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Few studies have investigated the distribution of sexual orientation among Chinese university students and identified the socio-demographic factors associated with sexual orientation. For the present study, we administered a paper-based, 5-point, self-report, sexual orientation scale to a stratified, random sample of 9071 undergraduates across all 10 universities in Guangzhou Higher Education Mega Center, Guangzhou, China. Multivariable ordinal regression analysis was used to explore the relationship between demographic factors and sexual orientation. A total of 8320 respondents completed the survey. Of 8182 valid respondents, 80.6% self-reported as exclusively heterosexual, 12.6% self-reported as mostly heterosexual, 5.4% self-reported as bisexual, 0.7% self-reported as mostly homosexual, and 0.8% self-reported as exclusively homosexual. About one fifth of male students and one fourth of female students reported some degree of divergence from exclusive heterosexuality. This indicates that in China there are a large number of university students who are potentially involved in same-sex sexual attraction. [ABSTRACT FROM AUTHOR]

While numerous papers have illuminated the worthiness of research collaboration, relatively few have addressed its prerequisites. In our study, seven prerequisites for research collaboration were extracted from the existing literature, and 460 student researchers were surveyed for their perceptions of the prerequisites’ importance. Focusing on voluntary research collaborations rather than brokered ones, it was found that socially oriented prerequisites such as reciprocal interactions, accountability, trust, and equality are perceived of more importance than prerequisites of psychical proximity, networking channels, and funds and material supplies (substance- and entity-related prerequisites). With latent regression analyses, we also found that Chinese and older, more experienced researchers are inclined to stress the importance of equality. Researchers of different cohorts prioritise substance- and entity-related prerequisites disparately. Specifically, Chinese researchers emphasise the necessity of funds, while researchers from first-tier universities place more value on networking channels. Disciplinary differences for the prerequisite of proximity were also discovered. Based on these results, discussion and implications were referred. Further suggestions on research collaboration studies are rendered. [ABSTRACT FROM AUTHOR]

Hearing loss is the most common sensory impairment, but limited studies focused on the association of socioeconomic status (SES) with hearing loss among adults of working age. This paper aimed to fill this gap among Chinese adults. We obtained data from Ear and Hearing Disorder Survey conducted in four provinces of China in 2014–2015. The survey was based on WHO Ear and Hearing Disorders Survey Protocol and 25,860 adults aged 25 to 59 years were selected in this study. Trained local examiners performed pure tone audiometry to screen people with hearing loss, and those who were screened positively for hearing loss were referred to audiologists to make final diagnosis. SES was measured by occupation, education and income. Results show after adjusting for SES measures and covariates, in urban areas, compared with white-collar workers, blue-collar workers and the unemployed were more likely to have hearing loss, with an odds ratio of 1.2 (95%CI: 1.0, 1.3) and 1.2 (95%CI: 1.0, 1.4), respectively. Compared with people with education of senior high school or above, those with junior high school, primary school and illiteracy had 1.6 (95%CI: 1.4, 1.8), 2.1(95%CI: 1.7, 2.5) and 2.6 (95%CI: 1.9, 3.7) times as likely to have hearing loss, respectively. In rural areas, the unemployed had 1.5 (95%CI: 1.0, 2.3) times the risk of hearing loss compared with white-collar workers, and illiterates had 1.6 (95%CI: 1.6, 2.1) times the risk of hearing loss compared with people with education of senior high school or above, after SES variables and covariates were taken into considerations. Income was not significantly associated with hearing loss in urban and rural areas. In conclusion, SES, in the form of occupation and education, was associated with hearing loss among working-aged population, and further studies are needed to explore the mechanism of such association. [ABSTRACT FROM AUTHOR]

In China, food safety problems have occurred frequently in the past ten years, causing great concern for the public. Adolescents, with higher exposure to problematic food, represent a unique target for interventions aimed at risk reduction. To understand their food safety knowledge, attitude and practice, a cross-sectional survey using paper questionnaire was carried out among 4,220 students (median age of 14 years, 50.3% females) from nine secondary schools in 3 districts of Beijing. The findings showed that the majority of respondents (42.0%) had a high knowledge level. Significant association was found between food safety knowledge score (median = 11, IQR:9–13) and demographic characteristics of region, school type, residence type, habit of smoking and alcohol use, academic record and parents’ education background. In terms of attitude and practice, only 17% of those surveyed regarded China’s food safety situation as good, 53.6% regarded it as worrying; almost all students (96.5%) did pay attention to food safety; 95.3% of the students had worried about the safety of the food provided by the small restaurants and street peddlers, but in reality, as many as 69.4% often or occasionally bought food from peddlers around their campuses and nearly half continued the consumption of such food in spite of worrying about its safety problems. Overall, the food safety knowledge among Beijing secondary school students was relatively good. They did not show much confidence in the country’s food safety situation, but many aware of the safety issues did not bother to change or take action. The study suggests that more systematic and targeted education on food safety is necessary for this age group. [ABSTRACT FROM AUTHOR]

