Objective To develop an interpretable machine learning model for predicting mortality risk in elderly intensive care unit (ICU) patients with type 2 diabetes mellitus (T2DM) and cerebral infarction,and to identify critical prognostic factors. Methods We extracted data of 514 elderly patients with T2DM and cerebral infarction from the Medical Information Mart for Intensive Care-Ⅳ database.The dataset was partitioned into training and test sets (7∶3 ratio) via scikit-learn.Within the training set,collinearity analysis was conducted,and features with variance inflation factor >5 were excluded.Lasso regression was further adopted to refine the feature selection.Six machine learning models-eXtreme Gradient Boosting (XGBoost),Logistic regression,LightGBM,AdaBoost,decision tree,and gradient boosting decision tree-were constructed and subjected to rigorous five-fold cross-validation.The optimal model was interpreted by SHAP analysis on the test set to determine the hierarchy of mortality-associated predictors and their nonlinear interactions. Results The XGBoost model demonstrated the best training performance and prediction generalization ability.The area under the curve for 30-day and 365-day mortality risk were 0.928 (95%CI=0.853-0.995) and 0.882 (95%CI=0.800-0.963),respectively.SHAP analysis revealed that the Oxford Acute Severity of Illness Score,length of hospital stay,congestive heart failure,length of ICU stay,peripheral capillary oxygen saturation,and heart rate were the top six predictive factors for 30-day mortality risk,while blood urea nitrogen,Oxford Acute Severity of Illness Score,peripheral capillary oxygen saturation,age,heart rate,and respiratory rate were the top six predictive factors for 365-day mortality risk. Conclusion The XGBoost model shows significant potential in predicting mortality risk in elderly ICU patients with T2DM and cerebral infarction,underscoring the importance of key clinical predictors.

BACKGROUND:As mobile health (mHealth) technologies become increasingly integrated into chronic disease management, understanding how mHealth literacy is associated with hypertension-related knowledge, attitudes, and practices (KAPs) is important. However, the psychosocial factors involved in this association remain unclear. This study aimed to examine the association between mHealth literacy and hypertension-related KAP among older adults with hypertension and to explore whether health empowerment and patient activation were involved in statistically significant indirect pathways. METHODS:A cross-sectional survey was conducted among 1500 community-dwelling older adults with hypertension in Hebei Province, China, between December 2024 and June 2025. Data were collected using the Problem-Based mHealth Literacy Scale, the Health Empowerment Scale for Elderly Patients with Chronic Disease, the Patient Activation Measure, and the Community Elderly Hypertension Patients Health Science Popularization Cognitive Scale. Partial correlation analyses were performed after controlling for sociodemographic covariates. An adjusted structural equation model was used to examine the hypothesized indirect pathway structure, and indirect effects were tested using bootstrapping with 5000 resamples. RESULTS:mHealth literacy was positively associated with hypertension-related KAP. The total effect of mHealth literacy on hypertension-related KAP was 0.399 (95% CI: 0.347-0.499), including a direct effect of 0.290 (95% CI: 0.238-0.341) and a total indirect effect of 0.108 (95% CI: 0.082-0.137). The indirect pathway through health empowerment was statistically significant and accounted for the largest proportion of the total effect (indirect effect = 0.079, 95% CI: 0.059-0.103). The indirect pathway through patient activation was also statistically significant (indirect effect = 0.019, 95% CI: 0.003-0.035), as was the sequential indirect pathway through health empowerment and patient activation (indirect effect = 0.010, 95% CI: 0.006-0.016). CONCLUSIONS:In this cross-sectional sample of older adults with hypertension, mHealth literacy was positively associated with hypertension-related KAP. The data were consistent with indirect associations involving health empowerment and patient activation, with the largest indirect association observed through health empowerment. These findings suggest that mHealth literacy and psychosocial self-management resources may both be relevant to hypertension-related KAP. Further longitudinal or intervention studies are needed to clarify the temporal and causal nature of these associations.

