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This study was aimed at comparing different formats of illustrations for children's books created by modern Chinese and Ukrainian artists. At the same time, it was not focused just on determining the leading format, but on identifying the attractiveness factors of each format. To this end, the study investigated children's illustration preferences drawing from the following three age groups: 5–6 years old (preschoolers), 7–8 years old (second‐graders), and 9–10 years old (fourth‐graders). According to the survey, children were most concerned with illustration colourfulness (this is true for paper and pop‐up books) and viewing convenience. There were no statistically significant differences found between Chinese and Ukrainian books in terms of these parameters. At the same time, Chinese e‐books appeared to outperform the Ukrainian texts in terms of feature management and illustration colourfulness. Publishers and artists of children's books can use these data for effective creative activity and making constructive decisions. At the same time, these findings may be of interest to parents, informing or guiding book selection for children. [ABSTRACT FROM AUTHOR]

Aims: This study aims to examine the prevalence of anxiety symptoms and identify predictors of anxiety among pregnant women with gestational diabetes mellitus and their partners and explore the mediating role of marital satisfaction between maternal and paternal anxiety. Design: A cross‐sectional study was conducted in Guangzhou, China, from July 2021 to May 2022. Methods: A total of 306 dyads of pregnant women with gestational diabetes mellitus and their partners completed the State–Trait Anxiety Inventory, Locke–Wallace Marital Adjustment Test and the socio‐demographic and clinical data sheet. Results: The prevalence of anxiety symptoms was 32.4% and 36.6% in pregnant women with gestational diabetes mellitus and their partners, respectively. The predictors of maternal anxiety were paternal anxiety, maternal marital satisfaction, maternal monthly salary, fasting glucose value and 1‐h glucose value. By contrast, the predictors of paternal anxiety were maternal anxiety, paternal marital satisfaction and paternal monthly salary. Moreover, the relationship between maternal and paternal anxiety was mediated by marital satisfaction. Conclusions: The anxiety symptoms of pregnant women with gestational diabetes mellitus and their partners influence each other, and this relationship was mediated by marital satisfaction. Every couple should be screened for anxiety symptoms and treated as a team rather than focusing solely on the pregnant woman. Summary statement: What is already known about this topic? Gestational diabetes mellitus is strongly associated with various short‐ and long‐term adverse maternal and neonatal outcomes.The diagnosis of gestational diabetes mellitus is stressful for pregnant women and their partners.No studies have been conducted to examine and compare the anxiety symptoms among pregnant women with GDM and their partners in mainland China. What this paper adds? The anxiety symptoms of pregnant women with gestational diabetes mellitus and their partners influence each other.The prevalence of anxiety symptoms was high in both pregnant women with gestational diabetes mellitus and their partners.Marital satisfaction played a mediating role between maternal and paternal anxiety. The implications of this paper: Study findings provide important information to guide future practice for nurses and other health‐care professionals.For the future, routine screening for anxiety symptoms is necessary for both pregnant women with gestational diabetes mellitus and their partners; mental health support should be delivered in a timely fashion for couples.Pregnant women with gestational diabetes mellitus and their partners should be treated as a team rather than focusing solely on pregnant women, with couples given training on enhancing marital satisfaction skills to prevent and reduce their anxiety symptoms. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known?: SDM improves clinical outcomes by increasing attendance and treatment adherence in adolescents diagnosed with depression.SDM could reduce treatment disagreements and enhance consumers' and their families' satisfaction with mental healthcare services.Healthcare professionals are a critical part of SDM. However, MHPs' practices of SDM in the daily management of adolescents diagnosed with depression need to be clarified. What the paper adds to existing knowledge?: From the viewpoints of MHPs, SDM was not extensively applied in the daily management of adolescents diagnosed with depression.MHPs who trust their consumers and have received training related to SDM are more likely to practice SDM in the daily management of adolescents diagnosed with depression.The positive preferences for providing information and family involvement in treatment decision‐making are facilitators; working in closed inpatient mental health wards and open inpatient mental health wards are hindering factors for MHPs' practices of SDM. What are the implications for practice?: MHPs should encourage information sharing with consumers and their family members to help them participate in treatment decision‐making actively.A trusting and friendly therapeutic relationship with consumers should be maintained in the daily management of adolescents diagnosed with depression.SDM‐related training should be encouraged for MHPs to promote widespread SDM. Introduction: Shared decision‐making (SDM) is an ideal model for a therapeutic relationship that can improve health outcomes. Healthcare professionals are a critical part of SDM, and they play an important role in the practices of SDM in the clinical setting. Evidence suggests that adolescents diagnosed with depression can benefit substantially from SDM. However, mental health professionals' (MHPs) practices of SDM for adolescents diagnosed with depression in China are not well‐documented. Aim: This study aimed to investigate the practices of SDM for adolescents diagnosed with depression from the viewpoints of MHPs in China. Method: In this cross‐sectional study, we recruited a total of 581 MHPs by convenience sampling. The Shared Decision‐Making Questionnaire—Physician Version (SDM‐Q‐Doc) was used to evaluate the MHPs' practices of SDM for adolescents diagnosed with depression. Results: The mean SDM‐Q‐Doc was 80.47 (±16.31). Within the six specific decision‐making situations, most MHPs selected non‐SDM (52.7%–71.6%). Substantial numbers of respondents believed that MHPs made the final decision, especially with regard to the development (37%) and adjustment of medication regimens (42%). The practice of SDM was predicted by MHPs' preference for providing information, their trust in consumers, preference for family involvement in treatment decision‐making, working in an outpatient clinic and receiving SDM training (F = 23.582; p =.000; R2 =.198; adjusted R2 =.189). Discussion: Although the MHPs' self‐rated score of SDM‐Q‐Doc was high, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. Thus, SDM needs to be further promoted by enhancing SDM‐related training for MHPs, thereby actively promoting the involvement of families, facilitating the information sharing for consumers and families, and building an active, trusting consumer‐practitioner relationship. Implications for Practice: MHPs should prioritise information sharing with consumers and families, as well as build trusting and friendly therapeutic relationships. Family involvement in treatment decisions should be encouraged when adolescents diagnosed with depression are in need. Actively participating in training related to SDM is also important. Future high‐quality evidence is still needed to explore the facilitators and barriers to SDM practices from a tripartite perspective of MHPs, adolescents diagnosed with depression and their families. [ABSTRACT FROM AUTHOR]

Background Study: As flipped learning is a flexible pedagogical methodology to tailor students' needs and maximize the learning effects, this study integrated peer learning with MosoTeach‐supported flipped mode in an undergraduate blended EFL course. MosoTeach is a popular online learning platform in China with a variety of learning resources. Objectives: The study aimed to test the impact of MosoTeach flipped learning (MTFL) mode on undergraduate EFL students' perceived motivation, participation, feedback, and test performance. Methods: A quasi‐experimental design was carried out in Z university during the spring semester of 2020, with the experimental group (n = 34) adopting the MTFL model and a control group (n = 33) the non‐flipped mode. Results and Conclusions: The independent t‐test results showed that the experimental MTFL group outperformed the control group in post‐test scores, and a positive correlation was found in the relationship between the experimental MTFL group's post‐test scores and MosoTeach learning experience points (LEPs). Moreover, the course perception questionnaire survey indicated a higher level of students' perceived motivation, participation, and feedback in the experimental MTFL group, which corresponded to the results of the content analysis of students' responses to open‐ended questions and reflective reports. But students in both groups experienced challenges such as isolation, procrastination and technological anxiety. Lay Description: What is currently known about this topicFlipped language learning is mostly reported to be effective in improving EFL learning.Peer learning is mostly reported to be effective in improving EFL learning.MosoTeach was investigated in English learning contexts before, but without experimental design. What this paper addsMosoTeach proved as a valid online learning platform in flipped language learning, and the learning experience points (LEPs) on MosoTeach could predict students' exam performance.Students in the experimental group (MosoTeach‐supported flipped) had better exam performance and a higher level of motivation, participation and feedback.Students in both groups experienced isolation, procrastination and technological anxiety. Implications for practice:Peer discussion boards in MosoTeach provide learning support effectively for students in pre‐class learning.Group projects and peer assessment in MosoTeach integrate pre‐class peer discussion into in‐class interaction successfully.MosoTeach provides equal opportunity for every student in the large‐size Chinese English classes, thus contributing to the equity of in‐class peer interactions. [ABSTRACT FROM AUTHOR]

The vulnerable children refer to the special group of children with deviation in the process of children's psychological development and personality formation due to growth dilemmas. This may incur a series of serious social and family problems. The vulnerable children mainly cover the children suffering from children's psychological problems, such as childhood autism, autism, social anxiety and hypersensitivity, fear, depression, and PTSD arising from other factors. At present, the research results at home and abroad mainly focus on the psychological dynamic correlation investigation and solution discussion of a certain kind of difficult factor in the children's psychological development based on statistical data by the experimental methods, such as scale and model, and there is a blind spot in the humanistic orientation theory construction of psychological treatment for vulnerable children, causing the social reflection on children's psychological predicament from the humanistic perspective cannot be performed in related researches and going against searching for universal and integral theoretical paradigm for solving related problems. Sophisticated technologies for the observations have emerged increasingly for enabling the psychological features of vulnerable children through developmental cognitive neuroscience experiments. This paper introduces humanistic art therapy theory, focuses on the construction of a theoretical paradigm, and verifies its effectiveness based on the experimental results on the psychological development of vulnerable children, with an efficient performance. This study mainly refers to children with difficulty in social inclusion and psychological development. The results showed that two kinds of art therapy can obviously improve the psychological disorders of vulnerable children. The goal was to enhance self-cognition, strengthen emotional interaction, and implement positive motivation. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to identify risk factors for cognitive impairment in advanced cancer patients and to develop predictive models based on these risk factors. Background: Cancer‐related cognitive impairment seriously affects the quality of life of advanced cancer patients. However, neural network models of cognitive impairment in patients with advanced cancer have not yet been identified. Design: A cross‐sectional design was used. Methods: This study collected 494 questionnaires between January and June 2022. Statistically significant clinical indicators were selected by univariate analysis, and the artificial neural network model and logistic regression model were used for multivariate analysis. The predicted value of the model was estimated using the area under the subject's working characteristic curve. Result: The artificial neural network and the logistic regression models suggested that cancer course, anxiety and age were the major risk factors for cognitive impairment in advanced cancer patients. All the indexes of artificial neural network model constructed in this study are better than those of the logistic model. Conclusion: The artificial neural network model can better predict the risk factors of cognitive impairment in patients with advanced cancer. Better prediction will enable nurses and other healthcare professionals to provide better targeted and timely support. Summary statement: What is already known about this topic?: Cancer‐related cognitive impairment has significantly affected the quality of life of patients with advanced cancer.Risk factors associated with cognitive impairment in patients with advanced cancer have not been adequately documented, and neural network models have not been identified. What this paper adds?: This study found that long a cancer course, anxiety and ageing were the most important risk factors for cognitive impairment in patients with advanced cancer.The artificial neural network showed good predictive indicators, indicating that it can be used to predict cognitive impairment in patients with advanced cancer. The implications of this paper: Neural network models can help nurses and other clinicians predict cognitive impairment in advanced cancer patients early which will allow provision of timely intervention. [ABSTRACT FROM AUTHOR]

