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To examine the developmental characteristics and trends affecting clinical research nurses (CRNs) in China and provide a reference for the training and employment of nursing talents in this specialty.Literature pertaining to CRNs published from the year in which the database was constructed to 2020 was searched. The databases used were the China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature and Weipu, while CiteSpace software was used to conduct a bibliometric analysis of literature quantity, annual distribution, literature journals and regional distribution, literature authors, subject funding status and literature type and keywords. The characteristics and trends affecting CRNs in China were then evaluated using a descriptive analysis.A total of 3735 pieces of literature were retrieved, and after deduplication and screening, 199 pieces of literature were retained for this study. Overall, the number of publications increased year-on-year. Of these publications, 17 papers (8.5% of the retained papers) were published in theIn China, CRNs are currently in a period of rapid development. Research into CRNs mainly involves single-centre studies and lacks financial support. In the future, it will be necessary to increase capital investment, strengthen cross-regional cooperation between authors and institutions to narrow the regional development gap, and promote strict and standardised CRN training models and qualification certification to improve the quality of clinical research nursing.

To evaluate the effectiveness of family-based intervention for adults with diabetes on glycosylated haemoglobin and other health-related outcomes.The impact of family-based intervention on adults with diabetes has been evaluated in various studies, but there is uncertainty about their effect on health-related outcomes for adults with diabetes.A systematic review and meta-analysis of randomised controlled trials.A review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Six relevant databases were searched from inception to 5 March 2021. Heterogeneity between studies was quantified by using Higgins' IThe review included 23 studies (3,114 participants). Family-based intervention had a significant effect on improving glycosylated haemoglobin levels, body mass index, blood pressure, fasting glucose, diabetes self-care, diabetes self-efficacy, diabetes distress and positive family support. Non-significant results were obtained for blood lipid, body weight, depression and negative family support. In particular, subgroup analyses indicated that family-based intervention in Asian regions was more effective in improving glycosylated haemoglobin levels than in other areas.Family-based intervention may improve diabetes control, diabetes self-care, psychological well-being and positive family support in adults with diabetes and is especially effective in Asian regions. Given the limitations in current studies, further studies are recommended to combine family theory with family-based intervention, and to examine the effectiveness of such intervention for family members.This review and meta-analysis provides evidence that family-based intervention can improve positive family support, which has a good effect on diabetes control and psychological well-being in adults with diabetes, and it is especially effective in Asian regions. Findings suggested that unreinforced participation by family members and integrating flexible strategies into family-based intervention may be equally effective.

Obesity and overweight conditions have become major health challenges worldwide. The exploration of effective weight loss strategies is essential. Nudges are currently advancing approaches that represent a new and better method for changing the behaviors of people. However, the effectiveness of nudge interventions on weight loss in overweight people who may be obese has not been synthesized in a systematic manner. In this study, a systematic literature search was performed. Only randomized controlled trials (RCTs) were considered. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated as summary statistics. In total, 25 RCTs involving a population of 5,929 individuals were included. Significant effects of the nudge strategy on weight loss (WMD: -0.96 kg, 95% CI: -1.49 to -0.43), body mass index (WMD: -0.3 kg/m2, 95% CI: -0.41 to -0.19) and waist circumference (WMD: -0.75 cm, 95% CI: -1.23 to -0.27) were observed. The subgroup analysis showed that the reduction in body weight associated with nudge interventions was significant in younger and more obese people. Moreover, the effect of nudge intervention on weight loss weakened over time. Overall, the nudge strategy can promote changes in weight loss, body mass index and waist circumference of adults, albeit at a mild magnitude and in particular types of individuals. Nudge strategies can be recommended to clinical practitioners and policy-makers to promote obesity management.

To design and develop a complex, evidence‑based, theory‑driven, and culturally appropriate character strengths-based intervention (CSI) for breast cancer patients, following the Medical Research Council (MRC) framework.From 2018 September to 2020 November, a complex intervention perspective was adopted. The rationale, methods, and processes employed in carrying out the study were reported. The acceptability and feasibility of intervention program were evaluated as a part of subsequent pilot study. Based on piloting, a refined and optimized definitive intervention was obtained. The development of the intervention is an iterative process involving input from three key stakeholders: experts, medical staff, and patient representatives.The systematic review revealed CSIs were effective and the selected theory served as a guide and indicated theory-inspired modifications. A representative team of breast cancer patients and oncology nurses collaboratively developed and tailored the intervention content and format with attention to the acceptability and feasibility. Five main strategies, including peripheral, evidential, linguistic, constituent-involving, and sociocultural strategies, were used to achieve and strengthen the cultural appropriateness. After the pilot phase, several refinements were made on the CSI program, such as editorial changes in the booklet or alternative suggestions for difficult strengths-based activities (e.g., outdoor activities). All participants not only expressed satisfaction with the program in process evaluation, but also reported perceived benefits such as enjoyable and sociable experience, better well-being, and increased confidence.Consideration of the MRC framework, theory guidance, and suggestions from stakeholders during intervention development can optimize uptake and sustainability in the clinical setting. It is recommended that randomized controlled trial be used in future studies to assess the intervention, the process and the mechanisms of the intervention. Our approach may offer implications for the design and implementation of similar initiatives to support cancer patients.ClinicalTrials.gov Register Identifier: NCT04219267, 07/01/2020, retrospectively registered.

