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This study aimed to evaluate the effects of a media literacy education intervention on adolescents’ responses to digital marketing of weight-control products, focusing on media literacy, persuasion resistance efficacy, and purchase intention. Using a quasi-experimental design, the study involved 326 11th-grade students from a municipal high school in Kaohsiung City, Taiwan, with 189 students in the intervention group and 137 in the comparison group. Conducted in 2023, the intervention group participated in baseline and follow-up assessments and attended four 50 min media literacy sessions, while the comparison group completed only baseline and follow-up assessments with standard instruction. The results indicated that the media literacy intervention had positive effects on adolescents’ conceptual, attitudinal, and critical media literacy, as well as their persuasion resistance efficacy in relation to digital marketing of weight-control products. However, no significant effect was observed on purchase intention. In conclusion, media literacy interventions can effectively enhance adolescents’ media literacy and their ability to resist persuasion.

[This corrects the article DOI: 10.1371/journal.pone.0278290.].

In this study, we examined the relationships between the use of online dating applications (apps), online victimization, and psychosocial distress among adolescents. This study was conducted in 2020. A sample of 2595 seventh-grade students from 30 Taiwanese middle schools was surveyed. We conducted a self-administered survey. Overall, 15% of the adolescents reported using online dating apps in the past year, while 78% reported having seen dating app advertisements on the internet in the past year. Multivariate analysis results indicated that adolescents’ exposure to the marketing of dating apps and poor academic performance were both associated with the use of online dating apps. Adolescents who used dating apps were more likely to experience online privacy victimization, cyberbullying victimization, and online sexual harassment. The use of dating apps by adolescents, online privacy victimization, cyberbullying victimization, and online sexual harassment were associated with higher levels of depression, anxiety, and stress. In conclusion, adolescent use of dating apps is related to online victimization and psychological distress.

Abstract Background Nurses must have spiritual competence to provide holistic patient care. Therefore, the designed instrument to assess nurses’ competence could be a practical guide for health care professionals. This study aimed to evaluate the validity and reliability of the spiritual care competency scale (SCCS) for oncology nurses in Taiwan. Methods This study used a convenience sample from a regional teaching hospital in Taiwan from November 2017 to February 2019, who were asked to complete the SCCS. We employed scale-content validity index (S-CVI). Exploratory Factor Analysis (EFA) was also used to evaluate the structural factor of SCCS. Confirmatory Factor Analysis (CFA) verified the construct validity of SCCS scale for oncology nurses in Taiwan. Test–retest reliability were also measured in this study at 2-week interval. Results The average S-CVI of SCCS was 0.96. The EFA produced four factors of 27 items, such as professionalization, improving the quality of spiritual care, personal support, patient counseling and referral, attitude towards patient spirituality and communication, assessment, implementation providing and evaluation of spiritual care. Fitting the 27 items yielded an acceptable model fit; X2/df = 2.41, RMSEA = 0.08, GFI = 0.80, AGFI = 0.80, CFI = 0.92, IFI = 0.92, NFI = 0.90, RFI = 0.90, TLI = 0.91, SRMR = 0.06. Cronbach’s alpha values were between 0.93 and 0.95, and the total Cronbach’s alpha was 0.96. The intraclass correlation coefficient (ICC) scores were between 0.43 and 0.88. Conclusions The result of this study demonstrated satisfactory validity and reliability for the SCCS in the nursing field in Taiwan. Implications for practice in this study serves as a reference for effectively evaluating nursing competency in spiritual care.

In this study, we examined influencer marketing and consumption of non-alcoholic beer by adolescents to determine how these factors could affect the intentions of adolescents to purchase and drink alcohol. A total of 3121 high-school students recruited from 36 schools in Taiwan completed a self-administered questionnaire during the COVID-19 pandemic in 2022. The results indicate that 19% of these adolescents consumed non-alcoholic beer and 28% consumed alcohol in the past year. Multivariate analysis positively associated adolescents’ exposure to influencer marketing with their purchase and consumption of non-alcoholic beer. Adolescents’ exposure to influencer marketing of non-alcoholic beer combined with lower levels of parental restrictive mediation was associated with increased odds of the purchase and consumption of alcohol. For individuals who did not purchase alcohol in the past year, both the exposure to influencer marketing and the consumption of non-alcoholic beer were associated with intending to purchase alcohol in the future. Similarly, individuals who previously abstained from the consumption of alcohol, both the exposure to influencer marketing and the consumption of non-alcoholic beer were associated with intending to consume alcohol. In conclusion, when adolescents were exposed to influencer marketing of non-alcoholic beer they were more likely to consume it, which resulted in an increased likelihood that they would then purchase and consume alcohol.

