Background: Professional identity is essential for the development, retention, and career commitment of highly educated nurses. Nursing master’s students occupy overlapping roles as students, clinical trainees, novice researchers, and future professionals, making their professional identity vulnerable to educational, clinical, occupational, and social pressures. This study aimed to explore the core themes, lived manifestations, and structural determinants of professional identity among nursing master’s students in China using naturally occurring social media texts. Methods: An explanatory sequential mixed-methods design was adopted. Publicly available texts related to professional identity among nursing master’s students in China were collected from Weibo, Zhihu, Xiaohongshu, and Douyin between January 1, 2015, and March 20, 2026. After deduplication, manual screening, and text preprocessing, the final corpus comprised 24,939 text records and 2,495,353 Chinese characters. Term frequency–inverse document frequency (TF-IDF) analysis, keyword co-occurrence network analysis, and latent Dirichlet allocation (LDA) modeling were used to identify core semantic structures. These findings were then interpreted using LDA-informed qualitative thematic analysis. Stratified analyses compared currently enrolled nursing master’s students with employed nursing master’s graduates. Results: Fourteen themes were identified in the overall corpus: uncertainty about employment pathways, mismatch between advanced education and career rewards, multiple role conflicts, peer pressure, discrimination related to prior educational background, academic and research-related stress, gender stereotypes, high-intensity workload, public devaluation and occupational stigmatization, insufficient family support, workplace bullying in clinical settings, diminished sense of meaning in research, supervisor–student power dynamics, and positive experiences of achievement. Stratified analyses indicated that currently enrolled students primarily expressed anticipatory career uncertainty, role conflict, and research-related stress, whereas employed graduates more often expressed unmet expectations regarding educational returns, inadequate job fit, and difficulties in professional resocialization. Conclusions: Professional identity among nursing master’s students in China is not merely an individual psychological issue, but reflects the combined influence of advanced nursing education, clinical labor structures, academic evaluation systems, social stigma toward nursing, and family expectations. Improving nursing master’s education requires strengthening clinical–research integration, standardizing supervisor–student relationships, improving clinical training environments, and establishing career development pathways that translate advanced education into recognized professional value.

This study aimed to construct and implement an in situ simulated emergency training (SET) course for nurses with low seniority and evaluate its effectiveness. This was an experimental study, and a purpose-sampling method was adopted. We selected 82 nurses with less than 5 years of experience working in a grade - III Class A hospital in Hubei province from August to December 2023 as the research objects, and randomly divided them into intervention group (n = 37) and control group (n = 45). The control group underwent routine stratified training, whereas the intervention group underwent in situ SET based on routine stratified training. Before and after training, we compared differences in the scores of the intervention and control groups in terms of critical thinking (CT), clinical communication (CC), clinical reasoning (CR), and first aid (FA). The constructed in situ simulated emergency training course consisted of nine courses, each of which covered one theme. The nine themes were acute myocardial infarction, diabetic ketoacidosis, secondary shock due to acute transfusion anaphylaxis, post-operative respiratory depression combined with pulmonary edema, unplanned extubation, impulsive violence, chemotherapeutic drug extravasation, patient suicide, and acute pulmonary embolism. The results of the empirical study showed that before training, there were no differences between the intervention and control groups in the scores for the following abilities: CT, CC, CR, and FA (p > 0.05). After training, the scores for CR and FA in the intervention group were higher than those in the control group (p < 0.05), while the scores for CT and CC did not differ from those in the control group (p > 0.05). The content of the in situ SET course is comprehensive, which is helpful in improving junior nurses’ CC and FA abilities and can serve as a reference for establishing a training course for them. However, the effects on the CT and CC were not significant. Further empirical studies are required to explore the targeted training courses.

