Background With China's socio-economic development, the dietary structure of Chinese residents has gradually shifted from a traditional Eastern pattern characterized by high carbohydrate intake to a relatively high-fat Western dietary model, alongside a growing burden of chronic diseases. However, dietary changes may vary across different occupational groups. Objective To analyze the long-term trends in dietary energy and three major macronutrient intake among various occupational groups aged 18-59 years in nine provinces of China from 1989 to 2018, providing a scientific basis for developing occupation-specific dietary intervention strategies. Methods Based on 11 waves of data (1989–2018) from the China Health and Nutrition Survey (CHNS), 57458 employed individuals aged 18-59 years were selected as observation subjects after applying inclusion and exclusion criteria. Joinpoint regression was used to analyze temporal trends by calculating the annual percentage change (APC) and average annual percentage change (AAPC) with 95% confidence intervals. The analysis covered the energy supply ratio from the three major macronutrients and the proportion of the participants within the acceptable macronutrient distribution ranges (AMDR) for the total occupational population and specific occupational group. Results From 1989 to 2018, the dietary structure of the occupational population in the nine provinces gradually Westernized. The carbohydrate energy supply ratio showed a decreasing trend (AAPC=−0.77%, 95%CI: −1.00%, −0.55%, P<0.05), while the fat energy supply ratio increased (AAPC=1.42%, 95%CI: 1.07%, 1.77%, P<0.05). The protein energy supply ratio remained largely unchanged (AAPC=−0.19%, 95%CI: −0.08%, 0.46%, P>0.05), and the total energy intake declined (AAPC=−0.62%, 95%CI: −0.94%, −0.30%, P<0.05). Among the occupational groups studied, white-collar workers were the first to show characteristics of dietary Westernization. Using the AMDR as the criterion, their average fat energy supply ratio first exceeded the AMDR upper limit (30%) in 1993, and their average carbohydrate energy supply ratio first fell below the AMDR lower limit (50%) in 2006, both time points being earlier than other occupational groups. Agricultural workers lagged in this transition (their average fat energy supply ratio first reached ≥30% in 2011), but their rate of increase in the fat energy supply ratio was the fastest among all occupational groups (AAPC=1.59%, 95%CI: 0.90%, 2.30%, P<0.05; P for trend comparison between groups<0.05). The other three occupational groups (blue-collar workers, service workers, and others) generally fell between these two extremes. Taking the fat energy supply ratio as an example, their AAPCs of increase were 1.02% (95%CI: 0.73%, 1.32%, P<0.05) for blue-collar workers, 0.85% (95%CI: 0.61%, 1.09%, P<0.05) for service workers, and 0.88% (95%CI: 0.58%, 1.17%, P<0.05) for others. Conclusion From 1989 to 2018, the macronutrient structure of the occupational population aged 18-59 years in nine China provinces is gradually Westernized. The energy supply ratios of carbohydrates and proteins primarily face issues of potential inadequacy, while the fat energy supply ratio is excessively high. Furthermore, the patterns of change vary among different occupational groups. It is recommended to propose personalized dietary advice tailored to specific occupations.

Climate change has evolved from an environmental issue into a global public health crisis, posing severe challenges to healthcare systems. Issues such as shifts in patient disease patterns, increased care demands for vulnerable populations, and insufficient resilience in nursing systems are becoming increasingly prominent. As the frontline of healthcare delivery, nursing practice directly confronts multiple health risks triggered by climate change. Under the Healthy China 2030 strategy, the role of nursing in addressing climate change cannot be overlooked. Therefore, this paper systematically reviewed the impacts of climate change on nursing practice and corresponding domestic and international strategies, and proposed recommendations for localized development pathways. First, strengthen climate health literacy in nursing education by integrating the climate change system into curricula and clinical practice. Second, promote nursing policy participation in global health governance to establish a climate-adaptive nursing policy system with Chinese characteristics. Finally, establish a multidisciplinary nursing research framework to foster integration among nursing science, climate science, public health, traditional Chinese medicine, and other relevant fields. This paper aims to provide theoretical foundations for constructing a climate-adaptive nursing system with Chinese characteristics, thereby advancing the coordinated development of Healthy China initiative and climate governance.