This study examined the relationships between children's mobile gaming preferences, online risks, and mental health. Data were obtained from a sample of 2,702 third and fourth grade students from 16 elementary schools in Taiwan and 9 schools in China. A self-administered questionnaire was used. The mental state of the children who participated in the study was assessed using the Strengths and Difficulties Questionnaire (SDQ), while mobile gaming addiction was assessed using the short form of the Internet Gaming Disorders Scale (IGDS9-SF). The results showed that about 54% of children played mobile games with others (multi-player), while 31% played mobile games alone, and 15% did not play mobile games. Multiple logistic regression results indicated that behaviors such as participating in multi-player games, playing violent games, a poor parent-child relationship, and living in a rural area were associated with a greater risk of mobile gaming addiction. Involvement in multi-player games, playing violent games, mobile gaming addiction, and exposure to mobile violence/pornography were associated with greater risks of cyber aggression/victimization. Multiple regression results showed that being a multi-player, playing violent games, mobile gaming addiction, exposure to violence/pornography, exposure to cyber aggression/victimization, and having a poor parent-child relationship were associated with emotional and behavioral problems.

Background: Gout is triggered by high urate levels and causes inflammation, pain, and an impaired quality of life. Immersion in water at 20-30°C reduces inflammation and pain in arthritis. Yet, relationships of immersion in water at 20-30°C with urate levels and the nucleotide-binding domain (NOD)-like receptor protein 1 (NLRP1) inflammasome have never been clarified. Objectives: We aimed to investigate the effects of immersion in water at 20-30°C on urate levels, the NLRP1 inflammasome, pain, and quality of life among acute gout patients. Methods: A community-based randomized control trial design was used with 2 parallel-intervention groups: immersion in water at 20-30°C (20 min/day for 4 weeks) group and a control group. In total, 76 eligible participants in Tomohon City, Indonesia, were assigned using block randomization. We analyze the results (coef. ß) and 95% confidence intervals (CIs) using a generalized estimating equation model. We analyzed mediating effects using a path analysis. Results: Significant pain alleviation (ß = -2.06 [95% CI = -2.67~-1.45]; ß = -2.42 [95% CI = -2.97~-1.87]) and improved quality of life (ß = 5.34 [95% CI = 3.12-7.57]; ß = 9.93 [95% CI = 7.02-12.83]) were detected at 2 and 4 weeks of follow-up compared to the pre-test and control group. Urate levels (ß = -0.34 [95% CI = -0.52~-0.16]) were reduced at the 2-week follow-up, but there was no significant change in the NLRP1 inflammasome compared to the pre-test and control group after immersion in water at 20-30°C. Both the NLRP1 inflammasome (ß = -0.48 [95% CI = -0.63~-0.34]); water 0.01) and urate levels (ß = -0.11 [95% CI = -0.24~-0.03]; p < 0.01) had partial indirect (mediating) effects on the link between immersion in water at 20-30°C and pain at the 4-week follow-up. Conclusions: Immersion in water at 20-30°C significantly decreased pain and increased the quality of life. Immersion in water at 20-30°C mediated NLRP1 and urate levels to decrease pain, although it had no significant effect on the NLRP1 inflammasome concentration after 4 weeks of follow-up and reduced urate levels only at 2 weeks after immersion in water at 20-30°C. [ABSTRACT FROM AUTHOR]

Background: Suicide is an important public health issue worldwide. Suicidal behavior in the elderly population represents a huge potential burden on national health care systems and economies, as the average lifespan has increased significantly in most countries in recent decades. The purpose of this study is to explore the relationship between nursing care and the overall suicide rate in the elderly. Methods: We used a fixed-effect model to analyze panel data comprising suicide-related events in Taiwan from 2001 to 2009. Two data sets provided by the Taiwan Department of Health of the Executive Yuan, Taiwan, and the Taiwan Demographic Fact Book produced by the Taiwan Ministry of the Interior were used. Death by suicide was defined as those coded E950-E958 according to the International Classification of Disease, Ninth Revision (ICD-9). These data comprised a longitudinal population-based survey of a nationwide sample of 23, 224, 912 residents. Results: Our study suggests that suicides in the elderly can be prevented with medical care offered by nurses. Our findings show that increasing the number of nursing staff reduced suicidal ideation in older adults. Although the results regarding elderly male suicides were not statistically significant, elderly female suicides were found to be significantly reduced. Conclusion: This study concluded that it is possible to reduce this public health issue and decrease the associated national financial burden by increasing the nursing workforce.

BACKGROUND:We identified rs17071138 T/C, rs3744941 C/T, and rs8089104 T/C gene polymorphisms of SERPINB5 (mammary serine protease inhibitor) that are specific to patients with oral cancer susceptibility and their clinicopathological status. METHODOLOGY/PRINCIPAL FINDINGS:In total, 1342 participants, including 601 healthy controls and 741 patients with oral cancer, were recruited for this study. Allelic discrimination of rs17071138 T/C, rs3744941 C/T, and rs8089104 T/C of the SERPINB5 gene was assessed by a real-time PCR with a TaqMan assay. We found that individuals carrying the polymorphic rs17071138 and rs8089104 are more susceptible to oral cancer (OR, 1.57; 95% CI, 1.07~2.31 and OR, 1.58; 95% CI, 1.04~2.39, respectively). Among oral cancer-related risk factor exposures, the individuals carrying the polymorphic rs17071138 had 4.26- (95% CI: 1.65~11.01; p = 0.002), 2.34- (95% CI: 1.19~4.61; p = 0.01), and 2.34-fold (95% CI: 1.38~3.96; p = 0.001) higher risks of developing oral cancer. CONCLUSIONS:Heterozygous TC of the SERPINB5 rs17071138 polymorphism may be a factor that increases susceptibility to oral cancer. Interactions of gene-to-gene and gene-to-oral cancer-related environmental risk factors have a synergetic effect that can further enhance oral cancer development.

