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Aim. This paper aimed to examine the current state of nurse safety behavior, and the effect of work engagement on it, and to explore the mediating effect of self-efficacy between work engagement and nurse safety behavior in specialized cancer hospitals. Background. Nurse safety behavior affects the quality of care and outcomes for patients with cancer. The research proves that self-efficacy is associated with work engagement, but the relationship between self-efficacy, work engagement, and nurse safety behavior needs to be clarified. Methods. This study used a convenience sampling method to survey 957 nurses from January to February 2023. The survey included tertiary specialized cancer hospitals in five provinces in China. Sociodemography information, the Work Engagement Scale, the Self-Efficacy Scale, and the Nurse Safety Behavior Scale were used for the survey. A Questionnaire Star program collected all the data automatically. The Statistical Package for the Social Sciences version 24 was employed for Pearson correlation and multiple regression analysis to examine the association between work engagement, self-efficacy, and nurse safety behavior. Structural equation models were built using Analysis of Moment Structures version 24.0 software. Results. The results showed that the nurse safety behavior was at a high level in specialized cancer hospitals. There was a significant positive relationship between the variables work engagement, self-efficacy, and nurse safety behavior with coefficients ranging from 0.244 to 0.564. The results of structural equation modeling revealed that self-efficacy partially mediated the effect between work engagement and nurse safety behavior, accounting for 25.3% of the total effect. Conclusion. Self-efficacy mediates the relationship between work engagement and nurse safety behavior, and by increasing self-efficacy, nurse safety behavior can be improved, thus ensuring patient safety. Implications for Nursing Management. Managers should promote high work engagement and nurse safety behaviors by fostering nurses' self-efficacy. [ABSTRACT FROM AUTHOR]

In order to explore and analyze the effect of music therapy interventions on college students with excessive anxiety, this paper selected 240 year 2017- to year 2020-enrolled undergraduates from a comprehensive university in Taiyuan City, Shanxi Province, in Central China as research objects. These college students had been diagnosed as excessive anxiety and were randomly divided into two groups—intervention group and control group—with 120 students in each group. The control group received conventional mental health treatment for college students, while the intervention group received music therapy interventions on this basis with 3 times a week for 24 times. The instruments used in the music therapy include piano, percussion instruments, melodic instruments, and diffuse instruments; the specific implementation of each therapy is divided into five parts: warm-up, rhythm percussion, song singing, instrumental ensemble, and music appreciation. The study results show that before treatment, the excessive anxiety score of college student in the control group was 63-76 with an average score of 72.58 ± 5.27 ; after treatment, that was 45-64 with an average score of 54.46 ± 6.82 ; before treatment, the excessive anxiety score of college student in the intervention group was 62-78 with an average score of 72.56 ± 5.51 ; after treatment, that was 26-44 with an average score of 33.19 ± 5.51. Before treatment, there was no significant difference in the excessive anxiety scores between the two groups of college students (P > 0.05); after treatment, the excessive anxiety scores of the two groups were lower than those before treatment, and the reduction degrees in the intervention group were bigger than those in the control group, with statistically significant difference (P < 0.05). Therefore, music therapy interventions can significantly reduce the excessive anxiety of college students; the analysis also shows that factors such as gender, grade, major, origin, repertoire type, therapy type, and anxiety type could affect the effect of music therapy interventions to some certain extent. For example, the effect of music therapy interventions on college students in psychology or related majors is better than that of students in other majors; the effect of receptive music therapy is better than that of creative and improvised music therapy; the effect of music therapy interventions on college students' life event, romantic relationship, and social anxiety is better than that on college students' test and job-hunting anxiety. [ABSTRACT FROM AUTHOR]

In order to supplement and improve the landscape evaluation system of traditional villages and play a positive guiding role in the specific protection and development of village landscape, this paper proposes the ecological landscape environment evaluation of traditional villages in Guanzhong from the perspective of rural revitalization. First of all, the relevant national and provincial evaluation standards are deeply studied, and the comprehensive evaluation system of the traditional village landscape in the Guanzhong region is constructed by using expert scoring and an analytic hierarchy process, which includes 6 criteria and 25 indicators. Three typical villages of different types and different development stages, namely, village A, village B, and Village C, were selected for landscape investigation and comprehensive evaluation. The results show that the weight of village location and landscape pattern is the largest, that is, the most important. The second is architectural landscape, with a weight of 0.236, accounting for a high proportion. Then, it is the natural landscape and street landscape, with a weight of 0.1-0.2. Finally, it is the intangible cultural landscape and landscape style protection, with a weight of less than 0.1. The alpha value of the comprehensive evaluation questionnaire of the village A is 0.984. The alpha value of the comprehensive evaluation questionnaire of village B is 0.941. The alpha value of the comprehensive evaluation questionnaire for the landscape of village C is 0.986, which is greater than 0.8. Conclusion. This study makes a comprehensive evaluation of the landscape of typical traditional villages. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between community care services and ageing in place in urban China. Using data from the 2010 Sample Survey on Aged Population in Urban/Rural China, and within the framework of a revised version of Andersen's model, the paper applies multilevel models and analyses the effects of community care on the preference between ageing in place and institutional care, and reveals that ageing in place is preferred even in urban China. However, the existence of community care services had no significant effect on the preference for ageing in place. The paper concludes by arguing that China needs to develop its community care services and promote the idea of community care in both culture and policy. Realising ageing in place also requires a multidisciplinary approach. A model of shared care, between family and state, is particularly appropriate for China. [ABSTRACT FROM AUTHOR]

Social determinants of public health have gained increasing attention. This paper studied whether social support from online communities related to maternal mental health. We focused on online maternity communities that group users with a similar prenatal status to facilitate their exchange of personal experiences and knowledge about maternal caring during pregnancy. Such online maternity communities are getting increasingly popular and can be found across countries and societies. We invited users—currently pregnant and gave birth within 1 year at the time of the study—from one such community in China to participate in a survey. The survey measured their perceived social support (PSS) exclusively from the peer group in the online community, their mental health and newborns' birth outcomes (N = 500). Users reported high score in PSS from the online peer group which was comparable to the ones from family, significant other and friends in other studies. We used linear regression models to examine the effects of PSS on mental health and birth outcomes. We found that a one‐point increase in the PSS score was associated with a 0.19‐point (p < 0.1) decrease in the prenatal depression and a 0.26‐point (p < 0.01) decrease in the postnatal depression, which was equivalent to 3% and 4.5% of the average respectively. Moreover, a one‐point increase in the PSS score was associated with a 14.49‐gram increase in a newborn's weight (p < 0.01). [ABSTRACT FROM AUTHOR]

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

Since the existing research on the direct introduction of ecological principles into the financing field is very weak, there is no systematic and dynamic research on financing efficiency from the perspective of ecology. Through in-depth analysis, this paper finds that the industrial financing ecology affects financing efficiency through financing scale, financing cost, financing structure, financing speed, and capital allocation. At the same time, financing efficiency also affects the industrial financing ecology through industrial policy, financial system, legal culture, ecological displacement, and genetic reorganization, this leads to the interaction and coevolution of the industrial financing ecology and financing efficiency. To measure the degree of synergy between the financing ecology and financing efficiency, we construct a composite system synergy model and take the new energy industry as an example to carry out empirical research, the empirical results show that the synergy between China's new energy industry financing ecology and efficiency at the current stage still has great room for improvement. [ABSTRACT FROM AUTHOR]