AIM:This study examined the factors influencing psychological crisis vulnerability (PCV) in older patients with multimorbidity and identified barriers/facilitators to expressing psychological distress. This was aimed at supporting clinical interventions and ageing policies. DESIGN:A cross-sectional study. METHODS:This study was designed using explanatory sequential mixed methods. In the quantitative study, 685 older patients in the inpatient and outpatient clinics of a tertiary hospital were selected using convenience sampling, and a cross-sectional survey was conducted using the Psychological Crisis Vulnerability Scale (PVS). In the qualitative study, 14 older patients with multiple chronic diseases in the geriatric department were interviewed in depth, and the interaction mechanism between vulnerability and self-disclosure was analysed. Qualitative themes on disclosure barriers/facilitators were contextualised within the high PCV subgroups (scores ≥ 80), demonstrating how vulnerability modulates self-disclosure. RESULTS:The quantitative study showed that the PCV score of older patients with multimorbidity (69.4 ± 12.8) was significantly lower than that of the community older norm, indicating that their PCV was at the lower to middle level. Multifactorial analysis showed that residence status, economic situation, marital status, age, type of chronic disease, and hospitalisation in the preceding 6 months were the main factors affecting PCV. The qualitative study extracted hindering factors (e.g., introverted personality, family atmosphere, negative cognition, economic pressure, negative feedback, insufficient knowledge, and time weakening) and facilitating factors (e.g., perceived benefits after disclosure, a good support system, and a strong willingness to express oneself) affecting self-disclosure. CONCLUSION:PCV in older patients with multimorbidity emerges from multidimensional determinants and complex self-disclosure dynamics. IMPACT:Strategic improvements in risk assessment protocols, positive expressive behaviour cultivation, layered psychosocial support frameworks, and healthy ageing policy execution collectively enhance mental well-being and sustainable ageing trajectories. REPORTING METHOD:The study follows the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION:Older patients from tertiary hospitals participated in this study.

Background:The mental health of widowed older adults has garnered increasing research attention due to its profound impact on well-being and quality of life. Despite growing scholarly interest, a comprehensive bibliometric analysis of evolving research trends, key topics, and knowledge structures remains scarce. This study aims to identify key research themes, emerging trends, and interdisciplinary linkages to inform future studies on the mental health of widowed older adults. Methods:A bibliometric analysis was conducted using data from the Web of Science Core Collection (2004-2024). CiteSpace, VOSviewer, and the R package "Bibliometrix" were utilized to visualize publication trends, country and author collaborations, keyword co-occurrences, theme analysis, and emerging research topics. Results:A total of 891 articles were analyzed. The United States produced the highest number of publications, followed by China and the United Kingdom, with the United States, England, and Canada exhibiting strong research collaborations. Depression, prevalence and mental health were identified as core research themes, while life satisfaction and social support emerged as growing areas of interest. Citation burst and thematic evolution analyses revealed shifting scholarly interest from clinical and diagnostic concerns towards psychosocial adaptation and person-centered approaches over time. Conclusion:This bibliometric study systematically maps the research landscape, hotspots, and emerging trends in the mental health of widowed older adults over the past two decades. The findings provide valuable insights for researchers seeking to identify key research directions, foster interdisciplinary collaborations, and develop targeted interventions to support the mental well-being of widowed older adults.

Background:Depression and anxiety are prevalent mental health issues among older adult widowed adults. However, the symptom-level relationships between these conditions remain unclear. Due to the high correlations and complex relationships among various symptoms, this study employs network analysis to explore differences in the network structures of depression and anxiety symptoms between widowed and non-widowed older adults. Methods:Propensity score matching was used to identify widowed older adults with similar demographic characteristics. Data from 1,736 widowed and 1,736 matched controls were analyzed using the Chinese Longitudinal Healthy Longevity Survey (2017-2018). Depression and anxiety were measured by the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and the seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Central and bridge symptoms were evaluated using expected influence (EI) and bridge expected influence (BEI), respectively. Results:Network analysis revealed similarities in central symptoms between widowed and non-widowed older adults, with both groups exhibiting "Feeling depressed or down" (CESD3), "Feeling tense and having difficulty relaxing" (GAD4), and "Being unable to stop or control worrying" (GAD2) as core symptoms. However, differences emerged in bridge symptoms. In the widowed group, "Feeling anxious, worried, or distressed" (GAD1) was most strongly connected to "Felt lonely" (CESD8); "Worrying too much about various things" (GAD3) was strongly linked to "Feeling increasingly exhausted and useless with age" (CESD4); and "Feeling depressed or down" (CESD3) had a strong association with "Becoming easily annoyed or irritable" (GAD6). In the non-widowed group, "Feeling anxious, worried, or distressed" (GAD1) exhibited the strongest association with "Having good sleep quality" (CESD10); "Getting upset over small matters" (CESD1) was closely connected to "Feeling anxious, worried, or distressed" (GAD1); and "Worrying too much about various things" (GAD3) was most strongly connected to "Feeling depressed or down" (CESD3). Conclusion:Common central and bridge symptoms highlight universal intervention targets. Addressing "Feeling depressed or down" in widowed and "Getting upset over small matters" in non-widowed older adults may help prevent depression-anxiety comorbidity. These findings support targeted interventions to improve mental health outcomes. Future research should evaluate tailored intervention effectiveness.

