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To understand the current situation of occupational exposure to blood-borne pathogens in a women's and children's hospital and analyze the causes to provide a scientific basis for improving occupational exposure prevention and control measures. We analyzed occupational exposure to blood-borne pathogens in a third-class women's and children's hospital from 2015 to 2018, considering the workers’ occupational categories and length of service; the sites, types, and causes of exposure; and the pathogens of the source patients. From 2015 to 2018, there were 146 cases of occupational exposure to blood-borne pathogens, mainly from sharp-instrument injuries (81.5%; 119/146). Trainees represented the highest proportion of occupational exposure (30.1%; 44/146), followed by nurses (29.5%; 43/146). Occupational exposure among staff with less than one year of service accounted for 43.2% (63/146) of cases. Fisher's exact test showed that different occupational groups had different types of occupational exposure, and among the occupationally exposed populations, the proportion of sharp injuries is higher than that of blood and body fluid exposure, and the difference is statistically significant ( χ 2  = 12.937, P  = 0.008). Different occupational groups faced exposure to different types of pathogens: medical staff were more likely than workmen to be exposed to hepatitis B, while workmen were more likely than medical staff to be exposed to unknown pathogens; these differences were statistically significant ( χ 2  = 55.344, P  < 0.001). Health records were established for all cases of occupational exposure to blood-borne pathogens, and no staff members contracted a blood-borne disease due to occupational exposure. In order to reduce occupational exposure, regular training in occupational protection for junior medical staff and workers should be strengthened, the monitoring and protection system of occupational exposure to blood-borne pathogens improved, standard prevention measures strengthened, operations standardized, safe injection equipment provided, and comprehensive measures taken.

To assess the prevalence of sharp injuries among healthcare workers (HCWs) in a tertiary specialist hospital and analyze the influencing factors to improve protective measures and mitigate exposure risks. A retrospective study was conducted using occupational exposure data from 2019 to 2022. Descriptive statistics, univariate analysis, and multivariate logistic regression were used for statistical analysis, focusing on factors such as gender, years of service, occupation, and exposure department. Among 151 reported occupational exposures, 76.16% (115/151) were sharp injuries. Significant differences were observed in age ( P  < 0.05), years of service ( P  = 0.04), and year of exposure ( P  = 0.02). Multivariate analysis revealed that healthcare workers with 1–5 years of service had a lower risk of sharp injuries compared to those with ≤ 1 year of service or > 5 years of service (OR 0.26, 95% CI 0.09–0.76). The risk of sharp injuries was significantly higher in 2021 (during the COVID-19 pandemic) compared to 2019 (OR 4.32, 95% CI 1.23–18.25). Most injuries occurred on the hands, with HBV being the primary blood-borne pathogen. No infections were reported during follow-up. This study highlights the need for tailored interventions and comprehensive protective measures for HCWs with varying years of service, particularly during public health emergencies like COVID-19, to mitigate sharp injuries and enhance occupational safety.

Background High parental expectations are increasingly recognized as a risk factor for youth mental health, yet the mechanisms underlying this association remain understudied, particularly in contexts like China where academic and familial pressures are pronounced. Existing literature highlights links between parental expectations and psychological distress but lacks clarity on mediating pathways. Methods This cross-sectional study analyzed data from 1,445 Chinese college students, using structural equation modeling (SEM). The model examined direct and indirect effects of parental expectations on psychological distress, with perceived stress and core self-worth as mediators, while controlling for co-variables. Results Parental expectations exhibited a substantial total effect on psychological distress (β = 0.216, p  < 0.001). Direct effects accounted for 43% of this association (β = 0.093), while 57% operated indirectly through three pathways: (1) perceived stress alone (27.3% mediation, β = 0.059), (2) a sequential chain of heightened stress, reduced core self-worth, and exacerbated distress (22.7% mediation, β = 0.049), and (3) reduced core self-worth alone (7.0% mediation, β = 0.015). The dual-mediator model revealed how parental expectations trigger stress-driven erosion of self-worth and, independently, a direct erosion of self-worth, disproportionately affecting young adults. Conclusion These findings underscore the dual nature of parental expectations as both direct and cascading stressors. The study advances stress-appraisal theories by elucidating mechanisms through which external pressures from parental expectation internalize as psychological harm. Culturally tailored interventions should target stress resilience and core self-worth reinforcement. By addressing conditional acceptance and fostering autonomy, strategies can mitigate mental health risks tied to excessive parental demands. This research calls for policy and educational reforms to balance parental aspirations with children’s well-being, emphasizing systemic support for marginalized youth.

