Nursing Workloads and Lower Urinary Tract Symptoms Among Chinese Female Nurses: The Mediating Role of Delayed Voiding Behaviors.

PURPOSE: Lower urinary tract symptoms (LUTS) are a challenge to the healthy nursing workforce. Nurses confront various objective and subjective nursing workloads which contribute to their LUTS, but less is known about how nursing workloads influence their LUTS. This study is designed to test hypotheses that delayed voiding behaviors mediate the relationships between nursing workloads and LUTS in female nurses. MATERIALS AND METHODS: This study analyzed the baseline data collected from an ongoing cohort study named Nurse Urinary Related Health Study in China. LUTS of nurses in 20 tertiary hospitals were assessed with the International Consultation on Incontinence Questionnaire‒Female Lower Urinary Tract Symptoms. Objective nursing workloads including working environment, working hours, and working schedule were collected, and perceived stress, the proxy of the subjective nursing workload, was assessed with the Perceived Stress Scale. Delayed voiding behaviors were assessed with 3 questions adapted from the Taiwan Nurse Bladder Survey. Structural equation modeling was used to run the mediation model. RESULTS: More than half (51%) of 13,191 female nurses had LUTS. Median age was 31 years (IQR 27-37). When delayed voiding behaviors served as a mediator, the direct effects of subjective nursing workload rather than objective nursing workloads on LUTS were significant. CONCLUSIONS: Nursing workloads influence nurses' LUTS via delayed voiding behaviors. Strategies tailored to delayed voiding behaviors should be developed, and these may work with stress-reducing strategies as the gatekeepers for nurses' bladder health.

Effect of vitamin D on pregnancy in women with polycystic ovary syndrome: retrospective and prospective studies.

RESEARCH QUESTION: Does vitamin D affect the pregnancy rate of patients with polycystic ovary syndrome (PCOS) receiving ovulation-induction therapy? DESIGN: The retrospective study included 200 patients with PCOS and 200 healthy women. The prospective study included 160 patients with PCOS receiving vitamin D or placebo supplementation. Pregnancy rates were assessed after a maximum of three cycles of ovulation induction. Serum concentrations of 25-hydroxycalciferol [25-(OH)D3], LH, FSH, progesterone, oestradiol, testosterone and fasting insulin; LH/FSH ratio; and body mass index were evaluated. RESULTS: In the retrospective study, patients with PCOS had lower 25-(OH)D3 concentrations than healthy women, pregnant patients with PCOS had higher 25-(OH)D3 concentrations than non-pregnant patients with PCOS (both P = 0.000), and the pregnancy rate was lower in the vitamin-D-deficient group compared with the non-vitamin-D-deficient group (P = 0.022). In the prospective study, compared with placebo supplementation, vitamin D supplementation increased the serum concentration of 25-(OH)D3 (P = 0.000), and reduced the LH/FSH ratio, and concentrations of LH and testosterone significantly (all P ≤ 0.049). After the intervention, it was found that the LH/FSH ratio, and concentrations of LH and testosterone were significantly lower in both groups compared with pre-intervention (P = 0.000). After ovulation induction, the pregnancy rate was higher in patients in the vitamin D supplementation group compared with the placebo supplementation group (P = 0.049). CONCLUSIONS: Vitamin D deficiency is common in patients with PCOS, and vitamin-D-deficient patients with PCOS have lower pregnancy rates after ovulation induction compared with non-vitamin-D-deficient patients with PCOS. Vitamin D supplementation can improve the pregnancy rate and mitigate basic hormone disorders. Therefore, monitoring vitamin D supplementation and checking vitamin D concentrations before and during interventions are essential for patients with PCOS.

A study to untangle the puzzle of urinary incontinence and frailty co-occurrence among older adults: The roles of depression and activity engagement.

