Abstract Vaccine literacy is related to residents' access to and use of vaccine-related information and services, and improving vaccine literacy can enhance vaccine confidence, reduce vaccine hesitancy, and improve vaccination compliance. Carrying out vaccine literacy evaluation is helpful to understand the awareness of and attitudes towards vaccines among residents, and provides the reference for clarifying influencing factors for vaccine literacy and finding a path for vaccine literacy improvement. This paper retrieved the literature related to vaccine literacy evaluation and extracted eight vaccine literacy evaluation tools, including The Human Papillomavirus Vaccine Literacy Questionnaire, Questions on Vaccine Literacy, Vaccine Literacy Scale for Italian adults, COVID-19 Vaccines Literacy Scale, The English HLS19 instrument for measuring Vaccination Health Literacy in the general population, Digital Vaccine Literacy Scale, The Chinese Version of the COVID-19 Vaccine Literacy Scale and Community Residents Vaccine Literacy Scale, and reviewed the evaluation objects, content, reliability, validity and application, providing countermeasures and suggestions for the promotion of vaccine literacy evaluation in China.

Objective: To analyze the clinical distribution and drug resistance trends of clinical isolates ofKlebsiella pneumoniaefrom a tertiary hospital in Henan Province from 2017 to 2021, and to provide recommendations for the rational use of antibiotics in the hospital. Methods: A retrospective study was conducted to collect and organize the drug sensitivity test results and clinical data of clinical isolates ofKlebsiella pneumoniaein the hospital from 2017 to 2021. The data was analyzed using WHO NET 5.6 and SPSS 26.0 software. Results: A total of 1 379 strains ofKlebsiella pneumoniaewere isolated in the hospital from 2017 to 2021, with an isolation rate of 17.87%. There was no significant difference in the isolation rates ofKlebsiella pneumoniaeover the entire five-year period.The top three sources of isolates were sputum(65.99%), secretion(12.98%), and urine(8.85%). The main departments for collecting isolates were the respiratory department(26.03%) and the ICU(24.58%), with the isolation rate in other departments being less than 5%. The drug sensitivity results showed that, except for the resistance rate of cefoperazone, the resistance rates of other antibacterial drugs showed statistically differences over the five years, generally showing a stable or decreasing trend. The carbapenem drugs imipenem and meropenem decreased from 33.1% and 33.5% in 2017 to 13.7% and 14.4% in 2021, respectively. In addition, the resistance rates of chloramphenicol and tetracycline class minocycline showed an increasing trend. Conclusion Klebsiella pneumoniaeis still the main pathogen isolated in the hospital, mainly in the respiratory department and ICU, with sputum, urine, and blood being the main specimens. The resistance rates have shown a stable or decreasing trend over the past five years, with a significant decrease in carbapenem resistance rates. However, attention should still be paid to the increasing resistance rates of chloramphenicol and minocycline. Clinically, antibiotics should be used rationally based on drug sensitivity results.

Abstract Enhancing the health literacy of the entire population is a prerequisite for improving the health of the entire population, and since the health attitudes and behaviors formed during childhood and adolescence have a profound impact on the health patterns of adulthood, the enhancement of health literacy of children and adolescents is of particular importance. As the main place for children and adolescents to receive education, schools should better fulfil the function of education and promotion of health literacy. China has been carrying out the pilot and promotion of health promoting schools (HPS) since 1995, and is currently in the stage of comprehensive improvement of HPS construction. This paper introduces the background and characteristics of Health-Literate Schools (HeLit-Schools) in foreign countries and compares them with HPS in China, drawing on the advantages of HeLit-Schools to provide a new idea and a new way of thinking for the construction of HPS in China and for the practice of the "Healthy China Initiative".

