Search

Background: At the beginning of the 21st century, international adoptions of children with cleft lip and/or palate increased dramatically in Sweden. Many children arrived partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. To date, the speech development of internationally adopted (IA) children has been described up to age 7–8 years, but later development remains unstudied. Aims: To investigate speech development between ages 5 and 10 years in children born with cleft lip and palate (CLP) adopted from China and to compare them with non‐adopted (NA) children with CLP. A secondary aim was to compare the frequencies of secondary palatal surgery and number of visits to a speech and language pathologist (SLP) between the groups. Methods & Procedures: In a longitudinal study, 23 IA children from China were included and matched with 23 NA children born in Sweden. Experienced SLPs blindly reassessed audio recordings from routine follow‐ups at ages 5 and 10 years. Velopharyngeal function (VPF) was assessed with the composite score for velopharyngeal competence (VPC‐Sum) for single words and rated on a three‐point scale (VPC‐Rate) in sentence repetition. Target sounds in words and sentences were phonetically transcribed. Per cent correct consonants (PCC) were calculated at word and sentence levels. For in‐depth analyses, articulation errors were divided into cleft speech characteristics (CSCs), developmental speech characteristics (DSCs) and s‐errors. Information on secondary palatal surgery and number of visits to an SLP was collected. Outcomes & Results: VPF differed significantly between the groups at both ages when assessed with VPC‐Sum, but not with VPC‐Rate. Regardless of the method for assessing VPF, a similar proportion in both groups had incompetent VPF but fewer IA than NA children had competent VPF at both ages. IA children had lower PCC at both ages at both word and sentence levels. More IA children had CSCs, DSCs and s‐errors at age 5 years, and CSCs and s‐errors at age 10. The development of PCC was significant in both groups between ages 5 and 10 years. The proportion of children receiving secondary palatal surgery did not differ significantly between the groups, nor did number of SLP visits. Conclusions & Implications: CSCs were more persistent in IA children than in NA children at age 10 years. Interventions should target both cleft and DSCs, be comprehensive and continue past the pre‐school years. WHAT THIS PAPER ADDS: What is already known on this subject: At the beginning of the 21st century, IA children with cleft lip and/or palate arrived in Sweden partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. Studies up to age 7–8 years show that adopted children, compared with NA peers, have poorer articulation skills, demonstrate both cleft‐related and developmental articulation errors, and are more likely to have velopharyngeal incompetence. Several studies also report that adopted children more often require secondary palatal surgery due to fistulas, dehiscence or velopharyngeal incompetence compared with NA peers. What this paper adds to existing knowledge: This longitudinal study provides additional knowledge based on longer follow‐ups than previous studies. It shows that the proportion of children assessed to have incompetent VPF was similar among IA and NA children. It was no significant difference between the groups regarding the proportion that received secondary palatal surgery. However, fewer IA children were assessed to have a competent VPF. Developmental articulation errors have ceased in most IA and all NA children at age 10 years, but significantly more adopted children than NA children still have cleft‐related articulation errors. What are the potential or actual clinical implications of this work?: Speech and language therapy should target both cleft‐related and developmental articulation errors. When needed, treatment must be initiated early, comprehensive, and continued past the pre‐school years, not least for adopted children. [ABSTRACT FROM AUTHOR]

Aim: To improve the level of hospital workers' safety performance in response to emergencies (e.g. COVID‐19), this paper examines the relationship between hospital workers' job control on safety performance, and the mediating role of hospital safety climate and the moderating role of social support. Design: In this cross‐sectional questionnaire survey, a convenience sampling of hospital workers from three hospitals that have COVID‐19 cases from Beijing and Shandong Province in China. Methods: These questionnaires were used to obtain self‐reported data on hospital workers' job control, hospital safety climate, social support and safety performance. Mplus software was used to calculate CFA. SPSS25.0 software was used to calculate mean values, standard deviations, correlations and regression analyses. Results: The participants were 241 hospital workers from three hospitals in China (male = 55.2%, female = 44.8%; age range <30 to >45; physician = 58%, nurse = 22%, other hospital worker = 20%). A moderated mediation model among job control, hospital safety climate, social support and safety performance was supported. Moderated mediation analysis indicates hospital workers' job control effectively improves the level of safety performance; hospital safety climate plays a partially mediating role in the process of job control affecting hospital workers' safety performance; social support moderates the effect of work control on medical workers' safety climate. Hence, it is important to increase job control and hospital safety climate. Further, social support for hospital workers should be encouraged, advocated and supported. [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]

Aim: This study aimed to develop a tool to measure paediatric specialist nurses' core competencies and examine the scale's validity and reliability. Design: An exploratory quantitative study. Methods: This study was performed in April 2022 with 302 paediatric specialist nurses in mainland China. Items were created through a literature review, a qualitative interview, and the Delphi method. The data were evaluated using descriptive statistics, independent sample t‐test, explanatory factor analysis, Pearson correlation coefficient, Cronbach's alpha coefficient and split‐half reliability. Results: The final scale consisted of five factors and 32 items. The factors were communication, coordination and judgement abilities; professional technology mastery ability; specialist knowledge mastery ability; medical‐related processes; and evidence‐based nursing competencies. The explained total variance of the five factors was 62.216%. The scale‐level and item‐level CVI of this scale was 1.00, and the mean CVR of the total scale was 0.788. The Pearson correlation coefficients of each dimension and the total dimension of the scale was 0.709–0.892, and within each dimension, it was 0.435–0.651. The Cronbach's α of this scale was 0.944, and its split‐half reliability was 0.883. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to investigate the current status of the core competencies and self‐directed learning ability of diabetes specialist nurses and to explore the relationship between these core competencies and their self‐directed learning ability. Design: A cross‐sectional survey design was used. Methods: This cross‐sectional study was conducted via a web‐based questionnaire platform in China from January 14 to April 24, 2023. The survey included a general information questionnaire, a diabetes specialist nurses' core competencies self‐assessment scale, and a nursing staff's self‐directed learning ability evaluation scale. The data was collected online. Descriptive, correlation and multiple linear regression analyses were conducted using SPSS 26.0 software. Results: 118 diabetes specialist nurses from 11 cities participated in this study. A positive correlation was observed between the core competencies of diabetes specialist nurses and their self‐directed learning ability. The characteristics affecting the core competencies of diabetes specialist nurses included age, participation in external learning and communication and self‐directed learning. Conclusions: The training of diabetes specialist nurses can focus on core competencies, and the ability to self‐direct learning can be used as an entry point to customize feasible theoretical and practical courses. The training system can further improve diabetes specialist nurses' core competencies and self‐directed learning abilities. Relevance to Clinical Practice: A reference can be established that nursing managers and nursing educators can use to develop training programs for specialist nurses by validating the link between their core competencies and self‐directed learning skills. Patient or Public Contribution: Participants were involved solely in the data collection process. No participant contributions were required for the study's design, outcome measurement or implementation. [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]

