Search

Aim: Recurrent miscarriage is considered a major life event. The main purposes of this study were to compare the differences in stress, anxiety, social support, sleep quality and depressive symptoms in couples experiencing recurrent miscarriage compared to peers who experience full‐term normal childbirth in southern Taiwan. Methods: Convenience sampling and snowball sampling were used respectively to recruit 78 couples with and 80 couples without recurrent miscarriage from October 2014 to July 2015. Five structured questionnaires including Perceived Stress Scale, State‐ Anxiety Inventory, Interpersonal Support Evaluation List, Pittsburgh Sleep Quality Index and Edinburgh Depression Scale were administered. Results: Women who experienced recurrent miscarriage perceived significantly higher levels of stress, anxiety and depressive symptoms than their husbands. Women in the recurrent miscarriage group reported significantly greater depressive symptoms than women of the other group. A stepwise multiple regression analysis indicated key predictors of depressive symptoms among women of childbearing age, accounting for 62.9% of the variance, were anxiety, stress, social support and history of recurrent miscarriage. Conclusion: Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than their peers who experienced normal childbirth. Health professionals can use the knowledge gained from these findings to evaluate women with recurrent miscarriage for stress, anxiety and depressive symptoms and develop supportive interventions. SUMMARY STATEMENT: What is already known about this topic? Recurrent miscarriage is considered a major life event and, for some, a failure to fulfil a core responsibility for the family lineage.Research about the differences between genders in both the type and degree of emotional response to a miscarriage is limited. What this paper adds? Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than women without recurrent miscarriage.The key predictors of depressive symptoms among women of childbearing age were anxiety, stress, social support and history of recurrent miscarriage, accounting for 62.9% of the variance. The implications of this paper: This study highlights the need to increase healthcare professionals' awareness of the importance of evaluating stress, anxiety and depressive symptoms in women with recurrent miscarriage.It is recommended that future studies develop and test supportive care protocols for couples experiencing recurrent miscarriage. [ABSTRACT FROM AUTHOR]

Background: Taiwan's higher education institutions prioritize interdisciplinary knowledge and cultural competence in cultural design, emphasizing the value of immersion in the local environment to develop cultural competence. However, challenges arise from the disappearance of traditional local lifestyles and limitations of traditional outdoor lectures such as group size and learning environment. Mobile augmented reality technology serves as a personal learning tool to overcome these challenges, enabling learners to uncover hidden knowledge in scenic locations and improving learning efficiency. Objective: The study utilized learning analytics to investigate the impact of using mobile augmented reality on enhancing learners' cultural competence. Methods: The study used both qualitative and quasi‐experimental quantitative research to evaluate the effects of mobile augmented reality on cultural competence. A total of 78 third‐year university students participated in the study, with 37 of them using mobile augmented reality to learn about culture. The researchers utilized both the Mann–Whitney U test and interviews to compare the effectiveness of mobile augmented reality with that of a 'real' tour guide in field courses. Results: The experimental results indicate that learners were able to continuously seek and find information about local culture through field exploration with mobile augmented reality, resulting in similar effects to those of attending a live lecture. Conclusions: It showed that incorporating mobile AR into field visits can create gamified and active learning scenarios that enhance immersion and drive active learning in local culture. The results in greater cultural knowledge and understanding, leading to the development of cultural competence in students. Lay Description: What is already known about this topic: There is a heightened emphasis on cultivating and demonstrating cultural competence across various fields due to the significantly grow of cultural and creative industries.Relying solely on traditional classroom teaching for learning about local culture may result in a diminished impact, as a comprehensive understanding of culture necessitates a keen sense of life.To address the limitations of traditional classroom lectures, educators continuously strive to enhance teaching methodologies by developing innovative approaches, such as experiential learning and community‐based learning, which involve hands‐on activities and real‐world engagement to foster increased learning motivation and improved effectiveness.Augmented reality (AR), a technology that overlays virtual images onto real scenes in real time, has gained extensive usage in diverse fields such as medicine, national defence, education, and entertainment, offering interactive gaming experiences and providing an opportunity to experience the culture and past lives of locals in the field, enhancing learners' understanding of cultural history and creating immersive encounters during visits.Particularly in digital learning, the integration of AR enables learners to engage with additional content through mobile devices, fostering an immersive and gamified learning experience. What this paper adds: The use of the AR app for learning about the local culture yielded comparable outcomes to traditional guided tours.Participants actively engaged in self‐directed learning and demonstrated a sense of initiative while utilizing AR.The flexibility and autonomy provided by field learning, which extended beyond the course period, allowed participants to revisit the field and explore at their own pace using AR.Demonstrates that participants took control and responsibility for their own learning, leading to an enhancement in learner autonomy.Participants who utilized the Roaming Jingliao AR system to explore cultural scenarios exhibited enhanced knowledge and attitudes regarding cultural competence, specifically in areas such as cultural understanding, rice food cultural knowledge, Songjiang folk arts, and skills and practices, which can be attributed to the immersive and autonomous nature of AR‐based knowledge learning in outdoor guided courses, minimizing the influence of external environmental factors and facilitating a deeper understanding of the content compared to traditional guided tours. Implications for practice and/or policy: The findings of this study highlight the importance of considering the limitations associated with a relatively small sample size when conducting research within a university curriculum. To enhance the validity and reliability of future studies, practitioners and policymakers should prioritize the inclusion of larger and more diverse samples, enabling a more comprehensive understanding of the impact of AR technology on cultural learning and informing evidence‐based practices and policies.The study's focus on a specific group of participants and their contextual background highlights the need for future research to include participants from diverse educational settings and cultural backgrounds, ensuring that the findings are more applicable and relevant to a broader population. Practitioners and policymakers should consider the importance of inclusivity and diversity when designing and implementing cultural learning interventions using AR technology.The recognition of technological limitations highlights the importance of considering the specific AR system used in cultural learning interventions. Practitioners and policymakers should be cautious when adopting AR technologies and recognize that different AR systems or platforms may yield different outcomes. Future research should focus on evaluating the effectiveness of various AR systems and platforms to inform decision‐making regarding the selection and implementation of AR technologies for cultural learning initiatives. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) can promote design performance, and may generate a high cognitive load and affect creative design thinking as well. In order to examine the effect of VR application on cognitive load and engineering design creativity, this study recruited 81 eighth‐grade students as participants and employed a non‐equivalent‐groups quasi‐experimental design to examine how VR application influences creativity components and creative performance. A creativity component scale (creative motivation, creative thinking, and professional cognition), a measurement of creative performance, and a cognitive load scale were used to collect data. The study also investigated the ability of VR application to predict creativity components and creative performance, using cognitive load as the mediator. The conclusions are as follows: (1) VR application had marked effects on professional cognition and creative motivation but no effect on creative thinking skills. (2) VR application had marked effects on the novelty and usefulness aspects of creative performance, particularly with respect to usefulness. (3) VR application had marked effects on extraneous and germane cognitive load, but no influence on intrinsic cognitive load, and (4) Both VR application and cognitive load were able to predict creativity components and creative performance. Their abilities to predict creative performance approached an acceptable level. Nevertheless, VR application had no effect on general creative thinking skills; therefore, other teaching strategies are needed to strengthen creative thinking. Lay Description: What is already known about this topicVirtual reality (VR) can transmit complex knowledge.Virtual reality (VR) can promote design performance.What this paper addsInfluence of VR application on creativity components and creative performance.Ability of VR application and cognitive load to predict creativity components.Ability of VR application and cognitive load to predict creative performance.Implications for practice and/or policyUsing VR teaching to improve learning effects and creativity in high‐risk, expensive, and inaccessible learning fields.Using VR teaching to practice repeatedly, and facilitate basic understanding of the application. [ABSTRACT FROM AUTHOR]

