Health information-seeking experience in people with head and neck neoplasms undergoing treatment: a qualitative study.

PURPOSE: To describe the health information-seeking experience and its influencing factors of people with head and neck neoplasms undergoing treatment. METHODS: This was a descriptive phenomenology study. Participants were recruited by purposive sampling. The semistructured interviews and all observation results were recorded. The data were analysed using Colaizzi's method. RESULTS: Fourteen participants were selected. We identified four themes that illustrate factors that influence the health information-seeking behaviour of participants: patients' awareness of health information needs, patients' competence, doctor-patient communication, and online advertising interference. We also determined the value of different types of information and patients' information needs and sources. CONCLUSION: These findings can help professionals understand patients' behaviours and think about how to deliver practical information support in a network environment to guide patients in continuous information seeking while taking specific factors into account.

Associations of CKIP-1 and LOX-1 polymorphisms with the risk of type 2 diabetes mellitus with hypertension among Chinese adults.

AIMS: Type 2 diabetes mellitus (T2DM) and hypertension are common high-incidence diseases, closely related, and have common pathogenic basis such as oxidative stress. Casein kinase 2 interacting protein-1 (CKIP-1) and low-density lipoprotein receptor (LOX-1) are considered to be important factors affect the level of oxidative stress in the body. The main purpose of this study was to explore the relationship between CKIP-1 (rs6693817 A > T, rs2306235 C > G) and LOX-1 (rs1050283 G > A, rs11053646 C > G) polymorphisms and the risk of hypertension and diabetes, and try to find new candidate genes for diabetes and diabetes with hypertension etiology in Chinese population. METHODS: 574 T2DM patients and 597 controls frequently matched by age and sex were selected for genotyping of CKIP-1 (rs6693817 A > T, rs2306235 C > G) and LOX-1 gene (rs1050283 G > A, rs11053646 C > G). Logistic regression was used to analyze the correlation between different genotypes and the risk of T2DM and T2DM with hypertension, and the results were expressed as odds ratio (OR) and 95% confidence interval (95% CI). RESULTS: We found that the risk of T2DM in the AA + AT genotype of rs6693817 was higher than that in the TT genotype in Chinese population (OR = 1.318, 95%CI: 1.011-1.717, P = 0.041), and the difference was still significant after adjustment (OR = 1.370, 95%CI: 1.043-1.799, Padjusted = 0.024), the difference of heterozygotes (AT vs TT: OR = 1.374, 95%CI: 1.026-1.840, Padjusted = 0.033) was statistically significant. But after Bonferroni correction, the significance of the above sites disappeared. And rs6693817 was associated with the risk of T2DM combined with hypertension before and after adjustment in dominant model (OR = 1.424, 95% CI: 1.038-1.954, P = 0.028; OR = 1.460, 95% CI: 1.057-2.015, Padjusted = 0.021, respectively) and in heterozygote model (OR = 1.499, 95% CI: 1.069-2.102, P = 0.019; OR = 1.562, 95% CI: 1.106-2.207, Padjusted = 0.011, respectively). However, only the statistical significance of the heterozygous model remained after Bonferroni correction. rs2306235, rs1050283 and rs11053646 were not significantly correlated with T2DM and T2DM combined with hypertension risk (P > 0.05). CONCLUSIONS: The results suggest that CKIP-1 rs6693817 is related to the susceptibility of Chinese people to T2DM with hypertension, providing a new genetic target for the treatment of diabetes with hypertension with in the future.

Association between the MCP-1 -2518 A > G (rs1024611) polymorphism and susceptibility to type 2 diabetes mellitus and diabetic nephropathy: a meta-analysis.

