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Purpose: To examine if the association between age and post-stroke cognition is mediated by apathy. Methods: A cross-sectional investigation was carried out with 389 stroke survivors and informants. Data were collected through the Apathy Evaluation Scale (AES-C) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Bivariate analyses were conducted between the IQCODE total score and each of the demographic and clinical characteristics as well as apathy, while Baron and Kenny's 4-step approach was used to examine the mediating effect of apathy on the association between age and post-stroke cognition. Results: Participants were aged 64.3 years on average, with a mean IQCODE score of 97.6 (SD: 14.8) and a mean AES-C score of 41.3 (SD: 8.0). IQCODE scores were positively correlated with age (r = 0.32, p < 0.001) and apathy (r = 0.54, p < 0.001). Apathy contributed to 24% of the total effect of age on post-stroke cognition, exerting a significant mediating effect on the relationship between age and post-stroke cognition. Conclusions: Apathy may have a significant impact on the cognitive health of stroke survivors. Therefore, the early identification of apathy symptoms could facilitate consideration of potential interventions, such as multisensory and cognitive stimulation, designed to improve cognitive outcomes in this population. IMPLICATIONS FOR REHABILITATION: Cognitive impairment after stroke is common and has negative impacts on survivors' rehabilitation and quality of life. Ageing survivors are prone to mood disorders which may be associated with poorer cognitive outcomes. Apathy was found to significantly mediate the relationship between age and post-stroke cognition. Psychological assessments should be carried out regularly to improve cognitive outcomes through the timely recognition and management of apathy. [ABSTRACT FROM AUTHOR]

Background: Most stroke survivors face restrictions in functional disability and social participation, which can impede their recovery and community reintegration. Participation self-efficacy refers to survivors' confidence in using strategies to manage participation in areas including community living and work engagement. This study aimed to assess the association between participation self-efficacy and participation among stroke survivors.Methods: This study adopted a cross-sectional correlational design with a convenience sample of 336 stroke survivors recruited from five hospitals in China. Participation self-efficacy was measured using the Chinese version of the Participation Strategies Self-Efficacy Scale (PS-SES-C) and participation measured using the Chinese version of the Reintegration to Normal Living Index (RNLI-C). The association between participation self-efficacy and participation was examined using multiple regression analysis with adjustment for potential confounders.Results: Participants had a mean age of 69.9 ± 11.5 years, with most (81.6%) having an ischaemic stroke, and more than half (61.6%) a first-ever stroke. After adjustment for potential confounders, every 10-point increase in the PS-SES-C total score was significantly associated with an average 1.3-point increase in the RNLI-C total score (B = 1.313, SE = 0.196, p < 0.001).Conclusions: This study demonstrates that participation self-efficacy is significantly associated with participation among Chinese community-dwelling survivors of a mild or moderate stroke. This suggests that rehabilitation programmes for stroke survivors may be more effective if they incorporate participation-focused strategies designed to enhance self-efficacy. (229 words). [ABSTRACT FROM AUTHOR]

To examine the psychometric properties of a Chinese version of the Participation Strategies Self-Efficacy Scale (PS-SES) among stroke survivors. The PS-SES was translated into Chinese. A cross-sectional descriptive study was conducted with 336 stroke survivors recruited from the neurology departments of five hospitals in China. Reliability, concurrent validity, and construct validity of the scale were determined. The Chinese version of the PS-SES (PS-SES-C) showed good internal consistency and test–retest reliability, with a Cronbach's α of 0.98 and an intraclass correlation coefficient of 0.79. There was a moderate to strong positive correlation between the PS-SES-C and Chinese version of the General Self-Efficacy Scale (r = 0.59, p <.001), positive correlations between the PS-SES-C and Chinese versions of the Modified Barthel Index (r = 0.59, p <.001), Rivermead Mobility Index (r = 0.70, p <.001), and Reintegration to Normal Living Index (r = 0.70, p <.001), and a negative correlation between the PS-SES-C and National Institutes of Health Stroke Scale (r = −0.63, p <.001). Known-group validity and factorial validity were also supported. The PS-SES-C is a reliable and valid instrument for assessing self-efficacy in managing the participation of Chinese stroke survivors. Self-efficacy significantly predicts activity and participation in stroke survivors and is a major outcome measure in many stroke rehabilitation programmes. The translated Chinese version of the Participation Strategies Self-efficacy Scale is a valid and reliable tool to evaluate stroke survivors' self-efficacy in managing participation. The Chinese version of the Participation Strategies Self-efficacy Scale can be used to assess stroke recovery among the Chinese population in clinical and research settings. [ABSTRACT FROM AUTHOR]

Background: The emergence of COVID-19 has been an ordeal for nurses worldwide. It is crucial to understand their experiences at the frontline, attempt to allay their concerns, and help inform future pandemic response capabilities. Aims: To explore nurses' lived experiences at the frontline in order to identify and address their concerns and help enhance future responses to infectious disease outbreaks. Methods: A qualitative study was carried out. Semi-structured interviews were conducted with 60 registered nurses who came to Hubei from different parts of China to care for patients with COVID-19. Interviews were audio-recorded and transcribed verbatim for thematic analysis. Results: Six major themes emerged: emotional turmoil due to personal and professional concerns, quality issues with personal protective equipment and associated physical discomfort, witnessing and managing patient distress, readiness of emergency response mechanisms in the health system, collective community awareness and preparedness, and heightened professional pride and confidence in future epidemic control. Discussion: Nurses were placed in challenging and unfamiliar situations to deal with unexpected and unpredictable events which caused considerable psychological and physical distress. Support in the form of government edicts, hospital management policies, community generosity and collegiality was highly welcomed by the nurses. Policy makers and managers should ensure that nurses are provided with the support and resources necessary for dealing with large-scale infectious disease outbreaks. Priority should be given to risk assessment, infection prevention and control, and patient and staff health and safety. [ABSTRACT FROM AUTHOR]

Aims Exercise promotes functional recovery among stroke survivors and is recommended to be commenced as soon as is feasible. However, little is known about stroke survivors' perception of participation in exercise or sitting Tai Chi, a more culturally appropriate and popular movement in China. To explore Chinese stroke survivors' perceptions of participation in exercise or sitting Tai Chi. Methods and results Face-to-face semi-structured interviews and content analysis of transcripts were conducted with a purposive sample of 30 stroke survivors. The qualitative study explored perceptions of post-stroke participation in exercise or sitting Tai Chi. The consolidated criteria for reporting qualitative research checklist was used to report findings. Perceived facilitators of exercise participation were healthcare professionals' encouragement and recommendations, family and peer support and survivors' motivation, intention, and self-perceived benefits. Perceived barriers were fear of falling, physical discomfort, and challenges in standing. Despite some reservations, most participants were willing to try sitting Tai Chi. Conclusions Encouragement and support, motivation, and perceived benefits were important for exercise participation after stroke. With the premise that all medical and nursing students in China are trained in Tai Chi, for stroke survivors with no access to formal exercise programmes, sitting Tai Chi may offer an appropriate alternative. [ABSTRACT FROM AUTHOR]

