To explore the network structures and gender differences of mental health literacy (MHL) and depressive/anxiety symptoms in maintenance hemodialysis (MHD) patients and identify core symptoms and bridge symptoms. We used convenience sampling to recruit 757 MHD patients from 6 hospitals in Sichuan Province, China. The Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the Chinese version of the Multidimensional Mental Health Literacy Scale (MMHL) were used for assessment. A network model was constructed, with centrality indicators and bridge strength calculated, network comparison tests and stability and accuracy tests were performed. The total score of MHL significantly negatively correlates with depressive symptoms (r = -0.22) and anxiety (r = -0.18). PHQ4 (Feeling tired or having little energy) and GAD4 (Trouble relaxing) showed higher strength centrality (1.205 and 1.184 respectively), while the strength of MHL2 (beliefs) was relatively high in the MHL cluster (0.546). In the bridge symptom analysis, the bridge strength of MHL2 (beliefs) was the highest (0.253), and PHQ3 (Trouble falling or staying asleep, or sleeping too much) was the key bridge symptom (0.143). Of note, significant difference was observed in the network structure between genders (p = 0.034). Our study mapped the complex interplay between MHL and depressive/anxiety symptoms in MHD patients. Fatigue is the core symptom, while the beliefs dimension of MHL and sleep problems are the key bridging symptoms. Future interventions should focus on fatigue, sleep, enhancing MHL knowledge, and reshaping positive beliefs, while considering gender-specific factors.

Pea protein isolate (PPI) is rich in essential amino acids and exhibits low allergenicity; nevertheless, its poor gelation performance constrains its use in gel-based systems. To overcome this limitation, this study introduced gelatin (GEL) to modify pea protein isolate and constructed a double-crosslinked composite hydrogel based on a plant-animal protein combination via transglutaminase (TGase). The effects of different GEL/PPI ratios on the structure, mechanical properties, thermal stability, and swelling behavior of the hydrogels were investigated. The results showed that TGase effectively mediated covalent cross-linking between GEL and PPI. As the proportion of PPI increased, the hardness, gel strength, fatigue resistance, and shape recovery of the hydrogels decreased. All hydrogels demonstrated a high water content (>80%), and the incorporation of GEL significantly enhanced the water-holding capacity. SEM observation revealed that the hydrogels displayed a honeycomb-like porous structure. With increasing PPI content, the pores became smaller, the pore walls thickened, and the structural density increased. TGA and DSC analyses indicated that all hydrogels possessed good thermal stability. The swelling capacity decreased with the introduction of PPI, and all gels conformed to the Schott second-order kinetic model. XRD patterns suggested that all gel samples were predominantly amorphous in structure. These findings demonstrate that double-crosslinked PPI can produce hydrogels with higher mechanical strength, water-holding capacity, and stability, thereby improving the functional properties of PPI. This study provides a theoretical basis for developing novel edible hydrogels.

This study aimed to examine factors associated with self-efficacy in individuals with stroke within a multidimensional framework. A total of 152 individuals with stroke were included in this cross-sectional observational study. Self-efficacy was assessed using the Daily Living Self-Efficacy Scale, functional independence using the Functional Independence Measure, participation using the Frenchay Activity Index, and fatigue using the Fatigue Severity Scale. Demographic and clinical data were also collected. Bivariate correlations and theory-driven hierarchical multiple linear regression analyses were conducted. The final model explained 46.9% of the variance in self-efficacy. Sex, education level, fatigue severity, and functional independence were identified as the factors most closely associated with self-efficacy, while age, stroke duration, employment status, and participation were not independently associated with self-efficacy in the final model. These findings indicate that self-efficacy after stroke is particularly related to functional independence and fatigue, while also reflecting the role of contextual characteristics such as sex and education. Addressing these factors may help guide rehabilitation approaches aimed at supporting self-efficacy in individuals with stroke.

Heart failure (HF) is a highly prevalent condition that contributes significantly to morbidity, mortality, and healthcare burden worldwide. In Portugal, the PORTHOS study estimated that 16.5% of adults aged 50 years and older have HF, underscoring the urgent need for earlier detection and optimized care pathways. N-terminal pro-B-type natriuretic peptide (NT-proBNP) has emerged as a key biomarker for HF screening, diagnosis, and prognosis. The recent reimbursement of NT-proBNP testing in Portuguese primary care represents a critical opportunity to enhance HF detection and management. This position paper provides evidence-based recommendations for clinical pathways following an elevated NT-proBNP result. We advocate for NT-proBNP measurement in individuals over 50 years old with diabetes, diuretic use, or symptoms such as fatigue, dyspnea or congestion. Age-specific cut-off values are recommended: ≥125 pg/mL for ages 50-79 and ≥250 pg/mL for those aged 80 and older. Confirmatory testing using echocardiography and electrocardiography is essential for diagnosis and management planning. Ensuring smooth transitions between primary and secondary care is vital to improving outcomes. We highlight challenges in continuity of care and emphasize the importance of multidisciplinary collaboration, along with the adoption of digital tools to strengthen communication. Integrating NT-proBNP testing into routine practice will enable earlier diagnosis, timely intervention, and more efficient healthcare delivery. A coordinated approach that combines clinical best practices, public health strategies, and active patient engagement is essential to reducing HF-related morbidity and mortality.

This comprehensive review explores nursing interventions and innovations in chemotherapy management, focusing on enhancing patient well-being through holistic and personalized care approaches. Nursing interventions play a critical role in managing physical symptoms associated with chemotherapy, such as nausea, vomiting, and fatigue, while also addressing the psychological aspects that impact patients' quality of life. This review was conducted by synthesizing findings from recent literature on nursing care in chemotherapy, focusing on interventions published between 2018 and June 2025. The review highlights the significance of education, support in nutrition and exercise, and the promotion of self-care strategies to foster patient independence and improve recovery outcomes. Innovations in drug delivery systems and personalized chemotherapy approaches have led to advancements in treatment efficacy and safety. The findings underscore the necessity for improved training and protocols to reduce medication errors and ensure optimal patient care while addressing challenges such as time toxicity and resource constraints. Overall, emphasizing a multifaceted approach in nursing interventions can greatly benefit patients undergoing chemotherapy.