Lifestyle factors are important modifiable risk factors for cognitive decline and dementia. The lifestyle intervention based on scientific assessment will be an important strategy and an orientation towards the implementation of primary prevention of dementia. So far, there is no special instrument to evaluate whether a lifestyle can help to reduce the risk of dementia in community-living residents.
To develop the Dementia Risk Reduction Lifestyle Scale (DRRLS) and test its reliability and validity, providing an instrument for scientifically evaluating whether a lifestyle is conducive to reducing the risk of dementia in community-living Chinese residents.
The item pool of the DRRLS was created based on the review of related theories of health promotion and literature analysis, then was used to form the initial version of the scale after the revision in accordance with the results of expert consultations and group discussion. After this, the initial version of the scale was pretested in a convenience sample of 30 middle-aged and elderly people in the community in January 2021, and was developed to be a revised version after revising items according to the pretest results. Then from January to October, 2021, the revised scale was tested in a large convenience sample of 506 community-dwelling middle-aged and elderly individuals. After screening items using item analysis of the test results of all 506 cases, exploratory factor analysis and confirmatory factor analysis were carried out with the test results of two randomly subdivided subsamples of the sample, subsample 1 (n=253) and subsample 2 (n=253) , respectively. Finally, the test results of the total sample were used for examining internal consistency and test-retest reliability, and the formal scale was formed eventually.
The formal Dementia Risk Reduction Lifestyle Scale consists of 32 items. Eight common factors were extracted by exploratory factor analysis (Health responsibility, Brain strengthening exercise, Brain healthy diet, mental activity, smoking control behavior, interpersonal relationship, stress management, spiritual growth) , explaining 60.189% variance of the total. Confirmatory factor analysis showed that the goodness-of-fit indices of the formal scale were acceptable: χ2/df=1.657, RMSEA=0.051, GFI=0.852, AGFI=0.819, NFI=0.743, TLI=0.858, IFI=0.880 and CFI=0.876. The content validity index, Cronbach's α, split-half reliability (odd-even) , and test-retest reliability of the formal scale were 0.943, 0.862, 0.909, and 0.864, respectively.
Our scale has been tested with good reliability and validity, which could be used as a suitable instrument for evaluating whether a lifestyle helps to reduce the risk of dementia in middle-aged and elderly people in the community.
The level of exercise self-efficacy of lung cancer patients affects the establishment of exercise goals and the belief of overcoming difficulties. Understanding the current situation has a good predictive effect on the exercise behavior of lung cancer patients, but there is no norm for exercise self-efficacy assessment tools for lung cancer patients in China, which makes the measurement results lack of reference standards.
To establish the norm of Exercise Self-efficacy Scale for lung cancer patients in Anhui Province.
Anhui Province was divided into northern, central and southern regions according to its geographical location. A total of 1 600 lung cancer patients were selected by regional stratified random sampling from January to August in 2021, and Exercise Self-efficacy Scale was used to investigate them, the mean, percentile and demarcation norm of the scale were established.
A total of 1 600 questionnaires were distributed, 1 459 valid questionnaires were recovered, with an effective recovery rate of 91.19%. The total score of Exercise Self-efficacy Scale for lung cancer patients in Anhui Province was (67.66±14.90) , and the score of efficacy expectation dimension was (63.09±18.13) , the outcome expectation dimension score was (73.48±14.10) . In this study, the mean norm of Exercise Self-efficacy Scale for lung cancer patients in Anhui Province was established according to gender and age groups (young group of 19-35 years old, middle-aged group of 36-59 years old, and elderly group of ≥60 years old) . The results of multiple linear regression analysis showed that gender, age, education level, occupation, regular exercise habits, concomitant diseases, hospital level, department, BMI and regional division were the influencing factors for the total score of exercise self-efficacy in lung cancer patients (P<0.05) . Therefore, the classification norm was established based on the above variables. With 5% as the interval, the percentile norm of the Exercise Self-efficacy Scale for lung cancer patients from 5 to 95 was established. With (-s) , (-0.5s) , (+0.5s) , (+s) as the boundary point, the exercise self-efficacy level of lung cancer patients was divided into five states according to the total score of the scale from low to high: very low, low, medium, high and very high.
This study preliminarily constructed the norm of Exercise Self-efficacy Scale for lung cancer patients in Anhui Province, which can provide a reference standard for the study of exercise self-efficacy level of this population, and also provide a theoretical basis for further exploring the influencing factors of exercise self efficacy in lung cancer patients.
Stroke severely influences the quality of human life, and imposes a great burden on the society, patients and their families. Although China has vigorously promoted the prevention and treatment of stroke, the prevalence of pre-hospital delay in stroke patients is still relatively high. The stroke pre-hospital delay behavioral intention may predict the possibility of stroke pre-hospital delay to some extent, but theassociated factors have rarely been studied.
