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Purpose: Early detection and management of coronary heart disease (CHD) are embedded into many community health service and primary care practices in western countries. The Framingham CHD risk score has been used to predict CHD and mortality for nearly 20 years, and it has predicted CHD event risk accurately in multiethnic populations. The aim of this study was to access the effect of a 6-month community-based intervention on CHD risk in individuals at high risk. Methods: A randomized controlled trial of individuals with a high 10-year CHD risk were recruited from two communities in China. Individuals in the intervention group (n = 53) received a 3-month group education and a 3-month coaching session. Physical examination and self-report questionnaires were used to collect both pre- and postintervention data on blood pressure, glucose, cholesterol, body mass index, smoking, depression, and health-related quality of life (HRQoL). Results: A total of 102 participants (85.0%) completed the 6-month study. Compared with the usual care group, the intervention group had a 5 mmHg greater reduction in systolic blood pressure (t = 2.01, p = .047), larger declines in glucose (t = −2.49, p = .015), cholesterol (t = −2.44, p = .017), body mass index (t = −2.58, p = .011), and depression (t = −2.05, p = .043), and better reports of HRQoL (t = 3.36, p = .001). No significant group differences in smoking behaviors were reported. Conclusion: A 6-month community-based intervention in a CHD high-risk population improved disease-related risk factors, depression, and HRQoL. Results provide preliminary evidence for primary prevention of cardiovascular disease risk in a community high-risk population. Keywords: coronary heart disease, intervention study, primary prevention

Cooking fumes (CFs) are mixtures of many toxic components, such as aldehydes, heterocyclic amines, polycyclic aromatic hydrocarbons, fat aerosols and particulate matters. CFs exposure has been proven to be associated with many diseases. Lung cancer takes the leading place among the diseases being reported caused by CFs exposure. Molecular and biochemical studies have found that CFs exposure may lead to lung cancer by gene damage, formation of reactive oxygen species, blockage of related proteins' function, and even cell death. However, reviews about the mechanisms of how CFs exposure leads to lung cancer are still lacking. Elucidation of the mechanisms of lung cancer caused by CFs exposure may provide a new insight into the prevention of lung cancer caused by CFs exposure, as well as laying the foundation for the toxicity study of CFs. In this minor review, the mechanisms of how CFs exposure leads to lung cancer were summarized and discussed.

Background Pathogenesis and diagnostic biomarkers for diseases can be discovered by metabolomic profiling of human fluids. If the various types of coronary artery disease (CAD) can be accurately characterized by metabolomics, effective treatment may be targeted without using unnecessary therapies and resources. Objectives The authors studied disturbed metabolic pathways to assess the diagnostic value of metabolomics-based biomarkers in different types of CAD. Methods A cohort of 2,324 patients from 4 independent centers was studied. Patients underwent coronary angiography for suspected CAD. Groups were divided as follows: normal coronary artery (NCA), nonobstructive coronary atherosclerosis (NOCA), stable angina (SA), unstable angina (UA), and acute myocardial infarction (AMI). Plasma metabolomic profiles were determined by liquid chromatography–quadrupole time-of-flight mass spectrometry and were analyzed by multivariate statistics. Results We made 12 cross-comparisons to and within CAD to characterize metabolic disturbances. We focused on comparisons of NOCA versus NCA, SA versus NOCA, UA versus SA, and AMI versus UA. Other comparisons were made, including SA versus NCA, UA versus NCA, AMI versus NCA, UA versus NOCA, AMI versus NOCA, AMI versus SA, significant CAD (SA/UA/AMI) versus nonsignificant CAD (NCA/NOCA), and acute coronary syndrome (UA/AMI) versus SA. A total of 89 differential metabolites were identified. The altered metabolic pathways included reduced phospholipid catabolism, increased amino acid metabolism, increased short-chain acylcarnitines, decrease in tricarboxylic acid cycle, and less biosynthesis of primary bile acid. For differential diagnosis, 12 panels of specific metabolomics-based biomarkers provided areas under the curve of 0.938 to 0.996 in the discovery phase (n = 1,086), predictive values of 89.2% to 96.0% in the test phase (n = 933), and 85.3% to 96.4% in the 3-center external sets (n = 305). Conclusions Plasma metabolomics are powerful for characterizing metabolic disturbances. Differences in small-molecule metabolites may reflect underlying CAD and serve as biomarkers for CAD progression.

