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Introduction: Total knee arthroplasty (TKA) is accompanied by severe postoperative pain, which is reported to be an important cause of chronic pain. Ultrasound-guided adductor canal block (ACB) combined with infiltration between the popliteal artery and posterior capsular of the knee (IPACK) has been proven to have a better effect on relieving acute pain after TKA. However, whether it has a significant effect on the incidence of chronic pain after TKA has not been reported. This trial was designed to investigate the effect of ultrasound-guided ACB combined with IPACK on the incidence and intensity of chronic pain after TKA. Methods: In this prospective, randomized, double-blind, placebo-controlled study, 100 subjects scheduled for TKA were randomly (1:1) divided into two groups: the ropivacaine group and the placebo group. Patients in each group received ultrasound-guided ACB + IPACK procedures with 0.25% ropivacaine or equal volume normal saline. All patients received multimodal analgesia. Pain intensity was assessed using the Numerical Rating Scale (NRS). The primary outcome was the incidence of chronic pain at 3 months after TKA by telephone follow-up. In addition, pain intensity in early resting and mobilized states, chronic pain intensity, the time to first rescue analgesia; opioid consumption; CRP and IL-6 after the operation; length of postoperative hospital stay; and cost of hospitalization and postoperative complications; as well as the function of the knee in the early stage after the operation, were recorded. Results: Ninety-one participants were included in the final analysis. At 3 months, the incidence of chronic pain was 30.4% in the ropivacaine group, significantly lower than 51.1% in the placebo group. Compared with the placebo group, the ACB + IPACK with ropivacaine group had significantly lower pain scores at 4 hours, 8 hours, 16 hours, and 24 hours after the operation; increased the knee range of motion at 8 hours and 24 hours after the operation; and a significantly decreased incidence of chronic pain at 3 months after the operation. During the follow-up period, there were no nerve block-related complications in either group. Conclusion: In the context of multimodal analgesia protocols, ACB combined with IPACK before surgery decreases the incidence and intensity of chronic pain 3 months after TKA compared with placebo injection. In addition, it reduces the NRS scores, whether at rest or during mobilization, and improves knee function within 24 hours after TKA. Trial registration: This trial was registered in the China Clinical Trial Center (registration number ChiCTR2200065300) on November 1, 2022. [ABSTRACT FROM AUTHOR]

The spatial delays of pulmonary tuberculosis (PTB) have been less explored. In this study, a total of 151,799 notified PTB cases were included, with median patient and diagnostic delays of 15 [interquartile range (IOR), 4–35] and 2 (IOR, 0–8) days, respectively. The spatial autocorrelation analysis and spatial–temporal scan statistics were used to determine the clusters, indicating that the regions in the southwestern and northeastern parts of Zhejiang Province exhibited high rates of long-term patient delay (LPD, delay ≥ 15 days) and long-term diagnostic delay (LDD, delay ≥ 2 days). Besides, the Mantel test indicated a moderately positive correlation between public awareness of suspicious symptoms and the LPD rate in 2018 (Mantel's r = 0.4, P < 0.05). These findings suggest that PTB delays can reveal deficiencies in public health education and the healthcare system. Also, it is essential to explore methods to shift PTB knowledge towards real changes in attitude and behavior to minimize patient delay. Addressing these issues will be crucial for improving public health outcomes related to PTB in Zhejiang Province. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether resilience mediates the connection between caregiver burden and hope among caregivers of patients with inflammatory bowel disease (IBD). Design: A cross‐sectional study. Methods: Two hundred patients with IBD were conveniently sampled from two tertiary hospitals in Jiangsu Province, China. The main instruments involved the Zarit Burden Interview, the 10‐item Connor‐Davidson resilience scale, and the Herth Hope Index. We conducted descriptive analysis and Pearson correlations using SPSS 25.0. The PROCESS v3.3 macro analysed the mediating effect. We report the results in line with the STROBE checklist. Results: Caregiver burden was significantly negatively connected with hope and resilience, whereas resilience positively correlated with hope. The mediation role of resilience was significant in the relationship between caregiver burden and hope, with mediating effects accounting for 47.86% of the overall effect. Conclusions: Resilience partially mediates the association between caregiver burden and hope among patients with IBD. This finding highlights the protective role of resilience in undermining caregiver burden and strengthening hope. Implications for Practice: In clinical practice, healthcare providers should perform routine psychological assessments for caregivers of patients with IBD. Furthermore, resilience training should be incorporated into interventions to alleviate caregiver burden and enhance hope. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Behçet's syndrome (BS) is a variant vasculitis that can involve multiple organs with inflammatory manifestations. This study aimed to provide a more comprehensive analysis of the clinical phenotypes and characteristics of BS patients. We enrolled 2792 BS patients referred from China nationwide to Huadong Hospital Affiliated to Fudan University from October 2012 to December 2022. Detailed assessments of demographic information, clinical manifestations, laboratory results, gastroscopy, and medical imaging were conducted. Cluster analysis was performed based on 13 variables to determine the clinical phenotypes, and each phenotype was characterized according to the features of BS patients. A total of 1834 BS patients were included, while 958 invalid patients were excluded. The median age at onset was 31 years (IQR, 24–40 years), and the median disease duration was 10 years (IQR, 5–15 years). Eight clusters were identified, including mucocutaneous (n = 655, 35.7%), gastrointestinal (n = 363, 19.8%), articular (n = 184, 10%), ocular (n = 223, 12.2%), cardiovascular (n = 119, 6.5%), neurological (n = 118, 6.4%), vascular (n = 114, 6.2%), and hematological phenotype (n = 58, 3.2%). Ocular (RR = 1.672 (95% CI, 1.327–2.106); P < 0.001), gastrointestinal (RR = = 1.194 (95% CI, 1.031–1.383); P = 0.018), cardiovascular (RR = = 2.582 (95% CI, 1.842–3.620); P < 0.001), and vascular (RR = = 2.288 (95% CI, 1.600–3.272); P < 0.001) involvement were more prevalent in male BS patients, while the hematological (RR = 0.528 (95% CI, 0.360–0.776); P = 0.001) involvement was more common among female patients. BS presents significant heterogeneity and gender differences. The eight phenotypes of BS patients we propose hold the potential to assist clinicians in devising more personalized treatment and follow-up strategies. Key Points • This cluster analysis divided adult-onset BS into eight clinical phenotypes. • BS demonstrates a high level of clinical heterogeneity and gender differences. • Hematologic phenotypes of BS present distinctive clinical characteristics. [ABSTRACT FROM AUTHOR]

We report a case of Carmi Syndrome in a neonate. Aim: To share our lessons in diagnosis of the case of Carmi Syndrome. Case Report: Carmi Syndrome is an extremely rare autosomal recessive genetic disorder characterized the coexistence of pyloric atresia and junctional epidermolysis bullosa, and with aplasia cutis congenita in approximately 28% patients. In this case, a full-term male neonate was born to a G4P2+1L1 multipara through cesarean section delivery in hospital in a non-consanguineous marriage with 4000mL of II°meconium-stained amniotic fluid. He was found extensive skin loss over lower legs and other parts, with scattered blisters and bilateral microtia. Plain abdominal X-ray revealed a large gastric air bubble with no gas distally. The mother had an intrauterine fetal loss previously for reasons unknown. The dermatologist diagnosed the newborn with Bart Syndrome, while the pediatric surgeon diagnosed congenital pyloric atresia(CPA). The parents refused further treatment and the neonate passed away about 30 hours after birth. Outcome: The neonate passed away about 30 hours after birth. Conclusion: Lessons from this case:①.Rule out Carmi Syndrome in patients with PA, and differentiate Bart syndrome and Carmi Syndrome in patients with abnormal skin manifestations. ②. For rare and/or severe diseases, multidisciplinary teams(MDTs) should be establish. ③. Genetic counseling and prenatal diagnosis are necessary prior to subsequent childbearings. ④.Termination of pregnancy might be contemplated if certain indicators are revealed. [ABSTRACT FROM AUTHOR]

Purpose: 10 mg rivaroxaban is widely used in the Chinese mainland. This study aims to explore the association between 10 mg once daily rivaroxaban and all-cause mortality in patients with nonvalvular atrial fibrillation (NVAF). Methods: This observational study enrolled 1131 NVAF patients at the cardiovascular department of the First Affiliated Hospital of Xi'an Jiaotong University. One-year outcomes included all-cause mortality and bleeding were recorded. Cox proportional hazards models and Kaplan-Meier analysis were utilized in the study. Results: In total, 1131 patients (402 no anticoagulants, and 729 rivaroxaban) were included. Cox proportional hazard analysis demonstrated that low-dose rivaroxaban (10 mg, HR: 0.14, 95% CI:(0.07–0.28), P<0.001; 15 mg, HR: 0.20, 95% CI:(0.09–0.43), P<0.001; 20 mg, HR: 0.22, 95% CI:(0.05–0.96), P = 0.044) exhibited lower mortality risk compared to untreated patients. Conclusions: 10 mg once daily rivaroxaban may provide survival benefits for elderly patients with NVAF. [ABSTRACT FROM AUTHOR]