This study aims to investigate the association between stressors, coping strategies and intention to leave the nursing profession among nurses.Job stressors and coping strategies are believed to affect turnover intention among nurses, but no large-scale study has been conducted on these associations in China yet.A cross-sectional secondary analysis was conducted among 51,406 nurses from 1858 hospitals. Univariable and multivariable logistic regression analyses were carried out, and odds ratios were reported.Overall, 49.58% nurses had an intention to leave the profession. It is found that stress from health condition, family, occupational injuries, nurse-patient tension, high job demands, strict leaders and colleague relationships were significantly associated with higher intention to leave. Coping strategies such as talking to family and friends, talking to leaders, doing outdoor activities, engaging in hobbies and attending on-the-job training were significantly associated with lower intention, but social gathering, psychological counselling and suffering in silence had an opposite effect.Our study provides new insights into the association between stressors, coping strategies and turnover intention among nurses in China.Evidence from this study indicates that policies promoting a safe and supportive work environment should be developed to help nurses cope with stress.

Objective To systematically summarize the reported prediction models for hypoglycemia in patients with diabetes, compare their performance, and evaluate their applicability in clinical practice. Methods We selected studies according to the PRISMA, appraised studies according to the Prediction model Risk of Bias Assessment Tool (PROBAST), and extracted and synthesized the data according to the CHARMS. The databases of PubMed, Web of Science, Embase, and Cochrane Library were searched from inception to 31 October 2021 using a systematic review approach to capture all eligible studies developing and/or validating a prognostic prediction model for hypoglycemia in patients with diabetes. The risk bias and clinical applicability were assessed using the PROBAST. The meta-analysis of the performance of the prediction models were also conducted. The protocol of this study was recorded in PROSPERO (CRD42022309852). Results Sixteen studies with 22 models met the eligible criteria. The predictors with the high frequency of occurrence among all models were age, HbA1c, history of hypoglycemia, and insulin use. A meta-analysis of C-statistic was performed for 21 prediction models, and the summary C-statistic and its 95% confidence interval and prediction interval were 0.7699 (0.7299–0.8098), 0.7699 (0.5862–0.9536), respectively. Heterogeneity exists between different hypoglycemia prediction models (τ2 was 0.00734≠0). Conclusions The existing predictive models are not recommended for widespread clinical use. A high-quality hypoglycemia screening tool should be developed in future studies.

Conventional wisdom affirmed that diabetes was irreversible, but current research shows that lifestyle interventions may achieve diabetes remission among patients with type 2 diabetes mellitus. Recently, many original studies have examined the effectiveness of lifestyle interventions. However, great heterogeneity in intervention approaches resulted in inconsistent intervention effects.The aim of this study was to determine the effectiveness of lifestyle interventions for diabetes remission among patients with type 2 diabetes mellitus.PubMed, CINAHL, Embase, Web of Science Core Collection, and Cochrane Library were searched for relevant articles from their inceptions to March 26, 2021. Reference lists and a relevant journal were searched manually as well. Both randomized controlled trials and quasi-experimental studies were included. The quantitative data extracted from the selected studies included diabetes remission rate, weight, and quality of life score. The risk of bias was assessed by the Cochrane and Joanna Briggs Institute's tool. RevMan version 5.3. was used to carry out the meta-analysis.This systematic review included 12 studies involving 3997 patients with type 2 diabetes mellitus. Lifestyle interventions included in the studies were mainly divided into diet-only interventions and diet combined with physical activity interventions. Among them, there were three types of diet: (1) low-energy diet, (2) low carbohydrate diet, and (3) Mediterranean diet. Moderate-intensity aerobic and resistance physical activity, walking, and maintaining habitual physical activity were the three types of physical activity interventions employed in the included studies. The results indicated that lifestyle interventions were effective for achieving diabetes remission, reducing weight, and improving quality of life in patients with type 2 diabetes mellitus.Lifestyle interventions were associated with significant effects on diabetes remission, reducing weight, and improving quality of life. As an important part of lifestyle interventions, diet and physical activity have a significant effect on blood glucose and weight control in patients with type 2 diabetes mellitus. It is therefore suggested that the contents of lifestyle interventions should focus on diet and physical activity.

Objectives To examine the validity and reliability of the Mandarin version of the Treatment Burden Questionnaire (TBQ) among stroke patients. Background Stroke patients need long-term management of symptoms and life situation, and treatment burden has recently emerged as a new concept that can influence the health outcomes during the rehabilitation process. Methods The convenience sampling method was used to recruit 187 cases of stroke patients in a tertiary grade hospital in Tianjin for a formal investigation. Item analysis, reliability and validity tests were carried out. The reliability test included internal consistency and test–retest reliability. And as well as content, structure and convergent validity were performed for the validity test. Results Of the 187 completed questionnaires, only 180 (96.3%) were suitable for analysis. According to the experts’ evaluation, the I-CVI of each item was from 0.833 to 1.000, and the S-CVI was 0.967. The exploratory factor analysis yielded three-factor components with a cumulative variation of 53.054%. Convergent validity was demonstrated using measures of Morisky’s Medication Adherence Scale 8 (r = –0.450, P < 0.01). All correlations between items and global scores ranged from 0.403 to 0.638. Internal consistency reliability and test–retest reliability were found to be acceptable, as indicated by a Cronbach’s α of 0.824 and an intraclass correlation coefficient of 0.846, respectively. Conclusions The Mandarin TBQ had acceptable validity and reliability. The use of TBQ in the assessment of treatment burden of stroke survivor may benefit health resources allocation and provide tailor therapeutic interventions to construct minimally disruptive care.

