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Anthony M, Turnbull A, Tadin D, Lin FV. Positive affect disrupts neurodegeneration effects on cognitive training plasticity in older adults. Soc Cogn Affect Neurosci 2024; 19:nsae004. [PMID: 38252656 PMCID: PMC10939393 DOI: 10.1093/scan/nsae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/02/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024] Open
Abstract
Cognitive training for older adults varies in efficacy, but it is unclear why some older adults benefit more than others. Positive affective experience (PAE), referring to high positive valence and/or stable arousal states across everyday scenarios, and associated functional networks can protect plasticity mechanisms against Alzheimer's disease neurodegeneration, which may contribute to training outcome variability. The objective of this study is to investigate whether PAE explains variability in cognitive training outcomes by disrupting the adverse effect of neurodegeneration on plasticity. The study's design is a secondary analysis of a randomized control trial of cognitive training with concurrent real or sham brain stimulation (39 older adults with mild cognitive impairment; mean age, 71). Moderation analyses, with change in episodic memory or executive function as the outcome, PAE or baseline resting-state connectivity as the moderator and baseline neurodegeneration as the predictor are the methods used in the study. The result of the study is that PAE stability and baseline default mode network (DMN) connectivity disrupted the effect of neurodegeneration on plasticity in executive function but not episodic memory. The study concludes that PAE stability and degree of DMN integrity both explained cognitive training outcome variability, by reducing the adverse effect of neurodegeneration on cognitive plasticity. We highlight the need to account for PAE, brain aging factors and their interactions with plasticity in cognitive training.
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Affiliation(s)
- Mia Anthony
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY 14627, USA
- Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA 94304, USA
| | - Adam Turnbull
- Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA 94304, USA
| | - Duje Tadin
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY 14627, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY 14642, USA
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
| | - F Vankee Lin
- Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA 94304, USA
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Liu C, Chen H, Zhang A, Gong X, Wu K, Liu CY, Chiou WK. The effects of short video app-guided loving-kindness meditation on college students' mindfulness, self-compassion, positive psychological capital, and suicide ideation. PSICOLOGIA-REFLEXAO E CRITICA 2023; 36:32. [PMID: 37902928 PMCID: PMC10616025 DOI: 10.1186/s41155-023-00276-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/18/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE The study investigated the effects of a short video app guided loving-kindness meditation (LKM) on college students' mindfulness, self-compassion, positive psychological capital, and suicide ideation. The purpose of the study is to investigate the intervention effect of LKM training on suicidal ideation among college students with the help of the short video application and to provide an empirical basis for the exploration of early suicide intervention strategies for college students. METHODS We recruited 80 college students from a university in China. The final 74 eligible participants were divided into two groups: app use group (n = 37) and the control group (n = 37). The app group accepted an 8-week app use interference, while the control group underwent no interference. We measured four major variable factors (mindfulness, self-compassion, positive psychological capital, and suicide ideation) before and after the app use intervention. RESULTS In the app group, self-compassion and positive psychological capital were significantly higher, and suicide ideation was significantly lower than the control group. In the control group, there were no noticeable differences in any of the four variables between the pre-test and post-test. CONCLUSIONS Our findings demonstrate that the short video app guided LKM may help to improve self-compassion, and positive psychological capital, and reduce suicide ideation. The finding of the short video app-guided LKM's effect extends our understanding of the integrative effects of positive psychology and digital media on the reduction of suicide ideation.
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Affiliation(s)
- Chao Liu
- School of Journalism and Communication, Hua Qiao University, Xiamen, 361021, China
- Business Analytics Research Center, Chang Gung University, Taoyuan, 33302, Taiwan
| | - Hao Chen
- Business Analytics Research Center, Chang Gung University, Taoyuan, 33302, Taiwan
- School of Film Television & Communication, Xiamen University of Technology, Xiamen, China
| | - Ayuan Zhang
- Teachers College, Beijing Union University, Beijing, 100101, China
| | - XiaoGang Gong
- College of Special Education, Beijing, 100101, China
| | - Kan Wu
- Business Analytics Research Center, Chang Gung University, Taoyuan, 33302, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Ko Chiou
- Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Department of Industrial Engineering and Management, Ming Chi University of Technology, New Taipei, Taiwan.
