Background:Among younger and middle-aged adults with diabetes, fear of progression (Fop) is a prominent psychological burden that is associated with impaired self-management and poorer long-term treatment adherence. Although self-disclosure has shown benefits in alleviating Fop in other chronic conditions, its role in younger and middle-aged adults with diabetes, and the pathways through which it might relate to Fop remain unclear. Purpose:To examine the effect of self-disclosure on FoP among younger and middle-aged adults with diabetes and to test the chain-mediating roles of social support and illness perception using a cross-sectional design. Patients and Methods:A survey was conducted in a tertiary hospital in Nanjing, China, from March 2023 to August 2024. Standardized scales were used to assess self-disclosure, social support, illness perception, and FoP. A multiple mediation model was tested using the PROCESS macro for SPSS (v22.0). Results:A total of 193 participants were included. Self-disclosure exhibited a substantial direct impact on FoP. It also exerted indirect effects through two pathways: (1) the independent mediation of illness perception and (2) the serial mediation of social support followed by illness perception. Conclusion:Self-disclosure is a meaningful and modifiable psychosocial factor associated with reduced FoP among younger and middle-aged adults with diabetes. Interventions aimed at facilitating disclosure, enhancing supportive communication, and reshaping maladaptive illness perceptions may help reduce FoP and support long-term self-management and adherence.

Aim:To investigate potential types of food avoidance among patients with inflammatory bowel disease (IBD) and identify the contributing factors. Background:Food avoidance may be an important risk factor for poor physical and mental health in patients with IBD. However, there is limited research on food avoidance within the Chinese context. Methods:Between July 2022 and December 2023, patients with IBD during appointment at the First Affiliated Hospital with Nanjing Medical University was investigated with paper questionnaires to assess food avoidance, food category avoidance, fear of disease progression, negative illness perception, IBD-related self-efficacy, and social support. Demographic and disease-related characteristics were also collected. Latent profile analysis (LPA) was used to examine food avoidance in patients with IBD, and the correlates were investigated using regression analysis. Results:LPA showed that respondents could be classified into three groups in terms of food avoidance, namely, the mild-food avoidance adaptation group (n = 72, 22.29%), the moderate-food pleasure deficiency group (n = 163, 50.46%), and the severe-food avoidance impairment group (n = 88, 27.24%). The total number of avoided foods in the three groups was 2.78 ± 2.37, 3.59 ± 2.49, and 3.89 ± 2.51, respectively (p = 0.02). In the multinomial logistic regression analysis, higher levels of fear of disease progression and negative perceptions were associated with the severe avoidance group. In contrast, patients in remission were more likely to fall into the mild and moderate avoidance groups. Conclusion:Patients with IBD may exhibit long-term, spontaneous food avoidance, which often presents at high levels. Furthermore, patients with IBD exhibit considerable heterogeneity in their food avoidance patterns, categorizing them into three distinct categories. Future dietary management strategies should be tailored based on the specific characteristics and predictive factors of these food avoidance patterns. Implications for Nursing Management:Given the prevalence and heterogeneity of food avoidance in patients with IBD, nurse managers should implement stratified interventions tailored to patient characteristics. Training nurses in culturally sensitive dietary education and emotional regulation strategies may improve the management of food-related behaviors and support patients' adaptive coping with the disease.

