Objective To understand the influence of nursing home service experience on humanistic caring ability of nurses.Methods Using the phenomenological method,15 clinical nurses after participation of nursing home service were interviewed,and the data were analyzed using 7 step Colaizzi method.Results 3 themes were extracted:service experience,the understanding of humanistic nursing care,influence of service experience on humanistic caring ability of nursing.Conclusions The participation of nurses in the nursing home services can promote the humanistic caring ability of nursing,which is a positive way of cultivating the ability of humanistic care ability.

Objective To find out the distribution of drinking-tea-borne fluorosis in the six ethnics in Qinghai Province, and to provide basic data for prevention and control of the disease. Methods In 2010, according to the requirement of “The National Surveillance Program of Drinking-Tea-borne Fluorosis”, six ethnics accounted for 99.59% of total population in Qinghai Province were investigated in 28 counties having brick-tea drinking habit. Three townships and a town in each county, two administrative villages(residents’ committee) in each township and town were chosen and 50 adults in each administrative village and residents ’ committee were selected to check skeletal fluorosis, dental fluorosis, urine fluoride and daily drinking amount of tea water. Five to six samples of drinking tea water were determined. Dental fluorosis was examined by Deans method; the fluoride content of brick-tea and urine were determined by fluoride ion selective electrode; the skeletal fluorosis was diagnosed based on “Endemic Osteofluorosis Clinical Indexing Diagnosis Standard”( WS 192-2008 ) . Results A total of 10 335 adults were surveyed, the number of Tibetan, Han, Hui, Mongolian, Tu and Salar ethnics were 4 972, 3 063, 1 196, 634, 235 and 235, respectively. The daily drinking amounts of tea water in Mongolian, Tibetan, Hui, Tu, Han and Salar ethnics were 2.53, 2.19, 1.74, 1.63, 1.22 and 1.07 L, respectively. Daily fluoride intakes in Tibetan, Mongolian, Tu, Hui, Han and Salar ethnics were 3.99, 2.78,2.27, 2.16, 1.78 and 1.28 mg, respectively. The medians of urinary fluoride concentration of the Tibetan, Tu, Hui, Han, Mongolian and Salar ethnics were 1.46, 1.19, 1.12, 0.98, 0.93 and 0.81 mg/L, respectively. The prevalence rates of dental fluorosis of the Hui, Han, Tibetan, Tu, Mongolian and Salar ethnics were 34.53%(413/1 196), 27.07%(829/3 063), 21.60%(1 074/4 972), 20.00%(47/235), 17.98%(114/634) and 6.38%(15/235), respectively. The incidence rates of clinical skeletal fluorosis of the Tibetan, Mongolian, Han, Hui, Tu and Salar ethnics were 13.42%(667/4 972), 11.04%(70/634), 9.31%(285/3 063), 7.61%(91/1 196), 5.53%(13/235) and 4.26%(10/235), respectively. Conclusions The distribution and prevalent status of drinking-tea-borne fluorosis in the six ethnics of Qinghai Province are different. Tibetan and Mongolian ethnics are the key population concerning the prevention and control of the disease.

