Psychometric properties of the Chinese version of the Cognitive Reserve Assessment Scale in Health in patients with cancer.

BACKGROUND: Cognitive reserve is a modifiable factor that could prevent cognitive decline in patients with cancer. The Cognitive Reserve Assessment Scale in Health (CRASH) is an instrument used to assess cognitive reserve. This study aims to develop and examine the psychometric properties of the Chinese version of the CRASH for patients with cancer. METHODS: A cross-sectional survey was conducted with 167 cancer patients from four wards of two hospitals in China. Thirty-one patients were re-assessed to examine the test-retest reliability. Four translators and three reviewers developed the Chinese version of the scale. We assessed its structural validity, concurrent validity, internal consistency, test-retest reliability, measurement error, and floor/ceiling effects. RESULTS: Confirmatory factor analysis showed a good model fit with the four-factor structure of the original CRASH. The CRASH scores were statistically significantly associated with neuropsychological test scores, indicating sufficient concurrent validity. The internal consistency was acceptable, except for leisure activities, with standardized Cronbach's alphas (0.64-0.94) and standardized Omega (0.66-0.95). There was excellent test-retest reliability, with a high intraclass correlation coefficient (0.914-0.993) of total scores and scores for each domain. The measurement error was acceptable, and no floor or ceiling effects were observed. CONCLUSIONS: The Chinese version of the CRASH is a valid and reliable instrument to assess cognitive reserve in patients with cancer. Moreover, cognitive reserve measured by the CRASH was associated with low cognitive performance in cancer patients.

The COVID-19 Pandemic, Racism, and Sleep Among Chinese Immigrants in the United States.

The current study aimed to investigate Chinese immigrants' sleep quality and associations between the coronavirus disease 2019 pandemic's impact and racism and sleep disruption using a cross-sectional online survey. A total of 507 Chinese immigrants were recruited via social network sites. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The pandemic's impact and racism were measured using questions developed for this study. More than 42% of participants reported poor sleep quality. Those who reported having been affected by the pandemic had poorer subjective sleep quality, longer sleep latency, and greater daytime dysfunction. Those who experienced racist incidents were more likely to use sleep medication and exhibit poor subjective sleep quality, long sleep latency, short sleep duration, and daytime dysfunction. Chinese immigrants' sleep health warrants particular consideration by health care professionals. Timely, effective interventions, such as relaxation techniques and online psychoeducation, need to be delivered in the Chinese community. [Journal of Psychosocial Nursing and Mental Health Services, 61(4), 45-51.].

Predictors of Post-traumatic stress symptomology in parents of infants with Congenital Heart Disease post-surgery and after four months.

PURPOSE: To identify predictors of post-traumatic stress symptomology among parents of infants with complex congenital heart defects at hospital discharge and after 4 months. DESIGN & METHODS: A secondary analysis utilizing data from a larger RCT performed in three pediatric cardiac centers in North America. Analysis included 158 parent-infant dyads. Generalized Linear Modeling was used to identify predictors of parental post-traumatic symptomology at hospital discharge, and after 4 months. Considered predictors included demographics/SES, illness, and psychosocial parameters. RESULTS: At discharge, parenting stress, education, and infant's medication number were linked to post-traumatic stress symptomology severity; Parenting stress, education, insurance type, and medications number predicted number of symptoms; Tube-assisted feeding predicted PTSD. At 4 months, parenting stress, ethnicity, and number of ED visits predicted PTSS severity; Parenting stress, ethnicity, and cardiologist visits predicted number of symptoms; Parenting stress, single ventricle physiology, and number of children predicted PTSD. CONCLUSIONS & PRACTICAL IMPLICATIONS: Parental psychosocial factors, additionally to illness and sociodemographic indicators, can potentially risk parents to experience PTSS/PTSD. Nursing and other healthcare professionals can participate in early screening of such factors to determine familial risk. TRIAL REGISTRATION: NCT01941667.

The efficacy and mechanisms of a guided self-help intervention based on mindfulness in patients with breast cancer: A randomized controlled trial.

