本研究为横断面研究，采用一般资料调查表、锻炼自我效能量表、感知锻炼益处/障碍量表、糖尿病特异性感知锻炼益处/障碍量表、糖尿病运动知识问卷、领悟社会支持量表和自评抑郁量表对192例超重/肥胖2型糖尿病（T2DM）患者进行调查，探讨其锻炼自我效能水平的影响因素。结果显示超重/肥胖T2DM患者锻炼自我效能属于中等水平，受到感知锻炼益处、糖尿病特异性感知锻炼障碍和社会支持的影响。

Purpose To translate the Moorong Self-Efficacy Scale (MSES) into Chinese and to examine its reliability and validity in patients with spinal cord injury (SCI). Methods A cross-sectional study design was employed. The MSES was translated into Chinese by forward- and back-translation and its psychometric properties were examined among 176 patients with SCI recruited from four rehabilitation centers in China using convenience sampling. Results In this study, all 176 patients were aged from 18 to 90 years old with an average of 39.51 +/- 14.07. The content validity index of the scale was 0.99. Principal components analysis with varimax orthogonal rotation was used. Three factors were extracted accounting for 39.083%, 11.149%, and 8.391% of the total variance and labeled as general self-efficacy (eight items), social self-efficacy (five items), and self-management self-efficacy (three items). Confirmatory factor analysis showed acceptable fit compared with previous studies. Pearson's correlation coefficient between the total scores of the MSES and the General Self-Efficacy Scale was 0.660 (p < 0.001). Cronbach's alpha coefficient was 0.892 for total items and 0.862, 0.817, and 0.739 for the three factors. The interclass correlation coefficients between the pretest and retest were 0.859 (0.733-0.925) for the total score. Conclusions The Chinese version of the MSES is reliable and valid, suggesting that it is suitable for evaluating self-efficacy of Chinese patients with SCI.

目的 探讨基于慕课的"健康评估"线上翻转课堂教学在护理本科生中的应用效果.方法 选择2019年春季51名2017级护理本科生实施基于慕课的线上线下混合式教学,选择2020年春季49名2018级护理本科生实施基于慕课的线上翻转课堂教学.分析2个年级"健康评估"期末理论考试成绩和慕课成绩差异,计算线上教学期间师生微信群互动情况及分析线上教学反馈结果.结果 2018级护理本科生的期末理论考试成绩与2017级相比差异无统计学意义(P＞0.05),2018级护理本科生的慕课成绩优于2017级(P＜0.05).在整个线上教学阶段,共产生互动次数1 109次,其中学生有效发言478次,每个学生产生线上互动次数平均10次.2018级护理本科生对本次线上教学整体满意度较高.结论 基于慕课的"健康评估"线上翻转课堂教学能够满足护理本科生的学习需求、保证其学习效果,并为未来实施线上教学以应对重大突发公共卫生事件提供建议.

目的 系统评价远程干预在居家脊髓损伤患者压力性损伤预防中的应用效果,为临床干预提供循证依据.方法 计算机检索中国生物医学文献数据库、中国知网、万方数据库、维普数据库、Cochrane Library、PubMed、Embase、Web of Science、Scopus、ProQuest和BMJ Best Practice从建库到2021年8月收录的相关文献.由2名研究人员进行质量评价后,采用RevMan 5.3软件进行Meta分析.结果 共纳入14篇文献,包括9项随机对照试验和5项类实验研究,共1582例患者.Meta分析结果显示,远程干预能降低居家脊髓损伤患者压力性损伤的发生率[RR=0.29,95％CI(0.20,0.43),P<0.001],提高患者的生活质量[SMD=0.94,95％CI(0.19,1.68),P=0.010]和满意度[SMD=0.86,95％CI(0.58,1.13),P<0.001];不良事件发生率比较,差异无统计学意义[RR=0.50,95％CI(0.20,1.27),P=0.140].结论 远程干预在居家脊髓损伤患者压力性损伤预防中是安全、可行的,能降低其压力性损伤的发生率,提高患者的生活质量和满意度.受纳入研究质量和数量的限制,上述结论尚需更多高质量的研究验证.