Aims and objectives To describe the patterns of diabetes self-management, depressive symptoms, metabolic control and satisfaction with quality of life over time in a cohort of Chinese youth with type 1 diabetes and to determine the relationships between these variables over time. Background Nurses have an important role in facilitating optimal self-management and health outcomes in youth with type 1 diabetes. Only a few studies have focused on patterns of diabetes adaptation over time in youth with type 1 diabetes, especially in China. Understanding changes in diabetes self-management, depressive symptoms, metabolic control and satisfaction with quality of life can facilitate assessment and intervention. Design This is a multi-site longitudinal descriptive study. Data for this report were collected at baseline with 136 eligible Chinese youth and 86 of them were followed up for the second time, 6–12 months after baseline data collection. Methods Instruments to measure diabetes self-management, depressive symptoms, metabolic control and satisfaction with quality of life were collected at two time points. The data were collected from July 2009–October 2010. Linear mixed model analysis was used to analyse the longitudinal data. Results Self-management decreased over time; however, depressive symptoms, metabolic control and satisfaction with quality of life did not change from baseline to 6–12 months in this sample of Chinese youth with type 1 diabetes. A decrease in diabetes self-management over time was associated with worse metabolic control, while an increase in depressive symptoms over time was associated with poorer quality of life satisfaction in this sample. Conclusions Chinese youth faced difficulties with diabetes adaptation, especially with the deterioration of diabetes self-management. Improving self-management and decreasing depressive symptoms may enhance diabetes adaptation with respect to metabolic control and quality of life. Relevance to clinical practice The deterioration of diabetes self-management over time in youth with type 1 diabetes in China deserves nurses' careful surveillance. Clinical interventions appropriate to the Chinese culture and health care system are needed to improve self-management and depressive symptoms in Chinese youth with type 1 diabetes.

To investigate caregiver burden in dementia and explore factors associated with different types of burden in a country without formal caregiver support using a province in China as a case.Cross-sectional questionnaire survey was used to collect data. One hundred and fifty-two family caregivers of people with dementia in community settings were recruited from 2012 to 2013 using convenience sampling. Objective burden was measured by caregiving hours and dementia-related financial burden. Subjective burden was measured and analysed using the Caregiver Burden Inventory and the Neuropsychiatric Inventory-Questionnaire. Multivariate regression models were employed to analyse factors associated with each type of subjective burden.Five types of subjective burden were measured by the Caregiver Burden Inventory, namely, physical burden, emotional burden, time-dependence burden, developmental burden, and social burden. Caregiver distress, as a subjective burden, was measured by the Neuropsychiatric Inventory-Questionnaire and reported by relating to the severity of care recipients' behavioural and psychological symptoms of dementia. This caregiver cohort showed a high level of physical, time-dependence, and developmental burdens, but a low level of emotional and social burdens. Factors contributing to each type of subjective burden measured by the Caregiver Burden Inventory differed from each other.The high level of objective and subjective burdens identified in this study suggests that government-funded formal caregiver support should be established and services should be designed to target different types of burdens and factors contributing to these burdens.

Although stigma is a significant barrier to HIV prevention and treatment globally, the culture-specific psychosocial processes through which HIV-infected Chinese experience stigma have not been described. This study used grounded theory to explore the social and psychological processes of HIV-related stigma experienced by Chinese injection drug users and proposed a culture-specific concept of stigma. The focus group had six participants, and we conducted 16 individual interviews. The core category emerged as “Double struggle: Returning to normalcy.” Key concepts were dual stigma and family support, while keeping secrets and active drug use were factors influencing the struggle to return to normalcy. Family responsibility played an important role in bringing family members together to cope with HIV. Recommendations for Chinese health care providers include leveraging the traditional Chinese concept of family responsibility to establish a family alliance in response to the dual stigma and providing psychological counseling and education in treatment clinics.