BACKGROUND: Mindfulness-based interventions (MBIs) can alleviate psychological distress in patients with cancer. However, face-to-face MBIs may be inconvenient for patients. Therefore, guided self-help interventions may be more accessible. The authors investigated the effects of a guided self-help MBI for depression, anxiety, and sleep disorder symptoms in patients with breast cancer and explored the potential underlying mechanisms. METHODS: One hundred forty-four postoperative patients with breast cancer were randomly assigned to an intervention group (6-week guided self-help MBI; n = 72) or a wait-list control group (routine treatment; n = 72). Self-reported depression, anxiety, sleep disorder symptoms, and rumination and worry as potential mediators were assessed at baseline and postintervention. Outcomes were then assessed at 1-month and 3-month follow-up. The intervention's effects over time and the potential mediating effect were analyzed using generalized estimating equations. The trial was registered at the Chinese Clinical Registry (ChiCTR-IOR-16008073). RESULTS: Significant improvements in depression and sleep disorder symptoms occurred in the intervention group compared with wait-list controls, and the improvements were maintained at 1-month and 3-month follow-up. Changes in rumination and worry mediated the intervention's effects on changes in depression and sleep disorder symptoms. CONCLUSIONS: A guided self-help MBI reduced depressive and sleep disorder symptoms by mitigating rumination and worry in patients with breast cancer. These findings support benefits of this accessible psychological intervention in oncology and provide insight into possible mechanisms of action. The current research contributes to discovering effective and widely accessible means for people with physical health conditions and may remove barriers that otherwise would have precluded participation in face-to-face psychological interventions.

Parental Post-traumatic Stress and Healthcare Use in Infants with Complex Cardiac Defects.

OBJECTIVE: To examine the associations between post-traumatic stress of parents of infants with complex congenital heart defects and their healthcare use for their infants during the early months of life. STUDY DESIGN: The current study is a secondary data analysis from a randomized controlled trial in which 216 parent-infant dyads were recruited from 3 cardiac intensive care units of large pediatric centers in Northeastern America. The current sample included 153 dyads with post-traumatic stress data at hospital discharge and at 4-months' follow-up. Poisson regressions were used to estimate the effect of post-traumatic stress change scores on number of emergency department (ED) visits, unscheduled cardiologist visits, and unscheduled pediatrician visits outcomes. RESULTS: Infants whose parents gained post-traumatic stress disorder over the study period were at increased risk for ED visits and unscheduled cardiologist visits. Increased symptom severity predicted more unscheduled cardiologist visits and more unscheduled pediatrician visits. Increased symptom clusters (avoidance, arousal, re-experiencing) predicted more ED visits, more unscheduled cardiologist visits, and more unscheduled pediatrician visits. CONCLUSIONS: Parents of infants with cardiac conditions may experience post-traumatic stress following cardiac surgery, which can be linked to greater healthcare use. Findings highlight the importance of screening and treating post-traumatic stress to preserve parental mental health and prevent adverse outcomes.

Internet-Based Sharing Nurse Program and Nurses' Perceptions in China: Cross-Sectional Survey.

BACKGROUND: China is currently piloting a "Sharing Nurse" program that aims to increase the accessibility of nursing services to at-home patients by enabling patients to order nursing services using mobile apps or online platforms. OBJECTIVE: This study aims to assess nurses' perceptions of the Sharing Nurse program, including their acceptance, concerns, needs, and willingness to take part in the program. METHODS: A total of 694 nurses participated in the questionnaire survey. The survey collected their sociodemographic and work-related information and their perceptions of the Sharing Nurse program using a self-developed questionnaire. RESULTS: The 694 respondents agreed that the Sharing Nurse program could provide patients with better access to nursing care (n=483, 69.6%). Their main concerns about the program were unclear liability division when medical disputes occur (n=637, 90.3%) and potential personal safety issues (n=604, 87%). They reported that insurance (n=611, 88%), permits from their affiliated hospital (n=562, 81.0%), clear instructions concerning rights and duties (n=580, 83.6%), real time positioning while delivering the service (n=567, 81.7%), and one-key alarm equipment (n=590, 85.0%) were necessary for better implementation of the program. More than half of the respondents (n=416, 60%) had an optimistic attitude toward the development of the Sharing Nurse program in China. However, only 19.4% (n=135) of the respondents expressed their willingness to be a "shared nurse." Further analyses found that nurses with a master's degree or above (χ23=28.835, P<.001) or from tertiary hospitals (χ23=18.669, P<.001) were more likely to be aware of the Sharing Nurse program and that male nurses were more willing to be shared nurses (Z=-2.275, P=.02). CONCLUSIONS: The Chinese Sharing Nurse program is still in its infancy and many refinements are needed before it can be implemented nationwide. Generally, Chinese nurses are positive about the Sharing Nurse program and are willing to participate if the program is thoroughly regulated and supervised.

