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: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 To analyze the service efficiency and changes of county-level public hospitals in Shandong Province from 2017 to 2023,and to provide references for improving the service efficiency of county-level public hospitals.Methods Based on the deta envelopment analysis method,BCC model was used to evaluate the static service efficiency of county-level public hospitals in 16 cities in Shandong Province in 2023,and to dynamically track the change trend of efficiency from 2017 to 2023 based on Malmquist index model.Results In 2023,the average comprehensive efficiency of county-level public hospitals in Shandong Province is 0.971,and the efficiency value of county-level public hospitals in 8 of the 16 cities is 1,which is in DEA effective state;From 2017 to 2023,the average total factor productivity of county-level public hospitals in Shandong Province was 0.906,with an overall decline of 9.4%in service efficiency.Conclusion The overall service efficiency of county-level public hospitals in Shandong Province is high,but regional differences are obvious,and the technical progress index is the key to further indicate the service efficiency.Local governments need to reasonably control the scale of county-level public hospitals,continuously improve their technical level,and strengthen their internal management,so as to improve their service efficiency.

OBJECTIVE To understand the prevalence of pathogens causing genital tract infections among the infer-tile patients so as to provide bases for clinical diagnosis,treatment and prevention.METHODS A total of 54,562 infertile patients who were treated in Reproductive Medicine Center of Tang Du Hospital of Air Force Medical University from Jul.2023 to Jan.2025 were enrolled in the study.The cervical swab samples were collect-ed from the female patients,and the urine samples were collected from the male patients.Chlamydia trachomatis(CT),Ureaplasma urealyticum(UU),Mycoplasma genitalium(MG)and Neisseria gonorrhoeae(NG)were tested by real-time fluorescent nucleic acid isothermal amplification for RNA.The statistical analysis was per-formed based on the gender,age and type of infection.RESULTS The total positive rates of UU,MG,CT and NG were 38.36％,2.85％,0.99％and 0.04％,respectively.The patients with CT plus MG infection were dominant a-mong the patients with mixed infections.The positive rates of UU and CT of the female patients were higher than those of the male patients(P＜0.001),while the positive rate of NG of the female patients was lower than that of the male patients(P=0.028).The patients aged more than 25 years old were susceptible to UU,with the positive rate highest among the patients aged between 35 and 40 years old.The patients aged less than 25 years old were dominant among the patients with MG and CT infections,and NG infection was more common among the patients aged between 25 and 35 years old.The positive rate of MG was higher among the patients aged less than 25 years old than among other age groups of patients(P＜0.005);the positive rate of MG was higher among the patients aged between 35 and 40 years old than among the patients aged between 30 and 35 years old(P＜0.005).The positive rate of CT was higher among the patients aged less than 25 years old than among all the age groups except for the 25 to 30 age group;the positive rate of CT of the patients aged no less than 40 years old was lower than that of the patients aged between 25 and 35 years old(P＜0.005).CONCLUSIONS UU is most common among the pathogens causing genital tract infections among the infertile patients.There are a variety of types of mixed infections.The female patients are more likely to have UU and CT infections,while the male patients are more likely to have NG infection.MG and CT infections shows a low-age trend.It is necessary to focus on the joint screening of multiple pathogens during the clinical diagnosis and treatment and strengthen the prevention and intervention to the susceptible population.

OBJECTIVE To understand the prevalence of pathogens causing genital tract infections among the infer-tile patients so as to provide bases for clinical diagnosis,treatment and prevention.METHODS A total of 54,562 infertile patients who were treated in Reproductive Medicine Center of Tang Du Hospital of Air Force Medical University from Jul.2023 to Jan.2025 were enrolled in the study.The cervical swab samples were collect-ed from the female patients,and the urine samples were collected from the male patients.Chlamydia trachomatis(CT),Ureaplasma urealyticum(UU),Mycoplasma genitalium(MG)and Neisseria gonorrhoeae(NG)were tested by real-time fluorescent nucleic acid isothermal amplification for RNA.The statistical analysis was per-formed based on the gender,age and type of infection.RESULTS The total positive rates of UU,MG,CT and NG were 38.36％,2.85％,0.99％and 0.04％,respectively.The patients with CT plus MG infection were dominant a-mong the patients with mixed infections.The positive rates of UU and CT of the female patients were higher than those of the male patients(P＜0.001),while the positive rate of NG of the female patients was lower than that of the male patients(P=0.028).The patients aged more than 25 years old were susceptible to UU,with the positive rate highest among the patients aged between 35 and 40 years old.The patients aged less than 25 years old were dominant among the patients with MG and CT infections,and NG infection was more common among the patients aged between 25 and 35 years old.The positive rate of MG was higher among the patients aged less than 25 years old than among other age groups of patients(P＜0.005);the positive rate of MG was higher among the patients aged between 35 and 40 years old than among the patients aged between 30 and 35 years old(P＜0.005).The positive rate of CT was higher among the patients aged less than 25 years old than among all the age groups except for the 25 to 30 age group;the positive rate of CT of the patients aged no less than 40 years old was lower than that of the patients aged between 25 and 35 years old(P＜0.005).CONCLUSIONS UU is most common among the pathogens causing genital tract infections among the infertile patients.There are a variety of types of mixed infections.The female patients are more likely to have UU and CT infections,while the male patients are more likely to have NG infection.MG and CT infections shows a low-age trend.It is necessary to focus on the joint screening of multiple pathogens during the clinical diagnosis and treatment and strengthen the prevention and intervention to the susceptible population.

