Depressive symptoms are common among rural adolescents and are closely linked to proximal social-ecological factors. However, it remains unclear how specific depressive symptom dimensions are connected with these factors, which proximal factors and depressive symptoms serve as bridge nodes, and whether these patterns differ by gender. A multi-stage cluster sampling method was used to survey 4,070 rural Chinese adolescents. Network analysis was performed using R software, with the model including depressive symptoms and proximal social-ecological factors. Bridge expected influence was calculated to identify bridge nodes. Network comparison tests were used to examine gender differences in network structure and strength. The strongest cross-community edge was observed between social support and anhedonia. Bridge expected influence identified parental rejection, negative mood, and negative coping as the most prominent bridge nodes in the overall network. Network comparison showed a significant difference in network structure, but not in global strength. In the male network, negative mood showed the highest BEI among depressive symptoms, whereas interpersonal problems showed the highest BEI in the female network. Proximal social-ecological factors are connected with depressive symptoms in a specific pathway. Parental rejection, negative coping, and gender-specific bridge symptoms may represent important targets for future interventions.

PURPOSE:To investigate consistency in awareness, attitudes, and engagement in advance care planning (ACP) among older adults with chronic illnesses and their families, as well as influencing factors. METHOD:A mixed methods sequential explanatory design was used, with data collected from 312 patient-family member dyads via validated questionnaires and 11 dyads through semi-structured interviews. RESULTS:Key findings revealed low consistency in ACP awareness (Kappa = 0.191 to 0.449), with 97.76% of participants unfamiliar with ACP terminology. General positive attitudes toward ACP were observed, with 70.51% viewing it as meaningful (Kappa = 0.431), although engagement consistency was low (intraclass correlation coefficient = 0.109 to 0.390). Qualitative findings identified personal and familial characteristics, family dynamics, traditional culture, and clinical decision-making models as influential factors. CONCLUSION:Despite generally positive attitudes toward ACP, low consistency in awareness and engagement among Chinese older adults and their families necessitate the implementation of culturally sensitive, family-centered ACP interventions.

Introduction In ACP studies, the Decisional Conflict Scale (DCS) is often combined with hypothetical scenarios as outcome measures. The validated three hypothetical scenarios relating to life-sustaining treatments and care utilization in the DCS proved to be a reliable and valid tool. However, there is a lack of decision conflict measurement tools combining scenarios in the context of ACP in China. Objectives To cross-culturally adapt and evaluate the psychometric property of the three hypothetical scenarios among Chinese older adults and preliminary application. Methods The Chinese version of the scenarios of DCS was culturally adapted, revised, and pre-surveyed to form the mainland China version. The psychometric properties of three hypothetical scenarios were conducted among 210 community-dwelling residents, and the preliminary application was carried out on 224 community- dwelling residents in four community health service centers in Zhengzhou City, Henan Province, China. Results The three culturally adapted scenarios were validated to have good internal consistency, and the results of the validation factor analysis indicated a good model fit. Preliminary application results indicate that Chinese community-dwelling older adults differ in preference distributions across scenarios and exhibit clinically significant decision-making conflicts. Conclusion The care and treatment scenarios for measuring decisional conflict regarding future care preferences showed good reliability and validity among the older adults in China. A substantial proportion of Chinese older adults reported clinically significant levels of decision conflict across a range of treatment and care related hypothetical scenarios. For the scenario response distribution of life-sustaining treatment, "hospital" and "emergency" showed a difference.

Advance care planning (ACP) is a crucial measure to ensure patient autonomy and improve end-of-life care quality. The sharing patient's illness representation to increase trust (SPIRIT) intervention is one of the most successful ACP intervention studies in the United States. By systematically reviewing the development and characteristics of the SPIRIT intervention, this study focuses on its strengths and weaknesses. Research findings indicate that the sustained clinical application of the SPIRIT intervention lies in its comprehensive intervention system. Based on this, new insights are proposed: building the ACP intervention system based on social and cultural contexts, evaluating it from a comprehensive and broad perspective, and applying it with continuous quality improvement as the goal.

