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Aims and Objectives: This study aimed to investigate the current status of the core competencies and self‐directed learning ability of diabetes specialist nurses and to explore the relationship between these core competencies and their self‐directed learning ability. Design: A cross‐sectional survey design was used. Methods: This cross‐sectional study was conducted via a web‐based questionnaire platform in China from January 14 to April 24, 2023. The survey included a general information questionnaire, a diabetes specialist nurses' core competencies self‐assessment scale, and a nursing staff's self‐directed learning ability evaluation scale. The data was collected online. Descriptive, correlation and multiple linear regression analyses were conducted using SPSS 26.0 software. Results: 118 diabetes specialist nurses from 11 cities participated in this study. A positive correlation was observed between the core competencies of diabetes specialist nurses and their self‐directed learning ability. The characteristics affecting the core competencies of diabetes specialist nurses included age, participation in external learning and communication and self‐directed learning. Conclusions: The training of diabetes specialist nurses can focus on core competencies, and the ability to self‐direct learning can be used as an entry point to customize feasible theoretical and practical courses. The training system can further improve diabetes specialist nurses' core competencies and self‐directed learning abilities. Relevance to Clinical Practice: A reference can be established that nursing managers and nursing educators can use to develop training programs for specialist nurses by validating the link between their core competencies and self‐directed learning skills. Patient or Public Contribution: Participants were involved solely in the data collection process. No participant contributions were required for the study's design, outcome measurement or implementation. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the psychometric properties of the Advance Care Planning Readiness Scale (ACPRS‐C) within the context of community‐dwelling older adults with chronic diseases residing in suburban counties in China. Design: Descriptive, cross‐sectional survey. Method s : The research method employed in this study is characterized as a methodological study. Self‐reported survey data were collected among community‐dwelling older adults with chronic diseases residing in suburban counties in China. Including the following psychometric characteristics, item analysis was performed using the decision value method and Pearson's correlation analysis. Content validity was assessed through expert panel evaluation. The internal consistency of the questionnaire was determined by calculating Cronbach's alpha coefficient and corrected item‐total correlation. Additionally, confirmatory factor analysis (CFA) was utilized to assess the construct validity of the ACPRS‐C. Results: A total of 228 older adults participated in this psychometric study from August to October 2023. The item content validity index ranged from 0.80 to 1.00, while the scale content validity index was 0.945. The scale demonstrated excellent internal consistency (Cronbach's alpha = 0.931), and the correlation between items and total score was satisfactory. The structural validity was deemed robust (CFA model fit: chi‐square/df = 1.121, comparative fit index = 0.992). Conclusion: The ACPRS‐C is a scale with strong psychometric properties to assess the ACP readiness within the context of community‐dwelling older adults with chronic diseases residing in suburban counties in China. Its reliability and validity hold considerable significance for both research and clinical practice. [ABSTRACT FROM AUTHOR]

Aim: Moral courage among healthcare workers has been extensively studied. However, few studies have been conducted on oncology specialist nurses, who frequently encounter complex moral situations. This study aimed to describe the current situation regarding moral courage and explored its influence on oncology specialist nurses in China. Design: This was an exploratory, descriptive study. Methods: A convenience sample of 390 nurses was conducted from 15 hospitals in Sichuan Province, China, between March and May 2023. Participants were assessed using the Moral Distress Scale‐Revised, Nurses' Moral Courage Scale and the Moral Sensitivity Questionnaire. Results: The results demonstrated that moral courage was negatively associated with moral distress, and positively associated with moral sensitivity. Having a master's degree or above, an intermediate title or senior title, medical ethics training, moral distress or moral sensitivity contributed to explaining 54.1% of the variance in moral courage. Conclusions: Moral courage was associated with several factors. Developing clinical intervention strategies and effective teaching methods will be critical for improving moral courage. No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to refine the Falling Risk Assessment Tool in Ophthalmology Inpatients (FRAT) and assess its psychometric properties. Design: A cross‐sectional design was used. Methods: A convenience sample of 730 patients in the ophthalmology department was recruited in a level A tertiary hospital in Guangdong Province from July 2021 to January 2022. Data were analysed using item analysis, interrater reliability, content validation, internal consistency reliability and exploratory factor analysis. Results: Five factors were extracted, accounting for 63.039% of the variance. The interrater reliability of the tool was 0.97. Cronbach's α was 0.658. The I‐CVI was 0.75–1.00, the S‐CVI/UA was 0.95 and the adjusted mean values of Kappa for indicators ranged from 0.72 to 1.00, as evaluated by the expert group. The FRAT showed satisfactory reliability and validity, and can be used to measure the fall risk assessment in ophthalmology inpatients. Patient or Public Contribution: After explaining the purpose, the patients received our fall risk assessment and answered the corresponding questionnaire questions. [ABSTRACT FROM AUTHOR]

