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{"title":"The importance of Naples prognostic score in predicting long-term mortality in heart failure patients.","authors":"Sidar Şiyar Aydın, Selim Aydemir, Murat Özmen, Emrah Aksakal, İbrahim Saraç, Faruk Aydınyılmaz, Onur Altınkaya, Oğuzhan Birdal, İbrahim Halil Tanboğa","doi":"10.1080/07853890.2024.2442536","DOIUrl":"10.1080/07853890.2024.2442536","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) remains a significant health problem despite advances in diagnosis and treatment options. Malnutrition and increased inflammation predict poor disease prognosis. The parameters of the Naples prognostic score (NPS) include albumin, total cholesterol, neutrophil-lymphocyte ratio (NLR), and lymphocyte-monocyte ratio (LMR). We aimed to assess the potential of NPS as a predictor of long-term mortality in patients with HF.</p><p><strong>Methods: </strong>A total of 1728 patients with HF who applied to our center between 2018 and 2022 were included in this study. The NPS was computed and the patients were divided into three groups according to their NPS values as follows: NPS = 0 (Group 1), NPS = 1-2 (Group 2), and NPS = 3-4 (Group 3). We also evaluated the association between NPS value and HF mortality.</p><p><strong>Results: </strong>The patients were followed for a mean follow-up duration of 30 months. The mortality rate was 8.3% (145 patients). We carried out Model-1 and -2 Cox regression analyses to identify long-term mortality determinants. Model-2 was constructed by adding NPS to Model-1. NPS was significantly associated with HF mortality (Hazard Ratio: 2.194, 95% Confidence Interval: 1.176-4.091, <i>p</i> = 0.014). According to the Kaplan-Meier plot and log-rank analyses, there was a statistically significant difference in the long-term mortality of patients with HF and their NPS values for the entire cohort.</p><p><strong>Conclusion: </strong>Based on our findings, NPS showed promise as an independent predictor of long-term mortality in individuals with HF.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2442536"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Gut in Critical Illness.","authors":"Jayshil J Patel, Mark Barash","doi":"10.1007/s11894-024-00954-4","DOIUrl":"10.1007/s11894-024-00954-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this narrative review is to describe the mechanisms for gut dysfunction during critical illness, outline hypotheses of gut-derived inflammation, and identify nutrition and non-nutritional therapies that have direct and indirect effects on preserving both epithelial barrier function and gut microbiota during critical illness.</p><p><strong>Recent findings: </strong>Clinical and animal model studies have demonstrated that critical illness pathophysiology and interventions breach epithelial barrier function and convert a normally commensal gut microbiome into a pathobiome. As a result, the gut has been postulated to be the \"motor\" of critical illness and numerous hypotheses have been put forward to explain how it contributes to systemic inflammation and drives multiple organ failure. Strategies to ameliorate gut dysfunction have focused on maintaining gut barrier function and promoting gut microbiota commensalism. The trajectory of critical illness may be closely related to gut epithelial barrier function, the gut microbiome and interventions that may contribute towards a deleterious pathobiome with immune dysregulation.</p>","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"27 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicenter pilot study of the effectiveness and safety of a monopolar radiofrequency device for improving periorbital and facial fine wrinkles.","authors":"Hee Joo Yang, Sun Young Choi, Joon Min Jung, Yoon-Seo Jo, Hye Sung Han, Young In Lee, Ju Hee Lee, Chong Hyun Won","doi":"10.1080/09546634.2025.2469633","DOIUrl":"10.1080/09546634.2025.2469633","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the effectiveness and safety of a new monopolar radiofrequency device equipped with a 5 cm² tip, against fine wrinkles around the eyes and cheeks.</p><p><strong>Materials and methods: </strong>This multicentered, prospective pilot study involved treating participants with mild-to-moderate wrinkles on both periorbital areas and cheeks using the monopolar radiofrequency device for one session. One and four months after treatment, wrinkle reduction, overall esthetic improvement, adverse events, and vital signs were evaluated.