Adenine base editor-mediated splicing remodeling activates noncanonical splice sites.

Adenine base editors (ABEs) are genome-editing tools that have been harnessed to introduce precise A•T to G•C conversion. The discovery of split genes revealed that all introns contain two highly conserved dinucleotides, canonical "AG" (acceptor) and "GT" (donor) splice sites. ABE can directly edit splice acceptor sites of the adenine (A) base, leading to aberrant gene splicing, which may be further adopted to remodel splicing. However, spliced isoforms triggered with ABE have not been well explored. To address it, we initially generated a cell line harboring C-terminal enhanced GFP (eGFP)-tagged ß-actin (ACTB), in which the eGFP signal can track endogenous ß-actin expression. Expectedly, after the editing of splice acceptor sites, we observed a dramatical decrease in the percentage of eGFP-positive cells and generation of splicing products with the noncanonical splice site. Furthermore, we manipulated Peroxidasin in mouse embryos with ABE, in which a noncanonical acceptor was activated to remodel splicing, successfully generating a mouse disease model of anophthalmia and severely malformed microphthalmia. Collectively, we demonstrate that ABE-mediated splicing remodeling can activate a noncanonical acceptor to manipulate human and mouse genomes, which will facilitate the investigation of basic and translational medicine studies.

The domestic elder abuse in China: Scale development and psychometric properties.

An effective screening tool is essential to elder abuse research. Although several instruments have been developed in China to measure elder abuse, they present several limitations. The instrument development involved three components: (1) generating questionnaire items; (2) questionnaire testing and data collection in older adults; and (3) psychometric evaluation of the Domestic Elder Abuse Scale (DEAS). We collected questionnaire responses from 3725 community-dwelling Chinese older adults. The 26-item DEAS showed good reliability and validity across five dimensions: physical abuse, psychological abuse, financial exploitation, neglect, and abandonment. These five factors accounted for 78.432 % of the total variance, and model fitting results were acceptable. The Cronbach's alpha coefficient of the scale was 0.975, and the test-retest intraclass correlation coefficient (ICC) was 0.934 after 2 weeks. This study developed a five-dimension instrument to measure elder abuse, with good psychometric properties, which can play an essential role in community-based studies in China.

Best-corrected visual acuity results facilitate molecular diagnosis of infantile nystagmus patients harboring FRMD7 mutations.

The visual function of patients with infantile nystagmus (IN) can be significantly decreased owing to constant eye movement. While, reaching a definitive diagnosis becomes a challenge due to genetic heterozygous of this disease. To address it, we investigated whether best-corrected visual acuity (BCVA) results can facilitate the molecular diagnosis of IN patients harboring FRMD7 mutations. 200 patients with IN from 55 families and 133 sporadic cases were enrolled. Mutations were comprehensively screened by direct sequencing using gene-specific primers for FRMD7. We also retrieved related literature to verify the results based on our data. We found that the BCVA of patients with IN harboring FRMD7 mutations was between 0.5 and 0.7, which was confirmed by data retrieved from the literature. Our results showed that BCVA results facilitate the molecular diagnosis of patients with IN harboring FRMD7 mutations. In addition, we identified 31 FRMD7 mutations from the patients, including six novel mutations, namely, frameshift mutation c.1492_1493insT (p.Y498LfsTer14), splice-site mutation c.353C > G, three missense mutations [c.208C > G (p.P70A), c.234G > A (p.M78I), and c.1109G > A (p.H370R)], and nonsense mutation c.1195G > T (p.E399Ter). This study demonstrates that BCVA results may facilitate the molecular diagnosis of IN patients harboring FRMD7 mutations.

Longitudinal relationships among career adaptability, resilience, and career commitment in chinese nursing undergraduates: testing differences in career interest between cross-lagged models.