BACKGROUND: Studies evaluating the association between monocyte chemoattractant protein-1 (MCP-1) -2518 A > G (rs1024611) polymorphism and type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN) are contradictory. The present study aims to provide a comprehensive assessment and more reliable estimation of the relationship between the MCP-1 rs1024611 polymorphism and T2DM and DN risk. METHODS: Eligible articles were retrieved from the PubMed, Web of Science, EMBASE, Cochrane, and China National Knowledge Infrastructure databases. The effect summary odds ratios (ORs) and 95% confidence intervals (CIs) were obtained to calculate the summary effect size. Heterogeneity was analyzed by subgroup analysis and meta-regression. Publication bias was tested using funnel plots and Egger's test. RESULTS: In total, sixteen studies were included. Thirteen studies involving 2,363 patients with T2DM and 4,650 healthy controls found no significant association between the MCP-1 rs1024611 polymorphism and T2DM in the overall population. Ethnicity stratification found an association between the GG + GA genotype and decreased T2DM risk in Caucasians (OR = 0.79, 95% CI: 0.66-0.93, P = 0.006; PQ = 0.372). No significant risks were found in the Asian population for any genetic models. Seven studies found an association between the GG + GA genotype and DN risk in the Asian population (OR = 1.37, 95% CI: 1.11-1.71, P = 0.004, PQ = 0.222). No significant risks were found in the Caucasian population with any genetic models. There were no statistically significant differences in genotype distribution between patients with T2DM and DN in Asians or Caucasians. Meta-regression revealed that genotyping method was a major driver of heterogeneity in five genetic models (GG + GA vs. AA: P = 0.032; GG vs. GA + AA: P = 0.028; GG vs. AA: P = 0.035; GG vs. GA: P = 0.041; G vs. A: P = 0.041). CONCLUSION: The MCP-1 rs1024611 polymorphism is associated with susceptibility to T2DM in Caucasians and DN in Asians. Larger, well-designed cohort studies are needed in the future to verify this association.

Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model.

Objective: Medication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level. Methods: This cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman's correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively. Results: Data from 388 participants were analyzed. The median (IQR [P25-P75]) score for medication adherence was 4.00 (2.00-4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (ßtotal -0.236 [95% confidence interval (CI) -0.333 to -0.140]). Medication adherence was influenced by frailty (ßdirect -0.192 [95% CI -0.284 to -0.099]) both directly and indirectly through health literacy (ßindirect -0.044 [95% CI -0.077 to -0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect -0.052 [95% CI -0.092 to -0.106]; effect -0.041 [95% CI -0.071 to -0.012]; effect -0.026 [95% CI -0.051 to -0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects. Conclusion: A moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.

Chronotypes and their association with sleep quality among Chinese college students of Anhui Province: a cross-sectional study.

OBJECTIVES: To describe the prevalence of chronotype and sleep quality among Chinese college students and explore the relationship between chronotype and sleep quality. DESIGN: A cross-sectional study. SETTING: Four colleges and universities in Anhui, China, between November and December 2020. PARTICIPANTS: A total of 4768 college students were recruited using a stratified, multistage, cluster sampling survey. OUTCOME MEASURES: Morningness-Eveningness Questionnaire 19 was used to determine the chronotype of the students and the Pittsburgh Sleep Quality Index (PSQI) was used to measure their sleep quality. The multiple logistic regression model was used to explore the potential association between chronotype and sleep quality. RESULTS: The self-reported proportions of evening-type (E-type), neutral-type and morning-type among college students were 51.17%, 45.14% and 3.69%, respectively. The mean PSQI score was 4.97±2.82 and the prevalence of poor sleep quality was 18.2%. After adjusting the covariates by multiple logistic regression analysis, E-type was positively associated with subjective sleep quality (OR=1.671, 95% CI 1.414 to 1.975), sleep latency (OR=1.436, 95% CI 1.252 to 1.647), sleep duration (OR=2.149, 95% CI 1.506 to 3.067), habitual sleep efficiency (OR=1.702, 95% CI 1.329 to 2.180), daytime dysfunction (OR=1.602, 95% CI 1.412 to 1.818) and overall poor sleep quality (OR=1.866, 95% CI 1.586 to 2.196). CONCLUSIONS: College students mainly exhibited E-type, and an elevated prevalence of poor sleep quality existed among these students. The E-type was positively associated with poor sleep quality.

A Novel Vermiculite/TiO2 Composite: Synergistic Mechanism of Enhanced Photocatalysis towards Organic Pollutant Removal.