Objective: We tested the feasibility of the in vitro culture of fetal nucleated erythroblasts from maternal blood for noninvasive prenatal screening as a substitute for culturing fetal nucleated erythroblasts from fetal villi. Method: Nucleated blood cells separated via Percoll from 52 samples of fetal villi and maternal peripheral blood were cultured with or without magnetic-activated cell sorting glycophorin A (MACS-GPA+), and detected by an anti-hemoglobin-epsilon (FITC) antibody. Gender of the epsilon-positive cells were identified by FISH and further confirmed by PCR of the villi karyotype. Developmental stages of nucleated erythroblasts from villi and blood with MACS-GPA+ were analyzed by Wright-Giemsa staining. Results: In the maternal blood, epsilon-positive cells were found in 4 and 24 cultured samples with and without MACS-GPA+, respectively. Also, Y-signals were visualized in 3 out of 4 and in 15 out of 24 cases in the epsilon-positive cells. Although epsilon-positive cells were found in all villus samples irrespective of MACS-GPA+ sorting, Y-signals were visualized in 31 out of 52 cases. Proerythroblasts and basophilic erythroblasts occupied 7 and 1% in fetal and maternal samples (with MACS-GPA+), respectively. Conclusions: The in vitro culturing of fetal nucleated erythroblasts from maternal blood is not feasible with the current techniques for prenatal diagnosis, because the fetal nucleated erythroblast is not well developed in vitro. This may be attributed to the low proportion of these erythroblasts at an early stage in the fetal circulation and the low permeability of these cells to the maternal blood.

Background The lack of dementia education programmes for health professionals in primary care is one of the major factors contributing to the unmet demand for dementia care services. Aims To determine the effectiveness of a nurse-led dementia education and knowledge translation programme for health professionals in primary care; participants' satisfaction with the programme; and to understand participants' perceptions of and experiences in the programme. Design A cluster randomized controlled trial was used as the main methodology to evaluate health professionals' knowledge, attitudes and care approach. Focus groups were used at the end of the project to understand health professionals' perceptions of and experiences in the programme. Participants and Settings Fourteen community health service centres in a province in China participated in the study. Seven centres were randomly assigned to the intervention or control group respectively and 85 health professionals in each group completed the programme. Methods A train-the-trainer model was used to implement a dementia education and knowledge translation programme. Outcome variables were measured at baseline, on the completion of the programme and at 3-month follow-up. A mixed effect linear regression model was applied to compare the significant differences of outcome measures over time between the two groups. Focus groups were guided by four semi-structured questions and analysed using content analysis. Results Findings revealed significant effects of the education and knowledge translation programme on participants' knowledge, attitudes and a person-centred care approach. Focus groups confirmed that the programme had a positive impact on dementia care practice. Conclusions A dementia education and knowledge translation programme for health professionals in primary care has positive effects on their knowledge, attitudes, care approach and care practice.

Summary Objectives To evaluate registered nurse compliance with standard precautions and to analyze the factors that affect compliance. Methods Study data were collected over a 3-month period from June to September 2007. The survey research method was used. A total of 1500 randomly sampled registered nurses from 18 hospitals in Hunan, China completed self-report questionnaires. Results Of the 1500 nurses included in the study, 1444 returned valid self-report questionnaires. Compliance with standard precautions was found to be low in the surveyed nurses. With a maximum possible score of 80, the quartile range of the overall score for compliance for all nurses was 48.29 (upper quartile score 76.36, lower quartile score 28.07), which was occupied by 64.7% of the participants. The factors most affecting compliance were: standard precautions training (odds ratio (OR) 2.17, 95% confidence interval (CI) 1.85–2.55) and knowledge (OR 1.94, 95% CI 1.01–3.41), followed by hospital grade (OR 1.61, 95% CI 1.79–1.86), presence of sharps disposal box in the department (OR 1.43, 95% CI 1.10–3.41), general self-efficacy (OR 1.29, 95% CI 1.04–1.59), exposure experience (OR 0.69, 95% CI 0.56–0.85), and department in which the nurse worked (OR 1.24, 95% CI 1.05–1.46). Conclusions The relevant authorities and hospital infection control department should pay more attention to nurse compliance with standard precautions. Standard precautions training should be strengthened and sufficient practical personal protection equipment provided in order to reduce hospital infections and protect the health of patients and medical staff.

