Although the anti-inflammatory diet has been linked to diverse diseases, its connection with depression remains inadequately explored. We aim to understand the association between anti-inflammatory diet, lifestyles, and depression in adult patients with chronic kidney disease (CKD). This study used convenience sampling to conduct a cross-sectional survey. From January 1, 2015 to December 31, 2023, a total of 10,540 participants from a health management center of a university-affiliated hospital. Anti-inflammatory dietary was assessed using the anti-inflammatory dietary diversity index (AIDDI), while depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ)-9. A self-reported questionnaire was used to collect demographic characteristics and lifestyle factors. Logistic regression analyses were conducted to assess the association between AIDDI, lifestyle factors, and depressive symptoms. Additionally, subgroup analyses were conducted to validate the stability of the results. A total of 10,540 participants were included in this study. In the fully adjusted model, participants with the higher AIDDI scores had a 20

Tumor recurrence is a major cause of treatment failure in central nervous system(CNS)tumors,although its underlying mechanisms have not yet been fully elucidated.Recent studies have suggested that neuropsychological stress may activate the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal-medullary system,thereby inducing the release of glucocorticoids,catecholamines,and inflammatory mediators.These processes may contribute to structural damage to the neurovascular unit,resulting in structural disruption of the blood-brain barrier(BBB)and increased BBB permeability.Increased BBB permeability not only provides a route for tumor-cell invasion but also facilitates infiltration of immunosuppressive cells into the brain parenchyma and the passage of proinflammatory cytokines across the BBB.These changes may remodel the tumor microenvironment(TME)and reactivate dormant tumor cells,thereby forming a potential regulatory axis that drives the recurrence of CNS tumors.This review systematically summarizes the potential regulatory axis of"neuropsychological stress-BBB dysfunction-TME remodeling-CNS tumor recurrence",elucidates the molecular mechanisms underlying neuropsychological stress-mediated BBB injury,and discusses how BBB abnormalities regulate the CNS TME and tumor-cell dormancy.Potential strategies,including BBB-targeted vascular normalization,localized and reversible BBB opening,active trans-BBB drug delivery,and psychological interventions,are also discussed.These insights may provide a theoretical basis and new perspectives for the prevention and management of CNS tumor recurrence.

Background Social adversity is a determinant of mental health in later life, yet the network connectivity patterns through which it becomes embedded within internalising psychopathology remain insufficiently understood. This study aimed to examine the transdiagnostic symptom network linking social adversity, psychological resources, and internalising psychopathology in older adults. Methods We conducted a cross-sectional study among older adults in Hunan Province, China. Guided by the Stress Buffering Model, validated self-report measures assessed perceived ageism as social adversity, loneliness and social alienation as interpersonal factors, depression and anxiety as internalising psychopathology, and self-efficacy and life scheme as psychological resources. A Gaussian Graphical Model was estimated using the graphical least absolute shrinkage and selection operator. Expected Influence and Bridge Expected Influence identified central and bridge nodes. Network Comparison Tests examined structural invariance across sociodemographic and clinical subgroups. Results A total of 1225 older adults were included in the analyses. The network showed a highly structured transdiagnostic architecture with a mean predictability of 52.9%. “Apathy and Anxiety” and “Unhappiness” emerged as the most influential nodes. “Somatic Tension Domain” and “Cognitive-Emotional Domain” demonstrated the highest bridge expected influence, connecting social adversity and alienation with depressive symptoms. “Self-Efficacy” and “Life Scheme” showed consistent negative associations with key bridge and depressive nodes. Network structure and global strength remained invariant across major sociodemographic and clinical subgroups. Conclusions Late-life internalising psychopathology was characterised by interconnected network patterns involving social adversity, interpersonal disconnection, anxiety, and depressive symptoms. Anxiety-related domains showed prominent bridge positions linking social adversity with depressive symptoms, while psychological resources were negatively associated with distress-related nodes.