Aims and objectives: To detect the mediating effect of resilience on the relationship between perceived social support and burnout in Chinese palliative nurses. Background: Palliative nurses are a group that is vulnerable to burnout. Perceived social support may contribute to decreasing palliative nurses' burnout and facilitating their personal resilience, and resilience may be associated with lower levels of burnout. However, these relationships were unclear in the Chinese context. Design: A cross‐sectional design. Methods: The STROBE guideline was performed to report this study. A mixed sampling method including convenience sampling and stratified sampling was used to recruit participants, and a total of 319 palliative nurses completed the Nursing Burnout Scale, the Perceived Social Support Scale and the Connor–Davidson Resilience Scale from May 2021 to September 2021. Influencing factors were primarily identified using independent‐sample t tests and one‐way ANOVA. Bootstrap method was used to detect the mediating effect of resilience. Results: The level of burnout in palliative nurses (23.4 ± 7.68) was higher than that of general nurses in China. Education level, health condition and monthly income were influencing factors of burnout. Resilience was detected as a mediator in the relationships between perceived social support and dimensions of burnout. Conclusions: Chinese palliative nurses experience a relatively high level of burnout, which may be influenced by several sociodemographic variables. Resilience could mediate the effect of perceived social support on the dimensions of burnout. Problem‐oriented and palliative‐tailored strategies should be developed to further address burnout in Chinese palliative nurses. Relevance to clinical practice: Nurse managers and policy makers should support nurse ongoing education, adopt health‐promoting interventions and optimise salary systems. In addition, perceived social support resources and resilience training programmes are also warranted. Patient or public contribution: All participants were invited to complete the informed consent form and paper questionnaires. Human resource managers helped us collect some subjective data through the personnel management system. Nurse managers of palliative units conducted regular staff meetings to promote the data collection process. [ABSTRACT FROM AUTHOR]

Background: Case management has been regarded as the front line of necessary change for fragmented healthcare system. Aim: This study proposed a case management intervention that is suitable for Chinese colorectal cancer patients and explored its effectiveness over a 12‐month follow‐up. Methods: A quasi‐experimental study was conducted in an oncology hospital in China. A total of 188 patients were recruited from May 2015 to February 2017; 85 patients in the control group and 80 patients in the intervention group were included in data analysis. The intervention group was managed for 1 year by a case manager who organized the multidisciplinary team, provided regular assessment, a consulting service and referrals. Quality of life, anxiety and depression, symptom distress, treatment adherence and unplanned readmission rates were measured. Results: Repeated measurement ANOVA showed significant intervention and time effects in global quality of life, anxiety and depression, symptom distress and oral chemotherapy adherence. The intervention group showed statistically significantly better overall treatment adherence and lower unplanned readmission rate. Conclusion: Nurse‐led case management was effective in improving psychosocial outcomes, treatment adherence and unplanned readmission rate of colorectal cancer patients. A case management model is feasible and effective in colorectal cancer patients and in hospital‐dominated healthcare systems where primary care is underutilized. Summary statement: What is already known about this topic?: Current evidence of the effectiveness of case management is limited due to mixed results and single settings.Case management is rarely tested in single‐type cancer patients and in countries with underdeveloped primary care. What this paper adds?: Nurse‐led hospital‐based case management can effectively improve quality of life, anxiety, depression, symptom distress, treatment adherence and unplanned readmission rates.In countries with underdeveloped primary care, case management is a feasible way to provide continuous care to cancer patients and to improve healthcare utilization. The implications of this paper: Nurse case managers can serve as a pivot in multidisciplinary management of cancer patients to promote interdisciplinary cooperation and resource integration.A case management model is feasible and effective in colorectal cancer patients and in hospital‐dominated healthcare systems where primary care is underutilized.Future studies and nursing practice should develop an online case management platform and set up posts for full‐time case managers. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to develop and test the psychometric properties of a Professional Nursing Support Scale for patients with cancer in mainland China. Methods: The study was conducted in two phases from January 2017 to January 2020. Phase I involved item generation and developing a preliminary version of Professional Nursing Support Scale through literature review, qualitative interviews, content validity evaluation and a pilot study. Phase II involved psychometric properties testing of the Professional Nursing Support Scale in 700 patients with cancer recruited from four public hospitals in Anhui Province, China. Results: A 49‐item Professional Nursing Support Scale was finally developed. Exploratory factor analysis showed a four‐factor structure of the 49‐item Professional Nursing Support Scale, accounting for 56.95% of variance. Cronbach's α ranged from 0.91 to 0.94 for the four subscales. Confirmatory factor analysis further confirmed the best model fit of four‐factor structure of the Professional Nursing Support Scale. The Professional Nursing Support Scale also showed an acceptable concurrent validity with Supportive Care Needs Scale short form 34 (r = 0.75, p < 0.001) and Psychological Distress Thermometer (r = 0.39, p < 0.001). Conclusions: The Professional Nursing Support Scale is a reliable and valid instrument to assess perceived needs of professional nursing support and support acquisition in relation to the care in Chinese patients with cancer. Summary Statement: What is already known about this topic? Nurses generally provide supportive care services and play imperative roles in supporting patients in cancer.Using a valid and reliable instrument to assess supportive care needs for patients with cancer is a critical step for the improvement of clinical practice and research. What this paper adds? Mixed methods were beneficial for developing the new self‐report and culturally appropriate instrument for Chinese patients with cancer.The Professional Nursing Support Scale (PNSS) is a reliable and valid instrument to assess perceived needs of professional nursing support and support acquisition in relation to the needs. The implications of this paper: The PNSS is expected to a reliable needs evaluation tool. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the effectiveness of an instant message‐based lifestyle and stress management intervention delivered by nurses on cardiovascular disease risk reduction. Methods: In this nonrandomized concurrent controlled trial conducted from March 2013 to September 2013, 164 eligible employees in two companies were assigned to the intervention (n = 83) and control (n = 81) groups based on their worksites. Only participants were blinded to group assignment. All participants received two education sessions during 1 month, and the intervention group also received an instant message‐based lifestyle and stress management intervention for 5 months. The primary outcome was the Framingham Risk Score, and the data were collected at the first month and the sixth month. Results: The final analysis included 80 participants in the intervention group and 76 in the control group. After the intervention, significant intervention effects were found for the mean value and the changes of the Framingham Risk Score and the proportion of participants who improved their diet and exercise (P < 0.05). There were trends for improvement in the proportion of smoking and levels of stress, but statistically significant levels (P > 0.05) were not met. Conclusion: An instant message‐based lifestyle and stress management intervention can reduce cardiovascular disease risk in high‐risk individuals. Summary statement: What is already known about this topic? Cardiovascular disease is the leading cause of death globally and causes a heavy economic burden, while lifestyle changes and stress management are modifiable and cost‐effective ways to reduce the risk of cardiovascular disease in high‐risk individuals.The widespread use of mobile phones facilitates the implementation of health education to improve lifestyle and is well adapted for use in the developing world.Instant messaging tools are widely used for daily and work communication because of convenience and free access. These tools have also been used to improve health knowledge and self‐management. What this paper adds? More than half of participants had unhealthy diets and insufficient exercise, which contributed to abnormal body mass index and cholesterol levels.Lifestyle‐related health education that provided tailored strategies for improving lifestyle and stress reduction, as well as timely feedback and peer support, can reduce cardiovascular disease risk in high‐risk individual.Instant messaging tools provide a cost‐effective and feasible platform for health education on prevention of cardiovascular disease. The implications of this paper: Improving unhealthy diet and levels of exercise, which can decrease the prevalence of obesity and dyslipidemia, are two main aspects for prevention of cardiovascular disease that require continued focus.Using instant messaging tools as a platform to deliver health education, nurses can more easily manage high CVD risk individuals and provide guidance on healthy lifestyle. These tools should be used more widely, especially in developing countries with limited resources and heavy economic burdens. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the level and influencing factors of fatigue in patients with rheumatoid arthritis. Methods: This cross‐sectional study was conducted in 243 patients with rheumatoid arthritis from April 2016 to March 2017. The Bristol Rheumatoid Arthritis Fatigue Multi‐Dimensional Questionnaire, Arthritis Self‐Efficacy Scale‐8, Visual Analogue Scale for pain, physical function subscale of Short Form 36‐Item Health Survey, Hospital Anxiety and Depression Scale, Perceived Social Support Scale, Pittsburgh Sleep Quality Index and a self‐designed demographic and disease‐related information questionnaire were used to collect the data. Stepwise linear multiple regression was used to clarify the impact of statistically significant variables (P < 0.05) in the independent sample t test, one‐way ANOVA and correlation analysis on the level of fatigue. Results: Stepwise linear multiple regression analyses showed that disease activity, self‐efficacy, physical function, pain, depression, duration of morning stiffness and anxiety were major factors influencing fatigue in patients with rheumatoid arthritis, which explained 59.5% of the total variance. Conclusion: Our study demonstrated a moderate level of fatigue in Chinese patients with rheumatoid arthritis. In clinical practice, nurses should explore individualized intervention programmes based on related predictors of fatigue to help patients relieve fatigue. Summary statement: What is already known about this topic? Fatigue is a common problem in patients with rheumatoid arthritis (RA).Little research has investigated what factors are associated with fatigue in patients with RA.Nurses need to understand the factors that potentially influence fatigue in patients with RA, in order to improve the quality of life. What this paper adds? Fatigue is moderate in Chinese patients with RA, which is lower than the results of western countries.Disease activity, self‐efficacy, physical function, pain, depression, duration of morning stiffness and anxiety are important factors affecting fatigue in patients with RA. The implications of this paper: Special attention should be paid to the RA patients with high level of fatigue.The findings of this study highlight the need to develop effective strategies to alleviate fatigue and eventually improve the quality of life in patients with RA. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to identify and compare the levels of compassion fatigue and job satisfaction among haemodialysis nurses in public and private hospitals in China and explore explanatory factors based on sociodemographic and occupational characteristics. Methods: A descriptive study was conducted using a self‐designed demographic questionnaire, the Professional Quality of Life Scale and the Minnesota Satisfaction Questionnaire, with responses from 283 haemodialysis nurses working at six public and private hospitals in China between June and November 2018. Results: The compassion fatigue score of public hospital nurses was significantly higher than that of private hospital nurses. Univariate analysis showed that there were significant differences in compassion fatigue among nurses based on the number of years worked, nature of employment, and education level. Correlational analysis showed a negative correlation between overall job satisfaction and compassion fatigue in both public and private hospitals. Multiple regression analysis showed that compassion fatigue among haemodialysis nurses in public hospitals was associated with years worked, type of employment, and intrinsic and extrinsic satisfaction, whereas in private hospitals, education level, years worked, and intrinsic and extrinsic satisfaction were significant. Conclusion: Haemodialysis nurses in public hospitals are more likely to develop compassion fatigue than those in private hospitals. Summary Statement: What is already known about this topic? Nurses are susceptible to developing compassion fatigue (CF) due to multiple challenges and harsh environments in practice.Although previous studies have highlighted that haemodialysis nurses across the globe face issues with the work environment, stress and burnout, there are few reports of CF among haemodialysis nurses.At present, many countries have both publicly and privately funded hospitals, and it is not known whether the CF of haemodialysis nurses differs by hospital type. What this paper adds? Haemodialysis nurses have high levels of CF, and haemodialysis nurses in public hospitals have higher CF and lower job satisfaction than those in private hospitals.The main factors associated with CF among haemodialysis nurses in public hospitals were years worked, type of employment, and intrinsic and extrinsic satisfaction.The main factors associated with CF in haemodialysis nurses in private hospitals were education level, years worked, and intrinsic and extrinsic satisfaction. The implications of this paper: There is a need to raise awareness among both nurses and nursing management staff of haemodialysis units regarding the existence of CF among haemodialysis nurses, especially in public hospitals.Different targeted interventions or solutions should be considered according to various factors associated with CF in different types of hospitals (public and private). [ABSTRACT FROM AUTHOR]

