📋 Browse Articles

Reducing residual cardiovascular risk following acute coronary syndrome (ACS) remains a major unmet clinical need. Despite substantial advances in lipid-lowering therapies, the risk of recurrent major adverse cardiovascular events (MACEs) after ACS remains high, with an estimated incidence of approximately 33.4% at 5 years. Residual cardiovascular risk is driven by multiple mechanisms, including persistent inflammation, a prothrombotic status, metabolic disturbances, and the presence of atherogenic lipoproteins beyond low-density lipoprotein cholesterol (LDL-C). Lipoprotein(a) (Lp(a)) is a pro-inflammatory, prothrombotic, and pro-atherosclerotic lipoprotein that appears to play a major role in residual risk after ACS or ischemic stroke. Elevated Lp(a) is a well-established independent and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Nevertheless, evidence regarding its prognostic value specifically after ACS remains limited, with marked heterogeneity across studies, which complicates direct comparisons and interpretation. In addition, while Lp(a) levels are predominantly genetically determined, recent studies have reported intra-individual variability, although their clinical significance remains uncertain. Finally, current therapeutic options specifically targeting Lp(a) are limited. Novel RNA-based therapies, including antisense oligonucleotides, small interfering RNAs, and emerging gene-editing approaches, have demonstrated profound and sustained reductions in circulating Lp(a) levels. Yet, whether this biological effect translates into reductions in hard clinical endpoints is under evaluation in ongoing clinical trials. This review aims to synthesize current evidence on the role of Lp(a) as a major contributor to residual cardiovascular risk following ACS. Show less

Data are limited regarding national clinician awareness, testing, and treatment of lipoprotein(a) [Lp(a)]. We conducted a national survey of US clinicians to investigate these issues. An internet-based survey of awareness, testing and treatment of Lp(a) was administered by a medical survey company to clinicians who have been in practice ≥5 years in the US or its territories. 2002 clinicians completed the survey: 47 % were primary care, 35 % cardiology, 9 % endocrinology, and 9 % neurology. 28 % were female, 24 % Asian, 4 % Hispanic, and 3 % Black. Most clinicians agree knowing the Lp(a) level can improve risk assessment and patient engagement. Patients with premature or recurrent CVD events are most likely to be targeted for Lp(a) testing and for prescribing possible future Lp(a)-targeted therapies. Show less

The long-term effects of SARS-CoV-2 infection are increasingly recognized, with heterogeneous physical and psychological symptoms that may persist for months, significantly affecting Health Related Quality of Life (HRQoL), functional capacity, and psychosocial well-being. This study explores distinct profiles of HRQoL and psychological symptoms in former COVID-19 inpatients and assesses the impact of clinical variables at admission on long-term outcomes. Patients hospitalised for COVID-19 at Molinette Hospital in Turin were contacted several months post-discharge (between June 2022 and June 2023) to complete a questionnaire assessing long-term HRQoL, sleep quality, depression, anxiety, stress, and fatigue. Clinical data at the time of hospitalisation were also available for each participant. A Latent Profile Analysis (LPA) was conducted on these physical and psychological variables, followed by multinomial logistic regression to examine how selected indicators of baseline COVID-19 severity and patient characteristics predicted profile membership. The sample consisted of 601 patients. LPA identified three health-related profiles: This study highlights a wide spectrum of post-COVID-19 conditions, ranging from good to severely compromised physical and mental health. Female gender, presence of comorbidities, and elevated early warning scores at hospital admission are risk factors for worse outcomes, emphasizing the need for comprehensive long-term care. The online version contains supplementary material available at 10.1007/s11136-026-04206-y. Show less

PurposeThis study aims to explore the latent classes of compassion fatigue among intensive care unit (ICU) nurses and identify the factors that influence their compassion fatigue.MethodsBetween November 2024 and February 2025, 1029 ICU nurses were selected as study participants using convenience sampling. Data were gathered through general demographic questionnaires, the Chinese version of the Short Scale of Compassion Fatigue (CFSS), the Occupational Stress Scale, the Perceived Social Support Scale, as well as the Professional Identity Scale. A latent profile analysis (LPA) was conducted based on the three dimensions of the CFSS as observed indicators. Additionally, factors influencing outcomes were analyzed using both univariate and multivariate logistic regression methods.Ethical considerationsThis study was approved by the Institutional Review Board of the Affiliated Hospital of Qingdao University.ResultsA total of 1029 valid questionnaires were obtained, resulting in an effective response rate of 93.46%. The average score on the ICU Nurse Compassion Fatigue Scale was 60.00 ± 27.36 points. Three distinct profiles were identified: low compassion fatigue-low secondary trauma type (33.04%), moderate compassion fatigue-overall fluctuation type (48.30%), and high compassion fatigue-high burnout type (18.66%). Multivariate logistic regression analysis revealed that health status, sleep quality, highest education level, occupational stress, professional identity, and social support significantly influence the potential compassion fatigue profiles among critical care nurses ( Show less

