A Delphi Study to Construct an Index of Practice for Community Nurses Providing Transitional Home Care for Patients with Chronic Diseases.

Community nurses play a key role in providing continuous home care for patients with chronic diseases. However, a perfect system of responsibilities and requirements has not yet been formed, and nurses cannot provide high-quality nursing services for home-based patients. We attempted to construct an index of the scope of practice for community nurses providing home-based transitional care for patients with chronic diseases and to guide nurses in playing an active role in transitional care work. From March to May 2023, 14 representative community nurses from the Shanghai Community Health Service Center were selected for group interviews and 2 rounds of Delphi consultation. A total of 14 valid questionnaires were collected. The authority coefficients were 0.94 and 0.93, and the Kendall coefficients were 0.56 and 0.59 for the 2 rounds of expert consultation (P < .05). Finally, an index system, including 6 primary indices (transitional caring provider, patient self-management facilitator, community group intervention organizer, home caregiver supporter, family physician team collaborator and supervisor of home medical equipment use, and medical waste disposal) was constructed for community nurses involved in providing home-based transitional care for patients with chronic diseases. The weight values of the 6 indices were 0.19, 0.17, 0.21, 0.13, 0.14 and 0.16, respectively (CR = 0.035, and the consistency test was passed), and 16 secondary indicators and 42 tertiary indicators were identified. In this Delphi study, an index system that can be used to determine community nurses' roles in providing home-based transitional and continuous care for patients with chronic diseases was successfully established. The index system is considered reliable and easy to use and will provide a meaningful reference for community nurses and policy-makers.

Healthcare costs attributable to abnormal weight in China: evidence based on a longitudinal study.

BACKGROUND: The prevalence of abnormal weight is on the rise, presenting serious health risks and socioeconomic problems. Nonetheless, there is a lack of studies on the medical cost savings that can be attained through the mitigation of abnormal weight. The aim of this study was to estimate the impact of abnormal weight on healthcare costs in China. METHODS: The study employed a 4-wave panel data from China Family Panel Studies (CFPS) between 2012 and 2018 (11,209 participants in each wave). Inpatient, non-inpatient and total healthcare costs were outcome variables. Abnormal weight is categorized based on body mass index (BMI). Initially, the two-part model was employed to investigate the impact of overweight/obesity and underweight on healthcare utilisation and costs, respectively. Subsequently, the estimated results were utilised to calculate the overweight/obesity attributable fraction (OAF) and the underweight attributable fraction (UAF). RESULTS: In 2018, healthcare costs per person for overweight and obese population were estimated to be $607.51 and $639.28, respectively, and the underweight population was $755.55. In comparison to people of normal weight, individuals who were overweight/obese (OR = 1.067, p < 0.05) was more likely to utilise healthcare services. Overweight/obesity attributable fraction (OAF) was 3.90% of total healthcare costs and 4.31% of non-inpatient costs. Overweight/obesity does not result in additional healthcare expenditures for young people but increases healthcare costs for middle-aged adults (OAF = 7.28%) and older adults (OAF = 6.48%). The non-inpatient cost of underweight population was significantly higher than that of normal weight population (ß = 0.060,p < 0.1), but the non-inpatient health service utilisation was not significantly affected. CONCLUSIONS: Abnormal weight imposes a huge economic burden on individuals, households and the society. Abnormal weight in Chinese adults significantly increased healthcare utilisation and costs, particular in non-inpatient care. It is recommended that government and relevant social agencies provide a better social environment to enhance individual self-perception and promote healthy weight.

Information-Motivation-Behavioral Skills Model Supplemented With the Moderated-Mediation Path: A Framework for Interpreting Patients' Online Medical Services Utilization.