OBJECTIVES:The purpose of this study was to assess relationships among periodontal conditions, salivary antioxidant levels, and patients' satisfaction with their prostheses. METHODS:This study was conducted at the Division of Prosthodontics, Department of Dentistry, Taipei Medical University Hospital. The periodontal condition of patients was based on an assessment of the plaque index (PI) and gingival index (GI). The pH value, flow rate, and buffer capacity of the saliva were estimated. The salivary total antioxidant status (TAS) and superoxide dismutase (SOD) level were also determined. Patients' satisfaction with prosthetic treatments was evaluated using the Chinese version of the short-form Oral Health Impact Profile (OHIP-14C). A multivariate regression model was used to determine whether patients' satisfaction with prosthetic treatment was affected by their oral health status. RESULTS:In total, 35 edentulous patients were recruited. In the Spearman correlation analysis, salivary pH (r = -0.36, p = 0.03) and the buffer ability (r = -0.48, p

The purpose of this study was to identify gene polymorphisms of mammary serine protease inhibitor (Maspin) specific to patients with oral cancer susceptibility and clinicopathological status.Three single-nucleotide polymorphisms (SNPs) of the Maspin gene from 741 patients with oral cancer and 601 non-cancer controls were analyzed by real-time PCR. The participants with G/G homozygotes or with G/C heterozygotes of Maspin rs2289520 polymorphism had a 2.07-fold (p = 0.01) and a 2.01-fold (p = 0.02) risk of developing oral cancer compared to those with C/C homozygotes. Moreover, gene-gene interaction increased the risk of oral cancer susceptibility among subjects expose to oral cancer related risk factors, including areca, alcohol, and tobacco consumption.G allele of Maspin rs2289520 polymorphism may be a factor that increases the susceptibility to oral cancer. The interactions of gene to oral cancer-related environmental risk factors have a synergetic effect that can further enhance oral cancer development.

To develop and evaluate the psychometric properties of a Chinese Feeding Difficulty Index (Ch-FDI) which assesses feeding difficulties in people with dementia (PwD).Scale items were developed using literature review based on Model of Feeding Difficulty. Content validity was evaluated and items were modified by expert panel. Following translation and back-translation, the Ch-FDI was piloted on residents with dementia. The reliability was tested by inter-rater reliability and test-retest reliability. Internal reliability was established by calculating Cronbach's α coefficient. The concurrent validity was evaluated by correlating with similar scale, the Edinburgh Feeding Evaluation in Dementia (EdFED). The exploratory factor analysis (EFA) with varimax rotation and parallel analysis (PA) was performed to test construct validity.Participants were recruited from long-term care facilities in Taiwan. A total of 213 residents with dementia participated in this study during May, 2010 to February, 2011.Content validation, translation and psychometric testing were completed on the 19 items of the Ch-FDI. The translated scale was piloted on 213 residents with dementia of feeding difficulty who were recruited from eight long-term care facilities in Taiwan. The reliability was supported by the internal consistency of Cronbach's α of 0.68 and a test-retest coefficient of 0.85. The content validity, face validity, concurrent validity, and construct validity were used.The Ch-FDI is a newly developed scale with fair psychometric properties aimed to measure feeding difficulties among residents with dementia in long-term care facilities in Taiwan. Using this reliable and valid tool can help healthcare providers to assess feeding problems of PwD and provide feeding assistance in order to promote quality of care during mealtime in long-term care facilities.

An additional affiliation is missing for the first author. Chun-Yin Hou is also affiliated with the Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.By Chun-Yin Hou; Ru Rutherford; Hsi Chang; Fong-Ching Chang; Liu Shumei; Chiung-Hui Chiu; Ping-Hung Chen; Jeng-Tung Chiang; Nae-Fang Miao; Hung-Yi Chuang and Chie-Chien TsengReported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author [Extracted from the article]

ABSTRACT: This study compared consistency of age- and gender-specific self-reported height and weight and calculated body mass index among a sample of high school students in Taipei County, Taiwan to reference values for Taiwanese school-aged youth obtained through national studies. Taipei high school students provided self-reports of height and weight that were similar to national reference values. Use of self-reported height and weight in this sample appeared warranted and may reliably be used to calculate aggregate indices of body mass, overweight, and obesity. This study compared prevalence of overweight and obesity in the current sample with other adolescent populations using international criteria (International TaskForce on Obesity). Using these criteria, 17.6% of boys and 9.4% of girls met the definition of overweight and 3.7% of boys and 1.6% of girls met the definition of obesity. While use of self-reported height and weight appears justified in this sample, researchers should not assume self-report measures will always be accurate. Researchers considering use of self-reported height and weight should compare their results to normative reference values when possible to increase confidence in using self-report measures of height and weight. [ABSTRACT FROM AUTHOR]

