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Objective: To establish the reliability, validity, and sensitivity to change of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) among Chinese subjects with osteoarthritis (OA) of the knee, living in mainland China.Methods: A multicenter, randomized, double-blind, placebo-controlled, parallel-group study was conducted for validation of the electronic personal digital assistant version of the WOMAC Numerical Rating Scale (NRS) 3.1 Index in China. A total of 287 subjects with OA of the knee were randomized to receive either meloxicam (15 mg) or placebo. Psychometric properties of the WOMAC were evaluated by estimating the reliability, validity, and sensitivity to change. Equivalence of the electronic version was also compared with the paper version.Results: Intraclass correlation coefficients for the WOMAC pain, stiffness, and physical function subscales were 0.81, 0.76, and 0.85, respectively, indicating good test-retest reliability. Similarly, internal consistency was strong (Cronbach's alpha for the 3 WOMAC subscales was 0.84, 0.86, and 0.96, respectively). Pearson's correlation coefficients for WOMAC pain and Short Form 36 health survey (SF-36) bodily pain, as well as WOMAC physical function and SF-36 physical functioning domains were >0.4, indicating convergent validity, whereas the coefficients for all 3 WOMAC domains with SF-36 mental health and mental health component scores were <0.4, indicating divergent validity. There was strong discriminant validity between healthy volunteers and OA patients. The effect sizes of change from baseline to week 12 in WOMAC subscale scores were large, demonstrating sensitivity to change. Equivalence between paper and electronic versions was very high.Conclusion: The culturally and linguistically validated Chinese version of the WOMAC NRS 3.1 for mainland China is psychometrically robust in its validity, reliability, and sensitivity to change for patients with OA of the knee. [ABSTRACT FROM AUTHOR]

In the medical practice in China, giving and taking "red envelopes" (monetary gifts) is a common phenomenon although few openly admit it. This paper, based on our empirical study including data collected from interviews and questionnaires with medical professionals and patients, attempts to explore why "red envelopes" have become a serious problem in the physician-patient relationship and how the situation can be improved. Previous studies show that scholars tend to correlate the spread of "red envelopes" in health care sector to the commercialization trend, the general erosion of traditional values, and the lowering of the moral level in the medical field. However, in this paper, the authors argue that medical professionals' choice of taking "red envelopes" is actually more a way to compensate for their problematic self-image and marred dignity in real practice. Medical professionals in China as a whole are in an embarrassing situation where the work pressure and income, and the sense of pride that used to be part of their profession are not comparable to each other. Under this circumstance, we believe that the effective way to deal with the "red envelopes" issue does not lie solely in introducing more stringent regulations or granting medical professionals higher payments, but rather in protecting and enhancing the professional dignity of all those working in healthcare. And on top of that, there must also be effort to cultivate a more favorable moral environment. [ABSTRACT FROM AUTHOR]

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How health care providers are paid affects how medicine is practiced. It is thus important to assess provider payment models not only from the economic perspective but also from the ethical perspective. China recently started to reform the provider payment model in the health care system from fee-for-service to case-based payment. This paper aims to examine this transition from an ethical perspective. We collected empirical studies on the impact of case-based payment in the Chinese health care system and applied a systematic ethical matrix that integrates clinical ethics and public health ethics to analyze the empirical findings. We identified eleven prominent ethical issues related to case-based payment. Some ethical problems of case-based payment in China are comparable to ethical problems of managed care and diagnosis related groups in high-income countries. However, in this paper we discuss in greater detail four specific ethical issues in the Chinese context: professionalism, the patient-physician relationship, access to care and patient autonomy. Based on the analysis, we cautiously infer that case-based payment is currently more ethically acceptable than fee-for-service in the context of China, mainly because it seems to lower financial barriers to access care. Nonetheless, it will be difficult to justify the implementation of case-based payment if no additional measures are taken to monitor and minimize its existing negative ethical implications. [ABSTRACT FROM AUTHOR]

Based on two years' ethnographic research on doctor-patient relations in urban China, this paper examines the causes of patients' mistrust of physicians. I identify the major factors at the societal, institutional, and interpersonal levels that lead to patients' mistrust of physicians. First, I set the context by describing the extent of mistrust at the societal level. Then, I investigate the institutional sources of mistrust. I argue that the financing mechanism of public hospitals and physicians' income structures are the most crucial factors in inducing patients' mistrust. Hospitals' heavy reliance on self-finance has basically caused public hospitals to run like private hospitals, resulting in blatant conflicts of interest between hospitals and patients. Related to this is physicians' reliance on bonuses and commissions as part of their regular incomes, which has inevitably resulted in overtreatment and, hence, mistrust from the patients. At the interpersonal level, I describe how individual physicians' attitudes toward and interaction with patients may also affect patients' sense of trust or mistrust in physicians. In conclusion, I discuss the ethical implications of the mistrust problem, and suggest changes at the institutional and interpersonal levels to mitigate the problem. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various articles in the issue on topics including socio-political, cultural and healthcare context of patient-physician mistrust; and implications of patient–physician trust and mistrust in the Chinese context.

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]

Objective: To obtain descriptive measures of maternal and perinatal health in the Ba Men Region of Inner Mongolia, China.Methods: Data collected from the Examination Chart for Pregnant Women for approximately 22,000 pregnancies in a three-county area of Inner Mongolia, China from December 1, 1996 through December 31, 1999 were analyzed for maternal, perinatal, and neonatal outcomes.Results: Compared to selected developing countries, a higher percentage of women (99%) in this region received at least one prenatal care visit. This region was also characterized by a low percentage of low birthweight (<2.5 kg) infants (1%) and neonatal mortality rate (5 deaths per 1000 live births).Conclusions: Maternal and neonatal health outcomes in this region of Inner Mongolia were better than those in selected developing countries. [ABSTRACT FROM AUTHOR]