Aim: This study aims to design a 100‐h training programme for nursing innovation teams and to evaluate the effect of this training programme using Kirkpatrick's model. Background: The innovative capability of nurses is a powerful driver for the development of the nursing discipline, and it is currently at a low to medium level in China. Innovation competency development has become a research trend in nurses' in‐service education, but only changes in nursing innovation behaviours before and after training have been evaluated. The cascading, continuous assessment tools are rarely used. Methods: This is a quasi‐experimental research design: pretest and posttest design. Totally, 61 clinical nurses from Hangzhou Hospital of Traditional Chinese Medicine were enrolled for innovation training. This innovation team training programme consisted of a 36‐h theoretical training phase and a 64‐h collaborative training phase. The four levels of Kirkpatrick's model, that is, reaction, learning, behaviour, and result, were applied for the evaluation together with questionnaires. Results: At reaction level, the nurses' attendance was over 85% in two phases. The differences between nurse organizational innovation climate scores of tested nurses before and after training were statistically significant (t = −22.559, P <.001). At learning level, there were statistically significant differences between nurses' innovation self‐efficacy scale scores of tested nurses before and after training (t = −16.832, P <.001). At behaviour level, the nursing innovation behaviour scale scores of tested nurses were significantly higher after training (t = −18.950, P <.001) than before the training. At result level, the clinical nurse innovation ability of tested nurses after the training were higher than before the training (t = −26.275, P <.001). The numbers of patent applications, granted patents, application for scientific research projects, sponsored scientific research projects, and papers published by team members after the training were larger than those before training (Z = −2.032, P =.042). Conclusion: Kirkpatrick's model can evaluate the effectiveness of nursing innovation training for clinical nurses. The nursing innovation training is beneficial to improve nurses' innovation capacity, organizational innovation climate and innovation self‐efficacy, and nursing innovation behaviour and promote the output of research and innovation projects. Implications for Nursing Management: Managers can flexibly develop training modules with regional characteristics based on this programme to effectively improve the innovation ability of clinical nurses, thus meeting the urgent demand for innovative nursing talents and the rapid development of nursing disciplines. [ABSTRACT FROM AUTHOR]

It is of great significance to build an efficient and cooperative innovation system and support system under the background of China persisting in leading the development with innovation and speeding up the construction of an innovation-oriented country. The collaborative relationship and profit distribution of each innovation subject will be analyzed through the study of the innovation activity in the innovation chain. With consideration of the characteristics of the innovation chain such as high risk, financing difficulty, cooperative partnership and so on and using the internal financing mode of supply chain for reference, the game model of internal financing between members of the innovation chain will be established. The game equilibriums will be solved and analyzed, and the optimal equilibriums will be achieved by designing the contracts to establish the internal financing mechanisms in the innovative chain. For the risk asymmetry at each stage of the innovation chain, the contracts will be optimized to construct the risk sharing mechanism to control the risk of the internal financing in the innovation chain. In order to make innovations, this paper creates the financial support mode of the innovation chain, improves the innovation support system and increases the efficiency of the innovation chain. [ABSTRACT FROM AUTHOR]

Aims. To develop an evidence-based practice (EBP) facilitating strategy informed by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and evaluates the strategy's effectiveness on promoting EBP. Background. Nurses are increasingly expected to use research evidence in practice to improve patients' outcomes, but the application of such evidence is still unsatisfactory. The facilitation of EBP in nursing needs the organization and the individual levels. Methods. Based on an analysis of EBP-promoting strategies and expert consultation, the core team of the nursing department developed an EBP group-based and project-oriented strategy under the guidance of the i-PARIHS framework. The strategy was implemented for six years and evaluated by a longitudinal design. The validated Chinese version of the self-reported Evidence Based Practice Questionnaire (EBPQ) was used to assess the attitudes, knowledge, and practice of the nurses. Results. The mean score of the total EBPQ was 4.46 (SD = 0.92) after one year of the EBP strategy, and the scores for knowledge, attitudes, and practice of EBP members were higher than those of general nurses p < 0.05 . After four years, EBP members' scores continued to increase. EBP groups conducted 51 EBP projects in the areas of emergency nursing, surgical and medical nursing, critical care, and so forth. Of these, 33 projects improved nursing practice by changing nursing procedures, upgrading nursing tools, and developing nursing standards, resulting in improved patient outcomes. Conclusion. The EBP group-based and project-oriented strategy can promote EBP. The composition of the EBP group, the annual audit of EBP projects, and the roles of internal and external facilitators were key components of this EBP-facilitating strategy. Implications for Nursing Management. The strategy is an organizational-level EBP-facilitation approach which can improve nurses' academic preparation for EBP through ongoing training and sustained EBP behavior that involves annual projects. [ABSTRACT FROM AUTHOR]

Aiming at 'ageing healthier and ageing better', a certain amount of highquality informal care should be available for elderly persons with physical disability as formal care is barely accessible in China. The demographic transition and family structural changes have dramatically weakened traditional norms of filial piety and the structure of intergenerational transfers. This article employed nationwide representative data from the first wave (2011) of Chinese Health and Retirement Longitudinal Study (CHARLS) in order to identify the duration of informal care provision at home for frail elders (1122 in rural areas and 577 in urban areas, total 1699), measured in monthly hours, before estimating the associations between intergenerational transfers and the received time of informal care with Tobit Model analysis. Results showed that financial support from the younger generation was unexpectedly negatively associated with the monthly hours of care, implying a reduction of caring support along with increasing financial transfers towards older parents. The lack of informal care could not be compensated by having more children, co-residing with children, or increasing the parent-to-child/grandchild transfers. Spouses were shown to replace children as the major caregivers. In addition, the communitybased long-term care system needs to be promoted to sustain and develop informal care, as the latter will become increasingly important with changing family dynamics. Finally, the received time of informal care, rather than the severity of physical disability measured by difficulty with ADLs or IADLs, was introduced to identify the actual demand for care by elders. The paper argues that it is important to reconceptualise and re-investigate the duration of care provision in the Chinese context in order to develop standards of payment as part of long-term care policies. [ABSTRACT FROM AUTHOR]

Background. Nurses play a critical role in the medical workforce during the COVID-19 pandemic while facing various difficulties and challenges. Grit, social support, and self-esteem are important psychosocial factors influencing job performance. However, few studies have explored the relationships among these factors in nurses. Aim. This study aimed to examine the association between grit and nurses' job performance during the COVID-19 pandemic and to explore the potential chain mediation through perceived social support and self-esteem. Methods. A cross-sectional survey design was employed. From January 2021 to May 2022, a total of 709 Chinese nurses in Chengdu and Kunming completed a web-based cross-sectional survey, which included standard assessments on grit, perceived social support, self-esteem, and job performance as well as Big Five personalities. The chain mediation model was tested using the PROCESS macro program in the SPSS software. Results. There was a moderate-to-large correlation (r = 0.40, p < 0.001) between grit and job performance in Chinese nurses. Furthermore, grit was indirectly linked to job performance through the chain mediating effect of perceived social support and self-esteem (all p < 0.05). These findings persisted even when Big Five personalities were included as additional controlling variables. Conclusions. This study reveals a stable link between grit and job performance among Chinese nurses and highlights the potential role of perceived social support and self-esteem in mediating this link. Implications for Nursing Management. Nursing managers can improve nurses' grit level and provide a supportive organizational environment conducive to enhancing self-esteem and thereby promoting their job performance. [ABSTRACT FROM AUTHOR]

Background. Altered maternal serum lipid metabolism is associated with hypertensive disorders in pregnancy (HDP). However, its range in pregnancy and characteristic among different subgroups of HDPs are unclear. Methods. Pregnant women with HDP who underwent antenatal care and delivered in Obstetrics and Gynecology Hospital of Fudan University during January 2018 to August 2022 were enrolled. The levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), apolipoprotein (Apo)-A, B, and E, free fatty acids (FFA), and small and dense low-density lipoprotein cholesterol (sdLDL) were measured during 4–16 weeks and 28–42 weeks of pregnancy. Results. A total of 2648 pregnant women were diagnosed with HDP, 1,880 of whom were enrolled for final analysis, including 983 (52.3%) preeclampsia (PE), 676 (36.0%) gestational hypertension (GH), and 221 (11.7%) chronic hypertension (CH). For all HDPs, serum TC, TG, LDLC, HDLC, Apo-A, Apo-B, Apo-E, and sdLDL increased significantly during pregnancy, while FFA decreased significantly. Notably, the levels of TC, LDLC, Apo-B, and sdLDL in PE group were equal to or lower than those in CH group at 4–16 weeks of pregnancy, but increased greatly during pregnancy (P < 0.05). Conclusions. Maternal serum lipid levels changed through pregnancy among women with HDPs. Women complicated with PE seem to have undergone a more significant serum lipid change compared to those with GH or CH. [ABSTRACT FROM AUTHOR]

