The Guangdong,Jiangxi and Fujian(GJF)provinces,located in the subtropical region of southeastern China,is one of the national key regions for soil erosion control and ecological restoration.This region is characterize...The Guangdong,Jiangxi and Fujian(GJF)provinces,located in the subtropical region of southeastern China,is one of the national key regions for soil erosion control and ecological restoration.This region is characterized by extensive red soil development and high rainfall erosivity,making it a representative landscape for exploring the interactions between land use change(LUC)and ecosystem services(ES).Despite the recognized importance of ES in hilly regions,comprehensive assessing the impacts of LUC on ES remain limited.This study investigates five key ES:water yield,soil conservation,carbon conservation,food supply,and habitat quality in GJF region from 2000 to 2020.By applying the InVEST model and the Geodetector method,we assessed the trade-offs,synergies,and transitions among ES,identified the natural and social drivers of ES dynamics,and quantified the contribution of LUC to ES changes using the ecosystem service contribution index.The results showed that cropland and woodland were the dominant land use types.Ecological restoration efforts positively influenced ES,with synergies intensifying and trade-offs diminishing over time.Land use conversions,particularly among woodland,grassland,and cropland,exerted significant impacts on ES.In particular,the conversion of woodland to other land uses had markedly negative effects on soil conservation,carbon conservation,and habitat quality.Forest cover was identified as a major driver of ES dynamics.These findings highlight the importance of maintaining and expanding forest and grassland cover,strengthening red soil conservation,and optimizing land use structure to achieve coordinated ecological protection and socioeconomic development in the subtropical hilly regions of southern China.展开更多
Accurately revealing the spatial heterogeneity in the trade-offs and synergies of land use functions(LUFs)and their driving factors is imperative for advancing sustainable land utilization and optimizing land use plan...Accurately revealing the spatial heterogeneity in the trade-offs and synergies of land use functions(LUFs)and their driving factors is imperative for advancing sustainable land utilization and optimizing land use planning.This is especially critical for ecologically vulnerable inland river basins in arid regions.However,existing methods struggle to effectively capture complex nonlinear interactions among environmental factors and their multifaceted relationships with trade-offs and synergies of LUFs,especially for the inland river basins in arid regions.Consequently,this study focused on the middle reaches of the Heihe River Basin(MHRB),an arid inland river basin in northwestern China.Using land use,socioeconomic,meteorological,and hydrological data from 2000 to 2020,we analyzed the spatiotemporal patterns of LUFs and their trade-off and synergy relationships from the perspective of production,living,ecological functions.Additionally,we employed an integrated Extreme Gradient Boosting(XGBoost)-SHapley Additive exPlanations(SHAP)framework to investigate the environmental factors influencing the spatial heterogeneity in the trade-offs and synergies of LUFs.Our findings reveal that from 2000 to 2020,the production,living,and ecological functions of land use within the MHRB exhibited an increasing trend,demonstrating a distinct spatial pattern of''high in the southwest and low in the northeast''.Significant spatial heterogeneity defined the trade-off and synergistic relationships,with trade-offs dominating human activity-intensive oasis areas,while synergies prevailed in other areas.During the study period,synergistic relationships between production and living functions and between production and ecological functions were relatively robust,whereas synergies in living-ecological functions remained weaker.Natural factors(digital elevation model(DEM),annual mean temperature,Normalized Difference Vegetation Index(NDVI),and annual precipitation)emerged as the primary factors driving the trade-offs and synergies of LUFs,followed by socioeconomic factors(population density,Gross Domestic Product(GDP),and land use intensity),while distance factors(distance to water bodies,distance to residential areas,and distance to roads)exerted minimal influence.Notably,the interactions among NDVI,annual mean temperature,DEM,and land use intensity exerted the most substantial impacts on the relationships among LUFs.This study provides novel perspectives and methodologies for unraveling the mechanisms underlying the spatial heterogeneity in the trade-offs and synergies of LUFs,offering scientific insights to inform regional land use planning and sustainable natural resource management in inland river basins in arid regions.展开更多
Economic development,food security,and ecological preservation are important issues encountered by karst re-gions.Faced with complex natural and social dynamics,we attempted to explore how interdependence within socio...Economic development,food security,and ecological preservation are important issues encountered by karst re-gions.Faced with complex natural and social dynamics,we attempted to explore how interdependence within socio-ecological system(SES)shaped sustainability in this region.A SES framework was constructed and three scenarios were predesigned:economic priority scenario,food security scenario,and ecological protection sce-nario.The System Dynamics model was used to simulate and forecast the evolution across various scenarios within the SES from 2005 to 2035.Through the Production-Possibility Frontiers in combined scenarios,trade-offpotential was identified and quantified.The results showed that the decoupling between social and ecological subsystems can be weaken in economic priority scenario,while coupling between them can be strengthen in food security scenario and ecological protection scenario.Within the SES,combined scenario analyses further suggest that the rocky desertification rate and the urban-rural income ratio exhibit the least trade-offpotential and inten-sity in combined economic priority scenario and ecological protection scenario,and the Soil Conservation and Food Supply demonstrate the least trade-offpotential and intensity in combined economic priority scenario and food security scenario.We can conclude the ecological engineering plays a significant role in alleviating trade-offs within the SES,but the effectiveness is limited.In light of intertwined socio-ecological challenges,combining ecological engineering with adaptive adjustments is a crucial strategy to enhance SES resilience and promote sustainable development in the South China Karst.展开更多
