BackgroundPhlegm-dampness constitution is a traditional Chinese medicine constitution typically associated with essential hypertension. Previous studies have demonstrated that auricular acupuncture effectively decreases blood pressure and adjusts the constitution. However, the mechanism underlying auricular acupuncture's effect is poorly understood.MethodsA non-blinded, randomized controlled trial will be undertaken between September 2022 and May 2023. Eighty essential hypertensive patients with a phlegm-dampness constitution will be randomly allocated to one of two groups. The intervention group will receive eight weeks of auricular acupuncture and regular use of antihypertensive drugs, while the control group will only receive antihypertensive drugs. The primary outcome will be any mean differences in office systolic blood pressure. The secondary outcomes investigations will include proteins of the renin-angiotensin system, office blood pressure of different genotypes, and phlegm-dampness constitution scores.DiscussionBy demonstrating how auricular acupuncture affects the renin-angiotensin system, this research will offer significant new information on the mechanism underlying the action of auricular acupuncture in hypertension. Moreover, the results will provide crucial clinical information on the associations between renin-angiotensin system gene polymorphisms and the antihypertensive effects of auricular acupuncture.Trial registrationRegistered at the chictr.org.

Objectives: Correlations between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) have been detected in previous observational studies. However, this association remains uncertain due to the potential presence of selection and confounding biases. Therefore, this bidirectional two-sample Mendelian randomization (MR) study was conducted to evaluate the causal relationship between OSA and GERD. Methods: In this study, instrumental variables (IVs) for OSA were selected from publicly available genetic summary data (27,207 cases and 280,720 controls). Summary statistics for GERD were obtained from a genome-wide association study of 602,604 individuals. The inverse variance weighted (IVW) method was used as the main MR method. The MR-Egger intercept test, MR pleiotropy residual sum and outlier, and leave-one-out analysis were used to detect pleiotropy. Heterogeneity was detected by Cochran's Q test. Results: The IVW results revealed that OSA [odds ratio (OR): 1.19, 95% confidence interval (CI): 1.11-1.28, p = 8.88E-07] was causally associated with the incidence of GERD. Moreover, there was evidence of GERD leading to OSA in the IVW analysis (OR: 1.44, 95%CI: 1.33-1.57, p = 7.74E-19). No directional pleiotropy was detected by the MR-Egger intercept test (all p > 0.05). Conclusion: This study found that OSA is linked to a higher incidence of GERD, and vice versa. This finding might be helpful for the screening and prevention of these two diseases.

ObjectiveWe determined the distribution of constitutional types of high-normal blood pressure in Traditional Chinese Medicine (TCM) and provided evidence for the prevention of high-normal blood pressure and hypertension.MethodsEight digital databases were searched from January 2011 to November 2022, including PubMed, EMBASE, Web of Science, EBSCOhost, CNKI, CBM, Wangfang, and CQVIP. We performed a meta-analysis with the random-effects model or fixed-effects model to describe the distribution of constitutional types of high-normal blood pressure in TCM. The studies were assessed based on heterogeneity testing and the potential for publication bias. The meta-analysis was performed on Stata software 15.0.ResultsA total of 17 studies with 8118 participants were included in this meta-analysis. The proportion of the biased constitution (82.3%; 95% CI: 75.6%–89.1%, p < 0.001) was higher than the balanced constitution (17.3%; 95% CI: 10.7–23.8%, p < 0.001). Phlegm-dampness constitution, Yin-deficiency constitution, and damp-heat constitution accounted for 16.0% (95%CI: 10.5–21.5%, p < 0.001), 14.8% (95% CI: 11.0–18.6%, p < 0.001), 11.3% (95% CI: 8.0–14.5%, p < 0.001) of the total high-normal blood pressure cases, respectively. The subgroup analyses performed that region, age and gender were positively associated with the distribution of constitution types of high-normal blood pressure in TCM. Compared with the general population, the risk of high-normal blood pressure in people with the phlegm-dampness constitution, Yin-deficiency constitution, and blood-stasis constitution was 2.665 (95%CI: 2.286–3.106, p < 0.001), 2.378 (95%CI: 1.197–4.724, p = 0.013), 1.965 (95%CI: 1.634–2.363, p < 0.001) times of the general population, respectively. Meanwhile, the risk of high-normal blood pressure was lower in people with a balanced constitution (0.248, 95%CI: 0.165–0.372, p < 0.001).ConclusionsPhlegm-dampness constitution, Yin-deficiency constitution, and damp-heat constitution were the common constitution types of high-normal blood pressure. There might also be differences in the distribution characteristics of TCM constitution among people with high-normal blood pressure in different regions, ages, and genders. Finally, a balanced constitution might be a protective factor for hypertensive people.