ObjectiveTo investigate the epidemic trends, key populations, and high-risk area characteristics of hand-foot-mouth disease (HFMD) in Ningbo from 2018 to 2023, and to provide evidence-based references for optimizing prevention strategies and precise allocation of prevention and control resources. MethodsData on HFMD cases with current addresses in Ningbo from 2018 to 2023 were collected from the China Information System for Disease Control and Prevention. Descriptive epidemiological methods were used to analyze the epidemiological characteristics of HFMD. Global spatial autocorrelation analyses were applied to detect spatial clustering of HFMD, and spatiotemporal scan analyses were conducted to identify spatiotemporal clusters. ResultsA total of 116 967 HFMD cases, were reported of which 2 were severe and none were fatal. The average annual incidence rate was 206.33 per 100 000 population, showing an overall declining trend. Seasonal patterns were observed, with bimodal distributions in 2018, 2019, 2021, and 2022 (main peak from May to July; secondary peak from September to November), and unimodal distributions in 2020 (peak from October to December) and 2023 (peak from July to October). Children aged 5 years and under accounted for the majority of cases (104 634 cases, 89.46%), with a mean age of (3.48±3.29) years. The male-to-female ratio was 1.44∶1. Children cared for at home (56.39%) and those attending kindergarten (35.97%) were the predominant populations. The highest average incidence rate was observed in Ninghai County (261.46/100 000), and the lowest in Fenghua District (152.46/100 000), while the average incidence rates in most districts/counties ranged from 188.22 to 226.53 per 100 000 population. The highest incidence rate was observed in areas classified as urban-rural fringes (240.08 per 100 000 population). Spatial analyses revealed global clustering in 2020 (Moran’s I=0.35, P<0.05), with hotspots concentrated in Ninghai county and Xiangshan county. Spatiotemporal scan analyses identified significant clusters each year from 2018 to 2023. The strongest cluster was detected in Cixi City from May to September in 2018 (LLR=27 249.53, RR=13.06, P<0.01), followed by Yinzhou District from April to October in 2019 (LLR=25 172.16, RR=10.61, P<0.01). ConclusionThe overall incidence of HFMD in Ningbo City shows a declining trend. The disease shows bimodal (spring-summer and autumn-winter) or unimodal (autumn-winter) seasonal patterns. Cases are predominantly seen in boys aged 5 years and under, and who are cared for at home or attend kindergarten、 High-risk areas are concentrated in southern counties (Ninghai and Xiangshan). It is recommended to strengthen health education and vaccination coverage for children aged 5 years and under, and to implement dynamic surveillance and targeted interventions in key areas during high-incidence seasons, so as to reduce transmission and spread.

Objective:To construct and validate a predictive model for postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic urological surgery.Methods:This retrospective study included the medical records of 932 patients who underwent robot-assisted laparoscopic urological surgery at the First Affiliated Hospital of Zhejiang University School of Medicine from January 2020 to February 2022. The patients were divided into a training group ( n=559) and a validation group ( n=373) at a 6∶4 ratio. Logistic regression analysis was used to determine the independent risk factors for PPCs, and a nomogram prediction model was constructed based on these factors. The performance of the model was evaluated using the receiver operating characteristic curve and calibration curve, and the clinical benefit was assessed using the clinical decision curve analysis. Results:The independent risk factors for PPCs included advanced age (>60 yr), smoking history, respiratory tract infection within 1 month, preoperative low SpO 2 (<96%), and prolonged length of postoperative hospital stay ( P<0.05), and the body mass index (18.5-<28.0 kg/m 2) was a protective factor. The nomogram prediction model developed based on the aforementioned 6 influencing factors had an area under the receiver operating characteristic curve of 0.81 (95% confidence interval 0.76-0.86) in training group and 0.80 (95% confidence interval 0.75-0.86) in validation group. The calibration curve indicated a good consistency between the predicted and actual occurrence curves, and the clinical decision curve analysis showed good accuracy and net benefit of the prediction model. Conclusions:The predictive model for PPCs is successfully constructed based on age, low body mass index, smoking history, history of respiratory tract infection within 1 month, preoperative low SpO 2 and prolonged length of postoperative hospital stay and has good predictive performance in patients undergoing robot-assisted laparoscopic urological surgery.

