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Background Studies: Captioning and repetition are widely used multimedia instructional devices for non‐native students. Generally, studies in this area have tended to focus on second language literacy skills rather than on learning new content knowledge. Additionally, posttests were administered immediately after the treatments, while the delayed influences of captioning and repetition have never been investigated. Objectives: This paper addressed these research gaps in two separate studies. More specifically, this study attempted to examine the influences of captioning and repetition on non‐native students' immediate and relayed retention. Methods: In Study One, three captioning conditions; word‐by‐word captions, closed captions, and no‐captions; were compared to examine their efficacies in immediate and delayed content knowledge retention on 82 Chinese university students. To address the limitations in Study One as the multimedia lesson was short and played only once, Study Two incorporated captioning and two repetition types in its design. One hundred and eleven Chinese university students watch a video lesson in one of four captioning and repetition conditions. Results: The statistical analyses of Study One indicated that there were no significant differences in both immediate and delayed retention test scores across the three captioning condition. Similarly, in Study Two, there were no significant differences in retention tests scores across the four captioning and repetition conditions. Findings: Neither the availability of captions nor the repetition types had any impact on the Chinese students' immediate or delayed content knowledge retention, which lent support to existing studies. Based on the research results, the limitations and future study possibilities are discussed. Lay Description: What Is Already Known About This TopicEmpirical studies on captioning have focused on immediate learning right after the treatment, so have studies on repetition.Empirical studies on multimedia lessons for non‐native students have focused on English language learning. What This Paper AddsThree types of captioning were compared to examine their efficacies in both immediate and delayed content retention of Chinese students.Two types of repetition were compared to examine their efficacies in both immediate and delayed content retention of Chinese students. Implications for Practice and/or Policy:Neither the availability of captions nor the repetition types had any impact on the Chinese students' immediate or delayed content knowledge retention.The availability of textual keywords adjacent to their corresponding graphics might have compromised the efficacy of captioning. [ABSTRACT FROM AUTHOR]

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]

Aim: To investigate the relationship among emotional intelligence (EI), resilience and academic procrastination (AP), and provide suggestions for the development of targeted intervention strategies and lowering of AP level of nursing undergraduates. Design: A cross‐sectional study. Methods: Three provincial universities offering nursing courses in China were investigated in this study. A convenience sample of 256 nursing undergraduates from May 2021 to September 2021 were recruited, with a response rate of 91.4%. Data were collected using face‐to‐face interviews. The survey tools included the General Information Questionnaire, Academic Procrastination Scale, Emotional Intelligence Scale and Resilience Scale. IBM SPSS v19.0 and Amos 22.0 were used for data analysis. Results: The AP of sampled nursing undergraduates was at the middle level (54.4 ± 21.5). The AP of nursing undergraduates was negatively correlated with EI and resilience. Moreover, the analysis on the mediating role of resilience via structural equation model showed a good fit, with χ2/df = 2.34, RMSEA = 0.07, CFI = 0.99, GFI = 0.95, TLI = 0.98. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

The topic of green human resource management (HRM) has drawn increasing attention of HRM scholars in the past decade. Recent research has called for more studies to identify the antecedents of green HRM used in organizations and explore the mediating mechanisms through which green HRM is related to performance outcomes. This study represents an effort to address these research needs by examining the joint effects of chief executive officer (CEO) environmental belief and external pollution severity on the use of green HRM and testing the mediating role of employee environmental commitment in the relationship between green HRM and firm performance. Drawing upon data collected from multiple sources (i.e., survey data from chief executive officer (CEOs), chief financial officers (CFOs), HR managers and employees, and archival data from government statistics), we found that CEO's environmental belief is significantly related to the use of green HRM, especially for companies operating in locations with severer pollution. Green HRM in turn has a positive relationship with the firm's environmental and financial performances via employee commitment to the environment. The findings highlight the often‐overlooked role of in the strategic HRM literature pertinent to environmental management and clarify the antecedents and influential mechanisms of green HRM at the firm level of analysis. We also discuss theoretical and practical implications in this study. [ABSTRACT FROM AUTHOR]

Background Late course accelerated hyperfractionation radiotherapy ( LCAHR) is used as a standard treatment option for locally advanced esophageal squamous cell carcinoma ( LAESCC) in China, but concerns remain regarding its efficacy and safety. The purpose of this paper was to evaluate the efficacy and safety of LCAHR. The comparisons examined were as follows: LCAHR versus conventional fractionation radiotherapy ( CFR) and LCAHR plus chemotherapy ( CT) versus LCAHR alone. Methods We searched the Cochrane Library, MEDLINE, EMBASE, CENTRAL, CBMdisc, and CNKI, as well as employing manual searches. The primary end points were survival and local control. The second end point was toxicities. Results Based on search criteria, we found 29 trials involving 3187 patients. Our results showed that LCAHR, compared with CFR, improved the survival and local control, and was, thus, more therapeutically beneficial. Further analysis revealed that LCAHR plus CT proved to be better for patients' survival and local control compared to LCAHR alone. Acute toxicities were increased rather than late toxicities. Conclusions There was a significant survival and local control benefit of LCAHR over CFR, as well as LCAHR plus CT over LCAHR alone. Considering the strength of the evidence, the results of this study indicate that this regimen would be a new promising modality worth further investigation. [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]