Aims: This study investigated self‐care activities and identified their related factors in Chinese patients with type 2 diabetes mellitus. Methods: A cross‐sectional study was conducted in Guangzhou, China, between September 2016 and February 2017, involving 202 Chinese patients with type 2 diabetes mellitus. Measures included the Summary of Diabetes Self‐Care Activities Questionnaire and Revised Illness Perception Questionnaire. Results: Self‐care activities in Chinese patients with type 2 diabetes mellitus were suboptimal overall. Foot care and blood sugar testing were the self‐care activities that were performed the least. One fifth of patients smoked. Some subscales of illness perceptions, receiving health education on diabetes, employment status, education level, body mass index, age and time since type 2 diabetes mellitus diagnosis, were related to self‐care activities in patients with type 2 diabetes mellitus. Conclusion: Health‐care providers and nurses should encourage greater engagement in self‐care activities in patients with type 2 diabetes mellitus, especially foot care and blood sugar testing. Illness perceptions may be used as a framework to guide interventions. Summary statement: What is already known about this topic? Diabetes is a global epidemic, and China has the largest number of patients with type 2 diabetes mellitus.Self‐care activities are a key factor in preventing complications and maintaining long‐term health in patients with type 2 diabetes mellitus.Illness perceptions are amendable to change by health‐care providers. What this paper adds? Self‐care activities in Chinese patients with type 2 diabetes mellitus were suboptimal; the least frequently performed self‐care activities were foot care and blood sugar testing, and one in five patients smoked.Some subscales of illness perceptions, receiving diabetes education, employment status, education level, body mass index, age and time since type 2 diabetes mellitus diagnosis, were related to self‐care activities in Chinese patients with type 2 diabetes mellitus. The implications of this paper: Illness perceptions may be used as a framework to guide interventions aimed at promoting self‐care activities in Chinese patients with type 2 diabetes mellitus.Interventions aimed at promoting self‐care activities should be tailored to the sociodemographic and clinical profiles of individual patients. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess the overall status of burnout in nurses in China on a national scale and investigate the demographic characteristics related to burnout and the relationships between demographics, job satisfaction and burnout. Methods: This was a national cross‐sectional study conducted by the Chinese Nursing Association between July 2016 and July 2017. Data were collected using a structured, self‐administered questionnaire. Results: A total of 51 406 registered nurses in 311 Chinese cities completed the questionnaire. Fifty per cent of the participants suffered burnout, and 33.8% of nurses had high scores on emotional exhaustion, 66.6% had high scores on depersonalization and 93.5% had low scores on personal accomplishment; 16.2% reported a high level of job satisfaction, only 0.4% was satisfied with their jobs and 70.7% intended to leave their jobs. Marital status, educational level, income and years of working experience affected job burnout. Nurses with a high level of burnout were more likely to have a high degree of job dissatisfaction and intend to leave their jobs. Conclusion: We found a high prevalence of burnout among nurses in China. Nursing managers need to pay more attention to job burnout and its influencing factors. Interventions to reduce nurse burnout should be implemented. SUMMARY STATEMENT: What is already known about this topic? Burnout is a prolonged response to chronic job‐related stress and it has a negative effect on job satisfaction and quality of nursing care. What this paper adds? The prevalence of burnout among nurses working in China is high.Marital status, educational level, income and years of working experience affect job burnout.Nurses with a high level of burnout have high job dissatisfaction and intend to leave. The implications of this paper: Nursing supervisors and managers need to be more aware of the high prevalence of job burnout among nurses in China.Interventions should be undertaken to prevent or reduce nurse burnout. [ABSTRACT FROM AUTHOR]

Purpose: Children with cochlear implants (CIs) have less experience accessing spoken language. Mandarin Chinese uses pitch information to contrast word meaning, and the signal that the CI devices provide is degraded. Thus, Mandarin-speaking children with CIs may face more challenges in the development of language skills. This study examines preschool Mandarin-speaking children's performance in lexical access. We hypothesized that children with CIs and their peers with normal hearing (NH) have comparable naming ability, but they process phonological or semantic information differently. Method: Twenty children with CIs and 20 age-matched children with NH were tested. The cross-modal visual–auditory picture–word interference paradigm was applied. The distractor was either phonologically related (mao55 cat -mao51 hat), semantically related (mao55 cat -shu214 mouse) or unrelated (mao55 cat -zhi214 paper) to the target, and it was aurally presented at four different points in time relative to the picture. Accuracy was compared between the two groups to tap into the children's naming abilities, and reaction time was analyzed to examine the effects of phonological and semantic information. Results: No group difference in accuracy was found. The phonologically related distractors led to significantly higher accuracy scores and shorter reaction times, whereas the semantically related distractors did not. Unlike the NH group, the CI group did not respond significantly faster or slower in phonologically related condition when the distractor and picture occurred simultaneously. Finally, the CI group made overall quicker responses than the NH group. Conclusions: Children with CIs are as successful as children with NH in word retrieval and production, and the two groups both show phonological priming effect and lack semantic effect. However, children with CIs do not process phonological information as early as their NH peers, and they may be more tasks directed and hence make quicker responses. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to understand the current situation and multiple factors affecting the core competence specializing in the maternal, neonatal and under‐five nursing in China. Background: Highly skilled nurses and midwives are essential worldwide for achieving the Sustainable Development Goals, especially in low‐ and middle‐income countries like China, due to the overwhelming COVID‐19 crisis. Method: The 890 nurses and midwives from 12 hospitals were investigated in this cross‐sectional study, with two questionnaires: the sociodemographic information and competency inventory for the registered nurses. Results: The participants reported a mean total score of 193.78 (±42.19) out of 220 and lowest in critical thinking and research ability (3.01 ± 0.82). The professional title, level, marital status, relationship quality, highest qualification, experience in specialist nurse training, participation in scientific research projects and publishing papers were the influencing factors (P <.05). Conclusions: The respondents' core competence needs improvement, especially critical regarding thinking and research ability. In addition, marriage and good or excellent relationship quality are factors that can potentially improve competence. Implications for Nursing Management: Targeted interventions for higher core nursing competence need to be implemented, especially focusing on nurses' marital status and emotional support from partners. [ABSTRACT FROM AUTHOR]

The role of formal volunteering in mental health promotion among older adults in China has been widely discussed during recent decades. However, the relationship connecting mental health with cross‐level interaction (i.e., average levels of participation in the community vs. individual participation) is still unclear. This paper examined the effects of cross‐level formal volunteering on depressive symptoms among older adults living in China. Using two waves of the China Longitudinal Aging Social Survey, a sample of 3128 Chinese older adults was surveyed in 2014 and 2016. Depressive symptoms were measured using the abbreviated CES‐D‐9. Individual fixed‐effects ordinary least squares regression models assessed the associations between individual‐ and community‐level formal volunteering and depressive symptoms in urban and rural areas separately. We found that in the urban sample, formal volunteering activities were negatively associated with depressive symptoms at the individual level (β = −0.49, SE = 0.22, p < 0.05). Higher community‐level formal volunteering was positively associated with depressive symptoms (β = 2.82, SE = 1.42, p < 0.05). When adding interactions between individual and community levels, engagement in individual‐level formal volunteering was associated with lower rates of depressive symptoms as community volunteering participation levels increased (β = −3.07, SE = 1.07, p < 0.01). High community‐level volunteering participation was detrimental for non‐volunteers. In rural areas, neither community‐ nor individual‐level formal volunteering was associated with changes in depressive symptoms. The current findings demonstrate formal volunteering may not always benefit mental health for all. The effects may depend on the community context and individual choices. Social policies aimed to promote mental health through formal volunteering need to be tailored according to the specific community social environment. [ABSTRACT FROM AUTHOR]

