ObjectiveTo conduct comprehensive assessment of internal and external cadmium exposure and health risks for Shanghai residents. MethodsCadmium levels in food samples were calculated by employing two dietary exposure assessment methods， total diet study （TDS） and food frequency questionnaire （FFQ）， to estimate the daily dietary cadmium exposure of Shanghai residents. The provisional tolerable monthly intake （PTMI） of cadmium set by joint food and agriculture organization/WHO expert committee on food additives （JECFA） was applied to evaluate the health risk. Differences in dietary and urinary cadmium were compared by rank-sum test among different regions， age， gender， smoking status， and BMI groups， and the association between internal and external cadmium exposure was investigated by correlation analysis. ResultsThe mean value of urinary cadmium for 1 300 respondents was 0.542 μg·L^-1. Urinary cadmium was higher in the population in central urban and urban-rural fringe areas than in the suburban area， higher in the older age group than in the younger age group， and higher in the smoking group than in the non-smoking group （all P<0.01）. The two assessment methods showed that the mean values of daily dietary cadmium exposure for Shanghai residents were 0.306 and 0.090 μg·kg^-1， with 3.69% and 0.85% of Shanghai residents exceeding the PTMI， respectively. Correlation analyses showed that dietary exposure to cadmium based on the FFQ method was positively correlated with the urinary cadmium level when smoking status， age， gender， and BMI were adjusted. ConclusionDietary exposure to cadmium of Shanghai residents is mainly derived from vegetables， aquatic products， cereals and potatoes， and is overall at a low-risk level. Dietary exposure assessment based on FFQ and risk monitoring data can effectively estimate long-term cadmium exposure.

Objective:To analyze the research progress of family psychological education in schizophrenia population, in order to understand the elements and current situation of family psychological education application, and provide guidance for future research in this field.Methods:According to the basic idea of scoping review, research on family psychological education for schizophrenia patients was systematically searched in PubMed, Embase, CINAHL, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, and China Biology Medicine. The search period was from database establishment to March 15, 2023.Results:A total of 15 articles were included, including 11 completely randomized controlled trials, 2 semi-randomized controlled trials, and 2 follow-up studies. The content consisted of the evaluation and intervention forms of family psychological education, and the development and implementation of specific intervention plans.Conclusions:There is limited research on family psychological education for patients with schizophrenia, and the implementation efforts around the world are insufficient. In the future, relevant research can be conducted to develop cost-effective education programs that are in line with China's culture and environment, so that schizophrenia patients and their families can receive evidence-based treatment to improve patient and family outcomes.

Objective:To translate the English version of the Beliefs Toward Mental Illness Scale (BTMI) into Chinese and test the reliability and validity of the Chinese version in college students.Methods:According to the Beaton cross-cultural adaptation guideline, the Chinese version of BTMI was formed. From April to May 2023, a questionnaire survey was conducted on 915 university students from 171 universities in 26 provinces, autonomous regions, and municipalities across China using convenience sampling, to analyze the reliability and validity of the scale.Results:A total of 915 questionnaires were distributed, and 814 valid questionnaires were collected, with an effective recovery rate of 88.96% (814/915). The Chinese version of BTMI had a total of 21 items. The Cronbach's α coefficient of the total scale was 0.922, and the Cronbach's α coefficients of each dimension were 0.745 to 0.921. The half reliability coefficient of the total scale was 0.797, and the retest reliability coefficient of the total scale was 0.903 ( P<0.01). Exploratory factor analysis extracted four common factors, namely social function, risk, incurability, and awkwardness, with a cumulative variance contribution rate of 62.29%. Confirmatory factor analysis showed that all important fitting indicators were greater than 0.900, indicating a good overall model fit. Conclusions:The Chinese version of BTMI has good reliability and validity, which can be used to evaluate the beliefs of Chinese university students about mental illness.

This article summarizes the research progress on situation awareness in nursing through literature review. Currently, research on situation awareness in nursing is mostly focused on foreign countries, and there is relatively little attention and research on it in China. This article reviews the relevant theories of situation awareness in nursing and its application status in medical settings, related factors, and improvement strategies, in order to provide theoretical references for future research on situation awareness in the nursing and even medical industries.

Objective:To analyze and elaborate on the concept and connotation of elder self-neglect, so as to provide reference for nursing practice.Methods:Literature on elder self-neglect was systematically searched on China National Knowledge Infrastructure, WanFang Data, China Biology Medicine disc, PubMed, Web of Science, and CINAHL. The search period was from database establishment to July 5, 2023. The literature was analyzed using Rodgers' evolutionary concept analysis as the theoretical framework.Results:A total of 63 articles were included. Elder self-neglect consisted of four defining attributes of disorder, danger, concealment, and closure. Antecedents contained physiological, psychological, social environment, and other factors. Consequences included the impact on the elderly themselves as well as the impact on others and the society.Conclusions:Elder self-neglect has a profound impact on individuals and society. By analyzing the concept of elder self-neglect and clarifying its conceptual attributes, researchers can conduct in-depth and comprehensive research on it, promoting the development of healthy aging.

