Prolonged electronic screen use can cause digital eye strain. It can be difficult to rectify due to increasing smartphone reliance, potentially leading to serious public health problems. To investigate the association between time spent on smartphones and digital eye strain (DES) among Hong Kong Chinese school-aged children. Of a total of 1,508 students (748 males, 49.6%) from 8 to 14¿years old (mean age = 10.91¿years, SD = 2.01) who provided valid data on DES, the 1,298 (86%) who completed the DES questionnaire at 1-year follow-up were included in the analysis. DES was measured using a 10-item scale, and the sum of the 10 dichotomised scores was used as the DES total score. The most commonly reported symptoms were eye fatigue (n = 804, 53.3%), blurred vision (changing from reading to distance viewing) (n = 586, 38.9%), and irritated or burning eyes (n = 516, 34.2%). The DES total scores at baseline and 1-year follow-up were 2.91 (SD = 2.90) and 3.20 (SD = 3.19), respectively. Linear regression controlling for demographic and socio-economic confounders showed that participants with baseline smartphone usage of 241 + min/d had a significantly higher baseline total DES score than those with baseline smartphone usage of 0¿60¿min/d (2.44 vs 3.21, P < 0.001), and participants with baseline smartphone usage of 181¿240¿min/d had a significantly higher 1-year follow-up total DES score than those with baseline smartphone usage of 0¿60¿min/d (2.80 vs 3.50, P = 0.003).

Background: Total hip arthroplasty and total knee arthroplasty are widely performed worldwide. Patients undergoing total hip or knee arthroplasty are often discharged after a short hospital stay. Using information and communication technologies, such as mobile applications, to provide rehabilitation services remotely may be a strategy to support patients' postoperative recovery. Objective: This study aimed to evaluate the effectiveness of a rehabilitation programme delivered via a mobile application among Chinese patients after total hip or knee arthroplasty. Design: Randomised controlled trial. Setting: A teaching hospital in Shanghai, China. Participants: Eighty-six patients who received a unilateral primary total hip or knee arthroplasty. Methods: The participants were recruited in the hospital and randomised into either the experimental or control group. Once discharged from the hospital, the control group (n = 43) received usual care, and the experimental group (n = 43) received usual care plus a 6-week mobile rehabilitation programme. Outcomes were assessed three times: the day before hospital discharge and 6 and 10 weeks after discharge. Primary outcomes were the changes in scores of self-efficacy and patient-reported physical function from baseline to 6 weeks post-discharge. Secondary outcomes included changes in scores of pain, depression, anxiety, and health-related quality of life. Data were analysed using generalised estimating equations. Results: At 6 weeks after hospital discharge, the experimental group showed statistically significant improvements compared to the control in scores of self-efficacy (adjusted mean difference = 0.72, 95% CI 0.31 to 1.14, P < .001) and patient-reported physical function (adjusted mean difference = 4.57, 95% CI 1.24 to 7.90, P = .007). The between-group difference in self-efficacy probably reached clinical significance. At week-10 follow-up, the experimental group had statistically significant improvements in scores of self-efficacy (adjusted mean difference = 0.64, 95% CI 0.33 to 0.95, P < .001), health-related quality of life (adjusted mean difference = 0.06, 95% CI 0.01 to 0.10, P = .018), anxiety (adjusted mean difference = - 0.51, 95% CI - 0.91 to - 0.10, P = .015), and depression (adjusted mean difference = - 0.37, 95% CI - 0.66 to - 0.08, P = .012). The between-group difference in self-efficacy and health-related quality of life may be clinically significant. Conclusion: Mobile application-based rehabilitation demonstrated potentially positive effects on patients' self-efficacy, patient-reported physical function, health-related quality of life, and levels of anxiety and depression. Trial registration: Registered with the Australian New Zealand Clinical Trials Registry on 6 July 2021 (ACTRN12621000867897).