The Wuding River Basin,situated in the Loess Plateau of northern China,is an ecologically fragile region facing severe soil erosion and imbalanced ecosystem service(ES)functions.However,the mechanisms driving the spat...The Wuding River Basin,situated in the Loess Plateau of northern China,is an ecologically fragile region facing severe soil erosion and imbalanced ecosystem service(ES)functions.However,the mechanisms driving the spatiotemporal evolution of ES functions,as well as the trade-offs and synergies among these functions,remain poorly understood,constraining effective watershed-scale management.To address this challenge,this study quantified four ES functions,i.e.,water yield(WY),carbon storage(CS),habitat quality(HQ),and soil conservation(SC)in the Wuding River Basin from 1990 to 2020 using the Integrated Valuation of Ecosystem Services and Tradeoff(InVEST)model,and proposed an innovative integration of InVEST with a Bayesian Belief Network(BBN)to nonlinearly identify trade-off and synergy relationships among ES functions through probabilistic inference.A trade-off and synergy index(TSI)was developed to assess the spatial interaction intensity among ES functions,while sensitivity and scenario analyses were employed to determine key driving factors,followed by spatial optimization to delineate functional zones.Results revealed distinct spatiotemporal variations:WY increased from 98.69 to 120.52 mm;SC rose to an average of 3.05×10^(4) t/hm^(2);CS remained relatively stable(about 15.50 t/km^(2));and HQ averaged 0.51 with localized declines.The BBN achieved a high accuracy of 81.9%and effectively identified strong synergies between WY and SC,as well as between CS and HQ,while clear trade-offs were observed between WY and SC versus CS and HQ.Sensitivity analysis indicated precipitation(variance reduction of 9.4%),land use(9.8%),and vegetation cover(9.1%)as key driving factors.Spatial optimization further showed that core supply and ecological regulation zones are concentrated in the central-southern and southeastern basin,while ecological strengthening and optimization core zones dominate the central-northern and southeastern margins,highlighting strong spatial heterogeneity.Overall,this study advances ES research by combining process-based quantification with probabilistic modeling,offering a robust framework for studying nonlinear interactions,driving mechanisms,and optimization strategies,and providing a transferable paradigm for watershed-scale ES management and ecological planning in arid and semi-arid areas.展开更多
Objective Observational studies have found associations between inflammatory bowel disease(IBD)and the risk of dementia,including Alzheimer’s dementia(AD)and vascular dementia(VD);however,these findings are inconsist...Objective Observational studies have found associations between inflammatory bowel disease(IBD)and the risk of dementia,including Alzheimer’s dementia(AD)and vascular dementia(VD);however,these findings are inconsistent.It remains unclear whether these associations are causal.Methods We conducted a meta-analysis by systematically searching for observational studies on the association between IBD and dementia.Mendelian randomization(MR)analysis based on summary genome-wide association studies(GWASs)was performed.Genetic correlation and Bayesian colocalization analyses were used to provide robust genetic evidence.Results Ten observational studies involving 80,565,688 participants were included in this metaanalysis.IBD was significantly associated with dementia(risk ratio[RR]=1.36,95%CI=1.04-1.78;I2=84.8%)and VD(RR=2.60,95%CI=1.18-5.70;only one study),but not with AD(RR=2.00,95%CI=0.96-4.13;I^(2)=99.8%).MR analyses did not supported significant causal associations of IBD with dementia(dementia:odds ratio[OR]=1.01,95%CI=0.98-1.03;AD:OR=0.98,95%CI=0.95-1.01;VD:OR=1.02,95%CI=0.97-1.07).In addition,genetic correlation and co-localization analyses did not reveal any genetic associations between IBD and dementia.Conclusion Our study did not provide genetic evidence for a causal association between IBD and dementia risk.The increased risk of dementia observed in observational studies may be attributed to unobserved confounding factors or detection bias.展开更多
This paper proposes an interdisciplinary talent training model that combines foreign language education with area studies.The model aims to cultivate international ocean affairs professionals with cross-cultural commu...This paper proposes an interdisciplinary talent training model that combines foreign language education with area studies.The model aims to cultivate international ocean affairs professionals with cross-cultural communication skills,in-depth regional and country knowledge,and practical expertise in ocean affairs.Additionally,the paper presents specific training pathways and policy recommendations for implementing this model.展开更多
In modern society,the globalization of literary works is evident,with exceptional literary pieces from various countries spreading worldwide.Among these,children’s literature,due to the specificity of its target audi...In modern society,the globalization of literary works is evident,with exceptional literary pieces from various countries spreading worldwide.Among these,children’s literature,due to the specificity of its target audience,imposes distinct requirements on children’s books,compelling translators to approach the text from a child’s perspective.“The Little Prince”has renowned both within and outside of China,and a careful reading of this work can provide us with much inspiration.To this end,the present study adopts the perspective of Gideon Toury’s Descriptive Translation Studies to conduct an in-depth analysis of the different English and Chinese translations in conjunction with the original French novel.This approach aims to better guide literary research and explores translation methods for children’s literature through the analysis of translation norms and rules.展开更多
Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth...Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.展开更多
China ranked first worldwide in the production and export of electric bicycles.As an emerging market for electric bicycles,Malaysia holds significant potential for trade collabor ation with China in this sector.This s...China ranked first worldwide in the production and export of electric bicycles.As an emerging market for electric bicycles,Malaysia holds significant potential for trade collabor ation with China in this sector.This study presents a compar ative analysis of the national electric bicycle standards in China and Malaysia,offering technical insights from a standardization perspective.These insights aim to support Chinese enterprises in strategically positioning their technologies in the Malaysian market.The findings reveal significant differences in technical parameters,safety requirements,and testing methods,highlighting the need for tailored product adapt ation.展开更多
This paper investigates the teaching reform of the Program Comprehension and Analysis course in the context of industry-education integration and AI empowerment.To align with the evolving needs of the software industr...This paper investigates the teaching reform of the Program Comprehension and Analysis course in the context of industry-education integration and AI empowerment.To align with the evolving needs of the software industry,the course content has been updated to incorporate AI techniques such as large language models and deep learning.The reform enriches educational resources and introduces innovative instructional approaches.In addition,high-quality practical teaching cases have been developed,and immersive,hands-on learning experiences have been designed based on industrial platforms and real-world applications.These initiatives aim to enhance the practical skills and innovative thinking of professional degree graduate students,fostering high-caliber talent that aligns with industry demands.A survey of 90 graduate students revealed high levels of satisfaction regarding course content,teaching methodology,and skill development.The reform has proven effective in cultivating interdisciplinary professionals with solid foundations in software engineering and AI-driven innovation.展开更多