This paper aimed to investigate the role of parental education in child disability in China. We used nationally representative data from China’s National Sample Survey on Disability, iterated twice, in 1987 and 2006, with data of 764,718 children aged 0–14 years. Logit models were used for statistical analysis. Results showed that the prevalence of child disability was significantly associated with each parent’s education. Maternal education was more important than paternal education in child disability in both surveys. The analysis of marginal effect indicated a one-year increase in maternal and paternal schooling led to an average decrease of 0.121% and 0.091% in the probability of child disability in 1987, and 19 years later, these figures had dwindled to 0.091% and 0.072%, respectively. [ABSTRACT FROM AUTHOR]

This paper presents the development and evaluation of the train-the-trainer (TTT) workshop for lay resident leaders to be lay health promoters. The TTT workshop aimed to prepare the trainees to implement and/or assist in conducting a series of community-based family well-being activities for the residents in a public low rent housing estate, entitled “Learning Families Project”, under the FAMILY project. The four-hour TTT workshop was conducted for 32 trainees (72% women, 43% aged ≥ 60, 41% ≤ elementary school education). The workshop aimed to promote trainees’ knowledge, self-efficacy, attitude and practice of incorporating the positive psychology themes into their community activities and engaging the residents to join these activities and learn with their family members. Post-training support was provided. The effectiveness of the TTT was examined by self-administered questionnaires about trainees’ reactions to training content, changes in learning and practice at three time points (baseline, and immediately and one year after training), and the difference in residents’ survey results before and after participating in the community activities delivered by the trainees. The trainees’ learning about the general concepts of family well-being, learning family, leadership skills and planning skills increased significantly with medium to large effect sizes (Cohen’s d: 0.5–1.4) immediately after the training. The effects of perceived knowledge and attitude towards practice were sustained to one year (Cohen’s d: 0.4–0.6). The application of planning skills to implement community activities was higher at one year (Cohen’s d: 0.4), compared with baseline. At one year, the residents’ survey results showed significant increases in the practice of positive communication behaviours and better neighbour cohesions after joining the family well-being activities of LFP. Qualitative feedback supported the quantitative results. Our TTT workshop could serve as a practical example of development and evaluation of training programs for lay personnel to be lay health promoters. Trial registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

We investigate the interdisciplinarity of mathematics based on an analysis of projects sponsored by the NSFC (National Natural Science Foundation of China). The motivation of this study lies in obtaining an efficient method to quantify the research interdisciplinarities, revealing the research interdisciplinarity patterns of mathematics discipline, giving insights for mathematics scholars to improve their research, and providing empirical supports for policy making. Our data set includes 6147 NSFC-sponsored projects implemented by 3225 mathematics professors in 177 Chinese universities with established mathematics departments. We propose the weighted-mean DIRD (diversity of individual research disciplines) to quantify interdisciplinarity. In addition, we introduce the matrix computation method, discover several properties of such a matrix, and make the computation cost significantly lower than the bitwise computation method. Finally, we develop an automatic DIRD computing system. The results indicate that mathematics professors at top normal universities in China exhibit strong interdisciplinarity; mathematics professors are most likely to conduct interdisciplinary research involving information science (research department), computer science (research area), computer application technology (research field), and power system bifurcation and chaos (research direction). [ABSTRACT FROM AUTHOR]

