Journal of Multidisciplinary Healthcare最新文献

Background: Tuberculosis (TB) remains one of the leading causes of death in Mbuji-Mayi, as in many other cities worldwide. Despite the availability of free treatment, TB continues to spread in the city due to weaknesses in health system performance, socioeconomic conditions, and limited financial resources. This study aimed to contribute to reducing TB-related mortality in Mbuji-Mayi by identifying risk factors affecting the survival of patients undergoing anti-tuberculosis treatment.

Methods: A retrospective cohort study was conducted among tuberculosis patients registered and followed up in the TB treatment centers (CDTs) of Mbuji-Mayi between January 1 and December 31, 2024. Data were collected from patient records and treatment registers. A total of 1,633 cases were included in the analysis. Survival probabilities were estimated using the Kaplan-Meier method, and factors associated with survival were identified using the Cox proportional hazards model.

Results: Multivariate analysis showed that comorbid conditions such as HIV and diabetes were significantly associated with mortality among TB patients (adjusted Hazard Ratio [aHR] = 4.65; p = 0.003). Drug resistance was strongly associated with reduced survival time (aHR = 12.12; p < 0.001). Male sex was more exposed to mortality compared to females (aHR = 9.94; p = 0.026), and tobacco or alcohol use was also a significant risk factor associated with decreased survival (aHR = 3.31; p = 0.046).

Conclusion: The overall survival probability remained high, ranging from 99.7% in the first month to 98.8% in the fifth month of treatment. Most deaths occurred early during therapy. Mortality among TB patients in Mbuji-Mayi is mainly influenced by comorbidity, drug resistance, male sex, and tobacco or alcohol consumption. Strengthening early detection, adherence support, and management of comorbid conditions could improve patient survival.

Purpose: This study evaluated whether an independent, online modified Pilates program alters function, interoception (internal body awareness), activity levels, and kinesiophobia (fear of movement) in people with symptomatic joint hypermobility.

Patients and methods: This pragmatic clinical trial included and exercise group that did 8 weeks of modified Pilates and an 8-week waitlist control group. People with symptomatic hypermobility were asked to do an independent, online Pilates program designed specifically for people with hypermobility; each module was about 25 minutes, and participants were asked to do at least 3 days/week. Outcome measures included the Bristol Impact of Hypermobility (BIoH), International Physical Activity Questionnaire (IPAQ), Revised Body Awareness Questionnaire (BARQ), and Tampa Scale of Kinesiophobia (TSK). Clinical Trial # NCT07118865.

Results: A total of 420 participants completed questionnaires at 8 weeks: 200 completed 8 weeks of Pilates and 220 were on a waitlist. The Pilates group demonstrated statistically significant improvements in BIoH, BARQ, and TSK immediately after the intervention (p<0.001 for each) and compared to the control group (p<0.001 for each). Improvements in the Pilates group remained statistically significant at 6 months. IPAQ did not change for any group.

Conclusion: This online Pilates program for people with symptomatic hypermobility improved BIoH, BARQ, and TSK, though changes were modest. The exercises did not improve IPAQ. Online exercise may provide a cost-effective way to encourage life-long activity in people with hypermobility. Limitations include the inability to monitor performance of the Pilates, high drop-out rates, and the inability to control for changes in other treatments patients may have received.

Background: Diabetes distress is a distinct psychological construct often conflated with depression in adults with Type 2 Diabetes Mellitus (T2DM) and multimorbidity. Current literature lacks a unified synthesis explaining how "therapeutic competition", where managing multiple conditions creates conflicting self-care demands, and cumulative regimen complexity specifically drive distress in this population.

Objective: This scoping review systematically maps the biopsychosocial determinants of diabetes distress in adults with T2DM and multimorbidity to inform integrated, patient-centered interventions.

Methods: A systematic search was conducted across PubMed/MEDLINE, Scopus, and EBSCOhost up to July 2025, following PRISMA-ScR guidelines. Peer-reviewed English studies examining diabetes distress in adults (≥18 years) with T2DM and multimorbidity were included. Evidence was thematically synthesized using a biopsychosocial framework.