Objective: Psychological distress is prevalent among young adult (YA) patients with cancer, yet the role of couples' communication in this specific population remains underexplored. This study aimed to investigate the status of couples' communication and examine its independent association with depression and anxiety in YA patients with cancer. Methods: A cross-sectional survey was conducted among YA patients with cancer. Participants completed the Cancer-Related Communication Problems Scale, PHQ-9 (depression), and GAD-7 (anxiety). Hierarchical linear regression analyses were performed to determine the association between communication barriers and psychological outcomes after controlling for demographic and clinical variables. Results: A total of 202 married YA patients with cancer participated in this study. The mean age was 34.69 ± 4.11 years (Range: 22–39 years). Participants reported a mild level of overall communication barriers (Total Score Mean ± SD: 13.41 ± 3.93; Range: 1–22). The mean anxiety and depression scores were 6.43 ± 5.16 (Range: 0–21) and 6.97 ± 5.47 (Range: 0–27). The top five specific barriers were difficulty with partner understanding of body image changes (Item 11, Mean ± SD = 1.46 ± 0.69), difficulty discussing worsening conditions (Item 13, Mean ± SD = 1.30 ± 0.68), difficulty sharing worries about treatment effectiveness (Item 9, Mean ± SD = 1.28 ± 0.71), avoidance of discussing sexual experience (Item 15, Mean ± SD = 1.11 ± 0.72) and selective disclosure to protect the spouse (Item 14, Mean ± SD = 1.07 ± 0.70). Univariate analysis indicated that unemployment and female sex were significantly associated with higher depression scores (P < 0.05), while no demographic variables were significantly associated with communication barriers. After adjusting for sex and unemployment status, communication barriers remained independently associated with depression (B = 0.26, 95% CI: 0.08, 0.44, P = 0.008), but not with anxiety (P > 0.05). Conclusions: Communication barriers were independently associated with depressive symptoms, but not anxiety, after adjustment for sex and employment status. These item-level findings suggest that body image and intimacy may be key topics for future dyadic communication interventions. Future psychosocial interventions may consider addressing open spousal dialogue about body image and sexual concerns in this population.

Background: Approximately 60% of patients with advanced cancer experience the distress of cancer-related fatigue (CRF), which significantly worsens their daily function and quality of life. Baduanjin has been regarded as a promising nonpharmacological intervention for alleviating CRF, anxiety, and depression and improving quality of life. Owing to varying degrees of CRF in patients with advanced cancer, patients may have insufficient endurance, making it difficult to implement standing Baduanjin. However, relevant evidence on sitting Baduanjin for CRF in patients with advanced cancer is lacking. Objective: This study aims to design a sitting Baduanjin intervention and explore the efficacy and safety of sitting Baduanjin in reducing CRF among patients with advanced cancer. Methods: This study will be a single-blind pilot randomized controlled trial. Patients with CRF will be enlisted from a tertiary cancer hospital in China. The participants (N=98) will be randomly assigned to either a sitting Baduanjin group or a control group at a 1:1 ratio using a block-randomized scheme. The participants in the sitting Baduanjin group will undergo a 16-week sitting Baduanjin intervention in addition to standard care, whereas the participants in the control group will receive standard care in the form of a booklet on the self-management of cancer symptoms. CRF will constitute the primary outcome, whereas anxiety, depression, and quality of life will serve as the secondary outcomes. These outcomes will be assessed at baseline (T0), 12 weeks (T1), and 16 weeks (T2). Results: The study was approved by the Medical Ethics Review Committee of Hunan Cancer Hospital in March 2024 (ethics approval number 2024.50). Before this full-scale randomized controlled trial, we conducted a pilot study, which demonstrated the feasibility and acceptability of sitting Baduanjin for patients with advanced cancer, with potential benefits for relieving fatigue. Conclusions: This randomized trial will evaluate the effectiveness of sitting Baduanjin exercises in alleviating CRF among patients with advanced cancer. If proven effective, it will provide a promising alternative intervention for patients with advanced cancer. Trial Registration: Chinese Clinical Trial Register ChiCTR-2400092148; https://www.chictr.org.cn/showproj.html? proj=242990 International Registered Report Identifier (IRRID): IRRID: DERR1-10.2196/84925

