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Emotions are critical to learning. However, the function of emotions in the emerging context of massive open online courses (MOOCs) has been under‐researched. The present study complemented this line of research by modelling the relation between learner emotions, engagement with videos, engagement with assignments, and self‐perceived achievement in a small private online course—a localized instance of an extended MOOC. The results suggested that whereas enjoyment, excitement, boredom, and annoyance were all significant predictors of video engagement, only excitement and annoyance were significant predictors of assignment engagement. Excitement, in particular, was the strongest or stronger predictor of both types of engagement. In addition, both types of engagement predicted self‐perceived achievement, but video engagement predicted self‐perceived achievement via the mediation of assignment engagement. Implications for designing more effective MOOCs were proposed. Lay Description: What is currently known about the subject Emotions predict engagement in learning settings other than MOOCs.Engagement predicts achievement in learning settings including MOOCs.Assignment engagement predicts achievement in MOOCs better than video engagement. What this paper adds The two types of engagement are predicted by different sets of emotions.Engagement predicts self‐perceived achievement in the SPOC.Video engagement predicts self‐perceived achievement via the mediation of assignment engagement.The majority of systematic reviews did not evaluate the quality of the primary papers which they examined. Implications for practitioners MOOC researchers should pay more attention to the design of assignments.MOOC developers should try to build more emotionally‐sound courses and platforms. [ABSTRACT FROM AUTHOR]

Responsive feeding serves as an important protective factor for infant growth and overall health development. This study based on self‐determination theory (SDT) aimed to assess the effects of a responsive breastfeeding (RBF) intervention programme on maternal breastfeeding and infant growth and development. A total of 110 mother–infant pairs were recruited and randomly divided into an intervention group (n = 55) and a control group (n = 55). The primary outcomes were breastfeeding motivation score, breastfeeding self‐efficacy (BSE) and exclusive breastfeeding rate; the secondary outcomes were infant physical development at 6 weeks and 3 months. A repeated measures ANOVA indicated that the intervention group had significantly higher Enjoyment scores compared to the control group at three time points: at discharge (MD: 5.28; 95% CI: 3.68 to 6.89; p < 0.001), 6 weeks post‐partum (MD: 5.06; 95% CI: 3.80 to 6.31; p < 0.001) and 3 months post‐partum (MD: 5.24; 95% CI: 4.12 to 6.35; p < 0.001). Similarly, the intervention group reported significantly higher connection and mother's self‐perception scores at discharge (MD: 4.31; 95% CI: 3.07 to 5.56; p < 0.001), 6 weeks post‐partum (MD: 4.69; 95% CI: 3.71 to 5.68; p < 0.001) and 3 months post‐partum (MD: 4.93; 95% CI: 4.14 to 5.72; p < 0.001), compared to the control group. In contrast, the pressure from significant others scores were higher in the control group relative to the intervention group at discharge (MD: −2.09; 95% CI: −2.88 to −1.31; p < 0.001), 6 weeks post‐partum (MD: −4.35; 95% CI: −5.20 to −3.49; p < 0.001) and 3 months (MD: −4.89; 95% CI: −5.70 to −4.08; p < 0.001). Finally, the intervention group also reported higher Instrumental Needs scores at all three time points: at discharge (MD: 1.96; 95% CI: 1.35 to 2.58; p < 0.001), 6 weeks post‐partum (MD: 3.58; 95% CI: 3.05 to 4.11; p < 0.001) and 3 months post‐partum (MD: 1.18; 95% CI: 0.68 to 1.69; p < 0.001). BSE scores were significantly higher in the intervention group compared to the control group at discharge (MD: 14.29; 95% CI: 10.38 to 18.21; p < 0.001), 6 weeks post‐partum (MD: 14.04; 95% CI: 11.05 to 17.02; p < 0.001) and 3 months post‐partum (MD: 6.80; 95% CI: 4.66 to 8.94; p < 0.001). The rates of exclusive breastfeeding were higher in the intervention group than in the control group at each stage of the intervention (p < 0.01). At 6 weeks post‐partum, the intervention group's infants showed slower weight (t = −0.90, p = 0.371) and length (t = −0.69, p = 0.495) growth compared to the control group, though not significantly. By 3 months post‐partum, there was a significant difference in both weight (t = −3.46, p = 0.001) and length (t = −2.95, p = 0.004) between the groups. The findings in this study suggest that the RBF intervention programme based on SDT may be effective in improving mothers' motivation to breastfeed, building breastfeeding self‐confidence and increasing the rate of exclusive breastfeeding. The effects of the intervention on infant physical development will need to be verified with longer follow‐up in future research. Key messages: This study validated the application of responsive breastfeeding (RBF) intervention during the exclusive breastfeeding phase of Chinese infants.The RBF intervention may help to increase mothers' level of autonomous motivation for breastfeeding, enhance breastfeeding self‐efficacy and increase exclusive breastfeedingrates. The intervention had no significant effect on the weight and length of 6 week old infants but significantly impacted 3monthold infants, with slower growth observed in the intervention group compared to the control group.Future intervention programmes shouldinclude extended follow‐up periods to investigate the long‐term effects of RBF on infant growth and development. [ABSTRACT FROM AUTHOR]

