Regional economy, physical environment and self-rated health among older adults in China: Evidence from XGBoost and SHAP.

To assess the perceived effectiveness of the school nurse services through students' responses and to examine whether there is a detectable relationship between the students' subjective health status and the school nurse's service delivery. We conducted our cross-sectional, quantitative research in the West Transdanubian region of Hungary using convenience sampling among high school students (n = 429). Given the non-probability sampling, the findings may not be generalizable to all student populations. Data were collected using standardized (SF-36, EQ-VAS, questions on the prevalence of subjective health complaints from the HBSC survey) and a self-developed questionnaire. Chi-square tests, correlation analyses and multivariable linear regression analyses were performed using SPSS Statistics 27.0 software. Students reported a higher level of health-related knowledge received from the school nurse, along with better perceived applicability of this knowledge in everyday life (p < 0.05). Nearly three quarters of respondents indicated that the school nurse's activities contributed to the development of their health-related attitudes and this perception showed a statistically significant association with both the quantitative and qualitative evaluation of the care provided (p < 0.05). Higher ratings of the perceived effectiveness of school nursing activities were associated with more favourable self-rated mental health and a lower level of reported health complaints; however, these associations were weak in magnitude. The results revealed statistically significant but weak associations between perceived school nurse services and selected indicators of students' self-rated health status. Due to the cross-sectional design and the use of self-reported data, causal inferences cannot be drawn. Nonetheless, the findings suggest that more favourable quantitative and qualitative evaluations of the care provided are linked to higher perceived effectiveness of school nurse activities. Further research on quality indicators of school nurse services and approaches tailored to students' needs may be warranted. The observed associations between students' perceptions of school nurse services and their health perceptions underscore the importance of continuous professional development for school nurses. This may include advanced training in health education and communication skills to further support the perceived effectiveness of their activities. What problem did the study address? We addressed the perceived effectiveness of school nurse services from the perspective of students and examined whether there is a detectable relationship between students' subjective health status and the services provided by school nurses. What were the main findings? The study found that higher levels of health-related knowledge reported as being provided by the school nurse were associated with more favourable student ratings of the applicability of this knowledge in everyday life. Students who reported more positive experiences with school nurse activities also tended to report more favourable health perceptions, which were reflected in the indicators used to evaluate the services. In addition, higher perceived effectiveness of school nurse services was associated with more favourable self-reported mental health and vitality, as well as a lower level of reported health complaints. Where and on whom will the research have an impact? The findings may be particularly relevant for school nurses, as they highlight the importance of their role and the potential need for continuous attention to service quality from the students' perspective. They may also be informative for students and school communities by underscoring that health education and services provided by school nurses are associated with more favourable self-reported health perceptions and overall well-being. No patients or members of the public were involved in the design, conduct, analysis, or reporting of this study beyond students' participation as anonymous questionnaire respondents.

Sedentary behavior and physical health status explain the relationship between years of residence in socioeconomically distressed counties and risk for Cardiovascular diseases.

School active commuting is a key behavior to promote physical activity in children, yet limited evidence exists in Chile. This study examined its prevalence and associated factors among Chilean schoolchildren. A cross-sectional study was conducted using data from the Chilean National Physical Activity and Sports Habits Survey, including a subsample of 1137 children aged 5-10 years derived from a nationally representative survey. School active commuting was defined as the dependent variable. Independent variables included sex, area of residence, socioeconomic status (SES), caregiver's education, self-rated health, leisure activities, and home-based physical or sedentary behaviors. About one in three children (35%) reported commuting actively to school. Boys showed higher participation than girls, and active commuting was more common among children from lower SES households and among those whose caregivers had lower educational attainment. Children who preferred physical activities during leisure time were also more likely to commute actively. No differences were observed by geographic area, self-rated health, or home-based activity levels. Schools and local communities should work together to ensure safe, equitable, and accessible environments that support active commuting. Active commuting remains low in Chilean children, emphasizing the need for multisectoral policies to promote physical activity and reduce inequalities.

Evaluation of the chronic disease self-management program in adults with epilepsy in a nationwide community network.

Smartphone function preference patterns and cognitive function in middle-aged and older Chinese adults: A cluster analysis study.

Development of an interpretable machine learning model-based online tool for risk identification of anxiety symptoms in Chinese older adults.

Health status in the valuation of benefits from improved air quality: Evidence from a systematic review and meta-regression of stated preference studies.

