Although green spaces have positive effects on mental health, the health benefits of green spaces at different spatial scales within the university environment remain unclear, and the underlying mechanisms are not yet well understood. This study constructs a "Stimulus-Organism-Response" (S-O-R) analytical framework across multiple spatial scales and, by integrating multi-source data with a multilevel mediation model, examines the impacts of the green space environment on the mental health of college students across 34 universities in China. The results confirm the "scale dependence" of green space benefits: although the overall campus (OC) exhibits relatively high greenness, it shows no significant association with mental health; in contrast, the green space environments within the campus buffer zone with 500 m (CBZ500) and the campus buffer zone with 1000 m (CBZ1,000) significantly promote college students' mental health by enhancing environmental satisfaction. This study reveals the substantial health value of green spaces within campus buffer zones and suggests that universities should strengthen the development and governance of green space environments in areas surrounding campuses.

Social isolation is a critical determinant of health that disproportionately affects people living with HIV/AIDS (PLWHA). Although existing literature has identified associations of family relationships and perceived stigma with social isolation, the ways in which these factors are statistically related remain insufficiently explored. This study aimed to assess the level of social isolation among PLWHA in China and to examine whether perceived stigma is statistically associated with the relationship between family relationships and social isolation. A cross-sectional study was conducted among 294 PLWHA recruited through convenience sampling from Chengdu Public Health Clinical Center and the Xichang Center for Disease Control and Prevention between March 2023 and July 2024. Participants completed questionnaires on sociodemographic variables, disease-related information, General Alienation Scale, Berger HIV Stigma Scale, and Family Intimacy and Adaptability Scale. Data were analyzed using descriptive statistics, t-tests, ANOVA, Pearson correlation, and Bootstrap mediation analysis (PROCESS Model 4) in SPSS 27.0. A total of 294 PLWHA (78.9

BackgroundGeneralized myasthenia gravis (gMG) is a rare, chronic autoimmune disorder that imposes a substantial disease burden in China. As novel therapeutic options emerge, understanding patient preferences has become essential for treatment decision-making. This study aimed to assess treatment preferences and willingness to pay (WTP) among Chinese gMG patients.MethodsThis multicenter, cross-sectional survey was conducted from March to August 2025 among patients with gMG in China. A discrete choice experiment was used to quantify patient preferences by presenting hypothetical treatment scenarios defined by eight key attributes. A mixed Logit regression model was used to identify preference drivers, and WTP was estimated to reflect the monetary value assigned to changes in treatment attributes.ResultsAmong the 909 analyzed patients, the mean age was 48.9 ± 13.27 years, and 61.8% were female. Within the selected attribute sets, safety was a key determinant of patient preferences, with consistently favored for lower risks of adverse drug reactions (ADRs) on metabolic diseases, infection, myelosuppression, and liver and kidney function impairment; WTP increased as risk levels decreased. Patients preferred oral administration, followed by subcutaneous injection and intravenous infusion. Infrequent dosing, once every-6-month, weekly or daily, was preferred over 2–3 times daily. Faster onset time of action (≤2 weeks) was favored, and higher out-of-pocket costs were disfavored. Subgroup analyses revealed young patients valued once weekly dosing, subcutaneous injection, and low risk of liver and kidney function impairment than old patients. Patients with high disease burden showed similar preferences for low and moderate ADRs risk. High-income patients favored low ADRs risk, infrequent dosing, subcutaneous injection, and were less sensitive to cost than to low- and medium-income patients.ConclusionThis large-scale study was the first to investigated treatment preferences and WTP among Chinese patients with gMG. Within the selected attribute sets, patients prioritized safety, infrequent and convenient administration route, affordability, and rapid onset of action. Patients were willing to invest financially in therapies that align with these preferences. Incorporating patient preferences in clinical decision-making and reimbursement policy may improve adherence, reduce disease burden, and enhance quality of life for individuals with gMG in China.

