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To explore the latent profiles, core associated factors, and complex mechanisms of work ability among healthcare workers in large tertiary hospitals in China. A cross-sectional study was conducted from July to October 2025. A convenience sample of 1,590 healthcare workers from a large tertiary hospital in Shaanxi Province was assessed using the Work Ability Index (WAI), the Maslach Burnout Inventory-General Survey (MBI-GS), and the Pittsburgh Sleep Quality Index (PSQI). Latent profile analysis (LPA) was employed to identify potential categories of work ability. Multivariable logistic regression analysis was performed to determine independently associated factors and to construct a nomogram prediction model. An additive interaction model and structural equation modeling (SEM) were used to analyze the joint effect and the influential pathways of job burnout and sleep disorder. LPA identified two distinct categories: "Good Work Ability" (73%) and "Poor Work Ability" (27%). Multivariable regression analysis indicated that job burnout (OR = 3.770, 95% CI: 2.510-5.661) and sleep disorder (OR = 2.890, 95% CI: 2.121-3.939) were the factors most strongly associated with poor work ability. Longer working years (≥21 years) and higher professional titles (intermediate/senior) were also associated with an increased likelihood of poor work ability. In contrast, higher education (master's degree or above) and regular physical exercise were associated with a decreased likelihood. The predictive nomogram model demonstrated good discriminative ability (AUCs of 0.781 and 0.740 for the training and validation sets, respectively) and clinical utility. Interaction analysis revealed a significant positive additive interaction between job burnout and sleep disorder (RERI = 5.164, AP = 47.453%). SEM supported a model in which job burnout was not only directly and negatively associated with work ability ( Among healthcare workers in large tertiary hospitals in China, job burnout and sleep disorder are two core and synergistic factors associated with work ability. The prediction model based on multiple factors can provide a practical tool for the early identification of high-risk individuals. Future occupational health intervention programs need to adopt integrated strategies, targeting both the alleviation of job burnout and the improvement of sleep quality as dual core objectives, and implement precise prevention and control for key populations such as those with long service years and high professional titles to maintain and enhance the work ability of healthcare workers. Show less

University students exhibit high rates of mental health problems alongside a significant gap between their physical activity (PA) intentions and actual behavior. To understand the psychological heterogeneity within this intention-behavior gap (IBG) in high-pressure academic environments, a person-centered approach is essential. The present study aimed to identify distinct psychological profiles of students based on key self-regulatory constructs related to PA and to examine how these profiles longitudinally predict changes in mental health over an academic semester. A two-wave longitudinal survey was conducted with a cohort of 850 university students during the post-pandemic return to campus life, situated within a high-achieving Chinese higher education context. At baseline (T1), PA intention, action and coping planning, self-efficacy, maladaptive perfectionism, and procrastination were measured. At both T1 and the end of the semester (T2), PA behavior (IPAQ-SF) and mental health outcomes, including depression (PHQ-9), anxiety (GAD-7), and academic burnout (SBI) were assessed. Latent Profile Analysis (LPA) was employed to identify distinct profiles from the T1 psychological data. Longitudinal regression models were then used to test the predictive validity of these profiles on T2 mental health, controlling for T1 baseline mental health, demographic covariates, and critically, T1 baseline PA behavior. LPA revealed four distinct profiles: "Effective Planners" (25.0%), "Ambitious Procrastinators" (30.0%), "Cautious Doers" (24.9%), and "Indifferent & Sedentary" (20.1%). The "Ambitious Procrastinators" exhibited the largest intention-behavior gap. Even after controlling for baseline PA behavior, membership in this profile significantly predicted greater increases in depression ( The physical activity intention-behavior gap is not a monolithic phenomenon, and the "Ambitious Procrastinators" represent a particularly vulnerable subgroup. Findings suggest that university wellness programs should move beyond generic motivational campaigns and instead deliver tailored, skill-based interventions**, such as specific cognitive restructuring and behavioral activation, **targeting the specific self-regulatory deficits of these high-risk students. Show less