PURPOSE: This study aimed to explore the internal determinants affecting patients' utilization of online medical services (OMS) based on the information-motivation-behavioral skills model from a behavioral perspective. DESIGN: A cross-sectional study. SETTING: This study was conducted in three medical institutions in Jiangsu Province, China. SUBJECTS: 470 internet users were enrolled from patients who came to the outpatient clinics. MEASURES: A self-administered questionnaire with feasible reliability and validity was used to investigate the demographic characteristics and OMS utilization-related information, motivation, behavioral skills, intention, and behavior. ANALYSIS: According to the constructed framework, structural equation modeling was used to test the relationships between those factors and OMS utilization behaviors. RESULTS: All direct paths are established except the path between information and intention. Information and motivation positively affected OMS utilization behavior through behavioral skills and intention (P < .001). Motivation and behavioral skills could positively influence OMS utilization behavior through intention (P < .01). Motivation was found to be the largest predictor of OMS utilization behavior. Moreover, gender played a moderating role in the interpretation of the behavior. CONCLUSIONS: Interventions should be conducted regarding information, motivation, and behavioral skills to promote patients' use of OMS. At the same time, the impact of gender on intervention effectiveness should also be considered.

Community Nurses Are Important Providers of Continuity of Care for Patients With Chronic Diseases: A Qualitative Study.

To clarify the functional orientation of community health nurses in the continuous care of patients with chronic diseases and to encourage community nurses to play their expected roles in extended nursing work. In this study, conducted from May to July 2020, the staff of Shanghai Community Health Service Center were sampled, and representative medical staff were selected for in-depth interviews and focus group discussions. Eighteen community medical staff members participated. The functions of community nurses in the continuous care of patients with chronic diseases are mainly as follows: ① undertaking individualized projects for patients' continuous treatment, nursing and rehabilitation; ② creating "peer education" conditions for patients; ③ providing supportive care to family caregivers; and ④ participating in the whole process of family doctor team health management. The results provide a reminder for nurse managers that under the new mission, community nurses need "one specialty and multiple abilities," appropriate nursing technology and good health management skills. The training of community nurses should better meet the practical needs of patients with chronic diseases.

OsCYBDOMG1, a cytochrome b561 domain-containing protein, regulates salt tolerance and grain yield in rice.

KEY MESSAGE: OsCYBDOMG1 positively regulates salt tolerance, plant growth, and grain yield by affecting ascorbate biosynthesis and redox state. Soil salinity is a major abiotic stress affecting rice growth and productivity. Many genes involved in the salt stress response have been identified, but the precise mechanisms underlying salt tolerance remain unclear. In this study, we isolated a salt-sensitive mutant of rice, rss5, which exhibited more severe wilting and chlorosis with a significant increase in lipid peroxidation, electrolyte leakage, and shoot Na+ concentration compared to wild-type plants. Map-based cloning, MutMap analysis, and genetic complementation revealed that a single-nucleotide mutation in a gene encoding a cytochrome b561 domain-containing protein (OsCYBDOMG1) was responsible for the mutant phenotype of rss5. The OsCYBDOMG1 gene was mainly expressed in young shoots and nodes, and the encoded protein was principally located in the plasma membrane and endoplasmic reticulum. Mutations of OsCYBDOMG1 resulted in decreased ascorbic acid (AsA) content and AsA/DHA (dehydroascorbate) ratio, which led to increased H2O2 accumulation and reduced salt tolerance. Moreover, plant growth and grain yield of rss5 and the OsCYBDOMG1 knockout mutant (cr-1) were significantly decreased compared to wild-type plants under normal conditions. The elite haplotype of OsCYBDOMG1 associated with higher salt tolerance and grain width and weight was mainly existed in japonica varieties. These results suggest that OsCYBDOMG1 plays an important role in the regulation of salt tolerance, plant growth, and grain yield in rice.

Analysis of Factors Affecting Psychological Resilience of Emergency Room Nurses Under Public Health Emergencies.

