乳酸盐与渗透胁迫对干酪乳酪杆菌Zhang的损伤机理及保护措施

目的:探究乳酸盐与渗透压胁迫对干酪乳酪杆菌Zhang的抑制作用并寻求解决方案。方法:分别使用乳酸钠、乳酸铵与氯化钠对菌体营造有机盐胁迫与渗透压胁迫,测定完全抑制浓度并绘制耐渗透曲线,通过测定菌体密度、活菌数、细胞损伤来观察LCZ受到的生理损伤与相容性溶质的保护效果。通过分批培养与恒定pH分批培养探究渗透压升高的关键因素,通过稀释发酵液以达到降低渗透压的效果,测定稀释后样品菌体密度、活菌数、干重得率的变化。结果:乳酸铵由于自身特性对LCZ具有强烈抑制作用;乳酸钠对LCZ的抑制作用较为温和,对LCZ起到的主要抑制作用是高渗抑制。L-脯氨酸对高渗环境下LCZ生物量积累及细胞活性均有显著保护作用,最优添加量为2 g/L。稀释发酵液处理对恒定pH补料培养菌体密度与活菌数的提升效果显著,最终发酵液OD_(600nm)与活菌数可达到19.68±0.429与(3.439±0.110)×10^(10)CFU/mL,分别是未稀释处理的1.61倍与1.46倍。结论:L-脯氨酸能够在一定程度上缓解高渗下LCZ的活性损伤。通过稀释发酵液处理降低发酵后期渗透压,能极大地提升发酵水平及细胞活性,研究结果为工业化生产及应用提供参考。

Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease worldwide,affecting about 1/4th of the global population and causing a huge global economic burden.To date,no drugs have been approved for the treatment of NAFLD,making the correction of unhealthy lifestyles the principle method of treatment.Identifying patients with poor adherence to lifestyle correction and attempting to improve their adherence are therefore very important.AIM To develop and validate a scale that can rapidly assess the adherence of patients with NAFLD to lifestyle interventions.METHODS The Exercise and Diet Adherence Scale(EDAS)was designed based on com-pilation using the Delphi method,and its reliability was subsequently evaluated.Demographic and laboratory indicators were measured,and patients completed the EDAS questionnaire at baseline and after 6 months.The efficacy of the EDAS was evaluated in the initial cohort.Subsequently,the efficacy of the EDAS was internally verified in a validation cohort.RESULTS The EDAS consisted of 33 items in six dimensions,with a total of 165 points.Total EDAS score correlated significantly with daily number of exercise and daily reduction in calorie intake(P<0.05 each),but not with overall weight loss.A total score of 116 was excellent in predicting adherence to daily reduction in calorie intake(>500 kacl/d),(sensitivity/specificity was 100.0%/75.8%),while patients score below 97 could nearly rule out the possibility of daily exercise(sensitivity/specificity was 89.5%/44.4%).Total EDAS scores≥116,97-115,and<97 points were indicative of good,average,and poor adherence,respectively,to diet and exercise recommendations.CONCLUSION The EDAS can reliably assess the adherence of patients with NAFLD to lifestyle interventions and have clinical application in this population.

Colorectal cancer screening: Modalities and adherence

In the last decade,several studies have explored various modalities and strategies for colorectal cancer(CRC)screening,taking into account epidemiological data,individual characteristics,and socioeconomic factors.In this editorial,we comment further on a retrospective study by Agatsuma et al published in the recent issue of the World Journal of Gastroenterology.Our focus is on screening trends,particularly in relation to efforts to improve the currently suboptimal uptake among the general population worldwide,aiming to enhance early diagnosis rates of CRC.There is a need to raise awareness through health edu-cation programs and to consider the use of readily available,non-invasive screening methods.These strategies are crucial for attracting screen-eligible populations to participate in first-line screening,especially those in high-or average-risk groups and in regions with limited resources.Liquid biopsies and biomarkers represent rapidly evolving trends in screening and diagnosis;however,their clinical relevance has yet to be standardized.