Scholars have suggested that flipped learning can be enhanced by designing effective in‐class learning activities to improve students' higher order thinking skills. Problem posing has been recognized as such a learning strategy that has great potential for improving students' higher order thinking skills. However, it has been reported as a challenging task for most students. Research evidence has indicated the potential of engaging students in group learning with step‐by‐step hints when conducting problem‐posing activities. Therefore, this study proposed a multilevel concept mapping‐based problem‐posing strategy to assist students in completing the problem‐posing tasks in flipped learning. To understand the effectiveness of the proposed strategy, a flipped learning system was developed and adopted in the science class of an elementary school. Seventy‐five fifth graders from three classes were divided into experimental group A, experimental Group B and a control group. Students in Group A used the concept map‐guided problem‐posing strategy for flipped learning (CMPP‐FL), students in Group B used the problem‐posing strategy‐based flipped learning, while students in the control group used the conventional flipped learning strategy. The results showed that the CMPP‐FL was effective in terms of improving students' learning performance, especially for students with higher levels of critical thinking tendency. Lay Description: What is already known about this topic: Flipped learning enabled teachers to have more class time to engage students in applying knowledge.Scholars have suggested that the value of flipped learning can be enhanced by designing effective in‐class learning activities to improve students' higher order thinkingProblem‐posing has been recognized as such a learning strategy that has great potential for improving students' higher order thinking. What this paper adds: This study proposed a multilevel concept mapping‐based problem‐posing strategy to assist students in completing the problem‐posing tasks in flipped learning.A flipped learning system was developed and adopted in the science class of an elementary school.It was also found that the results showed that the concept map‐guided problem‐posing strategy was effective in terms of improving students' flipped learning performance, especially for those with higher levels of critical thinking tendency. Implications for practice and/or policy: Employing concept maps as a guidance for problem posing is a promising approach.It is worth investigating the impacts of the concept map‐guided problem posing approach on the students with different personal characteristics, such as knowledge levels or motivational levels.It is worth applying the approach to other courses in the future to further explore its effectiveness. [ABSTRACT FROM AUTHOR]

Robotics education has received an increasing attention in recent years as a means to build students' motivation, team collaboration skills, and other valuable 21st century competencies. Yet there is a lack of experimental studies to investigate and identify strategies to facilitate robotics education. This study adopted a 2 × 2 quasi‐experimental design to investigate two strategies: the incorporation of augmented reality (AR) and the introduction of competition in robotics activities. Students' robotics task performance, team collaboration processes, 21st century learning competencies and learning motivation were measured as dependent variables. The results indicated that AR significantly improved students' motivation, team processes, and 21st century competencies. Moreover, the effects of AR were more pronounced with the competition groups. Implications are drawn to provide guidelines on the use of AR and competition in robotics education. Lay Description: What is currently known about the subject matter?Robots in education have been recognized as an effective approach to enhance learning competencies.The benefits of AR in learning gains and motivation. What their paper adds to this?To design robotics curricula that can be used in middle schools.To understand what middle school students can learn from the robotics curricula. The implications of study findings for practitionersHow to utilize AR in robotics education.What are the structure and pace of robotics curricula for middle school students? [ABSTRACT FROM AUTHOR]

Online search involves multitasking and may demand better working‐memory capacities (WMC) and additional cognitive aids. Given the constraints of human cognition, we tested the effectiveness of note‐taking strategies on university students' online search performance. Also examined were the profile configurations of WMC tests in silence and in irrelevant speech as well as its interaction effects with note‐taking strategies on online search performance. Among the participants of 60 university students, we found a four‐group WMC profile composition that differed significantly across WMC scores in both silence and irrelevant speech. Results showed that WMC profiles, note‐taking groups and their interaction effect were significant factors on online search performance. Both Free Note and Matrix Note were beneficial for the students in low silent WMC profile groups. Study results have both theoretical and practical implications, advancing our understanding of the interrelationship of WMC under different conditions and informing instructional practice of online search performance. Lay Description: What is already known about this topicWorking memory capacity is fundamental to multitasking ability.Online search is a typical multitasking behavior that requires constant switching between different information sources.Students who take note perform better than those who do not while reading materials with seductive but irrelevant information.What this paper addsStudents working memory capacity is examined under silent and irrelevant speech conditions.Students exhibited different profile patterns in their working memory capacity under silent and irrelevant speech conditions.Taking note, either in matrix form or free form, can significantly improve students' online search performance for those with high WMC ONLY in irrelevant speech or for those with low WMC in both silent and irrelevant speech conditions.Implications for practiceNote‐taking as auxiliary support may facilitate students' integration and evaluation of the online information across multiple sources during their online search.Instructions on how to self‐construct matrix note are needed to help students develop advanced note‐taking skills for their learning involving online search. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore the effect of a pedagogical model of digital games on students' scientific competencies that are advocated by the Programme for International Student Assessment (PISA). As a single game‐based learning strategy may not be enough to enhance such competencies, the online game in the current study incorporated the design of the proposed pedagogical gamification, assessment, modeling, and enquiry (GAME) model. The participants were 69 sixth grade students at one primary school in Taiwan. A quasi‐experimental design was adopted. The experimental group students learned with the GAME model, whereas the comparison group students only learned with traditional learning way. The results showed that the learning gain in scientific competencies of the experimental group was better than those of the comparison group. This study revealed that the GAME model has potential to promote students' PISA scientific competencies. It is suggested that the integral GAME model may serve as one kind of strategies to enhance students' scientific competencies. Lay Description: What is already known about this topic: The existing literature suggested that GBL has the potential to improve science learning.Studies of the effect of GBL on students' scientific competencies are still limited. What this paper adds: This study proposed the pedagogical GAME model that consists of gamification, assessment, modeling, and enquiry.This study revealed that the GAME model led to differences in primary school students' scientific competencies. Implications for practice and/or policy: The enquiry activities embedded in games were shown to be crucial for students' learning gains of scientific competencies.The GAME model may serve as a reference for improving students' scientific literacy. [ABSTRACT FROM AUTHOR]

This study combined 3D printing technology with experiential learning strategies (ELS) to design a hands‐on curriculum for preengineering students. The participants learned interdisciplinary knowledge and abstract scientific concepts through the curriculum. The study implemented a quasi‐experimental design to examine whether the students who learned using the 3D printing technology with ELS demonstrated better learning performances regarding the comprehension of abstract scientific concepts and hands‐on ability. This study selected 184 10th‐grade students from five classes, which were divided into three groups. The experimental process was conducted over a period of 11 weeks (for a total duration of 960 min). It was found that all of the preengineering students improved their comprehension of abstract scientific concepts. The students who learned using the 3D printing technology understood abstract scientific concepts better than those who learned using the traditional hands‐on tools, and the students who learned using the 3D printing technology with ELS demonstrated better hands‐on ability than the other two groups. Using 3D printing technology with ELS resulted in significant positive effects on the participants' handmade processes, in which the students reinforced the connection between knowledge and handmade products, resulting in better comprehension of abstract scientific concepts and hands‐on ability. Lay Description: What is already known about this topic: Applying 3D printing technology to a hands‐on curriculum offers many benefits, such as smoother and easier progress, and a shortened product development cycle and reduced development costs.Preengineering students must understand the impacts of engineering developments and become literate about the technological world around them, but disciplines that are too abstract for students at the high school level can easily lead to myths, and it can affect students' learning outcomes. What this paper adds: Combining 3D printing technology with ELS to design a learning activity.Through the process of this course design, students gained scientific knowledge about energy and produced a hands‐on windmill generator that converted wind energy into electricity. Implications for practice and/or policy: This study used 3D printing technology with ELS to help senior high school students improve their comprehension of abstract scientific concepts and hands‐on ability.By bridging the gap between interdisciplinary knowledge and a hands‐on curriculum, this study provided evidence of engaging in experiences when using 3D printing technology. [ABSTRACT FROM AUTHOR]