Psychological distress and sleep disturbance frequently co-occur among adolescents and young adults with gynecologic cancer, creating a substantial supportive care burden. Digital health microinterventions, particularly mobile-based approaches, may provide scalable and low-burden support. However, evidence regarding the feasibility, acceptability and potential effects of mobile health (mHealth) microinterventions in this population remains limited. This study aimed to evaluate the feasibility, acceptability and preliminary effectiveness of mHealth microinterventions targeting psychological distress and sleep disturbance among adolescents and young adults with gynecologic cancer. A two-arm, parallel-group randomized controlled trial was conducted between November 2025 and March 2026 in two tertiary hospitals. Participants were randomly assigned 1:1 to the intervention group (n = 10) or control group (n = 10). Both groups received routine care plus disease-related health education via the same WeChat platform. In addition, the intervention group received a 4-week trained research interventionist-assisted WeChat-based mHealth microintervention program. Feasibility outcomes (eligibility rate, enrollment rate, consent rate, retention rate, attrition rate, adherence indicators, and perceived feasibility) and acceptability (perceived acceptability and appropriateness, backend usage data and brief interview) and preliminary effectiveness outcomes were assessed. Assessments were conducted at baseline (T0), post-intervention (T1), 1-month follow-up (T2), and 2-month follow-up (T3). Generalized estimating equations were used to examine preliminary intervention effects. Participants and interventionists were not blinded because of the nature of the intervention. Data analysts were blinded to group allocation. No adverse events or harms were reported. Of 77 patients screened, 35 were eligible and 20 were randomized. The eligibility, enrollment, consent and retention rate were 45.5%, 26.1%, 57.1% and 100% respectively. In the intervention group (n=10), the overall intervention completion rate was 80%, and 90% of participants completed at least 75% of the intervention content. Mean scores for perceived feasibility, acceptability, and appropriateness were high at 16.40±1.90, 16.60±1.90, and 16.80±1.69, respectively. Backend usage data indicated high adherence to the psychological distress support package and the sleep behavioral regulation module. Brief post-intervention feedback indicated that the microinterventions were practical, easy to use, and low burden. Compared with the control group (n=10), the intervention group had lower psychological distress scores than the control group at T1, T2, and T3, with adjusted between-group differences of −2.22, −2.12, and −2.12, respectively. Sleep disturbance scores were lower in the intervention group at T1 and T2, with adjusted differences of −3.49 and −1.99, respectively. Anxiety symptoms showed exploratory between-group differences at T2 and T3, with adjusted differences of −0.80 and −3.20, respectively. No significant between-group differences in depressive symptoms were observed at post-baseline time points. The mHealth microinterventions demonstrated high feasibility and acceptability among adolescents and young adults with gynecologic cancer. Preliminary findings suggest potential short-term benefits for reducing psychological distress and improving sleep disturbance and anxiety symptoms. Further adequately powered trials with longer follow-up are needed to confirm these effects. NA

