Background: As the population ages with fewer children, depression symptoms are increasing among the elderly who lack companionship. Intergenerational support is closely related to depression in the elderly; hence how the behavioral patterns and emotional quality of intergenerational support affect depressive symptoms in the elderly should be further explored.Objective: To study the effects of intergenerational exchange patterns and intergenerational relationship quality on depressive symptoms in the elderly.Methods: A total of 8,015 people over 60 years old in CHARLS in 2018 were selected as the object of this study. First, the correlation between demographics, economic conditions, health status, intergenerational support patterns, intergenerational relationship quality, and depressive symptoms in the elderly were analyzed. Three regression analysis models were established to analyze the relationship between control variables, intergenerational support patterns, intergenerational relationship quality, and depressive symptoms in the elderly. Results: Among the intergenerational economic, care, and emotional exchange modes, the risk of depressive symptoms in the elderly in the mutual support group was 31.8, 38.4, and 25.5% lower than that in the non-communication group. Compared with the elderly with very poor intergenerational relationship quality, the elderly with good, very good, and excellent intergenerational relationship quality had 74.5, 84.0, and 85.6% lower risk of depressive symptoms.Discussion: Different cultural backgrounds also affect intergenerational exchange patterns and depression in the elderly. During the study of depressive symptoms, two aspects relating to intergenerational support should be considered behaviorally and emotionally: the intergenerational exchange model and the intergenerational relationship quality. As depression in the elderly is affected by multiple factors, the participation and joint efforts of the whole society are required to reduce depressive symptoms in the elderly and realize active aging.Conclusion: The intergenerational exchange pattern of mutual support and the higher quality of the intergenerational relationship can significantly reduce the depressive symptoms of the elderly.

Objective Empirical evidence on the availability bias associated with diagnostic errors is still insufficient. We investigated whether or not recent experience with clinical problems can lead physicians to make diagnostic errors due to availability bias and whether or not reflection counteracts this bias. Methods Forty-six internal medicine residents were randomly divided into a control group (CG) and experimental group (EG). Among the eight clinical cases used in this study, three experimental cases were similar to the disease of dengue fever (DF) but exhibited different diagnoses, one was actually DF, and the other four filler cases were not associated with DF. First, only the EG received information on DF, while the CG knew nothing about this study. Then, six hours later, all participants were asked to diagnose eight clinical cases via nonanalytic reasoning. Finally, four cases were diagnosed again via reflective reasoning. Results In stage 2, the average score of the CG in the diagnosis of experimental cases was significantly higher than that of the filler cases (0.80 vs. 0.59, p<0.01), but the EG's average score in the two types of cases was not significantly different (0.66 vs. 0.64, p=0.756 ). The EG and CG had significantly different scores for each experimental case, while no difference was observed in the filler cases. The proportion of diseases incorrectly diagnosed as DF among experimental cases ranged from 71% to 100% in the EG. There were no significant differences between the mean diagnostic accuracy scores obtained by nonanalytic reasoning and those obtained by the reflective reasoning in any cases. Conclusion Availability bias led to diagnostic errors. Misdiagnoses cannot always be repaired solely by adopting a reflective approach.

Objective: This study explored the relationship between smokers’ health literacy, knowledge of smoking hazards, and their intention to quit. Methods: Based on data from the 2019 Health Literacy and Tobacco Use Surveillance among residents of a city in Zhejiang Province, 1120 male smokers were screened. Differential tests were used to analyze whether smokers with varying levels of health literacy and knowledge about smoking hazards differed in their intention to quit smoking and the intensity of their intention. A multi-factor logistic regression model was constructed to explore the extent of these differences. Results: Only 24.8% of smokers had higher health literacy. Among smokers, those with an intention to quit had a higher health literacy level compared to those without such intention (32.7% vs. 17.0%, p < 0.001). Health literacy levels did not differ significantly between groups with different intensity of intention to quit (34.2% vs. 31.9% vs. 30.1%, p = 0.435). About 48.7% of the smokers a higher level of knowledge about smoking hazards. It was more prevalent in the intent to quit group compared to the no intent to quit group (54.0% vs. 43.4%, p < 0.001), and the low intent to quit group had lower knowledge compared to the moderate and high intent to quit groups (49.1% vs. 56.6% vs. 63.4%, p = 0.011). After adjusting for other influences, smokers with lower health literacy were less likely to have intention to quit (OR = 0.659, p = 0.016). And the association between knowledge about smoking hazards and whether smokers have the intention to quit is no longer significant, but it significantly affects the intensity of the intention to quit among smokers who already have the intention (OR = 0.623, p = 0.005). Conclusion: General health literacy may play a role in facilitating smokers’ progression from the stage of no intent to quit to one of intent to quit, but a more specific understanding of the harms of smoking may be needed to increase the strength of intent to quit.