Housebound older adults residing in relatively isolated living environments for extended periods encounter a range of health and psychological challenges, stemming from limited mobility spaces and diminished social engagements. The fear of falling, a prevalent psychological issue among this demographic, is intricately linked not only to the actual risk of falling but also exerts a profound influence on their behavioral patterns and quality of life. This study aims to understand the current situation of fear of falling, i.e., FOF, among the Housebound older adults and analyze its influencing factors to provide a reference for formulating targeted nursing interventions. A cross-sectional survey was conducted from February to April 2025. FOF scores of 229 Housebound older adults individuals were estimated by analyzing their responses to a general questionnaire and the Fear of Falling Questionnaire-Reversed (FFQ-R). Participants’ total FOF score was estimated as (41.90±9.95), representing a medium-to-high level of fear of falling. The results of univariate analysis indicated statistically significant difference in the FOF scores of the participants with different characteristics, namely, gender, marital status, education level, smoking history, drinking history, chronic disease history, living style, and fall history (P< 0.05). The results of multiple linear regression analysis suggested that gender, smoking history, chronic disease history, living style, and fall history were independent factors affecting fear of falling among the Housebound older adults. Based on our results, we recommend that community nurses should pay special attention to Housebound older adults, especially those who are female, live alone, or have a history of smoking, chronic disease, or falls and implement targeted nursing interventions to allay fear of falling among the Housebound older adults.

AIMS:This study aims to explore the relationship between Life's Essential 8 (LE8) and aortic valve calcification (AVC). METHODS AND RESULTS:The study included 30 561 participants from the Kailuan cohort who completed the Kailuan Health examination and underwent contemporaneous ultrasound assessment. A multifactorial logistic regression analysis was used to assess the relationship between LE8 score and AVC, along with subgroup analyses and an analysis of the impact of each component of LE8 on AVC. Among the 30 561 participants, 3717 (12.16%) cases of AVC were detected, with a detection rate of 12.16%. The detection rate of AVC significantly decreased with increased LE8 score (P < 0.001). The presence of AVC was reduced by 34% in the moderate cardiovascular health (CVH) group [odds ratio (OR) = 0.66, 95% confidence interval (CI) 0.60-0.72] and by 63% in the high CVH group (OR = 0.37, 95% CI 0.27-0.50). For each standard deviation increase in the LE8 score, the presence of AVC decreased by 23% (OR = 0.77, 95% CI 0.74-0.80). Analysis of the individual components of LE8 revealed that diet, exercise, body mass index, blood lipids, blood glucose, and blood pressure were all associated with the reduced presence of AVC. In contrast, no impact of sleep and smoking on AVC presence was observed. CONCLUSION:The study indicates that a higher LE8 score was associated with lower the presence of AVC.

Purpose: To investigate the effects of an exercise intervention based on a healthy action process orientation model (Health Action Process Approach, [HAPA]) on muscle strength and body function in middle-aged and elderly patients with gastrointestinal tumors. Methods: A control group (52 patients) and an intervention group (52 patients) from the North China University of Science and Technology were selected. The control group received routine perioperative exercise instructions, whereas the intervention group received a perioperative exercise regimen for middle-aged and elderly patients with gastrointestinal tumor sarcopenia based on the HAPA. Differences in muscle strength and somatic function were compared between the two groups. Results: Fifty-two patients in the control group and 50 in the intervention group completed the study. No significant difference was observed between grip strength in the intervention group and time or interaction effects (P<0.05). Body function score (short physical performance battery) was not significantly different between groups, but the time effect was significant (P<0.05). No significant difference was observed in the psoas muscle index before (P>0.05) and after the intervention (P<0.001) in the control group. Conclusion: A perioperative exercise regimen based on the HAPA model could increase muscle strength and body function in middle-aged and elderly patients with gastrointestinal tumors and delay the progression of sarcopenia.

