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Importance: The association of folate supplementation with congenital heart disease (CHD) prevention is controversial., Objective: To examine the association of maternal serum folate levels at early to midpregnancy with CHD risk in offspring., Design, Setting, and Participants: This case-control study recruited participants from one of China's largest cardiac referral centers between 2015 and 2018. CHD cases and non-CHD controls were matched according to maternal age at a ratio of 1:4. Data were analyzed from May to August 2023., Exposures: Maternal serum levels of folate, vitamin B12, and homocysteine were measured around the gestational age of 16 weeks., Main Outcomes and Measures: The primary outcome was CHD, which was confirmed using echocardiography. The association between CHD risk in offspring with maternal folate levels was measured using adjusted odds ratios (aORs) with 95% CIs in conditional logistic regression analyses. Interactions between folate, vitamin B12, and homocysteine and CHD were estimated on a multiplicative scale., Results: A total of 129 CHD cases with ventricular septal defect as the most common phenotype and 516 matched controls were included. The mean (SD) maternal age at pregnancy was 31.6 (5.3) years. There was a U-shaped association between maternal serum folate levels at early to midpregnancy and CHD risk in offspring. Compared with the offspring in the second and third quartiles of maternal folate, those in the lowest (aOR, 3.09; 95% CI, 1.88-5.08) and highest quartiles (OR, 1.81; 95% CI, 1.07-3.06) had increased odds of CHD. The ORs were higher when applying the World Health Organization criteria to determine the normal range for serum folate levels. Interaction analyses suggested that the adverse associations between low and high maternal folate and CHD risk might be further magnified by vitamin B12 deficiency or elevated homocysteine., Conclusions and Relevance: In this case-control study of CHD, low maternal serum folate levels in early to midpregnancy were associated with an increased CHD risk in offspring, and excessively high folate levels were also associated with an elevated CHD risk. Further investigation is needed to make causal inferences for the observed associations and elucidate the underlying mechanisms.

