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A marriage of convenience has been defined as a reciprocal relationship between a gay man and a lesbian that provides a way to cope with social, cultural, family, and political stress, but this definition may be oversimplified in explaining this type of reciprocal relationship in a guanxi (the system of social networks and influential relationships that facilitate business and other dealings) society such as China. Such relationships are undergoing a process of development and change rather than remaining stable in Chinese guanxi society. This paper explores the nature and process of the development of marriages of convenience between gay men and lesbians in China. The data were collected and analyzed according to the grounded theory method. A theoretical sampling strategy was employed, and a sample of 15 people involved in so‐called marriages of convenience was recruited from gay and lesbian communities in China. In our research, we found that the marriage relationships documented in this study included four stages: (1) men dang hu dui (being matched for marriage), (2) partnership, (3) friendship, and (4) kinship. Building a suitable relationship in a marriage of convenience can help gay men and lesbians meet social expectations while simultaneously retaining a degree of autonomy for their own homosexual identities. Maintaining and developing guanxi is a basic method of conflict resolution in Chinese society. Meanwhile, the ambiguity of the relationship within a marriage of convenience may cause conflict in these marriages. Treatment modalities are recommended to reorganize the system structuring these marriages and clarify ambiguous family boundaries by redefining who is in the family unit and his and her associated roles and responsibilities in the marriage of convenience. We conclude that more research is warranted to investigate how family therapy can be adapted for Chinese gay and lesbian individuals. [ABSTRACT FROM AUTHOR]

Background: Medical insurance and social security cards are an important incentive for the floating population to live a stable life in their current residence, but there has been little studies on their effect on settlement intentions. Therefore, the purpose of this paper was to study the impact of basic medical insurance for urban employees and application for personal social security cards on the settlement intentions of the floating population. With the increase of the desire to settle, the health management and the development of public health will be improved. Methods: Based on the 2017 survey data from the dynamic monitoring of China's floating population, we explored the influence of basic medical insurance for urban employees and social security cards on the floating population's settlement intentions. Additionally, this study also examined the comprehensive causal relationship, with social integration as the mediator variable. We used SPSS 21.0 software. The input method was used to analyze the influence of the above variables by binary logistic regression. Then we used AMOS22.0 software to establish the structural equation model of the relationship between the above three independent variables. Finally, we used bootstrapping method to analyze the direct effect, indirect effect and total effect of independent variables on settlement intention. Results: The settlement intention of members of the floating population after participating in basic medical insurance for urban employees was 23.2% higher than that of those who did not participate. The decision as to whether to apply for a personal social security card is related to their settlement intention. The standardized regression coefficients among social insurance and security, social integration, and settlement intention were positive values, and the Z values of the overall effect, indirect effect, and direct effect were all greater than 1.96; the confidence interval of the indirect effect did not include 0. We found that this model is a partial intermediary model, with an intermediary ratio of 10.66%. Conclusions: This article highlights the important impact of basic medical insurance for urban employees and individual social security cards on the floating population. The conclusions of this study provide suggestions for the government to use when designing policies to enhance the settlement intentions of the floating population and to improve the development of public health undertakings. [ABSTRACT FROM AUTHOR]

Background: The shift towards integrated care (IC) represents a global trend towards more comprehensive and coordinated systems of care, particularly for vulnerable populations, such as the elderly. When health systems face fiscal constraints, integrated care has been advanced as a potential solution by simultaneously improving health service effectiveness and efficiency. This paper addresses the latter. There are three study objectives: first, to compare efficiency differences between IC and non-IC hospitals in China; second, to examine variations in efficiency among different types of IC hospitals; and finally, to explore whether the implementation of IC impacts hospital efficiency. Methods: This study uses Data Envelopment Analysis (DEA) to calculate efficiency scores among a sample of 200 hospitals in H Province, China. Tobit regression analysis was performed to explore the influence of IC implementation on hospital efficiency scores after adjustment for potential confounding. Moreover, the association between various input and output variables and the implementation of IC was investigated using regression techniques. Results: The study has four principal findings: first, IC hospitals, on average, are shown to be more efficient than non-IC hospitals after adjustment for covariates. Holding output constant, IC hospitals are shown to reduce their current input mix by 12% and 4% to achieve optimal efficiency under constant and variable returns-to-scale, respectively, while non-IC hospitals have to reduce their input mix by 26 and 20% to achieve the same level of efficiency; second, with respect to the efficiency of each type of IC, we show that higher efficiency scores are achieved by administrative and virtual IC models over a contractual IC model; third, we demonstrate that IC influences hospitals efficiency by impacting various input and output variables, such as length of stay, inpatient admissions, and staffing; fourth, while bed density per nurse was positively associated with hospital efficiency, the opposite was shown for bed density per physician. Conclusions: IC has the potential to promote hospital efficiency by influencing an array of input and output variables. Policies designed to facilitate the implementation of IC in hospitals need to be cognizant of the complex way IC impacts hospital efficiency. [ABSTRACT FROM AUTHOR]

With the increased popularity of mobile learning, there is a growing demand on the understanding of how the scalable technology, such as mobile devices, influences individual learning behaviours as well as their learning outcome. A theoretical model was built based on the adaptive structuration theory (AST) and the knowledge spiral theory. Using this model, we examined the relationship between structural sources, individuals' adaptive structural behaviours, and their perceived learning. A Structural Equation Modeling method was employed in our empirical study. Findings indicate that users' task adaptation had a positive influence on their perceived learning, In addition, their exploitive technology adaptation influenced the ultimate perceived learning, but the impact of users' exploratory technology adaptation on learning was mediated by their task adaptation. Contrary to expectations, the effect of computer self-efficacy on exploitive and exploratory technology adaptation was negative, and exploratory technology adaptation negatively affected exploitive task adaptation. A detailed discussion of the findings and implications are provided in this paper. [ABSTRACT FROM AUTHOR]

