Background: Previous research has confirmed that dietary diversity is positively linked to mental health outcomes in older populations. Nevertheless, relevant evidence focusing specifically on Chinese older adults remains limited, and the internal mechanisms underlying this association I confirm. are not fully understood. Against this background, this study intended to investigate the association between dietary diversity and mental health among Chinese older individuals, explore the chain mediating roles of sleep quality and self-perceived quality of life, and further test whether gender moderates the above direct and mediating pathways. Methods: Using 2018 CLHLS data, 10,089 older adults aged 60 and above were selected as valid samples. Pearson correlation analysis was employed to determine the relationships between key variables. Hayes' PROCESS macro Model 6 was used for baseline serial mediation analysis, and Model 85 was used for moderated serial mediation with gender as the moderator, adopting 5000 bootstrap samples. Results: The results revealed significant positive correlations (p < 0.01) between key variables, including dietary diversity, sleep quality, self-rated quality of life, and mental health. Model 6 showed that dietary diversity serves as a positive and significant predictor of mental health (B = 0.130, p < 0.001). Three significant mediating pathways were identified through which dietary diversity affects mental health: (1) sleep quality (B = 0.076, 95% CI: 0.062, 0.092), (2) self-rated quality of life (B = 0.100, 95% CI: 0.083, 0.118), and (3) sleep quality and self-rated quality of life (B = 0.020, 95% CI: 0.016, 0.025). The total mediating effect of the three pathways reached 59.94%. Model 85 found that the interaction term of dietary diversity x gender was non-significant (p > 0.05), demonstrating no statistically significant gender moderation of any pathway. Gender-stratified conditional effects revealed numerical differences across subgroups. Conclusions: Higher dietary diversity is significantly correlated with better mental health among Chinese older adults. Sleep quality and self-rated quality of life play significant roles as serial mediators in this association. Although gender does not statistically moderate the whole association mechanism, subtle gender heterogeneity exists in the pathway effect magnitude. The above findings offer novel insights into the underlying mechanisms. Strategies aimed at improving dietary diversity, combined with targeted interventions to enhance sleep quality and self-rated quality of life, with slight gender-differentiated auxiliary suggestions, may effectively promote mental health and contribute to active aging in later life.

BACKGROUND:Physical frailty is a well-established risk factor for cognitive impairment, but the psychosocial mechanisms underlying this link remain insufficiently understood. Psychological well-being (PWB) may represent a modifiable pathway. This study examined whether PWB mediates the association between physical frailty and incident cognitive impairment, and whether this pathway varies by age or gender. METHODS:We analyzed data from 11,607 cognitively normal adults aged ≥60 years in the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2008-2018). Frailty was assessed using a deficit-based Frailty Index, PWB using validated multi-item scales, and cognition using the Mini-Mental State Examination. Associations were examined using correlation, multivariable regression, and survival analyses. Causal mediation analysis under a counterfactual framework with 1,000 bootstrap resamples estimated direct and indirect effects, with age- and gender-stratified analyses assessing moderated mediation. RESULTS:Over a median follow-up of 40.3 months, 19.5% of participants developed cognitive impairment. Frailty was associated with a 40% higher hazard of cognitive impairment (HR=1.40, 95%CI: 1.15-1.71), and PWB mediated 6.5% of this association. The proportion mediated was greatest among adults aged 60-79 years (10.8%) and was not modified by gender. CONCLUSIONS:PWB partially mediates the frailty-cognition association in Chinese older adults, with stronger mediation observed in younger age groups. Enhancing psychological well-being may offer a scalable and modifiable strategy to strengthen cognitive resilience in rapidly ageing societies.

