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Background: To evaluate the knowledge, attitude and practice of nurses regarding non-pharmacologic therapies for behavioral and psychological symptoms of dementia (BPSD). Methods: This cross-sectional, questionnaire-based study enrolled nurses at Peking Union Medical College Hospital (Beijing, China) between September 2022 and October 2022. Correlations between knowledge, attitude and practice scores were evaluated by Pearson correlation analysis. Factors associated with knowledge, attitude and practice scores were identified by multivariable linear regression. Based on a cross-sectional questionnaire survey, this study designed a questionnaire according to the Guidelines for Diagnosis and Treatment of Dementia in China, and randomly selected nurses from Peking Union Medical College Hospital to fill in the questions through the Wen-Juan-Xing online platform from September 2022 to October 2022. Results: The analysis included 210 nurses (202 females). The average knowledge, attitude and practice scores were 11.06±2.61 (total score: 18), 53.51±5.81 (total score: 60) and 64.66 ± 10.35 (total score: 80) points, respectively. Knowledge score was positively correlated with attitude score (r = 0.416, P < 0.001) and practice score (r = 0.389, P < 0.001); attitude and practice scores were also positively correlated (r = 0.627, P < 0.001). Multivariable analysis demonstrated that age ≥ 40 years-old (vs. ≤30 years-old) was associated with higher knowledge score (β = 1.48, 95% confidence interval [95%CI] = 0.42–2.54, P = 0.006). Age ≥ 40 years-old (β = 1.43, 95%CI = 0.35–2.51, P = 0.010 vs. ≤30 years-old) and bachelor's degree or higher (β = 1.11, 95%CI = 0.12–2.10, P = 0.028 vs. college degree or lower) were associated with higher practice score. Conclusions: Older age and higher education level were associated with higher knowledge, attitude and/or practice scores. The findings of this study may help guide the development and implementation of education and training programs to improve the management of BPSD by nurses in China. [ABSTRACT FROM AUTHOR]

Objectives: To identify factors associated with female sexual dysfunction (FSD) among Hong Kong Chinese women in a gynaecology outpatient clinic. Methods: Chinese women aged 18 to 65 years who had been sexually active in the past 4 weeks before recruitment and attended the gynaecology clinic of Kwong Wah Hospital between October 2020 and July 2021 were invited to participate in a sexual health survey. Participant demographics were collected through the clinical management system. Sexual function in the previous 4 weeks was assessed using the Female Sexual Function Index (FSFI). Results: 206 women (mean age, 43.6 years) were included in the analysis. The mean total FSFI score was 23.44; 42% of participants were at risk of FSD, with a total FSFI score of =23.45. The score was lowest in the sexual desire domain (2.88) and highest in the coital pain domain (4.51). Participants were divided into three age groups based on their reproductive age status: 18 to 35 years (n=44), 36 to 50 years (n=116), and 51 to 65 years (n=46). Although older age groups tended to have higher risks of FSD, the differences between groups were not significant. Specifically, only the satisfaction domain score was lower in the age group of 36 to 50 years than in the age group of 18 to 35 years (4.16 vs 4.61, p=0.01). The coital pain domain score was lower in menopausal women than in premenopausal women (3.76 vs 4.51, p=0.03). Parous women had a lower sexual desire domain score (2.78 vs 3.04, p=0.04) and higher vaginal lubrication domain score (4.42 vs 3.74, p=0.02) than nulliparous women. Women using contraception had a higher vaginal lubrication domain score than women not using contraception (4.47 vs 3.91, p=0.02). Women with distress related to sexual function had a lower total FSFI score (19.74 vs 23.78, p=0.01), lower satisfaction domain score (3.80 vs 4.42, p=0.02), and lower coital pain domain score (3.38 vs 4.51, p=0.01), compared with women without distress related to sexual function. Conclusion: Although older women tend to be at higher risk of FSD, the correlation between age and FSFI score was not significant. Menopausal women had a lower coital pain domain score; women not using contraception had a lower vaginal lubrication domain score. [ABSTRACT FROM AUTHOR]

Scope: The present investigation seeks to illuminate the current state and disparities in the knowledge, attitudes, and practices (KAP) among healthcare professionals regarding the management of lung cancer palliative care (LCPC) in China, while simultaneously assessing the prevalence and context of patientcontrolled analgesia (PCA) usage in the management of cancer-related pain. Methods: A total of 2093 healthcare practitioners from 706 hospitals across China completed a structured questionnaire that probed various facets of LCPC management. The questionnaire consisted of seven thematic sections, incorporating chi-square tests and Fisher's exact probabilities to statistically assess the discrepancies in KAP among healthcare professionals across different hospital grades. Ordered data distributions among hospital grades were compared using non-parametric Kruskal-Wallis H and Mann-Whitney U tests. Multiple-choice items were subjected to multiple-response crosstabulation analysis, while the Spearman rank-order correlation coefficient was employed to gauge potential associations among variables. Results: Around 84.2% of the respondents perceived anti-tumor therapy to be of equal importance to palliative care. Statistically significant differences (χ²= 27.402, P = 0.002) in satisfaction levels were observed, with participants from Tertiary hospitals demonstrating higher satisfaction compared to those from Secondary and Primary hospitals. Pain emerged as the most prevalent symptom necessitating LCPC. Major impediments to LCPC adoption included patients' and families' concerns about the safety of long-term palliative care-related drug use. 31.1% of the respondents cited the most frequent rationale for PCA use as cases involving patients who required systemic administration of large opioid doses or exhibited intolerable adverse reactions to opioids. The principal deterrents against the use of PCA for cancer pain management were (1): apprehension about adverse drug reactions due to overdose (2), concern about the potential for opioid addiction, and (3) the anticipated increase in patients' economic burdens. Over the preceding 24-month period, 33.9% of the surveyed healthcare practitioners reported no engagement in either online or offline LCPC-related training initiatives. Conclusion: This study emphasizes the pressing need for comprehensive training in LCPC among Chinese health personnels, particularly focusing on the effective management of cancer pain symptoms. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated the perceptions of healthcare providers in China regarding pediatric palliative care, particularly in critical care units (PICUs), where many children receive palliative care. To evaluate the knowledge, attitudes and practices of PICU personnel in China regarding pediatric palliative care. Methods: This cross-sectional study was conducted in five cities in China (Shanghai, Suzhou, Chongqing, Chengdu and Yunnan) between November 2022 and December 2022. Results: The analysis included 204 participants (122 females), with 158 nurses and 46 physicians. The average knowledge, attitude and practice scores were 9.75 ± 2.90 points (possible range, 0–13 points), 38.30 ± 3.80 points (possible range, 12–60 points) and 35.48 ± 5.72 points (possible range, 9–45 points), respectively. Knowledge score was higher for physicians than for nurses (P < 0.001) and for personnel with previous training in pediatric palliative care (P = 0.005). According to structural equation modelling knowledge had a direct positive effect on attitude (β = 0.69 [0.28–1.10], p = 0.001), and indirect on practice (β = 0.82 [0.36–1.28], p < 0.001); attitude had significant effect on practice as well (β = 1.18 [0.81–1.56], p < 0.001). Conclusions: There is room for improvement in the knowledge, attitudes and practices of PICU personnel in China regarding pediatric palliative care. The findings of this study may facilitate the design and implementation of targeted education/training programs to better inform physicians and nurses in China about pediatric palliative care. [ABSTRACT FROM AUTHOR]

Objective To evaluate the reliability, validity and diagnostic accuracy of the Canadian Longitudinal Study on Aging Epilepsy Algorithm (CLSA-EA) questionnaire (Chinese version) in screening Chinese adult epilepsy. Methods From August to October 2022, a total of 384 subjects and patients were included, who were respectively screened from urban and rural communities in Chengdu, Sichuan, and Department of Neurology of West China Hospital, Sichuan University. The CLSA-EA questionnaire (Chinese version) was used for the survey. Epilepsy was diagnosed according to 2014 International League Against Epilepsy (ILAE) criteria. Kappa coefficient and Cronbach's α coefficient were used to evaluate test-retest reliability and internal consistency, respectively. Construct validity was used to test validity. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic consistency κ value were calculated by confusion matrix method to evaluate the effect of screening. Results Finally, 348 questionnaires were obtained, including 190 epileptic cases (54.60%) and 158 non-epileptic cases (45.40%), of which 244 were retested subjects, including 123 epileptic cases (50.41%) and 121 non-epileptic cases (49.59%). Retest reliability analysis in epileptic cases showed that the consistency of items Q3a, Q3biii, Q3biv, Q4a and Q4b in CLSA-EA questionnaire (Chinese version) had moderate consistency (0.400 ≤ κ < 0.750; P = 0.000, for all). Items Q1, Q2, Q3bi, Q3bii, Q3bv, Q3bviand Q3bvii had poor consistency (0.000 ≤ κ < 0.400; P < 0.05, for all). In non-epileptic cases, the consistencies of items Q2, Q3a, Q3bi, Q4a and Q4b were moderate (P = 0.000, for all), Q3bv and Q3bviwere poor (P = 0.000, for all), and no consistencies of Q3bii, Q3biii and Q3biv were found (P > 0.05, for all). The internal consistency evaluation in epileptic cases showed that the internal consistency of all items and the sum of all items in the CLSA-EA questionnaire (Chinese version) were poor (Cronbach's α coefficient < 0.700). The internal consistency of items Q4a and Q4b for non-epileptic patients was also poor, but other items and the sum of all items were acceptable (Cronbach's α coefficient 0.700-0.800). The structural validity analysis showed that the cumulative variance contribution rate of the four factors was only 43%, and items Q1 and Q3a were not incorporated into the factors. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and consistency of CLSA-EA2 epilepsy determination algorithm were higher (> 0.900, for all). Conclusions The CLSA-EA questionnaire (Chinese version) has high sensitivity and specificity, which can guide the preliminary screening of epilepsy in China. However, the applicability, reliability and validity still need to be further considered. [ABSTRACT FROM AUTHOR]

Background: Advance care planning can be challenging because discussing end-of-life care often has negative connotations. Gamification is a novel approach to encourage advance care planning conversations in Western culture. Aim: To co-design a game with multiple stakeholders to promote advance care planning in Chinese communities. Design: A two-phase design guided by the Medical Research Council framework for developing complex interventions was adopted between May 2019 and August 2020. In phase I, a game prototype was developed based on literature review, expert consultation and end-user consultation. In Phase II, the game prototype was tested among end-users and refined according to their feedback and expertise of a multi-disciplinary team through an iterative process. Setting/participants: Experts in the field of aged care, palliative care, life education and game development and Chinese community-dwelling adults aged 60 years or older. Results: A board game called ' The Five Tastes Found in a Grocery Store ' was developed. The game design was shaped by Bandura's Self-efficacy theory and feedback from experts and end-users. The participants generally found the gaming experience enjoyable and appreciated the opportunity to discuss end-of-life care openly. Conclusions: This study is the first to develop an evidence-informed, theory-based, culturally sensitive game for promoting advance care planning in the Chinese community using a co-design approach. [ABSTRACT FROM AUTHOR]