Background: The Trunk Impairment Scale (TIS) has been translated into Chinese, but the psychometric properties of the Chinese version of the TIS (TIS-C) have not yet been established. We aimed to examine the reliability and validity of the TIS-C for assessing sitting balance among Chinese people with a stroke.Methods: A descriptive, cross-sectional design was used. We recruited a convenience sample of 170 subacute stroke patients aged 18 years or over from the neurology departments of four traditional Chinese medicine hospitals in China. Patients completed the TIS-C, the Berg Balance Scale and the Modified Barthel Index. The psychometric properties of the TIS-C were examined to establish test-retest reliability, internal consistency, equivalence, and content, criterion, and construct validity.Results: Intraclass correlation coefficients for inter-rater and intra-rater reliability ranged from 0.75 to 0.89 and from 0.90 to 0.97, respectively. The TIS-C Cronbach α was 0.86. The strong correlation between the total score of the TIS-C and the Berg Balance Scale (rs = 0.81, p < 0.001) or Modified Barthel Index (rs = 0.84, p < 0.001) suggested good concurrent and convergent validity, respectively. Known-group validity was supported by the significant difference (p < 0.001) in TIS-C scores between participants with mild and moderate stroke.Conclusions: The TIS-C is a valid and reliable tool for assessing static and dynamic sitting balance as well as coordination of trunk movement among stroke survivors with mild and moderate stroke. [ABSTRACT FROM AUTHOR]

Background/Objectives: Effective prevention of cardiovascular events in people with hypertension requires optimal control of blood pressure. Despite advances in management, poor adherence to antihypertensive medications is often reported as the major reason attenuating treatment efficacy. Research has provided limited evidence of associations between illness perceptions, satisfaction with consultations, and medication adherence. The aim of this study is to identify factors significantly associated with medication adherence in a group of Chinese older adults with essential hypertension. Design/Setting/Participants: A cross-sectional correlational study was conducted. Data were collected from 195 older adults (mean [SD] age, 76 [6.6] years) recruited from 12 community centers. Measurements: The Illness Perception Questionnaire--Revised was used to measure illness perceptions, and the Medical Interview Satisfaction Scale was used to measure satisfaction with individual consultations. The Morisky Medication Adherence Scale was used to measure the extent of adherence to antihypertensive medications. Multivariate logistic regression analysis was performed to examine factors, including illness perceptions, consultation satisfaction, and demographic and clinical characteristics, that were significantly associated with medication adherence. Results: More than half of the respondents (55.9%) acknowledged some degree of medication nonadherence. Older age, living alone, and perception related to treatment control were independently associated with increased odds of medication adherence, with odds ratios ranging from 1.14 to 1.92 (P < .05). Conclusion: The results highlight the importance of cultivating positive beliefs that hypertension is amenable to control by treatment. Furthermore, the adherence behavior of those of younger individuals and living with family should be closely monitored. [ABSTRACT FROM AUTHOR]

Objectives To determine the effect of nurse-implemented transitional care ( TC) on readmission and mortality rates in Chinese individuals with chronic heart failure ( CHF) in Hong Kong. Design Single-center randomized controlled trial of TC versus usual care ( UC). Setting University-affiliated hospital in Hong Kong. Participants Hospitalized Chinese individuals with CHF (N = 178; aged 78.6 ± 6.9, 45% male). Measurements: The TC group received a predischarge visit, two home visits, and then regular telephone calls over 9 months to provide self-care education and support, optimized health surveillance, and facilitation in use of community services. Primary endpoints were event-free survival, all-cause hospital readmission, and mortality during the 9-month follow-up. Secondary endpoints were length of hospital stay, self-care, and health-related quality of life ( HRQL). Data were analyzed using survival analysis and generalized estimating equations, following an intention-to-treat principle. Results Survival analysis indicated no significant differences in event-free survival, hospital readmission, or mortality between the TC and UC groups, although the TC group had a lower hospital readmission rate at 6 weeks (8.1% vs 16.3%, P = .048) and lower mortality at 9 months (4.1% vs 13.8%, P = .03). The TC group also had a shorter hospital stay ( P = .006) and significantly better self-care and HRQL. Because of attrition, sensitivity analyses were conducted to examine whether the intention-to-treat assumption affected the results. Per-protocol population analyses (hazard ratio ( HR) = 0.40, 95% confidence interval ( CI) = 0.17-0.93) and worst-case-scenario analysis ( HR = 0.44, 95% CI = 0.25-0.77) suggested a lower mortality risk in the TC group. Conclusion The translation of individual-centered nurse-implemented TC to the Chinese culture and healthcare context of Hong Kong appears beneficial. [ABSTRACT FROM AUTHOR]

Background Previous work using Mokken scaling analysis with the SF-36 has found subscales appearing to show excellent Mokken scaling properties. However, the values of scalability of the subscales are very large, raising the possibility that these are artificially high and this may result from violations of local stochastic independence between items. Objectives To analyse selected items from the Chinese Mandarin form of the SF-36 scale using Mokken scaling and to investigate if violations of local stochastic independence exaggerate scalability. Methods Exploratory Mokken scaling analysis was run using the online public domain software R by entering 19 items from the Chinese Mandarin form of the SF-36 items into the analysis. The items in the resulting scales, judged by the size of Loevinger's coefficient, were analysed for violations of monotony, 95% confidence intervals and invariant item ordering, including inspection of item pair plots. Results Two Mokken scales were obtained, one including items from the Physical Functioning subscale, and one including items from the Mental Health subscale of the Chinese Mandarin form of the SF-36. The Physical Functioning scale was very strong according to Loevinger's coefficient with high invariant item ordering; the Mental Health scale was moderately strong with weak invariant item ordering. Conclusion The strength of the Physical Functioning Mokken scale derived from the Chinese Mandarin form of the SF-36 is probably the result of an item chain and item overlap which violate local stochastic independence. This is due to the nature of the items in the Physical Functioning subscale, all of which relate to physical ability and some of which can only be achieved if previous items in the subscale have been achieved. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the psychometric properties of the Chinese Mandarin version of the Medical Outcomes Study Social Support Survey (MOS-SSS-CM) in patients with coronary heart disease (CHD) in mainland China. Methods: Measurement performance of the MOS-SSS-CM was tested on a convenience sample of 200 Chinese patients with CHD in a University-affiliated hospital in Xi’an, P. R. China. To establish reliability of the instrument, 40 patients were retested 2 weeks later through telephone interview. The traditional Chinese version of the MOS-SSS was transformed into a simplified Chinese Mandarin version and administered to participants, together with Chinese Mandarin versions of the Short Form-36 item Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Results: The MOS-SSS-CM had acceptable internal consistency with Cronbach α coefficients of 0.91 for the overall scale and 0.71–0.84 for the four subscales. The high correlation ( r = 0.56–0.87) between items and the remainder of the scale provides further evidence of internal consistency. The test–retest reliability was generally acceptable with intraclass correlation coefficients of 0.89 for the overall scale and 0.74–0.88 for the four subscales. There was acceptable concurrent validity with moderate significant correlations ( r ≥ 0.3, p < 0.01) between the MOS-SSS-CM and the Chinese Mandarin version of the HADS. Confirmatory factor analysis supported a four-factor structure of the MOS-SSS-CM measuring the self-perceived adequacy of functional support of Chinese patients with CHD. Conclusion: The MOS-SSS-CM is a valid and reliable measure for Chinese Mandarin-speaking patients with CHD. [ABSTRACT FROM AUTHOR]

