Search

Abstract Background Dietary diversity has been suggested as a potential preventive measure against frailty in older adults, but the effect of changes in dietary diversity on frailty is unclear. This study was conducted to examine the association between the dietary diversity score (DDS) and frailty among older Chinese adults. Methods A total of 12,457 adults aged 65 years or older were enrolled from three consecutive and nonoverlapping cohorts from the Chinese Longitudinal Healthy Longevity Survey (the 2002 cohort, the 2005 cohort, and the 2008 cohort). DDS was calculated based on nine predefined food groups, and DDS changes were assessed by comparing scores at baseline and the first follow-up survey. We used 39 self-reported health items to assess frailty. Cox proportional hazard models were performed to examine the association between DDS change patterns and frailty. Results Participants with low-to-low DDS had the highest frailty incidence (111.1/1000 person-years), while high-to-high DDS had the lowest (41.1/1000 person-years). Compared to the high-to-high group of overall DDS pattern, participants in other DDS change patterns had a higher risk of frailty (HRs ranged from 1.25 to 2.15). Similar associations were observed for plant-based and animal-based DDS. Compared to stable DDS changes, participants with an extreme decline in DDS had an increased risk of frailty, with HRs of 1.38 (1.24, 1.53), 1.31 (1.19, 1.44), and 1.29 (1.16, 1.43) for overall, plant-based, and animal-based DDS, respectively. Conclusions Maintaining a lower DDS or having a large reduction in DDS was associated with a higher risk of frailty among Chinese older adults. These findings highlight the importance of improving a diverse diet across old age for preventing frailty in later life.

Abstract. Instruction:. Growing pains are the most common cause of musculoskeletal pain in children, affecting both children's and caregivers' well-being. The lack of definitive diagnostic criteria complicates diagnosis and treatment. Objectives:. This study aims to outline the clinical features and identify factors associated with the frequency and intensity of growing pains in children in Chongqing, China. Methods:. A cross-sectional study was conducted in a children's hospital using its Internet hospital follow-up platform. Children initially diagnosed with growing pains between July and September 2022 were enrolled. Sociodemographics, pain locations, duration, frequency, intensity, and potentially related factors were collected. Results:. Eight hundred sixty-three children were enrolled (average age: 8.19 ± 3.24 years; 455 boys [52.72%]). Pain frequency was reported as quarterly (62.11%), monthly (24.80%), biweekly (1.74%), weekly (10.08%), and daily (1.27%). The prevalence of mild, moderate, and severe pain was 26.65%, 55.74%, and 17.61%, respectively. The knee was the most common pain location (63.85%), mostly encountered between 4 pm and 5 pm (20.51%). Multivariate analysis revealed that pain frequency negatively correlated with vitamin supplementation during pregnancy, positively correlated with underweight, bad temper, increased exercise, and cold lower extremities. Pain intensity positively correlated with irritability, increased exercise, and pain sensitivity but negatively correlated with age and vitamin supplementation during lactation. Conclusion:. Growing pains typically occur on a quarterly basis, predominantly affecting the knees during 4 pm to 5 pm. Factors in sociodemographics, maternal aspect, temperament, and exercise levels can influence pain frequency and intensity. Clinicians should consider these aspects when developing comprehensive strategies for pain management.

The longitudinal study investigated the directionality and transfer mechanism of cross-linguistic transfer of phonological awareness between L1 and L2 in predicting early writing (word dictation) in Chinese children learning English as L2. Ninety primary school Grade 1 (P1) students were assessed on phonological awareness in Cantonese (syllable deletion, onset deletion, rime deletion, and tone awareness), phonological awareness in English (syllable deletion, rime detection, and phoneme deletion), Cantonese word writing, and English word writing at Time 1. These students were assessed on the same measures 1 year later at Time 2 when they were in Grade 2. The results demonstrated bidirectional cross-linguistic transfer of phonological awareness and early writing between Cantonese and English. It also showed that the transfers were achieved through same time writing skills (bidirectional) and future phonological awareness (from L1 to L2 only). No direct effect of earlier phonological awareness to later writing skill was found.

