全科医学教育发展研究中心
科研成果简报

1.《社会支持对护士工作绩效的影响：一个关于心理资本、组织文化的有调节的中介模型》发表在《蚌埠医学院学报》第1期第49卷。该研究探讨社会支持对护士工作绩效的影响及其作用机制。采用工作绩效量表、领悟社会支持量表、心理资本问卷和组织文化量表对某市4家医院共计900名在职临床护士进行调查。调查结果显示，社会支持、心理资本、组织文化与护士工作绩效均呈明显正相关关系(P<0.01);社会支持对护士工作绩效的总效应明显(P<0.01),社会支持通过心理资本对护士工作绩效影响的间接效应明显(95%CI不包含0),社会支持对护士工作绩效直接效应明显(P<0.01);社会支持、组织文化可明显正向预测心理资本(P<0.01),社会支持与组织文化的交互效应明显(P<0.01);简单斜率图显示，随着组织文化水平的提高，社会支持对心理资本的正向简单效应随之增强。组织文化调节效应标准得分的转折点为-1.638。社会支持可以直接正向预测护士工作绩效；心理资本可部分中介社会支持对护士工作绩效的影响；组织文化对社会支持通过心理资本影响护士工作绩效的中介过程起正向调节作用。社会支持对护士工作绩效的影响机制为有调节的中介效应。

2.《基于潜在剖面分析的乳腺癌术后化疗患者应对方式分型及其影响因素分析》发表在《中华全科医学》第2期第22卷。该研究分析乳腺癌术后化疗患者应对方式的潜在类别，探讨不同潜在类别的乳腺癌术后化疗患者应对方式的影响因素。选取安徽省三所医院共601例乳腺癌术后化疗患者为研究对象，采用简易应对问卷、知觉压力量表和领悟社会支持量表进行问卷调查。调查结果显示,乳腺癌术后化疗患者应对方式可以分为“消极组”(C1)、“积极组”(C2)、“高积极-高消极组”(C3)3种潜在类别；不同类别乳腺癌术后化疗患者应对方式在人均月收入和居住地、知觉压力和领悟社会支持得分上差异均有统计学意义(P<0.05);相对于“积极组”,领悟社会支持(OR=0.957,P<0.001)得分水平越高出现在“消极组”的可能性越小，知觉压力(OR=1.069,P<0.01)得分水平越高出现在“消极组”的可能性越大；相对于“积极组”,居住地为农村(OR=1.510,P<0.05)出现在“高积极-高消极组”的可能性较大，知觉压力(OR=1.097,P<0.001)得分水平越高出现在“高积极-高消极组”的可能性越大；相对于“消极组”,领悟社会支持(OR=1.043,P<0.001)得分水平越高出现在“高积极-高消极组”的可能性越大，人均月收入<3 000元(OR=0.431,P<0.05)出现在“高积极-高消极组”的可能性小。本研究识别出乳腺癌术后化疗患者3种应对方式的潜在类别，专业护理人员和健康教育工作者可根据其不同应对方式潜在类别的心理特征实施个性化心理干预。

3.《本科护生性格优势对学业成绩的影响：负性生活事件、社会支持及时间管理的多重中介效应》发表在《蚌埠医学院学报》第3期第49卷。该研究分析性格优势、负性生活事件、社会支持和时间管理对本科护生学业成绩的影响及其作用机制。采用一般资料表、中文长处问卷、青少年自评负性生活事件量表、青少年时间管理倾向量表、社会支持量表对安徽省五所护理本科院校1 300名护生进行调查。调查结果显示,本科护生学业成绩优秀357人（32.8%）,一般462人（42.5%）,较差237人（21.8%）,很差32人（2.9%）;性格优势均分为（3.54±0.38）分，时间管理均分为（3.36±0.40）分，负性生活事件总分为（26.16±22.45）分，社会支持总分为（36.00±5.73）分；不同学业成绩本科护生性格优势和时间管理各维度、负性生活事件的学习压力和适应维度、社会支持的主观支持维度得分差异有统计学意义（P<0.05）;logistic回归分析结果显示，生命力、意志力、时间监控观、学习压力、主观支持五个因子有统计学意义（P<0.05）;Mplus中介模型拟合指数为χ2=17.514,P<0.01,CFI=0.984,TLI=0.962,RMSEA=0.042,SRMR=0.079,模型各拟合指数良好，模型可以接受。较为突出的生命力和意志力品质、良好的时间管理技能、适当的学习压力、较多的同伴及家庭的支持等可促进护生学业成绩的提高。

