This study aimed to comprehensively examine the association of gallstones, cholecystectomy, and cancer risk. Multivariable logistic regressions were performed to estimate the observational associations of gallstones and cholecystectomy with cancer risk, using data from a nationwide cohort involving 239 799 participants. General and gender-specific two-sample Mendelian randomization (MR) analysis was further conducted to assess the causalities of the observed associations. Observationally, a history of gallstones without cholecystectomy was associated with a high risk of stomach cancer (adjusted odds ratio (aOR)=2.54, 95% confidence interval (CI) 1.50-4.28), liver and bile duct cancer (aOR=2.46, 95% CI 1.17-5.16), kidney cancer (aOR=2.04, 95% CI 1.05-3.94), and bladder cancer (aOR=2.23, 95% CI 1.01-5.13) in the general population, as well as cervical cancer (aOR=1.69, 95% CI 1.12-2.56) in women. Moreover, cholecystectomy was associated with high odds of stomach cancer (aOR=2.41, 95% CI 1.29-4.49), colorectal cancer (aOR=1.83, 95% CI 1.18-2.85), and cancer of liver and bile duct (aOR=2.58, 95% CI 1.11-6.02). MR analysis only supported the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer. This study added evidence to the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer, highlighting the importance of cancer screening in individuals with gallstones.
Humans ; Mendelian Randomization Analysis ; Gallstones/complications* ; Female ; Male ; Cholecystectomy/statistics & numerical data* ; Middle Aged ; Risk Factors ; Aged ; Adult ; Neoplasms/etiology* ; Stomach Neoplasms/epidemiology*

Objective:To analyze the latent profile characteristics of self-management ability in patients with metabolic-associated fatty liver disease (MAFLD) and explore its influencing factors.Methods:This was a cross-sectional study. A total of 311 patients with metabolic-associated fatty liver disease (MAFLD) were selected from the First Affiliated Hospital of Sun Yat-sen University (including those receiving treatment and undergoing physical examinations) between August and October 2024. Data were collected using a general information questionnaire, the self-management Scale for Patients with Non-Alcoholic Fatty Liver Disease, and the Social Support Rating Scale. After excluding 51 patients due to incomplete questionnaire responses or logical inconsistencies, 260 patients were finally included in the analysis. Latent profile analysis was used to identify potential categories of patients′ self-management abilities. With the latent categories as the dependent variable and items with P<0.05 in univariate analysis as independent variables, a multivariate logistic regression analysis (with the "poor self-management group" as the reference group) was performed to explore the influencing factors. Results:Among the 260 participants included in the study, three potential categories of self-management behaviors were finally identified, namely the active self-management group with 106 cases (40.8%), the moderate self-management group with 118 cases (45.4%), and the passive self-management group with 36 cases (13.8%).Results of multivariate logistic regression analysis showed that, compared with the passive self-management group:Patients who resided in rural areas ( OR=0.130, 95% CI: 0.040-0.420), often stayed up late ( OR=0.200, 95% CI: 0.060-0.590), or had an average daily sleep duration of≤5 hours ( OR=0.160, 95% CI: 0.050-0.510) had a significantly lower probability of belonging to the "active self-management group";In contrast, patients with an education level of senior high school or above ( OR=7.530, 95% CI: 1.740-34.160) or a higher total score of social support ( OR=1.120, 95% CI: 1.030-1.210) had a significantly higher probability of being in the "active self-management group" (all P<0.05). Conclusion:There is heterogeneity in self-management ability among patients with metabolic associated fatty liver disease (MAFLD). Residential area, educational level, frequency of staying up late, average daily sleep duration, and social support are influencing factors of patients′ self-management ability.

Objective To explore the effect of stratified out-of-hospital health management led by case health manager on the health behaviour ability of the patients with chronic diseases.Methods A convenience sampling method was employed to select 481 patients with chronic diseases who underwent physical examinations at outpatient department of a Tier-IIIA hospital from April 2022 to April 2023.A health management team led by case health managers conducted questionnaire survey to investigate the individual characteristics of the patients,established personal record based on the physical examination,and implemented stratified out-of-hospital health management for the patients.The intervention lasted for 12 months.The health behaviour ability and chronic disease self-management efficacy of the patients before and after the intervention were compared with.Results After the case manager-led stratified out-of-hospital health management,the health behaviour ability of patients with chronic diseases was stronger than that before the implementation,the self-management efficacy of chronic diseases was better than that before the implementation,and the patients'satisfaction was higher than that before the implementation(all P<0.001).Conclusion Stratified out-of-hospital health management led by a case health manager can improve the health behaviour ability and self-management efficacy of the patient with chronic diseases,thereby improve the patients'satisfaction.

Objective To study the effect of incorporating comprehensive geriatric assessment(CGA)into the whole-process WeChat-based case health management in elderly population who took annual physical examinations,thereby to improve their ability in health self-management.Methods A randomised controlled trial was conducted to select 100 elderly people who took annual physical examinations in our hospital from July 2022 to June 2023.The elderly were randomly divided into a control group and an trial group,with 50 people per group.CGA was applied to both groups,but the control group was under conventional health management,while the trial group received the incorporation of CGA into a whole-process WeChat-based case health management.The self-rated abilities for health practices scale(SRAHP)was used to compare the scores between the two groups before intervention,at 3,6 and 12 months after intervention.The scores of fatigue,resistance,ambulation,illnesses&loss of weight scale(FRAIL)and the mini nutritional assessment-short form(MNA-SF)were compared between the two groups before intervention and at 12 months after intervention.Incidence of falls was also evaluated after intervention.Results All the participants completed the study.Repeated measures analysis of variance showed that total SRAHP scores had statistical significances in main effect on time,group and interaction(Ftime=193.451,P<0.001;Fgroup=23.661,P<0.001;Finteraction=29.970,P<0.001).Further analysis revealed that the elderly in trial group had higher total scores in SRAHP than those in the control group at 6 and 12 months after intervention(both P<0.001).At 12 months after intervention,the trial group showed better scores in FRAIL and MNA-SF than the control group(both P<0.05)as well as with a lower incidence of falls(P<0.05).Conclusion Incorporation of CGA into a comprehensive WeChat-based case health management,over a long-term,can effectively enhance the ability in health self-management among elderly individuals who take annual health examinations,improve frailty and nutritional status and reduce the incidence of falls.The health self-management discovered from this study provides a valuable reference for health management among the elderly people who take annual physical examinations.

