Prevalence and Risk Factors Associated with Feline Infectious Peritonitis (FIP) in Mainland China between 2008 and 2023: A Systematic Review and Meta-Analysis

To evaluate the overall prevalence of FIP infection in cats in mainland China and associated risk factors, studies on the prevalence of FIP conducted from 1 January 2008 to 20 December 2023 were retrieved from five databases-CNKI, Wanfang, PubMed, Web of Science, and ScienceDirect-and comprehensively reviewed. The 21 studies selected, with a total of 181,014 samples, underwent a rigorous meta-analysis after quality assessment. The results revealed a 2% prevalence of FIP (95% CI: 1-2%) through the random-effects model, showing considerable heterogeneity (I2 = 95.2%). The subsequent subgroup analysis revealed that the age and gender of cats are significant risk factors for FIP infection in mainland China. In order to effectively reduce and control the prevalence of FIP on the Chinese mainland, we suggest improving the immunity of cats, with special attention given to health management in kittens and intact cats, and continuously monitoring FIPV.

Sexual homicide offenders as repeat and nonrepeat offenders: An empirical study of sexual homicide cases in Mainland China

The comparative examination of different groups of sexual homicide offenders (SHOs) is currently limited. To expand our understanding of Chinese sexual homicides, this study aimed to distinguish between the modus operandi (MO) characteristics of repeat (i.e., with previous arrest and/or conviction) and nonrepeat (i.e., without previous arrest and/or conviction) offenders. Data were gathered from police arrest records, court documents, and published case reports in mainland China, covering a 31-year period (1988-2018). A sample of 86 male SHOs (31 repeat and 55 nonrepeat offenders) was identified and the offenders' MO characteristics were examined. Compared with nonrepeat offenders, repeat offenders were significantly more likely to commit sexual murder in outdoor locations, approach their victims initially using a non-surprise approach, engage in nonvaginal penetration of their victims, use a personal weapon to kill their victims, and move their victims' bodies away from the crime scene. However, repeat offenders were less likely to be arrested immediately after committing the murder. The findings have practical implications for police investigative strategies, such as suspect prioritization.

Prevalence of Mycobacterium bovis in deer in mainland China: a systematic review and meta-analysis

Background

Deer tuberculosis is a chronic zoonotic infectious disease, despite the existence of socio-economic and zoonotic risk factors, but at present, there has been no systematic review of deer tuberculosis prevalence in mainland China. The aim of this meta-analysis was to estimate the overall prevalence of deer TB in mainland China and to assess possible associations between potential risk factors and the prevalence of deer tuberculosis.

Methodology

This study was searched in six databases in Chinese and English, respectively (1981 to December 2023). Four authors independently reviewed the titles and abstracts of all retrieved articles to establish the inclusion exclusion criteria. Using the meta-analysis package estimated the combined effects. Cochran's Q-statistic was used to analyze heterogeneity. Funnel plots (symmetry) and used the Egger's test identifying publication bias. Trim-and-fill analysis methods were used for validation and sensitivity analysis. we also performed subgroup and meta-regression analyses.

Results

In this study, we obtained 4,400 studies, 20 cross-sectional studies were screened and conducted a systematic review and meta-analysis. Results show: The overall prevalence of tuberculosis in deer in mainland China was 16.1% (95% confidence interval (CI):10.5 24.6; (Deer tuberculosis infected 5,367 out of 22,215 deer in mainland China) 5,367/22215; 1981 to 2023). The prevalence in Central China was the highest 17.5% (95% CI:14.0-21.9; 63/362), and among provinces, the prevalence in Heilongjiang was the highest at 26.5% (95% CI:13.2-53.0; 1557/4291). Elaphurus davidianus was the most commonly infected species, with a prevalence of 35.3% (95% CI:18.5-67.2; 6/17). We also assessed the association between geographic risk factors and the incidence of deer tuberculosis.

Conclusion

Deer tuberculosis is still present in some areas of China. Assessing the association between risk factors and the prevalence of deer tuberculosis showed that reasonable and scientific-based breeding methods, a suitable breeding environment, and rapid and accurate detection methods could effectively reduce the prevalence of deer tuberculosis. In addition, in the management and operation of the breeding base, improving the scientific feed nutrition standards and establishing comprehensive standards for disease prevention, immunization, quarantine, treatment, and disinfection according to the breeding varieties and scale, are suggested as ways to reduce the prevalence of deer tuberculosis.

Exploring second language students' language assessment literacy: impact on test anxiety and motivation

Introduction

This research aims to investigate the impact of students' language assessment literacy (LAL) on their cognition. The study specifically examines how different levels of LAL influence two critical factors: test anxiety and motivation to learn a second language.

Methods

To achieve the research objectives, a questionnaire was administered to a sample of 415 university students in China. The questionnaire utilized a five-point Likert scale to assess students' levels of LAL, test anxiety, and motivation to learn a second language. Descriptive data were examined to reveal students' proficiency in LAL, along with their levels of test anxiety and motivation. Multilevel regression analyses were performed using Mplus to investigate whether students' LAL proficiency can predict their levels of test anxiety and motivation.

Results

The findings indicated that the participating students had a proficiency level of approximately 60% in the content of the LAL questionnaire. The analysis further revealed the relationships between specific dimensions of LAL and both test anxiety and second language motivation. The multilevel regression analysis suggested that theoretical knowledge about language and language learning, the understanding of the impact and social value of language assessments, and the uses of assessments to enhance learning, positively predicted students' extrinsic motivation. Furthermore, students' understanding of the uses of assessments to learn and their theoretical knowledge about language learning were identified as positive predictors of intrinsic motivation. Additionally, it was observed that students' LAL did not significantly predict test anxiety.

Discussion

These findings emphasize the significance of enhancing students' LAL due to the identified relationships between LAL dimensions and motivation to learn a second language. The study suggests pedagogical implications for improving LAL, with a focus on specific dimensions that positively impact students' motivation. The absence of a significant relationship between LAL dimensions and test anxiety prompts further exploration and consideration of additional factors influencing students' anxiety in language assessments.

Subjective well-being among PhD students in mainland China: the roles of psychological capital and academic engagement

The mental well-being of PhD students is a major concern in higher education. However, very few studies have investigated the influencing factors of PhD students' subjective well-being (SWB) - an important indicator of mental well-being. Even no study on the influencing factors of PhD students' SWB has been undertaken in mainland China. Based on job demands-resources theory, the present study pioneers the investigation of the relationship between PhD students' psychological capital (PsyCap; comprising self-efficacy, hope, resilience, and optimism) and SWB (comprising positive affect, negative affect, and life satisfaction) in mainland China. It further examined the mediating role of academic engagement (comprising vigor, dedication, and absorption) in this relationship. PhD students (n = 376) from two comprehensive universities in Jiangsu province responded to an online survey. The results showed that (1) self-efficacy was positively associated with life satisfaction, hope was positively associated with positive affect, optimism was significantly associated with all three dimensions of SWB, but resilience was not significantly associated with any of the three SWB dimensions; and (2) dedication mediated the relationship between hope and life satisfaction and that between optimism and negative affect and life satisfaction, but vigor and absorption did not mediate any of the PsyCap-SWB relationships. Limitations and practical implications of this study are discussed.

The relation between family socioeconomic status and depressive symptoms among children and adolescents in mainland China: a meta-analysis

Family socioeconomic status (SES) is widely believed to be associated with depressive symptoms in children and adolescents. The correlation between SES and depressive symptoms changes based on social culture and the economic development level. In China, which includes many children and adolescents, the magnitude of the relationship between SES and depressive symptoms and its potential moderators remains unclear. The current meta-analysis was conducted to determine the overall association between SES and depressive symptoms in children and adolescents in mainland China. We included 197 estimates in mainland China from 2000-2023. Among 147,613 children and adolescents aged 7-18 years, the results showed a weak but significant overall negative association between SES and depression (r = -0.076). Moderator testing showed that the composite SES indicator (r = -0.104) had a stronger association with depression than parental educational level (r = -0.065) and occupational status (r = -0.025) but not family income (r = -0.088). Additionally, the negative association between SES and depression became weaker over the past 20 years in China (β = 0.010). Furthermore, the magnitude of the relationship between SES and depression was stronger in West China (r = -0.094) than in Middle China (r = -0.065), but not East China (r = -0.075). These findings indicate that the relationship between SES and depression among children and adolescents in mainland China may vary based on social contexts. It is necessary to further explore the effect of these social factors and the underlying mechanisms.