Aim: To evaluate the psychometric properties of the Advance Care Planning Readiness Scale (ACPRS‐C) within the context of community‐dwelling older adults with chronic diseases residing in suburban counties in China. Design: Descriptive, cross‐sectional survey. Method s : The research method employed in this study is characterized as a methodological study. Self‐reported survey data were collected among community‐dwelling older adults with chronic diseases residing in suburban counties in China. Including the following psychometric characteristics, item analysis was performed using the decision value method and Pearson's correlation analysis. Content validity was assessed through expert panel evaluation. The internal consistency of the questionnaire was determined by calculating Cronbach's alpha coefficient and corrected item‐total correlation. Additionally, confirmatory factor analysis (CFA) was utilized to assess the construct validity of the ACPRS‐C. Results: A total of 228 older adults participated in this psychometric study from August to October 2023. The item content validity index ranged from 0.80 to 1.00, while the scale content validity index was 0.945. The scale demonstrated excellent internal consistency (Cronbach's alpha = 0.931), and the correlation between items and total score was satisfactory. The structural validity was deemed robust (CFA model fit: chi‐square/df = 1.121, comparative fit index = 0.992). Conclusion: The ACPRS‐C is a scale with strong psychometric properties to assess the ACP readiness within the context of community‐dwelling older adults with chronic diseases residing in suburban counties in China. Its reliability and validity hold considerable significance for both research and clinical practice. [ABSTRACT FROM AUTHOR]

Aim: Moral courage among healthcare workers has been extensively studied. However, few studies have been conducted on oncology specialist nurses, who frequently encounter complex moral situations. This study aimed to describe the current situation regarding moral courage and explored its influence on oncology specialist nurses in China. Design: This was an exploratory, descriptive study. Methods: A convenience sample of 390 nurses was conducted from 15 hospitals in Sichuan Province, China, between March and May 2023. Participants were assessed using the Moral Distress Scale‐Revised, Nurses' Moral Courage Scale and the Moral Sensitivity Questionnaire. Results: The results demonstrated that moral courage was negatively associated with moral distress, and positively associated with moral sensitivity. Having a master's degree or above, an intermediate title or senior title, medical ethics training, moral distress or moral sensitivity contributed to explaining 54.1% of the variance in moral courage. Conclusions: Moral courage was associated with several factors. Developing clinical intervention strategies and effective teaching methods will be critical for improving moral courage. No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Background Welfare for the disabled is becoming an important issue in China and care for people with intellectual disability is challenging because of the inadequacies in formal support and the social service system. Material and Method Based on ethnographic research in two villages in North China, this paper analyses the dilemmas of family care for people with intellectual disability. The essential data is the ethnographic record of three cases. Results Rural families strive to provide care through a set of arrangements and bear tremendous stress in the process. Conclusion Family care for people with intellectual disability in rural China has been increasingly challenged by the forces of labour migration, demographic changes and the ever-growing processes of commoditization. The role of the state has to be strengthened in welfare provision to balance the weakened family care ethos in transforming societies. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to refine the Falling Risk Assessment Tool in Ophthalmology Inpatients (FRAT) and assess its psychometric properties. Design: A cross‐sectional design was used. Methods: A convenience sample of 730 patients in the ophthalmology department was recruited in a level A tertiary hospital in Guangdong Province from July 2021 to January 2022. Data were analysed using item analysis, interrater reliability, content validation, internal consistency reliability and exploratory factor analysis. Results: Five factors were extracted, accounting for 63.039% of the variance. The interrater reliability of the tool was 0.97. Cronbach's α was 0.658. The I‐CVI was 0.75–1.00, the S‐CVI/UA was 0.95 and the adjusted mean values of Kappa for indicators ranged from 0.72 to 1.00, as evaluated by the expert group. The FRAT showed satisfactory reliability and validity, and can be used to measure the fall risk assessment in ophthalmology inpatients. Patient or Public Contribution: After explaining the purpose, the patients received our fall risk assessment and answered the corresponding questionnaire questions. [ABSTRACT FROM AUTHOR]

Aims: To investigate the beliefs and attitudes of intensive care unit (ICU) nurses and patients' family members towards an open visitation policy in the ICU in China and to explore the reasons that promote or hinder open visitation to improve visitation policy. Background: Open visitation policies are widely recommended in many countries. However, there are gaps between evidence and practice. Most ICUs in China still use a restrictive policy for family visits, which raises controversy. There are limited visiting times, and family visitors are not allowed to enter the ICU. Study Design: A multicentre survey was conducted in seven hospitals in China. The Beliefs and Attitudes towards Visitation in the Intensive Care Unit Questionnaire (BAVIQ) was administered to ICU nurses and patient families from 11 the ICUs of seven hospitals. A total of 275 questionnaires were completed and returned by ICU nurses and 139 by patients' family members. Results: Among nurses, the belief scale score was 2.87 ± 0.33 (range 2–4), and the attitude scale score was 5.53 ± 1.12 (range 2.33–7). The belief scale was divided into three subscales: nurses, patients, and patients' families. The subscale score for patients' families was the highest, and the nurses' subscale score was the lowest. Most (84.0%) of the nurses were satisfied with the current ICU visitation policy. The belief and attitude scores were 3.13 ± 0.39 (range 1.96–4) and 6.18 ± 1.20 (range 1.67–7), respectively, for family members. The scores of the three subscales, that is, patients, patients' families and nurses, were 3.13 ± 0.40, 3.26 ± 0.43, and 3.04 ± 0.49, respectively. Conclusion: Nurses' beliefs and attitudes towards implementing an open visitation policy in China are at a less positive level than those of patient family members. Relevance to Clinical Practice: The beliefs and attitudes of nurses towards open visitation policy in China need to be improved. The question of how to mobilize nurses' enthusiasm for an open visitation policy poses a challenge for ICU management. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have found an association between socioeconomic status (SES) and depressive symptoms among older adults, however the mechanisms underlying this association remained unclear. This study aimed to examine the mediating role of social support and the moderating role of living arrangement in the association between SES and depressive symptoms. Methods: Data was collected from the 2020 Household Health Interview Survey in Taian city, Shandong Province, China. A total of 3896 older adults aged 60 and above were included in this study. Depressive symptoms was measured by the Patient health Questionnaire‐9 (PHQ‐9), Social support by the Multidimensional Scale of Perceived Social Support (MSPSS), and other variables by related demographic scales. The moderated mediation model was examined using HAYES PROCESS 3.5. Results: SES negatively predicted depressive symptoms among older adults, and social support could mediate this association. Living arrangement played a moderating role in the relationship between social support and depressive symptoms (the second half of the mediating effect), and the effect was stronger among older adults who lived alone. Conclusions: Social support partially mediated the relationship between SES and depressive symptoms among older adults, and living alone strengthened the effect of social support on depressive symptoms. Interventions that address older adults' social support and living arrangement may ameliorate depressive symptoms among older adults. Key points: Socioeconomic status was negatively associated with depressive symptoms among Chinese older adults.Social support partially mediated the association between socioeconomic status and depressive symptoms.Living arrangement moderated the indirect effect of social support. Preventing depressive symptoms should be sensitive to differences in living arrangement. [ABSTRACT FROM AUTHOR]

