Objective To investigate the effects of different types of assistive products (APs) on the association between activities of daily living (ADL) and social participation among rural older adults in China. Methods A cross-sectional study was conducted among 301 rural older adults in China using a questionnaire. Parallel mediation and moderation analyses were employed to explore how different APs influence older adults’ social participation. Results This study found that all surveyed types of APs were negatively associated with ADL. However, only mobility APs mediated the relationship between ADL and social participation, and demonstrated a suppression effect (β = -0.028, P<0.01). Furthermore, mobility APs exhibited a positive moderating effect on the relationship between ADL and social participation (β=0.021, P<0.01). Conclusions This study reveals a complex mechanism through which APs influence the relationship between ADL and social participation. Future targeted nursing interventions prioritizing mobility APs may effectively reduce social participation disparities in rural aging populations

BACKGROUND:Global aging and rising severe illnesses prevalence have increased demand for palliative care, widening service gaps. Policy support is vital for advancing high-value services. AIM:To unveil the 35-year evolution of palliative care policy in mainland China. DESIGN:An in-depth analysis of the external and internal characteristics of palliative care policy documents. Developmental periods were delineated using core characteristics, key events, and annual releases. Network analysis mapped intersectoral collaboration in palliative care policy-making. Text mining techniques, including burst words and word frequency analysis, identified policy priorities and inclinations. Policy instruments were classified using Rothwell and Zegveld's framework to analyze the policy landscape and its evolution. SETTING/PARTICIPANTS:Palliative care policies, the research subject of this study, were retrieved from Chinese legal databases and government websites. RESULTS:Policy evolution spanned five periods: germination (1991-2002), exploration (2003-2010), expansion (2011-2015), rapid development (2016-2019), and stable development (2020-2023). Intersectoral collaboration among policymakers evolved from single-department regulation to multi-sectoral governance, with the National Health Commission serving as the pivotal entity. Policy priorities and inclinations reflected the unification of policy terminology, the establishment of an institution-community-home continuum, and the active incorporation of local elements. Policy instruments transitioned from imbalance to greater balance over time, although several sub-instruments remained underutilized. CONCLUSIONS:Mainland China has established a comprehensive palliative care policy framework with distinctive features, with development particularly accelerating after 2016. Nonetheless, gaps persist in dedicated legislation or planning, financially sustainable funding strategies, integration into health professional education, and supportive digital infrastructure. Future efforts should prioritize the transition from framework-building to ensuring equitable access.

Pressure ulcers (PUs) pose a significant challenge in the care of bedridden patients, to which automated tilt nursing beds have emerged as a promising solution. However, the lack of effective models to elucidate the mechanical responses of deep tissue during assisted repositioning and identify the optimal tilt angle has hindered the implementation of effective automatic assisted repositioning systems for long-term care patients. Therefore, this study developed a novel computational model that integrates the buttocks with a support mattress to simulate automatic assisted repositioning, thereby analyzing deep tissue responses and optimizing tilt angles for effective load offloading. Inverse modeling was used to reconstruct the 3D shape of the buttocks, nodal equivalence techniques were employed to simplify the mesh and accurately represent internal tissue contacts, and soft tissue parameters were optimized using Response Surface Methodology (RSM). Finally, finite element (FE) analysis was conducted to evaluate the biomechanical responses and optimize the repositioning strategies. Model validation demonstrated a deformation error of $6.93~\pm ~7.41$ mm (mean ± standard deviation) and interface pressure differences within 22.4%, demonstrating the efficacy and bio-fidelity of the system. Repositioning simulations at angles from 0° to 30° showed a 20% reduction in total soft tissue strain, with peak equivalent stress decreasing by 22.27% at the mattress- to-buttock interface and by 20.43% at the muscle-to-adipose tissue interface. These simulations suggest that a 30° turning angle is beneficial for alleviating pressure concentration, which may inspire the design and optimization of automatic assisted repositioning strategies in rehabilitation practices.

Aim: To explore the job demands of healthcare workers (HCWs) working in mobile cabin hospitals in Shanghai and identify the influencing factors. Design: The study had a cross-sectional design.Methods: Using the convenience sampling method, we selected 1223 HCWs (medical team members) working in these mobile cabin hospitals during April- May 2022. The findings of the general information questionnaire and the hierarchy scale of job demands of HCWs working in mobile cabin hospitals were used for the investigation.Results: The total score of job demands of the included HCWs was 132.26 +/- 9.53; the average score of the items was 4.73 +/- 0.34. Multivariate linear regression analyses showed that the following HCWs had significantly higher job demands: female HCWs and HCWs who received psychological training or intervention during the COVID- 19 pandemic, were satisfied with the doctor/nurse- patient relationship, received support from family members/friends/colleagues, believed that the risk of working in mobile cabin hospitals was high, had adapted to the working environment of mobile cabin hospitals and had college/undergraduate level of education. They would benefit from increased social support and better training in terms of psychological coping mechanisms(both theoretical knowledge and applicable skills) and COVID- 19 prevention,control and treatment abilities.

