Background Diabetes mellitus is difficult to cure and has a long process. The level of self-care is crucial for determining the regression and health outcomes of patients with diabetes. A comprehensive and theory-based tool is urgently needed to assess the level of self-care of diabetes. In this way, the self-care of patients with diabetes can be kept up to date and accurate nursing care can be carried out. Objective To examine the psychometric properties of the Chinese version of Self-Care of Diabetes Inventory (SCODI) , and provide a scientifically validated assessment tool for the self-care of Chinese patients with diabetes. Methods The Brislin Translation Model was used for translation and cultural adaptation of the English version of the SCODI into Chinese. A total of 261 adult patients with diabetes were enrolled using a consecutive sampling method at the First Affiliated Hospital and the Affiliated Sir Run Run Hospital of Nanjing Medical University from December 2022 to June 2023. Data were collected using a self-developed general information questionnaire and the Chinese version of SCODI.Exploratory factor analysis was used to assess the structural validity. Cronbach's α, split-half reliability and composite reliability were used to describe the reliability. Glycosylated hemoglobin was used as a criterion to assess the criterion-related validity. Spearman's rank correlation analysis was used to examinate the correlation between the Chinese version of SCODI score and glycosylated hemoglobin. Results The Chinses version of SCODI contained 4 dimensions and 40 items: self-care maintenance score (75.94±13.15) , self-care monitoring score (70.65±18.71) , self-care management score (69.16±18.24) , and self-care confidence score (85.41±13.63) . In the self-care maintenance dimension, 4 factors were identified: complication screening behaviors, exercise behaviors, hygienic care behaviors and diet-medication behaviors. The self-care monitoring dimension had 2 factors: physical monitoring and symptom identification. The self-care management dimension included 2 factors: autonomous behaviors and counseling behaviors. Two factors were extracted from the self-care confidence dimension: monitoring and managing confidence, health maintenance confidence. The Cronbach's α, split-half reliability and composite reliability values for the total scale were 0.915, 0.836 and 0.912, respectively. The Cronbach's α for the four dimensions were 0.709-0.908. A significantly negative correlation was observed between each subscale and glycosylated hemoglobin (rs=-0.160, -0.300, -0.177, -0.192; P<0.001) , serving as a criterion. Conclusion Based on the middle-range theory of self-care of chronic illness, the Chinese version of SCODI exhibits strong psychometric properties, making it a valid and reliable instrument for evaluating self-care of Chinese patients with diabetes.

Background Rural doctors are the most convenient providers of community-based rehabilitative services for chronic disease patients and disabled people in rural areas, with the promotion of graded diagnosis and treatment policies, people began to pay attention to the competence of community-based rehabilitative services among rural doctors. Objective By investigating the competence of community-based rehabilitative service among rural doctors, analyzing the shortage of competence, and providing references for improving it. Methods A multi-stage stratified cluster sampling and purposive sampling methods were used to select 3 916 rural doctors from five provinces in east, central, and western China. The survey was conducted from July to August 2020. The questionnaire mainly focused on investigating the possession of rural doctors' competence in rehabilitation function assessment and community rehabilitation guidance, as well as whether the competence could meet their actual work needs. Results Of the 3 916 rural doctors surveyed, 2 391 (61.1%), 3 704 (94.6%), 2 365 (60.4%) were found to have competence in rehabilitation function assessment, community rehabilitation guidance, and comprehensive community-based rehabilitative service, respectively. The comparison of the rehabilitation function assessing competence, community rehabilitation guiding competence, and comprehensive community rehabilitation service competence of rural doctors in the eastern, central, and western regions showed statistically significant differences (P<0.001), while the rural doctors in the western region had the lowest proportion of competence; There were statistically significant differences (P<0.05) in the proportion of the rehabilitation function assessing competence and the comprehensive competence of community rehabilitation services among rural doctors with different educational backgrounds and practicing qualifications. Rural doctors with an educational background of technical secondary school/ high school or below had a relatively higher proportion of competence, and general practitioners also had a relatively higher proportion of competence. The proportion of rural doctors who need to provide six services in daily work, including muscle strength grading assessment, motor function assessment, joint activity assessment, rehabilitation guidance for common disease patients, rehabilitation guidance for chronic disease patients, and rehabilitation guidance for disabled patients, was 73.5% (2 880/3 916), 73.8% (2 891/3 916), 74.1% (2 900/3 916), 96.3% (3 773/3 916), 95.9% (3 754/3 916), 89.1% (3 490/3 916), respectively. The proportion of the three classification competencies included in the rehabilitation function assessment competence that meet the work needs does not exceed 75.0%, and the three classification competencies included in the community rehabilitation guidance competence meet the work needs with a rate of 92.4% (3 487/3 916), 91.7% (3 441/3 916), 85.6% (2 987/3 916), respectively. Conclusion Overall, the community-based rehabilitation service competence of rural doctors in China is in relatively good condition. However, there are deficiencies in the competence of rural doctors in western China. The community-based rehabilitation service competence of rural doctors could meet the needs of rural residents, and with the gradual formation of the continuous rehabilitation service mode of staying in the hospital during the acute period and returning to the community during the recovery period, rural residents will have a higher demand for the community-based rehabilitation service of rural doctors. Therefore, positive measures should be taken to enhance the rehabilitation service competence of rural doctors, and practical exercises are the more effective measures we have found.