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

Digital competence is critical for university students to adapt to and benefit from digitally enhanced learning. Prior studies on its measurement mostly focus on educators and relied on factor analyses. However, there is a lack of valid and convenient tools to measure university students' digital competence. This study aimed to develop a digital competence scale for university students (DC‐US) in digitally enhanced learning with robust psychometric properties. An initial DC‐US with 23 items was proposed to measure the single latent trait of digital competence. It was validated and refined continuously through a pilot study, a main study and a predictive validity study in three datasets involving 825 participants altogether, using factor analyses, Rasch analyses and the partial least squares modelling. The final DC‐US turned out to comprise two subscales: technical literacy and digital skills, with 10 items retained, and manifested high internal consistency, unidimensionality and measurement invariance. The scale also demonstrated strong predictive validity, with technical literacy greatly predicting digital skills, which negatively predicted technostress. The DC‐US enables instructors and school administrators to conveniently obtain preliminary information of university students' digital competence, informing their digital class preparation and development of timely interventions for addressing digital deficiencies. Lay Description: What is already known about this topic?: Digital competence is critical for university students to adapt to and benefit from digitally enhanced learning (DEL).There is a lack of valid and convenient tools to measure university students' digital competence.Prior studies on its measurement mostly focus on educators and relied on factor analyses. What this paper adds?: A unidimensional, valid and unbiased digital competence scale was developed for university students.Rasch analyses and classical test theory were employed jointly for the scale development.The digital competence scale comprised two subscales: Technical literacy and digital skills. Implications for practice: University students can use the scale for a quick self‐assessment of their digital competence before joining DEL.Instructors can use the scale to gain an initial knowledge of their students' digital competence to inform digital class preparation.University administrators can rely on the scale to quickly evaluate the implementation effectiveness of DEL schemes. [ABSTRACT FROM AUTHOR]

Aim: This research aimed to explore the level of hope and symptom burden of breast cancer women undergoing chemotherapy, and predictive factors of hope were also investigated. Background: Chemotherapy brings physical and psychological stress to breast cancer patients. As an effective coping strategy, hope gives them the courage to overcome difficulties and improve prognosis and survival. Therefore, efforts are needed to raise hope. Design/Methods: A total of 450 women who were undergoing breast cancer chemotherapy participated in this cross‐sectional study. Sociodemographic data, disease characteristics, and measures of hope and symptom burden were collected using questionnaires. Hope was assessed using the validated Herth Hope Index, and the previously validated Memorial Symptom Assessment Scale was used to assess symptom burden. This paper adhered to the STROBE guidelines. Results: Chinese breast cancer chemotherapy women hope average scores of 30.15 ± 4.82 were in the medium range of the Hearth Hope Index as specified by Herth to be 24–35. Patients with age ≤45, religious beliefs and lighter symptom burden have a higher level of hope. These variables explained a total of 22.9% of the variation in hope. Conclusions: The level of hope for women undergoing breast cancer chemotherapy still needs to be further improved. Symptom burden can negatively predict hope. Relevance to clinical practice: If nurses can decrease breast cancer chemotherapy women symptom burden, there is an impact on increasing levels of hope. [ABSTRACT FROM AUTHOR]

Background: Most existing research on rural–urban health inequalities focuses on disparities in service access and health outcomes based on region. This paper examines rural–urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China. Methods: Utilizing administrative data from the Public Maternal Health Insurance scheme, we analyzed 54,733 live births in City A (2015–2019) and 25,849 live births in City B (2018–2019) in Guangdong Province in China. We constructed regression models using hukou status (rural versus urban) as the explanatory variable. Results: While there is no statistically significant difference in rural and urban mothers' probability of obtaining the minimum recommended number of prenatal care checkups in City A (OR = 0.990 [0.950, 1.032]), mothers with rural hukou status have a lower probability of obtaining the minimum recommended number of visits in City B than their counterparts with urban hukou (OR = 0.781 [0.740, 0.825]). The probability of delivering in tertiary hospital is lower among mothers with rural hukou than among those with urban hukou in both cities (City A: OR = 0.734 [0.701, 0.769]; City B: OR = 0.336 [0.319, 0.354]). Mothers with rural hukou are more likely to have a Cesarean section than those with urban hukou in both cities (City A: OR = 1.065 [1.027, 1.104]; City B: OR = 1.127 [1.069, 1.189]). Compared with mothers with urban hukou, mothers with rural hukou incurred 4 % (95 % CI [-0.046, -0.033]) and 9.4 % (95 % CI [-0.120, -0.068]) less in total medical costs for those who delivered via Cesarean section and 7.8 % (95 % CI [-0.085, -0.071]) and 19.9 % (95 % CI [-0.221, -0.177]) less for those who delivered via natural delivery in City A and City B, respectively. Conclusions: Rural hukou status is associated with younger age, no difference or lower probability of having a minimum number of prenatal checkups, higher likelihood of delivering in nontertiary hospitals, increased Cesarean delivery rates, and lower medical cost for delivery in these two Chinese cities. Evaluating how hukou status influences maternal healthcare in Chinese cities is important for devising targeted public policies to promote more equitable maternal health services. [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]

Accessible summary: What is known on the subject?: The attributes of readiness for hospital discharge (RHD) have been identified to be physical stability, adequate support, psychological ability, and adequate information and knowledge.Patient‐reported RHD has been regarded as an outcome indicator, and poor RHD leads to unplanned readmission, emergency department visits and even death.Knowledge regarding patient‐reported RHD and its factors among patients with depression is limited. What the paper adds to existing knowledge?: RHD among patients with depression is at a moderate level.More than a quarter of people with depression had low RHD.The knowledge dimension of the RHDS among patients with depression should be further strengthened.The length of stay, content received and delivery dimensions of the QDTS were significantly associated with RHD. What are the implications for practice?: This study encourages nurses to assess patient‐reported RHD at discharge in mental health settings.Nurses should pay more attention to patients with hospital stays longer than 20 days.Nurses could improve RHD by enhancing the quality of discharge teaching, particularly the content received and the skills nurses used to deliver such content.Nurses' managers could develop programmes to improve teaching skills via Internet technology, such as simulated patients and online interprofessional discharge planning. Introduction: Low readiness for hospital discharge (RHD) can be followed by negative healthcare outcomes. However, no studies have investigated RHD among patients with depression. Aim: This study aimed to examine patient‐reported RHD and its factors among patients with depression. Method: In total, 367 inpatients with depression were recruited and completed the Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). A binary logistic regression analysis was performed to explore the factors of RHD among patients with depression. Results: The total RHDS score was 7.70 ± 1.52. Approximately 28.9% of the participants had low RHD (RHDS score < 7). The results revealed that RHD was significantly associated with the length of stay, content received and delivery. Discussion: RHD among patients with depression is at a moderate level. More than a quarter of people with depression had low RHD. To improve RHD, enhancing the quality of discharge teaching is imperative for patients with depression. Implications for Practice: Nurses should pay more attention to patients with a hospital stay longer than 20 days. Nurses could improve RHD by enhancing the quality of discharge teaching, particularly the content received and the skills nurses used to deliver such content. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: Low utilization of the family‐oriented community rehabilitation services is a threatening challenge facing low‐ and middle‐ income countries.Family caregiver's trust in community healthcare providers is the precondition of service utilization and is shaped by their perceived quality of primary healthcare services from previous experience.Most of the studies concerning the relationship between perceived quality and institutional trust were conducted in western countries, resulting in limited attention paid to conditions in non‐western countries. Which aspect of quality predicts institutional trust in China has not been studied yet. What the paper adds to existing knowledge: In China's context, institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence.Significant rural–urban disparity was observed: among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief; institutional trust was only associated with worry relief in urban respondents. What are the implications for practice: Mental health nurses training or working with community healthcare workers may improve their technical and communicative competence. Priorities may differ between rural and urban areas.Mental health nurses or community healthcare workers may provide more family‐oriented psycho‐education to rural families, and more emotional support to urban families.Wider public anti‐stigma initiatives are needed to reduce the affiliated stigma of families of persons diagnosed with a severe mental illness. Introduction: Prior studies suggested that caregiver's trust in community healthcare providers is the precondition of the utilization of community‐based rehabilitation services and is shaped by their perceived quality of primary healthcare services. Nevertheless, the research conducted in non‐western countries is scarce, and which aspect of quality is associated with institutional trust in China has not been studied. Aim: To explore the association between perceived quality of primary healthcare services and institutional trust in China's context. Methods: This cross‐sectional study was conducted with 796 family caregivers from Eastern, Central and Western China between August 2018 and October 2019. Perceived quality of primary healthcare services was measured by technical competence, communication, worry relief and risk of privacy leak. Results: Institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence. Among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief. Contrary finding was observed in urban respondents. Discussion and implications for practice: With rural–urban disparity considered, strategies such as improving the technical and communicative competence of community healthcare workers, providing family‐oriented psycho‐education and emotional support, and promoting public anti‐stigma initiatives may be worth consideration. [ABSTRACT FROM AUTHOR]