Objective To observe the illness change trend of drinking water type endemic arsenic poisoning in Qinghai Province, comprehensively evaluate the effect of prevention and control measures, in order to provide a scientific basis for timely adjustment of the prevention and control measures. Methods From 2010 to 2013, according to the Drinking Water Type Endemic Arsenic Poisoning Monitoring Programs, 3 villages in 2 counties within Qinghai Province were randomly selected as monitoring sites. The arsenic content in drinking water of residents was measured, water improvement projects in all monitoring villages were investigated; at the same time an investigation of arsenic disease in resident population was conducted, and urinary arsenic content was monitored. Arsenic in drinking water and urine was determined by hydride generation atomic fluorescence spectrometry, and arsenic poisoning was diagnosed using Endemic Arsenic Poisoning Diagnostic Criteria (WS/T 211-2001). Results Of the three water improvement projects, two were water arsenic exceeded the standard, and one was intermittently operated. From 2010 to 2013, the arsenic poisoning detec tion rate in Baoning Village was 27.30% (193/707), 31.90%(245/768), 29.35%(221/753) and 28.22%(219/776); in Kecai Village was 32.62%(107/328), 34.83%(124/356), 31.26%(131/419) and 29.35%(118/402);and in Manimotai Village was 56.58%(43/76), 52.81%(47/89), 45.10%(46/102) and 34.69% (34/98), there was no significant difference statistically of the arsenic poisoning detection rates in the three monitored villages in the 4 years (χ2 =3.09, 0.04, 0.92, all P>0.05). From 2010 to 2013, women arsenic poisoning detection rate was 36.45%(203/557), 40.59%(246/606), 36.12%(225/623) and 34.77%(218/627), respectively;men was 25.27%(140/554), 28.01%(170/607), 26.57%(173/651) and 23.57%(153/649), respectively;women arsenic poisoning detection rates were higher than those of men (χ2 = 16.25, 21.32, 13.49, 19.38, all P < 0.05). Arsenic poisoning detection rate of people younger than 60 years old had a tendency to increase with age. In 2012 and 2013, 105 and 93 urine samples were tested, respectively; urinary arsenic geometric mean was 0.113 and 0.149 mg/L. Conclusions Water improvement projects and water quality are not optimistic, and prevalence of arsenic poisoning is still at a higher level. A sound long-term monitoring program should be established as soon as possible, the management and maintenance of water improvement projects should be strengthened, and the monitoring and prevention work should not be neglected.

Objective:To compare the accuracy of the needle tip reaching the target tissue between two subcutaneous injection techniques under ultrasound imaging in order to provide a basis for clinical injection to make a safe and reasonable decision.Methods:This was a parallel controlled non-inferiority comparative study. A total of 68 patients who received subcutaneous injections in the outpatient injection room of Nanjing Drum Tower Hospital Affiliated to Nanjing University from June 2021 to September 2022 were selected as the research subjects, and they were divided intothe A and B group according to the random number table method, there were 34 cases in each group. Group A received pinched skin injections, and group B received taut skin injections. Unify the injection site, injection needle length, and needle insertion angle. The accuracy rate of the needle tip reaching the target tissue, namely the subcutaneous fat layer, was compared between the two groups by ultrasound imaging, and the pain scores and the imaging performance during the injection process were observed.Results:The accuracy of the needle tip reaching the subcutaneous fat layer in the group A was 97.1%(33/34), which compared with the 100.0%(34/34) in the group B, there was no significant difference ( χ2 = 0.53, P>0.05). There was no significant difference about the distribution of pain scores between the two groups ( χ2 = 0.67, P>0.05). There were no significant differences about age, subcutaneous fat thickness and the distance from the needle tip to the myofascial in patients with different pain scores ( F = 1.20, 0.44, H = 0.64, all P>0.05). Conclusions:Under certain conditions, pinching the skin and tightening the skin have the same accuracy and safety when the needle tip reaches the subcutaneous fat layer of the target tissue, and the choice should be made according to the clinical situation. Imaging observations have enlightening significance for the practice of subcutaneous injection.

Objective:To investigate the longitudinal trajectory and influencing factors of cancer-related fatigue (CRF) in breast cancer patients during chemotherapy.Methods:From March 2019 to January 2020, breast cancer patients in Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine and Peking Union Medical College Hospital were selected as the research objects to conduct follow-up investigation. The survey tools included general information questionnaire, Cancer-related Fatigue Assessment Scale, International Physical Activity Questionnaire, and the Pittsburgh Sleep Quality Index Scale.Results:A total of 91 patients were included in the study. The incidence of severe CRF at each time point before chemotherapy, 3 weeks after chemotherapy and 6 weeks after chemotherapy were 1.1% (1/91), 8.8% (5/57) and 2.1% (1/48), respectively. The results of the generalized estimation equation showed that the trajectory of the total score CRF firstly increased and then decreased, reaching a peak at 3 weeks after chemotherapy (35.45±13.07), and mild CRF change showed statistical difference ( P<0.05). In addition, BMI and sleep and daytime dysfunction were the influencing factors of the total score of CRF. Disease stage, sleep disturbance and daytime dysfunction were the influencing factors of CRF with different severity. Conclusions:CRF is a prominent problem in breast cancer patients during chemotherapy. Attention should be paid to high-risk individuals with abnormal BMI and daytime function by medical staff.

