Objective This study aimed to explore the mediating role of marital adjustment between self-efficacy and quality of life in couples undergoing IVF treatment.Methods In this cross-sectional study, 293 infertile Chinese couples completed the General Self-Efficacy Scale, Marital Adjustment Test, and Fertility Quality of Life Scale. Data were analyzed using structural equation modeling based on the actor-partner interdependence mediation model.Results Both wives and husbands showed positive actor effects - their self-efficacy improved quality of life through their own marital adjustment. For partner effects, husbands' self-efficacy enhanced wives' marital adjustment, while husbands' marital adjustment unexpectedly reduced wives' quality of life.Conclusions Improving self-efficacy and marital adjustment can enhance quality of life for IVF couples. Healthcare providers should approach couples as an integrated unit and develop dyadic interventions to improve both partners' quality of life.

BACKGROUND:Drawing on data from the Global Burden of Disease (GBD) 2021 study, this research provides the first systematic assessment of the burden and trends of chronic kidney disease (CKD) among the global population aged 75 years and over between 1990 and 2021. Unlike previous studies covering the entire age spectrum, this study focuses on the age group with the highest concentration of disease burden and the greatest health vulnerability, with the aim of revealing the unique epidemiological patterns specific to this population. METHODS:The study methodology involved extracting data on the prevalence, incidence, mortality and disability-adjusted life years (DALYs) for chronic kidney disease (CKD) among people aged 75 years and over in 204 countries and territories from the GBD 2021 database. All reported rates are age-standardized. We calculated estimated annual percentage changes (EAPCs) to analyze trends and examined the association between the disease burden and the Sociodemographic Index (SDI). RESULTS:The study found that in 2021, approximately 127 million people aged 75 years and over worldwide were living with CKD. Between 1990 and 2021, the age-standardized prevalence declined slightly (EAPC = -0.06%; 95% UI: -0.09% - -0.03%), whilst incidence, mortality and DALY rates all rose significantly (EAPCs of 0.50%; 95% UI: 0.47%-0.53%, 1.55%; 95% UI: 1.48%-1.61% and 1.07%; 95% UI: 1.02%-1.12%, respectively), demonstrating the key phenomenon of 'prevalence-mortality trend divergence'. The relationship between the burden of disease and socio-economic development is complex: regions with low SDI bear the heaviest burden of mortality, whilst regions with high SDI have experienced the fastest growth in mortality rates. The study also revealed significant heterogeneity in the burden across age, gender and geographical regions. CONCLUSIONS:The burden of chronic kidney disease (CKD) among the global older adult population is rapidly shifting from a pattern of 'high prevalence' to one characterised by 'high incidence, high mortality and high disability', with the underlying drivers exhibiting fundamental differences across regions at various stages of development. This necessitates that public health strategies move beyond a 'one-size-fits-all' approach and instead develop highly age-specific and contextually tailored interventions. This study provides a detailed map for understanding the epidemiology of CKD in the context of extreme population ageing, and offers crucial evidence for the allocation of resources and the formulation of policies.