There has been increasing concern over water pollution, which poses a threat to human life and health. Absorption by low-cost absorbents is considered to be a cost-effective and efficient route. However, the non-reusability of absorbents greatly limits their applications. In this study, a novel vermiculite/TiO2 composite combining the inexpensive absorbent with the commonly used photocatalyst was firstly synthesized via the sol-gel method. On the one hand, the organic pollutants are absorbed by vermiculite and then decomposed through the photocatalysis process, enabling the next round of absorption and creating an absorption-decomposition reusable cycle. On the other hand, the modulation effect of optical and electronic structure on the prepared TiO2 photocatalyst by the vermiculite incorporation could significantly improve the photocatalytic activity and eventually enhance the aforementioned cyclic degradation capacity. The layer-structured vermiculite (Vt) supports a uniform coverage of TiO2 at an optimized ratio, providing an optimal adsorption environment and contact area between the photocatalyst and methylene blue (MB) molecules. Vt/TiO2 heterojunction is formed with Si-O-Ti bonding, at which electrons transfer from Vt to TiO2, enriching electron density in TiO2 and favoring its photocatalytic activity. Furthermore, the incorporation of Vt increases the light absorption of TiO2 in the visible range by narrowing the optical band gap to 1.98 eV, which could promote the generation of photo-excited carriers. In addition, PL measurements revealed that the carrier recombination is substantially suppressed, and the charge separation and migration are greatly enhanced by a factor of 3. As a result, the decomposition rate of MB is substantially increased 5.3-fold, which is ascribed to the synergistic effects of the elevated photocatalysis and the large absorption capacity governed by the chemisorption mechanism of the intra-particle diffusion. These results pave the way for composite design towards efficient, economical, and pragmatic water pollution treatment.

Cross-cultural adaptation and psychometric validation of the Chinese version of career success in nursing scale (CSNS).

OBJECTIVE: To translate the career success in nursing scale (CSNS) into Chinese and evaluate its psychometric properties. BACKGROUND: A lower sense of career success seriously affects the enthusiasm of nurses and increases their turnover rate. Therefore, an accurate assessment of the career success level of nurses is necessary. However, China does not have a professional tool for assessing the career success of nurses. METHODS: The stratified sampling method was used to recruit participants from 22 hospitals of different grades in 5 cities in China. A total of 650 and 348 subjects were selected for item analysis and reliability and validity tests, respectively, of the translated initial scale. RESULTS: The Chinese version of the CSNS (C-CSNS) with 33 items had good psychometric properties. Cronbach's α was 0.960, split-half reliability was 0.893, and ICC within two weeks was 0.981. Exploratory factor analysis extracted 5 common factors that explained 63.73% of the total variance, and confirmatory factor analysis supported acceptable construct validity. CONCLUSION: The C-CSNS has adequate construct validity and excellent psychometric properties and can be used for accurate assessment of nurses' career success. IMPLICATIONS FOR NURSING MANAGEMENT: A new tool that is more suitable for the Chinese hospital nursing context is available for evaluating Chinese clinical nurses' career success. Nursing managers can formulate appropriate management strategies according to the evaluation results to assist nurses in career development planning, thereby improving their career success level.

Pelvic floor dysfunction and its influencing factors during radiotherapy in cervical cancer survivors: A cross-sectional study.

PURPOSE: Radiotherapy can negatively affect the pelvic floor function of patients with cervical cancer; however, the impact of different radiotherapy times and other related factors on pelvic floor function in cervical cancer survivors during radiotherapy remains unclear. We aimed to investigate the status of pelvic floor dysfunction (PFD) in cervical cancer survivors during radiotherapy and to analyze the factors influencing PFD. METHODS: In this cross-sectional study, a convenience sampling method was used to recruit cervical cancer survivors undergoing radiotherapy from January 2022 to July 2022 at a tertiary first-class hospital located in northeastern China. The Pelvic Floor Distress Inventory-Short Form 20 was used for participants' self-report of their PFD during radiotherapy. RESULTS: Data from 120 cervical cancer survivors were included in this study. The results showed that the mean PFDI-20 total score was 32.69 ± 7.76. Multiple stepwise linear regression analysis showed that 56.9% of the variance in PFD was explained by age (ß = 0.25, p < 0.001), body mass index (ß = 0.32, p < 0.001), recurrence (ß = 0.29, p < 0.001), number of radiotherapy sessions (ß = 0.39, p < 0.001), and number of deliveries (ß = 0.35, p < 0.001). CONCLUSION: It is important to pay more attention to the PFD status of cervical cancer survivors receiving radiotherapy. Future therapeutic approaches should involve early identification of relevant risk factors early to provide patients with personalized care at different stages of radiotherapy for reducing their discomfort and improving their health-related quality of life.

Psychosocial adjustment and its influencing factors among head and neck cancer survivors after radiotherapy: A cross-sectional study.