This descriptive qualitative study explored the self-management experiences of older adults living with HIV in China, an emerging population facing the dual challenges of aging and chronic disease management. Seventeen participants aged 50-72 years were purposively recruited from Chengdu and Meishan between April and August 2025. Semi-structured interviews were conducted, audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke's six-step thematic analysis, following the COREQ checklist to ensure methodological rigor. Five major themes and ten subthemes were identified, encompassing diverse daily self-management practices, disease cognition and health information experiences, psychological and emotional responses, social support and resource utilization, and aging-related challenges and adaptations. Participants reported multiple barriers-including physical decline, stigma, limited health literacy, and treatment side effects-as well as facilitators such as proactive learning, psychological resilience, family engagement, and supportive healthcare services. The findings highlight the complex interplay of obstacles and adaptive strategies in self-management among older adults with HIV and underscore the need for culturally sensitive, age-appropriate educational and supportive interventions tailored to this population in China.

PurposeCollege student’s mental health issues have emerged as a significant public health concern. The urban campus environment, being the primary habitat for college students, plays a crucial role in influencing their mental health.Design/methodology/approachBased on survey data from 34 Chinese universities and 1173 college students in 2021, this study utilized deep learning and street view images to explore the relationship between various urban campus landscapes, college students' exercise participation, and mental health.FindingsThe study revealed substantial variations in campus landscape features, particularly in terms of spatial openness. While green campus landscapes (measured by the Green View Index and Normalized Difference Vegetation Index) showed no significant impact on exercise participation or mental health, the Sky View Factor did. Higher levels of campus openness and exercise frequency were associated with better mental health. The study also underscored that the influence of urban campus landscapes on college students' mental health was mediated by their exercise participation. Notably, spatial openness emerged as the most prominent differentiating factor among urban campus landscape attributes, significantly affecting students' exercise participation and mental health.Originality/valueThus, fostering open campus environments and reducing spatial constraints are vital steps in creating a sustainable urban landscape that can help alleviate potential negative effects on college students' mental health issues.

Rheumatoid arthritis (RA) is a chronic, incurable condition. Effective self-management behaviors can enable patients to monitor disease progression, alleviate symptoms, and enhance quality of life. However, the mechanisms underlying self-management behaviors remain unclear. This study aimed to explore the relationship between disease knowledge, coping style, social support, self-efficacy, and self-management behaviors in Chinese patients with RA, framed within the Information–Motivation–Behavioural skills model. A cross-sectional study was conducted among patients with RA from the rheumatology and immunology department of a tertiary hospital in Sichuan Province, China between September 2021 and March 2022. Data were collected by questionnaires. Structural equation modeling was employed to examine the direct and indirect pathways linking disease knowledge, coping style, social support, self-efficacy, and self-management behaviors. A total of 529 participants completed the questionnaire. The mean score of self-management behaviors was 61.68 ± 14.84. Disease knowledge (β = 0.351, 95% CI [0.211–0.478]), confrontation (β = 0.341, 95% CI [0.213–0.465]), and self-efficacy (β = 0.104, 95% CI [0.030–0.17]) had significant direct effects on self-management behaviors. Additionally, disease knowledge (β = 0.309, 95% CI [0.177–0.437]), avoidance coping (β = −0.023, 95% CI [−0.049 to −0.007]), and social support (β = 0.015, 95% CI [0.002–0.041]) indirectly influenced self-management behaviors through self-efficacy. Self-efficacy emerged as a key mediator in RA self-management, linking cognitive, motivational, and social factors. Interventions that enhance disease knowledge, promote proactive coping strategies, and strengthen social support: guided by the Information–Motivation–Behavioural skills model: may optimize self-management behaviors and improve clinical outcomes. These findings provide both theoretical and practical insights into psychosocial determinants of self-management in RA.