BackgroundDysphagia in older adults often necessitates long term parenteral nutrition (TPN). However, the optimal central venous access strategy, including implantable central venous access port (ICVAP), non-tunneled central venous catheter (NT-CVC) or peripherally inserted central catheter (PICC), remains uncertain, particularly regarding survival and complication risk.MethodsThis retrospective cohort study included 73 patients aged ≥65 years with dysphagia who received parenteral nutrition via ICVAP, NT-CVC, or PICC. Device selection was based on patient/family request and feasibility/acceptability at the discharge destination. Baseline characteristics were compared using ANOVA and chi-square/Fisher’s exact tests, and standardized mean differences (SMD) were reported to quantify baseline imbalance. Survival was evaluated using Kaplan–Meier curves with log-rank tests. Multivariable Cox proportional hazards models were performed to adjust for predefined covariates. Short-term mortality and complications were compared using chi-square or Fisher’s exact tests.ResultsSurvival differed significantly among the three groups (log-rank p < 0.001), with median survival of 305 days for ICVAP, 195 days for PICC, and 43 days for NT-CVC. After adjustment, NT-CVC was associated with a significantly higher mortality risk compared to ICVAP (HR = 4.15, 95% CI: 1.17–14.78, p = 0.028), while no significant difference was observed between PICC and ICVAP (HR = 1.05, 95% CI: 0.36–3.04, p = 0.927). Independent predictors of mortality included advanced age (HR = 1.08, p = 0.004), lower BMI (HR = 0.89, p = 0.034), higher CFS (HR = 3.70, p = 0.027), and total lymphocyte count (TLC) (HR = 1.00, p = 0.009). NT-CVC had the highest short-term mortality (34.6% at 30 days, 73.1% at 90 days, p < 0.05). No significant differences were observed in pneumonia or sepsis rates.ConclusionIn this cohort of elderly patients with dysphagia receiving long-term parenteral nutrition, ICVAP use was associated with longer survival compared with NT-CVC, while no significant survival difference was observed between PICC and ICVAP. Given the retrospective design and non-random catheter selection, these findings should be interpreted as associations and warrant confirmation in prospective, multicenter studies incorporating standardized complication definitions and patient-centered outcomes.

Background HIV and drug-susceptible tuberculosis (DS-TB) co-infection severely affects adolescents and young adults (10-24 years), leading to a significant infectious disease burden, yet this age group remains overlooked. This study assessed the 1990-2021 global, regional, and national disease burden of HIV and DS-TB co-infection with a specific focus on adolescents and young adults (10-24 years). Methods The Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) estimates disaggregated by HIV status and TB drug susceptibility. Number and rates of the incidence, prevalence, and mortality of HIV and DS-TB co-infection from 1990 to 2021 at the global, regional, and national level among individuals aged 10-24 years were collected from GBD 2021. Trends were analyzed by sex and Sociodemographic Index (SDI). Results In 2021, over 100 000 new cases and nearly 20 000 deaths were recorded globally, with the highest burden in low-SDI regions and Southern Africa. Globally, all metrics initially increased, then declined after reaching their peak. Higher disease burden occurred in females than in males. Conclusion HIV and DS-TB co-infection remains a critical public health challenge for adolescents and young adults. Greater attention must be directed to prevention, treatment, and care among adolescents and young adults.

A safe physical human-robot interaction (pHRI) in rehabilitation requires reliable perception and low-latency decision making under heterogeneous and unreliable sensor inputs. This paper presents a multimodal sensor-fusion-based safety framework that integrates physical state estimation, semantic information fusion, and an edge-deployed large language model (LLM) for real-time pHRI safety control. A dynamics-based virtual sensing method is introduced to estimate internal joint torques from external force-torque measurements, achieving a normalized mean absolute error of 18.5% in real-world experiments. An asynchronous semantic state pool with a time-to-live mechanism is designed to fuse visual, force, posture, and human semantic cues while maintaining robustness to sensor delays and dropouts. Based on structured multimodal tokens, an instruction-tuned edge LLM outputs discrete safety decisions that are further mapped to continuous compliant control parameters. The framework is trained using a hybrid dataset consisting of limited real-world samples and LLM-augmented synthetic data, and evaluated on unseen real and mixed-condition scenarios. Experimental results show reliable detection of safety-critical events with a low emergency misdetection rate, while maintaining an end-to-end decision latency of approximately 223 ms on edge hardware. Real-world experiments on a rehabilitation robot demonstrate effective responses to impacts, user instability, and visual occlusions, indicating the practical applicability of the proposed approach for real-time pHRI safety monitoring.

Aspiration is prevalent in the elderly population, and can lead to life-threatening conditions such as suffocation and aspiration pneumonia. However, gold-standard diagnostic approaches for aspiration-videofluoroscopic swallowing studies (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES)-involve radiation, invasive procedures, or operational complexity, and cannot provide continuous aspiration monitoring. Here, we develop a skin-interfaced wireless biomechanical system with tailored machine learning algorithms to detect aspiration in a continuous, user-friendly, non-invasive, and automated manner. The system detects post-swallow choking coughs as an indicator of aspiration, and evaluates a nursing-home cohort including aspiration elderly (n = 14) and non-aspiration elderly (n = 64). Leave-one-out cross-validation yields an average accuracy of 92% across four activity types, with a sensitivity of 91% in aspiration recognition. Additional testing on unseen aspiration patients supports patient-level generalization. Reliability analysis and confidence calibration enhance the interpretability of the machine learning classification model, and underpin clinical deployment. The approach provides a compact, user-friendly solution for continuous and dynamic aspiration monitoring in both home and institutional settings, holding promise for improving elderly healthcare.