Citation Liu Y-S, Wu L, Tong X-H, Wu L-M, He G-P, Zhou G-X, Luo L-H, Luan H-B. Study on the relationship between Th17 cells and unexplained recurrent spontaneous abortion. Am J Reprod Immunol 2011; 65: 503–511 Problem What is the relationship between Th17 cells and unexplained recurrent spontaneous abortion (URSA)? Method of study CD4+ interleukin (IL)-17A+ T (Th17) cells and CD4+ CD25brightFoxp3+ regulatory T (Treg) cells in peripheral blood were analyzed by flow cytometry; IL-17 concentrations in cell culture supernatants were quantitatively determined by enzyme-linked immunosorbent assay; and IL-17A positive cells in decidua tissues were measured by immunohistochemistry. Results The proportion of Th17 cells and IL-17A concentrations was both significantly higher in patients with URSA than in normal early pregnant (NEP) and non-pregnant (NP) patients, Treg frequencies were significantly lower in patients with URSA than in NEP patients, and the ratio of Th17 to Treg was significantly higher in the URSA group than in the other two. Additionally, the percentage of IL-17A cells in deciduas was significantly higher in patients with URSA than in NEP patients. Conclusions Human Th17 cells may play a major role in rejecting conceptus antigens and therefore may be harmful to the maintenance of pregnancy. The data also suggest that Treg cells are beneficial to pregnancy. There may exist a balance of Th17/Treg in normal pregnancy.

Aim and objectives. The purpose of this study was to describe the health quotient of Chinese undergraduates, to discern whether socio-demographic characteristics, academic achievements and perceived health status significantly affect the health quotient of Chinese college students and to identify the predictable factors of health quotient in undergraduates. Background. Rapidly increasing enrollment in higher education in China in recent years has brought growing concern about undergraduate health and lifestyle. The Health Quotient profile questionnaire, which assesses self-reported holistic health, provides opportunity to study the health of Chinese undergraduates. Design. A descriptive cross-sectional study. Methods. The study was conducted with 1874 Chinese undergraduates aged 15–28 from eight colleges in Changsha. Students were recruited by a multistage cluster stratified random sampling method. Results. The mean score of the Health Quotient questionnaire indicated a positive health quotient; however, 32·1% of the sample scored below the criterion score for a positive health quotient. Undergraduates scored low on knowledge of health. Gender, residence before university, father’s educational background, self-rated health, college category, achievement in study and status as student chief significantly predicted health quotient scores. Conclusions. Holistic health of college students is important and implies positive health behaviours and a focus on health promotion. The overall holistic health of the subjects was good, and students appear capable of managing their own health. Poor health knowledge may be an important factor in college students’ future health status. Risk factors associated with health quotient of undergraduates should be considered in college health care. Relevance to clinical practice. The health quotient is one instrument that can be used to assess college students’ holistic health and target health promotion interventions. Health knowledge dissemination could be a core task for Chinese college nurses. Further, international research that examines the relationship of student characteristics, college location, culture, health behaviours, health status and holistic health is indicated.

Drug abuse is a complicated social phenomenon rather than a neural disease. It especially fuels the HIV/AIDS epidemic. Researchers have shown interest in HIV-infected drug users as the socially and medically marginalized population, but they did not provide good enough care. Based on published English and Chinese journal articles and official reports, this integrated literature review summarizes the epidemic of drug abuse and HIV/AIDS, and comments on the clinical and psychosocial consequences, and harm reduction measures in China. Officially registered drug users have reached more than 1 million recently. A little under half of the people living with HIV/AIDS are injection drug users, as they transmit the disease through needle sharing and unprotected sexual behavior. The main consequences of drug abuse and HIV/AIDS included high prevalence of hepatitis viruses and tuberculosis co-infections, severe mental problems and extreme poverty. Even health professionals hold discriminative attitude toward drug users because of condemnation of drug abuse behavior and fear of HIV infection. Although interventions for drug addiction and harm reduction have been scaled up quickly, such as methadone maintenance treatment and needle syringe programs, the measures should be further revised, and the effectiveness needs to be evaluated appropriately. To enhance HIV-infected drug users' quality of life and the utility of medical services, improving health care providers' attitude is the first step. Then securing good quality of integrated medical care services with multidisciplinary cooperation will be essential.

