While extreme heat represents an established risk factor for mortality in patients with diabetes mellitus (DM), its synergistic effects with air pollution and green space remain incompletely elucidated. This study aimed to investigate the joint effects of heatwaves, air pollution, and green space on all-cause mortality in older adults aged ≥ 45 years with diabetes mellitus. We conducted a longitudinal analysis of data from 1,400 adults aged ≥ 45 years with DM, drawn from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Heatwaves were defined according to six intensity-duration thresholds, based on two temperature thresholds (95th/97.5th percentiles of daily maximum temperature) and three duration criteria (≥ 2/≥3/≥4 consecutive days). Time-varying Cox proportional hazards models were used to estimate hazard ratios (HRs), with adjustments for individual PM₂.₅, NO₂ and greenness exposures as time-varying covariates. Multiplicative and additive interactions were evaluated using product terms and the relative excess risk due to interaction (RERI), complemented by the attributable proportion due to interaction (AP) and the synergy index (S). Heatwave exposure was significantly associated with increased mortality risk in a graded exposure-response relationship, with HRs increasing from 1.027 (95

Objective:This study aimed to explore the potential categories of resourcefulness in patients with type 2 diabetes mellitus (T2DM) and their relationship with self-management. Methods:A total of 513 hospitalized T2DM patients in Xi'an were surveyed using a general information questionnaire, the Resourcefulness Scale, and the Diabetes Self-management Activities Scale for Type 2 Diabetes. Latent profile analysis (LPA) was conducted to identify resourcefulness subgroups, and their relationship with self-management was examined. Results:Patients with type 2 diabetes could be classified into three potential categories based on their resourcefulness status: a low resourcefulness level group (17.54%), a moderate resourcefulness level-social alienation group (66.66%), and a high resourcefulness level group (15.78%). Educational level, monthly per capita family income, and the presence or absence of complications were identified as factors influencing the potential categories of resourcefulness. Significant differences were observed in the total self-management scores among patients belonging to different potential categories of resourcefulness (F = 68.33, p < 0.001). Conclusion:Type 2 diabetes patients can be classified into three potential categories of resourcefulness, with those in the high resourcefulness level group demonstrating higher self-management ability. Improving the level of resourcefulness can contribute to enhancing patients' self-management capabilities.

Mental health literacy (MHL), defined as an individual’s knowledge, beliefs, and resources related to mental health disorders, is crucial for mental health. However, there is a lack of research evidence on young soldiers’ levels of MHL. To address this gap, this study aimed to explore MHL profiles and associated factors among young Chinese male soldiers. A cross-sectional study with 1,561 young Chinese male soldiers was conducted from April to December 2024. The participants were surveyed using the Multicomponent Mental Health Literacy Measure, Perceived Stress Scale, Self-Rating Anxiety Scale, and Self-Rating Depression Scale. Latent profile analysis, chi-square tests, multiple logistic regression, one-way analysis of variance (ANOVA), and the Student-Newman-Keuls (SNK) test were conducted. Latent profile analysis revealed three profiles characterized by high (n = 870, 55.73

To evaluate the effects of the Physical ACtivity Enhancement Scheme (PACES) on the physical activity levels and well-being of hemodialysis patients. This is a single-blinded, two-arm, parallel-group, randomized controlled trial. Participants were recruited in September 2022 and randomly allocated to the intervention and control groups at a 1:1 ratio. The intervention group received a 3-month PACES intervention in addition to routine care, while the control group received only routine care. Baseline and post-intervention data were collected via electronic medical records and questionnaires. Daily step count was defined as the primary outcome, and other relevant indicators were set as secondary outcomes. A total of fifty-three participants completed the study. Regarding the primary outcome, the intervention group obtained significant improvements in daily step count compared with the control group after intervention. In terms of secondary outcomes, the intervention group also showed clear advantages in perceptions of exercise benefits and barriers, exercise self-efficacy, utilization of social support, the effect of kidney disease, the burden of kidney disease, the physical component summary, and the mental component summary. These findings suggest that the PACES intervention may improve physical activity level and other health-related outcomes among hemodialysis patients. Given the limitations of single-centre design and relatively small sample size, further multi-centre and large-scale studies are warranted to examine its potential generalizability. This intervention has potential clinical value for helping patients maintain health and improve overall well-being during dialysis treatment. ClinicalTrials.gov Identifier NCT05718765. Registered on 24 December 2022. Retrospectively registered.

