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The supplementary motor area (SMA) is involved in the functional deficits of chronic ankle instability (CAI), but the structural basis of its abnormalities remains unclear. To determine the differences in volume- and surface-based morphologic features of the SMA between patients with CAI and healthy controls and the relationship between these features and the clinical features of CAI. Cross-sectional study. Sports medicine laboratory. A total of 32 patients with CAI (10 women, 22 men; age = 32.46 ± 7.51 years) and 31 healthy controls (12 women, 19 men; age = 29.70 ± 8.07 years) participated. We performed T1-weighted structural magnetic resonance imaging of participants and calculated volume- and surface-based morphologic features of SMA subregions. These subregions included anterior and posterior subdivisions of the medial portion of Brodmann area 6 (6 ma and 6 mp, respectively) and supplementary and cingulate eye fields. Between-group comparisons and correlation analysis with clinical features of CAI were performed. Moderately thinner 6 mp (motor-output site; Cohen d = −0.61; 95% CI = −1.11, −0.10; P =.02) and moderately plainer 6 ma (motor-planning site; Cohen d = −0.70; 95% CI = −1.20, −0.19; P =.01) were observed in the CAI than the control group. A thinner 6 mp was correlated with lower Foot and Ankle Ability Measure Activities of Daily Living subscale scores before (r = 0.400, P =.02) and after (r = 0.449, P =.01) controlling for covariates. Patients with CAI had a thinner 6 mp and a plainer 6 ma in the SMA compared with controls. The thin motor-output site of the SMA was associated with ankle dysfunction in patients. This morphologic evidence of maladaptive neuroplasticity in the SMA might promote more targeted rehabilitation of CAI. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to explore whether clinical ethical climate mediates the relationship between resilience and moral courage in a population of clinical nurses during COVID‐19, and if moral distress faced by nurses is a moderating factor. Background: Resilience can help nurses maintain their personal health during COVID‐19 when they face great physical and psychological shock and are prone to health problems. Moral courage, as an ethical competency, helps nursing staff in adhering to the principles and values of professional ethics. There is a strong correlation between resilience and moral courage, but the mechanism by which resilience contributes to moral courage is unclear. Method: A cross‐sectional study research is designed. Three hundred thirty clinical nurses from six hospitals in Beijing, Sichuan, and Fujian of China were included between August 2021 and March 2022. The survey instruments include the Nurses' Moral Courage Scale (NMCS), Connor‐Davidson Resilience Scale (CD‐RISC), Moral Distress Scale‐Revised (MDS‐R), and Hospital Ethical Climate Scale (HECS). Results: Ethical climate mediates 15% of the relationship between resilience and moral courage. The association between resilience and ethical climate, as well as the indirect relationship between resilience and moral courage, was modified by moral distress. Discussion: This study investigated the mechanisms by which resilience affects moral courage in clinical nurses in the context of COVID‐19, suggesting that moral courage can be increased by alleviating moral distress and increasing ethical climate. Implications for nursing and health policy: This study confirms the mediating effect of moral climate on the relationship between resilience and moral courage, as well as the moderating effect of moral distress. Hospital policymakers should value nurses' psychological resilience and moral courage, develop effective policies to prevent and manage stressors, build social support systems, and create a positive ethical climate. [ABSTRACT FROM AUTHOR]

Aim: The aims of the present study are to describe the status of selfmanagement behaviors and illness perception, and explore the relationship between illness perception and self-management behaviors among Chinese diabetic foot patients. Methods: A cross-sectional study was conducted at the endocrinology department of a comprehensive tertiary hospital in Guangzhou, China. Data were collected on illness perception, self-management behaviors, and demographic and clinical characteristics over 9 months among 156 subjects. Data were analyzed using Pearson correlation analysis, univariate analysis and multiple linear regression analysis. Results: Only 3.2% of participants maintained excellent self-management behaviors. Additionally, the participants perceived diabetic foot as chronic and could be well controlled through treatment. Multiple linear regression analysis revealed that illness perception was associated with self-management behaviors. Conclusions: Patient illness perception is an important factor influencing self-management behaviors. It may be helpful to improve self-management behaviors by tailoring the content of the intervention to fit the patients' illness perceptions. [ABSTRACT FROM AUTHOR]

Existing research on the relationship between high‐performance work systems (HPWS) and organizational innovation has paid insufficient attention to the boundary effects of employee participation and human capital. Bridging the human resource management (HRM) and employment relations literature, this study contributes to the contingency view of HRM and China‐specific research by investigating how human capital and employee participation, direct voice mechanism, and corporate governance participation jointly moderate the relationship between HPWS and organizational innovation. We test our three‐way interaction model using a sample of 108 firms and 1,250 employees in China. The results suggest that HPWS are positively associated with organizational innovation when employees with relatively less human capital are coupled with more direct voice mechanism or less corporate governance participation. In contrast, HPWS are negatively related to organizational innovation when employees possessing greater human capital are coupled with more direct voice mechanism. The theoretical and managerial implications and future research directions are discussed. [ABSTRACT FROM AUTHOR]

Aim: To measure nurses' turnover intention and identify associated factors in general hospitals in China. Background: Understanding nurses' turnover intention is important to retain nurses, but factors associated with turnover intention require elucidation. Method: A cross‐sectional survey was conducted across 23 hospitals in China to investigate nurses' (N = 12,291) turnover intention and its associated factors. Associated factors were explored by univariate and multilevel multiple logistic regression analysis. Results: The mean total score for nurses' turnover intention was 13.97 ± 3.63. High proactive personality score, a seriously ill family member, experience of negative workplace events, high work pressure and high work–family conflict increased the risk for turnover intention. A low turnover intention was associated with being a non‐local resident nurse, position title, high salary level, good person–organisation fit and person–group fit, and high family–work facilitation. Conclusion: Nurses with a proactive personality, heavy family care burden, experience of negative workplace events, no position title and a low salary may merit special consideration. Implications for Nursing Management: Nurses' personality traits should be further focused on, and it is important to build a nurse‐oriented organisation atmosphere, including protecting nurses from workplace violence, establishing friendly relationships with their families and expanding career paths. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Most elderly people undergoing peritoneal dialysis (PD) treatment have a high incidence of frailty, cognitive impairment and emotional disturbance leading to a significant impact on families. The burden experienced by the family caregivers could affect their physical and emotion health. The objective of this study was to examine the level of burden on family caregivers of elderly adults receiving PD and to identify any contributing factors. Materials and Methods: This was a cross‐sectional study employing convenience sampling. Patient–caregiver dyads were recruited from the outpatient clinic of a university hospital in China in 2019. Caregivers provided information on their perceived burden and health‐related quality of life. The elderly patients reported their functional dependence and depressive symptoms in the same interview. Linear regression analyses were used to determine the factors contributing to caregivers' burden. Results: Sixty patient–caregiver dyads were recruited. The patients had a mean age of 70.7 ± 7.4 years. The caregivers reported moderate levels of burden having ZBI score of 30.5 ± 15.9. Multivariate analyses showed that being female, perceiving one's financial status as insufficient, a low level of social support for the caregiver, depressive symptoms in the patients and disability in carrying out the instrumental activities of daily life were statistically significant predictors of caregiver burden (adjusted R2 = 0.46, p < 0.001). Conclusion: Elderly adults receiving PD who experience physical dependence and depressive symptoms are a burden for caregivers. In response to this challenge, interventions designed with the goal of supporting the emotional and mental wellbeing of caregivers are warranted. [ABSTRACT FROM AUTHOR]