Objective. As part of the efforts to build a practical, effective, and diversified medical insurance payment method, it is crucial for China to deepen the reform of ambulatory patient groups (APGs). This study was aimed to explore the mechanism and effect of this policy from three dimensions, including medical expenses, medical insurance funds, and medical services. Methods. In 2020, China's pilot reform of APG was initiated in Jinhua City, Zhejiang Province. Descriptive statistics, correlation analysis, and OLS regression analysis were utilized to evaluate the effect of the APG reform in Jinhua. Results. The implementation of the reform can contribute significantly to establishing a comprehensive medical service governance mechanism of classified settlement and coordinated promotion. It also plays a critical role in safeguarding people's lives and health by promoting the high-level development of medical insurance systems and public hospitals, optimizing the quality of medical services, and improving the efficiency of medical insurance funds. Conclusion. Through the lens of policy evaluation, our findings can provide useful experience for the implementation of the outpatient medical insurance payment method in developing countries. [ABSTRACT FROM AUTHOR]

Aims. This study was designed to investigate the impact of inclusive leadership on challenge-oriented citizenship behaviors and examine the mediating role of organizational justice on the relationship between inclusive leadership and challenge-oriented citizenship behaviors among nurses. Background. Leaders exhibiting an inclusive leadership style have the potential to create a positive work climate and motivate members of the organization. However, the mechanisms by which organizational justice contributes to this process remain to be explored, particularly in terms of how it motivates challenge-oriented organizational citizenship behaviors. Method. A cross-sectional questionnaire survey was conducted among nurses in China at the end period of the COVID-19 pandemic. A total of 527 registered nurses were enrolled and completed the self-report questionnaires including inclusive leadership scale, organizational justice scale, and challenge-oriented citizenship behavior scale. The hypotheses were tested using hierarchical multiple regression analyses and structural equation modelling. Results. The results of empirical tests revealed that nurse leader's inclusive leadership had a positive relationship on nurses' challenge-oriented organizational citizenship behaviors (β = 0.823, p < 0.001) after controlling several demographic covariates. Meanwhile, inclusive leadership was positively linked to organizational justice (β = 0.747, p < 0.001), and the indirect effect of inclusive leadership on nurses' challenge-oriented citizenship behaviors through organizational justice was statistically significant (β = 0.641, p < 0.001). Furthermore, the model fit indices were χ2/df = 1.952, RMSEA = 0.043, CFI = 0.979, and TLI = 0.977, indicating that the model had high quality. Conclusion. This study could help nurse leaders with inclusive leadership style have a better understanding and taking the advantages of the influence mechanism of organizational justice in inspiring nurses' challenge-oriented citizenship behaviors. While nurse managers can inspire challenge-oriented organizational citizenship behaviors through inclusive leadership, they should also emphasize the evaluative and behavioral-shaping effects of organizational justice. Both leadership and organizational justice are essential to motivate challenge-oriented organizational citizenship behaviors and to foster organizational development. Moreover, managers should focus on the process and conditions of implementing organizational justice to ensure fairness within the organization and to create a conducive environment for challenge-oriented organizational citizenship behaviors. [ABSTRACT FROM AUTHOR]

Background. Culturally relevant exercises may help improve health and address disparities faced by older immigrants due to language and cultural barriers. Few studies have focused on such exercise interventions among older Chinese immigrants at US daycare centers. Methods. We conducted a 10-week nonrandomized controlled trial in older Chinese immigrants in Philadelphia, US. The intervention group practiced Chinese Qigong (Baduanjin) 5 days a week guided by trained research assistants and video instructions. The control group maintained their usual daily activities. We collected self-report assessments on overall health, sleep, and fatigue and implemented two computerized cognitive tests measuring psychomotor vigilance task (PVT) and memory twice, preintervention and postintervention. Repeated measures general linear model (GLM) and paired samples t-tests were used for data analyses. Results. Eighty-eight older adults (Qigong, n = 53; control, n = 35) with an average age of 78.13 (SD = 5.05) were included. Groups showed no significant differences at baseline evaluation. After the 10-week exercise, the intervention group showed significant improvements in overall health (p = 0.032), fatigue (p < 0.001), and cognitive functions including memory (p = 0.01), response speed (p = 0.002), and response time (p = 0.012) on the PVT, as well as marginally significant benefits in sleep (p = 0.058). Between-group comparisons identified significant group-by-time interactions in health (p = 0.024), sleep (p = 0.004), fatigue (p = 0.004), and memory (p = 0.004). Conclusion. We revealed significant positive effects of Qigong in older Chinese immigrants across multiple health domains. Findings highlight the potential of a culturally relevant exercise in addressing health disparities. [ABSTRACT FROM AUTHOR]

Taking care of people with dementia is stressful for informal caregivers. Respite care can provide a break for them. But it is often underused, and its acceptability can be low in China. One reason is that it fails to meet their needs. This study aimed to explore the preference of caregivers of people with dementia for respite care services. A discrete choice experiment was used. Attributes and levels of respite care were informed by a literature review and expert consultations. A fractional factorial design was used to reduce the number of choice sets. A questionnaire survey was conducted in Tianjin, China. A mixed logit model was used to compute coefficients for attributes and levels. Respite care packages differed in five attributes, which were content, provider, duration, frequency, and cost. 322 caregivers completed valid discrete choice experiment questionnaires. All five attributes were statistically significant. Two most preferred attributes were "providers" (coefficient 1.297, p < 0.001) and "frequency" (coefficient 1.169, p < 0.001). Caregivers prefer highly qualified service providers and frequent respite care. The desirable respite care for caregivers would be assistance with personal care for people with dementia which was provided by an experienced worker with attitudes of understanding and respect towards people with dementia more than 3 times per week regularly and more than 4 h every time with a lower cost. This study offered new information on Chinese dementia caregivers' preferences for respite care. Policymakers should pay attention to the frequency and quality of providers when designing respite care to improve service uptake and ultimately lighten the burden on caregivers of people with dementia. [ABSTRACT FROM AUTHOR]

Aim: To explore the impact mechanism of transformational leadership and clan culture on the willingness to stay of nursing staff in the aged care industry. Background: Previous researchers had paid much attention to the leadership and culture, yet it was unclear how the transformational leadership and clan culture influence the willingness to stay of nursing staff, especially those in the aged care industry. Methods: A questionnaire was conducted in an aged care agency in Anhui Province, with a total of 217 valid questionnaires collected for empirical analysis. Results: (a) Transformational leadership indirectly affects willingness to stay by affecting organisational commitment and job satisfaction. (b) Clan culture also affects the willingness to stay by affecting their organisational commitment and job satisfaction. (c) Professional identity also has a significant positive impact on the willingness to stay. Conclusions: The findings of the study emphasize the importance of transformational leadership and clan culture in enhancing the willingness to stay of nursing staff in the aged care industry, and clarify the specific impact mechanism. Implications for Nursing Management: Nurse leaders in the aged care agencies should improve transformational leadership, and strive to build clan culture to help retain nursing staff better. [ABSTRACT FROM AUTHOR]

Background. Adherence to complete decongestion therapy (CDT) is of utmost importance for patients with breast cancer-related lymphedema (BCRL). However, past studies have demonstrated that adherence to CDT in BCRL patients is less than satisfactory. Our study aimed to describe the level of adherence to CDT among BCRL patients and utilize the Health Belief Model to analyse the key factors that influence adherence. Methods. We employed a convenient sampling method to select 158 patients with BCRL who were in the maintenance stage of CDT in a grade A tertiary tumour hospital in Guangzhou. A questionnaire survey was used to investigate patients' adherence to CDT, as well as their sociodemographic characteristics, medical history characteristics, disease knowledge, and health beliefs. Results. The CDT adherence score of BCRL patients was 96.46 ± 18.46 points, with an average score of 2.61 ± 0.50 points per item. The adherence rate was 65.18 ± 12.47%, indicating a moderate level of adherence. Factors that significantly influenced CDT adherence in BCRL patients included age under 45 years, having 0 or 1 child, experiencing 9 lymphedema symptoms, and having low levels of disease knowledge and health beliefs (p < 0.05). Conclusions. The level of adherence to CDT in BCRL patients is moderate and requires improvement. To enhance adherence to CDT, medical professionals should focus on patients who are younger, have fewer children, exhibit fewer symptoms of lymphedema, possess limited disease knowledge, and have weak health beliefs. [ABSTRACT FROM AUTHOR]