The incidence of cancer is increasing today, particularly lung and chest cancer. Employing novel methods to detect cancer in its earliest stages and discover painless, noninvasive treatments are urgently needed. The goal of the proposed study is to investigate the value of automated breast volume scanning (ABUS) in conjunction with contrast-enhanced ultrasonography (CEUS) in properly diagnosing breast cancer in its early stages and the effectiveness of neoadjuvant chemotherapy (NAC) in treating the disease. For the research study, information on 98 patients who had NAC and surgery in the breast surgery department of the Shaanxi Provincial Cancer Hospital has been gathered. All patients have received four cycles of NAC and underwent conventional ultrasound (HUSS), CEUS, ABUS, and pathological examination. At the same time, receiver operating characteristic (ROC) curve analysis, single factor, multiple linear regression, and other methods have also been used to analyze the diagnostic efficacy of breast cancer and NAC efficacy evaluation results. The study of this paper is totally based on the data collected from Shaanxi Provincial Cancer Hospital. The statistical and computational analyses are performed on the data collected for drawing inferences. When the findings are compared to the results of the pathological examination, HUSS has demonstrated a significant distinction between benign and malignant diagnoses with a statistical value of P < 0.05.ABUS combined with CEUS has shown no considerable differences in correlation study. Except for negative likelihood ratio, the diagnostic performance indexes of CEUS+ ABUS are substantially higher than HHUS with P < 0.05. ROC curve analysis is also performed which shows that CEUS and ABUS combination has higher precision in the analysis of breast cancer. ABUS pooled with CEUS shows great application value in the judgment of breast cancer as per the results obtained from the statistical analysis on data of 98 patients. [ABSTRACT FROM AUTHOR]

With the advent of mobile technologies, well‐designed fraction apps can be used to help children gain fraction knowledge, a challenging topic for both teachers and students. The present pilot study adopted a quasi‐experimental design to investigate whether children can learn fraction concepts equally well if half of the lesson time (20 min) is replaced with game‐based learning. Keeping the total lesson time (40 min) identical, the control group (N = 33) received traditional instruction, and the experimental group (N = 32) was presented with a blended learning approach spending half of the class time (20 min) playing tablet‐based fraction games, where each of the learners had their own tablet. The results suggested that in the posttest, the experimental group achieved similar learning gains to the control group and appear to have achieved better performance in the transfer test than the control group. This paper also discusses the efficiency of game‐based learning, the mechanism of how fraction games might enhance learning, and the potential of integrating game‐based learning in educational settings. Lay Description: What is already known about this topicAs a significant mathematical concept in daily life, fractions are crucial for later success in math learning.As a promising new technology, educational games show a great potential for improving learning.Well‐designed fraction apps can be used to help children gain fraction knowledge.What this paper addsGame‐based fraction learning can be combined with formal learning in school education.Game‐based fraction learning might provide a more efficient approach to increasing students' conceptual knowledge of fractions.The result showed that the experimental group achieved a similar cognitive level as the control group although they spent half of the time playing a game, suggesting that children can gain knowledge from the experiences of playing games.What are the implications for practice and/or policyThe result suggests that the proper use of educational games in teaching fractions can make learning more efficient.Further research needs to be done to determine whether the fraction understanding gained through playing these games will have an impact on students' future learning of more complicated fraction concepts. [ABSTRACT FROM AUTHOR]

Over the past decade, the call to foster computational thinking (CT) in every child has received considerable attention. However, there is little understanding of whether children are developmentally ready to think computationally and what specific CT concepts and skills can be developed at various ages. This study explored the developmental and gender differences in CT skills of 197 Grade 4–6 students (aged 9–13) before being exposed to instruction and investigated the age–gender interaction effects on their CT acquisition in an intervention combining both programming and non‐programming (unplugged) activities. Results show that students' CT skills followed a developmental progression before instruction. Gender difference across ages was insignificant in conditionals, logical operators, pattern recognition and generalization skills. Additionally, students of different ages developed CT differently during the intervention, and their CT acquisition was unaffected by gender. Implications for practice and research in CT education were discussed. Lay Description: What is currently known about the topic: Learning progressions for computational thinking have been defined in K‐12 curricula globally.Engaging in programming and non‐programming (unplugged) activities can increase students' CT skills.Controversial results have been reported on the age–gender interaction effects on CT development.Lack of understanding on children's actual progressive development of CT. What this paper adds: A developmental progression was found in CT skills of students aged 9–13. Students aged 12 and above had some a priori understanding of CT.No gender difference across ages existed in conditionals, logical operators, pattern recognition and generalization skills before instruction.Students aged 9–11 benefitted the most from an intervention combining both programming and unplugged activities compared to older students. Students' CT acquisition in the intervention was unaffected by gender.Given the intervention, students aged 9 and above developed conditionals, logical operators and pattern recognition skills. However, generalization skill was developed only for students aged 12 and above. Implications for practice and policy: The findings lay the foundation for designing evidence‐based age‐appropriate CT learning progression and pedagogies.Age‐appropriate learning content: Given appropriate learning experiences, students aged 9 and above may be ready to learn certain CT concepts and skills, including conditionals, logical operators and pattern recognition.CT pedagogies: Using programming and unplugged activities to develop CT requires careful consideration of students' cognitive development and gender needs. [ABSTRACT FROM AUTHOR]

Background: Education for asthmatic children in the outpatient department is insufficient. Aim: To evaluate the efficacy of a nurse‐led education pathway, a standard education programme, on children with asthma. Methods: One hundred and eighty participants enrolled and were randomly assigned to either the control group or the intervention group. The intervention group received predetermined step‐by‐step education sessions based on the self‐designed education pathway, while the control group received usual care. Asthma control, health‐related quality of life, and health‐care utilization measures were taken at baseline and at follow‐up visits between February 2016 and May 2018. Results: Significantly higher scores for health‐related quality of life and inhaler technique at the third‐month visit and asthma control test at the sixth‐month visit were seen in the intervention group. The numbers of unscheduled physician visits and school absences were lower in the intervention group than in the control group within 6 months. However, no significant differences were observed in emergency department visits and hospitalizations. Conclusion: The nurse‐led education pathway could be considered effective for children with asthma visiting the outpatient department. SUMMARY STATEMENT: What is already known about this topic? Education for asthmatic children in the outpatient department is fragmented and insufficient.Previous education programmes only provided information and did not check the patient's mastery of knowledge or assess their living environment.Education based on the clinical pathway has been implemented in emergency departments and inpatient hospitals but not in outpatient departments. What this paper adds? This study displays positive evidence of the effects of a nurse‐led education pathway on asthma control, health‐related quality of life, inhaler technique, and health‐care use.Education incorporating the home environment assessment and telephone consultations can be more beneficial for patients' self‐management of asthma.Children with asthma and their families acquire sufficient education related to improvements in health outcomes and health‐care use. The implications of this paper: This study provides evidence to support the use of a predesigned standard educational programme in children with asthma.This study indicates that education based on the clinical pathway can also be used in outpatient departments for continuity of care.The education pathway in this study provides a comprehensive education model for children with asthma that can also be implemented in other studies through the construction of care pathways adapted to specific diseases. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to evaluate incidences of inappropriate initial urinary catheter placements within an older inpatient cohort. Methods: A total of 200 inpatients that received urinary catheterizations within 24 hours of admission were recruited for this observational study. The key demographic and clinical factors were recorded. Adverse outcomes were assessed by examining incidences of catheter‐associated urinary tract infection (CAUTI) during hospitalization, after transfer to skilled nursing facilities, second, duration of hospital stay and by scoring changes on the Katz Index of Independence in Activities of Daily Living. Correlative relationships between demographic data and clinical factors with adverse outcomes were analyzed. Results: Inappropriate initial urinary catheterization in our cohort was approximately 39%. This was associated with elevated Charlson comorbidity index scores and increased dependency, with correlations to medical diagnosis. We also observed that the primary rationale for the procedure (inappropriate catheterization) was for neurogenic bladder (where intermittent catheterization was indicated) and in 'convenience‐of‐care' catheterizations. Inappropriate catheter placement was ultimately associated with an elevated CAUTI at point of discharge, with transfers to skilled nursing facilities and also with an increased duration of hospital stay. Conclusions: Inappropriate catheter placement was prevalence in southwestern China and associated with adverse outcomes. SUMMARY STATEMENT: What is already known about this topic? Urinary catheterization is a common procedure for geriatric in‐patients, yet up to half of such placements are inappropriately performed.Reducing inappropriate urinary catheter use is key to minimizing adverse outcomes such as urinary tract infection and genitourinary trauma.Although guidelines for in‐patient catheterization have been developed, there are no uniform standardized national guidelines in China that could advise physicians on the placement of inpatient urinary catheters.What this paper adds? High incidences of inappropriate initial urinary catheterizations in mainland China have been reported (as represented by a hospital in southwestern China).This study finds that inappropriate catheter placements are associated with catheter‐associated UTIs at the point of discharge, with transfers to skilled nursing facilities, and an increased duration of stay.We also find that inappropriate catheter placements occur when catheterization is indicated for neurogenic bladder (with intermittent catheterization), and for 'convenience‐of‐care' purposes.The implications of this paper: The study identifies situations where older in‐patients have an elevated risk of receiving inappropriate initial urinary catheterization which should receive special attention.The findings of this study highlight the need to develop effective uniform strategies to reduce inappropriate catheterization for older Chinese patients.The factors associated with inappropriate catheterization based on our findings could be useful in establishing the proactive strategies. [ABSTRACT FROM AUTHOR]

Aim: To assess the attitudes of newly graduated nurses in China toward their work environment and identify the factors affecting their perception. Background: Newly graduated nurses are the primary supply to cover the nursing shortage, but their stressful transition into clinical work has contributed to high turnover for decades. Although serving as a source of stress, the work environment can also be a source of support for new nurses. Methods: A total of 2361 new nurses at 31 tertiary hospitals in 20 provinces were surveyed from June to November 2018, using the Chinese version of the Practice Environment Scale‐Nursing Work Index. Basic information and their perception about work environment were collected. Results: New nurses rated their work environment with an overall score of 84.67 (12.85). Multiple linear regression identified that education level, monthly income, hospital type and location, participation (or not) in standardized training programmes and having (or not) a mentor/preceptor were factors significantly associated with their perception of the work environment. Conclusion: The perception of newly graduated nurses in China was mainly positive overall. Nursing managers may take full advantage of factors affecting the perception of work environment to support newly graduated nurses better, to help their retention and transition. Summary statement: What is already known about the topic? Newly graduated nurses experience transition shock at the beginning of their work.Supportive work environments can help successful transition. What this paper adds? Newly graduated nurses are not fully supported in their work environment.Staffing and resource inadequacy were the poorest environmental factors.Residency programmes had the most impact on the perceptions of newly graduated nurses about their work environment. Implications for nursing practice: These results can guide nursing managers to support the newly graduated nurses better in their transition process, thus helping retention of nursing human resource. [ABSTRACT FROM AUTHOR]

