Jing Li

Purpose: The study aimed to cross-culturally adapt and psychometrically test the Mandarin version of the Chinese Health Literacy Scale for Diabetes (M-CHLSD). Patients and Methods: A cross-sectional study was conducted in Beijing with 221 adults diagnosed with type 2 diabetes. The adaptation followed a rigorous five-step process: forward translation, synthesis, back translation, expert review (utilizing a two-round Delphi method), and cognitive interviews using the Questionnaire Appraisal System. Psychometric properties of the M-CHLSD were evaluated using reliability, content validity, and construct validity. Criterion validity was assessed by correlating the scale with glycemic measures and conducting group comparisons using the Mann–Whitney U-test. Results: The Delphi review highlighted the need for linguistic refinement, clinical accuracy, and contextual adaptation, leading to revisions aligned with Mainland China’s healthcare system. Pilot testing with 15 patients confirmed comprehensibility. Confirmatory Factor Analysis indicated a good model fit (Comparative Fit Index = 0.93, Tucker-Lewis Index = 0.91, Root Mean Square Error of Approximation = 0.064). The scale demonstrated excellent internal consistency (Cronbach’s α=0.884) and test-retest reliability (Intraclass Correlation Coefficient=0.82– 0.91). The M-CHLSD showed moderate correlations with fasting plasma glucose (ρ = − 0.36) and 2-hour postprandial glucose (ρ = − 0.39). The scale successfully distinguished between individuals with good versus poor glycemic control (Cohen’s d = 0.54– 0.56). A mild ceiling effect (15.1%) was observed. Conclusion: The M-CHLSD is a robust, reliable, and clinically relevant tool for assessing health literacy in Mandarin-speakers with diabetes. Its rigorous methodology, including Delphi, cognitive interviews, and comprehensive psychometric testing, makes it superior to other adapted tools. The scale’s strong clinical correlations and ability to stratify patients based on glycemic control ensure its utility in personalized education and follow-up care pathways.

Background: As the population ages, the prevalence of sarcopenia, particularly in nursing homes, becomes increasingly significant. This muscle degeneration condition commonly affects older adults, but aerobic and resistance exercises have been shown to effectively counteract it. Despite this, there is a notable gap in research focusing on enhancing exercise participation and muscle health among nursing home residents. Furthermore, understanding and improving residents' perceptions and acceptance of these exercise regimens is crucial to foster long-term engagement in physical activity. Methods: This pilot study employs a quasi-experimental cluster-controlled trial design to assess the feasibility of an integrated intervention that combines square dancing with progressive elastic band training for elderly residents in nursing homes who have sarcopenia or possible sarcopenia. Participants are assigned to either an intervention group or a control group at the nursing home cluster level. The intervention consists of a 12-week program conducted 3 times per week, followed by a 12-week observation period. Primary outcome measures include the intervention’s feasibility and acceptability, with secondary outcomes encompassing appendicular skeletal muscle mass, muscle strength, physical function, cognitive function, depressive symptoms, balance stability, and falls risk. The study aims to recruit 68 participants based on power analysis calculations to detect significant intervention effects. Discussion: The study investigated a frequently neglected and under-researched group of nursing home residents displaying symptoms of sarcopenia or possible sarcopenia. The findings are expected to lay the groundwork for developing sustainable and effective exercise programs that can markedly improve geriatric care practices and the treatment of sarcopenia.

Objectives: The study aimed to investigate the relationship between sarcopenia, possible sarcopenia, and cognitive impairment, and to analyze the impact of potential moderating factors. Methods: A comprehensive search was conducted on PubMed, EmBase, Web of Science, Cochrane Library, CNKI, Wanfang Databases, VIP and SinoMed from inception until March 2025. The quality of cross-sectional studies was assessed using the Agency for Healthcare Research and Quality Scale, while the Newcastle-Ottawa scale was used to assess the quality of included case-control and cohort studies. Subgroup analyses and meta-regression were employed to explore potential moderating variables and heterogeneity. Results: A total of 31 studies were included in this systematic review, of which 27 studies were quantitatively analyzed. The meta-analysis revealed that both sarcopenia and possible sarcopenia significantly associated with cognitive impairment (OR=1.88, 95%CI = 1.71–2.08), (OR=1.96, 95%CI = 1.50–2.58). Subgroup analyses revealed a stronger association between sarcopenia and cognitive impairment in specific demographics: among females with sarcopenia (OR=3.22, 95%CI = 1.23–8.40), in Asian populations (OR=1.96, 95%CI = 1.76–2.18), and within hospital settings (OR=3.12, 95%CI = 2.18–4.48). These findings underscore the influence of gender, ethnicity, and healthcare environment on the relationship between sarcopenia and cognitive impairment. An assessment of publication bias within studies providing adjusted odds ratios indicated potential bias. However, sensitivity analyses and trim-and-filling analyses confirmed the robustness of our findings, suggesting that the observed associations remain reliable despite the presence of publication bias. Conclusions: Individuals with sarcopenia or possible sarcopenia have approximately twice the odds of developing cognitive impairment compared to those without sarcopenia. Implementing systematic screening and targeted interventions for possible sarcopenia patients is essential to prevent from cognitive decline. Specifically, healthcare professionals should focus on women and inpatients with sarcopenia, employing proactive measures to avert cognitive impairment.