While internal migration is widely occurring in countries across the world and older people are more likely to be left behind by family members who out-migrated to other locations, little attention has been paid to the cognitive health of those people who have been left behind (PLB). Understanding how these demographic patterns relate to older persons’ cognitive health may inform efforts to reduce the disease burden due to cognitive decline. Data came from the China Health and Nutrition Survey in 1997, 2000 and 2004. Participants aged 55 to 93 who participated in a cognitive function screening test (score range: 0–31) in two or more waves and provided information on family members’ migration (n = 1,267) were included in the analysis. A mixed linear model was used to investigate the association between being left behind by any members who had not resided in the household for at least 6 months at baseline and cognitive function. Approximately 10% of the participants had been left behind by family members who migrated out of their communities. A significant interaction was observed in relation to cognitive function between being left behind and the number of years from the first test. Specifically, there was a less steep decline in cognitive function of PLB compared to people not left behind. This longitudinal study showed that PLB tended to have a higher cognitive function compared to those not left behind due to their relatively stable transition in cognitive function during the study period. [ABSTRACT FROM AUTHOR]

Objectives: The main objective of this study was to explore the associations of family relationships and negative life events with depressive symptoms among Chinese adolescents. Methods: A cross-sectional study of 3081 middle school students was conducted in Ganzhou City, Jiangxi Province, China. Students were asked to complete questionnaires regarding family relationships, negative life events, and depressive symptoms. A mediation analysis was carried out using a multiple regression analysis and the PROCESS macro method. Results: Of all participants, 19.9% reported experiencing depressive symptoms. The prevalence of depressive symptoms was 13.0% and 29.2% in participants with good and poor parental relationships, and the prevalence of depressive symptoms was 11.4% and 30.9% in participants with closed and alienated parental-child relationships, respectively. Parental relationships, parental-child relationships, and negative life events were positively correlated with depressive symptoms. The effect of parental relationships on depressive symptoms was fully mediated by negative life events (Effect = 0.052, 95% CI = [0.023, 0.082]), while the effect of parent-child relationships on adolescent depressive symptoms was partially mediated by negative life events (Effect = 0.075, 95% CI = [0.048, 0.104]). Conclusions: Our results showed a high prevalence of depressive symptoms in Chinese adolescents. Poor family relationships may have the potential to increase the risk of depressive symptoms, and they could affect depressive symptoms through negative life events. [ABSTRACT FROM AUTHOR]

School socioeconomic status (SES) is studied primarily as a variable to explain academic achievement; however, few previous studies have investigated how SES can influence individual student's academic achievement. The present study used a national representative sample of 10,784 grade 7 to 9 students (53.2% boys and 46.8% girls) in mainland China to examine the links between school SES and students' math and Chinese achievements, including the math and Chinese teacher-student relationships as mediating factors. The parents provided family socioeconomic information and the students reported on their teacher-student relationships. Achievements in math and Chinese were assessed using standardized tests. Multilevel mediation analyses revealed that school SES was positively related to students' math and Chinese achievements. Moreover, the link between school SES and students' math achievement was partially mediated by students' perception of the math teacher-student relationship. The Chinese teacher-student relationship had no mediating effect. This study indicated that school SES can influence individual student's academic achievement via their perception of teacher-student relationship. The poverty and lack of resources is obvious, yet low SES schools could make efforts in improving teacher-student relationship's quality to promote students' academic performance. Meanwhile, low SES schools should receive more attention from policymakers to improve teaching quality and school climate. Furthermore, the study findings could be used for future research on the gap between low and high SES schools. [ABSTRACT FROM AUTHOR]

An increasing number of young girls have attached great importance to their body-image in China. Body-image dissatisfaction has resulted in increased weight loss behavior. The aim of this study was to investigate the factors that were associated with underweight body-image in female college students. Self-administered questionnaires were completed by 2,023 young female participants from eight Chinese universities. In addition, 160 participants were involved in a qualitative study. The ideal body-image and the factors that influence weight were determined using descriptive and analytical statistics. We found that 1,484 out of 2,023 participants (73.36%) had taken action to lose weight in the past six months. Among these participants, 618 (30.55%, out of 2023) participants were already underweight, and 1,161 (57.39%, out of 2023) would like to be much thinner, which would lead to more underweight individuals. Moreover, non-scientific physical activity and diets were found to lead participants to the underweight subgroup. The participants’ Body Mass Index (BMI), peer advice and western culture influenced the problematic thin-ideal (ideal BMI < 18.5 was considered as the problematic thin-ideal) (P<0.05). Together, western influences leading to the “problematic thin-ideal” and “unhealthy weight-control behavior” have brought about an increased prevalence of desired underweight body-image among female college students in China, which might be harmful for their health. [ABSTRACT FROM AUTHOR]

