Correction: Accelerated weight gain, prematurity, and the risk of childhood obesity: A meta-analysis and systematic review.

[This corrects the article DOI: 10.1371/journal.pone.0232238.].

Smartphone-Based Cancer and Obesity Prevention Education Program for Chinese Women (SCOPE): A Pilot RCT.

Breast cancer prevalence has increased globally, with 12.2% of breast cancer cases identified in China. Obesity and unhealthy lifestyles are major risk factors for breast cancer. We conducted a randomized control trial to assess the feasibility and evaluate the preliminary effect of the Smartphone-Based Cancer and Obesity Prevention Education (SCOPE) program among adult biological women with a waist circumference greater than 80 cm. The SCOPE program includes tailored and culturally appropriate educational information for obesity and breast cancer prevention delivered by the research team via WeChat. The control group received non-tailored general health information via WeChat. A total of 102 women (52 intervention, 50 control) participated, and 87 (85%) completed 6-month follow-up assessments. For the primary study outcome at 6 months, women using SCOPE significantly reduced waist circumference (Cohen's d = -0.39, p < 0.001). For secondary outcomes at 6 months, women using SCOPE significantly reduced BMI (d = -0.18, p = 0.001) and increased breast cancer-related knowledge (d = 0.48, p = 0.001) and attitude (d = 1.39, p < 0.01). No significant findings were found regarding diet self-efficacy, physical self-efficacy, or breast cancer screening barriers. The results suggest the intervention has great potential to promote the health and wellness of women.

Rapid response nursing triage outcomes for COVID-19: factors associated with patient's participation in triage recommendations.

BACKGROUND: COVID-19 is an ongoing global health crisis with prevention and treatment recommendations rapidly changing. Rapid response telephone triage and advice services are critical in providing timely care during pandemics. Understanding patient participation with triage recommendations and factors associated with patient participation can assist in developing sensitive and timely interventions for receiving the treatment to prevent adverse health effects of COVID-19. METHODS: This cohort study aimed to assess patient participation (percentage of patients who followed nursing triage suggestions from the COVID hotline) and identify factors associated with patient participation in four quarterly electronic health records from March 2020 to March 2021 (Phase 1: 14 March 2020-6 June 2020; Phase 2: 17 June 2020-16 September 2020; Phase 3: 17 September 2020-16 December 2020; Phase 4: 17 December 2020-16 March 2021). All callers who provided their symptoms (including asymptomatic with exposure to COVID) and received nursing triage were included in the study. Factors associated with patient participation were identified using multivariable logistic regression analyses, including demographic variables, comorbidity variables, health behaviors, and COVID-19-related symptoms. RESULTS: The aggregated data included 9849 encounters/calls from 9021 unique participants. Results indicated: (1) 72.5% of patient participation rate; (2) participants advised to seek emergency department care had the lowest patient participation rate (43.4%); (3) patient participation was associated with older age, a lower comorbidity index, a lack of unexplained muscle aches, and respiratory symptoms. The absence of respiratory symptoms was the only factor significantly associated with patient participation in all four phases (OR = 0.75, 0.60, 0.64, 0.52, respectively). Older age was associated with higher patient participation in three out of four phases (OR = 1.01-1.02), and a lower Charlson comorbidity index was associated with higher patient participation in phase 3 and phase 4 (OR = 0.83, 0.88). CONCLUSION: Public participation in nursing triage during the COVID pandemic requires attention. This study supports using a nurse-led telehealth intervention and reveals crucial factors associated with patient participation. It highlighted the importance of timely follow-up in high-risk groups and the benefit of a telehealth intervention led by nurses serving as healthcare navigators during the COVID-19 pandemic.

The 18-month efficacy of an Intensive LifeStyle Modification Program (ILSM) to reduce type 2 diabetes risk among rural women: a cluster randomized controlled trial.

