Factors associated with health behaviours among stroke survivors: A mixed-methods study using COM-B model.

AIMS: To identify factors associated with health behaviours among stroke survivors, through a multi-centre study. DESIGN: A sequential mixed methods design. METHODS: In the quantitative research phase, a total of 350 participants were recruited through multi-stage sampling from December 2022 to June 2023. General information questionnaires, The Stroke Prevention Knowledge Questionnaire (SPKQ), Short Form Health Belief Model Scale (SF-HBMS), Health Promoting Lifestyle Profile (HPLPII), and the WHOQOL-BREF (World Health Organization Quality of Life Questionnaire, Brief Version) were distributed across five tertiary hospitals in Henan province, China. For the qualitative research component, semi-structured interviews were conducted to explore the barriers and facilitators of health behaviour. This study adheres to the GRAMMS guidelines. RESULTS: A total of 315 participants (90.0%) completed the survey. Identified barriers to health behaviour included residing in rural areas, higher scores on the Charlson Comorbidity Index (CCI) and mRS, as well as lower scores on SPKQ, SF-HBMS and WHOQOL-BREF. Twenty-four individuals participated in qualitative interviews. Twenty-eight themes were identified and categorised by frequency, covering areas such as knowledge, skills, intentions, social influences, social/professional role and identity, environmental context and resources, beliefs about capabilities, beliefs about consequences and behavioural regulation. Both quantitative and qualitative data suggested that health behaviour among stroke survivors is at a moderate level, and the identified barrier factors can be mapped into the COM-B model (Capability, Opportunity, Motivation and Behaviour). CONCLUSION: The study indicates that key barriers to health behaviour among stroke survivors align with the COM-B model. These identified factors should be carefully considered in the planning of future systematic interventions aimed at improving health behaviours among stroke survivors. PATIENT OR PUBLIC CONTRIBUTION: Patients were invited to completed questionnaires in the study and semi-structured interviews. The investigators provided explanation of this study' content, purpose and addressed issues during the data collection.

Resourcefulness Among Initial Ischemic Stroke Patients: A Longitudinal Study of 12 Months.

Objective: To explore distinct longitudinal trajectories of resourcefulness among initial ischemic stroke patients from diagnosis to 12 months, and to identify whether sociodemographic factors, disease-related factors, self-efficacy, family function, and social support can predict patterns in the trajectories of resourcefulness. Methods: A prospective longitudinal study was conducted. Initial ischemic stroke patients who met inclusion and exclusion criteria were followed up when still in hospital (Preparing for discharge, Baseline, T1), at 1 month (T2), at 3 months (T3), at 6 months (T4), at 9 months (T5) and 12 months (T6) (±1 week) after discharge. General information, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), General Self-Efficacy Scale (GSES), General Family Functioning Subscale (FAD-GF), and Social Support Rate Scale (SSRS) were used in T1. The Resourcefulness Scale© was evaluated at 6 time points. Growth mixture modeling was used to identify trajectory patterns of resourcefulness. Logistic regression was used to identify predictors of resourcefulness trajectories. Results: Three longitudinal trajectories of resourcefulness were identified and named as the high-stable class (38.9%, n=71), fluctuation class (41.2%, n=75), and low-stable class (19.9%, n=36), respectively. Dwelling areas (x2=6.805, P=0.009), education (x2=44.865, P=0.000), monthly income (x2=13.063, P=0.001), NIHSS scores (x2=44.730, P=0.000), mRS scores (x2=51.788, P=0.000), Hcy (x2=9.345, P=0.002), GSES (x2=56.933, P=0.000), FAD-GF (x2=41.305, P=0.000) and SSRS (x2=52.373, P=0.000) were found to be statistically significant for distinguishing between different resourcefulness trajectory patterns. Lower education (OR=0.404), higher NIHSS(OR=6.672) scores, and higher mRS(OR=21.418) scores were found to be risk factors for lower resourcefulness, whereas higher education(OR=0.404), GSES(OR=0.276), FAD-GF(OR=0.344), and SSRS(OR=0.358) scores were identified as protective factors enhancing resourcefulness. Conclusion: This study obtained three patterns of trajectories and identified their predictive factors in initial ischemic stroke. The findings will assist health care professionals in identifying subgroups of patients and when they may be at risk of low resourcefulness and provide timely targeted intervention to promote resourcefulness.