目的 总结国内外正常高值血压人群运动干预相关证据,为制定针对正常高值血压人群的运动方案提供依据.方法 系统检索BMJ Best Practice、UpToDate、Cochrane Library、JBI Library、国际指南协作网、英国国家卫生与临床优化研究所、苏格兰校际指南网络、PubMed、Web of Science、EBCOS、Embase、中国知网、万方数据知识服务平台等数据库,并补充检索国家心血管病中心、中国高血压联盟、国际高血压学会等数据库中正常高值血压人群运动干预相关文献,包括证据总结、临床决策、推荐实践、临床实践指南、专家共识、系统评价或M eta分析、随机对照试验,检索时限为2017年1月1日至2021年11月30日.由研究者独立进行文献质量评价,并对纳入的文献进行证据提取.结果 共纳入18篇文献,包括9篇指南、2篇临床决策、3篇系统评价、1篇专家共识和3篇随机对照试验,从适宜人群、运动前评估、运动强度、运动类型、减轻压力的运动类型、注意事项6个方面总结出24条证据.结论 正常高值血压人群运动方案的最佳证据可为社区卫生服务机构及健康管理中心的医护人员提供循证依据,但医护人员在应用证据时应考虑具体情境,对不同特点的个体进行准确评估,以便采取个体化、精细化干预措施.

目的 探讨青少年心境障碍患者父母创伤后成长的真实体验,为临床制订心理干预对策提供依据.方法 采用现象学研究方法,以目的抽样法选取 2021 年 11 月至 2022 年 1 月杭州市某三级甲等专科医院精神科收治的 12 名心境障碍青少年患者的父母进行半结构访谈,应用Colaizzi 7 步分析法分析资料.结果 共提炼出新的人生感悟、个人力量增强、与他人关系改变、积极抗争下的有效应对 4 个主题.结论 青少年心境障碍患者父母在应对创伤性事件时存在心理斗争,医护人员应充分关注患者父母内心体验并予以专业支持,促进其实现创伤后成长,提高照护能力.

Objective:To systematically review the qualitative research on dignity cognition and experience of the elderly in nursing homes.Methods:Qualitative research on the dignity cognition and experience of the elderly in nursing homes was retrieved by computer in PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, CINAHL, China National Knowledge Infrastructure, Wanfang Data, VIP and China Biology Medicine disc. The retrieval time limit was from the establishment of the database to May 31, 2021. The quality of the article was assessed using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center.Results:A total of 10 articles were included, and 30 research results were extracted. The research results were grouped into 8 categories, and 4 integrated results were synthesized, namely, the elderly's cognition of dignity, the impact of impaired dignity on the elderly, the factors affecting the maintenance of dignity, and the elderly's dignity maintenance strategies.Conclusions:Nursing homes should attach importance to the dignity of the elderly, provide dignity care, protect the autonomy of the elderly, and strengthen the social support system to promote the realization of the elderly with dignity.

Objective In the context of an increased focus on geriatric depression in recent years, this study examined the associations between different types of self-care disability, the number of self-care disabilities, and depressive symptoms among middle-aged and elderly Chinese people. Method The data for this study were extracted from the follow-up survey (conducted in 2018) of the China Health and Retirement Longitudinal Study (CHARLS). The sample comprised 10808 participants aged 45 years and older. The Activities of Daily Living (ADL) scale and the Center for Epidemiological Studies Depression (CESD-10) Scale were used to assess self-care disability and depressive symptoms, respectively. Result The prevalence of depressive symptoms and self-care disability among the surveyed residents was 45.1% and 23.4%, respectively. Overall, there was a significant positive association between self-care disability and depressive symptoms. Participants who reported having a self-care disability in relation dressing, bathing, transferring in and out of bed, using the toilet, and controlling urination and defecation were found to have a significantly higher risk of depressive symptoms. In addition, participants with a greater cumulative quantity of self-care disabilities had a higher risk of depressive symptoms, and higher CESD-10 scores. Conclusion Self-care disability is a risk factor for depressive symptoms among middle-aged and elderly Chinese people. A positive correlation between the number of self-care disabilities and the risk of depressive symptoms was found.