BACKGROUND AND OBJECTIVES:Disease-related malnutrition (DRM) mandates routine screening in many nations to ensure quality care as nutritional status often deteriorates during hospitalization. This study aimed to establish tool-specific prevalence benchmarks at admission and discharge, investigate sources of heterogeneity and evaluate diagnostic yields of one-step versus two-step GLIM approaches. METHODS AND STUDY DESIGN:A systematic search of Embase, PubMed, Web of Science, Cochrane Library, and CINAHL was conducted for cross-sectional studies on nutritional status published between 1 January 2018 and 30 Nov 2025 (PROS-PERO ID: CRD42023480467). Eligible studies were pooled in a meta-analysis of proportions using a random-effects model. RESULTS:Of 9,693 records retrieved, 179 studies involving 755,092 patients from 30 countries were included. At admission, the pooled prevalence was 0.41 (95% CI 0.35-0.49, I2 = 99.9%) by NRS2002 (≥3, adults), 0.62 (95% CI 0.57-0.67, I2 = 99.3%) by MNA-SF (≤11, older adults), 0.55 (95% CI 0.44-0.68, I2 = 98.5%) by STAMP (≥2, pediatric patients), and 0.39 (95% CI 0.35-0.44, I2 = 99.6%) by GLIM (adults). At discharge, three studies reported a pooled prevalence of 0.19 (95% CI 0.09-0.40, I2 = 94.6%) by NRS2002 for adults, significantly lower than admission (p = 0.044). Comparing GLIM strategies, no statistically significant difference was observed between one-step and two-step GLIM approaches (p = 0.062). CONCLUSIONS:DRM prevalence remains high at both admission and discharge, varying widely across countries and by tools. Discharge data are critically limited, reflecting gaps in routine screening practices. Regarding diagnosis, findings support a risk-adapted strategy. Pooled estimates may overestimate the true prevalence and should be interpreted with caution.

Background The age-related muscle weakness known as dynapenia severely exacerbates functional impairment and disability risk when comorbid with knee osteoarthritis (KOA).The epidemiological profile of this coexisting condition within specific clinical populations remains underexplored. This study aimed to investigate the prevalence and influencing factors of dynapenia among middle-aged and elderly patients with KOA, providing epidemiological evidence for the development of targeted prevention and management strategies. Methods This cross-sectional study employed a convenience sampling approach. Participants were recruited from patients diagnosed with KOA in the outpatient and inpatient departments of three tertiary hospitals in Guangdong Province, China, from December 2023 to September 2024. Investigators collected detailed demographic characteristics and disease-related information from all enrolled patients,and identified dynapenia by measuring handgrip strength (HGS) and muscle mass in patients with KOA. Results Among middle-aged and elderly patients with KOA, 173 individuals had dynapenia, with an overall prevalence rate of 27.03%, indicating that this disease is common in patients with KOA. Binary logistic regression analysis identified that age, education level, diabetes, and gout were closely associated with the occurrence of dynapenia. Conclusions As far as we know, this is one of the earliest studies to specifically investigate the prevalence and influencing factors of dynapenia in middle-aged and elderly patients with KOA. These findings underscore the importance of integrating routine muscle strength assessment into clinical practice, along with targeted interventions involving resistance training, nutritional optimization, and comorbidity management for this population.

BackgroundMany studies have established associations between smoke exposure and both accelerated cognitive decline and systemic inflammation. However, their interrelationship remains unclear.ObjectiveThis study aims to provide novel insights into the tripartite relationships linking smoke exposure, inflammatory biomarkers, and cognitive function among older adults.MethodsThis study analyzed data from 2503 participants in the National Health and Nutrition Examination Survey (NHANES, 2011-2014) and 3263 participants in the China Health and Retirement Longitudinal Study (CHARLS, 2011-2012). Serum cotinine was mainly used to assess smoke exposure in NHANES, while self-reported smoking status was used in CHARLS. Cognitive function was assessed using standard cognitive tests in NHANES and CHARLS. Inflammatory biomarkers included NLR, SII, leukocyte, neutrophil and lymphocyte in NHANES and leukocyte in CHARLS. Linear regression, nonlinear threshold effect models, and mediation analysis examined associations and mediating effects.ResultsHigher cotinine was associated with lower cognitive scores in NHANES (β = -0.219, p < 0.001). In CHARLS, current smokers exhibited lower cognitive scores than never-smokers (β = -0.090, p = 0.004). Neutrophil and leukocyte showed linear relationship with cognitive function in NHANES, while other inflammatory indicators showed significant nonlinear threshold effects. Mediation analysis revealed that neutrophil and leukocyte partially mediated 7.39% and 9.75% of the smoke-cognitive decline association.ConclusionsSmoking is related to cognitive decline in older adults from two national cohorts, with neutrophil and leukocyte partly mediating this link in the U.S. cohort. Interventions for smoking cessation and inflammation reduction may help mitigate cognitive decline.

