Objective: To analyze the effects of health literacy on overweight and obesity among primary school students and their parents in terms of salt, oil and sugar reduction (referred to as the "three reductions"), so as to provide a theoretical basis for the development of obesity control measures. Methods: From March to April 2024, a total of 1 022 fourthgrade primary school students and 913 parents were surveyed in 24 classes in six counties in Shandong Province using multistage cluster random sampling, and physical measurements of primary school students were conducted. Pearsons correlation analysis and ordered multivariate Logistic regression were used to investigate the associations between health literacy of primary school students and their parents with overweight and obesity among children. Results: The detection rates of overweight and obesity primary school students in Shandong Province were 14.87% and 24.66%, respectively, with significant sex difference in obesity rate (29.46% for boys and 19.76% for girls) (χ2=12.93, P<0.01). In addition to students reducing oil scores, parental reducing salt,reducing oil,reducing sugar, comprehensive health literacy scores and students reducing salt,reducing sugar and comprehensive health literacy scores showed a negative relationship with students overweight and obesity (r=-0.10, -0.08, -0.07, -0.10, -0.04, -0.07, -0.03, P<0.05). The overweight and obesity rates among primary school students with high parental reducing salt,reducing oil,reducing sugar and composite health literacy scores were lower (OR=0.69, 0.69, 0.71, 0.63, P<0.05); and the overweight and obesity rate among students with high parental and low parental and high and low parental health literacy scores were lower (OR=0.68, 0.57, P<0.05). Conclusion Improving health literacy regarding "three reductions" for parents and children, especially parents, can effectively reduce the risk of childhood overweight and obesity.

Objective:To understand the characteristics and trends of acute myocardial infarction (AMI) in Shandong Province and to provide evidence for formulating prevention and control strategies.Methods:Data were derived from the AMI incidence reports of Shandong Province's Chronic Disease Surveillance Information Management System in 2012-2021. The crude and standardized incidence rates were used as indicators to describe the incidence level of AMI. Joinpoint regression analysis was used to analyze the trends in the incidence and age of onset over the years. The contribution of population aging to the increase in AMI incidence was assessed using the rate difference decomposition method. The incidence of AMI in each district (county) in Shandong Province was visualized using ArcGIS 10.8 software, and global and local spatial autocorrelation analysis was performed using DeoDa 1.12 software.Results:From 2012 to 2021, 198 233 cases of AMI were reported from 19 provincial monitoring sites in Shandong Province, of which 53.13% were males and 97.12% were ≥45 years old. The reported crude incidence increased from 90.12 per 100 000 in 2012 to 176.54 per 100 000 in 2021, with an average annual increase of 7.01% ( Z=7.35 , P<0.001). There was no significant upward trend in standardized incidence ( Z=1.64 , P=0.140), but the standardized incidence of male residents showed an increasing trend ( Z=2.76 , P=0.028). Before 2014, the reported crude incidence of males was similar to that of females, but after 2014, the reported crude incidence of males was continuously higher than that of females. However, males' standardized incidence was higher than females in all years. Both crude and standardized incidence rates were higher in rural residents than in urban areas. The median onset of AMI increased from 71.6 years old in 2012 to 73.5 years old in 2021. The median age of onset in males was lower than that in females in all years, and in most years, the median age of onset in urban residents was lower than that in rural residents. The incidence of AMI in males showed a trend in younger age groups. According to the seasonal decomposition, the incidence peak of AMI was in January, and the trough was in September. The contribution of aging population to the increase in crude incidence of AMI increased from 8.63% in 2013 to 52.58% in 2021. The global spatial autocorrelation analysis showed that the incidence of AMI presented an obvious spatial clustering distribution. Local spatial autocorrelation analysis found that the high-incidence areas (counties) were mainly concentrated in Liaocheng City and Dezhou City in the northwest region of Shandong Province and Heze City in the southwest. Conclusions:The incidence of AMI among residents in Shandong Province was rising, with spatial clustering and seasonal clustering characteristics. People aged 45 years and older, male residents, and rural residents were at high risk of developing AMI. There was a certain trend of younger age at onset among men. Targeted prevention and control measures should be taken for high-incidence seasons, high-risk groups, and high-incidence clustering areas in northwestern Shandong Province.