Purpose: This study aimed to investigate the factors associated with perceived cognitive function among breast cancer patients treated with chemotherapy in China., Methods: The study was a multicenter cross-sectional design. Data were collected from 10 public hospitals in China between April 2022 and February 2023. A total of 741 participants completed questionnaires assessing sociodemographic and medical characteristics, perceived cognitive function, sleep quality, fatigue, anxiety, and depression. Hierarchical multiple regression analysis was used to assess the determinants of cognitive function., Results: The hierarchical multiple regression model accounted for 31.5% of variation in perceived cognitive function (sociodemographic 4.5%; medical 6.6%; exercise frequency 6.6%; sleep quality 2.1%; fatigue 2.8%; anxiety combined with depression 9.0%). Education level, chemotherapy type, number of chemotherapy cycles, and cyclophosphamide drug use were significant predisposing factors of perceived cognitive function (p < 0.001). Exercising ≥3 times/week (p < 0.001) was a significant factor positively influencing perceived cognitive function, meanwhile, anxiety (p < 0.001) and depression (p < 0 0.001) were negative factors., Conclusion: Our findings suggest that patients with low education levels, postoperative chemotherapy, cyclophosphamide treatment, and a greater number of chemotherapy cycles need more assessment. Sedentary patients, those who have never exercised, and those with anxiety or depression all showed greater cognitive decline. By identifying susceptible populations, encouraging regular exercise, and addressing anxiety and depression, healthcare professionals can contribute significantly to prevent patients' cognitive decline throughout chemotherapy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Iron-bound organic carbon (OC-Fe R ) is important for the stability of soil organic carbon (SOC) in salt marshes, and the Spartina alterniflora invasion reshaped local salt marshes and changed the SOC pool. To evaluate the effects of S. alterniflora invasion on the contribution of OC-Fe R to SOC, we determined the OC-Fe R content and soil characteristics in the 0-50 cm soil profile along the vegetation sequence, including mudflats (MF), S. alterniflora marshes established in 2003 (SA03) and 1989 (SA89), the ecotone of S. alterniflora and Phragmites australis (SE), S. salsa marsh (SS), and P. australis marsh (PA). The SOC content was 6.55-17.5 mg g -1 in the S. alterniflora marshes. Reactive iron oxides (Fe d , Fe o , Fe p ) accumulated significantly in the S. alterniflora and P. australis salt marshes. PA and S. alterniflora marshes had higher DOC contents of 0.28-0.77 mg g -1 . The OC-Fe R content in the 0-50 cm soil profile in these ecosystems ranged from 0.3 to 3.29 mg g -1 , with a contribution to the SOC content (f OC-FeR ) of approximately 11 %, which was highest in SA03 (16.3 % ~ 18.8 %), followed by SA89, SE, and PA. In addition, the molar ratios of OC-Fe R to Fe d were <1, indicating that the iron oxides were associated with SOC through sorption more than coprecipitation. According to the structural equation model, SOC, DOC and iron oxides were the direct driving factors of OC-Fe R formation, while the vegetation zone indirectly functioned by regulating organic C inputs, iron oxide formation, and pH. This study suggested that S. alterniflora invasion promotes iron-bound organic carbon accumulation by increasing organic C inputs and regulating iron oxide formation in salt marshes, but such promotion will degenerate with development duration., Competing Interests: Declaration of competing interest All the authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The social participation of older people should be encouraged, as it is fundamental to their well-being and the practice of aged care. Therefore, the ability of older persons to participate in society should be strengthened., Objective: To evaluate the preliminary effects of a WeChat-based educational intervention on the social participation of community-dwelling older adults in China., Methods: This study was a quasi-experimental design. Twenty-eight community-dwelling older adults participated in a WeChat-based educational intervention. The intervention contents included concepts and preparation of social participation, analysis of participation resources and capabilities, technological adaptation, emotional management, setting of to-do lists, etc. Social participation, self-worth and subjective well-being were measured via the WeChat application on smartphones at baseline, immediately after the intervention, and a 3-month follow-up. We analysed data using paired t-tests and analysis of variance (ANOVA)., Results: We found statistically significant improvements in social participation (active aging) (F = 4.408; p < .05) as well as the self-worth dimensions of moral worth (F = 4.135; p < .05) and psychological worth (F = 3.234; p < .05), and the negative-affect dimension of subjective well-being being decreased (F = 2.484; p < .05)., Conclusions: The WeChat-based education intervention can effectively improve social participation and self-worth, and may provide effective preventive healthcare solutions for older adults in China., Implications for Practice: The enormous value of the social participation of independent older adults must be recognised. Nurses can use smartphones to deliver health and social participation information in routine programs in aged care., (© 2023 John Wiley & Sons Ltd.)