Improving Internet addiction among nursing students is of great significance to the future development of the nursing industry. Previous studies have proved that childhood trauma is closely related to Internet addiction. However, the direct relationship between alexithymia and childhood trauma and Internet addiction has not been fully explored. The aim of this study is to identify different subgroups of nursing students based on their childhood trauma and to examine the mediating role of alexithymia between childhood trauma and Internet addiction. From April to May 2025, 3,697 nursing students were recruited as samples from Shandong, Hubei, Hunan, and Henan provinces in China by convenient sampling. This survey collected social demographic data. Including The Childhood Trauma Questionnaire - Short Form (CTQ-SF), the Toronto Alexithymia Scale (TAS-26), and the Internet addiction Scale. Potential profile analysis was used to determine the potential categories of childhood trauma characteristics of nursing students, and Pearson correlation analysis, Bayesian factor robustness analysis and mediation analysis were used to determine the potential relationships among variables. LPA identified three distinct groups based on their dominant usage: low (77.4%), medium (19.5%), and high (3.1%). In the relationship between childhood trauma and Internet addiction based on potential profile analysis, alexithymia has a significant mediating effect (SE = 0.442,95%CI = 0.095, 1.824; SE = 0.219, 95%CI = 0.093, 0.962). There is heterogeneity in childhood trauma among nursing students. Alexithymia plays an important mediating role in the relationship between childhood trauma and Internet addiction. It is suggested that nursing educators pay attention to the differences in childhood trauma among nursing students, provide corresponding psychological counseling for different students, improve them, thereby alleviating Internet addiction among nursing students and promoting their mental health. Show less

This study aimed to use latent profile analysis (LPA) to identify heterogeneous configurational patterns of short video addiction and emotion dysregulation among college students, and to systematically examine the predictive effects of cognitive reappraisal, emotional loneliness, and sociodemographic factors on latent profile membership. A cross-sectional survey design was employed. From April to July 2025, full-time undergraduate students were recruited from multiple universities in Shandong Province using a combination of convenience sampling and snowball sampling. Participants completed online questionnaires including the Short Video Addiction Scale, the Emotion Dysregulation Inventory (EDI), the Cognitive Reappraisal Scale, and the Emotional Loneliness Scale. A total of 1,168 valid questionnaires were obtained. LPA identified four optimal profiles: Profile 1 ("low short video addiction-low emotion dysregulation"), Profile 2 ("medium to lower short video addiction-medium to lower emotion dysregulation"), Profile 3 ("medium to upper short video addiction-medium to upper emotion dysregulation"), and Profile 4 ("high short video addiction-high emotion dysregulation"). Multivariable logistic regression analyses indicated that, with Profile 4 as the reference category, cognitive reappraisal significantly increased the likelihood of membership in lower-risk profiles, whereas emotional loneliness significantly decreased the likelihood of membership in lower-risk profiles. Among sociodemographic factors, being female and having an urban background significantly increased the likelihood of membership in Profile 1 (vs. Profile 4); being a non-only child and having no part-time work experience significantly predicted membership in Profile 3. Marked heterogeneity exists among college students in the measured dimensions of short-form video addiction and emotion dysregulation, and the two constructs exhibit highly concordant co-variation. The findings provide empirical support for developing risk-stratified and precision-oriented mental health intervention strategies. Show less

Physical activity, sedentary behaviour, and sleep were shown to be independently associated with low back pain (LBP). The aim of this cross-sectional study was to explore the associations between 24-hour movement behaviour compositions and the occurrence, severity, and estimated level of LBP impact on an individual’s life. A convenience sample of 197 adults (40% females, 37 ± 11 years of age) were asked to wear an activPAL accelerometer for at least 7 consecutive days to assess their time-use composition consisting of moderate- to vigorous-intensity physical activity (MVPA), light-intensity physical activity (LPA), sedentary behaviour (SB), and sleep and to complete a questionnaire on LBP and sociodemographic characteristics. Compositional isotemporal substitution analyses were conducted separately for the non-domain-specific and domain-specific (including occupational and non-occupational domains) movement behaviour compositions. Reallocating time from MVPA to any other movement behaviour or from sleep to LPA was associated with a higher LBP impact score. For example, reallocating 60 min/day from MVPA to LPA was associated with on average 17 points (95% CI: 6 to 28) higher LBP impact score (on a 0–70 scale). We did not find significant associations between the domain-specific time-use composition and LBP impact score ( Our study suggests that LBP sufferers with higher MVPA and sleep better cope with LBP. The differences in the LBP impact scores associated with theoretical reallocations between movement behaviours may be deemed clinically important. Future longitudinal and experimental studies in population-representative samples are needed to confirm our findings. Show less

This study examined the associations between 24-hour movement behaviors and health-related fitness in university students, and estimated the substitution effects using a compositional isotemporal substitution model. This study was conducted between May and June 2023, using a combination of convenience and random sampling to recruit 325 undergraduate students from Tianjin University of Science & Technology as participants, including 167 males and 158 females. Daily 24-hour activity behaviors were measured using a triaxial accelerometer(ActiGraph GT3X+), including moderate-intensity physical activity(MPA), vigorous-intensity physical activity(VPA), light-intensity physical activity(LPA), sedentary behaviors(SB), and sleep(SLP) duration. Body composition was assessed via body mass index(BMI), waist circumference, and body fat percentage. Muscular strength was measured by handgrip strength, cardiorespiratory fitness was measured by vital capacity and maximum oxygen uptake(VO₍₂ max)), and flexibility was assessed by the sit-and-reach test. Compositional data analysis was used to investigate the associations between activity behaviors and health-related physical fitness. A 15-minute isotemporal substitution model was applied to predict the effects of replacing one activity with another on outcome variables. The mean age of male participants was(19.74±1.16) years, and that of female participants was(19.51±1.29) years. Based on 24-hour compositional activity behavior analysis, college students spent an average of 16.42 minutes(1.14% of the day) in MPA, 26.57 minutes(1.85%) in VPA, 150.92 minutes(10.48%) in LPA, 645.78 minutes(46.05%) in SB, and 561.31 minutes(40.21%) in SLP. After adjusting for covariates including sex and age, isotemporal substitution models revealed that replacing an equivalent amount of sedentary time with MPA was associated with a reduction in BMI by 0.07-0.19 units, body fat percentage by 0.53-0.59 units, waist circumference by 0.16-0.27 cm, an increase in vital capacity by 119.18-152.67 mL, VO₍₂ max) by 1.76-1.88 mL/(kg·min), handgrip strength by 0.86-1.46 kg, and sit-and-reach performance by 0.19-0.38 cm. Similarly, increasing VPA led to decreases in BMI by 0.14-0.16 units, body fat percentage by 0.49-0.54 units, waist circumference by 0.12-0.23 cm, increases in vital capacity by 127.45-160.84 mL, VO₍₂ max) by 1.91-2.03 mL/(kg·min), handgrip strength by 0.98-1.56 kg, and sit-and-reach by 0.14-0.32 cm. Increasing LPA result ed in BMI increases of 0.11-0.12 units, handgrip strength increases of 0.65 kg, and sit-and-reach increases of 0.21 cm. Increasing SLP was associated with BMI reduction of 0.04 units and waist circumference reduction of 0.09 cm. MPA had the most significant effect on improving BMI, body fat percentage, and waist circumference, while VPA was more effective in enhancing cardiorespiratory fitness, muscular strength, and flexibility. SLP had a modest positive effect on BMI and waist circumference but was less impactful than MPA and VPA. SB and LPA were generally unfavorable for health-related physical fitness. Show less