</p><p><strong>Results: </strong>The study involved 13 participants (age: 35-62 years) and on a five-point scale, periorbital wrinkles showed a significant reduction at 4 weeks (0.96 ± 0.65) and 16 weeks (1.04 ± 0.59). On a five-point scale, cheek wrinkles also decreased at weeks 4 and 16 (1.00 ± 0.55 and 1.12 ± 0.64, respectively). On a five-point scale (range: -1-3), overall global esthetic improvement was rated by the participants at weeks 4 and 16 to be 2.23 ± 0.80 and 2.31 ± 0.61, respectively. Adverse events were not observed during the follow-up.</p><p><strong>Conclusion: </strong>A single session using the new monopolar radiofrequency device equipped with a 5 cm² tip safely and effectively improves mild-to-moderate periorbital and facial wrinkles.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":"36 1","pages":"2469633"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive characterization of the molecular feature of T cells in laryngeal cancer: evidence from integrated single-cell and bulk RNA sequencing data using multiple machine learning approaches.","authors":"Jie Cui, Yangpeng Ou, Kai Yue, Yansheng Wu, Yuansheng Duan, Genglong Liu, Zhen Chen, Minghui Wei, Xudong Wang","doi":"10.1080/07853890.2025.2477287","DOIUrl":"10.1080/07853890.2025.2477287","url":null,"abstract":"<p><strong>Background: </strong>The clinical relevance of T cell-related molecules at single-cell resolution in laryngeal cancer (LC) has not been clarified.</p><p><strong>Materials and methods: </strong>Three LC tissues and matching adjoining normal tissues from the hospital were used to perform 10X single-cell RNA sequencing. Hub T cell-related genes (TCRGs) were detected by applying ten machine learning (ML) techniques based TCGA and GEO databases, which were also utilized to create a prediction model (TCRG classifier) and a multicenter validation model. Lastly, we conducted a comprehensive analysis of the TCRG's correlation with immunological properties.</p><p><strong>Results: </strong>The analysis of single-cell RNA-seq data revealed that T cells are the primary components of the tumor microenvironment (TME), are significantly involved in cell differentiation pathways, and play a considerable role in intercellular communication. Based on 10 ML approaches, TCRG classifier were identified to develop and validate. The TCRG classifier exhibited excellent prognostic values with a mean C-index of 0.66 in six cohorts, serving as an independent risk factor (<i>p</i> < 0.01). Additionally, the TCRG exhibited a significant relationship with immune score, immune cell infiltration, immune-associated pathways, immune checkpoint inhibitors, human leukocyte antigen, and immunogenicity. Lastly, IPS, TCIC, TIDE, and IMvigor210 cohort analysis illustrated that the immunotherapy response may be accurately predicted using TCRG.</p><p><strong>Conclusion: </strong>A TCRG classifier is an excellent resource for predicting a patient's prognosis, potentially guiding the preservation of laryngeal function, and identifying patients who may have a positive response to immunotherapy, which might have profound effects on therapeutic practice.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2477287"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"circKCNQ5 promotes the proliferation of DNA-methyltransferase 3A R882 mutated acute myeloid leukemia cells by elevating high-mobility group box 1 expression.","authors":"Yijian Chen, Xiaodan Zhu, Chuanming Lin, Rong Xu, Pengxiang Xu, Liuyan Xin, Lin Li, Liqun Zhang","doi":"10.1080/07853890.2025.2478309","DOIUrl":"10.1080/07853890.2025.2478309","url":null,"abstract":"<p><strong>Background: </strong>Patients with acute myeloid leukemia (AML) harboring the DNA-methyltransferase 3 A (DNMT3A) R882 mutation (DR882MUT) usually have a high recurrence rate and poor prognosis. circKCNQ5 levels were aberrantly elevated in patients with AML according to the microarray platform. Therefore, the purpose of this study is to investigate the effect and mechanism of circKCNQ5 on DR882MUT AML cell proliferation.