To assess the effect of music therapy in improving chronic pain (CP), anxiety, depression, and quality of life using randomized controlled trials, and to explore the role of various moderators in MT effectiveness. Systematic review and Meta-analysis. We systematically searched four electronic databases for randomized controlled trials that investigated the effects of music therapy on chronic pain, anxiety, depression, and quality of life. We performed a Cochrane risk-of-bias assessment and calculated the pooled standard mean difference in the outcomes of the test and control groups after the intervention period. Nine randomized controlled trials were retrieved that included a total of 787 patients. Music therapy significantly reduced CP in the test group compared with that in the control group post-intervention and depression, no evidence was observed for improvement in anxiety and quality of life. Subgroup analysis reveals that MT is most effective when interventions are conducted in developed countries, targeting CNMP or cancer pain patients in health centers. The therapy is most effective when patients select their own music, use instruments or earphones, and receive treatment from trained professionals, with an ideal duration of 20 min, except in studies involving postoperative CP or those conducted in developing countries. Music therapy effectively reduces CP and depression, but has limited effects on anxiety and quality of life. Its effectiveness varies depending on the specific conditions and CP categories of patients, with differences observed between developing and developed countries. Future research should focus on developing standardized guidelines for music therapy, exploring its long-term effects on pain, anxiety, and quality of life, and conducting high-quality, multicenter RCTs in developing countries to support its global adoption in CP management.

The Chinese version of the Adult Sedentary Behavior Reduction Intention Questionnaire, a 16-item self-reported tool based on the Theory of Planned Behavior (TPB), was developed to assess adults’ intentions to reduce sedentary behavior. Internal consistency is used to measure the reliability of the questionnaire, while content and structural validity are studied to assess its validity. A mixed-methods exploratory sequential design with two phases. Adults aged over 18 years diagnosed with coronary heart disease, with a total daily sedentary time exceeding 6 h, normal cognitive function, and willingness to participate in the study were included. The study was conducted in two phases. In Phase 1, an initial item pool was developed through a literature review and refined using two rounds of Delphi expert consultation. Expert positivity, authority levels (Cr), coefficients of variation (CV), and Kendall’s W coefficient were calculated to assess representativeness, credibility, and consensus. A pilot study evaluated face validity and finalized the scale. In Phase 2, a cross-sectional study involving 316 participants was conducted to assess psychometric properties. Reliability was evaluated using Cronbach’s α and split-half reliability, while content validity was assessed using the content validity index (I-CVI). Construct validity was examined through confirmatory factor analysis (CFA). Phase 1 resulted in a preliminary questionnaire with four dimensions and 16 items. Sixteen experts completed two rounds of Delphi consultation, with high response rates (85

Abstract Background Sedentary behavior is gradually becoming the mainstream trend in people’s lifestyles, with a significant increase observed worldwide and across all age groups. The measure of adults’ intention to reduce sedentary behavior provides a significant reference for the intervention strategies. However, the measurement tool is lacking. Given that the Theory of Planned Behavior (TPB) serves as a robust psychosocial theory framework, widely applied in predicting various health behaviors, this study aims to extend this theory into the realm of sedentary behavior by developing and validating a questionnaire to evaluate adult intentions of reducing their sedentary behavior. Methods A preliminary item pool for the questionnaire was created through a literature review, followed by two rounds of Delphi expert consultation and a small-sample pilot study, resulting in the initial version of the questionnaire. A total of 316 adults with an average daily sedentary behavior duration of ≥6 hours were involved in the survey to determine its psychometric properties using reliability analysis, content validation, and confirmatory factor analysis. Results An initial version of the questionnaire with four dimensions (behavioral intention, subjective norms, attitudes, and perceived behavioral control) and 16 items was obtained. Subsequent psychometric property validation results showed that the overall Cronbach’s α coefficient for the questionnaire was 0.967, with Cronbach’s α coefficients for each dimension ranging from 0.911 to 0.950. The item-level content validity index (I-CVI) ranged from 0.813 to 1. The adjusted model indices were c2/df = 2.931, GFI = 0.906, AGFI = 0.857, IFI = 0.976, NFI = 0.965, TLI = 0.968, CFI = 0.976, and RMSEA = 0.078, all of which met the fitting criteria. Conclusions A theory-driven instrument is suitable for its use with Chinese adults to assess their level of intentions and the factors affecting the sedentary behavior, which provides the basis for future intervention studies.