Sleep structure assessed by objective measurement in patients with mild cognitive impairment: A meta-analysis.

OBJECTIVES: A meta-analysis was used to explore the characteristic changes in objective sleep structure of patients with mild cognitive impairment (MCI) compared with cognitively healthy older adults. MATERIALS AND METHODS: PubMed, EMBAS, Cochrane Library, Scopus, and Web of Science were searched until November 2023. A literature quality evaluation was performed according to the Newcastle-Ottawa Scale, and a meta-analysis was performed by RevMan 5.3 software. RESULTS: Fifteen studies with 771 participants were finally included. Compared with normal control groups, patients with MCI had a decreased total sleep time by 34.44 min, reduction in sleep efficiency by 7.96 %, increased waking after sleep onset by 19.61 min, and increased sleep latency by 6.97 min. Ten included studies showed that the patients with MCI had increased N1 sleep by 2.72 % and decreased N3 sleep by 0.78 %; however, there was no significant difference between the MCI and control groups in percentage of N2 sleep. Moreover, Twelve included studies reported the MCI groups had shorter REM sleep of 2.69 %. CONCLUSION: Our results provide evidence of abnormal sleep architecture in patients with MCI. As a "plastic state," abnormal sleep architecture may be a promising therapeutic target for slowing cognitive decline and dementia prevention.

Effectiveness of health management among individuals at high risk of stroke: An intervention study based on the health ecology model and self-determination theory (HEM-SDT).

Background: Stroke is the second leading cause of death in adults worldwide. However, up to 80% of strokes can be prevented by modifying risk factors. Objective: The study aims to assess the effectiveness of the Health Ecology Model and Self-Determination Theory (HEM-SDT) based health management intervention among individuals at high risk of stroke. Methods: A randomized controlled trial was conducted in Zhengzhou from May 1st, 2020, to December 31st, 2020. A total of 229 participants were recruited for the study, with 116 individuals at high risk of stroke being randomly assigned to the HEM-SDT health management group, while 113 participants were enrolled in the control group, following their current routine practices. The Generalized Estimating Equation model (GEE) was used to analyze the differences in health knowledge, belief and, behavior between the two groups at the beginning of the intervention, and at 6-month intervals after the intervention. The chi-square test was utilized to assess the control rate of risk factors. Results: After 6 months of intervention, there were significant improvements in health knowledge, behavior, and belief among the participants. The study found significant differences in the interaction effects between time and group for health knowledge (Mean, SD = 25.62 ± 3.88, 95%CI: 7.944-9.604, P＜0.001), health belief (Mean, SD = 87.18 ± 14.21, 95%CI: 23.999-29.887, P＜0.001), and health behavior (Mean, SD = 173.28 ± 24.22, 95%CI: 22.332-36.904, P＜0.001). Additionally, the rates of hypertension, hyperglycemia, dyslipidemia, high or medium risk condition of stroke, obesity, hyperhomocysteinemia, smoking, alcohol consumption, and lack of exercise also showed statistical significance (P＜0.05) after the intervention. Conclusion: The HEM-SDT health management model improves the health knowledge, behavior, and beliefs in people at high risk of stroke and remarkably it shows improvement in modifiable risk factors. It can be recommended for systematic health management in people at high-risk of stroke.

Resourcefulness as a mediator in the relationship between self-perceived burden and depression among the young and middle-aged stroke patients: A cross-sectional study.