Mindfulness would enhance university students’emotional well-being and study engagement.However,the role of affect(positive and negative emotions)and psychological resources(psychological capital)linking mindfulness ...Mindfulness would enhance university students’emotional well-being and study engagement.However,the role of affect(positive and negative emotions)and psychological resources(psychological capital)linking mindfulness to study engagement remain underexplored.This cross-sectional study surveyed 688 Chinese university students(females=413,mean age=20.3,SD=0.83),using validated self-report measures of mindfulness,positive and negative emotions,psychological capital,and study engagement.Structural equation modeling and bias-corrected bootstrap analyses(5000 resamples)revealed that mindfulness directly enhanced positive emotions,psychological capital,and study engagement,while reducing negative emotions.Positive emotions partially mediated the positive effect of mindfulness on psychological capital and study engagement.Negative emotions partially and negatively mediated only the mindfulness-psychological capital link.Psychological capital independently mediated the mindfulness-engagement relationship,and two sequential mediation pathways emerged:(a)mindfulness→positive emotions→psychological capital→higher study engagement and(b)mindfulness→reduced negative emotions→psychological capital→higher study engagement.Consistent with broaden-and-build(B&B)theory and Conservation of Resources(COR)theory,these findings suggest that mindfulness fosters study engagement primarily by promoting positive emotional experiences and strengthening psychological capital.By implication,university student support programs should employ mindfulness-based interventions to cultivate emotional and psychological resources for higher students’engagement and overall well-being.展开更多
BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as exp...BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as expanding treatment indications,which affect the fair distribution of medical resources.There is limited research on ethical issues in the field of digestive endoscopy.AIM To investigate the level of ethical awareness among gastrointestinal endoscopy practitioners and analyze the ethical issues involved in gastrointestinal endoscopy technology.METHODS A questionnaire survey was performed to collect relevant data(gender,age,degree of education,professional title,personnel category,the level of understanding medical ethical principles,ethics training and its learning pathways)from gastrointestinal endoscopy practitioners at the Second Hospital of Dalian Medical University and Dalian Friendship Hospital,including licensed physicians and nurses(including trainees and graduate students).RESULTS The majority of gastrointestinal endoscopy practitioners have received training on ethics,but there is still considerable room for improvement in their ethical awareness.Different learning pathways may affect the mastery of ethical principles, and understanding of ethical principles is more easily achieved through hospital ethics institutions.CONCLUSIONTo address the ethical issues in gastrointestinal endoscopy technology, it is necessary to enhance the humanisticeducation of gastrointestinal endoscopy practitioners, incorporate ethical standards into the technology assessmentprocess, and establish a patient-centered diagnostic and treatment model to improve the ethical awareness of practitionersand achieve a balance between technology and ethics.展开更多
Escalating global energy demands and climate urgency necessitate advanced electrochemical energy conversion and storage technologies(EECSTs)like electrocatalysis and rechargeable batteries.Improving their performance ...Escalating global energy demands and climate urgency necessitate advanced electrochemical energy conversion and storage technologies(EECSTs)like electrocatalysis and rechargeable batteries.Improving their performance relies on elucidating reaction mechanisms and structure-performance relationships via in situ studies.This review summarizes recent in situ studies of EECSTs through a variety of advanced characterization techniques aiming at mapping reaction pathways for the rational design of overall high-performance reaction systems.We outline the principles,capabilities,advantages,and limitations of various in situ techniques.Their applications in in situ studies of fuel cells,water/CO_(2)electrolysis,and lithium batteries are highlighted with representative examples.These studies enable dynamic tracking of chemical and structural evolution of overall reaction systems,including materials,intermediates,products,and surroundings during operation,providing insights critical to rational system design.Future advancements will involve integrating multimodal in situ/operando approaches with artificial intelligence to enable real-time monitoring at practical scales.Such integration promises precise mechanistic insights and robust structure-performance correlations,ultimately accelerating the development of high-performance EECSTs aligned with sustainability and market requirements.展开更多
Objective Patients with atherosclerotic cardiovascular disease(ASCVD)following percutaneous coronary intervention(PCI)are classified as very-high-risk individuals in cardiovascular disease(CVD)risk stratification.The ...Objective Patients with atherosclerotic cardiovascular disease(ASCVD)following percutaneous coronary intervention(PCI)are classified as very-high-risk individuals in cardiovascular disease(CVD)risk stratification.The distribution pattern of traditional Chinese medicine(TCM)syndromes in this patient population,as well as its association with blood lipid profiles and clinical prognosis,remains unclear.The present prospective cohort study aims to investigate these correlations,thereby providing insights to enrich the research fields.Methods We enrolled consecutive patients with ASCVD who underwent PCI at the Integrated Cardiology Unit of China-Japan Friendship Hospital between September 1,2020 and December 31,2022.Demographics and clinical characteristics,signs and symptoms defining each TCM syndrome,and fasting venous blood samples were collected at baseline and follow up or upon major adverse cardiovascular events(MACEs).We analyzed the correlation between TCM syndromes,blood lipid profiles,and MACEs,and developed a new joint prognostic model incorporating both TCM syndromes and blood lipids using logistic regression.The analyses were based on detailed baseline and one-year follow-up data.Results A per-protocol analysis was performed on 586 patients with complete data ultimately.During the one-year follow-up,174 patients(29.69%)experienced a MACE.We performed statistical analyses on comorbidities,medication,and biochemical indicators across groups defined by TCM syndrome differentiation.When comparing different TCM syndromes,no significant differences were found in age,body mass index(BMI),history of revascularization,comorbidities,family history of CVD,smoking or drinking,or statin intensity(P>0.05).Patients with intertwined phlegm and blood stasis syndrome exhibited significantly higher levels of total cholesterol(TC,5.27±1.18 mmol/L,P<0.001),triglyceride(TG,1.96±1.33 mmol/L,P=0.008),low-density lipoprotein cholesterol(LDL-C,3.35±0.79 mmol/L,P<0.001),and high-density lipoprotein cholesterol(HDL-C,1.24±0.81 mmol/L,P<0.001)compared with those with other TCM syndromes combined.A multivariable logistic regression model was constructed to predict MACEs.The model included TCM syndrome type[with intertwined phlegm and blood stasis as a predictor,adjusted odds ratio(OR)=1.413,95%confidence interval(CI):0.517–3.864,P=0.501],age(adjusted OR=0.97,95%CI:0.955–1.001,P=0.057),male gender(adjusted OR=0.698,95%CI:0.416–1.170,P=0.173),TC(adjusted OR=1.004,95%CI:0.513–1.965,P=0.990),and LDL-C(adjusted OR=5.825,95%CI:2.214–15.326,P<0.001).This model demonstrated good discriminatory ability for MACEs in post-PCI ASCVD patients[the area under the receiver operating characteristic(ROC)curve(AUC)=0.865,95%CI:0.816–0.914].Conclusion The intertwined phlegm and blood stasis TCM syndrome is associated with a distinct atherogenic lipid profile characterized by elevated levels of TC and LDL-C.The prognostic model that incorporates this TCM syndrome type along with conventional lipid parameters(TC and LDL-C)shows good discriminatory ability for predicting MACEs in ASCVD patients after PCI,underscoring the potential clinical utility of integrating TCM syndrome differentiation into CVD risk assessment.展开更多
