Objective: To assess the current status of knowledge, attitude, and practice (KAP) regarding health protection against air pollution among primary school students in China, and to analyze the impacts of fine particulate matter (PM 2.5 ) exposure, family, and individual factors on KAP levels, so as to provide empirical basis for implementing targeted interventions. Methods: Using stratified cluster random sampling method, a questionnaire survey was conducted among 19 297 primary school students from third to fifth grade across 30 provinces (autonomous regions and municipalities directly under the central government) in China in 2024. The questionnaire was developed based on the Technical Guidelines for the Assessment of Civic Environmental and Health Literacy (Trial), and encompasses three dimensions:knowledge, attitude, and practice. Spearman correlation analysis, Chi-square test, multivariate Logistic regression, and Bootstrap mediation effect test was applied for data analysis. Results: The overall mean KAP score for health protection against air pollution among primary school students was (79.73±13.53), with an adequacy rate of 80.47% ( n =15 528). The dimension scores for knowledge, attitude, and practice were (41.34±8.01, 16.43± 2.61 ), and (21.97±5.71), respectively. Knowledge was positively correlated with attitude and practice, and attitude was positively correlated with practice ( r =0.51, 0.35, 0.32, all P <0.01). Multivariate Logistic regression showed that the northeast region ( OR =2.36, 95% CI =2.02-2.75), having parents with a bachelor s degree or higher ( OR =4.76, 95% CI =2.71-8.37), living with both parents ( OR =1.33, 95% CI =1.15-1.55), being in the fifth grade ( OR =1.22, 95% CI =1.11-1.33), outdoor PM 2.5 level exceeding standard limits at the survey site ( OR =1.25, 95% CI =1.16-1.34), history of allergy ( OR =1.47, 95% CI =1.31-1.64), and wearing masks during heavily polluted weather ( OR =1.19, 95% CI =1.07-1.31) were promoting factors for KAP adequacy rate (all P <0.05). Conversely, obesity was a detrimental factor ( OR =0.78, 95% CI =0.69-0.88, all P <0.05). Conclusions Primary school students in China exhibit a favorable KAP level regarding health protection against air pollution, though regional, familial, and individual disparities persist. Exposure to PM 2.5 levels exceeding standard limits exerts a direct positive effect on enhancing health protection literacy. Future efforts should focus on the western region, families with lower educational attainment children to implement tailored, stratified interventions.

Objective:To evaluate the performance of three mainstream large language models (LLMs) in the review of drug reimbursement indications in hospitals, and to explore their potential in improving audit quality and efficiency, thereby safeguarding the medical insurance fund.Methods:A total of 3 247 outpatient prescription records were retrospectively collected from a specialized oncology hospital between January 2, 2022, and June 30, 2023. Manual assessment of the consistency between clinical diagnoses and drug reimbursement indications was used as the gold standard. Three LLMs, Baidu′s ERNIE Bot, Alibaba′s Tongyi Qianwen, and OpenAI′s ChatGPT-4o, were evaluated on the same task. Performance metrics included accuracy, precision, sensitivity, specificity, F1 score, and area under the curve (AUC).Results:The ERNIE Bot model returned 3 242 valid data, which took 314 min; The Tongyi Qianwen model returned a total of 3 162 valid data, taking 384 min; The ChatGPT-4o model returned a total of 3 218 valid data, taking 150 min. ChatGPT-4o demonstrated the best performance, with an accuracy of 88.41%, precision of 60.48%, sensitivity of 78.75%, specificity of 90.24%, F1 score of 0.68, and an AUC of 0.88.Conclusions:LLMs demonstrate stable performance in determining whether prescriptions align with reimbursement indications, with ChatGPT-4o approaching human-level accuracy and exhibiting more conservative specificity. These findings suggest that LLMs have practical value as auxiliary tools in drug indication reviews, contributing to improved audit efficiency and more refined management of medical insurance funds.

Objective To explore the establishment,implementation,and outcomes of an integrated physician-nurse team-based comprehensive management model for breast cancer chemotherapy outpatients,ai-ming to provide a reference for standardized patient care.Methods In January 2019,the Breast Surgery De-partment of Peking Union Medical College Hospital developed an integrated physician-nurse team and estab-lished a full-cycle management pathway covering the pre-chemotherapy,chemotherapy,and inter-cycle phases.This model featured appointment-based scheduling,time-segmented visits,and closed-loop patient management.Key performance indicators-including healthcare efficiency,chemotherapy safety,staffing ratios,and satisfaction levels among patients and healthcare providers-were compared between pre-implementation(2018)and post-imple-mentation(2019)periods.Results Before implementation,patient waited times ranged from 30 to 120(75.40±20.97)minutes,with an annual chemotherapy volume of 8 715 cases.Two ward nurses were routinely redeployed daily to support the chemotherapy clinic.Post-implementation,patients received timely chemotherapy per scheduled appointments without delays,annual chemotherapy volume in-creased to 10 101 cases,and staffing between two chemotherapy units became flexibly adjustable.Ward nurses transitioned from an on-call to a reserve role.Adverse events(chemotherapy-related,catheter-related,and nursing incidents)remained at 0,consistent with pre-implementation levels.Both patient and staff satisfaction scores significantly improved across all domains(all P＜0.05).Conclusions The integrated physician-nurse team-based chemotherapy management model enhances service efficiency,ensures treatment safety,optimizes workforce allocation,and improves satisfaction among patients and healthcare providers.