Objective: To report the results of a dose survey conducted across 31 provinces in mainland China from 2017 to 2018 and to analyse the dose level to determine the national diagnostic reference levels (DRLs) for paediatric CT procedures. Methods: At least ten patients for each age group (0– < 1, 1– < 5, 5– < 10, 10– < 15 years) and each procedure (head, chest and abdomen) for each CT scanner were selected from four to eight hospitals in each province. The dose information (CTDIvol and DLP) was collected from the HIS or RIS-PACS systems. The median values in each CT scanner were considered the representative dose values for the paediatric patients in CT scanning. The national DRLs were estimated based on the 75th percentile distribution of the median values. Results: A total of 24,395 patients and 319 CT scanners were investigated across 262 hospitals. For paediatric CT scanning in 4 different age groups, the median (P50) and the 75th percentile (P75) of CTDIvol and DLP for each scanning procedure were calculated and reported. National DRLs were then proposed for each procedure and age group. Conclusion: The dose level of CT scanning for children in mainland China was reported for the first time. The DRLs for paediatric CT in the present study are similar to those in some Asian countries but higher than those in European countries. Clinical relevance statement: The paediatric CT is an extensively used tool in diagnosing paediatric disease; however, children are more sensitive to radiation. Establishing the diagnostic reference level of paediatric CT examination is necessary to reduce the dose of CT in children and promote the optimisation of medical exposure. Key Points: • The DRLs for 3 paediatric CT procedures (head, chest and abdomen) and 4 age groups (0– < 1, 1– < 5, 5– < 10, 10– < 15 years) were proposed in mainland China first time. • The examination parameter and dose for children need to be further optimised in China, especially to lower the tube voltage in paediatric CT. [ABSTRACT FROM AUTHOR]

The psychosocial underpinnings of vaccine hesitancy are complex. Research is needed to pinpoint the exact reasons why people hesitate to vaccinate themselves or their children against vaccine-preventable diseases. One possible reason are concerns that arise from a misunderstanding of vaccine science. We examined the impact of scientific reasoning on vaccine hesitancy and human papillomavirus (HPV) vaccination intent through a cross-sectional study of parents of vaccine-eligible children (N = 399) at immunization clinics in Shanghai, China. We assessed the relationship between science reasoning and both vaccine hesitancy and HPV vaccine acceptance using general additive models. We found a significant association between scientific reasoning and education level, with those with less than a high school education having a significantly lower scientific reasoning that those with a college education (ß = -1.31, p-value = 0.002). However, there was little evidence of a relationship between scientific reasoning and vaccine hesitancy. Scientific reasoning therefore appears not to exert primary influence on the formation of vaccine attitudes among the respondents surveyed. We suggest that research on vaccine hesitancy continues working to identify the styles of reasoning parents engage in when determining whether or not to vaccinate their children. This research could inform the development and implementation of tailored vaccination campaigns. [ABSTRACT FROM AUTHOR]

Background and objective: Consensus methods are crucial in developing clinical guidelines. Different methods, such as the Delphi and nominal group techniques, are commonly used, but there is a lack of detailed instructions on how to implement them effectively. The survey aims to explore the opinions and attitudes of the chair, panel and working group on the critical elements of the consensus methods during guideline development. Methods: We used a cross-sectional design to conduct this study and sent a structured questionnaire to stakeholders, including the chair, panel members, and working group participants, through the popular mobile phone application WeChat.We selected participants using a combination of purposive and snowball sampling. The questionnaire gathered information on demographics, experiences, opinions, and concerns regarding consensus methods and guideline development. Results: The sample comprised 290 participants representing 31 provinces or municipalities. Among them, the most significant number of respondents (n = 107, 36.9%) were from Beijing. Most participants, specifically 211 (72.76%), held senior professional titles, while 186 (64.14%) adhered to ongoing guidelines. The Delphi method was the most commonly used consensus method (n = 132, 42.31%), but the respondents had only a preliminary understanding of it (n = 147, 47.12%). The consensus process also revealed the insufficiency of involving pharmacoeconomists, patients, and nurses. Conclusions: Consensus methods have to be standardised and used consistently in the guideline development process. The findings of this study offer insights into diverse roles and more effective ways to apply the consensus process during guideline development. [ABSTRACT FROM AUTHOR]

Introduction: Self-monitoring of blood glucose levels and changes in diet and lifestyle play important roles in the management of gestational diabetes mellitus (GDM).Methods: This cross-sectional study enrolled patients with GDM at Hangzhou Women's Hospital, China, between September 1, 2022, and October 26, 2022. A questionnaire was designed that included the following dimensions: demographic/clinical information, knowledge, attitude and practice. Correlations between knowledge, attitude and practice scores were evaluated using Spearman correlation analysis. Factors associated with practice score ≥ 14/16 were identified using multivariate logistic regression.Results: The analysis included 499 women with GDM and a mean age of 31.22± 3.89 years. The average knowledge, attitude and practice score were 11.55± 3.04, 34.23± 4.06 and 10.7± 2.87 points, respectively. Knowledge score was positively correlated with attitude score (r=0.318, P< 0.001) and practice score (r=0.351, P< 0.001); attitude and practice scores were also positively correlated (r=0.209, P< 0.001). Multivariate analysis identified higher knowledge score (odds ratio [OR], 1.138; 95% confidence interval [95% CI], 1.042– 1.244; P=0.004) and higher attitude score (OR, 1.137; 95% CI, 1.060– 1.219; P< 0.001) as independently associated with good practice (ie, practice score ≥ 14 points).Conclusion: The results provide important insights into the knowledge, attitudes and practices of women with GDM in China regarding GDM and its management. These findings may facilitate the development and implementation of education and training programs to improve the self-management of GDM by women in China. [ABSTRACT FROM AUTHOR]

The study's aims were to translate the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire to Chinese and examine its psychometric properties. Adapting it for use in China involved forward translation, synthesis, back translation, expert review, and pretesting. A convenience sample of 201 Chinese older adults completed the Chinese version (CHAMPS-C) to evaluate its construct validity index and associations with physiological, psychosocial, and energy expenditure measures. The construct validity index of the CHAMPS-C was 0.95, and it had fair to moderate associations with physiological and psychosocial measures, other scales of physical activity, and accelerometer measurements. Our structured, stepwise process of cross-cultural adaptation produced a scale (i.e., CHAMPS-C), with items equivalent in meaning to the English version, for use with Chinese older adults. The findings of this study indicate that the CHAMPS-C has acceptable reliability and validity to assess the physical activity of older Chinese adults. [ABSTRACT FROM AUTHOR]

Background: Invasive fungal disease (IFD) is associated with high morbidity and mortality. Data are lacking regarding physicians' perspectives on the diagnosis and management of IFD in China. Objectives: To evaluate physicians' perspectives on the diagnosis and management of IFD. Methods: Based on current guidelines, a questionnaire was designed and administered to 294 physicians working in haematology departments, intensive care units, respiratory departments and infectious diseases departments in 18 hospitals in China. Results: The total score and subsection scores for invasive candidiasis, invasive aspergillosis (IA), cryptococcosis and invasive mucormycosis (IM) were 72.0 ± 12.2 (maximum = 100), 11.1 ± 2.7 (maximum = 19), 43.0 ± 7.8 (maximum = 57), 8.1 ± 2.0 (maximum = 11) and 9.8 ± 2.3 (maximum = 13), respectively. Although the perspectives of the Chinese physicians were in good overall agreement with guideline recommendations, some knowledge gaps were identified. Specific areas in which the physicians' perspectives and guideline recommendations differed included use of the β‐D‐glucan test to facilitate the diagnosis of IFD, relative utility of the serum galactomannan test and bronchoalveolar lavage fluid galactomannan test in patients with agranulocytosis, use of imaging in the diagnosis of mucormycosis, risk factors for mucormycosis, indications for initiating antifungal therapy in patients with haematological malignancies, when to start empirical therapy in mechanically ventilated patients, first‐line drugs for mucormycosis and treatment courses for IA and IM. Conclusion: This study highlights the main areas that could be targeted by training programs to improve the knowledge of physicians treating patients with IFD in China. [ABSTRACT FROM AUTHOR]

This study assessed preferences for hypothetical vaccines for children in 2 large vaccine markets according to how the vaccine-preventable disease is transmitted via a discrete choice experiment. Surveys in China (N = 1350) and the United States (N = 1413) were conducted from April to May 2021. The discrete choice experiment included attributes of cost, age at vaccination, transmission mode of the vaccine-preventable disease, and whether the vaccine prevents cancer. Preference utilities were modeled in a Bayesian, multinomial logistic regression model, and respondents were grouped by vaccine preference classification through a latent class analysis. Individuals favored vaccines against diseases with transmission modes other than sexual transmission (vaccine for sexually transmitted infection [STI] vs airborne disease, in the United States, odds ratio 0.71; 95% credible interval 0.64-0.78; in China, odds ratio 0.76; 95% credible interval 0.69-0.84). The latent class analysis revealed 6 classes: vaccine rejecters (19% in the United States and 8% in China), careful deciders (18% and 17%), preferring cancer vaccination (20% and 19%), preferring vaccinating children at older ages (10% and 11%), preferring vaccinating older ages, but indifferent about cancer vaccines (23% and 25%), and preferring vaccinating children at younger ages (10% and 19%). Vaccine rejection was higher with age in the United States versus more vaccine rejection among those at the age of 18 to 24 and ≥ 64 years in China. The public had strong preferences against giving their child an STI vaccine, and the class preferring a cancer vaccine was less accepting of an STI vaccine. Overall, this study points to the need for more education about how some STI vaccines could also prevent cancers. • Countries have had mixed success rolling out vaccines for sexually transmitted infections (STIs). For example, human papillomavirus vaccination lags behind hepatitis B vaccination. • Individuals in the United States and in China had consistently strong dispreferences for STI vaccines, although the 2 countries varied in terms of what proportion and what groups would reject vaccines altogether. • Rollout of future STI vaccines should also consider preferences for when the vaccine be administered and what chronic diseases the vaccine prevents. [ABSTRACT FROM AUTHOR]