Existing evidence suggests residential greenness is beneficial to human,while no research to date explored the associations of greenness with age-related macular degeneration(AMD).To evaluate the association of greenn...Existing evidence suggests residential greenness is beneficial to human,while no research to date explored the associations of greenness with age-related macular degeneration(AMD).To evaluate the association of greenness with AMD,modification and mediation effect of air pollution,we conducted this prospective study.We con-structed weighted quantile sum(WQS)index as co-exposure to nitrogen oxides(NO_(x)),particulate matter<2.5μm(PM_(2.5)),particulate matter<10μm(PM10).Stratified Cox regression models were applied to test the effect of exposure.Effect modification of air pollution was assessed.Stratified Cox models through the indirect method and Aalen additive risk models were used in mediation analysis.Over median follow-up of 11.67 years,4596 AMD events were ascertained.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)of incident AMD for pollution per interquartile range(IQR)increment were 1.10(1.04–1.16)for nitrogen dioxide(NO_(2)),1.09(1.03–1.15)for NO_(x),1.14(1.05–1.24)for PM_(2.5),1.13(1.05–1.21)for PM10.The HR(95%CI)of AMD associated with greenness 1000 m buffer per IQR increment was 0.91(0.86–0.97),300 m buffer was 0.94(0.89–0.99).The as-sociation between greenness 1000 m and AMD was 28.59%,44.77%,35.59%,32.31%and 27.08%mediated by the decreased WQS index,NO_(2),NO_(x),PM_(2.5) and PM10,respectively.Increased greenness was associated with lower AMD incidence,and air pollution partly mediate it,which implies that interventions aimed at improving air quality and increasing greenness could have a dual benefit in mitigating AMD risk.展开更多
Objective:To analyze factors affecting the utilization of human immunodeficiency virus counseling and testing(HCT)service among human immunodeficiency virus risk groups at Hessa Air Genting Health Center,Asahan Regenc...Objective:To analyze factors affecting the utilization of human immunodeficiency virus counseling and testing(HCT)service among human immunodeficiency virus risk groups at Hessa Air Genting Health Center,Asahan Regency,North Sumatera,Indonesia.Methods:This quantitative unmatched case-control study was conducted from April 2024 to April 2025 at Hessa Air Genting Health Center,Asahan Regency,North Sumatra Province,Indonesia.Female sex workers and men who have sex with men were selected using purposive sampling based on predefined inclusion and exclusion criteria.Data were collected via questionnaires and analyzed using SPSS version 18.0,with univariate analysis,bivariate analysis(Chi-square test),and multivariate analysis(logistic regression analysis).Results:Comprehensive analysis of 75 cases and 75 controls was conducted to identify factors affecting the utilization of HCT services.Specifically,this study identified significant effects of knowledge(OR 3.2,95%CI 1.5-7.0,P=0.003),perception(OR 5.6,95%CI 2.5-12.5,P<0.001),information media(OR 3.1,95%CI 1.4-6.8,P=0.005),and health workers encouragement(OR 4.0,95%CI 1.5-10.4,P=0.005).In contrast,access to health services did not have a significant effect.Conclusions:Knowledge,perception,information media,and health worker encouragement had significant effects on HCT service utilization,with perception identified as the dominant factor.To improve utilization,strengthening positive perceptions,targeted training for healthcare workers,strengthened partnerships with local non-governmental organizations,and the use of social media for health promotion are recommended.展开更多
Background:Despite highly effective vaccines against SARS-CoV-2,COVID-19 vaccine hesitancy persisted in some populations in England during the pandemic,with rates and motivations for hesitancy varying by demographic g...Background:Despite highly effective vaccines against SARS-CoV-2,COVID-19 vaccine hesitancy persisted in some populations in England during the pandemic,with rates and motivations for hesitancy varying by demographic group.Addressing the drivers of vaccine hesitancy through targeted interventions in hesitant groups is a public health priority for better and more rapid control of disease spread.We aimed to characterise the determinants and subtypes of vaccine hesitancy and identify more persistent forms of hesitancy via analysis of vaccine uptake in a large cross-sectional cohort with linked National Health Service(NHS)data.展开更多
Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and wheth...Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and whether this association differs by baseline body-mass index(BMI).Methods:This retrospective cohort study used electronic health records from the TriNetX U.S.research network.Adults aged 20 years or older diagnosed with T2DM between 2016 and 2024 were included if they received any hypoglycemic agents within 3 months before and after diagnosis.Following 1:1 propensity score matching,both the GLP-1 RA user and non-user groups included 183,264 patients.The study outcome was defined as a diagnosis of malignant neoplasms.Hazard ratios(HRs)for overall and site-specific cancer risk were estimated using Cox proportional hazards models.Kaplan–Meier analysis and stratified analysis by BMI were performed.Results:Early GLP-1 RA use demonstrated a modest but significant association with reduced overall cancer risk(HR 0.93;95%CI:0.90–0.96).Reduced risks were noted for cancers of the digestive(HR 0.81),respiratory(HR 0.66),and female genital(HR 0.87)systems.In stratified analysis,benefits were more pronounced in patients with BMI≥30,particularly for pancreatic and colorectal cancers.Conclusion:Early initiation of GLP-1 receptor agonists in patients with diagnosed T2DM was associated with a modest reduction in overall cancer risk,particularly among individuals with obesity.These findings highlight the dual metabolic and oncologic value of prompt GLP-1 RA therapy.展开更多
基金funded by the National Natural Science Foundation of China(42377326 and 42201267)National Research-Development Support Plan Projects of China(Grant No.2017YFC05054)the Fujian Provincial Water Resources Department Science and Technology Project(MSK202308)。
文摘The Guangdong,Jiangxi and Fujian(GJF)provinces,located in the subtropical region of southeastern China,is one of the national key regions for soil erosion control and ecological restoration.This region is characterized by extensive red soil development and high rainfall erosivity,making it a representative landscape for exploring the interactions between land use change(LUC)and ecosystem services(ES).Despite the recognized importance of ES in hilly regions,comprehensive assessing the impacts of LUC on ES remain limited.This study investigates five key ES:water yield,soil conservation,carbon conservation,food supply,and habitat quality in GJF region from 2000 to 2020.By applying the InVEST model and the Geodetector method,we assessed the trade-offs,synergies,and transitions among ES,identified the natural and social drivers of ES dynamics,and quantified the contribution of LUC to ES changes using the ecosystem service contribution index.The results showed that cropland and woodland were the dominant land use types.Ecological restoration efforts positively influenced ES,with synergies intensifying and trade-offs diminishing over time.Land use conversions,particularly among woodland,grassland,and cropland,exerted significant impacts on ES.In particular,the conversion of woodland to other land uses had markedly negative effects on soil conservation,carbon conservation,and habitat quality.Forest cover was identified as a major driver of ES dynamics.These findings highlight the importance of maintaining and expanding forest and grassland cover,strengthening red soil conservation,and optimizing land use structure to achieve coordinated ecological protection and socioeconomic development in the subtropical hilly regions of southern China.
