Purpose Nasopharyngeal carcinoma (NPC) imposes significant psychosocial challenges on patients and their spouses, yet dyadic coping (DC) patterns and their determinants remain underexplored. This study aimed to assess DC levels and classify latent coping profiles among Chinese NPC patient-spouse dyads, and to identify factors associated with profile membership. Methods A cross-sectional study recruited 223 NPC patient-spouse dyads in Guangzhou, China, from September 2022 to May 2023. Participants completed the Dyadic Coping Inventory, the Perceived Stress Scale, and the General Self-Efficacy Scale. Latent profile analysis was performed using Mplus 8.3. Hierarchical multinomial logistic regression with the Balanced group as reference was conducted to determine factors associated with profiles. Results Three DC profiles were identified: Strained group (23.7%), Balanced group (65.5%), and Harmony group (10.8%). In Model 1, which excluded psychological factors, education level, intimate relationship quality, and source of income were significantly associated with profile membership. After adding psychological variables in Model 2, Strained group membership was associated with higher patient perceived stress, lower spouse self-efficacy, and poorer intimate relationship quality. Harmony group membership was associated with higher patient self-efficacy, higher patient perceived stress, and cancer stage. Conclusions These findings reveal the heterogeneity of DC patterns in Chinese NPC couples. Spouse self-efficacy protects against coping deterioration, while patient self-efficacy drives optimal harmony. Tailored interventions addressing gender-specific caregiving burdens and self-efficacy enhancement may improve dyadic coping in NPC populations.

Background Long-acting injectable antipsychotics (LAIs) have proven more effective for treating patients with schizophrenia than oral formulations. However, the use of LAIs in China remains low and this phenomenon is still under-researched. This study endeavors to provide a better understanding by systematically amalgamating the difficulties and barriers encountered by patients with schizophrenia in China when accessing LAIs from a process-oriented perspective, thereby making a significant contribution to filling the critical void in the existing literature.Methods Schizophrenia patients receiving rehabilitation services at community mental health rehabilitation centres in Guangzhou, China, were sampled using a convenience sampling method. Semi-structured qualitative interviews were conducted to explore participants' attitudes and experiences with LAIs treatment, and data were coded and analysed using thematic analysis.Results Between December 18, 2023, and April 23, 2024, 88 participants were recruited, including 33 patients, 33 primary caregivers, 11 community psychiatric management physicians (CPMPs), and 11 psychiatrists. Four major themes emerged from the study: (1) poorly coordinated organisational structures; (2) negative perceptions of patients regarding LAIs; (3) cautious and concern-ridden enrolment decisions; (4) unclear medication side effects. Serving as the foundation of the entire process, the poorly coordinated organisational structures described in Theme 1 provide the context for subsequent themes, which further identify specific process barriers that complicate access to LAIs.Conclusions This study explores barriers to LAIs treatment for schizophrenia from a process-oriented perspective, incorporating stakeholder attitudes and providing empirical evidence for clinical practice and policy improvement.Clinical trial number Not applicable.

The significance of issues in medical humanities, such as empathy, professionalism, patient-orientation, disclosure of harms, and communication skills, has been widely acknowledged in previous studies. While these studies have showcased the impact of individual facets of medical humanities on clinical practice, there exists a dearth of comprehensive assessments that encompass these constructs and their relationship with burnout and distress among medical students. This study aims to fill these gaps by exploring Chinese medical students’ overall perceptions of medical humanities across different educational phases and shedding light on the intricate associations between perceptions of humanities, burnout, and stress. We conducted a nationwide survey using a web-based questionnaire across 38 Chinese universities. The questionnaire includes Medical Humanities constructs, the Maslach Burnout Inventory constructs and the Perceived Stress constructs. The survey was administered using the snowball sampling method, with the data collection period running from September 8, 2022, to September 22, 2023. Participants included a national sample of 904 students (out of a total of 969) enrolled in medical schools. To investigate the relationships among all the constructs, PLS-SEM analysis was conducted by using the SmartPLS 3.3.9 software in this study. The student’s perception of medical humanities was significantly influenced by several factors: years of medical school education (β = -.077; P = .045), work burnout (β = -.208; P < .001), and perceived stress (β = -.467; P < .001). Work burnout was impacted by clinical clerkship experience (β = .106; P = .001), whereas perceived stress was influenced by the number of years in medical school (β = 0.102; P = .002). Additionally, work burnout acts as an intermediate variable between clinical clerkship experience and students’ perception of medical humanities. This study illuminated the complex relationship between medical education, burnout, stress, and students' perception of medical humanities issues. It underscores the critical importance of balancing technical proficiency with humanistic values in medical training. Implementing strategies that support students' well-being and foster empathy is essential in nurturing a compassionate and effective healthcare workforce.