To assess the vitamin D status in healthy 6‐month‐old infants, as well as vitamin D supplementation and feeding patterns in Guangzhou, China, serum 25‐hydroxyvitamin D (25OHD) concentrations of 202 infants were measured at birth (cord blood) and at 6 months of age in Guangzhou, China. Questionnaires acquiring demographic characteristics, maternal and infantile vitamin D supplementation during pregnancy and first 6 months after birth, and feeding patterns during the first 6 months were completed by participating mothers. Physical examinations and blood sampling were carried out among infants at 6 months of age. The majority of infants (93.6%) were supplemented with vitamin D during the first 6 months of life on a voluntary basis. The M ± SD of cord serum 25OHD concentration was 46.2 ± 16.4 nmol/L, whereas the M ± SD of 25OHD concentration at 6 months was 82.9 ± 24.9 nmol/L. Serum 25OHD concentrations <30 nmol/L were seen in 34 (16.8%) infants at birth but only one (0.5%) at 6 months. Only 11 (5.4%) infants had concentrations >75 nmol/L at birth, whereas the majority of infants (n = 131, 64.9%) had concentrations >75 nmol/L at 6 months. The main predictors of 25OHD levels at 6 months included season, vitamin D supplementation, parental education level, and feeding patterns. To conclude, serum 25OHD concentrations were low at birth in a southern Chinese population, and infantile supplementation is an effective way to improve 25OHD status. Exclusively breastfed infants might need greater vitamin D supplementation, and individualized vitamin D supplementation plans might be needed. [ABSTRACT FROM AUTHOR]

Aim: To develop and psychometrically test the distress thermometer for caregivers (DT‐C) and document the distress level in primary caregivers of children and adolescents diagnosed with schizophrenia. Design: A validation diagnostic accuracy study and descriptive cross‐sectional survey. Methods: DT‐C was adopted based on Harverman's distress thermometer for parents. The cut‐off score was detected by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale‐21 as a reference standard in a sample of 324 caregivers of children and adolescents diagnosed with schizophrenia in China collected between Jan 2017 and Feb 2018. Results: One‐item DT of DT‐C indicated a good retest reliability (r = 0.86) and one‐item DT and the Problem List (PL) indicated good convergent validity (r = 0.67–0.88). Overall and individual PL domains showed good internal consistency (KR 20 values ranged from 0.70–0.90). Setting seven as the cut‐off score, the values of sensitivity (0.72–0.81), specificity (0.86–0.90), Youden's index (0.61–0.70), positive predictive value (0.67–0.74), and negative predictive value (0.84–0.92) were most satisfactory and area under curve values showed significantly excellent discrimination (0.88–0.90). The average DT score for the 324 participants was 6.34 (SD 2.49), with 46.9% of the participants above the cut‐off. Caregivers above the cut‐off score faced significant multiple problems in practical, family/social, cognitive, emotional, and parenting domains. Conclusion: The DT‐C, with six domains containing 35 items in Problem List and with the cut‐off score at seven, can be a rapid screening tool to measure distress in these caregivers. The level of distress in caregivers was relatively high. Psychoeducation on specific needs and a solid mutual support network are recommended for mitigating caregivers' distress. Impact: This study adapted a reliable DT‐C to measure distress of caregivers, which has the potential to be introduced to caregivers of other types of child and adolescent mental disorders in research, assessments and care planning for health professionals. [ABSTRACT FROM AUTHOR]

Background: Depressive symptoms are prevalent and cause poor health outcomes in patients with heart failure. Studies show that the physical symptoms of heart failure are associated with depressive symptoms. However, little is known about the underlying mechanisms of this relationship. Aims: The purpose of our study was to examine the associations between physical symptoms, illness perceptions, coping strategies and depressive symptoms and to test the multiple mediation effects of illness perceptions and coping strategies on the relationship between physical symptoms and depressive symptoms in patients with heart failure. Methods: Physical symptoms, illness perceptions, coping strategies and depressive symptoms were assessed using self-reported questionnaires among 302 patients (64.2±11.9 years, 54% male) with heart failure in a tertiary general hospital. A serial multiple mediation model was tested using the PROCESS macro for SPSS. Results: Depressive symptoms were positively correlated with physical symptoms (r =0.487, p <0.01), illness perceptions (r =0.499, p <0.01) and acceptance–resignation coping (r =0.580, p <0.01). The relationship between physical symptoms and depressive symptoms was mediated by illness perceptions (indirect effect: 0.036, confidence interval (0.014, 0.059)) and by acceptance-resignation (indirect effect: 0.034, confidence interval (0.019, 0.053)), respectively, and by these two in serial (indirect effect: 0.021, confidence interval (0.013, 0.033)). Conclusion: Patients with heart failure who have more physical symptoms are vulnerable to the development of depression. Healthcare providers should implement interventions focused on changing illness perceptions and reducing acceptance–resignation coping to relieve depressive symptoms. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bisphenol A (BPA) is an endocrine disruptor that affects fetal growth in experimental studies. Bisphenol F (BPF) and bisphenol S (BPS), which have been substituted for BPA in some consumer products, have also shown endocrine-disrupting effects in experimental models. However, the effects of BPF and BPS on fetal growth in humans are unknown OBJECTIVES: Our goal was to investigate trimester-specific associations of urinary concentrations of BPA, BPF, and BPS with size at birth METHODS: The present study included 845 pregnant women from Wuhan, China (2013–2015), who provided one urine sample in each of the first, second, and third trimesters. Linear regressions with generalized estimating equations were applied to estimate trimester-specific associations of urinary bisphenol concentrations with birth weight, birth length, and ponderal index. Linear mixed-effects models were used to identify potential critical windows of susceptibility to bisphenols by comparing the exposure patterns of newborns in the 10th percentile of each birth anthropometric measurement to that of those in the 90th percentile. RESULTS: Medians (25th–75th percentiles) of urinary concentrations of BPA, BPF, and BPS were 1.40 (0.19–3.85), 0.65 (0.34–1.39), and 0.38 (0.13– 1.11) ng/mL, respectively. Urinary BPA concentrations in different trimesters were inversely, but not significantly, associated with birth weight and ponderal index. Urinary concentrations of BPF and BPS during some trimesters were associated with significantly lower birth weight, birth length, or ponderal index, with significant trend p-values (p,trend < 0.05) across quartiles of BPF and BPS concentrations. The observed associations were unchanged after additionally adjusting for other bisphenols. In addition, newborns in the 10th percentile of each birth anthropometry measure had higher BPF and BPS exposures during pregnancy than newborns in the 90th percentile of each outcome. CONCLUSIONS: Prenatal exposure to BPF and BPS was inversely associated with size at birth in this cohort. Replication in other populations is needed. [ABSTRACT FROM AUTHOR]

Aim: To explore the relationship between ethical climate (EC) and nurses' service behaviours (SB) and examine the moderating effect of nurses' employment type. Background: As most public hospitals in China implement the "dual‐track system" of nurses' employment, the two different types of nurses, contract‐employed nurses and state‐employed nurses, receive the different pay for the same work, which results in they providing different SB. It has become critical for hospital administrators and nursing managers to understand better the state of two groups of nurses and to find an effective method to improve the service level of the nursing workforce. Design: Stepwise multiple regression analyses of survey data collected in June and July 2017 from Chinese nurses employed in three tertiary hospitals. Methods: Chinese nurses (298 of 350 [85.1%]) were interviewed using the Ethical Climate Scale and Nurses' Service Behaviour Scale. Data were analysed statistically using descriptive statistics, confirmatory factor analysis, correlation coefficients (Pearson), two‐tailed t‐test and stepwise multiple regression analyses were conducted to test the proposed hypotheses. Data were analysed using SPSS and AMOS. Results: There were statistically significant correlations between EC and nurses' extra‐role service behaviour (ERSB) and overall service behaviour and nurses' employment type moderated the proposed relationships. Conclusion: Healthcare institutions should pay more attention to cultivate EC and implement new incentive mechanism to better stimulate nurses to provide ERSB. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyse the association between social determinants and the presence of essential hypertension in type 2 diabetes mellitus patients in one rural county (Jintan) of China. A health survey of Jintan residents was conducted in 2013, applying a cluster sampling method. Three hundred and fifty-seven type 2 diabetes mellitus patients were selected as research subjects. Among the patients selected, essential hypertension prevalence was 45.4% (n = 162). After univariate analyses and logistic regression analyses, an association was observed between the presence of essential hypertension in type 2 diabetes mellitus patients and marital status, described as 'others (unmarried, divorce, widower, etc.)', and participating in active physical activity. Both of these two significant variables were positively associated with the higher prevalence of essential hypertension in type 2 diabetes mellitus patients. In conclusion, the patients suffering from type 2 diabetes mellitus combined with essential hypertension often reported an association with more negative social determinants (with the exception of participation in physical activity). Further strengthening the comprehensive multi-disease management to control and reduce the prevalence of essential hypertension in type 2 diabetes mellitus patients is required. [ABSTRACT FROM AUTHOR]

