Longitudinal relationship between social participation, depressive symptoms, and activity impairment among older patients with arthritis: a moderated mediation analysis.

BACKGROUND: Arthritis primarily affects older people and is a prominent cause of their activity impairment. This study aimed to examine the mediating role of depressive symptoms in the relationship between social participation and activity impairment, as well as to determine whether sex moderated the mediating effect. METHODS: A total of 2247 older patients with arthritis were included from the China Health and Retirement Longitudinal Study between 2015 and 2018. We first examined a simple mediation model where depressive symptoms were a mediator between social participation and activity impairment. Furthermore, sex was systematically integrated into the model as a moderator. The mediation model and moderated mediation model were analyzed using PROCESS macro. RESULTS: Mediation analysis revealed that the association between social participation and activity impairment was partially mediated by depressive symptoms (B = -0.10, 95% CI = [-0.14, -0.06]) with intermediary effect of 28.6%. Moderated mediation analysis indicated that mediation model was moderated by sex. The indirect effect of social participation on activity impairment among female patients (B = -0.15, 95% CI = [-0.21, -0.09]) was stronger than male patients (B = -0.04, 95% CI = [-0.09, -0.01]). CONCLUSION: Social participation was the key protective factor associated with depressive symptoms and activity impairment among arthritis patients. Encouraging arthritis patients to social participation and improving the depressive symptoms might avoid activity impairment, especially for female patients.

Association Between Insomnia and Cognitive Frailty Among Older Patients With Chronic Heart Failure: Multiple Mediating Effects of Depressive Symptoms and Social Support.

BACKGROUND: Older patients with chronic heart failure (CHF) are prone to insomnia. Studies have shown that insomnia affects the onset of cognitive frailty and is also strongly associated with depressive symptoms and social support. However, information on how these factors interact to influence cognitive frailty remains underexplored. OBJECTIVE: Our aim in this study was to explore the multiple mediating roles of depressive symptoms and social support in the relationship between insomnia and cognitive frailty. METHODS: We recruited 300 hospitalized older patients with CHF to participate in this study. The participants completed the Athens Insomnia Scale, Geriatric Depression Scale, Montreal Cognitive Assessment, FRAIL Scale, and Social Support Rating Scale. The mediation hypothesis was tested using a multiple mediation model and bootstrapping method. RESULTS: In this study, 44% of the patients experienced insomnia, and 51.3% were in a state of cognitive frailty. Our main findings suggest that insomnia has an indirect effect on cognitive frailty through 2 pathways: the multiple mediating effects of depressive symptoms and social support, and a single mediating effect of depressive symptoms. The direct effect of insomnia on cognitive frailty is also significant. CONCLUSIONS: Older patients with CHF who experience insomnia tend to have more severe depressive symptoms, cognitive frailty, and poor social support. Thus, interventions to recognize insomnia early, improve depressive symptoms, and provide social support may reduce cognitive frailty in older patients with CHF. Longitudinal studies are necessary to further refine our findings and address the limitations of the current study.

The association between team cohesion and performance: A network analysis of nurses.

Team cohesion, as a necessary condition for the cooperation and development of a team, has been shown to have a strong association with team performance. However, the mechanism of this internal correlation is unclear and more in-depth studies are lacking. The study aimed to explore the complex links between the dimensions of team cohesion and performance in nurses. A total of 1639 practice nurses from 118 nursing teams were included in this cross-sectional study. Data were collected using the Team Cohesion Scale (including consistency of affection, behavior, and cognition) and the Team Effectiveness Scale (including cooperation satisfaction, and task performance). Using network analysis, the team cohesion and performance network was constructed, and the strength and bridge strength of nodes were calculated. The results showed that the edges between team cohesion and performance dimensions were all positively correlated. Cooperation satisfaction and consistency of affection are the core variables in the network. Interventions targeting cooperation satisfaction and consistency of affection need to be developed at the team level to maximize team cohesion and performance among nurses.

Longitudinal Trajectories of Depressive Symptoms Among Patients With Knee Osteoarthritis: The Role of Pain Intensity.