Aims: To investigate the beliefs and attitudes of intensive care unit (ICU) nurses and patients' family members towards an open visitation policy in the ICU in China and to explore the reasons that promote or hinder open visitation to improve visitation policy. Background: Open visitation policies are widely recommended in many countries. However, there are gaps between evidence and practice. Most ICUs in China still use a restrictive policy for family visits, which raises controversy. There are limited visiting times, and family visitors are not allowed to enter the ICU. Study Design: A multicentre survey was conducted in seven hospitals in China. The Beliefs and Attitudes towards Visitation in the Intensive Care Unit Questionnaire (BAVIQ) was administered to ICU nurses and patient families from 11 the ICUs of seven hospitals. A total of 275 questionnaires were completed and returned by ICU nurses and 139 by patients' family members. Results: Among nurses, the belief scale score was 2.87 ± 0.33 (range 2–4), and the attitude scale score was 5.53 ± 1.12 (range 2.33–7). The belief scale was divided into three subscales: nurses, patients, and patients' families. The subscale score for patients' families was the highest, and the nurses' subscale score was the lowest. Most (84.0%) of the nurses were satisfied with the current ICU visitation policy. The belief and attitude scores were 3.13 ± 0.39 (range 1.96–4) and 6.18 ± 1.20 (range 1.67–7), respectively, for family members. The scores of the three subscales, that is, patients, patients' families and nurses, were 3.13 ± 0.40, 3.26 ± 0.43, and 3.04 ± 0.49, respectively. Conclusion: Nurses' beliefs and attitudes towards implementing an open visitation policy in China are at a less positive level than those of patient family members. Relevance to Clinical Practice: The beliefs and attitudes of nurses towards open visitation policy in China need to be improved. The question of how to mobilize nurses' enthusiasm for an open visitation policy poses a challenge for ICU management. [ABSTRACT FROM AUTHOR]

Aim: To examine the status quo and influencing factors of sleep quality and work engagement of nurses participating in COVID‐19 during the post‐epidemic era and to study the relationship between them. Design: We conducted a cross‐sectional survey and correlational and predictive logic to determine the association between sleep quality and work engagement among nurses in Shanghai during the post‐epidemic era. Methods: This design involved 1060 frontline nurses in Shanghai. The Pittsburgh Sleep Quality Index questionnaire and the Utrecht Work Engagement Scale‐9 scales were used for data collection. Results: This study found that the sleep quality of frontline nurses was impaired and the nurses with poor sleep accounted for 48.20% during the post‐epidemic era. The work engagement of frontline nurses was at the medium level. Factors affecting nurses' sleep quality were the number of nurse night shifts, family support and nurse health. The factors affecting the nurse work engagement were monthly income, profession title, family support and self‐health status. There was a positive correlation between nurses' sleep quality and work engagement. [ABSTRACT FROM AUTHOR]

Aim: To investigate undergraduate nursing students' general study engagement using intra‐individual assessment and to evaluate the impact of core self‐evaluation and career calling on study engagement. Design: A descriptive and cross‐sectional design. Methods: Data were collected using a self‐administered questionnaire survey. Four hundred and twenty nursing students from first‐ to fourth (final)‐academic year in Guangzhou Medical University were invited to participate in the spring of 2021. The Cronbach's alpha, one‐way analysis of variance, Bonferroni post hoc analysis, Pearson correlation analysis and multiple stepwise regression analysis were used to analyse the data. Results: The first‐ and fourth‐year undergraduates showed significantly higher levels of study engagement (first‐year undergraduates, 3.52 ± 0.59; fourth‐year undergraduates, 3.54 ± 0.64), core self‐evaluation (first‐year undergraduates, 3.04 ± 0.48; fourth‐year undergraduates, 3.11 ± 0.45) and career calling (first‐year undergraduates, 3.65 ± 0.47; fourth‐year undergraduates, 3.69 ± 0.50) than those of second‐year undergraduates (study engagement, 3.32 ± 0.61; core self‐evaluation, 2.93 ± 0.52; career calling, 3.41 ± 0.50) and third‐year undergraduates (study engagement, 3.16 ± 0.61; core self‐evaluation, 2.88 ± 0.50; career calling, 3.34 ± 0.38). The Pearson correlation analysis among nursing students revealed a significant positive correlation between core self‐evaluation, career calling and study engagement (p < 0.01). A partial mediation effect of career calling was present in the relationship between core self‐evaluation and study engagement. [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]