Abstract Background Caregivers of breast cancer survivors experience various types of burden, which in turn is linked to patients' physical and psychological status. Family resilience might be able to decrease caregiver burden and facilitate survivors' individual resilience, and individual resilience might be related to caregiver burden. Nevertheless, these relationships have not yet been confirmed. Objective To determine the relationships between family resilience, breast cancer survivors' resilience, and principal caregivers' caregiver burden, as well as determine whether breast cancer survivors' individual resilience plays a mediating role in the relationship between family resilience and caregiver burden. Design Cross-sectional study design. Setting The comprehensive cancer center of a public hospital in Shandong Province, China. Participants The sample comprised 108 dyads of early-stage breast cancer survivors and their principal caregivers. Methods The principal caregivers completed the Shortened Chinese Version of the Family Resilience Assessment Scale and the Chinese Version of the Zarit Caregiver Burden Interview, while the breast cancer survivors completed the 10-item Chinese version of the Connor-Davidson Resilience Scale and provided their sociodemographic information. The mediating effect of individual resilience was estimated using the bootstrap method via IBM SPSS Amos 21.0. Results Caregiver burden was significantly negatively associated with both family resilience and breast cancer survivors' individual resilience (both p <.01). Furthermore, individual resilience mediated the relationship between family resilience and caregiver burden (b = −0.052; 95% confidence interval: −.412, −.036). Conclusions The findings suggest that both family resilience and breast cancer survivors' individual resilience may ease caregiver burden among the principal caregivers of breast cancer survivors, and family resilience tends to promote the survivors' individual resilience. Therefore, family resilience and survivors' individual resilience should be enhanced for breast cancer survivors and their family to ease the principal caregivers' caregiver burden. [ABSTRACT FROM AUTHOR]

Background and Objective: The health behaviors of hypertensive stroke patients in China are not satisfactory. In this study, we tested the effect of a Health Belief Model Comprehensive Reminder System on health behaviors and blood pressure control in hypertensive ischemic stroke patients after occurrence and hospital discharge. Methods: A randomized, parallel-group, assessor-blinded experimental design yielded participation of 174 hospitalized hypertensive ischemic stroke patients. The intervention consisted of face-to-face and telephone health belief education, a patient calendar handbook, and weekly automated short-message services. Data were collected at baseline and 3 months after discharge. Results: Three months after discharge, the intervention group showed statistically, significantly better health behaviors for physical activity, nutrition, low-salt diet, and medication adherence. The intervention group also had statistically, significantly decreased systolic blood pressure and increased blood pressure control rate. Smoking and alcohol use behaviors were not affected. Conclusion: At 3 months, use of the Comprehensive Reminder System based on the Health Belief Model, yielded improvement in most health behaviors and blood pressure control in hypertensive ischemic stroke patients. Continued implementation of this intervention protocol is warranted to determine the long-term effect. Smoking and alcohol use behaviors need to be targeted with a different intervention. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects of self-management educational intervention on the symptoms of patients with functional constipation. From January 2014 to April 2015, 66 patients with functional constipation were randomly assigned into intervention group receiving intensive educational interventions and control group receiving routine nursing care. The constipation score of all clinical symptoms (Bristol stool form scale, defecation interval, incomplete evacuation, evacuatory difficulty) at 1 month postdischarge were all significantly lower in the intervention group than in the control group (all, p < .05). At 1 month postdischarge, the intervention group had a significantly higher proportion of patients with good health habits (reasonable diet, regular exercise, good defecation habits, proper use of laxatives) as compared with the control group (all, p < .05). These data suggest educational intervention can effectively improve constipation symptoms and compliance with treatment of patients, and lead to the development of good health habits. [ABSTRACT FROM AUTHOR]

This is a single centre study in mainland China aiming to evaluate the reliability, validity and responsiveness of the Chinese version of EORTC QLQ‐BN20, designed by The European Organization for Research and Treatment of Cancer Quality of Life Group to evaluate the life quality of patients with brain tumour, cancer or metastases. One hundred and eighty‐eight patients with primary or secondary brain cancer from Hunan Provincial Tumor Hospital during September 2013 to June 2014 completed the Chinese EORTC QLQ‐C30/BN20 questionnaires developed by translation, back translation and cultural adaptation. Results were statistically analysed using SPSS17.0. The internal consistency (Cronbach's α coefficient) was between .753 and .869, the correlation coefficients among items and its own dimension were bigger than .4, and all items had a better correlation with its own dimension. The Spearman was used to analyse the correlation of each dimension between EORTC QLQ‐BN20 and EORTC QLQ‐C30, and the result showed that individual dimensions were moderately correlated, other dimensions were weakly correlated. In conclusion, the Chinese version of EORTC QLQ BN20 questionnaire had great relevance, reliability, convergent validity and discriminant validity. It provides a valuable tool for the assessment of health‐related quality of life in clinical studies of Chinese patients with primary or secondary brain cancer. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate whether positioning the body in a lateral decubitus position will facilitate nasogastric tube insertion in unconscious patients. Background Inserting a nasogastric tube into unconscious patients can be challenging because these patients cannot cooperate with the operator. The piriform sinus and arytenoid cartilage are the most commonly reported impaction sites. However, we found that the first impaction site was the backward displaced tongue when inserting a nasogastric tube in unconscious patients who often exhibited glossoptosis. Performing an intubation in the lateral decubitus position could make this procedure easy. Design This prospective, double-blind, parallel, randomised controlled trial was conducted in Hengshui City, Hebei Province, China. Methods A total of 110 cases of unconscious patients were enrolled. The patients were randomly assigned to a conventional group (group C) or a lateral decubitus position group (group L). In group C, the nasogastric tube was inserted while the patients were in a supine position using the conventional technique, and in group L, the tube was inserted in a lateral decubitus position or further tilting the body to a prone decubitus position 20-30°. We discussed reasonable intubation methods in unconscious patients by comparing the success rate on first insertion, the overall success rate, the intubation time and the complication rates between the two groups. Results Group L had a higher success rate on first insertion and overall success rate than group C ( p < .05). The intubation time in group L was shorter than that in group C ( p < .001), and the complication rate in group L was lower than that in group C ( p < .05). The differences were statistically significant. Conclusions The backward displaced tongue blocks the pharyngeal passage. Nasogastric tube insertions in the lateral decubitus position are recommended in unconscious patients because of the higher success rate, reduced intubation time and lower complication rate. Relevance to clinical practice This study provides an effective method for nasogastric tube insertions in unconscious patients. [ABSTRACT FROM AUTHOR]

Background: The Readiness for Hospital Discharge Scale (RHDS) was designed to assess the readiness of patients for discharge. The original English-language instrument has shown high degrees of reliability and validity, but no Chinese version of the scale has been verified. Purpose: The purpose of this study was to translate the RHDS into Chinese and assess the psychometric properties of this scale on laryngectomy patients in China. Methods: The RHDS was translated into Chinese using forward and back translation, semantic equivalence assessment, and pilot testing. The content and construct validity, internal consistency, and internal reliability of the translated scale were assessed using exploratory factor analysis and Pearson correlation analysis. Results: The content validity index of the developed Chinese version of the RHDS was .97, with the content validity indexes of RHDS items ranging between .75 and 1.00. The Cronbach's α coefficient for internal consistency was .97. Exploratory factor analysis revealed a three-factor structural model. All correlations among the three factor subscales were significant. Pearson's correlation coefficients between subscale factors and the total scale ranged from .81 to .97. Conclusions: The Chinese version of the RHDS is a valid and reliable instrument for assessing the discharge readiness of laryngectomy patients in China. [ABSTRACT FROM AUTHOR]

