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Aims: Dehydration is one of the common complications of dysphagia and poses significant risks including hospitalization and mortality, but the relationship between dysphagia and dehydration has received little attention. This study aims to determine the prevalence and risk factors for dehydration of patients with dysphagia in eastern China, and to provide reference for early identification and prevention of dehydration. Methods: A descriptive, cross‐sectional design was conducted. Three hundred and thirty‐seven (n = 337) patients with dysphagia participated in the study between August and December 2022. Information relating to participants' demographic variables, nutrition, cognition, functional, hydration status and fluid intake was collected. Univariate analysis was used to examine related impact factors, and then binary logistic regression analysis was conducted to determine reliable impact factors. Results: Among 337 patients with dysphagia, the average age was 63.47 ± 16.96, most participants were male (72.1%) and married (91.7%). The prevalence of dehydration was calculated to be 43.9%, the mean plasma osmolality score was 293.53 mmol/L. Diseases with the highest prevalence were stroke (78.3%), followed by hypertension (63.5%). The risk for dehydration increased with older age, usage of more medicines such as diuretics and beta‐blockers, worse functional status and lower fluid intake. Conclusion: This study found a high percentage of dehydration in patients with dysphagia. Findings can provide a basis for targeted nursing interventions for clinical prevention and treatment of dehydration. Summary statement: What is already known about this topic? Dehydration is one of the adverse consequences of dysphagia, and it causes physical stress to sufferers and enormous costs to the health care system.Previous studies have identified that personal factors (age, gender, health condition etc.), living environment, and social support may affect dehydration What this paper adds? Results showed high percentages of dehydration among patients with dysphagia; older age, greater use of medicines such as diuretics and beta‐blockers, worse functional status and lower fluid intake played a crucial role in hospital patients with dysphagia, leading to dehydration. The implications of this paper: This paper reveals prevalence and risk factors associated with dehydration of patients with dysphagia in hospital.Findings could provide reference data for development of nursing preventive interventions, to reduce the incidence of dehydration and improve the health level of patients. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the incidence of facial pressure injuries in health‐care professionals during the COVID‐19 pandemic in a meta‐analysis. Methods: Related studies were obtained through electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) Chinese Scientific Journal (VIP) China Biomedical Literature service systems (CBM) and Wanfang Data (from inception to 27 November 2021). The pooled incidence and the 95% confidence interval of facial pressure injuries were calculated with Review Manager v5.4 software. Results: Overall, 16 studies with 14 430 health‐care professionals were included. Pooled results showed that the pooled incidence of facial pressure injury in health‐care professionals was 58.8% (95% CI: 49.0%–68.7%; p < 0.01). The results of the subgroup analysis showed that the incidence of facial pressure injury in these staff was high, and predominantly stage I pressure injury, in the following cases: in health‐care professionals who wore personal protective equipment for longer than 4 h, in those without any training experience, and on the nose. Conclusion: Administrators and researchers should pay attention to preventing facial pressure injury related to the wearing of personal protective equipment (PPE) by ensuring all health‐care professionals receive training and by limiting prolonged periods of use. Summary statement: What is already known about this topic? Facial pressure injury was one of the most common effects experiencedby health‐care professionals wearing facial PPE during COVID‐19, which seriously affected their facial comfort and self‐image.A number of studies have reported the incidence of facial pressure injury in health‐care professionals, but the evidence is inconsistent.Medical staff are the main force during the COVID‐19. What this paper adds? This study showed that the pooled incidence of facial pressure injury in health‐care professionals was 56.8% during COVID‐19.This study showed that there was a higher incidence of facial pressure injury in staff who wore PPE for longer than 4 h and in those without any training experience.This study showed that the nose was the most common part of the face with pressure injury, and Stage I pressure injury was the most prevalent injury type in health‐care professionals. The implications of this paper: This study may provide evidence for managers about the development of guidelines for health‐care professionals to prevent and manage facial pressure injuries and promote the health of health‐care professionals. [ABSTRACT FROM AUTHOR]

Aims: This meta‐analysis aimed to synthesize the available evidence on the effectiveness of psychoeducational interventions on family function among families after stroke. Background: Family function may be improved by psychoeducational intervention, but findings about the effect of psychoeducation on family function among families after stroke have been mixed. Methods: This was a meta‐analysis carried out by searching five international electronic databases, including Cochrane Library, PubMed, EMBASE, Web of Science and CINAHL, as well as four national electronic databases, including Chinese Biological Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP and Wanfang. Two groups of researchers screened the studies independently, assessed the quality of the studies and extracted data. Meta‐analysis was performed by using the RevMan 5.3 software. Results: Five studies on psychoeducational interventions were included. Pooled analysis of these studies showed a small effect of the interventions on improving family function (WMD: −0.13, 95% CI: −0.24 to −0.01, P < 0.05). Subgroup analysis showed significant differences between the psychoeducation and control groups at 1 month postintervention (WMD: −0.12, 95% CI: −0.18 to −0.05, P < 0.05) and more than 6 months postintervention (WMD: −0.14, 95% CI: −0.24 to −0.04, P < 0.05). The psychoeducational interventions also had positive effect on improving the problem solving (WMD: −0.22, 95% CI: −0.14 to −0.03, P < 0.05) and communication (WMD: −0.23, 95% CI: −0.41 to −0.05, P < 0.05) functions of the family. There were significant differences in the group of dyad intervention (WMD: −0.14, 95% CI: −0.25 to −0.02, P < 0.05) and the group using face to face method (WMD: −0.58, 95% CI: −0.84 to −0.32, P < 0.05). Conclusions: Synthesized results demonstrated the favourable effect of psychoeducational interventions on the improvement of the family function among families after stroke, especially in terms of family problem solving and family communication. Future psychoeducational intervention research design should consider the combination of multiple intervention methods and the applicable population of intervention. Summary statement: What is already known about this topic? Good family function can promote the physical and mental health of family caregivers, improve the life quality of stroke survivors and lighten a heavy burden on the whole family.Family function may be improved by psychoeducational intervention, but findings about the effect of psychoeducation on family function among families after stroke have been mixed.What this paper adds? The psychoeducational intervention has a positive effect on family function among families after stroke, especially in terms of family problem solving and family communication.The implications of this paper: The psychoeducational intervention can be an acceptable method to improve family function among families after stroke. [ABSTRACT FROM AUTHOR]

Background: Zoomorphism, an obverse of conventional anthropomorphism, has been shown in many cases to be a powerful tool with respect to the metaphorical use of animals. Objectives: This study introduced zoomorphism into the instructional video design of pedagogical agents (PAs). Method: We first developed three image sets, each of which corresponded to a type of zoomorphic PA image construct (full panda, a human face with a panda body, and a human body with panda head imagery). Then, we conducted an image‐screening experiment in which 177 second‐grade students from a primary school were asked to select their favourite PA image for each image construct set. We used a realistic human PA as the baseline. Next, 114 second‐grade students from another school were randomly assigned to learn instructional videos on the topic of pandas using a PA with one of four imageries. Results and Conclusions: ANOVA and Kruskal–Wallis tests indicated that students presented with PAs with full‐panda imagery achieved significantly higher learning performance, learning experience, social presence, and learning interest than those presented with other imageries of PAs. The regression results showed that the effect of zoomorphic PAs with full‐panda imagery on learning performance was exerted in a direct way and that its effect on learning experience was mediated by social presence and learning interest. Implications: Our findings suggest that zoomorphic appearance is an essential quality for video learning that merits further investigation for the efficient imagery construction of PAs. Lay Description: What is already known about this topic: The inclusion of pedagogical agents with images that are attributed human qualities to animals known as anthropomorphism is very popular in multimedia education; however, the existing studies on the effects of such images on learning have shown inconsistent results. What this paper adds: We introduced the alternative philosophy of animal use‐zoomorphism, which is the obverse of anthropomorphism, into agent image building. Implications for practice and/or policy: Our study demonstrated that the zoomorphism of agent images increases learning performance and experience; thus, our findings suggest the prospect of zoomorphism in the development of agent image patterns. [ABSTRACT FROM AUTHOR]

Background: According to the World Population Outlook (2019), people over 65, usually accompanied by various chronic diseases, will make up 16% of the population in 2050. Therefore, the health problems of middle-aged and elderly people are becoming the focus of current global attention. Some scholars have found that the health of middle-aged and elderly people is related to the childhood socio-economic environment. Methods: Using the China Health and Retirement Longitudinal Study (CHARLS) data, this paper innovatively constructed four measurement dimensions of health (namely, self-rated health, physical health, emotional health, and mental health). Moreover, logistic regression was used to explore the impact of childhood socio-economic environment (such as parent's education level, work experience, etc.) on the health status of middle-aged and elderly people. Results: Compared with a poor childhood social-economic environment, a good childhood socio-economic environment is more advantageous to the self-rated health of middle-aged and elderly people, especially a childhood socio-economic environment close to the medium level; the psychological health of middle-aged and elderly people who have experienced an adverse childhood socio-economic environment was better than those who did not; the childhood socio-economic environment has no apparent impact on the cognitive situation of middle-aged and elderly people. Conclusions: Some policy implications can be drawn. For example, the government should vigorously introduce policies to help migrant workers' children receive education in cities and provide special education guarantees for migrant workers' children. Societies and families should also pay more attention to the childhood socio-economic environment. [ABSTRACT FROM AUTHOR]

Background: Elders' disability severity and caregiver health could predict elders' informal care time, but the mechanism by which the degree of disability in the elderly affects informal care time is unclear. Aim: The aim of this works is to explore the mediating roles of caregiver health and home‐based care quality between disability severity of elders and informal care time in far north‐western low‐income areas in China. Method: From September 2017 to February 2018, three hundred fifty‐two dyads of Kazakh disabled elders and informal caregivers in Xinjiang were interviewed. Structural equation modelling analyses were applied. Results: Significant positive correlations were observed between elders' disability severity and informal care time, caregiver health and informal care time, elders' disability severity and caregiver health. Significant negative correlations were observed between home‐based care quality and informal care time, elders' disability severity and home‐based care quality, caregiver health and home‐based care quality. Elders' disability severity had 71.94% direct effect on informal care time, 28.06% indirect effect on informal care time mediated by home‐based care quality and caregiver health. Conclusion: Caregiver health and home‐based care quality play mediating roles on the path relationship between the elders' disability severity and informal care time. Summary statement: What is already known about this topic? Elders' disability severity and caregiver health are critical factors that affect informal care time.The mechanism by which the degree of disability in the elderly affects informal care time is unclear. What this paper adds? Elders' disability severity is positively associated with caregiver health and negatively associated with home‐based care quality.The better home‐based care quality, the shorter the informal care time.Disabled elders' severity degree had a direct effect on informal care time and indirect effects on informal care time mediated by caregiver health and home‐based care quality. The implications of this paper: Community nurses, doctors and health care teams should provide medical services, nursing skills and knowledge for the dyads of disabled elders and informal caregivers and should provide emotional support for other family members to enable growth of the entire family in the process of long‐term care and to reduce informal care time.The government should attach great importance to the informal care time for disabled elders and propose specific informal care time cost compensation policies based on path relationships that influence informal care time. [ABSTRACT FROM AUTHOR]