Prevalence of Suicidal Ideation, Suicide Plans, and Suicide Attempts Among Children and Adolescents Under 18 years of Age in Mainland China: A Systematic Review and Meta-Analysis

Despite suicide in younger population having become a severe public health issue, information on the prevalence of suicidality among Chinese children and adolescents is still limited. This study aims to estimate the prevalence of suicidal ideation, suicide plans, and suicide attempts in Chinese children and adolescents aged under 18 years. A meta-analysis was conducted based on English and Chinese publications from January 1, 2010 to December 31, 2020 using random-effects models. Based on 132 eligible studies with a combined total of 1,103,309 Chinese children and adolescents below 18 years old, the pooled prevalence of the overall suicidal ideation, suicide plans, and suicide attempts were 15.4% (95% CI [14.3, 16.6]), 6.4% (95% CI [5.5, 7.4]) and 3.5% (95% CI [3.1, 4.1]), respectively. The subgroup analyses showed that there were significant variations of prevalence of suicidal risks across genders, school stages, and geographical areas in mainland China. It was the first systematic review and meta-analysis to show suicidality among younger population aged below 18 years is prevalent in mainland China. This study suggests that gender-age-region-specific prevention and intervention programs should be urgently needed to reduce suicidal risks among Chinese children and adolescents.

Impact of Digital Village Construction on Agricultural Carbon Emissions: Evidence from Mainland China

Reducing agricultural carbon emissions is required to reach the goal of carbon neutrality and mitigate the effects of climate change. With the advent of the digital economy, we aimed to determine if digital village construction can achieve carbon reduction in agriculture. As such, in this study, we used balanced panel data for 30 provinces in China from 2011 to 2020 to conduct an empirical analysis based on measuring the digital village construction level in each province. We found the following: Firstly, digital village construction is conducive to reducing the carbon emitted from agriculture, and the results of further tests showed that the carbon reduction effect of digital villages is mainly based on the reduction in carbon emissions from chemical fertilisers and pesticides. Secondly, the digital village construction has a stronger inhibiting effect on agricultural carbon emissions in major grain-producing areas than in non-major grain-producing areas. The level of rural human capital is the limiting condition for digital village construction to enable green agricultural development; in areas with higher levels of human capital, digital village construction has a significant inhibiting effect on agricultural carbon emissions. The above conclusions are valuable for the future promotion of digital village construction and the design of a green development model for agriculture.

Urban Surface Ozone Concentration in Mainland China during 2015-2020: Spatial Clustering and Temporal Dynamics

Urban ozone (O₃) pollution in the atmosphere has become increasingly prominent on a national scale in mainland China, although the atmospheric particulate matter pollution has been significantly reduced in recent years. The clustering and dynamic variation characteristics of the O₃ concentrations in cities across the country, however, have not been accurately explored at relevant spatiotemporal scales. In this study, a standard deviational ellipse analysis and multiscale geographically weighted regression models were applied to explore the migration process and influencing factors of O₃ pollution based on measured data from urban monitoring sites in mainland China. The results suggested that the urban O₃ concentration in mainland China reached its peak in 2018, and the annual O₃ concentration reached 157 ± 27 μg/m³ from 2015 to 2020. On the scale of the whole Chinese mainland, the distribution of O₃ exhibited spatial dependence and aggregation. On the regional scale, the areas of high O₃ concentrations were mainly concentrated in Beijing-Tianjin-Hebei, Shandong, Jiangsu, Henan, and other regions. In addition, the standard deviation ellipse of the urban O₃ concentration covered the entire eastern part of mainland China. Overall, the geographic center of ozone pollution has a tendency to move to the south with the time variation. The interaction between sunshine hours and other factors (precipitation, NO₂, DEM, SO₂, PM_2.5) significantly affected the variation of urban O₃ concentration. In Southwest China, Northwest China, and Central China, the suppression effect of vegetation on local O₃ was more obvious than that in other regions. Therefore, this study clarified for the first time the migration path of the gravity center of the urban O₃ pollution and identified the key areas for the prevention and control of O₃ pollution in mainland China.

Equity in the Allocation of General Practitioner Resources in Mainland China from 2012 to 2019

BACKGROUND

General practitioners (GPs) play a vital role in primary health care services and promoting the health equity of residents, but there is a paucity of evidence on equity in the allocation of GP resources in mainland China. This study explores equity in the allocation of GP resources from 2012 to 2019 in mainland China.

METHODS

We used GP data from 31 provinces, autonomous regions, and municipalities in mainland China. Lorenz curves, Gini coefficients, Theil indices, and agglomeration degree were used to analyze the data.

RESULTS

The total number of GPs in China was 365,082 in 2019, which corresponded to 2.61 GPs per 10,000 residents and accounted for 9.44% of the total number of practicing doctors in 2019. From 2012 to 2019, the Gini coefficient of GP allocation based on population decreased from 0.3123 to 0.1872. However, the Gini coefficient based on geographical area was maintained at 0.7108-0.7424. The Theil index of GP allocation based on population decreased from 0.0742 to 0.0270, but GP allocation based on geographical area was maintained at 0.5765-0.6898. The intra-regional contribution rates were higher than the inter-regional rates. The agglomeration degree based on geographical area and population decreased in the eastern region but increased in the central and western regions.

CONCLUSIONS

The number of Chinese GPs has increased rapidly in recent years, but the distribution of GPs across China is uneven. In the western and middle regions, there is a relative shortage. Equity in the allocation of GP resources based on population was far greater than that based on geographical area. In the future, the tough issue of inequitable GP resource allocation should be resolved by comprehensive measures from a multidisciplinary perspective.

The more academic burnout students got, the more problematic mobile phone use they suffered? A meta-analysis of mainland Chinese adolescents and young adults

Introduction

In recent years, the relationship between academic burnout (AB) and problematic mobile phone use (PMPU) has become the hot issue of scholars, and a lot of related research has been carried out, but the results are different. Most studies showed that there was a significant positive correlation between AB and PMPU. However, some studies showed that the relationship between AB and PMPU was not significant. While this study aimed at exploring the relationship between AB and PMPU, as well as the influence of some moderating factors (region, age, gender, publication year, the measurement instrument) on them.

Methods

According to the searching process for studies of PRISMA, we searched the related studies on AB and PMPU in Mainland China from January 2012 to November 2022 from CNKI, Wanfang Data, Chongqing VIP Information Co., Ltd. (VIP), Baidu scholar, ProQuest dissertations, Taylor & Francis, Springer, Web of Science, Google Scholar, EBSCO and PsyclNFO. Eventually, 50 studies were included in the meta-analysis, involving 38,488 subjects, with the sample size ranging from 193 to 2,260. CMA 3.0 was used to analyze the overall effect and test the moderating effect.

Results

The result shows that the relationship between AB and PMPU can be considered as a moderate correlation (r = 0.414, 95%CI [0.384, 0.443]), and moderator analysis shows that the relationship between AB and PMPU was moderated by the measurement instrument and publication year.

Discussion

Specifically, when the Mobile Phone Addiction Tendency Scale and the Smartphone Addiction Scale for College Students were used as PMPU measurement tools, the correlation coefficients between AB and PMPU were higher. When the publication year was used as a moderating variable, the relationship between AB and PMPU increased over the years. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022347277, identifier PROSPERO CRD42022347277.

Sociocultural-psychological predictors influencing parents' decision-making regarding HPV vaccination for their adolescent daughters in mainland China: An extended TPB model

Introduction

Enhancing human papillomavirus (HPV) vaccine uptake rates to protect women's health is an important public health issue worldwide. China has taken a series of measures in recent years to promote HPV vaccination among school-aged girls, but the vaccine uptake rate remains low. Investigating the factors influencing vaccination-related decision-making of adolescent girls' parents is key to solving the problem. This study aimed to examine the influence of sociocultural-psychological predictors, including exposure to HPV-related stories (positive/negative), affective reactions (pride/regret), injunctive norms on the Internet and perceived moral obligation, on parents' HPV vaccination-related decision-making for girls aged 13-15 years in mainland China.

