Encapsulating lithium at the microscale: selective deposition in carbon-doped graphitic carbon nitride spheres.

For stable lithium deposition without dendrites, three-dimensional (3D) porous structure has been intensively investigated. Here, we report the use of carbon-doped graphitic carbon nitride (C-doped g-C3N4) microspheres as a 3D host for lithium to suppress dendrite formation, which is crucial for stable lithium deposition. The C-doped g-C3N4microspheres have a high surface area and porosity, allowing for efficient lithium accommodation with high accessibility. The carbon-doping of the g-C3N4microspheres confers lithiophilic properties, which facilitate the regulation of Li+flux and dense filling of cavities with nucleated lithium, thereby preventing volume expansion and promoting dendrite-free Li deposition. The electrochemical performance was improved with cyclic stability and high Coulombic efficiency over 260 cycles at 1.0 mA cm-2for 1.0 mAh cm-2, and even over 70 cycles at 5.0 mA cm-2for 3.0 mAh cm-2. The use of C-doped g-C3N4microspheres as a 3D Li host shows promising results for stable lithium deposition without dendrite formation.

New treatment options for nonsurgical management of uterine fibroids.

PURPOSE OF REVIEW: Uterine fibroids is a common problem in reproductive-age individuals, frequently causing abnormal uterine bleeding, bulk symptoms, and adverse reproductive outcomes. Traditionally, almost half of the women with symptomatic fibroids received surgery for definitive treatment. There are a growing number of nonsurgical options for treatment that have become available for patients who desire conservative treatment or those with contraindications to surgery. RECENT FINDINGS: The introduction of oral gonadotropin-releasing hormone antagonists in combination with low-dose physiologic hormonal therapy demonstrated improvement in heavy menstrual bleeding, pain, and quality of life with preservation of bone density and a modest reduction in uterine volume with few hypogonadal side effects. Magnetic resonance-guided focused ultrasound surgery and uterine artery embolization continue to be minimally invasive procedural alternatives to hysterectomy that are safe and effective. SUMMARY: As more options for conservative management of uterine fibroids became available, it is important to counsel patients on possible options based on the size, location, and number of the fibroids as well as severity of the symptoms, plans for pregnancy, how close they are to menopause and their treatment goals.

"Elbow-Lock" Chest Compression Method in the Setting of Single Rescuer Pediatric Cardiopulmonary Resuscitation: A Crossover Simulation Study.

BACKGROUND: We designed a new 1-handed chest compression method, the "elbow-lock" chest compression (ELCC), for a single rescuer in pediatric cardiopulmonary resuscitation (CPR). Then, we compared the effectiveness between the ELCC and standard chest compression (SCC) method. METHODS: This prospective, randomized controlled, crossover simulation trial studied 34 emergency medical professionals, including physicians, nurses, and EMTs. We compare the quality of chest compression and fatigue point time between the ELCC and the SCC. RESULTS: Participants who performed the ELCC method maintained a proper depth of compression compared with SCC method (50.0 ± 0.3 mm vs 40.5 ± 0.4 mm, P < 0.001). However, the 2 methods did not differ in terms of compression velocity since neither reached the standard velocity (96.7 ± 7.1/minutes vs 91.7 ± 7.0/minutes, P < 0.016). With respect to the overall score, ELCC was more effective than the SCC (91.6 ± 3.7% vs 85.3 ± 8.8%, P = 0.002). In addition, the fatigue point time was slower in the ELCC group than the SCC group (7.3 ± 0.3/minutes vs 6.1 ± 0.4/minutes, P < 0.001). CONCLUSIONS: The single rescuer ELCC method is an effective alternative to the SCC method for pediatric CPR because the ELCC method can prevent elbow flexion.Trial registration: Our research is simulation manikin study. So we do not need to "trial registration".

Development of an Accurate and Sensitive Diagnostic System Based on Conventional PCR for Detection of African Swine Fever Virus in Food Waste.