Abstract Objectives: To examine dose-response associations of accelerometer-measured moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), and sedentary time (ST) with all-cause and ischemic heart disease (IHD) mortality among myocardial infarction (MI) survivors. Methods: UK Biobank participants with a confirmed history of MI were included. Wrist-worn accelerometers quantified daily MVPA, LIPA, and ST. Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs for each exposure (single-exposure models) and mutually adjusted partition models that included MVPA, LIPA, and ST simultaneously. Dose effects were modeled per 10 min/day higher MVPA and per 1 h/day higher LIPA and ST, and MVPA was also analyzed in 5 categories (0–<15, 15–<30, 30–<45, 45–<60, ≥60 min/day). Restricted cubic splines were used to visualize dose-response patterns. Results: A total of 2108 MI survivors were included (mean age 67.51 y; 79.13% men). During a median follow-up of 7.8 years (IQR: 7.3–8.4) and over 15,920.63 person-years, 295 all-cause deaths and 74 IHD deaths occurred. In partition models, higher MVPA was associated with lower all-cause mortality (per 10 min/day: HR: 0.93, 95% CI: 0.89–0.98) and lower IHD mortality (per 10 min/day: HR: 0.88, 95% CI: 0.80–0.98). Compared with MVPA 0–<15 min/day, MVPA ≥60 min/day was associated with lower all-cause mortality (HR: 0.50, 95% CI: 0.33–0.76) and lower IHD mortality (HR: 0.40, 95% CI: 0.17–0.92). Higher LIPA was inversely associated with all-cause mortality (per 1 h/day: HR: 0.85, 95% CI: 0.77–0.93), but not with IHD mortality (HR: 1.03, 95% CI: 0.85–1.24). ST was not independently associated with all-cause mortality (per 1 h/day: HR: 0.97, 95% CI: 0.90–1.04), or IHD mortality (HR: 1.03, 95% CI: 0.85–1.24). Conclusions: Among MI survivors, higher accelerometer-measured MVPA was consistently associated with lower all-cause and IHD mortality. LIPA showed an inverse association with all-cause mortality, whereas ST was not independently associated with mortality in mutually adjusted models.

[This corrects the article DOI: 10.3389/fnut.2026.1765556.].

BACKGROUND:Although work engagement and job satisfaction are two important indicators associated with care quality, their mediating effects on the relationship between perceived staffing and quality of care have not been adequately clarified. PURPOSE:This study was designed to determine the mechanism by which nurses' perceived staffing influences quality of care by clarifying the mediating roles of job satisfaction and work engagement. METHODS:A cross-sectional questionnaire survey was implemented among 2,142 clinical nurses from 211 inpatient wards in 13 hospitals. Work engagement, job satisfaction, perceived staffing, and rated quality of care were measured. RESULTS:Most (89.7%) of the respondents rated quality of care as good or better, and 56.1% perceived staffing in the wards as adequate. The two main findings of this study are as follows: (a) Perceived staffing influenced quality of care via one direct and three indirect pathways, with the indirect effect greater than the direct effect (β direct = 0.09, β total indirect = 0.25), and (b) work engagement and job satisfaction were important mediators of the impact of staffing on quality of care. CONCLUSION:Quality of care may be enhanced by improving the work engagement and satisfaction of nurses in their current job, suggesting an effective approach to alleviating the current nursing shortage.