Background: Depression is one of the most common and important symptoms of patients with neuromyelitis optica spectrum disorders. Depression is an important aspect of mental health which would be expected to affect a person's social participation. Studies have shown that depression and social participation are independent predictors of health-related quality of life. Depression especially affects its mental component and social participation especially affects its physical aspects. This study was designed to explore to what extent depression may regulate the relationship between social participation and quality of life. Methods: A convenience sample of 138 discharged patients with neummyelitis optica spectrum disorders were surveyed. They were asked about their demographic characteristics and disease-related information. Their ability in the activities of daily living was quantified using the Barthel Index. The 36-item short-form health survey, the Beck Depression Inventory and the Impact on Participation and Autonomy questionnaire were also administered. Univariate analysis and Pearson correlations were used to test for any significant relationships between the variables and quality of life. The mediating effect of depression on the association between social participation and life quality was examined using structural equation modeling. Results: The structural equation models provided an excellent fit for the data. Social participation and the physical aspects of life quality were found to be strongly associated. And depression was of course strongly related to the mental aspects. Depression was not a mediator in the significant relationship between social participation and the physical aspects of life quality, but depression was found to be a strong and significant meditator in the association between social participation and the mental aspects of life quality. Conclusion: These findings help to clarify the direct and indirect effects of depression and social participation on the life quality of patients with neuromyelitis optica spectrum disorders. While helping and encouraging patients to actively participate in social life should be supplemented by monitoring them for signs of depression and providing appropriate treatment.

BackgroundNeuromyelitis optica spectrum disorders seriously hinder social participation. Only clarifying the status of social participation and the factors most strongly influencing it can promote better-targeted support for those with neuromyelitis optica spectrum disorders. ObjectivesTo explore the factors influencing social participation among persons with neuromyelitis optica spectrum disorders. Methods138 persons with neuromyelitis optica were recruited by convenience sampling. They completed the Impact on Participation and Autonomy Questionnaire, and were rated using the Barthel index, the Beck Anxiety Inventory and the Beck Depression Inventory. The data were used to evaluate a generalized linear model predicting social participation. ResultsThe respondents mostly perceived good or very good possibilities of social participation, but participation outdoors and in social relations were considered more restricted. Ability in the activities of daily living, education level, bladder and bowel dysfunction, and depression were four significant predictors of social participation. ConclusionsStrengthening training in the activities of daily living, continuing education, giving positive psychological support and helping with bladder and bowel problems may help to promote social participation among those with neuromyelitis optica spectrum disorders.

Objective: To assess the effect of a self-management intervention delivered by mobile application (APP) for depression among community-dwell-ing individuals with spinal cord injury (SCI). Design: Randomized controlled trial.Settings: General communities in China.Participants: Community-dwelling individuals with SCI who were diagnosed within 2 years were recruited in this study (N=98). It was a conve-nience sample with an average age of 41.71, 82.7% participants were men.Interventions: Participants in the intervention group (n=49) received 5 sessions on self-management training provided by nurse-led multidisci-plinary team via APP at the second, fourth, sixth, eighth, and 12th weeks, respectively, after they discharge from hospitals. Participants in the con-trol group (n=49) received routine telephone counselling provided by follow-up nurses at the 12th week after they discharge.Outcome Measure: The outcome of this study is depression, which is not the primary outcomes in the registration of this program. Depression was measured by version 2 of Beck Depression Inventory at discharge (T0), the 12th week after discharge from hospitals (T1), and the 24th week after discharge from hospitals (T2).Results: There were 98 participants (49 in the intervention group and 49 in the control group) completing the intervention and data collection. Compared with the control group, the intervention group had lower level of depression at T2 (B=-5.76; 95% CI=-9.97,-1.54; P=.007). Small to moderate effect sizes on depression favoring the intervention were demonstrated at T1 (Cohen's d=-.178) and T2 (Cohen's d=-.535).Conclusions: APP-based self-management support can be a potential intervention to reduce depression among community-dwelling individuals with SCI.Archives of Physical Medicine and Rehabilitation 2023;104:195-202 (c) 2022 by the American Congress of Rehabilitation Medicine.