Objective To explore the usage intention of intelligent assistive devices among the elderly institution residents, so as to provide references for promoting and applying intelligent assistive devices.Methods A descriptive qualitative study was conducted.Purposive sampling was used to select 18 senior citizens for semi-structured interviews from three care institutions in Chongqing City.The content analysis method was applied for analyzing the interview data.Results Five themes and nine sub-themes were extracted, including expectations of performance（promoting self-care, solving care problems, meeting personalized needs）,influences from outside（government guidance, media publicity, acquaintance introduction）,contributing factors（institutional and environmental support, sound management system, professional resource support）,low self-efficacy, and perceived risks.Conclusions Although most senior citizens believe that intelligent assistive devices are beneficial to themselves, their intention to use them is influenced by many factors.Targeted countermeasures are put forward after comprehensive analysis in this study, so as to promote the application of intelligent assistive devices in care institutions.

ObjectiveSocial participation has become a policy framework to address population aging. However, little is known about the social participation of older adults in western China, and extensive, multicenter, regional research is lacking. This research investigated the profiles of social participation of older adults in western China and explored the characteristics and factors influencing social participation.MethodThis cross-sectional study was conducted in 3 provinces (Chongqing, Sichuan, and Inner Mongolia) in western China from March 2021 to December 2021 and included 3,456 participants aged 60 years or older. Social participation was assessed using the Chinese version of the Impact on Participation and Autonomy Questionnaire (IPA). Latent profile analysis (LPA) was performed to extract latent classes of social participation among older adults in western China. The chi-square test and multinomial regression analyses were used to identify differences between these classes.ResultsThree social participation classes were identified by LPA: high social participation (25.2%), moderate social participation (55.1%), and low social participation (19.7%). Being older, having a primary school education level, having mobility or speaking impairment, using assistive devices, and having a chronic disease were highly associated with the low social participation class (P < 0.05). Furthermore, older adults with no dependence (OR = 0.018, 95% CI = 0.005–0.062) or mild dependence (OR = 0.039, 95% CI = 0.011–0.139) in activities of daily living (ADLs) were less likely to be in the low social participation class. Older adults who were cared for by non-spouse primary caregivers were more likely to be assigned to the moderate social participation group (OR = 2.097, 95% CI = 1.501–2.930) than to the high social participation group.ConclusionsMost older adults in western China have a moderate level of social participation. Advanced age, reduced ADL ability, reduced speech ability, reduced mobility, and non-spouse care are related to the level of social participation. Healthcare professionals should pay attention to the predictors for different classes, identifying high-risk groups as early as possible.

目的 探讨养老机构老年人社会活动参与障碍因素,为制定干预措施提供依据.方法 采用质性研究,于2021年4-8月经目的抽样选取重庆市两所养老机构的11名老年人为研究对象,通过半结构式访谈收集资料,以国际功能、残疾和健康分类为框架,定向内容分析法进行分析.结果 养老机构老年人参与障碍可归纳为3个主题,6个亚主题:环境因素(居住环境流动限制,区域活动差异),个人因素(身体功能障碍,保持原有习惯),活动因素(活动组织者的能力,活动资源不足).结论 养老机构老年人社会活动参与有待拓展、参与过程存在阻碍;养老机构应重视机构老人的社会活动参与情况,开展个性化干预,促进活动参与.

目的 了解全膀胱切除术后患者康复阶段支持性照护需求现状及影响因素,为针对性干预提供参考.方法 采用 自制全膀胱切除术后患者支持照护需求量表,对238例全膀胱切除术后患者术后1周、1个月及6个月进行调查与分析.结果 患者术后1周、1个月及6个月支持性照护需求得分依次为94.09±5.21、92.82±4.79、90.78±5.14,3个时间点得分比较,差异有统计学意义(P＜0.05).多元回归分析显示,家庭人均月收入、年龄、居住地及合并慢性病是患者支持性照护需求的主要影响因素(均P＜0.05).结论 全膀胱切除术后患者支持性照护需求随时间延长呈下降趋势;医护人员应针对收入较低、身体状况较差及信息获取不便的患者给予相关支持与知识技能指导,以满足不同类别患者需求,从而全面提高患者术后生活质量.

目的 了解养老机构老年人社会参与现状,分析其影响因素.方法 采用方便抽样法,选取重庆市243名养老机构老年人,采用一般资料调查表、Barthel指数评定表、中文版自主参与测评问卷、社会支持评定量表、老化态度问卷进行横断面调查.结果 养老机构老年人社会参与得分为(31.70±15.52)分;多元线性回归显示,自理能力、老化态度、经济状况、客观社会支持是养老机构老年人社会参与的影响因素(均P＜0.01).结论 养老机构老年人社会参与水平仍有提升空间,养老机构应重视其社会参与状况,制订针对性干预措施,以提高机构老人的社会参与水平.