Objective: To explore the experience of incontinence-associated dermatitis (IAD) as perceived by nurses, obstacles in the nursing process, and need for IAD training and management., Methods: This single-setting descriptive qualitative study was conducted from June 5, 2018, to June 22, 2018. Ten nurses working in the respiratory ICU of a local hospital participated in semistructured interviews. The content analysis method was used to analyze, summarize, and refine the interview data., Results: The experience of ICU nurses with IAD can be divided into four types: nursing based on experiential knowledge, seeking self-improvement, disunity of cleaning methods and wiping skills, and postponement of nursing care because of priority allocation. Obstacles in the nursing process include a lack of relevant nursing knowledge and awareness, as well as the medical supplies needed. The goals of training and management include establishing IAD preventive nursing procedures, providing IAD care products, enhancing the practicality of training content and diversifying training methods, and establishing an information system to assist nurses caring for patients with IAD., Conclusions: The knowledge and behavior of ICU nurses regarding IAD need to be improved. Training and management are imperative. Facilities and nurse managers should actively seek solutions to stated obstacles, formulate training methods suitable for clinical needs, and promote the standardization of nursing for IAD., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Breast cancer-related lymphedema (BCRL) is a major long-term complication for post-surgery breast cancer survivors. Although several risk factors have been identified, lifestyle characteristics have been neglected in previous studies. The aim of this study was to develop and validate a nomogram for estimating this population's risk of developing lymphedema, taking into consideration their demographic, clinical, and personal lifestyle behaviors., Methods: In a cross-sectional study, we collected data from 775 post-operative breast cancer survivors who had attended a follow-up session in the recent 10 years (primary cohort). Lymphedema was assessed using the Norman telephone questionnaire, self-reported by patients. Multiple logistic regression was used to identify risk factors for lymphedema, including demographic, clinical, and lifestyle-related factors. A nomogram was constructed based on those factors and was validated using a separate group of 314 breast cancer patients (validation cohort)., Results: The factors independently associated with lymphedema were higher body mass index (BMI), modified radical mastectomy (MRM), postsurgical infection, chemotherapy, radiotherapy, exercise of the affected arm, and the active participation in physical activity (P<0.05). The area under the curve (AUC) values of the primary and the validation cohorts were 0.721 (95% confidence interval: 0.685-0.756) and 0.702 (95% confidence interval: 0.646-0.759), respectively., Conclusions: BCRL risk factors include MRM, radiotherapy, chemotherapy, and higher BMI, while the active physical activity behavior of patients appears to be a factor against lymphedema. The nomogram incorporating the patients' clinical and lifestyle factors might be useful for predicting lymphedema in breast cancer survivors., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Breast cancer (BC) survivors have a lifelong risk of developing lymphedema. This study investigated the prevalence of BC-related arm lymphedema among Chinese BC survivors diagnosed in the last 10 years and examined the demographic and clinical variables as well as lifestyle factors associated with lymphedema status., Methods: In this cross-sectional study, women with BC (N = 866) who had been diagnosed and followed up in the previous 10 years were recruited from the outpatient clinic of 4 general hospitals and one cancer association in China between August 2018 and October 2019. Lymphedema status was determined using the Norman telephone questionnaire as the patient-reported occurrence of hand/lower arm/upper arm swelling. Multiple logistic regression was used to identify risk factors for lymphedema., Results: The median time from BC diagnosis was 4.0 years (interquartile range, 2.0-5.0 years). 81.4% of the patients had undergone mastectomy. The prevalence of arm lymphedema among BC survivors was 49.0%. Age ≥50 years, monthly income <3000 RMB, modified radical mastectomy, postsurgical wound infection, chemotherapy, and radiotherapy were associated with an increased risk of BC-related arm lymphedema, whereas exercise of the affected arm, engagement in active physical activity, and timely reporting of symptoms of infection to a physician decreased the risk (P < 0.05)., Conclusions: Arm lymphedema is a common complication for postoperative BC survivors within 10 years. It is essential to identify patients at risk of lymphedema based on demographic, clinical, and lifestyle factors and implement interventions targeting modifiable lifestyle behaviors-eg, active physical activity during the postoperative period., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Patients with burn injuries resulting in visible disabilities may face negative emotional experiences during rehabilitation. Understanding the development of resilience in these patients may help those who are seeking methods to better adapt to their new situation., Purpose: This study aimed to explore the development of resilience in patients with burns during their convalescence., Methods: Ten patients with burn injuries who were convalescing in a general hospital in China were recruited and enrolled as participants. Data were collected using recorded, semistructured in-depth interviews and analyzed following the principles of grounded theory., Results: The development of resilience in patients with burns included five stages of "black hole," "introspection," "integration," "practice," and "growth." Both internal and external protective factors were identified. The internal protective factors included hope, sincerity, will, belief, and curiosity, and the external protective factor was mutual relationships that reflected the qualities of caring, support, sharing, commitment, and intimacy., Conclusions: Resilience was achieved gradually over several progressive steps through the five stages (black hole, introspection, integration, practice, and growth). The results of this research may provide insights and support to patients who seek to improve their adaptation to new situations.