Despite the prevalence of work teams in organizations, how newcomers become integrated into teams remains an understudied area. Drawing on research related to indirect social resources, in this paper we employ a social network perspective to examine how close teammates' friendship centrality can facilitate newcomers' adjustment by fostering the newcomers' own social capital in teams and promoting their subsequent task performance. Furthermore, our model incorporates institutionalized socialization tactics and political skill as two contingencies that can further strengthen the positive effects of indirect social resources on newcomers' adjustment. In a time‐lagged study using multiple sources of data, we found good support for our hypotheses. Specifically, close teammates' friendship centrality was positively related to newcomers' task performance through the mediating effect of newcomers' own friendship centrality in teams. The two moderators further strengthened this indirect effect. Overall, this study highlights the importance of "making the right friends" to facilitate newcomer adjustment into teams. [ABSTRACT FROM AUTHOR]

Aims: To investigate the efficacy of pre‐emptive remifentanil in alleviating pain during tracheal suctioning in patients under mechanical ventilation. Background: Goal‐directed sedation is recommended for patients under mechanical ventilation by the current guidelines. Whether goal‐directed sedation can prevent pain during tracheal suctioning in these patients is unknown. Design: This was a two‐centre, randomized, crossover, single‐blind trial conducted between August and October 2019. Methods: Patients under mechanical ventilation received low‐dose remifentanil, high‐dose remifentanil or placebo prior to each tracheal suctioning in a random order. The primary outcomes were evaluated using the critical‐care pain observation tool and Richmond agitation–sedation scale after tracheal suctioning. Adverse events were also documented. Results: A total of 39 patients who underwent 117 tracheal suctions were enrolled. After the tracheal suction, changes in the critical‐care pain observation tool and Richmond agitation–sedation scale scores were significantly lower in the low‐dose and high‐dose groups than in the placebo group (P < 0.001). A non‐significant increase in the absence of spontaneous breathing was observed in the high‐dose group compared to that in the placebo group. Conclusion: A pre‐emptive remifentanil bolus of 0.5 μg/kg can mitigate the pain associated with tracheal suctioning. SUMMARY STATEMENT: What is already known about this topic? Pre‐emptive analgesia is recommended by several guidelines to alleviate the pain associated with invasive and potentially painful procedures in ICU patients.Goal‐directed sedation can shorten the length of hospital stay and is recommended for patients in the ICU by several clinical practice guidelines.Literature regarding whether goal‐directed sedation management or pre‐emptive remifentanil can prevent the pain associated with tracheal suctioning in patients under mechanical ventilation is scarce. What this paper adds? A pre‐emptive remifentanil bolus of 0.5 μg/kg can mitigate the pain associated with tracheal suctioning. The implications of this paper: Normal opioid doses administered for goal‐directed sedation management might be insufficient to prevent the pain associated with tracheal suctioningPre‐emptive analgesia can alleviate the pain without increasing the risk of opioid‐related adverse events in ICU patients under mechanical ventilation. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion. Methods: This study was registered on International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023484937). We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Wei Pu Database by computer to collect controlled clinical studies on the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion from database establishment to November 2023. Two researchers screened the literature, extracted data and evaluated the risk of bias of the included studies, recorded the authors, and sample size, and extracted the intraoperative blood loss, operation time, Oswestry disability index (ODI), Visual analogue scale (VAS), disc height (DH), hospital length stay and complications in each study. Meta-analysis was performed using Revman 5.4 software provided by Cochrane Library. Results: A total of 6 cohort studies (CS) and 1 randomized controlled study with a total of 420 patients were included in this study, including 188 patients in the CBT group and 232 patients in the PS group. The CBT group had lower intraoperative blood loss than the PS group [mean difference (MD) = -129.38, 95% CI (-177.22, -81.55), P < 0.00001] and operation time was shorter than that of the PS group [MD = -1.42, 95% CI (-2.63, -0.20), P = 0.02]. Early postoperative back and leg pain improved more significantly in the CBT group [MD = -0.77, 95% CI (-1.35, -0.19), P = 0.01; MD = -0.24, 95% CI (-0.37, -0.10), P = 0.0005]. Conclusion: Compared with PS, CBT for adjacent segment degeneration after lumbar fusion has the advantages of less intraoperative blood loss, shorter operation time, and less back and leg pain in the early postoperative period. [ABSTRACT FROM AUTHOR]

Aim: To analyze the level of knowledge, attitudes, practices, and risk perception regarding COVID-19 among Chinese residents 1.5 years after the pandemic. Subject and methods: A cross-sectional study was carried out with both online and paper questionnaires. We included a variety of covariates that were characteristic-related factors such as age, gender, education level, and retirement status, as well as those closely associated with risk perception regarding COVID-19. Results: Participants (n = 3588), 53.49 ± 18.88 years old, from two provinces of China, of which 44.7% were male and 52.03% had a high school or greater level of education, answered the questions. More than 90% of participants had adequate background knowledge about COVID-19 and agreed or even strongly agreed with many attitude items related to the government's role in diagnosis, treatment, and dealing with COVID-19 infections. About three fifths of the participants reported fear of contracting COVID-19, but only a minority (18.63%) felt they were more susceptible than others. Respondents aged 45 years or younger were more likely to fear contracting the virus than those older than 45 years (adjusted OR = 1.464, 95% CI 1.196 to 1.794, P = 0.0002). High education level (adjusted OR = 1.503, 95% CI 1.187 to 1.904, P = 0.0007) and non-retired status (adjusted OR = 1.679, 95% CI 1.354 to 2.083, P < 0.0001) were associated with a higher perception of susceptibility to infection than others. Moreover, respondents who were not retired had a significantly reduced practice score (adjusted OR = 1.554, 95% CI 1.261 to 1.916, P < 0.0001). Age, retirement status, and education level were also associated with knowledge, attitude, and practice level. Conclusion: Our findings suggest that the public generally has trust in the COVID-19 vaccine and the government with regard to COVID-19 in China. We recommend that high-risk groups of communities, such as elders and patients with chronic diseases, be given greater consideration in the outbreaks. Health education campaigns combined with workplace preventive intervention should be aimed at improving COVID-19 knowledge and beliefs in order to encourage more optimistic attitudes and to maintain safe practices. [ABSTRACT FROM AUTHOR]

INTRODUCTION Healthcare workers are integral to public smoking cessation; however, their own smoking behavior can create a significant obstacle to intervening in patients' cessation efforts. Conversely, their success in quitting can enhance their ability to support patients. Research on smoking behavior, particularly smoking cessation among Chinese psychiatric professionals is limited. This study addresses this gap by examining the factors associated with smoking cessation in this population, providing insights for targeted tobacco control policies. METHODS A cross-sectional survey was conducted, targeting psychiatric professionals including psychiatrists and psychiatric nurses, in 41 tertiary psychiatric hospitals in China. From January to March 2021, a WeChat-based questionnaire was distributed to collect demographic, occupational, and health-behaviors (including smoking) data. Statistical analyses, including the chi-squared test and adjusted binary logistic regression analysis, were conducted to identify the factors associated with smoking cessation. RESULTS Among the 12762 psychiatric professionals who participated in the survey, 11104 (87.0%) were non-smokers, 1196 (9.4%) were current smokers, and 462 (3.6%) were ex-smokers. Several factors were found to be associated with smoking cessation. Women had a higher prevalence of ex-smokers than men (AOR=1.88; 95% CI: 1.332-2.666, p<0.001). Compared to East China, the prevalence of exsmokers among participants in Central and Northeast China was lower. Older age (≥50 years), higher level of education (Master's degree or higher), and non-drinkers, showed a higher likelihood of being ex-smokers. Notably, compared to current smokers, ex-smokers reported a lower prevalence of burnout (AOR=0.70; 95% CI: 0.552-0.892, p=0.004). CONCLUSIONS Smoking cessation interventions or health promotion programs should also focus on gender, age, education level, region, alcohol use, and burnout to effectively address smoking cessation within this specific professional group. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study examined the prevalence of tobacco exposure and drinking and ascertained the relationships between tobacco exposure, alcohol drinking, concurrent smoking and drinking, and hypertension in rural southwestern China. METHODS Data were collected from a cross-sectional health interview and examination survey, which included 7572 adults aged ≥35 years, in rural China. Participant demographic characteristics, smoking habits, exposure to secondhand smoke (SHS), and alcohol drinking habits were obtained using a standard questionnaire. Blood pressure (BP), height, weight, and waist circumference were measured for each participant. RESULTS The overall prevalence of smoking, SHS exposure, drinking, concurrent smoking and drinking, concurrent exposure to SHS and drinking, and hypertension was 37.7%, 27.4%, 16.2%, 12.6%, 1.6%, and 41.3%, respectively. Males had a significantly higher prevalence of smoking (74.1% vs 2.2%, p<0.01), drinking (31.1% vs 1.7%, p<0.01), and concurrent smoking and drinking than females (25.3% vs 0.3%, p<0.01). However, females had a higher prevalence of SHS exposure than males (30.2% vs 20.6%, p<0.01). Ethnic minorities had a higher prevalence of SHS exposure, drinking, and concurrent smoking and drinking, than Han participants (p<0.01). Participants with a higher education level had a higher prevalence of smoking, drinking, and concurrent smoking and drinking than their counterparts (p<0.01). In contrast, participants with a lower education level had a higher prevalence of SHS exposure than their counterparts (p<0.01). Multivariate logistic regression analysis found that smokers (AOR=1.31; 95% CI: 1.13-1.51), individuals exposed to SHS (AOR=1.24; 95% CI: 1.11-1.43), drinkers (AOR=1.31; 95%: CI: 1.15-1.50), and concurrent smokers and drinkers (AOR=1.45; 95% CI: 1.25-1.67) all had a higher probability of having hypertension (p<0.01). Additionally, concurrent smoking and drinking had the strongest association with the prevalence of hypertension (AOR=1.45; 95% CI: 1.25-1.67; p<0.01). CONCLUSIONS Socioeconomic factors play an important role in influencing the prevalence of smoking, exposure to SHS, and drinking in rural southwest China. Interventions to prevent and reduce hypertension should, in particular, focus on smokers, individuals exposed to SHS, drinkers, and, in particular, concurrent smokers and drinkers. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review and meta‐analysis aimed to determine the prevalence of loneliness and social isolation among informal carers of individuals with dementia and to identify potential influencing factors. Methods: We conducted a comprehensive search across 10 electronic databases, including PubMed, Cochrane, Embase, Web of Science, PsycINFO, CINAHL, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG. Our search strategy covered the inception of the databases up to September 16, 2023, with an updated search conducted on March 8, 2024. Prevalence estimates of loneliness and social isolation, presented with 95% confidence intervals, were synthesized through meta‐analysis. Subgroup analyses and meta‐regression were employed to explore potential moderating variables and heterogeneity. Results: The study encompassed 27 research papers involving 11,134 informal carers from 17 different countries. The pooled prevalence of loneliness among informal carers of individuals with dementia was 50.8% (95% CI: 41.8%–59.8%), while the pooled prevalence of social isolation was 37.1% (95% CI: 26.7%–47.6%). Subgroup analyses and meta‐regression indicated that various factors significantly influenced the prevalence of loneliness and social isolation. These factors included the caregiving setting, study design, the intensity of loneliness, geographical location (continent), data collection time, and the choice of assessment tools. Conclusions: This study underscores the substantial prevalence of loneliness and social isolation among informal carers of individuals with dementia. It suggests that policymakers and healthcare providers should prioritize the development of targeted interventions and support systems to alleviate loneliness and social isolation within this vulnerable population. Key points: Informal carers of people with dementia contend with unique circumstances that render them susceptible to both loneliness and social isolation.There is a significant prevalence of loneliness and social isolation in informal carers of individuals with dementia.Several significant moderators influence the prevalence of loneliness and social isolation among informal carers of individuals with dementia.Moderator analysis can guide targeted interventions and support systems for at‐risk informal carers of people with dementia to alleviate loneliness and social isolation. [ABSTRACT FROM AUTHOR]