Aim: To investigate the association of the number of natural teeth with overall dietary diversity and nutritional status in a nationally representative study among older adults in China. Materials and Methods: A cross‐sectional analysis was conducted among community‐dwelling adults aged 65 years or older from the Chinese Longitudinal Healthy Longevity Study. According to the self‐reported number of natural teeth, participants were categorized into ≥20, 10–19, 1–9 natural teeth, and edentulous. Dietary diversity score (DDS) was constructed based on intake frequencies of 10 food groups assessed by a simplified food frequency questionnaire. The geriatric nutritional risk index was used to measure the malnutrition status (i.e., normal, mild malnutrition, and moderate‐to‐severe malnutrition) among a subgroup of participants. Linear and multinomial logistic regression models were used to examine the corresponding associations. Results: Among 54,796 study participants, the mean (SD) age was 87.86 (11.45) years, 82.7% had poor dentition (<20 natural teeth), and 27.3% wore dentures. After multivariable adjustment, participants with poor dentition had lower DDSs (βedentulous = −0.39, 95% confidence interval [CI], −0.48, −0.30; β1‐9 teeth = −0.46, 95% CI, −0.55, −0.37; β10‐19 teeth = −0.36, 95% CI, −0.46, −0.26) than those with 20 natural teeth or more. For individual food items, edentulous, 1–9 and 10–19 natural teeth were associated with lower odds of regular intake of fresh fruits, fresh vegetables, meat, fish and aquatic products, eggs, legumes, preserved vegetables, tea, and garlic, but higher odds of regular intake of sugar and sweets. Among participants with poor dentition, individuals without dentures had lower intake frequencies of most food groups than those wearing dentures. In addition, poor dentition was related to lower odds of normal nutritional status (odds ratio = 0.49, 95% CI, 0.27, 0.89). Conclusions: Older adults with poor dentition had significantly lower dietary diversity and worse nutritional status. Future studies are warranted to identify effective interventions to improve the dietary quality and nutrition status among partially and fully edentulous individuals, including those with Stage IV periodontitis. [ABSTRACT FROM AUTHOR]

Pressure injury is a serious and preventable problem in intensive care units. Translating guidelines into clinical practice can reduce the incidence of pressure injury. Identifying clinical status, barriers and facilitators contribute to guideline implementation. To identify the knowledge, attitudes, and practices of pressure injury prevention in Chinese critical care nurses. Secondary data were extracted from a multicentric clinical trial. Knowledge and attitudes toward pressure injury prevention were assessed by a fourteen‐item questionnaire. The observed practices were recorded using a case report form. The report complies with the STROBE statement. A total of 950 critical care nurses in 15 hospitals from six provinces of China were investigated. A total of 53.1% of nurses received a median score of 6 points or less. Knowledge regarding the repositioning procedure, risk assessment, and heel pressure injury prevention was insufficient. Over 99% of nurses strongly or somewhat agreed that pressure injury prevention was very important and that they were willing to take measures to prevent pressure injury. A total of 27 781 patient days of pressure injury prevention practice were recorded. Repositioning was the most commonly used prevention measure, followed by support surfaces and prophylactic dressings. A combination of repositioning, support surface, and prophylactic dressing was lacking. Chinese critical nurses showed a low level of knowledge and a positive attitude toward pressure injury prevention. Practices of pressure injury prevention were unsatisfactory. There is a clear gap between the guidelines and clinical practices. The barrier (low‐level knowledge) and facilitator (positive attitude) were identified in this study. According to these findings, strategies need to be developed to promote guideline implementation. [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: To investigate the influencing factors in professional identity of undergraduate nursing students after the outbreak of COVID‐19. Design: Cross‐sectional study. Methods: The study covered 2,999 nursing students in six undergraduate nursing schools. Several self‐report questionnaires were used to collect the general information, psychological stress, coping styles and professional identity of the undergraduate nursing students. Results: The overall average score of the professional identity of nursing students (3.67 ± 0.51) has increased significantly after the outbreak of COVID‐19. The professional identity of the undergraduate nursing students was negatively correlated with psychological stress (r = −0.23, p <.001), expectation (r = −0.12, p <.001) and avoidance (r = −0.16, p <.001), but was positively correlated with solving problems (r = 0.18, p <.001) and seeking support (r = 0.12, p <.001). Academic performance, positions, grades, reasons for choosing a nursing profession, parents or relatives engaged in nursing work and the risk degree of residence were the factors influencing the professional identity score of undergraduate nursing students' (p <.001). [ABSTRACT FROM AUTHOR]