Patient satisfaction and follow-up adherence to glaucoma case management clinic in China

AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.

植物乳杆菌P8和干酪乳杆菌Zhang对母猪繁殖性能、血清生化指标和养分消化率的影响

本试验旨在研究植物乳杆菌P8和干酪乳杆菌Zhang对母猪繁殖性能、血清生化指标和养分消化率的影响。选择48头、第4胎次的长白×大白二元妊娠母猪,随机分为4组,每组12头,每头1个重复,饲养在定位栏内。对照组饲喂基础日粮,3个试验组分别在基础日粮中添加植物乳杆菌P8 3×10^(9)CFU/kg、干酪乳杆菌Zhang 3×10^(9)CFU/kg、复合菌3×10^(9)CFU/kg(植物乳杆菌P81.5×10^(9)CFU/kg+干酪乳杆菌Zhang1.5×10^(9) CFU/kg)。试验期从母猪妊娠期80 d开始至仔猪21 d断奶结束,测定母猪繁殖性能指标;于试验结束前1 d早晨母猪空腹采血测定血清生化指标;试验结束前3 d开始连续3 d收集母猪新鲜粪样,测定养分消化率。结果表明:与对照组相比,植物乳杆菌P8组、干酪乳杆菌Zhang组和复合菌组均提高了母猪的窝产活仔数、健仔数和初生窝重(P<0.05),干酪乳杆菌P8组和复合菌组提高了仔猪断奶个体重和断奶窝重(P<0.05);干酪乳杆菌P8组和复合菌组母猪血清尿素氮较对照组分别降低了8.81%和10.76%(P<0.05);与对照组相比,3个试验组均提高了母猪日粮粗蛋白质和钙的消化率(P<0.05)。由此可见,妊娠母猪日粮中添加3×10^(9)CFU/kg植物乳杆菌P8、干酪乳杆菌Zhang和复合菌均可提高母猪繁殖性能以及饲料养分粗蛋白质和钙的消化率。

Discovery of the Exquisite Meaning of the Word “chudu” in Chinese Poetry of the Adherents of a Former Dynasty

The word “chudu” comes from Qu Yuan’s Li Sao “huang lan kui yu chu du xi, zhao ci yu yi jia ming”. The original meaning was the day of birth. After the Song Dynasty, the literati began to use it to refer to birthdays. By the end of the Ming Dynasty, they had been calling their birthdays “chudu” once they celebrated it and they were so keen on birthday celebrations. Gu Yanwu pointed out that the word “chudu” only fits “the old ministers （or the exiled ministers） who lamented the crash of the Yingcapital of the country of “Chu” such as Qu Yuan. At the same time, its use in Huang Zongxi’s and Wang Fuzhi’s birthday poems is also consistent with this context. The unique situation and mood of the adherents led them to be close to Qu Yuan and Wen Tianxiang, which bestowed “chudu” the special meaning. It is very suitable for the ministers who suffered the crash of their Dynasties or those who were exiled distantly to express their feelings about the old dynasties and old friends. After these people, Chen Yinke consciously acknowledged this layer of interpreting “chudu” and used it, which has not only enriched the connotation of “chudu”, but also extended its cultural life. From Qu Yuan to Wen Tianxiang, until Gu Yanwu, Huang Zongxi, Wang Fuzhi, and then to Chen Yinke, we can take a glimpse of the spiritual world of the Chinese adherents of Dynasties.

Exploration of Zhangs' Rockery Gardening: A Case Study of Qi Biaojia's Yu Garden

Zhang Yifan is the son of gardening Master Zhang Nanyuan, and his story can only be found in Qi Biaojia's Diary. Qi recorded his communications with Zhang Yifan and Zhang's transformation over Yu Garden in detail, thus the diary shows high documentation value. Zhang's transformation over Yu Garden was important for others exploring and understanding the contents, style, and construction period of Zhangs' rockery gardening, and also for spreading Zhangs' style in Yuezhong(the present Shaoxing City, and Xiaoshan District of Hangzhou, including 8 counties of the former Shaoxing Prefecture). This paper summarized and verified the characteristics, contents and construction period of Zhangs' rockery gardening by analyzing the study case, and elaborated the spreading and development of Zhangs' gardening style in Yuezhong.