Objective: This paper aimed to examine the longitudinal validity of self-rated health (SRH) and whether it would be affected by possible changes in evaluation standards (i.e., response shift) over time. Design: Data are from a longitudinal survey of a nationally representative sample in China. Analytical sample was restricted to respondents aged 45 and above (n = 15,893). Individual fixed effects models were used to analyze changes in ratings on health anchoring vignettes and self-rated health over time. Main outcome measures: SRH at two time points with a -two-year span. Results: Both SRH and anchoring vignettes ratings displayed changes over a two-year span for all the studied age groups. Compared with the self-assessed change in health ("How would you rate your health as compared to that of last year?"), changes in SRH reported over time displayed a more stable and optimistic pattern. SRH responded to doctor diagnosed chronic disease and changes in functional limitation, before and after adjusting for evaluation standards. Conclusion: SRH is responsive to the newly diagnosed chronic disease and functional limitation, regardless of whether we consider response shift within the same respondents over time. [ABSTRACT FROM AUTHOR]

Background: Limited data regarding the effects of school-based obesity prevention programs focusing on the changes in obesity-related knowledge and behaviors in China are available. The objective of this paper was to evaluate the effects of a school-based comprehensive lifestyle intervention among Chinese kids against obesity (CLICK-Obesity) in primary schools in Nanjing. Methods: We designed a cluster randomized controlled trial in eight randomly selected urban primary schools among 4th graders between May 2011 to April 2012 in Jianye, an urban district of Nanjing. Each school was randomly assigned to either the intervention or control group (four schools in each group). Mixed regression models and generalized estimating equations (GEE) were used to adjust for individual-level covariates under cluster randomization. Results: In this study, 1178 students (96.2%; 665 boys and 513 girls, 544 in control and 634 in intervention) participated in the baseline survey with mean age 10.2 ± 0.5 years. At the end of one-year intervention, 1125 students (91.8%; 628 boys and 497 girls, 513 in control and 612 in intervention) were reassessed. Notably, we found that the intervention group improved the knowledge and awareness of obesity-related risk factors, presented a lower increase of consumption of red/white meat (with a mean difference of −180.9 g/week, 95% CI: −350.6 to −11.2, p = 0.040), a larger increase in the time spent playing ball (with a mean difference of 24.2 min/week, 95% CI: −5.3 to 53.7, p = 0.090), and a significant reduction in screen time (with a mean difference of −71.0 min/week, 95% CI: −125.3 to −16.6, p = 0.020) compared to the control group after cluster (school) adjustment. Conclusion: The school-based integrated intervention was successful to modify unhealthy lifestyle behaviors and had a potential effect on childhood obesity prevention in urban China. However, the long-term effects and cost-effectiveness need to be evaluated in through further study. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Prior research has demonstrated that childhood trauma can increase adolescents' suicidal ideation, and perceived stress plays a mediating role in the relationship between childhood trauma and adolescents' suicidal ideation. Character strengths, which are trait‐like positive personality characteristics, have also been found to be closely related to decreased stress and suicidal ideation. However, it is unclear whether character strengths act as a transfer mechanism that links childhood traumatic experiences with perceived stress and eventually suicidal ideation. What the paper adds to existing knowledge?: This study found that character strengths and perceived stress serially mediated the association between childhood trauma and suicidal ideation. Specifically, childhood trauma was associated with inferior character strengths, and the impaired character strengths further triggered high perceived stress, which was finally linked to a heightened risk of suicidal ideation. This study provided important theoretical implications for preventing suicidal risk among adolescents who are exposed to traumatic events during childhood. What are the implications for practice?: This study highlighted the roles of character strengths and perceived stress in the relationship between childhood traumatic experiences and suicidal ideation, which provided suggestions for designing nursing interventions to reduce adolescents' suicidal ideation, especially for those with traumatic childhood experiences. In addition to family nursing, school‐based regular monitoring and interventions of character strengths and perceived stress are necessary. Aim: This study sought to examine the mediating effects of character strengths and perceived stress on the relationship between childhood trauma and suicidal ideation among adolescents. Methods: A cross‐sectional survey was conducted on a sample of 1069 Chinese adolescents. The Chinese versions of the Suicidal Ideation Scale, Childhood Trauma Questionnaire, Perceived Stress Scale and Character Scale for Adolescents were used to assess adolescents' suicidal ideation, childhood trauma, perceived stress and character strengths. Results: The findings showed that childhood trauma influenced suicidal ideation directly and indirectly via perceived stress. Moreover, character strengths and perceived stress serially mediated the association between childhood trauma and suicidal ideation, implying that childhood trauma was associated with inferior character strengths, and the impaired character strengths further triggered high perceived stress, which was finally linked to a heightened risk of suicidal ideation. Conclusions: This study highlighted the joint contribution of childhood trauma, character strengths and perceived stress to suicidal ideation, providing theoretical and practical implications to guide mental health nurses to reduce the suicide risk among adolescents. Implications for Practice: These findings highlighted the importance of developing character strengths and stress‐coping strategies. Family nursing and school‐based regular monitoring and interventions of character strengths and perceived stress are necessary among adolescents who exposed to a high level of childhood trauma experiences to reduce their suicidal ideation and foster mental health. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Recurrence is common in patients diagnosed with major depressive disorder (MDD). Psychological resilience has been shown to be a protective factor against recurrence of depression. It has important clinical nursing significance to analyse the influencing factors of psychological resilience in major depressive disorder in remission (MDDR) patients. What the paper adds to existing knowledge?: There are few previous studies on the influencing factors of psychological resilience in patients diagnosed with MDDR. We found the education levels, personal monthly income, social support, well‐being and self‐efficacy were influencing factors of psychological resilience in patients diagnosed with MDDR. What are the implications for practice?: According to the factors affecting the psychological resilience of patients diagnosed with MDDR, targeted clinical nursing is helpful to prevent the recurrence of depression. Nurses should strengthen the nursing of patients with <12 years of education, and patients with personal monthly income less than 5000 RMB. In addition, nurses should cultivate patients' awareness of social support and identity, cultivate their ability to strive for social support, cultivate interpersonal skills and positive emotional experience to improve subjective well‐being and carry out self‐efficacy training to improve psychological resilience by enhancing patients' internal protective factors. Aim: Psychological resilience is closely related to recurrence of depression. There are few previous studies on the influencing factors of psychological resilience in patients diagnosed with major depressive disorder in remission (MDDR). Here, we investigated the current status of resilience in patients diagnosed with MDDR and its influencing factors. Methods: A descriptive cross‐sectional study was conducted from June 2019 to April 2021. One hundred and forty‐two patients diagnosed with MDDR were recruited from the Department of Psychiatry and Psychology of the General Hospital of Northern Theater Command. Demographic information, social support, well‐being, self‐efficacy and psychological resilience were collected using self‐reported questionnaires. Results: The psychological resilience of MDDR patients was lower than that of the healthy Chinese adults in China. Multiple logistic regression analysis showed that education, personal monthly income, social support, well‐being and self‐efficacy were associated with psychological resilience. Receiver operating characteristic (ROC) curve analysis further confirmed that social support, well‐being and self‐efficacy were associated with psychological resilience. Conclusion: The psychological resilience of MDDR patients was lower than that of the general population in China. The education levels, personal monthly income, social support, well‐being and self‐efficacy were influencing factors of psychological resilience. Implications for Practice: According to the factors affecting the psychological resilience of patients diagnosed with MDDR, targeted clinical nursing is helpful to prevent the recurrence of depression. [ABSTRACT FROM AUTHOR]