基金funded by the University Teachers Innovation Fund Project of Gansu Province(2025A-001)the Northwest Normal University Young Teachers'Scientific Research Ability Improvement Plan(NWNULKQN2024-20).
文摘Accurately revealing the spatial heterogeneity in the trade-offs and synergies of land use functions(LUFs)and their driving factors is imperative for advancing sustainable land utilization and optimizing land use planning.This is especially critical for ecologically vulnerable inland river basins in arid regions.However,existing methods struggle to effectively capture complex nonlinear interactions among environmental factors and their multifaceted relationships with trade-offs and synergies of LUFs,especially for the inland river basins in arid regions.Consequently,this study focused on the middle reaches of the Heihe River Basin(MHRB),an arid inland river basin in northwestern China.Using land use,socioeconomic,meteorological,and hydrological data from 2000 to 2020,we analyzed the spatiotemporal patterns of LUFs and their trade-off and synergy relationships from the perspective of production,living,ecological functions.Additionally,we employed an integrated Extreme Gradient Boosting(XGBoost)-SHapley Additive exPlanations(SHAP)framework to investigate the environmental factors influencing the spatial heterogeneity in the trade-offs and synergies of LUFs.Our findings reveal that from 2000 to 2020,the production,living,and ecological functions of land use within the MHRB exhibited an increasing trend,demonstrating a distinct spatial pattern of''high in the southwest and low in the northeast''.Significant spatial heterogeneity defined the trade-off and synergistic relationships,with trade-offs dominating human activity-intensive oasis areas,while synergies prevailed in other areas.During the study period,synergistic relationships between production and living functions and between production and ecological functions were relatively robust,whereas synergies in living-ecological functions remained weaker.Natural factors(digital elevation model(DEM),annual mean temperature,Normalized Difference Vegetation Index(NDVI),and annual precipitation)emerged as the primary factors driving the trade-offs and synergies of LUFs,followed by socioeconomic factors(population density,Gross Domestic Product(GDP),and land use intensity),while distance factors(distance to water bodies,distance to residential areas,and distance to roads)exerted minimal influence.Notably,the interactions among NDVI,annual mean temperature,DEM,and land use intensity exerted the most substantial impacts on the relationships among LUFs.This study provides novel perspectives and methodologies for unraveling the mechanisms underlying the spatial heterogeneity in the trade-offs and synergies of LUFs,offering scientific insights to inform regional land use planning and sustainable natural resource management in inland river basins in arid regions.
基金supported by the National Key Research and Develop-ment Program of China(Grant No.2022YFF1300701)the Sichuan Science and Technology Program(Grant No.2022JDJQ0015).
文摘Economic development,food security,and ecological preservation are important issues encountered by karst re-gions.Faced with complex natural and social dynamics,we attempted to explore how interdependence within socio-ecological system(SES)shaped sustainability in this region.A SES framework was constructed and three scenarios were predesigned:economic priority scenario,food security scenario,and ecological protection sce-nario.The System Dynamics model was used to simulate and forecast the evolution across various scenarios within the SES from 2005 to 2035.Through the Production-Possibility Frontiers in combined scenarios,trade-offpotential was identified and quantified.The results showed that the decoupling between social and ecological subsystems can be weaken in economic priority scenario,while coupling between them can be strengthen in food security scenario and ecological protection scenario.Within the SES,combined scenario analyses further suggest that the rocky desertification rate and the urban-rural income ratio exhibit the least trade-offpotential and inten-sity in combined economic priority scenario and ecological protection scenario,and the Soil Conservation and Food Supply demonstrate the least trade-offpotential and intensity in combined economic priority scenario and food security scenario.We can conclude the ecological engineering plays a significant role in alleviating trade-offs within the SES,but the effectiveness is limited.In light of intertwined socio-ecological challenges,combining ecological engineering with adaptive adjustments is a crucial strategy to enhance SES resilience and promote sustainable development in the South China Karst.
基金supported by the Science and Technology Project of Shaanxi Province Water Conservancy,China(2025slkj-10)the Natural Science Basic Research Program of Shaanxi Province,China(S2025-JC-QN-2416).