Validation of adherence prediction system for lifestyle interventions in nonalcoholic fatty liver disease

This editorial delves into the research article by Zeng et al published in the latest issue of World Journal of Gastroenterology.The manuscript contributes significantly to addressing the global health issue of nonalcoholic fatty liver disease(NAFLD)by introducing and validating the Exercise and Diet Adherence Scale(EDAS).The article effectively conveys the importance of the study,highlighting the prevalence of NAFLD,the lack of approved drugs for its treatment,and the crucial role of lifestyle correction.The use of the Delphi method for scale development and the subsequent evaluation of its reliability add scientific rigor to the methodology.The results demonstrate that the scale is correlated with key lifestyle indicators,which makes it a promising tool for assessing patient adherence to interventions.The identification of specific score thresholds for predicting adherence to daily calorie intake and exercise adds practical value to the scale.The differentiation among scores indicative of good,average,and poor adherence enhances its clinical applicability.In conclusion,the manuscript introduces EDAS,a valuable instrument that can contribute substantially to the field of NAFLD research and clinical practice.

Adherence to Pharmacotherapy in Post-Menopausal Women with Hypertension or Metabolic Syndrome: Real World Experience

Background: Adherence to medications is dependent upon a variety of factors, including individual characteristics of the patient, interactions with health care providers, and medication complexity. Even though several studies were conducted to test intervention strategies, results are uncertain. Aim: The aim of the study is to assess if a tailored combined intervention strategy improves medication adherence in a large population of post-menopausal women affected by hypertension or metabolic syndrome. Methods: We enrolled 6833 patients aged 50 to 69 years, 85.7% with hypertension, and 14.3% with metabolic syndrome. A network between patients, general practitioners, and cardiologists was established. Interventions included education, adequate information to patients, a simplified scheme of treatment, and periodic adherence assessment. These were either delivered as healthcare provider supports or using modern technology. Medication adherence was estimated by the proportion of days covered for all classes of drugs after the index date. Results: Non-adherent hypertensive women were 297 (5%), and those with metabolic syndrome were 73 (7.4%) (p Conclusions: The rate of non-adherence in both settings of postmenopausal women was 7.7%, much lower than that described in the literature. This rate was increased in patients with metabolic syndrome;probably it is related to the complexity of the therapeutic scheme or to a poor consciousness of the disease. Therefore, implementing a tailored combined intervention can improve significantly patients’ adherence to medical therapy.

Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Context/Objectives: Tuberculosis (TB) and HIV co-infection is a serious health problem in Cameroon. The problems associated with poor adherence to treatment are on the increase worldwide. This problem can be observed in all situations where patients are required to administer their own medication, whatever the type of illness. The general objective of this study was to assess the factors affecting adherence to treatment among HIV-TB co-infected patients in health facilities in the East Region in the COVID context. Method: A retrospective cohort study before and during COVID-19 was conducted in HIV care units in 13 health districts in the East Region of Cameroon. Data were collected using a questionnaire recorded in the Kobo Collect android application, analyzed using SPSS version 25 software and plotted using Excel. Results: The pre-COVID-19 cohort compared to the during-COVID-19 cohort had a 1.90 risk of not adhering to treatment (OR: 1.90, CI {1.90 - 3.37}) and the difference was statistically significant at the 5% level (p-value = 0.029). Frequency of adherence was 65.4% (140/214). Adherence before COVID-19 was 56.9% whereas during COVID-19, it was 74.3%. Conclusion: The implementation of targeted interventions in the COVID-19 context, using evidence-based data and integrating the individual needs of HIV-TB co-infected patients, improved adherence to concurrent anti-tuberculosis treatment and antiretroviral therapy during the COVID-19 Era.