Background: To explore the vitamin D status with its demographic and lifestyle factors including dietary, supplementation, and physical activity in 0–5 years old children. Methods: This was a large population‐based cross‐sectional multicentre study in which the children were recruited from 12 Children's Health Care Centers by a stratified cluster random‐sampling method in 10 cities in Jiangsu Province, China. Results: A total number of 5289 children were investigated. The prevalence of vitamin D deficiency was 30.1%. The concentration of 25 hydroxyvitamin D was 64.0 (46.3–83.0) nmol mL−1 after adjustment for covariates. Children with higher risk of vitamin D deficiency were more likely to be at older age, girls, survey conducted in spring, location in southern Jiangsu province, residence in urban, outdoor activity < 2 h day−1 (all p < 0.05). Moreover, those with lower risk were more likely to be the number of parity ≥ 2 times, vitamin D supplementation from birth to 6 months, the initial time of vitamin D supplementation after birth ≤ 1 months, vitamin D and calcium supplementation in the last 3 months, and dose of vitamin D supplementation > 400 IU day−1 (all p < 0.05). Children with preferences for sweets, meat consumption > 150.0 g day−1, milk consumption < 250 mL day−1, time of sleeping < 10 h day−1 had higher risks of vitamin D deficiency. However, these relationships were affected by demographics. Conclusions: Vitamin D status during the first five years of life was suboptimal and was associated with demographic and lifestyle determinants including milk, meat, sweets, vitamin D and calcium supplementation, sleeping and outdoor activity. [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]

Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular morbidity and mortality in hypertensives. Therefore, early identification of at-risk patients is necessary. The objective of this study was to estimate the risk of LVH among Chinese hypertensives by designing a nomogram. 832 hypertensives were divided into two groups based on the presence of LVH. The least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression were successively applied for optimal variable selection and nomogram construction. Discrimination power, calibration, and clinical usefulness were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. Internal validation was performed using the bootstrap method. The nomogram included five predictors, namely gender, duration of hypertension, age, body mass index (BMI), and systolic blood pressure. The area under the ROC curve (AUC) was 0.724 (95% CI: 0.687-0.761), indicating moderate discrimination. The calibration curve showed an excellent agreement between the predicted LVH and the actual LVH probability. The risk threshold between 5% and 72% according to the decision curve analysis, and the nomogram is clinically beneficial. Internal validation by bootstrapping with 1000 samples showed a good C-index of 0.715, which suggested that the predictive abilities for the training set and testing set were in consistency. Our study proposed a nomogram that can be utilized to assess the LVH risk rapidly for Chinese hypertensives. This tool could be useful in identifying patients at high risk for LVH. Further studies are required to ascertain the stability and applicability of this nomogram. [ABSTRACT FROM AUTHOR]

Blood pressure (BP) variability may have its effect on the development of vascular disease. The authors aimed to examine the association between the visit-to-visit variability (VVV) of BP and arterial stiffness in Chinese adults. The authors included 1407 participants from a prospective cohort study of community residents who were ≥40 years, without a history of myocardial infarction or stroke, and with data at the baseline, the second and the third visits in 2008, 2009, and 2013. The VVV of BP was defined as the standard deviation (SD), the coefficient of variation (CV), the average successive variability (ASV), and the variability independent of the mean (VIM) in BP levels at the 3 visits. Arterial stiffness was measured by brachial-ankle pulse wave velocity (ba-PWV) at the 2nd and the 3rd visits. Levels of ba-PWV change and the occurrence of an elevated ba-PWV increased significantly in the highest tertile of VVV measures of systolic BP (SBP) and pulse pressure (PP) compared with the lowest tertile, respectively. The multivariable regression analysis revealed that VVV measures of SBP and PP were significantly associated with levels of ba-PWV change and the risks of developing an elevated ba-PWV. The odds ratios (ORs) and 95% confidence intervals (CIs) for the risk were 2.12 (1.57-3.12) and 1.92 (1.38-2.68) in participants with the highest versus the lowest tertile of SBP-SD and PP-SD, respectively. No significant association was found for diastolic BP variability measures. The increased long-term variabilities of SBP and PP were associated with an increased risk of arterial stiffness. [ABSTRACT FROM AUTHOR]

The article offers information on the a molecular genetic study of a Chinese blood donor who was identified with a new mutation in the RHD gene in in Exon 2 and proved to have D-negative blood type by serologic testing. Polymerase chain reaction–sequence specific primer analysis displayed 10 whole RHD exons and on further DNA sequencing it identified a new RHD allele caused by a certain rare mutation.

Aim: Despite initiatives to increase elderly patients' access to surgical treatments, the prevalence and impact of postoperative infectious complications (PICs) in elderly patients in China are poorly described. The aim of our study was to describe PICs and associated mortality in elderly patients undertaking elective surgery in China. Methods: We analyzed data about elderly patients from China during the International Surgical Outcomes Study (ISOS), a 7‐day prospective cohort study of outcomes after elective surgery in in‐patient adults. All elderly patients (age ≥60 years) from 28 hospitals in China included in the ISOS study were included in this study as well. A review of 2014 elderly patients who underwent elective surgery in April 2014 was conducted. Results: Of 2014 elderly patients, 209 (10.4%) developed at least one postoperative complication. Infectious complications were most frequent, affecting 154 patients (7.6%); there was one death, or 0.6% 30‐day mortality, which was a significantly higher rate than among patients without PICs (0%). The most frequent infectious complication was superficial surgical‐site infection (3.3%). The length of hospital stay was longer in elderly patients with PICs than in those without PICs. Moreover, a total of 142 elderly patients (7.1%) were routinely sent to critical care after surgery, of whom 97 (68.3%) developed PICs. Compared to elderly patients admitted to a standard ward, those admitted to critical care immediately after surgery had a higher postoperative complication rate and critical care admission rate to treat complications. Conclusions: The present prospective, multicentre study found that 7.6% of elderly patients in China had PICs after elective surgery that could prolong hospital stay and increase 30‐day mortality. The clinical effectiveness of admission to critical care after surgery on elderly patients is not identified. Initiatives to increase elderly patients' access to surgical interventions should also enhance safe perioperative care to reduce PICs in China. [ABSTRACT FROM AUTHOR]