Aim. The aim of the study was to examine the effect of the length of working hours on missed nursing care, quality of nursing care, and perceptions of the nursing practice environment. Methods. A multicenter cross-sectional investigation using online questionnaires was conducted from April 2 to May 10, 2022, in twenty nine hospitals (13 Level-III hospitals and 16 Level-II hospitals). We collected data on the working hours of nurses and nurse-reported outcomes, including missed nursing care, quality of nursing care, and nursing practice environment. Restricted cubic spline (RCS) regression models were used to examine relationships between the hours per shift and nurse-reported outcomes. Results. We investigated 12,703 nurses with a response rate of 97.33%. Nurses worked on average 7.72 (SD = 1.16) hours on the day shift and 8.92 (SD = 2.20) hours on the night shift, respectively. On the day shift, working 7.5 hours shift showed minimal missed nursing care; meanwhile, working 7–7.5 hours were correlated with the highest satisfaction of the nursing practice environment and better quality of nursing care. On the night shift, the highest missed nursing care was found for a working duration of 12 hours to the working 7 hours, with the lowest satisfaction while better quality was observed. The percentage of nurses who reported working overtime was 30.33%. Nurses who worked overtime reported lower satisfaction and poorer quality of nursing care on all shifts; moreover, working overtime showed the positive correlation to missed nursing care on the day shift, while on night shift was not statistically significant. Conclusion. Positive outcomes were observed for nurses who reported working 7–7.75 hours on the day shift and 12 hours (no more than 15 hours) on the night shift. Implications of Nursing Management. The results reemphasized the need for managers to reduce the working hours, overtime work, and the frequency of the night shift. [ABSTRACT FROM AUTHOR]

Background. Health science popularization, especially digital health science popularization, is essential for development of the Healthy China Strategy. Current studies have focused on interpreting digital education popularization and confirming its positive function; however, reports regarding the limitations and shortcomings thereof are lacking. We aimed to research the current development of digital health science popularization in China, analyze the existing problems, and explore the methods to resolve these problems. Methods. We conducted a qualitative study by mixing in-depth interviews and grounded theory approaches. Participants were recruited according to the inclusion criteria via a snowballing process. Thirty-nine participants, including doctors, nurses, researchers, officers in government, and project leaders, were recruited from the Yangtze River Delta region. Online in-depth interviews with open questions were conducted, and the data were collected. Results. Our results revealed that digital health science popularization has the advantages of convenience, swiftness, friendliness, and social links. However, obvious deficiencies were also exposed, including low authenticity, limited audiences, a lack of manpower, and fragmentation. Conclusions. Current digital health science popularization needs to emphasize public welfare, promote the dissemination of information with professionalism and authority, cultivate cross-border talent, and develop institutional infrastructure to overcome the deficiencies thereof. This remains important to improve the quality and effectiveness of digital health science popularization. [ABSTRACT FROM AUTHOR]

Object. In order to achieve Healthy China 2030 and an effective and sequential diagnosis and treatment system, family doctor contracting is a crucial strategy for improving graded diagnosis and treatment and achieving universal health. Through the examination of data on community members' medical expenditures, this research investigates the influence of contracting on residents' primary care consultation behavior. Methods. Using a quantitative research approach based on information about residents' medical payment patterns, this study aims to examine the effect of family doctor contracting on residents' medical costs. Therefore, a two-part model and a Heckman two-stage model are used to explore the impact of contracting on residents' medical expenses in the community hospital based on the sample of contracted and noncontracted residents and the basic information and monthly checkout data of the residents provided by a community hospital in Beijing. Conclusion. Specifically, contracting increased residents' healthcare expenditures in community hospitals by increasing the number of departments and the frequency of visits, according to the results, which indicate that contracting significantly increased residents' healthcare costs in community hospitals. The frequency and number of departments in community hospitals for two target groups—the elderly and patients with chronic diseases—have increased significantly as a result of contracting, according to subgroup analysis. This finding suggests that family physicians make it possible for the daily care and treatment of these two priority groups to be met to a greater extent at the primary level. The empirical findings of this study reveal that the family doctor contracting system has a significant impact on how primary care and hierarchical treatment patterns are established. [ABSTRACT FROM AUTHOR]

Background. Reliable epidemiologic data on the present burden of hypertension are needed in developing region-specific strategies since previous studies have suggested that China is lagging in risk factor management. Objective. The study aimed at exploring the prevalence of hypertension and its associated factors among adult residents in Ganzhou, China. Methodology. A multistage, stratified, and cluster random sampling method was used to conduct the cross-sectional survey. The study selected four county-level districts in Ganzhou City, China, as the investigation area. Permanent residents aged ≥18 years who have settled in the area for 6 months or more were selected. A total of 7430 residents were involved in the study. Univariate and multivariate logistic regression analysis was carried out to identify predictors of hypertension. Results. The prevalence of hypertension in Ganzhou was 28.5%, and the age-standardized prevalence of hypertension was 22.4%. Univariate logistic regression analysis revealed that multiple variables have a statistically significant effect on the prevalence of hypertension. The elderly (odds ratio [95% CI]: 2.791 [2.594–3.004]), men (1.805 [1.583–2.058]), lower educated (0.848 [0.805–0.893]), a family history of hypertension (4.575 [3.900–5.368]), higher body mass index (1.344 [1.215–1.488]), central obesity (1.532 [1.304–1.799]), and less vegetable intake (1.150 [1.023–1.294]) were the major risk factors for hypertension. Conclusion. Hypertension is a major public health problem in Ganzhou and requires much effort to reduce its prevalence. An effective multifaceted implementation strategy is highly desirable to combat the emerging burden of hypertension. [ABSTRACT FROM AUTHOR]

Insampaedok-san (IS) has traditionally been prescribed as a medication for cold-related symptoms in Northeast Asia, including Korea and China. In this study, we focused on elucidating the molecular mechanism underlying the immunomodulatory activity of IS water extract (ISE) in macrophages. ISE significantly enhanced the levels of nitric oxide (NO) and prostaglandin E2 (PGE2) by increasing the expression of inducible NO synthase and cyclooxygenase-2 (COX-2) in a dose-dependent manner. ISE, which consists of many herbs, contains a large number of active compounds whose pharmacological targets and mechanisms are complicated. Therefore, network pharmacology analysis was used to predict the potential key components, targets, and mechanisms of ISE as immunomodulators. Subsequently, the network pharmacology results were validated experimentally. Seven key components were identified through HPLC-QTOF-MS. As predicted by the network pharmacology analysis, ISE increased the mRNA expression of Tnf and Il6. Furthermore, ISE increased the phosphorylation, nuclear translocation, and transcriptional activity of the p65 subunit of the nuclear factor-κB (NF-κB) signaling pathway. In contrast, rapamycin, an NF-κB inhibitor, suppressed the ISE-induced mRNA expression of Tnf and Il6. In conclusion, ISE is an immune activator that can elevate the production of NO, PGE2, and proinflammatory cytokines mediated by NF-κB signaling. [ABSTRACT FROM AUTHOR]

Remote sensing has been extensively applied in agriculture for its objectiveness and promptness. However, few applications are available for monitoring natural medicinal plants. In the paper, a multilevel monitoring system, which includes satellite and aerial remote sensing, as well as ground investigation, was initially proposed to monitor natural Rheum tanguticum resource in Baihe Pasture, Zoige County, Sichuan Province. The amount of R. tanguticum from images is M = S*ρ and S is vegetation coverage obtained by satellite imaging, whereas ρ is R. tanguticum density obtained by low-altitude imaging. Only the R. tanguticum which coverages exceeded 1m2 could be recognized from the remote sensing image because of the 0.1m resolution of the remote sensing image (called effective resource at that moment), and the results of ground investigation represented the amounts of R. tanguticum resource in all sizes (called the future resource). The data in paper showed that the present available amount of R. tanguticum accounted for 4% to 5% of the total quantity. The quantity information and the population structure of R. tanguticum in the Baihe Pasture were initially confirmed by this system. It is feasible to monitor the quantitative distribution for natural medicinal plants with scattered distribution. [ABSTRACT FROM AUTHOR]

De-qi refers to the participant's subjective sensations and objective body responses as well as the acupuncturist's perceptions while the acupuncturist needles certain acupoints in the participant's body. In recent years, De-qi is getting increasing attention of the researchers and many efforts have been made to understand its mechanism. By the broad literature survey, this paper explores the subjective De-qi sensation of the patients, its influencing factors, and the resulting physiological responses. The purpose of this paper is expected to find out a possible mechanism of De-qi and to provide certain scientific evidence for acupuncture fundamental research and clinical practice. [ABSTRACT FROM AUTHOR]