Resilience is essential for frontline health workers to cope with the unfavorable situations, especially under public health emergencies. Emergency room (ER) nurses are a special cohort of health professionals that may present moderate level of resilience. This study aimed to identify factors that are correlated with resilience in this special cohort to provide directions for intervention and management. ER nurses that have encountered a public health emergency within 3 months were recruited using purposive sampling and snowball technique for the study. Questionnaires, including Connor-Davidson Resilience Scale (CD-RISC), Zung Self-Rating Depression Scale (SDS), and Maslach Burnout Inventory-Human Services Survey (MBI-HSS) were established, followed by an in-depth interview to identify different clusters of themes. Thirteen ER nurses were recruited, and the average CD-RISC score was 66 ± 21. Resilience was negatively correlated with SDS index, and positively correlated with personal accomplishment. Five clusters of themes were identified from in-depth interviews, including physical tolerability, psychological tolerability, tenacity of internal drive, institutional implementation, and external adjustment. This study identified factors associated with resilience in ER nurses under public health emergencies, providing useful information for future directions for intervention.

Empirical validation of the information-motivation-behavioral skills model of gestational weight management behavior: a framework for intervention.

BACKGROUND: Unhealthy gestational weight gain is a modifiable risk factor for adverse maternal and child health. Appropriate and effective intervention strategies that focus on behavioral change or maintenance are critical in weight management during pregnancy. Our aim was to uncover the influencing factors and psychosocial mechanisms of gestational weight control behavior, and to construct a behavioral model suitable for intervention based on Information-Motivation-Behavioral skills (IMB) model. METHODS: A sample of 559 pregnant women from a municipal maternal and child healthcare facility in Jiangsu Province, China was enrolled in this cross-sectional empirical study. Partial least square structural equation modelling was used to verify the hypothesized model, and post hoc analyses was used to test the effect of parity and pre-pregnancy BMI on the model. RESULTS: The IMB model elements can predict gestational weight management (GWM) behavior well, with information being the most influential factor. As predicted, information affects GWM directly (ß = 0.325, p < 0.05) and indirectly (ß = 0.054, p < 0.05) through behavioral skills. Likewise, motivation has direct (ß = 0.461, p < 0.05) effects on GWM, and has indirect (ß = 0.071, p < 0.05) effects through behavioral skills. Behavioral skills have a direct impact (ß = 0.154, p < 0.05). The model had a goodness of fit (GOF = 0.421) and was robust when tested in subgroups of different parity or pre-pregnancy BMI. CONCLUSION: Findings from this study supported the predictions of the IMB model for GWM behavior, and identified its modifiable determinants. The tested behavior model for GWM can serve as a new validated intervention strategy in weight management among pregnant women.

Applying two behavioral theories to predict the willingness to receive COVID-19 vaccine booster in the elderly: A cross-sectional study.

BACKGROUND: The COVID-19 vaccination booster can effectively protect the elderly from infection while also lowering the risk of serious illness and death. However, barriers remain in willingness of the elderly to boost vaccination. OBJECTIVE: Using the protection motivation theory (PMT) and the theory of planned behavior (TPB), to study the factors that influence willingness of the elderly to get the COVID-19 vaccine booster. METHODS: The elderly who visited three randomly selected medical institutions in Nanjing's core urban region between March and April 2022 were chosen as study participants. A face-to-face survey was conducted using purposeful sampling and a self-designed questionnaire. The questionnaire contained sociodemographic characteristics, the elderly's willingness to obtain a COVID-19 vaccine booster, and psychosocial cognitive components based on the PMT and TPB. SmartPLS 3.0 was used to conduct structural equation modeling. RESULTS: 214 participants were included in the analysis. The combined model of the two behavioral theories explained the willingness to accept COVID-19 vaccine booster well with R2 of 0.490. Self-efficacy (ß = 0.315) was the strongest predictor of vaccine booster willingness. Subjective norms (ß = 0.160), perceived severity (ß = 0.157), and perceived vulnerability (ß = 0.159) also showed positive effects on vaccine booster willingness, while response cost (ß = -0.143) had a negative effect on the willingness. No significant association between attitudes, response efficacy and the willingness was discovered. CONCLUSION: The willingness of the elderly to receive the COVID-19 vaccine booster was affected by psychosocial cognitive factors. This study supports the applicability of the PMT and TPB models to interpret the willingness of the elderly in such areas.

Association between gestational depression and weight management behaviors during pregnancy: A cross-sectional study in Eastern China.

