Conectar
by Zhongqun Guo, Qiangqiang Liu, Feiyue Luo, Shaojun Xie, Tianhua Zhou
The acidic leachate injected during the mining process of ion-type rare earth ores can damage the environmental characteristics of the soil, thereby triggering the activation and release of associated heavy metals. Severe Zn contamination has been found in the environment of ion-type rare earth mining areas, but the activation and release of Zn in the soil during the leaching process have not been fully understood. This study investigated the activation and release patterns and mechanisms of Zn in soil under different leaching agents ((NH4)2SO4, MgSO4, Al2(SO4)3) and varying concentrations of Al2(SO4)3 (1%, 3%, 5%, 7%) using a simulated leaching experimental system. The results show that the activation and release patterns of Zn in the soil vary significantly under the influence of the three leaching agents. During the entire leaching cycle, the peak Zn concentration in the leachate was highest under MgSO4 leaching, while the residual Zn content in the soil under Al2(SO4)3 leaching approached the high-risk environmental threshold. The high-concentration systems (5%, 7%) of Al2(SO4)3 significantly enhanced the activation and release efficiency of Zn in the soil compared to the low-concentration systems (1%, 3%) of Al2(SO4)3. (NH4)2SO4 mainly promotes the activation and release of Zn through ion exchange between NH4+ and Zn2+ and the acidification effect; Al2(SO4)3, on the other hand, dominates the activation and release of Zn by providing a strongly acidic environment and dissolving and damaging the mineral lattice; while MgSO4 not only exchanges ions between Mg2+ and Zn2+, but also alters the soil colloidal structure, facilitating Zn activation and release. The promoting effects of the three leaching agents on the transformation of Zn in soil follow the order of Al2(SO4)3> (NH4)2SO4 > MgSO4, with the environmental risk assessment index (RAC) being highest after Al2(SO4)3 leaching, indicating the greatest potential environmental risk. Compared to the other three concentrations (1%, 5%, 7%) of Al₂(SO4)3, the 3% concentration of Al2(SO4)3 had the most significant promoting effect on the transformation of Zn in soil. This study provides a theoretical basis for optimizing the green mining process of ion-type rare earth ores and preventing heavy metal pollution, and offers scientific support for revealing pollution mechanisms and formulating remediation and risk assessment strategies.
by Wenya Bai, Shixuan Liu, Guilin Zhou, Xuelian Li, Huan Jiang, Jianlin Shao, Junchao Zhu
BackgroundMicroglia polarization plays a crucial role in the progression of cerebral ischemia-reperfusion injury (CIRI), but the mechanisms remain largely undefined. The preset study aimed to investigate the mechanism of microglia polarization following CIRI.
MethodsCIRI was modeled in C57BL/6J mice through middle cerebral artery occlusion-reperfusion and in BV2 cells via oxygen and glucose deprivation/reoxygenation. Reverse transcription-quantitative PCR, western blotting, flow cytometry and fluorescence staining were used to detect the expression levels of key proteins associated with microglia polarization, as well as the expression of TNFAIP3 and RACK1. The interaction between TNFAIP3 and RACK1 was verified by co-immunoprecipitation. TNFAIP3 or RACK1 gene interference (overexpression and/or silencing) was employed to examine the role of the TNFAIP3/RACK1 axis in microglia polarization following CIRI.
ResultsThe results revealed that Arg-1 expression decreased, inducible nitric oxide synthase expression increased and TNFAIP3 was upregulated 24 h after CIRI. Furthermore, TNFAIP3 interacted with RACK1 to deubiquitinate and increase the expression of RACK1. These results indicate that knocking down either TNFAIP3 or RACK1 promotes microglia M1 polarization, and overexpression of RACK1 can promote microglia M2 polarization. RACK1 exerts its neuroprotective effects through NF-κB, as demonstrated by the use of NF-κB inhibitors.