Background. The high turnover rate of new nurses is significantly impacted by the transition issue. Practice readiness has been identified as a key factor in ensuring a smooth transition, but there is currently a lack of specific instruments available in China to measure it. Aims. To translate and adapt the Casey-Fink Readiness for Practice Survey and validate its psychometric properties in senior nursing students in the Chinese cultural context. Methods. The descriptive cross-sectional study design was used. The English version of the Casey-Fink Readiness for Practice Survey was translated into Chinese according to Brislin's translation guidelines. A total of 590 senior nursing students from three nursing schools in China were surveyed with the Chinese version of the Readiness for Practice Instrument. Data analyses were performed to assess the reliability and validity of the instrument. The STROBE guidelines were used as the reporting method. Results. The validated Chinese version of the Casey-Fink Readiness for Practice Survey contained 18 items in the same four dimensions as the original English version. The internal consistency was satisfactory, with Cronbach's α and composite reliability values for all four dimensions above 0.70. The final confirmatory factor analysis model also demonstrated good fit indices, with the average variance extracted values for all dimensions above 0.50. Conclusion. The validated Chinese version of the Casey-Fink Readiness for Practice Survey is a reliable and effective instrument for measuring the readiness for practice among senior nursing students in China. Implications for Nursing Management. This study presents a valuable contribution to adapting an effective and reliable tool to assess readiness for practice among Chinese senior undergraduate nursing students. This will enable the development of specific strategies based on cultural context to optimize the readiness for practice for senior nursing students and smooth the transition of new nurses in China. [ABSTRACT FROM AUTHOR]

Background. Burnout is a common psychological syndrome among nurses, especially in the first few years of working. However, limited studies have evaluated the factors related to burnout among junior nurses. Aims. To investigate the levels of psychological flexibility, stress, and burnout among junior nurses and examine the role of demographic and workplace relationship factors, psychological flexibility, and perceived stress on burnout among junior nurses. Materials and Methods. A convenience sample of 481 junior nurses was recruited from three tertiary hospitals in China from July 2021 to August 2022. Data were collected, including demographic data, workplace relationships, psychological flexibility (measured by experiential avoidance and cognitive fusion), perceived stress, and burnout. The Independent t-test, one-way ANOVA, Wilcoxon–Mann–Whitney test, Kruskal–Wallis test, Spearman correlation, and hierarchical regression were used to analyze the data. Results. Junior nurses had a high level of burnout in different dimensions. Nurses with an undergraduate education, nurses working in the first year, and a lack of support from supervisors and poor colleague (nurse-nurse and nurse-doctor) relationships had the lowest level of psychological flexibility and the highest level of perceived stress and burnout. Spearman correlation indicated that experiential avoidance, cognitive fusion, perceived stress, and burnout were positively associated with each other. The regression model showed that psychological flexibility (especially cognitive fusion) and perceived stress influenced burnout in junior nurses. Conclusions. Higher psychological flexibility and lower perceived stress appear to improve burnout in junior nurses. Therefore, interventions targeting these two factors may provide a viable direction for the reduction of burnout among junior nurses. Implications for Nursing Management. Hospital authorities should create a harmonious working environment and provide some psychology training programs for junior nurses. [ABSTRACT FROM AUTHOR]

A critical need exists for new imaging tools to more accurately characterize bone quality beyond the conventional modalities of dual energy X-ray absorptiometry (DXA), ultrasound speed of sound, and broadband attenuation measurements. In this paper we investigate the microwave dielectric properties of ex vivo trabecular bone with respect to bulk density measures. We exploit a variation in our tomographic imaging system in conjunction with a new soft prior regularization scheme that allows us to accurately recover the dielectric properties of small, regularly shaped and previously spatially defined volumes. We studied six excised porcine bone samples from which we extracted cylindrically shaped trabecular specimens from the femoral heads and carefully demarrowed each preparation. The samples were subsequently treated in an acid bath to incrementally remove volumes of hydroxyapatite, and we tested them with both the microwave measurement system and a micro-CT scanner. The measurements were performed at five density levels for each sample. The results show a strong correlation between both the permittivity and conductivity and bone volume fraction and suggest that microwave imaging may be a good candidate for evaluating overall bone health. [ABSTRACT FROM AUTHOR]

Photoacoustic imaging (PAI) has been employed to reconstruct endogenous optical contrast present in tissues. At the cost of longer calculations, a compressive sensing reconstruction scheme can achieve artifact-free imaging with fewer measurements. In this paper, an effective acceleration framework using the alternating direction method (ADM) was proposed for recovering images from limited-view and noisy observations. Results of the simulation demonstrated that the proposed algorithm could perform favorably in comparison to two recently introduced algorithms in computational efficiency and data fidelity. In particular, it ran considerably faster than these two methods. PAI with ADM can improve convergence speed with fewer ultrasonic transducers, enabling a high-performance and cost-effective PAI system for biomedical applications. [ABSTRACT FROM AUTHOR]

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

Aim: To investigate nursing work patterns in a neurology department in a Chinese hospital. Background: Knowledge of nursing work patterns is important for nursing management and work design, and for the evaluation of organizational process change associated with the introduction of an innovation. Methods: A time‐and‐motion method was used to observe 14 registered nurses' (RNs') work patterns in a neurology department in a Chinese hospital. Results: There were 147 hr of observation. Overall, the most time‐consuming activities were verbal communication (28.5%) and documentation (28.3%), followed by indirect care (14.6%) and direct care (14%). Compared to support RNs, charge RNs spent 20% more time on documentation and 11% more time on verbal communication. Two‐thirds of the observed activities had a duration of less than 40 s. Conclusions: Communication, in verbal and written forms, consumed more than half of the nursing time. Conversely, nurses only spent about a quarter of their worktime on preparation for care provision and direct care provision. This reflects the significant role and resource‐consuming nature of communication to provide safe and quality care. Implications for Nursing Management: Communication methods need to be enhanced to improve nursing productivity. This may be achieved through the introduction of more effective nursing documentation methods. [ABSTRACT FROM AUTHOR]

Health education is one of the most effective and efficient ways to achieve the goal of universal health coverage and the sustainable development goals. The equity of access to health services (especially services from community healthcare centers) for internal migrants is an important issue of global concern. However, due to the registration system, long-term residence plan, education level, and other determinants, it is more difficult for internal migrants to enjoy equitable health education compared with local residents. At present, there is no research on signing up with family doctors mainly from community healthcare centers among internal migrants and their impact on access to health education services. In this nationwide cross-sectional study, we used the migrant population dynamic monitoring survey (MDMS) in 2018 to assess the disparities in signing up with a family doctor and its association with health education among internal migrants in China. Among the 151,892 participants, a total of 11.26% migrants had signed up with a family doctor and 81.37% internal migrants had received health education. There was a significant association between signing up with a family doctor and health education in the univariate model (aOR = 1.113; 95% CI: 1.095, 1.132) and the multivariate model (aOR = 1.107, 95% CI: 1.089, 1.126). Meanwhile, age (aORinteraction = 0.996, 95% CI: 0.994, 0.997), migration time (aORinteraction = 0.927, 95% CI: 0.907, 0.948), and migration range (aORinteraction = 0.994, 95% CI: 0.992, 0.997) also had an impact on the relationship between signing up with family doctors and health education. Due to the health education inequalities among internal migrants in China, we need to improve health education access and utilization of internal migrants. As signed up with family doctors was significantly associated with health education among migrants in China, we recommended that the government and healthcare facilities promote health education through family doctors. The number and professional ability of family doctors should also be improved especially in areas with weak healthcare service resources in the future. [ABSTRACT FROM AUTHOR]