While the use of experiments is important for developing students' scientific knowledge and skills, challenges may arise when teachers and students are conducting experiments in class, such as non‐reusable experimental resources, safety issues and difficulties simulating some specific effects. Augmented reality (AR) technology affords an alternative approach to conducting experiments by bringing students a virtual–real mixed learning environment. In this study, taking junior high school physics knowledge on the magnetic field as an example, we designed and developed an AR‐based mobile simulated experiment tool. This study investigates the effect of the AR‐based experiment on students' knowledge improvement and cognitive load compared with 3D and traditional experiments. A sample of 122 ninth‐grade students was randomly chosen and assigned to three groups (AR, 3D and Traditional). The results demonstrate that students in the AR group performed better than those in the 3D and Traditional groups in terms of their knowledge improvement. The AR group students also experienced the lowest cognitive load among the three groups. Moreover, students had positive perceptions about AR and 3D tools. The implications of this study are discussed. Lay Description: What is already known about this topic: Experiment is an important method for students' magnetic field learning.Traditional magnetic experiment consists of various procedures that may cause some inconvenience during learning.Augmented reality (AR) provides a virtual–real fusion environment to assist teaching and learning.While some studies indicate positive impact of AR on learner's cognitive load, some do not. What this paper adds: An AR‐based mobile simulated experiment tool was proposed based on the junior high school physics knowledge, the magnetic field.A Comparison was made among AR, 3D and traditional experiment for magnetic field learning.Higher knowledge improvement and lower cognitive load were observed in the AR group.3D and Traditional groups showed similar knowledge improvement and cognitive load. Implications for practice and/or policy: The AR design with hand‐held devices has unlimited scalability of educational applications.Serving the real object as marker and using the professional algorithm to simulate some specific phenomenon were recommended in future AR studies.The findings indicated that AR experimental tool had a statistically significant effect on students' knowledge improvement and cognitive load.The similar result between 3D and Traditional groups implies that not everything virtualized is good; we must consider the actual teaching and learning situations. [ABSTRACT FROM AUTHOR]

Computational thinking (CT) plays a vital role in the fields of science, technology, engineering and mathematics (STEM). However, whether students' learning attitude towards STEM is related to their CT skills remains unknown. Two studies were conducted to address this knowledge gap. In Study 1, we validated a newly developed STEM learning attitude scale among a sample of Chinese primary school students (N = 489). Exploratory and confirmatory factor analysis results revealed that the scale which consisted of three factors (mathematics, science and information technology) could sufficiently measure primary school students' STEM learning attitude in the current sample. In Study 2, we explored the association between students' STEM learning attitude and their CT skills. Evidence revealed that learning attitude towards STEM significantly predicted CT skills. We also found that girls had a more positive learning attitude towards STEM than boys, and the fourth grade might be the key period for the development of CT skills. Implications for promoting primary school students' STEM learning and CT skills were also discussed. Lay Description: What is currently known about this topic: Computational thinking (CT) plays a more and more important role in K‐12 education.STEM has become a natural field for integrating CT into classroom.Students' learning attitude determines their performance and achievements.CT is influenced by personal and situational factors. What this paper adds: Reliability and validity of the STEM learning attitude scale are psychometrically good.Students' STEM learning attitude can positively predict their CT skills.Girls may have more potential for the cultivation of CT in STEM education.The fourth grade may be the key period for the development of CT skills. Implications for practice and/or policy: Promoting CT skills in STEM education by improving students' learning attitude.Adopting teaching methods according to students' psychological and cognitive characteristics.Grasping the key stage of fourth grade to develop students' CT skills.Encouraging and protecting girls' interests and ideas in STEM education. [ABSTRACT FROM AUTHOR]

In the increasing pervasiveness of today's digital society, mobile devices are changing the face of education. Students can interact with mobile devices in context‐aware environment. This paper presents a mobile application based on expert system (Plant‐E) for students to acquire knowledge about plant classification by answering decision‐making questions. In order to study effectiveness of Plant‐E and cognitive load of students who experience different kinds of interaction in learning process, another mobile application (Plant‐G) only providing information pages of plants was developed. A quasi‐experiment was conducted with three classes of 137 seventh graders. The three classes, Class A with 46 students using Plant‐E in campus, Class B with 44 students using Plant‐G in campus, and Class C with 47 students using Plant‐G in a traditional classroom, constitute three groups with different interaction complexity. The research conducted pretest, posttest, and delayed test to evaluate learning performance of students in three classes and used a questionnaire to investigate their perceptions and attitudes towards proposed system. Results show that interaction complexity has an impact on students' learning performance and mental effort in mobile learning; the higher the interaction complexity is, the higher mental effort and the better learning performance in mobile learning will be. Lay Description: What is already known about this topic: Mobile devices can be used to meet the urgency of learning need and can provide guidance and clues for learners in context‐aware environment.During mobile learning in context‐aware environment, students need to interact with mobile devices and environment.Mental effort reflects cognitive load related to interaction complexity, and it can affect learning performance.Self‐efficacy affects the degree of mental effort by affecting the firmness of performance goal.Cognitive load and learning performance are the main concerns that need to be considered when evaluating the effectiveness of mobile learning. What this paper adds: Interaction complexity has an impact on students' learning performance and mental effort in mobile learning.In terms of the three levels of interaction complexity in this study, the higher the interaction complexity is, the better the results that students will get in mobile learning.The higher the interaction complexity is, the higher the mental effort that students invested into in mobile learning would be.The medium self‐efficacy group invested the most mental effort and got the best grades, rather than the high or low group.Rule‐based mobile learning expert system is feasible and effective for students to learn by interacting with learning objects in context‐aware environment. Implications for practice and/or policy: Efforts should be made to make mobile learning systems more interactive; for example, learners can learn more effectively by interacting with mobile system, which can improve the frequency of observing learning objects.Rule‐based mobile learning expert system can give learners more opportunities to know how experts do when solving problems and can provide a potential method for students to learn in context‐aware environment. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the mental health status, stressors and self‐adjustment of nurses in isolation wards at different periods in Wuhan, China. Background: Mental health issues easily occurred among the frontline medical workers of a major epidemic. However, the stressors and psychological adjustments experienced by nurses have not been well described. This is crucial to improving clinical quality and nursing safety and ensuring nurses' physical and psychological health. Methods: We performed a cross‐sectional prospective study using the Self Reporting Questionnaire‐20, stressor and self‐adjustment questionnaire administered to frontline nurses in Wuhan at two time points: after they had worked in isolation wards for 7–10 days (T1) and 2 months (T2). This paper complies with the STROBE reporting guideline for cross‐sectional studies. Results: T1 has 92 respondents, and T2 has 86. The positive rates of mental health problems were 26.09% and 9.30%, respectively, showing significantly different in the two periods. The main factors influenced mental health were self‐perceived stress and only child status. The most common stressors were as follows: a large infected population, high infectivity; concerned about family's health status; high mortality if not treated in time (T1); and long duration of the epidemic, separate from family for a long time (T2). In terms of self‐adjustment, 97.83%(T1)/88.04%(T2) of nurses thought it was necessary, but 9(T1) /5(T2) chose to avoid addressing it, and 8(T1) /5(T2) utilised a professional psychological counselling hotline. Conclusions: Mental health problems among frontline nurses fighting COVID‐19 need special attention, so administrators should offer timely counselling and strengthen effective psychosocial support to improve their mental resilience. Relevance to clinical practice: This study surveyed the mental problems and self‐adjustment status among nurses working Wuhan during the outbreak of COVID‐19, to provide administrators with a scientific basis to effectively intervene. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Schizophrenia is a severe and highly stigmatized mental illness. High internalized stigma affects FGs' quality of life and caregiving capacity.Worldwide studies aimed at internalized stigma among patients diagnosed with mental illness or their FGs have reported significant stigma and some correlates, but studies involving FGs that focus on a specific mental illness (e.g. schizophrenia) and report the impact of potential psychosocial variables (e.g. coping and hope) on internalized stigma are limited. What does the paper add to existing knowledge?: Internalized stigma was common among Chinese FGs of patients diagnosed with schizophrenia and half of them presented at a mild level. Internalized stigma was negatively associated with hope and positively associated with passive coping. FGs, who live with patients, have difficulty supervising medication, or care for a male relative has higher internalized stigma. What are the implications for practice?: Regarding informative support, interventions (e.g. enhancing mental health literacy programs and cognitive therapies) to provide knowledge about schizophrenia, the skills to manage patients' adherence to medications, the benefits of treatment and the possibilities of rehabilitation are necessary for FGs. Regarding psychosocial processes, effective interventions (e.g. group psychoeducation and group social skills training) aimed to enhance hope, social support and coping styles towards internalized stigma should be implemented among FGs. Both informative support and psychosocial interventions used to decrease FGs' internalized stigma can be delivered by healthcare providers or by peer caregivers. Introduction: Internalized stigma is prevalent among patients diagnosed with schizophrenia. Their family caregivers (FGs) also suffer from internalized stigma, but limited studies have addressed the issue. Aim: The aim of this study was to determine the severity of internalized stigma and its correlates among FGs of patients diagnosed with schizophrenia in Changsha, Hunan, China. Methods: A consecutive sample of 299 FGs was recruited at the psychiatric outpatient department of a tertiary hospital in Changsha. This study explored the relationships between internalized stigma and potential factors. Results: Nearly 50% of the FGs perceived mild internalized stigma, 24% of the FGs reported moderate level, and 6% had a severe level. Internalized stigma was associated with patients' characteristics (severity of illness) and FGs' characteristics (hope, social support, passive coping, age, education background, residence with the patient, caring for a male or a young patient and difficulty in supervising medication). Discussion and implications for practice: Informative and psychosocial interventions based on education and contact for FGs such as enhancing mental health literacy programs, cognitive therapies and group psychoeducation can provide FGs with a better understanding of schizophrenia and to promote hope, active coping and social support. [ABSTRACT FROM AUTHOR]