ObjectiveThis pilot randomized controlled trial evaluated the feasibility and preliminary effects of a Coping-Focused Dyadic Family Resilience Intervention (CFFRI) for Chinese breast cancer survivor-caregiver dyads.MethodsA randomized, single-blind controlled trial was conducted. Sixty dyads were randomly assigned to the CFFRI group (six sessions plus usual care; n = 30) or the control group (usual care alone; n = 30). Outcomes included family resilience, coping style, family disease burden, and social support, assessed at baseline (T0), one-week post-intervention (T1), and three-month follow-up (T2). Data were analyzed using t-tests and generalized estimating equations (GEE). Feasibility was assessed via recruitment, retention, and adherence rates, and intervention satisfaction.ResultsFor the primary outcome, family resilience, the between-group mean difference at T1 was 20.08 (95% CI: 14.61–25.55) for patients and 19.85 (95% CI: 13.65–26.04) for caregivers in the per-protocol analysis, with effects sustained at T2 (patients: 14.69, 95% CI: 10.71–18.68; caregivers: 15.73, 95% CI: 11.08–20.38). Similar patterns were observed in intention-to-treat analyses. For secondary outcomes, the CFFRI group showed improvements in coping style, reduced family disease burden, and enhanced social support. Feasibility outcomes were favorable: recruitment rate 75.00%, retention rate 91.67%, high adherence rate 90.00%, and mean satisfaction score of 4.52 (SD = 0.57) out of 5.ConclusionThe CFFRI is a feasible intervention that shows promise in enhancing family resilience, improving dyadic coping, alleviating family disease burden, and strengthening social support for both patients and caregivers, with benefits sustained at 3 months. These preliminary findings provide support for its preliminary efficacy and form the basis for a future fully powered randomized controlled trial.Clinical trial registrationhttps://www.chictr.org.cn/showproj.html?proj=135318, identifier [ChiCTR2100052108].

Maintenance hemodialysis patients exhibit low physical activity, which is associated with sarcopenia, increased risk of cardiovascular events, and elevated all-cause mortality. Social support is an important resource for promoting healthy behaviors. But the mechanisms of influencing these patients’ intrinsic psychological processes to raise physical activity levels are unclear. This study was a cross-sectional observational study from September 2021 to February 2022, enrolling 460 hemodialysis patients from four tertiary hospitals in Xi’an City. We assessed social support, exercise self-efficacy, and exercise benefits and barriers perceptions with the Social Support Rating Scale (SSRS), the Self-Efficacy for Exercise Scale (SEE), and the Dialysis Patient-perceived Exercise Benefits and Barriers Scale (DPEBBS) respectively. Daily total step count was measured using an Omron electronic pedometer (model HJ-321) worn continuously for seven days. Descriptive statistics, Pearson correlation analysis, and chain mediation analysis using the PROCESS macro developed by Hayes (Model 6) were performed; the significance of mediation effects was tested via bootstrapping. Pearson correlation analysis revealed significant positive correlations among social support, exercise self-efficacy, perceived exercise benefits and barriers, and total daily steps (r = 0.289–0.507; all P < 0.01). Chain mediation model analysis indicated social support’s total effect on daily steps was 0.289. Specific mediation pathways included: (1) social support → exercise self-efficacy → total daily steps; (2) social support → perceived barriers to exercise benefits → total daily steps; (3) social support → exercise self-efficacy → perceived barriers to exercise benefits → total daily steps. Significant positive correlations were observed among social support, exercise self-efficacy, perceived exercise benefits and barriers, and total daily steps (all P < 0.01). Chain mediation analysis revealed that social support’s total effect on daily steps was 0.289 (95