Clear cell renal cell carcinoma (ccRCC) is one of the most common and lethal types of urologic cancer. With low survival rates among patients in advanced stages of disease, and increasing rate of morbidity and mortality worldwide, novel therapeutic targets for ccRCC clinical intervention are necessary. In this study, we investigated the functional role of circZKSCAN1 in ccRCC progression. Our results suggested that circZKSCAN1 was abundantly expressed in ccRCC tumor tissues and cells. CircZKSCAN1 knockdown significantly inhibited cell proliferation, migration, invasion, and epithelial-to-mesenchymal transition of renal cell carcinoma (RCC) cells, whereas potentiated Natural Killer (NK) cell-mediated cytotoxicity against RCC cells in vitro and repressed tumor growth in vivo. Furthermore, we identified a novel circZKSCAN1/miR-1294/PIM1 axis was identified in RCC progression, showing that the expression of circZKSCAN1 expression in RCC cells was transcriptionally regulated by Kruppel-like factor 2. The results of our study may provide new insights for ccRCC basic research. Abbreviations: ccRCC: clear cell renal cell carcinoma; ChIP: chromatin immunoprecipitation; circRNA: circular RNA; EDU: 5‐ethynyl‐2’‐deoxyuridine; EMT: epithelial-mesenchymal transition; FBS: fetal bovine serum; FISH: RNA fluorescent in situ hybridization; KLF2: Kruppel-like factor 2; NC: normal control; NK cell: natural killer cell; NOD/SCID: nonobese severe diabetic/severe combined immunodeficiency; PIM1: Pim-1 proto-oncogene, serine/threonine kinase; RCC: renal cell carcinoma; ZKSCAN1: zinc finger with KRAB and SCAN domains 1

Objective To reveal the development characteristics and trends of clinical research nurses in China and provide a reference for the training and employment of nursing talents. Methods Literature about clinical research nurses published from the year of database construction to 2020 were searched through the CNKI, Wanfang, Chinese Biomedical Literature (CBM) and Weipu (VIP) databases, and CiteSpace software was used to conduct a multidimensional analysis of the included literature. Results A total of 3,735 pieces of literature were retrieved, and after deduplication and screening, 199 pieces of literature were finally retained for this study. The practice and exploration of CRNs were regionalised, with varying degrees of development, and CRNs were at the forefront of development in oncology specialties. Conclusion It is important to continue to expand the breadth and depth of researchto promote the continuous development of China’s medical and health care to align with international standards.

Aims and objectives To examine the effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes and to determine whether resilience mediates the effects of family functioning on self-management and glycaemic control. Background Poor self-management and glycaemic control are common in youth with type 1 diabetes. Family functioning and resilience are known to be important psychosocial factors that contribute to individual health and development. However, no studies have explored the effects of family functioning and resilience on self-management and glycaemic control among youths with type 1 diabetes in mainland China. Design This study was conducted using a survey with a convenience sample following the STROBE guidelines. Methods A total of 204 Chinese youth who had been diagnosed with type 1 diabetes for at least 6 months were recruited. Family functioning, resilience, self-management and diabetes distress were measured using self-reports and standard measurement tools. Glycaemic control was assessed by glycated haemoglobin (HbA1C ) levels. A structural equation model was used to test the hypothesised model. Results The final model accounted for 52.1% and 19.5% of the total variance of self-management and HbA1C level, respectively. Resilience had a direct effect on self-management and an indirect effect on control of HbA1C . Family functioning had an indirect effect on both self-management and control of HbA1C through resilience. The model remained invariant across the mild-distress and severe-distress groups. Conclusion In Chinese youth with type 1 diabetes, resilience positively affected self-management and ultimately optimised glycaemic control, even in the presence of diabetes distress. Family functioning positively affected self-management and glycaemic control by promoting resilience. Relevance to clinical practice This study found that family functioning and resilience had positive effects on self-management and glycaemic control in youth. This study confirms the importance of incorporating resilience assessments and family-based resilience interventions into clinical nursing practice with youth with type 1 diabetes.