The goal of this paper is to identify environmental, behavioral, and genetic predictors and early midlife correlates of problematic alcohol Use (PAU) patterns from adolescence to early midlife. The data are from 1463 twin individuals (60.5% female) in the population-based FinnTwin12 cohort born 1983-1987. PAU was assessed at ages 14, 22 and 37 using symptoms of alcohol use disorder (AUD) obtained from psychiatric interviews, mmMAST scores, and the AUDIT. Self-reported health and well-being were assessed at age 37. A behavioral and environmental risk index (BERI) was created by summing six risk factors: low socioeconomic status in childhood, family history of AUD, childhood externalizing and internalizing behaviors, adolescent substance use, peer substance use, and stressful life events in adolescence. The twins' genetic predispositions were indexed using polygenic scores for externalizing behavior (PGSEXT), PAU (PGSPAU), and depression (PGSMDD). Twins were classified into four PAU groups: Never (n = 599, reference), Remitted (n = 480), Persistent (n = 271), and Late-onset (n = 113). When included in the same model, both BERI and PGSEXT were significantly associated with Remitted PAU, while BERI scores and PGSPAU were significantly associated with Persistent PAU. Compared to the Never PAU group, individuals in the Persistent and Late-onset PAU groups reported lower educational attainment, poorer physical health, lower relationship satisfaction, lower life satisfaction, a worse financial situation, more depressive symptoms, recurrent pain, and sleep problems, and were less likely to be partnered or have children. Persistent PAU was associated with the most negative outcomes in early midlife, and childhood and adolescent risk factors and genetic risk as indexed by PGSPAU were strong predictors of group membership. Late-onset PAU may be the result of novel stressors in adulthood, given the lack of association with childhood and adolescent environmental risk or genetic risk.

Oral microbiome dysbiosis mediates the link between emotional disorders and systemic inflammation in heart failure.

Type 2 diabetes mellitus (T2DM) increases the risk of developing periodontal disease, and severe periodontal disease leads to poor diabetic control based on blood levels of glycated hemoglobin (HbA1c). However, less is known about diabetic control and caries. The authors aimed to compare HbA1c levels in a cohort of All of Us Research Program study participants with T2DM who had received a diagnosis of caries, gingivitis, or periodontitis. Included in this cross-sectional study were people who received a diagnosis of T2DM; a mutually exclusive diagnosis of caries, gingivitis, or periodontitis; and an HbA1c laboratory value within plus or minus 90 days of receiving the dental diagnosis. The primary outcome was the level of diabetic control dichotomized into controlled (HbA1c ≤ 64 mmol/mol [8%]) and uncontrolled (HbA1c > 64 mmol/mol [8%]). Covariates included demographic charactersitics, body mass index, smoking history, and self-reported general health. Differences between exposure groups were tested using t tests and χ2 tests and logistic regression modeled diabetic control at the time of dental disease diagnosis. The analytic data set included 2,421 participants. Mean (SD) age at diabetes diagnosis was 52.3 (12.0) years; 50.8% of participants were women, 27.7% were Black, 35.6% were White, 29.2% were Hispanic, and approximately 50% reported annual household income less than $25,000. Participants who received a diagnosis of caries had higher mean HbA1c levels. Participants who received a diagnosis of gingivitis or periodontitis were more likely to have controlled T2DM than those who received a diagnosis of caries. The study results underscore the need for further research to clarify the association between caries and diabetes. Although it is widely accepted that a bidirectional association exists between T2DM and periodontal disease, increased awareness among health care professionals of other oral-systemic associations is warranted.

We characterized modifiable risk and protective factors for cognitive decline in India. Using the first nationally representative population-based longitudinal sample of N = 6168 older adults in India, we evaluated associations of risk factors (demographic characteristics, self-reported and objective health characteristics, health behaviors, and sensory function) for late-life cognitive decline with up to 6.4 years of follow-up (range: 2.8 to 6.4 years). The mean rate of general cognitive decline was -0.029 SD per year and was progressively steeper with age. Most risk factors, particularly demographic and cardiovascular characteristics, were associated with steeper cognitive decline in expected directions: Associations of history of high cholesterol or heart attack on rate of cognitive decline, for example, were comparable to being 8 to 10 years older. Most risk factors were associated with change in expected directions, highlighting the potential generalizability to India of previously identified risk factors for dementia.

