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To generate the Chinese Sleep Health Index (SHI-C) in Mandarin with cross-cultural adaptations and test its psychometric properties.This study used a cross-sectional design. Health science students were included (N = 271) and a sub-set (n = 74) was invited for the re-test. Cross-cultural adaptation of the SHI-C was performed prior to formal validation. The SHI-C, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Bedtime Procrastination Scale, and Sleep Hygiene Index were used to measure variables of interest. Exploratory factor analysis was used to evaluate the structure validity. Bivariate analyses were used to evaluate the construct validity.Exploratory factor analysis identified 3 factors (ie, sleep quality, sleep duration, and disordered sleep) accounting for 55.6% of the total variance. The SHI-C total and sleep quality sub-index scores were significantly associated with both PSQI global score (r = -0.132, p.05; r = -0.182, p.01, respectively) and ISI score (r = -0.655, p.05; r = -0.820, p.05, respectively). SHI-C total, sleep quality sub-index, and sleep duration sub-index scores were significantly associated with Bedtime Procrastination Scale and Sleep Hygiene Index scores (r = -0.238 to -0.368, p.05). Students with insomnia (ISI9) or poor sleep quality (PSQI5) had significantly lower SHI-C scores than those without (73.5 vs. 89.0, p.01; 84.1 vs. 86.7, p.05, respectively). SHI-C showed good internal consistency (Cronbach's alpha = 0.73) and test-retest reliability (intraclass correlation coefficient = 0.82).The SHI-C demonstrated good validity and adequate reliability in a Chinese sample of health science students. It could be used to measure sleep health in future research and practice. Psychometric properties of the SHI-C among other Chinese populations remain to be confirmed.

Objective:To examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and maternal feeding practices.Setting:Pudong District, Shanghai, China.Participants:A convenience sample of 1164 mothers who were primary caregivers of preschool children.Results:Sixty per cent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0·212, P < 0·001). Structural equation modelling indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0·035, P < 0·001), restriction (β = 0·022, P < 0·001), and food as a reward (β = –0·017, P < 0·05).Conclusion:Child weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.

Increased professional commitment is essential for relieving the nursing workforce shortage, which is exacerbated by the COVID-19 pandemic. The professional commitment of graduating nursing students is a powerful predictor of their work commitment. However, limited information is available regarding graduating nursing students' professional commitment. Existing studies investigating nursing students' professional commitment are limited by their lack of theoretical foundation.To investigate the level of graduating nursing students' professional commitment and its multilevel influencing factors from the perspective of the Ecological Systems Theory in the early days following the COVID-19 outbreak.A descriptive cross-sectional study.Three educational institutions in Shanghai, China.513 nursing students who were graduating with an associate or bachelor's degree.The independent variables were measured by a self-designed questionnaire. The dependent variable professional commitment was measured by the Nursing Professional Commitment Scale. Hierarchical regression analyses, which allowed the independent variables entered in order, were performed to identify the significant predictor variables of the professional commitment and its dimensions.The level of professional commitment was 100.15 ± 20.35 (score ranged between 34 and 136). The individual factors (degree, whether had received a scholarship during the past academic years, ΔRThe graduating nursing students had a moderate level of professional commitment, which needed to be improved. Nursing educators should comprehensively consider various factors to understand the relationship between individuals and environmental systems, and implement targeted interventions to shape the positive professional values of nursing students.

Background: Young females tend to overestimate their weight status, which might induce unhealthy weight loss intentions and behaviours. This study aimed to examine weight perception measured by visual and verbal descriptions and its correlation with weight loss intentions among female nursing students. Methods: A cross-sectional survey was conducted among 600 female nursing students from four medical colleges in Shanghai, China. The participants rated perceptions of their weight by selecting a silhouette from the female Photographic Figure Rating Scale (PFRS) and one of the following verbal descriptions: “very underweight”, “slightly underweight”, “normal”, “overweight” or “obese”. Weight loss intentions were measured using the question “How often do you want to lose weight?”. Body mass index (BMI) was calculated from self-reported height and weight. Data were analysed using univariate and ordinal logistic regression analyses. Results: The accuracy of weight perceptions measured by verbal descriptions and visual descriptions was 44.50% and 55%, respectively. In females with underweight BMI (n = 135), 88.15% and 49.63% accurately classified their weight using visual descriptions and verbal descriptions, respectively. These females were more likely to overestimate (53.83% vs. 14.50%) and less likely to underestimate (1.67% vs. 30.50%) their weight when using verbal descriptions than when using visual descriptions. For verbal descriptions, weight overestimation was associated with weight loss intentions (odds ratio, 1.80, 95% confidence interval, 1.25–2.60). However, for visual descriptions, the two variables were not associated. Conclusions: A mismatch occurred between weight perceptions measured by the two methods and BMI status among female nursing students. Compared with verbal descriptions, visual descriptions had higher weight perception accuracy. However, weight overestimation measured by verbal descriptions was more likely to be associated with stronger intentions to lose weight than that of visual descriptions. These findings suggest that methodological discrepancies should be taken into account when measuring weight perception in future studies.