PURPOSE: Various physiological and psychological negative situations experienced by nurses as a result of COVID-19 pandemic have been shown to increase their perception of organizational difficulty and decrease their career commitment, thereby accelerating the turnover rate of nurses. Resilience and career adaptability have important influences on career commitment, so there is a need to evaluate the relationships between them and the underlying mechanisms. PATIENTS AND METHODS: Using a cross-lagged design, the Career Adaptability Scale, the Chinese version of career commitment, and Davidson's Resilience Scale as research methods, we studied 692 nursing students for two consecutive years to evaluate the relationship among career adaptability, resilience, and career commitment. RESULTS: Career adaptability at T1 substantially and positively predicts the career commitment at T2. Career adaptability and resilience are mutually predictive. No interaction is found between resilience and career commitment over time. There is a substantial difference in the cross-lagged relationship among career adaptability, resilience, and career commitment for low- and high-career interest. CONCLUSION: Our results show the importance of developing career commitment early on. Developing career adaptability, enhancing resilience, and increasing career interest in nursing students might help to increase career commitment.

Prevalence and predictors in self-neglect: A cross-sectional study of domestic migrant older adults in China.

Insufficient information is available on the prevalence and predictors of self-neglect among Chinese domestic migrant older adults resulting from rapid aging and mass population migration. This cross-sectional study was conducted on 597 older adults in four districts of Wenzhou from May to November 2020. A self-neglect scale was used to assess the prevalence of self-neglect among such adults. Sixteen potential predictors were considered in the domains of sociodemographic, health condition, socioeconomic, social isolation, intergenerational relationship, and filial piety. The prevalence of self-neglect within this population was 72.7%. Social isolation (OR = 0.823; 95%CI 0.684-0.990), physical health (OR = 0.966; 95%CI 0.941-0.992), intergenerational ambivalence (OR = 1.240; 95%CI 1.013-1.519), and affective-cognitive solidarity (OR = 0.796; 95%CI 0.719-0.880) were found to be independent predictors of self-neglect in this population. We suggest that community health service organizations should prioritize migrant older adults with a poor health status and those with intergenerational ambivalence to reduce self-neglect in migrant older adults. Such older adults should also be encouraged to participate in community activities for more social integration.

Intensive care unit dignified care: Development and validation of a questionnaire.

BACKGROUND: Patient dignity is sometimes neglected in intensive care unit (ICU) settings, which may potentially cause psychological harm to critically ill patients. However, no instrument has been specifically developed to evaluate the behaviors of dignified care among critical care nurses. AIM: This study aimed to develop and evaluate ICU Dignified Care Questionnaire (IDCQ) for measurement of self-assessed dignity-conserving behaviors of critical care nurses during care. METHODS: The instrument was developed in 3 phases. Phase 1: item generation; phase 2: a two-round Delphi survey and a readability pilot study; phase 3: cross-sectional survey with model estimation. The questionnaire was evaluated by item analysis, exploratory and confirmatory factor analysis, assessment of internal consistency reliability, and test-retest reliability. The investigation was conducted using a convenience sample of 392 critical care nurses from 6 cities in Zhejiang Province, China, of which 30 participated in the test-retest reliability survey 2 weeks later. ETHICAL CONSIDERATIONS: The study was approved by ethics committee. All participants provided written informed consent before the survey. The questionnaire survey was anonymous. RESULTS: The results showed acceptable reliability and validity of the IDCQ. The 17-item final version questionnaire was divided into 2 dimensions: absolute dignity and relative dignity. These two factors accounted for 62.804% of the total variance, and model fitting results were acceptable. The Cronbach's alpha coefficient of the questionnaire was 0.94, and the test-retest intraclass correlation coefficient (ICC) was 0.88 after 2 weeks. CONCLUSIONS: This study developed a brief and reliable instrument (IDCQ) to assess dignified care in ICU nursing. It can help critical care nurses identify their behaviors in maintaining patient dignity and discover their deficiencies. It may also serve as a clinical nursing management tool to help reduce patient disrespect experience in ICU.

Individual factors in dignified care: A cross-sectional study of critical care nurses.

