth mechanism for government funding investment, and difficulties in promptly identifying public needs. ConclusionJiangsu’s public-health system demonstrates leading nationally, yet several components remain underdeveloped. Future efforts should consolidate advantages while addressing weaknesses, further diversify content and forms, establish a stable funding increase mechanism, and clarify departmental functions, thereby providing solid health support for realizing the developmental goals of a “strong, rich, beautiful and high-quality” new Jiangsu.

ObjectiveTo systematically assess the public health governance capacity in Zhejiang Province, to conduct an in-depth analysis of its strengths and weaknesses, so as to provide scientific basis and strategic recommendations for further enhancement. MethodsA systematic collection of policy documents, public information reports, and research literature related to public health governance capacity in Zhejiang Province from 2002 to 2023 was conducted (encompassing a total of 1 263 policy documents, 138 pieces of information reports and 631 research articles). Based on the evaluation criteria suitable for public health systems previously developed by the research team, the basic status and magnitude of change in public health governance capacity in Zhejiang Province was evaluated. Additionally, normative gap analyses were employed to identify the strengths and weaknesses. ResultsZhejiang Province ranked 4th nationwide in terms of public health governance capacity with a score of 733.4 points (1 000.0-point maximum). The province has effectively implemented the principle of health first (scoring 698.5 points in the assessment of health-first strategy implementation) and attached sufficient importance to health-related goals (scoring 658.2 points in the scientific rationality of goal setting). However, the implementation of inter-departmental coordination and incentive mechanisms only scored 178.7 points, the feasibility of management and monitoring mechanisms scored even lower at only 144.0 points, and the coverage of incentive mechanisms scored 286.0 points. ConclusionZhejiang Province has effectively implemented its health first strategy and attached great importance to health targets, but still needs to strengthen cross-departmental coordination mechanisms and health-oriented incentives.

Objective To compare the efficacy and safety of different cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) combined with endocrine therapy (ET) for the treatment of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) advanced or metastatic breast cancer. Methods Randomized controlled trials (RCTs) on CDK4/6i for the treatment of HR+/HER2− metastatic or advanced breast cancer were retrieved from databases including PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP, and SinoMed, with the search period ranging from database inception to August 2023. Bayesian network meta-analysis was conducted using R 4.2.0 software. Results A total of 18 RCTs from 25 articles, involving 8 031 patients and 11 treatment regimens, were included. There was no significant difference in progression-free survival (PFS) or overall survival (OS) among different CDK4/6i+ET combinations. The highest cumulative probability for PFS was observed with dalpiciclib (DAL)+fulvestrant (FUL), while ribociclib (RIB)+FUL ranked first for OS. In terms of efficacy, abemaciclib (ABE)+aromatase inhibitors (AI) and ABE+FUL ranked first in objective response rate and clinical benefit rate, respectively. Regarding safety, statistically significant difference in grade 3-4 adverse events was observed among certain types of CDK4/6i (P<0.05). Conclusion Current evidence suggests that CDK4/6i+ET is superior to ET alone for the treatment of HR+/HER2− advanced/metastatic breast cancer. Different CDK4/6i+ET combinations demonstrate comparable or similar efficacy; however, the incidence of adverse reactions is higher with combination therapy. Treatment regimens should be selected based on individual conditions.

Objective To develop a toolkit suitable for assisting community health institutions in the early identification and inter-vention of mild cognitive impairment(MCI)among older adults.Methods A literature review was conducted to construct a draft of the identification and intervention toolkit.Tools with an expert approval rate above 70%were included after expert consultation.The final version of the toolkit was developed by integrating these tools with officially recommended tools in China.Results The expert consultation yielded an authority coefficient of 0.84.The finalized toolkit included the assessment tools of Mini-Mental State Examination,Montreal Cognitive Assessment,General Practitioner Assessment of Cognition,Cognitive Abilities Screening Instrument and Clock Drawing Test,and 18 intervention measures in-cluding pharmacological treatment,cognitive training and psychological interventions,etc.Conclusion The MCI Identification-Intervention Toolkit may serve as a reference for guiding the identification and inter-vention of MCI among older adults for community health institutions.