Introduction: Immune thrombocytopenia (ITP) is a common acquired hemorrhagic disease without "gold standard" for the diagnosis, long non‐coding RNA (lncRNAs) can participate in regulating gene expression through various mechanisms and may play a role in immune intolerance in ITP. Several previous studies have confirmed that lncRNA lncDC and THRIL are involved in the development of autoimmune diseases. This study investigates the relationship between expression levels of two plasma lncRNAs (lncDC and THRIL) and clinical characteristics of adult primary ITP patients, ascertain their potential applications as diagnostic markers of ITP. Methods: We recruited 102 subjects, including 41 ITP patients, 41 healthy controls (HCs) and 20 patients under myelosuppression phase after chemotherapy (MS). qRT‐PCR was used to detect the expression of two lncRNAs in the peripheral blood plasma of the three groups. Receiver operating characteristic (ROC) curves were used to test the diagnostic efficacy of lncDC and THRIL in ITP. Results: The expression level of lncDC was downregulated in ITP patients compared with HCs (p =. 012) and MS (p =.035), whereas THRIL was significantly upregulated (p =.0005, p <. 0001). We further revealed that lncDC has a high sensitivity (78. 05%), while THRIL has a high specificity (97. 56%). The area under the curve (AUC) (0.869, 95% CI: 0.795–0.943, p <.0001) of the ROC curve for this combination increased significantly. Conclusions: THRIL and lncDC expression levels were changed in adult ITP patients. The lncRNAs lncDC and THRIL can serve as potential diagnostic markers for adult primary ITP. [ABSTRACT FROM AUTHOR]

Background: Meeting 24‐h movement guidelines for children and adolescents has been associated with improved health indicators. However, the literature examining adherence to 24‐h movement guidelines among Chinese children and adolescents with intellectual disability (ID) remains lacking. This study aims to investigate the prevalence of meeting the 24‐h movement guidelines and its socio‐demographic correlates for this population. Methods: The sample includes 319 Chinese students with ID. Accelerometers are used to measure moderate‐to‐vigorous physical activity time and sleep duration. Questionnaires are adopted to measure screen time (ST) and demographic factors. Associations among socio‐demographic factors, body mass index and 24‐h movement are analysed by using multivariable logistic regressions. Results: The proportions of participants who meet none, moderate‐to‐vigorous physical activity, ST, sleep duration and all three recommendations are 8.15%, 33.54%, 54.23%, 75.55% and 17.55%, respectively. In general, multivariable logistic regression analysis indicates that older participants are less likely to meet the ST guidelines [odds ratio (OR): 0.931; 95% confidence interval (CI): 0.869–0.998] and more likely to meet the sleep guidelines (OR: 1.106; 95% CI: 1.016–1.204) than younger individuals. Participants with moderate ID are less likely to meet the sleep guidelines (OR: 0.345; 95% CI: 0.140–0.850) than those with profound ID. Individuals from families with middle‐income (OR: 0.434; 95% CI: 0.226–0.836) and high‐income (OR: 0.219; 95% CI: 0.080–0.605) levels were less likely to meet the physical activity guidelines than those from low‐income families. Furthermore, participants from high‐income families were less likely to meet ST (OR: 0.426; 95% CI: 0.187–0.969) and all three movement guidelines (OR: 0.083; 95% CI: 0.010–0.659) than those in the low household income groups. Conclusions: Interventions that improve the health‐related behaviours of children and adolescents with ID are needed, particularly those that target their increased engagement in physical activity. [ABSTRACT FROM AUTHOR]

Background: The field of early rehabilitation has developed slowly in mainland China and there are limited data on the implementation of early mobilisation (EM) practice in intensive care unit (ICUs) in China. Aims: To investigate the implementation of EM in ICUs in mainland China and to analyse its influencing factors. Study design: A cross‐sectional electronic survey was conducted in 444 ICUs across 11 provinces in China. Head nurses provided data on institutional characteristics and EM practice in ICUs. Logistic regression models were used to identify factors associated with the implementation of EM. Results: In all, 56.98% (253/444) of ICUs implemented EM with comprehensive or complete implementation in 86 ICUs. Of the 191 ICUs that did not use EM, 136 planned to implement EM in the near future. Of the 253 ICUs that used EM, 21.34% of ICUs implemented EM for all eligible patients, while 24.90% would evaluate and carry out EM within 48 h after ICU admission, 39.13% had collaborative EM teams, 34.39% reported the use of EM protocols, 14.63% reported multidisciplinary rounds and 17.39% had medical orders and charging standards for all EM activities. Only 18.18% of ICUs conducted frequent professional training for EM, and abnormal events occurred in 15.41% of ICUs during EM practice. Multivariate logistic regression analysis revealed that an economically strong province, the presence of a dedicated therapist team, more ICU beds and a higher staff‐to‐bed ratio favoured the implementation of EM. Furthermore, multidisciplinary rounds, well‐established medical orders and charging standards, and a high frequency of professional training can lead to the comprehensive promotion and development of EM practice in ICUs. Conclusions: Both the implementation rate and quality of EM practice for critically ill patients require improvement. EM practice in Chinese ICUs is still nascent and requires development in a variety of domains. Relevance to clinical practice: To facilitate the implementation of EM in ICUs, more human resources, especially the involvement of a professional therapist team, should be deployed. In addition, health providers should actively organize multidisciplinary rounds and professional training and formulate appropriate EM medical orders and charging standards. [ABSTRACT FROM AUTHOR]

The status‐legitimacy hypothesis proposes that those who are most disadvantaged by unequal social systems are even more likely than members of more advantaged groups to provide ideological support for the very social system that is responsible for their disadvantages. Li, Yang, Wu, and Kou (2020, Personality and Social Psychology Bulletin) sought to expand the generalizability of this hypothesis by testing it in China, addressing inconsistencies surrounding the empirical support for this hypothesis by postulating that the construct of status should be separated into an objective and subjective status marker. They reported that objective socioeconomic status (SES; income and education) negatively predicted system justification, while subjective SES positively predicted system justification. In the present study we attempt to replicate and extend the work of Li et al. in a cross‐cultural comparison of demographic stratified quota online samples in China and the United States. We test the status‐legitimacy hypothesis using objective and subjective SES to predict system justification using cross‐sectional and cross‐lagged regression analyses. We received partial support for Li et al.'s findings. Specifically, subjective SES positively predicted system justification for both societies during cross‐sectional and cross‐lagged longitudinal analyses. However, we failed to replicate Li et al.'s findings surrounding objective SES in China during cross‐sectional and cross‐lagged analyses. [ABSTRACT FROM AUTHOR]