Numerous studies have demonstrated the heterogeneity of depressive symptoms, but few studies have focused on the heterogeneity of depressive symptoms among rural Chinese adolescents. In November to December 2022, multistage sampling was employed to administer questionnaires to 1,816 rural adolescents aged 11–19 years from six schools in Henan Province, China. Depressive symptoms were measured using the Chinese version of the Children’s Depression Inventory Scale. Latent class analysis (LCA) was utilized to identify subgroups of depressive symptoms. The investigation of subgroup characteristics and associated factors was conducted through χ2 tests, ANOVA, and multinomial logistic regression analyses. The findings revealed a 24.24 % detection rate of depressive symptoms among Chinese rural adolescents. LCA analysis of responses to the 27 items in the Depressive Symptoms Scale led to the classification of depressive symptoms into four subgroups based on severity: “no depressive symptoms group” (22.5 %), a “low depressive symptoms group” (35.7 %), a “transition group” (31.6 %), and a “high depressive symptoms group” (10.2 %). Gender, grade level, academic performance, academic stress, family environment, and level of psychological resilience are associated factors for subgroups of depressive symptoms among rural adolescents. There should be increased training of rural educators to enable early recognition of depressive characteristics and risk factors, facilitating targeted prevention and intervention strategies.

Background: Depressive symptoms are one of the most common mental health problems in adolescence, and the relationship between perceived social support and depressive symptoms has been well-studied. However, little research has been conducted on the mediating role of specific coping styles in the relationship. Therefore, the primary purpose of this study was to examine the mediating role of specific coping styles in perceived social support and depressive symptoms in adolescents.Methods: A questionnaire was administered to 3887 Chinese junior and senior high school adolescents (mean age = 15.72 years, SD = 1.43) using a multistage stratified and cluster sampling method. The PROCESS model 4 was used to conduct a multiple mediation analysis.Results: Problem solving, seeking help, venting, fantasy and endurance mediated the relationship between internal family support or external family support and depressive symptoms. The problem solving coping style mediated the largest amount of effect, accounting for 22.32 % and 19.05 %, respectively.Limitations: This study used a cross-sectional survey and self-reported information, which may be the main research limitation. Conclusions: The findings suggest that higher social support not only directly reduces the likelihood of adolescent depression, but also influences depressive symptoms through specific coping styles. This may help further develop targeted prevention and interventions for at-risk adolescents for specific coping styles.

Purpose: The family plays a major role in medical decision-making in China. Little is known about whether family caregivers understand patients' preference for receiving life-sustaining treatments and are able to make decisions consistent with them when patients are incapable of making medical decisions. We aimed to compare preferences and attitudes concerning life-sustaining treatments of community-dwelling patients with chronic conditions and their family caregivers.Patients and Methods: We conducted a cross-sectional study among 150 dyads of community-dwelling patients with chronic conditions and their family caregivers from four communities in Zhengzhou. We measured preferences for life-sustaining treatments (cardiopulmonary resuscitation, mechanical ventilation, tube feeding, hemodialysis, chemotherapy), who should decide, the timing of making decisions, and their most important consideration. Results: The consistency of preferences for life-sustaining treatments between patients and family caregivers was poor to fair, with kappa values ranging from 0.071 for mechanical ventilation to 0.241 for chemotherapy. Family caregivers more frequently preferred each life-sustaining treatment for the patients than the patients themselves. More family caregivers than patients preferred the patient to make their own decisions about life-sustaining treatments (29% of patients and 44% of family caregivers). The most important considerations when deciding on life-sustaining treatments are family burden and the patient's comfort and state of consciousness. Conclusion: There is a poor to fair consistency between community-dwelling older patients and their family caregivers in their preferences and attitudes towards life-sustaining treatments. A minority of patients and family caregivers preferred that patients make their own medical decisions. We recommend healthcare professionals to encourage discussions between patients and their families on future care to improve the mutual understanding within the family about medical decision-making.

The current study aimed to explore the status and influencing factors of professional identity among psychiatric nurses as second victims in China by using a cross-sectional design. We investigated 291 psychiatric nurses from two psychiatric hospitals. Participants were asked to complete a demographic questionnaire, Second Victim Experience and Support Scale, Multidimensional Health Locus of Control Scale, and Professional Identity Scale for Nurses. Scores of professional identity of psychiatric nurses as second victims were moderate. Regression analysis showed that the second victim experience and support and internal control were significant predictors, explaining 34.2% of the variance in professional identity. Identifying risk factors related to the professional identity of psychiatric nurses as second victims will help managers take timely preventive measures to improve the awareness of the self-health responsibility of psychiatric nurses and reduce the adverse effects of patient safety incidents to enhance their professional identity. [Journal of Psychosocial Nursing and Mental Health Services, 61(12), 47-54.].

