Tianhui You

Background: Depression is a highly prevalent mental disorder with a global distribution. Informal caregivers are integral to the long-term care of individuals with depression. However, they frequently experience substantial caregiver burden, detrimentally impacting both caregiver well-being and patient prognosis. Despite the clinical significance of this issue, there is currently no systematic review or meta-analysis quantifying the overall magnitude of this burden and synthesizing its associated factors among informal caregivers of patients with depression. Objective: This study aimed to assess the level of caregivers’ burden among informal caregivers who are taking care of patients with depression and to systematically evaluate the associated factors through a narrative synthesis guided by the Stress-Appraisal Model. Methods: Eight electronic databases (PubMed, MEDLINE, Embase, PsycINFO, Web of Science, CNKI, Wan fang, and VIP) were systematically searched. Data extraction and quantitative synthesis were performed using STATA version 18.0. Statistical heterogeneity was assessed via Cochran’s Q test and the I ² statistic, followed by robust sensitivity and subgroup analyses. Concurrently, a narrative synthesis guided by the Stress-Appraisal Model was conducted to systematically identify associated factors, providing a theoretical basis for future targeted interventions. Results: The current systematic review and meta-analysis comprised all 1366 research respondents from 11 studies. The overall pooled mean score of caregiver burden was 38.15 (95% CI: 31.38, 44.92; I ² = 98.9%, p < 0.001) with a 95% prediction interval ranging from 19.67 to 56.67. Subgroup analyses indicated no significant differences based on patient type or country. However, caregivers of patients with severe depression exhibited a higher pooled mean burden 42.40 (95% CI: 29.85, 54.94) compared to those caring for patients with moderate depression 35.51 (95% CI: 22.74, 48.28). Furthermore, a disease course exceeding one year yielded a higher caregiver burden 39.26 (95% CI: 33.34, 45.18) than a duration of less than one year 34.42 (95% CI: 27.84, 40.99). Conclusion: The current systematic review and meta-analysis showed that caregivers of patients with depression generally experience substantial caregiving burden, with pooled effect estimates indicating that the overall severity of this burden approaches the moderate level. Nevertheless, due to the limited quantity of caregiving burden is affected by multiple clinical variables. Accordingly, the findings of current systematic reviews should be interpreted with caution. Furthermore, this study proposes that public health interventions targeting mental health indicators and social support systems should be implemented for informal caregivers of individuals with depression, with the objectives of reducing the caregiving burden of this population and potentially improving the quality of care accessed by patients with depression. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD420261373459 , identifier CRD420261373459.

Exercise is widely recommended for postoperative breast cancer patients due to its benefits for functional recovery and symptom management. However, real-world participation and long-term adherence remain consistently low. Existing research has largely focused on participation rates or perceived barriers, offering limited insight into the behavioral mechanisms that govern how exercise is initiated and sustained over time, particularly within specific cultural contexts. To explore the mechanisms underlying the initiation and maintenance of postoperative exercise behaviors among breast cancer patients, with particular attention to the interaction among behavioral capability, motivation, and cues across different stages of recovery. A qualitative study informed by grounded theory was conducted. Fifteen patients (n = 15) who had undergone unilateral mastectomy were purposively recruited from a tertiary hospital in Foshan, China. Semi-structured, in-depth interviews were carried out and analyzed using open, axial, and selective coding procedures. Postoperative exercise behavior was shaped by the dynamic interaction of three interrelated domains: capability, motivation, and cues. Capability—encompassing physical condition, exercise-related knowledge, and self-regulatory skills—functioned as a threshold condition for behavior initiation. Notably, the capability threshold evolved across the disease trajectory: in the early postoperative phase, it was primarily constrained by acute physical symptoms such as pain and limited mobility, whereas in the long-term recovery phase, it increasingly depended on patients’ self-regulatory capacity and ability to integrate exercise into daily life.Motivation acted as a fluctuating driver influenced by perceived benefits, emotional responses, and external support. Cues, including professional guidance and family reminders, functioned as both behavioral triggers and a key maintenance mechanism. In the absence of sustained cues, behavioral discontinuity frequently occurred, even among patients with adequate motivation and capability.Cultural beliefs regarding rest and activity, rooted in the Chinese context, influenced patients’ perceptions of exercise safety and timing, thereby shaping motivation and responsiveness to cues. Postoperative exercise behavior among breast cancer patients follows a staged mechanism characterized by capability-dependent initiation, motivation-driven fluctuation, and cue-dependent maintenance. These findings highlight the need for nurse-led, continuous, and context-sensitive interventions, rather than one-time education, to support long-term exercise adherence, particularly in cultural contexts where beliefs about rest and activity may shape patients’ exercise behaviors. Nursing interventions should move beyond information delivery and adopt a system-based behavioral support approach that strengthens exercise capability, by incorporating structured exercise prescriptions, continuous nurse-led follow-up, digital reminder systems, and family-supported cueing strategies into routine care.

