Teacher-centered models in fundamental nursing education face issues including high student-instructor ratios and limited personalized feedback, hindering nursing students’ clinical competency development. Peer-assisted learning with digital platforms is a promising solution. However, there remains a lack of research exploring the impact of structured digital platforms designed for peer practice in fundamental nursing education. This study aimed to evaluate the effectiveness of a structured digital platform for reciprocal peer practice in fundamental of nursing education. We conducted a quasi-experimental study involving 72 s-year undergraduate nursing students. The intervention group utilized reciprocal peer practice with the WeChat Mini Program, which was based on the BOPPPS teaching model (Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment, Summary), while the control group participated in traditional group training in 3 weeks. Pre- and post-assessments were conducted using validated instruments. Data analysis was performed using SPSS 23.0, employing independent samples t-test and Mann-Whitney U test to compare the effects between the groups. The intervention group showed statistically significant improvements in the operational skills (Z = -3.566, p < 0.001). Additionally, participants in the intervention group showed improvements in the critical thinking (t = 2.386, p = 0.020). While both groups reported gains in self-efficacy, the intervention group exhibited a more pronounced improvement in self-efficacy (t = 3.152, p = 0.002) with reduced variability. The findings of this study highlight the potential for integrating digital tools for peer-assisted learning in nursing education, particularly within institutions facing faculty shortages or those seeking to modernize their pedagogical approaches.

BACKGROUND:Postoperative delirium (POD) is a common and serious complication after cardiac surgery. Although family involvement is considered a promising nonpharmacological strategy, its efficacy specifically in patients undergoing cardiac surgery remains inadequately supported by systematic evidence. OBJECTIVE:Our aim was to evaluate the effectiveness of family interventions in preventing POD among patients undergoing cardiac surgery. METHODS:We systematically searched multiple databases from inception to July 2025 for randomized controlled trials (RCTs) assessing family intervention for POD in patients undergoing cardiac surgery. Study selection, quality assessment, and data extraction were performed independently by 2 reviewers. We conducted a meta-analysis using RevMan 5.4 and Stata 18.0, with effects expressed as risk ratios or standard mean differences and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to evaluate evidence quality. The protocol was registered on PROSPERO (CRD42024627097). RESULTS:A total of 6 RCTs with 508 patients were included in the analysis. Family intervention significantly reduced the incidence of POD (risk ratio = 0.38, 95% CI: 0.25-0.58, P < .001) and shortened hospital length of stay (standard mean difference = -1.07, 95% CI: -1.91 to -0.24, P < .05). Our subgroup analysis revealed no significant differences in outcomes based on family involvement level, age, or sample size. Additionally, interventions improved psychological well-being and increased caregiver satisfaction ( P < .05). CONCLUSIONS:Family intervention reduces POD incidence and hospital stay and enhances psychological outcomes for patients and caregivers. However, due to small sample sizes, further large-scale high-quality RCTs are warranted.

In a contemporary supply chain, the situations in which all upstream, midstream, and downstream participants face capital constraints commonly appear and call for participants to coordinate and form an alliance to adopt supply chain finance (SCF) to optimize their operations and improve performance. Applying a game-theoretic framework, we examine four SCF alliances associated with a capital-constrained supplier, manufacturer, and retailer, respectively, within a triple capital-constrained supply chain (TCSC), including partial and full alliance financing schemes, and compare the participants’ profit, propagation effect of insolvency risk, and supply chain performance with individual financing. Our findings suggest that full alliance financing, although generates more propagation effect of insolvency risk, brings additional profit to all participants in a TCSC than partial or individual financing through reduced double or triple marginalization, as reflected by lower wholesale price, higher order quantity, and lower financing amount. The initial capital level is important in affecting participants’ operational and financial decisions and profits. Regarding profit distribution plans, we find the Shapley value distribution approach is preferred by all parties more than expected profit or even distribution when the collaborative benefits from alliance financing are high. Asymmetric information affects participants’ operational and financial decisions, profits, and the propagation effect of insolvency risk. Our findings guide participants in forming an alliance to apply for financing and coordinate to use the funds to optimize operations, achieve higher profit, implement the Shapley value profit distribution approach, enhance information transparency, and strengthen the intensity of insolvency risk monitoring and control.

