Cross-cultural adaptation and validation of the Chinese version of the Sleep Health Index.

OBJECTIVE: To generate the Chinese Sleep Health Index (SHI-C) in Mandarin with cross-cultural adaptations and test its psychometric properties. METHODS: This study used a cross-sectional design. Health science students were included (N = 271) and a sub-set (n = 74) was invited for the re-test. Cross-cultural adaptation of the SHI-C was performed prior to formal validation. The SHI-C, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Bedtime Procrastination Scale, and Sleep Hygiene Index were used to measure variables of interest. Exploratory factor analysis was used to evaluate the structure validity. Bivariate analyses were used to evaluate the construct validity. RESULTS: Exploratory factor analysis identified 3 factors (ie, sleep quality, sleep duration, and disordered sleep) accounting for 55.6% of the total variance. The SHI-C total and sleep quality sub-index scores were significantly associated with both PSQI global score (r = -0.132, p < .05; r = -0.182, p < .01, respectively) and ISI score (r = -0.655, p < .05; r = -0.820, p < .05, respectively). SHI-C total, sleep quality sub-index, and sleep duration sub-index scores were significantly associated with Bedtime Procrastination Scale and Sleep Hygiene Index scores (r = -0.238 to -0.368, p < .05). Students with insomnia (ISI > 9) or poor sleep quality (PSQI > 5) had significantly lower SHI-C scores than those without (73.5 vs. 89.0, p < .01; 84.1 vs. 86.7, p < .05, respectively). SHI-C showed good internal consistency (Cronbach's alpha = 0.73) and test-retest reliability (intraclass correlation coefficient = 0.82). CONCLUSIONS: The SHI-C demonstrated good validity and adequate reliability in a Chinese sample of health science students. It could be used to measure sleep health in future research and practice. Psychometric properties of the SHI-C among other Chinese populations remain to be confirmed.

Bidirectional Associations between Parental Feeding Practices and Child Eating Behaviors in a Chinese Sample.

BACKGROUND: Child eating behaviors (CEBs) and parental feeding practices (PFPs) play critical roles in childhood obesity. However, the bidirectional relationships between CEBs and PFPs remain equivocal. This longitudinal study aimed to explore their bidirectional relationships. METHODS: A convenience sample of 870 parents with preschoolers was recruited in this longitudinal study (Shanghai, China). Three non-responsive feeding practices (NFPs), three responsive feeding practices (RFPs), five CEBs, and covariates were collected using validated questionnaires at baseline and the 6-month follow-up. Cross-lagged analyses using structural equation modeling (SEM) were performed to examine their bidirectional relationships. RESULTS: Eight hundred and fifty-three parents completed questionnaires, with a response rate of 98%. The mean age of their children at baseline was 4.39 years (standard deviation = 0.72 years). Eighteen out of sixty longitudinal cross-lagged paths were statistically significant. Parental encouragement of healthy eating and content-restricted feeding were found to be bidirectionally associated with child food fussiness. Four parent-driven associations and one child-driven association were identified between RFPs and CEBs. For example, monitoring was negatively associated with children's unhealthy eating habits (ß = -0.066, standard error (SE) = 0.025, p < 0.01). Eight child-driven associations and one parent-driven association were observed between NFPs and CEBs. For example, higher child satiety responsiveness predicted a higher pressure to eat (ß = 0.057, SE = 0.029, p < 0.01) and the use of food as a reward (ß = 0.083, SE = 0.031, p < 0.01). CONCLUSIONS: There were bidirectional, parent-driven, and child-driven associations. Parents should be encouraged to adopt RFPs to shape CEBs. Increasing parents' understanding of CEBs and providing them with reasonable coping strategies would help optimize PFPs.

Cross-cultural adaptation and validation of the Chinese version of the revised surveys on patient safety culture™ (SOPS®) hospital survey 2.0.

