Association of Smoking-Related Knowledge, Attitude, and Practices (KAP) with Nutritional Status and Diet Quality: A Cross-Sectional Study in China

Knowledge, attitude, and practice toward Helicobacter pylori among residents in Northeast China‌

The primary aim of this study was to investigate the knowledge, attitude, and practice(KAP) concerning Helicobacter pylori (H. pylori) and the factors influencing them among northeast China individuals. A questionnaire regarding H. pylori, grounded in the KAP theoretical framework, was tailored for northeast China individuals. The questionnaire was conducted online and analyzed statistically. Additionally, structural equation modeling was applied to verify the interconnections among social media usage, knowledge, attitude, and practice. A total of 712 valid questionnaires were analyzed. The mean scores were 2.69 ± 1.03 for knowledge, 4.09 ± 0.81 for attitude, and 3.40 ± 0.73 for practice. Various factors including sex, occupation, and social media usage influenced knowledge, attitude, and practice scores, with social media usage exerting a notable impact on all facets. The structural equation modeling analysis demonstrated that social media usage promoted higher levels of knowledge, attitude, and practice regarding H. pylori. Individuals possessing a higher level of knowledge and attitude concerning H. pylori demonstrated superior preventive practice. Northeast China residents have limited H. pylori knowledge but show a positive attitude and good preventive practice. The utilization of social media has significantly improved the population's knowledge, attitude, and practice concerning H. pylori.

Association between behavioural risk factors for hypertension and concordance with the Dietary Approaches to Stop Hypertension dietary pattern among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study

South Asians are among the fastest-growing immigrant population group in the United States (U.S.) with a unique disease risk profile. Due in part to immigration and acculturation factors, South Asians engage differently with behavioural risk factors (e.g. smoking, alcohol intake, physical activity, sedentary behaviour, and diet) for hypertension, which may be modified for the primary prevention of cardiovascular disease. Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, we conducted a cross-sectional analysis to evaluate the association between behavioural risk factors for cardiovascular disease and diet. We created a behavioural risk factor score based on smoking status, alcohol consumption, physical activity, and TV watching. We also calculated a Dietary Approaches to Stop Hypertension (DASH) dietary score based on inclusion of relevant dietary components. We used both scores to examine the association between engaging with risk factors for hypertension and the DASH diet among a cohort of South Asian adults. We found that participants with 3-4 behavioural risk factors had a DASH diet score that was 3 units lower than those with no behavioural risk factors (aβ: -3.25; 95% CI: -4.28, -2.21) and were 86% less likely to have a DASH diet score in the highest category compared to the lowest DASH diet score category (aOR: 0.14; 95% CI: 0.05, 0.37) in the fully adjusted models. These findings highlight the relationship between behavioural risk factors for hypertension among South Asians in the U.S.

The Impact of Short-Form Video and Optimistic Bias on Engagement in Oral Health Prevention: Integrating a KAP Model

College students are recognized as a demographic particularly susceptible to higher oral health risks due to irregular and unhealthy habits. While previous research has underscored these risks through descriptive studies within this group, a significant gap persists in the literature regarding the impact of contemporary media, specifically oral-health-related content, on the engagement in oral health prevention among Chinese college students. To address this gap, this study, guided by the extended knowledge-attitude-practice (KAP) theory model, explores the direct, mediated, and serially mediated mechanisms through which exposure to oral health short-form videos on Douyin influences their participation in oral health prevention. An empirical cross-sectional online survey was conducted, with valid data (N = 421) analyzed using descriptive statistics and hierarchical regression. Mediation and serial mediation analyses were also performed using SPSS version 25.0. The analysis revealed that exposure to oral health short-form videos had a positive direct effect on both oral health knowledge and the reduction of optimistic bias among Chinese college students. Furthermore, a significant serial mediation effect of oral health knowledge and oral health attitude was identified. The findings underscore the substantial applicability and explanatory power of the extended KAP theory model in understanding engagement in oral health prevention.

