This study aimed to investigate the longitudinal association between sleep disturbance and the risk of new-onset incontinence in middle-aged and older Chinese adults and to explore whether chronic lung diseases mediate this relationship.

A prospective cohort study based on a nationally representative survey.

Data were obtained from the China Health and Retirement Longitudinal Study, a national survey of middle-aged and elderly community-dwelling Chinese adults.

A total of 7098 participants aged ≥50 years who were continent at baseline in 2011 and completed follow-up in 2015 were included in the analysis.

Sleep disturbance was assessed via self-report and categorised into good versus poor quality. Incident incontinence was defined as a new onset of difficulty in controlling urination or defecation. Multivariable logistic regression models were used to estimate the association between baseline sleep disturbance and incident incontinence, adjusting for sociodemographic, behavioural and health-related covariates. Mediation analysis was conducted to evaluate the indirect role of chronic lung disease in the sleep–incontinence pathway. Subgroup and interaction analyses assessed whether key demographic or health factors influenced the sleep–incontinence association.

Sleep disturbance at baseline was significantly associated with a higher risk of developing incontinence over 4 years (adjusted OR 1.34, p=0.040). This association remained robust across subgroups, particularly among participants aged ≥65 years, rural residents, those with higher education and those with chronic lung disease. Mediation analysis revealed that chronic lung disease partially mediated the relationship between sleep disturbance and incontinence, accounting for 7.59% of the total effect (indirect effect: 0.00104, 95% CI 0.00012 to 0.00170). Subgroup and interaction analyses confirmed the consistency of the findings across various demographic and health strata.

Sleep disturbance was associated with higher odds of incident incontinence among middle-aged and older Chinese adults. Chronic lung disease contributed modestly to this association. These findings underscore the potential importance of sleep health and comorbidity management in continence care for ageing populations.

Tuberculosis (TB) remains a globally concerning infectious disease, and significant challenges persist in attaining the 2030 targets set by the WHO. With the rapid advancements in computer-aided detection (CAD) technology, CAD-assisted Chest X-Ray (CAD-CXR) has been applied in TB patients triaging, but the practical application value of the CAD-CXR system in real-world primary healthcare settings in China for TB prevention and control has not been fully elucidated. This protocol reports a design of a cluster randomised controlled trial (CRCT), which aims to evaluate the effectiveness and clinical pathway of CAD-CXR in enhancing TB diagnostic yield in primary healthcare settings, thereby contributing to global TB elimination strategies.

Scheduled for September 2025, this CRCT will recruit 22 townships in Yichang of Hubei Province, China. These townships will be randomly allocated at a 1:1 ratio to either the CAD-CXR system intervention group or the control group. In the intervention group, healthcare providers will use the CAD-CXR analysis system to assist in TB screening, whereas the control group will rely solely on conventional CXR interpretation by radiologists. The primary outcome of the study is the TB diagnostic yield; the secondary outcomes include diagnostic delay duration and the accuracy of the CAD-CXR system. These metrics will be comprehensively evaluated to assess the effectiveness of the CAD-CXR intervention. Findings from this study are anticipated to offer evidence-based recommendations regarding the optimal application scenarios and implementation pathways for CAD-CXR.

This study was approved by the Ethics Committee of the Peking Union Medical College (CAMS&PUMC-IEC-2025-044). Findings of this study will be disseminated through traditional academic pathways, including peer-reviewed publications and conference presentations.

NCT06963606.

To investigate Chinese parents’ preferences regarding generic drug substitution policies for children, to provide references for optimising these policies, enhancing parental acceptance rates of generic drug substitution for children, and improving paediatric medication accessibility.

A discrete choice experiment was employed, and voluntary sampling was used to select parents with at least one child aged 0–12 years from three cities located in the eastern, central and western regions of China for a questionnaire survey. A mixed logit model was used to estimate preference coefficients for various policy attributes, the relative importance (RI) of these attributes and the acceptance rates of different policy scenarios.

A total of 411 participants were included. Except for the generic registration standards, the differences in all other included attributes of the paediatric generic drug substitution policy were statistically significant (p

Chinese parents show a stronger preference for GCE and medicine use control within paediatric generic drug substitution policies. To enhance policy acceptance rates, it is recommended to continue implementing GCE and to respect parents’ autonomy in selecting medications for their children.