AIM(S):To identify latent fatigue profiles in adolescent and young adult (AYA) cancer patients and explore associated clinical and socioeconomic factors to guide precision nursing. DESIGN:A cross-sectional observational study. METHODS:A total of 218 AYA cancer patients were recruited from a tertiary cancer center between December 2025 and February 2026. Latent Profile Analysis was used to identify fatigue subgroups based on the Piper Fatigue Scale-Revised. Multinomial logistic regression was applied to examine correlates. RESULTS:Three distinct profiles emerged: 'Low-Fatigue Well-Adapted' (32.6%), 'High-Fatigue Somatic-Dominant' (38.1%), and 'High-Fatigue Emotional-Cognitive Exhaustion' (29.4%). The Somatic-Dominant group exhibited severe sensory fatigue but mild distress, strongly associated with chemotherapy (OR = 2.42, 95% CI: 1.03-5.68, p = 0.041) and non-working status (OR = 3.02, 95% CI: 1.38-6.58, p = 0.006). Conversely, the Emotional-Cognitive Exhaustion group showed severe affective and cognitive exhaustion. This profile was significantly linked to active chemotherapy (OR = 4.95, 95% CI: 1.98-12.38, p < 0.001), lower income levels (higher income: OR = 0.52, 95% CI: 0.38-0.71, p < 0.001), and gastrointestinal cancer (OR = 3.15, 95% CI: 1.12-8.85, p = 0.029). CONCLUSION:Fatigue in AYA patients appears highly heterogeneous, manifesting either as somatic-dominant patterns potentially associated with chemotherapy or multidimensional exhaustion linked to survival and economic pressures. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Nursing practice should transition from a uniform approach to phenotype-based precision symptom management. Patients with somatic-dominant fatigue require physical rehabilitation, whereas those experiencing emotional-cognitive exhaustion urgently need integrated nutritional, psychological, and socioeconomic support to mitigate their multidimensional burden. IMPACT:What problem did the study address? ○ The study addressed the limitation of treating cancer-related fatigue as a uniform symptom in AYA patients, which masks individual variability and the hidden burden of chronic socioeconomic constraints. What were the main findings? ○ Three distinct fatigue phenotypes were identified, revealing significant symptom heterogeneity. Severe emotional-cognitive exhaustion was strongly linked not only to chemotherapy but also to chronic economic constraints of maintaining employment while ill. Where and on whom will the research have an impact? ○ This research will impact oncology nurses, social workers, and clinical policymakers globally by providing an evidence-based framework for precision symptom management and targeted socioeconomic interventions for vulnerable AYA cancer survivors. REPORTING METHOD:This study adhered to the STROBE reporting guidelines for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

BACKGROUND AND AIMS:Nursing interruptions during medication administration (NIMA) critically contribute to medication administration errors. However, validated prediction tools for NIMA risk assessment are unavailable. This study aimed to develop and internally validate three machine learning-based prediction models (logistic regression [LR], decision tree [DT], and Naive Bayes [NB]) for identifying nurses' individualized risk of NIMA. METHODS:A total of 4758 Chinese nurses were recruited from 12 tertiary hospitals between November 2023 and January 2024. The outcome was defined as the occurrence of ≥ 1 NIMA during the latest work shift. We used univariate analysis and LR to identify predictors. Participants were randomly allocated to training (n = 3806; 80%) and internal validation (n = 952; 20%) sets. Three machine learning models were implemented in Python, with performance evaluated via 1000-iteration stratified bootstrapping. Key performance metrics included AUC, accuracy, recall, specificity, precision, F1-score, and G-mean. Models comparisons used the DeLong test. The best model was further assessed with the Hosmer-Lemeshow test and calibration curves. RESULTS:Overall, 52.1% of nurses experienced at least one NIMA event. Predictive features of NIMA included 18 factors, such as department type, marital status, shift type, general self-efficacy level, and the needs of multiple people. In the test set, AUCs ranged from 0.679 to 0.748. The LR model performed best, achieving the highest AUC of 0.748 (95% CI: 0.717-0.779), an accuracy of 0.694 (95% CI: 0.664-0.724), and other performance metrics, including precision, recall, specificity, F1-score, and G-mean. The calibration of the LR model was supported by the Hosmer-Lemeshow test (X2 = 7.062, p = 0.530). CONCLUSIONS:This study systematically evaluated multiple influencing factors of NIMA and developed three internally validated risk prediction models of NIMA. The LR-based nomogram and the web-based calculators showed the most consistent performance and may support risk stratification and targeted nursing management, pending external validation and feasibility assessment.