</p><p><strong>Methods: </strong>A DR882MUT cell line model was established. circKCNQ5 expression in AML cells expressing wild-type DNMT3A (DNMT3A-WT) or DR882MUT was analyzed using RT-qPCR. The proliferation of DNMT3A-WT and DR882MUT AML cells after transfection was measured using a CCK-8 assay. High-mobility group box 1 (HMGB1) protein expression was assessed by western blotting. The regulatory mechanism of circKCNQ5 on HMGB1 expression was studied using RNA pull-down and co-immunoprecipitation assays.</p><p><strong>Results: </strong>circKCNQ5 expression increased gradually in HS-5, DNMT3A-WT, and DR882MUT AML cells. circKCNQ5 overexpression facilitated the proliferation of DNMT3A-WT KG-1a and HL-60 cells, whereas circKCNQ5 silencing blocked DR882MUT KG-1a and HL-60 cell proliferation. CircKCNQ5 interacts with HMGB1 and enhanced HMGB1 protein levels by inhibiting HMGB1 ubiquitination. HMGB1 protein levels increased gradually in HS-5, DNMT3A-WT, and DR882MUT AML cells. Furthermore, circKCNQ5 overexpression elevated HMGB1 protein levels in DNMT3A-WT KG-1a and HL-60 cells, whereas circKCNQ5 silencing reduced HMGB1 protein levels in DR882MUT KG-1a and HL-60 cells. HMGB1 overexpression remarkably increased the proliferative ability of DR882MUT KG-1a and HL-60 cells and circKCNQ5 silencing.</p><p><strong>Conclusions: </strong>These findings verified that circKCNQ5 promotes the proliferation of DR882MUT AML cells by increasing HMGB1 expression.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2478309"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term alveolar-capillary diffusion impairments after severe SARS-CoV-2 pneumonia.","authors":"Laura Pini, Jordan Giordani, Guido Levi, Michele Guerini, Simone Piva, Elena Peli, Manuela Violini, Stefano Piras, Yehia El Masri, Alessandro Pini, Dina Visca, Deodato Assanelli, Maria Lorenza Muiesan, Nicola Latronico, Claudio Tantucci","doi":"10.1080/07853890.2025.2483383","DOIUrl":"10.1080/07853890.2025.2483383","url":null,"abstract":"<p><strong>Background: </strong>Persistent respiratory symptoms and impaired gas exchange are common in patients recovering from COVID-19 pneumonia. The Lung Diffusing Capacity for Carbon Monoxide (DLCO) and Carbon Monoxide Transfer Coefficient (KCO) do not adequately distinguish alveolar membrane dysfunction from vascular abnormalities. This study aimed to characterize persistent diffusion impairment in post-ICU patients with prior SARS-CoV-2 pneumonia and reduced DLCO.</p><p><strong>Methods: </strong>After hospital discharge, patients underwent spirometry, DLCO measurement, and a 6-minute walking test every six months. If DLCO remained impaired at 18-24 months, a combined Lung Diffusing Capacity for Nitric Oxide (DLNO) and DLCO assessment was performed to differentiate alveolar-capillary membrane (DmCO) and pulmonary capillary blood volume (Vc) alterations.</p><p><strong>Results: </strong>Among 20 patients with persistent DLCO reduction, 3 had an obstructive ventilatory pattern, 6 had restriction, and 12 had low KCO. In restrictive cases, KCO was reduced but remained within normal limits without compensation. The DLNO/DLCO ratio exceeded 113.5% predicted in all patients. DmCO was impaired in 7 patients, while Vc was reduced in 16.</p><p><strong>Conclusion: </strong>Both DLCO determinants were affected, with vascular impairment predominating. Vc reduction was present in most patients, with mean values below the lower limit of normality, whereas DmCO was less affected and often normal. The elevated DLNO/DLCO ratio suggests that persistent DLCO reduction is primarily driven by prolonged pulmonary capillary circulation dysfunction rather than alveolar membrane alterations, highlighting the vascular component as the primary site of long-term impairment.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2483383"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of pathological sensitivity for high-risk, localized prostate cancer receiving neoadjuvant hormonal therapy combined with radical prostatectomy.","authors":"Kai Shi, Shouzhen Chen, Xueli Wang, Wenfu Wang, Yaofeng Zhu, Bo Han, Yong Wang, Benkang Shi","doi":"10.1080/07853890.2025.2485399","DOIUrl":"10.1080/07853890.2025.2485399","url":null,"abstract":"<p><strong>Objective: </strong>The exact factors influencing the prognosis of patients with prostate cancer (PCa) receiving neoadjuvant hormonal therapy (NHT) remain obscure. In our previous study, we proposed a new pathological response grading system for PCa using NHT. The aim of this study was to explore the potential prognostic value of this new system in high-risk and locally advanced PCa patients receiving NHT.