BACKGROUND:The relationship between cognitive impairment, triglyceride-glucose (TyG) index, and depression in the elderly remains unclear. This study aims to explore the associations among cognitive impairment, TyG index, and the risk of depression in older adults, providing a basis for targeted prevention strategies. METHODS:This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Cognitive impairment was defined as the lowest quartile of three cognitive tests: the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test for learning and memory, the Animal Fluency test for executive function, and the Digit Symbol Substitution Test (DSST) for attention and processing speed. The TyG index was calculated as ln[triglycerides (mg/dL) × fasting glucose (mg/dL)/2], and participants were categorized into quartiles based on their TyG index. Multivariable logistic regression models were employed to investigate the relationships between cognitive impairment, TyG index, and depression in the elderly. RESULTS:A total of 2042 elderly participants (aged ≥ 60 years) were included in the study, among whom 312 (15.3%) were diagnosed with depression. Both cognitive impairment and higher TyG index were significantly associated with increased depressive symptoms among older adults in the United States. The risk of depression was 2.64 times higher (95% confidence interval [CI]: 1.33-5.23) in those with cognitive impairment compared to those with normal cognitive function. Participants in the highest TyG quartile had a multivariable-adjusted odds ratio (OR) of 1.61 (95% CI: 1.10-2.35) for depression compared to those in the lowest quartile. Similar results were observed across different genders, age groups, and baseline comorbidities. CONCLUSION:Our findings suggest that higher TyG index and cognitive impairment (including deficits in learning and memory, executive function, and attention/processing speed) are associated with a greater likelihood of depressive symptoms in older adults.

This prospective cohort study included 408,760 older adults to investigate complex interaction between waist circumference (WC), blood glucose (BG) or blood pressure (BP), and sex in relation to elderly mortality. We used Cox regression models incorporating a tensor product interaction function to model joint impacts of WC and four cardiometabolic markers on mortality, and developed a two-dimensional exposure-response function (ERF) to quantify the population adaptability to cardiometabolic dysfunction across different WC levels. The linear and nonlinear effects of BG and BP on mortality varied by WC, with significant synergistic interactions. The two-dimensional ERF quantified variations in excess mortality risk across different WC and cardiometabolic marker combinations. Individuals with higher WC exhibited a forward shift in risk thresholds, indicating reduced adaptability to elevated BG and BP levels. Our findings highlight the need for targeted cardiometabolic health management strategies to enhance adaptability and reduce the burden of cardiometabolic diseases in aging populations.

BACKGROUND:Effective decision-making is essential in nursing but often underdeveloped in students and novice nurses. Eye-tracking offers a real-time, objective way to study decision processes. METHODS:A pilot observational study was conducted, dividing nursing students into high- and low-experience groups based on internship exposure. Participants performed intravenous infusion preparation tasks of varying complexity. Eye-tracking and visualization techniques were used to analyze gaze patterns and decision-making trajectories. RESULTS:Under low-complexity conditions, both groups showed fewer fixations and shorter durations. As complexity increased, low-experience students exhibited more and longer fixations with frequent gaze shifts, while high-experience students maintained shorter fixation times, fewer transitions, and more organized attention. CONCLUSIONS:Task complexity and clinical experience may influence decision-making. Higher task complexity prompted a shift from intuitive to analytical processing, occurring earlier among less-experienced students. Findings support incorporating complexity-based tasks and expanded practice into nursing education to foster efficient, patient-centered decision-making skills.

We aimed to summarize the relationships among obesity, gut microbiota dysbiosis, short-chain fatty acids (SCFAs), and intestinal permeability, and to explore the potential dietary interventions that may reverse these imbalances. A scoping review was performed by searching Web of Science (WOS), PubMed, the Cochrane Library, and Science Direct from their inception until January 28, 2024. We applied predefined inclusion and exclusion criteria to select relevant articles for data extraction and synthesis. Analysis of 48 articles revealed that obesity was associated with elevated Firmicutes, Proteobacteria, and Firmicutes/Bacteroidetes ratio, with a concomitant reduction in Bacteroidetes. At the genus level, Desulfovibrio and Streptococcus were enriched. SCFAs (especially butyric, propionic, and acetic acids) declined, and intestinal permeability increased. Diet interventions, including probiotics, prebiotics, dietary patterns, and active food ingredients, reversed these shifts, promoting beneficial bacteria such as Bacteroides , Akkermansia , and Bifidobacterium , while reducing the abundance of Helicobacter . These changes in microbiota were accompanied by restored SCFA levels and improved intestinal permeability. These permeability changes involved alterations in physical (eg, tight junction proteins), chemical (eg, mucus production), and immune (eg, inflammatory and oxidative markers) barriers, with most of these changes likely mediated by gut microbiota and SCFAs. Changes in G-protein coupled receptors (GPCRs) in the gut were also observed, with a decrease in GPCRs under obese conditions and an increase following dietary interventions. This review emphasizes the critical role of gut microbiota dysbiosis, reduced SCFAs, and impaired intestinal permeability in obesity, as well as the potential of dietary interventions to reverse these changes and improve gut health. These findings underscore the importance of multigenera modulation based on microbiota ecological principles, and suggest future research on SCFA supplementation to offer new approaches for treating obesity linked to intestinal permeability.