BACKGROUND: Many lifestyle interventions have demonstrated efficacy up to one-year follow-up, yet maintaining improvements at longer-term follow-up is a well-recognized worldwide challenge, especially in underserved areas. The purpose of this study is to compare the 18-month efficacy of an Intensive LifeStyle Modification Program to usual care in reducing the risk for type 2 diabetes (T2D) among women with a history of gestational diabetes mellitus (GDM). METHODS: We conducted a two-arm, cluster randomized controlled trial among women with a history of GDM in China. A total of 16 towns (clusters) in two distinct rural areas in south-central China were randomly selected (8 towns per area) and assigned (1:1) to the intervention (Intensive LifeStyle Modification Program) or control (usual care) group with stratification in the two rural areas. The strategies for maintaining intervention effects were used (including setting recursive goals and providing a supportive environment, etc.) under the guidance of social cognitive theory. The primary outcome was a change in T2D risk; secondary outcomes included glycemic, weight-related, behavioral, and psychological variables. All outcomes were collected at baseline, 6, and 18 months. All participants entered the intention-to-treat analysis. Data were analyzed via generalized estimation equation models (accounting for clusters) at the individual level, with subgroup analysis included in the model. RESULTS: The sample included 320 women from 16 clusters (20 women per cluster). At 18 months, the intervention group demonstrated a significant improvement in T2D risk score, fasting blood glucose, body mass index (BMI), waist circumference, intention to eat low glycemic index food, perceived stress, quality of life in psychological and environmental domains, and social support over time (p < 0.05) based on the intention-to-treat analysis set. Subgroup analysis showed a significant interaction effect on T2D risk score in subgroups of different BMI, waist circumference, and blood glucose (p < 0.05). CONCLUSIONS: Over 18 months, the Intensive LifeStyle Modification Program reduced T2D risk among rural women with a history of GDM in China. Women who were overweight, had high abdominal adiposity, or had blood glucose intolerance benefited more from this intervention. This program serves as a potential diabetes prevention model for women with a history of GDM in low-resource settings worldwide. TRIAL REGISTRATION: Registered on Chinese Clinical Trial Registry (ChiCTR1800015023) on 1st March 2018, http://www.chictr.org.cn/showproj.aspx?proj=25569.

Bile Duct Stone Size May Influence the Efficacy of Endoscopic Sphincterotomy With or Without Large-Balloon Dilation: A Meta-Analysis.

Purpose: Endoscopic sphincterotomy (EPT) combined with endoscopic papillary large balloon dilatation (EPBD) are used to remove large common bile duct (CBD) stones. This meta-analysis compared the efficacy and safety of EPT+EPBD versus EPT alone in the removal of stones based on stone size. Materials and Methods: Twenty-two studies (11 randomized control trials [RCTs] and 11 non-RCTs) were identified and reviewed based on searches of Embase, PubMed, and Web of Science. CBD stone's size was measured with reference to diameter of the duodenoscope (13 mm) and size of the large dilatation balloon (17 mm) seen on cholangiogram. The stone clearance rate, required mechanical lithotripsy (ML), procedure time, and pancreatitis were compared according to the mean stone size, and further divided into Groups A (small) 10-13 mm, B (medium) 13-17 mm, and C (large) >17 mm. Results: Subgroup analysis according to CBD stone size showed EPT + EPBD had a significantly better initial stone clearance rate than EPT in Groups B (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.20-4.77) and C (OR = 3.05, 95% CI: 1.86-5.03), but not for Group A (OR = 1.41, 95% CI: 0.90-2.21). EPT+EPBD also required significantly less ML than EPT in Groups B (OR = 0.34, 95% CI: 0.15-0.77) and C (OR = 0.31, 95% CI: 0.13-0.73). EPT+EPBD had significantly shorter procedure time than EPT in Group B (standardized mean difference = -1.20, 95% CI: -2.08 to 0.32). In meta-regression analysis, Group B had a better OR in initial stone clearance rate and less ML usage rate correlation with the size of CBD stone, but not for Group C with larger stones. Conclusions: EPT+EPBD had a significantly better initial stone clearance rate, and required less ML with shorter procedure time than EPT for removing medium-sized CBD stones, but the efficacy was limited to large CBD stones. The study protocol and trial registration had been registered in PROSPERO (Registration No. CRD42020171689).