BackgroundOral frailty has emerged as a critical focus in public health due to its strong association with adverse health outcomes in older adults, such as cognitive decline, malnutrition, falls, disability, and mortality. Despite a growing body of research over the past decade, a comprehensive bibliometric analysis of this field remains lacking. This study addresses this gap by providing an overview of the research landscape, highlighting key achievements, identifying emerging trends, and proposing directions for future exploration.MethodsA bibliometric analysis was conducted on literature related to oral frailty in older adults published between 2013 and 2024, utilizing the Web of Science Core Collection (SCIE and SSCI). The analysis employed CiteSpace, VOSviewer, and the “bibliometrix” R package to visualize and evaluate contributions from countries/regions, organizations, authors, journals and articles. Additionally, references and keyword analyses were performed to identify research patterns and thematic trends.ResultsThe bibliometric analysis of 847 articles published from 2013 to 2024 revealed that Japanese scholars contributed the most publications in the field (n = 204), representing 24.09% of the total. The cooperation network map revealed the highest intensity of collaboration among researchers from the United Kingdom, the United States and Japan. Watanabe Y and Hirano H, both from Japan, were identified as the most prolific and frequently co-cited authors. The research focuses on the multifactorial mechanisms of oral frailty, comprehensive intervention measures and quality of life. Key research hotspots in the field included tongue pressure, tooth loss, social support, quality of life, health promotion, dental care, and root caries. Emerging research directions may include inflammation, swallowing function and oral function.ConclusionResearch on oral frailty in older adults has advanced significantly over the past decade, with Japan making particularly notable contributions to the field. The multifactorial mechanisms of oral frailty, multidimensional evaluation methods, and comprehensive intervention strategies are expected to remain central research focuses. Our findings aim to provide researchers with a clearer understanding of trends within this field.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024570590, PROSPERO CRD42024570590.

ObjectiveAnxiety and depression are common mental disorders in the elderly. Concurrent frailty may lead to worse clinical outcomes. This study examined the network structures of anxiety and depression in frail and non-frail older adults.MethodsThe Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and the Generalized Anxiety Disorder Scale-7 (GAD-7) were used to measure depressive and anxiety symptoms, respectively. Following propensity score matching (PSM), 877 frail elderly individuals were matched with 877 non-frail elderly individuals. Central (influential) and bridge symptoms were estimated using the expected influence (EI) and bridge expected influence (bridge EI), respectively. Network stability was assessed using the case-dropping bootstrap method.ResultsBased on the NCT results, there were no significant differences in the comparison of the network models between the non-frailty group and the frailty group in terms of global strength (7.175 vs. 7.136, S = 0.039, P = 0.802) and network structure (M = 0.137, P = 0.703). There were also no significant differences in edge weights between the networks of the two groups (P > 0.05).ConclusionNCT results showed no significant difference in the network structure of anxiety and depression between frail elderly and control groups. A slight decrease in network strength was observed in non-frail elderly but was not statistically significant. Both groups showed similar characteristics in bridging symptoms, central symptoms, overall strength, and network structure. Interventions for anxiety and depression are equally beneficial for both frail and non-frail elderly.