Objective: Spouses who are the major source of social support for married breast cancer patients sometimes do not know how to support the patient effectively. This study aimed to investigate the experiences and strategies of spouses identified as supportive for patients throughout the disease., Methods: A qualitative study using semi-structured in-depth interviews was conducted with 22 husbands of Chinese women with breast cancer, who had effectively supported their wives. Thematic analysis was used for data analysis., Results: Three themes emerged from the data: (a) following the diagnosis, the spouse focused on "problem solving under stress" by preparing the patient for the physician's disclosure of the diagnosis, helping her to cope with the shock, and aiding her in dealing with the treatment recommendations; (b) during treatment, the spouse focused on "functional compensation" to offset the patient's reduced self-care and family care abilities; and (c) following treatment, the spouse focused on "role return" by adapting to changes in the patient and assisting her return to the family and society., Conclusion: Chinese spouses of women with breast cancer exhibited support strategies that varied with disease progress. Healthcare providers should aid spouses in providing support according to the changing needs of patients with breast cancer., (© 2019 John Wiley & Sons Ltd.)

Aim To determine whether breast cancer survivors (BCS) at work following the diagnosis and/or treatment of breast cancer, in a rapidly developing country such as China experience similar to return to work challenges as reported in nations with established return to work (RTW) policy and procedures for employees with cancer. Methods Semi-structured interviews were conducted with 16 BCS who returned to work following diagnosis and/or primary cancer treatment. An Interpretative Phenomenological Analysis was used to investigate responses. Results Three recurring themes emerged: (1) challenges at work related to residual effects of diagnosis and/or primary treatment; (2) positive and negative responses from employers and/or supervisors; and (3) positive and negative responses from co-workers/colleagues. Although several participants experienced a high level of workplace support, there was a subgroup that did report challenges related to symptom burden, cognitive limitations, and both positive and negative responses by employers and co-workers were reported. Conclusions Findings indicate similar challenges in BCS who RTW during and/or following cancer treatment in both rapidly developing and developed nations. Results suggest that regardless of the existence of workplace policies and practices related to RTW for workers with a history of cancer, a subgroup of BCS experience similar challenges when returning to work. These findings highlight the international nature of RTW challenges and suggest the need for more global efforts to develop and evaluate workplace interventions to assist with these similarities.

Purpose: To describe the coping strategies and preferred coping style of Chinese children with leukemia during hospitalization., Methods: In-depth interview with a semi-structured interview were conducted with 29 Chinese children who underwent leukemia treatment. The Kippendorf's content analysis method was used to data analysis., Results: During the hospitalization, children had three ways of psychological adjustment: Self-regulation, assistance of health professionals, helping of parents. There were many coping strategies. Problem-focused coping included seeking information and problem solving, and emotion-focused coping included seek emotional support, self-control, acceptance, seeking other rewards., Conclusions: Children use different coping styles consistent with their cognitive development stage, and Chinese traditional culture affects children's coping strategies., (Copyright © 2017. Published by Elsevier Ltd.)

Aims and Objectives: To identify self-acceptance and associated socio-demographic and disease factors among Chinese women with breast cancer., Background: Although it is recognised that breast cancer can affect a woman's feelings of self-acceptance, there are few studies concerning the level of self-acceptance among women with breast cancer and factors associated with self-acceptance in this population., Design: Cross-sectional research design., Methods: Data were collected using the convenience sampling method. A total of 308 women with breast cancer were investigated using the Self-Acceptance Questionnaire., Results: The mean score on the Self-Acceptance Questionnaire was 39·79 ± 5·14, indicating that the women in this study had low levels of self-acceptance. Multiple regression analysis indicated that self-acceptance was positively associated with the time since diagnosis, household income and the presence of medical insurance/government-funded medical treatment, while Tumour, Lymph Node, Metastasis stage was negatively associated with self-acceptance. With respect to work status, retired patients had the highest levels of self-acceptance, those who had returned to work had moderate levels of self-acceptance and those who had not yet returned to work had the lowest levels of self-acceptance., Conclusions: This study demonstrates that the level of self-acceptance among women with breast cancer in China is low, and suggests that there is room to improve. Several factors are significantly associated with the self-acceptance of women with breast cancer., Relevance to Clinical Practice: Medical staff should realise that the level of self-acceptance among women with breast cancer in China is low and has room to improve. It is important to conduct appropriate interventions to improve self-acceptance among these women, based on an understanding of the factors associated with self-acceptance., (© 2016 John Wiley & Sons Ltd.)