BACKGROUND: Pain is the primary symptom of knee osteoarthritis (KOA), significantly associated with depressive symptoms. Whether the early pain intensity could distinguish different trajectories of depressive symptoms is not well understood among patients with KOA. AIMS: To identify heterogeneous depressive symptoms trajectories among patients with KOA, and investigate the association between depressive symptoms subgroups and pain intensity. DESIGN: Secondary analysis of a cohort sample. SETTING: Three waves of data from the China Health and Retirement Longitudinal Study was collected in 28 provinces across China. PARTICIPANTS: 702 patients with KOA aged ≥ 45 years completed the Center for Epidemiologic Studies Depression Scale biennially from 2011 to 2015. METHODS: Latent class growth analysis was performed to identify the optimal trajectory shape and number of classes. Multinomial logistic regression analysis was conducted to compare pain intensity across the trajectories. RESULTS: Four distinct trajectories were identified as follows: no depressive symptoms, highly stable, decreasing, and increasing. In multivariate analysis, compared with the "no depressive symptoms" class, patients in the "highly stable" class and "increasing" class were more likely to report moderate pain (p < 0.05) and severe pain (p < 0.05). In addition, there was no significant difference in pain intensity between "no depressive symptoms" class and "decreasing" class (p > 0.05). CONCLUSIONS: These results suggest important heterogeneity in depressive symptom trajectories among patients with KOA. Pain intensity could predict different depressive symptom trajectories in patients with KOA. Efforts to improve the depressive symptoms in patients with KOA must incorporate strategies to address pain.

Construction and Validation of Machine Learning Algorithms to Predict Chronic Post-Surgical Pain Among Patients Undergoing Total Knee Arthroplasty.

BACKGROUND: Chronic post-surgical pain (CPSP) is a common but undertreated condition with a high prevalence among patients undergoing total knee arthroplasty (TKA). An effective model for CPSP prediction has not been established yet. AIMS: To construct and validate machine learning models for the early prediction of CPSP among patients undergoing TKA. DESIGN: A prospective cohort study. PARTICIPANTS/SUBJECTS: A total of 320 patients in the modeling group and 150 patients in the validation group were recruited from two independent hospitals between December 2021 and July 2022. They were followed up for 6 months to determine the outcomes of CPSP through telephone interviews. METHODS: Four machine learning algorithms were developed through 10-fold cross-validation for five times. In the validation group, the discrimination and calibration of the machine learning algorithms were compared by the logistic regression model. The importance of the variables in the best model identified was ranked. RESULTS: The incidence of CPSP in the modeling group was 25.3%, and that in the validation group was 27.6%. Compared with other models, the random forest model achieved the best performance with the highest C-statistic of 0.897 and the lowest Brier score of 0.119 in the validation group. The top three important factors for predicting CPSP were knee joint function, fear of movement, and pain at rest in the baseline. CONCLUSIONS: The random forest model demonstrated good discrimination and calibration capacity for identifying patients undergoing TKA at high risk for CPSP. Clinical nurses would screen out high-risk patients for CPSP by using the risk factors identified in the random forest model, and efficiently distribute preventive strategy.

Effect of Exercise Rehabilitation in Patients With Acute Heart Failure: A Systematic Review and Meta-analysis.