Background:Cardiovascular disease with multimorbidity imposes substantial long-term financial burdens. Financial toxicity, the financial burden associated with healthcare, is increasingly recognized as a psychosocial stressor affecting health outcomes among chronically ill populations. However, its psychological heterogeneity in non-cancer patients is understudied. We aimed to identify financial toxicity profiles, their determinants, and associations with anxiety/depression in cardiovascular non-cancer multimorbidity. Methods:This study used a cross-sectional design. Utilizing latent profile analysis to identify distinct financial toxicity subgroups. Univariate and multivariate logistic regression analyses were employed to explore factors associated with subgroup membership. Inverse probability of treatment weighting based on covariate balancing propensity scores was applied to assess the associations between financial toxicity profiles and psychological distress. Doubly robust regression models were utilized to validate the robustness of the observed associations. Results:Financial toxicity was categorized into three latent profiles: mild (63.8%), moderate (11.0%), and none (25.2%). Demographic, economic, social support, and coping variables significantly differed across profiles. In weighted regression models using inverse probability of treatment weighting based on covariate balancing propensity scores, both mild and moderate toxicity were associated with elevated anxiety (β = 1.88 and 8.68, respectively) and depression scores (β = 4.21 and 11.92; all p < 0.01) compared to the no-toxicity group. These associations remained robust in doubly robust models adjusting for covariates (GAD-7: β = 1.72 and 8.31; PHQ-9: β = 4.08 and 11.48). Conclusion:Financial toxicity is prevalent and heterogeneous in cardiovascular multimorbidity. Its distinct profiles predict elevated psychological distress, supporting targeted interventions to alleviate financial burden and enhance mental health resilience.

This study aims to explore the core symptoms of Non-Suicidal Self-Injury (NSSI) in adolescents with depressive disorders and the relationship between childhood maltreatment (CM) and NSSI symptoms by using network analysis. A total of 689 adolescents with depressive disorders participated in the survey. The Chinese version of the Adolescent Non-Suicidal Self-Injury Assessment Questionnaire (ANSAQ) and the Short Form of the Childhood Trauma Questionnaire (CTQ-SF) were employed to measure NSSI and the symptoms of CM, respectively. Using network analysis, the NSSI network and the CM-NSSI network were constructed to identify the most central symptoms and the bridge symptoms within the networks. Within the NSSI network, "Intentional scratches", " Intentionally hitting hard objects with your head ", " Intentionally hitting oneself with fists or harder objects ", and " Intentional pinching " were identified as the primary symptoms of NSSI. "emotional abuse", "sexual abuse", and " Intentionally cut yourself " emerged as three key bridge symptoms linking CM with NSSI. This research is the first to investigate the symptom network of CM-NSSI in a sample of adolescents with depressive disorders, providing a foundation for subsequent NSSI prevention and the development of targeted intervention strategies.

Background:Non-suicidal self-injury (NSSI) is a significant social issue, especially among adolescents with major depressive disorder (MDD). This study aimed to construct a risk prediction model using machine learning (ML) algorithms, such as XGBoost and random forest, to identify interventions for healthcare professionals working with adolescents with MDD. Methods:This study investigated 488 adolescents with MDD. Adolescents was randomly divided into 75% training set and 25% test set to testify the predictive value of risk prediction model. The prediction model was constructed using XGBoost and random forest algorithms. We evaluated the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, recall, F Score of the two models for comparing the performance of the two models. Results:There were 161 (33.00%) participants having NSSI. Compared without NSSI, there were statistically significant differences in gender (P=0.035), age (P=0.036), depressive symptoms (P=0.042), sleep quality (P=0.030), dysfunctional attitudes (P=0.048), childhood trauma (P=0.046), interpersonal problems (P=0.047), psychoticism (P) (P=0.049), neuroticism (N) (P=0.044), punishing and Severe (F2) (P=0.045) and Overly-intervening and Protecting (M2) (P=0.047) with NSSI. The AUC values for random forest and XGBoost were 0.780 and 0.807, respectively. The top five most important risk predictors identified by both machine learning methods were dysfunctional attitude, childhood trauma, depressive symptoms, F2 and M2. Conclusion:The study demonstrates the suitability of prediction models for predicting NSSI behavior in Chinese adolescents with MDD based on ML. This model improves the assessment of NSSI in adolescents with MDD by health care professionals working. This provides a foundation for focused prevention and interventions by health care professionals working with these adolescents.