This study aimed to develop and validate a nomogram to predict the risk of peritoneal dialysis-associated peritonitis (PDAP) in patients undergoing peritopreneal dialysis. A retrospective analysis was conducted on clinical data from 376 patients at Nanhai District People’s Hospital in Foshan City, Guangdong Province, between December 2017 and December 2024. The dataset was randomly divided into a training set (n = 244) and a validation set (n = 132). Risk factors for PDAP were identified using Least Absolute Shrinkage and Selection Operator (LASSO) regression and logistic regression, and a predictive nomogram was developed and validated using R4.1.3. The model’s performance was evaluated through receiver operating characteristic (ROC) curves, the Hosmer-Lemeshow goodness-of-fit test, decision curve analysis (DCA), and clinical impact curves (CICs). Eight potential predictors were selected by LASSO regression analysis. Multivariate logistic regression analysis confirmed that age, dialysis duration, albumin, hemoglobin, β2-microglobulin, Potassium and lymphocyte count were independent risk factors for PDAP occurrence (P = 0.001). The nomogram’s area under the curve (AUC) was 0.929 (95% CI: 0.896–0.962) in the training set and 0.905 (95% CI: 0.855–0.955) in the validation set. The Hosmer-Lemeshow goodness-of-fit test indicated a good model fit (training set χ2 = 13.181, P = 0.106; validation set χ2 = 8.264, P = 0.408). Both DCA and CIC revealed that the nomogram model had good clinical utility in predicting PDAP. The proposed nomogram exhibited excellent predictive performance and clinical utility, providing a valuable tool for early identification and intervention in PDAP. Further external validation and prospective studies are recommended.

To investigate the risk factors for ischemic stroke in elderly patients with hypertension and type 2 diabetes mellitus. A total of 112 elderly patients with hypertension and type 2 diabetes, treated at Jiangmen Central Hospital from January 2023 to December 2023, were selected and categorized into a stroke group and a non-stroke group, each comprising 56 patients. The two groups were examined for demographic data, risk variables were evaluated by multifactorial logistic regression analysis, and the predictive value was determined using ROC curves. The comparison of hyperhomocysteinemia (HHcy), fibrinogen (FIB), and high-density lipoprotein cholesterol (HDL-C) between the non-stroke and stroke groups revealed statistically significant differences (P < 0.05). Logistic regression analysis indicated that HHcy (OR 16.936; 95% CI 1.946–146.071; P = 0.010), FIB (OR 1.773; 95% CI 1.238–2.540; P = 0.002), and HDL-C (OR 0.182; 95% CI 0.043–0.775; P = 0.021) were significant factors in the onset of ischemic stroke among elderly patients with hypertension and type 2 diabetes. ROC curve analysis revealed that the area under the curve (AUC) for FIB, HDL-C, and HHcy in diagnosing stroke associated with hypertension and type 2 diabetes mellitus in the elderly were 0.704, 0.640, and 0.598, respectively, while the AUC for the combined diagnosis of all three was 0.784. HHcy, FIB, and HDL-C independently influence the occurrence of ischemic stroke in elderly patients with hypertension combined with type 2 diabetes mellitus, and their combined enhanced predictive capability for ischemic stroke occurrence.