End-of-Life Communication Skills Training for Undergraduate Nursing Students to Address Cultural Obstacles in China.

Nurses face many difficulties and challenges related to how patients and their families deal with communication about end-of-life (EOL) care in China because of the strong influence of traditional Chinese culture. Moreover, education and training opportunities in EOL communication skills for nursing students are rare in mainland China. This study designed a progressive case involving a common EOL communication dilemma related to traditional Chinese culture and trained 50 undergraduate nursing students in EOL communication skills. A quasi-experimental design was used to compare the training outcomes of nursing students who were divided into a standardized patient simulation group and a role-playing group. The role-playing group (23 participants) was trained via group case discussion and role-playing among classmates, while the standardized patient simulation group (27 participants) completed EOL communication training by interacting with standardized patients and their families in a high-fidelity simulation. Attitudes toward death, self-confidence in EOL communication, and communication learning were evaluated in both groups during preintervention and postintervention. The results showed that all 3 variables improved after the intervention. This study shows that EOL communication skills training has a positive effect on nursing students to a certain extent.

Validity and Reliability of the Parental Health Literacy Questionnaire for Caregivers of Children Aged 0 to 3 Years in China.

Caregivers' health literacy plays a vital role in the quality of parenting and significantly impacts children's physical and psychological health. However, the instruments to assess the health literacy of caregivers of children aged 0 to 3 years are lacking. This study aimed to evaluate the reliability and validity of the Chinese Parental Health Literacy Questionnaire (CPHLQ) in China. We conducted a cross-sectional study. Six hundred and thirty-four caregivers of children aged 0 to 3 years were recruited from Shandong, Yunnan, and Shaanxi Provinces, representing the eastern, central, and western regions of China, between November 2020 and January 2021. The reliability was evaluated by internal consistency reliability and split-half reliability. The construct validity was determined by confirmatory factor analysis. Social determinants of parental health literacy were assessed by multivariate linear regression model. Results showed that CPHLQ had satisfactory reliability and acceptable construct validity. Mothers compared to other types of caregivers, higher education levels, and nuclear or extended families compared to other family compositions were significantly associated with higher parental health literacy. The study further demonstrated that CPHLQ is a reliable and valid instrument to measure the health literacy of caregivers of children aged 0 to 3 years in the Chinese population. It can be used as an evaluation tool for intervention research, to inform policy-making and future health education interventions of improving caregivers' health literacy.

Urine metals concentrations and dyslexia among children in China.

BACKGROUND: Exposures to heavy metals has been linked to many developmental disorders. However, few studies have investigated the effects of exposure and co-exposure to metals on dyslexia, especially with regard to dyslexics in China. OBJECTIVES: To investigate the association between urine metal concentrations and dyslexia in a case-control study among children in China. METHODS: A case-control study was conducted in the Tongji Reading Environment and Dyslexia (READ) research program. A total of 228 dyslexics and 228 controls were matched on gender, age (within one year), and grade. The concentrations of 21 urine metals were measured by an inductively coupled plasma-mass spectrometer (ICP-MS). Multivariable conditional logistic regression models were applied to estimate the adjusted odds ratios (ORs) of Chinese dyslexia. RESULTS: After adjusting for potential confounders, two metals (selenium and argentum) were significantly associated with dyslexia in single-metal multivariable models. Argentum was positively associated with the risk of dyslexia, while selenium was negatively associated. In the multiple-metal model, compared with extreme quartiles, the ORs (95% CIs) for selenium was 0.36 (95% CI: 0.14-0.93; Ptrend = 0.029). In the joint association analysis, children with higher levels of urine argentum and lower level of urine selenium had a significantly higher risk of dyslexia than those with low levels of argentum and selenium (OR = 5.06, 95% CI: 1.67-18.84). CONCLUSIONS: The findings suggest that exposure to selenium and argentum may relate to dyslexia in China. Longitudinal studies are needed to further evaluate these relationships and investigate potential mechanisms.

Association of health-risk behaviors and depressive symptoms and anxiety symptoms: a school-based sample of Chinese adolescents.