We aimed to examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and non-responsive feeding practices. We recruited a convenience sample of 1164 mothers who were primary caregivers of preschool children. Child body mass index (BMI) Z-score was calculated to assess child weight. The Chinese version of the Child Feeding Questionnaire (C-CFQ) was used to measure four common non-responsive feeding practices, weight perception and weight concern. Structural equation modeling (SEM) was used to examine the associations between child BMI Z-scores, maternal feeding practices, and other covariates. Sixty percent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0.212,P< 0.001). SEM indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0.035,P< 0.001), restriction (β = 0.022,P< 0.001), and food as a reward (β = -0.017,P< 0.05).ConclusionChild weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.What is KnownNon-responsive feeding practices may contribute to childhood obesity or eating disorders.Relationships between maternal weight perception and concern, child weight, and feeding practices have been mixed.What is NewChild weight may influence maternal non-responsive feeding practices through maternal weight perception and concern.Interventions are needed to increase the accuracy of caregivers’ perception of child weight which may influence maternal feeding practices and thereby contribute to child health.

BackgroundSmartphone overuse has been cited as a potentially modifiable risk factor that can result in visual impairment. However, associations between smartphone overuse and visual impairment have not been consistently reported.ObjectiveThe aim of this systematic review is to determine the association between smartphone overuse and visual impairment, including myopia, blurred vision, and poor vision, in children and young adults.MethodsWe conducted a systematic search in the Cochrane Library, Pubmed, EMBASE, Web of Science Core Collection, and ScienceDirect since the beginning of the databases to June 2020. Fourteen eligible studies (ten cross-sectional studies and four controlled trials) were identified, which included a total of 27110 subjects with mean ages ranging from 9.5 to 26.0 years. We used a random-effects model in the ten cross-sectional studies (n= 26962) and a fixed-effects model in the four controlled trials (n= 148) to combine odds ratios (OR) and effect sizes (ES). TheI2statistics was used to assess heterogeneity.ResultsA pooled OR of 1.05 (95% CI: 0.98, 1.13;p= 0.159) from cross-sectional studies suggests that smartphone overuse is not statistically significantly associated with myopia, poor vision, or blurred vision, however these visual impairments together are more apparent in children (OR = 1.06, 95% CI: 0.99, 1.14; p = 0.087) than in young adults (OR = 0.91, 95% CI: 0.57, 1.46; p = 0.707). In all the controlled trials, the smartphone overuse groups showed worse visual function scores compared with the less-use groups. The pooled ES is 0.76 (95% CI: 0.53, 0.99) and statistically significant (p< 0.001).ConclusionsOur results indicate that longer smartphone use may increase the likelihood of ocular symptoms including myopia, asthenopia, and/or ocular surface disease, especially in children. Thus, regulating use time and restricting the prolonged use of smartphones may prevent ocular and visual symptoms. Further research on the patterns of use, with longer follow-up on the longitudinal associations will help inform detailed guidelines and recommendations for smartphone use in children and young adults.