An undesirable psychological state may deteriorate individual's weight management-related behaviors. This study aims to see if ineffective weight control measures were linked to depressive symptoms during pregnancy. We conducted a cross-sectional questionnaire survey of 784 pregnant women and collected information on sociodemographic factors, maternal characteristics, depression, and weight management activities throughout pregnancy (exercise management, dietary management, self-monitoring regulation, and management objectives). About 17.5% of pregnant women exhibited depressive symptoms. The mean score on dietary management was upper-middle, exercise management and self-monitoring regulation were medium, and management objectives were lower-middle. Multivariable linear regression analysis revealed that pregnant women with depressive symptoms had lower levels of exercise management (ß = -1.585, p = 0.005), dietary management (adjusted ß = -0.984, p = 0.002), and management objectives (adjusted ß = -0.726, p = 0.009). However, there was no significant relationship between depressive symptoms and pregnant women's self-monitoring regulating behavior (p > 0.05). The findings indicated the inverse association between depressive symptoms and gestational weight management behaviors. These results offer important indications for pregnancy weight management professionals by highlighting the need for mental health interventions for pregnant women experiencing depressive symptoms.

Analysis of the Weight Management Behavior of Chinese Pregnant Women: An Integration of the Protection Motivation Theory and the Information-Motivation-Behavioral Skills Model.

Inappropriate gestational weight gain has become a public health concern that threatens maternal and child health. Pregnant women's ability to manage their weight during pregnancy directly impacts their weight gain. In this study, we integrated the protection motivation theory and the information-motivation-behavioral skills model to develop an integrative theoretical model suitable for pregnancy weight management and reveal significant explainable factors of weight management behaviors during pregnancy. Based on a cross-sectional survey of 550 pregnant women from Jiangsu province, we came up with our findings. The results showed that several factors influenced pregnancy weight management behavior. According to the research, information, self-efficacy, response costs, and behavioral skills were significantly associated with weight management behaviors during pregnancy, while behavioral skills were also significant mediators of information, self-efficacy, and behavior. Furthermore, the information related to pregnancy weight management had the biggest impact on weight management behavior during pregnancy. The results of the model fit were acceptable and the integrative model could explain 30.6% of the variance of weight management behavior during pregnancy, which implies that the integrative theoretical model can effectively explain and predict weight management behaviors during pregnancy. Our study provides practical implications for the integrative model in improving pregnancy weight management behavior and offers a theoretical base for the weight management of pregnant women.

Behaviour model integrated by protection motivation theory and information-motivation-behavioural skills model applying in pregnancy weight management (PrInMAMa): a study protocol for a randomised controlled trial in China.

INTRODUCTION: Excessive gestational weight gain poses a significant threat to maternal and child health. The healthy behaviour theory has been increasingly applied to weight management during pregnancy, but research is still insufficient. The successful application of the protection motivation theory (PMT) and the information-motivation-behavioural skills (IMB) model in the field of healthy behaviour laid the foundation for this intervention study. The overall aim of this study is to test the effectiveness of interventions based on the behaviour model integrated with the PMT and IMB model (PMT-IMB model) on weight management and provide feasible methods for weight management during pregnancy. METHODS AND ANALYSIS: This prospective, single-centre, randomised controlled trial involves two steps. First, based on the PMT-IMB model, evaluation tools and intervention materials will be developed. Second, more than 800 women in the first trimester of pregnancy will be randomly assigned to two groups and will be followed until 1 week after delivery. The control group will receive standardised antenatal care (ANC), whereas the experimental group will receive both standardised ANC and interventions based on the PMT-IMB model. After three surveys (at enrolment, at 28 weeks of gestation, and on the day of hospitalisation for delivery), primary outcomes (scores of the subscales of the PMT-IMB model, scores of the pregnancy weight management strategy scale, and gestational weight gain) and secondary outcomes (pregnancy outcomes and pregnancy complications) will be obtained. Differences in outcomes between the two groups will be analysed to evaluate the effectiveness of the intervention. ETHICS AND DISSEMINATION: The study protocol has been approved by the ethics committee of Nanjing Medical University. All participants will sign an informed consent form prior to enrolment. The findings of the study will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: ChiCTR2100043231.