Aims: The role of maternal genetic factors in the association between high glycated haemoglobin (HbA1c) levels and adverse birth outcomes remains unclear. Materials and Methods: In this study, the maternal HbA1c levels of 5108 normoglycemic pregnant women in China were measured, and A1298C and C677T polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene were genotyped. Results: Elevated HbA1c levels during the second trimester were associated with increased risks of macrosomia, large‐for‐gestational age (LGA), preterm birth (PTB), and reduced gestational age (p < 0.05). Pregnant women with MTHFR A1298C AA or C677T CT + TT genotypes were susceptible to adverse pregnancy outcomes related to HbA1c levels. Among pregnant women with the A1298C AA genotype, each standard deviation (SD) increase in HbA1c levels increased the risk of PTB by 1.32‐times and reduced the gestational age by 0.11 weeks (p < 0.05). For MTHFR C677T CC + TT genotype carriers, higher HbA1c levels were associated with 1.49‐, 1.24‐, and 1.23‐times increased risks of macrosomia, LGA, and PTB, respectively (p < 0.05). A U‐shaped curve for PTB risk in relation to HbA1c levels was observed among the C677T CC + TT participants, with a cut‐off value of 4.58%. Among subjects with the A1298C AA genotype combined with the C677T CT + TT genotype, each SD increase in HbA1c levels was associated with 1.40 and 1.37‐times increased risks of LGA and PTB, respectively. Conclusions: Our findings highlight the importance of glycaemic control during pregnancy and the potential impact of genetic factors on birth outcomes. However, further large‐scale studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: The Hani people, who reside in Yuanyang County, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, rely on rice terrace farming as their primary livelihood. They utilize plants in various traditional ritual practices. The Hani people have categorized the value of plants based on their natural attributes and have refined the ways of using different plants in specific rituals through practical observations and experiences derived from their agricultural culture. Although the plants used in these rituals hold significant cultural value, they have yet to be studied from the perspective of ethnobotany. This study aims to approach the ritual plants using ethnobotanical methods. Methods: Ethnobotanical fieldwork was conducted in 10 villages in Yuanyang County between 2021 and 2023. Data were collected from the local Hani people through semi-structured interviews and participatory observations and 41 informants were interviewed during the field investigations. The frequency of citation (FC) and relative frequency of citation (RFC) were utilized to evaluate the relative importance of ritual plants among the local communities. Results: A total of 36 plant species, belonging to 18 families and 34 genera, were recorded as being used in 11 ritual practices by the Hani people. Rosaceae, Poaceae, and Fabaceae were found to have the highest number of species. Most of the ritual plants used by the Hani people were collected from the wild. FC and RFC analysis showed that the preferred plants for Hani rituals were Rhus chinensis Mill, Oryza sativa L., Phyllostachys sulphurea (Carr.) A. et C. Riv. and Musa basjoo Siebold & Zucc. ex Iinuma. The 11 rituals are all centered around the performance of people, crops and livestock. The Hani people use plants in different rituals mainly based on their biological attributes. Conclusions: Many rituals of the Hani people are closely related to their production and livelihood, and the plants used in these rituals are deeply rooted in Hani's traditional ecological knowledge and beliefs. The Hani people's reverence for nature, respect for life, gratitude towards ancestors, and seeking blessings and disaster prevention for their families, crops, and livestock are all reflected in these rituals and their utilization of ritual plants. The Hani people showcase their agricultural culture in the Honghe Hani Rice Terraces through plant-based ritual performances. Studying ritual plants in the core area of the Hani Rice Terraces is of great significance for protecting the Hani Terrace farming culture. In the future, it is essential to pay more attention to the role of traditional knowledge in biodiversity conservation. [ABSTRACT FROM AUTHOR]

Background. Work engagement and patient-safety outcomes in nursing practice are critically significant. However, most previous studies evaluating antecedents of work engagement and patient-safety outcomes have used cross-sectional designs. Aims. To investigate the effects of job resources (organizational support and leader empowerment) and core self-evaluation on nurses' work engagement and patient-safety outcomes. Methods. This longitudinal study surveyed 2,618 registered nurses from 17 public hospitals in XuZhou, China. Participants completed self-report questionnaires on organizational support, leader empowerment, and core self-evaluation at baseline. Work engagement and patient-safety outcomes were collected 18 months after the baseline. The mixed linear regression and Johnson–Neyman statistical analysis were used to analyze data. Results. Organizational support was an outsize predictor of nurses' work engagement, followed by core self-evaluation and leader empowerment. Organizational support and core self-evaluation were equally crucial for predicting patient-safety outcomes. Moreover, the positive impact of leader empowerment on patient-safety outcomes became significant when the core self-evaluation score was below 51. Conclusions. This study demonstrated that organizational support, leader empowerment, and core self-evaluation are important determinants of nurses' work engagement and patient-safety outcomes. Implications for Nursing Management. Hospital managers and nurse leaders should consider providing multiple supports to motivate staff nurses to engage in work. When nurses' core self-evaluation is low, empowering training for nurse leaders should be essential to reduce adverse patient events. [ABSTRACT FROM AUTHOR]

Background: Among people living with HIV (PLHIV) on antiretroviral therapy (ART), the mortality of immunological non-responders (INRs) is higher than that of immunological responders (IRs). However, factors associated with immunological non-response following ART are not well documented. Methods: We obtained data for HIV patients from the National Free Antiretroviral Treatment Program database in China. Patients were grouped into IRs (CD4 cell count ≥ 350 cells/μl after 24 months' treatment), immunological incomplete responders (ICRs) (200–350 cells/μl) and INRs (< 200 cells/μl). Multivariable logistic regression was used to assess factors associated with immunological non-response. Results: A total of 3900 PLHIV were included, among whom 2309 (59.2%) were IRs, 1206 (30.9%) ICRs and 385 (9.9%) INRs. In multivariable analysis, immunological non-response was associated with being male (2.07, 1.39–3.09), older age [40–49 years (vs. 18–29 years): 2.05, 1.29–3.25; 50–59 years: 4.04, 2.33-7.00; ≥ 60 years: 5.51, 2.84–10.67], HBV co-infection (1.63, 1.14–2.34), HCV co-infection (2.01, 1.01–4.02), lower CD4 + T cell count [50–200 cells/μl (vs. 200–350 cells/μl): 40.20, 16.83–96.01; < 50 cells/μl: 215.67, 85.62-543.26] and lower CD4/CD8 ratio (2.93, 1.98–4.34) at baseline. Compared with patients treated with non-nucleoside reverse transcriptase inhibitors (NNRTIs) based regimens, those receiving protease inhibitors (PIs) based regimens were less likely to be INRs (0.47, 0.26–0.82). Conclusions: We found a sizable immunological non-response rate among HIV-infected patients. Being male, older age, coinfection with HBV and HCV, lower CD4 + T cell count and lower CD4/CD8 ratio are risk factors of immunological non-response, whereas PIs-based regimens is a protective factor. [ABSTRACT FROM AUTHOR]

Background: In many areas of China, over 30% of tuberculosis cases occur among the elderly. We aimed to investigate the spatial distribution and environmental factors that predicted the occurence of tuberculosis in this group. Methods: Data were collected on notified pulmonary tuberculosis (PTB) cases aged ≥ 65 years in Zhejiang Province from 2010 to 2021. We performed spatial autocorrelation and spatial-temporal scan statistics to determine the clusters of epidemics. Spatial Durbin Model (SDM) analysis was used to identify significant environmental factors and their spatial spillover effects. Results: 77,405 cases of PTB among the elderly were notified, showing a decreasing trend in the notification rate. Spatial-temporal analysis showed clustering of epidemics in the western area of Zhejiang Province. The results of the SDM indicated that a one-unit increase in PM2.5 led to a 0.396% increase in the local notification rate. The annual mean temperature and precipitation had direct effects and spatial spillover effects on the rate, while complexity of the shape of the greenspace (SHAPE_AM) and SO2 had negative spatial spillover effects. Conclusion: Targeted interventions among the elderly in Western Zhejiang may be more efficient than broad, province-wide interventions. Low annual mean temperature and high annual mean precipitation in local and neighboring areas tend to have higher PTB onset among the elderly. [ABSTRACT FROM AUTHOR]