The purposes of this study were to identify different psychological capital subtypes among college students through latent profile analysis (LPA) and to explore the associations of psychological capital subtypes, internet usage duration and physical exercise frequency with on both depression and anxiety. Cross-sectional study design was implemented. A cross-sectional survey was conducted using the "Questionnaire Star" platform. The questionnaires of Psychological Capital Scale, PHQ-9, and GAD-7 were administered to 1089 college students from a university in Zhengzhou, China. Latent profile analysis was applied to identify latent subtypes of psychological capital. Multivariate regression analysis was performed to investigate the associations of psychological capital subtypes with both depression and anxiety. Three psychological capital latent profiles were identified: low self-efficacy (11.7%), moderate (57.8%), and high psychological capital (30.5%) in Chinese college students. High psychological capital group showed significantly higher scores of self-efficacy, resilience, hope, and optimism than other two groups (P < 0.001). Internet usage time and physical exercise frequency exhibited positive associations with psychological capital subtypes. Compared with the low self-efficacy group, the moderate and high latent groups had significantly lower scores of both depression and anxiety. Older students had higher scores of both depression and anxiety than younger. Three latent profiles, low self-efficacy, moderate, and high psychological capital, were identified in Chinese college students. Self-efficacy is the key dimension distinguishing between the different subtypes. Adequate internet use and physical exercise frequency improved psychological capital profile. High psychological capital levels effectively reduced the scores of both depression and anxiety. Show less

To explore the associations between accelerometer-measured physical activity patterns and cardiovascular diseases (CVD), CVD-cause mortality, and all-cause mortality in people with osteoarthritis (OA). OA participants from the UK biobank with ≥36 h of accelerometer data, collected over one-week, were analyzed. Moderate to vigorous physical activity (MVPA) patterns were classified as: 'weekend warriors' (≥150 min/week, >50% on 1-2 days), active regular (>150 min/week), or inactive (<150 min/week). Mean min per week of light physical activity (LPA) were categorized into quartiles based on the distribution in the analytical sample. Among 10 210 study participants (mean age 58.1 ± 7.1 years; 64.5% female) followed for a median of 6.9 years, there were 1,538 incident cases of CVD, and 358 deaths, including 90 from CVD. Compared with inactive MVPA, both weekend warrior (adjusted hazard ratio, aHR (95% CIs); 0.73 (0.64-0.82)) and active regular MVPA (0.75 (0.65-0.87)) significantly lowered the risks of incident CVD. Notably, only the weekend warrior group showed significant reductions in CVD-cause mortality (0.55, 0.33-0.92), and all-cause mortality (0.75 (0.59-0.96)). Higher levels of LPA may link to lower CVD, CVD-cause mortality, and all-cause mortality risks in a dose-response manner. Subgroup analysis indicated that more prominent associations were found in individuals with a body mass index >30 or those aged over 60. Engaging in a weekend warrior pattern may confer unique survival benefits for OA patients, especially among older adults and those with obesity. LPA may have dose-dependent protective effects for CVD and mortality risk in OA patients. Show less

Older adults in nursing homes generally face psychological adaptation problems such as depression and anxiety. This study aimed to identify social relationship profiles among nursing home residents and explore their associations with depression and anxiety. A cross-sectional study was conducted between June and October 2023 among 1108 older residents from 42 nursing homes in Fujian Province, China. Social relationships were assessed using the Social Support Rating Scale (SSRS) and the Lubben Social Network Scale-6 (LSNS-6). Depressive-anxiety symptoms were measured using the Geriatric Depression Scale-Short Form and the Self-Rating Anxiety Scale (SAS), respectively. Latent Profile Analysis (LPA) was performed to identify distinct social relationship profiles, and ANOVA/ANCOVA were used to examine differences in depression and anxiety across profiles. The LPA analysis identified six distinct social relationship profiles. The "Low social support/low social network group" (24.7%) was the most prevalent, showing significantly higher levels of depression and anxiety compared to the others. The "Moderate social support/moderate friend network group" (20.9%) demonstrated an intermediate and balanced social relationship characteristic. When compared to the "Moderate-low social support/high friend network group" (8.1%) and the "Moderate-high social support/low friend network group" (18.1%), despite these two groups scoring higher or above-average in specific dimensions of social support or friend network, they still showed higher levels of depression than the "High social support/high social network group" (15.1%) and the "High social support/super high social network group" (13.1%). Social relationship profiles among nursing home residents are heterogeneous and significantly associated with depressive-anxiety symptoms. Show less