Objective:To summarize the research status of supportive care intervention schemes for patients with liver cancer, analyze relevant studies and identify the forms, contents, outcome indicators and effects of interventions, in order to provide references for medical staff to carry out relevant research.Methods:The scoping review method was used to search relevant articles in WanFang data, VIP, China National Knowledge Infrastructure, Web of Science, PubMed, Embase, Scopus, CINAHL and Cochrane Library. The search period was from the establishment of the databases to May 2, 2023, and the included articles was analyzed.Results:A total of 14 articles were included. The intervention scheme included information and care skills guidance, palliative care support, psychological support, multidisciplinary team support, family rehabilitation exercise guidance, and stress management. Intervention forms included online, offline and mixed intervention. The intervention duration was usually 3 or 6 months. The intervention frequency was usually 1~5 times a week, with each session lasting 20~60 minutes. The intervention scheme could improve the quality of life of liver cancer patients to a certain extent, alleviate anxiety and depression.Conclusions:At present, supportive care interventions are led by nurses and have the characteristics of comprehensiveness, personalization and unclear intervention effects. In the future, it is necessary to further optimize the content and strategy of intervention, and formulate scientific, applicable and standardized supportive care intervention schemes according to the disease and physical function status of liver cancer patients.

Objective:To explore the application of step-by-step mentorship combined with individualized assessment in practical nursing skill training in higher vocational colleges.Methods:A total of 219 nursing students of Class 2020 were selected from a higher vocational college; they were randomly divided into control group (107 students) and experimental group (112 students), both of which were offered nursing training courses in the first semester. The control group was offered conventional teaching, while the experimental group was offered step-by-step mentorship combined with individualized assessment. The two groups were compared for post-training assessment scores of theoretical knowledge and practical skills and pre-training and post-training comprehensive nursing ability as well as their recognition of the teaching methods after training. The t-test and chi-square test were performed using SPSS 22.0. Results:The post-training assessment scores of theoretical knowledge and practical skills were significantly higher in both subitem score [(89.68±3.58) vs. (82.56±3.35)] and total score [(91.75±3.01) vs. (85.36±2.58)] in the experimental group than in the control group ( P<0.05). There were no significant differences in pre-training comprehensive nursing ability between the two groups, while the post-training comprehensive nursing ability scores were significantly higher in both subitem score and total score [(86.53±2.61) vs. (80.32±2.31)] in the experimental group than in the control group ( P<0.05). After the training, students in the experimental group showed increased recognition of the teaching methods in stimulating their learning interest and initiative, improving their self-learning ability, improving their comprehensive literacy, improving their ability to apply theoretical knowledge, and improving their clinical thinking ability compared with the control group ( P<0.05). Conclusion:The application of step-by-step mentorship combined with individualized assessment in practical nursing skill training in higher vocational colleges can improve students' academic performance and comprehensive nursing ability and increase their recognition of the teaching methods, thus making it worthwhile to be widely adopted.

