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Background: The European Organisation for Research and Treatment of Cancer (EORTC) Group has developed a new multidimensional instrument measuring cancer-related fatigue to be used in conjunction with the quality of life core questionnaire (EORTC QLQ-C30). The module EORTC QLQ-FA13 assesses physical, cognitive, and emotional aspects of cancer-related fatigue.Methods: The methodology follows the EORTC guidelines for phase IV validation of modules. This paper focuses on the results of the psychometric validation of the factorial structure of the module. For validation and cross-validation confirmatory factor analysis (maximum likelihood estimation), intraclass correlation and Cronbach alpha for internal consistency were employed. The study involved an international multicenter collaboration of 11 European and non-European countries.Results: A total of 946 patients with various tumor diagnoses were enrolled. Based on the confirmatory factor analysis, we could approve the three-dimensional structure of the module. Removing one item and reassigning the factorial mapping of another item resulted in the EORTC QLQ-FA12. For the revised scale, we found evidence supporting good local (indicator reliability ≥ 0.60, factor reliability ≥ 0.82) and global model fit (GFI t1|t2 = 0.965/0.957, CFI t1|t2 = 0.976/0.972, RMSEA t1|t2 = 0.060/0.069) for both measurement points. For each scale, test-retest reliability proved to be very good (intraclass correlation: R t1-t2 = 0.905-0.921) and internal consistency proved to be good to high (Cronbach alpha = .79-.90).Conclusion: Based on the former phase III module, the multidimensional structure was revised as a phase IV module (EORTC FA12) with an improved scale structure. For a comprehensive validation of the EORTC FA12, further aspects of convergent and divergent validity as well as sensitivity to change should be determined. [ABSTRACT FROM AUTHOR]

Ethnic identity is considered a psychocultural asset of indigenous. Yet, the search for own ethnic identity can induce unpleasant feelings, especially for indigenous peoples who have encountered colonisation and oppression. Using indigenous peoples in Taiwan, this study examined the protective effect of perceived social support on the associations between ethnic identity and the adverse mental health of anxiety and depression. Participants were self-identified indigenous peoples in Taiwan (n  = 200; mean age = 29). A cross-sectional quantitative survey was adopted. Hypotheses were tested with structural equation modelling. Findings were: (1) low ethnic identity commitment was associated with high levels of depression and anxiety. (2) High ethnic identity exploration was associated with high levels of depression and anxiety. (3) Perceived social support was negatively associated with depression and anxiety. (4) Perceived social support protected participants with low ethnic identity commitment from developing depressive and anxiety. (5) Perceived social support protected participants with high ethnic identity of exploration from experiencing depressive symptoms, but not anxiety. Results highlighted the protective role of perceived social support in indigenous peoples with low levels of ethnic identity commitment and high ethnic identity exploration. Implications on using social support interventions to mobilise ethnic identity as a psychocultural asset were discussed. [ABSTRACT FROM AUTHOR]

Objective Divers with a history of decompression sickness may be at high risk for sleep problems. However, limited studies have investigated the relationship between diving exposure and sleep problems of occupational divers. This study investigated the association between diving exposure and sleep quality and quantity among male occupational divers in southern Taiwan. Methods This descriptive, cross-sectional study included 52 occupational divers and 121 non-divers recruited from southern Taiwan in 2018. Survey data were collected using the Taiwanese version of the Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and a self-report questionnaire that included demographic variables, diving exposure/protocols, and factors associated with sleep quality. Results Among all participants examined, occupational divers were significantly more likely to have both poor sleep quality (adjusted odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.48–6.06; P = 0.002) and excessive daytime sleepiness (adjusted OR = 4.49; 95% CI = 2.12–9.52; P < 0.001). The diving exposure time, depth, ascent rate, and decompression table use showed no significant associations between poor and good sleepers in the divers group. However, a history of decompression sickness was associated with poor sleep quality among divers (adjusted OR = 2.20; 95% CI = 1.07–4.54; P = 0.032). Conclusions Our results showed that occupational divers had poor sleep quality and more excessive sleepiness than non-divers. Decompression sickness likely contributes to poor sleep quality. Prevention and early detection of decompression sickness-related sleep problems should be an occupational health priority. [ABSTRACT FROM AUTHOR]