BACKGROUND:Disordered eating behaviors (DEBs) have been a prevalent issue among youths with type 1 diabetes (T1D), leading to impaired glycemic control, significant short- and long-term complications, and elevated mortality risk. Peer stress plays a critical role in the development of DEBs in adolescents. However, the association between peer stress and DEBs in youths with T1D remains unestablished, and the underlying mechanisms are unclear. This study investigated how peer stress influences DEBs and examined the parallel mediating role of dual-mode self-control-comprising both impulsive and control systems-in this relationship. METHODS:This cross-sectional study included 180 youths with T1D who were recruited from two tertiary hospitals in Nanjing, China, between December 2021 and September 2022. Data were collected using the peer stress subscale of the Diabetes Stress Questionnaire for Youths, the Dual-Mode Self-Control Scale, and the Diabetes Eating Problem Survey-Revised. Descriptive analyses and Pearson correlations were conducted in SPSS 22.0. Parallel mediation effects were tested via Model 4 of the PROCESS macro, using bias-corrected bootstrap with 5000 resamples to determine significant mediation. RESULTS:Peer stress significantly predicted DEBs (B = 0.55, p < 0.001). Only the impulsive system demonstrated partial mediation in the pathway from peer stress to DEBs (indirect effect = 0.13, 95% CI [0.04, 0.25]), accounting for 22.41% of the total effect. CONCLUSIONS:Peer stress directly influences DEBs and indirectly exacerbates DEBs through the activation of the impulsive system. These findings advance theoretical frameworks on peer stress and DEBs, informing interventions targeting peer stress reduction and impulse regulation to mitigate DEBs in youths with T1D.

Background:Fear of progression (FoP) is one of the most prevalent psychological responses among patients with chronic kidney disease (CKD), impairing mental health and quality of life. However, research on the heterogeneity of illness perceptions among CKD patients remains limited, and the relationship between distinct perception profiles and FoP is not yet well understood. This study aimed to identify latent profiles of illness perception in CKD patients and examine their associations with FoP. Methods:In this cross-sectional study, a total of 428 CKD patients were recruited from four tertiary hospitals through convenience sampling between May 1, 2023, and April 30, 2024. Participants completed questionnaires assessing demographic and clinical characteristics, illness perception, FoP, psychological flexibility, family resilience, and social support. Latent profile analysis was conducted to identify illness perception profiles, multinomial logistic regression was used to examine predictors of profile membership, and stratified regression analyses were performed to assess the associations between illness perception profiles and FoP. Results:Latent profile analysis identified three distinct illness perception profiles. Multinomial logistic regression analysis indicated that CKD stage, number of concomitant symptoms, psychological flexibility, family resilience, and social support significantly predicted the latent profiles of illness perception (P < 0.05). Stratified regression analysis further demonstrated that illness perception profiles were independently predicted FoP after controlling for key demographic and clinical variables. Conclusion:CKD patients exhibit heterogeneity in illness perception. Illness perception profiles were associated with FoP. Distinct illness perception profiles are associated with FoP, and are influenced by key psychosocial factors. These findings support the development of tailored, perception-based interventions to reduce FoP among CKD patients.

AIM:To identify and synthesize qualitative evidence on the stigma experiences of adolescents with type 1 diabetes. METHODS:Six databases were searched from inception to February 2024: PubMed, Cochrane Library, CINAHL, MEDLINE, Embase, and PsycINFO. This meta-synthesis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Findings from the included qualitative studies were synthesized using Thomas and Harden's methodology. RESULTS:About 17 studies were included in the meta-synthesis. Two synthesized findings emerged, including living in stigma (individual perceived and internalized stigma, stigma in interpersonal interactions, implicit stigma in the social structure) and coping with stigma (active stigma coping and escape-avoidance). CONCLUSION:This review is the first meta-synthesis specifically aimed at exploring the stigma experiences among adolescents with type 1 diabetes across individual, interpersonal, and structural levels. The multisourced stigma identified in this review is instrumental in the development of culturally informed and multitiered anti-stigma interventions for this population. It is imperative to enhance adolescents' coping abilities regarding stigma, as is the creation of a stigma-free environment for them.