Premature coronary artery disease (CAD) poses diagnostic challenges, particularly in patients with minimal traditional risk factors. High lipoprotein(a) [Lp(a)] is an independent, genetically determined risk factor for atherosclerotic cardiovascular disease, and it contributes to early and progressive CAD. We report the case of a 35-year-old African American woman with recurrent chest pain who was diagnosed with severe multivessel CAD despite minimal traditional cardiovascular risk factors. Further evaluation revealed markedly high Lp(a) levels. She underwent successful percutaneous coronary intervention and achieved optimal low-density lipoprotein cholesterol (LDL-C) control with high-intensity statin therapy and a PCSK9 inhibitor. Despite aggressive lipid-lowering therapy, she developed recurrent angina within 6 months, and repeat coronary angiography demonstrated disease progression. This case highlights the role of high Lp(a) in driving premature and progressive CAD independent of LDL-C levels. Early identification of high Lp(a) may improve risk stratification and inform management strategies. High Lp(a) may contribute to premature and progressive CAD even with optimal LDL-C control, supporting consideration of Lp(a) testing in young patients with unexplained or familial CAD. Show less

Falls have long been a significant safety concern worldwide, not only compromising the physical and psychological health of older adults and limiting their social engagement but also imposing substantial economic and caregiving burdens. Evidence on fall risk perception among Chinese community-dwelling older adults remains limited, especially for those transitioning to community living after hospital discharge. This research examined the subtypes of fall risk perception of Chinese community-dwelling older adults in the post-discharge transition and to explore subgroup characteristics and associated factors. A cross-sectional survey was conducted between January 2024 to March 2025 in Hangzhou, Zhejiang Province. A self-designed questionnaire was used to collect demographic and health-related information, The Fall Risk Perception Scale for Community-dwelling Older Adults was used to assess the fall risk perception, the objective fall risk was assessed by Morse Fall Scale. Latent profile analysis (LPA) was performed to extract latent classes of fall risk perception, and multinomial regression analyses were used to identify differences between these categories. A total of 468 older adults were included, with 56.0% were male. Three fall risk perception subtypes were identified by LPA: Low Perception-Social Context Desensitized Type (29.2%), Moderate Perception - Balanced Type (43.4%), and High Perception - Bio-behaviorally Salient Type (27.4%). Individuals who were aged with 70-79 (OR = 0.46, 95% CI: 0.27-0.77), with college education or above (OR = 0.31, 95% CI: 0.13-0.76), those who underwent surgery during hospitalization (OR = 0.26, 95% CI: 0.15-0.43), reported difficulty falling asleep (OR = 0.40, 95% CI: 0.20-0.82), and those with a history of falls (OR = 0.44, 95% CI: 0.24-0.81) were significantly more likely to be in the High Perception - Bio-behaviorally Salient Type. Compared to objective fall risk level, a third of participants (31.4%) correctly estimated their fall risk, 23.1% overestimated it and 45.5% underestimated it. Most older adults possess a Moderate Perception - Balanced Type toward fall risk. Key determinants of heightened risk perception included advanced age, higher education, fall history, and recent surgical experience. Tailored, profile-specific risk communication strategies are essential to improve perceptual accuracy during the hospital-to-home transition may support post-discharge fall prevention. Show less

The purpose of this study was to explore the latent profiles of ambivalence over emotional expression (AEE) in breast cancer patients and its influencing factors. From July 2024 to June 2025, breast cancer patients were recruited using a convenience sampling method from a tertiary hospital in China. A total of 388 participants completed demographic and clinical characteristic questionnaires, the Ambivalence Over Emotional Expression Questionnaire (AEQ), the Perceived Stress Scale-14 (PSS-14), the Social Support Rating Scale (SSRS), and the Irrational Beliefs Scale (IBS). Latent profile analysis (LPA) was used to identify AEE subgroups, followed by univariate analysis, ANOVA, and multinomial logistic regression to examine associated influencing factors. Based on the level of AEE, breast cancer patients were divided into 3 sub groups: "low conflict-active disclosure group " (34.5%), "moderate conflict-inhibition and regret group " (46.5%), and "high conflict-inhibition and regret group " (19.3%). The multivariate logistic regression analysis showed that retirement status, perceived stress, social support and irrational beliefs were factors influencing participants' AEE (P < .05). There was significant variability in AEE among 3 subgroups of breast cancer patients. Retirement status, perceived stress, social support, and irrational beliefs have an impact on AEE in breast cancer patients. It is crucial for healthcare professionals to promptly identify high-risk groups and implement targeted interventions to improve AEE. This study can help healthcare providers identify patients at high risk of AEE, enabling early intervention and targeted psychological nursing interventions. Healthcare providers can assist patients in establishing correct beliefs about their illness and alleviating perceived stress, thereby reducing the negative impact of AEE. Show less