To investigate the stroke pre-hospital delay behavioral intention and associated factors in residents.
Convenience sampling was used to select 645 Guangdong residents as the participants from July to September 2021. The Demographic Information Questionnaire developed by us, Chinese version of Ten-Item Personality Inventory, Chinese version of Perceived Social Support Scale, Simplified Coping Style Questionnaire and Stroke Pre-Hospital Delay Behavior Intention scale (SPDBI) were used in a survey for understanding the participants' personality characteristics, social support, coping styles and stroke pre-hospital delay behavioral intention. Multiple linear regression was used to explore the influential factors of stroke pre-hospital delayed behavioral intention.
A total of 645 valid questionnaires were collected (92.1%) . Of the 645 respondents, 312 (48.4%) knew nothing about stroke, and 262 (40.6%) had heard of the formula "stroke 120". The stroke pre-hospital delay behavior intention of the participants was in the intermediate level〔mean SPDBI score (71.3±18.7) 〕. Compared with the Chinese norm, these respondents had higher mean dimension score of warning of stroke symptoms, but lower mean total score of SPDBI, and lower mean scores of four dimensions (rationalization of non-healthcare seeking behavior, symptom attribution, habitual response style, emergency system use) (P<0.001) . Multiple linear regression analysis indicated that age, living with a spouse, awareness level of the "stroke 120" mantra (through assessing symptoms to early identify stroke) , extraversion, emotional stability, social support and negative response were associated with stroke pre-hospital delay behavior intention (P<0.05) .
The Guangdong residents had relatively poor level of stroke pre-hospital delay behavioral intention, and insufficient cognition of stroke symptoms. The community should strengthen the education of "stroke 120", and use personalized and diversified stroke education patterns according to individualized features of residents, so as to effectively improve their stroke pre-hospital delay behavior intention and reduce the stroke pre-hospital delay rate.
Exercise capacity is a strong predictive factor of mortality in hemodialysis patients. Hence, it is urgently needed to explore convenient and effective assessment tools to evaluate exercise capacity.
To validate the Duke Activity Status Index (DASI) and General Practice Physical Activity Questionnaire (GPPAQ) walking pace question in Chinese and British hemodialysis patients.
From January 2018 to September 2020, 40 hemodialysis patients from a Chinese tertiary hospital and 39 patients from Leicester Renal Network in the United Kingdom were assessed exercise capacity and walking speed using DASI and GPPAQ walking pace question, respectively. Meanwhile, the shuttle walking test (SWT) and gait speed test in short physical performance battery (SPPB) were conducted with the two cultural groups to validate the DASI and the GPPAQ walking pace question. The validity of DASI was tested by correlation analysis, and the validity test of GPPAQ pace problem was by analysis of variance, respectively.
There was a positive correlation between DASI and the incremental shuttle walking test (ISWT) in hemodialysis patients in China and the United Kingdom (rChina=0.39, rsUK=0.60; P<0.05) , but no correlation with the endurance shuttle walking test (ESWT) (P>0.05) . According to the self-assessment results of the pace problem in the GPPAQ, Chinese hemodialysis patients were classified into four categories: slow pace, steady pace, brisk pace, and fast pace, the objectively measured SPPB pace range of the 4 types of patients overlapped, and there was no significant difference in the average SPPB pace (P>0.05) . British hemodialysis patients were classified into three categories: slow pace, steady pace, and brisk pace, there was a statistically significant difference in the average SPPB pace measured objectively among the three types of patients (P<0.05) . Among them, the average SPPB pace of self-assessed slow pace patients was lower than that of self-assessed steady pace and brisk pace (P<0.05) .
DASI can effectively measure the exercise capacity of hemodialysis patients in China and the United Kingdom. In the two cultural groups, GPPAQ walking pace question could not assist patients inaccurately assessing their gait speed. However, it has potential utility for distinguishing between "slow" and "not slow" gait speed.
Prevalence and Influencing Factors of Sedentary Behavior in Community Stroke Patients
As a kind of unhealthy lifestyle, sedentary behavior is closely related to poor prognosis of stroke patients. So it is of great significance to understand sedentary behavior prevalence in stroke patients, and to formulate intervention measures based on its influencing factors.
To investigate sedentary behavior prevalence and associated factors in stroke patients in the community, providing a reference for the development of targeted interventions.
From August to December 2020, by use of convenience sampling, 230 eligible community stroke patients from Zhengzhou (including individuals who underwent reexaminations in neurology and neurosurgery clinics of three grade A tertiary hospitals and those who were from three communities) were selected to attend a survey using Demographic Questionnaire, Sedentary Behavior Questionnaire, the Chinese version of Fatigue Severity Scale, the Chinese version of Stroke Self-Efficacy Questionnaire, and Social Support Scale. Binary Logistic regression analysis was used to explore associated factors of sedentary behavior.