Aims This study examines the preliminary outcomes of an intervention targeting service providers in methadone maintenance therapy ( MMT) clinics in China. The intervention effects on both service providers and clients are reported. Design The MMT CARE intervention pilot was developed and implemented collaboratively with local health educators. After three group intervention sessions, trained providers in intervention clinics delivered two individual motivational interviewing sessions with their clients. Settings Six clinics in Sichuan, China, were randomized to either the MMT CARE intervention condition or a standard care condition. Participants A total of 41 providers and 179 clients were sampled from the six clinics. Measurements At baseline and three-, six-, and nine-month assessments, providers completed self-administrated paper/pencil questionnaires regarding provider-client interaction, MMT knowledge, perceived job-related stigma and clinic support. Clients completed a face-to-face survey about their concurrent drug use and drug avoidance self-efficacy. Mixed-effects regression models with clinic-level random effect were used to assess the intervention effects. Findings Significant intervention effects for providers were found in improved MMT knowledge, provider-client interaction and perceived clinic support. For clients, better improvements in drug avoidance self-efficacy and reduced concurrent drug use were observed for the intervention compared with the standard care group. Conclusions The MMT CARE intervention targeting providers in methadone maintenance clinics can improve providers' treatment knowledge and their interaction with clients. The intervention can also reduce clients' drug-using behavior through motivational interviewing sessions conducted by trained providers. [ABSTRACT FROM AUTHOR]

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

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

Background Little is known about the prevalence and relevant factors of polypharmacy in nonagenarian and centenarians. Aim The aim of this study is to examine the prevalence and associated factors of polypharmacy in a sample of nonagenarians and centenarians living in a rural area of China. Methods The data were from the 'Project of Longevity and Aging in Dujiangyan' study. Medication use and relevant covariates were obtained by face-to-face interviews. Minor polypharmacy was defined as the concomitant use of two to four medications, whereas major polypharmacy referred to the concomitant use of five or more medications. Results We included 859 participants with mean age of 93.7 ± 3.3 years. The number of chronic diseases was 1.4 ± 1.2 per subject, whereas the number of drugs was 0.8 ± 1.4 per subject. The prevalence of minor polypharmacy and major polypharmacy was 16.5% and 3.7% respectively. Illiteracy (odds ratio ( OR) 2.93, 95% confidence interval ( CI) 1.52 to 5.66), cognitive impairment ( OR 3.15, 95% CI 1.44 to 6.88), hypertension ( OR 2.88, 95% CI 1.46 to 5.67), respiratory disease ( OR 2.22, 95% CI 1.08 to 4.58), osteoarthritis ( OR 1.24, 95% CI 1.01 to 1.51), and cancer ( OR 10.70, 95% CI 1.90 to 126.80) were positively associated with minor polypharmacy. Illiteracy ( OR 4.24, 95% CI 1.53 to 11.81), hypertension ( OR 3.40, 95% CI 1.22 to 9.49) and cancer ( OR 3.40, 95% CI 1.14 to 10.12) were also positively associated with major polypharmacy. Conclusions Although most subjects suffer from some chronic diseases, minor polypharmacy and major polypharmacy are not common among nonagenarians/centenarians in rural China. [ABSTRACT FROM AUTHOR]