AIM: To determine the level of dignified care provided by critical care nurses, and explore the associated individual factors. BACKGROUND: Dignity is a fundamental right of human beings. Critically ill patients are dependent on nurses. Their need for respect and dignity is liable to be neglected in intensive care unit settings. Both critically ill survivors and dying patients suffer mental anguish due to loss of dignity. METHOD: This was a cross-sectional study of 526 critical care nurses working at intensive care units for adults in Zhejiang Province, China. Data were collected from February 2021 to May 2021 using the Intensive Care Unit Dignified Care Questionnaire, Wong and Law Emotional Intelligence Scale, Jefferson Scale of Empathy-Health Professional and Nurses Professional Values Scale-Revised. RESULTS: The total score of dignified care was 67.37 (8.83), with the standard score as 74.07 (12.99). Participants who performed poorly in absolute and relative dignity accounted for 8.4% and 31.2% of the total sample, respectively. Emotional intelligence (ß = .379, p < .001), empathy (ß = .319, p < .001), professional values (ß = .147, p < .001), age (ß = .075, p = .003) and training in dignified care (ß = .074, p = .010) were associated with dignified care, explaining 67.6% of the variance. CONCLUSION: The average level of participants' behaviours of maintaining patient dignity was medium. Critical care nurses need to improve their ability to maintain relative dignity of patients. Emotional intelligence, empathy, professional values, age level and training in dignified care were predictors of dignified care. IMPLICATIONS FOR NURSING MANAGEMENT: Improving emotional intelligence, empathy and professional values of critical care nurses and training them (especially less experienced nurses) will enhance their ability in dignified care. This study provides a novel perspective to help nursing managers develop interventions to promote humanized care in the intensive care unit.

Allometric escape and acoustic signal features facilitate high-frequency communication in an endemic Chinese primate.

The principle of acoustic allometry-the larger the animal, the lower its calls' fundamental frequency-is generally observed across terrestrial mammals. Moreover, according to the Acoustic Adaptation Hypothesis, open habitats favor the propagation of high-frequency calls compared to habitats with complex vegetational structures. We carried out playback experiments in which the calls of the Guizhou snub-nosed monkey (Rhinopithecus brelichi) were used as stimuli in sound attenuation and degradation experiments to test the hypothesis that propagation of Guizhou snub-nosed monkey calls is favored above vs through the forest floor vegetation. We found that low-pitched Guizhou snub-nosed monkey vocalizations suffered less attenuation than its high-pitched calls. Guizhou snub-nosed monkeys were observed emitting high-pitched calls from 1.5 to 5.0 m above the ground. The use of high-pitched calls from these heights coupled with the concomitant behavior of moving about above the understory may provide a signal for receivers which maximizes potential transmission and efficacy. Our results support the Acoustic Adaptation Hypothesis and suggest that by uncoupling its vocal output from its size, this monkey can produce a high-pitched call with a broad spectral bandwidth, thereby increasing both its saliency and the frequency range over which the animal may more effectively communicate in its natural habitat.

Gut microbiota in wild and captive Guizhou snub-nosed monkeys, Rhinopithecus brelichi.

Many colobine species-including the endangered Guizhou snub-nosed monkey (Rhinopithecus brelichi) are difficult to maintain in captivity and frequently exhibit gastrointestinal (GI) problems. GI problems are commonly linked to alterations in the gut microbiota, which lead us to examine the gut microbial communities of wild and captive R. brelichi. We used high-throughput sequencing of the 16S rRNA gene to compare the gut microbiota of wild (N = 7) and captive (N = 8) R. brelichi. Wild monkeys exhibited increased gut microbial diversity based on the Chao1 but not Shannon diversity metric and greater relative abundances of bacteria in the Lachnospiraceae and Ruminococcaceae families. Microbes in these families digest complex plant materials and produce butyrate, a short chain fatty acid critical to colonocyte health. Captive monkeys had greater relative abundances of Prevotella and Bacteroides species, which degrade simple sugars and carbohydrates, like those present in fruits and cornmeal, two staples of the captive R. brelichi diet. Captive monkeys also had a greater abundance of Akkermansia species, a microbe that can thrive in the face of host malnutrition. Taken together, these findings suggest that poor health in captive R. brelichi may be linked to diet and an altered gut microbiota.