There are increasing concerns about internet gaming disorder (IGD). No review of existing studies has system-atically analyzed and visualized the trends of IGD and those early identification of symptoms related to IGD beha-viors. This critical review focuses on the emerging trends for early identification of symptoms related to IGD behaviors in papers published in Web of Science Core Collection from 2009 to 2021 by scientometric analysis and critical review. Scientometric data analysis technique includes co-occurrence analysis, cluster analysis and burst analysis of authors, countries, keywords and co-citation to visualize those contributing and associated factors to develop IGD behaviors and their relationships to mental-emotional symptoms. About 81.8% of the papers were published in the following countries: United States, United Kingdom, Australia, China and South Korea. The top co-occurrence keywords were ¿children¿, ¿depression¿, ¿anxiety¿ and ¿attention deficit hyperactivity disorder (ADHD)¿, ¿scale¿, identifying the population, characteristics and commonly used assessment tools that are suscep-tible to certain symptoms relating to IGD of which influencing factors facilitate the understanding of the association of sociodemographic characteristics. The main emerging topics were identified in this critical review after conducted the scientometric analysis. The results identified five topics: game impulse, motivation, evaluation scale, mediating effects and diagnostic criteria. This study provides an overview of the research trends on the identity and development of the IGD field of study.

Purpose: We analyzed the association between bedtime smart device usage habits and accelerometer-measured sleep outcomes (total sleeping time, sleep efficiency, and wake after sleep onset) in Hong Kong children and adolescents aged 8¿14. Methods: A total of 467 students in Hong Kong participated in this study from 2016 to 2017. They self-reported their bedtime smart device usage habits. The primary caregiver of each participant was also invited to complete a self-administered questionnaire about the family¿s social-economic status and bedtime smart device usage habits. An ActiGraph GT3X accelerometer was used to assess participants¿ 7-day sleep outcomes. Results: The mean age of the participants was 10.3 (SD 1.9), and 54% were girls. Among the participants, 27% (n = 139) used a smart device before sleep, and 33% (n = 170) kept the smart device on before sleep. In total, 27% (n = 128) placed the smart device within reach before sleep, 23% (n = 107) would wake up when notifications were received, and 25% (n = 117) immediately checked the device after being awakened by a notification. Multiple regression controlling for age, sex, socio-economic status, and other confounders showed that those who woke up after receiving a notification had a statistically longer sleeping time (19.7¿min, 95% CI: 0.3, 39.1, p = 0.046), lower sleep efficiency (- 0.71%, 95% CI - 1.40, - 0.02, p = 0.04), and a longer wake after sleep onset (2.6¿min, 95% CI: 0.1, 5.1, p = 0.045) than those who did not. Nonetheless, all primary caregivers¿ bedtime smart device habits were insignificantly associated with all sleep outcomes of their children. Conclusion: Those who woke up after receiving smart device notifications had lower sleep efficiency and longer wake after sleep onset than those who did not, and they compensated for their sleep loss by lengthening their total sleep time.

There is a scarcity of resources and studies that utilize targeted weight management interventions to engage parents via mHealth tools targeting obese children and adolescents with mild intellectual disabilities (MIDs) extended from school to a home setting. To test the feasibility and acceptability of a school-based weight program (SBWMP) involving parents via mHealth tools designed to reduce weight, enhance knowledge and adopt healthy lifestyles, and thereby achieve better psychosocial well-being among children and adolescents with MIDs. Four special schools were randomly assigned as intervention or control schools. Students from the intervention group (n = 63) were compared to those in the control group (n = 52), which comprised those with usual school planned activities and no parental involvement. Demographics were considered as covariates in a general linear model, an ordinal regression model and a binary logistic regression model analyzing the relationships between the SBWMP and the outcome variables at baseline (T0) and six months later (T1). Body weight, body mass index, and triceps and subscapular skinfold thickness were lower in the intervention group compared to the control group, although the differences were not statistically significant. There was a positive and direct impact of the SBWMP on students¿ health knowledge and psychological impacts in the intervention group. The SBWMP extended to the home involving parents via mHealth tools is a feasible and acceptable program for this group with MIDs and their parents.