Objective To investigate the predictive value of plasma von Willebrand factor(VWF)antigen levels for the long-term prognosis of patients with acute myocardial infarction(AMI).Methods A total of 150 elderly patients diagnosed with AMI were selected and treated with percutaneous coronary intervention(PCI)at admission.The plasma VWF antigen level of the patients was detected within 24 hours after PCI.Patients were followed up for 12 months and were divided into the major adverse cardiac events(MACE)group and the non-MACE group according to the occurrence of MACE.The risk factors for MACE in AMI patients within 12 months were analyzed.The prognostic value of VWF antigen level in AMI patients were evaluated.The optimal cut-off value of plasma VWF antigen level was determined by receiver operating characteristic(ROC)curve.Patients were groups according to the optimal cut-off value.Kaplan-Meier curve was drawn to compare the occurrence of MACE in patients with different plasma VWF antigen levels.Results Among the 150 observed patients,7 patients were lost to follow-up,and eventually 143 patients were included.In 143 patients there were 53 patients(37.1%)in the MACE group and 90 cases(63.9%)in the non-MACE group.The age,B-type natriuretic peptide(BNP),D-dimer and VWF antigen levels were significantly higher in the MACE group than those in the non-MACE group.The results of the Cox proportional hazards model showed that age increase(HR=1.085,95%CI:1.014-1.160),increased plasma VWF antigen level(HR=1.030,95%CI:1.017-1.045)and increased BNP(HR=1.016,95%CI:1.004-1.027)were risk factors for elderly patients in the MACE group one year after surgery.The maximum approximately Youden index of plasma VWF antigen level for predicting MACE was 0.616,the optimal cut-off value was 162.5 μg/L,the sensitivity was 84.9%and the specificity was 76.7%.The results of survival analysis showed that the average time to MACE in the group with plasma VWF antigen≥162.5 μg/L was shorter than that in the group with plasma VWF antigen＜162.5 μg/L(7.7 months vs.11.6 months,Log-rank χ2=63.060,P＜0.001).Conclusion The increased plasma VWF antigen is an independent risk factor for AMI and can be used as a predictor of long-term prognosis in patients with AMI.

ObjectiveTo analyze the changes in the degree of coordination of China's major epidemic prevention and control efforts before and after the outbreak of the Corona Virus Disease 2019 (COVID-19), so as to explore the impact of epidemic prevention and control measures on coordination dynamics. MethodsA total of 3 864 policy documents related to epidemic prevention and control from January 2000 to December 2020 across 31 provinces (autonomous regions, and municipalities) in China were systematically collected. Contents specific to collaborative and cooperative efforts were extracted, and the extent of interdepartmental coordination were quantified to assess the effectiveness of epidemic prevention and control efforts. Wilcoxon signed-rank test was adopted to statistically analyze the differences between the indicators before and after the epidemic. ResultsThe average overall coordination level for major epidemic prevention and control in 31 provinces (autonomous regions, and municipalities) increased from 43.06% to 97.62%, and the average coordination levels in the eastern, central, and western China soared from 42.29%, 37.50%, and 47.46%, to 98.81%, 96.20%, and 97.46%, respectively, with statistically significant differences (all P<0.05). In terms of department categorization, coordination levels in the professional departments and the key support departments peaked at 100.00%, while other support departments rose to 95.43%, with an increase of 77.15%, 181.85%, and 139.89%, respectively, exhibiting noteworthy statistically significant differences (all P<0.001). ConclusionThe scope of coordination departments of China’s major epidemic prevention and control exists a remarkable surge following the COVID-19 outbreak, notable heightened coordination is particularly observed among the key support departments. Future endeavors should prioritize the roles played by diverse departments in epidemic prevention and control, enhancing both the clarity of departmental responsibilities and the effectiveness of interdepartmental coordination.

ObjectiveTo systematically evaluate the public health governance capacity of 40 cities in Jiangsu, Zhejiang, and Anhui Provinces, providing a scientific evaluation basis for building a "Healthy Yangtze River Delta". MethodsA comprehensive collection of policy documents, public information reports, and research literature related to public health governance capacity in Jiangsu, Zhejiang, and Anhui Provinces was conducted, totaling 6 920 policy documents, 1 720 information reports, and 1 200 literature pieces. Based on the evaluation standards for an appropriate public health system established by the research team, the basic status of public health governance capacity was assessed to identify the strengths and weaknesses of the 40 cities. ResultsIn 2022, the public health governance capacity score for the 40 cities in Jiangsu, Zhejiang, and Anhui Provinces was (562.5±38.0) points. In terms of specific areas, the emergency response field received the highest score of (791.4±49.7) points, while the chronic disease prevention and control field received the lowest score of (368.2±29.6) points. The Jiangsu-Zhejiang-Anhui region has largely achieved the strategic priority of health, gradually improved public health legal regulations, and established a basic organizational framework with a solid foundation for information and data infrastructure. However, challenges still need to be addressed, such as unstable government funding for public health, unclear departmental responsibilities, and barriers to information interoperability. ConclusionThe public health governance capacity of the 40 cities in Jiangsu, Zhejiang, and Anhui Province has been at a moderate level, but disparities have still existed across regions and fields. In the future, while continuing to deepen existing advantages, it is essential to accurately identify the causes of problems, establish a long-term and stable investment mechanism, enhance information connectivity mechanisms, further clarify departmental responsibilities, and promote the achievement of the "Healthy Yangtze River Delta" goal.