This study aimed to evaluate the effectiveness of VR-based training compared to traditional lecture-based training for medical trainees in managing MCIs, specifically focusing on road traffic accidents. The primary assessment was performed using an Objective Structured Clinical Examination (OSCE) and a theoretical knowledge test. A randomized controlled trial was conducted with 46 medical trainees receiving emergency medicine training. Participants were randomly assigned to either a VR-based Training Group or a Lecture-based Training Group, with each group receiving a 2-hour training session on mass casualty management. The training effectiveness was evaluated through pre- and post-training knowledge tests, OSCE performance, and post-training feedback questionnaires. Statistical analyses were performed to compare the two groups. Baseline characteristics were well-matched between groups. The VR-based Training Group demonstrated significantly higher post-test scores (83.96 ± 13.11) compared to the Lecture-based Training Group (72.17 ± 20.89, p = 0.03). The learning gain was also significantly greater in the VR-based Training Group (40.26 ± 15.61) compared to the Lecture-based Training Group (28.26 ± 17.04, p = 0.02). OSCE results showed that the VR-based Training Group demonstrated better performance than the Lecture-based Training Group across all stations, with significant improvements in triage, injury assessment, and overall scene management. Additionally, feedback from the post-training questionnaire revealed that the VR-based Training Group reported greater confidence in performing critical tasks. VR-based training may represent a more effective and engaging approach for teaching mass casualty management relative to traditional lecture-based methods. It may enhance both theoretical knowledge and practical skills, which could help better prepare medical trainees for high-pressure scenarios such as MCIs. As VR technology continues to evolve, its integration into medical education holds considerable potential for improving preparedness and clinical performance in emergency settings.

OBJECTIVE:The aims of this study was to explore the current condition of burnout, perceived organizational support and turnover intention among medical staff in Shenzhen, the impact of burnout and organizational support on turnover intention is explored to provide data reference and proposal support for hospital managers and related policy makers to take targeted decisions. DESIGN:Selecting medical staff from different hospitals and community health centers in Shenzhen for the questionnaire survey. The independent sample t-test, Pearson correlation analysis and the process plug-in Boostsrap method were used to analyze trends in data. SAMPLE:A total of 800 completed questionnaires had 774 valid outcomes and the effective recovery rate was 89.58%. MEASUREMENTS:The questionnaire content includes a general information questionnaire, Chinese Maslach Burnout Inventory General Survey, Perceived Organizational Support-Simplified Version scale, and turnover intention scale. RESULTS:There are significant correlation between occupational burnout, turnover intention and perceived organizational support (P < 0.01). Organizational support plays a partial mediating role in the impact of occupational burnout on turnover intention (OR = 0.09, 95% CI:0.06-0.13). CONCLUSIONS:There is currently a intention for medical staff to leave their jobs in some degree. Perceived organizational support plays a partial mediating role in the impact of occupational burnout on turnover intention.