Background: Virtual simulation and face-to-face simulation are effective for clinical judgment training. Rare studies have tried to improve clinical judgment ability by applying virtual simulation and face-to-face simulation together. This study aimed to evaluate the effect of an integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program on enhancing nursing students' clinical judgment ability and understanding of nursing students' experiences of the combined simulation. Methods: A sequential exploratory mixed-methods study was conducted in a nursing simulation center of a university in Central China. Third-year nursing students (n = 122) taking clinical training in ICUs were subsequentially assigned to the integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program arm (n = 61) or the face-to-face simulation-only arm (n = 61) according to the order in which they entered in ICU training. Clinical judgment ability was measured by the Lasater Clinical Judgment Rubric (LCJR). Focus group interviews were conducted to gather qualitative data. Results: Students in both arms demonstrated significant improvement in clinical judgment ability scores after simulation, and students in the integrated arm reported more improvement than students in the face-to-face simulation-only arm. The qualitative quotes provided a context for the quantitative improvement measured by the LJCR in the integrated arm. Most of the quantitative findings were confirmed by qualitative findings, including the domains and items in the LJCR. The findings verified and favored the effect of the combination of non-immersive virtual simulation and high-fidelity face-to-face simulation integrated program on enhancing nursing students' clinical judgment ability. Conclusions: The integrated virtual simulation and face-to-face simulation program was feasible and enhanced nursing students' self-reported clinical judgment ability. This integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program may benefit nursing students and newly graduated nurses in the ICU more than face-to-face simulation only. [ABSTRACT FROM AUTHOR]

Background: The insufficient number of general practitioners (GPs) is a major challenge facing China's healthcare system. The purpose of the GP transfer training programme was to provide training for experienced doctors to transition to general practice. However, research on the competencies of GP transfer training trainers in teaching skills in China is limited. This cross-sectional study aimed to examine the baseline familiarity with teaching skills among Chinese GP transfer training trainers. Methods: An online survey was conducted among trainers who participated in the 2021 Sichuan Province General Practice Training Trainer Program. The survey collected data on participants' characteristics and familiarity with 20 skills in three essential teaching knowledge areas: the core functions of primary care (five questions), preparation for lesson plan (four questions), and teaching methods (11 questions). Results: In total, 305 participants completed the survey. Familiarity rates were generally low across all three essential teaching knowledge areas. No significant differences were observed in familiarity rates between the tertiary and secondary hospitals. Conclusion: This study revealed gaps in the teaching skills of GP transfer training trainers in China. These results suggest the necessity for targeted training programs to enhance the teaching skills and competencies of trainers. [ABSTRACT FROM AUTHOR]

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Understanding the intention of community residents to seek help from mental health professionals (MHPs) is essential in targeting interventions that promote the prevention and treatment of depression. This study aimed to investigate the current status of Chinese community populations' depression help-seeking intentions from MHPs and explore factors influencing the intentions. Data were used from a survey conducted in a city in central China (n = 919 aged 38.68 ± 17.34, 72.1% female). Help-seeking intentions, help-seeking attitude, depression stigma, family function and depressive symptoms were measured. The total mean score on the intent to seek help from MHPs was 11.01 ± 7.78 and most of respondents were unwilling to seek professional help. Multiple linear regression showed that participants who were students, held a positive help-seeking attitude and had low personal stigma were more likely to have the intention to seek help from MHPs. It is necessary to utilize effective interventions to improve community residents' intention to seek professional help. These include promoting the importance of seeking professional assistance, optimizing the quality of mental health services and altering residents' prejudice to seeking professional help. [ABSTRACT FROM AUTHOR]

Background: Due to the increasing burden of life-limiting illnesses, the need for palliative care has increased. Nurses' palliative care competence is a vital factor in improving its accessibility. A reliable instrument is needed to measure nurses' competence in providing palliative care. Objective: Our aim was to translate and culturally adapt the Palliative Care Nursing Self-Competence Scale (PCNSC) into the Palliative Care Nursing Self-Competence Scale–Simplified Chinese (PCNSC-SC). Methods: Two cross-sectional studies were conducted after content validity had been confirmed during the instrument's translation and adaption. The convergent validity, construct validity, internal consistency, and homogeneity were evaluated in both the first and second studies. Test-retest reliability was assessed only in the first study. Clinical nurses who had a registered nurse qualification certificate and at least 12 months of work experience from a tertiary hospital in Hubei, China participated in the 2 studies. Results: The PCNSC-SC contains 8 dimensions and 34 items, based on goodness-of-fit indices and confirmatory factor analysis. The Cronbach's alpha of the PCNSC-SC was.984 and.990 in the 2 studies, respectively. The test-retest reliability of the PCNSC-SC after 2 weeks was.717. Conclusion: The PCNSC-SC can be used to evaluate perceived self-competence in palliative care of Chinese nurses with good reliability and validity. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to investigate the role of the family in supporting diabetes self‐management and explore the possible mechanisms between family and diabetes self‐management among rural patients in China. Background: The prevalence of Type 2 diabetes mellitus (T2DM) is growing rapidly in rural areas of China, where healthcare resources remain relatively poor and family members play an important role in chronic disease self‐management. Design: This was a multicentre cross‐sectional study. Methods: A total of 276 adults with T2DM were recruited from nine county hospitals in China. Diabetes self‐management, family support, family function, and family self‐efficacy were evaluated using the mature scales. A theoretical model was built based on the social learning family model and previous studies and then verified using a structural equation model. The STROBE statement was used to standardise the study procedure. Results: Family support and general family factors, including family function and self‐efficacy, were positively correlated with diabetes self‐management. Family support fully mediates the relationship between family function and diabetes self‐management and partially mediates the relationship between family self‐efficacy and diabetes self‐management. The model explained 41% of the variability in diabetes self‐management and had a good model fit. Conclusion: General family factors can explain nearly half of the change in diabetes self‐management in rural areas of China, while family support is a mediator between general family factors and diabetes self‐management. Family self‐efficacy, a potential intervention point of family based diabetes self‐management education, can be improved by building special lessons for family members. Relevance to Clinical Practice: This study emphasises the role of family in diabetes self‐management and proposes suggestions for diabetes self‐management intervention among patients with T2DM in rural areas of China. Patient or Public Contribution: Patients and their family members completed the questionnaire which was used for data collection. [ABSTRACT FROM AUTHOR]

Avian reovirus (ARV) infections, characterized by severe arthritis, tenosynovitis, pericarditis, and poor weight gain, have become increasingly serious in recent years. The economic impact is significant as it causes growth inhibition and immunosuppression. Some commercial poultry in China have been widely vaccinated with available ARV vaccines; however, infections continue to occur even after vaccination. This study aimed to isolate a novel variant, ARV-SD19/11103, from the joint tissues of infected broiler chickens vaccinated with ARV vaccines in Shandong Province. Genetic evolution analysis of the major protective antigen σC gene in ARVs showed that ARV-SD19/11103 was located in the genotype cluster I but not in the same sub-cluster as the S1133 vaccine strain. The amino acid sequence similarity between SD19/11103 and vaccine strains S1133, 1733, and 2408 was <80%. After analyzing the amino acid sequences of the σC protein, 33 amino acid differences were found between the new variant isolate and the vaccine strains. This novel variant showed obvious pathogenicity in specific pathogen-free chicken embryos and chicks and could cause serious disease in chickens vaccinated with commercially available ARV vaccines. Cross-neutralization experiments further demonstrated a significant antigenic difference between the novel variant and genotype cluster I ARV strains. The novel variant strain isolated in this study provides an important theoretical basis for understanding the prevalence and genetic evolutionary characteristics of ARV variant strains in our country. This study identified the causes of ARVs circulating and emphasizes the needs for developing new vaccines against novel ARV variants. [ABSTRACT FROM AUTHOR]

Urban green space accessibility is an essential consideration in determining environmental liveability and the well-being of individuals, and the spatial inequity of urban green space supply and demand has become a research focus. However, few studies have conducted a multidimensional and comprehensive assessment of the influences on accessibility from the different perspectives of supply and demand. To address this, our study centred on the mountainous Chongqing region and established a comprehensive research framework examining the spatial pattern of accessibility of urban green spaces and its correlation with physical geographical elements and socioeconomic factors. We reveal the spatial distribution characteristics of urban green space accessibility by using Gaussian-based two-step floating catchment area and network analysis methods and further observe the spatial clustering features utilising hotspot analysis. The ordinary least squares (OLS) model and the spatial lag model were used to evaluate the physical geographical and socioeconomic disparities. Our findings reveal explicit blind spots in urban green space accessibility, primarily within the 30 min travel threshold in the city's marginal area. A discernible supply–demand imbalance existed in the urban core, constituted by implicit blind spots. Furthermore, we identified that the relationship between urban green space accessibility and elevation under different methods is not always consistently significant over space because spatial heterogeneity may exist. Most concerningly, the study found inequities in urban green space accessibility, particularly impacting vulnerable demographics such as the elderly and lower-income groups. These results can inform urban planners and policymakers about the blind spots of urban green space accessibility and sufficiently consider the physical and socioeconomic heterogeneity of the space to determine where and how to implement inclusive urban greening policies or planning schemes. It is also of great significance in increasing awareness of vulnerable groups and preventing environmental inequality. [ABSTRACT FROM AUTHOR]