Background: 99mTc bone scintigraphy (BS) is still the most common approach for the evaluation of bone metastasis in China. The purpose of this study was to investigate the necessity of BS as part of a routine preoperative workup for patients with cT1N0 subsolid lung cancer. Methods: This was a prospective multicenter clinical trial (NCT03689439). Patients with cT1N0 subsolid nodules who were candidates for surgical resection were consecutively enrolled into the study. BS was performed preoperatively. The surgical plan could be changed if a positive result was detected. The primary endpoint was the incidence rate of the surgical plan being changed because of positive BS results. The secondary endpoint was the rate of positive BS findings and the rate of related complications. Results: From November 2018 to July 2019, 691 patients were enrolled into the study. None of the patients had positive BS results and no surgical plans were changed by BS findings. There were 222 male and 469 female patients. The average age was 54.8 ± 3.7 years old. The average tumor diameter was 14.9 ± 4.2 mm. There were 282 patients with pure GGO nodules and 409 with part‐solid nodules. A total of 470 patients had a single nodule, while 221 patients had multifocal lesions. The number of patients whose pathological diagnosis was invasive adenocarcinoma, minimally invasive adenocarcinoma, adenocarcinoma in situ and mucinous adenocarcinoma was 357, 293, 32 and nine, respectively. The number of patients who underwent lobectomy, segmentectomy and wedge resection was 234, 199 and 258, respectively. Conclusions: 99mTc bone scintigraphy is unnecessary in the preoperative workup for patients with cT1N0 subsolid lung cancer. Key points: Significant findings of the study: In this prospective study of 691 patients with cT1N0 subsolid lung cancer, no surgical plans were affected by positive bone scan findings. What this study adds: We suggest physicians consider canceling BS from preoperative workup for cT1 subsolid lung cancer patients. Clinical trial registry number: NCT03689439. [ABSTRACT FROM AUTHOR]

Objective: This study aims to explore the indicators for severity of coronavirus disease 2019 (COVID-19) in young patients between the ages of 18 and 40 years.Methods: This retrospective cohort study included 65 consecutively admitted patients with COVID-19 who were between 18 and 40 years old in Zhongnan Hospital of Wuhan University in Wuhan, China. Among them, 53 were moderate cases, and 12 were severe or critical cases. Epidemiological, clinical, and laboratory characteristics and treatment data were collected. A multivariate logistic regression analysis was implemented to explore risk factors.Results: The patients with severe/critical cases had obviously higher BMI (average 29.23 vs. 22.79 kg/m2 ) and lower liver computed tomography value (average 50.00 vs. 65.00 mU) than the group of moderate cases. The patients with severe/critical cases had higher fasting glucose, alanine aminotransferase, aspartate aminotransferase, and creatinine compared with patients with moderate cases (all P < 0.01). More severe/critical cases (58.33% vs. 1.92%) had positive urine protein levels. The severe/critical cases also experienced a significant process of serum albumin decline. Logistic regression analysis showed that male sex, high BMI (especially obesity), elevated fasting blood glucose, and urinary protein positivity were all risk factors for young patients with severe COVID-19.Conclusions: Obesity is an important predictor of COVID-19 severity in young patients. The main mechanism is related to damage of the liver and kidney. [ABSTRACT FROM AUTHOR]

Objectives: Caregiving does not have to be a totally negative experience for the husband caregivers of breast cancer survivors (BCS). There are growing interests in exploring the positive psychological changes (aka posttraumatic growth; PTG) among husbands of BCS. Western studies have shown that coping resources, cognitive appraisal, and coping strategies are associated with PTG among caregivers of BCS. Studies in the Chinese context are limited. This study examined the psychosocial correlates of PTG among husbands of Chinese BCS.Methods: Husbands of Chinese BCS (N = 176) were recruited from two hospitals in Weifang, China to complete a cross-sectional survey. Their levels of caregiving burden, marital satisfaction, cognitive appraisals, coping strategies, and PTG were measured.Results: After controlling for covariates, hierarchical regression results indicated that higher caregiving burden (β = .29), marital satisfaction (β = .27), challenge appraisal (β = 016), and social support seeking (β = .23) were associated with higher PTG (Ps < .05). Additionally, a significant interaction between caregiving burden and positive reframing emerged in explaining PTG (β = .17, P < .05). Positive reframing was only associated with higher PTG among those with higher caregiving burden (β = .25, P = .03), but not those with lower caregiving burden (β = -.09, P > .05).Conclusions: Stress and coping variables significantly contributed to PTG among husbands of Chinese BCS. Our findings implied that addressing those husband caregivers' marital satisfaction, challenge appraisal toward the impact of breast cancer, and social support seeking could be intervention strategies to facilitate their PTG. Among husbands having higher caregiving burden, positive reframing may also facilitate their PTG. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the mental status of pregnant women and to determine their obstetric decisions during the COVID-19 outbreak.Design: Cross-sectional study.Setting: Two cities in China--Wuhan (epicentre) and Chongqing (a less affected city).Population: A total of 1947 pregnant women.Methods: We collected demographic, pregnancy and epidemic information from our pregnant subjects, along with their attitudes towards COVID-19 (using a self-constructed five-point scale). The Self-Rating Anxiety Scale (SAS) was used to assess anxiety status. Obstetric decision-making was also evaluated. The differences between cities in all of the above factors were compared and the factors that influenced anxiety levels were identified by multivariable analysis.Main Outcome Measures: Anxiety status and its influencing factors. Obstetric decision-making.Results: Differences were observed between cities in some background characteristics and women's attitudes towards COVID-19 in Wuhan were more extreme. More women in Wuhan felt anxious (24.5 versus 10.4%). Factors that influenced anxiety also included household income, subjective symptom and attitudes. Overall, obstetric decisions also revealed city-based differences; these decisions mainly concerned hospital preference, time of prenatal care or delivery, mode of delivery and infant feeding.Conclusions: The outbreak aggravated prenatal anxiety and the associated factors could be targets for psychological care. In parallel, key obstetric decision-making changed, emphasising the need for pertinent professional advice. Special support is essential for pregnant mothers during epidemics.Tweetable Abstract: The COVID-19 outbreak increased pregnant women's anxiety and affected their decision-making. [ABSTRACT FROM AUTHOR]