目的 探究老年人营养状况在肌肉衰减症与口腔健康之间的中介作用.方法 2021年8月至2022年2月,采用分层随机整群抽样法对唐山市某社区的468名老年人进行调查.采用一般情况调查表、微型营养评估量表(MNA-SF)、简明口腔健康检查量表(BOHSE)收集相关资料,根据亚洲肌肉衰减症工作组(AWGS 2019)诊断标准诊断肌肉衰减症.结果 468名老年人中肌肉衰减症患者150人,占32.1％,口腔健康状况差是老年人肌肉衰减症的危险因素(0R=1.538,95％CI:1.340～1.766);营养状况好是老年人肌肉衰减症的保护因素(OR=0.297,95％CI:0.226～0.391).营养状况在口腔健康得分和是否患肌肉衰减症之间存在中介效应,其产生的中介效应为0.014(95％CI:0.007～0.020),占总效应的74.05％.结论 营养状况和口腔健康状况是老年人肌肉衰减症的影响因素,并且营养状况在口腔健康和肌肉衰减症之间具有中介效应.

目的 基于倾向性评分匹配法(PSM)探讨老年认知障碍的患病影响因素.方法 以2018年"中国健康与养老追踪调查"(CHARLS 2018)数据为基础,采用简版社区痴呆筛查量表(CSI-D)评价老年认知障碍情况,运用PSM对老年认知障碍组和对照组进行1∶1匹配,将匹配前后个体特征进行比较,匹配后进行χ2检验,将χ2检验中有意义的变量(P<0.05)筛选出来作为自变量,以是否为老年认知障碍为因变量进行logistic回归分析.结果 将2081例老年认知障碍患者纳入认知障碍组,非老年认知障碍者3375例纳入对照组.2组在性别、年龄等方面有统计学差异(P<0.05).匹配后老年认知障碍组及对照组分别为1912例.2组在性别、年龄等方面无统计学差异(P>0.05).logistic回归分析结果显示,残疾(OR = 1.545,95%CI:1.267～1.883)、慢性病(OR = 1.171,95%CI:1.022～1.341)等为老年认知障碍的危险因素.而社交活动(OR = 0.781,95%CI:0.684～0.893)、工作和劳动(OR = 0.765,95%CI:0.623～0.939)等为老年认知障碍的保护因素.结论 老年认知障碍的影响因素较多,经PSM控制混杂影响因素后显示残疾、慢性病等因素影响老年认知障碍的发生,应从多方面进行预防和干预.

One of the leading causes of diabetes-related deaths is myocardial damage, which may be the cause of heart failure in people with type 2 diabetes mellitus. The objective of the research was to look at the impact of coronary failure with kind a pair of type 2 diabetes mellitus. This project aimed to explore the protective impact of oleanolic acid on myocardial damage in type 2 diabetes mellitus and to investigate the connected mechanism. Specific pathogen free grade db/db male mice were elected as model, while the Db/m mice were opted for control. Different doses of drug intervention were performed and the general condition, cardiac function, blood glucose, blood lipids, degree of myocardial injury, and degree of oxidative stress were examined by morphological examination of myocardial tissues, biochemical examination, and gene and protein amount detection. The results showed that lactate dehydrogenase, creatine kinase isoenzyme, total cholesterol, triglycerides and malondialdehyde levels in serum of Db/db mice were increased, while phosphatidylinositol 3 kinase, protein kinase B, glucose transporter 4 expression and superoxide dismutase level in myocardial tissue were decreased. After using oleanolic acid, the serum concentrations of lactate dehydrogenase, creatine kinase isoenzyme, total cholesterol, triglycerides and malondialdehyde were declined in Db/db mice, while phosphatidylinositol 3 kinase, protein kinase B, glucose transporter 4 expression and superoxide dismutase level were rised. The results recommend that oleanolic acid has protective impact on cardiac muscle injury in Db/db mice and conjointly the mechanism could also be correlated with promoting the activation of phosphatidylinositol 3 kinase/protein kinase B/glucose transporter 4 signal transduction.