Background Self-efficacy, diabetes distress, knowledge, and education level are likely the important factors affecting diabetes self-management (DSM) behaviors. However, the theoretical mechanisms underlying these variables remain unclear. Aims The study aimed to test a model including variables of self-efficacy, diabetes distress, knowledge, and education level and DSM behaviors that were informed by social cognitive theory and the literature review among adults with type 2 diabetes. Methods A cross-sectional study design was employed. Among a convenience sample of 320 adults with type 2 diabetes, 265 eligible participants (response rate = 82.81%) were investigated, using the demographic information questionnaire, the Summary of Diabetes Self-Care Activities, the Self-Efficacy for Diabetes Scale, the Diabetes-Related Knowledge Questionnaire, and the Diabetes Distress Scale. Structural equation modeling was performed with 10,000 bootstrap samples using AMOS 23.0. Results The final model provided a good fit to the data (χ2 [22, N = 265] = 9.192, df = 5, p = .102, NFI = 0.972, RMSEA = 0.056). Self-efficacy had the strongest direct effect on DSM behaviors (β = 0.550, p = .000). Knowledge (β = 0.167, p = .004) and employment status (β = -0.130, p = .009) had a direct effect on DSM behaviors. The association between knowledge and DSM behaviors was partially mediated by self-efficacy (bootstrap mean = 0.160, 95% CI: 0.088, 0.237), explaining 49.08% of the total effect of knowledge on DSM behaviors. The association between diabetes distress and DSM behaviors (bootstrap mean = -0.113, 95% CI: -0.192, -0.043) and education level and DSM behaviors (bootstrap mean = 0.102, 95% CI: 0.047, 0.165) were completely mediated by self-efficacy. Conclusions Self-efficacy plays an important role in the mediation of the association between knowledge and DSM behaviors, diabetes distress and DSM behaviors, and education level and DSM behaviors, as well as a direct contributing role in the predication of DSM behaviors. Linking evidence to action Self-efficacy plays a direct contributing and mediating role in shaping DSM behaviors. The results of the model can help to develop evidence- and theory-based and culturally sensitive interventions. Strategies including goal setting, practicing, recording, peer models, persuasion, positive feedback, and encouragement can be used to address self-efficacy of patients. Interventions led by nurses that increase knowledge, reduce diabetes distress, and emphasize self-efficacy have the potential to promote changes in DSM behaviors.

BACKGROUND Stroke remains one of the major chronic illnesses worldwide that health care organizations will need to address for the next several decades. Individuals poststroke are subject to levels of cognitive impairment and mental health problems. Virtual reality (VR)-based therapies are new technologies used for cognitive rehabilitation and the management of psychological outcomes. OBJECTIVE This study performed a meta-analysis to evaluate the effects of VR-based therapies on cognitive function and mental health in patients with stroke. METHODS A comprehensive database search was performed using PubMed, MEDLINE (Ovid), Embase, Cochrane Library, and APA PsycINFO databases for randomized controlled trials (RCTs) that studied the effects of VR on patients with stroke. We included trials published up to April 15, 2021, that fulfilled our inclusion and exclusion criteria. The literature was screened, data were extracted, and the methodological quality of the included trials was assessed. Meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 894 patients from 23 RCTs were included in our meta-analysis. Compared to traditional rehabilitation therapies, the executive function (standard mean difference [SMD]=0.88, 95% confidence interval [CI]=0.06-1.70, P=.03), memory (SMD=1.44, 95% CI=0.21-2.68, P=.02), and visuospatial function (SMD=0.78, 95% CI=0.23-1.33, P=.006) significantly improved among patients after VR intervention. However, there were no significant differences observed in global cognitive function, attention, verbal fluency, depression, and the quality of life (QoL). CONCLUSIONS The findings of our meta-analysis showed that VR-based therapies are efficacious in improving executive function, memory, and visuospatial function in patients with stroke. For global cognitive function, attention, verbal fluency, depression, and the QoL, further research is required. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42021252788; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=252788

Nurses play a vitally important role in promoting equitable and essential care. China undertook bold reforms in its education and healthcare systems since 1990s. The effect of these reforms on the nursing workforce has not been assessed systematically.This study aims to assess the changing trends and the underlying challenges of the nursing workforce in Mainland China in the period of 1998-2018.Retrospective data analysis.Data were acquired from the National Health Statistics Yearbook from 1999 to 2019. Descriptive statistics were used to analyze the nature of the nursing workforce in terms of quantity, quality, and structure. Non-parametric tests were used to compare doctors and nurses in terms of number and work experiences. Global Moran's I index and hotspot analysis were applied to compare the equity in distribution of nurses at national and provincial levels.From 1998 to 2018, the number of nurses increased from 1.22 to 4.10 million with an average rate of increase of 6.3% per annum. The ratio of doctors to nurses changed from 1: 0.61 to 1: 1.14, reaching 1: 1 in 2013. The main educational level of registered nurses elevated to associated degree (48.9%), and nurses with advanced titles increased at the most rapid rate. In 2018, 60.3% of nurses were younger than 35 years old. The Global Moran's I index ranged from 0.211 to 0.198 (Z1.96, P0.05). Hotspot analysis showed the distribution of nurses was unequally concentrated in the northern region and with the highest distribution in Beijing.Great improvement on the scale and the quality of nursing workforce over the past 20 years has been witnessed in China. However, the shortage of nurses, outflow of younger nurses and the imbalance distribution of nursing workforce among the country are emerging challenges. Plans should not be ignored on continuously cultivating more qualified nurses, retaining younger nurses, attracting nurses to work in rural areas and the northeast region. Tweetable abstract: Numbers of Chinese nurses finally outstrip the number of doctors but do limited educational opportunities limits their contribution to the nation's health? New article in @ijnsjournal.

