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Objectives The objective of this study was to explore the phenomenon and determinants of healthcare service utilization in Chinese older adults with multimorbidity. Methods We adopted a mixed-methods explanatory design from July 2022 to May 2023. The quantitative research was a social network analysis to explore the phenomenon of healthcare service utilization in target participants. The quantitative results were further interpreted as the participant's propensity for healthcare services and the potential for information sharing between healthcare providers through shared patients. Logistic regression was conducted to identify individual determinants for healthcare service utilization. The quantitative research was followed by qualitative interviews with stakeholders to deeply understand the phenomenon of interest from the individual, healthcare system, and societal perspectives. Results We recruited 321 participants for the quantitative study. They preferred using medication services from primary healthcare providers, pharmacists at private pharmacies, and hospital specialists, and preferred using other services from hospital specialists. Dense relationships arose from shared patients among healthcare providers across various professions and settings, making it possible to share patient information. Primary healthcare providers were particularly important in the process, as they were closely related to others through patient sharing. Health status was identified through logistic regression and qualitative interviews as an individual determinant for healthcare service utilization. More determinants were explored in qualitative interviews with 30 stakeholders, including trust, resource allocation, healthcare accessibility, medical treatment process, and healthcare awareness. Discussion Strategies should be proposed to intervene with patients' nonoptimal propensity toward healthcare services and promote information sharing among healthcare providers. [ABSTRACT FROM AUTHOR]

Objective of this study was to identify factors that impact the successful implementation of integrated care for older adults with multimorbidity in China.Patients and Methods: From July 2022 to May 2023, 33 healthcare providers and managers involved in the delivery and management of healthcare services for older adults with multimorbidity were recruited from Zhejiang Province, China using purposeful and maximum variation sampling methods. Semi-structured, face-to-face in-depth interviews were conducted by the same interviewer in the participants' native Chinese language until data saturation was reached. Inductive thematic analysis was used to analyze the data, and then, themes were mapped onto six dimensions using the Rainbow Model of Integrated Care to allow for a comprehensive view of the study's findings.Results: Eleven themes were generated as facilitators and barriers to integrated care for older adults with multimorbidity in China. These themes include (1) clinical integration: patient-centered care, (2) professional integration: interdisciplinary teams and training, (3) organizational integration: resources and accessibility, (4) system integration: community and funds, incentives, and health insurance, (5) functional integration: electronic health record systems, workforce, and guidelines, and (6) normative integration: shared mission.Conclusion: Guided by the Rainbow Model of Integrated Care, various factors at both micro, meso, and macro levels that impact the implementation of integrated care for older adults with multimorbidity in the Chinese context have been identified in this study. The strategies for future interventions and policies should focus on promoting facilitators and addressing barriers. [ABSTRACT FROM AUTHOR]

Aims: Adherence to diet and exercise recommendations is crucial among metabolic syndrome (MetS) individuals. However, no studies have focused on comprehensive behavioural changes of diet and exercise among individuals with MetS. The present study aimed to explore determinants of adherence to diet and exercise behaviours among people with MetS based on the Capability, Opportunity, Motivation, and Behaviour (COM-B) model. Methods and results: A cross-sectional study was conducted in a health promotion centre of a large and general university hospital in Zhejiang Province, China, in 2021. A total of 241 individuals with MetS completed all scales. The mediation model was tested using structural equation modelling with bootstrapped samples. In the regression-based path analysis, MetS knowledge (β = 0.140), socioeconomic status (β = 0.162), and social support (β = 0.143) directly positively influenced diet behaviour. In addition, social support indirectly positively influenced exercise behaviour through coping and adaptation (β = 0.090). The final theoretical model showed a good fit (root mean square error of approximation = 0.057, comparative fit index = 0.946). Conclusion: Factors associated with diet behaviour were knowledge of MetS, socioeconomic status, and social support. Adaptation may be a mediator between social support and exercise behaviour. Intervention programmes targeting increased adherence to diet and exercise could include these factors for individuals with MetS. Graphical Abstract [ABSTRACT FROM AUTHOR]