Previous studies specific to breast nodules are relatively scarce and mainly rely on cross-sectional research methods, overlooking the dynamic evolution of breast nodules over time. Thus, the objective is to analyze the impact of lifestyle, mental health, and metabolic characteristics on the occurrence and progression of breast nodules by conducting a longitudinal study. This retrospective, longitudinal cohort study conducted from 2012 to 2021 included 114,774 measurements from the Health Management Center at the Third Xiangya Hospital of Central South University in China. All data were collected from the results of anthropometric measurements, laboratory tests, breast ultrasound and online questionnaire surveys. Generalized estimating equations (GEE) models were developed to examine the relationship. Women who always ate punctual meals or consumed soy products ≥ 5 times per week had lower odds of breast nodule occurrence (adjusted odds ratio [aOR] 0.798, 95

BACKGROUND:Nursing interruptions during medication administration occur frequently, often leading to medication errors and workflow delays that threaten patient safety and reduce nurses' work efficiency. Current research has relied mainly on observation or interviews, which are labor-intensive, time-consuming, and prone to substantial variability. Practical, standardized instruments are needed to assess nursing interruptions during medication administration (NIMA). METHODS:This cross-sectional descriptive study developed and validated the questionnaire for measuring nursing interruptions during medication administration (Q-NIMA) through a multistep, theory-driven process based on the Systems Engineering Initiative for Patient Safety model. Items were generated from literature and expert input, refined by two Delphi rounds with 12 experts, and piloted with 30 nurses. Item analysis was conducted for comprehensive evaluation, and validity evidence was gathered based on test content, internal structure, and relations to other variables. The sample was split for exploratory factor analysis (EFA) using FACTOR software (based on polychoric correlations and ULS extraction) and confirmatory factor analysis (CFA) using AMOS. Reliability was assessed using internal consistency (Cronbach's α and ORION coefficients) and stability (test-retest reliability). RESULTS:We selected 478 nurses from a tertiary hospital in Hunan Province from July to August 2025. The final questionnaire comprised 25 items across five dimensions. Item analysis indicated that the questionnaire had strong discriminant validity. The content validity indexes were 0.944 at scale level and 0.833-1.000 at item level. EFA extracted five factors explaining 74.25% of the total variance. CFA demonstrated good model fit (X2/df = 2.455, CFI = 0.942, TLI = 0.933, RMSEA = 0.078). Criterion validity showed a significant positive correlation (ρ = 0.310, p < 0.001) between the Q-NIMA and the NASA-TLX. The scale demonstrated excellent reliability: the total Cronbach's α was 0.973, split-half reliability was 0.951, and test-retest reliability (ICC) was 0.992. The five dimensions were labeled: nurse professional competence, nurse psychophysical state, patient-related interruptions, workplace colleague factors, and work system factors. CONCLUSION:The Q-NIMA demonstrates robust psychometric properties, including high reliability, validity, and stability. Furthermore, it serves as a valuable tool to evaluate how nurses perceive nursing interruptions during medication administration. By aligning items with medication tasks and work-system elements, the Q-NIMA moves beyond event counting to support risk profiling and targeted improvement of medication administration.