4.《工作-家庭支持对护士心理健康的影响：生涯适应力与积极应对方式的链式中介作用》发表在《蚌埠医学院学报》第5期第49卷。该研究基于生涯建构理论和生涯适应模型，探讨工作-家庭支持与护士心理健康之间的关系以及生涯适应力与积极应对方式的链式中介作用。采用便利抽样法选取安徽省25所综合性医院护士674名作为研究对象。采用一般资料调查表、工作-家庭支持量表、生涯适应力量表、简易应对方式量表、心理健康量表对研究对象进行调查，构建并检验链式中介模型。调查结果显示,674名护士工作-家庭支持总分为(105.42±23.03)分；生涯适应力总分为(87.72±15.56)分；积极应对方式总分为(37.02±6.40)分；心理健康总分为(25.23±9.36)分。工作-家庭支持与生涯适应力和积极应对方式均呈明显正相关关系(P<0.01),与心理健康呈明显负相关关系(P<0.01);生涯适应力与积极应对方式呈明显正相关关系(P<0.01),与心理健康呈明显负相关关系(P<0.01);积极应对方式与心理健康呈明显负相关关系(P<0.01)。护士生涯适应力和积极应对方式在工作-家庭支持和心理健康之间起链式中介作用。护士心理健康受内外在因素影响，亟须开展多样化的心理服务，改善护士心理健康水平；护理管理者需不断增强护士生涯适应力，提高护士积极应对方式，尤其重视家庭与组织支持。

5.《积极老龄化视域下老年人心理健康现状与应对策略研究》发表在《牡丹江医学院学报》第2期第45卷。该研究调查老年人心理健康现状，分析其影响因素，在积极老龄化视域下探讨应对策略。为提升老年人总体心理健康水平提供科学依据，为实现积极老龄化提供理论基础。采用分层抽样的方法，抽取蚌埠市社区老年人(≥60岁)130人，采用自行设计的一般资料调查表和老年人心理健康自评工具进行面对面调查。调查结果显示，调查的老年对象心理健康总分为(48.85±8.61),其中有76名(58.5%)老年人存在轻度及以上的心理健康问题，中重度心理健康问题老年人36人(27.7%)。多元线性回归分析结果显示，经济保障、锻炼次数、手机使用熟练程度以及慢性病患病情况均是老年人心理健康状况影响因素。蚌埠市的老年人心理健康问题不容忽视，受经济保障、慢性病患病情况、锻炼次数以及手机使用的熟练程度的影响，应结合积极老龄化的人口学背景，重视老年人心理健康状况，从政策保障、社会引导、家庭支持以及自我调节多方面努力，提升老年人心理健康水平。

6.《老年人数字健康技术应用障碍影响因素分析》发表在《医学信息学杂志》第4期第45卷。该研究对老年人数字健康技术应用现状展开横断面调查，调查社区老年居民应用数字健康技术面临的障碍及其影响因素。采用便利抽样方法，对蚌埠市639名老年人展开调查，通过多元线性回归分析探讨数字健康技术应用障碍的影响因素并建立结构方程模型。调查结果显示,客观环境可通过设备障碍、社交支持、隐私保护间接影响老年人数字健康技术应用。

7.《绝经后女性不同部位骨密度及FRAX?预测值与BMI的相关性分析》发表在《蚌埠医学院学报》第2期第49卷。该研究探讨绝经后女性不同部位骨密度（BMD）及骨折风险评估工具（FRAX?）计算出的骨折风险与体质量指数（BMI）的相关性。选取蚌埠医科大学第一附属医院就诊并进行BMD检查的绝经后女性313例，收集研究对象的人口统计学资料及BMD相关信息，并应用FRAX?工具计算未来10年发生主要骨质疏松性骨折（脊椎、前臂、髋骨或肩部骨折）的概率（PMOF）和髋部骨折的概率（PHF）,分析FRAX?预测值与BMD和BMI的相关性，以及联合股骨颈T值的FRAX?预测值和不联合股骨颈T值的FRAX?预测值是否有差异。调查结果显示,腰椎、股骨颈、全髋的BMD随着BMI的增加而增加（P<0.01）;FRAX?预测值在联合股骨颈T值的情况下，随着BMI的增加，骨折风险逐渐下降（P<0.01）;未联合股骨颈T值的FRAX?预测值在BMI<28 kg/m2时，随着BMI的增加，骨折风险逐渐下降（P<0.05）,当BMI≥28 kg/m2时，骨折风险开始出现上升趋势（P<0.05）;在骨量减少人群中，难以筛选出骨折高危人群，FRAX?严重低估了发生主要骨质疏松性骨折的风险。体质量过低的人群BMD通常较低，使用FRAX?评估其发生骨折的风险相对较高。