Sufficient physical activity has the potential to mitigate the late effects of cancer, but objective data of activity levels in patients after pediatric bone cancer are scarce. This study aimed to objectively assess physical activity levels in this population and explore differences based on patient- and treatment-related factors. As part of a cross-sectional study of a nationwide cohort of patients treated for pediatric bone sarcoma, we assessed physical activity using an accelerometer, the ActiGraph GT9X Link. Physical intensity levels were categorized as sedentary, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) and compared between subgroups stratified by sex, age, tumor location, type of surgery for tumors around the knee, and time since local therapy. Among 79 participants, 47% were female, and median age at evaluation was 19.8 years (IQR 17.5-23.9) with a median of 5.9 years (IQR 2.9-11.7) since local therapy. Mean daily sedentary time was 643 min (SD = 104), 127 min per day (SD = 58) was spent in LPA, and 63 min per day (SD = 35) in MVPA. Seventy-eight percent of participants met the World Health Organization's recommended level of MVPA. No significant differences in intensity levels were found between the various subgroups. Pediatric bone sarcoma patients seem to regain participation in higher-intensity activities post-treatment, with physical activity levels comparable to the general population. No surgical approach is superior in terms of physical activity. Implications for Cancer Survivors Shared decision-making is important in guiding the choice of local therapy and should be informed by lifestyle and individual preferences. High sedentary time suggests scope for improvement in survivorship care. Show less

Individuals with cancer often experience disrupted sleep, sedentary behavior, and reduced physical activity. This exploratory analysis examined the feasibility of continuous 24-h monitoring using wrist-worn accelerometers and characterized movement behaviors during a 12-week supervised resistance training program in individuals with cancer. We additionally aimed to evaluate whether daily movement behaviors (moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary time, and sleep) differed between exercise and non-exercise days. Thirty individuals with cancer wore Axivity accelerometers continuously while participating in supervised resistance training (2-3 sessions/week). Feasibility was assessed via wear-time compliance. Movement behaviors were analyzed descriptively across exercise and non-exercise days throughout the intervention. Participants demonstrated high adherence to continuous monitoring, with valid wear data on 70% of all days of the intervention. Within-person comparisons revealed significantly higher MVPA (+3.3 min) and LPA (+10.9 min) on exercise days. No significant changes were observed in sleep duration or sedentary time across the intervention or between exercise and non-exercise days. Continuous wrist-worn accelerometry is a feasible method for long-term behavioral monitoring in individuals with cancer. Supervised resistance training produced modest acute increases in physical activity but did not impact sleep or sedentary time. Show less

Current genetic testing for coronary artery disease (CAD) primarily targets monogenic variants in individuals with severe hypercholesterolemia. Whether supplementing monogenic testing with polygenic risk scores for CAD and Lp(a; lipoprotein[a]) levels [PRS A genetic probability for CAD (GenProb In the UK Biobank development cohort, PVs, polygenic risk scores for CAD and PRS GenProb Show less

With global population aging, the number of older adults in Chinese nursing homes is rising rapidly, and depression is the most prevalent mental health problem in this population. Most previous studies assessed depression via total scale scores, ignoring individual heterogeneity of depressive symptoms. This study aimed to identify distinct depressive symptom profiles and their associated factors in this population. Data were derived from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), with 353 valid nursing home older adults included. Depressive symptoms, anxiety and functional status were assessed using the CESD-10, GAD-7 and IADL scales. Latent profile analysis (LPA), univariate tests and multinomial logistic regression were performed, with supplementary effect size and sensitivity analyses to verify result robustness. Three distinct depressive symptom profiles were identified: low level (39%, n = 135), medium level (52%, n = 187) and high level (9%, n = 31). Town residence and anxiety were risk factors for moderate depression, while good self-rated health, regular exercise and social activity participation were protective factors. Good self-rated health protected against severe depression, while occasional television/radio viewing and anxiety were risk factors. Anxiety was the only independent correlate of high-level versus medium-level depression (OR = 1.322, p < 0.001). Supplementary analyses confirmed the robustness of core findings. The CESD-10, as a screening tool, has limited diagnostic efficacy for clinical depression, and the cross-sectional design cannot confirm causal relationships. Depressive symptoms in Chinese nursing home older adults show significant heterogeneity with three distinct latent profiles. Early screening and targeted stratified interventions should be implemented for this population to improve quality of life and promote healthy aging. Show less