Purpose: To establish baseline data in a population of young Chinese women from which lifestyle risk factors for cardiovascular disease (CVD) and the implications for long-term cardiovascular health can be examined. Methods: In a cross-sectional postal survey, a 125-item questionnaire (a translated version of the Minnesota Women's Health Survey) assessing lifestyle risk factors and perceptions of health was mailed to 987 Hong Kong Chinese nurses aged 26 years and returned by 617, yielding a response rate of 63%. Results: Of the women surveyed, 7% reported they smoked, 21% consumed alcohol regularly, and 32% exercised regularly. Ten percent reported being overweight or obese, 31% were underweight, and 8% used oral contraception. The findings have important implications for the long-term cardiovascular health of this group of young women health professionals. Conclusions: Baseline data of lifestyle cardiovascular risk factors demonstrate that approximately two thirds of the women in this study are at risk of developing CVD when the findings are interpreted within the classification of CVD risk in women developed by the American Heart Association. Further research is necessary to assess women's awareness of risk factors and perceived personal risk. [ABSTRACT FROM AUTHOR]

Aim. To explore Chinese health care professionals’ perceptions of cardiac rehabilitation for patients with coronary heart disease in mainland China. Background. Coronary heart disease is a rapidly growing major health problem in mainland China and little is known about the current provision of rehabilitation for this population. Design. A qualitative study. Methods. Face-to-face interviews were conducted with 18 Chinese health care professionals. The interviews were tape-recorded, transcribed and content analysis was used to identify categories. Results. Content analysis of the data revealed three major categories: underdeveloped cardiac rehabilitation services, multiple obstacles to the establishment of a cardiac rehabilitation programme and a perceived need for professional guidance to patients. Conclusion. The current situation of cardiac rehabilitation in hospitals of China is poor with multiple obstacles prohibiting the development of cardiac rehabilitation services in the country and this has resulted in high rates of recurrence of heart attacks, coronary risk factors going undetected and/or untreated and psychological distress being observed among Chinese coronary heart disease patients. Relevance to clinical practice. The findings provide useful pointers for Chinese health professionals to explore ways of providing an effective, safe, convenient and culturally sensitive rehabilitation programme for Chinese patients with coronary heart disease. [ABSTRACT FROM AUTHOR]

Aim. To evaluate further the psychometric properties of the Chinese version of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depression in Chinese patients with coronary heart disease in Xian, China. Background. There is considerable evidence that anxiety and depression are common in patients with coronary heart disease (CHD) and are associated with increased morbidity and mortality. A valid, reliable and sensitive screening tool that can be used readily on this group of patients would be useful for assessment, intervention and outcome evaluation. Design. A single group, cross-sectional study. Method. Measurement performance was tested on 314 Chinese patients with coronary heart disease and repeated on 173 of them two weeks later. Results. The Chinese version of HADS (C-HADS) had acceptable internal consistency and test-retest reliability, with a Cronbach alpha of 0·85 and intraclass correlation coefficient of 0·90, respectively. There was acceptable concurrent validity with significant ( p < 0·05) correlations between the anxiety and depression subscales of the C-HADS and CHD patients’ perceived health status as measured by the Chinese Mandarin version of the Short Form-36 health survey (CM:SF-36). Principal components analysis revealed a three-factor solution accounting for 53% of the total variance. The three underlying sub-scale dimensions are depression, psychic anxiety and psychomotor anxiety. The responsiveness of the C-HADS was also satisfactory with significant correlation between the changes in the C-HADS score and the changes in the Mental Health domain of the CM:SF-36 ( p < 0·01). Finally, over one-third of the patients demonstrated psychological distress. Conclusion. Empirical data support the C-HADS as a reliable and valid screening instrument for the assessment of anxiety and depression in Chinese-speaking patients with CHD. A tri-dimensional scoring approach should be considered as potentially clinically useful for this group of patients. Relevance to clinical practice. The C-HADS can guide and evaluate the delivery of psychological care for Chinese patients with CHD. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To perform a psychometric evaluation of the Myocardial Infarction Dimensional Assessment Scale (MIDAS) in Chinese patients with coronary heart disease. Design and setting: Patients with angina (n =162), MI (n =124) or heart failure (n =95) were recruited from a regional university-affiliated hospital. The Chinese version of the MIDAS (C-MIDAS), the Hospital Anxiety and Depression Scale (HADS) and the Short-Form 36 Health Survey (SF-36) were administered to all patients at baseline and the C-MIDAS was also administered seven day (n =92) and three months (n =363) later. Results: The C-MIDAS conforms to the 7-factor structure as proposed in the original version. It is reliable with Cronbach''s alphas from 0.73 to 0.94 and test–retest reliabilities from 0.76 to 0.92. Four of its subscales (physical activity, insecurity, emotional reaction and dependency) correlated significantly with the SF-36 and the HADS in each diagnostic group and had good discriminative properties in terms of gender, emotional disturbance and perceived health deterioration, with responsiveness supported by medium-high effect sizes (0.43–0.83) and standardize response means (0.46–0.82). The other three subscales measuring treatment-related impacts added little to the validity and responsiveness of the C-MIDAS. Conclusion: To render the C-MIDAS a core health-related quality of life measure for Chinese-speaking patients with coronary heart disease, further studies need to clarify the content adequacy and cultural relevancy of those subscales measuring treatment-related impact. [Copyright &y& Elsevier]

Family interventions in schizophrenia have shown positive effects on patients but little attention has been paid to their effects on family members, particularly those in non-Western countries. This randomized controlled trial evaluated the effectiveness of a bi-weekly, 12-session, family-led mutual support group for Chinese caregivers of schizophrenia sufferers over 6 months compared with standard psychiatric care. It was conducted with 76 families of outpatients with schizophrenia in Hong Kong of whom 38 were assigned randomly to either a mutual support group or standard care. Families’ psychosocial health status and patients’ symptom severity and length of re-hospitalizations at recruitment, one-week and 12-month post-intervention were compared between groups. Results of repeated-measures mixed model indicated that the mutual support group experienced significantly greater improvements in families’ burden, functioning and number of support persons and length of patients’ re-hospitalizations at two post-tests. The findings provide evidence that mutual support groups can be an effective family-initiated, community-based intervention for Chinese schizophrenia sufferers. [ABSTRACT FROM AUTHOR]