Autoimmune skin diseases, such as bullous pemphigoid, pemphigus, lupus erythematosus, vitiligo, psoriasis, and atopic dermatitis, are chronic conditions driven by dysregulated immune responses. While emerging evidence suggests a potential role of food intakes in modulating these diseases through immune and inflammatory pathways, the causal relationships remain unclear due to limitations of observational studies. This study employed a 2-sample Mendelian randomization (MR) approach to evaluate the causal effects of 25 food intakes on the risk of autoimmune skin diseases, using genetic variants as instrumental variables. Exposure data were derived from the UK Biobank, and outcome data were obtained from the FinnGen Biobank. The inverse variance weighted method, complemented by MR-Egger, weighted median, and MR-PRESSO analyses, identified significant causal associations. After Bonferroni correction for multiple testing ( P < 4 × 10⁻⁴), no associations remained statistically significant. However, several nominally significant ( P < .05) associations were identified. Genetically predicted oily fish intake was inversely associated with bullous pemphigoid, and melon intake with lupus erythematosus. Cereal, milk, poultry, and salted nuts intake showed inverse associations with pemphigus. Tea and salted nuts intake were associated with reduced atopic dermatitis risk, while cheese, dried fruit, and salted nuts intake were associated with lower psoriasis risk. Conversely, alcohol and poultry intake were associated with increased psoriasis risk. No causal associations were observed for vitiligo. Sensitivity analyses (including MR-Egger intercept, Cochran Q test, MR-PRESSO, and leave-one-out analysis) supported the robustness and directionality of these nominally significant effects, with no evidence of directional pleiotropy. Multiple nominally significant associations were observed, suggesting potential protective roles for foods such as oily fish, nuts, fruits, and tea in specific autoimmune skin conditions, and a potential risk associated with alcohol consumption for psoriasis. These suggestive findings highlight the need for further investigation in larger cohorts to clarify the role of diet in the prevention and management of autoimmune skin conditions.

BACKGROUND:Physical activity levels in hemodialysis patients are low and continue to decline, increasing mortality risk. Intradialytic exercise improves hemodialysis patients' quality of life and enhances their physical and psychological health. But existing reviews fail to provide the best evidence for enhancing physical activity levels in this population. This study is to examine the efficacy and safety of intradialytic exercise for hemodialysis patients. METHODS:MEDLINE, Embase, the Cochrane Library, CINAHL, Web of Science, PubMed, Wan Fang data, and SinoMed were searched up to March 2025. The reference lists of eligible studies were systematically checked to ensure comprehensive coverage of the relevant literature. Two independent reviewers searched the databases, selected trials, conducted a bias assessment, and extracted the data. Meta-analysis was conducted using Review Manager version 5.4.1. RESULTS:Of the 3,880 studies that were screened, 23 studies involving 1,114 patients were identified. Three types of exercise, 7 exercise durations, and 4 exercise intensity standards were compared. Physical activity level, VO2 peak, muscle strength, and muscle mass were reported. Statistically, in terms of exercise type, combined aerobic and resistance exercise improved physical activity levels (SMD = 0.99, 95% CI: 0.44-1.55) and VO2 peak (SMD = 1.01, 95% CI: 0.56-1.46). Meanwhile, resistance exercise significantly improved muscle strength (SMD = 0.52, 95% CI: 0.24-0.81). In terms of exercise intensity, moderate exercise intensity significantly improved physical activity levels (SMD = 0.55, 95% CI: 0.22-0.88), VO2 peak (SMD = 0.59, 95% CI: 0.12-1.07), and muscle strength (SMD = 0.37, 95% CI: 0.11-0.63). Additionally, higher-intensity exercise also significantly improved muscle strength (SMD = 1.02, 95% CI: 0.51-1.53). As for exercise duration, programs lasting up to 3 months positively impacted physical activity levels (SMD = 0.65, 95% CI: 0.17-1.13) and VO2 peak (SMD = 0.70, 95% CI: 0.19-1.21). Furthermore, exercise extending up to 6 months significantly improved muscle strength in hemodialysis patients (SMD = 0.41, 95% CI: 0.18-0.64). CONCLUSION:Evidence shows that intradialytic exercise interventions improve physical activity levels, VO2 peak, and muscle strength in hemodialysis patients. Future clinical intervention studies could conduct direct comparisons of protocols with different exercise modalities, intensities, and durations.