Factors Associated with the Practice of Low-Carb and Low-Fat Diets among Participants of the Longitudinal Study of Adult Health (ELSA-Brasil)

In the field of nutrition, both low-carbohydrate (LCD) and low-fat (LFD) diets were initially intended for specific subgroups but are now being embraced by the broader population for various purposes, including aesthetics and overall health. This study aims to assess sociodemographic, health, and lifestyle factors influencing diet choices among public servants in the ELSA-Brasil cohort. Diets were classified as LCD or LFD based on the Brazilian Diabetes Society (<45%) and WHO guidelines (<30%) respectively. A total of 11,294 participants were evaluated (45.3% men; 54.7% women) with a mean age of 52 ± 0.08 years. Having overweight, altered waist circumference, and a history of smoking confers higher chances of adopting an LCD compared to the usual diet, while being over 52 years, non-White race/skin color, in a lower income stratum, and having diagnosis of hypertension and/or diagnosis of diabetes mellitus decrease these chances. Regarding LFDs, belonging to the non-White race/skin color, being over 52 years old, being divorced, and practicing low physical activity decrease the chances of following such a diet compared to the usual diet. In conclusion, factors like age, socioeconomic status, health, and physical activity levels can be the key to understanding why individuals choose restrictive diets beyond clinical advice.

Sustaining Healthy Habits: The Enduring Impact of Combined School-Family Interventions on Consuming Sugar-Sweetened Beverages among Pilot Chinese Schoolchildren

This study assesses the enduring impact of combined school- and family-based interventions on reducing the consumption of sugar-sweetened beverages (SSBs) among schoolchildren in China. Two primary schools were assigned at random to either the Intervention Group or the Control Group, in Nanjing, eastern China. All students were in grade three and received an invitation to participate. In the first year, students in the Intervention Group received one-year intervention measures, including monthly monitoring, aiming to decrease the consumption of SSBs. Students in the Control Group only received regular monitoring without interventions. In the second year, both groups received only regular monitoring, without active interventions. A generalized estimating equations model (GEE) was used to assess the intervention effects. After two years, relative to the Control Group, the Intervention Group had a significantly improved knowledge of SSBs and an improved family environment with parents. In the Intervention Group, 477 students (97.3%) had adequate knowledge about SSBs, compared to 302 students (83.2%) in the Control Group (X2 = 52.708, p < 0.001). Two years later, the number of students who stated 'my home always has SSBs' in the Intervention Group (7.8%) was fewer than that in the Control Group (12.4%), which was a statistically significant finding (p < 0.05). One year later, both the frequency and the quantity of SSB consumption in the Intervention Group were less than those in the Control Group; such differences between the groups remained statistically significant for the quantity but not for the frequency of SSB consumption two years later. In the Intervention Group, the frequency of SSB consumption was significantly reduced by 1.0 times per week, compared to a reduction of 0.1 times per week in the Control Group in the first year (p < 0.05). In the second year, the frequency of SSB consumption was reduced by 0.8 times per week in the Intervention Group, compared to 0.5 times per week in the Control Group (p > 0.05). In the first year, the volume of SSB consumption was significantly reduced by 233 mL per week in the Intervention Group, compared to an increase of 107 mL per week in the Control Group (p < 0.05). In the second year, the volume of SSB consumption was reduced by 122 mL per week in the Intervention Group compared to an increase of 31 mL per week in the Control Group (p > 0.05). The combined school-based and family-based interventions had a positive effect on the students' knowledge of SSBs and their family dynamics during the first and second year. Relative to the Control Group, the Intervention Group had a statistically significant reduction in SSB consumption after 1 year, but not after 2 years.