Youth aggression is a serious global issue, but research identifying personality traits associated with aggression has focused on adults. Little is known about whether similar associations exist during adolescence; even less is known about these associations across cultures. This study examined links between personality and physical aggression in U.S. and Chinese adolescents, and tested whether temper mediates these associations. U.S. (N = 250) and Chinese (N = 199) young adolescents ( X ¯ age = 13.43 years) completed self-reports describing personality, temper, and aggression. Path analyses demonstrated that temper significantly mediated associations from agreeableness and neuroticism to aggression in both samples. The mediating effect of temper was marginally stronger in the Chinese sample than in the U.S. sample, suggesting temper plays a more important role in youth aggression in China than in the United States. Findings highlight the universal role of affect in aggression and demonstrate the importance of cultural context in understanding links between personality and youth aggression. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the burden of family caregivers of patients with retinoblastoma in China and the relationships between depression, caregiver burden and social support. A descriptive and correlational survey was conducted with 117 Chinese family caregivers of outpatient patients with retinoblastoma from the Department of Ophthalmology of a tertiary hospital in Shanghai, China. Family caregivers of outpatient patients with retinoblastoma were asked to respond to four questionnaires including sociodemographic questionnaire, Becker Depression Inventory, Caregiver Burden Inventory and Social Support Rating Scale. The incidence of depression in this study was 51.3%; the average score for social support indicated moderate social support available to the caregivers, although their level of caregiver burden was heavy. Depression scores were significantly positively correlated with caregiver burden scores and significantly negatively correlated with the social support scores. Heavy caregiver burden was associated with lower monthly income, low subjective social support and less use of social support. [ABSTRACT FROM AUTHOR]

We explored the effects of acupressure training on older adults’ sleep quality and cognitive function. Ninety older adults with impaired sleep quality were selected from screened volunteers and randomly divided into equal control and experimental groups; 82 completed the 1‐year follow‐up. Participants in the control group were given instructions on sleep health, while those in the experimental group received sleep health instructions plus individual and small group acupressure training sessions and support to practice the intervention on their own each day. All participants were assessed by trained assistants blind to study group allocation using Chinese versions of the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Mini‐Mental State Examination, and four subscales from the revised Chinese version of the Wechsler Memory Scale, at baseline and at 3, 6, and 12 months. Repeated measures analysis of variance showed that acupressure training improved older adults’ sleep quality and cognitive function, but the mediating effect of sleep on the relationship between acupressure training and cognitive function was not supported. Given the ease, simplicity, and safety of acupressure training observed with community‐dwelling older adults in China, attempts should be made to replicate these preliminary positive findings with larger samples. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background The new three-dimensional speckle tracking echocardiography (3D STE) may enable comprehensive quantification of global left ventricular ( LV) myocardial mechanics. Methods Twenty-four patients aged 29.3 ± 5.2 years and 22 controls were studied. 3D STE was performed to assess LV 3D global strain, twist and torsion, ejection fraction, and systolic dyssynchrony index ( SDI). The LV SDI was calculated as % of SD of times-to-peak strain of 16 segments/ RR interval. The global performance index ( GPI) was calculated as (global 3D strain·torsion)/ SDI. Area under the receiver operating characteristic curve ( AUC) was calculated to determine the capability of 3D STE parameters to discriminate between patients with (cardiac magnetic resonance T2* <20 ms) and those without myocardial iron overload. Results Compared with controls, patients had significantly lower LV global 3D strain (P < 0.001), twist (P = 0.01), torsion (P = 0.04), and ejection fraction (P < 0.001) and greater SDI (P < 0.001). The GPI was lower in patients than controls (P < 0.001). T2* value correlated positively with global 3D strain (r = 0.74, P < 0.001) and GPI (r = 0.63, P = 0.001), and negatively with SDI (r = −0.44, P = 0.03). The AUCs of GPI, global 3D strain, ejection fraction, torsion, and 1/ SDI were 0.94, 0.90, 0.87, 0.82, and 0.70, respectively. The GPI cutoff of 2.7°/cm had a sensitivity of 94.9% and a specificity of 88.9% of differentiating patients with from those without myocardial iron overload. Conclusions The LV composite index of strain, torsion, and dyssynchrony derived from 3D STE enables sensitive detection of myocardial iron overload in patients with thalassemia. [ABSTRACT FROM AUTHOR]

Of the 2008 Sichuan Earthquake survivors, there was a special group known as Shidu parents, who lost their only child in the disaster. The objective of this study was to estimate the posttraumatic stress disorder (PTSD) prevalence in the Shidu parents from different counties and explore the related risk factors. Across-sectional sample survey was conducted to collect data in 10 heavily damaged counties (n = 176) and 12 moderately damaged counties (n = 148). Probable PTSD prevalence in Shidu parents from the heavily damaged counties (83.5 %) was found to be higher than that in the moderately damaged counties (72.3 %). Many associated PTSD risk factors were identified in the cross-sectional study, such as being of Han ethnicity, losing a young child (18-27), losing a male child, living in the countryside, receiving low social support over the previous 6 years, and having high resilience were significant in the heavily damaged areas, and being of Han ethnicity, having a low monthly income, having a high education level, losing a young child (18-27), losing a male child, and having high resilience in the moderately damaged areas. [ABSTRACT FROM AUTHOR]

High-risk sexual behaviours (HRSBs), such as having male casual sexual partners (MCSPs) and unprotected anal intercourse (UAI), are combined with a high prevalence of HIV infection among gay/bisexual men. Sexual sensation seeking (SSS) and sexual compulsivity (SC), which are intrapersonal factors, were observed to have associations with HRSB among gay/bisexual men in Western nations. The aim of the study was to examine the relationships between SSS, SC, sociodemographic factors, and HRSB (defined as having MCSP and UAI with MCSP) among selfidentified gay and bisexual men in Southwest China. The study was cross-sectional, with a sample of 436 respondents. And their mean age was 24.5 years. The results confirmed that SSS, SC, and sexual attitude are associated with both having MCSP and UAI with MCSP in the Chinese cultural context, among the subgroup of men who have sex with men. Being older, not a student, and having transactional sex in the last 6 months were independently associated with having MCSP. Lower educational level, unemployed, having a relationship with a man, and an unsure HIV status were independently associated with UAI with MCSP. This study indicates that SSS and SC are cross-cultural personality traits related to HRSB. The results of this study may shed light on HIV prevention among gay/bisexual men in China. [ABSTRACT FROM AUTHOR]

Individuals’ Subjective Well-being (SWB) increases as they grow older. Past literature suggests that emotional intelligence may increase with age and lead to higher levels of SWB in older adults. The primary purpose of the present study was to test whether emotional intelligence would mediate the relationship between age and SWB. A total of 360 Chinese adults (age range: 20 to 79 years old) participated in this study. They filled out questionnaires that assessed their age, life satisfaction (The Satisfaction with Life Scale), affective well-being (The Positive and Negative Affect Schedule), and emotional intelligence (The Wong and Law Emotional Intelligence Scale). Using Structural Equation Modeling, the mediation model was supported, χ2 (75) = 194.21, p < .01; RMSEA = .07; CFI = .91. Emotional intelligence partially mediated the relationship between age and life satisfaction, and fully mediated the relationship between age and affective well-being. The findings suggest that older adults may use their increased emotional intelligence to enhance their SWB. [ABSTRACT FROM AUTHOR]

BACKGROUND: The objective of this study is to evaluate the effects of the Multi-disciplinary Orthopaedics Rehabilitation Empowerment (MORE) Program on reducing chronic disability among injured workers and improving efficiency of work rehabilitation process. METHODS:A cohort of patients with workplace injuries in the lower back were recruited from orthopaedics clinics and assigned to either MORE group (n = 139) or control group (n = 106). Patients in MORE group received an early MRI screening and a coordinated multi-disciplinary management, while patients in the control group received conventional care. Outcome variables are time to return-to-work (RTW) from date of injury, waiting time for MRI screening and time to medical assessment board (MAB). RESULTS: Patients in the MORE Program had significantly shorter duration for RTW (MORE: 6.1 months, Control: 12.8 months, p < 0.01), and more RTW cases (n = 64, 46.0%) compared to Control group (n = 29, 27.4%). The MORE group also had much shorter waiting time for MRI scans (91.85 vs. 309.2 days, p <0.001) and MAB referral after MRI scans (97.2 vs. 178.9 days, p = 0.001) compared to Control group. CONCLUSIONS: The MORE Program which emphasizes early intervention and early MRI screening, is shown to be effective in shortening sick leave and improving RTW outcomes of injured workers. [ABSTRACT FROM AUTHOR]