BACKGROUND: Exercise rehabilitation is conducive to increasing functional ability and improving health outcomes, but its effectiveness in patients with acute heart failure (AHF) is still controversial. PURPOSE: In this study, our aim was to systematically examine the efficacy of exercise rehabilitation in people with AHF. METHODS: A search was conducted for randomized controlled trial studies on exercise rehabilitation in patients with AHF up to November 2021. Two investigators conducted literature selection, quality assessments, and data extractions independently. The primary outcome was 6-minute walk distance, and the secondary outcomes were left ventricular ejection fraction, quality of life, Short Physical Performance Battery, readmission, and mortality. RevMan (version 5.3) software was used for the meta-analysis. RESULTS: Twelve studies with 1215 participants were included. Exercise rehabilitation significantly improved the 6-minute walk distance (mean difference [MD], 33.04; 95% confidence interval [CI], 31.37-34.70; P < .001; I2 = 0%), quality of life (MD, -11.57; 95% CI, -19.25 to -3.89; P = .003; I2 = 98%), Short Physical Performance Battery (MD, 1.40; 95% CI, 1.36-1.44; P < .001; I2 = 0%), and rate of readmission for any cause (risk ratio, 0.48; 95% CI, 0.26-0.88; P = .02; I2 = 7%), compared with routine care. However, no statistically significant effects on left ventricular ejection fraction (MD, 0.94; 95% CI, -1.62 to 3.51; P = .47; I2 = 0%) and mortality (risk ratio, 1.07; 95% CI, 0.64-1.80; P = .79; I2 = 0%) were observed. CONCLUSIONS: Compared with routine care, exercise rehabilitation improved functional ability and quality of life, reducing readmission in patients with AHF.

Relationship between quality of life, fear of disease progression, and coping styles in patients with pulmonary hypertension: A network analysis.

A poor quality of life (QoL) in patients with pulmonary hypertension (PH) is often associated with emotional disturbances and the ability to cope. Little is known, however, about the intrinsic links among the QoL, fear of disease progression (FoP), and coping styles in patients with PH. The purpose of this study was to elucidate the relationships among QoL, FoP, and coping styles in patients with PH. We conducted a cross-sectional survey of 247 patients from a tertiary hospital in Jinan, China and analyzed the relationships using network analysis. Participants completed the World Health Organization's Quality of Life Questionnaire, Fear of Disease Progression Questionnaire and Simple Coping Style Questionnaire during the survey period. The total QoL, positive coping, and negative coping scores were 46.55 ± 10.46, 31.75 ± 6.85, and 18.75 ± 4.66, respectively. The QoL psychological domain had the strongest centrality, deserving more attention than other domains. The coping styles were bridge nodes that connected the whole network, where negative coping and social family FoP, and positive coping and both social and psychological QoL had the strongest positive correlations. There were no significant sex-based or age-based differences in the networks. To improve QoL and psychological well-being in people with PH, healthcare professionals must focus on issues beyond the patient's physical health. Specifically, they should focus on positive coping styles, while developing interventions to promote positive coping and reduce negative coping styles.

Current status and influencing factors of spiritual needs of patients with advanced cancer: a cross-sectional study.

BACKGROUND: Spiritual needs have been associated with better physical health outcomes and provide a context for patients to gain hope and significance in coping with disease. This study aimed to understand the status of spiritual needs of patients with advanced cancer and conducted a quantitative study on the relationship between patient-reported physical, psychological, and social influencing factors and spiritual needs based on a biopsychosocial-spiritual model. METHODS: In this study, 200 oncology inpatients from Shandong Province were recruited using a convenience sampling method to conduct a cross-sectional survey using general data from December 2020 to June 2022. Correlation analysis was used to analyze the correlation between spiritual needs and cancer-related fatigue, anxiety and depression, the family care index, and social support. Multiple regression analysis was used to analyze the relationship between spiritual needs and the influencing factors. RESULTS: The spiritual needs score of the patients with advanced cancer was high. Multiple regression analysis revealed that cancer-related fatigue, social support, and religious beliefs influenced the spiritual needs of patients with advanced cancer. Compared with married patients, widowed or divorced patients scored 8.531 points higher on spiritual needs. Cancer-related fatigue, social support, religious beliefs, and marital status (divorced or widowed) explained 21.4% of the total variation in the spiritual needs of patients with advanced cancer. CONCLUSION: The spiritual needs of patients with advanced cancer were significantly correlated with cancer-related fatigue, depression, social support, and other factors. Religious beliefs, marital status, cancer-related fatigue, and social support were the main factors influencing the spiritual needs of patients with advanced cancer. This is a quantitative study, and medical staff can provide targeted spiritual care for patients with cancer based on the above influencing factors.