ConclusionThe present findings indicate that TNFAIP3 inhibits M1 microglial polarization via deubiquitination of RACK1 after CIRI, RACK1 exerts its effects through NF-κB.
by Jianhua Liao, Jun Cheng, Baoqing Liu, Yuzhi Shao, Chunyan Meng
The growing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections, coupled with the increasing resistance to existing antibiotics, underscores the critical need for novel therapeutic approaches to combat this pathogen. In this study, the role of yqhG, a conserved gene encoding a periplasmic protein, in MRSA virulence and stress adaptation was investigated. yqhG deletion in MRSA significantly attenuated virulence in a murine infection model, leading to reduced bacterial burden in infected organs and improved host survival. In vitro, the yqhG mutant exhibited impaired membrane integrity, reduced motility, and increased sensitivity to oxidative stress, but did not affect biofilm formation. These defects were fully restored upon genetic complementation. These findings highlight the critical role of yqhG in maintaining MRSA’s ability to withstand host-imposed stresses, suggesting that yqhG is a key determinant of MRSA pathogenesis. The study provides new insights into the stress-defense mechanisms employed by MRSA and underscores yqhG as a potential target for therapeutic strategies aimed at combating MRSA infections.
To examine how gender differences in the nursing work environment shape nurses' perceived quality of care and to identify gender-specific predictors and evaluative mechanisms.
A mixed-methods design was employed, integrating quantitative data analysis with qualitative in-depth individual interviews.
This study was conducted in two phases: The first phase was a quantitative analysis, based on a large national dataset from the 2017 Chinese Nursing Work Environment Survey (N = 16,382), in which secondary analysis was performed using hierarchical linear regression, relative importance analysis, and network analysis to identify key predictors. The second phase was a qualitative study, in which in-depth individual interviews were conducted with 30 clinical nurses (15 male and 15 female), and thematic analysis was applied to explore gender-differentiated experiences.
The core finding of this study is that gender-differentiated factors within the work environment significantly shape nurses' perception of care quality. Quantitative results showed that the strongest predictor for female nurses was professional development, whereas recognition of value was most salient for male nurses. Qualitative results corroborated these findings: female nurses emphasised continuing education and emotional support, while male nurses emphasised fair evaluation and professional identity. Both groups reported that high-intensity workloads hindered the delivery of ideal humanistic care, inducing moral distress and emotional suppression and exposing ethical gaps in organisational support.
Gender differences in the nursing work environment shape pathways to perceived care quality and expose deeper managerial and ethical challenges. A gender-sensitive, ethics-oriented management approach can enhance nurse satisfaction and care quality, providing empirical support for optimising workforce allocation and sustaining healthcare systems.
Findings direct nurse leaders to tailor improvement strategies—enhancing professional-development infrastructure for women and strengthening recognition mechanisms for men—while embedding explicit ethical support to reduce moral distress and improve both workforce well-being and patient outcomes.
No patient or public contribution.
by Hua-Hong Wu, Ya-Qin Zhang, Cheng-Dong Yu, Fang-Fang Chen, Jun-Ting Liu, Shao-Li Li, Xin-Nan Zong
BackgroundBrachydactyly type A3 (BDA3), a common finger deformity, demonstrates an inverse epidemiological relationship with population height, suggesting a potential link with individual stature. We aimed to investigate the distribution of BDA3 and its association with shorter stature in Chinese children.
MethodsFrom 2022 to 2023, we conducted a cross-sectional survey in 10 randomly selected schools in Beijing with children aged 3–18. We measured height on-site, obtained left hand-wrist X-rays, calculated predicted adult height (PAH) based on height and bone age, and diagnosed BDA3 deformity based on the X-ray images. And we compared the height and PAH between the BDA3 and Non-BDA3 groups by t-test or chi-square test, examined the association of BDA3 with shorter stature and shorter PAH using binary logistic regression model.
ResultsA total of 5,567 children participated, with 573 diagnosed with BDA3 (a detection rate of 10.3%). Notably, girls exhibited a significantly higher detection rate than boys (14.5% vs. 6.3%). The detection rate in children 12 years(15.3% vs. 7.6%). The average height and PAH were 0.30 SD and 0.22 SD lower, and the risk of shorter stature and shorter PAH were 1.57 times and 1.47 times higher in the BDA3 group than in the Non-BDA3 group, respectively. And, children >12 years in the BDA3 group had a significantly lower PAH than those in the Non-BDA3 group (about 2.0 cm). Conclusion: Children with BDA3 are more likely to have shorter stature and shorter PAH than those with no BDA3 in Chinese children aged 3–18 years.
