The Relationship Between Social Isolation and Cognitive Frailty Among Community-Dwelling Older Adults: The Mediating Role of Depressive Symptoms.

Purpose: Social isolation and depression have an impact on cognitive frailty. However, the underlying mechanisms between these variables have not been well defined. This study aims to investigate the mediating role of depressive symptoms in the association between social isolation and cognitive frailty among older adults in China. Methods: From Mar 2023 to Aug 2023, a cross-sectional study was conducted with 496 community-dwelling older adults aged ≥60 years in Nanjing, Jiangsu Province, China. Demographic information was collected using the General Information Questionnaire. The Lubben Social Network Scale-6 (LSNS-6), Geriatric Depression Scale 15-item (GDS-15), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and FRAIL scale were used for the questionnaire survey. Multiple linear regression and binary logistic regression were utilized to explore the associations among social isolation, depressive symptoms, and cognitive frailty, and Bootstrap analysis was used to explore the mediating role of depressive symptoms in social isolation and cognitive frailty. Results: Linear regression results revealed that social isolation was positively associated with depressive symptoms (ß = 0.873, p < 0.001). Logistic regression analysis showed that social isolation (OR = 1.769, 95% CI = 1.018~3.075) and depressive symptoms (OR = 1.227, 95% CI = 1.108~1.357) were significantly associated with cognitive frailty. Mediation analysis demonstrated that depressive symptoms significantly mediated the relationship between social isolation and cognitive frailty, with an indirect effect of 0.027 (95% CI = 0.003~0.051), and the mediating effect accounted for 23.6% of the total effect. Conclusion: Social isolation is associated with cognitive frailty in community-dwelling older adults, and depressive symptoms partially mediate the effect between social isolation and cognitive frailty. Active promotion of social integration among older individuals is recommended to enhance their mental health, reduce the incidence of cognitive frailty, and foster active aging.

Latent Class Analysis of Sleep in Mild Cognitive Impairment Patients and its Influencing Factors.

Background: Individuals with mild cognitive impairment (MCI) frequently experience sleep disorders, which may elevate the risk of developing Alzheimer's disease. Yet, sleep types in MCI patients and the factors influencing them have not been sufficiently investigated. Objective: The objective of this study was to explore potential sleep typing and its influencing factors in patients with MCI using latent class analysis. Methods: A cross-sectional survey was conducted in Jiangsu Province, China. Cognitive function in older adults was assessed using neuropsychological tests, including the Montreal Cognitive Assessment Scale-Beijing version (MoCA), the Mini-Mental State Examination (MMSE), the Activities of Daily Living Scale (ADL), and the Clinical Dementia Rating Scale (CDR). Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Latent class analysis based on PSQI scores and multinomial logistic regression analyses were employed to explore the influencing factors of sleep typing. Results: The study included a total of 611 patients with MCI. Latent class analysis identified three latent classes to categorize the sleep patterns of MCI patients: the good sleep type (56.6%), the insufficient sleep type (29.6%), and the difficulty falling asleep type (13.7%). Potential sleep typing is influenced by gender, chronic disease, physical exercise, social activity, brain exercise, smoking, frailty, subjective cognitive status, and global cognitive function. Conclusions: The findings of this study underscore the notable heterogeneity in the sleep patterns of patients with MCI. Future research may provide targeted prevention and interventions to address the characteristics and influencing factors of patients with different subtypes of sleep MCI.

Staff's experiences of a culturally specific DEmentia Competence Education for Nursing home Taskforce (DECENT) programme: A qualitative process evaluation.