The association between team resilience and team performance in nurses during COVID-19 pandemic: a network analysis.

BACKGROUND: Compared to other healthcare workers, nurses are more vulnerable to the potentially devastating effects of pandemic-related stressors. Studies have not yet investigated the deeper characteristics of the relationship between team resilience and team performance among nurses during the COVID-19 pandemic. This study aimed to elucidate the characteristics of team resilience and performance networks among nurses during the pandemic. METHODS: A cross-sectional study involving 118 nursing teams comprising 1627 practice nurses from four tertiary-A and secondary-A hospitals in Shandong Province, China, was conducted. Analyzing and Developing Adaptability and Performance in Teams to Enhance Resilience Scale and the Team Effectiveness Scale were used to measure team resilience and performance, respectively. The estimation of the network model and calculation of related metrics, network stability and accuracy, and network comparison tests were performed using R 4.0.2. RESULTS: Node monitoring had the highest centralities in the team resilience and performance network model, followed by node anticipation, cooperation satisfaction, and cooperation with other departments. Moreover, node cooperation satisfaction and learning had the highest levels of bridge centrality in the entire network. CONCLUSION: Monitoring, anticipation, cooperation satisfaction, cooperation with other departments, and learning constituted core variables maintaining the team resilience-performance network structure of nurses during the pandemic. Clinical interventions targeting core variables may be effective in maintaining or promoting both team resilience and performance in this population.

The mediating effects of social support and depressive symptoms on activities of daily living and social frailty in older patients with chronic heart failure.

OBJECTIVES: To investigate the level of social frailty (SF) in older patients with chronic heart failure (CHF) and examine the mediating role of social support and depressive symptoms between activities of daily living and SF. METHODS: Using a convenience sampling method, 205 older patients with CHF were recruited from China between November 2021 and May 2022. Activities of daily living, social support, depressive symptoms, and SF were assessed using a self-administered questionnaire. Data were analyzed using structural equation modeling. RESULTS: The final model obtained a good fit. Activities of daily living in older patients with CHF were directly related to SF. The multiple mediation analysis revealed that the relationship between activities of daily living and SF was mediated by social support (effect: -0.010, 95% CI [-0.021, -0.003]) and depressive symptoms (effect: -0.011, 95% CI [-0.019, -0.005) separately, and serially (effect: -0.007, 95% CI [-0.012, -0.003). CONCLUSIONS: Social support and depressive symptoms are multiple mediating variables in the relationship between activities of daily living and SF. Activities of daily living can improve patients' SF through social support and depressive symptoms.

Effects of medical insurance system on the hospitalization cost of acute myocardial infarction patients.

BACKGROUND: Acute myocardial infarction is still a burden on Chinese patients. Whether different medical insurance system have any influence on the hospitalization cost and therapeutic effect of acute myocardial infarction patient needs further investigation. METHOD: In this study, 600 patients were stratified by health insurance status to investigate the cost effectiveness. RESULT: Compared with free medical care, patients with other health insurance status have a significantly lower age (P Ë‚ 0.05-0.001), the youngest of which is new rural cooperative medical system. The hospital expense, nursing fee, length of stay, daily hospitalization cost, daily drug cost, daily nursing cost and percent of nursing cost of different health insurance status were statistically significant. ANCOVA analyses controlling for age showed that the differences of hospital expenses, nursing fee, length of stay and daily hospitalization cost were still statistically significant. Further studies found that health insurance status was the leading factors influencing length of stay (ß = - 0.305, P = 0.0000001), nursing costs (ß = - 0.319, P = 0.004), daily hospitalization costs (ß = 0.296, P = 0.0001) and occurrence of clinical events (ß = - 0.186, OR = 0.830, 95% CI 0.694-0.993, P = 0.041). CONCLUSIONS: The hospitalization cost, length of stay, nursing work and therapeutic effect of acute myocardial infarction patients are affected by different health insurance status and age.

Work-related potential traumatic events and job burnout among operating room nurses: Independent effect, cumulative risk, and latent class approaches.