Objective. China has, in recent years, seen an increase in the number of HIV-positive children due to the increase in number of HIV-positive women. The purpose of this study was to investigate the awareness and knowledge of mother-to-child transmission of HIV and its prevention among pregnant women attending the antenatal clinics in South Central China. Methods. The study was carried out in three antenatal clinics of three hospitals from February 2005 to March 2006, and it was based on personal interviews and questionnaires designed to assess the pregnant women's awareness about HIV/AIDS, evaluate their knowledge of possible routes of transmission, particularly mother-to-child transmission, and determine their familiarity with measures that prevent vertical transmission from mother to child. Two thousand three hundred and ninety pregnant women were included in the study. Results. All individuals were aware of HIV/AIDS. The majority (91%) of those women were aware that HIV/AIDS can coexist with pregnancy but only 64% had heard about mother-to-child transmission. Transplacental route, vaginal delivery and breastfeeding were identified as routes of transmission from mother to child by 85%, 60% and 20% of respondents, respectively. Cesarean section was believed to be a route of transmission by 55% of respondents, but no one identified cesarean section as a method of prevention of mother-to-child transmission. Conclusions. The level of awareness and knowledge of HIV/AIDS among pregnant women attending our antenatal clinics seems to be superficial; more education and knowledge about mother-to-child transmission are needed in China.

Objective The thrombospondin-4 (TSP-4) gene G29926C (A387P) polymorphism was recently reported to be associated with an increased risk of MI (myocardial infarction in American population. However, several subsequent studies produced controversial findings. The aim of this study was to explore the possible association between TSP-4 A387P polymorphism and ACS (acute coronary syndrome) in Chinese Han population. Methods: A case-control study including 412 patients with ACS and 337 controls free from CAD (coronary artery disease) was conducted. TSP-4 A387P polymorphism was determined by PCR (polymerase chain reaction) and RFLP (restriction fragment length polymorphism) analysis. Results: Slightly decreased frequency of GC genotype was observed in patients with ACS, compared with controls (5.3% vs. 7.1%), but the difference did not reach statistical significance (P=0.31). Similarly, the prevalence of C allele was 2.7% and 3.6% for ACS and control groups, respectively (P=0.32). None of homozygote was detected for C allele. Further analyses in subjects subgrouped according to sex and age also showed no association of TSP-4A387P polymorphism with ACS. Furthermore, after adjustment for conventional risk factors by multiple logistic regression analysis, the carrier prevalence of C allele did not differ significantly between ACS and control groups (OR=0.85; 95%CI: 0.45-1.59; P=0.60). Conclusion: The present study suggested that the TSP-4A387P variant showed a low prevalence compared with western populations and failed to associate with an altered risk of ACS in Chinese Han population. The findings further supplement experimental data for TSP-4 gene study of coronary disease.

Nurses must have adequate knowledge to manage the complexities of urinary incontinence. Nursing students are the nurses of the future, yet little is known about urinary incontinence education in undergraduate nursing programs.The aim of this study was (a) to assess the knowledge and attitudes of urinary incontinence held by undergraduate nursing students in China and (b) to explore the relationship between knowledge, attitudes and socio-demographic characteristics.A cross-sectional survey using cluster random sampling.Undergraduate departments of Nursing within the Faculty of Health Sciences at six Universities, located in different areas of China.A random selection of 6 faculties with a total of 1313 full time undergraduate nursing students completed the survey.Self-reported data were collected using two validated questionnaires, the Urinary Incontinence Knowledge Scale and the Urinary Incontinence Attitude Scale, to access students' knowledge and attitudes toward urinary incontinence.Overall urinary incontinence knowledge was poor (49.9%, 15.0/30) and attitudes about urinary incontinence were generally positive (71.7%, 43.0/60). A high level of interest in learning more about urinary incontinence was found. There was a weak correlation between urinary incontinence knowledge and attitudes (r=0.135, p0.01). There was also a significant positive correlation between urinary incontinence knowledge and attitudes and nursing students' year of study, urinary incontinence education and training, and formal clinical practicum experience in urology (p0.05).Chinese nursing students showed poor urinary incontinence knowledge but generally positive attitudes toward urinary incontinence. This study suggests there is a need to examine urinary incontinence content throughout undergraduate nursing curricula in China.