文摘The Wuding River Basin,situated in the Loess Plateau of northern China,is an ecologically fragile region facing severe soil erosion and imbalanced ecosystem service(ES)functions.However,the mechanisms driving the spatiotemporal evolution of ES functions,as well as the trade-offs and synergies among these functions,remain poorly understood,constraining effective watershed-scale management.To address this challenge,this study quantified four ES functions,i.e.,water yield(WY),carbon storage(CS),habitat quality(HQ),and soil conservation(SC)in the Wuding River Basin from 1990 to 2020 using the Integrated Valuation of Ecosystem Services and Tradeoff(InVEST)model,and proposed an innovative integration of InVEST with a Bayesian Belief Network(BBN)to nonlinearly identify trade-off and synergy relationships among ES functions through probabilistic inference.A trade-off and synergy index(TSI)was developed to assess the spatial interaction intensity among ES functions,while sensitivity and scenario analyses were employed to determine key driving factors,followed by spatial optimization to delineate functional zones.Results revealed distinct spatiotemporal variations:WY increased from 98.69 to 120.52 mm;SC rose to an average of 3.05×10^(4) t/hm^(2);CS remained relatively stable(about 15.50 t/km^(2));and HQ averaged 0.51 with localized declines.The BBN achieved a high accuracy of 81.9%and effectively identified strong synergies between WY and SC,as well as between CS and HQ,while clear trade-offs were observed between WY and SC versus CS and HQ.Sensitivity analysis indicated precipitation(variance reduction of 9.4%),land use(9.8%),and vegetation cover(9.1%)as key driving factors.Spatial optimization further showed that core supply and ecological regulation zones are concentrated in the central-southern and southeastern basin,while ecological strengthening and optimization core zones dominate the central-northern and southeastern margins,highlighting strong spatial heterogeneity.Overall,this study advances ES research by combining process-based quantification with probabilistic modeling,offering a robust framework for studying nonlinear interactions,driving mechanisms,and optimization strategies,and providing a transferable paradigm for watershed-scale ES management and ecological planning in arid and semi-arid areas.
基金supported by the China Postdoctoral Science Foundation(Grant No.2021M703366)Shenzhen Science and Technology Program(Grant No.KQTD20190929172835662).
文摘Objective Observational studies have found associations between inflammatory bowel disease(IBD)and the risk of dementia,including Alzheimer’s dementia(AD)and vascular dementia(VD);however,these findings are inconsistent.It remains unclear whether these associations are causal.Methods We conducted a meta-analysis by systematically searching for observational studies on the association between IBD and dementia.Mendelian randomization(MR)analysis based on summary genome-wide association studies(GWASs)was performed.Genetic correlation and Bayesian colocalization analyses were used to provide robust genetic evidence.Results Ten observational studies involving 80,565,688 participants were included in this metaanalysis.IBD was significantly associated with dementia(risk ratio[RR]=1.36,95%CI=1.04-1.78;I2=84.8%)and VD(RR=2.60,95%CI=1.18-5.70;only one study),but not with AD(RR=2.00,95%CI=0.96-4.13;I^(2)=99.8%).MR analyses did not supported significant causal associations of IBD with dementia(dementia:odds ratio[OR]=1.01,95%CI=0.98-1.03;AD:OR=0.98,95%CI=0.95-1.01;VD:OR=1.02,95%CI=0.97-1.07).In addition,genetic correlation and co-localization analyses did not reveal any genetic associations between IBD and dementia.Conclusion Our study did not provide genetic evidence for a causal association between IBD and dementia risk.The increased risk of dementia observed in observational studies may be attributed to unobserved confounding factors or detection bias.
基金supported by“Dalian Maritime University Teaching Reform Research Fund 2022 Annual Project”(Fund No.XJG2022-96).
文摘This paper proposes an interdisciplinary talent training model that combines foreign language education with area studies.The model aims to cultivate international ocean affairs professionals with cross-cultural communication skills,in-depth regional and country knowledge,and practical expertise in ocean affairs.Additionally,the paper presents specific training pathways and policy recommendations for implementing this model.
文摘In modern society,the globalization of literary works is evident,with exceptional literary pieces from various countries spreading worldwide.Among these,children’s literature,due to the specificity of its target audience,imposes distinct requirements on children’s books,compelling translators to approach the text from a child’s perspective.“The Little Prince”has renowned both within and outside of China,and a careful reading of this work can provide us with much inspiration.To this end,the present study adopts the perspective of Gideon Toury’s Descriptive Translation Studies to conduct an in-depth analysis of the different English and Chinese translations in conjunction with the original French novel.This approach aims to better guide literary research and explores translation methods for children’s literature through the analysis of translation norms and rules.
基金supported by the Science and Technology Fund Project of Guizhou Health Commission(gzwkj2025-163)。
文摘Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.
文摘China ranked first worldwide in the production and export of electric bicycles.As an emerging market for electric bicycles,Malaysia holds significant potential for trade collabor ation with China in this sector.This study presents a compar ative analysis of the national electric bicycle standards in China and Malaysia,offering technical insights from a standardization perspective.These insights aim to support Chinese enterprises in strategically positioning their technologies in the Malaysian market.The findings reveal significant differences in technical parameters,safety requirements,and testing methods,highlighting the need for tailored product adapt ation.
基金supported by Project of Higher Education Teaching Reform Research in Heilongjiang Province(Graduate Education)(Grant No.SJGYY2024030).
文摘This paper investigates the teaching reform of the Program Comprehension and Analysis course in the context of industry-education integration and AI empowerment.To align with the evolving needs of the software industry,the course content has been updated to incorporate AI techniques such as large language models and deep learning.The reform enriches educational resources and introduces innovative instructional approaches.In addition,high-quality practical teaching cases have been developed,and immersive,hands-on learning experiences have been designed based on industrial platforms and real-world applications.These initiatives aim to enhance the practical skills and innovative thinking of professional degree graduate students,fostering high-caliber talent that aligns with industry demands.A survey of 90 graduate students revealed high levels of satisfaction regarding course content,teaching methodology,and skill development.The reform has proven effective in cultivating interdisciplinary professionals with solid foundations in software engineering and AI-driven innovation.