Objectives: Our research aimed to evaluate the effectiveness of first‐line immune checkpoint inhibitors (ICIs) with etoposide and platinum (EP) for extensive‐stage small cell lung cancer (ES‐SCLC) and identify prognostic factors, as real‐world outcomes and the inconsistency of PD‐1 and PD‐L1 inhibitors are uncertain. Methods: We selected ES‐SCLC patients in three centers and conducted a propensity score‐matched analysis. The Kaplan–Meier method and Cox proportional hazards regression were conducted to compare the survival outcomes. We also performed univariate and multivariate Cox regression analyses to investigate predictors. Results: Among 236 patients included, 83 pairs of cases were matched. The EP plus ICIs cohort had a longer median overall survival (OS) (17.3 months) than the EP cohort (13.4 months) (hazard ratio [HR], 0.61 [0.45, 0.83]; p = 0.001). The median progression‐free survival (PFS) was also longer in the EP plus ICIs cohort (8.3 months) than in the EP cohort (5.9 months) (HR, 0.44 [0.32, 0.60]; p < 0.001). The EP plus ICIs group had a higher objective response rate (ORR) (EP: 62.3%, EP + ICIs: 84.3%, p < 0.001). Multivariate analysis presented that liver metastases (HR, 2.08; p = 0.018) and lymphocyte–monocyte ratio (LMR) (HR, 0.54; p = 0.049) were independent prognostic factors for OS, and performance status (PS) (HR, 2.11; p = 0.015), liver metastases (HR, 2.64; p = 0.002), and neutrophil‐lymphocyte ratio (NLR) (HR, 0.45; p = 0.028) were for PFS in patients with chemo‐immunotherapy. Conclusion: Our real‐world data demonstrated that ICIs with chemotherapy as the first‐line setting for ES‐SCLC are effective and safe. PS, liver metastases, and inflammatory markers could serve as valuable risk factors. [ABSTRACT FROM AUTHOR]

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

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

Background: Conducting routine mild cognitive impairment (MCI) and dementia screening for older adults in the community is important, which not only can improve our understanding of these diseases but also can increase early detection and treatment. Methods: To analyze the reliability and validity of the informant AD8 and explore the cut‐off values for screening MCI and dementia in the community‐dwelling older adults, this study adopted a multi‐stage cluster sampling method to recruit 327 participants aged 60 and over in communities. The informant AD8 and Clinical Dementia Rating (CDR) scales were used to evaluate cognitive function of the subjects, and the receiver operating characteristic curves (ROC) was conducted to test the screening efficacy. Results: Among the 327 participants, 33.0% of them met the criteria of MCI, and 3.4% of them met the criteria of dementia. The area under the receiver operating characteristic curve (AUC) of the informant AD8 for screening dementia was 0.974, with a screening cut‐off of three, sensitivity of 90.9% and specificity of 89.0%. But it has a poor discriminability in MCI screening [AUC = 0.645, 95% confidence interval (CI): 0.578–0.711]. Conclusions: This study suggests that the informant AD8 is an ideal and useful tool for dementia screening in community‐dwelling older adults. However, it is less capable to distinguish older adults with MCI from those with normal cognitive function. [ABSTRACT FROM AUTHOR]

Introduction: Singleton normal fetus with partial hydatidiform mole (PHM) pregnancy is a rare phenomenon. No previous reports have investigated the risk factors of gestational trophoblastic neoplasia (GTN) progression following this condition. Methods: We retrospectively enrolled cases of singleton normal fetuses with PHM pregnancies at West China Second University Hospital, Sichuan University, from 2005 to 2017. Other cases were identified from PubMed databases during 1975 to 2021 for the cohort study. Cox proportional hazards models were applied to evaluate risk factors for GTN progression based on the patient's clinical characteristics. Results: Overall, 36 cases of singleton normal fetuses with PHM pregnancies were enrolled. After a median follow‐up of 4.0 (0.8–12.0) months, nine (25.0%) patients progressed to GTN. Gestational age at pregnancy termination (hazard ratio [HR] 0.88; 95% confidence interval [CI] 0.78–0.99, p = 0.032), hyperthyroidism (HR 5.75; 95% CI, 1.16–28.50, p = 0.032), and reasons for pregnancy termination (medical indications vs. patients' choice; HR 0.25; 95% CI, 0.06–0.99, p = 0.049) were significantly correlated with GTN progression. Area under the receiver operating characteristic curve (AUC) of gestational age at pregnancy termination to predict non‐progression to GTN was 0.784 (95% CI, 0.615–0.903, p < 0.001). A clinically significant cutoff value, that is, gestational age of 24 weeks, was determined by comprehensively considering the cutoff values of AUC and clinical significance of gestational age. Conclusions: Compared to gestational age of pregnancy termination <24 weeks, ≥24 weeks was a protective factor for GTN. Therefore, there is enough evidence to continue pregnancy, except for uncontrolled severe complications, without increasing the risk of GTN progression. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the effect of training on organizational commitment, the mediating effect of employability and the moderating role of person–organization fit. Design: A correctional cross‐sectional research design was adopted for this study. Methods: A questionnaire‐based survey of 859 nurses in a public hospital in Western China was conducted to identify their perceptions of training, employability, organizational commitment and person–organization fit. Hierarchical linear regression and conditional process analysis on moderated mediation were performed. Results: Training had a positive effect on organizational commitment (p <.01). Internal and external employability mediated the relationship between training and organizational commitment (p <.01). Person–organization fit enhanced the indirect effect of training on organizational commitment through external employability (p <.05). [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]

This study advances research on high‐commitment work systems (HCWSs) and organizational innovation by examining how the configuration of middle managers' work–family issues (i.e., work–family conflict and work climate for sharing family concerns) shape the relationship between HCWSs and innovation performance. Using a matched sample of senior management team members, middle managers, and frontline employees from 113 Chinese manufacturing firms and two waves of survey, we found that HCWSs are associated with enhanced levels of middle managers' innovative behavior, an association that improves innovation performance. The results also show that high levels of work–family conflict weaken the relationship between HCWSs and innovative behavior, but can be attenuated when a work climate better facilitates the sharing of family concerns. The study contributes to the knowledge of the role of HCWSs and contextual conditions of their effects in enhancing organizational innovation performance, with specific implications for the Chinese context. [ABSTRACT FROM AUTHOR]