Continual image super-resolution (CISR) aims to efficiently adapt a pre-trained model to a variety of tasks while retaining knowledge from previously learned tasks, minimizing the need for intensive independent training. The primary challenges include catastrophic forgetting due to varying data distributions and degradation types, along with the necessity for high adaptability. While prompt-based continual learning has proven effective in image classification, its direct application to super-resolution (SR) often fails to meet the demands for detailed pixel-level restoration and domain discrimination in low-level characteristics. To address these challenges, we propose Learning Prompt Adapters (LPA), which dynamically generates pixel-wise prompts through a combination of multi-granularity prompt bases and identities. By adaptively integrating these prompts into the Transformer architecture, we effectively improve the model's performance on fine-grained details in super-resolution tasks, as well as enhancing the model's adaptability to new tasks and preserving knowledge from previous ones. Through organizing the low-rank prompt bases with specific identities, we set up an effective solution to managing cross-task differences and enhancing prompt richness. Extensive experiments on benchmarks comprising the NYU, RealSR, DIV2K, REDS, and MANGA109 datasets with diverse degradation types demonstrate that LPA significantly outperforms existing continual learning methods. Codes of this paper are available at: https://github.com/dummerchen/LPA. Show less

Although lipoprotein(a) [Lp(a)] is an established independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in primary prevention settings, it remains unclear whether Lp(a) contributes to an increased risk of adverse cardiovascular events in patients with established ASCVD. The current analysis combines the ATHEROREMO and IBIS-3 observational studies, which together enrolled 798 patients undergoing coronary angiography for stable angina pectoris or acute coronary syndrome. Intravascular ultrasound (IVUS) and near-infrared spectroscopy were performed to assess coronary plaque characteristics in a non-culprit study segment. Regression models were applied to relate Lp(a) to coronary plaque characteristics and long-term (up to 10 year) clinical outcomes. Lp(a) was analysed both as a continuous and categorical variable (using 75 nmol/L and 125 nmol/L as threshold). Mean age of the patients was 61.6 years (10.8); 75% were male; 19% had elevated Lp(a) levels (>125 nmol/L). Patients with Lp(a) > 125 nmol/L had a significantly higher prevalence of hypercholesterolemia and prior percutaneous coronary intervention. These patients demonstrated higher IVUS-derived plaque burden (40.7% (±11.5) vs. 38.6% (±10.7), p = 0.028), though no associations were found with other plaque characteristics, e.g. minimum lumen area, lipid core burden index and thin-cap fibroatheroroma. No association was found between Lp(a) and -5-year major adverse cardiac events (HR 1.06, 95% CI: 0.70-1.60, p = 0.78) and 10-year all-cause mortality (HR 0.63, 95% CI: 0.38-1.06, p = 0.78). Among patients with established ASCVD, Lp(a) was associated with plaque burden, supporting evidence that relates Lp(a) to atherosclerotic disease. However, Lp(a) was not associated with long-term mortality or cardiac adverse events in these patients. Show less

Cardiovascular disease (CVD) is the leading cause of death among older adults, with sedentary behavior (SB) as a key modifiable risk factor. While physical activity (PA) is associated with cardiovascular health, evidence remains limited on the specific effects of replacing SB with PA of varying intensities. To systematically review evidence on the cardiovascular effects of substituting SB with PA in adults aged 65 and older using isotemporal substitution modeling (ISM). Following PRISMA guidelines, seven databases were searched up to April 2025. Risk of bias was assessed using the JBI tool, and a narrative synthesis was conducted. Eighteen observational studies (15 cross-sectional, 3 cohorts) using ISM were included. Replacing 10-60 min of SB with moderate-to-vigorous PA (MVPA) was associated with more favorable in blood pressure, triglycerides, waist circumference, inflammatory markers (CRP, IL-6, GDF-15), and insulin sensitivity (HOMA-IS, Matsuda-ISI). Light-intensity PA (LPA) showed modest associations, particularly among frail or mobility-limited individuals. A daily substitution of 30 min was identified as a feasible reference window, with ≥60 min linked to additional vascular and autonomic benefits. Replacing SB with PA, especially MVPA, was consistently associated with favorable cardiovascular profiles in older adults. Even brief substitutionsmay be beneficial, supporting intensity-stratified public health strategies and refinement of physical activity guidelines for aging populations.Because most included studies were cross-sectional, these findings should be interpreted as associations rather than definitive causal effects, and reverse causation remains a plausible concern. https://www.crd.york.ac.uk/prospero/view/CRD420251021829/1/0, PROSPERO CRD420251021829. Show less