AIM: To understand participants' experiences with a culturally specific DEmentia Competence Education for Nursing home Taskforce programme within the contexts which was delivered. DESIGN: An exploratory descriptive qualitative approach. METHODS: Semi-structured individual interviews were conducted within one week with the participants upon their completion of the programme from July 2020 to January 2021. A purposive sample of participants with different demographic characteristics in five nursing homes was recruited to maximize the sample variation. Interviews were audiotaped and transcribed verbatim for qualitative content analysis. Participation was on voluntary and anonymous basis. RESULTS: Four major themes were identified, including perceived benefits of the programme (i.e., enhanced sensitivity to the needs of residents with dementia, increased communication with families of residents with dementia, facilitated guidance on care for residents with dementia), facilitators (i.e., comprehensive content, active learning, qualified trainer, intrinsic motivation and organizational support), barriers (i.e., busy working schedules, discrimination against care assistants' learning capability) and suggestions for improvement. CONCLUSION: The results suggested the acceptability of the programme. The participants positively appraised the programme in enhancing their dementia-care competence. The facilitators, barriers and suggestions identified provide insights on improving programme implementation. IMPACT: The qualitative findings from the process evaluation are pertinent to support the sustainability of dementia competence programme in nursing home setting. Future studies could address the modifiable barriers to enhance its effectiveness. REPORTING METHOD: This study was reported in adherence to the Consolidated criteria for reporting qualitatve studies (COREQ) checklist. PATIENT AND PUBLIC CONTRIBUTION: Nursing-home staff was involved in intervention development and delivery. IMPLICATIONS FOR PRACTICE/POLICY: The educational programme could be integrated into the routine practice in nursing homes to improve staff's dementia-care competence. More attention should be paid on the educational needs of the taskforce when implementing the educational programme in nursing homes. Organizational support is the precondition for the educational programme and cultivates a culture for practice change.

Evaluating the Risk of Social Isolation in Older People: AHP-Fuzzy Comprehensive Evaluation.

Background: Social isolation is a serious and pervasive health issue among older people, and it is difficult to identify and assess effectively. Based on a thorough and scientific evaluation index system, AHP-Fuzzy comprehensive evaluation could be a valuable technique. Objective: It is crucial to establish interventions that focus on risk factors for the prevention of social isolation in order to give a strong scientific foundation for enhancing older people's health habits. This can be achieved by using a fuzzy comprehensive evaluation method to assess the risk of social isolation in older people. Methods: A hundred community members over 60 from Nanjing were selected as the evaluation subjects in China. After the element layer was split into three categories of "social risk, economic risk, and cultural risk" using the analytic hierarchy process approach, a total of 22 assessment indicators were picked to develop a risk evaluation index system. Results: The risk level of social isolation belonging to the "low risk, relatively low risk, medium risk, relatively high risk, high risk" of membership degree are respectively "0.3392, 0.2632, 0.2257, 0.1069, 0.0650". Fuzzy comprehensive evaluation analysis showed that social relations (0.4934), monthly income (0.4654), health status (0.5960) were significant factors of social isolation risk in older people. The results showed that factors related to social risk had the most significant impact on social isolation. Conclusion: It is scientific and feasible to construct the risk evaluation index model of social isolation risk for the elderly by using AHP-Fuzzy comprehensive evaluation method. In preventing social isolation of older people in the future, we should pay attention to the impact of social and cultural factors on them, and provide practical intervention programs and references from the government, community, family.

A variant of RAG1 gene identified in severe combined immunodeficiency: a case report.

BACKGROUND: The recombination-activating gene 1 (RAG1) protein is essential for the V (variable)-D (diversity)-J (joining) recombination process. Mutations in RAG1 have been reported to be associated with several types of immune disorders. Typical clinical features driven by RAG1 variants include persistent infections, severe lymphopenia, and decreased immunoglobulin levels . CASE PRESENTATION: In this study, a 2-month-24-days-old infant with recurrent fever was admitted to our hospital with multiple infections and absence of T and B lymphocytes. The infant was diagnosed with severe combined immunodeficiency (SCID). A homozygous variation c.2147G>A (NM_000448.2: exonme2: c.2147G>A (p.Arg716Gln)) was identified in the RAG1 gene using whole-exome sequencing and Sanger sequencing. The predicted 3D structure of variant RAG1 indicated altered protein stability. Additionally, decreased expression of variant RAG1 gene was detected at both the mRNA and protein levels. CONCLUSIONS: Our study identified a novel homozygous variant in RAG1 gene that causes SCID. This finding expands the variant spectrum of RAG1 in SCID and provides further evidence for the clinical diagnosis of SCID.

Current situation and factors influencing elderly care in community day care centers: a cross-sectional study.

