Background With the continuous development of the healthcare industry, healthcare workers face increasing pressure, including long-term shift work and workplace violence from patients or their relatives. This not only affects the physical and mental health of healthcare workers but may also negatively impact the quality of patient care and the efficiency of medical services. Objectives To analyze the pathways through which shift work and workplace violence affect healthcare workers' self-rated health and depression symptoms, explore potential mediating role of job burnout, and conduct subgroup analyses to reveal differences among various groups. Methods Data were collected from 3706 frontline healthcare workers across 23 provinces from January 10 to February 5, 2019, using a snowball sampling method. The survey included basic demographic information, self-rated health, depression symptoms [assessed using the Patient Health Questionnaire-2 (PHQ-2)], workplace violence experience assessed using the Workplace Violence Scale), and job burnout (assessed using the Chinese Maslach Burnout Inventory). Data were analyzed using logistic regression, structural equation modeling (for mediating effects), and subgroup analysis to examine the impacts of shift work and workplace violence on health and depression symptoms. Results Among the subjects, 2700 workers (73.29%) reported shift work experience, 2079 workers (56.43%) experienced workplace violence, 633 workers (17.18%) reported poor self-rated health, and 687 workers (18.65%) reported depression symptoms. Shift work was associated with self-rated health (OR=0.572, 95%CI: 0.461, 0.710) and depression symptoms (OR=1.519, 95%CI: 1.190, 1.938), while workplace violence also associated with self-rated health (OR=0.566, 95%CI: 0.471, 0.681) and depression symptoms (OR=2.096, 95%CI: 1.740, 2.525). Job burnout significantly mediated the effects of shift work and workplace violence on self-rated health (indirect effects: −0.023, −0.027) and depression symptoms (indirect effects: 0.032, 0.037) (all P < 0.001). The subgroup analysis revealed that age, marital status, physical exercise, smoking, and alcohol consumption influenced the impacts of shift work and workplace violence on health. Conclusion Shift work and workplace violence significantly affect healthcare workers' self-rated health and depression symptoms, with job burnout playing a key mediating role in this process. This suggests that healthcare institutions should improve resource allocation, provide flexible scheduling systems, ensure adequate rest time, and increase psychological support and safety measures to help healthcare workers better cope with work-related stress and violence.

Health management is highly complex due to interactions across multiple levels and factors. System dynamics model (SDM) offers a holistic perspective and a dynamic analytical framework for understanding such complex systems. It has been applied across various domains of health management, including psychological interventions, chronic disease management, rehabilitation, optimization of medical services, and health policy development. By identifying key factors and pathways influencing health behaviors, determining critical targets for interventions, conducting cost-benefit analyses and process optimization, and simulating the long-term effects of health policies, SDM provides quantitative support for decision-making from individual-level interventions to macro-level policies. This article reviews the application of SDM in these four major areas within health management, discusses its advantages and limitations, and serves as a reference for researchers and practitioners aiming to utilize SDM in future studies. The goal is to advance health management toward greater personalization and precision, thereby offering stronger support for health interventions and policy development.
Humans ; Health Policy ; Models, Theoretical

Objective To explore the expression and significance of neutrophil extracellular traps(NETs)in peripheral blood of primary Sj?gren's syndrome(pSS)patients across different disease activity levels,and the predictive value of NETs and routine laboratory markers antithrombin Ⅲ(AT Ⅲ),alkaline phosphatase(ALP)and carbohydrate antigen 125(CA125)for pSS disease activity.Methods A total of 94 newly diagnosed pSS patients at the Affiliated Lianyungang Hospital of Xuzhou Medical University from October 2021 to December 2023 were categorized into active(n=49)and non-active(n=45)groups based on the European League Against Rheumatism(EULAR)Sj?gren's Syndrome disease activity index(ESSDAI).The levels of NETs biomarkers,namely serum myeloperoxidase(MPO)-DNA,were measured using ELISA.Laboratory routine indicators and MPO-DNA were integrated into multivariate Logistic regression to screen for independent influencing factors of pSS disease activity.Pearson's correlation was used to evaluate the relationship between MPO-DNA levels and ESSDAI scores.The efficacy of MPO-DNA alone or in combination with AT Ⅲ,ALP and CA125,for predictors of disease activity was evaluated using ROC curve.Results Serum MPO-DNA(23.884±3.494 μg/L),ALP(80.159±34.318 U/L)and CA125(20.300±16.560 U/ml)levels of active pSS patients were higher than those in the non-active patients(19.024±3.324 μ g/L,67.500±21.166U/L,13.200±6.340 U/ml),while AT Ⅲ(89.180±15.040 ng/ml)was lower than that in non-active patients(94.650±11.620 ng/ml),with significant differences(t=-7.921,-2.426,-2.925,2.094,all P＜0.05).Multivariate Logistic regression analysis showed laboratory indicator MPO-DNA,ALP and CA125 were independent risk factors,while AT Ⅲ was an independent protective factor(all P＜0.05).MPO-DNA was positively correlated with ESSDAI scores(r=0.602,P＜0.01).The AUC(95％CI)of the combination of ALP,CA125 and AT Ⅲ for predicting disease activity in pSS was 0.711(0.612～0.810).The AUC(95％CI)of MPO-DNA alone for predicting disease activity in pSS was 0.837(0.758～0.915),and the AUC(95％CI)of combination of MPO-DNA,ALP,CA125 and AT Ⅲ for predicting disease activity in pSS was 0.866(0.797～0.935),showing an improving in the predictive value.Conclusion The involvement of NETs in the occurrence and expression levels of pSS is related to its disease activity.NETs combined with ALP,CA125 and AT Ⅲ have effective diagnostic performance for the disease activity of pSS.This tool can serve as a biological indicator for predicting the disease activity of pSS.