Purpose: To describe the process by which Chinese women accept living with breast cancer., Methods: Individual interviews were conducted with 18 Chinese women who completed breast cancer treatment. Data were collected from September 2014 to January 2015 at a large tertiary teaching hospital in Beijing, China. In this grounded theory study, data were analyzed using constant comparative and coding analysis methods., Results: In order to explain the process of accepting having breast cancer among women in China through the grounded theory study, a model that includes 5 axial categories was developed. Cognitive reconstruction emerged as the core category. The extent to which the women with breast cancer accepted having the disease was found to increase with the treatment stage and as their treatment stage progressed with time. The accepting process included five stages: non-acceptance, passive acceptance, willingness to accept, behavioral acceptance, and transcendence of acceptance., Conclusions: Our study using grounded theory study develops a model describing the process by which women accept having breast cancer. The model provides some intervention opportunities at every point of the process., (Copyright © 2017. Published by Elsevier Ltd.)

Objective: To determine factors related to menopause symptoms among middle-aged registered nurses in Beijing., Methods: Self-administered questionnaires that included closed-ended questions on many factors possibly related to menopausal symptoms were distributed to 2100 registered nurses aged 40-55 at 20 hospitals in Beijing, China., Results: Menopausal status was most associated with menopausal symptoms (p < 0.01), including hot flashes and sweating, paresthesiae, insomnia, arthralgia/myalgia, palpitations, skin formication and an unsatisfactory sexual life. The odds ratios (ORs) were highest for hot flashes and sweating. Upsetting events in the past year and being pessimistic were significantly inversely correlated with almost all the symptoms analyzed. Hot flashes and sweating (p < 0.01), paresthesiae (p < 0.01), unsatisfactory sexual life (p < 0.01), irritability (p < 0.05), depression or suspicion (p < 0.05) and dizziness (p < 0.05) were negatively correlated with the frequency of sexual activity., Conclusion: Many factors may influence symptoms of the menopause. We found that menopausal status was most strongly associated with most menopausal symptoms, especially hot flashes and sweating. Psychosocial factors also played an important role. A higher frequency of sexual activity negatively correlated with most menopausal symptoms.

