Electronic Media Use and Sleep Quality: Updated Systematic Review and Meta-Analysis

BACKGROUND

This paper explores the widely discussed relationship between electronic media use and sleep quality, indicating negative effects due to various factors. However, existing meta-analyses on the topic have some limitations.

OBJECTIVE

The study aims to analyze and compare the impacts of different digital media types, such as smartphones, online games, and social media, on sleep quality.

METHODS

Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the study performed a systematic meta-analysis of literature across multiple databases, including Web of Science, MEDLINE, PsycINFO, PubMed, Science Direct, Scopus, and Google Scholar, from January 2018 to October 2023. Two trained coders coded the study characteristics independently. The effect sizes were calculated using the correlation coefficient as a standardized measure of the relationship between electronic media use and sleep quality across studies. The Comprehensive Meta-Analysis software (version 3.0) was used to perform the meta-analysis. Statistical methods such as funnel plots were used to assess the presence of asymmetry and a p-curve test to test the p-hacking problem, which can indicate publication bias.

RESULTS

Following a thorough screening process, the study involved 55 papers (56 items) with 41,716 participants from over 20 countries, classifying electronic media use into "general use" and "problematic use." The meta-analysis revealed that electronic media use was significantly linked with decreased sleep quality and increased sleep problems with varying effect sizes across subgroups. A significant cultural difference was also observed in these effects. General use was associated with a significant decrease in sleep quality (P<.001). The pooled effect size was 0.28 (95% CI 0.21-0.35; k=20). Problematic use was associated with a significant increase in sleep problems (P≤.001). The pooled effect size was 0.33 (95% CI 0.28-0.38; k=36). The subgroup analysis indicated that the effect of general smartphone use and sleep problems was r=0.33 (95% CI 0.27-0.40), which was the highest among the general group. The effect of problematic internet use and sleep problems was r=0.51 (95% CI 0.43-0.59), which was the highest among the problematic groups. There were significant differences among these subgroups (general: Qbetween=14.46, P=.001; problematic: Qbetween=27.37, P<.001). The results of the meta-regression analysis using age, gender, and culture as moderators indicated that only cultural difference in the relationship between Eastern and Western culture was significant (Qbetween=6.69; P=.01). All funnel plots and p-curve analyses showed no evidence of publication and selection bias.

CONCLUSIONS

Despite some variability, the study overall confirms the correlation between increased electronic media use and poorer sleep outcomes, which is notably more significant in Eastern cultures.

Revisiting the Asymmetric Matching Pennies Contradiction in China

The asymmetric matching pennies contradiction posits that contrary to the prediction of mixed-strategy Nash equilibrium, experimental subjects' choices are, in practice, based heavily on the magnitudes of their own payoffs. Own-payoff effects are robustly confirmed in the literature. Closely following the experimental setups in the literature which support the contradiction, we conduct a series of asymmetric matching pennies games in China, hypothesizing play which is closer to equilibrium frequencies than previously found. Contrary to previous experiments which were conducted in the United States, we find that there are essentially no own-payoff effects among Row players who face large payoff asymmetry. In a Quantal Response Equilibrium framework allowing for altruism or spite, the behavior of our subjects corresponded to a positive spite parameter, whereas the results of previous studies corresponded to altruism. Our results may be consistent with recent psychology literature that finds people from collectivist cultures are substantially more adept at taking the perspective of others compared with people from individualist cultures, a feature of the reasoning needed to obtain mixed-strategy equilibrium.

Development and psychometric properties of the Chinese Invalidating Family Scale

The present study aims to develop the Chinese Invalidating Family Scale (CIFS) and examine its psychometric properties. The CIFS comprises two parts that measure the degree (Part 1) and types (Part 2) of family invalidation. Study 1 explored the structure and reliability of the CIFS using data from Sample 1 (N = 1323; Mage  = 26.3) and Sample 2 (N = 152; Mage  = 25.1). Part 1 of the CIFS is separated into father (20 items) and mother (27 items) subscales. Exploratory factor analysis identified four factors for the father subscale and five factors for the mother subscale. The shared factors are neglect, denial, emotional dysregulation, and overemphasis on achievements, while psychological control is the unique dimension for Mother subscale. Part 2 includes five items assessing the types of family environment. Results indicated acceptable to good reliability of the CIFS, with Cronbach's α higher than 0.60, split-half reliability higher than 0.70, ICCs higher than 0.70, and high criterion-related validity. Study 2 examined the structure and the validity of Part 1 with Sample 3 (N = 2282; Mage  = 19.90) through confirmatory factor analysis. Part 1 showed good construct validity (RMSEAs = 0.05, GFI, NFI, CFI, and AGFI >0.90) and acceptable convergent validity (AVE >0.36, CR >0.76). Overall, the CIFS is a promisingly stable and valid tool to evaluate the invalidating family environment in Chinese culture.

Recommendations From a Chinese-Language Survey of Knowledge and Prevention of Skin Cancer Among Chinese Populations Internationally: Cross-sectional Questionnaire Study

BACKGROUND

There is a paucity of studies assessing awareness and prevention of skin cancer among Chinese populations.