An instructor's gestures have an effect not only on students' learning but also on teaching itself. In two experiments, this study tested whether instructors' use of gestures while recording video lectures affected their teaching performance, stress, and cognitive load. In Experiment 1, participants recorded video lectures with gestures or without gestures. As hypothesized, t tests showed that participants in the gestures condition had better teaching performance and lower cognitive load than participants in the no‐gestures condition, whereas there was no effect on stress level. In Experiment 2, participants recorded video lectures with either pointing gestures or representational gestures. The t tests indicated that participants in the pointing gestures condition showed better teaching performance and experienced lower stress than those in the representational gestures condition, but there was no difference in cognitive load. Overall, our findings suggest that in the new educational environment of video lectures, instructors should consider using gestures, especially pointing gestures, to improve their teaching and their experience of teaching. Lay Description: What is already known about this topic Instructors' gestures have benefits on learners' learning.Different types of gestures have different effect.Gestures can affect speaker's cognition. What this paper adds This study explored the effect of whether instructors' gestures and different types of gestures (pointing gestures and representational gestures) during recording instructional videos on their teaching.Instructors' gestures improved their teaching performance, induced cognitive load, and enhanced teaching efficacy.Instructors' pointing gestures were outperformed than representational gestures in teaching performance and stress level. Implications for practice and/or policy Instructors should consider using gestures when recording instructional videos, especially pointing gestures. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the relationship between work engagement and inclusive leadership in Chinese hospital head nurses. Besides, it explored the effect of the mediating role of inclusive leadership in the relationship between work engagement and innovative behaviour among Chinese hospital head nurses. Background: Head nurses are essential in the group of registered nurses who are to pass the Chinese licensure examination for nurses. Their work engagement and innovative behaviour are beneficial to improve the quality, efficiency and competitiveness of nursing services. However, little is known about the mediating role of inclusive leadership in the relationship between work engagement and innovative behaviour. Methods: In April 2018, a total of 374 Chinese head nurses were surveyed with a Work Engagement Scale, an Inclusive Leadership Scale and an Innovative Behavior Scale. Because the data were normally distributed in our study, Pearson's correlation coefficient (r) was used to conduct the correlation analysis of study variables. Multiple linear regression analysis was used to explore the factors of innovative behaviour. Model 4 of Hayes's (2013) PROCESS macro and Bootstrap method was used to examine the mediating role of inclusive leadership. Result: Inclusive leadership was significantly and positively correlated to innovative behaviour and work engagement (p < 0.01). Moreover, work engagement was correlated with innovative behaviour (p < 0.01). In addition, hospital level, publishing papers, work engagement and inclusive leadership were the factors of head nurses' innovative behaviour (p < 0.01). Inclusive leadership partially mediated the relationship between work engagement and innovative behaviour, accordingly. Conclusion: Work engagement affects innovative behaviour among Chinese head nurses, and inclusive leadership is a mediator in the relationship. We should take measures to improve the leaders' level of inclusive leadership, in order to strengthen head nurses' innovative behaviour. Implications for nursing management: According to the results of the study, the leaders of head nurses should pay attention to improve head nurses' innovative behaviour, inclusive leadership, work engagement, and the quality and competitiveness of nursing. [ABSTRACT FROM AUTHOR]

The aim of the study is to assess the feasibility of Drugs Rational Usage Guideline System (DRUGS)-supported clinical pathway (CP) for breast carcinoma, cataract, inguinal hernia and 2-diabetes mellitus whether the application of such a system could improve work efficiency, medical safety, and decrease hospital cost. Four kinds of diseases which included 1773 cases (where 901 cases using paper-based clinical pathways and 872 cases using DRUGS-supported clinical pathways) were selected and their demographic and clinical data were collected. The evaluation criteria were length of stay, preoperative length of stay, hospital cost, antibiotics prescribed during hospitalization, unscheduled surgery, complications and prognosis. The median total LOS was 1 to 3 days shorter in the DRUGS-supported CP group as compared to the Paper-based CP group for all types ( p < 0.05). Totel hospital cost decreased significantly in the DRUGS-supported CP group than that in Paper-based CP group. About antibiotics prescribed during hospitalization, there were no statistically differences in the time of initial dose of antibiotic and the duration of administration except the choice of antibiotic categories. The proportion of DRUGS-supported clinical pathway conditions where a broad-spectrum antibiotic was prescribed decreased from 63.6 to 34.5 % ( p < 0.01) in the Paper-based group. While after the intervention, the differences were statistically not significant in unscheduled surgery, complications and prognosis. In this study, DRUGS-supported clinical pathway for breast carcinoma, cataract, inguinal hernia, 2-diabetes mellitus was smoothly shifted from a paper-based to an electronic system, and confer benefits at the hospital level. [ABSTRACT FROM AUTHOR]

Malaysia is a multi-ethnic country with Malay, Chinese and Indian being the dominant ethnic groups. This paper investigates the three ethnic cultures in Malaysia by examining the individual-level values of managers and professionals. Based on 528 responses to a Schwartz Value Survey ( SVS) questionnaire, the paper identifies partial convergence of the value systems of Malay, Chinese and Indian people. It was found that the three ethnic groups do not differ significantly in the individualistic value dimensions of Self-enhancement and Openness-to-change. However, Malays are found to be more conservative and less self-transcendent than Chinese or Indians, while Chinese and Indians attribute the same importance to these two sets of values. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Studies show that psychological capital (PsyCap) is a protective factor against psychological distress, such as depressive symptoms. However, few have attempted to address the role of coping styles in the relationship between PsyCap and psychological distress., What does this paper add to existing knowledge? Our study found moderate levels of PsyCap among nurses in China. Among the subcategories of PsyCap, optimism and hope were most highly correlated with psychological distress. Psychological distress was positively associated with negative coping and negatively associated with positive coping., This study confirmed the partial mediating effect of coping styles in PsyCap and psychological distress among Chinese nurses. In other words, this study found direct and indirect effects of PsyCap on psychological distress mediated via coping styles., What are the implications for practice? The significant mediating effect of negative and positive coping styles between PsyCap and psychological distress has implications for hospital administrators, especially nurse leaders. Effective strategies should be implemented to improve PsyCap and coping styles among Chinese nurses, and alleviate psychological distress. Optimism and hope should be emphasized in PsyCap investment. Different styles of coping are influenced and modified by teaching and experience. Therefore, it is essential that nurse managers organize educational and training programmes to provide nurses with relative coping knowledge and techniques, and improve their coping ability. Several studies suggest that coping styles are affected by social support. Thus, nurse managers should assist nurses with social support and enhance coping strategies to reduce psychological distress., Abstract Introduction PsyCap includes four categories namely self-efficacy, hope, optimism and resilience. Research has demonstrated that PsyCap and coping styles affect current psychological distress. Nevertheless, few studies have explored the role of coping styles in PsyCap and psychological distress. Aim This study investigated the role of coping styles as a mediator in PsyCap and psychological distress among Chinese nurses. Methods Participants included 538 nurses who completed self-report questionnaires assessing PsyCap, coping styles and psychological distress. Linear regression analyses were used to explore the role of coping styles. Results PsyCap, coping styles and psychological distress were significantly correlated. Among the subcategories of PsyCap, optimism and hope were most highly correlated with psychological distress. Coping styles is a partial mediator of PsyCap and psychological distress. Implications for mental health nursing The significant role of negative and positive coping styles in PsyCap and psychological distress has implications for hospital administrators, especially nurse leaders. Effective strategies should be implemented to improve PsyCap and coping styles among Chinese nurses, to alleviate psychological distress. Optimism and hope should be the focus of the improvement. Different styles of coping are developed from education and experience. Therefore, it is necessary for nurse managers to organize educational and training programmes to improve coping skills among nurses. Studies suggest that coping styles are affected by social support. Thus, nurse managers should also assist nurses with social support and enhance coping strategies to reduce psychological distress. [ABSTRACT FROM AUTHOR]

Autism spectrum disorders (ASDs) are a group of mental illnesses highly correlated with gut microbiota. Recent studies have shown that some abnormal aromatic metabolites in autism patients are presumably derived from overgrown Clostridium species in gut, which may be used for diagnostic purposes. In this paper, a GC/MS based metabolomic approach was utilized to seek similar biomarkers by analyzing the urinary information in 62 ASDs patients compared with 62 non-ASDs controls in China, aged 1.5–7. Three compounds identified as 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (HPHPA), 3-hydroxyphenylacetic acid (3HPA), and 3-hydroxyhippuric acid (3HHA) were found in higher concentrations in autistic children than in the controls (p<0.001). After oral vancomycin treatment, urinary excretion of HPHPA (p<0.001), 3HPA (p<0.005), and 3HHA (p<0.001) decreased markedly, which indicated that these compounds may also be from gut Clostridium species. The sensitivity and specificity of HPHPA, 3HPA, and 3HHA were evaluated by receiver-operating characteristic (ROC) analysis. The specificity of each compound for ASDs was very high (>96%). After two-regression analysis, the optimal area under the curve (AUC, 0.962), sensitivity (90.3%), and specificity (98.4%) were obtained by ROC curve of Prediction probability based on the three metabolites. These findings demonstrate that the measurements of the three compounds are strong predictors of ASDs and support the potential clinical utility for identifying a subgroup of ASDs subjects. [ABSTRACT FROM AUTHOR]

Aims and objectives The primary aim of this study was to examine the correlations between patient and caregiver characteristics with caregiver burden, anxiety and depression in Alzheimer's Disease. Secondary aim was to determine which behavioural and psychological symptoms had the greatest impact on caregiver burden, anxiety and depression in Alzheimer's Disease. Background Caregivers of individuals with Alzheimer's Disease experience high levels of burden, both psychologically and physically. Previous studies have examined caregiver burden, anxiety and depression separately. However, no paper has examined these three psychological conditions simultaneously. Design A cross-sectional design. Methods A total of 310 patients with probable Alzheimer's Disease and their primary caregivers were assessed. Cognitive impairment and neuropsychiatric symptoms were assessed with the Mini Mental State Examination, Montreal Cognitive Assessment, Clock Drawing Test and Neuropsychiatric Inventory, respectively. Caregiver burden, anxiety and depression were assessed with the ZBI, Generalised Anxiety Disorder Scale-7 and Patient Health Questionnaire-9, respectively. Results All 12 neuropsychiatric symptoms in the Neuropsychiatric Inventory were significantly correlated with caregiver burden, anxiety and depression, with the top three neuropsychiatric predictors being depression, apathy and anxiety. Furthermore, higher levels of caregiver anxiety were associated with a longer duration of being a caregiver. Within caregivers, higher levels of depression were independently associated with higher numbers of additional caregivers, lower educational background and being the spouse of the patient. Higher levels of burden were associated with a longer duration of being a caregiver and being the spouse of the patient. Caregiver burden, anxiety or depression were not significantly correlated with hours/day of caring for the patient. Conclusions Caregiver burden, anxiety and depression were significantly correlated with different neuropsychiatric symptoms in the Neuropsychiatric Inventory. Relevance to clinical practice Practitioners are able to identify caregivers at risk for burden, anxiety and depression. Understanding which Neuropsychiatric Inventory symptom is more closely associated with distress in caregivers will help practitioners to be more specific and effective in detecting caregiver distress. [ABSTRACT FROM AUTHOR]