Knowledge, attitudes, practices and associated factors regarding high output stoma of ileostomy among colorectal surgical nurses: a multicentre cross-sectional study

PURPOSE

High output stoma(HOS) is one of the most common complications after ileostomy, leading to fluid and electrolyte disturbances and renal dysfunction, and increasing the risk of readmission. Routine health education for HOS should be provided, and nurses, as the primary educators, should have adequate knowledge and skills in this area. However, there is a paucity of research on the knowledge and practice of HOS management. This study used the Knowledge, Attitude and Behavioural Practice Model to assess the management of HOS by colorectal surgery nurses and to explore the factors that influence it.

METHOD

Using a multi-centre, cross-sectional study design, 398 colorectal surgery nurses from 6 hospitals in 6 cities in 6 provinces were surveyed using a structured electronic questionnaire to assess general information and knowledge, attitudes and management practices and training needs related to HOS of ileostomy.

RESULTS

Colorectal surgery nurses' knowledge and practice of HOS was low. The presence or absence of training is an important factor influencing nurses' knowledge, attitudes and practice, with most nurses having no training and stoma specialist nurses scoring relatively high on knowledge and practice.

CONCLUSIONS

Nurses play a very important role in the management of HOS, but this study shows that the current level of knowledge and practice of HOS among colorectal surgery nurses is concerning, and whether or not they have received training is the most critical influencing factor; therefore, training related to HOS is urgently needed.

The application of the PDCA cycle in the nutritional management of patients with nasopharyngeal carcinoma

OBJECTIVE

This study is to explore the effect of the Plan-Do-Check-Act (PDCA) cycle on the nutritional management of patients with nasopharyngeal carcinoma (NPC).

METHODS

A total of 100 NPC patients were randomly divided into a control group and a PDCA group, with 50 patients in each group. The control group adopted a routine nutritional management strategy, and the PDCA group adopted a PDCA cycle management strategy. The body weight, body mass index (BMI), hemoglobin, serum prealbumin, serum albumin, the Patient-Generated Subjective Global Assessment (PG-SGA) score, the Nutrition Risk Screening 2002 (NRS-2002) score, the incidence rate of nutritional risk, the grade of malnutrition, and the grade of oral mucositis were compared between the two groups.

RESULTS

The body weight, BMI, and serum prealbumin in the PDCA group were higher than those in the control group, and the difference was statistically significant (p < 0.05). The NRS2002 score and PG-SGA score in the PDCA group were lower than those in the control group, and the differences were statistically significant (p < 0.05). The incidence of nutritional risk, the grade of malnutrition, and the grade of oral mucositis were less in the PDCA group than those in the control group (p < 0.05). There was no significant difference in hemoglobin and serum albumin between the two groups (p > 0.05).

CONCLUSION

The PDCA cycle can improve body weight, BMI, and serum prealbumin in NPC patients. It can reduce the NRS2002 score, the PG-SGA score, the incidence of nutritional risk, the severity of malnutrition, and the severity of oral mucositis in NPC patients.

Development and User Evaluation of a Food-recognition app (FoodRec): Experimental Data and Qualitative Analysis

Background

different studies revealed strong correlation between smoking cessation and a worsening of the diet, whose consequence include loss of appetite, weight loss, etc.

Objective

the objective of FoodRec project is to exploit technology to monitor the dietary habits of people during their smoke quitting process, catching relevant changes which can affect the patient health and the success of the process. This work was an uncontrolled pre-test post-test open pilot study in which an interdisciplinary group created an app for food recognition (FoodRec) to monitor their mood status and dietary habits during the test period.

Methods

participants used the FoodRec App for two consecutive weeks for usability and suitability assessment. Tests included 149 smokers involved in a smoke quitting process, aged between 19 and 80. For the quantitative test, data were analyzed regarding users features, meals uploads, mood states and drink intakes. For the qualitative test, a user evaluation test of the app has been performed with four assignments being carried out on a group of 50 participants.

Results

the App was perceived as extremely user-friendly and lightweight. It also turned out to be useful in the perception of users' dietary habits and helpful in relieving the stress of a food intake reduction process.