Lipoprotein(a) [Lp(a)] is a genetically determined lipoprotein linked to atherosclerotic cardiovascular disease (CVD). Although well studied in adults, its familial determinants in children remain unclear. This systematic review and meta-analysis quantified Lp(a) across pediatric subgroups defined by familial cardiovascular risk, familial hypercholesterolemia (FH), sex, and ethnicity. Following PRISMA 2020 guidelines, fifty-one observational studies were analyzed using random-effects models (Review Manager 5.4.1). Mean differences (MD) with 95% confidence intervals (CI) were calculated. Subgroup, sensitivity, and meta-regression analyses explored heterogeneity. Among children and adolescents with FH, those with a parental history of premature cardiovascular disease (pCVD) had significantly higher Lp(a) concentrations than FH children without parental pCVD (MD = 10.24 mg/dL; 95% CI 3.06-17.43; Elevated Lp(a) in children with parental CVD or pCVD reflects a strong heritable pattern from early life. FH was associated with modest but consistent Lp(a) elevation, indicating an independent risk-modifying role rather than a defining feature. Sex-related differences were minimal, whereas ethnic variation was prominent. These findings support targeted Lp(a) assessment in children with familial cardiovascular risk using ancestry-aware reference standards, with consideration of repeat evaluation in early adulthood in higher-risk individuals. Show less

Previous studies have indicated that Kinesiophobia is associated with adherence to exercise rehabilitation. Given the multifaceted impact of Kinesiophobia and the complex diversity of individual characteristics, existing research struggles to identify the distinct features of Kinesiophobia. Latent Profile Analysis (LPA) identifies individuals’ latent traits based on their response patterns to observable measures, grouping individuals with similar symptom profiles into different categories, thereby better distinguishing differences among individuals. However, there is currently a lack of research on the kinesiophobia in the out-of-hospital early rehabilitation phase after Percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Therefore, the aim of this study is to investigate kinesiophobia in the out-of-hospital early rehabilitation phase after Percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD), classify it based on latent profile analysis, and explore the related factors of Kinesiophobia in CHD patients across different categories. This study selected coronary heart disease patients who were in the early outpatient rehabilitation stage after receiving PCI treatment at a tertiary hospital as the survey subjects. Latent Profile Analysis (LPA) was employed to fit potential classes of kinesiophobia among these patients. Chi-square tests, Kruskal-Wallis tests, and multinomial logistic regression were utilized to explore the factors influencing different kinesiophobia profiles in these patients. A total of 293 survey subjects were included, the age of the 293 patients was 62.31 ± 11.49 years, Males represent 77% of the total population. The results of potential profile analysis revealed that kinesiophobia in the out-of-hospital early rehabilitation phase of CHD in PCI-treated patients could be divided into three potential categories: the low kinesiophobia-exercise avoidance group (52.1%), the medium kinesiophobia-danger perception group (41.6%), and the high kinesiophobia-dysfunction group (6.3%). The logistic regression analysis results revealed that age, mode of residence, chronic comorbidities, polypharmacy, and debilitation were influential factors for different categories of kinesiophobia in the out-of-hospital early rehabilitation phase of CHD patients undergoing PCI. There is obvious group heterogeneity in kinesiophobia in the out-of-hospital early rehabilitation phaseof CHD patients undergoing PCI, and healthcare professionals should carry out individualized intervention Strategies to reduce the degree of kinesiophobia in patients on the basis of the characteristics and influencing factors of different categories. Show less

24-h activity encompasses four categories: light-intensity physical activity (LPA), moderate-to-vigorous-intensity physical activity (MVPA), sedentary behavior (SB), and sleep (SP). This study aims to investigate the effects of different physical activity components on executive function in older adults with chronic diseases and to examine substitution effects among activity components. The findings provide scientific evidence to inform physical activity interventions for improving executive function in older adults with chronic diseases. A total of 105 older adults (72.64 ± 6.82 years) were recruited. Following questionnaire screening, 75 older adults with chronic diseases were ultimately included. Accelerometers objectively measured participants' daily SP, SB, LPA, and MVPA. Executive function was objectively assessed using the Stroop task, N-back task, and More-odd-shifting task. Component linear regression equation assessed the relationship between different activities and executive function in older adults with chronic diseases. The dose-response effects of "one-for-one" substitutions between different activity behaviors were explored. Component linear regression results showed that SB positively correlated with inhibitory control ( SP and MVPA significantly improve inhibitory control in older adults with chronic diseases, while LPA significantly enhances their working memory. It is recommended that older adults with chronic diseases adjust their daily time structure by increasing diverse physical activities, ensuring adequate sleep duration, and reducing sedentary behavior to improve executive function. Show less