Firefighters exhibit a higher prevalence of mental health issues than other occupations because they often directly or indirectly experience potentially traumatic events. Previous research has suggested that recovery experiences, sleep, and fatigue may be protective or risk factors for firefighters' mental health. This study conducted regularised partial correlation network analysis to investigate and visualise the complex relationships between these variables. We collected data through an online survey, and 3144 career firefighters from a large east‐coast city in China, were included in the analyses. The results of the network analysis showed that: (1) only relaxation and mastery experiences directly correlated with one dimension of the mental health scale, namely, life/social functioning; (2) sleep quality had stronger correlations with mental health issues than sleep quantity; and (3) mental health issues were central nodes of the network. These results indicated that firefighters' mental health was close to other variables in the network and acted as a bridge linking other variables. Therefore, more attention should be paid to the mental health of firefighters to prevent comorbidities. The study's results also indicated that recovery experiences and sleep may be protective factors for firefighters' mental health. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to qualitatively explore the food choice determinants of both Chinese immigrants living in Australia and Chinese people living in mainland China. Methods: Eight Chinese Australian participants (female, n = 5; male, n = 3) and ten mainland Chinese participants (female, n = 5; male, n = 5) were recruited from Australia (primarily in Melbourne, Victoria) and China (predominantly in Zhengzhou, Henan province) between June 2021 and March 2022. Participants were diverse in age, socio‐economic background, occupation and health status. Semi‐structured in‐depth interviews were conducted in Mandarin either face‐to‐face or using online video/voice calls. Interviews were audio‐recorded and transcribed verbatim. Investigator triangulation was used to enhance scientific rigour. Results: Four themes were identified: (1) food choice determinants were shaped by traditional and modern nutrition perceptions and personal food philosophy; (2) physiological responses to food provide direct feedback that impacts future food choices; (3) consideration of convenience was a predominant influencer of food choice; and (4) the differences in food environments between China and Australia promoted distinctive food choice determinants for Chinese people. Conclusions: Chinese Australian and mainland Chinese participants' food choices are shaped by traditional Chinese nutrition philosophy, modern Western nutrition science and the contemporary food environment. There are clear cultural characteristics in their food choice determinants that should be considered by health educators, nutrition professionals and nutrition policymakers when developing culturally appropriate health interventions for Chinese people. Key points: This exploratory study identified various influencers of food choice in Chinese population, informing health educators to consider cultural aspects when planning interventions for Chinese communities. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to translate and adapt the traditional Chinese Food Allergy Quality of Life‐Parental Burden Questionnaire (TC‐FAQL‐PB) into simplified Chinese language and determine the validity and reliability of the translated version. Design: A methodologic study design involving instrument translation and psychometric evaluation was used for the present study. Methods: The simplified Chinese FAQL‐PB (SC‐FAQL‐PB) was developed following Guillemin's guidelines for cross‐cultural adaptation. A convenience sample of 230 participants was recruited. The psychometric properties were examined using internal consistency, test–retest reliability, item discrimination, content validity and construct validity. Results: The values of I‐CVI ranged from 0.83 to 1.00. The CFA model revealed that the study supported the two‐factor model. The questionnaire had good internal consistency with a Cronbach's alpha coefficient of 0.946. The item‐total correlation values ranged from 0.707 to 0.866. Test–retest reliability showed that the intraclass correlation coefficient was 0.926 (95% CI, 0.830–0.968). [ABSTRACT FROM AUTHOR]

Aim: To explore the relationship between university nursing students' academic procrastination, mindfulness, and future time perspective. Design: A cross‐sectional study. Methods: A total of 343 university nursing students recruited from eight provinces in China have reported procrastination characteristics through fulfilling an online website link. The main instruments involved Mindfulness Attention Awareness Scale (MAAS), Zimbardo Time Perspective Scale, and Procrastination Assessment Scale (PASS). Results: Participants who self‐assessed higher frequency and degree of academic procrastination tended to possess lower future time consciousness, and lower mindfulness. Mindfulness served as a mediation effect between future time perspective and academic procrastination. The study indicates that weakening an individual's procrastination can be alleviated through future time awareness and mindfulness. Concentrating on influencing factors, strengthening nursing student's future time perspective, and practicing mindfulness training could assist educators to decrease students' procrastination intentions and behaviours. [ABSTRACT FROM AUTHOR]

Aim: To investigate undergraduate nursing students' general study engagement using intra‐individual assessment and to evaluate the impact of core self‐evaluation and career calling on study engagement. Design: A descriptive and cross‐sectional design. Methods: Data were collected using a self‐administered questionnaire survey. Four hundred and twenty nursing students from first‐ to fourth (final)‐academic year in Guangzhou Medical University were invited to participate in the spring of 2021. The Cronbach's alpha, one‐way analysis of variance, Bonferroni post hoc analysis, Pearson correlation analysis and multiple stepwise regression analysis were used to analyse the data. Results: The first‐ and fourth‐year undergraduates showed significantly higher levels of study engagement (first‐year undergraduates, 3.52 ± 0.59; fourth‐year undergraduates, 3.54 ± 0.64), core self‐evaluation (first‐year undergraduates, 3.04 ± 0.48; fourth‐year undergraduates, 3.11 ± 0.45) and career calling (first‐year undergraduates, 3.65 ± 0.47; fourth‐year undergraduates, 3.69 ± 0.50) than those of second‐year undergraduates (study engagement, 3.32 ± 0.61; core self‐evaluation, 2.93 ± 0.52; career calling, 3.41 ± 0.50) and third‐year undergraduates (study engagement, 3.16 ± 0.61; core self‐evaluation, 2.88 ± 0.50; career calling, 3.34 ± 0.38). The Pearson correlation analysis among nursing students revealed a significant positive correlation between core self‐evaluation, career calling and study engagement (p < 0.01). A partial mediation effect of career calling was present in the relationship between core self‐evaluation and study engagement. [ABSTRACT FROM AUTHOR]

Dry skin and pressure injuries in older persons have become global health care problems. This was a multicentre, prospective cross‐sectional study in 44 hospitals and 8 long term care institutions from 20 provinces, autonomous regions and municipalities in China and aimed to explore the relationship between the two skin problems in older patients. We mainly found 11 602 cases with dry skin and 1076 cases with pressure injuries in a total of 33 769 valid participants. The overall prevalence of dry skin and pressure injuries was 34.4% (95% confidence interval [CI] 33.9–34.9) and 3.1% (95% CI 2.9–3.3). Stage 2+ pressure injuries were the most (32.9%), followed by stage 1 (32.4%). The patients with dry skin had more pressure injuries than ones without dry skin (50.0% vs 33.9%). The patients with very severe and severe dry skin had more pressure injury risk (OR 2.22 and 1.90) and more stage 2+ pressure injury risk (OR 2.83 and 1.63). Other nine predictors associated with overall pressure injuries and stage 2+ pressure injuries. The area under receiver operating characteristic (ROC) curve of the predictive models of overall pressure injuries and stage 2+ pressure injuries were 0.89 (95% CI 0.88–0.90) and 0.91 (95% CI 0.90–0.92), respectively. [ABSTRACT FROM AUTHOR]