This study identified the prevalence, influencing factors, and appropriate preprandial blood pressure (BP) management targets for postprandial hypotension (PPH) in older adults with hypertension in long-term care facilities (LTCFs). A multicenter cross-sectional study involving 25 LTCFs was conducted from June 2022 to August 2024. Trained researchers used validated automatic BP monitors to measure participants’ BPs 30 min and immediately before breakfast and at 0-, 30-, 60-, 90-, and 120-min postprandially. Statistical methods included logistic regression modeling and restricted cubic splines. PPH affected 56.7

Objectives To identify and assess the social support interventions provided to caregivers of older adults with dementia. By synthesising the findings, it seeks to provide insights into effective strategies that can enhance caregivers’ support.Design A scoping review.Data sources The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was strictly followed in this study. Searches were systematically conducted across five databases (PubMed, Web of Science, Embase, Cochrane Library, CINAHL) from their inception up to February 2025.Eligibility criteria for selecting studies We included original intervention studies published in English that examined social support interventions for caregivers of older adults with dementia, focusing on outcomes reporting social support.Data extraction and synthesis Data extraction was conducted using a standardised Microsoft Excel chart based on Arksey and O’Malley’s method. Two reviewers independently collected information on study characteristics (authors, country, publication year, design, sample size, assessment tools, interventions and outcomes). Disagreements were resolved by a third independent reviewer.Results A total of 31 studies were selected for this review, revealing six distinct categories of social support interventions for caregivers of older adults with dementia. These categories included peer support (n=7), counselling group intervention (n=2), health education (n=2), mindfulness-based stress reduction intervention (n=1), individual therapy (n=1) and multicomponent interventions (n=18). The findings indicate that these interventions significantly enhanced the social support available to caregivers, leading to positive outcomes such as reduced caregivers burden, anxiety, depression and improved coping skills.Conclusion This review underscores the variety of interventions designed to enhance social support for caregivers of older adults with dementia. The findings provide valuable insights for caregivers, administrators and other stakeholders, emphasising the critical need to adopt and promote effective social support strategies for this population.Trial registration details A review protocol was registered on the OSF（Open Science Framework） registries, with the following registration doi: https://doi.org/10.17605/OSF.IO/D9C53.

The cultivation of top innovative nursing talents with Chinese characteristics in the new era lends critical support to the accomplishment of the strategic goal of the Healthy China Initiative.Herein,we reviewed the historical development of nursing science in China,clarified the conceptual framework of nursing science with Chinese characteristics in the new era,and identified the essential qualities and competencies required for top innovative nursing talents.Furthermore,we analyzed the mission and challenges in cultivating these nursing talents,and put forward new approaches,including formulating new ethics and political education theories specific to nursing science with Chinese characteristics,establishing a cross-disciplinary educational model of Nursing+X,and creating a new nursing talent cultivation ecosystem adapted to the era of human-machine symbiosis.This study provides theoretical insights into the cultivation of top innovative nursing talents who align their development well with national strategic needs,embody patriotism,and possess a strong sense of contemporary responsibility.

This study aimed to cross-culturally adapt the MARA-Chinese version questionnaire and test its psychometric properties among Chinese women. This cross-cultural adaptation and validation study included three processes: cross-cultural adaptation, translation, and psychometric properties analysis. Original version of MARA was translated into Chinese. Content, conceptual, and semantic properties were compared with the original version and validated by an expertise panel. 600 participants, recruited in 16 provinces in China, filled out questionnaires to assess the reliability and the internal structure validity through exploratory factor analysis. 101 participants performed the retest to assess temporal stability. MARA-Chinese version questionnaire is composed of four scales: risk factors knowledge, signs and symptoms knowledge, risk perception, and barriers. The evidence of accuracy and validity of the scores are adequate both in terms of internal structure (factorial loadings > 0.60; CFI = 0.994; RMSEA = 0.049; RMSR = 0.053) and internal consistency and stability (Cronbach’s alpha > 0.75; Pearson correlation > 0.65). MARA-Chinese version questionnaire has adequate psychometric properties and is a valid and reliable tool to assess the breast cancer awareness of Chinese women through the assessment of knowledge of the risk factors and signs and symptoms of breast cancer, risk perception, and barriers to participate in breast cancer screening.

