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Pressure injury (PI) is common in the ICU and not well captured by single-risk tools such as the Braden scale. We aimed to develop and internally validate a machine-learning model to predict new-onset PI using routinely collected ICU data. This retrospective single-centre cohort included adult ICU patients with length of stay ≥ 48 h (2018–2023). The primary outcome was new-onset PI during ICU stay. Candidate predictors were pre-specified: minimum albumin, maximum lactate, SOFA, APACHE II, first recorded Braden score, age, BMI, a nutrition score and treatment indicators. Missing values were imputed (median/mode). A gradient boosting model (GBM) was evaluated with stratified 3-fold cross-validation; a random forest (RF) served as a benchmark (stratified 70/30 train–test split). Discrimination (AUC) was primary; calibration, Brier score, decision-curve analysis (DCA) and feature importance were secondary. Logistic regression quantified independent associations. Among included ICU stays, 14.6% developed PI. On multivariable analysis, higher lactate, lower albumin, lower Braden scores, older age, CRRT, prone positioning, enteral nutrition and analgesic exposure were associated with increased PI risk, whereas sedatives showed an inverse association. The GBM achieved AUC≈0.69 with acceptable calibration and net clinical benefit across thresholds commonly used in preventive workflows (≈0.10–0.50). Single markers or simple combinations displayed only modest discrimination. A GBM built from routine ICU data provided moderate, well-calibrated discrimination for predicting new-onset PI and demonstrated decision-relevant net benefit. The model can complement Braden-based screening by refining risk stratification and prioritising intensified prevention for patients most likely to benefit. External validation and prospective evaluation are warranted.
Health-promoting lifestyle (HPL) is strongly associated with health outcomes. In clinical practice, health-promotion behaviours in patients with head and neck cancer (HNC) are not good, which seriously affects patients' prognosis. This study aims to investigate the current status and influencing factors of HPL in HNC patients.
A cross-sectional study.
This study used a convenience sampling method to select 264 consecutive HNC patients who attended a tertiary hospital in northeast China from November 2023 to May 2024 for the survey. Data were collected using the Questionnaire for General Information, the Health-Promoting Lifestyle Profile Revised-II (HPLP-II R), the Health Literacy Management Scale (He LMS) and the Acceptance of Illness Scale (AIS).
The HPLP-II R scores of HNC patients were generally average (93.10 ± 15.60), with the highest scores on the nutrition dimension and the lowest scores on the exercise dimension. HPL was significantly and positively correlated with health literacy and disease acceptance. Multiple linear regression analysis showed that educational level, cancer recurrence, health literacy and disease acceptance were the influencing factors of HPL among patients with HNC, which altogether explained 25.9% of the total variance.
The HPL of HNC patients is at an average level and still has much room for improvement. Patients with high literacy levels, cancer recurrence, high health literacy and disease acceptance levels had relatively high levels of HPL.
HPL can enhance patients' internal motivation, enhance their self-management ability and improve their daily functional performance while reducing complications and improving their quality of life. This suggests that medical staff should give personalised health guidance according to patients' different health literacy in clinical work, improve patients' disease acceptance and pay attention to the development of HPL.
STORBE guidelines.
No patient or public contribution.
To explore the current status and associated factors of advance care planning intentions among people living with dementia in China.
An explanatory sequential mixed-methods design was adopted.
The research is guided by the knowledge-attitude-practice model and the theory of planned behaviour. Quantitative surveys were used to assess advance care planning intentions and associated factors in people living with dementia, followed by qualitative semi-structured interviews to delve into participants' perceptions and feelings about advance care planning. Quantitative data were analysed using multiple linear regression, while qualitative data were analysed using thematic analysis.
The overall advance care planning behavioural intention was at a moderately high level. The quantitative results revealed that higher education level, certain religious beliefs, greater advance care planning knowledge, positive behavioural attitudes and stronger subjective norms were significantly positively associated with advance care planning intentions. Qualitative analysis identified three themes: positive attitude but limited ACP awareness, supportive relationships enable early ACP consideration and cultural norms shape willingness to engage in ACP.