The study was to develop the e-healthy diet literacy (e-HDL) questionnaire based on the comprehensive health literacy (HL) conceptual framework, to examine the association among HL, e-HDL, health behaviors and outcomes. A nationwide study was conducted on 1342 adults aged 18 years and above, between April and September 2017. Multi-stage random sampling was used to recruit the participants from four regions and 19 cities and counties in Taiwan. HL and e-HDL were measured by HLS-SF12 and the e-healthy diet literacy questionnaire (e-HDLQ), respectively. Socio-demographics, behaviors (e.g. smoking, drinking and exercising) and health outcomes were also measured. Principal component analysis (PCA), linear regression models and logistic regression models were used. The mean age was 33.9 ± 11.4 years. The e-HDLQ was constructed with 11 items. A positive association between HL and e-HDL was found. In the multivariate analysis, HL and e-HDL were significantly lower in men and higher in those who used Facebook for searching information. HL was positively associated with the ability to pay for medication, and social status. The e-HDL was lower in older participants, and people who searched for healthy cooking, healthy food places or weight control, as compared with ones searched for nutritional therapies, while positively associated with education. Both HL and e-HDL were positively associated with health status and physical activities. In conclusion, the valid e-HDL survey tool was developed for general public use. The e-HDL strongly associated with HL, while both were determined by gender, online searching means and linked to health behaviors and outcomes. [ABSTRACT FROM AUTHOR]

Objective: To assess if health-related quality of life (HRQOL) of children with chronic kidney disease (CKD) and different comorbid conditions can be identified based on the EQ-5D child-friendly version (EQ-5D-Y).Design: Prospective cross-sectional study.Setting: A tertiary care medical center in Taiwan.Study Participants: All CKD patients aged 7-18 years treated at the center between May 2014 and December 2016.Main Outcome Measures: HRQOL assessment was done using EQ-5D-Y. Spearman correlation tests were used for construct validity of the traditional Chinese version of EQ-5D-Y. Test-retest reliability was determined through Cohen's kappa values and intraclass correlation coefficients (ICC). Laboratory results and CKD-related morbid conditions were ascertained and assessed their associations with HRQOL score using multivariate linear regression.Results: Of 68 participants, 53 of them completed two HRQOL assessments of HRQOL at least 6-month. Cross-sectional analysis revealed fair to moderate correlations between EQ visual analogue score and patient characteristics. Older children at assessment (P < 0.01), girls (P = 0.03) and presence of mineral bone disorders had a significantly negative impact on HRQOL. Children self-reported EQ-5D-Y dimensions were found to be fairly to highly reliable (kappa = 0.2 to 0.8), except for 'pain/discomfort' and 'anxiety/depression'.Conclusions: The EQ-5D-Y discriminated among children with different level of CKD-related clinical burden, but the psychometric properties may be limited in some HRQOL dimensions. Further research will need to address factors that may threaten validity and reliability data provided by children and adolescents. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess multilevel correlates of life satisfaction among people living with HIV/AIDS (PLWHA) in Taiwan, with a specific focus on marginalised men who have sex with men (MSM) and people who use injection drugs (PWID) in order to inform contextually relevant social work interventions consistent with an ecological approach. In 2011, we conducted a cross-sectional survey among a convenience sample of Taiwanese PLWHA (n = 355). Three multiple linear regressions (1-full sample; 2-MSM; 3- PWID) were conducted with life satisfaction as the outcome and socio-demographic (e.g. age), health (e.g. medication adherence), individual/intra-personal (e.g. internalised HIVrelated stigma), social/inter-personal (e.g. inter-personal empowerment) and community/ structural (e.g. HIV community participation) correlates. The fully adjusted model accounted for 34.4 per cent of the variance in explaining life satisfaction (F(17, 302)=10.84, p<0.001). Higher personal empowerment, lower AIDS knowledge, higher inter-personal empowerment, higher HIV community participation and higher income were significantly associated with greater life satisfaction. For subgroup comparisons, PWID had a statistically significantly lower mean life satisfaction score compared to MSM (p<0.001). Social workers can implement empowerment-oriented interventions to promote life satisfaction among Taiwanese PLWHA. More research is necessary to understand the experiences of Taiwanese PWID that may influence life satisfaction. [ABSTRACT FROM AUTHOR]