Gamification is typically implemented digitally. However, digital gamification is not always possible because of limited resources and logistical problems. It is thus necessary to explore low-threshold gamification methods that can be easily adopted in classrooms. One such method is non-digital gamification using physical game design elements. Currently, the literature provides a limited understanding of the design and effects of non-digital gamification. It is also unclear whether mixed gamification (ie, a combination of digital and non-digital gamification) is better than purely non-digital gamification. We explored these topics using an explanatory sequential mixed-methods design to compare the effectiveness of non-digital gamification in a face-to-face course and mixed gamification in a blended course in terms of student learning achievement, cognitive engagement and course satisfaction. Two secondary grade classes were randomly assigned to the mixed (N = 52) or non-digital (N = 52) gamification conditions. Contrary to our expectations, the quantitative results showed that the two approaches improved the students' learning achievement to the same extent. Although the students in the non-digital gamification condition reported significantly higher-course satisfaction than those in the mixed condition, the improvement in student cognitive engagement was significantly greater in the mixed gamification condition than in the non-digital condition. Through focus group interviews, we analysed the students' learning experiences and synthesised the factors that influenced student cognitive engagement and course satisfaction.

Background: Morphological awareness (MA) is the awareness and ability to manipulate morphemes, the smallest units of meaning in a language. It is identified as a strong cognitive precursor of word reading and reading comprehension. The current MA instructions are limited to classroom settings and delivered by teachers or experimenters. Few studies have included technology and its novel features to deliver MA instructions. Objectives: This study proposes a gamified learning approach embedded with self-regulated learning support for MA learning and examines its effects on improving English reading performance and intrinsic motivation among junior secondary grade students who learn English as a foreign language. Methods: This study adopted a randomized controlled trial design. Participants (N = 104) were randomly assigned into one of three conditions: self-regulated gamified programme, gamified programme, or non-gamified programme. Students received 16 sessions of instructions (30 min/session) and were evaluated on reading abilities (i.e., MA, word reading and reading comprehension) and intrinsic motivation before and after the programme implementation. Results and conclusions: Results from repeated measures ANOVA and follow-up ANCOVA showed that while the two gamified groups demonstrated greater improvement in MA (i.e., near transfer effect) and intrinsic motivation than non-gamified group, only the self-regulated gamified group showed more gains in multisyllabic word reading (i.e., far transfer effect) than non-gamified group. There was no significant time X group interaction effect on reading comprehension. Implications: Taken together, this research suggests gamification leads to better morphology learning and increases students' intrinsic motivation. The incorporation of self-regulated learning in gamification is recommended to achieve the far transfer effect on multisyllabic word reading.

Purpose: Morphological awareness (MA), the ability to reflect on and manipulate the smallest language units within a word, has been identified as an essential metalinguistic awareness to predict literacy development. In this study, we examine whether an online gamified English MA programme is more effective than physical face-to-face instruction in terms of cognitive, motivational and affective learning outcomes. Method: We applied a quasi-experimental design using a sample of 33 students in an intervention group (gamified MA programme) and 49 in a control group (face-to-face programme). Both programmes were 8 hours in duration (30 minutes/session for 16 sessions). Students' cognitive, motivational and affective learning outcomes were evaluated before and after delivery of the programmes. We took an exploratory sequential mixed-methods approach, in which qualitative data from semi-structured interviews were used to validate the quantitative results. Results: The intervention group performed significantly better than the control group in MA and intrinsic motivation. No differences were found for word reading, reading comprehension or affective engagement. The qualitative analyses of the interview responses revealed in detail the students' perceptions of gamified learning. Conclusion: The findings provide evidence for the beneficial effects of gamified learning experiences in terms of cognitive and motivational outcomes in comparison to face-to-face instruction.