The relationship between the mental health and academic achievement of college students is not only related to their individual growth and development but also has a profound impact on the quality of higher education and the cultivation of social talent. Understanding the interaction and influencing mechanisms between mental health and academic achievement can help individuals adjust learning and psychological states and achieve a virtuous cycle between mental health and academic achievement. A survey was conducted on 3871 freshmen using the Symptom Check-List-90 (SCL-90), Academic Self-efficacy Scale (ASES), China College Student Adjustment Scale (CCSAS), and basic quality assessment scores. The results showed that (1) Mental health is significantly correlated with learning adaptation, academic self-efficacy, and academic achievement, and mental health can significantly negatively predict academic achievement; (2) Learning adaptation partially mediates the relationship between mental health and academic self-efficacy; Academic self-efficacy plays a complete mediating role between mental health and academic achievement; (3) Learning adaptation and academic self-efficacy play a chain mediated role between mental health and academic achievement. Therefore, schools can enhance the cultivation of students' psychological qualities, cultivate their adaptability to changes in learning environments and learning methods, and systematically enhance the cultivation of students' academic self-efficacy to improve their academic achievements., Competing Interests: Declarations Ethics approval and consent to participate Firstly, this study strictly adheres to the Helsinki Declaration, and all methods are implemented in accordance with relevant guidelines and regulations. Secondly, this study has been approved by the committee of the Hebei Petroleum University of Technology. Finally, all participants voluntarily provided informed and written consent, indicating their willingness to participate and support the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: There is no relevant research on the symptoms and emotions of patients with advanced thyroid cancer in mainland China., Aim: To investigate the symptoms and negative emotions of patients with advanced thyroid cancer and to analyze the correlation between the two preliminarily., Methods: Using a convenience sampling method, 180 patients who visited a multidisciplinary outpatient service for advanced thyroid cancer at West China Hospital of Sichuan University from January 2023 to December 2023 were selected as the research subjects. A cross-sectional survey was conducted using the M.D. Anderson Symptom Inventory-Thyroid Cancer module (MDASI-THY) and Hospital Anxiety and Depression Scale (HADS). The correlation between symptom severity and negative emotions was determined by Spearman correlation analysis., Results: Disturbed sleep was the symptom with the highest incidence (74.4%) and the greatest severity (3.0 points), while mood distress was the symptom with the highest incidence (63.3%) and the greatest severity (2.0 points). 71 patients (39.4%) had anxiety, and 62 patients (34.4%) had depression. All symptoms and symptom interference were positively correlated with anxiety and depression (P < 0.05)., Conclusion: Patients with advanced thyroid cancer have multiple symptoms that seriously affect their daily lives and emotions. Medical staff should conduct targeted observation and preventive treatment to reduce the burden of symptoms and improve the negative emotions of patients., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University [Ethics Approval Number 2022(1781)]. Each participant had a face-to-face meeting with the researchers during which the researchers ensured that the patients met the study criteria and explained the study in detail. The researchers provided enough time for the patients to ask questions. Each participant signed the written consent to the study. All methods were ensured by following the relevant guidelines and regulations. Consent for publication Informed consent was obtained from the patient for publication of this article. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The association between problematic social networking sites use and depression is established, yet the directionality remains to be clarified. This longitudinal study investigated the causal dynamics between the two phenomena by administering a questionnaire to 191 college students from a university in Shandong Province, China, across four assessment points with an interlude of four weeks. The study found that the impact of depression on problematic social networking sites use is not consistently sustained throughout the academic semester. Initially, this impact reached significance, but it waned and ceased to be significant during the mid- and late-semester phases. These findings allude to the possibility that depression acts as a significant precursor to problematic social networking sites use. However, the interaction between them appears to be subject to temporal and contextual shifts. Consequently, interventions tackling problematic social networking sites use should progressively pivot from moderating screen time and social media engagement towards enhancing emotional robustness., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li, Li. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: To investigate how post-traumatic growth (PTG) and moral sensitivity influence service behaviour among healthcare workers (HCWs) in mainland China post-COVID-19, with a focus on the mediating role of moral sensitivity., Design: Cross- sectional survey design., Setting: This study was conducted in 27 provinces across mainland China, from 16 March to 2 April 2023., Participants: 1,193 HCWs, including 378 physicians and 815 nurses, were selected using convenience and snowball sampling methods., Methods: The survey included the Post-traumatic Growth Inventory-Chinese version (PTGI-C), the Moral Sensitivity Questionnaire-Revised Chinese Version (MSQ-R-CV) and a service behaviour scale. Structural equation modelling was employed to analyse the data, focusing on the associations between PTG, moral sensitivity, and service behaviours., Results: The study found significant associations between PTG and moral sensitivity (r=0.49, p<0.01), with both factors positively influencing HCWs' service behaviours. Specifically, PTG had a direct effect on service behaviours ( β =0.172, p<0.01) and an indirect effect through moral sensitivity ( β =0.333, p<0.01), with moral sensitivity mediating 65.8% of PTG's impact on service behaviours. The model explained 56.0% of the variance in service behaviours, indicating a substantial influence of these psychological factors on professional conduct., Conclusions: The findings highlight the significant role of PTG and moral sensitivity in shaping the service behaviours of HCWs in the aftermath of the COVID-19 pandemic. The study suggests that enhancing PTG and moral sensitivity through targeted interventions could improve HCWs' service delivery and resilience, emphasising the importance of incorporating psychological and ethical training into healthcare practices to prepare for future public health crises., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Primary health workers are crucial to the healthcare system, yet China experiences a notable shortage driven by high turnover rates. This study aimed to investigate the prevalence and determinants of turnover intention among primary health workers., Design: Cross-sectional study., Setting: Primary healthcare facilities across 21 cities in Guangdong province, China., Participants: Online questionnaires (SurveyStar, Changsha Ranxing Science and Technology) were administered to 16 573 primary health workers in September and October 2022., Primary and Secondary Outcome Measures: Variables measured included demographics, work-related factors, job satisfaction, emotional exhaustion and turnover intention. Comparisons of turnover intention were made across different categorical groups, and hierarchical regression analysis was used to pinpoint influencing factors., Results: The average turnover intention score among participants was 10.49±2.93. Notable positive correlations included those with male gender, single marital status, leadership positions and roles as public health physicians. Emotional exhaustion correlated positively (β=0.108), while job satisfaction showed a significant negative correlation (β=-0.154). Other negative influential factors were observed with tenure lengths of 6-10 years, 11-15 years and ≥16 years, as well as with senior professional titles, lower salary levels and perceptions of fair compensation., Conclusions: Turnover intention is notably prevalent among primary healthcare workers, with emotional exhaustion and job satisfaction identified as primary determinants. Salary, payment justice in compensation and tenure also significantly influence turnover intention. Based on the above analysis, a series of intervention measures can be expectedly unveiled to reduce the turnover intention of primary health workers and maintained the steady development of basic medical resources., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: This study aims to investigate the satisfaction levels of inpatients and identify the determinants of inpatient satisfaction and hospital recommendations., Design: A cross-sectional study was conducted in 2022., Setting: A tertiary general hospital in Sichuan Province, China., Participants: 271 inpatients were randomly selected and studied., Primary and Secondary Outcome Measures: A tailored questionnaire was developed to measure inpatient satisfaction and hospital recommendation. T-test and analysis of variance were employed to compare the differences in inpatients' demographic characteristics across five satisfaction domains. Multivariate binary logistic regression was performed to identify determinants associated with inpatient satisfaction and hospital recommendation., Results: The mean inpatient satisfaction score was 4.27 and the mean hospital recommendation score was 3.96. Inpatients showed the highest satisfaction with the physician care domain and the lowest satisfaction with the hospital environment domain. Statistically significant differences were observed in inpatient demographic characteristics among specific satisfaction domains. Older inpatients, those with Urban Employees and Residents Medical Insurance, from the internal medicine department, and inpatients from the hospital's older region reported the highest levels of satisfaction. Multivariate binary logistic regression revealed that the nursing care domain was the strongest positive predictor of both inpatient overall satisfaction and hospital recommendation. Additionally, the medical procedure and hospital environment domains were strong positive predictors for hospital recommendation and inpatient overall satisfaction respectively. The hospital region domain was a strong negative predictor for inpatient overall satisfaction., Conclusions: Higher satisfaction levels do not necessarily correlate with an increased likelihood of hospital recommendation. Inpatient satisfaction levels vary significantly based on factors such as age, gender, insurance type, hospital clinical department and region. The domains of nursing care and medical procedure are the influencing factors associated with inpatient overall satisfaction. The domains of nursing care, hospital environment and hospital region are the influencing factors of inpatient hospital recommendation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This study aims to investigate the potential impact of positive mental well-being on responses of patient-reported outcome measures (PROMs), such as EQ-5D-5L., Methods: This study utilized the data collected in a cross-sectional study in a sample consisted of individuals with different health conditions. Spearman's rank correlations were employed to investigate the relationship between the responses to the dimensions of EQ-5D-5L and the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). A binary logistic regression analysis and ordered logistic multivariable regression were utilized to examine how SWEMWBS scores could impact the responses to EQ-5D-5L dimensions, while controlling for variables such as age, gender, education level, health conditions, caring experience, and data collection methods. The effects of SWEMWBS on EQ-VAS and utility values were also examined., Results: One thousand nine individuals participated in the survey. Spearman's rank correlation revealed that all dimensions of EQ-5D-5L, except for the anxiety/depression dimension, exhibited weak correlations with all dimensions of SWEMWBS. Binary logistic regression and ordered logistic multivariable regression indicated that age, SWEMWBS scores, gender, health conditions, data collection methods, and caring experience significantly influenced the likelihood of reporting problems in EQ-5D-5L responses. Notably, better SWEMWBS outcomes increased the likelihood of reporting no or fewer problems across all EQ-5D-5L dimensions. Spearman's rank correlation suggested a moderate or strong positive correlation between SWEMWBS scores and EQ-5D-5L utility values and EQ-VAS. The results of multiple linear regression analysis revealed that SWEMWBS scores, health conditions, caring experience, and data collection methods were significantly associated with EQ-5D utility values and EQ-VAS., Conclusions: Individuals with better positive mental well-being results are more likely to report better results in PROMs like EQ-5D-5L. Future study is needed to understand the thought process and to explore strategies to cope with the response heterogeneity that led by the status of mental well-being., Competing Interests: Declarations Ethics approval and consent to participate The online survey was approved by the Ethics Committee of the University of Sheffield, United Kingdom (Approval letter number 025524), and the IRB of Jinan University, China (Approval letter number JNUKY-2020–001). The face-to-face study was approved by the Ethics Committee of Guizhou Medical University (Approval letter number 2021–101). Written informed consent was obtained from all participants. Consent for publication Manuscript is approved by all authors for publication. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The COVID-19 epidemic not only impacted China's economy but also induced periodic anxiety among employees, especially during its peak. Even as governmental controls relaxed, enterprises seemed unaffected externally. However, beneath the surface, the lingering effects on employee mental health persisted. Many faced dual stressors concerning their job and personal well-being due to the epidemic, heightening work-related anxieties. This research, a year after China resumed work, delves into the psychological stress influencing this sustained anxiety. A survey of 516 employees helped test the hypothesis using a multiple regression model. Findings indicated heightened continuous work anxiety due to the epidemic, particularly in hard-hit areas. However, individual resilience, organizational, and social support were found to mitigate these effects. The study underscores the sustained psychological aftermath of the epidemic on employees, urging health authorities to address it.