Adolescent health risk behaviors are a public health priority given their prevalence and their associations with chronic diseases and life quality in adulthood. This study examined the heterogeneity of adolescent health risk behaviors and the associations between demographic characteristics and subgroup membership in rural western China. In fall 2015, 2805 students from rural middle schools in Sichuan Province were surveyed using the Health-Related Behavior Questionnaire for Adolescents. Latent class analysis (LCA) was used to identify subgroups of adolescents with distinct patterns of health risk behaviors. Differences in class membership related to selected demographic characteristics were examined using multinomial logistic regression analysis. A four-class model emerged: (1) high-risk group (n = 108, 4.0%), (2) high-physical-inactivity and suicide-risk group (n = 340, 12.1%), (3) moderate-risk group (n = 897, 32.0%), and (4) low-risk group (n = 1460, 52.1%). The multinomial logistic regression analysis revealed that boys and adolescents with poor parental relationships and high allowances (spending money) were significantly more likely to be in the high-risk group than the low-risk group. Adolescents in rural western China are a heterogeneous population requiring different tailored and effective interventions.

Background Ensuring universal health coverage and equitable access to health services requires a comprehensive understanding of spatiotemporal heterogeneity in healthcare resources, especially in small areas. The absence of a structured spatiotemporal evaluation framework in existing studies inspired us to propose a conceptual framework encompassing three perspectives: spatiotemporal inequalities, hotspots, and determinants. Methods To demonstrate our three-perspective conceptual framework, we employed three state-of-the-art methods and analyzed 10 years’ worth of Chinese county-level hospital bed data. First, we depicted spatial inequalities of hospital beds within provinces and their temporal inequalities through the spatial Gini coefficient. Next, we identified different types of spatiotemporal hotspots and coldspots at the county level using the emerging hot spot analysis (Getis-Ord Gi* statistics). Finally, we explored the spatiotemporally heterogeneous impacts of socioeconomic and environmental factors on hospital beds using the Bayesian spatiotemporally varying coefficients (STVC) model and quantified factors’ spatiotemporal explainable percentages with the spatiotemporal variance partitioning index (STVPI). Results Spatial inequalities map revealed significant disparities in hospital beds, with gradual improvements observed in 21 provinces over time. Seven types of hot and cold spots among 24.78% counties highlighted the persistent presence of the regional Matthew effect in both high- and low-level hospital bed counties. Socioeconomic factors contributed 36.85% (95% credible intervals [CIs]: 31.84–42.50%) of county-level hospital beds, while environmental factors accounted for 59.12% (53.80–63.83%). Factors’ space-scale variation explained 75.71% (68.94–81.55%), whereas time-scale variation contributed 20.25% (14.14–27.36%). Additionally, six factors (GDP, first industrial output, local general budget revenue, road, river, and slope) were identified as the spatiotemporal determinants, collectively explaining over 84% of the variations. Conclusions Three-perspective framework enables global policymakers and stakeholders to identify health services disparities at the micro-level, pinpoint regions needing targeted interventions, and create differentiated strategies aligned with their unique spatiotemporal determinants, significantly aiding in achieving sustainable healthcare development.