Results: Of 269 records, 17 studies met the inclusion criteria. Thematic synthesis identified a synergistic interplay across four domains. Clinically, distress was driven primarily by treatment complexity (insulin regimens, polypharmacy) rather than disease duration, and was linked to poor glycemic control. Psychologically, distress emerged as a distinct mediator between depression and self-management. Behavioral challenges included medication non-adherence and physical inactivity. Notably, sociodemographic risks revealed significant cultural divergence: while socioeconomic disadvantage was universal, marital status acted as a protective buffer in Western cohorts but a source of caregiving strain in specific non-Western contexts.

Conclusion: Diabetes distress in multimorbidity is a biopsychosocial phenomenon driven by therapeutic competition and context-dependent social dynamics, rather than chronicity alone. Effective management requires a paradigm shift toward integrated care that prioritizes routine screening for high-risk profiles and culturally adapted support systems.

Background: This study aimed to develop an evaluation index system based on the Omaha System to identify postoperative rehabilitation nursing problems in patients after percutaneous coronary intervention (PCI). This evaluation system aims to facilitate the timely identification of nursing problems and enhance the reliability of nursing interventions during postoperative rehabilitation.

Methods: Rehabilitation nursing problems were identified through a comprehensive literature review and case analysis, considering both the physical and psychological characteristics of post-PCI patients. These problems were classified and organized according to the Omaha System. From September 2020 to February 2021, Delphi consultations were conducted with experts in China to finalize the evaluation indicators.

Results: After two rounds of expert consultation, the authority coefficients of the experts were 0.858 and 0.875, and Kendall's W coefficients were 0.194 and 0.150, respectively (both P < 0.01), indicating consensus. The final evaluation index system comprised 4 first-level indicators (domains), 21 second-level indicators (nursing problems), and 130 third-level indicators (specific symptoms/signs).

Conclusion: The Omaha System-based evaluation index developed in this study offers a clinically applicable framework for identifying and managing rehabilitation nursing problems in PCI patients. Supporting comprehensive and systematic assessment provides nurses with clear guidance for problem recognition, individualized care planning, and outcome monitoring. Its application has the potential to enhance care consistency, improve patient recovery, and promote evidence-based nursing decision-making, thereby contributing to improved quality of post-PCI rehabilitation care in clinical practice.

Purpose: Connective tissue diseases (CTDs) is a group of autoimmune diseases that damage multiple systems and can cause anxiety in pregnant women. The aim of this study was to identify risk factors of anxiety during third-trimester pregnancy among CTDs patients and to develop a predictive model to improve clinical outcomes.

Patients and methods: A total of 226 pregnant women with CTDs and 226 normal pregnant women were enrolled in this study during third-trimester pregnancy. This study analyzed risk factors for late pregnancy anxiety in pregnant women with CTDs using binary logistic regression. The probability of anxiety occurrence is predicted by nomogram and further validated by decision curve analysis (DCA), receiver operating characteristic curve (ROC), calibration curve.

Results: Anxiety levels were found to be significantly higher in pregnant women with CTDs compared to the control group (4.64±2.92 VS 3.97±2.44, P = 0.008). These results suggest that anxiety plays a critical role during the third trimester of pregnancy in this particular population. A total of 33 pregnant women with CTDs (14.6%) reported anxiety in third-trimester pregnancy. Risk factors associated with anxiety in third-trimester pregnancy include sleep disturbances (OR=4.226, 95CI% = 1.508-11.843), pregnancy stress (OR=1.121, 95CI% = 1.069-1.175) and family dysfunction (OR = 4.710, 95CI% =1.004-22.184).

Conclusion: The nomogram has clinical utility and robustly predicts the associated anxiety model. During third-trimester pregnancy, sleep disturbances, pregnancy stress, and family dysfunction increase the risk of anxiety in pregnant women with CTDs, which can result in an increased likelihood of emergency cesarean sections and more postpartum blood loss at 2 hours.

Background: Venous thromboembolism (VTE) is a significant cause of preventable morbidity and mortality among hospitalized patients. Although grid-based information management systems have shown effectiveness in VTE prevention, the boundary conditions and configurational pathways leading to optimal outcomes remain unclear.