To explore the relationships among fertility stress, dyadic coping and marital quality in couples undergoing in vitro fertilization-embryo transfer (IVF-ET). Couples receiving IVF-ET treatment at the clinic of the reproductive medicine centre of a hospital in China from February 2023 to October 2023 were selected by convenience sampling. A general information questionnaire, the Infertility Fertility Stress Scale (COMP-FPSS-SF), the dyadic coping inventory, and the marital adjustment test were used to evaluate the results. AMOS24.0 software was used to construct an actor-partner interdependence model that extended to mediation to analyze the relationships among couples' fertility stress, dyadic coping, and marital quality. The fertility stress level of IVF-ET wives was significantly higher than that of their husbands (p < 0.05). Wives' levels of dyadic coping and marital quality were significantly lower than those of husbands (p < 0.05). Fertility stress, dyadic coping, and marital quality were positively correlated between IVF-ET couples (p < 0.01). In terms of the actor effect, the fertility stress of IVF-ET couples had a significant impact on their marital quality through their dyadic coping (beta = -0.188, p < 0.05; beta = -0.109, p < 0.05). In terms of partner effects, wives' fertility stress significantly affected their husbands' marital quality through their own or their husbands' dyadic coping (beta = -0.055, p < 0.01; beta = 0.157, p < 0.01). Dyadic coping mediates the relationship between fertility stress and marital quality in IVF-ET couples. Nurses can use husbands and wives as central individuals and dyadic coping as the starting point to formulate intervention measures to reduce fertility stress and improve marital quality.