[This corrects the article DOI: 10.1371/journal.pone.0300074.].

Pediatric trauma plays a crucial role in pediatric mortality, with traffic injuries and falls frequently cited as leading causes of significant injuries among children. A comprehensive investigation, including geographical factors, is essential for developing effective strategies to prevent injuries and alleviate the burden of pediatric trauma. This study involved a retrospective analysis of clinical data from pediatric patients admitted to our hospital's intensive care unit (ICU) due to trauma over a 10-year period. Comprehensive analyses were conducted to elucidate trends, demographics, injury patterns, and risk factors associated with these admissions. This retrospective study included 951 pediatric patients (mean age: 4.79 +/- 3.24 years; mean weight: 18.45 +/- 9.02 kg; median time to ICU admission post-injury: 10.86 +/- 14.95 h). Among these patients, 422 (44.4%) underwent emergency surgery, and 466 (49%) required mechanical ventilation support, with a mean duration of 70.19 +/- 146.62 h. The mean duration of ICU stay was 6.24 +/- 8.01 days, and the overall mean hospitalization duration was 16.08 +/- 15.56 days. The predominant cause of unintentional injury was traffic accidents (47.9%), followed by falls (42.5%) and burns/scalds (5.3%). Most incidents involved children aged 0-6 years (70.7%), with males comprising 60.0% of patients. Injury incidents predominantly occurred between 12 and 6 PM (44.5%) and on non-workdays (37.6%). The most common locations where injuries occurred were roadsides (49%) and rural areas (64.35%). Single-site injuries (58.78%) were more prevalent than multiple-site injuries (41.22%), and head injuries were the most common among single- site injuries (81.57%). At ICU admission, the mean injury severity score was 18.49 +/- 8.86. Following active intervention, 871 patients (91.59%) showed improvement, while 80 (8.41%) succumbed to their injuries. Traffic injuries remain the primary cause of pediatric trauma leading to ICU admission, underscoring the importance of using appropriate child restraint systems and protective gear as fundamental preventive measures. The increased incidence of injuries among children aged < 6 years and those residing in rural areas highlights the need for targeted preventive strategies, necessitating tailored interventions and public policy formulations that address these high-risk populations.

Background Observational studies have suggested associations between sedentary behaviors (SB), physical activity (PA), sleep duration (SD), and obesity, but the causal relationships remain unclear. Methods We used Mendelian randomization (MR) with genetic variation as instrumental variables (IVs) to assess the causality between SB/PA/SD and obesity. Genetic variants associated with SB/PA/SD were obtained from Genome-wide association study (GWAS), and obesity data came from FinnGen. The primary MR analysis used the instrumental variable weighted (IVW) method, with sensitivity tests including Cochran Q, MR-Egger intercepts, and MR-Radial. Expression Quantitative Trait Loci (eQTL) analysis was applied to identify significant genetic associations and biological pathways in obesity-related tissues. Results The MR analysis revealed causal relationships between four SB-related lifestyle patterns and obesity. Specifically, increased genetic liability to television watching (IVW MR Odds ratio [OR] = 1.55, [95% CI]:[1.27, 1.90], p = 1.67×10−5), computer use ([OR] = 1.52, [95% CI]:[1.08, 2.13], p = 1.61×10−2), leisure screen time (LST) ([OR] = 1.62, [95% CI] = [1.43, 1.84], p = 6.49×10−14, and driving (MR [OR] = 2.79, [95% CI]:[1.25, 6.21], p = 1.23×10−2) was found to increase the risk of obesity. Our findings indicate that no causal relationships were observed between SB at work, sedentary commuting, PA, SD, and obesity. The eQTL analysis revealed strong associations between specific genes (RPS26, TTC12, CCDC92, NICN1) and SNPs (rs10876864, rs2734849, rs4765541, rs7615206) in both subcutaneous and visceral adipose tissues, which are associated with these SBs. Enrichment analysis further revealed that these genes are involved in crucial biological pathways, including cortisol synthesis, thyroid hormone synthesis, and insulin secretion. Conclusions Our findings support a causal relationship between four specific SBs (LST, television watching, computer use, driving) and obesity. These results provide valuable insights into potential interventions to address obesity effectively, supported by genetic associations in the eQTL and enrichment analysis. Further research and public health initiatives focusing on reducing specific SBs may be warranted.

