Background To identify the relationship between health literacy (HL) and mortality based on a systematic review and meta-analysis. Methods Literature published from database inception until July 2020 was searched using the PubMed and Web of Science databases, using relevant keywords and clear inclusion and exclusion criteria. The search was limited to English language articles. Two reviewers independently selected studies and extracted data. Pooled correlation coefficients and their 95% confidence intervals (CI) between HL and mortality were estimated using Stata 15.0 software. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis, and meta-regression. Quality of the original studies that were included in the meta-analysis was evaluated using the Newcastle–Ottawa Scale. A funnel plot and Egger’s test were used to determine whether significant publication bias was present. Results Overall, 19 articles were included, reporting on a total of 41,149 subjects. Eleven were prospective cohort studies, and all articles were considered “good” quality. The most used screening instruments were the short Test of Functional Health Literacy (S-TOFHLA) in Adults and the Brief Health Literacy Screen (BHLS). Among 39,423 subjects (two articles did not report the number of patients with low HL), approximately 9202 (23%) had inadequate or marginal HL. The correlation coefficient between HL and mortality was 1.25 (95%CI = 0.25–0.44). Conclusion Lower HL was associated with an increased risk of death. This finding should be considered carefully and confirmed by further research.

Introduction: Under the background of the accelerated aging of the population, comorbidity in the elderly has gradually become a social problem. At present, the related studies on chronic diseases are mainly focused on a single disease. This study aimed to investigate the prevalence of common chronic diseases, the conditions and patterns of comorbidity in middle-aged and elderly people in China. Methods: We extracted the data from China Health and Retirement Longitudinal Study (CHARLS). A total of 14 diseases were included, and the prevalence was assessed by selfreport. We calculate different disease combinations and perform descriptive statistics analysis of chronic disease and comorbidity status. Results: Among the 6754 subjects, 2833 (42.0%) people had at least one chronic disease, and 1138 (17.0%) people had two or more diseases at the same time. The top three diseases of prevalence were hypertension (15.4%), arthritis or rheumatism (11.0%), and stomach or digestive diseases (9.3%). Common dual disease combinations were hypertension and dyslipidemia, hypertension and arthritis or rheumatism, arthritis or rheumatism and stomach or digestive diseases. Conclusion:Comorbidity is common in the population, and the pattern of chronic disease comorbidity is complex. Hypertension exists in a variety of comorbidity patterns, and its screening and prevention should be strengthened.

Background Learning burnout is a passive mental state among students. It is a common phenomenon that can cause many bad outcomes in Chinese medical students, such as mental disorders and suicide, and its causes are complex. Purpose To analyze the relationship between alexithymia and learning burnout, as well as the mediating effect of mobile phone addiction, and provide clues for future interventions to deal with learning burnout among Chinese medical students. Methods In this cross-sectional study, convenience cluster sampling was used to produce a sample of 1200 medical universities in Chongqing, China. The Toronto Alexithymia Scale (TAS-20), Mobile Phone Addiction Tendency Scale (MPATS), and Learning Burnout Questionnaire (LBQ) were used to examine participants. Hierarchical regression was used to analyze the effect of alexithymia and mobile phone addiction on learning burnout. A structural equation model (SEM) with maximum likelihood was used to evaluate the mediating effect of mobile phone addiction on the relationship between alexithymia and learning burnout. The bootstrap method was used to confirm the significance of this mediating effect. Results The final sample size was 1062, with a valid response rate of 88.5%. The prevalence of learning burnout among Chinese medical students was 39.6%. Results of hierarchical regression revealed that alexithymia (ΔR 2 =0.198, P<0.01) and mobile phone addiction (ΔR 2 =0.021, P<0.01) were independent factors of learning burnout; the SEM revealed that the mediating effect of mobile phone addiction between alexithymia and learning burnout accounted for 25.16% of the total effect of alexithymia on learning burnout; the bootstrap method revealed that the bounds of the CI did not contain 0, confirming the significance of this mediating effect. Conclusion Of the medical students, 39.6% had learning burnout. Alexithymia can positively predict learning burnout, and this relationship is partially mediated by mobile phone addiction.

