Search Results (1,161)

Children in difficulty are at heightened risk of developing personality-related problems, partly due to gaps in family care and social protection. This study examines whether (a) the availability of an individual study desk at home—a basic family educational resource—is associated with borderline personality features (BPFs) in this population and (b) perceived social support and school life shape this association. Using survey data from 14,993 children in difficulty in Hubei Province, China, and applying propensity score matching (PSM), we find that children with their own desk report significantly lower levels of BPFs. The protective association between desk ownership and children’s perceptions of social support is stronger when children perceive higher social support, whereas indicators of school life do not significantly moderate this relationship. Heterogeneity analyses further show that the benefit of having a desk is greater for children without siblings. These findings highlight the protective role of physical learning environments and suggest that targeted provision of basic educational resources could serve as a practical entry point for early-intervention programs aimed at reducing the risk of developing BPFs. Full article

Community-based drug rehabilitation (CBDR) in China involves multiple types of frontline workers, yet little empirical research has examined how these workers carry out their respective roles and collaborate in practice. This study explored the roles, collaborative practices, and role boundaries of drug rehabilitation social workers (DRSWs) and community drug control officers (CDCOs) in CBDR in Guangzhou, China. Semi-structured in-depth interviews were conducted with 23 DRSWs and 9 CDCOs across two sequential phases, and data were analyzed using reflexive thematic analysis. The findings revealed that DRSWs primarily performed professional rehabilitation services alongside administrative assistance, while CDCOs focused on administrative management, support for enforcement-related procedures, and upward resource advocacy. Five areas of collaboration were identified, characterized by a spontaneous complementary division of labor. However, role boundary ambiguity was also observed at three interconnected levels: DRSWs’ administrative workload had expanded beyond an assisting capacity, some CDCOs described care-giving practices that approached the professional domain of social work, and workers reported that persons with drug use histories (PWUDs) often had difficulty distinguishing between the two roles. These findings highlight the need for clearer role definitions and institutionalized coordination mechanisms in CBDR. Full article

Background/Objectives: The global health landscape is currently confronted with dual challenges from both infectious diseases and chronic conditions. Medical–preventive integration has emerged as a pivotal strategy to address these issues, aiming to create a comprehensive, closed-loop framework that spans disease prevention, treatment, rehabilitation, and healthcare, ultimately improving population health outcomes. In the Chinese context, existing policies remain fragmented, scattered across various healthcare-related regulations, and lack systematic and comprehensive analysis. This policy fragmentation may impede the creation of synergistic effects essential for the effective implementation of integrated healthcare strategies. Methods: This study adopted a mixed-methods approach to analyze 85 national policies: a three-stage coding process identified 1088 policy nodes, and a three-dimensional framework (policy instruments (X) × full-cycle health service (Y) × integration stages (Z)) was applied to uncover systemic imbalances. Social network analysis and Latent Dirichlet Allocation (LDA) topic modeling were utilized to map interagency collaboration patterns and thematic shifts, which were visualized using Gephi and Sankey. Results: The analysis revealed that policy instruments are predominantly supply-side (45.04%) and environmental-side (40.35%), with demand-side instruments (14.61%) being notably underutilized, particularly in health financing. Rehabilitation services, representing just 8.27% of the policy focus, were identified as a significant gap in the comprehensive health service cycle. While 44.58% of the instruments facilitated collaboration of medical and preventive services, integration of medical–preventive management stagnated at 25.28%, reflecting institutional inertia that impedes the redistribution of cross-sector resources. Agency collaboration evolved from a siloed approach (2015–2018) to a networked structure (2019–2021) and transitioned to centralized governance post-2022. Thematic shifts in policy discourse moved from a “Healthy China” focus toward pandemic-driven disease surveillance, culminating in the recent development of smart health ecosystems. Conclusions: China’s policies for medical–preventive integration demonstrate notable structural imbalances, particularly in the economic instruments related to health financing and the private-sector participation in healthcare. These imbalances may impede the effective allocation of healthcare resources and hinder the seamless transition toward integrated care. Future policy efforts should focus on optimizing the structure of policy instruments, addressing gaps in the full lifecycle of health services, advancing integration reforms, and promoting the transformation of the healthcare system through enhanced collaborative governance among key stakeholders. Full article