Background With the nationwide implementation of the "Healthy China" strategy, the health disparities between urban and rural populations have narrowed. However, there is still a mismatch between the medical service capacities of village doctors and the medical service needs of rural residents. Village doctors are the first point of contact for rural residents' health concerns. Objective This study aims to evaluate the current medical service capacities of village doctors across the eastern, central, and western China, identify their strengths and weaknesses, and propose targeted strategies for improvement. The findings will provide references for building the capacities of primary health care professionals in rural areas. Methods In August 2020, the research group used the mixed methods of multi-stage stratified cluster sampling and typical sampling to select 3 916 village doctors from five provinces in the eastern, central, and western China. By distributing questionnaires on the "wjx.cn" platform, an online survey was conducted on the current status of the medical service capacities of village doctors from seven aspects: diagnosis and treatment of common and frequently occurring diseases, emergency response to critical conditions, standardized use of medical devices, community rehabilitation guidance, medical collaboration, medical document writing, and traditional Chinese medicine services. Results Among the 3 916 village doctors included in the analysis, 2 925 (74.7%) were able to diagnose and treat common and frequently occurring diseases. The competence rates of village doctors were highest in the central region (81.2%), followed by the eastern region (79.6%), and lowest in the western region (59.1%). 2 098 (53.6%) had the ability of emergency response to critical illnesses. The competence rates of village doctors were highest in the central region (61.6%), followed by the eastern region (52.3%), and lowest in the western region (40.1%). 2 081 (53.1%) could use medical devices in a standardized way. The competence rates of village doctors were highest in the central region (62.3%), followed by the eastern region (53.8%), and lowest in the western region (36.3%). 2 073 (52.9%) had the ability to provide community rehabilitation services. The competence rates of village doctors were highest in the central region (59.7%), followed by the eastern region (53.6%), and lowest in the western region (40.3%). 3 120 (79.7%) were capable of writing medical documents.The competence rates of village doctors were highest in the central region (82.6%), followed by the eastern region (82.0%), and lowest in the western region (72.7%). 2 190 (55.9%) possessed the ability of medical collaboration.The competence rates of village doctors were highest in the central region (61.0%), followed by the eastern region (57.9%), and lowest in the western region (45.3%). 2 443 (62.4%) were able to provide traditional Chinese medicine services. The competence rates of village doctors were highest in the western region (64.8%), followed by the central region (62.7%), and lowest in the eastern region (58.7%) . Conclusion Village doctors possess adequate medical service skills, essentially catering to the general medical service needs of rural residents. The overall medical service capacities should be improved, and there exist notable discrepancies in medical service capacities across various regions. It is recommended to strengthen the training of village doctors so as to enhance the overall quality of the primary health care professionals in rural areas, improve the construction of hardware facilities and information technology for village-level medical services, and promote the effective implementation of the first visit system at the primary health care level.

Carotid atherosclerosis is a degenerative disease that is a hemodynamic change caused by endothelial dysfunction and is an important cause of stroke, and the assessment of plaque stability plays an important role in predicting future clinical events. However, there is controversy in studies on the impact of calcification features on plaque stability. Previous studies have mostly categorized calcifications by their size, number, location, or shape, and explored their role in assessing plaque stability and clinical events. Based on a review of the previous literature, this article explores the correlation between calcification research and plaque stability and its value in predicting clinical events, and puts forward the existing problems and thoughts on future research directions, aiming to provide reference for research in this field.