Purpose: The factors that affect posttraumatic growth (PTG) in breast cancer survivors have been discussed for many years, but it remains unclear which are most influential. The purpose of this study was to determine the level of PTG and identify associated socio-demographic and clinical factors in Chinese breast cancer survivors., Methods and Sample: A descriptive research design with a convenience sampling method was employed to collect data using the simplified Chinese version of the Posttraumatic Growth Inventory (PTGI-SC). This questionnaire was administered to 1227 participants recruited from eight tertiary hospitals and cancer survivor groups in Beijing between April 2010 and April 2012., Key Results: PTG is present in Chinese breast cancer survivors, with an average PTGI-SC score of 70.18 ± 15.85. There were five variables in the regression model: exercise, other chronic disease, income, education level, and work status. Exercise showed the strongest positive association with PTG after breast cancer. Household income and educational level also positively influenced PTG. Survivors with other accompanying chronic diseases had lower PTG. Retired survivors had the highest PTG, those working had moderate PTG, and those on sick leave had the lowest PTG., Conclusions: PTG is common among Chinese breast cancer survivors. It is positively associated with exercise, income, education, and retirement, and negatively associated with the presence of other chronic diseases and working. The results may provide information on how to promote the development of PTG while nursing breast cancer survivors., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To describe the dynamic changes in posttraumatic growth (PTG) and psychological distress in hospitalized early-stage breast cancer (BC) survivors over a 6-month period., Methods: A longitudinal study design was adopted. The PTG inventory (PTGI) and distress management screening measure were used 3 months after diagnosis, then again at 6 and 9 months after diagnosis. For baseline data, 155 BC patients who were receiving chemotherapy were selected from four first-class tertiary hospitals in Beijing from April 2010 to March 2011 using a purposive sampling method. Of these, 120 BC patients completed the follow-up investigation. A repeated measures analysis of variance, followed by least significant difference post-hoc analysis, was used to compare PTG and psychological distress., Results: The total score of the PTGI was 62.72 ± 14.66 in BC survivors at 3 months after diagnosis.There was a weak negative relationship between PTG and psychological distress (r = –0.282, p<0.001).PTG increased and psychological distress decreased from 3 to 9 months after diagnosis. The PTGI scores were 63.24 ± 14.21, 68.26 ± 15.29, and 70.29 ± 16.07 at 3, 6, and 9 months after diagnosis, respectively, with distress thermometer scores of 3.62 ± 1.98, 2.59 ± 2.00, and 2.51 ± 1.00, respectively., Conclusions: At 3 months after diagnosis, BC survivors develop PTG at a low level while they are receiving chemotherapy. PTG showed a weak negative association with psychological distress. The level of PTG shows an increasing tendency, whereas the degree of psychological distress exhibits a downward trend in the 9 months after diagnosis.

Objective: To collect health information of Beijing middle-aged registered nurses during menopause., Methods: We distributed self-administered questionnaires to 2100 registered nurses aged 40-55 from 20 hospitals in Beijing. The objects of interest were selected by cluster sampling., Results: A total of 1686 questionnaires met the criteria and were used for statistical analysis. The average natural menopause age was 48.68 ± 3.61 years old. We determined that 37.83% of the objects had modified Kupperman Menopausal Index (KMI) scores ≥ 15. The top three menopause symptoms were fatigue (82.72%), irritability (70.24%), and arthralgia/myalgia (69.55%); hot flashes ranked eleventh (30.83%)., Conclusions: A total of 37.83% Beijing middle-aged registered nurses had menopause syndrome, and the top three symptoms were fatigue, irritability, and arthralgia/myalgia., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: Leukemia is the most common pediatric malignancy. Many children with leukemia display behavioral and emotional problems. Promoting children's psychological development and quality of life during hospitalization is an important activity carried out by health professionals., Objective: The objective of this study was to describe the experiences and feelings of Chinese children with leukemia in the hospital., Method: In-depth interviews were conducted with Chinese children with leukemia using a descriptive qualitative research method. The data were analyzed using content analysis., Results: Twenty-nine children with leukemia were interviewed. Almost all children had negative experiences and feelings during the early stage of hospitalization, and there were 3 levels of adaptation that they displayed: inability to adapt to hospitalization, a sense of being compelled to accept hospitalization, and adaptation to hospitalization., Conclusions: Three factors are associated with children's psychological distress, including the duration of treatment, children's personality, and age. Children of a younger age, with more extrovert personalities and who were undergoing longer treatment courses, adapted to hospitalization more easily., Implications for Practice: The findings provide information for health professionals to understand children's psychological status during hospitalization and help nurses to plan individualized psychological care for children.