Objective:To investigate the predictive role of relative diffusion-weighted imaging (DWI) signal intensity (DWI-rSI) in outcome in patients with anterior circulation large vessel occlusion cardioembolic stroke and successful recanalization after endovascular therapy (EVT).Methods:Patients with anterior circulation large vessel occlusion stroke due to cardioembolic embolism underwent EVT and successful recanalization at the Affiliated Hospital of Yangzhou University from March 2017 to March 2023 were retrospectively included. According to the modified Rankin Scale score 3 months after procedure, the patients were divided into a good outcome group (0-2 points) and a poor outcome group (3-6 points). Multivariate logistic regression analysis was used to identify independent predictive factors for poor outcome. Results:A total of 59 patients were enrolled, including 29 males (49.2%), median age of 74 years (interquartile range, 68-80 years). The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 15 (12-21), and the median DWI Alberta Stroke Program Early CT Score (ASPECTS) was 8 (5-9). Thirty-two patients (54.2%) had good outcome, and 27 (45.8%) had poor outcome. Among them, 9 patients (15.3%) died (6 died from cerebral herniation after malignant brain edema, 2 died from complications, and 1 died from severe intracranial hemorrhage after procedure). Twenty-one patients (35.6%) experienced hemorrhagic transformation, including 12 (20.3%) with symptomatic intracranial hemorrhage. There were significant differences in baseline systolic blood pressure, NIHSS score, DWI-ASPECTS, DWI-rSI, and incidence of symptomatic intracranial hemorrhage between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that baseline systolic blood pressure (odds ratio 0.977, 95% confidence interval 0.919-0.991; P=0.015) and DWI-rSI (odds ratio 11.809, 95% confidence interval 1.932-72.170; P=0.008) were the independent predictors for poor outcome. Conclusion:DWI-rSI can predict the outcome of patients with anterior circulation large vessel occlusion cardioembolic stroke and successful recanalization after EVT.

Objective:To investigate the effect of regional leptomeningeal collateral circulation (rLMC) score based on CT angiography (CTA) and onset-to-reperfusion time (OTR) on the outcome after endovascular treatment (EVT) in patients with anterior circulation acute large vessel occlusive stroke (ACA-LVOS).Methods:Patients with ACA-LVOS underwent EVT in the Department of Neurology, the Affiliated Hospital of Yangzhou University from July 2017 to July 2023 were included retrospectively. The rLMC score 0-10 was defined as poor collateral circulation, and 11-20 were defined as good collateral circulation. At 90 days after EVT, the modified Rankin Scale (mRS) was used to evaluate the outcome. A score of 0-2 was defined as a good outcome and 3-6 were defined as a poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcome after EVT. Results:A total of 144 patients with ACA-LVOS underwent EVT were enrolled, including 78 males (54.2%), median aged 73 years. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 16, the median baseline Alberta Stroke Program Early CT Score (ASPECTS) was 9, and the median OTR was 330.5 minutes. Eighty patients (55.6%) had good collateral circulation, 63 (43.8%) had poor outcome, including 13 deaths. Univariate analysis showed that there were significant differences in hypertension, previous stroke history, smoking, triglycerides, baseline NIHSS score, baseline ASPECTS, OTR, and collateral circulation status between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that good collateral circulation (odds ratio [ OR] 0.223, 95% confidence interval [ CI] 0.077-0.643; P=0.005) was an independent predictor of good outcome. In the poor collateral circulation group, longer OTR was an independent predictor of poor outcome ( OR 1.020, 95% CI 1.008-1.032; P=0.001). In the good collateral circulation group, longer OTR was not an independent risk factor for poor outcome ( OR 1.005, 95% CI 1.000-1.010; P=0.062). Conclusion:rLMC score based on CTA and OTR are the independent predictors of the outcome after EVT in patients with ACA-LVOS.

Objective:To explore the impact of the hospital health literacy environment on patients′ postoperative pain self-management behaviors, aiming to provide insights for hospitals to implement the Comprehensive Pain Management Pilot Work Program in hospitals and to promote self-health management among patients with other diseases or symptoms. Methods:From November to December 2023, a convenience sampling method was used to select postoperative patients from three grade A tertiary general hospitals in Zhejiang Province for an on-site questionnaire survey. The Chinese version of brief health literacy screen (BHLS), short-form health literacy environment scale (SF-HLES) and postoperative pain self-management behavior questionnaire (PPSMB) were used as survey tools to investigate the health literacy level of patients, the health literacy environment of the hospital, and the postoperative pain management behaviors of patients. Two-way ANOVA was used to compare the impact of different dimensions of the hospital health literacy environment on postoperative pain management behaviors among patients with different levels of health literacy. Multiple linear regression analysis was used to explore the relationship between the hospital health literacy environment, individual health literacy, and patients′ postoperative pain self-management behaviors, and to discuss the impact of individual health literacy on patients′ postoperative pain self-management behaviors under different hospital health literacy environments.Results:341 valid questionnaires were collected. The average score of the hospitals′ SF-HLES was (73.62±19.54) points. The average score of the patients′ BHLS was (9.65±2.88) points. The average score of the patients′ PPSMB was (25.99±6.35) points. Two-way ANOVA results showed that the interaction between individual health literacy and the clinical dimension ( F=5.463, P=0.020) and structural dimension ( F=6.470, P=0.011) of the hospital health literacy environment had a statistically significant impact on patients′ postoperative pain self-management behaviors, while the interaction with the interpersonal dimension ( F=0, P=0.984) had no statistically significant impact on pain self-management behaviors. Simple effect analysis indicated that only in the high health literacy environment of the clinical and structural dimensions did the difference in pain self-management behaviors between patients with good health literacy and those with limited health literacy had statistical significance ( P<0.001). Multiple linear regression analysis results showed that for each 1-point increase in the patients′ BHLS score, their PPSMB score increased by 3.74 points ( β1=0.832, P<0.001); for each 1-point increase in the hospital′s SF-HLES score, the patients′ PPSMB score could increase by 0.198 points ( β2=0.610, P<0.001). In a low health literacy environment, individual health literacy did not affect pain self-management behaviors ( P>0.05); however, in a high health literacy environment, for each 1-point increase in the patients′ BHLS score, their PPSMB score correspondingly increased by 4.037 points ( β4=0.317, P<0.001). Conclusions:The positive impact of individual health literacy on pain self-management is contingent upon a high-quality hospital health literacy environment. This suggests that optimizing the hospital health literacy environment is a necessary precondition for implementing the relevant content of the Comprehensive Pain Management Pilot Work Program and can provide a reference for promote self-health management among patients with pain and other diseases or symptoms.