AIMS: To explore the co-occurrence of urinary incontinence and frailty by testing the roles of depression and activity engagement guided by the mechanisms of common cause and interaction pathways. DESIGN: A secondary analysis of a 1-year three-wave panel data collected from older nursing home residents in China. METHODS: Changes in depression and activity engagement were regressed on urinary incontinence and frailty incidence underpinned by the common cause mechanism of chronic conditions co-occurrence, and these changes were also taken as mediators linking from frailty to urinary incontinence incidence supported by the interaction pathways' mechanism. RESULTS: A total of 348 older adults were included in this study, and 55.7% were women. The co-occurrence of urinary incontinence and frailty was found in 16.7% of the participants at baseline. Older adults with sole frailty at baseline had almost twice the rate of incident urinary incontinence (32.7%) compared with those without (16.7%) over a 1-year period. The subsample analyses showed that changes in depression and activity engagement failed to significantly predict the incidence of urinary incontinence and frailty. The mediating roles of these changes linking frailty to urinary incontinence incidence were also not statistically significant. CONCLUSION: The co-occurrence of urinary incontinence and frailty is prevalent in older nursing home residents. Older adults with frailty at baseline are more likely to develop urinary incontinence a year later. The common cause and interaction pathways mechanisms for the co-occurrence of urinary incontinence and frailty were not verified with changes in depression and activity engagement. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The phenomenon of urinary incontinence and frailty co-occurrence should be given extreme emphasis. Although statistically significant findings on the roles of depression and activity engagement were not inferred, this study provides multiple possibilities for future studies to test and depict a clear picture of this co-occurrence. IMPACT: What problem did the study address? This study was designed to test the roles of depression and activity engagement in predicting the incidence of urinary incontinence and frailty, and the mediating roles in linking frailty to urinary incontinence incidence. What were the main findings? Despite the methodological pitfalls in literature have been addressed, neither depression nor activity engagement would significantly predict the incidence of urinary incontinence and frailty in older adults. Their mediating roles in linking frailty to urinary incontinence incidence were also not significant. Where and on whom will the research have an impact? Our findings add important pieces of evidence to promote researchers' understanding and provide an important basis for untangling the puzzle of urinary incontinence and frailty co-occurrence. REPORTING METHOD: The report of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Relationship between fear of falling and quality of life in nursing home residents: The role of activity restriction.

This study investigates the mediating role of activity restriction in the relationship between the fear of falling and health outcomes. This was a cross-sectional study with convenience sampling of 316 nursing home residents. Generalized structural equation modeling was conducted to test the mediating role. The results showed that residents with fear of falling were more likely to restrict their activities and residents who often or always restricted activities reported lower levels of quality of life and higher levels of depression. Severe activity restriction accounted for 75 % of the total effect of fear of falling on quality of life and 69 % of the total effect of fear of falling on depression. Fall prevention efforts should focus on strategies or interventions to reduce residents' excessive fear of falling and promote activity engagement. Physical and social activities will not only prevent future falls but also improve residents' quality of life and mental health.

The sleep patterns and their associations with mental health among nursing home residents: a latent profile approach.

BACKGROUND: Nursing home residents commonly experience poor sleep conditions. However, few studies have explored the potential sleep patterns among nursing home residents. This study aimed to identify the sleep patterns in nursing home residents, compare residents' characteristics across sleep patterns, and examine the relationships between sleep patterns and residents' mental health (i.e., depressive and anxiety symptoms). METHODS: This cross-sectional study was conducted in 27 nursing homes in Jinan, China, from March to June 2018. In total, 353 participants were recruited via convenience sampling, and of which, 326 completed the survey. A latent profile analysis was performed to identify sleep patterns based on the seven dimensions of the Pittsburgh Sleep Quality Index. Bivariate analyses were conducted to compare residents' characteristics among the sleep patterns. Mixed-effects logistic regression analyses were adopted to investigate the relationships between sleep patterns and residents' mental health. RESULTS: Three sleep patterns were identified, including 'good sleepers', 'poor sleepers without hypnotic use', and 'poor sleepers with hypnotic use'. Residents' gender, education, pain, instrumental activities of daily living, and number of chronic conditions were significantly differentiated across the sleep patterns. Compared with 'good sleepers', 'poor sleepers without hypnotic use' were significantly associated with more depressive symptoms (OR = 3.73, 95% CI = 2.09, 6.65, p < 0.001), but not with anxiety symptoms (OR = 2.04, 95% CI = 0.97, 4.29, p = 0.062); whereas 'poor sleepers with hypnotic use' had significantly more depressive (OR = 5.24, 95% CI = 2.54, 10.79, p < 0.001) and anxiety symptoms (OR = 5.02, 95% CI = 2.13, 11.83, p < 0.001). CONCLUSIONS: This study reveals three distinct sleep patterns in nursing home residents and their significant associations with residents' mental health. These findings can inform future research to develop appropriate and tailored intervention strategies for improving sleep and promoting mental health for nursing home residents.