Medication-related issues are prevalent among older adults with chronic diseases, especially in community outpatient settings where medication regimens are complex and largely self-managed. These issues, such as inappropriate prescribing, non-adherence and drug interactions, can result in avoidable harm and increased healthcare burden. Although patient engagement is crucial for medication safety, few interventions are based on behavioural theory or tailored for older adults in low-resource settings. Digital health tools present promising opportunities to provide personalised, accessible medication safety support. This study aims to develop, implement and evaluate a theory-informed digital intervention to enhance medication safety engagement among older adults with chronic conditions in community settings.

This quasi-experimental study will take place in two community health service centres in Beijing, China. Participants will be older adults aged 60–80 years with type 2 diabetes and at least one additional chronic condition. They must be prescribed at least one antidiabetic medication, capable of using a smartphone, cognitively intact and permanent residents of Beijing. The study plans to recruit 388 participants (194 per arm) to achieve 80% power with a two-sided α=0.05. Participants will be assigned to either an intervention group receiving a digital medication safety programme or a control group receiving routine care and printed educational materials. The intervention is a structured, theory-informed programme delivered via a WeChat-based platform, aimed at enhancing medication safety engagement among older adults. The study follow-up will last 3 months. The primary outcome is the change in medication safety engagement, measured using a validated scale. Secondary outcomes include perceived efficacy in patient-physician interactions, medication knowledge and fasting glucose levels. The acceptability of the intervention will be evaluated in the intervention group using the System Usability Scale and qualitative interviews. Data collection will occur at baseline, 1 month and 2 months post-intervention.

Ethical approval was obtained from the Medical Ethics Committee of Capital Medical University, Beijing, China (initial approval Z2023SY066 on May 2023; amendment Z2025SY020 on April 2025). All participants will provide written informed consent prior to enrolment. The study findings will be disseminated through peer-reviewed publications and conference presentations. A model participant information sheet and informed consent form has been developed for this trial.

Chinese Clinical Trial Registry (ChiCTR2300072716).

Chronic low back pain (CLBP) is characterised by multifaceted pathophysiology involving both central sensitisation and peripheral dysfunction. Conventional therapies often fail to address this complexity due to their unidimensional targets. Paired associative stimulation (PAS), a dual-target neuromodulatory approach that combines central and peripheral interventions, has demonstrated efficacy in enhancing motor recovery post-stroke by synchronously inducing corticospinal plasticity and peripheral neuromuscular adaptation. Building on this paradigm, we propose a novel combined primary motor cortex (M1) and multifidus muscle stimulation protocol. The intervention pairs transcranial magnetic stimulation over M1 with peripheral magnetic stimulation targeting the multifidus muscle, hypothesising that temporally coordinated central and peripheral stimulation will synergistically enhance the corticospinal drive to the lumbar spine and restore multifidus neuromuscular control, thereby alleviating pain and improving functional capacity in CLBP.

This study will enrol 82 individuals diagnosed with CLBP between 18 and 65 years of age. Study participants will undergo randomisation into two parallel groups: the experimental arm receiving active PAS therapy (n=41) and the control arm receiving sham PAS treatment (n=41). The intervention protocol consists of 20 treatment sessions delivered across a 4-week timeframe, with participants attending five sessions weekly. Assessment time points are scheduled at study entry (baseline) and 4, 8 and 12 weeks following intervention initiation. The study’s primary outcome is the Oswestry Disability Index (ODI). Secondary outcomes encompass the Visual Analog Scale (VAS), Short-form McGill Pain Questionnaire (SF-MPQ), Short Form 36 Health Survey (SF-36), Pain Catastrophizing Scale (PCS), and functional magnetic resonance imaging (fMRI). Data analysis will adhere to the intention-to-treat methodology. Between-group comparisons across temporal measurement points will employ mixed-effects modelling approaches.

Ethical approval for the research protocol was obtained from the Ethics Committee of Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (approval number: 2025-K-45), with trial registration completed in the China Clinical Trial Registry on 27 April 2025. On study completion, findings will be prepared for submission to peer-reviewed academic publications.

ChiCTR2500101574.