Chronic low back pain (CLBP) is characterised by multifaceted pathophysiology involving both central sensitisation and peripheral dysfunction. Conventional therapies often fail to address this complexity due to their unidimensional targets. Paired associative stimulation (PAS), a dual-target neuromodulatory approach that combines central and peripheral interventions, has demonstrated efficacy in enhancing motor recovery post-stroke by synchronously inducing corticospinal plasticity and peripheral neuromuscular adaptation. Building on this paradigm, we propose a novel combined primary motor cortex (M1) and multifidus muscle stimulation protocol. The intervention pairs transcranial magnetic stimulation over M1 with peripheral magnetic stimulation targeting the multifidus muscle, hypothesising that temporally coordinated central and peripheral stimulation will synergistically enhance the corticospinal drive to the lumbar spine and restore multifidus neuromuscular control, thereby alleviating pain and improving functional capacity in CLBP.
This study will enrol 82 individuals diagnosed with CLBP between 18 and 65 years of age. Study participants will undergo randomisation into two parallel groups: the experimental arm receiving active PAS therapy (n=41) and the control arm receiving sham PAS treatment (n=41). The intervention protocol consists of 20 treatment sessions delivered across a 4-week timeframe, with participants attending five sessions weekly. Assessment time points are scheduled at study entry (baseline) and 4, 8 and 12 weeks following intervention initiation. The study’s primary outcome is the Oswestry Disability Index (ODI). Secondary outcomes encompass the Visual Analog Scale (VAS), Short-form McGill Pain Questionnaire (SF-MPQ), Short Form 36 Health Survey (SF-36), Pain Catastrophizing Scale (PCS), and functional magnetic resonance imaging (fMRI). Data analysis will adhere to the intention-to-treat methodology. Between-group comparisons across temporal measurement points will employ mixed-effects modelling approaches.
Ethical approval for the research protocol was obtained from the Ethics Committee of Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (approval number: 2025-K-45), with trial registration completed in the China Clinical Trial Registry on 27 April 2025. On study completion, findings will be prepared for submission to peer-reviewed academic publications.
ChiCTR2500101574.
Conventional treatments, like immunosuppressants for systemic lupus erythematosus (SLE), are associated with many side effects. Transcutaneous vagus nerve stimulation (tVNS) emerges as a promising adjunctive therapy, potentially offering a more benign therapeutic avenue for patients with SLE. The increased number of clinical trials, including randomised clinical trials, highlights the importance of a systematic review and meta-analysis to evaluate the efficacy and safety of tVNS in treating SLE. Consequently, the aim of this systematic review and meta-analysis protocol is to synthesise the available evidence to elucidate the efficacy and safety of tVNS for the treatment of SLE.
Databases include PubMed, Cochrane Library, Web of Science, Embase, Wanfang Database, China National Knowledge Infrastructure, VIP Database and Chinese BioMedical Literature Database. Data selection, extraction and quality assessment by two independent reviewers. Fatigue is the primary outcome, and secondary outcomes include pain, quality of life, negative emotions, adverse events and measures of SLE disease activity. We will use instruments appropriate for each study type to assess the risk of bias. The credibility of evidence will be evaluated using the grading of recommendation, assessment, development and evaluation system. For meta-analysis, we will use RevMan software to perform data synthesis (V.5.4.1). Besides, publication bias assessment, sensitivity, subgroup and meta-regression analyses will be conducted as appropriate.
All data used in our study will be extracted from published clinical trials and, therefore, no ethical approval is required. Study results will be disseminated through peer-reviewed journals and relevant academic conferences.
PROSPERO CRD42024525580.
To assess the knowledge, attitudes and practices (KAP) of male relatives of pregnant women regarding labour pain and analgesia.
A cross-sectional study.
Conducted at a maternal hospital in eastern China from 28 December 2023, to 3 April 2024.
Male relatives who accompanied pregnant women during antenatal registration visits.
Primary outcome: KAP levels. Secondary outcomes: demographic and social factors associated with KAP.
Among 547 invited participants, 533 responded (response rate: 97.4%). Of these, 94.1% were spouses. Median KAP scores were 5.00, 30.00 and 21.00. Most participants lacked knowledge about labour analgesia and had safety concerns. Structural equation modelling showed knowledge had a direct effect on attitude (β=0.577, 95% CI 0.483 to 0.671) and an indirect effect on practice via attitude (β=0.602, 95% CI 0.463 to 0.740). Multivariate analysis identified associations between knowledge and education (OR=3.705, 95% CI 2.136 to 6.425), religious belief (OR=0.268, 95% CI 0.095 to 0.756) and delivery cost awareness (OR=0.175, 95% CI 0.045 to 0.675). Knowledge (OR=1.076, 95% CI 1.016 to 1.139) and attitude (OR=1.457, 95% CI 1.337 to 1.588) predicted practice.
