Journal of Multidisciplinary Healthcare最新文献

Introduction: Stunting remains a persistent public health challenge in Indonesia, with significant implications for children's long-term health and national development.The PRECEDE-PROCEED Model (PPM) offers a comprehensive framework for designing effective health education interventions, yet its application in community-based stunting prevention in Indonesia remains underexplored.

Purpose: The purpose of this study was to identify and launch an increase in maternal knowledge before and after providing a health promotion intervention on stunting prevention.

Patients and methods: The research method used was a pre-experimental study that used a one-group pre-test and post-test design involving 52 mothers of children under five years in Cimahi, West Java. A 20-item validated questionnaire was administered before and after a structured 90-minute health education session based on the PPM framework. Educational content focused on nutrition, hygiene, immunization, and child stimulation.

Results: Data were analyzed using the Wilcoxon Signed-Rank Test due to non-normal score distribution. Research results show participants' mean knowledge score increased significantly from 18.67 (SD = 1.79) to 19.69 (SD = 0.96) post-intervention (p = 0.00006). Most participants (73%) achieved a perfect score after the session, indicating a positive effect of the intervention. Reduced score variability suggests enhanced and more uniform knowledge dissemination.

Conclusion: A health promotion intervention using the PRECEDE-PROCEED Model effectively improved maternal knowledge of stunting prevention. The participatory and contextualized approach demonstrated strong potential for replication in community health settings across Indonesia. Further studies should explore long-term behavioral outcomes and scalability.

Research limitations: Pre-experimental research design without a control group, so no comparison group that does not receive the intervention. The sample size is relatively small and limited to one location. Outcome measurement is only on short-term maternal knowledge. Focus only on maternal knowledge without measuring other aspects related to stunting prevention.

Purpose: To construct sex-specific metabolic patterns and investigate their effect on renal function decline among individuals without chronic kidney disease (CKD).

Patients and methods: The subjects were from a community-based health survey in China from 2012 to 2018. 8511 eligible participants with at least three times of investigations were included. Metabolic patterns were constructed by Latent Profile Analysis based on total cholesterol, blood pressure, and fasting glucose. Renal function decline was defined as eGFR < 90 mL/[min•1.73m²]. The effect of metabolic patterns on renal function decline over time was evaluated using Generalized Estimating Equations (GEE).

Results: Women were classified into No Metabolic Abnormalities (NMA), Hypertension-Impaired Fasting Glucose-Borderline Dyslipidemia (HIB), and Hypertension-Hyperglycemia-Borderline Dyslipidemia (HHB). Men were classified into NMA, Hypertension-Impaired Fasting Glucose-Normal Total Cholesterol (HIN), and Hypertension-Hyperglycemia-Normal Total Cholesterol (HHN). Compared to NMA, the risk of renal function decline over time was approximately 1.33 times higher in the HIB group and 1.41 times higher in the HHB group (95% CIs: 1.29-1.37 and 1.25-1.59, respectively). Consistently, these groups showed a faster eGFR decline over time than NMA. For men, the risks of renal function decline increased by 26% per year in the HIN group compared to NMA (95% CI = 1.19-1.33). No such time-dependent association was observed in the HHN group. Both HIN and HHN groups showed no significant effect on accelerated eGFR decline.

Conclusion: Women with HIB and HHB, and men with HIN, have an accelerated risk of renal function decline. Earlier management of metabolic abnormalities is critical for kidney protection.

Objective: This study examined the impact of the medical-prevention integration model on the efficiency of medical resource utilization in the management of chronic diseases (primarily hypertension and diabetes) among older adults. The analysis focused on its ethical implications (eg, progress in urban-rural equity of resource allocation, residual disparities in underdeveloped regions, and potential biases in service access for disadvantaged groups) and economic effects, with the goal of informing evidence-based health policies to support the "Healthy China" strategy.

Methods: We included 10,236 adults aged ≥60 with chronic diseases from six counties in Guangdong, two rural counties in Sichuan, and one suburban area in Jiangsu. A mixed-methods approach was applied: quantitative analysis of medical costs and related indicators using the Heckman two-stage model, supplemented by qualitative case studies and semi-structured interviews. Indicators for economic performance, efficiency, and equity were constructed, with subgroup analyses by age and education.