Background: The latest census data show that people over 60 years of age account for about 18.7% of the total population in China, and the aging of the population has become an irreversible trend in the 21st century. This study aimed to investigate the current status and factors influencing the care of the elderly in community day care centers in order to lay the foundation for the development of better services in community day care centers. Methods: This study was a cross-sectional survey using convenience sampling in Nanjing, China. The survey instrument was the Day care and Elderly Care Service Needs Questionnaire, which included the Ability of Daily Living Assessment (ADL), the Xiao Shuiyuan Social Support Rating Scale (SSRS) and the Day care Elderly Care Service Needs Survey Form, and a general information survey. Results: A total of 450 elderly people in day care centers were surveyed. The elderly had different levels of demand for day care services, especially regarding daily care. Correlation analyses indicated that age (r = 0.619), education level (r = 0.616), source of income (r = 0.582), caregiver (r = 0.557), satisfaction with care service (r = 0.603), and degree of ADL (r = 0.629) were correlated with the need for elderly day care services (all p < 0.05). The factors influencing the demand for day care services encompassed age, education level, income source, caregiver, satisfaction with service, and ADL (all p < 0.05). Conclusion: Elderly care services in community day care centers are mainly based on daily and spiritual comfort, and the needs of the elderly are influenced by many factors. Timely nursing care policies and measures that target these factors are needed to improve elderly care.

Nurse managers' burnout and organizational support: The serial mediating role of leadership and resilience.

AIMS: To investigate the relationship between organizational support and nurse managers' burnout and the serial multiple mediating effects of leadership and resilience. BACKGROUND: Nurse managers are at a high risk of burnout, especially during the COVID-19 pandemic. However, no research has been done to examine the associations between nurse managers' organizational support, leadership, resilience and burnout. METHODS: This cross-sectional study recruited 458 nurse managers from 13 tertiary public hospitals in Jiangsu, China. They completed the Survey of Perceived Organizational Support, the Clinical Leadership Survey, the Resilience Scale and the Maslach Burnout Inventor-Human Service Survey. The serial mediating effect of individual leadership and resilience was estimated using the structural equation modelling method via Mplus 7.0. RESULTS: There were direct and indirect effects of organizational support on burnout, controlling for work variables. Leadership and resilience serially mediate the association between organizational support and burnout (ß = -.051, 95% confidence interval: -0.093 to -0.020). CONCLUSIONS: Among nurse managers, organizational support may be sequentially associated with improved leadership first and then resilience, which in turn is related to decreased burnout. IMPLICATIONS FOR NURSING MANAGEMENT: We recommend that hospital administrators incorporate leadership, resilience and burnout assessment in the routine psychological screening of nurse managers and creatively apply the organizational interventions to decrease nurse managers' burnout.

Construction of path analysis model on related factors of social isolation in older people.

BACKGROUND: With the gradual acceleration of population ageing, social isolation in older people has increasingly become a hot topic of social concern. The reduction of valid social participation will cause older people to weaken their sense of belonging to the community and social acquisition, negatively impacting on older people's quality of life. This study is aimed to explore the main related factors affecting the social isolation of older people, so as to provide a solid scientific basis for improving the health behaviour of older people in China. METHOD: A cross-sectional study was conducted among 2267 community residents over 60 years old from four cites in Jiangsu Province, China. Perceived social support scale, Geriatric Depression Scale, Connor-Davidson Resilience Scale, Comprehensive Ability of Older People Assessment Scale and other influencing factors scales were used to investigate the current situation. Social isolation was measured with the Lubben Social Network Scale. Demographic data were evaluated using descriptive statistical analyses and relationships among study variables were determined to use a path analysis. All data were analyzed using SPSS version 22 and AMOS version 26 using T-test, analysis of variance, logistic regression analyses, and path analysis method. The test level was set at alpha = 0.05, and the difference was statistically significant at P-value <0.05. RESULTS: The results of the model test analysis indicated that the hypothesised paths were supported by data from our samples and demonstrated significance on the path coefficients (P < 0.05). Related factors in the three dimensions of social risk, economic risk and cultural risk have an impact on the social isolation of older people in the community through direct and indirect pathways, and also indirectly through the partially mediated role of depression. Overall, our hypothesised model was retained, indicating empirical support and adequate model fit indices for the theoretical model. CONCLUSION: The findings demonstrated the predictive role of related factors of social isolation in older people. In the future, we should focus on developing interventions by uniting many forces such as society, family and older people themselves to reduce social isolation among this vulnerable population and improve the quality of life of older people and promote healthy ageing.

Relationship between risk perception of COVID-19 and job withdrawal among Chinese nurses: The effect of work-family conflict and job autonomy.