Resident- and Institutional-Level Factors, Frailty, and Nursing Homes Residents.

BACKGROUND: Frailty is a major cause of adverse health outcomes, such as hospitalization, falls, disability, and morbidity, among older adults; the elucidation of factors affecting frailty trends over time may facilitate the development of effective interventions. OBJECTIVES: This study aimed to examine the trend of frailty over time (at baseline, 6-month follow-up, and 12-month follow-up) among Chinese nursing home residents and identify associated resident- and institutional-level factors. METHODS: This longitudinal study included 353 residents who were admitted into 27 nursing homes in Jinan, China. Frailty was defined based on the seven self-reported components of the FRAIL-NH scale, which was designed for nursing home residents. Information was gathered using scales that assessed resident-level (sociodemographic characteristics and physical, psychological, and social factors) and institutional-level characteristics (hospital affiliation, fitness sites, green space, occupancy percentage, staff-resident ratio, and staff turnover rate). These data were subjected to a multilevel linear analysis. RESULTS: Frailty was identified in 49.7% of residents at baseline and exhibited a progressively worsening trend over 1 year. Among institutional-level characteristics, the provision of fitness sites in nursing homes was a protective factor for frailty. Among resident-level characteristics, undernutrition was a significant independent risk factor and played a key role in increasing frailty over time. Other risk factors for frailty included younger age, poorer self-rated health, lower physical function, chewing difficulty, loneliness, anxiety, and being less active in leisure activities. DISCUSSION: Frailty was highly prevalent among Chinese nursing home residents and gradually increased over time. The results of this study could be used to inform the development of interventions targeted at modifiable risk factors and shape public health policies aimed at promoting healthy aging and delaying frailty and its adverse outcomes.

Quality of life in cancer patients with different preferences for nurse spiritual therapeutics: The role of psychological capital.

AIM: To explore the status of quality of life and psychological capital and analyse the different effects of psychological capital on the quality of life of cancer patients with different preferences for nurse spiritual therapeutics. DESIGN: A cross-sectional survey was used. METHODS: Two hundred and eight cancer patients were recruited using convenience sampling from a tertiary Chinese hospital, between March and July 2019. Data on preferences for nurse spiritual therapeutics (PNST), psychological capital (PsyCap) and quality of life (QoL) were collected using paper questionnaires. Hierarchical multiple regression was employed to investigate the different influences of PsyCap on QoL of cancer patients with various levels of PNST. RESULTS: Compared with patients having high PNST, patients with mild-moderate PNST experienced lower self-efficacy, hope, optimism, PsyCap and social/family well-being. PsyCap significantly explained the variance on QoL of patients with various levels of PNST. Age, gender, presence of caregiver were significant factors influencing physical, social/family and emotional well-being of patients with high PNST. CONCLUSION: The present study demonstrates disparities in PsyCap and QoL between cancer patients with mild-moderate and high PNST. It is essential to be aware of the positive influences of PsyCap on QoL and develop effective interventions for patients to improve their QoL, especially for those with mild-moderate PNST. IMPACT: It is necessary to realize the benefits of PsyCap on QoL of cancer patients with various levels of PNST. Appropriate training for nurses needs to be developed to promote their spiritual care competencies. Moreover, supportive interventions should be developed for cancer patients to improve their PsyCap and QoL.

Associations between perceived overqualification, organisational commitment and work passion of nurses: A multicentre cross-sectional study.