Does the Association of Sedentary Time or Fruit/Vegetable Intake with Central Obesity Depend on Menopausal Status among Women?

(1) Background: The prevalence of central obesity is growing rapidly among women, and the prevalence differs by menopausal status. Longer sedentary time and less fruit/vegetable (F/V) intake increased the risk of central obesity. Among women of different menopausal statuses, controversy surrounds the association between sedentary time or F/V intake and central obesity. This study aimed to explore whether the independent and joint associations between sedentary time or F/V intake and menopausal status are correlated with central obesity, respectively. (2) Methods: This cross-sectional study was conducted in Hunan, China. Self-reported questionnaires were used to gather information on demographic characteristics, menopausal status, sedentary time, and F/V intake. Waist circumference was measured at the study site. Binary logistic regression and multiple interaction models were used to explore the independent and joint associations of menopausal status and the above two lifestyle variables with central obesity. (3) Results: A total of 387 women with a mean age of 47.7 ± 6.6 years old participated in the study. The prevalence of central obesity was 52.8%. Peri- and post-menopause statuses and not taking five servings of F/V per day were risk factors of central obesity (p < 0.05), whereas no significant association was found between sedentary time and central obesity (p > 0.05). Among peri-menopausal (mutual odds ratio (OR): 2.466, 95% confidence interval [CI]: 0.984−6.182; p < 0.05) and post-menopausal women (mutual OR: 2.274, 95% CI: 1.046−4.943; p < 0.05), more than 4 h of sedentary time per day was associated with a high risk of central obesity. Among pre-menopausal women, the consumption of five servings of F/V per day was associated with a low risk of central obesity (mutual OR: 0.444, 95%CI: 0.236−0.837, p < 0.05). (4) Conclusions: More than half of women in the central south of China presented with central obesity, spent >4 h of sedentary time per day, or did not engage in recommended F/V intake. Healthier lifestyle intervention is warranted to prevent central obesity development, including reducing the sedentary time to <4 h per day for peri- and post-menopausal women, while increasing taking five servings of F/V per day for pre-menopausal women.

Factors Associated with Pre-Dental Students' Intention and Willingness to Serve in the Underserved Community and Vulnerable Population.

A potential solution to the problem of how to increase access to dental care for the underserved and vulnerable populations is to establish an early pipeline of underrepresented and minority college students for a career in dentistry. This study aims to explore factors associated with such pre-dental students' future intentions to serve. A cross-sectional design was utilized with 144 participants completing the questionnaire with four sections, including participants' demographics, experience in access to dental care, psychosocial factors, and intention to serve the underserved and vulnerable populations. Descriptive statistics, chi-squared test, and logistic regression were used for statistical analyses. A positive attitude (OR = 12.03) and higher confidence towards addressing access to dental care issues (OR = 10.43) were found to be the strongest factor for higher intention to serve the underserved and vulnerable populations. Higher knowledge on the prevalence of dental caries among children (OR = 3.18) and participants who experienced difficulty in getting a dental appointment, or finding an available dentist when needed (OR = 3.43), were also associated with higher intention. Identifying key factors associated with higher intention to serve the underserved and vulnerable populations as a future dentist may facilitate workforce recruitment in the Health Profession Shortage Areas (HPSAs).

Factors Associated with Hemoglobin A1c Level Among Women Without Prior Diabetes Diagnosis in Rural Areas of Central South China: A Cross-Sectional Study.