Objectives: The Chinese household debt has been increasing rapidly in recent years because of the expansion of consumers' spending and mortgage. Its effects on individuals' mental and physical well-being are poorly known. This study aims to examine the relationship of household debt with hypertension and depressive symptoms among the middle- and old-aged population.Methods: Nationally representative data were collected from China Health and Retirement Longitudinal Study 2015. Logistic regression analysis and mediation analysis were used to estimate associations of household debt with the presence of hypertension and depressive symptoms. The Sobel test was used to assess the mediation effect of depressive symptoms in the association of household debt and hypertension.Results: Among 12 274 subjects, those with high-level household debt exhibited 12% increased odds of hypertension and double odds of depressive symptoms compared to low-level household debtors. Household debt had a direct effect on hypertension and depressive symptoms and an indirect effect on hypertension via depressive symptoms.Conclusions: The relationships between household debt, depressive symptoms, and hypertension form a society-psychology-body view that is worth considering in household, community and clinical settings in hypertension management among middle-aged and elderly populations. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of metformin in megestrol acetate (MA)-based fertility-sparing treatment for patients with atypical endometrial hyperplasia (AEH) and endometrioid endometrial cancer (EEC).Design: A randomised, single-centre, open-label, controlled trial conducted between October 2013 and December 2017.Setting: Shanghai OBGYN Hospital of Fudan University, China.Population: A total of 150 patients (18-45 years old) with primary AEH or well-differentiated EEC were randomised into an MA group (n = 74) and an MA plus metformin group (n = 76).Methods: Patients with AEH or EEC were firstly stratified, then randomised to receive MA (160 mg orally, daily) or MA (160 mg orally, daily) plus metformin (500 mg orally, three times a day).Main Outcomes and Measures: The primary efficacy parameter was the cumulate complete response (CR) rate within 16 weeks of treatment (16w-CR rate); the secondary efficacy parameters were 30w-CR rate and adverse events.Results: The 16w-CR rate was higher in the metformin plus MA group than in the MA-only group (34.3 versus 20.7%, odds ratio [OR] 2.0, 95% confidence interval [CI] 0.89-4.51, P = 0.09) but the difference was more significant in 102 AEH patients (39.6 versus 20.4%, OR 2.56, 95% CI 1.06-6.21, P = 0.04). This effect of metformin was also significant in non-obese (51.4 versus 24.3%, OR 3.28, 95% CI 1.22-8.84, P = 0.02) and insulin-sensitive (54.8 versus 28.6%, OR 3.04, 95% CI 1.03-8.97, P = 0.04) subgroups of AEH women. No significant result was found in secondary endpoints.Conclusion: As a fertility-sparing treatment, metformin plus MA was associated with a higher early CR rate compared with MA alone in AEH patients.Tweetable Abstract: For AEH patients, metformin plus MA might be a better fertility-sparing treatment to achieve a higher early CR rate compared with MA alone. [ABSTRACT FROM AUTHOR]

To evaluate the association between plasma retinol levels with all-cause mortality and investigate the possible effect modifiers in general hypertensive patients with no previous cardiovascular disease (CVD). This case-control study was nested in the China Stroke Primary Prevention Trial (CSPPT), a randomized, double-blind, controlled trial conducted in 32 communities in Anhui and Jiangsu provinces in China. The current study included 617 cases of all-cause mortality and 617 controls matched on age (≤1 year), sex, treatment group, and study site. All-cause mortality was the main outcome in this analysis, which included death due to any reason. The median follow-up duration was 4.5 years. Overall, there was a U-shaped relation of plasma retinol with all-cause mortality. In the threshold effect analysis, the risk of all-cause mortality significantly decreased with the increase in plasma retinol (per 10 μg/dL increments: OR, 0.73; 95% CI: 0.61-0.87) in participants with plasma retinol <58.3 μg/dL and increased with the increase in plasma retinol (per 10 μg/dL increments: OR, 1.08; 95% CI: 1.01-1.16) in those with plasma retinol ≥58.3 μg/L. In participants with plasma retinol <58.3 μg/dL, a stronger inverse association was observed in those with higher time-averaged SBP (≥140 vs <140 mm Hg; P-interaction = .034), or higher vitamin E levels (≥11.5 [quartile 4]; vs <11.5 μg/mL; P-interaction = .013). The present study demonstrated that there was a U-shaped relationship of plasma retinol levels with the risk of all-cause mortality in general hypertensive patients, with a turning point around 58.3 μg/dL. [ABSTRACT FROM AUTHOR]

Objective: To assess whether a practical intervention based upon a smartphone application (app) would improve self-management and seizure control in adults with epilepsy.Design, Setting: Randomised, controlled trial in western China, December 2017 to August 2018.Participants: 380 eligible people with epilepsy were recruited; 327 completed the 6-month follow-up (176 in the app group, 151 in the control group).Main Outcome Measures: Self-management of epilepsy (measured with the validated Chinese Epilepsy Self-Management Scale, C-ESMS) and self-reported seizure frequency.Results: In the intention-to-treat analysis, the mean C-ESMS score increased significantly in the app group between baseline and the 6-month evaluation (from 121.7 [SD, 12.1] to 144.4 [SD, 10.0]; P < 0.001); improvements on the information management, medication management, and safety management subscales were also statistically significant. At 6 months, the mean overall C-ESMS score for the app group was significantly higher than that for the control group (125.4 [SD, 1.5];  P < 0.001). The proportion of patients who were seizure-free at the 6-month follow-up was larger for the app than the control group (54 of 190, 28% v 22 of 190, 12%), as was the proportion with reductions in frequency of between 75 and 100% (22 of 190, 12% v 8 of 190, 4%). Changes in C-ESMS score were not statistically associated with seizure frequency.Conclusions: Using a smartphone app improved epilepsy self-management scores in people in western China. It should be further tested in larger populations in other areas. Our preliminary investigation of building digital communities for people with epilepsy should encourage similar approaches to managing other chronic diseases.Trial Registration: Chinese Clinical Trial Registry, ChiCTR1900026864, 24 October 2019. [ABSTRACT FROM AUTHOR]