Background Depression and anxiety in patients with coronary heart disease (CHD) is associated with a poorer prognosis. Therefore, the screening for psychological distress is strongly recommended in cardiac care and rehabilitation. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool that has demonstrated good sensitivity and specificity for mental disorders. The factor structure of the HADS was investigated in CHD populations across three countries (Germany, Hong Kong, United Kingdom). Methods In total, HADS data from 1793 patients with CHD were explored using confirmatory factor analysis to establish the underlying factor structure of the instrument. Results Three-factor models were found to offer a superior fit to the data compared with two-factor (anxiety and depression) models in all countries. The anxiety items can be separated in a factor labelled autonomic anxiety and negative affectivity. Conclusions The HADS offers good possibilities to detect distressed patients with somatic illnesses, but the construct validity of the originally proposed two factors (depression, anxiety) remains unclear. In outcome studies, more precise scales should be used to reduce measurement errors based on the scales used. [ABSTRACT FROM AUTHOR]

Rationale Patient-reported outcomes such as health-related quality of life (HRQL) describe or characterize what patients have experienced as a result of their health care. However, treatment outcome comparisons among different pure or mixed populations of patients with myocardial infarction, angina or heart failure cannot be made using existing coronary heart disease (CHD)-specific HRQL instruments. Aims and objectives The aim of this study was to evaluate the psychometric properties of the Chinese version of the MacNew in a cohort of Hong Kong patients diagnosed with CHD. Methods Chinese translations of a CHD-specific HRQL instrument, the MacNew Heart Disease HRQL questionnaire (MacNew), the Short-form 36 Health Survey and the Hospital Anxiety and Depression Scale were administered to 365 Chinese-speaking patients with CHD at baseline and again 3 months later ( n = 363). The Medical Outcomes Trust Scientific Advisory Committee criteria were used to examine the psychometric properties of the Chinese MacNew Heart Disease HRQL questionnaire. Results The results warrant recommending the use of the MacNew as an outcome measure to enhance treatment evaluation in Chinese patients with CHD and a diagnosis of myocardial infarction, angina or heart failure, substantiating previous psychometric data on the MacNew in a number of different studies in patients speaking seven different languages. Conclusion The MacNew questionnaire may have value as a core CHD questionnaire for treatment outcome comparisons among pure or mixed populations of patients with myocardial infarction, angina or heart failure. [ABSTRACT FROM AUTHOR]

To test the reliability and validity of the Chinese Mandarin version of the SF-36 health survey (CM:SF-36) in patients with myocardial infarction (MI) in mainland China. Single group, cross-sectional design to test the measurement performance on a convenience sample of 180 Chinese patients with MI, 30 of whom were retested after 2 weeks to establish reliability. Cronbach’s α coefficients exceeded the 0.70 criterion for all subscales except General Health, indicating good internal consistency. Test–retest reliability was adequate (intraclass correlation coefficient >0.70) for all subscales. The significant differences were detected by the presence or absence of co-morbidities and the number of risk factors in most physical subscales indicating good discriminative validity. Principal components factor analysis with varimax rotation confirmed the presence of the eight factors, though the item loadings of the Vitality and Mental Health subscales were found to differ from the original ones of the SF-36. The CM:SF-36 is a psychometrically acceptable instrument for assessing the health status of Chinese patients with myocardial infarction. [ABSTRACT FROM AUTHOR]

Aim Despite increasing efforts to promote the utilisation of research in daily nursing practice it is apparent that there are a number of obstacles to address. This paper reports a study to examine the barriers to, and facilitators of, research utilisation among registered nurses in Hong Kong. Methods A survey design and a random sampling method was used. The final sample consisted of 1487 registered nurses working in private and public health-care sectors in Hong Kong. A bilingual version of the Research Utilisation Questionnaire, comprising a 31-item barriers scale, and an 8-item facilitators scale was used. The instrument was mailed to participants who were asked to return the completed questionnaire by mail. Results The highest ranking barriers to research utilisation reported by respondents were related mainly to organisational factors with regards to inadequate facilities, no authority to change procedures, and time constraints. Hong Kong nurses, however, did not appear to see any problem with regards to items related to characteristics of research, such as conclusions drawn from research being justified, research articles not being published fast enough, and literature reporting conflicting results. This indicates that nurses are aware of research developments in nursing and can critically analyse research reports. With regards to facilitators of research utilisation, respondents agreed that managerial and peer support are the greatest facilitators. Conclusions The results indicate that factors influencing research utilisation are multidimensional and should be taken into account by all involved in the research enterprise: researchers, practitioners, educators, managers and policy-makers. The results of this study provide directions on how to assist nurses in Hong Kong in their efforts to utilise research. [ABSTRACT FROM AUTHOR]

This column provides a discussion of the issues and challenges facing nurses and nursing in Hong Kong. The author introduces the role of nurses in the special administrative region and focuses on workforce, educational and practice issues, as well as on leadership in nursing. He concludes that Hon g Kong needs to have a strategic plan to determine sufficient numbers of properly educated nurses. [ABSTRACT FROM AUTHOR]

Background Depression is the most prevalent functional mental disorder of later life. It is estimated that about 5% of the elderly population of Hong Kong are suffering from depression. Aim To investigate the self-rated quality of life of community-dwelling elderly people diagnosed with depression, and to examine the relationships between quality of life and mental, physical health, functional status and social support. Methods and results A cross-sectional descriptive survey was conducted in psychiatric outpatient clinics. A convenience sample of 80 Chinese elderly people with a diagnosis of depressive disorder was recruited. Perception of quality of life was measured by the Hong Kong Chinese World Health Organization Quality of Life Scale–Brief Version. Participants' mental status, functional abilities, physical health condition, and social support status were assessed. Sixty-one (76.3%) participants were female. They were least satisfied with ‘meaningfulness of life’, ‘life enjoyment’, ‘concentration and thinking’, ‘energy’ and ‘work capacity’. Functional abilities had a positive association with participants' perceived quality of life, level of depression and number of physical health conditions had a negative association. Participants had low ratings of quality of life when compared with healthy persons and persons with chronic physical problems. Findings are discussed in light of the socio-cultural environment in Hong Kong. Conclusion Comprehensive treatment and better control of depression, including different modes of medical and psychosocial intervention, could help to improve participants' perception of quality of life. A longitudinal study with a larger sample with various levels of depression and socio-demographic characteristics is recommended. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Different factors have been shown to influence the development of models of advanced nursing practice (ANP) in primary-care settings. Although ANP is being developed in hospitals in Hong Kong, China, it remains undeveloped in primary care and little is known about the factors determining the development of such a model. The aims of the present study were to investigate the contribution of different models of nursing practice to the care provided in primary-care settings in Hong Kong, and to examine the determinants influencing the development of a model of ANP in such settings. A multiple case study design was selected using both qualitative and quantitative methods of data collection. Sampling methods reflected the population groups and stage of the case study. Sampling included a total population of 41 nurses from whom a secondary volunteer sample was drawn for face-to-face interviews. In each case study, a convenience sample of 70 patients were recruited, from whom 10 were selected purposively for a semi-structured telephone interview. An opportunistic sample of healthcare professionals was also selected. The within-case and cross-case analysis demonstrated four major determinants influencing the development of ANP: (1) current models of nursing practice; (2) the use of skills mix; (3) the perceived contribution of ANP to patient care; and (4) patients’ expectations of care. The level of autonomy of individual nurses was considered particularly important. These determinants were used to develop a model of ANP for a primary-care setting. In conclusion, although the findings highlight the complexity determining the development and implementation of ANP in primary care, the proposed model suggests that definitions of advanced practice are appropriate to a range of practice models and cultural settings. However, the findings highlight the importance of assessing the effectiveness of such models in terms of cost and long-term patient outcomes. [ABSTRACT FROM AUTHOR]

thompson d.r., lopez v., lee d. & twinn s. (2004) Journal of Clinical Nursing 13, 131–135 SARS – a perspective from a school of nursing in Hong Kong Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large. [ABSTRACT FROM AUTHOR]