Background: The relationship between alterations in thyroid function and cognitive deficits has been investigated in several previous studies. Hypo-or hyperthyroidism and, to a lesser extent, subclinical thyroid dysfunction can negatively affect cognitive performance. However, limited data are available on the potential association of thyroid function with mild cognitive impairment (MCI) and Alzheimer's disease (AD) in the elderly Chinese population. Methods: In the present study focusing on a population of elderly Chinese individuals ≥ 50 years of age, 77 cognitively normal controls, 64 patients with MCI, and 154 patients diagnosed with AD underwent assessment of thyroid status using thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4) levels as variables. Cognitive function was evaluated with the aid of comprehensive neuropsychological tests, such as the Mini-Mental State Examination (MMSE) and Memory and Executive Screening (MES). Results: Overall, 88.1 % of the subjects displayed normal thyroid function, 4.7 % were diagnosed with clinical hypothyroidism, 3.1 % with subclinical hypothyroidism, and 4.1 % with subclinical hyperthyroidism. After adjusting for covariates (age, sex, education years and body mass index), no association was evident between mild cognitive impairment or AD and thyroid dysfunction. However, lower serum TSH was correlated with risk of AD (odds ratio [OR]: 2.78, 95 % confidence interval [95% CI]: 1.11-6.99). Conclusion: Neither hypothyroidism nor subclinical hyperthyroidism was associated with AD and MCI in this population-based elderly Chinese cohort. Our findings need to be confirmed in a longitudinal study. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the impact of progressive muscle relaxation on state anxiety and self-efficacy in hospitalized patients admitted for an extremity fracture receiving elective surgery. Eighty four patients met the inclusion criteria and all were randomly assigned to either the progressive muscle relaxation group or the control group. The control group received standard orthopedic nursing care, and the experimental group received standard care along with daily progressive muscle relaxation throughout their hospitalization. The State Anxiety Inventory and Self-Efficacy Scales were administered before and after the intervention. Both paired-sample t tests and independent t tests showed that progressive muscle relaxation is effective in reducing state anxiety and enhancing the self-efficacy of patients with extremity fracture undergoing an elective surgery. [ABSTRACT FROM AUTHOR]

Consumption of high glycaemic index (GI) and glycaemic response (GR) food such as white rice has been implicated in the development of type 2 diabetes. Previous studies have reported the ability of individual amino acids to reduce GR of carbohydrate-rich foods. Because of the bitter flavour of amino acids, they have rarely been used to reduce GR. We now report the use of a palatable, preformed amino acid mixture in the form of essence of chicken. In all, sixteen healthy male Chinese were served 68 or 136 ml amino acid mixture together with rice, or 15 or 30 min before consumption of white rice. Postprandial blood glucose and plasma insulin concentrations were measured at fasting and every 15 min after consumption of the meal until 60 min after the consumption of the white rice. Subsequent blood samples were taken at 30-min intervals until 210 min. The co-ingestion of 68 ml of amino acid mixture with white rice produced the best results in reducing the peak blood glucose and GR of white rice without increasing the insulinaemic response. It is postulated that amino acid mixtures prime β-cell insulin secretion and peripheral tissue uptake of glucose. The use of ready-to-drink amino acid mixtures may be a useful strategy for lowering the high-GI rice diets consumed in Asia. [ABSTRACT FROM PUBLISHER]

Integrating the perspectives of psychological contract and sex differences, this study examines how organizational decision to reduce labour costs influences employees' perceived psychological contract breach and their commitment to their organizations. Using two experiments, we found three-way interaction effects among the decision to reduce labour costs, employee sex, and the managerial control over the decision. The decision of labour costs reduction leads to stronger feelings of psychological contract breach for females when the decision is in low than in high levels of managerial control, but the same decision leads to stronger psychological contract breach for males when the decision is in high than in low levels of managerial control. Furthermore, the indirect effect of labour costs reduction on employees' organizational commitment through psychological contract breach is also contingent upon the interaction between employee sex and managerial control. Our findings expand the literature of psychological contract and shed light on timely practical issues of management's decisions regarding labour costs reduction. Practitioner points Labour costs reductions in economic downturns lead to different responses from employees, and managers are advised to plan their actions bearing in mind such differences., Management in crisis or difficulties calls for more delicate considerations of employees' psychological feelings towards the organization., Nuanced empirical evidence informs us about the different needs and responses of a diverse group of employees and how their responses contradict. [ABSTRACT FROM AUTHOR]

Background: To explore the hypothesis that burning mouth syndrome (BMS) probably is a neuropathic pain condition, thermal and mechanical sensory and pain thresholds were tested and compared with age- and gender-matched control participants using a standardized battery of psychophysical techniques. Methods: Twenty-five BMS patients (men: 8, women: 17, age: 49.5 ± 11.4 years) and 19 age- and gender-matched healthy control participants were included. The cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), mechanical detection threshold (MDT) and mechanical pain threshold (MPT), in accordance with the German Network of Neuropathic Pain guidelines, were measured at the following four sites: the dorsum of the left hand (hand), the skin at the mental foramen (chin), on the tip of the tongue (tongue), and the mucosa of the lower lip (lip). Statistical analysis was performed using ANOVA with repeated measures to compare the means within and between groups. Furthermore, Z-score profiles were generated, and exploratory correlation analyses between QST and clinical variables were performed. Two-tailed tests with a significance level of 5 % were used throughout. Results: CDTs ( P < 0.02) were significantly lower (less sensitivity) and HPTs ( P < 0.001) were significantly higher (less sensitivity) at the tongue and lip in BMS patients compared to control participants. WDT ( P = 0.007) was also significantly higher at the tongue in BMS patients compared to control subjects . There were no significant differences in MDT and MPT between the BMS patients and healthy subjects at any of the four test sites. Z-scores showed that significant loss of function can be identified for CDT (Z-scores = −0.9±1.1) and HPT (Z-scores = 1.5±0.4). There were no significant correlations between QST and clinical variables (pain intensity, duration, depressions scores). Conclusion: BMS patients had a significant loss of thermal function but not mechanical function, supporting the hypothesis that BMS may be a probable neuropathic pain condition. Further studies including e.g. electrophysiological or imaging techniques are needed to clarify the underlying mechanisms of BMS. [ABSTRACT FROM AUTHOR]

We assessed the association between 5 well-defined polymorphisms of the transforming growth factor-β1 (TGFB1) gene and coronary artery disease (CAD) among patients with hypertension from northeast China. All study participants were classified into patients with CAD (n = 679) and controls (n = 686) according to angiographic results. Genotyping was carried out with the ligase detection reaction method. In single-locus analysis, only genotypes of rs1800469 differed significantly between patients with CAD and controls (P = .001); patients carrying the mutant allele of rs1800469 exhibited a 73% increased risk of CAD (P < .001). Haplotype analysis indicated that haplotype A-T-T-C-C (alleles in the order of rs1800468, rs1800469, rs1800470, rs1800471, and rs1800472) was associated with a 1.49-fold increased risk (P = .003). Interaction analysis identified an overall best 3-locus model including rs1800469, rs1800468, and rs1800471 (P = .003). Taken together, we identified a synergistic interaction between TGFB1 gene multiple polymorphisms that entailed greater risk of CAD in Chinese patients. [ABSTRACT FROM AUTHOR]