Suppose learners use their free time to go online to review course materials, and they do so by taking optional tests that consist of multiple‐choice questions (MCQs). What will happen if, for every practice question, there is always a choice (out of four possible choices) that is marked as "the (current) hot choice?" Will this make any difference in learning effects? To answer this question, an educational experiment was conducted. It was found that "hot designations" helped the experimental group perform significantly better in both the immediate post‐test exam and a delayed post‐test exam and that learners with higher levels of initial knowledge benefited more from this review strategy. From the results of a follow‐up questionnaire and one‐on‐one interviews, it was found that the proposed review strategy promoted a more thorough thinking style in subjects of the experimental group. Lay Description: What is already known about the subject matter: There are good reasons why multiple‐choice questions (MCQs) are a popular choice for tests.E‐learning such as game‐based/mobile learning often uses MCQs for formative assessment.The main "problem" with MCQs is that MCQ tests tend to encourage rote learning.It is desirable to use MCQ tests to promote meaningful learning.What this paper adds to the subject matter: An HMCQ is an MCQ with one of its four choices being marked as "the (current) hot choice."The proposed review strategy requires learners to use their free time to do online tests.Learners taking HMCQ tests better retained knowledge than learners taking MCQ tests.Learners with higher levels of initial knowledge benefited most from the HMCQ review strategy.Implications of study findings for practitioners: It should be worthwhile to use HMCQ tests to help learners review course materials.The effect of "hot" designations (in MCQs) on learning still needs to be clearly delineated.Are there other approaches that also go well with "hot" designations (in MCQs)? [ABSTRACT FROM AUTHOR]

INTRODUCTION Cigarette smoking affects blood pressure and is a major risk factor for cardiovascular diseases. The role of smoking cessation programs with respect to blood pressure remains inconclusive. Thus, this study aimed to investigate the effects of a smoking cessation program on blood pressure. METHODS Participants who attended the smoking cessation program in an outpatient clinic of a tertiary medical center in Taiwan from 2017 to 2018 were enrolled in this retrospective cohort study. Their smoking cessation status was traced via phone calls during the third month, and the researchers collected participant characteristics and blood pressure before and after the program. Differences in the participants' blood pressure, based on those with and those without hypertension, were compared using analysis of covariance. Univariable logistic regression models were used to determine factors associated with success in smoking cessation. In total, there were 721 participants. The participants had a mean age of 55.8±11.4 years and 68.1% of the participants were hypertensive. RESULTS During the program, the overall systolic blood pressure decreased by 4.0±17.9 mmHg and diastolic blood pressure decreased by 2.5±12.0 mmHg, from the baseline. Hypertensive participants showed a more prominent blood pressure lowering effect compared to non-hypertensive participants in terms of the subtraction difference of systolic blood pressure (-5.0±19.0 vs -1.9±15.2 mmHg, p=0.018) and diastolic blood pressure (-3.1±12.9 vs -1.1 ±9.6 mmHg, p=0.016). After multivariate control, the results showed that the adjusted subtraction difference of diastolic blood pressure was still more significant in the hypertensive group than in the non-hypertensive group. CONCLUSIONS The smoking cessation program significantly reduced both systolic blood pressure and diastolic blood pressure in the entire cohort. The results were more significant in the hypertensive group compared to the non-hypertensive group. [ABSTRACT FROM AUTHOR]

Learning a foreign language requires interaction with language input while involved in a task. Given that problem‐based learning (PBL) offers hands‐on application in realistic contexts, and that virtual reality (VR) enables learners to interact with multiple modalities of information, this study examines how the integration of VR technology into PBL contexts affects students' motivation for, problem‐solving during, and vocabulary acquisition in learning English as a foreign language (EFL). A total of 84 engineering majors who enrolled in a course of English for specific purposes were randomly assigned to either an experimental group or a control group. Students in the experimental group participated in a VR‐assisted PBL context, in which they were to view a PBL scenario using VR technology and then to create VR videos about solving the given problems. Those in the control group participated in a PBL context without the use of VR technology for viewing and solving the identical scenario. After the intervention, all the students wrote a problem‐solving analysis, took a vocabulary knowledge test, completed a learning motivation questionnaire, and participated in individual interviews. The results showed that the students in the experimental group significantly outperformed those in the control group in terms of vocabulary acquisition, and were more motivated to learn English related to their future careers, whereas there was no significant difference in the problem‐solving performance of the two groups. Implications of these findings highlight the value of engaging EFL learners in immersive environments for contextualized learning through the integrated use of VR and PBL. Lay Description: What is already known about this topic?: Virtual reality (VR) technology has been shown to enhance students' knowledge and skills in STEM fields.Problem‐based learning (PBL) has been widely used in medical education but not so much in foreign language education.English as a foreign language (EFL) students usually have very limited access to the target language beyond the classroom, thus lack a motivating reason for them to learn English after graduation. What this paper adds?: The VR‐assisted PBL approach proposed in this study was found to significantly enhance the EFL students' specialized vocabulary knowledge.The VR‐assisted PBL approach was found to motivate and sustain the EFL students' interest in career English.Exposing the EFL students to PBL contexts was capable of developing their problem‐solving performance, regardless of VR integration. Implications for practice and/or policy: The proposed approach has the potential to facilitate student learning in EFL education, particularly English for occupational purposes.EFL educators may apply the VR‐assisted PBL approach to narrow the gap between language classrooms and workplace contexts by immersing students in authentic contexts that were relevant to their occupational knowledge and workplace English. [ABSTRACT FROM AUTHOR]

This paper aims to investigate how a gamified learning approach influences science learning, achievement and motivation, through a context-aware mobile learning environment, and explains the effects on motivation and student learning. A series of gamified learning activities, based on MGLS (Mobile Gamification Learning System), was developed and implemented in an elementary school science curriculum to improve student motivation and to help students engage more actively in their learning activities. The responses to our questionnaire indicate that students valued the outdoor learning activities made possible by the use of a smartphone and its functions. Pre- and post-test results demonstrated that incorporating mobile and gamification technologies into a botanical learning process could achieve a better learning performance and a higher degree of motivation than either non-gamified mobile learning or traditional instruction. Further, they revealed a positive relationship between learning achievement and motivation. The correlation coefficient for ARCS dimensions and post-test shows that the ARCS-A (attention) is greater than ARCS-R, ARCS-C and ARCS-S. This means that the attention (ARCS-A) of this system is an important dimension in this research. The results could provide parents, teachers and educational organizations with the necessary data to make more relevant educational decision. [ABSTRACT FROM AUTHOR]

This paper describes our studies on non-parametric maximum-likelihood estimators in a semiparametric mixture model for competing-risks data, in which proportional hazards models are specified for failure time models conditional on cause and a multinomial model is specified for the marginal distribution of cause conditional on covariates. We provide a verifiable identifiability condition and, based on it, establish an asymptotic profile likelihood theory for this model. We also provide efficient algorithms for the computation of the non-parametric maximum-likelihood estimate and its asymptotic variance. The success of this method is demonstrated in simulation studies and in the analysis of Taiwan severe acute respiratory syndrome data. [ABSTRACT FROM AUTHOR]

An active transport mode provides an opportunity for integrating physical activity into one's daily life through walking, cycling, and the use of public transportation. The purpose of this study was to compare urban adults with chronic conditions who used active and inactive transport modes and to find differences in their health outcomes. A cross‐sectional study was conducted from September 2019 to May 2020. Participants were urban adults who self‐reported being overweight or obese, or having a diagnosis of chronic disease. Anonymous structured self‐reported questionnaires were used for data collection, including the World Health Organization Quality‐of‐Life Scale, International Physical Activity Questionnaire Short‐Form, and the frequency of eight modes of transportation. According to differences between the frequency score of weekly active and inactive transportation, participants were categorized into inactive, balanced, and active transport modes. In total, 617 valid responses were obtained. Participants who engaged in an active transport mode were found to have significantly less sedentary time, and better comprehensive, social, and environmental aspects of quality of life than those with an inactive transport mode. Engaging in active transportation and avoiding inactive transportation are recommended for urban adults with chronic diseases. [ABSTRACT FROM AUTHOR]

Under the influence of the western world, the solar New Year celebration seems to have fascinated everyone in Taiwan with the lunar New Year festivity showing much less vigor. This paper examines the impact of the solar and lunar New Years on the stock market of Taiwan, showing that the lunar effect outshines the solar one, but the magnitude is decreasing for both as the years go by. In addition, this effect is more significant in the year of horse. [ABSTRACT FROM AUTHOR]