Aim: To investigate the characteristics of workplace violence at primary hospitals in Southeast China and identify associated risk factors. Design: A cross‐sectional survey design was used for this work. Methods: We distributed a workplace violence questionnaire among medical staff at primary hospitals in Southeast Zhejiang Province, China. The data were collected between December 2016 and December 2017. We analysed the categorical data by using the chi‐square test and expressed it as frequencies. The risk factors were analysed by using multiple logistic regression analysis. Results: Among the 2,560 questionnaires, 1,842 (71.9%) medical staff indicated that they had experienced workplace violence. Verbal assault was the most common type, followed by physical and sexual assault. Furthermore, gender, age, marital status, education, technical position and number of hospital beds' numbers were independent risk factors. [ABSTRACT FROM AUTHOR]

Introduction: With the effective treatments of novel coronavirus disease 2019 (COVID-19), thousands of patients have recovered from COVID-19 globally. The public perceptions and views are vital to facilitate recovered COVID-19 patients reintegrate into society. In China, the rural population accounts for nearly 70% of the total population. Therefore, we chose to evaluate perceptions and views of rural residents towards COVID-19 recovered patients in China. Methods: Fifteen participants were sampled from a village with the severe COVID-19 epidemic in Zibo city, Shandong Province. The fifteen participants who lived in the village with COVID-19 recovered patients were included. They were over 18 years of age and were voluntary to participant in the study. A descriptive qualitative design using semi-structured telephone interviews was undertaken. Thematic analysis was undertaken. Results: Five main themes emerged from the data: (1) Perceived personal characteristics of COVID-19 recovered patients; (2) Perceived difficulties faced by COVID-19 recovered patients; (3) Perceptions on the social relationship with COVID-19 recovered patients; (4) Views on COVID-19 recovered patients going to public venues; (5) Views on helping COVID-19 recovered patients. Each theme was supported by several subthemes. Conclusion: Our study showed that discrimination and reduced social intimacy exist among rural residents. To improve their views or the situation, relevant departments could lead health educational programs and encourage supportive social connections. Through these strategic messaging, rural residents are expected to recognize that COVID-19 recovered patients need more social support, rather than discrimination and resistance, which helps recovered patients better return to society. [ABSTRACT FROM AUTHOR]

Background and aims: Large areas of paddy fields have been contaminated by cadmium (Cd) in both China and worldwide, resulting in excessive Cd accumulation in rice grains. Here, we investigated the effects of cultivars, water regimes, and growth stages on Cd accumulation in rice with different radial oxygen loss (ROL). Methods: Two groups of experiments were conducted: pot trials with soil-added Cd and solution-added agar using 20 rice cultivars and a rhizobag trial with Cd-contaminated soil and pot trial with solution-added agar under flooded and non-flooded water regimes with three growth stages and two cultivars. Results: Different rice cultivars exhibited different porosity, Cd tolerance, and Cd accumulation in grains, which were significantly correlated with ROL. Cd concentration in shoots was significantly lower under the flooded (0.13–1.01, mean 0.56 mg kg−1) than non-flooded regime (0.68–1.39, mean 0.97 mg kg−1). The low Cd-accumulating cultivar showed higher rates of ROL, higher Cd combined with Fe plaque formation, and lower Cd bioavailability in the rhizosphere soil than the high-Cd accumulating cultivar. Conclusions: Rice cultivars grown under flooded regimes effectively reduced Cd accumulation in edible parts, and the later stage was crucial for reducing Cd accumulation. Low Cd-accumulating cultivars generally exhibited a higher ability to reduce Cd bioavailability in the rhizosphere soil. [ABSTRACT FROM AUTHOR]