Aims: To explore the risk factors for poor medication adherence in older people with hypertension. Design: A cross‐sectional study. Methods: Participants were administered with a self‐report questionnaire about their demographic characteristics; additionally, their four‐item Morisky Medication Adherence Scale scores were calculated. The STROBE checklist was applied as the reporting guideline for this study (File S1). Results: Univariate analysis indicated that the following five factors were statistically significantly associated with medication adherence: education level (χ2 = 8.073, p =.045), co‐living (χ2 = 11.364, p =.010), hypertension complications (χ2 = 10.968, p =.001), admission blood pressure (χ2 = 8.876, p =.003), and falls (χ2 = 6.703, p =.010). Multivariable binary logistic regression analysis showed that there were four statistically significant predictors, such as people who lived with spouses and offspring (OR = 3.004, p =.017), and those who had high admission blood pressure (OR = 1.910, p =.003) had a greater risk of poor medication adherence, whereas those without hypertension complications (OR = 0.591, p =.026) and those without falls (OR = 0.530, p =.046) had a lower risk. Relevance to clinical practice: We believe that these findings contribute to the identification of high‐risk people with poor adherence, allowing nurses to identify people with poor adherence in a timely manner, and pay attention to the people's medication. [ABSTRACT FROM AUTHOR]

People with diabetes frequently have elevated diabetes distress. Although mindfulness‐based stress reduction (MBSR) therapy has been shown effective in reducing diabetes distress, it has only been delivered by psychologists or a multidisciplinary team with an attrition rate of up to 39%, which limits its dissemination to a broader audience. This study was aimed to pilot evaluate the feasibility of a nurse‐led MBSR therapy and explore its potential efficacy amongst people with type 2 diabetes mellitus. A total of 100 participants were randomly allocated either to the intervention group (nurse‐led MBSR therapy + regular diabetes education) or the control group (regular diabetes education). Data on diabetes distress, diabetes self‐efficacy, and diabetes self‐management were collected at baseline, 8 and 12 weeks. Hemoglobin A1c (HbA1c) was collected at baseline and 12 weeks. A generalized estimating equation analysis for repeated measures was used to determine intervention and time effects. As predicted, the nurse‐led MBSR therapy had a significant time‐by‐group interaction effect on diabetes distress total score (95% confidence interval [CI]: 0.58–0.77, p < 0.001), diabetes self‐efficacy (95% CI: −0.93 to −0.74, p < 0.001), diabetes self‐management (95% CI: −10.80 to −7.83, p < 0.001), and HbA1c levels (95% CI: 0.04–1.14, p = 0.03) in the intervention group compared with the control group over 12 weeks. This is the first nurse‐led MBSR therapy in a hospital setting that is feasible and has the potential to improve health outcomes. This approach may offer an innovative model to deliver MBSR therapy. A randomized controlled trial comparing the nurse‐led MBSR plus usual diabetes education with usual diabetes education along with a mechanism to equalize intervention attention between the groups is indicated. [ABSTRACT FROM AUTHOR]

Background: To date, no national‐scale psychiatric epidemiological survey for children and adolescents has been conducted in China. In order to inform government officials and policymakers and to develop a comprehensive plan for service providers, there was a clear need to conduct an up‐to‐date systematic nationwide psychiatric epidemiological survey. Methods: We conducted a two‐stage large‐scale psychiatric point prevalence survey. Multistage cluster stratified random sampling was used as the sampling strategy. Five provinces were selected by comprehensively considering geographical partition, economic development, and rural/urban factors. In Stage 1, the Child Behavior Checklist was used as the screening tool. In Stage 2, Mini‐International Neuropsychiatric Interview for Children and Adolescents and a diagnostic process based on the Diagnostic and Statistical Manual were used to make the diagnoses. Sampling weights and poststratification weights were employed to match the population distributions. Exploratory analyses were also performed using socio‐demographic factors. Prevalence in socio‐demographic factor subgroups and overall were estimated. Rao‐Scott adjusted chi‐square tests were utilized to determine if between‐group differences were present. Factor interactions were checked by logistic regression analyses. Results: A total of 73,992 participants aged 6–16 years of age were selected in Stage 1. In Stage 2, 17,524 individuals were screened and diagnosed. The weighted prevalence of any disorder was 17.5% (95% CI: 17.2–18.0). Statistically significant differences in prevalence of any psychiatric disorder were observed between sexes [χ2(1, N = 71,929) = 223.0, p <.001], age groups [χ2(1, N = 71,929) = 18.6, p <.001] and developed vs. developing areas [χ2(1, N = 71,929) = 2,129.6, p <.001], while no difference was found between rural and urban areas [χ2(1, N = 71,929) = 1.4, p =.239]. Male, younger individuals, children, and adolescents from developed areas had higher prevalence of any psychiatric disorder. The prevalence of any psychiatric disorder was found to decrease with the age in the male group, while the female group increased with the age. Individuals diagnosed with attention‐deficit hyperactivity disorder, oppositional defiant disorder, a tic disorder, conduct disorder, and major depression disorder had the highest rates of comorbidity. Conclusions: The prevalence of any psychiatric disorder we found is the highest ever reported in China. These results urgently need to be addressed by public mental health service providers and policymakers in order to provide access to the necessary treatments and to reduce the long‐term negative impact of these conditions on families and the society as a whole. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to create a structural equation model to evaluate the associations among demographic factors, health education, breast cancer‐related knowledge, attitudes, and breast self‐examination behavior among Chinese female college students. Methods: A survey was undertaken using a self‐administered questionnaire and targeting 2233 students from Eastern China. Structural equation modeling with the bootstrap approach was utilized to estimate the interrelationships and the strength of the associations among measured variables based on the hypothetical model. Results: Among the total participants, 14.7% of the female college students reported having performed breast self‐examination. The final structural equation model showed highly satisfactory fitness on indices. Breast self‐examination behavior was significantly linked to demographic factors, breast cancer related‐knowledge, attitudes, and health education. Health education had the greatest influence on breast self‐examination behavior. In addition, breast cancer related‐knowledge was significantly associated with demographic factors and health education. Health education and knowledge all significantly affected attitudes towards breast cancer. Conclusion: Breast self‐examination behavior was influenced by demographic factors, breast cancer related‐knowledge, attitudes towards breast cancer, and health education in a sample of female college students in China. Health education was the most important predictor of breast self‐examination behavior. [ABSTRACT FROM AUTHOR]