Background: Patients on maintenance hemodialysis suffer from diminished physical health. Directly supervised exercise programs have been shown to be effective at improving physical function and optimizing well-being. However, nurses seldom include an exercise intervention in the care plan for hemodialysis patients. Objectives: The purpose of this study was to examine the effects of a 12-week nurse-led case management program on home exercise training for hemodialysis patients. Design: The study was a randomized, two-parallel group trial. Settings: Hemodialysis units in two tertiary hospitals in Nanjing, mainland China. Participants: One hundred and thirteen adult patients who have been in stable condition while on dialysis treatment for more than 3 months were recruited and randomly assigned to either the study group (n = 57) or the control group (n = 56). Methods: Both groups underwent a brief weekly in-center exercise training session before their dialysis sessions for the first 6 weeks. The study group received additional nurse case management weekly for the first 6 weeks and biweekly for the following 6 weeks. The intervention was to facilitate patients in performing regular exercise at home. Outcome measures, including gait speed, 10-repetition sit-to-stand performance, and quality of life were collected at baseline, and at 6 and 12 weeks into the program. Results: The results revealed that patients in the study group demonstrated greater increases in normal gait speed [F(1,111) = 4.42, p = 0.038] than the control group. For the study group, a mean increase of 12.02 (±3.03) centimeters/second from baseline to week 12 was found. With regard to the fast gait speed, there was a marginally significant between-group effect [F(1,111) = 3.93, p = 0.050]. The study group showed a mean improvement of 11.08 (±3.32) cm/s, from baseline to week 12. Patients from both groups showed improvements in their 10-repetition sit-to-stand performance. The between-group differences approached significance [F(1,111) = 3.92, p = 0.050], with the study group showed greater improvement than the control group. The time taken by the patients in the study group to complete the 10-STS test increased by 5.75 (±3.88) s from baseline to week 12. Significant improvements in quality of life across three time points were found only in the study group. Conclusions: Home exercise using a nurse-led case management approach is practical and effective in improving the physical function and self-perceived health of stable hemodialysis patients. [ABSTRACT FROM AUTHOR]

Objectives The aim of the present study was to explore the magnetic resonance imaging correlates of the performance of instrumental activities of daily living ( IADL) in patients with Alzheimer's disease combined with cerebrovascular disease. Methods A total of 66 patients with Alzheimer's disease combined with cerebrovascular disease formed the study sample. Two regression models were constructed to find correlates of IADL. Model 1 only included clinical variables and model 2 included both clinical and magnetic resonance imaging variables. Results In model 1, with IADL as the dependent variable, the Mini-Mental State Examination ( MMSE) score, Physical Self- Maintenance Scale score at baseline and age were significant correlates accounting for 40.1% of the variance of IADL at baseline. MMSE score and age were also significant correlates of IADL at 6 months, accounting for 38.1% of the variance of it. In model 2, severity of white matter lesions, MMSE and Physical Self- Maintenance Scale scores at baseline significantly correlated with IADL at baseline, accounting for 52.1% of the variance of the dependent variables; severity of white matter lesions and MMSE significantly correlated with IADL at 6 months, accounting for 41.5% of the variance of the dependent variables. Conclusion In patients with Alzheimer's disease combined with cerebrovascular disease, subcortical ischemic lesions might be significant contributor to the functional status. Geriatr Gerontol Int 2015; 15: 588-593. [ABSTRACT FROM AUTHOR]

The colour of the edible portion of vegetables and fruit reflects the presence of specific micronutrients and phytochemicals. No existing studies have examined the relationship between the intake of vegetable and fruit colour groups and the risk of colorectal cancer. The present study, therefore, aimed to investigate these associations in a Chinese population. A case–control study was conducted between July 2010 and July 2014 in Guangzhou, China, in which 1057 consecutively recruited cases of colorectal cancer were frequency-matched to 1057 controls by age (5-year interval), sex and residence (rural/urban). A validated FFQ was used to collect dietary information during face-to-face interviews. Vegetables and fruit were classified into four groups according to the colour of their primarily edible parts: green; orange/yellow; red/purple; white. Unconditional logistic regression models were used to estimate the OR and 95 % CI. A higher consumption of orange/yellow, red/purple and white vegetables and fruit was inversely associated with the risk of colorectal cancer, with adjusted OR of 0·16 (95 % CI 0·12, 0·22) for orange/yellow, 0·23 (95 % CI 0·17, 0·31) for red/purple and 0·53 (95 % CI 0·40, 0·70) for white vegetables and fruit when the highest and lowest quartiles were compared. Total vegetable intake and total fruit intake have also been found to be inversely associated with colorectal cancer risk. However, the intake of green vegetable and fruit was not associated with colorectal cancer risk. The results of the present study, therefore, suggest that a greater intake of orange/yellow, red/purple and white vegetables and fruit is inversely associated with the risk of colorectal cancer. [ABSTRACT FROM PUBLISHER]

Salivary α-amylase (sAA) is responsible for the ‘pre-digestion’ of starch in the oral cavity and accounts for up to 50 % of salivary protein in human saliva. An accumulating body of literature suggests that sAA is of nutritional importance; however, it is still not clear how sAA is related to individual's nutritional status. Although copy number variations (CNV) of the salivary amylase gene (AMY1) are associated with variation in sAA levels, a significant amount of sAA variation is not explained by AMY1 CNV. To measure sAA responses to gustatory stimulation with citric acid, we used sAA ratio (the ratio of stimulated sAA levels to those of resting sAA) and investigated acute sAA responses to citric acid in children with normal (Normal-BMI, n 22) and low (Low-BMI, n 21) BMI. The AMY1 gene copy number was determined by quantitative PCR. We, for the first time, demonstrated attenuated acute sAA responses (decreased sAA ratio) to gustatory stimulation in Low-BMI (thinness grade 3) children compared with the Normal-BMI children, which suggest that sAA responses to gustatory stimulation may be of nutritional importance. However, child's nutritional status was not directly related to their resting or stimulated sAA levels, and it was not associated with AMY1 gene copy number. Finally, AMY1 CNV might influence, but did not eventually determine, sAA levels in children. [ABSTRACT FROM PUBLISHER]

With employee creativity becoming increasingly critical to the competitiveness of today's organisations, there is a need to better understand and refine the role that positive psychological constructs such as learning goal orientation ( LGO) and the now recognised psychological capital ( Psy Cap) may play in influencing creativity. In this study ( N = 405 software engineers nested in 56 teams from China), we drew from social learning theory and the theory of situational strength to test a cross-level moderated mediation model and found that the positive relationship between LGO and Psy Cap was stronger in teams low in learning behavior (i.e. weaker situational strength) and that the indirect effect of LGO on creativity via Psy Cap was significant when team learning behavior was moderate or low. Thus, our study results indicate that when the team context is less favorable for learning behavior, LGO individuals can draw from their Psy Cap to generate creativity. The contributions to theory development, directions for future research, and practical implications conclude the article. [ABSTRACT FROM AUTHOR]

Background: The nicotine dependence (ND) has negative and smoking abstinence self-efficacy (SASE) has positive effects on successful smoking cessation, but scant data is now available for what is the mediating role of SASE on the relationship between ND and successful smoking cessation. The aim of this study was to assess the abovementioned mediation. Methods: A case-control study was conducted with 642 successful spontaneous quitters as the cases, and 700 failed spontaneous quitters as the controls. ND and SASE were evaluated by Fagerström Test for Nicotine Dependence (FTND) scale and SASE scale, respectively. Propensity score as covariate in the regression model was used to adjust for potential confounders of age, age of smoking initiation, occupation, educational level and marital status. Total effect was decomposed into direct and indirect (mediating) effect using logistic regression based on the KHB method proposed by Holm et al. Results: After adjusting for the aforementioned potential confounders, the mediating effects among the total effect of ND on successful spontaneous smoking cessation were 32.90%, 12.14%, 35.64% and 83.03% for the total score of SASE and its three context-specific situation scores, i.e. positive/social situation, negative/affective situation and habit/addictive situation, respectively. Conclusions: This study indicates that SASE has a partial mediating effect on the association of ND with successful spontaneous smoking cessation. To boost the smokers' SASE could increase the probability of successful smoking cessation. [ABSTRACT FROM AUTHOR]