Advance care planning intentions among people living with dementia are shaped by a combination of social, familial and individual factors. Increasing public awareness, addressing cultural challenges and establishing professional teams are crucial to promoting advance care planning practices. Future research should focus on larger, multicenter studies to enhance intervention strategies.
Although the attitude toward advance care planning is more positive, various factors need to be carefully considered in the process of constructing relative intervention strategies.
This study did not include patient or public involvement in its design, conduct or reporting.
by Zijing Wang, Liyuan Ma, Zhanyuan Sun, Hengyi Lv, Ruxue Ma, Mengqi Ding, Hai Li, Tao Jiang
BackgroundDiethyl phthalate (DEP), a widely used plasticizer with endocrine-disrupting properties, has raised concerns regarding its potential carcinogenic effects. However, its precise role in colorectal cancer (CRC) development remains poorly understood.
MethodsThe chemical structure of DEP was obtained from the PubChem database. Potential targets of DEP were identified through ChEMBL and STITCH databases and intersected with known CRC-related genes to screen for candidate biomarkers. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to explore the biological functions and signaling pathways involved. Molecular docking was conducted to predict the binding affinities between DEP and core targets. Finally, 200-ns molecular dynamics (MD) simulations using GROMACS were employed to evaluate the binding stability and dynamic behavior of the DEP–target complexes.
ResultsA total of 62 overlapping genes were identified between DEP targets and CRC-associated genes. GO and KEGG enrichment analyses indicated enrichment in epigenetic regulation, chromatin remodeling, and cancer-related signaling pathways, including Notch, TGF-β, and FoxO. Protein–protein interaction analysis identified EP300, EZH2, HDAC1, HDAC2, and KDM1A as key epigenetic regulators. Molecular docking predicted moderate binding affinities between DEP and these targets (−6.6 to −5.7 kcal·mol ⁻ ¹). Subsequent 200-ns MD simulations suggested that DEP formed stable complexes with HDAC1, KDM1A, and EZH2, moderate stability with EP300, and partial dissociation with HDAC2, consistent with hydrophobic and hydrogen-bonding interactions at the binding interfaces.
ConclusionThis study provides a theoretical framework for exploring the molecular mechanisms through which DEP may contribute to CRC development, emphasizing the value of network toxicology in cancer research. These findings may inform future investigations into the risks of DEP exposure and support public health policy and the development of targeted therapeutic strategies.
Labour companionship is a recommendation by WHO that health authorities enable women to choose a companion during labour to ensure a safe and dignified labour experience for the birthing woman. However, most healthcare facilities in low- and middle-income countries do not necessarily consider this maternal need, which hampers a positive maternal experience during labour.
This study aims to examine midwives' perception towards the involvement of male partners in labour companionship.
An exploratory phenomenological approach was chosen and semi-structured interviews were used for this study.
The four main themes identified in this study include ‘Understanding of male partners' involvement in labour companionship’, ‘Involvement of midwives in decision-making’, ‘Barriers to male partners' involvement in labour companionship’ and ‘Facilitators of male partners' involvement in labour companionship’.
This study found a lack of understanding among midwives of the significance of male partners' involvement in labour companionship; and the identification of hierarchical and authoritarian leadership as a barrier to midwives' participation in decision-making highlights the need for transformational leadership styles to empower midwives. Overall, the findings of this study can inform maternity care policy as well as resource development, education and professional training in the field of midwifery.
by YanYing Zhu, XueYan Li, YueXin Chen, HaiYan Xie, YuKun Liu, XiaoChen Xu, Jing Wang
PurposeAxial elongation is a key factor in myopia progression, yet its genetic basis remains incompletely understood. This study aims to identify pathogenic genetic variants associated with excessively elongated axial length in children.