Background:At present, adherence to antipsychotic treatment is often poor, leading to the recurrence of symptoms. This increases the likelihood of the patient experiencing disability and thus increases the disease burden for the patient, their family, and society as a whole. However, to date, there is no clear evidence regarding the effect of medication adherence interventions on outcomes for patients with schizophrenia. Moreover, the traditional intervention methods are limited by manpower and resources in low- and middle-income countries. Recent studies have demonstrated that increasing a patient's level of self-compassion may improve their treatment adherence. Online mental health care interventions have advantages in terms of feasibility and acceptability for patients with schizophrenia. In this regard, a WeChat-based self-compassion training protocol to improve patient treatment adherence was designed in this study and will be evaluated in the future to determine its impact on patients with schizophrenia.Methods:The protocol for the randomized controlled trial (RCT) is based on the SPIRIT 2013 statement. This parallel RCT will aim to recruit 392 patients with schizophrenia who will be randomized at a 1:1 ratio into a 3-week intervention or control group. Both groups will receive routine care. The intervention group will also receive WeChat-based self-compassion training, which requires participants to complete three tasks every day, including a reading task, a meditation task, and a self-compassion journal task. The control group will receive WeChat-based psychological health education, which will only require participants to read positive articles about psychological health every day. Medication adherence, self-compassion, stigma, and social support will be measured at baseline (T0), immediately after the intervention (T1), and 3 weeks after the intervention (T2). Program feasibility will be evaluated throughout the course of the study, and acceptability will be measured immediately after the intervention (T1).Expected results:The intervention described here will address the barriers to accessing mental health care for people with schizophrenia, including patients' desire for independent management, difficulty accessing providers, and concerns about privacy and stigma. The current study provides guidance for clinical nurses to carry out psychological intervention, with the ultimate aim of addressing the problems associated with a shortage of psychological professionals in low- and middle-income countries.

BackgroundDietary modifications play an important role in the prevention and management of high-normal blood pressure (BP). The aim of this study was to investigate diet-related knowledge, attitudes, and behaviors, and the socio-demographic determinants of these, among young and middle-aged Chinese individuals with high-normal BP.MethodsData from the 2015 China Health and Nutrition Survey (CHNS) were analyzed in this study. A total of 1,756 subjects with high-normal BP were included. A chi-square test and binary logistic regression analysis were conducted to identify the risk factors toward diet-related knowledge, attitudes, and behaviors.ResultsA total of 37.4% of the participants knew about the Chinese Food Pagoda (CFP) or the Dietary Guidelines for Chinese Residents (DGCR). Overall, 39.8% of the subjects were classified as having adequate diet-related knowledge literacy, 27.8% reported positive diet-related attitudes to healthy eating, and 35.3% reportedly looked for nutrition knowledge. Of note, 72.4% and 80.1% of the participants reported liking to eat fruits and vegetables, respectively. Individuals with a middle school education [odds ratio (OR) = 1.784, 95% CI = 1.236–2.576], high school/vocational education (OR = 1.944, 95% CI = 1.305–2.896), and college degree or above (OR = 2.089, 95% CI = 1.341–3.322), who were living in a rural area (OR = 1.311, 95% CI = 1.048–1.639), proactively looking for nutrition knowledge (OR = 1.529, 95% CI = 1.227–1.906), and reported liking to eat vegetables (OR = 1.939, 95% CI = 1.409–2.688), were more likely to have sufficient dietary knowledge literacy. Managers (OR = 1.655, 95% CI = 1.039–2.635) were more likely to have positive dietary attitudes. Female gender (OR = 1.396, 95% CI = 1.089–1.790), high school/vocational school education (OR = 2.071, 95% CI = 1.269–3.379), college degree and above (OR = 2.207, 95% CI = 1.262–3.862), knowledge about the CFP or DGCR (OR = 8.138, 95% CI = 6.326–10.468), and sufficient dietary knowledge literacy (OR = 1.338, 95% CI = 1.050–1.705) were associated with an increased likelihood of looking for nutrition knowledge.ConclusionIndividuals with high-normal BP, predominantly males, living in rural area, with lower education, farmers, workers, service workers, and workers in the non-government employment unit may have poor diet-related knowledge, attitudes, and behaviors.