Aim. To develop a valid, reliable assessment tool to measure risk factors associated to low back pain (LBP) in intensive care unit (ICU) nurses. Background. LBP is defined as the pain extending from the 12th rib to the iliac crest and often coexists with buttock pain. Nursing has been identified among the top professions at risk of LBP. A mean of 70% prevalence per year in ICU nurses was reported, exceeding those employed in heavy industry. Environmental factors in workplace were also most important risks related to LBP in this population except factors including individual, physical, psychosocial, and lifestyle. However, there is lack of tools to assess environmental risk related to LBP for nurse managers currently. Methods. Focus group interviews, field research, and panel discussion were used to develop item pool. Two-round expert reviews and preinvestigation were carried out to form initial scale named Environmental Risk Assessing Instrument-Occupational Low Back Pain in Nurses (ERAI-N). A cross-sectional survey with 188 ICU participants in Hunan Province in China was implemented to collect data. Cronbach's alpha, split-half reliability, and test-retest reliability were used to test ERAI-N's reliability. Expert review was performed to test ERAI-N's content validity, and confirmatory factor analysis (CFA) was performed to assess its construct validity, being carried out in IBM SPSS Amos 26 Graphics. Results. Final version of ERAI-N scale had five dimensions with 18 items that were space, equipment, belief, guideline, and safe culture. ERAI-N scale's score of Cronbach's alpha, Guttman split-half, and intraclass correlation coefficient (ICC) was 0.958, 0.927, and 0.994, respectively. Item-level content validity scores ranged from 0.89 to 1.0, and scale-level content validity was 0.983. Standardized factor loadings ranged from 0.567 to 0.974. Model adjusted fit statistics were as follows: the chi-square statistic and degrees of freedom (χ2/df) = 3.943, root mean square error of approximation (RMSEA) = 0.071, incremental fit index (IFI) = 0.905, comparative fit index (CFI) = 0.904, parsimony normed fit index (PNFI) = 0.641, and parsimonious comparative fit index (PCFI) = 0.661. Conclusions. ERAI-N scale had moderate reliability, content validity, and construct validity. Implications for Nursing Management. Designers may use ERAI-N scale to plan the interior layout when design a new ICU. Nurse managers might utilize this instrument as a managing tool to assess whether there is environmental risk factors related to LBP in ICU. [ABSTRACT FROM AUTHOR]

Objective. This study focuses on the identification of risk factors, classification of stroke level, and evaluation of the importance and interactions of various patient characteristics using cohort data from the Second Hospital of Lanzhou University. Methodology. Risk factors are identified by evaluation of the relationships between factors and response, as well as by ranking the importance of characteristics. Then, after discarding negligible factors, some well-known multicategorical classification algorithms are used to predict the level of stroke. In addition, using the Shapley additive explanation method (SHAP), factors with positive and negative effects are identified, and some important interactions for classifying the level of stroke are proposed. A waterfall plot for a specific patient is presented and used to determine the risk degree of that patient. Results and Conclusion. The results show that (1) the most important risk factors for stroke are hypertension, history of transient ischemia, and history of stroke; age and gender have a negligible impact. (2) The XGBoost model shows the best performance in predicting stroke risk; it also gives a ranking of risk factors based on their impact. (3) A combination of SHAP and XGBoost can be used to identify positive and negative factors and their interactions in stroke prediction, thereby providing helpful guidance for diagnosis. [ABSTRACT FROM AUTHOR]

As a traditional Chinese medicine, Lianhua Qingwen capsules have been widely used to treat Coronavirus Disease 2019 (COVID-19). This study was aimed to demonstrate the association between treatment with Lianhua Qingwen capsules and the clinical outcomes of hospitalized patients with COVID-19. This retrospective study was conducted at four hospitals in Central China. Data of hospitalized COVID-19 patients were collected between December 19, 2019 and April 26, 2020. Based on whether Lianhua Qingwen capsules were used, patients were classified into Lianhua Qingwen and non-Lianhua Qingwen (control) groups. To control for confounding factors, we used conditional logistic regression in a propensity-score matched (PSM) cohort (1 : 1 balanced), as well as logistic regression without matching as sensitivity analysis. A total of 4918 patients were included, 2760 of whom received Lianhua Qingwen capsules and 2158 of whom did not. In the PSM model, after adjusting for confounders, the in-hospital mortality was similar between the Lianhua Qingwen group and the control group (6.8% vs. 3.3%, adjusted OR, 0.66 [95% CI, 0.38-1.15], p = 0.138). The negative conversion rate of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection was higher in the Lianhua Qingwen group (88.3% vs. 96.1%, adjusted OR, 4.02 [95% CI, 2.58-6.25], p < 0.001). The incidence of acute liver injury was comparable between the two groups (14.0% vs. 11.5%, adjusted OR: 0.85 [95% CI, 0.71-1.02], p = 0.083), and the incidence of acute kidney injury was lower in the Lianhua Qingwen group (5.3% vs. 3.0%, adjusted OR: 0.71 [95% CI, 0.50-1.00], p = 0.048). Treatment with Lianhua Qingwen capsules was not significantly associated with in-hospital mortality in COVID-19 patients. In the Lianhua Qingwen group, the negative conversion rate of SARS-CoV-2 infection was higher and the incidence of acute kidney injury was lower than in the control group. [ABSTRACT FROM AUTHOR]

This study aimed to explore the effect of the Wuhan lockdown on body mass index (BMI) among Wuhan residents as well as factors including food habits affected and changes in physical activity mediating the association. As a survey of the Wuhan lockdown, a random digit dialing method was used to sample residents aged 18 years and older. A computer-aided telephone interview was applied to survey 11,223 residents in Wuhan City in July 2020. Ordinary least squares (OLS) regression and mediation analysis were used to analyze the influence of the Wuhan lockdown on BMI. Demographic characteristics, lifestyle characteristics, and health status differed statistically significantly between residents living in and those who left Wuhan during the lockdown (mean BMI, 23.05 ± 0.04 kg/m2 and 22.34 ± 0.06 kg/m2, respectively). The mean BMI among residents living in Wuhan was 0.42 kg/m2 higher (P < 0.001) than that of residents who left Wuhan during the lockdown, as determined by multivariate OLS regression analysis. Residents living in Wuhan during the lockdown had higher BMI among those aged 18–29 and 30–44 years (P < 0.001), with no difference among those aged 45+ years. The association between living in Wuhan and increased BMI was the strongest among residents who were overweight/obese. The mediation analysis results showed an indirect effect path with living in Wuhan (through decreased physical activity and increasing BMI) and the direct effect of living in Wuhan during the lockdown. The lack of association between living in Wuhan and increased BMI among residents aged 45+ years was due to the indirect influence of living in Wuhan affecting food habits. The findings indicated that the lockdown in Wuhan city increased residents' BMI, especially among those who were young or overweight/obese, partly because of decreased physical activity. [ABSTRACT FROM AUTHOR]

The drifting elderly are an interprovincial floating elderly population that is mainly composed of unemployed older parents in China. They have left their usual residence and relocated to urban areas, facing challenge about social integration. As a neighborhood has played important roles in the floating population's social integration, this study was designed to investigate the influence of neighborhood-based identity and social participation on the social integration of the drifting elderly. Five rounds of data collection and analysis were conducted in a continuous crossover sequence using grounded theory. Twenty-four participants were recruited from three districts in Shanghai, China. The neighborhood was shown to play a prominent role in the drifting elderly's perceptions of social integration. Good neighborhood relations help the drifting elderly establish effective social support networks, interact with inflowing society, get in touch with more human resources, and form social relationships and networks. Neighborhood-based participants and identity were more conducive to eliminating heterogeneity and creating homogeneity for the drifting elderly. Thus, the neighborhood affects the social integration of the drifting elderly, which directly impacts their social feelings, integrations, and networks. Management of social integration among the drifting elderly should be focused on creating general opportunities for them to participate in neighborhood-based social events with a reasonable identity. [ABSTRACT FROM AUTHOR]

Currently, the number of empty-nest elders in China is rapidly increasing, and their overall health situation is not optimistic. The Chinese government has developed a series of policies to promote the community medical-nursing combined model to meet the health and pension care needs of elderly individuals. The demand for community medical-nursing combined services among empty-nest elders plays a decisive role in providing these services and must be fully recognized before these services are offered. However, only a few quantitative studies have focused on the demand for community medical-nursing combined services, and these studies failed to capture the complexity and dynamic nature of this demand. To address this research gap, this study innovatively conducted a descriptive and qualitative study to explore the demand for these services. Following the principle of data saturation, 14 empty-nest elders from communities in Wuhan, Hubei Province, were recruited using the purposive sampling method. Semistructured interviews were used to collect qualitative data. The inductive content analysis approach was used to analyze the data. The results revealed that Chinese empty-nesters' demand for community medical-nursing combined services was diverse and specific and comprised three themes (basic elderly care services, medical and nursing services, and psychospiritual support services), with fifteen subthemes. This study provides insights into the unique demand and implementation strategies for community medical-nursing services among empty-nest elders in China. Recommendations to enhance the intelligent elderly care system, infrastructure construction, and elderly care talent in the future provision of services for this particular group of people are provided. [ABSTRACT FROM AUTHOR]

