Objective To explore the mediating role of activities of daily living (ADL) in pain and depressive symptoms in the elderly in China. Methods Utilizing the data from 2020 China Health and Retirement Longitudinal Study, 4403 Chinese elderly individuals aged ≥ 60 years old were selected as the research subjects. Depression Scale (CES-D 10) of the Center for Epidemiological Survey and ADL scale were used in the study. The PROCESS4.1 macro was used to test the mediating effect of daily living activities between pain and depressive symptoms, and the Bootstrap method was applied for verification of the mediating variables. Results A total of 2368 cases of depressive symptoms were detected in the elderly in China, with a detection rate of 53.78%. Pain was positively correlated with depressive symptoms (r=0.27, P<0.01), and activities of daily living were negatively correlated with pain and depressive symptoms (r=-0.27, -0.337, P<0.01). The results showed that the total effect value of pain on depressive symptoms was 0.33, the direct effect value was 0.24, and the mediating effect value of daily living activities was 0.09, accounting for 27.27%. Conclusion Pain and activities of daily living are important factors influencing depressive symptoms in the elderly, and activities of daily living play a partial mediating role in the relationship between pain and depressive symptoms in the elderly.

Objective　To explore the mediating role of cognitive function in the association between literacy level and depressive symptoms in middle-aged and elderly people in China. Methods　 Using the fourth national follow-up data of the China Health and Elderly Care Tracking Survey 2018, 8 124 middle-aged and elderly people aged 45 years and above were included as the study subjects. The PROCESS 4.0 program was used to test the mediating effect of cognitive function between literacy level and depressive symptoms, and the Bootstrap method was used for the mediator variable validation. Results The detection rate of depressive symptoms among middle-aged and elderly people in China was 38.10%. After controlling for gender, place of residence, marital status, smoking, alcohol consumption, and exercise, literacy level was a negative predictor of depressive symptoms in middle-aged and elderly people (β =－0.480, t =－11.248, P<0.001). Cognitive function accounted for 58.75% of the amount of mediating effect between literacy level and depressive symptoms. Conclusion 　Literacy level and cognitive function are associated with depressive symptoms in middle-aged and elderly people. Literacy level can influence depressive symptoms directly or indirectly through the mediation of cognitive dysfunction.

Objective To explore the mediating effect of health-promoting lifestyle on the relationship between health literacy and stigma among middle-aged and elderly patients with type 2 diabetes mellitus (T2DM). Methods A stratified random sampling method was used to select 415 patients with T2DM from three general hospitals in Weifang to conduct a questionnaire survey using the Disease Stigma Assessment Scale for Type 2 Diabetes Mellitus (DSAS-2), the Health Literacy Scale, and the Type 2 Diabetes Health Promotion Scale (T2DHPS). Results Sickness stigma was negatively correlated with health literacy (r=-0.547, P<0.01) and negatively correlated with health promotion (r=-0.505, P<0.01), while health promotion was positively correlated with health literacy (r=0.398, P<0.01). Health-promoting lifestyle mediated the association between health literacy and stigma (β=0.0383, P<0.01), with the mediating effect accounting for 16.00% of the total effect. Conclusion Health literacy can influence the stigma of patients with type 2 diabetes mellitus through health promotion lifestyle, suggesting that the stigma of patients with diabetes can be improved through health promotion lifestyle intervention.

Objective To investigate the changing trend and epidemiological characteristics of the incidence and mortality of chronic kidney disease (CKD) with age, period and birth cohort in Chinese population. Methods Based on the data of incidence and mortality of CKD in Chinese population aged 20-80 years from 1990 to 2019 in GHDx database, joinpoint regression model was used to analyze the incidence and mortality trend of CKD. An age-period-cohort model was constructed to analyze the effects of age, period, and birth cohort on the trend of CKD incidence and mortality. Results Joinpoint regression analysis showed that the standardized incidence rate of chronic kidney disease in Chinese population increased from 146.37/100 000 in 1990 to 161.52/100 000 in 2019, while the standardized mortality rate decreased from 12.98/100 000 in 1990 to 11.23/100 000 in 2019. The APC model analysis showed that the risk of CKD incidence and death in the Chinese population increased with age, while the risk of CKD incidence increased with the increase of period. The risk of death did not change significantly with the increase of period. The cohort born later had a lower risk of CKD incidence and death compared to the cohort born earlier. Conclusion At present, the age effect and period effect of the incidence and death risk of chronic kidney disease in China are dominant. It is important to take effective measures and intervene in a timely manner, especially to strengthen the protection of older high-risk groups born earlier.