Objective:To construct the concept and its conceptual framework of hospital health literacy(HHL) for exploring the HHL promotion mechanism in the country.Methods:Based on the proceduralised grounded theory, twelve middle or senior managers of hospitals were selected for in-depth interviews and three hospitals were selected for field research from July 2021 to February 2022. Open coding, axial coding, and selective coding were used in data analysis, establishing the concept of HHL and its conceptual framework in China.Results:The conceptual framework of HHL was composed of an internal driver mechanism(hospitals improve their health literacy promotion management system, staff-led health literacy promotion, health literacy promoting physical environment construction), and an external driver mechanism(cooperate with external organizations and institutions to conduct health literacy promotion). The concept of HHL in China was derived as follows: the combination of supportive environments and human resources that health care organizations have in place can improve access and understandability of health information and simplify healthcare services to help patients of different health literacy levels more easily obtain, process, and understand health information as well as to make the most of medical services.Conclusions:Hospital health literacy promotion mechanism in China is a synergy between internal and external driver mechanisms.

Objective:To investigate the correlation between MRI markers of neurodegenerative diseases and vascular diseases and pre-stroke cognitive impairment (PSCI).Methods:Patients with minor acute ischemic stroke at first onset and aged ≥60 years admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University and the Department of Neurology, Linyi Jinluo Hospital from March 2019 to December 2021 were retrospectively enrolled. The imaging markers of cerebral small vessel disease and neurodegeneration were analyzed by dichotomy visual score. The former included cerebral white matter hyperintensities, vasogenic lacunar lesions, cerebral microbleeds, and enlarged perivascular space, and the latter included global cortical atrophy and medial temporal lobe atrophy. According to the score of Information Questionnaire on Cognitive Decline in the Elderly (IQCODE), the patients were divided into PSCI group (≥3.31 points) and non-PSCI group (<3.31 points). The clinical baseline data and MRI markers of both groups were compared. Multivariate logistic regression model was used to analyze the correlation between MRI markers and PSCI, and receiver operator characteristic (ROC) curve was used to analyze the predictive value of MRI markers to PSCI. Results:A total of 221 patients were enrolled in the study, including 77 patients (34.8%) in the PSCI group and 144 (65.2%) in the non-PSCI group. Univariate analysis showed that there were significant differences in age, years of education, pathological white matter hyperintensities, medial temporal lobe atrophy, and the proportion of patients with ≥1 abnormal MRI markers between the two groups (all P<0.05). Multivariate logistic regression analysis showed that older age (odds ratio [ OR] 1.089, 95% confidence interval [ CI] 1.034-1.146; P=0.001), years of education <6 years ( OR 3.134, 95% CI 1.534-6.401; P=0.002), medial temporal lobe atrophy ( OR 2.911, 95% CI 1.385-6.121; P=0.005), and presence of ≥1 abnormal MRI markers ( OR 2.823, 95% CI 1.305-5.938; P=0.007) were the independent risk factors for PSCI. ROC curve analysis showed that the area under the curve of medial temporal lobe atrophy and the presence of ≥1 abnormal MRI markers for predicting PSCI were both smaller (0.595 and 0.584 respectively), but the area under the curve was the largest when the two and years of education were combined (0.818, 95% CI 0.756-0.880; P<0.001), and its sensitivity and specificity for predicting PSCI were 79.9% and 71.4% respectively. Conclusions:The incidence of PSCI is high. Medial temporal lobe atrophy combined with other abnormal MRI markers has a certain predictive value for PSCI.