Forests, serving as crucial custodians of our planet's ecological balance, also constitute a significant source of livelihood for humanity. Karst regions, recognized as some of the world's most susceptible landscapes, grapple with the dual predicaments of ecological restoration and resident impoverishment. To bridge the gap between environmental and economic concerns, this manuscript employs an amalgamation of remote sensing and socio-economic methodologies to devise a comprehensive assessment framework, thereby scrutinizing the alterations in forest ecosystems from 2001 to 2020.The investigation reveals that over the past two decades, forest rehabilitation within the study area has yielded commendable outcomes, substantially mitigating various ecological dilemmas instigated by rocky desertification in this region. The forested area has increased significantly, and the ecosystem service value has more than doubled. These improvements are largely attributed to compulsory forest conservation measures, demonstrating their decisive influence. The study advocates meticulous management and conservation strategies to safeguard these unique ecosystems and ensure their sustainability. This research underscores the significance of striking a balance between maintaining ecological integrity and fostering economic development, thereby contributing to the broader discourse on sustainable forest management in vulnerable landscapes. [ABSTRACT FROM AUTHOR]

Background: Factory workers are a key population for HIV transmission in China, as they often engage in sexual risk behaviours. This study aims to evaluate sexual risk behaviours and associated factors among factory workers in Shenzhen, China. Methods: A cross-sectional study was conducted by using multi-stage stratified cluster random sampling. Full-time workers aged ≥18 years were eligible to participate in the study. A self-administered questionnaire was used to collect information. Univariate and multivariable logistic regression were applied to assess factors associated with sexual risk behaviours. Results: A total of 2029 factory workers were included. Mean age was 37.2 (±4.4) years; 48.5% were men. Two-thirds (64.9%) had had vaginal intercourse. Their sexual risk behaviours included condomless sex with casual partners in the last sex episode (23.6%), multiple sex partners (11.5%) and engaging in commercial sex (8.4%), in the past year. Having HIV/AIDS knowledge (adjusted odds ratio (AOR) 0.41, 95% confidence interval (CI) 0.24–0.70) and using a condom at sexual debut (AOR 0.08, 95% CI 0.05–0.13) were factors associated with condomless sex with casual partners in the last sex episode. Males (AOR 3.03, 95% CI 1.96–4.69 and AOR 2.19, 95% CI 1.33–3.60), local workers (AOR 2.11, 95% CI 1.01–4.42 and AOR 3.42, 95% CI 1.63–7.21), being single (AOR 2.04, 95% CI 1.39–3.01 and AOR 2.49, 95% CI 1.61–3.87), having sexual debut aged <18 years (AOR 5.98, 95% CI 3.28–10.89 and AOR 3.34, 95% CI 1.74–6.39), and substance use (AOR 2.01, 95% CI 1.38–2.93 and AOR 4.43, 95% CI 2.85–6.87) were associated with both having multiple sex partners and engaging in commercial sex in the past year. Conclusions: Sexual risk behaviours were prevalent despite most participants having basic HIV/AIDS knowledge. Future workplace-based prevention programs should target factory workers and there should be a focus on enhanced sexual education to reduce HIV transmission in China. Sexual transmission has been the main mode of HIV transmission, and data on sexual risk behaviours among factory workers from various industries are scarce in China. Sexual risk behaviours that showed associations with certain characteristics and experience of sexual debut were prevalent among factory workers in Shenzhen, China. There are massive labour forces in China, indicating an urgent need to strengthen sexual health education and promote safer sexual behaviours among factory workers. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), is a major public health issue in China. Nevertheless, the prevalence and drug resistance characteristics of isolates vary in different regions and provinces. In this study, we investigated the population structure, transmission dynamics and drug-resistant profiles of Mtb in Guangxi, located on the border of China.Methods: From February 2016 to April 2017, 462 clinical M. tuberculosis isolates were selected from 5 locations in Guangxi. Drug-susceptibility testing was performed using 6 common anti-tuberculosis drugs. The genotypic drug resistance and transmission dynamics were analyzed by the whole genome sequence.Results: Our data showed that the Mtb in Guangxi has high genetic diversity including Lineage 1 to Lineage 4, and mostly belong to Lineage 2 and Lineage 4. Novelty, 9.6% of Lineage 2 isolates were proto-Beijing genotype (L2.1), which is rare in China. About 12.6% of isolates were phylogenetically clustered and formed into 28 transmission clusters. We observed that the isolates with the high resistant rate of isoniazid (INH, 21.2%), followed by rifampicin (RIF, 13.2%), and 6.7%, 12.1%, 6.7% and 1.9% isolates were resistant to ethambutol (EMB), streptomycin (SM), ofloxacin (OFL) and kanamycin (KAN), respectively. Among these, 6.5% and 3.3% of isolates belong to MDR-TB and Pre-XDR, respectively, with a high drug-resistant burden. Genetic analysis identified the most frequently encountered mutations of INH, RIF, EMB, SM, OFL and KAN were katG_Ser315Thr (62.2%), rpoB_Ser450Leu (42.6%), embB_Met306Vol (45.2%), rpsL_Lys43Arg (53.6%), gyrA_Asp94Gly (29.0%) and rrs_A1401G (66.7%), respectively. Additionally, we discovered that isolates from border cities are more likely to be drug-resistant than isolates from non-border cities.Conclusion: Our findings provide a deep analysis of the genomic population characteristics and drug-resistant of M. tuberculosis in Guangxi, which could contribute to developing effective TB prevention and control strategies. [ABSTRACT FROM AUTHOR]

Cadmium (Cd), a highly toxic heavy metal for crops in China, poses a significant threat to rice cultivation. It is crucial to identify the genotypes with robust resistance to heavy metals, including Cd, in rice. The experiment was conducted to examine the mitigation effect of silicon (Si) on Cd toxicity levels in Se-enriched Z3055B and non-Se-enriched G46B rice genotypes. A basal dose of Si improved the growth and the quality of rice significantly by reducing the Cd content in rice roots, stems, leaves and grains and increased the yield, biomass and selenium (Se) content of brown rice in both genotypes. Additionally, Se content in brown rice and polished rice was notably higher in Se-enriched rice than in non-Se-enriched rice, with the highest amount at 0.129 mg/kg and 0.085 mg/kg, respectively. The results demonstrated that a basal fertilizer concentration of 30 mg/kg of Si was more effective in reducing Cd transport from roots to shoots in Se-enriched rice than in non-Se-enriched rice genotypes. Therefore, it can be concluded that Se-enriched rice genotypes are a viable option for food crop production in Cd-contaminated areas. [ABSTRACT FROM AUTHOR]

Aims: To investigate the relationship between organizational support and nurse managers' burnout and the serial multiple mediating effects of leadership and resilience. Background: Nurse managers are at a high risk of burnout, especially during the COVID‐19 pandemic. However, no research has been done to examine the associations between nurse managers' organizational support, leadership, resilience and burnout. Methods: This cross‐sectional study recruited 458 nurse managers from 13 tertiary public hospitals in Jiangsu, China. They completed the Survey of Perceived Organizational Support, the Clinical Leadership Survey, the Resilience Scale and the Maslach Burnout Inventor‐Human Service Survey. The serial mediating effect of individual leadership and resilience was estimated using the structural equation modelling method via Mplus 7.0. Results: There were direct and indirect effects of organizational support on burnout, controlling for work variables. Leadership and resilience serially mediate the association between organizational support and burnout (β = −.051, 95% confidence interval: −0.093 to −0.020). Conclusions: Among nurse managers, organizational support may be sequentially associated with improved leadership first and then resilience, which in turn is related to decreased burnout. Implications for Nursing Management: We recommend that hospital administrators incorporate leadership, resilience and burnout assessment in the routine psychological screening of nurse managers and creatively apply the organizational interventions to decrease nurse managers' burnout. [ABSTRACT FROM AUTHOR]

Background: Mental illness is a major burden of disease worldwide. Community Mental Health Services (CMHS) are key to achieving community-based recovery for people with mental illness. In China, even though the community management of patients with mental illness is improving, the barriers faced by Community Mental Health Workers (CMHWs) are unclear. This study explores the difficulties and challenges in CMHS from the perspective of CMHWs. The results of this study may provide a practical basis for the training of CMHWs. Methods: We carried out a qualitative study using an empirical phenomenological approach. Nine CMHWs were recruited from nine communities in Wuhan, Hubei Province, using purposive and snowball sampling. Face to face semi-structured in-depth interviews were conducted with them from December 27 to 28, 2019. Interview recordings were converted to text content by Nvivo 11.0 software and analyzed using Colaizzi's phenomenological method. Results: Three main themes were identified in this study: 1) Lack of role orientation leads to role ambiguity, 2) Failure to establish a therapeutic trust relationship with patients, and 3) Lack of communication and collaboration with various departments and peers. Seven sub themes were also identified. In these themes, CMHWs emphasized the importance of role clarity, therapeutic trusting relationships, and effective communication and coordination mechanisms. Conclusion: Although China has made great efforts on the road to improving the quality of CMHS, several salient issues regarding CMHWs must be addressed to optimize the quality of services provided by CMHWs. Community mental health institutions should help CMHWs overcome these difficulties, by maximizing its value and promoting the development of CMHS. [ABSTRACT FROM AUTHOR]