Objective:To comprehensively evaluate the cost and cost-effectiveness of the colorectal cancer screening program for key populations in Zhejiang Province from 2020 to 2022, and provide reference for optimizing colorectal cancer screening strategies.Methods:Based on the colorectal cancer screening program for key populations in Zhejiang Province from 2020 to 2022, parameters such as initial screening positivity rates, colonoscopy compliance rates, and detection rates for colorectal-related lesions among residents aged 50-74 were obtained. Questionnaire surveys assessed program costs and direct medical costs associated with colorectal cancer-related lesions. From a health system perspective, the cost-effectiveness ratio was calculated using the Early Detection Cost Index (EDCI) and the cost per detected case, followed by sensitivity analysis.Results:A total of 5 881 364 screenings were completed from 2020 to 2022. The initial screening positive rate (positive for either questionnaire or fecal immunochemical testing ) was 16.83%, with a colonoscopy compliance rates of 33.96% ( n=336 150). Detection rates for non-advanced adenomas, advanced adenomas, and colorectal cancer were 24.83% ( n=83 453), 11.91% ( n=40 033), and 1.01% ( n=3 397), respectively. Initial screening positivity rates and detection rates increased with age, while colonoscopy compliance rates decreased with age. Cost analysis showed a total project investment of 378 730 457 yuan, with initial screening costing 146 633 103 yuan (38.72%) and diagnostic colonoscopy 232 097 354 yuan (61.28%). The average cost per initial screening and diagnostic colonoscopy was 24.93 and 690.46 yuan, respectively. Direct medical costs for non-advanced adenomas, advanced adenomas, and colorectal cancer at stages Ⅰ, Ⅱ, Ⅲ, and Ⅳ were 4 921, 8 380, 42 547, 62 156, 66 720, and 72 334 yuan, respectively. Cost-effectiveness analysis indicated that screening needed to detect one case of colorectal cancer required 1 731 people and cost 111 490 yuan; the cost per detected advanced adenoma was 9 460 yuan, and the EDCI was 0.09. Costs decreased with increasing age per detected colorectal lesion. Sensitivity analysis showed that increasing colonoscopy compliance could reduce the cost-effectiveness ratio. Conclusions:The colorectal cancer screening program for key populations in Zhejiang Province demonstrates cost-effectiveness. Improving colonoscopy compliance can enhance overall screening effectiveness and economic benefits.

Objective To evaluate the frailty status and risk factors among hospitalized elderly patients after percutaneous coronary intervention(PCI),and to provide a reference for improving and delaying their frailty.Methods From March to August 2024,using convenience sampling,patients aged over 75 years who underwent PCI in a tertiary cardiovascular disease specialist hospital in Beijing were selected as the survey participants.Patient-related informations were collected through a self-designed general information questionnaire.The Fried Phenotype Frailty Scale,the Katz Activities of Daily Living,Lawton Instrumental Activities of Daily Living(IADL)scale,the Charlson Comorbidity Index,the Morse Fall Scale,the Mini Nutritional Assessment-Short Form(MNA-SF),and the 15-item Geriatric Depression Scale(GDS-15)were evaluated postoperatively until discharge.Univariate and multivariate logistic analyses were conducted to identify factors associated with frailty among patients after PCI.Results A total of 278 patients were included.The incidence of frailty after PCI was 52.16％.Based on Fried Phenotype scores,patients were divided into a non-frail group and a frail group.Univariate analysis showed statistically significant differences between the 2 groups in terms of age,gender,hemoglobin,NT-ProBNP,LVEF,IADL scores,living alone status,nutrition status,falls risk,and depression level(P＜0.05).Multivariate logistic regression analysis revealed that age,Lawton IADL scores,falls risk,nutrition status,depression level were factors influencing frailty,with odds ratios of 1.167,0.575,1.597,0.399,and 3.610,respectively(P＜0.05).Conclusion The incidence of frailty is high among patients aged over 75 years after PCI,and there are multiple risk factors affecting their frailty status.Clinical healthcare providers should prioritize long-term management of these patients and implement comprehensive interventions with the consideration of their physiological,psychological,and social conditions.