Methods

A cross-sectional online survey using quota sampling was conducted in February 2022. Four hundred and five valid and qualified questionnaires were obtained. Partial least squares structural equation modeling was performed by SmartPLS 3 (i) to evaluate the reliability and validity of the measurement models of 11 constructs, and (ii) to test the effect relationships of the sociocultural-psychological predictors on parents' intention to vaccinate their daughters.

Results

The study findings showed that parental decision-making regarding HPV vaccination was influenced by sociocultural and psychological factors. At the level of individual psychological factors, exposure to positive stories was significantly associated with perceived vaccine effectiveness (β = 0.331, t = 8.448, p < 0.001), which strongly predicted the attitude toward vaccination (β = 0.521, t = 8.133, p < 0.001); anticipated pride had more positive influence on vaccination-related decision-making (β = 0.156, t = 2.176, p < 0.05) than anticipated regret. In terms of social influence, injunctive norms on the Internet had a significantly positive influence on vaccination intention (β = 0.127, t = 2.382, p < 0.05), similar to descriptive norms (β = 0.135, t = 3.358, p < 0.01). Perceived moral obligation at the cultural level was the strongest predictor of parental decision-making regarding HPV vaccination (β = 0.193, t = 2.139, p < 0.05).

Discussion

This study is the first in mainland China to systematically examine the sociocultural-psychological predictors of parents' decision-making to vaccinate their 13-15-year-old daughters against HPV. A new extended TPB model with a sociocultural-psychological approach was developed. This model can support the investigation of factors affecting HPV vaccine uptake rates in the mainland Chinese population and similar populations and help to understand the differences in vaccination-related decision-making between Eastern and Western cultures. Furthermore, the study provided some suggestions for HPV vaccination communication campaigns targeting adolescent girls' parents.

Does the mainland China-Hong Kong exchange program change the views of local university students in Hong Kong on regional cooperation? A randomized control-group pre-test post-test experiment

The Chinese central government has been running an intensive exchange program called the Mainland China-Hong Kong Ten Thousand Student Exchange Program since 2012 to support local Hong Kong university students' visits to mainland China, with the aim of promoting exchange and regional cooperation between Hong Kong and mainland China. However, little is known about local Hong Kong university students' views on regional cooperation and whether the program is effective in changing their views. Using a randomized experimental design, we find that most students hold positive views on regional cooperation between Hong Kong and mainland China, but a considerable percentage of students oppose integration with mainland China. We also find that the program is effective in positively changing students' views on certain aspects of regional cooperation related to the free trade zones and the Hong Kong-Zhuhai-Macau Bridge, but is not significantly effective on other aspects of regional cooperation. This study provides the first causal quantitative evidence regarding the impact of the mainland China-Hong Kong exchange program on local university students' views regarding regional cooperation. The findings help inform the public about the prospect of regional cooperation and offer policy implications on youth exchange between mainland China and Hong Kong.

Performance evaluation index system in public hospitals: The Delphi technique in nursing

AIMS

To establish a general performance evaluation index system for nursing managers in public hospitals of Wenzhou city.

BACKGROUND

Head nurses' performance plays a critical role in the development and operation of hospitals. Owing to the lack of accuracy and defects in the current evaluation system in Mainland China, there is an urgent need to develop a systematic performance evaluation index system for nursing managers.

METHODS

A systematic review of literature, two rounds of expert consultation using the Delphi techniques, and empirical analyses were performed. In this study, a total of 20 experts in nursing-related fields were invited to provide reliable comments on the evaluation system. The index system was modified twice during the Delphi consultation, followed by a questionnaire (n = 113) to test the suitability of the system created for public hospitals in Wenzhou.

RESULTS

Both rounds of the consultation showed high response rates of 20 experts. A consensus of over 70% was reached for most indicators in the first round, while a 100% consensus was achieved for the modified index system in the second round. The results of the questionnaire for the modified index system were 100%, 98.23%, 100%, 96.46%, and 93.80% in terms of scientificity, public welfare, importance, measurability, and feasibility, respectively.

CONCLUSION

A suitable index system with 4 first-level indicators, 10 second-level indicators, and 37 third-level indicators was generated to assess head nurses' performance in public hospitals, thereby enhancing their cohesion and competitiveness.

IMPLICATIONS FOR NURSING MANAGEMENT

The modified performance evaluation index system serves as the cornerstone for the successful development of public hospitals and the provision of high-quality services for patients.

The Occurrence and Meta-Analysis of Investigations on Sarcocystis Infection among Ruminants (Ruminantia) in Mainland China

Sarcocystis is a zoonotic pathogen that threatens public health and the quality of food safety. To determine the Sarcocystis spp. prevalence in ruminants (Ruminantia) in China, we conducted a systematic review and meta-analysis. Data were collected from English databases (PubMed and Web of Science) and Chinese databases (Chinese Web of knowledge (CNKI), Database for Chinese Technical Periodicals (VIP) and Wan Fang databases). A total of 20,301 ruminants from 54 publications were evaluated. The pooled prevalence of Sarcocystis spp. among ruminants in mainland China was 65% (95% CI: 57-72%). Our results indicate that sarcocystosis is prevalent in ruminants, which show significant geographical differences. Therefore, it there is a need for continuous monitoring of infections of Sarcocystis spp. in ruminants to reduce the threat to human health and economic losses to the animal industry.

Differentiation Analysis on Carbon Emission Efficiency and Its Factors at Different Industrialization Stages: Evidence from Mainland China

Industrial production is currently the main source of global carbon emissions. There are obvious differences in regional carbon emission efficiencies (CEE) at different industrial stages. We investigate CEE and explore its factors in mainland China at different industrialization stages from 2008-2020 using the super-SBM model with an undesirable output and the STIRPAT model. There is significant spatial heterogeneity in regional CEE, with gaps gradually widening. CEE's spatial heterogeneity in mid-industrialized provinces is narrowing, while in late-industrialized and post-industrialized provinces, it is widening. CEE's factors also differ in provinces at different industrialization stages. At the mid-industrialization stage, the industrial structure (IS) is the dominant factor, while population urbanization (PU) is dominant at the late-industrialization stage, and both PU and IS are dominant at the post-industrialization stage. Based on CEE's characteristics at different industrialization stages, we propose suggestions for green development.

The longitudinal links between marital conflict and Chinese children's internalizing problems in mainland China: Mediating role of maternal parenting styles

The present study explored the role of parenting styles as mediating mechanisms in the link between marital conflict and Chinese children's internalizing problems. Participants were N = 1269 families (mothers, fathers, and children) from Shanghai, P. R. China. Multisource assessments were employed at three time points. Mothers and fathers reported their marital conflict and parenting styles (authoritative, authoritarian) and teachers and children reported on children's internalizing problems. Results from the Actor-Partner Interdependence Model (APIM) showed significant actor and partner effects for associations between marital conflict and parenting styles. After controlling for internalizing problems at Time 1, only maternal authoritarian parenting continued to mediate the relations between mothers' reported marital conflict and change in children's internalizing problems over time. This research provides valuable information about how important aspects of parenting influence the relations between marital conflict and internalizing problems among Chinese children.

The uneven reaction to combat the COVID-19 pandemic: Geovisualizing of fever clinics in mainland China

The COVID-19 pandemic has exerted unprecedented impacts on the world. Since its onset, China has established a network of fever clinics as an effective strategy to aggressively isolate and screen possible patients with COVID-19 symptoms. This study presents two fever clinic maps that visualize the uneven responses to the COVID-19 pandemic at the city level in mainland China. The maps highlight more resources in the southwest, northwest, east, and south China, and paucity in the far west parts of southwest and northwest China and in the north and northeast China.

Legislative and judicial responses to workplace sexual harassment in mainland China: Progress and drawbacks

Background

China has recently upgraded its anti-sexual harassment laws and regulations. The first-ever Chinese Civil Code, which took effect in 2021, has explicitly defined sexual harassment and imposed affirmative duties on employers to prevent and correct work-related sexual harassment. This study aims to map the status quo of China's anti-sexual harassment legal system and explore its progress and limits in dealing with workplace sexual harassment.

