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OBJECTIVES: The proportion of individuals with insomnia is increasing, and many older adults have insomnia. This study aimed to explore the relationships between family functioning and quality of life (QOL) among community-dwelling older adults with insomnia, as well as to explore the mediating role of sleep quality in this relationship. METHODS: The participants were 225 older adults with insomnia from community health service centers in Chongqing, China. The Family Care Index (APGAR) was used to assess family functioning, the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and the 36-item Short-Form Health Survey (SF-36) was used to assess QOL. RESULTS: The results showed that family functioning would be positively associated with QOL (p = .005) and that this relationship would be partially mediated by higher sleep quality (p < .001). CONCLUSIONS: Family functioning has a direct effect on QOL and an indirect effect on QOL through the regulation of sleep quality. Maintaining good family functioning is important for improving sleep quality and QOL in older adults with insomnia. CLINICAL IMPLICATIONS: Developing family functioning-based assessments and targeted intervention strategies could be beneficial for older adults with insomnia.

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BACKGROUND: The life satisfaction of the elderly in nursing home is the focus of social concern.The purpose of this study was to evaluate the effects of family function and sleep quality on life satisfaction among elderly individuals in nursing homes and examine the mediating effect of sleep quality between family function and life satisfaction. METHODS: A cross-sectional observational study was conducted .A total of 127 older adults who completed the Life Satisfaction Index A (LSI-A), the Family APGAR Index and the Pittsburgh Sleep Quality Index (PSQI) were recruited from four nursing homes in Chongqing, China. RESULTS: Life satisfaction was positively correlated with family function (r=0.434, p<0.01) and negatively correlated with PSQI (r = -0.514, p<0.01). PSQI was found to be negatively associated with family function (r=-0.387, p<0.01).Family function had a significant effect on PSQI (path a: ß=-0.8459, 95% CI=-1.2029, -0.4889), and PSQI had a significant effect on life satisfaction (path b: ß=-0.3916, 95% CI=-0.5407, -0.2425). The total effect (path c) and direct effect (path c') of family function on life satisfaction were significant (ß=0.8931, 95% CI=0.5626, 1.2235 and ß=0.56181, 95% CI=0.2358, 0.8879, respectively). The coefficient for the indirect effect of family function on life satisfaction through PSQI was statistically significant (ß=0.3312, 95% CI=0.1628, 0.5588). PSQI played a partial mediating role between family function and life satisfaction, and PSQI mediated 32.58% of the total effect of family function on life satisfaction. CONCLUSIONS: Family function and sleep quality were significant predictors of elderly people's life satisfaction in nursing homes. Sleep quality partially mediated the relationship between family function and life satisfaction.The interventions focused on promoting family function and improving sleep quality may be more helpful in improving elderly people's life satisfaction in nursing homes.

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This study explored the influence of genetic and environmental factors on adolescent anxiety. Ninety-eight monozygotic and dizygotic twins from Chongqing, China (aged 15-18 years) were assessed for anxiety with the Self-Rating Anxiety Scale (SAS). The Parenting Styles and Dimensions Questionnaire (PSDQ) and Strengths and Difficulties Questionnaire (SDQ) were applied to assess environmental factors. Venous blood was drawn from the twins for zygosity determination. Structural equation modeling was performed to evaluate the effects of additive genetic factors (A), common environmental factors (C), and individual-specific environmental factors (E) on adolescent anxiety. The estimates of A and E on adolescent anxiety were 0.34 (95% CI = 0.12-0.53) and 0.66 (95% CI:0.47-0.89), respectively. The environment played an important role in adolescent anxiety. Adolescent anxiety was significantly positively correlated with peer relations (r = 0.606, p < 0.05) and negatively correlated with prosocial behavior (r = 0.207, p < 0. 05). No sex differences were observed. Adolescent anxiety was influenced by both genetic and environmental factors. The individual-specific environmental factors played an important role. Consideration of these variables will facilitate the targeted and individualized implementation of specific interventions for adolescent anxiety.