To identify latent profiles of proactive health behaviors in patients with hypertension, examine the category-specific influencing factors. Proactive health behavior, as an emerging concept, refers to a self-motivated approach to systematically managing health-related factors in order to actively maintain and promote one's health status. However, existing studies have largely focused on describing the overall level of such behaviors among patients with hypertension, with insufficient exploration of behavioral heterogeneity within this population. Moreover, there has been a lack of systematic integration of established behavioral theories to explain the multifactorial mechanisms underlying different behavioral patterns, which limits the development of precise nursing interventions. A cross-sectional study was performed, involving 352 patients with hypertension from 8 communities in Anhui Province from September to December 2025. The survey tools included self-designed demographic and clinical instrument, the Proactive Health Behavior Scale for Hypertensive Patients, the Self-Efficacy Scale for Hypertensive Patients, the Health Literacy Management Scale (HeLMS). Latent profile analysis (LPA) was used to identify subtypes of proactive health behavior among hypertension patients. Multinomial logistic regression analysis was applied to determine the factors associated with the identified subtypes. A total of 352 questionnaires were distributed, yielding 321 valid responses (a response rate of 91.2%). The total score of proactive health behavior was 89.57 ± 22.99 points. The LPA revealed four profiles of proactive health behavior: the positive proactive health behavior profile (Class 1, The proactive health behavior among hypertension patients was at a moderate level, revealing four distinct behavioral categories with significant differences. Guided by the Health Belief Model, profile-specific influencing factors were analyzed, which informed the development of tailored intervention strategies. Show less

Given the globalization of the nursing workforce, psychological empowerment represents a critical intrinsic determinant of nurses' mobility intentions, specifically regarding cross-border work. To identify latent profiles of nurses' psychological empowerment, examine associated factors, and explore the relationship between these profiles and cross-border working intention. A cross-sectional multicenter study was conducted from March to September 2023. Using convenience sampling, clinical nurses were recruited through liaisons from nursing societies in nine cities of Guangdong Province. Data were collected through questionnaires covering sociodemographic questionnaire, psychological empowerment, and cross-border working intention, with analyses including chi-square tests, logistic regression, and latent profile analysis (LPA) performed using SPSS 23.0 and Mplus 8.3. A total of 3671 valid questionnaires were collected, and 39.5% of the respondents reported cross-border intentions. LPA identified three psychological empowerment profiles among nurses, ranked from high to low: the core-driven empowerment profile (16.94%), the adaptive empowerment profile (70.42%), and the constrained empowerment profile (12.64%). The nurses with lower salary, intermediate title, and without specialist nurse qualification were more likely to fall into the constrained empowerment profile. Psychological empowerment was positively correlated with nurses' cross-border work intention. The core-driven profile showed the highest cross-border work intention (50.6%), followed by the adaptive (38.2%) and constrained profiles (31.7%). For cross-border work, the constrained profile prioritized salary (87.1%) as the key concern, while the core-driven profile focused more on good promotion opportunities (70.3%). Psychological empowerment exerts a positive impact on clinical nurses' cross-border work intention, with the three identified empowerment profiles exhibiting divergent motivational priorities and decision logics. These findings highlight the need for subgroup-specific strategies to balance nursing workforce mobility and stability. The findings support a differentiated human resource strategy based on nurses' psychological empowerment profiles. For core-driven nurses, institutions should provide international career development channels to strengthen their domestic job embeddedness. For adaptive nurses, tailored skill training and decision-making autonomy should be offered to guide their mobility aspirations. For constrained nurses, competitive compensation and family support services should be prioritized to address their stability needs and rebuild professional confidence. These targeted measures balance talent mobility and domestic workforce stability. Show less

While family resilience is a recognized determinant of adaptation following stroke, the distinct, empirically derived profiles of family resilience among Chinese stroke survivor-caregiver dyads have not been clearly delineated. Identifying these profiles and their determinants is crucial for developing targeted interventions. To identify latent profiles of family resilience and examine the socio-demographic and clinical factors associated with profile membership among stroke patient-caregiver dyads in China. In this cross-sectional study, a convenience sample of 773 stroke survivor-caregiver dyads was recruited from three hospitals in Zhejiang Province, China. Latent profile analysis (LPA) was conducted on the 20-item Family Resilience Questionnaire (FRQ). Multinomial logistic regression was used to determine factors associated with profile membership. LPA supported a four-profile solution: Profile 1 "Low-Functioning Families" (22%), Profile 2 "Moderately Resilient - Low Cohesive Families" (24%), Profile 3 "Highly Resilient - Well-Functioning Families" (31%), and Profile 4 "High-Functioning - Optimistically Resilient Families" (24%). Multinomial logistic regression revealed that lower caregiver competence (higher FCTI scores) was strongly associated with profile membership (standardized aORs ranged from 2.58 to 43.19), whereas higher perceived social support (PSSS) was a significant protective factor (standardized aORs ranged from 0.03 to 0.19). Caregiver relationship and payment source were also significantly associated with profile membership. Family resilience among Chinese stroke families manifests in four distinct profiles, which are differentiated predominantly by caregiver competence and perceived social support. Our findings advocate for a precision family support paradigm, shifting from one-size-fits-all approaches to interventions tailored to distinct resilience profiles. Given the strong association, intervention programs should prioritize enhancing core caregiver competencies as a primary leverage point for building family resilience. Show less

Elevated lipoprotein(a) [Lp(a)] is an independent, causal risk factor for atherosclerotic cardiovascular disease (ASCVD), yet testing remains low. As our health system has expanded its efforts to increase Lp(a) awareness, we evaluated testing rates and their impact on care. Lp(a) testing rates were collected through electronic health record queries between 1/1/2022 to 12/31/2024. Baseline demographics, ASCVD status, Lp(a) testing rates by specialty, lipid lowering therapy (LLT) prescriptions and number of cardiology referrals were collected. 450,412 outpatients had ≥1 lipid panel order and 3.7 % ( While Lp(a) testing was low, it increased substantially over time. High risk Lp(a) levels were found irrespective of ASCVD status and were associated with more aggressive treatment. Systematic strategies to increase Lp(a) awareness and testing are warranted to mitigate cardiovascular risk. Show less