Methods

We reviewed China's anti-sexual harassment laws at the national, provincial, and municipal levels and observed how they were enforced in courts. All judicial cases of workplace sexual harassment published by Chinese courts between January 2021 and June 2022 were examined. From a comparative law perspective, we then identified the progress and drawbacks of China's legislative and judicial responses to workplace sexual harassment.

Results

China's current anti-sexual harassment legal system, while have made commendable progress, has its drawbacks: the definition of sexual harassment remains to be clarified and expanded to make it clear that sexual harassment is a form of gender discrimination and can include hostile environment harassment that is not directed against a specific person; the employer's obligations to prevent and correct sexual harassment need further delineation; employers lack guidelines for establishing a fair and effective grievance procedure; the difficulty of proving sexual harassment in litigation remains unsolved; the employer liability doctrine for sexual harassment lacks clarity; workers not in a traditional employment relationship receive inadequate legal protection from work-related sexual harassment.

Conclusions

The issues mentioned above merit consideration in China's future law revisions and judicial practice. In China and other societies where gender inequality remains high, it is recommended to regulate sexual harassment as a form of discrimination and to set clear compliance standards for employers in preventing and correcting sexual harassment.

Institutional policies on plagiarism management: A comparison of universities in mainland China and Hong Kong

Long characterized as a primary form of academic misconduct and a major threat to academic integrity, the issue of plagiarism has been extensively researched from multiple perspectives, including students' and academic staff's perceptions and attitudes concerning plagiarism, measures for detecting and deterring plagiarism and their effectiveness, and the higher education sector's response to plagiarism. Yet knowledge remains patchy regarding this last strand of research. With the aim of bridging this research gap, we examine and compare the plagiarism management policies adopted by a selection of universities in mainland China and Hong Kong, two contexts that have been influenced by different academic traditions. Analysis reveals both similarities and divergences in these universities' communication of plagiarism-related information, mechanism for plagiarism detection, provision of academic guidance and support for avoiding plagiarism, and competing discourses on plagiarism underpinning their mixed approaches to the problem. Implications for institutional policymaking and academic integrity education are discussed.

Dignity therapists' experience of conducting dignity therapy with terminal cancer patients in mainland China: A descriptive qualitative study

OBJECTIVE

This study investigated the experience of conducting dignity therapy with terminal cancer patients from the perspective of dignity therapists in mainland China.

METHODS

Semistructured interviews were conducted with 15 trained dignity therapists from across mainland China who have performed at least one time dignity therapy for terminal cancer patients. Data were analysed using content analysis.

RESULTS

Four main themes emerged. Firstly, therapists reported that they had many culture-specific experiences of conducting dignity therapy with Chinese patients. Secondly, they encountered various challenges while recruiting and delivering dignity therapy to patients. Thirdly, through conducting dignity therapy, therapists gained personal development although sometimes they empathised with patients' negative emotions. Lastly, they perceived great benefits of conducting dignity therapy to the culture of caring in clinical practice and healthcare provider-patient relationship.

CONCLUSION

Chinese culture influenced dignity therapists' experience of conducting dignity therapy in mainland China. A series of challenges and benefits of conducting dignity therapy to therapists' personal growth and clinical work were perceived. It is suggested that cultural impacts on dignity therapy implementation and the therapists' ability to deal with practical and emotional challenges need to be addressed in dignity therapy training. A more resource-saving dignity therapy protocol would be significant for dignity therapy implementation.

Evolution of ischemic stroke drug clinical trials in mainland China from 2005 to 2021

Background

To assess the temporal changes in the characteristics of ischemic stroke drug clinical trials conducted in mainland China in 2005–2021.

Methods

A statistical analysis of registered clinical trials on ischemic stroke was performed using the platform of the Center for Drug Evaluation of China National Medical Products Administration, the Chinese Clinical Trial Registry, and ClinicalTrials.gov websites.

Results

From January 1, 2005 to August 1, 2021, a total of 384 registered drug clinical trials on ischemic stroke were identified in mainland China. Over time, the number of trials gradually increased each year, with a significant growth in 2014, from 16 in 2013 to 42 in 2014. Phase IV trials (31.8%) accounted for the majority, followed by phase II (16.4%), phase I (10.9%), and phase III (8.6%). In terms of sponsorship, the proportion of investigator‐initiated trials (IITs) (60.7%) was higher than industry‐sponsored trials (ISTs) (39.3%). Additionally, trials involving traditional Chinese medicines (TCMs) (36.2%) accounted for the largest proportion, followed by trials involving antithrombotic therapy (19.5%) and cerebral protection agents (16.7%). Furthermore, over the past 17 years, the number of leading drug clinical trial units for ischemic stroke in mainland China has continuously increased. The leading principal units from Beijing, Shanghai, Guangdong, Jiangsu, and Liaoning accounted for the majority of the trials (67.4%).

Conclusion

In the past 17 years, great progress has been made in the research and development (R&D) of drugs and clinical trials for ischemic stroke in mainland China. The most extensive progress was observed in TCMs, antithrombotic therapy, and cerebral protection agents. More clinical trials are needed to confirm whether the newly developed drugs can improve the clinical efficacy of ischemic stroke. Simultaneously, more pharmaceutical R&D efforts of innovative drugs are warranted.

Dementia-friendly initiatives within the context of COVID-19 pandemic: Challenges and strategies perceived by service professional stakeholders from the USA and China

Purposes

Dementia-friendly initiatives (DFI) are community-based movements aimed to address stigma, exclusion, and discrimination associated with dementia. This study examined the challenges faced and strategies used by DFI prior to and during the COVID-19 pandemic from the perspectives of stakeholders in the USA and China.

Methods

Qualitative interviews with 17 stakeholders involved in DFI from the United States and mainland China were conducted via the Zoom platform. Semi-structured interview questions focused on DFI challenges and strategies prior to and during the pandemic. Thematic analysis was used to analyze the data.

Results

Three major challenges prior to the COVID-19 pandemic included low participation of persons with dementia, difficulties in building community collaborations, and limited funding and resources needed to sustain DFI. During the COVID-19 pandemic, challenges included exacerbated difficulties of involving persons with dementia and reduced policy support for DFI. Strategies implemented prior to COVID-19 included partnerships with community organizations to outreach and engage persons with dementia, and coordination of resources and diversification of funding sources to sustain DFI. Strategies during the COVID-19 pandemic centered on the implementation of person-centered technology to support persons with dementia and family caregivers, and the development of new programs that integrated efforts to address the impact of COVID-19.

Implications

DFI in the USA and mainland China shared similar challenges for DFI prior to and during COVID-19. During the COVID-19 pandemic, DFI in both countries showed resourcefulness through reliance on technology, community collaboration, and COVID-19–related resources to provide support and services. While it remains critical to advocate to the central government to fund DFI, DFI in both societies need to be open to other funding sources, hire persons with dementia as key staff members of DFI, and demonstrate its effectiveness through rigorous evaluation.

After-School Extracurricular Activities Participation and Depressive Symptoms in Chinese Early Adolescents: Moderating Effect of Gender and Family Economic Status

Although Western studies showed that participation in extracurricular activities was intimately linked to adolescents’ psychological adjustment, very few studies have addressed this issue among early adolescents in China. Based on a nationally representative sample of 9672 Chinese junior high school students (M_age = 14.54 years, SD = 0.70 years), this study investigated the relationship between participation in different extracurricular activities and depressive symptoms among Chinese early adolescents, and the moderating role of gender and family economic status. Results indicated that time spent completing homework, attending extracurricular tutoring, and playing online games after school was positively related to students’ depressive symptoms, whereas time spent on participating in physical exercise was negatively associated with students’ depressive symptoms. Besides, the relationships between after-school activities participation and student depressive symptoms were moderated by gender and family economic status. The theoretical and practical implications for the arrangement of after-school activities for Chinese early adolescents are discussed.

Acceptability of and barriers to human papillomavirus vaccination in China: A systematic review of the Chinese and English scientific literature

INTRODUCTION

Widespread adoption of the human papillomavirus (HPV) vaccine will require population acceptance and tailoring of immunisation services to community needs and preferences. We examined peer-reviewed publications on the acceptability of and barriers to the HPV vaccine across China.

METHODS

We searched English (MEDLINE, Embase, and Web of Science) and Chinese (CNKI, VIP, Wanfang data) databases between 1 January 2006 and 31 December 2017. We adopted a narrative approach for data synthesis.

