Objective To explore the influencing factors of rumination in patients with diabetic retinopathy (DR) using a structural equation model, and to examine the relationships between these factors.Impact pathway. Method  We selected 200 patients with DR who were treated at our hospital between January 2022 and June 2024. We collected general clinical information about these patients and used it for analysis.Event-related reflective thinking questionnaire (ERRI), social support rating scale (SSRS), and psychological resilience scale (CD-RISC-10). Conduct a survey of patients and analyze the various contributing factors.The pathways through which these factors influence one another. Results Show that social support, psychological resilience, sleep disorders, the progression of diabetes, household monthly total income, and educational attainment can all directly impact DR prevalence.
The levels of rumination differed among the groups, with the path coefficients being 0.502, 0.251, -0.181, -0.234, 0.326, and 0.275 (P < 0.05). Social support can influence mental well-being.Emotional resilience indirectly influences patients’ levels of rumination. Educational attainment can indirectly affect patients’ levels of rumination by influencing the total monthly household income. The path coefficient for this relationship is [insert value].
Results: 0.175, 0.492 (p < 0.05). Conclusion The level of rumination in DR patients is influenced by social support levels, psychological resilience levels, sleep disturbances, the duration of diabetes.Factors such as the total monthly household income and educational level can influence the situation. Healthcare professionals can develop corresponding intervention plans based on these factors to help patients improve their quality of life and address their psychological needs situation.

Objective To investigate the current state of fear regarding the progression of systemic lupus erythematosus (SLE) among patients, and to analyze the associated risk factors using a random forest model.Method A convenience sampling method was used to select 200 patients with systemic lupus erythematosus (SLE) admitted to a hospital in Jiujiang from October 2021 to January 2024 as the study subjects. The patients were divided into a fear of disease progression group and a non-fear of disease progression group based on whether they experienced fear about the progression of their disease. General information about the patients, scores from the SLEDAI (Systemic Lupus Erythematosus Disease Activity Index), Brief-IPQ (Brief Illness Perception Questionnaire), SSRS (Social Support Scale) were collected. The impact of potential variables on fear of disease progression was assessed using a random forest algorithm model, with an analysis of the importance ranking and out-of-bag error data classification errors for the variables with the lowest out-of-bag error rates. A binary logistic regression model was used to analyze the variables with the lowest out- of-bag error rates.Results showed that the incidence of fear of disease progression among patients with systemic lupus erythematosus was 62.50%. The random forest analysis indicated that the out-of-bag error rate was lowest when the number of variables was 10. The multivariate analysis revealed that occupation status (OR = 5.351), number of hospitalizations (OR = 6.493), SLEDAI score (OR = 1.558), positive coping (OR = 0.820), complete surrender (OR = 1.449), negative avoidance (OR = 1.484), Brief-IPQ score (OR = 1.429), and SSRS score (OR = 0.896) were independent factors associated with fear of disease progression in patients with systemic lupus erythemathosus (P < 0.05).Conclusion Patients with systemic lupus erythematosus are more likely to experience fear of disease progression. Those who are employed, have experienced their first hospitalization, have a high SLEDAI score, employ negative coping mechanisms, have a high Brief-IPQ score, and lack social support are at greater risk of experiencing fear of disease progression. Clinicians are advised to focus on high-risk individuals, promptly implement interventions, and reduce the incidence of fear of disease progression to improve patients’ quality of life.