BACKGROUND: Interest in Traditional Chinese Medicine (TCM) is growing rapidly beyond China. This interest is driven by a combination of factors including recognition of potential benefits of TCM; dissatisfaction with the traditional Western medical model; an increasing commitment to holistic care and increasing evidence for the interaction of psychological factors and outcomes of disease and treatment and health consumer demand. AIMS: This review article was prompted by the need to understand and interpret the increasing trend towards the use of TCM in heart disease. In particular, this article defines and describes TCM, and analyses implications and challenges for Western health care delivery models. LITERATURE SEARCH: This article provides a review of accessible evidence, to English speaking health care professionals. The CINAHL, MEDLINE, HealthSTAR, Academic ASAP and Cochrane databases were searched, identifying literature published from 1982. Search engines on the Internet were also used. Examples of keywords used were ‘Traditional Chinese Medicine’ and ‘heart’. CONCLUSION: Difficulties in accessing information regarding TCM have implications for health education in coronary heart disease and patient safety. The rapid uptake of TCM in both Western and Chinese societies mandates an understanding of the principles and potential interactions when TCM is complemented with Western medical treatment for heart disease. Development of this knowledge and understanding is essential in order to provide safe and effective health care to patients who use combination therapies. [Copyright &y& Elsevier]

The article offers information on a study which investigated the psychometric structure of the Stress in Nursing Students Scale (SINS) using a cohort of nursing students in Hong Kong, China. It reviews related literature on stress in nursing students. A comparison with the psychometric structure of the questionnaire obtained in Scotland is offered. Information on data collection is offered. It concludes that SINS should be used to measure the impact of stress, including clinical practice, in the education of nursing students.

Discusses cardiovascular care in Hong Kong, China. Status of the health care system; Importance of cardiovascular nursing; Information on the Nursing Council of Hong Kong.

Background: Post-stroke cognitive impairment (PSCI) adversely affects survivors' recovery trajectory and overall health outcomes. This study aimed to investigate the prevalence of PCSI and its associated risk factors., Methods: A cross-sectional study was conducted with stroke survivors recruited from the neurology units of three hospitals in Yunnan, China. Measures included the Frenchay Aphasia Screening Test (FAST), Apathy Evaluation Scale (AES), Fatigue Severity Scale (FSS), Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE), Montreal Cognitive Assessment (MoCA), and Charlson Comorbidity Index (CCI). Logistic regression analysis was carried out to identify risk factors significantly and independently associated with PSCI., Results: Of 389 stroke participants studied, 139 (36%) were found to have PSCI. Every 10-year increase in age [odds ratio (OR) =1.69, 95% confidence interval (CI): 1.27-2.24, p < 0.001], and 1-point increase in the AES (OR = 1.13, 95% CI: 1.07-1.18, p < 0.001) and FSS scores (OR = 1.06, 95% CI: 1.03-1.10, p < 0.001) were significantly associated with higher odds of PSCI. Conversely, a 1-point increase in the MoCA score (OR = 0.91, 95% CI: 0.87-0.95, p < 0.001) and having an undergraduate education (OR = 0.45, 95% CI: 0.24-0.84, p = 0.013) or postgraduate education (OR = 0.18, 95% CI: 0.06-0.50, p = 0.001) were associated with reduced odds of PSCI., Conclusions: PSCI is prevalent in the Chinese population, with advanced age, lower education levels, lower MoCA scores, and higher fatigue and apathy scores identified as strong risk factors. It is recommended that psychological and cognitive assessment be routinely incorporated into post-stroke rehabilitation pathways to mitigate cognitive decline., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023. Published by Elsevier B.V.)

Introduction: Though exercise during pregnancy can yield important maternal benefits, most pregnant women in China do less aerobic exercise than is currently recommended. This qualitative study aimed to explore the perceptions and experiences of physical exercise among pregnant women and to identify perceived barriers to and facilitators of exercise participation., Methods: Purposive sampling was used to recruit 40 pregnant women attending prenatal visits at an obstetrics outpatient department of a tertiary general hospital in Southern China. Individual semi-structured telephone interviews were conducted with the verbatim transcripts analyzed through content analysis., Results: Three main themes emerged from the data: perceptions and patterns of exercise; concerns and hesitations about participating in exercise; and determinants of adoption and maintenance of exercise participation. Though pregnant women recognised their need for physical exercise instruction, their demands remained unmet due to a combination of factors such as lack of knowledge, confidence, and support, and concerns about safety., Discussion: The findings of this study suggest that the provision of tailored exercise programs for pregnant women, which include education, reassurance, motivational strategies, and lay and professional support, may help improve knowledge, allay concerns, boost confidence, and bolster support when doing physical exercise., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest relevant to this article to disclose., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Misplacement of the nasogastric tube in the respiratory tract could cause serious complications and even death. Thus, nasogastric tube verification is necessary for optimal patient safety and comfort. Although end-tidal carbon dioxide detection is considered an effective approach to determine nasogastric tube location, there is a paucity of up-to-date evidence., Objectives: To review the diagnostic accuracy of end-tidal carbon dioxide detection in determining inadvertent airway intubation and verifying correct placement of nasogastric tubes., Design: A systematic review and meta-analysis., Methods: We searched clinical trials that evaluated the diagnostic accuracy of colorimetric capnometry or capnography in detecting nasogastric tubes located in the airway and differentiating between inadvertent airway intubation and correct nasogastric tube placement in any adult care setting. Four English language databases - Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL - and four Chinese language databases - China Biomedical Literature Database, WanFang Data, China National Knowledge Infrastructure, and Airiti Library - were searched from July 2009 to March 2021. Clinical trial registration databases and reference lists of included studies and relevant reviews were also searched. Two reviewers extracted the data of all included studies using a data extraction form. Two reviewers assessed the methodological quality independently with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We conducted meta-analysis using the hierarchical bivariate model and estimated the pool sensitivity and specificity of capnography and colorimetric capnometry. Forest plots were generated to display the results. Heterogeneity was investigated by meta-regression. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluations framework., Results: Of 1,155 records identified, seven new studies were added to this update and a total of 16 studies were analysed in the systematic review. The total absolute number of true positive, false negative, true negative, and false positive observations were 142, 6, 1,500, and 65 respectively. Low to very low certainty of evidence indicated that the use of colorimetric capnometry or capnography is potentially an effective method in differentiating between respiratory and nasogastric tube placement for critically ill adult patients. Pooled results (13 studies, 1,541 intubations) for sensitivity and specificity were 0.96 (95% confidence interval [0.88, 0.99]) and 0.99 (95% confidence interval [0.96, 1.00]), respectively., Conclusions: Colorimetric capnometry and capnography may have the potential to be of high sensitivity and specificity for the detection of inadvertent airway nasogastric tube placements in critically ill adults. More evidence is required to generalize the updated findings to different types of patients and settings., 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 © 2021. Published by Elsevier Ltd.)