Background: Women in rural areas of China face the unique risk of developing diabetes, but data on the glycemic status among women without prior diabetes diagnosis in rural areas are lacking which may limit the decision-making for diabetes screening or prevention. This study was aimed to describe the glycemic status of women determined by hemoglobin A1c (HbA1c) and explore its associating factors. Methods: A cross-sectional survey was conducted among women without prior diabetes diagnosis from two counties of rural areas in Central South China from July to October 2018. On the basis of the life course framework, data on socio-demographic, environmental health, genetic, biological (blood pressure, weight and height, lipids), psychosocial, and healthy behavioral factors were collected on site either through questionnaires or field measurements. The questionnaires included social-demographic sheet, Perceived Stress Scale, Self-efficacy scales for health-related diet and exercise behaviors, and Chinese Diabetes Risk Questionnaire. Generalized linear model analysis was performed to determine the associating factors of glycemic status, which was measured by HbA1c level. Results: A total of 647 women were included in the study. The median age of women was 51.00 years (range 35-65 years). The median HbA1c level was 5.1% (interquartile range 4.6%-5.5%, range 4-13.6%), and 8.7% (n=56) of women were identified as elevated glycemic status (HbA1c>6%). Environmental health factors (eg, living in less-developed county [ß=0.206, p=0.027]), biological factors (eg, higher body mass index [ß=0.201, p=0.036], higher total cholesterol [ß=0.097, p=0.040], history of gestational diabetes mellitus [ß=0.722, p<0.001]), and psychosocial factors (eg, higher perceived stress [ß=0.247, p=0.002]) were associated with higher HbA1c level. Conclusion: This study reported 8.7% of elevated glycemic status among women without prior diabetes diagnosis in rural Hunan Province, China. After a comprehensive investigation based on a theoretical framework, living in a less-developed county of rural areas, having larger body mass index, higher total cholesterol, higher perceived stress, and a gestational diabetes mellitus history were identified as associating factors of higher HbA1c level. Professional support regarding weight control, blood lipid control, stress management, and the prevention of gestational diabetes mellitus should be recommended among this population, especially for women from less-developed counties.

The 6-Month Efficacy of an Intensive Lifestyle Modification Program on Type 2 Diabetes Risk Among Rural Women with Prior Gestational Diabetes Mellitus: a Cluster Randomized Controlled Trial.

This study aimed to evaluate the efficacy of an intensive lifestyle modification program tailored to rural Chinese women with prior gestational diabetes mellitus compared with usual care. In a cluster randomized controlled trial, 16 towns (clusters) in two distinct rural areas in China were randomly selected (8 towns per district); and 320 women with prior gestational diabetes mellitus were recruited from these towns. With stratification for the two study districts, eight towns (160 women) were randomly assigned to the intervention group of a tailored intensive lifestyle modification program and 8 towns (160 women) to the control group. Process measures were collected on attendance, engagement, fidelity, and satisfaction. Primary efficacy outcomes included glycemic and weight-related outcomes, while secondary efficacy outcomes were behavioral outcomes and type 2 diabetes risk score, which were collected at baseline, 3-month, and 6-month follow-up. Generalized estimation equations were used to analyze the data. High attendance (72% of sessions), engagement (67% of interactive activities and group discussions), fidelity (98%), and satisfaction (92%) with the tailored intensive lifestyle modification program were achieved. There were significant reductions in fasting blood glucose, oral glucose tolerance test 2 h, waist circumference, and type 2 diabetes risk score of participants in the intervention group compared to the control group (p < .05). There was no significant intervention effect on body mass index or behavioral outcomes (p > .05). In this study, we demonstrate the successful efficacy of an Intensive Lifestyle Modification Program in reducing type 2 diabetes risk among younger women with prior gestational diabetes mellitus. This tailored program delivered by local healthcare providers is a promising approach for diabetes prevention in rural China, reducing health disparities in rural communities about diabetes prevention. Registered in the Chinese Clinical Trial Registry (ChiCTR2000037956) on 3rd Jan 2018.

Prevalence, awareness, and associated factors of high blood pressure among female migrant workers in Central South China.