Background: After achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI). Methods: We employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity. Results: From 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results. Conclusions: In the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI. [ABSTRACT FROM AUTHOR]

Background: This paper tries to describe prevalence and patterns of antibiotics prescription and bacteria detection and sensitivity to antibiotics in rural China and implications for future antibiotic stewardship. Methods: The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. It used mixed-methods comprising non-participative observations, exit-survey and microbiological study. Observations were conducted to record clinical diagnosis and antibiotic prescription. Semi-structured questionnaire survey was used to collect patient's sociodemographic information and symptoms. Sputum and throat swabs were collected for bacterial culture and susceptibility testing. Results: A total of 1068 (51.0% male vs 49.0% female) patients completed the study with diagnosis of respiratory tract infection (326,30.5%), bronchitis/tracheitis (249,23.3%), pharyngitis (119,11.1%) and others (374, 35.0%). They provided 683 sputum and 385 throat swab specimens. Antibiotics were prescribed for 88% of the RTI patients. Of all the specimens tested, 329 (31%) were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24% in all specimens), H. influenza (16%), H. parainfluenzae (15%), P. aeruginosa (6%), S.aureus (5%), M. catarrhalis (3%) and S. pneumoniae (2%). Conclusions: The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China. It reveals that prescription of antibiotics, especially broad-spectrum and combined antibiotics, is still very common and there is a clear need for stewardship programs aimed at both reducing the number of prescriptions and promoting single and narrow-spectrum antibiotics. [ABSTRACT FROM AUTHOR]

Objectives: This paper studies the institutional inequality that exists in the prevalence of diabetes and hypertension, as well as their diagnosis and medication management, between urban and rural residency status (hukou) holders in China. Methods: Exploiting the Chinese Health and Nutrition Survey, we primarily demonstrate that while a lower proportion of rural residency holders suffer from diabetes and hypertension, a larger proportion have never been diagnosed with these conditions and do not take medicine to control them. We explore the determinants of these disparities by the non-linear decomposition method. Results: Decomposition results illustrate that a large part of disparities in the prevalence of diabetes and hypertension can be explained by the differences in demographic structure and occupational socio-economic status. Regarding the ruralurban disparity in the under diagnosis and under-medication rates, the differences in demographic structure, household affluence, occupational socio-economic status and consumption patterns make the greatest contributions. Conclusions: This evidence suggests that improving the institutional economic inequality and enhancing the occupational mobility of rural residency holders are of paramount importance to mitigate any inequality in health and healthcare utilisation. [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]

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

Objective: This paper aims to explore the determinants of the online health information seeking (OHIS) and usage (OHIU) behaviours of consumers based on the perceived benefits and costs of such activities. Methods: This study applies questionnaires and empirical research methods. A questionnaire is designed according to the hypothesis model. A total of 282 questionnaires are obtained from patients and their accompanying families in two large hospitals, and the SPSS 17.0 and AMOS 17.0 (IBM, Almond, NY, USA) software are used to analyse the sample data and to test the research models. Results: Three key findings are obtained from the analysis. Firstly, functional, learning, social and personal integrative benefits positively affect the OHIS intent of consumers. Secondly, cognitive costs negatively influence the OHIU behaviour of consumers. Thirdly, personal integrative benefits and OHIS behaviour significantly influence the OHIU behaviour of consumers. Conclusion: This paper highlights the differences between OHIS and OHIU based on their impact factors and applies social exchange theory to understand such factors. Online health information providers must improve the ease of use of their websites or applications, enhance the quality of their health information and focus on their functionality. [ABSTRACT FROM AUTHOR]

Highlights • This paper explores the effects of four dimensions of social exclusion on self-rated health and depression among older people in China. • Lower level of exclusion from social relationships was associated with less likely to report fair or poor SRH. • Lower level of subjective feelings of exclusion was associated with less likely to report fair or poor SRH. • Lower level of subjective feeling of exclusion was associated with less likely to report depression. • Lower level of exclusion from financial products was associated with less likely to report depression. Abstract Background It is well established that social exclusion is a key social determinant of health; however, such association between social exclusion and health outcomes among older people remain a relatively under-researched area. This paper explores the effects of four dimensions of social exclusion on self-rated health and depression among older people in China. Methods This paper includes 8038 individuals aged 60 and over from the first wave national multi-stage probability sample (2014) from the China Longitudinal Aging Social Survey (CLASS). Descriptive univariate information for individual variables and four dimensions of social exclusion are presented. Multinomial and binary logistic regression models are used to examine the associations between social exclusion and self-rated health and depression. Results Older people who were in the lower level of exclusion from social relationships or subjective feelings of exclusion were significantly less likely to report fair or poor self-rated health than people in the higher level of exclusion (lower level of exclusion from social activities was significantly associated with being less likely to report poor SRH only). Older people who were in the lower level of subjective feeling of exclusion or exclusion from financial products were significantly less likely to report depression. Conclusions Different dimensions of social exclusion have different effects on self-rated health and depression. Social policies need to reflect this and efforts of services could usefully be oriented to prevent multi-dimensions of social exclusion. Ultimately, such policies should have the potential to enhance the health of older people in China. [ABSTRACT FROM AUTHOR]