Under Chinese law, the juridical status of the embryo and the foetus is unclear, mainly because the existing legislation can be subject to diverse interpretations due to its ambiguous language. Lack of clarity with the law has led to different understandings amongst Chinese legal scholars. However, although there has been no consensus, there has been a clear tendency to deprive embryos and foetuses of legal status or personhood, thereby excluding them from entitlement to fundamental rights, an understanding reinforced by the Confucian view of the beginning of life. It is expected that in the near future the Chinese courts will face issues involving embryos and foetuses more often, such as disputes over in vitro embryos. The lack of legal precedent could result in contradictory resolutions, therefore, the law should clarify the legal status of embryos and foetuses and accord to prenatal life special respect and treatment. [ABSTRACT FROM AUTHOR]

Background: Chinese blood donors with unconfirmed serological and/or molecular screening results are deferred permanently. This study investigated the implementation and performance of a follow-up program aiming to improve the notification and management of deferred donors in Dalian, China.Study Design and Methods: From January 2013 to February 2018, 411,216 donations were tested for HBsAg, anti-HCV, anti-HIV/HIV antigen, and antibodies to Treponema pallidum. HBV, HCV, and HIV nucleic acid testing (NAT) was performed in mini-pools of six or in individual donations (IDs). Reactive donations were evaluated further with alternative serological assays and ID-NAT re-testing. A follow-up procedure was developed to evaluate a subset of deferred donors that were either potential NAT yield cases, serology non-reactive and NAT non-repeated reactive (NRR), or serology NRR irrespective of NAT result.Results: Serological and molecular routine, plus supplemental testing, identified HBV, HCV, HIV, and TP in 503 (0.12%), 392 (0.09%), 156 (0.04%), and 2041 (0.49%) donations, respectively. Overall, 683 of 4156 (16.4%) eligible donors and 205 donors deferred prior 2013 participated in the program. They included 664 serology NRR and 224 NAT yield cases, and 58.8% repeat donors. All markers combined, follow-up documented false reactivity, primary acute infections, and OBI in 61.9% (550/888), 3.3% (29/888), and 12.8% (114/888) of these donors, respectively. Isolated anti-HBc or anti-HBs reactivity was observed in 22% of cases.Conclusion: Follow-up testing refined infection status in 78.0% (693/888) of deferred donors with unconfirmed screening results. This high false-positive rate encouraged to reevaluate the current screening strategies and to consider donor reentry. [ABSTRACT FROM AUTHOR]

Background: Previous data, although scant, indicated that the incidence of HIV in China has increased over the past decade. There is a growing concern about the impact of the HIV epidemic on blood safety.Methods and Materials: We used donation data from five geographically-disperse blood centers in 2013-2016 participating in the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) China program to estimate HIV prevalence and incidence among blood donors. Multivariable logistic regression model was used to examine factors associated with HIV infection in Chinese blood donors.Results: The overall HIV prevalence among first-time donors from 2013 through 2016 was 68.04 per 100,000 donors (95% CI 61.68-74.40). The HIV incidence rate was estimated to be 37.93 per 100,000 person-years (95% CI 30.62-46.97) among first-time donors and 20.55 per 100,000 person-years (95% CI 16.95-24.91) among repeat donors. There was substantial variation in HIV prevalence and incidence rates across blood centers. Multivariable logistic regression results showed that among first-time donors, being male, older than 25 years, minority ethnicity, less than college education, and certain occupations (commercial services, factory workers, retired, unemployed, or self-employed) were associated with positive HIV confirmatory testing results.Conclusion: HIV prevalence and incidence among blood donors remain low in the selected five regions in China; however, an increasing trend is observed at some blood centers. It is important to monitor HIV epidemiology in Chinese blood donors on a continuous basis, especially among populations and regions of higher risk. [ABSTRACT FROM AUTHOR]

This study investigated the association between perceived material deprivation, children's behavior problems, and parents' disciplinary practices. The sample included 1,418 8- to 12-year-old children and their parents in China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States. Multilevel mixed- and fixed-effects regression models found that, even when income remained stable, perceived material deprivation was associated with children's externalizing behavior problems and parents' psychological aggression. Parents' disciplinary practices mediated a small share of the association between perceived material deprivation and children's behavior problems. There were no differences in these associations between mothers and fathers or between high- and low- and middle-income countries. These results suggest that material deprivation likely influences children's outcomes at any income level. [ABSTRACT FROM AUTHOR]

Background: Previous studies have documented the therapeutic value of computed tomography (CT)‐guided percutaneous microwave ablation (MWA) for early‐stage non‐small cell lung cancer (NSCLC). However, few studies have focused on patients aged 80 years and older. This retrospective study aimed to evaluate the safety and clinical outcomes of CT‐guided percutaneous MWA in patients aged 80 years and older with early‐stage peripheral NSCLC. Methods: A retrospective analysis of 63 patients aged 80 years and older with cT1a‐2bN0M0 peripheral NSCLC who underwent CT‐guided percutaneous MWA was performed between January 2008 and January 2018 at 11 hospitals in Shandong Province, China. Results: The median follow‐up time was 21.0 months. The overall median survival time was 50 months. The cancer‐specific median survival time was not reached in five years. The one‐, two‐, three‐, four‐, and five‐year overall survival rates were 97.1%, 92.6%, 63.4%, 54.4%, and 32.6%, respectively. The one‐, two‐, and three‐year cancer‐specific survival (CSS) rates were 97.9%, 97.9%, and 69.4%, respectively. The four‐ and five‐year CSS rates were not achieved. A total of 14 patients (22.2%) had local progression. The one‐, two‐, three‐, four‐, and five‐year local control rates were 88.8%, 78.8%, 70.3%, 63.9%, and 63.9%, respectively. The mortality rate was 0% within 30 days after the procedure. Major complications included pneumothorax requiring drainage (21.1%), pulmonary infection (4.2%), and pleural effusions requiring drainage (2.8%). Conclusions: CT‐guided percutaneous MWA is a safe and effective modality for treating patients aged 80 years and older with early‐stage peripheral NSCLC. [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]