BACKGROUND: Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey (HSOPS 1.0), developed by the U.S. Agency for Healthcare Research and Quality in 2004, has been widely adopted in the United States and internationally. An updated version, the SOPS Hospital Survey 2.0 (HSOPS 2.0), released in 2019, has not yet been applied in China. The aim of the present study was to translate HSOPS 2.0 into Chinese version with cross-cultural adaptations and test its psychometric properties. METHODS: A convenience sample was used. Hospital nurses (N = 1013) and a sub-set (n = 200) was invited for the re-test. A three-stage study was conducted. Firstly, the HSOPS 2.0 was translated by a panel. Secondly, the content validity was tested using the two-round Delphi method and cognitive interview. Next, the construct validity was tested by the confirmatory factor analysis and further demonstrated by the convergent validity, discriminant validity, and correlations with the outcome of patient safety. Thirdly, the reliability was tested by internal consistency reliability and re-test reliability. RESULTS: The "float or PRN" and "manager" words were deleted as considered unfitted for the Chinese health care system. The content validity index provided evidence of strong content validity (I-CVI = 0.84 ~ 1.00, S-CVI = 0.98). Confirmatory factor analysis revealed a good model fit (χ2/df = 4.05, RMSEA = 0.06, CFI = 0.94) and acceptable factor loadings (0.41 ~ 0.97). Convergent validity, and discriminant validity supported the factorial structure of the Chinese version of HSOPS 2.0. Further evidence for the construct validity was derived from correlations with the outcome of patient safety (r = 0.10 ~ 0.41). A good internal consistency (Cronbach's α = 0.68 ~ 0.93, McDonald's omega = 0.84 ~ 0.96) and test-retest reliability (ICC = 0.78 ~ 0.95) showed acceptable reliability. Additionally, Chinese nurses reported markedly lower scores for three dimensions, including "Response to Error", "Communication Openness", and "Reporting Patient Safety Events", when comparing the findings of this study with those from U.S. research utilizing the HSOPS 2.0. CONCLUSION: The Chinese version of HSOPS 2.0 demonstrated good validity and reliability in a Chinese sample of hospital nurses, which suggests that it can be used to measure nurse-perceived patient safety culture in future research and practice. Psychometric properties of the Chinese version of HSOPS 2.0 among other Chinese healthcare professionals remain to be confirmed.

The level and influencing factors of graduating nursing students' professional commitment from the perspective of Ecological Systems Theory: A cross-sectional study.

BACKGROUND: Increased professional commitment is essential for relieving the nursing workforce shortage, which is exacerbated by the COVID-19 pandemic. The professional commitment of graduating nursing students is a powerful predictor of their work commitment. However, limited information is available regarding graduating nursing students' professional commitment. Existing studies investigating nursing students' professional commitment are limited by their lack of theoretical foundation. OBJECTIVES: To investigate the level of graduating nursing students' professional commitment and its multilevel influencing factors from the perspective of the Ecological Systems Theory in the early days following the COVID-19 outbreak. DESIGN: A descriptive cross-sectional study. SETTING: Three educational institutions in Shanghai, China. PARTICIPANTS: 513 nursing students who were graduating with an associate or bachelor's degree. METHODS: The independent variables were measured by a self-designed questionnaire. The dependent variable professional commitment was measured by the Nursing Professional Commitment Scale. Hierarchical regression analyses, which allowed the independent variables entered in order, were performed to identify the significant predictor variables of the professional commitment and its dimensions. RESULTS: The level of professional commitment was 100.15 ± 20.35 (score ranged between 34 and 136). The individual factors (degree, whether had received a scholarship during the past academic years, ΔR2 = 0.142), family factors (parents and siblings' attitudes towards one's majoring in nursing, ΔR2 = 0.153), educational factors (academic faculty's belief in nursing profession, leaders' emphasis on nursing profession, satisfaction with clinical instructors' role modeling, ΔR2 = 0.097), and social factors (reason for majoring in nursing, perceived nurse-patient relationship, ΔR2 = 0.153) were significant predictors of the graduating nursing students' professional commitment (R2 = 47.6 %, F = 32.277, p < 0.001). CONCLUSIONS: The graduating nursing students had a moderate level of professional commitment, which needed to be improved. Nursing educators should comprehensively consider various factors to understand the relationship between individuals and environmental systems, and implement targeted interventions to shape the positive professional values of nursing students.