Online medical consultation (OMC) is generating considerable interest among researchers and practitioners due to the mandatory quarantine measures implemented during the COVID-19 pandemic in China. However, the acceptance rate of OMC has declined over time. This paper aims to empirically investigate OMC acceptance using a proposed research model by integrating the technology acceptance model (TAM) with trust and its antecedent variables. A quantitative self-administered cross-sectional survey was conducted to collect data from 260 healthcare consumers. A partial least squares structural equation modeling method was used to examine the data. Results revealed that healthcare consumers' behavioral intention was influenced by attitudes, while perceived usefulness and trust significantly influenced behavioral intention through attitude as a mediator. In addition, perceived risk, perceived privacy protection, network externalities, cognitive reputation, and interactivity directly influenced trust. Overall, the research model explained 50% of the variance in attitude and 71% of the variance in behavioral intention. The study's findings should provide useful insights into making effective design, development, and implementation decisions for OMC services. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking is an independent and modifiable risk factor for the onset and development of psoriasis; however, evidence on the association between tobacco smoking and psoriasis treatment efficacy is limited. This study aimed to explore the influence of smoking on treatment efficacy in a cohort of patients with psoriasis in Shanghai, China. METHODS Patients with psoriasis were recruited from the Shanghai Skin Disease Hospital between 2021 and 2022. The treatment for patients with psoriasis includes acitretin, methotrexate, narrow-band ultraviolet/benvitimod, and biologics. Data were collected using a structured questionnaire, physical examination, and disease severity estimation at baseline, week four, and week eight. The achievement of a ≥75% reduction in psoriasis area and severity index (PASI75) score from baseline to week 8 was set as the primary outcome for treatment efficacy estimation. Data were analyzed using SAS 9.4. RESULTS A total of 560 patients with psoriasis were enrolled in this study, who were predominantly males (72.9%). The average age of patients was 48.4 years, and 38.8% of them were current smokers, 5.0% of them were former smokers. The median score of PASI among patients changed from 11.1 (interquartile range, IQR: 7.9-16.6) at baseline to 6.2 at week 4 and 3.1 at week 8, and 13.8% and 47.3% of patients with psoriasis achieved PASI75 at weeks 4 and 8, respectively. Logistic regression indicated that patients without tobacco smoking had a higher proportion of PASI75 achievement at week 8. The adjusted odds ratio (AOR) was 11.43 (95% CI: 6.91-18.89), 14.14 (95% CI: 8.27-24.20), and 3.05 (95% CI: 1.20-7.76) for non-smokers compared with smokers, current smokers, and former smokers, respectively. Moreover, former smokers had higher PASI75 achievement than current smokers (AOR=3.37), and patients with younger smoking initiation age, longer smoking duration, and higher smoking intensity had lower PASI75 achievement. CONCLUSIONS Tobacco smoking was negatively associated with PASI75 achievement both in current and former smokers, and former smokers had higher PASI75 achievement than current smokers. The implementation of tobacco control measures is beneficial for improving treatment responses. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking prevalence is high in China, and healthcare workers are important for tobacco control. This study aimed to determine the smoking status, cognition of tobacco hazards, and smoking cessation-related knowledge among respiratory healthcare workers, and to explore their ability to provide smoking cessation assistance. METHODS A cross-sectional study was conducted in 2021 among 1028 respiratory healthcare workers from 89 hospitals in Fujian Province, China. A self-designed electronic questionnaire was used to collect data on smoking status, knowledge of smoking hazards, and smoking cessation knowledge. Descriptive statistics were calculated for all questions. Logistic regression analysis was used to explore the relationship between awareness of the tobacco control goals of Healthy China 2030 and demographic characteristics. RESULTS Among the healthcare workers surveyed, 3.4% were smokers, all of whom were male. Most respondents (99.4%) were aware of smoking as a cause of lung cancer, but awareness of smoking as a cause of non-respiratory cancer was lower. The awareness rate of smoking cessation support was high (>90%), but only 40.0% of participants were aware of the Healthy China 2030 tobacco control targets. Male (HR=2.16; 95% CI: 1.69-2.80) and participation in the cessation clinic (HR=1.47; 95% CI: 1.10-1.96) were associated with higher awareness of the targets. CONCLUSIONS Respiratory healthcare workers in Fujian Province demonstrated a high level of awareness regarding behavioral and pharmacotherapy support for smoking cessation. In order to enable healthcare workers to play a more active role in tobacco control, there is a need to increase public awareness of smoking cessation services in Fujian Province. [ABSTRACT FROM AUTHOR]

The formation of information security behavioural intention (ISBI) can be complex and dynamic in different contexts. This paper aims to examine and compare different users' ISBI formalisation mechanisms when dealing with their personal affairs (non-work users) and organisational affairs (work users). Drawing on two principles of Conservation of Resources (COR) theory (i.e. resource loss principle, and resource gain principle), we developed two models to examine how situational support affects ISBI formation. The results of a study of 432 non-worker users and 261 work users indicate a curvilinear relationship between situational support and ISBI through subjective norms and risk perception for non-worker users, whilst a linear relationship via subjective norms is found for worker users. This is the first time that COR has been applied to explain the formation of ISBI. The findings broaden the research scope of individuals' ISBI by revealing how situational support affects the formalisation mechanism for different users in cross-contexts. The theoretical and practical implications of the findings and the future study are discussed. [ABSTRACT FROM AUTHOR]

INTRODUCTION Exposure to advertising is a determinant of electronic cigarette (e-cigarette) use among young adults. Few studies have explored the underlying mechanisms of advertising exposure on e-cigarette use among young Chinese adults. METHODS An online survey was administered to a sample of 2956 young adults (aged 20-34 years) who were never smokers, from April to May 2022, in China. Mediation analyses were used to test the mediating effects of curiosity and harm perception, and moderated mediation models were conducted to examine whether the relationships in mediation modeling vary across different levels of socioeconomic status (household income, education level, and residence). RESULTS Greater advertising exposure was associated with a higher likelihood of e-cigarette use (AOR=1.39; 95% CI: 1.26-1.54) and curiosity about e-cigarettes (AOR=1.33; 95% CI: 1.25-1.42), and the latter mediated the association between advertising exposure and e-cigarette use (proportion mediated=26.9%; 95% CI: 15.8%-40.7%) while harm perception did not. Additionally, the effect of advertising exposure on curiosity was moderated by household income (p=0.03) and residential area (p=0.001), and was stronger among participants with lower socioeconomic status. CONCLUSIONS E-cigarette advertising may promote young adults' experimentation by increasing their curiosity towards the products. Socially disadvantaged groups may be more susceptible to e-cigarette advertising. The study suggests that the government should explore options for better regulation of e-cigarettes to prevent initiation by never smokers and protect vulnerable populations. [ABSTRACT FROM AUTHOR]

Aim: Guided by the social embeddedness model of thriving at work, this paper explores how nursing organizational culture, work engagement and affective commitment affect nurses' thriving at work. Background: Thriving at work has implications for better employee and organization outcomes. The antecedents of thriving at work among the nursing population needs to be expanded by analysing the cross‐level impact of organizational and individual characteristics. Methods: A cross‐sectional design was used to collect data from 1437 frontline nurses in a tertiary teaching hospital in China between April and May 2020 through an online survey about perceived nursing culture, work engagement, affective commitment and thriving at work. Data were analysed using SPSS, and a structural equation model was established using the PROCESS macro. Results: Our results showed that work engagement and affective commitment mediated the relationship between nurses' perceived nursing culture and their thriving at work. Among nurses, work engagement was positively correlated to affective commitment. Conclusion: Our study confirmed the social embeddedness model of thriving at work by showing that both contextual and dispositional factors can influence nurses' thriving at work. Nurse leaders can foster nursing staff's thriving at work by building an inclusive work environment and by providing adequate resources to staff. Future research is needed to elaborate on employee and organizational outcomes associated with thriving at work. Impact: Nurse leaders should be the advocate for nurses to improve their organizational identification, fostering their thriving at work. Individual nurses can also take an active role in developing work‐related resources to sustain their thriving through self‐adaption processes. Collective thriving in the nursing workforce is needed to overcome adversity and hardship in the ever‐changing and increasingly demanding health care industry and to further contribute to the vitality of the broader social and public environments. Patient or public contribution: No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public. [ABSTRACT FROM AUTHOR]

Background WHO estimates that seasonal influenza epidemics result in three to five million cases of severe illness (hospitalisations) every year. We aimed to improve the understanding of influenza-associated hospitalisation estimates at a national and global level. Methods We performed a systematic literature review of English- and Chinese-language studies published between 1995 and 2020 estimating influenza-associated hospitalisation. We included a total of 127 studies (seven in Chinese) in the meta-analysis and analyzed their data using a logit-logistic regression model to understand the influence of five study factors and produce national and global estimates by age groups. The five study factors assessed were: 1) the method used to calculate the influenza-associated hospitalisation estimates (rateor time series regression-based), 2) the outcome measure (divided into three envelopes: narrow, medium, or wide), 3) whether every case was laboratory-confirmed or not, 4) whether the estimates were national or sub-national, 5) whether the rates were based on a single year or multiple years. Results The overall pooled influenza-associated hospitalisation rate was 40.5 (95% confidence interval (CI) = 24.3-67.4) per 100 000 persons, with rates varying substantially by age: 224.0 (95% CI = 118.8-420.0) in children aged 0-4 years and 96.8 (95% CI = 57.0-164.3) in the elderly aged >65 years. The overall pooled hospitalisation rates varied by calculation method; for all ages, the rates were significantly higher when they were based on rate-based methods or calculated on a single season and significantly lower when cases were laboratory-confirmed. The national hospitalisation rates (all ages) varied considerably, ranging from 11.7 (95% CI = 3.8-36.3) per 100 000 in New Zealand to 122.1 (95% CI = 41.5-358.4) per 100 000 in India (all age estimates). Conclusions Using the pooled global influenza-associated hospitalisation rate, we estimate that seasonal influenza epidemics result in 3.2 million cases of severe illness (hospitalisations) per annum. More extensive analyses are required to assess the influence of other factors on the estimates (e.g. vaccination and dominant virus (sub)types) and efforts to harmonize the methods should be encouraged. Our study highlights the high rates of influenza-associated hospitalisations in children aged 0-4 years and the elderly aged 65+ years. [ABSTRACT FROM AUTHOR]

Investigations have found maternal adverse childhood experiences (ACEs) cause an intergenerational danger to their children's health. However, no study has investigated the effects of maternal ACEs on behavioral problems of preschool children in China and gender differences on these effects. This paper aims to investigate the role of maternal ACEs on behavioral problems of preschool children in China and explore gender differences as related to these behavioral problems. Stratified cluster sampling method was used to select 7318 preschool children from 12 districts in Hefei city, China. A questionnaire survey was conducted to collect information on maternal exposure to ACEs and Conners' Parent Rating Scales. Logistic regression was used to analyze the relationship between maternal ACEs and children's behavioral problems. The prevalence of behavioral problems in preschool children was 16.0%, while it was higher among girls (18.4%) than boys (13.92%) (χ2 = 27.979, p < 0.001). The rate of behavioral problems in children in the group of mothers with ACEs was higher than those without ACEs (all p < 0.05). Maternal ACEs were associated with increased risk of the behavior problems in preschool children (adjusted OR 2.91, 95% CI 2.45–3.45), and no gender difference (in girls 3.01, 2.38–3.81, in boys 2.79, 2.17–3.58, respectively) was found. Maternal ACEs were associated with increased risk of each type of the behavioral problems of preschool children, except that maternal emotional neglect was not associated with psycho-physical problems, impulse-activities, and anxiety. The only gender differences found were higher conduct problems related to maternal emotional abuse and ACEs and higher anxiety related to maternal physical abuse and community violence in girls compared with boys. Mothers exposured to ACEs are more likely to have children with behavioral health problems in preschool period. Further research is needed to explore the mechanisms by which maternal ACEs influence children's behavioral problems. [ABSTRACT FROM AUTHOR]