Purpose: This study is aiming to investigate cardiovascular patients' attitudes towards self-management during hospitalization in China. Patients and Methods: Twenty-nine individuals living with cardiovascular disease from one designated Cardiology Department in Hangzhou, China, were recruited through a purposive sampling procedure. A qualitative descriptive methodology was used. Semi-structured interviews were also used to gain attitudes toward self-management. The interviews were audio-recorded, transcribed and analyzed by thematic analysis to develop the results. Results: Four themes were identified from the qualitative data: (1): Responsibilities of self-management; (2): Reflections on self-management; (3): Acknowledgement of self-management support; (4): Challenges in implementing and adherence to self-management. Additionally, interview data were also given to illustrate these main themes emerging during the analysis. Patients gradually took their responsibilities to manage chronic symptoms. During their self-management process, they did reflections to help correct their regiments through supportive interactions. Health system responsiveness, health disparities, social capital, and cultural setting were the main external factors influencing better self-management implementation and adherence. Conclusion: This study revealed the hospitalized cardiovascular patients' attitudes towards self-management in China. These findings emphasized the importance of patients' responsibility, reflections, and various social support receiving and pointed out specific external factors influencing the health outcomes and their quality of life. This study also proves the guide for the policymakers and health system better instructions to develop individually and culturally tailored advanced self-management interventions and programs. [ABSTRACT FROM AUTHOR]

Aims: To explore the relationships between work environment, value congruence and nurses' work outcomes; as well as to test the moderating effects of value congruence. Background: A poor nursing work environment in most of mainland China has negatively influenced nurses' job satisfaction, burnout and turnover intention. New insights such as improving nurses' value congruence should be proposed to better foster nurses. Methods: Cross‐sectional data were selected from the Chinese Nurses' Environment of Work Status study. In total, 19149 valid samples were collected. Hierarchical regression analyses and simple slope analyses were performed. Results: The correlation coefficients of the variables were all significant (p < .01) and in the expected direction. Value congruence moderated the relationship between nursing work environment and burnout (emotional exhaustion: β = 0.106, p < .01; depersonalization: β = 0.111, p < .01). Conclusions: Nursing work environment and value congruence were positively related to job satisfaction, and negatively related to burnout and turnover intention. The adverse impact of poor work environment on nurses' burnout can be buffered if nurses' value congruence is compatible with that of the organisation. Implications for Nursing Management: Except for improving the organisational characteristics, value congruence is a useful concept that managers can leverage to improve positive outcomes for both the organisation and its nurses. [ABSTRACT FROM AUTHOR]

Concentrations of six heavy metals (Cu, Ni, Zn, Cd, Cr, and Pb) in sediments and fine roots, thick roots, branches, and leaves of six mangrove plant species collected from the Futian mangrove forest, South China were measured. The results show that both the sediments and plants in Futian mangrove ecosystem are moderately contaminated by heavy metals, with the main contaminants being Zn and Cu. All investigated metals showed very similar distribution patterns in the sediments, implying that they had the same anthropogenic source(s). High accumulations of the heavy metals were observed in the root tissues, especially the fine roots, and much lower concentrations in the other organs. This indicates that the roots strongly immobilize the heavy metals and (hence) that mangrove plants possess mechanisms that limit the upward transport of heavy metals and exclude them from sensitive tissues. The growth performance of propagules and 6-month-old seedlings of Bruguiera gymnorhiza in the presence of contaminating Cu and Cd was also examined. The results show that this plant is not sufficiently sensitive to heavy metals after its propagule stage for its regeneration and growth to be significantly affected by heavy metal contamination in the Futian mangrove ecosystem. However, older mangrove seedlings appeared to be more metal-tolerant than the younger seedlings due to their more efficient exclusion mechanism. Thus, the effects of metal contamination on young seedlings should be assessed when evaluating the risks posed by heavy metals in an ecosystem. [ABSTRACT FROM AUTHOR]