BACKGROUND:Multiple factors of psychological distress in adolescent and young cancer patients continue to be unearthed, suggesting the warranted exploration of interventions that meet individualized psychological needs and are integrated into daily lives to alleviate their psychological distress. OBJECTIVE:To investigate the effects of the standardized communication system based on circadian rhythm regulation on psychological distress in adolescent and young adult cancer patients. DESIGN:A three-arm randomized controlled trial. SETTING AND PARTICIPANTS:A total of 129 adolescent and young adult cancer patients with psychological distress were recruited from the Third Xiangya Hospital of Central South University from January 2022 to May 2023. METHODS:Participants were randomly divided into three groups. Both intervention groups received eight standardized communication system intervention topics, while the control group received only routine psychological care. The difference between the two intervention groups was that the duration of the intervention in the intervention group 2 was matched to the three types of circadian rhythm of the study participants. The primary outcomes of psychological distress, anxiety, and depression, as well as the secondary outcomes of sleep quality and quality of life, were measured four times at baseline, immediately after completing the intervention, and one month versus three months after completing the intervention. The generalized estimating equations were used to compare the effects of the intervention across the three groups. RESULTS:In one month after the intervention, the two intervention groups significantly reduced psychological distress, anxiety, and depression, and improved the quality of sleep and quality of life in adolescent and young adult cancer patients compared to the control group (P < 0.01). Meanwhile, the intervention group 2 was more effective than the intervention group 1 in reducing psychological distress (-1.20, CI, -1.82 to -0.57, P < 0.001) and improving sleep quality (-1.72, CI, -2.83 to -0.62, P < 0.001) of patients. Moreover, the effects persisted three months after completing the intervention (P < 0.05). CONCLUSIONS:The standardized communication system interventions can effectively alleviate psychological distress, anxiety, and depression, and improve sleep quality and quality of life in adolescent and young adult cancer patients. In addition, the standardized communication system based on circadian rhythm regulation is more advantageous in improving the psychological distress and sleep quality of adolescent and young adult cancer patients than the standardized communication system intervention. REGISTRATION:The study was registered in the Chinese Clinical Trial Registry on January 3, 2022 (ChiCTR2200055230).

Antimicrobial hydrogels demonstrate significant potential in tackling global challenges of microbial drug resistance and infection control across various applications. These materials leverage their unique structural design to effectively incorporate and deliver antibacterial agents, enabling targeted action against multidrug-resistant pathogens. However, traditional antimicrobial hydrogels are often constrained by mechanical limitations, limiting their adaptability in complex environments, such as pressure ulcer treatment requiring antimicrobial activity and pressure monitoring. To address these challenges, we developed a highly pressure-sensitive antibacterial hydrogel incorporating liquid metal-loaded zinc oxide nanoparticles. The hydrogel utilizes the synergistic effect of reactive oxygen species (ROS) released from ZnO nanoparticles and Zn2+ to significantly inhibit bacterial growth, as evidenced by a 96.9 % wound healing rate in a rat model, demonstrating exceptional potential for accelerating wound repair. Furthermore, the hydrogel demonstrates outstanding pressure sensitivity (0.26 kPa-1) and remarkable stretchability (1450 %), enabling it to monitor diverse human body movements and detect subtle mechanical stimuli. This capability empowers healthcare professionals to promptly identify and manage pressure ulcer conditions. Our findings present a promising strategy for the development of multifunctional antibacterial hydrogel electronics with superior mechanical properties and sensing capabilities.

BACKGROUND:Depressive symptoms are closely associated with thyroid nodules (TNs). Lifestyle and dietary factors have been linked to depressive symptoms. Therefore, this study aimed to investigate the associations between dietary patterns-including dietary diversity, protein-enriched dietary, inflammatory dietary patterns, dietary habits and depressive symptoms in individuals with TNs. METHODS:This cross-sectional study included 53,539 participants who underwent physical examinations between January 2017 and March 2024. Participants completed self-reported questionnaires on demographic characteristics, physical health, activity levels, dietary index scores, dietary habits, and depressive symptoms. RESULTS:Participants were female (OR: 1.38, 95 % CI: 1.30-1.46), divorced or widowed (OR: 1.56, 95 % CI: 1.31-1.85), had a higher waist-hip ratio, and (OR: 2.22; 95 % CI: 1.43-3.43) and engaged in prolonged sedentary time (OR: 1.51; 95 % CI: 1.41-1.62) were more likely to report depressive symptoms. Regarding dietary factors, an anti-inflammatory dietary (OR: 0.79; 95 % CI: 0.75-0.83) and a protein-enriched dietary (OR: 0.87; 95 % CI: 0.83-0.92) were associated with a lower risk of depressive symptoms. However, irregular eating (OR: 2.00, 95 % CI: 1.81-2.21), overeating frequently (OR: 1.87; 95 % CI: 1.70-2.05), and being a former drinker (OR: 1.43, 95 % CI: 1.19-1.71) were associated with a higher risk of depressive symptoms in individuals with TNs. CONCLUSIONS:Unhealthy eating behaviors and prolonged sedentary time were associated with a higher risk of depressive symptoms in individuals with TNs, while anti-inflammatory and protein-rich diets were associated with lower odds. These findings suggest potential links between dietary and lifestyle factors and depressive symptoms, which may warrant further investigation in prospective or interventional studies.