This study used a group-based multi-trajectory model (GBMTM) to identify distinct muscle health trajectories and examine their associations with physical activity (PA) in middle-aged and older adults. Data were obtained from 2818 middle-aged and older adults (aged ≥40 years) in the China Health and Retirement Longitudinal Study (2011-2015). Muscle health was assessed using muscle mass (appendicular skeletal muscle mass index), muscle strength (handgrip strength), and physical performance (5-time chair stand test). PA was assessed using the International Physical Activity Questionnaire Short Form. A GBMTM was applied to jointly identify longitudinal trajectories of muscle mass, muscle strength, and physical performance, and to evaluate their associations with PA. In this study, four muscle health trajectories were identified: low-function declining, moderate-function declining, moderate-function stable, and high-function stable group. Engaging in ≥150 min/wk of light PA (LPA), moderate PA (MPA), or vigorous PA (VPA) was associated with the moderate-function stable group (LPA: aOR = 3.44, 95% CI: 1.94 - 6.11; MPA: aOR = 2.83, 95% CI: 1.67 - 4.96; VPA: aOR = 2.88, 95% CI: 1.61 - 5.13) and the high-function stable group (LPA: aOR = 5.20, 95% CI: 2.44 - 11.19; MPA: aOR = 4.10, 95% CI: 1.92 - 8.73; VPA: aOR = 3.42, 95% CI: 1.55 - 8.55). In older adults aged ≥70 years, associations persisted for MPA and VPA. Distinct muscle health trajectories highlight individualized muscle aging and inform personalized PA guidance. Regular PA ≥150 min/wk across intensities was associated with more favorable longitudinal muscle health. Show less

Adolescence is a critical period for rapid emotional and cognitive development. Depression and cognitive impairment frequently co-occur in this population, yet their comorbidity patterns and symptom-level interactions remain insufficiently explored. A total of 2,244 students (mean age = 16.8 ± 0.84 years; 1,218 males, 1,026 females) from a high school in Heilongjiang Province, China, were recruited. Depressive symptoms and cognitive impairment were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Perceived Deficits Questionnaire–Depression (PDQ-D). Latent profile analysis (LPA) was applied to identify subgroups, followed by network analysis to examine central symptoms (expected influence, EI), bridge symptoms (bridge expected influence, BEI), and network differences (NCT). The optimal LPA model identified three comorbidity subgroups: low, moderate, and high. NCT revealed significant differences in network structure and global strength between the low–moderate (S = 1.514, Adolescent Depression and Cognitive Impairment can be classified into low, moderate, and high comorbidity subgroups. Somatic symptoms emerged as the central symptom, while prospective memory impairment and interpersonal problems were identified as key bridge symptoms, suggesting potential intervention targets for early screening and stratified treatment. Not applicable. The online version contains supplementary material available at 10.1186/s12888-026-07946-w. Show less

Healthcare professionals are expected and motivated to engage empathetically with patients, their families, yet how different components of empathy, coping traits interact to shape psychological responses remains unclear. This study examined these relationships in medical, nursing students to inform tailored educational interventions METHODS: Participants who completed two surveys 2 years apart (30 medical students and 88 nursing students) were included. Empathy traits were assessed using the Interpersonal Reactivity Index, coping traits using the Brief Coping Orientation to Problems Experienced Inventory, and psychological responses using the Professional Quality of Life Scale. Mixed-effects models for repeated measures analyzed the impact of empathy and coping traits. Latent profile analysis (LPA) classified participants by empathy and coping traits. Personal distress was significantly associated with increased secondary traumatic stress (STS) and burnout, and decreased compassion satisfaction. Empathic concern was associated with increased compassion satisfaction. Active coping and support seeking were associated with increased compassion satisfaction and reduced burnout, whereas indirect coping was associated with increased STS and burnout. LPA identified three distinct profiles of empathy and coping traits, showing significant differences in psychological responses. Differences in empathy and coping traits influence psychological responses in medical and nursing students. Tailored interventions that consider these traits may be more effective. Show less

This study, adopting a person-centered approach and using network analysis, explores latent subtypes of Junzi personality among college students and their links to Receptiveness to Opposing Views, offering empirical backing for the ancient Chinese idea of "Junzi harmonize yet remain distinct." Traditional variable-centered methods often fail to fully expose the underlying typological structure due to the possible heterogeneous combinations in Junzi personality dimensions. Thus, a person-centered latent profile analysis (LPA) was used to pinpoint typical personality trait patterns. With 1116 college students as participants, the study employed the Junzi Personality Questionnaire Based on Confucian Thought and the Receptiveness to Opposing Views Scale. LPA identified three personality types: The Moderate Type (50%), The Daring-Aggressive Type (15%), and The Virtuously-Accomplished Type (35%). Regression analysis showed significant correlations between gender, age, and personality type, with The Virtuously-Accomplished Type scoring notably higher in Receptiveness to Opposing Views. Network analysis further revealed distinct differences in the network structures of Receptiveness to Opposing Views among the three types: The Moderate Type centered on "derogation of opponents," "refraining from what should not be done," and "respectfulness and propriety"; The Daring-Aggressive Type focused on "conversancy with righteousness and cherishment of benign rule," "derogation of opponents," and "respectfulness and propriety"; while The Virtuously-Accomplished Type highlighted "negative emotions" and "wisdom, benevolence, and courage," with "taboo issues" at the periphery in all datasets. The findings uncover the heterogeneity of Junzi personality and its varied associations with Receptiveness to Opposing Views, providing insights for understanding harmonious interactions in diverse settings. Show less

