While extreme heat represents an established risk factor for mortality in patients with diabetes mellitus (DM), its synergistic effects with air pollution

Background: A considerable proportion of older adults exhibit multiple modifiable health risk behaviors. Identifying not only the co-occurrence of health risk behaviors but, more importantly, their specific clustering patterns is essential for developing targeted multiple health behavior interventions. Methods: The study sample comprised 12,766 participants from the 2018 wave of the CLHLS. Data on their health risk behaviors (inadequate sleep, insufficient fruit intake, insufficient vegetable intake, salty diet, smoking, drinking, and irregular exercise), basic demographic information, and health outcomes (self-rated quality of life scores and self-rated health status) were obtained. Analytical methods included descriptive statistics, Spearman correlation, binary logistic regression, Odds/Expected (O/E) ratios, and network community detection. Results: The median age of the participants was 84 (75, 93) years, with 5,891 (46.15%) males. A high prevalence (64.36%) of co-occurring health risk behaviors (≥2) was observed. There was a negative correlation between the number of co-occurring health risk behaviors and self-assessed quality of life ( r = −0.173, p < 0.01), as well as self-assessed health level ( r = −0.141, p < 0.01). Gender, age, years of education, residence, and economic status significantly influenced the co-occurrence of behaviors (all p < 0.01). Smoking and drinking (O/E = 2.67), insufficient fruit and vegetable intake (O/E = 1.60), and a salty diet and smoking (O/E = 1.32) demonstrated the most significant clustering risks. Two distinct clustering patterns were identified, which can be termed an Addiction Behavior Pattern and an Unhealthy Activity-Eating Pattern. Conclusion: The co-occurrence of health risk behaviors is prevalent and associated with adverse health outcomes. Behaviors exhibit a clustering effect and demonstrate distinct clustering patterns. Public health interventions should move beyond single-behavior approaches to develop integrated strategies that target these specific clustering patterns for more effective management of multiple health risks.

Mental health literacy (MHL), defined as an individual’s knowledge, beliefs, and resources related to mental health disorders, is crucial for mental

Background: The hybrid teaching mode is a kind of teaching mode developed and applied in teaching activities from the perspective of "Internet+". This mode deeply integrates online teaching and offline classroom teaching, breaks through the limitations of time and space, and achieves the teaching goal of taking students as the main body and teachers as the leading role. The hybrid teaching mode has become the most popular teaching mode in Chinese universities. However, it is not clear how this teaching mode affects students’ learning attitude, pressure perception and academic self-efficacy.Objective: The purpose of this study is to explore the relationship between perceived stress, learning attitude and academic self-efficacy of undergraduate nursing students under the hybrid teaching mode, and provides reference for hybrid teaching. Design: A cross-sectional study.Settings and participants: From June 2022 to July 2022, the study was conducted using a convenience sample of 166 undergraduate nursing students from three universities in Xi’ an, China.Methods: Perceived Stress Scale, Learning Attitude Scale and Academic Self-efficacy Scale were administered to the nursing students by questionnaire star.Results: Undergraduate nursing students scored 2.69 ± 0.59 on the Perceived Stress Scale, 3.51 ± 0.57 on the Learning Attitude Scale, and 3.41 ± 0.61 on the Academic self-efficacy Scale. The total academic self-efficacy score was significantly negatively correlated with the perception of loss of control dimension of perceived stress (P<0.01), and was significantly positively correlated with undergraduate nursing students learning attitude and all its dimensions except the professional perception dimension (P<0.01). Learning attitude was a partial mediator between stress perception and academic self-efficacy among undergraduate nursing students, with proportion of effects of 49.68%.Conclusion: Under the hybrid teaching, the undergraduate nursing students perceived stress is at a lower level, and their learning attitude and academic self-efficacy are at a medium to upper level. Perceived stress and learning attitude have a negative and positive impact on academic self-efficacy, respectively. Learning attitude plays an intermediary role between the undergraduate nursing students' perceived stress and academic self-efficacy; The academic self-efficacy of nursing students can be improved by helping them establish a positive learning attitude and reduce their perceived stress.

Objective: To systematically analyze the current status of interventions for alleviating existential distress in hemodialysis patients, explore the core components, outcome measures, and effectiveness of these interventions, and provide a theoretical basis for developing interventions targeting existential distress in this population. Methods: Following the methodology of scoping reviews, eight databases—PubMed, SinoMed, CHINA, Embase, Web of Science, CNKI, Wanfang, and VIP were systematically searched using computerized methods. The search period spanned from database inception to July 1, 2025. Key information was extracted from the included studies, including publication year, intervention methods, intervention duration, and outcome measures. Results: A total of 15 studies were included. Interventions related to concepts of existential distress in hemodialysis patients primarily included cognitive-behavioral therapy, emotional release therapy, and relaxation training. These interventions demonstrated positive effects on psychological distress, psychological crisis, demoralization, and quality of life among hemodialysis patients. Conclusion: Currently, there are no intervention studies specifically targeting existential distress in hemodialysis patients. Healthcare professionals should, in the future, draw upon interventions related to existential distress concepts—such as those addressing demoralization and psychological crisis to develop tailored intervention programs for alleviating existential distress in hemodialysis patients.

Objective: This study aimed to explore the potential categories of resourcefulness in patients with type 2 diabetes mellitus (T2DM) and their relationship with self-management. Methods: A total of 513 hospitalized T2DM patients in Xi’an were surveyed using a general information questionnaire, the Resourcefulness Scale, and the Diabetes Self-management Activities Scale for Type 2 Diabetes. Latent profile analysis (LPA) was conducted to identify resourcefulness subgroups, and their relationship with self-management was examined. Results: Patients with type 2 diabetes could be classified into three potential categories based on their resourcefulness status: a low resourcefulness level group (17.54%), a moderate resourcefulness level–social alienation group (66.66%), and a high resourcefulness level group (15.78%). Educational level, monthly per capita family income, and the presence or absence of complications were identified as factors influencing the potential categories of resourcefulness. Significant differences were observed in the total self-management scores among patients belonging to different potential categories of resourcefulness ( F = 68.33, p < 0.001). Conclusion: Type 2 diabetes patients can be classified into three potential categories of resourcefulness, with those in the high resourcefulness level group demonstrating higher self-management ability. Improving the level of resourcefulness can contribute to enhancing patients’ self-management capabilities.