This study applied the non-parametric four-stage data envelopment analysis method (Four-Stage DEA) to measure the relative efficiencies of Chinese public hospitals from 2010 to 2016, and to determine how efficiencies were affected by eight factors. A sample of public hospitals (n = 84) was selected from Chongqing, China, including general hospitals and traditional Chinese medicine hospitals graded level 2 or above. The Four-Stage-DEA method was chosen since it enables the control of the impact of environment factors on efficiency evaluation results. Data on the number of staff, government financial subsidies, the number of beds and fixed assets were used as input whereas the number of out-patients and emergency department patients and visits, the number of discharged patients, medical and health service income and hospital bed utilization rate were chosen as study outputs. As relevant environmental variables, we selected GDP per capita, permanent population, population density, number of hospitals and number of available sickbeds in local medical institutions. The relative efficiencies (i.e. technical, pure technical, scale) of sample hospitals were also calculated to analyze the change between the first stage and fourth stage every year. The study found that Four-Stage-DEA can effectively filter the impact of environmental factors on evaluation results, which sets it apart from other models commonly used in existing studies. [ABSTRACT FROM AUTHOR]

Objective: In China, patients increasingly choose to access already severely overcrowded higher level hospitals, leaving lower level facilities with low utilization rates. This situation undermines the effectiveness and efficiency of the health system. The situation tends to worsen despite policy measures aimed at improvement. We systematically review the factors affecting patient choice to synthesize scientific understanding of health system access in China. The review provides an evidence base for measures to direct patient flow towards lower level facilities. Methods: We screened the peer-reviewed literature published from April 2009 to January 2016 that investigates Chinese patients’ choice of health care facilities at different levels and assessed 45 studies in total. We applied two structured forms to extract data on each study’s characteristics, methodology, and factors. Results of data synthesis: The results identified four factor types: 1) patient, 2) provider, 3) context and 4) composite: combined patient, provider, and/or context attributes. Patient factors are mentioned the most, but the evidence on patient factors is often inconclusive. Evidence suggests that the provider factors ‘drug variety’ and ‘equipment’, and composite factor ‘perceived quality’, push patients from lower levels towards higher levels. Conclusion: Underuse of primary care facilities and overcrowding of higher level facilities will likely be amplified by current demographic trends. Evidence suggests that improving drug availability, equipment and perceived quality of primary care services can improve the situation. Well-designed research that considers the interactions between factors is called for to better inform future interventions. [ABSTRACT FROM AUTHOR]

Births outside marriage (BoM) account for around 15% of all births globally. However, the distribution around the world is very uneven, as are cultural and political attitudes towards them. Studies from East Asia have shown that the percentage of such births is very low, with only modest increases in recent years. The orthodox demographic view holds that the maintenance of conservative views around the relationship between marriage and childbearing can play a role in keeping fertility low. Prenuptial pregnancies (PNP) (where births occur within eight months of marriage) have been identified as a growing phenomenon in Japan, possibly being an ‘alternative’ Asian pathway to family formation. As yet, no comprehensive statistical analysis of the trends of BoM or PNP has been performed for Hong Kong. Using a comprehensive microdata set of birth registration in Hong Kong from 1984–2015 (N = 1,680,831) we provide evidence of recent trends in such ‘alternative pathways’ to family formation and examine predictors through regression analysis. Our results indicate, in common with elsewhere in East Asia, low overall period rates of either BoM or PNP (although the latter has risen notably in recent years). While more recent birth cohorts exhibit higher prevalence of such births, their incomplete nature and higher expected propensity suggests that the figures are exaggerated. In our regression analysis, we find that lower educational attainment is a strong predictor of both BoM and PNP, suggesting that a bifurcation of experience may be occurring. This adds further evidence to the theory that the maintenance of traditional family formation systems in the context of revolutionised educational and work opportunities for women mean that the opportunity costs of the ‘marriage package’ become too high. Current disparities in rights and privileges between married and unmarried parents–and especially their children–means that targeted family planning services and support for vulnerable families are policy priorities. [ABSTRACT FROM AUTHOR]