Aim: This study aims to design a 100‐h training programme for nursing innovation teams and to evaluate the effect of this training programme using Kirkpatrick's model. Background: The innovative capability of nurses is a powerful driver for the development of the nursing discipline, and it is currently at a low to medium level in China. Innovation competency development has become a research trend in nurses' in‐service education, but only changes in nursing innovation behaviours before and after training have been evaluated. The cascading, continuous assessment tools are rarely used. Methods: This is a quasi‐experimental research design: pretest and posttest design. Totally, 61 clinical nurses from Hangzhou Hospital of Traditional Chinese Medicine were enrolled for innovation training. This innovation team training programme consisted of a 36‐h theoretical training phase and a 64‐h collaborative training phase. The four levels of Kirkpatrick's model, that is, reaction, learning, behaviour, and result, were applied for the evaluation together with questionnaires. Results: At reaction level, the nurses' attendance was over 85% in two phases. The differences between nurse organizational innovation climate scores of tested nurses before and after training were statistically significant (t = −22.559, P <.001). At learning level, there were statistically significant differences between nurses' innovation self‐efficacy scale scores of tested nurses before and after training (t = −16.832, P <.001). At behaviour level, the nursing innovation behaviour scale scores of tested nurses were significantly higher after training (t = −18.950, P <.001) than before the training. At result level, the clinical nurse innovation ability of tested nurses after the training were higher than before the training (t = −26.275, P <.001). The numbers of patent applications, granted patents, application for scientific research projects, sponsored scientific research projects, and papers published by team members after the training were larger than those before training (Z = −2.032, P =.042). Conclusion: Kirkpatrick's model can evaluate the effectiveness of nursing innovation training for clinical nurses. The nursing innovation training is beneficial to improve nurses' innovation capacity, organizational innovation climate and innovation self‐efficacy, and nursing innovation behaviour and promote the output of research and innovation projects. Implications for Nursing Management: Managers can flexibly develop training modules with regional characteristics based on this programme to effectively improve the innovation ability of clinical nurses, thus meeting the urgent demand for innovative nursing talents and the rapid development of nursing disciplines. [ABSTRACT FROM AUTHOR]

Individuals' gender development is influenced by the characteristics of personal and contextual environments. However, the role of sibling contexts in shaping gender norms has rarely been studied among Chinese youth at early adolescence as most of them were the only child. The aim of this paper is to compare perceived gender norms among adolescents aged 10–14 with different sibling configurations, to help inform and tailor guidance for sexual and reproductive health education in the future. We used the Global Early Adolescent Study baseline data collected from Shanghai, China. The sample for analysis was 1615 students. We used univariate analysis and multivariate ordinal logistic regression to compare perceived gender-stereotyped traits and gender role attitudes, stratified by age and sex. The results showed that sibling context was more influential for boys than girls at early adolescence in their gender socialization process. Among boys those who were with mixed-sex siblings scored higher on gender-stereotyped traits (ORonly-childvs. mixed-sex siblings = 0.67, 95% CI: 0.48–0.94, p = 0.019; ORsame-sex siblingsvs. mixed-sex siblings = 0.59, 95% CI: 0.37–0.96, p = 0.033). Younger early adolescents aged 10–12 who were the only child or who had mixed-sex siblings perceived more traditional gender role attitudes than those living with same-sex siblings (ORonly-childvs. same-sex siblings = 1.71, 95% CI: 1.06–2.75, p = 0.028; ORmixed-sex siblingsvs. same-sex siblings = 1.74, 95% CI: 1.03–2.94, p = 0.037). Comprehensive sexuality education with gender and power components being well addressed, both in and out of the family, is needed to provide extra gender-inclusive and gender-egalitarian environments for youth. [ABSTRACT FROM AUTHOR]

INTRODUCTION Managing chronic diseases and tobacco use is a formidable challenge in low- and middle-income countries (LMICs) with limited health literacy and access to quality healthcare. This study examines the empirical evidence from China, utilizing quasi-experimental approaches to assess the causal effect of chronic disease diagnoses on smoking behavior. METHODS Employing the diagnosis of chronic disease in the older cohorts of the population as a natural experiment, this study utilizes recent advancements in difference-in-difference estimation methods (CS-DID) to investigate the effect of a diagnosis on smoking behavior. Self-reported new diagnoses of conditions ascertained chronic disease diagnoses. CS-DID was run using the study sample from the 2011 to 2018 waves of the China Health and Retirement Longitudinal Study, comparing results with traditional two-way fixed effects and event-study models. RESULTS The average treatment effect (ATT) of CS-DID is slightly greater than the effects reported using conventional difference-in-difference methods. We found that diagnoses of cancer, heart disease, and stroke reduced smoking rates by 16% (95% CI: -24 -- -8), smoking intensity by 0.31 (95% CI: -0.46 -- -0.15), and had lasting impacts on smoking cessation behavior (one wave after diagnosis ATT= -0.17; 95% CI: -0.34 -- -0.00, two waves after diagnosis ATT= -0.17; 95% CI: -0.37--0.03). A diagnosis of a mild chronic disease, such as hypertension, diabetes, asthma, chronic lung disease, liver disease, or gastric disease, had more negligible and transient effects on smoking behavior. CONCLUSIONS Efforts to enhance smoking cessation in middle-aged and elderly patients with chronic diseases are crucial to improving health outcomes. The 'teachable moment' of chronic disease diagnosis should be seized to provide smoking cessation assistance to achieve the goal of healthy ageing. [ABSTRACT FROM AUTHOR]

INTRODUCTION Traditional Chinese medicine (TCM) may have special advantages in facilitating smoking cessation, but consensus on effectiveness is lacking. We aim to comprehensively review, update, and refine current evidence on TCM effectiveness and safety. METHODS Nine databases were searched from their inception up to 28 February 2023. Systematic reviews (SRs) and meta-analysis of TCM for smoking cessation were identified and retrieved. Additional databases and hand searches of RCTs from included SRs were performed for data pooling. Cochrane ROB tools and AMSTAR-2 were used to evaluate the methodological quality of RCTs and SRs, respectively. RCT data are presented as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CI) using RevMan 5.4. RESULTS Thirteen SRs involving 265 studies with 33081 participants were included. Among these 265 studies, 157 were duplicates (58.36%) and 52 were non-RCTs (19.62%). Combined with the remaining 56 RCTs identified through hand searches, 88 RCTs involving 12434 participants were finally included for data synthesis. All the SRs focused on acupoint stimulation, and the majority were of low or very low quality. The methodological quality of RCTs was either unclear or high risk. For continuous abstinence rate, TCM external interventions were better than placebo in 6 months to 1 year (RR=1.60; 95% CI: 1.14-2.25; I²=27%; n=5533 participants). Compared with placebo, TCM external application was effective in reducing nicotine withdrawal symptoms, and the effect was gradually stable and obvious in the fourth week (MD= -4.46; 95% CI: -5.43 -- -3.49; n=165 participants). Twelve RCTs reported adverse events as outcome indicators for safety evaluation, and no serious adverse events occurred. CONCLUSIONS Despite the methodological limitations of the original studies, our review suggests that TCM intervention shows potential effectiveness on the continuous abstinence rate. Extending the intervention time can enhance the effect of TCM on nicotine withdrawal symptoms. Referred to adverse events, more data for safety evaluation are required. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study investigated the relationship between environment support, social support and smoking cessation, to provide suggestions for the construction of environment and social support for tobacco control. METHODS This was a secondary analysis based on two cross-sectional surveys of adult smokers who participated in the six-month community smoking cessation intervention projects in Beijing. The study subjects were divided into a successful group (n=159) and an unsuccessful group (n=253). The status of the environment support, community tobacco exposure, and social support were compared between groups. A structural equation model (SEM) was established for Confirmatory Factor Analysis. RESULTS The univariate analysis showed that there were differences in smoking cessation outcomes among smokers with different home tobacco regulations, workplace tobacco regulations and number of smokers in the family. Differences in 6-month smoking reduction were also found with different promotion levels of anti-tobacco messaging and the frequency of smoking events at home. The logistic regression analysis indicated that home tobacco regulations (OR=1.30; 95% CI: 1.00-1.69), workplace tobacco regulations (OR=1.27; 95% CI: 1.05-1.54), and frequency of smoking events at home (OR=1.15; 95% CI: 1.02-1.29), were associated with smoking cessation. The results of the SEM showed that environment support (β=0.39; 95% CI: 0.05-0.73, p=0.026) and social support (β=0.37; 95% CI: 0.05-0.68, p=0.022) had influence on smoking cessation. CONCLUSIONS Environment support and social support are related to smoking cessation. Attention should be paid to the smoking regulations at home and workplace, anti-tobacco messaging, and social support by the family. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to investigate the prevalence, emotional and follow‐up burden of insulin injection‐related needle‐stick injuries among clinical nurses. Background: needle‐stick injures introduce statistically significant occupational hazards to healthcare workers. Although the large proportion of the needles injuries attributed to insulin injection, research evidence about the prevalence, emotional and follow‐up burden of such injures is lacking. Design: Cross‐sectional study. Methods: 5389 nurses were recruited from 45 hospitals in Shaanxi, China, from November 2018 to July 2019. Participants were administrated with a questionnaire specifically developed for this study. Descriptive statistics were used to present the findings. Results: All 5,389 nurses responded to the survey, of which 396 (7.4%) participants experienced 620 insulin injection‐related needle‐stick injuries in the past year, representing an annual prevalence of 115.0 per 1000 nurses. The annual prevalence of infection caused by the injuries was 18.7 per 1000 nurses. The injuries occurred most frequently when nurses were recapping the needle (42.4%). In the majority (98.4%) of the injuries, the hurt nurses took proper immediate actions. However, only 30.3% of nurses reported the injuries to the administrative staff, and in 43.2% of the injuries, the nurses refused or discontinued the suggested follow‐up. A large proportion (58.6%) of the hurt nurses experienced emotional changes. Multivariate logistic regression showed that department, removing and/or setting back needle caps with bare hands, frequency of insulin pen and syringes are associated with the incidence of insulin injection‐related needle‐stick injuries. This paper is reported following the STROBE recommendations. Conclusions: This survey demonstrated a considerably high prevalence of insulin injection‐related needle‐stick injuries among clinical nurses. Even though the majority of the hurt nurses took proper immediate actions, a large quantity of them failed to report the accidents to the administrative staff and complete the suggested follow‐up. Nurses who suffered from insulin injection‐related needle‐stick injuries were subject to various negative emotional changes. It portends a statistically significant risk to occupational health management for nurses. Relevance to clinical practice: Scientific preventive and management strategies are desirable in order to minimize the consequences of insulin injection‐related needle‐stick injuries. [ABSTRACT FROM AUTHOR]