The experience of a life‐threatening illness, such as cancer, can have an array of health impacts and social and psychological well‐being can be compromised. This study compared differences in unmet care needs, social support, and hope of Taiwanese women with either newly diagnosed (n = 72) or recurring (n = 39) gynecological cancer at baseline (T0) and three follow‐up surveys every 2 months (T1; T2; T3). Sociodemographic questions and three standardized self‐administered questionnaires were used. The generalized estimating equations (GEE) method was used to analyze data. Women with recurrent cancer reported higher levels of care needs and lower levels of hope than those with a primary diagnosis. Significant positive correlations between social support and hope scores were observed for women with recurring cancer at T1 and T2. However, these women reported less hope at T3 compared to those with a primary diagnosis. Routine assessment of women's care needs related to their medical condition and provision of different kinds of support can aim to improve well‐being and their hope for the future. [ABSTRACT FROM AUTHOR]

Abstract: In this paper, we employ the multivariate CUSUM (cumulative sum) test for covariance structure as well as the renormalized partial directed coherence (PDC) method to capture the structural causality change of real estate stock indices of five emerging Asian countries and regions (i.e., Thailand, Malaysia, South Korea, PR China, and Taiwan). Meanwhile, we develop a method to make the comparison of renormalized PDC more intuitive and a set of criteria to measure the result. One of our findings indicates that the regional influence of the Chinese real estate stock market on the causality structure of the five markets has arisen under the effect of the financial tsunami. [Copyright &y& Elsevier]

To investigate the effect of mandala coloring, plaid pattern coloring, and free-form drawing activities on anxiety and mood in older Taiwanese adults. A total of 120 older adults aged 55 years to 75 years were recruited from 18 community-based learning centers for older adults in southern Taiwan. They were randomly assigned to engage in one of the following four activities for 20 minutes: (1) mandala coloring group, (2) plaid pattern coloring group, (3) free-form drawing group, and (4) reading group (control). Information on sociodemographic, lifestyle, and perceived health status was collected at the baseline. In addition, anxiety levels, measured using the 20-item State-Trait Anxiety Inventory–State Anxiety Scale (STAI-S), were ascertained at the baseline (T1), after a brief anxiety induction (T2), and at the end of the assigned activity (T3). The mean anxiety levels among the four groups at T3 were analyzed using analysis of covariance, followed by Šidák multiple comparison test, as appropriate. The mean age of the 120 study participants was 65.1 years and 73.3% were females. A significantly lower anxiety level was observed only in the mandala coloring group (least square mean = 28.2; 95% confidence interval = 24.7–31.7) compared with the control group (least square mean = 36.0; 95% confidence interval = 32.9–39.2) (P = 0.004 , partial eta-squared = 0.113). Furthermore, when the STAI-S was analyzed at the item level, the mandala coloring group was significantly different from the control group in the following six feelings: calmed down, safe, at ease, rested, satisfied, and I feel good. In conclusion, short-term mandala coloring activity could significantly alleviate self-induced anxiety in community-dwelling older adults. Further studies on the long-term effects of mandala coloring activity in improving the emotional well-being of older adults are warranted. [ABSTRACT FROM AUTHOR]

Abstract: Based on the flipped‐classroom model and the potential motivational and instructional benefits of digital games, we describe a flipped game‐based learning (FGBL) strategy focused on preclass and overall learning outcomes. A secondary goal is to determine the effects, if any, of the classroom aspects of the FGBL strategy on learning efficiency. Our experiments involved 2 commercial games featuring physical motion concepts: Ballance (Newton's law of motion) and Angry Birds (mechanical energy conservation). We randomly assigned 87 8th‐grade students to game instruction (digital game before class and lecture‐based instruction in class), FGBL strategy (digital game before class and cooperative learning in the form of group discussion and practice in class), or lecture‐based instruction groups (no gameplay). Results indicate that the digital games exerted a positive effect on preclass learning outcomes and that FGBL‐strategy students achieved better overall learning outcomes than their lecture‐based peers. Our observation of similar overall outcomes between the cooperative learning and lecture‐based groups suggests a need to provide additional teaching materials or technical support when introducing video games to cooperative classroom learning activities. [ABSTRACT FROM AUTHOR]

Abstract: This study proposed a computerized inquiry‐stage‐dependent argumentation assistance and investigated whether this can help improve elementary students' performance in science processes and the construction of quality arguments. Various argumentation assistances were developed and incorporated into each stage of scientific inquiry in a computer‐supported scientific inquiry system. A nonequivalent quasi‐experimental design was adopted to evaluate the effectiveness of this approach. Two intact sixth grade classes (N = 55) participated in this study, and each student used a tablet computer to accomplish the designated inquiry activities. One class of students was arranged to use the stage‐dependent argumentation assistance, and the other used a generic text‐based interface. The findings indicate that students who used the stage‐dependent argumentation assistance could acquire significantly better science process and argument construction skills than those using the generic text‐based interface. [ABSTRACT FROM AUTHOR]

Recently, some studies proposed methods to promote socially shared regulation of learning (SSRL) level within a team because high SSRL levels enable an effective collaboration. Meanwhile, several studies also proposed methods in online collaboration to enhance individual self-regulated learning (SRL). Notably, most existing studies focused on proposing methods and tools either for enhancing SSRL level within a team or for enhancing individual SRL. A computer-supported collaborative learning (CSCL) environment with proper supports is promising for simultaneously enhancing the SSRL level within a team and individual SRL because SSRL and SRL have an inseparable relation and mutually influence during collaborative process. Based on the existing principles and theories, this work adopts the supports of group awareness and peer evaluation in CSCL with project-based learning. Group awareness (GA) can reveal collaborative behaviour of group members and regulate their participation while peer assessment (PE), which can appraise member’s contribution, can encourage individual responsibility and refine regulatory strategies. This study finds that the proposed group awareness and peer assessment (GAPE) (i.e. the experimental class) moderately reduces the free-rider effect and enhanced SSRL level and individual SRL, compared with NO-GAPE (i.e. the control group). Furthermore, this study also confirms that the perceived SSRL level can effectively predict individual SRL. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the effectiveness of a psychoeducational programme in enhancing motivation to change alcohol-addictive behaviour. Background The prevalence of alcohol abuse has increased over the past 10 years, and the age of initial alcohol use has decreased gradually in Taiwan. Alcohol dependence is one of the leading causes of disability and has led to increases in the incidence of crime and violence, with alcohol abuse identified as a problem in society. Design A quasi-experimental design with nonequivalent pre/post-testing was used. Methods Alcohol-dependent inpatients undergoing alcohol treatment were selected from the psychiatric ward of a teaching hospital in northern Taiwan. The effectiveness of the psychoeducational programme in enhancing motivation to change alcohol-addictive behaviour was evaluated with the Severity of Alcohol Dependence Data Questionnaire and the Stages of Change Readiness and Treatment Eagerness Scale. In total, 24 and 51 participants were recruited to the experimental and control groups, respectively, for the baseline survey, and 14 and 17 were in the final survey, respectively. Results After adjustment for baseline survey scores, the experimental group showed significantly greater increases in recognition and ambivalence relative to those observed in the control group. Conclusions The results not only showed that the psychoeducational programme was effective in reinforcing addicted inpatients' motivation for changing their drinking behaviour but also provided clinical nurses with practical methods via which to enhance patient motivation. Relevance to clinical practice The psychoeducational programme could assist clinical nurses in helping alcohol-dependent patients to recognise the nature of their problematic drinking; increase participants' ambivalence towards their drinking behaviour, leading to the contemplation of change; and strengthen the possibility that they will change their addictive behaviour. [ABSTRACT FROM AUTHOR]