AIM: To investigate the associations between perceived overqualification, organisational commitment and work passion of nurses. BACKGROUND: Few studies have considered the effects of perceived overqualification and organisational commitment on work passion of nurses, especially in developing countries. METHODS: This is a multicentre cross-sectional study. A total of 4511 nurses from eight tertiary hospitals were recruited. The Scale of Perceived OverQalification (SPOQ), the Organizational Commitment Scale (OCS) and the Work Passion Scale (WPS) were used to collect the data. Hierarchical multiple regression were employed. RESULTS: Perceived overqualification and organisational commitment were the main predictors for both harmonious and obsessive passions (each p < .001). The unique effect of organisational commitment (ßharmonious  = .608, ßobsessive  = .556) on work passion were six to eight times larger than these of perceived overqualification (ßharmonious = -.079, ßobsessive = .085). CONCLUSION: Our findings indicate that high perceived overqualification clearly reduces nurses' harmonious passion and increases their obsessive passion, whereas high organisational commitment significantly promotes nurses' harmonious and obsessive passions. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should distinguish the different effects of perceived overqualification and organisational commitment on work passion. Effective intervention should be developed to release nurses' potential abilities and improve their organisational commitment and work passion. Chinese Clinical Trial Registry: ChiCTR2100047974.

Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi-centre prospective point prevalence study.

Despite increasing preventive efforts, pressure injury still occurs in intensive care patients. This study was aimed to describe pressure injury prevalence, risk factors, and prevention practices in adult intensive care patients. This was a multi-centre, one-day, prospective point prevalence study in which a total of 198 intensive care units from 21 provinces in China participated. Overall and ICU-acquired prevalence in intensive care patients were 12.26% and 4.31%, respectively. Consistent with earlier reports, almost half of the ICU-acquired pressure injuries were at stage I, one-fourth were at stage 2, and the most common body sites for pressure injuries were sacral and heel region. Risk factors identified were consistent with prior studies. Repositioning was the most commonly used pressure injury prevention strategy, followed by alternating pressure mattresses/overlays, floating heels, and air-filled mattresses/overlays. These reflect a good level of adherence to recommended international pressure injury prevention clinical practice guidelines. The results provide a baseline reference for overall and ICU-acquired prevalence among adult intensive care patients in China. Future research on what contributed to the lower pressure injury incidence in China needs to be conducted to inform healthcare organisations on their future preventive strategies for pressure injury prevention.

Role of resilience and social support in the relationship between loneliness and suicidal ideation among Chinese nursing home residents.

OBJECTIVES: Loneliness is a risk factor of suicidal ideation, while resilience and social support are protective factors; however, the complex mechanisms behind these factors have not been examined among nursing home residents. This study evaluated the mediating effect of resilience on the association between loneliness and suicidal ideation and whether this mediating effect was moderated by social support. METHODS: Residents (N = 538; Aged ≥60years; 321 female, 217 male) from 37 nursing homes in China completed this cross-sectional study. Their loneliness, resilience, social support, and suicidal ideation were measured. Regression analyses using bootstrapping methods were conducted to explore the mediating and moderating effects. RESULTS: Some residents (14.9%, 80/538) reported current suicidal ideation. The correlation between loneliness and suicidal ideation was partially mediated by resilience (indirect effect = 0.067, 95% CI = 0.011-0.122). Overall social support moderated the resilience on suicidal ideation, indirectly impacting loneliness on suicidal ideation (moderating effect = 0.086 [95% CI = 0.005-0.167]). Support from family and nursing home staff moderated the direct (path c') and indirect path (path b) of the mediation model, respectively. CONCLUSIONS: Our findings underscore the vital role of resilience and social support to buffer against suicidal ideation, which is common among nursing home residents in China.HighlightsWe evaluated suicidal ideation in mainland Chinese nursing home residentsLoneliness and suicidal ideation were partially mediated by resilienceSocial support moderated the effect of loneliness and resilience on suicidal ideationThe results were self-reported and are not generalizable to all of ChinaResilience and social support can buffer against suicidal ideation among residents.

AMPKα2 knockout enhances tumour inflammation through exacerbated liver injury and energy deprivation-associated AMPKα1 activation.