Objective To analyze the service efficiency and changes of county-level public hospitals in Shandong Province from 2017 to 2023,and to provide references for improving the service efficiency of county-level public hospitals.Methods Based on the deta envelopment analysis method,BCC model was used to evaluate the static service efficiency of county-level public hospitals in 16 cities in Shandong Province in 2023,and to dynamically track the change trend of efficiency from 2017 to 2023 based on Malmquist index model.Results In 2023,the average comprehensive efficiency of county-level public hospitals in Shandong Province is 0.971,and the efficiency value of county-level public hospitals in 8 of the 16 cities is 1,which is in DEA effective state;From 2017 to 2023,the average total factor productivity of county-level public hospitals in Shandong Province was 0.906,with an overall decline of 9.4%in service efficiency.Conclusion The overall service efficiency of county-level public hospitals in Shandong Province is high,but regional differences are obvious,and the technical progress index is the key to further indicate the service efficiency.Local governments need to reasonably control the scale of county-level public hospitals,continuously improve their technical level,and strengthen their internal management,so as to improve their service efficiency.

Purpose To investigate the evaluation value of right-to-left shunt in atrial septal aneurysm(ASA)via contrast-enhanced transcranial Doppler,and analyze its clinical significance.Materials and Methods Forty patients with ASA who were performed on contrast-enhanced transcranial Doppler in Jiaozuo People's Hospital from June 2020 to July 2021,and 242 patients without ASA during the same period were enrolled.The overall incidence of right-to-left shunt was compared between the two groups in resting state and after Valsalva maneuver.All patients with right-to-left shunt were divided into small shunt group and large shunt group according to the number of microbubbles detected,comparing the incidence of small and big shunt,as well as alterations of shunt after Valsalva maneuver between the two groups.Results Contrast-enhanced transcranial Doppler in resting state:positive rate of ASA patients with right-to-left shunt was significantly higher than that of non-ASA patients via contrast-enhanced transcranial Doppler in resting state[47.5%(19/40)vs.29.8%(72/242);χ2=4.95,P=0.03].There were 14 ASA patients(73.7%)with small shunt and five ASA patients(26.3%)with large shunt.There were 61 non-ASA patients(84.7%)with small shunt and 11 non-ASA patients(15.3%)with large shunt.In resting state,there was no significant difference in ratio between small and large shunts,though there were mainly small shunt patients between the two groups(χ2=1.26,P=0.264).The positive rate of patients with or without ASA were significantly higher after Valsalva maneuver than those in resting state(positive rate of ASA patients was 77.5%,χ2=8.64,P=0.002;positive rate of non-ASA patients was 48.8%,χ2=80.49,P<0.001).The number of cases with massive shunt in ASA group were significantly higher than those in non-ASA group[64.5%(20/31)vs.47.5%(56/118);χ2=12.58,P<0.001].Conclusion ASA is often accompanied by right-to-left shunt,especially those with a substantial right-to-left shunt can trigger by the Valsalva maneuver.Therefore,attention should be paid to patients with ASA in clinical practice with standardized diagnosis and treatment.

Objective To evaluate the risk of bias and reporting quality in randomized controlled trials(RCTs)of the Chinese medicine injection for acute cerebral infarction in the last five years.Methods RCTs literature on Chinese medicine injection in the treatment of acute cerebral infarction was systematically searched in CNKI,Wanfang Data,VIP,China Biology Medicine Database(CBM),PubMed,Embase and Cochrane Library from April 20,2018 to April 20,2023.The risk of bias and reporting quality of included RCTs were evaluated using the Cochrane Risk of Bias Tool(ROB 1.0)and CONSORT-CHM Formulas 2017,respectively.Results A total of 4 301 articles were retrieved,and 408 RCTs were included according to inclusion and exclusion criteria.The ROB evaluation results showed that the the majority of studies were rated as having an unclear risk of bias due to the lack of reporting on allocation concealment,blind method,trial registration information,and funding sources.The evaluation results of CONSORT-CHM Formulas 2017 showed that the number of reported papers of 17 items was greater than or equal to 50%,and the number of reported papers of 25 items was less than 10%,and most of the RCTs did not show the characteristics of TCM syndrome differentiation and treatment.Conclusion The quality of Chinese medicine injection in the treatment of acute cerebral infarction RCTs is generally low.It is recommended that researchers refer to the methodology design of RCTs and international reporting standards,improve the trial design,standardize the trial report,and highlight the characteristics of TCM syndrome differentiation and treatment.

Rapid and living guidelines are those developed in response to public health emergencies in a short period of time using a scientific and standardized approach. Subsequently， they provide timely and credible recommendations for decision makers through regular and frequent updates of clinical evidence and recommendations. In this paper， we introduced the definition of rapid and living guideline as well as analyzed the basic characteristics of eight rapid and living guidelines in the field of traditional Chinese medicine （TCM） published till 2023 June， summarizing three core methodological issues in relation to how to rapidly develop guidelines， how to formulate recommendations when there is lack of evidence， and how to ensure the timeliness of guidelines. Based on the analysis of current rapid and living guidelines， it is implicated that there is necessity to carry out rapid and living guideline in the field of TCM， and the methodology of rapid integration of multivariate evidence in the field of TCM needs to be further explored； furthermore， it is necessary to further explore the obstacles of implementation of guidelines and promote timely updating， all of which provide certain theoretical references for relevant guideline developers and researchers.

In developing rapid and living guidelines of traditional Chinese medicine （TCM） in response to public health emergencies， it is important that evidence continue to be reviewed， and clinical questions and recommendations updated if necessary， due to the rapid changes in disease progression and the continuous generation of relevant research evidence. This paper proposed that the updating scope in dynamic mode should first be identified； then evidence monitoring should be carried out in four aspects， including clinical research， related guidelines or laws and regulations， disease progression， as well as clinical use of recommendations and clinical needs； finally， based on the results of the evidence monitoring， different options should be made， including revising the clinical questions， updating the evidence and recommendations， and withdrawing the guideline.