Objective: To explore the relationships among self-perceived burden, resourcefulness and depression, and to study further whether resourcefulness mediates the effects of self-perceived burden on depression in young and middle-aged stroke patients. Methods: A cross-sectional survey was conducted with 1050 young and middle-aged stroke patients. We used a general demographic questionnaire, Self-Perceived Burden Scale (SPBS), Resourcefulness Scale© (RS) and Hamilton Depression Scale (HAMD) to assess self-perceived burden, resourcefulness, and depression. Statistical methods included correlation analysis, multiple linear regression, and structural equation model. Results: 1018 valid questionnaires were collected with a response rate of 96.95%. Resourcefulness was inversely correlated with self-perceived burden (r = -0.367, p < 0.01) and depression (r = -0.625, p < 0.01); Self-perceived burden was positively associated with depression (r = 0.698, p < 0.01). Multiple linear regression analyses showed that resourcefulness mediated the effects of self-perceived burden on depression; The structural equation model demonstrated that the resourcefulness mediated the relationship between self-perceived burden and depression. Conclusion: Resourcefulness is a mediator between self-perceived burden and depression. Medical staff adjust the psychological state of stroke patients based on the theory of resourcefulness, thereby improving their problem-solving ability, actively encouraging patients to establish problem-solving strategies, providing disease rehabilitation knowledge and skills, and promoting the improvement of resourcefulness level.

mTOR inhibition overcomes RSK3-mediated resistance to BET inhibitors in small cell lung cancer.

Small cell lung cancer (SCLC) is a recalcitrant malignancy with limited treatment options. Bromodomain and extraterminal domain inhibitors (BETis) have shown promising preclinical activity in SCLC, but the broad sensitivity spectrum limits their clinical prospects. Here, we performed unbiased high-throughput drug combination screens to identify therapeutics that could augment the antitumor activities of BETis in SCLC. We found that multiple drugs targeting the PI-3K-AKT-mTOR pathway synergize with BETis, among which mTOR inhibitors (mTORis) show the highest synergy. Using various molecular subtypes of the xenograft models derived from patients with SCLC, we confirmed that mTOR inhibition potentiates the antitumor activities of BETis in vivo without substantially increasing toxicity. Furthermore, BETis induce apoptosis in both in vitro and in vivo SCLC models, and this antitumor effect is further amplified by combining mTOR inhibition. Mechanistically, BETis induce apoptosis in SCLC by activating the intrinsic apoptotic pathway. However, BET inhibition leads to RSK3 upregulation, which promotes survival by activating the TSC2-mTOR-p70S6K1-BAD cascade. mTORis block this protective signaling and augment the apoptosis induced by BET inhibition. Our findings reveal a critical role of RSK3 induction in tumor survival upon BET inhibition and warrant further evaluation of the combination of mTORis and BETis in patients with SCLC.

Robot-assisted rehabilitation training improves knee function and daily activity ability in older adults following total knee arthroplasty.

To evaluate the effects of robot-assisted rehabilitation training on knee function and the daily activity ability of older adults following total knee arthroplasty (TKA). Eighty-eight patients who underwent TKA were randomly assigned to a robot-assisted rehabilitation or traditional therapy group. The patients in the control group were treated with traditional manual rehabilitation therapy, while the patients in the experimental group were subjected to the robot-assisted rehabilitation program. Range of motion of the knee joint, Hospital for Special Surgery Knee Rating Score, and the modified Barthel Index were assessed on the first or second day after TKA (preintervention) and the discharge day (postintervention). Additionally, the length of hospital stay and related hospitalization expenses of the two groups were collected on the discharge day. Improvements in the active range of motion (p < 0.001), passive range of motion (p = 0.001), Hospital for Special Surgery Knee Rating Score (p < 0.001), and modified Barthel Index score (p = 0.004) were significantly better in the robot-assisted rehabilitation group than in the traditional therapy group. Interestingly, the length of hospital stay in the experimental group (9 days) was shorter than that in the control group (13 days), and the total cost of hospitalization was lower (p = 0.002). The robot-assisted rehabilitation training program is an effective intervention that significantly improves the daily activity ability and knee function of older adults following TKA.

Factor analysis of the Chinese version of the Self-care Ability Scale for the Elderly: A multi-centre cross-cultural validation study.

AIM: This study aimed to explore and confirm the factor structure and item distribution of the Chinese version of Self-care Ability Scale for the Elderly among older Chinese people. METHODS: A cluster random sampling method was used to collect 2856 older people from five different cities of China from July 2018 to July 2019. A questionnaire comprised of socio-demographic information and the Chinese version of the Self-care Ability Scale for the Elderly was administered, and SPSS 21.0 and Mplus 7.4 were used for analyses. RESULTS: Participants were aged 60 to 92 years, with a mean age of 71.52 (SD = 7.68) years. In the Exploratory Factor Analysis, the three-factor structure and item distribution of the Chinese version of the Self-care Ability Scale for the Elderly were verified to be better than other options. The factor loadings varied from 0.428 to 0.800, and the communality values ranged from 0.426 to 0.792. The modified model showed a good fit in the Confirmatory Factor Analysis. CONCLUSION: The Chinese version of the Self-care Ability Scale for the Elderly has a clear three-factor structure and a good item distribution. It serves as a convenient and accurate assessment tool to assess the self-care ability of older Chinese people.