Xin-Jun Jiang,1– 5 Hua Jiang,2 Yuan Chen,6 Xiao-An Wu,7 Xue-Lian Yu,8 Lei Liu,9 Ming-Zi Li2 1Department of Adults Nursing, School of International Nursing, Hainan Medical University, Haikou, People’s Republic of China; 2Department of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, People’s Republic of China; 3Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, People’s Republic of China; 4Key Laboratory of Trauma of Hainan Medical University, Hainan Medical University, Haikou, People’s Republic of China; 5Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province, The First Affiliated Hospital of Hainan Medical University, Haikou, People’s Republic of China; 6Department of Endocrinology, Wuyishan Municipal Hospital, Wuyishan, People’s Republic of China; 7Department of Endocrinology, People’s Hospital of Leping City, Leping, People’s Republic of China; 8Department of Endocrinology, Yanhua Hospital, Beijing, People’s Republic of China; 9Department of Health Education, Jimenli Primary Hospital, Beijing, People’s Republic of ChinaCorrespondence: Ming-Zi LiDepartment of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, People’s Republic of ChinaTel +86-10-82805230Email limingzi@bjmu.edu.cnBackground and Objective: The 12-month follow-up effect of the self-efficacy-focused structured education program (SSEP) requires in-depth confirmation. This study aims to verify whether the benefits of SSEP can be maintained in 12 months.Materials and Methods: A multicenter randomized controlled trial with 12-month follow-up conducted among 265 type 2 diabetes patients not on insulin from 4 hospitals in mainland China. The intervention group (n = 133) was administrated with SSEP, and the control group (n = 132) received the routine education. The indicators of metabolic and psychosocial aspects of the patients were assessed at baseline and 12 months.Results: As opposed to the control group, the primary outcomes of HbA1c in the intervention group were improved obviously in the 12th month during the 12-month follow-up (− 1.13%, P < 0.001). The secondary outcomes (ie, waist circumference, total cholesterol, low-density lipoprotein cholesterol, diabetes self-efficacy, diabetes self-management behaviors, diabetes knowledge and diabetes distress) were improved significantly in the intervention group as compared with the control group in the 12th month during the 12-month follow-up (− 3.14 cm, P = 0.001; − 0.30 mmol/L, P = 0.032; − 0.25 mmol/L, P = 0.008; 0.87, P < 0.001; 10.67, P < 0.001; 3.42, P < 0.001; − 4.97, P < 0.001). The non-significant difference in the secondary outcomes (ie, systolic pressure, diastolic pressure, triglycerides and high-density lipoprotein cholesterol) was identified between the two groups in the 12th month during the 12-month follow-up (P > 0.05).Conclusion: The SSEP provided sustainable benefits in outcomes of HbA1c, waist circumference, total cholesterol, low-density lipoprotein cholesterol, diabetes knowledge, diabetes distress, diabetes self-efficacy and diabetes self-management behaviors for type 2 diabetes patients not on insulin in the 12th month during the 12-month follow-up. Thus, it will be an effective education model capable of being generalized nationwide, and it can be referenced for the nations and regions under consistent conditions.Clinical Trial Registry: Chinese Clinical Trial Registry (ChiCTR‐IOR‐17011007).Keywords: diabetes mellitus, type 2, self efficacy, education

Background/Aims: Older adults are vulnerable to central obesity, while the association of changes in central fatness with risk of diabetes and metabolic control has not been investigated among this particular population. This study was aimed to address these issues.Methods: A total of 1,815 adults aged ≥ 60 years without diabetes at baseline were followed for 4 years. Incident diabetes was ascertained based on plasma glucose, hemoglobin A1c, medical history, and/or the use of anti-diabetic drugs. Central fatness was assessed by waist circumference (WC), waist-height ratio (WHtR), and body roundness index (BRI). Logistic regression analyses were used to assess the association of changes in central fatness with risk of diabetes, along with dose-response and mediation analyses.Results: During the 4-year follow-up, 177 participants developed diabetes. The risk of diabetes was increased by 42%, 41%, and 40% per 1 standard deviation increases in WC, WHtR, and BRI, respectively, in multivariable-adjusted models (all p < 0.01). Moreover, these relationships were all linearly-shaped (all pnonlinearity ≥ 0.11). Increases in WC, WHtR, and BRI correlated with increases in hemoglobin A1c, triglycerides-and-glucose index, triglycerides, white blood cell, and C-reactive protein (all p ≤ 0.04). Yet only changes in hemoglobin A1c and triglycerides-and-glucose index were identified as the possible mediators for risk of diabetes, with their mediating effect being about 35% and 21%, respectively.Conclusions: Increases in central fatness were related to elevated risk of diabetes, and this association might be partly explained by the worsening of glycemic control and insulin resistance in older adults.

Nurses' attitude is a significant determinant of incontinence-associated dermatitis (IAD) prevention, and a positive attitude may benefit quality improvement projects. This research aimed to translate the attitude towards the prevention of incontinence-associated dermatitis instrument (C-APrIAD) into Chinese and test the reliability and validity among Chinese nurses.The C-APrIAD was translated into Chinese using a standard procedure of backward-forward translation and cross-cultural adaption. Totally 170 nurses were recruited through the convenience sampling method from three tertiary hospitals in Tianjin, Shandong, and Heilongjiang province of China. Reliability (internal consistency, stability) and validity (content validity, structure validity, and convergent validity), were assessed. Convergent Validity was evaluated by correlation with the General Self-Efficacy Scale (GSES).Of the 170 completed questionnaires, 158 (93%) were suitable for analysis. The item-total correlation coefficients ranged from 0.39 to 0.80. The content validity of C-APrIAD was 0.96. A factor analysis indicated the construct of a 14-item instrument in a four factors solution: (1) beliefs about the impact of IAD on patients, (2) beliefs about team responsibility to prevent IAD, (3) beliefs about personal responsibility to prevent IAD, and (4) beliefs about the effectiveness of IAD prevention products and procedures. The correlation coefficient between the GSES and C-APrIAD was 0.49 (P 0.01). For the total instrument, the Cronbach's α coefficient was 0.87 and the test-retest reliability was 0.99.The C-APrIAD is reliable and valid. The C-APrIAD may benefit nursing research as well as clinical practice to optimize interventions to improve IAD prevention.