Inflammation-related biomarkers have been implicated in a wide range of cancer-related symptoms and patient-reported outcomes (PROs), including fatigue, pain, and depression. To interpret biomarker data among cancer patients, normative reference values from healthy populations are essential. This cross-sectional study aimed to provide sex- and age-stratified reference data distributions for 12 inflammation-related serum biomarkers in a representative sample of Dutch adults without a history of cancer. Adults from the LISS panel were selected to match cancer cohorts from the PROFILES registry in age and sex. Participants completed questionnaires and optionally provided blood samples using harmonized protocols aligned with the PROFILES registry. Serum levels of IL-1α, IL-1β, IL-6, IL-8, IL-10, IL-17A, IL-22, CRP, TGF-α, IFN-γ, IL-1RA, and soluble TNF receptors I and II (sTNFRI/II) were quantified using the Meso Scale Discovery (MSD) platform. Cytokine levels were stratified by demographics, lifestyle factors, and self-reported health conditions. ANOVAs were used to compare groups. In total 720 panel members filled out the questionnaires, of which 265 (mean age = 59.0, 47.9% male) provided additional serum blood samples. Biomarker levels varied by sex, age, BMI, smoking status, and number of health conditions. Notably, higher levels of IL-1RA and sTNFRI/II were observed in individuals with obesity or diabetes. Individuals with osteoarthritis exhibited elevated IL-6 and IL-1β levels. This study offers a robust reference dataset for key inflammatory biomarkers, stratified by relevant demographics, lifestyle factors, and self-reported health conditions. These data facilitate interpretation of biomarker-PRO relationships in cancer survivors and support comparative research across chronic disease populations.

Excessive alcohol consumption contributes substantially to the global burden of disease, yet population-level evidence on disparities in high-risk drinking among people with disabilities remains limited. We aimed to estimate and compare trends in the prevalence of high-risk drinking and all-cause mortality associated with drinking behavior among men with disabilities and those without disabilities. Nation-wide serial cross-sectional study. South Korea, using linked administrative national health check-up and mortality databases. A total of 7 551 340 adult men who participated in the National Health Insurance Service health check-up program in 2017, including 450 536 men with registered disabilities and 7 100 804 men without disabilities. High-risk drinking was defined as consumption of seven or more standard drinks per occasion at least twice per week, based on self-reported health check-up questionnaires. Age-standardized prevalence of high-risk drinking was estimated annually from 2009 to 2017. Associations between disability characteristics and high-risk drinking were estimated using multivariable logistic regression in 2017. All-cause mortality occurring within 2017 was ascertained through deterministic linkage to the national death registry using unique personal identifiers. In 2017, age-standardized prevalence of high-risk drinking was 17 141 per 100 000 among men with disabilities and 23 226 per 100 000 among men without disabilities. Among men aged 20-49 years, prevalence was 29 710 per 100 000 in those with mild disabilities and 26 332 per 100 000 in those without disabilities. In 2017, compared with men without disabilities, mild disability was associated with higher odds of high-risk drinking [adjusted odds ratio (aOR) = 1.12, 95% confidence interval (CI) = 1.11-1.13], whereas brain injury was associated with lower odds (aOR = 0.61, 95% CI = 0.58-0.65). In 2017, age-standardized mortality rates were 131.4 per 100 000 among non-drinkers, 99.2 among high-risk drinkers, 77.3 among moderate drinkers and 59.9 among low-risk drinkers. Across drinking categories, several disability groups had adjusted odds ratios greater than 1.0 for all-cause mortality compared with those for men without disabilities within the same drinking category. High-risk drinking prevalence among South Korean men was lower among those with disabilities than among those without disabilities from 2009 to 2017, with declining trends in both groups. High-risk drinking prevalence among South Korean men appears to differ by disability characteristics. Mortality odds ratios within drinking categories vary by disability type and severity when compared with men without disabilities in the same drinking category.

Prenatal education programs are a key component of maternal and newborn health promotion. Although the use of digital platforms for prenatal education increased during the COVID-19 pandemic, evidence for their effectiveness remains limited. In addition, conventional programs often omit content addressing adverse pregnancy outcomes due to concerns about increasing maternal anxiety or worry. This quasi-experimental study aimed to (1) evaluate participants' satisfaction and perceived acquisition of knowledge and health habits following a novel online prenatal education program delivered via Facebook, and (2) assess the impact of a novel session on managing complications during pregnancy and childbirth-preterm birth, newborn adaptation difficulties, and stillbirth-on participants' levels of pregnancy-related anxiety and worry. Participants completed the State Anxiety Inventory and Cambridge Worry Scale (CWS) before and after the session on complications (N = 162), and the modified EDUMA2 questionnaire at the program's conclusion (N = 93). High satisfaction (mean 9.01/10), improved self-rated knowledge and health habits, and high rates of recommendation were found. Post intervention, statistically significant reductions were observed in worry scores (CWS), particularly regarding fetal health, childbirth, and miscarriage, with no significant increase in anxiety levels (State-Trait Anxiety Inventory [STAI-S]). The online modality did not fully meet the social interaction needs of pregnant women and appeared to limit the participation of women's partners and migrant women. Online prenatal education can effectively promote maternal health literacy and may effectively address sensitive topics such as pregnancy and childbirth complications. Future programs should integrate hybrid formats and strategies to reduce digital access barriers, especially among vulnerable populations.