The association between abdominal obesity and pulmonary function trajectories among patients with COPD remain to be unclear. This study aimed to explore the association between abdominal obesity and pulmonary function trajectories among patients with COPD. Data were collected from the China Health and Retirement Longitudinal Study, which was a nationally representative investigation. The pulmonary function indicator was peak expiratory flow (PEF). Abdominal obesity was assessed using waist circumference, which was categorized into two groups: < 90/85 cm and ≥ 90/85 cm, in men/women. Latent class growth analysis was used to identify distinct pulmonary function trajectories. The logistic regression was used to assess the association between abdominal obesity and pulmonary function trajectories. Finally, a total of 775 patients with COPD aged 45 years and older were included, and 301 participants (38.84%) were abdominal obesity. The mean PEF value showed a decreasing trend, with respective average values of 205.84 L/min (SD = 104.16), 199.99 L/min (SD = 99.52), and 196.06 L/min (SD = 86.74) in 2011, 2013 and 2015. Two PEF trajectories were identified: “above average-high descending” trajectory (n = 187, 24.13%) and “low-maintenance” trajectory (n = 588, 75.74%). Unadjusted and adjusted analysis showed that baseline higher waist circumference was associated with “low-maintenance” trajectory. A negative association between abdominal obesity and pulmonary function trajectories was observed among patients with COPD. This suggests that increased abdominal fat may accelerate the decline of pulmonary function over time. These findings provide evidence for designing targeted programs to improve pulmonary function, particularly for patients with COPD of abdominal obesity.

Background This study aimed to estimate temporal trends in metabolically unhealthy obesity (MUO) among United States (US) adults by age, sex, race/ethnicity, and income from 1999 to 2018. Methods We included 17,230 non-pregnant adults from a nationally representative cross-sectional study, the National Health and Nutrition Examination Survey (NHANES). MUO was defined as body mass index ≥30 kg/m2 with any metabolic disorders in blood pressure, blood glucose, and blood lipids. The age-adjusted percentage of MUO was calculated, and linear regression models estimated trends in MUO. Results The weighted mean age of adults was 47.28 years; 51.02% were male, 74.64% were non-Hispanic White. The age-adjusted percentage of MUO continuously increased in adults across all subgroups during 1999–2018, although with different magnitudes (all P<0.05 for linear trend). Adults aged 45 to 64 years consistently had higher percentages of MUO from 1999–2000 (34.25%; 95% confidence interval [CI], 25.85% to 42.66%) to 2017–2018 (42.03%; 95% CI, 35.09% to 48.97%) than the other two age subgroups (P<0.05 for group differences). The age-adjusted percentage of MUO was the highest among non-Hispanic Blacks while the lowest among non-Hispanic Whites in most cycles. Adults with high-income levels generally had lower MUO percentages from 1999–2000 (22.63%; 95% CI, 17.00% to 28.26%) to 2017–2018 (32.36%; 95% CI, 23.87% to 40.85%) compared with the other two subgroups. Conclusion This study detected a continuous linear increasing trend in MUO among US adults from 1999 to 2018. The persistence of disparities by age, race/ethnicity, and income is a cause for concern. This calls for implementing evidence-based, structural, and effective MUO prevention programs.