Introduction:Acute respiratory infections (ARIs) represent a significant threat to global public health, particularly among older adults residing in long-term care facilities (LTCFs), where high-density living conditions facilitate the rapid transmission of infections. The perception of risk regarding ARIs among caregivers is critical, as it directly influences their protective behaviors and decision-making during epidemic outbreaks. Despite the importance of this perception, there is currently no validated instrument specifically designed to assess caregivers' risk perception of ARIs within the context of LTCFs. This study aims to address this gap by developing a reliable and accessible scale to measure caregivers' risk perception. Methods:We developed an initial scale through a comprehensive literature review and two rounds of Delphi consultations with 19 experts in related field. A total of 428 participants in LTCFs were surveyed, yielding 343 valid responses and efficiency rate of 80.14%. Following a systematic scale development process that encompassed pretest, item analysis, and exploratory factor analysis (EFA) involving 123 respondents, we refined the scale to its robustness. Confirmatory factor analysis (CFA) was conducted with an additional 220 participants, alongside rigorous tests for reliability, stability, and validity, to evaluate the final scale. Results:The developed scale consists of nine items categorized into three dimensions: severity, controllability, and susceptibility, all of which meet essential criteria for reliability and validity. The overall Cronbach'α coefficients for the scale was 0.795, with each dimension coefficient of 0.795, 0.707, and 0.791, respectively. Discussion:In its current form, this scale serves as a valuable tool for managers and practitioners, enabling them to preliminarily assess caregivers' risk perceptions regarding ARIs in LTCFs. By enhancing our understanding of caregivers' behaviors, this instrument has the potential to inform targeted interventions.

Chronic high-altitude disease (CHAD) is primarily driven by oxidative damage and inflammation. Hydrogen-rich water (HRW) is a novel functional food with demonstrated antioxidant and anti-inflammatory properties. However, its potential effects on inflammation and oxidative stress in CHAD remain unexplored. In this study, 50 participants with CHAD were recruited and assigned to the HRW or placebo water (PW) group for 60 days. After seven participants were lost to follow-up, 43 participants (HRW, n = 23; PW, n = 20) completed the intervention and were included in the analysis. Oxidative stress indicators and inflammation-related immune cells were evaluated before and after treatment, and transcriptional profiles of all participants were analyzed to determine the potential mechanism of HRW in CHAD. Baseline characteristics did not differ significantly between the two groups. Enrichment analysis showed that differentially expressed genes in the PW group between pre- and post-intervention were predominantly associated with inflammation- and cytokine-related pathways, whereas HRW treatment significantly downregulated these pathways. By integrating weighted gene co-expression network analysis and protein-protein interaction network analysis we identified six hub genes, including tumor necrosis factor, interleukin-1 beta, C-C motif chemokine ligand 3, C-C motif chemokine ligand 3-like 1, C-C motif chemokine ligand 4-like 2, and radiation-inducible immediate-early response 3. Furthermore, measurements of oxidative stress and inflammatory markers indicated a non-significant downward trend in oxidative stress and inflammation in patients with CHAD after HRW intake for 60 days. These results suggest the potential protective role of HRW in CHAD, providing a novel adjuvant therapy for CHAD.

