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Purpose: To compare risk of problematic internet use (PIU) and importance of digital media interactions for transgender and cisgender adolescents. Methods: A nationally representative group of adolescents took an online survey that included a measure of PIU (Problematic and Risky Internet Use Screening Scale-3 [PRIUSS-3]) and technology interactions (Adolescent Digital Technology Interactions and Importance scale). We compared mean scores for these scales and their subscales and rates of positive screens for PIU for transgender and cisgender adolescents. Results: Of 4575 adolescents participating, 53 (1.2%) were transgender, nonbinary, and gender-diverse (TNG) adolescents. TNG adolescents had higher PRIUSS-3 scores and higher mean scores for importance of technology to explore identity/go outside their offline environment. Conclusions: TNG adolescents report higher PIU risk, which may relate to differences in technology importance for this group. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to assess the level of moral courage among nurses in China, and to explore related influential factors, to help nursing managers take measures to improve nurses' moral courage. Design: A cross‐sectional study. Methods: The data adopted a convenient sampling method. From September to December 2021, 583 nurses from five hospitals in Fujian Province completed the Chinese version of the Nurses' Moral Courage Scale (NMCS). Data were analysed using descriptive statistics, chi‐square test, T‐test, Pearson correlation analysis and multiple regression analysis. Results: The Chinese nurses perceived themselves, on average, as morally courageous. The mean NMCS score was 3.64 ± 0.692. The six factors showed statistically significant correlations (p < 0.05) with moral courage. Regression analysis showed that the main factors influencing nurses' moral courage were active learning of ethics knowledge and nursing was a career goal. Conclusion: This study provides the self‐evaluation level and related influencing factors of Chinese nurses' moral courage. There is no doubt that nurses still need strong moral courage to face unknown ethical problems and challenges in the future. Nursing managers should pay attention to the cultivation of nurses' moral courage, using various forms of educational activities to help nurses alleviate moral problems and improve their moral courage, to maintain patients' access to high‐quality nursing. [ABSTRACT FROM AUTHOR]

Adolescents' digital technology use is nearly ubiquitous and has been associated with health benefits and risks, including risks of depression. The Adolescents' Digital Technology Interactions and Importance (ADTI) scale provides a novel approach to measuring how adolescents prioritize their technology use. The purpose of this study was to investigate the relationship between adolescents' technology interactions and mental health measures, including depression and mental well-being. This cross-sectional online survey study recruited adolescents aged 12–18 years using Qualtrics panels. Survey measures included the ADTI and assessments of depression and well-being. Analyses included the Kruskal–Wallis test and multivariate logistic regression analyses. The 4,592 participants had a mean age of 15.6 years (SD = 1.68), 46.4 percent were female, 66.9 percent were Caucasian, and 74.5 percent lived in a household with an income above the poverty line. The median ADTI total score was 48 (range 18–90), 23.0 percent (n = 1,055) of participants were categorized for at risk for depression and 54.8 percent (n = 2,477) of participants were categorized as high mental well-being. Participants with higher ADTI total scores were more likely to be at risk for depression (odds ratio [OR] = 1.059, 95 percent confidence interval [CI]: 1.054–1.064). Furthermore, participants with a higher ADTI total score were more likely to have a higher mental well-being (OR = 1.015, 95 percent CI: 1.012–1.019). We found that ADTI total scores were significantly higher both among adolescents who screened positive for depression and among adolescents with higher mental well-being. This intriguing finding suggests that it is possible that digital technology use intensifies either the positive or the negative mental states that adolescents bring to their online environment. [ABSTRACT FROM AUTHOR]

The relationship between insulin-like growth factor-1 (IGF-1) and systolic blood pressure (SBP) is controversial in adults and children. The purpose of this study was to investigate the relationship between the IGF-1 standard deviation score (IGF-1 SDS) and SBP in children with short stature. A cross-sectional analysis including 1315 children with short stature was conducted from March 2013 to October 2020. We estimated IGF-1, blood pressure and other laboratory tests, and anthropometric indicators were also evaluated. Subgroup analyses of the pubertal stage, sex, growth hormone levels, thyroid hormone levels, fasting blood glucose levels, and triglyceride levels were performed. A positive association between the IGF-1 SDS and SBP was observed by univariate analysis (p < .001). We further found a nonlinear association between the IGF-1 SDS and SBP. The inflection point for the curve was found at an IGF-1 SDS level of -2.91. In multivariate piecewise linear regression, there was a positive association between the IGF-1 SDS and SBP when the IGF-1 SDS was greater than -2.91 (β 1.56, 95% CI: 0.91, 2.22; p < .001). However, we did not observe a significant relationship between the IGF-1 SDS and SBP when the IGF-1 SDS level was less than -2.91 (β -0.95, 95% CI -3.17, 1.28; p = .379). This association was consistent across subgroup analyses. The present study demonstrated that there is a nonlinear relationship between the IGF-1 SDS and SBP in children with short stature. Increased serum IGF-1 levels were associated with elevated SBP when the IGF-1 levels reached the inflection point. [ABSTRACT FROM AUTHOR]