The hot and humid feeling of the urban environment enhances residents' discomfort indices. Although the cooling and humidifying effects of plant communities in various urban parks are significant, there is still insufficient evidence for the effects of plant community characteristics on temperature and humidity. In this study, 36 typical plant communities in the Changchun Water Culture and Ecological Park in China were selected in the summer (21–23 August 2020) from 8:00 to 18:00 for three days when it was sunny and windless. We obtained plant community characteristics through field measurements and drone recordings to explore the relationship between plant community characteristics and the mechanism of temperature and humidity. The study observed that (1) the canopy density and three-dimensional green amount were significantly related to the benefits of cooling and humidification. When the canopy density is between 0.7 and 0.8 and the three-dimensional green volume is above 4 m³/m², the greatest benefit is achieved; (2) the discomfort index is between 0.6 and 0.8, and the three-dimensional green volume is 4 m³/m²–6 m³/m² minimum; and (3) the changes in temperature and humidity are different for different types of plant communities, which lead to differences in people's perceptions of environmental comfort. The tree–grassland and tree–shrub–grass types had the most apparent improvement effects on comfort. The results show that in the design process of urban park plants, emphasis is placed on plant community configuration with apparent cooling and humidification effects, which can improve the comfort of tourists in hot and humid environments. The research results provide theoretical support for sustainable urban green space development. [ABSTRACT FROM AUTHOR]

The losses and damage caused by landslide are countless in the world every year. However, the existing approaches of landslide susceptibility mapping cannot fully meet the requirement of landslide prevention, and further excavation and innovation are also needed. Therefore, the main aim of this study is to develop a novel deep learning model namely landslide net (LSNet) to assess the landslide susceptibility in Hanyin County, China, meanwhile, support vector machine model (SVM) and kernel logistic regression model (KLR) were employed as reference model. The inventory map was generated based on 259 landslides, the training dataset and validation dataset were, respectively, prepared using 70% landslides and the remaining 30% landslides. The variance inflation factor (VIF) was applied to optimize each landslide predisposing factor. Three benchmark indices were used to evaluate the result of susceptibility mapping and area under receiver operating characteristics curve (AUROC) was used to compare the models. Result demonstrated that although the processing speed of LSNet model is the slowest, it still significantly outperformed its corresponding benchmark models with validation dataset, and has the highest accuracy (0.950), precision (0.951), F1 (0.951) and AUROC (0.941), which reflected excellent predictive ability in some degree. The achievements obtained in this study can improve the rapid response capability of landslide prevention for Hanyin County. [ABSTRACT FROM AUTHOR]

Background and aim: Patient deaths are common in the intensive care unit, and a nurse's perception of barriers to and supportive behaviors in end-of-life care varies widely depending upon their cultural background. The aim of this study was to describe the perceptions of intensive care nurses regarding barriers to and supportive behaviors in providing end-of-life care in a Chinese cultural context. Methods: A cross-sectional survey was conducted among intensive care nurses in 20 intensive care units in 11 general hospitals in central and eastern China. Instruments used in this study were general survey and Beckstrand's questionnaire. Data were collected via online survey platform. Descriptive analysis was used to describe general characteristics of participants and mean and standard deviations of the barriers and supportive behaviors. The mean and standard deviation were used to describe the intensity and frequency of each barrier or supportive behavior following Beckstrand's method to calculate the score of barriers and supportive behaviors. Content analysis was used to analyze the responses to open-ended questions. Results: The response rate was 53% (n = 368/700). Five of the top six barriers related to families and the other was the nurse's lack of time. Supportive behaviors included three related to families and three related to healthcare providers. Nurses in the intensive care unit felt that families should be present at the bedside of a dying patient, there is a need to provide a quiet, independent environment and psychological support should be provided to the patient and family. Nurses believe that if possible, families can be given flexibility to visit dying patients, such as increasing the number of visits, rather than limiting visiting hours altogether. Families need to be given enough time to perform the final rites on the dying patient. Moreover, it is remarkable that nurses' supportive behaviors almost all concern care after death. Conclusions: According to ICU-nurses family-related factors, such as accompany of the dying patients and acceptence of patient's imminent death, were found the major factors affecting the quality of end-of-life care. These findings identify the most prominent current barriers and supportive behaviors, which may provide a basis for addressing these issues in the future to improve the quality of end-of-life care. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to describe the prevalence of perceived self‐competence in palliative care among emergency care nurses and explore its predictors. Background: Emergency care nurses have a responsibility to develop palliative care competence to enhance the quality of life of dying patients and their families in the emergency department. Methods: With a convenience sample, a cross‐sectional study was conducted among 415 emergency care nurses from 22 hospitals in China. Descriptive analysis, Spearman correlation analysis and multivariate linear stepwise regression were performed. Results: Variables including marital status (single), emergency department not implementing palliative care, no palliative care training and true cooperation dimension were selected as independent predictors and explained 19.9% of variation in the regression model. Conclusions: Interventions to improve healthy work environments, offering palliative care training, advocating for policies in palliative care and offering support to unmarried nurses can advance nurses' palliative care competence. Implications for nursing management: This is the first study of emergency care nurses in China aimed at identifying predictors associated with palliative care self‐competence. It is significant in that palliative care training and a cooperative work environment are required to encourage the development of palliative care. [ABSTRACT FROM AUTHOR]

Cultivated land resources are important natural resource assets that are related to food security and sustainable development. Due to the many restrictive factors of the karst landform on agricultural production, the quantity and quality of cultivated land in the karst mountainous areas in Southwest China are poor. Reclaiming cultivated land to develop economy or to avoid transitional reclamation to protect ecology is an important proposition in this area. Analyzing changes in the physical and monetary value of cropland resources can help us to formulate more reasonable policies for the development and utilization of cultivated land resources, and to achieve a win-win scenario for economic development and ecological protection. Using multi-source remote sensing data and 20-year landcover data obtained by the GEE platform, this paper evaluated the cropland resources of the karst mountain areas of China at the pixel level. It was found that under the apparent outflow of the physical account of the cultivated land resources, the monetary value still maintained growth, proving that the current cultivated land-use policy in Guizhou Province has significantly improved the value of local cultivated land resources. [ABSTRACT FROM AUTHOR]

Background: Hypertension (HTN) is a global public health concern. However, the association between life events (LEs) and HTN is complex. Thus, we conducted a prospective cohort study to explore this complex association. Methods: A total of 8,077 government employees without HTN were recruited through cluster sampling between 2018 and 2019 in Hunan Province, China. At baseline, information regarding sociodemographic characteristics, LEs, and behavioral factors was collected. After the 1-year follow-up, the participants were revisited to obtain the HTN diagnosis. Crude and adjusted Poisson regression models were constructed to calculate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Cubic regression spline models were used to visualize the trends between LEs and HTN IRRs. Interactive and subgroup analyses were also performed. Results: The 1-year HTN incidence rate among government employees in Hunan province was 4.30% (95% CI: 3.86–4.74%). LEs were associated with a higher HTN risk (IRR, 1.02; 95% CI, 1.00–1.04). When calculating positive and negative LEs scores separately, only the latter was a risk factor for HTN incidence (IRR, 1.04; 95% CI, 1.03–1.06); conversely, positive LEs reduced the risk (IRR, 0.90; 95% CI, 0.85–0.96). Compared with patients in the lowest quartile of LEs score, those in quartiles two (IRR, 1.28; 95% CI, 0.96–1.71), three (IRR, 1.43; 95% CI, 1.04–1.96), and four (IRR, 1.73; 95% CI, 1.26–2.37) were at progressively higher risk. In restricted spline curves, a non-linear association was noted between LEs and HTN risk. Regarding the subcategories of LEs, work-related LEs, personal LEs, and all subcategories of negative LEs were associated with an increased risk of HTN. However, among positive LEs, only the family-related cases were associated with a lower risk of HTN. Conclusion: LEs had a non-linear association with an increased risk of HTN. Negative LEs were risk factors for HTN incidence, whereas positive LEs reduced the risk of HTN. Thus, the importance of LEs should be highlighted in the development of HTN prevention strategies and initiatives. [ABSTRACT FROM AUTHOR]

Background: Nursing professionalism is highly significant to the development of nursing. Florence Nightingale was the founder and leader of modern nursing, and Nightingale's nursing professionalism has a significant impact on nursing in China and all over the world. In the new era, a new understanding of Nightingale's nursing professionalism should be developed, and its positive role in nursing reshaped. Methods: A total of 1,557 nurses and nursing students from 27 provincial administrative regions of China were surveyed using a customized questionnaire. Their recognitions of Nightingale's nursing professionalism were evaluated based on scores, and statistical differences between and within the groups were analyzed using an Analysis of Variance (ANOVA). The elements of Nightingale's nursing professionalism were extracted by the exploratory factor method and a principal component analysis. Results: The Cronbach's α of the questionnaire was 0.965, and the two groups did not differ significantly (p > 0.05). Based on the standard that the cumulative contribution rate of common factor should be > 85%, three common factors of Nightingale's nursing professionalism, including professional emotion, professional ability and professional ethics, were extracted based on the Scree plot. Conclusions: This study aimed to explore the connotation of Nightingale's nursing professionalism. Our survey indicates that Nightingale's nursing professionalism is highly recognized by nurses and nursing students in China. Its connotation includes professional emotion, ability and ethics. Nursing education and nursing management should fully utilize the leading role of Nightingale and guide the professional behaviors of nurses to be consistent with Nightingale's nursing professionalism, thus, improving the degree of nurse professionalism. [ABSTRACT FROM AUTHOR]