Conclusion

this work investigated the role and impact of the FoodRec App in a large international and multicultural context. The experience gained in the current study will be used to modify and refine the large international RCT protocol version of the app.

Development and Initial Validity of the Patients' Literacy Scale Among Outpatients in Hangzhou City, China

PURPOSE

There are few studies on the intervention of the doctor-patient relationship (DPR) from patients' perspective, because of lacking appropriate measurement instruments for the effect of the patient interveqntion. Understanding the status of patients' literacy (the ability to initiatively obtain, read, and analyze health-related materials, make appropriate decisions, reduce risks of health-related problems) and developing the patients' literacy scale (PLS) align with the interests of patients, doctors, and researchers.

PATIENTS AND METHODS

This study was conducted in two stages: item building and item refinement. A total of 303 subjects were recruited from the outpatient hall in three hospitals with different levels in Hangzhou city, China. Twenty patients and seven experts determined the face and content validity, respectively. The construct validity, convergent, discriminant validity, and known-group validity of the scale were examined by exploratory and confirmatory factor analysis (EFA and CFA). Internal consistency, including Cronbach's alpha, McDonald's ω, split-half reliability, and composite reliability (CR), was also tested.

RESULTS

The EFA of PLS showed that Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was 0.787, and Bartlett's Test of Sphericity showed a significance of p < 0.001. The extracted four-factor (patient activation, knowledge, attitudes, practice) model explained 61.266% of the total variance. For the overall PLS, the Cronbach's alpha, McDonald's ω and split-half reliability coefficient were 0.815, 0.838 and 0.720, respectively. The CFA showed the goodness of fit (RMSEA = 0.065, CMIN/DF = 1.635, GFI = 0.900, CFI = 0.905, TLI = 0.909). The CR of each factor in this scale was 0.740, 0.732, 0.630, and 0.749, respectively.

CONCLUSION

This study showed that the PLS was valid and reliable to measure the patients' literacy (PL). The 15-item PLS can help not only measure PL but also be used as a standard and advocacy target for patients' behavioral model which can further improve the DPR.

The Status of Occupational Protection During COVID-19 Pandemic: Knowledge, Attitudes, and Practice of Healthcare Workers in Endoscopy Units, China

Background: SARS-CoV-2 spreads rapidly around the world, and some patients present gastrointestinal symptoms. The existence of the virus in the gastrointestinal tract makes digestive endoscopy a high-risk operation, which associated with an increased risk of infection rate in healthcare workers. This study aimed at exploring current knowledge, practice and attitudes of healthcare workers in endoscopy units in China regarding the status of occupational protection during COVID-19 pandemic.

Methods: A cross-sectional study of a national online survey involving 717 healthcare workers in endoscopy units from 94 medical structures in 24 provinces and municipalities around China was conducted online via a questionnaire platform called Wenjuanxing (wjx.cn). The data were analyzed using correlation approaches, Kruskal-Wallis test for independent samples, and linear regression models.

Results: Most Chinese healthcare workers in endoscopy units had a good knowledge of COVID-19 (median: 10; range: 7–12), showed a strikingly positive attitude (median: 65; range: 39–65), and carried out good practice (median: 47; range: 14–50) in strengthening the protection, disinfection and management of COVID-19. In terms of attitudes, female staff was more concerned about protection against COVID-19 than male staff (KW = 8.146, P = 0.004). Nurses performed better in both attitude (KW = 2.600, P = 0.009) and practice (KW = 6.358, P < 0.001) than endoscopic physicians when carrying out personal protection, patient care and environmental disinfection against SARS-CoV-2 infection. More positive attitudes in protection were related to better protective behavior in endoscopic daily medical work (r = 0.312; P < 0.001).

Conclusion: The findings of this study suggest that Chinese endoscopy healthcare workers have an excellent mastery of knowledge about COVID-19, which is transformed into positive beliefs and attitudes, contributing to good practice during daily endoscopic procedures. Medical staff may benefit from further education. With the gradual normalization amid the ongoing COVID-19 pandemic, protection and management in endoscopy units may be changed accordingly.