Studies have previously demonstrated that anxious attachment shapes the association between childhood traumatic experiences and somatic pain; however, it remains unclear how this relationship is influenced by anxious attachment in patients with depression. This study investigated how anxious attachment influences the relationship between childhood traumatic experiences and pain symptoms in depressed patients from a social psychological perspective. A total of 139 adult patients with depression participated in this study; the level of depression was assessed by a psychiatric professional. Childhood trauma, pain symptoms, and attachment dimensions were tested by various questionnaires. The moderating role of anxious attachment in the trauma‐pain association was examined using the PROCESS Model 1. Our findings showed that in depressed patients, childhood maltreatment had a significant positive impact on the severity of pain ratings. Moreover, anxious attachment influenced the relationship between childhood trauma and pain symptoms. Our study indicated that anxious attachment is not necessarily a negative outcome for depressed patients; moderate levels of anxious attachment alleviate childhood trauma‐related pain symptoms in individuals with highly traumatic experiences. Understanding the traumatic experiences and attachment styles of depressed patients with pain complaints can help to develop intervention strategies. [ABSTRACT FROM AUTHOR]

Aim: The aims of the study were to analyse the current situation of health literacy (HL), self‐management and health‐related quality of life (HRQOL) in patients with diabetic peripheral neuropathy (DPN), to explore the correlation between the three and to verify the mediating role of self‐management in HL and HRQOL. Design: A cross‐sectional survey. Methods: The convenience sampling method was used to select 401 DPN patients attending the First Hospital of Jinzhou Medical University in Liaoning Province, China, from December 2020 to December 2021 as the study population. The research instrument included socio‐demographic characteristics questionnaire, Health Literacy Management Scale (HeLMS), Summary of Diabetes Self‐Care Activities (SDSCA) and Short‐Form 12‐item Health Survey (SF‐12). SPSS 25.0 was applied to the data for descriptive analysis, Pearson correlation analysis and stratified multiple regression analysis. Mediating effects were tested using SPSS PROCESS macro 4.0 software. Results: HL and self‐management of DPN patients correlated positively with HRQOL. The mediation role of self‐management was significant in the relationship between HL and physical and mental HRQOL (physical component summary: β = 0.26, P < 0.01; mental component summary: β = 0.18, P < 0.01), with mediating effects accounting for 35.62% and 34.62% of the total effect. Conclusions: There was a positive correlation between HL, self‐management and HRQOL in patients with DPN. Self‐management plays a partially mediating role in the relationship between HL and HRQOL in DPN patients. It means that HRQOL in this population can be improved by increasing HL and thus self‐management in DPN patients. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association of the number of natural teeth with overall dietary diversity and nutritional status in a nationally representative study among older adults in China. Materials and Methods: A cross‐sectional analysis was conducted among community‐dwelling adults aged 65 years or older from the Chinese Longitudinal Healthy Longevity Study. According to the self‐reported number of natural teeth, participants were categorized into ≥20, 10–19, 1–9 natural teeth, and edentulous. Dietary diversity score (DDS) was constructed based on intake frequencies of 10 food groups assessed by a simplified food frequency questionnaire. The geriatric nutritional risk index was used to measure the malnutrition status (i.e., normal, mild malnutrition, and moderate‐to‐severe malnutrition) among a subgroup of participants. Linear and multinomial logistic regression models were used to examine the corresponding associations. Results: Among 54,796 study participants, the mean (SD) age was 87.86 (11.45) years, 82.7% had poor dentition (<20 natural teeth), and 27.3% wore dentures. After multivariable adjustment, participants with poor dentition had lower DDSs (βedentulous = −0.39, 95% confidence interval [CI], −0.48, −0.30; β1‐9 teeth = −0.46, 95% CI, −0.55, −0.37; β10‐19 teeth = −0.36, 95% CI, −0.46, −0.26) than those with 20 natural teeth or more. For individual food items, edentulous, 1–9 and 10–19 natural teeth were associated with lower odds of regular intake of fresh fruits, fresh vegetables, meat, fish and aquatic products, eggs, legumes, preserved vegetables, tea, and garlic, but higher odds of regular intake of sugar and sweets. Among participants with poor dentition, individuals without dentures had lower intake frequencies of most food groups than those wearing dentures. In addition, poor dentition was related to lower odds of normal nutritional status (odds ratio = 0.49, 95% CI, 0.27, 0.89). Conclusions: Older adults with poor dentition had significantly lower dietary diversity and worse nutritional status. Future studies are warranted to identify effective interventions to improve the dietary quality and nutrition status among partially and fully edentulous individuals, including those with Stage IV periodontitis. [ABSTRACT FROM AUTHOR]

Pressure injury is a serious and preventable problem in intensive care units. Translating guidelines into clinical practice can reduce the incidence of pressure injury. Identifying clinical status, barriers and facilitators contribute to guideline implementation. To identify the knowledge, attitudes, and practices of pressure injury prevention in Chinese critical care nurses. Secondary data were extracted from a multicentric clinical trial. Knowledge and attitudes toward pressure injury prevention were assessed by a fourteen‐item questionnaire. The observed practices were recorded using a case report form. The report complies with the STROBE statement. A total of 950 critical care nurses in 15 hospitals from six provinces of China were investigated. A total of 53.1% of nurses received a median score of 6 points or less. Knowledge regarding the repositioning procedure, risk assessment, and heel pressure injury prevention was insufficient. Over 99% of nurses strongly or somewhat agreed that pressure injury prevention was very important and that they were willing to take measures to prevent pressure injury. A total of 27 781 patient days of pressure injury prevention practice were recorded. Repositioning was the most commonly used prevention measure, followed by support surfaces and prophylactic dressings. A combination of repositioning, support surface, and prophylactic dressing was lacking. Chinese critical nurses showed a low level of knowledge and a positive attitude toward pressure injury prevention. Practices of pressure injury prevention were unsatisfactory. There is a clear gap between the guidelines and clinical practices. The barrier (low‐level knowledge) and facilitator (positive attitude) were identified in this study. According to these findings, strategies need to be developed to promote guideline implementation. [ABSTRACT FROM AUTHOR]

Background: eHealth literacy can facilitate the uptake of benefits of health for older persons. The aim of this study was to examine the association of eHealth literacy with depression, health‐related quality of life (HRQoL) among older persons. Methods: A survey of 6183 participants (aged 60 years and above) from 17 communities was conducted in June 2019. Participants answered questions related to basic information, eHealth literacy scale (eHEALS), geriatric depression scale and the short‐form health survey (SF‐36). Mediation model and a linear regression analysis were performed to explore the association between the eHEALS scores and related factors. Results: The mean score of eHEALS was 21.17 (SD = 8.25). eHEALS was significant higher in men, those with living in the city, those with high educated and stable income and those with living with children, as compared to their counterparts, respectively. Moreover, chronic diseases and depressive symptoms negatively associated with eHEALS, while actively obtaining health information and physical activity positively influenced eHEALS. Furthermore, depressive symptoms had direct and indirect effects on HRQoL, as mediated by eHealth literacy. Conclusions: The eHEALS acts as a mediator between depressive symptoms and HRQoL. As eHealth literacy is a protector for older people, efforts to improve the older persons' eHealth literacy could help to maintain health status. Therefore, healthcare providers formulate effective programs to improve eHealth literacy for older persons, which can bring benefits for health ageing. [ABSTRACT FROM AUTHOR]