Background Frailty and metabolic syndrome (MetS) are both common geriatric conditions and may have potentially important links in terms of risk factors, body composition and metabolic mechanisms, which could jointly affect the prognosis of older patients with gastric cancer. Clearly distinguishing the characteristics of the two syndromes and elucidating their intrinsic relationship can help to develop precise and targeted preoperative management strategies. Objective To compare the characteristics of preoperative frailty and MetS in older patients with gastric cancer, focusing on general information, blood indicators and body compositions, then analyze their correlation. Methods A total of 286 patients aged 60 to 80 years who were admitted to the Gastrosurgery Department of the Jiangsu Province Hospital for gastric malignancy from August 2021 to August 2022 were included and divided into the four groups: the frailty group (n=45), the MetS group (n=58), the frailty+MetS group (n=12) and the normal group (n=171) based on the presence of frailty and MetS, and the clinical indicators of these groups were compared. With frailty as the dependent variable, Logistic regression analysis was conducted to investigate the correlation of MetS and the diagnostic indicators with preoperative frailty. Results Statistically significant differences were observed among the four groups in terms of age, comorbidities, Nutritional Risk Screening 2002 (NRS2002) scores>3, fasting blood glucose, triglyceride, high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), hemoglobin, albumin, height, body mass, waist circumference, BMI, fat content, fat mass index, body fat percentage, visceral fat area, skeletal muscle content, skeletal muscle mass index, limb skeletal muscle mass index, muscle percentage, fat to muscle ratio and muscle to fat ratio (P<0.05). Multivariate Logistic regression analysis showed that age (OR=1.115, 95%CI=1.046-1.190), history of smoking (OR=2.156, 95%CI=1.134-4.096), NRS2002 score>3 (OR=2.359, 95%CI=1.159-4.802), CRP (OR=1.038, 95%CI=1.003-1.073) and central obesity (OR=0.405, 95%CI=0.183-0.896) were the risk factors for frailty in older patients with gastric cancer (P<0.05) . Conclusion The frailty group showed advanced age, elevated levels of inflammation and increased nutritional risk, along with an overall decline in fat and muscle composition. The MetS group showed increased comorbidities, elevated inflammation and albumin levels, abnormal markers of glycolipid metabolism, and overall increased fat and muscle composition. The frailty+MetS group had increased comorbidities, abnormal fasting blood glucose and HDL-C levels with increases only in fat-related components but no significant changes in muscle components. Thus, frailty was not significantly associated with MetS in this study.

Background Physical activity is the focus of disease management in patients with atrial fibrillation (AF), and different types and intensities of physical activity have different impacts on the health status of patients; however, the current distribution of physical activity types in patients with AF is not clearly characterized. Objective To explore differences in the distribution of the daily physical activity energy expenditure in patients with AF and the influencing factors. Methods A total of 300 AF patients newly admitted to the Department of Cardiology Medicine at the First Affiliated Hospital with Nanjing Medical University for elective catheter ablation from July to December 2023 were enrolled. General patient information was collected. The International Physical Activity Questionnaire-Long Form (IPAQ-L) was used to assess the level of physical activity, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) to evaluate fear of disease progression, the Cancer Acceptance Scale-Revised (CAS-R) to assess perceived control, and the Family Apathy Index (FAI) to gauge family care. A latent profile analysis was conducted on energy expenditure from various types of physical activity among AF patients. Starting from a one-class model, the number of classes was incrementally increased to determine the best-fitting model. Multivariate Logistic regression analysis was employed to investigate the impact of various factors on different latent profiles. Results Based on IPAQ-L scores, 80 patients (26.7%) had low, 63 (21.0%) had moderate, and 157 (52.3%) had high levels of physical activity. The latent profile analysis of patients' physical activity energy expenditure categorized them into two profiles: low energy expenditure-primarily sedentary (n=198) and high energy expenditure-primarily occupational physical activity (n=102). Univariate analysis revealed statistically significant differences in age, education level, occupation, family monthly income per capita, and scores on the FoP-Q-SF, CAS-R, and FAI between the two profiles (P<0.05). Multivariate Logistic regression analysis indicated that age 40-59 years (OR=0.280, 95%CI=0.087-0.899, P=0.017), bachelor's degree or higher (OR=0.331, 95%CI=0.124-0.883, P=0.027), mental labor (OR=0.315, 95%CI=0.121-0.817, P=0.032), retirement (OR=0.151, 95%CI=0.050-0.452, P<0.001), FoP-Q-SF score (OR=1.086, 95%CI=1.036-1.139, P<0.001), CAS-R score (OR=0.899, 95%CI=0.820-0.985, P=0.022), and FAI score (OR=0.828, 95%CI=0.707-0.969, P=0.018) were influencing factors of the latent profiles of physical activity (PA) energy expenditure (P<0.05) . Conclusion There are different latent profiles of physical activity energy expenditure among AF patients, with heterogeneous distribution characteristics across profiles. Patients aged 40-59, with bachelor's degree or higher, engaged in mental labor, retired, possessing strong perceived control, and receiving high family care are more likely to be classified as low energy expenditure-primarily sedentary. Interventions can be tailored based on the characteristics of different physical activity energy expenditure profiles and influencing factors to promote appropriate and scientific physical activity.