Male relatives showed limited knowledge, overall negative attitudes, but also showed compassion and concern, and insufficient practice and inadequate practices regarding labour pain and analgesia. Educational strategies targeting male relatives are needed to improve perinatal support.
Urolithiasis represents a significant global health burden. Comparing incidence trends between countries with distinct socioeconomic profiles, such as the United States and China, is crucial for tailoring public health strategies. This study aimed to characterise and compare the temporal trends of urolithiasis incidence in the United States and China from 1992 to 2021, thereby providing insights for global disease management.
Data on urolithiasis incidence in the United States and China from 1992 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 study. First, we utilised joinpoint regression analysis to quantify the magnitude and identify significant turning points in age-standardised incidence rate trends over the study period. Second, an age-period-cohort model (APC model) was applied to assess the independent influence of age, period and cohort effects on incidence. Finally, the Nordpred model was employed to project the incidence trends for the next decade.
From 1992 to 2021, the overall incidence of urolithiasis in the United States decreased, but has recently shown an increase; in China, there was a significant reduction. According to the APC model, the highest risk was observed among middle-aged and elderly individuals in these countries. The period and cohort effects in China showed a decline. In the United States, the period effect initially declined but has recently shown an increase; cohort effect peaked around 1930, then declined and also increased in recent years. Over the next decade, the incidence of urolithiasis in both countries was expected to increase.
This study analysed the temporal trends in urolithiasis incidence over the past 30 years in the United States and China. Both countries experienced notable advancements in the burden of urolithiasis; however, the risk of an increased incidence remained higher in the United States.
Immunotherapy combined with chemotherapy has shown potential in improving the pathological complete response (pCR) rate in luminal-type breast cancer. This study explores whether the addition of stereotactic body radiotherapy (SBRT) and the bispecific antibody AK112 (Ivonescimab) further enhances treatment efficacy.
This is a single-centre, prospective, phase II trial using Simon’s two-stage design to evaluate the efficacy and safety of neoadjuvant SBRT combined with Ivonescimab and chemotherapy. A total of 50 patients will be enrolled. The primary endpoint is pCR. Secondary endpoints include objective response rate, disease control rate, Residual Cancer Burden Index, 12-month event-free survival, safety and quality of life. Exploratory endpoints include six-point minimal residual disease (MRD) assessment. Data will be analysed using the Kaplan-Meier method and one-sided exact binomial test (alpha=0.05).
This study has been approved by the ethics committee of Hubei Cancer Hospital (Approval No.: LCKY2024011). Results will be disseminated through peer-reviewed journals and conference presentations.
Advanced-stage hepatocellular carcinoma (HCC) with high tumour burden and portal vein tumour thrombus (PVTT) is usually associated with poor survival outcomes. Rapid tumour control usually benefits long-term outcomes, which could be hardly achieved by solely systematic targeted and immunotherapy in current guidelines. Hepatic arterial infusion chemotherapy (HAIC) is reported as an effective intervention for rapid decrease of tumour burden. In order to determine the role of HAIC in the comprehensive treatments, a target trial emulation study is conducted to compare the effectiveness and safety of HAIC in combination with lenvatinib and programmed death receptor-1 (PD-1) inhibitors (H+L+P) to that of lenvatinib and PD-1 inhibitors (L+P) in patients with advanced HCC exhibiting high tumour burden and PVTT.
This target trial emulation study will be conducted at nationwide, multicentre CHANCE registries in China. We aim to include at least 228 patients with advanced-stage HCC with high tumour burden (up-to-seven criteria out) and PVTT who received L+P with or without HAIC as the first-line treatment between January 2021 and December 2023. The study design adheres to the framework of target trial emulation. To mitigate biases, a stabilised inverse probability of treatment weighting will be conducted. Overall survival is defined as the primary endpoint. Secondary endpoints consist of progression-free survival, objective response rate and adverse events.
Our study was approved by the Medical Research Ethics Committee of the First Hospital of China Medical University, and the study protocol was also approved by the institutional review boards of participating centres. The ethics committee waived informed consent because the study was retrospective. The findings of this study will be submitted for publication in peer-reviewed journals and will also be shared at multiple conferences on interventional radiology and oncology, ranging from local to international.
by Bijuan Chen, Zhouwei Zhan, Sisi Yu, Jiali Huang, Chuying Chen, Jie Wang, Jianji Pan, Shaojun Lin, Yun Xu
BackgroundLaryngeal cancer attributable to occupational asbestos exposure remains a significant public health concern, particularly in industrialized regions. This study analyzes the burden, trends, and contributing factors of laryngeal cancer due to asbestos exposure in China from 1990 to 2021.