Background Prolonged awkward postures during occupational activities can lead to excessive musculoskeletal load on the wrist of workers and symptoms such as wrist pain or discomfort. Objective To survey the prevalence of wrist pain among workers in 10 key industries and analyze its correlation with wrist working postures. Methods By using stratified cluster sampling method, workers from 10 key industries, such as footwear manufacturing industry, shipbuilding manufacturing industry, and automobile manufacturing industry, were selected from seven regions in North China, East China, Central China, South China, Southwest China, Northwest China, and Northeast China. The demographic information, wrist working postures, pain in wrist of the workers were collected through a cross-sectional survey. Pearson χ² test was used to compare prevalence by selected factors, trend χ² test for between group comparison, and unconditional logistic regression models for the association of wrist working postures with wrist pain. Results There were 64052 workers enrolled in this survey, and 56286 provided valid questionnaires (the effective rate was 87.8%). According to the survey, the prevalence of wrist pain was 23.3% (13112/56286), and the industries with higher prevalences were footwear manufacturing (27.1%, 1927/7106), automobile manufacturing (24.9%, 5378/21560), and shipbuilding and related equipment manufacturing (24.4%, 850/3488) industries. Finger pinching (OR=2.09, 95%CI: 1.95-2.24), frequent wrist bending (OR=2.03, 95%CI: 1.92-2.15), fixed wrist bending (OR=1.77, 95%CI: 1.69-1.85), wrist on hard edge (OR=1.34, 95%CI: 1.28-1.40), and arms over shoulders (OR=1.11, 95%CI: 1.05-1.17) increased the risk of reporting wrist pain. Conclusion Awkward postures are related to wrist pain among workers in selected 10 key industries. The related factors are wrist on hard edge, frequent wrist bending, finger pinching, fixed wrist bending, and arms over shoulders.

Objective To investigate the safety,feasibility,and efficacy of highly selective protective vagotomy in laparoscopic fundoplication.Methods Clinical data of 78 patients who underwent laparoscopic hiatal hernia repair plus fundoplication(short floppy Nissen procedure)for gastroesophageal reflux disease and hiatus hernia from January 2014 to December 2019 in our hospital were retrospectively analyzed.The patients were divided into two groups:the traditional operation group and the vagus nerve protection group.The operation time,blood loss during operation,hospital stay after operation and the incidence of postoperative complications were compared between the two groups.The GERD Q score,DeMeester score,lower esophageal sphincter pressure(LESP),and control of reflux symptoms at 6 months after operation in the two groups were analyzed.Results Both groups of surgeries were successfully completed,and there were no serious intraoperative side injuries.There was no significant difference between the traditionaloperationgroupandthevagusnerveprotectiongroupinoperationtime[(85.5±13.9)minvs.(88.3±18.6)min,t =0.729,P =0.468],intraoperative blood loss[(18.6±8.6)ml vs.(18.1±8.5)ml,t =-0.221,P =0.825],and postoperative transanal exhaust time[(2.0±0.7)d vs.(1.8±1.0)d,t =-1.227,P =0.224].The postoperative hospital stay in the traditional surgical group was significantly longer than that in the vagus nerve protection group[(9.4±3.0)d vs.(8.2±2.1)d,t =-2.172,P = 0.033].The incidence of surgical complications within 30 d after surgery in the traditional surgical group was 36.8%(14/38),which was significantly higher than that in the vagus nerve protection group[12.5%(5/40),χ2 = 6.267,P = 0.012].The traditional surgical group had a cure rate of 86.8%(33/48)at 6 months after surgery,which was not significantly different from the vagus nerve protection group[85.0%(34/40),Z =-0.232,P =0.816].There were no significant differences in GERDQscore,DeMeester score,LESP between the two groups at 6 months after surgery[(5.6±0.9)points vs.(5.8±0.8)points,t =1.232,P =0.222;(4.1±2.2)points vs.(4.2±2.2)points,t =0.261,P =0.795;(23.2±3.5)mm Hg vs.(23.5±3.8)mm Hg,t = 0.412,P = 0.681].Conclusion It is safe,feasible,and effective to apply the highly selective protective vagotomy in laparoscopic short floppy Nissen fundoplication to protect the vagus nerve.