The survey achieved a response rate of 97.8%. The average daily sedentary time of the respondents was (7.10±2.75) hours, and 179 cases (79.6%) had daily sedentary time ≥5 hours. The daily sedentary time differed significantly by age, living in rural or urban areas, education level, number of complications, number of chronic diseases and fatigue (P<0.05) . Binary Logistic regression analysis showed that age, number of complications, number of chronic diseases and fatigue had significant impacts on sedentary behavior (P<0.05) .
The prevalence of sedentary behavior in community-dwelling patients with stroke was high. It is recommended that health managers develop targeted interventions measures based on the above factors associated with sedentary behavior, thereby reducing sedentary behavior prevalence in this group.
A Comparative Study on the Accuracy of Prognosis of the End-of-life Assessment Form and Common Survival Prediction Scales in Advanced Cancer Patients
Accurately predicting the survival period of patients with advanced cancer can not only lay the foundation for palliative care centers to regulate the admission of patients and provide standardized services, but also help reduce "meaningless" over-treatment in the process of palliative care.However, there is still a lack of comparative study on the common survival prediction scales in China.
To compare the accuracy of the End-of-life Assessment Form and common survival prediction scale〔Palliative Prognostic Index (PPI) 、Palliative Performance Scale (PPS) 、Karnofsky Score (KPS) 〕in predicting the survival of patients with advanced malignant tumors, in order to provide a basis for the selection of survival prediction tools for advanced cancer patients.
Patients with advanced malignant tumors admitted to the hospice ward of Linfen Road Community Health Service Center of Jing'an Distirct of Shanghai from April 1, 2018 to February 1, 2020 were retrospectively selected as researchsubjects. At the time of admission, the general information questionnaire, End-of-life Assessment Form, PPI, PPS, KPS were used to evaluate the patient, and the survival time of the patient was observed and recorded (from admission to the date of death) . The survival time of all patients was analyzed by Kaplan-Meier method, and the survival curve was drawn. The Kaplan-Meier method was used to calculate the median survival of patients in different groups of each scale, the log-rank test was used to compare the differences in survival among patients in different groups of each scale, and the survival curves were drawn. Finally, by comparing the predicted survival time and the actual survival time of patients with different score segments of each scale, the accuracy rate of the End-of-life Assessment Form, PPI, PPS and KPS in predicting the survival time of patients with advanced malignant tumors were calculated.
A total of 315 patients with advanced malignant tumors were included in this study, of which 266 (84.4%) patients died during hospitalization and 49 (15.6%) patients were censored (right censored, type Ⅲ censored) . The median survival time of 315 patients was 10.00〔95%CI (8.10, 11.90) 〕d. The median survival time of patients in groups of 20.0~35.0 points, 35.5~45.0 points, 45.5~50.0 points, 50.5~60.0 points and 60.0~100.0 points of the End-of-life Assessment Form were 1.00〔95%CI (0.79, 1.22) 〕d, 5.00〔95%CI (3.92, 6.08) 〕d, 10.00〔95%CI (7.83, 12.17) 〕d, 22.00〔95%CI (18.42, 25.58〕d and 45.00〔95%CI (26.23, 63.77〕d (χ2=360.561, P<0.001) , respectively; The median survival time of patients in groups of 10~20 points, 30~40 points and 50~100 points of KPS were 1.00〔95%CI (0.66, 1.34) 〕d、7.00〔95%CI (5.23, 8.77) 〕d and 30.00〔95%CI (20.87, 39.13) 〕d (χ2=137.280, P<0.001) , respectively; The median survival time of patients in groups of 60%~100%, 30%~50% and 10%~20% of PPS were 35.00〔95%CI (25.90, 44.10) 〕d、12.00〔95%CI (9.66, 14.34) 〕d and 2.00〔95%CI (0.85, 3.15) 〕d (χ2=139.311, P<0.001) , respectively; The median survival time of patients in groups of 0~3.5 points, 4.0~5.5 points, 6.0~7.5 points, 8.0~10.0 points and 10.5~15.0 points of PPI were 33.00〔95%CI (25.39, 40.61) 〕d、12.00〔95%CI (8.15, 15.85) 〕d、6.00〔95%CI (4.72, 7.28) 〕d、3.00〔95%CI (1.76, 4.24) 〕d and 1.00〔95%CI (0.89, 1.11) 〕d (χ2=289.831, P<0.001) , respectively. The accuracy rate of the End-of-life Assessment Form, KPS, PPS and PPI to predict the survival time were 81.27% (256/315) 、57.78% (182/315) 、57.46% (181/315) 、73.65% (232/315) , respectively.
The End-of-life Assessment Form, PPI, KPS and PPS can be used to predict the survival time of advanced malignant tumors, but the End-of-life Assessment Form is superior to PPI, KPS and PPS in predicting the survival time of advanced malignant tumors.