Background: Although many young Chinese women migrate to urban regions for better opportunities, little is known about the prevalence and awareness of having high blood pressure (HBP) in this population. This study investigated the prevalence, awareness, and factors associated with HBP among young female migrant workers in Central South China. Methods: We conducted a cross-sectional study to identify HBP (2017 ACC/AHA guidelines) among female migrant workers aged 18-45 years in Central South China. Demographics, anthropometric measurements, hypertension-related lifestyle, awareness of HBP, and blood pressure were recorded. Logistic regression analysis was used to identify the factors associated with HBP (blood pressure ≥ 130/80 mmHg). Results: Overall, 232 female migrants participated in the study (mean age 34.4; standard deviation: 6.4 years). The prevalence of HBP was 27.2% (95% CI [21.6-33.2]), and 88.9% of the participants were unaware of their HBP status. Having rural medical insurance (odds ratio [OR] = 20.7; 95% confidence interval 95% CI [2.1-204.8]), awareness of having HBP (OR = 5.1; 95% CI [1.4-18.5]), physical inactivity (OR = 2.9; 95% CI [1.1-7.9]), and being overweight/obese (OR = 2.7; 95% CI [1.3-6.1]) were independently associated with HBP. Conclusions: This study revealed a high prevalence of HBP among young Chinese female migrant workers, as well as a high frequency of being unaware of their condition and some associated factors (rural medical insurance, awareness of having HBP, physical inactivity, and overweight/obesity). The uncontrolled HBP among young Chinese female migrant workers suggested that health education needs further promotion in such a population.

Factors Related to Psychological Distress in Multiparous Women in the First Trimester: A Cross-Sectional Study.

BACKGROUND: The birth rate in Taiwan has declined rapidly; thus, encouraging women to give birth is an important issue in the country. Pregnant women may experience psychological distress, which may negatively impact the health of children and mothers. Prenatal psychological distress is more common in multiparous women than in primiparous women. In addition, compared with that in the second and third trimesters, psychological distress in the first trimester is relatively high. Understanding psychological distress and the associated factors for multiparous women in the first trimester is important to providing early interventions and preventing subsequent maternal and child health problems. PURPOSE: This study was designed to examine the important predictive factors related to depression, anxiety, and stress among Taiwanese multiparous women in the first trimester. METHODS: A cross-sectional design was used. In all, 216 multiparous women at 16 weeks of pregnancy were recruited from three hospitals in Taiwan. Self-reported questionnaires were used to gather data on demographic characteristics, the parenting stress of motherhood, spousal support, and psychological distress. A multiple logistic regression analysis was conducted to examine the factors associated with psychological distress. RESULTS: The prevalence of depression, anxiety, and stress in multiparous women was found to be 31.9%, 42.6%, and 11.1%, respectively. The multiple logistic regression analysis indicated that the stress related to parent-child interaction was a significant predictor of depression and anxiety, the stress related to child-rearing was a significant predictor of anxiety, and low spousal instrumental support was a significant predictor of stress. The model respectively explained 30%, 27%, and 23% of the variance in depression, anxiety, and stress. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Reducing the stress related to parent-child interaction and child-rearing and encouraging spousal instrumental support should be considered during prenatal care when designing interventions to reduce the psychological distress of multiparous women in their first trimester.

The roles of parental absence, life skills and personality traits in mental health status among adolescents in rural China.

PROBLEM: Mental health issues in adolescents are public health concerns worldwide including China. However, there is a lack of research examining the role of parental absence status, life skills, and personality traits on the mental health of adolescents in rural China. METHOD: The purpose of this cross-sectional study was to examine the role of parental absence status, life skills, and personality traits on the mental health of adolescents in rural China. This study used self-developed demographic questionnaire, Mental Health Test (MHT), Middle School Student Life Skills Rating Scale, and Eysenck Personality Questionnaire. Binary logistic regression analyses were performed to examine the associated factors on different domains of MHT. RESULTS: Adolescents in rural China reported high proportion of mental health disorders (MHDs), including learning anxiety, sensitiveness, self-accusation, and physical symptoms tendency. Although 75.6% experienced parental absence, this was not associated with MHT after controlling for all other variables. Better mental health was correlated with life skills including communication skills, interpersonal morality, self-efficacy, and stress coping. The instability-neuroticism personality trait was positively associated with MHDs. DISCUSSION: Adolescents in rural China reported high positive rates of MHDs. Communication skills, interpersonal morality, self-efficacy, ability to cope with stress and Instability-neuroticism were important associated factors of MHDs. APPLICATION TO PRACTICE: Life skills and personality are two important factors that should be considered when assessing the mental health status of adolescents and formulating interventions.