BACKGROUND:Optimizing nutritional care for people with multimorbidity requires effective and feasible tools for early risk identification. This study aimed to investigate the associations of conicity index (C-index) and body roundness index (BRI) with multimorbidity among adults in Guangzhou, and to explore their potential utility in identifying individuals who may benefit from prioritized nutritional assessment. METHODS:Based on the Fourth Adult Chronic Disease and Risk Factor Surveillance Program in Guangzhou, a total of 15,532 adults were recruited in this cross-sectional study. Multiple logistic regression analysis, restricted cubic spline (RCS) analysis and receiver operating characteristic curve (ROC) analysis with DeLong's test were performed. RESULTS:The prevalence of multimorbidity was 38.95%. Higher C-index and BRI quartiles were significantly associated with increased multimorbidity risk. Compared with the lowest quartile, the adjusted OR for the highest C-index quartile was 1.98 (95% CI: 1.78-2.21), and for the highest BRI quartile it was 3.05 (95% CI: 2.74-3.41). A dose-response relationship was observed (p < 0.001). BRI showed statistically significantly higher discriminative ability relative to traditional anthropometric indices, though its overall discriminative performance was modest (AUC = 0.678). CONCLUSIONS:C-index and BRI are strongly and positively associated with multimorbidity. These simple, non-invasive indices may support community-based risk stratification and help identify individuals who warrant further clinical and nutritional assessment.

Background: With accelerated population aging, depressive symptoms in later life have become a major public health issue. The Chinese version of the MIND (cMIND) diet is a neuroprotective dietary pattern adapted to Chinese dietary habits. Previous studies have found that adherence to the cMIND diet is associated with lower levels of depressive symptoms, but the underlying statistical association patterns remain unclear. This study adopted a statistical moderated mediation framework to characterize cross-sectional associations, to examine the direct association between cMIND diet adherence and depressive symptoms, the statistical associational mediating pattern of social participation, and the exploratory moderating effect of exercise on the first segment of the statistical mediation chain. Methods: Data were drawn from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 8578 adults aged 65 years and older. Cross-sectional mediation and moderated mediation analyses were conducted using Model 4 and Model 7 of the PROCESS macro, with 5000 bootstrap resamples to test the significance of cross-sectional statistical indirect effects. Results: cMIND diet adherence was negatively associated with depressive symptoms (B = -0.414, p < 0.01). Social participation showed a statistical partial mediation pattern in this association, with the statistical indirect effect accounting for 14.02% of the total effect. Exploratory moderated mediation analysis showed that exercise moderated the first segment of the statistical mediation chain (B = 0.283, p < 0.01). The positive association between cMIND diet adherence and social participation was stronger among exercisers (simple slope = 0.635, p < 0.01) than among non-exercisers (simple slope = 0.352, p < 0.01). Correspondingly, the indirect association between cMIND diet adherence and depressive symptoms through social participation was stronger in the exercise group (indirect effect = -0.064, 95% CI [-0.079, -0.050]) than in the non-exercise group (indirect effect = -0.036, 95% CI [-0.045, -0.026]). Conclusions: Among Chinese older adults, higher adherence to the cMIND diet is significantly associated with lower levels of depressive symptoms, and this association shows a partial statistical mediation pattern linked to higher social participation. The positive association between cMIND diet adherence and social participation is more pronounced among adults who engage in regular exercise, which corresponds to a more pronounced statistical indirect association with depressive symptoms through social participation. As these findings are based on cross-sectional data and reflect only associational patterns, and given the limited effect magnitude, they provide only preliminary theoretical reference for the development of intervention strategies integrating dietary improvement and social participation promotion for late-life depressive symptoms.