- Department of Industrial Design, Chang Gung University, Taoyuan, Taiwan.
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Chung SK, Ho FYY, Chan HCY. The Effects of Zentangle® on Affective Well-Being Among Adults: A Pilot Randomized Controlled Trial. Am J Occup Ther 2022; 76:23883. [PMID: 35943847 DOI: 10.5014/ajot.2022.049113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Zentangle® is a self-help art modality purported to have repetitive, mindful, and meditative qualities. It can be a cost-effective intervention, but its effect on affective well-being has been underresearched. OBJECTIVE To evaluate the immediate and 2-wk postintervention effects of Zentangle delivered by a certified Zentangle teacher on affective well-being in the general population. DESIGN Two-armed parallel-groups pilot randomized controlled trial. PARTICIPANTS Thirty-eight participants from a nonclinical population. INTERVENTION Participants were randomized into the Zentangle group, which participated in a 2-hr Zentangle class and were encouraged to practice for 2 wk, or the waitlist control group. Participants learned basic Zentangle principles and drew two Zentangles under the teacher's instructions. OUTCOMES AND MEASURES The Positive and Negative Affect Schedule, 21-item Depression Anxiety Stress Scale, and Self-Compassion Scale-Short Form were used to assess positive and negative affect; depression, anxiety, and stress symptoms; and self-compassion. RESULTS Significant reductions in negative affect were found in the Zentangle group compared with the waitlist control group at both immediate and 2-wk postintervention assessments (ds = 1.04 and 0.79, respectively, p < .001). Participants who practiced Zentangle for >80 min per week had a significant reduction in anxiety symptoms and an improvement in self-compassion (ds = 0.84 and 0.24, ps < .05 and .005, respectively). No significant between-groups difference was found for other measures. CONCLUSIONS AND RELEVANCE Our results shed light on the effects of Zentangle on improving affective well-being in the general population. With sufficient practice, Zentangle can also help improve self-compassion and reduce anxiety. What This Article Adds: The results of this study could provide information to determine whether Zentangle can be used as a tool in occupational therapy intervention to improve affective well-being.
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Affiliation(s)
- Siu-Ki Chung
- Siu-Ki Chung, MA, was Student, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, at the time this research was conducted
| | - Fiona Yan-Yee Ho
- Fiona Yan-Yee Ho, PhD, is Assistant Professor, Department of Psychology, The Chinese University of Hong Kong, Hong Kong;
| | - Henri Chun-Yiu Chan
- Henri Chun-Yiu Chan, DSW, is Lecturer, Department of Childcare, Elderly and Community Services, Hong Kong Institute of Vocational Education (Sha Tin), Hong Kong
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Manfredi M, Yumi Nakao Morello L, Marques LM, Boggio PS. When humor is a matter of heart: effects on emotional state and Interbeat Interval. Soc Neurosci 2022; 17:329-338. [PMID: 35759463 DOI: 10.1080/17470919.2022.2095019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Previous studies demonstrated that exposure to humor has beneficial effects on psychological well-being. In the present work, we investigated the behavioral and psychophysiological effects of different types of humor on psychological well-being and on the performance during the execution of a stressful cognitive task. To this aim, we examined the behavioral and psychophysiological effects of ToM humorous and Slapstick humorous comic strips before and after executing a stressful cognitive task. We hypothesized that only slapstick humor could reduce the level of anxiety, increase positive affect and improve performance on the cognitive task. Our findings revealed that, at a specific point in time, exposure to ToM Humor and No Humor strips were associated with lower IBI (higher HR, increase in cardiac recruitment) than slapstick humor. This result suggests that humor involving ToM abilities and No Humor strips elicited a greater cognitive engagement level than slapstick humor. Moreover, in an exploratory analysis we found a positive correlation between cardiac deactivation during the exposure to slapstick Humor and individual empathy scores, suggesting that the empathy skills might influence cardiac recruitment and the level of cognitive engagement during the exposure to humorous material.