To explore the factors affecting sarcopenia in older adults in the community. Physical activity, diabetes mellitus, age, marital status, nutrition and depression were important factors that have an impact on sarcopenia. Physical activity, diabetes mellitus, age, marital status, nutrition and depression were important factors that have an impact on sarcopenia. Research on sarcopenia has primarily focused on single fields such as physiology or psychology. However, there is a lack of clear evidence to determine the influence of social factors on sarcopenia. Therefore, our aim was to explore the multidimensional factors that contribute to sarcopenia in older adults within the community. In this retrospective case–control study, we applied the diagnostic criteria from The Asian Working Group on Sarcopenia (AWGS) 2019 to categorize study subjects into control and case groups. Our aim was to examine the impact of physical, psychological, and social factors on community-dwelling older adults with sarcopenia across multiple dimensions. We utilized descriptive statistics, as well as simple and multivariate logistic regression analyses, to analyze the data. We compared the odds ratios (OR) of the factors between the two groups and ranked the importance of the influencing factors using the XGBoost algorithm in Python software. Combined with multivariate analysis and XGBoost algorithm results, it can be seen that physical activity is the strongest predictor of sarcopenia [OR] = 0.922(95

目的 观察营养联合运动干预方法对脑卒中伴肌少症患者的疗效.方法 2022年1月至6月,华北理工大学附属医院住院的脑卒中伴肌少症患者60例,随机分为对照组、营养组、运动组和联合组,每组各15例.4组均予常规康复训练,营养组增加营养干预,运动组增加运动干预,联合组增加营养和运动干预,共4周.干预前后采用生物阻抗分析法评估肌肉指数,握力计测量健侧和患侧握力,采用改良Barthel指数(MBI)和Berg平衡量表(BBS)评定日常活动能力和平衡功能.结果 对照组4例、营养组2例、运动组1例、联合组3例脱落.干预后,各组肌肉指数、握力、MBI评分、BBS评分均提高(|t|>3.004,P<0.05),联合组各项指标优于其他3组(P<0.05),运动组健侧握力高于营养组(P<0.05).结论 联合应用营养和运动干预能有效提高脑卒中伴肌少症患者肌肉质量、握力、日常生活活动能力和平衡功能,联合应用效果更佳.

目的 探讨基于计划行为理论的干预对肌少症老年人肌肉衰减和平衡能力的效果.方法 2022年9月至2023年2月,便利抽取河北省石家庄市丽水湾社区和书香苑社区的124例肌少症老年人,抛硬币法将书香苑社区的62例老年人设为对照组,丽水湾社区的62例老年人设为干预组.干预组实施基于计划行为理论的干预,包括行为态度、行为、主观规范、知觉行为控制和行为意向5个方面;对照组保持原来的生活方式,共干预12周.干预前后比较两组握力、5次坐立试验时间、相对四肢骨骼肌指数(RASM)、6 m步速和Berg平衡量表(BBS)评分.结果 干预后,干预组握力、RASM、6 m步速和BBS评分显著提高,5次坐立试验时间显著缩短(|Z|>6.257,|t|>28.643,P<0.001),且均优于对照组(|Z|>2.288,|t|>3.177,P<0.05).结论 基于计划行为理论的干预可有效改善肌少症老年人的肌肉衰减,提高平衡能力.

目的 探讨志愿者参与的奥马哈系统干预对社区老年人失能风险的影响.方法 2022年3～9月,将120例社区老年人随机分为对照组、观察组和志愿者组.对照组为空白对照,观察组给予基于奥马哈系统的综合干预,志愿者组引入志愿者参与综合干预,共干预3个月.分别于干预前、干预3个月后采用奥马哈结局评价表、老年人失能风险评价量表、世界卫生组织生活质量测定简表评价干预效果.结果 干预后,志愿者组和观察组健康行为领域的各项 目得分均高于对照组,其中志愿者组营养、身体活动、个人照料得分更高(均P＜0.05);志愿者组和观察组的失能风险评价量表总分显著低于对照组(均P＜0.05);志愿者组和观察组生活质量得分显著高于对照组(P＜0.05).结论 志愿者参与基于奥马哈系统的综合干预,能够改善老年人的健康行为,降低老年人的失能风险,提高其生活质量.