ABSTRACT Aim This study explored the prevalence and potential factors influencing chronic pain and provided increased theoretical and practical support for future studies on nursing students from a novel perspective. Design This study applied a cross‐sectional study design. Methods A cross‐sectional survey with 1825 nursing students was conducted at Heilongjiang Nursing College in Heilongjiang province of northern China, recruited using cluster sampling. Multivariate logistic regression analyses explored the factors associated with chronic pain among nursing students. Results The final study sample included 1802 nursing students and the prevalence of chronic pain among first‐year nursing students was 59.2%. The top five sites of body pain in the past year were the neck, head, lower back, shoulder, and legs. Sex, family history of chronic pain, alcohol consumption, and sleep quality were significantly associated with chronic pain. Conclusion Chronic pain was common among this sample of nursing students. Early assessment and intervention at different pain sites are necessary to reduce the potential negative effects of pain. Developing targeted inventions to improve chronic pain and enhance students' quality of life is crucial. Implications for the Profession and/or Patient Care Nursing students may suffer from chronic pain due to many potentially influential factors. In the process of daily management, schools or related personnel can take effective measures to intervene in these factors, thus reducing the prevalence of chronic pain and improving the quality of life. Patient or Public Contribution No patient or public contribution.

BACKGROUND:The burden of chronic diseases is known to be significantly increased by obesity, yet conventional measures like waist circumference (WC) and body mass index (BMI) do not accurately capture central adiposity. The Weight-Adjusted Waist Index (WWI), calculated as waist circumference (cm)/√weight (kg), has been proposed to assess abdominal fat distribution independent of overall body size and may theoretically outperform BMI and WC by reducing muscle-mass-related misclassification. Evidence regarding its association with multimorbidity remains limited. This study sought to elucidate these associations using nationally representative NHANES data and to verify the results in a prospective Chinese cohort (CHARLS). METHOD:Adults ≥20 years in NHANES 2017-2023 were included, applying sampling weights. Multimorbidity was defined as the coexistence of ≥2 chronic conditions, identified based on self-reported physician-diagnosed diseases in both NHANES and CHARLS. In NHANES, multivariable logistic regression, RCS, GAM, interaction analysis and Sensitivity analyses were performed, adjusting for demographics, socioeconomic status, lifestyle behaviors, and dietary factors. ROC curve analysis was then performed to evaluate and compare the predictive performance of WWI, BMI, and WC. WWI, BMI, and WC were analyzed in separate regression models to avoid multicollinearity interference when comparing predictive performance. External validation was conducted using Cox regression and RCS in CHARLS 2011-2028, adjusting for demographic, socioeconomic, and lifestyle variables. RESULT:In NHANES, WWI was significantly positively associated with multimorbidity (OR = 1.74; 95% CI: 1.59-1.90; P < 0.001). Participants in the highest quartile of WWI had over threefold higher odds of multimorbidity compared with those in the lowest quartile (OR = 3.04; 95% CI: 2.94-3.73; P < 0.001). RCS indicated a predominantly linear association, while GAM suggested a modest J-shaped pattern. Sex significantly modified the association (P for interaction <0.05). Sensitivity analysis in adults ≥45 years yielded consistent results. In the CHARLS cohort (n = 2985), higher WWI significantly predicted incident multimorbidity (HR = 1.14; 95% CI: 1.06-1.22). WWI showed the highest discriminative ability for multimorbidity (AUC = 0.709) compared with BMI and WC. CONCLUSIONS:WWI remained a significant and consistent predictor of multimorbidity, demonstrating greater discriminatory ability than BMI or WC. While RCS suggested a predominantly linear association, GAM revealed potential non-linearity at extreme WWI levels, indicating that dose-response patterns warrant further confirmation. Validation in the CHARLS cohort supports temporal association, offering greater causal plausibility. Collectively, these results highlight WWI as a practical marker for identifying high-risk individuals and for guiding early prevention strategies.