Objective:To establish 30-day of age transcutaneous bilirubin (TcB) reference curves for healthy neonates, and to investigate regional variations in bilirubin dynamics.Methods:A multicenter retrospective cohort study was conducted. A total of 220 950 healthy neonates born at a gestational age of 35-<42 weeks, with a birth weight ≥2 000 g, who did not receive phototherapy within 60 h after birth were recruited. All of them underwent remote TcB monitoring using the Bilibaby remote jaundice monitoring system between August 1 st, 2020 and December 31 st, 2024 in 426 hospitals. TcB data were collected within the period from birth to 30-day of age. The P40, P75, and P95 of TcB values were calculated, and dynamic TcB curves for 30-day of age were constructed. Patterns of bilirubin change, rates of change, and transition outcomes were described. Regional comparisons between South and North were conducted using linear mixed-effects models for TcB trajectories and Pearson′s chi-square test for outcome differences. Results:A total of 220 950 neonates were included, of whom 101 711 (46.03%) were female. Gestational age at birth was (38.75±1.12) weeks, and birth weight was (3 272±417) g. TcB levels increased rapidly within 3-day of age, peaked at 4-6-day of age, with peak values at P40, P75, and P95 of 200.6, 239.7 and 275.4 μmol/L (11.8, 14.1 and 16.2 mg/dl), respectively. TcB levels gradually declined thereafter and stabilized after 13-day of age, with values at P40, P75, and P95 fluctuating between 147.9-159.8, 190.4-200.6, and 231.2-239.7 μmol/L (8.7-9.4, 11.2-11.8, 13.6-14.1 mg/dl), respectively. Notably, among neonates categorized as low-or low-intermediate-risk within 3-day of age, 6 700 (12.76%) progressed to intermediate-high or high risk between 4 and 30 days of age. Before 13-day of age, TcB levels in the southern regions were consistently higher than those in the northern regions ( P=0.039); from 14 to 30 days of age, the overall TcB levels had no statistically difference, but the temporal changes in TcB still showed regional differences (degrees of freedom=3, all interaction P<0.05). Among neonates classified as low-or low-intermediate risk within 3-day of age, 25 326 were from southern regions, of whom 4 254 (16.80%) progressed to intermediate-high or high risk between 4 and 30 days of age. In northern regions, 27 193 neonates were classified as low-or low-intermediate risk within 3-day of age, among whom 2 446 (8.99%) progressed to intermediate-high or high risk. The risk progression between the 2 regions had statistically difference ( χ2=716.49, P<0.001). Conclusions:A TcB percentile curve for neonates within 30-day of age was established, revealing that both the overall TcB level and its temporal trend were higher in southern than in northern newborns. These findings provide baseline data to support continuous management of neonatal jaundice.

Objective:To evaluate the performance of three mainstream large language models (LLMs) in the review of drug reimbursement indications in hospitals, and to explore their potential in improving audit quality and efficiency, thereby safeguarding the medical insurance fund.Methods:A total of 3 247 outpatient prescription records were retrospectively collected from a specialized oncology hospital between January 2, 2022, and June 30, 2023. Manual assessment of the consistency between clinical diagnoses and drug reimbursement indications was used as the gold standard. Three LLMs, Baidu′s ERNIE Bot, Alibaba′s Tongyi Qianwen, and OpenAI′s ChatGPT-4o, were evaluated on the same task. Performance metrics included accuracy, precision, sensitivity, specificity, F1 score, and area under the curve (AUC).Results:The ERNIE Bot model returned 3 242 valid data, which took 314 min; The Tongyi Qianwen model returned a total of 3 162 valid data, taking 384 min; The ChatGPT-4o model returned a total of 3 218 valid data, taking 150 min. ChatGPT-4o demonstrated the best performance, with an accuracy of 88.41%, precision of 60.48%, sensitivity of 78.75%, specificity of 90.24%, F1 score of 0.68, and an AUC of 0.88.Conclusions:LLMs demonstrate stable performance in determining whether prescriptions align with reimbursement indications, with ChatGPT-4o approaching human-level accuracy and exhibiting more conservative specificity. These findings suggest that LLMs have practical value as auxiliary tools in drug indication reviews, contributing to improved audit efficiency and more refined management of medical insurance funds.