Lean body mass is crucial for maintaining muscle strength, particularly in patients with knee osteoarthritis. While it provides a protective effect against knee pain and functional decline, the specific relationship between total and regional lean body mass and knee pain and function in these patients remains unclear. This study aimed to investigate the relationship between total and regional lean body mass, and knee pain and function in patients with knee osteoarthritis, with subgroup analyses conducted based on BMI and sex. A total of 337 patients were included in the analyses. Clinical information and participant demographics were described descriptively. Linear regression analyses were conducted to investigate the relationship between total and regional lean body mass, and knee pain and function in patients with knee osteoarthritis, with subgroup analyses performed based on BMI and sex. The average age of 337 subjects was 63.8 ± 8.1 years, with 260 women (77.2

OBJECTIVE:This study aimed to explore the mediating role of inspiratory muscle strength between abdominal obesity and lung function in young people. DESIGN:Cross-sectional study. SETTING:This survey was conducted in Peking University Health Science Center, Beijing, China. PARTICIPANTS:404 subjects aged 18 and older. MAIN OUTCOME MEASURES:Forced expiratory volume in one second percent (FEV1%) predicted ≥80% was defined as the normal lung function. RESULTS:A total of 404 subjects were included, with maximal inspiratory pressure of 65.27±29.55 cmH2O. Among them, 61 subjects (15.10%) had central obesity, 106 subjects (26.24%) had a FEV1% predicted <80%. Abdominal obesity was significantly associated with lung function (OR=5.356, 95% CI 2.391 to 11.999, p<0.001) and inspiratory muscle strength (OR=3.537, 95% CI 1.441 to 8.679, p=0.006). Even after adjusting for inspiratory muscle strength, the relationship between abdominal obesity and lung function remained significant (OR=4.723, 95% CI 2.076 to 10.749, p<0.001), and there was a significant association between inspiratory muscle strength and lung function (OR=0.322, 95% CI 0.176 to 0.591, p<0.001). The z-test confirmed that inspiratory muscle strength mediated the relationship between abdominal obesity and lung function (|z|=2.14, p<0.05). CONCLUSION:This study highlighted the mediating role of inspiratory muscle strength between abdominal obesity and lung function.

Objective:This systematic review aimed to identify the predictors of recovery from dysphagia after stroke in the last ten years, thereby providing an evidence-based basis for nurses to identify high-risk patients and develop individualized rehabilitation plans to improve patient prognosis. Methods:Databases including the China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), China Science and Technology Journal (VIP), WanFang, PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, and Scopus were retrieved to search for literature on the predictors of recovery from dysphagia after stroke. The retrieval period was from January 2013 to December 2023. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS) and the Prediction model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed using Revman5.3 and Stata15.1 software. The review protocol has been registered with PROSPERO (CRD42024605570). Results:A total of 1,216 results were obtained, including 599 in English and 617 in Chinese. A total of 34 studies were included, involving 156,309 patients with post-stroke dysphagia, and the rate of dysphagia recovery increased from 13.53% at 1 week to 95% at 6 months after stroke. Meta-analysis results showed that older age [OR = 1.06, 95%CI (1.04, 1.08), P < 0.001], lower BMI [OR = 1.28, 95%CI (1.17, 1.40), P < 0.001], bilateral stroke [OR = 3.10, 95%CI (2.04, 4.72), P < 0.001], higher National Institutes of Health Stroke Scale (NIHSS) score [OR = 1.19, 95%CI (1.01, 1.39), P = 0.030], tracheal intubation [OR = 5.08, 95%CI (1.57, 16.39), P = 0.007] and aspiration [OR = 4.70, 95%CI (3.06, 7.20), P < 0.001] were unfavorable factors for the recovery of swallowing function in patients with post-stroke dysphagia. Conclusions:The lack of standardized criteria for rehabilitation assessment of post-stroke dysphagia has resulted in reported recovery rates of swallowing function exhibiting wide variability. Nurses should take targeted preventive measures for patients aged ≥70 years, low BMI, bilateral stroke, high NIHSS score, tracheal intubation, and aspiration to promote the recovery of swallowing function in patients with post-stroke dysphagia.