MethodsData were obtained from the Global Burden of Disease Study (1990–2021). We analyzed age-standardized death rates, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Temporal trends were assessed using joinpoint and decomposition analyses, and an age-period-cohort (APC) model was applied to examine mortality and DALY trends across different cohorts.
ResultsIn 2021, there were 234 deaths and 4,430 DALYs due to laryngeal cancer attributable to occupational asbestos exposure, predominantly affecting males. Mortality rates declined from 1990 to 2008, followed by a rise until 2012, and a subsequent decline. YLDs showed a consistent increase over time. APC analysis revealed higher mortality and DALY rates in older age groups and earlier birth cohorts. Decomposition analysis indicated that epidemiological changes were the largest driver of increased deaths in men, followed by population growth and aging. For DALYs, aging and population growth were key drivers, while epidemiological changes mitigated the burden.
ConclusionsThe burden of laryngeal cancer attributable to asbestos exposure has declined overall, but disability rates continue to rise, particularly among males. Effective strategies targeting prevention, early detection, and management of asbestos exposure are needed to reduce the disease burden in China.
To explore the network characteristics of symptom clusters in people with type 2 diabetes mellitus through network analysis, identify the core and bridging symptoms within the symptom network, and provide a foundation for targeted interventions and symptom management in people with T2DM.
A cross-sectional survey.
A total of 360 people with T2DM who were hospitalised in the endocrinology departments of two hospitals with Grade A in Daqing City between August 2024 and February 2025 were selected using a convenience sampling method. The symptoms of people with T2DM were measured using the Chinese version of the Diabetes Symptom Checklist-Revised (DSC-R). Symptom clusters were identified through factor analysis, and network analysis was used to identify core and bridging symptoms. This research adhered to the STROBE guidelines.
Six symptom clusters were obtained from factor analysis, which were psychological-behavioural symptom cluster, ophthalmological-neuropathy symptom cluster, cardiovascular symptom cluster, metabolic symptom cluster, body symptom cluster and nephrotic symptom cluster. Symptom network analysis revealed that ‘Deteriorating vision’ exhibited the highest strength centrality and expected influence. The top three symptoms with the highest bridge strength and bridge expected influence were ‘Aching calves when walking’, ‘Queer feeling in the legs or feet’ and ‘Sleepiness or drowsiness’.
People with T2DM commonly exhibit a range of symptoms. ‘Deteriorating vision’ is the most core symptom in people with T2DM. ‘Aching calves when walking’, ‘Queer feeling in the legs or feet’ and ‘Sleepiness or drowsiness’ are identified as the bridging symptoms in the network analysis. Healthcare professionals can design targeted interventions based on symptom clusters, core symptoms and bridging symptoms, thereby improving the efficiency of symptom management and optimising outcomes for people with T2DM.
No patient or public contribution.
The magnitude and persistence of diseases and multimorbidity between females and males are different. This study comprehensively quantified sex differences in the onset and progression of 108 major physical and mental diseases to multimorbidity through adulthood in Chinese population.
Quantitative analysis of real-world linked electronic health records.
Linked health records from 160 health facilities across primary, secondary and tertiary healthcare, comprising routinely collected electronic health records from the whole urban residents of Yichang, China between 1 January 2016 and 31 December 2019.
684 455 urban residents aged 20 years and above with documented health records during the study period.
The cumulative incidence, relative risks (RR) and 95% CIs, period prevalence, median age at disease diagnosis and the prevalence of multimorbidity of 108 major physical and mental diseases were computed. All analyses were stratified by sex and age groups.
The analysis included 684 455 individuals (54.8% females, mean age: 46.9), among whom 46.3% had multimorbidity, with a higher prevalence in females (47.6%) than males (44.9%). The chronological disease map revealed stark differences between females and males, with notable lower risk of obstructive sleep apnoea-hypopnoea syndrome (OSAHS, RR: 0.03, 95% CI: 0.01 to 0.11) for young adults, oesophageal cancer (RR: 0.02, 95% CI: 0.0 to 0.17) for mid-age adults and remarkable higher risk of lupus (RR: 8.8, 95% CI: 2.7 to 29.0) for older adults of females. Males exhibited an incidence surge in hypertension, diabetes, coronary disease and chronic obstructive pulmonary disease a decade earlier than females, while females had a life-long higher prevalence in immune-mediated diseases and urinary disorders. For the new incident diseases, the manifestation of eating disorders, anaemia and urinary incontinence was recorded 20 years earlier in females; whereas, males were diagnosed with hyperuricaemia, OSAHS and schizophrenia at younger ages.