Diet Versus Phylogeny: a Comparison of Gut Microbiota in Captive Colobine Monkey Species.

Both diet and host phylogeny shape the gut microbial community, and separating out the effects of these variables can be challenging. In this study, high-throughput sequencing was used to evaluate the impact of diet and phylogeny on the gut microbiota of nine colobine monkey species (N = 64 individuals). Colobines are leaf-eating monkeys that fare poorly in captivity-often exhibiting gastrointestinal (GI) problems. This study included eight Asian colobines (Rhinopithecus brelichi, Rhinopithecus roxellana, Rhinopithecus bieti, Pygathrix nemaeus, Nasalis larvatus, Trachypithecus francoisi, Trachypithecus auratus, and Trachypithecus vetulus) and one African colobine (Colobus guereza). Monkeys were housed at five different captive institutes: Panxi Wildlife Rescue Center (Guizhou, China), Beijing Zoo, Beijing Zoo Breeding Center, Singapore Zoo, and Singapore Zoo Primate Conservation Breeding Center. Captive diets varied widely between institutions, but within an institution, all colobine monkey species were fed nearly identical or identical diets. In addition, four monkey species were present at multiple captive institutes. This allowed us to parse the effects of diet and phylogeny in these captive colobines. Gut microbial communities clustered weakly by host species and strongly by diet, and overall, colobine phylogenetic relationships were not reflected in gut microbiota analyses. Core microbiota analyses also identified several key taxa-including microbes within the Ruminococcaceae and Lachnospiraceae families-that were shared by over 90% of the monkeys in this study. Microbial species within these families include many butyrate producers that are important for GI health. These results highlight the importance of diet in captive colobines.

Developing geriatric nursing micro-credentials for undergraduate nursing students based on training objectives: A modified Delphi study.

BACKGROUND: China's population has begun to age rapidly in the past several years and this trend is predicted to continue. In the face of this growing older population, the existing number of aged care personnel, especially medical care professionals, can hardly meet the demand for aged care services. AIM: To develop geriatric nursing micro-credentials (MCs) for undergraduate nursing students based on standardized training objectives and to specify the learning goals and course modules that correspond to each specific MC. DESIGN: Modified Delphi study. METHODS: An initial set of geriatric nursing MCs were developed based on the training objectives. Expert group discussion (n=13) reviewed the clarity and intelligibility of the statements' wording and supplemented the framework. A three-round Delphi survey (n=15) was then employed to obtain a consensus on the learning goals and course modules via an online questionnaire. Descriptive statistics were used to analyze the data. RESULTS: The final geriatric nursing MCs consisted of six courses, namely fundamentals of geriatric nursing (8 modules), geriatric sociology (6 modules), geriatric clinical nursing (3 modules), geriatric psychological nursing (8 modules), geriatric rehabilitation nursing (8 modules) and geriatric hospice care (10 modules). CONCLUSION: Nursing faculty can use the geriatric nursing MCs developed in this study to train current undergraduate nursing students to become backups for current, fully credentialed geriatric caregivers.

A fuzzy-set qualitative comparative analysis exploration of multiple paths to users' continuous use behavior of diabetes self-management apps.

BACKGROUND: Despite the obvious potential benefits of diabetes self-management apps, users' continuous use of diabetes self-management apps is still not widespread. Influential factors coexisted in information ecologies are likely to have a synthetic effect on users' continuous use behavior. However, it is less clear how factors in information ecologies combine to influence users' continuous use behavior. OBJECTIVE: The objectives of this study are to explore combinations of factors (perceived severity, information quality, service quality, system quality, and social influence) in information ecologies that lead to users' continuous use behavior of diabetes self-management apps and which combination is the most important. METHODS: Purpose sampling was used to recruit diabetes self-management app users from July 1, 2021 to January 31, 2022. Fuzzy-set qualitative comparative analysis (fsQCA) was then employed by conducting necessity and sufficiency analysis. RESULTS: In total 280 diabetes self-management app users participated. The necessity analysis indicated that no single factor was necessary to cause users' continuous use behavior, and the sufficiency analysis identified five different combinations of factors that lead to users' continuous use behavior. Of these five, the combination of high information quality, high service quality, and high social influence was found to be the most important path. CONCLUSIONS: Users' continuous use behavior of diabetes self-management apps results from the synergistic effects of factors in information ecologies. The five paths that directly contribute to users' continuous use, as well as the four user types preliminarily identified in this study may provide a reference for healthcare providers and app developers.