Digital technologies are increasingly integrated into elderly care systems and have important implications for sustainable social development. This study investigates whether China’s Smart Health and Elderly Care (SHEC) Pilot Program enhances elderly care service provision and improves the spatial equity of resource distribution. Using prefecture-level data on elderly care institutions from 2010 to 2021, this paper employs a staggered difference-in-differences (DID) approach to identify the impact of SHEC on elderly care service provision. SHEC is treated as a digitally oriented policy initiative rather than a direct measure of digital technology adoption intensity. The results show the following: First, the pilot program significantly expands the service capacity of the elderly care system, as reflected in increases in both the number of elderly care institutions and bed capacity. Second, the policy has stronger effects on service capacity expansion in less-developed and high-aging regions, whereas the estimated effects are limited in more-developed and low-aging regions. Third, the analysis also provides exploratory evidence on potential supply-side and demand-side mechanisms. Finally, the equity analysis based on the Theil index suggests that participation in SHEC improves allocative equity, thereby supporting sustainable social development. This paper contributes to the literature by highlighting how digital empowerment-oriented policy interventions in the elderly care sector promote the sustainable expansion and equitable allocation of public service resources. Full article

Accurate land use and land cover (LULC) data are essential for effective environmental management and reliable ecological modeling within complex landscapes such as the karst region of Southwest China. While new 10 m resolution global LULC products (i.e., ESA WorldCover, ESRI Land Cover, and annual mode composite of Dynamic World (DW)) offer unprecedented spatial detail, their reliability in heterogeneous karst remains poorly understood. We evaluated the accuracy and spatial consistency of these products for 2021 in the karst regions across five provinces in Southwest China using 1416 reference points collected through stratified random sampling. The ESA WorldCover dataset outperformed the others, achieving the highest overall accuracy (79.39 ± 2.19%). ESRI’s shrub metrics, however, reflect the structural absence of this class from its 2021 product rather than classification error. ESA’s superior performance in preserving fine-scale features is consistent with independent global assessments of both the 2020 and 2021 versions. This superior performance is attributed to its integration of Sentinel-1 SAR with optical data, a finer minimum mapping unit (100 m²), and expert-driven post-classification corrections. While all products successfully identified dominant classes like trees, substantial confusion emerged among spectrally similar classes such as shrubs, grass, and crops. A key finding was the strong effect of landscape heterogeneity on accuracy. Classification accuracy was 19.37% lower at patch edges (67.38%) compared to patch interiors (86.75%). Furthermore, edge reference points contribute disproportionately to total errors. Critically, none of the three products currently provide a sufficient basis for shrub-focused ecological monitoring in this region: ESA rarely detected shrub cover, DW mapped extensive but largely inaccurate shrub areas, and ESRI eliminated the shrub class from its 2021 product. These results show that while global 10 m products provide valuable information, careful product selection and regional validation remain essential for heterogeneous karst environments. Future improvements should integrate multi-source data (optical + synthetic aperture radar), apply topographic compensation for shadow effects, and develop region-specific approaches for mapping vegetation transitions. Full article

Background: Although the application of smart home technology in the Chinese eldercare market is widespread, its effectiveness from the users’ perspective remains underexplored. This qualitative study examines the perceptions and experiences of older adult users in adopting and applying the Care-on-Call services (Ping An Tong; PAT), a prominent example of smart home technology for eldercare in Mainland China. Methods: Individual and dyadic interviews were conducted with 28 older adult users from diverse physical, socioeconomic, and familial backgrounds. Thematic analysis was performed. Results: Two overarching themes were illustrated based on thematic analysis. First, the multifaceted challenges of using PAT encompass an incomplete cognition of the services, unfamiliarity with PAT systems, psycho-cultural resistance, ‘do it yourself, don’t bother others’, economic concerns of additional costs, and ethical concerns regarding information security and privacy. Second, bridging the technology divide highlights the empowerment of PAT use among older adults through a variety of educational methods to effectively utilize the services, enhancing service effectiveness through the integration of smart home technology and social service provision, and increasing service accessibility through inclusive services. The disparities in smart home technology application between China and the West are also discussed. Conclusions: Psychosocial support, organizational programs, and the integrated service model are recommended to promote the utilization of smart home technology among older adults in China. Full article