African swine fever virus (ASFV), a highly contagious virus, can cause diseases with high mortality rates in pigs, making it a pathogen of social and economic significance. ASFV has been reported to show potential long-term survival in living livestock, such as pigs, but also in leftover cooking meat and undercooked pork meat. Hence, it is possible that there could be direct reinfection or secondary infection through feed produced from household food waste and treatment facilities. Many polymerase chain reaction (PCR)-based molecular diagnostic techniques to detect ASFV in clinical swine samples have been reported. However, those with applicability for food waste samples, which contain relatively low viral copy numbers and may contain various unknown inhibitors of PCR, are still lacking. In this study, we developed a conventional PCR-based diagnostic system that can detect ASFV with high sensitivity from food waste sample types. The technique shows a 10-100 times higher limit of detection compared to that of previously reported methods based on conventional PCR and quantitative real-time PCR. It is also capable of amplifying a sequence that is approximately 751 nucleotides, which is advantageous for similarity analysis and genotyping. Moreover, a ASFV-modified positive material different from ASFV that could synthesize 1400 nucleotide amplicons was developed to identify false-positive cases and thus enhance diagnostic accuracy. The method developed herein may be applicable for future ASFV monitoring, identification, and genotyping in food waste samples. Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-022-01007-y.

Changes in the pattern of suicide attempters visiting the emergency room after COVID-19 pandemic: an observational cross sectional study.

BACKGROUND: This study aimed to find out the change in the rate and pattern of suicide attempts during severe acute respiratory syndrome COVID-19 pandemic period. METHODS: This study was a retrospective analysis of data collected as a part of an emergency room-based post-suicide management program. The data were collected through interviews and from medical records of suicide attempts, maintained in the emergency room, from January 19 to October 31, 2020, during the "COVID-19 period," and those who attempted suicide from January 19 to October 31, 2019 "pre-COVID-19 period." We extracted educational background, marital status, occupation, presence of domestic partner, history of mental illness, alcohol consumption, history of previous suicide attempts; suicide attempt method and location (i.e., at home or a place other than home) at the time of attempt, and whether the attempt was a mass suicide. In addition, we compared patient severity between "COVID-19 period" and "pre-COVID-19 period" using the initial KTAS (South Korean triage and acuity scale) level, consciousness level, and systolic blood pressure. In 2012, KTAS was developed through the Ministry of Health and Welfare's research project to establish triage system in South Korea. RESULTS: The analysis of the number of suicide attempts during "pre-COVID-19 period" and " COVID-19 period" showed that the number of suicide attempts during "COVID-19 period" (n = 440) increased compared to the "pre-COVID-19 period" (n = 400). Moreover, the method of suicide attempts during "COVID-19 period" included overdose of drugs such as hypnotics, antipsychotics, and pesticides that were already possessed by the patient increased compared to the "pre-COVID-19 period" (P < 0.05). At the time of the visit to the emergency room, high KTAS level, low level of consciousness, and low systolic blood pressure, were observed, which were significantly different between "COVID-19 period" and "pre-COVID-19 period" (P < 0.05). CONCLUSION: With the worldwide COVID-19 virus spread, suicide rate and suicide attempts at home have significantly increased. In addition, patient severity was higher in the "COVID-19 period" than that in the "pre-COVID-19 period." The increasing suicide attempt rate should be controlled by cooperation between the emergency room and regional organizations.

Growth Kinetics of Individual Co Particles Ex-solved on SrTi0.75Co0.25O3-δ Polycrystalline Perovskite Thin Films.

A precise control of the size, density, and distribution of metal nanoparticles dispersed on functional oxide supports is critical for promoting catalytic activity and stability in renewable energy and catalysis devices. Here, we measure the growth kinetics of individual Co particles ex-solved on SrTi0.75Co0.25O3-δ polycrystalline thin films under a high vacuum, and at various temperatures and grain sizes using in situ transmission electron microscopy. The ex-solution preferentially occurs at grain boundaries and corners which appear essential for controlling particle density and distribution, and enabling low temperature ex-solution. The particle reaches a saturated size after a few minutes, and the size depends on temperature. Quantitative measurements with a kinetic model determine the rate limiting step, vacancy formation enthalpy, ex-solution enthalpy, and activation energy for particle growth. The ex-solved particles are tightly socketed, preventing interactions among them over 800 °C. Furthermore, we obtain the first direct clarification of the active reaction site for CO oxidation-the Co-oxide interface, agreeing well with density functional theory calculations.

"Where Does it Come from?" Experiences Among Survivors and Parents of Children with Retinoblastoma in Kenya.