</p><p><strong>Methods: </strong>We retrospectively analyzed 84 patients with high-risk locally advanced PCa. All patients received at least 3 months of NHT before radical prostatectomy (RP). The new pathological response system, the Qilu NHT pathological score (QNPS), has been described in our previous study. According to the QNPS, 84 patients were divided into two groups. 62 patients with good pathological reactions were grouped into the drug-sensitive (DS) group and 22 patients with poor pathological reactions were grouped into the drug-resistant (DR) group. Surgical outcomes and prognostic data were also analyzed.</p><p><strong>Results: </strong>Survival analysis of two groups showed that the overall survival (OS) and progression-free survival (PFS) of the DS group were both significantly longer than those of the DR group (<i>p</i> < 0.05). We further explored the prognostic values of preoperative clinical and pathological characteristics on the postoperative OS and PFS. Preoperative PSA level (<24.50 or >24.50, HR = 98.36, 95% CI 1.376-7030.033, <i>p</i> = 0.035), Gleason score (≤7 or ≥8, HR = 10.44, 95% CI 1.371-79.425, <i>p</i> = 0.024) and cribriform growth pattern were found to be associated with PFS but not OS in univariable analysis. In addition, surgical margins and ductal adenocarcinoma differentiation showed a statistically significant correlation with OS in both univariable analysis and multivariable analyses.</p><p><strong>Conclusions: </strong>The difference in pathological response of PCa patients to neoadjuvant hormonal therapy has an important influence on patient survival, and can be used as an indicator to evaluate the prognosis of PCa.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2485399"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of compound glycyrrhizin in patients with alopecia areata: a systematic review and meta-analysis.","authors":"Ming Li, Lujing Xiang, Yan Li","doi":"10.1080/07853890.2025.2491659","DOIUrl":"10.1080/07853890.2025.2491659","url":null,"abstract":"<p><strong>Background: </strong>Although compound glycyrrhizin (CG) has been widely used to alopecia areata (AA) in China, its efficacy and safety remain unclear. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of CG for AA.</p><p><strong>Materials and methods: </strong>Eight literature databases were retrieved from their inceptions to 29 February 2024 to identify the eligible randomized controlled trials comparing CG plus conventional treatments with conventional treatments alone for the treatment of AA. Risk ratio (RR), mean difference and 95% confidence interval (CI) were used to estimate the pooled results. RevMan 5.4 (Cochrane Collaboration, Copenhagen, Denmark) and Stata 12.0 software (StataCorp., College Station, TX) were used for statistical analysis.</p><p><strong>Results: </strong>A total of 23 eligible studies with 2219 patients were included. The pooled results revealed that CG plus conventional treatments was superior to conventional treatments alone in cure rate (RR = 1.60, 95%CI [1.47, 1.74], <i>p</i> < .001), total efficacy rate (RR = 1.37, 95%CI [1.29, 1.45], <i>p</i> < .001) and the Severity of Alopecia Tool (SALT) score, regardless of different conventional treatments, treatment courses and doses of CG. In terms of safety, a few patients suffered from adverse events (AEs), including oedema, elevated blood pressure and gastrointestinal tract discomfort, and the incidence of oedema was higher in the patients receiving CG (RR = 2.53, 95%CI [1.04, 6.19], <i>p</i> = .04).</p><p><strong>Conclusions: </strong>The combination of CG and conventional treatments was effective and safe for patients with AA, and CG could promote hair regrowth with mild AEs.