Conventional treatments, like immunosuppressants for systemic lupus erythematosus (SLE), are associated with many side effects. Transcutaneous vagus nerve stimulation (tVNS) emerges as a promising adjunctive therapy, potentially offering a more benign therapeutic avenue for patients with SLE. The increased number of clinical trials, including randomised clinical trials, highlights the importance of a systematic review and meta-analysis to evaluate the efficacy and safety of tVNS in treating SLE. Consequently, the aim of this systematic review and meta-analysis protocol is to synthesise the available evidence to elucidate the efficacy and safety of tVNS for the treatment of SLE.

Databases include PubMed, Cochrane Library, Web of Science, Embase, Wanfang Database, China National Knowledge Infrastructure, VIP Database and Chinese BioMedical Literature Database. Data selection, extraction and quality assessment by two independent reviewers. Fatigue is the primary outcome, and secondary outcomes include pain, quality of life, negative emotions, adverse events and measures of SLE disease activity. We will use instruments appropriate for each study type to assess the risk of bias. The credibility of evidence will be evaluated using the grading of recommendation, assessment, development and evaluation system. For meta-analysis, we will use RevMan software to perform data synthesis (V.5.4.1). Besides, publication bias assessment, sensitivity, subgroup and meta-regression analyses will be conducted as appropriate.

All data used in our study will be extracted from published clinical trials and, therefore, no ethical approval is required. Study results will be disseminated through peer-reviewed journals and relevant academic conferences.

PROSPERO CRD42024525580.

To assess the knowledge, attitudes and practices (KAP) of male relatives of pregnant women regarding labour pain and analgesia.

A cross-sectional study.

Conducted at a maternal hospital in eastern China from 28 December 2023, to 3 April 2024.

Male relatives who accompanied pregnant women during antenatal registration visits.

Primary outcome: KAP levels. Secondary outcomes: demographic and social factors associated with KAP.

Among 547 invited participants, 533 responded (response rate: 97.4%). Of these, 94.1% were spouses. Median KAP scores were 5.00, 30.00 and 21.00. Most participants lacked knowledge about labour analgesia and had safety concerns. Structural equation modelling showed knowledge had a direct effect on attitude (β=0.577, 95% CI 0.483 to 0.671) and an indirect effect on practice via attitude (β=0.602, 95% CI 0.463 to 0.740). Multivariate analysis identified associations between knowledge and education (OR=3.705, 95% CI 2.136 to 6.425), religious belief (OR=0.268, 95% CI 0.095 to 0.756) and delivery cost awareness (OR=0.175, 95% CI 0.045 to 0.675). Knowledge (OR=1.076, 95% CI 1.016 to 1.139) and attitude (OR=1.457, 95% CI 1.337 to 1.588) predicted practice.

Male relatives showed limited knowledge, overall negative attitudes, but also showed compassion and concern, and insufficient practice and inadequate practices regarding labour pain and analgesia. Educational strategies targeting male relatives are needed to improve perinatal support.

Urolithiasis represents a significant global health burden. Comparing incidence trends between countries with distinct socioeconomic profiles, such as the United States and China, is crucial for tailoring public health strategies. This study aimed to characterise and compare the temporal trends of urolithiasis incidence in the United States and China from 1992 to 2021, thereby providing insights for global disease management.

Data on urolithiasis incidence in the United States and China from 1992 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 study. First, we utilised joinpoint regression analysis to quantify the magnitude and identify significant turning points in age-standardised incidence rate trends over the study period. Second, an age-period-cohort model (APC model) was applied to assess the independent influence of age, period and cohort effects on incidence. Finally, the Nordpred model was employed to project the incidence trends for the next decade.

From 1992 to 2021, the overall incidence of urolithiasis in the United States decreased, but has recently shown an increase; in China, there was a significant reduction. According to the APC model, the highest risk was observed among middle-aged and elderly individuals in these countries. The period and cohort effects in China showed a decline. In the United States, the period effect initially declined but has recently shown an increase; cohort effect peaked around 1930, then declined and also increased in recent years. Over the next decade, the incidence of urolithiasis in both countries was expected to increase.

This study analysed the temporal trends in urolithiasis incidence over the past 30 years in the United States and China. Both countries experienced notable advancements in the burden of urolithiasis; however, the risk of an increased incidence remained higher in the United States.