8.《FRQ与MFS在绝经后骨质疏松症人群中的应用》发表在《中华全科医学》第5期第42卷。该研究比较跌倒风险自评表(FRQ)与Morse跌倒评估量表(MFS)在绝经后骨质疏松症(PMOP)人群中的应用价值，为该人群跌倒风险评估工具的选择提供参考。采用便利抽样法纳入蚌埠医科大学第一附属医院体检或就诊的193例PMOP患者作为研究对象，使用FRQ和MFS进行跌倒风险评估。根据随访期间是否跌倒分为跌倒组(32例)和未跌倒组(161例),通过ROC曲线、灵敏度、特异度及Bayes判别分析评价量表。调查结果显示,跌倒组FRQ和MFS量表得分均高于未跌倒组，差异有统计学意义(P<0.001);FRQ、MFS的AUC分别为0.865和0.737,差异有统计学意义(P=0.003);FRQ、MFS临界值分别为4分和40分时，约登指数分别为0.546和0.360,此时灵敏度分别为0.844和0.813,特异度分别为0.702和0.547,阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为0.360、0.958、2.830、0.223和0.263、0.936、1.792、0.343,交叉检验准确率分别为72.5%和60.6%。 FRQ与MFS均能有效预测PMOP人群的跌倒风险。与MFS相比，FRQ预测价值更高。

9.《恩格列净通过上调Epac1表达抑制炎症反应减轻2型糖尿病大鼠肾损伤》发表在《细胞与分子免疫学杂志》第2期第40卷。该研究观察恩格列净(EM)对2型糖尿病(T2DM)大鼠肾损伤的治疗效果，并探讨其可能存在的机制。将SD雄性大鼠随机分为正常对照(NC)组、 T2DM组和EM组，每组6只。T2DM组和EM组，给予腹腔注射链脲佐菌素(STZ)建立T2DM模型，记录各组大鼠空腹血糖(FBG)和体质量。EM组给予EM溶液灌胃，其余两组予以等量的羧甲基纤维素钠溶液灌胃，给药12周。记录大鼠体质量和FBG后处死大鼠，留存腹主动脉血液和肾脏组织。全自动生化分析仪检测血清肌酐(Scr)、血尿素氮(BUN)、尿酸(UA)、甘油三酯(TG)、总胆固醇(TC);行Masson染色、过碘酸希夫(PAS)染色、 HE染色观察肾脏组织学变化，透射电镜观察肾脏超微结构变化；免疫组织化学染色法检测大鼠肾脏组织中环磷酸腺苷直接激活的交换蛋白1(Epac1)、肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、白细胞介素18(IL-18)的表达和分布。结果显示,与NC组相比，T2DM组大鼠体质量下降，FBG、 Scr、 BUN、 UA、 TC、 TG水平明显升高；肾小球基底膜增厚，足细胞足突融合，排列紊乱，内皮细胞窗孔消失；Epac1蛋白表达水平下降，TNF-α、 IL-1β、 IL-18的蛋白表达水平明显增高。与T2DM组相比，EM组大鼠体质量上升，FBG、 Scr、 BUN、 UA、 TC、 TG水平降低；肾损伤减轻，Epac1蛋白表达水平升高，TNF-α、 IL-1β、 IL-18的表达显著降低。结论 EM能够改善T2DM肾损伤。这种治疗效果是通过上调Epac1蛋白表达，抑制炎症反应介导的。

10.《Resilience and Flexibility for Clinical Nurses: A Latent Class Analysis》收录于SCI期刊《Journal of nursing management》.To explore potential resilience and psychological flexibility patterns in nurses and analyze the effects of related factors such as growth mindset and professional recognition of categories. Resilience and psychological flexibility can help nurses resist occupational pressure and play essential roles in promoting personal growth and professional development. A latent category approach was used to examine the patterns of heterogeneity in resilience and flexibility among 805 nurses. Differences in the influences related to resilience and flexibility were analyzed using univariate and multivariate logistic regressions, with demographic information, growth mindset, and career recognition as covariates. Participants were divided into three potential categories: toughness-flexible (32.8%), power-deficit-emotional (23.1%), and toughness-rigid (44.1%). The results of multivariate logistic regression analysis showed that monthly income, mode of employment, growth mindset, and professional identity were influential factors in the potential categories of nurse resilience and flexibility. Conclusion. One cohort of nurses had high resilience and low flexibility, and psychological rigidity was related to the fact that the monthly income was less than RMB 5,000 and the contractual mode of employment. An excellent growth mindset and a high professional identity indicate that nurses are resilient and flexible. Implications for Nursing Management. Hospitals and nursing managers should pay attention to nurses' different career development needs and implement appropriate safeguards.