Background Depressive symptoms and anxiety symptoms of adolescents not only affect youth but also have wide-ranging impacts on the health of adults. The study was carried out to determine the epidemiological characteristics of depressive symptoms and anxiety symptoms and the associations between the two and health-risk behaviors in Chinese adolescents. Methods Participants were recruited from the junior and senior high schools in China. Data were collected by self-designed questionnaires. The questionnaires included questions about demographic characteristics, depressive symptom scales, anxiety symptom scales and nine categories of health-risk behaviors. Descriptive analysis and binary logistic regression were performed by SPSS 21.0 software. Results There were 4.4% of the participants with depressive symptoms. Approximately 32.0% of the participants had anxiety symptoms. Girls and general senior school students were risk factors for depressive symptoms and anxiety symptoms. Multiple health-risk behaviors were associated with depressive symptoms and anxiety symptoms in Chinese adolescents. Conclusion Depressive symptoms and anxiety symptoms were prevalent in Chinese adolescents. Their distribution was affected by certain health-risk behaviors. Multiple health-risk behaviors were associated with depressive symptoms and anxiety symptoms in Chinese adolescents.

Dyslexia associated functional variants in Europeans are not associated with dyslexia in Chinese.

Genome-wide association studies (GWAS) of developmental dyslexia (DD) often used European samples and identified only a handful associations with moderate or weak effects. This study aims to identify DD functional variants by integrating the GWAS associations with tissue-specific functional data and test the variants in a Chinese DD study cohort named READ. We colocalized associations from nine DD related GWAS with expression quantitative trait loci (eQTL) derived from brain tissues and identified two eSNPs rs349045 and rs201605. Both eSNPs had supportive evidence of chromatin interactions observed in human hippocampus tissues and their respective target genes ZNF45 and DNAH9 both had lower expression in brain tissues in schizophrenia patients than controls. In contrast, an eSNP rs4234898 previously identified based on eQTL from the lymphoblastic cell lines of dyslexic children had no chromatin interaction with its target gene SLC2A3 in hippocampus tissues and SLC2A3 expressed higher in the schizophrenia patients than controls. We genotyped the three eSNPs in the READ cohort of 372 cases and 354 controls and discovered only weak associations in rs201605 and rs4234898 with three DD symptoms (p < .05). The lack of associations could be due to low power in READ but could also implicate different etiology of DD in Chinese.

The role of depressive symptoms, anxiety symptoms, and school functioning in the association between peer victimization and internet addiction: A moderated mediation model.

BACKGROUND: Both peer victimization and internet addiction are common public health problems for children and adolescents. Several studies found an association between peer victimization and internet addiction, but the mechanism underlying this association remained unclear. This study aimed to determine the mechanisms underlying this association. METHODS: Data was extracted from an epidemiologic study involving middle and high school adolescents, in which 15,415 individuals (14.6 ±â€¯1.7 years) were recruited. The moderated mediation models were examined using SPSS PROCESS macro 2.16 software, in which the mediation variables were depressive symptoms and anxiety symptoms, and the moderation variable was school functioning. RESULTS: The total indirect effect of verbal victimization on internet addiction through depressive symptoms and anxiety symptoms was found to be 0.4531, which accounted for 63.7% of the total effect of verbal victimization on internet addiction. Depressive symptoms and anxiety symptoms totally mediated the association between relational victimization and internet addiction and the association between the physical victimization and internet addiction. There were gender differences in the mediating effects of depressive and anxiety symptoms on the association between peer victimization and internet addiction. The indirect effect of the three different types of peer victimization (physical, verbal, relational) on internet addiction became stronger as school functioning increased. LIMITATIONS: We included two mediators in one model, and the data used in this study was self-reported and cross-sectional. CONCLUSIONS: Depressive symptoms and anxiety symptoms mediate the association between peer victimization and internet addiction. Students who score higher in school functioning were more likely to develop internet addiction when they encounter peer victimization.

Polymorphisms of Ionotropic Glutamate Receptor-Related Genes and the Risk of Autism Spectrum Disorder in a Chinese Population.

OBJECTIVE: To evaluate the association of GRIK2 and NLGN1 with autism spectrum disorder in a Chinese population. METHODS: We performed spatio-temporal expression analysis of GRIK2 and NLGN1 in the developing prefrontal cortex, and examined the expression of the genes in ASD cases and healthy controls using the GSE38322 data set. Following, we performed a case-control study in a Chinese population. RESULTS: The analysis using the publicly available expression data showed that GRIK2 and NLGN1 may have a role in the development of human brain and contribute to the risk of ASD. Later genetic analysis in the Chinese population showed that the GRIK2 rs6922753 for the T allele, TC genotype and dominant model played a significant protective role in ASD susceptibility (respectively: OR=0.840, p=0.023; OR=0.802, p=0.038; OR=0.791, p=0.020). The NLGN1 rs9855544 for the G allele and GG genotype played a significant protective role in ASD susceptibility (respectively: OR=0.844, p=0.019; OR=0.717, p=0.022). After adjusting p values, the statistical significance was lost (p>0.05). CONCLUSION: Our results suggested that GRIK2 rs6922753 and NLGN1 rs9855544 might not confer susceptibility to ASD in the Chinese population.

