Locus-resolution analysis of L1 regulation and retrotransposition potential in mouse embryonic development.

Mice harbor ∼2800 intact copies of the retrotransposon Long Interspersed Element 1 (L1). The in vivo retrotransposition capacity of an L1 copy is defined by both its sequence integrity and epigenetic status, including DNA methylation of the monomeric units constituting young mouse L1 promoters. Locus-specific L1 methylation dynamics during development may therefore elucidate and explain spatiotemporal niches of endogenous retrotransposition but remain unresolved. Here, we interrogate the retrotransposition efficiency and epigenetic fate of source (donor) L1s, identified as mobile in vivo. We show that promoter monomer loss consistently attenuates the relative retrotransposition potential of their offspring (daughter) L1 insertions. We also observe that most donor/daughter L1 pairs are efficiently methylated upon differentiation in vivo and in vitro. We use Oxford Nanopore Technologies (ONT) long-read sequencing to resolve L1 methylation genome-wide and at individual L1 loci, revealing a distinctive "smile" pattern in methylation levels across the L1 promoter region. Using Pacific Biosciences (PacBio) SMRT sequencing of L1 5' RACE products, we then examine DNA methylation dynamics at the mouse L1 promoter in parallel with transcription start site (TSS) distribution at locus-specific resolution. Together, our results offer a novel perspective on the interplay between epigenetic repression, L1 evolution, and genome stability.

The effectiveness of WeChat couple-based psychosocial support for gynaecological cancer: A randomised controlled trial.

OBJECTIVE: This study aimed to evaluate the effectiveness of an 8-week electronic couple-based psychosocial support platform (WeChat) for gynaecological cancer. DESIGN: Randomised controlled trial. SETTING: Oncology hospital in Shaanxi Province, China. PARTICIPANTS: A total of 98 dyads of women with gynaecological cancer and their intimate male partners were included. METHODS: Couple dyads were randomly allocated to either the WeChat couple-based psychosocial support or to a control group receiving eight WeChat articles on general education content related to diet and exercise. MAIN OUTCOME MEASURES: The primary outcome was sexual function assessed with the Female Sexual Function Index. The secondary outcomes of relationship satisfaction and quality of life were assessed with the Chinese version of Revised Dyadic Adjustment Scale, Functional Assessment of Cancer Therapy-General and The World Health Organization Quality of Life BREF. These outcomes were assessed before randomisation, and immediately and 3 months after the intervention. RESULTS: The study showed that the sexual function of women participants in the intervention group did not reach a significant level compared with the control group. Relationship satisfaction in the intervention programme improved significantly (adjusted mean difference 4.7, 95% confidence interval [CI] 2.0-7.4; p = 0.001) and quality of life (QoL 6.9, 95% CI 0.5-13.3; p = 0.035) 3 months after the intervention in women with gynaecological cancer. The intervention programme also showed significant positive effects on optimising relationship satisfaction (adjuste mean difference 3.0, 95% CI 0.3-5.7; p = 0.027) of male partners. CONCLUSIONS: The results provided additional knowledge and an evidence base for the application of the support programme to improve relationship satisfaction and QoL among couples living with gynaecological cancer.

Use of a Linguistically Appropriate Decision Aid for Cervical Cancer Screening of South Asian Ethnic Minority Women in Hong Kong: A Pilot Randomised Controlled Trial.

BACKGROUND: Decision aids have been shown to be effective in assisting the decision-making process in healthcare settings. This study aimed to examine the feasibility and acceptability of a linguistically appropriate printed decision aid for cervical cancer screening in South Asian women and to preliminarily estimate its effects on decisional conflicts, clarity of values, risk perception, the screening decision and screening uptake. METHODS: This was a pilot randomised controlled trial. Forty-eight South Asian women aged 25 to 64 years were recruited and allocated to either the intervention group or control group. The participants in the intervention group read a linguistically appropriate printed decision aid. RESULTS: All of the participants in the intervention group agreed that the decision aid was useful in aiding their decision-making. These participants showed significantly greater improvement in decisional conflicts, clarity of values and risk perceptions than those in the control group (all p < 0.05). The screening uptake rate was significantly higher in the intervention group than in the control group (p < 0.001). CONCLUSIONS: The decision aid was feasible and acceptable among South Asian women, and it resulted in reduced decisional conflict and increased screening uptake compared with usual care. To improve the convenience of using decision aids, they could be developed in various forms, such as printed and mobile application forms, to meet individual requirements. TRIAL REGISTRATION: The trial was registered at the Chinese Clinical Trial Registry on 23 October 2021 (ChiCTR2100052225).