AIMS: The objective of this study is to explore and compare the strength of associations between work-related potential traumatic events and burnout among operating room nurses based on three different approaches. DESIGN: The study followed a multisite cross-sectional design. METHODS: A stratified sampling method was conducted. Cities in the Shandong Province were divided into four groups, and two tertiary hospitals were randomly selected from all tertiary hospitals in cities of each group. A total of 361 eligible operating room nurses provided valid questionnaires between June and November 2019. Work-related potential traumatic events questionnaire and the Chinese version of the Maslach Burnout Inventory were conducted. Associations between individual, cumulative potential traumatic events, as well as latent class analysis-derived patterns of potential traumatic experiences with burnout were examined using logistic regression analysis. RESULTS: Specific traumatic events (e.g., patients' sudden death, bullying and ostracism from colleagues) were independently associated with an increased risk of burnout. Work-related potential traumatic events had a cumulative effect on burnout, whereby operating room nurses exposed to cumulative potential traumatic events carried a higher risk for burnout than others. The "multiple work-related potential traumatic events" pattern derived by latent class analysis was related to an increased risk of high depersonalization. CONCLUSION: Operating room nurses who reported specific or multiple work-related potential traumatic events were at high risk for burnout. It is of great significance to provide qualified and timely counselling or support. IMPACT: This study is the first to focus on work-related potential traumatic events among operating room nurses and examine their relationship with burnout based on three perspectives. The findings could help identify those operating room nurses who are at high risk of burnout in clinical practice. Hospital managers should develop targeted interventions to prevent or mitigate the harmful impact of potential traumatic events on occupational health.

Gap between risk factors and prevention strategies? A nationwide survey of fall prevention among medical and surgical patients.

AIMS: This study aimed to determine the extent to which nurses report assessing evidence-based falls risk factors and implementing targeted prevention for medical and surgical patients in China. DESIGN: This study was a national online survey. METHODS: The respondents were registered nurses working in medical and surgical units in 662 Chinese hospitals. The data concerning the falls risk factor assessments and targeted interventions implemented by nurses were collected online by the Nursing Management Committee of the Chinese Nursing Association in China in 2019. RESULTS: In total, 68 527 valid questionnaires were returned (95.0%). In medical and surgical units, nurses were most likely to report assessing balance, mobility and strength (81.6%) and orthostatic hypotension (76.4%) in falls patients and least likely to report assessing continence (61.3%) and feet and footwear (55.8%). Ensuring the use of appropriate footwear (79.3%) and managing syncope, dizziness and vertigo (73.8%) were the most common multiple interventions, while managing postural hypotension (48.8%) and cognitive impairment (48.4%) was the least common. Nine falls risk factors with clearly matched multifactorial interventions were identified in medical and surgical units (68.2%-97.1%). CONCLUSIONS: The implementation of multifactorial interventions in medical and surgical wards is inconsistent as reported by nurses in medical and surgical wards. Throughout China, nurses are generally concerned about falls risk factors and prevention for their patients; however, limited attention has been focused on continence, feet and footwear assessment and the management of cognitive impairment. Evidence-based falls prevention should be further tailored to the specific risk factors of each patient. IMPACT: Best practice guidelines for falls prevention in hospitals have been developed and published, and it is important for nurses to use these guidelines to guide practice. Our findings identify that in routine care, healthcare providers and hospitals can prevent falls.

Narrative therapy to relieve stigma in oral cancer patients: A randomized controlled trial.

AIMS AND OBJECTIVES: This study aimed to evaluate the efficacy of narrative therapy in relieving stigma in oral cancer patients who underwent major surgical treatment. BACKGROUND: Health-related stigma compromises mental health and life quality in people with physical or mental abnormalities. Narrative therapy has been implemented to overcome stigma among populations in a diversity of disease states. However, the effectiveness of narrative therapy in relieving stigma among patients with oral cancer is not known. DESIGN: This study was a randomized controlled trial, in which 100 oral cancer patients were selected and randomly assigned to the 'narrative therapy' group, who received narrative therapy treatment in addition to standard care, and the 'control' group, who was provided standard care only. METHODS: This research combined measurement of several questionnaires to evaluate stigma. Analysis of variance and paired t tests were employed for data analysis. RESULTS: Findings in this study demonstrated that narrative therapy treatment effectively relieved oral cancer patients' sense of shame, reducing overall stigma and significantly improving self-esteem and social relationships. CONCLUSIONS: Narrative therapy was demonstrated to be a promising therapeutic intervention for stigma relief in oral cancer patients.