Objectives: To explore the effects of combined intervention with education and progressive muscle relaxation (PMR) on quality of life (QoL), functional disability, and positive symptoms of patients with acute schizophrenia. Methods: This randomized controlled study took place in an acute schizophrenia ward in Changsha, China. Sixty-four patients with acute schizophrenia were randomly assigned to four groups: control, education, PMR, and education plus PMR. QoL was assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form. Functional disability was assessed with the Sheehan Disability Scale. Severity of positive schizophrenia symptoms was assessed with the Scale for the Assessment of Positive Symptoms. All patients were evaluated at baseline (within 72 hours before the interventions) and at the end of weeks 5 (when the interventions ended) and week 15 (a 10-week follow-up after the interventions). Results: The sociodemographic and clinical characteristics of all four study groups were similar at baseline. Repeated-measures analysis of variance showed significant differences among the interventions in improving QoL, functional disability, and positive symptoms over time in the patients. Education and PMR alone resulted in sustained improvement of QoL during the intervention period and a 10-week follow-up but had no significant effects on functional disability or positive schizophrenia symptoms. In contrast, combined intervention with education and PMR showed better effects on improving QoL than did education or PMR alone throughout the 15-week study. It also statistically significantly improved functional disability and positive schizophrenia symptoms during the intervention period and led to sustained improvement of functional disability during the 10-week follow-up. Conclusions: A combined intervention with education and PMR is effective in improving QoL, functional disability, and positive symptoms in patients with acute schizophrenia. The combined intervention model could be a new paradigm of adjunctive treatment for acute schizophrenia. [ABSTRACT FROM AUTHOR]

Protein–energy wasting (PEW) is strongly associated with high mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. However, its clinical assessment has not been well defined. The aim of the present study was to investigate the relationship between combined nutritional indicators and mortality in CAPD patients. In the present retrospective cohort study, a total of 885 incident CAPD patients were enrolled. Nutritional status at the initiation of CAPD was assessed by BMI and biochemical indices (serum albumin, prealbumin, transferrin, creatinine and total cholesterol). The primary outcome was all-cause mortality. Principal components factor analysis was used to identify the combined nutritional parameters. Their association with mortality was examined by multivariable-adjusted Cox models. The mean age was 47·4 (sd 14·8) years, 59·2 % (n 524) were male and 24·6 % (n 218) were diabetic. Of the total patients, 130 (14·7 %) had BMI < 18·5 kg/m2, 439 (49·6 %) had albumin < 38 g/l ( < 3·8 g/dl), 303 (34·2 %) had prealbumin < 300 mg/l ( < 30 mg/dl), 404 (45·6 %) had transferrin < 2 g/l ( < 200 mg/dl), 501 (56·6 %) had total cholesterol < 5·2 mmol/l ( < 200 mg/dl) and 466 (52·7 %) had creatinine < 707 μmol/l ( < 8 mg/dl). Overall, three components such as visceral proteins, muscle-mass surrogate and BMI were extracted, which explained 69·95 % of the total variance of the nutritional parameters. After adjusting for demographic variables, co-morbid conditions, Hb, TAG and high-sensitivity C-reactive protein, the factor score of visceral proteins including albumin, prealbumin and transferrin was independently associated with mortality (hazard ratio 0·73, 95 % CI 0·60, 0·89; P= 0·002). Lower visceral protein concentrations may be independently associated with higher mortality in incident CAPD patients. Simultaneous measurements of serum albumin, prealbumin and transferrin could be helpful to monitor PEW. [ABSTRACT FROM PUBLISHER]

Aim: To evaluate nurse staffing levels and nursing care delivery in adult general medical or surgical wards of hospitals in the Pudong district of Shanghai, China. Background: Rapid economic development and improved Chinese living standards have spurred increased demands for high-quality health care. Thus, the quality of nursing services has become a focus of attention. Design: A cross-sectional, descriptive design was used for the study. Methods: We used an anonymous survey to collect data from 1614 nurses from 98 wards in seven general hospitals in Pudong, Shanghai. Results: During day shifts, the nurse-to-patient ratios were >1:10. However, these ratios were much higher during evening and night shifts. The clinical frontline nursing workforce primarily consisted of nurses with junior college degrees that had limited working experience. Junior nurses with different educational backgrounds, professional levels and work experiences were assigned almost similar nursing care work as senior nurses. Conclusions: In the surveyed hospitals in the Pudong district, nurse staffing levels and skill mix may be inadequate to meet the increasing demands of patient care. The clinical nursing workforce needs to be strengthened and used effectively to enhance the quality and safety of patient care. Relevance to clinical practice: We should focus on the quantity and quality of the nursing workforce, as well as nursing skill utilisation. [ABSTRACT FROM AUTHOR]

With visions of a better life through transnational marriage, women immigrants are often quickly disappointed when they are faced with social isolation as a result of heavy household responsibilities. The current study investigates 506 Chinese migrant mothers living in areas of concentrated poverty in Hong Kong. Using path analysis the study examines how several exogenous variables, such as marital contentment, household finances, and social support, predict perceived integration into the host society, and how hope for a better future might mediate the relationship between these variables and perceived integration. The results of the study have implications for social service practice in low-income neighborhoods. [ABSTRACT FROM PUBLISHER]

Background: Lifestyle modification is an integral component of cardiac secondary prevention, while it has been confirmed that myocardial infarction (MI) patients' health-related behaviors are heavily influenced by their illness perception. Objectives: To evaluate the effect of a telephone follow-up intervention for improving MI patients' illness perception and lifestyle. Design: A randomized controlled trial, longitudinal research design was employed. Settings: Cardiac care units in four major general hospitals in Guangzhou, China. Participants: Inclusion criteria were being diagnosed with an initial acute MI, being able to communicate orally in Mandarin or Cantonese and read in Chinese, and living in Guangzhou. Exclusion criteria were with continuing uncontrolled arrhythmias or heart failure, being illiteracy, or with a history of major psychiatric illness, exercise-induced asthma, uncontrolled diabetes, or evidence of dementia. Method: 124 patients admitted with the first acute MI were randomized to receive either routine care or routine care plus a telephone follow-up intervention, which consist of a pre-discharge education and three telephone follow-up instructions. Data were collected before discharge, at the 6th and the 12th week after discharge from hospital, respectively. Results: At the 6th and the 12th week after discharge, patients in the intervention group had significantly positive perceptions about symptoms of MI (mean difference 3.27, 95% confidence interval 2.48-4.07, p < .001; mean difference 2.12, 95% confidence interval 1.34-2.89, p < .001 respectively) and how long their illness would last (mean difference -0.69, 95% confidence interval -0.91 to -0.47, p < .001; mean difference -0.74, 95% confidence interval -0.96 to -0.51, p < .001 respectively) compared with the control group. The intervention group also had more positive beliefs about the controllability (F = 4.23, p = .04) and more improved beliefs about the causes of MI than the control group. Moreover, the intervention improved the patients' nutrition (F = 5.16, p = .03) and physical activity at the 12-week follow-up (mean difference 0.37, 95% confidence interval 0.17-0.58, p < .001). [ABSTRACT FROM AUTHOR]

Despite researchers’ increasing attention on customer sexual harassment, few studies have investigated its effects on the service performance of frontline employees. This study examined the link between customer sexual harassment, as perceived by frontline employees, and their service performance by focusing on the mediating role of difficulty in maintaining display rules and the moderating role of traditionality. The results from a field survey of 359 supervisor–subordinate dyads in a chain of restaurants in China provided evidence that difficulty in maintaining display rules mediates the negative relationship between customer sexual harassment and service performance. In addition, Chinese traditional values attenuate the relationship between customer sexual harassment and difficulty in maintaining display rules and the mediating effect of difficulty in maintaining display rules. Implications for theory, research and management practice are discussed. [ABSTRACT FROM PUBLISHER]