Objective:To investigate the CT features of lung injury induced by paraquat poisoning and its relationship with prognosis, and to provide reference for the judgment of the condition and prognosis of paraquat poisoning.Methods:146 cases of paraquat poisoning patients were treated in the Third People's Hospital of Xuzhou City from January 2013 to April 2016. The cases were divided into mild group, moderate-severe group and fulminant group according to the concentration of paraquat in urine. The clinical data and CT imaging findings were analyzed and reconstructed in three-dimensional reconstruction. The extent of the lesion was observed and the relationship between CT and prognosis was explored.Results:Paraquat lung injury has many manifestations on CT images, and it's performance can be intersecting at the same time. Early lesions lighter cases, late CT imaging lesions can be completely absorbed or residual fibrosis, the prognosis was good; the early lesion was pulmonary consolidation, pleural effusion cases, the late CT image was usually pleural thickening and bronchiectasis, the prognosis was relatively good; early lesions were large patches of ground glass opacity cases, finally, pulmonary fibrosis was common, the mortality rate of 56.57%. There were significant differences in the extent of lung injury between different groups ( P<0.001) , and the difference in mortality was statistically significant when the lung injury was different ( P<0.001) . Multivariate stepwise Logistic regression analysis showed that ground-glass opacity ( OR value=2.013) , interstitial lung fibrosis ( OR=3.779) and mediastinal emphysema ( OR=33.118) were risk factors for death of lung injury caused by paraquat poisoning ( P<0.05) . Conclusion:There were many manifestations on CT images of paraquat lung injury, and the manifestations of paraquat lung injury can be intersecting at the same time. The pulmonary manifestations and outcomes of different paraquat types were different. The CT manifestations of lung injury in paraquat poisoning were mainly exudative changes at early stage, and can be gradually absorbed or evolved into interstitial changes at later stage. The cumulative damage range can be used as a reference for evaluating the prognosis. Ground-glass opacity, interstitial pulmonary fibrosis and mediastinal emphysema are the risk factors for death of lung injury caused by paraquat poisoning.

Objective:To investigate the CT features of lung injury induced by paraquat poisoning and its relationship with prognosis, and to provide reference for the judgment of the condition and prognosis of paraquat poisoning.Methods:146 cases of paraquat poisoning patients were treated in the Third People's Hospital of Xuzhou City from January 2013 to April 2016. The cases were divided into mild group, moderate-severe group and fulminant group according to the concentration of paraquat in urine. The clinical data and CT imaging findings were analyzed and reconstructed in three-dimensional reconstruction. The extent of the lesion was observed and the relationship between CT and prognosis was explored.Results:Paraquat lung injury has many manifestations on CT images, and it's performance can be intersecting at the same time. Early lesions lighter cases, late CT imaging lesions can be completely absorbed or residual fibrosis, the prognosis was good; the early lesion was pulmonary consolidation, pleural effusion cases, the late CT image was usually pleural thickening and bronchiectasis, the prognosis was relatively good; early lesions were large patches of ground glass opacity cases, finally, pulmonary fibrosis was common, the mortality rate of 56.57%. There were significant differences in the extent of lung injury between different groups ( P<0.001) , and the difference in mortality was statistically significant when the lung injury was different ( P<0.001) . Multivariate stepwise Logistic regression analysis showed that ground-glass opacity ( OR value=2.013) , interstitial lung fibrosis ( OR=3.779) and mediastinal emphysema ( OR=33.118) were risk factors for death of lung injury caused by paraquat poisoning ( P<0.05) . Conclusion:There were many manifestations on CT images of paraquat lung injury, and the manifestations of paraquat lung injury can be intersecting at the same time. The pulmonary manifestations and outcomes of different paraquat types were different. The CT manifestations of lung injury in paraquat poisoning were mainly exudative changes at early stage, and can be gradually absorbed or evolved into interstitial changes at later stage. The cumulative damage range can be used as a reference for evaluating the prognosis. Ground-glass opacity, interstitial pulmonary fibrosis and mediastinal emphysema are the risk factors for death of lung injury caused by paraquat poisoning.