Obesity results from the interaction of polygenic susceptibility and environmental factors. Given this complex etiology, physical activity (PA) remains a cornerstone of cost-effective intervention strategies. This longitudinal natural experiment investigated how PA modifies the effects of genetic predisposition on obesity in Chinese youth. We conducted a 4-year natural experiment leveraging curriculum-driven PA disparities in a specialized arts school (n = 591), creating distinct high-PA (HPA) and low-PA (LPA) exposure groups. Weighted genetic risk scores (WGRSs) were calculated from 13 Asian-derived obesity-related single-nucleotide polymorphisms. Annual anthropometric, metabolic, and lifestyle data were analyzed using generalized linear mixed models to assess gene-PA interactions on obesity. The WGRS predicted baseline obesity measures, with each unit increase associated with a 0.21-kg/m² higher BMI. Over the natural experiment period, BMI increases in the HPA group were smaller than in the LPA group. After adjusting for age, sex, ethnicity, and dietary factors, significant WGRS-PA interactions were observed for BMI trajectories. Participants with higher genetic risk for obesity experienced greater BMI and weight reduction benefits from sustained long-term PA. In summary, the present study identified a significant interaction effect between PA levels and WGRS in modifying BMI trajectories. Genetic susceptibility significantly modifies the protective effects of long-term PA on BMI progression in this cohort of Chinese youth. Show less

Many older adults with chronic obstructive pulmonary disease (COPD) are inactive and moderate-to-vigorous physical activity (MVPA) can be too strenuous for long-term maintenance. We examined effects of an intervention to increase light physical activity (LPA). Primary outcomes were physical activity (PA) and sedentary behavior (SB). Active for Life with COPD (Active-Life) is a self-efficacy-based intervention designed to increase LPA. Chair Exercises with Health Education (Chair-HE) served as an active control. PA and SB were measured with ActivPAL and ActiGraph accelerometers. We randomized 159 people with COPD to 10 weeks of Active-Life or Chair-HE. 128 people completed the intervention; 105 completed 1-year follow-up. The sample was 45% female, mean (SD) age was 69.6 (8.2), FEV Active-Life produced significant, sustained increases in PA for 12 months. Further work is needed to reduce SB and establish longer-term PA effects. Show less

The purpose of this article is to discuss the pathophysiology, epidemiology, clinical assessment, and management of elevated lipoprotein(a) (Lp(a)) levels in atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis (CAVS). Lp(a) is a unique lipoprotein consisting of 2 components: a low-density lipoprotein (LDL) moiety and a single molecule of apolipoprotein(a) (apo(a)), which binds to apolipoprotein B in the LDL moiety. The cholesterol content of the LDL moiety promotes atherosclerosis while apo(a) confers additional atherogenic and inflammatory properties to Lp(a). Lp(a) is an independent and causal risk factor for ASCVD and CAVS as well as all-cause mortality. Elevations in Lp(a) levels are genetically determined with minimal reductions observed in response to nonpharmacological risk factor modification. Currently available lipid-lowering drugs produce minimal or only modest percent changes in Lp(a) levels. As a consequence, Lp(a) is rarely measured in clinical practice. Several investigational agents designed to specifically target Lp(a) reduce levels by 80% to 100%. These agents work by decreasing the synthesis of apo(a) or by inhibiting the binding of apo(a) to apolipoprotein B. Phase 3 ASCVD outcome trials for several of these agents have completed enrollment. Elevated Lp(a) levels are a known risk factor for ASCVD and CAVS. Several investigational drugs produce 80% to 100% reductions in Lp(a) levels. However, until these therapies are proven to lead to favorable clinical outcomes, management of patients with elevated Lp(a) levels will continue to be limited to early and intensive ASCVD risk factor management. Show less

To identify latent profiles of Fear of Progression (FoP) in parents of children with cancer, explore their associated factors, and test the mediating role of Sense of Coherence (SOC) between FoP and psychological distress (PD). A cross-sectional study was conducted with 273 parents of children with cancer in China. We used latent profile analysis (LPA) to identify FoP profiles, multinomial logistic regression to determine associated factors, and mediation analysis to test the role of SOC. Three distinct FoP profiles were identified: medication sensitive with low fear (38%), treatment sensitive with moderate fear (21%), and overall high fear (41%). These profiles were significantly differentiated by disease-related (e.g., treatment history), individual-related, and interpersonal-related (e.g., self-disclosure) factors. Across the sample, higher FoP was associated with greater PD. Importantly, mediation analyses revealed that SOC significantly mediated the relationship between FoP and PD for the moderate and high FoP profiles, but not for the low LoP profile. Parents of children with cancer exhibit heterogeneous FoP profiles. SOC acts as a crucial mediator between FoP and PD, particularly for parents with moderate and high FoP profiles. These findings underscore the importance of screening for specific FoP profiles and suggest that tailored interventions designed to enhance SOC could effectively reduce PD in high-risk parents. Show less