AIMS AND OBJECTIVES:To determine the aspects of excretory dysfunction most influential in determining the quality of life of survivors of spinal cord injury.BACKGROUND:Excretory dysfunction is one of the most common and troublesome sequelae of spinal cord injury. Previous studies have shown that it can restrict social participation restriction, cause readmission and generally influence quality of life substantially.DESIGN:A cross-sectional survey of hospital inpatients following STOBE guidelines.METHODS:A convenience sample of 101 patients with traumatic or non-traumatic spinal cord injury were asked about their experiences of excretory dysfunction, and management and their self-perceived quality of life. Univariate analysis and multiple linear regression were performed to isolate the most important relationships.RESULTS:Only 2 of the 101 subjects professed to be unaffected by excretion dysfunction. Bladder-related dysfunction was the most frequently mentioned type of problem. Quality of life impairment was found to be most often associated with bladder accidents, bowel accidents and having more than one bladder complications.CONCLUSIONS:Excretory dysfunction substantially impacts quality of life after a spinal cord injury. Bladder accidents, bowel accidents and more than one bladder complication are factors independently influencing the quality of life of spinal cord injury survivors.RELEVANCE TO CLINICAL PRACTICE:To improve excretion-related QOL, patients' bladder and bowel self-management training should be strengthened seeking to prevent complications and reduce the risk of bladder and bowel accidents.

目的:以移动APP“脊髓损伤患者远程延续护理系统”中的《国际功能、残疾和健康分类》(ICF)相关随访指标为结局评定指标,纵向探讨脊髓损伤患者出院后功能状态的变化趋势.方法:2018年6月-2019年9月,选取广州市、十堰市和成都市4家医院的6个临床科室的符合纳入排除标准的91例脊髓损伤患者,随访护士以APP中的32个随访指标(31个ICF类目和1个不能被ICF涵盖的指标“照顾者的能力”)为测量工具,分别在患者出院时、出院后3个月和出院后6个月使用APP评定患者的功能状态.结果:75％(24个)ICF类目的适用率占90％以上,适用率最低的两个类目分别是性功能(29.67％)和生殖功能(14.29％);在32个随访指标中,21个ICF类目(5个身体功能领域的类目,全部10个活动和参与领域的类目,6个背景性因素领域的类目)和1个不能被ICF涵盖的指标“照顾者的能力”在3个时点的评定结果之间的差异均有显著性意义,表明居家SCI患者的这些功能状态随时间发展有所好转.未呈现明显好转趋势的10个类目涉及生理功能障碍和常见并发症,均属于身体功能和身体结构成份.结论:SCI患者出院后6个月内,大部分个体功能状态随着时间的推移逐渐好转.但部分生理功能障碍和并发症难以随着时间推移有明显改善,仍需要长期的康复和科学管理.

目的 对现有的神经源性膀胱功能障碍评估与管理相关指南进行整合,从而形成本土化证据资源.方法 以ADAPTE方法 为依据,形成神经源性膀胱功能障碍评估与管理的临床护理实践草案,通过神经源性膀胱功能障碍患者与相关专家的相继论证,对推荐意见进行评价并整合,最终修订形成正式版指南.结果 最终纳入5篇循证指南,整合形成的指南内容包括神经源性膀胱功能障碍的分类、病史采集、相关检查、导尿建议及辅助膀胱管理措施共5个主题,共20条推荐意见.结论 本研究整合形成了神经源性膀胱功能障碍评估与管理领域高质量的循证资源,为临床中的循证护理实践提供了参考和依据.

Background: The International Classification of Functioning, Disability, and Health (ICF) is a unified system of functioning terminology that has been used to develop electronic health records and assessment instruments. Its application has been limited, however, by its complex terminology, numerous categories, uncertain operationalization, and the training required to use it well. Together is a mobile health app designed to extend medical support to the families of spinal cord injury (SCI) patients in China. The app's core framework is a set of only 31 ICF categories. The app also provides rating guidelines and automatically transforms routine assessment results to the terms of the ICF qualifiers. Objective: The goal of the research is to examine the suitability of the ICF set used in the app Together for use as an instrument for assessing the functioning of SCI patients. Methods: A cross-sectional study was conducted including 112 SCI patients recruited before discharge from four rehabilitation centers in China between May 2018 and October 2019. Nurses used the app to assess patient functioning in face-to-face interviews. The resulting data were then subjected to Rasch analysis. Results: After deleting two categories (family relationships and socializing) and one personal factor (knowledge about spinal cord injury) that did not fit the Rasch model, the body functions and body structures, activities and participation, and contextual factors components of the ICF exhibited adequate fit to the Rasch model. All three demonstrated acceptable person separation indices. The 28 categories retained in the set were free of differential item functioning by gender, age, education level, or etiology. Conclusions: Together overcomes some of the obstacles to practical application of the ICF. The app is a reliable assessment tool for assessing functioning after spinal cord injury.