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BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic and life-threatening disease. Health-related quality of life (HRQoL) is vital for individuals with T2DM. However, little is known about the impact of psychological stability factors on HRQoL among individuals with T2DM in mainland China. METHODS: This multicenter cross-sectional study was conducted in five tertiary grade-A hospitals in Chongqing, China, from January to December 2019. A total of 385 individuals with T2DM were included by the convenient sample method. Fear of Progression (FOP) Questionnaire-short Form, Hypoglycemia Fear Survey II, diabetes-management self-efficacy scale, and EuroQol-5 Dimensions were used for data collection. RESULTS: The mean age of the 385 individuals was 57.65 (SD = 15.15) years, three-quarters of whom had a high school or above education level. The participants in our study had moderate HRQoL and were more likely to have poor scores in the pain/discomfort dimension. The FOP level was moderate on average, and 23.1% of individuals suffered from psychological dysfunction. The participants had higher levels of fear of hypoglycemia (FOH) and self-efficacy (SE). Multiple steppage-regression analysis predicted that higher levels of FOP and FOH, reduced SE, older age, longer duration since diagnosis, lower educational attainment, higher levels of HbA1c, and living with comorbid conditions were related to lower HRQoL. CONCLUSION: This study showed that the HRQoL among Chinese T2DM patients may be impaired by increased FOP and FOH, decreased SE, and poor glycemic control. In addition, as the patient's age and duration since diagnosis increase, their HRQoL further declines. We recommend improving HRQoL by encouraging individuals to attain more health education and resilience skills to enhance SE and reduce negative emotions among individuals with T2DM.

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Migrant older adults become more disadvantaged in health due to aging and migration-related problems. This study aimed to examine the mediating role of resilience in the relationship between perceived social support and health self-efficacy, and to test whether gender moderated the mediating effect of resilience between perceived social support and health self-efficacy among migrant older adults. A total of 184 migrant older adults were recruited from five communities. Resilience played a partial mediating role in the relationship between perceived social support and health self-efficacy. Moreover, age moderated the relationship between resilience and health self-efficacy. The relationship between resilience and health self-efficacy was stronger in male older adults than female ones. These findings provide a better understanding of the effects of perceived social support and resilience on health self-efficacy, which could guide targeted interventions for community health nurses to promote health self-efficacy among migrant older adults.

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BACKGROUND: Chronic hepatitis B is a serious and chronic health problem, requiring self-management to control the disease and related complications. OBJECTIVES: To develop a structural model to identify how social support, self-efficacy and disease knowledge contribute to their self-management behaviors in adults with chronic hepatitis B. DESIGN: A cross-sectional study. SETTINGS: Hepatology units in two hospitals in Chongqing, China. PARTICIPANTS: A total of 306 patients with chronic hepatitis B were recruited. METHODS: Data were collected using Social Support Rating Scale, Self-Efficacy for Managing Chronic Disease, Hepatitis B Knowledge Questionnaire and Chronic Hepatitis B Self-Management Scale. Structural equation model was applied to analyze the data. RESULTS: The final model showed good model fit. Social support directly influenced self-management behaviors (ß = 0.19, p < 0.01), and indirectly influenced self-management behaviors (ß = 0.20, p < 0.01) through self-efficacy. Self-efficacy directly influenced self-management behaviors (ß = 0.37, p < 0.05). Disease knowledge indirectly influenced self-management behaviors (ß = 0.12, p < 0.05) through self-efficacy. CONCLUSIONS: Our findings indicated that social support, self-efficacy and disease knowledge directly or indirectly affected self-management behaviors in adults with chronic hepatitis B. This provides a theoretical basis for developing self-management interventions for patients with chronic hepatitis B, which may lead to health improvements in this population.

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Patient safety is crucial to healthcare quality. It is important to assess the nursing students' safety attitudes to identify the weaknesses for developing education program and fostering students' engagement in patient safety practices. This study aimed to assess attitudes towards patient safety culture among postgraduate nursing students in China, and explore the factors that affect their safety attitudes and the relationships of safety attitudes and safety-related behaviors. This study used a cross-sectional survey design. A convenience sample of 231 postgraduate nursing students from ten medical universities in China completed the Chinese version of Safety Attitude Questionnaire, including six domains: teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions and stress recognition. The mean scores of the six domains ranged from 65.22 to 70.75 on a 100-point scale. Percentages of positive responses for the six domains were below 55%, with the two lowest percentages for working conditions (35.9%) and safety climate (30.7%). Significantly lower domain scores were found in students with younger age, no work experience, higher workload and received safety education. There were positive correlations between the six domains and safety-related behaviors except for stress recognition. Nursing educators should focus more on the improvement of patient safety education and establishment of supportive work environment to enhance postgraduate nursing students' attitudes towards safety culture.