In spite of the potentials promised by MOOCs (massive open online courses), the adoption rate of MOOCs is still low, especially in developing countries. Research on the adoption of MOOCs in developing countries is also limited. To fill this research gap, this research aims to study the adoption of MOOCs by extending current research on innovation and technology adoption in order to promote the diffusion of MOOCs in developing countries. Here, a conceptual framework, technology–user–environment was proposed to identify influential drivers and barriers of MOOC adoption. Eight hundred and twenty‐seven individuals in a developing country, were invited to participate in a questionnaire survey. Data were analysed by hierarchical regression, and the results show that for the (a) technological characteristics, perceived usefulness has the most significant influence, followed by lack of accessibility and performance‐to‐cost value; for the (b)user factors, self‐regulation was the most significant predictor of MOOC adoption, and female learners showed higher willingness to adopt MOOCs; and for the (c) social environmental factors, tradition and social norms and lack of information about MOOCs were negatively associated with adoption of MOOCs. Implications and suggestions are discussed at the end of this paper. Lay Description: What is already known about this topic: MOOCs (massive open online courses), as educational innovations, are supposed to bridge the digital divide and promote educational equity globally.The benefits of MOOCs for learners are obvious.However, the adoption rate of MOOCs is still relatively low while the dropout rate is high, especially in developing countries.Research on the adoption of MOOCs in developing countries is still limited.What this paper adds: This research proposed a conceptual framework, namely, technology–user–environment, in order to identify influential drivers and barriers from the technological characteristics of MOOCs as well as the user and the social environmental factors.After conducting a survey among 827 learners in a developing country, it was found that perceived usefulness of MOOCs, performance‐to‐cost value, and self‐regulation are positively associated with learners' intention of adopting MOOCs, whereas lack of accessibility tradition and social norms and lack of supporting information are negatively associated with their intention of MOOC adoption.Implications for practice and/or policy: For MOOC content provider, it is necessary to enhance the usefulness of MOOCs, as perceived usefulness is ranked as the strongest predictor of MOOC adoption.Universities in developing countries should help students overcome the potential obstacles at the beginning of MOOC learning by providing instructions to learners to search for course materials and how to use MOOCs to supplement their formal learning.Governments of developing countries are encouraged to be involved and support the development and delivery as well as the usage of MOOCs. Such participation by active stakeholders in developing countries has potential to bridge the digital divide between developed and developing countries.For learners, they should be equipped with self‐regulating strategies so that they will be competent to manage challenges (e.g., distractions) while learning in MOOCs. [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]

Traditionally, Chinese families have been the primary provider of care for older adults, and older people expected family care. However, along with the modernization and demographic transition, family functions have been weakened, and state-based care has begun to play an essential role in supporting family care for older people. This paper aims to assess the care preferences of older people and the different responsibilities of individuals and communities in modern China. Using data from the 2014 China Longitudinal Aging Social Survey (CLASS) and multinomial logistic regression modeling, we find that family care remains the cornerstone for older adults and their care preferences are associated with individual and community factors, mainly including the number of children, education level, residential area, the presence of health infrastructure and care facilities, and the values associated with filial piety of older adults. [ABSTRACT FROM AUTHOR]

This paper considers the impact of variables at three different levels—city, community and individual—on the depression of adults aged 45 years and above in China. Evidence shows that community factors, such as infrastructure and elderly centres, are critical to reduce depression but the effect of city-level factors such as lowering income inequality and improving public health investment is different for the segments of poor and non-poor as well as the rural and urban residents. This highlights the need to consider targeted policy mix options to avoid resource misallocation. Lastly, Chinese females' depression has worsened over time with ageing, particularly those who drink alcohol or are less educated are prone to depression prompting the need for specialist women health centres. [ABSTRACT FROM AUTHOR]

Background: China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time. Methods: We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China's overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February. Results: There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas. Conclusions: By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities. [ABSTRACT FROM AUTHOR]

The aim of this paper is to track the whereabouts of basic old-age insurance (BOI) contribution subsidies. Little research has paid attention to the misalignment between the implementation objects of subsidy policies and the actual beneficiaries. In recent years, local governments in China have followed a contribution subsidy policy to help persons with disabilities (PWDs) with lower life expectancies. This study applied an actuarial model to calculate the leakage rate of the BOI contribution subsidy. The primary data are from the life tables of the entire population and PWDs in K province in China in 2015. It was found that, under different booking interest rates, 35.27%–61.26% of the contribution subsidy for PWDs in the individual account will be inherited by their heirs, and under different discount rates, 18.21%–68.74% in the pooling account will be enjoyed by non-disabled participants. The policy of BOI contribution subsidy for PWDs failed to account for the shorter average life expectancy and the lower average income of PWDs and would result in a welfare loss for PWDs. Therefore, it was suggested that it should be replaced by a non-contributory pension policy for PWDs. • Track the whereabouts of basic old-age insurance (BOI) contribution subsidies. • Built an actuarial model to calculate the leakage rate of contribution subsidy. • 35%–61% of the contribution subsidy for PWDs will be inherited by their heirs. • 18%–69% in the pooling account will be enjoyed by non-disabled participants. [ABSTRACT FROM AUTHOR]

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

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]

Aim: This paper is a report of a study exploring the relationship between stoma acceptance and stoma care self‐efficacy in patients with colostomy and whether self‐disgust and stigma play mediating roles in this relationship. Design: A cross‐sectional survey design. Method: In all, 476 participants were recruited from a tertiary hospital and completed structured, anonymous, self‐report measures of stoma acceptance, self‐disgust, stigma, and stoma care self‐efficacy between January 2016‐March 2017. Results: Stoma acceptance was significantly negatively associated with personal disgust (r = −.640, p<.001), behavioural disgust (r = −.384, p<.001), and stigma (r = −.309, p<.001) and significantly positively associated with stoma care self‐efficacy (r =.689, p<.001). Furthermore, regression‐based mediation modelling showed that personal disgust and stigma had significant mediating effects on stoma acceptance and stoma care self‐efficacy. Conclusion: We demonstrated, for the first time, that emotional responses (self‐disgust and stigma) play important roles in the association between stoma acceptance and stoma care self‐efficacy. Addressing concerns about emotional disorder should become part of the routine care for patients with stoma. Impact: Patients with colostomy must cope with many challenges and undergo profound changes in daily life. Acceptance of the existence of the stoma and effective management of the stoma can aid patients in the return to a full and active life. Illness acceptance and psychological states have been widely reported to be correlates of the ability to successfully reconstitute a meaning of life, but these have not been specifically explored in patients with colostomy. This study examined the effect of stoma acceptance on stoma care self‐efficacy with the mediation role of self‐disgust and stigma. Evidence of the relationship between illness acceptance and self‐efficacy could offer practitioners to consider emotional factors like self‐disgust and stigma when aiming to improve stoma care and management. [ABSTRACT FROM AUTHOR]