BackgroundBedtime procrastination is common among university students and is associated with insufficient sleep and a range of adverse physical and psychological health outcomes. Previous studies have primarily focused on individual factors, such as self-control, mobile phone addiction, and negative emotions, while the interrelationships among future career clarity, learning experiences, exercise, and bedtime procrastination remain largely unexplored.ObjectiveBased on self-regulation theory, this study aimed to examine the association between future career clarity and bedtime procrastination among university students. It further examined whether learning satisfaction and learning stress statistically mediated this association in sequence, and whether exercise moderated the association between learning satisfaction and bedtime procrastination.MethodsA survey was conducted among 22,983 college students in Northeast China using an online questionnaire combined with respondent-driven sampling. Data were analyzed using partial correlation analysis, mediation effect testing, and moderation effect testing, with effect sizes and confidence intervals (CIs) estimated using the bootstrap method.ResultsPartial correlation analysis revealed a significant negative correlation between future career clarity and bedtime procrastination (r = −0.282, p < 0.001). Mediation effect testing showed that the total indirect effect of future career clarity on bedtime procrastination was significant (effect = −0.1024, 95% CI [−0.1092, −0.0958]), with learning satisfaction and learning stress serving as mediators individually and jointly constituting a chain mediation pathway. Moderation effect analysis indicated that exercise significantly moderated the relationship between learning satisfaction and bedtime procrastination (β = −0.0135, p < 0.05). The mediation effects were significant for both the low exercise group (simple slopes = −0.1816, LLCI = −0.1966, ULCI = −0.1667) and the high exercise group (simple slopes = −0.2177, LLCI = −0.2467, ULCI = −0.1887), with the negative predictive effect being stronger in the high exercise group.ConclusionFuture career clarity not only negatively predicts bedtime procrastination among college students directly but also exerts an indirect influence through the serial mediating effects of learning satisfaction and learning stress. Exercise plays a positive moderating role in this pathway. Grounded in self-regulation theory, these findings elucidates the relationships among goal setting, emotional monitoring, and behavioral adjustment, providing both a theoretical foundation and practical guidance for universities to reduce college students’ bedtime procrastination through multidimensional approaches such as career planning education, stress management, and the promotion of physical exercise.

Social activity in older adults is often correlated with their depressive symptoms, and this correlation is stronger in older adults with multimorbidity than in those without. However, few studies have analyzed this longitudinal association over time. This study aimed to examine the bidirectional longitudinal associations between social activity and depressive symptoms in older adults with multimorbidity. Additionally, we examined subjective life expectancy’s (SLE) moderating association in this bidirectional longitudinal association. Data were obtained from Waves 3 and 4 survey of 1435 older adults with multimorbidity (≥ 60 years) enrolled in the China Health and Retirement Longitudinal Study. We used cross-lagged panel models and grouped regression models to analyze the bidirectional longitudinal association between social activity and depressive symptoms, as well as the moderating association of subjective life expectancy, among Chinese older adults with multimorbidity. T1 social activity was significantly negatively associated with T2 depressive symptoms (β=-0.054, P < 0.050), and T1 depressive symptoms were significantly negatively associated with T2 social activity (β=-0.112, P < 0.010). SLE significantly moderated the association between T1 social activity and T2 depressive symptoms. Further, among participants with high SLE, the absolute value of the regression coefficient for the negative association of T1 social activity with T2 depressive symptoms (β=-0.134, P < 0.010) was larger than that for the association of T1 depressive symptoms with T2 social activity (β=-0.114, P < 0.050), indicating a more pronounced negative association for the former. All reported standardized coefficients were relatively modest; nevertheless, these statistically significant longitudinal associations are clinically and public health-relevant in this high-risk cohort of older adults with multimorbidity, who are disproportionately vulnerable to depressive symptom progression and social disengagement. Reciprocal longitudinal associations between social activity and depressive symptoms were observed among Chinese older adults with multimorbidity, with the negative longitudinal association from baseline depressive symptoms to subsequent social activity being larger in magnitude than the reverse association. Additionally, subjective life expectancy (SLE) showed a significant moderating effect on the association from baseline social activity to subsequent depressive symptoms.