[Temporal-spatial distribution and ecological evaluation of macroinvertebrate functional feeding groups in Yongding River Basin]. / æ°¸å®šæ²³æµåŸŸå¤§åž‹åº•æ –åŠ¨ç‰©åŠŸèƒ½æ‘„é£Ÿç±»ç¾¤æ—¶ç©ºåˆ†å¸ƒåŠç”Ÿæ€è¯„ä»·.

We investigated community structure of macroinvertebrate, water environment factors, hydrological factors at 23 sampling sites of the Yongding River basin from spring 2017 (April) to autumn 2017 (November). We analyzed the composition, spatial and temporal distribution of the macroinvertebrate functional feeding groups, as well as their responses to changes in riverine habitat. A total of 78 macroinvertebrate species were identified, with 52, 50 and 53 macroinvertebrate species in spring, summer and autumn respectively. The dominant functional feeding groups were gather-collectors, followed by predators, while the proportion of scrapers, filter-collectors and shredders were extremely low. Dominant species in the three seasons were all gather-collectors, including Orthocladius, Rheotanytarsus, Cricotopus in spring, Glyptotendipes in summer, and Polypedilum, Chironomus, Orthocladius in autumn. Results of redundancy analysis showed that the functional feeding groups of macroinvertebrate community structure were mainly influenced by water temperature, flow velocity, salinity, and total phosphorus in spring, by total phosphorus, dissolved oxygen, conductivity and flow capacity in summer, and by total phosphorus and dissolved oxygen in autumn. Total phosphorus had positive correlation with gather-collectors in all three seasons, indicating that the functional feeding groups of macroinvertebrates were affected by water pollution. The evaluation based on the metrics of functional feeding groups showed that: 1) in terms of material cycle, primary productivity of Guishui River were significantly higher than other regions, and that in autumn were significantly higher than other seasons. The secondary productivity and decomposition capacity of Yanghe River were significantly higher than other regions, and those in spring were significantly higher than other seasons. The autotrophy/heterotrophy of Yanghe River was significantly lower than other regions, and that in spring were significantly higher than other seasons. 2) The longitudinal transport capacity of Sanggan River was significantly higher than other regions, and that in autumn was significantly higher than other seasons. 3) The lateral input capacity of Guishui River was significantly higher than other regions, and that in summer was significantly higher than other seasons.

Determinants of physicians' online medical services uptake: a cross-sectional study applying social ecosystem theory.

OBJECTIVE: To investigate the determinants of willingness and practice of physicians' online medical services (OMS) uptake based on social ecosystem theory, so as to formulate OMS development strategies. DESIGN: Cross-sectional survey. SETTING: Research was conducted in two comprehensive hospitals and two community hospitals in Jiangsu, China, and the data were gathered from 1 June to 31 June 2020. PARTICIPANTS: With multistage sampling, 707 physicians were enrolled in this study. OUTCOME MEASURE: Descriptive statistics were reported for the basic characteristics. χ2 test, Mann-Whitney U test and Spearman's correlation analysis were used to perform univariate analysis. Linear regression and logistic regression were employed to examine the determinants of physicians' OMS uptake willingness and actual uptake, respectively. RESULTS: The mean score of the physicians' OMS uptake willingness was 17.33 (range 5-25), with an SD of 4.39, and 53.3% of them reported having conducted OMS. In the micro system, factors positively associated with willingness included holding administrative positions (b=1.03, p<0.05), OMS-related awareness (b=1.32, p<0.001) and OMS-related skills (b=4.88, p<0.001); the determinants of actual uptake included holding administrative positions (OR=2.89, 95% CI 1.59 to 5.28, p<0.01), OMS-related awareness (OR=1.90, 95% CI 1.22 to 2.96, p<0.01), OMS-related skills (OR=2.25, 95% CI 1.35 to 3.74, p<0.01) and working years (OR=2.44, 95% CI 1.66 to 3.59, p<0.001). In the meso system, the hospital's incentive mechanisms (b=0.78, p<0.05) were correlated with willingness; hospital advocated for OMS (OR=2.34, 95% CI 1.21 to 4.52, p<0.05), colleagues' experiences (OR=3.81, 95% CI 2.25 to 6.45, p<0.001) and patients' consultations (OR=2.93, 95% CI 2.02 to 4.25, p<0.001) were determinants of actual uptake. In the macro system, laws and policies were correlated with willingness (b=0.73, p<0.05) and actual uptake (OR=1.98, 95% CI 1.31 to 2.99, p<0.01); media orientation was also associated with willingness (b=0.74, p<0.05). CONCLUSION: Multiple determinants influence physicians' OMS application. Comprehensive OMS promotion strategies should be put forward from multidimensional perspectives including the micro, meso and macro levels.