OBJECTIVE

The aim of the study is to compare attitudes and practices regarding skin cancer risks and prevention between Chinese Asian and North American Chinese populations and between Fitzpatrick scores.

METHODS

A cross-sectional, internet-based, 74-question survey in Chinese was conducted focusing on Han Chinese participants internationally. The survey included Likert-type scales and multiple-choice questions. All participants were required to read Chinese and self-identify as being 18 years or older and Chinese by ethnicity, nationality, or descent. Participants were recruited on the internet over a 6-month period from July 2017 through January 2018 via advertisements in Chinese on popular social media platforms: WeChat, QQ, Weibo, Facebook, and Twitter.

RESULTS

Of the 113 completed responses collected (participation rate of 65.7%), 95 (84.1%) were ethnically Han Chinese, of which 93 (96.9%) were born in China and 59 (62.1%) were female. The mean age of these 95 participants was 35.8 (SD 13.3) years; 72 (75.8%) participants were born after 1975. Few but more North American Chinese reported that Chinese Asian populations received annual skin checks (4/30, 4.2% vs 0/65, 0%; P=.009) and believed that their clinician provided adequate sun safety education (13/30, 43.3% vs 15/65, 23.1%; P=.04). Participants with higher Fitzpatrick scores less frequently received sun safety education from a clinician (4/34, 11.8% vs 22/61, 36.1%; P=.02). More participants with lower Fitzpatrick scores used sunscreen (41/61, 67.2% vs 16/34, 47.1%; P=.05), but alternative sun protection use rates are similar across groups.

CONCLUSIONS

Cultural differences and Fitzpatrick scores can affect knowledge and practices with respect to sun protection and skin cancer among social media-using Chinese Asian and North American Chinese communities based on respondent demographics. Most participants in all groups understood that people of color have some risk of skin cancer, but >30% of all groups across regions and Fitzpatrick scores are unaware of current skin protection recommendations, receive insufficient sun safety education, and do not use sunscreen. Outreach efforts may begin broadly with concerted public and private efforts to train and fund dermatologists to perform annual total body skin exams and provide more patient education. They should spark community interest through mass media and empower Chinese people to perform self-examinations and recognize risks and risk mitigation methods.

Differences in the COVID-19 Pandemic Response between South Korea and the United States: A Comparative Analysis of Culture and Policies

The impact of the COVID-19 pandemic has varied across countries. Some countries controlled the virus relatively well, while others did not. In the United States, almost a million people died. However, South Korea's death toll is only about 12,000 even though its population is about one-sixth of the United States. What caused the difference? We argue that public compliance to government direction is the primary reason. South Korea's collective culture valuing communal benefits helped the people conform to government directions, such as mask wearing in public places. By contrast, American people resisted the government policies that restrict individual freedom due to the individualistic culture. In South Korea, historical experiences of relatively frequent national crises led to the rise of defensive nationalism, resulting in national union. However, the United States had relatively fewer national crises, and thus nationalism did not rise. Instead, national division, xenophobia, and hatred toward Asians prevailed in the United States. Besides the cultural differences, differences in national leader's characteristics, past experiences of public health crisis, and political system also contributed to the different outcomes of the crisis.

Exploring the mechanism of empathy on lens language and linguistic landscape on movie-induced tourism: The moderating effect of cultural differences

Since the development of film-induced tourism, scholars have increasingly shifted their attention to examining film-induced tourism from different perspectives. However, little research has been devoted to the underlying mechanisms by which audiences empathize with movie scenes. Current research believes that the lens language of movies is helpful for the communication between the movie and the audience. It not only helps the audience to shape the imagination of the movie scene, but also contributes to the construction of a virtual language landscape, and promotes the audience's cognition of the movie scene. Bringing their emotions and self-expression into the story ultimately enhances the audience's perception of where it was filmed. In exploring the framework of the transformation of empathy in lens language to landscape language, cultural differences are also proposed as the boundary conditions for the relationship between lens language and empathy. Structural equation modeling with PLS-SEM was employed to test the proposed hypotheses. The findings suggest that lens language positively predicts language landscape and empathy positively mediates the aforementioned relationship. Furthermore, the interaction term of cultural differences amplifies the relationship between lens language and empathy. Finally, we discuss theoretical and practical implications.

[Tactile communication within the father-mother-baby triad]

This literature review focuses on tactile interactions between parents and their infants. Research on the dyad has explored both cultural differences in touch and the relationship between touch style and hormonal secretion in both parents. The few studies that have examined this communicative modality within the triad have investigated the frequency and type of parent-infant touch, as well as the effect of skin-to-skin contact on tactile interactions at three months postpartum.

