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:分析衡阳市养老机构老年人的积极老龄化水平及影响因素.方法:采用便利抽样法,使用一般资料调查表、中文版积极老龄化量表、Snyder希望量表对衡阳市418名养老机构老年人进行调查.采用多元线性逐步回归分析老年人积极老龄化的影响因素.结果:衡阳市养老机构老年人积极老龄化总分为(87.21±22.32)分.文化程度、睡眠质量、锻炼时间、身体功能、希望水平、居住时间是养老机构老年人积极老龄化的影响因素(P<0.05).结论:衡阳市养老机构老年人积极老龄化为中等水平,其水平亟待提高,养老机构应采取针对性干预措施

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 探讨基于信息-动机-行为技巧(IMB)模型的中重度银屑病患者延续护理方案的应用效果.方法 选取2021年6-8月在上海市皮肤病医院住院治疗的80例中重度银屑病患者作为研究对象,采取随机数字法将其分为对照组(40例)及观察组(40例).对照组实施常规出院宣教及随访,观察组在其基础上实施基于IMB模型的中重度银屑病患者延续护理方案.比较2组患者干预前、干预6周和12周后的疾病认知、自我效能、自我管理及生活质量;比较2组干预12周后再入院率.结果 2组不同时间点疾病认知、自我效能、自我管理及生活质量的时间效应、组间效应及交互效应均有统计学意义(P＜0.05);观察组再入院率低于对照组,差异有统计学意义(P＜0.05).结论 基于IMB模型的中重度银屑病患者延续护理方案,可提高中重度银屑病患者的疾病知识与行为、自我效能感及自我管理行为,改善生活质量,降低再入院率.

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.

目的 了解社区女性乳腺癌相关知识的认知情况及筛查过程中的阻碍因素,为提升社区女性乳腺癌筛查率及认知水平提供参考.方法 采用半结构式访谈法,于2021年3月至4月对14名社区女性进行深入访谈.结果 共提炼出三大主题:乳腺癌相关知识的认知不足、乳腺癌筛查率较低、影响乳腺癌筛查的主要因素.结论 社区女性对乳腺癌的认知不足,乳腺癌筛查意愿薄弱,社区应根据影响女性乳腺癌筛查的相关因素,提高社区女性对乳腺癌筛查的重视程度,制定针对性措施,指导社区女性形成规律的筛查行为,为社区女性乳腺癌早期防治干预提供科学依据.

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.

目的 探讨阿尔茨海默病(AD)照顾者照护能力及影响因素.方法 选取2020年12月至2021年4月湖南省4所养老院的261例AD照顾者作为研究对象,使用调查表调查分析AD照顾者的照护能力,并分析其影响因素.结果 AD照顾者照顾能力得分为(28.46±9.11)分,所有项目平均得分为(2.85±0.91)分.各维度得分从高到低依次为家庭支援能力、家庭凝聚力和家庭照护认知能力.单因素分析显示,AD患者性别、文化背景、是否合并慢性疾病、夜间觉醒次数、照顾者性别、工作状况、是否与患者同住与照顾者的照护能力有关(P<0.05);多因素分析显示,照顾者性别、照顾者工作状况、照顾者是否与患者同住、AD患者文化背景、AD患者完全不能自理为照顾者照护能力的独立影响因素(P<0.05).结论 AD照护者的照护能力中等偏低.照顾者性别、工作状况、是否与患者同住、文化背景为照顾者照护能力的独立影响因素.