RESULTS

We identified 73 studies. The overall median acceptability of HPV vaccine was 71.8% (Q1-Q3: 58.6%-81%). Low levels of acceptability (<40%) of HPV vaccine were found in eastern regions of China. The largest differences of acceptability were observed between rural western regions (all >90%) and urban eastern regions (all <35%). Despite these regional variations, common barriers to HPV vaccine acceptance were concerns about vaccine safety, uncertainty over vaccine effectiveness, low perceived risk of cervical cancer and the price of the vaccine. The level of willingness to pay for the HPV vaccine (over 153 US dollars) was very low (<7%).

CONCLUSION

The acceptability of and attitudes towards HPV vaccine vary by regions and populations across China. HPV vaccination programmes will need to tailor service delivery as well as information materials to take account of regional concerns.

The Cradle-to-Cradle Life Cycle Assessment of Polyethylene terephthalate: Environmental Perspective

Over the last several years, the number of concepts and technologies enabling the production of environmentally friendly products (including materials, consumables, and services) has expanded. One of these ways is cradle-to-cradle (C2C) certified^TM. Life cycle assessment (LCA) technique is used to highlight the advantages of C2C and recycling as a method for reducing plastic pollution and fossil depletion by indicating the research limitations and gaps from an environmental perspective. Also, it estimates the resources requirements and focuses on sound products and processes. The C2C life cycle measurements for petroleum-based poly (ethylene terephthalate) (PET) bottles, with an emphasis on different end-of-life options for recycling, were taken for mainland China, in brief. It is considered that the product is manufactured through the extraction of crude oil into ethylene glycol and terephthalic acid. The CML analysis method was used in the LCIA for the selected midpoint impact categories. LCA of the product has shown a drastic aftermath in terms of environmental impacts and energy use. But the estimation of these consequences is always dependent on the system and boundary conditions that were evaluated throughout the study. The impacts that burden the environment are with the extraction of raw material, resin, and final product production. Minor influences occurred due to the waste recycling process. This suggests that waste degradation is the key process to reduce the environmental impacts of the production systems. Lowering a product’s environmental impact can be accomplished in a number of ways, including reducing the amount of materials used or choosing materials with a minimal environmental impact during manufacture processes.

Chinese University Students' Perceptions of Facilitation Strategies, Learning Motivation, and Satisfaction in Cloud-Based Virtual Classrooms

This study investigated university students' perceptions of facilitation strategies, learning motivation, and satisfaction, and the relationships between them in a cloud-based virtual classroom in mainland China. The results of an online questionnaire survey from a sample of 7,210 university students showed that students perceived high levels of facilitation strategies, learning motivation, and satisfaction. Students' demographic characteristics, such as discipline, university type, gender, and grade, did not significantly affect their perceptions of facilitation strategies and learning outcomes. Instructor-student interaction and instructor innovation were positively related to student learning motivation and satisfaction whereas the relationships between student interaction and learning motivation and satisfaction were weak and had no practical meaning. The findings of this study have implications for creating more effective synchronous online learning environments and achieving desirable learning outcomes.

Surveillance of Parenting Outcomes, Mental Health and Social Support for Primiparous Women among the Rural-to-Urban Floating Population

China has the largest population of floating rural-to-urban women worldwide, most of whom are of childbearing age. However, few studies have been conducted to monitor the changing trends in parenting outcomes, mental health and social support for these women in the early postpartum period. In this quantitative longitudinal study, 680 primiparous women among the floating population were recruited in Shenzhen, China. Face-to-face collection of socio-demographic questionnaires was completed by researchers in maternity wards on the third postnatal day. Follow-up electronic questionnaires were dispatched to women via email or WeChat at 6 weeks and 12 weeks following childbirth, including the Self-efficacy in Infant Care Scale (SICS), Edinburgh Postnatal Depression Scale (EPDS) and Postnatal Social Support Scale (PSSS), to measure maternal self-efficacy (MSE), postpartum depression (PPD) and social support, respectively. The mean scores of MSE for these floating women were 67.16 (14.35) at 6 weeks postpartum and slightly increased to 68.71 (15.00) at 12 weeks postpartum. The mean scores of EPDS remained almost stable, from 11.19 (4.89) to 11.18 (5.34) at the two time points. The prevalence of mild and severe PPD among floating women at 6 and 12 weeks after childbirth decreased from 54.4% to 40.1% and from 50.6% to 35.4%, respectively. The mean score of social support was 37.04 (10.15) at 6 weeks postpartum and slightly improved to 38.68 (10.46) at 12 weeks postpartum. Primiparous women among the rural-to-urban migrant population had an obviously negative status of parenting outcomes and mental health; and there was a lack of social support after childbirth. In future, tailored evidence-based interventions are highly needed to promote floating women’s parenting outcomes, mental wellbeing and social support in the early stages of motherhood. As a higher-risk group of PPD, primiparous women among the floating population require effective and accessible mental health care after childbirth, such as early PPD screening and timely therapeutic methods.

The Relationship Between Compulsive Buying and Hoarding in China: A Multicenter Study

There is no previous research that has explored the correlation between compulsive buying and hoarding in the Chinese population. This study aims to determine the relationship between compulsive buying and hoarding in a sample of the Chinese population comprising participants from mainland China (emerging economy) and Hong Kong (developed economy). Self-reported measures consisting of demographic questions, the Chinese version of the Hoarding Rating Scale (CHRS), and Richmond Compulsive Buying Scale-Traditional Chinese (RCBS-TC) were administered to participants. After data collection, common method biases were precluded. The RCBS-TC and CHRS were validated by confirmatory factor analysis and found correlated by Pearson correlation coefficient. The RCBS-TC and CHRS demonstrated satisfactory levels of internal consistency (Cronbach’s α = 0.872 and 0.828, respectively). A three-factor model, including hoarding, obsessive-compulsive, and impulse control disorders, was obtained through Confirmatory Factor Analysis (CFA) with the satisfactory fit for the total sample from Hong Kong and mainland China. A significant correlation was found between RCBS-TC and CHRS (r = 0.473). Findings also showed that 14% of the participants exhibited compulsive buying behavior. This study provides sufficient proof of the reliability and validity of RCBS-TC and CHRS. Their relationship was explored based on two sets of samples from different regions in Asia, which contributes more applicability in a cross-cultural context.

Development and Validation of a Questionnaire to Measure Chinese Preschool Teachers' Implementation of Social-Emotional Practices

We describe the development and validation of the Social-Emotional Teaching Practices Questionnaire-Chinese (SETP-C), a self-report instrument designed to gather information about Chinese preschool teachers’ implementation of social-emotional practices. Initially (study 1), 262 items for the SETP-C were generated. Content validation of these items was conducted separately with Chinese practice experts, research experts, and preschool teachers. Significant revisions were made to items based on theoretical evidence and empirical findings from initial content validation activities, which led to a 70-item version of the SETP-C. In study 2, preliminary psychometric integrity evidence and item characteristics of the SETP-C were gathered based on the data from a sample of 1,599 Chinese preschool teacher respondents. Results from confirmatory factor analyses suggested a seven-factor measurement model, and high internal consistency score reliability was documented for each dimension of the SETP-C. Results of item response theory graded response models further indicated adequate psychometric properties at the item level.

Seroprevalence of Toxoplasma gondii in cats in mainland China 2016-2020: a meta-analysis

BACKGROUND

Toxoplasma gondii can infect humans and most animals and has a very high infection rate worldwide, including in China. The number of people infected with T. gondii in China increases with the number of cats.

OBJECTIVES

We investigated the seropositive rate of T. gondii in cats over the last five years and analyzed the risk factors via meta-analysis.

METHODS

We retrieved 20 studies, with a total of 5,158 cats, published between 2016 and 2020, used the DerSimonian-Laird model and calculated seroprevalence estimates with the variance stabilizing double arcsine transformation.

RESULTS

The overall seroprevalence rate after sinusoidal conversion was 19.9% (95% confidence interval [CI], 15.9-23.9; 966/5,158), lower than the domestic report from 1995 to 2015 (24.5%, 95% CI, 20.1-29.0). There was substantial heterogeneity among studies (χ² = 262.32; p < 0.001; I² = 64.6%). Regression analysis of possible heterogeneous causes and subgroup analysis showed that age and whether cats were stray or not have a significant effect on the seropositive rate.