Objective: To analyze the current status of work-related musculoskeletal disorders (WMSDs), work fatigue and musculoskeletal pain in Chinese occupational population, and to study the relationship between work fatigue and musculoskeletal pain and WMSDs. Methods: A total of 66 961 employees from 323 enterprises in 15 key industries in China were selected as the study subjects using stratified cluster sampling method. The incidence of WMSDs in the past year was investigated using the Chinese version of the Musculoskeletal Disorders Questionnaire, and the work fatigue and musculoskeletal pain were investigated using Borg 6-20 Rating of Perceived Exertion Scale and visual analogue scale. The data were standardized using the age composition data of 18 to 60 years from the seventh national population census. Results: The standardized annual incidence of WMSDs was higher in the front-line workers than that in the administrative and other supportive staff (38.82% vs 36.30%). The detection rates of work fatigue and musculoskeletal pain in the study subjects were 44.54% and 63.08%, respectively. The result of S-curve fitting showed that the risk of WMSDs increased with the level of work fatigue (P<0.01). Among the front-line workers, the average of monthly fatigue frequency in the neck, shoulder, lower back, upper back, wrist/hand, foot and ankle, knee, leg, and elbow were higher in the group with WMSDs compared to those without WMSDs (all P<0.01). The pain degree of musculoskeletal pain was higher in all nine sites in the fatigued group than in the no-fatigue group (all P<0.01). The standardized detection rate of musculoskeletal pain was higher in the fatigued group than in the non-fatigued group (80.38% vs 25.71%). The work fatigue was moderate and positively correlated with musculoskeletal pain in all seven sites except the lower back and elbow, with Kendall Tau-b correlation coefficients ranging from 0.423 to 0.546 (all P<0.01). Conclusion: There is a good correlation between work fatigue and local musculoskeletal pain, work fatigue and WMSDs in Chinese occupational population. Implementing ergonomic interventions to control the development of work fatigue can be an effective measure for preventing WMSDs.

In order to evaluate the intervention effect of the school-based salt reduction model, 28 primary schools were selected in Shandong Province in September 2014 and randomly divided into intervention group (1 361 students, 1 306 parents) and control group (1 364 students,1 340 parents). A series of "small hands and big hands" salt reduction intervention activities were conducted in intervention group for 8 months. After the intervention, the total awareness rate of salt reduction knowledge, the total holding rate of related beliefs and the total reporting rate of related behaviors were 70.65%, 80.30% and 67.03% among students, and 85.66%, 93.77% and 87.93% among parents, in the intervention group, which were higher than those in the control group (37.12%, 66.52% and 50.07% among students; 55.11%, 87.52% and 57.96% among parents) (all P values <0.05). The school-based salt reduction model is effective and feasible.

In order to evaluate the intervention effect of the school?based salt reduction model, 28 primary schools were selected in Shandong Province in September 2014 and randomly divided into intervention group (1 361 students, 1 306 parents) and control group (1 364 students,1 340 parents). A series of "small hands and big hands"salt reduction intervention activities were conducted in intervention group for 8 months. After the intervention, the total awareness rate of salt reduction knowledge, the total holding rate of related beliefs and the total reporting rate of related behaviors were 70.65%, 80.30% and 67.03% among students, and 85.66%, 93.77% and 87.93% among parents, in the intervention group, which were higher than those in the control group (37.12%, 66.52% and 50.07% among students; 55.11%, 87.52% and 57.96% among parents) (all P values<0.05). The school?based salt reduction model is effective and feasible.

In order to evaluate the intervention effect of the school?based salt reduction model, 28 primary schools were selected in Shandong Province in September 2014 and randomly divided into intervention group (1 361 students, 1 306 parents) and control group (1 364 students,1 340 parents). A series of "small hands and big hands"salt reduction intervention activities were conducted in intervention group for 8 months. After the intervention, the total awareness rate of salt reduction knowledge, the total holding rate of related beliefs and the total reporting rate of related behaviors were 70.65%, 80.30% and 67.03% among students, and 85.66%, 93.77% and 87.93% among parents, in the intervention group, which were higher than those in the control group (37.12%, 66.52% and 50.07% among students; 55.11%, 87.52% and 57.96% among parents) (all P values<0.05). The school?based salt reduction model is effective and feasible.