A reliability and validity study of the electronic health literacy scale among stroke patients in China.

BACKGROUND: Patients with stroke usually use smartphones to obtain online information to maintain their health. But their ability to identify, evaluate and apply this information is still unknown. AIM: This study was designed to examine the reliability and validity of the electronic Health Literacy Scale among patients with stroke in China. DESIGN: This is a cross-sectional survey. METHODS: A demographic questionnaire, the electronic Health Literacy Scale (e-HLS) and the eHealth Literacy Scale (eHEALS) were administered to a sample of 648 patients with ischemic stroke recruited from December 2020 to March 2021 in a tertiary hospital. RESULTS: The Cronbach'α coefficient on the e-HLS-CHI was 0.907. Kappa consistency coefficient of test-retest reliability was 0.691 (p < .05). Three factors were extracted by Exploratory Factor Analysis (EFA), accounting for 90.84% of the total variance. Confirmatory Factory Analysis (CFA) revealed that three factors of e-HLS-CHI fit well (NFI = 0.979, RFI = 0.955, IFI = 0.987, TLI = 0.972, CFI = 0.987, RMSEA = 0.070, CMIN/DF = 2.586). Good simultaneous validity was suggested by the positive correlation of 0.94 (p < .001) between the e-HLS-CHI and eHEALS. When using eHEALS as the standard, the area under the ROC curve of e-HLS-CHI was 0.896 (95% CI: 0.831-0.960, p < .001). The sensitivity and specificity were 97.8% and 70.4% respectively. CONCLUSIONS: The e-HLS can be used to evaluate electronic health literacy of patients with stroke in China after translation and cultural adaption.

Experiences of health management among people at high risk of stroke in China: A qualitative study.

BACKGROUND: Effective health management of people at high risk of stroke in China is challenging. AIM: To explore and identify the experiences of health management among people at high risk of stroke in order to provide a foundation for a targeted health management strategy for this special group. DESIGN: A qualitative, descriptive study based on interviews. METHODS: Semistructured interviews were conducted with 31 people at high risk of stroke. The interviews were collated and analysed using Colaizzi's seven-step method. RESULTS: A total of 31 people at high risk of stroke were included, and the ages ranged from 40 to 86, with an average age of 60.71 (SD = 11.55). The experiences of health management were categorized into three themes. Theme 1: Facing many ongoing problems in health management, limited knowledge, lack of confidence and poor compliance. Theme 2: Accumulated some value experiences of coping with problems of health management, becoming active learners, promoting social interaction and enhancing self-health management. Theme 3: Sensitivity to multiple influencing factors, the severity of disease and complexity of disease management, family income and economic burden and the value of social support. CONCLUSIONS: This study explored the experiences of health management among people at high risk of stroke, and these findings are of great significance in the primary prevention of stroke.

Is sleep quality a moderated mediator between perceived stress and depression among stroke patients?

Background: Sleep quality can offer new insights into addressing depression among stroke patients. However, the current understanding of the mechanism by which sleep quality reduces depression is not clear in existing research. Objectives: This study aimed to identify the relationships and mechanisms among perceived stress, sleep quality, social support, and depression in stroke patients. Methods: A multicenter cross-sectional study was conducted from January to May 2023. Cluster random sampling was used to recruit 500 stroke patients from five hospitals in Henan Province, China. The Chinese Perceived Stress Scale (CPSS), Pittsburgh Sleep Quality Index (PSQI), Social Support Rating Scale (SSRS), and Hamilton Depression Scale (HAMD-24) were employed to assess perceived stress, sleep quality, social support, and depression, respectively. Data were analyzed using descriptive analysis, Pearson's correlation analysis, and moderated mediation analysis. The study adhered to the STROBE checklist for reporting. Results: Out of 500 participants, 471 completed the survey (94.2%). After controlling for sex and age, mediation analysis revealed that poor sleep quality partially mediated the relationship between perceived stress and depression (ß = 0.184, 95% CI: 0.110, 0.359). Additionally, social support played a moderating role in the mediation model. Conclusion: This study explained the moderated mediation of sleep quality and social support between perceived stress and depression. It provided a theoretical basis for the development of a sleep quality intervention program for reducing depression among stroke patients.