CONCLUSIONS

Articles published in recent five years suggest that the seroprevalence estimates of Toxoplasma gondii in cats has decreased. Cats, as the final host of T. gondii, are an important cause of the spread of the parasite, and this is an important concern for public health.

Green Space and Health in Mainland China: A Systematic Review

Non-communicable diseases (NCDs) have become a major cause of premature mortality and disabilities in China due to factors concomitant with rapid economic growth and urbanisation over three decades. Promoting green space might be a valuable strategy to help improve population health in China, as well as a range of co-benefits (e.g., increasing resilience to climate change). No systematic review has so far determined the degree of association between green space and health outcomes in China. This review was conducted to address this gap. Five electronic databases were searched using search terms on green space, health, and China. The review of 83 publications that met eligibility criteria reports associations indicative of various health benefits from more green space, including mental health, general health, healthier weight status and anthropometry, and more favorable cardiometabolic and cerebrovascular outcomes. There was insufficient evidence to draw firm conclusions on mortality, birth outcomes, and cognitive function, and findings on respiratory and infectious outcomes were inconsistent and limited. Future work needs to examine the health benefits of particular types and qualities of green spaces, as well as to take advantage of (quasi-)experimental designs to test greening interventions within the context of China's rapid urbanization and economic growth.

Advance care planning for older people in mainland China: An integrative literature review

BACKGROUND

Recently, the attempts to promote advance care planning (ACP) and advance directives (ADs) have appeared in mainland China. However, anecdotal evidence suggests that the concept of ACP and ADs is not widely known to the public and healthcare professionals.

AIM

To examine and synthesise currently available research about ACP and ADs for older people in mainland China, and to discuss implications for future nursing practice and research.

DESIGN

An integrative literature review.

METHODS

A systematic search was conducted in seven English electronic databases (CINAHL, MEDLINE, ProQuest, Cochrane, JBI, Scopus and Wiley) and four Chinese electronic databases (CNKI, Wanfang, VIP and CBM). Eligible articles were critically appraised using the Mixed Methods Appraisal Tool (MMAT).

FINDINGS

From various groups including older people, families and healthcare professionals, low levels of knowledge and awareness about ACP and ADs are reported. Demographic characteristics such as age, gender, education and clinical conditions were related to positive or negative attitude towards ACP. The main reason people cited for being 'reluctant/fairly reluctant' to make an AD was that they were 'Not familiar with it'.

CONCLUSIONS

Given that older people showed positive attitudes towards ACP, policy support and practice guidelines about ADs and ACP are necessary to respect their wishes and to guide healthcare professionals in mainland China.

Hepatitis B virus related stigma among Chinese living in mainland China: a scoping review

Stigma related to hepatitis B virus (HBV) has a detrimental impact on health outcomes of people living with HBV. A scoping review of published peer-reviewed articles focused on the Chinese population in mainland China published between 2010 and 2019 was undertaken. This review consists of five stages: identifying the research question, identifying relevant literature, study selection, charting the data, and collating, summarizing and reporting the results. Articles in Chinese were identified from the collection of Core Journals in the database of CNKI (China Academic Journals Full-text Database). Publications in English were identified in Global Health, Scopus, PsycINFO, Proquest and Web of Science. Forty-five peer-reviewed articles were selected for inclusion. Most studies under review focused on negative individual attitude and discrimination against people living with HBV (PLHBV) in employment, education, community and healthcare settings. There is limited information on lived experiences of those living with HBV and how they manage this stigma. The reviewed studies provide evidence for the existence of different forms of HBV-related stigma in a variety of settings. Knowledge about HBV and the level of education of research participants were the most frequently identified factors related to this stigma. These findings are useful to support HBV responses in China and countries with migration from China.

Intelligent "Internet Plus" services in the first case of home hemodialysis in mainland China

BACKGROUND

Many studies have shown that compared with those who use other dialysis modalities, patients using home hemodialysis (HHD) have an increased rate of survival and better quality of life. It was noted in 2006 that there was opportunity for significant expansion of the use of HHD in many countries. China covers a vast area and has a large amount of end-stage renal failure patients. But in mainland China, all dialysis treatments are in-center, and the number of HHD patients is zero. In 2018, our hospital received the permission of the Shanghai government to carry out HHD.

CASE PRESENTATION

We initiated four incident hemodialysis patients on an HHD regimen, one patient has been dialyzed in the home safely for 8 months. The biochemical parameters of the first patient remained stable on the regimen and he achieved standard Kt/V urea targets. Treatment-related adverse events were not reported during the follow-up. We combined HHD with intelligent "Internet Plus" real-time remote monitoring and introduced the Internet, especially visualization software, to replace traditional telephone and home visit methods. It is more intuitive and quicker to assist patients in performing home hemodialysis and improve the safety of treatment.

CONCLUSIONS

HHD can be performed by selected trained patients in mainland China. Combined with the internet, visualization software, and traditional telephone and home visits, it is intuitive and quick to assist patients in carrying out HHD and improve the safety of treatment. HHD broadens the choices for uremia patients in China.

Patients' and caregivers' knowledge and beliefs about mental illness in mainland China: A systematic review

This review aimed to systematically investigate patients' and caregivers' knowledge and beliefs about mental illness in mainland China. A total of 48 eligible studies (N = 11 895) were retrieved from eight electronic databases. Prevalence statistics were computed for themes (eg, stress) under each construct relating to knowledge or belief about mental illness (eg, beliefs about causes). Effect size r was calculated for each correlation with an identified construct. We found that only 27.8% of patients recognized the symptoms of schizophrenia. Although 65% of caregivers declared that they knew the names of the disorders that their ill relatives had, depression (43.6%), schizophrenia (28.5%) and anxiety disorders (18.1%) had low recognition rates. Both caregivers and patients preferred psychosocial explanations of mental illness. Pharmacological interventions (eg, antipsychotics), non-specific actives (eg, "getting out and learning more"), mental health professionals (eg, psychiatrists) and informal support (eg, family) were each considered helpful for different disorders by caregivers, whereas regular contact with mental health professionals was not highly rated as helpful by patients. Additionally, while more patients knew about the effects of the medications that they were taking, more caregivers emphasized the importance of medicine adherence. Psychosocial variables (eg, family burden) demonstrated significant effects on both groups' mental health literacy. The government should invest more in supporting caregivers of people with mental disorders and monitor the implementation of mental health policies.

Cross-Border Medical Services for Hong Kong's Older Adults in Mainland China: The Implications of COVID-19 for the Future of Telemedicine

Cross-border services and support are becoming an increasingly important part of Hong Kong's social policy because an increasing number of its older citizens are choosing to live in mainland China. Unfortunately, with the recent outbreak of COVID-19, medical services for cross-border older adults have been blocked due to strict immigration controls. This article examines the effects of COVID-19 on these older adults, with a specific focus on the interruption of medical services and the remedial measures taken by the government and non-governmental organizations. It also discusses the prospect of delivering care for cross-border older people using telemedicine, which is considered one of the most important methods for overcoming space-distance and reducing the risk of cross-contamination caused by close contact.

Government Intervention Measures Effectively Control COVID-19 Epidemic in Wuhan, China

The Coronavirus disease 2019 (COVID-19) outbreak has been brought under control through a nationwide effort, and now it has become a global pandemic and the situation seems grim. We summarized the measures taken in Wuhan and analyzed the effects to comprehensively describe the factors involved in controlling the COVID-19 in China. In China, several measures such as the lockdown of Wuhan, restriction of traffic and communities, increasing hospital beds, nationwide support from medical staff, epidemic prevention equipment and supplies, and establishment of makeshift shelter hospitals have been taken. The lockdown of Wuhan reduced the propagation of cases to other cities in Hubei province and throughout China, traffic and community restrictions reduced the flow of population and the spread of disease, increasing wards and beds and medical personnel reduced the incidence of severe cases and mortality, the establishment of the Fangcang shelter hospitals provided a good isolation and monitoring environment, and further reduced the spread and fatality of the disease. The fact that China was able to control the spread of COVID-19 within three months without a specific drug or vaccine suggests that these measures are more adequate and effective.