Tissue damage and its associated-inflammation act as tumour initiators or propagators. AMP-activated protein kinase (AMPK) is activated by environmental or nutritional stress factors, such as hypoxia, glucose deprivation, and other cell injury factors, to regulate cell energy balance and differentiation. We previously have reported that AMPKα2 deficiency resulted in the energy deprivation in tumour-bearing liver and the enhanced-hepatocyte death. In this study, AMPKα2 knockout mice and the liver metastasis model of colon cancer cells were used to address the role of AMPKα isoforms in tumour inflammation. First, we found that the AMPKα2 deficiency exacerbated the liver injury and recruitment of macrophages. Meanwhile, although compensatory expression of AMPKα1 was not significant after AMPKα2 knockout, AMPKα1 phosphorylation was elevated in remnant liver in AMPKα2 knockout mice, which was positively associated with the enhanced energy deprivation in the AMPKα2 deficient mice. Furthermore, the activated AMPKα1 in macrophage contributed to its polarizing to tumour-associated phenotype. Thus, the enhanced tumour-associated inflammation and activation of AMPKα1 in the AMPKα2 deficient mice may exacerbate the tumour development by affecting the tumour inflammatory microenvironment. Our study suggests that the two isoforms of AMPKα, AMPKα1 and AMPKα2 play different roles in controlling tumour development.

The prevalence of CGG repeat expansion mutation in FMR1 gene in the northern Chinese women of reproductive age.

BACKGROUND: The prevalence of CGG repeat expansion mutation in FMR1 gene varies among different populations. In this study, we investigated the prevalence of this mutation in women of reproductive age from northern China. METHODS: A total of 11,891 pre-conceptional or pregnant women, including 5037 pregnant women and 7357 women with the history of spontaneous abortion or induced abortion due to delayed growth of the embryos, were recruited. The number of CGG repeats in FMR1 was measured by the TRP-PCR method. We also offered genetic counseling and prenatal diagnosis to the women carrying pre-mutation or full mutation alleles. RESULTS: The prevalence of pre-mutation in reproductive women in northern China was 1/410, higher than that in southern China and Korea but lower than that in western countries. We also found that the prevalence of pre-mutation was relatively high (1/320) in women with abortion history. CONCLUSION: Screening for CGG repeat expansion mutation in FMR1 should be recommended to the women with the history of spontaneous abortion or induced abortion due to delayed growth of the embryos.

Development of a quality of life questionnaire for nursing home residents in mainland China.

OBJECTIVE: To develop and validate a quality of life (QOL) questionnaire for nursing home (NH) residents in mainland China. METHODS: A cross-sectional study including a development sample (n = 176) and validation sample (n = 371) of NH residents aged 60 and older was conducted between 2015 and 2016 in Jinan, Shandong Province, China. Resident interviews, literature reviews, expert panels, and pilot studies were used to identify QOL domains and items pertinent to NH life. Exploratory and confirmatory factor analysis were used to develop and validate a QOL questionnaire. Reliability (internal consistency, spilt-half reliability, and test-retest reliability) and validity (construct and criterion validity) were evaluated for the questionnaire. RESULTS: The self-report Chinese NH QOL questionnaire had 9 domains and 38 items including physical health (4 items), food enjoyment (6 items), security (3 items), environmental comfort (5 items), autonomy (2 items), meaningful activity (3 items), interrelationship (6 items), family relationships (3 items), and mood (6 items). The nine-factor model was confirmed with the following fit indices: χ2/df = 1.872, root mean square error of approximation = 0.049, comparative fit index = 0.913, and Tucker-Lewis index = 0.903. The 38-item NH QOL questionnaire showed satisfactory construct validity, criterion validity, internal consistency (Cronbach's alpha = 0.89, spilt-half reliability = 0.73, test-retest reliability = 0.76). CONCLUSIONS: The NH QOL questionnaire appears to be a reliable and valid instrument and should be incorporated into a set of quality measures for use with NH residents in mainland China.

Family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers.

Walsh's family resilience theory indicated that families could foster resilient outcomes among their members when they are facing changes or crises. However, little is known about family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers. Therefore, this study aimed to examine the direct and indirect relationships between family resilience, breast cancer survivors' post-traumatic growth (PTG), quality of life (QOL), and their principal caregivers' caregiver burden. A total of 108 breast cancer survivors/principal caregivers pairs completed a cross-sectional questionnaire survey in a comprehensive cancer of a public hospital in Shandong Province, China. The structural equation modelling (SEM) results showed that family resilience had direct and indirect effects on QOL and caregiver burden, and it was positively related to the PTG of the survivors. The survivors' PTG was positively related to their QOL, and their QOL was negatively associated with caregiver burden. Therefore, a better understanding of how family resilience contributes to PTG and QOL of the survivors and caregiver burden could help clinicians tailor interventions to enhance interventions aimed at improving both survivors' and caregivers' well-being.