Background Paediatric trauma is a pivotal factor contributing to paediatric mortality, with traffic injuries and falls being commonly reported as leading causes of significant injuries among children. Comprehensive investigations from multiple perspectives, including geographical considerations, are crucial to develop more effective strategies for preventing such injuries and thereby reducing the burden of paediatric trauma. Methods This study involved a retrospective analysis of clinical data from paediatric patients admitted to our hospital's intensive care unit (ICU) due to trauma over a 10-year period. Comprehensive analyses were conducted to elucidate trends, demographics, injury patterns, and risk factors associated with these admissions. Results This retrospective study included 951 paediatric patients (mean age: 4.79 ± 3.24 years; mean weight: 18.45 ± 9.02 kg; median time to ICU admission post-injury: 10.86 ± 14.95 hours). Of these patients, 422 (44.4%) underwent emergency surgery and 466 (49%) required mechanical ventilation support, with a mean duration of 70.19 ± 146.62 hours. The mean duration of ICU stay was 6.24 ± 8.01 days and overall mean hospital stay was 16.08 ± 15.56 days. The predominant cause of unintentional injury was traffic accidents (47.9%), followed by falls (42.5%) and burns/scalds (5.3%). Most incidents involved children aged 0–6 years (70.7%), with males comprising 60.0% of cases. Injury incidents predominantly occurred between 12 PM and 6 PM (44.5%) and on non-workdays (37.6%). The most common sites of injury were roadsides (49.0%) and rural areas (64.35%). Single-site injuries (58.78%) were more prevalent than multiple-site injuries (41.22%), and head injuries were the most common among single-site injuries (81.57%). At ICU admission, the mean injury severity score was 18.49 ± 8.86. Following active intervention, 871 patients (91.59%) showed improvement, whereas 80 (8.41%) succumbed to their injuries. Conclusion Traffic injuries remain the primary cause of paediatric trauma, underscoring the ongoing importance of appropriate use of child restraint systems and protective gear as fundamental preventive measures. The elevated incidence of injuries among children under 6 years old and those residing in rural areas highlights the need for targeted preventive strategies, necessitating tailored interventions and public policy formulations that specifically address these high-risk populations.

Introduction:Trauma is a significant global public health concern and the leading cause of morbidity and mortality in children. This study aimed to assess the independent predictors of trauma severity as well as mortality in pediatric patients admitted to the intensive care unit (ICU). Methods:In this cross-sectional study, following the STROBE checklist, we retrospectively analyzed the clinical and baseline characteristics of pediatric patients with trauma injuries admitted to the ICU of Children's Hospital of Zhejiang University School of Medicine, China, over a decade. Results:951 pediatric patients with a mean age of 4.79 ± 3.24 years (60.78% Boys) were studied (mortality rate 8.41%). Significant associations were observed between ISS and place of residence (p = 0.021), location of the injury (p = 0.010), year of injury (p <0.001), and injury mechanism (p <0.001). The two independent factors of trauma severity were the year of injury (β = 0.47; 95%CI: 0.28 - 0.65) and injury mechanism (β = -0.60; 95%CI: -0.88 - -0.31). Significant differences were observed between survived and non-survived regarding age (p <0.001), ISS score (p <0.001), time elapsed from injury to ICU (p <0.001), duration of mechanical ventilation (p <0.001), GCS score (p <0.001), and the proportion of patients requiring mechanical ventilation (p <0.001 ). The results of multivariate analysis indicated that age (OR = 0.805; 95%CI: 0.70 - 0.914; p = 0.001) and GCS score at ICU admission (OR = 0.629; 95%CI: 0.53 - 0.735; p < 0.001) acted as protective factors, whereas mechanical ventilation in the ICU (OR = 7.834; 95%CI: 1.766 - 34.757; p = 0.007) and ISS score at ICU admission (OR = 1.088; 95%CI: 1.047 - 1.130; p < 0.001) served as risk factors for mortality. Conclusion:Automobile-related injuries represent the leading cause of trauma in children, with escalating severity scores year over year among pediatric patients admitted to the ICU with trauma injuries. Based on the findings the independent predictors of mortality of pediatric trauma patients admitted to the ICU were age, GCS score at ICU admission; mechanical ventilation in the ICU, and ISS score at ICU admission. Also, the year of injury and injury mechanism were independent predictors of trauma severity.