Little is known about how climatic differences may psychologically impact individuals who migrate from one geographical area to another. A climatic demand theory perspective suggests that migration from more demanding climatic areas to less demanding climatic areas would lead to better psychological outcomes while predicting the opposite for migration from less demanding to more demanding climates. In contrast, a climatic‐fit perspective would predict that moving to areas that climatically are similar to one's home would lead to the best psychological outcomes whereas any major deviation would lead to worse outcomes. To test these competing perspectives, a longitudinal, multisite study was conducted with over 1,000 student migrants who moved from various areas in China to 12 cities. Participants' life satisfaction and perceived stress were assessed upon arrival and at the end of the semester together with their sociocultural adaptation. Supporting the climatic‐fit perspective, multilevel analyses showed that participants reported the least stress and highest sociocultural adaptation when they migrated to host sites that were climatically similar to their homes. Conversely, individuals who migrated from very demanding to less demanding climatic regions and vice versa reported an increase in stress and lower sociocultural adaptation. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the prevalence, incidence, and the associated factors of pressure injuries (PIs) among immobile hospitalised patients in China. Being immobile during hospitalisation put these patients at a higher risk of PIs. There is little literature about pressure injury (PI) prevalence or PI incidence in immobile hospitalised patients in hospitals in China. This was a multicentre, cross‐sectional, exploratory descriptive study. A total of 23 985 immobile patients were recruited from 25 general hospitals in six provinces of China from November 1, 2015 to March 18, 2016. Information was collected on demographic characteristics, physical assessment information, and treatment and nursing care measures. The PI period prevalence was 3.38%, and the PI cumulative incidence was 1.23%. Most PIs (84.03%) were Stage 1 or Stage 2. A total of 48.22% of PIs occurred in the sacrum or heel region. In the multivariate analysis, the following factors were associated with higher PI prevalence: age, gender, length of immobility, type of hospital, modified Braden Scale score, urinary incontinence, faecal incontinence, low serum albumin, the usage of fixation or restraint devices, and patient's discharge diagnosis (lower limb fracture, malnutrition, and spinal cord injury). PI prevalence for immobile hospitalised patients in the study was lower than those reported in literature. However, because of the large population in China, the number of patients who suffer with PIs can be very high. The relating factors of higher PI prevalence identified in this study were consistent with current literature. Patients with a higher number of these associated factors should be monitored more closely, and preventative measures should be taken to prevent PI occurrence in high‐risk populations. [ABSTRACT FROM AUTHOR]

The goal of this study is to examine individual-level and school-level predictors of teacher victimization (TV) by students in China based upon the multilevel social-ecological framework. A sample of 1711 teachers (7-12th grade) from 58 schools from eight provinces in mainland China completed measures of teacher victimization (i.e., physical TV, verbal TV, social TV, cyber TV, sexual harassment, and personal property offenses) by students, school-wide bullying and disciplinary practices, and demographics. In the present sample, 25.1% of teachers reported that they experienced at least one of the six forms of victimization from students in the past school year. Prevalence of teacher victimization ranged from 4.0% (physical victimization) to 16.8% (social victimization). Male teachers were more likely to experience all forms of TV and homeroom teachers were more likely than non-homeroom teachers to experience social TV. Schools with fewer students, but higher number of teachers, also had higher levels of TV. Student bullying and punitive disciplinary practices at the teacher level were associated with higher levels of most forms of TV. Implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

The CAPTRA‐Lung study (NCT03334864) is a prospective observational study that will capture real‐world data of patients with advanced or metastatic non‐small cell lung cancer (NSCLC) across China. The study aims to complement the results from current therapeutic regimens to improve the standard of diagnosis and treatment, evaluate the effectiveness and safety of systemic therapy, and determine the factors influencing the outcomes and responses to treatment. From January 2018 to December 2023, eligible patients with advanced or metastatic NSCLC who are receiving treatment and participating in follow‐up at 16 institutions in China, will be enrolled. The demographic, clinical, laboratory, and treatment characteristics and responses to treatment will be recorded in a case report form and transcribed into an electronic data capture system. Overall survival, progression‐free survival, overall response rate, and incidence of adverse events will be calculated from the time of initial enrolment until progression evaluated by physicians, last contact, date of death, or analysis cutoff date, respectively. Based on the disease characteristics and treatment strategies, four sub‐cohorts will also be established. This study cohort could serve as a pool of patients with advanced or metastatic NSCLC to support further research. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to evaluate the effectiveness of a modified 8-week reminiscence therapy on the burden, positive experience, and life satisfaction of older spouse caregivers and the life satisfaction of stroke survivors.Methods: We conducted a randomized controlled trial by using 75 older stroke couples recruited from communities in Zhengzhou, China. We randomly assigned participants to 1 of 3 groups: Group 1 (G1 , 25 couples, all attend intervention) and Group 2 (G2 , 22 couples, only caregivers attend intervention), who participated in a modified 8-week reminiscence therapy, and a waiting list (control) group (G3 , 28 couples). Interviewers blinded to treatment group assignment administered the life satisfaction to both stroke survivors and caregivers, caregiver burden, and positive experience for caregivers, at preintervention, immediately postintervention, and at 1 month and 3 months after cessation of the intervention.Results: We found a statistically significant interaction between treatment groups and assessment time points for the 4 outcome measures (P < .001). Although the effects were decreased after intervention at 1 month, the improvement in caregivers' positive experience, life satisfaction, burden, and life satisfaction of stroke survivors were still significant (P < .001).Conclusions: The use of a modified 8-week reminiscence therapy in this study sample improved the life satisfaction of stroke survivors and their spouse caregivers, improved the positive experience of caregivers, and decreased the burden of caregivers. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate combined effects of MESSAGE communication strategy and group reminiscence therapy (GRT) on elders with mild cognitive impairment (MCI) in long-term care facilities in Changchun, China.Methods: This study is a nonrandomized controlled trial. Subjects included 60 elders with MCI. Participants were divided into intervention (MESSAGE communication strategy combined with GRT) and control groups (without any intervention). Primary outcomes comprised cognitive function and quality of life of elderly people, as measured by the Beijing version of the Montreal Cognitive Assessment and the Chinese (mainland) version of Short-Form 36 Health Survey assessment.Results: We observed significant changes in cognitive function with mean difference of 1.962 after 12 weeks (P = .000; 95% confidence interval [CI] = 1.341, 2.582), delayed memory dimension of 1.115 (P = .003; 95% CI = 0.417, 1.813). The intervention group exhibited the following improvements: general health of 14.731 (P = .000; 95% CI = 8.511, 20.951), mental health of 21.038 (P = .000; 95% CI = 17.301, 24.776), role-emotional of 26.925 (P = .003; 95% CI = 10.317, 45.533), and vitality of 14.231 (P = .000; 95% CI = 10.084, 18.377).Conclusions: Using a sample of Chinese elderly people with MCI and residing in long-term care facilities, we concluded that application of MESSAGE communication strategy combined with GRT resulted in improved cognitive function and quality of life. [ABSTRACT FROM AUTHOR]