Background: In China, there is no unified standard for the responsibilities and authority of nurse anesthetists, resulting in different professional expectations from anesthesiologists and nursing managers, which may result in high levels of role stress and burnout in nurse anesthetists. Additional factors such as high occupational risk and heavy work may also contribute to role stress and burnout. Methods: In this multicenter cross-sectional study, an online questionnaire survey was conducted among 198 nurses from six tertiary hospitals in Shandong Province. The t test, analysis of variance, linear regression, and logistic regression were used to analyze the risk factors for role stress and professional burnout. Results: The scores of role conflict and role ambiguity in role stress were 30.61 ± 9.53 and 31.89 ± 9.56, respectively; satisfaction with income and the working environment, the hospital's attention, years of experience as a nurse, clarity concerning the nurse anesthetist's occupational scope, and attitude to career prospects were independent risk factors for role stress. The burnout data were non-normally distributed and were expressed as medians and quartiles. The scores of emotional exhaustion, depersonalization, and personal achievement in professional burnout were 30 (26-34), 11 (8-14), and 23 (20-26) respectively. The number of working hours per week, attitude to career prospects, satisfaction with the working environment and income, physical health, gender, and education were independent risk factors for burnout. Conclusions: Chinese nurse anesthetists were found to be in danger of high role stress and professional burnout, a situation requiring the attention of managers. [ABSTRACT FROM AUTHOR]

Objectives: To explore the correlations among social isolation and symptoms of anxiety and depression among patients with breast cancer in China and to further verify the mediating role of social support in social isolation and symptoms of depression or anxiety. Design: A cross‐sectional survey. Settings: The cluster sampling method was conducted for 456 female inpatients diagnosed with breast cancer at the Tumor Hospital Affiliated of Harbin Medical University from April 2019–September 2019. Methods: Pearson correlation analysis was used for identifying correlations among all the variables. Mediation effect analysis was used to examine the role of social support in social isolation and symptoms of depression or anxiety. Results: The results showed a prevalence of 73.26% and 70.44% for anxiety and depression symptoms in patients with breast cancer, respectively. Anxiety was significantly negatively correlated with social support (r = −.334, p <.01) and significantly positively correlated with social isolation (r =.369, p <.01). Similarly, depression was significantly negatively correlated with social support (r = −.289, p <.01) and significantly positively correlated with social isolation (r =.466, p <.01). Social support played a mediating role in social isolation and f symptoms of anxiety or depression among these patients. Conclusions: Social isolation was positively correlated with symptoms of anxiety and depression in patients with breast cancer, respectively. Social support for patients with breast cancer has a mediating effect on the patients' social isolation and symptoms of anxiety and depression. Therefore, the support of family, friends, hospitals, and organizations plays a positive role in reducing social isolation as well as symptoms of depression and anxiety in these patients. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effect of social support on psychological distress among Chinese lung cancer patients and clarify the mediating role of self‐esteem. Design: A cross‐sectional descriptive correlational survey of 441 Chinese lung cancer patients was designed. Methods: Self‐esteem was supposed to play a mediating role in the association between social support and psychological distress. We collected demographic information, the Distress Thermometer, Multidimensional Scale of Perceived Social Support and Rosenberg Self‐Esteem Scale. Results: Our revised model demonstrated an acceptable fit to the data (χ2 = 37.489, comparative fit index (CFI) = 0.965, Tucker‐Lewis index (TLI) = 0.926, root mean square error of approximation [RMSEA] = 0.099). Social support had a direct effect on self‐esteem and psychological distress, and self‐esteem had also a direct effect on psychological distress. Meanwhile, self‐esteem also partially mediated the relationship between social support and psychological distress among Chinese lung cancer patients. [ABSTRACT FROM AUTHOR]