Objectives: This study aimed to provide a comprehensive understanding of all intervention for learning burnout by meta-analyzing their effects.Methods: Relevant studies that had been published up to September 18, 2020, were identified through a systematic search of the PubMed, Web of Science, the China National Knowledge Infrastructure (CNKI), and Wan Fang databases. Eligible studies included randomized control trials of any learning burnout intervention conducted among students. The Jadad scale was used to evaluate the quality of the study. Random-effect meta-analyses, subgroup analyses, meta-regression analysis, and sensitivity analysis were conducted. Funnel plots and Egger's tests were used to evaluate publication bias. Duval and Tweedie's non-parametric trim-and-fill method was used to adjust the effect of publication bias.Results: Of the 5,245 articles found, 39 met the inclusion criteria for the systematic review. There were 3,400 students, including 1,847 students in the intervention group and 1,553 in the control group. A meta-analysis of 44 studies showed that the interventions were effective. Subgroup analyses were conducted according to education, scales, intervention measures, and intervention time. The results showed that, compared with the control group, the learning burnout scores of undergraduates, secondary vocational students, and middle school students were significantly lower. Based on different scales, all interventions were also effective. The funnel plot was asymmetric and consistent with the results of Egger's test. The trim-and-fill method was used, and seven missing studies were merged to obtain a symmetric funnel plot.Conclusions: This meta-analysis indicated that learning burnout interventions are effective. The subgroup analyses showed that group counseling is the most widely used, exercise intervention is probably the most effective, and 8 weeks or more is the appropriate intervention time. An integrated intervention study based on the factors of learning burnout adds value. More studies are needed to supplement the results in the future.

Learning burnout is a pressing issue among Chinese medical undergraduates and Postgraduates and has drawn continuous attention worldwide. Studies have found that problematic smartphone use could affect learning burnout, but more research is needed in this direction. Furthermore, few studies focused on the mediating effect of psychological capital on the relationship between problematic smartphone use and learning burnout. The present study was a cross-sectional survey that recruited 1,800 participants from a medical university in Chongqing, China. A questionnaire based on the Mobile Phone Addiction Tendency Scale, Psychological Capital Questionnaire, Learning Burnout Scale, and demographic variables were administered to these students, and 1,475 provided valid responses (81.94%). 771 were undergraduates (52.3%) and 704 were postgraduates (47.7%). Hierarchical regression and the bootstrap method were used to examine the mediating effect of psychological capital. After controlling for demographic variables, problematic smartphone use positively predicted learning burnout in undergraduates (β = 0.328, p &lt; 0.01) and in postgraduates (β = 0.342, p &lt; 0.01). The partial mediating effect of psychological capital was 0.068 in undergraduates and 0.074 in postgraduates, accounting for 20.67 and 21.64%, respectively, of the total effect of problematic smartphone use on learning burnout. All the 95% confidence intervals (CI) did not contain 0. Problematic smartphone use can directly predict learning burnout and their relationship was mediated by psychological capital in Chinese medical undergraduates and postgraduates. Strategies to alleviating problematic smartphone use and enhance psychological capital in medical undergraduates and postgraduates may provide useful suggestions for future interventions on dealing with learning burnout in Chinese medical undergraduates and postgraduates.