Effectiveness of two guided self-administered interventions for psychological distress among women with infertility: a three-armed, randomized controlled trial.

STUDY QUESTION: What is the effect of two guided self-administered interventions on psychological distress in women undergoing IVF or ICSI? SUMMARY ANSWER: A brief mindfulness intervention significantly reduced depression and improved sleep quality, while the gratitude journal intervention showed no significant effect on any outcome variables. WHAT IS KNOWN ALREADY: Mindfulness and gratitude journal interventions have been found to be beneficial in reducing negative affect and improving well-being. However, there are very few mental health professionals who implement such interventions in low- and middle-income countries. Therefore, two guided self-administered interventions for women with infertility were designed to help them cope with their psychological distress. STUDY DESIGN, SIZE, DURATION: A three-armed, randomized controlled trial was designed to evaluate the mindfulness and gratitude journal interventions for women undergoing IVF/ICSI. Between May 2016 and November 2017, at the reproductive center in a public hospital, 234 women were randomly assigned to the brief mindfulness group (BMG, n = 78), gratitude journal group (GJG, n = 78) or control group (CG, n = 78). The inclusion criteria were being a woman undergoing her first cycle of IVF, having at least junior middle school education and having no biological or adopted children. PARTICIPANTS/MATERIALS, SETTING, METHODS: Female infertility patients (n = 346) were approached, and 112 did not meet the inclusion criteria. All three randomized groups completed questionnaires on the day of down-regulation (T1), the day before embryo(s) transfer (T2), and 3 days before the pregnancy test (T3). The BMG completed four sessions and listened to a 20-minute audio daily, including guided mindfulness breathing and body scan. The GJG completed four sessions and wrote three gratitude journals daily. The CG received routine care. A generalized estimating equation was used in an intention-to-treat analysis. The primary outcome was depression. Secondary outcomes were anxiety, sleep quality, infertility-related stress, mindfulness and gratitude. MAIN RESULTS AND THE ROLE OF CHANCE: Participants of the BMG showed decreased depression (mean difference (MD) = -1.69, [-3.01, -0.37], d = 0.44) and improved sleep quality (MD = -1.24, [-1.95, -0.39], d = 0.43) compared to the CG, but the effect was not significant for anxiety, Fertility Problem Inventory totals, mindfulness, gratitude scores or pregnancy rates. The BMG showed a significant reduction in depression and improvement in sleep quality between T1 and T2, a continuous significant reduction between T1 and T3 and no reduction between T2 and T3. There were no significant effects on any of the variables for the GJG. LIMITATIONS, REASONS FOR CAUTION: The inclusion criteria may result in bias because some participants with low education were excluded and only women with infertility were included. A low compliance rate occurred in the gratitude journals group. Moreover, men were not included in this study. Further research should consider including spouses of the target population. WIDER IMPLICATIONS OF THE FINDINGS: The brief mindfulness intervention was beneficial in decreasing depression and improving sleep quality. Implementation of guided self-administered mindfulness could make the psychological counseling service more accessible for patients with infertility in resource-poor settings. The efficiency and feasibility of the gratitude journal intervention needs to be investigated further. STUDY FUNDING/COMPETING INTEREST(S): This study was funded by the National Social Science Foundation (17BSH054). The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER: ChiCTR-IOR-16008452. TRIAL REGISTRATION DATE: 9 May 2016. DATE OF FIRST PATIENT'S ENROLMENT: 15 May 2016.

Using propensity score matching with doses in observational studies: An example from a child physical abuse and sleep quality study.

Both physical abuse and poor sleep quality are public health concerns among adolescents, particularly in mainland China, but examining any causal effect of physical abuse on adolescents' sleep quality using a randomized controlled trial is not possible for obvious ethical reasons. Researchers have proposed the use of propensity score matching with doses to minimize overt bias and estimate the effect of multidose treatments or varying degrees of risk exposure in observational studies. In this paper, we demonstrate the propensity score methods with a focus on matching with doses in an examination of the relationship between physical abuse levels (frequency and number of perpetrators) and self-reported sleep quality among adolescents. Secondary analyses were conducted using data from the China Jintan Child Cohort. The sample comprised 707 adolescents (13.16 ± 0.90 years old) who had complete data on physical abuse, sleep, and covariates. Propensity scores were computed from eight covariates and used to carry out pair matching, matching with the frequency of abusive experience, and matching with the number of perpetrators. The standardized differences of covariates suggested an acceptable balance between groups after matching. The results derived from matching sets consistently indicated that adolescents being physically abused by parent(s) have worse sleep quality. Despite its inherent limitations, propensity score matching with doses provides a useful tool for nurse researchers analyzing observational data.