Large areas of the paddy fields in South China are contaminated with arsenic (As), which causes serious problems, including high As concentrations in brown rice. Three As-resistant iron-oxidizing bacteria (FeOB) namely, Bacillus sp. T2, Pseudomonas sp. Yangling I4 and Bacillus sp. TF1-3, were isolated and applied to rice grown in different As-contaminated environments to study the effects of FeOB on the As accumulation in rice and clarify the possible mechanisms involved. The results showed that FeOB inoculation significantly decreased the inorganic As concentrations in brown rice grown in pots and paddy fields by 3.7–13.3% and 4.6–12.1%, respectively. FeOB inoculation enhanced the formation of Fe plaque, which sequestered more As on the root surface. Moreover, a significantly lower level of As(III) influx was observed in the rice cultivated with FeOB than in the control. FeOB inoculation also decreased the As concentrations in pore water and the Fe(II)/Fe(III) ratio in rhizosphere soil. The present results suggest that FeOB inoculation decreased the inorganic As concentrations in brown rice by affecting the formation of Fe plaque, As(III) uptake kinetics and rhizosphere soil properties. Based on our results, FeOB inoculation could be considered a useful method to decrease inorganic As concentrations in brown rice grown in As-contaminated paddy fields. • FeOB decrease inorganic As in brown rice grown in As-polluted soils. • FeOB promote root Fe plaque formation, which sequestered As & reduce As(III) influx. • FeOB increase soil Fe(II)/Fe(III) ratio and decrease As in pore water. [ABSTRACT FROM AUTHOR]

In collaboration with the North Night Vision Science and Technology (Nanjing) Research Institute Co. Ltd, researchers at the Institute of High Energy of Physics in China have successfully developed the 20-inch micro-channel-plate photomultiplier tube (MCP-PMT) that exhibits high detection efficiency (DE) for use in the Jiangmen Underground Neutrino Observatory (JUNO). Due to the long drift path of electrons from photocathode to MCP, the 20-inch MCP-PMT has a time resolution on the order of nanoseconds. Recently, the team has made advancements in ultra-fast MCP-PMTs (FPMTs), achieving picosecond-level time resolution with both 1-inch and 2-inch types. By now, prototypes featuring single-anode, 2 × 2 anodes, 4 × 4 anodes, and 8 × 8 anodes have been successfully manufactured and tested. The 8 × 8 anode FPMT, in particular, demonstrates a transit time spread (TTS) of 36 ps (Sigma) in single photon mode, thanks to its meticulously engineered structure. To assess the FPMT's time performance under beam conditions, two beam tests were conducted at Fermi Lab and CERN. In these tests, the 8 × 8 pixel arrays of four distinct radiators, including LYSO, BGO, Pb glass and quartz glass, were paired with the 8 × 8 anodes FPMT. This setup involved the use of two radiator-coupled FPMT detectors for particle detection. The best coincidence time resolution recorded was 64 ps (Sigma) with a 120 GeV proton beam and 56 ps (Sigma) with a 108 GeV muon beam. [ABSTRACT FROM AUTHOR]

Close contacts of novel coronavirus disease 2019 (COVID-19) patients may suffer from physical and psychological problems. Few studies have investigated the quarantine experiences of close contacts of COVID-19 patients. The objective of this study was to best capture participants' quarantine experiences during the COVID-19 outbreak in China. A descriptive, qualitative design was used. All interviews were recorded and coded using thematic analysis. Fifteen participants took part in this study. The following five themes emerged: (1) experience in the early stage of quarantine; (2) experience in the middle stage of quarantine; (3) experience in the late stage of quarantine; (4) self-coping persisted throughout the quarantine period; and (5) external support was evident throughout the quarantine period. Our study highlights the need to assess the psychological state of close contacts in the early stage of quarantine and to provide psychological support for them, especially for the older and the less educated. Although close contacts had physical symptoms and psychological issues, they adopted positive coping strategies, which indicated that they were vulnerable but strong. Furthermore, external support from the Chinese government helped them cope with the quarantine effectively. Learning from the quarantine experience is expected to help the Chinese government and institutions from other parts of the world to better care for close contacts. [ABSTRACT FROM AUTHOR]