Objective To describe the scope and breadth of primary research regarding the implementation of the Safewards Model and its interventions in psychiatric wards. Methods A comprehensive search of the electronic databases,such as PubMed,Embase,CINAHL,PsycINFO,Web of Science,Scopus,Cochrane Library,JBI EvidenceBased Practice,JBI Evidence Synthesis,CNKI,WANFANG,VIP,and SinoMed,from database inception to August2022,has been conducted to retrieve all the potentially relevant articles. 2 researchers independently screened and extracted information for the retrieved literature,and the evidence was then synthesized and summarized. Results The included 19 articles comprehensively evaluated 14 safewards implementation studies in terms of its effectiveness,intervention fidelity,and feasibility. Conclusion The safewards interventions,if implemented with high fidelity,can effectively reduce the incidence of conflict events in psychiatric wards and the use of restrictive practices,and improve the ward atmosphere. Safewards provide an opportunity and platform by which trauma-informed and recovery-oriented practices in psychiatric setting can be achieved. For the future implementation of safewards,it is necessary to strengthen the training of staff,to help staff develop positive attitudes and beliefs toward safewards,and to seek support from hospital management level.

目的:将基于质量敏感指标的PDCA循环质量改进干预应用于介入手术室质量管理中，并探讨其干预效果。方法:选取2018年12月至2019年12月郑州大学第一附属医院行介入治疗患者120例为研究对象，按照入院先后顺序法两组基础资料具有匹配性原则将其分为研究组和参照组患者各60例。参照组实施常规护理质量管理，研究组在此基础上实施基于质量敏感指标的PDCA循环质量改进干预。比较两组患者的不良事件发生率、质量敏感指标检查结果护理质量、患者的满意度情况。结果:干预后，研究组患者的不良事件发生率显著低于参照组；研究组患者的质量敏感指标检查结果显著优于参照组；研究组患者对护理工作质量满意度评分显著高于参照组，差异均有统计学意义(均 P<0.05)。 结论:将基于质量敏感指标的PDCA循环质量改进干预应用于介入手术室中，可显著减少患者的不良事件发生情况，改善其患者质量敏感指标检查结果，提升患者对护理质量的工作满意度，对优化临床护理工作质量有显著促进作用。

In China, traditional culture advocates family consensus, and the advance care planning (ACP) engagement of family members is crucial to the implementation of ACP. However, there is still a lack of research on family members' engagement in ACP in mainland China. This study investigated the ACP engagement of family members of community-dwelling elderly patients with chronic diseases and provided evidence for further ACP intervention research. We conducted a mixed-methods sequential explanatory study, 273 family members were surveyed, and semistructured interviews were conducted. Following that, 12 family members were selected after statistical analysis to supplement the quantitative results. The results showed that the ACP engagement of family members of elderly patients with chronic diseases in the community was low, but the self-efficacy was higher. The age of family members, severity, and duration of patients' diseases were the main influencing factors for family members' ACP engagement. Traditional cultural, clinical decision-making mode, lack of understanding of ACP, and factors within the family may impede family members' engagement. This study showed that family-centered ACP practice has significant advantages in China and that future research should focus on the Chinese culture and medical system and highlight the role of families.

BACKGROUND Advance care planning (ACP) has become increasingly critical for older people. The Advance Care Planning Engagement Survey (ACPES) develops targeted interventions for older people by measuring ACP-related behaviours, while previous studies focus only on advance directives. Moreover, while ACPES has English and Dutch versions, it does not yet have a Mandarin Chinese version (ACPES-MC) that can be used for Chinese populations. OBJECTIVES To translate the ACPES into Mandarin Chinese and test its reliability and validity in community-dwelling older people with chronic diseases. METHODS The English version of the ACPES was translated into Mandarin Chinese using Functional Assessment of Chronic Illness Therapy. Four communities were recruited in central China (N = 450) by convenience sampling. Internal consistency and construct validity were used to evaluate the reliability and validity of the ACPES-MC. RESULTS The ACPES-MC consists of 34 items across five domains, with good internal consistency (0.817), with each dimension ranging from 0.606 to 0.881; exploratory factor analysis was distributed to four different factors and the total variance explained was 63.537%; and confirmatory factor analysis results showed that χ2  = 3791.131 (p < .001), χ2 /df = 1.106, CFI = 0.980, IFI = 0.980, NFI = 0.827 and RMR = 0.027, indicating a good model fit to previous factor structures. CONCLUSIONS The ACPES-MC is an effective and reliable tool that can measure the ACP-related behaviour stage of community-dwelling older people and evaluate the effect of ACP intervention. IMPLICATIONS FOR PRACTICE The ACPES-MC can be used in healthcare to identify potential ACP-related behaviours in community-dwelling older people with chronic diseases, including native and ethnic Chinese, evaluate their behaviour change stages and promote the application of ACP.