Behavior Characteristics and Risk for Metabolic Syndrome Among Women in Rural Communities in China.

BACKGROUND: Rapid economic growth and lifestyle changes in China have resulted in increased metabolic syndrome (MetS) rates. Few investigators have examined sex-specific risk factors and the role of menopause, stress, and sleep on MetS among women in China. OBJECTIVE: In this study, we aimed to identify the risk factors for MetS among women in rural China. METHODS: A cross-sectional study design was used, and participants were recruited from rural areas in China. Female participants older than 18 years were eligible to participate. Participants had their weight, height, waist circumference, blood pressure, and fasting blood measured at study sites. They also completed validated questionnaires regarding sociodemographic information and MetS-related health behaviors. RESULTS: A total of 646 women were included in this study. The overall prevalence of MetS was 26.2%. The MetS group had a greater number of overweight/obese women than the non-MetS group did. For premenopausal women, a higher income, being overweight/obese, and eating salty/marinated food increased their risk for MetS (odds ratio [OR], 2.56, 4.55, and 3.1, respectively). For postmenopausal women, a low level of education (OR, 0.44) and being overweight/obese (OR, 4.98) increased their risk of MetS. CONCLUSION: Almost half of the women in this study were overweight/obese, and many of them did not meet the national recommendations for a healthy lifestyle, increasing their risk for MetS. Developing cultural and behavioral interventions tailored for overweight/obese women is critical in reducing MetS.

Mediator Roles of Social Support and Hope in the Relationship Between Body Image Distress and Resilience in Breast Cancer Patients Undergoing Treatment: A Modeling Analysis.

Breast cancer and its treatment are particularly distressing for patients because of their potential impacts on body image. The most difficult phase of cancer treatment is usually the first year after a diagnosis. Cancer patients with strong resilience have the positive attitude, internal strength and external resources needed to cope with the disease and its treatment. This cross-sectional study investigated the mediator roles of hope and social support in the association between body image distress and resilience. A structured questionnaire was used to collect data for a convenience sample of 141 breast cancer patients undergoing treatment in southern Taiwan. Structural equation modeling was used for data analysis. The results showed that the final model had a good fit to the data and accounted for 51% of the total variance in resilience. The model of multiple parallel mediators of resilience revealed that hope and social support had mediator roles in the effect of body image distress on resilience. Hope had an important partial mediating role in the association between body image distress and resilience. Social support also had a partial mediating role in the relationship between body image distress and resilience. Social support did not directly affect resilience and indirectly affected resilience through hope. Psychosocial interventions aimed at reducing the impact of body image distress and increasing resilience in breast cancer patients should focus on cultivating hope and increasing social support, particularly support from family members and health professionals.

Are the factors associated with overweight/general obesity and abdominal obesity different depending on menopausal status?

Rapid modernization in China has impacted the daily lives and health of women, including a rise in obesity. However, little is known about the impact of menopausal status, behavior, and psychosocial factors on the risk of obesity for rural women in China. The aim of this study is to identify risk factors, including demographic information (education, family history of T2DM, menopausal status), obesity-related behavior, and psychosocial factors associated with overweight/general obesity and abdominal obesity. In a cross-sectional study design, participants had their weight, height, and waist circumference measured and completed questionnaires regarding family demographics, obesity-related health behaviors (physical activity, diet, sleep), and psychosocial information (stress, social support, and self-efficacy related to physical activity and healthy diet). A total of 646 women were included in this study; 46.6% were overweight/generally obese, and 48% had abdominal obesity. Postmenopausal women had a higher prevalence of general and central obesity. Regular physical activity decreased the risk for overweight/general obesity and abdominal obesity (OR = .41 and .31, respectively, p = .04) in premenopausal women. Postmenopausal women who had not breastfed their infants and reported moderate/high-stress had a higher risk for overweight/general obesity (OR = 3.93, and 2, respectively) and those who reported less than 6 hours of sleep per day increased their risk for abdominal obesity (OR = 2.08). Different factors associated with obesity were found in Chinese women, depending on menopausal status. Future studies should examine the impact of menopause on a woman's risk for obesity, as well as develop tailored interventions to improve health, well-being and reduce the risk of obesity.