Daily life difficulties among patients with ulcerative colitis in Japan and the United Kingdom: A comparative study

The difficulty of life scale (DLS) instrument is used to measure specific life problems in patients with ulcerative colitis (UC). Importantly, health care providers should consider the characteristics of the country in which they support patients with UC. This cross-cultural comparison study investigated DLS among patients with UC in Japan and the United Kingdom (UK). Outpatients attending one hospital in London and one in Osaka were included. We collected patient information using the DLS questionnaire, which comprises 18 items in three domains. Mean differences between Japan and the UK were compared for the total score and each domain of the DLS. Variables with P < .05 in univariate analysis were entered into a multiple regression model. We included 142 patients from Japan and 100 patients from the UK in the analysis. Univariate results showed that UK patients had more difficulties than Japanese patients in all three domains. Multivariate results showed that only "decline of vitality or vigor" showed significantly lower difficulty scores in Japanese patients. Having four or more bowel movements per day, visible bleeding, and being a homemaker or unemployed were significantly associated with greater difficulty according to the DLS total score. The level of daily life difficulties assessed using the DLS was greater among patients in the UK than among Japanese patients. This comparative study between patients with UC in Japan and the UK demonstrated certain country-related features for domain 3, "decline of vitality or vigor," of the DLS. The reasons why UK patients felt greater decline in vitality or vigor may be that these patients may have symptoms other than bowel symptoms; also, Japanese patients are more hesitant to express discomfort. The findings of this study might lead to a better understanding of culturally sensitive perceptions of daily life difficulties in UC.

Atopic Dermatitis: Conventional and Integrative Medicine

Although Western medicine and ideas about atopic dermatitis (AD) have become popular in many Asian countries, local beliefs about the disease and its treatment often prevail. The multi- racial background of these countries as well as the influence of the diverse religions (such as Taoism and Ramadan) in these regions often lead to diverse belief systems about the causes of AD (such as the Chi concept, also known as the balance of yin and yang) and the types of treatment (e.g. herbal remedies, topical versus concoctions, and decoctions). In addition, many of the cultural practices are preserved among the Southeast Asian minorities residing in the United Kingdom and North America. Eastern treatments typically take a holistic approach to AD and emphasize the psychosomatic component of the disorder. This overview provides a summary of the difference between conventional, complementary, alternative, and integrative medicine in terms of epidemiology, aetiology, therapy, and prognosis in children with AD. There are a number of similarities in genetic and environmental factors in epidemiology and aetiology; however, differences exist in terms of the concept of management. Complementary and alternative medicine, traditional Chinese medicine, and integrative medicine usage are not only prevalent among the Asian population but are also becoming more popular and accepted in Western societies.

Workaholism across European and Asian cultures during the COVID-19 pandemic

The current cross-cultural study examined the construct of workaholism across European and Asian cultures during the pandemic caused by coronavirus disease 2019 (COVID-19). A total of 2,617 recipients, aged 18-80 years from three Asian countries (China, India, and Indonesia) with higher levels of collectivistic values, and three European countries (Bulgaria, Germany, and Hungary) supposing to have higher individualistic values. The participants completed the online version of the two-dimensional measure, dubbed the Dutch Workaholism Scale (DUWAS). The goal of the study was to demonstrate that during the COVID-19 pandemic, it is the cultural context that mediates and influences the way of change in workaholics' attitudes. The results led to the conclusion that the way in which the COVID-19 crisis affects workaholism and workaholics' behavior depends on cultural and sex differences, and stages of the human life cycle. The data analysis revealed that cultural differences and sex affect the configuration of workaholism (excessive/compulsive): in the Asian sample, unlike the European, there was a significant increase in the level of workaholism compulsive; European female participants reported higher levels of workaholism compulsive and workaholism excessive, but the sex difference was not found in Asian sample. Along with cultural context, and sex differences, age also influences the configuration of workaholism. In this case, the separate stages of the human life cycle contribute in different ways to changes in levels of workaholism excessive and workaholism compulsive.

To Wear or Not to Wear: Analysis of Individuals' Tendency to Wear Masks during the COVID-19 Pandemic in China

During the COVID-19 pandemic, the percentage of Chinese people wearing masks was very high, as was the acceptance and initiative toward mask wearing. This national action merits our exploration of the psychological reasons as well as the general social and environmental factors behind this behavior. In this article, we integrated the Unified Theory of Acceptance and Use of Technology 2 (UTAUT 2) as well as Health Belief Model and set up a mask acceptance model. We used a questionnaire survey and received 337 valid questionnaires. The results indicate that social influence, perceived susceptibility to COVID-19, perceived hedonic benefit (appearance enhancement), and a perceived barrier (hindrance to communication) exert significant influences on the willingness to wear masks. Meanwhile, social influence plays an intermediary role between interdependent self-construal and intention to wear a mask. We hope to reveal the micro psychological reasons for the national action and reflect on the cultural characteristics of Chinese people in the special context of the COVID-19 pandemic.