Objective:To analyze the epidemiological and clinical features of infectious diseases of the central nervous system (CNS).Methods:A cross-sectional study and analysis were conducted to summarize the epidemiological and clinical characteristics of 9 918 patients with CNS infectious diseases, who were diagnosed and treated at 29 hospitals across China from January 1, 2001 to December 31, 2020. Data collected included demographic data, clinical manifestations, health economic indicators, and prognostic outcomes.Results:Among the 9 918 collected cases of CNS infectious diseases, 5 559 were male (56.0%) and 4 359 were female (44.0%), with an onset age of 38 (25, 53) years. Education level: slightly more junior high school education (2 651 cases, 26.7%), and less elementary school education and below (2 181 cases, 22.0%) were found. Occupational distribution: farmers were found predominant (3 215 cases, 32.4%), followed by workers (1 826 cases, 18.4%) and students (1 633 cases, 16.5%). Clinical manifestations: headache (6 074 cases, 61.2%), fever (5 869 cases, 59.2%) and positive meningeal irritation signs (2 273 cases, 22.9%) were the 3 most common clinical manifestations, followed by nausea and (or) vomiting (2 095 cases, 21.1%), impaired consciousness (2 077 cases, 20.9%), psychiatric symptom (1 866 cases, 18.8%) and epilepsy (1 627 cases, 16.4%), etc., and cranial nerve involvement was found in 669 cases (6.7%). Major pathogens included viruses in 6 814 cases (68.7%), Mycobacterium tuberculosis in 1 677 cases (16.9%), common bacteria in 864 cases (8.7%), fungi in 254 cases (2.6%), spirochetes of syphilis in 183 cases (1.8%), parasites in 121 cases (1.2%), and rickettsiae in 5 cases (0.1%). Urban-rural distribution: slightly more cases were found in the countryside (5 418 cases, 54.6%) than in the towns (4 500 cases, 45.4%). Distribution of onset by season: 2 412 cases (24.3%) fell ill in spring, 2 835 cases (28.6%) in summer, 2 187 cases (22.1%) in fall, and 2 484 cases (25.0%) in winter. Health economics: the duration of hospitalization was 15 (8, 27) days, and the cost of hospitalization was 1.53 (0.91, 3.02)×10 000 yuan. Prognosis: 9 531 cases (96.1%) were cured or improved, and 92 cases (0.9%) died. Conclusions:The pathogens responsible for CNS infectious diseases are predominantly viruses. Although the incidence is slightly higher during the summer months, the overall seasonal pattern is not particularly pronounced. These infections are more commonly observed in young and middle-aged males and present with a diverse range of clinical manifestations, contributing to a significant disease burden.

Objective To investigate the cost and payment management of DRG group malignant tumor targeted therapy and immunotherapy(RG19)in medical institutions,and provide reference suggestions for further improving DRG related systems.Methods A questionnaire survey was conducted on clinical doctors and medical insurance staff from 96 comprehensive hospitals and oncology specialized hospitals in 22 DRG pilot cities in China.The questions included the hospital management of RG19 group,and special payment policies in different regions.Results A total of 148 valid questionnaires were collected.The survey results showed that 37％of hospitals in the RG19 group was in a loss state,mainly due to the use of innovative drugs and the high proportion of targeted therapy and immunotherapy combined cases.46％of respondents believed that the current payment standards for RG19 group did not fully reflect the value of doctor plan development,and the grouping rules needed to be further optimized.Factors such as line of treatment,and drug use types should be comprehensively considered.In addition,24％of hospitals RG19 group made profits due to the high proportion of clinical trial cases,but most regions did not have special policies for payment of clinical trial cases.Conclusion Medical institutions should further strengthen the management of hospital internal cost control for DRG patients,and regions should pay more attention to clinical practice in formulating DRG grouping rules and payment schemes.

Objective To investigate the cost and payment management of DRG group malignant tumor targeted therapy and immunotherapy(RG19)in medical institutions,and provide reference suggestions for further improving DRG related systems.Methods A questionnaire survey was conducted on clinical doctors and medical insurance staff from 96 comprehensive hospitals and oncology specialized hospitals in 22 DRG pilot cities in China.The questions included the hospital management of RG19 group,and special payment policies in different regions.Results A total of 148 valid questionnaires were collected.The survey results showed that 37％of hospitals in the RG19 group was in a loss state,mainly due to the use of innovative drugs and the high proportion of targeted therapy and immunotherapy combined cases.46％of respondents believed that the current payment standards for RG19 group did not fully reflect the value of doctor plan development,and the grouping rules needed to be further optimized.Factors such as line of treatment,and drug use types should be comprehensively considered.In addition,24％of hospitals RG19 group made profits due to the high proportion of clinical trial cases,but most regions did not have special policies for payment of clinical trial cases.Conclusion Medical institutions should further strengthen the management of hospital internal cost control for DRG patients,and regions should pay more attention to clinical practice in formulating DRG grouping rules and payment schemes.