Purpose: A much higher prevalence of alexithymia has been found in medical students compared with the general population. This study aimed to test the potential mediating effect of psychological capital on the relationship between childhood trauma and alexithymia in Chinese medical students, thereby providing clues for future interventions aimed at dealing with alexithymia in this population. Methods: Convenience cluster sampling was used to recruit 1200 medical students in Chongqing, China. This cross-sectional study utilised the Childhood Trauma Questionnaire Short Form, the Toronto Alexithymia Scale, and the Psychological Capital Questionnaire. A structural equation model with maximum likelihood was used to study the mediating effect presented in the aim, and the significance of the mediating effect was examined by the bootstrap method. Multiple-group invariance analyses were also conducted to confirm the stability of the model. Results: A total of 1018 were identified to have valid responses with a rate of 84.83%. 38.4% were males, 61.6% were females. The prevalence of alexithymia was 16.5%. Results of structural equation model showed that childhood trauma was positively related to alexithymia, with a standard path coefficient of 0.219 (C.R.=6.644, P<0.001). The partial mediating effect of psychological capital was 0.060 (P<0.001), accounting for 21.51% of the total effect of childhood trauma on alexithymia. Results of bootstrap method showed that the lower and upper bounds of the 95% confidence interval did not contain 0, and the multiple-group invariance analyses showed that the p values of the changes in the degrees of freedom and chi-square value were greater than 0.05, thus confirming the stability of the model. Conclusion:Childhood trauma was a direct predictor of alexithymia among Chinese medical students, and the relationship between these two was partially mediated by psychological capital. Therefore, interventions aimed at enhancing psychological capital in this population may be effective at diminishing alexithymia.

Background: Since the outbreak of the coronavirus disease 2019 (COVID-19) world pandemic, it has had a significant negative impact on the economy and employment. The orderly resumption of work and production is an important factor in reducing the impact of the COVID-19 and an important guarantee of social and economic stability. The study aimed to investigate the knowledge, attitudes, and practice (KAP) of people returning to work about personal protection under the COVID-19 world pandemic.Methods: During March 2020, based on WeChat, QQ and other internet platforms, online questionnaire survey was conducted by the convenience sampling method. SPSS version 20.0 (SPSS, Inc., Chicago, IL, USA) was used for statistics analysis. Descriptive statistics and multiple linear regression analyses were conducted to analyze the data.Results: A total of 302 valid questionnaires was collected, and the valid response rate was 86.7%. About knowledge, people who return to work had the highest awareness rate of safe communication distance and the lowest awareness rate of exposure risk levels in different workplaces. The average scores of respondents in different occupations were higher than 95 in terms of personal protective attitude. In terms of practice, the average scores of respondents in different occupations were higher than 90 points. Multiple linear regression results showed that education and place of residence were the influencing factors of knowledge, while gender was the influencing factor of practice.Conclusion: The awareness of prevention and control among the 302 participants was good. There were differences in personal protection knowledge among different occupational groups, but there were no differences in attitude and practice. Our findings were of great significance to improve the pertinence of COVID-19 prevention programs.

Purpose Most studies that examined the relationship between internet use and sleep were conducted mainly in children and adolescents, and we know little about the use of internet among adults. The purpose of this study is to understand the internet use patterns of Chinese adults and to measure their associations with sleep duration from variety, frequency and type. Methods A total of 19,730 samples were selected from 2018 data of the China Health and Retirement Longitudinal study. Internet usage was obtained by specific questions, and the range of sleep period was grouped according to recommendations from the National Sleep Foundation. Kruskal–Wallis H -test and the chi-squared test were used for basic descriptive analysis, and multinomial logistic regression was used to analyze the relationships between internet use and sleep duration. Stata version 15.0 was used for data cleaning, and SPSS version 20.0 was used for statistics analysis. Results After screening, a total of 6346 persons were included in the analysis, of which 3148 (49.61%) were males and 3198 (50.39%) were females. Age ranged from 21 to 95 years, most persons were over 45 years old, with the median age of 56 years. Only 1180 (18.59%) participants used the internet, and almost all of them used mobile phones (1137, 96.36%), the other three types were desktop computer (232, 19.66%), laptop computer (69, 5.85%) and tablet (73, 6.19%). There were 912 (77.28%) and 268 (22.71%) participants who used only one and two or more types, respectively. In the unadjusted model, both short sleep and long sleep were associated with internet use compared with normal sleep duration (0.806 [0.708–0.918] p = 0.001; 0.345 [0.251–0.475] p < 0.000). After adjusting for all covariates, the association between long sleep and internet use still persisted (0.612 [0.433–0.865] p = 0.005), but no significant difference was found in short sleep (0.929 [0.803–1.075] p = 0.325). Conclusion Internet use was found to be closely associated with sleep and the duration of sleep negatively affected, which may provide new ideas for sleep hygiene recommendations and healthy media use. This conclusion needs more evidence to support.