Insulin therapy in type 2 diabetes: Insights into clinical efficacy, patient-reported outcomes, and adherence challenges

Insulin therapy plays a crucial role in the management of type 2 diabetes as the disease progresses.Over the past century,insulin formulations have undergone significant modifications and bioengineering,resulting in a diverse range of available insulin products.These products show distinct pharmacokinetic and pharmacodynamic profiles.Consequently,various insulin regimens have em-erged for the management of type 2 diabetes,including premixed formulations and combinations of basal and bolus insulins.The utilization of different insulin regimens yields disparate clinical outcomes,adverse events,and,notably,patient-reported outcomes(PROs).PROs provide valuable insights from the patient’s perspective,serving as a valuable mine of information for enhancing healthcare and informing clinical decisions.Adherence to insulin therapy,a critical patient-reported outcome,significantly affects clinical outcomes and is influenced by multiple factors.This review provides insights into the clinical effectiveness of various insulin preparations,PROs,and factors impacting insulin therapy adherence,with the aim of enhancing healthcare practices and informing clinical decisions for individuals with type 2 diabetes.

Mediating role of inner strength in the relationship between medication literacy and medication adherence among kidney transplant patients

Objective:Compared with long-term renal replacement therapy,kidney transplantation is the ideal treatment for end-stage renal disease(ESRD),significantly extending patient life and improving quality of life.Kidney transplant patients need to adhere to lifelong immunosuppressive medication regimens,but their medication adherence is generally poor compared with other organ transplant recipients.Medication adherence is closely related to medication literacy and psychological status,yet related studies are limited.This study aims to investigate the current status of medication adherence,inner strength,and medication literacy in kidney transplant patients,analyze the relationships among these 3 factors,and explore the mediating role of inner strength in the relationship between medication literacy and medication adherence.Methods:A cross-sectional survey was conducted from March to October 2023 involving 421 patients aged≥18 years who visited kidney transplantation outpatient clinics at 4 tertiary hospitals in Hunan Province.The inner strength,medication literacy,and medication adherence of kidney transplant patients were investigated using the Inner Strength Scale(ISS),the Chinese version of the Medication Literacy Assessment in Spanish and English(MedLitRxSE),and the Chinese version of the Morisky Medication Adherence Scale-8(C-MMAS-8),respectively.Univariate analysis was performed to examine the effects of demographic and clinical data on medication adherence.Correlation analysis was conducted to explore the relationships among medication literacy,medication adherence,and inner strength.Significant variables from univariate and correlation analyses were further analyzed using multiple linear regression,and the mediating effect of inner strength was explored.Results:Among the 421 questionnaires collected,408 were valid,with an effective rate of 96.91%.The scores of C-MMAS-8,MedLitRxSE,and ISS were 6.64±1.16,100.63±14.67,and 8.47±4.03,respectively.Among the 408 patients,only 86(21.08%)patients had a high level of medication adherence,whereas 230(56.37%)patients had a medium level of medication adherence,and 92(22.55%)patients had poor medication adherence.Univariate analysis indicated that the kidney transplant patients’age,marital status,education levels,years since their kidney transplant operation,number of hospitalizations after the kidney transplant,and adverse drug reactions showed significant differences in medication adherence(all P<0.05).Correlation analysis showed that inner strength positively correlated with both medication literacy(r=0.183,P<0.001)and medication adherence(r=0.201,P<0.001).Additionally,there was a positive correlation between medication adherence and medication literacy(r=0.236,P<0.001).Inner strength accounted for 13.22%of the total effect in the mediating role between medication literacy and medication adherence.Conclusion:The level of medication adherence among kidney transplant patients needs improvement,and targeted intervention measures are essential.Inner strength mediates the relationship between medication literacy and medication adherence in these patients.Healthcare professionals should focus on enhancing medication literacy and supporting patients’inner strength to improve medication adherence.