Abstract In order to help mitigate widespread cadmium (Cd) and arsenic (As) co-contamination in paddy soils in China, screening and breeding of low-accumulating rice ( Oryza sativa L.) cultivars (excluders) have been widely adopted. However, the performance of rice cultivars for grain Cd and As accumulation may vary in different growing environments. The inability to identify stable low-accumulating cultivars has largely hindered their application. In this study, 51 rice cultivars were evaluated at four Cd- and As-contaminated paddy sites in two crop seasons in northern Guangdong Province, China. The aim was to investigate the effects of cultivar, environment and their interactions in determining grain Cd and As concentrations, and so to identify stable low-accumulating cultivars. Results showed that environment effects dominated the Cd and As concentrations in rice grains, explaining 87% of the total variations. The crop season played a vital role; compared to early season, grain Cd levels increased and As levels lowered significantly in late season. Large variations in grain Cd, total As, inorganic As concentrations and the percentage of inorganic As were observed between different cultivars. Conventional japonica cultivars exhibited lower Cd levels but higher As levels in the grains than did indica cultivars. The cultivar × environment interaction (CEI) was significant, and its importance was comparable to the cultivar effect. By measuring and interpreting such an interaction, stable Cd and As excluder cultivars were identified based upon the yield, grain Cd and As levels as well as the stabilities of cultivars across the trial environments. Two stable Cd and As co-excluders were found among the hybrid indica cultivars. These results demonstrated that the variations in grain Cd and As concentrations could mainly be attributed to the environment effects and cultivar selection practices should include the analysis of CEI to identify stable low-accumulating rice cultivars. Graphical abstract Unlabelled Image Highlights • The environment and crop season are crucial in determining grain Cd and As. • Two hybrid indica cultivars exhibited stable Cd and As co-exclusion. • Stable excluders could be identified by analyzing cultivar × environment interaction. [ABSTRACT FROM AUTHOR]

• Healthy lifestyle was associated with reduced mortality risk. • PD, but not KDM-BA, was significantly associated with mortality risk. • PD mediated 9% of the total effect of the healthy lifestyle index on mortality. 1) examine the association between lifestyle and mortality; 2) examine the association between two aging measures and mortality; 3) evaluate the mediating effect of the two aging measures on the association between lifestyle and mortality among older Chinese adults. We used data from 2039 older adults (≥ 65 years) from the 2011/2012 biomarker substudy of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We created a healthy lifestyle index based on 5 factors (exercise, smoking, drinking, diet, and BMI, range: 0–5). We calculated two aging measures, the Klemera and Doubal method-biological age (KDM-BA) and physiological dysregulation (PD), based on 10 blood-based biomarkers using algorithms developed previously. A Cox proportional hazards model, general linear regression model, and formal mediation analysis were performed. After adjustment for age and sex, compared to participants without any healthy lifestyle factors, those with 5 healthy lifestyle factors had an 85% lower risk of mortality (hazard ratio [HR] = 0.15, 95% confidence interval [CI]: 0.04, 0.60). PD, but not KDM-BA, was significantly associated with mortality (HR = 1.69, 95% CI: 1.25, 2.29). The healthy lifestyle index was negatively associated with PD (β = -0.021, P = 0.012). PD mediated 9% (95% CI: 1%, 52%, P = 0.043) of the total effect of the healthy lifestyle index on mortality. In the older Chinese population, healthy lifestyle reduces mortality risk and aging partially mediates this association. The findings highlight the importance of adherence to a healthy lifestyle for promoting phenotypic aging even in late life. [ABSTRACT FROM AUTHOR]

Objectives: To develop a Chinese version of the Long-Term Conditions Questionnaire (LTCQ) and to test its reliability and validity in Chinese patients with chronic diseases., Methods: With the consent of the original authors, a Chinese version of LTCQ was developed according to the cultural adjustment guidelines. A questionnaire survey was conducted on 319 patients with chronic diseases in Sir Run Run Shaw Hospital, Wuyi County First People's Hospital and Hangzhou Gongchen Bridge Street Health Service Center. The questionnaire was evaluated by item analysis (including frequency analysis, total question correlation method and critical ratio method), reliability analysis (Cronbach's alpha coefficient) and validity analysis [including content validity (expert scoring method) and structural validity (exploratory factor analysis)]., Results: The Chinese version of the LTCQ included 20 entries, with a Cronbach's alpha coefficient of 0.926, a retest reliability of 0.829, a split-half reliability of 0.878, an entry content validity index of 1, and a content validity index at the questionnaire level of 1. Four common factors were extracted by exploratory factor analysis, namely physical state and daily life, psychological state, support and coping, and safe environment, with a cumulative variance contribution rate of 67.244%. Discussion: The Chinese version of the LTCQ developed in this study has good reliability and validity and it may be used to assess the long-term conditions of patients with chronic diseases in China.