Objectives: Among the dramatic increased internal migration in China in past three decades, a considerable proportion of young females migrated to urban areas and found employment in “entertainment venues”, who may be vulnerable to psychological distress. This study examines the prevalence of depression and explores its associations with health-risk behaviors and social capital among this subgroup. Methods: 358 female migrants were recruited from entertainment venues in a rapidly growing urban city in China. A survey which included measures of depressive symptoms, health-risk behaviors, social capital, and socio-demographic characteristics was administered. Multivariable logistic regression was conducted to identify the independent correlates of depression. Results: Of participants, 31.0% had clinically significant depressive symptoms (CES-D score ≥ 16). In multivariable models, greater likelihood of depressive symptoms was associated with working in massage centers/hotels (OR = 3.20, 95% CI: 1.80–5.70), having probable alcohol dependence (OR = 2.25, 95% CI: 1.22–4.16), self-reported lifetime use of illicit drugs (OR = 2.98, 95% CI: 1.26–7.06), growing up in a non-nuclear family (OR = 2.46, 95% CI: 1.18–5.16), and poor social capital (OR = 6.01, 95% CI = 2.02–17.87). Conclusion: Intervention strategies to address the high prevalence of depression among female migrants are needed, and should also aim to reduce problematic alcohol and drug use, improve social capital, and target women working in massage centers or hotels. [ABSTRACT FROM AUTHOR]

Background: Offering free glasses can be important to increase children’s wear. We sought to assess whether “Upgrade glasses” could avoid reduced glasses sales when offering free glasses to children in China. Methods: In this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools in 9 counties in Guangdong and Yunnan provinces, China, were randomized by school to one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase (main outcome) was assessed 6 months after randomization. Results: Among 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%) at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up. Glasses purchase was significantly less likely when free glasses were given: Control: 59/250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk (RR) 0.90 (0.56–1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59, 1.42), P = 0.69. Conclusions: Upgrade glasses can prevent reductions in glasses purchase when free spectacles are provided, providing important program income. Trial registration: ClinicalTrials.gov Identifier: . Registered on 31 August 2014. [ABSTRACT FROM AUTHOR]

Health literacy (HL) has become an important public health issue and is receiving growing attention. However, the HL levels of military college students in China have never been analyzed. This study aimed to investigate the HL and related associate factors in military college students in Chongqing, China. Data was obtained with the “Chinese Citizen Health Literacy Questionnaire (2012 edition)” from 3183 military college students aged 16–28 years at Chongqing in December 2015. A total score of ≥80 points determined adequate HL, and HL level was defined as the proportion of students who had adequate HL out of the total number of participants. Multiple logistic regression analysis with a stepwise forward likelihood ratio (LR) method was used to determine the effects of sociodemographic characteristics, health-related behaviors, and family-related factors on HL level. The mean score of HL was 68.56, and the HL level of military college students was 21.05%; the overall knowledge rate was 71.33%. The independent factors that were associated with HL level were years in college, educational system, time playing online games, annual household income and father's education level. Senior (odds ratio [OR] = 1.229, 95% confidence interval [CI] 1.018∼1.484), undergraduate (OR = 1.509, 95% CI 1.151∼1.978), time played games more than 5 hours each week (OR = 0.638, 95% CI 0.486∼0.837), annual household incomes more than 50,000 yuan (OR = 1.231, 95% CI 1.027∼1.476) and father's education level (high school: OR = 2.327, 95% CI 1.186∼4.565; university: OR = 2.450, 95% CI 1.244∼4.825), were independently associated with higher HL level. HL levels of military college students in Chongqing need to be improved across the board. Our data suggests that special emphasis should be placed on students in junior and those in the specialist educational system. School departments may also benefit from incorporating health literacy into their curricula and helping students manage the time they spend playing online games. [ABSTRACT FROM AUTHOR]

Objectives: China has high burden on both of tuberculosis (TB) and tobacco use. This study aims to explore the potential link between smoking and TB infection using baseline survey data of a large-scale population-based prospective study in rural China Methods: Between July 1 and Sept 30, 2013, based on the baseline survey of a population-based, prospective study in rural China, the relationship between smoking and TB infection, assessed by interferon-gamma release assays (IGRA), was investigated among the total study population and only among those smokers, respectively. Results: A total of 21,008 eligible rural registered residents (≥ 5 years old) from 4 rural sites were included in the analysis. Ever-smokers were more likely to be QuantiFERON-TB Gold In-Tube (QFT) positive than never smokers with an adjusted odds ratio (OR) of 1.34 (95% confidence interval (CI): 1.21–1.49). Among ever smokers, a significant linear dose–response relation was observed between duration of smoking (by years) and QFT positivity (p < 0.001). Stratified analysis suggested that such an association was not influenced by gender and age. Evidence for interaction of smoking status with age was found. Conclusions: Our results provide further evidence to support smoking might increase host susceptibility to TB infection. Populations under high risk of infection, such as elderly smokers, should be prior to TB infection controlling under a premise of community level intervention. [ABSTRACT FROM AUTHOR]