Aim: To determine the correct ShangRing size for paediatric circumcision using the no-flip technique.Methods: A cohort of 104 boys (from 6 to 14 years) underwent ShangRing circumcision at Ningbo First Hospital, China. The patients were randomly divided into three groups according to the different methods used for choosing the ring size. For Group A, the ring size was chosen using the ShangRing measuring tape; for Group B, ring size was chosen based on the diameter of penis measured using a self-designed scale plate; and for Group C, ring size was chosen based on the diameter of the glans measured using the self-designed scale plate. The surgery duration, foreskin dorsal slit rate, intra-operative and post-surgery pain score, pain duration, post-surgery ring detachment duration, pain score for ring detachment, complication rate and satisfaction rate were compared.Results: Group A had the highest dorsal slit rate and the longest surgical period. There were no significant differences in intra-/post-surgery pain or ring detachment duration among the three groups. The post-surgery oedema rate and foreskin asymmetry occurrence rate was the highest in Group A at 40.62 and 21.88%, respectively. Group C had the highest satisfaction rate (97.14%), with a significant difference from Group A (75.00%). Oedema and asymmetry of the foreskin increased, while the satisfaction rate simultaneously decreased when a larger ShangRing was chosen.Conclusions: The size of the ShangRing should be chosen in accordance with the diameter of the glans in paediatric ShangRing circumcision using the no-flip technique. [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]

Background: China has experienced a rapid growth in childhood adiposity in recent years. Although a large number of studies examine the effect of maternal employment on children's adiposity in developed countries, only a few studies investigate the issue in developing countries. Moreover, existing studies tend to suffer from a potential endogeneity issue.Aims: We provide new evidence on the causal effect of maternal employment on children's adiposity in China.Materials and Methods: We employ a difference-in-difference strategy that takes advantage of China's 1995 legislative change to labor regulations, which reduced the number of workdays from 6 to 5 days per week. Using longitudinal data from the China Health and Nutrition Survey (CHNS), we compare children whose mothers are wage-earning employees to those whose mothers are self-employed because the reform only affected the former.Results: Although maternal employment and childhood obesity in China exhibits the same positive association as in the United States, our difference-in-difference estimates present a different picture. We find that a reduction in the maternal labor supply led to children's weight gain. Further investigation reveals that the effect was stronger among children who were male, younger, in urban areas, and from households with low socioeconomic status.Discussion: Our evidence suggests that a change in maternal behaviors was likely responsible for children's weight gain. In particular, a greater proportion of treatment group mothers cooked and also devoted more time to cooking after the reform, which led to an increased caloric intake by their children. Such weight gain was beneficial for children who were previously underweight but harmful to those who became overweight.Conclusion: The finding implies that additional maternal time at home likely has a different effect in China compared to the United States. [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]

Objective: To assess the effect of maternal low flow oxygen administration during the second stage of labour on umbilical cord artery pH.Design: A randomised controlled trial.Setting: A tertiary teaching hospital in China.Population: Women in the second stage of labour with no complications.Methods: About 443 women were randomly allocated to receive either supplemental oxygen at a flow rate of 2 l/min or a sham supplementation by nasal cannula. Healthcare providers, women and outcome assessors were blinded to allocation.Main Outcome Measures: Umbilical cord artery pH and fetal heart rate (FHR) pattern.Results: Baseline characteristics were similar between the two groups. There were no significant differences between the two groups in the umbilical cord artery pH [median 7.261, interquartile range (IQR) 7.228-7.295 versus 7.266 (IQR 7.232-7.297), P = 0.64], the proportion with pH less than 7.2 [30/219 versus 34/224, P = 0.66, RR (relative risk) 0.9, 95% CI 0.57-1.42], and the proportion with normal FHR pattern (147/219 versus 153/224, P = 0.79, RR 0.98, 95% CI 0.86-1.12). Maternal partial pressure of dissolved oxygen was significantly higher in the oxygen group than in the sham group [median 150.0 mmHg (IQR 142.6-156.7) versus 112.0 (IQR 104.8-118.3), P < 0.001], whereas carbon dioxide was significantly lower in the oxygen group than in the sham group (mean difference -1.1, 95% CI -2.1 to -0.1, P = 0.03).Conclusion: The use of 2 l/min maternal oxygen during the second stage of labour did not adversely affect either the umbilical artery pH or the FHR pattern distribution.Tweetable Abstract: No difference in abnormal fetal acid base or normal heart rate if maternal O2 given, randomised trial finds. [ABSTRACT FROM AUTHOR]