PURPOSE: Psychosocial adjustment is an important issue in patients' long-term survival. Understanding psychosocial adjustment and its influencing factors in head and neck cancer survivors after radiotherapy is essential to help them return to society and lead a normal life. The purpose of this study was to describe the level of psychosocial adjustment and explore its influencing factors in head and neck cancer patients. METHODS: Between May 2019 and May 2022, 253 head and neck cancer survivors at a tertiary hospital in northeast China were enrolled in a cross-sectional study. The research instruments comprised the Demographic and Clinical Characteristics Questionnaire, the Self-report Psychosocial Adjustment to Illness Scale (PAIS-SR), the General Self-efficacy Scale (GSES), the Social Support Rating Scale (SSRS) and the M.D. Anderson Symptom Survey-head and neck Questionnaire (MDASI-H&N). RESULTS: The mean PAIS-SR score was 42.31 ± 16.70 (moderate). The multiple regression model revealed that 73.2% of the variance in psychosocial adjustment was explained by marital status (ß = -0.114, P = 0.005), return to work or not (ß = -0.275, P < 0.01), self-efficacy (ß = -0.327, P < 0.01), subjective support (ß = -0.106, P = 0.043), utilization of support (ß = -0.172, P < 0.01), and trouble with symptoms in daily life (ß = 0.138, P = 0.021). CONCLUSION: The psychosocial adjustment of head and neck cancer survivors after radiotherapy is an issue that needs to be addressed, and medical staff should develop effective, individualized interventions to improve their psychosocial adjustment by increasing their social support, improving their self-efficacy and strengthening symptom management according to their actual situation.

The impact of hazes on schizophrenia admissions and the synergistic effect with the combined atmospheric oxidation capacity in Hefei, China.

OBJECTIVES: Currently, most epidemiological studies on haze focus on respiratory diseases, cardiovascular diseases, etc. However, the relationship between haze and mental health has not been adequately explored. The purpose of this study was to investigate the influence of hazes on schizophrenia admissions and to further explore the potential interaction effect with the combined atmospheric oxidative indices (Ox and Oxwt). METHODS: We collected 5328 cases during the cold season from 2013 to 2015 in Hefei, China. By integrating the Poisson Generalized Linear Models with the Distributed Lag Non-linear Models, the association between haze and schizophrenia admissions was evaluated. The interaction between hazes and two combined oxidation indexes was tested by stratifying hazes and Ox, and Oxwt. RESULTS: Haze was found to be significantly linked to an increased risk of hospitalization for schizophrenia, and a 9-day lag effect on schizophrenia (lag 3-lag 11), with the largest effect on lag 6 (RR = 1.080, 95% confidence interval (CI): 1.046-1.116). Males, females, and <40 y (people under 40 years old) were sensitive to hazes. Furthermore, in the stratified analysis, we found synergies between two combined oxidation indexes and hazes. The interaction relative risk (IRR) and relative excess risk due to interaction (RERI) between Ox and hazes were 1.170 (95% CI: 1.071-1.277) and 0.149 (95% CI: 0.045-0.253), respectively. For Oxwt, the IRR and RERI were 1.179 (95% CI: 1.087-1.281) and 0.159 (95% CI: 0.056-0.263), respectively. It is noteworthy that this synergistic effect was significant in males and <40 y when examining the various subgroups in the interaction analysis. CONCLUSIONS: Our findings suggest that exposure to haze significantly increases the risk of hospitalization for schizophrenia. More significant public health benefits can be obtained by prioritizing haze periods with high combined atmospheric oxidation capacity.