Objective To analyze the factors related to susceptibility to incision infection after surgery in elderly diabetic gallbladder removal patients and construct a suitable lineage model. Methods Retrospectively, 495 patients who underwent gallbladder removal at the hospital from April 2022 to March 2024 were divided into model samples (346 cases) and validation samples (149 cases) by a ratio of 7: 3. The samples were divided into infected and uninfected groups according to whether postoperative incision infection had occurred. Collect relevant data before and after their surgery, analyze their risk factors and build a risk matrix model. Results There were 48 cases (13.87 per cent) in the infected group and 298 cases (86.13 per cent) among the uninfected group. Multivariate analysis showed that smoking, preoperative endoscopic retrograde cholangiopancreatography (ERCP),Surgery time, gallbladder rupture during surgery, gallbarrow stones, fluid around the gallbladder, white blood cell count, blood transfusion during surgical, steroid drugs, surgical incision, and ASA were ranked as independent influences of postoperative incision infection in patients (P < 0.05) to construct a risk matrix model.The area under the receiver characteristic curve was 0.930 (95% CI: 0.894-0.967), the sensitivity was 0.813, the specificity was 0.909, and the Youden index was 0.722.Hosemer-Lemeshow test showed χ 2 = 5.146, P = 0.742.Conclusion The line chart model predicted postoperative incision infection in patients with diabetic gallbladder removal in elderly patients was good. Healthcare professionals could determine the risk of postoperative incisions infection and take targeted interventions through indicators such as smoking status, ERCP, surgical incision and ASA grading.

Objective To explore the potential categories and influencing factors of the development trajectory of medication beliefs among individuals with schizophrenia during the recovery phase, and to analyze its impact on medication adherence.Method A prospective study was conducted on 200 patients with schizophrenia in the recovery phase who were treated at a hospital in Shaoxing City from January 2022 to January 2024. The use of medication beliefs was assessed using the Beliefs About Medication Questionnaire (BMQ) at the time of admission, 1 week after treatment, 1 month after treatment, and 3 months after treatment. Growth mixture modeling was used to analyze the optimal number of categories for the trajectory of medication belief development. Single-factor analysis and multivariate logistic regression were employed to examine the independent factors between potential categories and their impact on medication adherence.Results The development trajectories of medication beliefs for 200 patients can be categorized into three potential groups: high-stable (15.0%), medium-decreasing (13.5%), and low-decreasing (71.5%). There were statistically significant differences in medication adherence among patients within each group. Patients in the high-stable group had higher medication adherence compared to those in the other two groups (P < 0.05). Single-factor analysis and multivariable logistic regression analysis revealed that marital status, educational level, history of suicide, living situation, medication use, and Treatment Emergence Symptoms Scale (TESS) scores were all independent factors influencing the development of medication beliefs in patients with schizophrenia during the recovery phase (P < 0.05).Conclusion There are individual differences in the development trajectory of medication beliefs among individuals with schizophrenia during the recovery phase, which affects medication adherence. The development trajectory is influenced by factors such as marital status, educational level, history of suicide attempts, living arrangements, medication usage, and TESS scores. Personalized intervention measures should be developed to improve the development of medication beliefs.

Objective To explore the current situation, influencing factors, and intervention measures for the delayed initiation of the second stage of lactation in postpartum women. Methods We selected 197 women from the obstetrics department of Ganzhou Maternal and Child Health Hospital from December 2021 to December 2023 and investigated their second stage of lactation initiation time. We statistically analyzed the incidence of delayed second stage of lactation and performed logistic regression analysis to identify its influencing factors. We designed targeted intervention measures accordingly. Results The average time for the second stage of lactation initiation was 74.34 ± 5.78 minutes. Among the 197 women, 43 experienced delayed second stage of lactation, with an incidence rate of 21.83% (43/197). Results of the univariate analysis showed statistically significant differences between the two groups in terms of age, first childbirth, cesarean section, gestational diabetes, postpartum breastfeeding initiation time, anxiety, and depression (P < 0.05). Logistic regression analysis indicated that age ≥ 35 years, first childbirth, cesarean delivery, gestational diabetes, breastfeeding initiation time > 30 minutes, and anxiety and depression were risk factors for delayed second stage of lactation (P < 0.05) Conclusion Delayed second stage of lactation is closely related to various physiological, psychological, and obstetric factors. Special attention should be paid to high-risk groups such as older women and first-time mothers, and measures should be taken to optimize early postpartum maternal-infant contact, enhance gestational diabetes management, and provide psychological support to reduce the incidence of delayed lactation and promote successful breastfeeding.