The burden of atrial fibrillation (AF) in China is increasing, and catheter ablation has become a first-line treatment. The perioperative symptom clusters of AF patients undergoing catheter ablation are complex and diverse, closely related to patients´ quality of life, disease prognosis, and healthcare resource utilization, and therefore, warrant significant attention. This paper systematically reviews the research related to the perioperative symptom clusters of AF patients undergoing catheter ablation. It introduces the types and current status of these symptom clusters, summarizes the influencing factors of perioperative symptom clusters, organizes the assessment tools for AF symptom clusters, and finally elucidates the management strategies for perioperative symptom clusters in AF patients. The goal is to provide insights for developing innovative comprehensive management models for perioperative symptom clusters in AF patients.

Family hypercholesterolemia (FH) is a common genetic metabolic disease, characterized by an abnormal increase in low-density lipoprotein cholesterol (LDL-C), which may manifest as corneal arcus and xanthomas. Long-term high levels of LDL-C can increase the risk of atherosclerotic cardiovascular disease (ASCVD). FH patients have a higher risk of early-onset ASCVD, with homozygous FH being more severe. Global prevalence of FH has gradually gained attention, but diagnosis and treatment still face challenges. Leveraging the release of the 2023 Chinese Lipid Management Guidelines, this article primarily compares domestic and foreign screening and diagnostic approaches to emphasize the importance of screening for lipid profiles and recommend early identification of FH patients. Additionally, genetic testing is also recommended, including not only a few key genes but also other related genes or whole-genome detection. Furthermore, this article compares different guidelines on LDL-C control management levels and ASCVD risk factors for different LDL-C subgroups. It highlights the differences in dietary recommendations, lifestyle advice, and medication control between domestic and foreign guidelines, pointing out that statins are the primary cholesterol-lowering agents universally recognized as important, with combination therapy being particularly crucial. However, for patients who failed to achieve LDL-C control after maximally tolerated therapy, international lipid management guidelines have made updates. Meanwhile, for Homozygous familial hypercholesterolemia (HoFH) patients, high-intensity statin combination therapy with other medications is the preferred approach, and early treatment is crucial; timely consideration of lipoprotein apheresis and Recombinant proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can help reduce the incidence and mortality rate of ASCVD.

Background Cardiovascular diseases are the main cause of death in patients with type 2 diabetes mellitus (T2DM). Carotid intima-media thickening (CIMT) can predict the occurrence of cardiovascular diseases. Moderate-to-high levels of physical activities (PA) improve glycemic control and reduce the incidence of cardiovascular diseases and mortality. Exploring the relationship between this modifiable lifestyle and CIMT may be an effective strategy to prevent cardiovascular diseases in the early stage. Objective To analyze the correlation between PA at varying levels and CIMT in T2DM patients, and to provide a scientific basis for recommending individualized PA programs to them. Methods This was a cross-sectional study. From January 2019 to February 2022, a total of 3 099 T2DM patients visited endocrinology clinics at two tertiary hospitals in Jiangsu Province were selected. PA level in T2DM patients was surveyed using the International Physical Activity Questionnaire (IPAQ). They were assigned into mild and lower PA group, moderate PA group and vigorous PA group. The correlation between PA and CIMT was identified by binary logistic regression. Stratified analyses were performed based on the obesity degree, blood pressure, blood lipids, and hemoglobin A1c (HbA1c). Restricted cubic splines were used to evaluate the dose-response relationship between PA and CIMT with PA level as the continuous variable. Results Compared with those in the mild and lower PA group (n=981), T2DM patients in moderate PA group (n=1 389) and vigorous PA (n=729) were significantly younger with higher HbA1c and low-density lipoprotein cholesterol (LDL-C) (P<0.05). Binary Logistic regression analysis showed that moderate PA was negatively correlated with the risk of CIMT, and this correlation was independent of socio-demographic characteristics, lifestyle and blood lipids (OR=0.775, 95%CI=0.629-0.956, P<0.05). The results of restricted cubic spline showed a nonlinear relationship between PA level and the risk of high CIMT (Pnonlinear=0.014). Stratified analysis showed that PA was not associated with CIMT in T2DM patients with normal weight (n=996) or overweight (n=1 395) (P>0.05). However, only moderate PA was associated with CIMT in obese patients (n=708) (OR=0.614, 95%CI=0.382-0.987, P<0.05). Moderate PA was negatively associated with CIMT in patients (n=324) who did not meet any of the three indicators (blood pressure, blood lipids and HbA1c) and those (n=1 416) who met only one indicator (P<0.05) . Conclusion There is a dose-response relationship between PA levels and CIMT in T2DM patients thickening. Moderate PA is significantly negatively associated with CIMT, especially in T2DM patients with poor control of obesity, blood pressure, blood lipids, and glycaemia, while vigorous PA is not correlated with CIMT.