Effects of self-management interventions for cancer patients with pain: A systematic review of randomised controlled trials.

AIMS: To evaluate the effects of self-management interventions targeting individuals with cancer-related pain on pain intensity, self-efficacy, quality of life (QoL), pain medication adherence, and pain-related knowledge and provide recommendations for the content and format of self-management interventions based on the existing evidence. DESIGN: A systematic review of randomised controlled trials (RCTs) and narrative synthesis. DATA SOURCES: A search of six electronic databases, including Medline, PsycINFO, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. REVIEW METHODS: This systematic review followed the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published from January 2011 to March 2022 in English were retrieved. The Cochrane Risk of Bias Tool was used to assess quality. Data were summarised using narrative synthesis. RESULTS: This systematic review included six RCTs involving 748 patients with cancer-related pain. The results support the effectiveness of the intervention on QoL and pain-related knowledge. Mixed results were observed in the effectiveness on pain intensity, self-efficacy and medication adherence. Overall, the quality of the evidence was low. The content of self-management interventions varied across studies but with similar formats (face-to-face coaching and telephone follow-up). CONCLUSION: The existing evidence supports the effectiveness of self-management interventions on pain-related knowledge and QoL. Further high-quality RCTs are needed to determine the most effective interventions. RELEVANCE TO CLINICAL PRACTICE: Self-management is recommended to improve cancer patients' pain awareness, self-management behaviour and adaptability. Components for self-management of cancer pain, including patient attitude and knowledge assessment, nurse coaching and counselling, reinforcement during follow-up period, and provision of supplementary materials on pain management and medication adherence, could be covered in the intervention. In the future, it is worthwhile exploring an effective intervention using Internet-based information technology, for example WeChat, to aid the delivery of self-management intervention. NO PATIENT OR PUBLIC CONTRIBUTION: This systematic review does not necessarily involve patients or public members in this work.

Underdevelopment of the gut microbiota and bacteria species as non-invasive markers of prediction in children with autism spectrum disorder.

OBJECTIVE: The gut microbiota has been suggested to play a role in autism spectrum disorder (ASD). We postulate that children with ASD harbour an altered developmental profile of the gut microbiota distinct from that of typically developing (TD) children. Here, we aimed to characterise compositional and functional alterations in gut microbiome in association with age in children with ASD and to identify novel faecal bacterial markers for predicting ASD. DESIGN: We performed deep metagenomic sequencing in faecal samples of 146 Chinese children (72 ASD and 74 TD children). We compared gut microbial composition and functions between children with ASD and TD children. Candidate bacteria markers were identified and validated by metagenomic analysis. Gut microbiota development in relation to chronological age was assessed using random forest model. RESULTS: ASD and chronological age had the most significant and largest impacts on children's faecal microbiome while diet showed no correlation. Children with ASD had significant alterations in faecal microbiome composition compared with TD children characterised by increased bacterial richness (p=0.021) and altered microbiome composition (p<0.05). Five bacterial species were identified to distinguish gut microbes in ASD and TD children, with areas under the receiver operating curve (AUC) of 82.6% and 76.2% in the discovery cohort and validation cohort, respectively. Multiple neurotransmitter biosynthesis related pathways in the gut microbiome were depleted in children with ASD compared with TD children (p<0.05). Developing dynamics of growth-associated gut bacteria (age-discriminatory species) seen in TD children were lost in children with ASD across the early-life age spectrum. CONCLUSIONS: Gut microbiome in Chinese children with ASD was altered in composition, ecological network and functionality compared with TD children. We identified novel bacterial markers for prediction of ASD and demonstrated persistent underdevelopment of the gut microbiota in children with ASD which lagged behind their respective age-matched peers.

Effects of music intervention on anxiety, depression, and quality of life of cancer patients receiving chemotherapy: a systematic review and meta-analysis.