Objective To investigate the longitudinal changes in binary coping levels of patients with prostate cancer undergoing castration therapy at different time points, and to analyze the associated factors. Methods A prospective study was conducted, selecting 75 patients with prostate cancer who had undergone castration therapy at the Urology Department of a hospital in Wenzhou from October 2022 to October 2024. Binary coping levels were assessed using the Binary Coping Inventory (CDCI), the Locke-Wallace Marital Adjustment Test (MAT), and a general situation survey. The changes in binary coping levels over time were compared at 1 month, 3 months, 6 months, and 12 months after castration therapy, and the relevant factors influencing the changes in binary coping levels of prostate cancer patients undergoing castration therapy were analyzed using multiple linear regression analysis. Results A total of 70 patients completed the survey at the end of the follow-up period. The CDCI scores at 1 month, 3 month, 6 month, and 12 months were 108.93 ± 14.92, 111.39 ± 15.37, 104.77 ± 14.30, and 104.46 ± 13.99, respectively. Multiple linear analysis showed that occupation (b = -7.78, 95% CI = -15.12 to -0.45) and marital age (b = -4.41, 95%CI = -8.35 to -0.47) were significant factors influencing the binary coping levels of prostate cancer patients who had undergone long-term castration therapy. Conclusion The binary coping abilities of prostate cancer patients undergoing long-term castration therapy are generally low and show an initial increase followed by a decline over time. Occupation and marital age are important risk factors for changes in binary coping abilities. By assessing both the patients and their spouses, measures can be taken to promote collaboration between the couple, enhance their knowledge about the disease, and thereby improve the patients’ binary coping abilities.

Objective To explore the risk factors of venous catheter-associated bloodstream infection (CRBSI) in patients with acute pancreatitis (AP) by parenteral nutrition (PN), and to construct and validate the predictive model of Durian tree.  Methods A retrospective analysis of 140 patients with AP extraintestinal nutrition admitted to a hospital in Jijiang from January 2021 to August 2023 was a model group. The patients were divided into 20 CRBSI patients and 120 non-CRBSI patients according to whether or not they had CRBSI.  Univariate and binary logistic regression were used to analyze the influencing factors of CRBSI in patients with AP parenteral nutrition, and to construct a decision tree predictive model.  According to the distribution ratio of 7: 3, 60 patients with AP parenteral nutrition from September 2023 to April 2024 were selected as the verification group.  ROC curves were used to evaluate the predictive effectiveness of the model.  Results The incidence of CRBSI in 140 AP parenteral nutrition patients was 14.29%. The multifactorial analysis showed that age ≥ 60 years, duration of extraintestinal nutrition > 10 days, duration intubation > 14 days, and combined diabetes were independent influencing factors for CRBSI in patients with extraintestinal nutrition (P < 0.05). According to the proportion of nodes in CRBSI that represents the risk of CRBSI in AP parenteral nutrition patients, four high-risk groups were screened out: (1) parenteral nutrition time > 10 days, combined with diabetes, accounting for 62.50% of this node; The duration of parenteral nutrition was more than 10 days, without glycouria and catheterization was more than14days, accounting for 38.50% of the nodes.  The duration of parenteral nutrition was less than 10 days, the age was more than 60 years and the duration of intubation was more than 14 days, accounting for 40.00% of the nodes.  The duration of parenteral nutrition was less than10days, the age was more than60years, the duration of intubation was less than 14 days, and the incidence of glycouria was 20.00%.  In theROC curve, the area under the curve (AUC) of the training set was 0.929 (95% CI: 0.877-0.980), the sensitivity was 80.00%, and the specificity was 87.50%.  The AUC of the validation set was 0.926 (95% CI: 0.840-1.000), sensitivity 85.00% and specificity 83.00%.  Conclusion The decision tree predictive model based on the factors related to the occurrence of CRBSI in patients with extraintestinal nutrition has a good predictive effect, and clinicians may use this model to screen high-risk patients with extrauterine nutrition who are prone to CRBSI and intervene in a timely manner.

