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Objectives Non-suicidal self-injury (NSSI) behavior is a severe public health issue in adolescents. This study investigated the possible impact of the coronavirus disease 2019 (COVID-19) and analyzed psychological risk factors on adolescent NSSI. Methods A one-year follow-up study was conducted in September 2019 (Time 1) and September 2020 (Time 2) among 3588 high school students. The completed follow-up participants ( N  = 2527) were classified into no NSSI (negative at both time points), emerging NSSI (negative at Time 1 but positive at Time 2), and sustained NSSI (positive at both time points) subgroups according to their NSSI behaviors before and during the COVID-19 pandemic. Perceived family functioning, perceived school climate, negative life events, personality traits (neuroticism, impulsivity, and self-control) were assessed using self-report scales. Results The data indicated an increase (10.3%) in the incidence of NSSI. Compared to no NSSI subjects, the emerging NSSI and sustained NSSI subgroups had lower perceived family functioning, higher neuroticism, higher impulse-system but lower self-control scores, and more negative life events. Logistic regressions revealed that after controlling for demographics, neuroticism and impulse-system levels at Time 1 positively predicted emerging NSSI behavior, and similarly, higher neuroticism and impulsivity and lower self-control at Time 1 predicted sustained NSSI behavior. Conclusions These findings highlighted the aggravated impact of the COVID-19 on NSSI, and suggested that individual neuroticism, impulsivity, and self-control traits might be crucial for the development of NSSI behavior among adolescent students.

Online medical consultation can serve as a valuable means for rural residents to access high-quality health care resources, thereby mitigating the geographic and economic disadvantages prevalent in rural areas. Nevertheless, due to lower cognitive abilities, rural residents often face challenges in trusting and making effective use of online medical consultations. More likely, adopting a bounded rational decision-making model that facilitates the \"offline-to-online\" trust transfer could prove to be a potentially effective approach. This strategy aims to encourage less technologically experienced rural residents to trust and make use of online medical consultations. This study aims to characterize the status of \"offline-to-online\" trust transfer among rural residents in the context of internet health care, and analyze its direct impact on facilitating the utilization of online medical consultation. Additionally, we investigate the family spillover effect of \"offline-to-online\" trust transfer in promoting the use of online medical consultation among rural family members, considering its distributional effect across various education levels of the population. A multistage stratified random sampling method was used to survey participants in rural areas of China from July to September 2021, encompassing a total of 2597 rural residents from 960 rural households. Propensity score values were estimated using logit regression, and the propensity score matching method, using the K-nearest neighbor matching, radius matching, and kernel matching methods, was applied to create matched treatment and control samples of rural residents based on their experience of \"offline-to-online\" trust transfer. Subsequently, we calculated average treatment effect scores to compare the differences in utilizing online medical consultation between the treatment and control rural samples. As many as 551/960 (57.4%) rural residents experienced an \"offline-to-online\" trust transfer, with a higher likelihood observed in the older population with lower levels of education and higher satisfaction with local health care services. Furthermore, rural residents who underwent \"offline-to-online\" trust transfer were 37%-40% more likely to utilize online medical consultation compared with those who did not experience this trust transfer. Additionally, family members of householders who underwent \"offline-to-online\" trust transfer were 25%-28% more likely to utilize online medical consultation than those whose householders did not experience this trust transfer. Notably, when compared with populations with high-level education, the \"offline-to-online\" trust transfer had more significant direct and spillover effects on the utilization of online medical consultation services among rural residents with low-level education. To enhance the \"offline-to-online\" trust transfer among rural residents and its facilitation in their utilization of online medical consultation, as well as other mobile health (mHealth) and ubiquitous health (uHealth) services, we recommend that online health care providers adopt a \"patient-oriented\" service model. This approach aims to elevate rural residents' satisfaction with local health care services and harness the trust-building functions inherent in physician-patient relationships and among family members.