Background: Intensive lifestyle modifications have proved effective in preventing type 2 diabetes mellitus (T2DM), yet the efficiency and effectiveness of these modifications need to be improved. Emerging social media interventions are considered useful in promoting these lifestyles; nevertheless, few studies have investigated the effectiveness of combining them with behavior theory. Objective: This study aims to examine the effectiveness of a 6-month mobile-based intervention (DHealthBar, a WeChat applet) combined with behavioral theory compared with a printed intervention in improving dietary behaviors, physical activity, and intention to change these behaviors among populations at high risk for T2DM. Methods: Participants aged 23 to 67 years were recruited offline in Beijing, China, and were randomized into the intervention group or the control group, which received educational content via DHealthBar or a printed handbook, respectively. Educational materials were culturally tailored recommendations on improving dietary behaviors, physical activity, and intention to change based on the transtheoretical model. Participants in the intervention arm received push notifications twice per week on WeChat and had access to the educational content for the 6-month study period. Participants in the control arm received the same intervention content through printed materials. The outcomes of participants’ behavior change, intention to change behavior, and anthropometric characteristics were collected via online measuring tools at baseline, 3 months, and 6 months. Results: In this study, 79 enrolled individuals completed baseline information collection (control: n=38 vs intervention: n=41), and 96% (76/79) completed the 6-month follow-up visit. Attrition rates did not differ significantly between the 2 groups (χ21=0.0, P=.61). Baseline equivalence was found. Participants in both groups reported a statistically significant decrease in energy intake at the 2 follow-up assessments compared with baseline (3 months, control: exp[β]=0.83, 95% CI 0.74-0.92 vs intervention: exp[β]=0.76, 95% CI 0.68-0.85; 6 months, control: exp[β]=0.87, 95% CI 0.78-0.96 vs intervention: exp[β]=0.57, 95% CI 0.51-0.64). At 6 months, a significantly larger decrease was observed in the intervention group in energy, fat, and carbohydrate intake, accompanied with a significantly larger increase in moderate-intensity physical activity compared with the control group (energy: exp[β]=0.66, 95% CI 0.56-0.77; fat: exp[β]=0.71, 95% CI 0.54-0.95; carbohydrates: exp[β]=0.83, 95% CI 0.66-1.03; moderate-intensity physical activity: exp[β]=2.05, 95% CI 1.23-3.44). After 6 months of the intervention, participants in the intervention group were more likely to be at higher stages of dietary behaviors (exp[β]=26.80, 95% CI 3.51-204.91) and physical activity (exp[β]=15.60, 95% CI 2.67-91.04) than the control group. Conclusions: DHealthBar was initially effective in improving dietary behavior, physical activity, and intention to change these behaviors among populations who were at high risk of developing T2DM, with significant differences in the changes of outcomes over the 6-month intervention period. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000032323; https://tinyurl.com/y4h8q4uf

BACKGROUND Intensive lifestyle modifications have proved effective in preventing type 2 diabetes mellitus (T2DM), yet the efficiency and effectiveness of these modifications need to be improved. Emerging social media interventions are considered useful in promoting these lifestyles; nevertheless, few studies have investigated the effectiveness of combining them with behavior theory. OBJECTIVE This study aims to examine the effectiveness of a 6-month mobile-based intervention (DHealthBar, a WeChat applet) combined with behavioral theory compared with a printed intervention in improving dietary behaviors, physical activity, and intention to change these behaviors among populations at high risk for T2DM. METHODS Participants aged 23 to 67 years were recruited offline in Beijing, China, and were randomized into the intervention group or the control group, which received educational content via DHealthBar or a printed handbook, respectively. Educational materials were culturally tailored recommendations on improving dietary behaviors, physical activity, and intention to change based on the transtheoretical model. Participants in the intervention arm received push notifications twice per week on WeChat and had access to the educational content for the 6-month study period. Participants in the control arm received the same intervention content through printed materials. The outcomes of participants’ behavior change, intention to change behavior, and anthropometric characteristics were collected via online measuring tools at baseline, 3 months, and 6 months. RESULTS In this study, 79 enrolled individuals completed baseline information collection (control: n=38 vs intervention: n=41), and 96% (76/79) completed the 6-month follow-up visit. Attrition rates did not differ significantly between the 2 groups (χ21=0.0, P=.61). Baseline equivalence was found. Participants in both groups reported a statistically significant decrease in energy intake at the 2 follow-up assessments compared with baseline (3 months, control: exp[β]=0.83, 95% CI 0.74-0.92 vs intervention: exp[β]=0.76, 95% CI 0.68-0.85; 6 months, control: exp[β]=0.87, 95% CI 0.78-0.96 vs intervention: exp[β]=0.57, 95% CI 0.51-0.64). At 6 months, a significantly larger decrease was observed in the intervention group in energy, fat, and carbohydrate intake, accompanied with a significantly larger increase in moderate-intensity physical activity compared with the control group (energy: exp[β]=0.66, 95% CI 0.56-0.77; fat: exp[β]=0.71, 95% CI 0.54-0.95; carbohydrates: exp[β]=0.83, 95% CI 0.66-1.03; moderate-intensity physical activity: exp[β]=2.05, 95% CI 1.23-3.44). After 6 months of the intervention, participants in the intervention group were more likely to be at higher stages of dietary behaviors (exp[β]=26.80, 95% CI 3.51-204.91) and physical activity (exp[β]=15.60, 95% CI 2.67-91.04) than the control group. CONCLUSIONS DHealthBar was initially effective in improving dietary behavior, physical activity, and intention to change these behaviors among populations who were at high risk of developing T2DM, with significant differences in the changes of outcomes over the 6-month intervention period. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR2000032323; https://tinyurl.com/y4h8q4uf

In this study, the construct validity of the moisture subscale of the Braden Scale for Predicting Pressure Sore Risk is partially supported by the significant inverse relationships between moisture subscale scores, the number of wet observations and soiled observations, brief changes, and differences among the moisture subscale score groups.