Objective: Ginkgo diterpene lactone meglumine (GDLM) could improve the functional outcome after acute ischemic stroke (AIS). This study aimed to investigate the efficacy of GDLM on the quality of life in patients with AIS in China., Methods: This is a post hoc analysis of Efficacy and Safety of Ginkgo Diterpene Lactone Meglumine in Acute Ischemic Stroke trial. The quality of life was measured using the EuroQoL questionnaire, including EQ-5D and EQ visual analogue scale (EQ-VAS). The primary outcomes were changes in EQ-5D and EQ-VAS from baseline to day 14 and day 90 after randomization., Results: A total of 3219 patients with completed data on outcomes were enrolled, with median age of 63 years (interquartile range, 55-70) and 2,067 (64.2%) men. GDLM was associated with a significant decrease in scores of ED-5Q components (from 0 [no problem] to 3[extreme problem]), the mean difference between GDLM and placebo group was -0.14 for mobility, -0.11 for usual activities and self-care, -0.09 for pain/discomfort, and -0.34 for anxiety/depression on day 14, respectively. Similar results were observed on day 90. Additionally, there was statistically significant difference of changes in EQ-VAS between the GDLM group and the placebo group from baseline to day 14 (mean difference, 1.70; 95% confidence interval [CI], 0.78-2.62; P = 0.0003) and to day 90 after randomization (mean difference, 3.29; 95% CI, 2.37-4.22; P < 0.001)., Conclusions: In this analysis of Chinese patients with AIS, GDLM could improve the 14-day and 90-day quality of life compared with the placebo., Trial Registration: URL: https://www., Clinicaltrials: gov . Unique identifier: NCT02526225. Registration Date: 2016-02-01., Competing Interests: Declarations Ethics approval and consent to participate The trial design is in compliance with the Declaration of Helsinki and was approved by the ethics committee at Beijing Tiantan Hospital and at each participating site. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Maladaptive illness perception and coping strategies have been linked to illness-related quality of life in patients with chronic diseases. However, the impact of illness perception and coping strategies on vision-related quality of life (VRQOL) in patients with diabetic retinopathy (DR), a significant microvascular complication of diabetes mellitus, remains unclear. This study aims to evaluate the associations among illness perception, coping styles, and VRQOL in Chinese patients with DR, and to explore the mediating role of coping styles in the relationship between illness perception and VRQOL., Methods: This cross-sectional study included 303 adult Chinese with DR recruited from a general Grade-A tertiary hospital in Hunan, China. All participants completed clinical and demographic questionnaires. The Brief Illness Perception Questionnaire (BIPQ), the National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25), and the Medical Coping Modes Questionnaire were respectively adopted to assess the illness perception, VRQOL and coping styles. The BIPQ total scores were converted to logit scores using Rasch analysis. The NEI-VFQ-25 composite scores were converted to estimated person measures based on Rasch analysis and the method of successive dichotomizations. The relationships among these variables were assessed through independent-sample t-test, one-way analysis of variance, correlation analyses and multiple linear regression analysis, while SPSS Process model and the bootstrap analysis were utilized to evaluate the mediating effect., Results: Illness perception was positively correlated with resignation coping style (r = 0.33, P < 0.001) and negatively correlated with VRQOL (r = -0.43, P < 0.001). Resignation coping style was negatively correlated with VRQOL (r = -0.38, P < 0.001). Illness perception significantly predicted resignation coping style (t = 5.91, P < 0.001) and resignation coping style significantly predicted VRQOL (t = -5.30, P < 0.001). The mediating effect through resignation coping was - 0.49 (95% CI: -0.75 to -0.27), accounting for 21.08% of the total effect of illness perception on VRQOL., Conclusion: The study revealed that the resignation coping style partially mediated the relationship between illness perception and VRQOL among DR patients. Specifically, DR patients may accept their worsening circumstances without attempting to change them due to their perception that their illness is threatening and beyond control. This resignation coping strategy could, in turn, lead to poorer VRQOL. These findings suggest that interventions targeting the improvement of illness perception and coping strategies could enhance the VRQOL of DR patients., Competing Interests: Statements & declarations Ethics approval and consent to participate The study received ethical approval from the Ethics Committee of Xiangya School of Nursing at Central South University, China (Ethical approval number: E2020109). Informed consent was obtained from all individual participants included in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: To ensure workforce stability in China's healthcare system and maintain high-quality care, it is essential to comprehensively understand the interplay of factors contributing to turnover intention of healthcare workers. This study aims to examine the associations between potential factors and turnover intention in healthcare workers and explore the mediating effect of job satisfaction and work engagement in the association between them., Methods: In this cross-sectional study, a random sample of 1060 healthcare workers working in 98 public medical institutions were recruited to rate their turnover intention in 2018 in Shenzhen, China. Information on socio-demographic characteristics, job-related factors, turnover intention, job satisfaction, work engagement, work stress and doctor-patient relationship of participants were collected. Pearson's chi-squared tests and binary logistic regression analyses were performed to explore the association between these factor and turnover intention. Mediation analysis was used to explore the roles of potential mediators and moderators., Results: The results showed that age (OR: 0.35, 95%CI: 0.16 to 0.72), tenure (OR: 0.98, 95%CI: 0.96 to 0.99), administrative positions (OR: 0.33, 95%CI: 0.16 to 0.63), and night shift frequency (OR: 1.84, 95%CI: 1.26 to 2.67) were significantly associated with turnover intention. We identified the mediating effect of job satisfaction and work engagement in the relationship between administrative positions and turnover intention, while the suppressing effect in the relationship between professional titles and turnover intention. Additionally, we found that monthly income plays a moderating role in the relationship between work engagement and turnover intention, and in the association between professional titles and turnover intention., Conclusions: Greater job satisfaction and engagement, along with reasonable remuneration, were found to be associated with lower turnover intention among healthcare workers. Employers should proactively monitor the dynamic interactions among these factors and then develop more tailored interventions in order to alleviate the ongoing loss of healthcare workers., Competing Interests: Declarations Ethics approval and consent to participate The Sixth NHSS obtained ethics approval from the institutional review board of the Chinese National Bureau of Statistics (license number 2018-87) and was conducted in accordance with the Declaration of Helsinki. All participants gave informed consent to participate in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Mobile phone addiction (MPA) has numerous deleterious effects on college students, including depression, anxiety, cognitive impairments, and sleep disorders. Undergraduate nursing students play a crucial role as a significant reserve workforce in clinical nursing practice, and their compromised mental health status significantly influences the quality of nursing work and nurse-patient relationships in the future., Objectives: This study aims to investigate the associations between neuroticism and MPA among undergraduate nursing students, the mediating effect of self-control and the moderating effect of psychological capital., Methods: A total of 900 undergraduate nursing students participated in the survey, wherein the Eysenck Personality Questionnaire Short Form Scale China Version-Neuroticism Subscale (EPQ-RSC-N), Self-Control Scale (SCS), Positive Psychological Capital Questionnaire (PPQ), and Mobile Phone Addiction Tendency Scale (MPATS) were employed for assessment. To analyze the available data, various statistical methods were utilized, including common method bias test examination, descriptive statistics, chi-square tests, independent samples t-tests, Pearson's correlation analyses, as well as the Hayes' PROCESS Macro models 4 and 14., Results: (1) The prevalence of MPA in this study was found to be 34.89%. (2) The MPA was positively correlated with neuroticism (r = 0.287, p < 0.001), and was negatively correlated with self-control (r = -0.467, p < 0.001) and psychological capital (r = -0.260, p < 0.001). (3) Self-control played a partially mediating role in the association between neuroticism and MPA, with an effect size of 0.151, accounting for 52.98% of the total effect. (4) Psychological capital played a moderating role in the association between self-control and MPA. More specifically, with an increase in the level of psychological capital increases, the predictive effect of self-control on MPA gradually strengthens (β = -0.072, SE = 0.019, t = -3.708, p < 0.001)., Conclusion: The prevalence of MPA was relatively high among undergraduate nursing students, with neuroticism exerting a direct influence on it. Self-control served as a mediating factor that could partially alleviate MPA associated with neuroticism. Psychological capital has the ability to regulate the relationship between self-control and MPA. Therefore, enhancing self-control capabilities and cultivating psychological capital levels can effectively manage MPA among undergraduate nursing students., Competing Interests: Declarations Ethics approval and consent to participate This study received approval from the Ethics Committee of Tangdu Hospital (Approval ID: TDLL-202311-17) and adhered to the principles outlined in the Declaration of Helsinki. Prior to conducting the survey, all participants were provided with a comprehensive explanation of the study’s objectives, and informed consent was obtained. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Subjective socioeconomic status (SES), an individual's beliefs about his or her social class, is anticipated to be related to future orientation. This study proposed a moderation model to examine the relationship between subjective SES on future orientation and the protective role of low fatalism., Methods: Two studies were conducted to test the proposed model. Specifically, in Study 1, the structured questionnaires were administered to a sample comprising 217 Chinese participants (192 females, M age = 18.24 ± 0.63). In Study 2, the structured questionnaires and an Imaginative Scenario Test were administered to collect data among 244 Chinese participants (167 females, M age = 18.44 ± 0.73). Regression analyses were used to explore the moderating role of fatalism in the association between subjective SES on future orientation. The Bootstrap methods were used to test the significance of these moderating effects., Results: The results revealed two primary findings: (1) Fatalism moderated the pathway from subjective SES to future orientation. Specifically, low fatalism served as a protective factor, making low subjective SES less disruptive to their future orientation. (2) The moderating effect was primarily attributed to the "luck dimension", which was the belief that luck plays a pivotal role in determining one's fate., Conclusions: The findings contribute to enriching the current understanding of the subjective SES on future orientation and the protective role of low fatalism., Competing Interests: Declarations Ethics approval and consent to participate All procedures performed in studies involving human participants were approved by the Institutional Review Board of Zhejiang Normal University in China (ZSRT2020015) and complied with the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: This study aimed to explore the heterogeneity of community doctors based on their knowledge of dementia and the potential factors associated with their dementia literacy., Methods: A total of 1288 community doctors completed the Alzheimer disease knowledge scale (ADKS) in a cross-sectional study conducted between December 2021 and January 2022. We used latent class analysis (LCA) to explore potential clusters based on responses to the ADKS. Multivariate multinomial logistic regression analysis was performed to evaluate the associations between potential risk factors and the knowledge of community doctors., Results: Community doctors were divided into four clusters according to their knowledge structure (Akaike information criterion (AIC) = 35672.83, Bayesian information criterion (BIC) = 36307.63, adjusted BIC (aBIC) = 35916.91, entropy = 0.814): the severity-focused subgroup (n = 269), the physical issues-focused group (n = 370), the knowledge uncertainty group (n = 191), and the general-focused group (n = 458). Age, education level, type of practice, and professional title were associated with the knowledge structure of Alzheimer's disease (AD). In addition, the perception that patients seek care in community health centres for physical reasons and community doctors' failure to manage patients with recently identified cognitive impairment were associated with the structures of the ADKS among community doctors (P < 0.05)., Conclusions: There is heterogeneity in the level of AD knowledge among community doctors and their demographic characteristics, perceptions, and practices. Further efforts are needed to optimise the knowledge structure of dementia among community health care professionals., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: With the number of internet users booming, problematic internet use (PIU) has become a public health threat. This study aims to figure out the inter-relationships between PIU symptoms and personality traits with network-based analysis among young people and to discuss the gender difference in the above networks., Methods: Based on a national cross-sectional study in 2022, 4655 Chinese adolescents and young adults