Background: The 2019 novel coronavirus (COVID-19)-related depression symptoms of healthcare workers have received worldwide recognition. Although many studies identified risk exposures associated with depression symptoms among healthcare workers, few have focused on a predictive model using machine learning methods. As a society, governments, and organizations are concerned about the need for immediate interventions and alert systems for healthcare workers who are mentally at-risk. This study aims to develop and validate machine learning-based models for predicting depression symptoms using survey data collected during the COVID-19 outbreak in China. Method: Surveys were conducted of 2,574 healthcare workers in hospitals designated to care for COVID-19 patients between 20 January and 11 February 2020. The patient health questionnaire (PHQ)-9 was used to measure the depression symptoms and quantify the severity, a score of ≥5 on the PHQ-9 represented depression symptoms positive, respectively. Four machine learning approaches were trained (75% of data) and tested (25% of data). Cross-validation with 100 repetitions was applied to the training dataset for hyperparameter tuning. Finally, all models were compared to evaluate their predictive performances and screening utility: decision tree, logistics regression with least absolute shrinkage and selection operator (LASSO), random forest, and gradient-boosting tree. Results: Important risk predictors identified and ranked by the machine learning models were highly consistent: self-perceived health status factors always occupied the top five most important predictors, followed by worried about infection, working on the frontline, a very high level of uncertainty, having received any form of psychological support material and having COVID-19-like symptoms. The area under the curve [95% CI] of machine learning models were as follows: LASSO model, 0.824 [0.792–0.856]; random forest, 0.828 [0.797–0.859]; gradient-boosting tree, 0.829 [0.798–0.861]; and decision tree, 0.785 [0.752–0.819]. The calibration plot indicated that the LASSO model, random forest, and gradient-boosting tree fit the data well. Decision curve analysis showed that all models obtained net benefits for predicting depression symptoms. Conclusions: This study shows that machine learning prediction models are suitable for making predictions about mentally at-risk healthcare workers predictions in a public health emergency setting. The application of multidimensional machine learning models could support hospitals' and healthcare workers' decision-making on possible psychological interventions and proper mental health management. [ABSTRACT FROM AUTHOR]

Background: People with suicidal ideation post suicide-related information on social media, and some may choose collective suicide. Sina Weibo is one of the most popular social media platforms in China, and "Zoufan" is one of the largest depression "Tree Holes." To collect suicide warning information and prevent suicide behaviors, researchers conducted real-time network monitoring of messages in the "Zoufan" tree hole via artificial intelligence robots. Objective: To explore characteristics of time, content and suicidal behaviors by analyzing high suicide risk comments in the "Zoufan" tree hole. Methods: Knowledge graph technology was used to screen high suicide risk comments in the "Zoufan" tree hole. Users' level of activity was analyzed by calculating the number of messages per hour. Words in messages were segmented by a Jieba tool. Keywords and a keywords co-occurrence matrix were extracted using a TF-IDF algorithm. Gephi software was used to conduct keywords co-occurrence network analysis. Results: Among 5,766 high suicide risk comments, 73.27% were level 7 (suicide method was determined but not the suicide date). Females and users from economically developed cities are more likely to express suicide ideation on social media. High suicide risk users were more active during nighttime, and they expressed strong negative emotions and willingness to end their life. Jumping off buildings, wrist slashing, burning charcoal, hanging and sleeping pills were the most frequently mentioned suicide methods. About 17.55% of comments included suicide invitations. Negative cognition and emotions are the most common suicide reason. Conclusion: Users sending high risk suicide messages on social media expressed strong suicidal ideation. Females and users from economically developed cities were more likely to leave high suicide risk comments on social media. Nighttime was the most active period for users. Characteristics of high suicide risk messages help to improve the automatic suicide monitoring system. More advanced technologies are needed to perform critical analysis to obtain accurate characteristics of the users and messages on social media. It is necessary to improve the 24-h crisis warning and intervention system for social media and create a good online social environment. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to describe the experiences of nurses and other health care workers who were infected with coronavirus disease 2019. Methods: An empirical phenomenological approach was used. Sixteen participants were recruited in Wuhan using purposive and snowball sampling. Semistructured, in‐depth interviews were conducted by telephone in February 2020. Interviews were transcribed verbatim and analysed following Colaizzi's method. Results: Two themes emerged: (1) Intense emotional distress since becoming infected. Participants were fearful of spreading the virus to family and overwhelmed by a lack of information, experienced uncertainty and worried about treatment, felt lonely during isolation and reported moral distress about inadequate health care staffing. (2) Coping strategies were needed. They tried their best to address negative psychological reactions using their professional knowledge and gaining support from others and community resources. Conclusions: Preparedness for catastrophic events and providing timely and accurate information are major considerations in government policy development, related to pandemics and adequacy of health care personnel. Mental health resources and support, both short‐ and long‐term should be anticipated for health care providers to alleviate their fear and anxiety. Summary statement: What is already known about this topic? Health care workers, including nurses, are at the frontlines of the COVID‐19 outbreak and at high risk of infection.Experts have called for infection prevention for health care providers.Limited research has reported the experiences of health care workers infected by COVID‐19 using an empirical phenomenological approach. What this paper adds? Upon diagnosis, nurses and other health care workers experienced fear, uncertainty and distress like general patients.Health care workers reported moral distress about inadequate health care staffing issues.Health care workers could cope with their negative psychological reactions using professional knowledge and support from significant others and the community. The implications of this paper: Preparedness for large‐scale pandemics and a system that can provide openness and timely information needs consideration in policy development.Accurate information and good communication are vital to support infected health care workers and enhance their sense of safety and belonging.Long‐term support should be available when these health care workers return to work. [ABSTRACT FROM AUTHOR]

This study aimed to explore whether there were differences in suicidal ideation at different time points among sexual minority men (SMM) within five years of HIV diagnosis, and to investigate the influence of time and psychosocial variables on suicidal ideation. This was a five-year follow-up study focusing on the suicidal ideation among HIV-positive SMM who were recruited when they were newly diagnosed with HIV. Suicidal ideation and psychosocial characteristics including depression, anxiety, HIV-related stress, and social support were assessed within one month, the first year, and the fifth year after HIV diagnosis. A total of 197 SMM newly diagnosed with HIV completed three-time point surveys in this study. The prevalence of suicidal ideation was 27.4%, 15.7%, and 23.9% at one month, the first year, and the fifth year after HIV diagnosis, respectively. The risk of suicidal ideation was lower in the first year than baseline, but there was no significant difference between the fifth year and baseline. Emotional stress and objective support independently predicted suicidal ideation and they had interactions with time. The suicidal ideation of SMM newly diagnosed with HIV decreased in the first year and then increased in the fifth year, not showing a sustained decline trend in a longer trajectory of HIV diagnosis. Stress management, especially long-term stress assessment and management with a focus on emotional stress should be incorporated into HIV health care in an appropriate manner. In addition, social support should also be continuously provided to this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Internet gaming disorder (IGD) has become a serious public health problem in East Asia, and studies have reported IGD to be significantly associated with anxiety, but no causal relationship between the two has yet been demonstrated. Children are at high risk of developing IGD, however, previous studies have principally focused on the condition in adults and adolescents and reported non-clinical samples. A large-scale survey is needed to research and evaluate IGD and anxiety in children and adolescents to understand the current situation of IGD in children and explore the impact of IGD on anxiety. Methods: A cross-sectional study using an online questionnaire was conducted between March 1 and July 31, 2021. A total of 10,479 school children and adolescents in the western provinces of China were selected by convenience sampling. A questionnaire was used to collect data anonymously. The questionnaire covered IGD and the Revised Children's Manifest Anxiety Scale (RCMAS). Welch's ANOVA Test and Games-Howell test were used to test for differences in anxiety levels between IGD groups. Poisson regression analysis was used to further investigate the key predictors of IGD. Results: 3.2% of participants (n = 334) (95% CI: 2.9–3.2%) were classified as at high risk of presenting with IGD, 71.1% (n = 7,454) (95% CI: 70.3–72.0%) were classified as low-risk players, and 25.7% (n = 2,691) (95% CI: 24.9–26.5%) were classified as non-gaming. The average RCMAS score was (7.18 ± 7.534). The high-risk group had a higher total score RCMAS, as well as scoring higher in its three dimensions. Regression analysis using gender, age, and total RCMAS score as independent variables, and risk of IGD as a dependent variable showed that the odds ratio (OR) for gender was 2.864 (95% CI: 2.267–3.618), and the OR for total RCMAS score was 1.101 (95% CI: 1.087–1.114). The OR for age was not statistically significant. Conclusion: Anxiety was a predictor of IGD, with statistically significant group differences in total anxiety, as well as the dimensions of physiological anxiety, social correlation, and sensitivity. The timely assessment of anxiety in children and adolescents, training social skills, and facilitating effective integration into society could be effective ways of reducing the incidence and impact of IGD. [ABSTRACT FROM AUTHOR]