Relationships among occupational stress, toileting behaviors, and overactive bladder in nurses: A multiple mediator model.

AIMS: To investigate: (a) the prevalence of overactive bladder among male and female operating room nurses; (b) the unhealthy toileting behaviours that nurses adopt to void their bladders; and (c) the mediating roles that different toileting behaviours play in the relationship between occupational stress and overactive bladder. DESIGN: A cross-sectional design was used. METHODS: This study was conducted from July - September 2016 in Jinan, China. Four hundred eligible operating room nurses in five hospitals were recruited. Data were collected through survey questionnaires including the nurse job stress scale, the toileting behaviours scale and the overactive bladder symptom score questionnaire. Multivariate linear or logistic regression models, as appropriate, were used to test the mediation effect of each toileting behaviour on the relationship between occupational stress and overactive bladder. RESULTS: Overactive bladder was highly prevalent in both male and female nurses working in operating rooms. Approximately one of three nurses reported experiencing an overactive bladder. The most common unhealthy toileting behaviour was delayed voiding. Unhealthy toileting behaviours mediated the relationship between occupational stress and overactive bladder. With high levels of occupational stress, nurses tended to adopt unhealthy toileting behaviours to empty their bladders. The more the nurses engaged in unhealthy toileting behaviours (e.g. delayed voiding and straining to void), the greater the likelihood of having overactive bladders. CONCLUSIONS: This study highlights the mediating role of toileting behaviours on occupational stress and overactive bladder. To accommodate occupational stress, nurses engaged in unhealthy toileting behaviours that were detrimental to their bladder health.

Overactive bladder symptom severity, bother, help-seeking behavior, and quality of life in patients with type 2 diabetes: a path analysis.

BACKGROUND: This study aimed to investigate the relationships among overactive bladder (OAB) symptom severity, bother, help-seeking behavior, and quality of life (QOL) in patients with type 2 diabetes. METHODS: A total of 127 diabetic patients, aged at least 18 years, with overactive bladder from a hospital in Shandong Province, China, were recruited for this study. Symptom severity, bother, and quality of life were assessed using the Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), and Overactive Bladder Questionnaire Short Form (OAB-q SF), respectively. Help-seeking behavior was assessed by asking patients whether they consulted health care professionals or received treatment for their bladder problems. A two-step path analysis was performed to analyze the data. RESULTS: OAB symptom severity was directly associated with lower levels of QOL, and the strength of this association was no longer significant when taking bother and help-seeking behavior into account. Bother increased with OAB symptom severity, and patients with bothersome OAB tended to have lower levels of QOL. Moreover, bother increased help-seeking behavior; however, patients who sought help tended to have lower levels of QOL. CONCLUSIONS: Our findings highlight the role of bother and help-seeking behavior in the relationship between OAB symptom severity and QOL. To improve a patient's QOL, health care providers should focus not only on symptom bother but also on dysfunctional help-seeking patterns.

Vapocoolant spray versus placebo spray/no treatment for reducing pain from intravenous cannulation: A meta-analysis of randomized controlled trials.

BACKGROUND: Intravenous cannulation is a routine procedure in hospitalized patients, and pain can occur during the cannulation process. Vapocoolant spray is an advantageous analgesic alternative for intravenous cannula insertion. OBJECTIVES: The objective of our meta-analysis is to compare the effectiveness of vapocoolant spray and placebo spray/no treatment for pain reduction during intravenous cannulation. DESIGN: A meta-analysis to identify evidence from randomized controlled trials. METHODS: We searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang Data for publications before January 2018. The outcomes measured included pain during intravenous cannulation, patients' anxiety due to the spray, first attempt success rate, technical ease of the attempt, adverse events, and participant satisfaction. RESULTS: We included 11 studies with 1410 patients. The meta-analysis results showed that vapocoolant spray significantly decreased pain during intravenous cannulation compared with placebo spray or no treatment in both adults and children. In addition, vapocoolant spray significantly increased the technical ease of the attempt and participants' satisfaction. However, patients' anxiety due to spray, first attempt success rate, and adverse events were not associated with vapocoolant spray. CONCLUSIONS: This meta-analysis suggests that vapocoolant spray significantly decreased pain during intravenous cannulation when compared with placebo spray or no treatment in both adults and children. We recommend the use of vapocoolant spray during intravenous cannulation to decrease pain. Future research may help to unify pain measurement standards. Patients' anxiety due to spray and technical ease of the attempt should be explored in future research.