aged 14 to 25 were included. We adopted the 6-item Short-Form Problematic Internet Use Questionnaire (PIUQ-SF-6) and the 10-item version of the Big Five Inventory (BFI-10) to measure PIU and personality traits, respectively. Network analysis was used to identify influential nodes and edges and compare the network models between male and female participants., Results: The mean age of 4655 participants was 19.84, and 52.1 % (2424) of them were females. There are differences in age and gender between participants with and without PIU (P < 0.05). The network of personality and PIU showed that 22 out of the 28 edges were estimated to be nonzero, and "obsession-neuroticism" was the strongest positive edge between the two communities. Central symptoms (i.e., "obsession" and "control disorder") and bridge symptoms (i.e., "obsession" and "neuroticism") have been identified. Gender differences existed in network global strength: female = 3.71, male = 3.18 (p < 0.001)., Limitations: The cross-sectional study needs more evidence to build causal inference., Conclusions: The results of PIU-personality networks may contribute to the personalized prevention and treatment of PIU. The gender difference in PIU-personality networks also requires more attention and discussion., Competing Interests: Declaration of competing interest All authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: To estimate the prevalence of lifetime e-cigarette use and explore the association between lifetime conventional and electronic cigarette use with suicidality among Chinese adolescents, focusing on sex and school-type differences., Methods: A total of 22,509 students from 432 classes in 80 schools were recruited in Guangdong Province using a multistage, stratified cluster, random sampling method in 2021. Self-report questionnaires were used to collect information. Multivariable logistic regression models were performed and stratification analysis was conducted. All analyses were weighted and adjusted for the complex survey design., Results: The weighted prevalence of lifetime e-cigarette use among adolescents in Guangdong Province was 8.7 % (4.3 % were dual users and 4.4 % were e-cigarette-only users) and 2.6 % were conventional-cigarette-only users. Lifetime e-cigarette-only users (AOR [Adjusted OR] =1.46, 95 % CI = 1.21-1.76), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.58-2.46) and dual users (AOR = 1.67, 95 % CI = 1.38-2.02) were at a higher risk of suicidal ideation than non-users. Lifetime e-cigarette-only users (AOR = 2.03, 95 % CI = 1.53-2.70), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.42-2.73), and dual users (AOR = 2.76, 95 % CI = 2.10-3.61) had a significantly higher risk of suicide attempts than non-users. After further analysis stratified by sex and school type, the associations of lifetime cigarette use patterns with suicidality slightly varied., Limitation: The cross-sectional study design and self-report information., Conclusion: The prevalence of e-cigarettes among Chinese adolescents is concerning. Lifetime conventional and e-cigarette use were associated with suicidality among Chinese adolescents, with sex and school type moderating these associations. Targeted measures to restrict cigarette use, including new tobacco product (e-cigarette) use, among adolescents are warranted., Competing Interests: Declaration of competing interest The authors report no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Research on the associations of type-specific bullying victimization and poly-bullying victimization with suicidal ideation is limited and contradictory. This study aimed to examine these associations among school-aged adolescents., Methods: A total of 13,258 students from 3 middle schools and 4 high schools in a southern city in China completed a cross-sectional questionnaire in 2019. Multinomial logistic regressions were used to examine associations between type-specific bullying victimization and poly-victimization with suicidal ideation., Results: The latent class analysis identified three subgroups of suicidal ideation: low (70.0 %), moderate (24.0 %), and high (6.0 %). Compared with non-bullying victimization in the past year, the corresponding adjusted odds ratios [aOR] (95 % CI) of moderate and high suicidal ideation for only physical victimization were 1.74 (1.15, 2.63) and 2.51 (1.18, 5.38), respectively, for only relational victimization were 1.26 (0.97, 1.62) and 2.48 (1.65, 3.71), respectively, for only verbal victimization were 1.45 (1.17, 1.78) and 1.42 (0.90, 2.22), respectively, for only property victimization were 1.30 (1.03, 1.65) and 1.31 (0.80, 2.16), respectively, and for sexual victimization were 1.38 (1.03, 1.83) and 2.45 (1.50, 3.99), respectively. Poly-bullying victimization was associated with moderate (aOR two  = 1.45 (1.24, 1.70); aOR three  = 1.70 (1.41, 2.05), aOR four  = 2.03 (1.61, 2.58), aOR five  = 2.48 (1.74, 3.53)) and high suicidal ideation (aOR two  = 2.01 (1.49, 2.70), aOR three  = 3.87 (2.86, 5.25), aOR four  = 4.55 (3.20,6.46), aOR five  = 7.90 (5.06, 12.33))., Limitations: The research design is cross-sectional, and relevant data was based on self-reports., Conclusions: Different types of bullying victimization were associated with suicidal ideation and poly-bullying victimization and suicidal ideation association shows a dose-response-relationship., Competing Interests: Declaration of competing interest None of the authors have declared any potential conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: During the COVID-19 pandemic, hospitals implemented visitor restrictions to curtail the spread of the virus. The study aims to understand the perspectives of hospitalized patients and their family visitors on visitation restrictions and the factors influencing their willingness to adhere to these restrictions., Methods: This cross-sectional survey invited 1,200 participants, with 1,032 valid responses received, including 460 hospitalized patients and 572 family visitors., Results: The survey indicated that 88.91% of hospitalized patients and 93.00% of family visitors complied and adhered to the visitor restrictions. The predominant mode of communication was via phone (77.62%), with emotional support (56.40%) recognized as the primary purpose of visitation. Visitor restrictions significantly affected hospitalized patients, with 51.65% reporting feelings of loneliness and 42.44% reporting anxiety. After adjusting for age, gender, and other factors, hospitalized patients' willingness to follow visitation restrictions was linked to their awareness of the restrictions (odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.09-0.44) and their desire to protect (OR = 0.32, 95% CI: 0.14-0.76). Family members' willingness to follow the restrictions was related to their awareness of them (OR = 0.34, 95% CI: 0.12-0.95) and how well they communicated (OR = 0.23, 95% CI: 0.09-0.58)., Conclusions: Participants generally followed visitation restrictions, but these measures negatively impacted the psychological and social well-being of patients and their families, leading to increased feelings of loneliness and anxiety. Healthcare providers, hospital administrators, and policymakers should acknowledge the complex effects of these restrictions and focus on improving patient experiences in the future., Competing Interests: Declarations Ethical approval and consent to participate The Ningbo Medical Center LiHuili Hospital approved the study protocols for collecting and analyzing the survey data (No: KY2022SL246). Written informed consent was obtained from all participants. All procedures were performed following the relevant guidelines and regulations. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: Oral health is a critical area in healthy aging. Oral health literacy (OHL) plays an important role in improving oral health behaviors and oral health status. However, few studies have investigated OHL among community-dwelling older adults and the influential mechanism of OHL on oral health behaviors has not been clarified. The aim of this study is to explore the interaction pathways through which OHL influences oral health behaviors among community-dwelling older adults., Methods: This is a cross-sectional study. 429 community-dwelling older adults were recruited by a convenience sampling method from the activity service center in Zhenjiang, Southern China. The data were collected between September and November 2021 using the Oral Health Literacy Adult Questionnaire (OHL-AQ) and other sophisticated scale assessments. A theoretical model based on the information-motivation-behavioral skills model (IMB model) and previous research was developed and then validated using a structural equation model with AMOS v24.0., Results: The proposed model revealed a good fit to the data (χ2/df = 3.349, goodness of fit index = 0.957, adjusted goodness of fit index = 0.921, root mean squared error of approximation = 0.074, comparative fit index = 0.955, normed fit index = 0.938). Oral health information (β = 0.23) and motivation (β = 0.56) positively affected OHL. OHL (β = 0.20) and motivation (β = 0.25) positively affected self-efficacy; self-efficacy (β = 0.98) had a direct effect on oral health behavior. OHL had an indirect effect on oral health behaviors through self-efficacy (β = 0.19). Motivation can both directly influence oral health behavior (β = 0.18) and indirectly influence oral health behavior through OHL and self-efficacy(β = 0.35)., Conclusions: The study findings make a valuable contribution to the influential mechanism of OHL on oral health behaviors. OHL improved oral health behaviors through self-efficacy among community-dwelling older adults. Oral health information directly affected OHL. Motivation directly affected oral health behaviors as well as influence oral health behaviors by changing OHL., Competing Interests: Declarations Ethics approval and consent to participate Approval for this study was given by the Medical Ethics Committee of Jiangsu University (Approval number 2021 − 719) and written informed consent was obtained from the participants. All methods were performed following the Declarations of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Examining mental health among nurses in the later stages of the COVID-19 pandemic could offer valuable information for addressing these symptoms in the long term. Therefore, the current study aimed to assess the mental health and well-being of Chinese nurses, as well as investigate the impact of psychological flexibility and night shifts on this relationship., Method: In cross-sectional, hospital-based, multicenter study, 422 Chinese nurses were selected by multistage stratified cluster random sampling. The mental health status, psychological flexibility, and wellbeing were assessed via 12-item General Health Questionnaire (GHQ-12), Chinese version of Personalized Psychological Flexibility Index, and Chinese version of the 5-item WHO Well-Being Index, respectively. To examine the proposed theoretical model, we conducted structural equation modeling using SPSS Amos 26 version. The age, gender, night shift, psychological flexibility, mental health, and well-being data were entered into the model. Pearson correlation and chi-square were used to explore the correlation between variables., Results: The high night shifts, being young and low psychological flexibility significantly had a direct effect on worse mental health (night shifts: ES, 95% CI: 0.619, 0.328-0.725; age: ES, 95% CI: 0.542, 0.226-0.993; psychological flexibility: ES, 95% CI: 0.675, 0.369-1.466). The low psychological flexibility and worse mental health were able to directly effect on worse wellbeing (psychological flexibility: ES, 95% CI: 0.419, 0.757-1.519; mental health: ES, 95% CI: 0.719, 1.109-2.607). In addition, psychological flexibility through the mediation of mental health also had an indirect effect on wellbeing (ES, 95% CI: 0.269, 0.957-2.165)., Conclusions: Being young, having more night shifts and having less psychological flexibility can be related to the deterioration of mental health and well-being in nurses. Therefore, it is recommended that nurses use the shift routine program with the least focus on the night shifts. Also, interventions to teach younger nurses how to face work stress and interventions to improve the psychological flexibility of all nurses are needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The COVID-19 pandemic has significantly impacted advanced practice nurses' practice and posed great challenges in patient care delivery., Purpose: The aim of this study was to investigate the impact of the COVID-19 pandemic on the practice of advanced practice nurses in mainland China and Hong Kong Special Administrative Region (SAR). Methods A cross-sectional descriptive survey was conducted March 2021 and January 2022. Advanced practice nurses were invited to participate in an online survey. The questionnaire described the socio-demographic characteristics, the impact of the COVID-19 pandemic on advanced nursing practice, patient outcomes, education needs about COVID-19, and the challenges, support, and concerns related to the advanced practice nurse practice during the pandemic. Wilcoxon signed-rank test or McNemar test were applied to measure the practice of APNs before and during the COVID-19 pandemic., Results: Respondents (N = 336) were from mainland China (n = 234) and Hong Kong SAR (n = 102). Participants reported increased practice-related workload during the pandemic. The proportions of advanced practice nurses focused on disease prevention (36.9%) and psychosocial well-being (15.5%) for patient-focused outcomes during the pandemic were higher compared to before the pandemic. Key challenges and concerns during the pandemic included heavy workloads and health concerns for themselves and their families. Despite difficulties, there were reports of positive changes since the outbreak including implementation of innovative measures to facilitate the advanced practice nursing and education about COVID-19., Conclusion: The study findings highlight that advanced practice nurses' work and responsibilities have changed in response to the pandemic. Providing education about COVID-19, innovative measures to facilitate advanced practice nursing, and understanding advanced practice nurses' concerns and challenges in providing patient care may inform future developments for improving their professional practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chair et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