Age and Cultural Differences in Recognitions of Emotions from Masked Faces among Koreans and Americans

This study investigates age and cultural differences in the negative effects of senders’ wearing masks on receivers’ readabilities of senders’ facially expressed emotions in interpersonal interactions. An online experiment was thus conducted with Koreans and Americans aged over 20 years. Based on sampling quotas by nationality, age group and gender, Korean (n = 240) and American (n = 273) participants were recruited from panel members of a Korean research company and Amazon’s Mechanical Turk via email and the website, respectively. The participants played receiver roles to infer senders’ facially expressed emotions presented in photos in the experiment. They judged emotions facially expressed by the senders without masks and with masks are shown in photos. The results revealed that the senders’ wearing masks reduced the readabilities of the senders’ facially expressed anger among participants aged 30–49 years more than among participants aged 20–29 years. The senders’ wearing masks decreased the readabilities of the senders’ facially expressed fear for participants in their 50’s more than for participants in their 20’s. When the senders wore masks, the readabilities of the senders’ facially expressed happiness dropped among participants aged over 60 years more than among participants aged 20–49 years. When senders wore masks, American participants’ readabilities of disgust, fear, sadness and happiness expressed in the senders’ faces declined more than Korean participants’ readabilities of those emotions. The implications and limitations of these findings are discussed.

Does Procrastination Always Predict Lower Life Satisfaction? A Study on the Moderation Effect of Self-Regulation in China and the United Kingdom

Aims: Studies have shown the predictive effects of procrastination and self-regulation on wellbeing. However, little is known about the interactive effect between procrastination and self-regulation. This study explores whether self-regulation moderates the link between procrastination and wellbeing among British and Chinese young adults. Methods: This study adopted self-reported questionnaire survey among two hundred and sixty-five British and four hundred and seventy-five Chinese participants. SPSS and AMOS were used to test the moderation effect. Multi-group path analysis was used to compare the two countries. Results: Data analysis shows that self-regulation was a significant moderator of the relationship between procrastination and life satisfaction in the Chinese sample but not in the British sample. Procrastination predicted low life satisfaction only among the Chinese students with low self-regulation. Discussion: This study indicates that the effects of procrastination on wellbeing could be changed at different levels of self-regulation. Cultural difference can be an important factor when investigating procrastination and its impacts.

Individual Differences in Cognitive Constructs: A Comparison Between American and Chinese Culture Groups

Previous studies on human cognition show that people with different cultural backgrounds may differ in various ways. However, there are other unexplored possibilities for cultural differences including degree of handedness thought to reflect hemispheric coordination, reliance on verbal versus visual representation in problem solving, and working memory capacity both spatial and operational. We assessed each of these using the Edinburgh scale, a validated scale of style of processing, and two automatic working memory span tasks. Participants were either native Chinese students (who spoke Mandarin) or American students. Data showed that culture impacted the set of measures but gender did not and these factors did not interact. Chinese and American students showed the largest difference in their operational working memory. We also examined the pattern of correlations among the measures across the two groups and found differences due to cultural group as well.

Assessing the Measurement Invariance of the Gratitude Questionnaire-5 in Chinese and American Adolescents

Given the possibility of cultural differences in the meaning and levels of gratitude among children, we evaluated the measurement invariance of the Gratitude Questionnaire-5 (GQ-5) and differences in latent means across adolescents from two distinct cultures, China and America. Data were obtained from 1,991 Chinese and 1,685 American adolescents. Confirmatory factor analysis and multigroup confirmatory factor analysis were performed to examine the factor structure and the measurement equivalence across Chinese and American adolescents. The Cronbach's alpha and Item-total Correlations of the GQ-5 were also evaluated. Results of confirmatory factor analyses provided support for the expected one-factor structure. Also, a series of multi-group confirmatory factor analyses supported full configural invariance, full metric invariance, and partial scalar invariance between the two groups. Furthermore, the findings suggested that the GQ-5 is suitable for conducting mean level comparisons. The subsequent comparison of latent means revealed that the Chinese adolescents reported significantly lower gratitude than American adolescents.

Prevalence of and Factors Associated with School Bullying in Students with Autism Spectrum Disorder: A Cross-Cultural Meta-Analysis

Through this meta-analysis, we sought to examine the prevalence of, risks for, and factors associated with bullying involvement (victimization, perpetration, perpetration-victimization) among students with autism spectrum disorder (ASD). Additionally, we attempted to examine sources of variance in the prevalence and effect sizes of bullying in students with ASD across studies. Systematic database and literature review identified 34 relevant studies (31 for Western countries, three for Eastern countries). Pooled prevalence estimates for victimization, perpetration, and perpetration-victimization in general were 67%, 29%, and 14%, respectively. The risk of victimization in students with ASD was significantly higher than that in typically developing students and students with other disabilities. Further, deficits in social interaction and communication, externalizing symptoms, internalizing symptoms, and integrated inclusive school settings were related to higher victimization, and externalizing symptoms were related to higher perpetration. Finally, moderation analyses revealed significant variations in the pooled prevalences thereof depending on culture, age, school settings, and methodological quality and in the pooled effect sizes according to publication year and methodological quality. Our results highlight needs for bullying intervention for students with ASD, especially those who are younger, are in an inclusive school setting, and have higher social difficulties and externalizing/internalizing symptoms; for intensive research of bullying experiences among students with ASD in Eastern countries; and for efforts to improve the methodological quality of such research.