Aim: To investigate the influencing factors in professional identity of undergraduate nursing students after the outbreak of COVID‐19. Design: Cross‐sectional study. Methods: The study covered 2,999 nursing students in six undergraduate nursing schools. Several self‐report questionnaires were used to collect the general information, psychological stress, coping styles and professional identity of the undergraduate nursing students. Results: The overall average score of the professional identity of nursing students (3.67 ± 0.51) has increased significantly after the outbreak of COVID‐19. The professional identity of the undergraduate nursing students was negatively correlated with psychological stress (r = −0.23, p <.001), expectation (r = −0.12, p <.001) and avoidance (r = −0.16, p <.001), but was positively correlated with solving problems (r = 0.18, p <.001) and seeking support (r = 0.12, p <.001). Academic performance, positions, grades, reasons for choosing a nursing profession, parents or relatives engaged in nursing work and the risk degree of residence were the factors influencing the professional identity score of undergraduate nursing students' (p <.001). [ABSTRACT FROM AUTHOR]

Aim: The American Academy of Pediatrics and the European Centre for Pediatric and Adolescent Medicine guideline define fever as a temperature >38.0°C for all ages and recommend use of rectal thermometers in children <3 years. Based on new literature, this definition of fever using a fixed threshold of 38.0°C needs to be re‐examined. Design: A multi‐site diagnostic accuracy study was conducted to compare an "age‐based" threshold model with a "fixed" threshold over 38.0°C on a total of 894 patients of which 373 were ill. Methods: The "age‐based" and "fixed" threshold fever determinations were then compared to a clinical categorization ("well" or "ill") conducted by a clinician through a comprehensive examination. Results: The sensitivity and accuracy for the age‐based thresholds were found to be superior to the fixed thresholds in all ages and current ear thermometers were found equivalent to rectal thermometers in infants <6 months. [ABSTRACT FROM AUTHOR]

Background: In China, there is no unified standard for the responsibilities and authority of nurse anesthetists, resulting in different professional expectations from anesthesiologists and nursing managers, which may result in high levels of role stress and burnout in nurse anesthetists. Additional factors such as high occupational risk and heavy work may also contribute to role stress and burnout. Methods: In this multicenter cross-sectional study, an online questionnaire survey was conducted among 198 nurses from six tertiary hospitals in Shandong Province. The t test, analysis of variance, linear regression, and logistic regression were used to analyze the risk factors for role stress and professional burnout. Results: The scores of role conflict and role ambiguity in role stress were 30.61 ± 9.53 and 31.89 ± 9.56, respectively; satisfaction with income and the working environment, the hospital's attention, years of experience as a nurse, clarity concerning the nurse anesthetist's occupational scope, and attitude to career prospects were independent risk factors for role stress. The burnout data were non-normally distributed and were expressed as medians and quartiles. The scores of emotional exhaustion, depersonalization, and personal achievement in professional burnout were 30 (26-34), 11 (8-14), and 23 (20-26) respectively. The number of working hours per week, attitude to career prospects, satisfaction with the working environment and income, physical health, gender, and education were independent risk factors for burnout. Conclusions: Chinese nurse anesthetists were found to be in danger of high role stress and professional burnout, a situation requiring the attention of managers. [ABSTRACT FROM AUTHOR]

Objectives: To explore the correlations among social isolation and symptoms of anxiety and depression among patients with breast cancer in China and to further verify the mediating role of social support in social isolation and symptoms of depression or anxiety. Design: A cross‐sectional survey. Settings: The cluster sampling method was conducted for 456 female inpatients diagnosed with breast cancer at the Tumor Hospital Affiliated of Harbin Medical University from April 2019–September 2019. Methods: Pearson correlation analysis was used for identifying correlations among all the variables. Mediation effect analysis was used to examine the role of social support in social isolation and symptoms of depression or anxiety. Results: The results showed a prevalence of 73.26% and 70.44% for anxiety and depression symptoms in patients with breast cancer, respectively. Anxiety was significantly negatively correlated with social support (r = −.334, p <.01) and significantly positively correlated with social isolation (r =.369, p <.01). Similarly, depression was significantly negatively correlated with social support (r = −.289, p <.01) and significantly positively correlated with social isolation (r =.466, p <.01). Social support played a mediating role in social isolation and f symptoms of anxiety or depression among these patients. Conclusions: Social isolation was positively correlated with symptoms of anxiety and depression in patients with breast cancer, respectively. Social support for patients with breast cancer has a mediating effect on the patients' social isolation and symptoms of anxiety and depression. Therefore, the support of family, friends, hospitals, and organizations plays a positive role in reducing social isolation as well as symptoms of depression and anxiety in these patients. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore the association between diabetes‐related distress as a dependent variable and fear of hypoglycaemia as a independent variable in Chinese individuals with type 2 diabetes, which can provide a basis for the development of effective nursing interventions. Design: A cross‐sectional descriptive study. Methods: Pre‐piloted scales were used to determine whether they experienced fear of hypoglycaemia and whether this impacted upon their management of the disease. From June–October 2019, participants were asked to complete the "hypoglycaemia fear survey" and "diabetes distress scales" to assess levels of fear and distress. Stepwise multivariate regression analysis was applied to reveal relationship between distress as a dependent variable and fear as a independent variable. Covariates included demographic, clinical or lifestyle factors. Results: A total of 258 participants were recruited for the survey, and they were characterized by little or no distress (39.53%), moderate distress (45.35%) and high distress (15.12%). The prevalence of moderate to severe distress in patients was 60.47%. Increased diabetes‐related distress was strongly correlated with increased fear of hypoglycaemia and closely associated with the scores of the worry and behaviour subscales. These results indicated that 62.3% of diabetes‐related distress may be explained by fear of hypoglycaemia. Conclusion: Increased diabetes‐related distress is associated with increased fear of hypoglycaemia in individuals with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aim: Long‐term care needs are important for older adults with dementia in the West, but they have not received enough attention from China. This study evaluated the psychometric properties of a long‐term care needs instrument for older Chinese adults with dementia. Methods: A total of 1,212 older adults with dementia were recruited from five Chinese cities to complete a 30‐item long‐term care needs questionnaire. The reliability and validity of the questionnaire was evaluated using multiple assessments, including a content validity assessment, Cronbach's alpha, an item‐to‐total correlation test, and exploratory factor analysis. Results: The questionnaire was divided into four sub‐sections: life care services (eight items), basic and specialist care services (12 items), mental comfort psychological services (four items), and homecare support services (six items). Cronbach's alpha was.93 for the whole questionnaire and ranged from.83 to.92 for the four sub‐questionnaires. The item‐to‐total correlation coefficients for the four sub‐questionnaires were between.68 and.88, and the test–retest correlation coefficient was.88. Conclusion: Our results validated the reliability and validity of a questionnaire designed to measure the quality of long‐term care services for older Chinese adults with dementia. [ABSTRACT FROM AUTHOR]