To provide a reference for the realization of children's equal inheritance, this study examined the influence of child structure and means of eldercare on equitable family property distribution willingness. Using data from surveys of Chinese women's social status, this study analyzes the impacts of child structure and means of eldercare on family property distribution, with the children's surname choice and women's status as moderating factors. The results indicate that a child structure in which the family consists of more girls than boys, a higher number of children, and the choice of family support for eldercare significantly inhibit the equal distribution of family assets. However, the weakening of traditional views significantly promotes the equal distribution of household assets. These findings remain robust after endogenous and robustness tests. Moreover, the study finds that the impact of the structure of children and eldercare methods varied across different age groups, household registration attributes, and genders. Research on the willingness to distribute household wealth aids in understanding the effects and differences brought about by the structure of children and eldercare methods under current traditional cultural contexts, thereby promoting a more equitable distribution of household wealth., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chen, Ji. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Left-behind children(LBC) in rural China are at increased risk for mental health problems, including depression. This study aimed to estimate the prevalence of depression and identify key associate factors among Chinese rural LBC., Methods: A cross-sectional study was conducted using data from 36,612 LBC aged 6 to 18 years old across 596 data collection sites in Nanchong, Sichuan Province, China. Participants completed questionnaires assessing individual factors, family parenting situation, living events, and health-related data. Depression was measured using the Center for Epidemiological Studies-Depression Scale (CES-D). T-tests, chi-square, and logistic regression were performed to identify factors associated with depression., Results: The overall prevalence of depression among LBC was 6.75%. Logistic regression analysis revealed that family parenting situations, such as being from blended families (OR = 1.45) or being cared for by other family members (OR = 1.64), and dissatisfaction with the parenting situation (OR = 1.57) were significantly associated with higher odds of depression. Living events, including being misunderstood (OR = 1.82) and having disputes (OR = 1.48), and health-related factors, such as chronic diseases and regular medication use (OR = 2.38), also increased the risk of depression., Conclusions: This study highlights the high prevalence of depression among Chinese rural LBC and identifies key associate factors, including family parenting situation, negative living events and health-related factors. Targeted interventions and policies addressing these factors are needed to promote the mental health of this vulnerable population., Competing Interests: Declarations Ethics approval and consent to participate The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. All procedures involving human subjects/patients were approved by IRB in Wenzhou Seventh People’s Hospital (EC-KY-2022048). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Residents' sense of social class identity is of great significance for enhancing self-happiness and maintaining social stability. As a spiritual force, religious beliefs can significantly influence residents' subjective perceptions., Methods: Based on this, using data from the 2021 Chinese General Social Survey (CGSS 2021), this paper explores the impact of religious beliefs on residents' sense of social class identity through the probit model and Ordinary Least Squares (OLS) method, and analyzes potential mechanisms., Results: The baseline regression results indicate that religious beliefs significantly enhance residents' sense of social class identity(p < 0.05), a conclusion that holds true even after rigorous robustness tests. Furthermore, female residents(p < 0.05), residents with lower education levels(p < 0.05), and those who believe in domestic religions(p < 0.05) exhibit higher social class identification compared to those who believe in foreign religions. Mechanism analysis suggests that economic capital and social capital play mediating roles, indicating that religious beliefs enhance the economic(p < 0.01) and social capital of believers(p < 0.01), thereby increasing their sense of social class identity., Conclusions: Therefore, this paper suggests respecting residents' religious beliefs, while religious organizations should actively adapt to the needs of social development, providing spiritual comfort and moral guidance to residents., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Adverse Childhood Experiences (ACEs) have been implicated in the development of body pain, yet research on their impact on body pain and its progression remains scarce. This study aimed to examine the associations between ACEs and the presence and areas of body pain, as well as their developmental trajectories among middle-aged and older Chinese adults., Methods: We included participants aged 45 years and above from the China Health and Retirement Longitudinal Study (CHARLS) conducted between 2011 and 2018. Retrospective data on ACEs and pain sites were collected with questionnaires. The presence of pain at different body sites was categorized into three areas: head & neck, trunk, and limbs. ACEs consisted of ten types of adverse experiences and were cumulatively scored. For the cross-sectional analysis (2011), logistic regressions were performed to estimate the associations between ACEs and pain presence in specific areas. In the longitudinal analysis (2011-2018), we further applied group-based trajectory modelling (GBTM) to determine the developmental trajectories of body pain. Multinomial logistic regressions were then conducted to estimate the associations between ACEs and pain trajectories., Results: In the cross-sectional analysis (n = 8157), ACEs were positively associated with the presence of pain in the head & neck (odds ratio [OR] = 3.55, 95% confidence intervals [CI] = 2.37-4.74), trunk (OR = 3.28, 95% CI = 2.47-4.34), and limbs areas (OR = 2.30, 95% CI = 1.77-3.00) compared to no ACEs. These associations varied by sex and residence. In the longitudinal analysis (n = 5188), GBTM identified three developmental trajectories of body pain (n = 9521): high-increasing (7.44%), low-moderate (33.67%) and maintained-low trajectories (58.89%) trajectories. Compared to participants without ACEs, individuals had three ACEs and 4 or more ACEs were consistently associated with low-moderate (three ACEs: OR = 2.26, 95% CI = 1.81-2.83, four or more ACEs: OR = 3.11, 95% CI = 2.51-3.87) and high-increasing (three ACEs: OR = 3.28, 95% CI = 2.03-5.30, four or more ACEs: OR = 6.78, 95% CI = 4.30-10.68) body pain trajectories across sexes and residence., Conclusion: This study highlighted the significant association between ACEs and body pain among middle-aged and older Chinese, emphasizing the importance of preventing or mitigating ACEs as a strategy for the prevention and management of body pain., Competing Interests: Declarations Ethics approval and informed consent Informed consent was obtained from all participants involved in the study. All participants signed an informed consent during the investigation, and the project was approved by the Institutional Review Board at Peking University (IRB approval number for the main household survey: IRB00001052-1101). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Resilience is crucial for a health system to better prevent and respond to public health threats and provide high-quality services. Despite the growing interest in the concept of resilience in health care, however, there is little empirical evidence of the impact of organizational resilience, especially in primary care settings. As the largest professional group in primary care, primary care nurses are taking more and more responsibilities during their daily practice, which influences both their work conditions and well-being. This study aims to examine the association between organizational resilience and primary care nurses' working conditions and well-being. Using a convenience sampling approach, we recruited 175 primary care nurses from 38 community health centres (CHCs) in four cities in China. Organizational resilience was operationalized as comprising two domains: adaptive capacity and planning capacity, and measured using a 16-item scale. The primary care nurses' working condition indicators comprised variables of psychological safety, organizational commitment, professional commitment, and self-directed learning; well-being indicators included depression and burn-out. Hierarchical linear regression models were built for analysis. We found that the sampled CHCs have a relatively high level of organizational resilience. The organizational resilience was positively associated with the four indicators of working conditions: psychological safety (β = 0.04, P < 0.01), organizational commitment (β = 0.38, P < 0.01), professional commitment (β = 0.39, P < 0.01), and self-directed learning (β = 0.28, P < 0.01). However, organizational resilience was not significantly associated with the two well-being indicators. Furthermore, we found that the adaptive capacity has stronger association compared with planning capacity. Therefore, primary care manager should build resilient organizations, especially the adaptive capacity, in order to enhance primary care nurses' psychological safety, commitment and learning behaviours. Further studies should also be conducted to understand the link between organizational resilience and primary care nurses' well-being., (© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Background: In late 2022, China became the first country to roll out mucosal COVID-19 vaccines. No prior study has yet compared the immunization stress-related responses (ISRR) among different routes of COVID-19 vaccine delivery. We aimed to compare the immunization-related psychological stress and ISRR between mucosal and intramuscular COVID-19 vaccines., Methods: A cross-sectional questionnaire survey using a biopsychosocial framework design was performed from January 11 to 20, 2023. Adults with COVID-19 vaccination were eligible for the study, and a total of 1073 adults participated with community-based sample. Primary outcomes were the psychological stress levels and prevalence of ISRR. Multivariate regression models were employed to compare these outcomes between the two vaccination groups. The potential mediating effects of stress on vaccination and ISRR were examined using bootstrap sampling method. To further ensure the robustness of our results, sensitivity analysis with propensity score matching was performed., Findings: In the univariate analysis, participants who received mucosal vaccination reported significantly lower stress levels compared to those who received intramuscular vaccination (3.39 ± 3.02 vs. 3.93 ± 3.24, P = .006). The prevalence of overall ISRR was significantly lower in the mucosal group compared to the intramuscular group (38.4% vs. 47.9%, P = .002). Multivariate regression models revealed that participants who received mucosal vaccination had a significantly lower stress level (β = -0.516, 95% CI: -0.852 to -0.180; P = .003) and 38.7% fewer overall ISRR (OR = 0.613, 95% CI: 0.427 to 0.881; P = .008), particularly in terms of neurological symptoms. The immunization-related stress mediated the association between vaccination type and ISRR, with indirect effects estimated at 0.0663 (95% CI: 0.0195 to 0.1346) for overall ISRR., Conclusions: Mucosal COVID-19 vaccination was associated with reduced psychological stress and physical responses, as compared to intramuscular vaccination, which may contribute to increased trust and compliance with routine or mass vaccination efforts in the future., Competing Interests: Declaration of competing interest Authors declare no conflict of interests., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Healthcare practice environment plays a vital role in evaluation and the development of health sector in China. However, there are few comprehensive reviews and studies focusing on its state and changing trends. This study aimed to examine the dynamic trends in Chinese healthcare professionals' perceptions of their practice environment from 2008 to 2023 using age period cohort (APC) analysis., Methods: Four national cross-sectional surveys of healthcare professionals were conducted in 2008, 2013, 2018, and 2023. APC analysis was performed to distinguish effects of age, period and cohort. Covariates like gender, department, job satisfaction, and doctor-patient relationships were also analyzed., Results: Between 2008 and 2023, healthcare professionals' perceptions of their practice environment first declined and then improved. Those aged 28-38 during 2013-2018 and born between 1978 and 1988 had the most negative perceptions. After 2018, perceptions improved, peaking in 2023. Those under 23 and over 43 exhibited larger age effects. Birth cohorts after 1993 also had more positive effects. Controlling for covariates attenuated APC effects. Females, those in obstetrics and emergency medicine, nurses, technicians, and administrators perceived better environments. Higher job satisfaction and doctor-patient relationship harmony are also associated with more positive perceptions. Income matching efforts and perceptions of promotion fairness had positive impacts, while increasing severity of physical fatigue and psychological anxiety negatively influenced perceptions of the practice environment., Conclusions: The APC analysis provided nuanced insights into evolving practitioner perceptions amid healthcare reforms in China. Tailored policies focused on career stage and generation are needed to address disruptions and sustain improvements. Monitoring feedback on reforms and changes is essential for optimizing the practice environment over time., Competing Interests: Declarations Ethics approval and consent to participate This study is an anonymous questionnaire survey targeting healthcare professionals. It does not involve personally identifiable information, and all survey data will be securely stored and supervised by the China Association for Science and Technology. The Measures for the Ethical Review of Human Life Science and Medical Research (2023) issued by the National Health Commission of China states in Article 3 that human life science and medical research involving human biological samples and health information data fall within the scope of ethical review. Our survey merely collected the respondents' knowledge and perception of medical professionalism, work conditions and so on, without involving their biological samples or personal health information. The need for ethics approval is deemed unnecessary according to national regulations. All experiments were performed in accordance with relevant guidelines and regulations. The survey was conducted on the principles of anonymity and voluntariness, and no personal information was collected or associated. Informed consent to participate was obtained from all of the participants in the study. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: Despite the benefits of exclusive breastfeeding, the proportion of exclusively breastfed children remains low in rural China. Self-efficacy is one of the most crucial modifiable factors predicting breastfeeding behavior. However, existing instruments in China do not specifically measure self-efficacy for exclusive breastfeeding but rather measure self-efficacy for any breastfeeding. Furthermore, they have been validated only in high-income Chinese settings. We sought to adapt and validate an instrument to measure exclusive breastfeeding self-efficacy within rural Chinese contexts., Methods: We introduced relevant items to Dennis' Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), which can assess maternal self-efficacy for exclusive breastfeeding. It was then implemented in a multistage random cluster sampling design and cross-sectional survey with home-visit interviews among women 0-6 months postpartum (n = 654) in the rural areas of four counties in Sichuan, China. We performed item-total and adjusted item-total correlations, as well as exploratory factor analysis to remove redundant items and determine the latent factor structure. We further applied confirmatory factor analysis to test the dimensionality of the scale. We then assessed the reliability of the scale and conducted tests of predictive and divergent validity. Known group comparisons were made by primiparous status and breastfeeding support level. We compared the validated Exclusive Breastfeeding Self-Efficacy Scale with the BSES-SF in terms of reliability and validity to explore the added value of scale modification., Results: Our modification of the BSES-SF to target exclusive breastfeeding produced 19 items. This was further reduced to 15 items based on adjusted item-total correlations and exploratory factor analysis, forming the Exclusive Breastfeeding Self-Efficacy Scale. This scale had three dimensions: "Breast milk supply and quality," "Breastfeeding skills," and "Exclusive breastfeeding" subscales. The Exclusive Breastfeeding Self-Efficacy Scale demonstrated strong internal consistency and overall reliability with a Cronbach's alpha coefficient of 0.91. Predictive and divergent validity and known group comparison assessments supported its validity. Robust psychometric evaluations demonstrated enhanced validity and reliability compared to the original BSES-SF., Conclusions: Our Exclusive Breastfeeding Self-Efficacy Scale is valid and reliable for measuring exclusive breastfeeding self-efficacy within rural Chinese contexts and is ready for adaptation and validation for clinical and programmatic use elsewhere, particularly within LMICs., Competing Interests: Declarations Ethics approval and consent to participate This study received ethical approval from the Stanford University Institutional Review Board (Approval 44312) and the Sichuan University Ethical Review Board (Approval K2019029). Postpartum women provided written informed consent for their own and their child’s involvement in this study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Evidence-based guidelines advocate promoting sleep in intensive care unit (ICU) patients, yet many patients experience poor sleep quality. We sought to develop a collaborative evidence-based intervention with healthcare providers and assess whether evidence-based sleep interventions could improve sleep quality in awake adult ICU patients., Methods: We conducted a prospective, nonrandomized cluster control trial in two intensive care units (ICUs) at a tertiary general teaching hospital in China. Patients aged 18 years or older who stayed in the ICU for one night or more and were conscious were eligible for enrollment. We only blinded the patients, not the outcome assessors. On the basis of evidence-based practice and clinical reality, we developed intervention measures for the intervention group, which mainly included four aspects: reducing environmental noise in the ICU, adjusting nursing actions, modifying nighttime lighting, and other measures. The assessment tools used were wearable actigraphy sleep monitoring devices and the Richards-Campbell Sleep Questionnaire (RCSQ). The primary outcomes were patient sleep quality, including total sleep time, deep sleep time, light sleep time, rapid eye movement (REM) time, number of awakenings, overall sleep score, and patients' self-assessment of their sleep quality that night. The data collected were analyzed via SPSS and Mplus statistical software for between-group analysis, pre-post comparison, profile analysis, and calculation of the intervention effect size., Results: From September 1, 2023, to January 31, 2024, 713 patients underwent eligibility assessment, and ultimately 246 patients were included in the analysis, with 125 in the intervention group and 121 in the control group. Comparative analysis revealed no statistically significant differences in sleep quality between the two groups when the duration in the ICU = 1 night (P > 0.05), with a small intervention effect size. However, the intervention group had higher sleep quality scores (sleep monitoring wristband: 57.74 ± 22.55 > 57.72 ± 19.39; RCSQ questionnaire: 60.58 ± 22.14 > 57.61 ± 24.4) and total sleep time (440.42 ± 262.11 > 420.31 ± 236.89), a lower awakening frequency (3.98 ± 2.69 < 6.09 ± 4.66) and a lower awakening frequency (3.976 ± 2.693 < 6.09 ± 4.664) than did the control group. The sleep quality of patients who stayed in the ICU for > 1 night significantly improved in all the parameters except rapid eye movement time (min) according to the pre-post-test analyses (P < 0.05), with a medium to large intervention effect size and favorable intervention effects., Conclusion: Evidence-based interventions significantly improve sleep quality in ICU patients hospitalized for more than one day. However, our results do not support the improvement of sleep quality in patients admitted to the ICU for one day., Clinical Trial Registration: ChiCTR2300075763, Registered 14 September 2023-Retrospectively registered, https://www.chictr.org.cn/bin/userProject., Competing Interests: Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Zhongnan Hospital of Wuhan University [2023023 K]. All participants participated in the study voluntarily and anonymously and were told that they had the right to withdraw from the study at any time. Consent for publication All participants in this study were made aware that their data could be used in publications and gave approval for this use. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Ages of 0-3 years are critical stages for children's neurodevelopment. However, the impact of the home nurturing environment on early childhood neurodevelopment remains unclear., Objective: To explore the role of the home nurturing environment on early childhood neurodevelopment and to provide evidence of an association between fostering quality home nurturing and achieving optimal neurodevelopment., Participants and Setting: An online cross-sectional survey using the stratified sampling method was conducted from 16 June, 2021 to 18, February, 2022 in all 13 communities of Minhang District, Shanghai. A total of 2,402 children aged 0-3 years with balanced sex distribution were included., Methods: The quality of home nurturing environments was measured using validated Child Home Nurture Environment Scales. Neurodevelopment was measured using the Ages and Stages Questionnaire - Third edition (ASQ-3). Generalized Linear Mixed Modeling was used to analyze the association between the quality of home nurturing environments and neurodevelopment., Results: Among children aged 0-1, neglect or restriction was reported as the most prevalent problem (8.02%) among home nurturing environment dimensions, and was associated with an increased risk of suspected fine motor development delay (OR = 2.82, 95% CI: 1.18-6.69, P = 0.019). Among children aged 1-3, inadequate parental warmth, as the foremost (16.10%) problem, was associated with an increased risk of suspected gross motor development delay (OR = 4.12, 95% CI: 1.35-12.53, P = 0.013) and suspected personal-social development delay (OR = 12.50, 95%CI: 1.48-105.36, P = 0.020)., Conclusions: Poor home nurturing environments were associated with an increased risk of suspected early childhood neurodevelopment delay. There exists a need for services to guide for establishing a quality home nurturing environment., Competing Interests: Declarations Ethics approval and consent to participate The ethical approval was obtained from Shanghai Minhang Maternal and Child Health Care Hospital ([2020]-KS-06). All participants in the study had been informed and consented to participate in this study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Suboptimal health status (SHS) is an intermediate status between ideal heath and illness, it is characterized by the perception of health complaints, general weakness, decreased immunity and low energy. An increasing number of Chinese middle school students are suffering from psychological symptoms (PS), particularly anxiety and depression. The relationship between SHS and PS is unclear in adolescents. This study aimed to investigate the prevalence of SHS and the correlation between SHS and PS among Chinese middle school students and to identify the SHS-related risk factors from the perspective of public health., Methods: A cross-sectional study was conducted with the cluster sampling method among 1955 middle school students in Shantou, China. SHS was assessed by Suboptimal Health Status Questionnaire-25 (SHSQ-25). And the PS of anxiety and depression were assessed with Generalized Anxiety Disorder Scale (GAD-7) and Beck Depression Inventory-II Scale (BDI-II) self-assessment questionnaires. Variate logistic analysis was applied to explore risk factors of SHS. The relationship between SHS and PS among Chinese middle school students was subsequently analyzed., Results: Among the 1955 participants, 1904 middle school students were finally included in the analysis, the effective response rate was 97.39%. The prevalence of SHS was 10.3% (197/1904) while the prevalence of anxiety and depression was 30.7% (585/1904) and 34.1% (649/1904), respectively. A strong correlation was identified between SHS and PS among middle school students. With the aggravation of anxiety and depression, the probability of suffering from SHS increased (both P<0.01). The scores for various dimensions of SHS among the depression and anxiety groups were higher compared to those of the non-depression and non-anxiety groups (all P<0.01 ). Multivariate regression showed that compared with sleeping less than six hours, 6-8 h is a protective factor for SHS (OR = 0.486, 95%CI = 0.278-0.851)., Conclusions: Attention should be given to SHS and PS in Chinese middle school students, as they are strongly associated. Lack of sleep is a risk factor for SHS, so sufficient sleep should be recommended to prevent it. Identifying additional risk factors and promoting adequate sleep will improve adolescent health., Competing Interests: Declarations Consent for publication Not Applicable. Competing interests The authors declare no competing interests. Ethics approval and consent to participant This study was approved by the Ethics Committee of Shantou University Medical School (No. SUMC-2022-076) and we had also obtained the consent of participants and their parents or legal guardians. Before filling out the questionnaire, participants voluntarily signed an informed consent form., (© 2024. The Author(s).)

