Objective Although 30 min/day of moderate-intensity physical activity is suggested for preventing type 2 diabetes (T2D), the current recommendations exclusively rely on self-reports and rarely consider the genetic risk. We examined the prospective dose-response relationships between total/intensity-specific physical activity and incident T2D accounting for and stratified by different levels of genetic risk. Methods This prospective cohort study was based on 59 325 participants in the UK Biobank (mean age=61.1 years in 2013–2015). Total/intensity-specific physical activity was collected using accelerometers and linked to national registries until 30 September 2021. We examined the shape of the dose-response association between physical activity and T2D incidence using restricted cubic splines adjusted for and stratified by a polygenic risk score (based on 424 selected single nucleotide polymorphisms) using Cox proportional hazards models. Results During a median follow-up of 6.8 years, there was a strong linear dose-response association between moderate-to-vigorous-intensity physical activity (MVPA) and incident T2D, even after adjusting for genetic risk. Compared with the least active participants, the HRs (95% CI) for higher levels of MVPA were: 0.63 (0.53 to 0.75) for 5.3–25.9 min/day, 0.41 (0.34 to 0.51) for 26.0–68.4 min/day and 0.26 (0.18 to 0.38) for >68.4 min/day. While no significant multiplicative interaction between physical activity measures and genetic risk was found, we found a significant additive interaction between MVPA and genetic risk score, suggesting larger absolute risk differences by MVPA levels among those with higher genetic risk. Conclusion Participation in physical activity, particularly MVPA, should be promoted especially in those with high genetic risk of T2D. There may be no minimal or maximal threshold for the benefits. This finding can inform future guidelines development and interventions to prevent T2D.

Objective: To introduce patient-centered approach in China and to relate it with Chinese patient satisfaction via validating the Chinese version of Patient-Professional Interaction Questionnaire (PPIQ-C).Design: This cross-sectional survey was conducted through face-to-face interviews from June to September in 2019. Participants rated their patient-centered care experience via the 16-item translated PPIQ, their experience of the received medical service, and their overall satisfaction.Setting: Kunshan Huaqiao People's Hospital in Jiangsu, China.Participants: A total of 230 participants (87 males and 143 females; 108 outpatients and 122 inpatients).Results: PPIQ-C exhibited acceptable psychometric properties. Data revealed a single factor model of the 16 PPIQ-C items [χ(4)2 = 12.394, p = 0.823, CFI = 1.000, TLI = 1.019, RMSEA = 0.000, SRMR = 0.032] had a superior model fit over the original first-order with four correlated factors and the second-order structures. The overall reliability was excellent (McDonald's ω = 0.975). In terms of patient satisfaction, process, treatment quality, and communication significantly predicted patient satisfaction, while environment, staff attitude, and medical ethics did not [R² = 0.427, F₍₆₎ = 24.887, p < 0.001]. Most importantly, the total score of PPIQ-C predicted patient satisfaction above and beyond the above-mentioned medical service perspectives (B = 0.595, SE = 0.207, p = 0.004). Finally, the constructive effect of PCC on patient satisfaction was stronger for departments of Pediatrics than Surgery.Conclusions: The Chinese version of the PPIQ scale (PPIQ-C) exhibited acceptable psychometric properties. Yet the distinction among the four factors was not supported, suggesting potential difference(s) across cultures. Patient-centered care (PCC), reflected by the overall PPIQ-C score, predicted overall patient satisfaction above and beyond other medical service perspectives. Adopting PCC approach in appropriate situations will probably advance the development of performance evaluation systems in China, thus improving the overall health care and patient satisfaction.

How monetary incentives promote physicians’ job performance in terms of patient satisfaction has been widely discussed. The incentive dilemma debate concerns whether monetary incentives reduce physicians’ intrinsic motivation at work and even lead to moral hazard. This study investigated monetary incentive policies in a hospital and analyzed how monetary incentives affect performance and behavior. By means of income composition grouping, a treatment group and control group were established, and the identification of the effect on performance was implemented using the difference-in-difference (DiD) method. The mechanism analysis was implemented using the event-study approach (ESA) and path analysis. The study found that (1) monetary incentives promote physicians to improve patient satisfaction, and the average effect is a two-point increment (p < 0.0001); (2) the effects are short-term; and (3) in contrast to many criticisms, the improvement in patient satisfaction was mainly from the effort in working during the monetary incentive policy. The results of this study contribute empirical evidence regarding the effects of monetary incentives and their mechanism and can help hospital management formulate incentive plans.