Participation by patients with chronic diseases under primary health care requires more attention to achieve effective disease management and better health outcomes. In 2016, China proposed accelerating the establishment of a system of family doctors (FDs) and strengthening doctor-patient communication to better meet residents' health service needs. This study aimed to describe perceived participation in primary health care among patients with chronic diseases in northeastern China and explore the impact of FD contract services and patient's trust on patients' perceived participation. A cross-sectional survey of 847 patients with chronic diseases in 16 primary healthcare institutions was conducted in Jilin Province, China. Among all participants, 453 patients reported signing up for FD contract services (62.93%). The perceived participation of patients with chronic diseases was at a low level (mean = 6.71 and SD = 3.35). After controlling for sociodemographic variables and health-related variables, FD contract services directly and indirectly influenced patients' perceived participation. The patient's trust was a mediator in the relationship between FD contract services and perceived participation. This study confirmed the valuation of family doctor contract services and provided a theoretical basis for the formulation of primary health service policies. Health organizations should continue to enhance the capacity of primary health services and attract more chronic disease patients to contract with FD teams, thereby enhancing doctor-patient trust and increasing patient's participation in primary health care. [ABSTRACT FROM AUTHOR]

Purpose. The aim of this study was to analyze choroidal vascular density alteration in high myopia with or without choroidal neovascularization by using optical coherence tomography angiography (OCTA). Methods. This was a cross-sectional, observational study that included 60 high-myopia eyes. All the participants had comprehensive ophthalmic assessments with visual acuity, intraocular pressure, slit lamp-assisted biomicroscopy, color fundus photography, axial length, optometry, and OCTA. Age, sex, and comorbidities were collected from their medical charts. Univariate and multiple analyses were made to compare the age, spherical equivalent, choroidal vascular density, gender, and choroidal thickness between normal and patients with choroidal neovascularization. Results. 60 eyes with high myopia were included in our study, including 30 eyes with choroidal neovascularization and 30 eyes without choroidal neovascularization or other fundus pathology. The mean age of high myopic patients was older in the choroidal neovascularization group than in the normal group (48.43 ± 19.06 years vs. 28.83 ± 9.92 years, p < 0.01). The mean choroidal thickness of high myopic patients was thinner in the neovascularization group than in the normal group (68.81 ± 48.81 μm vs. 137.80 ± 66.33 μm, p < 0.01). The mean choroidal vascular density in the normal group was greater than in the choroidal neovascularization group (82.43 ± 8.73 vs. 67.54 ± 12.56, p < 0.01). There was no significant difference in spherical equivalent between the choroidal neovascularization group and the normal group (−10.56 ± 2.97D vs. −11.93 ± 3.38D, p = 0.11). Multivariate analysis showed that after adjusting for covariates, less choroidal vascular density and older age were independent factors associated with choroidal neovascularization in the high myopic eye. Conclusion. Decreased choroidal vascular density and older age played an important role in the development of choroidal neovascularization in high myopic eyes. OCTA may help us to identify the highly myopic patients that need to intervene. [ABSTRACT FROM AUTHOR]

Background. To explore the clinical characteristics of Posner-Schlossman syndrome (PSS) patients in China, especially the risk factors associated with the dynamic changes of corneal endothelial cell (CEC) density and retinal nerve fiber layer (RNFL) thickness during the course of the disease. Methods. In this retrospective cohort study, patients consequently suffering from PSS were recruited. Patients data including gender, age of onset, frequency of attack, and disease duration. We performed detailed ophthalmology examinations including intraocular pressure (IOP), best-corrected visual acuity (BCVA), slit-lamp examination, optical coherence tomography (OCT), assessing RNFL thickness, and determined CEC density in the outpatient department. The unaffected eyes served as control. Results. We recruited 121 patients (eyes, n = 125), including 69 (57.0%) males and 52 (43.0%) females with Posner-Schlossman syndrome. The age of first-onset was 33.81 ± 13.63 years old. The majority of these patients were aged 20-50 years (80.2%). The peak IOP was 47.67 ± 13.31 mmHg in the affected eyes. The frequency of PSS attack was 2.7 ± 3.7 times per year. The disease duration was 9.5 ± 10.4 years. Among all patients, there were 27 (22.31%) patients with a history of digestive disorders, 25 (20.66%) patients with a history of allergies, and 24 (19.83%) patients with a history of infectious disease. In the affected eyes, CEC density (2532.94 ± 490.83 /mm2 vs. 2777.13 ± 356.87 /mm2, p < 0.001), the RNFL thickness of four quadrants (superior 105.46 ± 29.86 μm vs. 121.33 ± 17.30 μm, p < 0.001 ; temporal 74.58 ± 22.21 μm vs. 81.94 ± 18.20 μm, p = 0.009 ; inferior 110.50 ± 33.42 μm vs. 128.29 ± 14.39 μm, p < 0.001 ; nasal 54.85 ± 14.48 μm vs. 63.49 ± 15.40 μm, p < 0.001) and central papillary (87.11 ± 21.18 μm vs. 99.18 ± 7.97 μm, p < 0.001) were significantly reduced compared to the fellow eyes. The disease duration and recurrent frequency were significantly associated with CEC density (p < 0.001 and p = 0.029) and the disease duration was significantly associated with RNFL thickness (p = 0.002). Conclusions. In this study, CEC loss and RNFL thinning were present in the affected eyes. Our results indicated that disease duration and recurrent frequency played an important role in the progression of PSS. [ABSTRACT FROM AUTHOR]

Objective. Our study aimed to develop and validate a nomogram to predict severe hypocalcemia (SH) before total parathyroidectomy (TPTX) without auto-transplantation in patients with secondary hyperparathyroidism. Methods. A total of 299 consecutive patients who underwent TPTX without transplantation for secondary hyperparathyroidism were selected from the General Hospital of Northern Theater Command between January 2013 and December 2021. Of these, patients who underwent surgery between January 2013 and December 2020 formed the training cohort (n = 208) to develop a nomogram, and those who underwent surgery thereafter formed the validation cohort (n = 91) to validate the performance of this nomogram. Univariate and multivariate logistic regression analyses were used to identify the risk factors associated with SH, and then, a nomogram was constructed. Results. The incidence of postoperative SH was 27.9% and 35.2% in the training and validation cohorts, respectively. The preoperative factors associated with SH were younger age, lower serum calcium (Ca) level, higher intact parathyroid hormone (iPTH) level, and higher serum alkaline phosphatase (ALP) level. Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.866 (95%CI, 0.816–0.916) and 0.867 (95% CI, 0.793–0.941) in predicting SH in the training and validation cohorts, respectively, and had well-fitted calibration curves. The positive predictive values of the nomogram were 64.7% (54.1%–78.4%) and 75.0% (58.6%–88.5%), and negative predictive values of the nomogram were 90.0% (82.9%–93.6%) and 86.4% (73.5%–94.0%) for the training and validation cohorts, respectively. Conclusions. We developed and validated a nomogram for the prediction of SH in patients who underwent TPTX without auto-transplantation for secondary hyperparathyroidism. Our nomogram may facilitate the identification of high-risk SH in patients after TPTX and optimization of preoperative decision-making. [ABSTRACT FROM AUTHOR]

Environmental monitoring is fundamental in assessing environmental quality and to fulfill protection and management measures with permit conditions. However, coastal environmental monitoring work faces many problems and challenges, including the fact that monitoring information cannot be linked up with evaluation, monitoring data cannot well reflect the current coastal environmental condition, and monitoring activities are limited by cost constraints. For these reasons, protection and management measures cannot be developed and implemented well by policy makers who intend to solve this issue. In this paper, Quanzhou Bay in southeastern China was selected as a case study; and the Kriging method and a geographic information system were employed to evaluate and optimize the existing monitoring network in a semienclosed bay. This study used coastal environmental monitoring data from 15 sites (including COD, DIN, and PO4-P) to adequately analyze the water quality from 2009 to 2012 by applying the Trophic State Index. The monitoring network in Quanzhou Bay was evaluated and optimized, with the number of sites increased from 15 to 24, and the monitoring precision improved by 32.9%. The results demonstrated that the proposed advanced monitoring network optimization was appropriate for environmental monitoring in Quanzhou Bay. It might provide technical support for coastal management and pollutant reduction in similar areas. [ABSTRACT FROM AUTHOR]