Clear cell renal cell carcinoma (ccRCC) comprises approximately 75% of renal cell carcinomas, which is one of the most common and lethal urologic cancers, with poor quality of life for patients and is a huge economic burden to health care systems. It is imperative we find novel prognostic and therapeutic targets for ccRCC clinical intervention. In this study, we found that the expression of the long noncoding RNA (lncRNA) ASB16-AS1 was downregulated in ccRCC tissues compared with non-diseased tissues and was also associated with advanced tumor stage and larger tumors. By constructing cell and mouse models, it was found that downregulated lncRNA ASB16-AS1 enhanced cell proliferation, migration, invasion, and promoted tumor growth and metastasis. Furthermore, by performing bioinformatics analysis, biotinylated RNA pull-downs, AGO2-RIP, and luciferase reporter assays, our findings showed that downregulated ASB16-AS1 decreased La-related protein 1 (LARP1) expression by inhibiting miR-185-5p and miR-214-3p. Furthermore, it was found that overexpression of LARP1 reversed the promotive effects of downregulated ASB16-AS1 on ccRCC cellular progression. Our results revealed that downregulated ASB16-AS1 promotes ccRCC progression via a miR-185-5p-miR-214-3p-LARP1 pathway. We suggest that this pathway could be used to monitor prognosis and presents therapeutic targets for ccRCC clinical management.

Aim: Diabetic peripheral neuropathy (DPN) is a common, severe microvascular complication of diabetes. Our study was to assess prevalence and risk factors for DPN in subjects with type 2 diabetes from 14 different countries. Methods: A total of 2,733 subjects with type 2 diabetes aged 18–65 years (45.3% men, mean duration of diabetes = 8.8 years) were included to perform this International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study in 14 countries. After a structured questionnaire was used in face-to-face interviews to collect sociodemographic characteristics and medical records of the participating subjects, laboratory tests were carried out for clinical measurement. Depressive symptoms were diagnosed and measured using the Patient Health Questionnaire-9. The potential risk factors for DPN were determined by multilevel mixed-effects logistic regression, accounting for clustering of participants within the country. Robustness of the estimates was assessed by sensitivity analysis. Results: The overall prevalence of DPN across different countries was 26.71%, whereas country-specific prevalences showed considerable variation. Multivariate analysis revealed that duration of diabetes (OR: 1.08 per 1-year increase, 95% CI: 1.06–1.09), poor glycemic control (OR: 1.11 per 1% increase in HbA1c, 95% CI: 1.05–1.18), and history of hypertension (OR: 1.58, 95% CI: 1.18–2.12), cardiovascular disease (OR: 2.07, 95% CI: 1.55–2.78) and depressive symptoms (OR: 1.92, 95% CI: 1.43–2.58) were independently and positively associated with the risk of DPN. Sensitivity analyses including or excluding patients from countries with extreme low or high prevalence of DPN yielded similar estimates in terms of trend and magnitude. Conclusions: This international study illustrates that more than a quarter of individuals with type 2 diabetes developed DPN. The prevalence was positively associated with the duration of diabetes, poor glycemic control, and history of hypertension, cardiovascular disease and depressive symptoms.

Background: Parents of adolescent with type 1 diabetes experience increased levels of diabetes distress and depression, which is linked to adolescent glycemic control. Parental resilience might be able to improve parental mental health and facilitate adolescent glycemic control. Nevertheless, these relationships have not yet been confirmed. Objective: To examine relationships between parental resilience, mental health (diabetes distress and depression), and adolescent glycemic control, as well as determine if parental resilience is the mediator of the association between parental mental health and adolescent glycemic control. Methods: Parents of adolescents with type 1 diabetes (age 13-19) completed a measure of resilience, diabetes distress and depressive symptoms as part of a screening questionnaire. Adolescents’ HbA1c was obtained from medical records. Results: Parental resilience was negatively related to maternal depressive symptoms, diabetes distress, and positively related to adolescents’ HbA1c value (all P < 0.01). In multivariate analyses, resilience was the only significant predictor of glycemic control. Conclusions: Given the links between parental resilience, parental mental health, and youth’ glycemic control, parental resilience may be important to consider when targeting both parents’ and adolescents’ adaptation to type 1 diabetes. Disclosure D. Luo: None. M. Li: None.