文摘Mindfulness would enhance university students’emotional well-being and study engagement.However,the role of affect(positive and negative emotions)and psychological resources(psychological capital)linking mindfulness to study engagement remain underexplored.This cross-sectional study surveyed 688 Chinese university students(females=413,mean age=20.3,SD=0.83),using validated self-report measures of mindfulness,positive and negative emotions,psychological capital,and study engagement.Structural equation modeling and bias-corrected bootstrap analyses(5000 resamples)revealed that mindfulness directly enhanced positive emotions,psychological capital,and study engagement,while reducing negative emotions.Positive emotions partially mediated the positive effect of mindfulness on psychological capital and study engagement.Negative emotions partially and negatively mediated only the mindfulness-psychological capital link.Psychological capital independently mediated the mindfulness-engagement relationship,and two sequential mediation pathways emerged:(a)mindfulness→positive emotions→psychological capital→higher study engagement and(b)mindfulness→reduced negative emotions→psychological capital→higher study engagement.Consistent with broaden-and-build(B&B)theory and Conservation of Resources(COR)theory,these findings suggest that mindfulness fosters study engagement primarily by promoting positive emotional experiences and strengthening psychological capital.By implication,university student support programs should employ mindfulness-based interventions to cultivate emotional and psychological resources for higher students’engagement and overall well-being.
文摘BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as expanding treatment indications,which affect the fair distribution of medical resources.There is limited research on ethical issues in the field of digestive endoscopy.AIM To investigate the level of ethical awareness among gastrointestinal endoscopy practitioners and analyze the ethical issues involved in gastrointestinal endoscopy technology.METHODS A questionnaire survey was performed to collect relevant data(gender,age,degree of education,professional title,personnel category,the level of understanding medical ethical principles,ethics training and its learning pathways)from gastrointestinal endoscopy practitioners at the Second Hospital of Dalian Medical University and Dalian Friendship Hospital,including licensed physicians and nurses(including trainees and graduate students).RESULTS The majority of gastrointestinal endoscopy practitioners have received training on ethics,but there is still considerable room for improvement in their ethical awareness.Different learning pathways may affect the mastery of ethical principles, and understanding of ethical principles is more easily achieved through hospital ethics institutions.CONCLUSIONTo address the ethical issues in gastrointestinal endoscopy technology, it is necessary to enhance the humanisticeducation of gastrointestinal endoscopy practitioners, incorporate ethical standards into the technology assessmentprocess, and establish a patient-centered diagnostic and treatment model to improve the ethical awareness of practitionersand achieve a balance between technology and ethics.
基金supported by the National Key Research and Development Program of China(2023YFA1508004)the National Natural Science Foundation of China(T2293692,22502164,92472203,22222903,52271229,22472074,22272069,22361132532,and 22021001)+6 种基金the Industry-University-Research Joint Innovation Project of Fujian Province(2023H6029)the Beijing National Laboratory for Molecular Sciences(BNLMS202305)the Scientific and Technological Project of Yunnan Precious Metals Laboratory(YPML-20240502063)the Liaoning Binhai Laboratory(Grant No.2024-05)the State Key Laboratory of Fine Chemicals,Dalian University of Technology(KF 2401)the Postdoctoral Fellowship Program of CPSF under Grant Number GZC20240897the China Postdoctoral Science Foundation(No.2025M770016).
文摘Escalating global energy demands and climate urgency necessitate advanced electrochemical energy conversion and storage technologies(EECSTs)like electrocatalysis and rechargeable batteries.Improving their performance relies on elucidating reaction mechanisms and structure-performance relationships via in situ studies.This review summarizes recent in situ studies of EECSTs through a variety of advanced characterization techniques aiming at mapping reaction pathways for the rational design of overall high-performance reaction systems.We outline the principles,capabilities,advantages,and limitations of various in situ techniques.Their applications in in situ studies of fuel cells,water/CO_(2)electrolysis,and lithium batteries are highlighted with representative examples.These studies enable dynamic tracking of chemical and structural evolution of overall reaction systems,including materials,intermediates,products,and surroundings during operation,providing insights critical to rational system design.Future advancements will involve integrating multimodal in situ/operando approaches with artificial intelligence to enable real-time monitoring at practical scales.Such integration promises precise mechanistic insights and robust structure-performance correlations,ultimately accelerating the development of high-performance EECSTs aligned with sustainability and market requirements.
基金Capital Health Development Scientific Research Project(2020-2-4064)National Key Research and Development Program of China(2018YFC2002502).
文摘Objective Patients with atherosclerotic cardiovascular disease(ASCVD)following percutaneous coronary intervention(PCI)are classified as very-high-risk individuals in cardiovascular disease(CVD)risk stratification.The distribution pattern of traditional Chinese medicine(TCM)syndromes in this patient population,as well as its association with blood lipid profiles and clinical prognosis,remains unclear.The present prospective cohort study aims to investigate these correlations,thereby providing insights to enrich the research fields.Methods We enrolled consecutive patients with ASCVD who underwent PCI at the Integrated Cardiology Unit of China-Japan Friendship Hospital between September 1,2020 and December 31,2022.Demographics and clinical characteristics,signs and symptoms defining each TCM syndrome,and fasting venous blood samples were collected at baseline and follow up or upon major adverse cardiovascular events(MACEs).We analyzed the correlation between TCM syndromes,blood lipid profiles,and MACEs,and developed a new joint prognostic model incorporating both TCM syndromes and blood lipids using logistic regression.The analyses were based on detailed baseline and one-year follow-up data.Results A per-protocol analysis was performed on 586 patients with complete data ultimately.During the one-year follow-up,174 patients(29.69%)experienced a MACE.We performed statistical analyses on comorbidities,medication,and biochemical indicators across groups defined by TCM syndrome differentiation.When comparing different TCM syndromes,no significant differences were found in age,body mass index(BMI),history of revascularization,comorbidities,family history of CVD,smoking or drinking,or statin intensity(P>0.05).Patients with intertwined phlegm and blood stasis syndrome exhibited significantly higher levels of total cholesterol(TC,5.27±1.18 mmol/L,P<0.001),triglyceride(TG,1.96±1.33 mmol/L,P=0.008),low-density lipoprotein cholesterol(LDL-C,3.35±0.79 mmol/L,P<0.001),and high-density lipoprotein cholesterol(HDL-C,1.24±0.81 mmol/L,P<0.001)compared with those with other TCM syndromes combined.A multivariable logistic regression model was constructed to predict MACEs.The model included TCM syndrome type[with intertwined phlegm and blood stasis as a predictor,adjusted odds ratio(OR)=1.413,95%confidence interval(CI):0.517–3.864,P=0.501],age(adjusted OR=0.97,95%CI:0.955–1.001,P=0.057),male gender(adjusted OR=0.698,95%CI:0.416–1.170,P=0.173),TC(adjusted OR=1.004,95%CI:0.513–1.965,P=0.990),and LDL-C(adjusted OR=5.825,95%CI:2.214–15.326,P<0.001).This model demonstrated good discriminatory ability for MACEs in post-PCI ASCVD patients[the area under the receiver operating characteristic(ROC)curve(AUC)=0.865,95%CI:0.816–0.914].Conclusion The intertwined phlegm and blood stasis TCM syndrome is associated with a distinct atherogenic lipid profile characterized by elevated levels of TC and LDL-C.The prognostic model that incorporates this TCM syndrome type along with conventional lipid parameters(TC and LDL-C)shows good discriminatory ability for predicting MACEs in ASCVD patients after PCI,underscoring the potential clinical utility of integrating TCM syndrome differentiation into CVD risk assessment.
