Elderly end-of-life patients often experience distress due to being caught in dilemmas of contemplation and decision-making. Narrative wills， grounded in life values and premised on respecting individual wishes and needs， present an individual’s unique life story through narrative forms， conveying their overall experience， interpretation of meaning， and understanding of life. They are preserved and passed on in a way that meets individual expectations， thereby promoting human exploration， reflection， and growth regarding the meaning of life through interpersonal interactions that transcend space and time. This paper explored the concept of narrative wills among elderly end-of-life patients， the ethical value and ethical principles of narrative wills， and the moral and ethical risks. It also provided specific ethical interpretations， assisting in the application and development of narrative wills in elderly end-of-life patients.

Objective:To construct a risk prediction model for postoperative incision infection in patients with rectal cancer undergoing ileostomy reversal surgery and to validate this model.Methods:A retrospective study was conducted on 700 patients who underwent ileostomy at The First Affiliated Hospital of Wenzhou Medical University. The patients were randomly divided into a modeling group ( n = 490) and a validation group ( n = 210) in a 7:3 ratio. The incidence of incision infection was recorded, and logistic multiple regression analysis was performed on various factors that may affect incision infection. A predictive model was constructed, and the application value of the predictive model was assessed. Results:Based on the occurrence of postoperative incision infection, patients in the modeling group who underwent ileostomy reversal surgery were divided into an infection group ( n = 61) and a non-infection group ( n = 429). There were no statistically significant differences between the two groups in terms of sex, age, body mass index, history of smoking, history of hypertension, history of immune system diseases, tumor, node, and metastasis staging, history of abdominal surgery, preoperative albumin levels, intraoperative hypothermia, and intraoperative blood loss (all P > 0.05). However, the proportion of patients with a history of diabetes was higher in the infection group [27.87% (17/61)] compared with the non-infection group [5.59% (24/429)]. The proportion of patients with a surgical duration > 90 minutes was also higher in the infection group [70.49% (43/61)] compared with the non-infection group [49.88% (214/429)]. Additionally, the proportion of patients with postoperative subcutaneous drainage was lower in the infection group [16.39% (10/61)] than in the non-infection group [40.56% (174/429)]. The proportion of patients with a history of radiotherapy and chemotherapy was higher in the infection group [75.41% (46/61)] compared with the non-infection group [53.15% (228/429)]. The proportion of patients with peristomal dermatitis was higher in the infection group [31.15% (19/61)] than in the non-infection group [4.20% (18/429)]. All these differences were statistically significant ( χ2 = 34.56, 9.09, 13.30, 10.74, 51.78, all P < 0.05). A history of diabetes, postoperative subcutaneous drainage, surgical duration, a history of radiotherapy and chemotherapy, and peristomal dermatitis were included in the regression model (all P < 0.05). Among these, a history of diabetes, peristomal dermatitis, surgical duration ≥ 90 minutes, and a history of radiotherapy and chemotherapy were identified as independent risk factors, while postoperative subcutaneous drainage was identified as a protective factor. The risk prediction model was constructed as follows: P = -3.791 + 2.594 × a history of diabetes + 1.839 × surgical duration - 2.261 × postoperative subcutaneous drainage + 2.673 × a history of radiotherapy and chemotherapy + 2.765 × peristomal dermatitis. The prediction of the nomogram model for the risk of incision infection after ileostomy reversal surgery in the modeling group showed an area under the receiver operating characteristic curve of 0.931 ( P < 0.001, 95% CI: 0.847-0.983), with a sensitivity of 83.41% and a specificity of 79.91%. The receiver operating characteristic curve results for the validation group indicated an area under the curve of 0.891 ( P < 0.001, 95% CI: 0.821-0.967), with a sensitivity of 75.00% and a specificity of 94.90%. Conclusions:A history of diabetes, peristomal dermatitis, surgical duration ≥ 90 minutes, and a history of radiotherapy and chemotherapy are independent risk factors for incision infection after ileostomy reversal surgery, while postoperative subcutaneous drainage is a protective factor. Constructing a predictive model based on these factors shows good predictive value for the occurrence of incision infection after ileostomy reversal surgery and needs further clinical investigation.