Although glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium–glucose co-transporter 2 inhibitors (SGLT2is) have demonstrated protective effects against chronic kidney disease, their impact on acute kidney injury (AKI) remains unclear. AKI and chronic kidney disease share overlapping clinical features but differ in pathogenesis and risk profiles. Previous analyses often grouped diverse agents into single categories, potentially concealing medication-specific renal risks. Given the widespread assumption of renoprotection, particularly among newer agents, there is a need to evaluate the comparative AKI risk of GLP-1RAs and SGLT2is at the individual drug and dose level. We performed a Bayesian network meta-analysis (NMA) following Cochrane-recommended methodology for safety-focused assessments. A systematic literature search across eight databases identified 67 randomized controlled trials (RCTs), including 199,877 participants. Eligible trials reported AKI outcomes or sufficiently explicit acute renal injury-related events associated with GLP-1RA or SGLT2i interventions. The primary outcome was the incidence of AKI; all-cause dropout was analyzed as a general tolerability measure. Odds ratios (ORs) with 95% credible intervals (CrIs) were calculated, and surface under the cumulative ranking curves (SUCRA) were used to estimate relative safety rankings. Only high-dose tirzepatide (10–15 mg/week) was associated with a significantly increased risk of AKI compared to controls (absolute risk difference: 0.28%; number needed to harm: 357). In contrast, lixisenatide, high-dose canagliflozin (300 mg/day), empagliflozin, and dapagliflozin were associated with reduced AKI risk. Risk rankings consistently identified high-dose tirzepatide as the most likely to induce AKI. Subgroup analyses excluding patients with baseline renal impairment yielded consistent results. High-dose tirzepatide may elevate AKI risk despite its metabolic benefits. Clinicians should assess renal vulnerability when prescribing GLP-1RAs or SGLT2is, particularly in patients with preserved kidney function. Further prospective trials are needed to clarify causal mechanisms and inform clinical decision-making. Full article

Sustainable agriculture requires careful evaluation of crop production materials, such as conventional mulching films, which improve yields and water efficiency but raise concerns related to waste, emissions, and supply chains. Assessing sustainable alternatives is therefore essential. This study compares the environmental life cycle impacts (LCA) and social impacts (S-LCA) of three agricultural mulching films: PLA-based, PBAT-based, and conventional LDPE film. The environmental assessment reflects conditions relevant to Lithuania, while the social assessment considers production contexts in Lithuania, Poland, and China. Results show that the highest environmental impacts occur during plastic granulate production, with PBAT generating 7.3 kg CO₂^eq, compared to 1.9 kg CO₂^eq for LDPE and 1.8 kg CO₂^eq for PLA (IPCC 100a method). Social risk analysis indicates that the main risks are associated with petroleum-based materials and, in the case of PLA, corn cultivation. PBAT-based films show the highest overall environmental impact; however, their ability to degrade in soil reduces the need for collection and transport. In contrast, LDPE films require removal and waste management but may offer more favorable outcomes when managed efficiently. Overall, while bioplastics involve diverse raw materials and energy-intensive production, conventional plastics may still provide lower environmental impacts under certain conditions. Full article

Balancing food security with ecological sustainability is a critical challenge for global agricultural development. This research explores how China’s “three rights separation” reform influences the ecological efficiency of cultivated land use. This institutional innovation separates ownership, contract, and management rights to improve land resource allocation. Utilizing panel data from China spanning from 2005 to 2023, this study employs a super-efficiency SBM model to evaluate ecological efficiency, a continuous difference-in-differences (DID) framework to identify the causal effects of the reform, and a mediation effect model to explore the underlying transmission mechanisms. The results show that the “three rights separation” reform significantly improves the ecological efficiency of cultivated land use, with a regression coefficient of 0.632 that is statistically significant at the 1% level. The findings remain robust across multiple robustness tests. Mechanism analysis reveals distinct hierarchical transmission pathways through the promotion of non-agricultural labor transfer, the optimization of planting structure, and the advancement of agricultural technological progress. Among these pathways, agricultural technological progress emerges as the primary driver. Furthermore, heterogeneity analysis indicates that the positive impact of the reform is more pronounced in non-major grain-producing regions, as well as areas characterized by higher levels of mechanization and land transfer. These results suggest that further deepening land tenure reform is essential, with careful consideration of regional disparities and the mediating role of labor factors, land resource allocation, and technological progress. Full article