Population genetic structure of Guizhou snub-nosed monkeys (Rhinopithecus brelichi) as inferred from mitochondrial control region sequences, and comparison with R. roxellana and R. bieti.

The Guizhou snub-nosed monkey (Rhinopithecus brelichi) is a primate species endemic to the Wuling Mountains in southern China. With a maximum of 800 wild animals, the species is endangered and one of the rarest Chinese primates. To assess the genetic diversity within R. brelichi and to analyze its genetic population structure, we collected fecal samples from the wild R. brelichi population and sequenced the hypervariable region I of the mitochondrial control region from 141 individuals. We compared our data with those from the two other Chinese snub-nosed species (R. roxellana, R. bieti) and reconstructed their phylogenetic relationships and divergence times. With only five haplotypes and a maximum of 25 polymorphic sites, R. brelichi shows the lowest genetic diversity in terms of haplotype diversity (h), nucleotide diversity (π), and average number of pairwise nucleotide differences (Π). The most recent common ancestor of R. brelichi lived ∼0.36 million years ago (Ma), thus more recently than those of R. roxellana (∼0.91 Ma) and R. bieti (∼1.33 Ma). Phylogenetic analysis and analysis of molecular variance revealed a clear and significant differentiation among the three Chinese snub-nosed monkey species. Population genetic analyses (Tajima's D, Fu's F(s) , and mismatch distribution) suggest a stable population size for R. brelichi. For the other two species, results point in the same direction, but population substructure possibly introduces some ambiguity. Because of the lower genetic variation, the smaller population size and the more restricted distribution, R. brelichi might be more vulnerable to environmental changes or climate oscillations than the other two Chinese snub-nosed monkey species. Am J Phys Anthropol, 2012. © 2011 Wiley Periodicals, Inc.

Effectiveness of apoptotic factors expressed on the wounds of patients with stage III pressure ulcers.

PURPOSE: The purpose of this study was to explore the expression of apoptotic factors in stage III pressure ulcers and explain their effects on wound healing. SUBJECTS AND SETTING: The sample comprised 8 patients with stage III pressure ulcers, along with 4 volunteers with normal skin who were undergoing elective surgical procedures. METHODS: Eight patient tissue specimens from wound of stage III pressure ulcers were obtained from hospitalized patients. Tissue specimens from 4 volunteer patients were obtained during surgery. All 12 tissue specimens were analyzed for presence of apoptosis-related factors including bax/bcl-2 (B-cell lymphoma 2), Fas/fasL (Fas ligand), and terminal deoxynucleotide transferase-mediated dUTP nick end labeling (TUNEL) as well as immunohistochemical analysis with Fas/FasL. RESULTS: Bax positive cells were strongly expressed from surrounding zone to center zone in the specimens obtained from stage III pressure ulcers, and Bcl-2 expression staining decreased contrarily (P < .01). Comparison, apoptotic factors bax positive cell and fas/fasL mRNA expression occurred rarely in tissue specimens from the control group. Fas/fasL mRNA-positive granules were detected in epidermal cells and fibroblasts, demonstrating a progressive increase from the margin of the pressure ulcers progressing toward the center of the wound bed. We also found an increased intensity of TUNEL staining in ulcer center as well as wound margin, compared with control skin tissue. CONCLUSION: These results suggest that molecular regulators of apoptosis are involved in pressure ulcer wound healing. Results also suggest that differences in the expression and distribution of the apoptotic related factors in stage III pressure ulcers play an important role in the delayed wound healing characteristic of these complex wounds.