Objective: To investigate the prevalence and risk factors of psychological symptoms and quality of life (QoL) in early patients with inflammatory bowel disease (IBD)., Methods: From September 2021 to May 2022, a unified questionnaire was developed to collect clinical data from early patients with IBD from 42 tertiary care hospitals. The influencing factors of psychological symptoms and poor QoL are screened by logistic regression analysis for constructing model in predicting poor QoL. The consistency index, receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration curve, and decision curve analysis (DCA) were used to evaluate the performance of the model., Results: A total of 939 early patients with IBD were surveyed, Among them, 20.3% exhibited anxiety, 21.7% had depression, 57.3% experienced sleep disturbance, and 41.9% reported poor QoL. The factors influencing psychological symptoms varied between ulcerative colitis (UC) and Crohn's disease (CD) patients. The QoL was primarily affected by disease activity, income level and depression. The AUC value of the model in the training group was 0.781 (95% CI: 0.748-0.814). The calibration diagram of the model closely matched the ideal curve. Compared to other prediction models, our model showed superior predictive capability, with NRI and IDI values of 0.324 (95%CI:0.196-0.4513) and 0.026 (95%CI:0.014-0.038), respectively. DCA indicated that the nomogram model could provide clinical benefits., Conclusion: Early patients with IBD exhibit a high prevalence of psychological symptoms and poor QoL. The nomogram prediction model we constructed demonstrates high accuracy and performance in predicting QoL in early patients with IBD., Competing Interests: Declarations Ethics approval and consent to participate The study complies with the Declaration of Helsinki. The study was approved by the Institutional Review Board of Renmin Hospital of Wuhan University, and informed consent was obtained from all patients. The clinical research Ethics Review approval number of Renmin Hospital of Wuhan University was WDRY2022-K150. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: As intrinsic capacity (IC) declines, older adults are at a significantly increased risk of frailty, care dependency, and death. Currently, the research on IC among older adults in China was still insufficient. We aimed to identify the status quo and influencing factors among community-dwelling older adults in China and explore the relationship between IC, external environment, and social network., Methods: A convenience sampling method was used to collect 312 older people from May 2023 to February 2024 in five communities in Chengdu, Sichuan Province. Data were collected using the general information questionnaire, Integrated Care of the Elderly (ICOPE) screening tool, World Health Organization Quality of live scale (WHOQOL-100), and Social Network Scale (LSNS-6)., Results: The IC score among Chinese community-dwelling older adults was 3.39 ± 1.60, and the prevalence of IC decline was 86.9%. Marital status, age, number of chronic diseases, social network, and external environment were influencing factors of IC, which explained 35.7% of the total variance. External environment and social network were positively correlated with IC., Conclusions: Chinese community-dwelling older adults had low IC scores and a high prevalence of IC decline. The government should focus on IC for older adults, especially those who are older, not married or widowed, and suffering from multiple chronic diseases. In addition, the richer the external resources available to older adults, the more social support they received, and the better the IC. These findings could provide a theoretical basis for managing and improving IC in older adults., Competing Interests: Declarations Ethics approval and consent to participate Written informed consent was obtained from all participants. The study was approved by Medical Ethics Committee of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (2022KL-033). All the participants were given detailed information about the goals, purposeand reasons for the research. All methods were carried out in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background and Aims: Cancer and its treatments may cause neurocognitive impairments in preschool children, but there is limited research on the neurocognitive outcomes of this population. This study, which assessed the neurocognitive function of preschool children with cancer and analyzed various influencing factors of neurocognitive functioning, is of significant importance. We aimed to investigate neurocognitive function and related risk factors in preschool children with cancer to inform preventive and intervention strategies., Methods: From September 2023 to May 2024, we recruited 100 preschool children with cancer. The Chinese version of the Ages & Stages Questionnaires, the Spence Preschool Anxiety Scale Chinese Version, and the Sleep Disturbance Scale for Children were used to collected data. Binary logistic stepwise regression analysis was used to explore the influencing factors of neurocognitive function in preschool children with cancer., Results: 49% of the preschool children with cancer had abnormalities in at least one neurocognitive dimension. The majority of children had abnormalities in gross motor dimension, accounting for 30%, which was related to age and frequency of participation in neurocognitive activities. Communication dimension was related to father's education level, dietary habit, and frequency of participation in activities. Fine motor dimension was associated with age, sex, and father's education level. Problem-solving dimension was associated with age and dietary habit. Personal-social dimension was related to age and radiotherapy., Conclusions: Nearly half of preschool children with cancer experienced neurocognitive impairment. The Chinese version of the Ages & Stages Questionnaires is a simple and effective tool for screening children with possible neurocognitive impairment. It was found that children's neurocognitive function was significantly influenced by family environment, dietary habit, cognitive activities, and cancer treatment. Therefore, it is recommended to strengthen family and social support, and to formulate personalized intervention such as cognitive therapy and dietary adjustment based on children's age and family background, which are important for promoting neurocognitive recovery., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Artificial intelligence (AI)-based chatbots have emerged as potential tools to assist individuals in reducing anxiety and supporting well-being., Objective: This study aimed to identify the factors that impact individuals' intention to engage and their engagement behavior with AI-based well-being chatbots by using a novel research model to enhance service levels, thereby improving user experience and mental health intervention effectiveness., Methods: We conducted a web-based questionnaire survey of adult users of well-being chatbots in China via social media. Our survey collected demographic data, as well as a range of measures to assess relevant theoretical factors. Finally, 256 valid responses were obtained. The newly applied model was validated through the partial least squares structural equation modeling approach., Results: The model explained 62.8% (R 2 ) of the variance in intention to engage and 74% (R 2 ) of the variance in engagement behavior. Affect (β=.201; P=.002), social factors (β=.184; P=.007), and compatibility (β=.149; P=.03) were statistically significant for the intention to engage. Habit (β=.154; P=.01), trust (β=.253; P<.001), and intention to engage (β=.464; P<.001) were statistically significant for engagement behavior., Conclusions: The new extended model provides a theoretical basis for studying users' AI-based chatbot engagement behavior. This study highlights practical points for developers of AI-based well-being chatbots. It also highlights the importance of AI-based well-being chatbots to create an emotional connection with the users., (©Yanrong Yang, Jorge Tavares, Tiago Oliveira. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 11.11.2024.)