We designed a school-based, nationwide program called the 'New Era in Eye Health' to strengthen teacher training and to examine whether the existence of a government vision care policy influenced teachers' vision care knowledge and students' behavior. Baseline data and 3-month follow-up data were compared. A random sample of teachers (n = 660) from school vision health clusters in 22 cities/counties in Taiwan were invited to participate in our study and 436 agreed to participate (response rate = 66.1%). The mean age of participant teachers was 41.2 years, while the length of service mean was 14.6 years. For monitoring teacher outcomes, five cities/counties were selected as the intensely monitored group based on certain criteria. Sunlight diaries (n = 5434) were distributed and 3342 (61.5%) were returned. Teachers showed significant improvements in knowledge and behavior on the school vision health questionnaire. At the 3-month follow-up, the number of recesses as recorded by students' 'sunlight diary' increased. When teachers had better knowledge and behavior, recesses also increased. This study provided valuable insights to guide dissemination efforts for school vision health interventions and to help teachers implement research into their school vision health activities. [ABSTRACT FROM AUTHOR]

Objectives: Employees in printing industries can be exposed to multiple solvents in their work environment. The objectives of this study were to investigate the critical components of chemical solvents by analyzing the components of the solvents and collecting the Safety data sheets (SDSs), and to evaluate the hazard communication implementation status in printing industries. Method: About 152 printing-related industries were recruited by area-stratified random sampling and included 23 plate-making, 102 printing and 27 printing-assistance companies in Taiwan. We analyzed company questionnaires (n = 152), SDSs (n = 180), and solvents (n = 20) collected from this sample of printing-related companies. Results: Analytical results indicated that benzene and ethylbenzene, which were carcinogen and possibly carcinogen, were detectable in the cleaning solvents, and the detection rate were 54.5% (concentrations: <0.011-0.035 wt%) and 63.6% (concentrations: <0.011-6.22 wt%), respectively; however, neither compound was disclosed in the SDS for the solvents. Several other undisclosed components, including methanol, isopropanol and n-butanol, were also identified in the printing inks, fountain solutions and dilution solvents. We noted that, of the companies we surveyed, only 57.2% had a hazard communication program, 61.8% had SDSs on file and 59.9% provided employee safety and health training. We note that hazard communication programs were missing or ineffective in almost half of the 152 printing industries surveyed. Conclusions: Current safety information of solvents components in printing industries was inadequate, and many hazardous compounds were undisclosed in the SDSs of the solvents or the labels of the containers. The implementation of hazard communications in printing industries was still not enough for protecting the employees' safety and health. [ABSTRACT FROM AUTHOR]

This study was designed to investigate the transformation in attitude of social work under-graduate students following the completion of a human rights module near the end of their academic programme in Taiwan. Twenty-five students who enrolled in the 'Human Rights, Gender and Social Work' module at a university in central Taiwan were evaluated by means of self-reported change in attitude towards human rights before and after participation in this semester-long module. Their attitude towards human rights was measured using a twenty-four-item, four-point Likert scale that was developed and previously validated by Xie and Dan (2003). Quantitative analysis was applied. Following an educational intervention of one semester's duration, the participants self-reported a statistically significant change in their attitude towards human rights. The linkage of human rights with social work practice can be facilitated by adopting a specific teaching methodology. [ABSTRACT FROM AUTHOR]

A variety of risk factors have been identified as able to engender adolescent vulnerability to depressed mood. Recently, the social work profession has started to validate spirituality as integral to individual well-being, and as a protective factor of one's poor adjustment outcome. The present study aims to investigate spirituality as a protective factor for depressed mood among Taiwanese adolescents. Risk factors examined include family economic strains, parent-adolescent conflict, negative peer relationships and academic expectation stress. Using a cross-sectional quantitative research design, we utilised the multi-stage, random cluster sampling method to select respondents. A total of 1,325 Taiwanese students from grades 10 to 12 were recruited to complete the self-reported questionnaires. Results of multiple linear regression analyses indicated that controlling for gender and age, family economic strains, pa rent-adolescent conflict, negative peer relationships and academic expectation stress were positively associated with depressed mood. Spirituality was found to be negatively associated with depressed mood, and to partially moderate the association between negative peer relationships and depressed mood. Findings suggest that the culturally specific concern of spirituality should be incorporated into helping depressed adolescents. Spirituality should be examined cross-culturally in social work research, education and practice. [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]