Mindfulness and burnout among bedside registered nurses: A cross-sectional study.

Nursing is a high stress job, and burnout of nurses is of particular concern. The aim of this cross-sectional survey study was to examine the relationship between mindfulness and burnout, and how the mindfulness facets vary in their associations with the different domains of burnout for Chinese nurses. A sample of registered bedside nurses working in a tertiary Chinese hospital (n = 763) was surveyed from February to June 2017 regarding mindfulness (i.e. acting with awareness, describing, and non-judging of experiences), burnout (i.e. emotional exhaustion, depersonalization, and personal accomplishment), and sociodemographic and job-related characteristics. Higher scores on the three facets of mindfulness were associated with less emotional exhaustion and depersonalization, and acting with awareness showed the highest regression coefficients. Personal accomplishment was positively associated with acting with awareness and describing, whereas it was negatively related to non-judging of experiences. Describing was the strongest facet associated with personal accomplishment. In conclusion, there were clearly correlations between mindfulness as a personal trait and burnout among Chinese bedside nurses. These findings suggest the potential benefits of tailored mindfulness-based interventions in reducing nurse burnout in China.

Child Physical Abuse, Non-anemic Iron Deficiency and Behavior Problems.

PURPOSE: Child abuse is regarded as a life-course social determinant of health problems. However, little is known about the nutritional status of physically abused children and their cumulative effect on child behavior. The present study aimed to examine the non-anemic iron deficiency status of abused children and the combined effect of physical abuse and non-anemic iron deficiency on child behavior in China. METHODS: This cross-sectional study comprised 314 children aged 11-14 (12.30±0.57) years old from Jintan, China. Children self-reported their physical abuse experiences and behavior problems. Blood iron and hemoglobin concentrations were also measured. RESULTS: Thirty-eight percent of children reported physical abuse experience, 17.5% had non-anemic iron deficiency, and the two risk factors co-occurred in 8.0% children. Physically abused children were more likely to be affected by non-anemic iron deficiency than their non-abused counterparts. Children who had experienced both physical abuse and non-anemic iron deficiency reported more behavior problems than children with neither or either risk factors. CONCLUSIONS: Physically abused children are more likely to have non-anemic iron deficiency. Children with the presence of both physical abuse experience and non-anemic iron deficiency have more behavior problems. There is a need to prevent both child abuse and non-anemic iron deficiency simultaneously to maintain normal child behavior development.

Establishing good collaborative research practices in the responsible conduct of research in nursing science.

BACKGROUND: Team science is advocated to speed the pace of scientific discovery, yet the goals of collaborative practice in nursing science and the responsibilities of nurse stakeholders are sparse and inconclusive. The purpose of this study was to examine nurse scientists' views on collaborative research as part of a larger study on standards of scientific conduct. METHODS: Web-based descriptive survey of nurse scientists randomly selected from 50 doctoral graduate programs in the United States. RESULTS: Nearly forty percent of nurse respondents were not able to identify good collaborative practices for the discipline; more than three quarters did not know of any published guidelines available to them. Successful research collaborations were challenged by different expectations of authorship and data ownership, lack of timeliness and communication, poorly defined roles and responsibilities, language barriers, and when they involve junior and senior faculty working together on a project. CONCLUSION: Individual and organizational standards, practices, and policies for collaborative research needs clarification within the discipline.

Association between trajectories of maternal depressive symptoms and length of hospital stay, hospitalization costs, and adverse maternal and infantile outcomes: A longitudinal observational study.