BACKGROUND Smartphone overuse has been cited as a potentially modifiable risk factor that can result in visual impairment. However, reported associations between smartphone overuse and visual impairment have been inconsistent. OBJECTIVE The aim of this systematic review was to determine the association between smartphone overuse and visual impairment, including myopia, blurred vision, and poor vision, in children and young adults. METHODS We conducted a systematic search in the Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, and ScienceDirect databases since the beginning of the databases up to June 2020. Fourteen eligible studies (10 cross-sectional studies and 4 controlled trials) were identified, which included a total of 27,110 subjects with a mean age ranging from 9.5 to 26.0 years. We used a random-effects model for meta-analysis of the 10 cross-sectional studies (26,962 subjects) and a fixed-effects model for meta-analysis of the 4 controlled trials (148 subjects) to combine odds ratios (ORs) and effect sizes (ES). The I2 statistic was used to assess heterogeneity. RESULTS A pooled OR of 1.05 (95% CI 0.98-1.13, P=.16) was obtained from the cross-sectional studies, suggesting that smartphone overuse is not significantly associated with myopia, poor vision, or blurred vision; however, these visual impairments together were more apparent in children (OR 1.06, 95% CI 0.99-1.14, P=.09) than in young adults (OR 0.91, 95% CI 0.57-1.46, P=.71). For the 4 controlled trials, the smartphone overuse groups showed worse visual function scores compared with the reduced-use groups. The pooled ES was 0.76 (95% CI 0.53-0.99), which was statistically significant (P CONCLUSIONS Longer smartphone use may increase the likelihood of ocular symptoms, including myopia, asthenopia, and ocular surface disease, especially in children. Thus, regulating use time and restricting the prolonged use of smartphones may prevent ocular and visual symptoms. Further research on the patterns of use, with longer follow up on the longitudinal associations, will help to inform detailed guidelines and recommendations for smartphone use in children and young adults.

Background People with Type 2 diabetes frequently report increased fatigue and sleep disturbance. These symptoms might put them at a higher risk for unhealthy eating behavior-detrimental to diabetes control. Objectives The aim of the study was to examine the effect of fatigue and sleep on eating behavior in people with Type 2 diabetes by using a daily diary approach. Methods Data from 56 patients were collected during a baseline interview and an 8-day ambulatory assessment period in the free-living setting. Each day, participants completed one diary upon awakening to assess their sleep duration and sleep quality during the previous night and morning fatigue. They also completed one diary before going to bed to assess their eating behavior during the day (e.g., uncontrolled eating, cognitive restraint, emotional eating, and snacking). Data from 7 days were analyzed using generalized estimating equations. Results During the 7 days, controlling for age, gender, and body mass index, between-person fatigue was a significant predictor of uncontrolled eating, emotional eating, and snacking. Similarly, controlling for the covariates, between-person sleep quality was a significant predictor of uncontrolled eating and emotional eating. No associations were found between sleep duration and eating behavior. Discussions At the between-person level, reporting higher fatigue or poorer sleep quality was associated with higher levels of unhealthy eating behavior. Patients with Type 2 diabetes with high fatigue or poor sleep quality may require additional attention to support their healthy eating.

BackgroundSmartphone overuse has been cited as a potentially modifiable risk factor that can result in visual impairment. However, reported associations between smartphone overuse and visual impairment have been inconsistent.ObjectiveThe aim of this systematic review was to determine the association between smartphone overuse and visual impairment, including myopia, blurred vision, and poor vision, in children and young adults.MethodsWe conducted a systematic search in the Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, and ScienceDirect databases since the beginning of the databases up to June 2020. Fourteen eligible studies (10 cross-sectional studies and 4 controlled trials) were identified, which included a total of 27,110 subjects with a mean age ranging from 9.5 to 26.0 years. We used a random-effects model for meta-analysis of the 10 cross-sectional studies (26,962 subjects) and a fixed-effects model for meta-analysis of the 4 controlled trials (148 subjects) to combine odds ratios (ORs) and effect sizes (ES). The I2 statistic was used to assess heterogeneity.ResultsA pooled OR of 1.05 (95% CI 0.98-1.13, P=.16) was obtained from the cross-sectional studies, suggesting that smartphone overuse is not significantly associated with myopia, poor vision, or blurred vision; however, these visual impairments together were more apparent in children (OR 1.06, 95% CI 0.99-1.14, P=.09) than in young adults (OR 0.91, 95% CI 0.57-1.46,P=.71). For the 4 controlled trials, the smartphone overuse groups showed worse visual function scores compared with the reduced-use groups. The pooled ES was 0.76 (95% CI 0.53-0.99), which was statistically significant (PConclusionsLonger smartphone use may increase the likelihood of ocular symptoms, including myopia, asthenopia, and ocular surface disease, especially in children. Thus, regulating use time and restricting the prolonged use of smartphones may prevent ocular and visual symptoms. Further research on the patterns of use, with longer follow up on the longitudinal associations, will help to inform detailed guidelines and recommendations for smartphone use in children and young adults.