植物乳杆菌Zhang-LL与马克斯克鲁维酵母菌M3共发酵葡萄汁酵素的工艺优化

【目的】以葡萄汁为原料,植物乳杆菌Zhang-LL及马克斯克鲁维酵母M3为发酵菌株,优化葡萄汁酵素的发酵工艺条件。【方法】比较植物乳杆菌Zhang-LL和马克斯克鲁维酵母M3在葡萄汁中的不同接种方式对益生菌活菌数和DPPH清除率的影响,筛选葡萄汁酵素最优接种发酵方式。进一步通过单因素试验及响应面试验,优化葡萄汁酵素最佳发酵工艺条件。【结果】植物乳杆菌Zhang-LL和马克斯克鲁维酵母M3共发酵可以显著提高葡萄汁酵素中益生菌活菌数和DPPH清除率;植物乳杆菌Zhang-LL和马克斯克鲁维酵母M3共发酵的最佳工艺条件为:按照1∶1比例接种,初始接种量5.00 lg CFU/mL、大豆蛋白胨添加量0.46%、34℃发酵18 h,植物乳杆菌Zhang-LL活菌数达6.60×10^(8)CFU/mL,马克斯克鲁维酵母M3活菌数达8.20×10^(7)CFU/mL,酵素DPPH清除率85.25%。【结论】乳酸菌与酵母菌协同发酵,在缩短发酵时间的同时还能达到较高的活菌数和DPPH清除率,可为葡萄汁酵素的工业化制备及后续多功能产品研发提供理论依据。

Scale offers the possibility of identifying adherence to lifestyle interventions in patients with non-alcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD)is the most common chronic liver disorder,and dietary and lifestyle interventions remain the mainstays of NAFLD therapy.Zeng et al established a prediction system to evaluate adherence to lifestyle interventions in patients with NAFLD and choose optimal management.Here,we discuss the application scenarios of the scale and the areas warranting further attention,aiming to provide a possible reference for clinical recommend-ations.

Healthcare Worker-Related Factors Contributing to Tuberculosis Treatment Non-Adherence among Patients in Kisumu East Sub-County

Background: Treatment non-adherence poses significant risks to health outcomes and impedes the health system’s efficiency, hence curtailing progress towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite interventions to address TB treatment non-adherence, Kenya still reports high TB treatment non-adherence rates of 35% and consequently poor treatment outcome rates. Health Care Workers (HCWs) play a critical role in linking the population to health services, yet little is known of their influence on patients’ TB treatment non-adherence in Kenya. Objective: To analyze HCW-related factors associated with TB treatment non-adherence among patients in Kisumu East Sub-County. Methods: Health facility-based analytical cross-sectional mixed-method study. A Semi-structured questionnaire on treatment adherence and patients’ perceptions of HCWs during the clinic visit was administered to 102 consenting adult (out of a total census of 107 adults) drug-susceptible TB patients. 12 purposively selected HCWs by rank from 6 health facilities participated in Key Informant Interview sessions. Medication adherence was measured using the Morisky Medication Adherence Scale and then expressed as a dichotomous variable. Quantitative analysis utilized STATA version 15.1 while qualitative deductive thematic analysis was done using NVIVO version 14. Results: TB treatment non-adherence rate of 26% (CI: 18% - 36%) was recorded. Overall, patients who felt supported in dealing with the illness were 8 times more likely to adhere to treatment compared to those who were not (aOR = 7.947, 95% CI: 2.214 - 28.527, p = 0.001). Key HCW related factors influencing adherence to treatment included: friendliness (cOR = 4.31, 95% CI: 1.514 - 12.284, p = 0.006), respect (cOR = 6.679, 95% CI: 2.239 - 19.923, p = 0.001) and non-discriminatory service (cOR = 0.1478, 95% CI: 0.047 - 0.464, p = 0.001), communication [adequacy of consultation time (cOR = 6.563, 95% CI: 2.467 - 17.458, p = 0.001) and patients’ involvement in their health decisions (cOR = 3.02 95% CI: 1.061 - 8.592, p = 0.038)] and education and counselling (cOR = 4.371, 95% CI: 1.725 - 11.075, p = 0.002). Conclusion: The study results underline importance of patient-centered consultation for TB patients and targeted education and counselling for improved treatment adherence.