While healthcare quality continues to improve in China, the ways in which healthcare professionals respond to grief over patient death remain under-recognized. This study used interpretive phenomenology to explore how 20 Chinese healthcare professionals navigate experiences of grief, particularly in relation to their agency. Data were collected through semi-structured interviews and participatory observation. Transcripts were analyzed using reflexive thematic analysis to generate four themes: (1) the root of grief: healthcare professionals' personal bonding with patients; (2) the exploratory transition: from a negative attitude to recognition; (3) interpersonal grief expression as shameful and burdensome; and (4) institutional barriers to acknowledging and supporting grief. The findings highlight a challenging yet agentic portrayal of healthcare professionals' grief experiences within the Chinese sociocultural context. By fostering a grief-literate workplace culture, hospitals can empower staff to navigate the grieving process more effectively, ensuring both their well-being and the continuity of high-quality patient care.

ABSTRACTBackgroundIn China, caregiving for cancer patients is primarily the responsibility of family members. This role often exposes family caregivers to the contemplation of mortality. Death anxiety among family caregivers may influence the care they offer to cancer patients.ObjectiveThis study aims to evaluate the prevailing level of death anxiety among Chinese family caregivers of cancer patients and identify its influencing factors.DesignThis cross‐sectional study followed the STROBE statement.MethodsA total of 220 family caregivers of cancer patients were recruited from a prominent tertiary hospital in southern China. The survey included a general information questionnaire, the Collett–Lester Fear of Death Scale, the Social Support Rating Scale and the Simple Coping Style Questionnaire. In addition to descriptive statistics, ANOVA, mean differences, correlations and regression analyses were computed.ResultsThe average score for death anxiety among family caregivers of cancer patients was 104.27 ± 21.02. Death anxiety was negatively correlated with a positive coping style and social support. Multiple linear regression analysis revealed that marital status, death education, patients' fear of death and coping style accounted for 41.0% of the variance in death anxiety among family caregivers.ConclusionsFamily caregivers of cancer patients experienced a moderate level of death anxiety. Individuals who were unmarried or divorced, lacked death education, had negative coping styles or cared for patients with fear of death tended to have high levels of death anxiety.Relevance to Clinical PracticeHealthcare providers should act as credible educators to reduce caregivers' death anxiety by imparting positive coping styles and accurate knowledge and values about death so caregivers can provide high‐quality care to patients.

In recent years, there has been a significant decrease in the desire to have children among Chinese women of childbearing age, particularly for the first child. This trend has sparked a growing interest in understanding the underlying factors. Although perceived stress has been speculated as an important factor in decreasing fertility intention, the precise mechanism is unclear. The current study, therefore, aims to investigate the psychological mechanisms linking perceived stress to fertility intentions among women of childbearing age without children, a topic of significant relevance and importance. Data were sourced from Chinese residents' psychology and behavior investigation (PBICR-2022). A multistage random sampling method was applied to recruit eligible participants. The Mplus8.3 software constructed a chain path model among the variables. The median fertility intention was 30(3–60) on a scale of 0 to 100. The mediation analysis revealed a significant negative influence of perceived stress on fertility intention (β = − 0.076, P < 0.001). Additionally, a more intricate pattern of chain-mediating effect was observed involving perceived stress, anxiety (β = 0.037, P < 0.05), family communication (β = 0.106, P < 0.001), subjective well-being (β = 0.088, P < 0.001) and fertility intention. Perceived stress not only directly suppressed fertility intention but also indirectly affected it through anxiety, family communication, and subjective well-being. Effective family communication and favorable subjective well-being emerged as factors that could augment fertility intentions among women of childbearing age without children.