This study aimed to determine the trajectories of perinatal depression and their relationship with length of hospital stay (LOS), hospitalization costs, and adverse maternal and infantile outcomes. This longitudinal observational study included 525 participants. Perinatal depressive symptoms were assessed at four waves (from the first trimester to the postpartum period). LOS, hospitalization costs, and adverse maternal (sleep, fatigue, anxiety, perceived stress, and memory problems) and infantile outcomes of participants were obtained from medical records and self-reported questionnaires. Trajectories of perinatal depressive symptoms were explored with latent class growth analysis. Associations between trajectories and adverse maternal and infant outcomes were explored with multiple linear regression and binary logistic regression models. The participants' average age was 29.6 ± 3.9 years. Five heterogeneous developmental trajectories of perinatal depressive symptoms were identified as follows: high-level (7.05%), moderate-increasing (12%), remission (15.05%), moderate-level (37.14%), and low-level (28.76%). The average LOS was 5.78 ± 2.13 days, and the average hospitalization costs were 12,695.27 ± 5457.51 yuan. Compared with the trajectory of low-level depressive symptoms, the LOS, hospitalization costs, and likelihood of adverse outcomes of women with high-level and moderate-increasing depressive symptom trajectories increased. The findings capture the heterogeneity of perinatal depression in Chinese women. Women in the moderate-increasing and high-level trajectory groups had longer LOS, more hospitalization costs, and poor birth outcomes. Elucidating the trajectories of perinatal depression and their relationship with maternal and infant health outcomes provides important insights into the development of person-centred care planning for women during pregnancy and postpartum.

Clinimetric Properties of the Chinese Short Form of the Sarcopenia Quality of Life Questionnaire in Patients With Cancer.

BACKGROUND: Sarcopenia, prevalent in patients with cancer, negatively affects quality of life. However, generic tools are unable to capture the minor effects of sarcopenia on quality of life. The short-form version of the Sarcopenia Quality of Life (SF-SarQoL) questionnaire was developed as an efficient tool to assess the impact of sarcopenia on quality of life in older adults. However, its clinimetric properties in patients with cancer remain unknown. PURPOSE: This study was designed to examine the clinimetric properties of the Chinese SF-SarQoL in patients with colorectal cancer, particularly with regard to its ability to detect changes in quality of life. METHODS: A longitudinal survey was conducted using the SF-SarQoL and other questionnaires on 408 patients with colorectal cancer planning to undergo surgery. Follow-up was subsequently conducted on 341 of these patients 1 month after surgery. The clinimetric properties of the SF-SarQoL were examined, including reliability (internal consistency), validity (construct validity, concurrent validity), sensitivity (ability to detect changes, discriminative ability), and floor and ceiling effects. RESULTS: The internal consistency of the SF-SarQoL was found to be acceptable (Cronbach's alpha = .94 and McDonald's omega = .94). Strong scalability of the total score and each item was confirmed using Mokken analysis. Concurrent validity analyses indicate the SF-SarQoL is significantly correlated with muscle-related and health-related questionnaire scores. The SF-SarQoL showed adequate sensitivity due to its good ability to detect changes in quality of life with a moderate effect size (Cohen's d = 0.56) and discriminate between sarcopenic and nonsarcopenic patients (area under the curve = 0.73, 95% CI [0.66, 0.79]) using receiver operating characteristic curve analyses. No floor or ceiling effects were observed. CONCLUSIONS: The Chinese SF-SarQoL exhibits good clinimetric properties in preoperative patients with colorectal cancer and is sufficiently sensitive to capture changes in quality of life after surgery.

The time sensitive and dose-responsive association between parental corporal punishment and sleep disturbances in preschoolers: A prospective cohort study.

BACKGROUND: To examine whether parental corporal punishment is associated with increased risk of concurrent and later sleep disturbances among preschoolers, and whether the association is time-sensitive or dose-responsive. METHODS: This 3-year prospective cohort study used data from the Shanghai Children's Health, Education and Lifestyle Evaluation, Preschool(SCHEDULE-P). Participants were newly enrolled preschoolers in November 2016(wave 1) and followed up in April 2018(wave 2) and April 2019(wave 3). Parents reported the children's corporal punishment experiences and sleep disturbances at each wave survey. Children's risk of sleep disturbances in relation to corporal punishment was examined using logistic regression, adjusting for children's age, gender, emotional/behavioral problems, family annual income, and maternal educational level. RESULTS: The participants of 19,668 children included 9436(47.98 %) females, with a mean age of 3.73(SD = 0.29) years at wave 1. Exposure to corporal punishment was associated with increased odds of concurrent sleep disturbances at wave 1, 2, and 3 (aOR,1.57; 95 % CI, 1.40-1.75; P < .001; aOR,1.60; 95 % CI, 1.43-1.80; P < .001; aOR,1.74; 95 % CI, 1.54-1.95; P < .001), respectively. Exposure to corporal punishment at any wave of preschool was associated with increased odds of sleep disturbances at wave 3, and the risks were greater for proximal and accumulative corporal punishment exposure. CONCLUSION: There is a time-sensitive and dose-responsive association between corporal punishment and sleep disturbance among preschoolers, with greater risk of sleep disturbances for proximal and accumulative exposure of corporal punishment. Promoting positive parenting strategies and avoiding corporal punishment can be a promising strategy to prevent and intervene sleep disturbances in preschoolers.