Objective: This study examined the relationships between parental mediation and Internet addiction, and the connections to cyberbullying, substance use, and depression among adolescents. Method: The study involved 1808 junior high school students who completed a questionnaire in Taiwan in 2013. Results: Multiple logistic regression analysis results showed that adolescents who perceived lower levels of parental attachment were more likely to experience Internet addiction, cyberbullying, smoking, and depression, while adolescents who reported higher levels of parental restrictive mediation were less likely to experience Internet addiction or to engage in cyberbullying. Adolescent Internet addiction was associated with cyberbullying victimization/perpetration, smoking, consumption of alcohol, and depression. Conclusion: Internet addiction by adolescents was associated with cyberbullying, substance use and depression, while parental restrictive mediation was associated with reductions in adolescent Internet addiction and cyberbullying. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the level of suicide attempts in three school-based samples of Southeast Asian adolescents (Taipei, Taiwan; the Philippines; Chiang Mai, Thailand) and deter- mine whether adolescent suicide attempters score higher on measures of hopelessness and loneliness relative to nonattempters. It was hypothesized that hopelessness and loneliness would be related to suicide attempts, and that hopelessness would continue to be associated with suicide attempts when controlling for loneliness. The prevalence of suicide attempts across the three samples of Asian youth were not consistent with Taiwanese girls and boys as the most likely to have ever attempted suicide. As expected, results showed that suicide attempters (in past 12 months and ever) scored higher on hopelessness and loneliness than nonattempters across all three samples and for both genders. However, the statistical control of loneliness demonstrably weakened the association between suicide attempt behaviour and hopelessness across the samples and for both genders, and resulted in nonsignificant ANCOVA tests for some of the sample-gender groups. These results attest to the need for more research investigating connections between youth suicide attempts, hopelessness and loneliness in adolescent populations. Loneliness should be included as a potential determinant of youth suicidal behaviour in future research. [ABSTRACT FROM AUTHOR]

The relationship between physical activity and psychosocial discomfort was investigated among a sample of 2,665 high school students in Taipei, Taiwan. Results showed that both boys and girls who were physically inactive or engaged in infrequent physical activity scored higher than their more physically active counterparts on three measures of psychosocial discomfort--loneliness, shyness, and hopelessness. Results also showed that a high proportion of Taipei City and Taipei County high school students did not report frequent participation in vigorous physical activity and strengthening exercises. This study's findings are discussed in the context of implications for health education programs aimed at increasing physical activity in youth. Additionally, this study explores cross-national differences in loneliness, shyness, and hoplessness between this sample of adolescents and samples of adolescents in the United States and another Asian country. [ABSTRACT FROM AUTHOR]

Objectives: This study explores depression changes and influencing factors in middle-aged and older individuals, focusing on different cognitive function states. Methods: This cohort study uses panel data from seven waves of the nationally representative Taiwan Longitudinal Study on Aging (1996–2015) with 2344 participants aged 50 or above. Data analysis was conducted from 25 January 2023 to 4 May 2023. Results: Multivariate logistic regression analyzed three trajectories: maintained mood, progressive depression, and consistent depression. Protective factors for progressive depression included self-health perception, exercise, family satisfaction, and financial well being, while risk factors were chronic diseases, pain, substance use, and daily activity limitations. Cognitive function emerged as a significant protective factor, while pain exhibited the highest risk. In the cognitive dysfunction group, only social participation showed notable differences. Conclusion: Progressive and consistent depression in middle-aged and older people have aroused concern. In addition to necessary protection and risk factors, special attention should be paid to the risks posed by the level of pain. Addressing pain as a crucial risk factor is essential, particularly for middle-aged and older people with cognitive impairment and depression, necessitating targeted support. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects of a media literacy education intervention on adolescents' responses to digital marketing of weight-control products, focusing on media literacy, persuasion resistance efficacy, and purchase intention. Using a quasi-experimental design, the study involved 326 11th-grade students from a municipal high school in Kaohsiung City, Taiwan, with 189 students in the intervention group and 137 in the comparison group. Conducted in 2023, the intervention group participated in baseline and follow-up assessments and attended four 50 min media literacy sessions, while the comparison group completed only baseline and follow-up assessments with standard instruction. The results indicated that the media literacy intervention had positive effects on adolescents' conceptual, attitudinal, and critical media literacy, as well as their persuasion resistance efficacy in relation to digital marketing of weight-control products. However, no significant effect was observed on purchase intention. In conclusion, media literacy interventions can effectively enhance adolescents' media literacy and their ability to resist persuasion. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to explore plans, considerations and factors influencing long‐term care among older sexual minority (SM) women. Design: Qualitative interview study. Methods: Semi‐structured in‐depth interviews were conducted with 37 older Taiwanese SM women between May and September 2019. This study analysed interview data using a socio‐ecological model and constant comparative analysis. Results: The most frequently reported long‐term care plans were housing and institutions, private medical or long‐term care insurance, financial planning and medical decisions. Factors associated with women's long‐term care plans were categorized using the socio‐ecological model level: (1) intrapersonal factors: current physical and mental health status, ageing signs and women's attitudes towards ageing; (2) interpersonal‐level factors: receiving support from partners, child(ren), siblings or significant others, concerns about being a caregiver for parents and worries regarding social isolation; (3) community‐level factors: receiving support from lesbian, gay, bisexual and transgender (LGBT) organizations; private lesbian online groups; or religious groups; (4) societal‐level factors: concerns about negative social environments, concerns about the healthcare system and healthcare providers, inappropriate policies and insufficient resources. Conclusion: This study identified multi‐level factors related to long‐term care plans and concerns among older Taiwanese SM women. Recommendations for nurses, managers of long‐term care and healthcare settings, policymakers, and governments have been provided to diminish health disparities and reduce anxiety among older SM women. Impact: This study assists nurses in understanding older SM women's long‐term care concerns and worries when accessing long‐term care and healthcare services and helps nurses provide SM‐sensitive services and care for women. Patient or Public Contribution: SM older women were recruited from LGBT organizations, LGBT‐friendly bookstores, restaurants, coffee shops and LGBT online chatrooms using purposive and snowball sampling. [ABSTRACT FROM AUTHOR]