Validity and Reliability of the Dyslexia Checklist for Chinese Children.

The study on developmental dyslexia (DD) has fairly matured in the past decades, even when there is a lack of a standardized and convenient instrument for dyslexia in the Chinese population. The purpose of this study was to assess the reliability and validity of the Dyslexia Checklist for Chinese Children (DCCC), which was administered to Chinese students in primary school. A total of 545 students from grades 2 through 6 were recruited in Wuhan to participate in this study. We used confirmatory factor analysis (CFA) to evaluate the structure validity of the DCCC. Concurrent validity was determined via correlations between the DCCC and the verbal comprehension index (VCI), and Chinese achievement. The reliability of the DCCC was assessed via test-retest reliability and internal consistency. The CFA suggested that the first order model with eight factors and 55 items fit the data well (RMSEA = 0.057, CFI = 0.930, and TLI = 0.925). The DCCC was negatively associated with VCI (r = -0.218) and Chinese achievement (r = -0.372). The test-retest reliability of the DCCC was 0.734, and the internal consistency of all subscales was above 0.752. The DCCC thus proved to have adequate validity and reliability to screen Chinese dyslexia among students in grades 2 through 6.

Development of Orthographic Awareness, Morphological Awareness and Rapid Automatized Naming of Elementary-level Students in China: A Longitudinal Analysis from Grades 1 to 4.

The longitudinal study sought to examine the dynamic development of cognitive skills for reading among elementary-level students in Mainland China. Two groups of students in first (n=164, mean age=6.65 years at first test) and second grade (n=202, mean age=7.73 years at first test) were followed on orthographic awareness, morphological awareness and rapid automatized naming (RAN) for two years. The children exhibited significant improvement in orthographic awareness, morphological awareness and RAN from grades 1 to 4. More importantly, to the orthographic and morphological awareness, while the children took a leap from grade 1 to 2 and grade 3 to 4, the progress developed at relatively slow rates from grade 2 to 3. In order to assure children's development of orthographic and morphological awareness, evidence-based orthographically and morphologically enhanced instruction is needed for Chinese children in the early elementary years, especially for those at the stage from grade 2 to 3.

Genetic variants in the CNTNAP2 gene are associated with gender differences among dyslexic children in China.

BACKGROUND: It is well known that males have a higher prevalence of developmental dyslexia (DD) than females. Although the mechanism underlying this gender difference remains unknown, the contactin-associated protein-like 2 (CNTNAP2) gene, which shows sex-specific patterns in some neurodevelopmental disorders, has attracted extensive attention. This study aimed to explore whether CNTNAP2 shows a sex-specific association with DD in a Chinese population. METHODS: Using genomic DNA samples of 726 students [372 cases (282 male, 90 female), 354 controls (267 male, 87 female)], we genotyped five SNPs of CNTNAP2. Gender-stratified logistic regression models were used to determine the relationships between the CNTNAP2 variants and DD. FINDINGS: After adjustment for the false discovery rate (FDR), two SNPs (rs3779031, rs987456) of CNTNAP2 were associated with DD risk in females but not in males. Female participants carrying the rs3779031 G allele had a lower risk of DD than those with the A genotype [GG vs AA: OR (95%CI) = 0.281 (0.097-0.814)]. The rs987456 CC genotype was associated with a decreased risk of DD in females [CC vs AA+CA: OR (95%CI) = 0.222 (0.078-0.628)]. Furthermore, the interaction between CNTNAP2 (rs987456) and environmental factors (scheduled reading time) played a protective role in females [OR (95%CI) = 0.431 (0.188-0.987)]. INTERPRETATION: We performed a genetic association study on CNTNAP2 variants and DD. The sex specificity of CNTNAP2 in DD, along with the gene-environment interaction may help us to understand gender differences in DD.

Pathways linking socioeconomic status to small-for-gestational-age (SGA) infants among primiparae: a birth cohort study in China.