A Fuzzy Neural Network-Based Evaluation Method for Physical Education Teaching Management in Colleges.

A novel Fuzzy Neural Network (FNN) teaching quality assessment model of physical education (PE) is presented at colleges and universities to enhance the validity of PE teaching quality evaluation. It is being done to enhance the accuracy of quality evaluations of PE instruction. In the first phase, out of 4 aspects of teaching material, teaching method, teaching attitude, and teaching effect, a multi-index assessment process of university physical education teacher performance based on the analytic hierarchy process (AHP) is created. The effectiveness of college PE instructors is assessed using this approach. The FNN model is used to develop a teaching quality assessment model for college PE courses. The FNN's parameter is the score data, and the FNN's output vector is equipped with better college PE (excellent, good, average, and low). In terms of assessing the instructional excellence of PE courses in colleges and universities, FNN has been proven to have superior classification accuracy, specificity, sensitivity, and F1 score when compared to other methods. When compared to other countries, this is the case. The proposed approaches resulted in a score of 96% for accuracy, 95% for specificity, 90% for sensitivity, and an F1 score of 94% for performance. The effectiveness of the proposed approach is shown by comparing the outcomes to those of standard physical education teaching strategies.

Problems and countermeasures associated with intercultural adaptation in international education according to the communication action theory model.

Due to the development of the Chinese economy, the consolidation of national power worldwide, and the increasing frequency of economic and cultural exchanges with foreign countries, the number of people from various countries who travel to China to engage in exchanges has increased significantly. Given the development of economic globalization, the acceleration of the process of educational internationalization represents a general trend in higher education development and a common requirement for universities. In addition to education, international students also experience cross-cultural adaptation, that is, behavioral adaptation or changes that occur in people in response to changes in their home country, whether in the form of external or internal cultural adaptation. For international students, the problem of cross-cultural adaptation not only hinders their learning progress but also affects their psychology and living conditions. This article explains the construction of Habermas's theory of communication action. According to this theory, the purpose of communication is to coordinate the common actions of actors, and this coordination is achieved through mutual communication, which is mediated by language. The article also discusses the cross-cultural adaptation experienced by international students in Chinese universities and highlights the importance of developing educational services for international students in the context of international education. Studies have shown that female students exhibit slightly worse psychological adaptation than male students and female students have a slightly higher rate of depression rate than male students. An interpersonal study of 120 international students traveling to China found that most of these students (60%) were able to adapt in terms of their interpersonal relationships. To solve the problems associated with cross-cultural adaptation of international students in China, some countermeasures have been proposed, mainly including active participation in interpersonal communication, an enhanced understanding of the new culture, and the amplification of cultural identity.

Exploring Psychoneurological Symptom Clusters in Acute Stroke Patients: A Latent Class Analysis.

Purpose: To identify latent classes of acute stroke patients with distinct experiences with the symptom clusters of depression, anxiety, fatigue, sleep disturbance, and pain symptoms and assess, if the selected variables determine a symptom-cluster experience in acute stroke patients. Participants and Methods: A sample of 690 participants were collected from July 2020 to December 2020 in a cross-sectional descriptive study. Latent class analysis was conducted to distinguish different clusters of acute stroke participants who experienced five patient-reported symptoms. Furthermore, multinomial logistic regression was selected to verify the influencing indicators of each subgroup, with selected socio-demographic variables, clinical characteristics, self-efficacy, and perceived social support as independent variables and the different latent classes as the dependent variable. Results: Three latent classes, named "all high symptom," "high psychological disorder," and "all low symptom," were identified, accounting for 9.6%, 26.3%, and 64.1% of symptom clusters, respectively. Patients in the "all high symptom" and "high psychological disorder" classes reported significantly lower quality of life (F=40.21, p <0.05). Female gender, younger age, higher National Institutes of Health Stroke Scale scores, and lower self-efficacy and perceived social support were risk factors associated with the "high psychological disorder" class. Younger patients with lower self-efficacy and perceived social support were more likely to be in the "all high symptom" class. Conclusion: This study identified latent classes of acute stroke patients that can be used in predicting symptom-cluster experiences following a stroke. Also, the ability to characterize subgroups of patients with distinct symptom experiences helps identify high-risk patients. Focusing on symptom clusters in clinical practice can inspire us to create effective targeted interventions for subgroups of stroke patients suffering from the same symptom cluster.