Bidirectional Associations between Parental Non-Responsive Feeding Practices and Child Eating Behaviors: A Systematic Review and Meta-Analysis of Longitudinal Prospective Studies.

BACKGROUND: Parental non-responsive feeding practices and child eating behaviors both play significant roles in childhood obesity. However, their longitudinal relationships are less clear. This systematic review aimed to examine their bidirectional associations. METHODS: A systematic search of five databases was conducted from inception to February 2022. Data synthesis was performed using a semi-quantitative and quantitative approach. RESULTS: A total of 14 studies with 15348 respondents were included. A total of 94 longitudinal effects from 14 studies of parental non-responsive feeding practices on child eating behaviors were investigated, and 19 statistically significant effects were discovered. Seventy-seven longitudinal effects from nine studies of child eating behaviors on parental feeding practices were examined, with fifteen being statistically significant. The pooled results of meta-analysis showed five statistically significant associations: parental restrictive feeding positively predicted child enjoyment of food (ß = 0.044; 95% CI: 0.004, 0.085); use of food as a reward positively predicted child emotional eating (ß = 0.09; 95% CI: 0.04, 0.15); child food responsiveness positively predicted restrictive feeding (ß = 0.04; 95% CI: 0.02, 0.06); use food as a reward (ß = 0.06; 95% CI: 0.03, 0.10). In addition, the pooled effects showed that child satiety responsiveness negatively predicted restrictive feeding (ß = -0.05; 95% CI: -0.08, -0.01). CONCLUSIONS: The bidirectional relationships between parental non-responsive feeding practices and child eating behaviors are inconsistent and a few showed statistical significance. Theory-driven longitudinal studies using validated instruments and controlling for potential confounders are needed to unveil their relationships and provide evidence for obesity prevention interventions.

Maternal perception of child weight and concern about child overweight mediates the relationship between child weight and feeding practices.

OBJECTIVE: To examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and maternal feeding practices. SETTING: Pudong District, Shanghai, China. PARTICIPANTS: A convenience sample of 1164 mothers who were primary caregivers of preschool children. RESULTS: Sixty per cent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0·212, P < 0·001). Structural equation modelling indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (ß = 0·035, P < 0·001), restriction (ß = 0·022, P < 0·001), and food as a reward (ß = -0·017, P < 0·05). CONCLUSION: Child weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.

Weight Perception Measured by Verbal Descriptions and Visual Descriptions: Which Measurement Correlates with Weight Loss Intentions among Female Nursing Students?

BACKGROUND: Young females tend to overestimate their weight status, which might induce unhealthy weight loss intentions and behaviours. This study aimed to examine weight perception measured by visual and verbal descriptions and its correlation with weight loss intentions among female nursing students. METHODS: A cross-sectional survey was conducted among 600 female nursing students from four medical colleges in Shanghai, China. The participants rated perceptions of their weight by selecting a silhouette from the female Photographic Figure Rating Scale (PFRS) and one of the following verbal descriptions: "very underweight", "slightly underweight", "normal", "overweight" or "obese". Weight loss intentions were measured using the question "How often do you want to lose weight?". Body mass index (BMI) was calculated from self-reported height and weight. Data were analysed using univariate and ordinal logistic regression analyses. RESULTS: The accuracy of weight perceptions measured by verbal descriptions and visual descriptions was 44.50% and 55%, respectively. In females with underweight BMI (n = 135), 88.15% and 49.63% accurately classified their weight using visual descriptions and verbal descriptions, respectively. These females were more likely to overestimate (53.83% vs. 14.50%) and less likely to underestimate (1.67% vs. 30.50%) their weight when using verbal descriptions than when using visual descriptions. For verbal descriptions, weight overestimation was associated with weight loss intentions (odds ratio, 1.80; 95% confidence interval, 1.25-2.60). However, for visual descriptions, the two variables were not associated. CONCLUSIONS: A mismatch occurred between weight perceptions measured by the two methods and BMI status among female nursing students. Compared with verbal descriptions, visual descriptions had higher weight perception accuracy. However, weight overestimation measured by verbal descriptions was more likely to be associated with stronger intentions to lose weight than that of visual descriptions. These findings suggest that methodological discrepancies should be taken into account when measuring weight perception in future studies.