The Efficacy of an Intensive Lifestyle Modification Program on Psychosocial Outcomes among Rural Women with Prior Gestational Diabetes Mellitus: Six Months Follow-Up of a Randomized Controlled Trial.

Women with prior gestational diabetes mellitus (GDM) are at a higher risk of type 2 diabetes and other health issues after delivery. They may have a lower quality of life (QoL), experience more medical-related stress, and need more support than those without it. This study aimed to examine the six-month efficacy of an intensive lifestyle modification program on perceived stress, social support, and QoL among women with prior GDM in rural China. A total of 320 women with prior GDM were randomly assigned to an intervention group (n = 160) and a control group (n = 160). Participants in the intervention group received an intensive lifestyle modification (ILSM) program, including a series of six biweekly face-to-face sessions and five biweekly phone sessions delivered by trained local health workers. The control group received the usual care. Data about perceived stress, social support, QoL, and HbA1c were collected at baseline, at three months, and at six-month follow-ups. Generalized estimating equation analysis was used to assess the efficacy of the intervention. There were significant improvements in the psychological domain (ß = 0.479 ± 0.153, p = 0.002) and environmental domain (ß = 0.462 ± 0.145, p = 0.001) of QoL over six months; there were significant group effects (ß = -0.718 ± 0.280, p = 0.010) and time effects (ß = 0.453 ± 0.211, p = 0.032) in physiological domain, and there were significant group effects in the social relations domain (ß = -0.669 ± 0.321, p = 0.037). The ILSM group had a more pronounced downward trend in HbA1c than the control group (ß = -0.050 ± 0.026, p = 0.059). The ILSM program can help women with GDM improve their psychological and environmental domain of QoL. It can be recommended as a form of health promotion for improving QoL among women with prior GDM in rural primary care settings in developing countries.

Nurse Leaders' Knowledge and Confidence Managing Disasters in the Acute Care Setting.

Whether natural or human-induced, disasters are a global issue that impact health care systems' operations, especially in the acute care setting. The current COVID-19 pandemic is a recent illustration of how health care systems and providers, especially nurses, respond to a rapidly evolving crisis. Nurse leaders in the acute care setting are pivotal in responding to the multifactorial challenges caused by a disaster. A quality improvement project was developed to increase nurse leaders' knowledge and confidence in disaster management during the COVID-19 pandemic at 2 Magnet-designated acute care hospitals within the John Muir Health system in Northern California. A total of 50 nurse leaders initially participated in this project, with 33 participants completing the postintervention survey. Results indicated significant improvement in perceived knowledge and confidence in disaster management after the intervention. Qualitative responses from project participants highlighted the need to annualize educational opportunities to sustain knowledge and consistently review emergency management operations plans. This quality improvement project provided an approach to educating nurse leaders in disaster management to promote resilience, support of employees, and optimal patient outcomes during disasters.

General self-efficacy and social support as mediators of the association between perceived stress and quality of life among rural women with previous gestational diabetes mellitus.

