Bei Li

Aims and objectives: To systematically review and compare the efficacy of different exercise interventions on bone mineral density (BMD, g/cm²) in patients with osteoporosis and osteopenia.Background: It is vitally important to prevent and treat bone loss in patients with osteoporosis and osteopenia. Exercise can effectively increase bone density and slow down bone loss in middle‐aged and older people. However, it is still unclear which type of exercise intervention is the most effective on bone mineral density.Design: Systematic review and network meta‐analysis (NMA) according to PRISMA.Methods: Randomised controlled trials of different exercise treatments for osteopenia and primary osteoporosis were included. A Frequentist network meta‐analysis was conducted to appraise the efficacy of different types of exercise. The outcome was bone mineral density of different parts of the body.Results: Ninety‐seven studies were included. The network meta‐analysis showed that combined exercise, resistance exercise, aerobic exercise and mind‐body exercise had a significant effect in improving the bone density of lumbar spine. The surface under the cumulative ranking area (SUCRA) values for mind‐body exercise was 0.99 and ranked first. For BMD of the femoral neck, all kinds of exercise interventions increased the bone density significantly compared with no exercise and the optimal type was mind‐body exercise (SUCRA = 0.99). In terms of the total hip bone mineral density, aerobic exercise and resistance exercise could improve hip bone density, with the resistance exercise (SUCRA = 0.95) ranking as first.Conclusions: This NMA demonstrated the mind–body exercise might be the optimal exercise type to increase the BMD of the lumbar spine and femoral neck and resistance exercise is the most promising type for total hip BMD.

Dementia is prevalent in worldwide, and increases the care burden and potential costs. Physical activity (PA) has been increasingly shown to be beneficial for them. This was a cross-sectional observational study aiming to investigate the status of PA among community-dwelling older adults with dementia in Beijing or Hangzhou, China, and verify the relationships between neuropsychiatric symptoms, activities of daily living (ADL), caregivers’ fear of patients’ falling and their PA using a path analysis approach. The level of PA among 216 included people with dementia was low. PA was related to the neuropsychiatric symptoms, with ADL and caregivers’ fear of patients’ falling have mediation roles. The findings indicated that person-centered strategies related to the management of these symptoms might be helpful to improve ADL, relieve caregivers’ concerns about them falling and consequently foster positive participation in PA.

Aims: To investigate which type of exercise is the most effective for people with mild cognitive impairment (MCI) or dementia.Background: Exercise is recommended as a promising intervention for people with cognitive impairment. However, which type of exercise is the most beneficial for people with MCI or dementia seems still unclear. The objective of this article is to assess the relative effectiveness of different types of exercise on cognitive function in people with MCI or dementia using network meta‐analysis.Design: Systematic review, meta‐analysis, and network meta‐analysis.Methods: We will systematically search electronic databases including PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, SPORTDiscus, and PsycINFO. To avoid missing the eligible literature, we will examine the reference lists of systematic reviews publication since 2017. WHO International Clinical Trials Registry Platform and ClinicalTrials.gov will also be retrieved to identify eligible trials. Two independent researchers will identify the eligible trials according to selection criteria and extract data. The risk of bias for included studies will be assessed by two pairs of reviewers based on the modified Cochrane Risk of Bias Tool. Discrepancies or disagreement will be discussed and resolved. Data will be analysed using pairwise meta‐analysis and network meta‐analysis.Discussion: This study will compare the relative effectiveness of different types of exercise and identify which type of exercise is the most effective for people with MCI or dementia.Impact: The results of this review will provide evidence on which domains of cognitive function are more responsive to what type of exercise. It will also help guide nursing clinical practice to optimize exercise therapy in people with MCI or dementia.PROSPERO registration number: CRD42020160620.

Accessible Summary: What is known on the subject?: The shortage of psychiatric nurses has become a focus problem attracting widespread concern. And the continuous improvement of quality of psychiatric care has always been a priority in psychiatric units. Previous studies about nurses from general hospitals indicated nursing work environment was a key factor affecting work‐related outcomes, but little attention was paid to psychiatric nurses and few studies focused on the five specific dimensions of nursing work environment. What the paper adds to existing knowledge?: Nurse participation in hospital affairs was the dimension with the highest proportion of participants dissatisfied. Nursing work environment and all its five dimensions had significant effects on work‐related outcomes, which were partly mediated by work engagement. For nurse‐perceived quality of care, collegial nurse‐physician relations showed the largest effect; while for turnover intention, the two dimensions of nurse participation in hospital affairs and nursing foundations for quality of care showed larger effects. What are the implications for practice?: Corresponding measures should be taken to improve nursing work environment, especially in the aspect of nurse participation in hospital affairs by promoting nurses' ability to participate, arousing their motivation to participate and offering them more opportunities to participate. Harmonious collegial relationship should be built by creating an atmosphere of equality, respect and collaboration, and enhancing the communication between doctors and nurses. Nursing foundations for quality of care need to be further improved through setting appropriate rules and regulations to ensure the quality of care and offering more opportunities to support nursing staff's growth and development. Introduction: With the increasing demand for high‐quality psychiatric care, it is imperative to improve psychiatric nurses' work engagement and work‐related outcomes. Nursing work environment has been identified as a protective factor in non‐psychiatric nurses, but little was known about psychiatric nurses.Aims: To identify the situation of nursing work environment, work engagement, nurse‐perceived quality of care and turnover intention among psychiatric nurses, and examine the relationship among them.Methods: A cross‐sectional design was adopted. Questionnaire investigation was implemented among psychiatric nurses from 43 clinical units. Structural equation modelling and path analysis were used to examine the causal relationship among variables.Results: The results showed 19.06% of participants were not satisfied with the overall work environment and 24.34% were not satisfied with the dimension of nurse participation in hospital affairs. Hypothesis testing results indicated that nursing work environment and its five dimensions had positive effects on nurse‐perceived quality of care and negative effects on turnover intention, which were both partly mediated by work engagement.Discussion: Supportive nursing work environment could improve nurses' work engagement, enhance nurse‐perceived quality of care and reduce nurses' turnover intention.Implications for Practice: Continuous efforts should be paid to the improvement of nursing work environment in psychiatric hospitals.

