Chronic disease incidence among the elderly is increasing, which is correlated with the acceleration of population aging. Evolving internet technologies may help prevent and provide interventions for chronic diseases in an accelerating aging process. However, the impact of daily internet use on the incidence of chronic diseases is not well understood.
This study aims to investigate whether daily internet use by middle-aged and older adults may inhibit or promote the occurrence of chronic diseases.
We included participants from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal survey of Chinese residents aged ≥45 years. We assessed 8-year data from wave 1 (June 2011-March 2012) to wave 4 (July-September 2018) in CHARLS. Data from wave 4 were used for a cross-sectional study, and data from all 4 waves were used for a longitudinal study. Self-reported data were used to track variables, including internet use, use frequency, and the incidence of different chronic diseases. Cox proportional hazards modeling was applied in the longitudinal study to examine the relationship between daily internet use and chronic diseases among middle-aged and older adults, while adjusting for sociodemographic characteristics and health behaviors. In addition, longitudinal data were used to analyze internet usage trends, and cross-sectional data were used to analyze the factors influencing internet use.
Among the 20,113 participants included in the longitudinal analyses, internet use increased significantly, from 2% to 12.3%, between 2011 and 2018. The adjusted model found statistically significant relationships between daily internet use and a lower incidence of the following chronic diseases: hypertension (hazard ratio [HR] 0.78, 95% CI 0.65-0.95, P=.01), chronic lung disease (HR 0.74, 95% CI 0.57-0.97, P=.03), stroke (HR 0.69, 95% CI 0.50-0.94, P=.02), digestive disease (HR 0.73, 95% CI 0.58-0.91, P=.005), memory-related disorders (HR 0.58, 95% CI 0.37-0.91, P=.02), arthritis or rheumatism (HR 0.60, 95% CI 0.48-0.76, P<.001), asthma (HR 0.52, 95% CI 0.33-0.84, P=.007), depression (HR 0.80, 95% CI 0.71-0.89, P<.001), and vision impairment (HR 0.83, 95% CI 0.74-0.93, P=.004). Moreover, our study also showed that with increasing frequency of internet use, the risk of some chronic diseases decreases.
This study found that middle-aged and older adults who use the internet have a reduced risk of developing chronic diseases versus those who do not use the internet. The increasing prevalence of daily internet use among middle-aged and older adults may stimulate contemplation of the potential role of internet platforms in future research on chronic disease prevention.

BACKGROUND: In malaria-endemic countries such as Rwanda, the appropriate use of mosquito bed nets is an effective intervention for malaria prevention. Despite being one of the demographics most impacted by malaria, there is a dearth of literature on the usage of mosquito bed nets by pregnant women in Rwanda. The study aimed to assess the prevalence and associated factors for mosquito bed net use among pregnant women in Rwanda.
METHODS: We used weighted data from the 2020 Rwanda Demographic and Health Survey of 870 pregnant women, and multistage stratified sampling was used to select participants. Multivariable logistic regression was conducted to determine the factors associated with mosquito bed net use, using SPSS (version 26).
RESULTS: Of the 870 pregnant women, 57.9% (95%CI: 54.6-61.1) used mosquito bed nets. However, 16.7% did not use bed nets among those owning bed nets. On one hand, older age (AOR = 1.59, 95%CI: 1.04-2.44), primary education (AOR = 1.18, 95%CI: 1.07-2.23), being married (AOR = 2.17, 95%CI: 1.43-3.20), being from Kigali region (AOR = 1.97, 95%CI: 1.19-3.91), partner\'s education (AOR = 1.22, 95%CI: 1.13-3.41), having recently visited a health facility (AOR = 2.07, 95%CI: 1.35-3.18), and being in the third pregnancy trimester (AOR = 2.14, 95%CI: 1.44-3.18) were positively associated with mosquito bed net use. On the other hand, low wealth index (AOR = 0.13, 95%CI: 0.07-0.24), and being from Eastern region (AOR = 0.42, 95% CI: 0.26-0.66) had a negative association.
CONCLUSIONS: About half of the pregnant women in Rwanda used mosquito bed nets and the usage was associated with various socio-demographics. There is a need for appropriate risk communication and continuous sensitisation to improve mosquito net use among pregnant women. Early antenatal care attendance and partner engagement in malaria prevention and mosquito net use, as well as consideration of household dynamics, are also crucial in improving not only mosquito net coverage but also utilization.

Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time.
We used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app.
This was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months\' postintervention (T3) to ascertain the sustained effect.
A total of 37.8% of mHealth+I and 18.3% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant (χ21=6.81, P=.009). Improvements in self-efficacy (β=4.30, 95% CI 0.25-8.35, P=.04) and depression levels (β=-1.98, 95% CI -3.78 to -0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 (β=-1.38, 95% CI -1.98 to -0.78, P<.001), with a marginal increase at T3.
The relatively low rates of mHealth app usage at follow-up are comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth.
ClinicalTrials.gov NCT03878212; https://clinicaltrials.gov/ct2/show/NCT03878212.
RR2-10.1159/000509129.

This analysis considers public interest in COVID-19-related issues as well as individuals\' risk perception and trust in society in their demand for face masks during the pandemic. Through a national survey, we examine demand during both the outbreak and the recovery stage of the pandemic and differentiate demand into purchasing and usage. The examination allows us to observe the evolvement of demand over time and stockpiling. We find that public interest and risk perception had a more significant association with mask demand during the outbreak stage, and trust was more connected with mask demand during the recovery stage. While stocking was evident in both stages, consumers were much less price sensitive in the outbreak stage. Overall, the relationship between most factors and mask demand was smaller in the recovery stage. Our research is useful for policymakers to assess the creation and termination of temporary legislation to help manage the value chain of personal protective equipment during a major public health crisis.

Routine HIV testing accompanied with pre-exposure prophylaxis (PrEP) requires innovative support in a real-world setting.
This study aimed to determine the usage of HIV self-testing (HIVST) kits and their secondary distribution to partners among men who have sex with men (MSM) in China, who use PrEP, in an observational study between 2018 and 2019.
In 4 major cities in China, we prospectively followed-up MSM from the China Real-world oral PrEP demonstration study, which provides daily or on-demand PrEP for 12 months, to assess the usage and secondary distribution of HIVST on quarterly follow-ups. Half of the PrEP users were randomized to receive 2 HIVSTs per month in addition to quarterly facility-based HIV testing. We evaluated the feasibility of providing HIVST to PrEP users.
We recruited 939 MSM and randomized 471 to receive HIVST, among whom 235 (49.9%) were daily and 236 (50.1%) were on-demand PrEP users. At baseline, the median age was 29 years, 390 (82.0%) men had at least college-level education, and 119 (25.3%) had never undergone facility-based HIV testing before. Three months after PrEP initiation, 341 (74.5%) men had used the HIVST provided to them and found it very easy to use. Among them, 180 of 341 (52.8%) men had distributed the HIVST kits it to other MSM, and 132 (51.6%) among the 256 men who returned HIVST results reported that used it with their sexual partners at the onset of intercourse. Participants on daily PrEP were more likely to use HIVST (adjusted hazard ratio=1.3, 95% CI 1.0-1.6) and distribute HIVST kits (adjusted hazard ratio=1.3, 95% CI 1.1-1.7) than those using on-demand PrEP.
MSM who used PrEP had a high rate of usage and secondary distribution of HIVST kits, especially among those on daily PrEP, which suggested high feasibility and necessity for HIVST after PrEP initiation. Assuming that fourth-generation HIVST kits are available, HIVST may be able to replace facility-based HIV testing to a certain extent.
Chinese Clinical Trial Registry ChiCTR1800020374; https://www.chictr.org.cn/showprojen.aspx?proj=32481.
RR2-10.1136/bmjopen-2019-036231.

The successful completion of medical practices often relies on information collection and analysis. Government agencies and medical institutions have encouraged people to use medical information technology (MIT) to manage their conditions and promote personal health. In 2014, Taiwan established the first electronic personal health record (PHR) platform, My Health Bank (MHB), which allows people to access and manage their PHRs at any time. In the face of the COVID-19 pandemic in 2020, Taiwan has used MIT to effectively prevent the spread of COVID-19 and undertaken various prevention measures before the onset of the outbreak. Using MHB to purchase masks in an efficient and orderly way and thoroughly implementing personal protection efforts is highly important to contain disease spread.
This study aims to understand people\'s intention to use the electronic PHR platform MHB and to investigate the factors affecting their intention to use this platform.
From March 31 to April 9, 2014, in a promotion via email and Facebook, participants were asked to fill out a structured questionnaire after watching an introductory video about MHB on YouTube. The questionnaire included seven dimensions: perceived usefulness, perceived ease of use, health literacy, privacy and security, computer self-efficacy, attitude toward use, and behavioral intention to use. Each question was measured on a 5-point Likert scale ranging from \"strongly disagree\" (1 point) to \"strongly agree\" (5 points). Descriptive statistics and structural equation analysis were performed using SPSS 21 and AMOS 21 software.
A total of 350 valid questionnaire responses were collected (female: 219/350, 62.6%; age: 21-30 years: 238/350, 68.0%; university-level education: 228/350, 65.1%; occupation as student: 195/350, 56.6%; average monthly income From the perspective of the populace, this study explored the factors affecting the use of MHB and constructed an interpretation model with a strong goodness of fit. The results of our analysis are consistent with the technology acceptance model. Through the diverse value-added services of MHB, Taiwan\'s experience in pandemic prevention with smart technology can facilitate future responses to unknown, emerging infectious diseases.