INTRODUCTION The World Health Organization recommends banning all forms of e-cigarette advertising, promotion, and sponsorship. The aims of the present study were to: 1) examine young people's exposure to e-cigarette advertising across a wide range of media in four diverse countries; and 2) identify any association between the number of different types of media exposures and e-cigarette use. METHODS A cross-sectional online survey was administered to approximately 1000 people aged 15-30 years in Australia, China, India, and the United Kingdom (n=4107). The survey assessed demographic characteristics, e-cigarette and tobacco use, numbers of friends and family members who vape, and exposure to multiple forms of e-cigarette advertising (e.g. television, radio, print, and various types of social media). Descriptive analyses were conducted on those who had heard of e-cigarettes (n=3095, significance threshold p<0.001) and a logistic regression analysis was used to identify factors associated with e-cigarette ever use (significance threshold p<0.05). RESULTS The majority (85%) of respondents who had heard of e-cigarettes reported being exposed to e-cigarette advertising on at least one type of media, and the average number of types of media to which respondents were exposed was 5 (range: 0-17). The number of media types was significantly associated with ever use of e-cigarettes (OR=1.05; 95% CI: 1.02-1.08, p=0.001). CONCLUSIONS Despite advertising restrictions in place in all four countries, large majorities of young people reported being exposed to e-cigarette advertising. Social media and advertising on/around vape shops and other retailers appear to be key exposure locations. Urgent attention is needed to address these forms of exposure given their apparent association with e-cigarette use. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study comprehensively assessed the association between eight metabolites of urinary nicotine and cognitive impairment. METHODS This cross-sectional study was based on the data of Shenzhen Aging Related Disorder Cohort (SADC), including 51 elderly community data variables such as demographic characteristics, neuropsychological assessment and environmental factors, from July 2017 to November 2018. Participant's cognitive function was assessed by Mini-Mental State Examination (MMSE) scale and urinary nicotine metabolite [including cotinine N-β-D-glucuronide (CotGluc), rac 4-hydroxy-4-(3-pyridyl) butanoic acid dicyclohexylamine salt (HyPyBut), trans-3'-hydroxy cotinine O-β-D-glucuronide (OHCotGluc), and cotinine (Cot), etc.] concentrations were measured by high-performance liquid chromatographytandem mass spectrometry (LC-MS/MS). Generalized linear models and restricted cubic spline models were used to explore the relationships between the urinary levels of nicotine metabolite and cognitive function. RESULTS A total of 296 individuals aged >60 years were included. Individuals in the third quartile of CotGluc had a 0.786 point (95% CI: -1.244 -- -0.329) decrease or in the highest quartile of OHCotGluc had a 0.804 point (95% CI: -1.330 -- -0.278) decreased in attention and calculation compared to those in the lowest quartile (all p for trend <0.05). Compared with those in the lowest quartile, individuals in the highest quartile of CotGluc, HyPyBut, OHCotGluc and Cot, respectively, corresponded to a 1.043 point (95% CI: -2.269-0.182), 1.101 points (95% CI: -2.391-0.188), 2.318 points (95% CI: -3.615 -- -1.020), and 1.460 points (95% CI: -2.726 -- -0.194) decreased in MMSE total score (all p for trend <0.05). A nonlinear dose-response relationship between urinary levels of CotGluc, HyPyBut, OHCotGluc or Cot and cognitive function (all overall p<0.05, non-linear p<0.05). Subgroup analysis showed that urinary levels of CotGluc, OHCotGluc or Cot were significantly negatively associated with cognitive function (all p for trend <0.05) among females and non-smokers. CONCLUSIONS The findings highlight the public health implications of environmental tobacco smoke exposure, and effective interventions need to be performed for vulnerable populations. [ABSTRACT FROM AUTHOR]

INTRODUCTION The widespread popularity of e-cigarettes is considered an important public health concern. However, only some studies have investigated the prevalence of e-cigarette use in Shanghai, China. Research on the perceived harmfulness of e-cigarettes and public support for e-cigarette regulations in China is limited. This study aimed to estimate e-cigarette awareness, prevalence, and associated factors among adults in Shanghai, China. METHODS This study used data from a representative survey conducted in Shanghai, China, in 2019. The survey was conducted at 64 surveillance points in Shanghai, China, using a multistage, stratified, cluster-randomized sampling design, recruiting community-based Chinese adults aged ≥15 years. Based on the principles outlined in the Global Adult Tobacco Survey (GATS) China Project, data were collected by conducting face-to-face interviews in households. Of the 3200 selected households, 3060 people completed the individual survey. The overall response rate was 97.4%. RESULTS In all, 72.3% of the respondents had heard of e-cigarettes. The respondents who had used e-cigarettes at some point in their life, used them in the last 12 months, and used them currently were 5.8%, 2.6%, and 1.3%, respectively. Among adult residents who had heard of e-cigarettes, 38.2% thought they were less harmful than traditional cigarettes. The respondents who perceived e-cigarettes as more harmful than traditional cigarettes were less likely to have ever used e-cigarettes (AOR=0.2; 95% CI: 0.1--0.5, p=0.0015) and more likely to support incorporating e-cigarettes into the regulation of smoking control (AOR=3.9; 95% CI: 1.8--8.6, p=0.0008). CONCLUSIONS Our findings reveal that the awareness about e-cigarettes was high, and the prevalence of e-cigarette use was similar to the findings from previous studies in China. The harmful perception of e-cigarettes warrants further attention from public health practitioners. [ABSTRACT FROM AUTHOR]

INTRODUCTION The Shenzhen government is widely considered to be most efficiently implementing smoke-free legislation in China. We evaluated and compared the impact of Shenzhen's two-phase smoke-free regulation on the incidence rates for ischemic and hemorrhagic stroke. METHODS An interrupted time series design was used to capture immediate and annual incidence changes from 2007 to 2016 for both ischemic and hemorrhagic stroke due to two-phase smoke-free regulation in Shenzhen, China, by using a generalized additive model. The first phase, implemented on 9 March 2010, required five main public places to be smoke-free. In the second phase, the comprehensive law was expanded to the whole city on 1 March 2014. RESULTS The regulation implementation during phase I was associated with a strong immediate decline in the incidence rate of ischemic stroke (-14.2%, 95% CI: -19.6 -- -8.4) and hemorrhagic stroke (-10.1%, 95% CI: -18.2 -- -1.2), but without showing the annual changes (p>0.05). Following the implementation of the comprehensive law, the gradual annual effect showed a significant change in ischemic stroke, with a 6.3% (95% CI: 8.9 -- -3.6) reduction. Neither the immediate nor gradual decreases in hemorrhagic stroke incidences associated with the comprehensive regulation were statistically significant during phase II (p>0.05). Subgroup analyses indicate that a much larger health effect of the regulation during phase I was greater among those aged ≥65 years than among those aged 35--64 years. CONCLUSIONS Shenzhen's two-phase smoke-free regulation was well implemented. Even though the regulation did not extend to the whole city, the immediate health benefits on the incidence rates of ischemic stroke and hemorrhagic stroke could be seen. However, the health benefits brought by the implementation of comprehensive smoke-free legislation were attenuated by previous smoke-free regulations in five main public places, which were more evident in hemorrhagic stroke. [ABSTRACT FROM AUTHOR]

Background: As a common social phenomenon, nurses' occupational burnout has a high incidence rate, which seriously affects their mental health and nursing level. The current assessment mostly uses the total score model and explores the influence of external factors on burnout, while the correlation between burnout items or dimensions is less explored. Ignoring the correlation between the items or dimensions may result in a limited understanding of nurse occupational burnout. This paper explores the item and dimension network structure of the Maslach Burnout Inventory-General Survey (MBI-GS) in Chinese nurses, so as to gain a deeper understanding of this psychological construct and identify potential targets for clinical intervention. Methods: A total of 493 Chinese nurses were recruited by cluster sampling. All participants were invited to complete the survey on symptoms of burnout. Network analysis was used to investigate the item network of MBI-GS. In addition, community detection was used to explore the communities of MBI-GS, and then network analysis was used to investigate the dimension network of MBI-GS based on the results of community detection. Regularized partial correlation and non-regularized partial correlation were used to describe the association between different nodes of the item network and dimension network, respectively. Expected influence and predictability were used to describe the relative importance and the controllability of nodes in both the item and dimension networks. Results: In the item network, most of the strongly correlated edges were in the same dimension of emotional exhaustion (E), cynicism (C) and reduced professional efficacy (R), respectively. E5 (Item 5 of emotional exhaustion, the same below) "I feel burned out from my work", C1 "I have become more callous toward work since I took this job", and R3 "In my opinion, I am good at my job" had the highest expected influence (z-scores = 0.99, 0.81 and 0.94, respectively), indicating theirs highest importance in the network. E1 "I feel emotionally drained from my work" and E5 had the highest predictability (E1 = 0.74, E5 = 0.74). It shows that these two nodes can be interpreted by their internal neighbors to the greatest extent and have the highest controllability in the network. The spinglass algorithm and walktrap algorithm obtained exactly the same three communities, which are consistent with the original dimensions of MBI-GS. In the dimension network, the emotional exhaustion dimension was closely related to the cynicism dimension (weight = 0.65). Conclusions: The network model is a useful tool to study burnout in Chinese nurses. This study explores the item and domain network structure of nurse burnout from the network perspective. By calculating the relevant indicators, we found that E5, C1, and R3 were the most central nodes in the item network and cynicism was the central node in the domain network, suggesting that interventions aimed at E5, C1, R3 and cynicism might decrease the overall burnout level of Chinese nurses to the greatest extent. This study provides potential targets and a new way of thinking for the intervention of nurse burnout, which can be explored and verified in clinical practice. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study aimed to investigate the impact of smoking on physical activity level, emotional status, and cardiopulmonary endurance in healthy young Chinese college students in order to develop future nicotine dependence management solutions. METHODS This survey-based study was conducted in college students aged 19-26 years who were currently smoking. Cardio-respiratory endurance was assessed by estimating VO2max. Participants were given a questionnaire containing five factors from the Cigarette Dependence Scale-5 (CDS-5), also assessed were variables for physical activity level, using the Global Physical Activity Questionnaire (GPAQ), and emotional status. The sports training behavior was assessed using the Coaching Behavior Scale for Sport (CBS-S). RESULTS A total of 400 participants were randomly selected and included in the study. All of them were current smokers. The highest percentage of participants had a score of 4 on the CDS-5 (n=93, 23.2%), scored 3-5 on each module of sports training, and experienced negative emotions, particularly depression (n=172; 43.0%) and anger (n=162; 40.5%). VO2max levels were significantly lower in participants with high nicotine dependence (CDS-5 score 4-5), and they correlated negatively with CDS-5 scores (r= -0.883, p<0.001). Nicotine dependence scores were negatively correlated with physical activity levels (r= -0.830, p<0.001), and high nicotine dependence scores were independently related to low physical activity (adjusted odds ratio, AOR=14.66; 95% CI: 4.98- 43.19, p<0.001). CONCLUSIONS Tobacco smoking has a negative impact on emotional status. It also reduces cardiopulmonary endurance by reducing VO2max levels and negatively affects physical activity. Accordingly, it is critical to implement effective tobacco prevention programs for college students, such as a smoking warning system and physical exercise training, as well as to educate them on how to quit smoking. [ABSTRACT FROM AUTHOR]