AIMS:To investigate the effects of different subtypes of lipohypertrophy (LH) on insulin total daily dose (TDD) requirements in patients with type 1 diabetes mellitus (T1DM), and to propose subtype-specific insulin dosage adjustment strategies after avoiding injection at sites of LH. METHODS:This prospective observational study enrolled hospitalised T1DM patients with a disease duration ≥1 year. Point-of-care ultrasound was performed immediately after their admission to determine the presence and the specific type of LH. An insulin pump was installed away from the LH sites of each patient. Continuous subcutaneous insulin was infused to control their blood glucose, and the insulin dose was titrated gradually until their blood glucose stabilised to the target. RESULTS:A total of 288 patients were included. According to ultrasound screening, 104 patients (36.11%) were LH free (LH-0) and 184 patients (63.89%) were found to have LH (LH+), of which 114 had nodular hyperechoic LH (LH-1), 62 had diffuse hyperechoic LH (LH-2) and 8 had hypoechoic LH (LH-3). Paired-sample t-test showed that all LH+ groups had a decrease in TDD and TDD/body weight after avoiding injections at the lesion sites (all p < 0.05). Compared with the LH-0 group, the TDD and TDD/body weight of the LH-2 and LH-3 groups were significantly reduced (all p < 0.05), whereas there was no significant change in the LH-1 group. Among the TDD reduced in the LH-2 and LH-3 groups, the bolus insulin dosage reduced accounted for the vast majority, with 88.05% (8.55/9.71 international unit [IU]/day) and 74.78% (18.12/24.23 IU/day), respectively. CONCLUSIONS:TDD reductions vary among patients with different subtypes of LH. Nodular hyperechoic LH may not require immediate dose adjustments. Patients with diffuse hyperechoic and hypoechoic LH necessitate bolus-focused dose reductions.

Objectives: The study aimed to explore social alienation types in patients with inflammatory bowel diseases (IBD) and identify influencing factors. Methods: This cross-sectional study was conducted using purposive sampling among patients with IBD from July 2022 to July 2023. Patients were assessed using the Generalized Social Alienation Scale (GSAS), the Brief Illness Perception Questionnaire (B-IPQ), the Hospital Anxiety and Depression Scale (HADS), and the Medical Coping Modes Questionnaire (MCMQ). Demographic and disease-related characteristics were also collected. Latent profile analysis (LPA) was used to identify potential subgroups of social alienation. Univariate analysis and multicollinearity analysis were conducted to explore the influencing factors, followed by multiple regression analysis to evaluate the effect of influencing factors on social alienation. Results: Three distinct profiles of social alienation were identified: integrated-low alienation group (n = 61, 20.20 %), accommodative-moderate alienation group (n = 195, 64.57 %), and maladaptive-high alienation group (n = 46, 15.23 %). Seven characteristics were associated with the profile’s membership: self-perceived financial stress, malnutrition risk, disease duration, illness comprehensibility, anxiety, depression, and acceptance-resignation coping mode. Conclusions: Patients with IBD were categorized into three subgroups based on social alienation levels. Financial stress, malnutrition risk, disease duration, illness comprehensibility, anxiety, depression, and acceptance-resignation coping mode were key predictors of the subgroup membership. Targeted interventions should be developed to mitigate the negative effects of social alienation, with a focus on improving illness perception, alleviating anxiety and depression, and promoting effective coping strategies.

Aims: To verify the association of stigma with mental well‐being, self‐management competency, and glycemic control in adolescents with type 1 diabetes (T1D) and to examine whether intentional self‐regulation buffers the negative consequences of stigma. Methods: This study used a cross‐sectional design with a convenience sample. A total of 307 adolescents with T1D were recruited from February 2022 to August 2023. Diabetes‐specific stigma, intentional self‐regulation, mental well‐being, and self‐management competency were assessed using self‐reports measurement tools. Glycated hemoglobin levels evaluated glycemic control. We used simple slopes and Johnson–Neyman (J–N) analyses to probe significant interactions. Results: Stigma was negatively associated with mental well‐being and self‐management competency among adolescents with T1D. The association between stigma and glycemic control was only found in the preadolescence group (≤13 years). Intentional self‐regulation moderated the association of stigma with mental well‐being and self‐management competency. In short, the negative effect of stigma on mental well‐being and self‐management competency became nonsignificant in the context of high intentional self‐regulation. Conclusions: Stigma is associated with impaired mental well‐being and decreased self‐management competency among adolescents with T1D. This study highlights intentional self‐regulation as a potential mechanism linking stigma to negative psychological and behavioral outcomes and guides developing stigma‐reduction interventions.