基金supported by the High-level Talents Introduction Plan from Central South University(No.502045003)the National Natural Science Foundation of China(No.42277438)Hunan Provincial Natural Science Foundation for Distinguished Young Scholars(No.2024JJ2082)to Fang Xiao,and the Postgraduate Independent Exploration and Innovation Project of Central South University,China(Nos.2024ZZTS0557 and 2023ZZTS0993)。
文摘Existing evidence suggests residential greenness is beneficial to human,while no research to date explored the associations of greenness with age-related macular degeneration(AMD).To evaluate the association of greenness with AMD,modification and mediation effect of air pollution,we conducted this prospective study.We con-structed weighted quantile sum(WQS)index as co-exposure to nitrogen oxides(NO_(x)),particulate matter<2.5μm(PM_(2.5)),particulate matter<10μm(PM10).Stratified Cox regression models were applied to test the effect of exposure.Effect modification of air pollution was assessed.Stratified Cox models through the indirect method and Aalen additive risk models were used in mediation analysis.Over median follow-up of 11.67 years,4596 AMD events were ascertained.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)of incident AMD for pollution per interquartile range(IQR)increment were 1.10(1.04–1.16)for nitrogen dioxide(NO_(2)),1.09(1.03–1.15)for NO_(x),1.14(1.05–1.24)for PM_(2.5),1.13(1.05–1.21)for PM10.The HR(95%CI)of AMD associated with greenness 1000 m buffer per IQR increment was 0.91(0.86–0.97),300 m buffer was 0.94(0.89–0.99).The as-sociation between greenness 1000 m and AMD was 28.59%,44.77%,35.59%,32.31%and 27.08%mediated by the decreased WQS index,NO_(2),NO_(x),PM_(2.5) and PM10,respectively.Increased greenness was associated with lower AMD incidence,and air pollution partly mediate it,which implies that interventions aimed at improving air quality and increasing greenness could have a dual benefit in mitigating AMD risk.
文摘Objective:To analyze factors affecting the utilization of human immunodeficiency virus counseling and testing(HCT)service among human immunodeficiency virus risk groups at Hessa Air Genting Health Center,Asahan Regency,North Sumatera,Indonesia.Methods:This quantitative unmatched case-control study was conducted from April 2024 to April 2025 at Hessa Air Genting Health Center,Asahan Regency,North Sumatra Province,Indonesia.Female sex workers and men who have sex with men were selected using purposive sampling based on predefined inclusion and exclusion criteria.Data were collected via questionnaires and analyzed using SPSS version 18.0,with univariate analysis,bivariate analysis(Chi-square test),and multivariate analysis(logistic regression analysis).Results:Comprehensive analysis of 75 cases and 75 controls was conducted to identify factors affecting the utilization of HCT services.Specifically,this study identified significant effects of knowledge(OR 3.2,95%CI 1.5-7.0,P=0.003),perception(OR 5.6,95%CI 2.5-12.5,P<0.001),information media(OR 3.1,95%CI 1.4-6.8,P=0.005),and health workers encouragement(OR 4.0,95%CI 1.5-10.4,P=0.005).In contrast,access to health services did not have a significant effect.Conclusions:Knowledge,perception,information media,and health worker encouragement had significant effects on HCT service utilization,with perception identified as the dominant factor.To improve utilization,strengthening positive perceptions,targeted training for healthcare workers,strengthened partnerships with local non-governmental organizations,and the use of social media for health promotion are recommended.
文摘Background:Despite highly effective vaccines against SARS-CoV-2,COVID-19 vaccine hesitancy persisted in some populations in England during the pandemic,with rates and motivations for hesitancy varying by demographic group.Addressing the drivers of vaccine hesitancy through targeted interventions in hesitant groups is a public health priority for better and more rapid control of disease spread.We aimed to characterise the determinants and subtypes of vaccine hesitancy and identify more persistent forms of hesitancy via analysis of vaccine uptake in a large cross-sectional cohort with linked National Health Service(NHS)data.
基金financial support fromthe Chung Shan Medical University Hospital,Taiwan(CSH-2022-A-009).
文摘Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and whether this association differs by baseline body-mass index(BMI).Methods:This retrospective cohort study used electronic health records from the TriNetX U.S.research network.Adults aged 20 years or older diagnosed with T2DM between 2016 and 2024 were included if they received any hypoglycemic agents within 3 months before and after diagnosis.Following 1:1 propensity score matching,both the GLP-1 RA user and non-user groups included 183,264 patients.The study outcome was defined as a diagnosis of malignant neoplasms.Hazard ratios(HRs)for overall and site-specific cancer risk were estimated using Cox proportional hazards models.Kaplan–Meier analysis and stratified analysis by BMI were performed.Results:Early GLP-1 RA use demonstrated a modest but significant association with reduced overall cancer risk(HR 0.93;95%CI:0.90–0.96).Reduced risks were noted for cancers of the digestive(HR 0.81),respiratory(HR 0.66),and female genital(HR 0.87)systems.In stratified analysis,benefits were more pronounced in patients with BMI≥30,particularly for pancreatic and colorectal cancers.Conclusion:Early initiation of GLP-1 receptor agonists in patients with diagnosed T2DM was associated with a modest reduction in overall cancer risk,particularly among individuals with obesity.These findings highlight the dual metabolic and oncologic value of prompt GLP-1 RA therapy.