Objective:To construct a risk prediction model for postoperative incision infection in patients with rectal cancer undergoing ileostomy reversal surgery and to validate this model.Methods:A retrospective study was conducted on 700 patients who underwent ileostomy at The First Affiliated Hospital of Wenzhou Medical University. The patients were randomly divided into a modeling group ( n = 490) and a validation group ( n = 210) in a 7:3 ratio. The incidence of incision infection was recorded, and logistic multiple regression analysis was performed on various factors that may affect incision infection. A predictive model was constructed, and the application value of the predictive model was assessed. Results:Based on the occurrence of postoperative incision infection, patients in the modeling group who underwent ileostomy reversal surgery were divided into an infection group ( n = 61) and a non-infection group ( n = 429). There were no statistically significant differences between the two groups in terms of sex, age, body mass index, history of smoking, history of hypertension, history of immune system diseases, tumor, node, and metastasis staging, history of abdominal surgery, preoperative albumin levels, intraoperative hypothermia, and intraoperative blood loss (all P > 0.05). However, the proportion of patients with a history of diabetes was higher in the infection group [27.87% (17/61)] compared with the non-infection group [5.59% (24/429)]. The proportion of patients with a surgical duration > 90 minutes was also higher in the infection group [70.49% (43/61)] compared with the non-infection group [49.88% (214/429)]. Additionally, the proportion of patients with postoperative subcutaneous drainage was lower in the infection group [16.39% (10/61)] than in the non-infection group [40.56% (174/429)]. The proportion of patients with a history of radiotherapy and chemotherapy was higher in the infection group [75.41% (46/61)] compared with the non-infection group [53.15% (228/429)]. The proportion of patients with peristomal dermatitis was higher in the infection group [31.15% (19/61)] than in the non-infection group [4.20% (18/429)]. All these differences were statistically significant ( χ2 = 34.56, 9.09, 13.30, 10.74, 51.78, all P < 0.05). A history of diabetes, postoperative subcutaneous drainage, surgical duration, a history of radiotherapy and chemotherapy, and peristomal dermatitis were included in the regression model (all P < 0.05). Among these, a history of diabetes, peristomal dermatitis, surgical duration ≥ 90 minutes, and a history of radiotherapy and chemotherapy were identified as independent risk factors, while postoperative subcutaneous drainage was identified as a protective factor. The risk prediction model was constructed as follows: P = -3.791 + 2.594 × a history of diabetes + 1.839 × surgical duration - 2.261 × postoperative subcutaneous drainage + 2.673 × a history of radiotherapy and chemotherapy + 2.765 × peristomal dermatitis. The prediction of the nomogram model for the risk of incision infection after ileostomy reversal surgery in the modeling group showed an area under the receiver operating characteristic curve of 0.931 ( P < 0.001, 95% CI: 0.847-0.983), with a sensitivity of 83.41% and a specificity of 79.91%. The receiver operating characteristic curve results for the validation group indicated an area under the curve of 0.891 ( P < 0.001, 95% CI: 0.821-0.967), with a sensitivity of 75.00% and a specificity of 94.90%. Conclusions:A history of diabetes, peristomal dermatitis, surgical duration ≥ 90 minutes, and a history of radiotherapy and chemotherapy are independent risk factors for incision infection after ileostomy reversal surgery, while postoperative subcutaneous drainage is a protective factor. Constructing a predictive model based on these factors shows good predictive value for the occurrence of incision infection after ileostomy reversal surgery and needs further clinical investigation.

OBJECTIVETo assess the differences in the health promotion demand of practitioners between urban and rural private enterprises by a comparative analysis, and to probe into the more scientific and targeted health promotion measures.

METHODSStratified cluster random sampling and self-designed questionnaire were adopted to survey 852 practitioners in urban and rural private enterprises of a Chinese city.

RESULTSThere were significant differences in practitioners between the two sorts of enterprises in terms of age, length of service, educational level, and forms of employment (P < 0.05 or P < 0.01). The basic knowledge and skills of practitioners in rural private enterprises were worse than those in urban private enterprises(P < 0.05 or P < 0.01). Practitioners in rural private enterprises were significantly less inclined to gain basic health promotion knowledge through enterprise training and network(P < 0.01). The demand of practitioners for health examination and hazard notification was significantly lower in rural private enterprises than in urban private enterprises (P < 0.05).

CONCLUSIONFocused and targeted health promotion should be carried out based on different demand characteristics of practitioners in rural and urban private enterprises.

China ; Data Collection ; Employment ; Health Promotion ; Humans ; Private Sector ; Rural Population ; Surveys and Questionnaires ; Urban Population