Objective:To establish 30-day of age transcutaneous bilirubin (TcB) reference curves for healthy neonates, and to investigate regional variations in bilirubin dynamics.Methods:A multicenter retrospective cohort study was conducted. A total of 220 950 healthy neonates born at a gestational age of 35-<42 weeks, with a birth weight ≥2 000 g, who did not receive phototherapy within 60 h after birth were recruited. All of them underwent remote TcB monitoring using the Bilibaby remote jaundice monitoring system between August 1 st, 2020 and December 31 st, 2024 in 426 hospitals. TcB data were collected within the period from birth to 30-day of age. The P40, P75, and P95 of TcB values were calculated, and dynamic TcB curves for 30-day of age were constructed. Patterns of bilirubin change, rates of change, and transition outcomes were described. Regional comparisons between South and North were conducted using linear mixed-effects models for TcB trajectories and Pearson′s chi-square test for outcome differences. Results:A total of 220 950 neonates were included, of whom 101 711 (46.03%) were female. Gestational age at birth was (38.75±1.12) weeks, and birth weight was (3 272±417) g. TcB levels increased rapidly within 3-day of age, peaked at 4-6-day of age, with peak values at P40, P75, and P95 of 200.6, 239.7 and 275.4 μmol/L (11.8, 14.1 and 16.2 mg/dl), respectively. TcB levels gradually declined thereafter and stabilized after 13-day of age, with values at P40, P75, and P95 fluctuating between 147.9-159.8, 190.4-200.6, and 231.2-239.7 μmol/L (8.7-9.4, 11.2-11.8, 13.6-14.1 mg/dl), respectively. Notably, among neonates categorized as low-or low-intermediate-risk within 3-day of age, 6 700 (12.76%) progressed to intermediate-high or high risk between 4 and 30 days of age. Before 13-day of age, TcB levels in the southern regions were consistently higher than those in the northern regions ( P=0.039); from 14 to 30 days of age, the overall TcB levels had no statistically difference, but the temporal changes in TcB still showed regional differences (degrees of freedom=3, all interaction P<0.05). Among neonates classified as low-or low-intermediate risk within 3-day of age, 25 326 were from southern regions, of whom 4 254 (16.80%) progressed to intermediate-high or high risk between 4 and 30 days of age. In northern regions, 27 193 neonates were classified as low-or low-intermediate risk within 3-day of age, among whom 2 446 (8.99%) progressed to intermediate-high or high risk. The risk progression between the 2 regions had statistically difference ( χ2=716.49, P<0.001). Conclusions:A TcB percentile curve for neonates within 30-day of age was established, revealing that both the overall TcB level and its temporal trend were higher in southern than in northern newborns. These findings provide baseline data to support continuous management of neonatal jaundice.

The view of"inferior practitioner guarding the gate while the superior practitioner keeping the trigger"during the clinical practive was recorded in in Huang Di Nei Jing(Huangdi's Cannon of Medicine).This paper probes into the diagnosis and treatment of bi-syndrome from the perspecitve of"guarding the gate"and"keeping the trigger".It is proposed that the lesion of five body constituents(i.e.,skin,vessel,muscle,tendon,and bone)constitutes the injured"gate"of bi-syndrome,and the disharmony of qi and blood constitutes the"trigger"of the onset of bi-syndrome.The location of lesions will be found through examining the gate,and the state of qi and blood will be confirmed after checking the trigger.For the treatment of bi-syndrome,"guarding the gate"is to enable the normality of five body constituents,and"keeping the trigger"is to maintain the abundance and harmony movement of qi and blood,which cover the consideration of focal lesions and the regulation of holistic qi and blood."Guarding the gate"is as important as"keeping the trigger",and the two are interrelated.Only by carefully examining the gate of the lesions and strictly checking the trigger of qi-blood movement,it is possible to identify the deficiency of healthy qi and the excess of the pathogens,the nature of the pathogens and the severity of illness of bi-syndrome,and then the corresponding therapeutic methods can be performed to achieve the efficacy.The view of"guarding the gate"and"keeping the trigger"expands the clinical approach to the diagnosis and treatment of bi-syndrome.