BACKGROUND: Music may be a safe and effective coping strategy for psychological management. The objectives of this review were to identify the effects of music interventions on anxiety, depression, and quality of life (QoL) among cancer patients receiving chemotherapy. METHODS: Fourteen databases were searched from the inception date to December 2020 to identify eligible randomized controlled trials (RCTs). Gray literature was also examined. The protocol of this systematic review was registered with PROSPERO (registration number: CRD42021223845). Two reviewers independently assessed eligibility, extracted data, and evaluated methodological quality. Meta-analysis was done. Subgroup analysis was conducted for intervention types, the person selecting music, music delivery method, timing, and session duration. RESULTS: Nine RCTs were identified, among which six were eligible for the meta-analysis. All studies were at a high risk of bias, and the overall quality of evidence was low to very low. The pooled results reveal that music intervention could reduce anxiety (SMD: - 0.29, 95% CI - 0.50 to - 0.08) and improve QoL (SMD: 0.42, 95% CI 0.02 to 0.82). However, it fails to affect depression (p = 0.79). The findings demonstrate no significant difference between patient-selected music and researcher-selected music, recorded music, and live music, while a length of 15-20 min/session and offering immediately before chemotherapy are more effective on anxiety than that of 30-45 min and delivering during chemotherapy. CONCLUSIONS: Music intervention may be a beneficial tool for anxiety reduction and QoL among cancer patients receiving chemotherapy. More high-quality RCTs are needed to ascertain the true impact of those outcomes.

3D hanging spheroid plate for high-throughput CAR T cell cytotoxicity assay.

BACKGROUND: Most high-throughput screening (HTS) systems studying the cytotoxic effect of chimeric antigen receptor (CAR) T cells on tumor cells rely on two-dimensional cell culture that does not recapitulate the tumor microenvironment (TME). Tumor spheroids, however, can recapitulate the TME and have been used for cytotoxicity assays of CAR T cells. But a major obstacle to the use of tumor spheroids for cytotoxicity assays is the difficulty in separating unbound CAR T and dead tumor cells from spheroids. Here, we present a three-dimensional hanging spheroid plate (3DHSP), which facilitates the formation of spheroids and the separation of unbound and dead cells from spheroids during cytotoxicity assays. RESULTS: The 3DHSP is a 24-well plate, with each well composed of a hanging dripper, spheroid wells, and waste wells. In the dripper, a tumor spheroid was formed and mixed with CAR T cells. In the 3DHSP, droplets containing the spheroids were deposited into the spheroid separation well, where unbound and dead T and tumor cells were separated from the spheroid through a gap into the waste well by tilting the 3DHSP by more than 20°. Human epidermal growth factor receptor 2 (HER2)-positive tumor cells (BT474 and SKOV3) formed spheroids of approximately 300-350 µm in diameter after 2 days in the 3DHSP. The cytotoxic effects of T cells engineered to express CAR recognizing HER2 (HER2-CAR T cells) on these spheroids were directly measured by optical imaging, without the use of live/dead fluorescent staining of the cells. Our results suggest that the 3DHSP could be incorporated into a HTS system to screen for CARs that enable T cells to kill spheroids formed from a specific tumor type with high efficacy or for spheroids consisting of tumor types that can be killed efficiently by T cells bearing a specific CAR. CONCLUSIONS: The results suggest that the 3DHSP could be incorporated into a HTS system for the cytotoxic effects of CAR T cells on tumor spheroids.

Influential barriers perceived by South Asians in Hong Kong to undergoing cervical cancer screening.

OBJECTIVE: To report the uptake rate of cervical cancer screening (the Papanicolaou [Pap] test) and identify the perceived barriers associated with screening uptake among South Asian women in Hong Kong. METHODS: This cross-sectional study involved a structured survey of 776 South Asian women aged 21 and above, recruited from the community. The participants' demographic characteristics, Pap test uptake and responses to a validated 14-item scale of perceived barriers to screening was collected. The data were analysed using descriptive statistics and logistic regression. RESULTS: The Pap test uptake rate was 40.3%. Multivariate analysis identified two perceived barriers significantly associated with the participants' Pap test uptake: (1) not knowing where to have the test and (2) the belief that they did not need a test if they felt well. CONCLUSION: Although language problems and embarrassment are commonly reported barriers to screening by South Asians, the participants were more concerned about where to have the test and whether they needed it. Future interventions should thus focus on enhancing their access to the service and clarifying their understanding of the need.