UNASSIGNED: Social media has become an integrated part of nursing profession, requiring nursing students to develop confidentiality and professional fitness to practice. The aim of this study was to investigate nursing students\' usage, professionalism and attitudes toward social media.
UNASSIGNED: A cross-section study was conducted online among undergraduate nursing students (n = 654). Questionnaires of self-directed learning, self-efficacy and usage and views toward social media were administered.
UNASSIGNED: Ethical approval was obtained from the Hubei University of Chinese Medicine.
UNASSIGNED: All participants were social media users. QQ (93.2%) was the most frequently used. 74.5% respondents spent 2-6 h on social media daily. The majority held positive attitudes toward social media. Year group and gender had influence on perceptions and attitudes toward social media. Furthermore, 81.5% students believed that social media positively influenced self-directed learning. Self-directed learning and learning motivation acted as predictors of the attitudes toward social media. Meanwhile, 67.3% students had posted personal photos and videos online, and 82.4% of them did not have privacy setting on social media. In addition,13.8% students attacked others or posted improper photos online. 22.9% participants witnessed improper posts from schoolmates or teachers, such as complaints about schoolmates or teachers (22.2%), foul language (11.1%), violence (3.9%), sexually suggestive photos (2.6%) and patient confidentiality (0.7%). In all, 15.0% respondents accepted \"friend request\" from patients. A total of 58.2% students were not aware of professional standards of behavior online for health care providers. In addition, 52.3% participants insisted that it is essential to develop social media and professionalism course for nursing students.
UNASSIGNED: Nursing students use social media extensively. Some students are at risk of carrying out unprofessional behavior which have detrimental effects on students\' future opportunities. This suggests that best practices and training in nurse education should be implemented to help students to be informed of professionalism.

Objective: To describe the status of non-steroidal anti-inflammatory drugs (NSAIDs) use in areas with a high incidence of upper gastrointestinal cancer in China. Methods: This study was based on the National Key Research and Development Program of \"National Precision Medicine Cohort of Esophageal Cancer\" and \"Study on Identification and Prevention of High-risk Populations of Gastrointestinal Malignancies (Esophageal cancer, Gastric cancer and Colorectal cancer)\" . From January 2017 to August 2018, 212 villages or communities with a high incidence of esophageal cancer or gastric cancer were selected from 12 regions in 6 provinces. A total of 35 910 residents aged between 40 and 69 years old who met the inclusion criteria and signed the informed consent were investigated and enrolled in this study. The use of NSAIDs, demographic characteristics, health-related habits, height, weight, and blood pressure were collected by the questionnaire and physical examination. The status of main NSAIDs (aspirin, acetaminophen and ibuprofen) use with the difference varying in genders, age groups and regions were analyzed by using χ(2) test and Cochran-Armitage trend analysis method. Results: Of 35 910 subjects, the mean age was (54.6±7.1) years old and males accounted for 43.42% (15 591). The overall prevalence of NSAIDs intake was 4.56% (1 638), but it significantly varied in different provinces (P<0.001). The overall prevalence of NSAIDs intake was 4.87% (1 750) in females, which was significantly higher than that in males 4.24% (1 524) (P<0.001). The prevalence of NSAIDs intake increased with age (P for trend <0.001). As the frequency of NSAIDs intake increased, the incidence of gastrointestinal symptoms, gastrointestinal ulcers and black stools increased (P for trend <0.05 for all). Conclusion: The use of NSAIDs is prevalent in some areas with a high incidence of upper gastrointestinal cancer in China. The increased use of NSAIDs may lead to more adverse effects related to the gastrointestinal tract.
目的： 分析中国部分上消化道癌高发区非甾体类抗炎药（NSAIDs）的使用现况。 方法： 基于\"中国食管癌专病队列\"和\"消化道恶性肿瘤（食管癌、胃癌、大肠癌）高危人群识别及高危人群预防研究\"，于2017年1月至2018年8月，在6个省份的12个上消化道癌高发地区，选取212个食管癌、胃癌高发的乡村/社区，招募35 910名符合纳入标准的40~69岁居民为研究对象。通过问卷调查和体检收集非甾体类药物的使用情况、社会人口学特征、健康相关行为等相关信息，并采用χ(2)检验和Cochran-Armitage趋势检验分析NSAIDs的使用情况及其性别、年龄和地区间的差异。 结果： 研究对象年龄为（54.6±7.1）岁，男性占43.42%（15 591名）；NSAIDs使用率为4.56%（1 638名）。不同省份的NSAIDs的使用率差异具有统计学意义（P<0.001）；女性使用率[4.87%（1 750名）]高于男性[4.24%（1 524名）]（P<0.001）；随着年龄增长，NSAIDs使用率呈增加趋势（P(趋势)<0.001）；随着NSAIDs使用频率增加，胃肠道症状、胃肠道溃疡和黑便发生率均呈增加趋势（P(趋势)值均<0.05）。 结论： 中国部分上消化道癌高发区NSAIDs的使用较为普遍；随着NSAIDs使用频率增加可能会导致胃肠道相关的不良反应。.