What is known on the subject?Distress screening amongst FGs is emphasized in worldwide studies, but existing general tools were found time‐consuming and sometimes inconvenient when using them amongst FGs of patients diagnosed with schizophrenia.The DT, a single‐item scale, was widely used to detect distress amongst FGs of cancer patients, showing good reliability, validity and discrimination power.The 21‐item Depression Anxiety and Stress Scale (DASS21) can identify distress in the general population and serve as a criterion to determine an optimal cut‐off score of the DT. What does the paper add to existing knowledge?: The DT presented good reliability, validity and discriminatory power amongst FGs of adults diagnosed with schizophrenia. A cut‐off score of six maximized sensitivity (77%) and specificity (76%). Over half of the FGs of adults diagnosed with schizophrenia reached this cut‐off score and experienced significant distress. Distress was higher in FGs of male patients, when FGs were parents, and for FGs whose educational background was primary school or below. What are the implications for practice?: The DT is an effective alternative to existing instruments in identifying distressed FGs of adults diagnosed with schizophrenia. It is important to provide FGs with distress screening programmes and interventions (e.g. skill‐building psychoeducation) to identify and relieve distress. In addition, future research could explore brief measures to simultaneously recognize potential negative and positive impacts of caregiving in FGs. [ABSTRACT FROM AUTHOR]

1HypothesisDisabled elders' activities of daily living, caregiver burden, caregiver depression, and caregivers' life satisfaction are significantly related to the life satisfaction of elderly people with disability.2HypothesisThere are direct and indirect effects between the life satisfaction of elders, disabled elders' activities of daily living, and family caregivers' factors. This study explored the interrelationships of disabled elders' life satisfaction and activities of daily living, caregivers' factors (burden, depression, and life satisfaction) through a structural equation model. In total, 621 dyads of disabled elders and informal family caregivers completed questionnaires during face ‐ to ‐ face interviews in Xinjiang Uyghur Autonomous Region from September 2013 to January 2014. Activity of daily living exerted a direct effect on life satisfaction of disabled elders and 30.4% indirect effect through caregivers' factors. Caregiver burden had a 60.0% direct effect on life satisfaction of disabled elders and a 40.0% indirect effect through the caregiver depression. Caregiver depression showed 76% direct effect on life satisfaction of disabled elders and 24% indirect effect through caregivers' life satisfaction. Direct relationships between activity of daily living and caregiver burden, caregiver burden and caregiver depression, and caregiver depression and caregivers' life satisfaction were observed. Activity of daily living had a 91.3% indirect effect on caregiver depression mediated by caregiver burden; caregiver burden had a 40.0% indirect effect on caregivers' life satisfaction mediated by caregiver depression. Results provide useful information for nurses and policymakers and shed light on the need to consider caregivers' factors in improving care recipients' life satisfaction. SUMMARY STATEMENT: What is already known about this topic? Disabled elders' life satisfaction is related to factors of the poor state of their own and caregivers' problem e.g. caregiver burden.The mechanism of how the factors affect disabled elders' life satisfaction is unclear. What this paper adds? The study created a causal chain among the disability elders' activity of daily living, caregivers' burden, depression, life satisfaction, and disabled elders' life satisfaction and explored the interrelationship between above factors and disabled elders' life satisfaction.Findings indicated that family caregivers' burden not only affects elders' life satisfaction directly but also brings further problems to affect disabled elders' life satisfaction indirectly. The implications of this paper: Government should pay high attention to the families of elderly people in long ‐ term home care; pension policies should support elders' families including informal family caregivers in poverty ‐ stricken ethnic minority areas.Examples of support include establishing assistance for the disabled elders, care training for family caregivers for free, establishment and improvement of respite care institutions, and psychological counselling. The caregiver's health should be comprehensively considered; formulation and improvement of a specialized disabled elders' family services.Nursing educators should include knowledge of the elderly in home care and ways of coping with care, nursing skills, and time management should be taught to family caregivers. [ABSTRACT FROM AUTHOR]

This study integrates the theory of planned behavior with a structural approach to examining social capital to investigate how bonding social capital affected Chinese women's tampon use intentions. Bonding social capital was operationalized as network closure, which included two main dimensions: density and hierarchy. Results from an online survey (N = 766) showed that network density was positively associated with attitudes toward, social norms about, and perceived behavior control around tampon usage, while network hierarchy negatively predicted attitudes only. Moreover, the indirect effects of network density on tampon use intentions were mediated by descriptive norms and perceived behavior control. Examining women's intentions to adopt a rarely used product in China, this study extended the theory of planned behavior into the realm of social capital in an understudied context. The findings provide practical implications for health communication practitioners in public education concerning feminine hygiene products and gynecological health. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking has been proven to increase the risk of cervical cancer, but it is still controversial whether smoking reduces women's ability to clear human papillomavirus (HPV) infection. This study investigated the association between smoking behaviors during follow-up and clearance of HPV infection in women with HPV-positive and pathologically normal uterine cervix in China, using a propensity score matching (PSM) analysis. METHODS The present prospective study included data from women examined in the Gynecology Department of Shanghai General Hospital from January 2018 to June 2020. Twenty patients who smoked throughout follow-up were selected and matched with 60 patients using the 1:3 PSM method on age, marital status, and whether infected with high-risk HPV (HR-HPV). At each visit, smoking and sexual behaviors were collected. The Kaplan--Meier method and a Cox proportional hazard regression model were used to evaluate the probability of clearing HPV infection within a 2-year follow-up. RESULTS A total of 80 patients were included in the study, all of whom were infected with at least one HR-HPV type at baseline. Current smokers had a lower likelihood of clearing the HPV infection than current non-smokers, after adjusting for a history of sexually transmitted diseases (STD), HPV infection status, and sexual behaviors during follow-up (AHR=0.478; 95% CI: 0.239--0.958, p=0.037). Additionally, longer duration, higher frequency and larger doses of smoking correlated with the lower clearance possibility of HPV infection (p for trend=0.029, 0.022 and 0.026, respectively). CONCLUSIONS This study showed that the use of tobacco throughout follow-up could increase the risk of a persistent HPV infection, this risk being higher for smokers with heavier tobacco consumption. Our results should alert HPV-positive women to reiterate the advice to cut-back on or stop smoking. [ABSTRACT FROM AUTHOR]

INTRODUCTION Significant changes occurred in the way people socialize and interact with each other since China reported its first COVID-19 cases. However, little is known about how smoking behaviors may have changed due to the COVID-19 pandemic in China. The aim of this study was to assess changes in smoking behavior and intention to quit during the early stage of the COVID-19 pandemic in China and to investigate the associated factors. METHODS An online cross-sectional survey was conducted among Chinese adult smokers. Participants were recruited through snowball sampling from 19 March to 2 April 2020. RESULTS A total of 1388 smokers participated in this study. Of those, 1014 (73.0%) reported not changing their cigarette consumption, 104 (7.5%) reported smoking more and 268 (19.3%) reported smoking less due to the pandemic. Average daily cigarette consumption among all participants decreased from 15.0 (IQR: 10.0--20.0) to 13.0 (IQR: 8.0-20.0) (W=6.919, p<0.001). For intention to quit, 270 (19.5%) respondents reported becoming more willing to quit, and 91 (6.6%) reported becoming less willing to quit. Multivariate analyses showed that tobacco addiction, overall knowledge about the relationship between smoking and COVID-19, level of attention devoted to COVID-19, anxiety, living alone, and number of smokers in the family were significantly correlated with cigarette consumption and intention to quit, and living alone was the strongest factor associated with increased cigarette consumption (AOR=5.29; 95% CI: 1.51-18.56). CONCLUSIONS The COVID-19 pandemic led to a slight decrease in cigarette consumption and an increase in quitting intention among Chinese smokers. During the early stages of the pandemic, it was important to focus on the anxiety of smokers, dispel smokers' misunderstandings of smoking and COVID-19 and create a supporting environment in the family to help smokers quit. [ABSTRACT FROM AUTHOR]

INTRODUCTION The home is the primary source of children's exposure to secondhand smoke. This study investigated the status and influencing factors of child exposure to secondhand smoke at home when people smoke in the household. METHODS Participants with at least one child living in their household from 10 communities in Chongqing were recruited and provided a self-administered questionnaire using a multistage proportional random sampling design from June to August 2021. The chi-squared test and binary logistic regression analyses were used to identify influencing factors. RESULTS The questionnaire completed by 1345 families showed that 631 (46.9%) families lived with smokers in their household, and 509 (80.7%) of those families reported that smoking occurred within the home while the children were present. Binary logistic regression analyses demonstrated that the time between waking up and household smokers having the first cigarette of the day (OR=0.44; 95% CI: 0.22-0.85), changes to smoking habits and behaviors within the last six months (OR=1.76; 95% CI: 1.06-2.90), attitudes towards tobacco control in the household (OR=2.91; 95% CI: 1.72-4.92), self-efficacy in maintaining a smoke-free home (OR=2.27; 95% CI: 1.36-3.79), having rules to maintain a smoke-free home (OR=3.25; 95% CI: 1.68-6.29), and the status of providing cigarettes to guests at home (OR=11.0; 95% CI: 1.33-90.8) were associated with exposure to SHS. CONCLUSIONS Education focusing on the impact of smoking on children's health should be encouraged. Smoke-free homes should be established, and smoking restrictions in the household should be enacted. Therefore, information about the available tobacco-control services should be given to family members and be used properly. It is an effective way to decrease the risk of at-home exposure to SHS for children, to overcome any obstacles in tobacco control. [ABSTRACT FROM AUTHOR]

INTRODUCTION The number of cessation clinics in China have been increasing ever since the Chinese government supported the establishment of smoking cessation clinics (SCCs) in each province in 2014. Many studies have examined smoking cessation behaviors among male smokers, but few of female smokers. This study aimed to understand female smokers' quitting behaviors in SCCs and identify predictors of successful cessation. METHODS This study used data of the SCCs Platform in China from 2018 to 2020. The self-reported 7-day point prevalence of abstinence rate (PPAR) at 1 month and at 3 months follow-up and the continuous abstinence rate (CAR) at 3 months follow-up are reported based on smokers' characteristics and intention to treat analysis. A multiple logistic regression model was used to identify predictors of continuous abstinence at 3 months follow-up. RESULTS The 7-day PPAR of female outpatients in SCCs was 29.20% at 1 month follow-up and 28.36% at 3 months follow-up. The CAR at 3 months follow-up was 19.88%. Female smokers who were prepared to quit within 7 days (AOR=2.86; 95% CI: 1.53-5.32), today (AOR=4.01; 95% CI: 2.35-6.85), had started to quit (AOR=7.11; 95% CI: 4.12-12.27), and used a combination of counseling and drugs (AOR=2.41; 95% CI: 1.73-3.35) were more likely to quit smoking. Associated with lower quitting rates were: living in the central region of China (AOR=0.47; 95% CI: 0.31-0.73) and the west region (AOR=0.48; 95% CI: 0.31-0.73); being aged 30-39 years (AOR=0.39; 95% CI: 0.23-0.64), and 40-49 years (AOR=0.41; 95% CI:0.24-0.69); being unemployed (AOR=0.64; 95% CI: 0.45-0.91); having a fair perceived health status at the first visit (AOR=0.65; 95% CI: 0.47-0.91) and a poor one (AOR=0.37; 95% CI: 0.21-0.64); having a moderate nicotine dependence (AOR=0.64; 95% CI: 0.44-0.92) and a severe one (AOR=0.50; 95% CI: 0.34-0.72). CONCLUSIONS In our study, the region of residence, age, employment, perceived health status, Fagerström test for nicotine dependence (FTND), readiness to quit, and intervention model were independent predictors of quitting for female smokers. Improving the motivation to quit, providing intensive psychological interventions and equipping SCCs with cessation medication would assist female smokers to quit. [ABSTRACT FROM AUTHOR]