Smartphone Overuse and Visual Impairment in Children and Young Adults: Systematic Review and Meta-Analysis.

BACKGROUND: Smartphone overuse has been cited as a potentially modifiable risk factor that can result in visual impairment. However, reported associations between smartphone overuse and visual impairment have been inconsistent. OBJECTIVE: The aim of this systematic review was to determine the association between smartphone overuse and visual impairment, including myopia, blurred vision, and poor vision, in children and young adults. METHODS: We conducted a systematic search in the Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, and ScienceDirect databases since the beginning of the databases up to June 2020. Fourteen eligible studies (10 cross-sectional studies and 4 controlled trials) were identified, which included a total of 27,110 subjects with a mean age ranging from 9.5 to 26.0 years. We used a random-effects model for meta-analysis of the 10 cross-sectional studies (26,962 subjects) and a fixed-effects model for meta-analysis of the 4 controlled trials (148 subjects) to combine odds ratios (ORs) and effect sizes (ES). The I2 statistic was used to assess heterogeneity. RESULTS: A pooled OR of 1.05 (95% CI 0.98-1.13, P=.16) was obtained from the cross-sectional studies, suggesting that smartphone overuse is not significantly associated with myopia, poor vision, or blurred vision; however, these visual impairments together were more apparent in children (OR 1.06, 95% CI 0.99-1.14, P=.09) than in young adults (OR 0.91, 95% CI 0.57-1.46,P=.71). For the 4 controlled trials, the smartphone overuse groups showed worse visual function scores compared with the reduced-use groups. The pooled ES was 0.76 (95% CI 0.53-0.99), which was statistically significant (P<.001). CONCLUSIONS: Longer smartphone use may increase the likelihood of ocular symptoms, including myopia, asthenopia, and ocular surface disease, especially in children. Thus, regulating use time and restricting the prolonged use of smartphones may prevent ocular and visual symptoms. Further research on the patterns of use, with longer follow up on the longitudinal associations, will help to inform detailed guidelines and recommendations for smartphone use in children and young adults.

Fatigue and Sleep Quality Predict Eating Behavior Among People With Type 2 Diabetes.

BACKGROUND: People with Type 2 diabetes frequently report increased fatigue and sleep disturbance. These symptoms might put them at a higher risk for unhealthy eating behavior-detrimental to diabetes control. OBJECTIVES: The aim of the study was to examine the effect of fatigue and sleep on eating behavior in people with Type 2 diabetes by using a daily diary approach. METHODS: Data from 56 patients were collected during a baseline interview and an 8-day ambulatory assessment period in the free-living setting. Each day, participants completed one diary upon awakening to assess their sleep duration and sleep quality during the previous night and morning fatigue. They also completed one diary before going to bed to assess their eating behavior during the day (e.g., uncontrolled eating, cognitive restraint, emotional eating, and snacking). Data from 7 days were analyzed using generalized estimating equations. RESULTS: During the 7 days, controlling for age, gender, and body mass index, between-person fatigue was a significant predictor of uncontrolled eating, emotional eating, and snacking. Similarly, controlling for the covariates, between-person sleep quality was a significant predictor of uncontrolled eating and emotional eating. No associations were found between sleep duration and eating behavior. DISCUSSIONS: At the between-person level, reporting higher fatigue or poorer sleep quality was associated with higher levels of unhealthy eating behavior. Patients with Type 2 diabetes with high fatigue or poor sleep quality may require additional attention to support their healthy eating.