Background Influenced by various factors such as socio-demographic characteristics, behavioral lifestyles and socio-cultural environment, the multimorbidity patterns in old adults remain complex. This study aims to identify their characteristics and associated multi-layered factors based on health ecological model. Methods In 2019, we surveyed a total of 7480 participants aged 60+ by using a multi-stage random cluster sampling method in Shanxi province, China. Latent class analysis was used to discriminate the multimorbidity patterns in old adults, and hierarchical regression was performed to determine the multi-layered factors associated with their various multimorbidity patterns. Results The prevalence of multimorbidity was 34.70% among the old patients with chronic disease. Over half (60.59%) of the patients with multimorbidity had two co-existing chronic diseases. “Degenerative/digestive diseases”, “metabolic diseases” and “cardiovascular diseases” were three specific multimorbidity patterns. Behavioral lifestyles-layered factors had the most explanatory power for the three patterns, whose proportions of explanatory power were 54.00, 43.90 and 48.15% individually. But the contributions of other multi-layered factors were different in different patterns; balanced diet, medication adherence, the size of family and friendship network, and different types of basic medical insurance might have the opposite effect on the three multimorbidity patterns ( p  < 0.05). Conclusions In management of old patients with multimorbidity, we should prioritize both the “lifestyle change”-centered systematic management strategy and group-customized intervention programs.

Background One of the effective ways to control hypertension is long-term self-management, which is difficult to maintain. Therefore, understanding how people engage in the process of self-management behaviour change is necessary. In this study, we aimed to examine the dynamic relationship between self-perceived disease control and self-management behaviours in Chinese middle-aged and older hypertensive patients, namely, medication use, self-monitoring, physical activity, tobacco and alcohol avoidance, and to explore the mediating role of subjective life expectancy (SLE) on this relationship. Methods Data were obtained from a nationally representative sample of 508 middle-aged and older hypertensive patients (aged 45+) from the 2013, 2015, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. A cross-lagged panel model combined with mediation analysis was used to determine the dynamic relationship between self-perceived disease control and self-management behaviours and to clarify the mediating effect of SLE on this ascertained relationship. Results Good self-perceived disease control subsequently predicted good medication use, self-monitoring and physical activity, and vice versa. Subjective life expectancy (SLE) partially mediated the prospective reciprocal relationships between self-perceived disease control and these self-management behaviours, which accounted for 37.11, 25.88, and 19.39% of the total effect of self-perceived disease control on medication use, self-monitoring and physical activity, respectively. These self-management behaviours had a significant and positive feedback effect on self-perceived disease control. However, neither the direct and indirect effects (via SLE) of self-perceived disease control on tobacco and alcohol avoidance were revealed. Conclusions Positive feedback loops of present self-perceived disease control, future SLE and self-management behaviours (medication use, self-monitoring, and physical activity) help middle-aged and older hypertensive patients adhere to these behaviours but are useless for the avoidance of addictive behaviours. Interventions aimed at enhancing the effect perception of general self-management behaviours (e.g., medication use, self-monitoring and physical activity) on the present disease control perspective, and future lifespan perspective would be beneficial for the consistent self-management behaviours of middle-aged and older hypertensive patients. The utility of present disease control perception to these self-management behaviours was much higher than the utility of future expectations. Alternative stress relief strategies may be conducive to long-term changes in addictive behaviours.

Di-(2-ethylhexyl) phthalate (DEHP) has the potential to disrupt the thyroid endocrine system, but the underlying mechanism is unknown. In this study, zebrafish (Danio rerio) embryos were exposed to different concentrations of DEHP (0, 40, 100, 200, 400 μg/L) from 2 to 168 hours post fertilization (hpf). Thyroid hormones (THs) levels and transcriptional profiling of key genes related to hypothalamus-pituitary-thyroid (HPT) axis were examined. The result of whole-body thyroxine (T4) and triiodothyronine (T3) indicated that the thyroid hormone homeostasis was disrupted by DEHP in the zebrafish larvae. After exposure to DEHP, the mRNA expressions of thyroid stimulating hormone (tshβ) and corticotrophin releasing hormone (crh) genes were increased in a concentration dependent manner, respectively. The expression level of genes involved in thyroid development (nkx2.1 and pax8) and thyroid synthesis (sodium/iodide symporter, nis, thyroglobulin, tg) were also measured. The transcripts of nkx2.1 and tg were significantly increased after DEHP exposure, while those of nis and pax8 had no significant change. Down-regulation of uridinediphosphate-glucuronosyl-transferase (ugt1ab) and up-regulation of thyronine deiodinase (dio2) might change the THs levels. In addition, the transcript of transthyretin (ttr) was up-regulated, while the mRNA levels of thyroid hormone receptors (trα and trβ) remained unchanged. All the results demonstrated that exposure to DEHP altered the whole-body thyroid hormones in the zebrafish larvae and changed the expression profiling of key genes related to HPT axis, proving that DEHP induced the thyroid endocrine toxicity and potentially affected the synthesis, regulation and action of thyroid hormones.