Background: Psychoeducation programmes for people with schizophrenia are shown to reduce relapses but few studies have indicated significant improvements in patients' illness awareness and insight, functioning, symptom severity or rates of readmission to hospital., Aims: To examine the effects of a mindfulness-based psychoeducation programme for Chinese people with schizophrenia., Method: A multisite randomised controlled trial was conducted with 107 out-patients with schizophrenia: 36 and 35 received a 6-month mindfulness-based psychoeducation and a conventional psychoeducation programme, respectively, and 35 received routine care alone. Patient outcome measures were psychiatric symptom severity, psychosocial functioning, social support, insight into illness/treatment, and frequency and duration of readmissions to hospital (ClinicalTrials.gov: trial registration NCT01667601)., Results: The mindfulness-based psychoeducation group reported significantly greater improvements in psychiatric symptoms, psychosocial functioning, insight into illness/treatment and duration of readmissions to hospital over 24 months when compared with the other two groups., Conclusions: Mindfulness-based psychoeducation appears to be a promising approach to treatment for Chinese patients with schizophrenia., (Royal College of Psychiatrists.)

Background: Healthcare providers are called on to assess and improve the health-related quality of life (HRQL) of patients with myocardial infarction (MI). However, there is lack of empirical data on HRQL of such individuals in mainland China. The purpose of this study is to assess HRQL and identify associated factors in hospitalized Chinese MI patients., Methods: A single group, cross-sectional design was adopted with a sample of 192 hospitalized MI patients at two teaching hospitals in Xi'an, People's Republic of China. HRQL was assessed using the Chinese Mandarin versions of the Short Form 36 health survey (SF-36), the Myocardial Infarction Dimensional Assessment Scale (MIDAS), and the Hospital Anxiety and Depression Scale (HADS)., Results: Chinese MI patients reported poor HRQL as measured by both the generic (SF-36) and disease-specific (MIDAS) instruments. Advancing age and the presence of heart failure, anxiety, and depression were significant predictors of overall HRQL. Smoking and hypertension were significant predictors of the physical aspects of HRQL., Conclusions: Assessing HRQL of hospitalized Chinese MI patients and identifying associated factors may help health professionals in the design and delivery of appropriately tailored and culturally relevant interventions to this group of patients.

Background: Myocardial infarction is a major cause of death and morbidity in many countries, including China. The aim of this study was to analyse a Mandarin Chinese translation of the Cardiac Depression Scale for a hierarchy of items according to the criteria of Mokken scaling., Findings: Data from 438 Chinese participants who completed the Chinese translation of the Cardiac Depression Scale were analysed using the Mokken scaling procedure and the 'R' statistical programme using the diagnostics available in these programmes. Correlations between Mandarin Chinese items and Chinese translations of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory were also analysed. Fifteen items from the Mandarin Chinese Cardiac Depression Scale were retained in a weak but reliable Mokken scale; invariant item ordering was evident but of low accuracy and the Mokken scaled items of the Chinese Cardiac Depression Scale correlated with the Hospital Anxiety and Depression Scale and the Beck Depression Inventory., Conclusions: Items from the Mandarin Chinese Cardiac Depression Scale form a Mokken scale and this offers further insight into how the items of the Cardiac Depression Scale relate to the measurement of depression in people with a myocardial infarction.

Background: Hierarchical scales are very useful in clinical practice due to their ability to discriminate precisely between individuals, and the original English version of the Myocardial Infarction Dimensional Assessment Scale has been shown to contain a hierarchy of items. The purpose of this study was to analyse a Mandarin Chinese translation of the Myocardial Infarction Dimensional Assessment Scale for a hierarchy of items according to the criteria of Mokken scaling. Data from 180 Chinese participants who completed the Chinese translation of the Myocardial Infarction Dimensional Assessment Scale were analysed using the Mokken Scaling Procedure and the 'R' statistical programme using the diagnostics available in these programmes. Correlation between Mandarin Chinese items and a Chinese translation of the Short Form (36) Health Survey was also analysed., Findings: Fifteen items from the Mandarin Chinese Myocardial Infarction Dimensional Assessment Scale were retained in a strong and reliable Mokken scale; invariant item ordering was not evident and the Mokken scaled items of the Chinese Myocardial Infarction Dimensional Assessment Scale correlated with the Short Form (36) Health Survey., Conclusions: Items from the Mandarin Chinese Myocardial Infarction Dimensional Assessment Scale form a Mokken scale and this offers further insight into how the items of the Myocardial Infarction Dimensional Assessment Scale relate to the measurement of health-related quality of life people with a myocardial infarction.

Objective: This study evaluated the effects of a home-based rehabilitation program for Chinese patients with myocardial infarction in terms of health-related quality of life and psychological status., Methods: This was a randomized, controlled trial with data collected at 2 university-affiliated public general hospitals in Xian (Shaanxi Province, People's Republic of China). One hundred and sixty patients with a myocardial infarction were randomly assigned to either the interventional group (a home-based cardiac rehabilitation program using a self-help manual) or the control group (usual care). Health-related quality of life (generic, Chinese Short Form 36-Item Health Survey; disease-specific, Chinese Myocardial Infarction Dimensional Assessment Scale) and psychological status (the Chinese Hospital Anxiety and Depression Scale) were measured at baseline, program completion (6 weeks), and 3 and 6 months after hospital discharge., Results: Significant differences were evident in the main outcomes when the home-based group was compared with the usual care group at 6 weeks, 3 months, and 6 months. The home-based group had significantly higher scores on 4 of the 8 domains of the Chinese Short Form 36-Item Health Survey and on 3 of the 7 dimensions of the Chinese Myocardial Infarction Dimensional Assessment Scale, with significantly lower scores on the anxiety, but not the depression, subscale of the Chinese Hospital Anxiety and Depression Scale., Conclusions: A simple, home-based cardiac rehabilitation program for patients with acute myocardial infarction, using a self-help manual, improves health-related quality of life and reduces anxiety. It appears feasible and acceptable, and does not produce inferior outcomes compared with usualcare in China., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: The study aims were to (a) describe the experiences of Chinese Australians with heart disease following discharge from hospital for an acute cardiac event; (b) identify patterns and cultural differences of Chinese Australians following discharge from hospital; and (c) illustrate the illness/health seeking behaviors and health beliefs of Chinese Australians., Design: Qualitative study., Methods: Interview data were obtained from the following sources: (a) focus groups of Chinese community participants without heart disease; (b) interviews with patients recently discharged from hospital following an admission for an acute cardiac event; and (c) interviews with Chinese-born health professionals working in Australia. Qualitative thematic analysis was undertaken., Results: Study themes generated from the data were: (1) linking traditional values and beliefs with Western medicine; (2) reverence for health professionals and family; and (3) juxtaposing traditional beliefs and self-management., Conclusions: Considering the influence of cultural values in developing health care plans and clinical decision making is important., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the validity and reliability of the Chinese version of the Short-Form Cardiac Depression Scale (CDS) as a screening tool., Methods: Measurement performance was tested on 239 Chinese cardiac patients who were asked to complete the Chinese versions of the Short-Form CDS, the CDS, the Beck Depression Inventory, and an overall measure (single item) of mood status., Results: The Chinese Short-Form CDS demonstrated acceptable internal consistency (Cronbach's α 0. 76). The high correlation coefficients (r = 0.63-0.74, P < 0.01) between the five items and the total scale provide further evidence of internal consistency. There was acceptable concurrent validity with significantly high correlations between the Chinese versions of the Short- Form CDS and the CDS (r = 0.80, P< 0.0001) and the Beck Depression Inventory (r = 0.64, P < 0.0001). Principal components analysis revealed a single dimension extracted from the data set, which resembles that reported by the authors of the original scale., Conclusion: The Chinese Short-Form CDS appears to be a valid and reliable user-friendly measure for monitoring depressed mood in Chinese-speaking patients with cardiac disease., (Copyright © 2011 The Academy of Psychosomatic Medicine. All rights reserved.)