Objective This study represents the inaugural attempt to systematically review and analyse the efficacy of bright light therapy on depression among women experiencing major depressive disorder or depressive symptoms during the perinatal period, encompassing its efficacy on depression scores, remission rates, and response rates.Methods We searched 10 databases for randomized controlled trials examining bright light therapy's efficacy on perinatal depression up to January 2024. Data extraction was performed independently by 2 investigators. The Cochrane Handbook guidelines appraised the study quality, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach assessed evidence certainty.Results We incorporated 6 studies, encompassing 151 participants. When contrasted with dim light therapy, bright light therapy did not significantly alter depression scores (standard mean difference = -0.29, 95% confidence interval [CI], -0.62 to 0.04, P = 0.08, I-2 = 34%) or response rates (risk ratio [RR] = 1.56, 95% CI, 0.98 to 2.49, P = 0.06, I-2 = 0%) in women experiencing perinatal depression. Conversely, bright light therapy was associated with a substantial increase in remission rates (RR = 2.63, 95% CI, 1.29 to 5.38, P = 0.008, I-2 = 2%).Conclusion Bright light therapy did not show efficacy in treating perinatal depression in terms of depression scores and response rates. However, regarding the remission rate, bright light did show efficacy compared to control conditions. Due to the limited sample size in the included studies, type II err or may occur. To obtain more conclusive evidence, future studies must employ larger sample sizes. Objectif La pr & eacute;sente & eacute;tude repr & eacute;sente la tentative inaugurale de r & eacute;viser syst & eacute;matiquement et d'analyser l'efficacit & eacute; de la luminoth & eacute;rapie sur la d & eacute;pression chez les femmes qui souffrent d'un trouble d & eacute;pressif majeur ou de sympt & ocirc;mes d & eacute;pressifs durant la p & eacute;riode p & eacute;rinatale, englobant son efficacit & eacute; sur les scores de d & eacute;pression, les taux de r & eacute;mission et les taux de r & eacute;ponse.M & eacute;thodes Nous avons recherch & eacute; dix bases de donn & eacute;es pour des essais randomis & eacute;s contr & ocirc;l & eacute;s examinant l'efficacit & eacute; de la luminoth & eacute;rapie sur la d & eacute;pression p & eacute;rinatale jusqu'en janvier 2024. L'extraction des donn & eacute;es a & eacute;t & eacute; ex & eacute;cut & eacute;e ind & eacute;pendamment par deux investigateurs. Les lignes directrices Cochrane Handbook ont & eacute;valu & eacute; la qualit & eacute; de l'& eacute;tude, et l'approche GRADE a & eacute;valu & eacute; la certitude des donn & eacute;es probantes.R & eacute;sultats Nous avons incorpor & eacute; six & eacute;tudes, regroupant 151 participants. Lorsque contrast & eacute;e avec la th & eacute;rapie avec lumi & egrave;re tamis & eacute;e, la luminoth & eacute;rapie n'alt & eacute;rait pas significativement les scores de d & eacute;pression [diff & eacute;rence moyenne standard = -0,29, 95 % intervalle de confiance (IC) : -0,62 & agrave; 0,04, P = 0,08, I-2 = 34%] ou les taux de r & eacute;ponse [Rapport de risque (RR) = 1,56, 95 % IC : 0,98 & agrave; 2,49, P = 0,06, I-2 = 0%] chez les femmes souffrant d'une d & eacute;pression p & eacute;rinatale. & Agrave; l'inverse, la luminoth & eacute;rapie & eacute;tait associ & eacute;e & agrave; une augmentation substantielle des taux de r & eacute;mission [TR = 2,63, 95% IC : 1,29 & agrave; 5,38, P = 0,008, I-2 = 2%].Conclusion La luminoth & eacute;rapie n'a pas montr & eacute; d'efficacit & eacute; pour traiter la d & eacute;pression p & eacute;rinatale pour ce qui est des scores de d & eacute;pression et des taux de r & eacute;ponse. Cependant, & agrave; l'& eacute;gard du taux de r & eacute;mission, la luminoth & eacute;rapie s'est montr & eacute;e efficace comparativement aux conditions de contr & ocirc;le. & Eacute;tant donn & eacute; la taille de l'& eacute;chantillon des & eacute;tudes s & eacute;lectionn & eacute;es, les erreurs de type II peuvent se produire. Afin d'obtenir des donn & eacute;es probantes plus concluantes, les futures & eacute;tudes doivent employer de plus grandes tailles d'& eacute;chantillon.

AIMS:To evaluate the sleep quality of patients with atrial fibrillation and its influencing factors, and explore whether illness perception mediates the relationship between family function and sleep quality. DESIGN:Cross-sectional survey conducted from November 2020 to November 2021. METHODS:A total of 191 participants validly completed the Pittsburgh Sleep Quality Index, the Family APGAR Index and the Brief Illness Perception Questionnaire. Data were analysed using descriptive statistics, independent samples t-tests, one-way ANOVA, Pearson correlation analysis and multiple linear regression analysis. Bootstrapping was used to detect the mediating role of illness perception. RESULTS:Patients with atrial fibrillation reported poor sleep quality, good family function and a moderate level of illness perception. The better the family function, the lower the level of illness perception and the better sleep quality in patients with atrial fibrillation. Patients with commercial medical insurance had lower levels of sleep quality relative to self-financed patients. EHRA III and EHRA IV patients had worse sleep quality than EHRA II patients. Illness perception played a significant mediating role in the relationship between family function and sleep quality. CONCLUSIONS:Patients with atrial fibrillation have poorer sleep quality, and the type of medical insurance and EHRA score are independent indicators related to their sleep quality. Future health education and interventions need to focus on strengthening and improving the emotional support of family members in order to improve family function and reduce illness perception, thereby improving sleep quality of patients with atrial fibrillation. IMPACT:This study provides further evidence that nurses need to enhance their awareness and provide ongoing education to better identify patients with AF who have family dysfunction and perceived high levels of illness threat perceptions, as these factors negatively impact sleep quality. REPORTING METHOD:This study was reported in strict compliance with the strengthening the reporting of observational studies in epidemiology (STROBE) guideline. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