OBJECTIVES: Evidence about the relationship between socioeconomic status (SES) and small-for-gestational-age (SGA) infants was insufficient among Chinese primiparae. In addition, factors that may mediate this relationship are poorly understood. The purpose of this study was to investigate the risk of and mediators between SES and SGA. DESIGN: Retrospective cohort study. SETTING: Wuhan, Hubei, China. METHOD: Participants were recruited from patients who gave birth in the maternity care hospital of Wuhan between September 2012 and October 2014. Logistic regression models were used to estimate the association between SES and SGA. Pathway analysis was performed to examine the contribution of maternal lifestyles and pregnancy-induced hypertension syndrome (PIH) to the relationship between SES and SGA. Total effect, direct effect and indirect effect of SES on SGA were measured. Effect sizes were evaluated by unstandardised estimates (B) and standardised estimates (ß). RESULTS: Among 8737 primiparae, 927 (10.61%) pregnant women had babies with SGA. High SES was inversely associated with risk of SGA (OR 0.856; 95% CI 0.737 to 0.995) after adjustment for potential confounders. Maternal obstetric characteristics, lifestyles and PIH completely mediated SES and SGA (indirect effect: B=-0.067, 95% CI -0.108 to -0.026). The indirect effect of SES was strengthened by PIH (B=-0.029), a multivitamin supplement (B=-0.021), prepregnancy body mass index (BMI) ≥18.50 (B=-0.009) and prepregnancy BMI ≥18.50 to gestational weight gain (GWG) not below the Institute of Medicine (IOM) recommendations (B=-0.003). CONCLUSIONS: Women from high SES predicted lower risk of PIH, more chances to take a multivitamin supplement during early pregnancy, keeping prepregnancy BMI ≥18.50 kg/cm2 and gaining adequate gestational weight which was not below IOM recommendations. Furthermore, lower risk of PIH, more chances to take a multivitamin supplement, prepregnancy BMI ≥18.50 kg/cm2 and GWG not below IOM recommendations were associated with a lower risk of SGA infants.

Neurexin gene family variants as risk factors for autism spectrum disorder.

Increasing evidence suggests that abnormal synaptic function leads to neuronal developmental disorders and is an important component of the etiology of autism spectrum disorder (ASD). Neurexins are presynaptic cell-adhesion molecules that affect the function of synapses and mediate the conduction of nerve signals. Thus, neurexins are attractive candidate genes for autism. Since gene families have greater power to reveal genetic association than single genes, we designed this case-control study to investigate six genetic variants in three neurexin genes (NRXN1, NRXN2, and NRXN3) in a Chinese population including 529 ASD patients and 1,923 healthy controls. We found that two SNPs were significantly associated with ASD after false discovery rate (FDR) adjustment for multiple comparisons. The NRXN2 rs12273892 polymorphism T allele and AT genotype were significantly associated with increased risk of ASD (respectively: OR = 1.328, 95% CI = 1.133-1.557, P < 0.001; OR = 1.528; 95% CI = 1.249-1.868, P < 0.001). The dominant model showed the same association (OR = 1.495, 95% CI = 1.231-1.816, P < 0.001). The NRXN3 rs12879016 polymorphism played a significant role in ASD susceptibility under the dominant model (OR = 0.747, 95% CI= 0.615-0.908, P = 0.023), with the same trend detected for the G allele and GT genotype (respectively: OR = 0.811, 95% CI = 0.699-0.941, P = 0.036; OR = 0.755, 95% CI = 0.615-0.928, P = 0.035). In conclusion, this study supports the importance of two genetic variants in the neurexin gene family in ASD susceptibility in China. Autism Res 2018, 11: 37-43. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is highly heritable, and studies have found a number of candidate genes that might contribute to ASD. Neurexins are presynaptic cell-adhesion molecules that affect the function of synapses and mediate the conduction of nerve signals, and they play an important role in normal brain development and become candidate genes for autism. The purpose of our study is to explore the association between variants of the neurexins gene family and ASD in a Chinese population through a case-control study.

A gradient relationship between low birth weight and IQ: A meta-analysis.

Multiple studies have reported that individuals with low birth weights (LBW, <2500 g) have a lower intelligence quotient (IQ) than those with normal birth weights (NBW, ≥2500 g). Based on 57 eligible individual studies including 12,137 participants, we performed a meta-analysis to estimate the association between low birth weight and individuals' IQ scores (IQs). The pooled weight mean difference (WMD) in IQs between NBW and LBW individuals was 10 (95% CI 9.26-11.68). The WMD was stable regardless of age. No publication bias was detected. The mean IQs of the extremely low birth weight (ELBW, <1000 g), very low birth weight (VLBW, 1000-1499 g), moderately low birth weight (MLBW, 1500-2499 g) and NBW individuals were 91, 94, 99 and 104, respectively. Additionally, the WMD in IQs with NBW were 14, 10 and 7 for ELBW, VLBW, and MLBW individuals, respectively. Two studies permitted estimates of the influence of social determinants of health to the discrepancy in IQs, which was 13%. Since IQ is inherited and influenced by environmental factors, parental IQs and other factors contribute to residual confounding of the results. As the conclusion was based on population studies, it may not be applicable to a single individual.