Background Previous studies have reported that credibility and content (argument quality) are the most critical factors affecting the quality of health information and its acceptance and use; however, this causal relationship merits further investigation in the context of health education. Moreover, message recipients' prior knowledge may moderate these relationships. Objectives This study used the elaboration likelihood model to determine the main effects of argument quality, source credibility and the moderating effect of self-reported diabetes knowledge on message attitudes. Methods A between-subjects experimental design using an educational message concerning diabetes for manipulation was applied to validate the effects empirically. A total of 181 participants without diabetes were recruited from the Department of Health, Taipei City Government. Four group messages were manipulated in terms of argument quality (high and low) × source credibility (high and low). Results Argument quality and source credibility of health information significantly influenced the attitude of message recipients. The participants with high self-reported knowledge participants exhibited significant disapproval for messages with low argument quality. Conclusion Effective health information should provide objective descriptions and cite reliable sources; in addition, it should provide accurate, customised messages for recipients who have high background knowledge level and ability to discern message quality. [ABSTRACT FROM AUTHOR]

Background: Particulate matter (PM) air pollution is associated with the risk of cardiovascular morbidity and mortality. However, the biological mechanism underlying the associations remains unclear. Atherosclerosis, the underlying pathology of cardiovascular disease, is a chronic inflammatory process. We therefore investigated the association of long-term exposure to fine PM (PM2.5) with C-reactive protein (CRP), a sensitive marker of systemic inflammation, in a large Taiwanese population.Methods: Participants were from a large cohort who participated in a standard medical examination programme with measurements of high-sensitivity CRP between 2007 and 2014. We used a spatiotemporal model to estimate 2-year average PM2.5 exposure at each participant's address, based on satellite-derived aerosol optical depth data. General regression models were used for baseline data analysis and mixed-effects linear regression models were used for repeated data analysis to investigate the associations between PM2.5 exposure and CRP, adjusting for a wide range of potential confounders.Results: In this population of 30 034 participants with 39 096 measurements, every 5 μg/m3 PM2.5 increment was associated with a 1.31% increase in CRP [95% confidence interval (CI): 1.00%, 1.63%) after adjusting for confounders. For those participants with repeated CRP measurements, no significant changes were observed between the first and last measurements (0.88 mg/l vs 0.89 mg/l, P = 0.337). The PM2.5 concentrations remained stable over time between 2007 and 2014.Conclusions: Long-term exposure to PM2.5 is associated with increased level of systemic inflammation, supporting the biological link between PM2.5 air pollution and deteriorating cardiovascular health. Air pollution reduction should be an important strategy to prevent cardiovascular disease. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to examine the effects of reminders, encouragement, and educational messages delivered by mobile phone on shoulder exercise compliance and improvements in shoulder function among patients with a frozen shoulder. Design and Methods A randomized controlled trial design was used. A convenience sample of patients with a frozen shoulder in an orthopedic outpatient clinic was recruited. All participants were instructed on how to do shoulder exercises and were provided with a printed pamphlet about shoulder exercises. Then, the intervention group received reminders, encouragement, and educational messages by mobile phone daily for the next 2 weeks, while the comparison group did not. Findings The intervention group had higher compliance with shoulder exercises than did the comparison group ( t = 2.263, p = .03) and had significant improvements in shoulder forward flexion ( F = 12.067, p = .001), external rotation ( F = 13.61, p = .001), and internal rotation ( F = 5.903, p = .018) compared to those in the comparison group after the 2-week intervention. Conclusions The text messages significantly increased patient compliance with shoulder exercises and thus improved patients' shoulder range of motion. Clinical Relevance Hospital or clinics can send appropriate messages to patients via text message platforms in order to remind and encourage them to do shoulder exercises. [ABSTRACT FROM AUTHOR]

Most systems for training self-regulated learning (SRL) behaviour focus on the provision of a learner-centred environment. Such systems repeat the training process and place learners alone to experience that process iteratively. According to the relevant literature, external scaffolds are more promising for effective SRL training. In this work, group awareness and peer assistance are used as external scaffolds in the process of training SRL behaviour, enhancing opportunities for self-reflection and stimulating and encouraging learners. This work further develops a system, called self-regulated learning with group awareness and peer assistance (SRL-GAPA). Experimental results reveal that SRL-GAPA provides significantly more participation in online training tasks and learning activities, better SRL behaviour and better learning achievement than the traditional SRL system (i.e,, a learner-centred environment). The SRL-GAPA benefited poorly self-regulated learners more than highly self-regulated students. Some implications of this finding are discussed. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the effects of a nurse-family partnership model on the self-efficacy of family caregivers (FCs) and the incidence of catheter-associated urinary tract infection (CAUTI) among patients. A randomized controlled study was conducted. We recruited 61 patients and their FCs, who were randomly divided into an experimental group (n = 30) and a control group (n = 31). In the experimental group, the main caregivers comprised a nurse-family partnership, whereas the control participants received routine care. The findings were as follows: (i) the incidence of CAUTI was lower in the experimental group than in the control group (20% vs. 38.8%), but the difference was not statistically significant; and (ii) no significant difference emerged for reported Caregiver Self-Efficacy Score between the two groups. The nursing team and FCs must become partners in cooperative caregiving to enhance the quality of patient care. [ABSTRACT FROM AUTHOR]

The primary goal of this study is to create and test a lecture-capture system that can rearrange visual elements while recording is still taking place, in such a way that student performance can be positively influenced. The system we have devised is capable of integrating and rearranging multimedia sources, including learning content, the instructor and students' images, into lecture videos that are embedded in a website for students to review after school. The present study employed a two-group experimental design, with 153 participants (145 females and 8 males) making up an experimental group in which lecture courses were recorded using the new lecture-capture system, and 149 participants (140 females and 9 males) forming a control group whose lectures were recorded by traditional means. All participants were in the freshman college and studying Introduction to Computer and Information Science in one of six classes, and were randomly assigned to one of the two groups. The participants' midterm examination and final examination scores were collected as indicators of their academic performance, with their mathematics entrance scores used as a pre-test. The findings obtained from analysis of covariance (ANCOVA) suggest that appropriate rearrangement of visual elements in lecture videos can significantly impact students' learning performance. [ABSTRACT FROM AUTHOR]

Auricular acupoint stimulation has become a popular weight loss method. However, its efficacy for obesity treatment has not been fully studied. This study aimed to investigate the effect of a 10-week intervention of auricular electrical stimulation combined with auricular acupressure on weight reduction in obese outpatients. In this single-blind randomized sham-controlled study, 134 participants were randomly assigned to an experimental group receiving stimulation at true acupoints, or a sham group receiving stimulation delivered in the same manner but at sham acupoints. Each participant received nutrition counseling by a nutritionist weekly. The results showed significant differences in body mass index, blood pressure, total cholesterol, triglyceride, and leptin or adiponectin over time within the group, but not between the groups. This study could not exclude the effect of placebo and dietary consultation. Further study that adds a control group receiving no treatment is therefore needed to confirm the effects of auricular acupressure. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the validity of the Chinese version of the CogState battery, a computerised cognitive testing among patients with heart failure in Taiwan. Background Cognitive deficits are common in patients with heart failure and a validated Chinese measurement is required for assessing cognitive change for this population. The CogState computerised battery is a measurement of cognitive function and has been validated in many languages, but not Chinese. Design A cross-sectional study. Methods A convenience sample consisted of 76 women with heart failure and 64 healthy women in northern Taiwan. Women completed the Chinese version of the CogState battery and the Montreal Cognitive Assessment. Construct validity of the Chinese version of the battery was evaluated by exploratory factor analysis and known-group comparisons. Convergent validity of the CogState tasks was examined by Pearson correlation coefficients. Results Principal components factor analysis with promax rotation showed two factors reflecting the speed and memory dimensions of the tests. Scores for CogState battery tasks showed significant differences between the heart failure and healthy control group. Examination of convergent validity of the CogState found a significant association with the Montreal Cognitive Assessment. Conclusion The Chinese CogState Battery has satisfactory construct and convergent validity to measure cognitive deficits in patients with heart failure in Taiwan. Relevance to clinical practice The Chinese CogState battery is a valid instrument for detecting cognitive deficits that may be subtle in the early stages, and identifying changes that provide insights into patients' abilities to implement treatment accurately and consistently. Better interventions tailored to the needs of the cognitive impaired population can be developed. [ABSTRACT FROM AUTHOR]