In this study, we examined the relationships between the use of online dating applications (apps), online victimization, and psychosocial distress among adolescents. This study was conducted in 2020. A sample of 2595 seventh-grade students from 30 Taiwanese middle schools was surveyed. We conducted a self-administered survey. Overall, 15% of the adolescents reported using online dating apps in the past year, while 78% reported having seen dating app advertisements on the internet in the past year. Multivariate analysis results indicated that adolescents' exposure to the marketing of dating apps and poor academic performance were both associated with the use of online dating apps. Adolescents who used dating apps were more likely to experience online privacy victimization, cyberbullying victimization, and online sexual harassment. The use of dating apps by adolescents, online privacy victimization, cyberbullying victimization, and online sexual harassment were associated with higher levels of depression, anxiety, and stress. In conclusion, adolescent use of dating apps is related to online victimization and psychological distress. [ABSTRACT FROM AUTHOR]

In this study, we examined influencer marketing and consumption of non-alcoholic beer by adolescents to determine how these factors could affect the intentions of adolescents to purchase and drink alcohol. A total of 3121 high-school students recruited from 36 schools in Taiwan completed a self-administered questionnaire during the COVID-19 pandemic in 2022. The results indicate that 19% of these adolescents consumed non-alcoholic beer and 28% consumed alcohol in the past year. Multivariate analysis positively associated adolescents' exposure to influencer marketing with their purchase and consumption of non-alcoholic beer. Adolescents' exposure to influencer marketing of non-alcoholic beer combined with lower levels of parental restrictive mediation was associated with increased odds of the purchase and consumption of alcohol. For individuals who did not purchase alcohol in the past year, both the exposure to influencer marketing and the consumption of non-alcoholic beer were associated with intending to purchase alcohol in the future. Similarly, individuals who previously abstained from the consumption of alcohol, both the exposure to influencer marketing and the consumption of non-alcoholic beer were associated with intending to consume alcohol. In conclusion, when adolescents were exposed to influencer marketing of non-alcoholic beer they were more likely to consume it, which resulted in an increased likelihood that they would then purchase and consume alcohol. [ABSTRACT FROM AUTHOR]

This study examined the relationships between children's mobile gaming preferences, online risks, and mental health. Data were obtained from a sample of 2,702 third and fourth grade students from 16 elementary schools in Taiwan and 9 schools in China. A self-administered questionnaire was used. The mental state of the children who participated in the study was assessed using the Strengths and Difficulties Questionnaire (SDQ), while mobile gaming addiction was assessed using the short form of the Internet Gaming Disorders Scale (IGDS9-SF). The results showed that about 54% of children played mobile games with others (multi-player), while 31% played mobile games alone, and 15% did not play mobile games. Multiple logistic regression results indicated that behaviors such as participating in multi-player games, playing violent games, a poor parent-child relationship, and living in a rural area were associated with a greater risk of mobile gaming addiction. Involvement in multi-player games, playing violent games, mobile gaming addiction, and exposure to mobile violence/pornography were associated with greater risks of cyber aggression/victimization. Multiple regression results showed that being a multi-player, playing violent games, mobile gaming addiction, exposure to violence/pornography, exposure to cyber aggression/victimization, and having a poor parent-child relationship were associated with emotional and behavioral problems. [ABSTRACT FROM AUTHOR]

Purpose: To examine suicide attempts and the influencing factors among Taiwanese lesbian, gay, bisexual, and transgender (LGBT) adults during the 2018 Taiwanese referendum on same‐sex issues. Research design and methods: The 2018 Taiwanese referendum was held on November 24. A cross‐sectional online survey was conducted between October 2018 and February 2019. A total of 1012 self‐identified LGBT adults were included in the final sample. Results: Among the 1012 Taiwanese LGBT adults, the rates of suicide attempts ranged from 9.1% to 24.4%. A younger age, being a student, having low income, having mental health issues, and having a high level of depressive symptoms were associated with a significantly higher risk of suicide attempts in the participants. Conversely, having a postgraduate degree, having high self‐esteem, and perceiving support from friends and family were associated with a lower risk of suicide attempts. Conclusion: This is the first study to investigate suicide attempts among LGBT individuals and the influencing factors within the context of a same‐sex marriage referendum in an Asian country. The results of this study demonstrate the importance of suicide prevention measures for the LGBT community, particularly during times of increased social stress and conflict between social groups with diverse sexual and gender identities. Clinical relevance: The results of this study suggest that nurses' and health‐care providers' sensitivity toward LGBT patients and their knowledge and skills in providing culturally competent care are key factors in suicide prevention for LGBT adults. Therefore, nurses and health‐care providers must be provided with training courses on culturally competent care. [ABSTRACT FROM AUTHOR]