Objective To analyze the factors related to treatment transition and adverse outcomes of patients with drug-resistant tuberculosis (RR-PTB) in farmers and herdsmen, so as to provide information for optimizing the control measures for drug-resistant TB in farmers.Methods The medical records of RR-PTB patients registered for treatment from January 2017 to December 2021 were collected from the "Nuclei Management System." A total of 710 RR-PTB farmers and herdsmen were included according to the study admission criteria, and the composition of adverse treatment outcomes was analysed and the trends over the five-year period, and the factors associated with adverse treatment results were analysed using logistic regression models.Results A total of 710 patients with RR-PTB were enrolled in this study. 365 patients (51.41%) had good outcome, of which 205 patients (56.16%) were cured and 160 patients (43.84%) were completed. Adverse outcomes were 345 (48.59 per cent), including 41 (11.88 per cent) treatment failures, 236 (68.41 per cent) absenteeism and 68 (19.71 per cent) deaths.The component ratio of adverse treatment outcomes in farmer-herdsman RR-PTB patients registered for treatment from 2017 to 2021 showed a decreasing trend (χ 2 trend = 36.3, P < 0.001).Multivariate logistic regression analysis showed that retreatment (OR = 1.543,95% CI: 1.095 ~ 2.176), long-term chemotherapy (OR = 2.311,95% CI: 1.058-5.046) and age ≥ 60 years (OR = 3.653,95% CI: 2.398-5.564) were risk factors for adverse outcomes. OR = 0.370,95% CI: 0.248 ~ 0.551), intensive hospitalization (OR = 0.494,95% CI: 0.316 ~ 0.772), The inclusion of bedaquiline in the treatment regimen (OR = 0.046,95% CI: 0.005 to 0.394) was a protective factor for adverse outcomes in patients.Conclusions The composition of adverse treatment outcomes among farmers and herdsmen of Lifupine-resistant tuberculosis in Gansu Province is decreasing year by year, but still relatively high. Priority should be given to people aged 60 years and above, patients who are being treated again, patients who use long-term treatment regimens, and patients who are not hospitalized for intensive treatment, and supervision of medication administration throughout the treatment should be strengthened to further reduce the composition of adverse treatment outcomes.

Objective To explore the changes in the cost structure and influencing factors of inpatients with cerebral infarction, and to provide a reference for effectively controlling the growth of cerebral infarction costs and reducing the economic burden on patients. Methods The first-page medical record information of patients with a principal diagnosis of cerebral infarction from January 1, 2020 to October 31, 2024, collected from the medical record statistics management system of a hospital, was used to analyze the changes in the internal composition of hospitalization costs by the structural variation degree method, and the multiple linear regression analysis method was adopted to explore the influencing factors of hospitalization costs in patients with cerebral infarction. Results Among the components of hospitalization costs, drug expenses accounted for the highest proportion (33.10%), followed by examination expenses (19.98%) and laboratory test expenses (17.83%). The structural variation degree of hospitalization costs in patients with cerebral infarction from 2020 to 2024 was 13.61%, and the top three contributors to structural variation were consumable expenses (23.44%), drug expenses (17.63%), and treatment expenses (14.55%). The results of multiple linear regression analysis showed that length of hospital stay, admission route, and whether surgery was performed were the main influencing factors of hospitalization costs in patients with cerebral infarction (P＜0.05). Conclusion The overall hospitalization costs of patients with cerebral infarction showed a downward trend. Consumable expenses and drug expenses were the main internal factors affecting hospitalization costs. In addition, length of hospital stay, admission route, and whether surgery was performed also had a significant impact on hospitalization costs. It is necessary to further optimize the cost structure, standardize the diagnosis and treatment process, improve the level of medical technology, and reasonably shorten the length of hospital stay.