A training programme for prevention of occupational exposure to bloodborne pathogens: impact on knowledge, behaviour and incidence of needle stick injuries among student nurses in Changsha, People's Republic of China Background. Although the human immunodeficiency virus (HIV) epidemic in China is expanding rapidly, the principles of universal precautions (UP) are not widely disseminated in Chinese hospitals. Lack of training about occupational prevention of bloodborne pathogens (BBP) may place student nurses at risk when they are in clinical practice. Aim. To examine the impact of structured training on prevention of occupational exposure to BBP on knowledge, behaviour, and incidence of medical sharp injuries among student nurses in Changsha, China. Methods. A quasi-experimental study evaluated changes in knowledge, self-reported UP behaviours, observed adherence to UP, and needle stick/sharp injuries during a 4-month follow-up period. The study population consisted of 106 student nurses in two classes. One class served as the experimental group, while the other served as a control group. Students in the experimental group participated in a structured training intervention consisting of lectures and demonstrations. Results. At 4 months, the group that received the BBP training scored significantly higher than the standard education group on both knowledge (P < 0.001) and behaviour (P = 0.002). Although students in the experimental group were not observed to practise UP significantly more frequently than those in the control group, they were less likely to experience needle stick/sharp injuries (OR = 0.29; 95% CI 0.11, 0.74; P = 0.004). Conclusion. Structured training in prevention of occupational exposure to BBP improved knowledge and behaviour and reduced the number of needle stick/sharp injuries among Chinese student nurses, compared with students who did not receive the training. Training in the techniques of UP could play a role in reducing the risk for occupational exposure to BBP among Chinese future nurses. In view of the accelerating HIV epidemic, implementation and evaluation of such training programmes are urgently needed.

Background Suboptimal care for people with dementia in hospital settings has been reported and is attributed to the lack of knowledge and inadequate attitudes in dementia care among health professionals. Educational interventions have been widely used to improve care outcomes; however, Chinese-language instruments used in dementia educational interventions for health professionals are lacking. Objectives The aims of this study were to select, translate and evaluate instruments used in dementia educational interventions for Chinese health professionals in acute-care hospitals. Design A cross-sectional study design was used. Participants and setting A modified stratified random sampling was used to recruit 442 participants from different levels of hospitals in Changsha, China. Methods Dementia care competence was used as a framework for the selection and evaluation of Alzheimer's Disease Knowledge Scale and Dementia Care Attitudes Scale for health professionals in the study. These two scales were translated into Chinese using forward and back translation method. Content validity, test–retest reliability and internal consistency were assessed. Construct validity was tested using exploratory factor analysis. Known-group validity was established by comparing scores of Alzheimer's Disease Knowledge Scale and Dementia Care Attitudes Scale in two sub-groups. A person-centred care scale was utilised as a gold standard to establish concurrent validity of these two scales. Results Results demonstrated acceptable content validity, internal consistency, test–retest reliability and concurrent validity. Exploratory factor analysis presented a single-factor structure of the Chinese Alzheimer's Disease Knowledge Scale and a two-factor structure of the Chinese Dementia Care Attitudes Scale, supporting the conceptual dimensions of the original scales. The Chinese Alzheimer's Disease Knowledge Scale and Chinese Dementia Care Attitudes Scale demonstrated known-group validity evidenced by significantly higher scores identified from the sub-group with a longer work experience compared to those in the sub-group with less work experience. Conclusions The use of dementia care competence as a framework to inform the selection and evaluation of instruments used in dementia educational interventions for health professionals has wide applicability in other areas. The results support that Chinese Alzheimer's Disease Knowledge Scale and Chinese Dementia Care Attitudes Scale are reliable and valid instruments for health professionals to use in acute-care settings.

Background Both Australia and China have a large proportion of people with dementia and the prevalence will triple in Australia and increase five times in China by 2050. The majority of people with dementia are reliant on family caregivers to provide daily care and to maintain the dignity in both countries. As a consequence, caregiver burden has become a major concern because of the negative impact on the care recipients’ and the caregivers’ health. It is strongly recommended that cross-national collaboration should be conducted to share experiences in fighting dementia. The aim of this study was to compare socially and culturally constructed enablers and barriers pertinent to dementia caregivers in one capital city in Australia and one capital city in China through critical reflection on the caregivers’ subjective and objective experiences for the improvement of dementia care services in both countries. Methods Giddens’ Structuration Theory was used as a framework to guide a concurrent mixed methods design with the qualitative strand as a priority. In the qualitative strand, data were collected by focus groups and in-depth interviews while in the quantitative strand, data were collected by questionnaire survey. Results In total 148 caregivers participated in the project with 57 of them from Australia (26 and 31 in the qualitative and quantitative strands respectively) and 91 of them from China (23 and 68 in the qualitative and quantitative strands respectively). Findings from the qualitative and quantitative strands were presented as three categories: A higher objective burden in the Chinese cohort versus a higher subjective burden in the Australian cohort; Unmet need for caregiver support in Australia and China; and Expectations for improving dementia services in Australia and for developing dementia services in China. Conclusions Dementia policy, services and resources need to be grounded on current research evidence in an ever-changing society like China. In Australia, dementia services need to have more components of preventing or reducing caregivers’ subjective burden. As subjective burden is mediated by culture, caregiver support mechanisms should consider caregivers’ needs associated with their cultural values.