Innovative behaviours are important for nursing postgraduates who are a significant reserve for future nursing career, thinking critically, utilizing technologies and solving complex problems. In nursing undergraduates’ education, innovative behaviour is closely linked with the development of professional identity. However, there are limited studies exploring innovative behaviours, influencing factors and educational requirements of nursing postgraduates. To investigate nursing postgraduates’ innovative behaviour, influencing factors, and the correlation between innovative behaviour and professional identity. Moreover, exploring nursing postgraduates’ requirements for innovational education. A national descriptive cross-sectional study was conducted among postgraduate students in Chinese nursing schools between October and November 2022. A general information questionnaire, The Nurses’ Innovative Behaviour Scale, the Professional Identity Questionnaire for Nurse Student, and a multiple-choice question about students’ innovation education requirements were collected. The independent-sample t-test, one-way analysis of variance (ANOVA), multiple linear regression, and Pearson’s correlation analyses were conducted. This study recruited 426 nursing postgraduates from 44 nursing schools across China. The mean score of innovative behaviour of nursing postgraduates was 38.96 ± 4.90 (min-max 10–50). Nursing postgraduates’ professional identity was positively correlated with innovative behaviour (r = 0.436, P < 0.01). Participants who read scientific literature frequently, had a high level of professional identity, and grew up in urban areas had high levels of innovative behaviour (adjusted R2 = 0.244, P < 0.001). It was determined that the level of innovative behaviour is associated with their professional identity and the frequence of reading scientific literature in nursing postgraduates. It is imperative for educators to foster an environment that encourages postgraduate nursing students to engage with a wider array of scholarly literature and elevates postgraduate nursing students’ professional identity. Furthermore, the dissemination of advanced knowledge and the adoption of diverse pedagogical approaches are likely to meet the innovative demands of nursing postgraduates.

BackgroundChronic mountain sickness (CMS), driven by chronic hypoxia, features erythrocytosis, cardiovascular impairment, and systemic oxidative stress. Current studies focus on haematological and cardiopulmonary changes, but multidimensional features like sleep disturbances, quality of life, and oxidative stress remain underexplored.MethodsThe cross-sectional study included 47 adult Tibetan residents living at 4,500 m and diagnosed with CMS using Qinghai criteria. Blood samples were collected, and questionnaires assessed quality of life, fatigue, and sleep. Multivariate logistic regression was used to explore associations between variables, using CMS comorbid with high-altitude polycythemia (HAPC) or sleep disturbance as endpoints.ResultsThe mean age of patients was 40.57 ± 6.21 years (29 males, 18 females). Males had higher RBC, HGB, HCT, UA, and T-AOC levels (all P < 0.001). A moderate to strong positive correlation was observed between these markers. 91.67% of patients with comorbid HAPC were males with severe CMS. Lower MCHC (OR = 0.80, P = 0.02) and higher T-AOC (OR = 1.47, P = 0.02) were associated with HAPC. Males (OR = 0.11, P = 0.03), higher 8-OHdG levels (OR = 0.95, P = 0.03), higher body pain scores (OR = 0.91, P < 0.01), and higher general health scores (OR = 0.90, P = 0.02) were more likely to report good sleep quality.ConclusionMales with CMS had higher T-AOC and better sleep quality than females. Good sleep quality was associated with better quality of life and less fatigue. Oxidative stress indicators correlated with clinical phenotypes, but causality requires further investigation. This trial was registered at Chinese Clinical Trial Registry (ChiCTR2400082685).

Meeting spiritual needs of older adults with chronic illnesses in multicultural settings is challenging but vital for well-being, respect, and global health equity. We conducted a qualitative study in culturally diverse regions of China to explore the spiritual experiences of older adults living with chronic diseases. Semi-structured, face-to-face interviews were conducted with a total of 28 participants, comprising 25 individuals suffering from chronic illnesses and 3 healthcare professionals. An inductive content analysis approach was utilized to analyze the data. Seven themes emerged, encompassing spiritual awareness, spiritual needs, spiritual resources, spiritual growth, spiritual equilibrium, spiritual outreach, and spiritual cultivation. The proposed model illustrates a spiraling growth trend in the spiritual experience of older adults. Regardless of their awareness of spirituality, the aging process prompts individuals to explore their spiritual needs and engage in spiritual experiences to varying extents. Addressing spiritual needs of older adults with chronic illnesses in multicultural context is vital. Respecting cultural diversity and fostering spiritual growth enhances dignity, autonomy equity, and well being of older adults. The study model reveals dynamic spiritual experiences, highlighting the need for individualized interventions. Not applicable.