Prevalence and associated factors of poly-victimization in Chinese adolescents.

Multiple types of victimization or poly-victimization (PV) can occur simultaneously during childhood, resulting in outcomes that are detrimental and difficult to reverse. Very few studies have focused on PV in Chinese adolescents. The present study is based on information collected from a stratified cluster sample of 1,561 females and 1,594 males aged 12-18 years living in Shandong Province, China. A self-administered questionnaire was used to assess background information, the Juvenile Victimization Questionnaire was used to measure the extent of victimization and PV, the Screen for Child Anxiety Related Emotional Disorders was used to measure anxiety levels, and a Depression Self-rating Scale for Children was used to ascertain depression. A majority of the study sample (66.2%) had experienced at least one form of victimization over the past year. Prevalence of PV was 16.9%, and was significantly higher among males (21.1%) than females (12.5%). Younger ages, one-child families, and lower socioeconomic status were positively associated with PV. Logistic regression analysis indicated that smoking, alcohol consumption, exposure to pornography, and anxiety- and depression-like symptoms were risk factors of PV. Results of this study highlight the need for further exploration of factors related to the PV of Chinese adolescents.

Poly-victimization and executive functions in junior college students.

This study sought to characterize executive dysfunctions in poly-victimized students without posttraumatic stress disorder (PTSD) symptoms and the relationship between neuropsychological and behavioral rating measures of executive functions (EFs). Based on self-report data of exposure to victimization and PTSD symptoms, 259 junior college students aged 18-21 years were classified into four groups: poly-victimization with PTSD symptoms (PVP), poly-victimization without PTSD symptoms (PVnP), non-poly-victimization (nPV), and non-victimization (nV). Respondents also completed the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). Of the 259 participants, 131 were administered a battery of neuropsychological tests from the Cambridge Neuropsychological Testing Automated Battery (CANTAB). The PVP group and the PVnP group performed worse than the nV group on most BRIEF-A scales. When compared with the nPV group, the PVP group demonstrated poorer performance on the scales of Inhibit, Shift, Emotional Control, Initiate, and Working Memory, while the PVnP group performed more poorly on the Working Memory scale and the Task Monitor scale. For all BRIEF-A scales, no significant differences were detected between the PVP group and the PVnP group. This study showed no between-group differences for most of the neuropsychological tests except for the Stop Signal Task (SST), and no correlations between these two measures of EFs. Overall, we found evidence of an association between deficits in EFs and poly-victimization. Although our study raises questions about the relationship between these two measures of EFs, it suggests that the use of the BRIEF-A in conjunction with the CANTAB provides a more complete assessment of the executive dysfunctions.

Screen use before sleep and emotional problems among adolescents: Preliminary evidence of mediating effect of chronotype and social jetlag.

BACKGROUND: Screen use before sleep is shown to be positively related to emotional problems. However, whether this relationship was mediated by circadian phenotypes (i.e., chronotype and social jetlag) remains unclear. METHODS: Data from two independent adolescent surveys among 2685 and 1368 adolescents, respectively, were used. Adolescents reported screen use before sleep (yes/no and screen time), chronotype, social jetlag, and emotional problems using questionnaires. Serial mediation analyses were performed. RESULTS: Adolescents who reported screen use before sleep showed later chronotype and greater social jetlag, which was further associated with a higher level of emotional problems. Such relationships held for screen use as a yes/no variable and screen time. The serial indirect effect of chronotype and social jetlag accounted for 6.2%-16.7% of the total effect of screen use before sleep on emotional problems. LIMITATIONS: The use of a cross-sectional design did not allow the establishment of causal links between the variables. All data were self-reported by adolescents, and might be subject to report bias and recall bias. CONCLUSIONS: These findings contributed to the existing literature by examining the mediating effect of chronotype and social jetlag in the relationship between screen use before sleep and emotional problems from a circadian rhythm perspective. Healthy media use habits and interventions targeting circadian characteristics may work towards promoting emotional health in adolescents.

Parenting and parenting resources among Chinese parents with children under three years of age: rural and urban differences.