ObjectiveThis study aims to develop and validate a prediction model for evaluating the social participation in the community middle-aged and older adult stroke survivors.MethodsThe predictive model is based on data from the China Health and Retirement Longitudinal Study (CHARLS), which focused on individuals aged 45 years or older. The study utilized subjects from the CHARLS 2015 and 2018 wave, eighteen factors including socio-demographic variables, behavioral and health status, mental health parameters, were analyzed in this study. To ensure the reliability of the model, the study cohort was randomly split into a training set (70%) and a validation set (30%). The Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used to identify the most effective predictors of the model through a 10-fold cross-validation. The logistic regression model was employed to investigate the factors associated with social participation in stroke patients. A nomogram was constructed to develop a prediction model. Calibration curves were used to assess the accuracy of the nomogram model. The model’s performance was evaluated using the area under the curve (AUC) and decision curve analysis (DCA).ResultA total of 1,239 subjects with stroke from the CHARLS database collected in 2013 and 2015 wave were eligible in the final analysis. Out of these, 539 (43.5%) subjects had social participation. The model considered nineteen factors, the LASSO regression selected eleven factors, including age, gender, residence type, education level, pension, insurance, financial dependence, physical function (PF), self-reported healthy,cognition and satisfaction in the prediction model. These factors were used to construct the nomogram model, which showed a certain extent good concordance and accuracy. The AUC values of training and internal validation sets were 0.669 (95%CI 0.631–0.707) and 0.635 (95% CI 0.573–0.698), respectively. Hosmer–Lemeshow test values were p = 0.588 and p = 0.563. Calibration curves showed agreement between the nomogram model and actual observations. ROC and DCA indicated that the nomogram had predictive performance.ConclusionThe nomogram constructed in this study can be used to evaluate the probability of social participation in middle-aged individuals and identify those who may have low social participation after experiencing a stroke.

目的 调查抑郁症患者照护家属的心理弹性水平及其人格特质和社会支持之间的相关性研究.方法 采用一般资料调查表、心理弹性量表、社会支持评定量表和艾森克人格问卷对163例抑郁症患者家属进行调查.结果 抑郁症患者家属的心理弹性总分为(63.33±15.49)分;Pearson相关分析显示抑郁症患者家属的心理弹性与社会支持、客观支持、对支持的利用度、内外向之间均成正相关(P＜0.05),心理弹性与神经质、婚姻状况之间成负相关(P＜0.05).多元回归分析显示客观支持、神经质、家庭月收入、医疗费用支付形式、婚姻状况5个因子依次进入回归方程(P＜0.05).结论 抑郁症患者家属的心理弹性水平较低,客观支持、神经质、家庭月收入、医疗费用支付形式、婚姻状况是抑郁症患者家属心理弹性的主要影响因素.

OBJECTIVE:This study evaluated the prevalence and perioperative risk factors for early high-output ileostomy (EHOI) and developed a precise nomogram model to predict the occurrence of EHOI. METHODS:140 patients who underwent ileostomy surgery at three hospitals in Wuhan, Hubei Province, between January 2022 and May 2022 were enrolled in this prospective cohort study. By using univariate and multifactorial logistic regression, independent risk variables for the development of EHOI were examined, and the nomogram model for predicting the risk of EHOI was created by using R software. The calibration curve and area under the receiver operating characteristic curve (ROC AUC) were used to evaluate the calibration and discrimination of the prediction model, Hosmer-Lemeshow to verify the fit of the model. Clinical impact curve (CIC) and decision curve analysis (DCA) were used to assess the model's clinical efficacy. RESULTS:A total of 132 patients participated in the study, and the incidence of EHOI was 25.8% (34/132). The nomogram model incorporated 3 risk factors hypertension, drinking habits, and high white blood cell (WBC) count after surgery. The AUC was 0.742, and the nomogram showed great calibration and clinical validity by comparing the calibration curve, DCA, and CIC. CONCLUSIONS:Hypertension, drinking, and high WBC was significantly correlated with EHOI. The nomogram model has great clinical value in predicting the EHOI.