Association of tag single nucleotide polymorphisms (SNPs) at lncRNA MALAT1 with type 2 diabetes mellitus susceptibility in the Chinese Han population: A case-control study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic, lifelong disease. The molecular mechanisms and pathophysiology of T2DM have not yet been fully elucidated. Dysregulation of the long non-coding RNA metastasis associated lung adenocarcinoma transcript 1 (lncRNA MALAT1) is considered one of the main contributing factors of the dysfunction found in many diseases, including those of the endocrine system. The aim of this study was to investigate the association between lncRNA MALAT1 single nucleotide polymorphisms (SNPs) and T2DM in the Chinese Han population. METHODS: We genotyped three SNPs (rs3200401 C > T, rs619586 A > G, rs11227209 C > G) of the MALAT1 gene, including 571 T2DM patients and 526 controls. The association between different genotypes and the risk of T2DM was analyzed using logistic regression, and the results were expressed by odds ratio (OR) and its 95% confidence interval (95%CI), and then stratified by age, sex, and BMI. P < 0.05 on both sides was considered as statistically significant. RESULTS: We found that the CT + TT genotypes of the rs3200401 polymorphism were significantly associated with an increased risk of T2DM in Chinese Han population (OR = 1.77; 95% CI:1.35-2.33; Padjusted < 0.001), whereas MALAT1 rs619586 AG + GG genotypes were associated with a reduced risk of T2DM (OR = 0.67; 95% CI:0.48-0.94; Padjusted = 0.021). Subsequent stratified analysis showed that compared with the rs3200401 CC genotype, CT + TT genotypes were associated with an increased risk of T2DM in the male, female, age ≥ 65 years, and BMI ≥ 24 subgroups (OR = 1.68, 95% CI:1.10-2.56, Padjusted = 0.016; OR = 1.83, 95% CI:1.27-2.62, Padjusted = 0.001; OR = 1.86, 95% CI:1.38-2.52, Padjusted < 0.001; OR = 2.13, 95% CI:1.45-3.15, Padjusted < 0.001; respectively). Haplotype analysis showed that T-A-C haplotype had a 1.533-fold increased risk of T2DM (95% CI, 1.208-1.945, P < 0.001) and C-G-G was associated with a decreased risk of T2DM. No significant association was found between rs11227209 and T2DM risk (P > 0.05). CONCLUSION: The results suggest that MALAT1 rs619586 and rs3200401 confer susceptibility for T2DM in the Chinese Han population and provide new genetic targets for the treatment of diabetes and its complications in the future.

Effects of Baduanjin exercise in nasopharyngeal carcinoma patients after chemoradiotherapy: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of traditional Chinese Baduanjin Qigong exercises on the physical and psychological recovery of patients with nasopharyngeal carcinoma after chemoradiotherapy. METHODS: Eighty-eight nasopharyngeal carcinoma patients who had completed chemoradiotherapy were randomly divided into the Baduanjin intervention group (n = 44) and the control group (n = 44). Patients in the intervention group practised Baduanjin exercise for 12 weeks, with the frequency of 40 min a day and 5 days a week after discharge from the hospital. Participants in the control group received usual care. Outcome indicators included quality of life (QOL), complications, cancer-related fatigue (CRF), sleep quality, anxiety, and depression. The intention-to-treat and per-protocol populations were compared using univariate analysis of variance. Partial eta squared was used as a measure of the effect size. RESULTS: A total of 75 patients completed the study. In the intention-to-treat analysis, after 12 weeks of exercise intervention, there were significant increases in the global FACT-H&N (95% CI = 2.09 to 11.47, ηp2 = 0.088), social/family well-being (95% CI = 0.13 to 2.26, ηp2 = 0.055), emotional well-being (95% CI = 0.34 to 2.44, ηp2 = 0.074), and head and neck cancer subscale scores (95% CI = 0.17 to 3.86, ηp2 = 0.052) in the Baduanjin group compared with the control group at the 12th week. In the per-protocol analysis, there were significant increases in the global FACT-H&N (95% CI = 4.11 to 11.75, ηp2 = 0.190), physical well-being (95% CI: 0.50 to 3.04, ηp2 = 0.096), social/family well-being (95% CI: 0.32 to 2.15, ηp2 = 0.090), emotional well-being (95% CI: 0.60 to 2.53, ηp2 = 0.125), functional well-being (95% CI: 0.25 to 2.49, ηp2 = 0.075), and head and neck cancer subscale (95% CI: 1.08 to 4.08, ηp2 = 0.139) scores in the Baduanjin group compared with the control group at the 12th week. CONCLUSION: The findings in this study indicate that Baduanjin exercise is an effective and appropriate intervention for improving quality of life and is worthy of recommendation and implementation by oncology nurses in the rehabilitation process of patients with nasopharyngeal carcinoma.

Association of rs2910164 in miR-146a with type 2 diabetes mellitus: A case-control and meta-analysis study.