Objective: To investigate the impact mechanism of grid-based information management on VTE prevention effectiveness, identify boundary conditions of moderating effects, and explore configurational pathways leading to high prevention outcomes.

Methods: A mixed-methods study design was employed. A total of 119 hospitalized patients from Affiliated Hospital of North Sichuan Medical college were enrolled between January and December 2024, with 58 patients in the control group (traditional management) and 61 in the intervention group (grid-based information management). The Johnson-Neyman (J-N) technique was used to identify the boundary conditions of nurses' VTE knowledge and departmental collaboration on intervention effectiveness. Fuzzy-set qualitative comparative analysis (fsQCA) was employed to identify configurational pathways leading to high VTE prevention outcomes.

Results: The intervention group demonstrated significantly higher VTE risk assessment completion rates (86.9% vs 63.8%, absolute difference 23.1%, 95% CI 8.7-37.5%, P<0.01), prevention measure implementation rates (90.2% vs 58.6%, absolute difference 31.6%, 95% CI 17.2-46.0%, P<0.01), and lower VTE incidence (3.3% vs 8.6%, absolute risk reduction 5.3%, 95% CI 0.4-10.2%, NNT=19, 95% CI 10-250, P=0.032). J-N analysis revealed that the positive effect of grid-based information management on VTE risk assessment became significant when nurses' VTE knowledge scores reached ≥42 points (P<0.05), and the effect on prevention measure implementation became significant when departmental collaboration scores reached ≥3.4 points (P<0.05). FsQCA identified three configurational pathways leading to high VTE prevention outcomes: technology-driven, collaboration-driven, and comprehensive support pathways, with an overall solution consistency of 0.892 and coverage of 0.684.

Conclusion: Grid-based information management effectively improves VTE prevention outcomes, but its effectiveness is contingent upon nurses' knowledge levels and departmental collaboration. Multiple equifinal pathways exist to achieve high VTE prevention outcomes, providing evidence for tailored implementation strategies.

Objective: To construct a scientifically sound and reliable management protocol for the physical activity symptom clusters in hospitalized stroke patients, based on the Symptom Management Theory (SMT).

Methods: This methodological study employed a multi-step approach. First, a preliminary protocol was drafted based on a systematic literature review and best evidence summary. Second, a two-round Delphi expert consultation process was conducted to refine and validate the protocol. Statistical analysis included calculating the positive coefficient, authority coefficient (Cr), coefficient of variation (CV), and Kendall's coefficient of concordance (W).

Results: Fifteen experts completed both consultation rounds. The expert positivity rates were 83.33% and 100%, respectively. The authority coefficients (Cr) were 0.89 and 0.91. The first round yielded a CV of 0.00-0.14 and a Kendall's W of 0.195 (P < 0.05). The second round yielded a CV of 0.00-0.11 and a Kendall's W of 0.160 (P < 0.05). The final protocol comprised 3 first-level domains, 14 second-level domains, and 31 third-level items, organized within the SMT framework of symptom experience, management strategies, and outcomes.

Conclusion: The developed management protocol for the management protocol demonstrates strong scientific validity, reliability, and practical applicability. It serves as a valuable tool for healthcare professionals to develop personalized care plans, potentially enhancing rehabilitation outcomes and quality of life for stroke patients. Future studies are required to test its efficacy in multi-center trials.

Background: Stroke is a major global cause of disability, and attention deficits are among the most common cognitive impairments in survivors. These deficits limit independence and hinder rehabilitation outcomes. Conventional post-stroke rehabilitation focuses primarily on motor recovery, while targeted cognitive rehabilitation, particularly attention training, remains underrepresented.

Purpose: This scoping review aimed to identify mobile application-based interventions developed to improve attention in stroke survivors. The secondary aim was to describe the implementation settings of these interventions.

Methods: This review followed the PRISMA-ScR Arksey and O'Malley frameworks. Systematic searches were conducted in PubMed, Scopus, EBSCO-host, and Google Scholar up to January 2025. Eligible studies included randomized controlled trials (RCTs), pilot RCTs, and quasi-experimental designs involving post-stroke patients with attentional deficits using mobile applications via smartphones or tablets. Methodological quality was appraised using the Joanna Briggs Institute (JBI) checklist for RCTs and the National Institutes of Health (NIH) tool for pre-post studies without a control group.