Background: Nurses must have spiritual competence to provide holistic patient care. Therefore, the designed instrument to assess nurses' competence could be a practical guide for health care professionals. This study aimed to evaluate the validity and reliability of the spiritual care competency scale (SCCS) for oncology nurses in Taiwan. Methods: This study used a convenience sample from a regional teaching hospital in Taiwan from November 2017 to February 2019, who were asked to complete the SCCS. We employed scale-content validity index (S-CVI). Exploratory Factor Analysis (EFA) was also used to evaluate the structural factor of SCCS. Confirmatory Factor Analysis (CFA) verified the construct validity of SCCS scale for oncology nurses in Taiwan. Test–retest reliability were also measured in this study at 2-week interval. Results: The average S-CVI of SCCS was 0.96. The EFA produced four factors of 27 items, such as professionalization, improving the quality of spiritual care, personal support, patient counseling and referral, attitude towards patient spirituality and communication, assessment, implementation providing and evaluation of spiritual care. Fitting the 27 items yielded an acceptable model fit; X2/df = 2.41, RMSEA = 0.08, GFI = 0.80, AGFI = 0.80, CFI = 0.92, IFI = 0.92, NFI = 0.90, RFI = 0.90, TLI = 0.91, SRMR = 0.06. Cronbach's alpha values were between 0.93 and 0.95, and the total Cronbach's alpha was 0.96. The intraclass correlation coefficient (ICC) scores were between 0.43 and 0.88. Conclusions: The result of this study demonstrated satisfactory validity and reliability for the SCCS in the nursing field in Taiwan. Implications for practice in this study serves as a reference for effectively evaluating nursing competency in spiritual care. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Sexual minority individuals are more likely to experience depressive disorders than heterosexual individuals.Factors associated with depressive symptoms among sexual minority individuals have been explored and examined; however, there is a limited evidence to understand the factors among sexual minority women in non‐western countries. What the paper adds to existing knowledge?: To the best our knowledge, this is the first study examining internalized homophobia, self‐esteem, social support and depressive symptoms among sexual minority women in Taiwan.Sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia, lower self‐esteem and fewer support from partners, friends, and families.Specifically, being single, being a student and having a higher personal income increased the risk of having depressive symptoms among sexual minority women. What are the implications for practice?: Mental health practitioners and nurses should be aware of and assess sexual minority women's level of internalized homophobia, self‐esteem, and received social support to reduce the risk of depressive symptoms and thus help prevent suicidal ideation.LGBT sex education and government involvement are essential to buffer the negative influences of a homophobic society on the mental health of sexual minority women. Introduction: Sexual minority women are more likely to report depressive symptoms than sexual minority men. However, there is a lack of evidence to understand factors associated with depressive symptoms among sexual minority women in non‐western countries. Aim: This study examined internalized homophobia, self‐esteem, social support and depressive symptoms among Taiwanese sexual minority women. Method: A total of 581 Taiwanese sexual minority women (Age range 20–48 years old, Mean 26.96, SD 5.718) completed an online survey. Results: Taiwanese sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia and lower self‐esteem. Perceived support from participants' partners, friends and families was related to lower risk of depressive symptoms. Being single, being a student and having a higher personal income were also found to increase the risk of having depressive symptoms among the women. Discussion: Mental health interventions are essential for sexual minority women with internalized homophobia and low self‐esteem. Implications for Practice: Mental health practitioners and nurses should be aware of and assess the concerns that sexual minority women have regarding healthcare services and provide culturally competent care to reduce the risk of depressive symptoms. [ABSTRACT FROM AUTHOR]

Purpose: To examine the health status and quality of life of middle‐aged and older sexual and gender minority adults in Taiwan. Research Design and Methods: A cross‐sectional online survey was conducted between May and December 2019. A total of 535 self‐identified lesbian, gay, bisexual, and transgender (LGBT) men and women ≥40 years of age were included in the final sample. An online questionnaire, which included the following three sections, was used to collect data in this study: (a) demographics, (b) the World Health Organization Quality of Life‐Brief Taiwan version, and (c) physical and psychological health status. Results: Middle‐aged and older Taiwanese LGBT adults who were single, were unemployed, and earned monthly incomes of <20,000 New Taiwan Dollars reported poorer quality of life. Participants with one or more physical or psychological health problems also reported poorer quality of life than those who had no health problems. In addition, singlehood, unemployment, and poor quality of life and health were positively associated with mental health issues. Conclusions: It is important to attenuate health disparities and mitigate discrimination within Taiwanese society to enhance the quality of life and mental health of middle‐aged and older Taiwanese LGBT adults. Clinical Relevance: Healthcare providers should be attuned to and knowledgeable about the health issues and specific healthcare needs of middle‐aged and older LGBT adults, and they should also provide culturally competent care to reduce health disparities of the LGBT adults. [ABSTRACT FROM AUTHOR]