Background: Intraoperative hypothermia is a common event during laparoscopic abdominal surgery. On one hand, intraoperative hypothermia can delay the metabolism and prevent tissue damage. One the other hand, long-term and severe intraoperative hypothermia may also lead to perioperative complications, such as increasing of peripheral resistance, coagulation dysfunction, intraoperative hemorrhage and post- operative shivering. Maintenance of normothermia during surgical procedures may improve the quality of patient care. Objectives: This study investigated the feasibility and efficacy of intraoperative cutaneous warming with an underbody warming system during laparoscopic gastrointestinal surgery. Methods: 110 patients undergoing laparoscopic surgery for gastrointestinal cancer between January and December 2011 were randomized into the laparoscopic control (Control) group and laparoscopic intervention (Intervention) group. Nasopharyngeal temperature, prothrombin time, activated partial thromboplastin time, and thrombin time were measured before and during surgery, intraoperative and postoperative complica- tions, as well as shivering after anesthesia and visual analog scale score for pain evaluation after surgery were also recorded. Clinical risk factors that may cause intraoperative hypothermia during laparoscopic surgery were also analyzed by correlation analysis. Results: The two groups were comparable at the baseline. Intraoperative hypothermia was observed in 29 patients (52.7%) in Control group and 3 (5.5%) in Intervention group. Nasopharyngeal temperature in Control group was significantly decreased since 30 min after the start of operation until the end of surgery comparing to that at the start of anesthesia, but there was no difference in the Intervention group. In Intervention group, the nasopharyngeal temperature was remaining at ~36.5 8C, indicating the feasibility and efficiency of the underbody warming system in preventing intraoperative hypothermia during laparoscopic gastrointestinal surgery. Moreover, with anesthesia and operation time increased, there was no significant change of coagulation function, hemoglobin level [ABSTRACT FROM AUTHOR]

The objectives of this study were to determine reliability of Chinese version of Acceptance and Action Questionnaire-II ( AAQ-II), the relationship between psychological acceptance (PA), and burnout syndrome and their risk factors among nurses in China. The reliability of AAQ-II in Chinese was evaluated first by testing on 111 doctors and 108 nurses in China. On the number of 845 nurses selected from nine city hospitals by using stratified cluster sampling method, the Maslach Burnout Inventory- General Survey was administered to establish the presence of burnout, and the AAQ-II was used to measure their PA. Results showed that the AAQ-II in Chinese had a good test-retest reliability. PA was statistically significantly negatively correlated to the three dimensionalities of burnout among nurses in China. Male and female nurses had a significant difference in PA. Risk factors for burnout were age (25-44 years), marital status (married), gender (male), hospital department (emergency) and position (primary title) as well as PA. The findings provide insights into the risk factors of burnout in Chinese nurses and may have clinical implications in preventing burnout in Chinese nurses. [ABSTRACT FROM AUTHOR]

Background and Objective: Postmortem studies indicate that the number and density of glial cells are reduced in different brain regions of patients with depression. Glial cell line-derived neurotrophic factor (GDNF) plays an important role in the pathogenesis of depressive disorder (DD) and might be a biomarker for damage to nerve cells. In this study, we compared the therapeutic effects of electroacupuncture (EA) and fluoxetine, a serotonin reuptake inhibitor, on DD patients, focusing on the serum level of GDNF. Design: This was a prospective, randomized clinical trial. Setting: Seventy-five patients with DD from the Department of Acupuncture, Beijing Hospital of Traditional Chinese Medicine, were recruited. Intervention: Twenty patients were treated with acupuncture for 6 weeks on the acupoints of Baihui (DU20) and Zusanli (ST36). Sixteen patients were treated with acupuncture for 6 weeks on the acupoints of Taichong (LR3), Sanyinjiao (SP6), Neiguan (PC6), and Shenmen (HT7), and constituted the electroacupuncture control group. The patients received acupuncture treatment five times per week. Twenty-five patients were treated with oral fluoxetine (20 mg/day) for 6 weeks. Outcome measures: All subjects were evaluated by the Hamilton Depression Rating Scale at four time points (0 [baseline], 2, 4, and 6 weeks after treatment). Serum GDNF was quantified in duplicate by enzyme-linked immunosorbent assay (ELISA). Results: EA and fluoxetine had similar curative effects on DD patients. EA had a faster onset of action, better response rate, and better improvement rate than fluoxetine. Both fluoxetine and EA treatment restored the normal concentration of GDNF in the serum of DD patients. Conclusion: EA treatment for depression is as effective as a recommended dose of fluoxetine. However, EA demonstrates an advantage in the regulation of the production of GDNF compared with fluoxetine. [ABSTRACT FROM AUTHOR]

Background: The Iowa Infant Feeding Attitude Scale (IIFAS) is used to evaluate maternal infant feeding attitude. The breastfeeding rate has declined but no validated instruments to assess infant feeding attitudes or related studies have been available in mainland China. Aims: The purpose of this study was to assess the reliability and validity of a mainland Chinese version of the IIFAS among postpartum women. Methods: Postpartum women (N = 660) were recruited from three university hospitals in Guangzhou in mainland China. The participants completed an IIFAS questionnaire before being discharged and accepted telephone follow-up sessions at 6 weeks and 3 months postpartum. The reliability of the scale was evaluated using intra-class correlations (ICC) for test-retest reliability, correlated item-total correlations and Cronbach's a. The validity of the scale was evaluated using the content validity index (CVI), construct validity using exploratory factor analysis and predictive validity using independent t-tests. Results: The ICC was 0.861. The correlated item-total correlations ranged from 0.262-0.691. Cronbach's a was 0.623. The CVI was 0.996. Four factors were extracted using exploratory factor analysis and they contributed to 48.69% of the total variance. Conclusions: The mainland Chinese version of the IIFAS scale can be considered a reliable, valid and predictive scale for assessing infant feeding attitudes among women in mainland China. In-hospital scores on the scale were significant predictors of the infant feeding method and breastfeeding duration at 3 days, 6 weeks and 3 months postpartum. Construct validity was confirmed and showed four factors. However, future studies are required to improve the lower level internal consistency of the IIFAS. [ABSTRACT FROM AUTHOR]

Aims and objectives. To verify with empirical evidence the hypothesised relation and the effect of quality of work life, job embeddedness and affective commitment on turnover intention of clinical nurses in China. Background. High turnover of the nursing workforce in healthcare organisations is a difficult and recurring problem in China as well as in many other countries in the world. It leads to great waste of resources and increases management cost. Developing and retaining the nursing workforce, which is a major challenge faced by human resources practitioners in hospitals and public health agencies, also becomes a subject of interest for management studies. Most of the literature about voluntary turnover focused on such traditional measures as job satisfaction and job alternatives in the past. The introduction of such new concepts as quality of work life, job embeddedness and affective commitment, which views the issue from a much broader and comprehensive spectrum, made a great breakthrough in the turnover study. In this study, we selected quality of work life, job embeddedness and affective commitment - three of the most important factors in employer-employee relations - and analysed the interaction between each one of them, as well as their co-effect on turnover intention of Chinese nurses. Methods. Cross-sectional survey and structural equation modelling were applied in studying the self-report questionnaires distributed to 1000 nurses employed in five large-scale government-owned hospitals in Heilongjiang Province, Northeast China. Findings. Our study confirmed the hypothesised positive relation of quality of work life with job embeddedness and affective commitment and the hypothesised negative relation of quality of work life with turnover intention, that is, high quality of work life perceived by the nurses enhances their job embeddedness and affective commitment and thus reduces their intention to leave the job. Conclusions. The effect of quality of work life is positive on job embeddedness and affection commitment and negative on turnover intention. Relevance to clinical practice. Nurse managers should pay great attention to the nurses' perception of quality of work life, and make great efforts in developing strategies and projects that can strengthen the nurses' embeddedness or connection with the job. [ABSTRACT FROM AUTHOR]

A higher turnover rate was identified in Chinese staff nurses and it was highly correlated with lower commitment. Empowering work environments that support professional practice have been positively related to nurse outcomes. This study was to integrate structural empowerment theory with magnet hospital characteristics and provide empirical evidence on the relationships between structural empowerment, professional practice environments and organizational commitment. A cross-sectional design was used to examine the relationships in a sample of 750 full-time nurses employed in five Chinese hospitals in 2011. Structural equation modeling was used to test the proposed hypotheses. The results support the hypothesized model. Professional practice environments partially mediated the relationship between empowerment and organizational commitment. Our findings suggest that higher empowerment facilitates the professional practice environments and commitment of these nurses. [ABSTRACT FROM AUTHOR]