Results: Model implementation was associated with significant efficiency gains: average annual per capita outpatient costs fell by 18.1%, hospitalization costs by 18.3%, chronic disease control rates rose by 13.6% (p<0.001), and emergency visits declined by 27.4%. The urban-rural control rate gap narrowed from 12.7% to 5.9% (53.2% reduction), though disparities remained (5% in Guangdong, 3% in Jiangsu, 11% in rural Sichuan). Subgroup analysis showed greater cost reductions for ages 60-70 (20.1%, p<0.01) than >70 (15.3%, p<0.05), and higher control rates among more educated participants (75.2% vs 59.7%, p<0.001).

Conclusion: The integration model improves efficiency and equity in chronic disease management, generating economic savings and reducing disparities. However, persistent regional gaps and barriers among vulnerable subgroups (eg, limited mobility in >70, low health literacy) require targeted interventions. Findings are generalizable to similar aging middle-income settings and support strengthening primary care and equitable resource allocation.

Background: The onset of rheumatoid arthritis (RA) most often occurs during the reproductive years. The chronic inflammatory state associated with the disease, along with the effects of therapeutic agents, contributes to a significantly higher incidence of adverse pregnancy outcomes compared to the general population. Standardized preconception management for childbearing-age patients with RA is an important prerequisite for achieving a safe pregnancy and promoting healthy offspring. However, existing evidence is scattered, and clinical practice lacks efficient evidence-based guidelines.

Objective: To identify, evaluate, and summarize the best available evidence on preconception care for childbearing age with RA, and to provide evidence-based guidance for clinical nursing practice.

Methods: A systematic search was conducted according to the "6S" pyramid model of evidence-based resources to identify evidence related to preconception management in childbearing-age patients with RA. Sources included clinical decision support systems, guidelines, databases, and professional association websites. The search covered all records from database inception until June 17, 2025.

Results: A total of 11 publications were included, comprising 3 guidelines, 5 expert consensuses, 2 clinical decisions, and 1 systematic review. From these sources, a comprehensive set of 23 best evidence recommendations was formed across seven key aspects: general principles, fertility risk assessment, preconception screening, pre-pregnancy medication adjustment, fertility preservation, weight and nutrition management, and psychological support. Among the evidence gathered, a strong recommendation was made for 15 items, while the remaining 8 received a weak recommendation.

Conclusion: This study provides a summary of best evidence for the preconception management of childbearing-age patients with RA, offering valuable guidance for clinical practice. To maximize patient benefits, healthcare providers should exercise careful clinical judgment when applying this evidence, taking into account the specific clinical context, individual patient circumstances, and preferences.

Trial registration: ES20258177.

Objective: To analyze the current status, research hotspots, and trends in the application of artificial intelligence (AI) in cardiovascular disease (CVD) using bibliometric methods, providing a reference for future research.

Methods: A systematic search was conducted in the WoSCC for relevant literature published from database inception to March 5, 2025. VOSviewer v.1.6.20 was used for co-occurrence analysis of institutions (≥10 publications) and authors (≥5 publications), and Scimago Graphica V1.0.25 was used to visualize collaboration networks among countries/regions. CiteSpace 6.3.R1 was employed for institutional co-occurrence analysis (≥5 publications), keyword co-occurrence, and clustering analysis.

Results: A total of 1738 relevant articles were included, with a gradual increase in annual publications, especially after 2018. The United States led in both publication volume and total citations. Harvard Medical School was the most prolific institution. Saba, Luca, and Suri, Jasjit S. were the most productive authors. 《IEEE ACCESS》was the journal with the most publications. High-frequency keywords included machine learning, coronary heart disease, and CVD, forming 10 clusters. Main research areas included AI in disease diagnosis, classification, biomarker discovery, and AI system design. Co-cited literature clusters into four AI-CVD directions: classification, risk prediction, algorithm refinement, imaging. In addition, issues such as the interpretability and clinical acceptance of AI data quality and patient privacy protection models cannot be ignored.