Objective:Exploring the effect of recovery-oriented family psychoeducation on the level of social support and family resilience of patients with schizophrenia in remission stage, providing theoretical basis for clinical application.Methods:Using a randomized controlled trial method and convenience sampling method, 60 patients with schizophrenia in remission who visited the outpatient department of the Affiliated Mental Health Center of Shanghai Jiao Tong University School of Medicine from April 2020 to March 2022 were selected as the study subjects, and they were divided into experimental group and control group, with 30 patients in each group according to their residence places. The control group was given routine health education; the experimental group was given the rehabilitation oriented family psychoeducation, before intervention and 3 months after intervention, Social Support Rating Scale and Family Resilience Questionnaire were used to evaluate the intervention effect.Results:A total of 60 patients were included in the control group, including 13 males and 17 females, aged (27.0 ± 6.5)years.In the experimental group, there were 14 males and 16 females, aged (28.0 ± 5.6) years. After intervention, the scores of subjective support, objective support and social support utilization in Social Support Rating Scale of the experimental group were 14.33 ± 3.36, 8.43 ± 1.63 and 9.60 ± 2.49, respectively, the control group were 16.20 ± 3.83, 10.00 ± 2.59 and 8.33 ± 2.28, respectively, and the differences were statistically significant ( t=2.00, 2.80, -2.05, all P<0.05). After intervention, the total score of Family Resilience Questionnaire and the scores of perseverance, support and harmony were 78.77 ± 9.61, 24.90 ± 3.07, 15.10 ± 2.23 and 23.63 ± 3.04, respectively. Higher than the control group 72.67 ± 15.96, 23.43 ± 4.92, 14.03 ± 3.60, 21.13 ± 5.13, the differences were statistically significant ( t values were -2.29--1.37, all P<0.05). Conclusions:Recovery-oriented family psychoeducation can improve the level of social support and family resilience of schizophrenia patients in remission.