Aims: This study aimed to develop and validate the psychometric properties of Information Needs Questionnaire for Differentiated Thyroid Cancer (INQ-DTC) in DTC patients with radioactive iodine (RAI) therapy. Design: Mixed methods. Methods: Using qualitative methods, we developed the initial questionnaire from a personal perspective of information needs of 15 patients with DTC. We used a formal Delphi consensus process to help assess the initial questionnaire and provide recommendations for its application. Totally, 230 DTC patients with RAI therapy were selected for the process of validation. Results: The final version of INQ-DTC contains 33 items. The total Cronbach's alpha coefficient was 0.945, the total split-half reliability was 0.822, and the test-retest value was 0.984 for the overall score. Exploratory factor analysis extracted 5 factors, which could explain 61.86% of the total variance. The Scale-level content validity index (S-CVI) was 0.928, and 0.929 for the item-level content validity index (I-CVI).

Self-harm, which affects the whole family system, is an international public health concern. Empirical evidence supports the efficacy of interventions incorporating a family/parent training component for self-injurious thoughts and behaviours, and a quantitative synthesis of these empirical studies has been undertaken and updated. A qualitative synthesis of the experiences of parents whose child self-harms remains limited. This report aimed to systematically review qualitative research about the experiences, preferences, and expectations of parents whose children self-harmed. A comprehensive search was conducted across ten databases and four grey literature sources, along with the manual search of reference lists and relevant websites. Study screening, data extraction, and quality appraisal were all performed by two independent researchers. Twenty-four articles, two of which were mixed-methods studies, were included and analysed using a meta-aggregation approach. Five synthesized findings were identified: initial negative reactions to the discovery of their child's self-harm, the ongoing impact of self-harm on parents and the wider family, parents' various coping strategies, parents' negative experiences with mental health professionals expectations, and the lack of and need for psychoeducational resources. Our review finds that parents express keen interest in engaging with the treatment process, and our results support family-based therapy. However, with the overwhelming emotions most parents experience, clinicians should approach them with sensitivity, empathy and finesse. Psychoeducational self-help resources should also be made readily available to parents who are reluctant to seek help.

预立医疗照护计划( ACP)支持处于任何年龄阶段及健康状态的成年人与医护人员及家庭分享个人价值观、生活目标及临终阶段医疗照护偏好〔1〕.ACP除强调完成生前预嘱或指定预立医疗委托人外,更注重通过沟通帮助个体思考自身价值观,为个体及其委托人的决策做准备〔2〕.美国于20世纪60年代末首次提出 ACP 的概念,并赋予其法律效力〔3〕.ACP的有效实施从仅需患者签署具有法律效力的文件发展至患者需思考并与其家庭、医护人员共同讨论、协商一致后形成文件并可视个人意愿更改与取消的过程〔4〕.但由于ACP所涉及的个人、社会文化因素与法律系统的复杂性, ACP的推行与使用受到限制〔5〕.本文通过多角度综述影响 ACP行为的因素,为促进医疗系统制订相应的管理方法,继而影响不同人群对ACP认知与态度,从而为提高其参与ACP的积极度提供借鉴.

BackgroundAs the physical function declines with age, and the disease progresses, elderly chronic disease patients face decreased cognitive function and abilities in communicating medical affairs and making relevant decisions, which will have a certain impact on the expression of end-of-life will. Early implementation of the advance care planning (ACP) for elderly patients will guarantee their medical decision-making autonomy. To facilitate the delivery of interventions to promote the implementation of ACP, it is important to study ACP behaviors and related stages of behavior change in this population.ObjectiveTo investigate ACP behaviors, and stages of behavior change as well as associated factors in elderly chronic disease patients in the community.MethodsFrom May to July 2020, by use of convenience sampling, 410 elderly chronic disease patients were selected from the community with coverage of healthcare services delivered by Hanghai East Road Community Health Center, Zhengzhou, and were invited to attend a survey using the General Information Questionnaire and the Chinese version of Advance Care Planning Engagement Survey. Stepwise multiple linear regression was used to identify the influencing factors of stages of behavior change of ACP.ResultsAltogether, 384 (93.7%) individuals who returned responsive questionnaires were included for analysis. Among the respondents who had been involved in ACP. 42 (10.9%) had "talked with family and friends about the medical decision maker", 39 (10.1%) had "talked with family and friends about medical care", 23 (6.0%) had "talked with the medical decision maker about decision-making flexibility", 12 (3.1%) had "asked doctors questions", but no one was involved in four main ACP behaviors. Two hundred and ninety-two (76.0%) respondents were in the pre-contemplation stage of behavior change, and 92 (24.0%) were in the contemplation stage of behavior change. Of the behavior change constructs, the total score of the knowledge showed no significant differences by socio-demographic factors (P>0.05) , but the total score of the contemplation differed significantly by education level, self-rated disease severity and healthcare-seeking related experience in recent five years (P<0.05) . Stepwise multiple linear stepwise regression analysis revealed that education level, hospitalization experience and medical-decision making in the past five years were associated with the contemplation of behavior change construct (P<0.05) .ConclusionOnly some elderly chronic disease patients in the community had been involved in ACP, and had contemplated ACP behaviors. To promote patient engagement in ACP, it is suggested that medical workers should consider ACP as a continuous process composed of multiple behaviors rather than a single behavior during the delivery of health education, and guide patients to increase their understanding of ACP process based on contemplating their ACP behaviors, as well as offer patients targeted interventions based on their current stage of behavior change.