In Search of a Cyber Supervision Process: From the Perspective of Social Work Supervisees in Mainland China

PURPOSE

The need for cyber supervision has arisen owing to a lack of access to supervision resources in remote locations in Mainland China. This study explores the experiences of receiving or implementing cyber supervision.

METHODS

Twenty-four graduates of a nationwide supervision training program participated in telephone interviews.

RESULTS

The findings revealed the themes concerning the process of conducting cyber supervision. Methods used by cyber-supervisors to understand supervision context and build supervisory relationships were identified.

DISCUSSION

The findings lead to an increased understanding of the process of cyber supervision and will have implications for the further development of cyber supervision.

CONCLUSION

Implications of this study provide insights into the important process of cyber supervision.

A scoping review of WeChat to facilitate professional healthcare education in Mainland China

AIM

WeChat is the most popular social media platform in mainland China, with over 1 billion active users. Although social media is widely used in professional healthcare education in western countries, research on WeChat-based education in healthcare in mainland China is disparate and not systematic. The current study seeks to address this gap.

METHOD

A scoping review was conducted to systematically describe studies of WeChat use in professional healthcare education. A comprehensive search involving three international databases in English and Chinese literature was conducted in April 2019. Articles were retained in this study if they were original studies that used WeChat as a tool to facilitate healthcare education in mainland China.

RESULTS

25 studies met the inclusion criteria and the majority of studies were either experimental or quasi-experimental. WeChat was used in both university settings and hospital settings. Hybrid education-which integrates WeChat education and face-to-face education-was more common in university settings, whereas hospitals used a combination of hybrid and WeChat-only strategies. Significant heterogeneity was observed regarding the type of accounts and methods for delivering content and facilitating online conversations. A majority of studies found positive outcomes with WeChat education.

CONCLUSIONS

This scoping review addressed a large gap in knowledge about the usage of WeChat in professional healthcare education. Of the existing studies identified, we observed considerable promise for future practice. We provide additional suggestions for conducting future research involving patients and other helping professionals in healthcare education to expand the usage of WeChat.

The prevalence and severity of periodontal disease in Mainland China: Data from the Fourth National Oral Health Survey (2015-2016)

AIM

To evaluate periodontal conditions in adults in mainland China based on data from the 4th National Oral Health Survey.

MATERIALS AND METHODS

Data of adult subjects (35- to 44-year-old group [N = 4409], 55- to 64-year-old group [N = 4622], and 65- to 74-year-old group [N = 4428]) were analysed. Demographic, socio-economic, personal habit, dental history, and health attitude data were obtained using a questionnaire. Periodontal condition was assessed using the standardized case definitions of the 2018 classification scheme. A multivariate analysis was performed to investigate the relationship between periodontitis severity and age, smoking status, gender, and region using generalized additive models after adjusting for confounders.

RESULTS

The frequency of subjects with periodontitis was 52.8%, 69.3%, and 64.6% in the three age groups, respectively. The frequency of subjects with severe periodontitis (stage III or IV) was 10.6%, 37.3%, and 43.5% in the three age groups, respectively. The severity of periodontal disease was positively associated with age. Current and former smokers exhibited significantly greater disease severity than non-smokers after adjustment for confounders. No significant difference of severity was found between males and females.

CONCLUSION

Within the limitations of the study, the prevalence of periodontitis is very high among adults in mainland China. Periodontal status is associated with age and smoking status.

Optimized stratification of risk factors in and beyond the CHA2DS2-VASc score to differentiate the real thromboembolic risk in mainland China: a systematic review and meta-analysis

Recent studies have demonstrated the limitations of the CHA2DS2-VASc score [congestive heart failure, hypertension, age (>65 years =1 point; >75 years =2 points), diabetes, and previous stroke/ transient ischemic attack (2 points), vascular disease] which lacks many of less common risk factors for stroke. Moreover, only two risk factors, gender and age, are assigned with different points according to the stratification in the CHA2DS2-VASc score. Thus, this meta-analysis was aimed to optimize the stratification of risk factors in and beyond the CHA2DS2-VASc score for patients in mainland China. PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Journal Database (VIP) were searched from their inception to January 2020 for articles assessing risk factors of nonvalvular atrial fibrillation (NVAF) with ischemic stroke in mainland China. Odd risks (ORs) with 95% confidence intervals (CIs) were applied for dichotomous variable, and the weighed mean differences (WMDs) with standard deviations (SDs) were used for continuous variables. The meta-analysis included 20 eligible studies involving 14,675 patients. Compared with the non-stroke group [systolic blood pressure (SBP): 132.99 mmHg, 95% CI: 131.86-134.12; diastolic blood pressure (DBP): 80.08 mmHg, 95% CI: 78.63-81.53], the ischemic stroke group (SBP:144.07 mmHg, 95% CI: 140.74- 147.40; DBP: 84.41 mmHg, 95% CI: 82.39-86.43) showed increased levels of SBP (WMD 10.98 mmHg, 95% CI: 7.80-14.17, P<0.00001) and DBP (WMD 4.46 mmHg, 95% CI: 2.57-6.35, P<0.00001). In addition, the ischemic stroke group demonstrated significantly lower levels of left ventricular ejection fractions (LVEFs) (WMD 3.05% 95% CI: -5.96 to -0.14, P=0.04), and significantly higher levels of total cholesterol (TC) (WMD 0.32 mmol/L, 95% CI: 0.04-0.61, P=0.02) and low density lipoprotein cholesterol (LDL-C) (WMD 0.14 mmol/L, 95% CI: 0.02-0.26, P=0.02), as compared with the non-stroke group. The optimized stratification and the addition of risk factors in and beyond the CHA2DS2-VASc score may improve the predictive performance, thus helping to differentiate patients with the real thromboembolic risk.

The Trend in Timing of Prenatal Diagnosis for Thalassemia at a Chinese Tertiary Obstetric Center

Thalassemia is a great health burden in mainland China. Carrier screening and prenatal diagnosis (PND) are essential for its prevention. The aim of this study was to describe the trend in the timing of PND for thalassemia in at-risk families in mainland China. All women who were at-risk for thalassemia and received PND at a mainland Chinese tertiary obstetric center between 2011 and 2019 were included. Information required for the survey was obtained from the database of the institute. In total, 4045 women underwent PND for thalassemia, including 1720 for β-thalassemia (β-thal) and 2325 for α-thalassemia (α-thal). The median gestational age for the PND procedure was 13 weeks. The number of PNDs performed increased year by year over this period. For both β-thal and α-thal, the proportion of women undergoing early PND also increased along with the time span. A total of 428 cases was diagnosed prenatally to be affected with β-thal major (β-TM) and 769 were affected with Hb Bart's disease. Most of the β-TM pregnancies and all of the Hb Bart's disease pregnancies were terminated. With the implementation of effective screening measures, births of affected infants have been dramatically avoided, and early PND has become the main approach, thus allowing the possibility of obtaining results at an earlier stage of pregnancy.

Antibiotic Resistance Patterns of Staphylococcus aureus Isolates from Retail Foods in Mainland China: A Meta-Analysis

Foodborne Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), is increasingly threatening human health. Pooled prevalence rates of S. aureus contamination have been extensively studied in retail food products in mainland China, but data regarding antibiotic resistance rates of S. aureus remain scattered. This study was designed to collect researches published between 2007 and 2017 in mainland China and to evaluate the antibiotic resistance of S. aureus from retail foods using a meta-analytic approach. We systematically searched the China National Knowledge Infrastructure (CNKI) and Web of Science databases to identify peer-reviewed literature. A number of multilevel random-effects models were fitted to estimate mean occurrence rates of antibiotic-resistant S. aureus, and subgroup analyses were performed to compare antibiotic resistance rates of S. aureus throughout the years and among the methods to determine the antimicrobial susceptibility. Among the considered antibiotics, S. aureus showed the highest resistance rate to penicillin G (87%, 95% confidence interval [CI] 83-90%), followed by ampicillin (72%, 95% CI 62-81%) and erythromycin (41%, 95% CI 36-46%). MRSA showed the highest resistance rate to ampicillin (98%, 95% CI 89-100%), followed by oxacillin (97%, 95% CI 80-100%) and penicillin G (96%, 95% CI 89-99%). Multidrug resistance (MDR) of S. aureus was most frequently observed to three antibiotics (17%, 95% CI 12-22%), and MRSA showed the highest resistance rate to four antibiotics (24%, 95% CI 5-67%). Subgroup analyses results proved that sources of heterogeneity among studies were neither publication year nor detection method. In conclusion, the meta-analysis showed that β-lactam antibiotics resistance of S. aureus and MRSA strains isolated from retail foods remained the most serious, and MDR of S. aureus and MRSA were also observed. Therefore, it is important to monitor the antibiotic resistance of S. aureus and MRSA in food chain, and food safety measures should be taken to reduce the transmission of this bacterium from foods to human beings.