Background There has been sharp increase in the incidence of hip fractures (HFs) with the increasing aging globally. However, it remains ambiguous regarding the association between HF risk and sleep duration. This study intended to explore the association between sleep duration and HF risk among the older adults. Methods The study assessed a cohort of 7,540 participants aged at least 60 years old using data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010, as well as from 2013 to 2014. Two distinct groups of HF and non-HF were constructed on the basis of their history of HFs. Based on the self-reported sleep duration through a structured questionnaire, multivariate logistic regression analyses were conducted to examine the relationship between sleep duration and HF risk. In addition, restricted cubic splines (RCS) were used to assess linearity. The receiver operating characteristic (ROC) curve was used to explore the threshold of sleep duration for HF risk. Results HFs were found in 129 patients among the 7,540 participants over 60 years of age with mean age of 70.17 ± 7.1 years. Significant differences in sleep duration were observed between the HF and non-HF groups (7.73 ± 1.68 h vs. 7.11 ± 1.42 h; p  = 0.006). The multivariate analysis was adjusted for sociodemographic, behavioral lifestyle, and comorbidities. A 1-h increase in sleep duration was associated with higher odds of having prior hip fractures in unadjusted models [odds ratio (OR) = 1.36; 1.11, 1.67; p  = 0.004], minimally adjusted models (OR = 1.23; 1.03, 1.48; p  = 0.025), second adjusted models (OR = 1.22; 1.02,1.45; p  = 0.026) and fully adjusted models (OR = 1.22; 1.03,1.45; p  = 0.026). The relationship remained consistent across all four models, indicating the correlation of a longer sleep duration with an elevated HF risk. RCS analysis revealed a statistically linear relationship between sleep duration and HF risk (p-nonlinear = 0.244, p-overall < 0.01). In addition, the identified threshold of sleep duration linked to HF risk was determined to be 7.5 h among the older adults (AUC = 0.611). Conclusion This study suggests an linear association between sleep duration and the risk of HFs. Further research is needed to validate these findings and more clearly identify the clinical relevance of this potential relationship.

Objectives Built on the Positive Youth Development (PYD) framework, this study examined how physical activity affected the subjective well-being of adolescents in the multi-ethnic area of southwest China. The mediating role of school connectedness as an external development asset and the moderating role of resilience as an internal development asset were specified and tested within the framework of sport-based PYD. Methods A cross-sectional survey of 3143 adolescents (47.2% boys with mean age = 12.88 and SD  = 1.68) was conducted in 2020. A structural equation model (SEM) was developed to estimate the direct effect of physical activity, the mediating effect of school connectedness, and the moderating effect of resilience on adolescents’ subjective well-being. Multi-group comparison was made to investigate differences and similarities across three parental absence subgroups: (1) both parents present, (2) one parent absent, and (3) both parents absent. Results As surmised, physical activity, school connectedness, and resilience all positively and significantly affected adolescents’ subjective well-being. SEM analyses revealed that school connectedness mediated the effect of physical activity on subjective well-being. Moreover, resilience moderated both the direct and indirect effects of physical activity (through school connectedness) on subjective well-being. Finally, the multi-group comparison revealed a moderating effect of parental absence on the moderated mediation model. Limitations This study is a cross-sectional survey, so inference of causal associations among the study variables is impossible. Conclusions Healthy lifestyle behaviors, school-supportive settings, and positive individual development assets can enhance the subjective well-being of adolescents in southwest China, especially those whose parents were absent. Physical activity interventions informed by the PYD framework should be incorporated into public health programs designed to foster the physical and mental health of left-behind adolescents in southwest China.