In recent years, it has become common to use the internet or computer tutoring with a programme or application for additional instruction (ICTPAAI), in addition to the mandatory school schedule. This study aimed to understand students' participation in ICTPAAI and its relation to academic achievement. Multilevel structural equation modelling was conducted on a sample comprising 6,425 Chinese students (Mage 15.72 years; 48.9% girls) who had various forms of additional instruction during the 2014/2015 school year. Results showed that the use of information and communication technology (ICT) to complete schoolwork, whether in school or outside of school, was positively associated with students' participation in ICTPAAI; however, students' ICT interest, ICT self‐efficacy and ICT autonomy were not. Students' participation in ICTPAAI was negatively associated with their academic achievement at the end of the school year; much variance was explained at the school level. These findings suggest that students should be cautious about participating in this form of additional instruction and that schools play an important role in students' participation in ICTPAAI. Lay Description: What is already known about this topicWhen having more ICT opportunities at and outside of schools and higher ICT propensities, students are more likely to participate in ICT‐related learning activities.Students with higher achievement motivation are more likely to be involved in learning activities.ICT use at school and outside of school may not improve students' academic achievement.What this paper addsICT opportunities at and outside of school, and student gender link to participation in internet and computer tutoring with a programme or application for additional instruction (ICTPAAI), but ICT autonomy, ICT self‐efficacy, ICT interest and achievement motivation do not.More variance of participation in ICTPAAI were explained at the school level than at the student level.ICTPAAI negatively associates with academic achievement.Implications for practice and/or policySchools play an important role in students' participation in ICTPAAI.Students, at least Chinese students, should be cautious about participating in ICTPAAI.Pay more attention to boys to prevent them from spending too much time on ICTPAAI. [ABSTRACT FROM AUTHOR]

Background: China is becoming an aging society at the fastest pace in history, and there are a large number of empty nesters in the country. With economic and social development, internal support systems among families are gradually weakening. Supporting the elderly is thus emerging as a significant issue, and promoting digital health technologies is an effective way to help address it. Encouraging the application of Internet to elderly care and Internet use among the elderly are important means of promoting digital health technologies. This paper examines the current state of the use of the Internet by the elderly and factors influencing it (including physical, psychological, and social) as well as demand among the elderly for smart services.Methods: A total of 669 subjects over the age of 60 years were randomly selected from 13 cities in Heilongjiang province and surveyed using questionnaires from May 1 to July 31, 2018. The questionnaires were collected for descriptive statistics, the chi-square test, and the analysis of influential factors.Results: Of the people surveyed, 38.6% used the Internet. Their favorite online activity was online dating (74.2%), and the health information they obtained through the Internet was mainly related to diet (63.1%) and exercise (47.1%). The subjects demanded smart bracelets (MD = 2.80) and emergency callers (MD = 2.77). Gender, age, education, monthly income, quality of life, number of friends, and social participation were found to have an impact on Internet use.Conclusions: More measures are needed to reduce barriers to the use of the Internet and promote digital health technologies. The society, equipment manufacturers, and family members of the elderly should work together to enable them to reap the benefits of online technologies. [ABSTRACT FROM AUTHOR]

Previous research on plagiarism has increased awareness and knowledge of the various aspects of this issue, such as contributing factors to plagiarism, students' and teachers' perceptions of plagiarism, and institutional policies and regulations on plagiarism. Yet much of this research, especially on the latter two aspects, has been conducted in Anglo-American contexts or English-as-a-second-language (ESL) settings (where English is an official or important language in the larger societal context), while the diversity of English-as-a-foreign-language (EFL) contexts (where English as a foreign language is largely used only in the language classroom) remains relatively under-researched. Of those studies that did focus on EFL contexts, the majority were based on survey data that were limited in the depth of information collected. To address this relative lack of in-depth understanding of how plagiarism is understood and acted against in EFL contexts, this paper reports on an interview study with 13 EFL teachers from 12 universities in mainland China. The study focused on the teachers' knowledge and attitudes concerning plagiarism, plagiarism-related pedagogical practices, as well as perceived stances and expectations of their institutions in plagiarism prevention. Its findings contribute to the current knowledge base of EFL academics' views and practices regarding plagiarism, add to our understanding of EFL teachers' experiences concerning plagiarism in specific educational settings, and inform institutions' efforts to develop and improve strategies and policies for preventing plagiarism. [ABSTRACT FROM AUTHOR]

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

Background: Over the last decade, the expenditure on public medical and health has increased greatly in China, however, problems as low efficiency and unfairness still exist. How to accurately describe the effectiveness of existing medical and health resources in combination with regional heterogeneity is of great significance to China's medical and health reform. Methods: Based on provincial panel data for the period of 2005 to 2017, combining expected output and unexpected output, this paper constructs a super-efficiency three-stage SBM-DEA model, to measure and analyze the spatial-temporal heterogeneity characteristics and influencing factors of public medical and health efficiency (PMHE). Results: (1) After the impacts of random error and external environmental factors are removed, the mean value of overall PMHE is 0.9274, failing to reach DEA efficiency, and PMHE shows a fluctuated downward trend. (2) The adjusted PMHE level shows a prominent spatial imbalance at the stage 3. The average efficiency level is ranked by the East > the West > the Central > the Northeast. (3) The increases of GDP per capita and population density are beneficial to the improvement of PMHE, while income level and education level are disadvantageous to PMHE, and last, the urbanization level, an uncertain effect. (4) There is no σ convergence of the PMHE in the East, the Central and the West, that is, the internal differences may gradually expand in the future, while the Northeast shows a significant σ convergence trending of PMHE. (5) The state's allocation of medical and health resources has undergone major changes during "The Twelfth Five-Year Plan". Conclusion: This study innovatively incorporates undesired outputs of health care into the efficiency evaluation framework by constructing the main efficiency evaluation indicators. The results of the robust evaluation conclude that China's existing investment in medical and health resources is generally not effective. Therefore, although China's health care reform has made certain achievement, it is still necessary to expand the investment in health care resources. [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]