Objective To report surgical outcomes of managing comminuted fractures of the inferior patellar pole with separate vertical wiring plus anchor suture fixation.Methods From January 2010 to January 2015,37 patients with comminuted fractures of the inferior patellar pole were treated with separate vertical wiring and anchor suture fixation.They were 15 men and 22 women,from 32 to 76 years of age (average,55.1 years).The intervals from fracture to surgery ranged from 2 to 3 days (average,2.1 days).According to the AO classification,all the fractures were type 34-A1.The visual analogue scale (VAS) scores,ranges of motion (ROM) of the knee,Bostman scores and postoperative complications were recorded at 6 weeks,3,6 and 12 months and the final follow-up postoperatively.Results The follow-up time for the 37 patients averaged 16 months (range,from 12 to 23 months).The fracture union time averaged 10 weeks after surgery (range,from 8 to 13 weeks).At postoperative 6 weeks,3,6 and 12 months and the final follow-up,respectively,the average VAS scores were 2.5,1.1,0.3,0.2 and 0.2 points,the average ranges of motion 109.5°,123.7°,128.6°,129.1° and 132.5°,and the average Bostman scores 23.7,26.9,29.1,29.4 and 29.6 points.No patient reported delayed union,nonunion,loss of reduction,wire breakage,wound problem or irritation from the implant.Conclusion Separate vertical wiring combined with anchor suture fixation is a useful technique for comminuted fractures of the inferior patellar pole,for it is easy to perform,allows early functional exercise and leads to fine curative outcomes.

Objective To investigate the clinical efficacy and prognosis of early protective pulmonary ventilation and intra-aortic balloon pump(IABP)combined with percutaneous coronary intervention(PCI)in treating patients with acute myocardial infarction(AMI)complicated with cardiogenic shock(CS)and hypoxemia.Methods The 49 patients diagnosed as AMI complicated with CS and hypoxemia and treated with early protective pulmonary ventilation and IABP combined with PCI in Tianjin Chest Hospital from January 2015 to December 2015 were retrospectively analyzed.Major adverse cardiovascular events(MACE)including sudden cardiac death,recurrent myocardial infarction,heart failure and development of target vessel revascularization were recorded during one year of follow-up visits.Survival rate was analyzed and Cox regression analysis was used to explore risk factors for occurrence of MACE after the treatment.Results The revascularization of target vessel was successfully operated on all of the 49 patients.The mean time from attack to hospitalization was(6.2±1.5)hours,while the mean time from emergency room to balloon dilatation was(118.55±28.28)minutes.In these patients,30(61.2%)cases were diagnosed as STEMI,among which 23(76.6%)cases as anterior wall myocardial infarction and 5(16.7%)cases as inferior wall myocardial infarction.While the other 19(38.8%)cases were diagnosed as non-STEMI.Using coronary arteriography,46(93.9%)cases had multi-vessel coronary artery disease,among which 13(26.5%)cases were complicated with severe left main coronary artery disease and 27(55.1%)cases had severe vascular calcification.44(89.8%)cases had TIMI perfusion grade 3 blood flow after PCI,while 5(10.2%)cases did not achieve TIMI grade 3 blood flow.One(2.0%)case had serious complications and 12(24.5%)patients died in hospital.31(63.3%)patients survived 1 year during follow-up visits.Total number of MACE was 32(65.3%).Among these events,18(36.7%)died,4 cases(8.2%)had recurrent myocardial infarction,13 cases(26.5%)had heart failure(HF)and 5 cases(10.2%)had target vessel revascularization(TVR).The total event-free survival rate was 34.7%.Multivariable Cox regression analysis showed that severe vascular calcification〔HR(95%CI):2.677(1.184-6.054),P=0.018〕,TIMI grade blood flow less than level 3 after PCI〔HR(95%CI):26.289(6.314-109.470),P=0.000〕and more than 120 minutes from emergency room to balloon dilatation〔HR(95%CI):2.923(1.325-6.446),P=0.008〕were risk factors for MACE.Conclusions Early protective pulmonary ventilation and IABP combined with emergency PCI are safe and effective for treatment of patients with AMI complicated with CS and hypoxemia.The pattern of treatment can significantly decrease death rate and increase 1-year survival rate.