Atherosclerotic cardiovascular disease (ASCVD) continues to be a major global health burden, with substantial residual cardiovascular risk remaining. Growing evidence highlights the liver’s pivotal role in the onset and development of ASCVD through multiple interconnected pathways. As the metabolic center of the body, the liver regulates the synthesis, secretion, and clearance of several atherogenic lipoproteins while simultaneously serving as a systemic inflammation amplifier, producing cytokines, acute-phase proteins, and coagulation factors. Traditional liver-targeted therapies, such as statins, have demonstrated that regulating liver metabolism can confer significant cardiovascular benefits. Subsequently, advances in nucleic acid-based drugs and in vivo gene-editing tools have broadened this strategy, enabling accurate and durable modulation of hepatic gene expression. However, recent clinical trials suggest that improvements in laboratory biomarkers do not always translate into proportional reductions in major adverse cardiovascular events. Moreover, the long-term safety and durability of lipid nanoparticles and gene-editing platforms remain ongoing concerns. Future research should focus on the classification of patients based on multiple omics data, and distinguish those whose main problem is metabolic disorder from those who are mainly at high risk of inflammation, thereby facilitating personalized therapeutic targeting. Overall, current evidence indicates that the liver represents a convergent therapeutic target for modulating both lipid metabolism and inflammation, offering a promising opportunity for deeper and more durable cardiovascular risk reduction. Show less

Conventional biomarkers such as low-density lipoprotein (LDL) and high-density lipoprotein may fail to identify patients' risk for significant coronary artery disease (CAD). This study evaluates the associations between multiple biomarkers and different CAD phenotypes, exploring a machine-learning biomarker-based patient clustering. We included 787 patients on primary prevention from the prospective ACTION registry (January 2024 to June 2025). All patients underwent coronary CTA and simultaneous biomarker testing, including LDL, high-density lipoprotein, triglyceride, apolipoprotein A-1, apolipoprotein B, lipoprotein(a) [Lp(a)], glycated hemoglobin (HbA1c), and high-sensitivity C-reactive protein. Of 382 patients (48.5%) with coronary artery calcium = 0, 42 (11%) had coronary plaque. These patients showed higher Lp(a) vs those without plaque (16.5 vs 11.5, P = .030), despite comparable SCORE2 risk (3.5% vs 3.0%, P = .284). Three biomarker-defined groups were identified after a machine learning unsupervised clustering: Cluster 1 had a favorable lipid profile with the lowest prevalence of CAD-Reporting and Data System (RADS) ≥ 3 (9.9%). Cluster 2 and 3, despite their significant intercluster differences in terms of Lp(a), LDL, and HbA1c levels, both showed a significantly higher prevalence of CAD-RADS ≥ 3 compared to cluster 1 (respectively 21.8% and 17.9%; vs cluster 1, P = .001). High-risk biomarker signatures were significantly associated to the prevalence of CAD-RADS ≥ 3, independently from the baseline SCORE2 (adjusted odds ratio 2.25; 95% confidence interval 1.32-3.82). Distinct biomarker signatures associate with distinct CAD prevalence and severity that conventional lipid markers fail to distinguish. Lp(a) appears relevant for early plaque detection in coronary artery calcium = 0 patients. A comprehensive biomarker evaluation may help identifying high-risk subgroups overlooked by a conventional assessment. Show less

Diabetic foot (DF) is a serious diabetes complication that increases ulceration, amputation and mortality risks. Effective foot self-care can prevent up to 85% of ulcer events. This study aimed to assess foot self-care behaviors among middle-aged and older DF patients, evaluate the impact of social support, and explore the mediating effects of frailty and fear of progression (FoP). We also identified patient subtypes using latent profile analysis. A cross-sectional study was conducted in a tertiary hospital from November 2024 to March 2025. A total of 361 patients with DF aged ≥45 years completed validated questionnaires, including the Social Support Rating Scale (SSRS), FRAIL Scale, FoP-Q-SF, and DFSQ-UMA. Structural equation modeling (SEM) assessed mediation effects, and latent profile analysis (LPA) identified subgroups based on frailty and FoP. A total of 383 questionnaires were distributed, with 361 valid responses collected, resulting in an effective response rate of 94.3%. The average score for foot self-care behavior was 58.52 ± 13.46, while levels of social support, frailty, and FoP were all at moderate levels. SEM indicated that Social support significantly predicted better foot self-care behavior (β = 0.225, P < 0.01). Frailty and FoP partially mediated this relationship (mediation effect: 6.68%). LPA identified three types of physical and mental profiles: Low FoP - Low Frailty Group (75.1%), Moderate FoP - Moderate Frailty Group (15.2%), and High FoP - High Frailty Group (9.7%). Importantly, patients in the High FoP-High Frailty Group demonstrated the lowest foot self-care behavior (mean = 43.70, P < 0.001), indicating the highest potential risk for ulcer occurrence and poor tissue outcomes. Social support enhances foot self-care in DF patients through reduced Frailty and FoP. Tailored interventions targeting high-risk subgroups may improve tissue outcomes and prevent ulcers. Show less