Stability and Hopf bifurcation of HIV-1 model with Holling II infection rate and immune delay.

This paper aims to analyse stability and Hopf bifurcation of the HIV-1 model with immune delay under the functional response of the Holling II type. The global stability analysis has been considered by Lyapunov-LaSalle theorem. And stability and the sufficient condition for the existence of Hopf Bifurcation of the infected equilibrium of the HIV-1 model with immune response are also studied. Some numerical simulations verify the above results. Finally, we propose a novel three dimension system to the future study.

Can Goal-Based Health Management Improve the Health Knowledge, Health Belief and Health Behavior in People at High Risk of Stroke? A Non-Randomized Controlled Trial.

PURPOSE: To examine the effectiveness of goal-based health management on health knowledge, health belief and health behavior in people at high risk of stroke. PATIENTS AND METHODS: This is a two-armed and non-randomized controlled trial from May 31, 2020 to December 31, 2020. Participants were arranged to receive regular health care (n=126) or goal-based health management (n=126). The generalized estimation equation was used to analyze the changes in the participants' health knowledge, health belief and health behavior at baseline (T0), 1-month (T1), 3-month (T3), and 6-month (T6). RESULTS: A total of 243 participants completed the 6-month study, of which 123 were in the control group and 120 were in the intervention group. After receiving goal-based health management, participants' health behavior (ß=27.154, p<0.001), health knowledge (ß=10.504, p<0.001) and health belief (ß=49.057, p<0.001) scores increased significantly. CONCLUSION: Goal-based health management can effectively improve the health knowledge, health belief and health behavior of people at high risk of stroke. We recommend that nurses can provide goal-based health management for people at high risk of stroke with support from hospitals and family members of people at high risk of stroke.

Association between illness perception and health behaviour among stroke patients: The mediation effect of coping style.

AIMS: This study aims to explore illness perception and coping style in relation to health behaviour and the mediating role of coping style between illness perception and health behaviour among stroke patients. DESIGN: Cross-sectional study. METHODS: This survey was conducted with 515 stroke patients aged ≥18 years from September 2019 to January 2020 in Zhengzhou, China. The demographic and clinical characteristics questionnaire, Stroke Illness Perception Questionnaire-Revised, Simplified Coping Style Questionnaire, and Health Behavior Scale for Stroke Patients were included in this study. Data analysis was performed by correlation analysis, multiple linear regression analysis, and structural equation modelling. RESULTS: The valid questionnaires were 495 (effective response rate: 96.1%). Low negative illness perception, high positive coping style, and low negative coping style are related to high level of health promoting behaviour (all p < 0.01). The results revealed that the effect of illness perception on health behaviour was partly mediated by coping style. It also confirmed that the mediation effect accounts for 43.7% (-0.169/-0.387) of the total effect. CONCLUSION: Illness perception may influence health behaviour partly because of coping style. IMPACT: This study implies that targeted interventions for stroke patients' illness perception are needed to motivate them to take proactive coping strategy to ultimately improve their health behaviours.

[Evidence-based nursing expert consensus on adult bedside ultrasound].

Bedside ultrasound plays an important role in the evaluation of critically ill patients. In order to standardize the application of bedside ultrasound, Chinese Research Hospital Association of Critical Care Medicine and Nursing Research Group of Chinese Research Hospital Association of Critical Care Medicine organized the experts in related fields in China to analyze, discuss and summarize the following contents: (1) bedside ultrasound assessment of lungs; (2) bedside ultrasound-guided nutrition tube placement; (3) bedside ultrasound assessment of gastric residual volume; (4) bedside ultrasound-guided endovascular catheterization. Finally, the Evidence-based nursing expert consensus on adult bedside ultrasound was formulated.

