iabetes is becoming a threat to global health (International Diabetes Federation, 2017). In China, type 2 diabetes mellitus (T2DM) accounts for approximately 87% to 91% of all types of diabetes, and the incidence of young patients is on the rise, which will be a heavy economic burden on patients and the country (Gao, 2006; Wang et al., 2017). Despite the regimen of oral medication and/or insulin for T2DM, successful blood glucose control relies more on patient selfmanagement, including diet, exercise, health education, and self-monitoring (Co et al., 2015; Hou, Li, Qiu, & Wang, 2014). However, unsuccessful blood glucose control remains a challenging problem among individuals with T2DM, due to morbidity, fi nancial income, family situation, and employment barriers, leading to poor self-management (Wang et al., 2012; Wu et al, 2011). Older adults comprise the largest population of individuals with T2DM. Due to their long disease history, more complex comorbidity, higher insulin resistance, lower educational level, and worse physical condition, it is diffi cult for older adults to maintain normal blood glucose levels (Tan et al., 2017). Hence, it is essential to fi nd alterna

Background: In recent years, disasters occurred frequently all over the world, and the role of nurses in public health emergencies and disaster emergencies was highlighted under the background of the covid19 epidemic. However, there was a lack of education and evaluation. Our study aims to cross-cultural adapt the Nurses' Perceptions of Disaster Core Competencies Scale (NPDCC) and evaluate the reliability and validity of the Chinese version.Methods: We translated the scale following the translation-integration-back translation-expert review procedure, adapted according to Chinese culture. We evaluated the reliability and validity of the scale, and a total sample of 911 nurse data from the Yangtze River Delta Regional Nursing Alliance Hospital was gathered.Results: The Chinese version of NPDCC included 45 items, 5 factors (critical thinking skills, special diagnostic skills, general diagnostic skills, technical skills, and communication skills) were extracted from the analysis, which could explain the 68.289% of the total variance. The content validity index was 0.925. The Cronbach's α of the total NPDCC score was 0.978, and 0.884-0.945 for every factor. The split-half for the scale was 0.930, and every factor was 0.861-0.894. Conclusions:The Chinese version of NPDCC has excellent reliability and validity, and it is suitable to measure nurses' perceptions of disaster core competencies in China. The next step is to promote the application in a large scale.

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Background Symptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have established networks of symptoms experienced by older patients on maintenance hemodialysis. Our goal was to examine the type of symptom clusters of older maintenance hemodialysis patients during dialysis and construct a symptom network to understand the symptom characteristics of this population. Methods The modified Dialysis Symptom Index was used for a cross-sectional survey. Network analysis was used to analyze the symptom network and node characteristics, and factor analysis was used to examine symptom clusters. Results A total of 167 participants were included in this study. The participants included 111 men and 56 women with a mean age of 70.05 ± 7.40. The symptom burdens with the highest scores were dry skin, dry mouth, itching, and trouble staying asleep. Five symptom clusters were obtained from exploratory factor analysis, of which the clusters with the most severe symptom burdens were the gastrointestinal discomfort symptom cluster, sleep disorder symptom cluster, skin discomfort symptom cluster, and mood symptom cluster. Based on centrality markers, it could be seen that feeling nervous and trouble staying asleep had the highest strength, and feeling nervous and feeling irritable had the highest closeness and betweenness. Conclusions Hemodialysis patients have a severe symptom burden and multiple symptom clusters. Dry skin, itching, and dry mouth are sentinel symptoms in the network model; feeling nervous and trouble staying asleep are core symptoms of patients; feeling nervous and feeling irritable are bridge symptoms in this symptom network model. Clinical staff can formulate precise and efficient symptom management protocols for patients by using the synergistic effects of symptoms in the symptom clusters based on sentinel symptoms, core symptoms, and bridge symptoms.

To explore exercise adherence and compliance as well as its related factors among elderly patients with type 2 diabetes mellitus (T2DM) to provide a basis for clinical intervention strategies. Patients and Methods:The present study was a cross-sectional study of 205 elderly patients with T2DM who regularly visited a Shanghai community health center from August 2020 to July 2021. Exercise adherence and compliance was measured using an exercise adherence and compliance questionnaire, and potential correlates were explored using multiple linear regression analysis. Results:The mean total score of the exercise adherence and compliance questionnaire was 16.72±5.08. The stepwise regression results revealed that exercise adherence and compliance was positively correlated with self-monitoring (F=3.510, P=0.005), exercise knowledge (r=0.784, P<0.001), exercise willingness (r=0.556, P<0.001), professional support (r=0.426, P<0.001), and self-efficiency (r=0.5, P<0.001). There was a negative correlation between hypoglycemia and exercise adherence and compliance (F=−3.672, P<0.001). Conclusion: Low exercise adherence and compliance was related to low glucose self-monitoring frequency, increased hypoglycemia, less exercise knowledge, less exercise willingness, less professional support, and less self-efficiency. When developing exercise instructions adapted to the cognitive and volitional needs of diabetic patients, it is essential to focus on their daily self-management habits and extrinsic motivation to improve exercise adherence and compliance.