Increasing physical activity is recommended for secondary stroke prevention. Remote telehealth delivery of complex stroke interventions (e.g. exercise) offers potential to meet the challenges of accessible stroke care for all survivors. However, the feasibility of remotely evaluating recommended outcomes, such as device-measured physical activity via wearable technology, is unknown. Furthermore, the effectiveness of physical activity interventions aimed at improving long-term physical activity for people with stroke is unclear. To evaluate the feasibility of remote measurement of physical activity via a research grade wearable device in the ENAbLE Pilot trial and report the effect of the physical activity intervention on device- and self-report measure physical activity. Analyses of secondary outcomes from a randomised trial (ENAbLE Pilot ACTRN12620000189921) involving adults more than 3 months to 10 years post stroke or TIA who were able to walk independently (with or without aid). Physical activity was measured using the International Physical Activity Questionnaire (IPAQ; self-report measure) and activPAL physical activity device. Feasibility outcomes included proportion of the IPAQ collected, and proportion of activPAL devices returned and days of valid data. To assess the effect of the intervention on physical activity outcomes, we used descriptive statistics and linear mixed models. Nearly all self-report (99%) and over three quarters (80%) of device-based measurements were available for analyses. No statistically significant differences in device measured physical activity were identified between participants who received the physical activity intervention and those who did not at the 3- or 6-month timepoints. Participants who undertook the physical activity intervention were more active at 12-months than non-physical activity intervention participants (activPAL measured time spent in moderate to vigorous physical activity (MVPA) 0.31 95% CI [0.07 to 0.55] hours/day, light physical activity (LPA) 0.22 [0.05 to 0.39] hours/day and daily step count 2321 [578 to 4064] steps). No statistically significant differences between groups were identified in the type of physical activity undertaken (IPAQ data), except at 12-months, when walking activity was greater in physical activity intervention participants. Remote measurement of physical activity using a wearable device after stroke and via self-report is feasible. The piloted physical activity intervention shows potential to improve physical activity. Show less

Flourishing is a key positive psychological construct that has been linked to favorable health-related outcomes in patients with inflammatory bowel disease in prior research. However, current research often overlooks the variations in flourishing levels within this population, as well as the mechanisms through which flourishing interacts with disease progression. This study aimed to identify latent categories of flourishing among patients with inflammatory bowel disease and to analyze the potential influencing factors. This study employed a cross-sectional, descriptive exploratory design involving 316 patients diagnosed with inflammatory bowel disease. Data collection was carried out using a general information questionnaire, the Flourishing Scale (FS), the IBD Self-Efficacy Scale (IBD-SES), the Resilience Scale for Inflammatory Bowel Disease (RS-IBD), and the Social Support Rating Scale (SSRS). Latent profile analysis (LPA) was utilized to identify potential subgroups exhibiting flourishing, while multiple logistic regression analysis was conducted to evaluate the influencing factors. The flourishing of individuals with inflammatory bowel disease was classified into three latent groups: the low flourishing-low support beneficiary group ( Patients with inflammatory bowel disease demonstrate three distinct latent categories of flourishing. Healthcare professionals should implement more accurate and targeted intervention measures based on the characteristics and influencing factors of different potential categories, in order to improve the flourishing levels of patients with inflammatory bowel disease. Show less

Spinal TB (STB) is paucibacillary form of disease caused by Mycobacterium Tuberculosis. Late diagnosis of STB can lead to significant disability and morbidity. There is limited data available on diagnostic yield of CT guided biopsy/ultrasonography guided aspiration by various laboratory tests (phenotypic and molecular) used in evaluation STB. Present study was conducted in Department Orthopaedics and Pathology at tertiary care centre in Delhi. Total 68 clinico-radiologically suspected cases undergoing percutaneous aspiration (CT/USG guided) were included in the study. The aspirated tissue/pus was sent for cytology/histopathology/culture/molecular tests. Diagnostic yield of CT/USG guided aspiration for various phenotypic (histopathology/cytology/AFB smear) and molecular tests (CBNAAT/LPA) was calculated alone and in various combination. pvalue <0.05 was considered significant. AFB smear had the lowest diagnostic yield in both USG and CT guided aspirate (28 % and 17.2 % respectively). Histology/cytology combination with molecular method had 100 % diagnostic yield similar to all tests combined. Diagnosis of STB was ascertained in all cases using the combination of molecular methods and phenotypic tests and no single test is effective in ascertaining the diagnosis. The tissue obtained by percutaneous CT guided biopsy/USG guided aspiration technique is adequate to submit tissue to all tests to ascertain diagnosis. Show less

To develop and evaluate an automated clinical decision support system (CDSS) capable of computing both categorical and exact-percentage cardiovascular risk (CVR) in routine clinical practice. We developed and implemented an automated CDSS (AlinIQ®) for CVR assessment within the Clinical Laboratory Department of Hospital Universitari i Politècnic La Fe (València, Spain), applied to patients referred from Primary Care. The analytical profile-requested either via automatic trigger or proactive clinician order-included total cholesterol, HDL-C, LDL-C, non-HDL-C, triglycerides, lipoprotein(a) [Lp(a)], serum creatinine, and estimated glomerular filtration rate. Additional required inputs were smoking status, systolic blood pressure, country of origin, and age at diabetes onset. The CDSS automatically computed SCORE2, SCORE2-OP, SCORE2-Diabetes, and SCORE2 Asia-Pacific, generating both categorical strata and exact-percentage CVR. Lp(a)-adjusted CVR was derived using coefficients from the Spanish Atherosclerosis Society. Following the ESC 2025 Focused Update, patients meeting predefined clinical criteria for moderate, high, or very high CVR were directly assigned to the corresponding category without SCORE calculation. The system also incorporated modifying risk factors, generating standardized interpretive comments and personalized lipid targets. Over one month, 2289 screenings were requested; 189 (8.3%) were excluded. A total of 171 patients (7.5%) were classified as high risk based on score-based calculation (164 [95.9%] triggered automatically), and 29 (1.6%) as very high risk (23 [79.3%] triggered automatically). 119 individuals (6.8%) were reclassified to a higher risk category after Lp(a)-based adjustment. This CDSS provides a scalable and reproducible framework for laboratory-driven cardiovascular prevention. Show less