Hypertension-linked renal fibrosis leads to the gradual loss of renal function and eventually progresses to end-stage renal failure, which exhibits poor clinical efficacy and is difficult to reverse. Therefore, clarifying the development mechanism of hypertension-linked renal fibrosis is crucial for its prevention and treatment. In this review, we conducted an in-depth exploration of the pivotal elements, along with their detailed mechanistic linkages in the pathogenesis of hypertension-linked renal fibrosis. It was found that the renin-angiotensin-aldosterone system (RAAS) is overactivated in hypertension. Angiotensin II (Ang II) and aldosterone (Aldo) jointly cause the abnormal accumulation of reactive oxygen species (ROS) by increasing the activity and expression of Nox2 and Nox4, inducing the inhibition and uncoupling of endothelial nitric oxide synthase (eNOS), enhancing expression of selected microRNAs (miRNAs), and reducing glucose-6-phosphate dehydrogenase (G6PD) expression. In turn, elevated ROS trigger renal inflammation by activating the mitogen-activated protein kinase (MAPK)-nuclear factor-kappa B (NF-κB) pathways as well as ferroptosis. Thereafter, renal inflammation can promote the process of renal fibrosis by activating the transforming growth factor β (TGF-β), platelet-derived growth factor (PDGF), and lysophosphatidic acid (LPA). This review not only emphasizes the core role of the mechanistic axis that plays a crucial role in the development of hypertension-driven renal fibrosis-the "RAAS-ROS-inflammation-fibrosis" axis-but also proposes promising therapeutic strategies targeting this axis, including modulating RAAS activity, controlling the increase in ROS, inhibiting inflammation, and blocking fibrotic progression. It aims to provide novel insights and potential therapeutic directions for hypertension-related renal fibrosis in the future. Show less

How schoolchildren distribute their time between movement behaviours may be impacted by the neighbourhood environment. Few studies have investigated the associations between the physical and social environment and the full movement behaviour composition, including times spent in moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behaviour, and sleep, and their findings are inconsistent. Therefore, our aim was to investigate this association in a large, national-representative sample of schoolchildren from major cities and regional/remote areas. We used data from the Longitudinal Study of Australian Children and the Child Health CheckPoint study, collected among 1230 child-parent pairs (child age range: 10–12 years). Parents were asked about neighbourhood general safety, access to destinations and services, and social capital and cohesion. Children’s time spent in MVPA, LPA, sedentary behaviour, and sleep was assessed using wrist-worn GENEActiv accelerometers. The associations between the physical and social environment characteristics (independent variables) and movement behaviour composition expressed as isometric log ratio coordinates (dependent variables) were examined using multiple linear regression analyses, adjusted for age, body mass index, pubertal status, sex, and socioeconomic position. Among schoolchildren from regional/remote areas, access to destinations and services (Pillai’s trace = 0.030; These findings highlight the importance of access to destinations and services, as well as social capital and cohesion, in shaping the movement behaviour composition among schoolchildren from regional/remote areas. More research is needed to draw conclusions about the association between neighbourhood environment and movement behaviour composition among schoolchildren from major cities. The online version contains supplementary material available at 10.1186/s12966-026-01879-z. Show less

This study develops and tests an AI-empowerment Configural Model to explain how artificial intelligence (AI) empowers language learning engagement. Grounded in ecological systems theory (EST) and ecological affordance theory (EAT), the model theorizes AI as an interactive agent within the learning ecosystem. A mixed-methods study of 475 Chinese university language learners demonstrates that AI'S effect on engagement is significantly mediated by the perceived quality of its ecological coupling with teachers, peers, and the environment. Latent profile analysis (LPA) further identifies three distinct learner configurations: low coupling-low engagement, moderate coupling-moderate engagement and high coupling-high engagement, which systematically differ in their coupling of AI. The model ultimately shifts the paradigm from tool implementation to strategic ecological governance, providing a practical basis for designing learning environments that leverage synergistic human-AI coupling to foster deeper, sustained engagement. Show less