Vaccine Acceptance and Its Influencing Factors: An Online Cross-Sectional Study among International College Students Studying in China.

BACKGROUND: With the continuous large-scale development of the COVID-19 vaccine, the acceptance of vaccination and its influencing factors at the individual level have become crucial to stemming the pandemic. This study aims to explore the factors that influence the acceptance of the COVID-19 vaccine among international college students. METHODS: The target population constituted international students pursuing various degrees in Jiangsu Province through an online cross-sectional study. A cluster random sampling was performed using a self-administered questionnaire. The Health Belief Model and Knowledge, Attitude/Beliefs, and Practice Theory served as the underlying theories to understanding the factors that influence vaccine acceptance. RESULTS: We received 330 responses. About 36.4% intended to accept the vaccine. The acceptance varied across respondents' place of residence, program of study, continent of origin, knowledge, susceptibility, severity, benefits, and cues to action (p < 0.05). A multivariable logistics regression revealed cues to action (p < 0.001), the perception of COVID-19 vaccination benefits (p = 0.002), and the perception of barriers (p < 0.001) that were associated with vaccine acceptance. CONCLUSIONS: The acceptance of the COVID-19 vaccine was low among international students. The correct and comprehensive beliefs of the target groups regarding the benefits and barriers of the vaccination must be raised. Various effective social strategies must be adopted to trigger the intention of COVID-19 vaccination. The study findings will inform the decisions of public health campaigners, aimed at reducing vaccine hesitation when the COVID-19 vaccine is widely available.

Online medical services utilization evaluated through the lens of socioecological theory and the information-motivation-behavioral skills model: evidence from China.

Online medical services (OMS) have become increasingly advantageous, but there are still several barriers to utilization among patients. This study aims to explore the factors influencing OMS utilization (OMSU) for patients in micro-, meso-, and macrosystems based on socioecological theory (SET) and from the perspective of the information-motivation-behavioral skills (IMB) model. We selected 1065 participants through multistage stratified cluster random sampling in Jiangsu, China. In microsystems, information and behavioral skills were positively associated with intention (ß = 0.84; ß = 3.21) and actual utilization (OR = 1.69; OR = 1.69). Education level (ß = 0.83) and personal motivation (ß = 1.68) were positively related to intention. Chronic diseases (OR = 2.03) had a positive relationship with actual use. In mesosystems, recommendations from people around the patients (ß = 1.14; OR = 1.99), provision of OMS in the nearest primary medical facility (ß = 0.98; OR = 3.60), and provision of instructional information by medical institutions (ß = 1.01; OR = 1.65) were related to OMSU. The average monthly household income (ß = 0.54) was related to intention. Patients who had information about the OMSU experiences of people around them (OR = 1.73) correlated with actual utilization. In macrosystems, the social medical insurance type (OR = 0.66) was associated with OMSU. This study supports the applicability of the SET and IMB model to interpret patients' OMSU.

[Review of traditional Chinese medicine external applications to treat chemistry phlebitis].

This article reviewed the literatures in this area over the past 5 years according to three parts: simple traditional Chinese medicine external application, combination of traditional Chinese medicine and Western medicine, combination of traditional Chinese medicine and physical therapy, and came to several effective prescriptions.