目的 探讨慕课中社会学习者的学习行为特点.方法 分析中山大学健康评估慕课2期课程数据,从整体学习者以及不同类型学习者的角度进行学习行为分析.结果 2期课程共有8 173名社会学习者注册,有550名(6.7％)学习者取得了最终成绩,学习者在各次测试中参与率呈下降趋势(R2=0.513,β=-0.161,F=9.479,P=0.013).在取得最终成绩的学习者中,坚定学习者有34名(6.2％),虎头蛇尾者233名(42.4％),无规律者283名(51.5％).除了首次测试、期末测试和2个专业要求相对较高的专题测试(实验室检查和影像学检查)之外,3组学习者在专题测试成绩上的差异无统计学意义(P＞0.05).网上互动方面,坚定学习者参与讨论比例最高(76.5％).与自由讨论相比,非坚定学习者更愿意参与有教师引导的、目的明确的病例讨论(P＜0.05).结论 参与慕课学习的社会学习者绝大部分为非坚定学习者(虎头蛇尾者和无规律者).在大多数专题(除了专业难度高的专题)中不同类型学习者的学习效果相似.在线上互动方面,坚定学习者大多积极地参与病例讨论和自由讨论,而非坚定学习者更喜欢参与病例讨论而非自由讨论.

Background: Massive open online courses (MOOCs) are innovative courses that have aroused great interest in the field of nursing education. However, most studies have focused only on the benefits of MOOCs rather than the issues and how to ameliorate them. Objectives: To compare the differences between the "blended learners" (who studied at a university and via a MOOC) and "social learners" (MOOC-only learners) in course completion, participation, performance, and online interactions. Design: A prospective cohort study. Settings and participants: The participants were social and blended learners registered on a 16-week Health Assessment MOOC on a Chinese MOOC platform. Methods: The data were collected from the MOOC learning records. The participants were categorized based on their participation: Committed learners (participated in all topic tests and the final exam), Early dropout learners (initially participated but did not finish the course), and Other learners (the remainder). The differences in course completion, participation, performance, and online interactions (in three case discussions and free discussions) between the blended and social learners, and among the three participation types, were assessed. Results: At total of 4106 participants registered, comprising 57 blended and 4049 social learners. The completion rates for blended and social learners were 100% and 7.14%, respectively. The blended learners showed stable participation rates over the course (chi(2) = 0.190, P = 0.663) while the social learners showed a trend of high to low participation (chi(2) = 179.602, P < 0.001). The blended learners had better performance than the social learners (all P < 0.05) except among the committed learners. The blended learners also had more online interactions than the social learners (chi(2) = 25.107, P < 0.001). The Early dropout and Other learners among the social learners participated more in the free discussions than the case discussions (P < 0.001). Conclusion: Blended learners benefit more from MOOCs than social learners, and online-to-offline blended approaches are recommended for future nursing education.

目的 探讨基于慕课的"健康评估"混合式教学改革在护理本科生中的应用效果.方法 选择2017年3—6月74名2015级护理本科生为对照组,接常规"健康评估"课程教学,将2018年3—6月57名2016级护理本科生作为观察组,接受基于慕课的"健康评估"混合式教学,用《健康评估学习自我效能问卷》调查并比较2组学生的学习自我效能水平,同时分析其期末理论和操作考试成绩差异及课程反馈评价结果.结果 观察组学习自我效能得分高于对照组(P<0.05),其期末理论和操作成绩均优于对照组(P<0.01),对课程的反馈评价优于对照组(P<0.05).结论 基于慕课的"健康评估"混合式教学改革比传统教学能更有效提高护理本科生的学习自我效能、改善其理论和操作成绩及对课程的反馈评价.