Purpose: Pituitary adenoma and its treatments can significantly impact the social function of young and middleaged patients. Monitoring social functioning trajectories over time provides a more holistic understanding of patients' quality of life. We aimed to study the social functional trajectories and their predictors to achieve individualized and comprehensive management. Methods: A longitudinal prospective survey was conducted from January 2021 to December 2022 in Nanjing, China. The convenience sampling method was adopted to recruit the patients with pituitary adenoma who underwent transsphenoidal surgery at the neurosurgery department in a tertiary-grade A hospital. The general information questionnaire, social disability screening scale and postoperative pituitary adenoma symptom distress scale were applied in different stages. Growth mixture modeling and the Logistic regression were utilized to identify the trajectory subgroups and their predictors of the social function. Results: Of 225 patients, 33 (14.67%) experienced "progressively recovered function", while 192 (85.33%) exhibited "persistently impaired social function". Factors associated with persistently impaired social function included fertility status (OR = 0.167, p = 0.001), visual loss (OR = 0.154, p = 0.012), and electrolyte disturbances at 6th month (OR = 0.047, p = 0.003). Conversely, patients with high monthly income (OR = 0.116, p = 0.000), good family support (OR = 3.890, p = 0.006), and preoperative headache (OR = 4.129, p = 0.006) were more likely to show progressively recovered function after surgery. Conclusions: Patients with pituitary adenoma still experience social dysfunction six months after surgery. Fertility status, family support, economic status, and symptom distress were significant predictors. This study emphasizes the crucial role of symptom distress and family support, providing a basis for follow-up and intervention strategies.

BACKGROUND:Work engagement is vitally crucial in nursing practice. While hindrance-challenge stress significantly influence work engagement across many professions, their specific effects and underlying mechanisms in nursing remain unclear. AIMS:To investigate how hindrance-challenge stress affect nurses' work engagement, examining the mediating role of self-regulatory fatigue and the moderating role of self-compassion. METHODS:A cross-sectional online survey was conducted among 559 nurses in a public tertiary medical center in Nanjing, China. Standardized measures for hindrance-challenge stress, self-regulatory fatigue, work engagement, and self-compassion were employed, and a moderated mediation model was tested via the PROCESS macro in SPSS software (v22.0). RESULTS:Hindrance stress reduced work engagement both directly and indirectly via self-regulatory fatigue. Challenge stress influenced work engagement only indirectly through self-regulatory fatigue. Self-compassion moderated the direct effect of hindrance stress, weakening its negative impact on work engagement among nurses with high self-compassion. CONCLUSIONS:Hindrance and challenge stress diminish nurses' work engagement through self-regulatory fatigue, with self-compassion mitigating the direct detrimental impact of hindrance stress. IMPLICATIONS FOR NURSING MANAGEMENT:Nursing leaders can enhance nurses' work engagement by mitigating hindrance-challenge stress and alleviating self-regulatory fatigue. This may be achieved through improved working conditions, optimized workload allocation, and the provision of robust organizational support resources. Furthermore, fostering self-compassion is essential, as it serves to buffer the detrimental effects of hindrance stress on engagement. Nurse managers are encouraged to implement interventions such as compassion-focused therapy or mindful self-compassion training to help maintain nurses' engagement in high-demand clinical environments.