Microblogs are revolutionising the way users produce, consume and distribute short content. The continuous content contributions of users are crucial for the sustainable development of microblogs. Knowledge regarding this user behaviour is scarce. Based on the uses and gratifications theory (U&G) and the social influence theory (SIT), this paper proposes an integrated research model with the aim of understanding the factors that affect users' continuous content contribution behaviours (CCCB) on microblogs. The data were collected from 379 microblog users in China. The empirical results indicate that perceived gratification had a positive but surprisingly trivial effect on continuous content contribution behaviours. Social influence had a strong and significantly positive effect on users' CCCB, it also had a positive moderating effect on the relationship between perceived gratification and CCCB. Users' perceived gratification was positively affected by the antecedents of self-expression, anticipated extrinsic rewards and anticipated reciprocity but negatively affected by privacy concerns. The platform attributes of microblogs (i.e. accessibility and interactivity) also influenced users' perceived gratification. This research contributes to social media research with regards to the theory of users' CCCB. [ABSTRACT FROM AUTHOR]

Aim: This paper explored the general phenomenon and psychological experience of the special background communication in night shift medical staff and provides better reference for night shift communication between doctors and nurses. Background: Physician–nurse communication has always been an important agenda for health care work and an important concept in nursing theory. During night shifts, effective doctor and nurse communication can enhance mutual trust, provide timely and appropriate medical services to patients, reduce adverse events and enhance patient safety. Design: A qualitative study was conducted. Methods: Husserl's descriptive phenomenology method and semi‐structured in‐depth interviews were used to collect data from 8 nurses and 5 doctors. Colaizzi's method was used to analyse data using MAXQDA 12. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was followed (see Appendix S1). Results: Three themes were extracted after sorting out and refining: the need to achieve goals in night‐time physician–nurse communication; obstacles in night‐time physician–nurse communication; and relationship culture in night‐time physician–nurse communication. Conclusion: Attention should be paid to the particularity of night shift and efficiency of achieving the goal of communication between doctors and nurses on night shift, and the hidden obstacles behind communication between doctors and nurses. Managers should pay attention to the cultural construction of night shift communication in the system, form a good night shift communication process and regularly train doctors' and nurses' related communication skills. And they should also study relationship culture rationally to improve the communication efficiency of night shift. Implications for nursing management: The experiences described in this study contribute to a better understanding of obstacles hidden behind night shift physician–nurse communication. This also provides valuable information to professional managers who develop good doctor–nurse relationship culture. [ABSTRACT FROM AUTHOR]

Chronic insomnia is a disease which brings intense mental pain and disturbing complications to patients worldwide. The oral microbiome exhibits a mechanistic influence on human health. Therefore, it is crucial to understand the oral microbial diversity in insomnia. Tongue diagnosis has been considered a critical basic procedure in insomnia therapeutic decision-making in Traditional Chinese Medicine (TCM). Hence, it is significant to elucidate the various oral microbiome differences in chronic insomnia patients with different tongue features. In this paper, we used 16S rRNA gene sequencing and bioinformatics analysis to investigate dynamic changes in oral bacterial profile and correlations between chronic insomnia patients and healthy individuals, as well as in patients with different tongue coatings. Moreover, the relationship between the severity of insomnia and oral microbiota was explored. Our findings showed that chronic insomnia patients harbored a significantly higher diversity of oral bacteria when compared to healthy controls. More importantly, the results revealed that the diversity and relative abundance of the bacterial community was significantly altered among different tongue coatings in patients but not in healthy individuals. Oral bacteria with a relative abundance > 1% and P < 0. 0 5 among different tongue groups were considered remarkable bacteria, which included three phyla Proteobacteria, Bacteroidetes, Gracilibacteria, and four genera, Streptococcus, Prevotella_7, Rothia, and Neisseria. Our findings indicate that changes in oral microbiome correlate with tongue coatings in patients with chronic insomnia. Thus, the remarkable microbiome may provide inspiration for further studies on the correlation between tongue diagnosis and oral microbiome in chronic insomnia patients. [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]

Background: Lesbian, gay and bisexual (LGB) people often face individual- and system-level barriers in health care. However, LGB people's experiences of health care in non-European and non-American settings have been scarcely studied. In China, while it has been estimated that there are at least 70 million gender and sexual minorities, there has been no larger-scale study on LGB people's experiences of health care beyond a focus on gay men and HIV. This study is the first larger-scale quantitative study to investigate LGB people's experiences of health care in China, where non-heterosexuality is officially silenced and the needs of non-heterosexual people are largely ignored by service providers. Methods: An online survey was designed in joint partnership by academic, community groups and the United Nations Development Programme. Targeted and snowball sampling was adopted for participant recruitment. Such unique cross-sectoral partnership made this research possible in the authoritarian state of China where data collection on LGB people is extremely rare. For the analysis in this paper, a sample of 15,611 Chinese LGB people were included. Frequency and descriptive statistics were conducted to describe the LGB respondents' demographic characteristics and their experiences in health care settings. Chi-square tests were conducted to test how experiences vary across LGB people with different demographic characteristics. Results: More than three quarters of the respondents said they would be willing to disclose to their medical care providers their sexual orientation if asked. However, only 5.7% of the respondents said that medical care providers ever asked them about their sexual orientation. About 8.0% of the LGB people surveyed reported having experienced negative treatment in medical care settings. Six percent (5.7%) of the Chinese LGB people said in accessing mental health care services, they were recommended, coaxed into, or provided conversion therapy for sexual orientation, gender identity or gender expression. Conclusions: There is a strong need to enhance LGB cultural competence among health care providers. Policymakers in China should also formulate laws, policies, regulations, clearly articulated codes of conduct, and transparent procedures and practices to ensure non-discrimination of LGB people in the health care system, with a particular focus on banning conversion therapy. [ABSTRACT FROM AUTHOR]