Background. Traditional Chinese medicine Smilax is the rhizome of liliaceous plant Smilax china L., which is used to treat pelvic inflammatory disease and anxieties. Purpose. To investigate the mechanism of anti-inflammatory activity of the extract from Smilax china L. (ES). Methods. The components of ES were identified by UPLC-QTOF-MS/MS. The anti-inflammatory activities were evaluated in xylene-induced ear oedema and egg white-induced plantar swelling test. Cell viability was examined by CCK-8 assay. The inflammatory mediators, proinflammatory cytokines, and MAPK and NF-κB signals in LPS-stimulated THP-1 cells were determined using ELISA, real-time PCR, and Western blot, respectively. Results. 20 compounds of ES were confirmed by comparing with the reference substance. ES displayed more prominent anti-inflammatory activity than the positive control "Jin Gang Teng" capsule in the in vivo acute inflammatory model. ES suppressed the expression of PGE2 and 6-Keot-PGF1α, and the ratio of IC50 (COX-1)/IC50 (COX-2) of ES was 3.15, which indicated that ES could selectively inhibit COX-2. ES dose-dependently (12.5, 25, and 50 mg/L) decreased the production and mRNA levels of proinflammatory cytokines IL-1β, IL-6, and TNF-α. Furthermore, ES significantly decreased LPS-induced phosphorylation of p38, JNK, ERK1/2, and p65, inhibiting the expression of IKKα and the degradation of IκBα. Conclusion. The results suggested that ES could selectively inhibit the activity of COX-2, and the anti-inflammatory effect of ES was associated with the inhibition of IL-1β, IL-6, and TNF-α via negative regulation of MAPK and NF-κB signaling pathways in LPS-induced THP-1 cells. [ABSTRACT FROM AUTHOR]

"Zou Fan" is currently the largest "tree hole" on Weibo, where people having suicidal ideation often express their thoughts and use this channel to seek support. Therefore, early suicide monitoring and timely crisis intervention based on artificial intelligence technology are needed for this social media user group. This research was based on the knowledge graph technology, whereby "Tree Hole Intelligent Agent" (i.e., Artificial Intelligence Program) was used to identify "Zou Fan Tree Hole" users at high risk for suicide, and then, the "Tree Hole Action" carried out proactive suicide crisis intervention with them. The "Tree Hole Action" has temporarily prevented 3,629 potential suicides. The "Tree Hole Action" plays a significant role in suicide risk monitoring and crisis intervention for social media users and has been seen to have an important social impact. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the relationships and the underlying mechanisms between work stress and mental health problems, and potential mediation effects through job dissatisfaction in a working population. Methods: A large population-based study among workers in China was conducted. The self-reported scales of assessing job dissatisfaction and work stress were included in the questionnaire. Generalized Anxiety Disorder-2 and Patient Health Questionnaire-2 were used for assessment of mental health. Univariate logistic regression was conducted to test the associations between work stress and mental health. Path analysis was conducted to test the proposed mediation model. Results: Of the 6,190 included employees, 27.72% reported that they perceived work stress, 14.84% of them reported that they were not satisfied with their work, 5.01% of the employees reported depressive symptoms, and 3.75% of the employees reported anxiety symptoms. The results of univariate logistic regression showed that employees who perceived work stress were more likely to report anxiety symptoms (adjusted odds ratio (AOR) = 2.78; 95% CI: 2.03–3.79) or depressive symptoms (AOR = 1.61; 95% CI: 1.22–2.12). The path analysis showed that work stress was positively associated with job dissatisfaction. Job dissatisfaction mediated the relationship between work stress and mental health problems among Chinese working adults. Conclusion: This study suggests the importance of psychosocial work environment for mental health among Chinese working adults. Work dissatisfaction is a stressor that may induce negative consequences on the mental health among Chinese workers. Interventions to help workers with stress management may be beneficial for their mental health. [ABSTRACT FROM AUTHOR]

Background: The Pittsburgh Sleep Quality Index (PSQI) has been a widely used instrument measuring sleep quality among people living with HIV (PLWH) in China while its psychometric properties have yet to be examined in this population. We aimed to assess the reliability and validity of the Chinese version of PSQI in PLWH and identify factors associated with sleep quality. Methods: This study was based on a longitudinal study of newly diagnosed PLWH, among whom the PSQI was used to measure sleep quality 5 years after HIV diagnosis (n = 386). To evaluate internal consistency, Cronbach's alpha and corrected item-total correlation were calculated. To assess construct validity, Pearson's correlation coefficients were calculated between PSQI scores and depression, anxiety, stress, and health-related quality of life (HRQoL). Known group validity was evaluated by comparing PSQI scores between participants with probable depression and those without. Binary logistic regression was conducted to identify factors associated with sleep disturbances. Results: The internal consistency Cronbach's alpha for the Chinese version of PSQI in PLWH was 0.713. Construct validity was established by significant relationships between PSQI and depression, anxiety, stress, and HRQoL. The PSQI scores in participants with probable depression were significantly higher than those without, indicating good known-group validity. Sleep disturbances were associated with less income, higher CD4 counts, antiretroviral treatment (ART) initiation, exercise, depression, and higher stress levels. Conclusions: The Chinese version of PSQI is feasible for use among Chinese PLWH. Over a third of PLWH reported sleep disturbances. More attention should be given to individuals with less income and on ART. Intervention aimed at improving mental health or facilitating exercise may improve sleep quality. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the demographics, clinical aspects, and major organ involvement of patients with late-onset Behçet's syndrome (BS) in a tertiary center in China. Methods: We conducted a cross-sectional study of consecutive BS patients in Huadong Hospital of Fudan University from September 2012 to January 2020. We compared clinical variables between patients with disease onset before and after 40 years of age. The relative risks (RRs) of clinical variables were calculated between the two age groups. Moreover, a hierarchical cluster analysis was conducted according to 29 variables to determine homogeneous subgroups in patients with late-onset BS. Results: We enrolled 152 late-onset BS patients, with a median age at onset of 47 years (interquartile range, IQR: 43–52 years). There is a higher prevalence of intestinal ulcers in late-onset BS than in early-onset BS (RR 1.47), but a lower prevalence of ocular involvements (RR 0.54) and folliculitis (RR 0.46). Female sex was associated with genital ulcers, erythema nodosum, and arthritis. Four clusters (C1–C4) were formed. C1 (n = 71), the largest cluster, was defined as the mucocutaneous group, C2 (n = 20) as the arthritis group, C3 (n = 39) as the gastrointestinal group, in which all patients presented with intestinal lesions, and five cases with esophageal ulcers. In C4 (n = 22), showing a mixture of uveitis and vascular lesions, 15 patients presented with uveitis and 8 had vascular lesions, and 1 case had central nervous system lesions. Conclusion: Four phenotype clusters were identified. Patients with skin lesions comprised the largest cluster, while gastrointestinal, panuveitis, and cardiovascular clusters are the most commonly involved organs in late-onset BS patients. Key Points • Our analysis demonstrated the phenotype discrepancy between early and late onset groups. • Four phenotype clusters were identified, with gastrointestinal, panuveitis and cardiovascular clusters representing commonly involved organs. [ABSTRACT FROM AUTHOR]

Background: About 83,000 COVID-19 patients were confirmed in China up to May 2020. Amid the well-documented threats to physical health, the effects of this public health crisis - and the varied efforts to contain its spread - have altered individuals' "normal" daily functioning. These impacts on social, psychological, and emotional well-being remain relatively unexplored - in particular, the ways in which Chinese men and women experience and respond to potential behavioral stressors. Our study investigated sex differences in psychological stress, emotional reactions, and behavioral responses to COVID-19 and related threats among Chinese residents.Methods: In late February (2020), an anonymous online questionnaire was disseminated via WeChat, a popular social media platform in China. The cross-sectional study utilized a non-probabilistic "snowball" or convenience sampling of residents from various provinces and regions of China. Basic demographic characteristics (e.g., age and gender) - along with residential living arrangements and conditions - were measured along with psychological stress and emotional responses to the COVID-19 pandemic.Results: Three thousand eighty-eight questionnaires were returned: 1749 females (56.6%) and 1339 males (43.4%). The mean stress level,as measured by a visual analog scale, was 3.4 (SD = 2.4) - but differed significantly by sex. Besides sex, factors positively associated with stress included: age (< 45 years), employment (unsteady income, unemployed), risk of infection (exposureto COVID-19, completed medical observation), difficulties encountered (diseases, work/study, financial, mental), and related behaviors (higher desire for COVID-19 knowledge, more time concerning on the COVID-19 outbreak). "Protective" factors included frequent contact with colleagues, calmness of mood comparing with the pre-pandemic, and psychological resilience. Males and females also differed significantly in adapting to current living/working, conditions, responding to run a fever, and needing psychological support services.Conclusions: The self-reported stress of Chinese residents related to the COVID-19 pandemic was significantly related to sex, age, employment, resilience and coping styles. Future responses to such public health threats may wish to provide sex- and/or age-appropriate supports for psychological health and emotional well-being to those at greatest risk of experiencing stress. [ABSTRACT FROM AUTHOR]