Background Chloropropanol esters (MCPDE) have attracted much attention in recent years as a kind of new contaminant found in various refined oils. The pollution of 3-monochloropropane-1,2-diol esters (3-MCPDE) is the most prominent. 3-MCPDE is hydrolyzed in organisms to 3-monochloropropane-1,2-diol which has been shown to have reproductive toxicity, nephrotoxicity, and potential carcinogenicity. Infant formula powders can be polluted by 3-MCPDE when refined edible oils are added during production. Objective To assess the risk of exposure to 3-MCPDE related to the consumption of infant formula powders for children aged 0-3 years in Shanghai market using the food consumption data and the data of 3-MCPDE contamination in these foods. Methods Gas chromatography-mass spectrometry was used to determine 3-MCPDE in 133 samples of infant formula powders in Shanghai. Using a multistage stratified random sampling method, a total of 807 infants and toddlers aged 0-3 years were randomly selected from each district/rural/town in Shanghai, including 208 children aged 0-6 months, 276 children aged 6-12 months, and 323 children aged 12-36 months. The food consumption data was investigated using food frequency questionnaire (FFQ) distributed by combining telephone inquiries and face-to-face interviews among guardians. Population's probability distributions of 3-MCPDE exposure were assessed by @Risk 7.5 software and Monte Carlo simulation algorithm. According to the dietary intake assessment model and the tolerable daily intake (TDI) of 3-MCPDE of 2.00 μg·(kg·d)⁻¹ proposed by the European Food Safety Authority (ESFA), a risk assessment of exposure to 3-MCPDE was conducted for infants and toddlers aged 0 to 3 years old in Shanghai who consumed 3-MCPDE via infant formula powders. Results The average concentration of 3-MCPDE in 133 samples of infant formula powders was 0.115 mg·kg⁻¹ with a positive rate of 100.00%. Among different types of formula powders, infant formula powders for infants of 0-6 months had the highest concentrations of 3-MCPDE and fat [0.136 mg·kg⁻¹ and 25.2 g (per 100 g sample) in average respectively]. There was a positive correlation between fat concentration and 3-MCPDE concentration in the samples (r=0.438, P<0.05). The average consumption of infant formula powders of 807 infants aged 0-3 years was 88.3 g·d⁻¹. Among all investigated age groups, the average consumption of infant formula powders by infants aged 0-6, 6-12, and 12-36 months was 87.7, 98.3, and 80.1 g·d⁻¹ respectively. The dietary exposure to 3-MCPDE from infant formula powders of infants aged 0-3 years averaged 0.83 μg·(kg·d)⁻¹ for general intake level or valued 1.44 μg·(kg·d)⁻¹ using the 95 percentile for high intake level. Exposure decreased with increasing age and was highest in infants 0-6 months of age, whose general and high intake levels were 1.41 and 2.34 μg·(kg·d)⁻¹, respectively. The risk population defined with the exposure higher than the TDI proposed by EFSA were proportioned to be 13.90% and 0.50% in infants aged 0-6 months and 6-12 months respectively, indicating a risk that cannot be ignored, and no risk in infants aged 12-36 months. Conclusion Among the investigated infants aged 0-3 years in Shanghai, those aged 0-6 months are at a high risk of exposure to 3-MCPDE. In view of the sensitivity of infants to pollutant exposure, the risk of exposure to 3-MCPDE should be highly concerned.

ObjectiveTo provide basic data of daily dietary intake from various food categories as well as in different regions， seasons， genders， and age groups in Shanghai residents aged 15 and over. MethodsMultistage stratified proportional probability sampling （PPS） was used to extract the samples， and food frequency questionnaire （FFQ） was used to investigate the dietary intake of the subjects in four seasons from 2012 to 2013. The weighted statistical analysis of the samples comprehensively considered the sampling design weights， the stratified adjustment weights， and the non-response adjustment weights. ResultsThe total daily dietary intake （excluding drinking water） of residents aged 15 years and above was 1 174.71 g， and the highest three daily dietary intake categories were cereals （252.31 g）， vegetables （205.36 g） and fruits （141.00 g）. The total daily dietary intake of the residents in the urban area， the suburban area and the rural area was 1 209.15 g，1 172.27 g and 948.50 g， respectively， and the total daily dietary intake in the outer suburb area was significantly lower than that in other areas （F=74.12，P<0.001）. The total daily dietary intake in different seasons was 1 232.47 g in spring， 1 166.80 g in summer， 1 241.15 g in autumn and 1 088.83 g in winter， respectively. The total daily dietary intake in winter was lower than that in other seasons （F=15.96，P<0.001）. Fruits and beverages intake showed apparent seasonality. The total daily dietary intake in male and female residents was 1 234.03 g and 1 112.32 g， respectively， and the total daily dietary intake of male was higher than that of female （F=78.59，P<0.001）. The total daily dietary intake of residents in different age groups was 1 218.64 g for 15‒44 years old， 1 141.27 g for 45‒59 years old， and 1 064.54 g for 60 years old and above （F=20.28，P<0.001）. ConclusionThe daily intake of cereals， livestock and poultry meat， aquatic products， eggs and edible oil is relatively balanced， but the daily intake of vegetables， fruits and milk is relatively insufficient for the residents aged 15 years and above in Shanghai. The daily intake of different food types shows distinguishable characteristics in urban and rural areas， seasons， age groups and genders.

Objective:To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy.Methods:A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO′s recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics.Results:A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant ( P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% ( OR=1.42, 95% CI: 1.07-1.88, P=0.015), 46% ( OR=1.46, 95% CI: 1.13-1.88, P=0.004), and 64% ( OR=1.64, 95% CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study ( P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age ( OR=2.87, 95% CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 ( OR=1.59, 95% CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes ( OR=1.58, 95% CI: 1.18-2.13, P=0.002) and premature delivery ( OR=1.52, 95% CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM ( OR=5.34, 95% CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM ( OR=1.44, 95% CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia ( OR=4.11, 95% CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia ( OR=1.46, 95% CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery ( OR=1.47, 95% CI: 1.13-1.92, P=0.004). Conclusions:Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.