AIM: The aim of this study was to examine the mediating role of work-family conflict and the moderating role of job autonomy on the association between risk perception of COVID-19 and job withdrawal among Chinese nurses during the initial disease outbreak. BACKGROUND: Nurses' job withdrawal can not only reduce the quality and efficiency of care but also give rise to turnover during the COVID-19 pandemic. Thus, it is essential to clarify how and when the risk perception of COVID-19 influences the job withdrawal behaviours of nurses and to provide guidelines for reducing nurses' job withdrawal. METHODS: A two-wave study was conducted among 287 Chinese nurses from 11 COVID-19-designated hospitals during the initial outbreak of the disease from March through April 2020. Data on the risk perception of COVID-19, job autonomy and work-family conflict were collected at time 1, and 1 month later, job withdrawal data were collected at time 2. Model 4 and Model 14 from SPSS macro PROCESS were used to test the mediating effect of work-family conflict and the moderating effect of job autonomy, respectively. RESULTS: Work-family conflict mediated 60.54% of the relationship between risk perception of COVID-19 and job withdrawal. Job autonomy positively moderated the relation between work-family conflict and job withdrawal (ß = 0.12, P < 0.01). CONCLUSION: Risk perception of COVID-19 influenced nurses' job withdrawal through work-family conflict. Job autonomy exaggerated the association between work-family conflict and job withdrawal. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should provide more supportive resources to help nurses cope with the risk of COVID-19 to decrease work-family conflict and job withdrawal, and they should strengthen supervision over the work processes of nurses.

A critical assessment of the potential vertical transmission hypotheses: Implications for research on the early-life infection with COVID-19.

The risk of potential vertical transmission in SARS-CoV-2 infected pregnant women is currently a topic of debate. To explore the correlation between the two, we searched PubMed, Embase®, and Web of Science for studies on vertical transmission of COVID-19. The quality of the studies was evaluated by the Cochrane risk of bias tool. Detailed information of each included case including methods of delivery, protection measures for mothers and neonates at birth, types of specimens, inspection time, results of testing and feeding patterns was collected to assess the possibility of vertical transmission. The results showed that of the 390 neonates reported in 36 studies, 23 were infected with SARS-CoV-2 by potential vertical transmission. From the perspective of virology and pathology, vertical transmission of SARS-CoV-2 was possible via uterus or breastmilk. Some reported potential vertically transmitted neonates could be attributed to horizontal transmission. It is extremely vital to fully elucidate the potential routes of transmission of SARS-CoV-2, implicating clinical practice and nursing to reduce the risk of not only horizontal transmission but also vertical transmission, thus protecting neonates from COVID-19 infection.

Hirudin protects against isoproternol-induced myocardial infraction by alleviating oxidative via an Nrf2 dependent manner.

Oxidative stress plays a critical role in the progression of myocardial injury. Increasing evidence suggests that hiruidin can treat patients with cardio-injury. However, the mechanism of hirudin against myocardial infraction remains unknown. In the present study, we evaluated the potential role and mechanism of hirudin on both isoproterenol (ISO)-induced myocardial infraction (MI) in rats and Hypoxia-Reoxygenation model in H9C2 cells. Compared with the model group, hirudin apparently decreased the levels of myocardial Creatine Kinase Isoenzyme-MB (CK-MB), lactate dehydrogenase (LDH), and alleviated myocardial histopathological changes induced by ISO injection. The underlying mechanisms were revealed by the following observations: Hirudin exerted its cardioprotective effect via restoring super oxide dismutase (SOD), attenuating reactive oxygen species (ROS) and malondialdehyde (MDA). It induced the activation of Nuclear factor erythroid 2-related factor 2 (Nrf2) signal pathway through disrupting Keap1-Nrf2 complex, thus Nrf2 translocated from cytoplasm to nucleus to regulate Nrf2-dependent gene (HO-1, SOD) expressions. Furthermore, it should be noted that hirudin restored mitochondrial membrane potential in addition to cytochrome C-related apoptosis.

Effectiveness of Auricular Acupressure for Acute Postoperative Pain after Surgery: A Systematic Review and Meta-Analysis.

OBJECTIVE: To identify the effectiveness of auricular acupressure (AA) in patients with acute postoperative pain after surgery by systematic review. METHODS: A search of randomized controlled trials was conducted in 5 English medical electronic databases and 4 Chinese databases. Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. Meta-analyses were performed using all time-points meta-analysis. RESULTS: A total of 26 studies with 1,682 participants were included. Results showed that compared with conventional therapy, AA significantly improved the total effective rate [risk ratio=1.25, 95% confidence interval (CI), 1.13 to 1.37, Plt;0.0001; heterogeneity: Plt;0.0001, I2=85%]. In the subgroup analysis, the results changed in different follow-up time and surgery categories. The pain relief in the AA group might be the most significant at 72 h after surgery (mean difference=-0.85, 95% CI,-1.20 to-0.50, Plt;0.0001) and in abdominal surgery (mean difference=-1.15, 95% CI,-1.41 to-0.90, Plt;0.0001). Sensitivity analysis demonstrated that the results of this meta-analysis were stable. No serious adverse effects were recorded. CONCLUSION: It was recommended to provide AA to patients with acute postoperative pain. However, a more accurate estimate of the effect requires further rigorously designed large-scale and high-quality RCTs for improving acute postoperative pain after surgery.