Background Ventricular arrhythmias (VA) arising from arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and idiopathic right ventricular outflow tract ventricular arrhythmias (RVOT-VA) share the pattern of left bundle branch block (LBBB)/inferior axis. The existence of QRS notching showed a discriminating effect of the two conditions in recent research; however, there are little data regarding the difference in the distribution of QRS notching. The aim of this study was to compare the VA morphology between the two conditions, especially evaluating the diagnostic role of QRS notching. Methods Electrocardiographic (ECG) recordings of VA episode with LBBB/inferior axis of 16 ARVD/C and 45 idiopathic RVOT-VA patients (30 originated from the septum, 15 from the free-wall) were gathered and compared. Results ARVD/C had longer mean QRS duration in all 12 leads, and significant differences existed in leads Ⅰ,Ⅱ,Ⅲ, aVL, aVF, and V1 (P < 0.05). Lead Ⅰ had the largest mean difference of 25.1 ± 5.8 ms. In addition, ARVD/C had more R-wave transition in lead V5 or later (37.5% vs 8.9%, P < 0.01).The presence of QRS notching (15/16 [93.8%] vs 36/45 [80.0%], P = 0.20) and the total number of leads expressing notching (2.88 ± 2.0 vs 2.80 ± 2.0, P = 0.90) were not different between ARVD/C and idiopathic RVOT-VA. However, QRS notching existing simultaneously in leads I and aVL was more common in ARVD/C (43.8% vs13.3%, P = 0.011). Conclusion Longer QRS duration, later precordial R/S transition, and QRS notching in lateral leads (leads Ⅰ and aVL) are useful in discriminating ARVD/C from idiopathic RVOT-VA. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to evaluate the factors predicting the response to allergen-specific immunotherapy ( ASIT) in children with asthma. Methods The case notes of children with asthma who received ASIT for 2 years were retrospectively reviewed. The cases were then divided into an effective clinical response group, defined as absence of asthma symptoms without requirement for medication for at least 6 months during follow up; and an ineffective clinical response group. At the time of initiating treatment, blood was collected for analysis of serum total IgE. Family history of atopy, history of passive smoking, onset age of wheezing and so on was obtained from each patient. Ten factors that may influence children's response were analyzed on logistic regression analysis and compared between groups. Results A total of 99 children with asthma received ASIT s.c. for 2 years during September 2007- February 2010. The average age was 8.66 ± 0.30 years. Good response to ASIT was found in 72 cases, while an inadequate response was found in 27 cases. Of the 10 factors tested for correlation with clinical response to ASIT, a significant correlation was found with onset age of wheezing and airway hyperresponsiveness ( AHR). The odds ratio for the onset age of wheezing was 2.81 (95% confidence interval [ CI]: 1.40-5.65, P = 0.004) and that for AHR was 1.33 (95% CI: 1.04-1.70, P = 0.021). Conclusion Potential predictors for the response to ASIT in children with asthma were identified. Onset age of wheezing and AHR may influence response to ASIT. [ABSTRACT FROM AUTHOR]

Backgroud and Objective Genetic factors may influence the colonization of pathogenic bacteria, therefore increasing the risk for the initiation and development of periodontal disease. The present study was carried out to investigate the association of CD14-260 polymorphisms, subgingival microbiota, and gingival crevicular fluid ( GCF) cytokine levels with cyclosporine A ( Cs A)-induced gingival overgrowth ( GO) in renal transplant patients. Material and Methods A total of 204 patients were dichotomized into two groups: 124 with GO and 80 without GO. The CD14-260 polymorphisms were measured using an allele-specific PCR method. The levels of periodontal pathogens were determined by real-time PCR of subgingival samples. GCF levels of IL-1 β and s CD14 were detected by ELISA. Results The frequency of CD14-260 genotype CT + TT was found to be similar in both groups. Patients with GO presented increased prevalence of Pg, Td, and Tf (red complex) and significantly higher levels of interleukin -1 β than those without GO. Patients with GO carrying CT + TT genotypes were found to have higher frequencies of Pg, Td, and Tf than those carrying the CC genotype. Furthermore, in the presence of red complex, CT + TT genotypes were associated with higher interleukin -1 β levels and severe GO. Multiple logistic regression analysis demonstrated that the severity of GO is not dependent on age, gender and pharmacological variables, being only associated with CD14-260 genotype and red complex periodontopathogens. Conclusion No association between CD14-260 polymorphisms and the prevalence of GO was revealed in renal transplant patients administered Cs A. However, CD14-260 CT + TT genotypes are associated with the prevalence of red complex periodontopathogens in patients with GO, and may thus play some role in the development of severe Cs A-induced GO. [ABSTRACT FROM AUTHOR]

ABSTRACT The aim of the current study was to explore the effect of health-related behaviours and the support of family members on the clinical symptoms of benign prostatic hyperplasia (BPH) patients, and to provide some clues for the symptoms control of BPH. The data were collected in three hospitals in Hubei Province, China, from June to September 2011. The health-related behaviours included cigarette smoking, alcohol intake, tea and coffee consumption, and drinking water regularly, and the support of family members included the support from spouse, siblings, and offspring in the previous year. The χ2 test and multivariable logistic regression models were used to assess their effects on the International Prostatic Symptom Score (IPSS). With regard to health-related behaviours, only coffee consumption (OR = 0·33, 95% CI: 0·11-0·96) and drinking water regularly (OR = 0·44, 95% CI: 0·24-0·81) had significant effects on the IPSS. Although the χ2 test suggested that support from offspring of patients with BPH was statistically significant, after adjusting for potential confounding variables the association was not statistically significant. Although there were some limitations, the current study provides preliminary clues and evidences for the role of coffee intake and regularly drinking water played in the Chinese men with BPH. More in-depth research is needed to enhance the role of health-related behaviours and social factors in the clinical practice of BPH. [ABSTRACT FROM AUTHOR]