Aims: To investigate the relationships between transformational leadership, psychological empowerment and innovative behaviour among nurses in China. Background: The innovative behaviour of nurses is important to adapt to the changing medical environment. However, there is currently a limited understanding of the relationship between nurses' innovative behaviour and transformational leadership and psychological empowerment during the pandemic. Methods: Convenience sampling was used to conduct an investigation involving 1317 nurses from 10 hospitals in China from January 2022 to April 2022. Data analysis was performed using correlation analysis, univariate analysis and multiple regression analysis. The STROBE checklist was followed when writing this manuscript. Results: High transformational leadership and high psychological empowerment were associated with high innovative behaviour. The results of the multiple linear regression analysis showed that physical condition, whether or not you have attended academic conferences or whether or not you have participated in fund research projects, transformational leadership and psychological empowerment were the main factors on nurses' innovative behaviour, together explaining 64.5% of the total variance. Conclusion: Promotion of transformational leadership and psychological empowerment is vital for nurses to promote innovation, thereby meeting the urgent demand for innovative nurses and the rapid development of nursing disciplines. Implications for Nursing Management: This study highlights the importance of transformational leadership in developing nurses' innovative behaviours. Understanding the role of psychological empowerment can help nurse managers formulate relevant intervention strategies and cultivate nurses' innovative behaviour. [ABSTRACT FROM AUTHOR]

Aims: We aim to determine the levels of patient safety value, safety attitude and safety competency and to explore the associations among these variables in emergency nurses in China. Background: Studies have focused on the individual characteristics of nurses as influencing factors of patient safety but not on the factors that may affect patient safety competency in the context of Chinese culture, such as safety value and safety attitude. Method: A cross‐sectional survey was conducted among emergency nurses in 22 hospitals. Results: The final model had acceptable fit indices (χ2/df = 3.512 < 5; CFI = 0.955 > 0.9; TLI = 0.942 > 0.9; IFI = 0.955 > 0.9; RMSEA = 0.068 < 0.08 [90% CI, 0.059 to 0.077]). A fully adjusted model was also tested, and the effects among variables were consistent with the hypothesized model. The SEM results showed that patient safety values had a significant direct effect on safety competency (b =.407, p <.001) and safety attitude (b =.656, p <.001). Patient safety attitude had a significant direct effect on safety competency (b =.493, p <.001). Patient safety values had an indirect effect on safety competency through safety attitude, and the total effect of safety values on safety competency was 0.730. Conclusions: Chinese nurses are at a moderate level of patient safety attitude and competency. Emergency nurses' safety value and safety attitude can be direct predictors of patient safety competency, and safety value can indirectly predict their patient safety competency through safety attitude. Implications for Nursing Management: Strengthening safety value is a critical step toward improving patient safety competency. Hospital administrators and educators should construct a patient safety culture that is guided and driven by appropriate values and ensure the development of necessary competencies in nurses. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate scheduling in COVID‐19‐designated hospitals, including working hours, rest days, adverse nursing outcomes and their relationship. Background: Hospitals are at the forefront of COVID‐19 prevention and control, and nurses are the main force on the frontline of the epidemic. Nursing shift is one of the most relevant and pressing issues for frontline nurses. However, there is a lack of national, large‐sample surveys on scheduling and adverse nursing outcomes in COVID‐19‐designated hospitals. Methods: Using a cross‐sectional online survey, we used nurse‐reported data to measure the characteristics of the work setting, samples and work schedule. A descriptive analysis was performed to assess the shift status and adverse outcomes of designated hospitals and frontline nurses. Logistic regression analysis was performed to determine the association between them. Results: Basic data were collected from 217 departments of 69 COVID‐19‐designated hospitals in 31 provinces in China. Nurses in the severe isolation ward worked mainly for 4 h per shift, whereas those in the fever clinic and observation ward worked mainly for 6–8 h. Half of the nurses had only 1 day of rest per week. Long working hours, lack of adequate rest time and overtime can seriously affect the quality and safety of nurses' work, resulting in adverse outcomes. Frontline nurses hope that scheduling guarantees the time to rest while ensuring fairness. Conclusions: The current evidence showed that frontline nurses were faced with long working hours, insufficient rest and overtime, which has a negative impact on nurse satisfaction, physical and mental health and quality of care. The government, hospitals and administrators still face many problems to overcome in their nursing schedules. Implications for Nursing Management: Governments and hospitals should take these factors, such as the work setting characteristics and demographic features of the frontline nurses, into account when selecting nurses to fight COVID‐19. Nurses have different working hours in different types of coronavirus unit; therefore, nursing managers should consider the working environment and nursing schedule needs, and in the future, we should pay attention to the fairness of nurses while ensuring their rest. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to investigate how the use of artificial intelligence is associated with the retention of elderly caregivers. Background: The turnover of elderly caregivers is high and increasing. Elderly care institutions are beginning to use artificial intelligence to support caregivers in their work, and the use of technology is critical to staff retention. Empowerment of elderly caregivers has been neglected by managers and researchers. Methods: This cross‐sectional study involved 511 elderly caregivers in 25 elderly institutions. Six validated standardized scales were used for data collection, and the software SPSS and SmartPLS were used for data analysis. Results: The quality of artificial intelligence has a significant positive effect on empowerment. Artificial intelligence psychological empowerment (β =.355, p <.001) and artificial intelligence structural empowerment (β =.375, p <.001) both had positive effects on retention intention, and the jointly explained variance (R2) was 42.6%. Conclusions: The results show that a significant relationship exists between artificial intelligence empowerment and retention intention. Elderly caregivers with more structural empowerment have higher retention intention. Implications for Nursing Management: Artificial intelligence suppliers need to pay attention to the role of product quality in elderly care services, continuously improve artificial intelligence quality, and strengthen the application and routine maintenance of artificial intelligence technologies. Elderly care institution managers should pay special attention to artificial intelligence structural empowerment (such as artificial intelligence‐related education and training, learning and development opportunities, and resource support). [ABSTRACT FROM AUTHOR]

The public long‐term care insurance (LTCI) scheme has been implemented in a few countries. Although the hypotheses of crowding‐out, crowding‐in and specialisation can facilitate our understanding of the relationship between LTCI and informal care use, existing studies may suffer from reverse causality. Employing a quasi‐experimental design, this study examined the policy effect of LTCI on informal care use among community‐dwelling older adults in China. Based on the data from three waves of the Chinese Longitudinal Healthy Longevity Survey, a staggered difference‐in‐differences (DID) with propensity score matching (PSM) approach was used to analyse the impact of LTCI on probability and hours of informal care use. The results showed that, for disabled older adults, LTCI reduced 43.3% of the probability and 82.4% of the weekly hours of informal care. LTCI also exhibited a spillover effect among nondisabled older adults through reducing the probability and weekly hours of informal care by 5.2% and 12.2%, respectively. Therefore, we argue that policymakers can consider rolling out the scheme for the entire country. Meanwhile, measures are needed to avoid a sharp decrease in informal care provision. [ABSTRACT FROM AUTHOR]

Migration‐related stress is detrimental to children's mental health, yet little is known about the potential mechanisms behind this association. This study examines the mediating role of inflow city identity in the association between migration‐related stress and depression and the moderating role of social participation amongst Chinese migrant children. A sample of 484 migrant children aged 8–17 years is randomly recruited through a cross‐sectional survey in Kunming, China. Inflow city identity partially mediates the association between migration‐related stress and migrant children's depression. Moreover, social participation moderates the above relationship. The direct and indirect effects are significant for migrant children with low social participation but insignificant for migrant children with high social participation. This study deepens the theoretical understanding of the underlying mechanism between migration stress and psychological distress and provides practical implications for preventing mental disorders in Chinese migrant children. [ABSTRACT FROM AUTHOR]