Objective To understand the epidemic situation of tea-drinking-borne fluorosis among children in Haixi Prefecture of Qinghai Province,and to provide basis for taking pertinent prevention and control measures.Methods In 2017,three townships (towns) were selected from five counties (cities) in Golmud,Delingha,Dulan,Ulan and Tianjun,Haixi,and one village (villages excluding excessive water fluoride) was selected from each township (town) as the investigation site.Fluoride content in drinking water,tea fluoride content and dental fluorosis in children aged 8-12 years were investigated.Water fluoride was determined using "Standard Test Method for Drinking Water" (GB/T 5750.5-2006);brick tea fluoride content was detected using "The Fluoride Content in Brick Tea" (GB 19965-2005);children's dental fluorosis was diagnosed using "Diagnosis of Dental Standard for Fluorosis"(WS/T 208-2011).Results Totally 75 drinking water samples were collected from each county (city).The water fluoride content ranged from 0.35 to 0.41 mg/L,with an average value of 0.37 mg/L,which was lower than the national drinking water fluoride standard of 1.00 mg/L.The fluoride content of 150 brick tea samples ranged from 206.0 to 796.0 mg/kg,with an average value of 629.8 mg/kg.A total of 1 325 children aged 8-12 were examined.The detection rate of dental fluorosis was 13.43％ (178/1 325),the index of dental fluorosis was 0.27,and the overall epidemic intensity was negative.The epidemic intensity in Dulan and Tianjun counties was marginal.There were significant differences in the detection rate of dental fluorosis among children of different ages (x2=35.26,P ＜ 0.05),and dental fluorosis was increased with ages in children.The detection rate of dental fluorosis in boys and girls was 13.31％ (90/676) and 13.56％ (88/649),respectively,with no significant difference (x2 =0.02,P ＞ 0.05).Conclusions There is an epidemic of tea-drinking-borne fluorosis among children in 5 counties (cities) of Haixi Prefecture.Although the epidemic is mild,it should not be ignored.Health education and publicity work for tea-drinking-borne fluorosis should be strengthened.

Objective:To study the epidemic status of drinking tea type endemic fluorosis in Qinghai Province.Methods:In 2019, in counties (cities, districts, referred to as counties) that had the habit of drinking brick tea in 8 cities (prefectures) of Qinghai Province, epidemiological investigation of drinking tea type endemic fluorosis was carried out in villages. Ten households were randomly selected from each village, to investigate the demographic data of each household and the drinking situation of brick tea, residents' drinking water and brick tea samples were collected to determine the fluorine content, and calculate the daily per capita tea fluorine intake. At the same time, skeletal fluorosis was examined in all adults over 25 years old, and dental fluorosis was examined in all children aged 8 to 12 years old in survey sites. The content of fluorine in tea and water was detected by ion selective electrode method; the diagnosis of skeletal fluorosis was based on "Diagnostic Criteria for Endemic Skeletal Fluorosis" (WS 192-2008), the diagnosis of dental fluorosis was based on "Diagnosis of Dental Fluorosis" (WS/T 208-2011).Results:The mean (range) of fluorine of the 3 602 water samples was 0.31 (0.20 - 1.00) mg/L. The geometric mean (range) of fluorine of the 31 067 brick tea samples was 646 (40 - 2 295) mg/kg, the fluorine content of the brick tea ≤300 mg/kg accounted for 7.80% (2 422/31 067) of the total samples. The proportion of drinking Fu brick-tea was 89.97% (27 952/31 067); and the daily per capita tea fluorine intake was 1.93 mg, the daily per capita tea fluorine intake in Guoluo, Yushu and Hainan prefectures were higher than the health standard (3.50 mg). The detection rate of skeletal fluorosis in adults was 0.16% (2 357/1 484 907), Yushu Prefecture was the highest [29.23% (592/2 025)], followed by Guoluo Prefecture, which was 8.21% (771/9 393). The detection rate of dental fluorosis in children was 4.79% (8 076/168 623), Yushu Prefecture was the highest [32.61% (1 562/4 790)].Conclusion:Drinking tea type endemic fluorosis is prevalent in Qinghai Province, with obvious regional characteristics, covering a large population. The disease is relatively popular in Yushu Prefecture and Guoluo Prefecture.