Social determinants of health (SDOH) disproportionately affect racial/ethnic groups. However, little is known about how the cumulative burden of SDOH disadvantage on health status varies by race/ethnicity. To examine the relative burden of SDOH disadvantage by race/ethnicity on two measures of health status of Health Resources and Services Administration-funded health center patients. Cross-sectional study design. We used the 2022 Health Center Patient Survey to identify a sample of adult health center patients (n = 3912). We developed an overall composite score and five specific sub-scores for each SDOH domain-health risk, economic, social, access, and built environment-to measure cumulative burden of SDOH disadvantage. We used self-reported fair or poor health status and moderate or high psychological distress to measure general and mental health, respectively. We used logistic regression models to examine the independent association of each SDOH domain and their relative burden on health status measures by racial/ethnic groups. Across all groups, higher health risk (OR = 1.57), economic (1.29), social (1.30), access (1.56), and built environment (1.15) disadvantage; and higher health risk (1.14), economic (1.44), and access (1.77) disadvantage were associated with fair or poor general health and greater psychological distress, respectively. However, some relationships differed by race/ethnicity. For example, higher health risk and access disadvantage increased the likelihood of poor general health among Non-Hispanic Black/African American and Hispanic/Latino patients. But economic disadvantage was significant for the former and social disadvantage was significant for the latter. Our study highlighted the importance of accounting for differential burden of SDOH domains on racial/ethnic groups. This requires comprehensive measurement of SDOH and its meaningful use to inform and improve care for diverse health center patients. Access disadvantage across all racial/ethnic groups emphasized the importance of culturally appropriate care coordination to improve patient health.

Chronic respiratory diseases (CRD) are a leading global cause of death, with high comorbidity rates of depression and chronic pain forming a bidirectional relationship that is associated with worse prognosis. Existing research lacks systematic analysis of their association in CRD patients, and traditional statistical methods are limited in identifying complex relationships, highlighting the need for machine learning-based exploratory analysis. This cross-sectional study used data from the 2015 wave of the China Health and Retirement Longitudinal Study (CHARLS), including 1,702 eligible CRD patients. Depression was assessed by the CESD-10 scale, and chronic pain was defined as self-reported long-term pain. Six machine learning algorithms (XGBoost, SVM, MLP, LightGBM, RF, LR) were employed, with model performance evaluated by AUROC, accuracy, and other metrics. LASSO regression selected key features, and subgroup and restricted cubic spline analyses explored heterogeneity and dose-response associations. Among participants, 43.2% had chronic pain. CESD-10 score showed the strongest association with chronic pain (AUC = 0.762), with a significant dose-response relationship: the highest CESD-10 tertile had a 7.18-fold higher risk of chronic pain (95% CI: 2.45-4.78, P < 0.001) after full adjustment. The XGBoost model achieved the best predictive performance among the six tested models (test set AUROC = 0.830). Subgroup analysis showed a stronger depression-pain association in urban than rural residents (P for interaction = 0.016). Key predictive factors include self-rated health status, activities of daily living (ADL), and gender, among others. Depression severity is robustly associated with chronic pain in CRD patients in a dose-dependent manner. The XGBoost model provides reliable early identification tools. These findings support routine depression assessment and geographically tailored bio-psycho-social interventions to disrupt the depression-pain cycle and improve patient outcomes.

V-safe: Summary of findings reported after COVID-19 vaccination to a US CDC active safety surveillance system through June 2023.

Prevalence and correlates of e-cigarette use among older adults aged 60years and over.

To compare rates of return to work (RTW), at 18months post-injury/infection, between workers with an absence from work due to COVID-19 and those with non-COVID injuries and illnesses, and to examine if RTW differences are explained by different factors in the RTW process. Telephone interviews were conducted among 18,000 workers with accepted lost-time workers' compensation claims 18months after their claim acceptance: 607 with work-related COVID-19 infections (oversampled) and 393 with other work-related injuries/illnesses. Potential outcome mediation models examined factors at the individual, workplace, healthcare provider, and system level involved in differences in RTW between workers with COVID-19 and non-COVID-19 claims, adjusting for a range of confounders. At 18months post-injury, approximately 13 more workers with COVID-19 infections were at work, per 100 workers, compared to those with other injuries or illnesses. Differences in self-rated health, experiencing financial difficulties, and disagreement with the workers' compensation agency, explained between 12 and 21% of these total differences (between 1 and 2 more workers returning to work per 100 workers). Other mediators explained relatively little of the total effect. Workers with work-related COVID-19 infections have better RTW rates, 18 months post-injury, compared to workers with other types of work-related injuries. The results of our study suggest that factors identified as important for RTW at the workplace and healthcare provider level may not be generalizable to the context of COVID-19 infections, within the context of the COVID pandemic.