Objective To analyze the distribution characteristics and influencing factors of patients with ultra-long hospital stay in a tertiary general hospital in Henan in 2023, and to explore measures to shorten the average length of hospital stay. Methods The first-page medical record information of 98,139 discharged patients from January 1 to December 31, 2023 was collected. The distribution characteristics of patients with hospital stay longer than 30 days were statistically analyzed. Chi-square test and multivariate logistic stepwise regression were used to analyze the influencing factors of ultra-long hospital stay. Results A total of 873 inpatients had a hospital stay longer than 30 days, accounting for 0.89% of all discharged patients. The male-to-female ratio was 1.28∶1, the average length of hospital stay was 44.32 days, and 75.49% of patients were aged 40-79 years. The top three departments were Rehabilitation Medicine (29.32%), Intensive Care Unit (15.23%), and Oncology (12.03%). The top three diseases were circulatory system diseases (22.45%), injuries, poisoning and certain other consequences of external causes (13.40%), and factors influencing health status and contact with health services (13.29%). Multivariate logistic stepwise regression showed that gender, age, surgery, ICD-10 disease category, critical illness status, admission condition, admission route, disease outcome, operation level, department transfer, discharge mode, and DRG relative weight (RW) were influencing factors for ultra-long hospital stay. Conclusion The actual situation and medical needs of patients should be fully considered. Measures such as preventive medicine, optimized medical processes, implementation of two-way referral, and strengthened hospital management should be comprehensively applied to shorten hospital stay on the premise of ensuring medical quality and patient safety.

Objective To explore the methods and pathways of disease-based cost accounting in TCM hospitals based on the expense-cost conversion method. Methods Cost-related data were collected, service units were reasonably set, the two-level allocation method was used to calculate department costs and service unit costs, the cost-expense ratio of service units was calculated, and expenses were converted into costs. Disease costs were calculated according to the expense data on the front page of medical records. Results The cost-expense ratios of 11 service units were obtained, and disease costs were calculated by taking DIP benchmark score diseases as examples. Conclusion The disease-based cost accounting method based on the expense-cost conversion method is operable and can provide a reference for the implementation of disease-based cost management in TCM hospitals.

Objective To explore the design and construction of a visual analysis system for disease-related costs. Methods Power BI was selected as the visual analysis tool. Data related to disease costs were collected, imported into Power BI to establish a data model and write measures. The visual interface was designed using Power BI Desktop to visually display the analysis results, and a complete visual analysis system for disease costs was constructed. Results The visual analysis system performed analysis and display from five perspectives: general overview, department cost analysis, DRG cost analysis, DIP cost analysis, and disease cost analysis. The system provided rich content and achieved excellent insight and analysis effects. Conclusion This study rapidly realized the construction of a visual analysis system for disease costs using Power BI. The system can effectively support refined management and decision-making.

Objective To investigate the completion quality of the front page of inpatient medical records in township and community health centers, so as to lay a solid foundation for DRG-based payment. Methods A total of 437 copies of the front page of inpatient medical records of discharged patients from 15 township and community health centers between January and February 2025 were randomly selected from the regional medical and health information system. Quality inspection was conducted in accordance with the 《Specifications for Completing Data on the Front Page of Inpatient Medical Records (2016 Edition)》, and scoring was performed according to the corresponding quality scoring criteria. Results The average score of the front page quality among the 15 institutions was 91.7. The highest score was 94.6 in Hospital A, and the lowest was 86.2 in Hospital O. The top five items with the highest error rates were coma time in patients with craniocerebral injury (98.9%), contact person relationship (47.4%), other diagnoses and coding (34.1%), household registration address and postal code (33.6%), and readmission plan within 31 days (28.6%). Conclusion The regional medical and health information system needs improvement, medical record administrators lack professional competence, and clinicians do not complete the front page standardizedly. Relevant departments can formulate measures from three aspects: system construction, personnel training and institutional improvement to effectively improve the data quality of the front page of inpatient medical records.