Objective To prioritize performance measures for colorectal cancer care to facilitate the implementation of a pay-for-performance (PFP) system. Design Questionnaires survey. Setting Medical hospitals in Taiwan. Participants Sixty-six medical doctors from 5 November 2009 to 10 December 2009. Intervention Analytic hierarchy process (AHP) technique. Main outcome measure(s) Performance measures (two pre-treatment, six treatment related and three monitoring related) were used. Results Forty-eight doctors responded and returned questionnaires (response rate 72.7%) with surgeons and physicians contributing equally. The most important measure was the proportion of colorectal patients who had pre-operative examinations that included chest X-ray and abdominal ultrasound, computed tomography or MRI (global priority: 0.144), followed by the proportion of stages I–III colorectal cancer patients who had undergone a wide surgical resection documented as ‘negative margin’ (global priority: 0.133) and the proportion of colorectal cancer patients who had undergone surgery with a pathology report that included information on tumor size and node differentiation (global priority: 0.116). Most participants considered that the best interval for the renewal indicators was 3–5 years (43.75%) followed by 5–10 years (27.08%). Conclusions To design a PFP program, the AHP method is a useful technique to prioritize performance measures, especially in a highly specialized domain such as colorectal cancer care. [ABSTRACT FROM PUBLISHER]

Objective: to determine whether depression is an important and independent predictor of falls in community-dwelling older people living in Taiwan.Design: longitudinal study.Setting: five randomly selected villages from Tainan city, Taiwan.Participants and methods: in total, 280 community-dwelling people not taking anti-depressant medication aged 65–91 years (mean age 74.9). Participants completed the Geriatric Depression Scale and underwent a range of sensorimotor, balance and mobility tasks and were then followed up for 2 years with monthly telephone calls to determine falls incidence.Results: of the 260 participants with complete follow-up data, 174 (66.9%) experienced no falls, 51 (19.6%) fell once and 35 (13.5%) fell two or more times. Depressive symptoms were significantly more prevalent in recurrent fallers (40.0%) and once-only fallers (27.5%) compared with non-fallers (16.1%). Negative binomial regression analysis identified depression, poor depth perception, reduced lower limb strength and increased sway as independent and significant predictors of falls.Conclusion: depressive symptoms were found to be common in older Taiwanese people and associated with an increased fall risk. These findings suggest that in addition to implementing approaches to maximise vision, strength and balance, fall prevention strategies should also include interventions to assess and treat depression. [ABSTRACT FROM PUBLISHER]

Objective This study reviews the rise and fall of the quality improvement (QI) methods implemented by hospitals in Taiwan, and examines the factors related to these methods. Design Cross-sectional, questionnaire-based survey. Setting One hundred and thirty-nine district teaching hospitals, regional hospitals and medical centers. Participants Directors or the persons in charge of implementing QI methods. Intervention(s) None. Main Outcome Measure(s) Breadth and depth of the 18 QI methods. Results Seventy-two hospitals responded to the survey, giving a response rate of 52%. In terms of breadth based on the hospitals’ self-reporting, the average number of QI methods adopted per hospital was 11.78 (range: 7–17). More than 80% of the surveyed hospitals had implemented eight QI methods, and >50% had implemented five QI methods. The QI methods adopted by over 80% of the surveyed hospitals had been implemented for a period of ∼7 years. On the basis of the authors’ classification, seven of the eight QI methods (except for QI team in total quality management) had an implementation depth of almost 70% or higher in the surveyed hospitals. Conclusions This study provides a snapshot of the QI methods implemented by hospitals in Taiwan. The results show that the average breadth of the QI methods adopted was 11.78; however, only 8.83 were implemented deeply. The hospitals' accreditation level was associated with the breadth and depth of QI method implementation. [ABSTRACT FROM PUBLISHER]