Background:End-stage kidney disease (ESKD) imposes a significant global health burden, with patients often experiencing poor quality of life (QoL) due to psychological distress and low self-efficacy. Digital health interventions (DHIs) offer potential to address these challenges. However, their effects in this population remain inconsistent, and a comprehensive synthesis of the evidence is lacking. Objective:The present study aims to assess the impact of DHIs on the psychological health, self-efficacy, and QoL of patients with ESKD and to evaluate engagement, adherence, and satisfaction with these interventions. Methods:A comprehensive search was conducted across six electronic databases (PubMed, Web of Science, Cochrane Library, PsycINFO, Embase, and CINAHL) up to January 21, 2025. Randomized controlled trials (RCTs) examining the effects of DHIs on psychological health, self-efficacy, or QoL in patients with ESKD were included. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias Tool (RoB 2). A meta-analysis was performed using Review Manager 5.4, with subgroup analyses by treatment modality, intervention type, and duration. Evidence quality was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Results:Twenty-three RCTs involving 2407 patients with ESKD from 12 countries were included. DHIs significantly improved depression (standardized mean differences [SMD] -0.41, 95% CI -0.63 to -0.19, P=.003) and overall QoL (SMD 0.55, 95% CI 0.07-1.03, P=.03). While DHIs did not significantly improve overall self-efficacy (SMD 0.56, 95% CI -0.06 to 1.18, P=.08), a benefit was observed in patients on hemodialysis (SMD 0.59, 95% CI 0.34-0.83, P<.001). Engagement was favorable, with completion rates above 63%, adherence rates of 54%-79%, and generally positive patient feedback on DHIs. Application-based interventions improved self-efficacy (SMD 0.66, 95% CI 0.31-1.02, P<.001) and overall QoL (SMD 0.50, 95% CI 0.04-0.96, P=.003); telemedicine improved depression (SMD -0.88, 95% CI -1.21 to -0.56, P<.001) and self-efficacy (SMD 2.76, 95% CI 2.32-3.20, P<.001); and video-based interventions improved depression (SMD -0.34, 95% CI -0.55 to -0.13, P=.002) and overall QoL (SMD 0.31, 95% CI 0.15-0.46, P<.001). Due to high heterogeneity and risk of bias, evidence quality was rated as low for depression and overall QoL, moderate for general anxiety, and very low for stress and self-efficacy. Conclusions:DHIs can significantly improve the psychological health and QoL of patients with ESKD, particularly when tailored to patients' needs and delivered through interactive platforms such as apps and telemedicine. High engagement and positive patient feedback suggest good acceptability in clinical practice. However, low evidence quality warrants cautious interpretation. Future research should involve more high-quality RCTs and design DHIs that address the unique needs of older patients, patients on peritoneal dialysis, and kidney transplant recipients.