目的 分析高血压人群管理中临床决策支持系统的功能、决策内容、评价指标及应用效果.方法 按范围综述方法 学框架,检索PubMed、Web of Science、EMBASE、Cochrane Library、IEEE Xplore、中国知网、万方医学网数据库和维普中文期刊文献库中有关临床决策支持系统在高血压人群管理中应用的中英文文献,时间为 2011 年 1 月至 2021 年 8 月,并对文献进行筛选、提取及总结.结果 共检索文献 11421 篇,最终纳入 12 篇,总结与分析了纳入文献的研究对象、决策内容、决策依据、系统功能、应用效果等.结论 临床决策支持系统可以改善高血压患者的临床结局;在未来研究中应关注正常高值血压人群,重视生活方式干预的决策支持和应用效果的卫生经济学评价.

目的 构建老年高血压患者血压控制情况与心理弹性、自我感知老化、服药依从性的结构方程模型,分析各变量间的路径关系,为制订高血压干预方案提供理论依据.方法 采用方便抽样法选取220例老年高血压患者进行问卷调查,采用相关分析和结构方程探究血压控制情况与心理弹性、自我感知老化、服药依从性的关系,构建结构方程模型.结果 心理弹性对血压控制情况的总效应为0.428,直接效应为0.268,间接效应为0.160.自我感知老化能直接对服药依从性产生负向效应(β=-0.179,P<0.01).结论 提高患者心理弹性和自我感知老化水平,可以有效提高老年高血压患者服药依从性和血压控制水平.

正常高值血压(收缩压120～139和/或舒张压 80～89 mm Hg[1],1 mm Hg=0.133 kPa)是高血压发展的关键阶段[2],全球健康成人正常高值血压的发生率为36.3％[3],部分发展中国家为30.7％～47.3％[4-8],我国为36.4％,平均年龄(44.0±16.0)岁[9].研究表明,从正常高值血压到高血压,心脑血管病风险增加[10-12].

目的 对基于自我同情的网络干预在心理障碍人群中的应用研究进行范围审查,以识别网络干预内容的要素及应用现状,为相关研究提供参考.方法 以JBI范围综述指南为方法学框架,检索中国知网、万方数据、维普网、中国生物医学文献数据库、PubMed、Embase、CINAHL、Web of Science、PsycINFO 和 Cochrane Library 中相关研究.检索时限为 建库至 2021 年 10 月.对纳入文献进行汇总和分析.结果 共纳入10篇文献,网络干预的内容要素包括提供自我同情教育、自我同情冥想、自我同情写作/日记和学习 日常生活中使用的自我同情技能.干预的有效性和可行性已得到初步证实.结论 基于自我同情的网络干预对心理障碍人群起到积极作用,在未来研究中需增加参与者之间的联系、干预者与参与者之间的互动,并将课程内容精简化、形象化、科技化,以提升干预效果.

目的 了解养老护理员视角下失能老人尊严照护体验.方法 采用目的 抽样法,选取杭州市某医养结合养老机构的12名养老护理员进行深度访谈,使用Colaizzi七步分析法进行资料分析.结果 提炼出2个主题及8项下属内容:尊严照护内容(缓解心身痛苦,维持良好的身体形象,把握照护尺度,肯定老人价值,寻求家庭社会支持);尊严照护培训需求(学习相关知识,提高工作技能,管理自身情绪).结论 养老护理员重视失能老人的尊严,但尊严照护能力较弱,养老机构需加强培训,提高养老服务质量.

Objectives:This study aimed to explore the dignity and related factors among older adults in long-term care facilities.Methods:Cross-sectional data were obtained from a sample of 253 Chinese older adults dwelling in long-term care facilities.Dignity among older adults was measured using the Dignity Scale,and its potential correlates were explored using multiple linear regressions.Results:Results showed that the total score of the Dignity Scale is 151.95±11.75.From high to low,the different factors of dignity among older adults in long-term care facilities were as follows:caring factors(4.83±0.33),social factors(4.73±0.41),psychological factors(4.66±0.71),value factors(4.56±0.53),autonomous factors(4.50±0.57),and physical factors(4.38±0.55).A higher score of the Dignity Scale was associated with higher economic status,fewer chronic diseases,less medication,better daily living ability and long-time lived in cities.Conclusion:Older adults with low economic status,more chronic diseases,and poor daily living ability,taking more medications,or the previous residence in rural areas seem to be most at low-level dignity in long-term care facilities and thus require more attention than their peers.