Background/Objectives: The digital transformation of healthcare has become a key component of building resilient and sustainable health systems. However, the long-term sustainability of digital health technologies depends not only on user acceptance but also on the institutional governance conditions that shape how these technologies are implemented and utilised in practice. This study examines how institutional factors shape the sustainable utilisation patterns of Internet of Things (IoT) technologies in regulated healthcare environments, with hospital IoT-based asset management systems, a mature and widely deployed use case in China’s public hospitals, providing the empirical context for the investigation. Methods: Drawing on institutional theory and the Technology Acceptance Model (TAM), we conceptualise user perceptions as behavioural micro-foundations through which institutional conditions influence technology utilisation. A survey of 293 healthcare professionals from two large public hospitals in China was analysed using Structural Equation Modelling (SEM), incorporating mediation and Multi-Group Analysis (MGA). Results: The results demonstrate that technical compatibility (TC) significantly enhances perceived ease of use (PEU) (β = 0.40), while organisational support (OS) positively influences both perceived usefulness (PU) (β = 0.35) and PEU (β = 0.30). Conversely, regulatory compliance (RC) negatively affects PU (β = −0.25) and PEU (β = −0.20), revealing a tension between accountability requirements and operational efficiency. The model explains between 58% and 67% of the variance in key constructs. Conclusions: Overall, the findings indicate that sustainable utilisation patterns depend on alignment between technological capabilities and institutional governance conditions, with user perceptions operating as behavioural micro-foundations through which institutional effects are transmitted. By integrating institutional theory with technology acceptance research, this study contributes a governance perspective for understanding sustainable digital transformation in healthcare systems and provides practical insights for designing interoperable, compliant, and supportive digital health infrastructures to enhance hospital operational efficiency and quality of care. Full article

Background: Maternal dietary avoidance during breastfeeding of infants with food allergies (FA) is common, but its impact on growth and development is unclear. Methods: This prospective cohort study enrolled infants aged 4–6 months who were mainly breastfed from the child health care clinic of Children’s Hospital of Chongqing Medical University, Chongqing, China. The participants were classified into a group with clinically diagnosed FA and a non-food allergies (NFA) group. To analyze avoidance extent, the FA group was stratified into high (≥5 types) and low (<5 types) avoidance subgroups based on the median number of avoided food categories. Outcomes included anthropometric Z-scores and ASQ:SE-2 social–emotional scores at 12 months, analyzed using Generalized Estimating Equations. Results: High avoidance mothers comprised 50% of the FA group. Compared to the high avoidance group, the non-FA group showed significantly better linear growth (β = 0.84, 95% CI 0.38–1.30, p < 0.001). Weight and head circumference showed no differences. High avoidance was associated with higher ASQ:SE-2 scores versus both the low avoidance and non-FA groups (p < 0.001), indicating greater social–emotional concerns. Conclusions: Extensive maternal dietary avoidance was associated with suboptimal linear growth and higher social–emotional risk scores in infants with FA, underscoring the need for integrated nutritional and developmental monitoring. These findings warrant cautious interpretation given the exploratory nature of this single-center study. Full article

Objectives: This study examines how different benefit payment modes under China’s long-term care insurance (LTCI) program influence healthcare utilization and medical expenditures among middle-aged and older adults. Specifically, it compares the effects of in-kind benefits and mixed benefits on healthcare service use and financial burden. Methods: This study uses data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, focusing on middle-aged and older adults with functional limitations. Exploiting the staggered implementation of LTCI pilot programs across 14 cities, a difference-in-differences (DID) approach is employed to estimate the causal effects of different benefit payment modes on healthcare utilization and expenditures. Heterogeneity analyses are conducted to explore differences between rural and urban populations. Results: The results indicate that the in-kind benefit mode significantly reduces inpatient visits, total medical costs, and out-of-pocket expenditures. By contrast, the mixed benefit mode shows only a modest reduction observed mainly in outpatient visits. Heterogeneity analysis further reveals that in-kind benefits are particularly effective in reducing healthcare utilization and medical expenditures among rural residents, while urban residents experience higher reductions in out-of-pocket spending. Conclusions: These findings highlight the importance of benefit design in shaping the effectiveness of LTCI policies. Prioritizing service-based benefits may improve healthcare system efficiency and reduce financial burdens among older adults. The results provide policy-relevant insights for optimizing LTCI benefit design in China and other aging societies. Full article