Developing a professional competence framework for the master of nursing specialist degree program in China: A modified Delphi study.

BACKGROUND: The urgency of ensuring adequate professional competence in clinical nursing practice is evident. However, there is little formal professional competence framework for the education of master's degree students in nursing specialist programs in China. OBJECTIVE: To develop a professional competence framework for the Master of Nursing Specialist (MNS) degree program in China. DESIGN: A modified Delphi study. PARTICIPANTS: An expert panel discussion was held with 12 experts, and Delphi rounds were conducted with 24 experts. METHODS: A literature review and an expert panel discussion were conducted to develop an initial competence framework. A two-round Delphi survey was employed to obtain a consensus on the framework through either an online or paper questionnaire. Descriptive statistics were used to analyze the data. The consensus threshold was set according to the mean (≥ 4.0), coefficient of variation (< 0.25), and consensus level of agreement (≥70 %). RESULTS: A consensus on seven domains and 54 items of the professional framework for the MNS degree program was achieved. The framework domains included clinical practice (12 items), professional attitude (8 items), collaboration and communication (5 items), professional development (8 items), research (7 items), education (7 items), and administration (7 items). CONCLUSION: The professional competence framework offers guidelines for MNS degree programs in China. Future research should focus on imbedding these competences in MNS degree programs to prepare qualified advanced practice nurses.

Patterns of Risky Health Behaviors and Associations With Chronic Diseases Among Young Adult Nursing Students: A Latent Class Analysis.

BACKGROUND: Little is known about how health behaviors cluster to form meaningful patterns that influence health outcomes in young adult nursing students. PURPOSE: The purpose of this study was to identify the unique health behavior patterns among young adult nursing students in China and examine the associations between health behaviors and chronic diseases. METHODS: Using an electronic app, the achievements of an exercise target, sedentary behavior, smoking and drinking, and dietary patterns were assessed in 1,480 nursing student participants aged 18-24 years from two medical universities in Eastern China. RESULTS: A four-class model was developed using latent class analysis that included the "failure to achieve exercise target, alcohol-drinking, and insufficient fruit and vegetable group" (Group 1, n = 187, 12.6%), the "alcohol-drinking and sedentary behavior group" (Group 2, n = 290, 19.6%), the "sedentary behavior only group" (Group 3, n = 721, 48.7%), and the "failure to achieve exercise target only group" (Group 4, n = 282, 19.1%). Logistic regressions indicated that nursing students in Group 2 (odds ratio [ OR ] = 0.42), Group 3 ( OR = 0.51), and Group 4 ( OR = 0.30) were less likely to have chronic diseases than those in Group 1 after adjusting for sociodemographic variables. CONCLUSIONS: The health behaviors were clustered in different patterns among young adult nursing students. Tailoring interventions to specific groups is suggested to improve health outcomes.

Potential effects of virtual interventions for menopause management: a systematic review.

IMPORTANCE: Menopausal women are one of the fastest growing demographic groups globally. Virtual interventions have emerged as alternate avenues for menopausal women to manage and cope with their symptoms. OBJECTIVE: The purpose of this review is to summarize existing research on the potential effects of virtual interventions for menopause management. EVIDENCE REVIEW: This systematic review was written in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, PsychINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsychARTICLES, and Sociology Database were used for literature search and searched from conception to December 2021. Original studies, including randomized controlled trials and quasi-experimental studies, were included if they evaluated a virtual intervention for menopause management and investigated the effects of these interventions on physical and psychosocial outcomes and/or the feasibility of these interventions among menopausal women. Included studies were published in peer-reviewed journals and assessed for quality using the Critical Appraisal Skills Program Checklists. FINDINGS: A total of 16 articles were included in this review. Virtual interventions have the potential to improve physical health outcomes including body weight/body mass index/waist circumference, pain, blood pressure, and cholesterol. However, conflicting results were identified for the outcomes of vasomotor and endocrine symptoms, sleep, and sexual functioning. Virtual interventions might also improve psychosocial outcomes, including knowledge and patient-physician communication, although conflicting results were again identified for treatment decision-making ability, quality of life, and anxiety and depression. Virtual interventions were feasible in terms of being usable and cost-effective, and eliciting satisfaction and compliance among menopausal women. CONCLUSIONS AND RELEVANCE: Virtual interventions might have the potential to improve the physical and psychosocial health outcomes of menopausal women, although some conflicting findings arose. Future studies should focus on including diverse menopausal women and ethnic minorities, conducting research within low- to middle-income countries and communities, further exploring intervention design to incorporate features that are age and culture sensitive, and conducting full randomized controlled trials to evaluate the effects of the interventions.