The effective management of one's reputation is an important social skill, but little is known about how it develops. This study seeks to bridge the gap by examining how children communicate about their own good deeds, among 7- to 11-year-olds in both China and Canada (total N = 378). Participants cleaned a teacher's messy office in her absence, and their responses were observed when the teacher returned. Only the Chinese children showed an age-related increase in modesty by choosing to falsely deny their own good deeds. This modest behavior was uniquely predicted by Chinese children's evaluations of modesty-related lies. The results suggest that culture-specific socialization processes influence the way children communicate with authority figures about prosocial deeds. [ABSTRACT FROM AUTHOR]

The cultural specificity of action prediction was assessed in 8-month-old Chinese and Swedish infants. Infants were presented with an actor eating with a spoon or chopsticks. Predictive goal-directed gaze shifts were examined using eye tracking. The results demonstrate that Chinese infants only predict the goal of eating actions performed with chopsticks, whereas Swedish infants exclusively predict the goal of eating actions performed with a spoon. Infants in neither culture predicted the goal of object manipulation actions (e.g., picking up food) performed with a spoon or chopsticks. The results support the view that multiple processes (both visual/cultural learning and motor-based direct matching processes) facilitate goal prediction during observation of other peoples' actions early in infancy. [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]

ABSTRACT Background A healthy work environment can increase nurse-reported job satisfaction and patient care outcomes. Yet the associations between healthy work environment, nurse job satisfaction and QC have not been comprehensively examined in Chinese ICUs. Aim To investigate the mediating effect of nurse job satisfaction on the relationship between healthy work environment and nurse-reported quality of care ( QC) in Chinese intensive care units ( ICUs). Methods A total of 706 nurses were recruited from 28 ICUs of 14 tertiary hospitals. The nurses completed self-reported questionnaires to evaluate healthy work environment, job satisfaction and quality of patient care. Mediation analysis was conducted to explore the mediating effect between nurse-reported healthy work environment and QC. Results Nurse work environment showed positive correlations with nurse-reported QC in the ICUs. Nurse-reported job satisfaction showed full mediating effects between healthy work environment and QC in the medical-surgical ICUs, surgical ICUs and neonatal/paediatric ICUs and indicated a partial mediating effect in the medical ICUs. Relevance to clinical practice Significant mediating effects of nurse job satisfaction provide more support for thinking about how to use this mediator to increase nurse and patient care outcomes. Nurse administrators can design interventions to increase nurse work environment and patient care outcomes with this mediating factor addressed. [ABSTRACT FROM AUTHOR]

Aim: Respiratory syncytial virus (RSV) infection is a major health problem in young children. This study aimed to investigate whether the interleukin (IL)-4 -590C/T and -33 C/T polymorphisms were associated with the susceptibility to RSV infection in Chinese Han children and with the severity of the infection.Methods: The IL-4 -590C/T and -33 C/T SNPs were evaluated in 218 inpatients with RSV bronchiolitis and 303 healthy controls. The severity of RSV bronchiolitis was evaluated using a respiratory scoring system.Results: The frequencies of IL-4 -590 CC, CT and TT in the 218 RSV bronchiolitis patients versus the 303 controls were 1.4% versus 1.7%, 21.1% versus 34% and 77.5% versus 64.4%, respectively. The frequencies of IL-4 -33 CC, CT and TT were 1.4%, 20.6% and 78%, respectively, in RSV bronchiolitis patients and 2.3%, 35.6% and 62%, respectively, in the controls. The frequencies of the IL-4 -590C/T and -33 C/T polymorphisms were significantly different between the two groups. There was a significant difference in the frequency of the T-T haplotype formed by -590C/T and -33C/T between the two groups. The respiratory score of the RSV bronchiolitis cases with -590TT was 3.02 ± 0.44, which was significantly higher than those with -590CT (2.80 ± 0.44). The score for patients with -33TT was 3.03 ± 0.43, which was significantly higher than the score of 2.78 ± 0.46 for patients with -33CT.Conclusions: In Chinese Han children, the IL-4 -590C/T and -33 C/T polymorphisms were associated with the susceptibility to RSV and the severity of the infection. [ABSTRACT FROM AUTHOR]

There have been numerous studies concerning the associations of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D), angiotensin II receptor 1 (AT1R) gene A1166C, and endothelial nitric oxide synthase (eNOS) gene 4b/a polymorphisms with risk of pregnancy hypertensive disorders (PHDs). However, the results are inconsistent. A total of 83 eligible studies (10,354/18,446 cases/controls) were included in this meta-analysis. Pooled odds ratios with corresponding 95% confidence intervals were used to calculate these associations. The effects of ethnicity and types of PHDs were also considered. Results showed significant associations between the ACE gene polymorphism and PHDs in all of the populations except that in Africa. The associations also existed in AT1R, eNOS gene polymorphism and PHDs in part of the gene models in the overall population. These results indicated the ACE gene polymorphism was associated with an increased risk of PHDs, whereas the eNOS and AT1R gene polymorphism only have increased susceptibility to PHDs in part of the gene models. [ABSTRACT FROM AUTHOR]

This study examined the impact of overweight/obesity on sodium, potassium, and blood pressure associations using the Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH) project baseline survey data. Twenty-four-hour urine samples were collected in 1948 Chinese adults aged 18 to 69 years. The observed associations of sodium, potassium, sodium-potassium ratio, and systolic blood pressure (SBP) were stronger in the overweight/obese population than among those of normal weight. Among overweight/obese respondents, each additional standard deviation (SD) higher of urinary sodium excretion (SD=85 mmol) and potassium excretion (SD=19 mmol) was associated with a 1.31 mm Hg (95% confidence interval, 0.37-2.26) and -1.43 mm Hg (95% confidence interval, -2.23 to -0.63) difference in SBP, and each higher unit in sodium-potassium ratio was associated with a 0.54 mm Hg (95% confidence interval, 0.34-0.75) increase in SBP. The association between sodium, potassium, sodium-potassium ratio, and prevalence of hypertension among overweight/obese patients was similar to that of SBP. Our study indicated that the relationships between BP and both urinary sodium and potassium might be modified by BMI status in Chinese adults. [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]