Aims and objectives: To evaluate the effects of an educational intervention programme on improving paediatric nurses¿ competencies in performing adolescent healthcare practice in central China. Background: The WHO Adolescent Health Framework was integrated into this training programme to examine the effects of educational interventions on the competencies of paediatric nurses in promoting adolescent healthcare. This study is one of the first in central China to evaluate paediatric nurses¿ competencies in promoting adolescent health. Design: The study used a mixed-method design with a quasi-experimental approach and focus group interviews. Methods: The study was conducted with 57 paediatric nurses from 28 institutes and hospitals in central China in 2010 to evaluate their competencies in adolescent health and development, specifically with regard to conducting needs assessments, planning effective interventions and evaluating outcome measures. The paediatric nurses received training and were assessed by individual and group work during the structured three-week programme. Data were collected before and after the training programme as pre- and post-tests. The researchers gathered information about their experiences by conducting focus group interviews. Results: The paediatric nurses demonstrated significant improvements in their adolescent healthcare practice after attending the three-week structured training programme. The post-test scores had significant effects on the dimensions of the adolescent healthcare practice competency checklist. The qualitative data also showed positive and encouraging experiences and feedback from the paediatric nurses in this study. Conclusion: The findings suggest that an educational intervention can change knowledge, attitudes and practice among paediatric nurses in adolescent healthcare. All the paediatric nurses in this study demonstrated increased competencies in carrying out adolescent healthcare practice after participating in the three-week intensive intervention programme. Relevance to clinical practice: This study showed that paediatric nurses have an important role in promoting and coordinating adolescent healthcare practice in primary healthcare practice.

Background: People who identify as lesbian, gay, bisexual and transgender (LGBT) can face many challenges in society including accessing education, care and support appropriate to individual needs. However, there is a growing and evolving evidence base about the specific needs of people with intellectual disabilities (ID) in this regard. Aims: The aim of this review was to explore the experiences of people with ID who identified as LGBT through an examination of studies that addressed their views and highlighted specific issues, concerns and service responses. Methods and procedures: A comprehensive search of relevant databases from February 1995 to February 2015 was conducted. Studies were identified that met specific criteria that included: empirical peer reviewed studies, the use of recognised research methods and focused on people with ID whom identified as LGBT. The search yielded 161 papers in total. The search was narrowed and 37 papers were screened using rigorous inclusion and exclusion criteria. Finally, 14 papers were considered suitable for the review. Outcomes and results: The data were analysed and key themes identified that included accessing health services, gender and sexual identity, attitudes of people with ID regarding their LGBT status, and education, supports and therapeutic interventions. Conclusions and implications: There is a need for service providers and carers to be more responsive to the concerns of people with ID who identify as LGBT to improve their health and well-being by reducing stigma and discrimination and by increasing awareness of their care and support needs. The implications are discussed in terms of policy, education, research and practice developments.

Background: Infectious diseases are common among schoolchildren as a result of their poor hand hygiene, especially in those who have developmental disabilities. Methods: A quasi-experimental study using a pre- to post-test design with a control group was used to test the feasibility and sustainability of simplified 5-step handwashing techniques to measure the hand hygiene outcome for students with mild intellectual disability. Sickness-related school absenteeism was compared. Results: The intervention group experienced a significant increase in the rating of their handwashing quality in both hands from pre- to post-test: left dorsum (+1.05, P <.001); right dorsum (+1.00, P <.001); left palm (+0.98, P <.001); and right palm (+1.09, P <.001). The pre- to post-test difference in the intervention group (+1.03, P <.001) was significantly greater than the difference in the control group (+0.34, P =.001). There were no differences between the post-test and the sustainability assessment in the intervention group. The intervention school experienced a significantly lower absenteeism rate (0.0167) than the control group in the same year (0.028, P =.04).Students in this study showed better performance in simplified handwashing techniques and experienced lower absenteeism than those using usual practice in special education school settings. Conclusion: The simplified 5-step hand hygiene technique has been proven effective in reducing the spread of infectious diseases.

