BACKGROUND:Walking pace (WP), a simple physiological indicator, has been found to be strongly associated with a variety of health outcomes in recent years. Among them, the relationship between walking pace and stroke is of particular interest. Given the high morbidity, disability and mortality associated with stroke, identifying modifiable indicators of health, such as walking pace, could help in stroke prevention strategies. However, the causal relationship between WP and stroke risk remains unclear. This study aims to determine the causal relationship between walking pace and risk of stroke using a two-sample Mendelian randomization approach in a European-ancestry population. METHODS:In order to evaluate the potential for a causal relationship between WP and stroke in people of European heritage, a two-sample Mendelian randomization (MR) study was carried out. Statistics about the association of single nucleotide polymorphisms (SNPs) with stroke were taken from FinnGen (R8) (n = 284,040), while the UK Biobank genome-wide association studies (GWAS) provided the summary data on the association of SNPs with WP (n = 459,915). The inverse-variance weighted (IVW) method was utilised as the primary strategy to examine the causal connection between WP and stroke. Additionally, complementary analyses were conducted using the MR-Egger and weighted median. In order to identify the potential directional pleiotropy and heterogeneity, the MR-Egger intercept test, the MR-PRESSO test, and Cochran's Q statistic were all carried out. This connection was evaluated using OR with 95% confidence intervals (CIs). RESULTS:A total of 48 SNPs were identified as valid instrumental variables in our two-sample MR analysis. The result showed that a slower walking pace is associated with a higher risk of stroke (OR = 0.573; 95% CI, 0.383-0.858, P = 0.007). The "leave-one-out" analysis demonstrated that the absence of a single SNP did not affect the robustness of our results. The MR-Egger intercept test indicated that genetic pleiotropy did not introduce bias into the results [intercept = -2.9E-03, SE = 0.008, P = 0.719] and Cochran's Q test revealed no heterogeneity. Therefore, the sensitivity analyses yielded comparable results. Consequently, the results of the sensitivity analyses were consistent. CONCLUSION:Our MR study revealed that WP is inversely associated with risk of stroke. These results provided evidence that slower WP causally increased the risk of stroke, recommending that patients with lower WP should have a prompt physical examination and targeted interventions to reduce their risk of stroke and enhance their quality of life.

目的:探讨蒙台梭利法在阿尔茨海默病(Alzheimer's disease,AD)照顾者照护能力培训中的应用效果.方法:于2021年7月—2021年9月,选取湖南省养老机构的AD照顾者为主要研究对象,采用随机抽样法将照顾者分为对照组和试验组,对照组接受常规AD照顾者培训,试验组在常规培训的基础上使用蒙台梭利法进行培训,干预前后分别采用老年病人家庭照护能力量表(FCCSE)、照顾者负担量表(CBI)、照顾者积极感受量表(PAC)评价两组AD照顾者照护能力、照顾负担和积极感受变化.结果:干预12周后,试验组AD照顾者FCCSE总分为(26.84±5.22)分,高于对照组的(23.66±5.14)分(P<0.05),PAC总分为(36.63±2.34)分,高于对照组的(24.78±1.79)分(P<0.05),CBI总分为(32.28±2.20)分,低于对照组的(50.59±2.84)分(P<0.05).重复测量方差分析显示,不同时间两组AD照顾者FCCSE、CBI、PAC得分比较差异有统计学意义(P<0.05),且时间因素和分组因素均存在交互效应(P<0.05).结论:蒙台梭利法可提高AD照顾者的照护能力,减轻照顾负担,增强其积极感受.

目的 调查鼻咽癌放化疗患者自我营养管理现状并分析其影响因素.方法 采用便利抽样法,选取 2022 年10月至 2023 年 2 月在衡阳市 4 所三甲医院肿瘤放射治疗科住院行放化疗的 359 例鼻咽癌患者为研究对象,使用一般资料调查表、卡式功能状态评分、患者主观整体评估量表(PG-SGA)和营养管理能力问卷进行调查,采用多元线性回归分析鼻咽癌放化疗患者自我营养管理的影响因素.结果 鼻咽癌放化疗患者自我营养管理得分为(24.27±6.46)分.单因素分析结果显示,不同年龄、居住地、文化程度、医保方式、照顾者、化疗周期数、放疗次数、家庭平均月收入、PG-SGA得分、合并疾病数的自我营养管理的得分比较,差异有统计学意义(P＜0.05).多元线性回归分析显示,文化程度、PG-SGA得分、家庭平均月收入及职工医保是鼻咽癌放化疗患者自我营养管理的影响因素(P＜0.05).结论 鼻咽癌放化疗患者自我营养管理能力呈中等偏下水平,应重点关注文化程度低、家庭平均月收入低、多种疾病共存、营养状况差及医保报销比例低的患者的自我营养管理水平,根据患者实际情况采取针对性的自我营养管理方案.