MethodsThis study included 56 children with axial lengths exceeding the normal range for their age group, and whole-exome sequencing (WES) was performed on their oral mucosal samples. Clinical evaluations included axial length measurement, refraction testing, and fundus photography to assess the degree of myopia and retinal changes. Co-segregation analysis was conducted in selected families (F#1, F#2, F#5) to validate the familial inheritance patterns of the variants.
ResultsFifteen children carried variants in genes including BBS2, OPN1LW, P4HA2, FBN1, LOXL3, FZD4, USH2A, COL2A1, and BFSP2, with five novel variants identified: BBS2 (c.700C > T), P4HA2 (c.1382C > G), FBN1 (c.7130T > C), LOXL3 (c.1580delC), and FZD4 (c.1315G > A). Notably, a rare compound heterozygous BBS2 variant (c.700C > T/c.534 + 1G > T) was found in a non-syndromic child, and the P4HA2 (c.419A > G) variant in family F#5 exhibited a phenotype distinct from previous studies.
ConclusionsThis study identified five novel variants sites and discovered two cases with phenotypes distinct from previous studies, thereby expanding the genetic variant spectrum associated with myopia and providing new targets for genetic screening and intervention.
To explore the abnormal experiences of time and space among transitional-age youth with major depressive disorder.
A descriptive phenomenological qualitative study.
The study was conducted at a psychiatric hospital in China. Purposive sampling was used to recruit transitional-age youth with major depressive disorder. Data were collected through semi-structured interviews and analysed using Colaizzi's method.
Seventeen participants were interviewed. The abnormal experiences of time and space among transitional-age youth with major depressive disorder were synthesised into five overarching themes: (1) Disturbance of Time Order; (2) Slackening of the Flow of Time; (3) Vital Inhibition; (4) Desynchronisation of Social Rhythms; and (5) Disturbance of Lived Space.
This study highlights that pervasive abnormalities in temporal and spatial experiences characterise transitional-age youth with major depressive disorder. These disturbances shape their sense of self, personal development, relationships and engagement with the world, underscoring the need for interventions that address these temporal and spatial disturbances within the context of developmental transition.
This study addresses a knowledge gap regarding the subjective experience of time and space among transitional-age youth with major depressive disorder. This study highlights that transitional-age youth with major depressive disorder experience desynchronisation across temporal, spatial, bodily and social domains. Moreover, the desynchronisation of social rhythms appears to be a unique and developmentally salient challenge for transitional-age youth with major depressive disorder. These insights expand phenomenological understandings of major depressive disorder and highlight the developmental vulnerabilities of major depressive disorder as it navigates this critical life phase.
Five participants were involved in reviewing and providing feedback on the interview content and results. Their contributions included enhancing the authenticity and credibility of the findings.
The study followed the Consolidated Criteria for Reporting Qualitative Research guidelines.
To identify factors associated with job embeddedness from the perspective of retaining new graduate nurses.
The study was cross-sectional in design.
Convenience and stratified sampling were used to recruit 415 newly graduated nurses from 12 tertiary hospitals in China. Anonymized data were collected through self-designed sociodemographic questionnaires, job embeddedness scale, feedback-seeking behaviour scale, authentic leadership perception scale and decent work scale. Appropriate indicators were used for descriptive statistics and t-tests, ANOVA, Pearson correlation analysis and multiple linear regression to examine the influencing factors.
The study showed that monthly income level, decent labour, authentic leadership and feedback-seeking behaviour were significant predictors of job embeddedness among new graduate nurses.
The job embeddedness of new graduate nurses is moderate. Nursing managers need to construct reasonable and fair compensation incentives, adopt positive leadership styles and encourage proactive feedback-seeking behaviours to improve the job embeddedness of new graduate nurses and alleviate the nursing talent shortage.
Exploring the factors influencing the job embeddedness of new graduate nurses provides a reference for establishing new graduate nurse retention strategies to help promote the career development of new graduate nurses and alleviate the nursing brain drain.
We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
No patient or public contribution.
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