The quality of informal care for people with dementia (PwD) has gained increasing importance, as most PwD prefer home-based care over institutional placement. However, evidence-based intervention programs tailored to distinct care quality profiles remain limited. Additionally, the absence of clear thresholds to identify PwD receiving low-quality informal care poses a challenge for research and clinical practice. Thus, this study aimed to identify the profiles of quality of care (QoC) among informal caregivers of PwD, explore influencing factors of different profile, and determine the optimal cut-off score of the Exemplary Care Scale (ECS). A cross-sectional survey was conducted. A total of 213 dyads of PwD and their informal caregivers were recruited from memory clinic, rehabilitation clinic, and neurological clinic of a tertiary hospitals and communities in Wuhan, Hubei, China, between July 15, 2023, and July 14, 2024. Latent profile analysis (LPA) was employed to identify QoC profiles. Multinomial logistic regression was performed to explore influencing factors of profile membership. Receiver Operating Characteristic (ROC) analysis was conducted to determine the ECS cut-off score. Three distinct QoC profiles were identified: high (24.41%), moderate (44.60%), and low (30.99%). Among informal caregivers, lower monthly income, insufficient social support, and higher perceived overload were associated with low QoC profile, whereas, better quality of pre-illness relationship with PwD and greater activities of daily living (ADL) of PwD were associated with high QoC. ROC analysis yielded an optimal ECS cut‑off score of 15, with high sensitivity (0.993) and specificity (0.955). This study identified three distinct QoC profiles among caregivers of PwD, underscoring the heterogeneity of informal care quality. The identified predictors and the validated ECS cut‑off score of 15 provide an empirical basis for developing tailored screening tools and targeted interventions for high‑risk caregiver subgroups. Show less

This study employs latent profile analysis (LPA) to identify potential categories of nurse burnout and to analyze differences in characteristics and influencing factors across burnout categories. From June to August 2025, a mixed sampling approach combining convenience and snowball sampling was used to recruit nurses from hospitals of varying levels in Southwest China. Three tools were used for data collection: A self-designed routine information questionnaire, Maslach Burnout Inventory-General Survey (MBI-GS) and Practice Environment Scale of the Nursing Work Index (PES-NWI), LPA identifies potential categories of nurses' professional burnout and uses multivariate logistic regression analysis to explore the factors associated with these categories. This study comprised a total of 809 participants. LPA identified four distinct latent classes of nursing burnout: Class 1, low-burnout-high-efficacy (11.5%); Class 2, mild-burnout-unfulfilled (33.9%); Class 3, moderate-burnout-exhausted (44.6%); and Class 4, severe-burnout-dysfunctional (10.0%). Multivariate logistic regression analysis showed that age, years of work experience, hospital level, nurses' participation in hospital management, nursing quality standards, staffing and resource adequacy, and medical care cooperation are significant predictors of burnout among nurses ( Nurse burnout in southwest China is mainly moderate to severe and exhibits distinctive characteristics. It is recommended to implement personalized interventions tailored to the specific characteristics of nurses' professional burnout to alleviate the situation. Particular attention should be given to nurses with fewer than five years of experience by providing enhanced job support and psychological assistance to help them navigate critical periods of professional burnout. These measures aim to safeguard nurses' physical and mental health, improving the overall quality of nursing, and promoting the healthy development of global medical care. Show less

Psychiatric nurses engage in high levels of emotional labor, which can significantly influence their burnout and job performance. While prior research has linked emotional labor to burnout, the nuanced interplay between different emotional regulation strategies remains underexplored. This study examines the distinct roles of surface acting (modifying outward expressions without changing internal feelings) and deep acting (adjusting internal emotions to align with external expectations) in psychiatric nursing, identifying their differential associations on burnout through network bridge analysis and latent profile analysis. A cross-sectional survey was conducted among 199 psychiatric nurses in a mental hospital in Wenzhou, China. Emotional labor was assessed using the Emotional Labor Scale, and burnout was measured with the Maslach Burnout Inventory-GS. Network bridge analysis was applied to identify key connections between emotional labor strategies and burnout dimensions. LPA was applied to reveal distinct emotional labor patterns. Surface acting emerged as the primary bridge linking emotional labor to burnout, displaying strong associations with emotional exhaustion and depersonalization. LPA identified four emotional labor profiles: These findings highlight the maladaptive effects of surface acting and the protective role of deep acting. Targeted interventions fostering deep acting may enhance psychiatric nurses' well-being and resilience. Future research should explore longitudinal shifts in emotional labor strategies. Show less