Objective:This study aimed to explore the stable longitudinal patient-centered self-protective factors of glycosylated hemoglobin (HbA1c) in adolescents with type 1 diabetes mellitus (T1DM). Methods:We used both cross-sectional and longitudinal datasets at the Diabetes Education Center and National Endocrine and Metabolism Centre of a university hospital in China from April 2020 to July 2022. Participants were assessed using the Adolescent Diabetic Behavior Rating Scale (DBRS), Diabetes Strengths and Resilience Measure for Adolescents (DSTAR-Teen). HbA1c and other clinical variables were obtained from the medical record at the same time. 266 adolescents (131 male, age 14.1±3.9 years) completed the cross-sectional assessments and 131 (62 male, age 14.6±3.3 years) participated in a follow-up at a 1-year visit interval. Results:Logistic regression analysis of cross-sectional data of 266 cases showed that there were significant positive effects between pump treatment (β=0.090, OR 2.460, P=0.005), DBRS scores (β=2.593, OR 13.366, P=0.002) and the meeting of standard HbA1c (<7.5%, 58 mmol/mol). Disease duration (β=-0.071, OR 0.932, P=0.033) was negatively correlated with it. The longitudinal multivariate generalized estimation equation model showed that DBRS scores (β=3.165, OR 23.681, P=0.009) and DSTAR-Teen scores (β=0.050, OR 1.051, P=0.012) had a positive influence on the meeting of standard HbA1c over one year time of 131 cases. Conclusion:Self-care and resilience had higher cross-temporal stability in influencing glycemic control over time. To reach a better glycemic control and improve long-term health outcomes, attention should be paid to the detection and enhancement of these patient-centered promoters.

AIM:To investigate whether resilience mediates the connection between caregiver burden and hope among caregivers of patients with inflammatory bowel disease (IBD). DESIGN:A cross-sectional study. METHODS:Two hundred patients with IBD were conveniently sampled from two tertiary hospitals in Jiangsu Province, China. The main instruments involved the Zarit Burden Interview, the 10-item Connor-Davidson resilience scale, and the Herth Hope Index. We conducted descriptive analysis and Pearson correlations using SPSS 25.0. The PROCESS v3.3 macro analysed the mediating effect. We report the results in line with the STROBE checklist. RESULTS:Caregiver burden was significantly negatively connected with hope and resilience, whereas resilience positively correlated with hope. The mediation role of resilience was significant in the relationship between caregiver burden and hope, with mediating effects accounting for 47.86% of the overall effect. CONCLUSIONS:Resilience partially mediates the association between caregiver burden and hope among patients with IBD. This finding highlights the protective role of resilience in undermining caregiver burden and strengthening hope. IMPLICATIONS FOR PRACTICE:In clinical practice, healthcare providers should perform routine psychological assessments for caregivers of patients with IBD. Furthermore, resilience training should be incorporated into interventions to alleviate caregiver burden and enhance hope. PATIENT OR PUBLIC CONTRIBUTION:None.

Background Despite previous research on the association between diabetes distress and disordered eating behaviors (DEBs) among youth with type 1 diabetes (T1D), there is a lack of understanding regarding the underlying mechanisms. This study aimed to investigate the relationships between diabetes distress and DEBs, specifically examining whether self-regulatory fatigue mediated the relationship and whether resilience moderated this mediation. Methods A cross-sectional study was performed among youth with T1D recruited from two diabetes centers in Nanjing, China. Measurement instruments included the problem areas in the diabetes-5 scale, the diabetes strengths and resilience measure for adolescents, the self-regulatory fatigue scale, and the Chinese version of diabetes eating problem survey-revised. Mediation and moderated mediation analyses were conducted. Results A total of 185 youths with T1D were involved in the current study. The results indicated that diabetes distress positively predicted DEBs. Self-regulatory fatigue partially mediated the association between diabetes distress and DEBs, accounting for 50.88% of the overall effect. Additionally, the pathway from self-regulatory fatigue to DEBs was moderated by resilience. Conclusion The current study examined whether self-regulatory fatigue mediated the relationship between diabetes distress and DEBs and whether resilience moderated the connection between self-regulatory fatigue and DEBs. These findings add to the theoretical basis of how diabetes distress influences DEBs and help guide the incorporation of diabetes distress, self-regulatory fatigue, and resilience into DEBs reduction programs for youth with T1D.

