Health inspectors are part of the public health workforce in China, and its shortage has been identified as an urgent priority that should be addressed. Turnover is one of the main contributors to the shortage problem. This research assessed the influence of professional identity, job satisfaction and work engagement on turnover intention of township health inspectors and explored the intermediary effect of job satisfaction and work engagement between professional identity and turnover intention among township health inspectors in China. Data were collected from 2426 township health inspectors in Sichuan Province, China. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. Results showed that a total of 11.3% of participants had a high turnover intention and 34.0% of participants had a medium turnover intention. Job satisfaction had a direct negative effect on turnover intention (β = −0.38, p < 0.001), work engagement had a direct negative effect on turnover intention (β = −0.13, p < 0.001), and professional identity had an indirect negative effect on turnover intention through the mediating effect of job satisfaction and work engagement. Our results strongly confirmed that professional identity, job satisfaction and work engagement were strong predicators of turnover intention. According to the results, desirable work environment, quality facilities, fair compensation and adequate advancement opportunities should be emphasized to improve job satisfaction. The turnover intention of health inspectors could be reduced through improving professional identity, enhancing job satisfaction and work engagement.

These results provide preliminary support that the mMBSR(BC) program may be feasible and acceptable, showing a clinical impact on decreasing psychological and physical symptoms. This mobile-based program offers a delivery of a standardized MBSR(BC) intervention to BCS that is convenient for their own schedule while decreasing symptom burden in the survivorship phase after treatment for breast cancer.

There has been growing concerns about racial and ethnic disparities in completion rates of advance directives (ADs) among community-dwelling older populations. While differences in AD completion rates in non-Hispanic Whites and African Americans have been reported, not much is known about the awareness and completion of ADs in other groups of ethnic minorities. Using a sample of community-dwelling Korean American older adults (n = 675) as a target, factors associated with their awareness and completion of ADs were explored. Guided by Andersen's behavioral health model, predisposing (age, sex, marital status, and education), need (chronic conditions and functional disability), and enabling variables (health insurance and acculturation) were included in the separate logistic regression models of AD awareness and AD completion. In both models, acculturation was found to be a significant predictor; those who had a higher level of acculturation were more likely to be aware of ADs and to have completed ADs. This study contributes to the knowledge about the role of acculturation in explaining AD awareness and completion among Korean American older adults and provides practice implications for possible AD educational interventions for this older adult minority population.

It is important to understand the unmet needs of family caregivers of advanced cancer patients for developing and refining services to address the identified gaps in cancer care. To explore their needs in Chinese mainland and the possible factors associated with their needs, a self-developed questionnaire was used to survey a sample of 649 participants in 15 hospitals of Shanghai. The data were analysed using descriptive statistics, factor analysis, t-test, one-way ANOVA, and Fishers least significant difference t-test. All statistical analyses were performed using SPSS 13.0. Seven dimensions of needs (maintaining health, support from healthcare professionals, knowledge about the disease and treatment, support on funeral, information on hospice care, psychological support for patients and symptoms control for patients) were extracted from the results by factor analysis. The dimension with the highest score was 'knowledge about the disease and treatment' (4.37), and that with the lowest score named 'support on funeral' (2.85). The results showed that the factors including burden of payment for treatment, former caregiving experience of family caregivers and length of caregiving time were associated with their needs. Cancer services need to consider how to tailor resources and interventions to meet these needs of family caregivers of advanced cancer patients.

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Depression is one of the most common psychological consequences of caregiving. Caring for patients with severe mental illness (SMI) adds significant challenges to family caregivers’ mental health. The purpose of this study was to describe the prevalence of depression among caregivers of SMI patients in rural areas of Sichuan province of China, to examine the influence of social support and care burden on depression, and to explore the intermediary effect of care burden between social support and depression among caregivers of SMI patients. Data were collected from 256 primary caregivers of SMI patients in rural Sichuan Province in China. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. We found that a total of 53.5% of caregivers had depression. Both care burden (β = 0.599, 95%CI: 0.392–0.776) and social support (β = −0.307, 95%CI: (−0.494)–(−0.115)) were directly related to depression, while social support had a direct association with care burden (β = −0.506, 95%CI: (−0.672)–(−0.341)). Care burden mediated the relationship between social support and depression. For the socio-demographic variables, gender, education level and per capita annual income of household had significant correlations with depression (p < 0.05). The results strongly demonstrated that social support and care burden were predictors of depression, especially social support. Policymakers should fully recognize the role of primary family caregivers in caring for SMI patients and promote interventions to decrease care burden and reduce caregivers’ depression by improving social support and network. More attention should be given to female caregivers and caregivers with lower education and lower household income levels.

Fatigue is associated with adverse health outcomes such as mortality, morbidity, and disability among middle aged and older adults.1 It is also an important component of the clinical manifestation of the frailty syndrome.2 The most recent evidence regarding fatigue prevalence among the U.S. adult population date back to the 1970s and early 1990s.3 -4 For example, a U.S. survey in 1974 showed that 14.3% men and 20.4% women reported suffering from "frequent fatigue."3 and another study found that 12% of men and 22% of women were considered to have "lack of energy."4 However, the current prevalence of fatigue in the U.S. older adult population is unclear. Therefore we described the prevalence of fatigue in a nationally representative sample of the U.S. middle aged and older adults in 2004. METHODSThis study used data from the 2004 wave of the Health and Retirement Study (HRS), a biennial longitudinal survey of a U.S. nationally representative sample of communitydwelling adults aged 51 and above.5 The present study included 17,084 individuals who completed the interview themselves and have complete data on fatigue symptoms. Fatigue is defined as positive response to at least one of two questions: "…during the past week, you felt that everything you did was an effort, or you could not get going?" We plotted the smoothed (locally weighted least squares, or LOWESS) prevalence of fatigue by age to show the unadjusted cross-sectional relationship between age and fatigue prevalence for men and women. RESULTSThe sample represented a population of 74 million U.S. adults aged 51 and above. The mean age of the sample was 64.6 years and 55.9% were female. White, Black, and Hispanics accounted for 81.9%, 9.2%, and 6.5% of the sample, respectively. The prevalence of fatigue was estimated at 31.2% (95% confidence interval: 30.0-32.5%). Fatigue was more common in women (33.3%) than in men (28.6%, p<0.01), and in minorities (47.5%) than in Whites (27.5%, p<0.01). Figure 1 illustrates the LOWESS smoothed fatigue prevalence by age for men and women. The relationship between age and fatigue prevalence appeared to be "J-shaped" among both men and women, with the lowest fatigue prevalence occurring among the 60-64 years old group for men and 65-69 years old group for women. The prevalence of fatigue appeared to reach its highest level among individuals aged 90+ years for both men and women. DISCUSSIONThe fatigue prevalence among both men and women were much higher than those reported in the literature from U.S. and European samples. For example, using the same fatigue definition, Vestergaard et al. reported prevalence rates of 15% and 29% among a sample of Italian men and women, respectively.6 In addition, using "lack of energy" as the definition of fatigue, Cheng et al. reported that 12% of men and 22% of women had fatigue.4 "Lack of energy" in that study was operationalized by a positive response to "sits around a lot for lack of energy" and having two of six symptoms. Therefore, the higher prevalence of fatigue in this U.S. populatio...

The findings suggest that Medicaid HCBS waiver programs may reduce the prevalence of low-care residents in NHs. Future studies should evaluate whether Medicaid HCBS waiver programs are effective in promoting community-living among low-care residents and mitigating the growth in long-term care expenditures.