Background: Patients with chronic liver disease generally have intestinal flora imbalance that is related to the development and worsening of the disease., Objective: The purpose of this study was to evaluate the effects of probiotic yogurt on intestinal flora of patients with chronic liver disease., Methods: A randomized controlled trial, pretest-posttest control group design, was used. Patients were randomized to an experimental group (41 patients) or a control group (40 patients). Patients in the experimental group were given probiotic yogurt (one cup each time, three times per day for 14 days) containing Bacillus bifidus, Lactobacillus acidophilus, Lactobacillus bulgaricus, and Streptococcus thermophilus within 2 hours after meals. Levels of fecal flora, symptoms and signs, and laboratory examination indexes were collected., Results: After intervention, the experimental group had a lower Escherichia coli count and reduced intestinal flora imbalance (p < .05). Comparison of the experimental and control groups after the intervention showed that the former had improved symptoms and signs, including significant improvement in debilitation, food intake, appetite, abdominal distension, and ascitic fluid (p < .05)., Conclusion: Probiotic yogurt reduces the levels of intestinal flora imbalance and has an additional therapeutic effect on patients with chronic liver disease.

Background: Nurses have considerable needs for communication skills training in cancer care because of the general lack of education and training on oncology-specific communication skills in Mainland China., Objectives: To evaluate the effectiveness of an integrated communication skills training program, in which an intensive learning session was combined with practice in the clinical unit to create a supportive ward atmosphere where nurses could practice skills in the workplace and obtain support of head nurses., Methods: To implement the communication skills training for 129 nurses, a quasi-experimental research design with a nonequivalent control group was used. Measures, including basic communication skills, self-efficacy in oncology-specific communication skills, communication outcome expectancies, and self-perceived support for communication, were administered at pretraining evaluation, formative evaluation (1 month after training), and summative evaluation (6 months after training) in the training group. Formative evaluation was not administered in the control group., Results: There was continued significant improvement in the overall basic communication skills, self-efficacy, outcome expectancy beliefs, and perceived support in the training group. No significant improvement was found in the control group over the same period., Discussion: Nurses' communication skills could be developed and consolidated under the integrated communication skills training model. Development of effective interventions to change nurses' negative outcome expectancies in communication with cancer patients is needed in further study.

Aims: The aims of the study were to develop an understanding of caring in nursing from the perspective of cancer patients and attempt to identify the concept of caring in the Chinese cultural context., Background: Caring as a concept remains elusive, the acceptable definitions of the term care have not been reached. The expressions, processes and patterns of caring vary among cultures, but there is a lack of Chinese culture-based study about caring in nursing., Methods: A qualitative research design was used and 20 cancer patients were interviewed using a semi-structured interview guide. A qualitative content analysis was used to identify themes in the data., Results: Three themes emerged from the data, which suggested that caring is delivering care in an holistic way: nurses' caring attitudes and their professional responsibility for providing emotional support, nurses' professional knowledge and their professional responsibility for providing informational support and nurses' professional skills and their professional responsibility for providing practical support. The caring behaviour of nurses as perceived by cancer patients involved the provision of emotional, informational, and practical support and help based on patients' needs. A model of caring in nursing was formulated., Conclusions: Caring in nursing as perceived by cancer patients involves nurses having qualified professional knowledge, attitudes and skills in oncology and providing the informational, emotional and practical supports and help required by cancer patients., Relevance to Clinical Practice: Caring is manifested in nursing actions through nurse-patient communication process. Patients have their inner expectation for nurses' caring behaviour and attitudes and nurses' performance of caring or uncaring behaviour has a direct influence on the feelings of patients. It is necessary for all nurses to continue improving their oncology professional knowledge, attitudes and skills as well as their abilities of offering informational, emotional and practical support and help for their cancer patients.