When Confucius meets Erikson: An innovative life review program on Chinese seniors with probable dementia

Before Erikson proposed the life stages, Confucius concluded an autobiographic review of his entire life in about 500 BC. Confucius' life stages may be closer to the life experiences of Chinese older adults. Therefore, the purpose of this study was to examine the effect of the life review program on cognitive ability, life satisfaction, meaning of life, and ego integrity. The experiment was based on a single-group time-series design with a four-time test across 21 weeks. The evoking materials were horticultural activities held in seven weekly sessions. The innovative life review program was in accordance with a combination of Confucius' and Erikson's life stages. Nine participants completed all sessions. There was a significant positive effect of time on participants' cognitive ability and meaning of life after the program. A combination of Confucius' and Erikson's life stages can be more advantageous for Chinese older adults than only Erikson's life stage.

Intercultural Sensitivity Levels and Cultural Difference Perceptions of Physicians and Nurses

Aim

This study was conducted to determine the level of intercultural sensitivity of the physicians and nurses.

Method

This research was a descriptive study. The sample group of the study were physicians (n=70) and nurses (n=87) working in the Public Hospital. 64.3% of physicians and 71.3% of nurses participated in the study. Data were collected between May, June and July 2017. Data of the study were collected by a questionnaire including personal information and Intercultural Sensitivity Scale. The questionnaire also includes an open-ended question of “What are cultural difference elements you describe in patients to whom you administer treatment and provide care”. Descriptive statistics related to the variables were calculated and Parametric and non-parametric tests were performed.

Results

In the present study, Intercultural Sensitivity Scale mean scores were determined as 3.46±0.48 for the physicians and 3.48±0.47 for the nurses. There was no significant difference between the marital status of physicians and nurses and the total score of the scale (p>0.05). The interaction engagement scores of single physicians and nurses were higher than the married ones. Interaction enjoyment mean scores were higher in the participants speaking a foreign language than those not speaking a foreign language. There were significant difference between Intercultural Sensitivity Scale total scores and interaction engagement, respect for cultural differences and interaction confidence subscales of physicians and nurses who have previous interaction with individuals from different cultures. Mean scores of the participants not receiving the training on cultural sensitivity were higher in the subscales of interaction engagement and interaction attentiveness (p<0.05).

Conclusion

It is recommended for physicians and nurses to try to increase their cultural sensitivity by knowing more people from different cultures. It is also recommended to develop language competence of the institutions in which they work and make plans to provide opportunities for physicians and nurses to gain experience abroad and cultural sensitivity education.

Reaching minimal clinically important difference in adult spinal deformity surgery: a comparison of patients from North America and Japan

OBJECTIVE

The Scoliosis Research Society-22r questionnaire (SRS-22r) has been shown to be reliable, valid, and responsive to change in patients with adult spinal deformity (ASD) undergoing surgery. The minimal clinically important difference (MCID) is the smallest difference in a health-related quality of life score that is considered to be worthwhile or clinically important to the individual. The authors hypothesized that the proportion of patients with ASD achieving an MCID in the SRS-22r score would be different between two culturally different cohorts. The purpose of this study was to compare the proportion of patients with ASD achieving MCID for the SRS-22r domains in North American (NA) and Japanese cohorts.

METHODS

A total of 137 patients from North America (123 women, mean age 60.0 years) and 60 patients from Japan (56 women, mean age 65.5 years) with at least 2 years of follow-up after corrective spine surgery for ASD were included. Except for self-image, published Japanese MCID values of SRS-22r for ASD were higher (function = 0.90, pain = 0.85, self-image = 1.05, subtotal = 1.05) than the published NA MCID values (function = 0.60, pain = 0.40, self-image = 1.23, subtotal = 0.43).

RESULTS

There was a statistically significant improvement in all SRS-22r domain scores at 2 years compared to baseline in both cohorts. Except for mental health (NA = 0.32, Japanese = 0.72, p = 0.005), the mean improvement from baseline to 2 years was similar between the NA and Japanese cohorts. The proportion of patients achieving MCID was higher in North America for function (NA = 51%, Japanese = 30%, p = 0.006), pain (NA = 80%, Japanese = 47%, p < 0.001), and subtotal (NA = 72%, Japanese = 35%, p < 0.001), while there was no significant difference for self-image (NA = 53%, Japanese = 58%, p = 0.454).

CONCLUSIONS

Despite similar improvements in SRS-22r domain scores from baseline to 2 years postoperatively, the proportion of patients reaching SRS-22r MCID for function, pain, and subtotal after ASD surgery was higher in the NA cohort than in the Japanese cohort. This may imply that patients in North America and Japan may value observed changes in clinical status differently.

Cultural Differences in Humor Perception, Usage, and Implications

Humor is a universal phenomenon but is also culturally tinted. In this article, we reviewed the existing research that investigates how culture impacts individuals’ humor perception and usage as well as humor’s implications for psychological well-being. Previous research has substantiated evidence that Easterners do not hold as positive an attitude toward humor as their Western counterparts do. This perception makes Easterners less likely to use humor as a coping strategy in comparison with Westerners. Despite this difference, Westerners and Easterners have similar patterns in the relationship between their humor and psychological well-being index, though the strength of the relationship varies across cultures. Implications and potential future research avenues discussed.