OBJECTIVES:Global aging has increased the demand for long-term care facilities (LTCFs) for older adults with dementia. This challenge is further exacerbated by systemic barriers such as insufficient infrastructure and a shortage of trained caregivers within LTCFs. These limitations heighten care risks for vulnerable populations and underscore the urgent need for tools to evaluate caregivers' risk perceptions-a critical determinant of safety practices. This study developed and validated the Care Risk Perception Scale (CRPS), a specialized instrument designed to assess caregivers' perceived risk associated with dementia care and inform targeted interventions in LTCFs. DESIGN:A mixed-method design was used, including literature review, 2 rounds of Delphi expert consultation (n = 22), and psychometric validation with 501 caregivers in LTCFs. SETTING AND PARTICIPANTS:Participants were caregivers of older adults with dementia in LTCFs in Sichuan Province, China. Inclusion criteria required at least 3 months of caregiving experience and cognitive competence, March-September 2024. METHODS:A mixed-method design was used: (1) literature review and 2 Delphi rounds (22 experts) generated a preliminary scale; (2) psychometric validation involved 501 caregivers from 150 Chinese LTCFs, including item analysis, exploratory factor analysis (n = 200), and confirmatory factor analysis (n = 301). RESULTS:The final CRPS contains 23 items across 4 dimensions: institutional, environmental, psychological support, and competency risks. The scale demonstrated strong reliability (Cronbach's α = 0.882 overall; 0.753-0.905 for subscales) and validity (content validity = 0.928). Exploratory factor analysis extracted 4 factors explaining 69.78% variance (Kaiser-Meyer-Olkin = 0.888, Bartlett's χ2 = 3753.073, P < .001). Confirmatory factor analysis confirmed model fit (χ2/df = 2.725, Comparative Fit Index = 0.928, Root Mean Square Error of Approximation = 0.075). Split-half reliability was 0.457 (P < .001), and test-retest reliability was 0.714 (P < .001). CONCLUSIONS AND IMPLICATIONS:The CRPS is a scientifically robust tool to assess care risk perceptions in LTCFs. By identifying caregivers' risk awareness gaps, it supports targeted interventions and policy reforms for standardized safety audits to enhance dementia care quality and safety.

BACKGROUND:The increasing research on design thinking in nursing underscores its potential to improve patient care and optimize healthcare systems. However, a comprehensive bibliometric analysis of this emerging field is still lacking. PURPOSE:This study aims to provide a thorough overview of existing research on design thinking in nursing using bibliometric indicators to examine trends and draw insights. METHODS:VOSviewer was used to conduct a bibliometric analysis, providing insights into the characteristics of the academic literature on design thinking in nursing. This study analyzed the literature from the inception of the database until March 20, 2024, using sources from the Web of Science Core Collection and the Cumulative Index to Nursing and Allied Health Literature database. RESULTS:The results reveal a substantial increase in research on design thinking in nursing, with 264 publications contributed by 1477 authors representing 634 organizations across 47 countries. These articles were published across 190 journals and referenced 10,093 sources from 5153 journals. The United States led in search contributions with 117 publications, while Stanford University stood out as the most prolific institution, averaging 40.3 citations per publication, highlighting its significant influence in the field. The study primarily explores broad themes in nursing, emphasizing key areas such as human-centered design, digital health, telemedicine, artificial intelligence (AI), education, innovation, and quality improvement. These findings reflect the increasing recognition of design thinking as a vital approach to enhancing nursing practice and education. CONCLUSION:This study highlights the growing global focus on design thinking in nursing, with Western regions emerging as key contributors to research in the field. The recognition of key areas, including human-centered design, digital health, telemedicine, AI, education, innovation, implementation science, and quality improvement, underscores the need for nursing to advance its design thinking approaches. The results emphasize the importance of nursing educators and practitioners adopting and integrating design thinking principles, as this approach can significantly improve educational outcomes and patient care.