Whether health insurance reduces alcohol consumption has been debated. To identify it, the authors used three-wave balance panel data from China Health and Nutrition Survey and applied a two-way fixed-effect model. The authors found that (1) health insurance reduces alcohol consumption, (2) the effect would be deducted when they have been diagnosed with diabetes, (3) the heterogeneity existed between old and young individuals as well as rural and urban areas, those old individuals would behave more cautious, and urban individuals would consume more alcohol. This study identified the effects of health insurance and the moderating effect of diabetes, which were helpful for policymakers to optimize health insurance policy to ensure the sustainability of health insurance and suggested that primary medical staff should assist patients to establish healthy living habits and reduce their risky behaviors.

Background: Nonpharmacological interventions are important prevention strategies for mild cognitive impairment (MCI), but effects vary significantly between individuals based on personal characteristics, while current practice relies on experience-based approaches lacking personalized, adaptive intervention strategies. Objective: The objective of our study was to develop and evaluate evidence-based adaptive intervention strategies for optimizing cognitive function among older adults with MCI using a Sequential Multiple Assignment Randomized Trial (SMART) design, comparing the effectiveness of cognitive training (CT) combined with virtual reality Taichi (VRTC) versus offline Taichi (OffTC) versus control, and to identify baseline characteristics that predict treatment response for personalized intervention delivery. Methods: We recruited 92 community-dwelling adults aged ≥60 years diagnosed with MCI from 3 districts in Shanghai, China. A 24-week SMART was conducted between April and December 2023. During the first stage (weeks 1-12), participants were randomly assigned to control (n=26) or intervention groups receiving CT combined with either OffTC (n=33) or VRTC (n=34). Nonresponders at week 12 were rerandomized to alternative or intensified interventions during the second stage (weeks 13-24). The primary outcome was the Memory Guard score (MGs) at 24 weeks. Dynamic treatment regimen analysis assessed optimal adaptive strategies using regression models. Results: A total of 81 participants completed the trial. CT+VRTC demonstrated significantly superior cognitive improvement compared to control (5.10 MGs, 95% CI 2.93-7.27; Cohen d=1.425, 95% CI 0.785-2.060; P<.001) and CT+OffTC (3.61 MGs, 95% CI 1.71-5.51; Cohen d=1.009, 95% CI 0.461-1.560; P<.001). At 24 weeks, adjusted mean MGs were: CT+VRTC 32.9 (95% CI 31.3-34.5), CT+OffTC 29.3 (95% CI 27.7-30.9), and control 27.8 (95% CI 26.0-29.6). Dynamic treatment regimen analysis revealed VRTC-based adaptive strategies consistently outperformed static approaches, with VRTC responders achieving the highest effectiveness (5.40 MGs improvement, 95% CI 3.10-7.70; P<.001). Treatment intensification proved more effective than modality switching for nonresponders. Subgroup analyses revealed that younger participants (≤71 years), individuals with lower baseline cognitive function, and those with comorbid conditions demonstrated enhanced responsiveness, suggesting these populations may derive greater benefit from virtual reality–based approaches. Conclusions: This SMART trial established the first evidence-based adaptive intervention framework for community MCI prevention, demonstrating that virtual reality–enhanced Taichi combined with CT produced superior outcomes compared with traditional exercise and control conditions. Treatment intensification proved more effective than modality switching for nonresponders. Diabetes showed a better response enabling personalized intervention selection. These findings provide clinicians with objective decision rules for treatment adaptation and identify high-benefit populations (younger adults, those with lower baseline cognition, and patients with metabolic comorbidities) for targeted intervention. The protocol can be implemented by community health workers within existing urban health care infrastructure, offering a scalable approach to precision-based cognitive health management in aging populations. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100042748; https://www.chictr.org.cn/showproj.html?proj=120941