Telehealth aims to revolutionize health care by migrating health care from hospitals and satellite clinics directly into the home and onto mobile devices. Telehealth has the potential to increase public access to healthcare in China, where large segments of the population remain underserved, yet little is known about current attitudes and use of telehealth in the country.
Our aim was to determine attitudes and use of telehealth in China among medical professionals and patients, as well as identify factors that may affect its use.
Using a custom-designed questionnaire, we performed a cross-sectional survey of medical professionals, medical students and patients at three large hospitals in Chengdu, Sichuan, China. We used a structural model to analyze the influence of factors that may affect use of telehealth.
Of 600 questionnaires that were distributed, 550 (96.49%) were analyzed. Most respondents (63.28%) were familiar with using telehealth to \"schedule medical appointments/pay medical fees online\", but relatively few (28.55%) used this feature. Nearly half of respondents were familiar with the concept of a \"virtual visit\" (46.18%), but only 12.18% had ever engaged in such visits. Medical professionals and students generally showed higher awareness and greater use of telehealth than patients. The strongest concern about telehealth among respondents was \"authenticity and reliability of data from remote monitoring of patients\" (75.17%). The proportion of respondents concerned about the potential disadvantages of telehealth was highest among students and lowest among patients. Awareness and use of telehealth were associated with previous experience with health-related use of the Internet and experience with traditional forms of telehealth, but not with social status or attitude toward telehealth.
Medical professionals and patients alike in China have a high awareness of telehealth, primarily traditional forms of telehealth, but only a small percentage actually use it. Patients have much lower awareness and use of telehealth than medical professionals and medical students, though they have generally positive attitudes towards telehealth. Telehealth is still in its infancy in China, and the environment for its development is largely favorable among current and future medical professionals.

BACKGROUND: Inhaled nitrites are commonly used by men who have sex with men (MSM) in western countries. As such compounds are not illicit, they are widely available in China. Recent studies have documented a high prevalence of inhaled nitrites use in this population.
METHODS: Snowball sampling was used to recruit 576 MSM in Beijing, China, who completed an anonymous face-to-face interview.
RESULTS: Of the participants, 49.8% had heard of \"Rush\" or \"inhaled nitrites\". The prevalence of use in the last three months was 28.3% among all participants and 56.8% among those with awareness about the compounds. A stepwise model found that age group (26-35 years old, ORm= 3.91; ≤ 25 years old, ORm = 3.05; reference group: >35 years old, P < 0.01) and multiple male sex partnerships (ORm = 2.29, P < 0.01) were associated with inhaled nitrites use. Adjusted for these two variables, constructs based on the Health Belief Model (HBM) were significantly associated with inhaled nitrites use in the last three months: Perceived Severity Scale [Adjusted Odds Ratios (AOR) = 0.72, P < 0.001], the Perceived Benefit Scale (AOR = 1.20, P < 0.001), the Perceived Barrier Scale (AOR = 0.81, P < 0.01), the Cue to Action Scale (AOR = 1.45, P < 0.001), and the Perceived Self-efficacy Scale (AOR = 0.71, P < 0.001).
CONCLUSIONS: The prevalence of inhaled nitrites use was high. It may further increase sharply among MSM in China when awareness becomes more common. Cognitive variables derived from the HBM provided a useful framework for designing interventions at structural, inter-personal and individual levels. Policy changes should also be considered.