目的 调查青少年1型糖尿病患者饮食行为紊乱现状并分析其影响因素.方法 便利选取于2021年12月—2022年9月在南京市某三级甲等医院复诊的187例青少年1型糖尿病患者作为调查对象,使用一般资料调查表、修订版糖尿病饮食行为紊乱量表、糖尿病相关问题量表-5、青少年糖尿病优势与韧性量表、青少年自我控制双系统量表进行调查,了解其饮食行为紊乱现状,并采用多元线性回归分析相关影响因素.结果 回收有效问卷174份.青少年1型糖尿病患者饮食行为紊乱得分为(21.25±10.93)分,饮食行为紊乱发生率为54.60％.多元线性回归分析结果显示,性别、BMI、心理痛苦、心理韧性和自我控制能力是饮食行为紊乱的影响因素.结论 青少年1型糖尿病患者饮食行为紊乱处于较高水平.医护人员应定期评估患者的饮食行为,尤其是女性、肥胖或超重患者,通过纠正其病态的体型认知、增强其控制疾病的信心,帮助其积极应对压力,减少负性情感体验,进而降低饮食行为紊乱的发生率.

Objective:To investigate the impact of phototherapy on lipohypertrophy (LH) induced by insulin injections.Methods:Ninety-nine diabetes patients with LH who were admitted to the Endocrinology Department of the First Affiliated Hospital of Nanjing Medical University between April 2021 and February 2022 were selected as the study subjects. The length, width, and depth of each LH were measured, and the maximum LH, total LH, and average LH of the long, wide, and deep diameters were collected for all patients. SPSS 26.0 software was used to randomly allocate the subjects to the experimental group (50 cases) and the control group (49 cases). The control group received routine nursing care and avoided insulin injections at the LH site, while the experimental group received phototherapy based on the control group measures, twice a day, for 20 minutes each time for each LH site. Two independent sample t-tests, Mann-Whitney U tests, paired t-tests, and Wilcoxon signed-rank tests were used to compare the intergroup and intragroup differences in the length, depth, and width of the maximal LH, total LH, and average LH in the two groups before and after intervention. Results:There were 3 patients lost to follow-up in the experimental group and 2 patients in the control group, respectively, and 47 patients were included in both groups. After intervention, the length, depth, and width of the maximum LH, total LH, and average LH were all smaller in both the experimental and control groups than before intervention (all P<0.05). After intervention, the depth of the maximum LH and average LH were smaller in the experimental group than in the control group (both P<0.05). Compared with the control group, the percentage changes in the length and depth of the maximum LH, the length, depth, and width of total LH, and the length, depth, and width of average LH before and after intervention were greater in the experimental group (all P<0.05). Conclusions:Avoiding insulin injections at the LH site during hospitalization is beneficial for the regression of LH in diabetes patients. Phototherapy can further reduce LH by stopping insulin injection at the LH site.