Purpose: To assess Taiwanese nurses' attitudes toward and knowledge about sexual minorities, and their awareness and behavior of providing care to sexual minority patients. Design: A cross‐sectional descriptive design was employed. Methods: A total of 323 Taiwanese nurses 20 years of age or older completed an online questionnaire between September and November 2019. It included five sections: demographics, the Attitudes Toward Lesbians and Gay Men Scale, Knowledge About Homosexuality Questionnaire, Gay Affirmative Practice Scale, and nurses' needs for promoting culturally competent care. Results: Taiwanese nurses held positive attitudes, and demonstrated high levels of awareness and behaviors of providing care to sexual minority patients. However, they had limited knowledge regarding homosexuality. More so, nurses who were older, self‐identified as heterosexuals, were married, had more than 10 years' work experience, and were Buddhists had poor knowledge about homosexuality. Nurses reported that for providing culturally competent care they required knowledge about sexual minorities' physical and mental health issues; the populations' social and welfare resources; communication skills training; privacy; and safe space. Conclusions: Information on homosexuality and health issues among sexual minority populations, communication skills training, privacy, and safe space should be provided to Taiwanese nurses to improve their abilities to provide culturally competent care and to reduce health inequalities among sexual minorities. Clinical Relevance: This study's results could be used as evidence for designing and providing training programs for nurses regarding culturally competent care, and thus promote quality nursing care and decrease difficulties of accessing healthcare services among sexual minority patients. [ABSTRACT FROM AUTHOR]

Little is known about the changes of people with schizophrenia disability in Taiwan who receive routine treatments under the current mental healthcare system. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to assess and track changes in the degree of disability in people with schizophrenia before and after 4 years of follow-up. Data on 4497 people with schizophrenia were acquired from the Taiwan Data Bank of Persons with Disability. The WHODAS 2.0 was used for disability assessment, and the chi-square test, logistic regression and generalised estimating equations were adopted for statistical analysis. People with schizophrenia exhibited improvement in cognition, mobility and participation among the six domains as well as in the overall score. The degree of disability in all domains remained mild to moderate among people aged 18–64 years; the degree of disability in cognition declined from moderate to severe among patients aged ≥65 years. The degree of disability in all domains remained mild to moderate among people with mild to moderate impairment; among those with severe impairment, the degree of disability in the domains of cognition and life activities declined from moderate to severe and the degree of disability in the domain of mobility declined from mild to moderate. Community-dwelling patients exhibited less degree of disability in all domains than their institutionalised peers. Early detection and treatment and an emphasis on communication and social problem-solving skills in rehabilitation programmes are recommended for people with schizophrenia. [ABSTRACT FROM AUTHOR]

Purpose: The views of butch‐ and femme‐identified lesbians toward their own breasts, breast cancer, breast cancer screenings, and their behavior and intentions toward breast health care were examined and compared in this study. Methods: A total of 208 Taiwanese lesbians (134 butch‐identified lesbians and 78 femme‐identified lesbians) completed an online survey. Results: Butch‐identified lesbians were more likely to hold negative views regarding their own breasts, which were found to be significantly and negatively associated with their actions in performing breast self‐examinations when compared with femme‐identified lesbians. Conclusions: Healthcare providers should be aware of and provide culturally competent care to lesbians with different identities. Clinical Relevance: The results can be employed as evidence for promoting lesbians' breast health, particularly butch‐identified lesbians. Healthcare providers should provide a supportive environment in order to promote a positive body image and improve breast health among lesbians. [ABSTRACT FROM AUTHOR]