Background: People living with HIV often face challenges related to quality of life, mental health, and social support. Nurse-led self-care interventions have been proposed as a means to address these issues, but their overall effectiveness needs systematic evaluation. Objectives: To systematically review and meta-analyze the effectiveness of nurse-led self-care interventions on quality of life, social support, depression, and anxiety among people living with HIV. Design: A systematic review and meta-analysis of randomized controlled trials. Methods: A systematic search of PubMed, EMBASE, Web of Science (Core Collection), Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Scopus, and PsycINFO (Ovid) was conducted for articles from inception to May 2024. Two authors independently screened studies and extracted data. Randomized controlled trials that investigated the effects of nurse-led self-care interventions on the quality of life, social support, depression, and anxiety in people living with HIV, published in English, were included. The quality of the included studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Meta-analyses were conducted using Review Manager 5.3 and Stata17, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Nineteen randomized controlled trials published between 2003 and 2024 were included. The metaanalysis showed that compared to the control group, nurse-led self-care interventions significantly improved quality of life (SMD = 0.45, 95% CI: 0.07 to 0.84, P <0.05) and reduced depression (SMD = -0.46,95 % CI: -0.75 to -0.17, P < 0.001; RR = 0.80, 95% CI: 0.68 to 0.94, P < 0.05). The impact on social support was not statistically significant (SMD = -0.02, 95 % CI: -0.25 to 0.22, P = 0.89). Only two studies reported beneficial effects on anxiety, indicating a need for further high-quality research. Conclusion: Nurse-led self-care interventions effectively improve the quality of life and reduce depression in people living with HIV, but current evidence shows these interventions have little impact on social support. The evidence regarding anxiety is limited, indicating a need for more rigorous research to explore the potential benefits of these interventions for anxiety in people living with HIV. These findings support the inclusion of nurse-led self-care interventions in routine HIV care to enhance the well-being of people living with HIV. Registration number: (PROSPERO): CRD42024548592.

PURPOSE:To explore the cancer-related fatigue(CRF) trajectories and their predictors of gastric cancer patients undergoing 6-cycle chemotherapy, and to identify subgroup characteristics of patients with different CRF trajectories. METHODS:A prospective longitudinal study was conducted between November 2020 and December 2021, involving 189 first-time chemotherapy gastric cancer patients at a tertiary general hospital in Chengdu, Sichuan Province, China. Data were collected 7 times within 6 chemotherapy cycles (before the first cycle(T0), and within 1 week after the end of each cycle (T1∼T6)).The CRF level was assessed by the Cancer Fatigue Scale. Growth mixture modeling was used to identify the latent classes of CRF trajectories. Group differences analyses were performed to determine characteristics of patients with different CRF trajectories, and multivariate regression analysis was adopted to identify predictors of CRF trajectories. RESULTS:The overall CRF level increased over time, with the greatest change from T0 to T1. Three CRF trajectories were identified: the acute fatigue group(Class1:23.8 %), the low fatigue group(Class2:59.8 %), and the gradually worsening fatigue group(Class3:16.4 %). Patients with pain or depression were more likely to be in the acute fatigue group, and female were more likely to be in the gradually worsening fatigue group, compared with the low fatigue group. CONCLUSIONS:The overall CRF trajectory and three sub-trajectories were identified. Patients with pain, depression, and being female are prone to CRF deterioration. Since CRF level increases fastest from T0 to T1, early prevention and management of CRF should be implemented in gastric cancer patients undergoing chemotherapy.

Elderly individuals living alone represent a vulnerable group with limited family support, making them more susceptible to mental health issues such as depression and anxiety. This study aims to construct a network model of depression and anxiety symptoms among older adults living alone, exploring the correlations and centrality of different symptoms. The goal is to identify core and bridging symptoms to inform clinical interventions. Using data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study constructed a network model of depression and anxiety symptoms among elderly individuals living alone. Depression and anxiety symptoms were assessed using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and the Generalized Anxiety Disorder Scale-7 (GAD-7), respectively. A Gaussian Graphical Model (GGM) was employed to build the symptom network, and the Fruchterman-Reingold algorithm was used for visualization, with the thickness and color of the edges representing partial correlations between symptoms. To minimize spurious correlations, the Least Absolute Shrinkage and Selection Operator (LASSO) method was applied for regularization, and the optimal regularization parameters were selected using the Extended Bayesian Information Criterion (EBIC). We further calculated Expected Influence (EI) and Bridge Expected Influence (Bridge EI) to evaluate the importance of symptoms. Non-parametric bootstrap methods were used to assess the stability and accuracy of the network. The Network centrality analysis revealed that GAD2 (Uncontrollable worry) and GAD4 (Trouble relaxing) exhibited the highest strength centrality (1.128 and 1.102, respectively), indicating their significant direct associations with other symptoms and their roles as core nodes in the anxiety symptom network. Other highly central nodes, such as GAD1 (Nervousness or anxiety) and GAD3 (Generalized worry), further underscore the dominance of anxiety symptoms in the overall network. Betweenness centrality results highlighted GAD1 (Nervousness or anxiety) and GAD2 (Uncontrollable worry) as critical bridge nodes facilitating information flow between different symptoms, while CESD3 (Feeling depressed) demonstrated a bridging role across modules. Weighted analyses further confirmed the central importance of GAD2 (Uncontrollable worry) and GAD4 (Trouble relaxing). Additionally, the analysis showed gender differences in the depression-anxiety networks of elderly individuals living alone. This study, through network analysis, uncovered the complex relationships between depression and anxiety symptoms among elderly individuals living alone, identifying GAD2 (Uncontrollable worry) and GAD4 (Trouble relaxing) as core symptoms. These findings provide essential insights for targeted interventions. Future research should explore intervention strategies for these symptoms to improve the mental health of elderly individuals living alone.