Aims To examine socially, culturally and politically constructed factors affecting family caregiver practice in dementia care, and to identify possible changes in a country with undeveloped dementia services. Background In China and many other low- and middle-income countries, social transformations are weakening the family care model, which has an impact on the population with dementia. Exploring the challenges that caregivers face may help the international healthcare community to improve dementia services. Design A double hermeneutic approach informed by Giddens' Structuration Theory was used. Methods In-depth semi-structured interviews with 23 family caregivers of people with dementia were conducted in 2012. The interviews were audiotaped, transcribed and analysed. Findings Analyses revealed three consequences of socially constructed factors in dementia care, which constrained caregiver practice. First, caregivers were unable to manage behavioural and psychological symptoms of dementia. Untreated aggressive behaviours caused harm to the person with dementia and endangered the caregiver and the public. Second, the burden on the primary caregiver was evident and caregivers received limited support. Third, there was little coordination between primary and specialist care services for people with dementia. On critical reflection of potential changes that could improve dementia services, caregivers suggested that community nurses have a leading role in coordinating dementia services and supporting caregivers. Conclusion Relying on family caregivers to care for people with dementia without the prevision of dementia services by the public healthcare system generates negative health outcomes for both care recipients and caregivers. The nursing workforce should be developed to support dementia services.

Background This study provides a comprehensive evaluation of nurse resources in Chinese hospitals and the link between nurse resources and nurse and patient outcomes. Methods Survey data were used from 9688 nurses and 5786 patients in 181 Chinese hospitals to estimate associations between nurse workforce characteristics and nurse and patient outcomes in China. Nurse and patient assessments in China were compared with a similar study in Europe. Results Thirty-eight percent of nurses in China had high burnout and 45% were dissatisfied with their jobs. Substantial percentages of nurses described their work environment and the quality of care on their unit as poor or fair (61% and 29%, respectively) and graded their hospital low on patient safety (36%). These outcomes tend to be somewhat poorer in China than in Europe, though fewer nurses in China gave their hospitals poor safety grades. Nurses in Chinese hospitals with better work environments and higher nurse-assessed safety grades had lower odds of high burnout and job dissatisfaction (ORs ranged from 0.56 to 0.75) and of reporting poor or fair quality patient care (ORs ranged from 0.54 to 0.74), and patients in such hospitals were more likely to rate their hospital highly, to be satisfied with nursing communications, and to recommend their hospitals (significant ORs ranged from 1.24 to 1.40). Higher patient-to-nurse ratios were associated with poorer nurse outcomes (each additional patient per nurse increases both burnout and dissatisfaction by a factor of 1.04) and higher likelihoods of nurses reporting poor or fair quality of care (OR=1.05), but were unrelated to patient outcomes. Higher percentages of baccalaureate nurses were strongly related to better patient outcomes, with each 10% increase in the percent of baccalaureate nurses increasing patient satisfaction, high ratings, and willingness to recommend their hospital by factors ranging from 1.11 to 1.13. Interpretation Nursing is important in quality and safety of hospital care and in patients' perceptions of their care. Improving quality of hospital work environments and expanding the number of baccalaureate-prepared nurses hold promise for improving hospital outcomes in China.