Objectives: To explore the therapeutic effects of M2 macrophages in diabetic nephropathy (DN) and their mechanism.Methods: We infused M2 macrophages stimulated with IL-4 into 10-week-old db/db mice once a week for 4 weeks through the tail vein as M2 group. Then we investigated the role of M2 macrophages in alleviating the infammation of DN and explored the mechanism.Results: M2 macrophages hindered the progression of DN, reduced the levels of IL-1β (DN group was 34%, M2 group was 13%, p < 0.01) and MCP-1 (DN group was 49%, M2 group was 16%, p < 0.01) in the glomeruli. It was also proven that M2 macrophages alleviate mesangial cell injury caused by a high glucose environment. M2 macrophage tracking showed that the infused M2 macrophages migrated to the kidney, and the number of M2 macrophages in the kidney reached a maximum on day 3. Moreover, the ratio of M2 to M1 macrophages was 2.3 in the M2 infusion group, while 0.4 in the DN group (p < 0.01). Mechanistically, M2 macrophages downregulated Janus kinase (JAK) 2 and signal transducer and activator of transcription (STAT) 3 in mesangial cells.Conclusions: Multiple infusions of M2 macrophages significantly alleviated inflammation in the kidney and hindered the progression of DN at least partially by abrogating the M1/M2 homeostasis disturbances and suppressing the JAK2/STAT3 pathway in glomerular mesangial cells. M2 macrophage infusion may be a new therapeutic strategy for DN treatment.

ObjectiveIrrigation is a conventional treatment for acute and chronic periprosthetic joint infections (PJI). However, there has been no unified standard for irrigation during surgery for PJI in the past, and the efficacy is uncertain. The purpose of this study is to create a new irrigation protocol to enhance the infection control rate and reduce the postoperative recurrence rate of PJI patients.MethodsWe conducted a single‐institution retrospective review with a total of 56 patients who underwent revision total hip or knee arthroplasties due to PJI from January 2011 to January 2022. Conventional irrigation (CI) was used in 32 cases, and standard operating procedure of irrigation (SOPI) was used in 24. The CI protocol carries out an empirical irrigation after debridement, which is quite random. Our SOPI protocol clearly stipulates the soaking concentration and time of hydrogen peroxide and povidone‐iodine. The irrigation is carried out three times, and tissue samples are taken from multiple parts before and after irrigation, which are sent for microbial culture. The important statistical indicators were the rate of positive microbiological culture and postoperative recurrence rate with an average follow‐up of 24 average months.ResultsThe drainage volume was lower in the SOPI group than in the CI group on postoperative day 3 (p < 0.01) and 7 (p = 0.016). In addition, the percentage of positive microbiological cultures after the third irrigation was less than that before (p < 0.01) and after (p < 0.01) the first irrigation. The most common causative organism was Staphylococcus aureus, which was detected in 25.0% and 12.5% of the SOPI and CI groups, respectively. The failure rate at the final follow‐up was 8.3% and 31.3% (p = 0.039) for the SOPI and CI groups, respectively.ConclusionCompared with the traditional CI method, SOPI standardized the soaking time of hydrogen peroxide and povidone‐iodine, increased the frequency of and irrigation, and proved that microorganisms were almost completely removed through the microbial culture of multiple tissues. SOPI has the potential to become a standardized irrigation process worthy of promotion, effectively reducing the postoperative recurrence rate of PJI patients.