Strengthening the nursing workforce is core to health system reform in China. Patient experiences of hospital care have been recognized as important in this endeavor. Studies exploring the relationships between nursing workforce and patient experiences of hospital care, however, are scarce. The aim of this cross‐sectional study was to examine the associations between nurse education level, nurse staffing, and hospitalized patients' experiences of hospital care. Participants were 1,582 nurses responsible for direct care and 1,305 hospitalized patients from 23 hospitals in Guangdong province, China in 2014. Education level of nurses was measured by the proportion of nurses holding a baccalaureate or higher degree. Nurse staffing was measured by the unit nurse‐patient ratio. The Hospital Consumer Assessment of Health care Providers and Systems Scale was used to measure patient experiences of hospital care. Structural equation modeling demonstrated that a higher proportion of nurses holding a baccalaureate or higher degree was related directly to better patient perceptions of communication with nurses, responsiveness of nurses, pain management, and physical environment, and related indirectly to overall hospital ratings and recommendation of the hospital. A higher nurse‐patient staffing ratio was associated directly with better patient perceptions of communication with nurses, education about new medications given in hospital, and physical environment, and indirectly with overall ratings and recommendation of the hospital. Our findings add new evidence in the Chinese societal context about the relationship between the nursing workforce and patient experiences of hospital care. Upgrading nurse education level and increasing nurse staffing could potentially improve patient experiences of hospital care. [ABSTRACT FROM AUTHOR]

Nurses play a key role in administering sedation to mechanically ventilated children, which impacts children's psychological, physiological and cognitive changes in the paediatric intensive care unit. This study aimed to survey the sedation practices of paediatric intensive care unit nurses on mechanically ventilated children in China and explored the influencing factors. A cross‐sectional survey was conducted based on electronic questionnaires comprised of the Nurse Sedation Practices Scale (Chinese version) in 14 different types of paediatric intensive care units of 11 academic hospitals in China from 15 February to 15 April 2017. A convenience sample of 495 nurses [73·4% response rate, (674)] completed the survey. Seven units applied Ramsay Sedation Scale as a sedative assessment tool. The majority of the nurses used observed behaviours and physiological changes of the ventilated children as indicators to assess the sedation level, and they had a positive attitude and intention, which may influence practice positively, whereas high clinical workload and the lack of communication between the nurses and families might hinder practice. The practice of sedation varied greatly in different regions, and the respondents of the northwest region scored lower. Paediatric nurses in China rarely used a validated paediatric instrument to assess sedation, and most nurses relied on physiological and behavioural cues. The quality of sedation training, nursing workload and regional economic disparity affected the sedation practice. The restricted visiting policy and lack of clearly defined nursing responsibilities around sedation may hinder effective sedation assessment and management. This study found that there was no paediatric‐validated tool popularized in paediatric intensive care units in China and explored influencing factors. We suggest that a validated tool, high‐quality training and hospital's policy, such as visiting regulation, should be promoted to improve the sedation practice. [ABSTRACT FROM AUTHOR]

Background: Core competencies of intensive care unit (ICU) nurses were defined as the essential capability to influence patient safety and interdisciplinary collaboration; however, there has been no research conducted that relates to core competencies of ICU nurses at Chinese tertiary‐A hospitals in Shanghai. Aims and objectives: To investigate the current state of core competencies and the factors that influence this key capability in ICU nurses in Chinese tertiary‐A hospitals. Design This was a multicentre, cross‐sectional study. Methods: A convenient sampling method was used to investigate 451 ICU nurses at five tertiary‐A hospitals in Shanghai. Data were collected using self‐administered questionnaires. Results: The core competencies of ICU nurses were above average, and the scores of seven dimensions, ranked from first to last, were medical ethics, clinical practice, nurse–nurse co‐operation, assessment and decision‐making, personal and professional development, teaching and research and nurse–physician co‐operation. Multivariate linear regression analysis showed that the factors exerting an influence on the core competencies of ICU nurses were title, role incumbent and ICU department. Conclusion: This study showed an above‐average level of core competencies among ICU nurses in tertiary‐A hospitals in Shanghai; however, competencies related to nurse–physician co‐operation and the translation of research into practice were underdeveloped. Relevance to clinical practice: Nursing managers should implement targeted interventions to improve nurse–physician co‐operation and translate research into practice competencies, such as high‐fidelity simulation, inter‐professional education, scientific research training and innovative skills tutorials. Moreover, this study demonstrated the influencing factors that can be used to improve core competences of ICU nurses. [ABSTRACT FROM AUTHOR]

Nursing students' beliefs about etiology and manifestation of mental illness will impact on their professional attitudes in future clinical practice. The aims of the present study were to examine and compare US and Chinese undergraduate nursing students' recognition of, and beliefs about, causes of depression and schizophrenia. A total of 310 US (n = 152) and Chinese (n = 158) nursing students completed the Australian National Mental Health Literacy Survey questionnaire between April 2016 and April 2017. Although nursing students in the USA and China were highly accurate in recognizing depression and schizophrenia, the US students were more likely to nominate multiple items alongside the correct diagnosis than the Chinese students. The Chinese students were more likely to view depression and schizophrenia as multi‐causally‐determined mental disorders than the US students. The findings highlight the need for the incorporation of mental health issues, including symptomatology of different mental disorders and their application to patient care, into various aspects of the US nursing curriculum. In China, opportunities can be created for nursing students to discuss the impact of personal beliefs on care delivery and social stigma during clinical placement. [ABSTRACT FROM AUTHOR]