To explore the association between perceived stress and quality of life (QoL) and the mediating role of general self-efficacy and social support in this association. Gestational diabetes mellitus (GDM) is one of the most common metabolic diseases suffered by pregnant women. Women with previous GDM may experience more medical-related stress and have a lower QoL than those without it. A multisite correlational study. Four hundred sixty-five women with previous GDM living in rural areas in China participated in this study from November 2017 to June 2019. The participants completed a set of self-reported socio-demographic questionnaires, the Perceived Stress Scale, the General Self-Efficacy Scale, the Social Support Rating Scale and the World Health Organization QoL assessment (Brief version). STROBE checklist was used as the guideline for this study. The mean QoL score was 13.97 (SD 2.07) for physical health, 13.75 (SD 1.98) for psychological health, 14.96 (SD 1.99) for social relations and 12.49 (SD 1.74) for environmental conditions. About 43.9% of women with previous GDM reported increased stress, which was negatively correlated with each of these QoL domains. Yet, the negative effect of perceived stress on QoL could be completely or partly mediated by better social support or general self-efficacy among this population. Nearly half of the women in the study living in rural China reported increased stress after delivery, and there is room to improve QoL in the environmental domain among women with previous GDM. Increasing general self-efficacy or social support can help these women avoid the negative effects of perceived stress on their QoL. These findings suggest that healthcare providers need to be cognizant of the importance of self-efficacy and social support for women with previous GDM in both enhancing QoL and reducing the negative impact of perceived stress on QoL.

Effectiveness of Multidisciplinary Care for Chronic Kidney Disease: A Systematic Review.

BACKGROUND: Chronic kidney disease (CKD) is a common chronic disease. As this disease is extremely complex, multidisciplinary care (MDC) is needed to provide complete and continuous care. AIM: A systematic literature review was performed to examine the constituents of MDC, the content of MDC interventions, and the health outcomes in CKD patients receiving MDC. METHODS: Searches of five Chinese and English databases for studies of CKD patients who had received MDC from 2007 to 2019 revealed 11 studies, which comprised 16,066 CKD patients. The Physiotherapy Evidence Database scale (Physiotherapy Evidence Database, 2017) was used to appraise study quality for randomized controlled trials, and the Joanna Briggs Institute Critical Appraisal tools (Joanna Briggs Institute, 2017) were for cohort studies. RESULTS: The MDC teams that provided comprehensive medical care for these patients included nephrologists, nurses, surgeons, general practitioners, pharmacists, psychotherapists, social workers, nutritionists, and other specialists. The literature review revealed that MDC for CKD slows the decline in estimated glomerular filtration rate and decreases patient mortality, the risk of renal replacement therapy, the need for emergent dialysis, and annual medical costs. Analyses of biochemical markers in the CKD patients showed that MDC improves control of serum levels of calcium and phosphate, improves control of parathyroid hormone, and reduces proteinuria and fasting blood glucose values. However, further studies are needed to determine the effects of MDC on all-cause mortality, blood pressure control, hospitalization rate, hospitalization for cardiovascular or infection events, medications use, and other biochemical markers in CKD patients. LINKING EVIDENCE TO ACTION: Cross-disciplinary collaboration of healthcare professionals is needed to ensure that patients undergo regular follow-up and periodic assessment of clinical status, in addition to ensuring that relevant resources and assistance are provided in a timely manner. A follow-up period of at least 2 years is also needed to ensure sufficient time to observe MDC results.

Impact on Healthy Behaviors of Group Obesity Management Visits in Middle School Health Centers.

This mixed-methods community-based participatory pilot study examined the feasibility and preliminary efficacy of group obesity management visits offered through school-based health centers. The study was implemented through an academic-community partnership in three school health centers serving primarily Latinx and African American youth. Participants (n = 71) completed pre- and post-surveys about intention to change diet and exercise habits, knowledge and self-efficacy related to healthy eating, and social support. Focus groups were conducted after the intervention and 18 months later. Group visits were feasible and highly valued by study participants. Quantitative results showed a significant decrease in soda consumption, increased support from classmates, and an increased number of exercise days. In focus groups, youth endorsed cooking, tasting, and shopping activities, noted the importance of family involvement in behavior change, and stated that stress reduction mindfulness exercises helped to change eating habits. Implications for school-based health care and school nursing are discussed.