Objective:To investigate the views of doctors on the incidence and treatment tactics of mild progression after epithelial growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)treatment in lung adenocarcinoma and provide suggestions to optimize the counter-measure strategies.Methods:Convenience sampling was used to conduct an online questionnaire survey for doctors specializing in onco-logy and respiratory diseases.Results:584 valid questionnaires were collected,and all the doctors expressed concerns regarding mild tumor progression after EGFR-TKI treatment.The coping strategies included maintaining the original TKI treatment,adding other treatments to the original TKI,changing the regimen,and performing secondary tissue biopsy,among which,most doctors chose to add other treatments to the original TKI.Conclusions:Doctors have noticed the enlargement of target lesions in still stable disease(SD)and most frequently chose to add other treatments to the original TKI as a coping strategy.This finding can provide a reference for framing future guidelines for large sample prospective clinical studies that are needed to find the most effective synergistic treatment options.

Objective:To investigate clinical efficacy and safety of dupilumab in the treatment of moderate to severe atopic dermatitis (AD) complicated with asthma.Methods:A self-controlled study before and after treatment was conducted to retrospectively analyze 45 patients with moderate to severe atopic dermatitis combined with asthma who received dupilumab in the respiratory allergy clinic of North Theater Command General Hospital from January 2021 to May 2024, which age ≥12 years, including 27 males, 18 females. The treatment period was 4 to 12 months. All patients were treated with dupilumab combined with inhaled glucocorticoids and long-acting beta2-receptor agonists, as well as symptomatic drugs for atopic dermatitis. Analyze the clinical data of the patients before and after treatment, including lung function, asthma and AD-related assessment scales. Generalized estimation equation was used to analyze the simple effect of time on the repeated measurement data following non-normal distribution, and Wilcoxon signed rank test was used to compare the differences of each observation index before and after treatment.Results:Among 45 patients with moderate to severe atopic dermatitis complicated with asthma, after treatment with dupilumab, the FEV 1 increased from 2.39 (1.87, 2.83) L at baseline to 2.50 (1.84, 2.97) L 3 months after treatment ( Z=2.417, P=0.016), 2.60 (1.95, 3.14) L 6 months after treatment ( Z=2.896, P=0.004); the FEV 1pred% increased from 74.10% (67.70%, 78.75%) at baseline to 77.09% (68.40%, 80.24%) at 3 months after treatment ( Z=2.574, P=0.010), and 77.20% (71.10%, 80.72%) at 6 months after treatment ( Z=2.861, P=0.004). Meanwhile, there were statistically significant differences in the ACT and Mini-AQLQ scales at 3, 6, and 12 months after treatment compared with those before treatment (ACT score Z=3.170, 4.216, 5.723; Mini-AQLQ score Z=3.231, 4.133, 5.826; all P<0.05). The EASI scale decreased from baseline 25.90 (18.95, 33.45) to 6.20 (1.15, 8.35) at 4 months after treatment ( Z=5.842, P<0.05) and 4.90 (2.75, 8.35) at 6 months after treatment ( Z=5.841, P<0.05), 4.00 (3.15, 5.05) at 12 months after treatment ( Z=5.841, P<0.05); The scores of each scale of IGA, NRS and DLQI decreased significantly compared with the baseline after 4 months, 6 months and 12 months of treatment, and this trend became more obvious with the extension of treatment time. The differences were statistically significant (IGA score Z=6.247, 6.070, 5.946; NRS score Z=5.960, 5.893, 5.879; DLQI score Z=5.880, 5.850, 5.848; all P<0.05). During treatment, 1 patient had local adverse reactions at the injection site and 1 patient had conjunctivitis. Conclusion:Dupilumab may have a positive effect on improving the clinical efficacy of patients with moderate to severe atopic dermatitis complicated with asthma. During the 12-month observation period, this biological agent generally demonstrated good safety characteristics.