Background: Effective self-care is the cornerstone of the successful management of heart failure (HF). The European Heart Failure Self-care Behaviour Scale is a brief, reliable and valid scale to measure this important construct among patients with HF. Although the EHFScBS has been translated to different languages, no Chinese version is available. Indeed, previous findings investigating the psychometric properties of EHFScBS indicated ambiguity of the conceptual structure of this scale., Aim: The aim of this study was to translate the European Heart Failure Self-care Behaviour Scale (EHFScBS) into Chinese and to test its psychometric properties in the Chinese patients with HF., Methods: The EHFScBS (English Version) was translated to Chinese using Brislin's forward and backward translation method. Panel review was used to examine its semantic equivalence and content validity. The EHFScBS (Chinese Version) was then tested with a convenience sample of 143 Chinese HF patients who attended a specialist clinic from January to September 2007., Results: The content validity index (CVI) of the EHFScBS (Chinese version) was satisfactory (Item CVI=0.96; Scale CVI=0.89), with Cronbach's alpha 0.82. Convergent validity was supported by a moderate relationship, statistical significant with a measure for social support (r=-0.36, p<0.001). However, the findings did not support the hypothesised three-factor structure of the EHFScBS (Chinese Version). Instead, all items except one fit well a two-factor structure to measure help-seeking and regimen-complying behaviours., Conclusion: The adequate psychometric properties and clear conceptual structure of EHFScBS (Chinese Version) warrant its use in Chinese patients with HF., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Aim: To explore Chinese health care professionals' perceptions of cardiac rehabilitation for patients with coronary heart disease in mainland China., Background: Coronary heart disease is a rapidly growing major health problem in mainland China and little is known about the current provision of rehabilitation for this population., Design: A qualitative study., Methods: Face-to-face interviews were conducted with 18 Chinese health care professionals. The interviews were tape-recorded, transcribed and content analysis was used to identify categories., Results: Content analysis of the data revealed three major categories: underdeveloped cardiac rehabilitation services, multiple obstacles to the establishment of a cardiac rehabilitation programme and a perceived need for professional guidance to patients., Conclusion: The current situation of cardiac rehabilitation in hospitals of China is poor with multiple obstacles prohibiting the development of cardiac rehabilitation services in the country and this has resulted in high rates of recurrence of heart attacks, coronary risk factors going undetected and/or untreated and psychological distress being observed among Chinese coronary heart disease patients. Relevance to clinical practice. The findings provide useful pointers for Chinese health professionals to explore ways of providing an effective, safe, convenient and culturally sensitive rehabilitation programme for Chinese patients with coronary heart disease.

The purpose of this study was to translate the Memorial Symptom Assessment Scale (MSAS) into Chinese and evaluate the psychometric properties of this version. The original MSAS is a 32-item, patient-rated measure that was developed to assess common cancer-related physical and psychological symptoms with respect to frequency, intensity, and distress. In this study, a two-phase design was used. Phase I involved iterative forward-backward translation, testing of content validity (CVI) and a pretest. Phase II established the psychometric properties of the Chinese version MSAS (MSAS-Ch). Results showed that the MSAS-Ch achieved content relevancy CVI of 0.94 and semantic equivalence CVI of 0.94. Pretesting was performed in 10 cancer patients, and the results revealed adequate content coverage and comprehensibility of the MSAS-Ch. A convenience sample of 370 patients undergoing cancer therapy or at the early post-treatment stage was recruited for psychometric evaluation. Confirmatory factor analysis confirmed the construct validity of the MSAS-Ch, with a good fit between the factor structure of the original version and our present sample data (goodness-of-fit indices all above 0.95). The internal consistency reliability of subscales and total MSAS-Ch was moderately high, with Cronbach alpha coefficients ranging from 0.79 to 0.87. The test-retest intraclass correlation results for the subscale and total MSAS-Ch ranged from 0.68 to 0.79. The subscale scores of MSAS-Ch were moderately correlated with the scores on various validation measurements that assessed psychological distress, pain, and health-related quality of life (r = 0.46-0.65, P < 0.01), confirming that they were measurements of similar constructs. The validity of the construct validity was also supported by comparing the MSAS-Ch scores for subpopulations that varied clinically. Inpatients and patients with poorer performance status scored higher on the MSAS-Ch subscale and total scores than outpatients and patients with higher performance status (P < 0.05). Our study shows that the MSAS-Ch has adequate psychometric properties of validity and reliability, and can be used to assess symptoms during cancer therapy and at the early post-treatment stage in Chinese-speaking patients.

Aims and Objectives: The aim of this study was to translate from English and evaluate the validity, reliability and cultural relevance of the Cardiovascular Limitations and Symptoms Profile (CLASP) as a health-related quality-of-life (HRQL) measure in Chinese patients with coronary heart disease., Background: Improvement in HRQL is increasingly used as a primary outcome in determining the treatment benefit using a generic instrument. However, disease-specific instruments are being cited as more responsive and sensitive in detecting even the smallest changes in health status. Therefore, valid and reliable disease-specific measures for patients with coronary heart disease are now being developed and evaluated., Design: Questionnaire design., Methods: The translation equivalence and content validity of the Chinese version of CLASP were evaluated by an expert panel. Measurement performance was tested on a convenience sample of 369 Chinese coronary heart disease patients., Results: The instrument demonstrated good content validity (content validity index 0.94), acceptable internal consistency (>0.70), except for two subscales of angina and tiredness and significant positive correlations among the subscales of CLASP, Hospital Anxiety Depression Scale and the Short Form 36 Health Survey. Principal components analysis revealed nine factors that together explained 69% of the variance., Conclusions: The results of this study support that CLASP is a valid and reliable disease-specific health status measure for Chinese patients with coronary heart disease. However, further item modifications and testings are needed when considering the cross-cultural context., Relevance to Clinical Practice: The use of disease-specific HRQL measures could effectively evaluate nursing interventions in clinical practice. Further validations of CLASP among different diagnostic groups, such as patients with heart failure and those who have survived an acute myocardial infarction, would provide further empirical support for its use with all patients with heart disorders.