Psychosocial and Socioeconomic Barriers to Treatment Adherence in Pediatric Atopic Dermatitis

Research Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition in children that significantly impacts physical health and quality of life. Adherence to treatment regimens is crucial for effective disease management but is often hindered by various psychosocial and socioeconomic barriers. Parental mental health issues, family dynamics, financial constraints, and limited access to specialized care contribute to inconsistent treatment adherence, exacerbating the condition. Purpose/Aim: The aim of this study is to explore the multifaceted barriers to treatment adherence in children with AD and evaluate the effectiveness of current interventions targeting these challenges. The study seeks to identify strategies that can improve adherence and health outcomes by addressing psychosocial and socioeconomic factors. Method: The method involves a comprehensive review of existing literature on the impact of psychosocial and socioeconomic factors on treatment adherence in children with AD. The study also examines various interventions designed to address these barriers, including community support programs, family-centered interventions, financial aid, integrated care models, and telehealth solutions. Results: Results indicate that psychosocial barriers, such as parental anxiety and depression, significantly hinder effective disease management. Family dynamics, including poor communication and single-parent households, complicate adherence efforts. Socioeconomic factors, such as financial constraints and limited healthcare access, further impede adherence. Interventions that address these barriers show promise in improving treatment adherence and health outcomes. Community support programs and family-centered interventions enhance parental mental health and family communication. Financial aid programs and integrated care models help mitigate economic and logistical challenges. Telehealth solutions improve access to specialized care, particularly in underserved areas. Conclusion: The study concludes that a holistic approach integrating medical treatment with psychosocial and socioeconomic support is essential for managing pediatric AD effectively. Policy recommendations include increased funding for community support programs, expanded telehealth services, and the integration of social services with medical care. Addressing these barriers comprehensively can enhance treatment adherence and improve the quality of life for children with AD. Further research should focus on long-term outcomes and diverse populations to refine these interventions and ensure they meet the needs of all affected children.

Effectiveness of Short Message Service Support on Adherence to Chemotherapy Treatment among Patients Attending Cancer Treatment Facilities in Kenya

Introduction: Cancer is a chronic debilitating disease that unnerves patients, communities, and nations. At some point in cancer patient’s disease experience, chemotherapy is used, and the patient is expected to adhere to treatment to improve survival and quality of life. Methods: This multisite Cluster Randomized Trial (CRT) evaluated the effectiveness of mobile phone Short Message Service (SMS) support on the adherence to treatment schedules among adult cancer patients in Kenya. Data was collected using questionnaires. Ethical approvals were obtained from relevant Ethical Review Boards (ERBs). Results: The mean adherence was 83%. There was a significant difference between treatment arms in relation to the adherence. The intervention arm had a higher mean adherence difference, M = 3.913, 95% CI 2.632-5.193, t (402) = 6.006, p ≤ 0.001), with Cohen’s d = 0.60. Although not significant, (χ2dd = 0.151, df = 1, p = 2.064), more women were perfect adheres than males. Perfect adherers were satisfied with SMS support (χ2dd = 7.620, df = 1, p = 0.06), were in the intervention arm (χ2dd = 22.942, df = 1, p ≤ 0.001), and had trust in the care provider (χ2dd = 10.591 p ≤ 0.001). SMS support was not significant in the multivariate analysis but had an estimated effect size of 0.958 (z = 1.424, p = 0.154, CI = 0.242-3.781), indicating that mean adherence was slightly better in the presence of the intervention. Conclusions: SMS-support intervention has demonstrated superiority in influencing adherence. Further, health system-related factors have a significant influence on the adherence to chemotherapy treatment. Interventions to re-design health systems that are responsive to unmet care needs of cancer patients must be explored. .