Conclusion: Research on AI in the field of CVD is still in a stage of rapid development. Currently, the hotspots in this field focus on the application of AI in CVD diagnosis and classification, the application of AI in CVD risk prediction, and the precise utilization of AI in CVD imaging. How to develop explainable AI models is a hot topic of research in the coming period.

Objective: Heart rate recovery (HRR) is a validated prognostic marker in cardiovascular disease (CVD). This study evaluated and compared the effects of 4-week high-intensity interval training (HIIT) and moderate-intensity interval training (MIIT) on post-exercise HRR in patients with CVD.

Methods: A total of 1,020 CVD patients undergoing cardiac rehabilitation (Jan 2021-May 2024) were screened, and 209 who completed 12 sessions and cardiopulmonary exercise tests were included (HIIT: 82; MIIT: 127). The mean ages were 55.2 (HIIT) and 52.9 years (MIIT), with females comprising 34.1% and 34.6%, respectively. The MIIT protocol included four 8-min cycling bouts (RPE 12-14) with 2-min active recovery, while HIIT involved 20-25 × 30-s high-intensity bouts (RPE 14-15) alternating with 30-s low-intensity recovery.

Results: Both interventions significantly improved HRR (HIIT: 3.1±8.7 bpm, P = 0.002; MIIT: 3.0±10.0 bpm, P = 0.001), with no between-group difference (P = 0.816). Peak VO₂ similarly increased in both groups (HIIT: 3.3±2.8; MIIT: 3.0±3.6 mL·kg^-1·min^-1; P < 0.001). Other related measures were also notably improved (P < 0.05). Multivariable regression analysis revealed that the change in HRR was inversely associated with the change in resting heart rate in both HIIT (β = -0.227, P = 0.04) and MIIT (β = -0.318, P < 0.001) cohorts.

Conclusion: Both short-term HIIT and MIIT comparably enhance HRR in patients with CVD, highlighting the clinical applicability of interval training as an efficient option for patients with limited time availability. However, the retrospective design limits causal inference and requires confirmation in future studies.

Background: Stroke is a leading cause of long-term disability, with attentional deficits affecting most survivors and limiting independence, activities of daily living (ADL), and quality of life. Conventional rehabilitation often lacks engagement and accessibility, which underscores the need for innovative strategies. Digital health interventions incorporating gamification may enhance attentional rehabilitation. However, the evidence remains limited.

Objective: This review systematically evaluated the effectiveness, safety, and gamification strategies of digital health interventions for attentional rehabilitation after stroke, including their impact on ADL.

Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The Scopus, PubMed, and EBSCO-host databases were searched for randomized controlled trials (RCTs) published from January 2015 to February 2025. Eligible studies included adult patients with stroke undergoing gamified digital interventions. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklist, and risk of bias was evaluated using the Cochrane RoB-2 tool.

Results: Twelve RCTs with 544 participants were included. The interventions employed computer-based programs, virtual reality systems, and mobile applications. The most common gamification elements were progression, feedback, levels, challenges, and points. Seven trials reported significant improvements in attentional performance, whereas five showed no measurable benefits. Only two studies demonstrated significant improvements in ADL. Safety outcomes were favorable, with mild adverse events (transient dizziness and ocular fatigue) reported in one trial.

Conclusion: Gamification-based digital health interventions are safe, feasible, and show promise in enhancing attention after stroke. However, heterogeneity, small sample sizes, and short intervention durations limit generalizability. Large-scale multicenter RCTs with standardized protocols and long-term follow-up are needed to establish clinical value.

Purpose: This study evaluated the effectiveness of evidence-based continuous quality improvement strategies in reducing peripherally inserted central catheter complications among premature infants in a tertiary neonatal intensive care unit.

Patients and methods: A retrospective cohort analysis was conducted on 722 premature infants requiring peripherally inserted central catheter placement from January 2020 to December 2023. The control group (n=154, January-December 2020) received routine bundle care, while a multidisciplinary evidence-based nursing team implemented continuous quality improvement protocols across three intervention periods: first-year implementation (n=147, 2021), second-year refinement (n=201, 2022), and third-year optimization (n=220, 2023). Primary outcomes included total complication rates and unplanned catheter removal. Multivariate logistic regression identified independent risk factors for complications.