Testing Two Student Nurse Stress Instruments in Chinese Nursing Students: A Comparative Study Using Exploratory Factor Analysis.

BACKGROUND: The development and transformation of nursing within professional tertiary education have exerted a great pressure and challenge upon nursing students. Stress experienced by nursing students is a common precursor of psychological distress and attrition. However, no scale is specifically used to evaluate the sources of stress experienced by nursing students in Mainland China. Aims and Objective. This study is aimed at testing and comparing the reliability and validity including sensitivity and specificity of two nursing students' stress instruments, the Chinese version of Student Nurse Stress Index Scale (SNSI-CHI), and the Stressors in Student Nursing Scale (SINS-CN) in Chinese nursing students, and describing the stress status of nursing students in China. METHODS: A cross-sectional survey was conducted in two nursing schools in Henan Province from August 2017 to January 2018. Data were collected by using a questionnaire comprising the Chinese version of SNSI (SNSI-CHI), the Chinese version of SINS (SINS-CN), and the Chinese Perceived Stress Scale (CPSS). Homogeneity and stability, content, construct and concurrent validity, and sensitivity and specificity were assessed. RESULTS: The Cronbach's alpha (α) of SNSI-CHI was 0.90, and the item-to-total correlations ranged from 0.35 to 0.66. The Cronbach's α of SINS-CN was 0.93, and the item-to-total correlations ranged from 0.19 to 0.61. The findings of exploratory factor analysis (EFA) confirmed a good construct validity of SNSI-CHI and SINS-CN. The Pearson's rank correlation coefficients, between total scores of SNSI-CHI and CPSS and SINS-CN and CPSS, were assessed to 0.38 (P < 0.01) and 0.39 (P < 0.01), respectively. Regarding the CPSS, as the criterion, the cut-points of SNSI-CHI and SINS-CN for the area under the receiver operator characteristic (ROC) curve were 0.77and 0.66, respectively. CONCLUSION: Both scales are valid and reliable for evaluating the source of stress of student nurses in China. Each has its own characteristics, but the SNSI-CHI demonstrated marginal advantage over the SINS-CN. The SNSI-CHI is short, is easily understood, and with clear dimension for the nursing students, and the SNSI-CHI is more acceptable for the users in China.

Identification of health behaviour clusters among people at high risk of stroke: A latent class profile analysis.

AIMS: To identify the possible latent classes of health behaviour reported by people at high risk of stroke and to explore the predictors of these different classes of health behaviour. DESIGN: A cross-sectional survey study. METHODS: A stratified cluster random sampling method was used to collect data from 2,500 individuals at high risk of stroke who were from Henan Province, China, from January 2018-January 2019. A latent class profile analysis was used to identify the health behaviour clusters and multinomial logistic regression was used to determine which factors predicted the emergent latent classes of health behaviour. RESULTS: High-risk individuals (N = 2,236) at high risk of stroke replied to the survey (89.44% response rate). Model fit indices (AIC = 257,509.610, BIC = 260,228.733, Entropy = 0.956) supported a three-class model of health behaviours. The latent classes were Class 1 (a good level of adaptive health behaviour, 31%, N = 693), Class 2 (a moderate level of adaptive health behaviour, 36%, N = 805) and Class 3 (a poor level of adaptive health behaviour, 33%, N = 738); Based on physical and belief, behaviour and clinical profiles, the three classes were further labelled self-realization deficiency subgroup, social contact anxiety subgroup and health responsibility absence subgroup respectively. Older age, male gender, no spouse, lower education and household income were risk factors associated with good health behaviour. After controlling these socio-demographic variables, high levels of health-related knowledge and attitude were the main positive predictors of health behaviour. CONCLUSIONS: This study has identified three different latent classes of health behaviour and their predictive factors in people at high risk of stroke in the Chinese setting. IMPACT: This study has significance for the promotion of adaptive health behaviour in individuals at high risk of stroke. It has allowed the identification of specific clusters of health behaviour that vary in terms of their adaptiveness and forms the basis for the development of a targeted intervention to promote health behaviour for each different subgroup.