Objective To analyze the efficiency of health resource allocation under the regional development pattern of "One Cluster, Two Cores, Three Circles" in Shandong Province from 2019 to 2023, so as to provide a reference for optimizing health resource allocation. Methods The BCC model of data envelopment analysis was used for horizontal analysis of health resource allocation efficiency in Shandong Province in 2023; the Malmquist index model was adopted for vertical analysis of the efficiency from 2019 to 2023. Results The input and output of health resources in Shandong Province generally showed an upward trend from 2019 to 2023. In 2023, within the Shandong Peninsula Urban Agglomeration, Jinan, Dongying, Dezhou, Qingdao, Rizhao, Linyi and Heze achieved DEA efficiency with both pure technical efficiency and scale efficiency equal to 1; Zaozhuang and Jining showed weak DEA efficiency with one of the two efficiencies equal to 1; Zibo, Tai'an, Liaocheng, Binzhou, Yantai, Weifang and Weihai presented DEA inefficiency with both values less than 1. The average total factor productivity of health resource allocation in Shandong Province was 1.007 from 2019 to 2023, with an annual average increase of 0.70%, and the order was Jiaodong Economic Circle > Provincial Capital Economic Circle > Lunan Economic Circle. Conclusion In 2023, the total amount of health resources in the Shandong Peninsula Urban Agglomeration is large, but the overall allocation efficiency is not optimal, with inter‑regional and intra‑regional differences. From 2019 to 2023, the overall efficiency is basically stable with a slight increase, but problems such as urban efficiency differentiation, uneven technological progress and unbalanced regional development exist. These problems can be solved by optimizing regional layout, strengthening regional coordination and implementing differentiated regional strategies.

Objective To revise an evaluation index system for college students based on the national 《Guidelines for the Evaluation of Citizens’ Environmental and Health Literacy (for Trial Implementation)》, so as to better understand the level of environmental health literacy and its influencing factors among college students in Shandong Province, and put forward targeted countermeasures and suggestions. Methods Undergraduates from several universities in Shandong Province were selected by stratified multistage random sampling and investigated with a self-designed questionnaire. Descriptive statistics were used to analyze the data, expressed as mean ± standard deviation or frequency percentage. Differences between groups were tested by analysis of variance or chi-square test. Spearman rank correlation was used for correlation analysis, and regression analysis was conducted with environmental health literacy and its dimensions as dependent variables. All tests were two-sided, and P < 0.05 was considered statistically significant. Results A total of 1692 valid questionnaires were collected. The overall level of environmental health literacy among college students was above average but with several deficiencies. The performance of the five dimensions ranked from high to low as follows: attitude > awareness > knowledge > skills > behavior. Medical students scored significantly higher in knowledge than students of other majors (4.69 ± 0.57 vs 4.44 ± 0.68, P < 0.05). Conclusion The revised evaluation index system is applicable to the assessment of environmental health literacy among college students. Although the level of environmental health literacy of college students in Shandong Province is above average, it still needs to be improved. It is necessary to strengthen the cultivation of practical transformation ability for students majoring in hygiene-related fields.

Objective Based on domestic and international literature from 2000 to 2024, to systematically analyze the research status, hotspots and development trends in the field of mental health of visually impaired populations, so as to provide scientific evidence for mental health interventions for this group. Methods Relevant literature was retrieved from CNKI and Web of Science Core Collection from January 1, 2000 to December 31, 2024. CiteSpace 6.4.R1 was used for visual analysis of knowledge mapping, including countries, institutions, authors and keywords. Results A total of 367 Chinese articles and 1001 English articles were included, with an overall upward trend in publication volume. Among English literature, the United States ranked first in both publication volume and academic influence. The University of London was the core research institution, with collaborative teams represented by Lamoureux, Ecosse L and Van Nispen, Ruth M A. Among Chinese literature, He Kan was the most productive author, and the School of Special Education of Beijing Union University was the most productive institution. Keyword co-occurrence and cluster analysis showed that domestic studies mainly focused on visually impaired students under special education, with emphasis on their psychological adaptation and educational interventions. International studies tended to explore psychological problems such as depression and anxiety in elderly visually impaired individuals, analyze the mechanisms linking visual impairment and mental health, and develop targeted psychosocial interventions. Conclusion Research on mental health of visually impaired populations has shown an overall upward trend both in China and abroad, but the total number of studies and high-quality papers in China are insufficient. Future research should expand the scope of database retrieval, integrate quantitative and qualitative methods, further explore the mental health needs of visually impaired populations, and carry out precise interventions.