Self-injurious behavior (SIB) among adolescents is an important public health issue worldwide. It is still uncertain whether homogeneous subgroups of SIB can be identified and whether constellations of SIBs can co-occur due to the high heterogeneity of these behaviors. In this study, a cross-sectional study was conducted on a large school-based sample and latent class analysis was performed (n = 10,069, mean age = 15 years) to identify SIB classes based on 11 indicators falling under direct SIB (DSIB), indirect SIB (ISIB), and suicide attempts (SAs). Social and psychological characteristics of each subgroup were examined after controlling for age and gender. Results showed that a four-class model best fit the data and each class had a distinct pattern of co-occurrence of SIBs and external measures. Class 4 (the baseline/normative group, 65.3%) had a low probability of SIB. Class 3 (severe SIB group, 3.9%) had a high probability of SIB and the poorest social and psychological status. Class 1 (DSIB+SA group, 14.2%) had similar scores for external variables compared to class 3, and included a majority of girls [odds ratio (OR) = 1.94]. Class 2 (ISIB group, 16.6%) displayed moderate endorsement of ISIB items, and had a majority of boys and older adolescents (OR = 1.51). These findings suggest that SIB is a heterogeneous entity, but it may be best explained by four homogenous subgroups that display quantitative and qualitative differences. Findings in this study will improve our understanding on SIB and may facilitate the prevention and treatment of SIB. [ABSTRACT FROM AUTHOR]

Background: Global literature has suggested a negative impact of acculturative stress on both physical and mental health among international migrants. In China, approximately 20 percent of its population is rural-to-urban migrant workers and there are significant cultural differences between rural and urban societies, but no data are available regarding the acculturative stress of Chinese migrant workers. This study aimed to explore the forms and contexts of acculturative stress among Chinese migrant workers. Methods: Qualitative data were collected from four focus group discussions with 17 Chinese rural-to-urban migrant workers and three individual interviews with three medical professionals who provided mental health services for factory-workers in Shenzhen, China. Results: The data in the current study showed that rural-to-urban migrant workers in China had experienced various forms of acculturative stress including difficulties in adapting to the environment, work-related stress, family-related stress, financial hardship, and lack of sense of belonging to cities. Conclusion: Rural-to-urban migration in China is a challenging transition with significant acculturative stress and demands for major adjustments among migrant workers. The assessment and management of acculturative stress is a necessary first step in providing mental health services to migrant workers. [ABSTRACT FROM AUTHOR]

The purpose of this study was to construct and validate a “Perceived Physical Literacy Instrument” (PPLI) for physical education teachers. Based on literature review and focus group interviews, an 18-item instrument was developed for the initial tests. This self-report measure, using a 5-point Likert scale, formed the PPLI and was administered to 336 physical education teachers in Hong Kong. The sample was randomly split, and exploratory and confirmatory factor analyses resulted in a 9-item, 3-factor scale. Exploratory factor analysis (EFA) item loadings ranged from 0.69 to 0.87, and Cronbach’s alpha ranged from 0.73 to 0.76. Confirmatory factor analysis (CFA) showed that the construct demonstrated good fit to the model. The PPLI thus appeared to be reliable and valid to measure the perceived physical literacy of physical education teachers. It is argued that the instrument can be used for both research and applied purposes and potential uses for the instrument in physical education, medical and health settings are discussed. [ABSTRACT FROM AUTHOR]