Impact of anxiety symptoms on dialysis adherence and complication rates:A longitudinal observational study

BACKGROUND Anxiety is a common psychological comorbidity in patients undergoing dialysis,yet its impact on treatment adherence and complication rates remains understudied.We designed a longitudinal observational study to investigate these relationships,based on the hypothesis that higher anxiety symptoms would be associated with increased complication rates and negatively associated with adherence to the dialysis regimen.AIM To investigate the relationship between anxiety symptoms,dialysis adherence,and complication rates in patients undergoing dialysis over a 24-month period.METHODS This observational study analyzed data from 250 adult patients who underwent hemodialysis or peritoneal dialysis at three Affiliated Hospitals of Youjiang Medical University for Nationalities over a period of 24 months.Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale at baseline and every 6 months.Dialysis adherence was evaluated through attendance records,interdialytic weight gain,and patientreported medication adherence.We recorded complications(infections,cardiovascular events,and hospitalizations)and used mixed-effects models and survival analyses to infer associations between anxiety symptoms,adherence measures,and complication rates.RESULTS Higher anxiety symptoms were significantly associated with poorer dialysis adherence,including increased missed sessions[incidence rate ratio=1.32,95%confidence interval(CI):1.18-1.47,P<0.001],greater interdialytic weight gain(β=0.24,95%CI:0.15-0.33,P<0.001),and lower medication adherence(odds ratio=0.85,95%CI:0.78-0.93,P<0.001).Patients with clinically significant anxiety(Hospital Anxiety and Depression Scale-Anxiety subscale≥8)had a higher risk of complications[hazard ratio(HR)=1.68,95%CI:1.32-2.14,P<0.001],particularly infections(HR=1.89,95%CI:1.41-2.53,P<0.001)and cardiovascular events(HR=1.57,95%CI:1.18-2.09,P=0.002).The relationship between anxiety and complications was partially mediated by adherence measures.CONCLUSION Anxiety symptoms in patients undergoing dialysis are associated with poorer treatment adherence and increased complication rates.Regular screening and targeted interventions to address symptoms may improve adherence and clinical outcomes.

Effective roles of exercise and diet adherence in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)is characterized by symptoms of excessive fat accumulation and steatosis in the liver without alcohol intake in patients.The associated pathogenic mechanism is not completely understood and there are no specific drugs for patients with NAFLD.Exercise and diet adherence are the best options for the management of NAFLD patients.Questionnaire associated analysis models of adherence to these interventions are used to assess their effectiveness in the management of NAFLD patients using specificity,sensitivity,and so on.Studies have indicated that the relative ratio of NAFLD can be reduced by physical activity with diet control.In the future,the pathogenesis of NAFLD should be clarified with stratified efforts to develop appropriate drugs,and both exercise and diet adherence should be optimized using better questionnaire design and evaluation models for patients with NAFLD.

Clinical effects of detailed nursing management interventions on medication adherence and disease perception in patients with drugresistant tuberculosis

BACKGROUND Tuberculosis(TB)is a chronic respiratory infectious disease that considerably jeopardizes human health,and there is no effective vaccine suitable for its prevention in the entire population.AIM To investigate the promotion of medication adherence and disease cognition in patients with drug-resistant(DR-)TB using detailed nursing management.METHODS In total,114 patients with DR-TB who were diagnosed and treated at our hospital between January 2019 and January 2023 were included in this study.Patients in the control group(n=57)were managed with conventional nursing care,while those in the observation group(n=57)were managed with detailed nursing care.Medication adherence,disease awareness scores,medication safety,and nursing satisfaction were compared between the two groups after the intervention.RESULTS The post-intervention medication compliance rate was 91.23%in the observation group and 75.44%in the control group,with the former being 15.79%higher than the latter(P<0.05).There was no statistically significant difference in the disease awareness scores between the two groups before the intervention;the disease awareness scores of the observation group were significantly higher than those of the control group after the intervention(P<0.05).The incidence of gastrointestinal reactions,joint swelling and pain,hearing loss,electrolyte disorders,and liver and kidney function abnormalities were lower in the observation group than those in the control group.The total nursing satisfaction of the observation group was higher than that of the control group(P<0.05).CONCLUSION Implementation of detailed nursing management for patients with DR-TB can effectively improve medication adherence,enhance awareness of the disease,ensure safety of medication,and improve satisfaction with nursing care.