Aims: To put forward a scientific hypothesis about the progression of insulin-injection-induced lipohypertrophy (LH) according to the high-frequency ultrasonic imaging of insulin injection sites and the blood glucose control of patients. Methods: A total of 344 patients were screened for LH by means of high-frequency ultrasound scanning. The results of their ultrasound examination were described in detail and categorized into several subtypes. Seventeen patients with different subtypes of LH were followed up to predict the progression of LH. To further verify our hypothesis, the effects of different types of LH on glycemic control of patients were observed by comparing glycated hemoglobin A1c (HbA1C) and other glycemic-related indicators. Results: LH was found in 255 (74.1%) patients. According to the high-frequency ultrasonic imaging characteristics, LH can be categorized into three subtypes in general. Among all the LHs, the most common type observed was nodular hyperechoic LH (n = 167, 65.5%), followed by diffuse hyperechoic LH (n = 70, 27.5%), then hypoechoic LH (n = 18, 7.0%). At the follow-up after six months, all 10 patients with nodular hyperechoic LH had LH faded away. Of the five patients with diffuse hyperechoic LH, two had inapparent LH, and three had diffuse hyperechoic parts which had shrunk under ultrasound. No obvious changes were observed in the two cases of hypoechoic LH. Compared with the LH-free group, the mean HbA1C of the nodular hyperechoic LH group increased by 0.8% (9 mmol/mol) (95% CI:−1.394~−0.168, p = 0.005), that of the diffuse hyperechoic LH group increased by 2.0% (21 mmol/mol) (95% CI: −2.696~−1.20, p < 0.001), and that of the hypoechoic LH group increased by 1.5% (16 mmol/mol) (95% CI: −2.689~−0.275, p = 0.007). Conclusions: It was hypothesized that the earlier stage of LH is nodular hyperechoic LH. If nodular LH is not found in time and the patient continues to inject insulin at the LH site and/or reuse needles, LH will develop into a diffuse type or, even worse, a hypoechoic one. Different subtypes of LH may represent differences in severity when blood glucose control is considered as an important resolution indicator. Further studies are needed to confirm our hypothesis on the progression and reversion of insulin-induced lipohypertrophy.

Objective:To investigate the ego-depletion level of adolescents with type 1 diabetes mellitus (T1DM) and to explore its association with glycemic control and quality of life.Methods:This was a cross-sectional survey study. A total of 195 adolescents with T1DM were recruited from the First Affiliated Hospital of Nanjing Medical University from March to September 2022 by convenient sampling method. The Self-Regulatory Fatigue Scale (SRF-S) and Short Form of the Chinese version Diabetes Quality of Life for Youth Scale (C-DQOLY-SF) and the general information questionnaire were collected and the glycated hemoglobin (HbA 1c) value was detected. Results:The total score of self-regulatory fatigue for 195 adolescents with T1DM was (42.23 ± 9.94) points, with a scoring rate of 52.79%, which was at a medium level. Pearson correlation analysis showed that the total score of self-regulatory fatigue was positively correlated with HbA1c ( r = 0.25, P<0.01), and negatively correlated with quality of life ( r = -0.61, P<0.01). The hierarchical linear regression results showed that after controlling for demographic sociolagy and disease variables, ego-depletion had a positive predictive effect on HbA1c ( t = 3.69, P<0.01), while ego-depletion had a negative predictive effect on Quality of life ( t = -8.48, P<0.01). Conclusions:Ego-depletion of adolescents with T1DM may affect their blood glucose control and quality of life, which should be noticed by medical workers.

Objective:This study aimed to investigate the effect of lipohypertrophy induced by insulin injection on blood glucose fluctuation in patients with type 1 diabetes mellitus.Methods:A total of 80 patients with type 1 diabetes mellitus were recruited between June 2021 and December 2021 from the First Affiliated Hospital of Nanjing Medical University. And these patients all received insulin injection more than six months. Lipohypertrophy was assessed by ultrasound scanning, and blood glucose fluctuation was evaluated using the flash glucose monitoring system(FGM). Univariate analysis and multivariate linear regression were used to analyze the relationship of lipohypertrophy and and core indicators of blood glucose fluctuation.Results:Compared with patients without lipohypertrophy, patients with lipohypertrophy had higher mean amplitude of glycemic excursions(MAGE), coefficient of variation(CV), mean of daily differences(MODD), standard deviation(SD) of blood glucose, time above range(TAR), and high blood glucose index(HBGI; all P<0.05), while time in range(TIR) of glucose markedly become lower( P<0.01). Moreover, multivariate linear regression analysis showed that lipohypertrophy detected by ultrasound was an independent influencing factor of TIR( β=-9.423, P=0.032), MAGE( β=1.114, P=0.039), CV( β=4.304, P=0.041), MODD( β=0.717, P=0.046) after adjusting for age at diagnosis, duration of insulin injection, fasting C-peptide, and daily dose of insulin per unit weight. Conclusion:Lipohypertrophy increases glycemic variability and imposes negative impact on glycemic control rate in patients type 1 diabetes mellitus.