Aim The study was conducted to explore the potential association of Matrix metalloproteinases ( MMP) -9 -1562C>T with susceptibility to periodontitis. Materials and Methods Electronic literature searches of PubMed, EMBASE and EBSCO databases were performed. Fixed-effects or random-effects models were used to calculate the pooled odds ratios (ORs) for four genetic comparisons. Results Seven eligible studies with a total of 628 cases and 689 controls were recruited in the pooled analysis. We found MMP-9 -1562C>T contributed to decreased risk of chronic periodontitis. Furthermore, the polymorphism was associated with modified risk of periodontitis among Caucasian populations. Conclusions This study indicated that MP-9 -1562C>T might be involved in the development of periodontitis. A replication of our results in independent large analysis populations is necessary to give evidence to our observation. [ABSTRACT FROM AUTHOR]

Inappropriate complementary feeding practices have led to, in part, significant disparities in growth and nutritional status between rural and urban children in China. A cluster-randomised, controlled trial was implemented in Laishui, China to assess the effectiveness of an educational intervention on caregivers' feeding practices and children's growth. Eight townships were randomly assigned to the intervention or control. Five hundred ninety-nine healthy infants were enrolled at 2-4 months old, and were followed up at ages 6, 9, 12, 15 and 18 months. The intervention group received information on enhanced home-prepared recipes and food preparation and hygiene through group training, counselling and home visit. Key outcomes were children's physical growth, caregivers' knowledge and behaviours on complementary feeding, and the infant and child feeding index ( ICFI). Analysis was by intention to treat. The intervention group achieved better knowledge and practices related to complementary feeding, and significantly higher ICFI scores at each follow-up point. Children in the intervention group achieved higher z-scores for weight-for-age ( WAZ) and weight-for-height ( WHZ) than the control (0.18 vs. 0.01 and 0.49 vs. 0.19, respectively) at 18 months old, and were less likely to have stunted growth (odds ratio = 0.71, 95% confidence interval: 0.53-0.94). Mixed model showed that the intervention group achieved significantly better linear growth over time, including WAZ ( P = 0.016), WHZ ( P = 0.030) and HAZ ( P = 0.078). These results indicated that an educational intervention delivered through local health services can enhance caregivers' knowledge and practices of complementary feeding and ultimately improve children's growth. [ABSTRACT FROM AUTHOR]

International Journal of Paediatric Dentistry 2011; 21: 200-209 This study determined the prevalence of children's dental behaviour management problems (BMP) in our clinic, investigated the influence of non-dental and dental background variables on BMP, and analysed the predictive power of these variables. The study group included 209 children aged 2-8 years who received dental treatment. Interviews were conducted with accompanying guardians. Children's dental behaviour was rated by a modified Venham's clinical anxiety scale and a cooperative behaviour rating scale. Regression models were used to analyse behavioural and interview data and to calculate the power of background variables to predict children's dental behaviour. During the first treatment, 29.7% of children displayed BMP. Four variables were found to predict BMP in 87.9% of cases. The risk factors for BMP were younger age, negative guardian expectations of the child's behaviour during treatment, anxiety or shyness around strangers, and presence of toothache. Children aged 2.5-3.5 years who attended kindergarten showed better dental behaviour than those who did not. This study is the first to report BMP prevalence in mainland China. Our results indicate that a simple pre-treatment interview could provide data allowing the dentist to identify children with special dental behavioural needs. [ABSTRACT FROM AUTHOR]

International Journal of Paediatric Dentistry 2011; 21: 23-28 To investigate the prevalence and distribution of developmental enamel defects in children with cerebral palsy (CP) in Beijing, China. A total of 135 children aged 1.5-6 years with moderate or severe congenital CP diagnosed in Beijing Boai Hospital from year 2005 to 2009 were recruited. The children underwent dental examination at the hospital dental clinic. Enamel defects (opacity and/or hypoplasia) were found in 44 (32.6%) out of 135 CP children. Enamel hypoplasia was found in 35 (25.9%) of the CP children, opacity alone was found in 5 (3.7%) of the CP children, and mixed defects (opacity and hypoplasia) was found in 4 (3.0%) of the CP children. Most of the enamel defects were located symmetrically in the primary incisors and first molars. 42.4% of children with enamel defects were born prematurely (<37 weeks) where as only 23.2% of them were born at normal gestational age. No statistically significant difference in the prevalence of enamel defects was found in relation to birth weight ( P > 0.05). A high prevalence of developmental enamel defects was found among the children with CP. The prevalence of defects varied with the tooth type and was associated with gestational age of the children. [ABSTRACT FROM AUTHOR]