The present study generalizes previous pay dispersion research to the Chinese context by examining the cross-level relationship between workgroup salary dispersion and employee turnover intention contingent on individual differences. Field survey data including annual objective salary and self-reported attitudes among 370 Chinese employees in 51 organizational workgroups supported our cultural predictions by showing that the relationship between workgroup salary dispersion and turnover intention was positive only among employees with higher rather than lower levels of Chinese traditionality and among those with lower rather than higher salary levels. Furthermore, the results of mediated moderation analyses suggest that a dual-deprivation path model can explain the above relationships. We discuss the theoretical, cultural, and practical implications of these findings for organizations. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

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

Aim: To investigate the epidemiology of chromosomal abnormalities (CA) in fetuses of all pregnancies based on a provincial‐wide birth defects‐monitoring system, which could provide scientific basis for making relatively policy and research. Methods: Chromosomal abnormalities cases were collected from all hospitals in Hunan Province, China, between 2016 and 2019. The prevalence of CAs was calculated to examine associations among infant sex, maternal age and region. The rates of prenatal diagnosis and termination of pregnancy (TOP) involving CA or associated anomalies were calculated as rates or proportions. Results: From 2016 to 2019, a total of 2 883 890 perinatal infants (28 weeks of gestation to postpartum 7 days) underwent prenatal screening and diagnostic tests, and 3181 fetuses were diagnosed as CA, with the prevalence of 11.03/10 000. The average prevalence of CAs was higher for male than female fetuses (11.33/10 000 vs 10.06/10 000) (OR = 1.13, 95% CI: 1.05–1.21), which was higher in urban areas than rural areas (23.03/10 000 vs 7.13/10 000) (OR = 3.23, 95% CI: 3.02–3.47), and the prevalence increased linearly with maternal age (Xtrend2 = 1821.844, P = 0.000). Among the fetuses with CAs, 3097 (97.36%) were diagnosed prenatally, and 3046 (98.35%) underwent TOP. The majority of CA were numerical abnormalities (90.18%). The main types of numerical autosomal abnormalities were trisomy 21 (6.69/10 000, 59.57%), trisomy 18 (1.13/10 000, 10.04%) and trisomy 13 (0.21/10 000, 1.88%). The main types of numerical gonosomal abnormalities were Klinefelter syndrome (0.68/10 000, 6.02%), Turner syndrome (0.49/10 000, 4.39%), Triple X syndrome (0.26/10 000, 2.29%) and 47,XYY syndrome (0.21/10 000, 1.91%). The three associated anomalies with the highest proportions were congenital heart defects (CHD) (41.06%), cleft palate or/and cleft lip (10.89%) and congenital talipes equinovarus (8.94%). Conclusion: The prevalence of CA was lower than that reported. Chromosome detection should be further promoted including test contest and coverage, especially for urban areas, older mothers and fetuses with CHD, cleft palate or/and cleft lip or congenital talipes equinovarus. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (Ptrend =.020) and 1.00, 0.64, 047, and 0.64 for high body fat (Ptrend =.012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries. [ABSTRACT FROM AUTHOR]

Objectives: To explore the factors associated with utilization of oral health services among Chinese adults and older adults according to the Andersen Behavior Model. Methods: Data from the 4th National Oral Health Survey (2015‐2016) in China were used. A total of 7206 people (3669 adults aged 35‐44 years and 3537 older adults aged 65‐74 years) were included in our analysis. Oral health service utilization in the past 12 months was the outcome variable. Explanatory variables were selected according to the Andersen Behavior Model. Descriptive statistics and bivariate associations (chi‐square tests) were analysed, followed by hierarchical Poisson regression models, which were conducted to determine the factors associated with oral health service utilization. Results: In total, 21.4% (95% CI: 19.4%‐23.7%) of adults (35‐44 years old) and 20.7% (95% CI: 18.6%‐22.9%) of older adults (65‐74 years old) utilized oral health services in the past 12 months. Nearly 80% of adults (78.7%, 95% CI: 74.0%‐82.7%) and more than 90% of older adults (93.7%, 95% CI: 91.0%‐95.6%) visited a dentist for treatment. Adults aged 35‐44 years old who were female (IRR: 1.15, 95% CI: 1.00‐1.33, P =.047), had good oral health knowledge and attitudes (IRR: 1.30, 95% CI: 1.06‐1.59, P =.011), perceived their oral health status as fair (IRR:1.51, 95% CI:1.24‐1.85, P <.001) or poor/very poor (IRR:2.52, 95% CI:2.01‐3.18, P <.001) and had a decayed, missing and filled teeth (DMFT) index >0 (IRR: 1.52, 95% CI: 1.11‐2.09, P =.009) were more likely to report dental visits in the past 12 months. Older adults who utilized oral health services tended to be female (IRR: 1.32, 95% CI: 1.09‐1.59, P =.004); to be covered by Urban Resident Basic Medical Insurance (URBMI) (IRR: 1.56, 95% CI: 1.18‐2.05, P =.002), Urban Employee Basic Medical Insurance (UEBMI) (IRR: 1.69, 95% CI: 1.32‐2.16, P <.001) or government medical insurance (GMI) (IRR: 1.03, 95% CI:1.01‐2.16, P =.044); to have a high education level (IRR: 1.37, 95% CI: 1.08‐1.74, P =.010); to have an income level in the 2nd tertile (IRR: 1.44, 95% CI: 1.13‐1.84, P =.003) or 3rd tertile (IRR:1.52, 95% CI:1.18‐1.95, P =.001); and to perceive their oral health status as poor or very poor (IRR: 1.53, 95% CI: 1.21‐1.95, P =.001). Conclusions: Sex and self‐perceived oral health status were associated with oral health utilization among Chinese population. Additionally, for older adults, education level, household income and insurance coverage were determinants of dental service use. These findings can aid in creating more targeted policies to increase the use of dental services by Chinese adults. [ABSTRACT FROM AUTHOR]