目的:探讨奥塔戈运动训练对老年人跌倒恐惧及身体机能的影响。方法:选择迁安市吉庆社区和民和社区筛查出的79名有跌倒恐惧的老年人，采用居住地分组法随机分为干预组39人和对照组40人。干预组进行12周奥塔戈运动训练，每周3次，每次约30min，对照组采取空白对照。分别在干预前、干预12周后采用国际版跌倒效能量表、Berg平衡量表、计时起立-行走测试进行评估。结果:干预12周后两组老年人跌倒恐惧、平衡能力、移动能力比较差异均有统计学意义（P<0.05）。结论:奥塔戈运动训练能够减轻老年人跌倒恐惧水平，提高平衡能力和移动能力，改善身体机能。

目的 探讨老年人失能与相关影响因素间的关系,构建老年人失能风险的贝叶斯网络预测模型.方法 以2018 年中国健康与养老追踪调查(CHARLS)数据为基础,使用GeNIe2.3 软件制作贝叶斯网络拓扑结构构建老年人失能风险预测模型.根据贝叶斯网络推理,受试者工作特征(ROC)曲线线下面积(AUC)评价模型的预测效果.结果 最终共选取样本5 825 例,其中失能老年人 1 705 例,失能率为 29.3%.老年人失能风险贝叶斯网络预测模型含有 14 个节点、28 条有向边,由社会因素、压力因素、个人因素和功能性因素 4 部分组成,影响老年人失能的风险分别为 51%、60%、66%和 36%.老年人失能风险的贝叶斯网络预测模型中ROC AUC为 0.667.结论 老年人失能的影响因素较多,基于贝叶斯网络构建的失能预测模型能够直观描述老年人失能与影响因素间的复杂关系,且有较好的预测能力,可以为预防老年人失能提供参考.

目的 了解社区老年人衰弱与自我忽视的现状,并探讨二者之间的关系,旨在为预防老年人衰弱的发生及延缓衰弱进程提供依据.方法 采用多阶段整群抽样法,选取唐山市2个社区的995名社区老年人为研究对象,采用一般情况问卷、老年人自我忽视问卷及中文版Tilburg衰弱评估量表(TFI)进行调查.结果 被调查社区老年人的自我忽视总分为(7.51±4.01)分,衰弱总分为(4.86±3.09)分,衰弱发生率为47.14%;自我忽视总分与衰弱总分呈正相关(r=0.639,P<0.001).多因素分析显示,自我忽视、合并慢性病数量、婚姻状况、性别、文化水平是老年人衰弱的主要影响因素.结论 社区老年人衰弱发生率较高,老年衰弱与自我忽视有关,医护人员应重视高风险人群的早期识别,积极改善老年人自我忽视,以延缓其衰弱进程.

肌肉衰减症是临床一种常见的疾病,严重影响老年人的生活质量和健康结局.然而,通过有效干预及个体化管理,可预防、延迟、治疗甚至逆转肌肉衰减症.目前,运动干预是肌肉衰减症的重要干预手段.通过综述近年来肌肉衰减症运动干预的国内外研究进展,旨在为医护人员制订老年肌肉衰减症患者运动干预方案提供参考依据.

目的 调查社区老年人跌倒恐惧现况及影响因素.方法 于2021年9月-2022年7月在唐山市某社区选取522名老年人,使用国际版跌倒效能量表、Berg平衡量表、计时-起立行走测试进行问卷调查,采用单因素分析及多因素Logistic回归分析影响因素.结果 522例社区老年人中,跌倒恐惧的发生率为61.3％.二元Logistic回归分析显示,文化程度、运动锻炼次数、慢性病、是否使用辅助器具、近1年跌倒史、平衡能力、移动能力是社区老年人跌倒恐惧的影响因素.结论 社区老年人跌倒恐惧发生率较高,护理人员可重点关注文化程度低、缺乏锻炼、患有慢性病、使用辅助器具、近1年有跌倒史、平衡能力和移动能力低下的老年人,制定相关干预措施促进老年人参与活动和锻炼,缓解其跌倒恐惧.