Background: The Chinese government has established a nationwide multiple-level medical insurance system. However, catastrophic health expenditure (CHE) causes great harm to the quality of life of households and pushes them into poverty. The objective of this paper is to assess the effect of medical insurance on CHE in China and compare the financial protection effects of different medical insurances. Methods: Panel data were obtained from China Family Panel Studies (CFPS) conducted in the years of 2012, 2014, and 2016. CHE incidence was measured by performing a headcount, and its intensity was estimated using overshoot and mean positive overshoot (MPO). In addition, concentration index (CI) was used to measure the degree of socioeconomic inequality of CHE occurrence. Furthermore, random effects panel Probit regression model was employed to assess the effect of medical insurance on CHE. Lastly, random effects panel Logit regression model was adopted to perform a robustness check. Results: From 2012 to 2016, the total CHE incidence jumped from 15.05% to 15.24%, and the CI in CHE changed from − 0.0076 to − 0.1512. Moreover, the total overshoot increased from 0.0333 to 0.0344, while the total MPO grew from 0.2213 to 0.2257. Furthermore, the global regression results show that residents covered by Supplementary Medical Insurance (SMI) were linked to a decreased probability of experiencing CHE. In addition, the regression results by gender indicate that SMI coverage for male residents had a significant effect on the prevention of CHE, while the effect was not significant for female residents. The regression results by health status show that SMI had a significant impact on reducing the likelihood of CHE occurrence for healthy residents, whilst the impact was not significant for unhealthy residents. Lastly, the robustness check results were consistent with those of previous findings. Conclusion: The results of this study suggest that CHE incidence and intensity became relatively higher among households. In addition, CHE occurrence was concentrated among the poorer households and the equality status worsened. Moreover, financial protection effects of the four medical insurance schemes against CHE varied significantly. Furthermore, the protection effect of SMI against CHE shows significant gender and health status disparities. [ABSTRACT FROM AUTHOR]

In order to realize the automatic epileptic seizure detection, feature extraction and classification of electroencephalogram (EEG) signals are performed on the interictal, the pre-ictal, and the ictal status of epilepsy patients. There is no effective strategy for selecting the number of channels and spatial filters in feature extraction of multichannel EEG data. Therefore, this paper combined sparse idea and greedy search algorithm to improve the feature extraction of common space pattern. The feature extraction can effectively overcome the repeating selection problem of feature pattern in the eigenvector space by the traditional method. Then we used the Fisher linear discriminant analysis to realize the classification. The results show that the proposed method can get high classification accuracy using fewer data. For 10 subjects, the averaged accuracy of epilepsy detection is more than 99%. So, the detection of an epileptic seizure based on sparse features using Fisher linear discriminant analysis classifiers is more suitable for a reliable, automatic epileptic seizure detection system to enhance the patient's care and the quality of life. [ABSTRACT FROM AUTHOR]

Aims: To test the direct effects of different surface acting strategies and the interactive effects of surface acting and recovery experiences on nurses' well‐being. Design: A two‐wave study design. Methods: Chinese hospital nurses (N = 372; 47.3% of initial sample) reported on their levels of surface acting, recovery experiences and well‐being using a paper and pencil survey in November 2017 and November 2018. Findings: Surface acting has long‐term effects on nurses' well‐being. Compared with positive expression, negative suppression generally tends to show more negative effects. Recovery experiences play a buffering role in the surface acting – nurses' well‐being relationship. Conclusion: These findings offer initial evidence for long‐term effects of surface acting and show how hospital nurses can avoid adverse effects of surface acting through fostering recovery experiences. Impact: Surface acting is a chronic stressor, having long‐term effects on nurses' well‐being. In contrast to positive expression, negative suppression has more detrimental impacts. Recovery experiences play a protective role by alleviating the adverse effects of surface acting. Managers and individuals are advised to differentiate distinct surface acting strategies. Managers should try best to facilitate employee recovery. Hospital nurses are well recommended to train themselves by adopting several recovery programmes. [ABSTRACT FROM AUTHOR]

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

Background: Lack of physical activity is a growing problem in China, due to the fast economic development and changing living environment over the past two decades. The aim of this review is to summarize the factors related to physical activity in Chinese children and adolescents during this distinct period of development. Methods: A systematic search was finished on Jan 10th, 2017, and identified 2200 hits through PubMed and Web of Science. English-language published studies were included if they reported statistical associations between factors and physical activity. Adapted criteria from the Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) statement and evaluation of the quality of prognosis studies in systematic reviews (QUIPS) were used to assess the risk of bias of the included studies. Related factors that were reported in at least three studies were summarized separately for children and adolescents using a semi-quantitative method. Results: Forty two papers (published 2002-2016) were included. Most designs were cross-sectional (79%), and most studies used questionnaires to assess physical activity. Sample size was above 1000 in 18 papers (43%). Thirty seven studies (88%) showed acceptable quality by methodological quality assessment. Most studies reported a low level of physical activity. Boys were consistently more active than girls, the parental physical activity was positively associated with children and adolescents' physical activity, children in suburban/rural regions showed less activity than in urban regions, and, specifically in adolescents, self-efficacy was positively associated with physical activity. Family socioeconomic status and parental education were not associated with physical activity in children and adolescents. Conclusions: The studies included in this review were large but mostly of low quality in terms of study design (cross-sectional) and methods (questionnaires). Parental physical activity and self-efficacy are promising targets for future physical activity promotion programmes. The low level of physical activity raises concern, especially in suburban/rural regions. Future research is required to enhance our understanding of other influences, such as the physical environment, especially in early childhood. [ABSTRACT FROM AUTHOR]

Computational thinking (CT), the ability to devise computational solutions for real‐life problems, has received growing attention from both educators and researchers. To better improve university students' CT competence, collaborative programming is regarded as an effective learning approach. However, how novice programmers develop CT competence through collaborative problem solving remains unclear. This study adopted an innovative approach, quantitative ethnography, to analyze the collaborative programming activities of a high‐performing and a low‐performing team. Both the discourse analysis and epistemic network models revealed that across concepts, practices, and identity, the high‐performing team exhibited CT that was systematic, whereas the CT of the low‐performing team was characterized by tinkering or guess‐and‐check approaches. However, the low‐performing group's CT development trajectory ultimately converged towards the high‐performing group's. This study thus improves understanding of how novices learn CT, and it illustrates a useful method for modeling CT based in authentic problem‐solving contexts. Lay Description: What is already known about this topic: Computational thinking competence includes computational concepts, computational practices, and computational perspectives.Collaborative programming has the potential to foster computational thinking competence development.What this paper adds: The low‐performing student group adopted a bottom‐up perspective at the beginning but transformed to a top‐down approach by the end.The low‐performing group's computational thinking development trajectory had convergent evolution towards the high‐performing group's trajectory.Implications for practice and/or policy: Computational thinking competence can be developed in collaborative contexts even when students begin with a bottom‐up approach.Computational thinking should go beyond the cognitive development of computational concepts to connect computational practice and computational identity.Quantitative ethnography approach has potential to model computational thinking competence in collaborative programming context. [ABSTRACT FROM AUTHOR]