Objective: Several studies have shown that miR-146a rs2910164 (C > G) is associated with type 2 diabetes mellitus (T2DM) susceptibility, but the results are still controversial. This study is divided into two parts, and one is to explore the relationship between miR-146a rs2910164 polymorphism and the genetic susceptibility of T2DM in Chinese Han population. Second, a meta-analysis on the basis of a larger sample size was used to determine whether this is a susceptibility gene for T2DM. Methods: A case-control study including 574 T2DM patients and 596 controls was used to evaluate the association of miR-146a rs2910164 polymorphism with the risk of T2DM in Chinese Han People. Then, we systematically searched studies investigating the correlation between miR-146a rs2910164 polymorphism and T2DM susceptibility published before April 2022 from PubMed, Web of Science, Wanfang, and China National Knowledge Infrastructure database, and a meta-analysis including six studies was carried out. The results were expressed by odds ratio (OR) and its 95% confidence interval (95% CI). Results: In a case-control study, we found that there were no statistical differences in genotype frequencies between T2DM and control group. Subgroup analysis showed that, compared with the CC genotype, CG + GG genotype was associated with a decreased risk of T2DM in the subgroup of individuals ≥ 65 years old (OR = 0.75; 95% CI: 0.58-0.98; P adjusted = 0.032) and BMI < 18.5 (OR = 0.16; 95% CI: 0.03-0.89; P adjusted = 0.037). In overall meta-analysis, significant heterogeneity was detected. No significant association between miR-146a rs2910164 polymorphism and T2DM was observed in all genetic models under random effects models. Subgroup analysis revealed that there was a significant difference in genotype frequencies between the T2DM and control group in recessive model (CC vs. CG + GG: OR = 1.79; 95% CI: 1.08-2.96; PQ = 0.307, I 2 = 4.0%) and homozygote model (CC vs. GG: OR = 1.79; 95% CI: 1.07-3.00; PQ = 0.216, I 2 = 34.7%) in Caucasians. Conclusion: The results of our study demonstrate that the miR-146a rs2910164 polymorphism might have ethnicity-dependent effects in T2DM and may be related to T2DM susceptibility in Caucasians.

Association of learning environment and self-directed learning ability among nursing undergraduates: a cross-sectional study using canonical correlation analysis.

OBJECTIVES: This study explores the relationship between the perception of the learning environment and self-directed learning (SDL) ability among nursing undergraduates. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study was conducted in December 2020 with 1096 junior and senior undergraduate nursing students (aged 16-22) from Wannan Medical College in Anhui Province, China. OUTCOME MEASURES: The Chinese version of the Dundee Ready Educational Environment Measure questionnaire and a validated Chinese version of college students' SDL ability scale were used to assess students' perceptions about their learning environment and their SDL ability. Canonical correlation analysis was performed to evaluate their correlation. RESULTS: The total score for the learning environment was 120.60 (scoring rate: 60.30%), and the score for SDL ability was 89.25 (scoring rate: 63.75%). Analysis indicated that the first canonical correlation coefficient was 0.701 and the contribution rate was 94.26%. The perception of the learning environment was mainly determined by students' perception of learning (SPL) and academic self-perceptions (SASP), with SDL ability mainly determined by self-management ability and cooperative learning ability. SPL and SASP were positively correlated with self-management ability and cooperative learning ability. Multiple linear regression analysis revealed that SPL, SASP, students' perceptions of atmosphere and students' social self-perceptions had a significant impact on SDL ability. CONCLUSIONS: The SDL ability of nursing undergraduates was not high. SPL and SASP were positively correlated with self-management ability and cooperative learning ability. Nursing educators can improve students' SDL ability by changing their learning environment, using, for example, new student-centred teaching methods.

Associations between Chinese college students' anxiety and depression: A chain mediation analysis.

OBJECTIVE: Anxiety and depression are great public health concerns among college students. The purpose of this study was to explore whether sleep quality and quality of life (QoL) play mediating roles in anxiety and depression among Chinese college students. METHOD: A total of 2757 college students (mean age = 19.07; SD = 1.14) completed the questionnaires, including a brief demographic survey. The 2-item General Anxiety Disorder (GAD-2) and the 2-item Patient Health Questionnaire (PHQ-2) were used to assess the symptoms of anxiety and depression, respectively. And the Pittsburgh Sleep Quality Index (PSQI) and the Short-Form 36 Health Survey (SF-36) were used to evaluate college students' sleep quality and QoL, respectively. Mediation analyses were conducted by using PROCESS macro in the SPSS software. RESULT: Anxiety had both direct and indirect effects on depression. Sleep quality and QoL were not only independent mediators in the relationship between anxiety and depression but also chain mediators. CONCLUSION: The results of the current study highlight the crucial role of early intervention for depression with a focus on college students with anxiety, more especially, on those with poorer sleep quality and lower QoL.