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2491659"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators and barriers of alcohol goals for Latinx men hospitalized with alcohol use disorder seen by an Addiction Consult Team.","authors":"Mariam S Carson, Alein Y Haro-Ramos, Naomi López-Solano, Carla Fernandez, Marcus Cummins, Alicia Fernandez, Triveni DeFries, Marlene Martin","doi":"10.1080/07853890.2025.2453634","DOIUrl":"10.1080/07853890.2025.2453634","url":null,"abstract":"<p><strong>Introduction: </strong>Latinx individuals are disproportionately affected by alcohol use disorder (AUD). Understanding Latinx individuals' barriers and facilitators to reach AUD-related goals can help implement culturally and linguistically concordant interventions to improve alcohol-related outcomes.</p><p><strong>Methods: </strong>We conducted semi-structured qualitative interviews with Latinx, Spanish-speaking men with AUD within 20 weeks of hospital discharge who were seen by an addiction consult team during hospitalization in an urban, safety-net hospital in San Francisco. Interviews focused on the facilitators and barriers to participants' AUD-related goals pre-, during, and post-hospitalization. We recorded and transcribed interviews and used a mixed deductive and inductive analytic approach until we reached thematic saturation (<i>n</i> = 10).</p><p><strong>Results: </strong>We identified three major themes: 1. Hospitalization was an actionable moment for change; 2. Social factors were closely intertwined with AUD goals; and 3. Accessible addiction, physical health, and mental health services can help achieve AUD goals.</p><p><strong>Conclusions: </strong>Hospitalization may serve as a facilitator for Latinx individuals with AUD to achieve AUD goals. Addressing social determinants of health including housing, immigration status, and social support networks before, during, and after hospitalization, may help facilitate AUD goals. Providing language-concordant and accessible services may decrease barriers to achieving AUD goals.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2453634"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Workload-capacity imbalances and their impact on self-management complexity in patients with multimorbidity: a multicenter cross-sectional study.","authors":"Binyu Zhao, Yujia Fu, Jingjie Wu, Erxu Xue, Chuyang Lai, Dandan Chen, Qiwei Wu, Jianing Yu, Qiaoyu Wu, Zhihong Ye, Jing Shao","doi":"10.1080/07853890.2025.2451195","DOIUrl":"10.1080/07853890.2025.2451195","url":null,"abstract":"<p><strong>Introduction: </strong>Multimorbidity is increasing globally, emphasizing the need for effective self-management strategies. The Cumulative Complexity Model (CuCoM) offers a unique perspective on understanding self-management based on workload and capacity. This study aims to validate the CuCoM in multimorbid patients and identify tailored predictors of self-management.</p><p><strong>Methods: </strong>This multicenter cross-sectional survey recruited 1920 multimorbid patients in five primary health centres and four hospitals in China. The questionnaire assessed workload (drug intake, doctor visits and follow-up, disruption in life, and health problems), capacity (social, environmental, financial, physical, and psychological), and self-management. Data were analyzed using latent profile analysis, chi-square, multivariate linear regression, and network analysis.</p><p><strong>Results: </strong>d Patients were classified into four profiles: low workload-low capacity (10.2%), high workload-low capacity (7.5%), low workload-high capacity (64.6%), and high workload-high capacity (17.7%). Patients with low workload and high capacity exhibited better self-management (β = 0.271, <i>p</i> < 0.001), while those with high workload and low capacity exhibited poorer self-management (β=-0.187, <i>p</i> < 0.001). Social capacity was the strongest predictor for all profiles. Environmental capacity ranked second for 'high workload-high capacity' (R² = 3.26) and 'low workload-low capacity' (R² = 5.32) profiles. Financial capacity followed for the 'low workload-high capacity' profile (R² = 5.40), while psychological capacity was key in the 'high workload-low capacity' profile (R² = 6.40). In the network analysis, socioeconomic factors exhibited the central nodes (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Personalized interventions designed to increase capacity and reduce workload are essential for improving self-management in multimorbid patients. Upstream policies promoting health equity are also crucial for better self-management outcomes.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2451195"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}