BackgroundeHealth literacy has increasingly emerged as a critical determinant of health, highlighting the importance of identifying its influencing factors; however, these factors remain unclear. Numerous studies have explored this concept across various populations, presenting an opportunity for a systematic review and synthesis of the existing evidence to better understand eHealth literacy and its key determinants. ObjectiveThis study aimed to provide a systematic review of factors influencing eHealth literacy and to examine their impact across different populations. MethodsWe conducted a comprehensive search of papers from PubMed, CNKI, Embase, Web of Science, Cochrane Library, CINAHL, and MEDLINE databases from inception to April 11, 2023. We included all those studies that reported the eHealth literacy status measured with the eHealth Literacy Scale (eHEALS). Methodological validity was assessed with the standardized Joanna Briggs Institute (JBI) critical appraisal tool prepared for cross-sectional studies. Meta-analytic techniques were used to calculate the pooled standardized β coefficient with 95% CIs, while heterogeneity was assessed using I2, the Q test, and τ2. Meta-regressions were used to explore the effect of potential moderators, including participants’ characteristics, internet use measured by time or frequency, and country development status. Predictors of eHealth literacy were integrated according to the Literacy and Health Conceptual Framework and the Technology Acceptance Model (TAM). ResultsIn total, 17 studies met the inclusion criteria for the meta-analysis. Key factors influencing higher eHealth literacy were identified and classified into 3 themes: (1) actions (internet usage: β=0.14, 95% CI 0.102-0.182, I2=80.4%), (2) determinants (age: β=–0.042, 95% CI –0.071 to –0.020, I2=80.3%; ethnicity: β=–2.613, 95% CI –4.114 to –1.112, I2=80.2%; income: β=0.206, 95% CI 0.059-0.354, I2=64.6%; employment status: β=–1.629, 95% CI –2.323 to –0.953, I2=99.7%; education: β=0.154, 95% CI 0.101-0.208, I2=58.2%; perceived usefulness: β=0.832, 95% CI 0.131-1.522, I2=68.3%; and self-efficacy: β=0.239, 95% CI 0.129-0.349, I2=0.0%), and (3) health status factor (disease: β=–0.177, 95% CI –0.298 to –0.055, I2=26.9%). ConclusionsThis systematic review, guided by the Literacy and Health Conceptual Framework model, identified key factors influencing eHealth literacy across 3 dimensions: actions (internet usage), determinants (age, ethnicity, income, employment status, education, perceived usefulness, and self-efficacy), and health status (disease). These findings provide valuable guidance for designing interventions to enhance eHealth literacy. Trial RegistrationPROSPERO CRD42022383384; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022383384

INTRODUCTION:The study aimed to investigate the prevalence of overweight and obesity among Chinese colorectal cancer survivors, and how they gain weight during treatment. METHODS:A sequential mixed method study was conducted. Pearson correlation analysis, univariate analysis and a multivariable-adjusted binary Logistic regression model were constructed to explore risk factors. Semi-structured in-depth interviews were conducted, and content analysis was employed for qualitative data analysis. RESULTS:There were 30.8% overweight and 4.2% obese colorectal cancer survivors. Gender (b = -1.10), caregiver (b = -0.76), dietary knowledge (b = -0.13, anxiety (b = 0.14), depression (b = -0.15), duration of illness (b = 0.95), and tumor staging (b = -1.25) were significantly associated with overweight and obesity. A total of four categories, six themes, and 12 codes were identified, revealing a "teachable moment" for lifestyle modification. DISCUSSION:One-third of the patients were overweight and obese. Being diagnosed was a "teachable moment" for lifestyle modification, but survivors showed limited knowledge and incorrect weight management goal.