Aim: This paper reports the findings of a study exploring the experiences and expectations of patients with cancer of supportive communication in the context of Chinese culture., Background: Patients with cancer experience psychological distress, particularly in the initial period after diagnosis. Supportive communication can positively affect their psychological adjustment. Previous studies have reported the functions, contents, types and sources of informational support for patients with cancer in Western studies, but patients from different cultural backgrounds who have cancer might have different preferences in seeking support., Methods: Semi-structured interviews were carried out with a convenience sample of 20 Chinese patients with cancer during 2002. Content analysis was used to identify themes within the data., Findings: Chinese patients with cancer have a substantial need to receive informational and emotional support during the period of their hospitalization. Their support networks include doctors, nurses, family members, relatives and fellow patients. The expectations of support from different sources varied according to the nature of the relationship between patients with cancer and providers of support. Patients were active in seeking information and they perceived communication with doctors, nurses and fellow patients as beneficial. Most would only express emotional needs to their close family members and did not expect healthcare professionals to provide emotional support. However, interviewees perceived the caring behaviours of nurses and the emotional support of fellow patients as two important sources of support., Conclusion: For Chinese patients, coping with illness and misfortune is largely a private and family affair, and most of them did not expect nurses to meet their emotional needs. Nurses should be aware of the type, timing and source of supportive communication that Chinese patients find valuable. This will help them to provide the appropriate support to meet patients' needs.

The aim of this study is to describe the experience and expectations of Chinese cancer patients with regard to the favorable and unfavorable words conveyed by their social support providers. In-depth interviews were conducted with 20 patients with cancer using a qualitative approach, and the data obtained were analyzed using content analysis. The findings indicated that favorable words inspired patients with cancer and raised their hopes. Such words included words expressing positive confirmation of patients' physical condition and mental status, words of encouragement and consolation, discussions of successful cases, information about advanced medical techniques and developments, practical instructions, emotional support from close relatives, confirmation about previous achievements for the family and about one's career, as well as small talk to distract the patient. Unfavorable words were those that weakened the patients' hopes and self-esteem. They included words expressing negative information and pessimistic attitudes, those indicating an overprotective attitude on the part of close relatives, as well as words expressing commiseration, advice, and an underestimation of the patients' suffering without empathy. The findings provide guidelines for nurses to communicate with patients with cancer verbally in a Chinese cultural context, and outline strategies for communication to meet psychologic needs of patients.

The first Chinese Hospital Information Systems (HIS) was used as a pilot project at People's Hospital, of Beijing Medical University (BMU). To assess the computer knowledge, attitudes, and skills of nurses working in the hospital, and to examine the relationships among these factors, 169 staff nurses working on clinical units were surveyed by proportionate stratified random sampling. Computer knowledge, attitudes, and skills were measured, by a nurses' computer knowledge questionnaire (NCKQ), nurses' computer attitude scale (NCAS), and nurses' computer skill scale (NCSS), respectively, developed by the investigators. Data analysis showed that the overall computer knowledge and skills of nurses were at moderate levels and the computer attitudes were neutral. Nurses' computer skills were significantly and positively correlated with both computer knowledge and computer attitudes; however, no significant correlation was found between computer knowledge and computer attitudes. Strategies to enhance nurses' computer knowledge, attitudes, and skills were proposed.

The main organophosphate (OP) resistance mechanism in the Culex pipiens complex is increased activity of esterases A and B. Fourth-stage larvae from 2 field populations of C. pipiens from Gaomi and Kunming, China, were compared for tolerance to parathion, dichlorovos (OP), and bassa (carbamate) insecticides. Both populations were resistant to OPs but not to bassa. Starch gel electrophoresis indicated that elevated esterase activity was correlated with OP resistance. High frequencies of amplified esterase genes B1 and A2-B2 (0.85 and 0.50) were discovered in Gaomi and Kunming, respectively. However, only low levels of gene amplification were detected.

Organophosphate (OP) insecticides have been used widely to control Culex pipiens L. populations and this has led to the emergence of OP-resistance. Predominantly, resistance in Cx. pipiens is caused by over-production of nonspecific esterases, such as Est beta 1(1) and Est alpha 2(1)/beta 2(1). These esterases confer multiple resistance to organophosphorus and carbamate insecticides. To define the esterases in Chinese Cx. pipiens, restriction fragment-length polymorphism analysis was performed at the esterase beta locus. A new esterase haplotype (Est beta 8) was found. Starch gel electrophoresis indicated that Est beta 8 was coelevated with a novel Est alpha 8. This article reports Est alpha 8/beta 8 esterase-mediated resistance in Cx. pipiens complex.