Objective To investigate the predictive value of plasma von Willebrand factor(VWF)antigen levels for the long-term prognosis of patients with acute myocardial infarction(AMI).Methods A total of 150 elderly patients diagnosed with AMI were selected and treated with percutaneous coronary intervention(PCI)at admission.The plasma VWF antigen level of the patients was detected within 24 hours after PCI.Patients were followed up for 12 months and were divided into the major adverse cardiac events(MACE)group and the non-MACE group according to the occurrence of MACE.The risk factors for MACE in AMI patients within 12 months were analyzed.The prognostic value of VWF antigen level in AMI patients were evaluated.The optimal cut-off value of plasma VWF antigen level was determined by receiver operating characteristic(ROC)curve.Patients were groups according to the optimal cut-off value.Kaplan-Meier curve was drawn to compare the occurrence of MACE in patients with different plasma VWF antigen levels.Results Among the 150 observed patients,7 patients were lost to follow-up,and eventually 143 patients were included.In 143 patients there were 53 patients(37.1%)in the MACE group and 90 cases(63.9%)in the non-MACE group.The age,B-type natriuretic peptide(BNP),D-dimer and VWF antigen levels were significantly higher in the MACE group than those in the non-MACE group.The results of the Cox proportional hazards model showed that age increase(HR=1.085,95%CI:1.014-1.160),increased plasma VWF antigen level(HR=1.030,95%CI:1.017-1.045)and increased BNP(HR=1.016,95%CI:1.004-1.027)were risk factors for elderly patients in the MACE group one year after surgery.The maximum approximately Youden index of plasma VWF antigen level for predicting MACE was 0.616,the optimal cut-off value was 162.5 μg/L,the sensitivity was 84.9%and the specificity was 76.7%.The results of survival analysis showed that the average time to MACE in the group with plasma VWF antigen≥162.5 μg/L was shorter than that in the group with plasma VWF antigen＜162.5 μg/L(7.7 months vs.11.6 months,Log-rank χ2=63.060,P＜0.001).Conclusion The increased plasma VWF antigen is an independent risk factor for AMI and can be used as a predictor of long-term prognosis in patients with AMI.

Objective:To explore the heterogeneity in the trajectories ofperinatal depressive symptoms and identify the related factors.Methods:A longitudinal follow-up study was conducted from January 2020 to June 2021.Baseline information,marriage satisfaction and social support status were collected at enrolment.Perinatal de-pressive symptoms were measured using the Edinburgh Postnatal Depression Scale(EPDS)at five time-points from second trimester to three-months postpartum.A Latent Class Growth Model(LCGM)was used to identify sub-groups of perinatal depressive symptoms trajectories and logistic regression was applied to examine associated risk and protective factors.Results:Two latent depression trajectory subgroups were identified A majority(72.2％,n=1 023)followed a curvilinear trajectory with low baseline scores that increased over time(curvilinear group),while 27.8％(n=393)maintained high,stable scores(linear group).Older age,higher marital satisfaction,and stronger social support were associated with a lower likelihood of belonging to the linear group(OR=0.96,0.94,0.89,re-spectively),while a personal or family history of depression increased this likelihood(OR=2.50,6.51).Conclusion:Trajectories of perinatal depressive symptoms vary significantly among individuals.The risk of persis-tent high-level symptoms is lowered by older age,stronger marital satisfaction,and greater social support,and heightened by a personal or family history of depression.

Objective:To explore the heterogeneity in the trajectories ofperinatal depressive symptoms and identify the related factors.Methods:A longitudinal follow-up study was conducted from January 2020 to June 2021.Baseline information,marriage satisfaction and social support status were collected at enrolment.Perinatal de-pressive symptoms were measured using the Edinburgh Postnatal Depression Scale(EPDS)at five time-points from second trimester to three-months postpartum.A Latent Class Growth Model(LCGM)was used to identify sub-groups of perinatal depressive symptoms trajectories and logistic regression was applied to examine associated risk and protective factors.Results:Two latent depression trajectory subgroups were identified A majority(72.2％,n=1 023)followed a curvilinear trajectory with low baseline scores that increased over time(curvilinear group),while 27.8％(n=393)maintained high,stable scores(linear group).Older age,higher marital satisfaction,and stronger social support were associated with a lower likelihood of belonging to the linear group(OR=0.96,0.94,0.89,re-spectively),while a personal or family history of depression increased this likelihood(OR=2.50,6.51).Conclusion:Trajectories of perinatal depressive symptoms vary significantly among individuals.The risk of persis-tent high-level symptoms is lowered by older age,stronger marital satisfaction,and greater social support,and heightened by a personal or family history of depression.