Previous studies have demonstrated that individuals with inflammatory bowel disease (IBD) experience distinct symptom clusters and generally have a lower quality of life compared to the general population. Rumination refers to the persistent and repetitive contemplation of the causes, consequences, and intricate details of a negative and stressful event. The multiple symptom clusters of IBD cause great distress, physical and financial stress, and thus may increase the level of rumination in patients. However, the relationship between rumination, symptom clusters, and quality of life in IBD patients remains unclear. Therefore, the objective of this study was to assess the state of rumination and examine its association with symptom clusters and quality of life among individuals with IBD. This study found a significant positive correlation between rumination and symptom clusters, while a significant negative correlation between rumination and quality of life in IBD patients (p < .001). Patients with higher levels of rumination in IBD exhibited more severe symptoms and poorer quality of life. Reducing rumination levels may prove beneficial in alleviating symptoms and improving the quality of life for IBD patients. In daily nursing practice, timely evaluation of rumination and appropriate interventions are essential to achieve better therapeutic outcomes.

Background:Action observation combined with motor imagery (AO+MI) training is considered a potentially effective approach for improving motor function in patients after stroke. Therefore, it is important to review and analyze the existing research evidence of its effectiveness. Objective:This study aims to evaluate the effectiveness of AO+MI training on the limb motor function of patients with stroke. Methods:A systematic search was conducted in PubMed, Cochrane Library, Web of Science, Embase, Proquest, Physiotherapy Evidence Database, ClinicalTrials.gov, and ChiCTR. The last search was performed in June 2025. Three reviewers independently screened the articles, and 2 reviewers extracted data. Quality assessments of randomized controlled trials were done using the Cochrane Risk-of-Bias Tool. The certainty of evidence was evaluated with GRADEpro GDT (Evidence Prime, Inc). A meta-analysis was performed using RevMan 5.3 (The Cochrane Collaboration) software and Stata software. Results:A total of 13 articles were included with 399 patients with stroke. The results of the meta-analysis showed that compared with routine rehabilitation, AO+MI could improve the upper extremity function (standard mean difference [SMD]=1.02, 95% CI 0.28-1.75; P=.007) and the lower extremity function (SMD=6.31, 95% CI 4.75-7.87; P<.001) of patients with stroke. There was no significant difference between AO+MI and routine rehabilitation for improving activities of daily living (SMD=0.06, 95% Cl -0.35 to 0.47; P=.06). AO+MI could promote the recovery of upper extremity function in patients compared with MI independently (SMD=0.97, 95% Cl 0.13-1.80; P=.02). There was no significant difference between synchronous combination and asynchronous combination in upper extremity function rehabilitation of patients after stroke (SMD=-1.04, 95% Cl -2.56 to 0.48). Conclusions:AO+MI can improve the motor function of limbs and can be considered an effective limb rehabilitation therapy for patients after a stroke.

BackgroundA considerable proportion of older adults exhibit multiple modifiable health risk behaviors. Identifying not only the co-occurrence of health risk behaviors but, more importantly, their specific clustering patterns is essential for developing targeted multiple health behavior interventions.MethodsThe study sample comprised 12,766 participants from the 2018 wave of the CLHLS. Data on their health risk behaviors (inadequate sleep, insufficient fruit intake, insufficient vegetable intake, salty diet, smoking, drinking, and irregular exercise), basic demographic information, and health outcomes (self-rated quality of life scores and self-rated health status) were obtained. Analytical methods included descriptive statistics, Spearman correlation, binary logistic regression, Odds/Expected (O/E) ratios, and network community detection.ResultsThe median age of the participants was 84 (75, 93) years, with 5,891 (46.15%) males. A high prevalence (64.36%) of co-occurring health risk behaviors (≥2) was observed. There was a negative correlation between the number of co-occurring health risk behaviors and self-assessed quality of life (r = −0.173, p < 0.01), as well as self-assessed health level (r = −0.141, p < 0.01). Gender, age, years of education, residence, and economic status significantly influenced the co-occurrence of behaviors (all p < 0.01). Smoking and drinking (O/E = 2.67), insufficient fruit and vegetable intake (O/E = 1.60), and a salty diet and smoking (O/E = 1.32) demonstrated the most significant clustering risks. Two distinct clustering patterns were identified, which can be termed an Addiction Behavior Pattern and an Unhealthy Activity-Eating Pattern.ConclusionThe co-occurrence of health risk behaviors is prevalent and associated with adverse health outcomes. Behaviors exhibit a clustering effect and demonstrate distinct clustering patterns. Public health interventions should move beyond single-behavior approaches to develop integrated strategies that target these specific clustering patterns for more effective management of multiple health risks.