Participation in Advance Care Planning and Associated Factors among Surrogate Decision Makers of Patients with Hematologic Malignancies
Advance care planning (ACP) helps patients to obtain medical care meeting their values, goals and preferencesunder the circumstances of loss of decision-making ability. The surrogate decision maker (SDM) plays a key role as the main participantinvolved in the process of ACP. But there are no studies on the participation and role of SDMs in ACP process in China.
To investigate the participation in ACP of SDMs of patients with hematologic malignancies and its associated factors, providing a reference for the development of localized strategies for ACP implementation, and for the promotion of ACP in China.
Convenient sampling was used to select the SDMs of 235 patients with hematologic malignancies recruited from Blood Diseases Hospital, Chinese Academy of Medical Sciences during October 2020 to March 2021. They were invited to compete a survey using the Chinese version of the 17-item Advance Care Planning Engagement Survey for Surrogate Decision Makers (C-ACP-SDM-17) , Chinese version of Mishel Uncertainty in Illness Scale-Family Member form (C-MUIS-FM) , Simplified Coping Style Questionnaire (SCSQ) , and Social Support Rating Scale (SSRS) . The C-ACP-SDM-17 scores were compared by demographic factors of the SDMs. Pearson correlation analysis was used to explore the correlation of C-ACP-SDM-17 score with C-MUIS-FM, SCSQ, and SSRS scores of SDMs. Multiple linear regression was used to analyze the factors associated with the participation in ACP of SDMs.
The average total scores of the C-ACP-SDM-17, C-MUIS-FM, and SSRS of the SDMs were (52.23±13.57) , (66.43±12.54) and (40.33±6.78) , respectively. And the average scores of two subscales of SCSQ of the SDMs, active coping and passive coping, were (24.34±6.94) , and (9.87±4.25) , respectively. Male, having experience of involvement in end-of-life medical decision making, awareness of life-sustaining treatment, and knowing of ACP were associated with statistically higher C-ACP-SDM-17 score of SDMs (P<0.05) . The total C-ACP-SDM-17 score of SDMs was negatively correlated with the total score of C-MUIS-FM, and scores of its two subscales, uncertainty and ambiguity, but was positively correlated with the score of active coping. Gender, involvement in end-of-life medical decision making, awareness of life-sustaining treatment, hearing about ACP, level of disease uncertainty, and level of active coping were factors associated with the involvement of SDMs in ACP (P<0.05) .
The ACP participation in SDMs of hematologic malignancies patients was above average. To increase their participation level, it is suggested for medical workers to encourage hematologic malignancies patients' male family members or family members with experience of involvement in end-of-life medical decision making to be SDMs, and give them ACP education, explanation of hematologic malignancies, as well as guide them to actively cope with the pressure of decision making.
Effect of Vestibular Training with Regular Rehabilitation on the Overall Development of Children with Global Developmental Delay and Hypotonia: a Randomized Controlled Trial
The increase in the number of children with global developmental delay and hypotonia is a growing concern. However, clinical rehabilitation for these patients is often carried out using monotherapy approaches, and the period for achieving improvement is relatively long.
To observe the effect of vestibular training with regular rehabilitation on muscle tone and global developmental level in children with global developmental delay with hypotonia, providing evidence for improving treatment options for these children.
Sixty children with global developmental delay accompanied by hypotonia who received rehabilitation training in Department of Pediatric Rehabilitation, Rehabilitation Center, the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from April 2018 to January 2020 were selected, and equally randomized into a control group (regular rehabilitation) and an observation group (vestibular training with regular rehabilitation) . Both groups were treated once daily, 6 days per week, for consecutive 4 weeks. Changes in the normative percentages of Griffiths Mental Development Scales (GMDS) subscales and development quotient, and muscle tone grading of both groups were observed before and after treatment. The overall response rates of muscle tone improvement were compared between the groups.
The values of normative percentages of GMDS subscales and development quotient were similar in both groups at baseline (P>0.05) , but they were more higher in the observation group after intervention (P<0.05) . The post-intervention level of muscle tone of the observation group was higher than that in the control group (P<0.05) although intergroup difference in baseline muscle tone level was insignificant (P>0.05) . The observation group had a much higher overall response rate of muscle tone improvement 〔86.7% (26/30) : 17 (56.7%) with significant responses, 9 (30.0%) with fair responses, 4 (13.3%) with no responses〕 than the control group〔56.7% (17/30) : 9 (30.0%) with significant responses, 8 (26.7%) with fair responses, 13 (43.3%) with no responses〕 (χ2=13.658, P<0.001) .
Vestibular training with regular rehabilitation could improve the muscle tone and developmental delay in children with global developmental delay and hypotonia, which was superior to regular rehabilitation.