Objective: To investigate the urban‐rural disparities in health risk factors, health status and outcomes in Tianjin, China and to make an international comparison with urban‐rural health in Australia. Design: A descriptive analytical cross‐sectional survey. Setting: Mobile research teams conducted door‐to‐door field surveys of each house or department. The teams included local administrative staff and Tianjin Center for Disease Control and Prevention's epidemiologists, clinicians and laboratory technicians. Participants: A total of 25 288 residents were interviewed and clinically observed, including 8583 urban residents and 16 705 rural residents. Main outcome measure: Health risk factors, health status and outcomes. Results: The age structure in urban areas of Tianjin was growing older. Rural residents received less high school education and university education than did urban residents. Urban residents had higher medical insurance coverage and paid more out‐of‐pocket medical expenditures than did rural residents. The prevalence of smoking and the crude alcohol consumption rate were higher in rural areas than in urban areas. Rural residents had feelings of higher self‐satisfaction concerning their health status than did urban residents. The prevalence of hypertensive disease, type 2 diabetes and heart, stroke and vascular diseases were significantly lower in rural areas than in urban areas. The incidence rate of serious injuries resulting from traffic accidents was significantly higher in rural areas than in urban areas. Conclusion: Contrary to Australian urban‐rural survey outcomes, the health status and outcomes of residents in rural areas of Tianjin seemed to be better than those of their counterparts in urban areas. The underlying determinants of these outcomes need to be explored with further study. [ABSTRACT FROM AUTHOR]

In this systematic review and meta-analysis, we evaluated the effectiveness, safety and comfort of StatLock for the securement of peripherally-inserted central catheters. PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, WanFang Database, and China Science and Technology Journal Database were searched. Randomized, controlled trials comparing StatLock with tape or suture on the performance of securing peripherally-inserted central catheters were selected. Meta-analysis was performed using Review Manager 5.3 software. Thirteen randomized, controlled trials involving 1970 patients were included. Our results showed that StatLock reduced the incidence of catheter dislodgement and unplanned removal. Moreover, patients in the StatLock group had lower incidence of skin ulceration, phlebitis, catheter-related bloodstream infection, and cellulitis, and felt more comfortable compared with those in the control group. Current evidence suggests that the StatLock securement device offer advantages over tape and suture in preventing catheter-related complications and improving patient comfort. However, as considerable heterogeneity was found among the included studies, and the quality of evidence for main outcomes was relatively low, the results should be viewed with caution. [ABSTRACT FROM AUTHOR]

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

The objectives of this study were to investigate usage patterns and factors associated with maternal dietary supplementation by Chinese women. A prospective cohort study of 695 mothers, who gave birth to a singleton baby, was conducted in Jiangyou, Sichuan Province of China. Information on dietary supplement use was collected from participants by personal interview at hospital discharge and followed up by telephone at 1, 3, and 6 months postpartum. Logistic regression analysis and generalised linear-mixed modelling were performed to determine factors affecting dietary supplementation during pregnancy and the first 6 months postpartum, respectively. A total of 81.8 and 32.1% of women consumed dietary supplements during pregnancy and postpartum, respectively. Calcium was the most popular supplement (pregnancy 63.9%; postpartum 28.1%), whereas folic acid was only taken during pregnancy (62.3%) with an average usage duration of 2.5 (standard deviation 1.3) months among users. High school and above education, adjusted odds ratio (OR) = 2.67, 95% confidence interval (CI) [1.63, 4.38], and attendance at prenatal classes (adjusted OR = 1.99, 95% CI [1.05, 3.76]) were associated with dietary supplementation during pregnancy. Mothers with a higher level of education (adjusted OR = 3.10, 95% CI [1.81, 5.30]) were also more likely to use dietary supplements in the postpartum period. Although dietary supplementation appeared to be common among Chinese mothers, maternal intake of folic acid was well below the guidelines. There is a need for further nutrition education on maternal use of micronutrient supplements, especially targeting mothers who are less educated. [ABSTRACT FROM AUTHOR]

Background After China's One-child Policy was replaced with the Two-child Policy in 2013, the rate of second pregnancies with a longer inter-pregnancy interval ( IPI) has suddenly increased in that country; however, the effect of long IPIs (≥49 months) on perinatal outcomes remains unreported. Methods This was a retrospective cohort study in China from July 2015 through June 2016. We used univariate and multivariate logistic regression models to test the associations among IPI, maternal age, and perinatal outcome (preterm delivery, term low birthweight, and small-for-gestational age). We included baseline factors and variables with biological plausibility as confounders. Results Our analytic sample included 3309 second pregnancies. The mean IPI was 75.36 months. Compared with second pregnancies with a short IPI of 7-24 months, those with long IPIs had higher adjusted odds ratios (ORs) of preterm delivery (1.70-2.00 [95% CI 1.20-3.33]) and term low birthweight (2.16-2.68 [1.10-6.17]), but not small-for-gestational age. The mean maternal age at current delivery was 32.0 years. Compared with the reference group (25-29 years), second pregnancies for the oldest maternal age group (≥35 years) showed no statistically significant increased ORs for adverse perinatal outcomes. Conclusion Long IPI is a significant contributor to preterm delivery and term low birthweight. Health care providers need to pay close attention to preterm delivery prevention and fetal growth during prenatal care for second pregnancies where the mothers have long IPIs. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to investigate the post-partum recovery of blood pressure (BP) in women with hypertensive disorders of pregnancy (HDP) and to evaluate HDP risk factors. Methods A total of 124 patients with gestational hypertension ( n = 63) or pre-eclampsia ( n = 61) who gave birth at Peking University People's Hospital between January and December 2013 were included in this study. The recorded clinical and laboratory parameters included the patients' general information, maternal pre-pregnancy body mass index, gestational weight gain, gestational age at onset and delivery, delivery mode and time taken for BP to return to normal level. Logistic regression analysis was performed to evaluate the influence of various risk factors on post-partum BP recovery. Results The mean interval for BP normalization was 24.1 ± 22.8 days (median, 7 days). Forty-six percent of the patients recovered from hypertension within three days, and 75% recovered within six weeks of delivery. About 90% of the patients required 60 days for BP to normalize after delivery. After adjusting for confounding factors, post-partum recovery from hypertension was found to be influenced by hypertension severity, maternal serum albumin level, a family history of hypertension and gestational week at delivery. Conclusions The BP of the majority of the patients with gestational hypertension or pre-eclampsia returned to normal within 60 days of delivery. Hypertension severity, maternal serum albumin level, a family history of family hypertension and gestational week at delivery influenced the time required for BP normalization. [ABSTRACT FROM AUTHOR]