Genetic testing and counseling have become integral to the timely control of heritable cancers, like the childhood eye cancer retinoblastoma. This study aimed to determine attitudes, knowledge and experiences related to retinoblastoma genetics, among survivors and parents of children with retinoblastoma in Kenya. This qualitative study used focus groups as the primary data collection method, coupled with a brief demographic questionnaire. Study settings were Kenyatta National Hospital and Presbyterian Church of East Africa Kikuyu Hospital. Thematic analysis was used to identify key themes. Thirty-one individuals participated in five focus groups. Two main concepts emerged: (1) the origins of retinoblastoma are unclear, and (2) retinoblastoma is associated with significant challenges. The lack of clarity surrounding the origins of retinoblastoma was linked to limited knowledge of retinoblastoma genetics, and limited genetic counseling delivery and uptake. The challenges associated with retinoblastoma were discussed in terms of the impact of the diagnosis on individuals and families, and unmet healthcare needs related to the diagnosis. Next steps will incorporate these findings to develop evidence-informed and accessible cancer genetic services in Kenya.

Integrated approach of eco-epigenetics and eco-metabolomics on the stress response of bisphenol-A exposure in the aquatic midge Chironomus riparius.

The stress response mechanisms of Bisphenol A (BPA), an endocrine disrupting compound, remain to be elucidated. In this study, we explored the effects of BPA on the non-biting midge Chironomus riparius through basic ecotoxicity assays, DNA damage (comet assay), eco-epigenetics (global DNA and histone methylations) and non-targeted global metabolomics (NMR based) approaches. The reproduction failure, increase in DNA damage, global DNA hyper-methylation, and increased global histone modification (H3K36) status were evident due to BPA exposure at 10% lethal concentration (LC10: 1 mg/L, based on 48 h acute toxicity). Moreover, non-targeted global metabolomics followed by pathway analysis identified alterations of energy metabolism, amino acids, and methionine metabolisms etc. Most importantly, we found a potential cross-talk between altered epigenetics and metabolites, such as, increase in methionine and o-phosphocholine metabolites corresponds with the phenomena of global hyper-methylation in DNA and H3K36 mark. Overall, our results suggests that the crosstalk of global metabolomics and epigenetic modification was fundamental of the underlying mechanisms in BPA-induced stress response in C. riparius.

Emticicia sediminis sp. nov. isolated from sediment of a shallow stream.

A novel bacterial strain, designated JBR12T, was isolated from sediment of a shallow stream in Cheonan, Korea. Phylogenetic analysis based on 16S rRNA gene sequences showed that strain JBR12T belongs to the genus Emticicia, and indicated that its closest relatives are Emticicia oligotrophica DSM 17448T (97.8 % sequence similarity) and E. ginsengisoli Gsoil 085T (94.3%). A DNA-DNA hybridization experiment revealed < 70 % genomic relatedness between strain JBR12T and E. oligotrophica DSM 17448T. The major fatty acids (>5% of the total) were iso-C15 : 0, summed feature 3 (C16 : 1ω7c and/or C16 : 1ω6c), iso-C15 : 0 3-OH, anteiso-C15 : 0 and iso-C15 : 0 3-OH. The DNA G+C content of strain JBR12T was 37.7 mol%. According to data from the present polyphasic taxonomic study, strain JBR12T represents a novel species of the genus Emticicia, for which the name Emticicia sediminis sp. nov. is proposed. The type strain is JBR12T ( = KACC 17466T = JCM 19321T).

Simple high-throughput analytical method using ultra-performance liquid chromatography coupled with tandem mass spectrometry to quantify total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol in urine.

BACKGROUND: Since the urinary concentration of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) is a reliable biomarker of exposure to tobacco smoke, we developed a relatively simple high-throughput chromatographic method to quantify total urinary NNAL concentrations in the general population. METHODS: The high-throughput analytical method was developed using ultra-performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS) to identify and quantify total urinary NNAL concentrations in 10 non-smokers and 15 otherwise healthy smokers. RESULTS: Loss of nitric oxide at m/z 30 was found to be the predominant mass transitioned, and therefore was used as the SIM transition to quantify both NNAL and NNAL-methyl-d3 in urine. The analytical method did not require sample derivatization. Standard curves for total NNAL concentrations were linear between 20 and 1500 pg/mL, with coefficients of determination >0.95. Precision and accuracy ranged from 2.2% to 8.6% (CV) and from -5.6% to 10.9% (percent error), respectively. The lowest limit of quantification was 6.7 pg/mL, and 2.0 pg/mL the lowest limit of detection (LLOD). Total urinary NNAL concentrations in non-smoker subjects were

Flavihumibacter cheonanensis sp. nov., isolated from sediment of a shallow stream.