Premastication is thought to be an adaptive behavior in the introduction of complementary plant-bassed food to infants. It arouses controversy, however, because of the potential for transmitting saliva-born infectious diseases. The aim of this study was to explore whether premastication by healthy caregivers was associated with children's health and behavior. The data were collected as part of the Maternal and Infant Nutrition and Growth study. From 8 cities in China, 1341 pairs of infants/toddlers and their caregivers were recruited. An interviewer-administrated questionnaire collected data on sociodemographic characteristics, feeding behaviors, and self-reported health status. Anthropometric measurements were taken and blood samples were collected for analysis of hemoglobin levels. The overall prevalence of premastication was 26.9% and varies from 14-43% among the 8 cities. Premastication was not associated with occurrences of illness or with the nutritional indicators of height-for-age Z score, weight-for-age Z score, weight-for-height Z score, head circumference Z score and hemoglobin ( P all >.05). Premastication occurred more often among infants who were raised by their parents ( P = .005), whose mothers' education was lower ( P < .001), who were subject to more concern from their parents ( P = .022), and whose parents thought their children had an obesity problem ( P = .001). Presmastication was not associated with food picky behaviors. Premastication is still a common feeding practice in China. More studies are needed to determine the biological, economic, and cultural benefits or harm from premastication. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Nursing-sensitive indicators are considered effective tools for improving the quality of care in hospitals. However, these have not been used in paediatric intensive care units ( PICUs) in China. Aim To develop nursing-sensitive indicators for PICUs and to assess the quality of nursing in PICUs in China based on the nursing-sensitive indicators. Design Multi-centre, cross-sectional study. Methods Structure, process and outcome indicators were developed and measured from 1 January to 31 March 2014 in seven PICUs in China. Results The structure indicators showed that one nurse cared for an average of 2·8 patients in a PICU, and 44% of nurses had a bachelor's degree. The process indicators revealed that hand-washing compliance varied across PICUs, whereas pain management and physical restraint have not been adequately addressed in China. The outcome indicators revealed that the incidence rates of ventilator-associated pneumonia and central-line-associated blood stream infections were 2·96 and 0·7, respectively, per 1000 device days. Patients were intubated for a total of 4392 mechanical ventilator days, and 32 patients (7·29‰) had an unplanned extubation. Nurses were moderately satisfied in their jobs (3·1 ± 0·3), and parents reported that nurses provide high quality of care. Conclusions This study developed and used nursing-sensitive indicators to assess the quality of nursing in PICUs in China, which provided a reference for national and international comparisons of nursing quality in PICUs. Nursing staffing levels and education should be improved. Pain management and physical restraints should be regulated in China's PICUs. Nurse managers need to explore staff attitudes towards implementation of family-centred care. The development of a national database of nursing quality indicators can contribute to quality and safety improvement. Relevance to clinical practice This study developed a set of nursing-sensitive indicators, and these indicators were used to assess and improve the quality of nursing in PICUs. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Perceptions of school safety have an important effect on students' development. Based on the model of 'context-process-outcomes,' we examined school safety as a context variable to explore how school safety at the school level affected students' self-esteem. METHODS We used hierarchical linear modeling to examine the link between school safety at the school level and students' self-esteem, including school liking as a mediator. The data were from the National Children's Study of China ( NCSC), in which 6618 fourth- to fifth-grade students in 79 schools were recruited from 100 counties in 31 provinces in China. RESULTS Multilevel mediation analyses showed that the positive relationship between school safety at the school level and self-esteem was partially mediated by school liking, controlling for demographics at both student and school levels. Furthermore, a sex difference existed in the multilevel mediation model. For boys, school liking fully mediated the relationship between school safety at the school level and self-esteem. However, school liking partially mediated the relationship between school safety at the school level and self-esteem among girls. CONCLUSION School safety should receive increasing attention from policymakers because of its impact on students' self-esteem. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effectiveness of a 6-month Liuzijue qigong ( LQG) program in promoting physical and psychosocial function in individuals with chronic obstructive pulmonary disease ( COPD). Design Single-blind, randomized controlled trial. Setting Seven hospital respiratory care centers in Beijing. Participants Individuals with COPD (N = 126; mean age 71.1 ± 2.7, range 65-85). Methods Participants were randomly assigned to one of two groups: LQG (n = 63) and control (n = 63). Subjects in the LQG group received a LQG program consisting of four 45-minute sessions each week and daily walking for 30 minutes for 6 months. Control subjects walked daily for 30 minutes. Data collection was performed at baseline, at 6 weeks, and at 6 months. Primary outcomes involved functional capacity, and secondary outcomes involved quality of life. Results The LQG group had greater improvements in the 6-minute walk test ( P = .02); specific airway conductance ( P = .02); monitored functional task evaluation ( P = .04); Medical Outcomes Study 36-item Short-Form Health Survey ( SF-36; general health ( P < .001), mental health ( P = .03)); Chronic Respiratory Questionnaire (dyspnea ( P = .05), emotion ( P = .05), and mastery ( P = .04) at 6-month follow-up. After 6 months, the control group had significant improvement only on the SF-36 mental health ( P = .02). Conclusion LQG promoted functional capacity and quality of life in older adults with COPD at 6 months and is a good alternative home exercise program for older adults in the rehabilitation of COPD. [ABSTRACT FROM AUTHOR]

ABSTRACT To determine the annual incidence and clinically relevant risk factors for foot ulceration in a large cohort study of diabetic foot ulcer (DFU) patients and diabetes mellitus (DM) patients in China. To investigate a cohort of 1,333 patients comprising 452 DFU patients and 881 DM patients, who underwent foot screening, physical examination, and laboratory tests in eight hospitals. The patients were assessed at baseline in terms of their demographic information, medical and social history, peripheral neuropathy disease (PND) screening, periphery artery disease (PAD) screening, assessment of nutritional status, and diabetic control. One year later, the patients were followed up to determine the incidence of new foot ulcers, amputation, and mortality. By univariate analysis, statistically significant differences were found in age, location, gender, living alone (yes/no), occupation, smoking, hypertension, PND, PAD, nephropathy, retinopathy, cataracts, duration of diabetes, Glycosylated hemoglobin A (HbA1c), fasting plasma glucose level, postprandial blood glucose level, insulin level, blood urea nitrogen, creatinine, cholesterol, triglyeride, high density lipoprotein (HDL), serum albumin, white blood cell, and body mass index. A binary logistic regression model was used to examine which of these risk factors were independent risk factors for foot ulceration. A total of 687 (51.5%) of the 1,333 patients were followed up for an average of 12 months; there were 458 DM patients and 229 DFU patients. A total of 46 patients died during the follow-up period; 13 were DM patients, and 33 were DFU patients. Of the 641 patients, 445 (69.4%) patients were DM patients, and 196 (30.6%) were DFU patients. At follow-up, 36/445 DM patients (8.1%), and 62/196 DFU patients (31.6%), developed new ulcers; 10/196 DFU patients underwent an amputation. The annual incidence of ulceration for DM patients and amputation for DFU patients were 8.1 and 5.1%, respectively. The annual mortality of the DM patients and DMF patients were 2.8 and 14.4%, respectively. A binary logistic regression model was used to examine which risk factors were independent risk factors for foot ulceration during the follow-up period, and the final results showed that nephropathy (odds ratio 2.32), insulin level (odds ratio 3.136, 2.629), and decreased HDL (odds ratio 0.427) were associated with increased risks for foot ulceration. Complications of diabetes affecting the feet represent a serious problem in China. The incidence of foot ulcers and amputation are much higher than that of Western countries. More intensive surveillance and aggressive care following a diagnosis of DFU and earlier referral to specialty care might improve the patient outcome. [ABSTRACT FROM AUTHOR]

Aim To investigate the characteristics of the different club drugs and associated high-risk sexual behaviours in China. Design Multicentre cross-sectional study. Setting Drug Detoxification and Rehabilitation Centres in six provinces, China. Participants A total of 1434 eligible club drug users were included. Measurements Participants were investigated by trained interviewers using a self-designed structured questionnaire to collect information on club drug use and associated behaviours. Findings Methamphetamine was the most commonly abused drug in participants (73.92%), who used it in their or their friends' homes by non-injection for the purpose of feeling euphoria. Among participants with sexual behaviours after club drug use, 75.21% reported having engaged in sex with multiple partners after club drug use during the past year and 79.84% had unprotected sex after using club drug during the past year. A two-level logistic model showed that male gender [adjusted odds ratio ( AOR) = 7.14; 95% confidence interval ( CI) = 4.17-12.5], unmarried ( AOR = 1.71, 95% CI = 1.04-2.79), long duration of club drug use during their life-time ( AOR = 1.76, 95% CI = 1.28-2.42) and severe acute intoxication after using club drugs during the past year ( AOR = 2.11, 95% CI = 1.07-4.15) were independent risk factors of multiple sex partners during the past year. Another two-level model showed that the club drug users who were female ( AOR = 1.79, 95% CI = 1.03-3.11) and had polydrug use during their lifetime ( AOR = 1.55, 95% CI = 1.01-2.34) had more risk for unprotected sex during the past year than without these characteristics. Conclusion High-risk sexual behaviours are common among club drug users in China. The prevention and intervention of club drug use could decrease the risk of sexual behaviours which further prevent HIV transmission and other sexually transmitted infections in China. [ABSTRACT FROM AUTHOR]