Validation of a Chinese version of the Analysing and Developing Adaptability and Performance in Teams to Enhance Resilience Scale in nurses in China.

AIM: This study examined the validity and reliability of the Analysing and Developing Adaptability and Performance in Teams to Enhance Resilience (ADAPTER) Scale in a sample of Chinese nurses. BACKGROUND: Nurse shortage caused by job stress in China is becoming more acute, while research on team resilience training among nurses is still rising. To accurately and consistently describe team resilience status prior to training and evaluate the effects of resilience interventions at the team level among nurses, it is critical to develop a valid and reliable Chinese measure. METHODS: This was a cross-sectional study of 838 nurses. The scale was translated into Chinese according to Brislin's guidelines. Validity was evaluated by content validity, discriminative validity, exploratory and confirmatory factor analyses and convergent validity. Reliability was estimated by item-to-total correlations, internal consistency and test-retest reliability. RESULTS: Exploratory and confirmatory factor analyses revealed a four-factor model. Content validity was good and discriminative validity showed a significant discriminative ability. The concurrent validity was acceptable. The reliability was demonstrated with item-to-total correlations of greater than .40, Cronbach's alpha of .97 and intraclass correlation coefficients of .946. CONCLUSIONS: The Chinese version of the scale is a valid and reliable instrument. IMPLICATIONS FOR NURSING MANAGEMENT: The scale can provide insight into nurses' team resilience and thereby inform the development of specific interventions aimed at improving the team resilience of nurses.

Stressors Among Chinese Frontline Health Care Workers Exposed to COVID-19 and Associated Mental Health Outcomes.

The current study aimed to identify the main stressors inherent to caring for patients with coronavirus disease 2019 (COVID-19) and associated mental health outcomes among frontline health care workers. Data were collected via an online questionnaire from 651 frontline health care workers providing direct medical services for patients with suspected or confirmed COVID-19. Participants reported the stressors inherent to caring for patients with COVID-19, including depression, anxiety, and insomnia. Data were analyzed using descriptive statistics and multivariable logistic regression analysis. The most common stressors were "Worry about being negligent and endangering coworkers" (76.2%), "Worry about getting infected" (74.7%), and "Protective gear causing physical discomfort" (73.6%). "Conflict between duty and safety" and "Protective gear causing physical discomfort" were linked to high risk of depression, anxiety, and insomnia. Findings suggest that frontline health care workers may develop adverse mental health outcomes in the face of certain stressors, requiring targeted interventions. [Journal of Psychosocial Nursing and Mental Health Services, 60(1), 17-22.].

Gender difference in suicidal ideation and related factors among rural elderly: a cross-sectional study in Shandong, China.

BACKGROUND: Suicide is a global public health problem which has significant negative influence on individuals, families and the society. The aim of this study is to investigate the prevalence of suicidal ideation and related factors among elderly people in rural China, and further examine the gender differences of suicidal ideation. METHODS: Data were collected from the 2017 Survey of the Shandong Elderly Family Health Service, which was conducted by Shandong University. A total of 5514 elderly aged 60 and above from rural Shandong were included in this study. Binary logistic regression model was performed to examine the gender difference towards suicidal ideation, and to identify the influencing factors of suicidal ideation by gender among elderly. RESULTS: 7.7% rural elderly reported suicidal ideation in the past 12 months in Shandong, China. The prevalence of suicidal ideation among females was significantly higher than that among males (P < 0.001). Education level, debts, stress of daily life, loneliness and psychological distress were significantly related to suicidal ideation in both males and females. Besides, negative life events and life satisfaction were found to be significantly associated with suicidal ideation in females but not in males. CONCLUSIONS: There was a significant gender difference towards suicidal ideation among rural elderly in Shandong, China. So, gender difference should be considered when medical practitioners and public health workers seek to prevent and manage suicidal ideation among rural elderly, which will be important to develop strategies for coping with risk factors for suicidal ideation among males and females. In other words, more attention should be paid to females who had encountered negative life event or with lower life satisfaction.