Mindful eating has gained attention in studies on healthy eating. However, measurement of it is scarce, particularly in pediatrics. This study aimed to translate and modify the 12-item Mindful Eating Questionnaire for Children (MEQ-C) using techniques based on both classical test theory (ICC) and item response theory (IRT) in Chinese children and adolescents. Of the 426 participants enrolled and randomly grouped, the test (n = 223) and validation (n = 203) subsamples were well-matched in age, gender, body mass index z score (BMIz), and waist to height ratio (WHtR) (p > 0.556). Three items were eliminated due to deviating from the mindful eating concept (content validity index < 0.71) and presenting as an independent dimension in parallel analysis, or yielding a poor distribution (−4.331 < b < −0.111). The final 5-item Mindless Eating and 4-item Awareness subscales were identified with sound Cronbach’s α of 0.802 and 0.779, respectively. The remaining items functioned well (a > 1, −3 < b < 3), and the Mindless Eating subscale was accurate for the low-to-medium range (−2 to 0) of the mindful eating measure. The Awareness one was reliable for the relatively high range (0 to 2). Participants’ mindful eating characteristics should be taken into consideration in practice.

Objective: Caregiver contribution (CC) is important for the self-care behaviors of chronic disease individuals, as it could enhance patient outcomes. Therefore, it is necessary to assess this CC by using a good validity and reliability instrument. The Caregiver Contribution to Self-Care Chronic Illness Inventory (CC-SC-CII) was designed to assess CC to self-care behaviors of patients with chronic illness in Italy. However, it was unclear whether this tool had sound psychometrics properties in the context of Chinese culture. Therefore, we performed the cross-cultural adaption of the CC-SC-CII and we tested its psychometric properties among Chinese caregivers of patients with chronic disease., Design: A cross-sectional observational design., Settings: Participants were recruited from communities and institutions in Pingdingshan, Henan Province, China., Participants: 301 caregivers of care recipients with chronic disease completed the Chinese version of the CC-SC-CII (C-CC-SC-CII)., Primary and Secondary Outcome Measures: The content validity index of items (I-CVI), the scale content validity index-average (S-CVI/Ave), exploratory factor analysis, confirmatory factor analysis (CFA), internal consistency and item analysis were tested., Results: The range of I-CVI was between 0.833 and 1.00, and the score of S-CVI was 0.991. In CFA, the C-CC to self-care monitoring scale had satisfactory fit indices. However, the C-CC to self-care maintenance and management scales had unsupported fit indices. The reliability coefficients of C-CC-SC-CII were 0.792, 0.880 and 0.870 for its three scales. Item-total correlations were all over 0.590. Test-retest reliability showed that the range of intraclass correlation coefficients was from 0.728 to 0.783., Conclusion: The C-CC-SC-CII has sound psychometrics characteristics and is a culturally appropriate and reliable instrument for assessing CC to the self-care behaviours of patients with chronic disease in China., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: Lifestyle factors have been well-established as essential targets for fighting individual chronic diseases, but little research has concentrated on multimorbidity from the perspective of multiple lifestyle factors in the Chinese population. Thus, this study aimed to explore the associations of lifestyle factors with the occurrence of multimorbidity., Methods and Results: Cross-sectional data retrieved from the China Health and Retirement Longitudinal Study were used for analysis. Multimorbidity was calculated on a simple count of self-reported chronic conditions. Lifestyle factors included sleep duration, physical activity, alcohol intake, smoking status, and body mass index. Logistic regression analysis was used to examine the independent and accumulating effects of lifestyle factors on multimorbidity. Latent class analysis was performed to explore the lifestyle patterns. Six thousand, five hundred, and ninety-one valid subjects were included for analysis. Overall, the community dweller's median number of chronic conditions was 1 (range 1-11) and median number of high-risk lifestyle factors was 2 (range 0-5). All lifestyle factors were associated with the occurrence of multimorbidity but varied between genders. We also identified that participants who accumulated more unhealthy lifestyle factors having a higher likelihood of multimorbidity. 'Physical activity and weight', 'smoke and drink', and 'sleep and weight' dominated high-risk lifestyles were the most common lifestyle patterns., Conclusion: This study revealed the associations of unhealthy lifestyle factors and their accumulating effect with multimorbidity in Chinese community dwellers. Three common lifestyle patterns indicated that a holistic approach focused on engaging and changing multiple modifiable lifestyle behaviours within an individual might be more effective in managing multimorbidity., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)