Emotions are critical to learning. However, the function of emotions in the emerging context of massive open online courses (MOOCs) has been under‐researched. The present study complemented this line of research by modelling the relation between learner emotions, engagement with videos, engagement with assignments, and self‐perceived achievement in a small private online course—a localized instance of an extended MOOC. The results suggested that whereas enjoyment, excitement, boredom, and annoyance were all significant predictors of video engagement, only excitement and annoyance were significant predictors of assignment engagement. Excitement, in particular, was the strongest or stronger predictor of both types of engagement. In addition, both types of engagement predicted self‐perceived achievement, but video engagement predicted self‐perceived achievement via the mediation of assignment engagement. Implications for designing more effective MOOCs were proposed. Lay Description: What is currently known about the subject Emotions predict engagement in learning settings other than MOOCs.Engagement predicts achievement in learning settings including MOOCs.Assignment engagement predicts achievement in MOOCs better than video engagement. What this paper adds The two types of engagement are predicted by different sets of emotions.Engagement predicts self‐perceived achievement in the SPOC.Video engagement predicts self‐perceived achievement via the mediation of assignment engagement.The majority of systematic reviews did not evaluate the quality of the primary papers which they examined. Implications for practitioners MOOC researchers should pay more attention to the design of assignments.MOOC developers should try to build more emotionally‐sound courses and platforms. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Readiness for hospital discharge (RHD) has been an important topic for nurses.RHD can be measured by the Readiness for Hospital Discharge Scale (RHDS), including 4 subscales: personal status, knowledge, coping ability and expected support.There are few studies that focus on RHD in patients diagnosed with mental disorders. What does the paper add to existing knowledge?: Improving patient‐reported RHD can decrease the risks of unscheduled post‐discharge clinic visits, readmission and poor quality of life (QOL) in patients diagnosed with anxiety disorders.Improving patient‐reported personal status can decrease the risk of poor QOL in patients diagnosed with anxiety disorders.Improving patient‐reported knowledge can decrease the risks of unscheduled post‐discharge clinic visits and readmission in patients diagnosed with anxiety disorders.Improving patient‐reported expected support can decrease the risk of unscheduled post‐discharge clinic visits in patients diagnosed with anxiety disorders.Improving the methods of discharge teaching and anxiety severity can enhance RHD in patients diagnosed with anxiety disorders. What are the implications for practice?: Nurses could enhance patient‐reported RHD to reduce unscheduled post‐discharge medical resource utilization or improve QOL by facilitating knowledge acquisition and skill development and improving social support systems.Nurse managers could add RHD assessment to patients' discharge process and train nurses in the methods of discharge education.Nurses could advance their methods of discharge education, such as listening to and answering patients' questions, choosing a convenient time and engaging in online education. Introduction: The association between readiness for hospital discharge (RHD) and post‐discharge outcomes remains unclear in individuals with anxiety disorders. Aim: To explore the factors of RHD and the effect of patient‐reported RHD on post‐discharge outcomes. Method: In the observational study, 373 patients diagnosed with anxiety disorders completed the self‐administered Readiness for Hospital Discharge Scale (RHDS) on discharge. After 30 days, phone interviews were conducted to collect data on post‐discharge outcomes, including self‐reported unscheduled medical service utilization, symptom severity and quality of life (QOL). Multiple logistic regression models were built to explore the relationships among sociodemographic characteristics, the RHDS and its subscales, and post‐discharge outcomes. Results: The unscheduled clinic visits were significantly associated with low RHD, knowledge and expected support. Readmission was significantly associated with low RHD and knowledge. Poor QOL was significantly associated with low RHD and personal status. Delivery, received content and anxiety severity were the predictors of RHD. Discussion: Improved RHD is associated with fewer unscheduled clinic visits and readmissions and better QOL. Enhancing discharge education can improve RHD. Implications for practice: Nurses should enhance patient‐reported RHD to improve post‐discharge outcomes by advancing the quality of discharge education in patients diagnosed with anxiety disorders. [ABSTRACT FROM AUTHOR]

Both physical abuse and poor sleep quality are public health concerns among adolescents, particularly in mainland China, but examining any causal effect of physical abuse on adolescents' sleep quality using a randomized controlled trial is not possible for obvious ethical reasons. Researchers have proposed the use of propensity score matching with doses to minimize overt bias and estimate the effect of multidose treatments or varying degrees of risk exposure in observational studies. In this paper, we demonstrate the propensity score methods with a focus on matching with doses in an examination of the relationship between physical abuse levels (frequency and number of perpetrators) and self‐reported sleep quality among adolescents. Secondary analyses were conducted using data from the China Jintan Child Cohort. The sample comprised 707 adolescents (13.16 ± 0.90 years old) who had complete data on physical abuse, sleep, and covariates. Propensity scores were computed from eight covariates and used to carry out pair matching, matching with the frequency of abusive experience, and matching with the number of perpetrators. The standardized differences of covariates suggested an acceptable balance between groups after matching. The results derived from matching sets consistently indicated that adolescents being physically abused by parent(s) have worse sleep quality. Despite its inherent limitations, propensity score matching with doses provides a useful tool for nurse researchers analyzing observational data. [ABSTRACT FROM AUTHOR]

Background While maternal adherence to a healthy lifestyle was shown to be associated with a lower risk of obesity in offspring, the potential role of overall parental lifestyles has not yet been explored. We aimed to address this gap by exploring whether parental adherence to an overall healthy lifestyle was associated with a lower risk of obesity in offspring. Methods We included 5881 children and adolescents aged 6-15 years at enrolment in the 2010, 2012, and 2014 waves of the China Family Panel Studies (CFPS) who were free of obesity and followed them until 2020. Parental healthy lifestyle score at study baseline was composed of five modifiable lifestyle factors (0-5; 1 for each): never smoking, non-habitual drinking, weekly exercise, modified dietary diversity score ≥5 points, and body mass index (BMI) of 18.5-23.9 kg/m2. We defined obesity according to the age- and gender-specific cutoffs by the BMI percentile curves for Chinese children aged 6-18 years. We used multivariable Cox proportional hazard models to examine the association between parental healthy lifestyle score (both as continuous and categorical variables) and risk of offspring obesity. Results Overall, 597 (10.2%) offspring developed obesity during a median follow-up of 6 years. Compared to the lowest tertile of parental healthy lifestyle score, participants in the highest tertile had a 42% (hazard ratio (HR) = 0.58; 95% confidence interval (CI) = 0.45-0.74) lower risk of obesity. Both maternal (HR = 0.75; 95% CI = 0.61-0.92) and paternal (HR = 0.73; 95% CI = 0.60-0.89) healthy lifestyle scores were associated with lower risks of obesity in offspring. For specific lifestyle factors, we observed beneficial associations for paternal diverse diet (HR = 0.73; 95% CI = 0.60-0.88) and healthy BMI (HR = 0.65; 95% CI = 0.55-0.78). Conclusions Adherence to an overall parental healthier lifestyle was associated with a lower risk of obesity in childhood and adolescence. This finding highlights the potential benefits of promoting a healthy lifestyle among parents for the primary prevention of offspring obesity. [ABSTRACT FROM AUTHOR]

Background Stroke is a significant global health issue, ranking as the second leading cause of death and the third leading cause of death and disability combined. This study aimed to examine the changes and differences in stroke burden from 1990 to 2019 in China and various global socio-demographic index (SDI) regions. Methods Data were obtained from the Global Burden of Diseases Study 2019, which included the incidence, prevalence, mortality, disability-adjusted life years (DALY), years of life with disability (YLD), and years of life lost (YLL) of stroke. The change trend of stroke burden was assessed based on age-standardised rates per 100 000 person-years and estimated annual percentage changes. The average annual rate of change in stroke burden was analysed using the average annual percentage change from 1990 to 2019. Pearson correlation analysis was used to explore the strength and direction of the correlation between stroke burden and SDI. Results Regions with high SDI showed the largest decline in age-standardised incidence, death, DALY, YLD, and YLL rates of stroke from 1990 to 2019. China experienced the largest increase in age-standardised prevalence and YLD rates of stroke from 1990 to 2019. There were significant differences in the average annual percent change in stroke burden among the majority of SDI regions. The burden for stroke at the national level was inversely correlated with SDI, despite some exceptions (Incidence: R = -0.417, P < 0.001; prevalence: R = -0.297, P < 0.001; mortality: R = -0.510, P < 0.001; DALY: R = -0.550, P < 0.001; YLD: R = -0.125, P = 0.075; YLL: R = -0.569, P < 0.001). Conclusions There were significant differences in the stroke burden across different regions with varying SDI levels from 1990 to 2019. The age-standardised prevalence rate and attributable disability burden of stroke remain substantial in different SDI regions, making it a major contributor to the overall disease burden. The severe burden of stroke highlights the importance of primary and secondary stroke-prevention strategies. Therefore, future strategies to prevent and reduce the burden of stroke should be formulated and implemented according to the SDI of each country. [ABSTRACT FROM AUTHOR]

Background Education levels play a critical role in the development of chronic obstructive pulmonary disease (COPD), which mainly affects the elderly, who generally have a low level of education in China. We aimed to investigate the association between education level and COPD clinical characteristics and outcomes, especially the effects of education level on the all-cause mortality of COPD in the Chinese population. Methods We retrieved data collected between December 2016 and June 2020 in the RealDTC, an ongoing multicenter, real-world study on the status of diagnosis and treatment of COPD. The patients were classified into low- and high-education groups. We extracted data on demographics, pulmonary function, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades, modified Medical Research Council (mMRC) scores, COPD Assessment Test (CAT) scores, exacerbation history, therapy, and comorbidities, and on mortality during three years of follow-up. Results We included 4098 patients with COPD, of whom 3258 (79.5%) were of low education. This group had higher ages, CAT scores, mMRC scores, and numbers of exacerbations, as well as a greater proportion of females, never smokers, biofuel exposure, and GOLD grade 3. Logistic regression showed that being aged ≥65 years, being female, having biofuel exposure, having CAT scores of 20-29, and having ≥2 exacerbations were independently associated with having low education (P < 0.05). Furthermore, low-education COPD patients had a higher cumulative mortality risk during three years of follow-up than their high-education counterparts (hazard ratio (HR) = 1.75; 95% confidence interval (CI) = 1.17-2.61, P = 0.006). Conclusions Low-education COPD patients, who accounted for most of our sample, had a higher symptom burden, risk of exacerbation, and risk of all-cause mortality. Clinicians attending COPD patients should be more attentive of individuals with low education levels. [ABSTRACT FROM AUTHOR]