Identifying the factors promoting colorectal cancer screening uptake in Hong Kong using Andersen's behavioural model of health services use.

BACKGROUND: Colorectal cancer (CRC) screening is an effective strategy to aid early cancer detection. However, the decision to undergo screening can be affected by a variety of factors. The aims of this study were to examine current CRC screening uptake in Hong Kong and identify the factors associated with it using Andersen's Behavioural Model as a guiding framework. METHODS: This cross-sectional study was conducted in Hong Kong from August 2019 to December 2020. A sample of 1317 Chinese individuals aged 50 to 75 years were recruited and completed a survey to identify predisposing, enabling, and need-for-care factors, and the colorectal cancer screening uptake rate (faecal occult blood test [FOBT] or faecal immunochemical test [FIT] and colonoscopy) was determined. RESULTS: The FOBT/FIT uptake rate was 43.9%, while that of the colonoscopy was 26.0%. The provision of a government subsidy for screening and the provision of information booklets were the most significant and second most significant enabling factors for FOBT/FIT uptake, respectively. Visiting a doctor five times or more in the previous year and being recommended to undergo a CRC screening by a doctor, were the most significant enabling factors for colonoscopy uptake. Age, the perceived benefit of and barriers to screening were important predisposing factors for FOBT/FIT and colonoscopy uptake. CONCLUSIONS: Screening uptake rates in Hong Kong have significantly increased over the last decade, although they remain lower than those in other countries. Continual efforts are warranted to promote government-subsidised screening. Relevant educational materials that address the barriers identified in this study should be developed and disseminated to the public.

Patient privacy protection among university nursing students: A cross-sectional study.

BACKGROUND: Protecting a person's right to privacy and confidentiality is important in healthcare services. As future health professionals, nursing students should bear the same responsibility as qualified health professionals in protecting patient privacy. OBJECTIVES: To investigate nursing students' practices of patient privacy protection and to identify factors associated with their practices. RESEARCH DESIGN: A cross-sectional study design was adopted. A two-part survey was used to collect two types of data on nursing students: (1) personal characteristics, including demographics, clinical experience and use of information and communication technology and social media and (2) practice of patient privacy protection, collected using the Patient Privacy Scale. PARTICIPANTS AND RESEARCH CONTEXT: A total of 319 nursing students aged 18 or above, studying pre-registration nursing programmes and who had attended at least one block of clinical placement, were recruited from a university in Hong Kong. ETHICAL CONSIDERATIONS: The study received ethical approval from the Survey and Behavioural Research Ethics Committee of the Chinese University of Hong Kong. The participants were informed of the study aim and written consent was obtained before completing the survey. FINDINGS: The mean total score on the Patient Privacy Scale was 119.7 out of 135. Nursing students who were regular users of Instagram and those who had never taken photographs with patients and hence did not need to obtain patient consent were associated with better practices of patient privacy protection (higher total scores on the Patient Privacy Scale). CONCLUSIONS: The findings improve our understanding of nursing students' practice of patient privacy protection and the associated factors. This will inform the development and revision of current strategies to enhance nursing students' practice of patient privacy protection, especially their use of social media.

Eating Behaviors and Diet Quality in Chinese Preschoolers with and without Autism Spectrum Disorder: A Case-Control Study.

OBJECTIVES: To compare mealtime behaviors and diet quality in Chinese preschoolers with autism spectrum disorder (ASD) and typically developing preschoolers in Hong Kong. STUDY DESIGN: This case-control study included a community sample of 65 families with preschoolers with ASD aged 3-6 years and 65 families with typically developing preschoolers matched for age and sex. Preschoolers' eating behaviors were assessed using the Brief Autism Mealtime Behaviour Inventory and the Preschoolers' Eating Behaviour Questionnaire (CPEBQ). Preschoolers' usual diet and nutrient intake were assessed using a validated food frequency questionnaire. Diet quality and diversity were generated using the Chinese Children Dietary Index total score and diet variety score. Between-group differences in various scales and dietary variables were examined using multivariate linear or logistics regression models adjusting for baseline demographic differences. RESULTS: Compared with the typically developing group, the ASD group had greater scores in the Brief Autism Mealtime Behaviour Inventory food refusal domain (P < .001), the CPEBQ food fussiness (P = .001) and eating habit (P = .001) domains, and lower CPEBQ exogenous eating score (P = .003) and initiative eating score (P < .001). The Chinese Children Dietary Index total score (P = .001) and diet variety score (P = .005) and intake of soy and soy products (P = .001) were lower in the ASD group compared with the typically developing group. CONCLUSIONS: Preschoolers with ASD showed more eating and mealtime problems, and lower diet quality and diversity than their typically developing counterparts. Our findings highlight the need for regular monitor and early identification of mealtime behavioral and nutrition problems among preschoolers with ASD.