Results: Eleven studies were included from 5840 identified records. Two types of mobile applications were identified: cognitive training applications (n = 4) incorporating structured exercises and telehealth support, and game-based rehabilitation applications (n = 7), emphasizing gamification and training tasks. The interventions were implemented in hospital-based and hybrid settings.

Conclusion: Mobile applications show promise in post-stroke attentional rehabilitation, with evidence supporting cognitive training and game-based programs via tablets in hospital or hybrid settings and these interventions improve attention. However, methodological variability and heterogeneous protocols limit study comparability. Future research needs standardized frameworks and large clinical trials, supported by digital literacy among healthcare professionals, to strengthen clinical integration within stroke rehabilitation.

Objective: The aim of this study is to explore the risk factors associated with the onset and clinical progression of moyamoya disease (MMD), as well as the outcomes of combined revascularization surgery (RS).

Methods: A retrospective analysis was performed on the medical records of 226 individuals diagnosed with MMD who underwent combined RS at the Department of Neurosurgery in 2022. Binary logistic regression analysis was used to identify risk factors related to the occurrence of cerebral ischemia (CIS), postoperative complications, lateralization of MMD involvement, progression from unilateral to bilateral MMD, and disease severity in cases presenting with CIS. Surgical effectiveness was assessed during follow-up.

Results: Hypertension (odds ratio [OR] = 1.816, 95% confidence interval [CI]: 1.031-3.197) and higher preoperative modified Rankin Scale scores (OR = 5.164, 95% CI: 1.145-23.295) were identified as independent risk factors for CIS. Male sex (OR = 4.219, 95% CI: 1.470-12.195) and age ≥ 50 years (OR = 3.979, 95% CI: 1.494-10.598) were independent predictors of postoperative complications following RS. No independent factors were associated with the affected side or bilateral progression of MMD (P > 0.05). Disease severity in patients with CIS was influenced by both Suzuki staging and age. The effective rate of RS at 3-6 months postoperatively was 96.46%.

Conclusion: Early intervention is recommended, particularly for male patients and those with modifiable risk factors such as hypertension. RS should ideally be performed during the early stages of Suzuki classification and before the age of 50 to reduce the risk of postoperative complications. For patients with advanced Suzuki stage or aged ≥ 50 years, comprehensive perioperative risk assessments and tailored postoperative management strategies are essential to ensure optimal surgical outcomes.

Background: Rheumatoid arthritis (RA) significantly impairs patients' quality of life. Psychological factors such as depression and self-disgust have been shown to be associated with quality of life; however, their interactions and combined effects remain unclear. Moreover, the level of self-disgust among Chinese patients with RA has not yet been investigated.

Objective: To examine the mediating effects of self-disgust in the relationship between depression and quality of life among patients with RA, and to provide a reference for clinical practice aimed at improving patients' quality of life.

Methods: This cross-sectional study was conducted at a tertiary general hospital in Guangzhou between August 2024 and February 2025, involving 342 patients with RA. Participants completed the General Information Questionnaire, the Questionnaire for the Assessment of Self-Disgust (QASD), the Hospital Anxiety and Depression Scale (HADS) and Quality of Life in RA Patients Scale. Univariate and Pearson correlation analyses were performed using SPSS 27.0, and mediation effects were tested with the Process plugin.

Results: The mean scores of depression, the Quality of Life in RA Patients Scale and QASD were (9.01±4.97), (82.23±16.73) and (27.58±13.67), respectively. Depression was significantly correlated with quality of life (r=0.787, P < 0.001), depression was significantly correlated with self-disgust (r=0.804, P < 0.001), and quality of life was significantly correlated with self-disgust (r=0.727, P < 0.001). Self-disgust exhibited a partial mediating effect on the relationship between depression and quality of life in patients with RA, accounting for 20.60% of the total effect.

Conclusion: Patients with RA have a relatively low quality of life. Self-disgust plays a partial mediating role between depression and quality of life in patients with RA. Nursing staff should pay attention to the assessment and screening of patients' depression and self-disgust, and implement targeted interventions to improve patients' quality of life.