Background. An uneven neurocognitive profile is a hallmark of autism spectrum disorder (ASD). Studies focusing on the visual memory performance in ASD have shown controversial results. We investigated visual memory and sustained attention in youths with ASD and typically developing (TD) youths. Method. We recruited 143 pairs of youths with ASD (males 93.7%; mean age 13.1, S.D. 3.5 years) and age- and sexmatched TD youths. The ASD group consisted of 67 youths with autistic disorder (autism) and 76 with Asperger's disorder (AS) based on the DSM-IV criteria. They were assessed using the Cambridge Neuropsychological Test Automated Battery involving the visual memory [spatial recognition memory (SRM), delayed matching to sample (DMS), paired associates learning (PAL)] and sustained attention (rapid visual information processing; RVP). Results. Youths with ASD performed significantly worse than TD youths on most of the tasks; the significance disappeared in the superior intelligence quotient (IQ) subgroup. The response latency on the tasks did not differ between the ASD and TD groups. Age had significant main effects on SRM, DMS, RVP and part of PAL tasks and had an interaction with diagnosis in DMS and RVP performance. There was no significant difference between autism and AS on visual tasks. Conclusions. Our findings implied that youths with ASD had a wide range of visual memory and sustained attention impairment that was moderated by age and IQ, which supports temporal and frontal lobe dysfunction in ASD. The lack of difference between autism and AS implies that visual memory and sustained attention cannot distinguish these two ASD subtypes, which supports DSM-5 ASD criteria. [ABSTRACT FROM AUTHOR]

BackgroundSchizophrenia patients have higher rates of minor physical anomalies (MPAs) than controls, particularly in the craniofacial region; this difference lends support to the neurodevelopmental model of schizophrenia. Whether MPAs are associated with treatment response in schizophrenia remains unknown. The aim of this case–control study was to investigate whether more MPAs and specific quantitative craniofacial features in patients with schizophrenia are associated with operationally defined treatment resistance.MethodA comprehensive scale, consisting of both qualitatively measured MPAs and quantitative measurements of the head and face, was applied in 108 patients with treatment-resistant schizophrenia (TRS) and in 104 non-TRS patients. Treatment resistance was determined according to the criteria proposed by Conley & Kelly (2001; Biological Psychiatry 50, 898–911).ResultsOur results revealed that patients with TRS had higher MPA scores in the mouth region than non-TRS patients, and the two groups also differed in four quantitative measurements (facial width, lower facial height, facial height, and length of the philtrum), after controlling for multiple comparisons using the false discovery rate. Among these dysmorphological measurements, three MPA item types (mouth MPA score, facial width, and lower facial height) and earlier disease onset were further demonstrated to have good discriminant validity in distinguishing TRS from non-TRS patients in a multivariable logistic regression analysis, with an area under the curve of 0.84 and a generalized R2 of 0.32.ConclusionsThese findings suggest that certain MPAs and craniofacial features may serve as useful markers for identifying TRS at early stages of the illness. [ABSTRACT FROM AUTHOR]

Aims and objectives We assessed the effects of a spinal cord injury home rehabilitation DVD on patients with spinal cord injury. Background Multimedia have been used widely in health care in the digital age. The provision of rehabilitation instructions is a major responsibility of the rehabilitation staff. Design This study adopted a quasi-experimental pretest-posttest control group design. Methods We collected data from a rehabilitation nursing ward at a medical centre between October 2011-April 2012. The participants were recruited before being discharged from the hospital. The experimental group ( n = 28) received multimedia DVD instructions for three months, in addition to teaching sessions conducted by the researcher, whereas the control group ( n = 31) received instructions without a DVD. Both groups completed the self-perception and self-efficacy scales used in this study before and after the intervention. Results The results indicated that, after the multimedia DVD intervention, the experimental group exhibited a considerably greater improvement in self-perception than did the control group. Although we recorded increased scores for both self-perception and self-efficacy for both groups, no marked differences emerged between the control and the intervention groups by using a generalised estimating equation. Conclusion These results suggest that the home rehabilitation DVD is an effective instrument for improving self-perception and self-efficacy in patients with spinal cord injury. However, monitoring these patients over the long term is necessary. Relevance to clinical practice Our study results confirmed that the spinal cord injury home rehabilitation DVD is a practical health education tool. We plan to use the proposed DVD intervention with a larger number of hospitalised patients, and to continuously monitor their improvement. [ABSTRACT FROM AUTHOR]

Students' creativity is an important focus globally and is interrelated with students' spatial abilities. Additionally, three-dimensional computer-assisted drawing (3 D-CAD) overcomes barriers to spatial expression during the creative design process. Does 3 D-CAD affect students' creative abilities? The purpose of this study was to explore the auxiliary effects of 3 D-CAD applications on students' creative design capabilities and on students with different spatial abilities. A total of 349 students from a public senior high school in Taoyuan County, Taiwan, participated in the study. The study used a non-equivalent pretest and post-test quasi-experimental design. The key results from the study include the following: (1) students' spatial abilities were moderately correlated with their creative performance, especially their functional creativity; (2) the 3 D-CAD applications enhanced students' creative performance, particularly with regard to aesthetics; and (3) in 3 D-CAD applications, students with better spatial abilities were superior to those with relatively poor spatial abilities with regard to creative performance. Additionally, the effect sizes of novelty and aesthetics were stronger than that of functionality. [ABSTRACT FROM AUTHOR]

In this study, we developed a digital game-based learning (DGBL) system, called the ToES, to foster students' creativity. Fifty-one fifth-grade students from two classes in a public school in Taipei, Taiwan, were recruited and consented to participate. Both classes consisted of students with mixed abilities studying a foundation unit entitled "Electrical Science" in a natural science course. One class was chosen to be the experimental group (EG) and the other class was the control group (CG). The goal of this study was to examine how different instructional strategies (i.e., traditional instruction and instruction using digital games) affected the students' creativity and their performance on manual skills. The analytical results indicated that the students' creativity and their performance on manual skills displayed positive growth when they were involved in acquiring knowledge and resolving tasks in a DGBL environment, which fostered their creativity and facilitated the generation of flow experiences. Moreover, there were three interesting findings related to the use of DGBL: (1) the ToES was an effective learning tool for cultivating the students' creativity; (2) there was a positive effect of creativity and their performance of manual skills; and (3) the ToES accelerated the improvement of practical behaviors regarding manual skills. [ABSTRACT FROM AUTHOR]

Improving students' reading comprehension is of significance. In this study, collaborative learning supported by Group Scribbles ( GS), a networked technology, was integrated into a primary reading class. Forty-seven 10-year-old students from two 4th grade classes participated in the study. Experimental and control groups were established to investigate the effectiveness of GS-supported collaborative learning in enhancing students' reading comprehension. The results affirmed the effectiveness of the intervention designed. In the experiment group, students' learning attitudes, motivation and interest were enhanced as well. Further analyses were done to probe students' interaction processes in the networked collaborative classroom and different collaboration patterns and behaviours were identified. Based on the findings obtained, implications for future learning design to empower L1 learning were elaborated. [ABSTRACT FROM AUTHOR]

Background: We evaluated the effectiveness of a transtheoretical model (TTM)-based passive smoking prevention programme developed to enhance passive smoking avoidance among pregnant women and women with young children in Taiwan. Methods: Subjects were pregnant women recruited from the obstetrics/gynaecology department and women with children younger than age 3 recruited from the paediatrics department of four hospitals in Taiwan. Participants were randomly assigned to a group receiving a TTM-based intervention programme or a comparison group receiving routine care. The intervention programme consisted of educational materials and phone counselling. Baseline assessment and post-test data were collected from both groups using a self-reported questionnaire developed based on stages of change related to readiness for passive smoking avoidance. Results: Determinants of change, post-test scores of knowledge, experiential and behavioural processes and self-efficacy were significantly different between the intervention group and comparison group among both pregnant women and mothers. Among pregnant women, the intervention group had significantly higher post-test scores than the comparison group. The distribution of percentages in three stages of change (Precontemplation, Contemplation/Preparation and Action/Maintenance) was significantly different between the two groups among both pregnant women and mothers. However, a higher percentage of mothers made progress in stages of change compared with pregnant women. Conclusion: A TTM-based intervention programme was potentially effective in passive smoking prevention by improving knowledge, experiential and behavioural processes and self-efficacy among pregnant women and women with young children. A higher percentage of mothers with young children had progressed in stages of change post-intervention compared with pregnant women. [ABSTRACT FROM AUTHOR]