Abstract Objectives To explore the impact of COVID-19 infection on medication adherence among rural-dwelling older adults with chronic diseases, and identify the medication taking behavior and its influencing factors among rural-dwelling older adults with COVID-19 infection. Methods A cross-sectional study of 111 rural-dwelling older adults was conducted from February to March 2023 in rural villages in China. Demographic and clinical characteristics, medication adherence, medication taking behavior, COVID-19 related illness perception, COVID-19 related stigma, and social network were evaluated by questionnaires. Independent-sample t test, Chi-square test, and multivariable logistic regression were performed to analyze the data. Results There was no significant difference in the medication adherence between COVID-19 infected group and non-COVID-19 infected group. For COVID-19 infected older adults, 63.93 % maintained taking medication for chronic diseases, but 32.79 % stopped taking medication during COVID-19 infection. COVID-19 related illness perception (OR=1.111, p=0.004) and social network (OR=1.156, p=0.010) correlated with the behaviors such as reducing the dose of medication or stopping taking medication during COVID-19 infection. Conclusions The COVID-19 infection has no effect on medication adherence among rural-dwelling older adults. Older adults with negative illness perception of COVID-19 and better social network were more likely to reduce or stop taking medication when they were infected with COVID-19. Thus, specific strategies to reduce negative perception about COVID-19 and strengthen social connection are warranted for rural-dwelling older adults.

A living will, a document signed by individuals who are conscious and in good health, serves to specify in advance his or her medical preferences in the event of incurable diseases in the future.This concept remains relatively unknown to many in mainland China.A mixed-methods study reveals that only 16.1 % of the 523 respondents in urban areas have a comprehensive understanding of living wills [1].This apparent lack of awareness largely stems from the taboo of talking and thinking about death in Chinese culture and the family-based medical decision-making, which is sometimes contrary to patients' autonomy and dignity [2].The concept of the living will was first introduced to mainland China in 2006 mainly through the non-profit website Choice and Dignity.The living will document "My Five Wishes" promoted by the website was adapted from "Five Wishes," the most renowned form of the living will in the United States.By 2022, among 113,289 registered users, 57,187 had signed "My Five Wishes" online [3].This led to the foundation of the Beijing Living Will Promotion Association in 2013 and the Shenzhen Living Will Promotion Association (SZLWPA) in 2021.These organizations have been playing a significant role in promoting the living will since their establishment.On 23 June, 2022, Shenzhen became the first city in mainland China to incorporate the living will into local legal regulations, Medical Regulations of the Shenzhen Special Economic Zone.In particular, Article 78 stipulates that medical institutions shall respect living wills from patients or their close relatives regarding lifesaving medical

Introduction: Mukbang is an emerging form of online entertainment of eating food and performance. Mukbang has become increasingly widespread among the youth. However, why the youth enjoy Mukbang and their specific experiences when watching the Mukbang remain unclear. Objective: This study aimed to explore the reasons, experiences, and perceived influence of youth watching Mukbang. Materials and methods: Thirty participants aged 14-35 years who had watched Mukbang in the past month were recruited online. The recruitment was conducted using a purposive sampling during March 13th to May 9th, 2022. We conducted a phenomenological descriptive qualitative study to explore the psychological experience of youth when watching the Mukbang. Semi-structured interviews were conducted face-to-face or via telephone following an outline. Data were analyzed using inductive thematic analysis. Results: Four major themes were identified: reasons for watching Mukbang, experiences while Mukbang watching, benefits of Mukbang watching, and harms of Mukbang watching. Each theme was divided into 12 subthemes. Conclusions: Mukbang potentially alleviates mental health problems and stimulates appetite. However, the negative effects of long-term Mukbang watching should also be considered. Properly utilizing Mukbang-watching benefits and addressing its potential adverse consequences associated with prolonged exposure are crucial.