Objective To systematically review the risk factors for balance dysfunction（BD） in the elderly,and provide a scientific basis for early screening of high-risk groups and targeted nursing measures.Methods The literature regarding the risk factors of BD in the elderly was collected via PubMed,Web of Science,MEDLINE,CNKI,Wanfang database and VIP database（from the establishment of the database to May 31,2022）.Two researchers independently screened the literature,extracted data,and then evaluated the risk of bias of the included studies.Meta-analysis was performed using RevMan 5.3 software.Results Ten meta-analyses representing 9394 sample were included.Meta analysis displayed that age（OR=1.83,95% CI:1.48,2.27）,gender（OR=1.48,95% CI:1.31,1.67）,depressive symptoms（OR=3.52,95% CI:1.12,11.03）,hypertension（OR=2.94,95% CI:1.53,5.65）,diabetes（OR=1.70,95 % CI:1.39,2.08）,fall history（OR=1.83,95% CI:1.32,2.55）,drug factors（OR=1.81,95 % CI:1.3 5,2.43）,musculo skeletal disorders（OR=1.95,95% CI:1.28,2.98）,lack of exercise（OR=3.81,95% CI:1.67,8.74）,vision systemic disease（OR=1.91,95% CI:1.50,2.43）were risk factors affecting BD in the elderly.Conclusion The occurrence of BD in the elderly is associated with many factors.Based on the above risk factors,the medical staffs should screen high-risk groups and take intervention measures as early as possible for the reduction of adverse health outcomes such as falls

目的:分析社区老年人抑郁症状影响因素及其拐点年龄.方法:采用随机抽样法选取衡阳市某社区1326名老年人作为研究对象,采用一般资料调查表、简版老年人抑郁量表对老年人进行调查,使用受试者工作特征(ROC)曲线预测老年人抑郁症状拐点年龄,构建Logistic回归模型验证拐点年龄对抑郁症状的预测能力.结果:社区老年人抑郁症状发生率为36.80％,ROC曲线分析结果显示,社区老年人抑郁症状的整体拐点年龄为74.5岁,女性(71.5岁)早于男性(75.5岁).Logistic回归分析结果显示,独居老年人[OR=1.712,95％CI(1.151,2.547)]、专科及以上文化程度的老年人[OR=1.847,95％CI(1.177,2.900)]、务农老年人[OR= 2.180,95％CI(1.326,3.583)]、无配偶的老年人[OR=1.379,95％CI(1.003,1.895)]、无医保老年人[OR=0.463,95％CI(0.270,0.797)]出现抑郁症状的风险较高.结论:年龄对社区老年人抑郁症状具有较高预测价值.无医保、独居、专科及以上文化程度、务农、无配偶的老年人是重点关注对象.

目的 探讨基于成果导向教育理念的护理学基础课程思政教学模式的教学效果.方法 采用便利抽样法,于2021年2-12月选取南华大学护理学院2019级的194名本科生作为对照组,于2022年2-12月选取2020级的146名本科生作为试验组.对照组按照常规教学方法进行教学,试验组在常规教学方法的基础上采用基于成果导向教育理念的护理学基础课程思政教学模式进行教学.干预后,比较两组护理本科生的课程成绩、试验组学生对"课程思政化"的认知态度和实施效果、教学满意度.结果 干预后,试验组护理本科生的课程总成绩为(85.65±7.31)分,对照组护理本科生的课程总成绩为(77.71±7.28)分,两组比较差异有统计意义(P＜0.01);试验组护理本科生对"课程思政化"认知态度得分为(32.62±2.15)分,"课程思政化"实施效果得分为(22.78±1.78)分;试验组护理本科生满意的思政案例形式是新闻报道和热点事件,满意的思政教学方法是体验式教学法和案例式教学法.结论 基于成果导向教育理念的护理学基础课程思政教学模式能提高护理本科生的学习成绩,为护理学基础课程思政教学课程建设提供参考.未来可将此教学模式应用至护理专业其他课程的教学改革中,以加快专业课思政建设进展.

ObjectiveTo analyze the influencing factors and inflection point age of depression symptoms among elderly in community.Methods1 326 elderly from a community in Hengyang city were selected as research subjects by random sampling method.A general information questionnaire and Geriatric Depression Scale-15 were used to investigate the elderly.The receiver operator characteristic（ROC） curve was used to predict inflection point age of depression symptoms among elderly.Logistic regression model was constructed to verify the predictive ability of inflection point age of depression symptoms.ResultsThe incidence rate of depression symptoms among elderly in community was 36.80%.The ROC curve analysis showed that the overall inflection point age of depressive symptoms in the elderly in the community was 74.5 years，of which women（71.5 years） were earlier than men（75.5 years）.The results of Logistic regression analysis showed that elderly living alone［OR=1.712，95%CI（1.151，2.547）］，elderly with college degree or above［OR=1.847，95%CI（1.177，2.900）］，farmers［OR=2.180，95%CI（1.326，3.583）］，and elderly without spouse［OR=1.379，95%CI（1.003，1.895）］，elderly without medical insurance［OR=0.463，95%CI（0.270，0.797）］ had higher risk of developing depression symptoms.ConclusionsAge has higher predictive value for depression symptoms among elderly in the community.Elderly who have not medical insurance，live alone，with college degree or above，farmers，or have not spouse are the key targets of attention.