The significant variations in disease nature and trajectory between sexes underscore the urgent needs for tailored prevention strategies and appropriate health resources allocation. Sex differences in disease profile should be considered to delay disease and multimorbidity progression, ultimately promoting health equity.
To explore the heterogeneity of disease-specific anxiety profiles among patients with chronic obstructive pulmonary disease (COPD) using latent profile analysis (LPA), and to identify the associations between distinct anxiety subtypes and inhaler medication adherence in patients with COPD.
Adherence to inhaled medication among patients with COPD continues to be suboptimal. Anxiety, a common comorbidity, may exacerbate this issue. However, the specific relationship between anxiety and adherence to inhaled medications remains unclear.
A prospective cohort study was conducted following the STROBE Checklist.
A prospective observational study employed the Anxiety Inventory for Respiratory Disease (AIR) to assess disease-specific anxiety in patients with COPD. Inhaler medication adherence was evaluated using the Test of Adherence to Inhalers (TAI) 6 months after initiating treatment. Latent Profile Analysis (LPA) was performed to identify distinct anxiety subtypes. Multiple linear regression analysis was conducted to examine the associations between identified anxiety subtypes and adherence dimensions, adjusting for sociodemographic and clinical variables.
Among 298 COPD patients, the overall AIR score was 5 (IQR: 2–11). Using LPA, three distinct anxiety subtypes were identified: Low Anxiety—Irritable Subtype (57.05%), Moderate Anxiety—Tense Subtype (26.85%) and High Anxiety—Anticipatory Subtype (16.10%). Through multiple linear regression analysis, the High Anxiety—Anticipatory Subtype was significantly associated with lower inhaler medication adherence among COPD patients.
This study revealed three latent profiles of disease-specific anxiety among COPD patients. The High Anxiety–Anticipatory Subtype was associated with a lower inhaler medication adherence in individuals with COPD after initiating treatment.
Identifying the relationship between disease-specific anxiety and inhaler medication adherence in patients with COPD after initiating treatment underscores the need for healthcare providers to assess anxiety during patient visits and prioritise patients with high anticipatory anxiety. When high anxiety adversely affects inhaler medication adherence, targeted interventions should be developed to improve adherence and prognosis.
No patient or public contribution.
To explore frail older adults' preferences and needs regarding mobile health (mHealth) exercise interventions in China. Additionally, it sought to identify the nudge strategies necessary for initiating and sustaining exercise behaviours among frail older adults.
A qualitative study.
The semi-structured interviews were conducted between April and May 2024 from two communities in Changsha, China. The data were analysed using a deductive framework analysis aligned to nudge theory, and an inductive thematic analysis to gather relevant needs and preferences.
This study involved 14 participants with pre-frailty or frailty, aged 60–82 years (median age of 64 years). While participants were generally receptive to new technologies, lower levels of health literacy and competing priorities often hindered their participation. Three primary functionality requirements were as follows. (1) Profession engagement: tailored exercise prescription, professional and timely feedback and guidance; (2) personalised knowledge encompassing pain management, successful cases and inspiration; (3) beneficial, tailored, dynamic, fragmented, challenging exercise courses. Participants showed positive attitudes towards simplification nudges, gamification nudges, social nudges, trustworthy nudges, reminder nudges, economic nudges, feedback nudges and pre-commitment nudges. Addressing privacy concerns was essential to build trust and acceptance among older adults.
These findings emphasised the importance of designing mHealth interventions that address frail older adults' specific needs and preferences while incorporating effective nudge strategies to promote engagement and adherence. Future researchers should explore wearables, ChatGPT language models, virtual coaching assistants, exercise snack to further optimise the experience and analyse the effects of nudges in mHealth exercise interventions among older adults.
Exercise systems or app development for frail older adults should meet three basic functionality and essential nudge strategies.
The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting.
Older adults' engagement and interview data contribute a lot.
To classify the unmet integrated care needs of older adults with multimorbidity and to explore the factors associated with different categories of unmet integrated care needs among the target population.