Oncology nurses' perceptions of work stress and its sources in a university-teaching hospital: A qualitative study

AIM

To explore and understand work stress and its sources among oncology nurses in a Saudi university-teaching hospital.

DESIGN

Qualitative descriptive study using semistructured interviews.

METHODS

Fourteen oncology nurses working in a university-teaching hospital were interviewed between October - December 2016. Qualitative content analysis according to the Krippendorff method was used to explore work-related stressors among oncology nurses in Saudi Arabia.

RESULTS

Two categories were emerged including "extent of work stress" and "work-related stressors". The second category included the following subcategories of workload and staff shortage, emotional demands, lack of social support, language barriers, and lack of respect from patients and family members and cultural differences.

Contingent National Belonging: The Perceived Fit and Acceptance of Culturally Different Peers Predicts Minority Adolescents' Own Belonging

Prevailing definitions of national identities in Europe equate belonging to the nation with “fitting in” culturally and leave immigrant minorities who are culturally different from the majority group struggling to belong. The present study focuses on an under-researched minority perspective on the intersubjective cultural contents of the national identity. We propose that minorities' national belonging is contingent on their perception that minority peers who deviate from the majority culture are accepted as real nationals. Our study aims to establish (a) minority perceptions of the national fit and acceptance of culturally different peers, and to test (b) the consequences of perceived fit and acceptance for minority adolescents' own national belonging, and (c) its affordances by the local peer context. Drawing on a large random sample of 1,489 Moroccan and Turkish minority youth (aged 12–18) and their peers across 312 classes in 63 Belgian schools, we varied cultural difference from the majority in three vignettes describing imaginary acculturating peers. Minority participants rated to what extent they saw each peer as a real national (perceived fit) and whether other nationals would accept this peer (perceived acceptance). As a measure of their own national belonging, they indicated their national self-identification. Additionally, the multi-level design included classroom contextual measures of majority peer presence and peer acculturation norms (peer norm of heritage culture maintenance). As expected, minority youth who perceived better national fit of culturally different peers, self-identified more strongly as nationals than those who perceived worse fit. This association was not explained by their own acculturation attitudes. In line with the contextual affordance of national fit, only in classes with majority peers, minority youth perceived higher national fit and acceptance of culturally different peers when peer norms supported the maintenance of a distinct heritage culture. We conclude that the national belonging of minority youth is contingent on the peer context through the perceived fit and acceptance of culturally different peers.

Sex Difference in Homicide: Comparing Male and Female Violent Crimes in Korea

The comparison of the South Korean male and female homicide offenders' characteristics and crime scene behaviours is presented in this study. A total of 537 cases of homicide offenders prosecuted in Korea between 2006 and 2010 were analyzed in terms of offenders' characteristics, victim-offender interaction, places of crime, and crime scene actions. Significant differences between male and female offenders were revealed in prior criminal history, offenders' personal characteristics, choice of victim, crime scene behaviours during and after the homicide, and choice of weapon. The parallel with the gender differences in homicides found in Western countries is discussed as well as the possible explanations for the gender-related characteristics found in this study.

[Psychological vulnerability of teams working with displaced Syrians in Lebanon]

In the context of the humanitarian crisis of Syrian refugees in Lebanon, a team of young Lebanese social workers attempted to identify the most economically vulnerable people. These professionals have themselves sometimes been exposed to social and economic difficulties, having in their own past experienced war and deprivation. They were confronted with experiences of war, poverty, inter-community conflicts, the recollection of their own family trauma or guilt. Support in the form of psychological care was provided to them.

Mindfulness in nursing students: The five facet mindfulness questionnaire in samples of nursing students in China, the Philippines, and South Africa

Mindfulness as a clinical strategy for helping manage physical and psychological symptoms is gathering an impressive evidence base. It is also being embraced widely for personal and professional development. As a therapeutic intervention for nurses working across a spectrum of settings, it helps expand practice, and integrating mindfulness in nursing undergraduate and graduate curricula is imminent. In the present study, we outline the development and measurement of mindfulness as a personality trait and therapeutic intervention, and advocate the use of a questionnaire alternative to expensive and impractical laboratory measures. The aims of the present study were to examine and compare the use and reliability of the Five Facet Mindfulness Questionnaire (FFMQ) in samples of nursing students from South Africa, China, and the Philippines, and compare the findings in the nursing student samples to other student and non-student samples. Three samples of students of nursing from China (n = 193), the Philippines (n = 243), and South Africa (n = 131) completed the 31-item FFMQ. The internal consistency was acceptable, and the correlations were significant among all facets and the total score. Although the total mean scores between the three samples were not significantly different, there were significant and interesting differences in the facet scores, and these are discussed in the light of likely cultural influences, and comparative data from other samples of students and clinical populations. The instrument shows promise for future use in educational research as a tool for curriculum change, for personal and professional development of nurses, and as a clinical tool for determining mindfulness changes over time.