In this paper, we carried out a randomized controlled clinical trial to explore the effect of 12-words-for-life-nurturing exercise on patients presenting with cervical spondylosis. After exercise intervention, the mean VAS and NDI scores of the patients decreased significantly and the scores of BP, VT, and MH in SF-36 Health Questionnaire were significantly higher. Exercise therapy showed significant effect on relieving pain and improving vitality and mental health. The 12-words-for-life-nurturing exercise may be a potential effective therapy for patients with cervical spondylosis. [ABSTRACT FROM AUTHOR]

This research conducted quasi-experiments in four middle schools to evaluate the long-term effects of an intelligent web-based English instruction system, Computer Simulation in Educational Communication ( CSIEC), on students' academic attainment. The analysis of regular examination scores and vocabulary test validates the positive impact of CSIEC, and in most cases, the positive impact is statistically significant. The reliability is ensured by the spectrum of the students from Grade 1 to Grade 3 in three junior high schools and from Grade 1 to Grade 2 in one senior high school, and of the teachers with or without blended learning experience, as well as by the various school locations from rural to urban areas in four provinces of China. The learning content-oriented design and the instant feedback feature of the web-based system, as well as its regular integration into the English class, contributed to its reliable positive effect on students' learning performance in ordinary examinations. This is the research's implication for instructional design. The conclusion of this paper could serve as a reference to the technical feasibility and pedagogical benefit of regular usage of appropriate Computer Assisted Learning system in the mainstream subject of middle schools. The multiple quasi-experiments in divergent school settings to ensure the results' reliability distinguish this research from previous ones that just implemented one single experiment in one school. [ABSTRACT FROM AUTHOR]

Aim: To assess the feasibility, acceptability, and preliminary efficacy of a culturally sensitive nurse‐led structured education programme for patients with type 2 diabetes. Background: A nurse‐led satisfactory diabetes education programme might be feasible. The structured education programme is considered a potential model that helps patients manage diabetes. Design A mixed‐method design. Methods: A convenience sample of 44 participants received the programme. Feasibility was assessed using the recruitment rate and the retention rate. Acceptability was assessed by interviews to obtain the perception and experience of participants. Also, preliminary efficacy on diabetes knowledge, self‐efficacy, self‐management behaviours, and clinical outcomes was assessed. Finally, data were collected from April to December 2015. Results: The recruitment rate and the retention rate were acceptable. Participants thought that the programme contributed to their positive changes. They enjoyed and accepted the programme, and they wanted to gain the ongoing support. Significant improvements in diabetes knowledge, self‐efficacy, self‐management behaviours, A1C, fasting blood glucose, low‐density lipoprotein cholesterol, weight, body mass index, and waist circumference were reported in 12‐week follow‐up. Conclusions: This programme is feasible and acceptable, and its preliminary efficacy is promising. Ongoing support, a control group, and long‐term follow‐up are required in future studies to assess its effectiveness. SUMMARY STATEMENT: What is already known about this topic? Unsatisfactory diabetes education and a shortage of general practitioners may promote the poor management of patients with type 2 diabetes.Structured education programmes for patients with type 2 diabetes could improve biomedical, psychological, and lifestyle outcomes.A structured education programme for patients with type 2 diabetes without receiving insulin therapy was developed in mainland China. What this paper adds? The structured education programme is feasible and exhibits high preliminary efficacy.Participants received the structured education programme and experienced positive change.Participants hope to gain the ongoing support to maintain self‐management behaviours. The implications of this paper: The study indicates that nurses can use this programme to help patients manage diabetes.The programme can be applied in regular clinic care and generalized to other community health service centres.The results can provide some guidance for the further assessment of the effectiveness of the programme. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to evaluate the health‐related quality of life of nursing workers and influential factors. Background: Nursing workers are under great occupational stress. However, few population‐level studies of nursing workers' health conditions have been reported from China. Design This was a cross‐sectional study conducted in 12 medical institutions in east China between January and March 2015. Methods: Social‐demographic information, nursing workers' work‐related information and health‐related quality of life using the Chinese (mainland) version of the Short Form 36 health survey were collected by a self‐administrated questionnaire. Results: Nursing workers reported significantly lower scores of the vitality, mental health dimensions, and mental component summary of the Short Form 36 survey compared with general population reference values. They scored significantly higher for five other dimensions and comparably for the physical role dimension. Pre‐job training, families' positive attitudes to their job, and good relationships with clients were positively related with nursing workers' mental well‐being. Conclusion: To promote nursing workers' mental health, compulsory work‐related training, voluntary psychological counselling, and targeted legislation are needed. SUMMARY STATEMENT: What is already known about this topic? Shortages of professional medical staff in medical institution at all levels will not be quickly met, and nursing workers are thought to be an important supplement in China.Population‐level study on nursing workers' point of view of their work and health condition has been little reported in China. What this paper adds? Nursing workers were mentally vulnerable regarding their vitality and mental health scores.Job training, families' positive attitudes to their job, and good relationships with clients were all protective factors for nursing workers' mental well‐being. The implications of this paper: Compulsory work‐related training for nursing workers provided by intermediary companies can help promote nursing workers' well‐being.Voluntary psychological counselling provided by hospitals can also be helpful to build a supportive work environment for nursing workers.Governments need to regulate this market and protect nursing workers' rights and benefits by legislation. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: The lateral root of Aconitum has been popularly used in traditional Chinese medicine (TMC) known as Fuzi which is beneficial for the treatment of various diseases, such as rheumatism, painful joints, syncope and bronchial asthma. However, it has a potential carditoxicity with a relatively narrow margin of safety. Aim of the study: This paper was designed to explore the mechanisms of Fuzi's toxicity and find out potential tissue-specific biomarkers of toxic effects. Material and methods: A myocardial lipidomics based on ultraperformance lipid chromatography coupled with quadrupole-time-of-flight mass spectrometry (UHPLC/Q-TOF MS) was developed to compare three cardiac lipid extraction methods and investigate the changes of lipids in mice heart of three different dosage groups. In addition, we concurrently inspected the biochemical parameters in plasma, observed the histology of the heart and recorded the electrocardiogram (ECG). Results: The cardiotoxicity of Fuzi was dose-dependent, and the high-dose group obviously manifested the heart damage in histology and a certain degree of arrhythmia. Significant changes of 14 lipid metabolites which primarily involved in phospholipid metabolism, sphingolipid metabolism, saturated fatty acid oxidation and unsaturated fatty acid peroxidation were identified and considered as the potential biomarkers of Fuzi toxicity. Conclusion: The lipidomics approach is helpful to search potential tissue-specific biomarkers and understand the underlying mechanisms of Fuzi toxicity on the heart. [Copyright &y& Elsevier]

Aims This study examines the preliminary outcomes of an intervention targeting service providers in methadone maintenance therapy ( MMT) clinics in China. The intervention effects on both service providers and clients are reported. Design The MMT CARE intervention pilot was developed and implemented collaboratively with local health educators. After three group intervention sessions, trained providers in intervention clinics delivered two individual motivational interviewing sessions with their clients. Settings Six clinics in Sichuan, China, were randomized to either the MMT CARE intervention condition or a standard care condition. Participants A total of 41 providers and 179 clients were sampled from the six clinics. Measurements At baseline and three-, six-, and nine-month assessments, providers completed self-administrated paper/pencil questionnaires regarding provider-client interaction, MMT knowledge, perceived job-related stigma and clinic support. Clients completed a face-to-face survey about their concurrent drug use and drug avoidance self-efficacy. Mixed-effects regression models with clinic-level random effect were used to assess the intervention effects. Findings Significant intervention effects for providers were found in improved MMT knowledge, provider-client interaction and perceived clinic support. For clients, better improvements in drug avoidance self-efficacy and reduced concurrent drug use were observed for the intervention compared with the standard care group. Conclusions The MMT CARE intervention targeting providers in methadone maintenance clinics can improve providers' treatment knowledge and their interaction with clients. The intervention can also reduce clients' drug-using behavior through motivational interviewing sessions conducted by trained providers. [ABSTRACT FROM AUTHOR]

Background. The characteristics of treatment based on syndrome differentiation (TBSD) cause great challenges to evaluate the effectiveness of the clinical methods. Objectives. This paper aims to evaluate the influence of physician to personalized medicine in the process of TBSD. Methods. We performed a randomized, triple-blind trial involving patients of primary insomnia treated by 3 physicians individually and independently. The patients (n = 30) were randomly assigned to receive treatments by the 3 physicians for every visit. However, they always received the treatment, respectively, prescribed by the physician at the first visit. The primary outcome was evaluated, respectively, by the Pittsburgh Sleep Quality Index (PSQI) and the TCM symptoms measuring scale. The clinical practices of the physicians were recorded at every visit including diagnostic information, syndrome differentiation, treating principles, and prescriptions. Results. All patients in the 3 groups (30 patients) showed significant improvements (>66%) according to the PSQI and TCM symptoms measuring scale. Conclusion. The results indicate that although with comparable effectiveness, there exist significant differences in syndrome differentiation, the treating principles, and the prescriptions of the approaches used by the 3 physicians. This means that the physician should be considered as an important factor for individualized medicine and the related TCM clinical research. [ABSTRACT FROM AUTHOR]