[Purpose]To analyze the incidence and mortality of lung cancer in Zhejiang cancer regi-stration areas in 2021 and trends from 2000 to 2021.[Methods]Using data from Zhejiang cancer registration areas from 2000 to 2021,the crude rate,age-standardized rate by Chinese standard population(ASRC)and the world standard population(ASRW),and composition ratio were calcu-lated to describe the incidence and mortality in 2021.Joinpoint regression was employed to ana-lyze temporal trends over the 22 years,calculating the annual percentage change(APC),average annual percentage change(AAPC),and their 95％confidence intervals(CI).[Results]The crude incidence rate of lung cancer in 2021 was 128.58/105,with an ASRC of 68.74/105,ac-counting for 24.22％of all cancers;the crude mortality rate was 51.55/105,with an ASRC of 21.58/105,constituting 27.98％of all cancer deaths.Both crude incidence rate(AAPC=5.73％,P＜0.001)and ASIRC(AAPC=4.14％,P＜0.001)of lung cancer showed significant increasing trends from 2000 to 2021.The crude mortality rate increased slowly(AAPC=1.76％,P＜0.001),while the ASMRC(AAPC=-0.40％,P=0.035)exhibited a modest decline.The increase in incidence was more pronounced in females than males,though no statistically significant difference was observed in mortality trends.The incidence rates in urban and rural areas showed similar growth trends;the crude mortality rate in rural areas was growing significantly faster than that in urban areas,and the decline in the ASRC was only statistically significant in urban areas.The incidence rate was in-creasing in all age groups.The mortality rate was declining among younger people(＜65 years old).The age group of 15～44 years old demonstrated a greater increase in incidence and a sharper decline in mortality than those aged 45 years old and above.[Conclusion]From 2000 to 2021,Zhejiang Province experienced a marked rise in lung cancer incidence with escalating disease burden.Despite severe population aging,ASRC of mortality declined steadily,reflecting effective prevention and control measures.

Objective It aims to establish data collection standards for the knowledge base of famous Traditional Chinese Medicine experts.Method A preliminary draft of the Data Collection Standards for the Knowledge Base of famous Traditional Chinese Medicine Experts was developed through literatureretrieval,expert interviews,and research group discussions.Two rounds of expert inquiries were conducted by Delphi method with 16 experts from disciplines such as medical informatics,library and information science,medical history and literature,and clinical Chinese medicine.It screened the core content through the Delphi method and formulated data collection standards.Result 59 articles were selected,and an expert inquiry form with 34 items was initially developed,including four aspects:data collection objects,data collection content,data collection and management,data collection principles and requirements.The positive coefficient of the two rounds of expert inquiry was 1,and the authoritative coefficient score was(0.94±0.06)points.The coefficient of variation of the two rounds of inquiry items were 0.113±0.043 and 0.069±0.041,respectively.The Kendall's Wcoefficients were 0.491 and 0.828,P＜0.01.Finally,a data collection standards for the knowledge base of famous Traditional Chinese Medicine experts with 31 items was formed.Conclusion The data collection content and standards of the famous doctors and experts knowledge base constructed by Delphi method have a high degree of expert recognition and consistency,which can provide standards and basis for the construction of the base in the future.