Objective Familial hypercholesterolemia ( FH) is the most common and serious monogenic disorder of lipid metabolism, causing premature coronary heart disease ( CHD) due to accelerated atherosclerosis from birth, and the study of left ventricular ( LV) function of this disease is seldom. The purpose of this study was to explore the value of layer-specific strain on assessing the early damage of LV function in asymptomatic and left ventricular ejection fraction ( LVEF) well-preserved patients with heterozygous FH (He FH). Methods A total of 49 patients aged 38.7±8.7 diagnosed with heterozygous familial hypercholesterolemia and who had undergone transthoracic echocardiography from 2010 to 2016 were included in this study. A total 32 healthy volunteers aged 35.6±10.3 were included as control group. Longitudinal and circumferential strains of the endocardium, myocardium, and epicardium ( LSendo, LSmyo, and LSepi and CSendo, CSmyo, and CSepi) were obtained by a software enabling the analysis of strains in three myocardial layers. Results In longitudinal strain ( LS), the LS of endocardium ( LSendo) and the LS of myocardium ( LSmyo) are significantly reduced in patients with He FH ( P<.001 in both). In circumferential strain ( CS), only the CS of endocardium ( CSendo) is significantly reduced ( P<.001). The degree of reduction in strain is positively correlated with the TC and LDLC. Conclusions Layer-specific evaluation of the left ventricle has great value in evaluating early impairment of LV in patients with FH. And this relatively novel technique may made it possible to help us understand the process of LV impairment in patients with FH better, thus preventing further damage. [ABSTRACT FROM AUTHOR]

HIV prevalence among Chinese men who have sex with men has rapidly increased in recent years. In this randomized, controlled study, we tested the feasibility and efficacy of motivational interviewing to reduce high-risk sexual behaviors among this population in Changsha, China. Eighty men who have sex with men were randomly assigned to either the intervention group, in which participants received a three-session motivational interviewing intervention over 4 weeks, or the control group, in which participants received usual counseling from peer educators. High-risk behavior indicators and HIV knowledge level were evaluated at baseline and 3 months after the intervention. Motivational interviewing significantly improved consistent anal condom use. However, there was no significant change in consistent condom use for oral sex or in the number of sexual partners over time. HIV knowledge scores improved equally in both groups. This study demonstrated that an intervention using motivational interviewing is feasible and results in increased condom use during anal sex for Chinese men who have sex with men. However, further work must be done to increase the use of condoms during oral sexual encounters. [ABSTRACT FROM AUTHOR]

Background There is limited information involving population data about the role of maternal health, fetal growth and neonatal health on children's developmental status at ages 4-7 years. Our aim was to determine the contribution of maternal, fetal and neonatal health to developmental status at ages 4-7 years. Methods In this 7-year follow-up prospective cohort study, a sample of 26 803 mothers participated in the beginning. Among their children, 19 187 voluntarily completed the development screening test or the social life ability survey, which were designed for two different age groups (<6 or ≥6 years old, respectively). Logistic regression analysis was used to link the data with the prenatal outcome card and interview questionnaire applied to pregnant women in previous study, to the analysis of various related factors such as demographic, socio-economic, disease and menstrual history, marriage and pregnancy care. Result Univariate and multivariate logistic regression analysis were used separately in two age groups [4-6 ( n = 8439) and 6-7 ( n = 10 748) years old] to analyse relative factors. Maternal age of 25-30 years, maternal education of high school and greater, family income and not drinking during pregnancy were associated with higher scores in development. Conclusion Both preconception and pregnancy health education and health care are the important maternal factors closely associated with children's cognitive and social competence. Public health policies for preconception care and public welfare for high-quality childcare are essential for improving children's life. [ABSTRACT FROM AUTHOR]

Background Child and adolescent anxiety has become a major public health concern in China, but little was known about the etiology of anxiety in Chinese children and adolescents. The present study aimed to investigate genetic and environmental influences on trait anxiety among Chinese children and adolescents. Rater, sex, and age differences on these estimates were also examined. Methods Self-reported and parent-reported child's trait anxiety was collected from 1,104 pairs of same-sex twins aged 9-18 years. Genetic models were fitted to data from each informant to determine the genetic (A), shared (C), and non-shared environmental (E) influences on trait anxiety. Results The parameter estimates and 95% confidence intervals ( CI) of A, C, E on self-reported trait anxiety were 50% [30%, 60%], 5% [0%, 24%], 45% [40%, 49%]. For parent-reported data, the corresponding parameter estimates were 63% [47%, 78%], 13% [1%, 28%], and 24% [22%, 27%], respectively. The heritability of anxiety was higher in girls for self-reported data, but higher in boys for parent-reported data. There was no significant age difference in genetic and environmental contributions for self-reported data, but a significant increase of heritability with age for parent-reported data. Conclusions The trait anxiety in Chinese children and adolescents was highly heritable. Non-shared environmental factors also played an important role. The estimates of genetic and environmental effects differed by rater, sex and age. Our findings largely suggest the cross-cultural generalizability of the etiological model of child and adolescent anxiety. [ABSTRACT FROM AUTHOR]