OBJECT:To explore the factors related to health-promoting lifestyles of the elderly based on social-ecosystem theory. DESIGN:A cross-sectional survey study was carried out to include 627 elderly people in communities in three cities of Hebei Province (Shijiazhuang, Tangshan, and Zhangjiakou) from October 2021 to January 2022 for questionnaire survey (601 validly returned cases). VENUE:Three cities of Hebei Province (Shijiazhuang, Tangshan, and Zhangjiakou). PARTICIPANTS:627 elderly people. INTERVENTIONS:A cross-sectional survey study. MAIN MEASUREMENTS:The questionnaire survey was conducted by using the general demographic data, health promotion life scale, frailty scale, general self-efficacy scale, health engagement scale, General Self-Efficacy Scale, The family Adaptability, Partnership, Growth, Affection, and Resolve scale, and Perceived Social Support Scale. RESULTS:The total health promotion lifestyle score for the elderly was 100.20±16.21, which was at the lower limit of the good level, with the highest mean score for nutrition (2.71±0.51) and the lowest mean score for physical activity (2.25±0.56). Stepwise linear regression showed that exercise frequency (95% confidence interval (CI) 1.304-3.885), smoking status (95% CI -4.190 to -1.556), self-efficacy (95% CI 0.071-0.185), health management (95% CI 0.306-0.590), frailty (95% CI -3.327 to -1.162) in the microsystem, marital status (95% CI 0.677-3.660), children's attention to the elderly health (95% CI 4.866-11.305), family care in the mesosystem (95% CI 1.365-4.968), and pre-retirement occupation (95% CI 2.065-3.894), living area (95% CI 0.813-3.912), whether receive community-based chronic disease prevention and management services (95% CI 2.035-8.149), social support (95% CI 1.667-6.493) in the macrosystem were the main factors affecting health promotion of life in the elderly (P<0.05). Hierarchical regression analysis showed the microsystem accounted for 17.2%, the mesosystem accounted for 7.1%, and the macrosystem accounted for 11.4%. CONCLUSION:The health promotion lifestyle of the elderly in Hebei Province was at the lower limit of good level. Among them, exercise frequency, children's attention to the elderly health, and pre-retirement occupation played a major role in relation to the health-promoting lifestyle of the elderly. Hence, it needs the joint action of individuals, families, and society to promote the elderly to adopt the health promotion lifestyle and realize healthy aging.

目的:构建以健康社会决定因素理论为框架的老年人失能风险预测评估指标体系,为有效评估老年人的失能风险提供依据.方法:通过查阅相关文献,分析老年人失能风险因素,以健康社会决定因素理论为框架,形成指标条目池,运用德尔菲法形成老年人失能风险预测评估指标体系.结果:共进行了2轮专家咨询,问卷的有效回收率均为100％,专家权威系数分别为0.90和0.92,肯德尔协调系数分别为0.189和0.237(均P<0.05).最终形成了包含3项一级指标、9项二级指标、40项三级指标的老年人失能风险预测评估指标体系.结论:构建的老年人失能风险预测评估指标体系可靠、科学,可为社区医疗机构评估老年人的失能风险提供参考依据.

目的 探讨共病老年人健康素养现状及其影响因素,为制定提高共病老年人健康素养的应对措施提供参考依据.方法 于2020年8月-2021年1月选取翔云道办事处华北理工大学附属医院社区卫生服务中心所辖社区的351名共病老年人为研究对象,采用一般资料调查表、疾病相关资料调查表、健康素养量表进行问卷调查.结果 共病老年人健康素养总分为85.27±9.10分,88.6％的患者健康素养偏低.经过单因素筛选,多元线性回归分析显示,年龄、文化程度、医疗费用负担、主要照顾者、共病确诊年限是共病老年人健康素养的主要影响因素(P<0.05),其中主要照顾者的影响最大,其次是文化程度.结论 共病老年人健康素养状况较差,年龄小、文化程度高、医疗费用负担小、不需要照顾及共病患病时间较短的共病老年人健康素养相对较高.