Objectives: Patients living with cardiovascular diseases use different strategies to solve various problems. This study aimed to identify the category, type and specific self-management strategies reported by hospitalized patients with cardiovascular diseases., Methods: This is a qualitative descriptive study. Twenty-eight individuals with cardiovascular diseases from a Cardiology Department affiliated with a school in China were recruited by purposive sampling. Face-to-face semi-structured interviews were used. The interviews were audio-recorded, transcribed, translated and analysed by using content analysis., Results: Five self-management strategy categories (medical and alternative therapy uptake, risk assessment and avoidance, resource seeking and utilization, maintaining normality, and optional management), and seventeen self-management strategy types, encompassing one hundred and ten specific strategies were identified. The most commonly used self-management strategy types were lifestyle adjustment (eleven strategies), self-maintenance (nine strategies) and problem-solving (nine strategies). Additionally, the most described explicit self-management strategies were receiving family/colleague support, maintaining daily routines, monitoring symptoms and managing side effects, discussing with professionals, using medicines, and improving awareness., Conclusion: This study identified diverse strategies reported by some Chinese cardiovascular patients. It may inform the design and development of personalized self-management interventions for health practitioners and policymakers, helping cardiovascular patients in Chinese communities worldwide receive culture-tailored services., (© 2021 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

Objectives: High levels of organisational citizenship behaviour can enable nurses to cooperate with coworkers effectively to provide a high quality of nursing care during the outbreak of COVID-19. However, the association between autonomy, optimism, work engagement and organisational citizenship behaviour remains largely unexplored. This study aimed to test if the effect of autonomy on organisational citizenship behaviour through the mediating effects of optimism and work engagement., Study Design: This was a cross-sectional study., Setting: The study was conducted in the Wuhan Jinyintan Hospital in China., Participants: In total, 242 nurses who came from multiple areas of China to work at the Wuhan Jinyintan hospital during the COVID-19 epidemic participated in this study., Methods: A serial mediation model (model 6) of the PROCESS macro in SPSS was adopted to test the hypotheses, and a 95% CI for the indirect effects was constructed by using Bootstrapping., Results: The autonomy-organisational citizenship behaviour relationship was mediated by optimism and work engagement, respectively. In addition, optimism and work engagement mediated this relationship serially., Conclusion: The findings of this study may have implications for improving organisational citizenship behaviour. The effects of optimism and work engagement suggest a potential mechanism of action for the autonomy-organisational citizenship behaviour linkage. A multifaceted intervention targeting organisational citizenship behaviour through optimism and work engagement may help improve the quality of nursing care among nurses supporting patients with COVID-19., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Social support can be a critical resource to help medical staff cope with stressful events; however, the moderating effect of social support on the relationship between burnout and anxiety symptoms has not yet been explored., Methods: The final sample was comprised of 514 intensive care unit physicians and nurses in this cross-sectional study. Questionnaires were used to collect data. A moderated model was used to test the effect of social support., Results: The moderating effect of social support was found to be significant (b = - 0.06, p = 0.04, 95%CI [- 0.12, - 0.01]). The Johnson-Neyman technique indicated that when social support scores were above 4.26 among intensive care unit medical staff, burnout was not related to anxiety symptoms., Conclusions: This is the first study to test the moderating effect of social support on the relationship between burnout and anxiety symptoms among intensive care unit staff.