A Gram-reaction-positive, rod-shaped, strictly aerobic and non-motile bacterial strain, designated WS16(T), was isolated from the sediment of a shallow stream located in Cheonan, Korea. The strain grew optimally at 28 °C, at pH 7.0 and in the absence of NaCl. Phylogenetic trees based on 16S rRNA gene sequences suggested that the isolate belonged to the genus Flavihumibacter of the phylum Bacteroidetes. Comparative 16S rRNA gene sequence analysis showed that strain WS16(T) was related most closely to Flavihumibacter petaseus T41(T) (96.8 % similarity). The isolate contained MK-7 as the predominant menaquinone and iso-C15 : 0, iso-C15 : 1 and iso-C17 : 0 3-OH as the major fatty acids. The genomic DNA G+C content of the isolate was 45.9 mol%. The results of a polyphasic taxonomic approach indicated that strain WS16(T) represents a novel species of the genus Flavihumibacter, for which the name Flavihumibacter cheonanensis sp. nov. is proposed. The type strain is WS16(T) ( = KACC 17467(T) = JCM 19322(T)).

Toward Healthy Aging in Palau.

BACKGROUND AND OBJECTIVES: Palau is facing a rapidly aging population and developing a comprehensive national aging policy to address the growing needs of older adults, but more research is needed to understand their circumstances and needs in relation to healthy aging. This study aims to investigate these factors and contribute to developing the National Policy on Care for the Aging. RESEARCH DESIGN AND METHODS: The study adopted a participatory action research design and included focus groups with older adults, public consultations, and stakeholder interviews, providing insights into the needs of an aging population and how to address them. Thematic analysis was conducted to understand the experiences and needs of older adults and possible system changes to address these needs. RESULTS: This study identified the need to recognize cultural changes and optimize social and physical environments to improve the health and well-being of older adults. Older adults are valued in Palauan society, but harmful stereotypes and mistreatment of older adults exist. To address those needs and challenges, our stakeholders proposed a range of services, programs, and policies across sectors to create a healthy-enabling environment. Our findings also highlight the importance of health systems proactively reaching individuals and families to address lifelong health needs. DISCUSSION AND IMPLICATIONS: Our results show the vital role of various sectors in fostering healthy aging and the importance of environmental and cultural perspectives in creating an age-friendly society, which can be an inspiration for other Pacific Island countries.

Promoting healthy ageing in the Western Pacific: A mini review of good practices and policy responses.

The Western Pacific Region is experiencing rapid population ageing, which has implications for almost all areas of society. Countries will need to prepare for population ageing by investing in health and optimizing living environments. This requires a whole-of-society approach to healthy ageing. Countries in the Western Pacific Region have been making significant progress in healthy ageing. Since the endorsement of the Regional Action Plan on Healthy Ageing, younger societies have also started preparing for population ageing, focusing on social and health systems transformation, community-based integrated care, social and technological innovations and research, monitoring and evaluation. As more countries are interested in healthy ageing and preparing for necessary social and health systems transformation, the case studies in this article can be an inspiration for Member States to transform their approaches to achieving a society where older adults are healthier and can participate fully.

Pasteurella multocida bacteremia: A case report of pelvic cavity inflammation with abnormal uterine bleeding, fever, and sclerotic bone lesions.

Background: Pasteurella multocida, is a bacterium that is frequently transmitted to humans from domestic pets. Infections are generally localized, but previous reports have exhibited that Pasteurella can cause systemic infections such as peritonitis, bacteremia and in some rare cases tubo-ovarian abscess. Case presentation: We present a case of a 46-year-old woman who came to the emergency department (ED) with complaints of pelvic pain, abnormal uterine bleeding (AUB), and fever. A non-contrast computed tomography (CT) of abdomen and pelvis showed uterine fibroids with sclerotic changes in lumbar vertebrae and pelvic bones causing a high degree of suspicion for cancer. On admission, blood culture, complete blood count (CBC) and tumor markers were drawn. Additionally, an endometrial biopsy was performed to rule out the possibility of endometrial cancer (EC). The patient underwent an exploratory laparoscopy with hysterectomy and bilateral salpingectomy. After diagnosis with P. multocida the patient was treated with five days of Meropenem. Conclusion: There are few cases of P. multocida peritonitis reported; in addition, findings of AUB with sclerotic bony changes in a middle-aged woman is often associated with EC. Thus, clinical suspicion from patient history, infectious disease work-up and diagnostic laparoscopy are essential for proper diagnosis and management.