BACKGROUND:The shortage of nurses is a worldwide issue. Turnover intention among nurses plays a critical role in shaping workforce stability and healthcare service quality. The inter-relationships between stress, psychological capital, job burnout, turnover intention, and well-being in nurses have not been fully clarified and warrant further study. AIM:This study aimed to investigate how stress affects turnover intention in Chinese nurses, focusing on the serial mediation of psychological capital and job burnout and the moderation of well-being. METHODS:Using a cross-sectional study design, registered nurses were recruited from 21 hospitals in eastern, central, and western China, with 4865 valid responses collected. Stress, psychological capital, well-being, job burnout, and turnover intention were measured using validated instruments. Associations among the variables were examined using a moderated serial mediation model (PROCESS Model 91), adjusting for demographic and occupational covariates. RESULTS:Stress was positively associated with turnover intention (r = 0.380, p < 0.01) and job burnout (r = 0.568, p < 0.01) but negatively associated with psychological capital (r = -0.374, p < 0.01) and well-being (r = -0.477, p < 0.01). Stress had a significant total effect on turnover intention (c = 0.290, p < 0.001), of which the direct effect (c' = 0.142, p < 0.001) accounted for 48.97% of the total effect. Psychological capital and job burnout significantly mediated this relationship. Specifically, the indirect effect through psychological capital was 0.016, accounting for 5.51% of the total effect, whereas the indirect effect through job burnout was 0.091, accounting for 31.38% of the total effect. Stress affected turnover intention through the serial mediation of psychological capital and job burnout (indirect effect = 0.041, 14.14% of the total effect). Well-being significantly moderated the association between psychological capital and job burnout, with an index of moderated mediation of -0.0008. The serial indirect effect decreased as well-being increased. CONCLUSION:Psychological capital and job burnout represent important mechanisms linking stress to nurses' turnover intention, and well-being moderates the pathway between psychological capital and job burnout. These findings provide evidence for multidimensional interventions to reduce nurses' turnover intention, including strengthening psychological capital assessment, improving occupational well-being, and optimizing workplace support systems. IMPLICATIONS FOR NURSING MANAGEMENT:Nurse administrators should adopt comprehensive strategies addressing stress, psychological capital, well-being, and job burnout to lower nurses' turnover intention and maintain workforce stability.

BACKGROUND AND OBJECTIVES:Globally, there is an increasing trend in the number of individuals utilizing home enteral nutrition (HEN). In China, HEN is currently at a nascent stage. We aim to investigate the current situation of home enteral tube feeding (HETF) caregivers to provide more convenient services and assistance to them in China. METHODS AND STUDY DESIGN:We conducted a questionnaire survey among family caregivers of enteral tube feeding patients preparing for hospital discharge to assess their awareness, needs, and preferences for resources. RESULTS:108 family caregivers were recruited in the study. 65 caregivers were considered proficient in tube feeding knowledge, while 43 were not, resulting in a non-proficiency rate of 39.8%. Education levels (p <0.001), employment status (p = 0.029), and the patients' age-adjusted Charlson Comorbidity Index (aCCI) (p = 0.032) were the critical factors affecting the caregivers' tube feeding knowledge. The risk of non-proficiency in tube feeding knowledge was increased for those with lower education levels compared with those with higher education levels (OR=5.08, 95% CI: 1.77-14.52). The family's monthly income and expenditure (p = 0.030) was the sole factor impacting the type of tube feeding service needs. CONCLUSIONS:Providing tube feeding knowledge to HETF patients and their caregivers before dis-charge is essential. Personalized training, especially for caregivers with lower education levels, can improve their understanding. Additionally, implementing online nutrition follow-ups and Nutrition-Nursing Joint Clinics can help address healthcare resource disparities and offer more accessible services to HETF patients in China.