Hypertension is a common disease affecting millions of people throughout the world. Currently, there is a growing interest in the traditional Chinese medicine (TCM) for patients with hypertension mainly due to the personalized therapy of TCM in many countries. Clinical treatment of patients relies on the successful differentiation of a specific TCM syndrome for hypertension. However, it is difficult to understand that TCM syndrome classifications depend on the clinical experience of a TCM practitioner. Therefore, discovering an objective biomarker associated with TCM syndrome may be beneficial for TCM syndrome classifications. This paper focused on high sensitivity C-reactive protein (HCRP), matrix metallopeptidase 9 (MMP9), and TCM syndrome, and aimed to investigate the relationships between TCM syndrome and the two inflammatory biomarkers in patients with essential hypertension. The result showed that both HCRP and MMP9 are positively correlated with syndrome of wind and phlegm turbidity. Detection of the serum levels of HCRP and MMP9 is beneficial for TCM syndrome classification and prediction of cardiovascular and cerebrovascular risk events in hypertensive patients. [ABSTRACT FROM AUTHOR]

Abstract: During the past three decades, an estimated 200 million rural residents have moved to urban centers in China. They are “sojourners” in the cities and maintain close ties with their home communities, which we term trans-local ties. This paper examines the relationship between migrants'' social ties and their mental health, and contrasts the trans-local ties with migrants'' ties in the receiving communities, which are termed local ties. We expect that for the migrants, trans-local ties foster better mental health not only through providing emotional support but also through generating favorable social comparisons; whereas local ties may furnish important social support, but may also produce negative social comparisons. We use data collected in Shanghai to test our expectations. We compare the migrants to a sample of Shanghai natives to assess patterns of relationship between social ties and mental health that are unique to the migrants. We find that for the migrants, more numerous trans-local ties are associated with better mental health, whereas the number of local ties is not a significant predictor. This pattern is not observed among the Shanghai natives. Moreover, for migrants, trans-local ties foster a favorable evaluation of their status in Shanghai and buffer their perception of discrimination; in contrast, more numerous local ties tend to be associated with a more negative perception of social status. The findings highlight an often-overlooked pathway between social ties and health outcomes, namely, through influencing social comparison and perceived social status. This study also suggests that in addition to reducing institutional and personal discrimination, facilitating close bonds between the migrants and their home communities may be a productive way to foster their well-being, in the context of contemporary urban China. [Copyright &y& Elsevier]

Abstract: Background: As cardiovascular diseases have become the leading cause of death in many countries including China, nurses are increasingly required to be abreast of technological advances and the skills necessary to manage this increasing health care problem. Chinese nurses are under pressure to provide skilled electrocardiography monitoring, and be sufficiently skilled to detect myocardial ischemia and infarction, in this large patient population. This presents a challenge for the nursing profession in China, particularly for nurses working in coronary care in a country where advancement has been so rapid, yet little research has been conducted or reported in the literature. Objectives: The two main objectives were: to explore the demographic and educational factors that affect the use of ST-segment monitoring and correct electrode placement by CCU/ICU nurses in China; and to explore the factors both individual and institutional that affect monitoring and lead placement. Methods: A self-administered questionnaire was distributed to nurses in 126 randomly selected tertiary hospitals, which were stratified into three homogeneous regions across China. The instrument examined demographics, information about hospitals, electrocardiogram devices, current practice patterns and perceptions toward monitoring and lead placement. Data from 734 nurses and 59 nurse managers from 59 hospitals were analyzed using t-tests, ANOVA, Chi-square test and logistic regression. Results: Electrocardiogram monitoring was used to detect myocardial ischemia by 43.7% of respondents, and 35.1% selected leads according to electrocardiogram or angiography findings. Most (70%) agreed that monitoring for acute coronary syndrome was important, while 39.2% did so, and 15.7% were able to identify correct placement. Logistic regression revealed a significant relationship between the uses of ST-segment monitoring and number of hospital beds, continuing education and a belief in its use and ease of use. Correct electrode placement was significantly correlated with respondents from university hospitals, hospitals with more acute coronary syndrome admissions and more independent thinking nurses. Conclusions: Despite best practice evidence, less than half of the sample used electrocardiogram monitoring to detect myocardial ischemia and the majority could not identify correct electrode placement, while ST-segment monitoring was not used routinely. This paper highlights the need for improvements in education both in universities and hospitals and discussion addresses conventions in units, which inhibit development of nurses’ skills. [Copyright &y& Elsevier]

Abstract: Aims: This paper is aimed to develop and validate the hypertension scale of the system of Quality of Life Instruments for Chronic Diseases, QLICD-HY. Methods: The QLICD-HY instrument was developed based on programmed decision procedures with multiple nominal and focus group discussions and pilot testing. A total of 157 inpatients with hypertension were used to provide the data measuring QOL three times before and after treatment. The psychometric properties of the scale were evaluated with respect to validity, reliability and responsiveness employing correlation and factor analyses, and t-tests. Results: Correlation and factor analyses confirmed good construct validity and criterion-related validity when using Short Form (36) Health Survey (SF-36) as a criterion. Test–retest reliability coefficients (Pearson r and intra-class correlation (ICC)) for the overall instrument score and all domains except for the hypertension-specific domain (SPD) (0.75) were higher than 0.80 with a range of 0.75–0.91; the internal consistency α for all domains except for the hypertension-specific domain (0.66) was higher than 0.70. The overall score and scores for most facets within each domain except for the social domain (SOD) had statistically significant changes (t-tests) after treatment with moderate effect sizes. Conclusion: QLICD-HY has good validity, reliability, responsiveness and can be used as the quality-of-life instrument for patients with hypertension. [Copyright &y& Elsevier]

Background: Previous studies in the world reported inconsistent results about the relationship of medical professional education with medical students' smoking behaviors, and no similar research had been published in China. Purpose: This paper aims to explore whether the differences of smoking-related knowledge, attitudes, and behaviors existed between medical and non-medical undergraduate students. Methods: Eight thousand one hundred thirty-eight undergraduate students sampled from a university in Guangzhou were investigated with a self-administered structured questionnaire about their smoking-related knowledge, attitude and behaviors, and other relevant factors. General linear model and multinomial logistic regression were conducted to test the differences in smoking-related knowledge, attitude, and behaviors between medical and non-medical students while controlling for potential confounding variables. Results: There was no difference in smoking-related knowledge scores between medical and non-medical freshmen, but medical sophomores and juniors had higher scores of smoking-related knowledge than their non-medical counterparts. The medical sophomores had higher mean score of attitudes towards smoking than non-medical ones. Before entering university, the difference in the prevalence of experimental and regular smoking between medical and non-medical college students was not significant. After entering university, in contrast, the overall prevalence of regular smoking was significantly higher among male non-medical college students than among male medical students. Stratified by current academic year, this difference was significant only among male sophomores. Conclusions: Medical students have higher smoking-related knowledge, stronger anti-smoking attitude, and lower prevalence of regular smoking than non-medical college students of similar age, which may be associated with medical professional education. [ABSTRACT FROM AUTHOR]

Background. Acute coronary syndromes (ACSs) are clinically cardiovascular events associated with dyslipidemia in common. Single nucleotide polymorphisms (SNPs) and haplotypes in the APOA1/C3/A5 gene cluster are associated with diabetes and familial combined hyperlipidaemia (FCH). Little is known about whether the polymorphisms in these genes affect lipid homeostasis in patients with ACSs. The present paper aimed to examine these associations with 4 SNPs in the APOA1 -75G > A, the APOC3 -455T > C, and APOA5 -1131T > C, c.553G > T variant to ACSs in Chinese Han. Methods. Chinese Han of 229 patients with ACSs and 254 unrelated controls were analyzed. Four SNPs in APOA1/C3/A5 cluster were genotyped and lipid was determined. Results. Our data show that minor allelic frequencies of APOC3 -455T > C, APOA5 -1131T > C, and c.553G > T polymorphisms in patients with ACSs were significantly higher than control group (P < 0.05). Furthermore, the 3 polymorphic sites were strongly of linkage disequilibrium, and minor alleles of 3 SNP sites had higher TG level than wild alleles (P < 0.05), APOC3 -455C and APOA5 c.553T allele carriers also had lower level of HDL-C. Conclusions. The minor alleles of APOC3 -455T > C, APOA5 -1131T > C, and c.553G > T polymorphisms are closely associated with ACSs. [ABSTRACT FROM AUTHOR]

The article presents a research paper which investigates the association between physical activity during pregnancy and GWG of Chinese urban pregnant women. For the study, a pregnant women cohort was established between 2005 and 2007 in Changzhou, China and physical activity levels of pregnant women were assessed using pedometer in the 2nd and 3rd trimester respectively. The study suggests that pregnant women being physically active have less weight gain during pregnancy.

Aim: The aim of the study was to explore the impact of nurse workloads on adherence to hand hygiene. Background: Adherence to hand hygiene and nursing workloads have been linked to quality of patient care. Therefore, it was important to understand the relationship to safe patient care. Design This cross‐sectional study was performed from January 2016 to June 2016. Methods: Workloads and adherence to hand hygiene for nurses on 3‐day shifts in a tertiary hospital were investigated in 2016. Actual hours worked per shift were timed using a stopwatch to assess nursing workloads. Descriptive and inferential statistics and multiple variable regression analysis were used to analyse the data. Results: Sixty‐four nurses from four wards were observed. The average adherence rate of hand hygiene was 26.6% and the average nursing workload per shift was 6.7 hours. Multiple regression revealed that nursing workload was negatively related to adherence rate of hand hygiene. Conclusion: Nurses in this study that had a low rate of adherence with hand hygiene frequently had high workloads. Adherence to hand hygiene was independently associated with actual hours worked per shift. SUMMARY STATEMENT: What is already known about this topic? Adherence to proper hand hygiene by nurses is one of the most effective and efficient ways to prevent the spread of hospital‐acquired infections and the dissemination of multi‐antimicrobial resistance.Adherence to hand hygiene among clinical nurses has been continually substandard and nurses' high workload is their most common self‐reported reason for nonadherence.High workloads are a common problem worldwide because of the shortage of nurses. What this paper adds? Nurses on surgical wards worked long hours.Adherence to hand hygiene was negatively related with nursing workloads.Nurses prefer hand washing to alcohol‐based hand rub for hand hygiene. The implications of this paper: In the general ward, high workloads pose barriers to adherence to hand hygiene, and any improvement efforts should be considered in this context.In general, increased numbers of patients are to be cared for lead to more opportunities for hand hygiene, but this heavy workload contributes to a lack of adequate time to perform proper hand hygiene, with a resulting decrease in adherence to hand hygiene.This study highlights the need for improvement programmes focusing on the quality and adherence rates for proper hand hygiene.Measuring adherence rates with hand hygiene and nursing workloads are helpful for both proper allocation of nursing resources and enhancement of patient safety. [ABSTRACT FROM AUTHOR]