OBJECTIVES: To identify key predictors of prolonged sickness absence among workers with occupational injuries in Hong Kong, with a focus on demographic, occupational, and injury-related factors. METHODS: We conducted a retrospective analysis of 66,658 occupational injury cases managed by a major rehabilitation coordination provider in Hong Kong, representing approximately 20% of all such cases in the region between 2003 and 2020. Prolonged absence outliers were defined as cases of sickness absence exceeding 129 days, based on Tukey’s Fence, a non-parametric method based on interquartile range. Multivariable logistic regression was used to examine associations between outlier status and the following predictors: age, gender, year of accident, physical demand, industry sector, skill level, injury type, and injured body region. All covariates were mutually adjusted in a single multivariable model. RESULTS: Outliers constituted 16.0% of the total sample. Older age and female gender were significant individual-level predictors. Fractures were strongly associated with extended sickness absence, whereas soft tissue injuries were linked to shorter recovery durations. Torso injuries—particularly to the back and pelvis—carried higher risks of prolonged absence, while lower limb injuries were associated with earlier return to work. Workers in physically demanding roles, especially within the construction and transportation industries, were associated with elevated risk. Notably, semiskilled workers had higher odds of prolonged absence than unskilled workers. CONCLUSION: This study identifies patterns that may influence prolonged sickness absence, suggesting that intersecting demographic, occupational, and injury-related factors contribute to variation in recovery outcomes. The present findings may help inform future efforts to prioritize tailored interventions for high-risk subgroups, including older employees, women, semiskilled laborers, and those engaged in physically strenuous jobs. Future research should also incorporate psychosocial variables to better capture additional drivers of delayed recovery.

Emerging evidence identifies the gut microbiota as a promising therapeutic target for late-life depression, yet its mechanisms and clinical applications remain insufficiently defined in aging populations. This review synthesizes findings from animal studies and clinical trials to examine how the gut microbiota contributes to late-life depression and to evaluate potential intervention. We first outline the association between microbial ecosystem alterations and mental health, emphasizing their relevance for late-life depression. Mechanistic pathways are then discussed in sequence: disruption of intestinal microbial networks that impair barrier integrity, dysregulation of microbial metabolites that disturb gut-brain communication, and maladaptive immune activation and signal transduction at the host-microbe interface. Building on these insights, we assess the therapeutic approaches, including dietary interventions, probiotics, prebiotics, postbiotics, and fecal microbiota transplantation. Recovery outcomes are also summarized, covering microbial composition, metabolite changes, neurological biomarkers and neuroimaging findings. Finally, we address major translational challenges, including individual variability, dynamic monitoring, technological limitations, and safety concerns. We highlight the methodological gaps that limit current research and propose future directions to advance mechanistic understanding and clinical translation. By integrating ecological balance with personalized strategies, gut microbiota-based interventions hold potential to improve prevention and treatment of late-life depression.

Objective:Adolescents and young adults (AYAs) with cancer suffer from a high prevalence of psychological distress, but validated, age-appropriate screening tools remain limited in China. The study aimed to translate and validate a Chinese version of the Adolescent and Young Adult Psycho-Oncology Screening Tool (AYA-POST). Methods:A methodological study was conducted, including forward and back translation, expert consultation, and a pilot testing. AYAs with cancer (n ​= ​301; 15-39 years at diagnosis; M age ​= ​34.00 ± 5.99 years) across two hospitals in China from September 2024 to April 2025 were included. Measures included sociodemographic, clinical data, the AYA-POST (comprising the Distress Thermometer [DT] and AYA Needs Assessment [AYA-NA]), and the Hospital Anxiety and Depression Scale (HADS). Results:All content validity indices were 1.0. Exploratory factor analysis yielded a four-factor solution explained 35% of the total variance, with a mean item complexity of 1.89. The DT correlated strongly with the HADS (r ​= ​0.533, P ​< ​0.001). A DT cut-off score of 4 showed optimal sensitivity (0.774; area under the curve ​= ​0.736). Cronbach's α was 0.754 for AYA-POST and ranged from 0.315 to 0.704 at domain level. The prevalence of psychological distress was 57.14% with a cut-off score of 4. The most frequent concerns were physical (83.72%), emotional (73.42%), and practical (66.78%). Conclusions:The Chinese version of the AYA-POST demonstrated acceptable validity and reliability in AYAs with cancer. It can be a tool for stratified distress and psychosocial concerns management, with a DT cut-off score of 4 recommended for initial screening.