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The current study aimed to examine the relationships among social support, coping strategy, and depressive symptoms in older adults with diabetes, and the mediating role of coping strategy in the relationship between social support and depressive symptoms. Participants were 152 older adults with diabetes from two community health service centers in Chongqing, China. Self-reported questionnaires were used to assess social support, coping strategy, and depressive symptoms. Data were analyzed using descriptive statistics, hierarchical multiple regression, and mediation analysis. Subjective support, support utilization, and coping strategy were significantly associated with depressive symptoms. Positive and negative coping had significant mediating effects on the relationship between subjective support or support utilization and depressive symptoms. To alleviate depressive symptoms in older adults with diabetes, assessment and enhancement of social support and facilitation of positive coping strategy are integral to nursing care for older adults with diabetes. [Journal of Gerontological Nursing, 45(4), 40-46.].

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BACKGROUNDS: Chronic hepatitis B (CHB) patients may face many problems resulted from their conditions. To delay the progress of CHB, patients should be responsible for the management of their conditions. There is no dedicated scale for assessing self-management behaviors of CHB patients. OBJECTIVES: This study aimed to develop and validate a self-report measure designed to assess the self-management behaviors for CHB patients (CHBSMS). DESIGN: A cross-sectional descriptive study design. SETTING: Participants were recruited from the infectious disease department of two hospitals in China. PARTICIPANTS: A sample of 248 and 346 CHB patients for item analysis and test for validity and reliability, respectively. METHODS: An initial 45-item scale developed based on item generation and a two-round Delphi survey was assessed by CHB patients for item analysis to develop a final scale. Construct validity was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Chronic Disease Self-Management Behavior Scale (CDSMBS) was used to test the criterion validity. Internal consistency and test-retest reliability were assessed by Cronbach's α coefficient and intraclass correlation coefficient (ICC), respectively. RESULTS: A 25-item scale was developed. EFA indicated a four-factor structure (symptom management, lifestyle management, psychosocial coping and disease information management), which accounted for 58.149% of the total variance. CFA indicated appropriate fit of the four-factor model. The total scores of CHBSMS was correlated with that of CDSMBS (r = 0.634, P < 0.01). The Cronbach's α coefficient (α = 0.887) and the test-retest correlation coefficient (ICC = 0.871) showed good internal consistency and stability of the scale. CONCLUSIONS: The 25-item CHBSMS is a reliable and valid measure that can be used to assess the self-management behaviors of CHB patients for improving patient education and health-related outcomes.

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OBJECTIVE: To explore the relations of adolescents externalizing problem behavior to genetic and environmental factors through twin study. METHODS: The externalizing problem behavior of 66 twin pairs from Chongqing City( aged from 12 to 18years) were investigated with the Youth Self-Report( YSR). The Parenting Styles and Dimensions Questionnaire( PSDQ) and Family Stresses Questionnaire( FSQ), Family Adaptability and Cohesion Scale( FACES) and Stressful Life Event( SLE) were applied to assess their environment factors. The blood sample was collected to identify zygosity oftwins. Structural equation modeling( SEM) was performed to evaluate the relations of adolescents externalizing problem behavior to the additive genetic factors( A), shared environment factors( C) and individual specific environmental factors( E). RESULTS: The effects of A and E on adolescent externalizing problem behavior were 0. 57( 95% CI 0. 37-0. 72) and 0. 43( 95% CI 0. 28-0. 63), respectively. There were significantly negative correlation between externalizing problem behavior and family cohesion( r =-0. 221, P <0. 05), the scores of adolescent externalizing problem behavior were positively correlated with the scores of family stresses( r = 0. 226, P < 0. 05), the scores of stress life events( r = 0. 194, P < 0. 05), the scores of Authoritarian-parenting-style( r = 0. 235, P <0. 05), the scores of Permissive-parenting-style( r = 0. 212, P < 0. 05). The scores of adolescents externalizing behavioral problems were not significantly correlated with the parenting education level and occupation. CONCLUSION: Adolescents externalizing problem behavior are influenced by additive genetic factors and individual specific environmental factors. Additive genetic factors play an important role. Family environment and parental rearing-pattern also have correlation with externalizing behavioral problems.