Aims The aims of this study were to assess the effectiveness of self-efficacy-focused education on health outcomes in persons with diabetes and review the strategies employed in the interventions. Background The traditional educational interventions for persons with diabetes were insufficient to achieve the desired outcomes. Self-efficacy-focused education has been used to regulate the blood sugar level, behaviors, and psychosocial indicators for persons with diabetes. Design This study is a systematic review and meta-analysis. Methods Studies on the effectiveness of self-efficacy-focused education in persons with diabetes were searched in six databases from inception until January 2018. The data were extracted and the quality of literature was assessed independently. Review Manager 5.3 was applied for the meta-analysis. Besides, the findings were summarized for narrative synthesis. Results Sixteen trials with 1,745 participants were included in the systematic review and ten trails with 1,308 participants in the meta-analysis. The meta-analysis for A1C, self-efficacy, self-management behaviors, knowledge, and quality of life (QOL) were represented in four, six, six, three, and three studies, respectively. The findings indicated that self-efficacy-focused education would probably reduce A1C, enhance self-efficacy, regulate self-management behaviors, increase knowledge, and improve the QOL for patients with diabetes. Weak quality studies, limited participants, and heterogeneity hindered the results pooled of the other secondary outcomes of fasting blood glucose, 2-hour plasma glucose, weight, weight circumference, body mass index, plasma lipid profile, and other psychological indicators. Goal setting, self-management skills practicing and recording, peer models, demonstration, persuasion by health providers, and positive feedback were the most commonly used strategies in the interventions. However, physiological/emotion arousal strategies were relatively less applied and varied significantly. Conclusion Individuals with diabetes may benefit a lot from the self-efficacy-focused education. However, insufficient high-quality studies, short-term follow-up period, relatively deficient physiological/emotion strategies, and incomplete outcome assessments were the drawbacks in most studies. Establishing satisfactory self-efficacy-focused education and better evaluating the effects were required in further studies.

Aims The aims of this study were to assess the effectiveness of self-efficacy-focused education on health outcomes in persons with diabetes and review the strategies employed in the interventions. Background The traditional educational interventions for persons with diabetes were insufficient to achieve the desired outcomes. Self-efficacy-focused education has been used to regulate the blood sugar level, behaviors, and psychosocial indicators for persons with diabetes. Design This study is a systematic review and meta-analysis. Methods Studies on the effectiveness of self-efficacy-focused education in persons with diabetes were searched in six databases from inception until January 2018. The data were extracted and the quality of literature was assessed independently. Review Manager 5.3 was applied for the meta-analysis. Besides, the findings were summarized for narrative synthesis. Results Sixteen trials with 1,745 participants were included in the systematic review and ten trails with 1,308 participants in the meta-analysis. The meta-analysis for A1C, self-efficacy, self-management behaviors, knowledge, and quality of life (QOL) were represented in four, six, six, three, and three studies, respectively. The findings indicated that self-efficacy-focused education would probably reduce A1C, enhance self-efficacy, regulate self-management behaviors, increase knowledge, and improve the QOL for patients with diabetes. Weak quality studies, limited participants, and heterogeneity hindered the results pooled of the other secondary outcomes of fasting blood glucose, 2-hour plasma glucose, weight, weight circumference, body mass index, plasma lipid profile, and other psychological indicators. Goal setting, self-management skills practicing and recording, peer models, demonstration, persuasion by health providers, and positive feedback were the most commonly used strategies in the interventions. However, physiological/emotion arousal strategies were relatively less applied and varied significantly. Conclusion Individuals with diabetes may benefit a lot from the self-efficacy-focused education. However, insufficient high-quality studies, short-term follow-up period, relatively deficient physiological/emotion strategies, and incomplete outcome assessments were the drawbacks in most studies. Establishing satisfactory self-efficacy-focused education and better evaluating the effects were required in further studies.

To examine the direct and indirect effects of depression, diabetes distress, diabetes self-efficacy and diabetes self-management on glycemic control among a group of T2DM patients in China.A convenience sample of 254 participants were selected from three outpatient departments in Beijing, China. They were surveyed using a self-administered questionnaire. Diabetes-related information was retrieved from their medical records. Descriptive statistics, independent student t tests, Chi-square tests, correlation analyses and Generalized Structural Equation Modeling were used.Only 91 (35.82%) participants achieved optimal glycemic control of HbA1c7.0% (53mmol/mol). Only diabetes self-management had a direct effect on glycemic control (OR=0.95, P0.001). Depression and diabetes distress had only indirect effects on glycemic control through both diabetes self-efficacy and diabetes self-management. Diabetes self-efficacy only had an indirect effect on glycemic control through diabetes self-management.Glycemic control among Chinese population with T2DM was suboptimal. Future interventions should focus on decreasing depressive symptoms and diabetes distress levels, and, therefore, improve diabetes self-efficacy and self-management practices and, ultimately, reach the optimal goal of glycemic control.

Objective This meta-analysis aimed to assess the effect of mobile application (app) interventions on weight loss in patients with type 2 diabetes. Methods Electronic databases were searched for randomized controlled trials examining the use of mobile app interventions with outcomes on weight loss evaluated by body weight or other measures such as BMI or waist circumference. A random-effects model was applied to obtain weight mean differences and 95% CIs. Results Fourteen studies enrolling 2,129 patients with type 2 diabetes were included. Mobile app interventions could significantly reduce body weight (weight mean difference, -0.84 kg; 95% CI: -1.51 to -0.17 kg) and lower waist circumference (-1.35 cm; 95% CI: -2.16 to -0.55 cm) but may not decrease BMI (-0.08 kg/m2 ; 95% CI: -0.41 to 0.25 kg/m2 ). The reductions appeared to be more pronounced in patients with obesity or among studies using mobile app interventions combined with other behavior components. However, weight loss was not moderated by the functionalities of the mobile apps (all Pinteraction > 0.05) or by the intervention duration (all P > 0.87). Conclusions Mobile app interventions lead to weight loss in patients with type 2 diabetes and are worth recommending for weight loss promotion.