Objective: This study aimed to identify distinct dyadic coping profiles among infertile couples undergoing assisted reproductive technologies (ARTs) and to examine the associations between these coping profiles, depressive symptoms, and fertility quality of life (FertiQOL). Methods: A total of 271 infertile couples undergoing ARTs were recruited from a reproductive medicine center in Zhengzhou, China, and completed standardized self-report measures. Latent profile analysis was conducted to identify distinct dyadic coping profiles at the couple level. Multinomial logistic regression was used to examine sociodemographic and infertility-related predictors of profile membership. Differences in depressive symptoms and FertiQoL across profiles were analyzed using the Bolck–Croon–Hagenaars method. Results: Four dyadic coping profiles were identified: high-coping wife and low-coping husband (15.4%), low dyadic coping (20.1%), medium dyadic coping (31.5%), and high dyadic coping (33.0%). Couples in the high dyadic coping profile reported the lowest levels of depression and the highest level of FertiQoL. Women in the low dyadic coping profile reported the highest depressive symptoms, while men in the high-coping wife and low-coping husband profile demonstrated the highest depression among male partners. Sociodemographic factors (household registration, family income) and infertility characteristics (type of infertility, infertility duration) were significant predictors of profile membership. Conclusions: Dyadic coping among infertile couples undergoing ARTs is heterogeneous and differentially associated with depression and FertiQoL. Low and asymmetric dyadic coping represent high-risk profiles linked to poorer outcomes in both partners. These findings suggest that dyadic coping may serve as a protective resource for infertile couples to improve their psychological well-being and quality of life, highlighting the importance of incorporating dyadic coping assessment into routine care and providing couple-centered psychosocial interventions in fertility care practice. Full article

Background: Artificial intelligence (AI) is increasingly embedded in routine primary care, yet how the levels of integration might affect its acceptability is unknown, especially in relationship-based service models where patients expect visible human stewardship. Prior experimental studies often treat AI adoption as a binary condition, leaving the “intensity gradient” of automation and the role of model specialization under-explored. We examine whether increasing AI integration in the clinical encounter erodes patients’ intention to seek care from family doctors in China, and whether labeling the AI as a medical-specific model buffers such erosion. Methods: We conducted a nationwide online survey experiment in China (N = 2790). Participants were randomly assigned to vignettes that varied by (i) the level of AI integration (low, medium, high) and (ii) the AI type (general-purpose vs. medical-specific large language model), with a human-only care scenario as a reference. Care-seeking intention from family doctors was assessed immediately after exposure. We estimated treatment effects using OLS regression with heteroskedasticity-robust standard errors, and examined the buffering hypothesis through an interaction term between AI integration intensity and AI type. Results: Care-seeking intention declined steadily as AI integration increased (p < 0.001), with the sharpest drop under high-intensity AI integration where clinical decisions were delegated to the AI system. Across all intensity levels, framing the system as a medical-specific AI consistently resulted in higher care-seeking intention than a general-purpose model. However, the interaction between AI intensity and the AI type was not statistically significant (p = 0.508). Conclusions: Patient acceptance of AI in primary care depends not only on whether AI is involved, but on how deeply AI is positioned in the encounter. Medical-specific AI labeling may enhance acceptance across all AI integration levels. The findings underscore the need to preserve human clinical agency in AI-embedded primary care. The results contribute to research on healthcare systems, digital health, and AI–patient interaction. Full article

Large-scale surface subsidence induced by extra-thick seam longwall top-coal caving (LTCC) is strongly amplified by thick unconsolidated overburden, posing serious serviceability risks to overlying linear infrastructure. Taking the S103 Provincial Highway above Panel 6118 in Inner Mongolia, China, as the engineering background, this study integrates theoretical analysis, numerical simulation, and in situ monitoring to investigate the subsidence-control mechanism of directional presplitting roof cutting. The results show that roof cutting mitigates surface subsidence by reconstructing the overburden structural system and weakening the stress-transfer chain, thereby transforming key-stratum deformation from integral bending to segmented block movement and narrowing the subsidence-affected zone. An equivalent mining-depth model for subsidence-boundary convergence is proposed to characterize the inward migration of the subsidence-basin boundary under thick unconsolidated cover, and a segmented probability-integral model is developed to explain the kink-like high-gradient feature in the post-cut subsidence profile. Parametric simulations of roof-cutting positions (p = 0, 2, 4, …, 32 m) show that the most effective mitigation occurs in the range p = 4–12 m; using minimum–maximum highway subsidence together with profile flattening as the optimization criteria, the representative optimum is identified at p ≈ 10 m, for which the maximum highway subsidence is approximately 57 mm, about 76% lower than that in the non-cutting case. The results further indicate that, although roof cutting significantly reduces subsidence and deformation gradients, fissure localization and possible discontinuous deformation near the pre-split weak plane still require careful field monitoring. Full article