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OBJECTIVE: This study aimed to develop a set of indicators that could be used to measure and monitor the self-management performance for chronic hepatitis B (CHB) patients on antiviral therapy in China. METHODS: A two-round Delphi study via e-mail correspondence was conducted, with a group of 30 Chinese experts. The Delphi questionnaire consisted of 53 indicators identified from a literature review. Experts rated and scored the importance of indicators on a five-point Likert scale. Consensus was considered to be reached if a median score in the top tertile (4-5) and ≥ 80% of panel ratings in the top tertile (4-5) after Round 2. The included indicators were validated with a group of 106 CHB patients. RESULTS: The response rates for the first and second rounds were 90.9% (n=30) and 86.7% (n=26), respectively. Three new indicators were suggested in the first round. 55 indicators were included in the second round after modified. 45 (81.8%) indicators achieved on the level of consensus, all of which had an inter-quartile range of 1 or below. The final set included 4 domains and 45 indicators which were well accepted and understandable by CHB patients. CONCLUSION: This Delphi study produced a set of 45 self-management indicators for CHB patients on antiviral therapy in China. These indicators could be used to measure and monitor the patients' self-management performance, with the goal of improving the quality of life in this population.

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OBJECTIVE: To explore the influence of genetic and environmental factors on adolescents violence behaviors. METHODS: The violence behaviors of 111 twin pairs from Chongqing (aged from 11 to 18 years) were investigated with risk behavior questionnaire-adolescent (RBQ-A). The Parenting Styles and Dimensions Questionnaire (PSDQ) and Stressful Life Event (SLE) and the General Functioning Scale of the MacMaster Family Activity Device (FAD-GFS) were applied to assess their environment factors. Structural equation modeling was performed to evaluate the effects of the additive genetic factors (A), shared environment factors (C) and individual specific environmental factors (E) on the adolescents violence behaviors. RESULTS: The effects of A and E on adolescents violence behaviors were 0.41 (95% CI 0.19-0.58) and 0.59 (95% CI 0.42-0.81) respectively. There were significantly negative correlation between violence behaviors and authoritative-parenting-style (r = -0.140, P < 0.05), the score of adolescents violence behaviors was positively correlated with repressive-parenting-style score (r = 0.133, P < 0.05), the score of adolescents violence behaviors were not significantly correlated with the family functions, stress life events and the parenting education level and occupation. CONCLUSION: Adolescents violence behaviors were influenced by additive genetic factors and individual specific environmental factors. Environmental plays an important role. It should not been ignored that parental rearing pattern play a role in adolescents violence behaviors.

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OBJECTIVE: To explore the influence of genetic and environmental factors on the executive function of twin children. METHODS: The executive function of 122 twin pairs from Chongqing (aged from 6 to 18 years) were investigated with the perseverative errors of the Wisconsin Card Sorting Test. Structural equation modeling was performed to evaluate the effects of the additive genetic factors (A), dominance genetic latent factors (D) and individual specific environmental factors (E) on the executive functions. RESULTS: The effects of D and E on perseverative errors were 0. 77 (95%CI: 0.65-0.84) and 0.23 (95%CI: 0.16-0.35), respectively. The probability of perseverative errors showed a significant negative correlation with family functioning and with the total GHQ-12 scores of the fathers and mothers (r:-0.335, -0.335, and -0.219, respectively, P<0.01). Perseverative errors were not significantly correlated with the parenting styles and stress life events. CONCLUSION: Perseverative errors are influenced by a common dominance genetic latent factor and individual specific environmental factors, but the role of environmental factors such as family functioning and parental health can not be ignored.

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