Academic self-efficacy is a critical predictor of academic success for nursing undergraduates. This study aimed to investigate the level of academic self-efficacy among nursing undergraduates and examine the mediating roles of resilience and learning attitude in the relationship between perceived stress and academic self-efficacy. A multicenter cross-sectional study was conducted among 260 nursing undergraduates from three universities in Shaanxi Province, China. Data were collected using the Perceived Stress Scale, Connor-Davidson Resilience Scale, Nursing Students' Learning Attitude Scale and Academic Self-Efficacy Scale. Chain mediation analysis was performed using SPSS PROCESS macro (Model 6) with 5,000 bootstrap samples. The score of academic self-efficacy of nursing undergraduates was 72.50 (66.00, 82.75). The mediation analysis showed that the chain mediating effect of resilience and learning attitude in the relationship between perceived stress and academic self-efficacy was significant (effect = -0.078, 95% CI [-0.235, -0.058]), accounting for 23.71% of the total effect. The indirect effect of perceived stress on academic self-efficacy through resilience was statistically significant (effect = -0.090, 95% CI [-0.313, -0.052]), while learning attitude alone did not mediate this relationship (effect = -0.041, 95% CI [-0.249, 0.039]). Findings suggest that resilience and learning attitude played a chain mediating role between perceived stress and academic self-efficacy among nursing undergraduates. Educators should prioritize resilience training and optimize the curriculum to foster students' positive learning attitudes, which helps students positively cope with stress and accomplish their academic goals.

Military personnel face more stresses and challenges, and they are at greater risk of insomnia compared to the general population. Mental health is one of the primary ways of managing insomnia. However, there are few studies regarding the mediator in the two variables among this population. This study aimed to investigate the insomnia, mental health literacy, and mental health in young soldiers, to explore the correlation of the three variables and to verify the mediating role of mental health literacy between mental health and insomnia. The cross-sectional study was conducted from March 2023 to March 2024. A total of 2375 soldiers was surveyed using the General Information Questionnaire, Insomnia Severity Index (ISI), 12-Item General Health Questionnaire (GHQ-12), and National Mental Health Literacy Questionnaire (NMHLQ). The data were processed using descriptive analysis, Mann-Whitney U test, Kruskal-Wallis H test, Spearman’s correlation analysis, stepwise regression analysis, and a mediation analysis. The questionnaire of 2297 participants was valid with an effective rate of 96.72

Objective: To explore the relationship between organizational identification, occupational stress, and insomnia among nurses and to analyze the moderating role of organizational identification between occupational stress and insomnia. Methods: Through stratified sampling, 720 nurses working in a tertiary A-level hospital in Shandong Province from March to May 2021 were surveyed using an effort-reward imbalance questionnaire, an organizational identification questionnaire, and the Athens Insomnia scale. Results: Organizational identification was negatively correlated with occupational stress and insomnia (r1 = -0.121, P1 < 0.01; r2 = -0.144, P2 < 0.01). Occupational stress was positively correlated with insomnia (r = 0.379, P < 0.01). Organizational identity significantly moderated nurses’ occupational stress and insomnia (β = -0.192, t = -2.558, P < 0.05). Conclusion: Occupational stress and organizational identification can predict insomnia. Organizational identification could negatively mediate the relationship between occupational stress and insomnia. Improving organizational identification may help alleviate insomnia symptoms by relieving occupational stress.