Towards digital healthy ageing: the case of Agatha and priorities moving forward.

Digital tools have an important role to play in meeting the health demands of ageing societies. However, current technological design paradigms often marginalize older people. We adopted a lean, user-centred approach to prototype the Avatar for Global Access to Technology for Healthy Ageing (Agatha), an interactive one-stop shop for healthy ageing promotion. Building on this experience, we present a vision for an integrated approach to "digital healthy ageing". Older people consulted predominantly associated "healthy ageing" with disease avoidance. Digital healthy ageing should take a more holistic approach, covering self-care, prevention, and active ageing. It should also consider social determinants of health in old age, including access to information and digital health literacy, as they interact with poverty, education, access to health services and other structural factors. We use this framework to map out key areas of innovation and explore policy priorities and opportunities for innovation practitioners.

Antiviral activity of Bifidobacterium adolescentis SPM1005-A on human papillomavirus type 16.

BACKGROUND: Probiotic lactic acid bacteria (LAB) support a functional and balanced immune system, and contribute to immune modulatory effects in combatting microbial pathogens, including viruses. Most cervical cancers are associated with anogenital region infection with high-risk (HR) human papillomavirus (HPV). In this study, we analyzed the antiviral activity of Bifidobacterium adolescentis SPM1005-A in the SiHa cervical cancer cell line expressing HPV type 16. METHODS: We assessed the cellular toxicity of B. adolescentis SPM1005-A in SiHa cells by the Trypan blue dye exclusion assay. Cells (3.6 × 105) in culture plates with or without B. adolescentis SPM1005-A in the same type of medium, were incubated with HPV type 16 at a concentration of 5.1 × 107 cfu/ml. For antiviral analysis, we performed quantitative real-time PCR (qRT-PCR) for E6 and E7 oncogene expressions and observed protein levels by immunoblotting. RESULTS: The qRT-PCR results showed that E6 and E7 mRNA levels decreased simultaneously. Western blot analysis revealed that the E6 protein expression slightly decreased after 24 and 48 h, but the level of E7 protein expression appear unaffected compared with that in the control. Decreased HPV16 E6 and E7 mRNA transcript and protein levels were not associated with cell morphology or significant cytotoxic effects. CONCLUSIONS: This study showed that B. adolescentis SPM1005-A had antiviral activity through suppression E6 and E7 oncogene expression. The results suggest that B. adolescentis SPM1005-A could be potential applications of HPV-associated cervical cancer prevention.

Flavobacterium dankookense sp. nov., isolated from a freshwater reservoir, and emended descriptions of Flavobacterium cheonanense, F. chungnamense, F. koreense and F. aquatile.

A novel yellow-pigmented bacterial strain, designated ARSA-19(T), was isolated from a freshwater reservoir in Cheonan, Korea. Cells were Gram-staining-negative, rod-shaped, strictly aerobic and positive for catalase and oxidase. The phylogenetic tree based on 16S rRNA gene sequences showed that strain ARSA-19(T) belonged to the genus Flavobacterium and was related to Flavobacterium macrobrachii an-8(T) (96.5% sequence similarity), F. koreense KACC 14969(T) (96.2%), F. chungnamense KACC 14971(T) (96.1%), F. cheonanense KACC 14972(T) (96.4%) and F. aquatile ATCC 11947(T) (95.6%). The isolate contained MK-6 as the predominant menaquinone and iso-C(15:0) (21.8%), iso-C(16:0) 3-OH (10.4%), iso-C(15:1) G (9.3%), summed feature 3 (iso-C(15:0) 2-OH and/or C(16:1)ω7c; 8.2%), iso-C(15:0) 3-OH (7.7%) and iso-C(16:0) (7.3%) as the major fatty acids. The polar lipids of strain ARSA-19(T) were phosphatidylethanolamine, four unknown aminolipids and two unidentified polar lipids. The DNA G+C content of strain ARSA-19(T) was 33.3 mol%. Based on its phenotypic and genotypic characteristics and on the phylogenetic evidence presented, strain ARSA-19(T) is considered to represent a novel species in the genus Flavobacterium, for which the name Flavobacterium dankookense sp. nov. is proposed. The type strain is ARSA-19(T) ( = KCTC 23179(T)  = JCM 17065(T)  = KACC 14968(T)). Emended descriptions of Flavobacterium cheonanense, Flavobacterium chungnamense, Flavobacterium koreense and Flavobacterium aquatile are also proposed.