Objectives: In this study, we aimed to estimate the prevalence of metabolic syndrome (MetS) among Chinese adults, describe the disease components and compare utility of the existing international criteria and Chinese diagnostic criteria., Design, Setting and Participants: A retrospective database analysis was conducted for one hospital in Zhejiang province, China. We analysed data (collected in 2017) from a total of 64 902 participants (37 500 males and 27 402 females), aged between 18 and 97 years, and who met the eligibility criteria., Main Outcome Measures: We employed three criteria for MetS proposed by the International Diabetes Federation (IDF) in 2005, the 2009 Joint Scientific Statement (harmonising criteria) and the China Diabetes Society (CDS) in 2013 to detect prevalence of MetS. Specifically, we analysed waist circumference, blood pressure, fasting plasma glucose, plasma triglycerides and plasma high-density lipoprotein cholesterol., Results: We found an estimated age-adjusted MetS prevalence of 20.4% using IDF 2005, 30.0% based on harmonising criteria 2009 and 16.3% under the CDS 2013. This prevalence was higher in males, older adults and increased body mass index. Analysis of agreements among the criteria were 87.2% (IDF and CDS), 87.1% (IDF and harmonising criteria) and 81.6% (CDS and harmonising criteria), while their kappa coefficients were 0.641, 0.708 and 0.572 for IDF versus CDS, IDF versus harmonising criteria and CDS versus harmonising criteria, respectively. The most prevalent MetS component was abdominal obesity (50.1%), followed by dyslipidaemia (49.5%) and hypertension (46.8%) using harmonising criteria., Conclusion: These findings revealed moderate agreement among the three criteria with utility in Chinese clinical settings. The harmonising criteria 2009 performed better in early identification of MetS in the Chinese population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: For the stabilization of the nursing profession in mainland China, a valid and reliable nursing work environment instrument, grounded in China's context, should be developed to better provide rigorous evidence for policy makers., Objective: The purpose of the current research was to further develop a scale that could capture the characteristics of the nursing work environment in mainland China., Methods: A convenience sample of 542 nurses employed in a tertiary hospital of mainland China completed the 108-item Chinese Nursing Work Environment (C-NWE) Scale (1st ed.). Items that did not differentiate between respondents with the highest and lowest 27% of total scores and those that did not meet criteria for factor loadings were set aside. Exploratory factor analysis based on the maximum likelihood method was used to identify the structure of the scale. The chi-square test was used to evaluate model fit, and expert review was conducted to test content validity. Reliability was estimated using Cronbach's alpha coefficient., Results: The revised C-NWE Scale, which consists of nine subscales and 47 items, is a simplified version of the C-NWE (1st ed.). Using exploratory maximum likelihood factor analysis, the normed chi-square fit index for a nine-factor solution was 1.97. The content validity index for the total scale was 0.93; Cronbach's alpha was .94., Discussion: Initial evidence of the psychometric properties of C-NWE scores was presented. Further studies could be conducted in various settings to identify the C-NWE Scale's validity and reliability.

Rice consumption has been identified as a major route of methylmercury (MeHg) exposure in some areas of inland China. We investigated two potential mitigation methods (water management and deliberate selection of rice cultivars) to reduce the amount of total mercury (Hg) and MeHg within the grain. Rice grown aerobically had markedly reduced total Hg and MeHg concentrations as well as a much lower proportion of MeHg in the grain. Remarkably, there were considerable variations in the total Hg and MeHg concentrations as well as the proportion of MeHg in the grain among the 24 cultivars grown in the same paddy soil. The Hg tolerance index (expressed as % mean of control root growth) also varied substantially among the different cultivars. Furthermore, negative correlations were found between the total Hg and MeHg concentrations (P<0.05) of grain and the proportion of MeHg in the grain (P<0.01)., (Copyright © 2011 Elsevier Ltd. All rights reserved.)