Objective: This study aimed to evaluate the validity, reliability, and cultural relevance of the Cardiac Depression Scale (CDS) as a disease-specific screening tool for Chinese cardiac patients., Methods: The language equivalency and content validity of the Chinese version of the CDS (C-CDS) were evaluated. Measurement performance was tested on 200 Chinese cardiac patients and repeated on 40 patients for test-retest reliability., Results: One item pertaining to sexual activity was removed from the Chinese version due to poor cultural relevance. The C-CDS demonstrated acceptable internal consistency (Cronbach's alpha of .91 for the total scale and .53-.78 for the subscales). The high correlation (r=.64-.89) between items and the remainder of their own scale provides further evidence of internal consistency. The test-retest reliability was satisfactory with intraclass correlation coefficients of .94 for the overall scale and .73-.92 for the six subscales. The total and subscale scores that were not significantly different (P>.05) over a 2-week period further support the stability of the instrument. There was acceptable concurrent validity with moderate (r>or=.3, P<.001) correlations between the C-CDS and the Chinese version of the Hospital Anxiety and Depression Scale. Principal component analysis revealed six factors, and one dimension was extracted from the data set, which closely resembles the structure of the original instrument., Conclusion: Empirical data support the C-CDS as a valid and reliable disease-specific tool in assessing depressed mood in Chinese-speaking patients with cardiac disease.

Objective: To test the reliability and validity of the Chinese Mandarin version of the SF-36 health survey (CM:SF-36) in patients with myocardial infarction (MI) in mainland China., Methods: Single group, cross-sectional design to test the measurement performance on a convenience sample of 180 Chinese patients with MI, 30 of whom were retested after 2 weeks to establish reliability., Findings: Cronbach's alpha coefficients exceeded the 0.70 criterion for all subscales except General Health, indicating good internal consistency. Test-retest reliability was adequate (intraclass correlation coefficient >0.70) for all subscales. The significant differences were detected by the presence or absence of co-morbidities and the number of risk factors in most physical subscales indicating good discriminative validity. Principal components factor analysis with varimax rotation confirmed the presence of the eight factors, though the item loadings of the Vitality and Mental Health subscales were found to differ from the original ones of the SF-36., Conclusion: The CM:SF-36 is a psychometrically acceptable instrument for assessing the health status of Chinese patients with myocardial infarction.

Background: With an increasing life expectancy, there is a rapidly growing sector that is aging. Depression is the most prevalent functional mental disorder of older population. It is estimated that about 21% of the older population in Shanghai are suffering from depression., Aim: This study investigated the self-rated health related quality of life of community-dwelling older people diagnosed with depression in Shanghai, and to examine the relationships between this and mental and physical health, functional status and social support., Methods: A cross-sectional survey was conducted in two community centres with a convenience sample of 71 participants. Measures included subjective perception of health related quality of life, level of depression, cognitive function, number of medical conditions, activities of daily living, functional abilities, and social support. The majority of the participants were female (n=52, 73.23%), and married (n=51, 71.8%)., Results: A higher level of depression was related to a poorer health related quality of life. Participants were least satisfied with their physical health. The level of depression, activities of daily living and satisfaction with social support were predictors of health related quality of life ratings., Conclusion: The study identified how depression affects the bio-psychosocial status of Chinese older people. Findings are discussed in light of the socio-cultural environment in Shanghai., (Copyright (c) 2006 John Wiley & Sons, Ltd.)

Depression is common in patients following stroke and has been found to be related to the degree of functional disability, recovery and engagement in rehabilitation. Consequently, screening for depression is crucial in this group in order to facilitate the delivery of appropriate psychological support. The current study sought to determine key psychometric properties of the Chinese version of the Geriatric Depression Scale (GDS) in this group. Three versions of the GDS were evaluated, these being the 30-item original measure (GDS-30), the short-form version comprising 15 items (GDS-SF) and a recently developed innovative four-item version (GDS-4). Confirmatory factor analysis revealed the GDS-30 and GDS-SF to offer an acceptable fit to data suggesting utility of these measures for screening. However, the GDS-4 offered a poor fit to the data, suggesting this measure was an inadequate measure of depression in this clinical group. Further, though GDS-30 and GDS-SF measures revealed good internal consistency, the performance of the GDS-4 was marginal. However, all GDS-derived measures demonstrated excellent convergent and divergent validity. It is concluded that the GDS-30 is a useful and appropriate screening instrument in this group. Further, the GDS-SF shows promise in terms of development as a multidimensional measure of depression that may have predictive and outcome monitoring potential. The psychometric shortcomings of the GDS-4 strongly suggest that this measure is unsuitable for screening in this clinical group.

Background: The burden of illness associated with Coronary Heart Disease (CHD) has determined this as a key focus for research at a basic science, individual and population level. Although considerable research has been conducted on specific aspects of the experience of CHD, such as anxiety or depression, there is a lack of research investigating the global aspects of the illness experience from the individual's perspective. Furthermore, there is a paucity of research examining the cross-cultural experiences of patients from Non-English Speaking Backgrounds (NESB). Given the multicultural nature of Australian society, and that health and illness are culturally constructed experiences (Manderson 1990), it is important to include the perspectives of people from minority cultures in health related research in order to provide culturally sensitive and appropriate health care and information during an illness. Further, the potential to prevent and modulate the course of CHD, by strategies such as smoking cessation and lipid management, mandate a health promotion agenda based on equity and access for all members of society., Aims: This article discusses cultural aspects of CHD in relation to nursing and allied health care during the recovery phase of an acute cardiac event. It reviews the research that has been conducted in this area, focusing on the Chinese-Australian population., Literature Search: The CINAHL, MEDLINE, FAMILY (Australian Family and Society Abstracts Database), PsychINFO, and Multicultural Australian and immigration Studies (MAIS) databases were searched, identifying literature published from 1982. Keywords used were Chin* (Chinese, China), Asia* (Asia, Asian), experience, adjustment, psychological, heart, coronary, cardiac, health and services. Reports not written in English were excluded. Australian Government reports were also searched, as well as hand searching of nursing and medical textbooks. These searches resulted in over 1000 articles. However, only around 50 were relevant for this review., Implications: Chinese-Australians are one of the fastest growing populations in Australia, and are at increased risk of CHD upon settling to Australia. Recommendations for future research and for the practice of nursing are provided.