Background To investigate the epidemiology of unintentional injury in children admitted to Intensive Care Unit (ICU) in China mainland. Methods A total of 39 hospitals in 19 provinces contributed to the 1-day point prevalence study of serious unintentional injury in children aged 0–16 years admitted to ICU. Results A total of 1,017 patients from the 39 participating ICUs on the study day were included. Among them, 56 pediatric patients were identified to be suffered from unintentional injury from 18 participating ICUs, accounting for 5.5% (56/1,017) of all the ICU patients. The percentage of boys was more than twice the percentage of girls. Most patients had an age of less than 6 years old (n=42, 75%). The leading cause of unintentional injury was fall (n=17, 30.4%). The patterns of unintentional injury in children were age-related. There were no urban-rural differences in our cohort. The injury happened on 12:00–18:00 PM in 27 cases (48.2%), and 28 patients (50%) had injuries happened at working day. 35 patients (62.5%) received primary treatment at local hospitals. Thirty-five patients (62.5%) needed resuscitation in the emergency department, 15 patients (26.8%) still needed resuscitation in ICU. These 56 children suffered from a total of 106 lesions corresponding to 1.89 lesions per patient. Respiratory failure was most commonly seen (n=18, 32.1%). There was no death in our cohort during the study. After effective treatment during their ICU stay, 45 (80.4%) patients showed improvement, with Glasgow Coma Scale (GCS), Pediatric Trauma Score (PTS) and Pediatric Risk of Mortality III (PRISM III) score significantly better than those before treatment (P<0.05). Conclusions Higher injury rates among children under 6 years old of age illustrate the need for preventive measures, especially programs and public policies targeting this high-risk group.

本文就静态行为的现状、静态行为与心血管疾病之间的关系、测量工具、干预措施等进行综述,以期为心血管疾病的防治和相关生活方式干预提供理论基础.

Background Epidemiological studies assessing the association between sedentary time and cardiovascular diseases (CVD) risks have been published at a rapid pace in recent years, which makes the periodic review of knowledge essential. Furthermore, much of the early and ongoing work used screen time as a marker of total sedentary time, which may weaken the association between sedentary time and CVD risks. Objective To update evidence on CVD risks associated with different types of sedentary time, especially total sedentary time and screen time, and to explore as a marker of total sedentary time, whether screen time had similar CVD risks with total sedentary time. Methods PRISMA guideline was followed for the performing and reporting of this systematic review and meta-analysis. Three independent researchers searched eight electronic databases and two clinical trial registries for all studies published between January 2015 and December 2021 that assessed the association between sedentary time and CVD risks in adults. A standardized form was used for data extraction and collection. Wilmot and colleagues’ modified tool was used for quality assessment. The categorical association was assessed by comparing the pooled effect sizes for CVD risks associated with the highest and the lowest sedentary time categories across included studies. Stata 16.0 and Review Manager 5.3 were used for all statistical analyses, P ≤ 0.05 was considered as statistically significant. Results Seventeen prospective cohort studies and two cross-sectional studies with 145,1730 participants and over 48,668 CVD cases and deaths were included. Two included studies measured sedentary time with the accelerometer, 16 studies with self-reported questions, and one study with both the accelerometer and self-reported questions. CVD outcomes were self-reported in two included studies and objectively adjudicated through medical records or death certifications in 17 studies. Compared with the lowest total sedentary time category (median duration, 2.75 h/d), participants in the highest category (median duration, 10.5 h/d) had an increased risk of CVD morbidity (pooled RR, 1.24; 95% CI, 1.21–1.27). Compared with the lowest total sedentary time category (median duration, 2.98 h/d), participants in the highest category (median duration, 10.2 h/d) had an increased risk of CVD mortality (pooled HR, 1.29; 95% CI, 1.13–1.47). The association between screen time and CVD risks was similar to total sedentary time with the cut-off point of 5–6 h/d. The associations between occupational sitting time, leisure sedentary time, and CVD risks stayed inconclusive. Conclusion Total sedentary time and screen time are both associated with cardiovascular health. As a marker of total sedentary time, screen time over 5–6 h/d had similar CVD risks with total sedentary time over 10–11 h/d.