BACKGROUND: Parenting is essential for children's development and preventing child abuse and neglect. Providing parenting services within the primary health care settings demonstrated effectiveness in improving parenting quality. However, little is known about the status of parenting and parenting resources in rural areas and whether they differ between rural and urban areas in Mainland China. OBJECTIVE: This study aimed to examine the rural-urban differences in parenting and availability of, utilization of, and need for parenting resources among Chinese parents with children under three years of age. PARTICIPANTS AND SETTING: A total of 425 parents of children under three years of age participated in an online survey between March and May 2020. METHODS: The Parenting and Family Adjustment Scale and Child Adjustment and Parenting Efficacy Scale were used to assess parenting, family adjustment, and parenting efficacy. The availability of, utilization of, and need for parenting resources were measured using self-developed questions based on literature. Chi-square tests, t tests, and Wilcoxon rank-sum test were used to examine the differences in responses between parents in rural and urban areas. RESULTS: Compared with their urban counterparts, rural parents reported a higher level of negative parenting and more limited parenting resources. Both rural and urban parents reported low availability and utilization of parenting resources as well as a great need for parenting support services. CONCLUSIONS: Rural parents faced more parenting challenges and limited parenting resources compared with urban parents. Both rural and urban parents with children under three years of age reported great needs for parenting resources. These findings highlight the potential of delivering accessible, sustainable, and cost-effective parenting programs via the primary health care system for public welfare in both urban and rural areas, with more attention paid to rural parents to help them improve their parenting.

Internet-delivered mindfulness-based interventions for mental health outcomes among perinatal women: A systematic review.

BACKGROUNDS: Mindfulness-based interventions (MBIs) delivered via the Internet become increasingly popular for improving maternal mental health, but the effectiveness of internet-delivered MBIs (iMBIs) is still unclear. METHODS: PubMed, PsycINFO, Embase, Scopus, CINAHL, and Cochrane Central Register of Controlled Trials were searched. We included studies that were randomized controlled trials (RCTs), quasi-experimental study design, and pre-post test design and contained information on the population of interest (women during pregnancy or within one year after delivery), intervention contents (mindfulness components), and intervention delivery formats (internet-based). ROBINS-I and RoB 2 were used to rate the risk of bias in non-RCTs and RCTs, respectively. RESULTS: Eleven studies composed of six RCTs and five non-RCTs were included. The overall risk of bias was high. IMBIs are effective in improving maternal depression and mindfulness and self-compassion. However, limited by the small number of studies included in the review, effect sizes of iMBIs cannot be estimated. Characteristics of iMBIs (delivery formats, duration, et al.) and studies (study design, measures et al.) were described. CONCLUSION: iMBIs are still in the initial stage. Studies with rigorous study design and larger sample size, and determining the optimal delivery formats and duration and intensity of interventions are necessary.

Patterns of sleep problems and internalizing and externalizing problems among Chinese adolescents: A latent class analysis.

OBJECTIVE: Different aspects of sleep problems tend to occur simultaneously, which could lead to adolescent health problems. We aimed to identify the distinct patterns of sleep problems and to explore their association with internalizing and externalizing problems. METHODS: Secondary data from 11,831 adolescents from the Shandong Adolescent Behavior and Health Cohort were obtained and after data cleaning, 9,871 (50.1% females, mean age was 15.02 ± 1.45 years) were used in this study. Sleep problems (short weeknight sleep duration, insomnia, daytime sleepiness, no post-lunch napping, and snoring), and covariates were measured at the baseline, and the internalizing and externalizing problems were measured at both the baseline and one-year follow-up. The latent class analysis was used to identify the patterns of sleep problems at the baseline. Linear mixed effect models were used to examine the relationship between classes of sleep problems and internalizing and externalizing problems. RESULTS: Three classes of sleep problems were identified, named as "short and disturbed sleep" (34.1%), "no post-lunch napping" (16.7%), and "no/mild sleep disturbance" (49.2%), respectively. The "short and disturbed sleep" class exhibited higher levels of internalizing and externalizing problems than the other two classes. Also, it showed a steeper decreasing trend in internalizing and externalizing problems over time. CONCLUSIONS: The findings shed light on the importance and significance of identifying the patterns of multiple sleep problems to effectively identify adolescents at higher risk of developing internalizing and externalizing problems, and to designate tailored intervention to eliminate co-occurring sleep problems to promote adolescent emotional and behavioral health.