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Affiliation(s)
- Mirella Manfredi
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Letícia Yumi Nakao Morello
- Social and Cognitive Neuroscience Laboratory, Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
| | - Lucas M Marques
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Paulo S Boggio
- Social and Cognitive Neuroscience Laboratory, Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
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Joshi N, Vinu V, Jois SN, Begum F, Salagame KK. The Need, Feasibility and Willingness to Explore "Meditation on Twin Hearts" as a Self-administered Tool for Mental Health Management among Transgender Women: An Exploratory Survey. Community Ment Health J 2022; 58:666-672. [PMID: 34255215 PMCID: PMC8276206 DOI: 10.1007/s10597-021-00869-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
Hijras are the transgender community and have been socio-economically marginalized and hence their mental healthcare needs to be addressed. This was a descriptive, qualitative study, conducted in Mysore, India to examine the mental health status of 33 transgender women (TGW) and their response to the "Meditation on Twin Hearts (MTH)" intervention. Assessment of anxiety, depression and suicidality was carried out before the meditative session followed by a single session of MTH. Their feedback on meditation experience was collected, coded, and transformed into quantitative data. Among total participants, 39.4% of TGW exhibited severe anxiety, 21.2% has severe depression and 75.8% of them were at suicidal risk. Depression was positively correlated with anxiety and suicidal behavior. Most participants reported MTH was useful with signs of improvements in mental state. Thus, a single session of MTH has shown good signs of improvement in mental state among TGW.
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Affiliation(s)
- Neha Joshi
- Public Health Research Institute of India, Mysuru, India
| | - V Vinu
- World Pranic Healing Foundation-India Research Center, Mysuru, India
| | - Srikanth N Jois
- World Pranic Healing Foundation-India Research Center, Mysuru, India.
| | - Fazila Begum
- Public Health Research Institute of India, Mysuru, India
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Boybay Koyuncu S, Yayan EH. Effect of Postpartum Yoga on Breastfeeding Self-Efficacy and Maternal Attachment in Primiparous Mothers. Breastfeed Med 2022; 17:311-317. [PMID: 35143340 DOI: 10.1089/bfm.2021.0320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: This study was conducted to determine the effect of yoga practice on the breastfeeding self-efficacy and maternal attachment of primiparous mothers in the postpartum period. Methods: This study was performed in a quasi-experimental model with pretest and posttest control groups. The domain of the study was formed with women with 20-40-day-old babies enrolled in two Family Health Centers. One hundred and twenty-four women participated in the study. The Individual Identification Form, Breastfeeding Self-Efficacy Scale, and Maternal Attachment Scale were completed by the experimental and control groups. The experimental group engaged in 60 minutes of postpartum yoga practice 2 days a week for 8 weeks in the company of the researcher. Results: After yoga practice, there was a statistically significant increase in the breastfeeding self-efficacy and improvement in the maternal attachment of the experimental group (p < 0.05). The corresponding increase and improvement of the mothers in the control group were less than those of the mothers in the experimental group (p < 0.05). Conclusion: This study finds that it is beneficial for both the mother's and the baby's physical and psychological health for health professionals to teach mothers to practice yoga, which positively affects breastfeeding and maternal attachment in the postpartum period.