Contribution: While design project courses offer first-year students a practical introduction to engineering, a portion of class time is usually spent on lecturing foundational knowledge instead of practicing engineering design. This article presents a blended design-based learning (bDBL) approach that makes class time more efficient and explores the changes in students' design competencies and intrinsic motivations. Background: Current approaches to cornerstone courses face challenges, such as heavy faculty involvement and heterogeneity of design projects. bDBL draws on the self-directedness of blended learning and the open-ended nature of design-based learning which may be a worthwhile instructional approach for cornerstone courses. Intended Outcomes: bDBL was applied in a cornerstone course that intended to let students understand what engineers do and motivate them in the field. Students' design competencies and intrinsic motivations were examined through pre- and post-self-reported surveys. Focus group interviews were conducted to elicit students' views on bDBL. Application Design: Online self-paced learning modules were created to deliver knowledge-based content. Students transfer what they learned from the online modules through launch-level demos. Then, students spend most of the class time working on team design projects to learn through mistakes and receive first-hand feedback from peers and instructors. Findings: From Fall 2018 to Spring 2020, 201 first-year students experienced bDBL. Quantitative results demonstrated increases in students' design competencies and intrinsic motivations. Four themes representing both positive and negative views of bDBL were elicited. A conceptual framework that connects the theoretical foundation, design elements, examined effects, and students' perceptions, is proposed.

Objectives To identify caregiver and children factors associated with caregiver burden on primary caregivers of children with cerebral palsy (CP).Design Systematic reviewData sources Seven electronic databases, including PubMed, Cochrane Library, Scopus, PsycINFO, Web of Science, CINAHL and Embase, were systematically searched up to 1 February 2023.Eligibility criteria Original observational studies reporting caregiver burden and related factors among caregivers of children with CP.Data abstraction and synthesis Two reviewers independently screened results and assessed the quality of studies. Title, abstract, full-text screening and data abstraction were done independently by two reviewers. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The quality of evidence for factors was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Results 16 articles were included in the review. All studies were cross-sectional and examined caregiver-reported burden measures. The Zarit Burden Interview was the most commonly used questionnaire. Depression of caregiver and severity of illness in children with CP were moderate quality of evidence for factors contributing to caregiver burden.Conclusions Higher caregiver burden is associated with more depressive feelings and worse life quality of the caregiver, and with more severe physical disability of the children. Future studies should focus on high-quality longitudinal research and appropriate assistance to reduce caregiver burden and improve the quality of caregiving for children with CP.PROSPERO registration number CRD42021268284.

Background: Research has established the link between morphological awareness and reading comprehension. However, the theoretical mechanisms underlying the association remain unclear. This study examined the direct and indirect effects of morphological awareness on reading comprehension in L1 Chinese and L2 English, with a sample of Chinese children who speak English as a second language (ESL). We tested theoretically driven predictions regarding the ways in which morphological awareness might impact reading comprehension. Methods: One hundred and fifty-six children in Grades 3 and 4 completed Chinese and English measures of morphological awareness (English: derivational awareness; Chinese: compound awareness), expressive vocabulary, word reading and reading comprehension, in addition to age, working memory and the other language's word definitions as control measures. Results: For both languages, analyses showed that morphological awareness had significant direct effects on both English and Chinese reading comprehension above and beyond mediators and control variables. In addition, morphological awareness had significant indirect effects on reading comprehension mediated by word reading (indirect path 1) as well as vocabulary and word reading in sequence (indirect path 2) after taking control variables into account. Vocabulary did not emerge as a mediator for either the English or the Chinese models. Conclusions: The results underscore the importance of morphology for reading comprehension and reveal the potential mechanisms that underpin their relations in L1 Chinese and L2 English. Our findings further specify the role of morphology in the reading systems framework and highlight the value of incorporating morphology into reading instruction for Chinese ESL children.