Body weight misperception and associated factors among female nursing students in Shanghai / 中国学校卫生

Objective@#To explore the prevalence of body weight misperception and its influencing factors among female nursing students in Shanghai.@*Methods@#A total of 600 female nursing students from 4 medical colleges in Shanghai were recruited by a convenient sampling method and investigated weight perception and associated factors through online questionnaires.@*Results@#Only 44.50%(267) participants accurately described their body weight,and the proportion of body weight overestimation was 53.83%(323). The consistency between perceived weight status and actual weight status was poor (Kappa=0.20). Factors affecting weight overestimation among female nursing students were personal actual weight levels (OR=0.09-15.02), self-recognized weight level among peers (OR=17.85-202.67), the influence of female image in the media on weight loss ideas (OR=3.21-6.14), living area (OR=1.12-2.55) and stereotypes of obesity (OR=0.98)(P<0.05).@*Conclusion@#Female nursing students have low rate of accurate estimation of body weight and tend to overestimate.

Attitudes Toward Obese Persons and Weight Locus of Control in Chinese Nurses: A Cross-sectional Survey.

BACKGROUND: Obese individuals frequently experience weight-related bias or discrimination-even in healthcare settings. Although obesity bias has been associated with several demographic factors, little is known about the association of weight locus of control with bias against overweight persons or about weight bias among Chinese health professionals. OBJECTIVES: The aim of the study was to examine attitudes toward obese patients in a sample of Chinese registered nurses (RNs) and the relationship between weight bias and nurses' weight locus of control. METHODS: RNs working in nine community health service centers across Shanghai, China, answered three self-report questionnaires: The Attitudes Toward Obese Persons Scale (ATOP), the External Weight Locus of Control Subscale (eWLOC) from the Dieting Belief Scale, and a sociodemographic profile. Hierarchical, stepwise, multiple regression was used to predict ATOP scores. RESULTS: From among 385 invited, a total of 297 RNs took part in the study (77.1% response rate). Participants scored an average of 71.04 on the ATOP, indicating slightly positive attitudes toward obese persons, and 30.08 on the eWLOC, indicating a belief in the uncontrollability of body weight. Using hierarchical, stepwise, multiple regression, two predictors of ATOP scores were statistically significant (eWLOC scores and status as a specialist rather than generalist nurse), but explained variance was low. DISCUSSION: Chinese RNs seemed to have relatively neutral or even slightly positive attitudes toward obese persons. Those nurses who believed that obesity was beyond the individual's control or worked in specialties were more likely to have positive attitudes toward obese people. Improved understanding of the comprehensive etiology of obesity is needed.

Chinese version of the Aging Perceptions Questionnaire (C-APQ): assessment of reliability and validity.

OBJECTIVES: To assess the reliability and validity of the Chinese version of Aging Perceptions Questionnaire (C-APQ). METHOD: Participants aged 65 years and over were recruited from February 2012 to November 2012. The Aging Perceptions Questionnaire was translated into Chinese version professionally. Content validity was examined by a panel of seven experts; item reliabilities were assessed by test-retest; internal consistency was assessed by Cronbach's α coefficient; half of the sample (N = 379) was selected to explore factorial structure of the C-APQ by exploratory factor analysis (EFA) and another half of the sample (N = 379) was selected to confirm the findings from the EFA by confirmatory factor analysis (CFA). Statistical package SPSS version 18.0 and Amos 17.0 were used for the analysis. RESULTS: The Cronbach's α coefficient of the C-APQ was 0.884. The test-retest reliability was satisfactory, with all intraclass correlation coefficients greater than 0.4. The overall content validity index was greater than 0.99. Seven factors (timeline acute/chronic, timeline cyclical, emotional representations, control positive, control negative, consequences positive and consequences negative) were identified in EFA and confirmed in CFA. CONCLUSION: The C-APQ could be a reliable and a valid measure of the self-perceptions of aging in the elderly in China, which may help to improve the life quality and extend longevity of the elderly.