Purpose of the research This paper adopted Protection Motivation Theory (PMT) to examine Chinese women's knowledge and perceptions of cervical cancer risk and factors influencing their motivation to receive future screening. Methods and sample A cross-sectional survey was conducted with 167 Chinese women (142 women were willing to receive a screening in the future and 25 women were not) in 2007 to collect women's socio-demographic information and sexual history, perceptions related to body health and knowledge about cervical cancer and screening, and Protection Motivation Theory measures. Key results The majority of women stated they intended to receive future screening and response efficacy was significantly associated with their intention. However, no significant association was observed between sexual history and protection motivation. Using multivariate analysis, cancer in relatives (odds ratio, OR = 9.97, 95% CI [1.44–436.3], p = 0.010), a perception that visiting a doctor regularly is important to health (OR = 9.85, 95% CI [1.61–999.9], p = 0.009)), and ever attending for cervical screening during the previous three years (OR = 3.49, 95% CI [1.23–11.02], p = 0.016) were significantly associated with women' motivation to receive future screening. Conclusion The findings of this study highlight the important role of women's beliefs in the value of cervical screening and previous screening experience in motivating them to receive a screening. Education intervention is needed to provide information and raise public awareness about the importance of cervical screening to women's health. Culture-related beliefs and social motivational processes in addition to those specified by PMT need to be addressed.

Although the relationship between self-efficacy and health-related behaviors is well known, limited data are available describing the association between self-efficacy and HIV stigma. Specifically, it is not known if the relationship between self-efficacy and health outcomes is mediated by HIV stigma. This study aimed to test these relationships. Data were collected from 202 HIV/AIDS patients in China using questionnaires measuring self-efficacy for disease management, self-reported 7 day medication adherence, perceived HIV/AIDS stigma and quality of life. The total mean score for self-efficacy was 6.73 (range, 2.78-10.0), and the total mean score for HIV stigma was 102.24 (range, 57.0-148.0). Seventy-four percent (150/202) of subjects reported missing no medication doses during past 7 days, and 73% (148/202) subjects reported a quality of life score over 60. There was a moderate level of association between self-efficacy and HIV stigma (Pearson r=-0.43, p=0.000). High self-efficacy predicted better medication adherence (odds ratio [OR]=1.82, 95% confidence interval [CI]=1.40-2.36) and better quality of life (OR=1.28, 95% CI=1.03-1.60) after controlling for demographic and HIV related characteristics. HIV stigma partially mediated the relationship between self-efficacy and medication adherence (OR=1.64, 95% CI=1.26-2.15; Sobel test result Z=1.975, p=0.048). HIV stigma totally mediated the relationship between self-efficacy and quality of life (OR=1.15, 95% CI=0.91-1.46; Sobel test result Z=2.362, p=0.018). The results suggest that, although self-efficacy is an important predictor for medication adherence and quality of life, HIV stigma as a mediator should not be neglected. Health care providers should also evaluate HIV stigma conditions when seeking to improve self-efficacy through interventions.

This cross-sectional study described the level of stigma reported by people living with HIV (PLWH) in south central China and identified factors associated with the individuals' perceptions of stigma. The authors carried out face-to-face interviews among 322 PLWH. Over half (51%) reported experiencing stigma, 78% reported feelings of negative self-worth, 75% reported interpersonal insecurity, 84% experienced financial problems, and 58% worried about disclosure of their disease. High levels of self-perceived stigma were associated with subjects who were injection drug users (p = .001), who were less satisfied with responses from family members (p = .001), who had disclosed their HIV status widely (p = .001), and who reported poorer health status (p = .001). Nurses working with PLWH should carry out psychological assessments and care without judgmental attitudes and help PLWH disclose their HIV status to family members, which could reduce HIV-related stigma in the context of Chinese culture.

The aim of this paper is to assess the subjective well-being of chronically ill inpatients to know which its influential factors are, what the significant predictors of SWB are, and what we can do in nursing care. A sample of 290 inpatients with chronic respiratory diseases, diabetes, and cardiovascular diseases responded to questionnaires assessing well-being, anxiety, and depression and gave suggestions about nursing during an interview. It was shown that these patients' subjective well-being was lower than that of the general population. Using ANOVA, Pearson correlations, and multivariate stepwise regression analysis, trait anxiety, anxiety, and means of payment were found to significantly influence subjective well-being. Interventions targeting trait anxiety, anxiety, and means of payments, such as paying more attention to individuals' psychological symptoms, implementing more cost-effective treatment or caring, and establishing positive relationship with patients are necessary to improve inpatients' subjective well-being.

This paper analyzes the advantages and disadvantages of GA and BP algorithms, and presents the iteration of hybrid algorithm based on both algorithms. The hybrid algorithm incorporates the stronger global search of GA into the stronger local search of BP, and can search out the global optimum faster than each algorithm. At last, the hybrid algorithm is proved converge to the global optimum with the probability of 1