Abstract Purposes The objective of this study was to assess the clinical significance and risk factors for postoperative diarrhea following primary colorectal cancer (CRC) surgery. Methods This prospective cohort study included patients with CRC who underwent radical non-stomy surgery between December 2021 and April 2022 at three tertiary care hospitals in Wuhan, Hubei Province. Assessment of risk factors and clinical impact of postoperative diarrhea after CRC surgeryby univariate and multifactorial logistic regression. Results The incidence of postoperative diarrhea was 20.3% (41/202). Multifactorial regression analysis showed that hypertension and diabetes mellitus were strongly associated with postoperative diarrhea (P=0.035 and P=0.037). Patients who after rectal resection were more likely to have postoperative diarrhea than patients after colectomy (P=0.030). Elevated postoperative C-reactive protein (CRP) was a strong predictor of postoperative diarrhea (P＜0.001). The probability of other complications was significantly higher in patients with diarrhea than in those without diarrhea (36.6% and 14.3%, P=0.001), with a significant impact on the development of late intestinal anastomotic fistula and abdominal infection in particular (P=0.001 and P=0.003). Conclusions Postoperative diarrhea in CRC is independently predicted by high postoperative CRP, hypertension, diabetes mellitus, and rectal resection. Early postoperative diarrhea can cause more serious problems to emerge.

Objective To explore the effect of hierarchical authorization of nurses in management of iatrogenic skin injury in hospita-lized patients.Methods Inpatients at risk of iatrogenic skin injury were divided into a control group（173 237 cases in 2018） and an observation group（205 511 cases in 2019 and 236 742 cases in 2021） in chronological order, respectively subjected to routine ma-nagement or management by hierarchically authorized nurses.Results After implementing hierarchical authorization of nurses in management of iatrogenic skin injury, 81 nurse specialists were trained and authorized.There were significant differences in the incidence rate, degree and outcomes of iatrogenic skin injury between the two groups（all P＜0.05）.Conclusion Implementation of hierarchical authorization of nurses could effectively reduce the incidence rate of iatrogenic skin injury in hospitalized patients, improve the outcome of skin injury, and improve the quality of nursing care.

Background: Insomnia is a common problem among patients with major depressive disorder (MDD). According to previous studies, the development and severity of Insomnia are influenced by childhood trauma experience. Furthermore, negative life events and dysfunctional attitudes may also mediate the impact. So, this study aimed to examine the association between childhood trauma, negative life events, dysfunctional attitudes and insomnia and investigate how negative life events and dysfunctional attitudes mediate the relationship between childhood trauma and insomnia in MDD.Method: This cross-sectional study recruited 621 college students with MDD. The Childhood Trauma Questionnaire (CTQ), Life Event Scale (LES), Dysfunctional Attitude Scale (DAS), Insomnia Severity Index (ISI), and Hamilton Depression Scale-17 (HAMD-17) were used to assess participants' psychosocial factors. Descriptive analysis, Chi-square test, t-test, Pearson correlations, and serial mediation analyses were used in data analysis. In order to eliminate the influence of the severity of depression symptoms, severity of depression symptoms was used as a control variable in this study. Results: There were 166 (26.7%) participants having clinical insomnia (ISI score > 14). After controlling for the effect of severity of depression symptoms, results of serial mediation analyses determined that childhood trauma has a direct (Estimate = 0.109, 95%CI: 0.023,0.190) and indirect (Estimate = 0.090, 95%CI: 0.054,0.137) impact to insomnia. The indirect impact of childhood trauma on insomnia through the pathways of negative life events alone (Estimate = 0.050, 95%CI: 0.024,0.093), dysfunctional attitudes alone (Estimate = 0.027, 95%CI: 0.008,0.050), and negative life events to dysfunctional attitudes (Estimate = 0.013, 95%CI: 0.006,0.024) were significant. Conclusions: This study demonstrates that screening for childhood trauma should be considered when treating insomnia in college students with MDD. Managing negative life events and dysfunctional attitudes may mitigate the negative impact of childhood trauma on insomnia in college students with MDD.