Effectiveness of seminar-case learning for use in practice teaching of statistics for undergraduates majoring in preventive medicine: a prospective cluster-randomized controlled trial.

BACKGROUND: The seminar-case learning (SCL) method is a case-oriented teaching model, with teachers and students as the main body of teaching, characterized by communication, interaction, and mutual inspiration. This study explored the effects of the SCL method versus traditional lecture-based learning (LBL) in the statistics curriculum for undergraduate students majoring in preventive medicine. Research questions were: 1) whether the scores of students in the experimental group (the SCL model) were higher than those in the control group (the LBL model); 2) whether the students' satisfaction in the experimental group was better than that in the control group; and 3) whether the self-report benefit of students in the experimental group was better than that in the control group. METHODS: We conducted a two-armed cluster-randomized education intervention trial in practice teaching of health statistics among undergraduates majoring in preventive medicine. Two administrative classes (classes 1-4 and classes 5-8) were divided into the experimental group and the control group according to the principle of drawing lots. The students in two groups received the same statistical theory course. For the arrangement of statistical practice course, the experimental group adopted the SCL model, and the control group used the LBL model. The teaching effect was evaluated via an examination and an anonymous questionnaire survey. RESULTS: Scores for noun explanation questions in the experimental group showed no statistical significance with that of the control group(U = 2911.0, P = 0.964). The scores of single choice, calculation, and case analysis questions, and the total scores were significantly higher than that of the control group (P < 0.05). Students' satisfaction with arrangements of the practice course in the experimental group (92.41%) was significantly higher than that of in the control group (77.03%), the difference was statistically significant (χ2 = 7.074, P = 0.008). The self-report benefit of students in the experimental group was better than that in the control group (P < 0.05). CONCLUSION: As an effective method of high-quality education, the SCL model is worthy of further promotion in the practice teaching of preventive medicine.

Association Between Online Self-Directed Learning Ability and Negative Emotions Among College Students During the COVID-19 Pandemic: A Cross-Sectional Study in Anhui Province, East China.

Background: This study investigated the correlation between depression, anxiety, and stress among college students engaged in online learning during the coronavirus disease 2019 (COVID-19) pandemic and self-directed learning (SDL) ability, which could provide a scientific basis for mental health education of the college students. Methods: A cross-sectional study was conducted among 5,558 students from two universities in Anhui province, East China. The Depression, Anxiety, and Stress Scale-21 (DASS-21) and the Self-directed Learning Ability Scale were used to conduct an online questionnaire survey. Results: A total of 35.15, 36.32, and 17.24% of college students reported symptoms of depression, anxiety, and stress, respectively. Males and nonmedical students were at higher risks to suffer from depression, anxiety, and stress. In adjusted model, compared with Q1 of self-management ability, the odds ratio (OR) of the Q2, Q3, and Q4 were as follows: 0.635 (0.531-0.759), 0.504 (0.415-0.611), and 0.312 (0.248-0.392) for depression; 0.639 (0.535-0.764), 0.653 (0.540-0.789), and 0.421 (0.338-0.525) for anxiety; and 0.649 (0.523-0.805), 0.579 (0.457-0.733), and 0.482 (0.364-0.637) for stress. For information capability, decrease in risk was even more pronounced: Q2 (0.654, 0.540-0.794), Q3 (0.560, 0.454-0.690), and Q4 (0.233, 0.181-0.301) for depression; Q2 (0.781, 0.646-0.945), Q3 (0.616, 0.501-0.757), and Q4 (0.276, 0.216-0.353) for anxiety; and Q2 (0.444, 0.357-0.553), Q3 (0.454, 0.357-0.578), and Q4 (0.272, 0.202-0.368) for stress. Compared with the Q2 group of cooperation learning ability, cooperation learning ability quartiles were positively associated with depression (Q1: 1.382, 95% CI: 1.138-1.678), anxiety (Q4: 1.260, 95% CI: 1.008-1.576), and stress (Q1: 2.002, 95% CI: 1.583-2.532; Q3: 1.600, 95% CI: 1.252-2.044; Q4: 1.674, 95% CI: 1.243-2.255). Conclusion: The prevalence of depression, anxiety, and stress among college students was high for those studying online at home during the COVID-19 pandemic, especially among nonmedical students and males. SDL ability was negatively associated with negative emotions of the college students during this period of online learning.