Optimizing evacuation efficiency under emergency with consideration of social fairness based on a cell transmission model.

Traffic assignment and management objectives are considered as two significant parts in developing the emergency evacuation plan, which can directly influence the evacuation performance and efficiency. From the perspective of disaster response operators, the evacuation objective frequently is to minimize the total evacuation time to reduce losses, which may lead to an unreasonable and unfair phenomenon where people in highest risk areas may be forced to sacrifice their priorities of evacuation to improve the system evacuation efficiency. In this paper, considering both efficiency and social fairness in emergency evacuation, a weight function consisting of risk evaluation index as variable and the emphasis degree of managers on social fairness principle as coefficient was initially proposed and embedded in system optimal (SO) objective function. Combining the weight function and other constraints based on an extended cell transmission model (CTM), the linear program (LP) model was established to realize the simulation of dynamic traffic assignment in emergency evacuation. Employing this model, the impact of the management strategy of balancing both efficiency and social fairness on evacuation results was studied in the "Tianjin Explosions" case. In the end, the conclusion of "balancing social fairness is valuable during evacuation" was obtained.

Redesigning the patient classification system in China: A pilot study.

The current prototype patient classification system in China has not been updated for over six decades. In the present study, we adopted a hybrid patient classification method using both disease severity and activities of daily living scores to classify patients. The time motion approach was used to measure the direct nursing time of 551 general acute care patients. We found that patients in old Categories according to ability of self-care and disease severity 1-4 received approximately 7.1, 4.6, 3.4, and 4.5 h of direct nursing care, and the number of hours was not significantly different between Categories 2, 3, and 4. In contrast, patients in new Categories 1-4 received approximately 10.1, 6.9, 4.4, and 2.4 h of direct nursing care in 24 h. The nursing hours were significantly different between all pairings of the new categories. The new classification system can be used to make nursing care assignments and adjust staffing.

A Method for Formulizing Disaster Evacuation Demand Curves Based on SI Model.

The prediction of evacuation demand curves is a crucial step in the disaster evacuation plan making, which directly affects the performance of the disaster evacuation. In this paper, we discuss the factors influencing individual evacuation decision making (whether and when to leave) and summarize them into four kinds: individual characteristics, social influence, geographic location, and warning degree. In the view of social contagion of decision making, a method based on Susceptible-Infective (SI) model is proposed to formulize the disaster evacuation demand curves to address both social influence and other factors' effects. The disaster event of the "Tianjin Explosions" is used as a case study to illustrate the modeling results influenced by the four factors and perform the sensitivity analyses of the key parameters of the model. Some interesting phenomena are found and discussed, which is meaningful for authorities to make specific evacuation plans. For example, due to the lower social influence in isolated communities, extra actions might be taken to accelerate evacuation process in those communities.

Evaluation of a Self-Management Program for Gastroesophageal Reflux Disease in China.

Gastroesophageal reflux disease is a chronic disease with a high incidence worldwide. The various symptoms have substantial impact on the quality of life of affected individuals. A long-term self-management program can increase the ability of patients to make behavioral changes, and health outcomes can improve as a consequence. This study's aim was to evaluate the effectiveness of a self-management program for gastroesophageal reflux disease. A total of 115 patients with gastroesophageal reflux disease were allocated to the experimental group and the control group. The former received self-management intervention along with conventional drug therapy, whereas the latter received standard outpatient care and conventional drug therapy. After the clinical trial, the control group also received the same self-management intervention. The levels of self-management behaviors, self-efficacy, gastroesophageal reflux disease symptoms, and psychological condition were compared. Those in the experimental group demonstrated significantly higher self-efficacy for managing their illness, showed positive changes in self-management behaviors, and had comparatively better remission of symptoms and improvement in psychological distress. The program helped patients with gastroesophageal reflux disease self-manage their illness as possible.