The importance of advance care planning in parkinsonism is increasingly recognised. Existing evidence shows plans are infrequent in this population. Little is known about the details of the plans themselves and whether patient factors predict advance care planning practices. This study aimed to describe advance care planning in people with parkinsonism enrolled in the PRoactive Integrated Management and Empowerment (PRIME-UK) trial, and identify factors associated with advance care planning. This is a cross-sectional substudy of 211 participants within the PRIME-UK randomised controlled trial, a single-centre trial that randomised 214 people with parkinsonism to receive either a novel model of care (PRIME-Parkinson care) or usual care (ISRCTN trial ID 16783200). The presence of a treatment escalation plan was used as a measure of advance care planning. At the time of this study, a quarter (n=53, 25%) of participants had a treatment escalation plan. 45% of plans were created during an emergency hospital admission. 100 participants had appointed a lasting power of attorney (LPA). In adjusted regression models, increasing parkinsonism severity (OR 2.2, 95% CI 1.55 to 3.12), increasing frailty (OR 3.69, 95% CI 1.42 to 9.63) and increasing comorbidity (OR 2.51, 95% CI 1.53 to 4.14) were associated with having a treatment escalation plan. Treatment escalation plans for people with parkinsonism are frequently completed in advanced disease during emergency hospital admission. Many individuals are appointing LPAs, suggesting an interest in future planning that could be further supported by clinicians. Future research should explore interventions to improve proactive outpatient advance care planning. 16783200. Show less

The present study aimed to investigate the combined impact of lipoprotein (a) [Lp(a)] and low-density lipoprotein (LDL) subfractions on cardiovascular outcomes in patients with acute coronary syndrome (ACS). The study enrolled 2061 ACS patients from Tianjin Chest Hospital. Participants were categorized into 4 groups based on their Lp(a) and the concentration of the sixth component particles of LDL(LDL-P6). The primary endpoint was the occurrence of major adverse cardiovascular events (MACE). The relationship between LDL-P6, Lp(a), and MACE was evaluated. Over a mean follow-up period of 5.4 years, 456 (22.1%) patients experienced MACE. Multivariate analysis identified both LDL-P6 and Lp(a) as significant independent predictors of MACE in ACS patients. Those in the highest-risk group had a substantially higher incidence of MACE compared with the lowest-risk group (HR 5.718; 95% CI 3.703-8.829; Show less

Enzyme immobilization is critical for enhancing enzyme stability and reusability. Catalytically active inclusion bodies (CatIBs) have emerged as a promising immobilization strategy due to their straightforward production, ease of separation, and high purity. Unlike traditional cross-linked enzyme aggregates (CLEAs) that require a precipitation step, CatIBs form through carrier-free self-aggregation during expression. To overcome the limitations of conventional methods, a novel technique has been developed in this study, focusing on L-phenylserine aldolase (LPA) as the model enzyme. A hybrid tag (HLHLHL) was fused to the N-terminus of LPA to generate 3HL-LPA, which promotes the formation of active inclusion bodies. Based on structural prediction and surface properties, the active aggregation process of 3HL tags through electrostatic interactions and hydrophobic interactions was analyzed. Innovatively, we combined CatIBs and CLEAs technologies to develop novel CatIBs-CLEAs. For comparison, a control was prepared by fusing a hexahistidine tag (HHHHHH) to LPA's N-terminus (6H-LPA) to enhance soluble expression, followed by conventional CLEAs preparation. Results showed that CatIBs-CLEAs achieved an activity recovery of 69.87% after glutaraldehyde crosslinking, significantly higher than the 48.1% for conventional CLEAs. CatIBs-CLEAs also exhibited superior thermal stability across temperatures, high stability between pH 5-9, and retained over 70% activity after seven batch cycles. The integrated CatIBs-CLEAs technology combines the production advantages of CatIBs with the stability benefits of CLEAs, offering a promising strategy for designing efficient, robust industrial biocatalysts with broad application potential. Show less

Individuals differ in their sensitivity to external stimuli. The Highly Sensitive Child (HSC) scale can be used to measure sensitivity in children and adolescents. However, the German version has yet to be validated. We examined the psychometric properties of the German self- and the parent report version of the HSC. Measurement invariance (MI) across age groups was tested for the parent report version and latent profile analysis (LPA) was used to identify sensitivity groups. Pooled data from German-speaking countries ( The online version contains supplementary material available at 10.1007/s12144-026-09244-w. Show less