Aims and objectives: To assess the willingness of nurses to receive vaccines as recommended by Taiwan's "Immunization Recommendations for Healthcare Personnel" (IRHCP), as well as the factors associated with their willingness. Background: Immunisation for healthcare personnel (HCP) is a means of reducing pathogen transmission. Also, vaccinating HCP reduces personnel and labour costs during an epidemic. Methods: A cross‐sectional study was conducted. A self‐administered questionnaire survey targeting nurses working in various service units at three hospitals was used. In total, 413 nurses completed the questionnaire. The main outcome measure was the willingness to receive vaccines recommended by the IRHCP, and the variables we assessed included knowledge regarding the IRHCP, individual perceptions (perceived risk of contracting the infection, perceived severity of the infection and perceived transmissibility after disease onset), perceived benefits and barriers to the vaccination, cues to the vaccination and demographics. This study followed the STROBE checklist for reporting this study. Results: The willingness of nurses to receive vaccines recommended by the IRHCP was high; the highest level of willingness was for the hepatitis B vaccine. The nurses' willingness to receive various vaccines recommended by the IRHCP was predicted by the knowledge regarding the IRHCP and perceived transmissibility after disease onset. Except the diphtheria–tetanus–acellular pertussis vaccine, perceived benefits and perceived barriers were also predictors of the willingness to receive vaccines. Conclusions: Our results showed that interventions focusing on increasing the knowledge regarding the IRHCP and perceived transmissibility after disease onset, emphasising the benefits of the vaccination and reducing the perceived barriers to the vaccination are needed to increase nurses' willingness to receive vaccines. Relevance to clinical practice: It is suggested using health education courses and mass media broadcasts at the individual and societal levels to raise awareness regarding the benefits of vaccines and enhance nurse' confidence in vaccination programs. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To investigate joint functioning and the quality of life (QOL) before and after total knee and total hip replacement and the factors that influence the QOL. Methods: A longitudinal study was conducted between August 2015 and January 2017. A questionnaire composed of the EQ‐5D, Oxford Hip Score, and Oxford Knee Score was used to collect data before surgery and 6 weeks, 3 months, and 6 months after surgery. Results: A repeated‐measures analysis of variance revealed significant differences in the EQ‐5D utility index between the preoperative and all 3 postoperative periods (F = 124.195, P < .05). There were significant differences in knee functioning (F = 133.859, P < .05) and hip functioning (F = 34.717, P < .05) between the preoperative and all 3 postoperative periods. The EQ‐5D utility index was significantly higher among patients undergoing total knee replacement than those undergoing total hip replacement (F = 15.490, P < .05) and higher among female than male patients (F = 7.613, P < .05). A positive correlation between the QOL and the perceived convenience of living at home was observed (P < .05). Conclusions: The findings are expected to inform patient education for patients undergoing arthroplasty surgery. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this study were to survey the frequency of engaging in a health-promoting lifestyle in patients with liver cirrhosis, and examine the mediating effects of a health-promoting lifestyle on relationships of symptoms and psychological distress with the quality of life (QOL).Methods: A cross-sectional study was conducted to recruit 148 cirrhotic outpatients from the gastroenterology outpatient department of one medical university hospital. All study participants completed self-administered questionnaires comprising a multidimensional symptoms scale, Hospital Anxiety and Depression Scale, short-form Chinese health-promoting lifestyle profile, and the Taiwanese version of the Short-Form 36. Hierarchical linear regression and mediation models were used to evaluate the effect of a health-promoting lifestyle on the QOL.Results: Results showed these cirrhotic outpatients reported low frequencies of health-promoting behaviors in their daily activities and had poor mental health but superior physical health. The hierarchical linear regression model found that depression, anxiety, and a health-promoting lifestyle were significant determinants of mental health. The mediation analysis further identified that a health-promoting lifestyle acted as a significant mediator which ameliorated the effects of depression and anxiety on the mental health aspect of the QOL.Conclusions: A health-promoting lifestyle can improve the mental health of the QOL. Healthcare professionals can develop effective health-promoting interventions to manage and improve the mental health of cirrhotic patients. [ABSTRACT FROM AUTHOR]

The lack of a suitable assessment tool may limit optimal stress management and impair the health-related quality of life of patients undergoing hemodialysis. The purpose of the study was to examine latent constructs and psychometric properties of the Vietnamese Hemodialysis Stressor Scale (HSS-V). In total, 180 patients receiving hemodialysis were recruited. Psychometric properties of the HSS-V, including the construct validity, internal consistency, and test–retest reliability, were tested after the instrument translation. The exploratory factor analysis resulted in a 24-item HSS-V with four extracted factors, which explained 58.32% of the total variance. The construct validity was confirmed by significant negative correlations between scores on the HSS-V and Vietnamese-version Short Form-36. The internal consistency (Cronbach’s α = .82-.91) and test–retest reliability (intra-class correlations coefficient = .91-.94) of the 24-item HSS-V were satisfactory. A simple structure and preliminary acceptable psychometric properties of the HSS-V were established and can serve as a basis for further studies. [ABSTRACT FROM AUTHOR]

This study assessed the computer/mobile device screen time and eye care behavior of children and examined the roles of risk perception and parental practices. Data were obtained from a sample of 2,454 child-parent dyads recruited from 30 primary schools in Taipei city and New Taipei city, Taiwan, in 2016. Self-administered questionnaires were collected from students and parents. Fifth-grade students spend more time on new media (computer/smartphone/tablet: 16 hours a week) than on traditional media (television: 10 hours a week). The average daily screen time (3.5 hours) for these children exceeded the American Academy of Pediatrics recommendations (⩽2 hours). Multivariate analysis results showed that after controlling for demographic factors, the parents with higher levels of risk perception and parental efficacy were more likely to mediate their child's eye care behavior. Children who reported lower academic performance, who were from non-intact families, reported lower levels of risk perception of mobile device use, had parents who spent more time using computers and mobile devices, and had lower levels of parental mediation were more likely to spend more time using computers and mobile devices; whereas children who reported higher academic performance, higher levels of risk perception and higher levels of parental mediation were more likely to engage in higher levels of eye care behavior. Risk perception by children and parental practices are associated with the amount of screen time that children regularly engage in and their level of eye care behavior. [ABSTRACT FROM AUTHOR]