Background: Family caregivers need to be supported in caring for patients at the end of life, but practical tools to assess their support needs have been missing in China. So this study aimed to culturally adapt and validate the Carer Support Needs Assessment Tool (CSNAT). Methods: Cross-cultural adaptation of the original CSNAT for a Chinese setting was performed according to Brislin's translation guidelines. A pilot study was conducted with 15 Chinese family caregivers of cancer patients receiving hospice home care and 5 medical staff. A cross-sectional survey of 205 family caregivers was conducted from December 2018 to May 2019 at a home-based hospice care institute in Shenzhen, China. The validation procedure comprised the establishment of (1) content validity by a group of six experts; (2) face validity by 15 family caregivers; (3) criterion validity by calculating Spearman's correlations between the CSNAT and caregiving burden, caregiving preparedness and quality of life scales; (4) internal consistency using Cronbach's alpha. Results: The CSNAT demonstrated good face validity and good content validity. CSNAT scores showed clear positive correlations with caregiving burden and negative correlations with preparedness for caregiving and quality of life. Internal consistency was high (Cronbach's alpha = 0.899), although such reliability testing is not recommended for this tool. Conclusions: The Chinese version of the CSNAT is a valid tool that is appropriate for identifying needs of family caregivers of cancer patients in home-based hospice care. [ABSTRACT FROM AUTHOR]

Background: The growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis is critical for the regulation of children's growth and development. Serum IGF-1 concentrations are usually low in individuals with idiopathic short stature (ISS) despite normal endogenous GH levels, and the associated underlying factors are unknown. This study aimed to explore the relationship between IGF-1 and hemoglobin (Hb) in children with ISS. Methods: A cross-sectional analysis was performed including 178 children and adolescents with ISS who were enrolled from March 2013 to February 2019. The related clinical and biochemical parameters were evaluated for each patient. Univariate analysis, smooth curve fitting and multivariate piecewise linear regression were performed. Result: The mean levels of IGF-1 standard deviation scores (SDS) and Hb were − 0.99 (− 1.60 - -0.09) and 131.81 ± 9.36 g/L, respectively. Univariate analysis displayed a significant positive association between Hb and IGF-1 SDS (P < 0.001). After adjusting for potential confounding factors, the positive relationship between Hb and IGF-1 SDS remained (P = 0.001). Furthermore, there was an inflection point for Hb in the curve. In a multivariate piecewise linear regression model, IGF-1 SDS was significantly positively associated with Hb when Hb concentrations were lower than 145 g/L (B 0.05; 95% CI 0.02, 0.07; P < 0.001). However, IGF-1 SDS decreased with increasing Hb levels when Hb concentrations were greater than 145 g/L (B -0.15; 95% CI -0.23, − 0.06; P = 0.001). Conclusion: This study demonstrated that Hb is associated with IGF-1 in Chinese children and adolescents with ISS. The levels of IGF-1 increased with the elevation of Hb, but when the concentration of Hb exceeded a certain range, with the increase of Hb, IGF-1 decreased instead. [ABSTRACT FROM AUTHOR]

Old Order Amish and Mennonites, or Plain populations, are a growing minority in North America with unique health care delivery and access challenges coupled with higher frequencies of genetic disorders. The objective of this study was to determine newborn screening use and attitudes from western Wisconsin Plain communities. A cross-sectional survey, with an overall response rate of 25 %, provided data representing 2010 children. In households with children (n = 297), the rate of newborn screening was 74 % and all children were screened in 40 % of these households. Lack of access to testing was the most common reason for not screening all children and parental age was inversely associated with testing. The majority of respondents reported some or more knowledge of screening, viewed screening as important, and had access to screening in their communities. Households with children who had never received newborn screening (26 %) reported lower frequencies of favorable responses in all categories compared to households that had at least one child screened. The difference in access to newborn screening was less marked between the groups compared to differences on knowledge and consideration of its importance. Moreover, 55 % of households who had never screened any of their children reported being unlikely or unsure of screening any future children. A focus on improving access to newborn screening alongside establishing approaches to change parental perceptions on the importance of newborn screening is necessary for increasing newborn screening in these Plain communities. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To test the interaction of perceived risk and benefits and how they impact stage of mammography readiness and adherence.Design: Cross-sectional study.Setting: Community gathering centers and healthcare clinics across Indiana.Sample: 299 African American women who had not had a mammogram in more than 18 months.Methods: In-person interviews were used to collect data on sociodemographics, health belief variables, and stage of readiness to undertake mammography screening. Four categories were created to measure the combined magnitude of high or low levels of perceived risk and benefit, with health belief variables linked to modified mammography screening behavior.Main Research Variables: Perceived risks and benefits, stage of readiness, and mammography adherence.Findings: The lowest rate of mammography adherence was in women with a high perceived risk and low perceived benefit toward mammography adherence (26%). The highest rate of adherence was in women with a high perceived benefit and low perceived risk (46%). Differences in mammography adherence were statistically significant between the groups (p = 0.009).Conclusions: The interaction of high perceived risk and low perceived benefits impacted readiness to undergo screening mammography.Implications for Nursing: Reducing disparities in breast cancer diagnosis and survival requires timely and efficient mammography adherence. African American medically underserved women with high perceived risk and low perceived benefits exhibited a reluctance to move forward with mammography adherence. Interventions are needed to increase the perception of mammography benefit and to subsequently reduce breast cancer mortality rates in that population. [ABSTRACT FROM AUTHOR]