Family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers.

Walsh's family resilience theory indicated that families could foster resilient outcomes among their members when they are facing changes or crises. However, little is known about family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers. Therefore, this study aimed to examine the direct and indirect relationships between family resilience, breast cancer survivors' post-traumatic growth (PTG), quality of life (QOL), and their principal caregivers' caregiver burden. A total of 108 breast cancer survivors/principal caregivers pairs completed a cross-sectional questionnaire survey in a comprehensive cancer of a public hospital in Shandong Province, China. The structural equation modelling (SEM) results showed that family resilience had direct and indirect effects on QOL and caregiver burden, and it was positively related to the PTG of the survivors. The survivors' PTG was positively related to their QOL, and their QOL was negatively associated with caregiver burden. Therefore, a better understanding of how family resilience contributes to PTG and QOL of the survivors and caregiver burden could help clinicians tailor interventions to enhance interventions aimed at improving both survivors' and caregivers' well-being.

Ginsenoside Rb1 enhances atherosclerotic plaque stability by skewing macrophages to the M2 phenotype.

Atherosclerosis (AS) is characterized as progressive arterial plaque, which is easy to rupture under low stability. Macrophage polarization and inflammation response plays an important role in regulating plaque stability. Ginsenoside Rb1 (Rb1), one of the main active principles of Panax Ginseng, has been found powerful potential in alleviating inflammatory response. However, whether Rb1 could exert protective effects on AS plaque stability remains unclear. This study investigated the role of Rb1 on macrophage polarization and atherosclerotic plaque stability using primary peritoneal macrophages isolated from C57BL/6 mice and AS model in ApoE-/- mice. In vitro, Rb1 treatment promoted the expression of arginase-I (Arg-I) and macrophage mannose receptor (CD206), two classic M2 macrophages markers, while the expression of iNOS (M1 macrophages) was decreased. Rb1 increased interleukin-4 (IL-4) and interleukin-13 (IL-13) secretion in supernatant and promoted STAT6 phosphorylation. IL-4 and/or IL-13 neutralizing antibodies and leflunomide, a STAT6 inhibitor attenuated the up-regulation of M2 markers induced by Rb1. In vivo, the administration of Rb1 promoted atherosclerotic lesion stability, accompanied by increased M2 macrophage phenotype and reduced MMP-9 staining. These data suggested that Rb1 enhanced atherosclerotic plaque stability through promoting anti-inflammatory M2 macrophage polarization, which is achieved partly by increasing the production of IL-4 and/or IL-13 and STAT6 phosphorylation. Our study provides new evidence for possibility of Rb1 in prevention and treatment of atherosclerosis.

Job stress and burnout: A comparative study of senior and head nurses in China.

Senior nurses can suffer from high job stress and burnout, which can lead to negative patient outcomes and higher turnover rates; however, few studies have examined this topic. We recruited 224 head and senior nurses from September to December 2015 using convenience and cluster sampling, to compare job stress and burnout levels between the two groups. The Nurse Job Stressors Inventory and Maslach Burnout Inventory scales were used to evaluate job stress and burnout, respectively. Results indicated that job stress scores significantly differed between head and senior nurses. The highest scoring subscales in both groups were time allocation and workload problems. Scores for the three burnout dimensions also significantly differed between the groups. Positive correlations between job stress and burnout were stronger among senior nurses than head nurses. Burnout may be higher among senior nurses given head nurses' potential for greater perceived job control. Our findings suggest that measures need to be taken to reduce burnout and turnover rates among senior nurses.