OBJECTIVES:Patients from different social environments and cultural backgrounds have different nursing needs. If nurses ignore the cultural differences of patients, it is easy to lead to the strained nurse-patient relationship, affect the nursing effect and cause harm to patients. Critical cultural competence (CCC) can help nurses to meet the nursing needs of patients from different cultural backgrounds, which is beneficial to building a harmonious nurse-patient relationship and improving the quality of nursing. Almutairi, et al designed the Critical Cultural Competence Scale (CCCS) which can be used to evaluate accurately nurses' CCC. No studies have reported the development of a critical cultural competence measurement tool for nurses or the introduction of foreign scales in China. This study aims to conduct Chinese and cross-cultural debugging and test the reliability of the English version of the CCCS in order to form CCCS suitable for Chinese cultural background and provide an effective evaluation tool for investigating the current situation of clinical nurses' CCC. METHODS:This study used Brislin's back-translation model to translate and back-translation the English version of CCCS. The Chinese version of CCCS was then created through cross-cultural debugging by expert consultation and a pre-survey with a sample size of 30 clinical nurses. From August to October 2019, 580 clinical nurses were surveyed using a whole group sampling method. The participants were randomly divided into 2 groups with a 7꞉3 ratio. One group (n=406) was used for exploratory factor analysis and reliability analysis, while the other group (n=174) was used for confirmatory factor analysis. Six experts used the scale-level content validity index (S-CVI) and the item-level content validity index (I-CVI) to assess content validity. In the exploratory factor analysis, items were screened using the critical ratio method, and were tested using the KMO (Kalser-Meyer-Olkin) index, Bartlett's sphericity test, and principal component analysis. In the confirmatory factor analysis, average variance extracted (AVE), goodness of fit index (GFI), adjusted goodness of fit index (AGFI), and root mean square error of approximation (RMSEA) were used to assess the degree of fit of the constructed model. For the total scale and the 4 subscales, the Cronbach's α coefficient, split-half reliability, and retest reliability were used to assess the scale's reliability. RESULTS:The S-CVI was 0.930, while the I-CVI ranged from 0.833 to 0.944. For all items, the critical ratio exceeded 3, and the difference between the high and low subgroups was statistically significant (P<0.05). Exploratory factor analysis revealed critical knowledge subscale had a KMO value of 0.676, with the total scale and other 3 subscales all having a KMO value >0.8 and a chi-square value of 814.32 to 12 442.45 for the Bartlett's spherical test, with degree of freedom ranging from 21 to 136 (P<0.001), indicating that all items were suitable for factor analysis. The principal component analysis showed that 17, 12, 7, and 7 items were extracted from the 4 subscales, with 4, 3, 2, and 2 components whose eigenvalues were more than 1, and the cumulative variance contribution was 66.0%, 54.3%, 56.6%, and 70.2%, respectively. The confirmatory factor analysis showed that the AVE of the 4 subscales were 0.637, 0.499, 0.560, and 0.565, GFI was 0.904, AGFI was 0.863, and RMSEA was 0.076. The Cronbach's α coefficient for the total scale and subscales ranged from 0.811 to 0.878, the split-half reliability ranged from 0.707 to 0.842, and the retest reliability was 0.827. CONCLUSIONS:The Chinese version of the CCCS has good reliability and validity, and it can be used as a valid assessment tool for clinical nurses' critical cultural competence in China.

AIM:To determine the level of critical cultural competence (CCC) among Chinese clinical nurses and explore its influencing factors.BACKGROUND:Previous research has only focused on the theoretical model of CCC and the development of assessment tools; however, no large-scale study has been conducted on the level of clinical nurses' CCC and its influencing factors.METHOD:Clinical nurses in 14 Level A tertiary hospitals (n = 3858) were surveyed using Almutairi's critical cultural competence scale (CCCS). Descriptive, univariate and multivariate analyses were performed.RESULTS:The mean score of CCC was 4.44 (SD = 0.33). Critical empowerment (M = 4.85, SD = 0.58) and critical awareness (M = 3.57, SD = 0.99) had the highest and lowest scores, respectively. Female nurses, nurses in the nursing department and nurses with higher positions had higher CCC.CONCLUSION:The CCC of clinical nurses can be strengthened through targeted training, especially considering the fact that male and low-ranking nurses who had the lower level of CCC work in different departments.IMPLICATIONS FOR NURSING MANAGEMENT:Hospital administrators should pay attention to the importance of culture and cultural differences among different countries or ethnic groups. Creating an equal and fair nursing environment and encouraging nurses to provide critical cultural nursing is important.