Brain structure differences between Chinese and Caucasian cohorts: A comprehensive morphometry study

Numerous behavioral observations and brain function studies have demonstrated that neurological differences exist between East Asians and Westerners. However, the extent to which these factors relate to differences in brain structure is still not clear. As the basis of brain functions, the anatomical differences in brain structure play a primary and critical role in the origination of functional and behavior differences. To investigate the underlying differences in brain structure between the two cultural/ethnic groups, we conducted a comparative study on education-matched right-handed young male adults (age = 22-29 years) from two cohorts, Han Chinese (n = 45) and Caucasians (n = 45), using high-dimensional structural magnetic resonance imaging (MRI) data. Using two well-validated imaging analysis techniques, surface-based morphometry (SBM) and voxel-based morphometry (VBM), we performed a comprehensive vertex-wise morphometric analysis of the brain structures between Chinese and Caucasian cohorts. We identified consistent significant between-group differences in cortical thickness, volume, and surface area in the frontal, temporal, parietal, occipital, and insular lobes as well as the cingulate cortices. The SBM analyses revealed that compared with Caucasians, the Chinese population showed larger cortical structures in the temporal and cingulate regions, and smaller structural measures in the frontal and parietal cortices. The VBM data of the same sample was well-aligned with the SBM findings. Our findings systematically revealed comprehensive brain structural differences between young male Chinese and Caucasians, and provided new neuroanatomical insights to the behavioral and functional distinctions in the two cultural/ethnic populations.

Prevalence of sleep problems in Japanese preschoolers in a medium-sized city: Community-based survey using the Children's Sleep Habits Questionnaire

Although the mean score of the Children's Sleep Habits Questionnaire (CSHQ) differs between countries, there are no normative data for the CSHQ of Japanese preschoolers based on a community sample. The aims of this study were therefore to present normative data for the CSHQ and determine the prevalence and characteristics of sleep problems in Japanese preschoolers. Parents or the primary caregiver of 482 preschoolers aged 4-5 years completed the CSHQ and the Strength and Difficulties Questionnaire. Approximately 80% of preschoolers scored above the cut-off for sleep disturbance on the CSHQ. In addition, co-sleeping was prevalent in Japanese preschoolers but the habit of co-sleeping contributed little to behavioral and emotional problems. Sleep problems appear to be prevalent in Japanese preschoolers based on the CSHQ, and could be associated with the Japanese sleep habit of co-sleeping.

Differences in health-related quality of life between European and Asian patients with hepatocellular carcinoma

AIM

The aim of this study is to explore the possible effects of clinical and cultural characteristics of hepatocellular carcinoma on patients' health-related quality of life (HRQoL).

METHODS

Patients with hepatocellular carcinoma from Asian and European countries completed the EORTC QLQ-C30 and the EORTC QLQ-HCC18. Comparisons were made using Student's t-test and Wilcoxon rank-sum test with method of false discovery to correct multiple comparisons. Multiway analysis of variance and model selection were used to assess the effects of clinical characteristics and geographic areas.

RESULTS

Two hundred and twenty-seven patients with hepatocellular carcinoma completed questionnaires. After adjusting for demographic and clinical characteristics, Asian patients still had significantly better HRQoL scores in emotional functioning, insomnia, (QLQ-C30) and in sexual interest (QLQ-HCC18). We also found an interaction in physical functioning (QLQ-C30) and fatigue (QLQ-HCC18) between geographic region and marital status, married European had worse HRQoL scores than Asian singles.

CONCLUSIONS

Both clinical characteristics and geographic areas affected the HRQoL in with hepatocellular carcinoma. Cultural differences and clinical differences in the pattern of disease due to active surveillance of Asian countries may explain the results.

Cultural differences in emotion: differences in emotional arousal level between the East and the West

Whether emotion is universal or social is a recurrent issue in the history of emotion study among psychologists. Some researchers view emotion as a universal construct, and that a large part of emotional experience is biologically based. However, emotion is not only biologically determined, but is also influenced by the environment. Therefore, cultural differences exist in some aspects of emotions, one such important aspect of emotion being emotional arousal level. All affective states are systematically represented as two bipolar dimensions, valence and arousal. Arousal level of actual and ideal emotions has consistently been found to have cross-cultural differences. In Western or individualist culture, high arousal emotions are valued and promoted more than low arousal emotions. Moreover, Westerners experience high arousal emotions more than low arousal emotions. By contrast, in Eastern or collectivist culture, low arousal emotions are valued more than high arousal emotions. Moreover, people in the East actually experience and prefer to experience low arousal emotions more than high arousal emotions. Mechanism of these cross-cultural differences and implications are also discussed.