Background Recognizing the effect of the digital economy on residents’ health can transform technological dividends into health and well-being and provide the basis for the construction of a “health-oriented” digital society development path. Methods This paper explores the direct impact of the digital economy on residents’ health and its mechanism by constructing a digital economic development index and combining data from the China Family Panel Studies (CFPS). Results The digital economy has a health-improving effect. At the individual level, the mechanism is to accumulate social capital and improve the quality of employment, whereas at the regional level, the mechanism is to promote the equalization of basic public services and improve the quality of the environment. The effectiveness of government governance plays a beneficial moderating role in this mechanism. The heterogeneity analysis shows that the digital economy had a more significant effect on the central, western, rural, and economically underdeveloped cities, as well as on males and the low-health group. Further analysis reveals that the digital economy increases intergenerational health mobility and helps alleviate health inequalities. Conclusions This paper not only enriches the study of health determinants but also provides a reference for collaboration between global digitalization and health governance.

Aim The objective of this study was to investigate the level of soluble suppression of tumorigenicity-2 (sST2) in patients with acute ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI), and to provide a new biomarker for clinical management and prognosis assessment. Method This was a prospective study. 148 STEMI patients following primary PCI were enrolled and divided into 2 groups by the median value of sST2 and afterwards followed up for 30 days to access the occurrence of major adverse cardiac events (MACEs), which were defined as cardiovascular death, heart failure and recurrent MI. Results sST2 ranged from 20.57 to 98.96 ng/mL. High sST2 group had higher MACEs rate compared to low sST2 group (28.8% vs. 8.0%, P  = 0.001). sST2 was positively correlated with age (r = 0.181, P  = 0.027), SYNTAX score (r = 0.257, P  = 0.002), high-sensitive C-reactive protein (hs-CRP) (r = 0.225, P  = 0.006), B-type natriuretic peptide (BNP) (r = 0.225, P  = 0.006) and negatively with left ventricle ejection fraction (LVEF) (r = -0.197, P  = 0.016). After adjustment for clinical variables, sST2 level (OR 3.680, P  = 0.015) and LVEF (OR 0.880, P  < 0.001) remained independent predictors of 30-days MACEs. In receiver operating characteristic curve (ROC) analyses, the area under the curve (AUC) of sST2 for predicting 30-days MACEs was 0.755( P  < 0.001). The AUC of sST2 combining hs-CRP and LVEF for prediction was 0.828(95%CI [0.743–0.912], P  < 0.001). Conclusion sST2 level after primary PCI was an independent risk factor of MACEs in STEMI patients through 30 days follow-up.

Background Fruit acidity and color are important quality attributes in peaches. Although there are some exceptions, blood-fleshed peaches typically have a sour taste. However, little is known about the genetic variations linking organic acid and color regulation in peaches. Results Here, we report a peach graph-based pangenome constructed from sixteen individual genome assemblies, capturing abundant structural variations and 82.3 Mb of sequences absent in the reference genome. Pangenome analysis reveals a long terminal repeat retrotransposon insertion in the promoter of the NAC transcription factor (TF) PpBL in blood-fleshed peaches, which enhances PpBL expression . Genome-wide association study identifies a significant association between PpBL and malate content. Silencing PpBL in peach fruit and ectopic overexpression of PpBL in tomatoes confirm that PpBL is a positive regulator of malate accumulation. Furthermore, we demonstrate that PpBL works synergistically with another NAC TF, PpNAC1, to activate the transcription of the aluminum-activated malate transporter PpALMT4 , leading to increased malate content. Conclusions These findings, along with previous research showing that PpBL and PpNAC1 also regulate anthocyanin accumulation, explain the red coloration and sour taste in blood-fleshed peach fruits.