Background: It is important to integrate adolescent health domains into pre-service nursing education in order to enhance undergraduate nursing students' competencies in promoting adolescent health. Aim: To determine the effectiveness of a structured adolescent health summer programme for Chinese undergraduate nursing students. Methods: A quasi-experimental design was used to evaluate differences in the Chinese undergraduate nursing students' perceived competency in promoting adolescent health. A stand-alone adolescent health course was implemented as an intervention with pre- and post-tests of a 2-week intensive summer programme in 2010. The questionnaire included demographics, adolescent health competency checklist and programme evaluation. Descriptive statistics with the Wilcoxon signed-ranks test and the Mann-Whitney U-test were used for data analysis. Results: Of the 113 nursing students, seniors perceived higher adolescent health competence mean scores than the juniors in the post-test phase. Majority of nursing students revealed the increasing awareness of the importance in promoting healthy lifestyle behaviours and psychosocial well-being after attending the summer programme. They agreed that nurses do have a role to play. Limitations: This 2-week summer programme may only have short-term impacts on students' perception. Conclusions: A stand-alone adolescent health summer programme can prepare nursing students to respond to the health issues of adolescents by enhancing their competence in health need assessment and service delivery. Implications for nursing and health policy: Nurses serve in a leadership role for health policies and programmes. In nursing education, it is important for students to understand how to put in place policies to resolve adolescent health issues. © 2013 International Council of Nurses.

A quasi-experimental study using a pretest-posttest design with a control group was used to evaluate the effects of a simplified 5-step multimedia visualization hand hygiene improvement program by schoolchildren with mild intellectual disability (MID). A total of twenty schoolchildren aged 6-12 years old with MID (12 males) were recruited and they were assigned into intervention (n= 10) and control (n= 10) groups. To evaluate the quality of their hand washing, Glow gel, which contains plastic simulated germs that are visible under an ultra-violet lamp, was applied to participants' hands to assess the quality of hand washing by comparing the amount of visible Glow gel before and after hand washing using a 4-point scale. Four raters used this 4-point scale to assess the quality of hand washing through digital photo images of the participants' hands. A total of eight digital photos per participant were taken. A fifteen-minute hand washing training session was conducted every school day for 4 weeks for the intervention group. Those in the control group received no training. A multimedia visual package on steps of hand washing was presented together with a reward system, whereby a number of stars were earned each week depending on the quality of hand washing. Results showed encouraging findings, as the schoolchildren in the intervention group showed significant improvement in hand washing (p< 0.001) and the improvement was stronger than that of the control group (p= 0.02). To conclude, a systematic instruction emphasizing multimedia visualization in a hand washing improvement program can be successfully implemented in a special school, and the effect of integrating multimedia visuals in the hand hygiene program could improve hand hygiene among schoolchildren with MID. © 2014 Elsevier Ltd.

Aim: To examine Chinese mothers' experience of caring for their hospitalized sick child. Background: Engaging the mother in providing care for a hospitalized sick child is considered one of the key elements for high-quality care in advanced paediatric nursing. There is evidence that a mother's belief in her capacity to manage stressful situations could improve the nurse-parent relationship because they might play an important role in protecting mothers against heightened stress during crisis situation. Design: An interpretive phenomenological approach involving semi-structured interview and thematic analysis was used. Method: Fifteen interviews were conducted in Hong Kong, China from April 2009-January 2010, with 15 mothers caring for their hospitalized sick children with acute injury or illness. Crist and Tanner's circular process of hermeneutic interpretive phenomenology was chosen to guide the data analysis. Findings: The prevailing concept identified through analysis was the 'constant vigilance' that mothers developed. Interpretation of data resulted in the identification of four key themes: 'being sensitive to others', 'providing helping hands', 'monitoring health conditions', and 'maintaining dialogues'. The findings highlight Chinese mothers' desire for participation in caring for their hospitalized child, their unexpressed needs for communication, and concern about being uncared by the busy health professionals, which affect their care for the child's health outcomes. Conclusion: The findings facilitate the development of family-centred care focuses on partnership of care between the nurse and family to enhance the Chinese family's active and participatory role. © 2012 Blackwell Publishing Ltd.