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Affiliation(s)
- Saadet Boybay Koyuncu
- Midwifery Department, Health Sciences Faculty, Adıyaman University, Adıyaman, Turkey
| | - Emriye Hilal Yayan
- Department of Child Health Nursing, Nursing Faculty, Inonu University, Malatya, Turkey
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Sharma M, Asare M, Lakhan R, Kanekar A, Nahar VK, Moonie S. Can the Multi-Theory Model (MTM) of Health Behavior Change Explain the Intent for People to Practice Meditation? J Evid Based Integr Med 2021; 26:2515690X211064582. [PMID: 34898284 PMCID: PMC8671666 DOI: 10.1177/2515690x211064582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Meditation is gaining popularity as adjuvant therapy for many chronic ailments, mental well-being, and spiritual growth. Behavioral theories have been underutilized in understanding meditation behavior. This study aimed to test if a fourth-generation multi-theory model (MTM) could explain the intent for starting and maintaining meditation behavior in a sample of US adults. A face and content valid 48-item instrument based on MTM was administered in a cross-sectional design through an online survey (n = 330). Internal consistency (Cronbach's alpha > 0.70) and construct validation using structural equation modeling of the subscales were all acceptable. Hierarchical multiple regression revealed that, after controlling for demographic covariates, the MTM constructs of participatory dialogue (β = 0.153; P = .002) and behavioral confidence (β = 0.479; P < .001) were statistically significant in predicting intent for starting meditation behavior and accounted for 32.9% of the variance. Furthermore, after controlling for demographic covariates, the MTM constructs of emotional transformation (β = 0.390; P < .001) and changes in the social environment (β = 0.395; P < .001) were statistically significant and accounted for 52.9% of the variance in the intent for maintaining meditation behavior. Based on this study, it can be concluded that MTM offers a pragmatic framework to design, implement, and evaluate evidence-based (theory-based) meditation behavior change interventions.
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Affiliation(s)
| | | | | | | | - Vinayak K Nahar
- 8083The University of Mississippi Medical Center, Jackson, USA
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Chen F, Lv X, Fang J, Li T, Xu J, Wang X, Hong Y, Hong L, Wang J, Wang W, Wang C. Body-mind relaxation meditation modulates the thalamocortical functional connectivity in major depressive disorder: a preliminary resting-state fMRI study. Transl Psychiatry 2021; 11:546. [PMID: 34689151 PMCID: PMC8542047 DOI: 10.1038/s41398-021-01637-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 08/12/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022] Open
Abstract
Mindfulness-based interventions such as meditation have increasingly been utilized for the treatment of psychological disorders and have been shown to be effective in the treatment of depression and relapse prevention. However, it remains largely unclear the neural mechanism of the therapeutic effects of meditation among depressed individuals. In this study, we investigated how body-mind relaxation meditation (BMRM) can modulate the thalamocortical functional connectivity (FC) in major depressive disorder patients and healthy controls. In the present study, we recruited 21 medication-naive adolescents with major depressive disorder (MDDs) and 24 matched healthy controls (HCs). We designed an audio recording to induce body-mind relaxation meditation. Resting-state fMRI (rs-fMRI) scans were collected before and after the BMRM intervention in both groups. The thalamus subregions were defined according to the Human Brainnetome Atlas, and functional connectivity (FC) was measured and compared to find brain regions that were affected by the BMRM intervention. Before the BMRM intervention, MDDs showed reduced FC of the bilateral precuneus/post cingulate cortex with the left posterior parietal thalamus and left caudal temporal thalamus, as well as an increased FC of the left occipital thalamus with the left medial frontal cortex. Moreover, aberrant FCs in MDDs at baseline were normalized following the BMRM intervention. After the BMRM intervention, both MDDs and HCs showed decreased FC between the left rostral temporal thalamus and the left inferior occipital. Given the small sample used in this study, future studies are warranted to evaluate the generalizability of these findings. Our findings suggest that BMRM is associated with changes in thalamocortical functional connectivity in MDDs. BMRM may act by strengthening connections between the thalamus and the default mode network, which are involved in a variety of high-level functioning, such as attention and self-related processes.
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Affiliation(s)
- Fangfang Chen
- grid.263488.30000 0001 0472 9649College of Mathematics and Statistics, Shenzhen University, Shenzhen, 518060 China
| | - Xueyu Lv
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Jiliang Fang
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Tao Li
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Jinping Xu
- grid.458489.c0000 0001 0483 7922Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055 China
| | - Xiaoling Wang
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Yang Hong
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Lan Hong
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Jian Wang
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Weidong Wang
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Chao Wang
- School of Psychology, Shenzhen University, Shenzhen, 518060, China. .,Shenzhen Key Laboratory of Affective and Social Cognitive Science, Shenzhen University, Shenzhen, 518060, China.