A cross-sectional survey using the statistical method of latent profile analysis.
From July 2022 to March 2023, 397 older adults with multimorbidity, aged 60 years or older, were recruited from one primary healthcare setting and from four secondary and tertiary hospitals to participate in face-to-face questionnaire surveys. The questionnaire used in this study to assess unmet integrated care needs among older adults with multimorbidity was self-designed through a series of steps, including a scoping review, expert consultation and cognitive interviews. Latent profile analysis was applied to uncover distinct profiles of unmet integrated care needs, and multinomial logistic regression was employed to explore whether the profiles were further distinguished by participants' sociodemographic and health-related covariates. The data were analysed using IBM SPSS v.29.0 and Mplus v.8.0.
The optimal solution was a four-profile model, characterised by high unmet integration needs, high unmet system integration needs, low unmet system integration needs and low unmet integration needs, respectively. Multinomial logistic regression results indicated that profile differences were associated with place of residence, number of coresidents and the presence or absence of complex multimorbidity.
The integrated care needs of older adults with multimorbidity have not yet been fully met. Classifying and characterising unmet integrated care needs profiles is a crucial step in the rational allocation of integrated care resources.
This study was reported based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for cross-sectional studies.
All participants were older adults with multimorbidity, and they were informed that they could withdraw from the study at any time.
This study aimed to investigate the effects of glycaemic control and diabetes distress on frailty in older Chinese patients with diabetes, and to explore the mediating role of diabetes distress between glycaemic control and frailty.
This is a descriptive, cross-sectional study. A total of 209 older patients with diabetes were recruited from a teaching hospital in Zhejiang Province. Data were collected from February to September 2022.
A self-designed questionnaire was used to collect demographic and disease-related data. The Fried Scale and Diabetes Distress Scale were employed to assess frailty and diabetes distress, respectively The bootstrap method was used to examine the mediating effects of diabetes distress on glycaemic control and frailty. The STROBE checklist was adhered to in the reporting of this study (see details in File S1).
The findings indicated a positive correlation between the level of glycaemic control and frailty, as well as between diabetes distress and frailty. Furthermore, diabetes distress was found to play a complete mediating role between glycaemic control and frailty.
The study findings highlight the relationship between glycaemic control, diabetes distress and frailty offering a valuable reference for enhancing the management of frailty in older patients with diabetes.
This study emphasizes the significance of managing glycaemic control and diabetes distress in older patients with diabetes to prevent frailty, and may contribute for healthcare professionals to developing effective measures to improve the frailty of older diabetic patients in clinical settings.
This study was conducted with the participation of older patients with diabetes who contributed data by completing study questionnaires and undergoing physical assessments.
To investigate the prevalence of physical inactivity in older adults living in nursing homes and explore the determinants of physical inactivity by using the Capability, Opportunity, Motivation–Behaviour model.
A multisite, cross-sectional study was performed by convenience sampling and questionnaire survey.
A total of 390 nursing home residents were recruited from three nursing homes in Southern China from May 2022 to April 2023. The participants completed a self-designed general information questionnaire, Physical Activity Scale for the Elderly, Self-Efficacy for Exercise Scale, Exercise Benefits Scale, Patient Health Questionnaire-9 and the Short Physical Performance Battery test. Descriptive statistics, univariate analysis, Spearman correlation analysis, and ordinal logistic regression were applied for data analysis.
The prevalence of physical inactivity among the nursing home residents reached 88.46%. Ordinal logistic regression results showed that exercise self-efficacy, perceived exercise benefits, physical function, availability of physical activity instruction, having depression, number of chronic diseases and living with spouse were the main influencing determinants of physical inactivity and explained 63.7% of the variance.
Physical inactivity was considerable in nursing home residents in China and influenced by complex factors. Tailored measures should be designed and implemented based on these factors to enhance physical activity while considering the uniqueness of Chinese culture.
Healthcare professionals should enhance physical activity of residents by increasing benefits understanding, boosting self-efficacy, improving physical function, alleviating depression and integrating personalized physical activity guidance into routine care services. And more attention should be paid to the residents who had more chronic diseases or did not live with spouse.
Physical inactivity is a significant problem in nursing home residents. Understanding physical inactivity and its determinants enables the development of tailored interventions to enhance their physical activity level.
This study was reported conforming to the STROBE statement.
Nursing home residents who met the inclusion criteria were recruited.
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