Reported contraceptive use, risk behaviours and STIs among military conscripts in Estonian defence forces

Limited research exists on sexually transmitted infection (STI) and risk behaviour among military personnel. Published research on condom use and types of contraceptives used yield mixed results, yet, the perception that military members are at higher risk for STIs remains. The objectives of this cross-sectional study were to measure factors such as condom use, contraceptive methods, and risky behaviours (i.e. drug use and sex with commercial sex workers) and investigate differences between ethnic groups, where culture could influence behaviour. Data were collected from a recruited population of 584 male, military conscripts in northeastern Europe. Using multinomial logistic regression models, statistically significant findings include an interaction between the use of contraceptive methods of Russians with casual partners and ethnicity, with higher odds of effective methods used among Estonians with regular partners (OR = 8.13) or casual partners (OR = 11.58) and Russians with regular partners (OR = 4.98). Effective contraceptive methods used less frequently with casual partners by ethnic Russians is important in providing education and risk reduction services to young, male conscripts. These findings may be used as a baseline to inform health education and STI prevention programmes tailored to military members in Eastern Europe in the absence of other published studies.

Truth telling in medical practice: students' opinions versus their observations of attending physicians' clinical practice

OBJECTIVE

Truth telling or transmitting bad news is a problem that all doctors must frequently face. The purpose of this cross-sectional study was to investigate if medical students' opinions of truth telling differed from their observations of attending physicians' actual clinical practice.

METHODS

The subjects were 275 medical clerks/interns at a medical center in northern Taiwan. Data were collected on medical students' opinions of truth telling, their observations of physicians' clinical practice, students' level of satisfaction with truth telling practiced by attending physicians, and cancer patients' distress level when they were told the truth.

RESULTS

Students' truth-telling awareness was significantly higher than the clinical truth-telling practice of attending physicians (p<0.001), and the means for these parameters had a moderate difference, especially in three aspects: method, emotional support, and providing additional information (p<0.001). Regardless of this difference, students were satisfied with the truth telling of attending physicians (mean ± SD=7.33 ± 1.74). However, our data also show that when cancer patients were informed of bad news, they all experienced medium to above average distress (5.93 ± 2.19).

CONCLUSIONS

To develop the ability to tell the truth well, one must receive regular training in communication skills, including experienced attending physicians. This study found a significant difference between medical students' opinions on truth telling and attending physicians' actual clinical practice. More research is needed to objectively assess physicians' truth telling in clinical practice and to study the factors affecting the method of truth telling used by attending physicians in clinical practice.

What Is Lacking in Patient-Physician Communication: Perspectives from Asian American Breast Cancer Patients and Oncologists

OBJECTIVES

Interactions between breast cancer patients and their oncologists are important as effective patient-physician communication can facilitate the delivery of quality cancer care. However, little is known about patient-physician communication processes among Asian American breast cancer patients, who may have unique communication needs and challenges. Thus, we interviewed Asian American patients and several oncologists to explore patient-physician communication processes in breast cancer care.

METHODS

We conducted in-depth interviews with nine Chinese- or Korean American breast cancer patients and three Asian American oncologists who routinely provided care for Asian American patients in the Washington DC metropolitan area in 2010. We conducted patient interviews in Chinese or Korean and then translated into English. We conducted physicians' interviews in English. We performed qualitative analyses to identify themes.

RESULTS

For women with limited English proficiency, language was the greatest barrier to understanding information and making treatment-related decisions. Both patients and oncologists believed that interpretation provided by patients' family members may not be accurate, and patients may neglect to ask questions because of their worry of burdening others. We observed cultural differences regarding expectations of the doctor's role and views of cancer recovery. As expressed by the patients and observed by oncologists, Asian American women are less likely to be assertive and are mostly reliant on physicians to make treatment decisions. However, many patients expressed a desire to be actively involved in the decision-making process.

CONCLUSION

Findings provide preliminary insight into patient-physician communication and identify several aspects of patient-physician communication that need to be improved for Asian American breast cancer patients. Proper patient education with linguistically and culturally appropriate information and tools may help improve communication and decision-making processes for Asian American women with breast cancer.

Lifetime comorbidities between phobic disorders and major depression in Japan: results from the World Mental Health Japan 2002-2004 Survey

BACKGROUND

Although often considered of minor significance in themselves, evidence exists that early-onset phobic disorders might be predictors of later more serious disorders, such as major depressive disorder (MDD). The purpose of this study is to investigate the association of phobic disorders with the onset of MDD in the community in Japan.

METHODS

Data from the World Mental Health Japan 2002-2004 Survey were analyzed. A total of 2,436 community residents aged 20 and older were interviewed using the WHO Composite International Diagnostic Interview 3.0 (response rate, 58.4%). A Cox proportional hazard model was used to predict the onset of MDD as a function of prior history of DSM-IV specific phobia, agoraphobia, or social phobia, adjusting for gender, birth-cohort, other anxiety disorders, education, and marital status at survey.

RESULTS

Social phobia was strongly associated with the subsequent onset of MDD (hazard ratio [HR]=4.1 [95% CI: 2.0-8.7]) after adjusting for sex, birth cohort, and the number of other anxiety disorders. The association between agoraphobia or specific phobia and MDD was not statistically significant after adjusting for these variables.

CONCLUSIONS

Social phobia is a powerful predictor of the subsequent first onset of MDD in Japan. Although this finding argues against a simple neurobiological model and in favor of a model in which the cultural meanings of phobia play a part in promoting MDD, an elucidation of causal pathways will require more fine-grained comparative research.