To identify differences in human immunodeficiency virus (HIV) risky behavior and healthy practices between rural and urban men who have sex with men (MSM) in Southeast China, a cross-sectional study was conducted on MSM aged ≥ 18 years recruited from four community-based organizations (CBOs) in seven cities in Zhejiang Province between October 2022 and March 2023. An electronic survey questionnaire was completed by the study participants to collect HIV risky behavior and healthy practices. The chi-square test and multiple logistic regression were used for analysis. Among the 1,993 MSM participants, 21.1% (420) were rural MSM. Compared with urban MSM, rural MSM was more likely to have a low level of education (high school and below; 46.2% vs. 40.2%, p = 0.028) and a low annual income (≤ 90,000 RMB; 71.2% vs. 64.7%, p = 0.013). Multiple logistic regression showed that, compared with urban MSM in the past 6 months behaviors, rural MSM had lower odds of finding casual sex partners on the Internet (adjusted odds ratio [aOR]: 0.790, 95% confidence interval [CI]: 0.633-0.986), using stimulants with online casual sex partners (aOR: 0.688, 95% CI: 0.506-0.936), and high odds of ever having sex with a female (aOR: 1.460, 95% CI:1.036-2.058). Rural MSM reported lower odds of an HIV knowledge score of 2-3 (aOR: 0.586, 95% CI: 0.454-0.756), HIV testing more than twice (aOR: 0.583, 95% CI: 0.455-0.748), and obtaining four to five types of HIV information (aOR: 0.661, 95% CI: 0.529-0.826), as well as higher odds of high/very high awareness of HIV infection risk (aOR: 2.312, 95% CI: 1.638-3.263), compared to urban MSM. Rural MSM and urban MSM reported discrepancies in HIV risky behavior, HIV knowledge and HIV-related healthy practices. Paying more attention to HIV risky behavior and improving healthy practices in rural areas may help to prevent HIV transmission., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)