Background Previous studies have yielded inconsistent findings regarding the association between age at menopause and bone health, with limited exploration of potential mediating factors, particularly in the less-developed muti-ethnic regions of China. Our objective was to analyze the association between age at menopause and bone health among postmenopausal women in southwest China, while also examining the mediating effect of body mass index (BMI) and the moderating effect of years since menopause on this association. Methods and results The analysis included a total of 15,352 naturally postmenopausal women obtained from the baseline data of the China Multi-Ethnic Cohort (CMEC) Study. Multiple linear regression was used for multivariate analysis. Mediation analysis was conducted to examine the mediating role of BMI in the association between age at menopause and bone health. A significant positive association was observed between age at menopause and bone health index (Quantitative ultrasound index, QUI). Specifically, with each year’s delay in age at menopause, there was an increase of 0.260 (95% confidence interval (CI): 0.152–0.368) in QUI. Notably, women with later menopause (menopausal age ≥ 53 years) exhibited a higher QUI ( β : 2.684, 95%CI: 1.503–3.865). Additionally, BMI partially mediated the relationship between age at menopause and QUI, accounting for 9.0% of the total effect, with an indirect effect coefficient β (95%CI) was 0.023(0.014, 0.032). Besides, it is worth mentioning that years since menopause moderated the association between age at menopause and bone health as well as the mediating effect of BMI. Conclusion Naturally postmenopausal women with a later age at menopause demonstrate enhanced bone health. Maintaining a moderately high BMI, without progressing to overweight or obesity, may provide health benefits for postmenopausal women, especially for those with a longer duration since menopause.

Purpose To analyse the relationship between multiple anatomic characteristics of the knee (tibia and femur) and isolated meniscal injury in women and men. Methods Forty-seven patients with isolated medial meniscal injuries, 62 patients with isolated lateral meniscal injuries, and 70 control subjects were included. Medial posterior tibial slope (MTS), lateral posterior tibial slope (LTS), medial tibial plateau depth (MTD), coronal tibial slope (CTS), femoral notch width (NW), femoral condylar width (FCW), intercondylar notch depth (ND), femoral notch width index (NWI), intercondylar notch shape index (NSI), and cruciate ligaments tensity (CLT) were measured from magnetic resonance images. Anatomic characteristics differing between groups were compared, and risk factors for isolated meniscal injury were identified by multivariate forward stepwise logistic regression for men and women separately. Results Risk factors for an isolated medial meniscal injury were a steeper MTS and a lowered MTD in men, and a steeper MTS and an increased NWI in women. Risk factors for isolated lateral meniscal injury were a steeper LTS and an increased NW in men, and a steeper LTS and a lowered ND in women. Risk factors for both medial and lateral meniscal injuries were a higher CTS, an increased NWI, and a looser CLT in men, and a higher CTS, an increased NSI, and a looser CLT in women. Conclusion The anatomic characteristics of the tibial plateau, femur, and cruciate ligaments influence the risk of suffering isolated meniscal injury, and the risk factors differ between men and women. This study provides a reference for developing identification criteria for those at risk of isolated meniscal injury. Level of evidence III.

Objective There are few studies regarding Internet use behaviors of Chinese rural adolescents based on behavioral theory. The aim of this study is to examine the applicability and effectiveness of the health action process approach model (HAPA) in the intervention of excessive Internet use behaviors among rural adolescents in China. Methods Three hundred twenty-seven participants who met the excessive Internet use criteria were involved in this study. Four interventions based on the HAPA model were conducted during 2015–2017. The structural equation model (SEM) was applied to fit the HAPA model. Results The rate of average daily time spent online on weekends more than 4 h dropped from 57.2 to 39.1% ( P  < 0.001). The rate of daily game time more than 2 h decreased from 51.1 to 35.2% ( P  < 0.001). The result of SEM showed that both the applicability and effectiveness of the HAPA model were well in the intervention of excessive Internet use behaviors with good fitted indicators (χ 2 /df = 2.066, GFI = 0.889, CFI = 0.938, TLI = 0.928, IFI = 0.938, RMSEA = 0.057). The direct and indirect effects of the main pathways in the HAPA model were statistically significant ( P  < 0.05). The comparison analysis of HAPA model variables identified that outcome expectancy, intention, maintenance self-efficacy had been improved significantly after interventions. Conclusion The intervention measures based on the HAPA model can effectively reduce excessive Internet use behaviors of Chinese rural adolescents, mainly through strengthen outcome expectancy, intention, and maintenance self-efficacy.