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Vitale E. The Mindfulness and the Emotional Regulation Skills in Italian Nurses During the COVID-19 Pandemic: A Descriptive Survey-Correlational Study. J Holist Nurs 2021; 39:345-355. [PMID: 34048291 DOI: 10.1177/08980101211015804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose: To analyze the differences in mindfulness level and emotional regulation skills, as cognitive reappraisal and expressive suppression subdimensions, according to sex and years of work experience in a sample of Italian nurses directly involved in the care of coronavirus disease 2019 (COVID-19) patients. Then, correlations were also performed in order to evidence relationships between the mindfulness tendency and the emotional regulation skills, both in cognitive reappraisal and expressive suppression, too. Design of study: Descriptive correlational study. Methods: In June 2020, an online questionnaire was administered. Data relating to sex and years of work experience, the Mindfulness Attention Awareness Scale (MAAS), and the Emotion Regulation Questionnaire (ERQ) in the cognitive reappraisal and expressive suppression subdimensions were collected. Findings: Two hundred nurses were enrolled. Males recorded higher MAAS values compared to females (p = .001). No significant differences were registered in the MAAS scores according to years of work experience and regarding the ERQ subscales according to sex and work of experience, too. Also, any correlations were reported between MAAS and ERQ subscales. Conclusions: Future training on the basic principles of mindfulness and Emotion Regulation were considered a priority in nurses to better self-modulate their own beings, particularly during the pandemic period.
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Xu X, Chen L, Yuan Y, Xu M, Tian X, Lu F, Wang Z. Perceived Stress and Life Satisfaction Among Chinese Clinical Nursing Teachers: A Moderated Mediation Model of Burnout and Emotion Regulation. Front Psychiatry 2021; 12:548339. [PMID: 34305659 PMCID: PMC8295563 DOI: 10.3389/fpsyt.2021.548339] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/06/2021] [Indexed: 01/07/2023] Open
Abstract
Our previous study indicated that clinical teaching nurses in China suffered high levels of perceived stress and burnout, mainly because they were taking double responsibilities of nursing and teaching at the same time. The study aimed to investigate the underlying mechanisms of how and when perceived stress increased the risk of burnout and decreased life satisfaction among clinical teaching nurses. Questionnaires about perceived stress, burnout, emotion regulation, and life satisfaction were self-administered to 1,372 teaching nurses from eight tertiary military hospitals in China. Correlation and hierarchical multiple regressions were employed for data analysis. The results revealed that perceived stress had direct and indirect impacts on life satisfaction, with the principal element of burnout-emotional exhaustion-acting as a mediator. Moreover, the association between perceived stress and emotional exhaustion was moderated by emotion suppression-a key emotion regulation strategy. The negative impact of perceived stress on burnout was stronger among teaching nurses with high emotion suppression than among those with low emotion suppression. The present study contributed to a deeper understanding of the relationship between perceived stress and life satisfaction and also suggested further research into emotion regulation interventions to alleviate or eliminate the impact of perceived stress on burnout and eventually improve the life satisfaction for Chinese clinical nursing teachers.
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Affiliation(s)
- Xia Xu
- Department of Nursing, Daping Hospital, Chongqing, China
| | - Ling Chen
- Department of Emergency, The 958th Hospital of PLA, Chongqing, China
| | - Yuan Yuan
- Department of Clinical Nursing Research and Teaching, Southwest Hospital, Chongqing, China
| | - Ming Xu
- Department of Health Management, Daping Hospital, Chongqing, China
| | - Xiaocui Tian
- Department of Neurology, Daping Hospital, Chongqing, China
| | - Fang Lu
- Department of Nursing Management, School of Nursing, Army Medical University, Chongqing, China
| | - Zonghua Wang
- Department of Field Nursing, School of Nursing, Army Medical University, Chongqing, China.,Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
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