Development of a highly sensitive and rapid detection method for Pea enation mosaic virus using loop-mediated isothermal amplification assay.

The Pea enation mosaic virus (PEMV) has infected plants in the family Leguminosae such as pea, chickpea, faba bean, and lentil plants worldwide that the virus can be transmitted by sap, aphids, and seeds. Among the damages that PEMV disease cause in plants are reduced crop productivity, severely misshapen pods, wart-like outgrowths or proliferation on the surface. Previously, enzyme-linked immunosorbent assay (ELISA), reverse transcription (RT)-nested polymerase chain reaction (PCR), and real-time PCR had been used to detect PEMV. However, these methods are time-consuming and require specific equipments. For this reason, the development of a highly specific and sensitive detection method has become necessary. In this study, a new method for PEMV-1 using the loop-mediated isothermal amplification (LAMP) assay has been developed with specific primer sets as inner- and outer primers. Results showed PEMV-1 has been successfully detected that LAMP could confirm a diluted PEMV-1 up to 10-6 cDNA. LAMP is about 10,000 times more sensitive than the RT-nested PCR and/or real-time PCR. Moreover, the processing time of the LAMP was decreased 3 h than RT-nested PCR. Although future validation will be required to confirm enablement in the field area, this study provides a valuable method to identify PEMV-1 that could offer some advantages including rapid detection, high specificity and high sensitivity than others.

Development of diagnostic systems for wide range and highly sensitive detection of two waterborne hepatitis viruses from groundwater using the conventional reverse transcription nested PCR assay.

Waterborne epidemics of human hepatitis virus A and E (HAV and HEV) have been reported worldwide. Molecular biology techniques, such as reverse transcription polymerase chain reaction (RT-PCR), have been widely used to detect the two hepatitis viruses. However, comparative studies of various types of samples are needed, and different environmental factors, including the low copy pathogens, presence of PCR inhibitors in the sample, unknown non-specific reaction with template, and sequence diversity leading to new variants in viruses, should be considered. In addition, standard positive material is required to determine the accuracy of the PCR and should be able to distinguish between false and real positives. In this study, we developed RT-PCR primer sets and optimised standard templates for HAV and HEV detection to address the above concerns associated with test sensitivity and possible PCR inhibition. Finally, previously reported diagnostic methods of HAV and HEV were compared and an applicability test using groundwater was performed. The nested RT-PCR developed in this study is expected to contribute to assess water safety by monitoring HAV and HEV in non-disinfected water, like groundwater.

Factors That Influence Sleep Disturbance and the Mediating Effects of Depression on Sleep Disturbance in Patients With Rheumatoid Arthritis.

Little is known about the nature of relationships between sleep disturbance and influencing factors in rheumatoid arthritis. The purpose of this study was to identify factors that influence sleep disturbance and to evaluate mediating effects of depression on sleep disturbance. A nonexperimental, descriptive, correlational study design was adopted. One hundred patients with rheumatoid arthritis were recruited. Inflammatory status and levels of pain, fatigue, functional disability, depression, and sleep disturbance were measured. The factors that directly influenced sleep disturbance were gender, rheumatoid arthritis duration, serum C-reactive protein level, fatigue, and depression. Depression was found to have mediating effects on the relationships between sleep disturbance and arthritis symptoms. Pain, fatigue, and depression were found to have significant direct or indirect impacts on sleep disturbance. Our findings may improve understanding of sleep disturbance and aid the development of effective nursing management strategies for patients with rheumatoid arthritis suffering from sleep disturbance.