OBJECTIVE The purpose of this study was to clarify the relationship between eHealth literacy, diabetic behavior rating, and caregiving burden among caregivers of children with type 1 diabetes mellitus (T1DM). METHODS A questionnaire-based cross-sectional study of 143 primary caregivers of T1DM was conducted. Electronic health literacy was quantified using the Chinese version of the eHealth Literacy Scale (eHEALS). Their diabetic management behavior rating and caregiving burden were measured by Diabetes Behavior Rating Scale-Parent Version (DBRS-P) and Zarit Burden Interview (ZBI), respectively. Pearson correlation analysis was used to estimate the relationship between the above variables. RESULTS Only 54 (37.76%) caregivers qualified by eHEALS scale, with a total score of 30.07 ± 4.54 out of 40. A positive correlation between DRBS-P scores and the scores of eHEALS (Pearson correlation coefficient r = 0.226, P = 0.007) and a negative correlation between ZBI and eHEALS scores (r = -0.166, P = 0.047) were observed. CONCLUSIONS The eHealth literacy level of caregivers of children with T1DM in China remains to be improved. Caregivers with higher eHealth literacy had better diabetic management behaviors and less caregiving burden. IMPLICATIONS TO PRACTICE This study suggests that hierarchical electronic health-based interventions should be designed according to the different levels of eHealth literacy of individuals, to enhance the ability of caregivers with different eHealth literacy levels to fully utilize eHealth resources to improve their daily disease management skills and reduce their burden when caring for T1DM children. In addition, improving eHealth literacy of caregivers for children with T1DM can be one of the important ways to enhance the effectiveness of electronic health-based programs designed for them.

背景 炎症性肠病(IBD)患者因疾病症状反复发作且迁延不愈易产生多种负性情绪.随着积极心理学的兴起,学者发现个体在患病过程中除了产生负性情绪,还会对压力性事件进行认知重评,探寻疾病给自身带来的积极意义,即疾病获益感.目的 探究IBD患者疾病获益感的潜在类别,并分析IBD患者疾病获益感的影响因素.方法 本研究为横断面研究,采用便利抽样法选取2020年9月至2021年4月在南京医科大学第一附属医院门诊就诊或住院的IBD患者为研究对象.使用一般资料调查表、修订版疾病获益感量表(BFS)、中文版伯克利情绪表达量表(BEQ)、社会支持评定量表(SSRS)进行调查.采用有序多分类Logistic回归分析探讨疾病获益感潜在类别的影响因素.结果 共回收问卷230份,有效问卷226份,有效回收率为98.3％.根据IBD患者疾病获益感的评估结果拟合潜在类别模型,最终得到IBD患者疾病获益感可分为3个类别,分别定义为低获益-应对无力组〔115例(50.9％)〕、中等获益组〔64例(28.3％)〕和高获益-感知被爱组〔47例(20.8％)〕.三组患者职业状态、家庭年收入、疾病活动度、中文版BEQ及各维度、SSRS及各维度得分比较,差异有统计学意义(P<0.05).有序多分类Logistic回归分析结果显示,正性情绪表达〔OR=1.246,95％CI(1.040,1.492)〕、负性情绪表达〔OR=1.206,95％CI(1.038,1.402)〕及主观支持〔OR=2.746,95％CI(2.114,3.565)〕是IBD患者疾病获益感的影响因素(P<0.05).结论 IBD患者疾病获益感存在明显的分类特征,其中低获益-应对无力组患者占比较大(50.9％),且患者疾病获益感的影响因素包括正性情绪表达、负性情绪表达和主观支持,因此需重点关注疾病获益感为低获益-应对无力的患者,鼓励其表达疾病相关感受并促进其对社会支持的感知,以提高患者的疾病获益感.