PURPOSEThis paper aims to clarify the concept of perceived health from the perspective of rural adults in China.METHODSWalker and Avant's concept analysis was applied.FINDINGSPerceived health from rural adults in China is a subjective assessment of their health status, which is deeply affected by Chinese traditional culture and being in a rural environment.CONCLUSIONSMost rural adults in China could perceive their health as good or poor, however, rural areas have disadvantages in health care, geographical location, and educational resources compared with urban counterparts, which may lead to some unscientific health attitudes and lifestyles and hinder their healthcare-seeking behaviors.IMPLICATION FOR NURSING PRACTICETo help nurses understand better the concept of perceived health with the rural background, which is different from urban areas. Perceived health provides rich information resources for nurses to carry out holistic care, and to lead rural adults in China to form a correct and positive attitude and lifestyle as possible.

BACKGROUND:Clinical nurse educator plays an indispensable role in promoting the development of nursing staff and nursing students in clinical settings. Too few core competencies for clinical nurse educators applicable to a given clinical setting are developed and validated by the research process. A better understanding of the core competencies for clinical nurse educators can inform the selection, training, and evaluation of clinical nurse educator. OBJECTIVE:To establish the core competencies for clinical nurse educators in China. DESIGN:Focus group interviews and the e-Delphi method were used. SETTINGS:This study was conducted in five teaching hospitals in China. PARTICIPANTS:Participants (n = 61), including nurse managers, clinical nurse educators, staff nurses, and nursing students were recruited for focus group interviews and 25 experts were selected for the e-Delphi study. METHODS:Based on a literature review and the focus group interviews, a preliminary set of clinical nurse educator's core competencies was formed. Subsequently, experts provided supportive and modification advice on core competencies in the two rounds e-Delphi study. The consensus percentage and the weight of each first-level, second-level index and its connotations were calculated. RESULTS:Two rounds of online Delphi expert consultation were completed by 25 experts, and the consensus was achieved on four first-level indices, 16 second-level specific competencies, and its 57 connotations. The first-level index included clinical teaching competency, clinical nursing skills, management and leadership competency, and innovation and research competency. Moreover, the consensus level of all indices was >75%, the coefficient of variation (CV) was less than 0.25 (p < 0.05) and the Kendall coefficient (W) was 0.169-0.503 (P < 0.01). CONCLUSIONS:The explicit statements of expected competencies for clinical nurse educators can be applied to diverse clinical scenarios and provide a reference for selection, training, and evaluation of the clinical nurse educators.

BACKGROUND:The current upper limits of normal (ULN) for serum alanine aminotransferase (ALT) are increasingly challenged. We aimed to re-evaluate the ULN for ALT and assess the potential impact on the classification of natural course of chronic hepatitis B virus (HBV) infection in children. METHODS:Laboratory data obtained from three hospitals in China were retrospectively analysed. In total, 2054 children with chronic HBV infection and 8149 healthy children at age ≤18 years were included in the study. RESULTS:Age-specific and gender-specific ULNs for ALT, at averages of 30 U/L for boys and 24 U/L for girls, were calculated from the data of healthy children. Using the revised ULNs vs. the current ULNs (40-50 U/L), 31-60% vs. 9-17% of the 2054 HBV-infected children had an abnormal result as seen in their ALT baseline analysis, and the highest abnormality rate was seen in the infants. Data of 516 HBV-infected children were applied for the classification of clinical phase, 28.8% vs. 19.8% of the children were classified into the phases of hepatitis B e antigen (HBeAg-)positive/negative hepatitis. During a median follow-up of 62 months, 39 of 153 children underwent HBeAg seroconversion, whereas 3 of them had persistently "normal" ALT, according to the current ULN. CONCLUSIONS:The revision of ULN for ALT in children substantially impacts the classification of the natural course of chronic HBV infection. Mild ALT fluctuation is common during the stage childhood, suggesting a need to rethink the current conceptions of immune tolerance and natural course of chronic HBV infection in the children.