Older adults with dementia face heightened care risk, defined as the uncertainty surrounding adverse events arising from the complex interplay of factors related to the individual, caregivers, the physical/social environment, and care processes during daily, rehabilitative, or recreational activities. It poses significant threats to their well-being, that of their families, and society at large. However, the approach to assessing care risk in older adults with dementia remains unclear. We aimed to identify current risk assessment tools and perspectives for older adults with dementia by providing a comprehensive overview and highlighting significant gaps in the current research. This study adhered to the Joanna Briggs Institute methodology for scoping review alongside the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Eight databases, including PubMed, CINAHL, Web of Science, Cochrane Library, SinoMed, CNKI, WANFAGN, and WIP, were searched from their inception to 30th December 2023. We identified 13,106 articles, 16 of which met the inclusion criteria. The research approaches adopted in the reviewed articles were qualitative analysis (N = 4, 25

Objectives Ensuring that children receive timely vaccinations is paramount for preventing infectious diseases, and parental attitude plays a pivotal role in this process. This study addresses this gap in the existing literature by examining parental attitudes towards vaccinating their children.Design A cross-sectional study.Methods An online survey including parents’ sociodemographic characteristics, risk perception and attitudes towards child vaccination towards COVID-19 was conducted. The modified large-scale group decision-making approach for practicality and binary logistic regression was used to identify the predictors influencing parents’ decision-making.Results Of the 1292 parents participated, 957 (74.1%) were willing to vaccinate their children, while 335 (25.9%) refused the vaccination. The study indicated that age, parental anxiety regarding child vaccination, concerns about the child’s susceptibility to the disease, opinions towards vaccination benefits versus disadvantages, place of residence, average family income and children’s health were significant predictors (p<0.05).Conclusions While most parents supported childhood vaccination, some opposed it. Addressing persistent barriers is crucial to ensure widespread vaccination and child well-being.

Importance:Blinding of individuals involved in randomized clinical trials (RCTs) can be used to protect against performance and biases, but discrepancies in the reporting of methodological features between registered protocols and subsequent trial publications may lead to inconsistencies, thereby reintroducing bias. Objective:To investigate inconsistency in blinding as reported in trial registries and publications. Data Sources:An exploratory dataset and a validation dataset were created. The exploratory dataset consisted of RCTs included in systematic reviews of adverse events from the SMART Safety database published between January 1, 2015, to January 1, 2020. The validation dataset was based on a literature search on PubMed for all registered RCTs published within the same time frame. Study Selection:Eligible RCTs for the exploratory dataset included were those that specified drug safety as the exclusive outcome and included at least 1 pairwise meta-analysis involving 5 or more RCTs of health care interventions. The validation dataset included a random selection of RCTs without restriction on outcome. Data Extraction and Synthesis:Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed during data extraction. RCTs were matched to their registries and information on blinding was extracted from both the journal publication and trial registry. Extraction was performed by 1 author and cross-checked by 2 additional authors, with discrepancies resolved via consensus. The data analysis was conducted between July 2023 and January 2024. Main Outcomes and Measures:The primary outcome was inconsistency in blinding reports in the publication and the associated trial registry. Factors associated with the inconsistency were further investigated using multivariable logistic regression. The results were then compared with the validation dataset. Results:A total of 1340 RCTs were included, with a median (IQR) sample size of 338 (152-772) participants. Of these, 749 (55.90%) were multiregional, 1220 (91.04%) were multicenter, and 835 (62.31%) were prospectively registered. The most frequently studied condition was cancer, representing 472 trials (35.22%). In the exploratory dataset, 1080 trials (80.60%) had inconsistent reporting of blinding in their published trial registry. Higher odds of inconsistency were associated with trials conducted as single-center (OR, 2.84; 95% CI, 1.24-7.74; P = .02) or those focused on cancer (OR, 3.26; 95% CI, 2.04-5.38; P < .001). Evaluation of the 98 RCTs in the validation dataset revealed that 70 (71.43%) had inconsistencies between the published trial and its registries. The occurrence of inconsistencies was significantly higher in the exploratory dataset than the validation dataset (P = .03). Conclusions and Relevance:In this systematic review of RCTs, there were significant inconsistencies in the reporting of blinding between trial publications and their corresponding registries. These findings underscore the importance of maintaining consistency between registered protocols and published trial reports to ensure methodological transparency and minimize bias.