Translation and validation of the Traditional Chinese version of the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (Version 2).

BACKGROUND: Cancer patients often experience severe financial distress due to the high cost of their treatment, and strategies are needed to objectively measure this financial distress. The COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) is one instrument used to measure such financial distress. This study aimed to translate the COST-FACIT (Version 2) [COST-FACIT-v2] instrument into traditional Chinese (COST-FACIT-v2 [TC]) and evaluate its psychometric properties. METHODS: The Functional Assessment of Chronic Illness Therapy (FACIT) translation method was adopted. The translated version was reviewed by an expert panel and by 20 cancer patients for content validity and face validity, respectively, and 640 cancer patients, recruited from three oncology departments, completed the translated scale. Its reliability was evaluated in terms of internal consistency and test-retest reliability. Confirmatory factor analysis has been used to evaluate the one- and two-factor structures of the instrument reported in the literature. The convergent validity was examined by the correlation with health-related quality of life (HRQoL) and psychological distress. Known-group validity was examined by the difference in the COST-FACIT-v2 (TC) total mean score between groups with different income levels and frequency of health care service use. RESULTS: The COST-FACIT-v2 (TC) showed good content and face validity and demonstrated high internal consistency (Cronbach's alpha, 0.86) and acceptable test-retest reliability (intraclass correlation coefficient, 0.71). Confirmatory factor analysis showed that the one- and two-factor structures of the instrument that have been reported in the literature could not be satisfactorily fitted to the data. Psychological distress correlated significantly with the COST-FACIT-v2 (TC) score (r = 0.47; p < 0.001). HRQOL showed a weak to moderate negative correlation with the COST-FACIT-v2 (TC) score (r = - 0.23 to - 0.46; p < 0.001). Significant differences were seen among the COST-FACIT-v2 (TC) scores obtained in groups of different income level and frequency of health care service use. CONCLUSIONS: The COST-FACIT-v2 (TC) showed some desirable psychometric properties to support its validity and reliability for assessing cancer patients' level of financial toxicity.

Actigraphy-measured rest-activity circadian rhythm disruption in patients with advanced cancer: a scoping review.

PURPOSE: Patients with later-stage cancer have been reported to demonstrate more disrupted rest-activity circadian rhythms (RACR) than those with earlier-stage cancer, but consolidated evidence of this is lacking. The aim of this review was to examine and map the existing evidence on actigraphy-measured RACR in terms of their (1) pattern, (2) prevalence, (3) related factors, and (4) outcomes in advanced cancer patients. METHODS: A comprehensive scoping review was conducted using Arksey and O'Malley's framework. A literature search was performed using nine databases: MEDLINE, Embase, PsycINFO, CINAHL, British Nursing Index, Cochrane Library, Scopus, Web of Science, and SINTA. RESULTS: Twenty-one studies were included in the review. Compared with the healthy population, advanced cancer patients were more likely to display weaker RACR, manifesting as lower activity levels during the day, more frequent and longer daytime naps, and fragmented nighttime sleep. The prevalence of RACR disruption among advanced cancer patients ranged from 31.3 to 54.9%. It was found to be linked to the presence of physical and psychological symptoms (fatigue, appetite loss, pain, dyspnoea, sleep disturbance, depression, and anxiety), chemotherapy, male sex, and also predict the lower quality of life and survival. CONCLUSION: Disruption of the RACR is prevalent in advanced cancer patients and is associated with a set of physical and psychological symptoms. It was also found to be a predictor of the quality of life and survival among these patients. These results indicate the importance of interventions to restabilise the disrupted RACR among advance cancer patients to improve their health outcomes.