Dietary Characteristics and Influencing Factors on Chinese Immigrants in Canada and the United States: A Scoping Review.

BACKGROUND: Chinese immigrants are an integral part of Canadian and American society. Chinese immigrants believe diet to be an important aspect of health, and dietary behaviours in this population have been associated with changes in disease risk factors and disease incidence. This review aims to summarize the characteristics of the dietary behaviours of Chinese immigrants and the associated influencing factors to better inform individual, clinical, and policy decisions. METHODS: This scoping review was written in accordance with PRISMA guidelines. MEDLINE, PsychINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsychARTICLES, and Sociology Database were utilized for the literature search. Articles were included if they explored dietary or nutritional intake or its influencing factors for Chinese immigrants to Canada or the United States. RESULTS: A total of 51 papers were included in this review. Among Chinese immigrants in Canada and the United States, the intake of fruits and vegetables, milk and alternatives, and fiber were inadequate against national recommendations. Chinese immigrants showed increased total consumption of food across all food groups and adoption of Western food items. Total caloric intake, meat and alternatives intake, and carbohydrate intake increased with acculturation. Individual factors (demographics, individual preferences, and nutritional awareness), familial factors (familial preferences and values, having young children in the family, and household food environment), and community factors (accessibility and cultural conceptualizations of health and eating) influenced dietary behaviours of Chinese immigrants. DISCUSSION AND CONCLUSION: Efforts should be undertaken to increase fruit, vegetable, and fibre consumption in this population. As dietary acculturation is inevitable, efforts must also be undertaken to ensure that healthy Western foods are adopted. It is important for healthcare providers to remain culturally sensitive when providing dietary recommendations. This can be achieved through encouragement of healthy ethnocultural foods and acknowledgement and incorporation of traditional health beliefs and values into Western evidence-based principles where possible.

Stress and coping styles among nursing students during the initial period of the clinical practicum: A cross-section study.

Objectives: This study aimed to explore the level of stress, types of stressors, type of coping styles, and factors influencing stress levels and coping styles among nursing students during the initial period of the clinical practicum. Methods: A cross-sectional survey design was used. In September 2017, participants were recruited from a tertiary hospital in Zhejiang Province, China, using a convenience sampling method. A demographic characteristics questionnaire, the Intern Nursing Student Stressor Scale, and the Simple Coping Style Questionnaire were used to collect data. Data were analyzed using descriptive analysis, independent sample t-tests, one-way analysis of variance, Pearson's correlation analysis, and multiple linear regression analysis. Results: A total of 158 nursing students were recruited, most of whom were female, undergraduates, and from rural areas. The nursing students perceived a moderate level of stress during the initial period of the clinical practicum. The need for knowledge and skills was the most common source of stress. Positive coping styles were most commonly adopted. Nursing students who were undergraduates, only children, and chose nursing major involuntarily experienced higher stress levels than those who were junior college students, not only children, and chose nursing major voluntarily. Nursing undergraduates were more likely to use positive coping styles than junior college students. Male nursing students and those experiencing higher stress levels related to the "environment and equipment of the wards" and the "nature and content of the work" were more likely to use negative coping styles. Conclusion: Nursing educators should offer targeted guidance based on the stress reported during the clinical practicum and the demographic characteristics of the nursing students. Guidance should be provided to encourage nursing students to adopt effective coping strategies and reduce stress.