Many studies of bribery acknowledge the important role of bribe-givers, but their true motives remain unclear. We propose that the likelihood of bribery depends on the willingness of an organization to affiliate with local parties or to be successful in a host country, or to have power over local parties. We further argue that different opportunities, either pervasive or arbitrary, facilitate different types of motives that affect the likelihood of bribery. In addition, we investigate the effect of perceived fairness on the likelihood of bribery. We employ a 3 (motives: affiliation vs. achievement vs. power) × 2 (opportunities: pervasiveness vs. arbitrariness) × 2 (perceived fairness: high vs. low) factorial design in experimental settings among Executive MBA students in southern Taiwan. Our findings indicate that, when companies perceive a higher level of distributive fairness, high-achieving organizations are more likely to offer a bribe when the condition is pervasive. When they have a powerful motive, arbitrariness engenders a higher likelihood of bribery. When they perceive less distributive fairness, there are no significant differences between motive and opportunity. [ABSTRACT FROM PUBLISHER]

In this study, we aimed to determine commonalities and differences in physical conditions and depressive symptoms of Chinese postpartum mothers in the United States and Taiwan, and whether their relationship differs by country. Data from 151 Chinese mothers in the United States and 238 Taiwanese mothers were analyzed. A physical health condition checklist and the Center for Epidemiologic Studies Depression (CESD) scale were used. More Taiwanese mothers experienced depression. Depression scores were correlated with physical conditions. Over 50% of mothers with depression experienced physical exhaustion, sleep disturbances, interrupted sleep, and decreases in memory. Active assessments and cultural care for managing physical conditions may prevent postpartum depression. [ABSTRACT FROM AUTHOR]

Aims and objectives To delineate the trajectories of functional status over four time points and to examine predictors of functional decline ( FD) in hospitalised older patients. Background About 30-60% of the older patients develop new dependence in activities of daily living ( ADL) during a hospital stay, which results in progressive disability after discharge. The functional trajectories and risk factors of FD among hospitalised older patients require identification. Design A cohort study. Methods The study consecutively recruited 273 patients aged 65 and older admitted to a medical centre in southern Taiwan. Functional trajectory, by ADL score, was observed at four time points: two weeks before admission, admission, discharge and three months after discharge. The ADL score two weeks before admission was used as a baseline functional status. Results Eighty-three (30·4%) patients experienced FD at three months after discharge. Functional trajectory as shown by ADL scores indicated that all 273 patients dropped steeply at admission and that two-thirds were gradually restored three months after discharge. Logistic regression revealed that the number of falls in the past year, Instrument Activities of Daily Living (IADL) status before admission, comorbidity and ADL decline between preadmission and discharge were significant predictors of FD three months after discharge. The ADL score decline during hospitalisation was the mediator of FD three months after discharge. Conclusions Findings indicate that the ADL function of those hospitalised older patients who reported having fallen more often in the previous year had more comorbidity, had a lower IADL score, and had more ADL score decline before admission and discharge would continue to decline after discharge. Relevance to clinical practice Clinical nurses can integrate the finding of this study with Comprehensive Geriatric Assessment to tailor intervention to restore older patient's physical function during hospitalisation. [ABSTRACT FROM AUTHOR]

Aims Inadequate self-control has been linked to behavioural and impulse-control problems such as overeating, alcohol and drug abuse and smoking. Construal-level theory ( CLT) suggests that a high-level construal (highlighting central goals associated with an event), relative to a low-level construal (highlighting means and resources), promotes self-control. Inspired by CLT, we examined whether smokers primed with a high-level (versus low-level) construal mind-set would show reductions in smoking that might be mediated by improved self-control. Design A single-factor (construal level: high, low, control) between-subjects design was employed. We used a widely employed why/how paradigm to induce high/low construal levels, whereby participants were asked to respond to questions about 'why' or 'how' they would maintain good physical health. Setting Laboratory at Kaohsiung Medical University, Taiwan. Participants A community sample consisting of 102 daily smokers participated in this experiment. Measurements The Stroop task measuring self-control was implemented after the construal-level manipulation. The dependent measure was actual cigarette consumption during an ostensible survey. Findings Participants in a high-level construal mind-set smoked fewer cigarettes [mean = 1.3, 95% confidence interval ( CI): 0.9, 1.7] than those in a low-level construal mind-set (mean = 2.6, 95% CI: 2.2, 3.0; P < 0.01). A bootstrapping analysis supported for the role of self-control ( B = −1.14, 95% CI: −1.65, −0.74, P < 0.01) as a mechanism underlying this effect. Conclusions Smokers primed with a high-level construal mind-set (i.e. cognitive abstraction) may induce greater self-control that leads to reduced cigarette consumption. Thus, reminding smokers to think abstractly about health may be an effective strategy that could help them to smoke fewer cigarettes. [ABSTRACT FROM AUTHOR]

Summary: The 12-week home-based virtual cycling training (hVCT) improved lower limb muscle strength and areal bone mineral density (aBMD) than the control program in children with cerebral palsy (CP). A muscle strengthening program, rather than general physical activity, is more specific in enhancing aBMD for these children. A novel hVCT is an effective and efficient strategy that enhances lower limb bone density in these children. Introduction: This is the first study to assess the efficacy of a novel hVCT program on bone density for children with spastic CP using a well-designed randomized controlled trial. Methods: Twenty-seven ambulatory children with spastic CP, aged 6-12 years, were randomly assigned to the hVCT group ( n = 13) or control group ( n = 14). Outcome measures-motor function [Gross Motor Function Measure-66 (GMFM-66)], muscle strength (curl up scores and isokinetic torque of knee extensor and flexor muscle) and aBMD of the lumbar and distal femur-were administered before and immediately after the 12-week intervention. Results: Analysis of covariance results show that the hVCT group had greater distal femur aBMD and isokinetic torques of knee extensor and flexor muscles than the control group at posttreatment ( p < 0.05). However, curl up scores, GMFM-66, and lumbar aBMD at posttreatment did not differ between the two groups. Conclusions: Analytical findings suggest that the muscle strengthening program is more specific in enhancing bone density for children with CP than general physical activity. Thus, the proposed 12-week hVCT protocol is an effective and efficient strategy for improving lower limb aBMD in these children. [ABSTRACT FROM AUTHOR]

yeh p.-m. & chang y. (2012) Family carer reactions and their related factors among Taiwanese with hospitalized relatives. Journal of Advanced Nursing 68(10), 2195-2206. Abstract Aim. The purpose of this study was to examine the relationships among family carer reactions and their related factors among Taiwanese with hospitalized relatives. Background. In Taiwan, most hospitalized patients have relatives or foreign labourers with them 24 hours a day. Limited research has focused on the reactions of family members who provide care for hospitalized relatives. Methods. A cross-sectional, correlation design was used. A convenience sample of 200 primary carers of hospitalized patients diagnosed with cancer, stroke, and enduring illness was recruited between 2009 and 2010. Data were collected by structured questionnaires. Results. The findings indicate that participants with a moderate level of family support experienced a moderate impact on health and finances, but a high impact on schedule. Family carers' health status and work time were significantly different between, before and after serving as a carer. The multiple regression model variables accounted for 40·1% of the total family carer reaction variance. Three factors were found to predict significantly greater impact on a family carer: (1) lower scores of caregiving knowledge, (2) increasing patient's activities of daily living dependency and (3) lack of family support. Conclusion. It is vital for nurses not only to assess patients' activities of daily living, but also to assess family carers' knowledge of caregiving and the patient's existing family support in developing a plan of care that reduces negative impact on family carers. [ABSTRACT FROM AUTHOR]