Background and Objective Acute exacerbations of chronic obstructive pulmonary disease ( AE- COPD) are leading causes of mortality in hospital intensive care units. We sought to determine whether dental plaque biofilms might harbor pathogenic bacteria that can eventually cause lung infections in patients with severe AE- COPD. Material and Methods Paired samples of subgingival plaque biofilm and tracheal aspirate were collected from 53 patients with severe AE-COPD. Total bacterial DNA was extracted from each sample individually for polymerase chain reaction amplification and/or generation of bacterial 16S rDNA sequences and cDNA libraries. We used a metagenomic approach, based on bacterial 16S rDNA sequences, to compare the distribution of species present in dental plaque and lung. Results Analysis of 1060 sequences (20 clones per patient) revealed a wide range of aerobic, anaerobic, pathogenic, opportunistic, novel and uncultivable bacterial species. Species indistinguishable between the paired subgingival plaque and tracheal aspirate samples (97-100% similarity in 16S rDNA sequence) were dental plaque pathogens ( Aggregatibacter actinomycetemcomitans, Capnocytophaga sputigena, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola) and lung pathogens ( Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Streptococcus pneumoniae). Real-time polymerase chain reaction of 16S rDNA indicated lower levels of Pseudomonas aeruginosa and Porphyromonas gingivalis colonizing the dental plaques compared with the paired tracheal aspirate samples. Conclusion These results support the hypothesis that dental bacteria may contribute to the pathology of severe AE- COPD. [ABSTRACT FROM AUTHOR]

Background/Aim There have been several studies of atrial fibrillation ( AF) over the past decades; however, data from Chinese patients are scarce. The aim of the study was therefore to describe the patient characteristics, risk profile and management strategies for Chinese AF patients presenting to emergency department ( ED). Methods We conducted a prospective, multicentre registry of patients with AF or atrial flutter ( AFL) in China. Participants were enrolled at 20 EDs, then data regarding baseline characteristics and treatment in EDs were collected. Results Of the 2016 Chinese patients, 1104 (54.8%) were female. Six hundred eighteen (30.7%) had paroxysmal AF, 452 (22.4%) had persistent AF and 945 (46.9%) had permanent AF. The most common comorbidity was hypertension (55.5%), followed by coronary artery disease (41.8%) and heart failure ( HF, 37.4%). The prevalence of concomitant cardiovascular risk factors, such as HF and valvular heart disease, increased as AF progressed. Among the patients with non-valvular AF, 110 (12.7%) of those with CHADS2 (congestive HF, hypertension, age of 75 years and greater, diabetes mellitus and history of stroke) ≥2 were prescribed oral anticoagulants ( OAC), while 119 (15.6%) of those with CHADS2 <2 received such agents. Among the 324 patients with valvular AF, 134 (41.4%) actually were treated with OAC. The international normalised ratio value was within the target range (2.0-3.0) in 96 patients only (26.4%). Moreover, a total of 16.2% of the patients received ≥1 anti-arrhythmic agents, whereas rate control agents were used more frequently (68.4%). Conclusions According to the present study, the risk profile and management of Chinese patients with AF/ AFL differed from that observed in previous studies. The use of OAC inadequately deviate from current guidelines. [ABSTRACT FROM AUTHOR]

Aim This study represents an initial effort at examining the association between the construct of self-compassion and human immunodeficiency virus ( HIV)-related anxiety in a multinational population with HIV disease. Background Previous studies have found that self-compassion is a powerful predictor of mental health, demonstrating positive and consistent linkages with various measures of affect, psychopathology and well-being, including anxiety. Methods Cross-sectional data from a multinational study conducted by the members of the International Nursing Network for HIV Research ( n = 1986) were used. The diverse sample included participants from Canada, China, Namibia, the United States of America and the territory of Puerto Rico. Study measures included the anxiety subscale of the Symptom Checklist-90 instrument, the Brief Version Self- Compassion Inventory and a single item on anxiety from the Revised Sign and Symptom Checklist. Findings Study findings show that anxiety was significantly and inversely related to self-compassion across participants in all countries. We examined gender differences in self-compassion and anxiety, controlling for country. Levels of anxiety remained significantly and inversely related to self-compassion for both males ( P = 0.000) and females ( P = 0.000). Levels of self-compassion and anxiety varied across countries. Conclusions Self-compassion is a robust construct with cross-cultural relevance. A culturally based brief treatment approach aimed at increasing self-compassion may lend itself to the development of a cost effective adjunct treatment in HIV disease, including the management of anxiety symptoms. [ABSTRACT FROM AUTHOR]

Background While caregivers of children with intellectual disabilities are burdened in every part of the world, it is suspected that particular contexts may make the situation worse. There is little literature on caregivers in China, where familial and clan responsibility rather than individual effort is emphasised, and where communal support, while treasured, is often lacking. Method A total of 211 caregivers in two cities, one with and the other without randomised design, participated in a survey study that assessed affiliated stigma, loss of face, anxiety, mental health and empowerment. Results A proportion of 60.6% of participants were found to be conspicuous cases with mental disturbance of a level which required further professional attention. Participants with better resource appeared to have coped better, enjoying lower psychological distress, lower anxiety and a higher level of personal empowerment. Multiple regression analysis revealed that mental health is related to the affective dimension of affiliated stigma, loss of face and anxiety level. This was found to account for more than half the variance (55%). Discussion The subjective burden of care occurs not in isolation but in a cultural field. Chinese caregiving is characterised by a lack of formal support, and such cultural concerns as loss of face and strong affiliated stigma. This socio-political context makes caregiving all the more challenging. The situation has to be addressed by both practitioners and policy makers if family caregiving is to be valued and made sustainable. [ABSTRACT FROM AUTHOR]

Background With the extended lifespan of people living with human immunodeficiency virus (HIV) due to the advent of antiretroviral therapy, the disclosure of HIV serostatus to their uninfected children is becoming more critical. However, limited data are available regarding parental HIV disclosure to children in China. We explore patterns of parental HIV disclosure and the reasons for disclosure or non-disclosure to children. Methods A preliminary study was conducted using open-ended questions in Guangxi, China in 2011 with 39 parents living with HIV. Results A majority of participants (77%) had not disclosed their HIV serostatus to their children. Participants who voluntarily disclosed tended to be older and were more likely to disclose to their adult children. Among parents who disclosed, reasons included a need for emotional and financial support, as well as feelings of obligation to their children. Among non-disclosing parents, primary reasons included concerns that children were too young to understand, fear of being stigmatized, and fear of increased psychological burden to children. Conclusions Few parents with HIV disclosed their HIV status to their children. These data indicate the need for future research to explore disclosure issues in relation to children's age and the implementation of developmentally appropriate interventions and support systems for parents and children affected by HIV in China. [ABSTRACT FROM AUTHOR]

We propose that problem-solving demand (PSD) is an important job attribute for employees' creative performance. Applying job design theory, we examined the relationship between PSD and employee creativity. The theorised model was tested with data obtained from a sample of 270 employees and their supervisors from three Chinese organisations. Regression results revealed that PSD was positively related to creativity, and this relationship was mediated by creative self-efficacy. Additionally, intrinsic motivation moderated the relationship between PSD and creative self-efficacy such that the relationship was stronger for individuals with high rather than low intrinsic motivation. We discuss our findings, implications for practice, and future research. [ABSTRACT FROM AUTHOR]