Chinese version of the nursing students' perception of instructor caring (C-NSPIC): assessment of reliability and validity.

BACKGROUND: The nursing students' perceptions of instructor caring (NSPIC) is an instrument to assess the influence of caring interactions between students and faculty on students' ability to care. However, the validity and reliability of the Chinese version has not yet been studied. OBJECTIVES: The study aimed to assess the validity and reliability of the Chinese version of NSPIC (C-NSPIC). DESIGN: This is a cross-sectional study. SETTING: The study was performed in three Tertiary Grade A (top level in China) and teaching hospitals in Shanghai, China. PARTICIPANTS: The participants of the study are nursing students during clinical practice. METHODS: The English version of nursing students' perception of instructor caring scale was professionally translated into Chinese and a pilot test was undertaken to ensure the equivalence of meaning and cultural appropriateness. The content validity of the C-NSPIC was examined by a panel of eight experts, and test-retest was conducted to assess the item reliabilities of the scale. A convenience sampling method was used to recruit nursing students. A first sample (N=256) was recruited to explore the factorial structure of the C-NSPIC using exploratory factor analysis (EFA), and a validation sample (N=358) was recruited to confirm the findings from the EFA using confirmatory factor analysis (CFA). SPSS version 16.0 was used for the EFA and Amos 17.0 was used for the CFA. RESULTS: The Cronbach's alpha coefficient of the C-NSPIC was 0.933. The test-retest reliability was satisfactory, with the ICC scores for each item ranging from 0.603 to 0.962. The overall content validity index was 0.96. Five factors (control versus flexibility, supportive learning climate, confidence through caring, appreciation of life meaning and respectful sharing) were identified in EFA, which was consistent with that of the original English version, and were confirmed by CFA. CONCLUSION: The C-NSPIC can serve as a reliable and valid instrument for assessing the nursing students' perception of instructor caring in China, which may help to improve the nursing students' caring ability in China.

Hypothesis for resolution of diabetes after sleeve gastrectomy.

Sleeve gastrectomy improves glucose metabolism as effective as Roux-en Y gastric bypass. The underlying mechanism is still not clear. We hypothesized that inhibition of GOAT activity was one therapeutic consequence of SG, and a status of low ghrelin level with low AG: UAG ratio might be an optimal gastrointestinal hormone profile for the remission of T2DM.

Fas ligand expression in colon cancer: a possible mechanism of tumor immune privilege.

AIM: To detect the expression of Fas ligand (FasL) in colon cancer tissues and cell lines and analyze the function of FasL-expressing colon cancer cells in inducing Fas-sensitive T lymphocyte apoptosis. METHODS: Ninety surgically resected colon cancer tissues and 15 hepatic metastasis specimens were investigated by immunohistochemical method with normal colon mucosa and colon adenoma as control. The relationship between FasL expression and pathologic features was also analyzed. FasL expression of 4 colon cancer cell lines, SW620, Lovo, LS-174T and SW1116, were detected by Western blotting assay. The function of FasL expressed on colon cancer cells was determined by coculture assay with Jurkat T lymphocytes, the apoptotic rate of which was detected by flow cytometry assay. RESULTS: Fifty-six (62.22%) cases of all the 90 colon cancer tissues and all (100%) the liver metastasis specimens expressed FasL, significantly higher than normal colon mucosa and colonic adenoma. Higher expression of FasL was found in more advanced stage of colon cancer and in cancer tissues with lymphatic or hepatic metastasis. All the colon cancer cell lines were found to express FasL. After coculture with the SW1116 cells for 24 h with an effector: target ratio 10:1, the rate of apoptosis of Jurkat cells rose from 1.9% to 21.0%. CONCLUSION: The expression of FasL is upregulated in colon cancer and the functionally expressed FasL can induce apoptosis of Fas-expressing T lymphocytes.