Background With the promotion of "strengthening the primary health" measures, the number of primary health professionals in China has increased significantly, but there is still a gap between the ability of primary care physicians and basic medical needs of residents. Objective To understand the current situation, characteristics and deficiencies of Chinese primary care doctors' community rehabilitation service ability, so as to provide scientific basis for making countermeasures to improve ability. Methods The method of multi-stage stratified sampling combined with typical sampling was adopted to carry out an online questionnaire survey on doctors in primary health institutions in Jiangsu province, Anhui province, Henan province, Chongqing City and Gansu province. The current situation of community rehabilitation service ability of primary care physicians was evaluated from four aspects: rehabilitation function evaluation, rehabilitation medical service, traditional Chinese medicine health guidance and traditional Chinese medicine physiotherapy. Results A total of 8 374 questionnaires were analyzed. Among the primary doctors surveyed, 4 697 cases (56.1%), 6 396 cases (76.4%), 5 833 cases (69.7%) and 4 834 cases (57.7%) were equipped with the ability of rehabilitation function assessment, rehabilitation medical services, TCM health guidance and TCM physiotherapy, respectively. Moreover, the abilities of primary doctors in rural areas were better than that in urban areas, and the difference was statistically significant (P<0.05). There were statistically significant differences in the rates of rehabilitation medical service guidance, traditional Chinese medicine health care guidance and traditional Chinese physiotherapy ability of primary doctors in different ages, educational qualifications, and positions (P<0.05). The pairwise comparison results showed that in terms of age. In terms of assessment ability of rehabilitation function, doctors under 30 years old and over 60 years old had a higher rate than those 30-<45 years old and 45-<60 years old (P<0.016), and doctors 45-<60 years old had a higher rate than those 30-<45 years old (P<0.016). The rate of rehabilitation medical service guidance ability of primary doctors under 45 years old was lower than that of primary doctors over 45 years old (P<0.016). The ability rate of doctors under 30 years old to provide TCM health care guidance and TCM physiotherapy was lower than that of 30-< 45 years old, 45-< 60 years old and over 60 years old (P<0.016), and the ability rate of doctors 30-<45 years old was lower than that of 45-< 60 years old and over 60 years old (P<0.016). The ratio of doctors aged 45-<60 years old was lower than that of doctors aged over 60 years old (P<0.016) .The ability rate of primary doctors with high school/secondary school education or below was higher than that of college degree and bachelor degree (P<0.016), and the ability rate of junior college degree doctors was higher than that of bachelor degree (P<0.016). The possessing rate of general practitioners was higher than that of rural physicians and practicing (assistant) physicians (P<0.016), and the possessing rate of rural physicians was higher than that of practicing (assistant) physicians (P<0.016). The rate of basic doctors in TCM post possessing TCM health care guidance and TCM physiotherapy ability was higher than that in clinical post and other post (P<0.016), and the rate of clinical post possessing was higher than that in other post (P<0.016). The rate of comprehensive ability of rehabilitation medicine was higher than that of traditional Chinese medicine (P<0.05) . Conclusion The ability of community rehabilitation was insufficient on the whole, and the ability of traditional Chinese medicine rehabilitation was relatively weak. It is necessary to improve the construction of the tiered diagnosis and treatment system, promote primary care physicians' experience and abilities. Also to strengthen the joint training of traditional Chinese medicine rehabilitation and modern Western medicine rehabilitation techniques, complete the training and construction of primary rehabilitation personnel, so that they can assume the responsibility of community rehabilitation.