Evidence for the effects of dietary diversity changes and cognitive frailty (CF) in the older adults is not clear. This study aimed to investigate the relationship between dietary diversity changes and CF in older adults Chinese. A total of 14,382 participants (mean age: 82.3 years) were enrolled. Dietary diversity scores (DDSs) were collected and calculated using a food frequency questionnaire. DDS changes between baseline and first follow-up were categorized into nine patterns. The associations between DDS changes and the incidence of CF were estimated using Cox proportional hazards models. During an 80,860 person-year follow-up, 3023 CF cases were identified. Groups with a decrease in DDS had increased CF risk compared with the high-to-high DDS group, with adjusted hazard ratios (HRs; 95% confidence intervals (Cis)) of 1.30 (1.06, 1.59), 2.04 (1.51, 2.74), and 1.81 (1.47, 2.22) for high-to-medium, high-to-low, and medium-to-low groups, respectively. Lower overall DDS groups were associated with greater CF risks, with HRs (95% CIs) of 1.49 (1.19, 1.86) for the low-to-medium group and 1.96 (1.53, 2.52) for the low-to-low group. Compared with the high-to-high group, significant associations with CF were found in other DDS change groups; HRs ranged from 1.38 to 3.12 for the plant-based DDS group and from 1.24 to 1.32 for the animal-based DDS group. Additionally, extreme and moderate declines in overall DDS increased CF risk compared with stable DDS, with HRs (95% CIs) of 1.67 (1.50, 1.86) and 1.13 (1.03, 1.24), respectively. In conclusion, among older adults, a declining or persistently low DDS and a moderately or extremely declining DDS were linked to higher incident CF. Plant-based DDS changes correlated more strongly with CF than animal-based DDS changes.

Objectives To synthesise current evidence from systematic reviews (SRs) regarding the efficacy and safety of non-pharmacological interventions to prevent and treat pain in newborn infants.Design Overview of SRs.Data sources We searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang Database, Chinese Science and Technology Periodical Database (VIP) and Google Scholar to identify all relevant SRs published in the last 5 years.Eligibility criteria for selecting studies We included SRs that evaluated the efficacy and safety of non-pharmacological interventions for neonatal pain.Data extraction and synthesis Two reviewers independently extracted the data, assessed the methodological quality using a Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and graded the evidence quality with the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results A total of 29 SRs were included in this overview, of which 28 focused on procedural pain and only 1 focused on postoperative pain. Based on AMSTAR 2, seven reviews were found to be of ‘high quality‘, eight of ‘moderate quality’, five of ‘low quality’ and nine of ‘critically low quality’. The GRADE results suggested that facilitated tucking, kangaroo care, sweet solutions, familiar odour or combined non-pharmacological interventions, such as a combination of sucrose and non-nutritive sucking, were effective and safe in reducing pain from medical procedures in neonates. However, sucrose alone was less effective than local anaesthesia or a combination of the two during circumcision.Conclusions Facilitated tucking, small volumes of sweet solutions, kangaroo care and familiar odour were recommended. Scientific implementation strategies should be developed to promote the clinical use of these effective non-pharmacological interventions. Meanwhile, further rigorous trials and SRs are needed to identify the best non-pharmacological approaches for pain from common surgery and illnesses in neonates.PROSPERO registration number CRD42021292583.

Abstract Morphological analysis is a form of problem solving to work out the meanings of unfamiliar words by applying knowledge of morphemes. It has emerged recently as an important predictor of reading comprehension. However, while gamification can potentially be used to teach this skill, few studies have examined its use. To address this, a computer-based gamified approach was developed specifically to improve English morphological analysis. It was integrated into teacher instruction and formed blended learning. In the gamification design, progression/achievement-oriented game design elements (e.g., points, badges, levels and progress bar) were adopted, as were non-digital and social game design elements. A mixed methods approach was used to evaluate the effectiveness of this blended gamified programme on improving students’ learning engagement and reading comprehension when compared to a conventional face-to-face, non-gamified method of teaching. The target was a group of Chinese students learning English as a foreign language (EFL). Two classes, comprising a total of 104 seventh graders, were assigned randomly to either the gamified or the non-gamified programme and received 10 sessions of training (55 min per session). The results of a one-way ANCOVA showed that students in the blended gamified programme performed significantly better on English reading comprehension than the face-to-face, non-gamified group. Furthermore, the blended gamified group showed significantly higher behavioural and cognitive engagement than the non-gamified group, although no significant difference was observed in emotional engagement. Interviews with the students shed light on the factors that improved their learning and engagement in the gamified class. This research expands the current understanding of gamification design and suggests some care should be taken in using social game design elements. [ABSTRACT FROM AUTHOR]