Objective:To investigate the clinical features and prognosis of male with anti-melanoma differentiation-associated gene 5 (MDA5) autoantibody.Methods:The clinical data of 246 patients with DM and anti-MDA5 autoantibodies hospitalized by Jiangsu Myositis Cooperation Group from 2017 to 2020 were collected and retrospectively analyzed. Chi-square test was performed to compared between counting data groups; Quantitative data were expressed by M ( Q1, Q3), and rank sum test was used for comparison between groups; Single factor survival analysis was performed by Kaplan-Meier method and Log rank test; Cox regression analysis were used for multivariate survival analysis. Results:①The male group had a higher proportion of rash at the sun exposure area [67.1%(47/70) vs 52.8%(93/176), χ2=4.18, P=0.041] and V-sign [50.0%(35/70) vs 30.7%(54/176), χ2=8.09, P=0.004] than the female group. The male group had higher levels of creatine kinase [112(18, 981)U/L vs 57 (13.6, 1 433)U/L, Z=-3.50, P<0.001] and ferritin [1 500 (166, 32 716)ng/ml vs 569 (18, 14 839)ng/ml, Z=-5.85, P<0.001] than the female group. The proportion of ILD [40.0%(28/70) vs 59.7%(105/176), χ2=7.82, P=0.020] patients and the red blood cell sedimentation rate[31.0(4.0, 101.5)mm/1 h vs 43.4(5.0, 126.5)mm/1 h, Z=-2.22, P=0.026] in the male group was lower than that of the female group, but the proportion of rapidly progressive interstitial lung disease (PR-ILD) [47.1%(33/70) vs 31.3%(55/176), χ2=5.51, P=0.019] was higher than that of the female group. ②In male patients with positive anti-MDA5 antibodies,the death group had a shorter course of disease[1.0(1.0, 3.0) month vs 2.5(0.5,84) month, Z=-3.07, P=0.002], the incidence of arthritis [16.7%(4/24) vs 42.2%(19/45), χ2=4.60, P=0.032] were low than those in survival group,while aspartate aminotransferase (AST)[64(22.1, 565)U/L vs 51(14,601)U/L, Z=-2.42, P=0.016], lactate dehydrogenase (LDH) [485(24,1 464)U/L vs 352(170, 1 213)U/L, Z=-3.38, P=0.001], C-reactive protein (CRP) [11.6(2.9, 61.7) mg/L vs 4.95(0.6, 86.4) mg/L, Z=-1.96, P=0.050], and ferritin levels [2 000(681, 7 676) vs 1 125 (166, 32 716)ng/ml, Z=-3.18, P=0.001] were higher than those in the survival group, and RP-ILD [95.8%(23/24) vs 22.2%(10/45), χ2=33.99, P<0.001] occurred at a significantly higher rate. ③Cox regression analysis indicated that the course of disease LDH level, and RP-ILD were related factors for the prognosis of male anti-MDA5 antibodies [ HR (95% CI)=0.203(0.077, 0.534), P=0.001; HR (95% CI)=1.002(1.001, 1.004), P=0.003; HR (95% CI)=95.674 (10.872, 841.904), P<0.001]. Conclusion:The clinical manifestations of male anti-MDA5 antibody-positive patients are different from those of female. The incidence of ILD is low, but the proportion of PR-ILD is high. The course of disease, serum LDH level, and RP-ILD are prognostic factors of male anti-MDA5 antibody-positive patients.

Solid dispersion technology is an advanced technology to improve the solubility and bioavailability of poorly soluble drugs.Inhibition of the recrystallization and amorphous phase separation of amorphous solid dispersion (ASD) active pharmaceutical ingredients are important to ensure product stability,so the characterization of ASD phase separation is essential.Based on the principle of phase separation,this paper analyzed and summarized the advantages,disadvantages and applicability of the various characterization techniques,in order to provide an efficient reference for the characterization and stability study of ASD.

Objective:To construct the whole-process intelligent management system for preventing PICC-related bloodstream infections and explore its effect in preventing PICC-related bloodstream infections.Methods:From January 2021 to December 2022, patients with PICC admitted to Wenzhou People' s Hospital were selected as the research subject, the patients from January to December 2021 were divided into the control groups, the patients from January to December 2022 were divided into the observation group. The whole-process intelligent management system for preventing PICC-related bloodstream infections was constructed and applied with artificial intelligence, this study compared the incidence of PICC-related bloodstream infections and the implementation rate of PICC whole-process bundled management projects before and after system application.Results:The incidence of PICC-related bloodstream infections in the control group was 0.55‰ (14/25 674), while the incidence in the observation group was 0.20‰ (5/25 226), with a statistically significant difference (χ 2=4.110, P<0.05). The implementation rates of PICC whole-process bundled management projects in the control group and observation group were 74.04% (2 319/3 132) and 92.11% (2 885/3 132), respectively, with a statistically significant difference (χ 2=363.782, P<0.01) . Conclusions:The whole-process intelligent management system for preventing PICC-related bloodstream infections constructed optimizes the prevention and treatment process of PICC-related bloodstream infections, effectively ensures the implementation of nursing interventions and monitoring measures, and reduces the incidence of PICC-related bloodstream infections.

As an excellent hosting matrices for enzyme immobilization, metal-organic framework (MOFs) provides superior physical and chemical protection for biocatalytic reactions. In recent years, the hierarchical porous metal-organic frameworks (HP-MOFs) have shown great potential in enzyme immobilization due to their flexible structural advantages. To date, a variety of HP-MOFs with intrinsic or defective porous have been developed for the immobilization of enzymes. The catalytic activity, stability and reusability of enzyme@HP-MOFs composites are significantly enhanced. This review systematically summarized the strategies for developing enzyme@HP-MOFs composites. In addition, the latest applications of enzyme@HP-MOFs composites in catalytic synthesis, biosensing and biomedicine were described. Moreover, the challenges and opportunities in this field were discussed and envisioned.
Metal-Organic Frameworks/chemistry* ; Porosity ; Enzymes, Immobilized/chemistry* ; Biocatalysis ; Catalysis

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.