BackgroundWith the rapid aging of China’s population, the proportion of older adults living alone has increased significantly, bringing their mental health concerns into sharp focus. This study aims to explore the network structure of anxiety and depressive symptoms among older Chinese adults who live alone, thereby identifying central and bridging symptoms to provide scientific evidence for potential intervention targets in prevention and treatment.MethodsA total of 1,952 older Chinese adults, aged 65 and older, living alone, were selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2017-2018. We assessed anxiety and depressive symptoms using Generalized Anxiety Disorder Scale (GAD-7) and the Center for Epidemiologic Studies Depression Scale (CES-D). We identified central and bridge symptoms via expected influences (EI) and bridge expected influences (BEI); network stability was evaluated using bootstrap methods.ResultsThe network structure uncovered four crucial connections between anxiety and depressive symptoms. GAD4 “Trouble relaxing”, GAD2 “Uncontrollable worry”, and CESD3 “Feeling blue/depressed” exhibited the highest EI values within the network. Meanwhile, GAD1 “Nervousness or anxiety” and CESD10 “Sleep disturbances” showed the highest BEI values within their respective communities.ConclusionThis exploratory study is the first to examine the reciprocal relationship between depressive and anxiety symptoms in older Chinese adults living alone. Targeting these central and bridging symptoms may effectively prevent comorbidity and facilitate targeted interventions for those at risk or currently experiencing these symptoms.

This study measured sociodemographic characteristics, dietary habits, lifestyle habits, genetics, and other factors that may contribute to the development of Rheumatoid Arthritis (RA). Independent risk factors for RA were identified by logistic regression analysis, and a prediction model was constructed. The area under the receiver operating characteristic curve (AUC) was used to evaluate the prediction accuracy of the model, and the calibration of the model was evaluated by the Hosmer-Lemeshow test. A total of 432 participants, comprising 216 healthy individuals and 216 patients diagnosed with RA at two hospitals in Sichuan, China, from March 2022 to January 2023 were included in this study. Logistic regression analysis revealed that occupation type, place of residence, history of mumps, dietary combination, sweet, damp dwelling, fish, vaccine history, and rs805297 were significantly associated with the pathogenesis of RA. The model constructed in this study showed good prediction, with an AUC of 0.912. The Youden index was 0.699, the sensitivity was 0.847 and the specificity was 0.852. The Hosmer-Lemeshow test results (χ2 = 8.441, P = 0.392) indicated that the model had good diagnostic value. The internal validation AUC was 0.942. We propose a new promising model for identifying individuals at risk of developing RA.

IntroductionUnilateral mastectomy induces postural alterations; however, the resolution of this issue in clinical settings remains unknown. This study aimed to explore the effects of wearing external breast prosthesis on the posture of patients after unilateral mastectomy.MethodsA total of 240 patients who underwent unilateral mastectomy for breast cancer in our hospital’s breast surgery department from September 2020 to March 2021 were selected, and they were registered and randomized in a 1:1 ratio to receive one of two treatments: (1) the intervention group wearing a external breast prosthesis (similar in weight to the breast) and (2) the control group wearing a cotton breast prosthesis (almost no weight). The generalized estimating equation method was used to analyze the impact of wearing external breast prosthesis on the patients’ body posture 3 and 6 months after the intervention.ResultsStatistically significant differences were observed between the two groups regarding forward head posture, shoulder asymmetry, scapular tilt, and neck tilt (P < 0.05). However, the two groups had no significant differences in scapular adduction/abduction, pelvic tilt, and trunk inclination (P > 0.05). Over time, all degrees of deviation in postural abnormalities exhibited an upward trend, with postural abnormalities becoming increasingly serious.DiscussionExternal breast prosthesis can improve postural abnormalities in patients with forward head posture, shoulder asymmetry, and scapular and neck tilts. However, there was no significant improvement in the short-term body posture of the patients concerning scapular adduction/abduction, pelvic tilt, or trunk inclination, indicating that further research is required to understand the effects of wearing external breast prosthesis on patients’ body posture.China clinical trial registryhttps://www.chictr.org.cn/showproj.html?proj=56939, identifier ChiCTR2000040897.