Aims and objectives: To investigate turnover intention among newly licensed registered nurses and to clarify the impact pathways of organisational justice, work engagement and nurses’ perception of care quality on turnover intention.Background: Nurse shortage is an ongoing and urgent issue worldwide, in which nurse turnover could exacerbate the situation. Newly licensed registered nurses will become the main nursing workforce in the future; however, previous studies have not revealed the specific reasons underlying their turnover intentions.Design: A descriptive cross‐sectional design.Methods: A total of 569 newly licensed registered nurses undertaking direct care were recruited from thirteen hospitals from October to November 2018 across Beijing, China. Based on the job demands–resources model, we advanced a hypothetical model, linking the paths between organisational justice, work engagement, nurses’ perception of care quality and turnover intention. Structural equation modelling was used to examine the hypothetical model. The study adhered to the STROBE statement for observational studies.Results: In total, 22.3% of newly licensed registered nurses had a high turnover intention. The final model had an acceptable fit and could explain 58% of the variance in turnover intention. The organisational justice was directly related to high work engagement, great nurses’ perception of care quality and low turnover intention. Additionally, organisational justice also had indirect effects on great nurses’ perception of care quality and low turnover intention, which were partially mediated by work engagement. However, the effect of nurses’ perception of care quality on turnover intention was not significant.Conclusion: The improvement of organisational justice could enhance work engagement, and nurses’ perception of care quality, and reduce turnover intention, which is crucial to improving care quality and addressing the shortage of nurses.Relevance to clinical practice: This study provides evidence for policymakers and hospital administrators to take targeted measures to enhance work engagement, foster high‐quality care and create better defences against losing nurses.

Aims: To clarify the specific impact paths among physical activity, activity of daily living, depression and quality of life among dementia patients.Design: A descriptive, cross‐sectional design.Methods: Dementia patients and their caregivers from five tertiary general hospitals and one dementia patients’ club were recruited. A total of 216 valid questionnaires were collected from November 2018 ‐ March 2019. Path analysis was performed by Mplus 7.0 to test the casual relationship among physical activity, activity of daily living, depression and quality of life.Results: Most patients with dementia presented a low level of physical activity and suffered from impaired quality of life. The modified model presented a good model fit and revealed that physical activity had indirect positive effects on quality of life mediated by activity of daily living and depression.Conclusion: The results showed that physical activity was a promising non‐pharmacological method to improve the performance of activity of daily living and reduce depressive symptoms and then enhance the quality of life among dementia patients.Impact: The findings were beneficial to elevate the awareness of physical activity among patients and professionals. This study was helpful to understand how physical activity exerted effects on life quality of dementia patients. This study provided a new perspective for researchers to elucidate the causal relationship of variables among dementia patients.

Aims: To synthesise the current research on exercise interventions and health‐related outcomes among community‐dwelling adults with Alzheimer's disease (AD).Methods: Integrative review of the literature reporting exercise interventions among people with AD living in the communities.Results: Seventeen studies presented in 24 quantitative papers with 1,068 participants diagnosed with Alzheimer's disease were reviewed. The interventions varied in intervention programme characteristics (e.g. baseline assessments, type of exercise, exercise dose, outcome measurements). Among them, (a) 13 studies appeared beneficial to physical fitness in different areas; (b) 9 studies reported the effects on cognitive ability and two studies showed the positive effects; (c) 12 studies reported the participants' adherence, but only 2 studies reported the participants' adherence using attendance and training intensity.Conclusion: Exercise is proven to be effective in physical fitness among community‐dwelling patients with AD. Future studies should verify the effects on cognitive function and possible mechanisms of different exercise types using more sensitive and objective outcome measurements. Additionally, treatment fidelity, cost‐effectiveness and long‐term effects should be explored.Implication for practice: Exercise may be effective and feasible for community‐dwelling people with AD, but its effects on cognition need to be verified in the future. This review provided recommendations for assisting nurses and other clinicians in developing, implementing, and/or evaluating exercise interventions for patients with AD.

Aim: To test the relationship between work practice environment and turnover intention, considering the mediation of work engagement and the moderation of work pressure among community health nurses.Design and Samples: A cross‐sectional survey design.Methods: A total of 410 nurses were recruited from 32 community health centres between September 2016–January 2017 with survey on work practice environment, work engagement, work pressure and turnover intention. Structural equation modelling was used to test a mediated moderation model.Results: Work practice environment was positively associated with higher work engagement and lower turnover intention and work engagement partially mediated the relationship between work practice environment and turnover intention. In addition, work pressure moderated the relationship between work practice environment and work engagement.Conclusion: The improvement of work practice environment including the physical and humanitarian environment could enhance nurse engagement and reduce turnover intention in community, which was more pronounced among high‐pressure nurses.Impact: In front of the nursing shortage, especially in communities, the strategies on how to retain and motivate nurses have become the focus of concern. Based on the job demands‐resources model and the conservation of resources theory, this study examined the effect of work practice environment on turnover intention with the mediation role of work engagement and the moderation role of work pressure among community health nurses. The nurse managers of communities should pay attention to the role of work practice environment in stimulating nurses’ engagement and decreasing turnover intention, especially when nurses are under high work pressure.