Psychological resilience and quality of life among middle-aged and older adults hospitalized with chronic diseases: multiple mediating effects through sleep quality and depression.

BACKGROUND: The present study is intended to examine the multiple mediating roles of sleep quality and depression in the relationship between psychological resilience and quality of life in middle-aged and older adults hospitalized with chronic diseases. METHODS: From October 2, 2021, to February 27, 2022, a questionnaire survey was conducted using a multistage stratified sampling method among 339 middle-aged and older adults (45 years and over) hospitalized with chronic diseases. These participants were recruited from a hospital in Zhejiang Province, China. The questionnaire included the Aged Cumulative Disease Rating Scale, the Psychological Resilience Scale, the Pittsburgh Sleep Quality Index Scale, the Depression Scale, and the Quality-of-Life Scale. A descriptive analysis was performed to characterize the sample. Linear regression was utilized to evaluate the relationship between psychological resilience and quality of life. Amos 24.0 was used to analyze the multiple mediated effects of sleep quality and depression. RESULTS: Psychological resilience exerted a remarkable direct effect on the quality of life in middle-aged and older adults hospitalized with chronic diseases (ß = 0.239, 95% CI = 0.125-0.354), which represented 52.98% of the total effect. Through three significantly mediated pathways indirectly affect the quality of life: (1) through the sleep quality pathway (ß = 0.115, 95% CI = 0.056-0.201), which represented 25.39% of the total effect; (2) through the depression pathway (ß = 0. 060, 95% CI = 0.023-0.114), which represented 13.24% of the total effect; and (3) through both the sleep quality and depression pathway (ß = 0. 038, 95% CI = 0.019-0.074), which represented 8.39% of the total effect. The total mediating effect was 47.02%. CONCLUSIONS: Sleep quality and depression mediate the relationship between psychological resilience and quality of life in middle-aged and older adults hospitalized with chronic diseases. Therefore, healthcare professionals and stakeholders should be concerned about the sleep status and mental health of middle-aged and older adults hospitalized with chronic diseases, strengthen their attention to psychological resilience, and provide interventions and treatment measures for hospitalized patients who have sleep problems and depressive tendencies.

Mediating effect of successful aging on the relationship between psychological resilience and death anxiety among middle-aged and older adults with hypertension.

Objective: The aging trend of China's population is severe and successful aging (SA) is imminent. Aging can lead to various chronic diseases, with hypertension being the most common. Due to this lifelong disease, patients suffer from many anxieties, as death anxiety (DA) can be the most prevalent. Studies have exhibited that middle-aged adults approaching the transition to an older state show more pronounced DA than the more senior. It has been suggested that psychological resilience (PR) can reduce DA. Therefore, this study aimed to analyze the mediating effect of SA between PR and DA in middle-aged and older adults with hypertension. Methods: A cross-sectional survey was designed. From August to December 2021, 298 middle-aged and older adults with hypertension were selected by multistage cluster random sampling in three districts (Ling he District, Gu ta District, and Tai He District) of Jinzhou City, Liaoning Province. They were surveyed using the demographic questionnaires, the Conner-Davidson Resilience Scale, the Successful Aging Inventory, and the Chinese version of a Likert-type Templer-Death Anxiety Scale. Descriptive analyses, independent sample T-test, and one-way analysis of variance (ANOVA) were used to describe demographic characteristics among hypertensive patients with different characteristics, respectively. Statistics were considered significant when P < 0.05. Pearson correlation coefficients describe the relationship between PR, SA, and DA. The research model was shaped through Structural Equation Modeling (SEM). SPSS PROCESS macro was used to verify the mediation model. A binary logistic regression model was used with DA as the dependent variable. Results: The scores for PR, SA, and DA in hypertensive patients are (49.52 ± 14.38) points, (51.22 ± 7.63) points, and (46.67 ± 9.03) points. PR was negatively correlated with DA (r = -0.307, P < 0.01). Moreover, incorporating SA as a mediating variable in PR and DA, SA was positively correlated with PR (r = 0.335, P < 0.01) and DA (r = 0.085, P > 0.05). The direct effect is opposite to the sign of the indirect effect. There is a suppression between PR and DA with a percentage of 20.7%. Good self-assessed health status [0.057 (0.018, 0.183)] may be a protective factor for DA. Conclusion: Healthcare providers should improve the PR of middle-aged and older adults with hypertension through interventions that reduce DA and increase the likelihood of SA.

Reliability and validity of the Chinese version of the self-directed learning instrument in Chinese nursing students.

BACKGROUND: In a rapidly changing healthcare environment, Self-directed learning (SDL) ability is recognized as a crucial condition for nursing students and nurse to deal with severe challenges positively. Developing SDL ability is becoming more and more important among nursing students. SDL is related to nursing students enhancing their own knowledge, skills and maintaining lifelong learning. This study is aim at translating the Self-directed Learning Instrument (SDLI) into Chinese and verify its reliability and validity among nursing students. METHODS: The study adopted a cross-sectional design and the multistage sampling design. The SDLI was translated into Chinese, and the reliability and validity of the scale were tested among 975 nursing students. RESULTS: The Cronbach's α value of the Chinese version of SDLI was 0.916. The split-half reliability coefficient was 0.829, and the retest coefficient was 0.884. The content validity index of the scale was 0.95. Furthermore, the four-factors model was obtained by using exploratory factor analysis, explaining 55.418% variance, and the communalities of the items ranged from 0.401 to 0.664. With modified confirmatory factor analysis, the fit indices were chi-square/degree of freedom (CMIN/DF) = 2.285, the comparative fit index (CFI) = 0.947, and the tucker lewis index (TLI) was 0.938. And, the model fitting indexes were all in the acceptable range and confirmatory factor analysis indicated that the model fit the SDLI well. CONCLUSION: The Chinese version of SDLI has good validity and reliability among nursing students. It can be used to measure the SDL ability of nursing students in China.

A Strongly Unforgeable Certificateless Signature Scheme and Its Application in IoT Environments.

With the widespread application of the Internet of Things (IoT), ensuring communication security for IoT devices is of considerable importance. Since IoT data are vulnerable to eavesdropping, tampering, forgery, and other attacks during an open network transmission, the integrity and authenticity of data are fundamental security requirements in the IoT. A certificateless signature (CLS) is a viable solution for providing data integrity, data authenticity, and identity identification in resource-constrained IoT devices. Therefore, designing a secure and efficient CLS scheme for IoT environments has become one of the main objectives of IoT security research. However, the existing CLS schemes rarely focus on strong unforgeability and replay attacks. Herein, we design a novel CLS scheme to protect the integrity and authenticity of IoT data. In addition to satisfying the strong unforgeability requirement, the proposed scheme also resists public key replacement attacks, malicious-but-passive key-generation-centre attacks, and replay attacks. Compared with other related CLS schemes without random oracles, our CLS scheme has a shorter private key, stronger security, and lower communication and computational costs.