BACKGROUND:The job performance of intensive care nurses is critical to the treatment and recovery of critically ill patients. Inclusive leadership, self-efficacy and organization-based self-esteem (OBSE) are important psychosocial factors affecting job performance. However, few studies have explored the relationships among these factors in critical care nurses. AIMS:To examine the impact of inclusive leadership on the job performance of intensive care nurses and to explore the potential mediation through self-efficacy and OBSE. METHODS:A cross-sectional survey design was employed. Between November and December 2023, a total of 460 intensive care nurses from China completed the survey, which included standard assessments on inclusive leadership, self-efficacy, OBSE, and job performance. Mediation analysis was conducted using structural equation modeling. Indirect effects were evaluated through bootstrapping. RESULTS:The results indicated significant positive correlations among inclusive leadership, self-efficacy, OBSE, and job performance (all P < 0.01). Inclusive leadership not only directly affected the job performance of intensive care nurses but also influenced it through the partial mediating roles of self-efficacy and OBSE, with the mediating effects accounting for 14.29 % and 30.61 % of the total effect, respectively. Additionally, the analysis found that self-efficacy and OBSE played a chain mediating role in the relationship between inclusive leadership and the job performance, with the mediating effect accounting for 22.45 % of the total effect. CONCLUSIONS:Inclusive leadership positively predict the job performance of intensive care nurses. Self-efficacy and OBSE act as mediating factors, further explaining how inclusive leadership improves the job performance of intensive care nurses. IMPLICATIONS FOR CLINICAL PRACTICE:Enhancing inclusive leadership can be achieved through targeted training programs that emphasize open communication, team collaboration, and recognition of diverse perspectives. For example, leadership workshops can include role-playing scenarios that promote active listening and constructive feedback. Furthermore, boosting self-efficacy and OBSE is essential, as these variables significantly mediate the relationship between inclusive leadership and job performance. Encouraging mentorship and providing opportunities for professional development can help nurses build their confidence and organizational identity, ultimately leading to improved performance and patient care outcomes.

Context. Cancer-related fatigue (CRF) can affect patients undergoing chemotherapy severely. A comprehensive intervention targeted for reducing CRF is lacking. Objectives. To evaluate the effectiveness of an innovative multifaceted web-based patient-empowered CRF management program for improving CRF, perceived self-efficacy for fatigue self-management (PSEFSM), physical activity, quality of sleep, anxiety, depression, pain and quality of life (QoL) among gastric cancer patients undergoing chemotherapy in China. Methods. A total of 92 eligible gastric cancer patients undergoing chemotherapy were recruited and randomly assigned to two groups. Participants in the intervention group received a 12-week CRF intervention including eight online sessions, patient diary for self-management practice; telephone follow-up and online support via WeChat. The control group received routine care. Primary outcome was CRF. Secondary outcomes included PSEFSM, physical activity, quality of sleep, anxiety, depression, pain, and QoL. Outcome variables were measured three times: at admission(T0), post-intervention(T1) and one-month post-intervention (T2). Repeated measures ANOVA or generalized estimating equations were used to evaluate the intervention effect. Results. Significant group by time interaction was found in the scores of total CRF and its three dimensions, PSEFSM, total physical activities, quality of sleep, anxiety, depression, and QoL of the two groups (P <0.05). No significant difference was found in pain scores (P>0.05). Conclusion. This study provides evidence that an innovative multifaceted web-based patient-empowered CRF management program is effective in reducing CRF and improving related symptoms (depression, anxiety, quality of sleep), physical activity, PSEFSM and QoL for gastric cancer patients undergoing chemotherapy. (c) 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

School climate and teacher-student interactions are important factors leading to differences in student development. However, the mechanisms through which these two factors influence university students' academic achievement remain unclear, and there is a notable lack of in-depth research from the perspective of group differences. The study analyzed a sample of 1236 students from 45 Chinese universities. Structural equation modeling was employed to examine the complex relationships among school climate, teacher-student interaction, academic self-efficacy, and academic achievement. Our findings show heterogeneity in the academic achievement of Chinese university students across different genders, grades, and disciplines, with females outperforming males, high-grade students outperforming low-grades, and liberal arts students outperforming science students. Overall, teacher-student interaction has a greater impact on academic achievement than school climate. Both school climate and teacher-student interaction influence academic achievement through the mediating role of academic self-efficacy. Notably, there are significant differences in the relationships among these variables across different groups. Specifically, school climate does not have a significant impact on the academic achievement of certain students, while teacher-student interaction exerts a stable and important positive influence on the academic achievement of all students, particularly benefiting those in the lower-scoring group.