Background Obese individuals frequently experience weight-related bias or discrimination-even in healthcare settings. Although obesity bias has been associated with several demographic factors, little is known about the association of weight locus of control with bias against overweight persons or about weight bias among Chinese health professionals. Objectives The aim of the study was to examine attitudes toward obese patients in a sample of Chinese registered nurses (RNs) and the relationship between weight bias and nurses' weight locus of control. Methods RNs working in nine community health service centers across Shanghai, China, answered three self-report questionnaires: The Attitudes Toward Obese Persons Scale (ATOP), the External Weight Locus of Control Subscale (eWLOC) from the Dieting Belief Scale, and a sociodemographic profile. Hierarchical, stepwise, multiple regression was used to predict ATOP scores. Results From among 385 invited, a total of 297 RNs took part in the study (77.1% response rate). Participants scored an average of 71.04 on the ATOP, indicating slightly positive attitudes toward obese persons, and 30.08 on the eWLOC, indicating a belief in the uncontrollability of body weight. Using hierarchical, stepwise, multiple regression, two predictors of ATOP scores were statistically significant (eWLOC scores and status as a specialist rather than generalist nurse), but explained variance was low. Discussion Chinese RNs seemed to have relatively neutral or even slightly positive attitudes toward obese persons. Those nurses who believed that obesity was beyond the individual's control or worked in specialties were more likely to have positive attitudes toward obese people. Improved understanding of the comprehensive etiology of obesity is needed.

Objective: To examine the effects of an integrated intervention program on the knowledge/skills, self-efficacy, and weight management practices among General Practitioners (GPs). Methods: A quasi-experimental (pre-and post-test) design was used. A convenience sample of 118 GPs from two community health services in Shanghai, China was recruited. The interventions included two 100 min training lectures with educational materials, including guidelines, brochures, and posters. Data were collected via self-administered questionnaires to measure knowledge/skills, self-efficacy, and practices regarding weight management at baseline and three-month post-intervention. Results: Overall, the knowledge/skills, self-efficacy, and practices related to obesity management among GPs were improved. There were significant increases in the frequencies of all items describing weight management practice after the intervention (P

Summary Background The nursing students' perceptions of instructor caring (NSPIC) is an instrument to assess the influence of caring interactions between students and faculty on students' ability to care. However, the validity and reliability of the Chinese version has not yet been studied. Objectives The study aimed to assess the validity and reliability of the Chinese version of NSPIC (C-NSPIC). Design This is a cross-sectional study. Setting The study was performed in three Tertiary Grade A (top level in China) and teaching hospitals in Shanghai, China. Participants The participants of the study are nursing students during clinical practice. Methods The English version of nursing students' perception of instructor caring scale was professionally translated into Chinese and a pilot test was undertaken to ensure the equivalence of meaning and cultural appropriateness. The content validity of the C-NSPIC was examined by a panel of eight experts, and test–retest was conducted to assess the item reliabilities of the scale. A convenience sampling method was used to recruit nursing students. A first sample (N = 256) was recruited to explore the factorial structure of the C-NSPIC using exploratory factor analysis (EFA), and a validation sample (N = 358) was recruited to confirm the findings from the EFA using confirmatory factor analysis (CFA). SPSS version 16.0 was used for the EFA and Amos 17.0 was used for the CFA. Results The Cronbach's alpha coefficient of the C-NSPIC was 0.933. The test–retest reliability was satisfactory, with the ICC scores for each item ranging from 0.603 to 0.962. The overall content validity index was 0.96. Five factors (control versus flexibility, supportive learning climate, confidence through caring, appreciation of life meaning and respectful sharing) were identified in EFA, which was consistent with that of the original English version, and were confirmed by CFA. Conclusion The C-NSPIC can serve as a reliable and valid instrument for assessing the nursing students' perception of instructor caring in China, which may help to improve the nursing students' caring ability in China.

Purpose. To increase the accuracy of coding for infantile diarrhea. Method. Case records of diarrhea, from January 2011 to December 2013, were searched in a hospital through the medical record management system, and the coding on the front page of the records was subjected to retrospective investigation and analysis. Results. During these years, 5.44% of all discharged patients were cases of infantile diarrhea, the majority of which were infants, accounting for 61.27%, followed by children, accounting for 17.27%. In 2011 and 2012, the codes for infantile diarrhea were mistakenly classified as K52.9. Through reviews of medical records, it was found that as a matter of fact, infectious diarrhea accounted for 70.49%, and non-infectious diarrhea accounted for 29.56%. Conclusion. The hospital should reinforce the training given to clinicians in writing the front page of medical records, along with ICD-10 training. The staff involved in the coding work should communicate with clinicians better, thereby ...