Objective To study the effect of incorporating comprehensive geriatric assessment(CGA)into the whole-process WeChat-based case health management in elderly population who took annual physical examinations,thereby to improve their ability in health self-management.Methods A randomised controlled trial was conducted to select 100 elderly people who took annual physical examinations in our hospital from July 2022 to June 2023.The elderly were randomly divided into a control group and an trial group,with 50 people per group.CGA was applied to both groups,but the control group was under conventional health management,while the trial group received the incorporation of CGA into a whole-process WeChat-based case health management.The self-rated abilities for health practices scale(SRAHP)was used to compare the scores between the two groups before intervention,at 3,6 and 12 months after intervention.The scores of fatigue,resistance,ambulation,illnesses&loss of weight scale(FRAIL)and the mini nutritional assessment-short form(MNA-SF)were compared between the two groups before intervention and at 12 months after intervention.Incidence of falls was also evaluated after intervention.Results All the participants completed the study.Repeated measures analysis of variance showed that total SRAHP scores had statistical significances in main effect on time,group and interaction(Ftime=193.451,P<0.001;Fgroup=23.661,P<0.001;Finteraction=29.970,P<0.001).Further analysis revealed that the elderly in trial group had higher total scores in SRAHP than those in the control group at 6 and 12 months after intervention(both P<0.001).At 12 months after intervention,the trial group showed better scores in FRAIL and MNA-SF than the control group(both P<0.05)as well as with a lower incidence of falls(P<0.05).Conclusion Incorporation of CGA into a comprehensive WeChat-based case health management,over a long-term,can effectively enhance the ability in health self-management among elderly individuals who take annual health examinations,improve frailty and nutritional status and reduce the incidence of falls.The health self-management discovered from this study provides a valuable reference for health management among the elderly people who take annual physical examinations.

Objective To explore the effect of stratified out-of-hospital health management led by case health manager on the health behaviour ability of the patients with chronic diseases.Methods A convenience sampling method was employed to select 481 patients with chronic diseases who underwent physical examinations at outpatient department of a Tier-IIIA hospital from April 2022 to April 2023.A health management team led by case health managers conducted questionnaire survey to investigate the individual characteristics of the patients,established personal record based on the physical examination,and implemented stratified out-of-hospital health management for the patients.The intervention lasted for 12 months.The health behaviour ability and chronic disease self-management efficacy of the patients before and after the intervention were compared with.Results After the case manager-led stratified out-of-hospital health management,the health behaviour ability of patients with chronic diseases was stronger than that before the implementation,the self-management efficacy of chronic diseases was better than that before the implementation,and the patients'satisfaction was higher than that before the implementation(all P<0.001).Conclusion Stratified out-of-hospital health management led by a case health manager can improve the health behaviour ability and self-management efficacy of the patient with chronic diseases,thereby improve the patients'satisfaction.

Objective:To analyze the latent profile characteristics of self-management ability in patients with metabolic-associated fatty liver disease (MAFLD) and explore its influencing factors.Methods:This was a cross-sectional study. A total of 311 patients with metabolic-associated fatty liver disease (MAFLD) were selected from the First Affiliated Hospital of Sun Yat-sen University (including those receiving treatment and undergoing physical examinations) between August and October 2024. Data were collected using a general information questionnaire, the self-management Scale for Patients with Non-Alcoholic Fatty Liver Disease, and the Social Support Rating Scale. After excluding 51 patients due to incomplete questionnaire responses or logical inconsistencies, 260 patients were finally included in the analysis. Latent profile analysis was used to identify potential categories of patients′ self-management abilities. With the latent categories as the dependent variable and items with P<0.05 in univariate analysis as independent variables, a multivariate logistic regression analysis (with the "poor self-management group" as the reference group) was performed to explore the influencing factors. Results:Among the 260 participants included in the study, three potential categories of self-management behaviors were finally identified, namely the active self-management group with 106 cases (40.8%), the moderate self-management group with 118 cases (45.4%), and the passive self-management group with 36 cases (13.8%).Results of multivariate logistic regression analysis showed that, compared with the passive self-management group:Patients who resided in rural areas ( OR=0.130, 95% CI: 0.040-0.420), often stayed up late ( OR=0.200, 95% CI: 0.060-0.590), or had an average daily sleep duration of≤5 hours ( OR=0.160, 95% CI: 0.050-0.510) had a significantly lower probability of belonging to the "active self-management group";In contrast, patients with an education level of senior high school or above ( OR=7.530, 95% CI: 1.740-34.160) or a higher total score of social support ( OR=1.120, 95% CI: 1.030-1.210) had a significantly higher probability of being in the "active self-management group" (all P<0.05). Conclusion:There is heterogeneity in self-management ability among patients with metabolic associated fatty liver disease (MAFLD). Residential area, educational level, frequency of staying up late, average daily sleep duration, and social support are influencing factors of patients′ self-management ability.

Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.