Abstract Background Patients in spine surgery often have emotional disorders which is caused by multi-factors. Therefore, a multidisciplinary and multimodal intervention program is required to improve emotional disorders during the perioperative period. However, related studies were rare. This study aimed to confirm that the multidisciplinary-based psychological management leading by nurses was effective in treating emotional disorders and show the assignments of the members of the multidisciplinary team with the orientations of nurses. Design A retrospective, comparative study. Method This study was a retrospective cohort research and compared the results between the intervention group and control group using the Huaxi Emotional Distress Index (HEI) which was used to evaluate emotional disorders. The intervention group consisted of patients who underwent surgery between January 2018 and December 2020 after psychological management was implemented. The control group consisted of patients with regular care who underwent surgery between January 2015 and December 2017. To improve comparability between the two groups, baseline data from the recruited patients were analyzed using propensity-score-matching (PSM) based on age, sex, marital status, education, and disease region. Results A total of 539 (11.5%) people developed emotional disorders, of which 319 (6.8%), 151 (3.2%) and 69 (1.5%) had mild, moderate mood and severe emotional disorders, respectively. 2107 pairs of patients were matched after PSM. Scores of HEI in the intervention group were heightened compared with those in the control group (P<0.001) after matching. Moreover, the incidence of emotional disorders in patients decreased after implementing psychological management (P = 0.001). The severity of emotional disorders was alleviated with statistical significance as well (P = 0.010). Conclusions Nurses-led Multidisciplinary-Based psychological management was able to reduce the incidence of emotional disorders and improve the severity of these in spine surgery patients.

AIMS:To systematically review and integrate qualitative-research results pertaining to psychological distress in patients with breast cancer and to clarify its causes and drivers. BACKGROUND:Patients with breast cancer experience psychological distress in the stages of diagnosis, treatment, and rehabilitation, which seriously affects their quality of life. Through comprehensive qualitative research, the study comprehensively describes the experiences of patients with breast cancer to guide medical personnel in taking better care of them. DESIGN:A systematic review and synthesis of qualitative studies. METHODS:Qualitative studies were included if they were related to the psychological-distress experiences of patients with breast cancer. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise study quality. Data were synthesised using the Thomas and Harden method of thematic and content analysis. DATA SOURCES:Nine electronic databases (PubMed, Embase, Cochrane Library, CINAL [via EBSCO], and PsycINFO, China Knowledge Resource Integrated Database, Wanfang, Chinese Biomedical, and Weipu) were searched from inception until February 2024. RESULTS:Thirteen studies were included in the meta-synthesis. Four analytical themes were identified: diagnostic and therapeutic, individual, environmental, and interpersonal factors. CONCLUSIONS:Psychological distress is a subjective feeling influenced by interactions among individual, therapeutic, environmental, and interpersonal factors, and it is commonly encountered among patients with breast cancer. Therefore, to optimise the management of psychological distress, the characteristics and external environment of patients with breast cancer should be carefully considered when delivering routine nursing care. IMPACT:Patients experience psychological distress at different stages of breast cancer; however, the causes of psychological distress at different stages differ. Medical staff should implement targeted psychological-distress intervention measures based on factors relevant to different stages. REPORTING METHOD:The Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. REGISTRATION:The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42023417364).

To investigate nurse practitioners' roles and competencies among rheumatology nurses in China, an online, cross-sectional survey was conducted between July 7 and 14, 2020 among the national cooperation group of nursing experts on management of rheumatic and immune diseases. A total of 796 valid questionnaires were returned and participants' mean total scores on the Nurse Practitioners' Roles and Competencies Scale (NPRCS) was 2.51 (SD = 0.55), indicating a medium level. Medical assistance, leadership reform, and clinical research had low scores in the six dimensions of the NPRCS. Nurse practitioners' roles and competencies in the area of rheumatology require improvement. Training should focus on medical assistance, leadership reform, and clinical research. The current study can provide a reference for an improved training framework of nursing practitioners in the rheumatology field.