Objective To evaluate the quality of life of patients with type 2 diabetes mellitus in Weifang City, Shandong Province and to explore its influencing factors. Methods A multistage stratified random sampling method was used to investigate patients in endocrine outpatient clinics in four medical institutions in Weifang from July to September 2022. The survey included general information, multi-dimensional evaluation of quality of life with the EQ-5D-5L scale, calculation of health utility values, and analysis of influencing factors using Tobit regression models. Results A total of 397 patients with type 2 diabetes were included in the present investigation, with health utility value of 0.82±0.21 points and visual analogue scale (VAS) score of 79.47±12.81 points. Pain or discomfort, anxiety or depression were more prominent in the study population. Age, diabetic complications, BMI, daily need for care, social support, and daily level of glycemic control were factors influencing health-related quality of life in patients with type 2 diabetes. Conclusion In the actual treatment of type 2 diabetes patients, an emphasis should be placed on protecting elderly type 2 diabetic patients, preventing and controlling the occurrence and development of diabetic complications, and improving daily blood glucose control to further improve the health-related quality of life of the population.

Objective:To identify the key convergence points in the medical-nursing combined care among literature, and establish a mechanism for medical-nursing combined care integration from the perspective of the synergy theory, for the purpose of promoting the integrated development of such care in China.Methods:Relevant literature on the medical-nursing combined care were retrieved from the CNKI database from September 2013 to September 2021. The search formula used was TI= "the medical-nursing care integration" AND SU=(convergence+ transformation+ coordination+ mechanism), while supplementary searches were made using " pkulaw.com database" and Baidu Scholar database. The method of literature content analysis was used to screen key points of the medical-nursing combined care, and the convergence mechanism was built based on the perspective of the synergy theory.Results:A total of 42 literatures were included in this study, 8 key convergence points of medica-nursing combined care integration were identified. Namely the 4 key horizontal convergence points of medical care, aging care, rehabilitation and nursing, the 3 key vertical convergence points of home care, institution care and community care, and the one key convergence point of institutional medical care. Based on the synergy theory and the 8 key convergence points, the " 431" convergence mechanism of medical-nursing combined care was constructed. This mechanism refered to the horizontal linkage of healthcare, nursing, rehabilitation and aging care, the vertical redirection among home care, institution care and community care modes, and the development mode focusing on institutional aging care.Conclusions:At present, the poor convergence between aging care and nursing care in China is a key roadblock hindering the integrated development of aging and nursing care. Medical-nursing combined care should be conducive to the " 431" convergence development, achieving horizontal linkage, vertical redirection, and resource sharing, for the purpose of high-quality development of China′s aging care system.

Objective To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Methods Totally, 2219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1％, 1755/2219) and the placenta percreta (PP) group (20.9％, 464/2219), according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. Results The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ2=157.961) and placenta previa (χ2=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01). Conclusions Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.

Objective To explore the present human resources and problems at community health centers in Shandong province .Methods PPS sampling method was used to extract data of 333 community health centers in 17 cities in Shandong province in 2015 .Then the human resource status was analyzed and evaluated by descriptive research indexes .Results Data showed that 333 community health centers had 19809 employees ,and 12271 of them having staffing quota. These employees include 6355 physicians ,5169 nurses ,and 3064 medical and pharmaceutical technicians .For the physicians ,4841 of them are medical practitioners ,1313 were assistant medical practitioners ,while the numbers of obstetricians and gynecologists ,general practitioners ,and TCM practitioners were 756 , 2124 and 432 respectively .Conclusions These community health service centers are faced with such problems as lack of human resources ,irrational personnel makeup ,and obvious shortage of public health ,general practitioners and medical/pharmaceutical professionals. It is recommended to increase and optimize manpower by means of motivating existing personnel ,introducing new manpower and training opportunities for the retention.Medical alliances are expected to encourage more high-end professionals to the primary institutions .

OBJECTIVE:To observe the therapeutic efficacy of active immunization combined with dydrogesterone in the treatment of recurrent abortion,and its effects on serum levels of leptin(LP)and adiponectin(ADPN). METHODS:Totally 103 patients with recurrent abortion from department of gyhecology,Jinan Third People's Hospital during Nov. 2015 to Nov. 2016 were selected as trial group,and then divided into trial group one(n＝51)and trial group two(n＝52)according to admission order. Other 100 normal pregnant women were taken as control group. Trial group one was given active immunization combined with dydrogesterone,including that lymphocytes from the patients'spouse were injected subcutaneously into the patient,every half a month,3 times of active immunization as a course of treatment,and was given Dydrogesterone tablet 10 mg after pregnancy,bid, until 3 months after the pregnancy. Trial group two was given Dydrogesterone tablet 10 mg,bid,until 3 months after the pregnancy. The serum levels of β-HCG,LP and ADPN were compared between trial group and control group at admission,the serum levels of β-HCG,LP,ADPN and pregnancy outcome(recurrent abortion,full-term pregnancy and successful delivery rate) was compared between 2 trial groups after treatment. RESULTS:At admission,the serum levels of β-HCG,LP and ADPN in trial group were significantly lower than control group. After treatment,the levels of β-HCG,LP and ADPN,successful delivery rate and full-term pregnancy rate in trial group one were significantly higher than trial group two, recurrent abortion rate was significantly lower than trial group two,with statistical significance(P＜0.05). No adverse reactions were observed in the study. CONCLUSIONS:The use of active immunization combined with dydrogesterone can significantly improve the serum levels of LP and ADPN as well as pregnancy outcome,with good safety.