Aim. To study the effect of an intervention combining self-efficacy theory and pedometers on promoting physical activity among adolescents. Background. The beneficial effects of regular physical activity on health in youths are well-documented. However, adolescence is found to be the age of greatest decline in physical activity participation. Physical activity participation among girls was generally less frequent and less intense than boys. Therefore, there is a strong need for effective interventions that can help promote physical activity in this population. Design. An experimental design. Methods. Two classes of female junior college students (mean age = 16) were randomly sampled from a total of four classes and, of those, one each was randomly assigned to either the intervention ( n = 46) or the control group ( n = 48). Self-efficacy was used as a core theoretical foundation of the intervention design, and pedometers were provided to the students in the intervention group. Distances between each domestic scenic spot were illustrated graphically in a walking log for students to mark the extent of their walking or running. Students in the control group participated in a usual physical education programme. The primary outcome was a change in the number of aerobic steps. The secondary outcomes were changes in cardiopulmonary endurance and exercise self-efficacy. Results. At 12-week follow-up, the mean change in aerobic steps was 371 steps and 108 steps in the intervention and control group, respectively. The difference in mean change between the two groups was 467 steps. Effects of the intervention on changes of cardiopulmonary endurance and perceived exercise self-efficacy scores were not found. Conclusions. Among adolescent girls, a 12-week intervention designed on the theoretical foundation of self-efficacy theory and provision of pedometers was found to have an effect on increasing their physical activity. The intervention, using graphs of domestic scenic spots to represent the distance of walking or running as monitored by pedometers, might enhance motivation regarding physical activity. Relevance to clinical practice. It is important for health professionals, including school health nurses, involved in the care of adolescent health, to design and provide a physical activity intervention combining self-efficacy theory and provision of pedometer to promote physical activity. [ABSTRACT FROM AUTHOR]

Aim. To evaluate the effectiveness of self-management intervention for people with diabetes mellitus. Background. Enhancing self-efficacy and improving health quality of life for persons with diabetes are ongoing challenges for health care providers. There currently is a need to develop and test the effects of a self-management programme. Design. A quasi-experimental design. Method. The study was carried out in the outpatient clinic of a municipal hospital in Taipei. Patients aged 30 and over with type 2 diabetes and an oral medication regimen were recruited. One hundred and forty-five participants completed the six-month post-treatment assessments (72 in the intervention group and 73 in the control group). Both control and intervention groups received a standard diabetic educational programme. The self-management intervention is to improve psychosocial skills or addressing attitudes and beliefs specific to diabetes or the regimen behaviours. The intervention group received the following additional interventions: (1) a diabetic booklet (2) DVD viewing (3) four counselling sessions (4) and a telephone follow-up. The main outcome measures were Short Form 12 for health-related quality of life, the Medical Outcomes Study Social Support scale and the Center for Epidemiology Studies Short Depression Scale. Results. The scores for social support were significantly increased in the intervention group at Time 2 and Time 3 (three and six months from commencement of the intervention) compared with those of the control group ( p < 0·01), whereas health-related quality of life and depression were not significantly different. Conclusions. The diabetic self-management intervention programme improved social support for participants, but future studies are needed. Replication of this study in various settings, with other populations, or with additional outcome measures may result in different findings. Relevance to clinical practice. Self-management programmes should be held regularly and evaluated in clinical practices, especially in developing countries. Providing practical screening tools and conducting psychological research on diabetes drive policy and health care system change. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the effects of concept mapping in developing critical thinking ability and approach to learning and studying. A quasi-experimental study design with a purposive sample was drawn from a group of nursing students enrolled in a medical-surgical nursing course in central Taiwan. Students in the experimental group were taught to use concept mapping in their Learning. Students in the control group were taught by means of traditional lectures. After the intervention, the experimental group had better overall critical thinking scores than did the control group, although the difference was not statistically significant. After controlling for the effects of age and the pretest score on critical thinking using analysis of covariance, the experimental group had significantly higher adjusted mean scores on inference and overall critical thinking compared with the control group. Concept mapping is an effective tool for improving students' ability to think critically. [ABSTRACT FROM AUTHOR]

To determine the effect of music therapy and verbal relaxation on state anxiety and anxiety-induced physiological manifestations among patients with cancer before and after chemotherapy. Cancer and its treatment provoke a series of changes in the emotional sphere of the patient's anxiety. Music therapy and verbal relaxation had reported the anxiety reduction effect on patients with cancer receiving chemotherapy. Few studies have been undertaken comparing music therapy and verbal relaxation in differentiating high-normal state anxiety subsample. A randomised controlled trial and permuted block design were used. Outpatient chemotherapy clinic operated by a University medical centre in southern Taiwan. Ninety-eight patients were randomised into three groups: the music therapy group received one-hour single music session; the verbal relaxation group received 30 minutes of guided relaxation; the control group received usual care. Spielberger State-Trait Anxiety Instrument, Emotional Visual Analog Scale, three biobehavioural indicators: skin temperature, heart rate and consciousness level were measured during and after chemotherapy. Music therapy had a greater positive effect on postchemotherapy anxiety than verbal relaxation and control groups and a significantly increase in skin temperature. Patients with high state anxiety receiving music therapy had a greater drop in postchemotherapy anxiety than did the normal state anxiety subsample. Both music and verbal relaxation therapy are effective in reducing chemotherapy-induced anxiety. Thirty minutes of intervention initiates anxiety reduction. Patients with high state anxiety receiving chemotherapy obtain the most benefit from music or verbal relaxation. Prior to chemotherapy, patients with high state anxiety must be sorted from all patients as they are more responsive to interventions. Oncology nurses can offer music and verbal relaxation as adjuvant interventions to reduce chemotherapy-induced anxiety and enhance the quality of care. [ABSTRACT FROM AUTHOR]

This research investigated how differently elementary school students participate in synchronous online collaborative learning by analysing their discussions with their partners. Two hundred and seventy-eight Taiwanese students, ranging in age from 11 to 12 years old, were involved in this study. The students were randomly arranged within-class into three-member groups. Each group used a collaborative learning system to discuss and accomplish a group assignment (creating a shared concept map). The textual discussions by each individual student were collected, categorised and accumulated. Cluster analysis was adopted to statistically classify students based on their discussion characteristics. We found that a student, while participating in online collaboration and communication, exhibited a distinct style: less contributing, coordination emphasising, communicative or task-oriented. In addition, students exhibiting the task-oriented pattern and students predominantly showing communicative behaviours were found to have better learning performance and retain more knowledge than students observed to be coordination emphasising or less contributing within group collaboration. [ABSTRACT FROM AUTHOR]

Background: A father who does not know how to assist the mother in relieving labor pains may experience a sense of powerlessness and anxiety. The objective of this study was to evaluate how an education program for expectant fathers who attended their partners' labor and birth affected their anxiety. Methods: In a randomized controlled trial, 87 expectant fathers who attended their pregnant partners through labor and birth at a hospital in central Taiwan were allocated by block randomization to an experimental (n = 45) and a control (n = 42) group. The men completed their basic personal information, a childbirth expectations questionnaire, and a Trait Anxiety Inventory when they were recruited. Two hours after birth of their child, all the expectant fathers completed a State of Anxiety Inventory. Results: Our results showed no statistically significant differences between the experimental and control groups of fathers in trait anxiety and their prenatal childbirth expectations. After analysis of covariance ( ANCOVA) was applied to correct for education level, sources of childbirth information, attendance at Lamaze childbirth classes, and childbirth expectations at baseline, the effect of the childbirth program was significant for the postnatal level of anxiety (F = 3.38, p = 0.001). Conclusions: The study findings justify the clinical implementation of a birth education program based on the self-efficacy theory as an effective means of reducing anxiety among expectant fathers. [ABSTRACT FROM AUTHOR]