Toileting behaviors and overactive bladder in patients with type 2 diabetes: a cross-sectional study in China.

BACKGROUND: Overactive bladder is more prevalent in patients with type 2 diabetes than in those without diabetes. Unhealthy toileting behaviors may be associated with the development and worsening of overactive bladder symptoms. However, little is known about the relationships between toileting behaviors and overactive bladder in patients with diabetes. This study aimed to identify unhealthy toileting behaviors that patients with type 2 diabetes adopted to empty their bladders and investigate the relationships between toileting behaviors and overactive bladder. METHODS: Patients with type 2 diabetes from the endocrinology outpatient department of a hospital in China were recruited. The Toileting Behaviors-Women's Elimination Behavior and Overactive Bladder Symptom Score questionnaires were used to assess the patients' toileting behaviors and overactive bladder symptoms. A multivariate logistic regression model was used to explore the relationships between toileting behaviors and overactive bladder. RESULTS: Almost 14% of patients with diabetes had overactive bladder. The unhealthiest toileting behavior was premature voiding. In the multivariate logistic regression analysis, premature voiding (OR = 1.286, p = 0.016) and straining to void (OR = 1.243, p = 0.026) were associated with overactive bladder. There was a greater likelihood of having overactive bladder when patients engaged in unhealthy toileting behaviors (premature voiding and straining to void). CONCLUSIONS: Overactive bladder in patients with type 2 diabetes was more than twofold higher than that in the general population. Thus, overactive bladder is not just an inconsequential condition for patients with diabetes. Unhealthy toileting behaviors, e.g., premature voiding and straining to void, may contribute to the onset or worsening of overactive bladder in patients with diabetes. Identification and awareness of these modifiable behavioral factors during diabetes care is an essential component of primary prevention, alleviation, and management of overactive bladder symptoms.

Characteristics of the Chinese rural elderly living in nursing homes who have suicidal ideation: A multiple regression model.

BACKGROUND: Chinese rural elderly are at higher risk of committing suicide. However, little is known about the suicidal ideation (SI) of institutional elderly residents in rural China. METHODS: 250 participants aged 60 or above living in Chinese rural nursing homes were recruited. Data were collected on subjects' SI, social-demographic characters, physical illness and psychological factors. Univariate comparisons and path analysis were conducted then. RESULTS: 19.5% (40/205) of the participants reported a current SI. Hopelessness and depression had significant direct impacts on SI, and self-esteem and loneliness can impact SI through the mediating of depression and hopelessness. Visiting frequency of children, number of physical illnesses and social activities can also affect SI through the mediating of loneliness or self-esteem. CONCLUSION: As the first study on path analysis of SI of rural institutional elderly, the findings are significant. All these factors in our model should be considered when interventions are being conducted.

Relationships among symptom severity, coping styles, and quality of life in community-dwelling women with urinary incontinence: a multiple mediator model.

PURPOSE: To investigate the relationships among symptom severity, coping styles, and quality of life (QOL) in community-dwelling women with urinary incontinence (UI). METHODS: A total of 592 women with UI participated in this cross-sectional study. Bivariate Pearson's correlation was used to examine the correlations between symptom severity, coping styles, and QOL. Multivariate regression models and Sobel tests were used to test the mediating effect of coping styles. Additionally, a multiple mediator model was used to examine the mediating role of coping styles collectively. All regression models were adjusted for age, education, marital status, income, duration of UI, and type of UI. RESULTS: Participants tended to use avoidant and palliative coping styles and not use instrumental coping style. Avoidant and palliative coping styles were associated with poor QOL, and partially mediated the association between symptom severity and QOL. Nearly 73% of the adverse effect of symptom severity on QOL was mediated by avoidant and palliative coping styles. CONCLUSIONS: The use of avoidant and palliative coping styles was higher with more severe urine leakage, and QOL tended to be poorer. Coping styles should be addressed in UI management. It may be of particular value to look closely at negative coping styles and implement education and training of patients in improving their coping skills related to managing UI, which will in turn improve their QOL.