Identifying a cut-off score for the COST measure to indicate high financial toxicity and low quality of life among cancer patients.

PURPOSE: To identify a cut-off score for the COmprehensive Score for financial Toxicity (COST) to predict a clinical implication of a high level of financial toxicity (FT). METHODS: A total of 640 cancer patients were recruited from three regional hospitals in Hong Kong. They completed a questionnaire comprising the COST measure and the Functional Assessment of Cancer Therapy - General (FACT-G) instrument. The cut-off score for the COST that predicts the lowest quartile of the FACT-G total score was identified by receiver operating characteristic (ROC) analysis. The sample was then stratified by this cut-off score, and characteristics were compared using Fisher's exact, chi-squared or independent sample t-test. RESULTS: The mean scores were 20.1 ± 8.8 for the COST and 71.6 ± 15.5 for the FACT-G. The ROC analysis suggested that the cut-off of 17.5 yielded an acceptable sensitivity and specificity. Characteristics of patients with a higher level of FT included being younger, having a monthly household income of < 10,000 HKD (approximately 1290 USD), being more likely not employed, having stage IV cancer and receiving targeted and/or immunotherapy. In terms of financial support, a higher proportion of these patients had discussed financial issues with health care professionals and had received financial assistance. In addition, fewer of them were covered by private health insurance. CONCLUSION: Our findings suggest a cut-off for the COST that can be used to screen for FT in clinical settings. In addition, while a considerable proportion of high-FT patients received targeted therapy, they often received financial assistance. There is a gap between financial hardship and assistance that warrants attention.

Sleep restores place learning to the adenylyl cyclase mutant rutabaga.

Sleep plays an important role in regulating plasticity. In Drosophila, the relationship between sleep and learning and memory has primarily focused on mushroom body dependent operant-learning assays such as aversive phototaxic suppression and courtship conditioning. In this study, sleep was increased in the classic mutant rutabaga (rut2080) and dunce (dnc1) by feeding them the GABA-A agonist gaboxadol (Gab). Performance was evaluated in each mutant in response to social enrichment and place learning, tasks that do not require the mushroom body. Gab-induced sleep did not restore behavioral plasticity to either rut2080 or dnc1 mutants following social enrichment. However, increased sleep restored place learning to rut2080 mutants. These data extend the positive effects of enhanced sleep to place learning and highlight the utility of Gab for elucidating the beneficial effects of sleep on brain functioning.

A family-based multimedia intervention to enhance the uptake of colorectal cancer screening among older South Asian adults in Hong Kong: a study protocol for a cluster randomized controlled trial.

BACKGROUND: Colorectal cancer (CRC) screening, such as fecal occult blood test (FOBT), is an effective way to prevent CRC, one of the most common cancers worldwide. However, studies found that South Asian ethnic minorities tend not to utilize CRC screening, whose importance on CRC prevention shall be educated among those from ethnic minorities, especially older adults. The purpose of this study is to develop and implement a family-based, multimedia intervention to augment the knowledge of CRC prevention among older South Asian adults in Hong Kong and enhance their motivation for undergoing FOBT. The acceptability and effectiveness of the intervention will be assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. METHODS: A cluster randomized controlled trial will be carried out. Three hundred and twenty South Asian dyads, comprising an older adult aged between 50 and 75 and a younger family member aged between 18 and 49, will be recruited in ten districts in Hong Kong through community organizations that provide support services for South Asians in local communities. Dyads will be randomly allocated to either the intervention or wait-list control group. Intervention dyads will receive intervention, whose contents are based on the health belief model, via multiple forms of media including PowerPoint presentation, video clip and health information booklet. Control dyads will receive intervention after post-intervention data are collected. For dyads in both groups, an appointment with a family doctor will be arranged for those willing to undergo FOBT. Outcomes will be assessed at baseline and post-intervention. Data will be analysed using the Generalised Linear Models Procedure in an intention-to-treat manner. DISCUSSION: Findings of this study will provide evidence of the benefits of utilizing multimedia and family-based approaches in intervention development to enhance the effectiveness of health promotion interventions for ethnic minorities. Further, the findings would provide reference to the potential incorporation of the intervention in the existing support services for South Asian ethnic minorities in local communities. TRIAL REGISTRATION: This trial is registered at the ISRCTN Registry ( ISRCTN72829325 ) on 19th July 2018.