11.《Evaluation of Chinese HIV Mobile Apps by Researchers and Patients With HIV: Quality Evaluation Study》收录于SCI期刊《Jmir Mhealth And Uhealth》.Against the backdrop of globalization, China remains one of the most heavily burdened countries in Asia with regard to AIDS. However, many high -risk groups and patients affected by AIDS may be less likely to actively seek care from medical institutions because of fear of experiencing shame or discrimination. Mobile apps provide a promising avenue for supporting the prevention, diagnosis, and treatment of AIDS. However, a comprehensive systematic evaluation of these mobile apps' functionality and quality has not been conducted yet. This study aims to identify the available mobile apps for AIDS in China, assess and discuss the functional features and quality of these Chinese AIDS mobile apps, and offer decision support for patients and clinical practitioners in accessing high -quality AIDS mobile apps. Furthermore, based on the evaluation results, recommendations for improvement will be provided. A systematic search was conducted on the Qimai app data platform, the Aladdin WeChat applet data platform, and WeChat to identify mobile apps related to AIDS. A snowball sampling method was used to supplement the potentially overlooked apps. The selected mobile apps underwent a rigorous screening process based on unified criteria. Subsequently, assessments were independently undertaken by 3 separate researchers and 2 patients with HIV, using both the Mobile App Rating Scale (MARS) and the User Mobile App Rating Scale (uMARS). Quantitative interpretations of the data were facilitated by the MedCalc statistical software (version 20.217, MedCalc Software). A total of 2901 AIDS mobile apps were included in the study, with 2897 identified through information retrieval and an additional 4 added via snowball sampling. After a rigorous selection process, 21 apps were determined to be usable. Among them, the Hong Feng Wan app achieved the highest combined average score, calculated based on the MARS (3.96, SD 0.33) and uMARS (4.47, SD 0.26). Overall, there was no significant correlation between MARS and uMARS (rapp quality total score=0.41; P=.07; rsubjective quality=0.39; P=.08). A notable issue was the widespread lack of user privacy protection, with only 24% (5/21) of the apps offering this feature. The number of available Chinese AIDS mobile apps is limited, with WeChat applets dominating the market. Nonetheless, the performance of WeChat mini -apps is generally inferior to that of independent apps, and there may be significant discrepancies between assessments conducted by researchers and those provided by genuine end users, emphasizing the necessity of involving real users in the development and evaluation of HIV mobile apps. In addition, developers of these Chinese HIV mobile apps need to devote attention to improving privacy protection mechanisms, in addition to considering the evaluations of researchers and real users. This will help attract more users and increase user loyalty.

12.《Willingness to purchase institutionalised elderly services and influencing factors among Chinese older adults: a nationwide cross-sectional study》收录于SCI期刊《BMJ Open》.Objectives In view of the serious ageing of China's population and the low desire of elderly people to purchase institutionalised elderly care services, we explored the willingness of Chinese elderly people to purchase institutionalised elderly care services and its influencing factors.Design This was a cross-sectional study. Three multivariate logistic regression analysis models of the willingness of elderly people to purchase institutionalised elderly care services were established (model 1: 'reluctance - willingness'; model 2: 'reluctance - hesitation'; and model 3: 'hesitation - willingness') to explore the factors that influence elderly people's willingness to purchase institutionalised elderly care services.Setting This study was based on the 2022 Psychology and Behaviour Investigation of Chinese Residents database.Participants Research data from 4123 older adults who met the requirements of this study were screened from the database.Results Of the 4123 respondents, roughly equal numbers had negative and positive attitudes towards purchasing institutionalised senior care services (1125, 27.3% vs 1079, 26.2%, respectively), and 1919 (46.5%) had hesitant attitudes. The analysis of model 1 showed that medical insurance participation, the number of children and siblings, chronic diseases and per capita monthly household income had an influential effect on the willingness of elderly people to purchase institutional care. In model 2, we found that factors such as per capita monthly household income and anxiety led to hesitancy among older adults to purchase institutionalised senior care services. In model 3, we further found that social support and health literacy led to a shift from hesitation to willingness to purchase institutionalised elderly care services.Conclusion The number of children, number of siblings, per capita monthly income of the family, medical insurance participation, health status, health literacy and social support were found to be the main factors influencing the purchase of institutionalised care by elderly individuals.