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

Aim This study aims to assess the prevalence of and factors associated with induced abortion among married women in rural areas of Anhui Province, China. Material and Methods A multistage probability sampling method was used to identify a representative sample of 53 652 married women aged 18-49 years in rural areas of Anhui Province, China. All women were interviewed in the form of a standardized questionnaire. Results We found that 32.0% (16 800) of these women had had at least one induced abortion: 21.1% (11 090) of women had had one; 7.6% (3976) of women had had two; and 4.1% (1734) of women had had at least three. The number of induced abortions per 100 pregnancies was found to be 22.0. Multivariate analysis showed that education, the age of a woman at her first marriage, number of total births, number of total pregnancies, and contraceptive methods were significant predictors for induced abortion after controlling for women's current age, employment and family yearly income. Conclusion The study shows that the prevalence of induced abortion is still very high among married women in rural China, and highly effective methods of contraception (sterilization, intrauterine device) decrease women's recourse to induced abortion. [ABSTRACT FROM AUTHOR]

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

Background and Aims Large cohort studies on smoking and mortality in elderly people are scarce, and few studies examined smokers aged 85+ years separately. We estimated the risks of all-cause and cause-specific mortality due to smoking in an elderly Chinese cohort in Hong Kong. Design A population-based prospective cohort of 65 510 Chinese enrolled from 1998 to 2001 and followed until May 2012. Setting All 18 Elderly Health Service centres in Hong Kong, China. Participants Elderly people aged 65+ years. Measurements Self-reported smoking status was assessed at baseline interview and categorized as never, former and current smokers. Findings Compared with never smokers, after adjustment for sex, age, education, social security assistance, housing type, monthly expenditure, alcohol use, depressive symptoms and health status, the hazard ratio ( HR) for current smokers was 1.89 [95% confidence interval ( CI) = 1.81-1.98] for all participants aged 65+ years at baseline, corresponding to an attributable fraction ( AF) of about 50%, which is based on AF = ( HR-1)/ HR. As the effect of smoking varied with age ( P for age interaction <0.001), subgroup analysis by age group showed that the adjusted HR for current smokers aged 65-84 years was 1.93 (95% CI = 1.84-2.03), and for 85+ years was 1.29 (95% CI = 1.05-1.58). All the risk estimates did not vary by sex ( P for sex interaction ranged 0.74-0.89). Conclusions In Hong Kong, the risk of death from smoking appears to be the same for Chinese women as it is for men. Half of all deaths in Chinese smokers aged 65 years and older and a quarter of all deaths in Chinese smokers aged 85 years and older are caused by smoking-attributable diseases. [ABSTRACT FROM AUTHOR]

Aim To characterize trends in drug abuse in China before and after the 2005 initiation of the ' People's War on Drugs'. Design Retrospective self-controlled study. Setting Annual, nation-wide surveillance from 2003 to 2010 of all registered drug users in China's National Surveillance System on Drug Abuse ( NSSDA). Participants A total of 1 184 124 drug users registered in NSSDA were involved in this study and were classified into three groups based on registered dates-pre-war group ( n = 230 278) registered 2003-04, phase I group ( n = 518 651) registered 2005-07 and phase II group ( n = 435 195) registered 2008-10. Measurements Indicators included proportions of:(i) new and relapsed drug users, (ii) heroin and synthetic drug users among new users, (iii) people aged 35 years or younger and (iv) women. Comparisons were made across groups using annual data to describe temporal trends. Findings Between 2003 and 2010 the proportion of heroin users decreased by 52.3% and synthetic drugs use increased 860.7% among new users, while a 12.8% decrease in the proportion of heroin users and a 918.8% increase in synthetic drug use in all users was detected. Compared with the pre-war group, the proportion of relapsed users decreased 2.6% and 29.1% in the phase I and phase II groups, respectively, but a significant increase in the proportion of new users was found in phase I ( OR = 1.24, CI = 1.15-1.35, p < 0.0001), followed by an apparent decrease in phase II compared with phase I ( OR = 0.75, CI = 0.70-0.80, p < 0.0001). Similarly, the proportion of heroin users decreased 15.1 and 24.2% among new drug users in phase I and phase II in comparison with the pre-war group. Conclusion The decrease in proportions of drug users in China between 2003/4 and 2008/10 may suggest some positive influence of the ' People's War on Drugs', especially in the decreased proportion of relapsed users. In contrast, there was a rapid increase in new synthetic drug use over the same period. [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]

Aim To evaluate the direct effects of periodontal therapy in Chronic Obstructive Pulmonary Disease ( COPD) patients with chronic periodontitis ( CP). Materials and Methods In a pilot randomized controlled trial, 60 COPD patients with CP were randomly assigned to receive scaling and root planing ( SRP) treatment, supragingival scaling treatment, or oral hygiene instructions only with no periodontal treatment. We evaluated their periodontal indexes, respiratory function, and COPD exacerbations at baseline, 6 months, 1, and 2 years. Results Compared with the control group, measurements of periodontal indexes were significantly improved in patients in two treatment groups at 6-month, 1-year, and 2-year follow-up (all p < 0.05). Overall, the means of forced expiratory volume in the first second/forced vital capacity ( FEV1/ FVC) and FEV1 were significantly higher in the two therapy groups compared with the control group during the follow-up ( p < 0.05). In addition, the frequencies of COPD exacerbation were significantly lower in the two therapy groups than in the control group at 2-year follow-up ( p < 0.05). Conclusions Our preliminary results from this pilot trial suggest that periodontal therapy in COPD patients with CP may improve lung function and decrease the frequency of COPD exacerbation. [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]