Impact of short-term temperature variability on emergency hospital admissions for schizophrenia stratified by season of birth.

Diurnal temperature range (DTR) and temperature change between neighboring days (TCN) are important meteorological indicators closely associated with global climate change. However, up to date, there have been no studies addressing the impacts of both DTR and TCN on emergency hospital admissions for schizophrenia. We conducted a time-series analysis to assess the relationship between temperature variability and daily schizophrenia onset in Hefei, an inland city in southeast China. Daily meteorological data and emergency hospital admissions for schizophrenia from 2005 to 2014 in Hefei were collected. After stratifying by season of birth, Poisson generalized linear regression combined with distributed lag nonlinear model (DLNM) was used to examine the relationship between temperature variability and schizophrenia, adjusting for long-term trend and seasonality, mean temperature, and relative humidity. Our analysis revealed that extreme temperature variability may increase the risk for schizophrenia onset among patients born in spring, while no such association was found in patients born in summer and autumn. In patients born in spring, the relative risks of extremely high DTR comparing the 95th and 99th percentiles with the reference (50th, 10 °C) at 3-day lag were 1.078 (95 % confidence interval (CI) 1.025-1.135) and 1.159 (95 % CI 1.050-1.279), respectively. For TCN effects, only comparing 99th percentile with reference (50th, 0.7 °C) was significantly associated with emergency hospital admissions for schizophrenia (relative risk (RR) 1.111, 95 % CI 1.002-1.231). This study suggested that exposure to extreme temperature variability in short-term may trigger later days of schizophrenia onset for patients born in spring, which may have important implications for developing intervention strategies to prevent large temperature variability exposure.

Exposure to bisphenol A and the development of asthma: A systematic review of cohort studies.

BACKGROUND: There is conflicting evidence about the association between bisphenol A (BPA) exposure and childhood asthma risk. We aimed to review the epidemiological literature on the relationship between prenatal or postnatal exposure to BPA and the risk of childhood asthma/wheeze. METHODS: The PubMed database was systematically searched, and additional studies were found by searching reference lists of relevant articles. RESULTS: Six studies fulfilled the eligibility criteria. Three studies found that prenatal BPA exposure is associated with an increased risk of childhood wheeze, while another study reported a reduced risk of wheeze. Regarding the postnatal BPA exposure, three studies demonstrated an increased risk of childhood asthma/wheeze. CONCLUSIONS: The mean prenatal BPA was associated with the risk of childhood wheeze/asthma. Besides, the influence of BPA exposure during the second trimester of pregnancy on the prevalence of childhood wheeze was marked. Further studies are urgently needed to explore the underlying mechanism about adverse effect of BPA exposure on childhood wheeze/asthma.

Nonlinear and Interactive Effects of Temperature and Humidity on Childhood Hand, Foot and Mouth Disease in Hefei, China.

BACKGROUND: Hand, foot and mouth disease (HFMD) is one of the major infectious diseases among children and remains a health threat, especially among Asian countries. Many epidemiologic studies suggested significant association of air temperature and humidity with childhood HFMD; however, evidence on the temperature effects on childhood HFMD in temperate cities is limited, and the interactive effects of temperature and humidity have not been studied yet. METHODS: Daily counts of HFMD in children younger than 15 years of age and daily meteorologic variables during 2010 to 2012 were obtained in Hefei, China. A distributed lag nonlinear model was applied to estimate the potential nonlinear association between temperature and childhood HFMD. The interactive effects between temperature and humidity on childhood HFMD were also investigated. RESULTS: Temperature rise was associated with higher risk of childhood HFMD. Within the incubation period of HFMD, temperature rise appeared to have the acute effects on childhood HFMD, and a 5°C increase of temperature at lag 0-6 days was associated with 24.8% (95% confidence interval: 11.94%-39.10%) increase of childhood HFMD. Females and children of 0-4 years of agewere more vulnerable to temperature rise. Notably, there were obvious combined effects between temperature and humidity on childhood HFMD-the risk of childhood HFMD elevated at higher temperature and humidity level. CONCLUSIONS: This study provides evidence that temperature and humidity may jointly affect childhood HFMD, and such interactive impact needs to be considered when evaluating the temperature-childhood HFMD relationship.