Results: Baseline characteristics showed comparable gestational age (31.32±4.05 to 31.98±4.21 weeks, P=0.419) and insertion timing across groups. Total complication rates demonstrated progressive reduction from 46.10% in controls to 32.65% in year 1, 19.90% in year 2, and 15.45% in year 3 (χ²=51.214, P<0.001), representing a 66.5% overall reduction. Unplanned removal rates decreased from 24.03% to 11.82% (χ²=13.128, P=0.004). Multivariate logistic regression analysis revealed routine care (adjusted OR=4.707, 95% CI: 2.861-7.742, P<0.001) and first-year implementation (adjusted OR=2.672, 95% CI: 1.595-4.477, P<0.001) as independent risk factors, while higher gestational age was protective (adjusted OR=0.876, 95% CI: 0.837-0.916, P<0.001).

Conclusion: Implementation of evidence-based continuous quality improvement strategies achieved substantial and sustained reductions in peripherally inserted central catheter complications among premature infants, supporting systematic adoption of multidisciplinary approaches to optimize vascular access outcomes in vulnerable neonatal populations.

Background: Acupuncture therapy is widely utilized globally to treat irritable bowel syndrome (IBS) with promising outcomes. However, in recent years, bibliometric analyses have yet to be performed. Consequently, this paper aims to comprehensively analyze the literature from the past 20 years using CiteSpace, VOSviewer, and Excel to identify research hotspots and predict future trends.

Methods: A bibliometric search on acupuncture therapy for IBS was conducted using the Web of Science Core Collection, covering 2004 to 2024. The bibliometric analysis included examining annual publications, countries, authors, cited authors, institutions, journals, cited journals, cited references, and keywords. CiteSpace 6.3.R1, VOSviewer 1.6.18, and Microsoft Excel 2021 facilitated this analysis by creating a knowledge mapping.

Results: A total of 128 papers were included in the final analysis, revealing a general upward trend in annual publications. The predominant type of literature identified was articles. China exhibited the highest centrality of published articles. Wu Huangan emerged as the most prolific author, while Drossman DA had the most cited publications. The Shanghai University of Traditional Chinese Medicine was identified as the most productive institution. Evidence-based Complementary and Alternative Medicine published the most relevant articles, whereas Gastroenterology was the most frequently cited journal. The article Pei LX (2020) was the most cited reference, and Chao GQ (2014) had the highest centrality among cited references. Keyword analysis identified research hotspots focused on clinical symptoms (especially abdominal pain) and gut-related mechanisms. Furthermore, keyword burst analysis revealed that visceral hypersensitivity and gut microbiota are key research frontiers, indicating recent surges in scientific interest.

Conclusion: This study analyzed the literature on acupuncture therapy for IBS by bibliometric methods, revealing its current status and research hotspots and providing a reference for researchers to conduct more in-depth studies in the field.

Uric acid nephropathy (UAN) represents a critical and multifactorial renal disorder closely linked to hyperuricemia, inflammation, and gut microbiota dysregulation. Recent advances have revealed the pivotal role of the gut-kidney axis in modulating urate metabolism, immune activation, and oxidative stress. This review synthesizes emerging preclinical and clinical evidence to construct an integrative framework for understanding UAN, highlighting both crystal-dependent and crystal-independent mechanisms that drive tubular injury and fibrosis. Accumulating data underscore the reciprocal crosstalk between renal dysfunction and gut dysbiosis, mediated by microbial metabolites such as short-chain fatty acids (SCFAs), indoxyl sulfate, and p-cresol sulfate. We further evaluate therapeutic interventions targeting the gut-kidney axis-including probiotics, synbiotics, postbiotics, fecal microbiota transplantation (FMT), and engineered microbial therapies-which have shown promise in restoring microbial balance and improving urate handling. By integrating multi-omics profiling with systems biology, this review proposes a precision-medicine roadmap that leverages microbiome signatures and metabolic phenotyping for risk stratification and personalized intervention. Moreover, we emphasize the need for supportive regulatory frameworks and interdisciplinary collaboration to enable the clinical translation of microbiota-based strategies. Collectively, this work provides a strengthened conceptual foundation for microbiome-informed prevention and treatment of uric acid-related kidney disease.