目的 探讨丹红注射液对冠心病不稳定型心绞痛的临床治疗效果.方法 80例冠心病不稳定型心绞痛患者随机分为对照组和试验组,每组40例.对照组患者给予抗缺血、抗血小板、抗凝与抗脂治疗,即口服单硝酸异山梨酯缓释片+阿司匹林肠溶片+低分子肝素钙+阿托伐他汀钙片.试验组患者在对照组基础上加用丹红注射液,比较2组患者心绞痛治疗效果评价、心电图治疗效果评价、中医证候治疗效果与治疗前后相关临床指标[心率(HR)、收缩压(SBP)、舒张压(DBP)、血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、超敏C反应蛋白(hs-CRP)、血同型半胱氨酸(Hcy)、N-瑞端脑钠肽(NT-proBNP)].结果 试验组患者心绞痛治疗总有效率、心电图治疗总有效率、中医证候总有效率明显高于对照组(P<0.05);2组患者治疗后HR、SBP、DBP、TC、TG、HDL-C、hs-CRP、Hcy与NT-proBNP水平与同组治疗前比较均显著性降低,LDL-C水平均显著性上升,差异均有统计学意义(P<0.01);试验组患者hs-CRP、Hcy与NT-proBNP水平显著低于对照组,差异有统计学意义(P<0.01).结论 丹红注射液对冠心病不稳定型心绞痛的临床治疗效果显著,具有借鉴性.

目的 研究胺碘酮联合美托洛尔对快速心律失常的治疗价值.方法 试验对象:我院近2年收治的83例快速心律失常患者.患者分组方法:随机数字表法.83例患者分为A组和A+M组两个组别.A组单纯静脉注射胺碘酮;A+M组胺碘酮联合美托洛尔静脉注射.观察指标:(1)有效率、转复率;(2)不良反应发生率;(3)治疗前后患者舒张压、收缩压、心率和起效时间.结果 (1)A+M组相比于A组有效率、转复率更高,差异有统计学意义(P＜0.05).(2)两组不良反应发生率差异无统计学意义(P＞0.05).(3)治疗前两组舒张压、收缩压、心率相似,差异无统计学意义(P＞0.05);治疗后A+M组相比于A组舒张压、收缩压、心率改善更显著,且A+M组起效时间短于A组,差异有统计学意义(P＜0.05).结论 胺碘酮联合美托洛尔对快速心律失常的治疗效果确切,可提高有效率和转复率,改善心率和血压水平,起效更快,不增加不良反应,安全性高,值得推广.

目的 研究血浆脑钠肽(BNP)在心力衰竭诊治中的应用价值.方法 研究资料来自2014-03-2016-02鞍山市肿瘤医院心力衰竭患者100例,作为研究组,并选取同期100例正常体检者,作为正常组.对心衰者和正常者BNP采用微粒酶荧光免疫检测技术进行测定,并行心脏B超检查,记录心功能和左室射血分数(LVEF),就心衰者和正常者BNP、LVEF进行比较,并对BNP诊断的敏感性、特异性进行统计.结果 研究组患者BNP明显高于正常组,LVEF明显低于正常组,t检验显示P＜0.05.研究组中,根据心功能分为Ⅱ级组、Ⅲ级组、Ⅳ级组,其中,组与组之间BNP、LVEF有明显差异,t检验显示P＜0.05.BNP诊断的敏感性、特异性分别为92.00％和93.00％.结论 BNP在心力衰竭诊治中的应用价值高,有较好的敏感性和特异性,心力衰竭患者BNP明显高于正常人,LVEF明显低于正常人,且随着心功能分级的增加,BNP增加,LVEF降低,BNP对心力衰竭诊断作用良好.

目的：了解尼莫地平在脑血管病治疗中的应用情况,分析影响尼莫地平药物依从性的因素。方法185例神经内科连续入院的脑血管病患者,收集其临床特征及可能影响尼莫地平药物依从性的因素,随访发病后3个月尼莫地平药物的应用情况,并进行统计分析。结果185例脑血管病患者,住院期间48.1%(89/185)应用尼莫地平。住院期间使用尼莫地平与高血压病史及蛛网膜下腔出血存在相关性。3个月随访时尼莫地平的总体应用率为23.3%(42/180),明显低于住院期间尼莫地平的应用率,3个月随访时尼莫地平药物依从性好与出院医嘱有关。结论尼莫地平在脑血管病治疗中的依从性差,出院医嘱是应用尼莫地平在脑血管病中依从性好的促进因素。