Abstract Background: Frailty has been described as the most problematic expression in the context of considerable aging progression. Moreover, frailty-associated disability severely affects individuals and the society. Evidence has suggested that assistive devices (ADs) usage can slow functional decline, improve dependency and well-being with aging. Considering there is a paucity of published evidence on elderly assistive aids for the management of frailty, the present study aimed to shed light on the potential mediating effect of assistive devices usage on the frailty through the relationship between frailty and disability, and provide a theoretical basis for a health behavior intervention for frailty. Methods: Convenience sampling method was used to select 335 older adults aged over 60 years using the FRAIL scale and the Barthel index for Activities of Daily living (ADL). Pearson’s r correlations were used to examine the association between the frailty, disability and assistive devices use and structural equation modelling (SEM) was to test a hypothetical mediation model. Results: Of the 335 sample aged 60 or older, the participants’ mean age was 70.8 years old (SD = 6.6), mean scores of frailty and ADL disability was 2.71 (SD = 1.3) and 50.39 (SD = 24.5), respectively. Merely 21.8% of the participants were using ADs. Pearson’s ranalsysi demonstrated that ADL disability and ADs use were significantly correlated with frailty. Lastly, ADs use mediated the relationship between frailty and disability. Conclusions: This study demonstrates that ADs usage may potentially serve as a tool for frailty management by mediating the association between frailty and disability. However, at present, ADs usage rate is rather low at the context of amounting rates of frailty. Therefore, the routine assessment of frailty and prescription of elderly assistive products are crucial when designing and implementing health promotion programme for elderly persons.

BACKGROUND With the aging world population, the incidence of falls has intensified and fall-related hospitalization costs are increasing. Falls are one type of event studied in the health economics of patient safety, and many developed countries have conducted such research on fall-related hospitalization costs. However, China, a developing country, still lacks large-scale studies in this area. AIM To investigate the factors related to the hospitalization costs of fall-related injuries in elderly inpatients and establish factor-based, cost-related groupings. METHODS A retrospective study was conducted. Patient information and cost data for elderly inpatients (age ≥ 60 years, n = 3362) who were hospitalized between 2016 and 2019 due to falls was collected from the medical record systems of two grade-A tertiary hospitals in China. Quantile regression (QR) analysis was used to identify the factors related to fall-related hospitalization costs. A decision tree model based on the chi-squared automatic interaction detector algorithm for hospitalization cost grouping was built by setting the factors in the regression results as separation nodes. RESULTS The total hospitalization cost of fall-related injuries in the included elderly patients was 180479203.03 RMB, and the reimbursement rate of medical benefit funds was 51.0% (92039709.52 RMB/180479203.03 RMB). The medical material costs were the highest component of the total hospitalization cost, followed (in order) by drug costs, test costs, treatment costs, integrated medical service costs and blood transfusion costs The QR results showed that patient age, gender, length of hospital stay, payment method, wound position, wound type, operation times and operation type significantly influenced the inpatient cost (P < 0.05). The cost grouping model was established based on the QR results, and age, length of stay, operation type, wound position and wound type were the most important influencing factors in the model. Furthermore, the cost of each combination varied significantly. CONCLUSION Our grouping model of hospitalization costs clearly reflected the key factors affecting hospitalization costs and can be used to strengthen the reasonable control of these costs.

OBJECTIVE:This study aims to develop and validate a CT-based radiomics nomogram integrated with clinic-radiological factors for preoperatively differentiating high-grade from low-grade clear cell renal cell carcinomas (CCRCCs).METHODS:370 patients with complete clinical, pathological, and CT image data were enrolled in this retrospective study, and were randomly divided into training and testing sets with a 7:3 ratio. Radiomics features were extracted from nephrographic phase (NP) contrast-enhanced images, and then a radiomics model was constructed by the selected radiomics features using a multivariable logistic regression combined with the most suitable feature selection algorithm determined by the comparison among least absolute shrinkage and selection operator (LASSO), recursive feature elimination (RFE) and ReliefF. A clinical model was established using clinical and radiological features. A radiomics nomogram was constructed by integrating the radiomics signature and independent clinic-radiological features. Performance of these three models was assessed using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA).RESULTS:Using multivariate logistic regression analysis, three clinic-radiological features including intratumoral necrosis (OR=3.00, 95% CI=1.30-6.90, p=0.049), intratumoral angiogenesis (OR=3.28, 95% CI=1.22-8.78, p=0.018), and perinephric metastasis (OR=2.90, 95% CI=1.03-8.17, p=0.044) were found to be independent predictors of WHO/ISUP grade in CCRCC. Incorporating the above clinic-radiological predictors and radiomics signature constructed by LASSO, a CT-based radiomics nomogram was developed, and presented better predictive performance than clinic-radiological model and radiomics signature model, with an AUC of 0.891 (95% CI=0.832-0.962) and 0.843 (95% CI=0.718-0.975) in the training and testing sets, respectively. DCA indicated that the nomogram has potential clinical usefulness.CONCLUSION:The CT-based radiomics nomogram is a promising tool to predict WHO/ISUP grade of CCRCC preoperatively and noninvasively.