Aim To assess the feasibility, acceptability, and preliminary efficacy of a culturally sensitive nurse-led structured education programme for patients with type 2 diabetes. Background A nurse-led satisfactory diabetes education programme might be feasible. The structured education programme is considered a potential model that helps patients manage diabetes. Design A mixed-method design. Methods A convenience sample of 44 participants received the programme. Feasibility was assessed using the recruitment rate and the retention rate. Acceptability was assessed by interviews to obtain the perception and experience of participants. Also, preliminary efficacy on diabetes knowledge, self-efficacy, self-management behaviours, and clinical outcomes was assessed. Finally, data were collected from April to December 2015. Results The recruitment rate and the retention rate were acceptable. Participants thought that the programme contributed to their positive changes. They enjoyed and accepted the programme, and they wanted to gain the ongoing support. Significant improvements in diabetes knowledge, self-efficacy, self-management behaviours, A1C , fasting blood glucose, low-density lipoprotein cholesterol, weight, body mass index, and waist circumference were reported in 12-week follow-up. Conclusions This programme is feasible and acceptable, and its preliminary efficacy is promising. Ongoing support, a control group, and long-term follow-up are required in future studies to assess its effectiveness.

Objectives a) to explore the effect of family functioning on diabetes distress among adolescents with type 1 diabetes(T1D); and b) to examine whether resilience mediates the relationship between family functioning and diabetes distress. Methods Youth with T1D recruited from a national endocrine center of a public hospital in China from May 2017 to October 2018. A total of 189 participants (aged 8–24 years) completed the survey about their resilience, family adaptability and cohesion, diabetes distress and provided demographic and clinical information. The moderation analyse was preformed to determine whether the resilience strengthens the protective impact of family adaptability and cohesion on diabetes distress. The simple slopes analyse was used to probe significant interactions. Results The mean score of diabetes distress was 29.58±22.09 with 31.7% of patients having severe diabetes distress. Multivariate linear regression analyses indicated that resilience enhanced the association that high family functioning had with low diabetes distress (β =-0.22,t=-0.318, P=0.002). However, simple slopes found that benefits of high resilience for lower diabetes distress was only apparent in the context of low family adaptability and cohesion(β =-0.941, t=-4.090, P =0.001). Conclusions Many youth with type 1 diabetes reported severe diabetes distress which was associated with poor glycemic control and decreased quality of life. The finding of study suggest that family-based interventions which considered resilience factors are promising for youth with high diabetes distress especially for those have poor family functioning.

Background: There is an increasing interest on Cognitive Impairment (CI) in patients with type 2 diabetes mellitus (T2DM), but evidence is conflicting regarding the association between CI and glycemic control. Objective: The present study aimed to estimate the prevalence of CI in patients with T2DM from northern rural China in order to determine whether cognitive dysfunction is related to glycemic control. Methods: First, we conducted a study with a cross-sectional design. We performed cluster random sampling of 1848 residents who were aged 60 years or older and lived in the countryside in China. All eligible participants with and without T2DM were interviewed and screened for cognitive function status. Diagnoses for dementia and Cognitive Impairment No Dementia (CIND) were based on the standard criteria. Second, on the basis of the results of the cross-sectional survey, we conducted a case-control study. In the T2DM group, we identified cases of T2DM with Cognitive Impairment (T2DM-CI), as well as cases of T2DM with normal cognition (T2DM-NC) to be used as controls. The effects of specific diabetes-related variables were examined. After matching for sex, age, and education level in the T2DM-CI and T2DM-NC groups, multivariate logistic regression analyses were performed to evaluate risk factors for T2DM-CI. Results: In the cross-sectional study, the prevalence of T2DM with CIND and dementia were 28.3% (95% CI: 23.5-33.2) and 9.5% (95% CI: 6.3-12.6), respectively. Compared with subjects without DM, the prevalence of CI in T2DM patients was more frequent than the prevalence of CI in the general population in almost every age group. In the case-control study, the multivariate logistic regression analyses showed that variables, including duration from diabetes onset, glycosylated hemoglobin A1c level (HbA1c), and severe hypoglycemia history, were significantly associated with an increased risk of CI in patients with T2DM (odds ratios [ORs] [95%CIs]: 1.67 [1.03-2.70], 1.40 [1.15-1.72], and 2.72 [1.02- 7.21], respectively [P Conclusion: The present study demonstrates a high prevalence of CI in patients with T2DM among the elderly population of rural China. Glycemic control, including HbA1c and exposure to severe hypoglycemia, affected cognitive function in patients with T2DM.

Body-weight fluctuation is associated with an increased risk of all-cause mortality. Yet no studies investigate its association with risk of diabetes in adults aged ≥ 60 years. This study aimed to address this issue.A total of 1,565 participants free of diabetes at baseline in the CHARLS were followed for 4-year. Body-weight was collected at baseline and every 2-year. Body-weight fluctuation was primarily calculated as the root-mean-square-error deviation from the regression line of body-weights against years. The risk of diabetes was estimated using logistic regression analysis.During the 4-year follow-up, 153 participants developed diabetes. The risk of diabetes was increased by 23% (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.06 to 1.43) per every 1-standard deviation higher of body-weight fluctuation after controlling for cardiovascular risk factors. The association appeared pronounced among participants with poor physical performance (both P 0.03). Participants with overweight/obesity and a high body-weight fluctuation had the largest increase in the risk for diabetes (OR 3.03). Body-weight fluctuation correlated with hemoglobin A1c and white blood cells at follow-up or their change scores from baseline, especially in females (all P 0.02).Body-weight fluctuation led to an increased risk of diabetes in adults aged ≥ 60 years.