Close links between students' conceptions of and approaches to learning were established in the past research. However, only a few quantitative studies investigated this relationship particularly with regard to mobile learning (m‐learning). The correlation between learners' conceptions and approaches to m‐learning was analysed using a partial least squares analysis applied to data obtained from a sample of 971 undergraduate students in China. The results indicated that students' conceptions of m‐learning could be classified into reproductive, transitional, and constructive levels. Students may hold multiple m‐learning applications than a predominant one; hence, examining m‐learning as one monolithic entity may provide limited information. Latent profile analysis identified four learning profiles based on students' preferred m‐learning applications: passive, mixed, surface‐supportive, and high‐engagement.. Moreover, a general trend was observed, whereby students with reproductive and surface‐supportive learning profiles showed a tendency to adopt surface approaches, whereas those expressing constructive and mixed learning profiles were more inclined to adopt deep approaches. Interestingly, students with transitional conceptions and high‐engagement learning profiles tended to take both surface and deep approaches. Lay Description: What is already known about this topic Previous studies have confirmed that conceptions of learning are closely linked with approaches to learning that tend to influence on learning performance.Conceptions of ubiquitous learning/mobile learning (m‐learning) appeared a hierarchy, ranging from reproductive to constructivist conceptions. What this paper adds This study indicated that students' conceptions of m‐learning can be classified into reproductive, transitional, and constructive levels. Accordingly, the results of the latent profile analysis revealed four learning profiles that were able to characterize students in terms of their critical applications of m‐learning, namely, the high‐engagement, mixed, surface‐supportive, and passive m‐learning profiles.A general trend was observed, whereby students with reproductive and surface‐supportive learning profiles showed a tendency to adopt surface approaches, whereas those expressing constructive and mixed learning profiles were more inclined to adopt deep approaches. Interestingly, students with transitional conceptions and high‐engagement learning profiles tended to take both surface and deep approaches. Implications for practice and/or policy The structure relationship between conceptions of and approaches to m‐learning and the role of different m‐learning profiles in approaches to m‐learning deepened the understanding of m‐learning processes and outcomes.In order to develop suitable approaches to m‐learning and motivations specific to Chinese educational context, college educators and teachers might consciously guide students to cultivate their perceptions of m‐learning based on the findings in this study. [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]

A semantic diagram tool is proposed in this study in order to structure collaborative problem solving (CPS) based on cognitive load theory (CLT). To investigate its effects on transaction cost and the deepening of user understandings, a comparative quasi‐experiment was designed and conducted with 49 participants from a university in East China. Analysis of group dialogic acts and self‐reported cognitive load showed that a semantic diagram tool can decrease transaction costs during CPS. It can thereby help collaborators invest less effort into those procedural conversations that are necessary for managing social interaction but which do not directly contribute to deepening collaborative learning in the task domain. Data analysis of pretested and posttested domain understanding suggested that learners achieved a greater depth of understanding after CPS supported by the semantic diagram tool. These findings are interpreted in terms of CLT. A semantic diagram tool can release the learner's limited working memory from procedural conversation, creating more working memory capacity for deepening problem understanding. Therefore, this study demonstrates one means whereby a semantic diagram tool functions as a promising technological support to structure CPS. Lay Description: What is already known about this topic: Group coordination and communication are conducted with a cost, which may impede learning.From the point of cognitive load theory, deep learning would occur when extraneous cognitive load is reduced to its minimal in the learning context.External representations have a positive effect on the cognitive and social dimensions of learning.What this paper adds: Semantic diagram tools can decrease transaction costs during collaborative problem solving (CPS) learning process.Semantic diagram tools can deepen student understanding during CPS.Implications for practice and/or policy: Semantic diagram tools with conceptual and sociocognitive support of CPS are a promising way to stimulate deep learning.The combination of CLT and sociocultural theory is a promising way to deepen our general theoretical understanding of social interactions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the incidence rate of nephrotoxicity in Tripterygium wilfordii Hook. f (TwHF) preparations approved by the China Food and Drug Administration and the potential risk factors. Methods: CENTRAL, PubMed, SinoMed, Chinese National Knowledge Infrastructure, VIP, China Important Conference Papers Database, China Dissertation Database, and online clinical trial registry websites were searched for articles that reported on nephrotoxicity of TwHF preparations until November 23, 2017. There was no limitation for study design. Results: A total of 36 articles involving 2,017 participants were included. Results showed that the incidence of nephrotoxicity associated with TwHF preparations was 5.81% (95% confidence interval: 4.43–7.57). Subgroup analysis showed that the disease type, combined medication, duration, and study design were not correlated with the incidence of nephrotoxicity. Conclusion: The incidence rate of nephrotoxicity in TwHF preparations was 5.81%. The possible risk factors, such as disease type, the combination with other drugs, medication time, and study design, were not found to be correlated with the incidence of nephrotoxicity. However, due to the limited number of included articles, the limited sample size, and the poor methodology quality, the incidence rate of nephrotoxicity of TwHF preparations might be overestimated, and more prospective articles are needed to explore the potential influence factor. [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]

Aims and objectives. To describe nurses' perceptions concerning their professional practice environment in mainland China and identify factors associated with these views. Background. Globally, the environments in which nurses work influence the quality of nursing practice and health care. Design. A cross-sectional descriptive survey using both paper- and online-based delivery modes was used. Method. A convenience sampling method was used. The survey questionnaire was composed of sociodemographic items and the 38-item Chinese version of Professional Practice Environment survey. The content of the paper-based questionnaire was identical to the online survey. Pearson's chi-square test was conducted to compare the demographic characteristics of these two data sets. Descriptive statistics analysis included frequency, percentage, mean and standard deviation. Multiple linear regression analysis using the Backwards method was applied to identify independent predictors of each subscale of the 38-item Chinese version of Professional Practice Environment. Results. A total of 573 questionnaires were analysed. The mean score of each subscale of the 38-item Chinese version of Professional Practice Environment in this study ranged from 2-66-3-05. All subscales except work motivation (3-05, standard deviation: 0-44) scored less than 3-0. Areas rated as most in need of improvement included control over practice, interpersonal interaction, supportive leadership and handling conflict, and staff relationships with physicians and autonomy. Conclusion. This study has identified nurses' perspectives regarding their workplaces in contemporary China. These data have provided an important baseline for developing and implementing culturally appropriate strategies to improve the working environment of Chinese nurses. Relevance to clinical practice. A supportive and enabling work environment promotes professional development and the safety and quality of health care. Addressing these factors is important in optimising work place environments. [ABSTRACT FROM AUTHOR]