Background: Depressive symptoms is more prevalent in middle-aged and older populations, and the development of Internet technology has brought new challenges and opportunities for the mental health of this group. This study aims to explore the bidirectional relationship between Internet device diversity and levels of depressive symptoms through longitudinal data analysis, as well as investigate the mediating role of social participation. Methods: Data for the analysis was retrieved from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, 2018, and 2020, which included 9259 middle-aged and older adults. The sum of the number of devices mentioned by each participant was calculated to assess the diversity of internet device use, a weighted total score of how frequently and to what extent individuals had participated in various social activities in the past month was calculated to measure the social engagement, and the Center for Epidemiological Studies Depression Scale was used to calculate depressive symptoms. A cross-lagged mediation model and bivariate correlation analysis were employed to examine the longitudinal relationships among depressive symptoms, internet device diversity, and social participation. Age, gender, highest education level, marital status, drinking status, smoking history, self-rated health, sleep duration, and chronic health conditions were adjusted as covariates. Results: The results from the three waves of longitudinal data revealed mutual predictive relationships among internet device diversity, social participation, and depressive symptoms. The mediating effect was significant (beta = -0.612, 95 % CI -0.796 to -0.429), with significant gender differences observed. Furthermore, our findings indicated that social participation functioned as a protective factor against depressive symptoms, and the association between social participation and depressive symptoms was not a straightforward linear relationship. This suggests that participation in social activities (either high or low) is associated with a lower risk of depressive symptoms compared to no social participation, with no gender differences. Conclusions: This study suggests that there is a relationship between internet device diversity and lower levels of depressive symptoms among middle-aged and older adults in China. Social participation mediates the relationship between internet device diversity and depressive symptoms, and different levels of social engagement have different effects on depressive symptoms. It is recommended to increase support for social participation among middle-aged and older adults, strengthen structural social capital, and better leverage the use of the internet to reduce depressive symptoms levels and promote the physical and mental well-being of this population.

Data sharing within psychiatric and behavioral research represents a novel application of ethical principles in practice; however, it suffers from a dearth of practical experience and established ethical norms. In this study, we comprehensively examined the ethical considerations surrounding the acquisition, management, sharing, and utilization of such data. We graded sensitive data and suggest ethical standards for privacy protection based on varying levels of data sensitivity. The objective of this study is to foster orderly and standardized open sharing of psychiatric and behavioral research data, thereby advancing the development and progress of related academic disciplines in China. This Chinese expert consensus has been registered on the International Guide Registration platform (Registration Number: PREPARE-2024CN412).

Background and objectives:To investigate the current status of clinical pathway implementation for food for special medical purpose (FSMP) in China and provide a scientific basis for constructing a standardized pathway. Methods and study design:An E-questionnaire was distributed to 27 clinical nutrition quality control centers in tertiary medical institutions in China from September to October 2023 via random stratified sampling. Results:Ninety-eight valid questionnaires were ultimately recovered. The number of FSMPs used ranged from 1 to 33. The rates of active nutritional risk screening, nutritional status assessment and diagnosis before FSMP therapy were 93.87, 93.88, and 97.96%, respectively. In addition to nutritional physicians, dietitians, and clinicians, nurses participated in prescribing FSMP in 12.24% of the hospitals. Before a prescription was issued, 65 (66.33%) hospitals had an audit process conducted by superior clinicians or dietitians. The frequency of routine ward rounds for more than half of the hospitalized inpatients was once a day. Post-discharge follow-up was implemented in 57 (58.16%) hospitals. The preparation of FSMP in 77 (87.50%) hospitals was included in the supervision of nosocomial infection. The frequency of infection supervision in half of the hospitals was once a month. Sixty-four (65.31%) hospitals had established monitoring and treatment plans for FSMP adverse reactions. Eighteen (18.37%) hospitals had set up FSMP counters for patients. Outpatients from 79 (80.61%) hospitals received FSMP in the department of clinical nutrition. Forty-five (45.92%) hospitals had charge codes. More than 20 different types of charges were collected. Conclusion:An FSMP clinical pathway prototype (Nutritional Screening-Assessment-Diagnosis-Treatment) has been implemented in China's tertiary medical institutions. However, many irregularities exist. A standardized clinical pathway with universality and enforceability needs to be developed and promoted. There is an urgent need for China to strengthen its regulation policies and for other countries to share their experiences in the clinical application of FSMP.

[This corrects the article DOI: 10.3389/fphys.2025.1582036.].