Objective:To construct advance care planning (ACP) interventions for end-stage cancer patients based on Watson care theory, so as to provide basis for ACP practice in end-stage cancer patients.Methods:Semi-structured interviews were conducted to establish items pool for "ACP interventions based on Watson care theory for end-stage cancer patients ". Delphi expert inquiry method was used to evaluate, revise and supplement the items, and the final version of "ACP interventions for end-stage cancer patients" was formed. The positive coefficient and authority coefficient of experts were calculated, and Kendall harmony coefficient and variation coefficient were used to evaluate the degree of expert consensus.Results:The "ACP interventions for end-stage cancer patients" was constructed with 19 items in 4 dimensions, including 7 items in the preparation phase, 6 items in the initiation phase, 4 items in the execution phase and 2 items in the follow-up phase. The effective recovery rates of the 2 rounds of questionnaire were both 100%. The authority coefficient of expert consultation was 0.835. The coefficient of variation of each item was 0 to 0.21. The Kendall harmony coefficients of the two rounds of consultation were 0.290 and 0.267, respectively.Conclusions:The ACP interventions for end-stage tumor patients constructed in this study has good authority and coordination, and reflects Watson care theory, which has certain reference significance for clinical ACP implementation.

Abstract Background Hemorrhagic transformation (HT) is a critical issue in thrombolytic therapy in acute ischemic stroke. Damage-associated molecular pattern (DAMP)-stimulated sterile neuroinflammation plays a crucial role in the development of thrombolysis-associated HT. Our previous study showed that the phthalide derivative CD21 attenuated neuroinflammation and brain injury in rodent models of ischemic stroke. The present study explored the effects and underlying mechanism of action of CD21 on tissue plasminogen activator (tPA)-induced HT in a mouse model of transient middle cerebral artery occlusion (tMCAO) and cultured primary microglial cells. Methods The tMCAO model was induced by 2 h occlusion of the left middle cerebral artery with polylysine-coated sutures in wildtype (WT) mice and macrophage scavenger receptor 1 knockout (MSR1−/−) mice. At the onset of reperfusion, tPA (10 mg/kg) was intravenously administered within 30 min, followed by an intravenous injection of CD21 (13.79 mg/kg/day). Neuropathological changes were detected in mice 3 days after surgery. The effect of CD21 on phagocytosis of the DAMP peroxiredoxin 1 (Prx1) in lysosomes was observed in cultured primary microglial cells from brain tissues of WT and MSR1−/− mice. Results Seventy-two hours after brain ischemia, CD21 significantly attenuated neurobehavioral dysfunction and infarct volume. The tPA-infused group exhibited more severe brain dysfunction and hemorrhage. Compared with tPA alone, combined treatment with tPA and CD21 significantly attenuated ischemic brain injury and hemorrhage. Combined treatment significantly decreased Evans blue extravasation, matrix metalloproteinase 9 expression and activity, extracellular Prx1 content, proinflammatory cytokine mRNA levels, glial cells, and Toll-like receptor 4 (TLR4)/nuclear factor κB (NF-κB) pathway activation and increased the expression of tight junction proteins (zonula occludens-1 and claudin-5), V-maf musculoaponeurotic fibrosarcoma oncogene homolog B, and MSR1. MSR1 knockout significantly abolished the protective effect of CD21 against tPA-induced HT in tMCAO mice. Moreover, the CD21-induced phagocytosis of Prx1 was MSR1-dependent in cultured primary microglial cells from WT and MSR1−/− mice, respectively. Conclusion The phthalide derivative CD21 attenuated tPA-induced HT in acute ischemic stroke by promoting MSR1-induced DAMP (Prx1) clearance and inhibition of the TLR4/NF-κB pathway and neuroinflammation.