Background Participants with prediabetes are at a high risk of developing type 2 diabetes (T2D). Recent studies have suggested that blocking the receptor activator of nuclear factor-κB ligand (RANKL) may improve glucose metabolism and delay the development of T2D. However, the effect of denosumab, a fully human monoclonal antibody that inhibits RANKL, on glycemic parameters in the prediabetes population is uncertain. We aim to examine the effect of denosumab on glucose metabolism in postmenopausal women with osteoporosis and prediabetes. Methods This is a 12-month multicenter, open-label, randomized controlled trial involving postmenopausal women who have been diagnosed with both osteoporosis and prediabetes. Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density T score of ≤ − 2.5, as measured by dual-energy X-ray absorptiometry (DXA). Prediabetes is defined as (i) a fasting plasma glucose level of 100–125 mg/dL, (ii) a 2-hour plasma glucose level of 140–199 mg/dL, or (iii) a glycosylated hemoglobin A1c (HbA1c) level of 5.7–6.4%. A total of 346 eligible subjects will be randomly assigned in a 1:1 ratio to receive either subcutaneous denosumab 60 mg every 6 months or oral alendronate 70 mg every week for 12 months. The primary outcome is the change in HbA1c levels from baseline to 12 months. Secondary outcomes include changes in fasting and 2-hour blood glucose levels, serum insulin levels, C-peptide levels, and insulin sensitivity from baseline to 12 months, and the incidence of T2D at the end of the study. Follow-up visits will be scheduled at 3, 6, 9, and 12 months. Discussion This study aims to provide evidence on the efficacy of denosumab on glucose metabolism in postmenopausal women with osteoporosis and prediabetes. The results derived from this clinical trial may provide insight into the potential of denosumab in preventing T2D in high-risk populations. Trial registration This study had been registered in the Chinese Clinical Trials Registry. Registration number: ChiCTR2300070789 on April 23, 2023. https://www.chictr.org.cn .

当患者进入生命终末期时,无为的状态就是顺应天命,不做过多治疗,不刻意追求患者生命的长度,但同时不是什么都不做,而是在符合某个价值观体系下努力实现患者的愿望,实现圆满结局.在提高患者舒适度,减少痛苦的同时,要推崇"有为"的价值体系,以患者及家属的多元愿望为指引,协助其圆满走完人生.对于医护人员,则需要加强医护人员的生命教育,加强专业训练,使得医学技术与患者的身心和谐一致,给予适当的关怀和照护,很放松自然地去帮助患者实现愿望.

本文通过归纳、分析当前我国城乡居民基层中医药卫生服务利用的研究现状,提出我国促进基层中医药卫生服务利用,优化基层中医药卫生服务质量的建议.建议从健全服务体系,完善中医药卫生服务内部供给机制;优化宏观环境,破除中医药卫生服务利用的外部壁垒;紧扣群众需求,发挥中医药服务的特色优势;摆脱空间依赖,促进"互联网+"中医药的健康发展等四方面展开阐述,以期为基层中医药卫生健康工作的开展带来启示.

基于对生物医学的批判,疾病叙事转向抓住第一人称的痛苦体验,是为病人赋权的主体性回归过程,成为一种批判性与补充性研究方法.叙事医学促使医务人员达成共情,深入理解病人的生理与社会苦痛,创造医患对话空间.然而,这些叙事局限于医患之间普适性单向互动表达.微型民族志作为叙事医学新范式,是资料收集、赋权、共情、治疗为一体的研究范式,将阿尔茨海默病老人的主体性互动研究作为微型民族志的典型案例,为完善中国叙事医学理论与方法带来更多启示.