Objective: Team-based learning (TBL) is an increasingly popular teaching method in medical education. However, TBL hasn’t been well-studied in the ophthalmology clerkship context. This study was to examine the impact of modified TBL in such context and to assess the student evaluations of TBL. Methods: Ninety-nine students of an 8-year clinical medicine program from Zhongshan Ophthalmic Centre, Sun Yat-sen University, were randomly divided into four sequential units and assigned to six teams with the same faculty. The one-week ophthalmology clerkship module included traditional lectures, gross anatomy and a TBL module. The effects of the TBL module on student performance were measured by the Individual Readiness Assurance Test (IRAT), the Group Readiness Assurance Test (GRAT), the Group Application Problem (GAP) and final examination scores (FESs). Students’ evaluations of TBL were measured by a 16-item questionnaire. IRAT and GRAT scores were compared using a paired t-test. One-way analysis of variance (ANOVA) and subgroup analysis compared the effects among quartiles that were stratified by the Basic Ophthalmology Levels (BOLs). The BOLs were evaluated before the ophthalmology clerkship. Results: In TBL classes, the GRAT scores were significantly higher than the IRAT scores in both the full example and the BOL-stratified groups. It highlighted the advantages of TBL compared to the individual learning. Quartile-stratified ANOVA comparisons showed significant differences at FES scores (P < 0.01). In terms to IRAT, GRAT and GAP scores, there was no significant result. Moreover, IRAT scores only significantly differed between the first and fourth groups. The FES scores of the first three groups are significantly higher than the fourth group. Gender-specific differences were significant in FES but not the IRAT. Overall, 57.65% of student respondents agreed that TBL was helpful. Male students tended to rate TBL higher than female students. Conclusion: The application of modified TBL to the ophthalmology clerkship curriculum improved students’ performance and increased students’ engagement and satisfaction. TBL should be further optimized and developed to enhance the educational outcomes among multi-BOLs medical students. [ABSTRACT FROM AUTHOR]

Background: China has rapidly expanded health insurance coverage over the past decade but its impact on hypertension control is not well known. We analyzed factors associated with hypertension and the impact of health insurance on the management of hypertension in China from 1991 to 2009. Methods and Findings: We used individual-level data from the China Health and Nutrition Survey (CHNS) for blood pressure, BMI, and other socio-economic variables. We employed multi-level logistic regression models to estimate the factors associated with prevalence and management of hypertension. We also estimated the effects of health insurance on management of hypertension using propensity score matching. We found that prevalence of hypertension increased from 23.8% (95% CI: 22.5–25.1%) in 1991 to 31.5% (28.5–34.7%) in 2009. The proportion of hypertensive patients aware of their condition increased from 31.7% (28.7–34.9%) to 51.1% (45.1–57.0%). The proportion of diagnosed hypertensive patients in treatment increased by 35.5% in the 19 years, while the proportion of those in treatment with controlled blood pressure remained low. Among diagnosed hypertensives, health insurance increased the probability of receiving treatment by 28.7% (95% CI: 10.6–46.7%) compared to propensity-matched individuals not covered by health insurance. Conclusions: Hypertension continues to be a major health threat in China and effective control has not improved over time despite large improvements in awareness and treatment access. This suggests problems in treatment quality, medication adherence and patient understanding of the condition. Improvements in hypertension management, quality of medical care for those at high risk, and better health insurance packages are needed. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence of snoring during pregnancy and its effects on key pregnancy outcomes. Methods: Pregnant women were consecutively recruited in their first trimester. Habitual snoring was screened by using a questionnaire in the 1st and 3rd trimester, respectively. According to the time of snoring, participants were divided into pregnancy onset snorers, chronic snorers and non-snorers. Logistic regressions were performed to examine the associations between snoring and pregnancy outcomes. Results: Of 3 079 pregnant women, 16.6% were habitual snorers, with 11.7% were pregnancy onset snorers and 4.9% were chronic snorers. After adjusting for potential confounders, chronic snorers were independently associated with gestational diabetes mellitus (GDM) (RR 1.66, 95%CI 1.09–2.53). Both pregnancy onset and chronic snorers were independently associated with placental adhesion (RR 1.96, 95%CI 1.17–3.27, and RR 2.33, 95%CI 1.22–4.46, respectively). Pregnancy onset snorers were at higher risk of caesarean delivery (RR 1.37, 95%CI 1.09–1.73) and having macrosomia (RR 1.54, 95%CI 1.05–2.27) and large for gestational age (LGA) (RR 1.71, 95%CI 1.31–2.24) infants. In addition, being overweight or obese before pregnancy plays an important role in mediating snoring and adverse pregnancy outcomes. Conclusions: Maternal snoring may increase the risk of adverse pregnancy outcomes, and being overweight or obese before pregnancy with snoring is remarkable for researchers. Further studies are still needed to confirm our results. [ABSTRACT FROM AUTHOR]