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

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

Strengthening the nursing workforce is core to health system reform in China. Patient experiences of hospital care have been recognized as important in this endeavor. Studies exploring the relationships between nursing workforce and patient experiences of hospital care, however, are scarce. The aim of this cross‐sectional study was to examine the associations between nurse education level, nurse staffing, and hospitalized patients' experiences of hospital care. Participants were 1,582 nurses responsible for direct care and 1,305 hospitalized patients from 23 hospitals in Guangdong province, China in 2014. Education level of nurses was measured by the proportion of nurses holding a baccalaureate or higher degree. Nurse staffing was measured by the unit nurse‐patient ratio. The Hospital Consumer Assessment of Health care Providers and Systems Scale was used to measure patient experiences of hospital care. Structural equation modeling demonstrated that a higher proportion of nurses holding a baccalaureate or higher degree was related directly to better patient perceptions of communication with nurses, responsiveness of nurses, pain management, and physical environment, and related indirectly to overall hospital ratings and recommendation of the hospital. A higher nurse‐patient staffing ratio was associated directly with better patient perceptions of communication with nurses, education about new medications given in hospital, and physical environment, and indirectly with overall ratings and recommendation of the hospital. Our findings add new evidence in the Chinese societal context about the relationship between the nursing workforce and patient experiences of hospital care. Upgrading nurse education level and increasing nurse staffing could potentially improve patient experiences of hospital care. [ABSTRACT FROM AUTHOR]

Nursing students' beliefs about etiology and manifestation of mental illness will impact on their professional attitudes in future clinical practice. The aims of the present study were to examine and compare US and Chinese undergraduate nursing students' recognition of, and beliefs about, causes of depression and schizophrenia. A total of 310 US (n = 152) and Chinese (n = 158) nursing students completed the Australian National Mental Health Literacy Survey questionnaire between April 2016 and April 2017. Although nursing students in the USA and China were highly accurate in recognizing depression and schizophrenia, the US students were more likely to nominate multiple items alongside the correct diagnosis than the Chinese students. The Chinese students were more likely to view depression and schizophrenia as multi‐causally‐determined mental disorders than the US students. The findings highlight the need for the incorporation of mental health issues, including symptomatology of different mental disorders and their application to patient care, into various aspects of the US nursing curriculum. In China, opportunities can be created for nursing students to discuss the impact of personal beliefs on care delivery and social stigma during clinical placement. [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]

Aim To investigate the characteristics of the different club drugs and associated high-risk sexual behaviours in China. Design Multicentre cross-sectional study. Setting Drug Detoxification and Rehabilitation Centres in six provinces, China. Participants A total of 1434 eligible club drug users were included. Measurements Participants were investigated by trained interviewers using a self-designed structured questionnaire to collect information on club drug use and associated behaviours. Findings Methamphetamine was the most commonly abused drug in participants (73.92%), who used it in their or their friends' homes by non-injection for the purpose of feeling euphoria. Among participants with sexual behaviours after club drug use, 75.21% reported having engaged in sex with multiple partners after club drug use during the past year and 79.84% had unprotected sex after using club drug during the past year. A two-level logistic model showed that male gender [adjusted odds ratio ( AOR) = 7.14; 95% confidence interval ( CI) = 4.17-12.5], unmarried ( AOR = 1.71, 95% CI = 1.04-2.79), long duration of club drug use during their life-time ( AOR = 1.76, 95% CI = 1.28-2.42) and severe acute intoxication after using club drugs during the past year ( AOR = 2.11, 95% CI = 1.07-4.15) were independent risk factors of multiple sex partners during the past year. Another two-level model showed that the club drug users who were female ( AOR = 1.79, 95% CI = 1.03-3.11) and had polydrug use during their lifetime ( AOR = 1.55, 95% CI = 1.01-2.34) had more risk for unprotected sex during the past year than without these characteristics. Conclusion High-risk sexual behaviours are common among club drug users in China. The prevention and intervention of club drug use could decrease the risk of sexual behaviours which further prevent HIV transmission and other sexually transmitted infections in China. [ABSTRACT FROM AUTHOR]