Transnational queer sociological analysis of sexual identity and civic-political activism in Hong Kong, Taiwan and mainland China

The sociology of homosexuality lacks engagement with queer theory and postcolonialism and focuses primarily on the global metropoles, thus failing to provide a plausible account of non-Western non-normative sexual identities. This research adopts the author's newly proposed transnational queer sociology to address these deficiencies. First, it critiques the Western model of sexual identity predominantly employed to elucidate non-Western, non-normative sexualities. It does so by examining not only the queer flows between West and non-West but also those among and within non-Western contexts to produce translocally shared and mutually referenced experiences. Second, the proposed approach combines sociology with queer theory by emphasizing the significant role of material, as well as discursive, analyses in shaping queer identities, desires and practices. This article employs the approach to examine young gay male identities, as revealed in 90 in-depth interviews conducted in Hong Kong (n = 30), Taiwan (Taipei, n = 30) and mainland China (Shanghai, n = 30) between 2017 and 2019. More specifically, it highlights the interplay between the state and identity by investigating the intersection and intertwining effects of these young men's sexual and cultural/national identities, revealing three different forms of civic-political activism. The article both demonstrates the way in which sexuality and the state are mutually constituted and provides nuanced analysis of the heterogeneity of contemporary homosexualities in Hong Kong, Taiwan and mainland China. In applying a new sociological approach to understanding sexuality, this research joins the growing body of scholarship within sociology that is decentring the Western formation of universal knowledge.

Depressive symptoms among adult children caregivers in China: moderating effects of working status and gender

Objectives: With over one-fifth of the world's older population, shrinking family size and increasing number of women in the workforce, elder care is a growing challenge for families in mainland China. This study explored the moderating effect of working status and gender on caregiving time and depressive symptoms among adult children caregivers in mainland China. Method: Participants were 660 adult children caregivers from a nationally representative sample of individuals aged 45 + (N = 13,204) who participated in the China Health and Retirement Longitudinal Study (CHARLS) Wave 2 (2013). Multiple linear regression was used to analyze the direct effect of caregiving time and the moderating effects of working status and gender on symptoms of depression among caregivers. Results: Significant main effect between caregiving time and depressive symptoms was found controlling for demographic covariates. The three-way interaction between working status, gender and caregiving time was also significant. Working status and gender moderate the effect of caregiving time on depressive symptoms: among employed men and women caregivers, spending more hours providing care predicted fewer depression symptoms. Unemployed men caregivers who spent more hours providing care showed highest level of depressive symptoms. Conclusion: The relationship between caregiving time and depressive symptoms was moderated by working status and gender. Future research is needed to explore factors that influence changes in caregivers' health and well-being over time.

Spatial distribution of tuberculosis and its socioeconomic influencing factors in mainland China 2013-2016

BACKGROUND

To assess the spatial epidemic characteristics of TB and identify the key areas for disease prevention and control.

OBJECTIVE

To explore the spatial distribution and socioeconomic influencing factors of TB in mainland China from 2013 to 2016.

METHODS

Spatial autocorrelation was used to explore the spatial distribution characteristics of TB at the quantitative level. Ordinary least squares (OLS) and geographically weighted regression (GWR) models were conducted to explore the association between factors and TB incidence from both global and local perspectives.

RESULTS

There was a significant positive spatial autocorrelation of TB at the provincial level (P < 0.05): hot spots were mainly located in the west of Xinjiang and Tibet, and cold spots in the eastern coastal areas. Four latent factors on the socioeconomic dimension, involving the proportion of illiterate people aged 15 and over, per capita disposable income in rural areas, the number of health technicians per 1000 population and the urban population density, were associated with TB incidence. The GWR model showed that the effect of the same factor on TB incidence varied with geographical location.

CONCLUSIONS

Spatial clustering of TB incidence in mainland China still exists. The differences of socioeconomic factors in different locations can be confirmed by GWR model. Targeted preventive and control measures or policies will be conducive in effectively reducing the incidence of TB, especially in hot spots.

Prevalence of human T-cell lymphotropic virus type-1 infection among blood donors in mainland China: a systematic review and meta-analysis of the last 20 years

Background: The southeastern coastal area of China has a high prevalence of HTLV-1 infection among blood donors. However, the estimation of HTLV-1 prevalence on a national and regional level is little known. The aim of this study is to understand and explore the estimation of HTLV-1 infection prevalence among blood donors on a national and regional level in mainland China by using a systematic review and meta-analysis. Study design and methods: All relevant publications of the past two decades (1998-2017), which were reported in both English and Chinese languages, were adopted and systematically assessed. The estimation of prevalence and its 95% confidence interval (CI) at the level of provinces/municipalities and overall were estimated using meta-analysis method. Results: From the 327 studies searched, 60 met the inclusion criteria. These were from 18 provinces and four municipalities and included 1,420,079 blood donors. The overall estimation of the HTLV-1 prevalence in blood donors was 0.169‰, and its 95% CI was 0.121‰-0.240‰. Conclusion: A disproportionate distribution of HTLV-1 infection among blood donors in different provinces/municipalities regarding its prevalence has been reported. This study recommends developing appropriate HTLV-1 screening strategies of blood donors in various regions of China considering regional prevalence, and cost-effectiveness.

Impacts of Road Traffic Network and Socioeconomic Factors on the Diffusion of 2009 Pandemic Influenza A (H1N1) in Mainland China

The 2009 pandemic influenza virus caused the majority of the influenza A virus infections in China in 2009. It arrived in several Chinese cities from imported cases and then spread as people travelled domestically by all means of transportation, among which road traffic was the most commonly used for daily commuting. Spatial variation in socioeconomic status not only accelerates migration across regions but also partly induces the differences in epidemic processes and in responses to epidemics across regions. However, the roles of both road travel and socioeconomic factors have not received the attention they deserve. Here, we constructed a national highway network for and between 333 cities in mainland China and extracted epidemiological variables and socioeconomic factors for each city. We calculated classic centrality measures for each city in the network and proposed two new measures (SumRatio and Multicenter Distance). We evaluated the correlation between the centrality measures and epidemiological features and conducted a spatial autoregression to quantify the impacts of road network and socioeconomic factors during the outbreak. The results showed that epidemics had more significant relationships with both our new measures than the classic ones. Higher population density, higher per person income, larger SumRatio and Multicenter Distance, more hospitals and college students, and lower per person GDP were associated with higher cumulative incidence. Higher population density and number of slaughtered pigs were found to advance epidemic arrival time. Higher population density, more colleges and slaughtered pigs, and lower Multicenter Distance were associated with longer epidemic duration. In conclusion, road transport and socioeconomic status had significant impacts and should be considered for the prevention and control of future pandemics.

The Development Path of the Lighting Industry in Mainland China: Execution of Energy Conservation and Management on Mercury Emission

The development path of the lighting industry in mainland China was studied in this work. Lighting electricity accounts for about 12% of social electricity consumption in mainland China, while only approximately 15% of electricity is conversed into light when incandescent light bulbs are used. To reduce electrical energy consumption and mercury emission from coal burning in the lighting industry, China worked out a roadmap to replace incandescent light bulbs with energy-saving fluorescent lamps (FLs). However, FL products utilize mercury to give out light and release mercury in their production, consumption and disposal processes. Therefore, the challenges of the lighting industry that mainland China are facing are controlling mercury pollution through the environmentally-friendly producing of fluorescent lamps, effective collecting and treating of spent fluorescent lamps. It was proposed that to effectively reduce energy consumption and mercury pollution, a good way to do this is developing energy-saving and mercury-free light emitting diode lighting industry. The mainland China Government's strategies to develop lighting industry are worthy of consideration and emulation by other countries.