Effective self-management behaviors offer a promising pathway to address the health challenges faced by patients with chronic diseases. As a key factor influencing self-management behaviors, multidimensional health literacy has yet to be systematically studied in relation to its impact on patients with chronic diseases across different socioeconomic statuses. To systematically investigate the influence of functional, communicative, critical, and distributed health literacy on self-management behaviors among patients with chronic diseases from different socioeconomic statuses. A modified multidimensional health literacy and self-management behavior questionnaire was used to assess the health literacy and self-management behaviors of patients with chronic diseases. A total of 590 valid samples were obtained, and participants were divided into high and low socioeconomic status groups based on their socioeconomic background. Correlation analysis and multiple linear regression were conducted to explore the influence of various dimensions of health literacy on self-management behaviors across different socioeconomic statuses. After controlling for confounding variables, the communicative (β = 0.262, P < 0.01) and distributed (β = 0.343, P < 0.01) health literacy dimensions showed a significant positive impact on self-management behaviors in the low socioeconomic status group. In the high socioeconomic status group, critical (β = 0.253, P < 0.05) and distributed (β = 0.267, P < 0.01) health literacy demonstrated a significant positive effect on self-management behaviors. No significant impact was observed for functional health literacy in either group. The study comprehensively reveals the distinct effects of different dimensions of health literacy on self-management behaviors among patients with chronic diseases from varying socioeconomic statuses. These findings provide a theoretical basis for developing strategies aimed at improving self-management behaviors through health literacy enhancement, particularly tailored to patients from different socioeconomic backgrounds.

Introduction: Self-management behaviors are vital in chronic disease prevention and management, with self-efficacy acting as a key mediator between health literacy and these behaviors. However, disease duration may amplify or attenuate health literacy's impact on self-efficacy—either through experiential learning or management fatigue—requiring empirical validation of its moderating role. This study thus applied a moderated mediation framework to investigate how multidimensional health literacy influences self-management via self-efficacy, and whether disease duration moderates the health literacy–self-efficacy pathway, aiming to clarify efficacy belief dynamics in long-term adaptation. Methods: A cross-sectional study of 601 patients with chronic disease in Wenzhou's Ouhai District assessed health literacy, self-efficacy, and self-management. Using Hayes' PROCESS macro (Model 4 for mediation analysis and Model 7 for moderated mediation analysis, with 5,000 bootstrap iterations). Results: We found that self-efficacy partially mediated the relationship between health literacy and self-management behaviors (ES = 0.082, 95%CI: 0.055–0.110; 22.601% of total effect). Crucially, disease duration positively moderated the effect of health literacy on self-efficacy ( B = 0.014, p < 0.05, 95%CI: 0.002–0.026), strengthening the indirect effect of health literacy on self-management through self-efficacy as duration increased. Discussion: These findings demonstrate that self-efficacy mediates the health literacy–self-management link, while disease duration enhances health literacy's effect on self-efficacy, supporting stage-specific precision interventions.

The influence of different dimensions of intergenerational support on depression in older adults has a configuration effect. Existing researches have only used linear analyses to examine the independent effects of each dimension of intergenerational support on depression in older adults, resulting in the nature of the effects of each dimension of intergenerational support on the presence of depression in older adults remaining highly controversial. To explore the synergy and substitution effects (configurational effects) of dimensions of intergenerational support on depression in older adults. Based on data from the 2018 China Health and Retirement Longitudinal Study(CHARLS), depression among older adults was used as the outcome variable, and intergenerational support (including three dimensions of emotional, economic, and caregiving support) was used as the antecedent variable. Qualitative comparative analysis (QCA) was used to analyze the configurational effects of intergenerational support on depression in older adults. A single dimension of intergenerational support cannot be a necessary condition for depression in older adults.Factor configurations of different dimensions of intergenerational support as a sufficient condition for depression in older adults. The consistency parameter for all solution configurations in this study is 0.83, with a coverage of 0.61. The research identifies four types of configurational patterns associated with older adults’ depression: “Unidirectional Care Deficiency Type” (consistency mean of 0.84, coverage of 0.49), “Bidirectional Care Deficiency Type” (consistency mean of 0.86, coverage of 0.33), “Bidirectional Economic Deficiency Type” (consistency mean of 0.85, coverage of 0.48), and “Mixed Type” (consistency mean of 0.83, coverage of 0.23). Depression in older adults is influenced by the configurational effects of intergenerational support. The complex link between intergenerational support and depression in older adults should be examined from a holistic perspective, paying attention to the dynamic balance of intergenerational support reception and provision.