Background Tuberculosis (TB) is an important public health problem in China and environmental and genetic factors have an impact on its occurrence and development. We explored the relationship between environmental factors, genetic susceptibility genes and gene–environment interactions and the incidence of TB, as well as their high-risk combination, which can provide a scientific basis for prevention of the disease. Methods The 242 individuals, which included 82 TB patients, 67 family genetically related patients and 93 healthy controls, all of whom were of the Han population in Guangdong Province. The basic information of subjects was collected, including general conditions, behaviour habits, family environmental factors and blood samples. Two single nucleotides with potential functions (interleukin-10 [IL-10] rs1800896, interferon-γ [IFN-γ] rs2430561) were screened by bioinformatics tools and identified by polymerase chain reaction–restriction fragment length polymorphism. Results We found that gender, education, TB exposure history, fitness activities, residential areas and indoor hygiene conditions were all associated with the occurrence of TB. In the dominant model, AG+GG of IL-10 and AA of IFN-γ are high-risk genotypes. Multifactor dimensionality reduction (MDR) analysis of TB-prone families shows that a combination of male sex, IL-10 AA and AG genotypes and smoking history are elements of high risk for TB infection (prediction accuracy 62.45%, cross-validation consistency 10/10). The MDR analysis of the TB patients group and the healthy control group showed that the combination of low education level, history of TB exposure, and IFN-γ AA genotype represented a higher risk of TB infection (prediction accuracy 80.34%, cross-validation consistency 10/10). Conclusions The occurrence of TB in TB-prone families in the Han population of Guangdong Province is related to environmental factors as well as cytokines IL-10 and IFN-γ. We also found high-risk combinations of genes and environmental factors, providing clues for the timely detection of high-risk groups. [ABSTRACT FROM AUTHOR]

Since 2011, China has implemented a large‐scale public housing programme, constructing tens of millions of apartments to cope with increasing housing shortages and difficulties. Using the case study of Changsha, this study explored the likely fate of this inchoate but significant social policy initiative. We propose a ghettoisation framework for the underlying and interrelated socio‐economic mechanisms that produce and maintain the problem‐ridden public housing development. By applying the analysis framework, this study assessed the status of physical, economic and social decay in public rental housing in Changsha. It is concluded that Chinese public housing projects foster physical dilapidation, economic deprivation and social marginalisation and, at the extreme, may be turned into urban ghettos similar to those found in many other countries, if this downward spiral of physical, economic and social decay persists. Chinese city governments have been aware of the physical dilapidation of public rental housing and have endeavoured with physical improvement and upgradation and government procurement of operation and management services. However, these endeavours are doomed to eventually be fruitless without systematic amelioration of economic and social decay. This study can be applied to worldwide cities with public housing development programmes, by guiding policymakers to advocate for concentrated efforts in problem‐ridden projects and for broader, system‐wide reforms to prevent the worst case scenario of ghettoisation. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that the outbreak of infectious diseases would result in mental health problems. Females are in greater risk for psychological problems than males. The present study investigated gender differences of depression and anxiety and explored associated factors during the COVID-19 epidemic among Chinese social media users.Methods: We recruited 3088 participants through social media cross China. Participants completed sociodemographic and the COVID-19 epidemic related questions, the 2-item Patient Health Questionnaire (PHQ-2), and the 2-item Generalized Anxiety Disorder Scale (GAD-2), the Chinese version of the 10-item Connor-Davidson Resilience Scale. We applied Chi-square test and ANOVA for data description and linear regression analysis for exploring factors associated with depression and anxiety.Results: Of 3063 participants eligible for analysis, the total prevalence of depression and anxiety was 14.14 and 13.25%. Females were experiencing more severe stress and anxiety symptoms, while males showed better resilience to stress. The severity of depression symptoms would decrease with the increase of age resilience, and it would increase if being unemployed, feeling less adapted, being more stressed. The severity of anxiety symptoms would decrease with higher education and better resilience, and it would increase if being female, spending over 60 min on COVID-19 related information, less adapted, and being more stressed.Conclusion: The findings show the increased prevalence of depression and anxiety in Chinese population during the COVID-19 epidemic, and females are experiencing more severe anxiety symptoms than males. As social media is the current main resource of information related to COVID-19, interventions should be implemented to help users to limit the time they spend on social media and to get key information related to the epidemic from authoritative and authentic resource to avoid infodemic and prevent mental health problems. [ABSTRACT FROM AUTHOR]

We examine the informativeness of short selling in the Chinese stock market based on monthly and daily short-interest data from January 2011 to July 2018. We find that short selling negatively predicts future stock returns in China. The pattern is robust when controlling for firm size, book-to-market ratio, and liquidity. A long-short strategy using a short-interest ratio (SIR)—shares shorted to shares outstanding—generates a 0.865% monthly return. We also document that return predictability is stronger when short selling is restricted. Meanwhile, we examine the information content of short-selling activity, and we confirm that the significant negative relationship between preannouncement short activity and post-announcement period returns. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: No studies have been performed to examine the association of sexual activity and pelvic floor muscle (PFM) morphology or function during pregnancy. The aim of this study was to survey the frequency of sexual intercourse and examine the associations between the frequency of sexual intercourse and the PFM morphology in pregnant women of mainland China. The relationship between sexual intercourse frequency and stress urinary incontinence (SUI)-related symptoms was also evaluated. Methods: Pregnant women in their first or second trimester were enrolled from January 2017 and November 2017. The morphology of the PFM was examined by transperineal ultrasound, and SUI-related symptoms were assessed by the International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF). Multivariable regression analyses were used to estimate coefficients [95% confidence intervals (CI)] with adjustment for the possible effects of cofounders. Results: In total, 323 pregnant women (mean age, 29.66 ± 4.32 years) were included in the analysis. Almost 49% of the women had no sexual intercourse during pregnancy. Compared with pregnant women who had no sexual intercourse, those who had sexual intercourse more than once a month had stronger LA th at rest (β = 0.59, P = 0.004 for two or three times per month; β = 0.59, P = 0.044 for weekly or more). No significant relationship was found between the frequency of sexual intercourse and any ICIQ-SF-related items. Conclusions: Chinese women had inactive sexual intercourse during pregnancy. There is a slight association between increased sexual intercourse frequency and a thicker levator ani muscle in pregnant women. Future work may be directed at determining the causality of this association. [ABSTRACT FROM AUTHOR]

Rapeseed is the major oil crop with the largest planting area in China. However, its productivity and cultivation area are severely affected by low temperature (LT) stress. This review summarized research progresses on evaluation of LT tolerance, molecular mechanisms of LT responses in rapeseed, and breeding of novel rapeseed variety with LT resistance. The application of genome wide association study (GWAS) and multi-omics in ongoing LTrelated research were highlighted, which had theoretical significance in exploring genetic resources for LT resistance, and elucidating regulation mechanism of LT response in rapeseed. [ABSTRACT FROM AUTHOR]

Cold treatment (vernalization) is required for winter crops such as rapeseed (Brassica napus L.). However, excessive exposure to low temperature (LT) in winter is also a stress for the semi-winter, early-flowering rapeseed varieties widely cultivated in China. Photosynthetic efficiency is one of the key determinants, and thus a good indicator for LT tolerance in plants. So far, the genetic basis underlying photosynthetic efficiency is poorly understood in rapeseed. Here the current study used Associative Transcriptomics to identify genetic loci controlling photosynthetic gas exchange parameters in a diversity panel comprising 123 accessions. A total of 201 significant Single Nucleotide Polymorphisms (SNPs) and 147 Gene Expression Markers (GEMs) were detected, leading to the identification of 22 candidate genes. Of these, Cab026133.1, an ortholog of the Arabidopsis gene AT2G29300.2 encoding a tropinone reductase (BnTR1), was further confirmed to be closely linked to transpiration rate. Ectopic expressing BnTR1 in Arabidopsis plants significantly increased the transpiration rate and enhanced LT tolerance under freezing conditions. Also, a much higher level of alkaloids content was observed in the transgenic Arabidopsis plants, which could help protect against LT stress. Together, the current study showed that AT is an effective approach for dissecting LT tolerance trait in rapeseed and that BnTR1 is a good target gene for the genetic improvement of LT tolerance in plant. [ABSTRACT FROM AUTHOR]