OBJECTIVES:Vaccine hesitancy persists as a significant global health concern, especially during public health crises. This study aimed to explore factors influencing vaccination acceptance during a major public health crisis and establish a model of influencing factors. DESIGN:A cross-sectional study. METHODS:An anonymous cross-sectional survey was conducted online, encompassing sociodemographic characteristics, anxiety levels, personal risk perception and attitudes towards vaccination acceptance. Data analysis was performed using t-tests, one-way analysis of variance and multiple linear regression techniques in IBM SPSS Statistics V.25.0 (IBM Corp., Armonk, NY, USA). RESULTS:A total of 3921 participants participated in the survey. The mean acceptance attitudes were above the moderate level (M=4.02, SD=0.51), the mean risk perception score was below the moderate level (M=2.66, SD=0.58), and the mean score on the Self-Rating Anxiety Scale was also below the moderate level (M=2.05, SD=0.53). The results showed that internal variables (gender, age, marital status, professional background, region) and external variables (average family income, distance from home to vaccination site, family medical background) were statistically significant (p<0.05). Gender, region, distance from home to the vaccination site, anxiety, family medical background, risk coping, emotional perception and psychological representation of unusual severity were identified as significant predictors of vaccination acceptance attitudes, with the model explaining 35% of the variance (R²= 0.35, adjusted R²= 0.33). Based on these results, we constructed a theoretical model of influencing factors for vaccine acceptance attitudes. CONCLUSIONS:Despite increased acceptance of vaccination during major public health events, factors that both support and hinder acceptance remain. Identifying these factors allows for effective disease control and informs the development of public health strategies and crisis response measures.

AbstractDespite abundant scientific evidence supporting immunization benefits, vaccine hesitancy remains a significant global health concern, particularly during public health crises. Exploring public attitudes towards vaccination is crucial. This study aimed to develop and validate a tailored Public Vaccination Attitudes Scale specifically under the unique circumstances of a public health crisis. A psychometric evaluation was conducted using a cross-sectional study during the peak of a major public health crisis. The scale was developed and its psychometric properties validated using three approaches: (1) generating the item pool through literature research and focus group discussions; (2) assessing the items through expert consultation; and (3) evaluating construct validity, content validity, and internal consistency reliability through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Data from a total of 3921 respondents were randomly divided into two subsets, one for EFA (n = 1935) and the other for CFA (n = 1986). A 22-item draft scale with five factors was created after literature research and focus group discussion. The content validity of this scale ranged between 0.88 and 1.00. EFA showed a 17-item scale with four factors (Cronbach’s α > 0.7) accounting for 68.044% of the total variance. CFA showed that the values of the fit indices, including convergent validity and discriminant validity, were excellent or acceptable. The overall Cronbach’s α was 0.874, and each factor ranged from 0.726 to 0.885. This study introduces a valuable tool for assessing vaccination attitudes during public health crises, aiding researchers, policymakers, and nurses in combating vaccine hesitancy. Emphasizing the importance of fostering vaccine acceptance, it enhances disease control during emergencies, contributing to the knowledge needed for more effective public health strategies and crisis responses

Grounded in the cultural context of Chinese filial piety, this study employs structural equation model to analyze survey data from elderly participants. It explores the effect and path of progeny-parents family travel on the elderly's sense of well-being and examines the mediating roles of generational interaction, optimistic emotion, and psychological resilience. The findings indicate that progeny-parents family travel positively influences the well-being of the elderly, with generational interaction, optimistic emotion, and psychological resilience serving as intermediary roles. Theoretically, this study enriches the localized perspective of family travel's psychological and behavioral impact on the elderly. It elucidates the spillover effects of family travel within the framework of filial piety culture, delineates the mechanisms by which family travel enhances elderly well-being, and offers theoretical insights for businesses to develop customized family travel products and services.