Sexual risk behavior and illicit drug use among people living with HIV/AIDS (PLWHA) contribute to poor health and onward transmission of HIV. The aim of this collaborative multi-site nursing research study was to explore the association between self-compassion and risk behaviors in PLWHA. As part of a larger project, nurse researchers in Canada, China, Namibia, Puerto Rico, Thailand and the US enrolled 1211 sexually active PLWHA using convenience sampling. The majority of the sample was male, middle-aged, and from the US. Illicit drug use was strongly associated with sexual risk behavior, but participants with higher self-compassion were less likely to report sexual risk behavior, even in the presence of illicit drug use. Self-compassion may be a novel area for behavioral intervention development for PLWHA. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Aim This study represents an initial effort at examining the association between the construct of self-compassion and human immunodeficiency virus ( HIV)-related anxiety in a multinational population with HIV disease. Background Previous studies have found that self-compassion is a powerful predictor of mental health, demonstrating positive and consistent linkages with various measures of affect, psychopathology and well-being, including anxiety. Methods Cross-sectional data from a multinational study conducted by the members of the International Nursing Network for HIV Research ( n = 1986) were used. The diverse sample included participants from Canada, China, Namibia, the United States of America and the territory of Puerto Rico. Study measures included the anxiety subscale of the Symptom Checklist-90 instrument, the Brief Version Self- Compassion Inventory and a single item on anxiety from the Revised Sign and Symptom Checklist. Findings Study findings show that anxiety was significantly and inversely related to self-compassion across participants in all countries. We examined gender differences in self-compassion and anxiety, controlling for country. Levels of anxiety remained significantly and inversely related to self-compassion for both males ( P = 0.000) and females ( P = 0.000). Levels of self-compassion and anxiety varied across countries. Conclusions Self-compassion is a robust construct with cross-cultural relevance. A culturally based brief treatment approach aimed at increasing self-compassion may lend itself to the development of a cost effective adjunct treatment in HIV disease, including the management of anxiety symptoms. [ABSTRACT FROM AUTHOR]

Background While caregivers of children with intellectual disabilities are burdened in every part of the world, it is suspected that particular contexts may make the situation worse. There is little literature on caregivers in China, where familial and clan responsibility rather than individual effort is emphasised, and where communal support, while treasured, is often lacking. Method A total of 211 caregivers in two cities, one with and the other without randomised design, participated in a survey study that assessed affiliated stigma, loss of face, anxiety, mental health and empowerment. Results A proportion of 60.6% of participants were found to be conspicuous cases with mental disturbance of a level which required further professional attention. Participants with better resource appeared to have coped better, enjoying lower psychological distress, lower anxiety and a higher level of personal empowerment. Multiple regression analysis revealed that mental health is related to the affective dimension of affiliated stigma, loss of face and anxiety level. This was found to account for more than half the variance (55%). Discussion The subjective burden of care occurs not in isolation but in a cultural field. Chinese caregiving is characterised by a lack of formal support, and such cultural concerns as loss of face and strong affiliated stigma. This socio-political context makes caregiving all the more challenging. The situation has to be addressed by both practitioners and policy makers if family caregiving is to be valued and made sustainable. [ABSTRACT FROM AUTHOR]

Background: Secondhand smoke (SHS) exposure harms pregnant women and the fetus. China has the world's largest number of smokers and a high male smoking prevalence rate.Objective: To compare exposure to SHS among rural and urban Chinese non-smoking pregnant women with smoking husbands, and analyze factors associated with the level of SHS exposure and hair nicotine concentration.Setting: Sichuan province, China.Population: In all 1,181 non-smoking pregnant women with smoking husbands recruited from eight district/county Women and Children's hospitals.Methods: The women completed a questionnaire in April and May 2008. Based on systematic sampling, 186 pregnant women were selected for sampling the nicotine concentration in their hair. Ordinal logistic regression analysis was conducted to examine correlates with self-reported SHS exposure (total and at home); linear regression was conducted for the sub-sample of hair nicotine concentrations.Main Outcome Measures: Secondhand smoking exposure rates, hair nicotine levels.Results: About 75.1% of the non-smoking pregnant women with smoking husbands reported regular SHS exposure. The major source of exposure was through their husband. In the multivariate analysis, the risk of greater SHS exposure (total and at home) and hair nicotine concentration was increased for women who were rural, had a husband with greater cigarette consumption, less knowledge about SHS, less negative attitudes about SHS, and no smoke-free home rules.Conclusions: The high prevalence rate of SHS exposure suggests that it is important for non-smoking pregnant women, especially rural women, to establish smoke-free home rules and increase knowledge and negative attitudes towards SHS. [ABSTRACT FROM AUTHOR]