Study protocol: a randomized controlled trial study on the effect of a game-based exercise training program on promoting physical fitness and mental health in children with autism spectrum disorder.

BACKGROUND: Suboptimal physical activity levels and tolerance, poor motor skills and poor physical health are demonstrated in children with Autism Spectrum Disorder (ASD). We speculate that social interaction and communication deficits in children with ASD are two major factors that hinder these children from actively participating in group physical activities. While previous studies have demonstrated that exercise intervention improves motor skills and behavioral outcomes in children with ASD, these programs tend to focus only on a single sport, which may not cater to the interests of different children with ASD. In this protocol, a game-based exercise training program designed by a multi-disciplinary team (pediatrics, physical education and psychology) will be implemented by front-line healthcare providers trained following the train-the-trainer (TTT) model and subjected to validation. METHOD: Using a randomized controlled trial design, the effectiveness of the game-based exercise program will be examined for 112 young children with ASD. These children were randomly assigned to two groups, which will be tested and trained in either one of the two arms of the waitlist conditions (control and intervention). The assessment of physical and psychological traits will be conducted at baseline (pre-test), at 16-weeks (post-treatment) and at 32-weeks (follow-up) of the program. DISCUSSION: Most of the interventions designed for ASD children target either their psychological traits or physical conditions, without bridging the two states. With the recognition of bidirectional relations between mental and physical health, the present game-based exercise program which includes multiple level of difficulties was developed to equip ASD children with the necessary skills for engaging in sustainable team sports or even professional sport training. The program, if effective, will provide an entertaining and engaging training for whole-person development among children with ASD. TRIAL REGISTRATION: This study is registered with the Chinese Clinical Trial Registry ( ChiCTR-IOR-17011898 ). Registered 6th July 2017.

Translation and validation of translation in cross-cultural research: Strategies used in a study of cervical cancer screening among ethnic minorities.

AIMS: A discussion of the challenges encountered during instrument translation and validation while researching cervical cancer screening among ethnic minorities and the strategies used to overcome them. BACKGROUND: Given the increasing ethnic and cultural diversity of populations in different countries, culturally sensitive instruments are needed to evaluate people's attitudes, perceptions, and health practices. Often, such instruments are lacking in the study population's language. DESIGN: Discussion paper. DATA SOURCES: The discussion is based on our previous experience including the challenges encountered in the translation process and in the semantic and content validation and the strategies used to overcome them. IMPLICATION FOR NURSING: Seeking help from community centres or translation agencies to use translators with a health care background and of the same cultural origins as the target participants is effective. Actively contacting potential experts through email addresses obtained from published research articles is another effective way to find suitable experts. Field testing of the study questionnaire is important in validation, as it uncovers difficulties that go beyond translation. CONCLUSION: Good planning and preparation before the translation and validation work begins is always required. Working closely with translators and experts through discussion is the key to success.

Strategies for recruiting South Asian women to cancer screening research and the lessons learnt.

AIMS: The aim of this study was to describe and discuss the recruitment strategies used in a research study of cervical cancer screening among South Asian women, the challenges encountered and the lessons learnt from the experience. BACKGROUND: Ethnic minority populations face different barriers to participating in research studies. Strategies have been developed to recruit this population to health-related research in Western countries, but there is little information about such research in the Asian region. DESIGN: Discussion paper. DATA SOURCES: The discussion is based on our previous experience. The source of this experience is the recruitment strategies used, their results and the challenges encountered during the process. IMPLICATIONS FOR NURSING: Culturally, relevant strategies and maintaining good relationships with stakeholders improved participant recruitment. Familiarity with South Asians' traditional calendar - when cultural and religious festivals are held every year - would aid the setting up of appropriate schedules for participant recruitment, either before or after the periods when they cannot be reached, such as Ramadan. South Asian women are often busy with childcare and housework. This is their major responsibility in the family and any failure to fulfil such duties is a source of stress and may foster feelings of guilt. A better understanding of their daily routines is therefore important. Such information enables the establishment of daily meeting schedules to increase the success rate of recruitment. CONCLUSION: Recruitment is a tedious process, but appropriate planning and taking account of cultural and religious practices and daily schedules will help to improve its rate of success.