Abstract Objective: The current investigation sought to examine the experiences and perspectives of the project coordinators, participating parents, and children to identify strategies for enhancing children’s engagement and adherence to outdoor physical activities. Methods: A descriptive, qualitative study was conducted from October 2019 to December 2019 through in-depth interviews with 32 families who participated in the Community Child Myopia Prevention Project, 15 project volunteers, and 8 community organizers. Results: Five themes and 10 subthemes were identified to enhance children’s participation rate and adherence to the project. The 5 themes were as follows: (1) overcoming parental barriers, (2) attracting parental participation, (3) active support from parents, (4) creating a positive experience for children, and (5) integration into children’s daily lives. Conclusions: Empowering parents and children by meeting their needs, creating innovative activities, and connecting them with community social networks support the successful integration of the outdoor activity program into their daily lives. The sharing and integration of community resources through community empowerment can provide a framework for developing future community interventional projects.

Background The number of empty nest elderly in China has gradually increased in recent years. There is growing concern about the physical and mental health of this population as empty nest elderly are commonly at the risk of compromising health, home safety and quality of life. This study reported the health and well-being of empty nest elderly with regards to their health status, depression and satisfaction, lifestyle as compared to non-empty nest elderly in China. Methods Data was collected from the 2018 follow-up interviews of China Health and Retirement Longitudinal Survey. We included 4,630 empty nest elderly and 6,188 non-empty nest elderly. Chi-square Test and Logistic Regression were used to compare the differences between these two groups. Results As compared to the non-empty nest elderly, there was higher proportion of empty nest elderly who suffered from dyslipidemia, diabetes, chronic lung diseases, heart attack (27.0% vs. 25.0%; 16.6% vs. 15.1%; 19.4% vs. 16.4%; 26.3% vs. 23.4%, P < 0.05). The empty nest elderly had higher proportion of participants who drank more than once a month (25.3% vs. 23.9%, P < 0.05), who felt satisfied with their marriage (71.6% vs. 66.2%, P < 0.001), who were satisfied with their children’s relationship (85.2% vs. 83.2%, P < 0.001). However, these significances disappeared in the Logistic Regression analysis (P > 0.05). Conclusion Our study showed that significant between-group difference was found between empty nest elderly and non-empty nest elderly in their health and wellbeing. However, disappearance of such difference in the multivariable analysis may indicate improved health and wellbeing among the empty nest elderly. Even though our study still suggested the importance of improving the health, lifestyles and family dynamics of the elderly and promoting the integration of health and social care for the elderly, especially among the empty nest elderly.

Smoking is a major public health problem in most countries and usually occurs in marginalized groups. Analyzing the smoking behavior of migrant workers, a marginalized group in China, is of practical significance. Using panel data from the China Health and Retirement Longitudinal Study (CHARLS) database from 2013 to 2018, this study examined influence factors of smoking behavior (whether to smoke and smoking frequency) among migrant workers in China through the Heckman two-stage model. The results showed that the smoking rates of migrant workers were positively associated with social activity and a sense of loneliness, while smoking frequency was negatively associated with work stress and life satisfaction. Meanwhile, smoking behavior was associated with the demographic variables such as gender, age, and education level. Gender differences in smoking behavior were particularly notable among Chinese migrant workers. Furthermore, there was regional heterogeneity in smoking behavior among migrant workers. Smoking behavior in the eastern region was mainly influenced by psychological factors of wellbeing, such as social activity and life satisfaction, while it was affected by material conditions such as income in the central-western region. Effective strategies to control tobacco use among migrant workers are proposed in order to promote social integration between urban and rural residents, increase vocational education and training, and strengthen anti-smoking propaganda among migrant workers.

目的 探讨三角选题法在人文护理研究选题中的应用与实践,为护理人员在进行科学研究选题中提供借鉴.方法 整理团队过往几年的研究经验提出三角选题法框架,结合研究论文概述三角选题法的应用与实践.结果 三角选题法是由现实背景出发,以解决现实难题作为研究的核心,包括现实背景、现实难题、研究问题3个环节.结论 通过三角选题法,能够有效降低选题困难,避免选题脱离实际等问题,是护理科研可行有效的选题方法.