Trends in Diet Quality and Related Sociodemographic, Health, and Occupational Characteristics among Workers in Spain: Results from Three Consecutive National Health Surveys (2006-2017)

Poor dietary practices are commonly reported in working populations from different economic sectors, resulting in increased absenteeism and a decrease in productivity. The aims of this study were to describe the frequency of food consumption and diet quality in workers aged ≥16 years from 2006 to 2017 in Spain and to evaluate the factors associated with diet quality. A nationwide cross-sectional study was carried out among workers using data from the Spanish National Health Surveys in 2006 (n = 11,068), 2011 (n = 7497) and 2017 (n = 8890). Sociodemographic, occupational, and health-related variables were used as well as diet quality data. A multiple linear regression was performed to determine the characteristics related to overall diet quality. The percentage of workers who consumed vegetables, at most, once or twice per week decreased from 2006 to 2017 (p < 0.001). A lower diet quality score was related to the consumption of tobacco and alcohol and being aged ≥25 years old, while a higher diet quality score was linked to being a woman, having Spanish nationality, receiving optimal perceived social support, being physically active in one's main occupation, doing leisure-time physical activity, and the type of contract.

Inadequate Knowledge, Attitude and Practices about Second-Hand Smoke among Non-Smoking Pregnant Women in Urban Vietnam: The Need for Health Literacy Reinforcement

The rate of exposure to second-hand smoke (SHS) is relatively high in several countries, including Vietnam, and health issues related to SHS have worsened in recent years, especially for pregnant women and their infants. Enhancement of knowledge, attitude, and practice (KAP) scores of pregnant women in Vietnam could raise practical interventions to protect their health and reduce complications of SHS. A cross-sectional study of 432 pregnant women who came to the Obstetrics Department of Bach Mai Hospital, Hanoi, Vietnam for antenatal care was conducted in 2016 to collect information about their KAP related to SHS. Composite mean scores from survey questions assessing their KAP were calculated on a 10-point scale, finding mean scores of 4.19, 7.45, and 4.30, respectively. Higher scores indicated better knowledge, attitude, and practice. Generalized linear models identified that age, occupation, living place, and sources of information were associated with SHS-related KAP. Findings from this study indicate that suitable programs related to SHS should be implemented to improve and reinforce health literacy to both mothers and smokers to reduce the harmfulness of smoking on women and their infants' health.

Association of Infant and Child Feeding Index with Undernutrition in Children Aged 6-59 Months: A Cross-Sectional Study in the Maldives

Adequate dietary intake is critically important for child growth and development. This study aimed to analyze the prevalence of undernutrition and its association with infant and child feeding index (ICFI). This cross-sectional study was conducted among children (younger than5 years) and their mothers from Lhaviyani Atoll, Maldives. The data were obtained by interviewing the children's mothers via pretested questionnaires. Infant and child feeding index scores were calculated from the dietary information. Weight-for-age z-scores (WAZ), length/height-for-age z-scores (LAZ/HAZ), and weight-for-length/height z-scores were calculated from anthropometric data taken according to the WHO criterion. Linear regression tests were used to find the association of nutritional status with ICFI scores. A total of 800 children and their mothers participated in this study. The prevalence of underweight, stunting, and wasting was 24.6%, 32.4%, and 16.3%, respectively. The mean ICFI scores (13.0) of children aged 6-8 months were better than those of children in other age-groups. In food groups, the intake of fish was higher among the respondents, whereas the consumption of vegetables and fruits was lower. Infant and child feeding index scores were significantly associated (P < 0.05) with WAZ and LAZ/HAZ after adjustment for confounders. Overall, the findings showed that Maldivian children consumed the limited number of food items that resulted in an inadequate intake of nutrients which further resulted in the high prevalence of malnutrition.