PurposeDepression considerably influences the clinical outcomes, treatment compliance, quality of life, and mortality of hemodialysis patients. Exercise plays a beneficial role in depressive patients, but its quantitative effects remain elusive. This study aimed to summarize the effects of exercise training on depression in patients with end-stage renal disease undergoing hemodialysis.MethodsThe PUBMED, EMBASE, and Cochrane Library databases were systematically searched from inception to April 2023 to identify published articles reporting the effect of exercise training on the depression level of patients with End-Stage Renal Disease undergoing hemodialysis. Data were extracted from the included studies using predefined data fields by two independent researchers. The Cochrane Handbook for Systematic Reviews of Interventions and Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies were employed for quality evaluation.ResultsA total of 22 studies enrolling 1,059 patients who participated in exercise interventions were included. Hemodialysis patients exhibited superior outcomes with intradialytic exercise (SMD = −0.80, 95% CI: −1.10 to −0.49) and lower levels of depression following aerobic exercise (SMD = −0.93, 95%CI: −1.32 to −0.55) compared to combined exercise (c − 0.85, 95% CI: −1.29 to −0.41) and resistance exercise (SMD = −0.40, 95%CI: −0.96 to 0.17). Regarding exercise duration, patients manifested lower depression levels when engaging in exercise activities for a duration exceeding 6 months (SMD = −0.92, 95% CI: −1.67 to −0.17). Concerning the duration of a single exercise session, the most significant improvement was noted when the exercise duration exceeded 60 min (SMD = −1.47, 95% CI: −1.87 to −1.06).ConclusionOur study determined that exercise can alleviate depression symptoms in hemodialysis patients. This study established the varying impacts of different exercise parameters on the reduction of depression levels in hemodialysis patients and is anticipated to lay a theoretical reference for clinicians and nurses to devise tailored exercise strategies for interventions in patients with depression.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database, with registration number CRD42023434181.

Bernhard Sehm1,2*Kristian Barlinn3Eduardo Candelario-Jalil4Krishna Kumar Veeravalli5Chunping Ni6Jun Yao7

BackgroundCoronary heart disease has a high incidence rate, a high mortality rate, a high recurrence rate, and a high medical cost. In addition, some patients need to undergo percutaneous coronary artery stent implantation (CASI), which is a kind of traumatic treatment. Patients can easily experience negative emotions such as anxiety and depression after surgery, which seriously affects quality of life.ObjectivesThe aim of this study was to evaluate the effectiveness of an empowerment-based telephone follow-up intervention on resilience and quality of life in patients who underwent CASI.DesignThe design of the study is a randomized controlled trial.MethodsA total of 92 patients were recruited after CASI from the Internal Medicine Cardiovascular Department of a Grade A tertiary hospital in Xi’an, China. The patients were randomly divided into a control group and an intervention group. The control group performed routine care, whereas the intervention group developed a telephone follow-up program based on empowerment theory while carrying out routine care. Patients were investigated using the coronary heart disease-related knowledge questionnaire, the Connor–Davidson Resilience Scale (CD-RISC), and the 36-Item Short-Form Health Survey (SF-36) to compare the effects of the intervention before and after 1 month of intervention.ResultsAfter a 1-month telephone follow-up intervention based on the empowerment theory for patients after CASI, the variations in knowledge related to coronary heart disease and all of its subscale scores were greater in the intervention group than in the control group. Except for the three dimensions of risk factor, induction factor, and rehabilitation-related knowledge, the variations in knowledge related to coronary heart disease and the other subscale scores were significantly different between the two groups (p < 0.05). The variations in resilience and scores on the three subscales in the intervention group were greater than those in the control group, and the difference between the two groups was statistically significant (p < 0.05). The variations in the quality of life and overall health, emotional functions, and social functions were significantly greater in the intervention group than in the control group (p < 0.05).ConclusionsA telephone follow-up intervention based on the empowerment theory can effectively improve the resilience and quality of life of patients after CASI. This follow-up approach can provide a theoretical basis and practical reference for hospitals and communities to carry out targeted continuing nursing for patients after CASI. The long-term effects of the intervention and its underlying mechanisms require further study.Clinical trial registrationhttp://www.chictr.org.cn/showproj.aspx?proj=173682, identifier ChiCTR2200064950.